JP5259071B2 - エンド・エフェクター支持部付き手術用ステープラー - Google Patents
エンド・エフェクター支持部付き手術用ステープラー Download PDFInfo
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- 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
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- 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
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2933—Transmission of forces to jaw members camming or guiding means
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2939—Details of linkages or pivot points
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2939—Details of linkages or pivot points
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Description
本発明は、概して手術用装置に関し、特にエンド・エフェクター用の支持部を有する手術用ステープラーおよび/またはカッターに関するものである。
内視鏡下および腹腔鏡下手術用器械は、従来の開腹手術用装置よりも好まれることがよくある。これは、自然な開口部(内視鏡下)または小さな切開部(腹腔鏡下)を使用すると、術後の回復時間を短縮し、合併症を減らすのに役立つからである。この結果、著しい発展があって、内視鏡下および腹腔鏡下手術用の器械が、遠位エンド・エフェクターを所望の手術部位に正確に配置するのに適した域まで達した。このような遠位エンド・エフェクターは、多くの方法で組織と係合し、診断または治療の効果(例えば、エンドカッター、異物鉗子、カッター、ステープラー、クリップアプライヤ(clip applier)、アクセスデバイス(access device)、薬物/遺伝子治療送達装置、および超音波、RF、レーザ等を用いるエネルギー装置)を達成する。
本発明は、概して、手術用ステープラーおよび/またはカッターのアンビルを支持するための方法および装置を提供するものである。ある実施形態では、手術用ステープラーが、1つ以上のステープルを保持するためのカートリッジアームを有するエンド・エフェクターと、そのカートリッジアームに軸回転するように連結されていて、ステープルを変形させるのに有効であるアンビルとを含むことがある。この装置には、さらに支持部を含んでいることがあり、この支持部は、1つ以上のステープルをカートリッジアームから打ち出し、アンビルにあてて変形させるときに、エンド・エフェクターに接触して、アンビルの撓みを小さくするように構成されている。典型的な実施形態では、カートリッジアームが少なくとも1つの一直線の列となっている複数のステープルを保持するように構成されていることがある。エンド・エフェクターおよび支持部はまた、他の実施形態では、支持部が折り畳まれた位置にあるときに、約16mmより小さい最大外径を有し、エンド・エフェクターを小さい開口部またはオリフィスに入れることが可能である。
一般的に、ステープルを組織に送るためのエンド・エフェクターと、エンド・エフェクターの撓みを防止するための支持部とを有する外科手術用ステープラーおよび/またはカッターを提供する。具体的には、エンド・エフェクターが、ステープルを支持するように構成されているカートリッジアームと、カートリッジアームに軸回転するように連結されていて、カートリッジアームから打ち出されたステープルを変形させるように構成されているアンビルとを有することがある。支持部は、エンド・エフェクターと連結していることがあり、また、支持部は、アンビルアームがカートリッジアームに対して軸回転できる第1の折畳み位置と、支持部がアンビルと係合していて、1つ以上のステープルがカートリッジアームから打ち出され、アンビルにあたって変形するときに、アンビルの撓みを実質的に制限する第2の伸長位置との間で可動であることがある。支持部は、1つ以上の、直線状に並んだステープル列またはステープル・ラインを送る比較的長いエンド・エフェクターがある細く長い手術用ステープラーおよび/またはカッターで使用する場合に特に有効である。これは、この支持部が、複数ステープルからなる長いラインを取り付ける間に、アンビルの遠位端の撓みを実質的に防止できるからである。