JPH08289895A - 縫合器 - Google Patents
縫合器Info
- Publication number
- JPH08289895A JPH08289895A JP7096431A JP9643195A JPH08289895A JP H08289895 A JPH08289895 A JP H08289895A JP 7096431 A JP7096431 A JP 7096431A JP 9643195 A JP9643195 A JP 9643195A JP H08289895 A JPH08289895 A JP H08289895A
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Abstract
(57)【要約】
【目的】内視鏡下の手術に使用でき、切除する範囲を少
なくできる縫合器を提供することにある。 【構成】曲線状の複数のステープル7列を有するカート
リッジ9と、このカートリッジ9との間で組織を挟む面
を持つアンビル8と、前記ステープル7を前記アンビル
8へ向けて打出すステープル押出し板15と、前記アン
ビル8を前記カートリッジ9へ向けて移動させ、かつス
テープル押出し板15をステープル7列に沿って駆動す
るステープル打出しレバーとを備えた縫合器において、
前記ステープル押出し板15と前記ステープル打出しレ
バーとをワイヤー20で接続し、このワイヤー20の一
端がステープル打出しレバーに固定され、中途部がカー
トリッジ9の先端近傍を通過し、前記ステープル押出し
板15と摺動自在に接続した後、他端がカートリッジ9
に接続されていることを特徴とする。
なくできる縫合器を提供することにある。 【構成】曲線状の複数のステープル7列を有するカート
リッジ9と、このカートリッジ9との間で組織を挟む面
を持つアンビル8と、前記ステープル7を前記アンビル
8へ向けて打出すステープル押出し板15と、前記アン
ビル8を前記カートリッジ9へ向けて移動させ、かつス
テープル押出し板15をステープル7列に沿って駆動す
るステープル打出しレバーとを備えた縫合器において、
前記ステープル押出し板15と前記ステープル打出しレ
バーとをワイヤー20で接続し、このワイヤー20の一
端がステープル打出しレバーに固定され、中途部がカー
トリッジ9の先端近傍を通過し、前記ステープル押出し
板15と摺動自在に接続した後、他端がカートリッジ9
に接続されていることを特徴とする。
Description
【0001】
【産業上の利用分野】この発明は、腹壁等を貫通して体
腔内に挿入し、体腔内の生体組織を縫合する縫合器に関
する。
腔内に挿入し、体腔内の生体組織を縫合する縫合器に関
する。
【0002】
【従来の技術】内視鏡下外科手術等においては腹壁等を
貫通して体腔内に挿入して体腔内の組織を縫合する縫合
器が用いられている。この種の縫合器には従来、例え
ば、特開平3−12126号公報で知られている。
貫通して体腔内に挿入して体腔内の組織を縫合する縫合
器が用いられている。この種の縫合器には従来、例え
ば、特開平3−12126号公報で知られている。
【0003】特開平3−12126号公報は、経皮的に
体腔内に挿入され、体腔内組織を縫合する縫合器で、挿
入部と、この挿入部の先端部に開閉自在に設けられ一方
がアンビル、他方がステープルを保持するカートリッジ
からなる縫合器本体と、前記挿入部の先端部に設けられ
カートリッジからステープルを打出すファイリングレバ
ーと、縫合器本体を開閉せしめる縫合開閉レバーとから
構成されている。
体腔内に挿入され、体腔内組織を縫合する縫合器で、挿
入部と、この挿入部の先端部に開閉自在に設けられ一方
がアンビル、他方がステープルを保持するカートリッジ
からなる縫合器本体と、前記挿入部の先端部に設けられ
カートリッジからステープルを打出すファイリングレバ
ーと、縫合器本体を開閉せしめる縫合開閉レバーとから
構成されている。
【0004】前記ステープルは、チタン等の金属製のU
字形状で、ステープルを直線状に組織に打出し変形させ
た後、ステープル列の間をリニアカッターで切除するよ
うになっている。この縫合器は、内視鏡下手術において
トラカールカニューラから入れて体腔内で縫合と切除が
同時に行え、手術時間の短縮という点で大きく貢献して
いる。
字形状で、ステープルを直線状に組織に打出し変形させ
た後、ステープル列の間をリニアカッターで切除するよ
うになっている。この縫合器は、内視鏡下手術において
トラカールカニューラから入れて体腔内で縫合と切除が
同時に行え、手術時間の短縮という点で大きく貢献して
いる。
【0005】しかし、前記リニアカッターは直線状に組
織の縫合を行うため、組織を切除する範囲が大きく、ま
た1ケ所を部分切除をするために3回〜4回使用する必
要があり、手術時間が長く患者にとって負担の大きいも
のであった。
織の縫合を行うため、組織を切除する範囲が大きく、ま
た1ケ所を部分切除をするために3回〜4回使用する必
要があり、手術時間が長く患者にとって負担の大きいも
のであった。
【0006】また、曲線状に組織の縫合切除を行うこと
ができる外科器具は、特開平6−121798号公報で
知られているが、この器具はステープルを生体吸収性樹
脂としており、開腹手術用の構造をしている。同様の器
具でワイヤ駆動式の外科器具はSU 1,011,11
6Aにおいても知られている。
ができる外科器具は、特開平6−121798号公報で
知られているが、この器具はステープルを生体吸収性樹
脂としており、開腹手術用の構造をしている。同様の器
具でワイヤ駆動式の外科器具はSU 1,011,11
6Aにおいても知られている。
【0007】
【発明が解決しようとする課題】しかしながら、前記特
開平3−12126号公報の縫合器具は、直線状の縫合
切除を行うため、正常な組織の切除範囲が広くなり、ま
た、1ケ所切除するのに3〜4回のカートリッジ交換を
必要としていた。カートリッジの交換をするためにはト
