JP2012517858A - 縫合装置及び方法 - Google Patents
縫合装置及び方法 Download PDFInfo
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Abstract
【選択図】 図7B
Description
[0146]図11A-に示すように、直腸は、上痔核動脈、中痔核動脈及び下痔核動脈として分類される痔核動脈を有している。痔核動脈は、直腸動脈としても知られている。本明細書で説明する装置が目標とする動脈は、通常、上痔核動脈としても知られる直腸動脈の長手方向の粘膜下分岐であり、簡単化のために、本明細書では、多くの場合、痔核動脈と呼ぶ。歯状線(それより上位/口の方では粘膜が痛みを示さない)は、通常、入口を越えて肛門括約筋まで直腸内約2〜3cmである。(肛門括約筋を、内部肛門括約筋及び外部肛門括約筋として分類することができる。)痔核は、痔核動脈と血管との間の接合部分に位置している。外部痔核は、肛門の外側に位置している。内部痔核は直腸内に位置している。
Claims (85)
- 痔核を治療する方法であって、
痔核動脈の位置を特定するステップと、
前記痔核動脈を固定するステップと、
前記痔核動脈を自動的に封止するステップと、
を含む方法。 - 自動的に封止する前記ステップが、前記痔核動脈を機械的に結紮するサブステップを含む、請求項1に記載の方法。
- 機械的に結紮する前記サブステップが、前記痔核動脈を圧縮するサブステップを含む、請求項2に記載の方法。
- 固定する前記ステップが吸引力を付与するサブステップを含む、請求項1に記載の方法。
- 固定する前記ステップが、前記痔核動脈に隣接する組織内にフックを挿入するサブステップを含む、請求項1に記載の方法。
- 固定する前記ステップが、前記痔核動脈に隣接して接着剤を塗布するサブステップを含む、請求項1に記載の方法。
- 痔核を治療する方法であって、
痔核動脈の位置を特定するステップと、
前記痔核動脈を固定するステップと、
前記痔核動脈を自動的に封止するステップであって、前記動脈内の流れを検知するサブステップと、流れが検出されると前記封止をトリガするサブステップとを含む、ステップと、
を含む方法。 - 自動的に封止する前記ステップが、前記動脈を圧縮するサブステップを含む、請求項7に記載の方法。
- 前記動脈を圧縮するサブステップが、前記動脈に隣接する組織を吸引して組織の山を形成することと、前記組織の山の上にクリップを送り出すこととを含む、請求項8に記載の方法。
- 自動的に封止する前記ステップが、前記動脈内の流れが検出されると前記動脈を焼灼するサブステップを含む、請求項7に記載の方法。
- 焼灼する前記サブステップが、RFエネルギーを前記動脈に送達することを含む、請求項10に記載の方法。
- 焼灼する前記サブステップが、前記動脈内に又は上に蒸気を送達することを含む、請求項10に記載の方法。
- 焼灼する前記サブステップが、前記動脈を凝固させることを含む、請求項10に記載の方法。
- 自動的に封止する前記ステップが、前記動脈内の流れを検出すると前記動脈を硬化させるサブステップを含む、請求項7に記載の方法。
- 前記動脈を硬化させる前記ステップが、前記動脈内に又は上に硬化剤を送達するサブステップを含む、請求項14に記載の方法。
- 位置を特定する前記ステップが、ドップラー超音波を用いて位置を特定するサブステップを含む、請求項7に記載の方法。
- 痔核を治療する方法であって、
痔核動脈の位置を特定するステップと、
前記痔核動脈を固定するステップと、
前記痔核動脈を遠隔で封止するステップと、
を含む方法。 - 遠隔で封止する前記ステップが、封止装置を作動させて前記痔核動脈を閉鎖するサブステップを含み、作動させる前記サブステップが、直腸の外側で前記装置を制御することを含む、請求項17に記載の方法。
- 前記装置が焼灼器を含み、前記焼灼器が前記痔核動脈を焼灼し、前記装置を作動させる前記サブステップが前記焼灼器を作動させることを含む、請求項17に記載の方法。
- 前記装置が圧縮手段配置装置を含み、前記圧縮手段配置装置が前記痔核動脈を圧縮する圧縮手段を配置する、請求項17に記載の方法。
- 前記圧縮手段配置装置が縫合糸配置装置を含む、請求項20に記載の方法。
- 前記圧縮手段配置装置がクリップ装着器を含む、請求項20に記載の方法。
- 前記圧縮手段配置装置がステープラを含む、請求項20に記載の方法。
- 位置を特定する前記ステップが、ドップラー超音波を用いて位置を特定するサブステップを含む、請求項17に記載の方法。
