JP2017159029A - 小径内視鏡部分を有する外科手術用ステープラ - Google Patents
小径内視鏡部分を有する外科手術用ステープラ Download PDFInfo
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
- A61B17/105—Wound clamp magazines
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
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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
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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
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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
- A61B17/32—Surgical cutting instruments
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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
- A61B17/07292—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
- A61B2017/0046—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
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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
- A61B2017/07214—Stapler heads
- A61B2017/07228—Arrangement of the 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
- A61B2017/07214—Stapler heads
- A61B2017/07235—Stapler heads containing different staples, e.g. staples of different shapes, sizes or materials
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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
- A61B2017/07214—Stapler heads
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- A—HUMAN NECESSITIES
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- 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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
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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
- A61B17/32—Surgical cutting instruments
- A61B2017/320044—Blunt dissectors
Abstract
【課題】小径内視鏡部分を有する外科手術用ステープラを提供する。【解決手段】外科手術用ステープラ2であって、作動デバイス4と、作動デバイスに取り外し可能に固着される、再装填部10であって、再装填部は、本体部分12と、ツールアセンブリ14とを含み、本体部分は、第1の直径を画定する大径部分と、大径部分から遠位に延在する、第2の直径を画定する小径部分とを含み、ツールアセンブリは、小径部分の遠位端上に支持され、小径部分は、8mmトロカールを通して通過するように定寸され、ツールアセンブリは、2つの側のそれぞれに単一楔を有する滑動部を伴う、可撤性かつ交換可能なステープルカートリッジを含む、再装填部と、を備える、外科手術用ステープラ。【選択図】図1A
Description
本開示は、外科手術用ステープラに関し、より具体的には、とりわけ、小児科および胸部外科手術手技を含む、内視鏡下外科手術手技を行うために好適な小径内視鏡部分を含む、内視鏡下外科手術用ステープラに関する。
組織の同時解離および縫合をもたらす、外科手術用ステープラは、当技術分野において周知である。外科手術用ステープラの出現は、組織縫合の速度を増加させ、したがって、外科手術手技の速度の増加は、患者外傷を低減させる。
皮膚内の小切開を通して、またはカニューレを通して、組織を内視鏡下で縫合するための内視鏡下外科手術用ステープラもまた、当技術分野において周知である。観血外科手術手技によってではなく、皮膚内の小切開を通して組織を内視鏡下で縫合することもまた、患者外傷を低減させる。
典型的には、内視鏡下外科手術用ステープラは、ツールアセンブリを支持する、伸長本体を含む。伸長本体およびツールアセンブリ(内視鏡部分)は、皮膚内の小切開またはカニューレを通して通過するように定寸される。伸長本体およびツールアセンブリの寸法を最小限にし、患者への外傷を最小限にすることが有利である。したがって、内視鏡下使用のために好適な小径外科手術用ステープラの継続的必要性が存在する。
