JP2011083618A - 外科的ステープルデバイスのためのツールアセンブリ - Google Patents
外科的ステープルデバイスのためのツールアセンブリ Download PDFInfo
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
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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
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
- A61B17/105—Wound clamp magazines
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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
- A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
- A61B17/0686—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying below the tissue during stapling
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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
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- 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
- A61B2017/003—Steerable
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- 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
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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
- 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
- A61B2017/07271—Stapler heads characterised by its cartridge
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- 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
- A61B2017/07278—Stapler heads characterised by its sled or its staple holder
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- 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
- A61B2017/07285—Stapler heads characterised by its cutter
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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
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- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
- A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2939—Details of linkages or pivot points
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B17/32—Surgical cutting instruments
- A61B2017/320052—Guides for cutting instruments
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Abstract
【課題】操作が簡単で、任意の所望の配向においてツールアセンブリを位置付け得るツールアセンブリの配向を調節するための機構を備える、改善された内視鏡的外科的ステープルデバイスを提供する。
【解決手段】独立して回転可能なツールアセンブリ12を備える外科的ステープルデバイスが開示される。このツールアセンブリ12は、アンビル14およびカートリッジアセンブリ16を備え、これらは、間隔を空けた位置と接近した位置との間で互いに関して移動可能である。クランプ部材20は、アンビル14に関して、カートリッジアセンブリ16を、間隔を空けた位置から接近した位置まで移動するために、戻った位置から進んだ位置まで移動可能である。動的クランピング部材は、カートリッジアセンブリ16から複数の締め具を駆出するために、戻った位置から進んだ位置まで、アンビル14およびカートリッジアセンブリ16に関して移動可能に位置付けられている。
【選択図】図1
【解決手段】独立して回転可能なツールアセンブリ12を備える外科的ステープルデバイスが開示される。このツールアセンブリ12は、アンビル14およびカートリッジアセンブリ16を備え、これらは、間隔を空けた位置と接近した位置との間で互いに関して移動可能である。クランプ部材20は、アンビル14に関して、カートリッジアセンブリ16を、間隔を空けた位置から接近した位置まで移動するために、戻った位置から進んだ位置まで移動可能である。動的クランピング部材は、カートリッジアセンブリ16から複数の締め具を駆出するために、戻った位置から進んだ位置まで、アンビル14およびカートリッジアセンブリ16に関して移動可能に位置付けられている。