ラカールカニューラから1回毎に器具を体外に取り出す
必要があり、術者にとって使いづらいものであった。ま
た、切除範囲が広くなるという点で患者に負担が大き
く、術後の回復も遅れる可能性もあった。
開平3−12126号公報の縫合器具は、直線状の縫合
切除を行うため、正常な組織の切除範囲が広くなり、ま
た、1ケ所切除するのに3〜4回のカートリッジ交換を
必要としていた。カートリッジの交換をするためにはト
ラカールカニューラから1回毎に器具を体外に取り出す
必要があり、術者にとって使いづらいものであった。ま
た、切除範囲が広くなるという点で患者に負担が大き
く、術後の回復も遅れる可能性もあった。
【0008】さらに、内視鏡部分全体が直線形状である
ため、内視鏡下の手術において内視鏡部分先端が見えに
くく、操作性が悪くなるという問題点があった。また、
SU 1,011,116Aは直接駆動手段とステープ
ル押し出し手段5を接続しているため、大きいスライド
力量を必要としていた。特開平6−121798号公報
の縫合器具は曲線状に切除縫合ができるものの、内視鏡
下手術には使用できないものであった。さらにハンドル
部分から先端まで全体が一定の曲率をもち、内部の構成
品を一定の曲率で曲がった形状をしているため、小さな
曲率構造にはできなかった。
ため、内視鏡下の手術において内視鏡部分先端が見えに
くく、操作性が悪くなるという問題点があった。また、
SU 1,011,116Aは直接駆動手段とステープ
ル押し出し手段5を接続しているため、大きいスライド
力量を必要としていた。特開平6−121798号公報
の縫合器具は曲線状に切除縫合ができるものの、内視鏡
下手術には使用できないものであった。さらにハンドル
部分から先端まで全体が一定の曲率をもち、内部の構成
品を一定の曲率で曲がった形状をしているため、小さな
曲率構造にはできなかった。
【0009】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、内視鏡下の手術に使用
でき、切除する範囲を少なくできる縫合器を提供するこ
とを目的とする。
ので、その目的とするところは、内視鏡下の手術に使用
でき、切除する範囲を少なくできる縫合器を提供するこ
とを目的とする。
【0010】
【課題を解決するための手段】この発明は前記目的を達
成するために、曲線状の複数のステープル列を有するス
テープル収容手段と、このステープル収容手段との間で
組織を挟む面を持つステープル変形手段と、前記ステー
プルを前記ステープル変形手段へ向けて打出すステープ
ル打出し手段と、前記ステープル変形手段を前記ステー
プル収容手段へ向けて移動させ、かつステープル打出し
手段をステープル列に沿って駆動する駆動手段とを備え
た縫合器において、前記ステープル打出し手段と前記駆
動手段とを接続する細長軟性手段を設け、この細長軟性
手段は一端が駆動手段に固定され、中途部が前記ステー
プル収容手段の先端近傍を通過し、前記ステープル打出
し手段と摺動自在に接続した後、他端が前記ステープル
収容手段に接続されていることを特徴とする。
成するために、曲線状の複数のステープル列を有するス
テープル収容手段と、このステープル収容手段との間で
組織を挟む面を持つステープル変形手段と、前記ステー
プルを前記ステープル変形手段へ向けて打出すステープ
ル打出し手段と、前記ステープル変形手段を前記ステー
プル収容手段へ向けて移動させ、かつステープル打出し
手段をステープル列に沿って駆動する駆動手段とを備え
た縫合器において、前記ステープル打出し手段と前記駆
動手段とを接続する細長軟性手段を設け、この細長軟性
手段は一端が駆動手段に固定され、中途部が前記ステー
プル収容手段の先端近傍を通過し、前記ステープル打出
し手段と摺動自在に接続した後、他端が前記ステープル
収容手段に接続されていることを特徴とする。
【0011】
【作用】駆動手段により細長軟性手段に引く力が加わる
と、ステープル打出し手段と接する部分にステープル収
容手段の先端向きの力が加わり、ステープル打出し手段
がステープル収容手段の先端へ向けて移動し、ステープ
ル収容手段内の曲線状に並ぶステープルをステープル変
形手段へ向けて順次打ち出す。各ステープルは組織に変
形固定され、曲線状にステープル列が複数できる。
と、ステープル打出し手段と接する部分にステープル収
容手段の先端向きの力が加わり、ステープル打出し手段
がステープル収容手段の先端へ向けて移動し、ステープ
ル収容手段内の曲線状に並ぶステープルをステープル変
形手段へ向けて順次打ち出す。各ステープルは組織に変
形固定され、曲線状にステープル列が複数できる。
【0012】
【実施例】以下、この発明の各実施例を図面に基づいて
説明する。図1〜図6は第1の実施例を示し、図1は縫
合器の全体図である。この縫合器は、挿入部1とこの挿
入部1の基端部に設けられた操作部2および挿入部1の
先端部に設けられた縫合部3とから構成されている。
説明する。図1〜図6は第1の実施例を示し、図1は縫
合器の全体図である。この縫合器は、挿入部1とこの挿
入部1の基端部に設けられた操作部2および挿入部1の
先端部に設けられた縫合部3とから構成されている。
【0013】操作部2には術者が把持するハンドル部4
が設けられ、このハンドル部4には駆動手段として開閉
自在のステープル打出しレバー5とアンビル開閉ノブ6
が設けられている。縫合部3には後述するステープル7
を受けて変形させるステープル変形手段であるアンビル
8とステープル7を複数放出可能に収容するステープル
収容手段であるカートリッジ9とが設けられている。
が設けられ、このハンドル部4には駆動手段として開閉
自在のステープル打出しレバー5とアンビル開閉ノブ6
が設けられている。縫合部3には後述するステープル7
を受けて変形させるステープル変形手段であるアンビル
8とステープル7を複数放出可能に収容するステープル
収容手段であるカートリッジ9とが設けられている。
【0014】アンビル8とカートリッジ9は長手方向に
