JP2014205052A - 関節運動および発射力メカニズム - Google Patents
関節運動および発射力メカニズム Download PDFInfo
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- 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
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- 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
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- 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
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Abstract
【課題】ある角度を回って発射力または駆動力を伝動することが可能である外科ステープリング器具を提供する。
【解決手段】ハンドル12から遠位方向に延在する細長い管状部材16を有し、該細長い管状部材は、近位部分34と、遠位部分32と、関節運動セクション30とを有し、該関節運動セクションは、該遠位部分と該近位部分との間に配置され、該関節運動セクションは、該遠位部分が該近位部分に対して動くことを可能にする、ハンドル部材と、該近位部分に配置された駆動要素と、該遠位部分の中に配置された伝達バーと、該関節運動セクションに配置された伝達デバイスとを含む駆動力メカニズムであって、該伝達デバイスは、該駆動要素から駆動力を受け入れ、該関節運動セクションを回って、該伝達バーに向かって該駆動力を再配向し、該伝達デバイスは、該関節運動セクションに回転可能に据え付けられている、駆動力メカニズムとを備えている。
【選択図】図1
【解決手段】ハンドル12から遠位方向に延在する細長い管状部材16を有し、該細長い管状部材は、近位部分34と、遠位部分32と、関節運動セクション30とを有し、該関節運動セクションは、該遠位部分と該近位部分との間に配置され、該関節運動セクションは、該遠位部分が該近位部分に対して動くことを可能にする、ハンドル部材と、該近位部分に配置された駆動要素と、該遠位部分の中に配置された伝達バーと、該関節運動セクションに配置された伝達デバイスとを含む駆動力メカニズムであって、該伝達デバイスは、該駆動要素から駆動力を受け入れ、該関節運動セクションを回って、該伝達バーに向かって該駆動力を再配向し、該伝達デバイスは、該関節運動セクションに回転可能に据え付けられている、駆動力メカニズムとを備えている。
【選択図】図1
Description
(関連出願の引用)
この出願は、2007年11月6日出願の米国仮特許出願第60/985,663号の利益と優先権とを主張し、その全開示が、本明細書において参考として援用される。
この出願は、2007年11月6日出願の米国仮特許出願第60/985,663号の利益と優先権とを主張し、その全開示が、本明細書において参考として援用される。
(技術分野)
本開示は、外科器具における使用のための発射力メカニズムに関する。さらに詳細には、本開示は、外科ステープリング器具の中で、ある角度を回って発射力または駆動力を伝動することが可能である発射力メカニズムに関する。
本開示は、外科器具における使用のための発射力メカニズムに関する。さらに詳細には、本開示は、外科ステープリング器具の中で、ある角度を回って発射力または駆動力を伝動することが可能である発射力メカニズムに関する。
様々な外科器具が、体腔内で手術を行うために、当該分野において公知である。これらの器具の一定のものが、患者の体のアクセス開口部を通過するように構成されている。器具のハンドル部分は、体の外側に残っているが、器具の細長い部分は、出入り口を通過して体腔の中に進む。これらのタイプのデバイスが利用されるときには、体の外側からの器具のハンドル部分の操作によって、体の中の細長い部分の遠位端を配向することは、多くの場合に困難である。
独自の器具が開発されており、該独自の器具は、体に入る器具の細長い部分が、体の外側の、器具のハンドル部分の位置とは無関係に、体の中で曲げたり、動いたりすることを可能にする。これらの「関節運動」外科器具は、様々なメカニズムを利用することにより、細長い部分を体の中で曲げたり、再配向したりさせる。
器具の細長い部分が、体の中で曲げられたり、再配向されたりすることは、比較的容易であるが、屈曲部を回って、そして、細長い部分と関連付けられたエンドエフェクタに作動または駆動力を伝動する能力が、問題を提起する。これらの問題は、駆動要素が細長い部分における屈曲部を回って通過するときの、駆動要素の反りまたは曲がりに起因する力の損失などを含む。
ハンドルから遠位方向に延在している細長い管状部材を含む外科器具が提供される。細長い管状部材は、近位部分と、遠位部分と、関節運動セクションとを有し、該関節運動セクションは、遠位部分と近位部分との間に配置されている。関節運動セクションは、遠位部分が近位部分に対して動くことを可能にする。
