JP2002528161A - 挿入体を用いた外科手術用把持装置および同装置の使用方法 - Google Patents
挿入体を用いた外科手術用把持装置および同装置の使用方法Info
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/2812—Surgical forceps with a single pivotal connection
- A61B17/282—Jaws
- A61B2017/2825—Inserts of different material in jaws
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
- A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2946—Locking means
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/06—Measuring instruments not otherwise provided for
- A61B2090/061—Measuring instruments not otherwise provided for for measuring dimensions, e.g. length
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Abstract
(57)【要約】
使用者がリンク機構を介してハンドル組立体（２７、２７ａ）を作動させて、軸線方向に関して可動である第１のジョーおよび第２のジョー（３４、３６）を開閉することができる。ラチェット組立体（３０、１０５）がリンク機構の一部として構成されており、徐々に閉じていく位置にジョーを維持するように協働する、一連のラチェット歯（７６、１２３）とラチェット爪（７８、１３０）とを備えている。ラチェット歯または爪のいずれかに連結されたロック（１３２、１３４、１３６）がそれぞれの要素を互いに間隔を設けた関係に維持して、ロックが手動で解除されるまで、ラチェット組立体の動作を抑止している。ジョー支持体により保有されている挿入体（４１、４１ａ）が遠位の高プロファイルパッド（４７、４７ａ）と近位の低プロファイルパッド（４５、４５ａ）とを備えているが、これらパッドは織物メッシュで被覆して、牽引力を向上させることができる。これに関与する方法は、ラチェット要素の一方をラチェット要素の他方と互いに間隔を設けた関係に手動でロックする段階を含んでいる。
Description
【０００１】関連出願の相互参照 本願は、１９９８年１０月２３日に出願された、「挿入体を備えた外科手術用
把持装置および同装置を使用する方法」という名称の米国予備出願連続番号第60
/105,406号に基づく優先権を主張すると同時に、１９９９年9月２３日に出願さ
れた、「無外傷性バブコックジョー挿入体を備えた腹腔鏡把持装置」という名称
の、米国予備出願連続番号第60/156,032号にも基づいて優先権を主張する。
把持装置および同装置を使用する方法」という名称の米国予備出願連続番号第60
/105,406号に基づく優先権を主張すると同時に、１９９９年9月２３日に出願さ
れた、「無外傷性バブコックジョー挿入体を備えた腹腔鏡把持装置」という名称
の、米国予備出願連続番号第60/156,032号にも基づいて優先権を主張する。
【０００２】
本発明は一般に外科手術用機器に関するものであり、より特定すると、無外傷
性ジョー挿入体を備えている腹腔鏡把持装置に関連している。
性ジョー挿入体を備えている腹腔鏡把持装置に関連している。
【０００３】
先行技術の把持装置は金属から形成されたバブコックジョーを利用して、器官
または組織を堅固に把持して、移動させられるようにしてきた。バブコックジョ
ーの形状は、胃のような大型器官の一部を把持して掴む際に特に有効であり、腹
腔鏡ニッセン胃底皺襞形成術として公知の処置手順で胃を移動させるために、ほ
ぼ常に採用されている。バブコックジョーが金属から形成されている場合、この
ジョーは高度の牽引力を供与するが、同時に、その過程で、隣接した周囲の組織
に外傷を与えがちでもある。金属製ジョーはまた、過剰なクランプ力が付与され
ると、繊細な組織に孔を穿ってしまう傾向もあった。このような不適切性に対処
するために、先行技術の把持装置は、金属製ジョーの許容クランプ圧を最小限に
抑えるように、或いは、許容クランプ圧を調節するように設計されていた。不規
則な形状を有している組織への外傷は、クランプ用ジョーを整合させる、或いは
、変形させることにより抑制することが可能であるが、先行技術の金属製ジョー
については不可能であった。
または組織を堅固に把持して、移動させられるようにしてきた。バブコックジョ
ーの形状は、胃のような大型器官の一部を把持して掴む際に特に有効であり、腹
腔鏡ニッセン胃底皺襞形成術として公知の処置手順で胃を移動させるために、ほ
ぼ常に採用されている。バブコックジョーが金属から形成されている場合、この
ジョーは高度の牽引力を供与するが、同時に、その過程で、隣接した周囲の組織
に外傷を与えがちでもある。金属製ジョーはまた、過剰なクランプ力が付与され
ると、繊細な組織に孔を穿ってしまう傾向もあった。このような不適切性に対処
