JP2010536398A - 治療用処置具 - Google Patents
治療用処置具 Download PDFInfo
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical 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
- A61B17/07207—Surgical 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
- A61B18/082—Probes or electrodes therefor
- A61B18/085—Forceps, scissors
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical 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
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
- A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
- A61B2018/00023—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids closed, i.e. without wound contact by the fluid
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/0063—Sealing
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1467—Probes or electrodes therefor using more than two electrodes on a single probe
Abstract
【選択図】 図3
Description
この発明の第2の態様における、生体組織を治療するための治療用処置具は、少なくとも2つの生体組織を保持するための保持面をそれぞれ有する1対の保持部材と、前記1対の保持部材の少なくとも一方が他方に対して相対的に移動するように操作させるハンドルと、前記保持面の少なくとも一方に配置され、前記少なくとも2つの生体組織同士を封止するとともに、その封止させた部位の近傍で生体組織同士の接触を維持させるための出力部とを具備する。
第1の実施の形態について図1(a)ないし図7を用いて説明する。ここでは、治療用処置具として、例えば腹壁を通して処置を行うための、リニアタイプのバイポーラ型高周波処置具12を例にして説明する。
図1(a)および図1(b)に示すように、治療処置システム10は、高周波処置具(治療用処置具)12と、エネルギ源14とを備えている。
高周波処置具12は、ハンドル22と、シャフト24と、開閉可能な保持部26とを備えている。ハンドル22には、ケーブル28を介してエネルギ源14が接続されている。エネルギ源14には、図示しないが、フットスイッチやハンドスイッチが接続されている。このため、これらフットスイッチやハンドスイッチを術者が操作することにより、エネルギ源14から高周波処置具12へのエネルギの供給のON/OFFが切り換えられる。
一方、ハンドル22の他端側は、術者に把持される把持部である。ハンドル22は、その他端側に並設されるように、保持部開閉ノブ32を備えている。この保持部開閉ノブ32は、ハンドル22の略中央の部分でシャフト24の後述するシース44(図2(a)および図2(b)参照)の基端に連結されている。この保持部開閉ノブ32をハンドル22の他端に対して近接および離隔させると、シース44がその軸方向に沿って移動する。ハンドル22は、さらに、保持部開閉ノブ32に並設された状態で、後述するカッタ84を移動させるためのカッタ駆動ノブ34を備えている。
筒体42の外側には、その軸方向に沿って凹部46が形成されている。この凹部46には、後述する第1の高周波電極(出力部)56に接続される第1の通電ライン92aが配設されている。筒体42の内部には、後述する第2の高周波電極(出力部)58に接続される第2の通電ライン92bが挿通されている。
なお、カッタ84の長溝84bの一端、他端および一端と他端の間には、移動規制ピン86を係止し、カッタ84の移動を制御するための係止部84cが形成されている。
