JP2003521304A - 双極式把持器具 - Google Patents

双極式把持器具

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JP2003521304A
JP2003521304A JP2001555584A JP2001555584A JP2003521304A JP 2003521304 A JP2003521304 A JP 2003521304A JP 2001555584 A JP2001555584 A JP 2001555584A JP 2001555584 A JP2001555584 A JP 2001555584A JP 2003521304 A JP2003521304 A JP 2003521304A
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clamping
jaw
cutting
jaws
clamping jaw
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JP3691793B2 (ja
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ルッツェ，テオドル
マイエンベルガー，ルペルト
ロスバイラー，クリストフ
バイスハウプト，ディーター
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アエスクラップ アクチェンゲゼルシャフト ウント コンパニー コマンディトゲゼルシャフト
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    • 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
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod

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  • Life Sciences & Earth Sciences (AREA)
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  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Plasma & Fusion (AREA)
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Abstract

(57)【要約】 本発明は、相互に向けて移動され得る２個の挟持用顎部を備えた双極式把持器具に関する。上記挟持用顎部は、相互から電気的に絶縁されると共に高周波電圧源の電極に各々接続され得る。上記挟持用顎部は夫々、相互に離間関係で配置された２個の挟持要素であって該挟持要素間に長手スロットを形成すると共に各挟持要素が挟持用表面を有する２個の挟持要素を備える。上記把持器具は更に、上記挟持用顎部の上記長手スロット内で変位可能であると共に切断刃を有する切断要素を備えた切断デバイスを備える。本発明の目的は、駆動機構の構造設計態様と斯かるデバイスの操作性とを改良するに在る。この目的の為に、上記切断要素は、その切断刃が一方の挟持用顎部の各挟持要素の間の上記長手スロット内に収容されると共に他方の挟持用顎部に向かう方向において該一方の挟持用顎部の挟持用表面を越えて延在しない様に、一方の挟持用顎部の長手スロット内に配置される。この挟持用顎部の各挟持要素は上記切断要素に対し、該切断要素の上記切断刃が上記挟持用表面を越えて突出するまで上記挟持用顎部の閉じ移動と逆方向に弾性移動可能である。

Description

【発明の詳細な説明】
【０００１】 本発明は、相互に移動可能な２個の挟持用顎部であって、相互から電気的に絶
縁されると共に高周波電圧源の電極に各々接続可能であり、当該挟持用顎部の各
々は、相互に離間関係で配置された２個の挟持要素であって該挟持要素間に長手
スロットを形成すると共に各挟持要素が挟持用表面を有する２個の挟持要素を備
えるという２個の挟持用顎部と、これらの挟持用顎部の上記長手スロット内で変
位可能であると共に切断刃を有する切断要素を備えた切断デバイスと、を備えた
