JP2014531241A - ステープル補強クリップを備えた外科用器具 - Google Patents
ステープル補強クリップを備えた外科用器具 Download PDFInfo
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Abstract
Description
図1〜図6は、外科手術を行うために、図1Aに示すような非関節動作状態でトロカールカニューレ通路を通って患者の体内の手術部位まで挿入するように寸法決めされている、例示的な外科ステープル用及び切断用の器具(10)を図示している。外科ステープル用及び切断用の器具(10)は、実施部分(22)に接続されたハンドル部分(20)を含み、実施部分は、関節機構(11)において遠位方向で終端するシャフト(23)と、遠位に取り付けられたエンドエフェクタ(12)とを更に備える。関節機構(11)及びエンドエフェクタ(12)がトロカールのカニューレ通路を通って挿入された後、図1Bに図示されているように、関節制御(13)によって関節機構(11)を遠隔的に関節動作させることができる。そのようにして、エンドエフェクタ(12)は、所望の角度から又は他の理由のために、臓器の背後に到達する又は組織に近づくことができる。本明細書では、「近位」及び「遠位」といった用語は、器具(10)のハンドル部分(20)を握っている臨床医を基準として使用されていることを理解されたい。したがって、エンドエフェクタ(12)は、より近位のハンドル部分(20)に対して遠位である。(便宜上、また説明を明確にするため、本願では「垂直」及び「水平」といった空間的な用語を図面に対して使用する点が更に認識されるであろう。しかしながら、外科用器具は、多くの配向及び位置において使用され、これらの用語は、制限的及び絶対的であることが意図されない。
図7は、例示的な補強クリップ(100)を示す。ステープル(47)が一旦手術部位に挿入されると、補強クリップ(100)は、埋め込まれたステープル(47)に隣接した切断組織(192)に沿って適用されて、ステープル(47)によってもたらされる組織シールを補強できることが理解されるであろう。しかしながら、補強クリップ(100)は、本明細書の教示を考慮して当業者には明白となるような、他の様々な方法で使用されてもよいことが理解されるであろう。
図9A〜Bは、展性を有する例示的な補強クリップ(200)を示し、例示的な補強クリップ(200)は組織(90)に適用される。図9Aは、既にステープル留めされ、切断縁部(192)を残して切断されている組織(90)を示す。補強クリップ(200)は、図9Aでは、脚部(204)がステープル(47)を覆うように、組織(90)の上に位置している。補強クリップ(200)は、頂部(202)及び歯部(206)を更に備える。補強クリップ(200)は展性であるので、シャフト(254)に接続されたつかみ具(252)を有する適用器具(250)を使用して、組織(90)が切断されステープル留めされているステープル(47)の周りで、補強クリップ(200)を折り畳むことができる。
図10A〜Bは、任意の特定の位置を保持するように付勢されていない、全体的に可撓性の機構を有する例示的な補強クリップ(300)を示す。特に、この例の補強クリップ(300)は、脚部(304)を接続するリビングヒンジ(302)を備える。脚部(304)は歯部(306)につながっている。図示される変形例はまた、補強クリップ(300)を組織(90)の周りで閉じるのに使用され得る係止機構(350)を示している。リビングヒンジ(302)は、脚部(304)を簡単に分離してステープル(47)の上の位置まで至らせることができるように、十分に可撓性である。補強クリップ(300)をステープル(47)の周りに十分に設置した後、図10Bに示されるように係止機構(350)を補強クリップ(300)の上に滑らせ、それによって補強クリップ(300)をクランプ位置で係止することができる。この例では、係止機構(350)はリビングヒンジ(302)上に位置決めされるが、本明細書の教示を考慮して当業者には明白となるように、係止機構(350)の任意の好適な場所が使用されてよい。例えば、係止機構(350)は脚部(304)の周りで留められてよい。この例では、係止機構(350)はU字形のクリップを備えるが、係止機構の任意の好適な構造が使用されてよい。いくつかの単なる例示的な変形例では、係止機構(350)は、返し、留め金、又は本明細書の教示を考慮して当業者には明白となるような他の任意の好適な係止機構を備えてもよい。
