JP2002085415A - 外科用ステープラ - Google Patents

外科用ステープラ

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Publication number
JP2002085415A
JP2002085415A JP2000283320A JP2000283320A JP2002085415A JP 2002085415 A JP2002085415 A JP 2002085415A JP 2000283320 A JP2000283320 A JP 2000283320A JP 2000283320 A JP2000283320 A JP 2000283320A JP 2002085415 A JP2002085415 A JP 2002085415A
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Japan
Prior art keywords
anvil
cartridge
staple
outer rod
surgical stapler
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JP4297603B2 (ja
Inventor
Masayuki Miyazawa
昌幸 宮澤
Keiichiro Yoshida
慶一郎 吉田
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INPREST CO Ltd
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INPREST CO Ltd
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Abstract

(57)【要約】 【課題】 体組織を正確な位置で挟み込むことができ、
また、挟み込んだ位置でのアンビルのがたつきを防止し
て確実な止血、切断、及び、縫合動作が行える外科用ス
テープラを提供する。 【解決手段】 アウターロッド１４に対するインナーロ
ッドの後退運動でアンビル本体６Ａの後端面６Ｈがアウ
ターロッド側のアンビル衝合面１４Ａと当接し、リンク
部６Ｂの軸６Ｅ回りにアンビル６が回動して閉じる動作
が行われる。アンビルが閉じた位置では後端面６Ｈがア
ンビル衝合面に押しつけられてカートリッジ５のステー
プル打出し面５Ａに対しアンビルのステープル受面６Ｃ
が前後方向に整合され、且つ、リンク部の回動支持位置
後方の規制面６Ｇがアウターロッドの内周面に当接して
ステープル打出し面に対してステープル受面が略平行に
位置決めされる。

Description

【発明の詳細な説明】
【０００１】
【発明の属する技術分野】本発明は、内視鏡手術等の外
科手術において、体組織をステープルで縫合するために
用いる外科用ステープラに関する。
【０００２】
【従来の技術】近年、胸部や腹部等の体腔内の疾患を治
療する外科手術においては、開胸手術もしくは開腹手術
に比較して感染の危険が少なく、しかも、傷の治りが早
い等の理由から、内視鏡手術が行われるケースが増加し
ている。
【０００３】内視鏡手術は、トロカーという器具を用い
て患者の胸部や腹部に小孔を貫通させ、前記小孔に挿入
したカニューレ管という細長い管を通して患者の体内に
細長いシャフト部を有する手術具を差し込んで行う手術
であって、この種の手術においては、腸管や血管等の体
組織を切断し、同時に切断した部分の両側を外科用ステ
ープルによって縫合する構造の外科用ステープラが広く
用いられている。
【０００４】このような外科用ステープラは、外科医が
手で把持して操作するハンドル部と、前記ハンドル部に
一方の端部が取り付けられた細長いシャフト部と、前記
シャフト部の他方の端部に取り付けられたカートリッ
ジ、アンビル等から構成されている。
【０００５】前記カートリッジには、多数のステープル
がシャフト部の軸方向に対して左右両側にそれぞれ複数
列配列された状態で収容されており、また、アンビル
は、これらのステープルが打ち出される孔が多数形成さ
れているカートリッジのステープル打出し面に対向して
開閉自在に設けられている。
【０００６】ステープル打出し面の幅方向中央には、ブ
レード通過溝が長手方向に形成されていて、ステープル