双極式把持器具に関する。
【０００２】 双極式把持器具に依れば、把持された領域における出血を制御すべく該領域内
の組織が凝固され得る。
【０００３】 斯かる器具によりたとえば血管の一定領域を凝固してからこの凝固済領域にお
ける切開により血管を離断することで、出血のリスクが先行凝固により最小化さ
れることは知られている。これを行うために通常は異なる器具により実施される
完全に別個の処置段階、すなわち、一方では双極式把持器具による凝固、および
、他方では凝固済組織に対する切断デバイスによる離断が必要である。
【０００４】 一体的な切断デバイスを備えた双極式把持器具も知られている(CIRCON製切断
用三極式鉗子のカタログ；米国特許第5,458,598号)。この把持器具において、該
器具の各挟持用顎部は長手スロットにより相互に近接配置された２個の挟持用表
面へと分割され、且つ、凝固の後において各挟持用表面間に保持された組織の部
分を離断する切断刃を備えた切断要素が当該器具の長手方向において上記各長手
スロット内へと押し出され得る。既に公知の該器具においては、各挟持用顎部を
閉じて凝固をもたらすと共に上記切断デバイスの切断要素を前進すべく別個の駆
動機構が配備されねばならない。故に、好適には筒状シャフト式の器具として設
計される該器具は比較的に複雑な設計態様であることに加え、該器具のユーザは
最初に組織を把持してから該組織を離断すべく別体的な２個の駆動機構を操作せ
ねばならない。
【０００５】 本発明の目的は、特にユーザが必要とするのは最初に組織を把持してから該組
織を離断するひとつの起動機構のみであることから操作が容易とされた汎用種類
の双極式把持器具を設計するに在る。
【０００６】 この目的は本発明に依れば、冒頭に記述された種類の双極式把持器具であって
、上記切断要素は、その切断刃が一方の挟持用顎部の各挟持要素の間の上記長手
スロット内に収容されると共に他方の挟持用顎部に向かう方向において該一方の
挟持用顎部の挟持用表面を越えて延在しない様に、一方の挟持用顎部の長手スロ
ット内に配置され、且つ、この挟持用顎部の各挟持要素は上記切断要素に対し、
該切断要素の上記切断刃が上記挟持用表面を越えて突出するまで上記挟持用顎部
の閉じ移動と逆方向に弾性移動可能であるという双極式把持器具により達成され
る。
【０００７】 故に上記各挟持用顎部の閉じ移動の開始時において上記切断要素は、該切断要
素の上記切断刃が上記長手スロット内に収容されて作動可能にならない様に、一
方の挟持用顎部の長手スロット内に収容される。この場合に上記器具は習用の双
極式把持器具と同様に作動し、その場合に上記挟持用表面は上記切断要素を全く
露出させずに、把持されるべき組織に対して載置される。閉じ移動のこの部分に
おいては、習用の手法で高周波電圧を印加することで凝固が引き起こされ得ると
共に、凝固の後、上記双極式把持器具はまた再び習用の双極式把持器具の様に取
り外され得る。
【０００８】 他方、もし凝固の後で上記閉じ移動がこの双極式把持器具により継続されるな
ら、上記各挟持用顎部は上記切断デバイスを担持する上記挟持用顎部の各挟持要
素が該挟持用顎部の上記閉じ移動と逆方向に弾性移動可能である如く強制的に相
互に移動されることから、上記切断デバイスの上記切断刃は解除されて該切断刃
は上記挟持要素の弾性変位に依り上記挟持用表面を越えて突出する。故に上記器
具は今や切断器具であり、その場合に上記切断要素は他方の挟持用顎部の上記長
手スロット内に到達することで、上記各挟持用顎部間に係合された組織を離断す
る。この切断移動は、上記各挟持用顎部の通常の閉じ移動の直後に追随する。ユ
ーザが起動すべきものは、ひとつの駆動機構のみである。軽い起動の場合には凝
固されるべき組織が単に挟持されて堅固に保持されるが、上記各挟持用顎部を強
力に閉じると、各挟持用顎部間に保持された組織部分は付加的に切断される。
【０００９】 第1好適実施例において、上記切断要素および上記各挟持要素の両者は上記挟
持用顎部と一体的に構築され、且つ、上記切断要素は上記挟持用顎部の堅固な部
分であるが、上記各挟持要素は弾性変形可能領域を介して上記挟持用顎部の残り
の部分に接合される。特に、上記弾性変形可能領域は高さの低い弾性屈曲可能な
薄寸体により形成され得る。
【００１０】 別実施例において上記挟持用顎部は、上記切断要素と当該把持器具上の該挟持