するために、先行技術の把持装置は、金属製ジョーの許容クランプ圧を最小限に
抑えるように、或いは、許容クランプ圧を調節するように設計されていた。不規
則な形状を有している組織への外傷は、クランプ用ジョーを整合させる、或いは
、変形させることにより抑制することが可能であるが、先行技術の金属製ジョー
については不可能であった。
【０００４】 先行技術の把持装置は、ラチェット機構を有しているとともに、把持装置のジ
ョーが口を閉じる度ごとに、ラチェット機構を一時的に解離させるためにレバー
を動かす必要があった。腸のような長い管状物を通してジョーを「作動させる」
ことを医者に要求する処置手順は、このタイプのラチェット機構を用いた場合に
は、相対的に遂行不可能であった。その結果、ラチェット機構を用いた把持装置
とラチェット機構を用いていない把持装置の、両方のタイプの把持装置を手術室
に備えておく必要があった。
ョーが口を閉じる度ごとに、ラチェット機構を一時的に解離させるためにレバー
を動かす必要があった。腸のような長い管状物を通してジョーを「作動させる」
ことを医者に要求する処置手順は、このタイプのラチェット機構を用いた場合に
は、相対的に遂行不可能であった。その結果、ラチェット機構を用いた把持装置
とラチェット機構を用いていない把持装置の、両方のタイプの把持装置を手術室
に備えておく必要があった。
【０００５】
本発明の無外傷性腹腔鏡把持装置は、先行技術の上述の欠陥を克服している。
これは、ジョー組立体にバブコック形状の使い捨て可能な挿入体を組み入れるこ
とにより達成される。この構成を利用すると、挿入体のバブコック形状が胃の底
部のような組織を掴んで保持するのに役立つ一方で、エラストマーのパッドが組
織への外傷を排除する。高度の無外傷性牽引力を供与することに加えて、エラス
トマーのパッドは不規則な形状の組織に順応するように整合および変形する能力
もある。この構成を利用すれば、本件の装置は胃の底部のような弛緩組織を掴ん
で保持する際に特に有効となる。
これは、ジョー組立体にバブコック形状の使い捨て可能な挿入体を組み入れるこ
とにより達成される。この構成を利用すると、挿入体のバブコック形状が胃の底
部のような組織を掴んで保持するのに役立つ一方で、エラストマーのパッドが組
織への外傷を排除する。高度の無外傷性牽引力を供与することに加えて、エラス
トマーのパッドは不規則な形状の組織に順応するように整合および変形する能力
もある。この構成を利用すれば、本件の装置は胃の底部のような弛緩組織を掴ん
で保持する際に特に有効となる。
【０００６】 把持装置は、ジョーの各部に切り込まれた１対の垂直方向のノッチと、これに
対応する、成形により各挿入体に組み込んだ１対の垂直方向のリブとから構成さ
れた、ジョー装着システムへの改良型挿入体を備えている。挿入体のリブはジョ
ーのノッチの中に載置され、挿入体がジョーの各部から軸線方向に除去されるの
を防止している。この改良型装着システムにより、軸線方向に挿入体が滑ったり
、移動したりする恐れなしに、器官または組織を軸線方向に引っ張るために本件
装置を使用することができるようになる。
対応する、成形により各挿入体に組み込んだ１対の垂直方向のリブとから構成さ
れた、ジョー装着システムへの改良型挿入体を備えている。挿入体のリブはジョ
ーのノッチの中に載置され、挿入体がジョーの各部から軸線方向に除去されるの
を防止している。この改良型装着システムにより、軸線方向に挿入体が滑ったり
、移動したりする恐れなしに、器官または組織を軸線方向に引っ張るために本件
装置を使用することができるようになる。
【０００７】 腹腔鏡把持装置は、ジョーを適所にロックすることができるようにするラチェ
ット機構も備えている。この機構は通常は作動状態にあって、装置のハンドルの
動作でジョーの口を閉じさせるばかりか、口を閉じたロック状態にジョーを維持
する。ジョーのロックを解除するためにトリガーを設けて、ラチェット機構を一
時的に非作動状態にする。新規な蝶ネジを作動させて、ラチェット機構を完全に
非作動状態にすることができる。これにより、トリガーを反復作動させずとも、
医者は即時に組織を把持したり解放したりすることができる。
ット機構も備えている。この機構は通常は作動状態にあって、装置のハンドルの
動作でジョーの口を閉じさせるばかりか、口を閉じたロック状態にジョーを維持
する。ジョーのロックを解除するためにトリガーを設けて、ラチェット機構を一
時的に非作動状態にする。新規な蝶ネジを作動させて、ラチェット機構を完全に
非作動状態にすることができる。これにより、トリガーを反復作動させずとも、
医者は即時に組織を把持したり解放したりすることができる。
【０００８】 本発明は、まず、ラチェット機構を一時的に非作動状態にすることのできるト
リガーを備え、更に、ラチェット機構を完全に非作動状態にすることのできる新
規な蝶ネジを備えていることで、手術室に２つのタイプの把持装置を保管してお
く必要性を除去している。
リガーを備え、更に、ラチェット機構を完全に非作動状態にすることのできる新
規な蝶ネジを備えていることで、手術室に２つのタイプの把持装置を保管してお
く必要性を除去している。
【０００９】 本発明の上述の特性および利点と、それ以外の特性および利点とは、本発明の
好ましい実施形態の説明と、それと関連する図面とを利用すれば、より良く理解
される。
好ましい実施形態の説明と、それと関連する図面とを利用すれば、より良く理解
