JP2008515550A - 内視鏡外科用クリップ取付器 - Google Patents
内視鏡外科用クリップ取付器 Download PDFInfo
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- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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- A61B2017/12004—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for haemostasis, for prevention of bleeding
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
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- 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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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0803—Counting the number of times an instrument is used
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B90/08—Accessories or related features not otherwise provided for
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B90/08—Accessories or related features not otherwise provided for
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- A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
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Abstract
Description
本特許出願は、2004年10月8日に出願された、米国仮特許出願第60/617,104号、および、2004年10月8日に出願された、米国仮特許出願第60/617,016号に対する優先権を主張し、これらの出願は、共に、その全体が本明細書中に参考として援用される。
本明細書は、外科用クリップ取付器に関する。さらに詳しくは、本明細書は、外科用クリップ取付器のジョー構造を安定にするための機構を有し、さらに外科用クリップ取付器の空打ちを防止するため、外科用クリップ取付器が収容中のクリップを使い果たしたときに外科用クリップ取付器の発射を防止するための機構を有している外科用クリップ取付器に関する。
腹腔鏡手術は、腹部の体内で実行される。この手術は、小さな切開を介し、皮膚の小さな入り口切開を通って挿入される細い内視鏡チューブまたはカニューレを介する。体の各所で実行される最小限の侵襲の手術は、広く「内視鏡」手術と称されることが多い。外科医が、アクセスポートをもたらすべく、入り口切開を通じて体内にチューブまたはカニューレ装置を挿入して展開する。このポートにより、このポートを通って種々の手術器具を挿入することができる。
外科用クリップの挿入の際に外科用クリップ取付器のジョーを互いに離間した安定な位置に保持するように構成されたジョー制御機構を有している新規な内視鏡外科用クリップ取付器が開示される。さらに、この新規な内視鏡外科用クリップ取付器は、ロックアウト機構を有している。ロックアウト機構は、残りの止血クリップが存在していない場合に、外科用クリップ取付器の動作を防止する。この新規な内視鏡外科用クリップ取付器は、クリップが打ち出されたことを医師に知らせるための信号装置をさらに有している。ここに開示されるジョー制御機構、ドライバロックアウト、および信号装置は、すべて内視鏡外科用クリップ取付器において提示および説明されるが、ここに開示される機構が、任意の外科用クリップ取付器へと適用可能であり、あるいは押し付け可能な一対のジョーを有する他の器具へと適用可能であることに、注意すべきである。
