JP5357167B2 - 侵襲性を最小限に抑えた拍動する心臓内の弁尖を修復するための器具 - Google Patents
侵襲性を最小限に抑えた拍動する心臓内の弁尖を修復するための器具 Download PDFInfo
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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
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
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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
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0482—Needle or suture guides
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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
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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
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00243—Type of minimally invasive operation cardiac
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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
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/06004—Means for attaching suture to needle
- A61B2017/06042—Means for attaching suture to needle located close to needle tip
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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
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0807—Indication means
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
- A61B2090/306—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using optical fibres
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/361—Image-producing devices, e.g. surgical cameras
- A61B2090/3614—Image-producing devices, e.g. surgical cameras using optical fibre
Description
実施例において、患者の拍動する心臓内の弁尖を修復するための器具は、ハンドルアセンブリ、捕捉アセンブリ、及び針ヘッドを備える。ハンドルアセンブリはシャフト及びアクチュエータ機構を含む。シャフトはハンドルの先端部から患者の胸腔内に延びる。アクチュエータ機構はハンドルアセンブリの基端部の基端側に位置される。捕捉アセンブリはシャフトの先端部から延び、拍動する心臓内に位置される。捕捉アセンブリは先端部および基端部を有する。先端部は弁尖を把持及び解放するクランプ機構を含む。基端部はシャフトに操作自在に連結される。クランプ機構の第1のクランプ顎部は捕捉アセンブリの長手方向軸に沿ってアクチュエータ機構の駆動に応じて選択的に位置決め可能であり、第1のクランプ顎部及び第2のクランプ顎部の内側表面間に空隙を形成する。針ヘッドは、捕捉アセンブリ内に摺動自在に位置決め可能であり、針が弁尖を貫通するときにアクチュエータ機構による針の選択的な駆動に応じて、捕捉アセンブリによって搬送される縫合糸に対して少なくとも部分的に係合する。ハンドルアセンブリ及び捕捉アセンブリの少なくとも1つは付勢部材を含み、第1のクランプ顎部及び第2のクランプ顎部の内側表面間に空隙が形成されるか閉じられるに先立ってアクチュエータ機構の選択的な駆動が付勢部材が圧倒するように、付勢部材は第1のクランプ顎部及び第2のクランプ顎部のうち少なくとも1つを相互に付勢する。
実施例において、弁尖修復のための器具及び指示を提供する方法は、上述した任意の実施例において、弁尖を修復すべく上述した任意の実施例における処置のための指示を提供する工程を含む。
実施例において、方法は弁修復処置の一部として上述した任意の実施例における弁修復器具及び交換可能な縫合糸カートリッジを使用する工程を含む。
本発明は、様々な変更物や代替物へ変更可能であるが、その詳細は図面において実施例として示されており、以下に詳述される。しかしながら、本発明は、記載された特定の実施例に限定されるものではない。本発明は、その趣旨および範囲内に含まれる全ての変更物や均等物や代替物を包含するものである。
