JP4934188B2 - シース導入装置 - Google Patents
シース導入装置 Download PDFInfo
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- JP4934188B2 JP4934188B2 JP2009298930A JP2009298930A JP4934188B2 JP 4934188 B2 JP4934188 B2 JP 4934188B2 JP 2009298930 A JP2009298930 A JP 2009298930A JP 2009298930 A JP2009298930 A JP 2009298930A JP 4934188 B2 JP4934188 B2 JP 4934188B2
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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
- A61B17/3431—Cannulas being collapsible, e.g. made of thin flexible material
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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
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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
- A61B17/3439—Cannulas with means for changing the inner diameter of the cannula, e.g. expandable
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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
- A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
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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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- 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
- A61B17/1155—Circular staplers comprising a plurality of staples
-
- 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
- A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
- A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
- A61B2017/349—Trocar with thread on outside
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- Surgical Instruments (AREA)
- Media Introduction/Drainage Providing Device (AREA)
Description
本開示は、2002年11月22日に出願された米国仮出願第60/429,049号の利益およびそれに対する優先権を主張し、その全体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、外科用器具導入システムおよび使用の方法に、そしてより詳細には、半径方向に拡張可能なシースを利用し、かつ比較的小さな切開を通る比較的大きな接近面積を可能にする導入システムおよびそれを用いる方法に関する。
組織に環状アレイのステープラを付与するために外科用ステープラは、当該技術分野で周知である。これらのステープラは、代表的には、遠位端に提供されるステープラアセンブリを含む。このステープラアセンブリは、一般に、ステープラのアレイ、アンビルおよびこれらステープラをアンビルに対して追い出すための構造を含む。このアンビルは、対応する、それに対してステープラが形成されるバケット形状部材のアレイを含む。
材を半径方向に拡張するために用いられ、そして器具のための接近を提供する。拡大部材を拡張することで、拡張部材を拡大部材中に導入するために力が付与されなければならない。この拡張部材を導入し、かつ拡大部材を拡張するために必要な力を減少するための手段を提供することが所望される。
本開示は、半径方向に拡張可能なシースを利用し、そして比較的小さな切開を通る比較的大きな接近領域を可能にする導入システムおよびそれを使用する方法に関する。
より特定すれば、本願発明は以下の項目に関し得る。
(項目1)
患者の身体中の開口部を通る接近を可能にするシースシステムであって:
