JP3631251B2 - 糸切断用装置 - Google Patents
糸切断用装置 Download PDFInfo
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- JP3631251B2 JP3631251B2 JP52449995A JP52449995A JP3631251B2 JP 3631251 B2 JP3631251 B2 JP 3631251B2 JP 52449995 A JP52449995 A JP 52449995A JP 52449995 A JP52449995 A JP 52449995A JP 3631251 B2 JP3631251 B2 JP 3631251B2
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- cutting
- cutting device
- endoscope
- suture
- yarn
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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
- A61B17/04—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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0467—Instruments for cutting sutures
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- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
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- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
- Materials For Medical Uses (AREA)
- Endoscopes (AREA)
Description
公知の外科手術において、例えば縫い合わせを形成するために用いられる縫合糸は通常、鋏を使用して切断される。しかしながら、このような選択は、たわみ内視鏡に沿って手術を行う者には利用されないであろう。このような手術においては、使用される器具は、内視鏡の末端部に配置されるとともに、通常、内視鏡内部のチャンネル(channel)に沿って延びる操作手段によって遠隔操作されなければならない。このような方法で公知の鋏を遠隔操作することは、少なくとも困難であり、おそらく不可能であろう。切除器具を使用することも知られているが、内視鏡的使用のために十分な切除器具の存在は、一般に認められていない。
本発明は、内視鏡を使用して外科用縫合糸を切断するための糸切断用装置において、前記外科用縫合糸を摺動自在に挿通させるのに十分な寸法の少なくとも一つの貫通孔を有する切断部材と、この切断部材を内視鏡の末端部に配置可能とするための配置手段と、を備え、前記切断部材の貫通孔は糸切断用切刃を有し、前記配置手段は、一端が前記切断部材に連結され他端が使用者の操作用の取付部材に連結された延長部材を有し、これにより使用者が前記切断部材を内視鏡に対して移動させながら縫合糸の尾部を引っ張って張力を生じさせることで前記縫合糸の切断を行うように構成されているものである。
ここで、添付図面の図1乃至図4を参照して、本発明の一実施形態について更に詳細に説明する。これらの図面は、この実施形態の使用の連続した段階を示すものである。
図1は、他の図面と同様、本発明による縫合糸切断装置が挿通可能な生検チャンネル(biopsy channel)2を有する内視鏡1の末端部を示している。実際には、もちろん、内視鏡は他にも、例えば観察チャンネル(viewing channel)のような種々の特徴部分を有しているであろうが、これらは図示されておらず、公知のものであると仮定されている。
本発明による糸切断用装置は、柔軟なワイヤ4の末端に取り付けられた切断部材3を備えている。例示すれば、ワイヤ4は、外科手術に使用可能な鉄鋼製の1mmワイヤである。他の実施形態においては、このワイヤ4がボーデン式ケーブル(Bowden cable)に置き換えられる。このワイヤ4の先端は、取付け部材5内に固着されている。この取付け部材5は、糸切断装置を使用する際に外科医によって把持されるのに十分な寸法と形状とを有している。ワイヤ4は、プラスチック管6によって覆われている。このプラスチック管6は、切断部材3にも、取付部材5にも連結されておらず、その内部をワイヤ4が摺動自在となっている。この管6は、好ましくは四フッ化エチレン樹脂か、その他の低摩擦材料で作られ、切断部材とそのワイヤが容易にチャンネル2に沿って通ったり、引き出されたりできるよう配慮されている。実際には内視鏡1は、患者の内部にある場合に多くの屈曲部を有するであろうから、これらの屈曲部の存在にかかわらず、切断部とそのワイヤとがチャンネル2に沿って自由に動けるよう考慮する必要がある。
切断部材3は、その前端面8から側面9まで延びる2つの貫通孔7を有している。切断部3は、好ましくは円柱形状を有し、貫通孔7は、好ましくは横断面において円形をなしている。貫通孔7は、外科用縫合糸を摺動自在に挿通させられるような寸法を有していなければならず、直径0.6mmの貫通孔を用いるのが適していると確認されている。貫通孔7が上記側壁9を貫通して開口する部分において、貫通孔7の円形横断面によって楕円形状の開口が形成されることになる。各楕円開口の湾曲した端部は、後述するような縫合糸切断のためのアーチ状に曲がった切刃(arcuately curved cutting edge)を有している。
図面は、本発明による切断装置の使用例を示している。この使用例においては、外科医が外科用縫合糸10を、U字型の患者組織片11に通し、そこに結び目12を結んでいる。このような処置をなすことにより、患者の体内通路を通って身体開口部から延出する2つの縫合糸尾部13が残る。例えば、縫合糸が患者の胃の内層に挿入されていた場合は、縫合糸の端部が患者の食道を通って口から延出することになる。
そして、糸切断用装置は内視鏡内に挿入され、このことにより、切断部材3が内視鏡の末端部外方に配置されるとともに、取付け部材5が内視鏡の先端部外方に配置される。そして縫合糸尾部13は、各々貫通孔7の一つに通され、縫合糸切断装置の入った内視鏡が患者の口から挿入される。この挿入は、切断部材3が上記結び目12に隣接するまで継続されるが、その事実は内視鏡の内視チャンネルを通して確認することができる。このような挿入の過程において、縫合糸尾部13は、それらの自由端部が常に患者の口から延出した状態のまま、貫通孔7内を摺動する。以上のようにして、図1に示す状態に到達することになる。