Claims (47)
- 外科用クリップを身体組織へと適用するための装置であって、
・ハンドル部、
・ハンドル部から遠位方向に延び、長手方向軸を定めている本体、
・本体内に配置された複数の外科用クリップ、
・離間位置と近接位置との間で可動である第1および第2のジョー部分をさらに有しており、本体の遠位端部に隣接して取り付けられているジョーアセンブリ、
・前記第1および前記第2のジョー部分の間を長手方向に可動であるウェッジプレート、
・前記ジョー部分が離間位置にあるときに、前記ジョーアセンブリへと外科用クリップを1つずつ遠位方向に前進させるように構成されたクリップ押し器、
・前記本体内に少なくとも部分的に配置され、前記ハンドル部の操作に応答して長手方向に可動であるアクチュエータ、
・前記第1および前記第2のジョー部分を近接位置へと動かすため、前記ジョー部分に隣接して配置されたジョー閉鎖部材、および
・前記ウェッジプレートに隣接して前記ハウジング内で付勢されている可動部材
を有しており、
前記アクチュエータが、前記ウェッジプレートを、最も遠位側の位置へと所定の距離だけ長手方向に前進させ、
前記ウェッジプレートが、前記最も遠位側の位置において前記第1および前記第2のジョー部分の間に配置される端部を有しており、該ウェッジプレートの端部が、前記外科用クリップの装填の際に前記ジョーアセンブリを前記離間位置に保つように構成され、該ウェッジプレートの端部が、前記装填の際に前記ジョーアセンブリに加わるトルクおよび外力を軽減し、
前記可動部材が、前記ジョーアセンブリへの前記外科用クリップの前記装填の際に、前記ウェッジプレートを前記最も遠位側の位置に保持し、
前記可動部材が、前記装填の終了時に偏向させられ、偏向によって前記ウェッジプレートを解放し、前記ウェッジプレートの前記最も遠位側の位置からの長手の近位方向への引き込みを可能にする、装置。 - 前記アクチュエータが、カムを有しており、
前記ウェッジプレートが、カム溝を有しており、
前記カムが、前記カム溝内のカム面に係合可能であり、
前記カムが前記カム面に接触することで、前記ウェッジプレートが前記ジョーアセンブリの前記第1のジョー部分と前記第2のジョー部分との間を遠位方向に動かされる、請求項1に記載の装置。 - 前記ウェッジプレートに実質的に整列した構成部品をさらに有しており、
該構成部品が、該構成部品のカム溝およびカム造作を有しており、
該カム造作が、前記構成部品のカム溝に位置しており、
前記構成部品のカム溝が、前記ウェッジプレートの前記カム溝に整列しており、
前記カム造作が前記カムに接するとき、前記構成部品の前記カム造作が、前記カムを前記ウェッジプレートの前記カム面との係合から外すように横方向に駆動し、前記構成部品が前記ウェッジプレートの遠位方向への動きを終結させる、請求項2に記載の装置。 - 前記ウェッジプレートが、近位側の窓をさらに有しており、
該近位側の窓が、該窓の側面から延びて第1の近位窓部と第2の近位窓部とを形成する部材を有しており、
前記可動部材が、前記第1の近位窓部から前記第2の近位窓部へと移動する第1の部位を有しており、
前記可動部材が、前記第1の部位で前記第1および前記第2の近位窓部の少なくとも一方を保持して、前記ウェッジプレートを前記最も遠位側の位置に保持するように構成されている、請求項3に記載の装置。 - 前記ウェッジ部材を前記最も遠位側の位置に保持するため、前記可動部材の第2の部位を付勢するための付勢用部品をさらに有している、請求項4に記載の装置。
- 前記可動部材が、第1の位置から第2の位置へと移動し、
該第1の位置において、可動部材の前記第1の部位が前記ウェッジプレートを保持し、該第2の位置において、前記可動部材が方向を変えて前記ウェッジプレートを保持せず、前記可動部材が前記ウェッジプレートの端部の前記ジョーアセンブリからの近位側への引き込みを許す、請求項5に記載の装置。 - 前記可動部材が、第2のカム造作によって前記第1の位置から前記第2の位置へと向きを変え、