【選択図】図1
Description
本願は、米国仮特許出願番号60/416,088(2002年11月4日出願)(その全体が本明細書中に参考として援用される)からの優先権を主張する。
(背景)
(1.技術分野)
本開示は、組織を処置するためのツールアセンブリに関する。より具体的には、本開示は、組織を処置するために分節および回転可能な内視鏡的外科ツールアセンブリに関する。
(1.技術分野)
本開示は、組織を処置するためのツールアセンブリに関する。より具体的には、本開示は、組織を処置するために分節および回転可能な内視鏡的外科ツールアセンブリに関する。
(2.関連技術の背景)
ツールアセンブリの対向するジョー構造の間の組織を把持し、その後、把持した組織を締めるための外科的ステープラーは当該分野で周知である。これらのデバイスは、締められた組織を切開するためのナイフを備え得る。腹腔鏡または内視鏡的な構成を有するこのようなステープラーがまた、当該分野で周知である。これらの内視鏡的外科的ステープラーの例は、米国特許第6,330,965号、同第6,250,532号、同第6,241,139号、同第6,109,500号および同第6,079,606号に記載され、これらの全ては、その全体が本明細書中に参考として援用される。
ツールアセンブリの対向するジョー構造の間の組織を把持し、その後、把持した組織を締めるための外科的ステープラーは当該分野で周知である。これらのデバイスは、締められた組織を切開するためのナイフを備え得る。腹腔鏡または内視鏡的な構成を有するこのようなステープラーがまた、当該分野で周知である。これらの内視鏡的外科的ステープラーの例は、米国特許第6,330,965号、同第6,250,532号、同第6,241,139号、同第6,109,500号および同第6,079,606号に記載され、これらの全ては、その全体が本明細書中に参考として援用される。
代表的に、これらのステープラーは、少なくとも2つの側面に沿って間隔の空いた列に整列される複数のステープルを収容するためのステープルカートリッジと、ステープルがカートリッジから駆動されるにつれて、ステープルのステープル脚を受容し、ステープルを形成するための複数のポケットを備えるアンビルを有するツール部材を備える。このアンビルは、代表的には、カートリッジの近くで旋回可能に支持され、開位置と閉位置との間で旋回可能である。
腹腔鏡または内視鏡的な外科手順の間に、外科的部位へのアクセスは、小さな切開を介してか、または、患者の小さな入口創傷を通して挿入された狭いカニューラを介して達成される。外科的部位にアクセスするための限定された領域に起因して、多くの内視鏡的ステープラーが、デバイスの内視鏡的身体の部分を回転するか、または、デバイスのツールアセンブリが関節をなすための機構を備える。代表的に、各機構は、外科医によって操作されて、処置される組織に対してツールアセンブリを適切に配向するアクチュエータによって制御される。このような操作は、時間がかかり、外科医により所望されるツールアセンブリの正確な配向を生じないかもしれない。
従って、操作が簡単で、任意の所望の配向においてツールアセンブリを位置付け得るツールアセンブリの配向を調節するための機構を備える、改善された内視鏡的外科的ステープルデバイスに対する必要性が存在する。
(要旨)
本開示に従って、1対のジョーを有するツールアセンブリを備える外科的機器が開示される。このツールアセンブリは、アンビル、および、その中に複数の締め具が支持されているカートリッジアセンブリを備える。このカートリッジアセンブリは、間隔を空けた位
置と接近した位置との間でアンビルに関して移動可能である。クランプ部材は、アンビルに関して、カートリッジアセンブリを、間隔を空けた位置から接近した位置まで移動するために、戻った位置から進んだ位置まで移動可能である。動的クランピング部材は、カートリッジアセンブリから複数の締め具を駆出するために、戻った位置から進んだ位置まで、アンビルおよびカートリッジアセンブリに関して移動可能に位置付けられている。可撓性ケーブルから形成される駆動部材は、クランプ部材および動的クランピング部材に作動可能に接続され、その戻った位置と進んだ位置との間でクランプ部材および動的クランピング部材を移動させるために移動可能である。
本開示に従って、1対のジョーを有するツールアセンブリを備える外科的機器が開示される。このツールアセンブリは、アンビル、および、その中に複数の締め具が支持されているカートリッジアセンブリを備える。このカートリッジアセンブリは、間隔を空けた位
置と接近した位置との間でアンビルに関して移動可能である。クランプ部材は、アンビルに関して、カートリッジアセンブリを、間隔を空けた位置から接近した位置まで移動するために、戻った位置から進んだ位置まで移動可能である。動的クランピング部材は、カートリッジアセンブリから複数の締め具を駆出するために、戻った位置から進んだ位置まで、アンビルおよびカートリッジアセンブリに関して移動可能に位置付けられている。可撓性ケーブルから形成される駆動部材は、クランプ部材および動的クランピング部材に作動可能に接続され、その戻った位置と進んだ位置との間でクランプ部材および動的クランピング部材を移動させるために移動可能である。
好ましくは、駆動部材は、外側シースおよび中心ロッドを備える同軸ケーブルを備える。中心ロッドは、軸方向に移動可能であり、外側シースに関して回転可能である。外側シースは、クランプ部材に作動可能に接続され、中心ロッドは、閉鎖部材に作動可能に接続されている。
好ましくは、カラーが、ステープルデバイスの本体部分に旋回可能に固定されている。本体部分は、外科的ステープルデバイスの遠位端または使い捨て可能な充填ユニットの近位端を形成し得る。