次に、外科医は、図2において各々矢印で示すように、切断部材3を結び目12から遠ざけるとともに、内視鏡1を結び目12に近づけながら、縫合糸尾部13を引っ張って張力を生じさせる。このことにより、縫合糸尾部13が上記曲がった切刃に対して押し付けられることになる。この切刃は、上述したように、貫通孔7の末端部に形成されている。これらの切刃が曲がっているという事実は、縫合糸が切刃の長さ方向に対してほぼ中心部に保持される傾向にあることを意味する。もし、切刃の形成される開口部が例えば長方形であって、切刃が真っ直ぐであるとすれば、縫合糸尾部13は、切刃の一端側や他端側へ滑って、効果的な切断動作が妨げられてしまうであろう。
図3に示すように、上述したような手順によって、縫合糸尾部13は切断され、患者の口から取り出される。そして、最終的な結果が、図4に図示されている。
Claims (8)
- 内視鏡を使用して外科用縫合糸を切断するための糸切断用装置において、
前記外科用縫合糸を摺動自在に挿通させるのに十分な寸法の少なくとも一つの貫通孔を有する切断部材と、
この切断部材を内視鏡の末端部に配置可能とするための配置手段と、
を備え、
前記切断部材の貫通孔は糸切断切刃を有し、
前記配置手段は、一端が前記切断部材に連結され他端が使用者の操作用の取付部材に連結された延長部材を有し、これにより使用者が前記切断部材を内視鏡に対して移動させながら縫合糸の尾部を引っ張って張力を生じさせることで前記縫合糸の切断を行うように構成されている、糸切断用装置。 - 前記糸切断切刃はアーチ形状である、請求項1記載の糸切断用装置。
- 前記貫通孔は、前記切断部材の湾曲した表面と交わることにより、前記糸切断切刃を形成する、請求項2記載の糸切断用装置。
- 前記切断部材は、円柱形状をなすとともに、その前端面から円筒状表面までを貫通して延びる前記貫通孔を少なくとも一つ有する、請求項3記載の糸切断用装置。
- 一対の前記貫通孔が設けられた、請求項4記載の糸切断用装置。
- 前記一対の貫通孔は、互いに直径方向に向かい合っている、請求項5記載の糸切断用装置。
- 前記延長部材は、鞘によって覆われるとともに、この鞘の中で摺動自在となっており、
前記鞘は、前記切断部材にも、前記取付部材にも連結されていない、請求項1乃至6のいずれかに記載の糸切断用装置。 - 内視鏡に取付けられる、請求項1乃至7のいずれかに記載の糸切断用装置。
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
GB9405791A GB9405791D0 (en) | 1994-03-23 | 1994-03-23 | Device for use in cutting threads |
GB9405791.6 | 1994-03-23 | ||
PCT/GB1995/000653 WO1995025470A1 (en) | 1994-03-23 | 1995-03-23 | Device for use in cutting threads |
Publications (2)
Publication Number | Publication Date |
---|---|
JPH09510382A JPH09510382A (ja) | 1997-10-21 |
JP3631251B2 true JP3631251B2 (ja) | 2005-03-23 |
Family
ID=10752393
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP52449995A Expired - Fee Related JP3631251B2 (ja) | 1994-03-23 | 1995-03-23 | 糸切断用装置 |
Country Status (7)
Country | Link |
---|---|
US (1) | US5755730A (ja) |
EP (1) | EP0751747B1 (ja) |
JP (1) | JP3631251B2 (ja) |
AU (1) | AU3245895A (ja) |
DE (1) | DE69509642T2 (ja) |
GB (1) | GB9405791D0 (ja) |
WO (1) | WO1995025470A1 (ja) |
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-
1994
- 1994-03-23 GB GB9405791A patent/GB9405791D0/en active Pending
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1995
- 1995-03-23 EP EP95912340A patent/EP0751747B1/en not_active Expired - Lifetime
- 1995-03-23 US US08/714,103 patent/US5755730A/en not_active Expired - Lifetime
- 1995-03-23 DE DE69509642T patent/DE69509642T2/de not_active Expired - Lifetime
- 1995-03-23 WO PCT/GB1995/000653 patent/WO1995025470A1/en active IP Right Grant
- 1995-03-23 JP JP52449995A patent/JP3631251B2/ja not_active Expired - Fee Related
- 1995-03-23 AU AU32458/95A patent/AU3245895A/en not_active Abandoned
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WO1995025470A1 (en) | 1995-09-28 |
AU3245895A (en) | 1995-10-09 |
US5755730A (en) | 1998-05-26 |
JPH09510382A (ja) | 1997-10-21 |
GB9405791D0 (en) | 1994-05-11 |
EP0751747B1 (en) | 1999-05-12 |
EP0751747A1 (en) | 1997-01-08 |
DE69509642D1 (de) | 1999-06-17 |
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