JP4485730B2 - 吻合、ステープル吻合及び切除器具用の流体搬送機構 - Google Patents
吻合、ステープル吻合及び切除器具用の流体搬送機構 Download PDFInfo
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
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Description
発明の属する技術分野
本発明は、吻合、ステープル吻合及び切除の外科器具を用いた流体搬送機構に一般に関し、とりわけ、上記器具が切除された大腸のステープル吻合部位及び切断部位にフィブリンをそれによって搬送しうるフィブリン注入機構に関する。
【0002】
従来の技術
胃腸管内の癌性又は他の異常な組織を識別する時に外科治療がしばしば処方されている。癌の手術の分野、とりわけ、癌性又は他の異常な組織を含む胃腸管の部分を切除する外科処置の分野には、多数の独自に形成された器具が含まれている。本器具とそれらの機能についての記載と組み合わせて、外科手術における当業界の状態について記載する。
【0003】
胃腸管の癌を治療する方法を決定する時に答えなければならない第一の問題は、癌性の組織の特定の位置に関する。これは、当業界において設けられている器具は、器具が胃腸管内に挿入する距離に関して制限があるので、非常に重要である。もし癌性の組織が例えば大腸の上であるならば、与えられた標準の器具を使用することができず、特定の設備が必要となる。これらの設備を用いると、腸管の中身で周囲の組織を汚染する可能性を一般に増し、また、手術の長さを増し、これに伴って麻酔が必要となり、機械化された装置によって得られる正確な吻合及びステープル吻合の利益がなくなってしまう。
【0004】
とりわけ、癌性組織が機器の到達可能な大腸内の位置にある時、患者の腹部が最初に開かれて腸管が露出する。外科医は、癌性の組織の両側において大腸の管を切断するリニアカッタ及びステープル吻合装置を利用し、それにより、腸管の二つのステープル吻合された端部(肛門に向けられている遠端と、小腸に最も近い近端)を形成する。これは、一時的に汚染を最小化するためになされる。
【0005】
とりわけ、図1を参照すると、リニアステープル吻合器具5の端部において、腸管が切り抜き要素1、2の間に位置する。外科医は、装置のハンドル4内でトリガ3を搾ることによって、切り抜き要素1、2を一緒にする。大腸の締め付けられた端部を通して一連のステープル6を駆動するように第二のトリガ(又は、同じトリガの第二の動作)が作動され、それにより、端部を閉鎖及び離断する。
【0006】
外科医は、近端部を部分的に開放し、吻合及びステープル吻合器具の取外し可能なアンビル部を露出した近端部内に挿入する。この段階は、外科処置の残りの段階と同様に、外科器具の機能に関連している。とりわけ、図2に関して、外科医は、器具7を取ることによって始め、ハンドル9の基部にあるダイヤル8を手動で回転させ、それにより、反対の端部にあるアンビルヘッド10を前進させる。外科医は、アンビルヘッド10がその最も極端に延伸した位置に前進するまで、ダイヤル8を回転させ続ける。この手動の回転は、ほぼ30回の360度回転を必要とする。一旦完全に延伸すると、器具のアンビルヘッドが器具7から取り外され、連結ポストが近端の部分的な開口部内に挿入され、この開口部を通して外方向に延びている。この近端の部分的な開口は縫合して閉鎖される。その連結ステム12がステープル吻合された遠端を貫通するまで、吻合及びステープル吻合器具7の延伸軸11は肛門を通って下側の大腸内に挿入されて前進させられる。次いで、外科医は、アンビルの連結端部と軸を共に接合し、再びハンドル内のダイヤルを手動で回転し始め、この時、アンビルヘッドを軸の端部13のより近くにもたらす。
【0007】
一旦、アンビルヘッド及び軸が共に近くにもたらされると、外科医がさらに30回手動でダイヤルを回転させた後、ハンドル内のグリップスタイルのトリガ14が手動で作動させられる。この作動により、円形のブレード15が軸の先端から半径外方向に前進し、アンビル10の対向面16と接触するようになる。ブレードは、大腸のステープルで閉鎖された近端及び遠端を通して切断し、それにより、大腸の新しい一対の近端及び遠端を接続する。切断された組織は、軸の端部において内部容積部に保持されている。
【0008】
切断を行う固定段階において、新たに開放された端部が一連のステープル17によって接合される。ステープル17は、軸の先端の周辺部における穴を通して前進させられる(軸はアンビルの対向面に押圧されかつ軸によって閉鎖されている)。連結された軸及びアンビルは患者から引かれる。
【0009】
前述の全ての装置は、従来技術の多くの装置と同様に、完全に使い捨てとみなされており、一回の使用の後に実際に捨てられる。これら装置は、多数の可動部を有する複雑な装置であり、実質的な構造的一体性、それゆえ製造費用を必要とする。これら装置が一度だけ使用され、いずれの部分も二度と使用することができないという事実により、この装置の使用は高価で資源の無駄となる。
【0010】
