JP2001522632A - 双極電気外科器具 - Google Patents

双極電気外科器具

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JP2001522632A
JP2001522632A JP2000520061A JP2000520061A JP2001522632A JP 2001522632 A JP2001522632 A JP 2001522632A JP 2000520061 A JP2000520061 A JP 2000520061A JP 2000520061 A JP2000520061 A JP 2000520061A JP 2001522632 A JP2001522632 A JP 2001522632A
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sealing surface
bipolar electrosurgical
electrosurgical instrument
sealing surfaces
instrument according
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JP4074747B2 (ja
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スティーヴン ポール ボイス
デイル フランシス シュモルツ
ロバート ルージー
カーク ブライアン オルソン
ケイト ライランド ローズ
ダニエル リー ザ セカンド トリムバーガー
マシュー アール ミッチェル
ジェニファー セラフィン ケネディー
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シャーウッド サーヴィシス アクチェンゲゼルシャフト
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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
    • A61B17/2816—Pivots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • 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
    • 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
    • A61B17/2833—Locking means
    • A61B2017/2837—Locking means with a locking ratchet
    • 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
    • A61B2017/2945—Curved jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00404—Blood vessels other than those in or around the heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00619—Welding
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1425—Needle
    • A61B2018/1432—Needle curved
    • 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
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself

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Abstract

(57)【要約】 双極電気外科器具（１０）は血管及び管束組織を把持しシールすル対向可能な密封表面（１８、１９）をジョー（１６、１７）に備えている。内側及び外側部材（１１、１２）は密封表面を円弧状に動かすことができる。開放ロックボックス（１３）は横方向面の整列を維持する横方向支持体を備えたピボットを構成する。器具部材におけるラチェット（２５、２６）はシール処理中組織に対する一定の閉鎖力を保持する。各部材におけるシャンク部分（１４、１５）は密封表面を互いに保持する適当なばね力を発生するように構成される。外科手術中、器具は管束組織を把持し、緊締し、そして緊締した組織に双極電気外科電流を加えるのに用いられ得る。一つの実施の形態において、密封表面は、器具のジョーが互いに閉じられるときに短絡を防止するため部分的に絶縁される。別の実施の形態においては、密封表面はジョーに取り外し可能に装着される。

Description

【発明の詳細な説明】
【０００１】 発明の分野 本発明は、人間又は動物の血管を普遍的に閉じる電気外科器具、及び一層特に
圧力と電気外科電流とを組み合わせて加えることにより血管及び管束組織をシー
ルする双極電気外科器具に関するものである。