例えば、手術用ステープラーは、長さが約60mmから90mmの範囲内にあるエンド・エフェクターを有することがある。支持部は、内視鏡下および腹腔鏡下の処置で使用する場合にも、特に有効である。なぜなら、支持部を折り畳むことができ、エンド・エフェクターと支持部を自然な開口部(例えば、のど)を通して、あるいは、カニューレやその他の小さな経路のような小さなアクセスポートを通して導入できることがあるからである。例えば、典型的な実施形態では、エンド・エフェクターと支持部が、支持部が折畳まれた位置にあるときに約16mmより小さい最大外径を有することがあり、支持部を約16mm以下の径を有する経路を介して挿入することが可能であることがある。当業者には分かるであろうが、この支持部はさまざまな留め具搬送装置に使用でき、また、本明細書で開示する直線状ステープラーは、単に参考目的のために示すものである。
(1) 手術用ステープラーにおいて、
少なくとも1つのステープルを保持するためのカートリッジアーム、および、前記カートリッジアームに軸回転するように連結されており、前記少なくとも1つのステープルを変形させるのに有効であるアンビル、を有するエンド・エフェクターと、
前記エンド・エフェクターに連結されている支持部であって、前記アンビルおよび前記カートリッジアームが互いに対して軸回転できる近位位置と、前記支持部が前記エンド・エフェクターの少なくとも中央部分と係合して、少なくとも1つのステープルが前記カートリッジアームから打ち出され、前記アンビルにあてて変形されるときに、前記カートリッジアームに対する前記アンビルの撓みを防止する遠位位置との間で可動である、支持部と、
を備える、手術用ステープラー。
前記支持部は、前記近位位置にあるときには、前記エンド・エフェクターと軸方向に位置が揃っており、前記遠位位置にあるときには、前記エンド・エフェクターに対して実質的に横方向に広がっている、手術用ステープラー。
(3) 実施態様1記載の手術用ステープラーにおいて、
前記支持部は、前記アンビルにスライド可能に連結されたリンク機構を含む、手術用ステープラー。
(4) 実施態様3記載の手術用ステープラーにおいて、
前記リンク機構は、
前記エンド・エフェクターから近位方向に延びている細長いシャフトに軸回転するように連結されている近位リンク部と、
一方の端部において前記近位リンク部に軸回転するように連結されており、反対側の端部で前記アンビルに軸回転するように連結されている遠位リンク部と、
を含む、
手術用ステープラー。
前記遠位リンク部は、前記アンビルと前記カートリッジアームとの間に形成された軸回転連結部に対して遠位の位置で前記アンビルに連結されている、手術用ステープラー。
(6) 実施態様1記載の手術用ステープラーにおいて、
前記支持部は、前記アンビルの少なくとも一部にわたってスライド可能に配置できるスリーブを含む、手術用ステープラー。
(7) 実施態様1記載の手術用ステープラーにおいて、
前記エンド・エフェクターに連結されており、前記アンビルを前記カートリッジアームの方へ押しつけるように構成されている作動部、
をさらに備えている、手術用ステープラー。
(8) 実施態様1記載の手術用ステープラーにおいて、
前記支持部は、前記アンビルを前記カートリッジアームの方へ押しつけるように構成されている、手術用ステープラー。
複数のステープルを保持するように構成されているカートリッジアームと、
近位端および遠位端を有するアンビルであって、前記近位端が前記カートリッジアームに回転軸において連結されている、アンビルと、
前記アンビルに可動に連結されている支持部であって、前記回転軸より遠位の位置で前記アンビルに接触して、複数のステープルが前記カートリッジアームから打ち出され、前記アンビルにあてて変形されるときに、前記アンビルの撓みを減らすように構成されている、支持部と、
を備える、手術用ステープラー。
(10) 実施態様9記載の手術用ステープラーにおいて、
前記支持部は、前記アンビルが前記回転軸回りに動くことができる近位位置と、前記支持部が前記回転軸回りに前記アンビルが動くことを防止する遠位位置との間を動くことができる、手術用ステープラー。
前記支持部は、互いに軸回転するように連結されている少なくとも2つのリンク部を有し、前記リンク部の少なくとも1つは、前記アンビルにスライド可能に連結されている、手術用ステープラー。
(12) 実施態様9記載の手術用ステープラーにおいて、
前記支持部は、
前記アンビルにスライド可能に連結された遠位リンク部と、
一方の端部において前記遠位リンク部に軸回転するように連結されており、反対側の端部において、前記カートリッジアームから近位方向に延びている細長いシャフトに軸回転するように連結されている近位リンク部と、
一方の端部において前記細長いシャフト部に軸回転するように連結されており、反対側の端部において前記遠位リンク部および前記近位リンク部に軸回転するように連結されている中間リンク部と、