される。
【００１０】
腹腔鏡把持装置が図１に例示されており、一般に参照番号１０と指定されてい
る。把持装置１０は套管針１２を通して作動自在に設置され、患者１６の腹部内
へと延び入っている。腹部１４の内部では、把持装置１０を作動させて、例えば
、胃１８を把持し、更に、外科手術処置手順で必要とされるとおりに胃を移動さ
せることができる。
る。把持装置１０は套管針１２を通して作動自在に設置され、患者１６の腹部内
へと延び入っている。腹部１４の内部では、把持装置１０を作動させて、例えば
、胃１８を把持し、更に、外科手術処置手順で必要とされるとおりに胃を移動さ
せることができる。
【００１１】 図２を参照すると、この実施形態の把持装置１０が近位端２３と遠位端２５の
間に延在するバレル２１を備えているのが分かる。ハンドル組立体２７およびラ
チェット機構３０が近位端２３に配置され、遠位端２５においてジョー組立体３
２を作動させるように運動自在である。
間に延在するバレル２１を備えているのが分かる。ハンドル組立体２７およびラ
チェット機構３０が近位端２３に配置され、遠位端２５においてジョー組立体３
２を作動させるように運動自在である。
【００１２】 図３では、ジョー組立体３２は、図３に例示されているような開位置と図４に
例示されているような閉位置との間で相対的に可動である１対の対向するジョー
の各部３４、３５を備えているように例示されている。ジョーの各部３４、３５
には、各々と関連する無外傷性の挿入体３８、４１がそれぞれ設けられている。
例示されているような閉位置との間で相対的に可動である１対の対向するジョー
の各部３４、３５を備えているように例示されている。ジョーの各部３４、３５
には、各々と関連する無外傷性の挿入体３８、４１がそれぞれ設けられている。
【００１３】 この実施形態の挿入体４１は図３から図５に最良に例示されており、細長い射
出成形されたプラスチック製の挿入体基部４３と、挿入成形された低プロファイ
ルの無外傷性パッド４５と、ポリエステル製編組材料５０で包むことができる高
プロファイルのパッド４７とを備えている。
出成形されたプラスチック製の挿入体基部４３と、挿入成形された低プロファイ
ルの無外傷性パッド４５と、ポリエステル製編組材料５０で包むことができる高
プロファイルのパッド４７とを備えている。
【００１４】 図５に最良に例示されているように、使い捨て可能な挿入体４１は１対の垂直
方向のリブ５２も組み入れており、これらリブは、これと対応する、挿入体ジョ
ー３６の１対の垂直方向のノッチ５４に収納されるように位置決めされている。
ノッチ５４はジョー３６の遠位先端の付近に配置されており、顎部の強度を損な
うことは無い。この実施形態では、リブ５２は射出成形されたプラスチック製の
挿入体基部４３と一体の部分であるのが好ましい。これら部材の機能は、ジョー
から挿入体が軸線方向に除去されるのを阻止するために、ジョー３６とは相対的
に軸線方向遠位方向に挿入体が引っ張られるのを防止することである。リブ５２
とノッチ５４の相互作用を利用すれば、図７に矢印５６で例示されるように、１
回の旋回運動だけで挿入体４１がジョー３６から取り外せる。
方向のリブ５２も組み入れており、これらリブは、これと対応する、挿入体ジョ
ー３６の１対の垂直方向のノッチ５４に収納されるように位置決めされている。
ノッチ５４はジョー３６の遠位先端の付近に配置されており、顎部の強度を損な
うことは無い。この実施形態では、リブ５２は射出成形されたプラスチック製の
挿入体基部４３と一体の部分であるのが好ましい。これら部材の機能は、ジョー
から挿入体が軸線方向に除去されるのを阻止するために、ジョー３６とは相対的
に軸線方向遠位方向に挿入体が引っ張られるのを防止することである。リブ５２
とノッチ５４の相互作用を利用すれば、図７に矢印５６で例示されるように、１
回の旋回運動だけで挿入体４１がジョー３６から取り外せる。
【００１５】 把持装置１０の軸線方向断面図が図８に例示されている。この図では、好まし
い実施形態のバレル２１が、互いに相対的に運動してジョー組立体３２を作動さ
せることができる、外側管５８および中央シャフト６１を備えているのが分かる
。外側管５８および内側シャフト６１の相対運動は、ハンドル組立体２７と、そ
れと関連するラチェット機構３０との動作により達成される。穴を設けたシリン
ダ６３は、これと関連するピン６５と連携して動作して、ジョー組立体３２の位
置合わせをする能力を把持装置１０に与える。
い実施形態のバレル２１が、互いに相対的に運動してジョー組立体３２を作動さ
せることができる、外側管５８および中央シャフト６１を備えているのが分かる
。外側管５８および内側シャフト６１の相対運動は、ハンドル組立体２７と、そ
れと関連するラチェット機構３０との動作により達成される。穴を設けたシリン
ダ６３は、これと関連するピン６５と連携して動作して、ジョー組立体３２の位
置合わせをする能力を把持装置１０に与える。
【００１６】 例示の実施形態では、内側シャフト６１と、管５８に固定されたハンドルハウ
ジング７４に接して旋回自在であるハンドル７２との間には、拡張部７０が連結
されている。ハンドルハウジング７４と相対的なハンドル７２の運動が、管５８
と相対的に、拡張部７０と、それと関連するシャフト６１とを運動させ、それに
より、ジョー組立体３２を作動させる。