好ましくは、ツールアセンブリは、カラー部材に回転可能に取り付けられている。好ましい実施形態において、同軸ケーブルの中心ロッドは、中心ロッドの回転が、閉鎖部材の回転を起こし、ツールアセンブリのカラー部材に関する回転を起こし、ツールアセンブリの独立した回転を容易にするように、動的クランピングデバイスに接続されている。
好ましい実施形態において、動的クランピング部材は、アンビルの表面を係合するように位置付けられた第1のフランジ部分と、カートリッジアセンブリの表面を係合するように位置付けられた第2のフランジ部分を備える。この第1および第2のフランジ部分は、一緒になって、アンビルとカートリッジアセンブリとの間の最大組織ギャップを規定する。
すなわち、本発明は以下を特徴とする。
(項目1) ツールアセンブリであって、以下:
アンビルおよびカートリッジアセンブリであって、該カートリッジアセンブリは、複数の締め具を有し、間隔を空けた位置と接近した位置との間で該アンビルに関して移動可能であり、該カートリッジアセンブリおよび該アンビルは、該接近した位置における組織ギャップを規定する、アンビルおよびカートリッジ;
クランプ部材であって、該カートリッジアセンブリを、該間隔を空けた位置から該接近した位置に、該アンビルに関して移動するために、戻った位置から進んだ位置まで移動可能である、クランプ部材;ならびに
該アンビルおよび該カートリッジアセンブリに関して移動可能に位置付けられた動的クランピング部材であって、該動的クランピング部材は、該カートリッジアセンブリから複数の締め具を駆出するために、戻った位置から進んだ位置まで移動可能である、動的クランピング部材;ならびに
該クランプ部材および該動的クランピング部材に作動可能に接続された駆動部材であって、該駆動部材は、可撓性ケーブルから形成され、かつ、その戻った位置と進んだ位置との間で、該クランプ部材および該動的クランピング部材を移動するために移動可能である、駆動部材
を備える、ツールアセンブリ。
アンビルおよびカートリッジアセンブリであって、該カートリッジアセンブリは、複数の締め具を有し、間隔を空けた位置と接近した位置との間で該アンビルに関して移動可能であり、該カートリッジアセンブリおよび該アンビルは、該接近した位置における組織ギャップを規定する、アンビルおよびカートリッジ;
クランプ部材であって、該カートリッジアセンブリを、該間隔を空けた位置から該接近した位置に、該アンビルに関して移動するために、戻った位置から進んだ位置まで移動可能である、クランプ部材;ならびに
該アンビルおよび該カートリッジアセンブリに関して移動可能に位置付けられた動的クランピング部材であって、該動的クランピング部材は、該カートリッジアセンブリから複数の締め具を駆出するために、戻った位置から進んだ位置まで移動可能である、動的クランピング部材;ならびに
該クランプ部材および該動的クランピング部材に作動可能に接続された駆動部材であって、該駆動部材は、可撓性ケーブルから形成され、かつ、その戻った位置と進んだ位置との間で、該クランプ部材および該動的クランピング部材を移動するために移動可能である、駆動部材
を備える、ツールアセンブリ。
(項目2) 前記駆動部材が、同軸駆動ケーブルを備え、該同軸駆動ケーブルが、外側
シースおよび中心ロッドを備える、項目1に記載のツールアセンブリ。
シースおよび中心ロッドを備える、項目1に記載のツールアセンブリ。
(項目3) 前記中心ロッドが、該中心ロッドに関して移動可能である、請求項2に記載のツールアセンブリ。
(請求項4) 前記中心ロッドが、前記外側シースに関して軸方向に移動可能である、請求項2に記載のツールアセンブリ。
(請求項5) 前記中心ロッドが、前記外側シースに関して回転可能である、項目2に記載のツールアセンブリ。
(項目6) 前記外側シースが、前記クランプ部材に作動可能に接続されている、項目2〜5のいずれか1項に記載のツールアセンブリ。
(項目7) 前記中心ロッドが、前記動的クランピング部材に作動可能に接続されている、項目2〜6のいずれか1項に記載のツールアセンブリ。
(項目8) 前記ツールアセンブリが、本体の部分に旋回可能に固定されている、項目1〜7のいずれか1項に記載のツールアセンブリ。
(項目9) 前記ツールアセンブリが、カラー部材に作動可能に接続されており、そして、該カラー部材は、前記本体の部分に旋回可能に固定されている、項目8に記載のツールアセンブリ。
(項目10) 前記ツールアセンブリが、前記カラー部材に回転可能に取り付けられている、項目9に記載のツールアセンブリステープラー。
(項目11) 前記同軸ケーブルの前記中心ロッドが、前記動的クランピング部材に作動可能に接続されており、その結果、該中心ロッドの回転が、前記ツールアセンブリの回転に影響を及ぼす該動的クランピング部材の回転に影響を及ぼす、項目2〜10のいずれか1項に記載のツールアセンブリ。
(項目12) 前記動的クランピング部材が、前記アンビルの表面を係合するように位置付けられた第1のフランジ部分と、前記カートリッジアセンブリの表面を係合するように位置付けられた第2のフランジ部分とを備え、該第1および第2のフランジ部分は、その戻った位置からその進んだ位置までの該動的クランピング部材の移動の間に、最大の組織ギャップを規定するように位置付けられている、項目1〜11のいずれか1項に記載のツールアセンブリ。
(項目13) 前記クランプ部材が輪状であり、該クランプ部材が、前記アンビルおよび前記カートリッジアセンブリの近位端付近に位置付けられ、かつ、その進んだ位置にある場合、該クランプ部材は、前記ツールアセンブリの近位端において、最大の組織ギャップを規定する、項目1〜12のいずれか1項に記載のツールアセンブリ。
(項目14) 前記中心ロッドが、巻かれた可撓性ケーブルから形成される、項目2に記載のツールアセンブリ。
(項目15) 前記外側シースが、スチールメッシュ、プラスチック、ニチノールおよびKevlarからなる群から選択される、項目2に記載のツールアセンブリ。
(項目16) 前記動的クランピング部材に付随するナイフの刃をさらに備える、項目1に記載のツールアセンブリ。
(項目17) 前記ナイフの刃が、前記動的クランピング部材上に形成される、項目14に記載のツールアセンブリ。
