JP3791856B2 - 医療用縫合器 - Google Patents
医療用縫合器 Download PDFInfo
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
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Description
【発明の属する技術分野】
この発明は、生体の管腔臓器(腸管、食道等)の外科手術において用いる医療用縫合器に関する。
【0002】
【従来の技術】
現在、管腔臓器(腸管、食道等)の外科手術において、管腔臓器の吻合作業を行う医療用縫合器は、操作部から延長する挿入部の先端部に、U字型形状の複数のステープルを円周上に配置したヘッドと、ステープルを変形するためのヘッドに対面する位置にあるアンビルとが設けられている。
【0003】
そして、ヘッドとアンビルとを対向する管腔臓器の内部に挿入し、ヘッドとアンビルとの間の距離を縮めた後、ステープルを打ち出し、対向するアンビル面に設けられた溝によりステープルを変形させると同時に、ステープル列の内側に残る余分な組織をステープル列の内側に配置された円筒刃により切離することで吻合を完成させる縫合器が一般に知られている。
【0004】
例えば、米国特許第5,392,979号明細書のように本体側のヘッドからアンビルは比較的簡単に着脱自在になっており、アンビルとヘッドの距離が吻合するのに最適な距離になった時にアンビルが本体側ヘッドより外せなくなる。ここで、安全機構を解除することでステープルの打ち出しが可能になる。このときの最適な距離はインジケータにより術者に視覚的に伝わる構成となっていた。このような構造の縫合器としては一般に米国特許第5,205,459号明細書も知られている。
【0005】
これとは別に、特開昭55−108347号公報のように、ディスポーザブルタイプでない管腔臓器用の縫合器も使用されている場合もあるが、その構造は挿入部と操作部からなる本体において、本体を再利用し、挿入部先端のステープルカートリッジとアンビルとを交換することで複数回使用するというものだった。
【0006】
また、従来の管腔臓器用の縫合器に共通した構造として、ステープルを挿入部先端に配置してステープルを遠位端方向に押し出すため、その構造上、ステープルの足を遠位端方向を向けた構造である。
【0007】
【発明が解決しようとする課題】
しかしながら、米国特許第5、392、979号明細書、同特許第5、205、459号明細書に開示された管腔臓器用の縫合器の場合には、アンビル未装着の場合であっても、インジケータが吻合するのに最適な距離を示した場合には安全機構が解除され、術者が誤ってステープルを打ち出してしまうことがあり、ステープルの無駄打ちや、不用意な円筒刃の突き出しがあった。こういった管腔臓器用の縫合器はディスポーザブルタイプであり、一度使用すると縫合器全体を廃棄処分するため手術毎に購入する必要があり、病院のコストがかかったものであった。
【0008】
また、特開昭55−108347号公報に開示された本体再利用タイプの管腔臓器用縫合器はアンビルとステープルカートリッジを交換できるが、アンビルは挿入部先端のロッドにネジ込み式で着脱する構造であり、手術中のアンビルの取付方法が煩雑であった。
【0009】
前記米国特許第5、392、979号明細書、同特許第5、205、459号明細書、特開昭55−108347号公報に共通して、既に公知とされる管腔臓器用の縫合器による吻合では、ステープルの足の遠位端方向に向いており、ステープルの足が適切に変形出来たかが手術直後に確かめられず、術後の合併症を未然に防ぐことが出来なかった。
【0010】
この発明は前記事情に着目してなされたもので、その目的とするところは、ステープルによる吻合状態を容易に確認し、術後の合併症を軽減できるとともに、ステープルの無駄打ちを低減できる医療用縫合器を提供することにある。
【0011】
【課題を解決するための手段】
請求項1に係る発明は、操作部およびこの操作部から延長する挿入部とからなる本体と、
この本体の先端部に設けられステープルを変形させるアンビルヘッドと、
前記アンビルヘッドの位置よりも遠位に位置して前記アンビルヘッドと対向して設置されるとともに前記アンビルヘッドに足を向けてステープルを配置するステープルヘッドと、
前記ステープルヘッドを移動させる第1の部材と、
前記ステープルを打ち出す動きを前記ステープルヘッドに伝達するとともに前記第1の部材の内側に配置された第2の部材とを設け、
前記第2の部材は、
ステープルヘッドを打ち出すために前記操作部側に設けられたステープル作動部材と、
前記ステープル作動部材とは分離して前記ステープルヘッド側に設けられ、前記第1の部材によって前記ステープルヘッドがアンビルヘッド側にある基端側位置に移動したときに前記ステープル作動部材と係合する係合部を有する、ステープルを前記ステープルヘッドから打ち出すためのステープル押出部材と、
を有することを特徴とする請求項1に記載の医療用縫合器である。
請求項2に係る発明は、前記ステープルヘッドの前記基端側位置が、
前記アンビルヘッドの先端と前記ステープルヘッドの後端との距離が、前記ステープルの組織穿通部分の長さよりも短い位置であることを特徴とする請求項1に記載の医療用縫合器である。
請求項3に係る発明は、前記ステープルヘッドが前記本体から着脱可能であることを特徴とする請求項1または請求項2に記載の医療用縫合器である。
請求項4に係る発明は、前記ステープルヘッドに縫合後の余分な組織を切除するカッターを設けたことを特徴とする請求項3に記載の医療用縫合器である。
【0012】
