CN101061964A - 用于执行内窥镜粘膜切除术的设备和方法 - Google Patents
用于执行内窥镜粘膜切除术的设备和方法 Download PDFInfo
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Abstract
本发明涉及用于执行内窥镜粘膜切除术的设备和方法。一种外科手术装置包括具有远端和近端的细长轴,枢转连接到远端并可运动通过解剖平面的臂以及设置在上述臂上并能够从未展开构型运动到展开构型的切割元件,其中当处于未展开构型时上述切割元件与解剖平面大致对齐,而当处于展开构型时至少部分地横过解剖平面。
Description
技术领域
本发明申请涉及医疗设备和方法,以及更具体地涉及用于在人体的胃肠道和食道内执行切除手术的医疗设备和方法。
背景技术
人体内的胃癌通常由发展成表面肿瘤和其它增生的前体病变和息肉而产生。这种病变和增生通常开始于胃肠道的黏膜层(例如,结肠黏膜)中,并且随着癌症的发展可扩散到黏膜下层以及之外。因此一些医生认为成功的癌症治疗和预防通常需要从胃肠道识别并去除可疑组织。
因此,医生会收集来自胃肠道的组织样本(例如,黏膜样本)并对上述样本组织进行检测,以便确定是否存在癌细胞。上述组织取样可单纯是预防疾病的或是响应于癌症征兆指示进行的处理。当检测到癌变等时,有疗效的治疗通常需要完全切除可疑组织。
已经发展了各种技术来从胃肠道壁去除组织。这种技术通常使用通过自然孔(例如,肛门)进入体内的内窥镜,因此,通常称之为内窥镜粘膜切除(“EMR”)技术。
现有技术的EMR技术通常包括“抬升-切割”手术,其中当医生在病变组织周围进行切割时,使用圈套器和镊子来抓握和抬升病变组织。上述切割通常通过黏膜和黏膜下层来进行,特别小心不要穿透肌肉。但是,这种技术存在一些缺陷,包括关于去除整个可疑区域的难度以及在切割过程中穿透肌肉的危险。
因此,需要在人体胃肠道和食道内执行切除手术的改进的设备和方法。
发明内容
在一个方面中,提供一种外科手术装置,其包括具有远端和近端的细长轴,枢转连接到远端并可运动通过解剖平面的臂,以及设置在臂上并适于从未展开构型运动到展开构型的切割元件,其中当处于未展开构型时上述切割元件与解剖平面大致对齐,而当处于展开构型时至少部分地横过解剖平面。
在另一个方面中,提供一种外科手术装置,其包括具有远端和近端的细长轴,连接到远端并可相对于彼此运动通过解剖平面的至少两个臂,以及设置在至少其中一个臂上的切割元件,上述切割元件适于从未展开构型运动到展开构型,其中当处于未展开构型时上述切割元件与解剖平面大致对齐,而当处于展开构型时至少部分地横过解剖平面。
在又一个方面中,提供一种用于从患者器官切除患病组织的方法,并且该方法包括下述步骤:将具有至少一个臂的装置定位在器官的第二层和第三层之间,将上述臂运动通过位于上述第二和第三层之间的解剖平面以便从第三层钝切除(bluntly dissect)第二层,以及从臂展开切割元件,其中上述切割元件向着第一层并远离第三层展开。
更具体地说,本发明涉及如下内容:
(1).一种外科手术装置,包括:
具有远端和近端的细长轴;
枢转连接到所述远端并可运动通过解剖平面的第一臂;以及
设置在所述第一臂上并能够从未展开构型运动到展开构型的切割元件,其中当处于所述未展开构型时所述切割元件与所述切割表面大致对齐,而当处于所述展开构型时至少部分地横过所述解剖平面。
(2).如第(1)项所述的装置,其中进一步包括枢转连接到所述远端并且能够相对于所述第一臂运动通过所述解剖平面的第二臂。
(3).如第(2)项所述的装置,其中所述第二臂以剪刀状的动作相对于所述第一臂运动。
(4).如第(2)项所述的装置,其中当所述第二臂相对于所述第一臂运动时,所述第二臂保持大致平行于所述第一臂。
(5).如第(2)项所述的装置,其中所述第二臂包括能够从所述未展开构型运动到所述展开构型的第二切割元件,其中当处于所述未展开构型时所述第二切割元件与所述解剖平面对齐,而当处于所述展开构型时至少部分地横过所述解剖平面。
(6).如第(1)项所述的装置,其中进一步包括连接到所述第一臂并延伸通过所述细长轴的第一致动索,其中所述第一致动索的操作便于所述第一臂的相应运动。
(7).如第(1)项所述的装置,其中进一步包括连接到所述切割元件并延伸通过所述细长轴的第二致动索,其中所述第二致动索的操作便于所述切割元件的展开。
(8).如第(7)项所述的装置,其中所述切割元件是单极刀,并且所述第二致动索将所述单极刀电连接到单极电能源。