この欠陥に加え、以前の記載から容易に認めることができるように、従来技術の装置は、克服することが望ましい多数の他の制限を備えている。これらの制限には、(吻合及びステープル吻合器具のダイヤル及びトリガの機能と、切断及びステープル吻合器具の多数のトリガの機能とを含む)多数の異なる機能を外科医が手動で作動しなければならない要件が含まれている。
【0011】
別の欠陥は、従来技術の装置が新たに切断された組織の部位へ流体を搬送しうる手段を提供できないということである。治癒処置を促進する薬又は他の物質が、ステープル吻合及び切断処理と同時に又は後に部位へ搬送させられるならば、組織の治癒又は他の医療任務を迅速に行うことができる。このような物質はフィブリンであり、結合組織の主な蛋白質成分であり、特に、二つの以前の別組織を接合する時に傷跡を形成する処理などの組織修繕処理の基本的な要素として機能する。それゆえ、新たにステープル吻合されて切断された組織の部位にこのような物質を注入する能力は、物質を搬送することができない従来技術の装置に対して利点がある。
【0012】
それゆえ、本発明の主な目的は、目標組織のステープル吻合及び切断部位に薬搬送を行うことができる薬搬送機構を提供することである。
【0013】
さらに、本発明の主な目的は、薬搬送機構の部分を再使用することができることにより資源の無駄を減じる、切断、吻合及びステープル吻合用器具と一体の形態の薬搬送機構を提供することである。
【0014】
さらに、本発明の目的は、外科医が異なる構成要素及び機構を手動で作動する要求を減じる薬搬送機構を提供することである。
【0015】
本発明の他の目的は、以下に付与した記載、図面と関連して好適な実施例の詳細な記載によって認識することができる。
【0016】
発明の概要
本発明の前述の目的は、電子機械ドライバ組立体に連結された、吻合及びステープル吻合アタッチメントと一体である薬搬送機構によって与えられる。
【0017】
ハンドル150と柔軟な駆動軸155とを有する電子機械ドライバ組立体が図3に示されている。ハンドル150は、一つ以上好ましくは二つのフィンガトリガ160を有するピストルグリップスタイル形状を有する。フィンガトリガ160は、(以下、より十分に記載される)別個の柔軟な駆動軸170を各々が回転させる少なくとも一つの好ましくは二つの別個のモータ165に独立に連結されている。モータ165は、各々二方向モータであり、ハンドルの頂部の手動駆動スイッチ172に連結されている。使用者は、このスイッチによって各モータの回転方向を選択的に変更しすることができる。この二方向の出力は、電流方向に対応する方向に回転するモータを選択することによって最も簡単に実現することができる。駆動スイッチの作動は、この出力に応じて電流方向を変更する。この例では、モータに供給する電源175は、バッテリーパック(及び、最も望ましくは、充電式のバッテリーパック)などの直流電源でなければならない。装置が交流で使用可能でなければならない場合には、変圧器を備えることができ、より高性能な中間歯車組立体を設けることができる。この記載と関連して、記載した本発明の実施例は、直流を提供する充電式バッテリーパックを採用している。
【0018】
モータ構成要素に加え、ハンドルは、リモート式状態インジケータ180と、軸操縦185と、オンオフスイッチ(図示せず)とを有するいくつかの他の特徴をさらに有する。最初に、リモート式状態インジケータは、LCD(又は同様な読出し装置)を備えうる。使用者は、このインジケータによって、構成要素の位置(例えば、ステープルを駆動する前に締め付け要素が適切な位置にあるか否か)を知ることができる。次に、ハンドルは、(以下により十分に記載する軸部に移植されるガイドワイヤによって)柔軟な軸の運動を指向するために、例えば、ジョイスティック又はトラックボールなどの、手動で作動可能な操縦手段を有する。最後に、ハンドルは、さらなる電源と、電力をアタッチメントに選択的に供給するためのオンオフスイッチとを有しうる。
【0019】
とりわけ、柔軟な軸に関しては、軸は、好ましくは、組織と両立可能でありかつ殺菌可能な(すなわち、オートクレーブに耐えるように十分に凹凸がある)簡単なエラストマー材料で形成された管状シース195を備えている。種々の長さの軸を設けることができる。柔軟な軸とハンドル部は分離可能としうる。もし分離可能であるならば、軸の近端とハンドルの遠端の間の界面は、駆動構成要素用の連結手段を備えている。
【0020】
特に、軸の駆動構成要素に関しては、管内で回転しうる柔軟な駆動軸220をそれぞれが有する一対の比較的に小さな固定管215がエラストマーシース内にある。柔軟な駆動軸自体は、ハンドル内のモータから軸の遠端へトルクを伝達するが、患者の大腸を通して「曲がりくねる」必要があると外科医がみなす時に、曲げる、角度を付ける、湾曲するのに十分に柔軟である。しかしながら、本明細書で説明する吻合及びステープル吻合アタッチメントなどのアタッチメントと駆動軸の遠端を連結するために、駆動軸の遠端は、連続的にトルクを伝達できる構造を有しなければならない。例えば、駆動軸の遠端200を六角形とすることができ、それにより、アタッチメントの連結界面の六角形凹所内に嵌め込む。適切なトルクをアタッチメントに与えることを保証するように、適切な歯車機構を軸の遠端又はアタッチメントの界面部分に設けることができる。
【0021】
