JP2020062478A - 動力式外科手術用ステープル留めデバイス - Google Patents
動力式外科手術用ステープル留めデバイス Download PDFInfo
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Abstract
Description
本願は、米国特許出願第13/788,293号(これは、2013年3月7日に出願された)の一部継続出願であり、これは、米国特許出願第12/189,834号(これは、2008年8月12日に出願され、現在は放棄されている)の一部継続出願であり、これは、米国仮特許出願第60/997,854号(これは、2007年10月5日に出願された)の利益および優先権を主張する。本願は、米国仮特許出願第61/942,937号(これは、2014年2月21日に出願された)に関連する。上記出願の各々の全内容は、本明細書中に参考として援用される。
1.技術分野
本開示は、機械的外科手術用ファスナーを患者の組織内に埋め込むための外科手術用ステープラーに関し、そして特に、外科手術用ファスナーを組織内に発射するためにモータによって動力を与えられる外科手術用ステープラー、および1つ以上の感知されたフィードバック信号に応答してこのステープラーを制御するためのフィードバック制御器に関する。
現在公知であるデバイスは、組織をクランプするため、ならびに外科手術用ファスナーを組織内で展開および形成するために、代表的に、10〜60ポンドの手の力を必要とし得、これは、繰り返し使用するにつれて、外科医の手を疲労させ得る。外科手術用ファスナーを組織内に埋め込む、気体によって動力を与えられる空気式ステープラーは、当該分野において公知である。これらの器具のうちの特定のものは、トリガ機構に接続された加圧ガス供給源を利用する。このトリガ機構は、押下されると、単に加圧ガスを解放して、ファスナーを組織に埋め込む。
(項目1)
エンドエフェクタであって、
第一の組織接触表面を有する第一の顎部材;
該第一の顎部材の該第一の組織接触表面に対向する第二の組織接触表面を有する第二の顎部材であって、該第一の顎部材と該第二の顎部材とは、互いに対して開位置とクランプされた位置との間で移動可能である、第二の顎部材;および
該第一の顎部材または該第二の顎部材の内部に位置する検出アセンブリであって、該第一の顎部材と該第二の顎部材との間の組織の性質を検出するように構成されている、検出アセンブリ
を備える、エンドエフェクタ。
(項目2)
上記検出アセンブリは、上記第一の組織接触表面または上記第二の組織接触表面のうちの一方から上記対向する組織接触表面に向けて光を放出するように構成された光源、および該放出された光の特性を感知するように構成された光センサを備え、該検出アセンブリは、上記第一の顎部材と上記第二の顎部材との間の組織の性質を、該放出された光の該感知された特性から決定するように構成されている、上記項目に記載のエンドエフェクタ。
(項目3)
上記光源は、上記第一の顎部材の上記第一の組織接触表面から光を放出するように構成されており、そして上記光センサは、該第一の顎部材の内部に位置し、そして該第一の顎部材と上記第二の顎部材との間の組織から反射された、放出された光の特性を感知するように構成されている、上記項目のいずれかに記載のエンドエフェクタ。
(項目4)
上記検出アセンブリは、上記第二の組織接触表面から光を放出するように構成された第二の光源、および上記第二の顎部材の内部に位置する第二の光センサを備え、該光センサは、上記第一の顎部材の内部に位置し、該第二の光源から放出された、該第一の顎部材と該第二の顎部材との間の組織を透過した光の特性を感知するように構成されており、該第二の光センサは、上記第一の光源から放出された、該第一の顎部材と該第二の顎部材との間の組織を透過した光の特性を感知するように構成されており、そして該第二の光源から放出された、該第一の顎部材と該第二の顎部材との間の組織から反射した光の特性を感知するように構成されている、上記項目のいずれかに記載のエンドエフェクタ。
(項目5)