非拡張状態にあるとき第1の断面積を有する管腔を規定する半径方向に拡張可能な管状シース、および上記管状シースの近位端に作動可能に連結されたハンドルアセンブリを有する拡大アセンブリであって、上記ハンドルアセンブリが、その中に形成されたアパーチャ、およびそのアパーチャ中にあるハンドル上に規定される第1のねじを規定する拡大アセンブリ;および
上記拡大アセンブリの管状シースの第1の断面積より大きい第2の断面積を有する管腔を規定する管状部材を含み、かつ第2のねじを規定する外表面を有し、上記第2のねじが上記第1のねじを係合するために配列されている拡張アセンブリを備える、シースシステム。
(項目2)
上記半径方向に拡張可能なシースが上記非拡張状態にあるとき、上記半径方向に拡張可能なシースの管腔中に受容されるサイズの導入器をさらに備える、項目1に記載のシースシステム。
(項目3)
上記拡張アセンブリの管状部材が、上記拡大アセンブリのハンドルアセンブリ中に形成されたアパーチャ内に除去可能に受容されるような形態および寸法である、項目1に記載のシースシステム。
(項目4)
上記拡大アセンブリの管状シースが、個々のフィラメントのメッシュを備える、項目2に記載のシースシステム。
(項目5)
上記フィラメントが、上記管状シースの半径方向の拡張が上記管状シースの軸方向短縮化を引き起こすように弾性である、項目4に記載のシースシステム。
(項目6)
上記管状シースが、個々のフィラメントの管状編み組みを備える、項目2に記載のシースシステム。
(項目7)
上記導入器のシャフトが、上記管状シースの管腔内に除去可能に受容可能である、項目2に記載のシースシステム。
(項目8)
上記拡張アセンブリの管状部材の遠位進行が、上記管状シースの上記第1の断面積から第2の断面積への半径方向拡張を生じる、項目3に記載のシースシステム。
(項目9)
上記拡張アセンブリの近位端にシールをさらに備える、項目8に記載のシースシステム。
(項目10)
上記シールが、エラストマーポリマー材料およびポリイソプレンの少なくとも1つから作製される、項目9に記載のシースシステム。
(項目11)
上記拡張アセンブリの管状部材の管腔内に除去可能に受容される形態および寸法である拡大器をさらに備える、項目8に記載のシースシステム。
(項目12)
上記拡大器の遠位端がテーパー状である、項目11に記載のシースシステム。
(項目13)
上記拡大器の遠位端がねじを規定する、項目12に記載のシースシステム。
(項目14)
上記拡大器が、上記拡大器が上記管状部材の管腔内に受容されるとき、そのテーパー状遠位端が上記管状部材の遠位端を超えて延びるような長さを有する、項目12に記載のシースシステム。
(項目15)
上記導入器のシャフトが、上記導入器が上記管状シースの管腔内に受容されるとき、その遠位端が上記管状シースの遠位端を超えて延びるような長さを有する、項目14に記載のシースシステム。
(項目16)
上記拡張アセンブリの近位端に除去可能に取り付けられる形態および寸法のコンバーターをさらに備え、上記コンバーターがその中に形成されたアパーチャを含み、上記コンバーターのアパーチャが、上記拡張アセンブリのシール中に形成された開口部の断面積より小さい断面積を有する、項目9に記載のシースシステム。
(項目17)
患者の身体中の開口部を通る接近を可能にするシースシステムを用いる方法であって:
管腔を規定する半径方向に拡張可能なシース、およびアパーチャおよび上記アパーチャ中の第1のねじを規定する近位ハウジングを有する拡大アセンブリを、患者の身体中の開口部中に挿入する工程;および第2のねじを規定する外表面をもつ管状部材を有する拡張アセンブリを、上記拡大アセンブリの管腔中に導入する工程であって、上記拡大アセンブリの管腔および上記患者の身体中の開口部を半径方向に拡張し、上記導入が、上記第1のねじを第2のねじと係合することを含む工程、を包含する、方法。
(項目18)
上記拡大アセンブリを挿入する工程の前に、上記拡大アセンブリ中に導入器を挿入する工程をさらに包含する、項目17に記載の方法。
(項目19)
上記拡張アセンブリを導入する工程の前に、上記拡張アセンブリ中に拡大器を挿入する工程をさらに包含する、項目17に記載の方法。
(項目20)
上記拡大アセンブリの管腔が第1の断面積を有し、そして上記拡張アセンブリの管腔が拡大アセンブリの管腔の第1の断面積より大きい第2の断面積を有する、項目17に記載の方法。
(項目21)
上記シースが個々のフィラメントのメッシュから作製される、項目20に記載の方法。
(項目22)
上記管状シースの半径方向拡張が、上記シースの軸方向短縮化を引き起こす、項目21に記載の方法。
(項目23)
上記拡張アセンブリの導入が、上記拡大アセンブリのシースを通る上記拡張アセンブリの管状部材の遠位進行を含み、上記シースの半径方向拡張を生じる、項目17に記載の方法。
(項目24)
上記第1のねじが第2のねじと係合することが、上記拡大アセンブリに対する上記管状部材の回転を含む、項目17に記載の方法。
(項目25)
上記拡張アセンブリが上記管状部材の管腔を横切って配置されたシールを含み、上記シールがその中に形成された開口部を含む項目17に記載の方法であって、上記シールの開口部を通って上記管状部材中への器具を導入する工程をさらに含む、方法。
(項目26)
上記管状部材の近位端にコンバーターを除去可能に取り付ける工程をさらに含む項目25に記載の方法であって、上記コンバーター中に形成された開口部が、上記シール内に形成された開口部の断面積より小さい断面積を有する、方法。
(項目27)
患者の身体中の開口部を通る接近を提供する方法であって:
皮膚切開を作製する工程;
上記皮膚切開中に、管腔を規定する半径方向に拡張可能なシースおよび上記管腔内に配置された平滑末端導入器を有する拡大アセンブリを挿入する工程;