以前に提案したように、ハンドルに取り付けられた手動で作動可能な操縦手段と関連して、シースは、柔軟であるがその遠端近傍においてシースの内面に連結された少なくとも二つのガイドワイヤ205をさらに有する。ガイドワイヤは、操縦手段の動作によって別のガイドワイヤに関して軸線方向に移動することができ、それに応じてこの動作によりシースを曲げ及び湾曲する。
【0022】
また、以前に提案したように、ハンドルのLCDインジケータと関連して、軸は電気的な導線210をさらに収納する。この電気的導線は、アタッチメントの状態について示す(例えば、アンビル部がSBR部に極めて近接しているか否かについて示し、外科医がステープル吻合するのに安全であることを知る)ために、アタッチメントからハンドルへ信号を伝える。同様に、必要ならば別の態様のアタッチメントへ電力を供給するために第二の電気的導線を設けることができる。
【0023】
前述のように、本発明は、電子機械装置ドライバ用の吻合及びステープル吻合アタッチメントと一体に形成されている。このような吻合及びステープル吻合アタッチメントは、アンビル部と、ステープル、ブレード及び貯蔵部(SBR部)とを備え、SBR部は、前述の軸要素の駆動構成要素に連結可能である一対の回転駆動軸と、回転駆動軸に取り付けられた対応する対の前進及び後退ナットとを有するが、回転及びそれゆえ駆動軸の回転時の駆動軸に沿った線形的な前進及び後退が防がれる。
【0024】
アンビル部は、鈍い鼻状の頂部と、底面上の平坦な切断支持面と、底面から軸線方向に延びている自由に回転する連結ポストとを有する弾丸状である。この連結ポストは、回転駆動軸の一つに取り付けられた対応のナットに選択的に連結及び取外し可能であるように形成されている。
【0025】
SBR部は筒状であり、中空内部を有するハウジングを形成する。一連のステープル口が、ハウジングの筒状壁の軸線方向外側に面した面上にあり、これらステープル口を通して装置のステープルが放出される。ステープル口を通してステープルを駆動するために、一連のステープルドライバがステープル口の下において、筒状壁内に取り付けられている。より正確には、ステープルドライバは、SBR部の壁に着座する一つの筒状構成要素の外側縁における一連の突出部である。ステープルは、放出され始める前に穴内に取り付けられており、ステープルドライバ及びそれらの突出部の前進運動によって穴を通して前進させられる。
【0026】
ブレードは、同様に筒状であり、ハウジングの内側において、その壁の内面に対して着座する。ブレード及びステープルドライバの両方が第二のナットに取り付けられる。第二のナットは他の回転駆動軸に取り付けられている。回転駆動軸が回転する時、(回転しないように制限されている)ナットは軸に沿って前進し、ブレード及びステープルドライバを線形的に前進させる。それゆえ、ブレード及びステープルドライバは、ハンドルの適切なトリガの作動に応じて、ハウジングから軸線方向に外方に選択的に前進可能である。
【0027】
治癒処置を促進するために、アタッチメントは、本発明に適している、すなわち、前述の切断及びステープル吻合動作の直後に、切断及びステープル吻合部位において、薬やフィブリンなどの治癒物質を搬送する機構に適している。いくつかの実施例のうちのいずれかでこの機構を採用しうる。いくつかの実施例のうち二つを例として以下に記載する。一般に、本発明は、流体を収納する供給室と、治療部位と供給室の間で連通している流通路と、流通路を通して流体を押すことが必要とされる力より大きな力で供給室内で移動する搬送又はプランジャドライバとを備えている。
【0028】
好適な実施例において、本発明は、(他の形状を使用することができるが)延長筒状断面を有する供給室を備え、この供給室は、ステープル吻合口の代わりにアタッチメントのステープルハウジング内に形成されている。すなわち、ステープルハウジングは、ステープル口と共に複数の供給室を有する。これら全ての供給室は、前述のように同一の部品及び同一の機能を有する。供給室の口部は、内側に面する突起部又は歯が最も内側の縁周辺部において並べられた流通路を形成する。供給室はフィブリンで充填された袋を収納する。搬送又はプランジャドライバは供給室内で移動する。搬送又はプランジャドライバは、各ステープルがステープルハウジング内のステープル口から突出するのと同様に、供給室の最も内側の端部から突出している。
【0029】
(ステープルドライバ及びブレードドライバを駆動するために電子機械ドライバに接続されている)アタッチメントの回転駆動軸が(電子機械ドライバハンドル上のトリガを介して)作動させられる時、ステープルドライバは前進し、ステープルハウジング内の対応のステープル口を通してアタッチメントのアンビルに対して複数のステープルを押し、目標組織を通過してステープル吻合する。同時に、ステープルドライバは、対応の供給室を通して各搬送又はプランジャドライバを押すように前進する。各搬送又はプランジャドライバが供給室を通して前進する時、ドライバがフィブリンの袋を突起部に対して押圧する。袋が流通路の内側に面した突起部に対して押圧する時、袋は裂け、フィブリンを流通路を通して外へ新たにステープル吻合された組織へ解放する。一方、ブレードドライバは、前方へ移動し、新たにステープル吻合された組織を通してブレードを押し、余剰分を切断する。アタッチメントが除去され、治癒処理は始まり、切断及びステープル吻合部位にフィブリンがあることにより促進される。
