JP2010505504A - 外科手術を補佐するためのクリップ器具、補助システム、および、その方法 - Google Patents
外科手術を補佐するためのクリップ器具、補助システム、および、その方法 Download PDFInfo
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- 238000000034 method Methods 0.000 title claims abstract description 22
- 238000001356 surgical procedure Methods 0.000 title claims abstract description 18
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- 230000037431 insertion Effects 0.000 claims abstract description 66
- 210000000056 organ Anatomy 0.000 claims abstract description 58
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- 238000002324 minimally invasive surgery Methods 0.000 description 4
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- A—HUMAN NECESSITIES
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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
- A61B1/12—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 with cooling or rinsing arrangements
- A61B1/121—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 with cooling or rinsing arrangements provided with means for cleaning post-use
- A61B1/122—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 with cooling or rinsing arrangements provided with means for cleaning post-use using cleaning tools, e.g. brushes
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- A—HUMAN NECESSITIES
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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
- A61B1/313—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 for introducing through surgical openings, e.g. laparoscopes
- A61B1/3132—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 for introducing through surgical openings, e.g. laparoscopes for laparoscopy
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Abstract
特に、(a)上記システムを準備し、(b)腹腔および/または中空状臓器、生体・人工開口、腔口、術後腔のいずれか1以上の内部に上記クリップ600を挿入し、(c)上記挿入具800を介してクリップの咬合部606、607を開き、(d)組織を把持し、(e)クリップのフックを腹腔および/または中空状臓器、生体・人工開口、腔口、術後腔のいずれか1以上の内壁に固定し、(f)挿入具800をクリップ600から外し、(g)挿入具800を腹腔および/または中空状臓器、生体・人工開口、腔口、術後腔のいずれか1以上から取り出すことからなる。
【選択図】図7
Description
この状況は、咬合部間に臓器または組織に挟み込んだ状態におけるクリップ操作の典型的な配置状態であり、腹膜に対してクリップを固定/解放することができる。
腹壁に大きな切開孔を加えることなく、あるいは、牽引臓器を保持するために必要な別のトロカールと専用器具を用いて行う低侵襲の内臓牽引を行うために、本発明の挿入具とクリップを一例として適用できる。
装着
1.クリップ600のフック601を挿入具800のフック902に接続する。
2.挿入具の引き金805を引き、解除する。ストッパ機構が働き引き金805が確実にロックされ、クリップ600が挿入具の管803の端部を閉止状態に装着される(図13参照)。
挿入
3.装着した挿入具を腹壁に位置づけたトロカールを通して腹部に挿入する(図13)。
4.牽引する対象の臓器に届いたら、引き金805を引いてクリップのフラップ607を開く(図15参照)。
牽引
5.咬合部606とフラップ607の間の臓器1602を把持して、引き金802を解除して臓器の上でフラップ607を閉じる。
