JP2014184142A - マイクロ外科手術器具と、マイクロ外科手術器具とともに使用するためのローディングユニット - Google Patents

マイクロ外科手術器具と、マイクロ外科手術器具とともに使用するためのローディングユニット Download PDF

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JP2014184142A
JP2014184142A JP2014056547A JP2014056547A JP2014184142A JP 2014184142 A JP2014184142 A JP 2014184142A JP 2014056547 A JP2014056547 A JP 2014056547A JP 2014056547 A JP2014056547 A JP 2014056547A JP 2014184142 A JP2014184142 A JP 2014184142A
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assembly
loading unit
cartridge assembly
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sled
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JP6353673B2 (ja
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Stanislaw Kostrezewski
コスツルゼウスキー スタニスロウ
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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
    • 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
    • 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
    • A61B17/00234—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
    • A61B2017/00296—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00407—Ratchet means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
    • A61B2017/00473—Distal part, e.g. tip or head
    • 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
    • A61B2017/00539—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated hydraulically
    • 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
    • A61B17/068—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
    • 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
    • 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
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder
    • 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
    • A61B2017/07285—Stapler heads characterised by its cutter

Abstract

【課題】より広い用途を可能にする外科手術器具との係合のために構成されているローディングユニットを提供する。
【解決手段】ローディングユニットが長手方向軸を規定する近位本体部分２１０と、近位本体部分と機械的に協働して配置されているツールアセンブリ２２０により構成され、さらにツールアセンブリは、カートリッジアセンブリ４００とアンビルアセンブリ３００とを含み、カートリッジアセンブリおよびアンビルアセンブリのうちの少なくとも１つは、カートリッジアセンブリとアンビルアセンブリとの間に組織を係合するために、開いた位置と接近させられた位置との間で他方に対して移動可能であり、カートリッジアセンブリは、その中に複数の締め具を収容するように構成されており、ツールアセンブリの直径は、約８ｍｍ未満であるか、または約８ｍｍと等しい、ツールアセンブリとを含む構成とする。
【選択図】図４

Description

背景
技術分野
本開示は、一般に、組織を外科手術により接合するための器具に関し、より詳しくは、外科手術締め器具およびローディングユニットに関し、このローディングユニットは、比較的小さい直径を有するエンドエフェクターを含む。
関連技術の背景
組織を外科手術により接合するために使用される種々のタイプの外科手術器具は、当該分野において公知であり、例えば、切開、切除、吻合において組織または器官を閉じるために、胸部および腹部の手順において器官を閉塞するために、ならびに組織を電気外科的に融合または密封するために一般的に使用される。