第1の保持部材52および第2の保持部材54は、それぞれ全体的に絶縁性を有することが好適である。第1の保持部材52は、第1の高周波電極56が配設される第1の保持部材本体(以下、主に本体という)62と、この本体62の基端部に設けられた基部64とを一体的に備えている。第2の保持部材54は、第2の高周波電極58が配設される第2の保持部材本体66と、この本体66の基端部に設けられた基部68とを一体的に備えている。
連続電極56aは、例えば略U字状に、第1の保持部材52の本体62の基端部に2つの端部を有するように連続的に形成されている。なお、この実施の形態では、連続電極56aの基端部の間隔は、後述するカッタ案内溝94の幅程度である(図3(a)および図3(c)参照)が、連続電極56aの基端部の間隔は、適宜に設定可能である。すなわち、カッタ案内溝94の縁部から離れた位置に連続電極56aが設けられていても良い。
一方、複数の離散電極56bは、略U字型の仮想的な軌跡に沿って、略等間隔に同形状のものが配設されている。離散電極56bは、例えば円形状に形成されている。離散電極56b同士は、互いに対して略所定の間隔に配設され、かつ、各離散電極56bは、連続電極56aに対しても適当な距離だけ離間した位置に配設されている。離散電極56bの位置は、処置を行ったときに、後述する離散電極58b間との間の生体組織が熱により変性することを許容するが、離散電極56b同士の間の生体組織が熱により変性することを極力防止するとともに、離散電極56bと連続電極56aとの間の生体組織の熱による変性を極力防止した位置にある。
なお、図示しないが、第2の高周波電極58の連続電極には便宜的に符号58aを付し、離散電極には符号58bを付して以下の作用について説明する。
図2(a)に示すように、第1の保持部材52に対して第2の保持部材54を閉じた状態で、例えば、腹壁を通して腹腔内に高周波処置具12の保持部26およびシャフト24を挿入する。高周波処置具12の保持部26を処置対象の生体組織に対して対峙させる。
保持部26の第1および第2の保持部材52,54で処置対象の生体組織を保持する(挟持する)ため、ハンドル22の保持部開閉ノブ32を操作する。このとき、筒体42に対してシース44をシャフト24の基端部側に移動させる。弾性部材74の付勢力によって、基部64,68間を筒状に維持することができなくなり、第1の保持部材52に対して第2の保持部材54が開く。
第1および第2の保持部材52,54の保持面62a,66aで、並設させた状態の1対の腸管IC1,IC2を、両腸管IC1,IC2の壁面を挟み込むように保持する。この状態で、第1および第2の高周波電極56,58にそれぞれエネルギを供給する。すると、第1の保持部材52の連続電極56aと第2の保持部材54の連続電極58aとの間に挟持した腸管IC1,IC2同士を加熱して変性させる。このため、腸管IC1,IC2の壁面同士が連続的に変性される。したがって、腸管IC1,IC2同士が接合される。
第1および第2の保持部材52,54の保持面62a,66aに連続電極56a,58aおよび離散電極56b,58bをそれぞれ配置した。そして、第1の保持部材52の連続電極56aと第2の保持部材54の連続電極56aとの間の生体組織(例えば腸管IC1,IC2同士)を加熱して変性させて連続的に接合させることができる。このため、例えば管状などの生体組織を密着させたりシールすることができる。さらに、第1の保持部材52の離散電極56bと第2の保持部材54の離散電極58bとの間の生体組織(例えば腸管IC1,IC2同士)を加熱して変性させて生体組織同士を接合させることができる。すなわち、生体組織同士を離散的に接合することができる。
この実施の形態では、図3(a)に示すように、略U字型の連続電極56aの外側の、略U字型の仮想的な軌跡上に、離散電極56bを等間隔に配置する例について説明した。離散電極56bは、その他、図5(a)に示すように、ジグザグ状の頂点の位置に配置されていることも好適である。すなわち、離散電極56bは、2列に配設されていることも好適である。この場合の離散電極56b間の配置や距離も、連続電極56aの出力の大きさや、離散電極56b自体の生体組織に対する面積などにより適宜に決められる。
図5(b)に示すように、矩形状の離散電極56bを円形状の電極の代わりにジグザグ状に配置することも好適である。その他、離散電極56bの配置は、ランダムなど、種々の変更が許容される。離散電極56bの形状も、楕円状や菱形、多角形など、種々の変更が許容される。
また、図示しないが、モノポーラ型の高周波処置具を用いる場合、第1の保持部材52および第2の保持部材54の一方だけに高周波電極が配設されていることも好適である。
次に、第2の実施の形態について図8ないし図9(b)を用いて説明する。この実施の形態は第1の実施の形態の変形例であって、第1の実施の形態で説明した部材と同一の部材には同一の符号を付し、詳しい説明を省略する。
