JP2004216192A - 装置および医療器具 - Google Patents
装置および医療器具 Download PDFInfo
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Abstract
【解決手段】 可撓性器具の遠位部において操作可能に構成された第一部材720および第二部材722を備え、第一部材720は、可撓性部材822によって結合された二つの固定部品824a、824bを有する組織固定装置730を備え、第一部材720および第二部材722は相互作用することで患者の体内に組織固定装置730を配置し、二つの固定部品824a,824bは所定の相対距離を隔てて配置される装置700である。
【選択図】 図45
Description
一態様では、本発明は、中空の身体器官内の組織を再構成する内視鏡治療方法を提供する。ここで、説明のみを目的として本発明のこの態様について、胃に適用される場合の本発明の方法のステップを開示している図1〜図13を参照して説明する。本発明の方法を以下に示すような任意の中空器官に適用してもよい。広い意味で本発明は、少なくとも、再構成される中空器官の内面を係合し、係合された組織の部分を操作して再構成を行い、かつ係合された組織を固定して前記操作により達成された再構成を維持するステップを含む。この方法には、前記手順中のすべてを通して、またはその一部において内視鏡による視覚化のステップを含んでもよい。再構成された組織により形成される形状の詳細について、以下に示す。
内視鏡による視覚化は、前記手順のすべてまたは一部に使用してもよく、あるいは全く使用しなくてもよい。本発明のある好適な実施形態によれば、少なくとも組織が係合されている部分を内視鏡で視覚化するのに関連して本願方法が施行される。典型的には、図1に示すように、本発明の方法にかかる第1のステップには、第1の中空器官10の内部または内腔に内視鏡14を進入するステップを含んでいる。好適には、内視鏡14は、液体を介して第1の中空器官10と通じている第2の中空器官12の内腔11を介して、第1の中空器官10の内部に進入される。
図2に示すように、本発明のこの態様の最初のステップは、第1の中空器官10の内面16の選択された部分を係合することである。
図3に示すように、本発明の次のステップでは、第1の中空器官10の内面16の係合された部分は、第1の中空器官10の少なくとも一部分を再構成するように操作される。第1の中空器官10の内面16は、装置18によって操作され、再構成された部分20を形成する。この操作ステップでは、装置18によって内面16の組織の係合された部分に、組織を押したり、引いたり、ねじったり、巻いたり、重ねたり、皺を寄せたり、または元の位置および/またはそのような力が加えられる前の構造から組織をずらすのに有効な物理的力が加えられる。好適な実施形態では、実際に係合されている部分と近接した状態で連続している組織は、係合された部分に加えられる力の大きさおよび方向に比例して、少なくともある程度の変形力を元の構造から受けることになる。少なくとも第1の中空器官10の内部層16の陥入、膨出、または陥入と膨出との組み合わせを成すために、係合された組織の操作が行われてよい。
この操作ステップの後、図7および図8に示されるように、再構成された部分20の形状が永久的に維持される効果が達成されるように、後に続くステップには、第1の中空器官10の再構成された部分20を永久的に固定する方法が含まれる。器官10の再構成された部分20は、組織係合装置18を経て係合された組織の部分に加えられる操作力がオペレータの管理のもとで維持されると同時に、このオペレータは、以下に示す組織固定装置22の遠位エフェクタ・エンド21を再構成された部分20と接触させる。組織固定装置22の遠位エフェクタ・エンド21は、少なくとも1つの生物学的適合性のある以下に示す組織固定装置24を含んでおり、少なくとも1つの生物学的適合性のある組織固定装置24を再構成された部分20に適用するような構造となっている。組織固定装置22は、組織係合装置18と共に、その適用に合い前後して第1の中空器官の内腔13に進入される。この後、組織固定装置22が、少なくとも1つの生物学的適合性のある組織固定装置24を適用するように作動し、再構成された部分20の形状を永久的に固定または定着させる。