駆動力メカニズムが、外科器具に提供され、そして、近位部分に配置された駆動要素と、遠位端に配置され伝達バーと、関節運動セクションに配置された伝達デバイスとを含む。伝達デバイスは、駆動要素から駆動力を受け入れ、そして、関節運動セクションを回って、そして、伝達バーに向かって駆動力を再配向する。伝達デバイスは、関節運動セクションに回転可能に据え付けられている。
伝達デバイスは、関節運動セクションに回転可能に据え付けられている。一実施形態において、駆動要素は、関節運動の部分に回転可能に据え付けられた歯車である。駆動要素は、ラックを含み、該ラックは、ラックの長手方向の動きに応答して歯車を回転させるように歯車と係合可能である。伝達バーは、歯車と係合可能なラックを含むので、歯車の回転が、遠位部分内で長手方向に伝達バーを動かす。
代替の実施形態において、伝達デバイスは、関節運動セクションに回転可能に据え付けられた少なくとも1つのホイルを含む。駆動要素は、可撓性ケーブルであり、該可撓性ケーブルは、少なくとも1つのホイルの周りを通っている。駆動メカニズムは、前記遠位部分に回転可能に据え付けられたトグルを含み、トグルの第1の端が、伝達バーに接続されている。トグルの第2の端は、ケーブルに接続されている。ケーブルは、上側セクションと下側セクションとを含み、上側セクションは、トグルの第1の端に接続され、下側セクションは、トグルの第2の端に接続されている。
外科器具は、さらに、遠位端に配置されたアクチュエータを含むことにより、外科器具と関連付けられたエンドエフェクタを動作させる。伝達バーは、アクチュエータと係合可能であり、かつ、アクチュエータと係合可能な駆動歯を含む。
特定の実施形態において、駆動歯は、アクチュエータと解放可能に係合可能である。アクチュエータは、複数のアバットメントを含み、駆動歯は、アバットメントと係合可能な駆動面を含む。駆動歯はまた、近位傾斜面を含み、該近位傾斜面は、アバットメントと係合可能であることにより、アバットメントから駆動歯を係合解除する。
したがって、本発明は、以下の項目を提供する。
(項目1)
外科器具であって、
ハンドルであって、該ハンドルから遠位方向に延在する細長い管状部材を有し、該細長い管状部材は、近位部分と、遠位部分と、関節運動セクションとを有し、該関節運動セクションは、該遠位部分と該近位部分との間に配置され、該関節運動セクションは、該遠位部分が該近位部分に対して動くことを可能にする、ハンドル部材と、
該近位部分に配置された駆動要素と、該遠位部分の中に配置された伝達バーと、該関節運動セクションに配置された伝達デバイスとを含む駆動力メカニズムであって、該伝達デバイスは、該駆動要素から駆動力を受け入れ、そして、該関節運動セクションを回って、そして、該伝達バーに向かって該駆動力を再配向し、該伝達デバイスは、該関節運動セクションに回転可能に据え付けられている、駆動力メカニズムと
を備えている、外科器具。
外科器具であって、
ハンドルであって、該ハンドルから遠位方向に延在する細長い管状部材を有し、該細長い管状部材は、近位部分と、遠位部分と、関節運動セクションとを有し、該関節運動セクションは、該遠位部分と該近位部分との間に配置され、該関節運動セクションは、該遠位部分が該近位部分に対して動くことを可能にする、ハンドル部材と、
該近位部分に配置された駆動要素と、該遠位部分の中に配置された伝達バーと、該関節運動セクションに配置された伝達デバイスとを含む駆動力メカニズムであって、該伝達デバイスは、該駆動要素から駆動力を受け入れ、そして、該関節運動セクションを回って、そして、該伝達バーに向かって該駆動力を再配向し、該伝達デバイスは、該関節運動セクションに回転可能に据え付けられている、駆動力メカニズムと
を備えている、外科器具。
(項目2)
上記駆動要素は、関節運動の部分に回転可能に据え付けられた歯車である、項目1に記載の外科器具。
上記駆動要素は、関節運動の部分に回転可能に据え付けられた歯車である、項目1に記載の外科器具。
(項目3)
上記駆動要素は、ラックを含み、該ラックは、該ラックの長手方向の動きに応答して上記歯車を回転させるように該歯車と係合可能である、項目2に記載の外科器具。
上記駆動要素は、ラックを含み、該ラックは、該ラックの長手方向の動きに応答して上記歯車を回転させるように該歯車と係合可能である、項目2に記載の外科器具。
(項目4)
上記伝達バーは、上記歯車と係合可能なラックを含むので、該歯車の回転が、上記遠位部分内で長手方向に該伝達バーを動かす、項目2に記載の外科器具。
上記伝達バーは、上記歯車と係合可能なラックを含むので、該歯車の回転が、上記遠位部分内で長手方向に該伝達バーを動かす、項目2に記載の外科器具。
(項目5)
上記伝達デバイスは、上記関節運動セクションに回転可能に据え付けられた少なくとも1つのホイルを含む、項目1に記載の外科器具。
上記伝達デバイスは、上記関節運動セクションに回転可能に据え付けられた少なくとも1つのホイルを含む、項目1に記載の外科器具。
(項目6)
上記駆動要素は、可撓性ケーブルであり、該可撓性ケーブルは、上記少なくとも1つのホイルの周りを通っている、項目5に記載の外科器具。