前記アクチュエータが、前記可動部材の向きを変えて前記ウェッジプレートとの係合から外れ、前記ウェッジプレートの引き込みを許すように構成されている、請求項6に記載の装置。 - 前記ウェッジプレートが、前記ジョーアセンブリの少なくとも一部分を押すように構成された丸みを帯びた遠位端を有している、請求項7に記載の装置。
- トリガおよび前記ハンドル部の少なくとも一方の対応する切り欠きと対をなす爪を有しているロックアウト機構をさらに有しており、
該ロックアウト機構が作動しているとき、前記爪が、前記トリガおよび前記ハンドル部の前記少なくとも一方によって前記アクチュエータが長手方向に動かされることがないように阻止している、請求項1に記載の装置。 - 前記ロックアウト機構が、前記爪を備える第1の回転可能部材および切り欠きを有する第2の回転可能部材を有しており、前記第2の回転可能部材の内表面の内周を実質的に巡って複数の歯が配置されており、
さらに前記ロックアウト機構が、柱を有する第3の回転可能部材を有しており、前記柱が前記ロックアウト機構を前記ハンドル部に取り付けるように構成されている、請求項9に記載の装置。 - 請求項10に記載の装置であって、前記爪が、前記複数の歯と噛み合うように前記第2の回転可能部材の前記内表面で回転し、
該装置が、前記複数の歯の数と少なくとも同じ数のクリップを有しており、
前記複数のクリップが使い果たされたときに、前記爪が前記切り欠きへと前進し、前記第1の回転可能部材の前記さらなる回転によって、前記爪が前記切り欠きを横切って前記第2の回転可能部材から出て、前記爪が前記ハンドル部の前記対応する切り欠きと対をなすように構成されている、装置。 - 自由部と付勢部とを有する回転可能部材をさらに有しており、
前記ハンドル部が、リブを有しており、
ハンドル部の操作に応答して前記アクチュエータが長手方向に移動するとき、該アクチュエータが前記回転可能部材を回転させ、該回転可能部材が前記自由部を回転させて前記リブに接触させ、該接触が前記外科用クリップが打ち出された旨を聴覚によって知らせる、請求項1に記載の装置。 - 外科用クリップを身体組織へと適用するための装置であって、
・ハンドル部、
・前記ハンドル部から遠位方向に延び、長手方向軸を定めている本体、
・前記本体内に配置された複数の外科用クリップ、
・離間位置と近接位置との間で可動である第1および第2のジョー部分をさらに有しており、前記本体の遠位端部に隣接して取り付けられているジョーアセンブリ、
・前記第1および前記第2のジョー部分の間を長手方向に可動であるウェッジプレート、
・前記ジョー部分が前記離間位置にあるときに、前記ジョーアセンブリへと外科用クリップを1つずつ遠位方向に前進させるように構成されたクリップ押し器、
・前記本体内に少なくとも部分的に配置され、前記ハンドル部の操作に応答して長手方向に可動であるアクチュエータ、および
・前記第1および前記第2のジョー部分を前記近接位置へと動かすため、前記ジョー部分に隣接して配置されたジョー閉鎖部材
を有しており、
前記アクチュエータが、前記ウェッジプレートを、最も遠位側の位置へと所定の距離だけ長手方向に前進させ、
前記ウェッジプレートが、前記最も遠位側の位置において前記第1および前記第2のジョー部分の間に配置される端部を有しており、該ウェッジプレートの端部が、前記外科用クリップの装填の際に前記ジョーアセンブリを前記離間位置に保つように構成され、該ウェッジプレートの端部が、前記装填の際に前記ジョーアセンブリに加わるトルクおよび外力を軽減し、
前記アクチュエータが、さらに信号装置を動作させ、該信号装置が、前記複数のクリップの少なくとも1つが打ち出された旨の知らせをもたらす、装置。 - 前記信号装置が、視覚表示装置である、請求項13に記載の装置。
- 前記視覚表示装置が、液晶表示装置、発光ダイオード、電子装置、電子表示装置、変化可能な表示装置、白黒表示装置、カラー表示装置、色つきバックライト、およびこれらの任意の組み合わせである、請求項14に記載の装置。
- 前記視覚表示装置が、電気コンタクトを有しており、
該電気コンタクトが、該電気コンタクトの切り替わりにもとづいて表示されるパラメータを現在のパラメータへと変化させ、
自由端と固定端とを有する可動部材がさらに存在し、前記固定端が前記ハンドル部および前記アクチュエータへと接続されており、