(項目18) 前記ツールアセンブリが駆動カラーを備え、前記外側シースが、該駆動カラーに取り付けられている、項目2〜17のいずれか1項に記載のツールアセンブリ。
(項目19) 外科的ステープラーと共に使用するためのツールアセンブリであって、以下:
アンビル;
少なくとも1つのステープルを有するカートリッジアセンブリであって、該カートリッジアセンブリは、間隔を空けた位置と接近した位置との間で該アンビルに関して移動可能である、カートリッジアセンブリ;
該ツールアセンブリの近位端に隣接して位置付けられたクランプ部材であって、該クランプ部材は、該アンビルおよび該カートリッジアセンブリを該接近した位置まで動かすために、戻った位置から進んだ位置まで移動可能である、クランプ部材;ならびに
該ツールアセンブリ内に位置付けられ、かつ、該カートリッジアセンブリからステープルを駆出するために、戻った位置から該ツールアセンブリを通って進んだ位置まで移動可能な、動的クランピング部材であって、該動的クランピング部材は、該アンビルの表面を係合する上側フランジ部分および該カートリッジアセンブリの表面を係合する下側フランジ部分を備え、該上側フランジ部分および下側フランジ部分の少なくとも1つは、該カートリッジアセンブリの長手軸方向軸に対して横方向の軸に沿った弓状断面を有する、動的クランピング部材
を備える、ツールアセンブリ。
アンビル;
少なくとも1つのステープルを有するカートリッジアセンブリであって、該カートリッジアセンブリは、間隔を空けた位置と接近した位置との間で該アンビルに関して移動可能である、カートリッジアセンブリ;
該ツールアセンブリの近位端に隣接して位置付けられたクランプ部材であって、該クランプ部材は、該アンビルおよび該カートリッジアセンブリを該接近した位置まで動かすために、戻った位置から進んだ位置まで移動可能である、クランプ部材;ならびに
該ツールアセンブリ内に位置付けられ、かつ、該カートリッジアセンブリからステープルを駆出するために、戻った位置から該ツールアセンブリを通って進んだ位置まで移動可能な、動的クランピング部材であって、該動的クランピング部材は、該アンビルの表面を係合する上側フランジ部分および該カートリッジアセンブリの表面を係合する下側フランジ部分を備え、該上側フランジ部分および下側フランジ部分の少なくとも1つは、該カートリッジアセンブリの長手軸方向軸に対して横方向の軸に沿った弓状断面を有する、動的クランピング部材
を備える、ツールアセンブリ。
(項目20) 前記動的クランピング部材に付随するナイフの刃をさらに備える、項目19に記載のツールアセンブリ。
(項目21) 前記ナイフの刃が、前記動的クランピング部材の中心本体部分上に形成される、項目19または20に記載のツールアセンブリ。
(項目22) 前記カートリッジアセンブリが、少なくとも1つのステープルの各々に付随するそりおよびプッシャーを備え、該ステープルを該カートリッジアセンブリから駆出するために、該そりが、該プッシャーとの係合における閉鎖部材によって駆動されて、該少なくとも1つのステープルとの係合において該プッシャーを駆動する、項目19〜21のいずれか1項に記載のツールアセンブリ。
(項目23) 前記カートリッジアセンブリが、複数のステープルおよびプッシャーを備える、項目22に記載のツールアセンブリ。
(項目24) 前記上側フランジおよび前記下側フランジが、実質的に垂直に並んでいる、項目19〜23のいずれか1項に記載のツールアセンブリ。
(項目25) 前記ナイフの刃が、前記上側フランジと前記下側フランジとの間の前記中心本体部分上に配置されている、項目20〜24のいずれか1項に記載のツールアセンブリ。
操作が簡単で、任意の所望の配向においてツールアセンブリを位置付け得るツールアセンブリの配向を調節するための機構を備える、改善された内視鏡的外科的ステープルデバイスに対する必要性が存在する。
開示される外科的ステープルデバイスの種々の好ましい実施形態が、図面を参照して本明細書中に開示される。
図1は、間隔を空けた位置のアンビルおよびカートリッジアセンブリを備える、開示される外科的ステープルデバイスの1つの好ましい実施形態の側面斜視図である。
図1Aは、図1に示される外科的ステープルデバイスの、アンビルの近位端、回転カラーおよびアダプターの側面斜視図である。
図2は、図1に示される外科的ステープルデバイスの側面図である。
図3は、図2に示される外科的ステープルデバイスの見かけの内側構成要素の平面図である。
図4は、カートリッジアセンブリを通るデバイスの長手軸に沿って取った、図2に示される外科的ステープルデバイスの断面図である。
図5は、近位にツール部材を備える動的クランピング部材を通る横軸に沿って取った、図3に示される外科的ステープルデバイスの断面図である。
図6は、カートリッジアセンブリおよびアンビルを通る、ツールアセンブリの横軸に沿って取った、図3に示される外科的ステープルデバイスの断面図である。
図7は、図1に示される外科的ステープルデバイスの動的クランピング部材の正面斜視図である。
図8は、図1に示される外科的ステープルデバイスのクランプ部材の正面斜視図である。
図9は、図1に示される外科的ステープルデバイスの駆動カラーの正面斜視図である。
図10は、図1に示される外科的ステープルデバイスのツールアセンブリの側面斜視分解図である。
図11は、図10に示されるツールアセンブリの近位端の拡大図である。
図12は、図1に示される外科的ステープルデバイスの内視鏡の本体部分の側面斜視分解図である。
図13は、図1に示される外科的ステープルデバイスの側面断面図である。
図14は、本開示に従う閉鎖部材の別の実施形態である。
図15は、本開示のカートリッジハウジングの平面図である。
図16Aは、本開示のそりおよびプッシャー部材の斜視図である。
図16Bは、本開示のそりおよびプッシャー部材の斜視図である。
図17Aは、線17Aに沿って取った、図16Bのカートリッジアセンブリの一部の断面端図であり、本開示の1つの実施形態に従うそり、プッシャー部材およびステープルの配列を例示する。
図17Bは、カートリッジアセンブリの一部の断面端図であり、本開示の別の実施形態に従うそり、プッシャー部材およびステープルの配列を例示する。
