JP2020032288A - 卵円孔開存を閉鎖するための縫合装置及び方法 - Google Patents
卵円孔開存を閉鎖するための縫合装置及び方法 Download PDFInfo
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- A61B2017/00575—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect for closure at remote site, e.g. closing atrial septum defects
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- A—HUMAN NECESSITIES
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- A61B2017/00575—Implements for plugging an opening in the wall of a hollow or tubular organ, e.g. for sealing a vessel puncture or closing a cardiac septal defect for closure at remote site, e.g. closing atrial septum defects
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- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
- A61B2017/047—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery having at least one proximally pointing needle located at the distal end of the instrument, e.g. for suturing trocar puncture wounds starting from inside the body
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- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
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Abstract
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Claims (36)
- 卵円孔開存内に経皮的に送られるように構成された近位端及び遠位端を有する細長い本体と、
第1の縫合糸端部を保持するようになされた少なくとも第1の縫合糸留めアームであって、後退位置から延在位置に前記本体から延在可能であり、前記卵円孔開存の一次中隔及び二次中隔のうちの1つの周りに配置されるように構成された第1の縫合糸留めアームと、
前記細長い本体内に摺動可能に収容された少なくとも第1の縫合糸捕捉機構であって、前記第1の縫合糸留めアームが前記延在位置にある時、前記第1の縫合糸捕捉機構の遠位端を前記第1の縫合糸留めアームによって保持された前記第1の縫合糸端部に係合するために、前記卵円孔開存の一次中隔及び二次中隔のうちの1つを通って移動可能である第1の縫合糸捕捉機構とを備える、卵円孔開存を縫合するための縫合装置。 - 第2の縫合糸端部を保持するようになされた少なくとも第2の縫合糸留めアームであって、後退位置から延在位置に前記本体から延在可能であり、前記卵円孔開存の一次中隔及び二次中隔のうちのもう一方の周りに配置されるように構成された、第2の縫合糸留めアームと、
前記細長い本体内に摺動可能に収容された第2の縫合糸捕捉機構であって、前記第2の縫合糸留めアームが前記延在位置にある時、前記第2の縫合糸捕捉機構の遠位端を前記第2の縫合糸留めアームによって保持された前記第2の縫合糸端部に係合するために、前記卵円孔開存の一次中隔及び二次中隔のうちのもう一方を通って移動可能である第2の縫合糸捕捉機構とをさらに備える、請求項1に記載の縫合装置。 - 前記第1の縫合糸捕捉機構が、前記第1の縫合糸留めアームが延在位置にある時、前記第1の縫合糸捕捉機構の前記遠位端を前記第1の縫合糸留めアームによって保持された前記第1の縫合糸端部に係合するために、近位から遠位の方向に移動可能である、請求項2に記載の縫合装置。