本開示によると、外科手術用ステープラは、縮径の遠位部分を有し、小径トロカールアセンブリを通して内視鏡部分の挿入を促進する、内視鏡部分を含むように提供される。実施形態では、内視鏡本体部分は、本体部分と、ツールアセンブリとを含む。本体部分は、大径部分と、小径部分とを有し、大径部分は、小径部分の直径を上回る直径を有する。小径部分は、大径部分から遠位に延在し、ツールアセンブリは、大径部分の遠位端上に支持される。実施形態では、例えば、繋止アセンブリを含む、外科手術用ステープラのより大きい内部構成要素(外科手術用ステープラの他の内部構成要素と比較して)は、小径部分の直径が、小径トロカールアセンブリ、例えば、8mmトロカールアセンブリを通して小径部分およびツールアセンブリの通過を促進するように最小限にされ得るように、本体部分の大径部分内に格納される。
本開示の一側面では、外科手術用ステープラは、作動デバイスと、作動デバイスに取り外し可能に固着される、再装填部とを含む。再装填部は、本体部分と、ツールアセンブリとを含む。本体部分は、大径部分と、大径部分から遠位に延在する小径部分とを含む。ツールアセンブリは、小径部分の遠位端上に支持され、8mmトロカールを通して通過するように定寸される。
実施形態では、外科手術用ステープラは、駆動アセンブリを含み、ツールアセンブリは、アンビルアセンブリと、複数のステープルを支持するカートリッジアセンブリを含み、駆動アセンブリは、本体部分およびツールアセンブリを通して移動可能であり、ステープルをカートリッジアセンブリから吐出する。
いくつかの実施形態では、伸長本体は、作動デバイスから遠位に延在し、再装填部は、伸長本体の遠位端上に支持される。
ある実施形態では、係止部材を含む、係止アセンブリが、本体部分の大径部分内に支持される。
実施形態では、再装填部の本体部分の大径部分は、筐体を含み、係止部材は、筐体内に支持され、係止部材が駆動アセンブリに係合し、駆動アセンブリを後退位置に維持する、第1の位置から、係止部材が筐体部分に対する駆動アセンブリの遠位移動を可能にする、第2の位置まで移動可能である。
いくつかの実施形態では、繋止アセンブリは、再装填部の大径部分を中心として搭載される回転可能スリーブ含む。回転可能スリーブは、再装填部の大径部分を中心とする回転可能スリーブの回転が、第1の位置から第2の位置への係止部材の移動をもたらすように、係止部材と係合される。
ある実施形態では、回転可能スリーブは、カムスロットを画定し、係止部材は、カムスロット内に受容されるカムフィンガを含み、再装填部の大径部分を中心とする回転可能スリーブの回転は、回転可能スリーブをカムフィンガに係合させ、係止部材を第1の位置から第2の位置に移動させる。
実施形態では、係止部材は、後退位置からの駆動アセンブリの遠位移動を妨害するように位置付けられる、遮断フィンガを含む。
いくつかの実施形態では、駆動アセンブリは、近位駆動部材を含み、作動デバイスは、制御ロッドを含み、近位駆動部材は、コネクタを近位本体部分の大径部分内に支持し、コネクタは、制御ロッドに取り外し可能に係合し、制御ロッドの移動を近位駆動部材の移動に変換するように構成される。
ある実施形態では、駆動アセンブリは、ツールアセンブリを通して平行移動し、複数のステープルをカートリッジアセンブリから吐出するように位置付けられる、動的咬持部材を含む。
実施形態では、カートリッジアセンブリは、メススロットと、メススロットの両側の2列のステープルとを画定する、カートリッジ本体を含む。
実施形態では、カートリッジ本体は、メススロットの両側に1列のプッシャを支持する。
実施形態では、解離用先端は、カートリッジアセンブリの遠位端上に支持される。
実施形態では、バットレス材料が、アンビルアセンブリ上に支持される。
例えば、本発明は、以下を提供する。
(項目1)
外科手術用ステープラであって、
作動デバイスと、
上記作動デバイスに取り外し可能に固着される、再装填部であって、上記再装填部は、本体部分と、ツールアセンブリとを含み、上記本体部分は、第1の直径を画定する大径部分と、上記大径部分から遠位に延在する、第2の直径を画定する小径部分とを含み、上記ツールアセンブリは、上記小径部分の遠位端上に支持され、上記小径部分は、8mmトロカールを通して通過するように定寸され、上記ツールアセンブリは、2つの側のそれぞれに単一楔を有する滑動部を伴う、可撤性かつ交換可能なステープルカートリッジを含む、再装填部と、
を備える、外科手術用ステープラ。
(項目2)
駆動アセンブリをさらに含み、上記ツールアセンブリは、アンビルアセンブリと、複数のステープルを支持するカートリッジアセンブリとを含み、上記駆動アセンブリは、上記本体部分および上記ツールアセンブリを通して移動可能であり、ステープルを上記カートリッジアセンブリから吐出する、上記項目に記載の外科手術用ステープラ。
(項目3)
上記作動デバイスから遠位に延在する伸長本体をさらに含み、上記再装填部は、上記伸長本体の遠位端上に支持される、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目4)
上記本体部分の大径部分内に支持される係止部材を含む、係止アセンブリをさらに含む、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目5)
上記再装填部の本体部分の大径部分は、筐体を含み、上記係止部材は、上記筐体内に支持され、上記係止部材が上記駆動アセンブリに係合し、上記駆動アセンブリを後退位置に維持する、第1の位置から、上記係止部材が上記筐体部分に対する上記駆動アセンブリの遠位移動を可能にする、第2の位置に移動可能である、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目6)
上記繋止アセンブリは、上記再装填部の大径部分を中心として搭載される回転可能スリーブを含み、上記回転可能スリーブは、上記再装填部の大径部分を中心とする上記回転可能スリーブの回転が、上記第1の位置から上記第2の位置への上記係止部材の移動をもたらすように、上記係止部材と係合される、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目7)
上記回転可能スリーブは、カムスロットを画定し、上記係止部材は、上記カムスロット内に受容されるカムフィンガを含み、上記再装填部の大径部分を中心とする上記回転可能スリーブの回転は、上記回転可能スリーブを上記カムフィンガに係合させ、上記係止部材を上記第1の位置から上記第2の位置に移動させる、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目8)
