JP2005144192A - モノポーラ伸張部を備えているバイポーラ鉗子 - Google Patents
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Abstract
【解決手段】 内視鏡鉗子のハウジングに取付けられたシャフトの遠位端に第1顎部材及び第2顎部材が取付けられる。内視鏡鉗子は、第1顎部材及び第2顎部材を互いに相関的に、両顎部材が互いに間隔を設けて配置される第1位置から、両顎部材が協働して間に挟んだ組織を把持する第2位置に移動させるアクチュエータを備える。各顎部材は電気外科手術エネルギー源に接続され、バイポーラモードで両顎部材は間に挟んだ組織を通してバイポーラエネルギーを伝達して組織を処理する。モノポーラ素子は第1の顎部材内の第1位置から、第1の顎部材から遠位にある第2位置に移動可能であり、両顎部材と独立して作動可能である。
【選択図】 図1A
Description
本願はローエス(Lawes)らにより2003年9月17日に出願された「モノポーラ伸張部を備えているバイポーラ鉗子(Bipolar Forceps Having Monopolar Extension)」という発明名称の米国予備出願連続番号第60/520,579号(特許文献1)の優先権を主張するものであり、同出願の全内容をここに援用する。
本件開示は電気外科手術用の鉗子に関するものであり、特に、本件開示は電気外科手術的効果を増長させるために選択的に電力投入可能で、かつ/または、伸張自在なモノポーラ伸張部を備えている、組織を凝固し、組織を閉じ、かつ/または、組織を切断するための内視鏡バイポーラ電気外科手術用鉗子に関連している。
電気外科手術用の鉗子は機械的クランプ動作と電気エネルギーの両方を利用して、組織および血管を加熱して組織を凝固させ、組織を焼灼し、かつ/または、組織を閉じることにより、止血を実施する。切開外科手術処置と併用するための開放型鉗子の代用として、かなり多数の昨今の外科医が内視鏡および内視鏡器具を利用することで、より小さい穿孔状の切開部を通して諸器官に遠隔から接近するようにしている。その直接的な結果として、患者は傷が小さくて済んだり、治癒時間が短縮されるという恩恵を得る傾向にある。
ここで図1Aから図1Dを参照すると、多様な外科手術処置手順と併用するための内視鏡鉗子10の一実施形態が例示されている。そのため本明細書では、血管閉鎖鉗子を例示して説明しているが、それ以外のタイプの鉗子または手術鋏を利用してもよいことが想像されるが、上記両器具ともが焼灼、凝固、または、それ以外の目的で組織処理を実施するとともに、本明細書に記載されているようにモノポーラ応用例のために構成されている。更に、図面は内視鏡外科手術処置手順に関連して使用するための鉗子10を描写しているが、本件開示はより従来型に近い切開外科手術処置手順について使用されてもよい。そのため本明細書では、鉗子10が内視鏡器具に関連づけて説明されるが、鉗子10の開放型改訂版が上述のものと同じ動作構成要素、または、類似する動作構成要素を備えているとともに、以下に記載されるような特性を有していても良いものと思量される。
上述のように、鉗子10がバイポーラ動作に適した構成にされた場合、スイッチ200を作動状態にすることによりエネルギーを顎部材110から組織を通って顎部材120に伝達して、組織を処理する。モノポーラモードでは、スイッチ200(または、フットスイッチのような別個のスイッチ)を作動状態にすることでモノポーラ素子154にエネルギーを伝達し、組織を通して、更に、患者の隣接位置または患者に接触させて設置された戻りパッドのような戻り電極550に伝達する。モノポーラ作動モードにより、モノポーラ素子154は無血管組織構造体を迅速に処置し、かつ/または、狭い組織平面部を迅速に切開することができる。
トリガー71が解放されるとき、ナイフ185は自動的にナイフチャネル115の中に引っ込められ、図5Aに示すように、作動前の位置に戻される。同時に、止め具119は、その初期位置に逆戻りし、その後の作動のために、ナイフチャネル115を一時的にさえぎる。
12 シャフト
20 ハウジング
30 ハンドルアセンブリ
40 可動ハンドル
44 ロックフランジ
50 固定ハンドル
60 往復運動スリーブ
70 トリガーアセンブリ
80 回転アセンブリ
90 フランジ
100 末端作動体アセンブリ
110 第1顎部材
117 戻り止め突起部
120 第2顎部材
300 電気外科手術用発電機
310 ケーブル
550 戻り電極
Claims (17)
- 内視鏡鉗子において、
シャフトが取付けられたハウジングを備え、シャフトは、その遠位端に第1顎部材および第2顎部材が取付けられており、
さらに、第1顎部材と第2顎部材が互いに間隔を設けて配置される第1位置から、両顎部材が協働して間に挟んだ組織を把持する第2位置へと、第1顎部材および第2顎部材を互いに相関的に移動させるアクチュエータと、
