JP2006500090A - 組織係止具並びに関連した展開システム及び方法 - Google Patents
組織係止具並びに関連した展開システム及び方法 Download PDFInfo
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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
- A61B17/064—Surgical staples, i.e. penetrating the tissue
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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
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
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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
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
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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
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
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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
- A61B2017/00831—Material properties
- A61B2017/00867—Material properties shape memory effect
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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
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/044—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors with a threaded shaft, e.g. screws
- A61B2017/0443—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors with a threaded shaft, e.g. screws the shaft being resilient and having a coiled or helical shape in the released state
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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
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B2017/0641—Surgical staples, i.e. penetrating the tissue having at least three legs as part of one single body
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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
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B2017/0647—Surgical staples, i.e. penetrating the tissue having one single leg, e.g. tacks
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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
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B2017/0649—Coils or spirals
Abstract
Description
本願は、Robert Devries等の同日出願米国特許出願第10/230,682号「Devices and Methods for Fastening Tissue Layers」に関連する。その出願の開示内容の全てが、ここに一体に組み入れられる。
本発明は、外科用組織係止具、並びに該組織係止具を繰り出すための関連した展開システム及び方法に関する。特に、本発明は、例えば、胃食道逆流症(GERD:Gastroesophageal Reflux Disease)の治療用の皺襞形成術(fundoplication procedure)に用いられる組織係止具に関する。
Claims (73)
- 複数の組織層を結合するために用いる組織係止具であって、
送出状態から展開状態へと拡がるように構成された基端部材と、
送出状態から展開状態へと拡がるように構成された先端部材と、
基端部材を先端部材に連結する連結部材とを備え、
展開状態にて、前記基端部材及び前記先端部材は、複数の組織層を固定することを特徴とする組織係止具。 - 前記基端部材、前記先端部材、及び前記連結部材の少なくとも1つは、形状記憶材料から形成される1記載の組織係止具。
- 前記基端部材及び前記先端部材の少なくとも1つは、機械的手段により拡張されることを特徴とする請求項1記載の組織係止具。
- 生体適合材料を備えたことを特徴とする請求項1記載の組織係止具。
- 生体順応性材料を備えたことを特徴とする請求項1記載の組織係止具。
- 前記基端部材、前記先端部材、及び前記連結部材の少なくとも1つは、血液凝固剤を含む請求項1記載の組織係止具。
- 前記基端部材、前記先端部材、及び前記連結部材の少なくとも1つは、治療用物質を含む請求項1記載の組織係止具。
- 前記治療用物質は、結合中の組織間の癒着を促進することを特徴とする請求項7記載の組織係止具。
