JP2008086787A - 外科用ステープル止め装置 - Google Patents
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- 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
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- A—HUMAN NECESSITIES
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- 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
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- A—HUMAN NECESSITIES
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- 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
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- 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
- A61B2017/07214—Stapler heads
- A61B2017/07278—Stapler heads characterised by its sled or its staple holder
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2923—Toothed members, e.g. rack and pinion
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- A61B17/28—Surgical forceps
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- A61B2017/2926—Details of heads or jaws
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- A—HUMAN NECESSITIES
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- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
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- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
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- A61B90/08—Accessories or related features not otherwise provided for
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Abstract
【解決手段】ハウジング36と、該ハウジング36によって支持された可動ハンドル24と、ハウジング36から遠位方向に延び、長手方向軸線を構成する細長い本体14と、少なくとも一部がハウジング36内に支持された作動シャフトと、細長い本体の遠位端に支持されたローディングユニット16と、レバーとカム部材とを備えた関節運動機構とを有する、外科用ステープル止め装置10。
【選択図】図1
Description
外科用ファスナーを順次適用し、ファスナーによって綴じられた組織を選択的に
切開する内視鏡外科用ステープル止め装置に用いるための関節運動機構に関する
。
外科用ファスナーで接合する外科装置が当該技術で知られている。或る器具では
、ファスナーで接合した組織を切断するナイフが設けられる。ファスナーは、典
型的には、外科用ステープルの形態であるが、二部品ポリマー製ファスナーを利
用しても良い。
ぞれが組織を捕捉またはクランプ止めするのに用いられる。典型的には、これら
部材の一方は、少なくとも横二列に配列された複数のステープルを収容したステ
ープルカートリッジを支持し、他方の部材は、ステープルがステープルカートリ
ッジから押し出されるときにステープルの脚部を形成するための表面を画定する
アンビルを有する。一般的には、ステープル止め作業は、ステープルカートリッ
ジの中を長手方向に移動するカムバーによって行われ、カムバーは、ステープル
をステープルカートリッジから順次排出するようにステープルプッシャーに作用
する。ナイフがステープル列の間を移動して、ステープル止めされた組織をステ
ープル列の間で長手方向に切断し及び/又は切開するのが良い。この種の器具は
、例えば、米国特許第3079606号及び同第3490675号に開示されて
いる。
は、二重のステープル列を切開部の両側に付ける。これは、使い捨てローディン
グユニットを用いて行われ、このユニットでは、カム部材が、二組の交互配置さ
れたステープル支持溝の間の細長い案内路を通って移動する。ステープル押し出
し部材が支持溝内に位置し、且つ、使い捨てローディングユニットのステープル
カートリッジからステープルを排出すべく長手方向に動くカム部材が押し出し部
材に接触するように位置決めされる。この種類のステープル止め装置の他の例が
、米国特許第4429695号及び同第5065929号に開示されている。
科方法で用いられるように設計されたものである。しかし、内視鏡または腹腔鏡
を使用する方法では、外科手術は、小さい切開部あるいは、皮膚の小さい入口傷
に挿入された細いカニューレを通して行われる。内視鏡及び/又は腹腔鏡を使用
する外科方法の特定の要望に対応するために、内視鏡外科用ステープル止め装置
が開発され、例えば、米国特許第5040715号(グリーン等)、同第530
7976号(オルソン等)、同第5312023号(グリーン等)、同第531
8221号(グリーン等)、同第5326013号(グリーン等)、及び同第5
332142号(ロビンソン等)に開示されている。
器具、例えばMultifire ENDO GIA*30及びMultifi
re ENDO GIA*60として製造し、販売してきた。これらの器具は、
著しい臨床的な利益をもたらした。それにもかかわらず、例えば、製造のコスト
および複雑さを減少させることによって、改良を行うことが可能である。
ィングユニット(U.S.サージカル)及びステープルカートリッジ(エシコン
、Ethicon)とともに使用するように構成されている。例えば、長さが3
0mm、45mm及び60mmであるステープルの平行な列を付けるための個々
の直線ステープル止め装置が、現在、入手できる。かくして、通常の手術中、外
科医に、種々の異なるステープル止め器具を単一の腹腔鏡外科方法を行うために
利用することを要求することがある。このような場合、腹腔鏡外科方法と関連し
た時間、複雑さ及び全体コストを増大させる。加えて、多数のステープル止め装
置寸法を設計し製造する場合、単一の多目的ステープル止め装置を作る場合と比
べて、コストがより増大する。
種々の異なる寸法のローディングユニットを採用する、上記のような手術方法中
に使用するための外科装置を提供することはきわめて有益であろう。また、寸法
が異なり、又は、ステープル止め、クリップ止め、切断及び/又は関節運動のよ
うな目的が異なる使い捨てローディングユニットを用いて、前記装置が多数の仕
事を行うことができれば、きわめて有益であろう。
社が製造し販売する内視鏡ステープル止め器具と比較して、Multifire
ENDO GIA*30及び60の器具の重要な利益をいささかも犠牲にしな
いことが強く望まれる。例えば、そのような改良は、器具の各火入れごとに新し
いナイフの刃を提供する利益があるべきであり、また、手術チームが使い捨てロ
ーディングユニットを取外すことを選択しない限り或いは選択するまで、使い捨
てローディングユニットはステープル止め器具内に確実に保持される利益がある
べきである。これらの利点は、歴史的に、U.S.サージカルの器具には認めら
れ、エシコンの器具には認められなかった。
