JP2006289089A - 案内された状態で側方へ移動する関節運動部材を備えた外科用器械 - Google Patents
案内された状態で側方へ移動する関節運動部材を備えた外科用器械 Download PDFInfo
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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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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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2943—Toothed members, e.g. rack and pinion
Abstract
【解決手段】内視鏡下用途に特に適した外科用器械(2004)は、シャフトの近位部分内に設けられていて、エンドエフェクタ(2016)を選択された側に旋回させる側方スライド部材を備えることによりエンドエフェクタを関節運動させる。側方スライド部材とシャフトのフレームとの間に案内機構(2012,2008 )を設けることにより、差動的に互いに逆向きの作動力(例えば、油圧力、流体力、機械的力)が、側方スライド部材をつかえさせることなく、側方スライド部材に作用する。
【選択図】図10
Description
本願は、2005年2月18日にケネス・ウェールス(Kenneth Wales ) およびチャド・ブードロー(Chad Boudreaux)名義で出願された共通所有者の米国特許出願第11/061,908号(発明の名称:SURGICAL INSTRUMENT INCORPORATING A FLUID TRANSFER CONTROLLED ARTICULATION MECHANISM)の権益主張出願であり、この米国特許出願を参照により引用し、その開示内容を本明細書の一部とする。
本発明は一般に、内視鏡下でエンドエフェクタ(例えば、体内カッタ、把持器、カッタ、ステープラ、クリップ留め具、接近用器具、薬物/遺伝子治療送達器具および超音波、RF、レーザ等を利用したエネルギー器具)を手術部位に挿入するのに適した外科用器械、特に、関節運動シャフトを備えたかかる外科用器械に関する。
内視鏡下外科用器械は、切開部が小さいほうが術後回復期間および合併症を減少させる傾向があるので、伝統的な開放式外科用器具よりも好ましい場合が多い。したがって、トロカールのカニューレを通って遠位エンドエフェクタを所望の手術部位に正確に配置するのに適した内視鏡下外科用器械類の大々的な開発が行われた。これら遠位エンドエフェクタ(例えば、体内カッタ、把持器、カッタ、ステープラ、クリップ留め具、接近用器具、薬物/遺伝子治療送達器具および超音波、RF、レーザ等を利用したエネルギー器具)は、診断効果または治療効果を達成するのに多くの仕方で組織に係合する。
本発明は、取っ手とエンドエフェクタとの間に取り付けられた関節運動シャフトを有し、このシャフトの近位部分内に設けられていて、エンドエフェクタのピボット特徴部に作用する側方スライド部材を用いた外科用器械を提供することにより先行技術の上述の問題および他の問題を解決する。側方スライド部材の互いに反対側に設けられた側方運動アクチュエータは、各側への旋回を制御する。この側方運動部材は、作用すべき広い長手方向表面積を提供する。有利には、可動コンポーネントを収納支持するシャフトのフレームは、側方スライド部材に係合する側方案内機構を有し、かくして、もしそのように構成していなければ、性能を損なう場合のあるつかえが回避される。
関節運動シャフトの概要
図面を参照すると(幾つかの図にわたり、同一の符号は同一の部品を示している)、図1は、外科用器械を示しており、この外科用器械は、図示の形態では、本発明の独特の利点をもたらすことができる特に外科用ステープル留め兼用切断器械10である。特に、外科用ステープル留め兼用切断器械10は、外科手技を実施するために図1に示すような非関節運動状態でトロカールカニューレ通路を通って患者(図示せず)の体内の手術部位まで挿入可能に寸法決めされている。作業部分12をいったんカニューレ通路中へ挿入すると、作業部分12の細長いシャフト16の遠位部分内に組み込まれた関節運動機構14を図2に示すように関節運動制御装置18によって遠隔的に関節運動させることができる。図示の形態では、ステープル留め組立体20として示されたエンドエフェクタが、関節運動機構14の遠位側に取り付けられている。かくして、関節運動機構14を遠隔的に関節運動させることにより、ステープル留め組立体20は、細長いシャフト16の長手方向軸線から関節運動する。かかる傾斜位置は、切断およびステープル留めのために所望の角度から組織に接近し、あるいは他の臓器および組織により遮られた組織に接近すると共に(あるいは)配置状態を確認するために内視鏡をステープル留め組立体20の後ろに位置決めしてこれと整列させることができるという点において有利な場合がある。