(好ましい実施形態の詳細な説明)
ここで開示される外科的ステープルデバイスの好ましい実施形態が、図面を参照して詳細に記載され、この図面において、同じ参照番号は、いくつかの図の各々において、同一または対応する要素を示す。
ここで開示される外科的ステープルデバイスの好ましい実施形態が、図面を参照して詳細に記載され、この図面において、同じ参照番号は、いくつかの図の各々において、同一または対応する要素を示す。
図1〜13は、一般に10として示される、開示される外科的ステープルデバイスの1つの好ましい実施形態を例示する。ステープルデバイス10は、アンビル14およびカートリッジアセンブリ16を有するツールアセンブリ12、内視鏡の本体部分18、クランプ部材20および回転カラー22を備える。ツールアセンブリ12は、内視鏡の本体部分18の遠位端において旋回部材24の周りで旋回可能に支持される。アダプター26は、本体部分18の遠位端に固定され、上側および下側の伸長部分28を備える。アダプター18a(図12)は、本体の前側8に位置付けられ得、デバイスの内側成分の位置づけを維持する。あるいは、アダプター26は、内視鏡の本体部分18と一体となって形成され得る。旋回部材24は、ツールアセンブリ12が、内視鏡的部分18の長手軸に関して約90°の関節をなし得るように、上側および下側の伸長部分28と回転カラー22の近位部分22a(図1A)との間で伸長する。種々の異なる関節型(例えば、球とソケット、可撓性カップリング、汎用関節など)が、よりよい程度の関節を可能にするために提供され得ることが想定される。
カートリッジアセンブリ16は、複数のステープル(示さず)を収容するカートリッジ16a、カートリッジ16aを受容するための間隙を規定するチャネル部分30、動的クランピング部材32(図7)およびそり31を備える。動的クランピング部材32は、好ましくは、カートリッジ16a内のそり31の近くに位置付けられる。ナイフの刃34は、好ましくは、動的クランピング部材32の本体部分32aの中間(好ましくは中央)に位置付けられ、締められた組織を切開する。ナイフの刃34は、動的クランピング部材に直接機械加工され得るか、または、そこに固定もしくは取り外し可能に固定され得る。あるいは、ナイフの刃34は、そり上に形成され得るか、または、そりに固定もしくは取り外し可能にもしくは旋回可能に固定され得る。そり31は、カートリッジ16aを通して移動するようにスライド可能に位置付けられ、公知の様式でカートリッジからステープルを駆出する。動的クランピング部材32は、上側フランジ36aおよび下側フランジ36bを備える。図5に示すように、フランジ36aは、カートリッジ16a内に形成されたスロットまたは間隙38内に位置付けられ、フランジ36bは、アンビル14内に形成された間隙40内に位置付けられる。あるいは、フランジ36aおよび36bは、間隙内にスライド可能に位置付けられる必要はないが、むしろ、アンビル14上の上側軸受け表面およびカートリッジアセンブリ16上の下側軸受け表面を係合する必要のみが存在する。図7に例示するように、フランジ36aおよび36bは、好ましくは、弓状または半円形であり、ステープラーの作動の間に、歪みを最小限にし、アンビルおよび/またはカートリッジの配列を維持する。動的クランピング部材32は、それと係合するそりの近位に位置付けられ、カートリッジを通して移動可能である。閉鎖部材32は、デバイス10の発射の間に、そり31に近接するツールアセンブリ12の領域内に、所望の、好ましくは均質な組織ギャップを提供、修復および/または維持する。動的クランピング部材32のカートリッジアセンブリ16を通る移動は、カートリッジアセンブリを通してそりを進める。
アンビルおよび/または動的クランピング部材(好ましくは両方)は、1つの物質から形成され、デバイスの把持、デバイスを通る移動、およびデバイスの発射の間に、それぞれのアンビルおよび/または動的クランピング部材のゆがみを最小限にするような厚みもしくはゲージであることが想定される。このような物質としては、外科用グレードのステンレス鋼が挙げられる。好ましくは、アンビルは、固体の1つのピースのユニットとして形成される。あるいは、当該分野で公知なように、アンビルは、アンビル本体と、ステープルを形成する複数のポケットを有するアンビルプレートを備えるパーツのアセンブリから形成され得る。アンビルが、例えば、把持もしくは予備把持の間および/またはステープルの発射の間に上向きに曲がるアンビルの遠位端のような歪みを最小限にするのに、合理的に可能かつ必要な強度であることが望ましい。
図1Aを参照して、アンビル14の近位端は、輪状間隙14bを有する円筒状部分14aを備える。円筒状部分14aは、カラー22の孔22a内に受容されるような寸法である。少なくとも1つの旋回ピン23(図1)が、カラー22を通って間隙14b内に延び、アンビル14の近位端を孔22a内に軸方向に固定する。ピン23は、輪状間隙14b内に位置付けられるので、アンビル14は、カラー22内で回転可能である。他の手段が、アンビル14をカラー22に回転可能に取り付けるために提供され得ることが想定される。第2のピン25(図1)は、以下に説明されるように、カラー22を通って延び、カラー22を関節リンク52の遠位端に固定する。
示されないが、公知の様式で、カートリッジアセンブリ16のチャネル部分30の近位端が、アンビル14の近位端に形成されたか、または、アンビル14の近位端に取り付けられた旋回部材(例えば、タブまたはピン)を受容するための間隙を備える。アンビル14の近位端およびカートリッジ16は、カラー22内に拘束され、アンビルの旋回部材が、カートリッジアセンブリ16のチャネル部分30の間隙から外れることを防止する。あるいは、当該分野で公知の他の機械的配置を使用して、アンビル14をカートリッジアセンブリ16に旋回可能に固定し得る。カートリッジアセンブリ16は、アンビル14に旋回可能に取り付けられているので、両方が、カラー22に関して回転可能であることに注意すべきである。