時に組織を切開するための外科用ステープル止め装置を提供する。外科用ステー
プル止め装置は、直線長さが30mm乃至60mmのステープル列を有する使い
捨てローディングユニットを受け入れるようになっている。外科用ステープル止
め装置は、関節運動式および非関節運動式使い捨てローディングユニットを受け
入れるようにもなっている。
ドルアセンブリーを含む。可動ハンドルは、組織をクランプ止めするために作動
ストロークにわたって移動でき、使い捨てローディングユニットからステープル
を排出する。細長い本体は、ハンドルアセンブリーから遠位方向に延び、且つ長
手方向軸線を画定する。歯付きラックを有する作動シャフトが、つめ機構によっ
て可動ハンドルと作動的に関連する。作動シャフトの遠位端は、使い捨てローデ
ィングユニット内に位置した軸線方向駆動アセンブリーに作動的に係合する遠位
端を有する制御棒に連結される。
レバーは、段付きカム動作用チャンネルを有するカム部材と作動的に係合する。
カム部材は並進部材と係合し、該並進部材は、段付きカム動作用チャンネル内に
受け入れられるように寸法決めされたピンを含み、その結果、レバーの枢動によ
り並進部材の直線運動を生じさせる。第一関節運動リンクは、並進部材に係合す
る近位端と、使い捨てローディングユニット内に位置決めされた第二関節運動リ
ンクに係合する遠位端とを含む。並進部材の直線運動により、関節運動リンクの
直線運動を生じさせて、使い捨てローディングユニットの工具アセンブリーの関
節運動を生じさせる。
れた使い捨てローディングユニットの型式を感知する感知機構を含む。感知機構
は、細長い本体に固着された使い捨てローディングユニットに係合すべく細長い
本体内に配置された感知器管を含む。感知器管に連結された感知シリンダーが、
関節運動レバーの移動を防止すべく第一位置で関節運動機構に係合するように形
成されたタブ部分を有する係止リングに係合する。関節運動式使い捨てローディ
ングユニットがステープル止め装置の細長い本体に固着されているとき、係止リ
ングは感知シリンダーによって第二位置に移動させられ、タブ部分を関節運動機
構から取り外して、関節運動レバーの移動を可能にする。それに対して、非関節
運動式使い捨てローディングユニットは、該関節運動レバーの係止を解くことは
ない。
したがって、本発明は以下を提供する。
(1)外科用ステープル止め装置において、
a)ハウジング、
b)上記ハウジングによって支持され、作動行程により移動できる可動ハンドル
、
c)上記ハウジングから遠位方向に延びて縦方向の軸を画定し、使い捨てローデ
ィングユニットと解放自在に係合する構成の遠端を有する細長い本体、
d)少なくとも一部が上記ハウジング内に支持され、作動行程による可動ハンド
ルの移動に応じてハウジング内部に長手方向に移動可能に取り付けられた作動シ
ャフト、および
e)係止部材およびプランジャーを含む発射閉止アセンブリーを有し、上記係止部
材は少なくとも一部がハウジング内に枢動自在に取り付けられ、プランジャーは
、上記ロック部材を作動シャフトの長手方向前進を妨げる第一位置から作動シャフ
トの長手方向前進を許す第二位置まで枢動させるために、上記係止部材と作動的に
係合して移動自在である、
外科用ステープル止め装置。
(2)上記プランジャーは、装置の使用者がアクセス可能な位置まで
ハウジングの壁を貫いて延びる項目1に記載の外科用ステープル止め装置。
(3)上記係止部材は、スロットを形成した延長部を含み、上記プラ
ンジャーは、上記プランジャーに形成されたカム動作面を含み、上記カム動作面は、
スロット内に受け入れられるように寸法決めされ且つ構成され、プランジャーは
、係止部材を第一の位置から第二の位置へ枢動させるため、カム動作面を移動さ
せてスロットの壁と係合させるように移動自在である、項目1に記載の外科用
ステープル止め装置。
(4)上記係止部材と作動係合している付勢部材を更に有し、上記付勢
部材は、上記係止部材を第一の位置まで付勢するように位置決めされた、項目4
に記載の外科用ステープル止め装置。
(5)上記係止部材は、上記係止部材を第二の位置に保持するするため
に、上記係止部材と上記プランジャーを解放自在に作動係合させたままにするように
形作られた少なくとも一つの係止面を有する、項目1に記載の外科用ステープ
ル止め装置。
(6)プランジャーは、上記プランジャーに形成されたテーパされた、
実質的に環状のカム動作部材を有し、上記プランジャーは、細長い本体の長手軸線
に対して実質的に垂直な方向に移動することができるようにハウジング内に支持
され、シャフトの一部分が、ハウジングの対向する壁を通って延び、係止部材は
、カム動作部材を受け取るように形作られたスロットを有する近位延長部を有し
、上記係止部材は、その遠位端を中心に枢動自在にハウジング内に支持され、上記ハ
ウジング内のプランジャーの移動により、カム動作面をスロットを画定する対向
する壁のいずれかに当接させて、係止部材を第一の位置から第二の位置へ移動さ
せることができる、項目1に記載の外科用ステープル止め装置。
(7)係止部材が、係止面を有し、上記ロック面は、係止部材が作動シ
ャフトの長手方向の前進を妨げるため第一の位置にあるときに、作動シャフトに
形成された当接面に係合するように位置決めされる、項目1に記載の外科用ス
テープル止め装置。
(8)係止部材が係合部材を更に有し、上記作動シャフトが、肩部を
有し、係合部材は、作動シャフトがハウジング内を近位方向に移動しないように
するため作動シャフトが第一の位置にあるときに、肩部に係合するように位置決
めされる、項目7に記載の外科用ステープル止め装置。
(9)外科用ステープル止め装置であって、
a)ハウジングと、
b)上記ハウジングによって支持された可動ハンドルとを有し、上記作動ハンドル
が作動行程に亘って移動することができ、
c)上記ハウジングから遠位方向に延び、長手方向軸線を画定する細長い本体を
有し、上記細長い本体が、使い捨てローディングユニットに解放自在に係合するよ
うになった遠位端を有し、
d)作動シャフトと駆動つめとを備えた前進アセンブリーを有し、作動シャフ
トが歯付きラックを有し、少なくとも一部がハウジング内に支持され、駆動つめ
が可動ハンドルと作動的に関連され、ラックと係合するように付勢され、作動行
程中、駆動つめは作動シャフトの長手方向前進をもたらすように移動可能であり
、
e)作動シャフトと作動的に関連されたリリース板を備えた引き込み機構を有
し、リリース板は、駆動つめのラックとの係合を解くため、駆動つめと作動係合
するように作動シャフトに対して移動することができる、
外科用ステープル止め装置。
(10)引き込み機構は、さらに、ハウジングの外部に位置決めされ
た少なくとも一つの引き込みノブを更に有し、上記少なくとも一つの引き込みノブ
が、リリース板に作動的に連結され、上記リリース板を移動させて駆動つめと係合
させるように移動可能である、項目9に記載の外科用ステープル止め装置。
(11)リリース板が、少なくとも一つのカムスロットを有し、作動
シャフトが各カムスロット内に位置決めされたピンを有し、リリース板が結合ロ
ッドによって少なくとも一つの引き込みノブに連結され、結合ロッドの移動によ
りリリース板を作動シャフトに対して移動させることができ、これにより上記ピン
がリリース板にカム動作して駆動つめと係合する、項目10に記載の外科用ス
テープル止め装置。
(12)上記駆動つめが横方向に延びた翼部を有し、リリース板が、
駆動つめのラックとの係合を解くため、横方向に延びた翼部と係合するように移
動することができる、項目10に記載の外科用ステープル止め装置。
(13)外科用ステープル止め装置であって、
a)ハウジングと、
b)上記ハウジングによって支持された可動ハンドルとを有し、上記可動ハンドル
が作動行程に亘って移動することができ、
c)上記ハウジングから遠位方向に延び、長手方向軸線を画定する細長い本体を
有し、上記細長い本体が使い捨てローディングユニットに解放自在に係合するよう
になった遠位端を有し、
d)作動シャフトと、駆動つめと、係止つめとを備える前進アセンブリーを有
し、作動シャフトが歯付きラックを有し、少なくとも一部がハウジング内に支持
され、駆動つめが、可動ハンドルと作動的に関連され、作動行程中作動シャフト
の長手方向前進をもたらすため、ラックと係合するよう移動可能であり、係止つ
めは、作動シャフトを長手方向固定位置に保持するため、ラックと係合するよう
に付勢され、