上記駆動要素は、可撓性ケーブルであり、該可撓性ケーブルは、上記少なくとも1つのホイルの周りを通っている、項目5に記載の外科器具。
(項目7)
上記駆動メカニズムは、上記遠位部分に回転可能に据え付けられた回転部材を含み、該回転部材の第1の端が、上記伝達バーに接続されている、項目6に記載の外科器具。
上記駆動メカニズムは、上記遠位部分に回転可能に据え付けられた回転部材を含み、該回転部材の第1の端が、上記伝達バーに接続されている、項目6に記載の外科器具。
(項目8)
上記回転部材は、レバー、リンク、および歯止めから成る群から選択される、項目7に記載の外科器具。
上記回転部材は、レバー、リンク、および歯止めから成る群から選択される、項目7に記載の外科器具。
(項目9)
上記回転部材の第2の端は、上記ケーブルに接続されている、項目7に記載の外科器具。
上記回転部材の第2の端は、上記ケーブルに接続されている、項目7に記載の外科器具。
(項目10)
上記ケーブルは、上側セクションと下側セクションとを含み、該上側セクションは、上記回転部材の上記第1の端に接続され、該下側セクションは、該回転部材の上記第2の端に接続されている、項目9に記載の外科器具。
上記ケーブルは、上側セクションと下側セクションとを含み、該上側セクションは、上記回転部材の上記第1の端に接続され、該下側セクションは、該回転部材の上記第2の端に接続されている、項目9に記載の外科器具。
(項目11)
上記外科器具は、上記遠位端に配置されたアクチュエータを含むことにより、該外科器具と関連付けられたエンドエフェクタを動作させ、上記伝達バーは、該アクチュエータと係合可能である、項目1に記載の外科器具。
上記外科器具は、上記遠位端に配置されたアクチュエータを含むことにより、該外科器具と関連付けられたエンドエフェクタを動作させ、上記伝達バーは、該アクチュエータと係合可能である、項目1に記載の外科器具。
(項目12)
上記伝達バーは、上記アクチュエータと係合可能な駆動歯を含む、項目11に記載の外科器具。
上記伝達バーは、上記アクチュエータと係合可能な駆動歯を含む、項目11に記載の外科器具。
(項目13)
上記駆動歯は、上記アクチュエータと解放可能に係合可能である、項目12に記載の外科器具。
上記駆動歯は、上記アクチュエータと解放可能に係合可能である、項目12に記載の外科器具。
(項目14)
上記アクチュエータは、複数のアバットメントを含み、上記駆動歯は、該アバットメントと係合可能な駆動面を含む、項目13に記載の外科器具。
上記アクチュエータは、複数のアバットメントを含み、上記駆動歯は、該アバットメントと係合可能な駆動面を含む、項目13に記載の外科器具。
(項目15)
上記アバットメントは、窓、ノッチ、ピン、および歯から成る群から選択される項目14に記載の外科器具。
上記アバットメントは、窓、ノッチ、ピン、および歯から成る群から選択される項目14に記載の外科器具。
(項目16)
上記駆動歯は、近位傾斜面を含み、該近位傾斜面は、上記アバットメントと係合可能であることにより、該アバットメントから該駆動歯を係合解除する、項目14に記載の外科器具。
(摘要)
駆動力メカニズムを組み込んでいる外科器具が提供され、該駆動力メカニズムは、外科器具の関節運動させられたセクションを通過して駆動力を伝動することが可能である。一連のラックが、伝達歯車と接続することにより、関節運動させられたセクションを周って力を伝える。代替の実施形態において、一連のケーブルセクションと、ホイルまたは滑車とが、提供されることにより、外科器具の関節運動させられたセクションを通って駆動力を伝動する。
上記駆動歯は、近位傾斜面を含み、該近位傾斜面は、上記アバットメントと係合可能であることにより、該アバットメントから該駆動歯を係合解除する、項目14に記載の外科器具。
(摘要)
駆動力メカニズムを組み込んでいる外科器具が提供され、該駆動力メカニズムは、外科器具の関節運動させられたセクションを通過して駆動力を伝動することが可能である。一連のラックが、伝達歯車と接続することにより、関節運動させられたセクションを周って力を伝える。代替の実施形態において、一連のケーブルセクションと、ホイルまたは滑車とが、提供されることにより、外科器具の関節運動させられたセクションを通って駆動力を伝動する。
本開示の駆動力メカニズムの様々な実施形態が、図面を参照して本明細書において開示されている。
図1は、駆動力メカニズムの第1の実施形態を組み込む関節運動外科ステープラの斜視図である。
図2は、図1の外科ステープラのハンドルアセンブリの、部分的に断面で示された側面図である。
図3は、未作動位置における、図1の外科ステープラの遠位端部分の、部分的に断面で示された拡大斜視図である。
図4は、図1の外科器具の力伝達コンポーネントの斜視図である。
図5は、関節運動された位置において示され、組織切断部の周りに配置された、図1の外科ステープラの遠位端部分の、部分的に断面で示された斜視図である。
図6は、外科ステープラの作動中の、図5と同様な斜視図である。
図7は、外科ステープラのさらなる作動のために再設置された駆動力メカニズムの一部分を例示している拡大斜視図である。
図8は、最初の作動の間の、外科ステープラのステープルカートリッジとアンビルとの、部分的に断面で示された拡大側面図である。