- 痔核を治療する方法であって、
痔核動脈の表面の組織に吸引力を付与するステップ
を含む方法。 - 前記痔核動脈の位置を特定するステップと、前記痔核動脈に治療装置を固定するステップとをさらに含み、固定する前記ステップが、前記痔核動脈の表面の組織に吸引力を付与するサブステップを含む、請求項25に記載の方法。
- 痔核動脈を治療する装置であって、
遠隔位置特定コンポーネント、結紮コンポーネント及び固定コンポーネントを備える先端部と、
前記先端部に対して基端側のハンドルと、
前記ハンドルと前記先端部との間の首部であって、非直線状である首部と、
を具備する装置。 - 痔核動脈を治療する装置であって、
遠隔位置特定コンポーネント、結紮コンポーネント及び固定コンポーネントを備える先端部と、
前記先端部に対して基端側のハンドルと、
前記ハンドルと前記先端部との間の首部であり、角度的に関節動作可能である首部と、
を具備する装置。 - 痔核動脈を治療する装置であって、
遠隔位置特定コンポーネント、結紮コンポーネント及び固定コンポーネントを備える先端部であり、先端部直径が約3cmを下回る、先端部と、
前記先端部に対して基端側のストッパであって、ストッパ直径が約3cmを上回る、ストッパと、
を具備する装置。 - 前記先端部直径が約2cmを下回る、請求項29に記載の装置。
- 前記先端部直径が約1.5cmを下回る、請求項29に記載の装置。
- 前記先端部直径が約1cmを下回る、請求項29に記載の装置。
- 前記結紮コンポーネントがクリップを含む、請求項29に記載の装置。
- 前記結紮コンポーネントが焼灼コンポーネントを含む、請求項29に記載の装置。
- 前記焼灼コンポーネントが電極を含む、請求項34に記載の装置。
- 前記焼灼コンポーネントがHIFUトランスデューサを含む、請求項35に記載の装置。
- 前記結紮コンポーネントがタンポナーデ剤を含む、請求項29に記載の装置。
- 前記結紮コンポーネントが硬化剤を含む、請求項29に記載の装置。
- 前記結紮コンポーネントがイオン化放射線源を含む、請求項29に記載の装置。
- 前記固定コンポーネントが吸引源を含む、請求項29に記載の装置。
- 前記吸引源が、前記遠隔位置特定コンポーネント及び前記結紮コンポーネントに隣接する吸引ポートと流体連通する、請求項40に記載の装置。
- 前記吸引源が当該装置の残りの部分に対して並進可能である、請求項41に記載の装置。
- 前記遠隔位置特定装置がドップラーセンサを含む、請求項29に記載の装置。
- 前記遠隔位置特定コンポーネントが流れ検出器を含む、請求項29に記載の装置。
- 前記遠隔位置特定コンポーネントが、前記流れ検出器が流れを検出すると音響信号を放射するように構成されている、請求項44に記載の装置。
- 痔核動脈を治療する装置であって、
結紮・位置特定対の直交格子であり、各結紮・位置特定対が動脈位置特定器に隣接するか又はその中に動脈結紮器を備え、結紮・位置特定対の2つの行及び2つの列を備える直交格子
を具備する装置。 - 前記動脈結紮器がRF電極を含む、請求項46に記載の装置。
- 前記動脈位置特定器がドップラーセンサを含む、請求項46に記載の装置。
- 痔核動脈を結紮する方法であって、
肛門内に装置を挿入するステップであり、前記装置が検知素子及び結紮素子を備える、ステップと、
前記検知コンポーネント及び前記結紮コンポーネントが歯状線より上位であるように前記装置を前進させるステップと、
手による縫合を用いることなく前記痔核動脈を結紮するステップと、
を含み、直接視覚化なしに行われる方法。 - 挿入する前記ステップが、前記肛門を約2cm未満拡張させるサブステップをさらに含む、請求項49に記載の方法。
- 前進させる前記ステップが、前記検知コンポーネント及び前記結紮コンポーネントが前記歯状線より約1cm上位であるように前記装置を前進させるサブステップを含む、請求項50に記載の方法。
- 痔核動脈を治療する方法であって、
前記痔核動脈のすべてを同時に結紮するステップ
を含む方法。 - 前記結紮が、直腸内の組織を円周方向に焼灼するサブステップを含む、請求項52に記載の方法。
- 前記直腸内に前記歯状線を越えて結紮装置を挿入するステップをさらに含む、請求項53に記載の方法。
- 挿入する前記ステップが、前記装置に対し、前記直腸内に約8cmを上回って前記結紮装置が挿入されるのを防止するサブステップを含む、請求項54に記載の方法。
- 前記装置に対して防止する前記サブステップが、前記肛門に当接することを含む、請求項54に記載の方法。
