JP2018534055A - 内視鏡外科用クリップアプライヤ - Google Patents
内視鏡外科用クリップアプライヤ 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
- A61B17/12—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
- 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
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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
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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
- A61B2017/00464—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable for use with different 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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2901—Details of shaft
- A61B2017/2902—Details of shaft characterized by features of the actuating rod
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Abstract
【選択図】図1
Description
本開示は、外科用クリップアプライヤに関する。より具体的には、本開示は、種々の異なる内視鏡アセンブリと共に使用するために構成される把手アセンブリを有する、内視鏡外科用クリップアプライヤに関する。
内視鏡外科用ステープラ及び外科用クリップアプライヤは、当該技術分野で既知であり、いくつかのはっきりと異なる有用な外科手技に使用される。腹腔鏡外科手技の場合、腹部内部へのアクセスは、皮膚の小さい切開口を通して挿入される細管またはカニューレによって実現される。身体の他の場所で実施される低侵襲手技は、一般的には内視鏡手技と称されることが多い。典型的には、管またはカニューレデバイスが、切開口を通して患者の身体内に延ばされ、アクセスポートを提供する。このポートは、外科医が、トロカールを使用してそこを通していくつかの異なる外科用器具を挿入し、切開から遠く離れて外科手技を実施することを可能にする。
駆動バー上で旋回可能に支持されるラチェット爪と、ハウジングから延在してその中に内視鏡アセンブリを解放可能に係合するように構成された受容アセンブリと、を含む。第1の内視鏡アセンブリは、ラチェット用途に構成され、近位ハブ、細長いシャフト、エンドエフェクタアセンブリ、及び駆動アセンブリを含む。近位ハブは、受容アセンブリ内に挿入可能であり、受容アセンブリ内で解放可能に係合可能であり、その中に配置されたラチェットラックを含む。ラチェットラックは、複数のラチェット歯を画定する。細長いシャフトは、近位ハブから遠位に延在する。エンドエフェクタアセンブリは、細長いシャフトの遠位端に支持される。駆動アセンブリは、近位ハブ及び細長いシャフト内に摺動可能に配置され、かつ近位端及び遠位端を画定する内側シャフトを含む。内側シャフトの遠位端は、非発射位置から発射位置への内側シャフトの運動がエンドエフェクタアセンブリの操作をもたらすように、エンドエフェクタアセンブリに動作可能に結合される。近位ハブが受容アセンブリ内に解放可能に係合した状態で、駆動バーの近位位置から遠位位置に向かう初期移転は、ラチェット爪がそのラチェット歯と連続的に係合してラチェットラックに沿って漸進的に前進するに従って、遠位位置に向かう駆動バーのさらなる遠位移転が、非発射位置から発射位置に向かって漸進的に内側シャフトを付勢するように、ラチェット爪を運動させて、ラチェットラックと係合させ、かつ駆動バーを駆動アセンブリと当接させる。
Claims (20)
- 部分使い捨て(reposable)外科用器具であって、
把手アセンブリであって、
ハウジングと、
前記ハウジング内に摺動可能に支持される駆動バーと、
前記ハウジングに旋回可能に接続されたトリガであって、非作動位置から作動位置までの前記ハウジングに対する前記トリガの運動が、前記駆動バーを近位位置から遠位位置に移転させるように、前記駆動バーに動作可能に結合されたトリガと、
前記駆動バー上に旋回可能に支持されるラチェット爪と、
前記ハウジングから延在してその中に内視鏡アセンブリを解放可能に係合するように構成された受容アセンブリと、を含む、把手アセンブリと、
ラチェット用途に構成された第1の内視鏡アセンブリであって、
前記受容アセンブリ内に挿入可能であり、前記受容アセンブリ内で解放可能に係合可能な近位ハブであって、その中に配置されたラチェットラックを含み、前記ラチェットラックが複数のラチェット歯を画定する、近位ハブと、
前記近位ハブから遠位に延在する細長いシャフトと、
前記細長いシャフトの遠位端に支持されるエンドエフェクタアセンブリと、
前記近位ハブ及び前記細長いシャフト内に摺動可能に配置された内側シャフトを含み、かつ近位端及び遠位端を画定する駆動アセンブリであって、前記内側シャフトの前記遠位端は、非発射位置から発射位置までの前記内側シャフトの運動が、前記エンドエフェクタアセンブリの操作をもたらすように、前記エンドエフェクタアセンブリに動作可能に結合される、駆動アセンブリと、を含む、第1の内視鏡アセンブリであって、
