JP3488245B2 - 内視鏡ステープラ - Google Patents
内視鏡ステープラInfo
- Publication number
- JP3488245B2 JP3488245B2 JP50182698A JP50182698A JP3488245B2 JP 3488245 B2 JP3488245 B2 JP 3488245B2 JP 50182698 A JP50182698 A JP 50182698A JP 50182698 A JP50182698 A JP 50182698A JP 3488245 B2 JP3488245 B2 JP 3488245B2
- Authority
- JP
- Japan
- Prior art keywords
- stapler
- endoscope
- head
- anvil
- stapler head
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets 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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/00296—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
-
- 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
- A61B2017/07221—Stapler heads curved
-
- 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
- A61B2017/2905—Details of shaft flexible
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
- A61B2090/306—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using optical fibres
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Molecular Biology (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
- Nonmetallic Welding Materials (AREA)
- Laser Surgery Devices (AREA)
Description
めの外科用ステープラに関する。より詳細には、本発明
は、内視鏡に取付けられる外科用ステープラに関する。
本発明は、限定するわけではないが、経口又は通肛外科
措置に対する特定の用途を有している。
の効率的な方法を提供することは、外科技術では早くか
ら知られている。実際には、或る種の外科措置では、縫
合ではなく、外科用ステープルを使用することは、組織
を結合する好ましい方法になっている。外科用ステープ
ラの普通の使用は、結腸の一部を取り除いた後の結腸の
治療に関連するものである。例えば、結腸に腫瘍が見つ
かったとき、結腸の大部分を取り除くことは稀ではな
い。次いで、結腸の残部を吻合と呼ばれる外科措置で結
合し、チューブ状部分を結合して連続したチューブ状径
路を形成する。
患部を露出させるように開放される。次いで、結腸の患
部を外科的に取り除き、結腸の残部を結合する。ステー
プラの使用の前には、吻合措置は、外科医が腸の端を切
り正確に整列させ縫合によって端を接合しつつ整列を維
持しなければならないので、骨が折れ、時間がかかって
いた。円形ステープラの開発は、外科医が、チューブ状
径路を閉塞している過剰組織を切除しつつ、結腸の部分
を結合する1以上の列のステープルを同時に提供するこ
とによって、吻合措置を著しく簡素化した。しかしなが
ら、円形ステープラを使用した場合でさえ、ステープラ
を出し入れするため、結腸の健康な部分に接近口を設け
る必要がある。ステープラを吻合に使用し、結腸から接
近口を介して取り出した後、結腸の接近口の箇所を縫合
又は線形ステープリングによって治療する必要がある。
ち幾つかは市販されている。例えば、ブリンコーホッフ
等に付与された米国特許第5,205,459号、メイン等に付
与された同第5,261,920号、フォックス等に付与された
同第5,271,544号、ブリンカーホッフ等に付与された同
第5,285,945号、メイン等に付与された同第5,333,773
号、ピートラフィッタ等に付与された同第5,445,644号
(これらの特許を参考文献としてここに含める)に開示
されているような、米国ニュージャージー州サマービル
のエシィコン社から商品名プロキシメイトとして販売さ
れている円形ステープラがある。アランヒに付与された
米国特許第5,005,749号、アランヒに付与された同第5,1
94,731号、グリーンに付与された同第5,360,154号、ビ
オルタ等に付与された同第5,443,198号、キャラブレー
ゼ等に付与された同第5,437,684号、ゲリー等に付与さ
れた同第5,447,514号、ファン・レーウェン等に付与さ
れた同第5,454,825号、ビオルタ等に付与された同第5,4
74,223号(これらの特許を参考文献としてここに含め
る)に開示されているような、米国コネチカット州ノー
ウォークのユナイテッド・ステーツ・サージカル・コー
ポレーションから商品名オート・サチュアとして販売さ
