JP4856741B2 - 手術用ステープラーおよび手術方法 - Google Patents
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- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- 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
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- 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
- A61B2017/07278—Stapler heads characterised by its sled or its staple holder
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
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Description
本願は2002年4月16日に出願された米国仮出願第番号60/373,224号の利益とそれに対する優先権を主張するものであり、そのすべての内容が参考として本明細書に援用される。
(1.技術分野)
本開示は手術用具と手術用ステープルで修復または接合した身体組織の特性強化法に関し、より詳しくは手術用の機械的ファスナーを非機械的な生体適合性傷口閉鎖材料と同時に施し、手術目的部位の修復組織または接合組織の特性を強化する様に形成された手術用具に関する。
体の身体組織を接合または接着する努力において、医学分野では長年にわたり様々な技術を利用してきた。歴史的には、縫合が重症の身体組織を接合し傷口を閉じるための技術として用いられていた。歴史的には縫合は手術針と手術糸で行われ、最近では以下に述べる様な多様な高分子または金属ステープルで行われている。縫合が意図する機能は、傷口または身体組織の端を治療期間中に相互に保持し、不快感、苦痛および治療に要する時間を低減することである。
本開示は手術用機器、および修復または接合する身体組織の特性強化法に関する。
複数の接触パッドのそれぞれが、電気エネルギーを少なくとも複数の接触パッドそれぞれに移送および/または接触パッドそれぞれから発散するための電力線に電気的に接続されている。針収容スロット内に収容し得る複数のフィンガーのそれぞれ、複数の針のそれぞれ、および接触パッドのそれぞれが電気エネルギー源に電気的に接続されている。
より特定すれば、本発明は、以下の項目に関し得る。
(項目1)
手術用ステープルにより修復または接合される身体組織の1つ以上の特性を強化するための方法であって、上記方法は、以下:
それぞれ手術用ステープラーの遠位端に隣接して位置し、相互に併設されて操作可能なステープル床およびステープルカートリッジを含む上記手術用ステープラーを提供する工程であって、上記ステープルカートリッジは、以下:
作業表面と、
作業表面中に形成された1列以上の個別ステープルスロットと、
個別のステープルスロット内に個別に配置された複数の手術用ステープルと、
スロットからステープル床に向かって手術用ステープルを発射するための駆動部材と、
上記手術用ステープルを身体組織内に発射することにより形成される、上記手術用ステープルにより修復または接合される上記身体組織の一つ以上の特性を強化するように形成かつ適合される身体組織の特性強化システムであって、生体適合性傷口閉鎖材料の容器、および容器とカートリッジの作業表面とを連通する複数の導管を含む上記身体組織の特性強化システムと、
それぞれが先端を有する複数の展開可能な針であって、上記先端が上記ステープルカートリッジの上記作業表面の外へ伸長し、身体組織の隣接する層の少なくとも1層を貫入し、上記生体適合性傷口閉鎖材料を上記針の外部に沿って移送し身体組織の1つ以上の層を貫入し得るように上記導管中に適合かつ配置される針
を含むものとする工程と、
ステープル床とステープルカートリッジをその間にある身体組織の隣接する層に接近させる工程と、
手術用ステープラーを発射する工程であって、複数の手術用ステープルを上記身体組織の隣接する層を通して駆動することによって、上記身体組織層を相互に機械的に固定すると共に、上記身体組織強化システムを同時に作動させることによって修復または接合された身体組織の隣接する層の1つ以上の特性を強化することを含む手術用ステープラーを発射する工程を有することを特徴とする方法。
(項目2)
上記身体組織の特性強化システムの作動が、所定量の生体適合性傷口閉鎖材料を、修復または接合された隣接する身体組織層の少なくとも一個所またはその間に移送することを含むことを特徴とする項目1に記載の方法。
