JP4468815B2 - 垂下弁を備えた外科接近装置 - Google Patents
垂下弁を備えた外科接近装置 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
- A61B17/34—Trocars; Puncturing needles
- A61B17/3498—Valves therefor, e.g. flapper valves, slide valves
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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
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3462—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3462—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals
- A61B2017/3464—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals with means acting on inner surface of valve or seal for expanding or protecting, e.g. inner pivoting fingers
Description
幾つかの既存の「浮動」装置では、「フロート」が横方向にのみ設けられていた。その結果、望ましい浮動特性は、器具が適所にあるときにのみ有効である。これにより、浮動弁は、器具の挿入時に器具に対して傷つけやすいままである。鋭い先端を有する器具は弁構造体に対して特に有害である。
腹腔鏡外科手術は進化している療法である。器具作用の顕著な変化は、現在使用されている最良のトロカール弁さえも刺激していた。従って、トロカール弁の範囲、耐久性および感度を広げる必要性が継続して残っている。
種々の実施形態では、この組立体は、弁オリフィスが器具を受入れるように適切に位置決めされるように、弁を挿入されるべき器具と整合させる。また、組立体は、器具を弁オリフィスに対するこの最適な位置に向けて部分的に整合したり或いは案内したりする。吊り下げまたはぶら下がり弁組立体は、器具の挿入角度および動作に応答する可撓性継手を介してハウジングに連結されている。その結果、弁オリフィスは、器具の挿入または操作中、著しくは刺激されない。
本発明のこれらおよび他の特徴および利点は好適な実施形態および関連図面を参照して良く理解されるであろう。
トロカールが図1Aに示され、参照番号10で示されている。このトロカール10は、ハウジング12と、端キャップ13と、カニューレ14とを有している。これらの3つの要素は、トロカールの軸線に沿って延びており、そして外科用器具21を受入れるための作用チャンネル18を画成している。器具21の不在時に、作用チャンネル18をシールし、それにより吹き込みガスの損失を防ぐためにゼロ弁23が設けられる。器具21が存在しているとき、作用チャンネル18をシールするために、隔膜弁25が器具21と共に器具シールを形成する。器具21が不在のとき、ゼロ弁23は閉弁して作用チャンネル18をシールする。
図1Aに示されるトロカール19は、隔膜弁25がハウジング12とほぼ固定された関係に保たれるという点で従来技術の代表的なものである。運悪く、この種類の構造では、器具21が軸線を外れて挿入されたり移動されたりすると、隔膜弁25が横方向に伸ばされ、そして図1Bの頂面図に示すように、キャットアイ27を形成する傾向がある。キャットアイ27は器具21のまわりに望ましくない開口部29を形成し、その結果、吹き込みガスが損失する。
それにもかかわらず、浮動構造体30の移動に対する或る程度の摩擦抵抗がある。この抵抗が解消されるまで、図2Bに示すように、隔膜弁25の或る程度の横方向伸張があり、キャットアイ27の或る程度の展開がある。この僅かなキャットアイ作用さえも解消するために、隔膜弁25のオリフィスは、これを器具21の直径より小さく形成することにより強化されることができる。もちろん、この小さい直径は、隔膜弁25と器具21との摩擦を増し、また受入れできる器具のサイズの全範囲を狭める。それにもかかわらず、図2Cに示すように軸線を外れた丸いオリフィスを達成することができる。
細長い管50はポリウレタン、天然または合成ゴムのような弾性材料、または金属またはプラスチックのような剛性材料で形成されることができる。重要なことには、この実施形態では、トロカール10の任意の他の構造への細長い管50の取付けは、モジュール40の吊下げまたはぶら下がり特性を最大にするために近位端部52のところのみに行なわれる。
軸線16と垂直な2次元平面においてのみ浮動する図2の従来技術と比較すると、モジュール40の遠位端部54は実際に3次元で浮動する。事実上、ぶら下がりモジュール40により横切られる点の軌跡が、平らな表面ではなく、むしろ球面を定める傾向がある。このぶら下がり構造では、モジュール40は揺動自在であり、横方向の移動に対してほぼゼロの抵抗をもたらす。この特性はレバーアームとして機能する管50の長さにより更に高められる。器具21を挿入すると、軸線を外れた挿入または移動により生じられるいずれの横方向の力も、レバーアームを通して端キャップ13の取付け構造に伝達されて弁56、58の横方向整合を容易にする。
隔膜弁56と器具21との低い摩擦の場合、隔膜弁57のもっと大きい直径も認められる。従来技術の密な隔膜と比較してみると、使用者は実質的に摩擦の無い器具の挿入および扱い易さを経験するであろう。
この場合、第2の管状部材の非常に可撓性のカプラ65は、ぶら下がりシールモジュール40を側方に移動させたり、曲げたり、回転させたり、さもなければ、挿入された或いは接近している器具により位置決めしたりすることができる一連の薄い渦巻状特徴を備えている。非常に可撓性のカプラ65の追加の実施例は、同じ目的を達成するために伸びたり折り曲がったりする薄い材料よりなってもよい。非常に可撓性のカプラ65の追加の実施例は同じ目的を達成するジューロメータ材料製の支持領域を有してもよい。
この場合、3つの同軸要素、すなわち、延長ボールスリーブ78、第1シール部材81および第2シール部材83は、回転ボールジョイント70と共に本発明のぶら下がりシールを構成している。