用顎部の軸受とから成る堅固な第1部分と、上記各挟持要素から成ると共に上記
第1部分に弾性移動可能に取付けられた第2部分とによる二部材構造とされる。
【００１１】 上記各挟持要素はたとえば、上記第1部分に弾性枢動可能に取付けられ得る。
【００１２】 上記第2部分は、上記各挟持要素を夫々形成する２本の平行な脚部と、これら
の脚部を接続すると共に上記長手スロットを上記挟持用顎部の末端に向けて閉じ
る薄寸体（ウェブ）とを備えたU形状設計態様であり、且つ、上記第2部分は上記
各脚部の自由端部にて上記第1部分に回転可能に取付けられるのが好適である。
これは、上記各挟持用表面を担持する上記挟持用顎部の上記第2部分の極めて安
定な配置に帰着する。
【００１３】 切断デバイスを有さない上記他方の挟持用顎部における上記長手スロットは好
適にはその両端部にて閉じられることから、切断処置の間において全ての側が閉
じられたこの長手スロット内へと上記切断デバイスが進入すると共に、該他方の
挟持用顎部が極めて安定な配置構成を形成することに対しても貢献する。
【００１４】 以下における本発明の好適実施例の説明は、各図面と共に本発明を更に詳述す
るものである。
【００１５】 各図中に示された手術器具は、末端3および基端4を有する長寸の筒状シャフト
2を備えた筒状シャフト式器具1として設計される。
【００１６】 基端4においてシャフト2は、固定グリップ6と、該グリップ6に枢動可能に接続
されたグリップ7とを備えたハンドル5に接続される。グリップ7はプッシュプル
式ロッド8に対して関節接続されるが、該ロッド8はシャフト2を貫通延伸すると
共に、シャフト2に対してグリップ7を枢動することで長手方向に前進可能および
後退可能である。
【００１７】 シャフト2の末端3にて該シャフトにはホルダ9が挿入されるが、該ホルダ9はそ
の末端にて、相互に平行に延在する２本の軸受アーム10であって、末端方向に突
出して両者間に軸受空間11を囲繞する２本の軸受アーム10を担持する。この軸受
空間内には、たとえば実質的にU形状設計態様であると共に軸受アーム10の内側
をカバーするセラミック材料である電気絶縁材料から成る絶縁体12が挿入される
。
【００１８】 プッシュプル式ロッド8はホルダ9および絶縁体12の両者を貫通延伸し、軸受空
間11の領域内で終端する。
【００１９】 それらの自由端部の領域において各軸受アーム10はベアリング軸14を受容すべ
く相互に整列した開口13を有するが、該ベアリング軸14は、当該器具の上記シャ
フトの長手軸心の長手方向を横切るべく延伸し且つ該シャフトの開放末端におけ
る軸受空間11を貫通する。
【００２０】 このベアリング軸14上には、相互に独立して枢動運動すべく近接して２個の挟
持用顎部15、16が取付けられるが、これらの顎部の基端17、18は軸受空間11内へ
と突出する。基端17、18は夫々リンク19、20に関節接続され、これらのリンクの
他端もまたプッシュプル式ロッド8の末端に対して関節接続されることから、こ
れらのリンク19、20は基端17および18と協働することで四部材リンク機構を形成
するが、プッシュプル式ロッド8の前進および後退時に挟持用顎部15および16は
ベアリング軸14により形成された回転軸心の回りにおいて該リンク機構を介して
枢動可能であり；プッシュプル式ロッド8が前進されたときに各挟持用顎部は枢
動離間されすなわち開かれると共に、プッシュプル式ロッド8が後退されたとき
に挟持用顎部15、16は閉じられる。
【００２１】 挟持用顎部15および16は異なる設計態様である。以下においては挟持用下側顎
部16と称される上記の２個の挟持用顎部の一方は、三部材設計態様である。この
顎部は、ベアリング軸14の直前まで延在する基部区画21と、実質的にベアリング
軸14の領域内に配置された中央区画22と、他方の挟持用顎部15に臨む実質的に平
坦な上側24が把持性能を高める横手方向リブ25を備えた挟持用表面を形成すると
いう末端区画23と、を備える。
【００２２】 中央区画22はたとえばセラミック材料などの電気絶縁材料から成ると共に、基
部区画21を末端区画23に接続することで、金属から成るが故に導電的であるこれ
らの２個の区画を電気的に絶縁する。中央区画22はその表面により末端区画23お
よび基部区画21の両者に対して着座することで、重複領域における積層構造を生