【0030】
別の実施例において、流通路は、内側に面している突起部を有さない。代わりに、流通路は障害物がない。しかしながら、フィブリンの袋及び別個の搬送又はプランジャドライバの代りに、供給室は、鋭い先端を有するカニューレを備えている。カニューレの鋭い先端がステープル吻合面に向けられている(すなわち、放出室から押し出された時、先端は組織を穿孔し、最終的にアンビルの平坦な切断面によって止められる)。カニューレの鋭い端部の直に内側において、好適な実施例の内側に面している突起部と同様に、カニューレの内側の周辺部には内側に面している突起部が並べられている。フィブリンの袋がカニューレの内側に着座する。搬送又はプランジャドライバはフィブリンの袋の背後に位置する。この搬送又はプランジャドライバは、カニューレの壁に取り付けられているが、カニューレの先端がアンビルに到達した後に壁から離れて破断するように設定されている。すなわち、アタッチメントの回転駆動軸が作動させられる時、ステープルドライバが前進し、ステープルハウジング内の対応のステープル口を通して、アタッチメントのアンビルに抗して複数のステープルを押し、目標組織を通過してステープル吻合する。同時に、ステープルドライバは前進して各搬送又はプランジャドライバを押す。搬送又はプランジャドライバは、最初に、カニューレを供給室から押し出し、組織を通してアンビルに抗して押す。一旦、カニューレの先端がアンビルに到達すると、搬送又はプランジャドライバは前に押され続ける。この運動により、搬送又はプランジャドライバを破断させてカニューレの壁から離し、以後、ドライバをカニューレ自体を通して前進させ続けることができる。各搬送又はプランジャドライバがカニューレを通して前進する時、ドライバはフィブリンの袋を突起部に対して押圧する。袋がカニューレの内側に面している突起部に対して押圧する時、袋は裂け、カニューレを通して、新たにステープル吻合された組織の反対側へフィブリンを解放する。一方、ブレードが前進し、新たにステープル吻合された組織を通してブレードを押し、余剰分を切断する。アタッチメントが除去され、治癒処理が始まり、切断及びステープル吻合部位にフィブリンがあることにより促進される。
【0031】
さらに別の実施例では、直前に記載した破断部の代りに、搬送ドライバとカニューレの間の圧縮可能な接続部を備えてもよい。例えば、搬送ドライバをカニューレに接続するためにばねを使用することができる。これは、最初のカニューレのアンビルへの移動中においてカニューレドライバ組立体の剛性を維持すると共に、袋に対して押圧するように搬送ドライバを前進させ続けることができる。すなわち、一旦、カニューレの先端がアンビルに到達して停止すると、ばねが圧縮するので、搬送ドライバは前に押され続け、搬送ドライバを袋に対して押圧させることができる。この装置の残りの操作は前述の通りである。本実施例の別個の独特な態様は、組立体を再使用することができることである。破壊される搬送ドライバとカニューレの間の接続部の代わりに、ばねは装置の操作の後に元の状態に戻り、組立体を殺菌して別の用途に準備することができる。
【0032】
同じ処置中において、治療部位の両側に到達するように、種々の実施例を互いに関連して使用することができるということに注意すべきである。例えば、カニューレを採用しない実施例は治療部位の近側に到達することができ、その一方で、カニューレを採用する実施例は治療部位の遠側に到達することができる。
【0033】
実際には、以下の方法で、一旦、(線形締め付け及びステープル吻合段階が完了する前に)除去される大腸の部分が切除されると、このアタッチメントが使用される。外科医は、吻合及びステープル吻合アタッチメントを電子機械ドライバに連結し、アンビル部を最も完全に前進させることによって始める。アンビルヘッドは、除去され、露出された近端内に挿入される。この近端は、(ステープル吻合された近端から突出している連結ポストを用いて)ステープル吻合されて閉鎖される。外科医は、アタッチメントの軸及びSBR部が大腸のステープル吻合された遠端を貫通するまで大腸の上に前進させる。外科医は、前進及び後退する対応の駆動軸のナットにアンビルを連結する。次に、ハンドル内のモータの開始により、アンビルをSBR部に向けて後退させる。アンビル部及びSBR部は、ブレード及びステープルドライバを駆動するのに十分に近くなり、次に、ハンドルの他のトリガを作動することにより、対応の他の回転駆動軸が、ブレード及びステープルドライバをアンビル部の平坦な切断支持面に向けて前進させる。ブレードは大腸のステープル吻合された閉鎖された端部を通して切断し、切断された組織を内側貯蔵部内に残す。切断と同時に、新たに開放された端部が、(アンビルの対向面に当接されて閉鎖される)SBRの周辺縁部内の穴を通して前進させられる一連のステープルによって共に接合されている。ステープル吻合と同時に、ステープルドライバは、供給室内で搬送又はプランジャドライバを前に押す。ドライバは、内側に面している突起部に対して袋を押し、それにより、袋を破断し、フィブリンを解放する。次に、フィブリンは、流通路から出て切断及びステープル吻合部位へ押される。アタッチメント及び柔軟な軸が患者から引込められる。