打出し面上に突出して体組織を切断するためのブレード
が、前記ブレード通過溝に沿ってスライドするように構
成されている。
【０００７】前述した構造の外科用ステープラを使用す
る際は、カニューレ管を通してシャフト部と、その先端
に設けられたカートリッジ及びアンビルを患者の体腔内
に挿入し、ハンドル部に設けられているトリガーレバー
（操作レバー）を操作することによって、先ずアンビル
を閉じて、カートリッジのステープル打出し面とアンビ
ルとの間で切断する体組織を挟み込む。
【０００８】次いで、ハンドル部に設けられている前記
トリガーレバーと同一、あるいは、別のトリガーレバー
を操作することによってブレードを前進させ、体組織を
前記ブレードで切断していく。このとき、ブレードの両
側では、体組織はカートリッジのステープル打出し面と
アンビル間で組織が挟み込まれて止血されている。
【０００９】この切断動作に連動して、形成された切断
部の両側にステープル打出し面からカートリッジ内のス
テープルが打ち出され、切断部両側の組織を貫通してス
テープル先端が、前記ステープル打出し面に対向するア
ンビルのステープル受面に押し当てられることで折り曲
げられて、前進するブレード後方の切断部の両側が順次
縫合されていく。
【００１０】
【発明が解決しようとする課題】前述したような、従来
の外科用ステープラにおいては、アンビルが閉じられる
際に、アンビルの先端側が、カートリッジのステープル
打出し面に対して円弧状の軌跡を描いて接近移動するた
め、間に挟み込まれる体組織が滑って逃げてしまい、確
実な挟み込みが困難で、止血が不完全となるとともに、
体組織の切断や縫合を正確な位置で行うことが困難であ
った。
【００１１】また、アンビルには、閉じた位置で軸着部
の遊び等による左右方向にがたつきが存在し、このがた
つきによってカートリッジのステープル打出し面から打
ち出されてくるステープルの折り曲げ動作が不確実にな
る問題も生じていた。
【００１２】そこで、本発明は、前述したような従来技
術における問題点を解消し、体組織を正確な位置で挟み
込むことができ、また、挟み込んだ位置でのアンビルの
がたつきを防止して確実な止血、切断、及び縫合動作が
行える外科用ステープラを提供することを目的とする。
【００１３】
【課題を解決するための手段】前記目的を達成するた
め、本発明は、ハンドル部の前端から軸方向前方に延び
るシャフト部を有し、前記シャフト部の外側部分を構成
するアウターロッドの前端に、複数のステープルを収容
したカートリッジが保持されているとともに、シャフト
部長手方向と略直角方向に形成されたカートリッジのス
テープル打出し面に対してアンビルが開閉自在に設けら
れ、アウターロッド内にスライド自在に嵌挿されている
インナーロッドの前後動操作でアンビルが開閉される構
造の外科用ステープラに適用される。
【００１４】本発明において、アンビルは、ステープル
打出し面と対向する側にステープル受面が形成されたア
ンビル本体と、前記アンビル本体の後端から後方に向け
て延設されたリンク部から構成されている。
【００１５】前記リンク部は、その前後方向の中間部分
でインナーロッド前端部に、アンビルの開閉運動面と垂
直な軸回りに回動自在に支持されているとともに、付勢
部材により前記軸回りにアンビルが常時開く向きに回動
するように付勢されている。
【００１６】そして、アウターロッドに対するインナー
ロッドの後退運動によって、アンビル本体後端面がこれ
に対向してアウターロッド側に形成されたアンビル衝合
面と当接して前記付勢部材の付勢力に抗してアンビルの
閉じる動作が行われる。
【００１７】また、アンビルが完全に閉じた位置では、
アンビル本体の後端面が前記アンビル衝合面に押しつけ
られてカートリッジのステープル打出し面に対してアン
ビルのステープル受面が整合するように前後方向に位置
決めされ、且つ、リンクにその回動支持位置より後方に
形成された規制面がアウターロッドの内周面に当接し
て、カートリッジのステープル打出し面に対してアンビ
ルのステープル受面が略平行に位置決め保持されるよう
になっている。
【００１８】前記アンビル開閉機構においては、アンビ
ルが閉じたときにカートリッジに形成されたセンタリン
グ溝内に嵌入してカートリッジに対するアンビルの左右
方向の位置決めを行うヒレ状のセンタリングガイドをリ
ンク部に設けてあることが望ましい。
【００１９】
【発明の実施の形態】本発明の外科用ステープラは、従