【０００２】 背景技術 外科処置において組織を握持し、解剖し、そして緊締するのに普通止血鉗子が
用いられる。それは通常、血管を切断することなくそれらの血管を締付けるため
にジョー間の機械的作用を用いる簡単なやっとこのような工具である。また通常
止血鉗子の場合のように、装置を適当な一に緊締できかつロックできるようにハ
ンドル間のインターロックラチェットを有する。
【０００３】 多く止血鉗子は典型的な開放外科処置に用いられる。止血鉗子で管束組織を緊
締すると、外科医は組織のまわりを縫合わせて普遍的に閉じてから止血鉗子をは
ずすのが普通である。幾つかの止血鉗子は、外科医が緊締した組織の各部分のま
わりを縫合わせる状況となるまで外科処理領域にそのまま残され得る。
【０００４】 細い血管は縫合わせる必要なしに電気外科器具を用いて閉鎖されてきた。例え
ば、神経外科は双極器具を用いて直径２ｍｍ以下の脳内の血管を凝固してきた。
これらの双極器具は典型的には二つのアームを互いに近付く方向に偏向させて組
織を掴むピンセットのような装置である。しかしながら、これらの器具は直径約
２ｍｍ以上の血管をシールすることができないことがわかった。長い間、縫合わ
せる必要なしに大きな血管や管束組織を容易な仕方でシールする要求があった。
【０００５】 細い血管を凝固する処置は基本的に血管のシールと異なると考えられる。凝固
は、組織セルが破断されて乾燥される組織の乾燥方法として定義される。血管の
シールは、架橋し溶けた質量体に再形成するように組織内のコラーゲン液化する
方法として定義される。従って、細い血管の凝固はそれらの細い血管を普遍的に
閉塞するのに十分である。比較的太い血管は普遍的閉鎖を保証するためシールさ
れる必要がある。
【０００６】 この技術分野において、多数の双極電気外科鉗子及びクランプが公知である。
しかしながら、これらの器具は最終シールを達成するために血管に正しい圧力を
加えるように構成されてない。またこれら全ての器具は、止血鉗子の単純性及び
親密さを双極電気外科回路と組み合わせないという欠点がある。
【０００７】 血管シール用の双極電気外科電力曲線の例は、１９９５年９月１９日に出願し
た米国特許出願第０８／５３０，４９５号、発明の名称“Energy Delivery Syst
em for Vessel Sealing ”に開示されており、この文献は参照文献として結合さ
れ、本明細書の一部を成す。 １９９５年９月１９日に出願した米国特許出願第
０８／５３０，４５０号、発明の名称“Vascular Tissue Sealing Pressure Con
trol and Method ”には血管をシールする別の外科器具が開示されており、この
文献は参照文献として結合される。
【０００８】 米国特許第３７１，６６４号には、正極及び負極をジョーに設けた一対の電気
鉗子が開示されている。 米国特許第７２８，８８３号には、電気を用いてジョーの一つを加熱する電熱
器具が開示されている。 米国特許第１，５８６，６４５号には、組織を凝固する双極器具が開示されて
いる。 米国特許第２，００２，５９４号には、組織の凝固及び切断を同一器具で行う
ことのできる双極手術用光学器具が開示されている。 米国特許第２，１７６，４７９号には、金属粒子を見つけ出し除去する器具が
開示されている。器具のジョーは、それらジョー間に導電性物質が位置すると電
気回路が形成されるように構成される。短絡を避けるために絶縁されたピボット
及び絶縁されたラチェットが用いられる。 米国特許第３，６５１，８１１号には、組織を切取りそして凝固する双極電気
外科器具が開示されている。 米国特許第４，００５，７１４号には、作動スリーブによって開閉するジョー
を備えた双極凝固鉗子が開示されている。 米国特許第４，３７０，９８０号及び同第５，１１６，３３２号には、止血鉗
子緊締機能及び電気焼灼機能を単一器具で行うことのできる電気焼灼止血鉗子が
開示されている。単極電気外科構造が示され記載されている。 米国特許第４，５５２，１４３号には、電気焼灼止血鉗子を含む一連の取り外
し可能なスイッチ電気焼灼器具が開示されている。単極電気外科構造が示され記
載されている。 米国特許第５，０２６，３７０号には、包囲された電気スイッチング機構を備
えた電気焼灼止血鉗子が開示されている。単極電気外科構造が示され記載されて
いる。 米国特許第５，４４３，４６３号には、多数の電極を備えた凝固鉗子が開示さ
れている。 米国特許第５，４８４，４３６号には、組織を同時に切取り凝固す
る双極電気外科器具が開示されている。
【０００９】 文献“The Mechanism of Blood Vessel CLOSURE BY High Frequency Electroa
gulation”には犬の血管における実験が開示されている。第８２３頁の最終行か
ら始まる文章には “電気鉗子、各ブレードは互いに絶縁され、そして高周波発
生装置の端子に接続される”と記載されている。
【００１０】 文献“Studies on coagulation and development of an automatic computeri
zed bipolar coagulator”の第１５０頁には“直径２〜２，５ｍｍ以上の動脈を