ジング７４に接して旋回自在であるハンドル７２との間には、拡張部７０が連結
されている。ハンドルハウジング７４と相対的なハンドル７２の運動が、管５８
と相対的に、拡張部７０と、それと関連するシャフト６１とを運動させ、それに
より、ジョー組立体３２を作動させる。
【００１７】 ラチェット組立体３０は一連のラチェット歯７６を備えている。これらの歯７
６は拡張部７０に沿って形成されており、ハンドルハウジング７４を貫通して蝶
ネジ８１に連結されている爪７８と相対的に運動可能である。拡張部７０と、こ
れと関連するシャフト６１とを管５８と相対的に運動させて、ジョー組立体３２
の口を閉じさせると、ラチェット歯７６が爪７８の上を滑動して、ジョー組立体
３２をその最も閉じた位置にロックする。
６は拡張部７０に沿って形成されており、ハンドルハウジング７４を貫通して蝶
ネジ８１に連結されている爪７８と相対的に運動可能である。拡張部７０と、こ
れと関連するシャフト６１とを管５８と相対的に運動させて、ジョー組立体３２
の口を閉じさせると、ラチェット歯７６が爪７８の上を滑動して、ジョー組立体
３２をその最も閉じた位置にロックする。
【００１８】 ロックされたラチェット組立体３０をトリガー８３の動作によって解放させる
ことができるが、このトリガーは、図１２に例示されているように、ハンドルハ
ウジング７４に接して旋回自在であるとともに、ラチェット歯７６から爪７８を
取り外すように作動可能である。爪７８が作動位置へと偏倚されると、トリガー
８３の解放によって、爪がラチェット歯７６と再度噛み合って、図９から図１１
に例示された作動状態に入れるようにする。
ことができるが、このトリガーは、図１２に例示されているように、ハンドルハ
ウジング７４に接して旋回自在であるとともに、ラチェット歯７６から爪７８を
取り外すように作動可能である。爪７８が作動位置へと偏倚されると、トリガー
８３の解放によって、爪がラチェット歯７６と再度噛み合って、図９から図１１
に例示された作動状態に入れるようにする。
【００１９】 蝶ネジ８１の動作によって、ラチェット歯７６から爪７８を恒久的に除去する
ことを達成することができる。このネジ８１を回転させることにより、ラチェッ
ト歯７６と適正空間関係に保持される。従って、トリガー８３を反復的に作動さ
せなくても、ラチェット機構３０を恒久的に非作動状態にすることができる。
ことを達成することができる。このネジ８１を回転させることにより、ラチェッ
ト歯７６と適正空間関係に保持される。従って、トリガー８３を反復的に作動さ
せなくても、ラチェット機構３０を恒久的に非作動状態にすることができる。
【００２０】 本発明の更なる実施形態が図１４から図１９に例示されている。この実施形態
では、前述した構成の各要素に類似している各構成要素は、同一参照番号に小文
字「ａ」を後に続けた符号で指定される。従って、図１４は、把持装置１０ａと
、遠位端２５ａにジョー組立体３２ａが配置されたバレル２１ａと、近位端２３
ａに配置されたハンドル組立体２７ａとを例示している。この実施形態では、回
転ノブ１０１は、ルアー取付具１０３を利用すれば、穴を設けたシリンダ６３に
類似する態様で機能する。
では、前述した構成の各要素に類似している各構成要素は、同一参照番号に小文
字「ａ」を後に続けた符号で指定される。従って、図１４は、把持装置１０ａと
、遠位端２５ａにジョー組立体３２ａが配置されたバレル２１ａと、近位端２３
ａに配置されたハンドル組立体２７ａとを例示している。この実施形態では、回
転ノブ１０１は、ルアー取付具１０３を利用すれば、穴を設けたシリンダ６３に
類似する態様で機能する。
【００２１】 遠位端２５ａには、図５から図７を参照しながら前述したものに類似する態様
で、１対のジョー挿入体３８ａ、４１ａを、それらと関連する互いに対向するジ
ョー各部３４ａ、３６ａの上に搭載することができる。ラチェット機構１０５は
、より詳細に後述するようなハンドル組立体２７ａと一緒に動作可能である。
で、１対のジョー挿入体３８ａ、４１ａを、それらと関連する互いに対向するジ
ョー各部３４ａ、３６ａの上に搭載することができる。ラチェット機構１０５は
、より詳細に後述するようなハンドル組立体２７ａと一緒に動作可能である。
【００２２】 図１５を参照しながらジョー組立体３２ａを説明するが、同図では、バレル２
１ａの軸線は参照番号１０７と指定されている。この図では、射出成形されたプ
ラスチック製の挿入体４１が、挿入成形された低プロファイルのエラストマー製
パッド４５ａおよび圧縮成形された高プロファイルのエラストマー製パッド４７
ａと一緒に例示されている。これらパッド４５ａおよび４７ａの相対的な高さが
、特に重要となる。
１ａの軸線は参照番号１０７と指定されている。この図では、射出成形されたプ
ラスチック製の挿入体４１が、挿入成形された低プロファイルのエラストマー製
パッド４５ａおよび圧縮成形された高プロファイルのエラストマー製パッド４７
ａと一緒に例示されている。これらパッド４５ａおよび４７ａの相対的な高さが
、特に重要となる。
【００２３】 挿入体４１ａの把持能力および掴み能力を向上させるために、低プロファイル
パッド４５ａの高さを最小限に抑えながら、高プロファイルパッド４７ａの高さ
を最大限にしている。これに加えて、表面１１０は、高プロファイルパッド４７
ａを支持しているが、低プロファイルパッド４５ａを支持している表面１１２と
