JP2006000638A - 非同一線上の軸に取り付けられた無性ジョーを備えた内視鏡クリップアプライヤー。 - Google Patents
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Abstract
【解決手段】 基端部及び先端部を有する可撓性チューブと、可撓性チューブ内に延在する、基端部及び先端部を有する制御部材と、チューブの先端部及び制御部材の先端部に結合された一対の同一の無性ジョーと、ジョーに近接した複数のクリップと、チューブの基端部及び制御部材の基端部に結合されたアクチュエータとを含む内視鏡クリップアプライヤー。
【選択図】 図1
Description
本願は、言及することを以ってその開示内容の全てを本明細書の一部とする同日出願の米国特許出願(整理番号:ISD‐083)(名称:「外科用クリップ(Surgical Clip)」)に関連する。
図1‐図6に、手動アクチュエータの第1の実施形態が示されている。図30‐図37に、手動アクチュエータの現在好適な実施形態が示されており、詳細は後述する。
ここで図7‐図10を参照されたい。制御部材36及び48が、手動アクチュエータ18の先端部に結合された可撓性コイル12の内部に延在する。本発明に従えば、コイル12は、剛性部材60によって互いに結合された基端部分12a及び先端部分12bの2つの部分を有する。剛性部材60は、実質的に円筒状であって、端部60‐2及び60‐3よりも直径の大きな中心部分60‐1を有する。端部60‐2及び60‐3は、コイル12a及び12b内に適合する寸法であり、中心部分60‐1は、コイル12a及び12bの外径と実質的に同じ外径寸法を有する。剛性部材60は4つの孔60a‐60dを有する。その1つの孔60dは、ねじを備えており、第2の制御部材48のねじ部分に螺合する。剛性部材60がコイル12a及び12bに対して固定されているため、このねじの螺合により、第2の制御部材48がクランク26(図2)によって回転すると、第2の制御部材48が剛性成部材60の内部を先端側に移動することを理解されたい。
ここで図11‐図13を参照されたい。ねじ付きの第2の制御部材48の先端部がクリッププッシャー70に結合されている。図12に最も良く示されているように、プッシャー70は、概ね直線状の部材であって、ノッチ70bが横断する軸外孔70aを有する。内側に湾曲し先端側に延びた一対のフィンガー70c及び70dが、肩70f及び70gによって先端開口70eから離れている。図11に最も良く示されているように、ねじ付き制御部材48の先端部が孔70a内に延び、ノッチ70b内に保持されたシリンダ72に結合されている。シリンダ72は、制御部材48に対して加締めるまたは溶接することができる。プッシャーと制御部材の結合は、制御部材がプッシャーに対して自由に回動できる結合である。図11に最も良く示されているように、制御部材48の先端部48bが尖っており、孔70aの先端部に円錐壁70hが画定されている。円錐壁70hは、その頂角が先端48bの頂角よりも大きい。上記した説明から、当業者には、制御部材48が回転すると、制御部材48が先端側に前進し、プッシャーが先端側に押し出されることを理解できよう。制御部材48とプッシャー70の摩擦係合が、円錐壁70hの頂点と先端48bの小さな係合面積に限定されていることを理解できよう。
図13及び図16に最も良く示されているように、一連のクリップ76が、ジョー組立体20の基端側のコイル12の先端部分12bの内側のガレージ80内に受容されている。ガレージ80の詳細は図14‐図17に示されている。ガレージ80は通常、複数の平行な側壁80a‐80l、及び側壁に対して垂直な先端側に延びた一対のフィンガー80m及び80nを含む。各側壁は、複数の外側を向いたスペーサ(例えば、80c‐1、80c−2、80c‐3、80c‐4)を有する。これらのスペーサは、コイルの内面に係合し、プルワイヤ62及び64(図16を参照)が通過できるようにコイルとガレージとの間の空間を確保している。外側に向いたスペーサを形成することにより、細いストリップ(例えば、80ab、80bc、80cdなど)になり、ガレージに可撓性が付与される。器具の先端部における可撓性は、内視鏡が反転した場合に重要であろう。図16に最も良く示されているように、クリップがガレージ内に配置されると、この細い領域で1つのクリップが別のクリップに対して当接する。従って、クリップがその当接部で曲がることができる。