(項目3)
手術用ステープラーを発射する際に、生体適合性傷口閉鎖材料がステープルカートリッジの容器から放出されることを特徴とする、項目1に記載の方法。
(項目4)
上記準備工程において上記複数の展開可能な針のそれぞれが通常、非伸長位置に付勢され、その付勢に対向して上記伸長位置へ移動可能であることを特徴とする、項目3に記載の方法。
(項目5)
上記身体組織の特性強化システムの作動には身体組織に隣接する層の少なくとも一つの層、または隣接する層間に所定量のエネルギーを送り、上記身体組織の隣接する層の少なくとも一つの層を焼灼することを含むことを特徴とする、項目1に記載の方法。
(項目6)
上記複数の展開可能な針は所定量のエネルギーを上記身体組織の少なくとも1層に送り、上記身体組織を焼灼するように適合されていることを特徴とする、項目1に記載の方法。
(項目7)
上記生体適合性傷口閉鎖材料が接着材であることを特徴とする項目1に記載の方法。
(項目8)
上記接着材がタンパク質由来のアルデヒド系接着材料を含むことを特徴とする項目7に記載の方法。
(項目9)
上記接着材がアルブミン/グルタルアルデヒド材料を含むことを特徴とする項目7に記載の方法。
(項目10)
上記接着材がシアノアクリレート系材料であることを特徴とする項目7に記載の方法。
(項目11)
上記生体適合性傷口閉鎖材料が組織封入剤であることを特徴とする項目1に記載の方法。
(項目12)
上記組織封入剤が合成ポリエチレングリコール系ハイドロゲル材料から構成されることを特徴とする項目11に記載の方法。
(項目13)
生体適合性傷口閉鎖材料が止血剤であることを特徴とする項目1に記載の方法。
(項目14)
止血剤がフィブリノーゲンとトロンビンの組み合わせを含むことを特徴とする項目13に記載の方法。
(項目15)
手術用ステープラーであって、上記手術用ステープラーが、以下:
ステープルカートリッジを第一顎部の遠位端に収容するように適合されている第一顎部であって、上記ステープルカートリッジは複数の手術用ステープルそれぞれを含み、ステープルカートリッジの中に形成された複数のステープルスロットを有する作業表面を含む第一顎部と、
第二顎部の遠位端にステープル床を有する第二顎部であって、手術用ステープラーの作動中はステープルカートリッジおよびステープル床を相互に接近させ得る第二顎部と、
手術用ステープルをそのステープルスロットから接近したステープル床に向けて発射するための駆動部材と、
手術用ステープラーにより修復または接合される身体組織の一つ以上の特性を強化するための身体組織の特性強化システムであって、上記身体組織強化システムが、以下:
上記ステープルカートリッジに搭載された複数のステープルを放出するために上記手術用ステープラーを発射する前、発射後および発射と同時の少なくとも何れかに標的ステープル部位へ所定量の手術用生体適合性傷口閉鎖材料を分配するための生体適合性傷口閉鎖材料分配システムであって、上記生体適合性傷口閉鎖材料をその中に収容するための少なくとも1個の容器をステープルカートリッジ中に有する上記身体組織の特性強化システム、
上記ステープルカートリッジ中に形成された複数の導管であって、少なくとも1個の接着材容器と連通し、そこから上記ステープルカートリッジの作業表面に伸びている複数の導管、および
それぞれ先端を有する複数の展開可能な針であって、針の先端が上記ステープルカートリッジの作業表面から外に伸び、上記身体組織の隣接する層の少なくとも1層を貫入し、生体適合性傷口閉鎖材料を針の外部に沿って移送し、上記生体組織の1つ以上の層に貫入させるようにステープルカートリッジの導管中に適合かつ配置される複数の針を有する身体組織の特性強化システム
を備えることを特徴とする手術用ステープラー。
(項目16)
第一顎部がステープルカートリッジ内で摺動して配置されるように適合される駆動部材を収容する様に適合され、上記駆動部材が遠位方向へ移動すると上記駆動部材は生体適合性傷口閉鎖材料を複数の導管を通って容器から、導管内に配置された針の周りに押出す様に適合され、上記生体適合性傷口閉鎖材料を修復または接合される上記身体組織中へ貫入させることを特徴とする項目15に記載の手術用ステープラー。
(項目17)
上記ステープルカートリッジがさらに
1つ以上の横に間隔を空けた個々のステープルスロット列であって、ステープルカートリッジに沿って伸長するステープルスロット列と、
バックスパンを有し、相互に個々のステープルスロット内に配置された複数の個別の手術用ステープルと、
相互にステープルスロット内、および複数のステープルの一つをスロットから押出す位置に配置された複数のステープルプッシャーであって、上記駆動部材が上記ステープルプッシャーをスロット内に移動させ、そして同時に所定量の生体適合性傷口閉鎖材料を針の周囲および複数の導管の外へ放出する様に適合される複数のステープルプッシャーを有することを特徴とする項目16に記載の手術用ステープラー。