(9).如第(1)项所述的装置,其中所述切割元件包括电启动的切割装置。
(10).如第(9)项所述的装置,其中所述切割元件与所述第一臂电绝缘。
(11).如第(1)项所述的装置,其中当处于所述展开构型时所述切割元件大致垂直于所述解剖平面。
(12).如第(1)项所述的装置,其中当所述第一臂设置在人体器官的黏膜层和肌肉层之间时,所述第一臂的所述解剖平面与所述肌肉层大致对齐,并且当处于所述展开构型时,控制所述切割元件基本上远离所述肌肉层。
(13).一种外科手术装置,包括:
具有远端和近端的细长轴;
连接到所述远端并能够相对彼此运动通过解剖平面的至少两个臂;以及
设置在至少其中一个所述臂上的切割元件,所述切割元件能够从未展开构型运动到展开构型,其中当处于所述未展开构型时所述切割元件与所述解剖平面对齐,而当处于所述展开构型时至少部分地横过所述解剖平面。
(14).如第(13)项所述的装置,其中进一步包括连接到所述臂并延伸通过所述细长轴的第一致动索,其中所述第一致动索的操作便于所述臂的相应运动。
(15).如第(13)项所述的装置,其中进一步包括连接到所述切割元件并延伸通过所述细长轴的第二致动索,其中所述第二致动索的操作便于所述切割元件运动到所述展开构型。
(16).如第(15)项所述的装置,其中所述切割元件是单极刀,并且所述第二致动索将所述单极刀电连接到单极电能源。
(17).如第(15)项所述的装置,其中所述切割元件是单极刀,并且所述第二致动索与所述单极刀电绝缘。
(18).如第(13)项所述的装置,其中所述切割元件包括电启动的切割装置。
(19).如第(18)项所述的装置,其中所述电启动的切割装置包括单极刀。
(20).如第(13)项所述的装置,其中当处于所述展开构型时所述切割元件大致垂直于所述解剖平面。
(21).如第(13)项所述的装置,其中所述臂设置在人体器官的黏膜层和肌肉层之间,所述臂的所述解剖平面与所述肌肉层大致对齐,并且当处于所述展开构型时,控制所述切割元件大致远离所述肌肉层。
(22).一种用于从患者器官切除目标组织的方法,其中所述器官至少由两层构成,所述方法包括步骤:
将具有至少一个臂的装置定位在所述器官的第一层和第二层之间;
将所述臂运动通过位于所述第一层和所述第二层之间的解剖平面以便从所述第二层钝切除所述第一层;以及
从所述臂展开切割元件,其中使所述切割元件向着所述第一层并远离所述第二层展开。
(23).如第(22)项所述的方法,其中进一步包括当所述切割元件展开时,通过相对于所述解剖平面运动所述臂而围绕所述目标组织进行切割的步骤。
(24).如第(23)项所述的方法,其中所述切割元件是单极刀,并且所述切割步骤包括将单极电能供应到所述单极刀的步骤。
(25).如第(22)项所述的方法,其中所述器官是结肠,所述第一层是所述结肠的黏膜下层,并且所述第二层是所述结肠的肌肉层。
(26).如第(22)项所述的方法,其中所述器官是人的食道、人的胃以及人的胆囊中的至少一个。
(27).如第(23)项所述的方法,其中所述装置包括两个臂,所述臂分别包括至少其中一个所述切割元件。
(28).如第(27)项所述的方法,其中所述切割步骤包括改变所述臂中的第一个相对于所述臂中的第二个的分开程度。
从下述说明、附图以及所附的权利要求书可以明了所公开设备和方法的其它方面。
附图说明
图1是用于执行EMR手术的所公开设备的一个方面的透视图;
图2是图1所示设备处于第二构型的透视图;
图3是图1所示设备的透视图,其中上述切割元件处于展开位置;
图4是图3所示设备处于第二构型的透视图;
图5是用于执行EMR手术的所公开设备的一个替换方面的透视图;
图6是图5所示设备处于第二构型的透视图;
图7是图6所示设备的透视图,其中上述切割元件处于部分展开的位置;
图8是图6所示设备的透视图,其中上述切割元件处于完全展开的位置;
图9是图8所示设备处于第二构型的透视图;
图10A是切割元件第一替换方面的部分断面正视图;
图10B是图10A所示切割元件处于展开位置的部分断面正视图;
图11A是切割元件第二替换方面的正视图;
图11B是图11A所示切割元件处于展开位置的正视图;
图12A是切割元件第三替换方面的部分断面正视图;
图12B是图12A所示切割元件处于展开位置的部分断面正视图;
图13是患者的胃肠道壁的剖视图;
图14是根据用于执行EMR手术的所公开方法的一个方面的图13所示胃肠道壁的剖视图;
图15是根据用于执行EMR手术的所公开方法的一个方面的图14所示胃肠道壁的剖视图;
图16是图15所示胃肠道壁的部分断面俯视平面图,其中根据用于执行EMR手术的所公开方法的一个方面,图6所示的设备插入通过图15中所示的切口;