成する。これに加え、中央区画22はその後縁部26および前部軸受面27を介して夫
々、基部区画21および末端区画23上に支持されることから、基部区画21は末端区
画23に対して堅固に接続され且つ末端区画23から電気的に絶縁される。
【００２３】 その側部にて中央区画22は、該区画と一体的に形成されたスリーブ28を担持す
る。該スリーブ28は、２個の挟持用顎部15および16内の軸受開口29および30を貫
通延伸すると共に、自身内にベアリング軸14を受容する。これによりベアリング
軸14は、挟持用顎部15と、挟持用顎部16の基端18とから電気的に絶縁される。ベ
アリング軸14自体は金属から成ると共に、シャフト2に対して導電的に接続され
たホルダ9の各支承アーム10に対して導電的に接続される。シャフト2は、不図示
の高周波電圧源との電気接続を確立するための電気接続手段31を担持する。
【００２４】 ベアリング軸14は挟持用顎部16の末端区画23に直接接触することから、末端区
画23とベアリング軸14との間の該領域内には導電的接続が確立される。これによ
り挟持用顎部16の末端区画23は、上記高周波電圧源の電極に接続される。
【００２５】 他方の電極は不図示の様式でプッシュプル式ロッド8に接続されることから、
挟持用顎部16の基部区画21と挟持用顎部15全体との両者が、リンク19および20を
介して上記高周波電圧源の該第2電極に接続され得る。
【００２６】 基部区画21のボア32に係合するピン33を介して該基部区画21に関し付加的に固
定された中央区画22は挟持用顎部16の末端区画23を該挟持用顎部16の基部区画21
から電気的に分離することから、２個の挟持用顎部15および16は相互から電気的
に絶縁されると共に上記電圧源の電極に対して夫々接続される。
【００２７】 以下において挟持用上側顎部15と称される他方の挟持用顎部は、図１乃至図４
の実施例においてその全体が金属から成ると共に一体的構造である。基部区画34
は、挟持用下側顎部16の基部区画21と類似した設計態様である。該基部区画は、
相互に平行に延在して両者間に長手スロット36を形成する同一設計態様の２個の
挟持要素37を備えた末端区画35へと遷移する。両挟持要素37は夫々、挟持用下側
顎部16に臨む側にてひとつの挟持用表面38を有するが、該挟持用表面は挟持用下
側顎部16の挟持用表面24に臨むと共にそれと同様に横手方向リブ39を備える。
【００２８】 両挟持要素37は低い構造高さの帯片状薄寸体40を介して基部区画34に接続され
るが、該帯片状薄寸体40は、この領域においてアーム状挟持要素37の弾性枢動す
なわちベアリング軸14に平行に延在する枢動軸心の回りにおける枢動が可能であ
る如き平坦な設計態様である。
【００２９】 ２個の挟持要素37間に開放されて残存する長手スロット36内には、基部区画34
に対して堅固に接続されると共にその下側縁部が切断刃42として設計されたカッ
タ41が突出する。各挟持要素37が未変形であるとき、すなわちそれらが基部区画
34に関して弾性枢動されていないとき、切断刃42は完全に長手スロット36内に配
置され、すなわち、該切断刃は２個の挟持要素37の挟持用表面38を越えて下方に
は突出しない(図２および図３の図示内容)。
【００３０】 但し、各挟持要素37が上方にすなわち各挟持用顎部の開き方向に弾性枢動され
たとき、この切断刃42は各挟持用表面38の間から下方に向けて移動して作動可能
となり得る。
【００３１】 同様に、挟持用下側顎部16には、挟持用上側顎部15の長手スロット36と整列す
ると共に両端部にて閉じられた長手スロット43が形成される。長手スロット43の
長さは、カッタ41の切断刃42が該長手スロット43に進入し得る如き寸法である。
【００３２】 この様にして構築された上記器具は、同様の様式で双極式把持器具として且つ
切断器具として機能する。
【００３３】 プッシュプル式ロッド8が前進位置に在るとき、挟持用顎部15および16は先ず
枢動離間されると共に当該鉗子が開き位置に配置される。この位置においてたと
えば血管44などの処理されるべき組織は、上記各挟持用顎部の挟持用表面24およ
び38に対して載置されて把持され得る(図３)。この様にして２個の挟持用顎部15
および16に対して血管が着座することから、それ自体が双極式鉗子に関して公知
