外科手术,最小侵入性

摘要： 目的：探讨软硬通道联合微创手术治疗大量高血压脑出血临床疗效。方法：对30例大量高血压脑出血患者采用软硬通道联合穿刺术，观察其治疗效果。结果：术后3月 GOS 评分：5分1例，4分4例，3分17例，2分2例；自动出院失访4例，死亡2例。结论：大量高血压脑出血病死率及致残率高，软硬通道联合微创手术是一种有效、安全、快捷的手术方法。

摘要： Objective To investigate the percutaneously looped thread transection for treatment of stenosing tenosynovitis and evaluate its treatment outcome .Methods From January 2014 to October 2016, Eighty-four patients with stenosing tenosynovitis were randomly divided into the open decompressionand group (42 cases) and percutaneously looped thread transection group (42 cases) in Department of Orthopedics, Affiliated Laiwu Hospital of Taishan Medical College .Incision near the digit horizontal stripes , tendon sheath were cut off in the open decompressionand group .Percutaneously looped thread transection was under the guidance of ultrasound , threading from the deep and shallow transverse tendon sheath , respectively , forming loops to cut off and decompressed the flexor tendon .Visual analog scale ( VAS ) was used to evaluate the extent of pain before the operation and 1 or 4 weeks after the operation , the comprehensive curative effect were evaluated 3 months after the operation .Results In the two groups pain was alleviated .The VAS improved from (7.0 ±1.3)prior operation to(5.2 ±1.6) and (2.8 ±1.1)1 week and 4 weeks after the operation in the open decompressionand group , respectively.The difference before and after the operation was significant ( P0.05).There were no infection, poor healing, blood vessel and nerve damage after operation in both two groups.Conclusion Percutaneously looped thread transaction under ultrasound for the surgical treatment of stenosing tenosynovitis has less trauma and rapid recovery .It has such advantage as being effective, simple , and reach the same effects as the open decompression surgery .%目的 探讨闭合环线切割手术治疗狭窄性腱鞘炎的临床疗效.方法 2014年1月至2016年10月泰山医学院附属莱芜医院骨二科狭窄性腱鞘炎患者84例,按不同手术方法随机分成两组.手术切开组(42例)于掌指关节横纹近侧做切口,显露并切断腱鞘.环线切割组(42例)在超声引导下进行,分别从腱鞘的深层及浅层穿线,形成环套切断腱鞘,松解屈肌腱.术前及术后1、4周测定疼痛强度视觉类比评分(VAS),术后3个月综合疗效评定.结果 两组患者术后1周后疼痛全部缓解,手术切开组治疗前及术后1周和4周后VAS评分分别为(7.0±1.3)、(5.2±1.6)、(2.8±1.1)分,相互之间比较差异均有统计学意义(均P0.05).两组术后均无感染、愈合不良及血管、神经损伤等并发症发生.结论 超声引导下的环线切割手术治疗狭窄性腱鞘炎具有操作简便、安全有效、微创、易于推广等优点,达到与手术切开相同的疗效.