れている他の円形ステープラがある。ステープルヘッド
アセンブリ、シャフトアセンブリ、およびハンドルアセ
ンブリを含む幾つかの要素は、全ての円形ステープラに
略共通している。ステープルヘッドアセンブリは全て、
円形の周囲に配列された複数のステープルを保持するス
テープルホルダと、組織を貫通するステープルの端を形
成するように作用する円形アンビルと、円形ナイフ又は
メスと、ステープルをステープルホルダから押し出して
ナイフを作動させるドライバとを有している。シャフト
アセンブリは典型的には、アンビルへの力に抵抗すべく
操作ハンドルからアンビルに引張力を伝達するための引
張部材を保持する、実質的に剛な長さ方向に湾曲したシ
ャフトと、ステープルを組織内に押し込み、ステープル
に隣接した組織を通してナイフを駆動すべく、ステープ
ルドライバを前進させるため、操作ハンドルアセンブリ
からの圧縮力を伝達するための圧縮部材とを有してい
る。ハンドルアセンブリは典型的には、ハンドルと、1
以上のレバー及び/又はノブとを有している。レバーと
ノブは、アンビルをステープルホルダに対して移動さ
せ、ステープルとナイフを発射するのに使用される。
てきたが、吻合措置は依然として、外傷と内傷を残す極
めて侵入的な措置である。実際には、腹腔を開放しなけ
ればならないうえ、別の外科手術に至る再発の可能性を
回避するため、結腸の大きな部分が取り除かれる。さら
に、上述のように、結腸は、円形ステープラのための口
を提供するため、健康な箇所で穿刺しなければならず、
次いで、この穿刺を(腹腔を縫合し或いはステープル留
めするように)縫合し或いはステープル留めしなければ
ならない。
けるのが望ましいことは明らかである。この目的のた
め、ステープラの接近口を提供するのに結腸の健康な箇
所を穿刺する必要のないように肛門から挿入することが
できる種々の可撓性の外科用ステープラが提案されてい
る。これらの可撓性シャフトステープラは、ベーカー等
に付与された米国特許第4,671,445号、ノイレス等に付
与された同第4,473,077号、シフマンに付与された同第
4,488,523号、ベーカー等に付与された同第4,754,909
号、ウィルクに付与された同第5,258,008号、グラント
等に付与された同第5,271,543号、フーベン等に付与さ
れた同第5,433,721号、ブランコ等のPCT出願WO93/15668
号に開示されており、これらを参考文献としてここに含
める。これらの可撓性シャフトステープラは1つの利点
を有しているが、ステープラが適所にあるとき、腹部手
術の必要性を回避することはなく、腹腔鏡や開腹手術以
外に手術部位を見る方法はない。さらに、可撓性シャフ
トステープラは、他の欠点を有している。特に、幾つか
の可撓性シャフトステープラは、結腸内に十分に到達す
るような長いシャフトを有していない。他の可撓性シャ
フトステープラは、作るのが厄介及び/又は実際的でな
く、かつ高価なシャフトアセンブリを有している。他の
可撓性シャフトステープラは、周囲に配置される多数の
ステープルの同時発射に必要な力のため、課題を有して
いる。欠点の特定の性質にかかわらず、これらは明らか
に、可撓性シャフトステープラが市場で成功を収めてい
ないことを示している。
ッセラー等に付与された米国特許第5,197,649号に示さ
れており、この特許は、直腸から挿入されるが、結腸の
患部が侵入的な手術具を使用して既に取り除かれている
ことを必要としている操作可能な内視鏡ステープラを提
供している。ベッセラー等の操作可能な内視鏡ステープ
ラは、標準的な内視鏡の基本操作および視覚能力と、内
視鏡の遠位端のところの円形ステープルヘッドアセンブ
リと、アンビルとステープルヘッドのステープラを一緒
にしてステープルとナイフを発射するためのケーブルお
よびプーリシステムとを有する特製の器具を提案してい
る。単一の装置において内視鏡の視覚装置をステープラ
と結合する概念は一定の利点を有しているが、普通に使
用される内視鏡の完全なリエンジニアリングは、望まし
いものではない。実際には、ステープラは典型的には、
洗浄と精確な寸法の調整が難しいので、使い捨て器具で
あり、内視鏡は、再使用される高価な器具である。した
がって、ベッセラー等によって提案された組合せ器具
は、装置の洗浄や殺菌が不可能であるので、経済的に採
算がとれないであろう。さらに、ベッセラー等によって
提案された装置の機構は、実用的ではない多くの欠点を
有している。例えば、単一のケーブルおよびプーリシス
テムがアンビルとステープラを一緒にしステープラとナ
イフを発射するように表面上作用するが、ステープル留
めの後にアンビルをステープラに対して開放させるため
の機構が設けられていない。さらに、寸法が規定されて
おらず、(可撓性の内視鏡シャフト部分とヘッド部分の
相対寸法を比較すると)ステープラのヘッド部分が大き
く(例えば、可撓性シャフトの3倍)、操作上の問題が
あるように見える。最後に、他の外科技術を使用するこ
となしに、360゜の吻合を行うのが不可能である。吻合
を行う前に腸から剥離させなければならない腸間血管弧
に腸の外面の一方の側が取付けられている。開放又は腸
腔鏡手術による以外に剥離を行う公知の方法はない。
と内視鏡を直腸から挿入し、切開を必要としないよう
に、可撓性の内視鏡ステープラを内視鏡上に設けること
が示唆されている。このような可撓性の内視鏡ステープ
ラは、ヘッドアセンブリと、可撓性のチューブ部材と、
近位制御アセンブリとを有している。可撓性のチューブ
部材は、ステープラに対して移動する標準的な内視鏡を
