JP2010508873A - Staple device - Google Patents

Staple device Download PDF

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Publication number
JP2010508873A
JP2010508873A JP2009519074A JP2009519074A JP2010508873A JP 2010508873 A JP2010508873 A JP 2010508873A JP 2009519074 A JP2009519074 A JP 2009519074A JP 2009519074 A JP2009519074 A JP 2009519074A JP 2010508873 A JP2010508873 A JP 2010508873A
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Japan
Prior art keywords
anvil
cartridge
connecting member
connecting
portion
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Granted
Application number
JP2009519074A
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Japanese (ja)
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JP5021028B2 (en
Inventor
厚典 上月
宏 堀川
伸一 宮田
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ジョンソン・エンド・ジョンソン株式会社
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Priority to JP2006300762 priority Critical
Priority to JP2006300762 priority
Application filed by ジョンソン・エンド・ジョンソン株式会社 filed Critical ジョンソン・エンド・ジョンソン株式会社
Priority to PCT/JP2007/071439 priority patent/WO2008056618A2/en
Priority to JP2009519074A priority patent/JP5021028B2/en
Publication of JP2010508873A publication Critical patent/JP2010508873A/en
Application granted granted Critical
Publication of JP5021028B2 publication Critical patent/JP5021028B2/en
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B17/07207Surgical 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 the staples being applied sequentially
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072Surgical 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
    • A61B2017/07214Stapler heads
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2932Transmission of forces to jaw members
    • A61B2017/2939Details of linkages or pivot points
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • A61B2017/320052Guides for cutting instruments

Abstract

An object of the present invention is to provide a stapling apparatus capable of preventing a living tissue from slipping between a cartridge and an anvil during stapling and firmly holding the living tissue.
In the stapling apparatus according to the present invention, when the closing lever 40 is operated, the closing pipe 4 slides forward to urge the second connecting member 16 forward. The biased second connecting member 16 moves along the bent long groove 12b while rotating, and rotates the first connecting member 14 forward. The anvil 6 connected to the first connecting member 14 and the second connecting member 16 performs parallel closing on the cartridge 5.
[Selection] Figure 2

Description

  The present invention relates to a surgical instrument used in a surgical operation, and more particularly to a stapling apparatus that sutures a living tissue using staples.

In the field of surgery, staples are composed of a cylindrical insertion portion having an anvil that can be opened and closed with respect to the cartridge at the distal end, and a gun grip-type operation portion connected to the proximal end of the insertion portion. The device is widespread.
By using this stapling device, the insertion portion is inserted into the body, a plurality of rows of staples accommodated in the cartridge are driven out against the living tissue, and the living tissue between the staple rows is linearly cut with a knife. Suture and excision of the affected area can be performed simultaneously.

  FIG. 1 shows an external perspective view of a conventionally used stapling apparatus. This stapling apparatus is provided with cartridges 5 for storing staples in a plurality of rows and an anvil 6 having a plurality of grooves for deforming the staples. When the stapling apparatus 1 is used, staples are ejected from the cartridge 5 while the living tissue is sandwiched between the anvil 6 and the cartridge 5, and the living tissue between a plurality of staple rows arranged at the same time is excised with a knife. .

The operation will be described in detail. When the closing lever 40 is operated, the anvil 6 rotates in the direction of the staple cartridge, and the living tissue is sandwiched between the anvil 6 and the cartridge 5.
Subsequently, when the staple driving lever 27 is operated, the cam bar housed in the insertion portion 2 moves in the cam bar slot on the back surface of the cartridge toward the cartridge leading end, and the tip of the cam bar contacts the staple holding member to hold the staple. The member is pushed in the direction of the anvil 6, the staple is driven out, and then the cutter slides on the cartridge surface and a slot provided on the surface of the anvil 6. By this operation, the portion of the living tissue sandwiched between the anvil 6 and the cartridge 5 is stapled over a plurality of rows, and at the same time, the central portions of the left and right rows are cut. By repeating this stapling, a desired living tissue such as an affected part can be excised.
When the staple driving lever 27 is released, the cam bar and the knife slide in the slot and return to the initial position by the force of the winding spring provided in the vicinity of the staple driving lever 27. Thereafter, when the release button 42 provided on the back of the operation unit is pressed, the anvil 6 is fully opened with respect to the cartridge 5.

  Patent Documents 1 and 2 are disclosed as stapling apparatuses including the above-described insertion portion, anvil opening / closing means (closing lever 40), and staple driving means (staple driving lever 27).

Japanese Patent Laid-Open No. 2003-603 Japanese Patent Laid-Open No. 9-238947

  Since the conventional stapling apparatus is configured as described above, when the anvil 6 is closed with respect to the cartridge 5, the anvil 6 is closed in an arc shape with its rear portion as a fulcrum. The tip part was in contact with the living tissue. Therefore, as the anvil 6 is closed, there is a problem that the living tissue sandwiched between the anvil 6 and the cartridge 5 becomes slidable in the distal direction of the anvil 6.

  The present invention has been made to solve the above-described problems, and provides a stapling apparatus that prevents the living tissue from slipping between the cartridge and the anvil during stapling and can firmly hold the living tissue. The purpose is to do.

A stapling apparatus according to the present invention includes an insertion portion, and an operation portion connected to the insertion portion and having an anvil opening / closing means and a staple driving means.
The insertion portion engages an anvil that opens and closes with respect to a cartridge that stores staples, a cartridge holder that holds the cartridge, and a first connecting shaft provided at one end of the cartridge holder through the hole. Accordingly, the other end is connected to the first connecting member connected to the anvil at the first connecting portion, and the second connecting shaft provided at one end is connected to the groove formed in the cartridge holder. And the other end is connected to the anvil at the second connecting portion, and the front and rear are connected to the anvil opening / closing means and arranged behind the cartridge holder. And a slidable closing pipe.
When the anvil opening / closing means is operated, the closing pipe slides to urge the second connecting member forward, and the urged second connecting member moves along the groove while rotating, The one connecting member rotates forward with the first connecting shaft as a fulcrum, and the anvil connected to the first connecting member and the second connecting member performs parallel closing on the cartridge.

