JP2003523253A - 電気機械式駆動装置と組み合わせて使う組織ステープル留め用アタッチメント - Google Patents

電気機械式駆動装置と組み合わせて使う組織ステープル留め用アタッチメント

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JP2003523253A
JP2003523253A JP2001561232A JP2001561232A JP2003523253A JP 2003523253 A JP2003523253 A JP 2003523253A JP 2001561232 A JP2001561232 A JP 2001561232A JP 2001561232 A JP2001561232 A JP 2001561232A JP 2003523253 A JP2003523253 A JP 2003523253A
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マイケル ピー ホイットマン
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パワー メディカル インターヴェンションズ インコーポレーテッド
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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
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A61B17/0684—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying above the tissue during stapling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A—HUMAN NECESSITIES
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00473—Distal part, e.g. tip or head
    • A—HUMAN NECESSITIES
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    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
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    • A61B2017/2905—Details of shaft flexible
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/74—Manipulators with manual electric input means
    • A61B2034/742—Joysticks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery

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Abstract

(57)【要約】 電気機械式駆動装置（５０）と組み合わせて使うためのステープラーアタッチメント（１００）には、ステープル保持部材（１１８）が備わっており、このステープル保持部材はステープル閉鎖部材（１２４）にばねで取り付けられ、このステープル閉鎖部材は、ねじ付き軸（１１２）の周囲で同心状に取り付けられたねじ付き駆動要素（１１６）に取り付けられ、それによって、ステープル閉鎖部材（１２４）とステープル保持部材（１１８）とが、ハウジング（１０２）の内部で軌道に沿って前進しかつ後退することができる。ステープル（１３０）は、ねじ付き軸（１１２）の回転によって、ステープル保持部材（１１８）がハウジング（１０２）のステープル放出用遠位端（１０４）における開口（１０８）に形成された開口縁（１１０）で停止されるまで、前進する。この位置では、ステープル（１３０）の叉部が前進して、ステープル放出用遠位端（１０４）から出て、接合される組織の中へ入る。ステープル保持部材（１１８）とステープル閉鎖部材（１２４）との間のばね（１２６）が縮むので、ステープル閉鎖部材（１２４）は前進し続ける。この前進によって、ステープル閉鎖部材（１２４）がステープル（１３０）を閉じたＤ字形状の形態に変形させる。ステープル閉鎖部材（１２４）がさらに前進すると、ステープル（１３０）は、ハウジング（１０２）のステープル放出用遠位端（１０４）を介してアタッチメント（１００）から解放される。ねじ付き軸（１１２）の逆回転によって、ステープル閉鎖部材（１２４）とステープル保持部材（１１８）とがステープル収容位置の中へ後退し、その位置で、ばね押しステープルディスペンサー（１４８）が、ステープルカートリッジ（１４４）の中における複数のステープル（１４６）の１つを、次の処置に備えて、ステープル保持部材（１１８）のステープル担持要素におけるステープル担持溝（１４０）の中へ押し込む。

Description

【発明の詳細な説明】
【０００１】 （発明の背景） （発明の分野） 本発明は、一般に、電気機械式駆動装置用アタッチメントに関するものであり
、さらに詳しくは、組織をステープル留めするのに使うことのできる電気機械式
駆動装置用アタッチメントに関するものである。
【０００２】 （従来技術の説明） 腹壁における、ヘルニアを起こした筋肉組織を識別する際には外科的介入がほ
とんどいつも必要である。この処置は、考え方において何のこともないものであ
るが、特にたいてい遠隔的に実施される限り、すなわち、患者の体幹下部に形成
された小さい門脈を通して実施される限り、技術的に洗練された多くの特徴を含