対し横向きにある曲率を持って湾曲しており、アンビル
8はハンドル部4のアンビル開閉ノブ6を操作すること
により開閉自在であり、閉じた状態ではカートリッジ9
の上面とアンビル8の下面はほぼ平行な位置関係になっ
ている。ここで、アンビル8及びカートリッジ9の中心
線の曲率はR30以上、好ましくはR30となってい
る。
対し横向きにある曲率を持って湾曲しており、アンビル
8はハンドル部4のアンビル開閉ノブ6を操作すること
により開閉自在であり、閉じた状態ではカートリッジ9
の上面とアンビル8の下面はほぼ平行な位置関係になっ
ている。ここで、アンビル8及びカートリッジ9の中心
線の曲率はR30以上、好ましくはR30となってい
る。
【0015】また、図2〜図4に示すように、アンビル
8はステンレスなどの金属・合金を用いて射出成形、鋳
造などで作られ、下面にステープル変形手段としての複
数の変形凹部10の列がアンビル8の曲率に沿って曲線
状に配置されている。カートリッジ9のステーブル7列
間には後述するカッター11がスライドするカッター溝
12が設けられている。
8はステンレスなどの金属・合金を用いて射出成形、鋳
造などで作られ、下面にステープル変形手段としての複
数の変形凹部10の列がアンビル8の曲率に沿って曲線
状に配置されている。カートリッジ9のステーブル7列
間には後述するカッター11がスライドするカッター溝
12が設けられている。
【0016】さらに、カートリッジ9は挿入部1に固定
されているカートリッジホルダ13に対してラッチ,カ
ムピンなどの機構を用いて着脱自在であり、カートリッ
ジ9の上面に開口を持つスロット13aを有している。
スロット13aにはチタン合金、もしくはステンレス製
のU型のステープル7が上面に脚先端を向けた状態でス
ライド自在に収納されており、ステープル7の下部には
ポリカーボンなどの樹脂製ステープルホルダ14がスラ
イド自在に収容されている。
されているカートリッジホルダ13に対してラッチ,カ
ムピンなどの機構を用いて着脱自在であり、カートリッ
ジ9の上面に開口を持つスロット13aを有している。
スロット13aにはチタン合金、もしくはステンレス製
のU型のステープル7が上面に脚先端を向けた状態でス
ライド自在に収納されており、ステープル7の下部には
ポリカーボンなどの樹脂製ステープルホルダ14がスラ
イド自在に収容されている。
【0017】前記スロット13aは曲線状に並べられて
おり、4列〜6列の配列となっている。また、各列ごと
のスロット13aの数は外側列から内側列へ向けて順次
少なくしてもよいし、スロット13aの大きさ自体を内
側列へいくに従って列毎に小さくしてもよい。なお、同
様にステープル7の幅も変化させている。
おり、4列〜6列の配列となっている。また、各列ごと
のスロット13aの数は外側列から内側列へ向けて順次
少なくしてもよいし、スロット13aの大きさ自体を内
側列へいくに従って列毎に小さくしてもよい。なお、同
様にステープル7の幅も変化させている。
【0018】前記カートリッジ9の下面のスロット13
a列の間には、ステープル打出し手段としての斜面15
aを有するステープル押出し板15をスライドするため
のスライド溝16が2本または各スロット13a列ごと
に設けられている。ステープルホルダ14は下部にカム
面14aもしくは面取り部を持っていてステープル押出
し板15の斜面15aと摺動するようになっている。
a列の間には、ステープル打出し手段としての斜面15
aを有するステープル押出し板15をスライドするため
のスライド溝16が2本または各スロット13a列ごと
に設けられている。ステープルホルダ14は下部にカム
面14aもしくは面取り部を持っていてステープル押出
し板15の斜面15aと摺動するようになっている。
【0019】前記カートリッジホルダ13は上面にカー
トリッジ9を受ける部分を持ち断面がU型形状をしてい
る。そして、カートリッジホルダ13の下面の先端部に
は固定プーリ16が回転自在に軸支されている。また、
カートリッジホルダ13の下面の後端にはカートリッジ
ホルダ13の中心線に沿って設けられたスリット状のプ
ーリガイド17の中を駆動プーリ18がスライド自在に
設けられている。
トリッジ9を受ける部分を持ち断面がU型形状をしてい
る。そして、カートリッジホルダ13の下面の先端部に
は固定プーリ16が回転自在に軸支されている。また、
カートリッジホルダ13の下面の後端にはカートリッジ
ホルダ13の中心線に沿って設けられたスリット状のプ
ーリガイド17の中を駆動プーリ18がスライド自在に
設けられている。
【0020】また、図5に示すように、駆動プーリ18
の上面で、カートリッジホルダ13の内側にはステープ
ル押出し板15およびカッター11が接続されている。
さらに駆動プーリ18にはこれを後方に付勢するコイル
バネ、ゴムなどの弾性部材19が接続されている。
の上面で、カートリッジホルダ13の内側にはステープ
ル押出し板15およびカッター11が接続されている。
さらに駆動プーリ18にはこれを後方に付勢するコイル
バネ、ゴムなどの弾性部材19が接続されている。
【0021】カートリッジホルダ13の下面には細長軟
性手段としてのワイヤー20が設けられている。なお、
ワイヤー20の材質は炭素繊維、SUSまたは合成樹脂
の線状部材、軟性部材でもよい。前記ワイヤー20の一
端はカートリッジホルダ13の下面に固定され、駆動プ
ーリ18の周りを回って、固定プーリ16を囲み、さら
にハンドル部4のステープル打出しレバー5と接続され
ている。
性手段としてのワイヤー20が設けられている。なお、
ワイヤー20の材質は炭素繊維、SUSまたは合成樹脂
の線状部材、軟性部材でもよい。前記ワイヤー20の一
端はカートリッジホルダ13の下面に固定され、駆動プ
ーリ18の周りを回って、固定プーリ16を囲み、さら
にハンドル部4のステープル打出しレバー5と接続され
ている。
【0022】前記ステープル押出し板15は厚みが0.