安全に凝固することはできなかった”と記載されている。また第１５１頁の第５
行には“静脈は直径３〜４ｍｍまで安全に凝固され得る”と記載されている。
【００１１】 ロシア国特許第４０１，３６７号には、作動ジョーを互いに平行にさせるリン
ク機構を備えた双極器具が開示されている。 先行文献の記載には、ラチェットで保持したサイジングされたばね負荷源から
、血管及び管束組織をシールするのに十分な一定圧力を都合よく加えることので
きる双極電気外科器具を構造は提案されていない。
【００１２】 発明の概要 本発明の一般的な目的は、縫合や外科的クリップを必要とせずに、組織を溶か
すことのできる双極電気外科器具を提供することにある。本器具は、対向可能な
ジョーに設けた二つの密封表面間に電気外科電流を流す。電気外科電流はジョー
間に緊締された組織に流れ、そして組織を溶かしかつ普遍的なシールを形成する
ためにコラーゲンを再成形する。
【００１３】 本発明の一つの利点は、血管を素早く溶かし、そして血液や他の流体を通過に
対して普遍的にシールするができることにある。それにより器具は手術室時間を
短縮し、目標とする組織に近付き易くなり、そして外科処置の効率を増大する。
【００１４】 別の利点は、血管を普遍的にシールするのに縫合やステープルを必要とせず、
また患者の体内に異物が残らないことにある。
【００１５】 さらに別の利点は、器具を適用することで血管をシールすることができ、その
後器具を外科部位から外すことができることにある。これにより外科部位は、外
科医が近付く際の妨げとなる外部からの器具のない状態に保たれることにある。
【００１６】 さらに別の利点は、器具によって適当量の圧力を一つ又は複数の血管に加える
ことができ、それにより外科のよい結果の可能性を高めることができることにあ
る。
【００１７】 本発明の双極電気外科器具は、開放ロックボックスで接続した内側及び外側部
材と、インターロックラチェット歯と、密封表面に通じる導電性通路を備えた電
気端子とを有している。内側及び外側部材は各々近位端近くにリングハンドルを
、また遠位端近くに対向可能な密封表面を備えている。近位端は外科医によって
保持され、制御され、一方遠位端は組織を操作するのに用いられる。開放ロック
ボックスは内側及び外側部材を結合して各対向可能な密封表面を円弧状に動かさ
せる。開放ロックボックスは一般に、両密封表面がほぼ同一平面内で動くように
横方向支持体を形成するように構成される。密封表面は好ましくは、器具のジョ
ーが互いに近付けられて閉じられると、互いに対向して整列される。横方向支持
体を形成するために、開放ロックボックスは内側部材上にのびかつ外側部材に取
付けられた少なくとも一つのフランジ及びピボットを備えている。
【００１８】 器具は、内側及び外側部材の各々におけるシャンク部分の寸法を調整すること
によって適切な閉鎖力をもたらすようにされる。シャンク部分はそれぞれのラチ
ェットスタブとピボットで限定された各部材の部分として画定される。使用中、
外科医はリングハンドルを握って密封表面間で組織を圧搾する。各部材のシャン
ク部分は板ばねのように曲がり、そしてラチェットで一定力を保持するように偏
向位置にロックされ得る。本発明の目的の一つは、器具の密封表面における適当
な閉鎖力の範囲に相応するラチェット止めの範囲を設けることにある。
【００１９】 リングハンドルの近くで各部材にはラチェット歯が設けられる。ラチェット歯
は通常、シャンクからのばね力に対してインターロックするように構成される。
従ってばね力はピボットを密封表面を互いに保持するよう伝達される。器具にお
いては、シールすべき組織の形態及び厚さに応じて閉鎖力の範囲が要求される。
従って、複数のラチェット止めを設けて各々徐々に大きな力を密封表面を与える
ようにするのが望ましい。各リングハンドルには電気コネクタが設けられる。電
気コネクタは部材及びリングハンドルと一体に形成される金属ポストであり得る
。電気外科発生装置からの双極電気ケーブルは電気コネクタで器具に接続される
。内側及び外側部分の各々における導電通路は電流を密封表面に導く。導電通路
はステンレス鋼部材に沿ってのび得る。好ましくは、外科医及び患者が不注意に
電気的火傷をしないようにするため部材の外側面に電気絶縁被覆が設けられる。
【００２０】 用語は次のように定義される。器具に加えられる力はジョー間の組織に加えら
れることになる総体力である。ジョーは器具のロックボックスから先端までの器
具の遠位端近くの部材である。電極は組織に電気を伝導する金属面である。密封
表面は組織と直接接触する電極上の特徴である。シャンクは、ロックボックスと
ラチェットとの間の各部材の部分である。リングハンドルは、外科医が握る、器
具の近位端近くの部材における要素である。ロックボックスは部材を回動させる
構造体であり、ピボットピン及び他の共動面を備えている。内側部材は、ロック
ボックスの内部に捕らえられる部材である。外側部材はロックボックスの外側の
部材である。電極圧力は加わる力を密封表面の全面積上に分割することによって
計算される。組織圧力は加わる力をジョー間に位置する組織の面積上に分割する
ことによって計算される。
【００２１】 血管融合（以下血管シールと記載する）用の器具は、器具のジョー間において