ギアアセンブリーと、スライド板とを備えた逆止めクラッチ機構を有し、ギア
アセンブリーが作動シャフトの運動をスライド板の運動に変換するように位置決
めされ、スライド板がカム面を有し、作動シャフトの長手方向前進に応じて、カ
ム面が係止つめに係合してラックとの係合を解くように係止つめ付勢する第一の
位置から、カム面が係止つめから間隔を隔てられる第二の位置まで移動すること
ができる、
外科用ステープル止め装置。
(14)ギアアセンブリーが、互いに作動連結された第一、第二ギア
を有し、作動シャフトおよび上記スライド板が、各々、一組のギア歯を有し、第
一のギアは作動シャフトのギア歯と噛み合うように位置決めされ、第二のギアは
スライド板のギア歯と噛み合うように位置決めされ、作動シャフトの長手方向前
進運動は、作動シャフトの長手方向前進がスライド板の長手方向前進運動に変換
する、項目13に記載の外科用ステープル止め装置。
(15)ハウジング内に固定して取り付けられたピンを更に有し、ス
ライド板が、ピンを受け入れるように作られた細長いスロットを有し、ピンは、
スライド板の長手方向前進を制限するため、スロットの端部に当接するように位
置決めされている、項目14に記載の外科用ステープル止め装置。
(16)第一のギアが、第一のシャフトに回転自在に取り付けられ、
第二のギアが、第二のシャフトに回転自在に取り付けられ、上記第一、第二のシャ
フトが、スプリングクラッチによって互いに作動連結され、上記スプリングクラッ
チにより、ピンがスライド板の更なる長手方向前進を妨げた後でも、第一のシャ
フトが第二のシャフトとは独立して回転することができる、項目15に記載の
外科用ステープル止め装置。
(17)作動シャフトが、第一、第二組のギア歯を有し、上記作動シャ
フトの第一第二組のギア歯は、作動シャフトの長手方向前進の少なくとも一部の
間、第一のギアと噛み合うように位置決めされ、上記第一組のギア歯は、カム面が
係止つめに係合する位置から、カム面が係止つめから間隔が隔てられる位置にス
ライド板を長手方向に前進させるように、作動シャフトに位置決めされ上記第二組
のギア歯は、作動シャフトの引き込み中、カム面が係止つめから間隔が隔てられ
ている位置から、カム面が係止つめに係合してラックとの係合を解くように係止
つめを付勢する位置にスライド板を近位方向に戻すように作動シャフトに位置決
めされている、項目16に記載の外科用ステープル止め装置。
(18)外科用ステープル止め装置であって、
a)ハウジングと、
b)上記ハウジングによって支持された可動ハンドルとを有し、上記可動ハンドル
が作動行程に亘って移動自在であり、
c)ハウジングから遠位方向に延び、長手方向軸線を構成する細長い本体と、
d)少なくとも一部がハウジング内に支持された作動シャフトとを有し、上記作
動シャフトが、作動行程に亘る可動ハンドルの移動に応じて、ハウジング内を長
手方向に移動することができるように取り付けられ、
e)細長い本体の遠位端に支持されたローディングユニットを有し、上記ローデ
ィングユニットが、近位ハウジング部分と遠位工具アセンブリーとを有し、近位
ハウジング部分が細長い本体の長手方向軸線と一致する長手方向軸線と、遠位工
具アセンブリーに作動連結された第一の関節運動リンクとを有し、遠位工具アセ
ンブリーが近位ハウジング部分に枢動自在に取り付けられ、
f)レバーとカム部材とを備えた関節運動機構を有し、レバーがカム部材と操
作接続され、上記カム部材が第一の関節運動リンクに作動連結され、段付きカムス
ロットを有し、レバーが工具アセンブリーを近位ハウジング部分の長手方向軸線
に対して関節運動するように移動自在であり、段付きカムスロットの各段が工具
アセンブリーのあらかじめ定められた関節運動位置を構成する、
外科用ステープル止め装置。
(19)関節運動アセンブリーが並進部材を更に有し、上記並進部材は
、これに固定された第一の端部と段付きカムスロット内に受け入れられるように
寸法形状決めされた第二の端部とを備えたピンを有し、並進部材の遠位端が、第
一の関節運動リンクに作動連結されている、項目18に記載の外科用ステープ
ル止め装置。
(20)レバーが、ハウジングの遠位端に隣接して枢動自在に取り付
けられている、項目19に記載の外科用ステープル止め装置。
(21)上記カム部材は、細長い本体の長手方向軸線に対してほぼ垂
直な方向の移動に限定され、上記並進部材は、細長い本体の長手方向軸線とほぼ
平行な方向の移動に限定される項目20に記載の外科用ステープル止め装置。
(22)上記関節運動機構は、さらに、第二の関節運動リンクを含み
、上記第二の関節運動リンクは、第一の関節運動リンクの近端と作動係合する遠端
と並進部材と作動係合する近端とを有する項目20に記載の外科用ステープル
止め装置。
(23)外科用ステープル止め装置において、
a)作動行程により移動できる可動ハンドルを含むハンドルアセンブリー、
b)ハンドルアセンブリーから遠位方向に延び且つ長手方向の軸線を画定し、
関節運動式および非関節運動式双方の使い捨てローディングユニットの両方に解
放自在に係合するようになった遠端を有する細長い本体、
c)少なくとも一部が上記ハンドルアセンブリー内で支持され、作動ハンドルの
手動操作に応じて長手方向に移動するように取り付けられた作動シャフト、
d)ハンドルアセンブリーに隣接して取り付けられた関節運動レバーおよび関
節運動リンクを含み関節運動レバーに作動連結された近端および細長い本体の遠
端に隣接して配置された遠端を有する関節運動機構、および、
e)上記細長い本体内に配置され、且つ関節運動機構と作動的に関連し、細長い
本体と係合する使い捨てローディングユニットの種類を感知するための感知部材
を含む感知機構、
からなる外科用ステープル止め装置。
(24)上記感知機構は、細長い本体内に移動自在に配置され、上記
感知部材は、非関節運動式の使い捨てローディングユニットと細長い本体との係
合に応じて第一の位置に移動でき、また関節運動式の使い捨てローディングユニ
ットと細長い本体との係合に応じて第二の位置に移動できる、項目23に記載
の外科用ステープル止め装置。
(25)上記第一の位置では、上記感知機構は、上記関節運動機構と
作動的に操作係合して関節運動レバーの移動を防止する項目24に記載の外科
用ステープル止め装置。
(26)上記関節運動機構は、段付きカムスロットを有するカム部材
を含み、上記カム部材は、関節運動レバーと関節運動リンクの間に作動的に配置さ
れる、項目25に記載の外科用ステープル止め装置。
以下、添付の図面を参照して、本発明にもとづく内視鏡を使用する外科用ステ
ープル止め装置の好ましい実施形態を詳細に説明する。なお、図面中、同一また
は類似の要素は同じ参照番号で示す。
め装置のオペレータに最も近い端を指す。また、「遠位」とは、ステープル止め
装置のオペレータに最も遠い端を指す。
もので、全体が参照番号10で示されている。簡単に述べれば、外科用ステープ
ル止め装置10は、ハンドルアセンブリー12および細長い本体14を含む。使
い捨てローディングユニットすなわちDLU16が細長い本体14の遠位端に解
放自在に固着される。使い捨てローディングユニットは、複数の外科用ステープ
ルを収容したカートリッジアセンブリ18および該カートリッジアセンブリ18
に対して移動自在に固定されたアンビルアセンブリー20を有する工具アセンブ
リー17を含む。使い捨てローディングユニット16は、長さが約30mmない
し約60mmの直線のステープル列を適用するように構成されている。本発明は
、例えば45mmなど他の長さの直線のステープル列を有する使い捨てローディ
ングユニットにも適用可能である。ハンドルアセンブリー12は、静止ハンドル
部材22、可動ハンドル部材24、およびバレル部分26を含む。好ましくは、
回転可能な部材28がバレル部分26の前端に取り付けられ、ハンドルアセンブ
リー12に対する細長い本体14の回転を容易にする。また好ましくは、関節運
動レバー30も回転可能なノブ28に隣接してバレル部分26の前方端に取り付
けられ、工具アセンブリー17の関節運動を容易にする。一対の引き込みノブ3
2がバレル部分26に沿って移動自在に配設され、以下に詳細に説明するように
、外科用ステープル止め装置10を引き込み位置に戻す。
リー12の静止ハンドル部材22及びバレル部分26を形成する成形ハウジング
半部36aおよび36bで形成されたハウジング36を含む(図1参照)。可動
ハンドル部材24は、ハウジング半部36aおよび36bの間で枢動ピン28を