2〜0.3のステンレス板材、もしくは樹脂の板材の両
端を折り曲げた形状をしており、スライド溝16に沿っ
て摺動する際、曲率に沿って変形可能になっている。さ
らにステープル押出し板15の中央部には図6に示すよ
うに、駆動プーリ18と嵌合するための嵌合孔21が穿
設され、この嵌合孔21の前方にはスリット22が設け
られている。
2〜0.3のステンレス板材、もしくは樹脂の板材の両
端を折り曲げた形状をしており、スライド溝16に沿っ
て摺動する際、曲率に沿って変形可能になっている。さ
らにステープル押出し板15の中央部には図6に示すよ
うに、駆動プーリ18と嵌合するための嵌合孔21が穿
設され、この嵌合孔21の前方にはスリット22が設け
られている。
【0023】前記アンビル8の後部にはカムピン23が
突設されており、このアンビル8の後部にはアンビル開
閉部材24がスライド可能に嵌合されている。アンビル
開閉部材24の側面にはカムピン23と係合するカム溝
25が設けられている。さらにアンビル開閉部材24の
後部には開閉ワイヤ26がロー付け、カシメなどの方法
で固定され、ハンドル部4内においてアンビル開閉ノブ
6と固定されている。
突設されており、このアンビル8の後部にはアンビル開
閉部材24がスライド可能に嵌合されている。アンビル
開閉部材24の側面にはカムピン23と係合するカム溝
25が設けられている。さらにアンビル開閉部材24の
後部には開閉ワイヤ26がロー付け、カシメなどの方法
で固定され、ハンドル部4内においてアンビル開閉ノブ
6と固定されている。
【0024】アンビル開閉部材24の後方には挿入部1
内に固定されたコイルスプリング27が設けられ、アン
ビル開閉部材24を先端側へ付勢している。なお、コイ
ルスプリング27に代ってゴム、弾性金属、弾性樹脂を
介在してもよい。
内に固定されたコイルスプリング27が設けられ、アン
ビル開閉部材24を先端側へ付勢している。なお、コイ
ルスプリング27に代ってゴム、弾性金属、弾性樹脂を
介在してもよい。
【0025】前記挿入部1の先端部には長軸方向に対し
て垂直方向にカムスリット28が設けられ、アンビル8
の後端のカムピン23がアンビル開閉部材24のカム溝
25を通ってカムスリット28と嵌合している。さら
に、アンビル8の後端には開閉する際の回転中心となる
突起29が設けられ、この突起29は挿入部1の先端部
と回動自在に嵌合している。
て垂直方向にカムスリット28が設けられ、アンビル8
の後端のカムピン23がアンビル開閉部材24のカム溝
25を通ってカムスリット28と嵌合している。さら
に、アンビル8の後端には開閉する際の回転中心となる
突起29が設けられ、この突起29は挿入部1の先端部
と回動自在に嵌合している。
【0026】次に、前述のように構成された縫合器の作
用について説明する。図7および図8に示すように、生
体の体壁30に孔31を開け、トラカール32を挿入し
た後、アンビル8とカートリッジ9を閉じた状態でトラ
カール32を通して体腔33内へ挿入する。このとき、
トラカール32のシース32aはテフロン(商品名)、
塩化ビニール、ゴア(商品名)などの合成樹脂または軟
性材でできているためアンビル8とカートリッジ9が湾
曲していても挿通可能となる。さらに、トラカール32
の口金32bには弁手段、シール手段(いずれも図示し
ない)が設けられているため、体腔33内を気腹してい
るCO2 ガスなどが漏出することはない。
用について説明する。図7および図8に示すように、生
体の体壁30に孔31を開け、トラカール32を挿入し
た後、アンビル8とカートリッジ9を閉じた状態でトラ
カール32を通して体腔33内へ挿入する。このとき、
トラカール32のシース32aはテフロン(商品名)、
塩化ビニール、ゴア(商品名)などの合成樹脂または軟
性材でできているためアンビル8とカートリッジ9が湾
曲していても挿通可能となる。さらに、トラカール32
の口金32bには弁手段、シール手段(いずれも図示し
ない)が設けられているため、体腔33内を気腹してい
るCO2 ガスなどが漏出することはない。
【0027】そして、術者が縫合器のハンドル部4を把
持し、アンビル8およびびカートリッジ9を目的部位に
導き、アンビル8とカートリッジ9との間に組織34を
置き、ハンドル部4のアンビル開閉ノブ6を回転させ、
開閉ワイヤ26、アンビル開閉部材24をハンドル部4
側へスライドさせる。すると、アンビル8の後部のカム
ピン23はカム溝25に沿って上側へ移動し、アンビル
8が突起29を支点として回動してカートリッジ9に対
して閉じられる。
持し、アンビル8およびびカートリッジ9を目的部位に
導き、アンビル8とカートリッジ9との間に組織34を
置き、ハンドル部4のアンビル開閉ノブ6を回転させ、
開閉ワイヤ26、アンビル開閉部材24をハンドル部4
側へスライドさせる。すると、アンビル8の後部のカム
ピン23はカム溝25に沿って上側へ移動し、アンビル
8が突起29を支点として回動してカートリッジ9に対
して閉じられる。
【0028】その後、ステープル打出しレバー5を閉じ
ると、ステープルワイヤ20はハンドル部4側に引か
れ、カートリッジホルダ13の下面にある駆動プーリ1
8と固定プーリ17の回りのステープルワイヤ20のル
ープが縮小し、結果として駆動プーリ18はプーリガイ
ド17に沿ってカートリッジ9の先端側へスライドして
いく。同時にステープル押出し板15およびカッター1
1も各々スライド溝16、カッター溝12の中をカート
リッジ9の先端までスライドする。このときステープル
押出し板15の斜面15aによって各ステープルホルダ
14、ステープル7はアンビル8の変形凹部10に向け
て押し出され、アンビル8、カートリッジ9間の組織3
4を挟んだ状態で閉じた形に順次変形されて縫合され
る。
ると、ステープルワイヤ20はハンドル部4側に引か
れ、カートリッジホルダ13の下面にある駆動プーリ1
8と固定プーリ17の回りのステープルワイヤ20のル
ープが縮小し、結果として駆動プーリ18はプーリガイ
ド17に沿ってカートリッジ9の先端側へスライドして
いく。同時にステープル押出し板15およびカッター1
1も各々スライド溝16、カッター溝12の中をカート
リッジ9の先端までスライドする。このときステープル
押出し板15の斜面15aによって各ステープルホルダ
14、ステープル7はアンビル8の変形凹部10に向け
て押し出され、アンビル8、カートリッジ9間の組織3
4を挟んだ状態で閉じた形に順次変形されて縫合され
る。
【0029】さらに、組織34に固定された曲線状のス
テープル7列の間をカッター溝12に沿ってカッター1
1が前進し、組織34を切断していく。カッター11に