外科用ステープル留め兼用切断器械10は、作業部分12の近位側に連結されていて、位置決め運動、関節運動、閉鎖運動および発火運動をこの作業部分にもたらす取っ手部分22を有している。取っ手部分22は、ピストル型握り24を有し、ステープル留め組立体20のクランプまたは閉鎖を生じさせるよう臨床医によってクロージャトリガ26をこの握り24に向かって旋回自在にかつ近位側へ引き寄せられる。発火トリガ28が、クロージャトリガ26の一段と外側に位置し、この発火トリガは、ステープル留め組立体20内にクランプされた組織のステープル留めおよび切断を生じさせるよう臨床医によって旋回自在に引かれる。しかる後、クロージャ解除ボタン30を押してクランプ状態のクロージャトリガ26を解除し、かくしてクランプされた状態の組織の切断およびステープル留め端部を解除する。取っ手部分22は、シャフト16および関節運動したステープル留め組立体20をシャフト16の長手方向軸線回りに回転させるよう細長いシャフト16と一緒に運動できるよう結合された回転ノブ32を更に有している。取っ手部分22は、もし万が一つかえが生じた場合、発火機構(図1または図2には示さず)を引き戻すのを助け、ステープル留め組立体20の開放がその後に生じることができるようにする発火引き戻し取っ手34を更に有する。
図3〜図5では、作業部分12は有利には、内視鏡下および腹腔鏡下手技に適した小径内で長手方向回転運動、関節運動、閉鎖運動および発火運動の多数の作動運動を含む。ステープル留め組立体20(「エンドエフェクタ」)は、旋回自在に取り付けられたアンビル42(図1、図2、図4および図5)を備えた細長いチャネル40として示されている1対の旋回自在に取り付けられた対向したジョーを有する。アンビル42を閉鎖して細長いチャネル40にクランプすることは、フレーム組立体44(図3)が取っ手部分22に回転自在に取り付けられた状態で細長いチャネル40の長手方向に支持することによって達成され、二重ピボットクロージャスリーブ組立体46は、このフレーム組立体44上で、長手方向に動いて、ステープル留め組立体20が図2に示すように関節運動していても、それぞれ遠位および近位運動のための閉鎖および開放作用をアンビル42に与える。
図4および図5を参照すると、発火バー66は、E−ビーム165の遠位側で終端しており、このE−ビームは、アンビル42に設けられたアンビルスロット168に入ってアンビル42を確認してこれをステープル配列および切断中、閉鎖状態に維持するのを助ける上側案内ピン166を有している。細長いチャネル40とアンビル42との間の間隔は、中間ピン170を細長いチャネル40の頂面に沿って摺動させる一方で、底部足部172が細長いチャネル40に設けられた長手方向開口部174によって案内された状態で細長いチャネル40の下面に沿ってこれに対向して摺動することによりE−ビーム164によって更に維持される。上側案内ピン166と中間ピン170との間に位置するE−ビーム164の遠位側に設けられた切断面176は、クランプされた状態の組織を切断し、他方、E−ビームは、くさび形そり180を遠位側に移動させ、それによりステープルドライバ182が、上方に駆動するステープル184をカム駆動してこれをステープルカートリッジ本体188に設けられている上方に開口したステープル穴186から出してアンビル42のステープル配列下面190に押し付けて配列することにより交換可能なステープルカートリッジ178を作動させる。ステープルカートリッジトレイ192が、ステープルカートリッジ178の他の部品を底部から包囲してこれらを定位置に保持する。ステープルカートリッジトレイ192は、細長いチャネル40の長手方向開口部174の上に位置する後方に開口したスロット194を有し、かくして、中間ピン170が、ステープルカートリッジトレイ192の内部を通る。
図3、図4および図6〜図8では、関節運動ロック機構200が、有利には、ステープル留め組立体20を所望の関節角度に維持するよう構成されている。関節運動ロック機構200は、左側作動ブラダ100および右側作動ブラダ102に加わる荷重を減少させる。特に、圧縮ばね202(図3)が、関節運動ロック部材111の近位端204と取っ手部分22との間に近位側に位置決めされていて、関節運動ロック部材111を遠位側に付勢している。特に図4を参照すると、関節運動ロック部材111の遠位端210のところに設けられた2つの平行なスロット206,208が、フレームグラウンド48に設けられた上方に突き出ている案内リブ212,214をそれぞれ受け入れる。案内リブ212,214は、平行なスロット206,208よりも長手方向に短く、或る範囲の相対的な長手方向移動を可能にしている。それにより、特に図8を参照すると、関節運動ロック部材111から遠位側に突き出た歯付き凹部216として示されている遠位摩擦面の選択的な当接係合は、関節運動フレーム部材114の頂部近位凹部220内に受け入れられたブレーキ板218に設けられている対応のロック歯車セグメント217に連係している。ブレーキ板218に設けられた遠位穴221および近位穴222は、頂部近位凹部220から上方に突き出た遠位ピン223および近位ピン224を受け入れる。