上記管腔から上記平滑末端導入器を除去する工程;および
管状部材を有する拡張アセンブリを上記拡大アセンブリの管腔中に導入する工程であって、上記拡大アセンブリの管腔および上記患者の身体中の切開を半径方向に拡大する工程、を包含する、方法。
(項目28)
上記拡張アセンブリが上記拡大アセンブリの管腔中に導入されるとき、上記管状部材中に拡大器が配置される、項目27に記載の方法。
現在開示されるシースシステムの好ましい実施形態は、ここで、描写した図面を詳細に参照して説明され、そこでは、同様の参照番号は、類似または同一の要素を識別する。以下の図面および説明において、用語「近位」は、伝統的であるように、オペレーターに最も近い本開示のシースシステムの端部をいい、その一方、用語「遠位」は、オペレーターから最も遠いシースシステムの端部をいう。
。ロッド800は、腹部壁「A」中に形成された切開を開放状態に、拡張アセンブリ400および拡大器300がロッド800上を切開中に挿入されるまで維持する(図27を参照のこと)。拡張アセンブリ400および拡大器は、図1および3〜11と組み合わせて上記で論議されるようである。拡大器300の管腔304は、拡張アセンブリ400および拡大器300が挿入されるときロッド800を受容する。次に、ロッド800は、除去される(図28を参照のこと)。拡大器300は、次いで、拡張アセンブリ400から除去される(図29を参照のこと)。望ましくは、拡大器300の管腔304は、ロッド800とほぼ同じサイズであり、そして拡大器300のテーパーは、管状部材402のより大きな直径のサイズまで腹部壁「A」中に形成された切開を拡張する。
100 拡大アセンブリ
400 拡張アセンブリ
300 導入器
Claims (27)
- 患者の身体中の開口部を通る接近を可能にするシースシステムであって:
非拡張状態にあるとき第1の断面積を有する管腔を規定する半径方向に拡張可能な管状シース、および該管状シースの近位端に作動可能に連結されたハンドルアセンブリを有する拡大アセンブリであって、該ハンドルアセンブリが、その中に形成された開口部、および該開口部の周縁表面に沿って形成される第1のねじを規定する拡大アセンブリ;および
該拡大アセンブリの管状シースの第1の断面積より大きい第2の断面積を有する管腔を規定する管状部材を含み、該管状部材が、少なくとも該管状部材の遠位端にすぐ近接する位置から該管状部材の近位端にすぐ近接する位置まで該管状部材の実質的に全長に沿って形成された第2のねじを規定する外表面を有し、該第2のねじが、該管状部材を該管状シースを通って該全長に沿って軸方向に進行するために該第1のねじを係合するように配列されている拡張アセンブリを備える、シースシステム。 - 前記半径方向に拡張可能なシースが前記非拡張状態にあるとき、該半径方向に拡張可能なシースの管腔中に受容されるサイズの導入器をさらに備える、請求項1に記載のシースシステム。
- 前記拡張アセンブリの管状部材が、前記拡大アセンブリのハンドルアセンブリ中に形成された開口部内に除去可能に受容されるような形態および寸法である、請求項1に記載のシースシステム。
- 前記拡大アセンブリの管状シースが、個々のフィラメントのメッシュを備える、請求項2に記載のシースシステム。
- 前記フィラメントが、前記管状シースの半径方向の拡張が該管状シースの軸方向短縮化を引き起こすように弾性である、請求項4に記載のシースシステム。
- 前記管状シースが、個々のフィラメントの管状編み組みを備える、請求項2に記載のシースシステム。
- 前記導入器のシャフトが、前記管状シースの管腔内に除去可能に受容可能である、請求項2に記載のシースシステム。
- 前記拡張アセンブリの管状部材の遠位進行が、前記管状シースの前記第1の断面積から第2の断面積への半径方向拡張を生じる、請求項3に記載のシースシステム。
- 前記拡張アセンブリの近位端にシールをさらに備える、請求項8に記載のシースシステム。
- 前記シールが、エラストマーポリマー材料およびポリイソプレンの少なくとも1つから作製される、請求項9に記載のシースシステム。
- 前記拡張アセンブリの管状部材の管腔内に除去可能に受容される形態および寸法である拡大器をさらに備える、請求項8に記載のシースシステム。
- 前記拡大器の遠位端がテーパー状である、請求項11に記載のシースシステム。
- 前記拡大器の遠位端がねじを規定する、請求項12に記載のシースシステム。
- 前記拡大器が、該拡大器が前記管状部材の管腔内に受容されるとき、そのテーパー状遠位端が該管状部材の遠位端を超えて延びるような長さを有する、請求項12に記載のシースシステム。
- 前記導入器のシャフトが、該導入器が前記管状シースの管腔内に受容されるとき、その遠位端が該管状シースの遠位端を超えて延びるような長さを有する、請求項14に記載のシースシステム。
- 前記拡張アセンブリの近位端に除去可能に取り付けられる形態および寸法のコンバーターをさらに備え、該コンバーターがその中に形成された開口部を含み、該コンバーターの開口部が、該拡張アセンブリのシール中に形成された開口部の断面積より小さい断面積を有する、請求項9に記載のシースシステム。
- 患者の身体中の開口部を通る接近を可能にするシースシステムであって:
管腔を規定する半径方向に拡張可能なシース、および開口部および該開口部の周縁表面に沿って形成される第1のねじを規定する近位ハウジングを有する拡大アセンブリを、患者の身体中の開口部中に挿入する手段;および