图17和图18是图15所示胃肠道壁的剖视图,其中根据用于执行EMR手术的所公开方法的一个方面,图5所示的设备执行钝切除手术;
图19是根据用于执行EMR手术的所公开方法的一个方面,在切割元件展开之后的图18所示胃肠道壁的剖视图;
图20是图19所示的胃肠道壁的剖视图,示出根据用于执行EMR手术的所公开方法的一个方面切除可疑组织;以及
图21是图20所示胃肠道壁的部分断面俯视平面图。
具体实施方式
参照附图1至4,总的用标记100代表的改进的EMR装置的第一方面可包括设置在细长轴106的远端104上的切除/致动组件102。组件102和轴106可具有能穿过人体自然孔(未示出)的尺寸和形状。上述轴106可是柔性的,并且可具有在内窥镜手术中足以通过人体胃肠道的长度。
组件102可包括头部108,第一可动臂110,第二可动臂112,连杆组件114以及致动连杆或索116。上述连杆组件114可包括四个枢转连接的连杆126并且可设置在头部108内。致动索116可延伸通过细长轴106,这样其可由使用者使用。
连杆组件114可包括远端118和近端120,其中远端118可在第一枢转点122处连接到第一臂110和第二臂112,并且近端120可在第二枢转点124处连接到致动索116。另外,连杆组件114的连杆126可在第三枢转点128和第四枢转点130处连接。
如图1和3中所示,如箭头A所示的方向操作索116可获得连杆组件114的压缩(即,连杆126可相对于装置100的纵向轴线径向延伸)以及臂110、112围绕枢转点122相应枢转到打开构型。参照图2和4,如箭头B所示的方向操作索116可获得连杆组件114的扩展(即,连杆126可相对于装置100的纵向轴线轴向延伸)以及臂110、112围绕枢转点122相应枢转到关闭构型。
因此,通过操作索116,使用者可将装置100的臂110、112运动到打开位置、关闭位置或者剪刀状动作之间的各种位置。这样,当装置100定位在组织层之间时,使用者可钝切除组织并当使用在此描述的剪刀状动作时通过将装置推进通过组织而将上述层分开。
对此,本领域的那些技术人员可意识到装置100可设置有各种臂和/或连杆组件,这样上述臂可以各种方式相对于彼此运动和/或分开。例如,可提供连杆组件,这样相应的臂在打开和关闭时可保持大致平行。
再次参照图1至4,每一臂110、112可提供有可展开的切割元件组件132,以便展开切割元件134。上述切割元件134可以是单极刀、电灼烧刀或者其它电启动的切割装置。可替换的,切割元件134可以是诸如手术刀等的机械切割装置。
切割元件组件132可将切割装置134从如图1和图2所示的第一(即,未展开的)构型推进到如图3和图4所示的第二(即,展开的)构型。在一个方面中,切割元件134可相对于相关臂110、112在大致径向方向上展开。在另一个方面中,切割元件134可在大致垂直于或至少部分地横过臂110、112运动平面的方向上展开。
在一方面,除了切割元件134之外,切割元件组件132可包括连接到致动连杆或索138的致动杆136,其中操作致动索138可促使切割元件134展开。致动索138可延伸通过轴106,这样其可在轴106的近端处由使用者操作。在一方面,致动索138可连接到电源,并且可提供单极电能到切割元件134。
切割元件134可包括切割尖端146以及枢转端148,其中切割元件134的枢转端148可在枢转点150处枢转连接到相关的臂110、112。致动杆136可包括远端140和近端142,其中远端140可在枢转点144处枢转连接到切割元件134。致动杆136的近端142可连接到致动索138并且可包括与相关臂110、112中的凸轮轨道154滑动接合的销152。
因此,致动索138的操作(例如,推动,拉动,扭曲等)可如箭头C所示的方向上推动致动杆136,从而将切割元件134推进到展开位置。此外,相反操作可将切割元件134缩回到装置100的相关臂110、112中。
参照图5至9,总的用标记200表示的改进的EMR装置可包括设置在细长轴206远端204上的切除/致动组件202。组件202可由设置在轴206近端(未示出)的使用者控制器(未示出)来操作。
组件202可包括在枢转点214处连接到头部212的第一和第二可动臂208、210。连杆组件216以及相关的致动索218可连接到臂208、210,以便允许使用者通过操作致动索218(例如,通过使用者控制器)使第一臂相对于第二臂运动。例如,如图5和图6所示,上述臂208、210可以剪刀状的方式通过解剖平面。