図3、図4および図7を参照すると、作業部分12は有利には、単一ピボットフレームグラウンド48上に長手方向に並進してこれを包囲する二重ピボットクロージャスリーブ組立体46を有する。これら機構およびこれらの作用について以下に詳細に説明する。特に図7を参照すると、関節運動機構14は、クロージャスリーブ組立体46がアンビル開放状態に向かって近位側に引っ込められた状態の関節運動状態で示されている。アンビル42が開放した状態で、関節運動制御装置18を作動させると、関節クロージャリング116が、上側および下側二重ピボットクロージャリンク134,140のそれぞれの上方に差し向けられた遠位ピン136および下方に差し向けられた遠位ピン142回りに旋回する。フレームグラウンド48は、フレームグラウンド48を遠位フレーム部材114に接合する近位ピン157として示された単一のピン回りに旋回する。アンビル42が開放した状態では、フレームグラウンド48の近位ピン147は、クロージャスリーブ組立体46の上側および下側二重ピボットリンク134,140の最も遠位側の位置と整列する。この位置決めにより、アンビル42が開いた状態で、ステープル留め組立体20の容易な旋回および回転が可能である。クロージャスリーブ組立体46を遠位側へ移動させてアンビル42を旋回させてこれを閉鎖すると、真っ直ぐなクロージャ管52は、フレームグラウンド48回りに遠位側に動き、関節クロージャリング116は、ピボットリンク134,140により押圧されると、関節遠位フレーム部材114の軸線に沿って遠位側へ動く。リンク134,140のそれぞれの二重ピボットピン136,138および142,144は、器具(図示せず)を関節運動させたときにこれらが遠位閉鎖位置に向かって押圧されると、真っ直ぐなクロージャ管52および関節クロージャリング116との係合を容易にする。遠位閉鎖位置では、フレームグラウンドピボットピン(「近位ピン」)147は、完全関節運動時に近位ピボットピン138,144と垂直方向に整列しまたは効果的に働いている状態で遠位ピン136,142と近位ピン138,144との間の任意の箇所に位置することができる。
図8では、図7の関節運動機構14は、部分的に分解され、下から見た状態で示され、従来型可撓性支持板と比べて利点をもたらす中実壁発火バー支持体設計(ドッグボーン形リンク160)を示している。支持板は、隙間を橋渡しし、発火バー66を単一フレームグラウンドピボット関節運動継手1801中を支持した状態で案内するために用いられる。可撓性発火バーは、公知であるが、例えば図4、図8および図9に示す中実壁発火バーを設けると、独特な利点が得られる。次に図8を参照すると、フレームグラウンド48は、フレームグランド48の底部に沿って延びるフレームナイフスロット1802を有し、遠位ナイフスロット164が、発火バー66(図示せず)を摺動自在に受け入れるために関節運動遠位フレーム部材114の底部に沿って延びている。フレームグラウンド48は、上述されており、このフレームグラウンドは、遠位フレーム部材114との直接的な単一ピボット連結部157を有する。ピンの近位端157に回転自在に連結され、ピンの遠位端159に可動的に連結された固定壁ドッグボーン形リンク160は、左側の側方ガイド1818および右側の側方ガイド1820を有し、これらガイド相互間には、発火バー66(図4)の摺動通過用の案内スロット1822が画定されている。
さらに図9を参照すると、フレームグラウンド1916に設けられた左側および右側上向きフランジ1918,1920が、T−バー1926に設けられた穴を側方に通過して関節運動機構1928のつかえを最小限に抑えるのを助ける遠位および近位側方ピンガイド1922,1924を有している。別の例として、図7において、T−バー104は有利には、ダブテール形側方ガイド1930を有し、この側方ガイドは、T−バーに形成されたダブテール形チャネル1932内で側方に摺動する。さらに別の例として、図12において、フレームグラウンド1936に設けられた隆起リブ1934が、T−バー1940に形成された矩形スロット1938内に受け入れられている。つかえを生じない側方並進を一段と容易にするため、遠位および近位側方支承軌道は各々、それぞれ複数の玉軸受1946,1948を有している。さらに別の例として、図13において、複数個のフレーム側方溝1950〜1954が、フレームグラウンド1956に形成され、これに対応したT−バー側方溝1958〜1962がT−バー1964に設けられている。摺動ローラ1966〜1970が、それぞれ対をなす側方溝1950/1958,1952/1960,1954/1962内に捕捉された状態で位置している。これらは、T−バー1940の望ましくない起動または回転を阻止する側方案内部材の全てではない。