摘要： Objective To evaluate the clinical effectiveness of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in single-level lumbar degeneration disease treatment.Methods We retrospectively analyzed the clinical data of 32 patients who underwent the MIS-TLIF surgery from Nov.2013 to Oct.2014 in Shanghai Tongji Hospital.Clinical and radiological outcomes including operation time,X-ray exposure,surgical blood loss,drainage blood loss,complications,visual analogue scores (VAS),Oswestry disability index (ODI) scores,average intervertebral space and fusion rate.VAS scores of low back and leg pain,ODI scores were recorded before and after surgery to evaluate the functional recovery,average intervertebral space height,lumbar and surgical Cobb angle were measured by X-rays before and after surgery to assess recovery of intervertebral space height and the change of lumbar kyphosis.The Bridwell criterion was used for evaluating the interbody fusion and the MacNab criterion was used for assessment after surgery.Results All the patients received successful surgery.The mean operative time was (171.9 ±31.1) min with (36.7 ± 16.4) seconds radiation exposure,and mean blood loss was (153.3 ± 64.8) ml,drainage blood loss was (58.9 ± 49.2) ml.All cases were followed up for (11.6 ± 3.3) months.Compared with preoperation,VAS score of low back and leg pain,ODI score and average intervertebral space showed significant improvements after surgery.There were 26 (81.3％) cases were grade Ⅰ and Ⅱ 3 months after surgery according to the Bridwell criteria while the number was 31 (96.9％) at the last follow-up.The clinical results were excellent in 22 cases,good in 8 cases and fair in 2 cases according to the MacNab criteria at the final follow-up.Conclusion MIS-TLIF under Spodight work channel system is a safe and effective procedure for single segment lumbar degenerative disease and it may offer patients additional advantages in less trauma and reduction of hospital stay.%目的 探讨Spotlight管状微创工作通道下的经椎间孔入路椎间融合(MIS-TLIF)治疗单节段腰椎退变性疾病的临床疗效.方法 回顾性分析2013年11月至2014年10月同济大学附属同济医院脊柱外科32例行Spotlight微创通道下的单节段MIS-TLIF手术资料,记录患者手术时间,术中射线暴露时间,术中出血量,术后引流量.记录患者手术前后腰、腿视觉模拟量表评分(VAS)及Oswestry功能障碍指数(ODI)评分评估患者功能改善情况,测量椎间隙平均高度、腰椎Cobb角和手术节段Cobb角评价椎间孔恢复及腰椎矢状位曲度改变情况,末次随访以Bridwell评价椎间融合情况,以MacNab量表评价临床治疗效果.结果 所有病例均顺利完成手术,手术时间(171.9±31.1) min;术中射线暴露时间为(36.7±16.4)s;术中出血(153.3±64.8) ml,术后引流(58.9±49.2) ml.所有患者均获得随访,随访时间(11.6±3.3)个月,术后2周及末次随访时腰、腿VAS评分及ODI评分较术前明显改善(P＜0.01);术前椎间隙高度为(0.98±0.26) cm,术后2周及末次随访为(1.28±0.21) cm和(1.22±0.20) cm,(P＜0.01).根据Bridwell椎间融合评价标准,术后3个月Ⅰ级和Ⅱ级为26例,占总数的81.3％,末次随访Ⅰ级和Ⅱ级为31例,占总数的96.9％;根据MacNab量表评价量表,其中优22例,良8例,可2例.结论 Spotlight微创工作通道下的MIS-TLIF治疗单节段腰椎退变性疾病安全、有效,具有创伤小、恢复快的优点.

摘要： Objective To compare the clinical outcomes among three kinds of transforaminal interbody fusion technique in the treatment of single segment lumbar degenerative disease.Methods From October 2012 to November 2014, a total of 67 cases of lumbar degenerative disease of single segment underwent surgical intervention were retrospectively analyzed , including 19 cases by mis-transforaminal lumbar interbody fusion ( TLIF), 25 cases by mini-open TLIF and 23 cases by open TLIF.Blood loss, surgical time, fluoroscopy time and hospital costs were recorded.Pre-and postoperative back pain was assessed with visual analogue scale ( VAS ) , and lumbar function was evaluated with Oswestry disability index ( ODI).Results mis-TLIF group need more surgical time , fluoroscopy time and more hospital costs when compared to mini-open TLIF group and open TLIF group ( P0.05).mis-TLIF group tended to lose less blood than mini-open TLIF group ( P0.05).mis-TLIF group and mini-open TLIF group was superior to open TLIF group in VAS of the second day postoperative [(3.2 ±1.6) scale,(3.4 ±1.5) scale vs(5.8 ±1.4)scale](P<0.05).Conclusion mis-TLIF, mini-open TLIF and open TLIF can all get satisfactory clinical outcomes in the treatment of single segment lumbar degenerative disease.mis-TLIF and mini-open TLIF was superior to open TLIF in blood loss , early postoperative recovery.Compared with mis-TLIF, mini-open TLIF reduce the fluoroscopy time and hospital costs , and also has a shorter learning curve.%目的：对比分析经椎间孔椎体间融合术不同手术方式治疗单节段腰椎退行性疾病的临床疗效。方法2012年10月至2014年11月浙江省人民医院骨科治疗的单节段腰椎退变性疾病患者67例。病例采用数字表法随机分为3组：通道辅助下微创经椎间孔入路腰椎间融合术（ mis-TLIF）组（19例）、微创小切口经椎间孔入路腰椎间融合术（mini-open TLIF）组（25例）、传统经椎间孔入路腰椎间融合术（ open TILF ）组（23例）。分析比较3组手术时间、术中出血量、术中射线暴露时间、住院费用。疗效评价指标采用Oswestrv功能障碍指数（ODI），疼痛视觉模拟评分（VAS）。结果mis-TLIF组手术时间长于其他2组（P＜0.05），mini-open TLIF组与open TLIF组比较差异无统计学意义（P＞0.05）；术中出血量：open TLIF组＞mini-open TLIF组＞mis-TLIF组（P＜0.05）；术中射线暴露指标、住院费用：mini-open TLIF组与open TLIF组比较差异无统计学意义（ P＞0.05），而两组均优于mis-TLIF组（ P＜0.05）。术后2 d VAS评分，mis-TLIF组与mini-open TLIF组比较差异无统计学意义（P＞0.05），而均优于open TLIF组[（3.2±1.6）分、（3.4±1.5）分比（5.8±1.4）分]（P＜0.05）；3组术后ODI评分差异无统计学意义（P＞0.05）。结论3种TLIF手术均可获得良好的临床疗效。微创TLIF手术较传统开放手术具有创伤小、出血少、术后恢复快等优点；而微创TLIF手术中，mini-open TLIF手术具有术中射线暴露少、住院费用低、学习曲线短的优势，值得在临床推广应用。