受け入れるための大きなルーメン、および鉗子器具、ケ
ーブル、ヘッドアセンブリの操作要素等を受け入れるた
めの小さなルーメンを含む、多くのルーメンを有してい
る。ヘッドアセンブリは、クラムシェル(細長い切頭楕
円)形のステープラヘッドと、同様な形状のアンビルと
を有しており、これらは、互いにヒンジ止めされてい
る。ステープルは、ステープラヘッドに配置されたカー
トリッジ内に置かれ、四分の一円曲線および四分の一円
から延びた直線を形成する2列を占めている。アンビル
は、同様な形体を備えている。ナイフが、ステープルの
内部に同様に形作られたトラックに沿って移動する。ス
テープラヘッドは、ベベルギアと関連したケーブルおよ
びプーリ装置を利用して、アンビルに対して移動する。
提案した装置は、吻合を行うことを意図しておらず、侵
入的な腹部手術(即ち、切開)を必要とすることなし
に、結腸の小さな部分の組織全体の切除とステープリン
グ治療を行う。治療の際の外傷が少なく、必要ならば繰
り返し治療することができるので、結腸の患部の組織全
体の切除が、侵入的な腹部手術を避けことができる十分
な治療になるものと思われる。
な改良を提供するが、依然として幾つかの欠点を有して
いる。第1に、ヒンジ付きステープラヘッドとアンビル
を備えたクラムシェル形の構成は、幾つかの理由のた
め、最適なものではない。まず、ヒンジ付き構成では、
ステープラを閉鎖すると、組織は、ステープラから外方
に押され、これにより所望の組織を得るのに失敗するお
それがある。次に、ヒンジ付き構成では、ステープラが
開放したとき、クラムシェルとステープラ装置の全体径
が著しく増大し、これにより患部でない組織を引き裂く
おそれがある。次に、アンビル内に受け入れられるステ
ープルの整列が非常に困難である。何故ならば、(間に
捕捉された組織の量と密度に応じて)ステープラヘッド
とアンビルが常に同じ位置に接近するとは限らないから
である。さらに、クラムシェル形ヒンジ付きステープラ
では、ステープラヘッドの機構が非常に複雑で扱いにく
い。特に、湾曲部分と直線部分をもつステープラの構成
により、ナイフおよびステープルドライバの形状に関す
る問題が生ずる。同様に、ステープラヘッドを開閉する
ためのベベルギアをもつケーブルおよびプーリ装置は、
非常に複雑で、装置内に大きな空間を必要とする。さら
に、あらゆる機械的な問題のため、このようなステープ
ラ装置のヘッドは、非常に大きく、結腸内で操作しにく
い。最後に、操作能力等を含む、このような装置の複雑
さのため、使い捨て装置の製造コストは非常に高くな
り、商業的に受け入れられる可能性が少ない。
供することである。
用される内視鏡ステープラを提供することである。
可能に取付けられる内視鏡ステープラを提供することで
ある。
となしに、組織の厚さ全体の切除を行う内視鏡に関連し
て使用される内視鏡ステープラを提供することである。
続的に発射されるステープラの半円形の配列を有する内
視鏡ステープラを提供することである。
差し向けることができる30mm以下の直径を有するステー
プラヘッドを備えた内視鏡ステープラを提供することで
ある。
動するアンビルとステープラヘッドとを有する内視鏡ス
テープラを提供することである。
鏡ステープラのヘッドのところで手術部位の内視鏡によ
る視認を可能にする内視鏡ステープラを提供することで
ある。
用し易い使い捨て内視鏡ステープラを提供することであ
る。
ステープル発射機構とを備えた内視鏡ステープラを提供
することである。
外し可能に取付けられる内視鏡ステープラを提供するこ
とである。
よる内視鏡ステープラは、内視鏡の遠位端に取り外し可
能に配置できるステープラヘッドを有している。ステー
プラヘッドは、取り外し可能なステープルカートリッジ
を収容する不動部分と、不動部分から発射されたステー
プルの端を受け入れ曲げるためのアンビルを有する可動
部分とを備えている。好ましい実施例によれば、ステー
プルカートリッジは、互い違いになっている半円形の2
列のステープルを収容している。可動部分は、不動部分
のウォームギアに係合するねじ付きシャフトによって、
不動部分に連結されており、第1の回転可能な制御ワイ
ヤが、ウォームギアに連結されている。実質的に半円形
の発射カムが、不動部分のステープルカートリッジの手
前に置かれている。発射カムは、スプライン付き内面を
有しており、スプライン付き内面には、第2の回転可能
な制御ワイヤに連結されたスプラインギアが係合してい
る。本発明の或る実施例では、ステープル留めに続いて
組織が切られるように、発射カムにナイフが連結されて
いる。本発明の別の実施例では、ステープル留めの後に
組織を切るため、ステープルカートリッジに隣接して、
レーザ光路が設けられている。
位端は、制御ワイヤ用のルーメンおよび標準的な内視鏡
用のルーメンを有するスリーブに連結されている。本発
明の別の実施例では、変形された内視鏡に、制御ケーブ
ル用のルーメンが設けられている。変形された内視鏡
は、ねじ連結体又はスナップ連結体によって、ステープ
ラヘッドに取り外し可能に取付けられている。これによ
り、制御ワイヤの近位端は、内視鏡の近位端の付近に配
置され、ケーブルを回転させるための装置に取付けられ
ている。
下の詳細な説明を読むことによって明らかになるであろ
う。
テープラの斜視図である。
ドの一部透明で切取り部のある拡大長さ方向断面図であ
る。
る。
テープラの第3図と同様な図である。
鏡ステープラのステープラヘッドの切取り平面図であ
る。
プラの第2図と同様な図である。