  In the stapling apparatus according to the present invention, the length between the first connecting portion and the first connecting shaft is equal to the length between the second connecting portion and the second connecting shaft, and the anvil is connected to the first connecting shaft. When the cartridge is fully closed, the length between the first connecting portion and the second connecting portion is equal to the length between the first connecting shaft and the second connecting shaft. The first connecting portion, the second connecting portion, the first connecting shaft, and the second connecting shaft form a vertex of a parallelogram.

  In the stapling apparatus according to the present invention, a notch is provided at the foremost portion of the groove of the cartridge holder, and the second connecting shaft is notched when the anvil is fully closed with respect to the cartridge. It is characterized by engaging with.

  In the stapling apparatus according to the present invention, the rotation angle of the second connecting shaft from when the second connecting shaft and the notch are engaged until the anvil is fully closed with respect to the cartridge is set. It is characterized by being 20 ° or less.

  In the stapling apparatus according to the present invention, the closing pipe is provided with a hole on the upper surface of the front portion thereof, and a protrusion provided on the second connecting member is engaged with the hole.

  In the stapling apparatus according to the present invention, a pin is provided at a front portion of the hole portion of the closing pipe in a direction perpendicular to the axis of the closing pipe, and the pin is provided in front of the protruding portion of the second connecting member. It is characterized by hanging in a groove.

  In the stapling apparatus according to the present invention, a cam bar extending from the operation unit toward the insertion unit is connected to the staple driving lever, and when the staple driving unit is operated, the cam bar is a staple storage unit in the cartridge. The staple holding member provided in the vicinity is pushed up to drive out staples.

  The stapling apparatus according to the present invention is characterized in that a knife extending from the operation portion toward the insertion portion is coupled to the staple driving means together with the cam bar, and slides forward when the staple driving means is operated. Yes.

  In the stapling apparatus according to the present invention, the anvil is provided with guides protruding downward on both side surfaces, and the guides are positioned on both sides of the cartridge holder when the anvil is closed with respect to the cartridge. Yes.

According to the stapling apparatus according to the present invention, the above-described so-called four-joint link mechanism is applied, so that the anvil performs parallel closing with respect to the cartridge, and the living tissue can be pressed and firmly held between the cartridge and the anvil, so that the stable. Can be stapled.
Further, by adopting this structure, the anvil opening / closing mechanism can be minimized, and the diameter of the closing pipe can be minimized accordingly. Therefore, it is possible to provide a stapling apparatus that can use a thin trocar (insertion tube). .

  According to the stapling apparatus of the present invention, by applying the above-described so-called four-joint parallel link mechanism, the pressure distribution when the anvil presses the cartridge becomes uniform, and a large gripping force is obtained. It is possible to prevent the living tissue from slipping between the cartridge and the anvil and to firmly hold the living tissue.

  According to the stapling apparatus of the present invention, it is possible to prevent the anvil from opening due to a load at the time of staple driving.

  According to the stapling apparatus according to the present invention, since the degree to which the living tissue is scratched between the anvil and the cartridge at the time of parallel closing is reduced, damage to the living tissue can be reduced.

  According to the stapling apparatus according to the present invention, the movement of the entire parallel closing mechanism can be controlled by controlling the movement of the second connecting member.

  According to the stapling apparatus according to the present invention, the movement of the entire parallel closing mechanism can be controlled with higher accuracy.

  According to the stapling apparatus according to the present invention, stapling can be performed in a state where the living tissue is sandwiched between the anvil and the cartridge.

  According to the stapling apparatus according to the present invention, the living tissue can be excised simultaneously with stapling.

  According to the stapling apparatus according to the present invention, the alignment (alignment position) between the anvil and the cartridge holder (cartridge) can be defined.

Hereinafter, in order to describe the present invention in more detail, the best mode for carrying out the present invention will be described with reference to the accompanying drawings.
Embodiment 1 FIG.
Embodiment 1 of the present invention will be described below. FIG. 2 is an overall perspective view of the stapling apparatus according to the first embodiment. 3 is a cross-sectional view in which the anvil 6 of the stapling apparatus 1 of FIG. 3 is an initial state of the stapling apparatus 1.
The stapling apparatus 1 includes a cylindrical elongated insertion portion 2 that is inserted into the body, and an operation portion 3 that is connected to a proximal end portion of the insertion portion 2 and has a gun grip type. A closing pipe 4 that slides back and forth is provided in the vicinity of the distal end of the insertion portion 2, and further, an anvil 6 that can be opened and closed with respect to the cartridge 5 and a first connecting member 14 that controls the posture thereof. The second connecting member 16 and the cartridge holder 12 are provided.

Hereinafter, the structure of the distal end portion of the insertion portion 2 will be described with reference to FIGS. 4 is an exploded perspective view of the vicinity of the distal end portion of the insertion portion 2 in the stapling apparatus 1 shown in FIG.
The cartridge holder 12 is bent in a substantially U shape in cross section, and holds the cartridge 5 in a detachable manner. Further, a pair of notches 12e for locking the cartridge 5 is formed on the front side surface of the cartridge holder 12. On the other hand, a pair of engaging protrusions 5 a are provided on the front side surface of the cartridge 5. The engaging protrusion 5a of the cartridge 5 is detachably engaged with the notch 12e of the cartridge holder 12.

The anvil 6 includes guides 6a at left and right positions slightly rearward in the length direction. The guide 6a is positioned so as to sandwich the cartridge holder 12 from the left and right when the anvil 6 is closed, and plays a role of defining the alignment (alignment position) between the anvil 6 and the cartridge holder 12 (cartridge 5). The guide 6a is not limited to this shape and arrangement, and may be omitted.
End portions of the anvil 6 in the direction of the operation unit 3 are rotatably connected to end portions of the first connection member 14 and the second connection member 16 via connection pins (connection portions) 13a and 13b, respectively.
A connecting shaft 14a and a connecting shaft 16a project from the side surfaces of the other ends of the first connecting member 14 and the second connecting member 16, respectively. On the other hand, a hole 12a and a bent long groove 12b are provided on both side surfaces of the rear portion of the cartridge holder 12.
The connecting shaft 14a of the first connecting member 14 is inserted into the hole 12a, and the first connecting member 14 rotates with the connecting shaft 14a as a fulcrum. The connecting shaft 16a of the second connecting member 16 engages with the bent long groove 12b and moves along the bent long groove 12b while rotating. Accordingly, the second connecting member 16 rotates and moves back and forth.