中心に枢動自在に支持されている。好ましくはねじりスプリングである付勢部材
40が、可動ハンドル24を付勢して静止ハンドル22から遠ざける。作動シャ
フト46が、ハウジング36のバレル部分26内で支持され、歯付きラック48
を含む。横方向に延びる翼部43aおよび43bを備えたラック係合フィンガー
43を有する駆動つめ42が、可動ハンドル24の一端に枢動ピンを中心に枢動
自在に取り付けられている。同じく好ましくはねじりスプリングである付勢部材
50が、駆動つめ42の係合フィンガー43を作動シャフト46の歯付きラック
48に向って付勢するように位置決めされている。可動ハンドル24は枢動自在
で、駆動つめ42の係合フィンガー43を動かして作動シャフト46の歯付きラ
ック48と接触させ、作動シャフト29を遠位方向へ直線的に前進させる。作動
シャフト46の前方端は、制御棒52の近端49を回転自在に受けており、それ
によって、作動シャフト46の直線前進に対応して制御棒52を直線前進させる
。ラック係合部材55を有する係止つめ54が、ハウジング36内に枢動ピン5
7を中心に枢動自在に取り付けられており、同じく好ましくはねじりスプリング
である付勢部材56によって歯付きラック48に向って付勢されている。係止つ
め54の係合部材55は、作動シャフト46を長手方向に固定された位置に保持
するため歯付きラック48と係合するように移動できる。
によって作動シャフト46の近端に連結されている。連結棒60は、引き込みノ
ブ32を受けるための左右の係合部分62aおよび62bおよび作動シャフト4
6にその近端に隣接して形成された一対の長手方向のスロット34a内で並進す
るように寸法決めされ且つ構成された中央部分62cを含む。解放板64が、作
動シャフト46と作動的に関連しており、引き込みノブ32の手動操作に応じて
作動シャフト46に対して移動するように取り付けられている。一対の間隔を隔
てたピン66が、作動シャフト46の側面から外方に延び、解放板64に形成さ
れた一対の傾斜カムスロット68に係合する。引き込みノブ32が後方移動する
と、ピン66は、解放板64を作動シャフト46および歯付きラック48に対し
て下方に解放し、解放板64の底部分が歯付きラック48の下に延びて、駆動つ
め42の係合フィンガー43を歯付きラック48との係合から外すことができる
。解放板64の近端には、連結棒60の中央部分62cを収容するための横方向
のスロット70が形成されており、引き込みノブ32が後方に引かれて作動シャ
フト46を引き込み、したがって制御棒52を後方に引込むとき、連結棒60の
長手方向の並進に順応する細長いスロット34(図1参照)がハンドルアセンブ
リー12のバレル部26に画定される。作動シャフト46は、スプリング72に
よって近位方向に付勢され、該スプリングは、一端がコネクタ74を介して連結
棒部分62に、また他端が作動シャフト46上の柱76に固定されている。
含み、該発射閉止アセンブリー80は、プランジャー82および枢動自在の係止
部材83を含む。プランジャー82は、付勢スプリング84によって中央位置へ
付勢され、環状のテーパカム動作面85を含む。プランジャー82の各端部は、
静止ハンドル22の上端に隣接してハウジング36を貫いて(図1参照)延びて
いる。枢動自在の係止部材83は、その遠端が枢動ピン86を中心にハウジング
半部36aと36bとの間に枢動自在に取り付けられ、また、係止面88および
スロット89を形成した近位延長部90を含む。係止部材83は、スプリング9
2によって反時計回りに付勢され、シャフト46の前進およびそれに続くステー
プル止め装置の発射を防止するため係止面88を、作動シャフト46の遠端に当
接する位置へ移動させる。環状のテーパカム動作面85は、近位延長部90のテ
ーパスロット89内に延びている。プランジャー82が、付勢スプリング84の
付勢に抗して横方向いずれかの方向に移動すると、テーパカム動作面85を動か
してテーパスロット89の側壁と係合させ、図4において係止部材83を枢動ピ
ン86を中心に時計回りに枢動させて、ブロック面88を作動シャフト46の前
進、したがってステープル止め装置の発射を可能にする位置へ移動させる。ブロ
ック面88は、凹部87によってこの位置に保持され、凹部はカム動作面85の
テーパ−尖端を受けて係止部材83を反時計回りの位置に係止する。発射閉止ア
センブリー80の操作は、以下でさらに説明する。
機構を含み、該逆止めクラッチ機構は、第一のシャフト96に回転自在に取り付
けられた第一のギア94、第二のシャフト100に取り付けられた第二のギア9
8、およびハウジング36内に滑動自在に取り付けられた滑動板102(図6お
よび7)を含む。滑動板102は、係止つめの枢動ピン57を中心に滑動自在に
位置決めされるように寸法決めされ且つ構成された細長いスロット104、第二
のギア98の歯と噛み合うように構成されたギア板106、およびカム面108
を含む。引き込み位置では、滑動板102のカム面108は、係止つめ54と係
合して、該係止つめ54が歯付きラック48と係合するのを防止する。作動シャ
フト46は、該作動シャフト46の移動中該作動シャフト46の第一のギア94
と係合するように位置決めされた近位組のギア歯110bから隔てられた遠位組
のギア歯110aを含む。可動ハンドル24を枢動ピン38を中心に枢動させて
作動シャフト46を前進させると、作動シャフト46の遠位のギア歯110aは
、第一のギア94および第一のシャフト96と噛み合ってそれらを回転させる。
第一のシャフト96は、スプリングクラッチアセンブリーによって第二のシャフ
ト100に連結され、第一シャフト96の回転が第二シャフト100の回転を引
き起こす。第ニシャフト100の回転が、ギア板106と係合する第二のギア9
8の回転を引き起こし、その結果、滑動板102の直線前進を生じさせる。滑動
板102の直線前進は、細長いスロット104の長さに制限される。滑動板をス
ロット104の長さだけ前進させたとき、カム面108は、係止つめ54を解放
し、それによって係止つめ54を移動させて歯付きラック48と係合させる。作
動シャフト46の前進が続くと、ついにはギア歯110bを移動させてギア板1
06と係合させる。しかし、滑動板102は、位置が長手方向に固定されている
ため、スプリングクラッチは強制的に解放され、したがって作動シャフト46が
遠位方向に前進し続けることを可能にする。
)引き込み位置に戻されると、ギア歯110bは、第一のギア94と係合して第
二のギア98を逆方向に回転させ、滑動部材102をハウジング36内に近位方
向に引き込む。滑動部材102の近位方向への移動は、係止つめ54と歯付きラ
ック48の間の係合に先立ってカム面108を係止つめ54へ前進させ、該係止
つめ54を、作動シャフト46の引き込みを可能にする位置へ付勢する。
6bの間で支持される枢動部材114を中心にハウジング36内に枢動自在に取
り付けられた緊急戻りボタン112を含む。戻りボタン112は、バレル部分2
6の近端に配置された外部配置の部材116を含む。部材116は、枢動部材1
14を中心に移動できて、係止つめ54の近端と係合してステープル止め装置1
0の発射行程中ラック係合部材55を歯付きラック48との係合から外し、作動
シャフト46の引き込みを可能にする。上に述べたように、作動シャフト46の
前進のクランプ止め部分の間、滑動板102は、つめ54をラック48との係合
から外し、それによって作動シャフト46を引き込むのに戻りボタン112の作
動は必要ない。
−10を参照して、ハウジング36は、好ましくは成形半部28aおよび28b
で形成される回転部材28の近端に形成された環状リブ118を受け入れるよう
に構成された環状チャンネル117を含む。環状チャンネル117および環状リ
ブ118は、回転部材28とハウジング36の間の相対回転を可能にするもので
ある。内側ハウジング122は、外側ケーシング124内に受け入れられるよう
に寸法決めされ、内部ボア126(図8)を含み、該ボアは、内側ハウジングを
貫ぬいて延び、且つ第一の関節運動リンク123および制御棒52を滑動自在に
受け入れるように寸法決めされる。ハウジング122およびケーシング124の
近端は、各々が、それぞれ一対の径方向に対向した開口130および128を含
み、これらの開口は、回転部材28の遠端上に形成された径方向の突起132を
受け入れるように寸法決めされる。突起132および開口128および130は