よってカートリッジ9の先端部分まで組織34を切断し
た後、ステープル打出しレバー5を開くと、駆動プーリ
18はコイルバネ19によりカートリッジ9の後部まで
引き戻され、同時にカッター11もカートリッジ9の後
部まで引き戻される。ステープル押出し板15は駆動プ
ーリ18が引き戻される際、スリット22を通って戻る
ためカートリッジ9の先端側へとり残されることにな
る。
テープル7列の間をカッター溝12に沿ってカッター1
1が前進し、組織34を切断していく。カッター11に
よってカートリッジ9の先端部分まで組織34を切断し
た後、ステープル打出しレバー5を開くと、駆動プーリ
18はコイルバネ19によりカートリッジ9の後部まで
引き戻され、同時にカッター11もカートリッジ9の後
部まで引き戻される。ステープル押出し板15は駆動プ
ーリ18が引き戻される際、スリット22を通って戻る
ためカートリッジ9の先端側へとり残されることにな
る。
【0030】本実施例によれば、アンビル8、カートリ
ッジ9が湾曲しているため対象組織が見易く、挟み込み
易くなる。また、ステープル打出しレバー5とステープ
ル押出し板15とをワイヤー20で接続したことにより
曲線に沿って進むステープル押出し板15への伝達ロス
が少なくなる。さらにカートリッジ9、アンビル8に大
きな曲率をつけられ、組織切除範囲が少なくなり、かつ
カートリッジ9の交換回数も減って医療費削減、手術時
間の短縮にもつながる。
ッジ9が湾曲しているため対象組織が見易く、挟み込み
易くなる。また、ステープル打出しレバー5とステープ
ル押出し板15とをワイヤー20で接続したことにより
曲線に沿って進むステープル押出し板15への伝達ロス
が少なくなる。さらにカートリッジ9、アンビル8に大
きな曲率をつけられ、組織切除範囲が少なくなり、かつ
カートリッジ9の交換回数も減って医療費削減、手術時
間の短縮にもつながる。
【0031】ワイヤー20をループを介してステープル
押出し板15とステープル打出しレバー5を接続したた
め滑車の原理により駆動力が小さくなる。また、伸長部
分を設けたことにより、処置の際に組織が見易くなり、
かつ挿入部1の径をφ12以下とすると、内視鏡下手術
に使用できる。
押出し板15とステープル打出しレバー5を接続したた
め滑車の原理により駆動力が小さくなる。また、伸長部
分を設けたことにより、処置の際に組織が見易くなり、
かつ挿入部1の径をφ12以下とすると、内視鏡下手術
に使用できる。
【0032】図9および図10は第2の実施例を示し、
第1の実施例のワイヤー20の代わりに帯状板体からな
る複数の駆動板35を連結ピン36によって横方向に回
動自在に連結すると共に、駆動板35とステープル押出
し板15とを連結ピン35aによって横方向に回転自在
に連結した構成である。さらに、駆動板35の連結部3
5bは幅が他の部分に比べ広幅に形成され、カートリッ
ジホルダ13の側壁と摺動するようになっている。
第1の実施例のワイヤー20の代わりに帯状板体からな
る複数の駆動板35を連結ピン36によって横方向に回
動自在に連結すると共に、駆動板35とステープル押出
し板15とを連結ピン35aによって横方向に回転自在
に連結した構成である。さらに、駆動板35の連結部3
5bは幅が他の部分に比べ広幅に形成され、カートリッ
ジホルダ13の側壁と摺動するようになっている。
【0033】したがって、ステープル押出しレバー5を
閉じると、各駆動板35はカートリッジホルダ13内を
スライドし、カートリッジホルダ13の曲がりに沿って
駆動板35の連結部35bが連結ピン36を支点として
屈曲してステープル押出し板15、カッター11へと力
を伝達していく。
閉じると、各駆動板35はカートリッジホルダ13内を
スライドし、カートリッジホルダ13の曲がりに沿って
駆動板35の連結部35bが連結ピン36を支点として
屈曲してステープル押出し板15、カッター11へと力
を伝達していく。
【0034】本実施例によれば、複数の駆動板35を回
転自在に連結しステープル押出し板15へ接続したこと
により、簡単な構造で曲がりのあるカートリッジホルダ
13内へ力を伝えることができる。さらに駆動板35と
ステープル押出し板15を回転可能に接続したことでカ
ートリッジ9の先端方向へ押す直線的な力が、曲がりの
接線方向へ向けられスムーズにステープル押出し板15
をスライドさせることができる。
転自在に連結しステープル押出し板15へ接続したこと
により、簡単な構造で曲がりのあるカートリッジホルダ
13内へ力を伝えることができる。さらに駆動板35と
ステープル押出し板15を回転可能に接続したことでカ
ートリッジ9の先端方向へ押す直線的な力が、曲がりの
接線方向へ向けられスムーズにステープル押出し板15
をスライドさせることができる。
【0035】図11および図12は第3の実施例を示
し、ステープル押出し板15の斜面15aの先端に屈曲
して側方に伸びる位置決め材37を設けた構成である。
位置決め材37は隣接するステープル押出し板15もし
くはカートリジホルダ13の側壁と接しており、好まし
くは接する部分に上方へ折曲する折曲片37aが設けら
れている。
し、ステープル押出し板15の斜面15aの先端に屈曲
して側方に伸びる位置決め材37を設けた構成である。
位置決め材37は隣接するステープル押出し板15もし
くはカートリジホルダ13の側壁と接しており、好まし
くは接する部分に上方へ折曲する折曲片37aが設けら
れている。
【0036】したがって、ステープル押出し板15がカ
ートリッジホルダ13内を先端側へ向けてスライドする
際、折曲片37aを有する位置決め材37はカートリッ
ジホルダ13の側壁に押され、斜面15aの先端はステ
ープルホルダ14の下部のカム面14aと接するように
位置決めされる。
ートリッジホルダ13内を先端側へ向けてスライドする
際、折曲片37aを有する位置決め材37はカートリッ
ジホルダ13の側壁に押され、斜面15aの先端はステ
ープルホルダ14の下部のカム面14aと接するように
位置決めされる。
【0037】本実施例によれば、ステープル押出し板1
5の先端が常にスライド溝16の中心に沿ってスライド
されるように位置決めされるため、ステープルホルダ1
4を収容するスロット13aに干渉されることなくスム
ーズにスライド溝16を動くことができ、カートリッジ
9およびアンビル8の曲率を小さくすることができる。
5の先端が常にスライド溝16の中心に沿ってスライド
されるように位置決めされるため、ステープルホルダ1
4を収容するスロット13aに干渉されることなくスム
ーズにスライド溝16を動くことができ、カートリッジ
9およびアンビル8の曲率を小さくすることができる。
【0038】なお、本実施例の変形例として位置決め材