である如く２個の挟持用顎部15および16に対して高周波電圧を印加することで上
記接触領域における血管44の凝固が可能となる。
【００３４】 この凝固は挟持用顎部15、16の位置にて生じ、その場合にこれらの挟持用顎部
は上記開き位置に関して中間位置へと枢動されるが、未だ完全には閉じられない
。この中間位置において血管44上の挟持用上側顎部15の圧力は、薄寸体40の領域
において挟持要素37が弾性枢動されずに未変形のままである如く未だ低いことか
ら、切断刃42と共にカッタ41は長手スロット36内に留まり、すなわち切断刃42は
作動不能である(図３)。
【００３５】 しかしプッシュプル式ロッド8を後退することにより挟持用顎部15および16が
更に閉じられたときに挟持用顎部15および16は相互に対して強制的に押圧される
ことから各挟持要素37は薄寸で弾性屈曲可能な薄寸体40の領域で屈曲され、すな
わち、各挟持要素37は上記閉じ位置とは逆の上方に枢動することから、カッタ41
の切断刃42は、挟持用表面38を越えて下方に移動して血管44に着座し、挟持用顎
部15および16が更に閉じられると該血管を切断し得る一方、カッタ41は切断刃42
と共に挟持用顎部16の長手スロット43に進入する。
【００３６】 故に枢動可能グリップ7の同一の閉じ移動により操作者は、処理されて切断さ
れるべき組織を、先ず把持し、次に高周波電圧を印加して凝固し、最終的にグリ
ップ7の更なる枢動により凝固済領域にて離断し得る。このために必要なのはひ
とつの駆動機構のみであり、且つ、操作者は上述の作動位置が順次に行われる如
き要件に従い自身が枢動操作する単一レバーにより該処置を実施し得る。
【００３７】 図５の実施例は、図１乃至図４と類似した設計態様である。故に同様の部材は
同一の参照番号で示される。
【００３８】 ひとつの相違は挟持用上側顎部15の領域のみにあり、図５の実施例においてこ
れは二部材設計態様である。この実施例において、２個の挟持要素37は挟持用顎
部15の基部区画34に対して弾性薄寸体40を介して接合されるのではなく、軸受ピ
ン45を介してすなわちカッタ41から基部区画34への遷移領域において、カッタ41
上に枢動可能に取付けられる。該実施例において挟持要素37はそれらの末端にて
横手方向帯状部46により相互に接合されることから、２個の挟持要素37は該横手
方向帯状部46と協働して一体的構成要素を形成する。
【００３９】 図中には概略的にのみ示されると共に一方ではカッタ41に接続され且つ他方で
は横手方向帯状部46に接続されるスプリング要素47は、各挟持用表面38がカッタ
41の切断刃42を越えて下方に突出する位置すなわち切断刃42が長手スロット36内
に完全に収容されて作動不能となる位置に各挟持要素37を保持する。上記各挟持
要素はこのスプリング要素47の作用に対して弾性的に枢動し得ることから、切断
刃42は記述された如き様式で長手スロット36から抜け出て作動可能となる。
【００４０】 この実施例において挟持要素37は軸受ピン45を介して基部区画34に対して導電
的に接続されることから、この場合にも各挟持用表面38は高周波電圧源の電極に
接続される。
【図面の簡単な説明】
【図１】 図１は、２個の枢動可能挟持用顎部を備えた筒状シャフト式器具として設計さ
れた双極式把持器具の側面図である。
【図２】 図２は、２個の挟持用顎部と該挟持用顎部に対する駆動要素の分解斜視図であ
る。
【図３】 図３は、各挟持用顎部を把持位置とした挟持用顎部領域における図１の器具の
側面図である。
【図４】 図４は、各挟持用顎部を切断位置とした図３と同様の図である。
【図５】 図５は、図２と同様の切断デバイスを備えた挟持用顎部の改変例の斜視図であ
る。
【手続補正書】
【提出日】平成１４年８月２２日（２００２．８．２２）
【手続補正１】
【補正対象書類名】明細書
【補正対象項目名】請求項７
【補正方法】変更
【補正の内容】
───────────────────────────────────────────────────── フロントページの続き (72)発明者 ロスバイラー，クリストフ ドイツ連邦共和国，78166 ドナウエスヒ ンゲン，カールシュトラーセ 65 (72)発明者 バイスハウプト，ディーター ドイツ連邦共和国，78194 イムメンディ ンゲン，バッハツィムメラー エーシュ 10 Ｆターム(参考） 4C060 DD50 GG06 KK03 KK04 KK10 KK15 MM24 MM25 【要約の続き】 ある。