図1および4を参照して、ツールアセンブリ12が内視鏡の本体部分18に関して関節をなすための関節機構が提供される。関節機構は、近位の関節リンク50と遠位の関節リンク52を備える。近位の関節リンク50は、内視鏡の本体部分18の近位端から延びる第1の端部50aおよび本体部分18内に位置付けられた第2の端部50bを有し、第2の関節リンク52の第1の端部52aに旋回可能に接続されている。関節リンク52の第2の端部52bは、旋回部材24(すなわち、ツールアセンブリ12の旋回軸)からずれた点において、ピン25(図1)によって回転カラー22に旋回可能に接続されている。関節リンク52は、内視鏡の本体部分18に形成されたスロット54内に拘束される。この拘束に起因して、関節機構は、デバイスの長手軸の片側の弧に渡って、ツールアセンブリ12が関節をなすことができるのみである。好ましくは、上で同定された旋回接続の各々は、旋回ピンを備える。あるいは、旋回部材は、上記の構成要素と一体に形成され得るか、または、ピンを備えない旋回部材が使用され得る。他の型の関節リンクもまた意図される。
使用に際して、ツールアセンブリ12の長手軸が、本体部分18の長手軸と整列され、近位の関節リンク50が、図4の矢印「A」によって示される方向に引っ込められる場合、リンク50は、旋回部材24の周りでのツールアセンブリ12の、図4の矢印「B」により示される方向への関節を起こすようにリンク52を引っ込める。ツールアセンブリ12は、リンク50を矢印「C」により示される方向に進めることによって、関節をなさない位置まで戻され得る。関節機構の動きを制御するための機構は、以下で議論される。
図3〜9を参照して、アンビル14およびカートリッジアセンブリ16を近づけ、ステープルを発射し、かつ、ツールアセンブリ12をカラー22に関して回転するための駆動機構が提供される。この駆動機構は、中心ロッド62および外側シース64を有する同軸ケーブルもしくは駆動部材60(図3)、駆動カラー66(図9)、クランプ部材(ここでは、クランプリング20として示される)ならびに動的クランピング部材32を備える。中心ロッド62は、可撓性部材であるか、可撓性部材を備え、この可撓性部材は、カートリッジ16aを通して動的クランピング部材32を押すための適切な圧縮強度を有する。好ましくは、中心ロッド62は、左巻きまたは右巻きの可撓性ケーブルを備える。あるいは、適切な強度特徴を有する他の物質(例えば、NitinolTM)がまた使用され得る。中心ロッド62の直径は、カートリッジ16a内の利用可能な空間内に位置付けら
れるために十分小さくなければならない。外側シース64は、中心ロッド62の周りに位置付けられ、部分的に、中心ロッド62が圧縮状態にある間に、中心ロッド62を安定化かつ中心ロッド62の座屈を防止するために機能する。好ましくは、外側シース62はまた、スチールメッシュ、強化プラスチックまたはニッケルチタン合金(例えば、NitinolTM)から形成される可撓性ケーブルである。必要な強度要件を有する他の適切な物質(ポリパラ−フェニレンテレフタルアミド物質(例えば、DuPontから市販されているKevlarTM)が挙げられる)が、外側シースを形成するために使用され得る。
れるために十分小さくなければならない。外側シース64は、中心ロッド62の周りに位置付けられ、部分的に、中心ロッド62が圧縮状態にある間に、中心ロッド62を安定化かつ中心ロッド62の座屈を防止するために機能する。好ましくは、外側シース62はまた、スチールメッシュ、強化プラスチックまたはニッケルチタン合金(例えば、NitinolTM)から形成される可撓性ケーブルである。必要な強度要件を有する他の適切な物質(ポリパラ−フェニレンテレフタルアミド物質(例えば、DuPontから市販されているKevlarTM)が挙げられる)が、外側シースを形成するために使用され得る。
中心ロッド62は、外側シース64内でスライド可能に位置付けられ、好ましくは内視鏡の本体部分18の近位端から延びる第1の近位端62a(図4)および動的クランピング部材32に取り付けられている第2の端62bを備える。動的クランピング部材32は、好ましくは、中心ロッド62の第2の端62bを受容するために、その中に形成される間隙68(図7)を備える。第2の端62bは、例えば、間隙68内で、把持、溶接(図4におけるように)、鑞着、ピン付けなどによって、または、間隙68を利用して、動的クランピング部材32に固定され得、そしてまた間隙68の形状に合うように機械加工され得る。
外側シース64は、好ましくは、細長い本体部分18の近位端から延びる第1の近位端64aと、駆動カラー66に固定されている第2の遠位端64bを有する。駆動カラー66(図9)は、好ましくは、外側シース64を受容し、そこを通る中心ロッド62の通過のためにチャネルを提供するための中心孔70を備える。駆動カラー66の外側表面は、好ましくは、回転可能に固定された関係においてクランプ部材またはリング20を係合するための係合構造体(例えば、ノッチ72)を備える。クランプリング20はまた、駆動カラー66の係合構造体と嵌合して、駆動カラー66をクランプリング20に回転可能に固定し、その結果、これらが、一緒に回転するための係合構造体(例えば、筋または突出部74)を備える。クランプリング20の遠位端20aは、動的クランピング部材32のフランジ部分36aおよび36bを受容および係合するように構成された1対の切り抜き76を備える。
使用の際に、中心ロッド62および外側シース64は、戻った位置から部分的に進んだ位置まで、一緒に移動可能であり、駆動カラー66、クランプリング20および動的クランピング部材32を第1の進んだ位置まで進める。クランプリング20は、好ましくは、アンビル14の近位端とカートリッジアセンブリ16の周りに位置付けられる。カートリッジアセンブリ16は、その外側表面上に形成されたカム表面80(図2)を備える。動的クランピング部材32は、戻った位置から第1の進んだ位置まで移動し、動的クランピング部材32のフランジ36bは、カートリッジアセンブリ16のカム表面80を係合し、カートリッジアセンブリ16を開位置から閉位置もしくは把持された位置まで旋回させる。クランプリング20はまた、第1の進んだ位置からアンビル14の近位端およびカートリッジアセンブリ16を取り囲む位置まで遠位に移動させられる。この位置において、クランプリング20は、アンビル14の近位端とカートリッジアセンブリ16との間のギャップが、所定の距離を越えないようにする。