37の代わりにステープル押出し板15の斜面15aの
先端の下部に突起を設け、カートリッジホルダ13の上
面にガイド溝を設けてもよい。この場合、構造が簡単に
なるという効果がある。
37の代わりにステープル押出し板15の斜面15aの
先端の下部に突起を設け、カートリッジホルダ13の上
面にガイド溝を設けてもよい。この場合、構造が簡単に
なるという効果がある。
【0039】図13は第4の実施例を示し、挿入部1の
先端部近傍にその長軸方向に対して横方向に回転可能な
回転部38を設けた構成である。回転部38は挿入部1
の先端に突出部39が設けられ、この突出部39には上
下方向に突出する回転ピン40が設けられている。ま
た、突出部39の内部には開閉ワイヤ26、ワイヤー2
0が通るように空洞に形成されている。
先端部近傍にその長軸方向に対して横方向に回転可能な
回転部38を設けた構成である。回転部38は挿入部1
の先端に突出部39が設けられ、この突出部39には上
下方向に突出する回転ピン40が設けられている。ま
た、突出部39の内部には開閉ワイヤ26、ワイヤー2
0が通るように空洞に形成されている。
【0040】さらに、突出部39にはアンビル8および
カートリッジ9を支持する管状の支持部材41が嵌合さ
れていて、この支持部材41の突出部39と嵌合する連
結部42には回転ピン40と係合する係合孔43が設け
られている。さらに、連結部42の後端部には回転ワイ
ヤー44が接続され、回転ワイヤー44は挿入部1の内
部を通って回転を操作するための制御手段である回転ノ
ブ45に接続されている。この回転ノブ45は挿入部1
の軸に対して回転もしくはスライド自在であり、回転運
動を軸方向に変換する手段、例えば、ネジカム機構によ
り回転ワイヤー44に力を伝えるようになっている。な
お、回転ワイヤー44に代って線状部材もしくは棒状部
材でもよい。
カートリッジ9を支持する管状の支持部材41が嵌合さ
れていて、この支持部材41の突出部39と嵌合する連
結部42には回転ピン40と係合する係合孔43が設け
られている。さらに、連結部42の後端部には回転ワイ
ヤー44が接続され、回転ワイヤー44は挿入部1の内
部を通って回転を操作するための制御手段である回転ノ
ブ45に接続されている。この回転ノブ45は挿入部1
の軸に対して回転もしくはスライド自在であり、回転運
動を軸方向に変換する手段、例えば、ネジカム機構によ
り回転ワイヤー44に力を伝えるようになっている。な
お、回転ワイヤー44に代って線状部材もしくは棒状部
材でもよい。
【0041】したがって、回転ノブ45を操作し、回転
部38から先端側の支持部材41、アンビル8、カート
リッジ9、ステープル押出し板15等を横方向に回転さ
せることにより所望の方向へ向けることができる。
部38から先端側の支持部材41、アンビル8、カート
リッジ9、ステープル押出し板15等を横方向に回転さ
せることにより所望の方向へ向けることができる。
【0042】本実施例によれば、アンビル8、カートリ
ッジ9をハンドル部4の回転ノブ45により操作するこ
とで任意の方向へ向けることができ、操作性の向上につ
ながる。
ッジ9をハンドル部4の回転ノブ45により操作するこ
とで任意の方向へ向けることができ、操作性の向上につ
ながる。
【0043】前述した実施態様によれば、次のような構
成が得られる。 (付記1)曲線状の複数のステープル列を有するステー
プル収容手段と、このステープル収容手段との間で組織
を挟む面を持つステープル変形手段と、前記ステープル
を前記ステープル変形手段へ向けて打出すステープル打
出し手段と、前記ステープル変形手段を前記ステープル
収容手段へ向けて移動させ、かつステープル打出し手段
をステープル列に沿って駆動する駆動手段とを備えた縫
合器において、前記ステープル打出し手段と前記駆動手
段とを接続する細長軟性手段を設け、この細長軟性手段
は一端が駆動手段に固定され、中途部が前記ステープル
収容手段の先端近傍を通過し、前記ステープル打出し手
段と摺動自在に接続した後、他端が前記ステープル収容
手段に接続されていることを特徴とする縫合器。
成が得られる。 (付記1)曲線状の複数のステープル列を有するステー
プル収容手段と、このステープル収容手段との間で組織
を挟む面を持つステープル変形手段と、前記ステープル
を前記ステープル変形手段へ向けて打出すステープル打
出し手段と、前記ステープル変形手段を前記ステープル
収容手段へ向けて移動させ、かつステープル打出し手段
をステープル列に沿って駆動する駆動手段とを備えた縫
合器において、前記ステープル打出し手段と前記駆動手
段とを接続する細長軟性手段を設け、この細長軟性手段
は一端が駆動手段に固定され、中途部が前記ステープル
収容手段の先端近傍を通過し、前記ステープル打出し手
段と摺動自在に接続した後、他端が前記ステープル収容
手段に接続されていることを特徴とする縫合器。
【0044】(付記2)前記細長軟性手段は、線状部材
であることを特徴とする付記1記載の縫合器。 (付記3)前記細長軟性手段は、ステンレスワイヤーで
あることを特徴とする付記1記載の縫合器。
であることを特徴とする付記1記載の縫合器。 (付記3)前記細長軟性手段は、ステンレスワイヤーで
あることを特徴とする付記1記載の縫合器。
【0045】(付記4)前記細長軟性手段は、炭素繊維
であることを特徴とする付記1記載の縫合器。 (付記5)前記細長軟性手段は、合成繊維であることを
特徴とする付記1記載の縫合器。
であることを特徴とする付記1記載の縫合器。 (付記5)前記細長軟性手段は、合成繊維であることを
特徴とする付記1記載の縫合器。
【0046】(付記6)前記曲線状に並ぶステープル列
の間を切断する手段をステープル打出し手段に固定した
ことを特徴とする付記1記載の縫合器。 (付記7)前記ステープル列の曲率Rを30mm以上と
したことを特徴とする付記1記載の縫合器。
の間を切断する手段をステープル打出し手段に固定した
ことを特徴とする付記1記載の縫合器。 (付記7)前記ステープル列の曲率Rを30mm以上と
したことを特徴とする付記1記載の縫合器。
【0047】(付記8)曲線状の複数のステープル列を
有するステープル収容手段と、このステープル収容手段
との間で組織を挟む面を持つステープル変形手段と、前
記ステープルをステープル変形手段へ向けて打出し変形
させるステープル打出し手段と、前記ステープル変形手
段をステープル収容手段へ移動させかつステープル打出
し手段を駆動する駆動手段とで構成される縫合器におい
て、ステープル収容手段は各ステープル列に沿って曲線
状にステープル打出し手段をガイドするガイド手段を有
し、ステープル打出し手段はステープル打出し手段の先