図9は、組織切断部をステープリングするために外科ステープラのさらなる作動を例示している、図8と同様な拡大側面図である。
図10は、駆動力メカニズムの代替の実施形態を組み込んでいる外科ステープラのハンドルアセンブリの、部分的に断面で示された側面図である。
図11は、関節運動されていない位置において示された、図10の外科ステープラの遠位端部分の、部分的に断面で示された斜視図である。
図12は、関節運動された位置において示され、組織の周りに配置された、図10の外科ステープルの遠位端部分の、部分的に断面で示された斜視図である。
図13は、作動中の、図12と同様な斜視図である。
図14は、さらなる作動のために再設置している駆動力メカニズムの一部分の拡大斜視図である。
外科器具における使用のための、本開示の駆動力メカニズムの実施形態が、ここで、図面を参照して詳細に記述される。図面においては、同様な参照番号は、いくつかの図面のそれぞれにおいて、同様な要素または対応する要素を示す。当該分野において一般的であるように、用語「近位」は、ユーザまたはオペレータ、すなわち、外科医または医師により近い部分またはコンポーネントを指すが、用語「遠位」は、ユーザからより遠くに離れた部分またはコンポーネントを指す。
図1は、駆動力メカニズムの一実施形態を組み込んでいる外科ステープラ10を例示する。外科ステープラ10は、概して、ハンドル12と、ハンドル12から遠位方向に延在している遠位端部分14とを含む。遠位端部分14は、内視鏡的使用のために構成され、ハンドル12の遠位端18から延在している細長い管状部材16を含む。顎アセンブリ20が、細長い管状部材16の遠位端22に据え付けられ、そして、ステープルカートリッジ24とアンビル26とを含む。アンビル26は、ステープルカートリッジから間隔を空けられた開位置とステープルカートリッジ24に実質的に隣接した閉位置との間で動くように据え付けられている。トリガ28がハンドル12に提供されることにより、顎アセンブリ20を作動させる。
外科ステープラ10は、細長い管状部材16における関節運動セクション30の周りで屈曲または関節運動することが可能であるタイプの外科器具である。関節運動セクション30は、細長い管状部材16に沿ってほぼ中間に配置され、細長い管状部材16を遠位部分32と近位部分34とに分けている。細長い管状部材16は、関節運動セクション30の軸「A」の周りで角度αにわたって屈曲する。関節運動アクチュエータ36が、ハンドル12に提供されることにより、(図1および図2に示された)軸Aの周りで近位部分34に対して遠位部分32を動かす。関節運動アクチュエータ36は、アーティキュレータ(articulator)40およびアーティキュレータ42とを動かし、該アーティキュレータ40および該アーティキュレータ42は、関節運動アクチュエータ36から関節運動セクション30に延在している。(図5を参照すると)明確には示されていないが、軸Aの周りで角度αにわたる、細長い管状部材16の近位部分34に対する細長い管状部材16の遠位部分32の、角度のある運動をもたらすことが可能である様々なメカニズムが、当該分野において公知である。例えば、連動装置、可撓性バンド、歯車などである。特定の実施形態において、角度αは、近位部分34の長手方向軸から約0°から約90°、またはそれ以上までの間であり得る。
組織に対して顎アセンブリ20を適切に配向するために、外科ステープラ10は、ハンドル12に回転可能に据え付けられた回転ノブ44を含む。細長い管状部材16は、回転ノブ44の円錐頭部分46に据え付けられ、ふしくれだった部分48が、回転ノブ44に提供されることにより、ハンドル12に対する遠位端部分14の回転を容易にする。
図2を参照すると、ドライバ50が、ハンドル12の中での長手方向の運動のために据え付けられている。一対の誘導レール52および誘導レール54がハンドルに提供されることにより、ドライバ50を支持する。上記のように、トリガ28は、顎アセンブリ20を作動させるように提供される。トリガ28は、ハンドル20に形成された旋回ポスト56に旋回するように据え付けられている。トリガ28の上端58は、旋回ピン60によってドライバ50に接続されている。トリガ28の運動が、ハンドル12の中でドライバ50を移動させることにより、顎アセンブリ20を作動させる。戻りバネ62は、旋回ポスト56の上に配置され、かつ、第1の端64において、ハンドル12に形成された突起66と係合可能である。誘導バネ64の第2の端68がトリガ28を係合することにより、開位置または未発射位置にトリガ28を付勢する。
上記のように、外科ステープラ10は、トリガ28から顎アセンブリ20に作動力を伝達するために駆動力メカニズムを含む。駆動力メカニズムは、細長い管状部材16の近位部分34の中に提供された駆動バー70を含む。駆動バー70は、駆動バー70の近位端72において、ハンドル12に回転可能に据え付けられた回転カラー74に接続されている。回転カラー74は、ドライバ50の遠位端76に接続されている。遠位端部分14が、回転ノブ44の操作によって回転させられたときに、回転カラー74は、駆動ロッド70および他の駆動力メカニズムコンポーネントが、回転することを可能にするために提供される。