上記係止部材は、上記後退位置からの上記駆動アセンブリの遠位移動を妨害するように位置付けられる、遮断フィンガを含む、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目9)
上記駆動アセンブリは、近位駆動部材を含み、上記作動デバイスは、制御ロッドを含み、上記近位駆動部材は、コネクタを上記本体部分の大径部分内に支持し、上記コネクタは、上記制御ロッドに取り外し可能に係合し、上記制御ロッドの移動を上記近位駆動部材の移動に変換するように構成される、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目10)
上記駆動アセンブリは、上記ツールアセンブリを通して平行移動し、上記複数のステープルを上記カートリッジアセンブリから吐出するように位置付けられる、動的咬持部材を含む、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目11)
上記カートリッジアセンブリは、メススロットと、上記メススロットの両側の2列のステープルとを画定する、カートリッジ本体を含む、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目12)
上記カートリッジ本体は、上記メススロットの両側に1列のプッシャを支持する、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目13)
上記アンビルアセンブリの遠位端上に支持される解離用先端をさらに含む、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目14)
上記アンビルアセンブリ上に支持されるバットレス材料をさらに含む、上記項目のいずれか一項に記載の外科手術用ステープラ。
(摘要)
外科手術用ステープラは、本体部分と、ツールアセンブリとを含む。本体部分は、大径部分と、大径部分から遠位に延在する小径部分とを含む。大径部分は、ステープラの再発射を防止し、デバイスの小径部分の直径が、8mmトロカールを通してステープラの小径部分およびツールアセンブリの通過を促進するように最小限にされることを可能にするように適合される、繋止アセンブリを含む、デバイスのより大きい内部構成要素を支持する。
例えば、本発明は、以下を提供する。
(項目1)
外科手術用ステープラであって、
作動デバイスと、
上記作動デバイスに取り外し可能に固着される、再装填部であって、上記再装填部は、本体部分と、ツールアセンブリとを含み、上記本体部分は、第1の直径を画定する大径部分と、上記大径部分から遠位に延在する、第2の直径を画定する小径部分とを含み、上記ツールアセンブリは、上記小径部分の遠位端上に支持され、上記小径部分は、8mmトロカールを通して通過するように定寸され、上記ツールアセンブリは、2つの側のそれぞれに単一楔を有する滑動部を伴う、可撤性かつ交換可能なステープルカートリッジを含む、再装填部と、
を備える、外科手術用ステープラ。
(項目2)
駆動アセンブリをさらに含み、上記ツールアセンブリは、アンビルアセンブリと、複数のステープルを支持するカートリッジアセンブリとを含み、上記駆動アセンブリは、上記本体部分および上記ツールアセンブリを通して移動可能であり、ステープルを上記カートリッジアセンブリから吐出する、上記項目に記載の外科手術用ステープラ。
(項目3)
上記作動デバイスから遠位に延在する伸長本体をさらに含み、上記再装填部は、上記伸長本体の遠位端上に支持される、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目4)
上記本体部分の大径部分内に支持される係止部材を含む、係止アセンブリをさらに含む、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目5)
上記再装填部の本体部分の大径部分は、筐体を含み、上記係止部材は、上記筐体内に支持され、上記係止部材が上記駆動アセンブリに係合し、上記駆動アセンブリを後退位置に維持する、第1の位置から、上記係止部材が上記筐体部分に対する上記駆動アセンブリの遠位移動を可能にする、第2の位置に移動可能である、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目6)
上記繋止アセンブリは、上記再装填部の大径部分を中心として搭載される回転可能スリーブを含み、上記回転可能スリーブは、上記再装填部の大径部分を中心とする上記回転可能スリーブの回転が、上記第1の位置から上記第2の位置への上記係止部材の移動をもたらすように、上記係止部材と係合される、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目7)
上記回転可能スリーブは、カムスロットを画定し、上記係止部材は、上記カムスロット内に受容されるカムフィンガを含み、上記再装填部の大径部分を中心とする上記回転可能スリーブの回転は、上記回転可能スリーブを上記カムフィンガに係合させ、上記係止部材を上記第1の位置から上記第2の位置に移動させる、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目8)
上記係止部材は、上記後退位置からの上記駆動アセンブリの遠位移動を妨害するように位置付けられる、遮断フィンガを含む、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目9)
上記駆動アセンブリは、近位駆動部材を含み、上記作動デバイスは、制御ロッドを含み、上記近位駆動部材は、コネクタを上記本体部分の大径部分内に支持し、上記コネクタは、上記制御ロッドに取り外し可能に係合し、上記制御ロッドの移動を上記近位駆動部材の移動に変換するように構成される、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目10)
上記駆動アセンブリは、上記ツールアセンブリを通して平行移動し、上記複数のステープルを上記カートリッジアセンブリから吐出するように位置付けられる、動的咬持部材を含む、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目11)