、回転部材28および細長い本体14を互に関して長手方向にまた回転自在に固
定する。したがって、ハンドルアセンブリー12に対する回転ノブ28の回転に
より、細長い本体14をハンドルアセンブリー12に対して回転させる。
バー30、カム部材136、並進部材138、および第一の関節運動リンク12
3を含む(図9)。関節運動レバー30は、回転部材28から外方に延び、また
好ましくはそれと一体に形成された枢動部材140を中心に枢動自在に取り付け
られる。突起142がカム部材136との係合のために、関節運動レバー30か
ら下方に延びている。
を含み、該ハウジングは、その片側を通って延びる細長いスロット146とその
反対側に形成された段付きカム動作面148を有する。カム動作面148の各段
は、ステープル止め装置10の関節運動の特定の角度に対応している。図には5
段示されているが、段数は、これより多くてもあるいは少なくてもよい。細長い
スロット146は、関節運動レバー30に形成された突起142を受けるように
構成される。ハウジング144は、遠端の段付き部分150および近位の段付き
部分152を含む。近位の段付き部分152は、凹部154を含む。
回転部材28の内壁に沿って形成された溝158内に滑動自在に受け入れられる
ように構成された複数の峰部156を含む。該峰部156と該溝158の係合に
よって、回転部材28と並進部材138の相対回転を防止するとともにそれらの
相対直線運動を許す。並進部材138の遠端は、アーム160を含み、該アーム
は、関節運動リンク123の近端から延びるフィンガー164を受け入れるよう
に構成された開口162を含む(図10a参照)。例えばテフロン(登録商標)などの非研磨性材料でつくられたハウジング168を有するピン166は、並進部材138に
固定され、且つ段付きカム動作面148内に受けられるように寸法決めされてい
る。
0および152は、回転部材28に形成されたフランジ170および172の下
に位置決めされて、カム部材136をステープル止め装置10の長手方向軸線に
対して横方向の移動に制限する。関節運動レバー30を枢動部材140を中心に
枢動させると、カム部材136は、回転部材28上を横方向に動かされて段付き
カム動作面148をピン166に対して横方向に移動させ、ピン166を強制的
に段付きカム面148に沿って近位方向および遠位方向に移動させる。ピン16
6は、並進部材138に固定して取り付けられているため、並進部材138も近
位方向および遠位方向に動かされ、それに対応して第一の作動リンク123を近
位方向および遠位方向へ移動させることになる。
構が、ステープル止め装置10内で細長い本体14からハンドルアセンブリー1
2内へ延びている。感知機構は、細長い本体14のボア26内に滑動自在に支持
された感知器官176を含む。感知器官176の遠端は、細長い本体14の遠端
に向けて配置され、感知器官176の近端は、一対のこぶ180によって感知シ
リンダー174の遠端内に固定されている。感知器リンク182の遠端は、感知
器シリンダー178の近端に固定されている。感知器リンク182(図8aおよ
び8c参照)は、枢動自在な係止部材83のカム動作面83aに係合する球根状
端部184を有する。使い捨てローディングユニット(図示せず)が細長い本体
14の遠端に挿入されるとき、使い捨てローディングユニットは、感知器官17
6の遠端177に係合し、感知器官176を近位方向に駆動し、それによって感
知器シリンダー178および感知器リンク182を近位方向に駆動する。感知器
リンク182が近位方向に移動することにより、感知器リンク182の球根状端
部184をカム面83aの遠位方向へ移動させ、それによって係止部材83をス
プリング92の作用でステープル止め装置10の発射を可能にする位置から阻止
位置まで枢動させる。この阻止位置では、阻止部材83は、作動シャフト46に
係合してステープル止め装置10の発射を防止するように位置決めされる。感知
器リンク182および係止部材83は、使い捨てローディングユニットが細長い
本体14に固定された後では、まず発射閉止アセンブリー80を操作しない限り
外科用ステープル止め装置10の発射が妨げられるように機能する。リンク18
2の近位方向への移動によって、係止部材83を図5に示す位置へ移動させるこ
とは理解されよう。
内に受け入れられるように構成されたこぶ部分186を有する係止リング184
は、制御タブ部分188と近位フランジ部分190の間で感知器シリンダー17
8の回りに位置決めされる。フランジ部分190と係止リング184の間に配置
されたスプリング192は、係止リングを感知器シリンダー178の回りで遠位
方向に付勢する。延長挿入尖端193を有する関節運動式の使い捨てローディン
グユニット16bがステープル止め装置10の細長い本体14の遠端内に挿入さ
れるとき、挿入尖端193がタブ部分188を近位方向に動かして係止リング1
84と係合させ、係止リング184及びこぶ186をカム部材136の凹部15
4の近位方向に付勢する(図12b参照)。こぶ186が凹部154の近位方向
に位置決めされると、カム部材136は、横方向に自由に移動してステープル止
め装置10の関節運動を行うことができる。非関節運動式の使い捨てローディン
グユニットは、長い挿入尖端をもたない(図12a参照)。したがって、非関節
運動式の使い捨てローディングユニットが細長い本体14内に挿入されるとき、
感知器シリンダー178は、こぶ186を凹部154から移動させるに十分な距
離近位方向に引き込められない。したがって、カム部材136は、凹部154内
に位置決めされた係止リング184のこぶ186によって横方向に移動するのを
妨げられ、関節運動レバー30は、その中央位置に係止される。
ニットの細長い本体14内への挿入中作動される制御棒ロック機構190を含む
。制御棒ロック機構190は、スプリング194によって遠位方向に付勢された
ブロック板192を含み、また傾斜カム面195を有する近位フィンガー189
を含む。半円形の係合部材196は、スプリング197によって横方向制御棒5
2に向って付勢されている。制御棒52は、係合部材196を受け入れるように
構成された環状凹部199を含む。ブロック板192は、係合部材196から隔
てられた遠位位置から係合部材196の背後に位置した近位位置まで移動できる
。近位位置では、係合部材196は、ブロック板192との係合によって凹部1
99から付勢されるのを妨げられている。以下に詳細に説明するように使い捨て
ローディングユニット16が細長い本体14の遠端に挿入される間(図1参照)
、ブロック板192のカム面195は、使い捨てローディングユニットを回転さ
せて細長い本体14と係合させ板192を近位位置へ付勢すると、使い捨てロー
ディングユニット16のこぶ254(図30)によって係合される。凹部199
内に配置される係合部材196がブロック板192によって凹部内に保持され、
こぶ254は、カム面195に係合して組み立て中制御棒52の長手方向の移動
を防止する。使い捨てローディングユニット16が細長い本体14に対して正し
く配置されるとき、使い捨てローディングユニット16の近端のこぶ254はカ
ム面195から外れ、スプリング194はブロック板192をその遠位位置へ戻
し、したがって制御棒52のその後の長手方向移動を可能にする。使い捨てロー
ディングユニットのこぶがカム面195から外れると、耳に聞こえるクリック音
が生じて、使い捨てローディングユニット16が細長い本体14に正しく装着さ
れたことを示すことは理解されよう。
分14の遠端に解放自在に係合するようになった近位ハウジング部分200を含
む(図1)。取り付けアセンブリー202は、ハウジング部分200の遠端に枢
動自在に固定され、また、工具アセンブリー17の近端を受け入れるように構成
され、それによって、ハウジング部分200の長手方向軸線と垂直な軸線を中心
とする取り付けアセンブリー202の枢動は、工具アセンブリー17の関節運動
を行なわせる。
ンブリー20およびカートリッジアセンブリー18を含む。アンビルアセンブリ
ー20は、複数のステープル変形用空所206(図22)を有するアンビル部分
204と該アンビル部分204の上端面に固着されたカバー板208(図24)
を含み、アンビル部分とカバー板との間に空所210を画定する。カバー板20
8は、ステープル止め装置10のクランプ止めおよびは発射の間に組織をはさむ
のを防ぐために設けられる。空所210は、軸方向の駆動アセンブリー212の
