JP2009534158A - 経管腔的外科手術システム - Google Patents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
- A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00002—Operational features of endoscopes
- A61B1/00043—Operational features of endoscopes provided with output arrangements
- A61B1/00045—Display arrangement
- A61B1/00052—Display arrangement positioned at proximal end of the endoscope body
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- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00112—Connection or coupling means
- A61B1/00121—Connectors, fasteners and adapters, e.g. on the endoscope handle
- A61B1/00128—Connectors, fasteners and adapters, e.g. on the endoscope handle mechanical, e.g. for tubes or pipes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00131—Accessories for endoscopes
- A61B1/00135—Oversleeves mounted on the endoscope prior to insertion
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3403—Needle locating or guiding means
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
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- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
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- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00278—Transorgan operations, e.g. transgastric
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- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
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- A61B2017/3405—Needle locating or guiding means using mechanical guide means
- A61B2017/3407—Needle locating or guiding means using mechanical guide means including a base for support on the body
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- A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
- A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
- A61B2017/3484—Anchoring means, e.g. spreading-out umbrella-like structure
- A61B2017/3486—Balloon
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- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/50—Supports for surgical instruments, e.g. articulated arms
Abstract
【選択図】図17
Description
12bによって切開部に固定される。腹膜腔内に作業空間を作り出すために、アクセス用カニューレを通じて注入ガスが腹膜腔内へ導入される。アクセス用カニューレには、切開部を通じてシーリングされたアクセスを可能とするためのバルブまたはシールを備えるようにすることもでき、これによって注入したガスの圧力を損失することなく腹膜腔内への器具の無菌経路を形成することができるようになる。アクセス用カニューレ10は、編組を埋め込んだ高分子材料(例えば、ポリウレタン)でてきたフレキシブルなチューブで構成することができる。別の実施例では、もっと剛性の高いアクセス用カニューレを使用することもできる。‘009出願(ここで引用することにより、本出願に組み入れられるものである。)には、アンカー部、胃のような体内壁に切開を形成するための要素、および閉鎖用器具などを含め、アクセス用カニューレ・システムに関する種々の追加コンポーネントが説明されている。
12bを使用することによって胃壁の切開部に固定されると、後で説明するタイプの処置用カニューレと保持システムがアクセス用カニューレを通り、腹膜腔内へ導入される。
30bには、図示するように、曲げられた先端部分が備えられており、この部分は、プル・ワイヤ、マンドレル、あるいは変形カテーテルの技術分野において公知となっているその他の変形機構と、導入器、およびガイド・ワイヤを利用することによって、追加的にあるいは代替的に所定の方向へ変形できるようになっている。
30bは二つの処置器具32を同時に使用することができるようになるので有用である。処置用カニューレ30a, 30bは、同じアクセス用カニューレ10(図1参照)の中を経由して腹膜腔内へ導入される。そして、アクセス用カニューレ10の中を一または複数のシャフト26が伸び、あるいは、これらのシャフト26が分かれて配置された複数のカニューレ10の中を伸び、処置用カニューレ30a,
30bは、シャフト26の内腔を通るようになっている(図3参照のこと)。
30bの相対的な方向を維持することができるという別の利点も有している。図2Bに良く分かるように描かれていることであるが、リンケージ36は、シャフト26に取り付けられた第一のマウント部38と、処置用カニューレ30a,
30bに取り付けられた第二のマウント部40a, 40bを備えている。リンケージ・バー42a, 42bは、第一のマウント部38と第二のマウント部40a, 40bに回動自在に結合されている。第二のリンケージ・バー44a,
44bは、第二のマウント部40a, 40bとピボット点46に回動自在に結合されている。図2Aと2Bからも分かるように、極端に違う方向からのアプローチ方向を使用して処置器具32を体内へ挿入しているにもかかわらず、施術者にとって慣れた方向からのアプローチ方法を採用して、処置場所までアクセスできるように、保持システム24は処置用カニューレ30a,
30bを配置するようになっている。処置用カニューレ30a, 30bが変形可能な特性を有しているため、これらの処置用カニューレ30a, 30bが、処置器具32を必要な場所に配置できるようにするために操作される。そして、このことは、操縦し、変形させるための特別な技術を備えた処置器具32を必要とすることなく実現されている。リンケージ36は、処置用カニューレ30a,
30bの処置場所に対する相対的な方向を維持するようになっている。
図3は、第二の実施例に係る経管腔的外科手術システム100を示したものである。この経管腔的外科手術システム100は、ロッキング・スパイン102と一対の処置ツール・カニユーレ104を備えている。この経管腔的外科手術システム100は、図2A,
2Bの実施例と類似のものであるが、相違点は、処置ツール・カニユーレ104は保持システムのロッキング・スパイン102のシャフト内の内腔105を通っていることである。そしてこのことによって、経管腔的外科手術システム100が占有する空間を低減させた流線型のシステムを構成できるようになっている。内視鏡107もまた、ロッキング・スパイン102の中を通って伸びており、施術者は経管腔的外科手術システム100の先端部で行われている処置状況を観察することができるようになっている。処置器具32は処置ツール・カニユ―レ104を通って処置場所まで伸びている。処置器具32には、腹膜腔内で必要な処置を行うのに必要となる鉗子、開創器、その他の器具が備えられている。
106bで構成されている。各ケーブルは、ケーブルに張力を付与ために、図4に示すロック位置に動かすことができるロッキング・ハンドル108に連結されており、これによってロッキング・スパイン102に剛性を付与することができるようになっている。ロッキング・スパイン102をフレキシブルな状態になるように解放するために、ロッキング・ハンドル108は矢印Aで示す方向へ動くようになっている。複数のスパイン・セグメント106aは、中心軸に対して垂直な端面を有するシリンダ状セグメントである。これらの複数のスパイン・セグメント106aをケーブルで連結し、ロッキング・ハンドル108をロック状態にすることによって、比較的直線状のスパイン部分110が形成される。これとは別のスパイン・セグメント106bは角度のついた端面を有しており、この角度のついた端面を有するスパイン・セグメント106bの組合せを適切に選択し、図4に示すロック状態にすることによって、所定の曲げられた状態の端部部分112を形成するように組み立ることができるようになっている。
角度15°、ケーブル#1は穴Aを通過、ケーブル#2は穴Dを通過」のように記載されている。