上記カートリッジアセンブリは、メススロットと、上記メススロットの両側の2列のステープルとを画定する、カートリッジ本体を含む、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目12)
上記カートリッジ本体は、上記メススロットの両側に1列のプッシャを支持する、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目13)
上記アンビルアセンブリの遠位端上に支持される解離用先端をさらに含む、上記項目のいずれか一項に記載の外科手術用ステープラ。
(項目14)
上記アンビルアセンブリ上に支持されるバットレス材料をさらに含む、上記項目のいずれか一項に記載の外科手術用ステープラ。
(摘要)
外科手術用ステープラは、本体部分と、ツールアセンブリとを含む。本体部分は、大径部分と、大径部分から遠位に延在する小径部分とを含む。大径部分は、ステープラの再発射を防止し、デバイスの小径部分の直径が、8mmトロカールを通してステープラの小径部分およびツールアセンブリの通過を促進するように最小限にされることを可能にするように適合される、繋止アセンブリを含む、デバイスのより大きい内部構成要素を支持する。
小径内視鏡部分を伴う本開示の外科手術用ステープラの種々の実施形態が、図面を参照して本明細書に説明される。
小径内視鏡部分を伴う本開示の外科手術用ステープラの実施形態が、ここで、図面を参照して詳細に説明され、類似参照番号は、いくつかの図のそれぞれにおける同じまたは対応する要素を指定する。本説明では、用語「近位」は、概して、臨床医により近い装置の部分を指すために使用される一方、用語「遠位」は、概して、臨床医からより遠いステープラの部分を指すために使用される。加えて、用語「内視鏡下」は、概して、内視鏡下、腹腔鏡下、および関節鏡下外科手術手技を含む、小切開または患者の身体の中に挿入されるカニューレを通して行われる外科手術手技を指すために使用される。最後に、用語「臨床医」は、概して、医師、看護士、および支援人員を含む、医療従事者を指すために使用される。
図1Aは、概して、10として示される、小径再装填部を含む、本開示の外科手術用ステープラ2の一実施形態を図示する。外科手術用ステープラ2は、ハンドルアセンブリまたは作動デバイス4と、縦軸を画定する伸長本体6と、再装填部10とを含む。伸長本体6は、作動デバイス4上に支持され、そこから遠位に延在し、外科手術用ステープラ再装填部10は、伸長本体6の遠位端上に支持される。代替として、伸長本体6および再装填部10は、再装填部10が、外科手術用ステープラ2の伸長本体6上に取り外し不可能に支持される、またはその一体型延在部を形成するように、一体的に形成されることができることが想定される。
図1B−4を参照すると、外科手術用ステープラ再装填部10は、本体部分12と、搭載アセンブリ14(図2)と、ツールアセンブリ16とを含む。本体部分12は、伸長本体6の縦軸と整合される縦軸を画定し、結合部分18(図1B)と、大径部分20と、内視鏡または小径部分22とを有する。大径部分は、小径部分の直径を上回る直径を有する。実施形態では、再装填部10の小径部分22は、8mmトロカールアセンブリ(図示せず)内に受容されるように定寸される一方、大径部分20は、約12mmの直径であって、以下に詳細に論じられるように、コネクタおよび繋止アセンブリを支持するように定寸される。
ツールアセンブリ16は、アンビルアセンブリ24と、カートリッジアセンブリ26とを含む。カートリッジアセンブリ26は、アンビルアセンブリ24と連動して枢動可能に支持され、開放位置(図2)と閉鎖または接近位置(図4)との間で移動可能である。搭載アセンブリ14は、本体部分12の遠位端上に支持され、ツールアセンブリ16を枢動可能に支持し、以下に詳細に論じられるであろうように、図4に示される関節運動位置(図1B)と非関節運動位置との間の本体部分12の縦軸に垂直な軸を中心としたツールアセンブリ16の関節運動を促進する。
実施形態では、組織解離器30(図2)が、アンビルアセンブリ24の遠位端に固着される。組織解離器30は、テーパ状構成を有し、カートリッジアセンブリ26の遠位端の遠位に延在し、ツールアセンブリ16が、外科手術部位に隣接する組織を中心として操作されることを可能にする。代替として、組織解離器30は、カートリッジアセンブリ26に取り付けられることができる。加えて、アンビルアセンブリ24は、バットレス材料32を含み、当技術分野において公知のように、縫合および解離されている組織を補強してもよい。
図5および6を参照すると、再装填部10の本体部分12の大径部分20は、上側筐体半区分34aと、下側筐体半区分34bとを含む、内側筐体を含む。上側および下側筐体半区分34aおよび34bは、近位駆動部材38および第1の関節運動連結部40を摺動可能に受容する、チャネルを画定する。上側筐体半区分34aは、下側筐体半区分34b上に形成され、半区分34aと34bとの間に結合し、その整合を維持する、突出部36(図6)を受容する、陥凹(図示せず)を含む。筐体半区分34aおよび34bは、半区分34aおよび34bの分離を防止する、近位本体管42内に受容される。
下側筐体半区分34bの近位端は、結合部分18を画定し、バヨネット式結合配列において外科手術用ステープラ2の作動デバイス4の本体部分6(図1)の遠位端に取り外し可能に係合するための係合出っ張り140を含む。本構造のさらなる詳細な説明に関しては、参照することによってその全体として本明細書に組み込まれる、米国特許第5,865,361号(「第‘361号特許」)を参照されたい。
近位駆動部材38は、コネクタ48を支持する離間された可撓性脚部46によって画定された近位部分を含む、伸長本体44を有する。コネクタ48は、作動デバイス4の制御ロッド(図示せず)に取り外し可能に係合し、制御ロッドの移動を近位駆動部材38の移動に変換するように構成される。コネクタ48は、再装填部10が発射された後、再装填部10を繋止するように機能する、繋止アセンブリ50を枢動可能に支持する。コネクタ48、制御ロッド(図示せず)、および繋止部材50の詳細は、第‘361号特許に説明されている。コネクタ48および繋止部材50ならびに以下に説明されるステープラ2の他の構成要素を格納するために、再装填部10に大径部分20を提供することによって、小径部分22の直径は、例えば、8mmトロカールアセンブリ内に受容され得るように、約8mmまで最小限にされることができる。大径部分20は、約12mmまたはより大きい直径であることができる。