を有する内視鏡に使用される本発明を示したものであ
る。
プラの第3図と同様な図である。
プラの第4図と同様な図である。
テープラの第9図と同様な図である。
る。
である。
である。
る。
である。
る。
しい実施例による内視鏡ステープラ10が一般に、ステー
プラ10を通常の内視鏡16に取付けるためのスリーブ14を
備えたステープラヘッド12を有している。ステープラヘ
ッド12は、不動部分18と、可動部分20とを有しており、
これらの部分については、第2図〜第5図を参照して詳
細に後述する。しかしながら、一般に、本発明の好まし
い実施例によれば、可動部分20は、可撓性の捩れにくい
制御ワイヤを回転させることによって動かされ、不動部
分18は、同様な可撓性の捩れにくい制御ワイヤ24によっ
て操作される。
央ルーメン14aと、2つの外部又は側部ルーメン14b、14
cとを有している。中央ルーメン14aは、好ましくは相互
係止手段14eを有する長さ方向スリット14dによって容易
に接近できる。側部ルーメン14b、14cは、制御ワイヤ2
2、24をそれぞれ備えている。第1図に示されるよう
に、制御ワイヤ22、24の近位端はルーメン14bを出て、
後述するように制御ワイヤを回転させるための回転手段
25、27に連結されている。回転手段25、27は、ラチェッ
ト式ハンドホイール、ノブ、電気モータ、ラック・ピニ
オンフットペダル等、或いはこれらの組み合わせでもよ
い。
は、内視鏡の遠位端が図示されているようにステープラ
ヘッド12の不動部分18の内部にあるように内視鏡16をス
リット14からスリーブ14に挿入することによって、通常
の内視鏡16に取付けられている。内視鏡16は有利には、
4つのポート16a〜16dを備えており、そのうち2つ(例
えば、16a、16c)は光路となり、別の2つ(例えば、16
b、16d)は器具用ルーメンとなる。当業者は、内視鏡の
ポートが第1A図に概略的に示されているが、異なる内視
鏡が異なる構成のポートを有してもよいことを認識する
であろう。同様に、スリーブ14が第1A図に概略的に示さ
れているが、異なる数および位置のルーメンを備えた異
なる厚さを有するものでもよいことを認識するであろ
う。
に、内視鏡16のルーメン(例えば、16d)からステープ
ラヘッドの不動部分18と可動部分20との間の空隙に鉗子
26を挿入し、詳細には後述するように、組織をステープ
ラ内に引っ張り込むのがよい。鉗子26は、通常の鉗子で
もよく、或いはニーマンに付与された米国特許第4,880,
015号(この特許を参考文献としてここに含める)に記
載されているような関節式鉗子でもよい。
図により詳細に示されている。次に第2図〜第5図を参
照すると、ステープラヘッド12の不動部分18は、取り外
し可能なステープルカートリッジ30を有しており、ステ
ープルカートリッジ30は、2列のステープル32を備え、
各ステープルは、それ自身のドライバ34を有している。
第3図に最も良く示されるように、ステープル32は、互
い違いになった2つの半円形の列に配列されている。し
かしながら、ステープルが好ましくは半円形の列に配列
されているが、ステープルカートリッジ30は好ましく
は、取り外し可能なカートリッジに安定性を与えるため
に、円のまわりに約200゜〜220゜延びている。実質的に
半円筒形のステープル用カム36が、ステープルカートリ
ッジ30の下方かつ後方に回転可能に取付けられている。
ステープル用カム36は、傾斜した前面38と、複数の内面
スプラインとを有している。本発明の1つの実施例によ
れば、切断用ナイフ42が、遠位内部分のところでカム36
に連結されている。上述の制御ワイヤ22は、スプライン
付きローラに連結され、スプライン付きローラは、ステ
ープル用カム36のスプライン付き面40に係合している。
当業者は、ケーブル22を回転させるとカム36が回転する
ことを認識するであろう。さらに、カムが回転すると、
傾斜した前面38は連続してステープル32のドライバ34に
係合し、ステープルは、カムの回転時に、連続して発射
される。本実施例によれば、ナイフ42は、組織がステー
プル留めの後に切断されるように、カムの前面の後方に
配列されている。
ステープル曲げディンプルをもつ半円形のアンビル48を
有している。可動部分20は、長さ方向キー路52aをもつ
ねじ付きポスト52によって、不動部分18に連結されてい
る。好ましくは、周囲を視認できるように、ポスト52と
アンビル48との間の空隙に凸面鏡54が設けられている。
所望ならば、凸面鏡に、遠位方向の視認のため透明レン
ズ又は部分(図示せず)で終わっている可動部分20の通
路(図示せず)に通じる中央孔を設けてもよい。遠位方
向の視認は、ステープラ付き内視鏡を結腸を通して操作
する場合に望ましい。或いは、鏡の代わりに、透明レン
ズ又は窓を備えた通路を設けてもよい。可動部分20の遠
位端20aは好ましくは、ステープラの腸内での移動を容
易にするため、テーパしている。この実施例では、可動
部分は、半卵形である。
付きポスト52は、不動部分18内に延びており、軸60に取
付けられたアイドラーウォームギア58が係合している。
さらに、ポスト52のキー路52aに係合して回転を阻止す
るキー53が、不動部分18に設けられている。制御ケーブ
ル24の遠位端は、ウォームギア62に連結されており、ウ
ォームギア62は、アイドラーギア58に係合している。当
業者は、捩じれないケーブル24を回転させるとウォーム
ギア62が回転し、アイドラーギア58を回転させることを
認識するであろう。また、アイドラーギア58が回転する