ここで図3を参照すると、駆動ロッド70は、近位部分34を通って関節運動セクション30に延在している。駆動ロッド70の遠位端78は、第1のラック80を含むことにより、関節運動セクション30を回って、そして、関節運動セクション30を通って駆動力を伝達することを容易にする。駆動ロッド70は、誘導チューブ82を通って経路を定められ、該誘導チューブ82が、細長い管状部材16の近位部分34の中に据え付けられることにより、関節運動コンポーネントから駆動メカニズムコンポーネントを分ける。関節運動セクション30を通って駆動力を伝達するために、伝達デバイス30、例えば、伝達歯車84が、関節運動セクション30の中で中央スピンドル86に回転可能に据え付けられている。中央スピンドル86は、軸Aに沿って関節運動セクション30の中に据え付けられている。伝達歯車84は、以下で考察されるように駆動ロッド70と係合可能である。伝達バー88は、細長い管状部材16の遠位部分32の中に提供され、そして、駆動ロッド70から受け入れられた力を顎アセンブリ20に伝達するように提供される。伝達バー88は、伝達バー88の遠位端92において第2のラック90を含み、該第2のラック90は、伝達歯車84と係合可能である。伝達バー88の遠位端94は、駆動歯96において終端している。
図4を参照すると、第1のラック80は、複数の第1の歯98を含み、該複数の第1の歯98は、伝達歯車84に形成された歯車の歯100と係合可能である。同様に、第2のラック90は、複数の歯102を含み、該複数の歯102もまた、伝達歯車84の歯車の歯100と係合可能である。したがって、駆動ロッド70が、長手方向に動いたときに、第1のラック80は、伝達歯車84を回転させ、次に、該伝達歯車84が、遠位部分32の中で長手方向に伝達バー88を駆動させる。
再び図3を参照すると、アクチュエータ104が、遠位部分32の中に可動に据え付けられている。アクチュエータ104の遠位端106は、クロスバー108を含み、該クロスバー108は、アンビル26の角度を付けられた縁と係合可能であることにより、開位置と閉位置との間でアンビル26を動かす。明確には示されていないが、ナイフがまた、アクチュエータ104の遠位端106と関連付けられることにより、アンビル26とステープルカートリッジ24との間に捕捉された組織を切断する。アンビル26が長手方向スロット112を含むことにより、顎アセンブリ20を通るナイフの通行を可能にする。
伝達バー88から駆動力を受け入れるために、アクチュエータ104の近位端114は、一連のアバットメント116を提供され、該一連のアバットメント116は、伝達バー88の遠位端94において駆動歯96と係合可能である。駆動歯96は、次のアバットメント116と繰り返し係合することにより、遠位部分32の中でアクチュエータ104を増分的に前進させ、それにより顎アセンブリ20を作動させる(図3および図7を参照)。アクチュエータ104は、1対の誘導チャネル118および誘導チャネル120によって、遠位部分32の中での長手方向の動きのために支持されている。アバットメント116は、アクチュエータ104における窓、ノッチ、ピン、または歯を画定する表面として形成され得る。
外科ステープラの屈曲部を回って駆動力を伝動する、外科ステープラ10の開示された駆動力メカニズムの使用が、ここで記述される。まず、図2および図3を参照すると、外科ステープラ10が、初期位置にあり、バネ62がトリガ28を開位置または未発射位置に付勢している。トリガ28の上端58が、ドライバ50をハンドル12の中で近位位置に配置し、したがって、駆動バー70をハンドル12の中で近位位置に配置する(図2)。図3に示されているように、細長い管状部材16の遠位部分32は、近位部分34と長手方向に整列しており、アンビル26は、ステープルカートリッジ24から間隔を空けられた開位置にある。伝達バー88およびアクチュエータ104もまた、遠位部分32の中で近位位置にある。
ここで図1および図5を参照すると、関節運動アクチュエータ36(図1)の作動の際に、アーティキュレータ40およびアーティキュレータ42が作動させられることにより、細長い管状部材16を関節運動セクション30の軸Aにおいて屈曲させ、それにより近位部分34に対して約90°の角度で細長い管状部材16の遠位部分32を配置する(図5)。上記のように、様々なメカニズムおよび方法が、関節運動セクション30において屈曲および関節運動を達成するために、当該分野において公知である。最初、顎アセンブリ16は、手術される組織切断部「T」の周りに配置される。