中心ロッド62および外側シース64が第1の進んだ位置まで移動し、カートリッジアセンブリ16を移動させ、従って、アンビル14を把持された位置まで移動させた後、中心ロッド62は、第2の進んだ位置まで外側シース64とは独立して進め得、カートリッジ16aを通して、動的クランピング部材32を移動させて、カートリッジアセンブリからステープルを駆出し、閉鎖部材32のナイフの刃34を使用することによって組織を切断し得る。あるいは、閉鎖部材32のフランジ36aおよび36bが、アンビル14および/またはカートリッジアセンブリ16上でカム表面を係合して、一方または両方を旋回
して、組織の把持を提供し得ることが意図される。図5および6を参照して、チャネル82が、中心ロッド62に側方支持を提供するようにカートリッジ16a内に形成され、中心ロッド62の戻った位置から第2の進んだ位置までの移動の間に、中心ロッド62が、詰まらないようにしている。
して、組織の把持を提供し得ることが意図される。図5および6を参照して、チャネル82が、中心ロッド62に側方支持を提供するようにカートリッジ16a内に形成され、中心ロッド62の戻った位置から第2の進んだ位置までの移動の間に、中心ロッド62が、詰まらないようにしている。
上記のように、アンビル14は、カラー22に回転可能に固定されており、中心ロッド62は、動的クランピング部材32に固定されており、そして、外側シース64は、駆動カラー66に固定されている。同軸上部材60が回転すると、ツールアセンブリ全体が、カラー22の中心軸の周りを回転する。より具体的には、動的クランピング部材32は、アンビル14およびカートリッジアセンブリ16内に拘束されているので、中心ロッド62に適用される任意のトルクは、動的クランピング部材32を介してツールアセンブリ12に移される。従って、同軸上部材60が回転されて、カラー22の長手軸の周りでツールアセンブリ12を回転させ得る。
上記のツールアセンブリは、例えば、米国特許第6,330,965号に開示されるような使い捨ての充填ユニットであり得るか、そのように改変したものであるか、または、これに組み込まれ得、または、任意の公知の外科的ステープルデバイスの遠位端に直接取り付けられ得る。関節部材を起動するため、または接近、把持、発射ならびにツール回転機構のためのハンドルアセンブリは、具体的に本明細書中に開示されていないが、広範種々の異なる作動機構およびハンドル構成(肘金、回転可能かつスライド可能なノブ、旋回可能なレバーもしくはトリガ、ピストルグリップ、インラインハンドル、遠隔操作システムおよびこれらの任意の組み合わせが挙げられる)の使用が想定される。例えば、図13Aに示されるように、ハンドルアセンブリは、ピストル型200(ツールアセンブリ回転ノブ210、関節レバー212および本体回転ノブ214を備える)を備え得る。上記のツールアセンブリの、機械式システムの一部としての使用がまた想定される。
アンビルアセンブリのみのために、好ましくはまた、閉鎖部材およびクランピングリングのために、より重いゲージの物質を利用することにより、組織の長さに沿って増強された把持圧力を提供し、今度は、組織を通してステープルが形成される場所の近くにあるアンビルと、その場所の上にあるカートリッジ表面との間のより均質な組織ギャップを提供する。さらに、組織を予備把持する(すなわち、ステープルの変形の前に組織を把持する)ためのクランピングリングの使用は、遠位方向に、そして、半径方向外側にいくらかの組織流体を追いやり、その変形の間にステープルの水力による取り外しが起こる可能性を減少させる傾向にある。ツール部材に沿って移動するにつれて把持する、閉鎖部材などの使用は、組織からおよび/もしくは組織内での流体流れ、ならびに/または、アンビルの遠位端の引き戻りを補うことを補助し、それによって、アンビルとカートリッジアセンブリとの間の所望の組織ギャップを維持する。
図14に示すような別の好ましい実施形態において、閉鎖部材132は、間隔の空いた、中間部分132aに取り付けられた、上側フランジ136aおよび下側フランジ136bを備える。以前の実施形態においてのように、閉鎖部材132は、好ましくは、部分的にカートリッジアセンブリ116のカートリッジ118の内部にあるそり140の近位に位置付けられる。ナイフの刃134は、好ましくは、締められた組織を切開するために、閉鎖部材132の中間部分132a上に位置付けられる。ナイフの刃134は、中間部分132aのセクション上に直接機械加工され得るか、または、中間部分132aに固定もしくは取り外し可能に取り付けられ得る。あるいは、ナイフの刃134は、そり140の一部として形成され得るか、または、そり140に固定もしくは取り外し可能に固定され得る。上側フランジ136aおよび下側フランジ136bは、ほぼ弓状の構造であり、実質的に同一の湾曲を有する。あるいは、上側フランジ136aおよび下側フランジ136bの湾曲は、異なっていて、より大きいか、またはより少ない構造支持を提供してもよい
。各フランジ136a、136bは、さらに、内側表面135a、135bおよび外側表面137a、137bを備える。好ましくは、閉鎖部材132は、内側表面135a、135bが互いに向き合うように構築される。上側フランジ136aおよび下側フランジ136bは、アンビルとカートリッジ表面との間の最大の組織ギャップを規定するように機能する。
。各フランジ136a、136bは、さらに、内側表面135a、135bおよび外側表面137a、137bを備える。好ましくは、閉鎖部材132は、内側表面135a、135bが互いに向き合うように構築される。上側フランジ136aおよび下側フランジ136bは、アンビルとカートリッジ表面との間の最大の組織ギャップを規定するように機能する。