そのような外科手術器具の１つの例は、外科手術ステープル留め器具であり、それは、アンビルアセンブリと、外科手術締め具の並びを支持するためのカートリッジアセンブリと、カートリッジアセンブリとアンビルアセンブリとを接近させるための接近メカニズムと、カートリッジアセンブリから外科手術締め具を射出するための発射メカニズムとを含み得る。
外科手術器具を用いて、外科医がアンビル部材とカートリッジ部材とを接近させることは、一般的である。次に、外科医は、器具を発射して、締め具を組織中に据え付け得る。さらに、外科医は、締め具の列（複数可）に隣接する組織、または締め具の列（複数可）の間の組織を切断するために、同じ器具または別個の器具を使用し得る。
さらに、単回使用ローディングユニット（「ＳＵＬＵ」）または使い捨てローディングユニット（「ＤＬＵ」）は、外科手術ステープル留め器具の細長い部分または内視鏡部分に取り付けられ得る。そのようなローディングユニットは、例えば、外科手術ステープル留め器具が、より広い用途を有することを可能にする。ローディングユニットは、単回使用のために構成され得、および／または１回よりも多く使用されるように構成され得る。
さらに、エンドエフェクターおよび／またはローディングユニットは、一般に、その中に含まれる種々の構成要素によってサイズが制限される。すなわち、代表的に利用可能なものよりも小さい直径を有するエンドエフェクターおよび／またはローディングユニットの必要性が存在し得るが、エンドエフェクターおよび／またはローディングユニットの直径は、代表的に、例えば、その中に含まれるステープルプッシャー、Ｉ−梁、作動そり、および締め具の、サイズ、幾何学的形状、および／または配向によって制限される。
概要
本開示は、外科手術器具との係合のために構成されているローディングユニットに関する。ローディングユニットは、近位本体部分とツールアセンブリとを含む。近位本体部分は、長手方向軸を規定する。ツールアセンブリは、近位本体部分と機械的に協働して配置されており、カートリッジアセンブリとアンビルアセンブリとを含む。カートリッジアセンブリおよびアンビルアセンブリのうちの少なくとも１つは、カートリッジアセンブリとアンビルアセンブリとの間に組織を係合するために、開いた位置と接近させられた位置との間で他方に対して移動可能である。カートリッジアセンブリは、その中に複数の締め具を収容するように構成されている。ツールアセンブリの直径は、約８ｍｍ未満であるか、または約８ｍｍと等しい。
開示される実施形態において、ツールアセンブリの直径は、約７ｍｍと等しい。
開示される実施形態において、近位本体部分の部分の直径は、ツールアセンブリの直径と実質的に等しい。
開示される実施形態において、ローディングユニットは、締め付け部材をさらに含み、この締め付け部材は、カートリッジアセンブリおよびアンビルアセンブリと機械的に協働して配置されている。ここで、締め付け部材は、垂直軸を規定する垂直部分を含み、この垂直部分は、長手方向軸に対して実質的に直角である。ローディングユニットは、作動そりをさらに含むことがさらに開示され、この作動そりは、少なくとも部分的にカートリッジアセンブリ内で長手方向に並進可能である。作動そりは、少なくとも２つのカム作用表面を含み、第１のカム作用表面は、長手方向軸および垂直軸を通って延びている面（垂直軸は、この面の中にある）に対して第１の角度で延び、第２のカム作用表面は、この面に対して第２の角度で延びている。第１の角度および第２の角度は、約１５°と約４０°との間、または約２０°と約３５°との間であることがさらに開示される。作動そりは、Ｖのようなプロフィールを含むことがさらに開示される。カートリッジアセンブリの第１の組織接触表面の少なくとも大部分は、第１の角度に対して実質的に直角の角度で配置され、カートリッジアセンブリの第２の組織接触表面の少なくとも大部分は、第２の角度に対して実質的に直角の角度で配置されていることがさらに開示される。
開示される実施形態において、カートリッジアセンブリは、その中に複数の締め具を含む。複数の締め具の各々は、垂直軸に対して平行でも直角でもない角度でカートリッジアセンブリから射出されるように構成されている。
開示される実施形態において、締め付け部材は、アンビルアセンブリを係合するための頂部部分と、カートリッジアセンブリを係合するための底部部分とを含む。頂部部分の最上方表面と底部部分の最下方表面との間に規定される全体の高さは、約１ｍｍと約２．５ｍｍとの間であるか、または約２ｍｍである。
開示される実施形態において、ローディングユニットは、作動そりをさらに含み、この作動そりは、少なくとも部分的にカートリッジアセンブリ内で長手方向に並進可能である。締め付け部材は、アンビルアセンブリを係合するための頂部部分と、カートリッジアセンブリを係合するための底部部分とを含む。底部部分の最下方表面は、作動そりの最上方表面よりも締め付け部材の頂部部分に近い。
本開示はまた、外科手術器具のツールアセンブリとともに使用するためのカートリッジアセンブリに関する。カートリッジアセンブリは、少なくとも部分的にその中に配置されている複数の締め具と、作動そりとを含み、この作動そりは、第１の長手方向軸に沿って、カートリッジアセンブリの中で長手方向に並進するために構成されている。複数の締め具の各々は、第１の長手方向軸に対して非直角の角度で射出されるように構成されている。
開示される実施形態において、作動そりは、Ｖのようなプロフィールを含み、この作動そりは、第１の角度で配置されている第１のカム作用表面と、第２の角度で配置されている第２のカム作用表面とを含む。カートリッジアセンブリが第１の組織接触表面と第２の組織接触表面とを含むことがさらに開示される。第１の組織接触表面の少なくとも大部分は、第１の角度に対して実質的に直角の角度で配置されている。カートリッジアセンブリの第２の組織接触表面の少なくとも大部分は、第２の角度に対して実質的に直角の角度で配置されている。