每一臂208、210可包括三个枢转连接的连杆:近端连杆220,中间连杆222以及远端或末端连杆224。臂208的近端连杆220可在枢转点214处枢转连接到臂210的近端连杆220。每个臂208、210的中间连杆222可包括在枢转点228处枢转连接到末端连杆224的远端部分226以及在枢转点232处枢转连接到近端连杆220的近端部分230。
每一臂208、210的末端连杆224可包括位于其上的切割元件234。切割元件234可以是单极刀、电灼绕刀或其它电启动的切割装置。可替换的,切割元件234可以是诸如手术刀等的机械切割装置。可选的,切割装置234可缩回到相关的臂208、210中,这样当只在需要时切割元件234才展开。
致动线或索236可连接到末端连杆224,并且可延伸通过中间和近端连杆222、220,通过头部212和轴206,并且设置成用于轴206近端处(例如在使用者控制器处)的操作。因此,可将(例如,拉动,推动,扭转等)力施加到索236,从而将臂208、210的连杆126从图6所示的位置推进到如图7所示的部分展开位置,并且最后达到图8中所示的完全展开位置(或其间的各种位置)。
这样,当臂208、210处于完全展开位置时,切割元件234大致垂直于或至少部分地横过臂208、210运动的平面(即,解剖平面)。
在一个方面,致动索236可是导电性的,并且可电连接切割元件234到电源(未示出)(例如,单极电能源),从而用作致动元件以便展开切割元件234,并且用作导体以便将电能供应到切割元件234。
就此,本领域的那些技术人员可意识到,在此描述的EMR装置允许使用者控制两个或多个臂以打开一关闭型的动作相对运动通过平行解剖平面,并且在大致垂直于或至少部分地横过钝解剖平面的方向上展开切割元件。此外,本领域的技术人员将意识到,各种可展开的切割元件可用于在此描述的装置。
参照图10A和10B,总的用标记300表示的可展开切割元件组件的第一替换方面可包括延伸通过装置(例如,装置100)的相关臂306(例如,臂110)内部通道304的导丝302。导丝302的远端部分308可通过臂306中的开孔310离开内部通道304。导丝302的近端部分312可延伸通过臂306以及相关的装置,这样其可由使用者(例如,通过使用者控制器(未示出))具体化和/或操作,并且连接到单极电能源(未示出)。
导丝302的最远末端314可固定连接到臂306,这样当导丝302如箭头D所示的方向推进时,导丝302的远端部分308可相对于相关臂306径向延伸,并且形成切割尖端316,如图10B所示。
这样,通过将导丝302在箭头D所示的方向上推进可展开切割元件,而将导丝302在箭头E所示的方向上推进可缩回切割元件。当电能供应到导丝302时,切割尖端316可起到单极刀的作用。
参照图11A和11B,总的用标记400表示的可展开切割元件组件的第二替换方面可包括第一连杆402,第二远端连杆404,第三连杆406以及切割元件408。切割元件408可固定连接到远端连杆404。
切割元件408可以是电致动切割装置的电极,并且可电连接到电源(未示出)。可替换的,切割元件408可以是诸如手术刀等的机械切割装置。
可以如此设置连杆402、404、406,从而使第一连杆402相对于第三连杆406运动,导致切割元件从图11A所示的未展开位置运动到图11B所示的展开位置。在一个方面,第一连杆402可通过第一铰链410连接到第二连杆404,并且第三连杆406可通过第二铰链412连接到第二连杆404。第一和/或第二铰链410、412可以是活动铰链、枢转点等。
这样,第三连杆406相对于第一连杆402在箭头F所示方向上的运动会将切割元件408推进到展开位置。
参照图12A和12B,总的用标记500表示的可展开切割元件组件的第三替换方面可包括第一电绝缘护套502,第二电绝缘护套504,两个柔性线圈506、508以及切割元件510。第一柔性线圈506可延伸通过第一护套502,且第二柔性线圈508可延伸通过第二护套504。柔性线圈506、508的远端部分512可连接到彼此以形成尖端514,并且切割元件510可固定连接到尖端514。
切割元件510可以是电致动切割装置的电极,并且可电连接到电源(未示出)。例如,至少其中一个柔性线圈506、508可起到导体的作用,并电连接切割元件510到电源。可替换的,切割元件408可以是诸如手术刀等的机械切割装置。
因此,通过将第一线圈506在如箭头G所示的方向上推进和/或第二线圈508在如箭头H所示的方向上推进,可将切割元件510从图12A所示的第一构型展开到图12B所示的第二构型。
