JP4703978B2 - 閉じていないアンビルに対する発射ロックアウトを備えた外科用ステープラ - Google Patents
閉じていないアンビルに対する発射ロックアウトを備えた外科用ステープラ Download PDFInfo
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- JP4703978B2 JP4703978B2 JP2004149549A JP2004149549A JP4703978B2 JP 4703978 B2 JP4703978 B2 JP 4703978B2 JP 2004149549 A JP2004149549 A JP 2004149549A JP 2004149549 A JP2004149549 A JP 2004149549A JP 4703978 B2 JP4703978 B2 JP 4703978B2
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- 238000010304 firing Methods 0.000 title claims abstract description 181
- 239000012636 effector Substances 0.000 claims abstract description 77
- 230000007246 mechanism Effects 0.000 claims description 46
- 238000001356 surgical procedure Methods 0.000 claims description 10
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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
- A61B17/068—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
- A61B17/07207—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 the staples being applied sequentially
-
- 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
-
- 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
- A61B2017/0725—Stapler heads with settable gap between anvil and cartridge, e.g. for different staple heights at different shots
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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
- A61B17/068—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
- A61B2017/07285—Stapler heads characterised by its cutter
Description
本願は、それぞれ言及することを以って本明細書の一部とする4つの同時係属中の自己の同時出願に関連する。これらの同時出願の名称は次の通りである。
(1)フレデリック・イー(Frederick E.)、シェルトン4世(Shelton IV)、マイク・セッツァー(Mike Setser)、及びブルース・ウエイスンバーグ(Bruce Weisenburgh)による、「誤発射防止用の単一ロックアウト機構を備えた外科用ステープラ(SURGICAL STAPLING INSTRUMENT HAVING A SINGLE LOCKOUT FOR PREVENTION OF FIRING)」。
(2)フレデリック・イー(Frederick E.)、マイク・セッツァー(Mike Setser)、ブライアン・ジェイ(Brian J.)、及びヘンメルガーン(Hemmelgarn)による、「別々の閉止システム及び発射システムを備えた外科用ステープラ(SURGICAL STAPLING INSTRUMENT HAVING SEPARATED DISTINCT CLOSING & FIRING SYSTEMS)」。