本開示はまた、外科手術器具に関し、この外科手術器具は、ハンドルアセンブリと、ハンドルアセンブリから遠位方向に延びている細長い本体部分と、細長い本体部分の遠位端との係合のために構成されているローディングユニットとを含む。ローディングユニットは、長手方向軸を規定する近位本体部分と、近位本体部分と機械的に協働して配置されているツールアセンブリとを含む。ツールアセンブリは、カートリッジアセンブリとアンビルアセンブリとを含む。カートリッジアセンブリおよびアンビルアセンブリのうちの少なくとも１つは、カートリッジアセンブリとアンビルアセンブリとの間に組織を係合するために、開いた位置と接近させられた位置との間で他方に対して移動可能である。カートリッジアセンブリは、その中に複数の締め具を収容するように構成されている。ツールアセンブリの直径は、約８ｍｍ未満であるか、または約８ｍｍと等しい。
開示される実施形態において、外科手術器具は、締め付け部材をさらに含み、この締め付け部材は、カートリッジアセンブリおよびアンビルアセンブリと機械的に協働して配置されている。締め付け部材は、垂直軸を規定する垂直部分を含み、この垂直部分は、長手方向軸に対して実質的に直角である。
開示される実施形態において、カートリッジアセンブリは、その中に複数の締め具を含み、複数の締め具の各々は、垂直軸に対して平行でも直角でもない角度でカートリッジアセンブリから射出されるように構成されている。
開示される実施形態において、外科手術器具は、作動そりを含み、この作動そりは、少なくとも部分的にカートリッジアセンブリ内で長手方向に並進可能である。作動そりは、少なくとも２つのカム作用表面を含む。第１のカム作用表面は、長手方向軸および垂直軸を通って延びている面（垂直軸は、この面の中にある）に対して第１の角度で延び、第２のカム作用表面は、この面に対して第２の角度で延びている。第１の角度および第２の角度は、約１５°と約４０°との間、または約２０°と約３５°との間であることがさらに開示される。
本発明は、例えば以下の項目を提供する。
（項目１）
外科手術器具との係合のために構成されているローディングユニットであって、該ローディングユニットは、
長手方向軸を規定する近位本体部分と、
該近位本体部分と機械的に協働して配置されているツールアセンブリであって、該ツールアセンブリは、カートリッジアセンブリとアンビルアセンブリとを含み、該カートリッジアセンブリおよび該アンビルアセンブリのうちの少なくとも１つは、該カートリッジアセンブリと該アンビルアセンブリとの間に組織を係合するために、開いた位置と接近させられた位置との間で他方に対して移動可能であり、該カートリッジアセンブリは、その中に複数の締め具を収容するように構成されており、該ツールアセンブリの直径は、約８ｍｍ未満であるか、または約８ｍｍと等しい、ツールアセンブリと
を含む、ローディングユニット。
（項目２）
上記ツールアセンブリの直径は、約７ｍｍと等しい、上記項目に記載のローディングユニット。
（項目３）
上記近位本体部分の部分の直径は、上記ツールアセンブリの直径と実質的に等しい、上記項目のうちのいずれか一項に記載のローディングユニット。
（項目４）
締め付け部材であって、該締め付け部材は、上記カートリッジアセンブリおよび上記アンビルアセンブリと機械的に協働して配置され、該締め付け部材は、垂直軸を規定する垂直部分を含み、該垂直部分は、上記長手方向軸に対して実質的に直角である、締め付け部材をさらに含む、上記項目のうちのいずれか一項に記載のローディングユニット。
（項目５）
作動そりであって、該作動そりは、少なくとも部分的に上記カートリッジアセンブリ内で長手方向に並進可能であり、該作動そりは、少なくとも２つのカム作用表面を含み、第１のカム作用表面は、上記長手方向軸および上記垂直軸を通って延びている面に対して第１の角度で延び、該垂直軸は、該面の中にあり、第２のカム作用表面は、該面に対して第２の角度で延びている、作動そりをさらに含む、上記項目のうちのいずれか一項に記載のローディングユニット。
（項目６）
上記作動そりは、Ｖのようなプロフィールを含む、上記項目のうちのいずれか一項に記載のローディングユニット。
（項目７）
上記第１の角度および上記第２の角度は、約１５°と約４０°との間である、上記項目のうちのいずれか一項に記載のローディングユニット。
（項目８）
上記第１の角度および上記第２の角度は、約２５°である、上記項目のうちのいずれか一項に記載のローディングユニット。
（項目９）
上記カートリッジアセンブリの第１の組織接触表面の少なくとも大部分は、上記第１の角度に対して実質的に直角の角度で配置され、該カートリッジアセンブリの第２の組織接触表面の少なくとも大部分は、上記第２の角度に対して実質的に直角の角度で配置されている、上記項目のうちのいずれか一項に記載のローディングユニット。
（項目１０）
上記カートリッジアセンブリは、その中に複数の締め具を含み、該複数の締め具の各々は、上記垂直軸に対して平行でも直角でもない角度で該カートリッジアセンブリから射出されるように構成されている、上記項目のうちのいずれか一項に記載のローディングユニット。
（項目１１）
上記締め付け部材は、上記アンビルアセンブリを係合するための頂部部分と、上記カートリッジアセンブリを係合するための底部部分とを含み、該頂部部分の最上方表面と該底部部分の最下方表面との間に規定される全体の高さは、約１ｍｍと約２．５ｍｍとの間である、上記項目のうちのいずれか一項に記載のローディングユニット。
（項目１２）
作動そりであって、該作動そりは、少なくとも部分的に上記カートリッジアセンブリ内で長手方向に並進可能であり、上記締め付け部材は、上記アンビルアセンブリを係合するための頂部部分と、該カートリッジアセンブリを係合するための底部部分とを含み、該底部部分の最下方表面は、該作動そりの最上方表面よりも該締め付け部材の該頂部部分に近い、作動そりをさらに含む、上記項目のうちのいずれか一項に記載のローディングユニット。
