JP2006000639A - 内視鏡クリップアプライヤー用のクリップ収納装置 - 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12と、可撓性チューブ12内に延在する、基端部及び先端部を有する制御部材と、可撓性チューブ12の先端部及び制御部材の先端部に結合された一対のジョー20と、可撓性チューブ12の基端部及び制御部材の前記基端部に結合されたアクチュエータ18と、ジョー20の基端側に配置されたクリップ用の収納装置とを含む内視鏡クリップアプライヤー10。収納装置は、最下位のクリップが取り付けられてジョー20が最下位のクリップから離れる時に、最下位から2番目のクリップを把持して収納装置からその2番目のクリップが外れないように構成された少なくとも1つの付勢ストッパーを有する。
【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、
前記ジョーの基端側に配置されたクリップ用の収納装置とを含み、
前記収納装置が、最下位のクリップが取り付けられて前記ジョーが前記最下位のクリップから離れる時に、最下位から2番目のクリップを把持して前記収納装置からその2番目のクリップが外れないように構成された少なくとも1つの付勢ストッパーを有することを特徴とする内視鏡クリップアプライヤー。
(2)更に、前記チューブの前記先端部に結合されたクレビスを含み、
前記ジョーが前記クレビスに結合されており、
前記収納装置が前記クレビスから基端側に延出し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)前記クレビスが、先端リップで終わっている内部を有しており、前記収納装置が前記先端リップに係合するための手段を有することを特徴とする実施態様(2)に記載の内視鏡クリップアプライヤー。
(4)前記クレビスが、2つの側面窓を備えた内部を有しており、前記収納装置が前記2つの側面窓に係合するための手段を有することを特徴とする実施態様(2)に記載の内視鏡クリップアプライヤー。
(5)前記クレビスが2つの側面窓を備えた内部を有しており、前記収納装置が前記2つの側面窓に係合するための手段を有することを特徴とする実施態様(3)に記載の内視鏡クリップアプライヤー。
(7)前記収納装置がクリップを整列した状態に維持す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。
(8)前記制御部材が、それぞれが対応するジョーに結合された一対のプルワイヤを含み、
前記収納装置が複数の側面スペーサを含み、これらの側面スペーサが、前記収納装置と前記プルワイヤが延在する前記可撓性チューブの間の前記収納装置の両側に空間を画定し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。
(9)内視鏡クリップアプライヤー内に複数のクリップを維持するための収納装置であって、
基端部及び先端部を有する直線状の空間を画定する少なくとも2つの離間した側壁と、
前記先端部から先端側に延出した、前記側壁に結合された少なくとも1つのフィンガーとを含み、
前記フィンガーが前記収納装置内にクリップを維持するための手段を含むことを特徴とする収納装置。
(10)前記フィンガーが前記側壁に実質的に垂直な平面に延在することを特徴とする実施態様(9)に記載の収納装置。
(12)前記少なくとも2つの側壁が、第1の平面に延在する第1の複数の側壁と、前記第1の平面から離間してその平面に平行な第2の平面に延在する第2の複数の側壁を含むことを特徴とする実施態様(9)に記載の収納装置。
(13)前記第1の複数の側壁が、それらの各側壁間に第1の複数の細いストリップの1つが配置されるように前記第1の複数の細いストリップによって互いに結合されており、
前記第2の複数の側壁が、それらの各側壁間に第2の複数の細いストリップの1つが配置されるように前記第2の複数の細いストリップによって互いに結合されていることを特徴とする実施態様(12)に記載の収納装置。
(14)前記第1の複数の側壁の少なくとも一部及び前記第2の複数の側壁の少なくとも一部が、チューブ内に前記収納装置を維持するための外側を向いたスペーサを有することを特徴とする実施態様(13)に記載の収納装置。
(15)前記フィンガーが、クレビスの内部に係合し、かつ前記収納装置を前記クレビスに結合するように適合された構造を含むことを特徴とする実施態様(11)に記載の収納装置。
最下位のクリップが取り付けられた時に最下位から2番目のクリップが収納装置から外れないようにその2番目のクリップを把持するように構成された少なくとも1つの付勢ストッパーで、前記クリップを直線状構造内に軸方向に整列するステップを含むことを特徴とする方法。
(17)更に、一対のプルワイヤのために直線状構造の両側に空間を維持するステップを含むことを特徴とする実施態様(16)に記載の方法。
(18)更に、前記直線状構造をクレビスに結合するステップを含むことを特徴とする実施態様(16)に記載の方法。