前記構成によれば、ステープルヘッドを既に切離された腸管の一端に挿入し、ステープルヘッドより伸びた細長い連結部を腸管端部より外に出した状態で巾着縫合する。挿入部は腸管の別の切開部より挿入されるか、または、経肛門的に挿入され、挿入部先端のステープルヘッドの連結部を腸管のもう一端より突出した状態で巾着縫合する。
【0013】
ステープルヘッドを挿入部先端の連結部へ装着して挿入してから操作部を操作し、ステープルヘッドをアンビルヘッドへ引き寄せる。ステープルヘッドとアンビルヘッド間の距離が吻合するのに適切な距離になって操作部を操作すると、ステープルヘッドと挿入部先端とを連結するステープルヘッドの連結部を介して力が伝わり、ステープルヘッドからステープルが打ち出され、ステープルの足がアンビルヘッドに設けられた溝により変形する。これと同時にステープルラインより内側の余分な組織を円筒状のカッターで切離することで吻合が完了する。
【0014】
【発明の実施の形態】
以下、この発明の各実施形態を図面に基づいて説明する。
図1〜図12は第1の実施形態を示し、図1に示すように、医療用縫合器1の本体2は、操作部3と、この操作部3から緩やかに湾曲しながら延長した挿入部4とから構成されている。挿入部4の先端部には後述するアンビルヘッド5が設けられ、このアンビルヘッド5には後述するステープルヘッド6が着脱可能に設けられている。
【0015】
操作部3にはステープルヘッド6をアンビルヘッド5へ引き寄せる操作を行う回転ノブ7とステープルヘッド6より後述する組織結合留め具としてのステープル11を打ち出す操作を行うレバー8が設けられている。
【0016】
図2〜図5に基づいてステープルヘッド6および挿入部4の先端の構成を説明すると、ステープル11は、図2(d)に示すように、基部11aとこの基部11aに対して略直角に折曲する2本の足11bとによってU字型形状をなしている。
【0017】
図2(a)(b)に示すように、挿入部4の先端部に設けられたアンビルヘッド5に対向した位置にはステープルヘッド6が取り付けられ、ステープルヘッド6の内部には複数のステープル11が環状に配置された複数の穴状のステープルチャンネル12に通常収納されている。このとき、ステープル11は基部11aから伸びた2本の足11bの先端をアンビルヘッド5側に向けた状態である。ステープルチャンネル12の内側にはこれと同軸に配置された組織を切り離すための円筒カッター13が設けられており、円筒カッター13はその鋭利な先端13aをアンビルヘッド5側に向け、ステープル11を直接押し出すステープル打ち出し手段としてのステープルプッシャー14に取り付けられている。
【0018】
また、ステープルプッシャー14のアンビルヘッド5側には複数の棒状突起14aが設けられており、ステープルチャンネル12の内部にその各々の棒状突起14aの先端一部が挿入されている。ステープルプッシャー14の軸中心にはステープルプッシャー14を駆動するためのステープル駆動シャフト15が固定されている。
【0019】
また、ステープル駆動シャフト15のアンビルヘッド5側には一対の板ばね16が取り付けられており、その板ばね16のアンビルヘッド5側先端には内側に突出するラッチ17が設けられている。ステープルヘッド6のアンビルヘッド5側にはステープル駆動シャフト15と板ばね16を収納するステープルヘッドスリーブ18が設けられている。
【0020】
図3および図4に示すように、ステープルヘッドスリーブ18のアンビルヘッド5側には一対の板ばね19が成形されている。さらに、板ばね19の先端には内側に突出するラッチ20が設けられている。ステープルヘッドスリーブ18の外周部には板ばね頭部16aをステープルヘッドスリーブ18の外周部より外側へ拡がることを可能にする板ばね移動穴18aが設けられている。板ばね移動穴18aは板ばね頭部16aの軸方向の長さよりも長い寸法となっている。ステープルヘッドスリーブ18のアンビルヘッド5側の外周部にはステープル11の径方向の位置決め用として図1(b)および図4(a)に示すように、複数のリブ21が設けられている。
【0021】
さらに、図2(b)に示すように、ステープルチャンネル12を形成するステープルチャンネルケーシング12aのキー溝22に対してもステープルヘッドスリーブ18の遠位端方向にあるリブ23により位置決めされている。これによりステープルヘッドスリーブ18に対してステープル11の径方向に関して位置決めが可能となる。ステープルヘッド6内に収納される各部品はステープルヘッドケーシング24により保持されている。
【0022】
また、図2(c)に示すように、挿入部4の先端部のアンビルヘッド5にはステープル11を曲げるための環状に配置された複数の溝25を有するアンビル26が設けられており、アンビル26の溝25に対して径方向の位置決め手段27が設けられている。アンビル26と同軸に、かつ円筒カッター13の対向する位置には円筒カッター13の受けとなる受け板28があり、受け板28の内側、中心部にはトラカール30が設けられている。
【0023】
トラカール30にはステープル駆動シャフト15に取り付けられた板ばね16のラッチ17と係合する円形断面溝29が設けられている。トラカール30は操作部3側のトラカール駆動ガイド31と連結されており、操作部3のレバー8からの力をトラカール駆動ガイド31に伝えるトラカール駆動部材32が設けられている。さらに、トラカール30を収容し、ステープルヘッドスリーブ18の板ばね19に設けられたラッチ20に係合する円形断面溝33を持つトラカールスリーブ34がトラカール30の外側に設けられている。
【0024】