摘要： 目的：比较切开复位锁定加压钢板与闭合复位顺行髓内钉治疗肱骨干骨折的临床疗效。方法2010年5月至2012年7月于北京积水潭医院创伤骨科接受手术治疗的肱骨干骨折患者122例，按照手术方式分为钢板组和髓内钉组，其中钢板组患者63例，髓内钉组患者59例。比较两组患者住院和手术相关指标。术后采用门诊或电话方式对患者进行定期进行随访，按照肩关节评分标准（Neer、Myao）评估患者肩、肘关节功能，采用欧洲五维健康量表（EQ－5D）评价患者生活质量。结果所有患者均顺利完成手术。两组患者住院时间、恢复工作时间和返岗率差异均无统计学意义（均P ＞0．05），髓内钉组患者手术时间、出血量、并发症发生率低于钢板组。钢板组和髓内钉组患者均完成3年以上随访，平均随访时间分别为（41．2±4．2）个月和（42．1±4．7）个月，末次随访时两组患者肩关节评分分别为（93．8±6．1）分和（92．1±4．2）分，肘关节评分为（94．9±2．9）分和（96．2±1．5）分，EQ－5D 评分为（0．92±0．06）分和（0．93±0．06）分，两组各项评分差异均无统计学意义（均 P ＞0．05）。术后所有患者均达到骨性愈合，无延迟愈合或不愈合、内固定断裂、松动、畸形愈合等情况发生。结论钢板螺钉内固定和顺行髓内钉内固定均是治疗肱骨干骨折安全、有效的手术方法。两种手术各有利弊，医生需根据患者具体情况选择合适的手术方式。%Objective To evaluate the mid-term clinical efficacy of plate and intramedullary nail for humeral shaft fracture.Methods In this retrospective study a total of 122 patients with humeral shaft fracture were divided into 2 groups according to surgery type from May 2010 to July 2012.There were 63 patients in plate group and 59 patients in intramedullary nail group.The factors related to the operation for each group were compared respectively.The clinical outcome was evaluated by the Neer scores, Myao scores and EuroQol 5 dimensions scores (EQ-5D).All the patients were followed up periodically in the next 3 years.Results There were no significant differences between the two groups on hospital stay and time of returning to work ( P >0.05 ) .While the operation time, amount of intraoperative blood loss and complication rate were less in intramedullary nail group.The mean follow-up duration was (41.2 ±4.2) months in plate group and (42.1 ±4.7) months in intramedullary nail group respectively.At the last follow-up the postoperative Neer scores, Myao scores and EQ-5D scores showed no significant differences between the 2 groups[Neer:(93.8 ±6.1) vs(92.1 ±4.2); Myao:(94.9 ±2.9) vs(96.2 ±1.5), P >0.05]. There were no cases complicated with nonunion, delayed union, infection and deformity during the follow-up period.Conclusions The mid-term outcome of open reduction and internal fixation with plate and close reduction with intramedullary nail for humeral shaft fracture is satisfactory.Although both surgeries are safe and effective, they also have some defaults.The doctors should choose the right surgery carefully according to the actual situation of the patients.