別の態様では、本発明は、GERD治療のために胃内の組織を再構成する内視鏡治療方法に関するものである。この治療方法は、胃の液体内容物が食道に入ってくるときに、胃の液体内容物を妨げる有効な障壁となるフラップ弁を形成しながら、胃組織の隆起が、食道の開口部を覆う状態の所見に基づくものである。効果的なフラップ弁は、逆止め弁として機能し、すなわち、げっぷの間に胃から食道へガスを適切に逃がすことを可能にしながら、嚥下された液体および固形物が食道から胃まで自由に通過することを可能にするが、この逆方向には通過させない。
<隆起の形成または既存のフラップ弁の締めつけ>
図14および図15に示されるように、十分な隆起があるが、封止面が不適切に並置されている状態を治療するためには、選択的には少なくとも1つの胃壁34の下層を含む胃10の内面16を2ヶ所以上の別々の部分73および部分75にて係合する。図15に示すように、係合部73および係合部75を、胃に向かう食道の開口部36近傍で、胃食道のフラップ弁70に存在する隆起部分67に対向している、胃36に向かう食道の開口部側に配置する。図15に示すように、係合部73および係合部75の場所は、制限されない。図15に示すように、係合部73および係合部75の場所および隆起部分67の場所は、胃に向かう食道の開口部36の対向する側の配置によって関連付けられる。したがって、臨床的に実行する場合、係合部73および係合部75の場所は、隆起部分67の場所に左右されるため、係合部73および係合部75の場所ならびに隆起部67の場所は、胃に向かう食道の開口部36の周囲に180°回転させた分だけ、図15に示したものとは異なるものになる。次に、係合部73および係合部75の場所を、互いに図15に示した矢印の方向に移動させ、組織の膨隆部または小丘部72を形成する。この動作は、搾り出しを含む操作によって容易に行うことができる。このように作られた組織の隆起72は、弁座69の封止面を隆起部67方向にずらすことができる。このように操作された胃の組織では、少なくとも1つの組織固定装置を用いて、前述したような方法で組織固定地点77で固定して組織の膨隆部72の形状を係合させる。したがって、このように永久的に確立された組織の膨隆部72は、存在する隆起部分67の封止面方向に弁座69の封止面を移動させて、受容能力のあるフラップ弁を効果的に再構成する。
<フラップの形成または増大>
十分なフラップは存在しないが、密封表面は適切に並置される状態を補修するために、図20および図21についてすでに記載した方法を使用する。胃内壁組織16は、随意的に胃壁34の少なくとも1つの基底層を含んでおり、胃に通じる食道の開口部36付近の各点37および39で係合されている。以後の操作、ならびに固定工程によって、適切に配置された胃組織および胃に通じる食道の開口部36の少なくとも1つの重要な部分を覆うのに十分な領域のフラップが生じるように、各点37および39は、胃に通じる食道の開口部36に対して位置しなければならない。各点37および39で係合された胃組織は、矢印38の方向(例えば、胃に通じる食道の開口部36に向かう方向)で操作される。2つの点37および39の操作は、図4に示されており、連続的にまたは同時に図5に示すような実質的に矩形のフラップ40の形成または増大を生じる。次いで、胃組織は、先に記載の方法で2つの固定点35で固定され、フラップ40の矩形形状が実質的に維持される。胃に通じる食道の開口部36上のフラップ46のサイズおよび耐密性は、固定点35の位置に基づいて変動する。
<密封表面を共に接近させることを組み合わせたフラップの作製または増大>
組織の十分なフラップはすでに存在せず、密封表面も並置されていない状態を補修するために、図20〜23について以下に記載の技術により一対の膨出を、形成および固定することによって胃に褶曲形成する。
もう1つの局面において、本発明は、裂孔ヘルニアを治すための内視鏡的方法に関するものである。本願方法は、胃の1つの面を内側から係合させること、ヘルニアを軽減すること(例えば、横隔膜の下のヘルニア部分を再配置するために係合された胃の部分を操作すること)、胃の部分を、胃に対する外因性の組織構造の面と接触させるために係合された該胃の部分を操作すること、および胃の部分を、胃に対する外因性の組織構造の面に固定することを含んでいる。