図17‐図27に、クレビス82及び一対のジョー84及び86を含むジョー組立体20の詳細が例示されている。各ジョーは、無性噛み合いジョーすなわち各ジョーが同一であって、互いに噛み合うように構成されている。各ジョーは、基端タング84a及び86a、ジョーの長軸の両側の互いに半ピッチずれた側歯84b及び86b、先端歯84c及び86c、及び取付け孔84d及び86dを含む。ジョーは、それぞれの取付け孔を介してクレビスに結合されている。図27に最も示されているように、クレビス82は、2つの軸がずれたボス82a及び82bを有する。これらのボスに、ジョーがリベットによって取り付けられ、所定の位置に保持されている。プルワイヤ62及び64の先端部がドッグレッグに曲げられ、ジョーのそれぞれのタング84a及び86aに結合されている。従って、プルワイヤの先端側への移動により、図18及び図19に示されているようにジョーが開き、プルワイヤの基端側への移動により、図20及び図21に示されているようにジョーが閉じることを理解されたい。ずれたボスを用いることにより、ジョーのメカニカルアドバンテージが増大する。クレビスはまた、一対のストッパー82e及び82f(図26に最も良く示されている)を備えている。これらのストッパーは、ジョーのタングの耳84a‐1及び86a‐1に係合して、閉じる時にジョーが軸から45度〜60度回動することを可能にし、またジョーの約10度の過剰な回動を可能にする。これにより、閉じたジョーが内視鏡の内腔内を介して曲がった通路を移動することができる。
図28‐図28bを参照すると、クリップ301及びクリップ前進機構の代替の実施形態が示されている。クリップ301は、基端部にねじ孔301aが設けられているという点を除いて、上記したクリップと実質的に同じ構造を有する。図28に、回動可能な制御部材148のねじ端部148aに螺合した複数のクリップ301‐304が示されている。制御部材148は、コイルまたはアクチュエータに対して平行移動しないように取り付けられるという点を除いて、上記した制御部材48に類似している。具体的には、制御部材148は、基端コイルと先端コイル(不図示)との間に位置するスラスト軸受312内に配置されたスラストカラー310に取り付けられている。制御部材148が回転すると、制御部材とのねじ係合によりガレージ(不図示)が平行移動して、クリップ301‐304は回転しない。
図30‐図37に、現在好適な手動アクチュエータ418が例示されている。400が加算された類似の参照番号は、図1‐図6の手動アクチュエータ18の類似した構成部品を指す。手動アクチュエータ418は、レバー422、ノブ424、及びクランク426を含む。この実施形態の第1の態様に従えば、第2のクランク426’が、アクチュエータの反対側に設けられている。図30及び図32に最も良く示されているように、クランク426及び426’は、ギザギザが付けられていて、クランク26のようにクランクハンドルを備えていない。図31‐図33に示されているように、アクチュエータ418はアクチュエータ18と同様に、フィンガーグリップ428、及びサムグリップ430を有するレバー422を備えている。係合フック432及び434により、図32に示されているようにレバーを閉じた位置に解除可能に固定することができる。
図38‐図40に、力制限ばね以外は上記したアクチュエータと実質的に同一の手動アクチュエータ600の力制限ばねの第1の代替の実施形態が例示されている。アクチュエータ600は、リンケージ604に結合されたサムレバー602を有する。リンケージ604の先端部が、ばね606の先端部に係合している。ワッシャー608が、ばね606の基端部近傍に配置され、シャトル610がワッシャー608の基端側に配置されてリンケージ604のストッパー壁611に当接している。制御部材612が、リンケージ604、ばね606、及びワッシャー608を通過してシャトル610に結合されている。シャトル610は、図40に例示されている2つの同一部品から構成されている。それぞれの部品610は、概ね円柱状であって、一対の固定ナブ610a及び610bと、一対のナブ受容ソケット610c及び610dを有する。部品610の内部には、中心をずれたワイヤ係合タング610eが形成され、両端には軸方向の半孔610f及び610gが形成されている。上記説明から、当業者であれば、制御ワイヤをシャトルの2つの部品間に配置し、これらの部品を互いに押圧して制御ワイヤを2つのタング610eによってS字状に曲げ、シャトルを制御ワイヤに対して固定できることを理解できよう。
現在好適な実施形態では、十分な円柱の剛性が得られるように可撓性コイルの少なくとも一部(この場合は先端側コイル12b)が予荷重される。ジョー84及び86が閉じると、プルワイヤによりクレビスとナットの間の荷重が大きくなる。クリップが取り付けられると、プルワイヤが先端側に作動してジョーが開く。圧迫されたクリップ列の力、そして必要に応じてプルワイヤからの力が、先端側コイルの予荷重に十分に打ち勝ち、ジョー及びクレビスが、ジョーの成形アンビルに対して圧迫されたクリップの尖叉から離れる。この概念の代替の実施形態では、クレビスのボスに取り付けるための楕円形の孔をジョーに設ける。ジョーが閉じる際に、プルワイヤによりジョーがクレビスに対して基端側に移動する。プルワイヤの張力が解放されて先端側に作動すると、ジョーもまた、クレビスに対して先端側に移動してクリップの尖叉に対する圧縮荷重が解除される。