6.一旦、ストッパ802を押して挿入具800の端部からクリップ600を開放する。クリップと挿入具のフック601、902はそのまま係止状態にある(図12参照)。
7.クリップ600を回転して、フック601を措置対象の内腹壁1601の所定箇所に位置づける。フック601で腹部組織1601を貫通して臓器1602を牽引する(図16参照)。
挿入具除去
8.一旦、ストッパ802を押して挿入具のフック902を解除し、挿入具800を回転させてフック902をクリップのフック601から外し、これらを別々に側方に摺動させる。
9.クリップ600を残したまま、トロカールを通して挿入具800を抜くことができる。
牽引位置の変更または除去
10.解放された挿入具のストッパ802を1、2回押してフック902を伸長させる。
11.解放された挿入具800をトロカールを通して腹腔に挿入する。
12.側部から接近して挿入具のフック902とクリップのフック601を係止し、ストッパ802が止まるまで引き金805を引き、フック601と902を係着させる(図12参照)。
13.挿入具800を上方に動かして、クリップのフック601を腹壁1601の組織から外す。
14.次の選択肢がある:
(a)クリップ取り外し: 引き金805が止まり、フラップ607が開くまで引き金を引き、組織1602をフラップ607から解放し、引き金805を離してフラップを閉じ、クリップ600を挿入具800に装着し、トロカールを通して取り外す。
(b)腹壁上でのクリップの位置変更: 段階7〜9に従う。
(c)別の臓器または他の位置での牽引の反復措置: 段階4〜9に従う。
Claims (23)
- スリーブ状に封入された圧縮バネを備え、前記圧縮バネが前記クリップの咬合部を囲繞し、且つ、咬合部を押圧して互いに近接させることを特徴とする外科手術に用いるクリップ。
- 前記挿入具と係合するフックまたはループ係合手段を備えたことを特徴とする請求項1記載のクリップ。
- 前記フック係合手段よって、腹腔内壁および/または中空状臓器、生体・人工開口、腔口、術後腔のいずれか1以上の内壁への固定を行うことを特徴とする請求項2記載のクリップ。
- 器具基部に反力を付与しながら前記係合手段を引くことで作動させることを特徴とする請求項2記載のクリップ。
- 前記クリップの咬合部を前記係合手段で開放させることを特徴とする請求項4記載のクリップ。
- (a)少なくとも1つのクリップと、(b)少なくとも1つの挿入具からなり、前記クリップが第1および第2手段とからなり、前記第1手段によって生体の体腔内部の内面に装置を取り付け、前記第2手段によって手術器具または装置を取り付けることを特徴とする外科手術に用いるシステム。
- 前記クリップが挿入具と係合するフックまたはループ係合手段を備えたことを特徴とする請求項6記載のシステム。
- 前記フック係合手段によって腹腔内壁および/または中空状臓器、生体・人工開口、腔口、術後腔のいずれか1以上の内壁への固定を行うことを特徴とする請求項7記載のシステム。
- 前記挿入具によって、前記クリップを腹腔内および/または中空状臓器、生体・人工開口、腔口、術後腔のいずれか1以上の内部へ挿入することを特徴とする請求項6記載のシステム。
- 前記挿入具によって、前記クリップを腹腔内および/または中空状臓器、生体・人工開口、腔口、術後腔のいずれか1以上の内部から離脱させることを特徴とする請求項6記載のシステム。
- 前記クリップによって、器具基部に反力を付与しながら前記係合手段を引くことで作動することを特徴とする請求項7記載のシステム。
- 前記挿入具によって、前記クリップを腹腔内および/または中空状臓器、生体・人工開口、腔口、術後腔のいずれか1以上の内部に再度連結させることを特徴とする請求項6記載のシステム。
- 前記挿入具によって、前記クリップを腹腔内および/または中空状臓器、生体・人工開口、腔口、術後腔のいずれか1以上の内部から引き抜くことを特徴とする請求項12記載のシステム。
- 外科手術中に装置および/または交換先端部の固定、および/または、腹腔内、中空状臓器内、生体・人工開口、腔口、術後腔のいずれか1以上の内臓および/または組織の牽引に用いることを特徴とする請求項1記載のクリップ。
- 更に固定装置を備えたことを特徴とする請求項6記載のシステム。
- 前記固定装置が、連結した第1および第2取付手段を有し、前記第1取付手段によって生体の体腔内部の内面に装置を取り付け、前記第2取付手段によって前記体腔内部の手術器具または装置に取り付けることを特徴とする請求項15記載のシステム。
- 前記第1取付手段が、体腔の内面または体腔内の各種臓器に取り付けられる低侵襲手段を有し、前記手段が、吸引カップなどの吸引手段と、体腔内部、外部または両方に位置づけられる磁石または電磁石などの磁気手段と、特に、鉤部材、固定ワイヤーまたは自留クランプなどの機械手段と、圧着ゲル剤などの接着手段のいずれかまたはこれらを組み合わせた手段から選ばれた手段であることを特徴とする請求項16記載のシステム。
- 空腔壁に大きい開口を追加形成することなく、一箇所から他所に移動させて体腔の下面または体腔内の各種組織に再度取り付ける手段を更に備えたことを特徴とする請求項16記載のシステム。
- 吸引カップ、磁気手段、機械手段、接着手段あるいはこれらを組み合わせた複数の固定装置を取り付ける手段を更に備えて、それらを共に用いて比較的重い対象を保持するか、または、それらの間の荷重を分散することを特徴とする請求項16記載のシステム。