図8に示すように、略U字状の連続電極56aの外側には、連続電極56aから枝分かれした複数の枝電極(維持部材、第2の接合部材)56cが一体的に形成されている。これら枝電極56cは、連続電極56aの軸方向に対して直交する方向に延出されている。すなわち、この実施の形態では、第1の実施の形態で説明した離散電極56bの代わりに枝電極56cが配設されている。
なお、各枝電極56cの長さや幅(太さ)、更には、枝電極56c同士の間隔や数は、適宜に設定される。図8中では、連続電極56aの太さは、枝電極56cの太さに比べて太く描かれているが、同じ太さであったり、枝電極56cの方が太かったりすることも許容される。
図9(a)に示すように、第1の保持部材52の本体62の最も先端側(基部64に対して離隔した側)の枝電極(維持部材、第2の接合部材)56dは、図8に示す第1の保持部材52の本体62の最も先端側の枝電極56cに対して変形されている。すなわち、第1の変形例における図9(a)に示す枝電極56dは、図8に示す第1の保持部材52の本体62の最も先端側の枝電極56cに比べて長く形成されている。
したがって、腸管IC1,IC2に加えられる力F2に対する耐性を増加させることができるので、腸管IC1,IC2の吻合が解除され難い状態にすることができる。
図9(b)に示すように、第1の保持部材52の枝電極(維持部材、第2の接合部材)56eは、図8に示す第1の保持部材52の枝電極56cに対して変形されている。第2の変形例における枝電極56eは、連続電極56aの軸方向(略U字型の仮想的な軌跡)に対して直交する方向ではなく、斜めに配設されている。この第2の変形例の場合、各枝電極56eは、例えば、基端側に向かって延出されている。
これは、例えば腸管IC1,IC2を吻合したときに、連続電極56aで変性させた部位の先端、すなわち、腸管IC1,IC2同士が二股に分かれる部位Biから腸管IC1,IC2同士の吻合を解除するように力F2が働いた場合に、腸管IC1,IC2同士を接合する接合力を増して、その吻合の解除を防止するためである。
次に、第3の実施の形態について図10ないし図11(b)を用いて説明する。この実施の形態は第1および第2の実施の形態の変形例であって、第1および第2の実施の形態で説明した部材と同一の部材には同一の符号を付し、詳しい説明を省略する。
図10に示すように、第1の保持部材52には、略方形波状の連続的な高周波電極56が配設されている。ここで、図10中の符号56gで示す部分の電極は、第1および第2の実施の形態で説明した連続電極56a(図3(a)参照)と同様に、カッタ案内溝94の縁部に沿って配設されている。すなわち、電極56gは、略U字状の軌跡上に配置されている。しかし、電極56gは、連続電極56aとは異なり、不連続に配設されている。
さらに、図10中の符号56iで示す部分の電極は、電極56hの延出された端部同士を接続する状態に配設されている。そして、電極56iも、電極56g,56hと同様に、不連続に配設されている。すなわち、電極56iは、第1の実施の形態で説明した離散電極56b(図3(a)参照)と同様に、略U字状の軌跡上に互いに離間した状態に配設されている。
一方、電極56hは、図8中に示す枝電極56cと同様に互いに離間している。このため、電極56hは、連続電極の一部をなすとともに、枝電極としての作用を有するものである。さらに、電極56iは、連続電極の一部をなすとともに、互いに離間した状態に不連続に形成されているので、離散電極としての作用を有するものである。
すなわち、これら電極56h,56iは、それぞれ、連続電極の作用による生体組織LTの連続的な変性による接合に加えて、図3(a)に示す離散電極56bや図8に示す枝電極56cと同様の作用により生体組織LT同士を引き寄せて密着させておくために用いられる。
第3の実施の形態では連続的に略方形波状の高周波電極56が配設されているものとして説明したが、図11(a)に示すように、略サインカーブ状に形成されていることも好適である。図11(a)に示すように、高周波電極56が略サインカーブ状に形成されている場合、符号56jで示す略サインカーブのボトムの位置(カッタ案内溝94に近接する位置)の電極は、第3の実施の形態で説明した電極56gの代わりとして作用する。
同様に、電極56lで示す略サインカーブのトップの位置(カッタ案内溝94から離隔する位置)の電極は、第3の実施の形態で説明した電極56iの代わりとして作用する。