上記光源は、上記第一の顎部材の上記第一の組織接触表面から光を放出するように構成されており、そして上記光センサは、上記第二の顎部材の内部に位置し、そして該第一の顎部材と該第二の顎部材との間の組織を透過した、放出された光の特性を感知するように構成されている、上記項目のいずれかに記載のエンドエフェクタ。
(項目6)
上記検出アセンブリは、超音波変換器および超音波センサを有する超音波プローブを備える、上記項目のいずれかに記載のエンドエフェクタ。
(項目7)
上記第一の顎部材および上記第二の顎部材のうちの一方は、ステープルカートリッジを備え、該ステープルカートリッジは、該第一の顎部材と該第二の顎部材との間の組織を通して発射されるように構成された複数のステープルを備える、上記項目のいずれかに記載のエンドエフェクタ。
(項目8)
外科手術用器具であって、
ハンドル;
該ハンドルから延びる細長シャフト、ならびに
該細長シャフトの遠位端に連結されたエンドエフェクタであって、該エンドエフェクタは、
第一の組織接触表面を有する第一の顎部材;
該第一の顎部材の該第一の組織接触表面に対向する第二の組織接触表面を有する第二の顎部材であって、該第一の顎部材と該第二の顎部材とは、互いに対して開位置とクランプされた位置との間で移動可能である、第二の顎部材;
該第一の顎部材または該第二の顎部材の内部に位置する検出アセンブリであって、該第一の顎部材と該第二の顎部材との間の組織の性質を検出するように構成されている、検出アセンブリ
を備える、エンドエフェクタ
を備える、外科手術用器具。
(項目9)
上記検出アセンブリは、
感知された特性を示す信号を受信すること;
該信号を分析して、上記第一の顎部材と上記第二の顎部材との間の組織の性質を決定すること;および
該第一の顎部材と該第二の顎部材との間の該組織の該性質のフィードバックを使用者に提供すること
を行うように構成されたプロセッサを備える、上記項目に記載の外科手術用器具。
(項目10)
上記プロセッサは、上記ハンドル内、上記細長シャフト内、または上記エンドエフェクタ内に位置する、上記項目のいずれかに記載の外科手術用器具。
(項目11)
上記検出アセンブリは、感知された特性を示す信号を発生させるように、および該感知された特性を上記プロセッサに伝送するように構成されたセンサを備える、上記項目のいずれかに記載の外科手術用器具。
(項目12)
上記センサは、上記第一の顎部材と上記第二の顎部材との間の組織に向けて放出された光の性質を感知するように構成されている、上記項目のいずれかに記載の外科手術用器具。
(項目13)
上記センサは、上記第一の顎部材と上記第二の顎部材との間の組織に向けて放出された超音波を感知するように構成されている、上記項目のいずれかに記載の外科手術用器具。
(項目14)
上記ハンドル上に位置するスクリーンをさらに備え、該スクリーンは、上記プロセッサと作動可能に関連しており、そして上記第一の顎部材と上記第二の顎部材との間の組織の上記性質のフィードバックを表示するように構成されている、上記項目のいずれかに記載の外科手術用器具。
(項目15)
上記スクリーンは、上記第一の顎部材と上記第二の顎部材との間の組織のソノグラムを表示するように構成されている、上記項目のいずれかに記載の外科手術用器具。
(項目16A)
エンドエフェクタの互いに対して移動可能である第一の顎部材と第二の顎部材との間に配置された組織の性質を検出する方法であって、
該顎部材のうちの一方から他方の顎部材に向けて、エネルギーを放出する工程;
該第一の顎部材と該第二の顎部材との間の該組織の組織の性質を示す特性を、該顎部材のうちの一方に位置するセンサを用いて感知する工程;
組織の性質を示す該特性の信号を、該センサからプロセッサに伝送する工程;
該プロセッサを用いて、該信号から組織の性質を決定する工程;および
該組織の性質のフィードバックを使用者に提供する工程
を包含する、方法。
(項目17A)
上記顎部材のうちの一方からエネルギーを放出する工程が、該顎部材のうちの一方から光を放出することを包含する、上記項目に記載の方法。
(項目18A)
上記顎部材のうちの一方からエネルギーを放出する工程が、該顎部材のうちの一方から超音波エネルギーを放出することを包含する、上記項目のいずれかに記載の方法。