- 前記第2の縫合糸捕捉機構が、前記第2の縫合糸留めアームが前記延在位置にある時、前記第2の縫合糸捕捉機構の前記遠位端を前記第2の縫合糸留めアームによって保持された前記第2の縫合糸端部に係合するために、遠位から近位方向に移動可能である、請求項3に記載の縫合装置。
- 前記第1の縫合糸留めアームが、前記細長い本体の長手方向軸線と鋭角を形成する、請求項1に記載の縫合装置。
- 前記第1の縫合糸留めアームが、前記細長い本体の長手方向軸線から約35°〜約55°の間で延在するように構成された、請求項1に記載の縫合装置。
- 前記第1及び第2の縫合糸留めアームが、前記細長い本体の長手方向軸線と鋭角を形成し、前記第1の縫合糸留めアームが、その延在位置で概ね近位に延在する遠位端を有し、前記第2の縫合糸留めアームが、その延在位置で概ね遠位に延在する遠位端を有する、請求項2に記載の縫合装置。
- 前記細長い本体が、その中に2つの案内ワイヤを収容するように構成されている、請求項1に記載の縫合装置。
- 前記縫合糸留めアームが、案内ワイヤを前記細長い本体の長手方向軸線から遠ざかるように導くための、案内ワイヤガイドを備えている、請求項1に記載の縫合装置。
- 前記縫合糸留めアームが、前記縫合糸捕捉機構を導いて前記第1の縫合糸端部に係合するように構成された偏向装置を備えている、請求項1に記載の縫合装置。
- 前記第1の縫合糸捕捉機構が第1の針を備えている、請求項1に記載の縫合装置。
- 前記第1の針の前記遠位端が縫合糸端部に係合するための溝を備えている、請求項11に記載の縫合装置。
- 前記第1の縫合糸留めアームが前記延在位置にある時、前記第1の縫合糸捕捉機構を前記第1の縫合糸留めアームの前記縫合糸留めに向かって案内するように構成された少なくとも第1の案内をさらに備えている、請求項1に記載の縫合装置。
- 請求項1の前記縫合装置及び第2の縫合装置を備える卵円孔開存を縫合するためのキットであって、前記第2の縫合装置が、
前記卵円孔開存内に経皮的に送られるように構成された近位端及び遠位端を有する第2の細長い本体と、
第2の縫合糸端部を保持するようになされた少なくとも第2の縫合糸留めアームであって、後退位置から延在位置に前記本体から延在可能であり、前記卵円孔開存の一次中隔及び二次中隔のうちのもう一方の周りに配置されるように構成された、第2の縫合糸留めアームと、
前記細長い本体内に摺動可能に収容された少なくとも第2の縫合糸捕捉機構であって、前記第1の縫合糸留めアームが前記延在位置にある時、前記第2の縫合糸捕捉機構の遠位端を前記第2の縫合糸留めアームによって保持された前記第2の縫合糸端部に係合するために、一次中隔及び二次中隔のうちのもう一方を通って移動可能である第2の縫合糸捕捉機構とを備える、卵円孔開存を縫合するためのキット。 - 前記第1の縫合糸留めアームの前記遠位端に係合するために移動するとき、前記第1の縫合糸捕捉機構が請求項1の前記縫合装置の前記遠位端に向かって移動し、前記第2の縫合糸留めアームに係合するために移動する時、前記第2の縫合糸捕捉機構が前記第2の縫合装置の前記近位端に向かって移動する、請求項14に記載のキット。
- 第1の縫合装置及び第2の縫合装置を備える卵円孔開存を縫合するためのシステムであって、
前記第1の縫合装置が、
近位端及び遠位端を有する第1の細長い本体と、
第1の縫合糸端部を保持するようになされた第1の縫合糸留めアームであって、後退位置から延在位置に前記第1の本体から延在可能であり、前記卵円孔開存の一次中隔の周りに配置されるように構成された第1の縫合糸留めアームと、
前記細長い第1の本体内に摺動可能に収容された第1の縫合糸捕捉機構であって、前記第1の縫合糸留めアームが前記延在位置にある時、前記第1の縫合糸捕捉機構の遠位端を前記第1の縫合糸留めアームによって保持された前記第1の縫合糸端部に係合するために、前記卵円孔開存の一次中隔の1つを通って近位から遠位の方向に移動可能である第1の縫合糸捕捉機構とを備え、
前記第2の縫合装置が、
近位端及び遠位端を有する第2の細長い本体と、
第2の縫合糸端部を保持するようになされた第2の縫合糸留めアームであって、前記第2の縫合糸留めアームが、後退位置から延在位置に前記第2の本体から延在可能であり、前記卵円孔開存の二次中隔の周りに配置されるように構成される、第2の縫合糸留めアームと、