【0034】
本発明は、吻合及びステープル吻合アタッチメント又は大腸切除工具に関連しないと装置と関連した用途に使用することができ、むしろ、他の外科装置を含みかつ関連した用途に使用することができるので、本発明は単独で、又は、ブレード、ステープラー、他の装置、又は、薬又は他の治癒物質を治療部位に搬送する装置の組み合わせで使用することができるということを注意すべきである。
【0035】
好適な実施の形態の詳細な説明
本発明は、特定の実施例を示す添付図面を参照して以下により十分に記載されているが、当業者は、本発明の機能及び結果を実現しつつ本明細書に記載した本発明を修正することができるということを最初に理解するべきである。したがって、本発明の広範な範囲内の例示的な特定の構造、態様及び特徴として以下の記載を理解することができ、本発明の広範な範囲を制限するものとして理解するべきでない。同様な参照番号は同様な特徴の同様な要素について指している。
【0036】
本発明の好適な実施例の吻合及びステープル吻合アタッチメントの薬搬送機構が図4〜9に示されている。とりわけ、図4をここで参照すると、伸長位置にある吻合及びステープル吻合アタッチメントの斜視概観図が示されている。アンビル部20とステープル、ブレード及び貯蔵(SBR)部25が、連結ポスト30によって接続されており、連結ポスト30は、アンビル部20の平坦支持面35から延びており、SBR部25の複数の回転駆動軸40の一つに取り付けられた対応ナットと選択的に連結可能かつ取り外し可能である。
【0037】
図5をさらにここで参照すると、SBR部25の内部の断面図が示されている。SBR部25は、筒状であり、中空の内部又は貯蔵部45を有する。ステープル吻合面50は、アンビル部20の切断支持面35に向けて軸線方向外側に面し、かつ一連のステープル口55(ステープルハウジング58内に形成されている)を有する。さらに、示しているように、ステープル口55の代わりに、一連の供給室95が形成されている。ステープル駆動軸80内において、ステープル口55を通してステープル60を駆動するために対応ステープル口55の背後に一連のステープルドライバ65が取り付けられている。より正確には、ステープルドライバ65は、駆動シリンダ70の外縁部上にある一連の突出部である。駆動シリンダ70は、SBR部25に着座し、SBR部25の第二の駆動軸(図示せず)に接続されている。ステープル60は、放出される前に、示すステープル口55の背後に取り付けられており、ステープルドライバ65及びそれらの突出部の前進運動によってステープル口55を通して前進させられる。ブレード75は、同様に筒状であり、ステープル駆動軸80に隣接してSBR部に着座している。示しているように、ブレード75及びステープルドライバ65は駆動シリンダ70に取り付けられ、駆動シリンダ70はSBR部25の第二の駆動軸(図示せず)に接続されている。
【0038】
図6及び7をここで参照すると、本発明の好適な実施例に適した吻合及びステープル吻合アタッチメントのより接近した断面図が示されている。アタッチメントのSBR部25の壁28と、ステープルハウジング58と、ステープル口55(図5)の代わりの供給室95とが示されている。同様な供給室95が、ステープル部55の代わりにステープル面50の周辺部(図4に最もよく示されている)に沿って形成されている。供給室を筒状とすることができる。又は、供給室は、図7に示す延長筒状断面、又は、他の形状を有しうる。供給室の口は、内側に面している突起部又は歯92を有する最も内側の縁周辺部に沿って並べられている流通路90を形成する。搬送又はプランジャドライバ110は供給室95内で移動している。図5に最もよく示しているように、搬送又はプランジャドライバ110は、各ステープル60がステープルハウジング58内のステープル口55から突出する方法と同様に、供給室110の最も内側の端部から突出している。
【0039】
図8及び9をここで参照すると、本発明の別の実施例に適した吻合及びステープル吻合アタッチメントのより接近した断面図が示されている。本実施例の多くの態様が好適な実施例の態様と同じであり、同じように番号が付けられている。しかしながら、この別実施例において、流通路90は、内側に面している突起部又は歯を有さない。その代わり、流通路90は障害物がない。しかしながら、フィブリンの袋及び別個の搬送又はプランジャドライバの代わりに、供給室95は、鋭い先端を有するカニューレ112を備えている。カニューレ112の鋭い先端は、ステープル吻合面50に向けられている(すなわち、鋭い先端が供給室95から押し出される時、この先端は組織を穿孔し、アンビル(図示せず)の平坦な切断面によって最終的に止められる)。カニューレ112の鋭い端部の直ぐ内側において、カニューレ112の内側周辺部には、好適な実施例の内側に面する突起部と同様に、内側に面する突起部又は歯92が並べられている。フィブリンの袋100がカニューレ112の内側に着座している。搬送又はプランジャドライバ110が袋100の背後に配置されている。示しているように、この搬送又はプランジャドライバ110は、カニューレ112の壁に取り付けられているが、カニューレの先端がアンビルに到達した後に破断して壁から離れるように配置されている。この破断部114は影で記されている。