んでいる。さらに詳しく説明すると、ほとんどの場合に利用されるこの技術には
、患者の下腹部に２〜３個の穿刺孔を形成すること、それぞれの孔から対応する
円筒状の管を挿入すること、この管を介して細長い器具を通すこと、ヘルニアの
部位から軟組織を退縮させること、および裂き傷の付けられた組織をステープル
留めによって閉塞することが含まれている。この最後の閉塞ステップには、回復
していく穿刺孔の上方に位置する軟組織および臓器を支持する目的のために、そ
の孔を覆って置かれる合成メッシュの使用が、たいてい含まれている。このメッ
シュは、その欠陥の近傍において筋肉組織に直接、ステープル留めされる。本発
明は、ステープル留め用要素である機器に向けられている。
【０００３】 伝統的なステープル留め機構は簡単な方法で作用する。このステープルは、初
めＵ字形状に配置される。ステープル駆動装置の要素が、ステープルの底部に当
接し、そして、接合される対象を通して、上方へ延びているとともに静止したア
ンビル部に向いているステープルの叉部を前進させる。連結される対象には、こ
れらの対象の後方に配置されて適切な支持をもたらし、それによって、ステープ
ルの叉部が押し通されるアンビル部がたいていの場合に必要である。ステープル
の叉部が連結される対象を通って前進すると、その叉部はアンビル部に当接する
。アンビル部には、その中に形成され、ステープルがステープル駆動装置に誘発
されて前進するときにステープルの塑性変形を案内するためのステープル曲げ用
案内溝が備わっていることが多い。この塑性変形によって、ステープルは、初め
のＵ字形状から伝統的な箱形状になるために、互いの方へ曲がる（あるいは折り
重なる）。次に、箱形状のステープルは、それが結合された対象へ連結されるこ
とによって、ステープル留め機構から引き出される。
【０００４】 腹腔鏡手術および内視鏡手術に利用されたステープラー装置は、デザインおよ
び機能の点で、伝統的なステープル留め機構とはかなり異なっている。伝統的な
ステープル留め機構とは異なり、空間的に別個であって対向するアンビル部は、
実用的でないので、使われていない。その代わりに、この外科的ステープラー装
置には、一体化されたステープル駆動装置およびアンビルからなる構成要素であ
って、ステープルを、結合される組織の中にまた同組織を介して保持するととも
に前進させる構成要素が備わっている。さらに詳しく説明すると、図１に示され
たように、従来技術の内部外科用組織ステープラー装置には細長い管１０が備わ
っており、この管は最小侵襲性射入口の門脈管を通して摺動するように構成され
ている。管１０の先端１２には複数の個別ステープルが含まれており、これらの
ステープルは、ステープル駆動装置によって連続状に結合している。それぞれの
ステープルは初め、Ｕ字形状にされている。このＵ字形状は、その相異なる領域
を識別することで、より具体的に説明することができる。ステープルの平坦な底
部には、中央部分と側方部分とがある。平坦な底部の最側方端に配置されている
上方延出状叉部は、長さがそれぞれほぼ等しく、また、平坦な底部の長さの３分
の１にほぼ等しい。ステープル駆動装置は初め、ステープルの底部に中央部分で
押し当てられて、ステープルを押す。ステープルは、叉部がハウジングの先端を
越えて延出し、次いで接合される組織に貫入するまで、前方へ進められる。ステ
ープルのそれ以上の前進は、この機構の先端に固定されているアンビル部によっ
て阻止される。このアンビルは、従来のステープル留め機構のアンビルとは異な
り、ステープル駆動装置の反対側で、ステープルの底部の中央部分に当接するだ
けである。同じように言えば、ステープルがこの装置における先端の内部に充分
に前進すると、先端のアンビルは、ステープルが背面側にあるステープル駆動装
置と前面側にあるアンビルとの間に閉じ込められるようになるまで前方へ移動す
るのを防止する。
【０００５】 このとき、ステープルを閉じるために第２の機構が働く。この閉鎖機構には、
その先端の内部から前方へ進むとともにステープルの平坦な底部の側方部分に当
接するまっすぐな一対の尖叉が備わっている。叉部を曲げるための尖叉が引き続
いて前進すると、ステープルの叉部が強制的に互いの方向へ折れるように、ステ
ープルが変形する。しかしながら、実際に曲がる部位はその叉部に沿っていない
。その部位は、平坦な底部の側方部分と中央部分とのつなぎ目である。このこと
によって、従来のステープル留め機構で得られる充分に変形したステープルがＢ
字形状であるのとは異なり、Ｄ字形状を得るために、この外科用ステープラー装
置の中に充分に変形したステープルが生じる。ステープルが接合された組織に連
結されると、ステープルを曲げる前記尖叉がまず後退し、次いでステープルを前
記アンビルから引き出すためにこの装置の軸がねじられることで、ステープルの
解放が行われる。
【０００６】 本発明の観点で認識すべき、従来技術の外科用ステープラー装置の付加的な特
徴は、すべての前進用要素、すなわちステープル駆動装置および叉部曲げ用尖叉
が移動されるということである。従来技術のこの最小侵襲性外科用ステープラー
装置においては、細長い管状部分は引金を含むハンドルで終わっている。この引
金には、引金の圧縮により初めはステープル駆動装置が叉部曲げ用尖叉を移動さ
せることなく前進するという、二重の機能が備わっている。ステープルが充分に
前進しかつ曲がるための準備状態にあると、グリップ型引金を引き続いて圧縮す
ることで、前記尖叉が、先端を通して前進しステープルに当接する。
【０００７】 ステープルを前進させ次いでステープルを変形させるための２段階機構と同様
に、手動引金操作が、ともに故障のおそれをはらんでいるということは、容易に
認識される。加えて、ステープルが組織に結合したときにステープルをアンビル
から引き出すためにこの装置の軸をねじらせる為の必要性には、このような操作
がステープルと組織との両方に応力をもたらして、組織に裂傷を引き起こすかな
り大きいおそれが存在する。