図3に示すように、トラカールスリーブ34は操作部3側において、ステープルヘッド駆動ガイド35が連結され、操作部3の回転ノブ7からの力をステープルヘッド駆動ガイド35に伝えるステープルヘッド引張り部材36が設けられている。そして、トラカール駆動ガイド31とステープルヘッド駆動ガイド35とは挿入部4内でトラカール駆動部材32とステープルヘッド引張り部材36とが同軸でない位置関係からトラカール30とトラカールスリーブ34が同軸である関係に変換する役目をしている。また、トラカールスリーブ34が収容されるアンビルヘッド5の内部にはステープルヘッド6の径方向の位置決め用の複数のキー溝37が設けられている。
【0025】
次に、前述のように構成された医療用縫合器の作用について説明する。
生体の管腔臓器、例えば腸管の一端へステープルヘッド6を挿入し、巾着縫合をステープルヘッドスリーブ18の外周面に施し、また挿入部4が挿入された腸管の他端をトラカールスリーブ34の外周面に同様に巾着縫合を施す。
【0026】
その後、ステープルヘッド6のステープルヘッドスリーブ18内へトラカール30とトラカールスリーブ34を挿入すると、板ばね頭部16aは板ばね移動穴18aから拡がることにより、挿入部4の先端にステープルヘッド6が装着される。このとき、トラカール30の先端の円形断面溝29とトラカールスリーブ34の円形断面溝33にはそれぞれラッチ17とラッチ20とが係合している(図2(a)参照)。
【0027】
操作部3の回転ノブ7を回すと引張り力がステープルヘッド駆動部材36を介してステープルヘッド駆動ガイド35、トラカールスリーブ34、ステープルヘッドスリーブ18へと伝わり、ステープルヘッド6がアンビルヘッド5側に引き寄せられてくる(図5(a)参照)。
【0028】
ステープルヘッド6がある程度引き寄せられるとステープルヘッドスリーブ18に設けられたリブ21がアンビルヘッド5の内部のキー溝37に係合することでステープルヘッド6の径方向の位置決めが自動的に完了する。図5(b)にはリブ21がアンビルヘッド5のキー溝37に係合している様子と板ばね頭部16aがキー溝の山37aに接している様子が示されている。
【0029】
吻合を行うのにアンビル26とステープルヘッド6の間隔が最適な距離になったことがインジケータ(図示せず)により確認できたら、安全ロック(図示せず)を解除する。レバー8を握ると、引張り力がトラカール駆動部材32を介してトラカール駆動ガイド31、トラカール30、板ばね16、ステープル駆動シャフト15、ステープルプッシャー14へと伝わり、図6(a)に示すようにステープル11がステープルチャンネル12より押し出される。押し出されたステープル11はアンビル26の溝25により変形をする。図6(b)は変形したステープル11を示す。このとき、操作部3からの引張り力により板ばね頭部16aは外側へ拡がろうとするがキー溝の山37aと接しているため拡がらず、板ばね移動穴18aに沿って板ばね頭部16aが操作部3側に移動し、必要以上にステープルプッシャー14が操作部3側に移動しないように動作を制限する(図4(b)参照)。これと同時に円筒カッター13がステープルヘッド6より押し出され、腸管内のステープルラインよりも内側の余分な組織を切離し吻合作業を終了する。
【0030】
次に、図7〜図12に基づいて操作部3および挿入部4の手元側について説明すると、挿入部4の分解図を示す図7によると、挿入部4の手元側内部ではステープルヘッド駆動部材36とトラカール駆動部材32がカーブした挿入シャフト46の内部で3つの案内部材45a,45b,45cの間に挟まれ、ステープルヘッド駆動部材36とトラカール駆動部材32の位置関係は挿入シャフト46のどこの位置でも径方向に関して一定に保たれており、ステープルヘッド駆動部材36とトラカール駆動部材32は案内部材45a,45b,45cの間を軸方向に移動可能になっている。また、トラカール駆動部材32の近位端には穴32aが穿設されている。
【0031】
図8に示すように、操作部3の内部には軸方向の中心にロッド47が設けられ、操作部3を構成するケーシング48aとケーシング48bに設けられた半円形断面の溝49に嵌合している。ロッド47の手元側には角雄ネジ50が加工されている。角雄ネジ50の部分は角雌ネジ52の加工された角ネジシャフト51にねじ込まれている。角ネジシャフト51の手元側には回転ノブ7が設けられている。
【0032】
また、ロッド47には板状の安全ガイド53が組み付けられている。この安全ガイド53はケーシング48aの遠位端付近に設けられた角溝54に係合されている。さらに、ロッド47の遠位端にはトラカール駆動部材32がロッド47に対して相対的に摺動自在に組み付いており、ステープルヘッド駆動部材36はロッド47に組み付けられている。挿入シャフト46はケーシング48a,48bに挟まれるように組み付けられている。
【0033】
さらに、ロッド47の外周部を取り囲むようにコ字型のステープル作動部材55がケーシング48の内部に摺動自在に配置されており、ステープル作動部材55には上面にラッチ57が固定されている。ステープル作動部材55の側面両側にはアーム58a,58bがピン56により組み付けられている。アーム58a,58bはトリガー59a,59bに回転自在に組み付けられている。トリガー59a,59bはケーシング48に組み付けた太ピン60に関して回転自在に組み付けられており、トリガー59aには太ピン60に通された巻ばね61の一端が固定されている。また、トリガー59a,59bはレバー62を挟むように固定されている。
【0034】
安全ガイド53の下面には安全ロック63がその上面63aが接するようにケーシング48a,48bに軸方向に回転自在に組み付けられており、ロック部63bはトリガー59aの近位端側エッジ59cに接している。インジケータ64はJ字状に曲げられた板ばね65により遠位端方向に付勢した状態でケーシング48aの内側側面に回転自在に取り付けられている。解除レバー66は一端にピン67が付いており、もう一端には引っ張りばね68が付いている。解除レバー66はケーシング48bに対して解除レバー66の指かけ66aをケーシング48bに開けられた穴69を介してケーシング48bの表面に突き出した状態で回転自在に組み付けられている。穴69は指かけ66aが作動できるような形状に開けられている。
