JP2004500190A - 外科用クリップの適用装置 - Google Patents
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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
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- A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
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Abstract
Description
(発明の背景)
1)技術分野
本発明は一般に体組織に外科用クリップ(挾子)を取り付けるためのクリップ適用組立体に関する。特に、本発明はクリップ適用組立体における適正な整合状態を保持するために、顎装置の一部分に沿って延在して、顎装置にハウジングを押圧する初期荷重を作用させる支持面を備えたクリップ適用組立体に関する。
【0002】
2)従来技術の説明
外科用クリップを取り付けるクリップ適用組立体は外科分野において周知である。従来技術のクリップ適用組立体は基端および先端を有する細長いハウジングを含む。従来技術の組立体のハウジングはクリップ供給面も形成されている。それらの組立体は、ハウジングの先端から延在する顎装置と、クリップ供給面から、体組織に外科用クリップを取り付ける顎装置へ外科用クリップを送るためのハウジング内部のクリップ駆動装置も含んでいる。
【0003】
従来技術のクリップ適用組立体は、ハウジングの先端の顎装置が自由な動きまたは浮動を許されているという点で十分ではない。すなわち、従来技術では、顎装置に初期荷重を作用させて顎装置の動きまたは浮動を防止するために顎装置に実質的に押圧される部材がクリップ適用組立体に全くない。外科用クリップが顎装置へ送られるときにクリップ供給面および顎装置が整合されていなければならないことは一般に理解される。適正な整合状態は、体組織に対する外科用クリップの適正な取り付けを保証する。従来技術の組立体における顎装置は初期荷重を作用されておらず、従って動くことを許されているために、それらの組立体内部の外科用クリップがクリップ供給面から顎装置へ誤給送されてしまうことが一般にある。顎装置への外科用クリップの誤給送はクリップ適用組立体内部での外科用クリップの詰まりを生じるか、体組織への外科用クリップの不適正な取り付けを生じることになる。このような2つの結末は、詰まりを解消するために必要な時間の点で、また外科用クリップの取付けミスが生じた場合には患者の安全の点で、機能不全となることがこの分野で理解されている。
【0004】
従来技術のクリップ適用組立体に関する上述した機能不全が理由となって、ハウジングの先端から顎装置の一部分に沿って延在し、外科用クリップをクリップ供給面から顎装置へ適正に送ることができるように顎装置をクリップ供給面と整合状態に保持するために、顎装置に押圧されて初期荷重を作用させる支持面を含む新規なクリップ適用組立体を実現することが望まれる。顎装置は初期荷重を作用され、顎装置がクリップ供給面と常に整合状態にあることから外科用クリップは顎装置へ誤給送され得ないので、それなりに外科手術時間および患者の安全は最適化される。
【0005】
(発明の概要および利点)
クリップ適用組立体が開示される。本発明のクリップ適用組立体は1つまたは複数の外科用クリップを患者の体組織に取り付ける。このクリップ適用組立体は基端および先端を有する細長いハウジングを含む。このハウジングは、先端に隣接して配置されたクリップ供給面を形成される。クリップ適用組立体はハウジングの先端から延在し、少なくとも1つの顎チップ(顎の先端部分)に含まれている顎装置も含む。顎装置は第1および第2のレッグ(脚)を含むことが好ましい。クリップ駆動装置がハウジング内部に配置される。このクリップ駆動装置はクリップ供給面から顎装置へ外科用クリップを送り、クリップはその後に顎装置にて体組織に取り付けられる。
【0006】