遠端を受け入れるように構成される(図27参照)。長手方向のスロット214
が、アンビル部分204を通って延びて軸方向の駆動アセンブリー212の保持
フランジ284をアンビル空所210に通すのを容易にする。アンビル部分20
4に形成されたカム面209は、組織198のクランプ止めを容易にするため軸
方向の駆動アセンブリー212に係合するように位置決めされている。アンビル
部分204に形成された一対の枢動部材211は、開位置とクランプ止め位置の
間でアンビル部分を案内するためにキャリヤ216に形成されたスロット213
内に位置決めされる。一対の安定化部材215が、キャリヤ216に形成された
それぞれの肩部217に係合して、カム面209が変形されるときアンビル部分
204がステープルカートリッジ220に対して軸方向に滑動するのを防止する
。
リヤ216を含む。細長い支持チャンネル218は、ステープルカートリッジ2
20を受け入れるように寸法決めされ且つ構成される。ステープルカートリッジ
220および細長い支持チャンネル218に沿って形成されたタブ222および
スロット224は、ステープルカートリッジ220を支持チャンネル218内に
保持する機能を果たす。ステープルカートリッジ220に形成された一対の支持
ストラット223は、支持チャンネル218内でステープルカートリッジ220
をさらに安定させるために、キャリヤ216の側壁に当たるように位置決めされ
る。
228を受ける保持スロット225を含む。複数の間隔を隔てた長手方向のスロ
ット230が、ステープルカートリッジ220を通って延び、作動そり234の
直立カムウェッジ232を収容する。中央の長手方向のスロット282が、ステ
ープルカートリッジ220の全長に沿って延び、ナイフの刃280の通過を容易
にする。外科用ステープル止め装置10の操作中、作動そり234は、ステープ
ルカートリッジ220の長手方向のスロット230の中を並進し、カムウェッジ
232を前進させてプッシャー228と順次接触させ、該プッシャー228をス
ロット224内で垂直方向に並進させ、ファスナー226をスロット224から
アンビルアセンブリー20のステープル変形用空所206へ付勢する。
側取り付け部分236および238を含む。各取り付け部分は、その各側部に、
キャリヤ216の近端をそれに固定するためのねじ山付きボルト242(図21
参照)を受け入れるように寸法決めされたねじ山付きボアを有する。一対の中央
配置の枢動部材244(図21参照)が、ハウジング部分200の遠端に係合す
る一対のカプリング部材246を介して上側取り付け部分と下側取り付け部分の
間に延びている。カプリング部材246は、その各々が、ハウジング部分200
の近端に形成された溝250内に受け入れられるように構成されて取り付けアセ
ンブリー202およびハウジングハウジング部分200をそれに対して長手方向
に固定された位置に保持する噛み合い近位部分248を含む。
グ251内に収容された上側ハウジング半体250および下側ハウジング半体2
52を含む。ハウジング半体250の近端は、細長い本体14および挿入尖端1
93と解放自在に係合する係合こぶ254を含む。該こぶ254は、本体14の
遠端とともに差し込み式カプリングを形成する。これについては、以下でさらに
詳細に説明する。ハウジング半体250および252は、軸方向駆動アセンブリ
ー212を滑動自在に受け入れるチャンネル252を画定する。第二の関節運動
リンク256は、ハウジング半体250および252の間に形成されたスロット
258内に滑動自在に配置されるように寸法決めされる。一対の吹き出し板25
4が、工具アセンブリー17の関節運動の間駆動アセンブリー212の外方膨ら
みを防ぐために軸方向駆動アセンブリー212の遠端に隣接したハウジング部分
200の遠端に隣接して位置決めされる。
細長い金属板を含む。好ましくは、二枚以上の金属板がリンク256を形成する
ように積み重ねられる。関節運動リンク256の近端は、第一の関節運動リンク
123(図9参照)に係合するように構成されたフック部分258を含み、遠端
は、取り付けアセンブリー202に形成された突起262に係合するように寸法
決めされたループ260を含む。突起262は、枢動ピン244から横方向にず
らされており、第二の関節運動リンク256の直線移動により、取り付けアセン
ブリー202を枢動ピン244を中心に枢動させ、工具アセンブリー17を関節
運動する。
268および近位係合部270を有する細長い駆動ビーム266を含む。駆動ビ
ーム266は、材料の一枚のシートまたは好ましくは多数の積み重ねられたシー
トからつくることができる。係合部270は、駆動部材272に形成された一対
の保持スロット272aおよび272bと取り付け係合するように寸法決めされ
且つ構成された一対の係合フィンガー270aおよび270bを含む。駆動部材
272は、使い捨てローディングユニット16の近端が外科用ステープル止め装
置10の細長い本体14と係合したときに制御棒52(図35参照)の遠端27
6を受け入れるように構成された近端ポートホール274を含む。
278およびステープル止めの間作動そり234の中央部分と係合する当接面2
8によって画定される。面283の基部の面285は、ステープルカートリッジ
220の底に沿って滑動自在に配置された支持部材287を受け入れるように構
成されている。ナイフの刃280は、ステープル止めされた身体組織の列の間を
切開するために、ステープルカートリッジ220(図30)の中央の長手方向の
スロット282を通して作動そり234の背後で僅かに並進するように配置され
る。保持フランジ284は、垂直のストラット278から遠位方向に突出し、円
筒状のカムローラー286をその遠端で支持する。カムローラー286は、アン
ビル本体204のカム面209と係合してアンビル部分204を身体組織に対し
てクランプ止めするように寸法決めされ且つ構成される。
材270に枢動自在に固定されている。係止装置288は、チャンネル296を
画定する一対の細長いグライド292および294を含む。ウェブ298が、グ
ライド292および294の上面の一部分を接合し、そして駆動部材270の遠
位位置で駆動ビーム266に形成された細長いスロット298内に嵌まるように
構成され且つ寸法決めされる。水平カム300および302が、それぞれグライ
ド292および294から延び、下方ハウジング半体252の内面に沿って収容
されている。図42に最もよく示されるように、ねじりスプリング304が、駆
動部材270に隣接して配置され、係止装置288の水平カム300および30
2と係合して、通常は係止装置288を下方ハウジング半体252に向って棚部
310上へ下方に付勢する。係止装置288は、軸方向駆動アセンブリー212
とともにハウジング部分200を通って並進する。係止装置288の操作を以下
に説明する。
操作の手順
図40−44を参照して、ステープル止め器具10を使用するときには、まず
使い捨てローディングユニット16を細長い本体14の遠端に固定する。上に述
べたように、ステープル止め器具10は、関節運動式および非関節運動式で約3
00mmから約60mmの間の直線のステープル列を有する使い捨てローディン
グユニットとともに使用することができる。使い捨てローディングユニット16
を細長い本体14に固定するためには、制御棒52の遠端276を使い捨てロー
ディングユニット16の挿入尖端193内に挿入し、挿入尖端193を図41の
矢印「A」で示す方向に細長い本体14の遠端内へ長手方向に滑り込ませ、第二
の関節運動リンク256のフック部分258が細長い本体314のチャンネル3
10内部で滑動するようにする。こぶ254を、各々細長い本体14のそれぞれ
のチャンネル(図示せず)に整合させる。フック部分258がチャンネル310
の遠位の壁312と係合すると、使い捨てローディングユニット16を図41−
44に矢印「B」で示す方向に回転させ、第二の関節運動リンク256のフック
部分258を移動させて第一の関節運動リンク123のゆび164と係合させる
。こぶ254は、また、本体14の環状チャンネル314内部で差し込み式カプ
リングを形成する。ローディングユニット16の回転中、こぶ254は、ブロッ
ク板192のカム面195(図41)と係合し、まず板192を図41および4
3に矢印「C」で示す方向に移動させて係合部材196を制御棒52の凹部19
9内に係止して、使い捨てローディングユニット16の取り付け中に制御棒52