摘要： 目的：总结一次性简易立体定向系统微创钻孔治疗高血压脑出血的初步经验。方法回顾性分析26例高血压脑出血病例资料，均应用一次性简易立定向系统，结合软通道技术，微创钻孔引流治疗。结果全部病例均一次性置管成功，术后再出血1例。无颅内感染和死亡病例。随访3~6个月，采用ADL （日常生活能力）分级法，ADLⅠ级3例、Ⅱ级9例、Ⅲ级12例、Ⅳ级2例。结论应用一次性简易立体定向系统、微创钻孔引流治疗高血压脑出血具有操作简便、定位准确、血肿引流效果好、手术安全等优点，值得临床推广和应用。%Objective To review the primary experience with use of minimally invasive burr hole drainage with simple and disposable stereotactic device in the treatment of hypertensive intracerebral hemorrhage (HICH). Methods The clinical data of 26 HICH patients were analyzed retrospectively. All the patients were treated by disposable and simple stereotactic mini-invasive burr hole drainage in combination with soft catheter technology. Results All the cases were cathetered successfully by single use and postoperative re-bleeding was observed in one patient. There was no intracerebral infection or death. During follow-up of 3 to 6 months, according to activity of daily living (ADL) scale, there was ADL gradeⅠin 3 cases, gradeⅡin 10, gradeⅢin 12 and grade IV in 2. Conclusions The advantages of disposable and simple stereotactic minimally invasive burr hole drainage for HICH is easy to handle and accurate to position with good efficacy of hematoma drainage and operative safety, thus being worthy of clinical popularization and wide application.

摘要： Objective To investigate the safety and effectiveness of minimally invasive small bone window craniotomy for supratentorial spontaneous intracerebral hemorrhage (sICH). Methods The clinical data of 46 patients with supratentorial sICH were analyzed. The hematoma volume was 30-60 ml. The hematoma was located in the thalamus in 3 cases, subcortical in 9 and basal ganglia in 34. All the patients were operated by vertical incision and small bone window craniotomy after locating the hematoma according to CT scanning. After most of hematoma was evacuated, the drainage tube was placed in the cavity of hematoma. According to the postoperative extent of hematoma evacuation, the patients were determined whether to administer urokinase irrigation or not, and the duration of drainage. Results The repeated CT scan within 12 h after operation revealed the hematoma evacuation was more than 80%in 33 cases,>60%-80%in 9 and 50%-60%in 4. The average in-hospital time was 16 ± 6.8 d. According to the Glasgow Outcome Scale, favorable outcome (GOS 4-5) was observed in 40 cases and unfavorable (GOS 1-3) in 6. Conclusions For supratentorial sICH with hematoma volume of 30-60 ml without cerebral herniation, early minimally invasive small bone window craniotomy after position CT scan could improve the living quality of such patients.%目的：探讨小骨窗入路微创手术治疗幕上自发性脑出血（sICH）的安全性和疗效。方法分析46例sICH病例资料，出血量30~60 ml；丘脑出血3例，皮质下出血9例，基底核区出血34例。经CT扫描定位后行直切口、小骨窗开颅，清除大部分血肿后，留置引流。术后根据血肿清除程度，确定是否给予尿激酶冲洗和引流时间。结果术后12 h内复查头颅CT示血肿清除＞80%33例，＞60%~80%9例，50%~60%4例。平均住院时间（16±6.8） d。根据GOS判断预后：预后良好（4~5分）40例，预后不良（1~3分）6例。结论对于血肿量在30~60 ml、无脑疝发生的幕上sICH，采用CT扫描定位后早期小骨窗微创手术治疗，可改善病人生存质量。