近位駆動部材38の遠位端は、以下に詳細に説明されるように、近位駆動部材38の遠位移動が駆動アセンブリ56の遠位移動をもたらすように、駆動アセンブリ56のフック付き近位端と係合される、フック付き部分52を含む。
また、図7を参照すると、第1の関節運動連結部40(図6)は、再装填部10が作動デバイス4に固着されると、作動デバイス4の関節運動シャフト(図示せず)に係合するように構成される、フック付き近位端58を有する。第1の関節運動連結部40の遠位端は、本体部分12の小径部分22内に摺動可能に位置付けられる、第2の関節運動連結部60の近位端と係合される。第2の関節運動連結部60の遠位端は、図7に見られ、以下にさらに詳細に説明されるように、第2の関節運動連結部60の縦方向移動が垂直軸を中心としたツールアセンブリ16の枢動移動をもたらすように、本体部分12の縦軸からオフセットされた場所におけるピン60a(図7)によって、搭載アセンブリ14に枢動可能に接続される。
本体部分12の小径部分22は、外側管66内に受容された上側および下側半区分64aおよび64b(図5)を含む、内側本体を含む。上側および下側半区分64aおよび64bは、近位駆動部材38、駆動アセンブリ56、および第2の関節運動連結部60を摺動可能に受容する、チャネル(図示せず)を画定する。上側および下側半区分64aおよび64bの遠位端はまた、以下に詳細に説明されるであろう、段付き切り込み70を画定する。
図7−9を参照すると、ツールアセンブリ16は、アンビルアセンブリ24と、カートリッジアセンブリ26とを含む。アンビルアセンブリ24は、アンビル本体72と、アンビル本体72の底側に固着され、チャネル76(図9)を画定する、アンビルプレート74とを含む。実施形態では、解離器先端30は、アンビルプレート74の遠位端上に支持される。アンビルプレート74は、以下にさらに詳細に説明されるように、複数のステープル受容凹部72a(図9)と、再装填部10の駆動アセンブリ56の作業端80(図7)の一部を摺動可能に受容するように定寸される、縦方向スロット78とを画定する。アンビル本体72の近位端は、搭載アセンブリ14の円筒形枢動部材84を受容するための孔82aを画定する、ブラケット82を含む。
いくつかの実施形態では、カートリッジアセンブリ24は、チャネル90と、カートリッジ本体92とを含む。カートリッジ本体92は、スナップ嵌合接続によってチャネル90に取り付けられる。より具体的には、カートリッジ本体92は、チャネル90の側壁内に画定された開口部98内に受容され、カートリッジ本体92をチャネル90内に固着させる、一連の突出部96を含む。突出部96は、突出部96が、チャネル90の側壁を通り過ぎ、開口部98の中に入ることを可能にするためのテーパ状側壁と、突出部96を開口部98内に保定し、カートリッジ本体92のチャネル90からの不慮の分離を防止するための水平上側表面とを有してもよい。
チャネル90は、それぞれ、アンビル本体72およびチャネル90内に形成される開口部102および104を通して延在する、枢動部材100によって、アンビル本体72に枢動可能に固着される。カートリッジ本体92は、2列のみのステープル保定スロット104をメススロット106の両側に画定し、ツールアセンブリ16の直径の縮小を促進してもよい。メススロット106は、以下に説明されるように、チャネル90内に画定された伸長スロット106a(図9)と整合され、動的咬持部材の通過を促進する。ステープル保定スロット104は、カートリッジ本体92の組織接触表面110に沿って位置付けられ、アンビルプレート74のステープル形成凹部72a(図9)と整合される。各スロット104は、締結具またはステープル112およびプッシャ114を受容するように構成される。作動滑動部116は、カートリッジ本体92を通して縦方向に通過し、プッシャ114と係合し、連続して、ステープル112をカートリッジ本体92から吐出するように位置付けられる。
搭載アセンブリ14は、上側搭載部分120と、下側搭載部分122とを含む。搭載部分120および122はそれぞれ、枢動部材84を含む。前述のように、枢動部材84は、アンビル本体72の近位端上に形成されるブラケット82(図7)の孔82a内に受容され、上側搭載部分120をアンビル本体72に固着させる。第1の結合部材126は、枢動部材82aもまた受容する開口部126aを画定する、第1の端部と、再装填部10の本体部分12の上側半区分64aの遠位端に画定された陥凹70内に受容される、第2の端部とを有する。枢動部材82はまた、下側搭載部分122上に支持され、第2の結合部材128の第1の端部に画定された開口部128a内に受容される。第2の結合部材128は、本体部分12の下側筐体半区分64b内に画定された陥凹70内に受容され、下側搭載部分122を再装填部10の本体部分12の下側筐体半区分64bに枢動可能に固着させる、第2の端部を有する。枢動部材100は、アンビル本体72内に形成される開口部102と、チャネル90内に形成される開口部105とを通して延在し、下側搭載部分122内に形成される開口部130(図7)内に受容され、下側搭載部分122をチャネル90に固着させる。上側および下側搭載部分120および122は、ピンまたはリベット134を使用して、ともに固着される。
前述のように、第1の関節運動連結部40は、作動デバイス4の関節運動機構に取り外し可能に結合され、ツールアセンブリ16の関節運動を制御する。より具体的には、作動デバイス4の関節運動機構(図示せず)が動作されると、第1の関節運動連結部40は、前進され、第2の関節運動連結部60の対応する前進を生じさせる。第2の関節運動連結部60の遠位端は、枢動部材84によって画定された軸からオフセットされた場所において上側搭載部分120に接続される。したがって、第2の関節運動連結部60の縦方向移動は、ツールアセンブリ16を枢動部材84によって画定された軸を中心として枢動させる。