前記細長い第2の本体内に摺動可能に収容された第2の縫合糸捕捉機構であって、前記第2の縫合糸留めアームが前記延在位置にある時、前記第2の縫合糸捕捉機構の遠位端を前記第2の縫合糸留めアームによって保持された前記第2の縫合糸端部に係合するために、前記卵円孔開存の二次中隔を通って遠位から近位方向に移動可能である第2の縫合糸捕捉機構とを備える、卵円孔開存を縫合するためのシステム。 - 近位端及び遠位端を有する細長い本体と、
第1の縫合糸端部を保持するようになされた第1の縫合糸留めアームであって、後退位置から延在位置に前記本体から延在可能であり、前記卵円孔開存の一次中隔の周りに配置されるように構成された第1の縫合糸留めアームと、
第2の縫合糸端部を保持するようになされた第2の縫合糸留めアームであって、後退位置から延在位置に前記本体から延在可能であり、前記卵円孔開存の二次中隔の周りに配置されるように構成された、第2の縫合糸留めアームと、
前記細長い本体内に摺動可能に収容された第1の縫合糸捕捉機構であって、前記第1の縫合糸留めアームが前記延在位置にある時、前記第1の縫合糸捕捉機構の遠位端を前記第1の縫合糸留めアームによって保持された前記第1の縫合糸端部に係合するために、前記卵円孔開存の一次中隔を通って近位から遠位の方向に移動可能である第1の縫合糸捕捉機構と、
前記細長い本体内に摺動可能に収容された第2の縫合糸捕捉機構であって、前記第2の縫合糸留めアームが前記延在位置にある時、前記第1の縫合糸捕捉機構の遠位端を前記第2の縫合糸留めアームによって保持された前記第2の縫合糸端部に係合するために、前記卵円孔開存の二次中隔を通って遠位から近位の方向に移動可能である第2の縫合糸捕捉機構とを備える、卵円孔開存を縫合するための縫合装置。 - 前記第1及び第2の縫合糸留めアームが同時に延在されるように構成されている、請求項17に記載の縫合装置。
- 前記第1の縫合糸捕捉機構を駆動する第1のアクチュエータと、前記第2の縫合糸捕捉機構を駆動する第2のアクチュエータとをさらに備える、請求項17に記載の縫合装置。
- 前記第1及び第2のアクチュエータが、異なった時間に展開されるように構成されている、請求項17に記載の縫合装置。
- 前記細長い本体が、
そこを通って延在する複数の管腔を有する細長い管状部材と、
前記細長い本体に装着された拡大器組立体であって、そこを通って延在する複数の管腔を有する拡大器組立体と、
前記拡大器組立体に装着された遠位先端とをさらに備え、
前記細長い管状部材及び前記拡大器組立体を通る複数の連続的な通路を形成するために、前記複数の拡大器管腔が前記複数の管状部材の管腔と整列している、請求項17に記載の縫合装置。 - 一次中隔及び二次中隔を有する卵円孔開存を閉鎖する方法であって、
前記一次中隔及び前記二次中隔のうちの1つの周りに第1の縫合糸留めアームを配置するステップであって、前記第1の縫合糸留めアームが第1の縫合糸端部を保持するステップと、
第1の針を、前記一次中隔及び二次中隔のうちの1つの組織を通して進め、前記第1の縫合糸留めアーム内に保持された前記第1の縫合糸端部に係合させるステップと、
前記第1の縫合糸端部を前記第1の針によって担持して、前記第1の針を前記一次中隔及び二次中隔のうちの1つの組織を通して後退させるステップと、
第2の縫合糸留めアームを前記一次中隔及び前記二次中隔のもう一方の周りに配置するステップであって、前記第2の縫合糸留めアームが第2の縫合糸端部を保持するステップと、
第2の針を、前記一次中隔及び二次中隔のうちのもう一方の組織を通して進め、前記第2の縫合糸留めアーム内に保持された前記第2の縫合糸端部に係合させるステップと、
前記第2の針を、前記第2の縫合糸端部と共に、前記一次中隔及び二次中隔のうちのもう一方の組織を通して後退させるステップと、
前記一次中隔及び前記二次中隔を閉鎖するように引き付けるステップとを含む方法。 - 前記第1の針が第1の方向に進められ、前記第2の針が第2の方向に進められ、前記第2の方向が概ね前記第1の方向と反対である、請求項22に記載の方法。
- 前記第1の縫合糸留めアームが前記一次中隔の上に配置され、前記第2の縫合糸留めアームが前記二次中隔の上に配置される、請求項22に記載の方法。
- 前記第2の縫合糸留めアームが前記二次中隔の上に配置される前に、前記第1の縫合糸留めアームが前記一次中隔の上に配置される、請求項24に記載の方法。
- 前記一次中隔及び前記二次中隔を閉鎖するように引き付けるステップが、前記第1の縫合糸端部及び第2の縫合糸端部に結び目を付けるステップを含む、請求項22に記載の方法。
- 第2の結び目を前記第1の縫合糸端部及び第2の縫合糸端部に付けるステップをさらに含む、請求項26に記載の方法。
- 前記卵円孔開存に対して、前記縫合糸端部の上に送られるパッチを付けるステップをさらに含む、請求項22に記載の方法。
