JP2019000703A - 開創器 - Google Patents
開創器 Download PDFInfo
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- JP2019000703A JP2019000703A JP2018180036A JP2018180036A JP2019000703A JP 2019000703 A JP2019000703 A JP 2019000703A JP 2018180036 A JP2018180036 A JP 2018180036A JP 2018180036 A JP2018180036 A JP 2018180036A JP 2019000703 A JP2019000703 A JP 2019000703A
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- retractor device
- retracting device
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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
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0293—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with ring member to support retractor elements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors 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
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00831—Material properties
- A61B2017/00946—Material properties malleable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
- A61B2017/0225—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery flexible, e.g. fabrics, meshes, or membranes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B2017/0287—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with elastic retracting members connectable to a frame, e.g. hooked elastic wires
Abstract
Description
52 腹部キャビティ
54 腹部領域
56 開創デバイス
58 人の手
60 腹壁
62 外科的切開創
100 開創デバイス
102 第1外リング
104 第2内リング
106 共通の軸線
108 第1ヒンジ
110 第2ヒンジ
114 チューブ状気密メンブレン又はシース
Claims (65)
- 体壁の切開創を開創するための開創デバイスにおいて、
第1外リングと、
第2内リングと、
前記第1外リングを前記第2内リングに連結する第1ヒンジと、
前記第1外リングを前記第2内リングに連結する第2ヒンジであって、前記第1及び第2のヒンジは、共通の軸線に沿って位置決めされており、前記第1及び第2のリングの周囲上で互いに実質的に反対側にある、第2ヒンジと、
前記第1外リングの周囲及び前記第2内リングの周囲に連結されたチューブ状シースと、
前記第1外リング及び前記第2内リングが互いに実質的に同心の第1同心状態と、
前記第1外リング及び前記第2内リングを前記軸線を中心として回転し、前記第1及び第2のリングの平面間に所定の角度を形成する、角度をなした第2状態と、
前記開創デバイスを前記角度をなした第2状態に維持するための手段とを含み、
前記シースは、前記第1及び第2のリングが前記角度をなした第2状態にあるとき、実質的に円筒形である、開創デバイス。 - 請求項1に記載の開創デバイスにおいて、
前記第1同心状態では、前記シースには張力が実質的に加わっていない、開創デバイス。 - 請求項1に記載の開創デバイスにおいて、
前記第1同心状態で、前記第1及び第2のリングを前記第1及び第2のヒンジ間の軸線に沿って圧縮することによって、前記開創デバイスを大きく流線型にし、体壁の前記切開創への前記開創デバイスの挿入を容易にする、開創デバイス。 - 請求項1に記載の開創デバイスにおいて、