また、図5を参照すると、実施形態では、駆動アセンブリ56は、弾性材料、例えば、ステンレス鋼、ばね鋼鉄の複数のスタックされたシート140a−cから形成される。材料のシート140a−cの近位端は、クリップ、例えば、シート金属クリップ142の伸長陥凹142a内に受容される。金属クリップ142は、ある程度の相対的縦方向移動を可能にしながら、シート140a−cのそれぞれの近位端の整合を維持する。駆動アセンブリ56の材料のシート140a−cのそれぞれの遠位端は、溶接によって等、動的咬持部材150に固着される。金属クリップ142およびシート140a−cの近位端は、フック形状であって、近位駆動部材38の縦方向移動が駆動アセンブリ56の縦方向移動をもたらすように、近位駆動部材38のフック付き部分52に係合する。
図7に最良に示されるように、動的咬持部材150を含む、駆動アセンブリ56の作業端80はまた、メス152を画定する。メス152は、動的咬持部材150の垂直支柱154上に支持または形成される。動的咬持部材150は、上側フランジ156と、下側フランジ158とを含む。上側フランジ156は、アンビルアセンブリ24のチャネル76(図9)内に摺動可能に受容されるように位置付けられ、下側フランジ158は、カートリッジアセンブリ26のチャネル90の外側表面90a(図9)に沿って摺動可能に位置付けられるように位置付けられる。駆動アセンブリ56の遠位移動は、最初に、下側フランジ158を前進させ、チャネル90上に形成されるカム表面160と係合させ、カートリッジアセンブリ26をアンビルアセンブリ24に向かって閉鎖または接近位置に枢動させる。その後、駆動アセンブリ56の前進は、動的咬持部材150がツールアセンブリ16を通して移動するにつれて、動的咬持部材150に隣接するアンビルアセンブリ24とカートリッジアセンブリ26との間の最小組織間隙を徐々に維持する。
滑動部116は、動的咬持部材150のすぐ遠位の位置においてカートリッジ本体92内に支持される。動的咬持部材150の遠位端は、滑動部116に係合し、カートリッジアセンブリ26のカートリッジ本体92を通して駆動させるように位置付けられる。滑動部116は、カートリッジアセンブリ116内に位置付けられるプッシャ114に係合し、ステープル112をカートリッジ本体92から吐出するように位置付けられる、第1および第2のカム部材166と168とを含む。各プッシャ114は、カートリッジ本体92のメススロット106の片側上に位置付けられる2つのステープル112を支持する。
下側搭載部分122は、駆動アセンブリ56のシート140a−cを摺動可能に受容する、縦方向スロット122aを画定する。ブローアウトプレート123が、縦方向スロット122a内のシート140a−cの両側上に位置付けられる。ブローアウトプレート123のそれぞれの遠位端は、下側搭載部分122に固定して固着される。実施形態では、ブローアウトプレート123のそれぞれの遠位端123aは、下側搭載部分122に形成されるスロット内に締まり嵌めされ、ブローアウトプレート123のそれぞれの遠位端を下側搭載部分122に軸方向に固定する。ブローアウトプレート123のそれぞれの近位端は、本体部分12の小径部分22内で自由に摺動する。駆動アセンブリ56が、前進され、動的咬持部材150をカートリッジ本体92を通して前進させ、関節運動位置におけるツールアセンブリ16を用いてステープル112を発射させると、ブローアウトプレート123は、駆動アセンブリ56のシート140a−cが外向きに座屈することを防止する。前述のように、ブローアウトプレート123の近位端は、相互に連動して摺動可能であって、ブローアウトプレート123とシート140a−cとの間の曲率半径の差異を補償する。これは、シート140a−cが相互およびブローアウトプレート123と結合することを防止する。
図6および8を参照すると、繋止アセンブリ170が、再装填部10の近位端を中心として支持され、再装填部10が外科手術用ステープラ2の作動デバイス4に取り付けられるまで、駆動アセンブリ56の軸方向移動を防止する。繋止アセンブリ170は、回転可能スリーブ172と、係止部材174とを含む。回転可能スリーブ172は、本体部分12の上側および下側筐体半区分34a、34bの近位端を中心として搭載され、2つの近位に延在するフィンガ176を含む。回転可能スリーブ172はまた、カムスロット178(図8)を画定する。係止部材174は、下側筐体半区分34bに画定された切り込み179(図8)内に枢動可能に支持され、遮断フィンガ180と、カムフィンガ182とを含む。カムフィンガ182は、回転可能スリーブ172のカムスロット178内に位置付けられ、遮断フィンガ180は、コネクタ48(図6)の経路の中に下向きに延在し、近位駆動部材38の移動を妨害する。回転可能スリーブ172が、以下にさらに詳細に説明されるように回転されると、カムフィンガ182は、回転可能スリーブ172によって係合され、係止部材174を、遮断フィンガ180が、コネクタ48、したがって、近位駆動部材38の移動を妨害する、係止状態から、遮断フィンガ180がコネクタ48の移動の経路から離間された位置に枢動される、係止解除状態に枢動させる。
係止スリーブ172が下側筐体半区分34の近位端を中心として位置付けられると、係止スリーブ172の近位に延在するフィンガ176は、出っ張り140と整合するように位置付けられる。各近位に延在するフィンガ176は、陥凹188(図6)内に受容され、スリーブ176を非作動回転可能固定位置に取り外し可能に保定する、内向きに延在する突出部186を含む。再装填部10が作動デバイス4(図1)に取り付けられると、再装填部10の近位端は、作動デバイス4(図1)の遠位端の中に挿入され、再装填部10および作動デバイス4のバヨネット式結合構成要素に係合するように回転される。作動デバイス4が再装填部10に連動して回転されるにつれて、作動デバイス4の一部は、係止スリーブ176の近位に延在するフィンガ176に係合し、係止スリーブ172を再装填部10を中心として回転させる。これが生じると、カムフィンガ182は、回転可能スリーブ172によって係合され、係止部材174を係止状態から係止解除状態に枢動させる。前述のように、係止状態では、遮断フィンガ180は、コネクタ48の遠位移動を妨害して、近位駆動部材38の移動を妨害し、再装填部10の発送または取扱の際に生じ得る、再装填部10の早すぎる作動を防止するように位置付けられる。