就此,本领域内的那些技术人员会意识到,组件300、400和/或500起到在此所述的EMR装置的臂(例如,臂110、112或臂208、210)的作用。可替换的,组件300、400和/或500可独立于在此所述的EMR装置的臂和/或设置在在此所述的EMR装置的臂中。
参照图13至21,在此所述的设备和方法可在内窥镜手术过程中用于从患者的肠壁602切除病变组织600或其它可疑组织或增生。但是,本领域的那些技术人员可意识到,在此所述的设备和方法可用于执行其它各种医疗手术,包括从体内的食道壁或其它组织或器官去除可疑组织。
肠壁602通常由四层构成:黏膜604,黏膜下层606,肌肉608以及浆膜薄层610。成功的治疗通常需要切除病变600以及黏膜604和黏膜下层606的邻近部分而不穿透肌肉608。因此,在此所述的设备和方法允许医生分开邻近病变600(也就是,目标组织612)的黏膜604和黏膜下层606,并且切除目标组织612而不穿透肌肉608。
参照图13和14,医生可通过将流体614通过注射针616等注射入黏膜下层606而促使或使得黏膜604和黏膜下层606与肌肉608分离。流体614可以是诸如消毒生理盐水液的液体或者诸如二氧化碳气的气体。如图14所示,流体614可在黏膜下层606中形成缓冲垫618并且可抬升目标组织612,从而促使EMR装置的插入。
在一个方面,注射针616可安装到EMR装置的臂上或者另外连接到EMR装置的臂。在另一方面,注射针616可缩回到EMR装置的臂内。
参照图15和16,医生可形成通过黏膜604和黏膜下层606进入目标组织612中的初始切口620,从而接近在目标组织612之下的在黏膜下层606和肌肉608之间的区域。在一个方面,可使用任意可得到的外科手术工具或技术借助于刀或手术刀形成切口620。在另一方面,可使用在此所述的EMR装置形成切口620。
再次参照图15和16,以及仅参照装置200做为例子,装置200可设置成未展开的位置(见图6)并且切割元件234可由例如单极电能致动。可通过将致动切割元件234应用到组织来形成切口620,这样切割元件234穿透黏膜604和黏膜下层606,并提供接近黏膜下层606和肌肉608之间的区域。通过移置装至200的臂208、210可增加切口620的尺寸,同时致动切割元件234。
就此,本领域的那些技术人员会意识到,可使用如上所述的切割元件(也就是用于切除可疑组织的切割元件)形成切口620。但是,本领域的那些技术人员也会意识到,在此所述的EMR装置可具有用于形成初始切口620的单独和/或独立的切割系统。
装置200可插入通过初始切口620并定位在黏膜下层606和肌肉608之间。如在图17和18中所示,借助于在此描述的臂208、210的剪刀状动作,装置200会进入到目标组织612之下,以便将黏膜下层606从肌肉608分开或将黏膜下层606从肌肉608钝切除,以及如果必要,使得之间的任意接触组织分开。
一旦目标组织612与肌肉608分开,切割元件234可设置成展开位置,这样切割元件234至少部分地横过钝解剖平面,如图19所示。在一个方面,切割元件234可展开,这样它们在装置200上(也就是,远离肌肉608)切割黏膜下层606和黏膜604。在另一方面,可展开切割元件234,这样它们指向由肠壁602形成的内腔中心。
参照图20和21,一旦切割元件234被展开和致动(也就是用单极电能),由将装置200从通过肌肉608和黏膜下层606之间的区域推进和/或缩回,同时以在此所示的剪刀状动作打开和关闭臂208、210而切除目标组织612。产生的切割622可从肠壁602去除目标组织612,这样其可使用例如圈套器、抓钳等从胃肠道去除。
这样,在此所述的设备和方法允许医生通过从邻近目标组织612的肌肉608平行切除黏膜下层606,以及使用控制为远离肌肉608平面的切割元件(例如,切割元件234)围绕目标组织612进行切割而从肠壁602切除可疑组织。
虽然已经示出和描述了所公开的设备和方法的各方面,但是对于本领域的那些技术人员来说可产生各种变型。本申请涵盖所有的变型并且本发明的保护范围只由权利要求来限定。
Claims (10)
1.一种外科手术装置,包括:
具有远端和近端的细长轴;
枢转连接到所述远端并可运动通过解剖平面的第一臂;以及
设置在所述第一臂上并能够从未展开构型运动到展开构型的切割元件,其中当处于所述未展开构型时所述切割元件与所述切割表面大致对齐,而当处于所述展开构型时至少部分地横过所述解剖平面。