図44及び図45に、取付け孔184d及び186dを除いてジョー84及び86に実質的に同一であるジョー184及び186の代替の実施形態が例示されている。この実施形態では、取り付け孔184d及び186dは円形ではない。これらの取付け孔は、偏円すなわちスロットである。これにより、ジョーが開閉する時に先端側及び基端側にスライドすることができる。従って、ジョーは、図44に示されているように、閉じる時に基端側に移動する。この位置で、クリップが、上記したように成形アンビルとして作用する閉じたジョーの中に発射される。図45に示されているように、ジョーは、開く時に、成形されたクリップから離れるように先端側にスライドし、これによりジョーの先端アンビルが成形クリップの尖叉から離れるため、ジョーが容易に開くことができる。
(1)内視鏡クリップアプライヤーであって、
基端部及び先端部を有する可撓性チューブと、
前記可撓性チューブ内に延在する、基端部及び先端部を有する制御部材と、
前記チューブの前記先端部及び前記制御部材の前記先端部に結合された一対の同一の無性ジョーと、
前記ジョーに近接した複数のクリップと、
前記チューブの前記基端部及び前記制御部材の前記基端部に結合されたアクチュエータとを含むことを特徴とする内視鏡クリップアプライヤー。
(2)前記各ジョーが非同一線上の異なる軸にそれぞれ回動可能に取り付けられていることを特徴とする実施態様(1)に記載の内視鏡クリップアプライヤー。
(3)前記チューブが長軸を有しており、
前記各ジョーが基端タング及び先端歯を有しており、
前記基端タング及び前記先端歯が互いに前記長軸の反対側に設けられていることを特徴とする実施態様(1)に記載の内視鏡クリップアプライヤー。
(4)前記ジョーが閉じると、前記ジョーの内部が前記クリップを成形するためのアンビルを成すことを特徴とする実施態様(1)に記載の内視鏡クリップアプライヤー。
(5)前記クリップが2つの対抗した尖叉を有し、前記アンビルにより前記各尖叉が概ね半円状に曲げられることを特徴とする実施態様(4)に記載の内視鏡クリップアプライヤー。
基端部及び先端部を有する可撓性チューブと、
前記可撓性チューブ内に延在する、基端部及び先端部を有する制御部材と、
前記チューブの前記先端部及び前記制御部材の前記先端部に結合された一対の同一の無性ジョーと、
前記チューブの前記基端部及び前記制御部材の前記基端部に結合されたアクチュエータとを含み、
前記ジョーの内部がアンビルを成すことを特徴とする内視鏡クリップアプライヤー。
(7)内視鏡クリップを排出する方法であって、
内視鏡の内腔を介して、一対の同一の無性ジョーを有する器具を送るステップと、
前記ジョーを組織に対して閉じるステップと、
前記閉じたジョーの内部に前記クリップを押し込んで前記クリップを排出するステップとを含むことを特徴とする方法。
(8)前記ジョーを閉じる前記ステップが、前記各ジョーを別々の非同一線上の軸を中心にそれぞれ回動させるステップを含むことを特徴とする実施態様(7)に記載の方法。
(9)前記クリップを排出する前記ステップが前記ジョーの内部で前記クリップを成形するステップを含むことを特徴とする実施態様(7)に記載の方法。
(10)前記成形するステップが前記クリップの一部を約180度の弧に曲げるステップを含むことを特徴とする実施態様(9)に記載の方法。
(12)内視鏡クリップアプライヤーであって、
基端部及び先端部を有する可撓性チューブと、
前記可撓性チューブ内に延在する、基端部及び先端部を有する制御部材と、
前記チューブの前記先端部及び前記制御部材の前記先端部に結合された一対の性ジョーと、
前記ジョーに近接した複数のクリップと、
前記チューブの前記基端部及び前記制御部材の前記基端部に結合されたアクチュエータとを含み、
前記各ジョーが非同一線上の異なる軸にそれぞれ回動可能に取り付けられていることを特徴とする内視鏡クリップアプライヤー。
12 可撓性コイル
14 可撓性コイル基端部
16 可撓性コイル先端部
18 手動アクチュエータ
20 ジョー組立体
22 レバー
24 ノブ
26 クランク
26a 外周フィンガーグリップ
26b 刻み付き外周面
26c クランクハンドル
28 フィンガーグリップ
30 サムグリップ
32 レバー係合フック
34 フィンガーグリップ係合フック
36 第1の制御部材
36a シェパードクルック
38 ばね
38a 基端カップラー
38b 力制限キャップ
38c 力制限カップ
38d オーバーロードナット
38e 先端カップラー
40 スプライン
44 リンケージ
44a U字型部材
48 第2の制御部材
48a シェパードクルック
48b 制御部材先端部
50 クラウン歯車
52 ピニオン
54 シリンダ
55、57 軸受
56 フライホイール
58 戻り止めロック
58a プッシュボタン
58b フランジ
58c 固定ピン
58d フランジ
58e ばね
58f 段付き孔
60 剛性部材
62 プルワイヤ
66 ジョイナー
68 2内腔可撓性シース
70 クリッププッシャー
70a 孔
70c、70d フィンガー
70e 先端開口
70h 円錐壁
72 シリンダ
74 クリップ
76 一連のクリップ
78 最下位のクリップ
80 ガレージ
80m、80n フィンガー
80m‐1、80n‐1 先端クリップ
80m‐2、80n‐2 基端ストッパー
80p、80q フィンガー