と、ねじ付きシャフト52が、回転方向に応じて近位方向
又は遠位方向に移動することも認識するであろう。
け入れるために、互いに幾分間隔を隔てられていること
が認識されるであろう。さらに、不動部分18の遠位端に
は、開口18a、18bが設けられており、内視鏡の光学要素
は、これらの開口を通して(そして、窓が設けられてい
る場合には、可動部分を通して)、不動部分18と可動部
分20との間の空隙を見ることができ、これらの開口を通
して、可撓性の鉗子(第1図では26)を通すことができ
る。したがって、可動部分20の鏡54は、ステープラの不
動部分18と可動部分20との間に軸線方向に置かれた結腸
壁を見るのを助ける。
内視鏡ステープラは、次のようにして使用される。すな
わち、ステープラ10を内視鏡16に取付けた後、内視鏡16
の光学および操作手段によって、アセンブリを肛門から
手術部位に進める。手術部位に到達すると、鉗子26を内
視鏡の器具ポートから挿入し、鉗子26を使用して、患部
組織をステープラの可動部分20と不動部分18との間の空
隙に引き込む。十分な組織が適所にあるとき、制御ワイ
ヤ24を回転させ、ステープルカートリッジ30とアンビル
48との間に組織を捕捉している不動部分18に向かって近
位方向に可動部分20を引く。可動部分20と不動部分18が
密着すると、制御ワイヤ22を回転させ、半円形の2列の
ステーブル32を患部組織のまわりに連続して発射し、患
部組織をステープル留めされた組織からナイフ42で切断
する。次いで、装置を腸から回収することができるよう
に、制御ワイヤ24を反対方向に回転させて、可動部分20
をステープラの不動部分18から僅かに離す。患部組織を
取り除くことができるように、ステープラの可動部分20
と不動部分18をより完全に開放する。同じ措置において
第2の手術部位が含まれる場合には、使用済みのステー
プルカートリッジ30を取り外し、新しいステープルカー
トリッジと交換し、装置を肛門から再び挿入する。単一
の措置が終了すると、ステープラ10を内視鏡16から取り
外し、廃棄処分する。
別の第1の実施例に係るステープラ100は、実施例10と
実質的に同一であり、同じ参照符号は、同じ要素を示し
ている。この実施例では、ナイフは、半円形の列のファ
イバオプティック142と交換されており、ファイバオプ
ティック142は、単一の光路部材142aに光学的に結合さ
れている。光路部材142aは、レーザ照射源(図示せず)
に結合されている。光路部材142aは、内視鏡16のルーメ
ンの1つから供給してもよく、第1図のスリーブ14の第
3の外部ルーメン(図示せず)から供給してもよい。こ
の実施例の利点は、硬化した患部組織を最小の労力で切
断することができることである。
の実施例に係るステープラ200は、実施例10と実質的に
同一であり、同じ参照符号は、同じ要素を示している。
この実施例では、不動部分218に、上部光学窓216が設け
られており、側部視認内視鏡116が使用される。内視鏡1
16は、視認ポート117が窓219と整列するように配列され
ている。この実施例の利点は、可動部分と不動部分が閉
鎖位置にあるときに内視鏡のオプティックを使用するこ
とができることである。
発明による第2の実施例に係るステープラ300を示して
おり、同じ参照符号は、同じ要素を示している。この実
施例では、可動部材320は実質的に卵形であり、下部ね
じ付きポスト352および2つの側部安定ポスト351、353
によって、不動部材316に連結されている。したがっ
て、制御ワイヤ324は、不動部材318の下部分に配置さ
れ、ウォームギア362によってねじ付きポスト352に直接
結合されている。この実施例の利点は、透明路が内視鏡
16の遠位端に設けられており、部材318、320の結合がよ
り安定していることである。内視鏡16がより遠位位置に
置かれているので、可動部材と不動部材が閉鎖している
とき内視鏡の遠位端を受け入れるため、可動部分320に
凹部321が設けられている。凹部は又、ファイバオプテ
ィックからの光を、好ましくは遠位端にレンズ又は透明
窓を有している可動部材320から透過させる。所望なら
ば、第1図〜第5図を参照して上述したように、凹部32
1に鏡(図示せず)を設けてもよい。
11図の実施例は、内視鏡の遠位端がステープラの不動部
分と可動部分との間で接合されるように、ステープラに
対して移動させることができる内視鏡についても使用す
ることができる。このようにして、結腸壁のより直接的
に視認を得ることができ、内視鏡が第9A図に示される位
置から回収され(第9図に示されるような)ステープラ
内に戻されるとき、内視鏡鉗子を適当な位置に自然に差
し向け、組織を把持しステープラ領域に引き込む。内視
鏡のステープラに対する移動は、内視鏡よりも幾分大き
な中央ルーメンをもつステープラチューブを準備し、こ
れにより摩擦を減らし隙間を形成する(すなわち、内視
鏡とステープラチューブとの間に環状の空隙を形成す
る)ことによって、達成される。同時に、ステープラヘ
ッドの可動部分320には好ましくは、内視鏡の遠位端を
受け入れる凹部321aが設けられている。かくして、内視
鏡を凹32a内に押し進めることによって、内視鏡がステ
ープラを前方に押した状態で、内視鏡とステープラを両
方とも前進させることができる。内視鏡を手前に僅かな
距離引っ張ると、ステープラは適所にとどまり、内視鏡
を所望のように差し向けることができる。次いで、鉗子
を使用して組織をステープラに引っ張り込み、内視鏡と
鉗子をステープラ内に更に引っ込める。ステープラ留め