弁56のような隔膜弁の作動に関する他の態様があり、これを図15ないし図21に示してある。この態様は、器具21のような挿入された器具に対するオリフィス57のような隔膜オリフィスの関係である。この関係は、器具のサイズおよび形状の広い範囲にわたって行なうのにトロカールの弁が一般に必要とされるので、特に重要なものである。トロカール弁により、腹腔鏡外科医が、トロカール弁に起因した不当な干渉または制限なしに仕事を行なえるはずである。従って、本発明の好適な実施形態では、隔膜オリフィス57は隔膜弁56の作動を最適にするように寸法決めされ且つ形成されている。
シールモジュール40が回動されたり、浮動されたり或いは旋回されたりしても、その運動を生じるのに必要とされる力が過剰であることがあり、この場合、オリフィス57が変形し、弁56が漏れる。従って、幾つかの好適な実施形態では、オリフィス57がゆがみまたは伸びなしに挿入された器具21の動作に追従する傾向があるように、吊り下げられたモジュールすなわち垂下モジュールが、その遠位端部54のところで横方向に不拘束である構成を備えることが重要である。この有利な結果は、器具がキャットアイ作用を生じることなしに軸線47がずらされている図21および図22により明らかに示されている。
モジュール40の長さは、もちろん、トロカール10の大きさにより制限される。それにもかかわらず、弁モジュール40は、代表的には、一致より大きい、好ましくは少なくとも2の長さ対直径の比を有する。横方向の移動に対する抵抗に影響する材料の選択または他の構成要素に起因して、この比の変化が生じてもよい。
もちろん、構造体130により行なわれる案内機能は、多くの他の実施形態により達成されることができる。幾つかの例が図44ないし図50に示されている。
これらの実施形態の各々において、案内構造体130は、代表的には、広い範囲の器具の直径を受入れることができるように可撓性である。それにもかかわらず、案内構造体130は、隔膜弁56の貫通に先立って管50を移動させるために力を器具から伝達することが必要である。隔膜弁56が貫通され、且つ器具が完全に挿入されると、案内構造体130は弁のリップに対する圧力によってではないが、弁56の周囲に対する圧力によって隔膜弁56の同軸移動を容易にする。
Claims (25)
- 近位端部と遠位端部との間に延びている軸線を有し、且つ外科器具を受入れるようになっている作用チャンネルを有する外科装置であって、
作用チャンネルに沿って配置された弁ハウジングと、
弁ハウジングに配置されていて、外科器具が作用チャンネルに配置されると、外科器具に対して器具シールを形成するようになっている弁組立体と、
細長い形状を有し、弁組立体の作用チャンネルの少なくとも一部を画成する管と、
弁ハウジングと管との間に配置され、管の揺れ運動を容易にする可撓性コネクタと、
管により支持されていて、器具シールを形成するための特性を有する隔膜弁と、を備えており、
前記隔膜弁は可撓性コネクタから第1の距離のところに配置されており、この第1の距離は作用チャンネル内の外科器具の移動に応じて管および隔膜弁の移動を容易にするための第1レバーアームをなしていることを特徴とする外科装置。 - 前記弁組立体に含まれる案内構造体を更に備えており、この案内構造体は、外科器具の移動に応じて管および隔膜弁の移動を容易にする第2のレバーアームをなすように可撓性コネクタから第2の距離のところに配置されていることを特徴とする請求項1に記載の外科装置。
- 前記案内構造体は、器具と少なくとも1つの接触線を提供するように構成されており、それによって、弁組立体と器具との間の摩擦力を減少させることを特徴とする請求項2に記載の外科装置。
- 前記案内構造体は、作用チャンネルに外科器具が不在の状態で作用チャンネルをシールするための特性を有するゼロ弁を備えていることを特徴とする請求項2に記載の外科装置。
- ゼロ弁は、隔膜弁の遠位方向に配置されていることを特徴とする請求項4に記載の外科装置。
- 案内構造体は隔膜弁の剛性より大きい剛性を有していることを特徴とする請求項2に記載の外科装置。
- 案内構造体は、弁の近位方向に配置されていることを特徴とする請求項2に記載の外科装置。
- 案内構造体は、器具が作用チャンネルに挿入されると、器具に接触するために各々が管の内方に延びている複数の突起を有していることを特徴とする請求項2に記載の外科装置。
- 突起は環状体、折曲げ部、フィン、フィンガおよび葉片のうちの少なくとも1種を含むことを特徴とする請求項2に記載の外科装置。
- 前記管は直径を有しており、前記第1レバーアームは管の直径より大きい長さを有していることを特徴とする請求項1に記載の外科装置。
- 管は遠位端部および近位端部を有しており、
可撓性コネクタは、管の近位端部と弁ハウジングとの間に配置されたハウジングシールを形成することを特徴とする請求項1に記載の外科装置。 - 隔膜弁は、管の遠位端部のところに配置されていることを特徴とする請求項11に記載の外科装置。
- 可撓性コネクタは、弁ハウジングに対して管の近位端部を浮動させるための特性を有していることを特徴とする請求項1に記載の外科装置。
- 管の近位端部は、可撓性コネクタのまわりに回動可能であり、弁ハウジングに対して揺動自在であることを特徴とする請求項1に記載の外科装置。
- 管は、直径と、この直径より大きい軸方向長さとを有していることを特徴とする請求項1に記載の外科装置。
- 管は、円錐形の形状を有していることを特徴とする請求項1に記載の外科装置。
- 管は、円筒形の形状を有していることを特徴とする請求項1に記載の外科装置。
- ハウジングの諸部分がソケットを画成しており、可撓性コネクタは、ソケット内で移動可能なボールを備えていることを特徴とする請求項1に記載の外科装置。
- 可撓性コネクタは、ベローズよりなることを特徴とする請求項1に記載の外科装置。
- 前記可撓性コネクタは、器具の挿入中、器具に追従するための、および器具による弁の系に先立って弁を好適な配向へ移動させるための特性を有している支持体を備えており、
前記支持体は、近位端部および遠位端部を有する管よりなり、管の近位端部はハウジングに連結されており、管の遠位端部は弁に連結されており、前記管は、長さと、この長さより小さい直径とを有していることを特徴とする請求項1に記載の外科装置。 - 前記支持体の少なくとも一部が、ハウジングに対して移動可能であることを特徴とする請求項20に記載の外科装置。