(項目18)
生体適合性傷口閉鎖材料分配システムがさらに上記ステープルカートリッジを通って縦方向に伸びる柔軟な内張を含み、駆動部材が上記ステープルカートリッジを通って遠位方向に移動した場合、内張により上記生体適合性傷口閉鎖材料と駆動部材の接触が防止されることを特徴とする、項目16に記載の手術用ステープラー。
(項目19)
複数の針が先端と、針が上記ステープルカートリッジ内に完全に保持される第一位置と、複数の針の先端が上記ステープルカートリッジの上記作業表面から突出する第二位置を有することを特徴とする、項目16に記載の手術用ステープラー。
(項目20)
複数の針のそれぞれが第一位置に付勢されることを特徴とする項目19に記載の手術用ステープラー。
(項目21)
上記手術用ステープラーが開放消化器吻合手術を行うためであることを特徴とする項目15に記載の手術用ステープラー。
(項目22)
上記手術用ステープラーが内視鏡または腹腔鏡消化器手術を行うためであることを特徴とする項目15に記載の手術用ステープラー。
(項目23)
上記手術用ステープラーが末端−末端吻合手術を行うためであることを特徴とする項目15に記載の手術用ステープラー。
(項目24)
上記生体適合性傷口閉鎖材料がタンパク質由来のアルデヒド系接着材を含む接着材であることを特徴とする項目15に記載の手術用ステープラー。
(項目25)
上記生体適合性傷口閉鎖材料がアルブミン/グルタルアルデヒド材料を含む接着材であることを特徴とする項目24に記載の手術用ステープラー。
(項目26)
上記生体適合性傷口閉鎖材料がシアノアクリレート系材料から構成される接着材であることを特徴とする項目24に記載の手術用ステープラー。
(項目27)
上記生体適合性傷口閉鎖材料が組織封入剤であることを特徴とする項目15に記載の手術用ステープラー。
(項目28)
上記組織封入剤が合成ポリエチレングリコール系ハイドゲル材料から構成されることを特徴とする項目27に記載の方法。
(項目29)
生体適合性傷口閉鎖材料が止血剤であることを特徴とする項目15に記載の手術用ステープラー。
(項目30)
上記複数の導管が1つ以上の横方向に間隔を空けたステープルスロットの列に隣接、またはその間に配列するように配置されることを特徴とする、項目15に記載の手術用ステープラー。
(項目31)
複数の展開可能な針のそれぞれが、手術用ステープラーを発射後に複数の展開可能な針のそれぞれを上記ステープルカートリッジ内に引き戻すための後退要素を備えることを特徴とする項目15に記載の手術用ステープラー。
(項目32)
ステープルカートリッジを第一顎部の遠位端に収容するために適合される第一顎部であって、上記ステープルカートリッジが複数の個別の手術用ステープルと、その中に形成される複数のステープルスロットを有する作業表面を含むステープルカートリッジを含む第一顎部と、
第二顎部の遠位端にステープル床を有する第二顎部であって、手術用ステープラーの作動中はステープルカートリッジとステープル床が相互に接近し得る第二顎部と、
手術用ステープルをステープルスロットから接近したステープル床に向かって発射するための駆動部材と、
上記外科的ステープラーによって修復または接合される身体組織の隣接した層の一つ以上の特性を強化するために上記ステープルカートリッジと作動可能に結合する組織焼灼システムであって、上記組織焼灼システムはそれぞれ先端を有する複数の展開可能な針を含み、上記針が上記カートリッジ内に適合かつ配置され、その先端が上記ステープルカートリッジの上記作業表面から突き出し、上記身体組織の隣接する層の少なくとも1層を貫入し、電気手術エネルギーを上記手術ステープラーの発射の少なくとも前、後および発射と同時の何れかに上記身体組織に移送し得る組織焼灼システムを有することを特徴とする手術用ステープラー。
(項目33)
組織焼灼システムが、
上記手術用ステープラーに電気的に接続される第一および第二電力線を経由して電気エネルギー源を有し、上記複数の展開可能な針が完全に上記ステープルカートリッジ内に保持される第一位置と、複数の展開可能な針の各々の先端が上記ステープルカートリッジから突出する第二位置を有することを特徴とする項目32に記載の手術用ステープラー。
(項目34)
上記第一顎部が上記ステープルカートリッジ内に摺動可能に収容されるよう適合される駆動部材を含み、駆動部材が複数の展開可能な針のそれぞれを上記第一位置から上記第二位置へ移動するよう適合されることを特徴とする項目33に記載の手術用ステープラー。
(項目35)
上記駆動部材がエネルギー伝導ストリップを含み、上記エネルギー伝導ストリップが上記第一電力線に電気的に接続され、複数の展開可能な針のそれぞれを上記第一電力線と電気的に接続することを特徴とする項目34に記載の手術用ステープラー。