適切な量の圧力で組織を押圧すべきであることが実験からわかった。圧力は好ま
しくは血液搬送管腔を閉じるのに十分である。圧力は好ましくは、組織が器具の
ジョー内で割れないように十分に低い。
【００２２】 器具のジョーは操作処理中短絡してはならない。組織は典型的には、電気外科
電流の加えるときに厚さが減少し、それにより密封表面は近付く方向に動くこと
ができる。この厚さの減少により、電極は互いに直接接触してはならない。一方
、短絡は組織のまわりの通路に優先的に電気外科電流を流し、シールが不充分と
成り得る。
【００２３】 図１を参照すると、器具１０は内側部材１１と外側部材１２を備えている。内
側部材１１と外側部材１２は開放ロックボックス１３を介して接続され、この開
放ロックボックス１３はフランジ３３間にギャップを備えている。用語“内側”
及び“外側”は開放ロックボックス１３における部材のそれぞれの位置に従って
部材１１、１２及びそれらの構成部分を区別するのに用いられる。内側部材１１
は開放ロックボックス１３の内側面内に通常嵌合され、そしてフランジ３３で捕
らえられる。外側部材は一般に開放ロックボックス１３の外側面を形成している
。
【００２４】 内側部材１１は内側シャンク（柄部）１４と、内側ジョー１６と、内側リンク
ハンドル２０とを備えている。同様に、外側部材１２は外側シャンク１５と、外
側ジョー１７と、外側リンクハンドル２１とを備えている。リンクハンドル２０
、２１は器具１０を保持して操作する外科医に合わせて構成される。ジョー１６
、１７は対向する密封表面１８、１９間に組織を把持するように構成される。
【００２５】 各シャンク１４、１５はそれぞれラチェットスタブ２４又は２５を備えている
。ラチェット歯２６、２７は、部材１１、１２を適当な位置に保持するような仕
方でインターロックするように構成される。シャンク１４、１５は、ジョーが外
科医によって互いに押圧されるときに、板ばねのように偏向される。シャンク１
４、１５の偏向により、ラチェット歯２６、２７をインターロックすることによ
り対抗され得るばね復帰力が発生される。
【００２６】 器具１０は、ラチェット歯２６、２７がインターロックされる際には短絡しな
い。これは電気絶縁材料の適当な選択及び交換によって達成される。好ましい実
施の形態において、ラチェット歯２６、２７は、ラチェットスタブ２４、２５に
押嵌められる高分子材料から成る。好ましい実施の形態においては、ラチェット
歯２６、２７をラチェットスタブ２４、２５に固定するのにラチェットねじ２８
が用いられる。製造中に、ラチェット歯２６、２７は、ラチェットスタブ２４、
２５にブランクを押嵌めた後、弧のブランクによって形成され得る。
【００２７】 第２の実施の形態においては、部材の一方１１又は１２はその部材の一体部分
としてラチェットスタブ及びラチェット歯を備え、一方、他方の部材１２又は１
１は、ラチェットが係合されるときに部材１１、１２間の短絡を防止する絶縁性
層を備えている。
【００２８】 ロックボックス１３は、部材１１、１２を回動結合する機能を備えている。さ
らに、フランジ３３はジョー１６、１７の整列を維持する横方向支持体を構成す
る。閉じたロックブロック構造は一般に標準の止血構成に用いられ、内側部材は
外側部材のスロットを介して完全に捕らえられる。本発明における開放ロックボ
ックス１３はフランジ３３間に隙間を備え、この点において閉じたロックブロッ
ク構造と異なっている。開放ロックボックス１３における隙間は電気絶縁ピボッ
トを装着しやすくするためのである。
【００２９】 本発明における電気絶縁ピボットは、肩部ワッシャー２９を備え、この肩部ワ
ッシャー２９はロックボックスねじ３０を支持している。肩部ワッシャー２９は
、部材１１、１２間の短絡を防止する電気絶縁性材料で構成される。ロックボッ
クスねじ３０のヘッドには大きなねじキャップ３１が装着される。ロックボック
スねじ３０のねじ付き端部には小さなねじキャップ３２が装着される。
【００３０】 各部材１１、１２は双極電気外科的発生装置の極に接続される。電気コネクタ
２２、２３は都合の良い接続点を形成するためリングハンドル２０、２１に設け
られる。部材１１、１２はステンレス鋼のような導電性材料で形成される。電気
コネクタ２２、２３及び密封表面１８、１９を除いて部材の露出面には好ましく
は絶縁材料で噴霧被覆される。
【００３１】 双極電気外科電流の特性は電気外科的発生装置の構成によって決められる。好
ましい実施の形態において、発生装置はピーク−ピーク電圧が１３０ボルト以下
である出力を発生する。これは、それより高い電圧では火花が生じ組織を局部的
に焦して組織を溶着し損なうことになり得るからである。好ましい実施の形態に
おける発生装置は少なくとも２アンペアＲＭＳの高周波数出力電流を発生できる
。高電流は組織を十分に加熱してコラーゲンを溶かすので重要である。比較的低
い電流ではしばしば破壊強さが低いため組織の溶着は弱くなる。
【００３２】 動作において、器具１０は密封表面１８、１９の間に組織を把持するのに用い
られる。外科医はキングハンドル２０、２１を互いに握り締めて組織に圧力を加
える。ラチェット歯２６、２７は、組織の形態及び組織の厚さに応じて適当なラ
チェット設定でインターロックされる。双極電気外科電流は器具及び組織を通し