（項目１３）
外科手術器具のツールアセンブリとともに使用するための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、
少なくとも部分的にその中に配置されている複数の締め具と、
作動そりであって、該作動そりは、第１の長手方向軸に沿って、該カートリッジアセンブリの中で長手方向に並進するために構成されている、作動そりと
を含み、該複数の締め具の各々は、該第１の長手方向軸に対して非直角の角度で射出されるように構成されている、
カートリッジアセンブリ。
（項目１４）
上記作動そりは、Ｖのようなプロフィールを含み、該作動そりは、第１の角度で配置されている第１のカム作用表面と、第２の角度で配置されている第２のカム作用表面とを含む、上記項目のうちのいずれか一項に記載のカートリッジアセンブリ。
（項目１５）
第１の組織接触表面および第２の組織接触表面であって、該第１の組織接触表面の少なくとも大部分は、上記第１の角度に対して実質的に直角の角度で配置され、上記カートリッジアセンブリの該第２の組織接触表面の少なくとも大部分は、上記第２の角度に対して実質的に直角の角度で配置されている、第１の組織接触表面および第２の組織接触表面をさらに含む、上記項目のうちのいずれか一項に記載のカートリッジアセンブリ。
（項目１６）
外科手術器具であって、該外科手術器具は、
ハンドルアセンブリと、
該ハンドルアセンブリから遠位方向に延びている細長い本体部分と、
カートリッジアセンブリとアンビルアセンブリとを含むツールアセンブリであって、該カートリッジアセンブリおよび該アンビルアセンブリのうちの少なくとも１つは、該カートリッジアセンブリと該アンビルアセンブリとの間に組織を係合するために、開いた位置と接近させられた位置との間で他方に対して移動可能であり、該カートリッジアセンブリは、その中に複数の締め具を収容するように構成されており、該ツールアセンブリの直径は、約８ｍｍ未満であるか、または約８ｍｍと等しい、ツールアセンブリと
を含む、外科手術器具。
（項目１７）
締め付け部材であって、該締め付け部材は、上記カートリッジアセンブリおよび上記アンビルアセンブリと機械的に協働して配置され、該締め付け部材は、垂直軸を規定する垂直部分を含み、該垂直部分は、上記長手方向軸に対して実質的に直角である、締め付け部材をさらに含む、上記項目のうちのいずれか一項に記載の外科手術器具。
（項目１８）
上記カートリッジアセンブリは、その中に複数の締め具を含み、該複数の締め具の各々は、上記垂直軸に対して平行でも直角でもない角度で該カートリッジアセンブリから射出されるように構成されている、上記項目のうちのいずれか一項に記載の外科手術器具。
（項目１９）
作動そりであって、該作動そりは、少なくとも部分的に上記カートリッジアセンブリ内で長手方向に並進可能であり、該作動そりは、少なくとも２つのカム作用表面を含み、第１のカム作用表面は、上記長手方向軸および上記垂直軸を通って延びている面に対して第１の角度で延び、該垂直軸は、該面の中にあり、第２のカム作用表面は、該面に対して第２の角度で延びている、作動そりをさらに含む、上記項目のうちのいずれか一項に記載の外科手術器具。
（項目２０）
上記第１の角度および上記第２の角度は、約１５°と約４０°との間である、上記項目のうちのいずれか一項に記載の外科手術器具。
（項目２１）
外科手術器具であって、該外科手術器具は、
カートリッジアセンブリおよびアンビルアセンブリであって、該カートリッジアセンブリおよび該アンビルアセンブリのうちの少なくとも１つは、該カートリッジアセンブリと該アンビルアセンブリとの間に組織を係合するために、開いた位置と接近させられた位置との間で他方に対して移動可能であり、
該カートリッジアセンブリは、その中に複数の締め具を収容するように構成されている、カートリッジアセンブリおよびアンビルアセンブリと、
ウェッジの形状を有する作動そりと、
該作動そりによって係合されるために、該カートリッジアセンブリに配置されている複数のプッシャーと、
該カートリッジアセンブリおよびアンビルアセンブリを通って並進可能である締め付け部材と、
そりバーであって、該そりバーは、該カートリッジアセンブリを通って並進可能であり、該作動そりを、該カートリッジアセンブリを通って遠位方向に移動させるように構成されており、その結果、該作動そりは、該プッシャーを係合する、そりバーと
を含む、外科手術器具。
（項目２２）
上記締め付け部材は、上記アンビルアセンブリおよびカートリッジアセンブリを上記接近させられた位置に持ってくるために、上記アンビルアセンブリを係合するための上方部分と、上記カートリッジアセンブリを係合するための下方部分とを有する、上記項目のうちのいずれか一項に記載の外科手術器具。
（項目２３）
上記下方部分は、カートリッジチャネルの上方部分を係合する、上記項目のうちのいずれか一項に記載の外科手術器具。
（項目２４）
上記接近させられた位置にある場合、上記カートリッジアセンブリおよびアンビルアセンブリの直径は、約８ｍｍ未満であるか、または約８ｍｍと等しい、上記項目のうちのいずれか一項に記載の外科手術器具。
（項目２５）
上記カートリッジアセンブリは、上記締め付け部材の一方の側において２列の上記締め具を規定し、該締め付け部材の他方の側において２列を規定する、上記項目のうちのいずれか一項に記載の外科手術器具。
（項目２６）
上記プッシャーは、各々、２つのプッシャープレートを有する、上記項目のうちのいずれか一項に記載の外科手術器具。
（項目２７）
上記締め付け部材は、ナイフ刃を有する、上記項目のうちのいずれか一項に記載の外科手術器具。