図14および図15では、別のフレームグラウンドおよび閉鎖機構2200が、二重ピボットフレーム組立体2204を有する外科用器械2202を有している。特に、フレームグラウンド2206は、二重ピボットフレームドッグボーン2210により遠位フレーム部材2208に連結され、この二重ピボットフレームドッグボーンは、フレームグラウンド2206に設けられた近位ボア2214に旋回自在に係合する近位ピボットピン2212および遠位フレーム部材2208の遠位ボア2218に係合する遠位ピボットピン2216を有する。発火バー66(図14および図15には示さず)を収納状態で案内する案内スロット2220が、ドッグボーン2210の下面に設けられている。ナイフスロット2222が、遠位フレーム部材2208に設けられている。図示のように、クロージャリング2230を45°の角度まで関節運動させることにより、遠位フレーム部材2208が45°の角度まで関節運動すると共にフレームドッグボーン2210がその角度の半分まで関節運動する。その結果、発火バー66は、互いに間隔を置いた2つの浅い半分の曲げを受け、上述した利点の全てを有する。
図16〜図19では、側方運動が用いられてエンドエフェクタ232の関節運動を行わせている状態を示すよう側方運動関節運動機構230が概略的に示されている。側方運動は、外科用器具234の長手方向軸線に向かうまたはこれから遠ざかる少なくとも1つの要素の運動である。この運動は一般に、機構230を2等分する水平線である長手方向軸線に対して直角であり、回転運動または長手方向運動を含まない。側方運動関節運動機構は、図16〜図19に示すように流体作動式のものであってもよく、あるいは、図20〜図23に示すように機械的に作動されるものであってもよい。
側方運動関節運動機構230は、図16〜図19に概略的に示されており、この関節運動機構は、流体制御システム235を有し、この流体制御システムは、この中で長手方向に延びる流体で満たされた互いに平行な左側流体ブラダ236および右側流体ブラダ238を有し、これら流体ブラダは、流体242の運動により側方部材またはT−バー240を側方に移動させる。全ての方向は、長手方向軸線を基準としている。図16および図17の非関節運動図を参照すると、遠位側に設けられたエンドエフェクタ232は、ピン244を中心として旋回し、このエンドエフェクタは、近位端に歯車セグメント246を有している。ピボットピン244が、フレーム(図示せず)に取り付けられている。T−バー240の遠位端のところに設けられたラック248が、歯車セグメント246に作動可能に係合する。T−バー240およびラック248は、軸線A−Aに沿って側方に動くことができる。長い左側および右側流体ブラダ236,238の遠位部分は、側方に動くことができるT−バー240の側方に位置し、この遠位部分は、クロージャスリーブ250内に側方に拘束されると共にフレーム252によって垂直方向下方に拘束されると共にスペーサ254によって垂直方向上方に拘束される。左側作動流体ブラダ236は、流体242で満たされていて、この流体ブラダは、左側遠位作動ブラダ256、左側流体通路258および左側近位リザーバブラダ260を有している。右側流体ブラダ238は、流体242を収容しており、この右側流体ブラダは、右側遠位作動ブラダ262、右側流体通路264および右側近位リザーバブラダ268を有している。固定仕切り270がフレーム252から延出し、ブラダ260,268と流体通路258,264を分離している。固定仕切り270およびクロージャスリーブ250は、流体通路258,264を拘束し、ブラダ236,238の流体通路部分258,264の拡張を阻止する。近位リザーバブラダ260,268のうちの一方の圧縮およびエンドエフェクタ232の関節運動のための側方に動くことができる“C”字形圧縮部材272が、関節運動制御機構230に設けられている。加うるに、他の部品、例えばフレーム252に設けられた発火バースロット276を貫通した発火バー274を設けるのがよい(図17および図19)。
側方運動および関節運動を生じさせる流体機構を上述したが、機械的機構は、流体ブラダ206,208により得られるのとほぼ同じ側方運動を達成することができる。図20および図21では、変形例としての側方運動関節運動機構300が、外科用器械301のための側方運動および関節運動を生じさせる機械的制御システム、特に長手方向に運動する部材を用いている。図示の形態では、特に図20を参照すると、側方運動スライドバー302が、細長い長手方向シャフト308の互いに反対側の側部でこのスライドバーから側方に延びる少なくとも1対の傾斜した左側カム面304と右側カム面306を有している。図示の形態では、別の1対の近位左側および右側傾斜カム面310,312もまた設けられている。右側長手方向運動リンク314は、これに対応した内方に差し向けられている遠位および近位傾斜カウンタ面316,318を有し、これらカウンタ面は、遠位および近位右側カム面306,312と位置が合ってこれに摺動自在に係合して、長手方向運動リンク314の遠位側への長手方向運動がスライドバー302の左向き側方運動を引き起こすようになっている。理解されるべきこととして、この傾斜接触状態を逆にして遠位側への運動が右向きの運動を引き起こすようにしてもよい。