て加えられ組織を溶かせる。
【００３３】 ジョー１６、１７は負荷のかかった状態での曲げに耐える構造及び横断面を備
えている。従って、工学的分析の目的で、シャンク部分１４、１５は、一度密封
表面１８、１９が合わせられると片持ち支持梁として作用する。この理想的な片
持ち梁の長さは、ロックボックスねじ３０からそれぞれのラチェットスタブ２４
又は２５の位置までのびている。ばね定数をもつ板ばねとして各シャンクを構成
することは可能である。各ラチェットスタブ２４又は２５の位置は板ばねの復帰
力の作用に抗してジョー１６、１７に特殊な閉鎖力を伝達するように決められる
。
【００３４】 ばね定数は一般に、シャンク材料のヤング率、シャンクの慣性モーメント及び
シャンク部分１４、１５の長さの関数である。器具１０のジョー１６、１７が互
いに閉じられると、各シャンク部分１４、１５はほぼ片持ち支持梁となる。適当
には各シャンク部分１４、１５の方向は応力−歪み曲線の線形領域内に留まると
仮定される。このような梁の振舞いは材料技術者に周知である。ばね定数が大き
くなると、密封表面１８、１９の間の閉鎖力は大きくなる。同様に、ばね定数が
小さくなると、密封表面１８、１９の間の閉鎖力は小さくなる。シャンク部分１
４又は１５の長さ及びラチェット止め２６、２７間の距離に関連して適当なばね
定数が選択される。
【００３５】 動物実験の結果では、密封表面１８、１９が組織に作用する圧力の大きさは適
切な外科的結果を保証するのに重要であることが示されている。７ｋｇ／ｃｍ2 から１３ｋｇ／ｃｍ2の動作範囲内の組織圧力が動脈及び繊維束をシールするの に有効であると示された。連続したラチェット位置が上記動作範囲内の圧力を生
じるように、ラチェット歯２６、２７の切換えと共にシャンク部分１４又は１５
のばね定数を調整するのが望ましい。一つの実施の形態では、連続したラチェッ
ト位置は２ｍｍ離間している。組織に加わる圧力については幾つかの仕方で説明
できる。技術者に認められるように、組織に作用する圧力の量は密封表面と接触
する組織の表面積に依存する。一つの実施の形態では、各密封表面１８、１９の
幅は２〜５ｍｍの範囲であり、好ましくは４ｍｍ幅であり、一方、各密封表面１
８、１９の長さは好ましくは１０〜３０ｍｍの範囲である。少なくとも一つのイ
ンターロックラチェット位置が好ましくは密封表面の幅の単位ｍｍ当たりほぼ４
００〜６５０ｇの閉鎖力を保持することが実験から判った。例えば、密封表面１
８、１９の幅が４ｍｍである場合には、閉鎖力は好ましくは１６００ｇ〜２６０
０ｇの範囲である。一つの実施の形態において、閉鎖力は幅の単位ｍｍ当たり５
２５ｇであり、密封表面１８、１９の幅が４ｍｍである場合には２１００ｇの閉
鎖力を発生する。
【００３６】 電流の局部集中は組織に一様でなく影響することに成り得ることが実験から認
められ、この結果の可能性を低減するために、各密封表面１８、１９は好ましい
実施の形態では縁部を丸くされる。更に、テーパー状の密封表面１８、１９は、
テーパーにより密封表面１８、１９の長さ方向に沿って組織に比較的一定の圧力
が作用するので、ある実施の形態では有利であることがわかった。密封表面１８
、１９の幅はある実施の形態では調整され、幅で分割した閉鎖力が長さ方向に沿
ってほぼ一定であるようにされ得る。
【００３７】 一つの実施の形態では、絶縁性材料から成る止め部材３７は、図１に示すよう
に密封表面１８、１９の間に少なくとも０．３ｍｍの最小間隔を維持するために
器具に設けられる。 止め部材３７は、密封表面１８、１９の間の短絡の可能性を低減する。
【００３８】 ある実施の形態においては、図１１に示すように、密封表面１８、１９は導電
性領域３８と絶縁性領域３９を備え、これら導電性領域３８及び絶縁性領域３９
は、対向可能な密封表面１８、１９が対向して合わせられたときに各導電性領域
３８が絶縁性領域３９と対向するように配列される。ある実施の形態において、
密封表面１８、１９は、ピン又はソケット装置のような標準の機械的インターフ
ェースによってそれぞれの部材１１又は１２から取り外すことができる。
【００３９】 図２には３２ｍｍの湾曲した密封表面の実施の形態を示す。図３は図２の側面
図である。図２の部材１１、１２は４１０ステンレス鋼で形成される。シャンク
部分１４、１５の長さ及び横断面領域は単位インチの偏向当たり２５ポンドのば
ね定数をもつように図２及び図３に示されている。
【００４０】 図４及び図５に示す実施の形態は２０ｍｍの湾曲した密封表面を備えている。
図６及び図７に示す実施の形態は３２ｍｍの真直ぐな密封表面を備えている。図
２〜図７の各実施の形態は標準の止血鉗子の形態とるように構成される。
【００４１】 図８、図９及び図１０には、ある実施の形態において部材１１、１２を接続す
るためにロックボックスねじ３０の代りに用いられ得る肩部ピン３４の三つの図
を示す。肩部ピン３４は少なくとも一つの傾斜面３５を備え、この傾斜面３５は
部材の一方１１又は１２と係合して、ジョー１６、１７が互いに近接する方向に
動く際に機械的干渉を増大させる。一つの実施の形態において、肩部ピン３４は
密封表面１８、１９の整列を助けるため開放ロックボックス１３の一部を形成す