（項目２８）
上記アンビルアセンブリおよび上記カートリッジアセンブリのうちの少なくとも１つは、非直角の角度を有する、上記項目のうちのいずれか一項に記載の外科手術器具。
（摘要）
外科手術器具との係合のために構成されているローディングユニットが開示される。ローディングユニットは、近位本体部分とツールアセンブリとを含む。近位本体部分は、長手方向軸を規定する。ツールアセンブリは、近位本体部分と機械的に協働して配置されており、カートリッジアセンブリとアンビルアセンブリとを含む。カートリッジアセンブリおよびアンビルアセンブリのうちの少なくとも１つは、カートリッジアセンブリとアンビルアセンブリとの間に組織を係合するために、開いた位置と接近させられた位置との間で他方に対して移動可能である。カートリッジアセンブリは、その中に複数の締め具を収容するように構成されている。ツールアセンブリの直径は、約８ｍｍ未満であるか、または約８ｍｍと等しい。
本開示の外科手術器具およびローディングユニットの種々の実施形態は、図面を参照して本明細書中に開示される。
図１は、本開示の実施形態に従う、第１のハンドルアセンブリを含む外科手術器具の斜視図である。 図２は、本開示の実施形態に従う、第２のハンドルアセンブリを含む外科手術器具の斜視図である。 図３および図４は、本開示に従う、ローディングユニットの斜視図である。 図３および図４は、本開示に従う、ローディングユニットの斜視図である。 図５は、図３および図４のローディングユニットの斜視図であり、関節運動させられた位置に配置されているエンドエフェクターを例示している。 図６は、図２における線６−６を通って得られるエンドエフェクターの部分の半径方向の断面図である。 図７は、図３および図４のローディングユニットの種々の内部構成要素の斜視図である。 図８は、図７に示されるローディングユニットの部分の斜視図である。 図９は、図３および図４のローディングユニットの種々の内部構成要素の斜視図である。 図１０は、図９に示されるローディングユニットの部分の斜視図である。 図１１は、ローディングユニットの部分の組み立て図である。 図１２は、図１１に示されるローディングユニットの部分を例示している。 図１３は、図１１に示されるローディングユニットの部分を例示している。 図１４は、本開示のローディングユニットの部分の斜視図である。 図１５は、図１４に示されるローディングユニットの部分を例示している。 図１６は、図８における線１６−１６に沿って示される場合の、ローディングユニットの部分の長手方向の切断図である。 図１７は、ローディングユニットの部分の長手方向の断面図である。 図１８は、図１７に示されるローディングユニットの部分を例示している。
詳細な説明
本開示の外科手術器具、本開示の外科手術器具との使用のためのローディングユニット、および本開示の外科手術器具との使用のためのカートリッジアセンブリの実施形態が、図面を参照して詳細に記載され、図面において、類似の参照数字は、数枚の図の各々において、対応する要素を表す。当該分野において一般的であるように、用語「近位」は、使用者または操作者、例えば、外科医または医師により近い部分または構成要素を指し、用語「遠位」は、使用者からより遠くに離れた部分または構成要素を指す。
本開示の外科手術器具は、図１および図２において、参照数字１００と示される。一般的に、外科手術器具１００は、ハンドルアセンブリ１１０と、ハンドルアセンブリ１１０から遠位方向に延びている細長い本体部分１２０と、細長い本体部分１２０の遠位端に隣接して配置されているローディングユニット２００とを含む。図１は、第１のハンドルアセンブリ１１０（例えば、動力式ハンドルアセンブリ）を含む外科手術器具１００を例示し、図２は、第２のハンドルアセンブリ１１０を含む外科手術器具１００を例示している。例えば、モーター駆動、液圧式、ラチェットなどのような他のタイプのハンドルが使用され得ることも想定される。本明細書中で用いられる場合、「ハンドルアセンブリ」は、全てのタイプのハンドルアセンブリを包含する。ローディングユニット２００は、例えば、外科手術器具１００がより広い用途を有することを可能にするために、外科手術ステープル留め器具１００の内視鏡部分１２０に取り付け可能である。本明細書中で用いられる場合、「ローディングユニット」は、単回使用ローディングユニット（「ＳＵＬＵ」）および使い捨てローディングユニット（「ＤＬＵ」）の両方を包含する。さらに、または代替的に、外科手術器具１００は、カートリッジを有し得、このカートリッジは、器具の再使用可能な顎において、取り外し可能で交換可能である。
外科手術ステープル留め器具とともに使用するためのローディングユニットの例は、Ｂｏｌａｎｏｓらに対する共有に係る米国特許第５，７５２，６４４号に開示され、その内容全体は、これにより、本明細書中で参考として援用される。内視鏡外科手術ステープル留め器具のさらなる詳細は、Ｍｉｌｌｉｍａｎらに対する共有に係る米国特許第６，９５３，１３９号において詳細に記載され、その内容全体は、これにより、本明細書中で参考として援用される。
本開示に従う外科手術器具１００において、発射ロッドは、ハンドルアセンブリ１１０の作動を通して遠位方向に移動させられて、締め具６００を配備する。図１に例示される実施形態を参照すると、スイッチ１１２の少なくとも部分的な作動は、発射ロッドを長手方向に並進させる。図２に例示される実施形態を参照すると、静止したハンドル１３４に対する移動可能なハンドル１３２の少なくとも部分的な作動は、発射ロッドを長手方向に並進させる。発射ロッドの並進は、ナイフバー１４０の並進およびそりバー１５０の並進をもたらす（例えば、図１７および図１８を参照のこと。図１８を特に参照すると、ナイフバー１４０は、近位セクション１４０ａと遠位セクション１４０ｂとを含み、これらは、一緒につながれている）。さらに、ナイフバー１４０の並進は、締め付け部材５００の並進をもたらして、少なくとも１つの顎部材を他方に対して接近させ、そりバー１５０の並進は、作動そり５２０の並進をもたらして、締め具６００がカートリッジアセンブリ４００のポケット４０１から射出されることをもたらす。