来の内視鏡手術用の外科用ステープラと同様に、アンビ
ルの開閉をシャフト部の後端に設けられるハンドル部側
から、シャフト部に設けられているアウターロッド内部
のインナーロッドを前後動操作することによって行うも
のである。
【００２０】しかしながら、従来の外科用ステープラで
は、アンビルの開閉をその後端部側を軸とした単純な円
弧運動で行っているに対して、本発明では、アンビル先
端がほぼ直線運動に軌跡を描いて開閉し、また、閉じる
動作が完了してカートリッジとアンビルとの間に体組織
を挟み込んだ状態では、アンビルはカートリッジに対し
て所定位置に位置決めされる構造になっている。
【００２１】すなわち、本発明の外科用ステープラにお
いては、アンビルはカートリッジのステープル打出し面
と対向するステープル受面が形成されたアンビル本体と
その後方に延設されているリンク部から構成され、前記
リンク部の前後方向中間部分がインナーロッド前端のア
ンビル受部に回動自在に軸支され、この軸回りにアンビ
ルが開閉運動を行う。
【００２２】また、アンビルは常時カートリッジに対し
て開く方向に付勢部材によって付勢されており、この付
勢部材は、例えば、インナーロッド前端に形成したアン
ビル受部と、アンビルのリンク部間に組み込んだ板ばね
によって構成することができる。なお、付勢部材はこれ
に限らず、他の種類のばねを用いてもよい。
【００２３】アンビルを閉じる場合には、アウターロッ
ドに対してインナーロッドを後退する方向に操作する。
これは、従来の外科用ステープラで行われているよう
に、ハンドル部に設けられているトリガーレバーをイン
ナーロッドと連動させ、ハンドル部側でトリガーレバー
を操作して行うことができる。
【００２４】インナーロッドが後退すると、これに連結
されているアンビルも後退移動し、アンビル本体の後端
面がこれに対向するようにアウターロッド側に形成され
ているアンビル衝合面に当接して押され、その結果、ア
ンビルは付勢部材の付勢力に抗して、リンク部の屈曲部
分の軸支位置回りに回動して閉じられる。
【００２５】この際、アンビルのカートリッジに対する
運動は、インナーロッド前端のアンビル受部に対する回
動と、インナーロッドの後退移動の合成運動となり、ア
ンビル前端は、ほぼ直線的にカートリッジに接近し、閉
じる動作が完了する位置の近傍では、アンビルのステー
プル受面は、カートリッジのステープル打出し面に対し
てほぼ平行に接近してこれらの間に体組織を挟み込む。
【００２６】そして、アンビルが完全に閉じた位置で
は、アンビルは、なおインナーロッドによって後退方向
に引っ張られているため、アンビル本体の後端面がアウ
ターロッド側のアンビル衝合面に押しつけられて、アン
ビルはカートリッジに対して前後方向に位置決めされ、
同時に、リンク部の後端に形成された規制面がアウター
ロッドの内周面に当接して、カートリッジのステープル
打出し面とアンビルのステープル受面とが平行になるよ
うに位置決めされる。
【００２７】なお、アンビルのリンク部にセンタリング
ガイドを設けている場合には、前記センタリングガイド
がカートリッジに形成されているセンタリング溝に嵌入
することによって、カートリッジに対してアンビルの左
右方向のがたつきが防止される。
【００２８】こうしてアンビルを完全に閉じた後は、従
来のこの種の外科用ステープラと同様に、カートリッジ
とアンビルとの間に挟み込まれた体組織をブレードを前
進させて切断し、これと同時に、カートリッジのステー
プル打出し面からアンビルのステープル受面に向けて順
次ステープルを打出して体組織の切断部の左右両側を縫
合する。
【００２９】
【実施例】以下、本発明の実施例を詳細に説明する。図
１は、本発明の外科用ステープラの全体構造を示す側面
図であって、外科用ステープラ１は手で保持するハンド
ル部２と、前記ハンドル部の前端から前方に延びる細長
いシャフト部３と、このシャフト部３の前端に取り付け
られた切断縫合部４から構成されている。
【００３０】切断縫合部４には、体組織を切断するため
の図示しないブレードがシャフト部３の長手方向にスラ
イドするように内蔵されているとともに、このブレード
によって切断された体組織の切断部分の両側を縫合する
ために、多数のステープルが収容されたカートリッジ５
と、前記カートリッジ５に形成されたステープル打出し
面５Ａに対して開閉動作し、体組織を前記ステープル打