【0035】
次に、作用について説明すると、図9の初期状態において、操作部3の回転ノブ7を時計方向に回すと、ロッド47が角ネジのために回転ノブ7方向(手元側)へ引き寄せられるが、ロッド47の遠位端に取り付けられたステープルヘッド駆動部材36に引張力が働き、ステープルヘッド駆動ガイド35、トラカールスリーブ34へと引張力が加わり、トラカールスリーブ34に装着されたステープルヘッド6が引き寄せられてくる。
【0036】
このとき、ロッド47にモーメントが加わるが、ロッド47の回転防止用の角溝54に安全ガイド53が摺動自在に組み付いているため回転することがなく、またステープルヘッド6が手元側に十分に引き寄せられる直前でもコ字型のステープル作動部材55の内側に安全ガイド53が入るため回転することはない。
【0037】
ステープルヘッド6とアンビル26の距離が最適になったことをインジケータ64により視覚的に術者に対して知らされるとき、ケーシング48の内部では安全ガイド53が安全ロック63の上面63aから外れる。さらにロッド47の遠位端に摺動自在に取り付けられたトラカール駆動部材32も手元側に引き寄せられ、トラカール駆動部材32の近位端に加工された穴32aにラッチ57が係合する(図10参照)。
【0038】
次に、安全ロック63をロッド47の軸に対して平行な軸に関して回転させると、トリガー59aの近位端側エッジ59cに接していたロック部63bが外れ、トリガー59a,59bが回転可能な状態になる。ここでレバー62を握るとトリガー59a,59bが太ピン60を中心にして回転するためトリガー59a,59bに回転自在に取り付けられたアーム58a,58bを近位端方向に押すため長ピン56を介してステープル作動部材55も近位端方向に引き寄せられる。
【0039】
このとき、ステープル作動部材55の上面にラッチ57に係合したトラカール駆動部材32にも引張力が作用し、トラカール駆動ガイド31を介して挿入部4の先端のトラカール30が引き寄せられるのでステープルヘッド6内に配置されたステープル11が打ち出される(図11参照)。
【0040】
ステープル11が打ち出された後、レバー62を握る力を緩めると巻きばね61の作用によりトリガー59a,59bが元に戻り、アーム58a,58b、ステープル作動部材55、ラッチ57、トラカール駆動部材32、トラカール30へと圧縮力が作用して最終的にステープルプッシャー14の棒状突起14aがステープルチャンネル12内にもどされる。このとき、ステープルヘッドスリーブ18の板ばね19はアンビルヘッド5の内部に接しているため板ばね19は拡がらず、ステープルヘッド6はアンビルヘッド5から外れることはない。
【0041】
ステープル11が打ち出された後、ステープルヘッド6とアンビル26の間を拡げるためには、図12のように操作部3のケーシング48bに設けられた解除レバー66を下げるとトラカール駆動部材32に解除レバー66のピン67が当たりトラカール駆動部材32が持ち上げられるためステープル作動部材55上のラッチ57からトラカール駆動部材32の穴32aが外れ、回転ノブ7を反時計回りに回転させるとステープルヘッド駆動部材36に圧縮力が働きステープルヘッド駆動ガイド35を介してトラカールスリーブ34が遠位方向へ押されるため、ステープルヘッド6がアンビルヘッド5より遠位方向へ作動する。
【0042】
なお、ラッチ57からトラカール駆動部材の穴32aが外れ、遠位方向に作動した後、解除レバー66の指かけ66aから指を外せば解除レバー66は元に戻る。
【0043】
本実施形態の医療用縫合器1を腸管などから抜去するためには操作部3の解除レバー66を下げると、トラカール駆動部材32がラッチ57より外れ、回転ノブ7を反時計方向に回転(1/3回転程度)させると、ステープルヘッド6がアンビルヘッド5から離れていく。この状態でレバー8を強く握ってもステープルプッシャー14の棒状突起14aおよび円筒カッター13は突き出すことはない。その後、挿入部4を回転させながら腸管内から抜去する。使用後の医療用縫合器1はステープルヘッド6をトラカールスリーブ34より外し、新しいステープルヘッド6を装着することで何回でも本体2を使用できる。
【0044】
したがって、ステープルヘッド6はそれ単体ではステープル11を打ち出したり、円筒カッター13を突き出したりできない。挿入部4の先端にステープルヘッド6の装着、ステープルヘッド6とアンビルヘッド5間の距離調整、安全ロック63の解除という3段階を行って、はじめてステープル11を打ち出せる状態となる。したがって、従来の医療用縫合器の構成と比べてアンビルヘッドの付け忘れによるステープルの無駄打ちを未然に防ぎ、円筒カッターによる悪影響が防止され、吻合するまでの安全性に優れる。
【0045】
また、従来の縫合器では安全ロック解除後、使用済みであればアンビルヘッドの位置がどこにあってもレバーを握ると、ステープルプッシャーや円筒カッターが突き出るが、本実施形態の医療用縫合器の場合、手術で使用後、安全ロック63を解除したままの状態で誤ってレバー62を握ってもアンビル面26とステープルヘッド6の距離がステープル11を打ち出すのに適した距離になっていなければ、ステープルヘッド6よりステープルプッシャー14の棒状突起14aと円筒カッター13が突き出さないため、吻合後の安全性に優れている。
【0046】
ステープル11はその足11bを肛門側(手元側)に向けてステープルヘッド6内に配置しているため、ステープル11を変形後、足11bの変形状態が一連の吻合作業終了後、肛門よりスコープを挿入することで観察できる。したがって、術後の合併症を未然に防げる。