摘要： 目的：探讨多小切口肋骨手术在肋骨良性肿瘤或瘤样病变切除术和肋骨骨折肋骨纯钛接骨板内固定术中的优缺点。方法：术前在体表贴铅字精确定位肋骨切除点和肋骨骨折处，并各定位点处设计2～3cm小切口，钝性分离病变，然后切除肋骨肿瘤或瘤样病变、用肋骨接骨板内固定骨折肋骨。结果：31例患者手术经过顺利，肋骨良性肿瘤及瘤样病变切除彻底；骨折患者术后胸壁稳定性明显改善，2例吸烟25年以上的患者分别出现轻度肺不张，支气管镜下吸痰后，肺不张消失，其余患者无传统手术常见并发症。结论：对于部分细长型的肋骨良性肿瘤或瘤样病变采用双小切口切除病变肋骨，安全可靠；对于闭合性的多根多处肋骨骨折采用多小切口肋骨接板内固定术，远期生活质量优于普通单切口手术。对年轻女性患者更有推广价值。%Objective:Analysis experience of rib operation by more small incisions in 31 cases ,and investi‐gate the advantages and disadvantages of rib operation by more small incisions in excision of rib benign tumor or tumor‐like lesion and internal fixation of rib fractures with titanium rib‐plate .Methods:Paste type on the lesion area for the preoperative accurate positioning rib resection points and rib fractures ,and design 2‐3cm small incisions re‐spectively through every location point ,and then complete blunt separation ,resection of rib tumors or tumor‐like le‐sions and internal fixation of rib fracture with rib‐plate .Results :All operations were smoothly in 31 cases .Rib be‐nign tumor and tumor‐like lesions were removed completely ;and stability of chest wall were significantly improved in patients with rib fractures .Mild pulmonary atelectasis disappeared after bronchoscopic sputum suction in 2 patients more than 25 years of smoking .There were no complications of traditional operation in the remaining patients .Con‐clusion :Excision of rib lesions are safe and reliable for some of slender rib benign tumors or tumor‐like lesions by double small incisions ;and the patients of closed multiple rib fractures accepting internal fixation of rib fractures with rib‐plate by more small incisions had better long‐term quality of life than by ordinary single incision operation .There are more promotional value for young female patients .

摘要： 目的：通过内镜与小切口开放手术切除甲状腺临床疗效对比分析，探讨使用内镜行甲状腺切除的安全性及可行性。方法：回顾性分析行内镜甲状腺切除术的35例患者，及同一时期行小切口开放手术切除同类型甲状腺的35例患者的临床资料。在手术时间、术中出血量、神经及旁腺损伤、术后引流量、引流管拔出时间、术后切口疼痛程度和持续时间、患者满意度、住院费用及住院时间等方面进行对比分析。结果：内镜手术除在手术时间方面无明显优势，但在其他方面等同或优于小切口开放手术。结论：内镜甲状腺切除安全、有效、可行，在临床上有进一步推广应用的前景。

摘要： 用于在病人体内侵入最小化的手术的牵引组织的方法和装置。一牵引器(20)包括由一第一部分(22)和第二部分(42)构成的工作通道(50)。第一和第二部分可以从一用于插入的、使皮肤和组织受到最小伤害的第一结构彼此相对移动到一在插入后进一步使皮肤和组织以最小化侵入方式牵开的扩大结构。器械可与第一和第二部分配合，并且可操作地使第一和第二部分彼此相对运动。

摘要： 本发明介绍了一种用于微创外科手术的、特别是用在外科手术机器人系统中的外科手术器械和/或内窥镜的保持和定位装置，其包括第一转动轴线(3)，保持元件(4)围绕第一转动轴线能够转动地布置，其中，第一转动轴线(3)与至少一个外科手术器械(9；17a；17b)和/或内窥镜(9；17a；17b)的纵轴线(11)在枢转点(13)上始终以如下方式相交：在保持元件(4)上装设有推移驱动装置(5)，推移驱动装置将器械驱动单元(15)绕枢转点(13)能够转动地布置，以及伸缩装置(8)设置在器械驱动单元(15)上，由伸缩装置使外科手术器械(9；17a；17b)和/或内窥镜(9；17a；17b)沿其纵轴线(11)借助引导装置(10、10s)能够以如下方式平移运动到身体中：外科手术器械(9；17a；17b)和/或内窥镜(9；17a；17b)的纵轴线(11)能够相对于伸缩装置(8)可变调整。

摘要： 提供检测作用在端部执行器上的力的手术系统、外科手术系统、控制设备、变形生成体、外科手术器具等。手术系统包含：具有一个或多个连杆的臂；设置在臂的前端的端部执行器；检测端部执行器中发生的变形的第一变形检测单元；检测连杆中发生的变形的第二变形检测单元；以及处理单元，基于来自第一变形检测单元和第二变形检测单元的检测结果来计算在作用在体内端部执行器上的力。

摘要： 一种流动外科手术中心可以包括混合手术室。所述混合手术室可以包括至少一堵铅屏蔽墙、地板、和天花板。所述流动外科手术中心还可以包括成像设备，所述成像设备布置在所述混合手术室内。所述流动外科手术中心可以进一步包括手术台，所述手术台布置在所述混合手术室内。所述流动外科手术中心可以另外地包括与所述手术室相邻的电力室。所述电力室可以包括用于所述成像设备的电源。所述流动外科手术中心还可以包括从所述电力室至所述成像设备的管线，所述管线被配置用于向所述成像设备传递电力。