措置の後、内視鏡とステープラを近位端のところで一緒
に把持し、一緒に回収することによって、内視鏡とステ
ープラを患者から取り出すことができる。
る別の第2の実施例に係るステープラ400に示してお
り、同じ参照符号は、同じ要素を示している。この実施
例では、可動部材と不動部材を閉鎖したとき側部視認内
視鏡116の遠位端を受け入れるため、可動部材420に大き
な凹部421が設けられている。半径方向に向いた鉗子ポ
ートを有する適当な側部視認内視鏡は、シルバースタイ
ン等に付与された米国特許第4,646,722号に記載されて
おり、この特許を参考文献としてここに含める。
に係るステープラ500を示しており、同じ参照符号は、
同じ要素を示している。この実施例では、内視鏡16をス
テープラヘッドを通過させ手前に曲げて手術部位を視認
させるため、可動部材520に、貫通孔521が設けられてい
る。
に係るステープラ600を示しており、同じ参照符号は、
同じ要素を示している。この実施例は、光学ポート616
a、616b、器具(鉗子)ポート616c、および制御ワイヤ6
22、624を搬送するポート616d、616eを有する特殊な内
視鏡616に使用するように設計されている。内視鏡の遠
位端には溝617が設けられており、不動部材618の近位端
には連結装置619が設けられている。図示されるよう
に、ポート616a〜616cは、硬いチューブとして内視鏡の
遠位端を超えて延び、ステープラの不動部分618と可動
部分620との間の空隙に達しており、ステープラから内
視鏡を取り外すとき、制御ワイヤをポート616d、616eか
ら取り出すことができる。
る第5の実施例に係るステープラ700は、上述の第4の
実施例に係るステープラと幾分似ており、同じ参照符号
は、同じ要素を示している。不動部分718は、2つの光
路776a、776bおよび器具ポート776cを備えたねじ付き近
位端719を有している。光路と器具ポートは、開口の方
へ差し向けられた湾曲した遠位端を有しており、開口か
ら組織が引っ張られる。光路および器具ポートの近位端
は、内視鏡716の光路および器具ポートに連結するため
の中空端を有している。この実施例では、制御ワイヤ72
2、724の遠位端は硬く、キー路や六角ソケットカップリ
ングのような連結端をもつ不動部分718内で終わってい
る。内視鏡716は、不動部分718のねじ付き端719と合致
する回転可能なねじ付きカラー717を有している。内視
鏡716の光ポート716a、716bは、内視鏡の遠位端を超え
て延び、不動部分718の光路776a、776bの中空端と合致
している。同様に、内視鏡716の器具ポート716cは、内
視鏡の遠位端を超えて延び、不動部分718の器具ポート7
76cの中空端と合致している。内視鏡716のルーメン716
d、716e内を搬送される制御ワイヤ722′、724′は、不
動部分718内の制御ワイヤ722、724の連結端と合致する
硬質コネクタ(キー付き又は六角コネクタ)で終わって
いる。これにより、ポートおよび制御ワイヤを整列さ
せ、内視鏡および不動部分の近位端を一緒に押し、ねじ
付きカラー717を不動部分のねじ付き端719上に捩じるこ
とによって、不動部分718は、内視鏡716に連結される。
これらの手順を逆に行うことによって、内視鏡をステー
プラから容易に取り外すことができる。
きた。本発明の特定の実施例を説明したが、本発明は、
これらの実施例に限定されるものではない。かくして、
半円形のステープリングパターンが開示されているが、
180゜以下の弧状パターンを利用することもできる。ま
た、2列の互い違いのステープルが示されているが、1
列、又は他の形体の多数列を使用しても、同様な結果が
得られる。さらに、ステープラヘッドの可動部分に配置
された鏡に関して特定の形体が開示されているが、他の
形体を使用することもできる。例えば、内視鏡とステー
プラを結腸を通して操作する際に前方視認を可能にし、
内視鏡とステープラが略適所にあるとき結腸壁の周囲視
認を可能にするため、鏡は、移動可能であり、回転可能
であり、或いはヒンジ止めされているのがよい。また、
ステープラヘッドの遠位端と近位端に光学窓を有する種
々の実施例が示されているが、他の形体の光学窓を使用
することもできる。さらに、2つの小さなルーメン、大
きなルーメン、およびスリットを有する特別のステープ
ラチューブが示されているが、異なる配置のより多くの
ルーメンを有し、スリットを備えた或いはスリットなし
のステープラチューブを使用してもよい。さらに、特定
のギア形体および配置に関連してステープラヘッドが説
明されているが、他の形体を使用して同様な結果を得る
ことができる。例えば、スプライン付き内面を有する回
転カムを、駆動ギアが配置されたスプライン付き外面を
有する回転カムと交換してもよい。
されているが、当業者は、他の消化器系の通腔措置に利
用することができ、口並びに肛門から挿入することがで
きることを認識するであろう。また、特別仕様の内視鏡
に関連して本発明の一定の実施例を説明したが、特別仕
様の内視鏡/ステープラの実施例の形体を変えてもよ
い。例えば、異なる配列のルーメンおよび制御ワイヤ、
制御ワイヤを駆動ギアに連結するための異なる連結手段
を使用しても、同様の結果を得ることができる。したが
って、本発明の精神と請求の範囲に記載された範囲から
逸脱することなしに、他の修正を行うことができる。
Claims (23)
- 【請求項1】内視鏡に使用される使い捨て内視鏡ステー
プラであって、 a)不動部分および可動部分を有するステープラヘッド
