JP2014057867A - ひだ形成術用のステープル留めシステム - Google Patents
ひだ形成術用のステープル留めシステム Download PDFInfo
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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
- 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
-
- 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
-
- 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
- A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
-
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/128—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips
- A61B17/1285—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for applying or removing clamps or clips for minimally invasive surgery
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
- A61F5/0003—Apparatus for the treatment of obesity; Anti-eating devices
- A61F5/0013—Implantable devices or invasive measures
- A61F5/0036—Intragastrical devices
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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
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
-
- 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
- A61B17/07292—Reinforcements for staple line, e.g. pledgets
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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
- A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00743—Type of operation; Specification of treatment sites
- A61B2017/00818—Treatment of the gastro-intestinal system
- A61B2017/00827—Treatment of gastro-esophageal reflux
-
- 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
-
- 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
- A61B2017/07228—Arrangement of the staples
-
- 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
- A61B2017/1139—Side-to-side connections, e.g. shunt or X-connections
-
- 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
- A61B2017/1157—Staplers for performing anastomosis in a single operation applying the staples radially
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/30—Surgical pincettes without pivotal connections
- A61B2017/306—Surgical pincettes without pivotal connections holding by means of suction
Abstract
【解決手段】ひだ形成術用のステープル留めシステムは、末端を有する主軸を備える。その主軸の末端が負圧供給源に接続されるように構成された真空槽18を備える。主軸はステープル留め部材13を備え、そのステープル留め部材がアンビル40及びステープルヘッド42を含み、前記ステープルヘッドはステープル70を収容するカートリッジ44を備え、前記ステープルがひだを形成するために胃壁組織に打ち込まれる。補強材74は前記カートリッジ及びアンビルの少なくとも一方に近接して配置され、前記ひだを補強するためにステープルに係合する。
【選択図】図15B
Description
図2は、内視鏡的な使用にふさわしい組織のひだ形成術用のシステム10の一実施例を示しているが、もし望まれれば、外科的な使用や腹腔鏡の使用にも適する。
図23Aのシステム110は、圧搾とその後のステープル留めに対する、カートリッジとドライバーの連続する移動を可能にする。システム110は入れ子のシリンダー112a、112bおよび112c、流体入口114a、114bおよび114c、Oリングシール116a〜116dを有している。流体圧力が入口114aを経由してシステムに導入される場合、シリンダー112bが左に向かって前進する。一度、シリンダー112bのOリングシール116bが、入口114bを横切ると、流体圧力が入口114cを経由してシリンダー112aに加えられ、その結果図面の左にシリンダー112aを移動させる。この配置は、例えばシリンダー112bに結合したステープルカートリッジに使用されるように、第1の圧搾に用いられ、次に、流体やガス圧力の単一の源を使用して、例えばシリンダー112aに結合したステープラドライバーを作動して、組織をステープル留めするのに使用される。
様々な形式の補強が、褶襞形成システムを使用して形成されたひだに、またはその上に埋め込まれる。この補強はステープル配列を補強するために機能し、ステープルによって組織に加えられた力をより平等に分布させるのを支援し、及び/又は対向する漿膜の層の間の結合を促進する。適切な補強は、粘膜の組織の側面に加えられた補強(「粘膜の側面補強」)と同様に、漿膜の組織層の上に又はその層の間に位置する補強(「漿膜の側面補強」)を含んでいる。
開示されたシステムを使用する1つの方法は、主として図8と図9とを参照して次に記述される。
次に、組み立てられた褶襞形成装置10aは、食道を経由して胃Sへ運ばれるもので、好ましくは保護シースを通して食道を通過する。内視鏡98も処置の視覚化を提供するために胃へ渡される。内視鏡は、好ましくは褶襞形成装置10aに取り付けられるが、それは別々の構成装置でもよい。
上述から明白なように、開示された内視鏡的システムは、胃の外面でくぼみを形成するように、胃の中への組織を引き寄せるように機能し、そして、しわを形成するために対向する胃壁断面のくぼみの互いの内側を覆うようにステープル留めする(あるいは縫合する、留める、粘着する等)。内視鏡的システムは、胃の外部上のくぼみ内で強い組織粘着を促進し、増強するべき漿膜表面間の材料を保持する型の材料をさらに置いてもよい。さらにあるいはその代わりに、ステープルを相互に連結させる構造のような粘膜を補強するものが埋め込まれてもよい。これらのシステムはこの作用を行なうために好都合な実施例を提供しているが、別の多くの多様な代替の器具やシステムが、本発明の範囲内でその代わりに使用されてもよい。さらに、開示された実施例は、追加の実施例を生み出す際に、変化した態様で互いに結合してもよい。したがって、ここに記述された実施例は、内視鏡的な組織のひだ形成術を行なうのに役立つシステムの代表的な具体例として扱われるべきであり、請求された発明の適用範囲を制限するためには使用されるべきでない。