(項目19A)
上記第一の顎部材または上記第二の顎部材のうちの一方に連結されたステープルカートリッジからのステープルが、該第一の顎部材と該第二の顎部材との間の組織に通して発射されるように構成されている、上記項目のいずれかに記載の方法。
(項目20A)
組織の性質を決定する工程が、組織の厚さを決定することを包含し、そして上記方法が、
該決定された組織の厚さを予め決定された組織の厚さ値と比較する工程;および
該組織の厚さが該予め決定された組織の厚さ値より大きい場合、上記エンドエフェクタのさらなる機能を防止する工程
をさらに包含する、上記項目のいずれかに記載の方法。
(項目16B)
組織の性質を検出する方法であって、
エンドエフェクタの互いに対して移動可能である第一の顎部材と第二の顎部材との間に、組織を配置する工程;
該顎部材のうちの一方から他方の顎部材に向けて、エネルギーを放出する工程;
該第一の顎部材と該第二の顎部材との間の該組織の組織の性質を示す特性を、該顎部材のうちの一方に位置するセンサを用いて感知する工程;
組織の性質を示す該特性の信号を、該センサからプロセッサに伝送する工程;
該プロセッサを用いて、該信号から組織の性質を決定する工程;および
該組織の性質のフィードバックを使用者に提供する工程
を包含する、方法。
(項目17B)
上記顎部材のうちの一方からエネルギーを放出する工程が、該顎部材のうちの一方から光を放出することを包含する、上記項目のいずれかに記載の方法。
(項目18B)
上記顎部材のうちの一方からエネルギーを放出する工程が、該顎部材のうちの一方から超音波エネルギーを放出することを包含する、上記項目のいずれかに記載の方法。
(項目19B)
上記第一の顎部材または上記第二の顎部材のうちの一方に連結されたステープルカートリッジから、該第一の顎部材と該第二の顎部材との間の組織に通して、ステープルを発射させる工程をさらに包含する、上記項目のいずれかに記載の方法。
(項目20B)
組織の性質を決定する工程が、組織の厚さを決定することを包含し、そして上記方法が、
該決定された組織の厚さを予め決定された組織の厚さ値と比較する工程;および
該組織の厚さが該予め決定された組織の厚さ値より大きい場合、上記エンドエフェクタのさらなる機能を防止する工程
をさらに包含する、上記項目のいずれかに記載の方法。
摘要
エンドエフェクタは、互いに対して移動可能である第一の顎部材および第二の顎部材を備える。この第一の顎部材および第二の顎部材は、それぞれ、他方の顎部材の組織接触表面に対向する組織接触表面を備える。このエンドエフェクタは、第一の顎部材または第二の顎部材の内部に位置する検出アセンブリを備え、この検出アセンブリは、この第一の顎部材とこの第二の顎部材との間の組織の性質を検出するように構成されている。この検出アセンブリは、この第一の顎部材とこの第二の顎部材との間の組織に向けて光を放出するように構成された光源を備え得るか、またはこの第一の顎部材とこの第二の顎部材との間の組織に向けて超音波エネルギーを放出するように構成された超音波変換器を備え得る。
要旨
本開示の1つの局面によれば、動力式外科手術用ステープラーが開示される。このステープラーは、ハウジング、このハウジングから遠位方向に延びて第一の長手方向軸を規定する内視鏡部分、少なくとも部分的にハウジング内に位置する駆動モータ、およびこの駆動モータと機械的に協働するように位置する発射棒を備える。この発射棒は、長手軸方向に並進し、このモータによって、この発射棒を通って延びる第一の長手方向軸の周りで回転可能である。このステープラーはまた、この内視鏡部分の遠位部分に隣接して位置するエンドエフェクタを備える。このエンドエフェクタは、この発射棒と機械的に協働し、その結果、この発射棒は、このエンドエフェクタの外科手術機能を駆動する。このステープラーは、主要駆動スイッチをさらに備え、この主要駆動スイッチは、トグルスイッチとして一緒に形成された第一のスイッチおよび第二のスイッチを備える。この第一のスイッチは、この駆動モータを第一の方向に活性化させて、このエンドエフェクタの第一の外科手術機能を容易にするように適合されており、そしてこの第二のスイッチは、この駆動モータを第二の方向に活性化させて、このエンドエフェクタの第二の外科手術機能を容易にするように適合されている。