図11(b)に示すように、この変形例は、第3の実施の形態で説明した符号56oで示す部分(図8に示す枝電極56cに相当する部分)の電極が、第3の実施の形態で説明した図10に示す電極56hに対して斜めに形成されて、より長く形成されている。これは、例えば図4(a)に示すように腸管IC1,IC2を吻合したときに、高周波電極56で変性させた部位の先端から腸管IC1,IC2同士が二股に分かれる部位Biに腸管IC1,IC2同士の吻合を解除するように力が働いた場合に、その吻合の解除を防止するため、すなわち、腸管IC1,IC2同士を接合する接合面積を増して接合力を増すためである。したがって、第2の変形例の電極56oは、図10に示す電極56hよりもその腸管IC1,IC2に対する接触面積が増加するため、その腸管IC1,IC2同士の接合力を増すことができる。
次に、第4の実施の形態について図12(a)ないし図14(c)を用いて説明する。この実施の形態は第1の実施の形態の変形例であって、第1の実施の形態で説明した部材と同一の部材には同一の符号を付し、詳しい説明を省略する。
図12(a)に示す高周波処置具12のシャフト24の筒体42およびシース44には、それぞれ後述する蒸気(気体)や液体(組織液)などの流体が放出される流体放出口48a,48bが形成されている。これら流体放出口48a,48bは、シャフト24の基端側に形成されている。
図13(a)に示すように、連続電極56aおよび離散電極56bは、図3(a)に示す第1の実施の形態と略同じ位置に配設されている。
第1の実施の形態で説明したように、処置対象の生体組織LTを第1の保持部材52と第2の保持部材54との間で保持する。このとき、障壁部98が生体組織LTに密着するとともに、生体組織LTが第1の高周波電極56および第2の高周波電極58に接触する。
第1の実施の形態で説明した効果と同様の効果については、記述を省略する。
高周波処置具12により、保持部26で狭持した処置対象の生体組織LTに高周波電流を与えるときに、障壁部98を密着させることによって、処置対象の生体組織LTから発生する流体が、第1の保持部材52の障壁部98に向かって流れても、その流体を第1および第2の高周波電極56,58の第1および第2の流体放出溝94a,94bおよび連通路94c内に導入することができる。
図14(a)および図14(b)に示すように、流体放出溝94a,94bを連通する連通路(第1の連通路)94cは、管路として形成されている。このため、各連通路94cは、それぞれ本体62の内部に形成されている。
図14(c)に示すように、第1の連通路94cは、第1の変形例と同様に、管路として形成されている。この第1の連通路94cには、カッタ案内溝94にも連通された管路状の第2の連通路94dが形成されている。
次に、第5の実施の形態について図15を用いて説明する。この実施の形態は、第2および第4の実施の形態の変形例であって、第2および第4の実施の形態で説明した部材と同一の部材には同一の符号を付し、詳しい説明を省略する。
図15に示すように、高周波電極56の外側には、流体放出溝94eが形成されている。さらに、流体放出溝94eの外側の縁部には、障壁部98が形成されている。ここで、障壁部98は、保持面62aに対して突出されている。
この実施の形態に係る治療処置システム10の作用および効果については、第4の実施の形態で説明した作用および効果と同様であるので、説明を省略する。
次に、第6の実施の形態について図16(a)ないし図16(d)を用いて説明する。この実施の形態は第1および第4の実施の形態の変形例であって、第1および第4の実施の形態で説明した部材と同一の部材には同一の符号を付し、詳しい説明を省略する。
図16(b)に示すように、蒸気放出溝94a,94bを連通する連通路94cは、図14(c)に示す状態と同様に、管路として形成されている。さらに、蒸気放出溝94aとカッタ案内溝94とを連通する連通路94dも、管路として形成されている。
第1の実施の形態で説明したように、処置対象の生体組織LTを第1および第2の保持部材52,54の間で保持する。このとき、障壁部98a,98bが生体組織LTに密着するとともに、生体組織LTが第1および第2の高周波電極56,58に接触する。さらに、第1および第2の保持部材52,54の本体62,66に設けられた冷却板104に生体組織LTが密着する。
この実施の形態に係る治療処置システム10の、第1および第4の実施の形態と同じ効果については、その説明を省略する。
高周波処置具12により、保持部26で保持した処置対象の生体組織LTに高周波電流を与えるときに、第1および第2の保持部材52,54の障壁部98a,98bをそれぞれ生体組織LTに密着させることができる。このため、処置対象の生体組織LTから発生する流体が、第1および第2の保持部材52,54の障壁部98a,98bに向かって流れても、その流体を、連続電極56aと障壁部98aとの間の流体放出溝94a、離散電極56bと障壁部98bとの間の流体放出溝94bを通してカッタ案内溝94内に導入して、高周波処置具12の外部に排出することができる。