このクリップ適用組立体は、ハウジングの先端から顎装置の一部分に沿って延在する支持面をさらに含む。その位置で支持面は顎装置のその部分に押圧されて初期荷重を作用させ、すなわち、クリップ供給面と適正な整合状態に顎装置を保持するために一定の力を作用させる。換言すれば、ハウジングは顎装置に押圧されるように常に初期荷重を作用される。それなりに外科用クリップは誤給送されることなくクリップ供給面から顎装置へ適正に送られることができ、また外科用クリップは適正に、クリップ適用組立体内部で詰まりを生じることなく、体組織に取り付けられることができる。
【0007】
本発明の他の利点は、以下の詳細な説明を参照し、添付図面に関連させて考えることにより一層よく理解されるので、容易に明白となるであろう。
【0008】
(好ましい実施例の詳細な説明)
図面を参照すれば、幾つかの図を通じて同じ符号は同様または同じ部分を示しており、クリップ適用組立体は全体を符号10で示されている。クリップ適用組立体10はこの分野では外科用クリップの適用装置10としても参照されており、以下の説明ではそのように参照する。クリップ適用装置10は患者の体組織に外科用クリップ12(図5に単独に示されている)を取り付ける。勿論、クリップ適用装置10は1つの外科用クリップ12を取り付けることでときどき説明されるが、クリップ適用装置10は患者に複数の外科用クリップを取り付けることもできることを理解しなければならない。この好ましい実施例のクリップ12は図5に開示した形状のもので、クリップ・ベース14およびクリップ・レッグ16を含んでいる。
【0009】
まず図1を参照すれば、クリップ適用装置10は細長いハウジング18、すなわち軸を含み、このハウジングは基端20および先端22を有する。ハウジング18は射出モールド成形ポリカーボネートで形成されることが好ましい。ハウジング18は上側半体24および下側半体26をさらに含む。要求されるわけではないが、ハウジング18の上側半体24および下側半体26は互いにスナップ嵌め付けされることが好ましい。ハウジング18は先端22に隣接してクリップ供給面28(図3に最も良く示されている)を形成されている。図示するように、クリップ供給面28は図面で符号を付されていない第1および第2の分岐給送面を含む。外科用クリップ12はクリップ供給面28の近くでハウジング18の内部、好ましくはカートリッジ内に収容されることを理解しなければならない。
【0010】
図2を参照すれば、クリップ適用装置10は顎装置30をさらに含み、顎装置30は少なくとも1つの顎チップ32および少なくとも1つの顎ショルダ34を含む。顎装置30は患者の体組織に外科用クリップ12を取り付けるために開閉される。顎ショルダ34は角度を付されることができるが、この好ましい実施例の顎ショルダ34は湾曲されている。これは以下にさらに説明される。顎装置30はハウジング18の先端22から特定の角度で外方へ延在する。図示されるように、顎装置30はハウジング18の先端22から外方且つ上方へ延在する。それなりに顎装置30は下面36を含むと説明されることができる。しかしながら以下に説明されるクリップ適用装置10は回転式であるので、ハウジング18から上方へ向いた顎装置30の延在部分は説明のために用いられるだけであり、重要なことではない。顎装置30は少なくとも1つのクリップ・トラック38をさらに含む。本発明は2つのクリップ・トラック38を含むことが好ましい。クリップ・トラック38はクリップ供給面28から外科用クリップ12を受け入れる。外科用クリップ12を体組織に取り付けるために顎装置30が開閉されるときに外科用クリップ12がクリップ・トラック38内に配置される。
【0011】
図1に戻って参照すれば、本発明のクリップ適用装置10はハンドル40および引き金42と組合されて使用される。本発明の範囲を変更することなく何れの形式とすることができる引き金42がハンドル40に配置され、外科用クリップ12をクリップ供給面28から顎装置30へ送ることを助成する。当業者に認識されるようにハンドル40および引き金42は回転機構44によってクリップ適用装置10のハウジング18に対して回転可能である。さらに、クリップ適用装置10とハンドル40との間の取付けのために支持軸46がハンドル40とハウジング18との間に任意に組み込むことができる。支持軸46が含まれるならば、図1に示されるようにハンドル40との連結のためにハウジング18の基端20が支持軸46に取り付けられる。それなりに本発明のクリップ適用装置10は或る量の外科用クリップ12を使い果たした後に交換でき、ハンドル40、引き金42および支持軸46は再使用できる。