比して、ジョー３６の中のより低い位置、すなわち、より深い位置に在る。これ
ら表面１１０、１１２は、両表面の間に配置された切取り部１１４と同様に、図
１６および図１７の側面図および断面図にそれぞれ、最も良く例示されている。
表面１１０が挿入体基部４１ａの中のより低い位置、すなわちより深い位置に在
る場合には、高プロファイルパッド４７ａにはより大きな厚みを設けることがで
き、それゆえ、低プロファイルのパッド４５ａの弾性と相対的に増大した弾性を
供与することができる。この構成は、把持装置１０ａに小型直径の套管針１２（
図１）を貫通させることができるようにする一方で、挿入体４１ａの無外傷性の
特性を最大限にしている。更に、挿入体基部４１ａの切取り部１１４が切込みの
面積を最大にしている。
パッド４５ａの高さを最小限に抑えながら、高プロファイルパッド４７ａの高さ
を最大限にしている。これに加えて、表面１１０は、高プロファイルパッド４７
ａを支持しているが、低プロファイルパッド４５ａを支持している表面１１２と
比して、ジョー３６の中のより低い位置、すなわち、より深い位置に在る。これ
ら表面１１０、１１２は、両表面の間に配置された切取り部１１４と同様に、図
１６および図１７の側面図および断面図にそれぞれ、最も良く例示されている。
表面１１０が挿入体基部４１ａの中のより低い位置、すなわちより深い位置に在
る場合には、高プロファイルパッド４７ａにはより大きな厚みを設けることがで
き、それゆえ、低プロファイルのパッド４５ａの弾性と相対的に増大した弾性を
供与することができる。この構成は、把持装置１０ａに小型直径の套管針１２（
図１）を貫通させることができるようにする一方で、挿入体４１ａの無外傷性の
特性を最大限にしている。更に、挿入体基部４１ａの切取り部１１４が切込みの
面積を最大にしている。
【００２４】 この実施形態では、高プロファイルのパッド４７ａは支持用のジョー３６ａの
先端から遠位方向に配置されている。高プロファイルのパッド４７ａを支持して
いる表面１１０は低プロファイルのパッド４５ａを支持している表面１１２より
低い位置にあるばかりか、ジョー３６ａの支持表面１１６よりも低い位置にある
。軸線１０７に関して測定した場合、ジョー３６ａの支持表面１１６が、低プロ
ファイルのパッド４５ａを支持している表面１１２よりも長い距離で軸線から間
隔を設けており、高プロファイルのパッド４７ａを支持している表面１１０より
も短い距離で軸線から間隔を設けているのが分かる。従って、この実施形態では
、エラストマー製パッド４７ａの底部表面がジョー３６ａの頂部表面よりも下の
位置に在って、このパッドの厚みを最大限にして挿入体４１ａの無外傷性特性を
向上させることができるようにしながら、ジョー３６ａの強度を維持している。
高プロファイルのエラストマー製パッド４７ａが載置されていることによって、
プラスチック製挿入体基部４１ａへの一層堅固な固着も可能となっている。表面
１１０、１１２、１１６の上記のような相対的な高さが図１７に最も良好に例示
されている。
先端から遠位方向に配置されている。高プロファイルのパッド４７ａを支持して
いる表面１１０は低プロファイルのパッド４５ａを支持している表面１１２より
低い位置にあるばかりか、ジョー３６ａの支持表面１１６よりも低い位置にある
。軸線１０７に関して測定した場合、ジョー３６ａの支持表面１１６が、低プロ
ファイルのパッド４５ａを支持している表面１１２よりも長い距離で軸線から間
隔を設けており、高プロファイルのパッド４７ａを支持している表面１１０より
も短い距離で軸線から間隔を設けているのが分かる。従って、この実施形態では
、エラストマー製パッド４７ａの底部表面がジョー３６ａの頂部表面よりも下の
位置に在って、このパッドの厚みを最大限にして挿入体４１ａの無外傷性特性を
向上させることができるようにしながら、ジョー３６ａの強度を維持している。
高プロファイルのエラストマー製パッド４７ａが載置されていることによって、
プラスチック製挿入体基部４１ａへの一層堅固な固着も可能となっている。表面
１１０、１１２、１１６の上記のような相対的な高さが図１７に最も良好に例示
されている。
【００２５】 ハンドル組立体２７ａおよびラチェット機構１０５の更なる実施形態が図１８
および図１９に例示されている。この実施形態において、ハンドル組立体２７ａ
は不可動性フィンガーハンドル７４ａと、旋回自在に装着された親指用ハンドル
７２ａとを備えている。ラチェット機構１０５は、一連のラチェット歯１２３を
保有しているレバー１２１を備えている。レバー１２１は拡張部１３５を備えて
おり、親指用ハンドル７２ａに固定されたピン１２７に旋回自在に搭載されてい
る。ラチェット機構１０５は、フィンガーハンドル７４ａに固定された爪１３０
も備えている。
および図１９に例示されている。この実施形態において、ハンドル組立体２７ａ
は不可動性フィンガーハンドル７４ａと、旋回自在に装着された親指用ハンドル
７２ａとを備えている。ラチェット機構１０５は、一連のラチェット歯１２３を
保有しているレバー１２１を備えている。レバー１２１は拡張部１３５を備えて
おり、親指用ハンドル７２ａに固定されたピン１２７に旋回自在に搭載されてい
る。ラチェット機構１０５は、フィンガーハンドル７４ａに固定された爪１３０
も備えている。
【００２６】 ラチェット機構１０５のこの特定の実施形態はまた、親指用ハンドル７２ａに