- 前記基端部材、前記先端部材、及び前記連結部材の少なくとも1つは、生体吸収性材料から形成される1記載の組織係止具。
- 前記基端部材及び前記先端部材の少なくとも1つは、展開状態にて外方へ拡がるように構成された複数の脚を含む請求項1記載の組織係止具。
- 前記基端部材及び前記先端部材の少なくとも1つは、複数の脚を含み、各脚は、該脚の一部に近接した少なくとも1つの湾曲部分を有し、その脚の一部は、展開状態にて外方へ拡がるように構成されていることを特徴とする請求項1記載の組織係止具。
- 前記先端部材は、鋭利な先端を含む請求項1記載の組織係止具。
- 前記先端部材は、鋭利な尖頭を備えたことを特徴とする請求項1記載の組織係止具。
- 前記基端部材、前記先端部材、及び前記連結部材は、中央部分にて相互に連結された少なくとも2本のワイヤにより形成されて、前記連結部材を形成していることを特徴とする請求項1記載の組織係止具。
- 前記各ワイヤは、送出状態にて実質的に直線状であり、展開状態にて湾曲していることを特徴とする請求項14記載の組織係止具。
- 前記基端部材、前記先端部材、及び前記連結部材は、一本のワイヤにより形成されたことを特徴とする請求項1記載の組織係止具。
- 前記ワイヤは、送出状態にて実質的に直線状であり、展開状態にて螺旋形である16記載の組織係止具。
- 前記ワイヤは、送出状態にて実質的に直線状であり、展開状態にて非直線部分を含む請求項16記載の組織係止具。
- 前記基端部材及び前記先端部材の少なくとも1つは、形状記憶材料製の平坦面を含む請求項1記載の組織係止具。
- 前記基端部材及び前記先端部材の少なくとも1つは、展開状態にて籠状構造を形成する複数の可撓部材を含む請求項1記載の組織係止具。
- 前記基端部材及び前記先端部材の少なくとも1つは、T型部材を含む請求項1記載の組織係止具。
- 前記基端部材、前記先端部材、及び前記連結部材の少なくとも1つは、ステント状構造を含む請求項1記載の組織係止具。
- 前記連結部材は、前記先端部材と前記基端部材との間に圧縮力を作用させるように構成されたことを特徴とする請求項1記載の組織係止具。
- 前記連結部材は伸縮式である1記載の組織係止具。
- 前記連結部材は、折りたたみ式のベローズを含む請求項1記載の組織係止具。
- 前記連結部材は、ボールソケット機構を含む請求項1記載の組織係止具。
- 前記連結部材は、編まれた構成を含む請求項1記載の組織係止具。
- 当該組織係止具の少なくとも一部を通す中空孔を、さらに備えたことを特徴とする請求項1記載の組織係止具。
- 前記孔は、組織層間に癒着促進剤を投与するように構成されたことを特徴とする請求項28記載の組織係止具。
- 前記組織係止具は、食道の壁を胃基底部の壁に取り付けるのに充分な長さを有することを特徴とする請求項1記載の組織係止具。
- 拡張可能な組織係止具を展開するように構成された送出システムであって、
縮小状態にある組織係止具を収容するように構成されたルーメンを有する可撓チューブと、
前記組織係止具を前記チューブの前記ルーメンに沿って案内する推進器と、
前記推進器の先端に連結して前記組織係止具を把持するように構成された連結システムとを、備えたことを特徴とする送出システム。 - 2つの組織壁をともに折りたたむ装置をさらに含む請求項31記載の送出システム。
- 前記チューブは、前記装置のルーメン内に配置されていることを特徴とする請求項32記載の送出システム。
- 前記チューブは、身体の外へと延びるのに充分な長さを有することを特徴とする請求項31記載の送出システム。
- 前記チューブは、先端に形成された鋭利な切刃を備えたことを特徴とする請求項31記載の送出システム。
- 前記チューブは、複数の組織係止具を収容可能に構成されていることを特徴とする請求項31記載の送出システム。
- 前記チューブの基端にて前記連結システムを駆動する手段を、さらに備えたことを特徴とする請求項31記載の送出システム。
- 前記チューブは、それを被覆して組織を穿孔する鞘を有することを特徴とする請求項31記載の送出システム。
- 前記鞘は、穿孔する先端を含む請求項38記載の送出システム。
- 穿孔ツールが、前記チューブを通じて送出されることを特徴とする請求項31記載の送出システム。
- 組織の第1の壁を組織の第2の壁に取り付ける方法であって、
拡張可能な組織係止具を装置内に縮小状態にて提供し、該組織係止具は、基端部材及び先端部材を有し、
前記装置を、前記第1の組織の壁に連なる身体の通路へと挿入し、
前記装置を、前記第1の組織の壁上の位置に近接させて配置し、
前記装置を、前記第1と第2の組織の壁を貫いて通し、
前記先端部材が完全に前記装置から突出して前記第2の組織の壁に対して拡がるように、前記組織係止具を前記装置の開口へ向けて進め、
前記基端部材が前記第1の組織の壁に対して拡がるように、前記組織係止具を解放することを特徴とする方法。 - 前記先端部材は、鋭利な先端を含み、さらに、前記装置を前記第1と第2の組織の壁を貫いて通す前に、前記先端部材の少なくとも一部を前記装置外へと進めることを特徴とする請求項41記載の方法。
- さらに、前記第1と第2の組織の壁を、前記鋭利な先端で穿孔することを特徴とする請求項42記載の方法。
- 前記装置を前記第1と第2の組織の壁を貫いて通す前に、前記第1と第2の組織の壁を穿孔器具で穿孔することを特徴とする請求項41記載の方法。
- 前記の貫いて通すステップは、前記第1と第2の組織の壁を、前記装置の鋭利な先端により穿孔することを含む請求項41記載の方法。
- 前記第1の組織の壁は食道壁であり、前記第2の組織の壁は胃基底壁である41記載の方法。
- 前記基底壁を前記食道壁に近接させて折りたたむことを含む請求項46記載の方法。
- 前記組織係止具は、前記食道壁を穿孔する前に、前記基底壁を穿孔することを特徴とする請求項41記載の方法。
- 前記組織係止具は、前記基底壁及び前記食道壁を実質的に同時に穿孔することを特徴とする請求項41記載の方法。
- 複数の組織層を結合するために用いる組織係止具であって、
第1の部材と、
第2の部材と、
前記第1の部材を前記第2の部材に連結する連結部材と、
前記組織層に実質的に一定の力を適用する適用手段とを、備えたことを特徴とする組織係止具。 - 前記適用手段は、圧縮可能である50記載の組織係止具。
- 前記適用手段は、ベローズ状構造を含む請求項51記載の組織係止具。
- 前記適用手段は、バネを含む請求項51記載の組織係止具。
- 前記適用手段は、バルーンを含む請求項51記載の組織係止具。
- 前記連結部材は前記適用手段を含み、該適用手段は細長い可撓部材である50記載の組織係止具。
- 複数の組織層を結合するために用いる組織係止具であって、
第1の部材と、
第2の部材と、
前記第1の部材を前記第2の部材に連結する連結部材と、