図1および図6を参照すると、トリガ28が近位方向に作動および圧搾され、上端58にドライバ50をハンドル12の中で遠位方向に駆動させる。ドライバ50が遠位方向に動いたときに、ドライバ50は、細長い管状部材16の近位部分34の中で遠位方向に駆動バー70を駆動させる。図6に最も良く示されているように、駆動バー70の遠位方向への動きが、軸Aで向きを変えて時計回り方向に、かつ、矢印Bの方向に伝達歯車84を回転させる。特に、駆動バー70の第1の歯98は、伝達歯車84の歯車の歯100を係合し、回転させる。伝達歯車84は、駆動バー70から駆動力を受け入れ、角度α、ここでは90°にわたって、力を伝達バー88に伝達したり、向け直したりする。特に、歯車の歯100は、第2のラック90における第2の歯102を係合し、細長い管状部材16の遠位部分32の中で遠位方向に伝達バーを強制する。したがって、第1のラック80を含む駆動バー70と、伝達歯車84と、第2のラック90を含む伝達バー88との組み合わせが、駆動力の伝達または「向け直し」メカニズムを形成し、駆動力が、外科ステープラ10の一部分に形成された角度にわたって伝動されることを可能にする。上記のように、本明細書において開示された駆動力メカニズムは、他の外科器具、例えば、グラスパ、カッタ、クリップアプライヤなどに等しく適用可能である。さらに、開示された駆動力メカニズムは、外科器具の他の位置、例えば、ハンドルと細長い管状部材との接合部、エンドエフェクタの隣などに配置された関節運動セクションを有する他の外科器具に等しく適用可能である。
図7を参照すると、上記のように、伝達バー88の駆動歯96は、ラチェットの様式または増分的な様式で連続するアバットメント116を係合することにより、遠位部分32の中で遠位方向にアクチュエータ104を動かし、それにより顎アセンブリ20を作動させる。一部の場合において、顎アセンブリ20を完全に作動させるためにトリガ28を複数回作動させることが必要となり得る。トリガ28の各作動に対して、伝達バー88、特に、駆動歯96が、ストローク長d1にわたって動く。駆動歯は、遠位駆動面122を有することにより、アバットメント116を係合する。伝達バーが戻りストロークを通過するために、駆動歯96は、近位傾斜面124を含み、該近位傾斜面124は、駆動歯96がアバットメント116から係合解除されたり、抜けたりすることを可能にする。トリガ28のさらなる作動が、駆動歯96の遠位駆動面122に次のアバットメント116を係合させる。誘導レール126および誘導レール128が、遠位部分32の中に提供されることにより、伝達バー88の遠位端94がアバットメント116から離れて横方向に動くことと、遠位部分32の中での伝達バー88の長手方向の動きに、伝達バー88を誘導することとを可能にする。
図6および図8を参照すると、完全な作動の際に、アクチュエータ104のクロスバー108が、アンビル26における、角度を付けられた縁110を係合し、ステープルカートリッジ24に対して閉位置にアンビル26を動かす。
ここで図9を参照すると、外科ステープラ10のさらなる作動の際に、アクチュエータ104が、アンビル26におけるスロット112を通って遠位方向に動いたときに、アクチュエータ104と関連付けられたステープルバー130が、ステープルカートリッジ24を通って遠位方向に動かされる。ステープルバー130は、プッシャ132を係合し、該プッシャ132は、ステープルカートリッジ24のステープルポケット134の中に配置されている。プッシャ132は、同様にステープルポケット134の中に配置されているステープル136をアンビル26に向かって駆動させるので、先端138および先端140が、組織Tを貫通して、アンビル26のステープル折り返しポケット142の中に駆動させられ、それにより組織切断部Tをステープリングする。上記のように、アクチュエータ104と関連付けられたナイフが、クロスバー108を用いて遠位方向に動くことにより、ステープル136によって形成されたステープル線の間で組織を切断する。
ここで図10〜図14を参照すると、外科器具、例えば、外科ステープラ10における使用のための駆動力メカニズムの別の実施形態が、開示されている。まず、図10を参照すると、外科器具は、上で記述されたものと同様である。しかしながら、駆動バー、ラック、および歯車の代わりに、開示された代替の実施形態は、ケーブル、ホイルおよび/または滑車のシステムを含むことにより、トリガ28から、関節運動セクション30を回って、そして、関節運動セクション30を通過して、顎アセンブリ20に駆動力を伝達する。特に、ホイル150は、ハンドル12の旋回軸152に回転可能に据え付けられている。上端58が、トリガ28の作動に応答して駆動ホイル150を回転させるために、旋回ピン60において駆動ホイル150に接続されている。駆動ケーブル154は、ホイル150の回りを通過し、細長い管状部材16の近位部分34を通って、そして関節運動セクション30を通って、細長い管状部材16の遠位部分32に延在している。駆動ケーブル154は、ホイル150を周って通過するように可撓性の材料から形成される。駆動ケーブル154は、上側セクション156と下側セクション158とを含む。トリガ28が作動させられたときに、トリガ28の上端58は、ハンドル12内で、時計回り方向にホイル150を回転させることにより、上側セクション156を遠位方向に前進させ、下側セクション158を細長い管状部材16の中で近位方向に引き込む。カラー160が、ハンドル12の中に提供されており、細長い管状部材16が上で記述されたように回転したときに、駆動ケーブル154が回転することを可能にする。