- 前記支持体は、ハウジングと回動関係を有していることを特徴とする請求項21に記載の外科装置。
- 前記支持体は、ハウジングと摺動可能な関係を有していることを特徴とする請求項21に記載の外科装置。
- 弁は管と一体であることを特徴とする請求項1に記載の外科装置。
- 作用チャンネルに沿って器具を受入れるようになっているトロカールであって、
近位端部と遠位端部との間に延びている軸線を有するカニューレと、
請求項1乃至24のいずれか1項に記載の外科装置と、を備えており、
前記弁ハウジングは、近位端部と、遠位端部とを有しており、前記弁ハウジングの遠位端部は、カニューレの近位端部に連結されていることを特徴とするトロカール。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US10/264,550 US7083626B2 (en) | 2002-10-04 | 2002-10-04 | Surgical access device with pendent valve |
PCT/US2003/029442 WO2004033004A1 (en) | 2002-10-04 | 2003-09-16 | Surgical access device with pendent valve |
Publications (3)
Publication Number | Publication Date |
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JP2006501943A JP2006501943A (ja) | 2006-01-19 |
JP2006501943A5 JP2006501943A5 (ja) | 2006-10-19 |
JP4468815B2 true JP4468815B2 (ja) | 2010-05-26 |
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JP2004543317A Expired - Lifetime JP4468815B2 (ja) | 2002-10-04 | 2003-09-16 | 垂下弁を備えた外科接近装置 |
Country Status (5)
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US (5) | US7083626B2 (ja) |
EP (3) | EP3002018B1 (ja) |
JP (1) | JP4468815B2 (ja) |
CA (1) | CA2499085A1 (ja) |
WO (1) | WO2004033004A1 (ja) |
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US8574146B2 (en) * | 2000-04-14 | 2013-11-05 | Attenuex Technologies, Inc. | Implant with high vapor pressure medium |
US10327880B2 (en) | 2000-04-14 | 2019-06-25 | Attenuex Technologies, Inc. | Attenuation device for use in an anatomical structure |
US6682473B1 (en) | 2000-04-14 | 2004-01-27 | Solace Therapeutics, Inc. | Devices and methods for attenuation of pressure waves in the body |
WO2002034108A2 (en) | 2000-10-19 | 2002-05-02 | Applied Medical Resources Corporation | Surgical access apparatus and method |
EP2422829B1 (en) | 2001-08-14 | 2013-03-06 | Applied Medical Resources Corporation | Surgical access sealing apparatus |
US6958037B2 (en) | 2001-10-20 | 2005-10-25 | Applied Medical Resources Corporation | Wound retraction apparatus and method |
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2003
- 2003-09-16 EP EP15193919.6A patent/EP3002018B1/en not_active Expired - Lifetime
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- 2003-09-16 EP EP11181291.3A patent/EP2397085B1/en not_active Expired - Lifetime
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- 2003-09-16 JP JP2004543317A patent/JP4468815B2/ja not_active Expired - Lifetime
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EP1545660B1 (en) | 2012-11-07 |
US8118785B2 (en) | 2012-02-21 |
WO2004033004A1 (en) | 2004-04-22 |
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US7771395B2 (en) | 2010-08-10 |
JP2006501943A (ja) | 2006-01-19 |
US8613727B2 (en) | 2013-12-24 |
US20060229637A1 (en) | 2006-10-12 |
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