【0040】
同じ処置の間において、フィブリンを治療部位の両側に搬送するために、好適な実施例及び別の実施例を互いに関連して使用することができるということを注意すべきである。
【0041】
操作中(両実施例の操作について以下に記載する)、一旦、(線形締め付け及びステープル吻合段階が完了する前)除去すべき大腸の部分が切除されると、アタッチメントが使用される。外科医は、吻合及びステープル吻合アタッチメントを電子機械ドライバに連結し、ハンドル(図示せず)内のモータ(図示せず)の開始することによってアンビル部20を最も完全に前進させることによって操作を始める。次いで、アンビル部20は、電子機械ドライバから取り外され、露出した近端内に挿入される。この近端は、ステープル吻合で閉鎖される(連結ポスト30がステープル吻合された近端から突出している)。外科医は、第一の回転駆動軸40及びアタッチメントのSBR部25を大腸のステープル吻合された遠端を通過するまで、大腸の上方へ前進させる。次いで、外科医は、連結ポスト30を介して、アンビル部20を第一回転駆動軸40に再連結する。次のハンドル(図示せず)内のモータ(図示せず)を反転させ始めることにより、アンビル部20をSBR部25に向けて後退させ、ステープルで閉鎖された大腸の基端と大腸の遠端を一緒にする。アンビル部20及びSBR部25がブレード75及びステープルドライバ65を駆動するのに十分に近くなる時、ハンドル(図示せず)の第二トリガ(図示せず)を次に作動することにより、対応の第二回転駆動軸(図示せず)はブレード75及びステープルドライバ65をアンビル部25の平坦な切断支持面35に向けて前進させる。一旦、ブレード75がアンビル部25の平坦な切断支持面35に到達すると、ブレード75は、ステープル吻合で閉鎖された大腸の近端と大腸の遠端を通して切断し、ここで切断された組織を貯蔵部45内に残す。一方、ステープルドライバ65(切断動作直後に行うステープル吻合動作の時間を正確に計測するために、ステープルドライバ65は、ブレード75の平面のわずか背後に位置決めされており、ブレード75と共に前進する)は、ステープル60の尻部に到達し、前進し続け、ステープル60をステープル口55を通して、ステープル吻合面50に向けて、最後に、平坦な切断支持面35に抗して押し、この動作により、ステープルの突起部を曲げてステープル60を閉鎖し、それにより、新たに切断された開放した大腸の近端と遠端を共に接合する。
【0042】
同時に(好適な実施例において)、ステープルドライバ65が前進して対応の供給室95を通して各搬送又はプランジャドライバ110を押す。各搬送又はプランジャドライバ110は、供給室95を通して前進する時、それがフィブリンの袋100を圧縮する。袋が流通路95の内側に面している突起部又は歯95に押圧する時、袋は裂け、フィブリンを流通路95を通して新たにステープル吻合された組織に解放する。一方、ブレードドライバ76(図5)は前方に移動し、新たにステープル吻合された組織を通してブレード75(図5)を押し、余剰分を切断する。アタッチメントが除去され、治癒処置が始まり、切断及びステープル吻合部位にフィブリンがあることによって促進される。
【0043】
あるいは、同時に(別実施例において)、ステープルドライバ65(図5)は、各搬送又はプランジャドライバ110を押すように前進する。搬送又はプランジャドライバ110は、最初にカニューレ112を供給室95から出し、組織を通して、アンビル部20(図5)の平坦な切断面35に抗して押す。一旦、カニューレ112の先端がアンビル20(図5)に到達すると、搬送又はプランジャドライバ110は前に押され続ける。この運動により、搬送又はプランジャドライバ110をカニューレ112の壁から離れて破断し(剥離部114が破断する)、以後、ドライバ110は、カニューレ自体を通して前方に移動する時、ドライバ110はフィブリンの袋100を圧縮する。袋100がカニューレ112の内側に面している突起部92に対して押圧する時、袋100が裂け、カニューレ112を通して、新たにステープル吻合された組織の反対側へフィブリンを解放する。一方、ブレードドライバ76(図5)は前方に移動し、新たにステープル吻合された組織を通してブレード75を押し、余剰分を切断する。アタッチメントが除去され、治癒処置が始まり、切断及びステープル吻合部位にフィブリンがあることによって促進される。
【0044】
本明細書の発明の概要において前述したように、直前に記載した破断部の代わりに、搬送ドライバとカニューレの間の圧縮可能な接続部を採用した実施例も同様に機能する。例えば、もしばね(図示せず)が破断部の代わりに使用された場合、一旦、カニューレ112の先端がアンビル(図5)に到達すると、搬送又はプランジャドライバ110は前に押され続ける。この運動によりばねを圧縮し続け、搬送又はプランジャドライバ110は、カニューレ112自体を通して前進し続けることができる。各搬送又はプランジャドライバ110がカニューレを通して前進し、ドライバ110はフィブリンの袋100を圧縮する。残りの操作は前述の通りである。
【0045】
特定の実施例の新たに新規な薬搬送機構について記載して示したが、添付した請求の範囲のみによって制限される本発明の広範な精神及び原理から逸脱することなく、変形及び修正が可能であることが当業者に明らかである。