- 前記結紮が、前記痔核動脈にエネルギーを付与するサブステップを含む、請求項52に記載の方法。
- 前記エネルギーが赤外線エネルギーを含む、請求項57に記載の方法。
- 前記エネルギーがRFエネルギーを含む、請求項57に記載の方法。
- 前記エネルギーがHIFUエネルギーを含む、請求項57に記載の方法。
- 前記エネルギーが熱エネルギーを含む、請求項57に記載の方法。
- 前記エネルギーが電気焼灼エネルギーを含む、請求項57に記載の方法。
- 痔核動脈を治療する装置であって、
痔核動脈の位置を特定するセンサと、
前記痔核動脈を熱的に結紮するエネルギープローブと、
前記センサ及び前記エネルギープローブを歯状線の少なくとも1cm上方に配置する安全機構と、
前記センサに結合された処理ユニットと、
前記エネルギープローブに結合されたエネルギー発生器と、
を具備する装置。 - 前記安全機構がストッパを含む、請求項63に記載の装置。
- 前記ストッパが、当該装置の残りの部分より直径が大きい、請求項63に記載の装置。
- 前記センサが超音波ドップラートランスデューサである、請求項63に記載の装置。
- 前記エネルギープローブが高周波電極、高強度超音波アブレーションプローブ、蒸気送達ポート及び/又はレーザ送信機である、請求項63に記載の装置。
- 前記センサが、前記エネルギープローブの中間に又はそれに隣接して配置される、請求項63に記載の装置。
- 前記センサ及び/又は前記エネルギープローブが拡張可能部材に配置される、請求項63に記載の装置。
- 前記拡張可能部材がバルーンを含む、請求項69に記載の装置。
- 前記拡張可能部材がバスケットを含む、請求項69に記載の装置。
- 前記拡張可能部材がメッシュを含む、請求項69に記載の装置。
- 前記安全機構がタッチセンサ及び/又は挿入深さ指示器である、請求項63に記載の装置。
- 前記処理ユニット及び前記エネルギー発生器が、前記痔核動脈の直接視覚化を必要とすることなく、動脈結紮プロセスを最適化するように情報を交換するように構成されている、請求項63に記載の装置。
- 痔核を治療する方法であって、
治療装置を肛門に挿入するステップであり、前記治療装置がセンサ及びエネルギープローブを備える、ステップと、
前記センサ及び前記エネルギープローブを歯状線の少なくとも1cm上方に配置するステップと、
前記治療装置の先端部を、前記治療装置が直腸内部組織と接触するように拡張させるか又は関節動作させるステップと、
少なくとも1つの痔核動脈の位置が特定されるまで前記治療装置を関節動作させるステップであり、回転させるサブステップ及び/又は並進させるサブステップを含む、ステップと、
前記痔核動脈を、前記エネルギープローブにより熱的に結紮するステップと、
を含む方法。 - 前記痔核動脈を結紮する前記ステップが切開を行わないサブステップを含む、請求項75に記載の方法。
- 前記痔核動脈を結紮する前記ステップが、前記痔核動脈の壁の温度を、約70℃を上回るまで上昇させるサブステップを含む、請求項76に記載の方法。
- 前記痔核動脈を結紮する前記ステップが、前記エネルギーを前記歯状線の上方に配置した後に発生する、請求項76に記載の方法。
- 痔核の治療のために痔核動脈を結紮する装置であって、
管状ハウジングと、
前記管状ハウジングの先端部の、吸引により組織ひだを形成するために開放空洞を画定する吸引チャンバであり、前記組織ひだの基部を少なくとも部分的に挟み付けるように配置可能な圧縮クリップを受け取る手段を有する、吸引チャンバと、
前記吸引チャンバ及び前記クリップ配置機構に対して基端側のドップラー超音波センサと、
前記管状ハウジングの基端部の、前記吸引チャンバ内の吸引力を活性化し前記組織ひだの前記基部を少なくとも部分的に挟み付けるようにクリップを配置する機構を備えたハンドルと、
を具備する装置。 - 前記圧縮クリップが、先端の長さが異なるかかりを備えている、請求項79に記載の装置。
- 前記圧縮クリップがワイヤストックを含む、請求項79に記載の装置。
- 痔核の治療のために痔核動脈を結紮する方法であって、
組織の組織表面上にドップラー超音波センサを配置するステップと、
動脈の位置が特定されるまで、前記組織表面に沿って前記超音波センサを移動させるステップと、
前記組織を垂直方向に挟み付けることにより、前記検出された動脈内の血流を中断させる組織ひだを形成するステップと、
圧縮クリップを送り出すことにより、前記組織ひだの前記基部を少なくとも部分的に挟み付けることにより前記検出された動脈内の血流を停止させるステップと、