を備え、該ステープラヘッドが、アンビルと、ステープ
ルをアンビルに発射するための手段とを有し、 b)ステープラヘッドを内視鏡に連結するための手段
と、 c)可動部分を不動部分に対して移動させるための手段
とを備え、 可動部分と不動部分が、ねじ付きシャフトによって互い
に連結されており、前記移動させるための手段が、ねじ
付きシャフトに係合するウォームギアを有していること
を特徴とするステープラ。 - 【請求項2】前記発射するための手段が不動部分内に収
容され、前記アンビルが可動部分内に収容されているこ
とを特徴とする請求の範囲第1項に記載のステープラ。 - 【請求項3】前記移動させるための手段が、ウォームギ
アを回転させるための可撓性の捩れにくいワイヤを有し
ていることを特徴とする請求の範囲第2項に記載のステ
ープラ。 - 【請求項4】前記ワイヤが、内視鏡の長さの実質的に全
体に延びており、近位端のところで、ワイヤを捩じるた
めの手段に連結されていることを特徴とする請求の範囲
第3項に記載のステープラ。 - 【請求項5】内視鏡に使用される使い捨て内視鏡ステー
プラであって、 a)不動部分および可動部分を有するステープラヘッド
を備え、該ステープラヘッドが、アンビルと、ステープ
ルをアンビルに発射するための手段とを有し、 b)ステープラヘッドを内視鏡に連結するための手段
と、 c)可動部分を不動部分に対して移動させるための手段
とを備え、 前記発射するための手段が、ステープラヘッドの長さ方
向軸線と実質的に直交した平面内において、実質的に半
円形の列のステープルを連続して発射するための手段を
有していることを特徴とするステープラ。 - 【請求項6】前記発射するための手段が、実質的に半円
形のカムを有していることを特徴とする請求の範囲第5
項に記載のステープラ。 - 【請求項7】d)前記カムを回転させるための手段と、 e)前記列のステープルに隣接して実質的に半円形の径
路を切断するための手段とを更に備えていることを特徴
とする請求の範囲第6項に記載のステープラ。 - 【請求項8】前記カムが、スプライン付き面を有し、カ
ムを回転させるための前記手段が、スプライン付き面に
係合するスプラインギアを有していることを特徴とする
請求の範囲第7項に記載のステープラ。 - 【請求項9】前記回転させるための手段が、スプライン
ギアに連結された可撓性の捩れにくいワイヤを有してい
ることを特徴とする請求の範囲第8項に記載のステープ
ラ。 - 【請求項10】前記ワイヤが、内視鏡の長さの実質的に
全体に延びており、近位端のところで、ワイヤを捩じる
ための手段に連結されていることを特徴とする請求の範
囲第9項に記載のステープラ。 - 【請求項11】前記切断するための手段が、カムに取付
けられたナイフを有していることを特徴とする請求の範
囲第7項に記載のステープラ。 - 【請求項12】前記切断するための手段が、レーザオプ
ティカルファイバ列を有していることを特徴とする請求
の範囲第7項に記載のステープラ。 - 【請求項13】内視鏡に使用される使い捨て内視鏡ステ
ープラであって、 a)不動部分および可動部分を有するステープラヘッド
を備え、該ステープラヘッドが、アンビルと、ステープ
ルをアンビルに発射するための手段とを有し、 b)ステープラヘッドを内視鏡に連結するための手段
と、 c)可動部分を不動部分に対して移動させるための手段
とを備え、 ステープラヘッドが、内視鏡の視認領域を広げるための
鏡手段を有していることを特徴とするステープラ。 - 【請求項14】ステープラヘッドが光学窓を有している
ことを特徴とする請求の範囲第13項に記載のステープ
ラ。 - 【請求項15】内視鏡に使用される使い捨て内視鏡ステ
ープラであって、 a)不動部分および可動部分を有するステープラヘッド
を備え、該ステープラヘッドが、アンビルと、ステープ
ルをアンビルに発射するための手段とを有し、 b)ステープラヘッドを内視鏡に連結するための手段
と、 c)可動部分を不動部分に対して移動させるための手段
とを備え、 前記連結するための手段が、ステープラヘッドに連結さ
れた可撓性スリーブを有しており、該スリーブが、内視
鏡を受け入れるためのルーメンを有していることを特徴
とするステープラ。 - 【請求項16】前記スリーブが、その長さの少なくとも
一部に沿って、長さ方向スリットを有していることを特
徴とする請求の範囲第15項に記載のステープラ。 - 【請求項17】前記スリーブが、制御ワイヤをステープ
ラヘッドに搬送するための少なくとも1つの付加的なル
ーメンを有していることを特徴とする請求の範囲第16項
に記載のステープラ。 - 【請求項18】使い捨て内視鏡ステープラと再使用可能
な内視鏡の組合せであって、 a)不動部分および可動部分を有するステープラヘッド
を備え、該ステープラヘッドが、アンビルと、ステープ
ルをアンビルに発射するための手段と、ステープラヘッ
ドを内視鏡に連結するための近位連結手段と、可動部分
を不動部分に対して移動させるための手段とを有してお
り、 b)内視鏡を近位連結手段に連結するための遠位連結手
段を有する内視鏡を備えていることを特徴とする組合
せ。 - 【請求項19】前記近位連結手段と前記遠位連結手段
が、ねじ連結を形成していることを特徴とする請求の範
囲第18項に記載の組合せ。 - 【請求項20】前記近位連結手段と前記遠位連結手段
が、互いにスナップ嵌めされていることを特徴とする請
求の範囲第18項に記載の組合せ。 - 【請求項21】使い捨て内視鏡ステープラと再使用可能