が長手方向に動くのを防ぐ。回転の最終段階では、こぶ254がカム面195と
の係合から外され、ブロック板192が係合部材196の背後から図42および
44の矢印「D」で示す方向に移動できるようにして、再び制御棒52の長手方
向の移動を可能にする。
合しているときには、使い捨てローディングユニットの感知機構が作動される。
挿入尖端193は感知器官176に係合して、感知器官176を図43の矢印「
E」で示す方向に近位方向に移動させる。すでに説明したように、感知器官17
6の近位方向への移動は、感知器シリンダー178および感知器リンク182の
図43aの矢印「E」で示す方向の近位方向移動を行なわせ、係止部材83を作
動シャフト46の移動を、ブロックしない位置からブロックする位置へと図43
の矢印「Y」で示すように反時計回りに枢動させる。
置10に取り付けたら、工具アセンブリー17を組織320の回りに配置するこ
とができる(図45)。組織をアンビルアセンブリー20とカートリッジアセン
ブリー18の間でクランプするために、静止ハンドル24を、ねじりスプリング
40の付勢に抗して図46の矢印「E」で示す方向に動かし、駆動つめ42を移
動されて作動シャフト46の肩部322と係合させる。肩部322と駆動つめ4
6との係合によって作動シャフト46を前進させ、したがって制御棒52を遠位
方向に前進させる。制御棒52は、その遠端が駆動ビーム266を含む軸方向の
駆動アセンブリー212(図48)に連結されており、したがって、制御棒52
の遠位方向の移動によって駆動ビーム266を図48および49に矢印「F」で
示す遠位方向に移動させ、カムローラー286を動かしてアンビル部分204の
カム面209と係合させ、アンビル部分204を図49に矢印「G」で示す方向
に付勢させる。可動ハンドル24の完全な一行程で作動シャフト46が約15m
m前進するが、これが最初の行程中組織をクランプするには十分であるがステー
プルを発射するには十分でない距離であることは理解されよう。
の(クランプ止め)行程の間、滑動板102(図46)は、係止つめ54が歯付
きラック24に係合するのを防止する。ハンドル24を解放した後作動シャフト
46をその長手方向の位置に維持するために、係合部材324(図47)が係止
部材83に設けられて作動シャフト46の肩部326に係合させ且つシャフト4
6をその長手方向の位置に保持する(図47参照)。可動ハンドル24を解放す
ると、ねじりスプリング40がハンドル24を静止ハンドル22から隔てられた
位置に戻すので駆動つめ42をラック48上を移動する。この位置で、駆動つめ
42は付勢されて歯付きラック48と係合し、作動シャフト46をその長手方向
の固定位置に保持する。
の一行程動かす。すでに説明したように、ステープル止め装置10は、約30m
mから約60mmの間の直線のステープル列を有する使い捨てローディングユニ
ットを受け入れることができる。可動ハンドル24の各行程で、好ましくは作動
シャフト46を15mm前進させ、組織をクランプ止めするためには一行程が必
要であるため、ステープルを発射するためには可動ハンドルは(n+1)行程作
動させなければならい。ただし、nは、ステープル止め装置10に取り付けられ
た使い捨てローディングユニット内の直線のステープル列の長さを15mmで割
って得られた商である。
ンブリー80(図4)を作動して係止面88をそのブロック位置(図47)から
非ブロック位置へ移動させなければならない。これは、プランジャー82を押し
下げ、カム動作面85を動かして係止部材83のスロット89の側壁と係合させ
、該係止部材83を図50に矢印「G」で示す方向に枢動させることによって行
われる(図5も参照のこと)。その後は、可動ハンドル24を作動して作動シャ
フト46を適当な行程数だけ前進させ、それによって制御棒52および駆動ビー
ム266を図51に矢印「H」で示す遠位方向に動かし、作動そり234をステ
ープルカートリッジ220を通して前進させてステープルの排出を行うことがで
きる。可動ハンドル54の最初のすなわちクランプ止め行程の後 (第二の行程
中に)、スライド102は係止つめ54上を通り、ねじりスプリング56が係止
つめ54を図50に矢印「I」で示す方向に動かして歯付きラック48と係合さ
せ、作動シャフト46をその長手方向の位置に保持することは理解されよう。
て制御棒52および駆動部材266を引き込むためのは、引き込みノブ32(図
1参照)を近位方向に引いてピン66がリリース板64を歯48上方で図53に
矢印「J」で示す方向に動かし、駆動つめ42を歯48との係合から外れるよう
にする。上に述べたように、駆動つめ42が歯48との係合から外された後は、
戻り止めクラッチ機構に対して、係止つめ54は、滑動102によって歯付きラ
ック48(図示せず)との係合から外されるように付勢されて矢印「L」で示す
近位方向に動かされる。
が歯付きラック48と現に係合しているときに作動シャフトを引き込むためには
、緊急戻りボタン112を図54に矢印「Z」で示す方向に押して、係止つめ5
4を歯付きラック48との係合から外す。駆動つめ52をラック48から解放す
るためには、すでに説明したように、引き込みノブ32(図1)も同時に後方に
引かなければならない。
い本体14に固定し、関節運動レバー30を図55に矢印「M」で示す方向に枢
動させたとき、カム部材136は突起142(図10)によって、回転ノブ28
のフランジ170と172の間で矢印「N」で示す方向に横方向に動かされる。
並進部材138は、並進部材138に固定されている峰部156(図13)によ
って回転するのを防止されているため、ピン166は、強制的に段付きカム面1
48に沿って動かされる。ピン166の移動により、並進部材138を図55お
よび56に矢印「P」で示す方向に移動させ、第一の関節運動リンク123を遠
位方向に前進させることになる。第一の関節運動リンク123の遠端は、取り付
けアセンブリー202の突起262に連結された第二の関節運動リンク256(
図42)の近端に係合しており、第二のリンク256を図57に矢印「Q」で示
す方向に前進させる。突起262は、枢動部材244から横方向にずらされてい
るため、第二の関節運動リンク256の遠位方向の前進により、取り付けアセン
ブリー202および工具アセンブリー17を図57および58に矢印「R」で示
す方向に枢動させる。図59において、回転部材28を回転させて、細長い本体
14をその長手方向軸線を中心に回転させることができ、工具アセンブリー17
が関節運動されることは理解されよう。
運動を示す。第二の関節運動リンク256を関節運動レバー30を図55で見て
反時計回りに回転させることによって引き込むとき、ピン66は、強制的に段付
きカム面148に沿って近位方向に動かされ、並進部材138および第一の関節
運動リンク123を近位方向に動かす。第一の関節運動リンク123の近位方向
への移動により、第二の関節運動リンクを図58に矢印「S」で示す近位方向へ
動かし、工具アセンブリー17を図61に矢印「T」で示す時計回り方向に回転
させる。
ると、工具アセンブリー17の関節運動角度は、22.5度となる。カム動作面
148は、5つの段部分340を含んでいる。第三の段部分は、非関節運動式工
具アセンブリーに対応し、第一および第五の段部分は、工具アセンブリー17の
45度の関節運動に対応する。各段部分は、平坦で、ピン166が係合している
ときには関節運動レバー30が固定位置に保持される。
明する。図39では、閉止装置288は、発射前の位置にあり、水平のカム30
0および302は、下方ハウジング半体252の側壁に形成された突起330の
上端にのっている(図37)。この位置では、係止装置288は、下方ハウジン
グ半体252の底面に形成された突起332との整合からずれて持ち上げられ、
ウェブ298は、駆動ビーム266内に画定された棚344と長手方向に並置さ
れる。この構成により、使い捨てローディングユニット16を使用不能にするよ
うに係止装置288を作動することなく、外科医が位置を満足するまでアンビル
20(図38)を開かせて、ステープル止めされるべき組織に位置決めし直すこ
とができる。
置288は、突起330(図示せず)から外れ、突起332から遠位にあるスプ
リング304によって基部の下方ハウジング半体252と係合するように付勢さ
れる。係止装置288は、装置の発射操作中、この形態にとどまる。