図9−11を参照すると、上記で簡単に説明されたように、作動滑動部116は、それぞれ、第1および第2のカム部材166と、168とを含む。各カム部材166、168は、メススロット106の片側のプッシャ114の列に係合するように位置付けられる。プッシャ114の列内のプッシャ114はそれぞれ、二重発射プッシャであって、ステープルの内側列に1つと、ステープル112の外側列に1つずつ、2つのステープル112をメススロット106の片側に支持する。したがって、各プッシャ114が、滑動部116のカム部材166、168のうちの1つによって、カートリッジ本体92から上向きに駆動されるにつれて、2つのステープル112は、ステープル112の各列からのステープルが1つずつ、カートリッジ本体92のステープル保定スロット104から組織「T」(図9)の中に駆動される。実施形態では、カム部材166および168の角度は、カム部材166および168(図10)の近位端に沿って増加する、またはより急峻になってもよい。これは、プッシャ114の初期上向き移動が、より優れたステープル変形を提供するようにより制御されることを可能にする。メススロット106の両側の2列のステープルおよび単一列の二重プッシャを提供することによって、ツールアセンブリ16の直径は、最小限にされ、かつ小径トロカールアセンブリ、例えば、8mmを通して受容されることができる。
実施形態では、ステープル112はそれぞれ、同じサイズである。代替として、メススロット106に最も近い内向きステープル列内のステープル112は、メススロット106からより遠い外向き列のステープル内のステープル112より小さい。例えば、内向き列のそれぞれ内のステープル112は、約2mmの高さであることができ、外向き列のそれぞれ内のステープルは、約2.5mmの高さであってもよい。本ステープル配列は、より大きい範囲の組織厚さにおいてより優れた止血を提供し、発射の間、ステープラのジョーにかかる負荷の減少をもたらすであろう。
図13−20は、概して、200として示される、小径内視鏡部分を伴う、本開示の外科手術用ステープラの別の実施形態を図示する。ステープラ200は、ハンドルアセンブリ210と、縦軸を画定する伸長本体部分212と、伸長本体部分212の遠位端上に支持されるツールアセンブリ214とを含む。実施形態では、ハンドルアセンブリ210、伸長本体部分212、およびツールアセンブリは、相互に固定して固着され、相互から取り外し不可能である。
図13を参照すると、ハンドルアセンブリ212は、定常ハンドルまたはグリップ216と、定常ハンドル216と連動して作動ストロークを通して移動可能であり、ツールアセンブリ214を作動させる、発射ハンドル220と、伸長本体212の遠位端と連動してツールアセンブリ214を関節運動させるように機能する、関節運動ノブ218と、ツールアセンブリ214を非作動位置に戻すための後退ノブ222と、伸長本体部分212の回転を促進するための回転ノブ224と、ハンドルアセンブリ212と連動するツールアセンブリ214とを含む。米国特許第7,967,178号および第‘361号特許はそれぞれ、本開示の外科手術用ステープラ200と併用するために好適なハンドルアセンブリを開示しており、参照することによってその全体として本明細書に組み込まれる。
また、図14を参照すると、前述のように、実施形態では、ツールアセンブリ214は、伸長本体212の遠位端に固定して固着され、アンビルアセンブリ230(図13)と、カートリッジアセンブリ232とを含む。アンビルアセンブリ230は、前述のアンビルアセンブリ24に類似し、ここではさらに詳細に説明しない。カートリッジアセンブリ232は、カートリッジアセンブリ232が、可撤性ステープルカートリッジ本体234を含み、外科手術用ステープラ200の再使用を促進するという点において、前述のカートリッジアセンブリ26と異なる。より具体的には、外科手術用ステープラ200が、作動され、ステープルをカートリッジアセンブリ232のカートリッジ本体234から吐出後、使用済みカートリッジ本体234は、カートリッジアセンブリ232のチャネル240から除去され、装填されたカートリッジ本体234と交換され、外科手術用ステープラ200の再使用を促進することができる。
また、図15−18を参照すると、カートリッジアセンブリ232は、カートリッジ本体234と、支持プレート235と、チャネル240(図16)と、滑動部242と、複数のステープル244と、二重プッシャ248の第1および第2の列246aおよび246bと、発射繋止アセンブリ250とを含む。カートリッジ本体234は、支持プレート235内に受容され、アセンブリは、スナップ嵌合接続によって、チャネル240に取り付けられる。ツールアセンブリ214は、前述の搭載アセンブリ14と類似様式において、それぞれ、上側および下側搭載部分252aおよび252bを含む、搭載アセンブリ252によって、伸長本体212の遠位端に固着される。
カートリッジ本体92に関して前述のように、カートリッジ本体234は、中心メススロット252と、中心メススロット252の両側上に位置付けられる2列のステープル受容スロット254とを画定する。いくつかの実施形態では、ステープル受容スロット254の各列内のスロット254は、中心メススロット252の同一側で他の列内のスロット254に対して交互される。プッシャ248の各列246a、246b内の各プッシャ248は、中心メススロット252の個別の側上の各列内に1つずつのスロット254を含む、2つのスロット254aと関連付けられる。滑動部242は、駆動アセンブリ260によってカートリッジを通して押動され、プッシャと相互作用し、これは、ステープルをアンビルに対して駆動させる。プッシャはそれぞれ、2つのプッシャプレート間に単一カム表面を有する。各プッシャプレートは、ステープルを支持し、交互される。滑動部は、両側のカム表面に接触するための単一楔と、メススロット内を進行する中心部材とを有する。
駆動アセンブリ260は、伸長本体212の遠位端内で摺動可能であって、動的咬持部材262を含む。動的咬持部材262は、駆動アセンブリ260が、駆動アセンブリ56に関して前述の様式において、後退位置から前進位置に移動されるにつれて、ツールアセンブリ214を通して平行移動し、ステープル244をカートリッジアセンブリ232から吐出するように構成される。