前記維持手段は、前記第1及び第2のヒンジの少なくとも一方の近位側に位置決めされたラチェット機構を含む、開創デバイス。 - 請求項4に記載の開創デバイスにおいて、
前記ラチェット機構は、前記第1及び第2のヒンジの各々の近位側に位置決めされている、開創デバイス。 - 請求項1に記載の開創デバイスにおいて、
前記維持手段は、前記体壁の外側の前記開創デバイスに取り付けられたバルブ構造を含む、開創デバイス。 - 請求項1に記載の開創デバイスにおいて、
前記シースは、エラストマー材料で形成されている、開創デバイス。 - 請求項1に記載の開創デバイスにおいて、
前記シースは、非膨張性材料で形成されている、開創デバイス。 - 体壁の切開創を開創するための開創デバイスにおいて、
第1リングと、
第2リングと、
前記第1リングを前記第2リングに連結する第1ヒンジと、
前記第1リングを前記第2リングに連結する第2ヒンジであって、前記第1及び第2のヒンジは、共通の軸線に沿って位置決めされており、前記第1及び第2のリングの周囲上で互いに実質的に反対側にある、第2ヒンジと、
前記第1及び第2のリングの各々に連結された伸縮性チューブ状シースと、
第1及び第2のリングの平面間に角度が形成され、前記シースが実質的に弛緩状態にあり、前記開創デバイスの近位端と遠位端との間に実質的に貫通内腔を形成する第1弛緩状態と、
第1及び第2のリングを近位開口部平面及び遠位開口部平面を横切って互いに向かって回転し、前記第1及び第2のリングが実質的に同心であり、前記第1及び第2のリング間で前記シースに張力が加わっている、張力が加わった第2状態とを含み、
前記開創デバイスが前記張力が加わった第2状態にあるとき、前記エラストマー製シースに加わった張力を解放することにより、前記開創デバイスを第1弛緩状態にすることができる、開創デバイス。 - 請求項9に記載の開創デバイスにおいて、
前記張力が加わった第2状態では、前記シースの内腔は減少し、実質的に塞がれており、前記開創デバイスは実質的に平らである、開創デバイス。 - 請求項9に記載の開創デバイスにおいて、
前記張力が加わった第2状態で、前記第1及び第2のリングを前記第1及び第2のヒンジ間の軸線に沿って圧縮することによって、前記開創デバイスを大きく流線型にし、体壁の前記切開創への前記開創デバイスの挿入を容易にする、開創デバイス。 - 体壁の切開創を開創するための開創デバイスにおいて、
連続した遠位リングと、
第1半リングと、
第2半リングと、
前記遠位リング、前記第1半リング、及び前記第2半リングを互いに連結する第1ヒンジと、
前記遠位リング、前記第1半リング、及び前記第2半リングを互いに連結する第2ヒンジであって、前記第1及び第2のヒンジは、共通の軸線に沿って位置決めされており、前記遠位リングの周囲上で互いに実質的に反対側にある、第2ヒンジと、
前記遠位リングと前記第1及び第2の半リングとの間に連結されたエラストマー製周囲シースと、
前記第1半リングが、前記遠位リングの近位側で前記軸線の第1側に位置決めされ、前記第2半リングが、前記遠位リングの近位側で前記軸線の第2側即ち反対側に位置決めされた第1中立状態と、
前記第1半リングを第1及び第2のヒンジを中心として第1方向に前記軸線の前記第2側の前記遠位リングの近位側の位置まで回転することにより、前記遠位リングと前記第1半リングとの間に連結された前記シースの部分を張力が加わった状態に置き、前記第2半リングを第1及び第2のヒンジを中心として第2方向即ち逆方向に前記軸線の前記第1側の前記遠位リングの近位側の位置まで回転することにより、前記遠位リングと前記第2半リングとの間に連結された前記シースの部分を張力が加わった状態に置く、張力が加わった第2状態とを含む、開創デバイス。 - 請求項12に記載の開創デバイスにおいて、
前記第1及び第2の半リングを、これらの半リングが前記遠位リングと実質的に同心になるまで、前記軸線を中心として更に回転する、開創デバイス。 - 請求項12に記載の開創デバイスにおいて、
前記張力が加わった第2状態で、前記遠位リング及び前記第1及び第2の半リングを前記第1及び第2のヒンジ間の軸線に沿って圧縮することによって、前記開創デバイスを大きく流線型にし、体壁の切開創への前記開創デバイスの挿入を容易にする、開創デバイス。 - 請求項12に記載の開創デバイスにおいて、
前記シースは、更に、前記第1及び第2の半リング間に連結されている、開創デバイス。 - 請求項12に記載の開創デバイスにおいて、
前記第1及び第2の半リングの少なくとも一方が、前記遠位リングの外面に沿って位置決めされている、開創デバイス。 - 請求項12に記載の開創デバイスにおいて、
前記第1及び第2の半リングの少なくとも一方が、前記遠位リングの内面に沿って位置決めされている、開創デバイス。 - 請求項12に記載の開創デバイスにおいて、