2.如权利要求1所述的装置,其中进一步包括枢转连接到所述远端并且能够相对于所述第一臂运动通过所述解剖平面的第二臂。
3.如权利要求2所述的装置,其中所述第二臂以剪刀状的动作相对于所述第一臂运动。
4.如权利要求2所述的装置,其中当所述第二臂相对于所述第一臂运动时,所述第二臂保持大致平行于所述第一臂。
5.如权利要求2所述的装置,其中所述第二臂包括能够从所述未展开构型运动到所述展开构型的第二切割元件,其中当处于所述未展开构型时所述第二切割元件与所述解剖平面对齐,而当处于所述展开构型时至少部分地横过所述解剖平面。
6.如权利要求1所述的装置,其中进一步包括连接到所述第一臂并延伸通过所述细长轴的第一致动索,其中所述第一致动索的操作便于所述第一臂的相应运动。
7.如权利要求1所述的装置,其中进一步包括连接到所述切割元件并延伸通过所述细长轴的第二致动索,其中所述第二致动索的操作便于所述切割元件的展开。
8.如权利要求7所述的装置,其中所述切割元件是单极刀,并且所述第二致动索将所述单极刀电连接到单极电能源。
9.如权利要求1所述的装置,其中所述切割元件包括电启动的切割装置。
10.如权利要求9所述的装置,其中所述切割元件与所述第一臂电绝缘。
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-
2007
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- 2007-04-25 CA CA002586351A patent/CA2586351A1/en not_active Abandoned
- 2007-04-27 ES ES07251783T patent/ES2322404T3/es active Active
- 2007-04-27 JP JP2007119047A patent/JP5188744B2/ja not_active Expired - Fee Related
- 2007-04-27 EP EP07251783A patent/EP1849424B1/en not_active Not-in-force
- 2007-04-27 DE DE602007000794T patent/DE602007000794D1/de active Active
- 2007-04-28 CN CN2007101053773A patent/CN101061964B/zh not_active Expired - Fee Related
Cited By (3)
Publication number | Priority date | Publication date | Assignee | Title |
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CN103607970A (zh) * | 2011-06-21 | 2014-02-26 | 库克医学技术有限责任公司 | 可扩展探头 |
CN103607970B (zh) * | 2011-06-21 | 2017-03-15 | 库克医学技术有限责任公司 | 可扩展探头 |
CN106137323A (zh) * | 2016-08-29 | 2016-11-23 | 张云飞 | 腹腔镜间隙游离器 |
Also Published As
Publication number | Publication date |
---|---|
DE602007000794D1 (de) | 2009-05-14 |
EP1849424B1 (en) | 2009-04-01 |
US20070255277A1 (en) | 2007-11-01 |
CA2586351A1 (en) | 2007-10-28 |
US7867228B2 (en) | 2011-01-11 |
JP2007296345A (ja) | 2007-11-15 |
AU2007201822B2 (en) | 2012-09-20 |
CN101061964B (zh) | 2011-01-12 |
ES2322404T3 (es) | 2009-06-19 |
AU2007201822A1 (en) | 2007-11-15 |
EP1849424A1 (en) | 2007-10-31 |
JP5188744B2 (ja) | 2013-04-24 |
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