JP2009268908A - テークアップ構成要素を用いた可変の組織圧縮 - Google Patents
テークアップ構成要素を用いた可変の組織圧縮 Download PDFInfo
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Abstract
【解決手段】外科用ファスナ適用装置であって、近位端と遠位端とを有し、アンビル部材を含む第一の顎部であって、該アンビル部材は長手方向軸に沿って延び、組織接触表面を含む、第一の顎部と、該第一の顎部に移動可能に結合された近位端と遠位端とを有し、カートリッジ部材を含む、第二の顎部と、該第一の顎部と該第二の顎部との間に位置する止血部材であって、該止血部材は、該第一の顎部および該第二の顎部の接近の間に、少なくとも二つの異なる圧縮力を組織に加えるように構成され、かつ寸法を合わせられた階段状のプロフィールを有する、止血部材とを備えている、外科用ファスナ適用装置。
【選択図】図1
Description
本出願は、2008年5月9日に出願された米国仮特許出願第61/051,907号の利益およびこの出願に対する優先権を主張し、この仮特許出願の全内容が本明細書において参照により援用される。
(1.技術分野)
本開示は外科用ファスナ適用装置に関する。より詳細には、本開示は、可変の圧縮力を用いて、複数の外科用ファスナを組織に適用するために、外科用ファスナ適用装置と共に使用するためのツールアセンブリと、それを使用する方法と、製造する方法とに関する。本開示は、また、一緒に接合される組織を支持し、接合された組織の止血を提供することに役立ち、そして/または治癒を促進するための止血部材および外科用ファスナを適用する際に用いられるアクセサリに関する。
多種多様な外科用ファスナ適用装置が当該分野で公知であり、これらの一部は、様々な外科的手順における使用に特に適合されており、該手順は、端部間吻合、円形の端部間吻合、開放消化管吻合、内視鏡消化管吻合、および横吻合を含むが、これらに限定されない。これらの手順の経過の間に用いられ得る適切な装置の例は、特許文献1、特許文献2、特許文献3および特許文献4に見られ得る。
本開示は、組織に可変の圧縮を加え、そして/または可変の厚さの組織を収容する外科用ファスナ適用装置に関する。より具体的には、本開示の原理に従った、外科用ファスナ適用装置は、その中に形成された切断線にすぐ隣接する組織を通る血液の流れを制限して、止血を達成し、その一方で切断線からより多くの取り外された組織を通る血液の流れを最大化して、不必要な壊死を制限するように作用する。
(項目1)
外科用ファスナ適用装置であって、
近位端と遠位端とを有し、アンビル部材を含む第一の顎部であって、該アンビル部材は長手方向軸に沿って延び、組織接触表面を含む、第一の顎部と、
該第一の顎部に移動可能に結合された近位端と遠位端とを有し、カートリッジ部材を含む、第二の顎部と、
該第一の顎部と該第二の顎部との間に位置する止血部材であって、該止血部材は、該第一の顎部および該第二の顎部の接近の間に、少なくとも二つの異なる圧縮力を組織に加えるように構成され、かつ寸法を合わせられた階段状のプロフィールを有する、止血部材と
を備えている、外科用ファスナ適用装置。
(項目2)
上記止血部材は、上記圧縮力が上記長手方向軸を横断する軸に沿って変化するように構成され、かつ寸法を合わせられる、上記項目のいずれか1項に記載の外科用ファスナ適用装置。
(項目3)
上記止血部材は、上記組織に加えられる上記圧縮力が上記カートリッジ部材の中心線に対して外側に減少し、その結果、該カートリッジ部材の該中心線のより近くの組織を通る血流が、該カートリッジ部材の該中心線からより遠い組織を流れる血流未満であるように構成され、かつ寸法を合わせられる、上記項目のいずれか1項に記載の外科用ファスナ適用装置。
(項目4)
上記止血部材は、上記圧縮力が上記長手方向軸に沿って変化するように構成され、かつ寸法を合わせられる、上記項目のいずれか1項に記載の外科用ファスナ適用装置。
(項目5)
上記止血部材は、上記組織に加えられる上記圧縮力が上記長手方向軸に沿って近位方向において減少し、その結果、上記アンビル部材および上記カートリッジ部材の遠位端により近い組織を通る血流が、該アンビル部材および該カートリッジ部材の近位端により近い組織を通る血流未満であるように構成され、かつ寸法を合わせられる、上記項目のいずれか1項に記載の外科用ファスナ適用装置。
(項目6)