288は、突起330の下を通過して突起332の上方にのるようになり、最後
には係止装置288の最遠端が突起332に近づく。スプリング304は、係止
装置288を付勢して突起332と並置整合させ、使い捨てローディングユニッ
トを効果的に使用不能にする。装置を再作動させようと試みても、制御棒52が
係止装置288の近端面に当接し、該面は枢動ピン242の回りにモーメントを
与えるように対角方向に傾斜され、係止装置288の288の遠端は、回転付勢
されて突起332と接触する。また、図63に矢印「W」で示す遠位に向かう力
が常時働いているため、係止装置に与えられるモーメントは増大し、係止装置は
、突起332に当接して、制御棒52の遠位方向への移動を禁止する。
ーディングユニットは、該使い捨てローディングユニット16を図41、42、
および44に矢印「B」で示す方向と反対の方向に回転させることによって、細
長い本体14の遠端から取り外し、第二の関節運動リンク256のフック部分2
58を第一の関節運動リンク123のフィンガー164との係合から外し、また
こぶ254を細長い本体14のチャンネル314内部との係合から外すことがで
きる。回転させた後は、使い捨てローディングユニット16を、図41に矢印「
A」で示す方向と反対の方向に滑動させれば、本体14を使い捨てローディング
ユニット16から外すことができる。その後は、上に述べたようにして他の関節
運動式および/または非関節運動式使い捨てローディングユニットを細長い本体
の遠端に固定させれば、さらに外科用ステープル止めおよび/または切断作業を
つづけることができる。上に述べたように、各使い捨てローディングユニットは
、約30mmから約60mmの間で異なる直線のステープル列を含むものとする
ことができる。
は理解されよう。例えば、ステープル止め装置は、ステープルを適用するのに使
用する必要はなく、当業者には公知の二部分ファスナーを適用するために使用す
ることもできる。さらに、直線のステープルまたはファスナー列の長さは、特定
の外科手術の要件を満たすように修正することができる。そして、作動シャフト
の一行程の長さおよび/または使い捨てローディングユニット内の直線のステー
プルおよび/またはファスナー列の長さは、それに応じて変化させることができ
る。したがって、上の説明は、本発明を限定するものではなく、好ましい実施形
態を例示するためのものであると理解されるべきである。当業者には、記載の特
許請求の範囲およびその精神から逸脱することなく他の修正または変更を行うこ
とも可能であろう。
Claims (5)
- 外科用ステープル止め装置であって、a)ハウジングと、b)該ハウジングによって支持された可動ハンドルとを有し、該可動ハンドルが作動行程に亘って移動自在であり、c)ハウジングから遠位方向に延び、長手方向軸線を構成する細長い本体と、d)少なくとも一部がハウジング内に支持された作動シャフトとを有し、該作動シャフトが、作動行程に亘る可動ハンドルの移動に応じて、ハウジング内を長手方向に移動することができるように取り付けられ、e)細長い本体の遠位端に支持されたローディングユニットを有し、該ローディングユニットが、近位ハウジング部分と遠位工具アセンブリーとを有し、近位ハウジング部分が細長い本体の長手方向軸線と一致する長手方向軸線と、遠位工具アセンブリーに作動連結された第一の関節運動リンクとを有し、遠位工具アセンブリーが近位ハウジング部分に枢動自在に取り付けられ、f)レバーとカム部材とを備えた関節運動機構を有し、レバーがカム部材と操作接続され、該カム部材が第一の関節運動リンクに作動連結され、段付きカムスロットを有し、レバーが工具アセンブリーを近位ハウジング部分の長手方向軸線に対して関節運動するように移動自在であり、段付きカムスロットの各段が工具アセンブリーのあらかじめ定められた関節運動位置を構成する、外科用ステープル止め装置。
- 関節運動アセンブリーが並進部材を更に有し、該並進部材は、これに固定された第一の端部と段付きカムスロット内に受け入れられるように寸法形状決めされた第二の端部とを備えたピンを有し、並進部材の遠位端が、第一の関節運動リンクに作動連結されている、請求項1に記載の外科用ステープル止め装置。
- レバーが、ハウジングの遠位端に隣接して枢動自在に取り付けられている、請求項2に記載の外科用ステープル止め装置。
- 前記カム部材は、細長い本体の長手方向軸線に対してほぼ垂直な方向の移動に限定され、前記並進部材は、細長い本体の長手方向軸線とほぼ平行な方向の移動に限定される請求項3に記載の外科用ステープル止め装置。
- 前記関節運動機構は、さらに、第二の関節運動リンクを含み、該第二の関節運動リンクは、第一の関節運動リンクの近端と作動係合する遠端と並進部材と作動係合する近端とを有する請求項4に記載の外科用ステープル止め装置。
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US08/935,980 US5865361A (en) | 1997-09-23 | 1997-09-23 | Surgical stapling apparatus |
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JP2007291373A Withdrawn JP2008086788A (ja) | 1997-09-23 | 2007-11-08 | 外科用ステープル止め装置 |
JP2007291372A Expired - Lifetime JP4500343B2 (ja) | 1997-09-23 | 2007-11-08 | 外科用ステープル止め装置 |
JP2007291374A Expired - Lifetime JP4500344B2 (ja) | 1997-09-23 | 2007-11-08 | 外科用ステープル止め装置 |
JP2007291371A Expired - Lifetime JP4500342B2 (ja) | 1997-09-23 | 2007-11-08 | 外科用ステープル止め装置 |
JP2010026980A Expired - Lifetime JP5084061B2 (ja) | 1997-09-23 | 2010-02-09 | 外科用ステープル止め装置 |
JP2010118856A Withdrawn JP2010234061A (ja) | 1997-09-23 | 2010-05-24 | 外科用ステープル止め装置 |
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JP2000512464A Expired - Lifetime JP4257029B2 (ja) | 1997-09-23 | 1998-09-18 | 外科用ステープル止め装置 |
JP2007291373A Withdrawn JP2008086788A (ja) | 1997-09-23 | 2007-11-08 | 外科用ステープル止め装置 |
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JP2007291371A Expired - Lifetime JP4500342B2 (ja) | 1997-09-23 | 2007-11-08 | 外科用ステープル止め装置 |
JP2010026980A Expired - Lifetime JP5084061B2 (ja) | 1997-09-23 | 2010-02-09 | 外科用ステープル止め装置 |
JP2010118856A Withdrawn JP2010234061A (ja) | 1997-09-23 | 2010-05-24 | 外科用ステープル止め装置 |
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AU (1) | AU750646B2 (ja) |
CA (6) | CA2571579C (ja) |
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Families Citing this family (2040)
Publication number | Priority date | Publication date | Assignee | Title |
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