もう1つの局面では、本発明は、本発明の方法に従って中空気管内の組織を再構成するのに有用な新規の器具に関するものである。そのような器具は、組織係合装置、組織操作装置、組織固定装置、および検視内視鏡のうち少なくとも2つを組み入れることができる。好ましい実施態様では、以下に記載のように、本発明は組織係合装置、組織操作装置、および組織固定装置を組み合わせた単一の器具を提供する。この組み合わせ器具の独特な特徴は、該器具が3次元空間における任意の所望の方向で2つ以上の点を操作することができることである。
Claims (31)
- 可撓性器具の遠位部において操作可能に構成された第一部材および第二部材を備え、
前記第一部材は、可撓性部材によって結合された二つの固定部品を有する組織固定装置を備え、
前記第一部材および前記第二部材は、相互作用することで患者の体内に前記組織固定装置を配置し、前記二つの固定部品は、所定の相対距離を隔てて配置される装置。 - 前記可撓性部材は、前記固定部品とは異なる材料で形成されている請求項1に記載の装置。
- 前記可撓性部材は、縫合糸で構成されている請求項1に記載の装置。
- 前記固定部品の各々は、前記可撓性部材を受け入れる穴を画定している請求項1に記載の装置。
- 前記第二部材は、前記組織固定装置の一部を備えている請求項1に記載の装置。
- 前記第一部材は、前記二つの固定部品を前記所定の相対距離を隔てて収容する二つのチャネルを画定している請求項1に記載の装置。
- 前記第一部材は、前記二つのチャネルをそれぞれ画定する二つの組織刺通要素を更に備えている請求項6に記載の装置。
- 前記第二部材は、前記二つの組織刺通要素をそれぞれ受け入れる二つの孔を画定している請求項7に記載の装置。
- 前記二つの固定部品は、前記所定の相対距離を隔てて前記第一部材に結合されている請求項1に記載の装置。
- 可撓性部分によって結合された固定部分を具備する組織固定装置を有し、生体組織を刺通可能に構成された部材を備え、
前記部材は、可撓性器具の遠位部において操作可能に構成され、前記組織固定装置の前記固定部分を前記生体組織を介して所定の相対距離を隔てて配置する装置。 - 前記可撓性部分は、前記固定部分とは異なる材料で形成されている請求項10に記載の装置。
- 前記可撓性部分は、縫合糸で構成されている請求項10に記載の装置。
- 前記固定部分の各々は、前記可撓性部分を受け入れる穴を画定している請求項10に記載の装置。
- 前記組織固定装置の一部を含む第二部材を更に備えている請求項10に記載の装置。
- 前記部材は、前記固定部分を前記所定の相対距離を隔てて収容するチャネルを画定している請求項10に記載の装置。
- 前記部材は、前記チャネルを画定し且つ前記生体組織を刺通する要素を備えている請求項15に記載の装置。
- 前記要素を受け入れる孔を画定する第二部材を更に備えている請求項16に記載の装置。
- 前記固定部分は、前記所定の相対距離を隔てて前記部材に結合されている請求項10に記載の装置。
- 二つの組織刺通要素と、
可撓性部分によって結合された固定部分を含む組織固定装置と、
を備え、
前記固定部分と前記可撓性部分とは、異なる材料で形成され、
前記二つの組織刺通要素は、前記組織固定装置の前記固定部分を生体組織を介して配置可能に構成されている装置。 - 前記可撓性部分は、縫合糸で構成されている請求項19に記載の装置。
- 前記固定部分の各々は、前記可撓性部分を受け入れる穴を画定している請求項19に記載の装置。
- 前記二つの組織刺通要素は、前記固定部分を収容するチャネルを画定している請求項19に記載の装置。
- 二つの組織刺通要素と、
縫合糸によって結合された固定部分を含む組織固定装置と、
を備え、
前記二つの組織刺通要素は、前記組織固定装置の前記固定部分を生体組織を介して配置可能に構成されている装置。 - 前記固定部分の各々は、前記縫合糸を受け入れる穴を画定している請求項23に記載の装置。
- 前記二つの組織刺通要素は、前記固定部分を収容するチャネルを画定している請求項23に記載の装置。
- 可撓性を有するコイルシャフトと、
前記コイルシャフトの遠位端に位置する組織刺通コイルと、
を備え、
前記組織刺通コイルは、前記コイルシャフトの少なくとも一部とは異なる態様で巻かれている医療器具。 - 前記コイルシャフトを超えて配置される部材を更に備えている請求項26に記載の医療器具。
- 前記部材および前記コイルシャフトは、相対的に移動可能に構成されている請求項27に記載の医療器具。
- 前記部材は、組織を固定可能に構成されている請求項27に記載の医療器具。