【０００８】 さらに、別の欠点は、ステープルを放出するための機構が、引金の圧縮および
解放に応じて前方および後方へ移動する細長い剛性軸に連結された引金である、
ということである。この軸の剛性によって、外科医は、ステープルを適切に一線
配置するために、装置全体を操作しなければならない。腹腔のヘルニアはたいて
い腹腔の底部で起きるので、この操作はきわめて難しいことが多い。
【０００９】 最後に、従来技術の外科用ステープラー装置の使用に関して説明すると、同装
置は完全に使い捨て用に構成されている。同装置を再利用することができないこ
とによって、装置の使用コストが増大している。さらに具体的に言うと、このよ
うな特徴によって、医療用使用についての明らかな要請のために全体の製造コス
トは少なくないが、新しい装置を手術ごとに使わなければならないので、処置当
たりのコストは増大している。実際、同装置に用意されているステープルよりも
多いステープルが手術に必要であるときには、空のステープルカートリッジを簡
単に交換することができないので、全体として新しい装置を使わなければならな
い。
【００１０】 従って、本発明の主な目的は、装置の細長い軸が通過する軟組織を著しく変形
させることなく、操作により適切な箇所の中へ容易に入れることのできる外科用
ステープラー装置を提供することである。
【００１１】 本発明の１つの目的は、１段階ステープル放出機構の備わった外科用ステープ
ラー装置を提供することでもある。
【００１２】 本発明の関連した目的は、ステープルが装置の先端から解放されるときに周囲
の組織に圧力を与えない外科用ステープラー装置を提供することである。
【００１３】 本発明の付加的な目的は、先端およびステープル駆動装置を廃棄する必要がな
く、それによって、医療廃棄物と装置の使用に関する費用とを従来技術の外科用
ステープラー装置と比べて最小限にする外科用ステープラー装置を提供すること
である。
【００１４】 本発明の他の諸目的は、以下に用意され、かつ、好適な実施形態の詳細な説明
の中における記載を図面とともに考慮することで、認識されると思われる。
【００１５】 （発明の概要） 本発明の前記諸目的は、電気機械式駆動装置に連結可能であって同装置により
駆動可能な本発明のステープル留めアタッチメントによってもたらされる。特に
、このアタッチメントは、連結用近位端で電気機械式駆動装置の撓みやすい駆動
軸の遠位端に連結され、それによって、アタッチメントのねじ付き軸が電気機械
式駆動装置の撓みやすい軸の撓みやすいドラフト軸に連結される。電気機械式駆
動装置において駆動された指掛式引金によって撓みやすいドラフト軸が回転する
と、ねじ付き軸によって、アタッチメントのねじ付き駆動要素が、アタッチメン
トのハウジングの中で回転するとともに前進して、ハウジングの中で移動する。
ねじ付き駆動要素が前進すると、ねじ付き駆動要素に取り付けられたステープル
閉鎖部材が、ばねでステープル閉鎖部材に連結されたステープル保持部材ととも
に前進する。このようにして、ステープル保持部材のステープル担持要素におけ
るステープル担持溝の中に担持されたステープルは、このアタッチメントのステ
ープル放出用遠位端の開口へ向かって前進し、接合される組織の中へ入る。ステ
ープルが組織に貫入し、ステープル保持部材がステープル放出用遠位端の開口に
形成された開口縁に当接した後に、ばねは、ステープル閉鎖部材がステープルを
同開口へ向けて引き続き前進するように、縮む。ステープル閉鎖機構が引き続き
前進すると、ステープルがステープル担持溝の溝縁に押し付けられ、かつ、ステ
ープル閉鎖部材の突出尖叉がステープルの平坦な底部の側方部分に係合し、ステ
ープルの叉部が閉鎖されてＤ字形状が形成され、それによって、組織が接合され
る。ステープル閉鎖機構がさらに前進すると、ステープル閉鎖部材の傾斜面がス
テープルの平坦な底部に係合し、ステープルがステープル担持溝の外側へ強制的
に排出されて、ステープルがこのアタッチメントから完全に放出されるとともに
解放される。電気機械式駆動装置において駆動された指掛式引金によって、撓み
やすいドラフト軸が逆に回転すると、ねじ付き軸が逆に回転してねじ付き駆動要
素が後退することで、ステープル担持要素とステープル保持部材とは、ステープ
ル担持要素が、ハウジングの中で複数のステープルを収容するステープルカート
リッジに隣接するステープル収容位置へ戻るまで、ハウジングの内部で後退する
。ステープル担持要素がこの位置へ戻ると、２番目のステープル留め処置に備え
て、ステープルカートリッジと機能的に通じているばね押しステープルディスペ
ンサーにより押された複数のステープルから１つのステープルが、ステープルカ
ートリッジからステープル担持要素のステープル担持溝の中へ入る。
【００１６】 さて、電気機械式駆動装置に関する図２を参照しながら、いっそう詳しく説明
すると、一例としての実施形態に係る電気機械式駆動装置５０には、ハンドル５
２と撓みやすい軸５４とが備わっている。ハンドル５２は、ピストル握り型デザ
インをしており、これには一対の指掛式引金５８ａ、５８ｂが備わっており、こ
れらの引金は別々のモーター６０、６２に別々に連結されている。これらのモー
ターは、電源６４に連結されており、この電源によって動力の供給を受け、また
、別々の撓みやすい駆動軸７８ａ、７８ｂのそれぞれを回転させる（以下にいっ
そう詳しく説明される）。モーター６０、６２は、それぞれ二方向性モーターで
あり、また、使用者がそれぞれのモーター６０、６２の回転方向を選択的に変え
ることができるように、ハンドル５０の頂部に取り付けられた手動式駆動スイッ
チ６６にも連結されている。この例において、電源６４は直流を設ける再充電可
能なバッテリーパックである。
【００１７】 ハンドル５０にはさらに、（１）遠隔操作状態表示器６８、（２）撓みやすい
軸操縦手段７０および（３）任意の付加的電源（図示略）が含まれている。遠隔
操作状態表示器６８には、使用者が構成要素の位置に関する情報（例えば、この