出し面５Ａとの間で挟み込んでステープル打出し面５Ａ
側から体組織を貫通したステープルの針先を受けて折り
曲げるアンビル６が設けられている。
【００３１】また、ハンドル部２には、アンピル６を閉
じる方向に操作するための第１のトリガーレバー７と、
ブレードを前進させるとともにカートリッジ５内に収容
されているステープルをステープル打出し面５Ａから対
向するアンビル６に向けて打出して体組織を縫合する動
作を行うための第２のトリガーレバー８が設けられてい
る。
【００３２】外科用ステープラ１を取り扱う医師は、患
者の体にトロカーで開けた穴に差し込んだカニューレ管
を通して体腔内にシャフト部３を差し込んで、その先端
側に設けられている切断縫合部４を患部等の切断縫合す
る部位に位置させ、別のカニューレ管から患者体内に挿
入した内視鏡でモニターしながら、ハンドル部２の第１
及び第２のトリガーレバー７、８を操作して体組織の切
断と、ステープルによる前記切断部位の両側部分の縫合
を行う。
【００３３】図２は、外科用ステープラ１のハンドル部
２内部の構造を示す断面図であって、同図に示すよう
に、第１のトリガーレバー７は、軸９でハンドル部２に
回動自在に支持されており、その一部にはピニオン歯７
Ａが形成されている。
【００３４】前記ピニオン歯７Ａは、軸１０でハンドル
部２に回動自在に支持されている中継ピニオン１１の一
部に形成されているピニオン歯１１Ａに噛み合ってい
る。この中継ピニオン１１には、後述する係止カム部１
１Ｂを挟んでピニオン歯１１Ｃが形成されていて、この
ピニオン歯１１Ｃは、ハンドル部２内の一対の隔壁２
Ａ、２Ｂ間を前後にスライドするスライド筒１２に形成
された、ラック歯１２Ａと噛み合っている。
【００３５】また、スライド筒１２の内部には、圧縮コ
イルばね１３が組み込まれていて、前記圧縮コイルばね
１３によって、スライド筒１２は常に後方の隔壁２Ｂ側
に向けて付勢されている。
【００３６】一方、シャフト部３は、ハンドル部２に保
持されている中空のアウターロッド１４と、アウターロ
ッド１４の内部に、その軸方向にスライド自在に嵌挿さ
れた中空のインナーロッド１５と、インナーロッド１５
のさらに内部に、その軸方向にスライド自在に嵌挿され
たインナーシャフト１６から構成されている。
【００３７】アウターロッド１４の後端部は、ハンドル
部２の前端に回動自在に支持されている回転ノブ１７の
中心に形成された中心孔１７Ａに抜き差し自在に嵌挿さ
れており、また、前記中心孔１７Ａの前方に連続したね
じ孔１７Ｂに螺合するロックピース１８に形成された中
心孔１８Ａを貫通している。
【００３８】回転ノブ１７には、中心孔１７Ａとねじ孔
１７Ｂとの境の部分に、後方へ縮径するテーパ面１７Ｃ
が形成されており、回転ノブ１７にロックピース１８を
ねじ込んでいくと、前記テーパ面１７Ｃがロックピース
１８の後端部外周に形成されたテーパ面を半径方向内側
圧迫して弾性変形させることで、ロックピース１８を介
してアウターロッド１４が回転ノブ１７に摩擦固定され
る。
【００３９】一方、インナーロッド１５は、アウターロ
ッド１４の後端からハンドル部２内後方に突出し、スラ
イド筒１２に対して連結具１９で回転のみ可能に連結さ
れている。
【００４０】詳細な図示は省略しているが、前記連結具
１９の下部は下方に向いたＵ字状に形成され、このＵ字
状の二股部分がインナーロッド１５の後端部外周に形成
されている環状溝１５Ａに回転自在に係合しており、前
記連結具１９のハンドル部２の上面に露出している分解
ノブ１９Ａを指で引っ張って連結具１９を上方へ引き出
すことによって、前記環状溝１５Ａとの係合が外れ、イ
ンナーロッド１５がスライド筒１４から分離できるよう
になっている。
【００４１】なお、回転ノブ１７を回転することによっ
て、切断・縫合する体組織の向きに応じて、シャフト部
３とともに切断縫合部４をハンドル部２対して任意の向
きに回転させることができる。
【００４２】一方、第２のトリガーレバー８は、軸２０
でハンドル部２に回動自在に支持されているとともに、
ハンドル部２内のばね軸２１との間に張設された引張り
コイルばね２２で、図２における時計回り方向に回動付
勢されている。
【００４３】また、トリガーレバー８には、トリガーレ
バー７に形成されているフック部７Ｂと係合するフック
部８Ａが形成されていて、トリガーレバー７が図２に示
す前進位置にあるときには、フック部７Ｂとフック部８