【0047】
使用済みのステープルヘッド6を挿入部4の先端から外し、新たに新しいステープルヘッド6を装着できるため、本体2は再利用できる。したがって、ディスポーザブルタイプの縫合器に比べて何回でも使用できるためコストがかからない。さらに、円筒カッター13もステープルヘッド6に内蔵されているため同時に交換でき、円筒カッター13の切れ味が落ちることはない。
【0048】
図13は第2の実施形態を示し、第1の実施形態と同一構成部分は同一番号を付して説明を省略する。本実施形態は第1の実施形態のステープルヘッドスリーブ18の代わりにステープルヘッドスリーブ18aを、ステープル駆動シャフト15の代わりにステープルヘッドシャフト38を用いたこと、トラカール30がステープルヘッド駆動部材36に連結されたこと、トラカールスリーブ34がトラカール駆動部材32に連結されたことを除いて第1の実施形態と同様である。
【0049】
本実施形態のステープルヘッドスリーブ18aはステープルプッシャー14に取り付けられており、ステープルヘッドシャフト38はステープルヘッド6を支持する。挿入部4の先端のトラカール30は操作部3の回転ノブ7に対して挿入シャフト46内のステープルヘッド駆動部材36を介してつながっており、トラカールスリーブ34は挿入シャフト46内のトラカール駆動部材32を介してレバー8を握る力が伝わるような構成となっている。
【0050】
ステープルヘッドスリーブ18aは挿入部4の先端のトラカールスリーブ34に組み付くようになっており、ステープルヘッドシャフト38に取り付けた板ばね16はラッチ17によりトラカール30に組み付くようになっている。
【0051】
したがって、第1の実施形態と同様に、ステープルヘッドスリーブ18aの外周面とトラカールスリーブ34の外周面に腸管の巾着縫合を施す。ステープルヘッド6を挿入部先端のトラカール30に装着するとステープルヘッドスリーブ18aがトラカールスリーブ34へ、ステープルヘッドシャフト38に取り付けられた板ばね16がトラカール30に組み付く。
【0052】
操作部3の回転ノブ7を回すと、ステープルヘッド駆動部材36を介してトラカール30に伝わった引張力がステープルヘッドシャフト38の板ばね16、ステープルヘッドシャフト38、ステープルヘッド6へと伝わりステープルヘッド6がアンビルヘッド5側に引き寄せられてくる。
【0053】
ステープルヘッド6とアンビル26間が最適な位置関係になったとき操作部3のレバー8を握ると、引張力がトラカール駆動部材32を介してトラカールスリーブ34からステープルヘッドスリーブ18a、ステープルプッシャー14へと伝わり、ステープルチャンネル12からステープル11が押し出される。押し出されたステープル11はアンビル26に設けられた溝25により変形し、これと同時に円筒カッター13がステープルヘッド6より押し出され腸管内のステープルラインより内側の余分な組織を切離し吻合作業を終了する。
【0054】
したがって、第1の実施形態と同様な効果が得られる。
図14は第3の実施形態を示し、第1の実施形態と同一構成部分は同一番号を付して説明を省略する。本実施形態はステープルヘッド6について外径の異なる数種類のステープルヘッド6a,6bを用意し、本体2のアンビルヘッド5においてアンビル26と受け板28が外形の異なる数種類のアンビル26a,26b、受け板28a,28bをアンビルヘッド5に選択的に着脱できるようにしたことを除き第1の実施形態と同じである。なお、アンビル26a,26bと受け板28a,28bとは互いに組み付いており、アンビル部組39a,39bとしてアンビルヘッド5より同時に着脱が可能である。ステープルヘッド6a,6bとアンビル部組39a,39bとは組み合わせの間違い防止のため、外径の組み合わせの正しいステープルヘッド6a,6bとアンビル部組39a,39bとでセットで梱包されていることが望ましい。
【0055】
したがって、腸管等を吻合する際、ステープルヘッド6aを腸管内に挿入するが、ステープルヘッド6aの外径が腸管の内径に合わなかった場合、本体2を廃棄することなく、ステープル11の収納された外径が異なるサイズのステープルヘッド6bに交換することで本体2を使用できる。その際、一緒に梱包されているアンビル26bと受け板28bの組み付いたアンビル部組39bを位置決め手段27により位置合わせを行い、本体2のアンビルヘッド5に付け替えることができる。
【0056】
本実施形態によれば、第1の実施形態の効果に加えて、腸管を吻合する際、使い捨て(ディスポーザブルタイプ)の縫合器を使用していた場合には、梱包状態を解いた後で、ステープルヘッドあるいはアンビルヘッドの外径が腸管の内径に合わないことに気付いても、縫合器全体を捨てざるを得ないが、本実施形態の縫合器では別サイズのステープルヘッド6aまたは6bに付け替えることで本体2をそのまま使用できる。また、使用済みのステープルヘッド6a,6bを交換することで本体2を再使用することができる。よって病院では使い捨ての縫合器に比べて格段にコストを抑えることができる。
【0057】
図15は第4の実施形態を示し、第1および第2の実施形態と同一構成部分には同一番号を付して説明を省略する。本実施形態は、第1,2の実施形態の円筒カッター13の代わりに円筒カッター40を用いており、その鋭利な先端40aをステープルヘッド6方向に向けてアンビルヘッド5の内部に配置されている。円筒カッター40を作動させる円筒カッター駆動手段としてステープルヘッドスリーブ18aの外周部にラック41と円筒カッター40の内側にラック43と、ラック41とラック43とに噛合するピニオン42を設けたこと、円筒カッター40に対するステープルヘッド6の内部に受け板44を配置したことが、第1,2の実施形態と異なる構成である。