(項目36)
複数の展開可能な針のそれぞれと伝導ストリップが導電性材料で作製されることを特徴とする、項目35に記載の手術用ステープラー。
(項目37)
上記ステープル床が上記第二電力線に電気的に接続していることを特徴とする、項目36に記載の手術用ステープラー。
(項目38)
複数の展開可能な針が第二位置にあり、上記複数の展開可能な針の個別の遠位端が目的とするステープル位置で組織を貫入し、上記複数の針の先端が上記ステープル床に接触しないことを特徴とする、項目37に記載の手術用ステープラー。
(項目39)
上記複数の展開可能な針が第一位置に付勢していることを特徴とする、項目38に記載の手術用ステープラー。
(項目40)
組織焼灼システムが互いに上記複数の展開可能な針の各々の周りに配置された複数のばねを含み、個別の上記複数の展開可能な針を第一位置に付勢させることを特徴とする、項目37に記載の手術用ステープラー。
(項目41)
上記電気エネルギー源が電気手術用発電機であることを特徴とする、項目33に記載の手術用ステープラー。
(項目42)
遠位端に、第一顎部とステープル床を有する第二顎部を含む手術用ステープラーであって、上記手術用ステープラーが、以下:
上記第一顎部に選択的に収容され得るステープルカートリッジであって、上記ステープルカートリッジが、以下:
その上面に形成された、1個以上の横方向に間隔を空けたステープルスロット列と、
上記ステープルスロット内にそれぞれ配置された複数の手術用ステープルと、
個別の上記複数のステープルを上記ステープルスロットから押出し、射出する位置に、上記ステープルスロット内にそれぞれ配置された複数のステープルプッシャーと、
上記ステープルカートリッジ内に配置された複数の展開可能な針であって、上記複数の展開可能な針のそれぞれは上記針が上記ステープルカートリッジ内に完全に保持される第一位置と、上記針の先端部が上記ステープルカートリッジから突出する第二位置を有する展開可能な針を有するステープルカートリッジと、
第一顎部と操作可能に結合する駆動部材であって、上記ステープルカートリッジ内に摺動可能に収容され、直線的に移動し、上記複数のステープルプッシャーと上記複数の展開可能な針を同時に横方向に移動させるように適合された駆動部材であって、上記駆動部材はその長さに沿って長さ方向に伸びるエネルギー伝導ストリップを含む、駆動部材と、
上記手術用ステープラーに電気的に接続した電気エネルギー源であり、上記電気エネルギー源は上記ステープル床に電気的に接続した第一電力線と、
上記駆動部材の伝導ストリップに接続され、上記駆動部材が上記ステープルカートリッジを通って遠位方向に移動する場合、上記複数の展開可能な針のそれぞれと電気的に連通し得る第二電力線を含む電気エネルギー源を有することを特徴とする、手術用ステープラー。
(項目43)
上記展開可能な針のそれぞれと、上記伝導ストリップが導電性材料で形成されていることを特徴とする、項目42に記載の手術用ステープラー。
(項目44)
上記複数の展開可能な針が第二位置にある場合、上記複数の展開可能な針個別の先端が目的とするステープル位置で組織を貫入し、上記ステープル床と接触しないことを特徴とする、項目42に記載の手術用ステープラー。
(項目45)
上記複数の展開可能な針それぞれが第一位置に付勢していることを特徴とする、項目42に記載の手術用ステープラー。
(項目46)
上記組織焼灼システムが互いに上記複数の展開可能な針の周りにそれぞれに配置された複数のばねを含み、上記複数の展開可能な針を第一位置に付勢させることを特徴とする、項目42に記載の手術用ステープラー。
(項目47)
手術用ステープラー内に取り外し可能に収容される様に形成される手術用ステープルカートリッジであって、上記ステープルカートリッジは、以下:
作業表面と、
上記作業表面内に形成された、横方向に間隔を空けた1個以上のステープルスロット列と、
それぞれ上記ステープルスロット内に配置され、隣接する身体組織層を互いに機械的に固定する複数の手術用ステープルと、
上記手術用ステープラーにより修復または接合される身体組織の一つ以上の特性を強化する組織の特性強化システムであって、上記組織の特性強化システムは修復または接合される身体組織を非機械的に強化する様に形成され、組織の特性強化システムは、以下:
上記手術用ステープラーを発射する前、発射する後および発射中の何れかの間に、上記ステープルカートリッジに搭載した複数のステープルを放出し、所定量の手術用生体適合性傷口閉鎖材料を目的とするステープル位置へ分配するための傷口閉鎖材料分配システムであって、上記組織の特性強化システムは上記生体適合性傷口閉鎖材料を収容するために上記ステープルカートリッジ内に配置された少なくとも1個の容器を有する傷口閉鎖材料分配システムと、