発射繋止アセンブリ250は、枢動掛止部材270と、付勢部材272とを含む。掛止部材270は、下側搭載部分252b上に枢動可能に支持され、駆動アセンブリ260の遠位端上に形成される停止表面274に係合し、使用済みカートリッジを用いた外科手術用ステープラ200の再発射を防止するように位置付けられる。発射繋止アセンブリ250を含む、カートリッジアセンブリ232の動作は、米国特許公開第2015/0272576号および米国特許出願第14/812,143号に説明されており、参照することによってその全体として本明細書に組み込まれる。
実施形態では、ステープル244はそれぞれ、同じサイズである。代替として、メススロット252に最も近い内向きステープル列内のステープル244は、メススロット252からより遠い外向き列のステープル内のステープル244より小さい。例えば、内向き列のそれぞれ内のステープル244は、約2mmの高さであることができ、外向き列のそれぞれ内のステープル244は、約2.5mmの高さであってもよい。本ステープル配列は、より大きい範囲の組織厚さにおけるより優れた止血を提供し、発射の間のステープラのジョーにかかる負荷の減少をもたらすであろう。
前述のように、外科手術用ステープラ200は、伸長本体部分212の遠位部分を含む、内視鏡部分と、小径、例えば、8mmトロカールを通した挿入を促進するような縮径であるように構成される、ツールアセンブリ214とを含む。より具体的には、繋止アセンブリをカートリッジアセンブリ232の中に組み込み、カートリッジ本体234に4列のステープルおよび2列の二重プッシャ248を提供することによって、外科手術用ステープラ200の内視鏡部分の直径は、最小限にされることができる。
当業者は、本明細書に具体的に説明され、付随の図面に図示されるデバイスおよび方法が、非限定的例示的実施形態であることを理解するであろう。一例示的実施形態に関連して図示または説明される要素および特徴は、本開示の範囲から逸脱することなく、別の実施形態の要素および特徴と組み合わせられてもよいことが想定される。同様に、当業者は、前述の実施形態に基づいて、本開示のさらなる特徴および利点を理解するであろう。故に、本開示は、添付の請求項によって示されるものを除き、具体的に図示および説明されたものによって限定されない。
Claims (14)
- 外科手術用ステープラであって、
作動デバイスと、
前記作動デバイスに取り外し可能に固着される、再装填部であって、前記再装填部は、本体部分と、ツールアセンブリとを含み、前記本体部分は、第1の直径を画定する大径部分と、前記大径部分から遠位に延在する、第2の直径を画定する小径部分とを含み、前記ツールアセンブリは、前記小径部分の遠位端上に支持され、前記小径部分は、8mmトロカールを通して通過するように定寸され、前記ツールアセンブリは、2つの側のそれぞれに単一楔を有する滑動部を伴う、可撤性かつ交換可能なステープルカートリッジを含む、再装填部と、
を備える、外科手術用ステープラ。 - 駆動アセンブリをさらに含み、前記ツールアセンブリは、アンビルアセンブリと、複数のステープルを支持するカートリッジアセンブリとを含み、前記駆動アセンブリは、前記本体部分および前記ツールアセンブリを通して移動可能であり、ステープルを前記カートリッジアセンブリから吐出する、請求項1に記載の外科手術用ステープラ。
- 前記作動デバイスから遠位に延在する伸長本体をさらに含み、前記再装填部は、前記伸長本体の遠位端上に支持される、請求項1に記載の外科手術用ステープラ。
- 前記本体部分の大径部分内に支持される係止部材を含む、係止アセンブリをさらに含む、請求項1に記載の外科手術用ステープラ。
- 前記再装填部の本体部分の大径部分は、筐体を含み、前記係止部材は、前記筐体内に支持され、前記係止部材が前記駆動アセンブリに係合し、前記駆動アセンブリを後退位置に維持する、第1の位置から、前記係止部材が前記筐体部分に対する前記駆動アセンブリの遠位移動を可能にする、第2の位置に移動可能である、請求項4に記載の外科手術用ステープラ。
- 前記繋止アセンブリは、前記再装填部の大径部分を中心として搭載される回転可能スリーブを含み、前記回転可能スリーブは、前記再装填部の大径部分を中心とする前記回転可能スリーブの回転が、前記第1の位置から前記第2の位置への前記係止部材の移動をもたらすように、前記係止部材と係合される、請求項5に記載の外科手術用ステープラ。
- 前記回転可能スリーブは、カムスロットを画定し、前記係止部材は、前記カムスロット内に受容されるカムフィンガを含み、前記再装填部の大径部分を中心とする前記回転可能スリーブの回転は、前記回転可能スリーブを前記カムフィンガに係合させ、前記係止部材を前記第1の位置から前記第2の位置に移動させる、請求項6に記載の外科手術用ステープラ。
- 前記係止部材は、前記後退位置からの前記駆動アセンブリの遠位移動を妨害するように位置付けられる、遮断フィンガを含む、請求項7に記載の外科手術用ステープラ。
- 前記駆動アセンブリは、近位駆動部材を含み、前記作動デバイスは、制御ロッドを含み、前記近位駆動部材は、コネクタを前記本体部分の大径部分内に支持し、前記コネクタは、前記制御ロッドに取り外し可能に係合し、前記制御ロッドの移動を前記近位駆動部材の移動に変換するように構成される、請求項8に記載の外科手術用ステープラ。
- 前記駆動アセンブリは、前記ツールアセンブリを通して平行移動し、前記複数のステープルを前記カートリッジアセンブリから吐出するように位置付けられる、動的咬持部材を含む、請求項2に記載の外科手術用ステープラ。
- 前記カートリッジアセンブリは、メススロットと、前記メススロットの両側の2列のステープルとを画定する、カートリッジ本体を含む、請求項10に記載の外科手術用ステープラ。
- 前記カートリッジ本体は、前記メススロットの両側に1列のプッシャを支持する、請求項11に記載の外科手術用ステープラ。
- 前記アンビルアセンブリの遠位端上に支持される解離用先端をさらに含む、請求項2に記載の外科手術用ステープラ。
- 前記アンビルアセンブリ上に支持されるバットレス材料をさらに含む、請求項2に記載の外科手術用ステープラ。
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CN107049397A (zh) | 2017-08-18 |
US20170231633A1 (en) | 2017-08-17 |
JP2021090867A (ja) | 2021-06-17 |
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