両顎部材の各々に接続されて、両顎部材がバイポーラモードで選択的に作動することができるようにした電気外科手術エネルギー源とを備え、このバイポーラモードにより両顎部材は間に挟んだ組織を通してバイポーラエネルギーを通電し、組織を処理することができるようになっており、
さらに、少なくとも第1の顎部材の内部に収容され、第1の顎部材内の第1位置から第1の顎部材から遠位にある第2位置へと選択的に移動可能であるモノポーラ素子を備え、モノポーラ素子は電気外科手術エネルギー源に接続され、両顎部材とは独立して選択的に作動自在となるように構成されている、
ことを特徴とする内視鏡鉗子。 - 前記モノポーラ素子は先鋭な切開端縁を備えていることを特徴とする、請求項1に記載の内視鏡鉗子。
- 前記鉗子はナイフを更に備えており、該ナイフは第1の顎部材と第2の顎部材のうちの少なくとも一方の内部に画定されたナイフチャネルの内側で選択的に移動可能であって、第1顎部材と第2顎部材の間に位置する組織を切開することを特徴とする、請求項1に記載の内視鏡鉗子。
- 前記鉗子は血管閉鎖用の鉗子であり、前記第1顎部材と前記第2顎部材のうちの少なくとも一方は、その上に少なくとも1個の非導電性の係止部材を有しており、この係止部材は、組織が第1顎部材と第2顎部材の間に挟まれて保持された際に、両顎部材の間の距離を制御することを特徴とする、請求項1に記載の内視鏡鉗子。
- 前記モノポーラ素子はナイフであり、該ナイフは、前記第1顎部材と前記第2顎部材のうちの少なくとも一方の内部に定められたナイフチャネルの内側で選択的に移動可能であり、両顎部材の間に挟まれた組織をまず切開してから、続いて、両顎部材から遠位方向に伸張し、該ナイフは電源投入されて、組織をモノポーラ方式で処理することを特徴とする、請求項1に記載の内視鏡鉗子。
- 前記ナイフは安全装置を有しており、該安全装置は、ナイフが前記第1顎部材および前記第2顎部材の遠位先端部から伸張した場合にのみナイフが電気的に活性化することしか許容しないことを特徴とする、請求項5に記載の内視鏡鉗子。
- トリガーが作動することで、ナイフを移動させて前記第1顎部材および前記第2顎部材の間に挟まれた組織を分割すると共に、第1顎部材内の第1位置から第1顎部材から遠位にある第2位置へと前記モノポーラ素子を伸張させることを特徴とする、請求項3に記載の内視鏡鉗子。
- アクチュエータが作動することで、前記第1顎部材および前記第2顎部材を互いに相関的に前記第1位置から前記第2位置へと移動させて両顎部材の間に挟まれた組織を把持すると共に、第1顎部材内の第1位置から第1顎部材から遠位にある第2位置へと前記モノポーラ素子を伸張させることを特徴とする、請求項1に記載の内視鏡鉗子。
- 前記鉗子がもう1つ別な第2のアクチュエータを更に備えており、該アクチュエータが作動することで、前記第1顎部材内の第1位置から第1顎部材から遠位にある第2位置へと前記モノポーラ素子を伸張させることを特徴とする、請求項1に記載の内視鏡鉗子。
- 内視鏡鉗子において、
シャフトが取付けられたハウジングを備え、シャフトはその遠位端に第1顎部材および第2顎部材が取付けられており、第1顎部材は第2顎部材に対して遠位方向に伸張し、
さらに、第1顎部材と第2顎部材が互いに間隔を設けて配置される第1位置から、両顎部材が協働して間に挟んだ組織を把持する第2位置へと、第1顎部材および第2顎部材を互いに相関的に移動させるアクチュエータと、
両顎部材の各々に接続されて、両顎部材がバイポーラモードで選択的に作動することができるようにした電気外科手術エネルギー源とを備え、このバイポーラモードにより両顎部材は間に挟んだ組織を通してバイポーラエネルギーを通電し、組織を処理することができるようになっており、
さらに、制御スイッチを備え、制御スイッチは、選択的に作動状態にされると、第2顎部材を非活性化するとともに第1の顎部材を第1の電位で活性化し、同時に、戻り電極を異なる電位で活性化して、第1の顎部材がモノポーラ方式で選択的に組織を処理することができるようにしている、
ことを特徴とする内視鏡鉗子。 - 前記鉗子は安全装置を更に備えており、安全装置は、前記第1顎部材と前記第2顎部材が第2位置に配置された時のみに制御スイッチを電気活性化することしか許容しないようにすることを特徴とする、請求項10に記載の内視鏡鉗子。
- 内視鏡鉗子において、
シャフトが取付けられたハウジングを備え、シャフトはその遠位端に第1顎部材および第2顎部材が取付けられており、第1顎部材は第2顎部材に相対して遠位方向に伸張し、
さらに、第1顎部材と第2顎部材が互いに間隔を設けて配置される第1位置から、両顎部材が協働して間に挟んだ組織を把持する第2位置へと、第1顎部材および第2顎部材を互いに相関的に移動させるアクチュエータと、