図16(c)に示すように、冷却パイプ102は除去されている。その代わりに、本体62および基部64には、一体的に溝状のダクト112a,112bが形成されている。
図16(d)に示すように、冷却パイプ102は除去されている。その代わりに、本体62および基部64には、一体的に溝状の第1および第2のダクト112a,112bが形成されている。第1および第2のダクト112a,112bは、第1の保持部材52のカッタ案内溝94の中心軸に対して対称的にそれぞれ1対形成されている。それぞれ1対の第1および第2のダクト112a,112bのうち、一方が冷却水などの冷媒流入用であり、他方が冷媒流出用である。
次に、第7の実施の形態について図17(a)ないし図18を用いて説明する。この実施の形態は第1の実施の形態の変形例であって、第1の実施の形態で説明した部材と同一の部材には同一の符号を付し、詳しい説明を省略する。
図17(a)に示すように、第1の保持部材52からは、離散電極56b(図3(a)参照)が除去され、その代わりにサージカルステープル(維持部材、第2の接合部材、出力部)132を放出するための複数のスロット、すなわちスリット134が形成されている。複数のスロット134は、カッタ案内溝94を挟んで両側に、かつ、連続電極56aの外側に、例えば2列に配置されている。図18に示すように、これらスロット134には、傾斜面136aを有するステープルプッシャ136が進退自在に収納されている。ステープルプッシャ136の上面には、ステープル132が1つずつ脚部132aを第2の保持部材54の方向に向け、かつ、第2の保持部材54の保持面66aの方向に突出可能に収納されている。第1の保持部材52の内部には、ステープルプッシャ136に対向してプレートガイド溝138が形成されている。プレートガイド溝138には、ステープルプッシャ136の傾斜面136aと同様に傾斜された傾斜面140aを有する作動スレッド140がスライド可能に配設されている。作動スレッド140は、カッタ84および駆動ロッド82に並設された状態に配置され、カッタ84および駆動ロッド82に略平行に駆動されるステープル操作部(図示せず)により、カッタ駆動ノブ34と同様に、ハンドル22によりその移動を操作可能である。したがって、第1の保持部材52は、ステープル132のカートリッジとしての機能をも有する。
第1の実施の形態で説明したように、処置対象の生体組織LTを第1の保持部材52と第2の保持部材54との間で保持する。このとき、生体組織LTが第1および第2の高周波電極56,58の連続電極56a,58aに接触する。
第1および第2の保持部材52,54の保持面62a,66aに連続電極56a,58aをそれぞれ配置した。このため、第1の保持部材52の連続電極56aと第2の保持部材54の連続電極56aとの間の生体組織(例えば腸管IC1,IC2)LT同士を加熱して変性させることにより、生体組織LT同士を連続的に接合させることができる。したがって、例えば管状などの生体組織LTを密着させたり封止させることができる。
次に、第8の実施の形態について図19を用いて説明する。この実施の形態は第1および第7の実施の形態の変形例であって、第1および第7の実施の形態で説明した部材と同一の部材には同一の符号を付し、詳しい説明を省略する。
図19に示すように、第1の実施の形態(図3(a)参照)に対して、第1の保持部材52からは連続電極56aが除去され、その代わりにステープル132が放出されるスロット134が配設されている。すなわち、第1の保持部材52の保持面62aには、ステープル(封止部材、出力部、第1の接合部材)132がそれぞれ配設された複数のスロット134が形成されている。例えば円形状の離散電極56bは配設されたままである。
第1の実施の形態で説明したように、処置対象の生体組織LTを第1の保持部材52と第2の保持部材54との間で保持する。このとき、生体組織LTが第1および第2の高周波電極56,58の離散電極56b,58bに接触する。
第1の保持部材52の離散電極56bの内側のスロット134からステープル132を放出し、第2の保持部材54の離散電極58bの内側のステープル変形溝142でステープル132の1対の脚部132aをそれぞれ内側に折り曲げるように形成した。このため、ステープル132によって、生体組織LTを略隙間無く連続的かつ機械的に接合することができる。
次に、第9の実施の形態について図20ないし図21(d)を用いて説明する。この実施の形態は、第1の実施の形態の変形例である。