Ａは互いに係合状態となり、トリガーレバー８の回動が
ロックされている。
【００４４】トリガーレバー８のハンドル部２の外側へ
露出している端部と反対側に位置するハンドル部２内の
端部には、軸２０と平行な軸２３で送り爪２４が回動自
在に支持されている。
【００４５】前記送り爪２４の前端は、軸２３に装着さ
れているねじりコイルばね２５で、その上方に配置され
ているラチェットバー２６のラチェット歯２６Ａに係合
する向きに常時付勢されている。
【００４６】また、前記送り爪２４の後端部は、トリガ
ーレバー８が図２に示すように復帰位置にあるときに
は、ハンドル部２内に形成されているストッパ壁２Ｃに
当たって、送り爪２４はラチェット歯２６Ａとの係合が
外れた位置に回動されている。
【００４７】一方、ラチェットバー２６は、スライド筒
１２の中心部を貫通してハンドル部２内に突出するイン
ナーシャフト１６の後端に固定されていて、インナーシ
ャフト１６とともに、ハンドル部２内において軸方向に
スライド自在に支持されている。
【００４８】また、ラチェットバー２６の後端部には、
ハンドル部２の上面に形成された溝状の開口部２Ｄから
外部に露出してラチェットバー２６の前進位置を視認す
るためのインジケータボタン２７が固定されている。
【００４９】図４は、シャフト部３の先端に設けられて
いる縫合切断部４の側面図であり、同図に示すように、
カートリッジ５は、アウターロッド１４の前端からさら
に前方へ延長して形成されているチャンネル状のカート
リッジホルダ３０内に保持されている。
【００５０】カートリッジ５を間に挟んで保持するカー
トリッジホルダ３０の左右の側壁にはそれぞれ、図５に
示すように前後２カ所に切欠部３０Ａ、３０Ｂが形成さ
れている。
【００５１】これらの切欠部３０Ａ、３０Ｂは、図６に
示すカートリッジ５の左右両側面の前後に形成された係
合突部５Ｂ、５Ｃにそれぞれ係合し、カートリッジホル
ダ３０に対してカートリッジ５を前後方向に位置決めし
ている。
【００５２】一方、アンビル６は、図６乃至図９に示す
ようにアンビル本体６Ａと、その後端部から後方へ延び
る側面視が略Ｖ字状に形成された、リンク部６Ｂから構
成されている。
【００５３】アンビル本体６Ａの裏面、ずなわちカート
リッジ５のステープル打出し面５Ａに対向する面はステ
ープル受面６Ｃとなっている。また前記リンク部６Ｂに
は、屈曲部分６Ｄの左右両側に一対の耳軸６Ｅが突設さ
れていて、これらの耳軸６Ｅは、インナーロッド１５に
前端の二股状のアンビル受部１５Ｂに形成されている、
左右一対のスリット孔１５Ｃに差し込まれて支持されて
いる。
【００５４】これらのスリット孔１５Ｃは、耳軸６Ｅを
回動自在に保持する円形孔と、その内径よりやや狭い幅
で、前記円形孔とアンビル受部１５Ｂ下面との間を連通
するスリットとから形成されて鍵穴状になっていて、ア
ンビル６をアンビル受部１５Ｂに組み付ける際に、耳軸
６Ｅをアンビル受部１５Ｂの下面側からスリット孔１５
Ｃのスリットを通して圧入し、円形孔内に嵌入保持させ
る構造になっている。
【００５５】図４に示すように、アンビル受部１５Ｂと
耳軸６Ｅは、通常、アウターロッド１４の先端より内側
に引っ込んだ位置に配置されており、前述した第１のト
リガーレバー７が引かれていない状態では、アンビル６
はインナーロッド１５先端のアンビル受部１５Ｂとリン
ク部６Ｂ間に組み込まれている付勢部材としての板ばね
３１の付勢力によって開いた位置に保持されている。
【００５６】図７に示すように、リンク部６Ｂは、その
屈曲部分６Ｄより前方の部分が、アンビル本体６Ａのス
テープル受面６Ｃ側へ連続するように延びていて、前記
部分の下面には、ヒレ状のセンタリングガイド６Ｆが形
成されている。
【００５７】前記センタリングガイド６Ｆは、アンビル
６がカートリッジ５に対して閉じたときに、カートリッ
ジ５のステープル打出し面５Ｂの後端部中央に形成され
たセンタリング溝５Ｄ（図６参照）内に侵入して位置決
めされ、カートリッジ５に対するアンビル６の左右方向
のがたつきが除去されるようになっている。
【００５８】また、リンク部６Ｂの後端には規制面６Ｇ
が形成されており、前記規制面６Ｇは、アンビル６がカ
ートリッジ５に対して閉じたときに、アウターロッド１
４の前端部内周面に当接して、ステープル受面６Ｃがカ
ートリッジ５のステープル打出し面５Ａと平行になるよ
うに位置決めする役割を果たしている。
【００５９】図６に示すように、カートリッジ５のステ