前記近位ハブが前記受容アセンブリ内に解放可能に係合した状態で、前記駆動バーの前記近位位置から前記遠位位置に向かう初期移転は、前記ラチェット爪がその前記ラチェット歯と連続的に係合して前記ラチェットラックに沿って漸進的に前進するに従って、前記遠位位置に向かう前記駆動バーのさらなる遠位移転が、前記非発射位置から前記発射位置に向かって漸進的に前記内側シャフトを付勢するように、前記ラチェット爪を運動させて、前記ラチェットラックと係合させ、かつ前記駆動バーを前記駆動アセンブリと当接させる、第1の内視鏡アセンブリと、を備える、部分使い捨て外科用器具。 - 前記ラチェット爪の前記ラチェットラックとの係合に先んじて、前記駆動バーは、近位に戻ることが可能になり、それにより、前記内側シャフトを前記非発射位置に向かって戻す、請求項1に記載の部分使い捨て外科用器具。
- 前記ラチェット爪が前記ラチェットラックに係合した状態で、前記駆動バーは、近位に戻ることを阻害され、それにより、前記内側シャフトが前記非発射位置に向かって戻ることを阻害する、請求項1に記載の部分使い捨て外科用器具。
- いったん前記内側シャフトが前記発射位置に到達すると、前記ラチェット爪は、前記ラチェットラックを空けて、そこから脱係合される、請求項1に記載の部分使い捨て外科用器具。
- 前記ラチェット爪が空けられて、前記ラチェットラックから脱係合された状態で、前記駆動バーは、近位に戻ることが可能になり、それにより、前記内側シャフトを前記非発射位置に向かって戻す、請求項4に記載の部分使い捨て外科用器具。
- 前記第1の内視鏡アセンブリの前記駆動アセンブリは、前記内側シャフトの前記近位端と動作可能に係合されたプランジャーをさらに含み、前記駆動バーは、前記プランジャーに当接して、前記プランジャーを遠位に付勢し、それにより、前記内側シャフトを前記非発射位置から前記発射位置に向けて付勢するように構成されている、請求項1に記載の部分使い捨て外科用器具。
- 前記プランジャーは、前記内側シャフトと一緒に、前記非発射位置から前記発射位置まで移転するように構成され、前記プランジャーは、前記内側シャフトとは無関係に遠位に、かつ前記発射位置から終了位置まで、それらに対して移転するようにさらに構成されている、請求項6に記載の部分使い捨て外科用器具。
- 前記第1の内視鏡アセンブリの前記駆動アセンブリは、第1及び第2のばねを含み、前記第2のばねは、前記内側シャフトと一緒に前記プランジャーが前記非発射位置から前記発射位置まで移転するとき、前記第1のばねが圧迫されるように、かつ、前記プランジャーが前記内側シャフトとは無関係に遠位に、ならびに前記発射位置から前記終了位置まで、それらに対して移転するとき、前記第2のばねが圧迫されるように、前記第1のばねのものよりも大きいばね定数を定義する、請求項7に記載の部分使い捨て外科用器具。
- 前記近位位置から前記遠位位置までの前記駆動バーの移転は、前記把手アセンブリの作動ストローク長を画定し、前記非発射位置から前記発射位置までの前記内側シャフトの移転は、前記把手アセンブリの前記作動ストローク長よりも小さい前記第1の内視鏡アセンブリの発射ストローク長を画定し、前記発射位置から前記終了位置までの前記プランジャーの移転は、前記第1の内視鏡アセンブリの前記発射ストロークの完了後、前記把手アセンブリの前記作動ストロークの完了を可能にする、請求項7に記載の部分使い捨て外科用器具。
- 前記第1の内視鏡アセンブリの前記エンドエフェクタアセンブリは、第1及び第2の顎部材を含み、前記第1の内視鏡アセンブリの前記駆動アセンブリの前記内側シャフトの前記非発射位置から前記発射位置までの運動は、前記第1及び第2の顎部材を開位置から閉鎖位置まで運動させる、請求項1に記載の部分使い捨て外科用器具。
- 前記第1及び第2の顎部材は、それらの間に外科用クリップを受容するように構成され、前記第1及び第2の顎部材の前記開位置から前記閉鎖位置までの運動が、前記外科用クリップを形成する、請求項10に記載の部分使い捨て外科用器具。
- 非ラチェット用途に構成された第2の内視鏡アセンブリであって、
前記受容アセンブリ内に挿入可能であり、前記受容アセンブリ内で解放可能に係合可能である近位ハブと、
前記近位ハブから遠位に延在する細長いシャフトと、
前記細長いシャフトの遠位端に支持されるエンドエフェクタアセンブリと、
前記近位ハブ及び前記細長いシャフト内に摺動可能に配置された内側シャフトを含み、かつ近位端及び遠位端を画定する駆動アセンブリであって、前記内側シャフトの前記遠位端は、非発射位置から発射位置までの前記内側シャフトの運動が、前記エンドエフェクタアセンブリの操作をもたらすように、前記エンドエフェクタアセンブリに動作可能に結合される、駆動アセンブリと、を含む、第2の内視鏡アセンブリであって、
前記第2の内視鏡アセンブリの前記近位ハブが前記受容アセンブリ内に解放可能に係合された状態で、前記駆動バーの前記近位位置から前記遠位位置までの移転が、前記駆動バーを運動させて、前記駆動アセンブリと当接させ、それにより、前記内側シャフトを前記非発射位置から前記発射位置まで連続的に付勢する、第2の内視鏡アセンブリと、をさらに備える、請求項1に記載の部分使い捨て外科用器具。 - 前記第2の内視鏡アセンブリの前記近位ハブが前記受容アセンブリ内に解放可能に係合された状態で、前記ラチェット爪は、前記近位位置と遠位位置との間の前記駆動バーの移転中に待機したままである、請求項12に記載の部分使い捨てアセンブリ。
- 前記第2の内視鏡アセンブリの前記近位ハブが前記受容アセンブリ内に解放可能に係合された状態で、前記駆動バーは、近位に戻ることが可能になり、それにより、前記駆動バーの遠位移転中の任意の点で、前記内側シャフトを前記非発射位置に向かって戻す、請求項12に記載の部分使い捨てアセンブリ。