80r 基端カラー
82 クレビス
82a、82b ボス
82c、82d 先端フィン
82e、82f ストッパー
84、86 ジョー
84a、86a 基端タング
84b、86b 側歯
84c、86c 先端歯
86a 基端タング
86d 取付け孔
112 コイル
113 基端ブッシュ
115 ワッシャー/スペーサ
118 ハンドル
119 凹部
136 制御部材
138 圧縮羽
148 制御部材
148a ねじ端部
182 先端側クレビス
184、186 ジョー
184d、186d 取付け孔
301‐304 クリップ
301a ねじ孔
310 スラストカラー
312 スラスト軸受
418 アクチュエータ
422 レバー
424 ノブ
426 クランク
426’ 第2のクランク
428 フィンガーグリップ
430 サムグリップ
432、434 係合フック
446 トランスミッション
447 入力平歯車
449 ステップアップ平歯車
452 ピニオン
454 シリンダ
456 フライホイール
500 クランク軸
502、504 円柱構造
506 ラチェット歯
508 ポスト
510 ラチェット爪
512 カウンタ歯車
514 ハブ歯車
516 表示
518 直立リブ
520、522 窓
524 インデックス孔
526 ランプ
528 ステップ
530 板ばね
532 リップ
534 タング
536 リフティングランプ
538 開口
604 リンケージ
606 ばね
608 ワッシャー
610 シャトル
610a、610b 固定ナブ
610c、610d ナブ受容ソケット
610e ワイヤ係合タング
610f、610g 半孔
611 ストッパー壁
700 アクチュエータ
702 サムレバー
702a レバー上側部品
702b レバー下側部品
702e、702d 脚
702f 上部フィンガー
703 回動ポスト
706 捩りばね
706a ばね前部
706b ばね後部
710 ボール
710a、710b 固定ナブ
710c、710d ナブ受容ソケット
710e ワイヤ係合タング
710f、710g 半孔
Claims (8)
- 内視鏡クリップアプライヤーであって、
基端部及び先端部を有する可撓性チューブと、
前記可撓性チューブ内に延在する、基端部及び先端部を有する制御部材と、
前記チューブの前記先端部及び前記制御部材の前記先端部に結合された一対の同一の無性ジョーと、
前記ジョーに近接した複数のクリップと、
前記チューブの前記基端部及び前記制御部材の前記基端部に結合されたアクチュエータとを含むことを特徴とする内視鏡クリップアプライヤー。 - 前記各ジョーが非同一線上の異なる軸にそれぞれ回動可能に取り付けられていることを特徴とする請求項1に記載の内視鏡クリップアプライヤー。
- 前記チューブが長軸を有しており、
前記各ジョーが基端タング及び先端歯を有しており、
前記基端タング及び前記先端歯が互いに前記長軸の反対側に設けられていることを特徴とする請求項1に記載の内視鏡クリップアプライヤー。 - 前記ジョーが閉じると、前記ジョーの内部が前記クリップを成形するためのアンビルを成すことを特徴とする請求項1に記載の内視鏡クリップアプライヤー。
- 前記クリップが2つの対抗した尖叉を有し、前記アンビルにより前記各尖叉が概ね半円状に曲げられることを特徴とする請求項4に記載の内視鏡クリップアプライヤー。
- 内視鏡クリップアプライヤーであって、
基端部及び先端部を有する可撓性チューブと、
前記可撓性チューブ内に延在する、基端部及び先端部を有する制御部材と、
前記チューブの前記先端部及び前記制御部材の前記先端部に結合された一対の同一の無性ジョーと、
前記チューブの前記基端部及び前記制御部材の前記基端部に結合されたアクチュエータとを含み、
前記ジョーの内部がアンビルを成すことを特徴とする内視鏡クリップアプライヤー。 - 内視鏡クリップを排出する方法であって、
内視鏡の内腔を介して、一対の同一の無性ジョーを有する器具を送るステップと、
前記ジョーを組織に対して閉じるステップと、
前記閉じたジョーの内部に前記クリップを押し込んで前記クリップを排出するステップとを含むことを特徴とする方法。 - 内視鏡クリップアプライヤーであって、
基端部及び先端部を有する可撓性チューブと、
前記可撓性チューブ内に延在する、基端部及び先端部を有する制御部材と、
前記チューブの前記先端部及び前記制御部材の前記先端部に結合された一対の性ジョーと、
前記ジョーに近接した複数のクリップと、
前記チューブの前記基端部及び前記制御部材の前記基端部に結合されたアクチュエータとを含み、
前記各ジョーが非同一線上の異なる軸にそれぞれ回動可能に取り付けられていることを特徴とする内視鏡クリップアプライヤー。
Applications Claiming Priority (8)
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US10/867,395 US7367939B2 (en) | 2004-06-14 | 2004-06-14 | Rotational, translational and torqueing control members for an endoscopic instrument |