図22および図23において、更に変形例としての関節運動機構400が、外科用器械406の関節運動を生じさせるよう側方運動スライドバー404として示された側方部材を移動させる回転可能なリンク402を用いている。側方運動スライドバー404は、エンドエフェクタ(図示せず)の近位端のところで図16および図20に関して上述した回転歯車またはカム作用溝と作動可能に係合することができる。回転可能なリンク402を少なくとも一方のアーム408が長手方向軸線に対して回転自在に横方向にこのリンクから延びてスライドバー内のソケット410に嵌まり込んだ状態でスライドバー404の下に配置するのがよい。スライドバー404は、頂部スペーサ412と底部フレーム414との間で垂直方向に拘束され、底部フレームは、回転可能なリンク402を受け入れてアーム408の回転を許容する長手方向トラフ416を有している。スペーサ412およびフレーム414は、管状スリーブ418によって包囲されている。回転リンク402を回転させることにより、アーム408は、弧を描いて動き、それにより、スライドバー404が回転方向に動いて側方に移動する。
図24において、外科用器械500は、細長いシャフト504の長手方向軸線に沿って整列したスライド部材502を有し、この外科用器械は、左側座屈部材506と右側座屈部材508との間の側方運動を可能にし、フレームおよびスペーサ(図示せず)によって垂直方向に拘束されている。各座屈部材506,508は、それぞれの固定遠位取付け部510,512および長手方向に並進可能な近位リンク514,516を有している。それぞれの左側および右側可撓性部材518,520は、スライドバー502に対向して、これらのそれぞれの近位リンク514,516の遠位側への長手方向運動に関して側方侵入量で、内方に弓形に曲がる。図24に示す非関節運動状態では、近位リンク514,516は、差動的には位置決めされておらず、かくして、スライド部材502の遠位側に突き出た先端部522は、エンドエフェクタ528のピボットピン526に対して近位側に開口したV字形カム溝524内に心出しされる。図25では、左側近位リンク514は、遠位側に送り進められており、右側近位リンクは、近位側へ引っ込められており、スライドバー502は、右側に側方に並進し、それにより、遠位側に突き出た先端部522をカム駆動させてこれをV字形カム溝524の右側部分に押し付け、その結果、ピボットピン526回りのエンドエフェクタ528の左向き関節運動が生じる。
図26において、外科用器械600は、遠位側に連結されたエンドエフェクタ602を有し、このエンドエフェクタは、スライドバー608の側方運動により細長いシャフト606に対してそのピボットピン604回りに弧を描いて選択的に関節運動する。特に、スライドバー608の遠位ソケット610は、ピボットピン604の遠位側で開口したV字形カム溝612に係合する。スライドバー608は、フレームおよびスペーサ(図示せず)により細長いシャフト606内で垂直方向に拘束される。スライドバー608の互いに反対側の側方側部上で内方に差し向けられた左側および右側圧縮ばね614,616は、細長いシャフト606の遠位端部618の近位側に位置する。これらばね614,616は、スライドバー608におよびかくしてエンドエフェクタ602に心出し付勢力をもたらす。スライドバー608の互いに反対側の側部に設けられた左側および右側電磁石620,622は、スライドバー608と一体のまたはこれに取り付けられた鉄製標的624を引き付け、それにより選択的に図27に示すようにスライドバー608を側方に変位させ、エンドエフェクタ602の関節運動を生じさせるよう選択的に作動される。単純化のため、長手方向に整列したコイルが示されている。ただし、1つ以上の電磁石を整列させてスライドバー608に垂直な磁界を生じさせてもよいことは理解されるべきであり、例えば、複数個のコイル(図示せず)をスライドバー608の長手方向長さ方向に沿って整列させ、各コイルは、スライドバー608の側方運動軸線と整列したその長手方向軸線を有する。
(1)外科用器械において、
近位カム作用面を備えたエンドエフェクタと、
長手方向軸線と整列した側方凹部を備えるフレームを有する細長いシャフトと、
前記エンドエフェクタを前記細長いシャフトの遠位端部に旋回自在に取り付ける関節運動継手と、
前記側方凹部内に設けられていて、前記エンドエフェクタの前記近位カム作用面に係合する遠位端部を備えたスライドバーと、
前記スライドバーを前記フレームに係合させ、前記スライドバーの側方および長手方向整列運動を行わせる側方案内機構と、
前記細長いシャフトに近位側で取り付けられていて、関節運動を生じさせて前記スライドバーを側方に運動させるよう作動的に構成された取っ手部分と、を有する、外科用器械。
(2)実施態様(1)記載の外科用器械において、
前記エンドエフェクタの前記近位カム作用面は、前記スライドバーの前記遠位端部を受け入れる近位側に差し向けられたカム凹部を有する、外科用器械。
(3)実施態様(1)記載の外科用器械において、
前記エンドエフェクタの前記近位カム作用面は、歯車セグメントを有し、前記スライドバーの前記遠位端部は、歯車ラックを有する、外科用器械。
(4)実施態様(3)記載の外科用器械において、
前記側方案内機構は、前記フレームに側方に形成されたチャネルと、前記チャネル内に受け入れられていて、前記スライドバーに垂直に取り付けられたリブとを有し、