- 前記第2の内視鏡アセンブリの前記エンドエフェクタアセンブリは、第1及び第2の顎部材を含み、前記第2の内視鏡アセンブリの前記駆動アセンブリの前記内側シャフトの前記非発射位置から前記発射位置までの運動が、前記第1及び第2の顎部材を開位置から閉鎖位置まで運動させる、請求項12に記載の部分使い捨て外科用器具。
- 前記第2の内視鏡アセンブリの前記第1及び第2の顎部材は、それらの間に外科用クリップを受容するように構成され、前記第1及び第2の顎部材の前記開位置から前記閉鎖位置までの運動が、前記外科用クリップを形成する、請求項15に記載の部分使い捨て外科用器具。
- 前記第2の内視鏡アセンブリの前記駆動アセンブリは、前記内側シャフトの前記近位端と動作可能に係合されたプランジャーをさらに含み、前記駆動バーは、前記プランジャーに当接して、前記プランジャーを遠位に付勢し、それにより、前記内側シャフトを前記非発射位置から前記発射位置に向けて付勢するように構成されている、請求項12に記載の部分使い捨て外科用器具。
- 前記プランジャーは、前記内側シャフトと一緒に、前記非発射位置から前記発射位置まで移転するように構成され、前記プランジャーは、前記内側シャフトとは無関係に遠位に、かつ前記発射位置から終了位置まで、それらに対して移転するようにさらに構成されている、請求項17に記載の部分使い捨て外科用器具。
- 前記第2の内視鏡アセンブリの前記駆動アセンブリは、第1及び第2のばねを含み、前記第2のばねは、前記内側シャフトと一緒に前記プランジャーが前記非発射位置から前記発射位置まで移転するとき、前記第1のばねが圧迫されるように、かつ、前記プランジャーが前記内側シャフトとは無関係に遠位に、ならびに前記発射位置から前記終了位置まで、それらに対して移転するとき、前記第2のばねが圧迫されるように、前記第1のばねのものよりも大きいばね定数を定義する、請求項18に記載の部分使い捨て外科用器具。
- 前記近位位置から前記遠位位置までの前記駆動バーの移転は、前記把手アセンブリの作動ストローク長を画定し、前記非発射位置から前記発射位置までの前記内側シャフトの移転は、前記把手アセンブリの前記作動ストローク長よりも小さい前記第2の内視鏡アセンブリの発射ストローク長を画定し、前記発射位置から前記終了位置までの前記プランジャーの移転は、前記第2の内視鏡アセンブリの前記発射ストロークの完了後、前記把手アセンブリの前記作動ストロークの完了を可能にする、請求項18に記載の部分使い捨て外科用器具。
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US20130131697A1 (en) | 2011-11-21 | 2013-05-23 | Covidien Lp | Surgical clip applier |
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US9931124B2 (en) | 2015-01-07 | 2018-04-03 | Covidien Lp | Reposable clip applier |
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2015
- 2015-11-03 CA CA2998890A patent/CA2998890A1/en not_active Abandoned
- 2015-11-03 WO PCT/CN2015/093626 patent/WO2017075752A1/en active Application Filing
- 2015-11-03 US US15/751,240 patent/US10702279B2/en active Active
- 2015-11-03 CN CN201580084311.3A patent/CN108348259B/zh active Active
- 2015-11-03 EP EP15907594.4A patent/EP3370625B1/en active Active
- 2015-11-03 AU AU2015413639A patent/AU2015413639A1/en not_active Abandoned
- 2015-11-03 JP JP2018521252A patent/JP6626197B2/ja active Active
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2020
- 2020-06-19 US US16/905,974 patent/US20200315629A1/en not_active Abandoned
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EP3370625A4 (en) | 2019-09-25 |
EP3370625A1 (en) | 2018-09-12 |
US10702279B2 (en) | 2020-07-07 |
EP3370625B1 (en) | 2020-07-01 |
CN108348259B (zh) | 2020-12-11 |
AU2015413639A1 (en) | 2018-04-05 |
US20200315629A1 (en) | 2020-10-08 |
JP6626197B2 (ja) | 2019-12-25 |
CN108348259A (zh) | 2018-07-31 |
WO2017075752A1 (en) | 2017-05-11 |
CA2998890A1 (en) | 2017-05-11 |
US20180235637A1 (en) | 2018-08-23 |
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