ステープラーアタッチメントのハウジングのステープル放出用遠位端がステープ
ルの駆動に先立って適切な位置にあるかどうかの情報）を得るためのＬＣＤある
いは同様な読取装置が備わっている。次に、ハンドル５０には、手動式駆動可能
な操縦手段７０も含まれており、この操縦手段としては、撓みやすい軸７２の動
きを指示するための、例えばジョイスティックあるいはトラックボールなどがあ
る（以下にいっそう詳しく説明される）。最後に、ハンドル５０には、アタッチ
メントに電力を選択的に供給するための付加的電源（図示略）とオン／オフスイ
ッチ（図示略）とが含まれていてもよい。
【００１８】 撓みやすい軸７２についていっそう詳しく説明すると、この撓みやすい軸には
管状外装７４が備わっているが、この外装は、組織適合性かつ殺菌可能性のある
（すなわち、オートクレーブに耐えるほど充分にじょうぶである）単一エラスト
マー材料から形成されているのが好ましい。本発明に関しては、さまざまな長さ
の撓みやすい軸７２を用意することができる。そのようにした場合には、撓みや
すい軸７２とハンドル５０とは分離可能なものであるべきであり、その結果、撓
みやすい軸７２の近位端とハンドル５０の遠位端との接合部には、駆動要素のた
めの連結手段が含まれている。撓みやすい軸７２の駆動要素に関して具体的に説
明すると、このエラストマー製外装の内部にはいっそう細い一対の固定管７６ａ
、７６ｂが配されているが、これらの固定管には撓みやすい駆動軸７８ａ、７８
ｂがそれぞれ含まれており、これらの撓みやすい駆動軸は、対応する固定管７６
ａ、７６ｂの内部で回転することができる。それぞれの撓みやすい駆動軸７８ａ
、７８ｂ自体は、ハンドル５０における対応駆動モーター６０、６２からの回転
力を撓みやすい軸７２の遠位端８０へ移すことができるとともに、外科医が患者
の腸管を通して撓みやすい軸７２を「くねらせる」必要があると考えるときに、
曲げられ、角度付けされ、曲線状にされるなど、充分に撓みやすいものでもある
。例えば、撓みやすい駆動軸７８ａ、７８ｂには、鋼織りファイバーケーブルが
備わっていてもよい。このような目的のために他の撓みやすい駆動軸が適してい
るかもしれない、ということは認識される。撓みやすい軸７２の遠位端８０を本
発明のステープル留めアタッチメントのようなアタッチメントに連結するために
（以下にいっそう詳しく説明される）、撓みやすい駆動軸７８ａ、７８ｂの遠位
先端８２ａ、８２ｂには、前記回転力を引き続いて移すことのできる形態が備わ
っている。例えば、撓みやすい駆動軸７８ａ、７８ｂの遠位先端８２ａ、８２ｂ
は、六角形であり、それによって、このステープル留めアタッチメントのハウジ
ングにおける連結用近位端のソケットの中、あるいは六角形の凹所に嵌められる
。先に示唆されたように、ハンドル５０に取り付けられた手動式駆動可能な操縦
手段７０とともに、撓みやすい軸７２には、少なくとも２つの操縦ワイヤ８４が
さらに含まれており、これらのワイヤは、撓みやすいものの、その遠位端８０の
近傍で撓みやすい軸７２の内面に連結されている。操縦ワイヤ８４は、手動式駆
動可能な操縦手段７０の駆動により、互いに関連して軸方向へ移動するようにさ
れていてもよく、従ってこのような動作によって、撓みやすい軸７２が曲げられ
て曲線状になる。また、先に示唆されたように、ハンドル５０の遠隔操作状態表
示器６８とともに、撓みやすい軸７２には、このアタッチメントに連結するため
の電気リード線８６がさらに含まれている。電気リード線８６は、このアタッチ
メントメントの状態を表示するために（例えば、接合される組織がステープル留
め用アタッチメントのステープル放出用遠位端に隣接しているかどうかを表示し
たり、ステープルカートリッジの中に残されたステープルの数を表示したりする
ために）、信号をアタッチメントからハンドル５０まで導く。同様に、もしもそ
れが望まれるのであれば、アタッチメントの別の面に電力を供給するために、付
加的な電気リード線を設けることもできる。
【００１９】 本発明のステープル留め用アタッチメントについてさらに詳しく説明すると、
このアタッチメントには、ステープル放出用遠位端と、アタッチメントを撓みや
すい軸の遠位端へ連結するためのソケットのある連結用近位端とを有するハウジ
ングが備わっている。ステープル放出用遠位端には、ステープルが連続的に放出
される開口と、この開口に形成された開口縁とが備わっている。アタッチメント
には、連結用近位端が撓みやすい軸の遠位端に連結されたときに電気機械式駆動
装置における撓みやすい軸の撓みやすいドラフト軸に係合するねじ付き軸がさら
に備わっており、その結果、ねじ付き軸は、撓みやすい軸の撓みやすいドラフト
軸の回転に応じて回転する。ねじ付き軸には、それに取り付けられたねじ付き駆
動要素が備わっており、この要素は、構造がナットに類似しているものの、ハウ
ジングの内部で案内されて移動し、その結果、ねじ付き軸の回転によって、アタ
ッチメントのハウジングの内部でねじ付き駆動要素をねじ付き軸に沿って前進さ
せあるいは後退させる。
【００２０】 アタッチメントにはさらに、ステープル保持部材と、このステープル保持部材
に一体であるステープル担持要素と、このステープル担持要素に一体であるアン
ビル部とが備わっている。アタッチメントにはさらに、ステープル保持部材の周
囲に同心状に取り付けられたステープル閉鎖部材が備わっている。ステープル保
持部材とステープル閉鎖部材とは、ばねで互いに連結されているとともに、ねじ
付き駆動要素に取り付けられており、それによって、ねじ付き駆動要素が前進す
ると、ステープル保持部材とステープル閉鎖部材とが前進するようになっている
。ステープル閉鎖部材にはさらに、一対の突出部、すなわち突出尖叉が備わって
おり、これらの突出尖叉は、ステープルの平坦な底部の側方部分でステープルに
係合するように位置決めされている。ステープル閉鎖部材にはさらに、傾斜面が