上記止血部材は、上記組織に加えられる上記圧縮力が上記長手方向軸に沿って遠位方向において減少し、その結果、上記アンビル部材および上記カートリッジ部材の近位端により近い組織を通る血流が、該アンビル部材および該カートリッジ部材の遠位端により近い組織を通る血流未満であるように構成され、かつ寸法を合わせられる、上記項目のいずれか1項に記載の外科用ファスナ適用装置。
(項目7)
上記止血部材の上記階段状のプロフィールは、第一の接触表面および第二の接触表面を規定し、該第二の接触表面は、上記長手方向軸に対して該第一の接触表面の外側に位置し、該第一の組織接触表面は、上記アンビル部材の組織接触表面との第一のギャップを規定し、該第二の組織接触表面は、該アンビル部材の該組織接触表面との第二のギャップを規定し、該第二のギャップは該第一のギャップよりも大きい、上記項目のいずれか1項に記載の外科用ファスナ適用装置。
(項目8)
上記第一の組織接触表面および上記第二の組織接触表面は、構成において、概して平坦である、上記項目のいずれか1項に記載の外科用ファスナ適用装置。
(項目9)
上記第一の組織接触表面は、第一の壁表面を介して上記第二の組織接触表面に接続され、該第一の壁表面は、概して、先細の構成を有する、上記項目のいずれか1項に記載の外科用ファスナ適用装置。
(項目10)
上記止血部材の上記階段状のプロフィールは、上記長手方向軸に対して上記第二の組織接触表面の外側に位置する第三の組織接触表面をさらに規定し、該第三の組織接触表面は、該第二のギャップより大きい、上記アンビル部材の上記組織接触表面との第三のギャップを規定する、上記項目のいずれか1項に記載の外科用ファスナ適用装置。
(項目11)
上記第二の組織接触表面は、第二の壁表面を介して上記第三の組織接触表面に接続され、該第二の壁表面は、概して、先細の構成を有する、上記項目のいずれか1項に記載の外科用ファスナ適用装置。
(項目12)
上記カートリッジ部材内に位置する複数の外科用ファスナをさらに含み、各外科用ファスナは実質的に等しい高さを有する、上記項目のいずれか1項に記載の外科用ファスナ適用装置。
(項目13)
上記止血部材は、上記第一の顎部と上記第二の顎部との間に位置する組織の層を支持するために、実質的に弾性の材料で形成される、上記項目のいずれか1項に記載の外科用ファスナ適用装置。
(項目14)
上記止血部材は、上記カートリッジ部材にしっかりと固定される、上記項目のいずれか1項に記載の外科用ファスナ適用装置。
(項目15)
上記止血部材は、上記カートリッジ部材に取り外し可能に固定される、上記項目のいずれか1項に記載の外科用ファスナ適用装置。
(項目16)
上記アンビル部材は、その中に形成された複数のポケットを含み、各ポケットは、実質的に均等な深さを規定するために、該アンビル部材の上記組織接触表面に延びる形成表面を含む、上記項目のいずれか1項に記載の外科用ファスナ適用装置。
(項目17)
アンビルと少なくとも一つの列に配置された複数の外科用ファスナを有するカートリッジとを含む外科用ファスナ適用装置と共に使用するための止血部材であって、該止血部材は、少なくとも1列の外科用ファスナを覆うように形状が決められ、かつ構成され、該止血部材は、該アンビル部材および該カートリッジ部材の接近の間に組織に少なくとも二つの異なる圧縮力を加えるように形状が決められ、構成され、かつ寸法が合わせられるプロフィールを含む、止血部材。
(項目18)
上記外科用ファスナ適用装置は、長手方向軸を有し、上記アンビルおよびカートリッジは、概して、該長手方向軸に沿って延び、上記止血部材は、上記圧縮力が該長手方向軸を横断する軸に沿って変化するように構成され、かつ寸法が合わせられる、上記項目のいずれか1項に記載の止血部材。
(項目19)
上記組織に加えられる上記圧縮力が、上記カートリッジ部材の中心線に対して外側に減少して、その結果、該カートリッジ部材の該中心線のより近くの組織を通る血流が、該カートリッジ部材の該中心線からより遠い組織を通る血流未満であるように、上記止血部材が、構成され、かつ寸法を合わせられる、上記項目のいずれか1項に記載の止血部材。
(項目20)
上記止血部材は、上記圧縮力が上記長手方向軸に沿って変化するように構成され、かつ寸法が合わせられる、上記項目のいずれか1項に記載の止血部材。
(項目21)
上記外科用ファスナ適用装置は、長手方向軸を有し、上記アンビルおよびカートリッジは、弓形の形状であり、該アンビルおよびカートリッジは、該長手方向軸を横断するように延び、該止血部材は、上記圧縮力が該長手方向軸を横断する軸に沿って変化するように構成され、かつ寸法が合わせられる、上記項目のいずれか1項に記載の止血部材。