両顎部材の各々に接続されて、両顎部材がバイポーラモードで選択的に作動することができるようにした電気外科手術エネルギー源とを備え、このバイポーラモードにより両顎部材は間に挟んだ組織を通してバイポーラエネルギーを通電し、組織を処理することができるようになっており、
さらに、制御スイッチを備え、制御スイッチは、選択的に作動状態にされると、第1の電位で第1の顎部材と第2の顎部材を活性化するとともに、これとは異なる電位で戻り電極を活性化し、これにより、第1顎部材と第2顎部材が組織をモノポーラ方式で選択的に処理することができるようにしている、
ことを特徴とする内視鏡鉗子。 - 前記鉗子は安全装置を更に備えており、安全装置は、前記第1顎部材と前記第2顎部材が第2位置に配置された時のみに制御スイッチを電気活性化することしか許容しないようにすることを特徴とする、請求項12に記載の内視鏡鉗子。
- 電気外科手術用発電機からの電気外科手術エネルギーで組織を処理する方法であって、
内視鏡鉗子を設ける段階を含み、内視鏡鉗子は、
シャフトが取り付けられたハウジングを備え、シャフトはその遠位端に第1顎部材および第2顎部材が取付けられており、
さらに、第1顎部材と第2顎部材が互いに間隔を設けて配置される第1位置から、両顎部材が協働して間に挟んだ組織を把持する第2位置へと、第1顎部材および第2顎部材を互いに相関的に移動させるアクチュエータと、
少なくとも第1の顎部材の内部に収容され、第1の顎部材内の第1位置から第1の顎部材から遠位にある第2位置へと選択的に移動可能であるモノポーラ素子と、
患者の体組織に接触して設置される戻り電極を備え、
前記方法は、さらに、
両顎部材の各々にモノポーラ素子を接続し、戻り電極を電気外科手術用発電機に接続する段階と、
両顎部材の間に組織を挟んで把持する段階と、
両顎部材を選択的に活性化させて、両顎部材の間に挟まれた組織をバイポーラ方式で処理する段階と、
モノポーラ素子と戻り電極とを両顎部材からは独立して選択的に活性化させて、組織をモノポーラ方式で処理する段階とを含むことを特徴とする方法。 - 前記第1顎部材と前記第2顎部材を選択的に活性化させて組織を処理する段階の後に、両顎部材の遠位端から前記モノポーラ素子を伸張させる段階を含むことを特徴とする、請求項14に記載の方法。
- モノポーラ素子を選択的に活性化させる前記段階は、前記第1顎部材および前記第2顎部材を不活性化させる段階を含むことを特徴とする、請求項14に記載の方法。
- 前記第1顎部材と前記第2顎部材を選択的に活性化させて組織を処理する段階の後に、両顎部材から前記組織を解放する段階を含むことを特徴とする、請求項14に記載の方法。
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Also Published As
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EP1530952B1 (en) | 2010-01-06 |
AU2010212496A1 (en) | 2010-09-16 |
US8257352B2 (en) | 2012-09-04 |
EP1530952B2 (en) | 2013-10-16 |
US20140100569A1 (en) | 2014-04-10 |
CA2487579C (en) | 2013-01-29 |
DE602004024947D1 (de) | 2010-02-25 |
JP4988909B2 (ja) | 2012-08-01 |
US7367976B2 (en) | 2008-05-06 |
ES2335759T3 (es) | 2010-04-05 |
JP2011005282A (ja) | 2011-01-13 |
AU2010212496B2 (en) | 2013-08-22 |
US10441350B2 (en) | 2019-10-15 |
ES2335759T5 (es) | 2014-02-04 |
AU2004231188B2 (en) | 2010-11-11 |
US8597296B2 (en) | 2013-12-03 |
JP5202788B2 (ja) | 2013-06-05 |
US20110004209A1 (en) | 2011-01-06 |
US20130023874A1 (en) | 2013-01-24 |
JP5336551B2 (ja) | 2013-11-06 |
JP2011212449A (ja) | 2011-10-27 |
EP1530952A1 (en) | 2005-05-18 |
US20080243120A1 (en) | 2008-10-02 |
AU2004231188A1 (en) | 2005-06-02 |
US20050137590A1 (en) | 2005-06-23 |
CA2487579A1 (en) | 2005-05-17 |
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