【図面の簡単な説明】
【図1】 従来技術の線形締め付け及びステープル吻合器具の側方斜視図である。
【図2】 従来技術の吻合及びステープル吻合器具の側方斜視図である。
【図3】 本明細書に記載した吻合及びステープル吻合アタッチメントを駆動するために使用される電子機械装置ドライバのハンドル及び柔軟な軸の側断面図である。
【図4】 本発明の一体の薬搬送機構を有する吻合及びステープル吻合アタッチメントの斜視図である。
【図5】 本発明の好適な実施例の一体の薬搬送機構を有する吻合及びステープル吻合アタッチメントの側断面図であり、ステープル口内にあるステープルを示している。
【図6】 本発明の好適な実施例の一体の薬搬送機構を有する吻合及びステープル吻合アタッチメントの側断面図であり、供給室内にある袋を示している。
【図7】 本発明の好適な実施例の一体の薬搬送機構を有する吻合及びステープル吻合アタッチメントの正面断面図であり、供給室内にある袋を示している。
【図8】 本発明の別実施例の一体の薬搬送機構を有する吻合及びステープル吻合アタッチメントの側断面図であり、カニューレを示している。
【図9】 本発明の別実施例の一体の薬搬送機構を有する吻合及びステープル吻合アタッチメントの正面断面図であり、カニューレを示している。
Claims (17)
- 流体を収納する供給室と、
治療部位と前記供給室を連通している流通路と、
前記流通路を通して前記流体を押すのに必要な力よりも大きな力で前記供給室内で移動する搬送ドライバであって、前記搬送ドライバは、吻合ステープルアタッチメント内に収容され、前記吻合ステープルアタッチメントは、ステープルドライバを備え、前記ステープルドライバは、前記吻合およびステープル吻合アタッチメントの壁の表面からステープルを駆動しかつ前記搬送ドライバを押すように構成されている、搬送ドライバと
を備え、
前記供給室内にありかつ前記流体を包囲する袋をさらに備え、前記供給室及び前記流通路の中の少なくとも一つは、少なくとも一つの鋭い内側部分を有する、流体搬送装置。 - 前記供給室及び前記流通路の中の少なくとも一つは、内部と、前記流通路の壁から延びておりかつ前記内部に向けられている少なくとも一つの鋭い突起部とを有している請求項1に記載の装置。
- 前記突起部は、前記流通路を通して前記治療部位まで前記流体を押す前記搬送ドライバの移動方向と反対の方向に構成されている請求項2に記載の装置。
- ハウジングをさらに備え、前記ハウジングは、前記供給室を収納し、かつまっすぐなステープルを収納するように構成されている口部を収納する請求項1に記載の装置。
- 回転駆動軸をさらに備え、前記回転駆動軸は前記ステープルドライバを駆動するように構成されている請求項4に記載の装置。
- 前記搬送ドライバは筒状である請求項4に記載の装置。
- 流体を収納する供給室と、
治療部位と前記供給室を連通している流通路と、
前記流通路を通して前記流体を押すのに必要な力よりも大きな力で前記供給室内で移動する搬送ドライバであって、前記搬送ドライバは、吻合ステープルアタッチメント内に収容され、前記吻合ステープルアタッチメントは、ステープルドライバを備え、前記ステープルドライバは、前記吻合ステープルアタッチメントの壁の表面からステープルを駆動しかつ前記搬送ドライバを押すように構成されている、搬送ドライバと
を備え、
カニューレをさらに備え、前記カニューレは、鋭い遠端を有し、前記カニューレは、前記供給室内に収納され、かつ前記供給室内で移動するように構成されており、
前記搬送ドライバは、前記カニューレを駆動し、
前記カニューレ内にありかつ前記流体を包囲する袋をさらに備え、前記カニューレは、少なくとも一つの鋭い内側部分を有する、流体搬送装置。 - 前記カニューレは、内部と、前記カニューレの壁から延びておりかつ前記内部に向けられている少なくとも一つの鋭い突起部とを有している請求項7に記載の装置。
- 前記突起部は、前記流通路を通して前記治療部位まで前記流体を押す前記搬送ドライバの移動方向と反対の方向に構成されている請求項8に記載の装置。
- ハウジングをさらに備え、前記ハウジングは、前記供給室を収納し、かつまっすぐなステープルを収納するように構成されている口部を収納する請求項7に記載の装置。
- 回転駆動軸をさらに備え、前記回転駆動軸は前記ステープルドライバを駆動するように構成されている請求項10に記載の装置。
- 前記搬送ドライバは筒状である請求項10に記載の装置。
- 前記搬送ドライバは、前記カニューレの壁に取り付けられている請求項7に記載の装置。
- 前記搬送ドライバと前記カニューレを接続するコネクタ部をさらに有する請求項13に記載の装置。
- 前記コネクタ部は前記搬送ドライバ又は前記カニューレよりも構造的に弱い請求項14に記載の装置。
- 前記コネクタ部は圧縮可能である請求項14に記載の装置。
- 前記コネクタ部はばねを有する請求項16に記載の装置。
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US09/510,932 US6491201B1 (en) | 2000-02-22 | 2000-02-22 | Fluid delivery mechanism for use with anastomosing, stapling, and resecting instruments |