上記ステープルカートリッジ内に形成された複数の導管であって、上記複数の導管が少なくとも1個の接着材容器からステープルカートリッジの上面へ伸びる複数の導管と、
それぞれ先端を有する複数の展開可能な針であって、上記針はカートリッジと導管内に配置され、それにより、針の先端が上記ステープルカートリッジの作業表面から外へ伸び、身体組織の少なくとも隣接する1層を貫入し、上記生体適合性傷口閉鎖材料を上記針の外部に沿って移送し、上記身体組織の1以上の層を貫入する複数の展開可能な針を有する組織の特性強化システムを含むことを特徴とする、手術用ステープルカートリッジ。
(項目48)
上記組織の特性強化システムは上記隣接する身体組織の少なくとも1層に所定量の上記生体適合性傷口閉鎖材料を移送し、上記身体組織の隣接する層を互いに接着する様に形成されることを特徴とする、項目47記載の手術用ステープルカートリッジ。
(項目49)
上記組織の特性強化システムは上記隣接する身体組織の間に所定量の所定量の生体適合性傷口閉鎖材料を移送し、上記身体組織の隣接する層を互いに接着する様に形成されることを特徴とする、項目47記載の手術用ステープルカートリッジ。
(項目50)
上記ステープルカートリッジが所定量の上記生体適合性傷口閉鎖材料を含む様に形成される容器を含むことを特徴とする、項目47記載の手術用ステープルカートリッジ。
(項目51)
上記複数の展開可能な針の各々が通常、後退条件で付勢していることを特徴とする、項目50記載の手術用ステープルカートリッジ。
(項目52)
上記身体組織強化システムが所定量の電気エネルギーを上記隣接する身体組織の少なくとも1層に移送し、上記身体組織の隣接する層を焼灼する様に形成されることを特徴とする、項目45記載の手術用ステープルカートリッジ。
(項目53)
上記複数の展開可能な針が所定量の電気エネルギーを上記身体組織の少なくとも1層に移送し、組織を焼灼する様に形成されることを特徴とする、項目47記載の手術用ステープルカートリッジ。
(項目54)
上記複数の展開可能な針のそれぞれが後退条件に付勢していることを特徴とする、項目53記載の手術用ステープルカートリッジ。
(項目55)
手術用ステープラ−であって、以下:
上記ハンドルアセンブリ、
ハンドルアセンブリから伸びるチューブ部、
上記チューブ部の遠位端に作動可能に結合されたステープルカートリッジアセンブリであって、上記ステープルカートリッジがステープル収容スロットの一対の環状アレーを含み、ここで、ステープル収容スロットのそれぞれが身体組織の隣接する層を互いに機械的に固定するために配置された手術用ステープルを含むステープルカートリッジアセンブリと、
上記ステープルカートリッジアセンブリに対向して上記チューブ部の遠位端にシャフトで作動可能に接続された床部材と、
上記身体組織の隣接する層の修復または結合を、上記手術用ステープラーの発射で形成された環状ステープル線に沿って互いに非機械的に強化する様に形成される身体組織の特性強化システムであって、上記身体組織の特性強化システムが針収容スロットの環状アレーと、身体組織強化剤を移送するために互いに針収容スロットの上記環状アレー中に配置された複数の展開可能な針を含む身体組織の特性強化システムを有することを特徴とする、手術用ステープラー。
(項目56)
上記身体組織の特性強化システムが所定量の上記生体適合性傷口閉鎖材料を身体組織の隣接する層に移送し、上記身体組織の隣接する層の修復と結合を互いに強化する様に形成されることを特徴とする、項目55に記載の手術用ステープラー。
(項目57)
上記生体適合性傷口閉鎖材料が接着材であり、上記身体組織の特性強化システムが所定量の上記接着材を上記身体組織の隣接する層の少なくとも1層に移送し、上記身体組織の隣接する層を互いに接着する様に形成されることを特徴とする、項目55に記載の手術用ステープラー。
(項目58)
上記手術用ステープラーが末端−末端吻合手術を行うためのものであることを特徴とする、項目55に記載の手術用ステープラー。
(項目59)
上記ステープルカートリッジアセンブリがステープルプッシャーを含み、上記ステープルプッシャーが互いに周辺に間隔を有するフィンガーの遠位部確定同心円リングを含み、上記フィンガーがステープル収容スロットの上記一対の環状アレーのそれぞれ一つと上記針収容スロットの環状アレーのそれぞれ一つ内に収容可能に形成されることを特徴とする、項目58に記載の手術用ステープラー。
(項目60)
個別の展開可能な針が後退位置に付勢していることを特徴とする、項目59に記載の手術用ステープラー。
(項目61)
個別の展開可能な針がばねで後退位置に付勢していることを特徴とする、項目59に記載の手術用ステープラー。
(項目62)
個別の針と上記針収容スロット内に収容し得る個別のフィンガーとの間で上記針収容スロットのアレー中に互いに配置された複数のカプセルを更に含むことを特徴とする、項目61に記載の手術用ステープラー。