備わっており、この傾斜面は、ステープルの底部の中央部分に係合するように適
合されている。ステープル担持要素には、アンビル部を有する角のあるステープ
ル担持溝あるいは溝縁が備わっている。
【００２１】 アタッチメントにはさらに、アタッチメントのハウジングに取り付けられた交
換可能なステープルカートリッジが備わっている。このステープルカートリッジ
には、複数のステープルが収容されている。ステープルカートリッジは、ばね押
しステープルディスペンサーに機能的に通じている。
【００２２】 ステープル留め用アタッチメントのハウジングにおける連結用近位端がこの電
気機械式駆動装置の撓みやすい軸の遠位端における遠位端に連結されると、ステ
ープル留め用アタッチメントのねじ付き軸が、撓みやすい軸の撓みやすいドラフ
ト軸に係合する。この電気機械式駆動装置の指掛式引金を引いて、撓みやすいド
ラフト軸を遠隔駆動すると、撓みやすいドラフト軸は回転し、次いでねじ付き軸
が回転することで、ねじ付き駆動要素がアタッチメントのハウジングの内部で前
進する。この電気機械式駆動装置の手動式駆動スイッチを遠隔切換し、続いて電
気機械式駆動装置の指掛式引金により遠隔駆動すると、撓みやすいドラフト軸が
逆に回転することで、ねじ付き駆動要素がアタッチメントのハウジングの内部で
後退する。従って、前記のように、ステープル保持部材とステープル担持要素と
は、ねじ付き駆動要素とともに前進しかつ後退する。ステープル担持要素が、ス
テープルカートリッジの近傍にあるステープル収容位置に後退すると、ばね押し
ステープルディスペンサーにより押された１つのステープルが、ステープルカー
トリッジからステープル担持要素のステープル担持溝の中へ入る。ステープル保
持部材とステープル閉鎖部材とがハウジングの内部で前進すると、ステープルは
ステープル担持溝の内部へ運ばれる。ステープル担持溝の角度によって、ステー
プルはこの前進の際にステープル担持溝の中に残ることが保証される。ステープ
ルはハウジングのステープル放出用遠位端へ搬送され、ステープルの叉部は接合
される組織の中に挿入される。叉部が同組織の中へ入り込んだ後に、ステープル
保持部材がステープル放出用遠位端の開口縁によって停止される。ねじ付き駆動
要素の前進が続けられると、ステープル閉鎖部材とステープル保持部材とを連結
するばねが縮んで、ステープル閉鎖部材がさらに前進する。ステープル閉鎖部材
がさらに前進すると、突出尖叉が、ステープルの平坦な底部の側方部分でステー
プルに係合し、ステープルがステープル担持溝の溝縁に押し付けられることで、
ステープルの平坦な底部の側方部分が曲がり、ステープルの叉部が閉鎖されてＤ
字形状になり、それによって組織が接合される。ねじ付き駆動要素の前進が続け
られると、ステープル閉鎖部材がさらに前進することで、ステープル閉鎖部材の
傾斜面が、ステープルの平坦な底部の中央部分に係合し、ステープルがステープ
ル担持溝から強制的に排出されて完全に放出され、ステープルがアタッチメント
から解放される。その後、ねじ付き駆動要素が後退して、ステープル担持要素と
ステープル保持部材とがハウジングの内部で後退する。ステープル担持要素がス
テープルカートリッジの近傍にあるステープル収容位置に戻ると、２番目のステ
ープル留め処置に備えて、２番目のステープルが、ばね押しステープルディスペ
ンサーによりステープルカートリッジからステープル担持要素のステープル担持
溝の中へ押し込まれる。
【００２３】 （好適な実施形態の詳細な説明） 先に記載したように、本発明は、電気機械式駆動装置と組み合わせて使う組織
ステープル留め用アタッチメントからなる。より詳しくは、また、ここで図３お
よび図４を参照すると、アタッチメント１００の好適な実施形態は、ハウジング
１０２を備えてなり、このハウジングは、ステープル放出用遠位端１０４と連結
用近位端１０６とを有し、この連結用近位端は、アタッチメント１００を電気機
械式駆動装置（図２に最もよく示されている）の撓みやすい軸（図２の部材７２
として最もよく示されている）の遠位端（図２の部材８０として最もよく示され
ている）に連結するためのソケット１１４を有している。（一般的には、「吻合
・ステープル留め・切除用器具とともに使用するための電気機械式駆動装置」と
題された同時係属中の米国特許出願第０９／３２４，４５２号を参照のこと。）
ステープル放出用遠位端１０４には、ステープルが連続的に放出される開口１０
８と、開口１０８の中に形成された開口縁１１０とが備わっている。アタッチメ
ント１００には、連結用近位端１０６が撓みやすい軸の遠位端に連結されたとき
に撓みやすい軸の撓みやすいドラフト軸（図２の部材７８ａあるいは７８ｂとし
て最もよく示されている）に係合するねじ付き軸１１２が備わっており、その結
果、撓みやすい軸の撓みやすいドラフト軸の回転に対応してねじ付き軸１１２が
回転する。ねじ付き軸１１２には、それに取り付けられたねじ付き駆動要素１１
６が備わっており、この要素は、構造がナットに類似しているものの、ハウジン
グ１０２の内部で案内されて移動し、その結果、ねじ付き軸１１２が、アタッチ
メント１００のハウジング１０２の内部でねじ付き駆動要素１１６をねじ付き軸
１１２に沿って前進させあるいは後退させる。
【００２４】 アタッチメント１００にはさらに、ステープル保持部材１１８と、このステー
プル保持部材１１８に一体であるステープル担持要素１２０と、このステープル
担持要素１２０に一体であるアンビル部１２２とが備わっている。アタッチメン
ト１００にはさらに、ステープル保持部材１１８の周囲で同心状に取り付けられ
たステープル閉鎖部材１２４が備わっている。ステープル保持部材１１８とステ
ープル閉鎖部材１２４とは、ばね１２６で互いに連結されているとともに、ねじ
付き駆動要素１１６に取り付けられており、それによって、ねじ付き駆動要素１
１６が前進すると、ステープル保持部材１１８とステープル閉鎖部材１２４とが
前進するようになっている。ステープル閉鎖部材１２４には、一対の突出部、す