- 細長くて可撓性を有するコイルシャフトと、
前記コイルシャフトの遠位端に位置する組織刺通コイルと、
前記コイルシャフトを越えて配置される部材と、
を備え、
前記部材および前記コイルシャフトは、相対的に移動可能に構成されている医療器具。 - 前記部材は、組織を固定可能に構成されている請求項30に記載の医療器具。
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US09/520,273 US6663639B1 (en) | 1999-06-22 | 2000-03-07 | Methods and devices for tissue reconfiguration |
US09/574,424 US6494888B1 (en) | 1999-06-22 | 2000-05-19 | Tissue reconfiguration |
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US8617196B2 (en) | 2004-12-08 | 2013-12-31 | Xlumena, Inc. | Method and apparatus for performing needle guided interventions |
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US10595852B2 (en) | 2012-03-21 | 2020-03-24 | Ethicon Llc | Methods and devices for creating tissue plications |
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Also Published As
Publication number | Publication date |
---|---|
EP1187559A1 (en) | 2002-03-20 |
EP1447052A3 (en) | 2004-10-20 |
CA2556189A1 (en) | 2000-12-28 |
DE60036377D1 (de) | 2007-10-25 |
ATE372726T1 (de) | 2007-09-15 |
AU5760600A (en) | 2001-01-09 |
JP3842128B2 (ja) | 2006-11-08 |
JP2003502098A (ja) | 2003-01-21 |
HK1112827A1 (en) | 2008-09-19 |
EP1815803B8 (en) | 2011-10-05 |
US20020193816A1 (en) | 2002-12-19 |
EP1658812B1 (en) | 2011-10-26 |
ES2290043T3 (es) | 2008-02-16 |
US7153314B2 (en) | 2006-12-26 |
CA2378529C (en) | 2006-10-31 |
EP1447052B1 (en) | 2012-02-15 |
EP1187559B1 (en) | 2007-09-12 |
EP1658812A1 (en) | 2006-05-24 |
ATE545371T1 (de) | 2012-03-15 |
CA2556189C (en) | 2009-10-27 |
EP1815803B1 (en) | 2011-05-18 |
DE60036377T2 (de) | 2008-06-12 |
EP1447052A2 (en) | 2004-08-18 |
AU771895B2 (en) | 2004-04-08 |
US6494888B1 (en) | 2002-12-17 |
ATE530124T1 (de) | 2011-11-15 |
CA2378529A1 (en) | 2000-12-28 |
EP1815803A1 (en) | 2007-08-08 |
WO2000078227A9 (en) | 2001-11-22 |
WO2000078227A1 (en) | 2000-12-28 |
ATE509582T1 (de) | 2011-06-15 |
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