【0012】
顎装置30は以下にさらに説明される第1および第2のレッグを含むことが好ましい。しかしながら、本発明の顎装置30は本発明の範囲を変更することなく何れの数のレッグも含むことができることを理解しなければならない。この好ましい実施例の顎装置30は第1の基端レッグ48および第1の先端レッグ50を特に含む。第1の顎チップ52が顎装置30の第1の先端レッグ50に配置され、第1の顎ショルダ54が第1の基端レッグ48および第1の先端レッグ50の間に形成されている。この好ましい実施例は第2の基端レッグ56および第2の先端レッグ58も含む。第2の顎チップ60は顎装置30の第2の先端レッグ58に配置され、第2の顎ショルダ62が第2の基端レッグ56および第2の先端レッグ58の間に形成されている。第1の顎ショルダ54および第2の顎ショルダ62は何れも湾曲されることが好ましい。
【0013】
クリップ適用装置10は、この分野でクリップ・プッシャとして知られているクリップ駆動装置64も含み、クリップ駆動装置はクリップ供給面28から顎装置30へ外科用クリップ12を送るためにハウジング18の内部に配置される。ハウジング18はガイド・トラック66またはチャンネルも形成されており、このトラックはハウジング18の中央に配置され、またクリップ供給面28の第1および第2の分岐給送面の間に配置される。従って、ガイド・トラック66はクリップ駆動装置64が外科用クリップ12をクリップ供給面28から顎装置30へ送る突起に64を中央位置に保持する。本発明はクリップ・ガイド・フィンガ68も組み込んでおり、クリップ・ガイド・フィンガは外科用クリップ12が顎装置30へ送られるときにクリップ供給面28の分岐給送面の各々において外科用クリップ12に対する圧力を保持することに使用される。認識されるように、クリップ駆動装置64を作動させて外科用クリップ12を顎装置30へ送るために、引き金42が作動される、すなわち引かれる。
【0014】
図3を参照すれば、本発明は支持面70を組み入れており、この支持面はハウジング18の先端22から顎装置30の一部分、すなわち或る長さに沿って延在する。さらに詳しくは、支持面70はハウジング18の下側半体26にてハウジング18の先端22から延在する。支持面70は顎装置30のその部分、特に顎装置30の下面36に対して一定の力を作用させることで押圧される。それなりに支持面70は作用的且つ連続的に顎装置30に初期荷重を作用させ、これにより顎装置30が動く、すなわち浮動することを防止して、顎装置30をクリップ供給面28との整合状態に保持する。本出願の説明を通じて顎装置30に初期荷重を作用させると論じる用語が使用されたときは、そのような用語は支持面70が顎装置30のその部分に押圧されてハウジング18が常に顎装置30に初期荷重を作用させることを示すことを意図する。支持面70は顎装置30のクリップ・トラック38をクリップ供給面28と整合させる。上述したように、クリップ適用装置10が適正な整合状態にあるとき、外科用クリップ12はクリップ供給面28から顎装置30のクリップ・トラック38へ適正に送られることができる。
【0015】
図3を参照すれば、支持面70はパッドとも称される隆起した当接面72を含む。この隆起当接面72はそれが一体部分であるような支持面70の直接の伸長部である。顎装置30に初期荷重を作用させるために、隆起当接面72は支持面70から顎装置30へ向かって突出している。図4に最も良く示されるように、顎装置30を効果的に押圧するために、隆起当接面72は支持面70までの変化させた厚さを確定する。さらに詳しくは、この変化させた厚さは、図4に示されるように第1の厚さ74および第2の厚さ76として説明でき、顎チップ32に最も近い第2の厚さ76はクリップ供給面28に最も近い第1の厚さ74よりも厚い。隆起当接面72は特定の傾斜Sを有する頂面78を含む。頂面78の傾斜Sは顎チップ32へ向けて外方へ増大し、顎装置30に初期荷重を作用させるために顎装置30の部分に押圧される隆起当接面72の頂面78となる。頂面78の傾斜Sの値は重要ではないが、頂面78の傾斜Sがハウジング18から顎装置30の延在している角度に等しいかそれを超えることが重要である。