ープル打出し面５Ａには、カートリッジ５の長手方向中
央を前端部付近からセンタリング溝５Ｄに達する範囲で
ブレード通過溝Ｇ１が形成されているとともに、前記ブ
レード通過溝Ｇ１を挟んでその両側に多数のステープル
打出し孔ｈがそれぞれ千鳥状配列で３列ずつ並んで形成
されている。
【００６０】一方、アンビル６のステープル受面６Ｃに
は、図９に示すように、これらのステープル打出し孔ｈ
と同数のステープル屈曲凹部Ｃが、ステープル打出し孔
ｈとそれぞれ対向する位置に形成されている。
【００６１】また、カートリッジ５側に形成されている
ブレード通過溝Ｇ１と対向して、ステープル受６Ｃ面の
長手方向中央にはブレード通過溝Ｇ２が形成されてお
り、さらに、前記ブレード通過溝Ｇ２に連続して、リン
ク部６Ｂの中央にはブレードを通過させるためのスリッ
トＳが形成されている。
【００６２】前述したように構成されている、外科用ス
テープラ１は、第１のトリガーレバー７を図２に示す位
置から指をかけて引き、軸９回りに反時計方向に回動さ
せると、トリガーレバー７の動きは中継ピニオン１１を
介して、スライド筒１２に伝達され、スライド筒１２
は、圧縮コイルばね１３の付勢力に抗して後退する。
【００６３】スライド筒１２が後退移動すると、これに
連結されているインナーロッド１５も後退し、このイン
ナーロッド１５のアウターロッド１４に対する相対的な
後退変位は、その先端に設けられているアンビル受部１
５Ｂを介してアンビル６の左右両側の耳軸６Ｅを後方へ
移動させ、結果的に、アウターロッド１４側にアンビル
６が引き寄せられる。
【００６４】そうすると、アンビル本体６Ａの後端面６
Ｈが図１０に示すように、アウターロッド１４に形成さ
れているアンビル衝合面１４Ａに突き当たり、さらにア
ンビルがアウターロッド１４内に引き込まれていく結
果、アンビル６は板ばね３１の付勢力に抗して閉じる方
向に回動する。
【００６５】アンビル６が閉じる動作は、アンビル６の
アンビル受部１５Ｂに対する耳軸６Ｅ回りの回動とイン
ナーロッド１５の後退移動の合成運動となるので、図１
０に示すように、アンビル前端はほぼ直線的にカートリ
ッジ５に接近し、閉じる動作が完了する位置の近傍で
は、アンビル６のステープル受面６Ｃは、カートリッジ
５のステープル打出し面５Ａに対してほぼ平行になっ
て、これらの間に体組織をカートリッジ５の前方に逃が
すことなく、確実に挟み込むことができる。
【００６６】こうして、アンビル６がカートリッジ５の
ステープル打出し面５Ａとの間で図示していない体組織
を挟み込んで閉じた位置まで変位したときには、アウタ
ーロッド１４のアンビル衝合面１４Ａにアンビル本体６
Ａの後端面６Ｈが押し付けられて、アンビル６はカート
リッジ５に対して前後方向に位置決めされ、また、これ
と同時にリンク部６Ｂ後端の規制面６Ｇが、アウターロ
ッド１４の内周面に当接して、アンビル６はカートリッ
ジ５に対してステープル受面６Ｃとステープル打出し面
５Ａとが適正位置で平行に対向するように位置決めされ
る。
【００６７】このとき、さらに、アンビル６に設けられ
ているセンタリングガイド６Ｆも、カートリッジ５に形
成されたセンタリング溝５Ｄ内に侵入して位置決めさ
れ、アンビル６の左右方向のがたつきが規制される。
【００６８】アンビル６が閉じると、図３に示すよう
に、中継ピニオン１１に形成されている係止カム部１１
Ｂに、ハンドル部２側から係止カム部１１Ｂ側に向けて
ばね付勢されているストッパ２８が係合し、中継ピニオ
ン１１の逆転が阻止され、アンビル６は、閉じた位置を
保持される。
【００６９】なお、体組織を本来挟む位置からずれて挟
んでしまった場合には、図１に示すように、ハンドル部
２の一方の側面に露出してストッパ２８と一体に動くよ
うに設けられているロック解除ボタン２９を指で後退さ
せることで、ストッパ２８と中継ピニオン１１の係止カ
ム部１１Ｂとの係合を解除し、アンビル６を解放するこ
とができる。
【００７０】一方、第１のトリガーレバー７を引ききっ
て、そのフック部７Ｂが第２のトリガーレバー８のフッ
ク部８Ａから外れると、第２のトリガーレバー８は引く
ことが可能になる。
【００７１】このとき、アンビル６は前述した閉じた状
態になっており、第２のトリガーレバー８を引くと、先
ず、送り爪２４の後端部がストッパ壁２Ｃから離れるこ
とによって、前記送り爪２４は、軸２３回りにねじりコ