固定されているロックピン１３２と、拡張部１２５に搭載されているとともに、
レバー１２１と一緒に旋回してロックピン１３２と嵌合および解離することが可
能な１対のアーム１３４、１３６とを備えている。
固定されているロックピン１３２と、拡張部１２５に搭載されているとともに、
レバー１２１と一緒に旋回してロックピン１３２と嵌合および解離することが可
能な１対のアーム１３４、１３６とを備えている。
【００２７】 動作においては、図１８に例示されている第１位置と図１９に例示されている
第２位置との間でピン１２７を中心としてレバー１２１を旋回させることができ
る。この第１位置では、レバーがバネ１４１により偏倚されて、歯１２３が爪１
３０と噛み合う結果となる。この位置では、この把持装置１０ａにはラチェット
特性が供与されており、これはすなわち、親指用ハンドル７２ａを移動させてフ
ィンガーハンドル７４ａと近接状態にすると、顎状部１３４ａ、１３６ａが徐々
に口を閉じた位置へとロックされてゆくことを意味する。ラチェット機構１０５
を解離させるために、歯１２３が爪１３０から解離されるまで、バネ１４１の偏
倚に抗してレバー１２１をピン１２７を中心として旋回させることができる。
第２位置との間でピン１２７を中心としてレバー１２１を旋回させることができ
る。この第１位置では、レバーがバネ１４１により偏倚されて、歯１２３が爪１
３０と噛み合う結果となる。この位置では、この把持装置１０ａにはラチェット
特性が供与されており、これはすなわち、親指用ハンドル７２ａを移動させてフ
ィンガーハンドル７４ａと近接状態にすると、顎状部１３４ａ、１３６ａが徐々
に口を閉じた位置へとロックされてゆくことを意味する。ラチェット機構１０５
を解離させるために、歯１２３が爪１３０から解離されるまで、バネ１４１の偏
倚に抗してレバー１２１をピン１２７を中心として旋回させることができる。
【００２８】 図１９に例示された第２位置では、アーム１３４、１３６がロックピン１３２
と嵌合するまで、レバー１２１が爪１３０から離れる方向に旋回させられる。こ
の位置で、レバー１２１が手動で作動状態にされて、ピン１３２からアーム１３
４、１３６を取り外すまで、ラチェット歯１３２を恒久的に爪１３０から取り外
す。アーム１３４、１３６がピン１３２からロック解除されてしまうと、バネ１
４１がレバー１２１を偏倚させて第１位置へと戻す。
と嵌合するまで、レバー１２１が爪１３０から離れる方向に旋回させられる。こ
の位置で、レバー１２１が手動で作動状態にされて、ピン１３２からアーム１３
４、１３６を取り外すまで、ラチェット歯１３２を恒久的に爪１３０から取り外
す。アーム１３４、１３６がピン１３２からロック解除されてしまうと、バネ１
４１がレバー１２１を偏倚させて第１位置へと戻す。
【００２９】 レバー１２１が第２位置にある時には、ラチェット特性が抑止されるが、すな
わち、ジョーの各部３４ａ、３６ａを徐々にそれぞれの閉位置にロックしなくて
も、ハンドル７２ａ、７４ａを自由に移動させることができることが注意を引く
。ラチェットレバー１２１が第２位置にある場合には、ラチェット機構１０５か
ら何らの干渉も受けずに、把持装置１０ａを容易に「作動させる」ことができる
。
わち、ジョーの各部３４ａ、３６ａを徐々にそれぞれの閉位置にロックしなくて
も、ハンドル７２ａ、７４ａを自由に移動させることができることが注意を引く
。ラチェットレバー１２１が第２位置にある場合には、ラチェット機構１０５か
ら何らの干渉も受けずに、把持装置１０ａを容易に「作動させる」ことができる
。
【００３０】 ここに開示した多様な実施形態に対して、それらの概念の精神および範囲から
逸脱せずに多くの他の修正を行うことが可能であるものと解釈される。例えば、
多様なタイプの外科手術装置が、多様なタイプの構成および材料と同様に思量さ
れる。それぞれの部品の構成は元より、それらの相互作用に対しても多くの修正
を行うことができることが明白である。このような理由から、上記説明は本発明
を限定するものと解釈するべきではなく、好ましい実施形態の単なる具体例であ
ると解釈するべきである。添付の特許請求の範囲により限定されるような本発明
の範囲および精神の枠内で、当業者ならば他の修正例を思いつくだろう。
逸脱せずに多くの他の修正を行うことが可能であるものと解釈される。例えば、
多様なタイプの外科手術装置が、多様なタイプの構成および材料と同様に思量さ
れる。それぞれの部品の構成は元より、それらの相互作用に対しても多くの修正
を行うことができることが明白である。このような理由から、上記説明は本発明
を限定するものと解釈するべきではなく、好ましい実施形態の単なる具体例であ
ると解釈するべきである。添付の特許請求の範囲により限定されるような本発明
の範囲および精神の枠内で、当業者ならば他の修正例を思いつくだろう。
【図１】 患者の体内に挿入して患者の胃を把持するように位置決めされた
腹腔鏡装置の斜視図である。
腹腔鏡装置の斜視図である。
【図２】 図１に例示された把持装置の斜視図である。
【図３】 把持装置の遠位端のジョーを示し、ジョーが開位置にあるのを例
示した拡大斜視図である。
示した拡大斜視図である。
【図４】 ジョーが閉位置にあるのを例示した、ジョー組立体の側面立面図
である。
である。
【図５】 ジョー組立体に関連するジョー挿入体の底面斜視図である。