(3)フレデリック・イー(Frederick E.)、シェルトン4世(Shelton IV)、マイク・セッツァー(Mike Setser)、及びブルース・ウエイスンバーグ(Bruce Weisenburgh)による、「使用済みカートリッジに対するロックアウトを備えた外科用ステープラ(SURGICAL STAPLING INSTRUMENT HAVING A SPENT CARTRIDGE LOCKOUT)」。
(4)フレデリック・イー(Frederick E.)、シェルトン4世(Shelton IV)、マイク・セッツァー(Mike Setser)、及びブルース・ウエイスンバーグ(Bruce Weisenburgh)による、「Eビーム発射機構が組み込まれた外科用ステープラ(SURGICAL STAPLING INSTRUMENT INCORPORATING AN E-BEAM FIRING MECHANISM)」。
図2‐図4を参照すると、発射バー14が、発射中にエンドエフェクタ12の間隔を制御する垂直方向に離間した3つのピンを含む。具体的には、上部ピン38が、アンビル18と細長い溝形部材16のピボット近傍のアンビルポケット40内に入るように配置されている。アンビル18が閉じた状態で発射されると、上部ピン38が、アンビル18に形成された先端方向に延びた長手方向のアンビルスロット42内を先端側に移動する。アンビル18における僅かな上方への反りは、上部ピン38による下方への力によって解消される。
Eビーム発射バー14によって提供される正確な垂直空間は、内視鏡装置の制限された空間に適している。更に、Eビーム発射バー14により、図5に示されている位置と同様のその先端部に垂直方向の反りを付与するキャンバーとアンビル16との組立が可能となる。このキャンバーアンビル16は、厚みの薄いアンビル16であってもエンドエフェクタ12に所望のギャップを付与するのに役立つという利点があり、大きさが制限される内視鏡装置に適している。
図6‐図9を参照すると、ガラス充填ポリカーボネートなどのポリマー材料から成形された第1のベース部分50及び第2のベース部分52から構成されるハンドル部分20が示されている。第1のベース部分50は、複数の円筒状のピン54を備えている。第2のベース部分52は、それぞれが六角形の開口58を備えた複数の延出部材56を含む。円筒状のピン54は、六角形の開口58内に受容されて摩擦により保持され、これにより、第1のベース部分50と第2のベース部分52の組立てが維持される。
図10‐図16に、外科用ステープラ/切断器具10のエンドエフェクタ12が詳細に示されている。上記したように、ハンドル部分20により、エンドエフェクタ12の閉止動作と発射動作を別々に行うことができる。このエンドエフェクタ12の別々の閉止及び発射(すなわち、ステープル止め及び切断)が、臨床的な柔軟性を保っているという利点がある。加えて、エンドエフェクタ12は、医師が組織を配置してクランプした後に、発射中の閉止間隔を維持するという前記した能力も提供する。これらの特徴により、この特徴がなければ不十分な量の組織がクランプされる場合に十分な間隔を提供したり、この特徴がなければ過剰な量の組織がクランプされる場合にクランプする力を強くして、外科用ステープラ/切断器具10の能力を手順的及び構造的に高めることができる。
使用する場合、外科用ステープラ/切断器具10は、図1、図2、及び図17‐図23に示されているように用いられる。図1‐図2において、器具10は開始位置にあり、細長い溝形部材16の先端部にスナップ嵌めされた発射されていないステープルが完全に装着されているステープルカートリッジ37を有する。トリガ26及び28は前方の位置にあって、エンドエフェクタ12は開いている。これは体内の内腔内のトロカールまたは他の開口を介して挿入された後の典型的なエンドエフェクタ12である。次いで、図17に示されているように、医師が器具10を操作して、ステープル止め及び切断する組織248をステープルカートリッジ37とアンビル18との間に配置する。
図24−図26に、過剰な量の組織248のクランプによるエンドエフェクタ12の異常な動作を回避する有利なアンビルロックアウト機構260の詳細が示されている。具体的には、アンビルロックアウト機構260は、発射バー14が部分的または完全に発射されて組織を切断するが、その切断された組織を閉じるためにその切開部の両側にステープルが適切に形成されないミス発射を回避する。
(実施態様A)
外科器具であって、
発射動作を引き起こすことができるハンドル部分と、
前記ハンドル部分からの前記発射動作に応答する実施部分とを含み、