本開示の動力式外科手術用器具の実施形態が、ここで図面を参照しながら詳細に記載される。図面において、同じ参照番号は、数枚の図の各々において、同じ要素または対応する要素を表す。本明細書中で使用される場合、用語「遠位」とは、動力式外科手術用器具またはその構成要素の、使用者から遠い方の部分をいい、一方で、用語「近位」とは、動力式外科手術用器具またはその構成要素の、使用者に近い方の部分をいう。
突出部175がこの内視鏡部分に挿入されると、変位される。この変位の量は、センサによって分析されて識別データに変換され、器具10が、ステープルサイズ、カートリッジ長さ、装填ユニット169の型、および適切な係合などを決定することを可能にする。これらの変位センサは、スイッチ、接点、磁気センサ、光学センサ、可変抵抗、直線または回転可変容量形変換器であり得、これらはばね付勢され得る。これらのスイッチは、それらの活性化状態に基づいて、2進コードを器具10に伝送するように構成される。より具体的には、数個の突出部175は、これらのスイッチのうちの数個を選択的に活性化させるために十分な距離だけ延び、これによって、突出部175の組み合わせに基づいて、独特のコードを生成する。
RS232(登録商標)、Serial RS485(登録商標)、USART(登録商標)、Ethernet(登録商標)など)または無線(例えば、Bluetooth(登録商標)、ANT3(登録商標)、KNX(登録商標)、ZWave(登録商標)、X10(登録商標)無線 USB(登録商標)、IrDA(登録商標)、Nanonet(登録商標)、Tiny OS(登録商標)、ZigBee(登録商標)、802.11
IEEE、および他の無線周波数、赤外線、UHF、VHF通信など)のいずれでもよい。
Claims (15)
- エンドエフェクタであって、
第一の組織接触表面を有する第一の顎部材と、
前記第一の顎部材の前記第一の組織接触表面に対向する第二の組織接触表面を有する第二の顎部材であって、前記第一の顎部材と前記第二の顎部材とは、互いに対して開位置とクランプされた位置との間で移動可能である、第二の顎部材と、
前記エンドエフェクタの長手方向軸に沿って、前記第一の顎部材と前記第二の顎部材とを通って移動可能であるように構成されたナイフと、
前記第一の顎部材または前記第二の顎部材の内部に位置する検出アセンブリであって、前記検出アセンブリは、前記第一の顎部材と前記第二の顎部材との間の組織の脈管の性質を検出することと、前記組織の前記脈管の性質に基づいて前記ナイフが作動することを防止することとを行うように構成されている、検出アセンブリと
を備える、エンドエフェクタ。 - 前記検出アセンブリは、前記第一の組織接触表面または前記第二の組織接触表面のうちの一方から前記対向する組織接触表面に向けて光を放出するように構成された第一の光源と、前記放出された光の特性を感知するように構成された光センサとを含み、前記検出アセンブリは、前記第一の顎部材と前記第二の顎部材との間の前記組織の前記脈管の性質を、前記放出された光の前記感知された特性から決定するように構成されている、請求項1に記載のエンドエフェクタ。
- 前記第一の光源は、前記第一の顎部材の前記第一の組織接触表面から光を放出するように構成されており、前記光センサは、前記第一の顎部材の内部に位置し、前記光センサは、前記第一の顎部材と前記第二の顎部材との間の組織から反射された、放出された光の特性を感知するように構成されている、請求項2に記載のエンドエフェクタ。
- 前記検出アセンブリは、前記第二の組織接触表面から光を放出するように構成された第二の光源と、前記第二の顎部材の内部に位置する第二の光センサとを含み、前記光センサは、前記第一の顎部材の内部に位置し、前記光センサは、前記第二の光源から放出された、前記第一の顎部材と前記第二の顎部材との間の組織を透過した光の特性を感知するように構成されており、前記第二の光センサは、前記第一の光源から放出された、前記第一の顎部材と前記第二の顎部材との間の組織を透過した光の特性を感知するように構成されており、前記第二の光センサは、前記第二の光源から放出された、前記第一の顎部材と前記第二の顎部材との間の組織から反射した光の特性を感知するように構成されている、請求項3に記載のエンドエフェクタ。