When the anvil 6 is closed with respect to the cartridge 5, the first connecting member 14 is sandwiched between grooves 16 e provided on the lower surface of the second connecting member 16. Further, in the vicinity of the center portion of the first connecting member 14, a semicircular concave portion 14b for avoiding the connecting pin 13b at that time is provided.
A protrusion 16b is provided on the upper surface of the rear portion of the second connecting member 16, a groove 16c is provided in front of the protrusion 16b, and a stopper 16d is provided in the front height direction. A hole 4a is provided on the top surface of the tip of the closing pipe 4, and a pin 4b is provided in front of the hole 4a.
The protrusion 16b engages with the hole 4a, and the pin 4b moves between the groove 16c on the second connecting member 16 and the stopper 16d, thereby controlling the movement of the second connecting member 16. As a result, it plays a role of controlling the movement of the entire distal end portion (hereinafter referred to as a parallel closing mechanism) of the insertion portion 2. Detailed operation of the parallel closing mechanism will be described later.

Next, actual living tissue stapling will be described with reference to FIGS. FIG. 5 is an enlarged cross-sectional view showing a state where the living tissue is stapled using the stapling apparatus 1 of FIG. 6 is an exploded perspective view of the vicinity of the insertion portion of the stapling apparatus shown in FIG.
In the cartridge 5, a plurality of substantially U-shaped staples 7 (see FIG. 5) made of a biocompatible material such as titanium are accommodated in a plurality of rows in a state where both ends can be released toward the anvil 6. 8 is formed. In the first embodiment (FIG. 4), four rows of the staples 7 accommodated in the staple accommodating portion 8 of the cartridge 5 are formed.

  As shown in FIG. 5, a staple holding member 10 is disposed in the staple storage portion 8 below each staple 7. A slope for pushing the staple 7 toward the anvil 6 is formed below the staple holding member 10. The staple holding member 10 is supported so as to be slidable in the direction of the anvil 6 while being in contact with the staple 7. One staple holding member 10 holds two staples arranged substantially next to each other in adjacent rows.

  As shown in FIG. 6, the tip portion of the knife 20 is provided with an edge portion serving as a cutting blade. Further, the cam bar 21 is provided with a slope for pushing out the staple 7 at the front end portion thereof. The other ends of the knife 20 and the cam bar 21 are connected to the cam bar adapter 23. The knife 20 and the cam bar 21 are slidable with respect to the cartridge 5.

  As shown in FIG. 4, a knife slot (not shown) is formed on the surface of the cartridge 5 in the direction of the anvil 6 to guide the sliding movement of the knife 20 between the staple rows. A groove 11 for deforming the staple 7 and a guide groove 9 on which an edge portion of the knife 20 slides are provided on the back surface of the anvil 6 facing the cartridge 5. Further, a cam bar slot (not shown) for guiding the movement of the cam bar 21 is formed on the back surface of the cartridge 5 below the staple row.

  As described above, when the living tissue 44 is sandwiched between the cartridge 5 and the anvil 6 and the lower portion of the staple holding member 10 is pushed up toward the anvil 6 as the cam bar 21 advances through the cam bar slot, Staple 7 is driven out. The staples 7 sequentially ejected for each row are sandwiched between the groove 11 of the anvil 6 and the cartridge 5 to stap the living tissue 44. At the same time, the knife 20 advances through the knife slot and the guide groove 9 to cut the central portion of the living tissue 44 (see FIGS. 4 and 5).

  Next, the operation of the parallel closing mechanism of the stapling apparatus 1 will be described with reference to FIGS. 7 to 11 are cross-sectional views showing a series of operations (parallel closing) from the fully open state to the fully closed state of the parallel closing mechanism. FIG. 7 is a cross-sectional view showing the operation of the parallel closing mechanism, and shows a fully open state (initial state). In addition, in order to make it easy to see, the 2nd connection member 16 is made into the side view instead of sectional drawing.

  In FIG. 7, in the initial state, the pin 4b is engaged with the groove 16c, and the protrusion 16b is engaged with the hole 4a. The first connecting member 14 rotates with the connecting shaft 14a as a fulcrum. Moreover, since the closing pipe 4 is urged rearward, the pin 4b also urges the protrusion 16b rearward. As a result, the anvil 6 connected to the second connecting member 16 and the first connecting member 14 connected to the anvil 6 are also urged rearward. Since the 1st connection member 14 stands | starts up and becomes a form which supports the anvil 6, the fully open state as shown in figure is formed. At this time, the connecting shaft 16a is located at the rearmost part of the bent long groove 12b.

FIG. 8 is a cross-sectional view showing the operation of the parallel closing mechanism following FIG. First, the closing pipe 4 is urged forward. The pin 4b is spaced apart from the protrusion 16b and contacts the inner wall of the groove 16c at a position facing the protrusion 16b to urge the second connecting member 16 forward. Accordingly, the connecting shaft 16a moves while rotating along the groove 12b. As a result, the second connecting member 16 rises and tilts forward.
Since the distance L1 between the connecting pins 13a-13b is constant, the connecting pin 13a also moves forward by the amount that the connecting pin 13b (second connecting member 16) has moved. That is, the first connecting member 14 rotates forward.
Accordingly, the anvil 6 is inclined with respect to the cartridge 5 with the connecting pins 13 a and 13 b as fulcrums, and moves forward by the rotation angle of the first connecting member 14.

  FIG. 9 is a cross-sectional view showing the operation of the parallel closing mechanism continued from FIG. The closing pipe 4 is further slid forward from the state of FIG. The pin 4b is substantially at the uppermost position in the height direction inside the groove 16c. The protruding portion 16 b is detached from the hole portion 4 a and is accommodated in the closing pipe 4. The 1st connection member 14, the 2nd connection member 16, and the anvil 6 continue the operation | movement demonstrated in FIG. At this time, the connecting shaft 16a is at a substantially intermediate position of the bent long groove 12b.

  FIG. 10 is a cross-sectional view showing the operation of the parallel closing mechanism following FIG. The closing pipe 4 is further slid forward from the state of FIG. The pin 4b is disengaged from the groove 16c and rides on the upper surface of the second connecting member 16. Accordingly, the pin 4b pushes the second connecting member 16 from the upper surface. The 1st connection member 14, the 2nd connection member 16, and the anvil 6 continue the operation | movement demonstrated in FIG.