イルばね２５の付勢力で同図時計回りに回動し、その前
端がラチェットバー２６のラチェット歯２６Ａに係合す
る。
【００７２】そして、このまま第２のトリガーレバー８
を引いていくと、ラチェットバー２６は前進し、このラ
チェットバー２６とともに、インナーシャフト１６も前
進する。このとき、ラチェットバー２６とインナーシャ
フト１６の軸方向変位は、同時に動くハンドル部２の後
部上面に露出しているインジケータボタン２７の変位に
よって目で確認することができる。
【００７３】インナーシャフト１６の軸方向移動は、図
１に示す切断縫合部４に組み込まれているブレード（図
示せず）を前進させる。前記ブレードは、カートリッジ
５とアンビル６にそれぞれ形成されているブレード通過
溝Ｇ１、Ｇ２を通過して、アンビル６とカートリッジ５
のステープル打出し面５Ａの間に挟み込まれている体組
織を後方から前方に向けて切断する。
【００７４】このとき、ブレードの後方両側では、ブレ
ードの前進に伴って、カートリッジ５内に収容されてい
るステープルが、ステープル打出し面５Ａからアンビル
本体６Ａのステープル受６Ｃ面に向かって順次打ち出さ
れ、ブレードの左右両側に形成された体組織の切断面が
直ちに縫合されていく。
【００７５】なお、トリガーレバー８は、複数回引いて
戻すことを繰り返すことにより、体組織の切断縫合する
長さに対応した距離だけインナーシャフト１６を前進さ
せることができる。
【００７６】カートリッジ５内に収容されているステー
プルをステープル打出し面からアンビル６のステープル
受６Ｃ面へステープルを打ち出す動作と、ブレードを前
進させる動作は、インナーシャフト１６の前進移動に連
動して行われ、この機構自体については、既に周知であ
るため、これらの動作を行うための機構についての説明
は省略する。
【００７７】体組織の切断と縫合が完了したら、第２の
トリガーレバー８を前方へ戻して、送り爪２４がラチェ
ット歯２６Ａから外れた図２に示す状態で、インジケー
タボタン２７を後方へ引いて戻し、ブレードをカートリ
ッジ５とアンビル６の間からシャフト部３の中に退避さ
せる。
【００７８】次いで、図１に示すロック解除ボタン２９
を開放位置へ操作すると、中継ピニオン１１の係止カム
部１１Ｂがストッパ２８から開放され、スライド筒１２
とインナーロッド１５は圧縮コイルばね１３の付勢力に
よって後退する。その結果、アンビル６は板ばね３１の
付勢力によって開いて挟んでいた体組織を解放し、同時
に第１のトリガーレバー７は前進位置に復帰回動する。
【００７９】なお、この実施例においては、アンビル６
のリンク部６Ｂを側面視略Ｖ字状に形成しているが、リ
ンク部６Ｂの形状は、これに限らず、同等の機能を維持
できるものであればこれ他の形状、例えば側面視逆３角
形状等であってもよい。
【００８０】
【発明の効果】以上に説明したように、請求項１記載の
発明によれは、アンビルがカートリッジのステープル打
出し面に対して閉じる動作を行うときに、アンビル先端
はほぼ直線的にカートリッジに接近するため、従来のア
ンビル先端側が円弧状の軌跡を描いて閉じる構造のもの
と比較して、体組織を挟む際に組織が滑って逃げてしま
うようなことがなく、体組織を正確な位置で確実に挟み
込むことができる。
【００８１】また、アンビルが完全に閉じた位置では、
アンビル本体の後端面とアウターロッド側のアンビル衝
合面とが当接してアンビルがカートリッジに対して前後
方向に位置決めされ、且つ、リンク部後端に形成された
規制面が、アウターロッド内周面に当接して、カートリ
ッジのステープル打出し面とアンビルのステープル受面
とが平行になるように位置決めされるので、体組織の止
血、切断、及び、縫合動作を確実に行うことができる。
【００８２】また、請求項２記載の発明によれば、前述
した請求項１に記載した発明の効果に加え、さらに、カ
ートリッジに対するアンビルの左右のがたつきが除去さ
れるので、体組織の止血、切断、及び、縫合動作を、よ
り正確な位置で確実に行うことができる。
【図面の簡単な説明】
【図１】 本発明の外科用ステープラの側面図である。
【図２】 図１に示す外科用ステープラにおけるアンビ
ルを開いた状態の部分断面図である。
【図３】 図１に示す外科用ステープラにおけるアンビ
ルを閉じた状態の部分断面図である。
【図４】 本発明における縫合切断部の側面図である。
【図５】 アウターロッド前端に設けられたカートリッ
ジホルダの側面図である。