な内視鏡の組合せであって、 a)不動部分および可動部分を有するステープラヘッド
を備え、該ステープラヘッドが、アンビルと、ステープ
ルをアンビルに発射するための手段と、ステープラヘッ
ドを内視鏡に連結するための近位連結手段と、可動部分
を不動部分に対して移動させるための手段とを有してお
り、 b)側部視認ポートを有する内視鏡を備えていることを
特徴とする組合せ。 - 【請求項22】前記ステープラヘッドが、光学窓を有し
ていることを特徴とする請求の範囲第21項に記載の組合
せ。 - 【請求項23】使い捨て内視鏡ステープラと再使用可能
な内視鏡の組合せであって、 a)不動部分および可動部分を有するステープラヘッド
を備え、該ステープラヘッドが、アンビルと、ステープ
ルをアンビルに発射するための手段と、ステープラヘッ
ドを内視鏡に連結するための近位連結手段と、可動部分
を不動部分に対して移動させるための手段とを有してお
り、 b)内視鏡を備え、 前記内視鏡と前記ステープラヘッドのうち一方に、ステ
ープラヘッド内の不動部分と可動部分との間に湾曲した
器具ポートが形成されていることを特徴とする組合せ。
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US08/662,659 | 1996-06-14 | ||
US08/622,659 | 1996-06-14 | ||
US08/662,659 US6119913A (en) | 1996-06-14 | 1996-06-14 | Endoscopic stapler |
PCT/US1997/010181 WO1997047231A2 (en) | 1996-06-14 | 1997-06-13 | Endoscopic stapler |
Publications (2)
Publication Number | Publication Date |
---|---|
JP2000512185A JP2000512185A (ja) | 2000-09-19 |
JP3488245B2 true JP3488245B2 (ja) | 2004-01-19 |
Family
ID=24658633
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP50182698A Expired - Fee Related JP3488245B2 (ja) | 1996-06-14 | 1997-06-13 | 内視鏡ステープラ |
Country Status (7)
Country | Link |
---|---|
US (2) | US6119913A (ja) |
EP (1) | EP0910289B1 (ja) |
JP (1) | JP3488245B2 (ja) |
AT (1) | ATE320219T1 (ja) |
CA (1) | CA2258128A1 (ja) |
DE (1) | DE69735485T2 (ja) |
WO (1) | WO1997047231A2 (ja) |
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1997
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- 1997-06-13 JP JP50182698A patent/JP3488245B2/ja not_active Expired - Fee Related
- 1997-06-13 WO PCT/US1997/010181 patent/WO1997047231A2/en active IP Right Grant
- 1997-06-13 EP EP97928955A patent/EP0910289B1/en not_active Expired - Lifetime
- 1997-06-13 CA CA002258128A patent/CA2258128A1/en not_active Abandoned
- 1997-06-13 DE DE69735485T patent/DE69735485T2/de not_active Expired - Lifetime
-
2000
- 2000-08-04 US US09/633,113 patent/US6302311B1/en not_active Expired - Lifetime
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EP0910289A4 (en) | 2000-07-26 |
EP0910289A2 (en) | 1999-04-28 |
WO1997047231A3 (en) | 1998-02-05 |
CA2258128A1 (en) | 1997-12-18 |
US6119913A (en) | 2000-09-19 |
DE69735485D1 (de) | 2006-05-11 |
JP2000512185A (ja) | 2000-09-19 |
ATE320219T1 (de) | 2006-04-15 |
EP0910289B1 (en) | 2006-03-15 |
DE69735485T2 (de) | 2006-10-12 |
WO1997047231A2 (en) | 1997-12-18 |
US6302311B1 (en) | 2001-10-16 |
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