JP4463560B2 - 管状組織の内部結紮のための装置 - Google Patents
管状組織の内部結紮のための装置 Download PDFInfo
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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
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
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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
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
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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
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
- A61B17/12013—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot 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
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12022—Occluding by internal devices, e.g. balloons or releasable wires
- A61B17/12131—Occluding by internal devices, e.g. balloons or releasable wires characterised by the type of occluding device
- A61B17/12136—Balloons
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F6/00—Contraceptive devices; Pessaries; Applicators therefor
- A61F6/20—Vas deferens occluders; Fallopian occluders
- A61F6/202—Means specially adapted for ligaturing, compressing or clamping of oviduct or vas deferens
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F6/00—Contraceptive devices; Pessaries; Applicators therefor
- A61F6/20—Vas deferens occluders; Fallopian occluders
- A61F6/208—Implements for ligaturing
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F6/00—Contraceptive devices; Pessaries; Applicators therefor
- A61F6/20—Vas deferens occluders; Fallopian occluders
- A61F6/22—Vas deferens occluders; Fallopian occluders implantable in tubes
- A61F6/225—Vas deferens occluders; Fallopian occluders implantable in tubes transcervical
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/22031—Gripping instruments, e.g. forceps, for removing or smashing calculi
- A61B17/22032—Gripping instruments, e.g. forceps, for removing or smashing calculi having inflatable gripping elements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/30—Surgical pincettes without pivotal connections
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
- A61B18/082—Probes or electrodes therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
- A61B2017/00557—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
- A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
- A61B2017/12018—Elastic band ligators
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
- A61B2017/2215—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions having an open distal end
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/30—Surgical pincettes without pivotal connections
- A61B2017/303—Surgical pincettes without pivotal connections with four or more legs
Description
されている。近位端22はアクセスポート37を含むことができ、アクセスポート37は、麻酔薬、抗生物質または他の物質を、卵管の結紮部付近に注入するために管状要素21に注入することを可能にする。
ネルを有する装置の具体例も本発明の範囲内にあるとみなされる。同様に、バルーン51に取り付けられたバーブ54a,54b,54cなどの数も変更され得る。
ヤ100はその初期位置に戻る。
図7および8の特徴は、装置の設計における別の変型も示す。2つ以上の結紮バンドが管状要素21の遠位端23にてリップ40上に、または他の何らかのやり方で保持され得る。図7および8には2つの結紮バンド41aおよび41bが示されているが、これより多数の結紮バンドも用いられ得る。以下に記載するように、2つの結紮バンド41aおよび41bを設けることにより、2つの結紮を卵管内に形成して、管のより確実な閉塞をもたらすことが可能である。結紮バンド41aおよび41bを連続して解放するためには、プッシャバルーン42(図7)またはプッシャディスク48(図8)が、リップ40から結紮バンド41aを押し出すのに十分な第1の距離だけ伸展されなければならず、次いで、結紮バンド41bをリップ40から押し出すのに十分な第2の距離だけ伸展されなければならない。プッシャバルーン42は第1の容積まで伸張され、次いで、第2の、より大きい容積まで、2つの結紮バンドを連続して押し出すために伸張される。同様に、プッシャディスク48は、結紮バンド41aと41bを連続して解放するのに十分な2つの異なる位置まで伸展される。2つの結紮バンドを用いて2つの卵管の結紮を同じ装置により連続して行うことも可能であろうが、これは好ましくない。なぜなら、装置を1つの卵管から引き出し、その後装置を第2の卵管に再び挿入することが、装置の汚染、および、子宮または第2の卵管に汚染物または感染因子を導くこときっかけをもたらすからである。