図３〜図５を参照すると、本開示のローディングユニット２００が示されている。ローディングユニット２００は、長手方向軸「Ａ−Ａ」を規定する近位本体部分２１０と、１対の顎部材（すなわち、アンビルアセンブリ３００およびカートリッジアセンブリ４００）を含むツールアセンブリまたはエンドエフェクター２２０とを含む。近位本体部分２１０は、外科手術器具１００の内視鏡部分１２０に取り外し可能に取り付けるように構成されている。より詳しくは、ローディングユニット２００の挿入先端２０２は、外科手術ステープル留め器具１００の内視鏡部分１２０の遠位端の中に線形に挿入される。挿入先端２０２のナブ２０４は、内視鏡部分１２０の遠位端に隣接して形成されるスロットを通って線形に移動する。その後、ローディングユニット２００は、ナブ２０４が内視鏡部分１２０内のスロットを通って横切って移動するように、長手方向軸「Ａ−Ａ」の周りに回転させられる。さらに、ローディングユニット２００と内視鏡部分１２０との係合中、ハンドル部分１１０の発射ロッドは、ローディングユニット２００のナイフバー１４０を係合する。
図６を参照すると、締め付け部材５００は、Ｉの形をした断面を含み、この締め付け部材５００は、アンビルアセンブリ３００を係合するように構成されている頂部部分５０２と、カートリッジアセンブリ４００を係合するように構成されている底部部分５０４と、垂直部分５０３とを含み、この垂直部分５０３は、頂部部分５０２と底部部分５０４とを接続し、その遠位表面において切断エッジ５０６を含み得る。より詳しくは、締め付け部材５００の底部部分５０４とカートリッジアセンブリ４００との間の係合は、アンビルアセンブリ３００およびカートリッジアセンブリ４００の互いに対する相対的な位置を維持することを助ける。
作動そり５２０にさらに関して、作動そり５２０の遠位方向の並進は、その後、複数のプッシャー５４０を係合し、プッシャー５４０がカートリッジアセンブリ４００のそれぞれの組織接触表面４１０に向かって移動することをもたらし、アンビルアセンブリ３００に向かって締め具６００を射出することをもたらす。締め具６００の射出後、ステープル留めされた組織を切断するために、締め付け部材５００の切断エッジ５０６が、その遠位面に含まれ得る。
図６〜図１８を参照すると、ローディングユニット２００のさらなる詳細が例示されている。一般に、本明細書中に開示されるローディングユニット２００の特徴は、約１２ｍｍの直径を有する器具と比較される場合、ローディングユニット２００が比較的小さい直径（例えば、７ｍｍ〜８ｍｍ）を有することを可能にする。ローディングユニット２００の直径は、アンビルアセンブリ３００の半径方向に最も外側の壁とカートリッジアセンブリ４００の半径方向に最も外側の壁との間で測定される（図６を参照のこと）。そのような低プロフィールは、ローディングユニット２００が同様の直径を有するトロカールの中に挿入されることを可能にする。認識され得るように、これらの低プロフィールローディングユニット２００は、例えば、小児科の外科手術および／または他の薄い組織の場所において有用である。さらに、例示される実施形態において、ローディングユニット２００の近位本体部分２１０の近位部分２１２は、より大きい直径の細長い部分１２０（例えば、約１２ｍｍ）を有する外科手術器具の細長い部分を係合するようなサイズおよび構成にされており、従って、より広い用途を可能にする。
図６を特に参照すると、ローディングユニット２００の半径方向の断面が、遠位端から示されている。示されるように、プッシャー５４０、締め具６００、アンビルアセンブリ３００の組織接触表面３１０、およびカートリッジアセンブリの組織接触表面４１０は、面Ｃ−Ｃに対して非直角の角度で配置されている（図８）。面Ｃ−Ｃは、長手方向軸Ａ−Ａを通って、および垂直軸Ｂ−Ｂを通って延びており、垂直軸Ｂ−Ｂは、締め付け部材５００の垂直部分５０３によって規定される。さらに、垂直軸Ｂ−Ｂは、面Ｃ−Ｃ内にある。これらの非直角の角度、および締め付け部材５００の相対的な低プロフィール（より大きい（例えば、１２ｍｍ）器具の締め付け部材と比較される場合）は、例えば、ローディングユニット２００が小さい直径を有することを可能にすることを助ける。締め付け部材５００の全体の高さは、約１ｍｍと約２．５ｍｍとの間であるか、または約２ｍｍであることが想定される。
図６をさらに参照すると、ならびに図１１〜図１３および図１７〜図１８をさらに参照すると、ローディングユニット２００のさらなる詳細が示されている。図１７および図１８を特に参照すると、ローディングユニット２００の断面が示されており、この断面は、ナイフバー１４０、そりバー１５０、アンビルアセンブリ３００、カートリッジアセンブリ４００、締め付け部材５００、および作動そり５２０を含む。図６および図１２を特に参照すると、カートリッジアセンブリ４００は、カートリッジ４０８（２つの半体を含む）とカートリッジチャネル４０９とを含む。カートリッジ４０８は、カートリッジチャネル４０９内に配置されている。