を備えている、
手術用ステープラー。
前記支持部の前記アンビルに対する遠位方向の動きを制限するように構成されている停止部、
をさらに備えている、手術用ステープラー。
(14) 実施態様13記載の手術用ステープラーにおいて、
前記停止部が、
前記アンビルに形成された細長いスロットと、
前記支持部に連結されていて、かつ、前記細長いスロットにスライド可能に配置されているピン部材と、
を含む、
手術用ステープラー。
(15) 実施態様14記載の手術用ステープラーにおいて、
前記アンビルにある前記細長いスロットは、前記アンビルの前記遠位端に対して近位側で終端している、手術用ステープラー。
前記支持部は、前記アンビルの上にスライド可能に配置できるスリーブを含む、手術用ステープラー。
(17) 実施態様9記載の手術用ステープラーにおいて、
前記カートリッジアームは、ステープルカートリッジを有し、前記ステープルカートリッジは、前記カートリッジアーム内に配置されており、少なくとも1つのまっすぐな列に配列された複数のステープルを収容している、手術用ステープラー。
(18) 実施態様9記載の手術用ステープラーにおいて、
前記カートリッジアームおよび前記アンビルは、少なくとも60mmの長さを有する、手術用ステープラー。
前記カートリッジアームおよび前記アンビルは、少なくとも90mmの長さを有する、手術用ステープラー。
(20) 実施態様10記載の手術用ステープラーにおいて、
前記カートリッジアーム、前記アンビル、および前記支持部は、前記支持部が近位位置にあるときに、最大外径が16mm未満である、手術用ステープラー。
(21) 組織をステープル留めする方法において、
手術用ステープラーのカートリッジとアンビルとの間に組織を配置する段階と、
支持部を前記アンビルに対して前進させて、前記アンビルの前記カートリッジに対する動きを妨げる段階と、
少なくとも1つのステープルを前記カートリッジから打ち出し、前記アンビルと前記カートリッジとの間に配置された組織に通し、前記アンビルにあてて前記ステープルを変形させることで前記組織をステープル留めする段階と、
を含む、方法。
組織を配置する前に、前記手術用ステープラーを、アクセスチューブ(access tube)を介して挿入する、方法。
(23) 実施態様21記載の方法において、
少なくとも1つのステープルを打ち出す前に、前記アンビルと前記カートリッジとの間の組織をユーザが決めた期間打つ(impinging)、方法。
(24) 実施態様21記載の方法において、
前記少なくとも1つのステープルを打ち出す段階は、少なくとも一列に配列された複数のステープルを打ち出す段階を含む、方法。
Claims (7)
- 手術用ステープラーにおいて、
少なくとも1つのステープルを保持するためのカートリッジアーム、及び、前記カートリッジアームに軸回転するように連結されており、前記少なくとも1つのステープルを変形させるのに有効であるアンビル、を有するエンド・エフェクターと、
遠位端部を有し、前記エンド・エフェクターに連結されている支持部であって、前記遠位端部が、
前記アンビル及び前記カートリッジアームが最開位置と最閉位置との間を軸回転できるようにする最近位位置と、
前記支持部の前記遠位端部が前記エンド・エフェクターの中央部分と係合して、少なくとも1つのステープルが前記カートリッジアームから打ち出され、前記アンビルにあてて変形されるときに、前記アンビルの撓みを防止する最遠位位置と、
の間で移動可能である、支持部と、
を備え、
前記支持部は、前記近位位置にあるときには、前記エンド・エフェクターと軸方向に位置が揃っており、前記遠位位置にあるときには、前記エンド・エフェクターの軸方向に直交する向きに広がっている、手術用ステープラー。 - 請求項1記載の手術用ステープラーにおいて、
前記支持部は、前記アンビルにスライド可能に連結されたリンク機構を含む、手術用ステープラー。 - 請求項2記載の手術用ステープラーにおいて、
前記リンク機構は、
前記エンド・エフェクターから近位方向に延びている細長いシャフトに軸回転するように連結されている近位リンク部と、
一方の端部において前記近位リンク部に軸回転するように連結されており、反対側の端部で前記アンビルに軸回転するように連結されている遠位リンク部と、
を含む、
手術用ステープラー。 - 請求項3記載の手術用ステープラーにおいて、
前記遠位リンク部は、前記アンビルと前記カートリッジアームとの間に形成された軸回転連結部に対して遠位の位置で前記アンビルに連結されている、手術用ステープラー。 - 請求項1記載の手術用ステープラーにおいて、
前記支持部は、前記アンビルの少なくとも一部にわたってスライド可能に配置できるスリーブを含む、手術用ステープラー。 - 請求項1記載の手術用ステープラーにおいて、
前記エンド・エフェクターに連結されており、前記アンビルを前記カートリッジアームの方へ押しつけるように構成されている作動部、