前記アクチュエータが前記ハンドル部の操作に応答して長手方向に移動するとき、前記アクチュエータが前記可動部材を運動させ、前記可動部材が前記自由端を前記電気コンタクトに接するように運動させ、前記コンタクトが前記視覚表示装置を前記表示されたパラメータから前記現在のパラメータへと変化させる、請求項14に記載の装置。 - 外科用クリップを身体組織へと適用するための装置であって、
a)ハンドルとハンドルに対して可動であるトリガとを有しており、該トリガがトリガロックアウトノッチを有しているハンドルアセンブリ、
b)前記ハンドルから遠位方向に延び、長手方向軸を定めている本体、
c)前記本体内に配置された複数の外科用クリップ、
d)離間位置と近接位置との間で可動である第1および第2のジョー部分をさらに有しており、本体の遠位端部に隣接して取り付けられているジョーアセンブリ、
e)前記ジョー部分が前記離間位置にあるときに、前記ジョーアセンブリへと外科用クリップを1つずつ遠位方向に前進させるように構成されたクリップ押し器、
f)前記本体内に少なくとも部分的に配置され、前記ハンドルアセンブリの操作に応答して長手方向に可動であるアクチュエータ、
g)第1の端部にて前記アクチュエータへと接続され、第2の端部にて前記トリガへと接続されているリンク、
h)前記第1および前記第2のジョー部分を近接位置へと動かすため、前記ジョー部分に隣接して配置されたジョー閉鎖部材、および
i)ロックアウト機構
を有しており、
前記ロックアウト機構が、
・第1の軸と、第1の爪を有する第1のアームとを有しており、前記第1の軸が前記ハンドルアセンブリに固定に係合している第1の回転可能部材、
・第2の柱と、内表面の内周を実質的に巡って配置された複数の歯とを備えており、円周部に逃げノッチを有している第2の回転可能部材、および
・前記第2の回転可能部材の前記第2の柱を受け入れるための開口を有しており、前記トリガと係合するように構成されている第3の回転可能部材
を有し、
前記第1の爪が、前記第2の回転可能部材の前記内表面で回転し、前記第1の爪が、前記複数の歯と噛み合うように構成されており、前記トリガが引かれるたびに前記爪が前記複数の歯のうちの次の歯へと前進し、
前記複数のクリップの数が、少なくとも前記歯の数と同じであり、
前記複数のクリップが使い果たされたときに、前記第1の爪が前記逃げノッチへと進められ、前記トリガがさらに引かれて前記複数のクリップが使い果たされているときに、前記第1の爪が、前記逃げノッチを横切って前記第2の回転可能部材から出て前記トリガのノッチへと移動し、当該装置の動作を防止する、装置。 - 前記第1の回転可能部材が、ロックアウト・アームである、請求項17に記載の装置。
- 前記第2の回転可能部材が、ロックアウト・ホイールである、請求項17に記載の装置。
- 前記第3の回転可能部材が、インデクサー・ホイールである、請求項17に記載の装置。
- 前記第1の爪が、端部に接続されたノーズ部材を有しており、該ノーズ部材が、前記トリガのノッチと対をなすためのものである、請求項17に記載の装置。
- 前記複数の外科用クリップのうちの少なくとも1つのクリップが打ち出されたことを医師に知らせるための信号装置をさらに有している、請求項17に記載の装置。
- 外科用クリップを身体組織へと適用するための装置であって、
・ハンドル部、
・前記ハンドル部から遠位方向に延び、長手方向軸を定めている本体、
・前記本体内に配置された複数の外科用クリップ、
・離間位置と近接位置との間で可動である第1および第2のジョー部分をさらに有しており、前記本体の遠位端部に隣接して取り付けられているジョーアセンブリ、
・前記第1および前記第2のジョー部分の間を長手方向に可動であるウェッジプレート、
・前記ジョー部分が前記離間位置にあるときに、前記ジョーアセンブリへと外科用クリップを1つずつ遠位方向に前進させるように構成されたクリップ押し器、
・前記本体内に少なくとも部分的に配置され、前記ハンドル部の操作に応答して長手方向に可動であるアクチュエータ、および
・前記第1および前記第2のジョー部分を前記近接位置へと動かすため、前記ジョー部分に隣接して配置されたジョー閉鎖部材
を有しており、
前記アクチュエータが、前記ウェッジプレートを、最も遠位側の位置へと所定の距離だけ長手方向に前進させ、