  FIG. 11 is a cross-sectional view showing the operation of the parallel closing mechanism continued from FIG. 10 and shows a fully closed state. The closing pipe 4 is further slid forward from the state of FIG. The pin 4b is stopped moving forward by the stopper 16d, and urges forward while pressing the second connecting member 16. By pressing the second connecting member 16 with the pin 4b, it is possible to prevent the anvil 6 from being opened due to a load at the time of stapling. At this time, the connecting shaft 16a moves to the position of the foremost part of the bent long groove 12b, and the second connecting member 16 advances while rotating with respect to the cartridge 5. The 1st connection member 14 is inserted | pinched by the groove | channel 16e of the back side of the 2nd connection member 16, and the connection pin 13b hooks in the recessed part 14b (refer FIG. 4). In actual use, as shown in FIG. 5, the living tissue 44 is firmly held between the cartridge 5 and the anvil 6.

  As the parallel closing mechanism operates in the order of FIGS. 7 to 11, the second connecting member 16 approaches the first connecting member 14, and the distance L2 between the connecting shafts 14a-16a gradually decreases. Since the distance L1 between the connecting pins 13a-13b is constant, the anvil 6 is moved to a parallel position with respect to the cartridge 5 by displacing the distance L2.

On the other hand, when the anvil 6 shifts from the closed state to the fully opened state (initial state), the operation opposite to the operation described above, that is, a series of operations shown in FIGS. 11 to 7 is performed. The closing pipe 4 slides rearward, the pin 4b moves rearward on the upper surface of the second connecting member 16 (FIGS. 11 to 9), and urges the second connecting member 16 rearward by engaging with the groove 16c. (FIG. 8, FIG. 7). While the second connecting member 16 is rotating, the second connecting member 16 is also moved backward and moved back to the initial position as the connecting shaft 16a rotates and moves to the rearmost part along the bent long groove 12b. To do.
Since the distance L1 between the connecting pins 13a-13b is constant, the first connecting member 14 also rotates backward.
The anvil 6 is supported by the first connecting member 14 and moves upward, and retreats by the rotation angle of the first connecting member 14.

  The parallel closing mechanism of the stapling apparatus uses a four-bar linkage mechanism. Specifically, the first connecting member 14 corresponds to a crank that performs a rotational motion, and the second connecting member 16 corresponds to an insulator that performs a reciprocating motion. The anvil 6 corresponds to a connecting rod that transmits the movements of the first connecting member 14 and the second connecting member 16 to each other, and the cartridge holder 12 corresponds to a fixed frame.

Next, an operation mechanism of the stapling apparatus 1 will be described with reference to FIGS. 3, 6, and 12. FIG. 12 is an exploded perspective view of the vicinity of the operation unit of the stapling apparatus shown in FIG.
The knife 20 has an edge portion serving as a cutting edge at the tip. A cam bar adapter 23 is provided on the side opposite to the edge portion of the knife 20, that is, on the end portion in the direction of the operation portion 3. The cam bar adapter 23 is connected to the ends of the knife 20 and the cam bar 21 in the direction of the operation unit 3. An end of the cam bar adapter 23 in the direction of the operation unit 3 is connected to the cam bar rack 24, and a groove 15 that can be engaged with the lock lever 43 is provided on the upper surface of the other end of the cam bar rack 24. It has been. Teeth 24 a are provided on the lower surface of the intermediate portion of the cam bar rack 24, and the teeth 24 a mesh with the outer periphery of the gear 25.

  The gear 25 includes a small gear portion 25 a having a small radius that is coaxially interlocked. The teeth of the small gear portion 25 a mesh with teeth 26 a provided on the lower surface of the front portion of the firing rack 26. Teeth 26 b are also provided at the rear lower portion of the firing rack 26, and mesh with teeth 27 a provided at the upper portion of the staple driving lever 27. The staple driving lever 27 has a shape in which a lever portion protrudes from a substantially disc-shaped portion whose center is fixed to the center, and can rotate around a shaft 28b fixed to the casing 28 of the operation portion 3, and has an upper disk shape. The tooth 27a mentioned above is provided in a part of the part. The staple driving lever 27 is always urged in the opening direction by a winding spring 30 (see FIG. 3) provided near the shaft 28b.

  A cylindrical cap 31 is fixed to the boundary between the operation unit 3 and the insertion unit 2 so as to be rotatable with respect to the casing 28. The closing pipe 4 passes through the center of the cap 31 and extends to the inside of the operation unit 3. The end of the closing pipe 4 in the direction of the operation unit 3 is connected to the slider 32. The slider 32 is always urged in the direction of the operation unit 3 by a spring 29 (see FIG. 3) provided between the cap 31 and the slider 32. The other end side of the slider 32 is connected to the connecting member 34 by a pin, and the other end side of the connecting member 34 is connected to the closing lever 40 by a pin.

Closing lever 40 is provided rotatably around a shaft 2 8a fixed to the operating portion 3 of the casing 28. The shaft 28a is in the same position as the shaft 28b to which the staple driving lever 27 is fixed, but is not directly coupled to the staple driving lever 27, and the closing lever 40 and the staple driving lever 27 can be rotated separately. ing.
The closing lever 40 is composed of a cam portion having first and second cam surfaces 40a and 40b and an operation portion protruding substantially in the opposite direction. The first and second cam surfaces 40a and 40b are arranged in different shapes in the order of the outer side and the inner side in the axial direction of the closing lever 40, respectively. The first cam surface 40 a engages with the pre-release button 41, and the second cam surface 40 b engages with the release button 42.

  The pre-release button 41 is rotatably supported by a shaft 28c provided in the casing 28. The front end portion of the pre-release button 41 is engaged with an arc-shaped depression provided on the first cam surface 40 a of the closing lever 40. The other end of the pre-release button 41 can protrude to the outside of the casing 28, and the surface protruding to the outside is a portion that is pressed and operated by the user.