図8Bに示す実施例では、リンケージ120をアクセス用カニューレ10から取り出し、そして/または、リンケージ120を展開した状態にするために、縦方向の処置ツール・カニユ―レ104の先端部を先端の方向に向かって前へ進めることによってリンケージ120を展開することができるように成っている。一方、図6に示すリンケージ120では、引張ワイヤ127を引くことによって、リンケージ120を開いた状態に展開させることができるようになっている。これらとは別の実施例では、ピボット点122,
124, 125(回動自在のマウント部122, 124, 125)には、リンケージ120の展開を容易にするためにスプリングにより荷重をかけることができるようになっている。腹膜腔内でリンケージ120を展開させるために、ここで説明した展開機構の組合せ、あるいはここでは特に説明しなかった展開機構をも使用することができる。
10B参照)が共通の処置場所にアクセスできるように、処置ツール・カニユ―レ104の方向を決めるものである。
Claims (24)
- 経管腔的外科手術システムにおいて、
フレキシブルな状態と剛な状態を有する細長い支持部材であって、経管腔によって体内腔の中へ入る長さに比例する支持部材と、
細長い支持部材が剛になることによって保持される拡張可能なフレームであって、展開された状態になるまで拡張することができるフレームと、
拡張可能なフレームに結合された少なくとも二つの処置ツール・カニユ―レであって、処置ツール・カニユ―レの各々は体内腔において処置を行うためのツールを受け入れるための空腔を備え、カニユ―レ内に配置されたツールを共通の処置場所へアクセスさせるために、展開された位置にある当該フレームによって、空腔を所定の位置に配置するようになっている処置ツール・カニユ―レとを備えることを特徴とするシステム。 - 請求項1に記載の経管腔的外科手術システムにおいて、
前記細長い支持部材は、ケーブルによって結合された複数のスパイン要素から構成されるセグメント化されたスパインを備え、当該支持部材は、ケーブルに張力を適用することによってフレキシブルな状態から剛な状態に移行することができることを特徴とするシステム。 - 請求項1に記載の経管腔的外科手術システムにおいて、
前記細長い支持部材は空腔を備え、前記処置ツール・カニユ―レは当該空腔を通って伸びていることを特徴とするシステム。 - 請求項1に記載の経管腔的外科手術システムにおいて、
前記処置ツール・カニユ―レは、当該処置ツール・カニユ―レの先端部分に結合された複数の引張ワイヤを備え、当該引張ワイヤの少なくとも1つに張力を加えることによって当該先端部分が変形するようになっていることを特徴とするシステム。 - 請求項4に記載の経管腔的外科手術システムにおいて、
前記引張ワイヤはジンバルに結合された基端部を備え、当該ジンバルは当該引張ワイヤへ張力を付与するために多方向に動かすことができるようになっていることを特徴とするシステム。 - 請求項5に記載の経管腔的外科手術システムにおいて、
前記ジンバルは開口部を有するツール用ポートを有し、当該ジンバルはツール用ポートの動きによって可動になっており、当該ツール用ポートは、ツールの先端が処置ツール・カニユ―レの中を前へでていくときに、ツールの先端部を受けるようになっていることを特徴とするシステム。 - 請求項6に記載の経管腔的外科手術システムにおいて、
前記ツール用ポートは、ツール用ポートの中に配置されたツールのハンドルの動きによって可動になっていることを特徴とするシステム。 - 請求項1に記載の経管腔的外科手術システムにおいて、
前記フレームは、少なくとも二つのフレーム部材を備え、当該フレーム部材の各々は処置ツール・カニユ―レに回動自在に結合されていることを特徴とするシステム。 - 請求項1に記載の経管腔的外科手術システムにおいて、
経管腔的に挿入可能なアクセス用カニューレと、
当該アクセス用カニューレに結合され、体内組織の壁に設けた切開部に当該アクセス用カニューレを保持するために膨張できるようになっているアンカーと、を更に備え、
当該アクセス用カニューレは、空腔と、細長い指示部材と、フレームおよび、フレームがつぶれた状態にあるときにアクセス用カニューレの空腔の中へ挿入できる処置ツール・カニユ―レを備えていることを特徴とするシステム。 - 請求項4に記載の経管腔的外科手術システムにおいて、前記システムは、更に
マウント部と、
マウント部に配置された一対のアクチュエータとを備え、
各処置ツール・カニユ―レの引張ワイヤは、当該アクチュエータの一つに結合されていることを特徴とするシステム。 - 請求項10に記載の経管腔的外科手術システムにおいて、
前記アクチュエータは、処置器具用ポートを備え、処置ツール・カニユ―レの一つの中に配置された処置ツールが、対応する当該処置器具用ポートの一つを通って伸び、処置器具用ポートの範囲内における処置ツールのハンドルの動きによって引張ワイヤを動かすことを特徴とするシステム。 - 請求項10に記載の経管腔的外科手術システムにおいて、
前記マウント部は、外科手術テーブルに取付けられていることを特徴とするシステム。 - 最小の侵襲的な医療的処置を施すための方法であって、