る。別の実施の形態では、肩部ピン３４は開放ロックボックス１３なしで使用さ
れ、フランジ３３なしで部材１１、１２を互いに可動に結合する。干渉嵌めは、
加えられた力が密封表面１８、１９の間に適当な作動圧力を形成するのに十分で
あることを保証するために器具１０のサイジングが必要である。肩部ピン３４で
生じた干渉のレベルに関連してシャンク部分１４、１５に僅かに高いばね定数を
用いるのが好ましい。
【００４２】 双極電気外科器具の使用法は下記の段階から成る。外科医は、器具１０のリン
グハンドル２０、２１を掴んでジョー１６、１７を操作する。血管又は管束組織
は対向可能な密封表面１８、１９間で押圧される。対向可能な密封表面１８、１
９は好ましくは、開放ロックボックス１３の整列作用により又はある実施の形態
では肩部ピン３４の整列作用により整列した対向状態となる。外科医は更に部材
１１、１２のシャンク部分１４、１５を偏向させてラチェット歯２６、２７を係
合させる。こうしてラチェット歯２６、２７を係合させることにより、シャンク
部分１４、１５は偏向した位置に保持され、ジョー１６、１７に閉鎖力として伝
達される一定のばね力を発生する。電気外科発電器がリングハンドル２０、２１
におけるコネクタ２２、２３を介して器具１０に接続される。発電器と器具１０
との間の回路を閉じるのに電気スイッチが用いられる。このスイッチはValleyla
b Inc., Boulder COから入手できるValleylabのカタログNo.E6009のような脚踏 みスイッチである。電気外科電流は、それぞれの電気コネクタ２２又は２３とそ
れぞれの密封表面１８又は１９との間の内側及び外側部材１１、１２の各々にお
ける導電路を流れる。電気アークから外科医を守るために、密封表面１８、１９
を除いて各部材１１、１２は電気絶縁性被覆３６で実質的に覆われる。
【００４３】 上記の実施の形態は単に本発明の原理の応用を例示するだけのものであること
が理解されるべきである。本発明の精神及び範囲から逸脱せずに種々の変更及び
代りの構成が当業者によって成され得る。特許請求の範囲はそのような変更及び
構成を包含するものである。
【図面の簡単な説明】
【図１】 血管融合用の双極器具を部分的に分解して示す斜視図である。
【図２】 長い湾曲したジョーをもつ血管融合用の双極器具の概略平面図である。
【図３】 図２に示す器具の側面図である。
【図４】 短い湾曲したジョーをもつ血管融合用の双極器具の別の実施の形態を示す概略
平面図である。
【図５】 図４に示す器具の側面図である。
【図６】 真直ぐなジョーをもつ血管融合用の双極器具の別の実施の形態を示す概略平面
図である。
【図７】 図６に示す器具の側面図である。
【図８】 肩部ピンを示す斜視図である。
【図９】 肩部ピンの側面図である。
【図１０】 肩部ピンをの正面図である。
【図１１】 密封表面を対向させて合わせたときの短絡を防止する導電性領域及び絶縁性領
域を示す一対の密封表面の各々の平面図である。
───────────────────────────────────────────────────── フロントページの続き (72)発明者 ルージー ロバート アメリカ合衆国 コロラド州 80301 ボ ールダー ホワイト ロック サークル 4670−＃５ (72)発明者 オルソン カーク ブライアン アメリカ合衆国 コロラド州 80403 ゴ ールデン ソーロディン ドライヴ 10256 (72)発明者 ローズ ケイト ライランド アメリカ合衆国 コロラド州 80304 ボ ールダー アルパイン アベニュー 1303 −17ビー (72)発明者 トリムバーガー ダニエル リー ザ セ カンド アメリカ合衆国 コロラド州 80634 グ リーリー シックスティーンス ストリー ト 4147 (72)発明者 ミッチェル マシュー アール アメリカ合衆国 コロラド州 80301 ボ ールダー バッキンガム ロード 7339 (72)発明者 ケネディー ジェニファー セラフィン アメリカ合衆国 コロラド州 80301 ボ ールダー インディペンダンス ロード 5235 Ｆターム(参考） 4C060 GG06 GG08 KK04 KK10 KK15 KK47

Claims (22)

    【特許請求の範囲】
  1. 【請求項１】 各々近位端近くのリングハンドルと遠位端近くの対向可能な
    密封表面を備え、各対向可能な密封表面がある長さと幅をもつ内側及び外側部材
    ； 各対向可能な密封表面を円弧状に動かすように内側及び外側部材を結合し、内
    側部材上にのびかつ外側部材に取付けられた少なくとも一つのフランジとピボッ
    トを備えた開放ロックボックス； 各リングハンドルの近くに位置し、対向可能な密封表面間の閉鎖力を保持する
    少なくとも一つのインターロックラチェット位置をもつラチェット歯； 内側及び外側部材の各々に設けられ、それぞれのラチェット歯及びピボットで
    限定され、閉鎖力に抗してばね負荷を発生するシャンク部分； 各リングハンドルと各シャンク部分と開放ロックボックスとをほぼ覆う電気絶
    縁性被覆； 各リングハンドルに設けられた電気コネクタ；及び それぞれの電気コネクタとそれぞれの密封表面との間で内側及び外側部材の各