An intermediate portion of the release button 42 is rotatably supported on the same shaft 28c to which the pre-release button 41 provided on the casing 28 is fixed. Although it is the same axis | shaft 28c, the pre-release button 41 and the release button 42 are the separate bodies, and can respectively move independently. A notch in the front portion of the release button 42 engages with a notch of substantially the same shape provided on the second cam surface 40 b of the closing lever 40. Similar to the pre-release button 41, the other end of the release button 42 can protrude to the outside of the casing 28, and the surface protruding to the outside is a portion that is pressed and operated by the user.
More specifically, the notch of the second cam surface 40b forms a recess. When the notch at the front of the release button 42 is fitted in the center of the recess, the other end of the release button 42 is It protrudes out of the casing 28 and can be operated. However, if the closing lever 40 rotates in either the clockwise or counterclockwise direction and the notch of the release button 42 is released from this recess, the other end of the release button 42 does not protrude out of the casing 28. I can't do it.

The lock lever 43 is rotatably supported on a shaft 28c to which a pre-release button 41 provided on the casing 28 is fixed. The lock lever 43 is fitted into a recess 41a provided on the inner surface of the pre-release button 41 in the direction of the shaft 28c. The lock lever 43 and the pre-release button 41 can move independently. One end of the lock lever 43 is a protrusion that can be engaged with the groove 15 of the cam bar rack 24, and the other end abuts on one surface inside the recess 41 a of the pre-release button 41. Further, a leaf spring (not shown) is provided between the inside of the recess 41 a of the pre-release button 41 and the lock lever 43, and the lock lever 43 is urged in the direction of the groove 15.
When the pre-release button 41 protrudes from the casing 28 and is in the operable position, the other end of the lock lever 43 comes into contact with one surface inside the recess 41 a of the pre-release button 41 so that one end of the lock lever 43 is released from the groove 15. It has become.

The casing 28 is provided with a grip 46, and the grip 46, the lever portion of the closing lever 40, and the lever portion of the staple driving lever 27 are arranged in the direction from the operation portion 3 to the insertion portion 2.
When the anvil 6 is fully closed with respect to the cartridge 5, the tip portion of the prerelease button 41 rotates to the right, and the protrusion above the lock lever 43 contacts the inner surface of the recess of the prerelease button 41. 43 also rotates to the right, and one end of the lock lever 43 is released from the groove 15.

  Next, operation of the stapling apparatus 1 will be described with reference to FIGS. 3, 4, 13, and 14. As shown in FIG. 3, the anvil 6 is fully opened with respect to the cartridge 5, and the closing lever 40 and the staple driving lever 27 are in a direction away from the grip 46. The insertion part 2 of the stapling apparatus 1 in this state is inserted into the body. After confirming the affected part, the distal end of the insertion part 2 is moved to the place where it is desired to be excised and the closing lever 40 is operated in the direction of the grip 46. At this time, the connecting shaft 16a of the second connecting member 16 is located at the rearmost part of the bent long groove 12b.

FIG. 13 is a cross-sectional view showing a state in which the anvil 6 of the stapling apparatus shown in FIG. When the closing lever 40 is operated, the closing lever 40 rotates about a shaft 28 a fixed to the casing 28. A connecting member 34 connected by a pin in the vicinity of the cam portion is pushed out toward the insertion portion 2. The closing pipe 4 connected to the connecting member 34 via the slider 32 is also pushed out toward the insertion portion 2. The extruded closing pipe 4 urges the second connecting member 16 forward while pressing the second connecting member 16 with the pin 4b.

  The urged second connecting member 16 moves slightly forward while rotating by moving the connecting shaft 16a forward along the bent long groove 12b. Since the distance L1 between the connecting pins 13a-13b is constant, the first connecting member 14 rotates so as to fall forward about the connecting shaft 14a. Since the anvil 6 is connected to the first connecting member 14 and the second connecting member 16, the anvil 6 moves slightly forward so as to close in parallel from the top to the bottom with respect to the cartridge 5.

14 is a cross-sectional view in which the anvil 6 of the stapling apparatus shown in FIG. If the operating part of the closing lever 40 is further pulled from the state of FIG. 13, the connecting shaft 16a moves to the position of the foremost part of the bent long groove 12b, and the second connecting member 16 rotates to the horizontal position. Accordingly, the first connecting member 14 also rotates forward, and the anvil 6 connected to the first connecting member 14 and the second connecting member 16 performs parallel closing on the cartridge 5. In actual use, the living tissue is sandwiched between the anvil 6 and the cartridge 5 (see FIG. 5).
When the closing lever 40 is pulled down to the end, the closing lever 40 is locked, and the staple driving lever 27 becomes movable. In this state, if the staple driving lever 27 is operated, stapling to the affected area is performed. At the same time, the knife 20 advances through the knife slot and the guide groove 9 to cut the central portion of the living tissue 44 (see FIGS. 4 and 5).

As described above, according to the first embodiment, the anvil 6 performs parallel closure with respect to the cartridge 5 by applying the four-bar linkage mechanism, and the living tissue 44 is pressed and firmly fixed by the cartridge 5 and the anvil 6. Since it can be pinched, stapling can be performed stably.
Further, by adopting this structure, the opening / closing mechanism of the anvil 6 can be minimized, and accordingly, the diameter of the closing pipe 4 can be minimized. Therefore, it is possible to provide the stapling apparatus 1 that can use a thin trocar.
Further, by supporting the anvil 6 with two parts of the first connecting member 14 and the second connecting member 16, the posture of the anvil 6 is controlled.
Also, the second connecting member 16 is not a simple rotational movement, and the connecting shaft 16a is moved along the bending long groove 12b, so that the anvil 6 can be closed in parallel with the cartridge 5 in the latter half of the closing. . Since the anvil 6 is closed in parallel with the cartridge 5, a large gripping force is obtained. As a result, the living tissue is prevented from slipping between the cartridge and the anvil during stapling, and the living tissue is firmly clamped. Can do.
Further, when the closing pipe 4 rides on the second connecting member 16, it is possible to prevent the distance (gap) between the anvil 6 and the cartridge 5 from being widened by the load at the time of staple formation.