フレキシブルな状態にある細長い支持部材を経管腔的に挿入し、体内組織に設けた切開部を通して体内空腔へ進めるステップと、
当該細長い支持部材をフレキシブルな状態から剛な状態へ変換するステップと、
細長い支持部材によって、体内空腔においてフレームを展開するステップであって、当該フレームは一対の処置ツール・カニユ―レに結合されているステップと、
処置ツール・カニユ―レの中で処置ツールの位置決めを行なうと共に、当該処置ツールを使って体内空腔において処置を行なうステップ
からなることを特徴とする方法。 - 請求項13に記載の最小の侵襲的な医療的処置を施すための方法であって、当該方法が更に、処置ツール・カニユ―レを通って体内空腔内に伸びている処置ツールの位置を変えるために、処置ツール・カニユ―レの先端位置を変形させるステップを含むことを特徴とする方法。
- 請求項14に記載の最小の侵襲的な医療的処置を施すための方法であって、前記処置ツール・カニユ―レの先端位置を変形させるステップには、処置ツール・カニユ―レの先端部分に結合された引張ワイヤに張力を付与することが含まれる
ことを特徴とする方法。 - 請求項15に記載の最小の侵襲的な医療的処置を施すための方法であって、
前記処置ツール基端側部分がツール・ポートを通って伸び、
前記引張ワイヤはツール・ポートに結合されており、
前記処置ツール・カニユ―レを変形させるステップが処置ツールの基端側部分を操作することを含む
ことを特徴とする方法。 - 請求項16に記載の最小の侵襲的な医療的処置を施すための方法であって、
当該方法が、処置ツールの動きに対応して、処置ツール・カニユ―レの変形量を増幅させることができるようになっており、その増幅の程度を調整するステップを更に含むことを特徴とする方法。 - 請求項14に記載の最小の侵襲的な医療的処置を施すための方法であって、
処置ツール・カニユ―レを変形した位置でロックするステップを更に含むことを特徴とする方法。 - 請求項18に記載の最小の侵襲的な医療的処置を施すための方法であって、
処置ツール・カニユ―レを変形させ、処置ツール・カニユ―レから処置ツールを取り出し、当該処置ツール・カニユ―レへ第二の処置ツールを挿入するステップを更に含むことを特徴とする方法。 - 請求項13に記載の最小の侵襲的な医療的処置を施すための方法であって、
前記管腔は、口、膣、直腸を含むグループの中から選択されることを特徴とする方法。 - 請求項13に記載の最小の侵襲的な医療的処置を施すための方法であって、
剛な状態において、支持部材は、体内空腔中の目標とする場所へ向けて処置ツール・カニユ―レを方向付けるために、曲線状の姿勢を有することを特徴とする方法。 - 請求項21に記載の最小の侵襲的な医療的処置を施すための方法であって、
前記切開部は胃の中に設けられ、
前記曲線状の姿勢によって、前記支持部材が切開部から前方であってかつ上方に向けて伸びるようになることを特徴とする方法。 - 請求項21に記載の最小の侵襲的な医療的処置を施すための方法であって、
前記切開部は胃の中に設けられ、
前記曲線状の姿勢によって、処置ツール・カニユ―レの中の処置ツールを体内空腔中にある胆嚢にアクセスするための位置に配置することを特徴とする方法。 - 請求項13に記載の最小の侵襲的な医療的処置を施すための方法であって、
フレームを展開することによって、処置ツール・カニユ―レの先端側開口部を体内空腔の中の目標とする場所に向けることを特徴とする方法。
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JP2021522043A (ja) * | 2018-04-27 | 2021-08-30 | インペリアル カレッジ オブ サイエンス、テクノロジー アンド メディスン | 腹腔鏡手術用器具 |
JP7386846B2 (ja) | 2018-04-27 | 2023-11-27 | インペリアル・カレッジ・イノベーションズ・リミテッド | 腹腔鏡手術用器具 |
Also Published As
Publication number | Publication date |
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US20110066173A1 (en) | 2011-03-17 |
CA2650474A1 (en) | 2007-11-08 |
JP5091229B2 (ja) | 2012-12-05 |
WO2007127199A1 (en) | 2007-11-08 |
JP2013031672A (ja) | 2013-02-14 |
EP2012650A1 (en) | 2009-01-14 |
AU2007243484B2 (en) | 2013-08-15 |
AU2007243484A1 (en) | 2007-11-08 |
EP2012650B1 (en) | 2016-07-27 |
US7833156B2 (en) | 2010-11-16 |
US20080045803A1 (en) | 2008-02-21 |
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