前記実施部分が、
前記ハンドル部分に連結され、溝スロットを含む細長い溝形部材と、
前記細長い溝形部材によって受容されたステープルカートリッジと、
前記細長い溝形部材に回動可能に連結され、アンビル溝を含むアンビルと、
前記アンビルに係合可能な、前記細長い溝形部材に長手方向に係合している発射装置と、
前記アンビルが開いている時に前記発射装置が前記アンビルと係合するのを妨げるように適合されたアンビルロックアウト機構とを含むことを特徴とする外科器具。
(1)前記アンビルが、前記アンビル溝に係合することができる上部装置を含み、前記アンビルロックアウト機構が、前記アンビルが閉じている時に前記上部装置を前記アンビル溝内に移動させるブラント傾斜面を含むことを特徴とする実施態様Aに記載の外科器具。
(2)前記発射装置が、発射中に前記ステープルカートリッジを作動させることができることを特徴とする実施態様Aに記載の外科器具。
(3)前記アンビルが、発射されていない位置にある時に前記発射装置に近接する凹部と、発射された時に前記発射装置の上側部材を受容するために前記凹部に連通した長手方向のアンビル溝とを含むことを特徴とする実施態様Aに記載の外科器具。
(4)前記細長い溝形部材が長手方向の溝を含み、前記発射装置の下側部分が、前記長手方向の溝に互いに対向して係合する中間部材と下側部材とを含むことを特徴とする実施態様(3)に記載の外科器具。
(5)前記細長い溝形部材が長手方向の溝を含み、前記発射装置の下側部分が、前記長手方向の溝に互いに対向して係合する中間部材と下側部材とを含むことを特徴とする実施態様Aに記載の外科器具。
外科器具であって、
別々に発射動作及び閉止動作を引き起こすことができるハンドル部分と、
前記ハンドルからの別々の前記発射動作及び前記閉止動作に応答する実施部分とを含み、
前記実施部分が、
前記ハンドル部分に連結された細長い溝形部材と、
前記細長い溝形部材に回動可能に連結され、凹部及びアンビル溝を含むアンビルと、
前記細長い溝形部材と前記アンビルとの間に長手方向に受容された先端側を向いた切断縁、前記アンビル溝に選択的に係合可能な上側部材、前記細長い溝形部材に長手方向に係合している下側部分を含む発射装置であって、発射されていない位置にある時に前記アンビルの個別の前記閉止動作が可能になるように、前記上側部材が前記アンビル凹部内に受容されている、前記発射装置と、
前記アンビルが閉じていない時に前記上側部材をブロックする、前記アンビル凹部と前記アンビル溝とが連通したアンビルロックアウト機構とを含むことを特徴とする外科器具。
(6)前記アンビルロックアウト機構が、基端側がブラント面で終わっている前記アンビル溝の表面を含み、前記ブラント面が、前記アンビルが持ち上がっている時に前記発射装置に当接するように配置されていることを特徴とする実施態様Bに記載の外科器具。
(7)前記アンビルロックアウト機構が更に、前記アンビル溝の内面と前記ブラント面とを連結するブラント傾斜面を含むことを特徴とする実施態様(6)に記載の外科器具。
(実施態様C)
エンドサージェリー器具であって、
別々に発射動作及び閉止動作を引き起こすことができるハンドル部分と、
エンドサージェリー・カニューレ通路内に挿入できる大きさのエンドエフェクタと、
前記ハンドル部分と前記エンドエフェクタとの間に取り付けられ、前記発射動作及び前記閉止動作を別々に前記ハンドル部分から前記エンドエフェクタに伝達できるように機能的に構成されたシャフトとを含み、
前記エンドエフェクタが、
前記シャフトに連結された細長い溝形部材と、
前記閉止動作に応答して開いた位置から閉じた位置に移動する、前記細長い溝形部材に回動可能に連結されたアンビルと、
前記細長い溝形部材と前記アンビルとの間に長手方向に受容され、発射のための先端側への移動の際にアンビル溝に係合可能な上側部材を含む発射装置と、
アンビルが開いている状態に応答して前記発射装置の先端側への移動を妨げるように機能的に構成されたアンビルロックアウト機構とを含むことを特徴とするエンドサージェリー器具。
(8)前記ハンドル部分が、クランプによって前記閉止動作を引き起こして、そのクランプによる閉止動作に応答して前記発射動作を可能にするように構成されており、前記アンビルロックアウト機構が、クランプによる閉止動作と過剰な量のクランプされた組織による閉じた位置から離れる方向へのアンビルの回動とを含むアンビルが開いた条件に応答するように機能的に構成されていることを特徴とする実施態様Cに記載のエンドサージェリー器具。
(9)更に、前記細長い溝形部材内に受容されたステープルカートリッジを含み、前記発射装置が、発射中に前記ステープルカートリッジを作動させることができることを特徴とする実施態様Cに記載のエンドサージェリー器具。