(1) 装置であって、
(a)カッター及びステープラーを備える外科用器具であって、前記カッターが、組織の一部分を切断するように構成された、外科用器具、
(b)前記ステープラーと連通している複数のステープルであって、前記ステープラーが、前記複数のステープルを組織の切断部分に導入するように構成され、前記ステープラーが、前記複数のステープルでステープルラインを形成するように構成された、複数のステープル、並びに、
(c)前記ステープルラインを選択的に覆うように構成された補強クリップであって、前記補強クリップが、前記複数のステープルが切断組織の一部分に導入された後で適用されるように構成され、前記補強クリップが、頂部と、前記ステープルラインによって画定される範囲を覆うように操作可能な幅を有する脚部と、組織内へとしっかり固定されるように構成された歯部と、を備え、前記補強クリップが、前記ステープルライン及び前記切断組織の一部分を覆うように構成された、補強クリップ、
を含む、装置。
(2) 前記頂部がリビングヒンジを備える、実施態様1に記載の装置。
(3) 前記頂部が、前記リビングヒンジを係止するように操作可能な少なくとも1つの係止機構を更に備え、それによって前記リビングヒンジを所定の位置に定着させる、実施態様2に記載の装置。
(4) 前記少なくとも1つの係止機構が、少なくとも1つの留め金を含む、実施態様3に記載の装置。
(5) 前記リビングヒンジがラチェット機構を含み、前記ラチェット機構が、前記リビングヒンジが一方向にのみ移動可能であるように構成された、実施態様2に記載の装置。
(7) 前記吸収性材料がポリジオキサノンを含む、実施態様6に記載の装置。
(8) 前記補強クリップが、組織の切断部分の周りにシールを形成するように構成された、実施態様1に記載の装置。
(9) 前記補強クリップが、細長いC字形の断面を備える、実施態様1に記載の装置。
(10) 前記補強クリップが、変形可能な材料を含む、実施態様1に記載の装置。
(12) 適用器具を更に備え、前記適用器具が、前記ステープルラインの上で前記補強クリップをクランプするように構成された、実施態様1に記載の装置。
(13) 前記適用器具が、前記ステープルラインを締め付け固定するように十分な力でクランプするように更に構成された、実施態様12に記載の装置。
(14) 前記補強クリップが、内側部分及び外側部分を備え、前記内側部分が切断組織の一部分の周りに位置決め可能であり、前記補強クリップの前記歯部が、前記内側部分が前記外側部分から機械的に分離されたままであるように、十分な力でクランプするように構成された、実施態様1に記載の装置。
(15) 前記補強クリップが、前記ステープルラインに接触することなく前記ステープルラインを取り囲むように構成された、実施態様1に記載の装置。
(a)頂部、脚部、及び歯を備えるクリップであって、ステープルラインを取り囲むように構成され、前記クリップの前記脚部が、前記ステープルラインの幅に重なるのに十分な広さの幅を備え、前記歯が、組織をしっかり固定するように構成され、前記頂部が、変形可能な材料を含む、クリップ、並びに、
(b)外科用適用器具であって、前記適用器具が、前記クリップと選択的に連通し、前記適用器具が、前記クリップを手術部位に送達するように構成され、前記適用器具が、前記クリップをクランプし、それによって前記クリップをしっかり固定するように更に構成され、前記外科用適用器具が、前記ステープルラインの上で前記クリップをクランプするように更に構成された、外科用適用器具、
を含む、装置。
(17) 前記頂部が、リビングヒンジ及び係止機構を備え、前記リビングヒンジが、前記脚部を移動可能にすることができるように操作可能であり、前記係止機構が、前記リビングヒンジの移動を選択的に防ぐように構成された、実施態様16に記載の装置。
(18) 前記係止機構が、前記リビングヒンジの上に位置決め可能な返しを備える、実施態様16に記載の装置。
(19) 前記クリップが、時間と共に吸収されるように構成された吸収性材料を含み、前記吸収性材料がポリジオキサノンを含む、実施態様16に記載の装置。
(20) 補強クリップ、外科用カッター及びステープラー、並びに外科用適用器具を使用して、ステープルラインを補強する方法であって、前記補強クリップが、一対の平坦なクランプ脚部、前記脚部の間に位置決めされた頂部、及び前記脚部と連通している歯を備え、前記方法が、