US09/510,932 | 2000-02-22 | ||
PCT/US2001/005433 WO2001062162A1 (en) | 2000-02-22 | 2001-02-21 | A fluid delivery mechanism for use with anastomosing, stapling, and resecting instruments |
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JP2009268155A Division JP5087065B2 (ja) | 2000-02-22 | 2009-11-25 | 吻合、ステープル吻合及び切除器具用の流体搬送機構 |
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JP4485730B2 true JP4485730B2 (ja) | 2010-06-23 |
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JP2009268155A Expired - Fee Related JP5087065B2 (ja) | 2000-02-22 | 2009-11-25 | 吻合、ステープル吻合及び切除器具用の流体搬送機構 |
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EP (1) | EP1257207B1 (ja) |
JP (2) | JP4485730B2 (ja) |
AT (1) | ATE308275T1 (ja) |
AU (1) | AU2001238553A1 (ja) |
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2000
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2001
- 2001-02-21 ES ES01911006T patent/ES2250361T3/es not_active Expired - Lifetime
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- 2001-02-21 AU AU2001238553A patent/AU2001238553A1/en not_active Abandoned
- 2001-02-21 AT AT01911006T patent/ATE308275T1/de active
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Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
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US20210059670A1 (en) * | 2015-09-23 | 2021-03-04 | Ethicon Llc | Surgical stapler having motor control based on a drive system component |
US20190201034A1 (en) * | 2017-12-28 | 2019-07-04 | Ethicon Llc | Powered stapling device configured to adjust force, advancement speed, and overall stroke of cutting member based on sensed parameter of firing or clamping |
Also Published As
Publication number | Publication date |
---|---|
EP1257207A1 (en) | 2002-11-20 |
JP5087065B2 (ja) | 2012-11-28 |
JP2010042310A (ja) | 2010-02-25 |
DE60114570D1 (de) | 2005-12-08 |
EP1257207B1 (en) | 2005-11-02 |
ES2250361T3 (es) | 2006-04-16 |
JP2003532455A (ja) | 2003-11-05 |
AU2001238553A1 (en) | 2001-09-03 |
US6491201B1 (en) | 2002-12-10 |
US20030089757A1 (en) | 2003-05-15 |
WO2001062162A1 (en) | 2001-08-30 |
ATE308275T1 (de) | 2005-11-15 |
US6695199B2 (en) | 2004-02-24 |
DE60114570T2 (de) | 2006-07-06 |
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