前記第1と第2の部材の間の前記連結部材の長さを調節する調節手段とを、備えたことを特徴とする組織係止具。 - 前記調節手段は、前記連結部材を前記第1の部材に解放可能に固定するために、前記第1の部材に対応した構造を含む請求項56記載の組織係止具。
- 前記構造は、前記連結部材の移動を前記第1の部材を通る方向に制限するように構成されたことを特徴とする請求項57記載の組織係止具。
- 前記構造は、ラチェット状機構を含む請求項58記載の組織係止具。
- 前記構造は、付勢機構を含む請求項58記載の組織係止具。
- 前記付勢ロック機構は、圧力を付勢するバネを含む請求項60記載の組織係止具。
- 前記構造は、偏心カムを含む請求項58記載の組織係止具。
- 前記調節手段は、前記第1の部材に対応した歯を含む請求項56記載の組織係止具。
- 前記第1の部材は、前記調節手段を含み、該調節手段は、前記第1の部材を逆にするための構造を含む請求項56記載の組織係止具。
- 前記連結部材に対する前記第1の部材の回転により、前記第1と第2の部材の間の前記連結部材の長さが調節されることを特徴とする請求項56記載の組織係止具。
- 前記調節手段は、前記連結部材を収容するために前記第1の部材上のスロットを含む請求項65記載の組織係止具。
- 前記第1の部材は、前記調節手段を含み、該調節手段は、対応する円板を収容して前記連結部材を間に固定する皿を含む請求項56記載の組織係止具。
- 前記調節手段は、前記連結部材を受容する切欠を前記第1の部材内に含む請求項56記載の組織係止具。
- 前記第1の部材に対応した構造は、連結部材の構造と協働して前記連結部材の長さを調節することを特徴とする請求項57記載の組織係止具。
- 前記連結部材の構造は、前記連結部材に沿って間隔をあけて配置された複数の拡張部を含む請求項69記載の組織係止具。
- 前記複数の拡張部により、前記第1の部材と前記第2の部材との間の前記連結部材の長さにおける漸進的な調節が可能となることを特徴とする請求項70記載の組織係止具。
- 前記第1の部材に対応した構造は、アームのあるねじりバネを含む請求項57記載の組織係止具。
- 複数の組織層を結合するために用いる組織係止具であって、
第1の部材と、
第2の部材と、
前記第1の部材を前記第2の部材に連結する連結部材とを備え、該連結部材は、第2の部分に実質的に平行な第1の部分を含み、前記第1と第2の部分は、前記第1と第2の部材の間を延びて前記第1の部材を貫き、連結して結び目状の構成を前記第1の部材に対向して形成することを特徴とする組織係止具。
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Application Number | Priority Date | Filing Date | Title |
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US10/230,672 US20040044364A1 (en) | 2002-08-29 | 2002-08-29 | Tissue fasteners and related deployment systems and methods |
PCT/US2003/025818 WO2004019787A2 (en) | 2002-08-29 | 2003-08-19 | Tissue fasteners and related deployment systems and methods |
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JP2006500090A true JP2006500090A (ja) | 2006-01-05 |
JP2006500090A5 JP2006500090A5 (ja) | 2006-10-05 |
JP4456482B2 JP4456482B2 (ja) | 2010-04-28 |
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US (3) | US20040044364A1 (ja) |
EP (1) | EP1530442B1 (ja) |
JP (1) | JP4456482B2 (ja) |
AT (1) | ATE526884T1 (ja) |
AU (1) | AU2003263892A1 (ja) |
CA (1) | CA2463870A1 (ja) |
ES (1) | ES2369537T3 (ja) |
WO (1) | WO2004019787A2 (ja) |
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JP2021506461A (ja) * | 2017-12-20 | 2021-02-22 | ダブリュ.エル.ゴア アンド アソシエイツ,インコーポレイティドW.L. Gore & Associates, Incorporated | 人工腱索修復デバイス及びそのデリバリー |
JP7307071B2 (ja) | 2017-12-20 | 2023-07-11 | ダブリュ.エル.ゴア アンド アソシエイツ,インコーポレイティド | 人工腱索修復デバイス及びそのデリバリー |
JP7463430B2 (ja) | 2017-12-20 | 2024-04-08 | ダブリュ.エル.ゴア アンド アソシエイツ,インコーポレイティド | 人工腱索修復デバイス及びそのデリバリー |
Also Published As
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ES2369537T3 (es) | 2011-12-01 |
WO2004019787A3 (en) | 2004-06-17 |
EP1530442B1 (en) | 2011-10-05 |
CA2463870A1 (en) | 2004-03-11 |
WO2004019787A2 (en) | 2004-03-11 |
JP4456482B2 (ja) | 2010-04-28 |
US20040044364A1 (en) | 2004-03-04 |
US20140031841A1 (en) | 2014-01-30 |
US20090216265A1 (en) | 2009-08-27 |
EP1530442A2 (en) | 2005-05-18 |
AU2003263892A1 (en) | 2004-03-19 |
ATE526884T1 (de) | 2011-10-15 |
US8579935B2 (en) | 2013-11-12 |
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