Embodiment 2. FIG.
The second embodiment of the present invention will be described below.
The stapling apparatus according to the second embodiment applies a four-joint parallel link mechanism. FIG. 15 is a cross-sectional view showing the operation of the parallel closing mechanism of the stapling apparatus according to Embodiment 2, and shows a fully open state (initial state). FIG. 16 is an exploded perspective view of the vicinity of the distal end portion of the insertion portion 2 in the stapling apparatus 1 shown in FIG. The configuration and operation of the insertion portion 2 shown in FIG. 16 are substantially the same as those of the stapling apparatus according to the first embodiment, and only the differences will be described below.

  15 and 16, the stapling apparatus 1 is provided with a long groove 12 c on the side wall of the cartridge holder 12 instead of the bent long groove 12 b shown in FIG. 4. Furthermore, a notch 12d is provided at a position slightly depressed from the tip of the long groove 12c. The notch 12d is for engaging at the foremost part when the connecting shaft 16a of the second connecting member 16 moves through the long groove 12c.

  Next, the operation of the parallel closing mechanism of the stapling apparatus 1 will be described with reference to FIGS. FIGS. 17-21 is sectional drawing which shows a series of operation | movement (parallel closing) from the fully open state of a parallel closing mechanism to a fully closed state. FIG. 17 is a cross-sectional view showing the operation of the parallel closing mechanism, and shows a fully open state (initial state). In addition, in order to make it easy to see, the 2nd connection member 16 is made into the side view instead of sectional drawing.

  In FIG. 17, in the initial state, the pin 4b is engaged with the groove 16c, and the protrusion 16b is engaged with the hole 4a. The first connecting member 14 rotates with the connecting shaft 14a as a fulcrum. Moreover, since the closing pipe 4 is urged rearward, the pin 4b also urges the protrusion 16b rearward. As a result, the anvil 6 connected to the second connecting member 16 and the first connecting member 14 connected to the anvil 6 are also urged rearward. Since the 1st connection member 14 stands | starts up and becomes a form which supports the anvil 6, the fully open state as shown in figure is formed. At this time, the connecting shaft 16a is located at the rearmost part of the long groove 12c.

FIG. 18 is a cross-sectional view showing the operation of the parallel closing mechanism following FIG. First, the closing pipe 4 is urged forward. Pin 4b, by pressing the inner wall of the anvil 6 side in the groove 16c, urges the second connecting member 16 forward. Accordingly, the connecting shaft 16a moves while rotating along the long groove 12c. As a result, the second connecting member 16 is inclined while moving forward.
Since the distance L1 between the connecting pins 13a-13b is constant, the connecting pin 13a also moves forward by the amount that the connecting pin 13b (second connecting member 16) has moved. That is, the first connecting member 14 rotates forward.
Accordingly, the anvil 6 is inclined with respect to the cartridge 5 with the connecting pins 13 a and 13 b as fulcrums, and moves forward by the rotation angle of the first connecting member 14. At this time, the connecting shaft 16a is at a substantially intermediate position of the long groove 12c.

FIG. 19 is a cross-sectional view showing the operation of the parallel closing mechanism following FIG. The closing pipe 4 is further slid forward from the state of FIG. The positional relationship between the pin 4b and the groove 16c is the same as in FIG. The protruding portion 16b slightly falls into the closing pipe 4 in a state of being hooked on the hole portion 4a.
The 1st connection member 14, the 2nd connection member 16, and the anvil 6 continue the operation | movement demonstrated in FIG. The connecting shaft 16a moves down to the foremost part of the long groove 12c and falls slightly, and engages with the notch 12d. At this point, the four points of the connecting pins 13a and 13b and the connecting shafts 14a and 16a form a parallelogram. In the parallelogram, since the side connecting the connecting pins 13a-13b and the side connecting the connecting shafts 14a-16a are parallel, the anvil 6 is also parallel to the cartridge holder 12 (cartridge 5).
Thereafter, the first connecting member 14 and the second connecting member 16 are inclined (rotated) forward by the same angle about the connecting shafts 14a and 16a, respectively. Accordingly, the rotational torques of the first connecting member 14 and the second connecting member 16 are equal.

FIG. 20 is a cross-sectional view showing the operation of the parallel closing mechanism following FIG. The closing pipe 4 is further slid forward from the state of FIG. The pin 4b urges the second connecting member 16 forward in a state of being hooked in the groove 16c.
Since the connecting shaft 16a is engaged with the notch 12d, the second connecting member 16 does not advance any further and further rotates forward. At the same time, the first connecting member 14 also rotates by the same angle as the second connecting member 16. The anvil 6 connected to the first connecting member 14 and the second connecting member 16 is lowered (approached) while maintaining a parallel state with respect to the cartridge 5.

FIG. 21 is a cross-sectional view showing the operation of the parallel closing mechanism continued from FIG. 20 and shows a fully closed state. The closing pipe 4 is further slid forward from the state of FIG. The pin 4b urges the second connecting member 16 forward as in FIG.
Since the connecting shaft 16a is engaged with the notch 12d, the second connecting member 16 further rotates and finally becomes parallel to the cartridge holder 12. At the same time, the first connecting member 14 also rotates by the same angle as the second connecting member 16. In that case, the front-end | tip part of the 2nd connection member 16 is hooked on the hollow-shaped curved part 14c provided in the rear-end part of the 1st connection member 14 (refer FIG. 16).
The anvil 6 is substantially grounded to the surface of the cartridge 5. In actual use, as shown in FIG. 5, the living tissue 44 is firmly held between the cartridge 5 and the anvil 6.
Further, since the second connecting shaft 16a is engaged with the notch portion 12d, it is possible to prevent the anvil 6 from being opened due to a load at the time of stapling.

As the parallel closing mechanism operates in the order of FIGS. 17 to 19, the second connecting member 16 approaches the first connecting member 14, and the distance L <b> 2 between the connecting shafts 14 a-16 a gradually decreases. Since the distance L1 between the connecting pins 13a-13b is constant, the anvil 6 is moved to a parallel position with respect to the cartridge 5 by displacing the distance L2.
At the time of FIG. 19, the distance L1 = L2 and the parallelogram having the connecting pins 13a and 13b and the connecting shafts 14a and 16a as vertices is completed, and the parallelogram rotates forward in the order of FIGS. As it moves, the anvil 6 closes parallel to the cartridge 5.