を含む方法。 - 前記圧縮クリップが送り出された後に前記動脈を通る血流の中断を確認するステップであり、ドップラー超音波センサを用いるサブステップを含む、ステップをさらに含む、請求項82に記載の方法。
- 挟み付ける前記ステップが前記組織に吸引力を付与するサブステップを含み、送り出す前記ステップが、吸引の方向に対して垂直に前記圧縮クリップを送り出すサブステップを含む、請求項82に記載の方法。
- 前記ドップラー超音波センサを配置する前記サブステップが、直腸内に治療装置を前進させることを含み、前記装置が測定装置であり、前記治療装置の前記前進を測定して、前記治療装置の作業端が前記直腸の歯状線の上方にあることを確実にするステップを含む、請求項82に記載の方法。
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- 2015-12-21 US US14/977,537 patent/US20160106435A1/en not_active Abandoned
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JP2013542779A (ja) * | 2010-10-15 | 2013-11-28 | サージクランプ プロプライエタリー リミテッド | 外科用クランプ装置およびそれとともに使用するための器具 |
JP2015529518A (ja) * | 2012-09-01 | 2015-10-08 | コーニンクレッカ フィリップス エヌ ヴェ | アブレーション計画のための超音波ボリュームフロー測定 |
JP2015536945A (ja) * | 2012-11-02 | 2015-12-24 | ニューロトロニック・インコーポレイテッドNeurotronic, Inc. | 化学的アブレーション用製剤および種々疾患の治療方法 |
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JP2017526423A (ja) * | 2014-08-04 | 2017-09-14 | オヴェスコ エンドスコピー アーゲー | 部分的に吸収可能な組織クリップ |
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US12005207B2 (en) | 2014-10-30 | 2024-06-11 | Neurotronic, Inc. | Chemical ablation and method of treatment for various diseases |
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US10537375B2 (en) | 2015-04-24 | 2020-01-21 | Neurotronic, Inc. | Chemical ablation and method of treatment for various diseases |
JP2022519673A (ja) * | 2019-02-12 | 2022-03-24 | ザ ボード オブ トラスティーズ オブ ザ レランド スタンフォード ジュニア ユニバーシティー | 高強度集束超音波のためのシステムおよび方法 |
Also Published As
Publication number | Publication date |
---|---|
US20120059394A1 (en) | 2012-03-08 |
WO2010096174A1 (en) | 2010-08-26 |
US9232947B2 (en) | 2016-01-12 |
EP2398548A4 (en) | 2015-04-22 |
JP6105699B2 (ja) | 2017-03-29 |
WO2010096174A4 (en) | 2010-10-14 |
JP5885506B2 (ja) | 2016-03-15 |
EP2398548A1 (en) | 2011-12-28 |
WO2010096174A8 (en) | 2011-10-06 |
EP2398548B1 (en) | 2017-04-19 |
JP2016093483A (ja) | 2016-05-26 |
US20160106435A1 (en) | 2016-04-21 |
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