は薬剤配送管腔として機能し得る。あるいは、1以上の薬剤配送管腔を管状要素21の壁部に、図5に示されたチャネル46aおよび46と同様に設け得る。さらに別の手段として、薬剤配送管腔を、第2の管状要素を追加することにより設けることができ、この第2の管状要素は管状要素21を取り囲み、かつ管状要素21と同軸状であり、これにより薬剤配送管腔を管状要素21と第2管状要素の間に形成する。薬剤は、図1に示されているように、薬剤配送管腔に連結され得るアクセスポート37を介して薬剤配送管腔に注入され得る。
押し込まれ、卵管壁39を把持し、または卵管壁39と係合する。もちろん、組織の把持は、別のグラスパ機構、例えば、図6.5,6.6,7および8に示されたようなグラスパ機構を用いて行われることもできる。
1結紮と第2結紮の間にあり、内腔73は、子宮により近い側の最も近位に位置する。工程6〜8が、複数の結紮バンドを1つの卵管に取り付けるために必要な回数だけ繰り返され得る。しかし、確実な結紮は1〜3個の結紮バンドにより形成され、それより多数の結紮バンドは必要なく、または望ましくないであろうことが予測される。
基づいて選択される接着剤である。幾つかのシアノアクリレート化合物が人体への使用に承認されているが、Trufill(商標)(コーディス・ニューロバスキュラー(Cordis Neurovascular)社)が、現在、体内(非皮相)での使用に承認されている。この接着剤の使用に関しては副作用をなくすことが望ましいため、装置200はTrufill接着剤の使用に限定されない。
4〜5cm)であり、この領域にて卵管の内径が約2mmから約5mmに突然増大する。卵管膨大部における、内径に対する壁厚の比により、この領域が陥入に適した第1の範囲である。カテーテル204の先端214は、卵管膨大部に配置された後、卵管の内径に近い5mmに膨張される。次いで、装置200を、膨張された先端214に対する抵抗がさらなる引き戻しを妨げるまで引き戻す(近位方向に)。この手順は、膨大部-峡部接合部
に適切に配置することを保証する。図18は、バルーン210の膨張により接着剤を、バルーン210と管230の内面232の間に接触させて配置する様子を示す。バルーン210は、望ましくは、ホルマリン溶液、例えば10%ホルマリン溶液により膨張される。さらに、伸張可能な先端214が、図17および18に、複数の脚235を有して示されており、各脚235は、管に挿入されるための、実質的に潰された、または縮められた位置にある。
織を焼灼し、かつ、可能であればバルーン210をカテーテル202から分離することを補助するための電源を設けることも本発明の範囲内にある。あるいは、カテーテル202は、カテーテル202に所与の量の張力を加えたときに既知の弱い連結部にて優先的に分離するように連結され得る。
の範囲から逸脱せずに行われ得る。また、1つの特定の実施形態による特徴および要素が、別の実施形態にも同様に、本文にて規定される本発明の範囲から逸脱せずに適用され得る。
Claims (11)
- 管状組織の第1の管状部分をめくり返して組織束を形成し、かつ、少なくとも1つの結紮構造物を前記組織束に取り付けるための装置であって、
遠位端、近位端、および、これらの端部間の管腔を含む長尺状導管であって、前記遠位端が前記管状組織に挿入されるように適合されている長尺状導管と、
長尺状部材の遠位端にて支持されたグラスパであって、前記長尺状部材が前記管腔内にスライド可能に配置され、前記グラスパが前記導管から遠位方向に伸展可能であり、該グラスパが径方向に拡張した位置にある場合に前記管状組織の内側の把持される組織を把持し、かつ、前記把持された組織と共に近位方向に引き込まれることができるグラスパと、
前記グラスパが前記第1管状部分をめくり返すことを補助し、これにより該管状組織を通過する通路を閉塞するように構成および配置された第1管状部分の周囲をめくり返すべく折り曲げる折曲げ機構と、
前記装置の遠位端付近に解放可能に支持された結紮構造物と、
前記導管の前記遠位端付近に配置され、かつ、前記結紮構造物を前記組織束に取り付けるように適合された取付け構造物とを含む装置。 - 前記グラスパが、バルーン構造物を含み、同バルーン構造物は前記折曲げ機構より遠位側にて膨張するように配置されることができる請求項1に記載の装置。
- 前記グラスパが、さらに接着物質を含み、接着物質が前記バルーンの膨張により解放されて、前記バルーンと前記把持された組織との間に接着層を形成する請求項2に記載の装置。
- 前記バルーンが、外壁および内壁を有する二重壁の膨張構造物を含み、前記外壁と内壁の間に接着物質が配置され、前記膨張構造物の前記外壁が、前記バルーンの膨張時に伸張可能な孔を有して、前記接着物質が前記伸張された孔を通過することを可能にしている請求項3に記載の装置。
- 前記折曲げ機構が、膝を有する脚を含み、前記脚が、前記管状組織の第1の断面を、前記管状組織の、前記グラスパが把持している位置の第2の断面の直径よりも大きい直径に伸張させるための半径方向移動に適合されており、これにより前記脚が、前記グラスパが前記折曲げ機構に対して近位方向に引き込まれるときに前記管状組織に周方向の折曲げを形成することを補助する請求項1に記載の装置。
- 前記脚が、前記膝より遠位の脛部と、前記膝より近位の腿部を含む請求項5に記載の装置。
- 前記脛部と前記腿部とがほぼ同じ長さである請求項6に記載の装置。
- 前記脛部が、前記腿部の長さよりも短い長さを有し、これにより、前記グラスパが把持係合位置から折曲げ位置に近位方向に移動されるときに、前記膝の第1の半径方向外側への変位、および、前記膝の第2の半径方向内側への移動を生じさせる請求項6に記載の装置。
- 各々が膝を有する複数のトグル脚を含み、前記脚が、中心線の周囲に間隔をあけて配置された複数の膝をもたらすように配置され、かつ、前記第1断面を伸張させるために前記複数の膝の共通する径方向の移動と協調するように配置されている請求項5に記載の装置。
- 前記取付け構造物が前記導管の前記遠位端の一部を含む請求項1に記載の装置。
- 前記結紮構造物が弾性のOリングを含む請求項1に記載の装置。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US10/079,015 US6736822B2 (en) | 2002-02-20 | 2002-02-20 | Device and method for internal ligation of tubular structures |
PCT/US2003/005019 WO2003070085A2 (en) | 2002-02-20 | 2003-02-20 | Device and method for internal ligation of tubular structures |
Publications (2)