(項目63)
各カプセルが所定量の生体適合性傷口閉鎖材料をカプセル化することを特徴とする、項目62に記載の手術用ステープラー。
(項目64)
各カプセルが圧縮力を加えると破裂する様になっていることを特徴とする、項目63に記載の手術用ステープラー。
(項目65)
上記針収容スロット内およびそれぞれの針収容スロットを通して収容可能な上記フィンガーの遠位方向移動により上記圧縮力がカプセルそれぞれに加えられることを特徴とする、項目64に記載の手術用ステープラー。
(項目66)
上記針収容スロット内に収容可能な上記フィンガーの遠位移動が上記複数の針を展開させることを特徴とする、項目65に記載の手術用ステープラー。
(項目67)
上記身体組織強化システムが所定量の電気エネルギーを上記身体組織の隣接する層に移送し、上記身体組織の隣接する層を互いに焼灼する様に形成されることを特徴とする、項目55に記載の手術用ステープラー。
(項目68)
上記身体組織強化システムが所定量の電気エネルギーを上記身体組織の隣接する層の少なくとも1層に移送し、上記身体組織の隣接する層を互いに焼灼する様に形成されることを特徴とする、項目55に記載の手術用ステープラー。
(項目69)
上記針収容スロット内に収容可能な上記フィンガーの遠位移動が上記複数の針を展開させることを特徴とする、項目68に記載の手術用ステープラー。
(項目70)
上記床部材が上記複数の展開可能な針のそれぞれと併設される軸方向の配列で配置される複数の接触パッドを含むことを特徴とする、項目69に記載の手術用ステープラー。
(項目71)
上記針収容スロット内に収容可能な上記複数のフィンガーのそれぞれ、および上記複数の針のそれぞれ、および上記接触パッドのそれぞれが導電性材料で製作されていることを特徴とする、項目70に記載の手術用ステープラー。
(項目72)
上記針収容スロット内に収容可能な上記複数のフィンガーのそれぞれが、上記針収容スロット内に収容し得る上記複数のフィンガーに電気エネルギーを移送する様になっている電力線に電気的に接続されていることを特徴とする、項目71に記載の手術用ステープラー。
(項目73)
上記複数の接触パッドのそれぞれが、電気エネルギーを少なくとも複数の上記接触パッドそれぞれに移送および/または接触パッドのそれぞれから発散する様になっている電力線に電気的に接続されていることを特徴とする、項目72に記載の手術用ステープラー。
(項目74)
上記針収容スロット内に収容し得る上記複数のフィンガーのそれぞれ、上記複数の針のそれぞれ、および上記接触パッドのそれぞれが電気エネルギー源に電気的に接続されていることを特徴とする、項目73に記載の手術用ステープラー。
本開示による手術用ステープラーの好ましい実施形態を図面を参照して詳細に説明するが、類似の参照番号は類似または同一の要素を示す。本明細書に用いられ、伝統的に用いられる“遠位”という用語は使用者から遠い部分を示し、一方、“近位”という用語は使用者に近い部分を示す。
Inc.))が含まれる。使用し得る封入剤には例えばフィブリン封入剤およびコラーゲン系封入剤、およびポリマー系組織封入剤が含まれる。市販される封入剤にの例には合成ポリエチレングリコール系ハイドロゲル材料(商品名:コシール(CoSealTM)、コヒージョンテクノロジーズアンドバックスターインターナショナル社(Cohesion Technologies and Baxter International,Inc.))が含まれる。用い得る止血剤の例にはフィブリン系、コラーゲン系、酸化
再生セルロース系およびゼラチン系局所止血剤が含まれる。市販される止血材料にはフィブリノーゲン−トロンビン組み合わせ材料(商品名:コスタシス(CoStasisTM)、チコヘルスケアグループ、LP;およびティッセル(TissselTM)、バクスターインターナショナル社(Baxter International,Inc.)が含まれる。
102 第一ハンドル
103 第一顎部
104 ステープルカートリッジ
106 第二ハンドル
107 第二顎部
108 ステープル床
Claims (11)
- 手術用ステープラーであって:
ステープルカートリッジを第一顎部の遠位端に収容するために適合される第一顎部であって、該ステープルカートリッジが複数の手術用ステープルと、その中に形成される複数のステープルスロットを備える作業表面を有するステープルカートリッジを含む第一顎部と、
第二顎部の遠位端にステープル床を有する第二顎部であって、手術用ステープラーの作動中に該ステープルカートリッジと該ステープル床が相互に接近し得る第二顎部と、
手術用ステープルをステープルスロットから、接近したステープル床に向かって発射するための角度付き表面を備えた駆動部材と、