(10)前記アンビルが、発射されていない位置にある時に前記発射装置に近接する凹部と、発射された時に前記発射装置の上側部材を受容するために前記凹部に連通した長手方向のアンビル溝とを含み、前記アンビルロックアウト機構が、前記発射装置の前記上側部材が前記凹部から前記アンビル溝に移動するのを選択的に防止するように構成されていることを特徴とする実施態様Cに記載のエンドサージェリー器具。
(12)前記長手方向の溝が長手方向のスロットを含み、前記発射装置の前記下側部分が、前記細長い溝形部材の前記長手方向のスロットに互いに対向して係合する中間部材と下側部材とを含むことを特徴とする実施態様(11)に記載のエンドサージェリー器具。
(13)前記アンビルロックアウト機構がブラント面を含み、前記ブラント面が、前記アンビルが前記閉じた位置にある時に前記発射装置の前記上側部材の下側に位置し、前記アンビルが前記開いた位置にある時に前記発射装置の前記上側部材と当接することを特徴とする実施態様(10)に記載のエンドサージェリー器具。
(14)前記アンビルロックアウト機構が更に、前記ブラント面と前記アンビル溝との間の移行部である傾斜面を含むことを特徴とする実施態様(13)に記載のエンドサージェリー器具。
(15)前記アンビルロックアウト機構が、発射バー上側部材をロックアウトする手段を含むことを特徴とする実施態様Cに記載のエンドサージェリー器具。
(16)前記エンドエフェクタが更に、発射中に前記アンビルと前記細長い溝形部材との間隔を確実に維持するための手段を含むことを特徴とする実施態様(15)に記載のエンドサージェリー器具。
12 エンドエフェクタ
14 Eビーム発射機構または発射バー
16 溝形部材
18 アンビル
20 ハンドル部分
22 実施部分
23 シャフト
24 ピストルグリップ
26 閉止トリガ
28 発射トリガ
30 解放ボタン
32 閉止スリーブ
34 フレーム
36 発射駆動部材
37 ステープルカートリッジ
38 上部ピン
40 アンビルポケット
42 アンビルスロット
44 発射バーキャップ
45 スロット
46 中間ピン
47 発射駆動スロット
48 切断縁
49 垂直スロット
50 第1のベース部分
52 第2のベース部分
54 円筒状ピン
56 延出部材
58 六角形開口58
60 回動ノブ
62 貫通孔
64 ボス
70 外周ノッチ
72 溝形部材固定部材
74 ハンドル部分
76 ギア部分
78 中間部分
86 ヨーク
89 凹部
102、112、124 ばね
104 第1のクランプフック
118 上部ラッチアーム
122 凹部
128 係合面
130 前面
136 マルチプライヤ
138 駆動部材
140 金属製駆動ロッド
141 第1のギアラック
142 第2のギアラック
144 ノッチ
146 歯
148 第2のノッチ
150 第1のピニオンギア
152 第2のピニオンギア
154 第1のギアラック
156 ギア部分
204 ステープラ開口
208、210 延長構造
212、214 凹部
216 カートリッジ本体
218 ウェッジスレッド
220 シングルドライバ、ダブルドライバ
222 ステープル
224 カートリッジトレイ
226 取付けキャビティ
227 アンカー部材
228 ウェッジ
230 アンビルカムスロット
232 アンビルピボット
234 タブ
236 アンビルカム構造
238 発射コネクタ
239 スロットガイド
246 傾斜部分
248 組織
250 発射バーストッパー
260 アンビルロックアウト機構
262 ブラント傾斜面
264 ブラント面
266 傾斜面
268 内面
Claims (11)
- 外科器具であって、
発射動作を引き起こすことができるハンドル部分と、
前記ハンドル部分からの前記発射動作に応答する実施部分とを含み、
前記実施部分が、
前記ハンドル部分に連結され、溝スロットを含む細長い溝形部材と、
前記細長い溝形部材によって受容されたステープルカートリッジと、
前記細長い溝形部材に回動可能に連結され、アンビル溝を含むアンビルと、
前記アンビルに係合可能な、前記細長い溝形部材に長手方向に係合している発射装置と、
前記アンビルが開いている時に前記発射装置が前記アンビルと係合するのを妨げるように適合されたアンビルロックアウト機構とを含み、
前記発射装置が、前記アンビル溝に係合することができる上側部材を含み、