Publication Number | Publication Date |
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JP2005517481A JP2005517481A (ja) | 2005-06-16 |
JP4463560B2 true JP4463560B2 (ja) | 2010-05-19 |
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Application Number | Title | Priority Date | Filing Date |
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JP2003569051A Expired - Fee Related JP4463560B2 (ja) | 2002-02-20 | 2003-02-20 | 管状組織の内部結紮のための装置 |
Country Status (12)
Country | Link |
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US (2) | US6736822B2 (ja) |
EP (1) | EP1482843A4 (ja) |
JP (1) | JP4463560B2 (ja) |
CN (1) | CN100462057C (ja) |
AP (1) | AP2004003114A0 (ja) |
AU (1) | AU2003215317A1 (ja) |
BR (1) | BR0307838A (ja) |
CA (1) | CA2476817A1 (ja) |
EA (1) | EA200401017A1 (ja) |
MX (1) | MXPA04008121A (ja) |
WO (1) | WO2003070085A2 (ja) |
ZA (1) | ZA200406627B (ja) |
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US9579091B2 (en) | 2000-01-05 | 2017-02-28 | Integrated Vascular Systems, Inc. | Closure system and methods of use |
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US6896682B1 (en) * | 2000-11-14 | 2005-05-24 | Biomedical Engineering Solutions, Inc. | Method and system for internal ligation of tubular structures |
US6623510B2 (en) | 2000-12-07 | 2003-09-23 | Integrated Vascular Systems, Inc. | Closure device and methods for making and using them |
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US8690910B2 (en) | 2000-12-07 | 2014-04-08 | Integrated Vascular Systems, Inc. | Closure device and methods for making and using them |
US6558400B2 (en) | 2001-05-30 | 2003-05-06 | Satiety, Inc. | Obesity treatment tools and methods |
US7083629B2 (en) * | 2001-05-30 | 2006-08-01 | Satiety, Inc. | Overtube apparatus for insertion into a body |
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-
2002
- 2002-02-20 US US10/079,015 patent/US6736822B2/en not_active Expired - Fee Related
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2003
- 2003-02-20 WO PCT/US2003/005019 patent/WO2003070085A2/en active Application Filing
- 2003-02-20 EA EA200401017A patent/EA200401017A1/ru unknown
- 2003-02-20 EP EP03711137A patent/EP1482843A4/en not_active Withdrawn
- 2003-02-20 CA CA002476817A patent/CA2476817A1/en not_active Abandoned
- 2003-02-20 AU AU2003215317A patent/AU2003215317A1/en not_active Abandoned
- 2003-02-20 JP JP2003569051A patent/JP4463560B2/ja not_active Expired - Fee Related
- 2003-02-20 CN CNB038042029A patent/CN100462057C/zh not_active Expired - Fee Related
- 2003-02-20 BR BR0307838-8A patent/BR0307838A/pt not_active IP Right Cessation
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BR0307838A (pt) | 2005-10-25 |
US20040215215A1 (en) | 2004-10-28 |
EP1482843A2 (en) | 2004-12-08 |
EA200401017A1 (ru) | 2005-12-29 |
ZA200406627B (en) | 2006-06-28 |
US6736822B2 (en) | 2004-05-18 |
WO2003070085A9 (en) | 2004-06-24 |
CA2476817A1 (en) | 2003-08-28 |
AP2004003114A0 (en) | 2004-09-30 |
WO2003070085A3 (en) | 2004-05-21 |
CN1635854A (zh) | 2005-07-06 |
AU2003215317A1 (en) | 2003-09-09 |
MXPA04008121A (es) | 2005-09-08 |
US20030158563A1 (en) | 2003-08-21 |
CN100462057C (zh) | 2009-02-18 |
WO2003070085A2 (en) | 2003-08-28 |
EP1482843A4 (en) | 2011-01-12 |
JP2005517481A (ja) | 2005-06-16 |
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