- 前記第2取付手段が、吸引カップなどの機械手段と、フック/ループ連結部材と、接続紐または接続ロッドと、接着手段と、磁気手段またはこれらを組み合わせた手段から選ばれた手段であり、更に、前記第2取付手段に取り付けた前記手術装置が、カッティング手段と、止血ユニットと、証明手段と、カメラおよびカメラクリーニング手段などの画像手段と、特に体腔内の他方の壁面または体腔内部の各種臓器に取り付けられる線材などの引抜手段である空腔壁あるいは体腔内の各種臓器へ押圧力を付与する低侵襲付勢手段と、体腔内の他方の壁面または体腔内の各種臓器に取り付けられるロッドなどの押圧手段と、これらの組み合わせ手段から選ばれた手段であることを特徴とする請求項16記載のシステム。
- (a)請求項8に記載のシステムを準備し、(b)腹腔および/または中空状臓器、生体・人工開口、腔口、術後腔のいずれか1以上の内部に前記クリップを挿入し、(c)前記挿入具を介してクリップの咬合部を開き、(d)前記咬合部で内臓または組織を把持し、(e)前記クリップのフックを前記腹腔および/または中空状臓器、生体・人工開口、腔口、術後腔のいずれか1以上の内部に固定し、(f)前記挿入具を前記クリップから外し、(g)前記挿入具を前記腹腔および/または中空状臓器、生体・人工開口、腔口、術後腔のいずれか1以上の内部から取り出し、これによって腹壁への更なる切開を不要にしたことを特徴とする外科手術中に内臓を牽引する方法。
- 前記挿入具を介して、前記腹腔および/または中空状臓器、生体・人工開口、腔口、術後腔のいずれか1以上の内部に前記クリップを再度結合させる処理を加えたことを特徴とする請求項21記載の方法。
- クリップを再配置および/または前記腹腔および/または中空状臓器、生体・人工開口、腔口、術後腔のいずれか1以上からの取り出しの処理を加えたことを特徴とする請求項21記載の方法。
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US84863606P | 2006-10-03 | 2006-10-03 | |
US60/848,636 | 2006-10-03 | ||
PCT/IL2007/001185 WO2008041226A2 (en) | 2006-10-03 | 2007-09-25 | A clip device, system and method for assisting surgical procedures |
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JP2010505504A true JP2010505504A (ja) | 2010-02-25 |
JP2010505504A5 JP2010505504A5 (ja) | 2010-11-11 |
JP5153776B2 JP5153776B2 (ja) | 2013-02-27 |
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US (3) | US8397335B2 (ja) |
EP (2) | EP2076166A4 (ja) |
JP (1) | JP5153776B2 (ja) |
WO (3) | WO2008041225A2 (ja) |
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DE10154163A1 (de) | 2001-11-03 | 2003-05-22 | Advanced Med Tech | Vorrichtung zum Aufrichten und Stabilisieren der Wirbelsäule |
WO2008041225A2 (en) | 2006-10-03 | 2008-04-10 | Virtual Ports Ltd | Lens cleaning device, system and method for surgical procdures |
US8979931B2 (en) | 2006-12-08 | 2015-03-17 | DePuy Synthes Products, LLC | Nucleus replacement device and method |
US7655004B2 (en) | 2007-02-15 | 2010-02-02 | Ethicon Endo-Surgery, Inc. | Electroporation ablation apparatus, system, and method |
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WO2008041227A2 (en) | 2008-04-10 |
JP5153776B2 (ja) | 2013-02-27 |
US20090250081A1 (en) | 2009-10-08 |
US8945155B2 (en) | 2015-02-03 |
EP2073721A4 (en) | 2014-12-31 |
WO2008041225A3 (en) | 2009-04-23 |
US8397335B2 (en) | 2013-03-19 |
EP2076166A2 (en) | 2009-07-08 |
WO2008041226A2 (en) | 2008-04-10 |
WO2008041226A3 (en) | 2009-05-07 |
EP2073721B1 (en) | 2018-11-07 |
EP2076166A4 (en) | 2015-03-11 |
US20090209947A1 (en) | 2009-08-20 |
WO2008041227A3 (en) | 2009-09-17 |
US20090222029A1 (en) | 2009-09-03 |
EP2073721A2 (en) | 2009-07-01 |
WO2008041225A2 (en) | 2008-04-10 |
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