図11を参照すると、駆動ケーブル154からアクチュエータ104に駆動力を伝えるために、レバー162が遠位部分32の中に提供され、そして、中央ポスト164の旋回点166に旋回するように据え付けられている。駆動ケーブル154の上側セクション156の遠位端168は、レバー162の第1の端170に接続され、下側セクション158の遠位端172は、レバー162の第2の端174に接続されている。
上記のように、開示された駆動力メカニズムは、外科ステープラ10の関節運動セクション30の中に配置された伝達デバイスを組み込むことにより、細長い管状部材16が、角度αにわたって屈曲されたときに、細長い管状部材16を通過する駆動力を伝達し、向け直す。この実施形態において、伝達デバイスは、一対のホイルの形態であり、該一対のホイルは、上側ホイル176と下側ホイル178とを含み、該上側ホイル176と該下側ホイル178とは、関節運動セクション30の中に配置されたスピンドル180に回転可能に据え付けられている。スピンドル180は、外科ステープラ10の軸Aに配置されている。
伝達バー182は、遠位部分32の中に配置されることにより、レバー162とアクチュエータ104との間で力を伝達する。近位端184は、レバー162の第1の端178に付着され、伝達バー182の遠位端186は、駆動歯188に取り付けられ、該駆動歯188は、上に記述された駆動歯96と実質的に同じように機能することにより、アバットメント116を係合し、遠位部分32の中でアクチュエータ104を前進させる。
ここで図10〜図14を参照し、まず、図10および図11を参照すると、使用の際に、トリガ28が、ホイル150と共に未発射位置にあり、停止している。細長い管状部材16の近位端34は、関節運動セクション30および遠位部分32と長手方向に整列している。アンビル26は、ステープルカートリッジ24から間隔を空けられた開位置にある。
図10および図12を参照すると、上に記述されたように、関節運動アクチュエータ36が作動されることにより、関節運動セクション30において細長い管状部材16を屈曲させ、組織切断部「T」に対して顎アセンブリ16を配置するので、アンビル26とステープルカートリッジ24とが、組織切断部「T」の周りに配置される。トリガ28が作動させられることにより、ホイル150を時計回り方向に回転させ、駆動ケーブル154の下側セクション158を近位方向に引き込み、そして、上側セクション156が遠位方向に動くことを強制したり、可能にしたりする。
図12に示されているように、駆動ケーブル154の上側セクション156は、関節運動セクション30において上側ホイル176を回って進むが、下側セクション158は、下側ホイル178を回って進む。下側セクション158が、近位方向に引き込まれたときに、下側セクション158は、レバー162の第2の端174を引張り、レバー162を時計回り方向に回転させ、レバー162の第1の端170を遠位方向に駆動させる。第1の端170の遠位方向への運動が、伝達バー182を遠位方向に駆動させ、駆動歯188をアバットメント116と係合させ、そして、細長い管状部材16の遠位部分32の中で遠位方向にアクチュエータ104を前進させる。
図13を参照すると、上で考察されたように、アクチュエータ104の遠位方向への運動が、アンビル26の角度を付けられた縁110に対してクロスバー108を強制することにより、ステープルカートリッジ24に対して閉位置にアンビル26を動かす。トリガ28の次の作動が、外科ステープラ10のさらなる作動をもたらし、うえに記述されたように組織Tをステープリングする。
図14を参照すると、駆動歯188はまた、ストローク長d1を通過することにより、アバットメント116と連続的に係合することによってアクチュエータ104を増分的に前進させる。駆動歯188は、アバットメントとの係合のための遠位駆動面190と、近位傾斜面192とを含み、該近位傾斜面192は、駆動歯188の戻りストロークの際に、駆動歯188がアバットメント116から係合解除し、次のアバットメント116と再係合することを可能にする。
このように、上記の駆動力メカニズムは、駆動力が、外科器具のハンドルから、外科器具の関節運動されたセクションを周って伝動され、そして、最終的に、外科器具の顎アセンブリに伝動されることを可能にする。
様々な改変が、本明細書において開示された実施形態に行われ得ることが、理解されるべきである。例えば、他の作動メカニズム、例えば、気体の動力で動くメカニズムなどが提供され得る。さらに、開示された駆動力メカニズムは、関連付けられるエンドエフェクタ付近に関節運動点を有する外科器具における使用にも等しく適している。したがって、上の記述は、限定として解釈されるべきではなく、特定の実施形態の単なる例示として解釈されるべきである。当業者は、添付の特許請求の範囲の範囲および精神の範囲内で他の改変を想定する。
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- 2008-11-04 CA CA2642774A patent/CA2642774C/en not_active Expired - Fee Related
- 2008-11-05 ES ES08253619T patent/ES2360643T3/es active Active