前記外科用器械は、前記リブを前記歯車ラックに連結する可撓性長手方向部分を更に有し、
前記エンドエフェクタの操作により、前記長手方向部分を撓ませる前記歯車セグメントの後方駆動が引き起こされ、前記リブが起動されて該リブが前記チャネル内に嵌まる、
外科用器械。
(5)実施態様(1)記載の外科用器械において、
前記側方案内機構は、
前記細長いチャネル内の前記側方凹部を横切って側方に間隔を置いて位置する左側ブラケット表面および右側ブラケット表面と、
前記スライドバーに設けられていて、前記左側ブラケット表面および前記右側ブラケット表面と整列した少なくとも1つの側方貫通穴と、
前記スライドバーの前記側方貫通穴内に受け入れられ、各前記ブラケット表面に取り付けられた少なくとも1つのスライドピンと、を有する、外科用器械。
前記側方案内機構は、
前記側方凹部に隣接して前記フレームに形成された側方チャネルと、
前記スライドバーに取り付けられていて、前記側方チャネル内に摺動自在に受け入れられた側方リブと、を有する、外科用器械。
(7)実施態様(1)記載の外科用器械において、
前記側方案内機構は、
前記フレームに隣接して前記スライドバーに形成された側方チャネルと、
前記側方凹部内に延びた状態で前記フレーム表面に取り付けられていて、前記スライドバーの前記側方チャネル内に摺動自在に受け入れられた側方リブと、を有する、外科用器械。
(8)実施態様(1)記載の外科用器械において、
前記側方案内機構は、
前記フレームに隣接して前記スライドバーに形成された側方チャネルと、
前記側方凹部および前記スライドバー側方チャネルに隣接して前記フレームに形成された対応の側方チャネルと、
前記スライドバー側方チャネルおよび前記フレーム側方チャネルにより画定された側方案内凹部内に受け入れられた支承部材と、を有する、外科用器械。
(9)実施態様(8)記載の外科用器械において、
前記支承部材は、少なくとも1つの球面軸受を含む、外科用器械。
(10)実施態様(8)記載の外科用器械において、
前記支承部材は、真円軸受を含む、外科用器械。
前記スライドバーおよび前記細長いシャフトの前記側方凹部に隣接して位置する前記フレームの表面のうち選択された一方は、側方リブを有し、他方の表面は、前記側方リブおよび複数個の軸受を受け入れるように寸法決めされた側方チャネルを含む、外科用器械。
(12)実施態様(1)記載の外科用器械において、
前記スライドバーの側方および長手方向整列運動を可能にするよう前記スライドバーを前記フレームに係合させる側方案内機構は、前記スライドバーに平行に整列すると共に前記シャフトの垂直中心線と整列した回転可能なリンクを有し、該回転可能なリンクは、前記スライドバーの近くの表面に旋回自在に接合されていて、前記回転可能なリンクが回転すると、前記スライドバーの側方運動を生じさせる、外科用器械。
(13)実施態様(12)記載の外科用器械において、
前記回転可能なリンクは、前記スライドバーの長手方向長さに沿って間隔を置いて設けられていて、作動中、整列状態を維持する前記スライドバーへの複数個のピボット接合部を有する、外科用器械。
(14)実施態様(1)記載の外科用器械において、
右側および左側の遠位流体作動ブラダが、前記スライドバーのそれぞれの側に配置され、前記取っ手部分は、流体を前記右側および左側の遠位流体作動ブラダに差動的に移送するよう作動的に構成された関節運動制御装置を含む、外科用器械。
(15)実施態様(1)記載の外科用器械において、
右側および左側の機械的アクチュエータが、前記スライドバーのそれぞれの側に配置され、前記取っ手部分は、差動的長手方向運動を前記右側および左側機械的アクチュエータに及ぼして前記スライドバーを側方に変位させるよう作動的に構成された関節運動制御装置を含む、外科用器械。
近位カム作用面を備えたエンドエフェクタと、
前記エンドエフェクタに取り付けられていて、長手方向軸線と整列した側方凹部を画定するフレームを有する細長いシャフトと、
前記エンドエフェクタを前記細長いシャフトの遠位端部に旋回自在に取り付ける関節運動継手と、
前記側方凹部内に設けられていて、前記エンドエフェクタの前記近位カム作用面に係合する遠位端部を備えたスライドバーと、
前記側方凹部内の前記スライドバーの各側に設けられた右側および左側のアクチュエータと、
前記スライドバーおよび前記フレームのうちの選択された一方に形成された側方チャネルおよび前記スライドバーおよび前記フレームのうちの他方に形成された側方リブを有する側方案内機構と、
前記細長いシャフトに近位側に取り付けられていて、差動的長手方向運動をそれぞれの前記アクチュエータにもたらして前記スライドバーを側方に動かすよう作動的に構成された取っ手部分と、を有する、外科用器械。
(17)実施態様(16)記載の外科用器械において、
前記右側および左側アクチュエータは、ブラダを有し、前記取っ手部分は、流体を前記右側および左側ブラダアクチュエータのうちの選択された一方に移送し、流体を他方のブラダアクチュエータから移送するよう作動的に構成されている、外科用器械。
(18)実施態様(16)記載の外科用器械において、