なわち突出尖叉１２８が備わっており、これらの突出尖叉は、ステープル１３０
の平坦な底部１３４（図４に最もよく示されている）の側方部分１３２（図４に
最もよく示されている）でステープル１３０に係合するように位置決めされてい
る。ステープル閉鎖部材１２４にはさらに、傾斜面１３６が備わっており、この
傾斜面は、ステープル１３０の底部１３４の中央部分１３８（図４に最もよく示
されている）に係合するように適合されている。ステープル担持要素１２０には
、アンビル部を有する角のあるステープル担持溝１４０あるいは溝縁１４２が備
わっている。
【００２５】 アタッチメント１００にはさらに、アタッチメント１００のハウジング１０２
に取り付けられた交換可能なステープルカートリッジ１４４が備わっている。ス
テープルカートリッジ１４４には、複数のステープル１４６が収容されている。
ステープルカートリッジ１４４は、ばね押しステープルディスペンサー１４８に
機能的に通じている。
【００２６】 作動については、ステープル留め用アタッチメント１００のハウジング１０２
における連結用近位端１０６がこの電気機械式駆動装置（図２に最もよく示され
ている）の撓みやすい軸の遠位端に連結されると、ステープル留め用アタッチメ
ント１００のねじ付き軸１１２が、撓みやすい軸（図２の部材７２として最もよ
く示されている）の撓みやすいドラフト軸（図２の部材７８ａあるいは７８ｂと
して最もよく示されている）に係合する。この電気機械式駆動装置の指掛式引金
（図２の部材５８ａあるいは５８ｂとして最もよく示されている）を引いて、撓
みやすいドラフト軸を遠隔駆動すると、撓みやすいドラフト軸は回転し、次いで
ねじ付き軸１１２が回転することで、ねじ付き駆動要素１１６がアタッチメント
１００のハウジング１０２の内部で前進する。この電気機械式駆動装置の手動式
駆動スイッチ（図２の部材６６として最もよく示されている）を遠隔切換し、続
いて電気機械式駆動装置の指掛式引金により遠隔駆動すると、撓みやすいドラフ
ト軸が逆に回転することで、次いでねじ付き軸１１２が逆に回転し、ねじ付き駆
動要素１１６がアタッチメント１００のハウジング１０２の内部で後退する。従
って、前記のように、ステープル保持部材１１８とステープル担持要素１２０と
は、ねじ付き駆動要素１１６とともに前進しかつ後退する。ステープル担持要素
１２０が、ステープルカートリッジ１４４の近傍にあるステープル収容位置に後
退すると、ばね押しステープルディスペンサー１４８により押された複数のステ
ープル１４６から１つのステープルが、ステープルカートリッジ１４４からステ
ープル担持要素１２０のステープル担持溝１４０の中へ入る。ステープル保持部
材１１８とステープル閉鎖部材１２４とがハウジング１０２の内部で前進すると
、ステープル１３０はステープル担持溝１４０の内部で運ばれる。ステープル担
持溝１４０の角度によって、ステープル１３０はこの前進の際にステープル担持
溝１４０の中に残ることが保証される。ステープル１３０はハウジング１０２の
ステープル放出用遠位端１０４へ搬送され、ステープル１３０の叉部１５０（図
４に最もよく示されている）は接合される組織の中に挿入される。叉部１５０が
同組織の中へ入り込んだ後に、ステープル保持部材１１８がステープル放出用遠
位端１０４の開口縁１１０によって停止される。ねじ付き駆動要素１１６の前進
が続けられると、ステープル閉鎖部材１２４とステープル保持部材１１８とを連
結するばね１２６が縮んで、ステープル閉鎖部材１２４がさらに前進する。ステ
ープル閉鎖部材１２４がさらに前進すると、突出尖叉１２８が、ステープル１３
０の平坦な底部１３４（図４に最もよく示されている）の側方部分１３２（図４
に最もよく示されている）でステープル１３０に係合し、ステープル１３０がス
テープル担持溝１４０の溝縁１４２に押し付けられることで、ステープル１３０
の平坦な底部１３４の側方部分１３２が曲がり、ステープル１３０の叉部１５０
が閉鎖されてＤ字形状になり、それによって組織が接合される。ねじ付き駆動要
素１１６の前進が続けられると、ステープル閉鎖部材１２４がさらに前進するこ
とで、ステープル閉鎖部材１２４の傾斜面１３６が、ステープル１３０の平坦な
底部１３４の中央部分１３８に係合し、ステープル１３０がステープル担持溝１
４０から強制的に排出されて完全に放出され、ステープル１３０がアタッチメン
ト１００から解放される。その後、ねじ付き駆動要素１１６が後退して、ステー
プル担持要素１２０とステープル保持部材１１８とがハウジング１０２の内部で
後退する。ステープル担持要素１２０がステープルカートリッジ１４４の近傍に
あるステープル収容位置に戻ると、２番目のステープル留め処置に備えて、２番
目のステープルが、ステープル担持要素１２０のステープル担持溝１４０の中へ
押し込まれる。
【図面の簡単な説明】
【図１】 図１は、従来技術の手術用ステープラー装置の斜視図である。
【図２】 図２は、本発明と組み合わせて使う電気機械式駆動装置の斜視図である。
【図３】 図３は、ステープル保持部材およびステープル担持要素がステープル装填位置
にある、本発明のステープル留め用アタッチメントの側面断面図である。
【図４】 図４は、ステープル保持部材およびステープル担持要素がステープル放出配置
にある、本発明の（図３に関しては９０°で曲がっている）ステープル留め用ア
タッチメントの側面断面図である。
