JP5302344B2 - 手術器具アクセス装置 - Google Patents
手術器具アクセス装置 Download PDFInfo
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- 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/024—Detecting, measuring or recording pulse rate or heart rate
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves
- A61B5/0507—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves using microwaves or terahertz waves
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- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0293—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with ring member to support retractor elements
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- A—HUMAN NECESSITIES
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- 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
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- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
- A61B5/6887—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient mounted on external non-worn devices, e.g. non-medical devices
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Description
本発明は、広くは、体壁を横切って体腔内へ手術器具により密封アクセスすることを容易にする装置に関する。
図1には、患者の全身が参照番号10で示されている。患者10は手術台15上で仰向け状態にあるところが示されており、この状態で、腹壁25を通して行われる器具アクセスを用いて、腹腔20内の手術が行われる。一般に腹腔鏡手術と呼ばれているこの手術形式では、グラスパ(把握器)40および内視鏡45等の器具を腹壁に通して最小侵襲アクセスを行うのに、一般にトロカール30、35が使用される。
上記概説にもかかわらず、腹腔鏡手術に関しては、37mmまでの直径をもつ器具を、同じアクセス装置を用いて、腹壁25を通して腹腔20内に挿入できることがしばしば望まれることに留意することが重要である。器具のこの挿入により、外科医は、アクセス装置を交換したり多数のアクセス装置を使用する必要なくして、種々の解剖学的構造要素への直接的アクセスを行うことが可能になる。
特に腹腔鏡手術の場合には、腹壁25を持上げて腹腔20内の作業空間の体積を増大させるため、二酸化炭素のようなガスを腹腔20内に注入するのが有利である。一般に気腹術と呼ばれているこの注入圧力の維持は、アクセスが、例えばトロカール30、35並びにアクセス装置55を腹壁25に通すことが望まれる場合に特に困難である。このため、グラスパ40および内視鏡45等の器具が存在する場合および存在しない場合の両方におけるシーリング特性を有するこのようなアクセス装置を提供することに大きな努力が払われてきた。
接着剤リング90の機能は、多くの異なる材料および形状を用いて種々の方法で達成できることは理解されよう。例えば、切開部50上の所定位置にパッド65を維持するのに、接着剤以外の多くの材料を使用できる。切開部50の周囲のシールの形成は、接着剤以外の方法で達成することもできる。また、接着剤85により形成された連続シールの形状は、必ずしも円形である必要はない。それどころか、切開部50の回りに囲いを形成するのに充分な大きさを有するものであれば、あらゆる連続パターンが所望のシーリング関係を形成できる。
以上、本発明を或る構造形態に関連して開示したが、これらの開示は、本発明の多くの異なる実施形態の単なる例示であることは理解されよう。従って、本発明の概念はここに開示した実施形態のみに限定されるものではなく、本発明の範囲は、特許請求の範囲の記載のみを参照して決定すべきである。
60 アクセスチャネル
65 パッド
75 スリッド
85 接着剤
100 ゲルキャップ
102 キャップリング
105 ベース
110 開創器
125 保護シールド(スリーブ)
140b 隆起壁
145b 環状リップ
155 内方リング
160 外方リング
165 可撓性スリーブ
200 テンプレート
Claims (29)
- 患者の切開部に対する配置に適合させる手術用アクセス装置であって、37mmまでの直径を有する手術器具をアクセス装置を通して挿入しかつ手術器具とのシーリング関係を維持する手術用アクセス装置において、
ゲル材料およびアクセスチャネルを備えた弁構造を有し、
アクセスチャネルは、患者の切開部に連通するように延びている保護スリーブを備えており、
ゲル材料はエラストマを含み、