- 2008-11-05 ES ES10007175T patent/ES2381716T3/es active Active
- 2008-11-05 AT AT08253619T patent/ATE499047T1/de not_active IP Right Cessation
- 2008-11-05 AT AT10007175T patent/ATE551957T1/de active
- 2008-11-05 AU AU2008243109A patent/AU2008243109B2/en not_active Ceased
- 2008-11-05 EP EP10007174.5A patent/EP2241267B1/en not_active Not-in-force
- 2008-11-05 JP JP2008284896A patent/JP5393111B2/ja not_active Expired - Fee Related
- 2008-11-05 EP EP10007175A patent/EP2241268B1/en not_active Not-in-force
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- 2008-11-05 DE DE602008005087T patent/DE602008005087D1/de active Active
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2011
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2012
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2013
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2014
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WO2017221307A1 (ja) * | 2016-06-20 | 2017-12-28 | オリンパス株式会社 | 処置具 |
JPWO2017221307A1 (ja) * | 2016-06-20 | 2019-02-28 | オリンパス株式会社 | 処置具 |
US11134972B2 (en) | 2016-06-20 | 2021-10-05 | Olympus Corporation | Treatment tool |
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CA2910005C (en) | 2018-07-24 |
ES2381716T3 (es) | 2012-05-30 |
ATE499047T1 (de) | 2011-03-15 |
CA2642774C (en) | 2016-01-12 |
JP2009112820A (ja) | 2009-05-28 |
US7954685B2 (en) | 2011-06-07 |
CA2642774A1 (en) | 2009-05-06 |
ATE551957T1 (de) | 2012-04-15 |
JP5393111B2 (ja) | 2014-01-22 |
US20160310135A1 (en) | 2016-10-27 |
EP2057949A2 (en) | 2009-05-13 |
US8292148B2 (en) | 2012-10-23 |
EP2057949B1 (en) | 2011-02-23 |
US9381016B2 (en) | 2016-07-05 |
US20130299552A1 (en) | 2013-11-14 |
ES2360643T3 (es) | 2011-06-07 |
EP2241268A1 (en) | 2010-10-20 |
JP5778214B2 (ja) | 2015-09-16 |
EP2241268B1 (en) | 2012-04-04 |
AU2008243109A1 (en) | 2009-05-21 |
CA2910005A1 (en) | 2009-05-06 |
US20110198386A1 (en) | 2011-08-18 |
DE602008005087D1 (de) | 2011-04-07 |
EP2057949A3 (en) | 2009-06-10 |
EP2241267A1 (en) | 2010-10-20 |
US10022124B2 (en) | 2018-07-17 |
US8496152B2 (en) | 2013-07-30 |
EP2241267B1 (en) | 2013-04-17 |
AU2008243109B2 (en) | 2014-01-09 |
US20090114699A1 (en) | 2009-05-07 |
US20130015229A1 (en) | 2013-01-17 |
JP2013215602A (ja) | 2013-10-24 |
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