Claims (7)

    【特許請求の範囲】
  1. 【請求項１】 相互に移動可能な２個の挟持用顎部(15、16)であって、相互
    から電気的に絶縁されると共に高周波電圧源の電極に各々接続可能であり、当該
    挟持用顎部の各々が、相互に離間関係で配置された２個の挟持要素(37)であって
    該挟持要素間に長手スロット(36)を形成すると共に各挟持要素が挟持用表面(38)
    を有するという２個の挟持要素(37)を備えている２個の挟持用顎部(15、16)と、
    これらの挟持用顎部(15、16)の上記長手スロット内で変位可能であると共に切断
    刃(42)を有する切断要素を備えた切断デバイスと、を備えた双極式把持器具にお
    いて、 上記切断要素(41)は、その切断刃(42)が一方の挟持用顎部(15)の各挟持要素(3
    7)の間の上記長手スロット(36)内に収容されると共に他方の挟持用顎部(16)に向
    かう方向において該一方の挟持用顎部の挟持用表面(38)を越えて延在しない様に
    、一方の挟持用顎部(15)の長手スロット(36)内に配置され、且つ、 この挟持用顎部(15)の各挟持要素(37)は上記切断要素(41)に対し、該切断要素
    (41)の上記切断刃(42)が上記挟持用表面(38)を越えて突出するまで上記挟持用顎
    部(15、16)の閉じ移動と逆方向に弾性移動可能であることを特徴とする、双極式
    把持器具。
  2. 【請求項２】 前記切断要素(41)および前記各挟持要素(37)の両者は前記挟
    持用顎部(15)と一体的に構築され、且つ、 上記切断要素(41)は上記挟持用顎部(15)の堅固な部分であるが、上記各挟持要
    素(37)は弾性変形可能領域(40)を介して上記挟持用顎部(15)の残りの部分(34)に
    接合されることを特徴とする、請求項１記載の器具。
  3. 【請求項３】 前記弾性変形可能領域(40)は高さの低い弾性屈曲可能な薄寸
    体により形成されることを特徴とする、請求項２記載の器具。
  4. 【請求項４】 前記挟持用顎部(15)は、前記切断要素(41)と当該把持器具上
    の該挟持用顎部(15)の軸受とを備える堅固な第1部分と、前記各挟持要素(37)を
    備えると共に上記第1部分に弾性移動可能に取付けられた第2部分とを有する二部
    材構造であることを特徴とする、請求項１記載の器具。
  5. 【請求項５】 前記各挟持要素(37)は前記第1部分に弾性枢動可能に取付け
    られることを特徴とする、請求項４記載の器具。
  6. 【請求項６】 前記第2部分は、前記挟持要素(37)を形成する２本の平行な
    脚部と、これらの脚部を接続すると共に前記長手スロット(36)を前記挟持用顎部
    (15)の末端に向けて閉じる薄寸体(46)とを備えたU形状設計態様であり、且つ、 上記第2部分は上記各脚部の自由端部にて前記第1部分に回転可能に取付けられ
    ることを特徴とする、請求項５記載の器具。
  7. 【請求項７】 切断デバイスを有さない前記他方の挟持用顎部(16)における
    前記長手スロット(43)はその両端部にて閉じられることを特徴とする、請求項１
    乃至６のいずれか一項または幾つかの項に記載の器具。
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US6743230B2 (en) 2004-06-01
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EP1250102A1 (de) 2002-10-23
ES2200975T3 (es) 2004-03-16
EP1250102B1 (de) 2003-06-18
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ATE243004T1 (de) 2003-07-15
US20020183784A1 (en) 2002-12-05

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