───────────────────────────────────────────────────── フロントページの続き (81)指定国 ＥＰ(ＡＴ，ＢＥ，ＣＨ，ＣＹ， ＤＥ，ＤＫ，ＥＳ，ＦＩ，ＦＲ，ＧＢ，ＧＲ，ＩＥ，Ｉ Ｔ，ＬＵ，ＭＣ，ＮＬ，ＰＴ，ＳＥ，ＴＲ)，ＯＡ(ＢＦ ，ＢＪ，ＣＦ，ＣＧ，ＣＩ，ＣＭ，ＧＡ，ＧＮ，ＧＷ， ＭＬ，ＭＲ，ＮＥ，ＳＮ，ＴＤ，ＴＧ)，ＡＰ(ＧＨ，Ｇ Ｍ，ＫＥ，ＬＳ，ＭＷ，ＭＺ，ＳＤ，ＳＬ，ＳＺ，ＴＺ ，ＵＧ，ＺＷ)，ＥＡ(ＡＭ，ＡＺ，ＢＹ，ＫＧ，ＫＺ， ＭＤ，ＲＵ，ＴＪ，ＴＭ)，ＡＥ，ＡＧ，ＡＬ，ＡＭ， ＡＴ，ＡＵ，ＡＺ，ＢＡ，ＢＢ，ＢＧ，ＢＲ，ＢＹ，Ｂ Ｚ，ＣＡ，ＣＨ，ＣＮ，ＣＲ，ＣＵ，ＣＺ，ＤＥ，ＤＫ ，ＤＭ，ＤＺ，ＥＥ，ＥＳ，ＦＩ，ＧＢ，ＧＤ，ＧＥ， ＧＨ，ＧＭ，ＨＲ，ＨＵ，ＩＤ，ＩＬ，ＩＮ，ＩＳ，Ｊ Ｐ，ＫＥ，ＫＧ，ＫＰ，ＫＲ，ＫＺ，ＬＣ，ＬＫ，ＬＲ ，ＬＳ，ＬＴ，ＬＵ，ＬＶ，ＭＡ，ＭＤ，ＭＧ，ＭＫ， ＭＮ，ＭＷ，ＭＸ，ＭＺ，ＮＯ，ＮＺ，ＰＬ，ＰＴ，Ｒ Ｏ，ＲＵ，ＳＤ，ＳＥ，ＳＧ，ＳＩ，ＳＫ，ＳＬ，ＴＪ ，ＴＭ，ＴＲ，ＴＴ，ＴＺ，ＵＡ，ＵＧ，ＵＺ，ＶＮ， ＹＵ，ＺＡ，ＺＷ 【要約の続き】 進し続ける。この前進によって、ステープル閉鎖部材 （１２４）がステープル（１３０）を閉じたＤ字形状の 形態に変形させる。ステープル閉鎖部材（１２４）がさ らに前進すると、ステープル（１３０）は、ハウジング （１０２）のステープル放出用遠位端（１０４）を介し てアタッチメント（１００）から解放される。ねじ付き 軸（１１２）の逆回転によって、ステープル閉鎖部材 （１２４）とステープル保持部材（１１８）とがステー プル収容位置の中へ後退し、その位置で、ばね押しステ ープルディスペンサー（１４８）が、ステープルカート リッジ（１４４）の中における複数のステープル（１４ ６）の１つを、次の処置に備えて、ステープル保持部材 （１１８）のステープル担持要素におけるステープル担 持溝（１４０）の中へ押し込む。

Claims (19)

    【特許請求の範囲】
  1. 【請求項１】 ａ）開口と、この開口に形成された開口縁とを有しているハ
    ウジングと、 ｂ）このハウジングの中に配置されたねじ付き回転軸と、 ｃ）このねじ付き回転軸に取り付けられ、かつ、ねじ付き回転軸の回転に対応
    して前記ハウジングの内部で移動するステープル閉鎖部材と、 ｄ）ステープルを担持し、かつ、ばねによって前記ステープル閉鎖部材に連結
    されたステープル保持部材と を備えてなり、 ｅ）前記ねじ付き回転軸を回転させることで、前記ステープル閉鎖部材と前記
    ステープル保持部材とを前記開口へ向けて前進させるとともに、前記ステープル
    を、前記ステープル保持部材がさらに前進して前記ステープル保持部材と前記開
    口縁との当接によって阻止されるまで、接合される組織の中へ前進させ、 ｆ）前記ねじ付き回転軸を引き続き回転させることで、前記ステープル閉鎖部
    材を、前記ばねが縮むようにさらに前進させ、次いで ｇ）前記ねじ付き回転軸を引き続き回転させることで、前記ステープル閉鎖部
    材によって前記ステープルを組織の内部で閉鎖させる 組織接合用ステープラーアタッチメント。
  2. 【請求項２】 前記ステープルは、前記ステープル保持部材が前記ハウジン
    グの内部のステープル収容位置にあるときに、前記ステープル保持部材の中に装
    填される、請求項１に記載のステープラーアタッチメント。
  3. 【請求項３】 前記ステープルは、ばね押し機構の使用によって、前記ステ
    ープル保持部材の中に装填される、請求項１に記載のステープラーアタッチメン
    ト。
  4. 【請求項４】 前記ステープルは、前記ステープル保持部材の中に装填され
    る前にはステープルカートリッジの中に保持されており、かつ、前記ステープル
    保持部材が前記ハウジングの内部のステープル収容位置にあるときに前記ステー
    プルカートリッジから前記ステープル保持部材の中へ押し込まれることで、前記
    ステープル保持部材の中に装填される、請求項２に記載のステープラーアタッチ
    メント。
  5. 【請求項５】 前記ステープルは、前記ステープル保持部材が前記ハウジン
    グの内部のステープル収容位置にあるときに、ばね押しステープルディスペンサ
    ーによって前記ステープルカートリッジから前記ステープル保持部材の中へ押し
    込まれる、請求項４に記載のステープラーアタッチメント。
  6. 【請求項６】 前記ステープル閉鎖部材が、ステープル保持部材の周囲に同
    心状に取り付けられている、請求項１に記載のステープラーアタッチメント。
  7. 【請求項７】 前記ステープル保持部材は、前記ステープルが前記ステープ
    ル保持部材の前進の際に内部で担持されるステープル担持溝を備えており、この
    ステープル担持溝は、前記ステープル保持部材が前記開口縁に当接した後に前記
    ステープルの平坦な底部が前記ステープル閉鎖部材によって押し付けられる溝縁
    を有している、請求項１に記載のステープラーアタッチメント。
  8. 【請求項８】 前記ステープル担持溝は、前記ステープルが前記ステープル
    保持部材の前進の際に前記溝の内部に残ることを保証するために、角度が付けら
    れている、請求項１に記載のステープラーアタッチメント。
  9. 【請求項９】 前記ステープル閉鎖部材が前記ステープルにおける前記の平
    坦な底部を前記溝縁に押し付けた後に、前記ステープル閉鎖部材を引き続き前進
    させることで、前記ステープル閉鎖部材によって前記ステープルにおける前記の
    平坦な底部の側方部分を前記ステープルが組織の内部で閉鎖されるまで押し付け
    る、請求項７に記載のステープラーアタッチメント。
  10. 【請求項１０】 前記ステープル閉鎖部材が、前記ステープルにおける前記
    の平坦な底部の前記側方部分に係合する突出部を備えている、請求項９に記載の
    ステープラーアタッチメント。
  11. 【請求項１１】 前記ステープルが組織の内部で閉鎖された後に、前記ねじ
    付き回転軸を引き続き回転させることで、前記ステープルを前記ステープル保持
    部材から解放する、請求項１に記載のステープラーアタッチメント。
  12. 【請求項１２】 ａ） 前記ステープル保持部材は、前記ステープルが前記
    ステープル保持部材の前進の際に内部で担持されるステープル担持溝を備えてお