前記第1半リングの第1端部分及び前記第2半リングの第1端部分が重なり、前記第1半リングの第2端部分及び前記第2半リングの第2端部分が重なる、開創デバイス。 - 請求項18に記載の開創デバイスにおいて、
前記第1半リングの前記第1端部分は、前記遠位リングと前記第2半リングの前記第1端部分との間に位置決めされ、
前記第1半リングの前記第2端部分は、前記遠位リングと前記第2半リングの前記第2端部分との間に位置決めされ、
前記第1及び第2の半リングは、これらの第1及び第2の半リングを前記第1及び第2のヒンジを中心として回転するとき、互いを越えて回転するようになっている、開創デバイス。 - 請求項12に記載の開創デバイスにおいて、
前記遠位リングは、体壁の内面に当接するようになっている、開創デバイス。 - 体壁の切開創を開創するための開創デバイスにおいて、
第1遠位保持リングと、
第2近位保持リングと、
前記第1及び第2の保持リングに連結された、内腔を持つチューブ状周囲シースと、
各々が前記遠位保持リングに連結され、前記シースの前記内腔及び前記近位保持リングを通って近位方向に延びる複数の張力ストラップと、
近位ロックリングであって、前記ストラップを前記近位保持リングの内面と前記ロックリングの外面との間に捕捉する大きさ及び形態を持ち、前記近位保持リングと前記ロックリングとの間に前記ストラップが存在する状態で前記近位保持リングの内腔内に位置決めされるようになった近位ロックリングとを含み
前記ストラップは、近位方向に引っ張られて適当な張力が加えられた後、切開創を開創するようになっており、
前記ロックリングは、前記ストラップの張力に応じて、前記近位保持リングの前記内面に食い込み、前記ストラップが前記ロックリングと前記近位保持リングとの間で遠位方向に滑らないようにする、開創デバイス。 - 請求項21に記載の開創デバイスにおいて、
前記近位保持リングの前記内面及び前記ロックリングの前記外面の少なくとも一方がベベル状になっている、開創デバイス。 - 請求項21に記載の開創デバイスにおいて、
前記複数のストラップの各々は、強く薄い非弾性材料で形成されている、開創デバイス。 - 請求項21に記載の開創デバイスにおいて、
張力が加わった前記ストラップの少なくとも一つを近位方向に僅かに引っ張ることによって前記複数のストラップの張力を解放し、前記ロックリングを前記近位リングから解放し、前記ロックリングを取り外す、開創デバイス。 - 体壁の切開創を開創するための開創デバイスにおいて、
近位保持リングと、
前記近位保持リングに連結された、前記近位保持リングから遠位方向に延びる複数の賦形可能な延長エレメントであって、これらの延長エレメントは、低プロファイルの第1挿入状態から、前記延長エレメントの遠位端が半径方向外方に延びる高プロファイルの第2拡張保持状態まで移行するように形成されている、延長エレメントとを含む、開創デバイス。 - 請求項25に記載の開創デバイスにおいて、更に、
前記開創デバイスの内腔内に位置決めされた周囲シースを含む、開創デバイス。 - 請求項25に記載の開創デバイスにおいて、
前記近位保持リングは、体壁の外面に当接するようになっている、開創デバイス。 - 請求項25に記載の開創デバイスにおいて、
前記延長エレメントは、軸線方向で半円形の断面を持つ薄板金製のストリップで形成されており、
前記延長エレメントの各々は、前記半円形断面の外湾曲が半径方向外方に位置決めされるように配向されており、
前記延長エレメントは、前記半円形の外面を内方に曲げたとき、湾曲した高プロファイルの第2状態に移行する、開創デバイス。 - 請求項28に記載の開創デバイスにおいて、
前記延長エレメントはばね鋼で形成されている、開創デバイス。 - 請求項25に記載の開創デバイスにおいて、
前記延長エレメントは形状記憶材料で形成されており、
第1温度では、前記延長エレメントは、実質的に直線状の第1状態にあり、
比較的高温の第2温度では、前記延長エレメントは、湾曲した第2状態に移行し、この第2状態では、前記延長エレメントの前記遠位端は半径方向外方に延びる、開創デバイス。 - 請求項30に記載の開創デバイスにおいて、
前記延長エレメントは、ニッケル−チタニウム合金で形成されている、開創デバイス。 - 請求項25に記載の開創デバイスにおいて、更に、
複数の引っ張りワイヤを含み、これらの引っ張りワイヤの各々は、夫々の延長エレメントの遠位部分に連結されており、前記引っ張りワイヤを近位方向に引っ張ったとき、夫々の延長エレメントを半径方向外方に逸らすように形成されている、開創デバイス。 - 請求項32に記載の開創デバイスにおいて、更に、
前記開創デバイスの内腔内に位置決めされた周囲シースを含む、開創デバイス。 - 請求項32に記載の開創デバイスにおいて、
前記近位保持リングは、体壁の外面に当接するようになっている、開創デバイス。 - 請求項32に記載の開創デバイスにおいて、