前記右側および左側アクチュエータは、各々が可動近位端部を備えた座屈部材を有し、前記取っ手部分は、前記座屈部材の前記近位端部を差動的に位置決めするよう作動的に構成されている、外科用器械。
(19)実施態様(16)記載の外科用器械において、
前記フレームと前記スライドバーとの間に挿入された球面軸受と、真円軸受とから成る群から選択された支承部材を更に有する、外科用器械。
ステープル留め組立体と、
前記ステープル留め組立体に取り付けられていて、長手方向軸線と整列した側方凹部を画定するフレームを有する細長いシャフトと、
前記ステープル留め組立体を前記細長いシャフトの遠位端部に旋回自在に取り付ける関節運動継手と、
前記側方凹部内に設けられていて、前記ステープル留め組立体の近位カム作用面に係合する遠位端部を備えたスライドバーと、
前記側方凹部内の前記スライドバーの各側に設けられた右側および左側アクチュエータと、
前記フレームにより画定された前記凹部内で前記スライドバーを側方に案内し、前記スライドバーを前記シャフトの長手方向軸線と平行整列状態に維持する手段と、
前記細長いシャフトに近位側に取り付けられていて、差動長手方向運動をそれぞれのアクチュエータにもたらして前記スライドバーを側方に動かすよう作動的に構成された取っ手部分と、を有する、外科用器械。
12 作業部分
14,230,300,400 関節運動機構
16 細長いシャフト
18 関節運動制御装置
20,2016 ステープル留め組立体またはエンドエフェクタ
22 取っ手部分
24 ピストル型握り
26 クロージャトリガ
28 発火トリガ
30 クロージャ解除ボタン
46 クロージャスリーブ組立体
44 フレーム組立体
80 関節運動アクチュエータ
94 流体関節運動システム
116 関節クロージャ管
178 交換可能なステープルカートリッジ
200,2000 関節運動ロック機構
500,600,1900,2004 外科用器械
1801 関節運動継手
Claims (12)
- 外科用器械において、
近位カム作用面を備えたエンドエフェクタと、
長手方向軸線と整列した側方凹部を備えるフレームを有する細長いシャフトと、
前記エンドエフェクタを前記細長いシャフトの遠位端部に旋回自在に取り付ける関節運動継手と、
前記側方凹部内に設けられていて、前記エンドエフェクタの前記近位カム作用面に係合する遠位端部を備えたスライドバーと、
前記スライドバーを前記フレームに係合させ、前記スライドバーの側方および長手方向整列運動を行わせる側方案内機構と、
前記細長いシャフトに近位側で取り付けられていて、関節運動を生じさせて前記スライドバーを側方に運動させるよう作動的に構成された取っ手部分と、
を有する、外科用器械。 - 請求項1記載の外科用器械において、
前記エンドエフェクタの前記近位カム作用面は、前記スライドバーの前記遠位端部を受け入れる近位側に差し向けられたカム凹部を有する、外科用器械。 - 請求項1記載の外科用器械において、
前記エンドエフェクタの前記近位カム作用面は、歯車セグメントを有し、
前記スライドバーの前記遠位端部は、歯車ラックを有する、
外科用器械。 - 請求項3記載の外科用器械において、
前記側方案内機構は、前記フレームに側方に形成されたチャネルと、前記チャネル内に受け入れられていて、前記スライドバーに垂直に取り付けられたリブとを有し、
前記外科用器械は、前記リブを前記歯車ラックに連結する可撓性長手方向部分を更に有し、
前記エンドエフェクタの操作により、前記長手方向部分を撓ませる前記歯車セグメントの後方駆動が引き起こされ、前記リブが起動されて該リブが前記チャネル内に嵌まる、
外科用器械。 - 請求項1記載の外科用器械において、
前記側方案内機構は、
前記細長いチャネル内の前記側方凹部を横切って側方に間隔を置いて位置する左側ブラケット表面および右側ブラケット表面と、
前記スライドバーに設けられていて、前記左側ブラケット表面および前記右側ブラケット表面と整列した少なくとも1つの側方貫通穴と、
前記スライドバーの前記側方貫通穴内に受け入れられ、各前記ブラケット表面に取り付けられた少なくとも1つのスライドピンと、
を有する、
外科用器械。 - 請求項1記載の外科用器械において、
前記側方案内機構は、
前記側方凹部に隣接して前記フレームに形成された側方チャネルと、
前記スライドバーに取り付けられていて、前記側方チャネル内に摺動自在に受け入れられた側方リブと、
を有する、
外科用器械。 - 請求項1記載の外科用器械において、
前記側方案内機構は、
前記フレームに隣接して前記スライドバーに形成された側方チャネルと、
前記側方凹部内に延びた状態で前記フレーム表面に取り付けられていて、前記スライドバーの前記側方チャネル内に摺動自在に受け入れられた側方リブと、
を有する、
外科用器械。 - 請求項1記載の外科用器械において、
前記側方案内機構は、
前記フレームに隣接して前記スライドバーに形成された側方チャネルと、
前記側方凹部および前記スライドバー側方チャネルに隣接して前記フレームに形成された対応の側方チャネルと、
前記スライドバー側方チャネルおよび前記フレーム側方チャネルにより画定された側方案内凹部内に受け入れられた支承部材と、
を有する、