ここでは、エネルギ処置具として、例えば腹壁を通して、もしくは腹壁外で処置を行うための、サーキュラタイプのバイポーラ型高周波処置具(治療用処置具)12bを例にして説明する。
シャフト204の先端には、保持部206が配設されている。図21(a)および図21(b)に示すように、保持部206は、シャフト204の先端に形成された本体側保持部(第1の保持部材)222と、この本体側保持部222に着脱可能な離脱側保持部(第2の保持部材)224とを備えている。本体側保持部222に対して離脱側保持部224が閉じた状態では、本体側保持部222および離脱側保持部224の保持面222a,224aが互いに対して対向している。
図21(b)に示すように、本体側挟持部222を離脱側挟持部224に対して閉じた状態で例えば腹壁を通して腹腔内に高周波処置具12bの挟持部206およびシャフト204を挿入する。高周波処置具12bの本体側挟持部222と、離脱側挟持部224とを処置したい生体組織に対して対峙させる。
本体側挟持部222および離脱側挟持部224に連続電極254a,274aおよび離散電極254b,274bを配置した。そして、本体側挟持部222の連続電極254aと離脱側挟持部224の連続電極274aとの間の生体組織LTを加熱して変性させて接合させることができる。このため、生体組織LT同士を略円環状に封止することができる。さらに、本体側挟持部222の離散電極254bと離脱側挟持部224の離散電極274bとの間の生体組織LTを加熱して変性させて接合させることができる。このため、生体組織LT同士を離散的に接合することができる。
次に、第10の実施の形態について図22(a)を用いて説明する。この実施の形態は、第2、第3および第9の実施の形態の変形例である。
図22(a)に示すように、連続電極254aの外側には、枝電極(維持部材、第2の接合部材)254cが一体的に形成されている。枝電極254cは、連続電極254aの軸方向(円周方向)に対して直交する方向(径方向外方)に延出されている。すなわち、この実施の形態では、第8の実施の形態で説明した離散電極254bの代わりに枝電極254cが配設されている。
次に、第11の実施の形態について図22(b)を用いて説明する。この実施の形態は、第9および第10の実施の形態の変形例である。
図22(b)に示すように、本体側挟持部222には、略方形波状の連続的な高周波電極254が配設されている。ここで、図22(b)中の符号254dで示す部分の電極は、第9および第10の実施の形態で説明した連続電極254aと同様に、カッタ案内溝246の外側の縁部に沿って配設されている。しかし、電極254dは、連続電極254aとは異なり、不連続に配設されている。図22(b)中の符号254eで示す部分の電極は、第10の実施の形態で説明した枝電極254c(図22(a)参照)と同様に、電極254dに対して直交する方向に同じ長さだけ延出されている。さらに、図22(b)中の符号254fで示す部分の電極は、電極254eの延出された端部同士を接続する状態に配設されている。そして、電極254fも、電極254dと同様に、不連続に配設されている。
このため、第3の実施の形態の変形例を示す例えば図11(a)や図11(b)などのように、電極254は、種々の変形が許容される。
次に、第12の実施の形態について図23(a)ないし図23(c)を用いて説明する。この実施の形態は、第4ないし第6、第9ないし第11の実施の形態の変形例である。
図23(a)ないし図23(c)に示すように、第1の高周波電極254の連続電極254aの外側には、円環状に蒸気放出溝256aが形成されている。この流体放出溝256aは、カッタ242が配設された第1の流体通気路246aに連通されている。この流体放出溝256aの外側には、連続電極254aの表面よりも高い位置に障壁部258aが形成されている。すなわち、本体側挟持部222の障壁部258aは、連続電極254aの表面よりも離脱側挟持部224のヘッド部264に近接されている。
なお、障壁部258a,258bの表面は、略面一である。
なお、障壁部278a,278bの表面は、略面一である。
この実施の形態に係る治療処置システム10の、第9の実施の形態と同じ作用については、その説明を省略する。
この状態で、フットスイッチやハンドスイッチを操作する。エネルギ源14からケーブル28を介して第1の高周波電極254および第2の高周波電極274にそれぞれエネルギが供給される。
この実施の形態に係る治療処置システム10の、第9の実施の形態と同じ効果については、その説明を省略する。