生体適合性傷口封鎖材料をその中に含むための、該ステープルカートリッジ中に配置される少なくとも1つの容器と、
該ステープルカートリッジ中に形成される複数の導管であって、該少なくとも1つの容器から該ステープルカートリッジの作業表面まで連通する複数の導管と、
該容器中に配置された所定量の生体適合性傷口封鎖材料と、
該容器内に配置される内張とを備え、該駆動部材が該容器を通って遠位方向に進行されるとき、該内張が該駆動部材の角度付き表面に乗り上げ、それによって該ステープルカートリッジの導管を通って外に該傷口封鎖材料を押す、手術用ステープラー。 - さらに複数の針を備え、該複数の針の1つが、前記導管の各1つに配置される、請求項1に記載の手術用ステープラー。
- 前記複数の針が、該複数の針が前記ステープルカートリッジ内に完全に保持される第1の位置と、該複数の針が該ステープルカートリッジの前記作業表面から突き出す第2の位置を有する、請求項2に記載の手術用ステープラー。
- 前記ステープルカートリッジがさらに、前記ステープルスロット内の各1つに配置され、そして前記複数のステープルの1つを該スロットから押す位置にある複数のステープルプッシャーを備え、前記駆動部材が該ステープルプッシャーを該スロット中に移動し、そして同時に所定量の生体適合性傷口封鎖材料を前記複数の導管を通って外に放出するよう適合された、請求項1に記載の手術用ステープラー。
- 前記ステープルスロットが、1つ以上の側方に間隔を置いた列に整列される、請求項1に記載の手術用ステープラー。
- 前記生体適合性傷口封鎖材料が、タンパク質由来の、アルデヒド系の接着材である、請求項1に記載の手術用ステープラー。
- 前記生体適合性傷口封鎖材料が、アルブミン/グルタルアルデヒド材料を含む接着材である、請求項6に記載の手術用ステープラー。
- 前記生体適合性傷口封鎖材料が、シアノアクリレート系の材料を含む接着材である、請求項6に記載の手術用ステープラー。
- 前記生体適合性傷口封鎖材料が、組織密封材料である、請求項1に記載の手術用ステープラー。
- 前記生体適合性傷口封鎖材料が、合成ポリエチレングリコール系のヒドロゲル材料である、請求項1に記載の手術用ステープラー。
- 前記生体適合性傷口封鎖材料が、止血剤である、請求項1に記載の手術用ステープラー。
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US7377928B2 (en) | 2002-04-15 | 2008-05-27 | Cook Biotech Incorporated | Apparatus and method for producing a reinforced surgical staple line |
US7517356B2 (en) * | 2002-04-16 | 2009-04-14 | Tyco Healthcare Group Lp | Surgical stapler and method |
US7207471B2 (en) * | 2002-05-10 | 2007-04-24 | Tyco Healthcare Group Lp | Electrosurgical stapling apparatus |
ES2540098T3 (es) | 2002-05-10 | 2015-07-08 | Covidien Lp | Aparato grapador quirúrgico que tiene un conjunto aplicador de material para cierre de heridas |
EP1503671B1 (en) * | 2002-05-10 | 2006-10-11 | Tyco Healthcare Group Lp | Wound closure material applicator and stapler |
ES2268384T3 (es) | 2002-06-17 | 2007-03-16 | Tyco Healthcare Group Lp | Estructuras anulares de soporte. |
-
2003
- 2003-04-16 US US10/510,451 patent/US7517356B2/en active Active
- 2003-04-16 ES ES03726314T patent/ES2360613T3/es not_active Expired - Lifetime
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- 2003-04-16 EP EP11182903.2A patent/EP2404555B1/en not_active Expired - Lifetime