【図６】 把持装置と関連するジョーの一方部分の頂面斜視図である。
【図７】 把持装置のジョーの一方部分の挿入体の旋回自在な取り付けを例
示している側面立面図である。
示している側面立面図である。
【図８】 図２の線８−８に沿って破断された把持装置を示し、把持装置の
近位端のラチェット機構を例示している軸線方向断面図である。
近位端のラチェット機構を例示している軸線方向断面図である。
【図９】 ラチェット機構と、それに関連するハンドル組立体とを示す軸線
方向断面拡大図である。
方向断面拡大図である。
【図１０】 ラチェット機構が作動状態にあるのを示す軸線方向断面拡大図
である。
である。
【図１１】 ラチェット機構と、それと関連するハンドル組立体とを示す軸
線方向断面図である。
線方向断面図である。
【図１２】 ラチェット機構が一時的に非作動状態にあるのを示す軸線方向
断面図である。
断面図である。
【図１３】 ラチェット機構が恒久的に非作動状態にあるのを示す軸線方向
断面図である。
断面図である。
【図１４】 本発明の把持装置の更なる実施形態の側面立面図である。
【図１５】 図１４の実施形態に関連するジョー組立体の斜視図である。
【図１６】 図１５のジョー組立体の側面立面図である。
【図１７】 図１６のジョー組立体の軸線方向断面図である。
【図１８】 ハンドル組立体とラチェット組立体が第１位置に配置されて、
ラチェット特性を備えた把持装置を提供しているのを示す側面立面図である。
ラチェット特性を備えた把持装置を提供しているのを示す側面立面図である。
【図１９】 ラチェット組立体が第２位置にあって、ラチェット特性を抑止
しているのを例示する側面立面図である。
しているのを例示する側面立面図である。
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Claims (12)
- 【請求項１】 外科手術用把持装置であって、 開位置と閉位置との間で、軸線方向に関して互いに相対的に運動可能である第
１ジョーおよび第２ジョーと、 第１位置と第２位置との間で使用者が自在に作動させることができるハンドル
組立体と、 ハンドル組立体と第１ジョーおよび第２ジョーとの間に連結されたリンク機構
とを備えており、ハンドル組立体を第１位置まで移動させた時に、ジョーを開位
置まで移動させ、ハンドル組立体を第２位置まで移動させた時に、ジョーを閉位
置まで移動させるための特性をリンク機構が有しており、 リンク機構の一部として構成されているとともに、ハンドル組立体を第１位置
から第２位置まで移動させた時に、ジョーを徐々に徐々に閉じてゆく位置に位置
するように協働する、一連のラチェット歯と爪とを有しているラチェット組立体
と、 一連のラチェット歯と爪のうちの一方に連結されて、一連のラチェット歯およ
び爪を間隔を設けた関係に保持して、ロックが手動で解除されるまで、ラチェッ
ト組立体の動作を抑止するためのロックとを更に備えている、外科手術用把持装
置。 - 【請求項２】 前記第１のジョーが、 支持表面を有しており、開位置と閉位置との間で移動可能であるジョー支持体
と、 ジョー支持体上に取外し自在に搭載されたジョー挿入体とを備え、挿入体が遠
位端および近位端を有しており、 プロファイルを有しているとともに、挿入体の遠位端に搭載されている遠位パ
ッドと、 プロファイルを有しているとともに、挿入体の上で遠位パッドから近位方向に
搭載されている近位パッドとを更に備え、 遠位パッドのプロファイルが近位パッドのプロファイルよりも高い、請求項１
に記載の外科手術用把持装置。 - 【請求項３】 前記ジョー支持体が、前記挿入体を支持するための第１の支
持表面を有しており、第１の支持表面が軸線から概ね第１の距離だけ間隔を設け
られており、 前記挿入体が前記遠位パッドを支持するための第２の支持表面を有しており、
第２の支持表面が軸線から概ね第２の距離だけ間隔を設けられており、 挿入体が前記近位パッドを支持するための第３の支持表面を有しており、第３
の支持表面が軸線から概ね第３の距離だけ間隔を設けられており、 第１の距離が第２の距離よりは短く、第３の距離よりは長い、請求項２に記載
の外科手術用把持装置。 - 【請求項４】 外科手術用把持装置であって、 開位置と閉位置との間で運動可能である１対のジョーと、 第１位置と第２位置の間で運動して、開位置と閉位置との間でジョーを運動さ
せることができるハンドル組立体と、 第１のプロファイルを有しているとともに、挿入体の遠位端に配置されている
第１の弾性パッドと、 第２のプロファイルを有しているとともに、挿入体の上で第１のパッドから近
位方向に配置されている第２の弾性パッドとを備えており、 第１のパッドの第１のプロファイルが第２のパッドの第２のプロファイルより
も高い、外科手術用把持装置。 - 【請求項５】 前記第１の弾性パッドと前記第２の弾性パッドのうちの少な
くとも一方を備えた挿入体を形成している基部を更に備えており、挿入体が前記
ジョーのうちの関連する一方の上に取外し自在に搭載可能である、請求項４に記
載の外科手術用把持装置。 - 【請求項６】 前記ハンドル組立体と前記１対のジョーとの間に接続された
リンク機構と、 リンク機構の一部として構成されているとともに、一連とラチェット歯とラチ
ェット爪が互いに噛み合って、ラチェット特性をリンク機構に供与しているラチ