摘要： 本申请的一个非限制性实施例涉及通过最小侵入性外科手术方法使连接元件与一个或多个诸如脊柱的骨或骨部相邻定位的系统。该系统一般包括能与一个或多个骨或骨部配合的多个骨锚定件以及可移除地配合到骨锚定件的多个锚定件延伸件。连接元件插入器与锚定件延伸件中的一个可配合，并沿锚定件延伸件的纵向轴线可运动。在最小侵入性外科手术过程中，当插入器沿纵向轴线朝骨锚定件运动时，连接元件的前端部转动离开纵向轴线，且连接元件定位在与多个骨锚定件相邻的位置。然而，在其它实施例中，可设想不同的形式和应用。

摘要： 用于在病人体内侵入最小化的手术的牵引组织的方法和装置。一牵引器(20)包括由一第一部分(22)和第二部分(42)构成的工作通道(50)。第一和第二部分可以从一用于插入的、使皮肤和组织受到最小伤害的第一结构彼此相对移动到一在插入后进一步使皮肤和组织以最小化侵入方式牵开的扩大结构。器械可与第一和第二部分配合，并且可操作地使第一和第二部分彼此相对运动。

摘要： 公开了一种在外科手术导航系统中使用的追踪装置。所述装置包括电磁传感器，所述电磁传感器被配置成产生依赖于外部电磁场的传感器信号。所述装置还包括被电连接至所述传感器的至少一个线元件，其中所述线元件包括第一线段、第二线段和被布置在所述第一线段与所述第二线段之间的第三线段。所述装置还包括包含芯部的应变消除单元，其中所述芯部包括纵向轴线、外表面和沿所述外表面围绕所述纵向轴线周向地延伸的至少一个凹部，其中所述第一线段在所述应变消除单元的第一侧延伸到所述应变消除单元中，所述第二线段在所述应变消除单元的与所述第一侧相反的第二侧延伸到所述应变消除单元中，并且所述第三线段在所述凹部内延伸。

摘要： 本公开涉及电动机驱动的多输出外科手术泵组合件和结合所述外科手术泵组合件的外科手术发生器。更具体而言，涉及一种外科手术泵组合件包含：电动机，所述电动机被配置成提供电动机输出；变速器组合件，所述变速器组合件被配置成接收所述电动机输出并且提供多个变速器输出；以及多个泵。所述多个泵中的每个泵被配置成接收所述多个变速器输出中的一个变速器输出。一种外科手术发生器包含：至少一个能量模块，所述至少一个能量模块被配置成产生能量递送信号；至少一个能量端口，所述至少一个能量端口被配置成连接到外科手术器械以向所述外科手术器械递送所述能量递送信号；以及所述外科手术泵组合件。

摘要： 本发明介绍了一种用于微创外科手术的、特别是用在外科手术机器人系统中的外科手术器械和/或内窥镜的保持和定位装置，其包括第一转动轴线(3)，保持元件(4)围绕第一转动轴线能够转动地布置，其中，第一转动轴线(3)与至少一个外科手术器械(9；17a；17b)和/或内窥镜(9；17a；17b)的纵轴线(11)在枢转点(13)上始终以如下方式相交：在保持元件(4)上装设有推移驱动装置(5)，推移驱动装置将器械驱动单元(15)绕枢转点(13)能够转动地布置，以及伸缩装置(8)设置在器械驱动单元(15)上，由伸缩装置使外科手术器械(9；17a；17b)和/或内窥镜(9；17a；17b)沿其纵轴线(11)借助引导装置(10、10s)能够以如下方式平移运动到身体中：外科手术器械(9；17a；17b)和/或内窥镜(9；17a；17b)的纵轴线(11)能够相对于伸缩装置(8)可变调整。

摘要： 本实用新型涉及一种外科手术器械系统，其包含外科手术紧固件施加器和定位引导件。所述定位引导件包含植入物引导件。所述植入物引导件限定引导通道，所述引导通道构造成接收植入物的一部分以相对于所述末端执行器支撑所述植入物，以使所述外科手术紧固件施加器能够击发一个或多个紧固件穿过所述植入物，用于将所述植入物固定到组织。本实用新型还涉及一种用于外科手术器械的定位引导件以及一种内窥镜外科手术钉施加器系统。