- 前記第1及び第2の縫合糸留めアームが前記卵円孔開存のトンネルに経皮的に送り込まれる細長い本体から延在し、延在位置にある前記第1の縫合糸留めアームが前記細長い本体の長手方向軸線と鋭角を形成し、近位の方向に延在し、延在位置にある前記第2の縫合糸留めアームが前記細長い本体の長手方向軸線と鋭角を形成し、遠位の方向に延在する、請求項22に記載の方法。
- 前記第1の縫合糸留めアームと第1の針が第1の縫合装置に設けられ、前記第2の縫合糸留めアーム及び第2の針が第2の縫合装置に設けられ、前記第1及び第2の縫合装置が前記卵円孔開存に個別に送られる、請求項22に記載の方法。
- 一次中隔及び二次中隔を有する卵円孔開存を閉鎖する方法であって、
第1の細長い本体を卵円孔開存のトンネル内に進めるステップと、
第1の縫合糸留めアームを後退位置から延在位置に前記第1の細長い本体から延在させ、前記第1の縫合糸留めアームが第1の縫合糸端部を保持するステップと、
前記第1の縫合糸留めアームを前記一次中隔及び前記二次中隔のうちの1つの周りに配置するステップと、
前記細長い本体内に配置された第1の針を、前記一次中隔及び二次中隔のうちの1つの組織を通して前記本体から外側に進め、前記第1の縫合糸留めアーム内に保持された前記第1の縫合糸端部に係合させるステップと、
前記第1の縫合糸端部を前記第1の針によって担持して、前記第1の針を前記第1の細長い本体内に後退させるステップと、
前記第1の細長い本体を前記卵円孔開存の前記トンネルから引き出すステップと、
第2の細長い本体を卵円孔開存の前記トンネル付近に進めるステップと、
第2の縫合糸留めアームを後退位置から延在位置に前記第2の細長い本体から延在させるステップであって、前記第2の縫合糸留めアームが第2の縫合糸端部を保持するステップと、
前記第2の縫合糸留めアームを前記一次中隔及び前記二次中隔のうちのもう一方の周りに配置するステップと、
前記第2の細長い本体内に配置された第2の針を、前記一次中隔及び二次中隔のうちのもう一方の組織を通して前記本体から外側に進め、前記第2の縫合糸留めアーム内に保持された前記第2の縫合糸端部に係合させるステップと、
前記第2の縫合糸端部を前記第2の針によって担持して、前記第2の針を前記第2の細長い本体内に後退させるステップと、
前記第2の細長い本体を前記卵円孔開存の前記トンネルから引き出すステップと、
前記一次中隔及び前記二次中隔を閉鎖するように引き付けるステップとを含む方法。 - 前記細長い本体が、案内ワイヤに沿って前記卵円孔開存の前記トンネル内に進められる、請求項31に記載の方法。
- 第2の案内ワイヤを上大静脈内に進めるステップと、前記細長い本体を前記第2の案内ワイヤに沿って進めるステップとをさらに含む、請求項32に記載の方法。
- 前記第1又は第2の縫合糸留めアームを前記二次中隔の周りに配置する時、前記細長い本体が案内ワイヤに沿って上大静脈に向かって進められる、請求項31に記載の方法。
- 第2の案内ワイヤを前記卵円孔開存の前記トンネル内に進めるステップと、前記第1及び第2の縫合糸留めアームのうちの1つを前記二次中隔の周りに配置するために、前記細長い本体を前記第2の案内ワイヤに沿って進めるステップとをさらに含む、請求項34に記載の方法。
- 第3の細長い本体を卵円孔開存の前記トンネル付近に進めるステップと、
第3の縫合糸留めアームを後退位置から延在位置に前記第3の細長い本体から延在させるステップであって、前記第3の縫合糸留めアームが第3の縫合糸端部を保持するステップと、
前記第3の縫合糸留めアームを前記一次中隔及び前記二次中隔のうちのもう一方の周りに配置するステップと、
前記第3の細長い本体内に配置された第3の針を、前記一次中隔及び二次中隔のうちのもう一方の組織を通して前記本体から外側に進め、前記第3の縫合糸留めアーム内に保持された前記第3の縫合糸端部に係合させるステップと、
前記第3の縫合糸端を前記第2の針によって担持して、前記第3の針を前記第2の細長い本体内に後退させるステップと、
前記第3の細長い本体を前記卵円孔開存の前記トンネルから引き出すステップとをさらに含む、請求項31に記載の方法。
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US20120283752A1 (en) | 2012-11-08 |
JP6629916B2 (ja) | 2020-01-15 |
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