前記アンビルロックアウト機構がブラント傾斜面を含み、前記ブラント傾斜面は基端側のブラント面および先端側の傾斜面を有し、前記ブラント面は、前記アンビルが十分に閉じていない場合に、前記発射装置の先端側への移動を妨げるように前記上側部材と当接する位置であって、前記アンビルが十分に閉じられている場合に、前記発射装置の先端側への移動を許容するように前記上側部材よりも下側の位置に備えられており、前記傾斜面は、前記アンビルが十分に閉じられている場合に、前記上側部材を前記アンビル溝内に案内するようになっていることを特徴とする外科器具。 - 前記発射装置が、発射中に前記ステープルカートリッジを作動させることができることを特徴とする請求項1に記載の外科器具。
- 前記アンビルが、発射されていない位置にある時に前記発射装置に近接する凹部と、発射された時に前記発射装置の上側部材を受容するために前記凹部に連通した長手方向の前記アンビル溝とを含むことを特徴とする請求項1に記載の外科器具。
- 前記細長い溝形部材が長手方向の溝を含み、前記発射装置の下側部分が、前記長手方向の溝に互いに対向して係合する中間部材と下側部材とを含むことを特徴とする請求項3に記載の外科器具。
- 前記細長い溝形部材が長手方向の溝を含み、前記発射装置の下側部分が、前記長手方向の溝に互いに対向して係合する中間部材と下側部材とを含むことを特徴とする請求項1に記載の外科器具。
- 外科器具であって、
別々に発射動作及び閉止動作を引き起こすことができるハンドル部分と、
前記ハンドルからの別々の前記発射動作及び前記閉止動作に応答する実施部分とを含み、
前記実施部分が、
前記ハンドル部分に連結された細長い溝形部材と、
前記細長い溝形部材に回動可能に連結され、凹部及びアンビル溝を含むアンビルと、
前記細長い溝形部材と前記アンビルとの間に長手方向に受容された先端側を向いた切断縁、前記アンビル溝に選択的に係合可能な上側部材、前記細長い溝形部材に長手方向に係合している下側部分を含む発射装置であって、発射されていない位置にある時に前記アンビルの個別の前記閉止動作が可能になるように、前記上側部材が前記アンビル凹部内に受容されている、前記発射装置と、
前記アンビルが閉じていない時に前記上側部材をブロックする、前記アンビル凹部と前記アンビル溝とが連通したアンビルロックアウト機構とを含み、
前記アンビルロックアウト機構がブラント傾斜面を含み、前記ブラント傾斜面は基端側のブラント面および先端側の傾斜面を有し、前記ブラント面は、前記アンビルが十分に閉じていない場合に、前記発射装置の先端側への移動を妨げるように前記上側部材と当接する位置であって、前記アンビルが十分に閉じられている場合に、前記発射装置の先端側への移動を許容するように前記上側部材よりも下側の位置に備えられており、前記傾斜面は、前記アンビルが十分に閉じられている場合に、前記上側部材を前記アンビル溝内に案内するようになっていることを特徴とする外科器具。 - エンドサージェリー器具であって、
別々に発射動作及び閉止動作を引き起こすことができるハンドル部分と、
エンドサージェリー・カニューレ通路内に挿入できる大きさのエンドエフェクタと、
前記ハンドル部分と前記エンドエフェクタとの間に取り付けられ、前記発射動作及び前記閉止動作を別々に前記ハンドル部分から前記エンドエフェクタに伝達できるように機能的に構成されたシャフトとを含み、
前記エンドエフェクタが、
前記シャフトに連結された細長い溝形部材と、
前記閉止動作に応答して開いた位置から閉じた位置に移動する、前記細長い溝形部材に回動可能に連結され、アンビル溝を含むアンビルと、
前記細長い溝形部材と前記アンビルとの間に長手方向に受容され、発射のための先端側への移動の際にアンビル溝に係合可能な上側部材を含む発射装置と、
アンビルが開いている状態に応答して前記発射装置の先端側への移動を妨げるように機能的に構成されたアンビルロックアウト機構とを含み、
前記アンビルロックアウト機構がブラント傾斜面を含み、前記ブラント傾斜面は基端側のブラント面および先端側の傾斜面を有し、前記ブラント面は、前記アンビルが十分に閉じていない場合に、前記発射装置の先端側への移動を妨げるように前記上側部材と当接する位置であって、前記アンビルが十分に閉じられている場合に、前記発射装置の先端側への移動を許容するように前記上側部材よりも下側の位置に備えられており、前記傾斜面は、前記アンビルが十分に閉じられている場合に、前記上側部材を前記アンビル溝内に案内するようになっていることを特徴とするエンドサージェリー器具。 - 更に、前記細長い溝形部材内に受容されたステープルカートリッジを含み、前記発射装置が、発射中に前記ステープルカートリッジを作動させることができることを特徴とする請求項7に記載のエンドサージェリー器具。