【0058】
本実施形態によれば、第1,2の実施形態と同様に、ステープルヘッドスリーブ18aの外周面とトラカールスリーブ34の外周面に腸管の巾着縫合を施す。ステープルヘッド6を挿入部4の先端のトラカール30に取り付けると、ステープルヘッドスリーブ18aがトラカールスリーブ34へ、ステープルヘッドシャフト38に取り付けられた板ばね16がトラカール30に組み付く。操作部3の回転ノブ7を回すと、トラカール30に伝わった引張力がステープルヘッドシャフト38の板ばね16、ステープルヘッド6へと伝わりステープルヘッド6がアンビル26側に引き寄せられてくる(図15(a)参照)。
【0059】
ステープルヘッド6とアンビル26間が最適な位置関係になったとき操作部3のレバー8を握ると引張力がトラカールスリーブ34からステープルヘッドスリーブ18a、ステープルプッシャー14へと伝わり、ステープルチャンネル12からステープル11が押し出される。
【0060】
押し出されたステープル11はアンビル26に設けられた溝25により変形し、これと同時に、ステープルヘッドスリーブ18aがアンビルヘッド5側に引き寄せられるのに伴いラック41がピニオン42を介してラック43をステープルヘッド6側に動かし、円筒カッター40の鋭利な先端40aがアンビルヘッド5より突き出す。
【0061】
ステープルヘッド6に配置された受け板44に円筒カッター40が押しつけられることで腸管内のステープルラインより内側の余分な組織を切離し吻合作業を終了する(図15(b)参照)。手術終了後、ステープルヘッド6は廃棄処分し、本体2は次回使用時にステープルヘッド6を交換することで再使用できる。
【0062】
本実施形態によれば、第2の実施形態の効果に加えて、円筒カッター40を本体2のアンビルヘッド5に配置したことにより、ステープルヘッド6の交換コストが下がるため1回当たりの手術費用が低減される。
【0063】
図16は第5の実施形態を示し、第3の実施形態と同一構成部分には同一番号を付して説明を省略する。本実施形態では、第3の実施形態の構成に加えて、ステープルヘッド6a,6bとアンビル部組39a,39bとがサイズ別に梱包材70a,70bに梱包されたこと、ステープルヘッド6a,6bとアンビル部組39a,39bのそれぞれに色の異なるにサイズ別カラー71a,71bを設けたことを除いて第3の実施形態と同じである。
【0064】
本実施形態によれば、腸管吻合時に、図16(a)に示すように、梱包材70aから開封したステープルヘッド6aと、アンビル部組39aとが腸管の内径に合わなかった場合、図16(b)に示すように、梱包材70bから開封したサイズの異なるステープルヘッド6bと、アンビル部組39bを使用する。サイズの組み合わせが分からなかった場合には、ステープルヘッド6a,6bとアンビル部組39a,39bのそれぞれサイズ別に設けられたサイズ別カラー71a,71bに従い組み合わせて付け替える。
【0065】
本実施形態によれば、第3の実施形態の効果に加えて、ステープルヘッド6a,6bと、アンビルヘッド部組39a,39bとがそれぞれサイズ別に組み合わせて梱包材70a,70bに梱包されているため、1つの梱包材を開封すれば良く、同時に複数の梱包材70a,70bを開封してしまった場合には、サイズ別に設けられた色の異なるサイズ別カラー71a,71bに従い、組み合わせて使用すれば良いためサイズ間違いがなく使用できる。この他の構成として、サイズ別カラーとは異なる指標、組み合わせ部材等を設けた場合にも同様の効果が得られる。
【0066】
前述した実施形態によれば、次のように構成が得られる。
(付記1) 操作部およびこの操作部から延長する挿入部とからなる本体と、この本体の先端部に設けられ複数のステープルを変形させるアンビルヘッドとを有する医療用縫合器において、前記本体の先端部にアンビルヘッドを設け、このアンビルヘッドと対向する位置に複数のステープルを配置したステープルヘッドを設けたことを特徴とする医療用縫合器。
【0067】
(付記2) 操作部およびこの操作部から延長する挿入部とからなる本体と、この本体の先端部に設けられ複数のステープルを変形させるアンビルヘッドとからなる医療用縫合器において、アンビルヘッドを本体に配置し、複数のステープルとステープル打ち出し手段とがアンビルヘッドと対向する位置にあることを特徴とする医療用縫合器。
【0068】
(付記3) 付記1または付記2の医療用縫合器において、複数のステープルが配置された位置と、アンビルヘッドの配置された位置との距離とが離れた第1の位置と、前記複数のステープルの位置と、前記アンビルヘッドの位置との距離とが近接した第2の位置とがあり、前記第1の位置と前記第2の位置との間で複数のステープルが移動可能な医療用縫合器。
【0069】
(付記4) 付記1または付記2の医療用縫合器において、ステープルは基部と基部の両端から伸びた2本の足とからなる複数のステープルが配置された位置と、アンビルヘッドが配置された位置との間隔が少なくともステープルの足の長さよりも長い第1の位置と、前記複数のステープルの位置と前記アンビルヘッドの位置との間隔がステープルの足の長さよりも短く近接した第2の位置とがあり、前記第1の位置と前記第2の位置との間で複数のステープルが移動可能な医療用縫合器。
【0070】
(付記5) 付記3または付記4の医療用縫合器において、複数のステープルはケーシングに収納されており、ケーシングは第2の位置において本体先端より取れなくなることを特徴とする医療用縫合器。
【0071】
(付記6) 付記5の医療用縫合器において、アンビルヘッドを本体に配置し、複数のステープルとステープルを打ち出す手段とがアンビルヘッドに対向する位置から着脱自在に配置したことを特徴とする医療用縫合器。