Claims (10)
- ひだ形成術用のステープル留めシステムにおいて、
末端を有する主軸であって、その主軸の末端が負圧供給源に接続されるように構成された真空槽(18)を備え、かつ、その主軸がステープル留め部材(13)を備え、そのステープル留め部材がアンビル(40)及びステープルヘッド(42)を含み、前記ステープルヘッドはステープル(70)を収容するカートリッジ(44)を備え、前記ステープルがひだを形成するために胃壁組織に打ち込まれるように構成された前記主軸と、
前記カートリッジ及びアンビルの少なくとも一方に近接して配置され、前記ひだを補強するためにステープルが係合する補強材(74)と
を備えるステープル留めシステム。 - 前記ステープル留めシステムの使用時に、前記真空槽が胃壁組織に接触して位置決めされ、その組織をアンビルとステープルヘッドとの間の位置に行き込んで、ひだを形成するために胃壁組織にステープルが打ち込まれることを可能にする請求項1に記載のステープル留めシステム。
- 前記補強材は金属または高分子材料によって形成されている請求項1に記載のステープル留めシステム。
- 前記補強材は、ひだ形成の完了に際し、ひだの中のステープルが互いにつながれるように位置決めされる請求項1に記載のステープル留めシステム。
- 前記補強材は、ステープルが胃壁組織を貫通してアンビルに接触する時にステープルの突起部がその補強材の近くに折り重なって補強材を捉えてステープルとともに連結されるように構成される請求項1に記載のステープル留めシステム。
- 前記補強材は円形状を有する請求項1に記載のステープル留めシステム。
- 前記ステープルは前記カートリッジ内で円形パターンに沿って配列される請求項1に記載のステープル留めシステム。
- 前記ステープル留め部材は胃壁組織を貫通するステープルの2つの同心リングを生成するように構成されている請求項1に記載のステープル留めシステム。
- 前記真空槽は胃壁組織を真空槽に引き込むために胃壁組織と接触するように配置される開口部を有する請求項1に記載のステープル留めシステム。
- 前記ステープル留め部材は胃の内部において胃壁組織に向かって横方向に移動するように構成されている請求項1に記載のステープル留めシステム。
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
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US82553406P | 2006-09-13 | 2006-09-13 | |
US60/825,534 | 2006-09-13 | ||
US11/542,457 | 2006-10-03 | ||
US11/542,457 US9055942B2 (en) | 2005-10-03 | 2006-10-03 | Endoscopic plication devices and methods |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
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JP2009528276A Division JP2010503460A (ja) | 2006-09-13 | 2007-09-12 | 内視鏡的褶襞形成術装置および方法 |
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JP2015187878A Division JP6153982B2 (ja) | 2006-09-13 | 2015-09-25 | ひだ形成術用のステープル留めシステム |
Publications (2)
Publication Number | Publication Date |
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JP2014057867A true JP2014057867A (ja) | 2014-04-03 |
JP6153847B2 JP6153847B2 (ja) | 2017-06-28 |
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JP2009528276A Pending JP2010503460A (ja) | 2006-09-13 | 2007-09-12 | 内視鏡的褶襞形成術装置および方法 |
JP2013226051A Expired - Fee Related JP6153847B2 (ja) | 2006-09-13 | 2013-10-30 | ひだ形成術用のステープル留めシステム |
JP2015187878A Expired - Fee Related JP6153982B2 (ja) | 2006-09-13 | 2015-09-25 | ひだ形成術用のステープル留めシステム |
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JP2009528276A Pending JP2010503460A (ja) | 2006-09-13 | 2007-09-12 | 内視鏡的褶襞形成術装置および方法 |
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JP2015187878A Expired - Fee Related JP6153982B2 (ja) | 2006-09-13 | 2015-09-25 | ひだ形成術用のステープル留めシステム |
Country Status (7)
Country | Link |
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US (3) | US9055942B2 (ja) |
EP (2) | EP2066243B1 (ja) |
JP (3) | JP2010503460A (ja) |
AU (1) | AU2007294801B2 (ja) |
CA (1) | CA2666594C (ja) |
ES (2) | ES2565631T3 (ja) |
WO (1) | WO2008033409A1 (ja) |
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CA2666594C (en) | 2015-01-13 |
US20100228272A1 (en) | 2010-09-09 |
EP2574285B1 (en) | 2016-01-20 |
AU2007294801B2 (en) | 2013-10-10 |
JP2015226856A (ja) | 2015-12-17 |
EP2574285A1 (en) | 2013-04-03 |
WO2008033409A9 (en) | 2008-05-15 |
US8469977B2 (en) | 2013-06-25 |
US20150238193A1 (en) | 2015-08-27 |
WO2008033409A1 (en) | 2008-03-20 |
ES2401355T3 (es) | 2013-04-18 |
JP2010503460A (ja) | 2010-02-04 |
AU2007294801A1 (en) | 2008-03-20 |
JP6153847B2 (ja) | 2017-06-28 |
CA2666594A1 (en) | 2008-03-20 |
US20070219571A1 (en) | 2007-09-20 |
JP6153982B2 (ja) | 2017-06-28 |
EP2066243A1 (en) | 2009-06-10 |
ES2565631T3 (es) | 2016-04-06 |
US9055942B2 (en) | 2015-06-16 |
EP2066243B1 (en) | 2012-12-12 |
US10299796B2 (en) | 2019-05-28 |
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