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 (16)
- 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、
前記ジョーの基端側に配置されたクリップ用の収納装置とを含み、
前記収納装置が、最下位のクリップが取り付けられて前記ジョーが前記最下位のクリップから離れる時に、最下位から2番目のクリップを把持して前記収納装置からその2番目のクリップが外れないように構成された少なくとも1つの付勢ストッパーを有することを特徴とする内視鏡クリップアプライヤー。 - 更に、前記チューブの前記先端部に結合されたクレビスを含み、
前記ジョーが前記クレビスに結合されており、
前記収納装置が前記クレビスから基端側に延出し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。 - 前記クレビスが、先端リップで終わっている内部を有しており、前記収納装置が前記先端リップに係合するための手段を有することを特徴とする請求項2に記載の内視鏡クリップアプライヤー。
- 前記クレビスが、2つの側面窓を備えた内部を有しており、前記収納装置が前記2つの側面窓に係合するための手段を有することを特徴とする請求項2に記載の内視鏡クリップアプライヤー。
- 前記クレビスが2つの側面窓を備えた内部を有しており、前記収納装置が前記2つの側面窓に係合するための手段を有することを特徴とする請求項3に記載の内視鏡クリップアプライヤー。
- 前記収納装置が可撓性であ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。
- 前記収納装置がクリップを整列した状態に維持す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。
- 前記制御部材が、それぞれが対応するジョーに結合された一対のプルワイヤを含み、
前記収納装置が複数の側面スペーサを含み、これらの側面スペーサが、前記収納装置と前記プルワイヤが延在する前記可撓性チューブの間の前記収納装置の両側に空間を画定し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。 - 内視鏡クリップアプライヤー内に複数のクリップを維持するための収納装置であって、
基端部及び先端部を有する直線状の空間を画定する少なくとも2つの離間した側壁と、
前記先端部から先端側に延出した、前記側壁に結合された少なくとも1つのフィンガーとを含み、
前記フィンガーが前記収納装置内にクリップを維持するための手段を含むことを特徴とする収納装置。 - 前記フィンガーが前記側壁に実質的に垂直な平面に延在することを特徴とする請求項9に記載の収納装置。
- 前記少なくとも1つのフィンガーが、前記先端部から先端側に延出した、前記側壁に結合された2つの離間したフィンガーを含み、前記各フィンガーが前記収納装置内にクリップを維持するための手段を含むことを特徴とする請求項9に記載の収納装置。
- 前記少なくとも2つの側壁が、第1の平面に延在する第1の複数の側壁と、前記第1の平面から離間してその平面に平行な第2の平面に延在する第2の複数の側壁を含むことを特徴とする請求項9に記載の収納装置。
- 前記第1の複数の側壁が、それらの各側壁間に第1の複数の細いストリップの1つが配置されるように前記第1の複数の細いストリップによって互いに結合されており、
前記第2の複数の側壁が、それらの各側壁間に第2の複数の細いストリップの1つが配置されるように前記第2の複数の細いストリップによって互いに結合されていることを特徴とする請求項12に記載の収納装置。 - 前記第1の複数の側壁の少なくとも一部及び前記第2の複数の側壁の少なくとも一部が、チューブ内に前記収納装置を維持するための外側を向いたスペーサを有することを特徴とする請求項13に記載の収納装置。
- 前記フィンガーが、クレビスの内部に係合し、かつ前記収納装置を前記クレビスに結合するように適合された構造を含むことを特徴とする請求項11に記載の収納装置。
- 内視鏡クリップアプライヤー内に複数のクリップを収納する方法であって、
最下位のクリップが取り付けられた時に最下位から2番目のクリップが収納装置から外れないようにその2番目のクリップを把持するように構成された少なくとも1つの付勢ストッパーで、前記クリップを直線状構造内に軸方向に整列するステップを含むことを特徴とする方法。
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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 |
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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 |
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