    々に設けられ、対向可能な密封表面間に電気外科電流を流す導電路 を有することを特徴とする双極電気外科器具。
  2. 【請求項２】 閉鎖力が、ｍｍ幅当たりほぼ４００〜６５０ｇの範囲の値と
    幅とを掛けて計算した積であることを特徴とする請求項１に記載の双極電気外科
    器具。
  3. 【請求項３】 各密封表面の幅がほぼ２〜５ｍｍの範囲にあることを特徴と
    する請求項１に記載の双極電気外科器具。
  4. 【請求項４】 各密封表面の長さがほぼ１０〜３０ｍｍの範囲にあることを
    特徴とする請求項１に記載の双極電気外科器具。
  5. 【請求項５】 各密封表面が電流の集中を低減する丸みを帯びた縁部を備え
    ていることを特徴とする請求項１に記載の双極電気外科器具。
  6. 【請求項６】 密封表面間に少なくとも０．３ｍｍの最小離間距離を維持す
    る止め部材が設けられることを特徴とする請求項１に記載の双極電気外科器具。
  7. 【請求項７】 密封表面の幅が長さ方向に沿ってテーパー状となっているこ
    とを特徴とする請求項１に記載の双極電気外科器具。
  8. 【請求項８】 幅で分割した閉鎖力が長さ方向に沿ってほぼ一定であること
    を特徴とする請求項１に記載の双極電気外科器具。
  9. 【請求項９】 さらに、対向可能な密封表面の各々に設けられた導電性領域
    と絶縁性領域を有し、対向可能な密封表面を対向位置に係合させたときに各導電
    性領域が絶縁性領域と対向するように導電性領域と絶縁性領域を配置したことを
    特徴とする請求項１に記載の双極電気外科器具。
  10. 【請求項１０】 各対向可能な密封表面がそれぞれの部材に取はすし可能に
    取付けられていることを特徴とする請求項１に記載の双極電気外科器具。
  11. 【請求項１１】 各々近位端近くのリングハンドルと遠位端近くの対向可能
    な密封表面を備えた第１及び第２部材； 各対向可能な密封表面を円弧状に動かすように第１及び第２部材を結合し、各
    対向可能な密封表面が円弧状に動く際に第１及び第２部材間の干渉嵌合を変化さ
    せる傾斜面をもつ肩部ピンを備えた絶縁されたピボット； 各リングハンドルの近くに位置し、対向可能な密封表面間の閉鎖力を保持する
    少なくとも一つのインターロックラチェット位置をもつラチェット歯； 第１及び第２部材の各々に設けられ、それぞれのラチェット歯及びピボットで
    抑制され、閉鎖力に抗してばね負荷を発生するシャンク部分； 各リングハンドルと各シャンク部分とをほぼ覆う電気絶縁性被覆； 各リングハンドルに設けられた電気コネクタ；及び それぞれの電気コネクタとそれぞれの密封表面との間で第１及び第２部材の各
    々に設けられ、対向可能な密封表面間に電気外科電流を流す導電路 を有することを特徴とする双極電気外科器具。
  12. 【請求項１２】 少なくとも一つのインターロックラチェット位置が、ｍｍ
    幅当たりほぼ４００〜６５０ｇの範囲の閉鎖力を保持することを特徴とする請求
    項１１に記載の双極電気外科器具。
  13. 【請求項１３】 各密封表面の幅がほぼ２〜５ｍｍの範囲にあることを特徴
    とする請求項１１に記載の双極電気外科器具。
  14. 【請求項１４】 各密封表面の長さがほぼ１０〜３０ｍｍの範囲にあること
    を特徴とする請求項１１に記載の双極電気外科器具。
  15. 【請求項１５】 各密封表面が電流の集中を低減する丸みを帯びた縁部を備
    えていることを特徴とする請求項１１に記載の双極電気外科器具。
  16. 【請求項１６】 密封表面間に少なくとも０．３ｍｍの最小離間距離を維持
    する止め部材が設けられることを特徴とする請求項１１に記載の双極電気外科器
    具。
  17. 【請求項１７】 密封表面の幅が長さ方向に沿ってテーパー状となっている
    ことを特徴とする請求項１１に記載の双極電気外科器具。
  18. 【請求項１８】 幅で分割した閉鎖力が長さ方向に沿ってほぼ一定であるこ
    とを特徴とする請求項１１に記載の双極電気外科器具。
  19. 【請求項１９】 さらに、対向可能な密封表面の各々に設けられた導電性領
    域と絶縁性領域を有し、対向可能な密封表面を対向位置に係合させたときに各導
    電性領域が絶縁性領域と対向するように導電性領域と絶縁性領域を配列したこと
    を特徴とする請求項１１に記載の双極電気外科器具。
  20. 【請求項２０】 各対向可能な密封表面がそれぞれの部材に取はすし可能に
    取付けられていることを特徴とする請求項１１に記載の双極電気外科器具。
  21. 【請求項２１】 各々近位端近くのリングハンドルと遠位端近くの対向可能
    な密封表面を備えた内側及び外側部材を動かして、対向可能な密封表面間に組織
    を把持する段階と； 各対向可能な密封表面を円弧状に動かすように第１及び第２部材を結合し、か
    つ各対向可能な密封表面が円弧状に動く間に第１及び第２部材間の干渉嵌合を変
    化させる傾斜面をもつ肩部ピンを備えた絶縁されたピボットを用いて対向可能な
    密封表面を対向状態に整列させる段階と； 各リングハンドルの近くに位置し、対向可能な密封表面間の閉鎖力を保持する