端をガイド手段の中心に位置決めする手段を有すること
を特徴とする縫合器。
有するステープル収容手段と、このステープル収容手段
との間で組織を挟む面を持つステープル変形手段と、前
記ステープルをステープル変形手段へ向けて打出し変形
させるステープル打出し手段と、前記ステープル変形手
段をステープル収容手段へ移動させかつステープル打出
し手段を駆動する駆動手段とで構成される縫合器におい
て、ステープル収容手段は各ステープル列に沿って曲線
状にステープル打出し手段をガイドするガイド手段を有
し、ステープル打出し手段はステープル打出し手段の先
端をガイド手段の中心に位置決めする手段を有すること
を特徴とする縫合器。
【0048】(付記9)曲線状の複数のステープル列を
有するステープル収容手段と、このステープル収容手段
との間だけ組織を挟む面を有するステープル変形手段
と、前記ステープルをステープル変形手段へ向けて打出
し変形させるステープル打出し手段と、前記ステープル
変形手段をステープル収容手段へ向けて移動させかつス
テープル打出し手段を駆動する駆動手段とで構成される
縫合器において、前記ステープル打出し手段と駆動手段
は少なくとも1つの連絡手段と回転自在に接続されるこ
とを特徴とする縫合器。
有するステープル収容手段と、このステープル収容手段
との間だけ組織を挟む面を有するステープル変形手段
と、前記ステープルをステープル変形手段へ向けて打出
し変形させるステープル打出し手段と、前記ステープル
変形手段をステープル収容手段へ向けて移動させかつス
テープル打出し手段を駆動する駆動手段とで構成される
縫合器において、前記ステープル打出し手段と駆動手段
は少なくとも1つの連絡手段と回転自在に接続されるこ
とを特徴とする縫合器。
【0049】(付記10)前記駆動手段とステープル収
容手段、ステープル打出し手段、ステープル変形手段を
細長支持手段により連結し、前記細長支持手段は少なく
とも1つの長軸に対して横方向に回転自在な回転部を有
することを特徴とする付記1記載の縫合器。
容手段、ステープル打出し手段、ステープル変形手段を
細長支持手段により連結し、前記細長支持手段は少なく
とも1つの長軸に対して横方向に回転自在な回転部を有
することを特徴とする付記1記載の縫合器。
【0050】(付記11)前記ガイド手段は、ガイド溝
であることを特徴とする付記8記載の縫合器。 (付記12)前記ステープル打出し手段は、少なくとも
1つのカム手段を有することを特徴とする付記8記載の
縫合器。
であることを特徴とする付記8記載の縫合器。 (付記12)前記ステープル打出し手段は、少なくとも
1つのカム手段を有することを特徴とする付記8記載の
縫合器。
【0051】(付記13)前記連結手段は、板状の部材
よりなることを特徴とする付記9記載の縫合器。 (付記14)前記連絡手段は、中間にくびれを有するこ
とを特徴とする付記9記載の縫合器。
よりなることを特徴とする付記9記載の縫合器。 (付記14)前記連絡手段は、中間にくびれを有するこ
とを特徴とする付記9記載の縫合器。
【0052】付記1によれば、駆動手段と打出し手段が
細長軟性手段で連結されるため曲線状のステープル列に
沿ってスムーズにステープル打出し手段が移動すること
ができ、ステープル変形に要する力も小さくすることが
できる。さらにステープルの曲率も小さくすることがで
き、組織切除範囲も少なくすることができる。また、ス
テープル打出し手段が滑車の原理を用いて移動させられ
るため、駆動手段に必要な力が小さくできる。
細長軟性手段で連結されるため曲線状のステープル列に
沿ってスムーズにステープル打出し手段が移動すること
ができ、ステープル変形に要する力も小さくすることが
できる。さらにステープルの曲率も小さくすることがで
き、組織切除範囲も少なくすることができる。また、ス
テープル打出し手段が滑車の原理を用いて移動させられ
るため、駆動手段に必要な力が小さくできる。
【0053】付記2、3、4、5によれば、線状部材に
することにより、ステープル収容手段内に設置し易くな
る。また、ステープル収容手段のサイズも小さくでき
る。付記6によれば、一度に組織を曲線状に縫合、切除
することができ、手術時間の短縮につながる。付記7に
よれば、曲率Rを30mmとしたことにより、より一層
患部組織を効率よく切除することができる。
することにより、ステープル収容手段内に設置し易くな
る。また、ステープル収容手段のサイズも小さくでき
る。付記6によれば、一度に組織を曲線状に縫合、切除
することができ、手術時間の短縮につながる。付記7に
よれば、曲率Rを30mmとしたことにより、より一層
患部組織を効率よく切除することができる。
【0054】付記8によれば、ステープル打出し手段が
ガイド溝に沿って駆動手段によりステープル収容手段先
端側へ向けてスライドされる時、ガイド溝側壁と打出し
手段先端が摺動せずに移動する。したがって、ステープ
ル収容手段がガイド溝の側壁に干渉されることなくスム
ーズに摺動することができ、駆動する力も小さくでき
る。付記9によれば、駆動手段からの力が、ステープル
打出し手段に伝えられる際、ステープル打出し手段のス
ライドしようとする方向に応じ連結部材も回転する。し
たがって、ステープル打出し手段が、スムーズに曲線状
のステープル列に沿って移動することができる。
ガイド溝に沿って駆動手段によりステープル収容手段先
端側へ向けてスライドされる時、ガイド溝側壁と打出し
手段先端が摺動せずに移動する。したがって、ステープ
ル収容手段がガイド溝の側壁に干渉されることなくスム
ーズに摺動することができ、駆動する力も小さくでき
る。付記9によれば、駆動手段からの力が、ステープル
打出し手段に伝えられる際、ステープル打出し手段のス
ライドしようとする方向に応じ連結部材も回転する。し
たがって、ステープル打出し手段が、スムーズに曲線状
のステープル列に沿って移動することができる。
【0055】付記10によれば、回転部の角度を任意に
変えステープル収容手段ステープル打出し手段、ステー
プル変形手段を患部組織方向へ向ける。したがって、任
意の方向の組織を縫合することができ、かつ体腔内にお
ける操作性も向上する。付記11によれば、ガイド手段
をガイド溝とすることにより、構造を簡単にすることが
できる。
変えステープル収容手段ステープル打出し手段、ステー
プル変形手段を患部組織方向へ向ける。したがって、任
意の方向の組織を縫合することができ、かつ体腔内にお
ける操作性も向上する。付記11によれば、ガイド手段
をガイド溝とすることにより、構造を簡単にすることが
できる。
【0056】付記12によれば、カム手段によりステー
プル打出しを行うことにより小さい力量でステープルを