1つの好ましい実施形態において、カートリッジアセンブリ116は、カートリッジハウジング118の長手軸に沿って整列した複数の保持スロット122を備える。図15に示されるように、保持スロット122は、第1のグループ124および第2のグループ126を形成するように整列される。好ましくは、各グループ124、126は、列のうちの少なくとも1つが、残りの列から長手軸方向にずれるように構成される、3列の保持スロット122を備える。内側列の各保持スロット122が、外側列の対応する保持スロット122と実質的に長手軸に整列しており、保持スロット122の中間列が、内側列および外側列から長手軸方向にずれるように、保持スロット122の少なくとも2列が、カートリッジアセンブリ118の各グループ124、126に配置されることがさらに好ましい。従って、保持スロット122の内側列および外側列は、カートリッジハウジング118の最も近位の位置から最も遠位の位置まで長手軸方向に整列している。好ましくは、内側列および外側列の保持スロット122は、最も近位および最も遠位の保持スロットを規定する。記載されるような保持スロット122の有利な位置づけは、組織の締めを改善し、出血を最小限にする。
図16A〜17Bを参照して、そり140およびプッシャー部材150のさらなる実施形態が例示される。プッシャー部材150は、ベース部分152を備える。図16Aにおいて、そり140は、カートリッジハウジング118内を長手軸方向に進み、プッシャー部材150のベース152を係合し始める。そり140が、さらに長手軸方向に進むにつれて(図16B)、プッシャー部材150のベース152は、そり140の直立したカムウェッジ144を係合する。そり140の長手軸方向の動きは、カムウェッジ144に沿って、それによって、プッシャー部材150まで長手軸方向の推進力を移動させる。好ましくは、プッシャー部材150は、そりの長手軸方向の移動に対して固定した関係にあり、カートリッジアセンブリ118の長手軸に対して実質的に直交して移動し、それによって、保持スロット122を通してステープル160を移動させるために、ステープル160のバックスパン162に推進力を移動させる。図17Aに示すように、1つの好ましい実施形態において、そり140のカムウェッジ144は、プッシャー部材122内の間隙154を係合する。間隙154は、カムウェッジ144をスライド係合するために構成および適合されている。一旦カムウェッジ144が間隙154を係合すると、そり140のさらなる長手軸方向の移動が、プッシャー部材150を長手軸に対して実質的に垂直な整列に維持するように働く。このように構成され、一旦そり140によって係合されると、プッシャー部材150は、保持スロット122を通って移動する際に、長手軸に対して実質的に直交するその関係性を維持する。あるいは、プッシャー部材150aは、図17Bに示すような、そり140aのカムウェッジ144aの間の空間146aと共存するように構成され得る。以前の実施形態においてのように、プッシャー部材150aのベース152aは、そり140aの空間146aとのスライド係合のために構成および適合される。なおさらに、プッシャー部材150aはそり140aのカムウェッジ144aを係合するので、プッシャー部材150aは、保持スロット122を通って移動する際に、長手軸に対して実質的に直交するその関係性を維持する。
本明細書中に開示された実施形態に対して、種々の改変がなされ得ることが理解される。例えば、ツールアセンブリは、もっぱらステープルデバイスとして記載されているが、ステープル以外の締め具(2つのパーツからなる締め具を含む)に適用するために使用さ
れ得る。従って、上記明細書は、限定としてではなく、単なる好ましい実施形態の例示として解釈されるべきである。当業者は、本明細書に添付される特許請求の範囲の範囲および精神内で、他の改変を想定する。
れ得る。従って、上記明細書は、限定としてではなく、単なる好ましい実施形態の例示として解釈されるべきである。当業者は、本明細書に添付される特許請求の範囲の範囲および精神内で、他の改変を想定する。
10 ステープルデバイス
14 アンビル
16 カートリッジアセンブリ
12 ツールアセンブリ
18 内視鏡の本体部分
20 クランプ部材
22 回転カラー
24 旋回部材
26 アダプター
14 アンビル
16 カートリッジアセンブリ
12 ツールアセンブリ
18 内視鏡の本体部分
20 クランプ部材
22 回転カラー
24 旋回部材
26 アダプター
Claims (1)
- 図1に示すようなツールアセンブリであって、以下:
アンビルおよびカートリッジアセンブリであって、該カートリッジアセンブリは、複数の締め具を有し、間隔を空けた位置と接近した位置との間で該アンビルに関して移動可能であり、該カートリッジアセンブリおよび該アンビルは、該接近した位置における組織ギャップを規定する、アンビルおよびカートリッジ;
該カートリッジアセンブリの近位端および該アンビルに近接して位置付けられたクランプ部材であって、該クランプ部材は、該カートリッジアセンブリの近位端および該アンビルを並列した配列に維持するために第1の位置から第2の位置まで移動可能である、クランプ部材;ならびに
該アンビルおよび該カートリッジアセンブリに関して移動可能に位置付けられた動的クランピング部材であって、該動的クランピング部材は、該カートリッジアセンブリから複数の締め具を駆出する間に、該動的クランピング部材に近接した該カートリッジセンブリと該アンビルとの間の最大組織ギャップを規定するために第1の位置から第2の位置まで移動可能である、動的クランピング部材
を備える、ツールアセンブリであって、
該ツールアセンブリが、カラー部材に作動可能に接続されており、そして、該カラー部材は、前記ステープルデバイスの本体の部分に旋回可能に固定されている、ツールアセンブリ。
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JP2014155825A (ja) * | 2013-02-18 | 2014-08-28 | Covidien Lp | 内視鏡処置のための装置 |
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