本明細書に開示される外科用ファスナ適用装置およびその使用方法の様々な実施形態が、ここで、図面を参照して詳細に記載され、同様の参照数字は、同様のまたは同一の要素を識別する。図面において、そして以下の説明において、当該分野において伝統的かつ従来的であるように、用語「近位」は、使用中に、オペレータに近い、外科用ファスナ適用装置の端部またはその構成要素をいい、一方で、用語「遠位」は、オペレータから遠い端部をいう。さらに、用語「外科用ファスナ」は、組織をともに接合するという意図された目的に適した生体適合性材料からなる任意の実質的に剛性の構造を含む(外科用ステープル、クリップなどを含むがこれらに限定されない)ことが理解されるべきである。
本開示は、外科用ファスナ適用装置と、組織への可変の圧縮の付加とに関する。より具体的には、本明細書で開示される外科用ファスナ適用装置は、不必要な壊死を制限するために、切断線からさらに除去される組織を通る血液の流れを最大化しながら、止血を実行するために、その中に形成される切断線にすぐ隣接する組織を通る血液の流れを制限するように作用する。一つの実施形態において、それぞれがアンビルと外科用ファスナカートリッジとを含む第一の顎部と第二の顎部とを有する、その遠位端に結合されたツールアセンブリを有する外科用ファスナ適用装置が開示される。その中でも特に、外科用ファスナカートリッジは、ツールアセンブリの第一の顎部と第二の顎部との間でクランプ留めされる組織に少なくとも二つの異なる圧縮力を加えるように構成される止血部材を含む。
1002 ハンドルアセンブリ
1003A 可動ハンドル
1003B 静止ハンドル
1004 細長いシャフト
1006 ツールアセンブリ
1008 細長いシャフトの遠位端
1010 第一の顎部
1012 第二の顎部
1100 アンビル
1200 外科用ファスナカートリッジ
Claims (21)
- 外科用ファスナ適用装置であって、
近位端と遠位端とを有し、アンビル部材を含む第一の顎部であって、該アンビル部材は長手方向軸に沿って延び、組織接触表面を含む、第一の顎部と、
該第一の顎部に移動可能に結合された近位端と遠位端とを有し、カートリッジ部材を含む、第二の顎部と、
該第一の顎部と該第二の顎部との間に位置する止血部材であって、該止血部材は、該第一の顎部および該第二の顎部の接近の間に、少なくとも二つの異なる圧縮力を組織に加えるように構成され、かつ寸法を合わせられた階段状のプロフィールを有する、止血部材と
を備えている、外科用ファスナ適用装置。 - 前記止血部材は、前記圧縮力が前記長手方向軸を横断する軸に沿って変化するように構成され、かつ寸法を合わせられる、請求項1に記載の外科用ファスナ適用装置。
- 前記止血部材は、前記組織に加えられる前記圧縮力が前記カートリッジ部材の中心線に対して外側に減少し、その結果、該カートリッジ部材の該中心線のより近くの組織を通る血流が、該カートリッジ部材の該中心線からより遠い組織を流れる血流未満であるように構成され、かつ寸法を合わせられる、請求項2に記載の外科用ファスナ適用装置。
- 前記止血部材は、前記圧縮力が前記長手方向軸に沿って変化するように構成され、かつ寸法を合わせられる、請求項1に記載の外科用ファスナ適用装置。
- 前記止血部材は、前記組織に加えられる前記圧縮力が前記長手方向軸に沿って近位方向において減少し、その結果、前記アンビル部材および前記カートリッジ部材の遠位端により近い組織を通る血流が、該アンビル部材および該カートリッジ部材の近位端により近い組織を通る血流未満であるように構成され、かつ寸法を合わせられる、請求項4に記載の外科用ファスナ適用装置。
- 前記止血部材は、前記組織に加えられる前記圧縮力が前記長手方向軸に沿って遠位方向において減少し、その結果、前記アンビル部材および前記カートリッジ部材の近位端により近い組織を通る血流が、該アンビル部材および該カートリッジ部材の遠位端により近い組織を通る血流未満であるように構成され、かつ寸法を合わせられる、請求項4に記載の外科用ファスナ適用装置。
- 前記止血部材の前記階段状のプロフィールは、第一の接触表面および第二の接触表面を規定し、該第二の接触表面は、前記長手方向軸に対して該第一の接触表面の外側に位置し、該第一の組織接触表面は、前記アンビル部材の組織接触表面との第一のギャップを規定し、該第二の組織接触表面は、該アンビル部材の該組織接触表面との第二のギャップを規定し、該第二のギャップは該第一のギャップよりも大きい、請求項2に記載の外科用ファスナ適用装置。
- 前記第一の組織接触表面および前記第二の組織接触表面は、構成において、概して平坦である、請求項7に記載の外科用ファスナ適用装置。