- 前記アンビルが、発射されていない位置にある時に前記発射装置に近接する凹部と、発射された時に前記発射装置の上側部材を受容するために前記凹部に連通した長手方向の前記アンビル溝とを含み、前記アンビルロックアウト機構が、前記発射装置の前記上側部材が前記凹部から前記アンビル溝に移動するのを選択的に防止するように構成されていることを特徴とする請求項7に記載のエンドサージェリー器具。
- 前記細長い溝形部材が、前記発射装置の下側部分がスライド可能に係合する長手方向の溝を含むことを特徴とする請求項9に記載のエンドサージェリー器具。
- 前記長手方向の溝が長手方向のスロットを含み、前記発射装置の前記下側部分が、前記細長い溝形部材の前記長手方向のスロットに互いに対向して係合する中間部材と下側部材とを含むことを特徴とする請求項10に記載のエンドサージェリー器具。
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US441580 | 1995-05-15 | ||
US10/441,580 US7143923B2 (en) | 2003-05-20 | 2003-05-20 | Surgical stapling instrument having a firing lockout for an unclosed anvil |
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JP (1) | JP4703978B2 (ja) |
AT (1) | ATE449570T1 (ja) |
AU (2) | AU2004202166A1 (ja) |
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-
2004
- 2004-05-19 JP JP2004149549A patent/JP4703978B2/ja active Active
- 2004-05-20 AU AU2004202166A patent/AU2004202166A1/en not_active Abandoned
- 2004-05-20 MX MXPA04004888A patent/MXPA04004888A/es active IP Right Grant
- 2004-05-20 EP EP04252978A patent/EP1479347B1/en active Active
- 2004-05-20 ES ES04252978T patent/ES2334914T3/es active Active
- 2004-05-20 DE DE602004024267T patent/DE602004024267D1/de active Active
- 2004-05-20 CA CA2468130A patent/CA2468130C/en not_active Expired - Fee Related
- 2004-05-20 AT AT04252978T patent/ATE449570T1/de not_active IP Right Cessation
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Also Published As
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ES2334914T3 (es) | 2010-03-17 |
ATE449570T1 (de) | 2009-12-15 |
JP2004344661A (ja) | 2004-12-09 |
EP1479347B1 (en) | 2009-11-25 |
CA2468130C (en) | 2012-05-15 |
AU2004202166A1 (en) | 2004-12-09 |
US20040232199A1 (en) | 2004-11-25 |
AU2010241284A1 (en) | 2010-11-25 |
CA2468130A1 (en) | 2004-11-20 |
AU2010241284B2 (en) | 2011-08-18 |
EP1479347A1 (en) | 2004-11-24 |
DE602004024267D1 (de) | 2010-01-07 |
US7143923B2 (en) | 2006-12-05 |
MXPA04004888A (es) | 2005-04-11 |
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