【0016】
支持面70は、その面が顎ショルダ54,62に接触しないようにそれらの顎ショルダ54,62のまわりを型どる輪郭部分80をさらに含む。輪郭部分80は第1の顎チップ52および第2の顎ショルダ62へ向かって顎ショルダ54,62の先で支持面70が顎装置30の部分に押圧されることを可能にしている。好ましい実施例におけるように、顎ショルダ54,62が湾曲されているならば、支持面70および顎ショルダ54,62が互いに接触しないように輪郭部分80は補完的な形状にて顎ショルダ54,62のまわりに湾曲される。しかしながら、顎ショルダ54,62が湾曲されていない場合には、支持面70および顎ショルダ54,62が接触しない限りにおいて輪郭部分80は角度を付与されることができる。
【0017】
顎装置30の第1の先端レッグ50および第2の先端レッグ58に関しては、隆起当接面72は第1の先端レッグ50および第2の先端レッグ58に直接に初期荷重を作用させるために支持面70から突出される。これを達成するために、隆起当接面72は第1の支柱82および第2の支柱84を含む。隆起当接面72の第1の支柱82は顎装置30の第1の先端レッグ50に初期荷重を作用させ、隆起当接面72の第2の支柱84は顎装置30の第2の先端レッグ58に初期荷重を作用させる。
【0018】
最後に、支持面70は溝86も形成されている。溝86は第1の支柱82および第2の支柱84の間に配置され、好ましい実施例では溝86は中央に位置されている。溝86は外科用クリップ12を取り付けるときに体組織を適当に受け入れる。
【0019】
初期荷重の付与には、隆起当接面72が幾分かの圧力を連続的に顎装置30に作用させるようにする公差を必要とするだけである。顎装置30は典型的に金属で作られ、顎装置30のクリップ・トラック38の配向に悪影響せずにハウジング18の支持面70から初期荷重を受ける。このように、隆起当接面72の高さはクリップ・トラック38とクリップ供給面28との整合に悪影響を与えることなく或る「適当な範囲(window of opportunity)」内で変化できる。隆起当接面72を含む支持面70の使用によれば、隆起当接面72の高さは±0.010の公差内に収まるべきことだけである。これまで、クリップ・トラック38の位置公差は±0.010であり、クリップ供給面28の位置公差は±0.015であるので公差合計は±0.025に等しかった。この結果、本発明はクリップ供給面28と顎装置30のクリップ・トラック38との整合精度は約160%ほど改善する。
【0020】
本発明は図解的に説明され、使用した用語は限定ではなく、説明の言葉が自然となるように意図された。
【0021】
明らかなように、本発明の多くの変更および変形が上述の教示に照らして可能である。従って、特許請求の範囲の記載の範囲内で理解されるべきであり、符号は便宜のためだけのもので、どのようにも制限されるべきものではなく、本発明は特定した説明以外に実現することができるのである。
【図面の簡単な説明】
【図1】
クリップ適用装置の斜視図である。
【図2】
顎装置、および顎装置に押圧される支持面を図示しているクリップ適用装置の拡大した斜視図である。
【図3】
顎装置が取り外され、支持面を十分に詳細に示しているクリップ適用装置の拡大斜視図である。
【図4】
支持面を示すクリップ適用装置の側面図である。
【図5】
本発明のクリップ適用装置で使用される外科用クリップの斜視図である。
Claims (22)
- 体組織に外科用クリップを取り付けるためのクリップ適用組立体であって、
基端および先端を有し、前記先端に隣接してクリップ供給面を形成された細長いハウジングと、
前記ハウジングの前記先端から延在し、少なくとも1つの顎チップを含む顎装置と、