前記ウェッジプレートが、前記最も遠位側の位置において前記第1および前記第2のジョー部分の間に配置される端部を有しており、該ウェッジプレートの端部が、前記外科用クリップの装填の際に前記ジョーアセンブリを前記離間位置に保つように構成され、該ウェッジプレートの端部が、前記装填の際に前記ジョーアセンブリに加わるトルクを軽減し、
前記アクチュエータが、前記複数のクリップの少なくとも1つが打ち出された旨を知らせるように構成された可聴装置をさらに動作させる、装置。 - 前記可聴装置が、クリックレバーを有しており、
該クリックレバーが、前記アクチュエータへと接続され、
さらに前記可聴装置が、前記ハンドル部の内側ハウジングへと接続されたリブを有しており、
前記アクチュエータが遠位方向に移動するとき、該アクチュエータが前記クリックレバーを回転させ、該クリックレバーが全ストロークにて回転して該全ストロークにおいて前記リブに接触し、該接触によって音波が生じ、該音波が前記複数のクリップの少なくとも1つが打ち出された旨を知らせるように構成されている、請求項23に記載の装置。 - 前記複数の外科用クリップのうちの少なくとも1つのクリップが打ち出された旨を視覚的に知らせるように構成された視覚表示器をさらに有している、請求項24に記載の装置。
- 前記視覚表示器が、電気コンタクト板を有する表示装置を有しており、
該表示装置が、パラメータを表示し、
前記アクチュエータが遠位方向に移動するとき、該アクチュエータがレバーを動かし、該レバーが前記電気コンタクト板に接触し、該接触によって、前記表示装置が前記パラメータから現在の表示パラメータへと変化する、請求項25に記載の装置。 - 前記パラメータが、打ち出されたクリップの数、残りのクリップの数、手術時間の表示、外科のデータ、止血用クリップの情報、画像、およびこれらの任意の組み合わせで構成されるグループから選択される、請求項26に記載の装置。
- 請求項23に記載の装置であって、前記ウェッジプレートにカム溝を、該カム溝にウェッジプレートカム面を備えつつさらに有しており、前記ウェッジプレートが、丸みを帯びた遠位端と近位側の窓とを有しており、
該装置が、さらにフィラー部品を有していて、該フィラー部品が、フィラー部品カム造作を有しているフィラー部品カム溝を前記カム溝に整列させて有するとともに、近位側の窓および該窓内のばね棒部材を有しており、該フィラー部品は、前記本体に固定されており、
さらに当該装置が、前記フィラー部品へと接続された可動部材を有しており、該可動部材が第1および第2のアームを有していて、該第2のアームが前記ばね棒部材によって付勢されており、
前記アクチュエータが、カムリンクを有し、該カムリンクが、前記カム溝内を遠位方向に駆動され、前記カムが前記ウェッジプレートカム面に接触して前記ウェッジプレートを遠位方向に動かし、前記丸みを帯びた遠位端が装填のために前記ジョーの間へと動かされる、装置。 - 前記カムリンクが、前記フィラー部品カム造作に接触し、カム作用によって前記ウェッジプレートカム面との係合から解放される、請求項28に記載の装置。
- 前記カムリンクが、カム作用によって前記ウェッジプレートカム面との係合から解放されるとき、前記可動部材の前記第2のアームが、前記ウェッジプレートの前記丸みを帯びた遠位端を装填のために前記ジョーの間に保持する、請求項29に記載の装置。
- 前記アクチュエータが遠位方向にさらに駆動されるとき、該アクチュエータが前記第1のアームの向きを変え、該第1のアームが前記第2のアームを回転させ、該第2のアームが前記ウェッジプレートを解放し、前記ウェッジプレートの遠位端が前記ジョーの間から引き込まれる、請求項30に記載の装置。
- 外科用クリップを身体組織へと適用するための装置であって、
・ハンドル部、
・前記ハンドル部から遠位方向に延び、長手方向軸を定めている本体、
・前記本体内に配置された複数の外科用クリップ、
・離間位置と近接位置との間で可動である第1および第2のジョー部分をさらに有しており、前記本体の遠位端部に隣接して取り付けられているジョーアセンブリ、
・前記第1および前記第2のジョー部分の間を長手方向に可動であるウェッジプレート、
・前記ジョー部分が前記離間位置にあるときに、前記ジョーアセンブリへと外科用クリップを1つずつ遠位方向に前進させるように構成されたクリップ押し器、
・前記本体内に少なくとも部分的に配置され、前記ハンドル部の操作に応答して長手方向に可動であるアクチュエータ、および