外科用器械。 - 請求項8記載の外科用器械において、
前記支承部材は、少なくとも1つの球面軸受を含む、外科用器械。 - 請求項8記載の外科用器械において、
前記支承部材は、真円軸受を含む、外科用器械。 - 外科用器械において、
近位カム作用面を備えたエンドエフェクタと、
前記エンドエフェクタに取り付けられていて、長手方向軸線と整列した側方凹部を画定するフレームを有する細長いシャフトと、
前記エンドエフェクタを前記細長いシャフトの遠位端部に旋回自在に取り付ける関節運動継手と、
前記側方凹部内に設けられていて、前記エンドエフェクタの前記近位カム作用面に係合する遠位端部を備えたスライドバーと、
前記側方凹部内の前記スライドバーの各側に設けられた右側および左側のアクチュエータと、
前記スライドバーおよび前記フレームのうちの選択された一方に形成された側方チャネルおよび前記スライドバーおよび前記フレームのうちの他方に形成された側方リブを有する側方案内機構と、
前記細長いシャフトに近位側に取り付けられていて、差動的長手方向運動をそれぞれの前記アクチュエータにもたらして前記スライドバーを側方に動かすよう作動的に構成された取っ手部分と、
を有する、外科用器械。 - 外科用器械であって、
ステープル留め組立体と、
前記ステープル留め組立体に取り付けられていて、長手方向軸線と整列した側方凹部を画定するフレームを有する細長いシャフトと、
前記ステープル留め組立体を前記細長いシャフトの遠位端部に旋回自在に取り付ける関節運動継手と、
前記側方凹部内に設けられていて、前記ステープル留め組立体の近位カム作用面に係合する遠位端部を備えたスライドバーと、
前記側方凹部内の前記スライドバーの各側に設けられた右側および左側アクチュエータと、
前記フレームにより画定された前記凹部内で前記スライドバーを側方に案内し、前記スライドバーを前記シャフトの長手方向軸線と平行整列状態に維持する手段と、
前記細長いシャフトに近位側に取り付けられていて、差動長手方向運動をそれぞれのアクチュエータにもたらして前記スライドバーを側方に動かすよう作動的に構成された取っ手部分と、
を有する、外科用器械。
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US11/100,847 US7654431B2 (en) | 2005-02-18 | 2005-04-07 | Surgical instrument with guided laterally moving articulation member |
US11/100,847 | 2005-04-07 |
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EP (1) | EP1709912A3 (ja) |
JP (1) | JP5000181B2 (ja) |
KR (1) | KR20060107393A (ja) |
CN (1) | CN100508899C (ja) |
AU (1) | AU2006201220B2 (ja) |
BR (1) | BRPI0601197A (ja) |
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2005
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- 2006-04-07 KR KR1020060031750A patent/KR20060107393A/ko not_active Application Discontinuation
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Also Published As
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CA2542082C (en) | 2014-12-23 |
SG126845A1 (en) | 2006-11-29 |
CN100508899C (zh) | 2009-07-08 |
CA2542082A1 (en) | 2006-10-07 |
KR20060107393A (ko) | 2006-10-13 |
BRPI0601197A (pt) | 2006-12-05 |
RU2006111323A (ru) | 2007-10-27 |
US7654431B2 (en) | 2010-02-02 |
AU2006201220B2 (en) | 2012-04-05 |
US20060226196A1 (en) | 2006-10-12 |
EP1709912A2 (en) | 2006-10-11 |
EP1709912A3 (en) | 2007-01-03 |
AU2006201220A1 (en) | 2006-10-26 |
JP5000181B2 (ja) | 2012-08-15 |
CN1843302A (zh) | 2006-10-11 |
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