使用において、発射ロッドの遠位方向の並進は、上で議論されるように、ナイフバー１４０を遠位方向に並進させる。さらに、ナイフバー１４０の遠位方向の並進は、ナイフバー１４０の突出部１４３（図１７を参照のこと）が、そりバー１５０の近位面１５１と接触することをもたらし、それにより、そりバー１５０の遠位方向の並進をもたらす。そりバー１５０が遠位方向に移動する場合、そりバー１５０の遠位面１５２は、カートリッジアセンブリ４００のカム作用表面４０２と接触し、それにより、カートリッジアセンブリ４００がアンビルアセンブリ３００に向かって移動することをもたらす。さらに、ナイフバー１４０が遠位方向に移動する場合、締め付け部材５００の頂部部分５０２は、アンビルアセンブリ３００内のスロット３０４内で遠位方向に前進させられ、締め付け部材５００の底部部分５０４は、カートリッジアセンブリ４００のカートリッジチャネル４０９内のスロット４１４内で遠位方向に前進させられて、顎部材を互いに対して安定にすることを助け、顎部材の間に一定のギャップを維持することを助ける。従って、所定の量の発射ロッドの遠位方向の移動は、顎部材の接近および安定化をもたらす。
発射ロッドおよび従ってナイフバー１４０の引き続きの前進は、作動そり５２０の近位面５２２へのそりバー１５０の引き続きの前進をもたらし、作動そり５２０の遠位方向の移動をもたらす。作動そり５２０が遠位方向に前進する場合、その角度を付けたカム作用表面５２４（図６および図１２を参照のこと）は、プッシャー５４０のカム作用表面と接触し、従って、プッシャー５４０が締め具６００を係合することをもたらし、その後、（例えば、顎部材の間に保持される組織を通して）アンビルアセンブリ３００のそれぞれのポケット３２０に向けて締め具６００を射出することをもたらす。（例えば、図６において）示されるように、作動そり５２０は、実質的にＶの形をしたプロフィールを含む。（例えば、図１２において）示されるように、各プッシャー５４０は、コネクター５４２によって相互接続されている２つの長手方向に間隔が空けられた締め具接触部分またはプッシャープレート５４４を含む。さらに、発射ロッドの引き続きの前進はまた、ナイフバー１４０および締め付け部材５００の引き続きの前進をもたらし、その結果、締め付け部材５００の頂部部分５０２がアンビルアセンブリ３００のスロット３０４内を移動し続け、締め付け部材５００の底部部分５０４がカートリッジチャネル４０９のスロット４１４内を移動し続ける。さらに、締め付け部材５００の切断エッジ５０６は、締め付け部材５００に含まれる場合、顎部材の間に配置されている（および上で議論されるように、組織が締められた後の）組織を切断する。そりカムは、ほぼ同時に４列のステープル全てを発射して、ナイフが組織を切断する直前にナイフスロットの両側における組織を密封するように望ましく配置されている。
示されるように、および上で議論されるように、ローディングユニット２００の種々の特徴は、ローディングユニットおよび顎部材の小さい直径（例えば、７ｍｍ）を可能にするようなサイズおよび配向にされている。特に、作動そり５２０のカム作用表面５２４、プッシャー５４０、ポケット４０１、および締め具６００は、（長手方向軸Ａ−Ａを通って延びている）垂直軸Ｂ−Ｂに対して第１の非直角の角度（例えば、約１５°と約４０°との間、または約２０°と約３５°との間）で配置されている。さらに、アンビルアセンブリ３００の組織接触表面３１０およびカートリッジアセンブリ４００の組織接触表面４１０は、それぞれ、対応する第２の非直角の角度で配置され、その結果、組織接触表面３１０は、組織接触表面４１０に対して、それぞの表面の各々の全長の少なくとも大部分に沿って、実質的に平行であり、第１の非直角の角度および第２の非直角の角度は、互いに対して実質的に直角である（すなわち、締め具６００は、例えば、アンビル３００の組織接触表面３１０の角度と実質的に直角である角度で配置されている）。さらに、締め付け部材５００は、作動そり５２０のカム作用表面５２４とプッシャー５４０との間の角度によって形成される空間内に配置されている（図６を参照のこと）。
次に図５、図７、図８、図１１、図１３、および図１６を参照すると、外科手術器具１００の関節運動機構が示されている。関節運動機構は、ローディングユニット２００のエンドエフェクター２２０が近位本体部分２１０に対して旋回できることを可能にする（図５を参照のこと）。関節運動機構は、細長い本体部分１２０に隣接して配置されている関節運動レバー７００（図１および図２を参照のこと）と、関節運動レバー７００と機械的に協働して配置されている関節運動リンクと、関節運動リンクと係合可能である関節運動ロッド７１０であって、この関節運動ロッド７１０は、ローディングユニット２００の近位本体部分２１０を通って延び、エンドエフェクター２２０の近位部分２２２の関節運動ピン２２３と係合する、関節運動ロッド７１０と、ローディングユニット２００の近位本体部分２１０とエンドエフェクター２２０との間に配置されている旋回アセンブリ７２０とを含む。図１３を特に参照すると、旋回アセンブリ７２０は、リンク７２２を含み、このリンク７２２は、近位本体部分２１０のスタビライザー７２４とエンドエフェクター２２０の近位部分２２２のリンクピン２２４（図１６）とを旋回可能に連結する。さらに、１対のクリップ７３０は、近位本体部分２１０とエンドエフェクター２２０との間に延びている。図８に示されるように、ナイフバー１４０は、クリップ７３０の間に延びている。特定の実施形態において、クリップは、ブローアウトプレートとして機能し、このプレートは、デバイスに固定されている端を有する。
使用において、第１の方向（例えば、反時計回り）への関節運動レバー７００の回転は、関節運動リンクおよび関節運動ロッド７１０の遠位方向の移動をもたらし、従って、エンドエフェクター２２０が、近位本体部分２１０に対して第１の方向（例えば、図５における矢印「Ｃ」）に旋回することをもたらし、第２の方向（例えば、時計回り）への関節運動レバー７００の回転は、関節運動リンクおよび関節運動ロッド７１０の近位移動をもたらし、従って、エンドエフェクター２００が、近位本体部分２１０に対して第２の方向（例えば、矢印「Ｃ」の逆）に旋回することをもたらす。