【0072】
(付記7) 付記1または付記2の医療用縫合器において、組織を切断するカッターを設けたことを特徴とする医療用縫合器。
(付記8) 付記7の医療用縫合器において、カッターをアンビルヘッドと対向する位置に配置したことを特徴とする医療用縫合器。
【0073】
(付記9) 付記7の医療用縫合器において、カッターをステープルの対向する本体に配置したことを特徴とする医療用縫合器。
(付記10) 付記7の医療用縫合器において、カッターの刃部を受ける受け板を設けたことを特徴とする医療用縫合器。
【0074】
(付記11) 付記10の医療用縫合器において、アンビルヘッドと受け板を本体の先端に着脱自在に配置し、複数のステープルとステープル打ち出し手段とカッターをアンビルヘッドに対向する位置に着脱自在に配置し、アンビルヘッドと本体の先端には径方向の位置決め手段を設けたことを特徴とする医療用縫合器。
【0075】
(付記12) 付記10の医療用縫合器において、アンビルヘッドとカッターを本体の先端に着脱自在に配置し、複数のステープルとステープル打ち出し手段と受け板をアンビルヘッドに対向する位置に着脱自在に配置し、アンビルヘッドと本体の先端には径方向の位置決め手段を設けたことを特徴とする医療用縫合器。
【0076】
(付記13) 付記1または付記2の医療用縫合器において、ステープルは2本の足と2本の足とをつなぐ基部とからなり、足の先端は鋭利な形状をしており、2本の足の鋭利な先端をアンビルヘッド側に向けて、アンビルヘッドに対向する位置に配置したことを特徴とする医療用縫合器。
【0077】
(付記15) 組織結合留め具と、組織結合留め具を押し出す押し出し手段と、前記組織結合留め具を収納するケーシングと、組織結合留め具を留める補助を行う補助部と、遠位端に挿入部と近位端に操作部とを具備する本体とを有する医療用縫合器において、補助部を挿入部先端に設け、ケーシングは補助部と対向する遠位端位置に配置し、ケーシングは本体先端より伸びた第1の作動手段と、第2の作動手段により連結されており、第1の作動手段はケーシングと補助部間の距離を調整し、第2の作動手段は本体から押し出し手段へ組織結合留め具を押し出す力を伝達することを特徴とする医療用縫合器。
【0078】
(付記16) 付記15の医療用縫合器において、組織結合手段はステープルであり、押し出し手段はステープル打ち出し手段であり、補助手段はステープルを変形させる面を持つアンビルヘッドであることを特徴とする医療用縫合器。
【0079】
(付記17) 付記16の医療用縫合器において、ステープルは基部と基部から伸びた2本の足とからなり、ケーシングとアンビルヘッド間の間隔がステープルの足の長さよりも長い第1の位置と、ケーシングとアンビルヘッド間の間隔がステープルの足の長さよりも短い第2の位置とがあり、第1の作動手段は前記第1の位置と第2の位置との間において、ケーシングの移動を行い、第2の作動手段は本体からステープル打ち出し手段へステープルを打ち出す力を伝達することを特徴とする医療用縫合器。
【0080】
(付記18) 付記15または付記17の医療用縫合器において、第1の作動手段と第2の作動手段とは同軸に相対的に可動できること特徴とする医療用縫合器。
【0081】
(付記19) 付記15付記17または付記18の医療用縫合器において、第2の作動手段はシャフトであり、第1の作動手段は筒状のスリーブであり、第2の作動手段は第1の作動手段の管路内部に配置したことを特徴とする医療用縫合器。
【0082】
(付記20) 付記15付記17または付記18の医療用縫合器において、第1の作動手段と第2の作動手段は少なくとも一部にアンビルヘッドの外径よりも細い外径部分を有することを特徴とする医療用縫合器。
【0083】
(付記21) 付記16の医療用縫合器において、第1の作動手段の一部には、第1の作動を分離合体する手段と、第2の作動手段の一部には、第2の作動手段を分離合体する手段を設けたことを特徴とする医療用縫合器。
【0084】
(付記22) 付記21の医療用縫合器において、第1の作動手段は筒状のスリーブであり、第2の作動手段はシャフトであり、第1の作動手段と第2の作動手段とは同軸に相対的に作動可能とすることを特徴とする医療用縫合器。
【0085】
(付記23) 付記21または付記22において、少なくとも一部の分離合体手段はラッチと溝により構成されることを特徴とする医療用縫合器。
(付記24) 付記21付記22または付記23において、第1の作動手段に第2の作動手段の動作を制限する制限手段を設けたことを特徴とする医療用縫合器。
【0086】
(付記25) 複数のステープルと、ステープルを打ち出すステープル打ち出し手段と、ステープルを変形させるアンビルヘッドと、遠位端に挿入部と近位端に操作部とを具備する本体とを有する医療用縫合器において、ステープルは基部と基部から伸びた2本の足とからなり、複数のステープルが配置された位置とアンビルヘッドの配置された位置との間隔が少なくともステープルの足の長さより長い第1の位置と、前記複数のステープルが配置された位置とアンビルヘッドが配置された位置との間隔がステープルの足の長さよりも短い第2の位置とがあり、本体内部には、前記複数のステープルを前記第1の位置から前記第2の位置へ作動させる引張部材と、第2の位置からステープル打ち出し手段を作動させる作動部材とがあり、引張部材が前記複数のステープルを第1の位置から第2の位置へ移動後、作動部材が作動準備状態になることを特徴とする医療用縫合器。
【0087】
(付記26) 付記25の医療用縫合器において、引張部材は第1の引張部材であり、作動部材は第2の引張部材であることを特徴とする医療用縫合器。