高周波処置具12bにより、挟持部206で狭持した処置対象の生体組織に高周波電流を与えるときに、本体側挟持部222の障壁部258a,258bと離脱側挟持部224の障壁部278a,278bとをそれぞれ生体組織に密着させることができる。このため、処置対象の生体組織から発生する流体が、本体側挟持部222の障壁部258a,258bおよび離脱側挟持部224の障壁部278a,278bに向かって流れても、その流体を第1の高周波電極254の連続電極254aと障壁部258aとの間の蒸気放出溝256aを通し、離散電極254bと障壁部258bとの間の蒸気放出溝256bを通してそれぞれ第1の流体通気路246a内に導入することができる。さらに、第2の高周波電極274の連続電極274aと障壁部278aとの間の蒸気放出溝276aを通し、離散電極274bと障壁部278bとの間の蒸気放出溝276bを通して第2の蒸気通気路246b内に導入することができる。
次に、第13の実施の形態について図24(a)ないし図24(c)を用いて説明する。この実施の形態は、第7ないし第9、第12の実施の形態の変形例であって、第7ないし第9、第12の実施の形態で説明した部材と同一の部材には同一の符号を付し、詳しい説明を省略する。
図24(a)および図24(b)に示すように、本体側保持部222からは、第9の実施の形態で説明した複数の離散電極254b(図21(d)参照)が除去され、その代わりにサージカルステープル(維持部材、第2の接合部材、出力部)282を放出するための複数のスロット284が形成されている。複数のスロット284は、連続電極254aの外側に、例えば連続電極254aと略同心状の略円環状の軌跡上に適当な間隔ごとに形成されている。
第9の実施の形態で説明したように、処置対象の生体組織LTを本体側保持部222と離脱側保持部224との間で保持する。このとき、生体組織LTが連続電極254a,274aに接触する。
本体側保持部222および離脱側保持部224に連続電極254a,274aをそれぞれ配置し、かつ、本体側保持部222の連続電極254aの外側のスロット284からステープル282を放出し、離脱側保持部224の連続電極274aの外側のステープル変形溝292でステープル282の1対の脚部をそれぞれ内側に折り曲げるように形成した。そして、本体側保持部222の連続電極254aと離脱側保持部224の連続電極274aとの間の生体組織LT同士を加熱して変性させることにより、生体組織LT同士を連続的に接合させることができる。このため、生体組織LT同士を密着させたり封止させることができる。さらに、ステープル282によって、生体組織LTを連続的に接合した部位の外側の近傍を離散的に機械的に接合することができる。
Claims (15)
- 生体組織を治療するための治療用処置具であって、
少なくとも2つの生体組織同士の所望の領域を封止した状態に接合するための封止部材と、
前記封止部材により接合された部位の近傍の組織を接触させた状態に維持する維持部材と
を具備することを特徴とする治療用処置具。 - 前記維持部材は、前記少なくとも2つの生体組織に機械的/物理的作用を与えるために互いに離間して配置された複数の部材を有することを特徴とする請求項1に記載の治療用処置具。
- 前記封止部材は、前記少なくとも2つの生体組織に機械的/物理的作用を与えるために連続した部材を有し、
前記維持部材は、前記少なくとも2つの生体組織に機械的/物理的作用を与えて前記生体組織同士を接触させた状態を維持するために、不連続な複数の部材を有することを特徴とする請求項1に記載の治療用処置具。 - 前記封止部材および前記維持部材は、高周波、ヒータ、ステープルの少なくとも1つにより前記生体組織を封止させ、生体組織の接触を維持させる部材を備えていることを特徴とする請求項1ないし請求項3のいずれか1に記載の治療用処置具。
- 前記封止部材および前記維持部材は、前記少なくとも2つの生体組織を保持するための1対の保持部材の少なくとも一方に配設されていることを特徴とする請求項1ないし請求項3のいずれか1に記載の治療用処置具。
- 生体組織を治療するための治療用処置具であって、
少なくとも2つの生体組織を保持するための保持面をそれぞれ有する1対の保持部材と、
前記1対の保持部材の少なくとも一方が他方に対して相対的に移動するように操作させるハンドルと、
前記保持面の少なくとも一方に配置され、前記少なくとも2つの生体組織同士を封止するとともに、その封止させた部位の近傍で生体組織同士の接触を維持させるための出力部と
を具備することを特徴とする治療用処置具。 - 前記出力部は、
前記保持面の少なくとも一方に配置され、前記生体組織同士を封止した状態に接合する第1の接合部材と、
前記第1の接合部材の近傍に設けられ、前記第1の接合部材で接合させた生体組織の周囲の生体組織の接触を維持させるために離散的に配設された第2の接合部材と