- 前記第一の光源は、前記第一の顎部材の前記第一の組織接触表面から光を放出するように構成されており、前記光センサは、前記第二の顎部材の内部に位置し、前記光センサは、前記第一の顎部材と前記第二の顎部材との間の組織を透過した、放出された光の特性を感知するように構成されている、請求項2に記載のエンドエフェクタ。
- 前記検出アセンブリは、超音波変換器と超音波センサとを有する超音波プローブを含む、請求項1に記載のエンドエフェクタ。
- 前記第一の顎部材および前記第二の顎部材のうちの一方は、ステープルカートリッジを含み、前記ステープルカートリッジは、複数のステープルを含み、前記複数のステープルは、前記第一の顎部材と前記第二の顎部材との間の組織を通って発射されるように構成されている、請求項1に記載のエンドエフェクタ。
- 外科手術用器具であって、
ハンドルと、
前記ハンドルから延びる細長シャフトと、
前記細長シャフトの遠位端に結合されたエンドエフェクタと
を備え、
前記エンドエフェクタは、長手方向軸を有し、
前記エンドエフェクタは、
第一の組織接触表面を有する第一の顎部材と、
前記第一の顎部材の前記第一の組織接触表面に対向する第二の組織接触表面を有する第二の顎部材であって、前記第一の顎部材と前記第二の顎部材とは、互いに対して開位置とクランプされた位置との間で移動可能である、第二の顎部材と、
前記エンドエフェクタの前記長手方向軸に沿って、前記第一の顎部材と前記第二の顎部材とを通って移動可能であるように構成されたナイフと、
前記第一の顎部材または前記第二の顎部材の内部に位置する検出アセンブリであって、前記検出アセンブリは、前記第一の顎部材と前記第二の顎部材との間の組織の脈管の性質を検出することと、前記組織の前記脈管の性質に基づいて前記ナイフが作動することを防止することとを行うように構成されている、検出アセンブリと
を含む、外科手術用器具。 - 前記検出アセンブリは、プロセッサを含み、
前記プロセッサは、
感知された特性を示す信号を受信することと、
前記信号を分析することにより、前記第一の顎部材と前記第二の顎部材との間の前記組織の前記脈管の性質を決定することと、
前記第一の顎部材と前記第二の顎部材との間の前記組織の前記脈管の性質のフィードバックを使用者に提供することと
を行うように構成されている、請求項8に記載の外科手術用器具。 - 前記プロセッサは、前記ハンドル内、または、前記細長シャフト内、または、前記エンドエフェクタ内に位置する、請求項9に記載の外科手術用器具。
- 前記検出アセンブリは、センサを含み、前記センサは、感知された特性を示す信号を生成することと、前記感知された特性を前記プロセッサに伝送することとを行うように構成されている、請求項9に記載の外科手術用器具。
- 前記センサは、前記第一の顎部材と前記第二の顎部材との間の組織に向けて放出された光の性質を感知するように構成されている、請求項11に記載の外科手術用器具。
- 前記センサは、前記第一の顎部材と前記第二の顎部材との間の組織に向けて放出された超音波を感知するように構成されている、請求項11に記載の外科手術用器具。
- 前記ハンドル上に位置するスクリーンをさらに備え、前記スクリーンは、前記プロセッサと作動可能に関連付けられており、前記スクリーンは、前記第一の顎部材と前記第二の顎部材との間の前記組織の前記脈管の性質のフィードバックを表示するように構成されている、請求項9に記載の外科手術用器具。
- 前記スクリーンは、前記第一の顎部材と前記第二の顎部材との間の組織のソノグラムを表示するように構成されている、請求項14に記載の外科手術用器具。
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AU2016200084A1 (en) | 2016-08-04 |
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