前記弁構造は更に、前記ゲル材料に挿入され、またはモールド成形されたキャップリングを有しており、
前記保護スリーブは、前記キャップリングの内径部の周囲に接合され、またはモールド成形され、患者の切開部を通して手術時に延びることを特徴とする手術用アクセス装置。 - 前記エラストマはシリコーンを含むことを特徴とする請求項1記載の手術用アクセス装置。
- 前記エラストマはウレタンを含むことを特徴とする請求項1記載の手術用アクセス装置。
- ウレタンにより発泡ゲルを形成する発泡剤を更に有することを特徴とする請求項3記載の手術用アクセス装置。
- 前記ゲル材料は、ウレタン、ポリ塩化ビニル、イソプレン、スチレン−エチレン−ブチレン−スチレン、オイルおよび発泡剤の少なくとも1つを含むことを特徴とする請求項1記載の手術用アクセス装置。
- 前記エラストマはベースおよびオイルを含み、オイルは、ベースによりエラストマのオイル混合物を形成することを特徴とする請求項1記載の手術用アクセス装置。
- 前記オイルは、植物油、石油およびシリコーンオイルの少なくとも1つを含むことを特徴とする請求項6記載の手術用アクセス装置。
- 前記保護スリーブは、器具の挿入時および引抜き時に創傷の保護を行うことを特徴とする請求項1記載の手術用アクセス装置。
- 弁構造の周囲に配置される、中空空間を形成する少なくとも1つの支持リングと、
前記中空空間内に作動可能に配置される開創器とを更に有することを特徴とする請求項1記載の手術用アクセス装置。 - 前記開創器は、内方リングと、外方リングと、これらの内方リングと外方リングとを連結する可撓性スリーブとを有することを特徴とする請求項9記載の手術用アクセス装置。
- 前記保護スリーブは単一管状部材であることを特徴とする請求項1記載の手術用アクセス装置。
- 前記保護スリーブは、複数の軸線方向スリットを備えかつ軸線方向に延びている複数のスリーブ部材を有していることを特徴とする請求項1記載の手術用アクセス装置。
- 前記保護スリーブおよびキャップリングは同じ材料からなることを特徴とする請求項1記載の手術用アクセス装置。
- 前記保護スリーブおよびキャップリングは異なる材料からなることを特徴とする請求項1記載の手術用アクセス装置。
- 手術用アクセス装置であって、該手術用アクセス装置を通って患者の体壁の切開部内に延びる器具とのシーリング関係を形成する手術用アクセス装置において、
切開部の周囲の体壁とのシーリング関係をなして切開部に対して配置されかつ患者の切開部に連通するように延びる弁構造と、
該弁構造に含まれかつ体壁の切開部に対して配置される弁とを有し、
該弁は、弁構造を通って延びる器具が存在しない第一状態と、弁構造を通って延びる器具が存在する第二状態とを有し、
第一状態にある弁は、弁構造を通って延びる器具が存在しないときにゼロシールを形成し、
第二状態にある弁は、弁構造を通って延びる器具が存在するときに器具とのシールを形成し、
前記弁構造は更に、前記弁に挿入され、またはモールド成形されたキャップリングを有しており、
前記弁構造は更に、キャップリングの内径部の周囲に接合され、またはモールド成形された保護スリーブを有していることを特徴とする手術用アクセス装置。 - 前記保護スリーブは、器具の挿入時および引抜き時に創傷の保護を行うことを特徴とする請求項15記載の手術用アクセス装置。
- 弁構造の周囲に配置される、中空空間を形成する少なくとも1つの支持リングと、
前記中空空間内に作動可能に配置される開創器とを更に有することを特徴とする請求項15記載の手術用アクセス装置。 - 前記開創器は、内方リングと、外方リングと、これらの内方リングと外方リングとを連結する可撓性スリーブとを有することを特徴とする請求項17記載の手術用アクセス装置。
- 前記保護スリーブは単一管状部材であることを特徴とする請求項15記載の手術用アクセス装置。
- 前記保護スリーブは、複数の軸線方向スリットを備えかつ軸線方向に延びている複数のスリーブ部材を有していることを特徴とする請求項15記載の手術用アクセス装置。
- 細長形状を有する弁構造と、
弁構造とともに、手術器具を受入れることができるサイズを有しかつ構成されたワーキングチャネルを形成する少なくとも1つの壁と、
ワーキングチャネル内に配置されるゲルであって、ワーキングチャネル内に配置される37mmまでの直径をもつ任意の器具とのシールを形成できるゲルとを有し、
前記弁構造は、ゲルキャップおよび腹壁ベースを有しており、
前記ゲルキャップは更に、ゲルパッドと、周囲キャップリングと、該周囲キャップリングの内径部の周囲に接合され、またはモールド成形された保護スリーブとを有していることを特徴とする医療用アクセス装置。 - 前記保護スリーブは単一管状部材であることを特徴とする請求項21記載の医療用アクセス装置。
- 前記保護スリーブは、複数の軸線方向スリットを備えかつ軸線方向に延びている複数のスリーブを有していることを特徴とする請求項21記載の医療用アクセス装置。
- 前記キャップリングは、腹壁ベースとのシーリング関係を形成するための、内周部の環状空隙を有していることを特徴とする請求項21記載の医療用アクセス装置。
- 前記腹壁ベースは、開創器の内方リングを固定するための、前記ベースの内径部に沿う丸められた端面を有していることを特徴とする請求項24記載の医療用アクセス装置。
- 前記腹壁ベースは、キャップとのシールを形成しまたはキャップからベースを解放するための、ベースの内径部に沿う複数のトグルを有していることを特徴とする請求項24記載の医療用アクセス装置。
- 前記腹壁ベースは、キャップとのシールを形成しまたはキャップからベースを解放するための、ベースの内径部に沿う複数のラッチを有していることを特徴とする請求項24記載の医療用アクセス装置。