を有することを特徴とする請求項6に記載の治療用処置具。 - 前記第1の接合部材は、前記保持面の少なくとも一方に配置された電極を備え、
前記第2の接合部材は、前記保持面の少なくとも一方に配置された複数の電極を備えていることを特徴とする請求項7に記載の治療用処置具。 - 前記第1の接合部材は、前記保持面の少なくとも一方に配置された電極を備え、
前記第2の接合部材は、前記第1の接合部材の電極から分岐した複数の電極を備えていることを特徴とする請求項7に記載の治療用処置具。 - 前記出力部に隣接して設けられた少なくとも1つの障壁部をさらに具備し、
前記障壁部は、前記出力部に対して同一またはそれよりも高い位置にあることを特徴とする請求項6ないし請求項9のいずれか1に記載の治療用処置具。 - 前記保持部材は、前記出力部の近傍に設けられ、前記保持部材により保持された生体組織から発生される流体を通過させる流路、すなわち、溝や管路を備えていることを特徴とする請求項6ないし請求項9のいずれか1に記載の治療用処置具。
- 前記第1の接合部材は、高周波、ヒータ、ステープルの少なくとも1つにより前記生体組織を封止させる部材であり、
前記第2の接合部材は、高周波、ヒータ、ステープルの少なくとも1つにより前記生体組織を離散的に接合させる部材であることを特徴とする請求項7に記載の治療用処置具。 - 前記ステープルを用いる場合、前記1対の保持部材のうち、一方の保持部材には前記ステープルが突出するためのスリットが配設され、他方の保持部材の保持面には、前記ステープルの脚部を変形させる変形溝が配設されていることを特徴とする請求項12に記載の治療用処置具。
- 前記第1の接合部材および前記第2の接合部材は、前記保持面の少なくとも一方に連続した状態に配置されていることを特徴とする請求項7に記載の治療用処置具。
- 前記出力部は、前記保持面の少なくとも一方に、連続した波形に形成されていることを特徴とする請求項6に記載の治療用処置具。
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US11/838,403 US20090048589A1 (en) | 2007-08-14 | 2007-08-14 | Treatment device and treatment method for living tissue |
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EP (1) | EP2178455B1 (ja) |
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US11684411B2 (en) | 2015-11-25 | 2023-06-27 | Gyrus Acmi, Inc. | Thermal control devices for electrosurgical instruments |
JP2019502431A (ja) * | 2015-11-25 | 2019-01-31 | ジャイラス エーシーエムアイ インク | 電気外科器具用熱制御装置 |
WO2018016011A1 (ja) * | 2016-07-19 | 2018-01-25 | オリンパス株式会社 | 処置具 |
JPWO2018016011A1 (ja) * | 2016-07-19 | 2019-05-09 | オリンパス株式会社 | 処置具 |
WO2018185901A1 (ja) * | 2017-04-06 | 2018-10-11 | オリンパス株式会社 | 処置具 |
JP2021034232A (ja) * | 2019-08-26 | 2021-03-01 | 株式会社ダイレクト・アール・エフ | 解凍機及び解凍機用の電極装置 |
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CN101778606B (zh) | 2013-06-12 |
US20090048589A1 (en) | 2009-02-19 |
EP2178455A4 (en) | 2011-06-22 |
WO2009022614A1 (en) | 2009-02-19 |
CN101778606A (zh) | 2010-07-14 |
EP2178455A1 (en) | 2010-04-28 |
EP2178455B1 (en) | 2015-05-06 |
JP5220844B2 (ja) | 2013-06-26 |
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