- 前記第一の組織接触表面は、第一の壁表面を介して前記第二の組織接触表面に接続され、該第一の壁表面は、概して、先細の構成を有する、請求項7に記載の外科用ファスナ適用装置。
- 前記止血部材の前記階段状のプロフィールは、前記長手方向軸に対して前記第二の組織接触表面の外側に位置する第三の組織接触表面をさらに規定し、該第三の組織接触表面は、該第二のギャップより大きい、前記アンビル部材の前記組織接触表面との第三のギャップを規定する、請求項7に記載の外科用ファスナ適用装置。
- 前記第二の組織接触表面は、第二の壁表面を介して前記第三の組織接触表面に接続され、該第二の壁表面は、概して、先細の構成を有する、請求項10に記載の外科用ファスナ適用装置。
- 前記カートリッジ部材内に位置する複数の外科用ファスナをさらに含み、各外科用ファスナは実質的に等しい高さを有する、請求項1に記載の外科用ファスナ適用装置。
- 前記止血部材は、前記第一の顎部と前記第二の顎部との間に位置する組織の層を支持するために、実質的に弾性の材料で形成される、請求項1に記載の外科用ファスナ適用装置。
- 前記止血部材は、前記カートリッジ部材にしっかりと固定される、請求項1に記載の外科用ファスナ適用装置。
- 前記止血部材は、前記カートリッジ部材に取り外し可能に固定される、請求項1に記載の外科用ファスナ適用装置。
- 前記アンビル部材は、その中に形成された複数のポケットを含み、各ポケットは、実質的に均等な深さを規定するために、該アンビル部材の前記組織接触表面に延びる形成表面を含む、請求項1に記載の外科用ファスナ適用装置。
- アンビルと少なくとも一つの列に配置された複数の外科用ファスナを有するカートリッジとを含む外科用ファスナ適用装置と共に使用するための止血部材であって、該止血部材は、少なくとも1列の外科用ファスナを覆うように形状が決められ、かつ構成され、該止血部材は、該アンビル部材および該カートリッジ部材の接近の間に組織に少なくとも二つの異なる圧縮力を加えるように形状が決められ、構成され、かつ寸法が合わせられるプロフィールを含む、止血部材。
- 前記外科用ファスナ適用装置は、長手方向軸を有し、前記アンビルおよびカートリッジは、概して、該長手方向軸に沿って延び、前記止血部材は、前記圧縮力が該長手方向軸を横断する軸に沿って変化するように構成され、かつ寸法が合わせられる、請求項17に記載の止血部材。
- 前記組織に加えられる前記圧縮力が、前記カートリッジ部材の中心線に対して外側に減少して、その結果、該カートリッジ部材の該中心線のより近くの組織を通る血流が、該カートリッジ部材の該中心線からより遠い組織を通る血流未満であるように、前記止血部材が、構成され、かつ寸法を合わせられる、請求項18に記載の止血部材。
- 前記止血部材は、前記圧縮力が前記長手方向軸に沿って変化するように構成され、かつ寸法が合わせられる、請求項17に記載の止血部材。
- 前記外科用ファスナ適用装置は、長手方向軸を有し、前記アンビルおよびカートリッジは、弓形の形状であり、該アンビルおよびカートリッジは、該長手方向軸を横断するように延び、該止血部材は、前記圧縮力が該長手方向軸を横断する軸に沿って変化するように構成され、かつ寸法が合わせられる、請求項17に記載の止血部材。
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Publication number | Publication date |
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EP2116195B1 (en) | 2018-10-03 |
AU2009201689B2 (en) | 2014-07-10 |
CA2664467C (en) | 2016-11-22 |
EP2116195A1 (en) | 2009-11-11 |
US8091756B2 (en) | 2012-01-10 |
US20090277947A1 (en) | 2009-11-12 |
JP2015003052A (ja) | 2015-01-08 |
CA2664467A1 (en) | 2009-11-09 |
AU2009201689A1 (en) | 2009-11-26 |
JP5646821B2 (ja) | 2014-12-24 |
CN103405256B (zh) | 2015-10-28 |
CN103405256A (zh) | 2013-11-27 |
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