前記クリップ供給面から前記顎装置へ外科用クリップを送るために前記ハウジング内部に配置されたクリップ駆動装置と、
前記ハウジングの前記先端から前記顎装置の一部分に沿って延在し、外科用クリップを前記クリップ供給面から前記顎装置へ適正に送ることができるようにするために、前記顎装置に初期荷重を作用させるように前記部分に押圧されて前記顎装置を前記クリップ供給面と整合状態に保持する支持面とを含むクリップ適用組立体。 - 前記顎装置に初期荷重を作用させるために前記支持面から前記顎装置へ向かって突出する隆起当接面を前記支持面が含む請求項1に記載された組立体。
- 前記顎装置に初期荷重を作用させるために前記支持面が前記部分に対して押圧されるように、前記隆起当接面が厚さを変化されている請求項2に記載された組立体。
- 前記支持面の変化された厚さが前記クリップ供給面に最も近い第1の厚さと、前記少なくとも1つの顎チップに最も近い第2の厚さとを含み、前記第2の厚さが前記第1の厚さよりも厚い請求項3に記載された組立体。
- 前記顎装置は前記ハウジングの前記先端から或る角度で延在しており、前記隆起当接面は傾斜を有する頂面を含み、前記顎装置に初期荷重を作用させるために前記頂面が前記部分に押圧されるように、前記少なくとも1つの顎チップへ向かって外側へ前記頂面の前記傾斜が増大している請求項2に記載された組立体。
- 前記顎装置は少なくとも1つの顎ショルダをさらに含み、前記支持面が前記顎ショルダと接触せず、また前記顎ショルダの先の前記少なくとも1つの顎チップへ向かう前記顎装置の前記部分に押圧されるように、前記顎ショルダのまわりを型どる輪郭部分を前記支持面が含む請求項1に記載された組立体。
- 前記少なくとも1つの顎ショルダが湾曲されており、前記輪郭部分が前記湾曲した顎ショルダのまわりを型どる請求項6に記載された組立体。
- 第1の基端レッグと、第1の顎チップを有する第1の先端レッグと、前記第1の基端レッグおよび第1の先端レッグの間の第1の顎ショルダと、第2の基端レッグと、第2の顎チップを有する第2の先端レッグと、前記第2の基端レッグおよび第2の先端レッグの間の第2の顎ショルダとを前記顎装置がさらに含む請求項1に記載された組立体。
- 前記第1および第2の先端レッグに初期荷重を作用させるために、前記支持面から前記顎装置の前記第1および第2の先端レッグへ向かって突出した隆起当接面を前記支持面が含む請求項8に記載された組立体。
- 第1および第2の支柱を前記隆起当接面がさらに含み、前記隆起当接面の前記第1の支柱は前記第1の先端レッグに初期荷重を作用させ、前記隆起当接面の前記第2の支柱は前記第2の先端レッグに初期荷重を作用させる請求項9に記載された組立体。
- 前記支持面が前記第1の顎ショルダに接触せず、前記第1の顎チップへ向かう前記第1の顎ショルダの先の前記顎装置の前記部分に押圧されるように、また前記支持面が前記第2の顎ショルダに接触せず、前記第2の顎チップへ向かう前記第2の顎ショルダの先の前記顎装置の前記部分に押圧されるように、前記第1および第2の顎ショルダのまわりを型どる輪郭部分を前記支持面がさらに含む請求項10に記載の組立体。
- 前記ハウジングが上側半体および下側半体をさらに含み、前記顎装置に初期荷重を作用させるために前記支持面が前記下側半体にて前記ハウジングの前記先端から延在している請求項1に記載された組立体。
- 前記クリップ供給面から外科用クリップを受け入れる少なくとも1つのクリップ・トラックを前記顎装置が含み、前記顎装置に初期荷重を作用させて前記顎装置の前記クリップ・トラックを前記クリップ供給面との整合状態に保持するために、前記支持面が前記部分に沿って延在して前記部分に押圧される請求項1に記載された組立体。
- 前記クリップ駆動装置を中央に保持するために、前記クリップ供給面の第1および第2の分岐給送面の間に前記クリップ駆動装置のガイド・トラックを前記ハウジングがさらに形成されている請求項1に記載された組立体。
- 前記ハウジングの前記先端から上方へ前記顎装置が延在する請求項1に記載された組立体。
- 前記顎装置に初期荷重を作用させるために、前記ハウジングの前記先端から前記顎装置の下面に沿って前記支持面が延在し、前記下面に押圧される請求項15に記載された組立体。