(付記27) 付記25または付記26の医療用縫合器において、アンビルヘッドは本体の先端に配置し、ステープルとステープル打ち出し手段とはアンビルヘッドに対向する位置に設けたことを特徴とする医療用縫合器。
【0088】
(付記28) 付記23または付記25または付記26または付記27の医療用縫合器において、第2の引張部材の作動準備状態は、安全ロックを解除することで、ステープル打ち出し手段を作動できる状態になることを特徴とする医療用縫合器。
【0089】
【発明の効果】
以上説明したように、この発明の医療用縫合器によれば、本体の先端部にアンビルヘッドを設け、このアンビルヘッドと対向する遠位の位置に複数のステープルを配置したステープルヘッドを設けたことにより、腸や食道などの管腔臓器の吻合を行った後の状態を容易に確認し、術後の合併症を軽減できるとともに、ステープルの無駄打ちがない。
【図面の簡単な説明】
【図1】この発明の第1の実施形態の医療用縫合器を示し、(a)は全体の構成図、(b)はステープルヘッドとアンビルヘッドの側面図。
【図2】同実施形態の医療用縫合器を示し、(a)はステープルヘッドとアンビルヘッドの縦断側面図、(b)は図1のa−a線に沿う断面図、(c)は図1のb−b線に沿う断面図、(d)はステープルの側面図。
【図3】同実施形態の医療用縫合器のステープルヘッドとアンビルヘッドの縦断側面図。
【図4】同実施形態の医療用縫合器のステープルヘッドスリーブの斜視図。
【図5】同実施形態の医療用縫合器の作用を説明するための図で、(a)はステープルヘッドとアンビルヘッドの縦断側面図、(b)は(a)のc−c線に沿う断面図。
【図6】同実施形態の医療用縫合器の作用を説明するための図で、(a)はステープルヘッドとアンビルヘッドの縦断側面図、(b)はステープルを変形したときの側面図。
【図7】同実施形態の医療用縫合器の挿入部の分解斜視図。
【図8】同実施形態の医療用縫合器の操作部の分解斜視図。
【図9】同実施形態の医療用縫合器の作用を説明するための操作部の縦断側面図。
【図10】同実施形態の医療用縫合器の作用を説明するための操作部の縦断側面図。
【図11】同実施形態の医療用縫合器の作用を説明するための操作部の縦断側面図。
【図12】同実施形態の医療用縫合器の作用を説明するための操作部の縦断側面図。
【図13】この発明の第2の実施形態の医療用縫合器のステープルヘッドを示し、(a)はステープルの打ち出し前の縦断側面図、(b)はステープルの打ち出し後の縦断側面図。
【図14】この発明の第3の実施形態の医療用縫合器のステープルヘッドとアンビルヘッドの縦断側面図。
【図15】この発明の第4の実施形態の医療用縫合器のステープルヘッドとアンビルヘッドを示し、(a)はステープルの打ち出し前の縦断側面図、(b)はステープルの打ち出し後の縦断側面図。
【図16】この発明の第5の実施形態の医療用縫合器のステープルヘッドとアンビルヘッドの梱包形態を示す斜視図。
【符号の説明】
1…医療用縫合器
2…本体
3…操作部
4…挿入部
5…アンビルヘッド
6…ステープルヘッド
11…ステープル
Claims (4)
- 操作部およびこの操作部から延長する挿入部とからなる本体と、
この本体の先端部に設けられステープルを変形させるアンビルヘッドと、
前記アンビルヘッドの位置よりも遠位に位置して前記アンビルヘッドと対向して設置されるとともに前記アンビルヘッドに足を向けてステープルを配置するステープルヘッドと、
前記ステープルヘッドを移動させる第1の部材と、
前記ステープルを打ち出す動きを前記ステープルヘッドに伝達するとともに前記第1の部材の内側に配置された第2の部材とを設け、
前記第2の部材は、
ステープルヘッドを打ち出すために前記操作部側に設けられたステープル作動部材と、
前記ステープル作動部材とは分離して前記ステープルヘッド側に設けられ、前記第1の部材によって前記ステープルヘッドがアンビルヘッド側にある基端側位置に移動したときに前記ステープル作動部材と係合する係合部を有する、ステープルを前記ステープルヘッドから打ち出すためのステープル押出部材と、
を有することを特徴とする医療用縫合器。 - 前記ステープルヘッドの前記基端側位置は、
前記アンビルヘッドの先端と前記ステープルヘッドの後端との距離が、前記ステープルの組織穿通部分の長さよりも短い位置であることを特徴とする請求項1に記載の医療用縫合器。 - 前記ステープルヘッドが前記本体から着脱可能であることを特徴とする請求項1または請求項2に記載の医療用縫合器。
- 前記ステープルヘッドに縫合後の余分な組織を切除するカッターを設けたことを特徴とする請求項3に記載の医療用縫合器。
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JP10703296A JP3791856B2 (ja) | 1996-04-26 | 1996-04-26 | 医療用縫合器 |
US08/840,230 US6050472A (en) | 1996-04-26 | 1997-04-11 | Surgical anastomosis stapler |
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JP10703296A JP3791856B2 (ja) | 1996-04-26 | 1996-04-26 | 医療用縫合器 |
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JPH09289991A JPH09289991A (ja) | 1997-11-11 |
JP3791856B2 true JP3791856B2 (ja) | 2006-06-28 |
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