    少なくとも一つのインターロックラチェット位置をもつすラチェット歯を係合さ
    せる段階と； 内側及び外側部材の各々に設けられ、それぞれのラチェット歯及びピボットで
    抑制されたシャンク部分を偏向させてばね負荷を発生させる段階と； 各リングハンドルに設けられた電気コネクタを介して器具に双極電気外科電流
    を接続して、それぞれの電気コネクタとそれぞれの密封表面との間で内側及び外
    側部材の各々に設けられた導電路に電流を流し、対向可能な密封表面間に電気外
    科電流を流す段階と を有し、電気絶縁性被覆により各シャンク部分と開放ロックボックスとをほぼ覆
    うことを特徴とする双極電気外科器具の使用法。
  22. 【請求項２２】 各々近位端近くのリングハンドルと遠位端近くの対向可能
    な密封表面を備えた内側及び外側部材を動かして、対向可能な密封表面間に組織
    を把持する段階と； 各対向可能な密封表面を円弧状に動かすように第１及び第２部材を結合し、内
    側部材上にのびかつ外側部材に取付けられた少なくとも一つのフランジとピボッ
    トを備えた開放ロックボックスを用いて対向可能な密封表面を対向状態に整列さ
    せる段階と； 各リングハンドルの近くに位置し、対向可能な密封表面間の閉鎖力を保持する
    少なくとも一つのインターロックラチェット位置をもつすラチェット歯を係合さ
    せる段階と； 内側及び外側部材の各々に設けられ、それぞれのラチェット歯及びピボットで
    抑制されたシャンク部分を偏向させてばね負荷を発生させる段階と； 各リングハンドルに設けられた電気コネクタを介して器具に双極電気外科電流
    を接続して、それぞれの電気コネクタとそれぞれの密封表面との間で内側及び外
    側部材の各々に設けられた導電路に電流を流し、対向可能な密封表面間に電気外
    科電流を流す段階と を有し、電気絶縁性被覆により各シャンク部分と開放ロックボックスとをほぼ覆
    うことを特徴とする双極電気外科器具の使用法。
JP2000520061A 1997-11-12 1998-11-11 双極電気外科器具 Expired - Fee Related JP4074747B2 (ja)

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US08/968,779 1997-11-12
US08/968,779 US6187003B1 (en) 1997-11-12 1997-11-12 Bipolar electrosurgical instrument for sealing vessels
PCT/US1998/023950 WO1999023959A1 (en) 1997-11-12 1998-11-11 Bipolar electrosurgical instrument for sealing vessels

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JP2006501938A (ja) * 2002-10-04 2006-01-19 シャーウッド・サービシーズ・アクチェンゲゼルシャフト 管を封鎖するための電気外科手術用器具
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JP7431647B2 (ja) 2019-04-17 2024-02-15 エルベ エレクトロメディジン ゲーエムベーハー ジョイントシール付き電気手術器具

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CA2716415C (en) 2012-03-27
EP1611859B1 (en) 2009-03-25
US6187003B1 (en) 2001-02-13
CA2309724C (en) 2010-10-12
EP1611859A3 (en) 2008-06-04
ES2258826T3 (es) 2006-09-01
AU1395199A (en) 1999-05-31
EP1033940A4 (en) 2001-09-26
EP2050410B1 (en) 2013-01-23
EP1033940B1 (en) 2006-02-15
CA2716415A1 (en) 1999-05-20
DE69833505T2 (de) 2006-11-02
DE69833505D1 (de) 2006-04-20
DE69840696D1 (de) 2009-05-07
EP2050410A3 (en) 2009-05-27
JP4074747B2 (ja) 2008-04-09
ES2323877T3 (es) 2009-07-27
WO1999023959A1 (en) 1999-05-20
EP2050410A2 (en) 2009-04-22
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CA2309724A1 (en) 1999-05-20
EP1611859A2 (en) 2006-01-04

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