・前記第1および前記第2のジョー部分を前記近接位置へと動かすため、前記ジョー部分に隣接して配置されたジョー閉鎖部材
を有しており、
前記アクチュエータが、前記ウェッジプレートを、最も遠位側の位置へと所定の距離だけ長手方向に前進させ、
前記ウェッジプレートが、前記最も遠位側の位置において前記第1および前記第2のジョー部分の間に配置される端部を有しており、該ウェッジプレートの端部が、前記外科用クリップの装填の際に前記ジョーアセンブリを前記離間位置に保つように構成され、該ウェッジプレートの端部が、前記装填の際に前記ジョーアセンブリに加わるトルクを軽減し、
前記本体が、回転可能部材によって前記ハンドルへと接続され、該回転可能部材が、前記ハンドルおよび前記本体に固定に接続され、該回転可能部材の回転時に、前記本体が回転するとともに前記ジョー部分が回転し、
前記回転可能部材が、第1の細長いノブハウジングと周囲に複数の切り欠きが配置されてなる第2のノブとを有する複数の部材であり、前記第2のノブが、前記ノブハウジングを覆って配置されており、
前記複数の部材の少なくとも一方が、前記本体を回転させるべく人差し指によって回転させられるように構成されている、装置。 - 前記信号装置が、聴覚装置であり、前記クリップの打ち出しに応答してチャイムを発する、請求項13に記載の装置。
- 前記信号装置が、聴覚装置であり、前記クリップの打ち出しに応答して記録済みの特徴的な音を発する、請求項13に記載の装置。
- 前記信号装置が、電池で駆動される聴覚装置であり、視覚表示器である、請求項13に記載の装置。
- 前記電池駆動の視覚表示器が、タブを有しており、
該タブが、電池の電気コンタクトと前記視覚表示器との間に配置されており、
該タブが、前記電池の枯渇を防止するため前記電池と前記視覚表示器との間に取り外し可能に接続され、最初の使用時に前記タブを取り除くことで前記視覚表示器にエネルギーが供給される、請求項35に記載の装置。 - 前記タブが、非導電性の材料から作られている、請求項36に記載の装置。
- 前記タブが、絶縁性のポリマー材料から作られている、請求項37に記載の装置。
- 前記信号装置が、可聴装置であり、前記ハンドル部の所定の偏向に応答して特徴的な音を発する、請求項13に記載の装置。
- 前記信号装置が、可聴装置であり、前記クリップの圧縮に応答して特徴的な音を発する、請求項13に記載の装置。
- 前記信号装置が、可聴装置であり、前記クリップの装填に応答して特徴的な音を発する、請求項13に記載の装置。
- 前記信号装置が、可聴装置であり、前記クリップの装填に応答して第1の特徴的な音を発し、前記クリップの圧縮に応答して第2の特徴的な音を発し、前記複数のクリップの他のクリップの装填に応答して第3の特徴的な音を発し、前記第1〜第3の特徴的な音が異なっている、請求項13に記載の装置。
- 前記信号装置が、可聴装置であり、前記本体内の前記複数のクリップの枯渇に応答して特徴的な音を発する、請求項13に記載の装置。
- 前記信号装置が、電池駆動、太陽エネルギー駆動、電気駆動、およびこれらの任意の組み合わせで構成されるグループから選択されるやり方で駆動される、請求項13に記載の装置。
- 前記信号装置が、いくつかの異なるクリップ適用の事象について、複数の異なる信号をもたらす、請求項13に記載の装置。
- 前記信号装置が、レンズおよび表示装置を有する視覚装置であり、前記レンズが前記表示装置を拡大する、請求項13に記載の装置。
- 前記付勢用部品が、ばね棒部材である、請求項5に記載の装置。
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JP2010046488A (ja) * | 2008-08-25 | 2010-03-04 | Tyco Healthcare Group Lp | 外科手術用クリップアプライアおよび組み立て方法 |
JP2010051807A (ja) * | 2008-08-29 | 2010-03-11 | Tyco Healthcare Group Lp | コネクタプレートを有する内視鏡外科手術用クリップアプライア |
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