- 前記クリップ供給面から前記顎装置へ外科用クリップを送るために、ハンドル、および前記ハンドルに配置された前記クリップ駆動装置を作動させるための引き金と組み合わされた請求項1に記載された組立体。
- 前記ハンドルおよび背引き金が前記ハウジングに対して回転可能である請求項17に記載された組立体。
- 前記ハンドルおよび背ハウジングの間に配置された支持軸をさらに含む請求項17に記載された組立体。
- 前記ハンドルとの連結のために、前記ハウジングの前記基端が前記支持軸に取り付けられた請求項19に記載された組立体。
- 外科用クリップの取り付け時に体組織を受け入れるために、前記第1および第2の支柱の間に配置された溝を前記支持面が形成されている請求項10に記載された組立体。
- 体組織に取り付けられる外科用クリップと、
基端および先端を有し、前記先端に隣接してクリップ供給面を形成された細長いハウジングと、
前記ハウジングの前記先端から延在し、少なくとも1つの顎チップを含む顎装置と、
前記クリップ供給面から前記顎装置へ前記外科用クリップを送るために前記ハウジング内部に配置されたクリップ駆動装置と、
前記顎装置に初期荷重を作用させて前記顎装置を前記クリップ供給面と整合状態に保持し、前記外科用クリップが前記クリップ供給面から前記顎装置へ適正に送られることができるように、前記ハウジングの前記先端から前記顎装置の一部分に沿って延在し、前記部分に押圧される支持面とを含むクリップ適用組立体。
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JP2014531248A (ja) * | 2011-09-15 | 2014-11-27 | テレフレックス メディカル インコーポレイテッドTeleflex Medical Incorporated | 自動外科用結紮クリップアプライヤ |
US10130373B2 (en) | 2011-09-15 | 2018-11-20 | Teleflex Medical Incorporated | Automatic surgical ligation clip applier |
US10307166B2 (en) | 2011-09-15 | 2019-06-04 | Teleflex Medical Incorporated | Manual surgical ligation clip applier |
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Also Published As
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---|---|
WO2001056455A2 (en) | 2001-08-09 |
EP1251784A4 (en) | 2005-11-30 |
JP2006218331A (ja) | 2006-08-24 |
WO2001056455A3 (en) | 2002-05-10 |
KR20020081295A (ko) | 2002-10-26 |
AU3665101A (en) | 2001-08-14 |
MXPA02007506A (es) | 2004-08-23 |
CA2398820A1 (en) | 2001-08-09 |
DE60130317T2 (de) | 2008-06-12 |
CN1424891A (zh) | 2003-06-18 |
EP1251784A2 (en) | 2002-10-30 |
CN1302754C (zh) | 2007-03-07 |
CA2398820C (en) | 2009-04-07 |
US20010047178A1 (en) | 2001-11-29 |
AU783228B2 (en) | 2005-10-06 |
DE60130317D1 (de) | 2007-10-18 |
US6520972B2 (en) | 2003-02-18 |
EP1251784B1 (en) | 2007-09-05 |
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