    り、かつ ｂ）前記ステープルが組織の内部で閉鎖された後に、前記ねじ付き回転軸を引
    き続き回転させることで、前記ステープル閉鎖部材が前記ステープルを前記ステ
    ープル担持溝の外へ押し出す、請求項１１に記載のステープラーアタッチメント
    。
  13. 【請求項１３】 ａ） 前記ステープル閉鎖部材が、前記ステープルの平坦
    な底部の中央部分に係合する傾斜面を備えており、かつ ｂ）前記ステープルが組織の内部で閉鎖された後に、前記ねじ付き回転軸を引
    き続き回転させることで、前記傾斜面が前記ステープルを前記ステープル担持溝
    の外へ押し出す、請求項１２に記載のステープラーアタッチメント。
  14. 【請求項１４】 ａ） 前記ステープル担持溝は、前記ステープル保持部材
    が前記開口縁に当接した後に前記ステープルの平坦な底部の中央部分が前記ステ
    ープル閉鎖部材によって押し付けられる溝縁を有しており、 ｂ）前記ステープル閉鎖部材が前記中央部分を前記溝縁に押し付けた後に、前
    記ねじ付き回転軸を引き続き回転させることで、前記ステープル閉鎖部材の突出
    部を、前記ステープルが組織の内部で閉鎖されるまで、前記ステープルにおける
    前記の平坦な底部の側方部分に係合させ、 ｃ）前記ステープル閉鎖部材が、傾斜面を備えており、それによって、前記ス
    テープル閉鎖部材が前記中央部分に係合し、 ｄ）前記ステープルが組織の内部で閉鎖された後に、前記ねじ付き回転軸を引
    き続き回転させることで、前記ステープル閉鎖部材が前記中央部分に係合して前
    記ステープルを前記ステープル担持溝の外へ押し出す、請求項１２に記載のステ
    ープラーアタッチメント。
  15. 【請求項１５】 前記ステープル閉鎖部材が、前記ステープルにその側方箇
    所で係合して前記ステープルを撓ませる少なくとも２つの突出部を備えている、
    請求項１に記載のステープラーアタッチメント。
  16. 【請求項１６】 前記ステープル保持部材が、前記ステープルと前記開口と
    の間に配置されたアンビル部を備えており、このアンビル部が、前記ステープル
    を撓ませるための支持部および案内部として機能する、請求項１５に記載のステ
    ープラーアタッチメント。
  17. 【請求項１７】ａ）開口とこの開口に形成された開口縁とを有しているハウ
    ジングと、 ｂ）このハウジングの中で長手方向に前進しかつ後退するステープル閉鎖部材
    と、 ｃ）ステープルを担持し、かつ、ばねによって前記ステープル閉鎖部材に連結
    されたステープル保持部材と を備えてなり、 ｄ）前記ステープル閉鎖部材を前記開口へ向けて前進させることで、前記ステ
    ープル保持部材を前記開口へ向けて前進させるとともに、前記ステープルを、前
    記ステープル保持部材がさらに前進して前記ステープル保持部材と前記開口縁と
    の当接によって阻止されるまで、接合される組織の中へ前進させ、 ｅ）前記ステープル閉鎖部材を引き続き前進させることで、前記ばねを縮ませ
    るとともに、前記ステープル閉鎖部材によって前記ステープルを組織の内部で閉
    鎖させる 組織接合用ステープラーアタッチメント。
  18. 【請求項１８】 前記ステープル閉鎖部材が、前記ステープルにその側方箇
    所で係合して前記ステープルを撓ませる少なくとも２つの突出部を備えている、
    請求項１７に記載のステープラーアタッチメント。
  19. 【請求項１９】 前記ステープル保持部材が、前記ステープルと前記開口と
    の間に配置されたアンビル部を備えており、このアンビル部が、前記ステープル
    を撓ませるための支持部および案内部として機能する、請求項１８に記載のステ
    ープラーアタッチメント。
JP2001561232A 2000-02-22 2001-02-21 電気機械式駆動装置と組み合わせて使う組織ステープル留め用アタッチメント Expired - Fee Related JP4277470B2 (ja)

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JP2006000641A (ja) * 2004-06-14 2006-01-05 Ethicon Endo Surgery Inc ねじ付きクリップを備えた内視鏡クリップアプライヤー
JP2006000637A (ja) * 2004-06-14 2006-01-05 Ethicon Endo Surgery Inc 内視鏡器具に用いるための回動、平行移動、及びトルクを制御する装置
JP4732020B2 (ja) * 2004-06-14 2011-07-27 エシコン・エンド−サージェリィ・インコーポレイテッド ねじ付きクリップを備えた内視鏡クリップアプライヤー
JP2012030090A (ja) * 2004-10-08 2012-02-16 Tyco Healthcare Group Lp 内視鏡外科用クリップ取付器

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EP1257206A1 (en) 2002-11-20
PT1257206E (pt) 2006-11-30
DE60121138T2 (de) 2007-07-12
EP1257206B1 (en) 2006-06-28
JP4277470B2 (ja) 2009-06-10
ES2267726T3 (es) 2007-03-16
AU2001238643A1 (en) 2001-09-03
WO2001062161A1 (en) 2001-08-30
ATE331472T1 (de) 2006-07-15
US6533157B1 (en) 2003-03-18

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