少なくとも該管状部材の遠位端にすぐ近接する位置から該管状部材の近位端にすぐ近接する位置まで該管状部材の実質的に全長に沿って形成された第2のねじを規定する外表面をもつ管状部材を有する拡張アセンブリを、該拡大アセンブリの管腔中に導入する手段であって、該拡大アセンブリの管腔および該患者の身体中の開口部を半径方向に拡張し、該導入が、該管状部材を該管状シースを通って該全長に沿って軸方向に進行するために該第1のねじを第2のねじと係合することを含む手段、を備える、システム。 - 前記拡大アセンブリを挿入する前に、該拡大アセンブリ中に導入器を挿入するための手段をさらに備える、請求項17に記載のシステム。
- 前記拡張アセンブリを導入する前に、該拡張アセンブリ中に拡大器を挿入する手段をさらに包含する、請求項17に記載のシステム。
- 前記拡大アセンブリの管腔が第1の断面積を有し、そして前記拡張アセンブリの管腔が拡大アセンブリの管腔の第1の断面積より大きい第2の断面積を有する、請求項17に記載のシステム。
- 前記シースが個々のフィラメントのメッシュから作製される、請求項20に記載のシステム。
- 前記管状シースの半径方向拡張が、該シースの軸方向短縮化を引き起こす、請求項21に記載のシステム。
- 前記拡張アセンブリの導入が、前記拡大アセンブリのシースを通る該拡張アセンブリの管状部材の遠位進行を含み、該シースの半径方向拡張を生じる、請求項17に記載のシステム。
- 前記第1のねじが第2のねじと係合することが、前記拡大アセンブリに対する前記管状部材の回転を含む、請求項17に記載のシステム。
- 前記拡張アセンブリが前記管状部材の管腔を横切って配置されたシールを含み、該シールがその中に形成された開口部を含む請求項17に記載のシステムであって、該シールの開口部を通って該管状部材中への器具を導入する手段をさらに含む、システム。
- 前記管状部材の近位端にコンバーターを除去可能に取り付ける手段をさらに含む請求項25載のシステムであって、該コンバーター中に形成された開口部が、前記シール内に形成された開口部の断面積より小さい断面積を有する、システム。
- 前記拡張アセンブリが前記拡大アセンブリの管腔中に導入されるとき、前記管状部材中に拡大器が配置される、請求項1に記載のシステム。
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-
2003
- 2003-11-24 WO PCT/US2003/037540 patent/WO2004047654A2/en active Application Filing
- 2003-11-24 US US10/720,510 patent/US7896897B2/en not_active Expired - Fee Related
- 2003-11-24 EP EP03787091A patent/EP1562493B1/en not_active Expired - Fee Related
- 2003-11-24 ES ES03787091T patent/ES2340379T3/es not_active Expired - Lifetime
- 2003-11-24 AU AU2003295878A patent/AU2003295878B2/en not_active Ceased
- 2003-11-24 DE DE60331463T patent/DE60331463D1/de not_active Expired - Lifetime
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- 2003-11-24 JP JP2004555675A patent/JP4456488B2/ja not_active Expired - Fee Related
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Also Published As
Publication number | Publication date |
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JP2006507097A (ja) | 2006-03-02 |
CA2505638A1 (en) | 2004-06-10 |
AU2003295878B2 (en) | 2008-07-10 |
DE60331463D1 (de) | 2010-04-08 |
WO2004047654A3 (en) | 2004-08-26 |
ES2340379T3 (es) | 2010-06-02 |
EP1562493A2 (en) | 2005-08-17 |
EP1562493B1 (en) | 2010-02-24 |
JP2010104802A (ja) | 2010-05-13 |
AU2003295878A1 (en) | 2004-06-18 |
US7896897B2 (en) | 2011-03-01 |
WO2004047654A2 (en) | 2004-06-10 |
JP4456488B2 (ja) | 2010-04-28 |
US20110144618A1 (en) | 2011-06-16 |
US20040172041A1 (en) | 2004-09-02 |
CA2505638C (en) | 2011-10-25 |
US8753368B2 (en) | 2014-06-17 |
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