本開示は、本明細書中で議論されるように、外科手術器具１００、ローディングユニット２００および／またはカートリッジアセンブリ４００を用いる方法も含む。
上の記載は、多くの詳細を含むが、これらの詳細は、本開示の範囲において限定するものと解釈されるべきではなく、単に、その種々の実施形態の例示と解釈されるべきである。従って、上の記載は、限定するものではなく、単に種々の実施形態の例証と解釈されるべきである。当業者は、ここに添付される特許請求の範囲の趣旨および範囲内で他の改変を想定する。
１００ 外科手術器具
２００ ローディングユニット
２１０ 近位本体部分
３００ アンビルアセンブリ
４００ カートリッジアセンブリ

Claims (15)

  1. 外科手術器具との係合のために構成されているローディングユニットであって、該ローディングユニットは、
    長手方向軸を規定する近位本体部分と、
    該近位本体部分と機械的に協働して配置されているツールアセンブリであって、該ツールアセンブリは、カートリッジアセンブリとアンビルアセンブリとを含み、該カートリッジアセンブリおよび該アンビルアセンブリのうちの少なくとも１つは、該カートリッジアセンブリと該アンビルアセンブリとの間に組織を係合するために、開いた位置と接近させられた位置との間で他方に対して移動可能であり、該カートリッジアセンブリは、その中に複数の締め具を収容するように構成されており、該ツールアセンブリの直径は、約８ｍｍ未満であるか、または約８ｍｍと等しい、ツールアセンブリと
    を含む、ローディングユニット。
  2. 前記ツールアセンブリの直径は、約７ｍｍと等しい、請求項１に記載のローディングユニット。
  3. 前記近位本体部分の部分の直径は、前記ツールアセンブリの直径と実質的に等しい、請求項１に記載のローディングユニット。
  4. 締め付け部材であって、該締め付け部材は、前記カートリッジアセンブリおよび前記アンビルアセンブリと機械的に協働して配置され、該締め付け部材は、垂直軸を規定する垂直部分を含み、該垂直部分は、前記長手方向軸に対して実質的に直角である、締め付け部材をさらに含む、請求項１に記載のローディングユニット。
  5. 作動そりであって、該作動そりは、少なくとも部分的に前記カートリッジアセンブリ内で長手方向に並進可能であり、該作動そりは、少なくとも２つのカム作用表面を含み、第１のカム作用表面は、前記長手方向軸および前記垂直軸を通って延びている面に対して第１の角度で延び、該垂直軸は、該面の中にあり、第２のカム作用表面は、該面に対して第２の角度で延びている、作動そりをさらに含む、請求項４に記載のローディングユニット。
  6. 前記作動そりは、Ｖのようなプロフィールを含む、請求項５に記載のローディングユニット。
  7. 前記第１の角度および前記第２の角度は、約１５°と約４０°との間である、請求項５に記載のローディングユニット。
  8. 前記第１の角度および前記第２の角度は、約２５°である、請求項５に記載のローディングユニット。
  9. 前記カートリッジアセンブリの第１の組織接触表面の少なくとも大部分は、前記第１の角度に対して実質的に直角の角度で配置され、該カートリッジアセンブリの第２の組織接触表面の少なくとも大部分は、前記第２の角度に対して実質的に直角の角度で配置されている、請求項５に記載のローディングユニット。
  10. 前記カートリッジアセンブリは、その中に複数の締め具を含み、該複数の締め具の各々は、前記垂直軸に対して平行でも直角でもない角度で該カートリッジアセンブリから射出されるように構成されている、請求項４に記載のローディングユニット。
  11. 前記締め付け部材は、前記アンビルアセンブリを係合するための頂部部分と、前記カートリッジアセンブリを係合するための底部部分とを含み、該頂部部分の最上方表面と該底部部分の最下方表面との間に規定される全体の高さは、約１ｍｍと約２．５ｍｍとの間である、請求項４に記載のローディングユニット。
  12. 作動そりであって、該作動そりは、少なくとも部分的に前記カートリッジアセンブリ内で長手方向に並進可能であり、前記締め付け部材は、前記アンビルアセンブリを係合するための頂部部分と、該カートリッジアセンブリを係合するための底部部分とを含み、該底部部分の最下方表面は、該作動そりの最上方表面よりも該締め付け部材の該頂部部分に近い、作動そりをさらに含む、請求項４に記載のローディングユニット。
  13. 外科手術器具のツールアセンブリとともに使用するための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、
    少なくとも部分的にその中に配置されている複数の締め具と、
    作動そりであって、該作動そりは、第１の長手方向軸に沿って、該カートリッジアセンブリの中で長手方向に並進するために構成されている、作動そりと
    を含み、該複数の締め具の各々は、該第１の長手方向軸に対して非直角の角度で射出されるように構成されている、
    カートリッジアセンブリ。
  14. 前記作動そりは、Ｖのようなプロフィールを含み、該作動そりは、第１の角度で配置されている第１のカム作用表面と、第２の角度で配置されている第２のカム作用表面とを含む、請求項１３に記載のカートリッジアセンブリ。
  15. 第１の組織接触表面および第２の組織接触表面であって、該第１の組織接触表面の少なくとも大部分は、前記第１の角度に対して実質的に直角の角度で配置され、前記カートリッジアセンブリの該第２の組織接触表面の少なくとも大部分は、前記第２の角度に対して実質的に直角の角度で配置されている、第１の組織接触表面および第２の組織接触表面をさらに含む、請求項１４に記載のカートリッジアセンブリ。
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