前記延長エレメントは、ばね鋼で形成されている、開創デバイス。 - 請求項32に記載の開創デバイスにおいて、
前記引っ張りワイヤは、集合的に展開してもよく、又は個々に展開してもよい、開創デバイス。 - 請求項32に記載の開創デバイスにおいて、更に、
前記延長エレメントの各々の前記外面の長さに沿って位置決めされた引っ張りワイヤリテーナを含み、前記引っ張りワイヤの各々は、夫々の引っ張りワイヤリテーナを通過する、開創デバイス。 - 請求項37に記載の開創デバイスにおいて、
各引っ張りワイヤリテーナはチューブを含み、夫々の引っ張りワイヤは前記チューブを通過する、開創デバイス。 - 請求項37に記載の開創デバイスにおいて、
各引っ張りワイヤリテーナは少なくとも一つのアイレットを含み、前記引っ張りワイヤは夫々のアイレットを通過する、開創デバイス。 - 請求項39に記載の開創デバイスにおいて、
各引っ張りワイヤリテーナは、夫々の延長エレメントの長さに沿って長さ方向に整合した複数のアイレットを含み、前記引っ張りワイヤは前記複数のアイレットの夫々を通過する、開創デバイス。 - 体壁の切開創を開創するための開創デバイスにおいて、
複数の湾曲リングセグメントに分けられる、調節自在の周囲を持つ実質的に環状形状の外リングであって、前記湾曲リングセグメントの各々は、第1近位側、第2遠位側、前記外リングの周囲に亘る第1端、及び前記外リングの周囲に亘る第2端を含む、外リングと、
前記外リングから遠位方向に延びる、複数の細長いチューブセグメントに分けられる実質的にチューブ状の構造であって、前記チューブセグメントの各々は、夫々の湾曲リングセグメントに連結されており、夫々の湾曲リングセグメントから遠位方向に延びる、実質的にチューブ状の構造と、
前記外リングの周囲を調節するための手段とを含み、
前記外リングの直径は、前記湾曲リングセグメントを離すように移動することによって増大し、前記湾曲リングセグメントを互いに近付けるように移動することによって減少する、開創デバイス。 - 請求項41に記載の開創デバイスにおいて、
前記チューブ状構造の前記チューブセグメントの各々は、隣接したチューブセグメント間に重なりが実質的にないように、これらのチューブセグメントが連結された前記湾曲リングセグメントの夫々の前記第1端と前記第2端との間を周方向に延びる、開創デバイス。 - 請求項41に記載の開創デバイスにおいて、
前記チューブセグメントの各々は、前記隣接したチューブセグメントが重なるように、前記チューブセグメントが連結された前記湾曲リングセグメントの夫々の前記第1端及び前記第2端の少なくとも一方を越えて周方向に延びる、開創デバイス。 - 請求項41に記載の開創デバイスにおいて、
前記チューブセグメントの各々の輪郭は、前記チューブセグメントが連結された前記湾曲リングセグメントの夫々の湾曲に実質的に従う、開創デバイス。 - 請求項41に記載の開創デバイスにおいて、
前記湾曲リングセグメントは、前記外リングの直径を調節する際に前記外リングの実質的周囲形状を維持するため、可撓性である、開創デバイス。 - 請求項41に記載の開創デバイスにおいて、
前記チューブセグメントの各々は、これらのチューブセグメントが連結された前記湾曲リングセグメントの夫々の湾曲に変化に従うように、実質的に可撓性である、開創デバイス。 - 請求項41に記載の開創デバイスにおいて、
前記外リングの周囲を調節するための手段は、前記外リングの隣接した湾曲リングセグメントを互いに連結し、前記外リングの環状形状を形成するようになったラチェット機構を含む、開創デバイス。 - 請求項47に記載の開創デバイスにおいて、
前記ラチェット機構は、
前記湾曲リングセグメントの各々の近位面に設けられた溝であって、これらの溝は、夫々の湾曲リングセグメントの湾曲に実質的に従い、前記夫々の湾曲リングセグメントの前記第1端に開放しており、第1外湾曲面及び第2内湾曲面を形成する、溝と、
前記溝の各々に位置決めされた複数のラチェット歯と、
前記湾曲リングセグメントの各々の前記第2端から延びる、隣接した湾曲リングセグメントの前記溝と噛み合うようになった細長いプロチュバランスと、
前記プロチュバランスの各々に位置決めされた、前記夫々の隣接した湾曲リングセグメントの前記溝の前記ラチェット歯と相互作用するようなった少なくとも一つのラチェット歯とを含む、開創デバイス。 - 請求項48に記載の開創デバイスにおいて、
前記湾曲リングセグメントの各々の前記第1端は、隣接した湾曲リングセグメントの前記第2端と隣接して位置決めされ、
各湾曲リングセグメントの前記細長いプロチュバランスは、前記細長いプロチュバランスの少なくとも一つのラチェット歯が前記溝の前記ラチェット歯と相互作用するように、他方の隣接した湾曲リングセグメントの前記溝に挿入される、開創デバイス。 - 請求項48に記載の開創デバイスにおいて、