(a)前記外科用カッター及びステープラーを手術部位に導入すること、
(b)前記手術部位の組織の一部分を、前記外科用カッター及びステープラーを用いて切断すること、
(c)前記外科用カッター及びステープラーを用いて前記組織の切断部分をステープル留めし、それによってステープルラインを作り出すことであって、前記組織の切断部分をステープル留めする行為が、組織の一部分を切断する行為と実質的に同時に起こる、こと、
(d)前記外科用カッター及びステープラーを前記手術部位から除去すること、
(e)前記外科用適用器具を前記手術部位に導入すること、
(f)前記補強クリップを前記ステープルラインに適用すること、
(g)前記ステープルラインの幅を前記補強クリップで取り囲むこと、
(h)前記ステープルラインを前記補強クリップでクランプすること、
(i)前記外科用適用器具を除去すること、
を含む、方法。
Claims (19)
- 装置であって、
(a)カッター及びステープラーを備える外科用器具であって、前記カッターが、組織の一部分を切断するように構成された、外科用器具、
(b)前記ステープラーと連通している複数のステープルであって、前記ステープラーが、前記複数のステープルを組織の切断部分に導入するように構成され、前記ステープラーが、前記複数のステープルでステープルラインを形成するように構成された、複数のステープル、並びに、
(c)前記ステープルラインを選択的に覆うように構成された補強クリップであって、前記補強クリップが、前記複数のステープルが切断組織の一部分に導入された後で適用されるように構成され、前記補強クリップが、頂部と、前記ステープルラインによって画定される範囲を覆うように操作可能な幅を有する脚部と、組織内へとしっかり固定されるように構成された歯部と、を備え、前記補強クリップが、前記ステープルライン及び前記切断組織の一部分を覆うように構成された、補強クリップ、
を含む、装置。 - 前記頂部がリビングヒンジを備える、請求項1に記載の装置。
- 前記頂部が、前記リビングヒンジを係止するように操作可能な少なくとも1つの係止機構を更に備え、それによって前記リビングヒンジを所定の位置に定着させる、請求項2に記載の装置。
- 前記少なくとも1つの係止機構が、少なくとも1つの留め金を含む、請求項3に記載の装置。
- 前記リビングヒンジがラチェット機構を含み、前記ラチェット機構が、前記リビングヒンジが一方向にのみ移動可能であるように構成された、請求項2に記載の装置。
- 前記補強クリップが吸収性材料を含む、請求項1に記載の装置。
- 前記吸収性材料がポリジオキサノンを含む、請求項6に記載の装置。
- 前記補強クリップが、組織の切断部分の周りにシールを形成するように構成された、請求項1に記載の装置。
- 前記補強クリップが、細長いC字形の断面を備える、請求項1に記載の装置。
- 前記補強クリップが、変形可能な材料を含む、請求項1に記載の装置。
- 前記外科用器具が、前記外科用ステープラーを使用して前記ステープルを組織の一部分に導入するように作動するように構成され、前記補強クリップが、導入された前記ステープル全てを一回の作動で覆うように構成された、請求項1に記載の装置。
- 適用器具を更に備え、前記適用器具が、前記ステープルラインの上で前記補強クリップをクランプするように構成された、請求項1に記載の装置。
- 前記適用器具が、前記ステープルラインを締め付け固定するように十分な力でクランプするように更に構成された、請求項12に記載の装置。
- 前記補強クリップが、内側部分及び外側部分を備え、前記内側部分が切断組織の一部分の周りに位置決め可能であり、前記補強クリップの前記歯部が、前記内側部分が前記外側部分から機械的に分離されたままであるように、十分な力でクランプするように構成された、請求項1に記載の装置。
- 前記補強クリップが、前記ステープルラインに接触することなく前記ステープルラインを取り囲むように構成された、請求項1に記載の装置。
- 装置であって、
(a)頂部、脚部、及び歯を備えるクリップであって、ステープルラインを取り囲むように構成され、前記クリップの前記脚部が、前記ステープルラインの幅に重なるのに十分な広さの幅を備え、前記歯が、組織をしっかり固定するように構成され、前記頂部が、変形可能な材料を含む、クリップ、並びに、
(b)外科用適用器具であって、前記適用器具が、前記クリップと選択的に連通し、前記適用器具が、前記クリップを手術部位に送達するように構成され、前記適用器具が、前記クリップをクランプし、それによって前記クリップをしっかり固定するように更に構成され、前記外科用適用器具が、前記ステープルラインの上で前記クリップをクランプするように更に構成された、外科用適用器具、