US10/867,498 US8211119B2 (en) | 2004-06-14 | 2004-06-14 | Endoscopic surgical instrument having a rotational actuator |
US867483 | 2004-06-14 | ||
US10/867,413 US7357806B2 (en) | 2001-12-06 | 2004-06-14 | Clip ejector for endoscopic clip applier |
Publications (2)
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JP2006000638A true JP2006000638A (ja) | 2006-01-05 |
JP4732019B2 JP4732019B2 (ja) | 2011-07-27 |
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JP2005172750A Active JP4732020B2 (ja) | 2004-06-14 | 2005-06-13 | 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 |
JP2005172739A Active JP5073180B2 (ja) | 2004-06-14 | 2005-06-13 | 内視鏡クリップアプライヤー用のクリップ収納装置 |
JP2005172721A Active JP4749773B2 (ja) | 2004-06-14 | 2005-06-13 | 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 |
JP2005172724A Active JP4732019B2 (ja) | 2004-06-14 | 2005-06-13 | 非同一線上の軸に取り付けられた無性ジョーを備えた内視鏡クリップアプライヤー。 |
JP2005172745A Expired - Fee Related JP4948788B2 (ja) | 2004-06-14 | 2005-06-13 | 内視鏡クリップアプライヤー用のクリップディスペンサ |
JP2005172698A Expired - Fee Related JP4954501B2 (ja) | 2004-06-14 | 2005-06-13 | 力を制限するアクチュエータを備えた内視鏡外科器具 |
JP2005172702A Active JP4727309B2 (ja) | 2004-06-14 | 2005-06-13 | エネルギー蓄積要素を備えた回動アクチュエータを有するアクチュエータを備えた内視鏡外科器具 |
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JP2005172739A Active JP5073180B2 (ja) | 2004-06-14 | 2005-06-13 | 内視鏡クリップアプライヤー用のクリップ収納装置 |
JP2005172721A Active JP4749773B2 (ja) | 2004-06-14 | 2005-06-13 | 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 |
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JP2005172698A Expired - Fee Related JP4954501B2 (ja) | 2004-06-14 | 2005-06-13 | 力を制限するアクチュエータを備えた内視鏡外科器具 |
JP2005172702A Active JP4727309B2 (ja) | 2004-06-14 | 2005-06-13 | エネルギー蓄積要素を備えた回動アクチュエータを有するアクチュエータを備えた内視鏡外科器具 |
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EP (8) | EP1607057B1 (ja) |
JP (7) | JP4732020B2 (ja) |
CN (7) | CN100446714C (ja) |
AU (7) | AU2005202126B2 (ja) |
CA (7) | CA2508865C (ja) |
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US10926420B2 (en) | 2015-07-17 | 2021-02-23 | Olympus Corporation | Manipulator |
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