- 前記腹壁ベースは、キャップとのシールを形成しまたはキャップからベースを解放するための、ベースの内径部に沿う係合手段を有していることを特徴とする請求項24記載の医療用アクセス装置。
- 前記腹壁ベースは、対応キャップリングに嵌合するための、ベースの内径部に沿う隆起壁を有していることを特徴とする請求項24記載の医療用アクセス装置。
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Application Number | Priority Date | Filing Date | Title |
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US10/666,579 US7163510B2 (en) | 2003-09-17 | 2003-09-17 | Surgical instrument access device |
US10/666,579 | 2003-09-17 |
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JP2006526913A Division JP2007505691A (ja) | 2003-09-17 | 2004-08-30 | 手術器具アクセス装置 |
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JP2011092755A JP2011092755A (ja) | 2011-05-12 |
JP5302344B2 true JP5302344B2 (ja) | 2013-10-02 |
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JP2011001815A Expired - Lifetime JP5302344B2 (ja) | 2003-09-17 | 2011-01-07 | 手術器具アクセス装置 |
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JP2006526913A Withdrawn JP2007505691A (ja) | 2003-09-17 | 2004-08-30 | 手術器具アクセス装置 |
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US (3) | US7163510B2 (ja) |
EP (2) | EP1662969B1 (ja) |
JP (2) | JP2007505691A (ja) |
AU (1) | AU2004277853B2 (ja) |
CA (1) | CA2537599A1 (ja) |
WO (1) | WO2005032331A2 (ja) |
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2003
- 2003-09-17 US US10/666,579 patent/US7163510B2/en not_active Expired - Lifetime
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- 2004-08-30 WO PCT/US2004/028250 patent/WO2005032331A2/en active Application Filing
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- 2004-08-30 JP JP2006526913A patent/JP2007505691A/ja not_active Withdrawn
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- 2004-08-30 CA CA 2537599 patent/CA2537599A1/en not_active Abandoned
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EP1662969B1 (en) | 2015-07-01 |
US8187177B2 (en) | 2012-05-29 |
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EP2444014A1 (en) | 2012-04-25 |
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WO2005032331A2 (en) | 2005-04-14 |
US7163510B2 (en) | 2007-01-16 |
AU2004277853B2 (en) | 2011-05-19 |
JP2007505691A (ja) | 2007-03-15 |
EP2444014B1 (en) | 2016-03-02 |
JP2011092755A (ja) | 2011-05-12 |
WO2005032331A3 (en) | 2006-09-08 |
US20120215070A1 (en) | 2012-08-23 |
CA2537599A1 (en) | 2005-04-14 |
EP1662969A4 (en) | 2009-05-06 |
US20070151566A1 (en) | 2007-07-05 |
EP1662969A2 (en) | 2006-06-07 |
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