【図６】 本発明の外科用ステープラの要部を示す分解
斜視図である。
【図７】 本発明の外科用ステープラにおけるアンビル
の側面図である。
【図８】 本発明の外科用ステープラにおけるアンビル
の平面図である。
【図９】 本発明の外科用ステープラにおけるアンビル
をステープル受面側から見た図である。
【図１０】 アンビルのカートリッジに対する動きを示
す概略図である。
【符号の説明】
１ 外科用ステープラ、 ２ ハンドル部、 ２
Ａ、２Ｂ 隔壁、２Ｃ ストッパ壁、 ２Ｄ 開
口部、 ３ シャフト部、４ 切断縫合部、 ５
カートリッジ、 ５Ａ ステープル打出し面、５
Ｂ、５Ｃ 係合突部、 ５Ｄ センタリング溝、
６ アンビル、６Ａ アンビル本体、 ６Ｂ リ
ンク部、 ６Ｃ ステープル受面、６Ｄ 屈曲部
分、 ６Ｅ 耳軸、 ６Ｆ センタリングガイド、
６Ｇ 規制面、 ６Ｈ 後端面、 ７ 第１のト
リガーレバー、７Ａ ピニオン歯、 ８ 第２のト
リガーレバー、 ９ 、１０ 軸、１１ 中継ピニ
オン、 １１Ａ ピニオン歯、 １１Ｂ 係止カム
部、１１Ｃ ピニオン歯、 １２ スライド筒、
１２Ａ ラック歯、１３ 圧縮コイルばね、 １４
アウターロッド、１４Ａ アンビル衝合面、 １
５ インナーロッド、 １５Ａ 環状溝、１５Ｂ
アンビル受部、 １５Ｃ スリット孔、１６ イ
ンナーシャフト、 １７ 回転ノブ、 １７Ａ 中
心孔、１７Ｂ ねじ孔 １８ ロックピース、 １
９ 連結具、 ２０ 軸、２１ ばね軸、 ２２
引張りコイルばね、 ２３ 軸、２４ 送り
爪、 ２５ ねじりコイルばね、 ２６ ラチェッ
トバー、２６Ａ ラチェット歯、 ２７ インジケ
ータボタン、 ２８ ストッパ、 ２９ ロック解
除ボタン、 ３０ カートリッジホルダ、３０Ａ、３
０Ｂ 切欠部、 ３１ 板ばね（付勢部材）。

Claims (2)

    【特許請求の範囲】
  1. 【請求項１】 ハンドル部の前端から軸方向前方に延び
    るシャフト部を有して、前記シャフト部の外側部分を構
    成するアウターロッドの前端に複数のステープルを収容
    したカートリッジが保持されているとともに、シャフト
    部長手方向と略直角方向に形成されたカートリッジのス
    テープル打出し面に対してアンビルが開閉自在に設けら
    れ、アウターロッド内にスライド自在に嵌挿されている
    インナーロッドの前後動操作でアンビルが開閉される外
    科用ステープラであって、 アンビルはステープル打出し面と対向する側にステープ
    ル受面が形成されたアンビル本体と、前記アンビル本体
    の後端から後方に向けて延設されたリンク部からなり、 前記リンク部は、その前後方向の中間部分でインナーロ
    ッド前端部に、アンビルの開閉運動面と垂直な軸回りに
    回動自在に支持されているとともに、付勢部材によりア
    ンビルが常時開く向きに回動するように付勢され、 アウターロッドに対するインナーロッドの後退運動によ
    って、アンビル本体後端面がこれに対向してアウターロ
    ッド側に形成されたアンビル衝合面と当接し、前記付勢
    部材の付勢力に抗してアンビルの閉じる動作が行われる
    とともに、 アンビルが完全に閉じた位置では、アンビル本体の後端
    面が前記アンビル衝合面に押しつけられて、カートリッ
    ジのステープル打出し面に対してアンビルのステープル
    受面が整合するように前後方向に位置決めされ、且つ、
    リンクにその回動支持位置より後方に形成された規制面
    がアウターロッドの内周面に当接して、カートリッジの
    ステープル打出し面に対してアンビルのステープル受面
    が平行に位置決め保持されることを特徴とする外科用ス
    テープラ。
  2. 【請求項２】 アンビルが閉じたときにカートリッジに
    形成されたセンタリング溝内に嵌入してカートリッジに
    対するアンビルの左右方向の位置決めを行うセンタリン
    グガイドをリンク部に設けたことを特徴とする請求項１
    記載の外科用ステープラ。
JP2000283320A 2000-09-19 2000-09-19 外科用ステープラ Expired - Fee Related JP4297603B2 (ja)

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