押し出すことができ、構造も簡単になる。付記13によ
れば、板材にすることでより簡単な構造にできる。また
ステープル収容手段も小型化できる。付記14によれ
ば、曲線状のステープル列に沿ってスライドする際、周
囲と接する部分の面積が小さくなりスライドする力量が
小さくスムーズに移動できる。
プル打出しを行うことにより小さい力量でステープルを
押し出すことができ、構造も簡単になる。付記13によ
れば、板材にすることでより簡単な構造にできる。また
ステープル収容手段も小型化できる。付記14によれ
ば、曲線状のステープル列に沿ってスライドする際、周
囲と接する部分の面積が小さくなりスライドする力量が
小さくスムーズに移動できる。
【0057】
【発明の効果】以上説明したように、この発明によれ
ば、駆動手段とステープル打出し手段が細長軟性手段で
連結されるため曲線状のステープル列に沿ってスムーズ
にステープル打出し手段が移動することができ、ステー
プル変形に要する力も小さくすることができる。さらに
ステープルの曲率も小さくすることができ、組織切除範
囲も少なくすることができる。また、ステープル打出し
手段が滑車の原理を用いて移動させられるため、駆動手
段に必要な力が小さくできるという効果を奏する。
ば、駆動手段とステープル打出し手段が細長軟性手段で
連結されるため曲線状のステープル列に沿ってスムーズ
にステープル打出し手段が移動することができ、ステー
プル変形に要する力も小さくすることができる。さらに
ステープルの曲率も小さくすることができ、組織切除範
囲も少なくすることができる。また、ステープル打出し
手段が滑車の原理を用いて移動させられるため、駆動手
段に必要な力が小さくできるという効果を奏する。
【図1】この発明の第1の実施例に係る縫合器の全体の
斜視図。
斜視図。
【図2】同実施例の構成部品の分解斜視図。
【図3】同実施例の縫合部の縦断側面図。
【図4】同実施例のカートリッジの一部を断面した平面
図。
図。
【図5】同実施例のステープル押出し板の斜視図。
【図6】同実施例のステープル押出し板およびカッター
の斜視図。
の斜視図。
【図7】同実施例の作用説明図。
【図8】同実施例の作用説明図。
【図9】この発明の第2の実施例に係る縫合器のステー
プル押出し板およびカッターの斜視図。
プル押出し板およびカッターの斜視図。
【図10】同実施例の作用説明図。
【図11】この発明の第3の実施例に係る縫合器のカー
トリッジの一部を断面した平面図。
トリッジの一部を断面した平面図。
【図12】同実施例のステープル押出し板を示し、
(a)は斜視図、(b)はA部の正面図。
(a)は斜視図、(b)はA部の正面図。
【図13】この発明の第4の実施例に係る縫合器の斜視
図。
図。
1…挿入部、2…操作部、3…縫合部、4…ハンドル
部、5…ステープル打出しレバー、6…アンビル開閉ノ
ブ、7…ステープル、8…アンビル、9…カートリッ
ジ、10…変形凹部、11…カッター、15…ステープ
ル押出し板、20…ワイヤー。
部、5…ステープル打出しレバー、6…アンビル開閉ノ
ブ、7…ステープル、8…アンビル、9…カートリッ
ジ、10…変形凹部、11…カッター、15…ステープ
ル押出し板、20…ワイヤー。
Claims (1)
- 【請求項1】 曲線状の複数のステープル列を有するス
テープル収容手段と、このステープル収容手段との間で
組織を挟む面を持つステープル変形手段と、前記ステー
プルを前記ステープル変形手段へ向けて打出すステープ
ル打出し手段と、前記ステープル変形手段を前記ステー
プル収容手段へ向けて移動させ、かつステープル打出し
手段をステープル列に沿って駆動する駆動手段とを備え
た縫合器において、 前記ステープル打出し手段と前記駆動手段とを接続する
細長軟性手段を設け、この細長軟性手段は一端が駆動手
段に固定され、中途部が前記ステープル収容手段の先端
近傍を通過し、前記ステープル打出し手段と摺動自在に
接続した後、他端が前記ステープル収容手段に接続され
ていることを特徴とする縫合器。
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP7096431A JPH08289895A (ja) | 1995-04-21 | 1995-04-21 | 縫合器 |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP7096431A JPH08289895A (ja) | 1995-04-21 | 1995-04-21 | 縫合器 |
Publications (1)
Publication Number | Publication Date |
---|---|
JPH08289895A true JPH08289895A (ja) | 1996-11-05 |
Family
ID=14164825
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP7096431A Withdrawn JPH08289895A (ja) | 1995-04-21 | 1995-04-21 | 縫合器 |
Country Status (1)
Country | Link |
---|---|
JP (1) | JPH08289895A (ja) |
Cited By (638)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JP2005144193A (ja) * | 2003-11-19 | 2005-06-09 | Sherwood Services Ag | 切断機構付きの開放手術用血管密封器械 |
JP2006501955A (ja) * | 2002-10-04 | 2006-01-19 | タイコ ヘルスケア グループ エルピー | 外科用ステープリングデバイスのためのツールアセンブリ |
JP2007524451A (ja) * | 2003-06-17 | 2007-08-30 | タイコ・ヘルスケア・グループ・リミテッド・パートナーシップ | 外科用ステープリング装置 |
JP2008155024A (ja) * | 2006-12-21 | 2008-07-10 | Tyco Healthcare Group Lp | 関節式手術用ステープラのためのステープルドライバ |
JP2008212640A (ja) * | 2007-01-11 | 2008-09-18 | Ethicon Endo Surgery Inc | 湾曲した切断部材を備えた手術用自動縫合器 |
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