The state of FIGS. 19-21, ie, the state which changes only the angle (rotation angle), maintaining the parallelism of the said parallelogram, is equivalent to a 4-joint parallel link mechanism.
Accordingly, in the stages of FIGS. 19 to 21, since the rotational torques of the first connecting member 14 and the second connecting member 16 are equal, the force with which the anvil 6 presses the cartridge 5 becomes uniform.

  The starting point is the time when the connecting shaft 16 a is engaged with the notch 12 d, and the fully closed state of the anvil 6 with respect to the cartridge 5 is the end point. The forward turning angle of the first connecting member 14 (first connecting shaft 14a) and the second connecting member 16 (second connecting shaft 16a) between the start point and the end point is 20 ° or less. It is composed. Therefore, the amount of movement of the anvil 6 relative to the cartridge 5 is small, and the degree of rubbing the living tissue held between the two is reduced. The rotation angle is preferably 15 ° or less.

On the other hand, when the anvil 6 shifts from the closed state to the fully open state (initial state), the operation opposite to the operation described above, that is, a series of operations shown in FIGS. The closing pipe 4 slides backward, and the pin 4b engages with the groove 16c, thereby biasing the second connecting member 16 backward. While the second connecting member 16 is rotating, the second connecting member 16 is moved backward along the long groove 12c while rotating and the second connecting member 16 is also moved backward to retract to the initial position. .
Since the distance L1 between the connecting pins 13a-13b is constant, the first connecting member 14 also rotates backward.
The anvil 6 is supported by the first connecting member 14 and moves upward, and retreats by the rotation angle of the first connecting member 14.

Next, a measurement method and result of the gripping force of the staple device will be described.
First, at the start of measurement, the closing lever 40 of the stapling apparatus is pulled to the end to bring it into a locked state. At this time, the anvil 6 is fully closed as shown in FIG.
Next, the cartridge holder 12 is fixed to the jig, while the anvil 6 is not fixed.
Next, a tensile load is gradually applied to the fully closed anvil 6 in the direction of opening from the cartridge 5. Since the anvil 6 is not fixed, it gradually opens according to the magnitude of the tensile load. Then, the opening amount of the anvil 6 with respect to the cartridge 5 when the tensile load is increased is measured.

FIG. 22 is a diagram illustrating a measurement result of the gripping force of the stapling apparatus according to the second embodiment.
A tensile load applied to the anvil 6 in the direction in which the anvil 6 opens from the cartridge 5 is defined as P [kgf].
The clearance between the anvil 6 and the cartridge 5 when the tensile load P is applied is S [mm]. The gap S is 0 mm in the fully closed state, and becomes larger as the load P increases.
The opening amount from the horizontal state when the tensile load P is applied is S ′ [mm]. A case where the anvil 6 is in a horizontal state with respect to the cartridge 5 is set as a reference (± 0 mm) for the opening amount S ′. In the fully closed state, it is assumed that the anvil 6 is inclined to the cartridge 5 side by 2.20 mm (opening amount S ′ = − 2.20 mm) from the horizontal state with respect to the cartridge 5. That is, when the anvil 6 and the cartridge 5 are in the horizontal state, it is assumed that there is a gap S = 2.20 mm between them.

As shown in FIG. 22, even if the tip of the anvil 6 is pulled with a tensile load P = 10 kgf, the anvil 6 is tilted toward the cartridge 5 by 0.05 mm from the horizontal state (opening amount S ′ = − 0.05 m). That is, this measurement result means that the stapler used for measurement can output a gripping force of 10 kgf even when the anvil 6 is horizontal with respect to the cartridge 5.
The data in FIG. 22 is an example of the stapling apparatus according to the second embodiment, and does not define the gripping force of the stapling apparatus according to the present invention.

As described above, according to the second embodiment, in addition to the effects of the first embodiment, the pressure distribution when the anvil 6 presses the cartridge 5 becomes uniform by applying the four-node parallel link mechanism, A large gripping force can be obtained. As a result, it is possible to prevent the living tissue from slipping between the cartridge and the anvil during stapling, and to firmly hold the living tissue.
In addition, since the degree to which the living tissue is scraped between the anvil 6 and the cartridge 5 at the time of parallel closing is reduced, damage to the living tissue can be reduced.

  Although the stapling apparatus according to the present invention has the configuration as described above, the parallel closing mechanism can be applied to various other stapling apparatuses. For example, the present invention can be applied to a stapling apparatus that does not have a cutting mechanism such as a knife.

The first connecting member 14 may be changed from two to one on one side, or may be changed to a left-right integrated symmetrical structure such as the second connecting member 16.
Conversely, the second connecting member 16 may have a left and right separated structure like the first connecting member 14.

The shape of the bent long groove 12b or the long groove 12c is not limited to this, and may be another shape such as a diagonal line or a sine curve.
At that time, in order to prevent the living tissue from slipping toward the tip of the anvil 6 more effectively, the shape of the bent long groove 12b or the long groove 12c is changed so that the anvil 6 is closed with respect to the cartridge 5 from the tip. It is also possible to do.
Furthermore, by newly providing (folded) a long groove in the cartridge holder 12 that engages with the connecting shaft 14a of the first connecting member 14, the first connecting member 14 may also move along the (folded) long groove. it can.