をさらに備えている、手術用ステープラー。 - 請求項1記載の手術用ステープラーにおいて、
前記支持部は、前記アンビルを前記カートリッジアームの方へ押しつけるように構成されている、手術用ステープラー。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
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US11/163,243 US8096459B2 (en) | 2005-10-11 | 2005-10-11 | Surgical stapler with an end effector support |
US11/163,243 | 2005-10-11 |
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JP2007105471A JP2007105471A (ja) | 2007-04-26 |
JP5259071B2 true JP5259071B2 (ja) | 2013-08-07 |
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US (1) | US8096459B2 (ja) |
EP (1) | EP1774916B1 (ja) |
JP (1) | JP5259071B2 (ja) |
CN (1) | CN1947663B (ja) |
AT (1) | ATE423516T1 (ja) |
AU (1) | AU2006222747B2 (ja) |
BR (1) | BRPI0604289B8 (ja) |
CA (1) | CA2563014C (ja) |
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DE (1) | DE602006005301D1 (ja) |
DK (1) | DK1774916T3 (ja) |
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HK (1) | HK1103002A1 (ja) |
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US5865361A (en) | 1997-09-23 | 1999-02-02 | United States Surgical Corporation | Surgical stapling apparatus |
US10835307B2 (en) | 2001-06-12 | 2020-11-17 | Ethicon Llc | Modular battery powered handheld surgical instrument containing elongated multi-layered shaft |
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JP2007105471A (ja) | 2007-04-26 |
BRPI0604289B8 (pt) | 2021-06-22 |
ATE423516T1 (de) | 2009-03-15 |
EP1774916B1 (en) | 2009-02-25 |
CN1947663B (zh) | 2010-09-29 |
BRPI0604289A (pt) | 2007-08-21 |
CA2563014A1 (en) | 2007-04-11 |
AU2006222747B2 (en) | 2013-01-17 |
CN1947663A (zh) | 2007-04-18 |
DE602006005301D1 (de) | 2009-04-09 |
PT1774916E (pt) | 2009-04-03 |
HK1103002A1 (en) | 2007-12-14 |
DK1774916T3 (da) | 2009-05-18 |
BRPI0604289B1 (pt) | 2018-05-02 |
AU2006222747A1 (en) | 2007-04-26 |
PL1774916T3 (pl) | 2009-07-31 |
EP1774916A1 (en) | 2007-04-18 |
CY1109853T1 (el) | 2014-09-10 |
CA2563014C (en) | 2014-05-20 |
SI1774916T1 (sl) | 2009-08-31 |
US20070083233A1 (en) | 2007-04-12 |
US8096459B2 (en) | 2012-01-17 |
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