ェット組立体と、 一連のラチェット歯をラチェット爪から解離させて、リンク機構のラチェット
特性を抑止するロックとを更に備えている、請求項５に記載の外科手術用把持装
置。 - 【請求項７】 前記ロックが、 前記ハンドル組立体により支持されているポストと、 前記一連のラチェット歯と前記爪のうちの一方により保持されており、ポスト
に取外し自在に嵌合して一連のラチェット歯および爪を適正空間関係にロックし
て、前記リンク機構の前記ラチェット特性を抑止する１対のアームとを備えてい
る、請求項６に記載の外科手術用把持装置。 - 【請求項８】 外科手術用把持装置を作動させる方法であって、 ハンドル組立体によりリンク機構を介して運動可能となる１対のジョーを把持
装置に設ける段階を含み、リンク機構が第１ラチェット要素および第２ラチェッ
ト要素を設けたラチェット組立体を備えており、第１ラチェット要素が第１位置
と第２位置の間で可動であり、 第１ラチェット要素および第２ラチェット要素のうちの少なくとも一方を移動
させて第１ラチェット要素および第２ラチェット要素のうちの他方と作動係合状
態にし、リンク機構にラチェット特性を供与する段階と、 第２ラチェット要素から第１ラチェット要素を取外して、リンク機構のラチェ
ット特性を抑止する段階と、 上記取外し段階の期間中、第１ラチェット要素を第２位置に手動でロックして
、第２ラチェット要素と互いに間隔を設けた関係に第１ラチェット要素を維持し
、リンク機構のラチェット特性を抑止する段階と、 第１ラチェット要素を第１位置へ移動させて第２ラチェット要素と噛み合わせ
るとともに、リンク機構にラチェット特性を供与する段階と、 上記移動段階の期間中、第２位置に在る第１ラチェット要素を手動でロック解
除する段階とを更に含んでいる、方法。 - 【請求項９】 前記第１の供与する段階が、ラチェット爪の形式の前記第１
ラチェット要素と、ラチェット爪と嵌合可能である一連のラチェット歯の形式の
前記第２ラチェット要素とを設けて、ラチェット特性を供与する段階を含んでい
る、請求項８に記載の方法。 - 【請求項１０】 前記供与する段階が、一連のラチェット歯の形式の前記第
１ラチェット要素と、ラチェット歯と噛み合うための特性を有しているラチェッ
ト爪の形式の前記第２ラチェット要素とを設けて、ラチェット特性を供与する段
階を含んでいる、請求項８に記載の方法。 - 【請求項１１】 前記ロック段階が、前記把持装置にポストを設ける段階と
、 前記第１ラチェット要素に１対のアームを設ける段階と、 ポストの周囲でアームをロックして、第１ラチェット要素を前記第２位置に保
持する段階とを含んでいる、請求項８に記載の方法。 - 【請求項１２】 前記ロック段階が、蝶ネジを回転させて前記ラチェット爪
を前記第２位置にロックする段階を含んでいる、請求項８に記載の方法。
Applications Claiming Priority (5)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US10540698P | 1998-10-23 | 1998-10-23 | |
| US60/105,406 | 1998-10-23 | ||
| US15603299P | 1999-09-23 | 1999-09-23 | |
| US60/156,032 | 1999-09-23 | ||
| PCT/US1999/025050 WO2000024322A1 (en) | 1998-10-23 | 1999-10-22 | Surgical grasper with inserts and method of using same |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| JP2002528161A true JP2002528161A (ja) | 2002-09-03 |
Family
ID=26802547
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP2000577941A Pending JP2002528161A (ja) | 1998-10-23 | 1999-10-22 | 挿入体を用いた外科手術用把持装置および同装置の使用方法 |
Country Status (4)
| Country | Link |
|---|---|
| EP (1) | EP1123051A4 (ja) |
| JP (1) | JP2002528161A (ja) |
| CA (1) | CA2347286A1 (ja) |
| WO (1) | WO2000024322A1 (ja) |
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Also Published As
| Publication number | Publication date |
|---|---|
| EP1123051A4 (en) | 2003-01-02 |
| EP1123051A1 (en) | 2001-08-16 |
| CA2347286A1 (en) | 2000-05-04 |
| WO2000024322A1 (en) | 2000-05-04 |
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