It is a whole perspective view of the conventional stapling apparatus. 1 is an overall perspective view of a stapling apparatus according to Embodiment 1 of the present invention. FIG. 3 is a cross-sectional view in which the anvil 6 is fully opened with respect to the cartridge 5 in the stapling apparatus 1 of FIG. 2. FIG. 3 is an exploded perspective view of the vicinity of the distal end portion of the insertion portion 2 in the stapling apparatus 1 shown in FIG. 2. It is an expanded sectional view which shows a mode that the biological tissue is stapled using the stapling apparatus 1 of FIG. FIG. 3 is an exploded perspective view of the vicinity of an insertion portion 2 of the stapling apparatus 1 shown in FIG. 2. It is sectional drawing which shows operation | movement of the parallel closing mechanism of the stapling apparatus which concerns on Embodiment 1, and has shown the full open state (initial state). It is sectional drawing which shows operation | movement of the parallel closure mechanism following FIG. It is sectional drawing which shows operation | movement of the parallel closure mechanism following FIG. FIG. 10 is a cross-sectional view showing the operation of the parallel closing mechanism following FIG. 9. It is sectional drawing which shows operation | movement of the parallel closure mechanism following FIG. 10, and has shown the fully closed state. FIG. 3 is an exploded perspective view of the vicinity of an operation unit 3 of the stapling apparatus 1 shown in FIG. 2. FIG. 3 is a cross-sectional view of the stapling apparatus 1 shown in FIG. FIG. 3 is a cross-sectional view in which the anvil 6 is fully closed with respect to the cartridge 5 in the stapling apparatus 1 shown in FIG. 2. FIG. 4 is an overall perspective view of a stapling apparatus according to a second embodiment. FIG. 16 is an exploded perspective view of the vicinity of the distal end portion of the insertion portion 2 in the stapling apparatus 1 shown in FIG. It is sectional drawing which shows operation | movement of the parallel closing mechanism of the stapling apparatus which concerns on Embodiment 2, and has shown the full open state (initial state). It is sectional drawing which shows operation | movement of the parallel closure mechanism following FIG. It is sectional drawing which shows operation | movement of the parallel closure mechanism following FIG. It is sectional drawing which shows operation | movement of the parallel closure mechanism following FIG. It is sectional drawing which shows operation | movement of the parallel closing mechanism following FIG. 20, and has shown the fully closed state. FIG. 10 is a diagram illustrating a measurement result of gripping force of the stapling apparatus according to the second embodiment.

DESCRIPTION OF SYMBOLS 1 Staple apparatus 2 Insertion part 3 Operation part 4 Closing pipe 4a, 12a Hole part 4b Pin 5 Cartridge 5a Engagement protrusion 6 Anvil 6a Guide 7 Staple 8 Staple storage part 9 Guide groove 10 Staple holding member 11, 15, 16e Groove 12 Cartridge Holder 12b Bending long groove 12c, 16c Long groove 12d, 12e Notch portion 13a, 13b Connecting pin 14 First connecting member 14a, 16a Connecting shaft 14b, 41a Recessed portion 14c Bending portion 16 Second connecting member 16b Protruding portion 16d Stopper 20 Knife 21 Cam bar 23 Cam bar adapter 24 Cam bar rack 24a, 26a, 26b, 27a Teeth 25 Gear 25a Small gear part 26 Firing rack 27 Staple launch lever 28 Casing 28a, 28b, 28 Shaft 29 Spring 30 Winding spring 31 Cap 32 Slider 34 Connecting member 40 Closing lever 40a First cam surface 40b Second cam surface 41 Prerelease button 42 Release button 43 Lock lever 44 Biological tissue 46 Grip L1 13a-13b distance Distance between L2 14a-16a

Claims (9)

  1. In a stapling apparatus comprising: an insertion portion; and an operation portion connected to the insertion portion and having an anvil opening / closing means and a staple driving means.
    The insertion part is
    An anvil that opens and closes with respect to a cartridge containing staples;
    A cartridge holder for holding the cartridge;
    A first connecting shaft provided at one end is connected to the cartridge holder by engaging the cartridge holder through a hole, and the other end is connected to the anvil at a first connecting portion. ,
    A second connecting member is connected to the cartridge holder by engaging a second connecting shaft provided at one end with a groove formed in the cartridge holder, and the other end is connected to the anvil at a second connecting portion. When,
    A closing pipe that is connected to the anvil opening and closing means and is arranged behind the cartridge holder and is slidable back and forth;
    When the anvil opening / closing means is operated, the closing pipe slides to urge the second connecting member forward, and the urged second connecting member moves along the groove while rotating, The stapling apparatus is characterized in that the one connecting member rotates forward with the first connecting shaft as a fulcrum, and the anvil connected to the first connecting member and the second connecting member closes the cartridge in parallel. .
  2. The length between the first connecting portion and the first connecting shaft is equal to the length between the second connecting portion and the second connecting shaft,
    When the anvil is fully closed with respect to the cartridge, the length between the first connecting portion and the second connecting portion, and the length between the first connecting shaft and the second connecting shaft. The first connection portion, the second connection portion, the first connection shaft, and the second connection shaft form a vertex of a parallelogram. Staple device.
  3. A notch is provided at the forefront of the groove of the cartridge holder,
    When the anvil is fully closed with respect to the cartridge,
    The stapling apparatus according to claim 2, wherein the second connecting shaft is engaged with the notch.
  4.   The rotation angle of the second connecting shaft from when the second connecting shaft and the notch are engaged until the anvil is fully closed with respect to the cartridge is 20 ° or less. The stapling apparatus according to claim 3.
  5. The closing pipe is provided with a hole in its upper surface;
    The stapling apparatus according to claim 1, wherein a protrusion provided on the second connecting member engages with the hole.
  6.   A pin is provided in a front direction of the hole of the closing pipe in a direction perpendicular to the axis of the closing pipe, and the pin is hooked in a groove provided in front of the protrusion of the second connecting member. The stapling apparatus according to claim 5.
  7.   A staple holding member provided in the vicinity of a staple storage portion in the cartridge when a cam bar extending from the operation portion toward the insertion portion is connected to the staple driving lever and the staple driving means is operated. 2. The stapling apparatus according to claim 1, wherein the staple is pushed out to drive out staples.
  8.   8. The knife according to claim 7, wherein a knife extending from the operation portion toward the insertion portion is connected to the staple driving means together with the cam bar, and slides forward when the staple driving means is operated. Stapling device.
  9. The anvil is provided with guides protruding downward on both side surfaces,
    2. The stapling apparatus according to claim 1, wherein the guide is positioned on both sides of the cartridge holder when the anvil is closed with respect to the cartridge.
JP2009519074A 2006-11-06 2007-10-29 Staple device Active JP5021028B2 (en)

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US9855040B2 (en) 2015-03-04 2018-01-02 Covidien Lp Surgical stapling loading unit having articulating jaws
CN105919640B (en) * 2016-05-30 2018-07-27 杭州天任生物科技有限公司 Endo-GIA under the hysteroscope of one-part form propulsion, backing mechanism and its composition
US20190298352A1 (en) * 2018-03-28 2019-10-03 Ethicon Llc Surgical stapling devices with improved rotary driven closure systems

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WO2008056618A3 (en) 2008-10-02
WO2008056618A2 (en) 2008-05-15

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