を含む、装置。 - 前記頂部が、リビングヒンジ及び係止機構を備え、前記リビングヒンジが、前記脚部を移動可能にすることができるように操作可能であり、前記係止機構が、前記リビングヒンジの移動を選択的に防ぐように構成された、請求項16に記載の装置。
- 前記係止機構が、前記リビングヒンジの上に位置決め可能な返しを備える、請求項16に記載の装置。
- 前記クリップが、時間と共に吸収されるように構成された吸収性材料を含み、前記吸収性材料がポリジオキサノンを含む、請求項16に記載の装置。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US13/233,681 | 2011-09-15 | ||
US13/233,681 US9254180B2 (en) | 2011-09-15 | 2011-09-15 | Surgical instrument with staple reinforcement clip |
PCT/US2012/054406 WO2013039821A1 (en) | 2011-09-15 | 2012-09-10 | Surgical instrument with staple reinforcement clip |
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JP2014531241A true JP2014531241A (ja) | 2014-11-27 |
JP6208134B2 JP6208134B2 (ja) | 2017-10-04 |
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JP2014530718A Active JP6208134B2 (ja) | 2011-09-15 | 2012-09-10 | ステープル補強クリップを備えた外科用器具 |
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US (1) | US9254180B2 (ja) |
EP (2) | EP2755590B1 (ja) |
JP (1) | JP6208134B2 (ja) |
CN (1) | CN103917188B (ja) |
BR (1) | BR112014006383B1 (ja) |
IN (1) | IN2014DN01970A (ja) |
MX (1) | MX343434B (ja) |
RU (1) | RU2611916C2 (ja) |
WO (1) | WO2013039821A1 (ja) |
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EP3461428B1 (en) | 2022-11-09 |
BR112014006383A2 (pt) | 2017-04-04 |
RU2014114841A (ru) | 2015-10-20 |
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EP3461428A1 (en) | 2019-04-03 |
EP2755590B1 (en) | 2018-11-21 |
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JP6208134B2 (ja) | 2017-10-04 |
MX2014003170A (es) | 2014-09-22 |
EP2755590A1 (en) | 2014-07-23 |
US20130068821A1 (en) | 2013-03-21 |
US9254180B2 (en) | 2016-02-09 |
WO2013039821A1 (en) | 2013-03-21 |
CN103917188B (zh) | 2017-02-15 |
BR112014006383B1 (pt) | 2020-12-22 |
RU2611916C2 (ru) | 2017-03-01 |
CN103917188A (zh) | 2014-07-09 |
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