前記ラチェット歯は、前記夫々の湾曲リングセグメントの前記溝の第1外湾曲面に位置決めされている、開創デバイス。 - 請求項48に記載の開創デバイスにおいて、
前記ラチェット歯は、前記夫々の湾曲リングセグメントの前記溝の第2内湾曲面に位置決めされている、開創デバイス。 - 請求項48に記載の開創デバイスにおいて、
前記ラチェット歯は、前記夫々の湾曲リングセグメントの前記溝の遠位面に位置決めされている、開創デバイス。 - 請求項48に記載の開創デバイスにおいて、更に、
前記溝の夫々の前記第1外湾曲面及び前記第2内湾曲面の少なくとも一方の溝の各々に位置決めされた保持チャンネルと、
前記細長いプロチュバランスの各々に位置決めされたリップとを含み、前記リップは、夫々のプロチュバランスの長さに沿って長さ方向に延び、前記夫々の隣接した湾曲リングセグメントの前記溝の前記保持チャンネルと相互作用するようになっている、開創デバイス。 - 請求項41に記載の開創デバイスにおいて、更に、
前記チューブ状構造の遠位端に連結された内リングを含み、前記内リングは、前記外リングと実質的に反対側にある、開創デバイス。 - 体壁の切開創を開放するための開創デバイスにおいて、
第1近位端及び第2遠位端を持ち、体壁に完全に嵌着するのに十分に長いチューブ状シースと、
前記シースが第1周囲を持ち、前記シースがその周囲に亘って波形をなす第1折り畳み状態と、
前記シースが前記第1周囲よりも大きい第2周囲を持つ第2拡張状態とを含み、
前記シースは、前記第2拡張状態に向かって押圧されており、
前記シースは、前記第1折り畳み状態に圧縮でき、
前記シースを前記第1折り畳み状態に保持する力を取り除くと、前記シースは前記第2拡張状態に開放する、開創デバイス。 - 請求項55に記載の開創デバイスにおいて、
前記シースは、展性の実質的に円形の部材から形成されている、開創デバイス。 - 請求項55に記載の開創デバイスにおいて、更に、
前記シースを圧縮して前記第1折り畳み状態にするための手段を含む、開創デバイス。 - 請求項57に記載の開創デバイスにおいて、
前記圧縮手段は、前記シースの波形に通した繰り紐を含む、開創デバイス。 - 請求項58に記載の開創デバイスにおいて、
前記シースは、前記繰り紐を前記シースから遠ざかるように半径方向に引っ張ったとき、前記第1折り畳み状態に圧縮され、続いて前記繰り紐を解放したとき、前記第2拡張状態に拡がるようになっている、開創デバイス。 - 体壁の切開創を開放するための開創デバイスにおいて、
第1外リングと、
第2内リングと、
前記第1及び第2のリングに連結された実質的に円筒形のスリーブと、
前記第1外リングと関連した、前記第1リングを半径方向外方に押圧する第1押圧部材と、
前記第2内リングと関連した、前記第2リングを半径方向外方に押圧する第2押圧部材とを含み、
前記第1及び第2の押圧部材は、前記円筒形スリーブを、切開創を開創する張力が加わった状態に置く、開創デバイス。 - 請求項60に記載の開創デバイスにおいて、
前記第1押圧部材は、前記第1外リング内に位置決めされたばね状コアを含み、
前記第2押圧部材は、前記第2内リング内に位置決めされたばね状コアを含む、開創デバイス。 - 請求項60に記載の開創デバイスにおいて、
前記円筒形スリーブは、前記円筒形スリーブを軸線方向に圧縮された第1状態と、軸線方向に延ばされた第2状態との間で移行できる、半径方向折り目線を含む、開創デバイス。 - 請求項62に記載の開創デバイスにおいて、
前記軸線方向に圧縮された第1状態で、前記開創デバイスを、前記内外のリングに沿った向き合った箇所で半径方向に更に圧縮し、前記開創デバイスを細長い低プロファイルの実質的に楕円形形状に変形し、切開創への挿入を容易にする、開創デバイス。 - 体壁の切開創を開放するための開創デバイスにおいて、
腹部キャビティの外側に残る大きさ及び形態の第1外リングと、
周囲に沿った向き合った箇所で半径方向に圧縮され、細長い楕円形形状に変形し、切開創及び腹部キャビティ内への挿入を容易にするようになった、可撓性第2内リングと、
前記第1及び第2のリングに連結された、前記第1及び第2のリング間で張力が加えられるように形成された実質的に円筒形のスリーブとを含み、
前記第1リングは、実質的に中空の膨張可能な構造を含み、前記開創デバイスは、前記第1リングが身体の外側に位置決めされており且つ前記第2リングが前記腹部キャビティに位置決めされたとき、前記第1リングを膨張することによって前記スリーブに作用する張力を増大し、前記切開創を開創する、開創デバイス。 - 請求項64に記載の開創デバイスにおいて、
前記円筒形スリーブは、半径方向折り目線を含み、これらの半径方向折り目線により、前記円筒形スリーブは、前記軸線方向に圧縮された第1状態と前記軸線方向に延ばされた第2状態との間で移行できる、開創デバイス。
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