- 2003-04-16 EP EP03726314A patent/EP1494595B1/en not_active Expired - Lifetime
- 2003-04-16 ES ES11182903.2T patent/ES2622252T3/es not_active Expired - Lifetime
- 2003-04-16 DE DE60336213T patent/DE60336213D1/de not_active Expired - Lifetime
- 2003-04-16 CA CA2703164A patent/CA2703164C/en not_active Expired - Fee Related
- 2003-04-16 WO PCT/US2003/011778 patent/WO2003088845A2/en active Application Filing
- 2003-04-16 EP EP11182902.4A patent/EP2401971B1/en not_active Expired - Lifetime
- 2003-04-16 ES ES11182902.4T patent/ES2622453T3/es not_active Expired - Lifetime
- 2003-04-16 EP EP10172147.0A patent/EP2298187B1/en not_active Expired - Lifetime
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2008
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- 2009-06-18 JP JP2009145882A patent/JP4856741B2/ja not_active Expired - Fee Related
- 2009-12-02 US US12/629,242 patent/US8413869B2/en not_active Expired - Lifetime
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US8413869B2 (en) | 2013-04-09 |
CA2481943C (en) | 2010-08-03 |
EP2404555B1 (en) | 2017-03-15 |
DE60336213D1 (de) | 2011-04-14 |
EP1494595A2 (en) | 2005-01-12 |
ES2360613T3 (es) | 2011-06-07 |
JP2012040398A (ja) | 2012-03-01 |
EP1494595B1 (en) | 2011-03-02 |
JP4350529B2 (ja) | 2009-10-21 |
JP2009240798A (ja) | 2009-10-22 |
AU2003228556A1 (en) | 2003-11-03 |
AU2003228556B2 (en) | 2008-01-24 |
ES2622453T3 (es) | 2017-07-06 |
US20050184121A1 (en) | 2005-08-25 |
CA2703164C (en) | 2013-10-08 |
JP2006506106A (ja) | 2006-02-23 |
US20080230583A1 (en) | 2008-09-25 |
EP2401971A2 (en) | 2012-01-04 |
EP2401971A3 (en) | 2012-09-05 |
US7635073B2 (en) | 2009-12-22 |
ES2622252T3 (es) | 2017-07-06 |
CA2703164A1 (en) | 2003-10-30 |
US20100076429A1 (en) | 2010-03-25 |
EP2404555A3 (en) | 2012-09-05 |
EP2401971B1 (en) | 2017-03-15 |
EP2404555A2 (en) | 2012-01-11 |
ES2631512T3 (es) | 2017-08-31 |
EP2298187A1 (en) | 2011-03-23 |
WO2003088845A2 (en) | 2003-10-30 |
EP2298187B1 (en) | 2017-06-07 |
WO2003088845A3 (en) | 2004-04-08 |
CA2481943A1 (en) | 2003-10-30 |
US7517356B2 (en) | 2009-04-14 |
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