本発明の実施例は、拍動する心臓及び心肺バイパス法の両者にて心臓弁を修復するために胸腔鏡撮像手段を使用する、或いは拍動する心臓における心臓弁の胸腔鏡による修復をするための装置、システム、及び方法を示す。上記課題のために使用可能な器具は参照符号100にて示される。
図1Bに、本発明の実施例における、ハンドルアセンブリ300、捕捉アセンブリ302、及び針318を備える器具100を示す。ハンドルアセンブリ300は先端部304及び基端部306を有する。ハンドルアセンブリはシャフト308及びアクチュエータ309を備える。シャフト308はハンドルアセンブリ300の先端部304から延び、通常患者の胸腔内に延伸される。アクチュエータ309は基端部306の基端側に位置される。捕捉アセンブリ302は通常先端部310及び基端部312を有する。先端部310は第1のクランプ顎部316及び第2のクランプ顎部318によって形成されるクランプ機構314を備える。実施例において、クランプ機構314は弁尖を把持及び解放する。更なる実施例において、第1のクランプ顎部316や第2のクランプ顎部318はアクチュエータ309の駆動に応じて捕捉アセンブリ302の長手方向の軸に沿って選択的に位置され、第1のクランプ顎部316及び第2のクランプ顎部318の内側表面(図示しない)間に空隙を形成する。
実施例において、手術室充填カートリッジ122は、手術室充填カートリッジ122に縫合糸112が設けられていないことを除いて、形状及び機能において予めセットされた縫合糸カートリッジ120に略類似する。
図1Aに示すように、一実施例において、シャフト104は通常シャフト104の先端部に先端ほど細くなる形状の領域200、及び先端ほど細くなる形状の領域から基端側に延びる略均一な領域を有する。均一な領域は略均一に円筒状であり、先端ほど細くなる形状の領域は略円形の端部から略楕円形の端部に遷移する。一実施例において、先端ほど細くなる形状の領域200は約1センチメートル乃至10センチメートルの範囲の長さである。別例において、先端ほど細くなる形状の領域200は約2センチメートル乃至5センチメートルの範囲の長さである。別例において、先端ほど細くなる形状の領域200は約4センチメートル乃至5センチメートルの範囲の長さである。
本発明の実施例における閉じた位置において、下部クランプ顎部124及び上部クランプ顎部128の外側表面は略円滑な表面を形成する。この円滑な表面により、クランプ114は短期間にて組織の弾性によって、クランプの断面より小さな組織開口部内に挿入可能である。図4A乃至4E、及び8に示す本発明の実施例において、シャフトの径はクランプ114の最大径の約85%である。クランプ対シャフトの径の比率を使用することにより、身体組織は弾性の限界の範囲内にて延びることができ、これにより、シャフト104の断面領域と比較して、クランプ114内に特大の尖捕捉領域を設けることができる。
Claims (7)
- 患者の拍動する心臓内の弁尖を修復するための器具であって、
ハンドルの先端部から患者の胸腔内に延びるシャフト、及びハンドルアセンブリの基端部の基端側に位置されるアクチュエータ機構を含むハンドルアセンブリであって、該シャフトは径、及び拍動する心臓の切開部を通過するようにシャフトの先端部に長手方向軸線に沿って通常円形の断面を有する、前記ハンドルアセンブリと、
該シャフトの先端部から延び、拍動する心臓内に位置される捕捉アセンブリであって、同捕捉アセンブリは弁尖を把持及び解放するクランプ機構を含む先端部及びシャフトに操作自在に連結される基端部を含み、該捕捉アセンブリの先端部は、捕捉アセンブリの長手方向軸線を横断してシャフトの径より大きい最大径を有するとともに捕捉アセンブリの長手方向軸線の周りに非対称である断面を有し、クランプ機構の第1のクランプ顎部及び第2のクランプ顎部のうち1つは捕捉アセンブリの長手方向軸線に沿ってアクチュエータ機構の駆動に応じて選択的に位置決め可能であり、捕捉アセンブリの長手方向軸線の周りに非対称の周辺部を有する第1のクランプ顎部及び第2のクランプ顎部の内側表面間に空隙を形成する、前記捕捉アセンブリと、
該捕捉アセンブリ内に摺動自在に位置決め可能であり、針が弁尖を貫通するときにアクチュエータ機構による針の選択的な駆動に応じて、捕捉アセンブリによって搬送される縫合糸に対して少なくとも部分的に係合する針ヘッドとを備え、
内側表面の領域はシャフトの径と等しい径を有する円形クランプ顎部の内側表面領域に対して漸増し、捕捉アセンブリは心臓の切開部に配置されるシャフトとともに心臓内にて回動自在であることとを特徴とする患者の拍動する心臓内の弁尖を修復するための器具。 - 前記シャフトは長手方向軸線に沿って等軸であることを特徴とする請求項1に記載の器具。
- 前記捕捉アセンブリは複数の組の光ファイバーを更に含み、ファイバーの各組はクランプ機構の内側表面における先端部にて終端する伝送ファイバー及び返送ファイバーを有し、ファイバーはシャフトを通じてハンドルアセンブリを退出しハンドルアセンブリの基端部にハンドルアセンブリを越えて延び、
前記器具は、第1のクランプ顎部及び第2のクランプ顎部の内側表面間の空隙にて弁尖の捕捉を確認する捕捉確認システムを更に備え、同捕捉確認システムは前記ハンドルアセンブリとは別体のハウジング及び同ハウジングの外側表面から視認可能な少なくとも1つのレンズを含み、該ハウジングは各伝送ファイバーの基端部と光通信する電源により駆動される光源を含み、該レンズは各返送ファイバーの基端部と光通信し、捕捉アセンブリによって弁尖が捕捉されたか否かを示す各返送ファイバーの先端部に応じて、第1のクランプ顎部及び第2のクランプ顎部の内側表面間の空隙から受容される光を表示することを特徴とする請求項1に記載の器具。 - 前記捕捉確認システムは弁尖の表面が内側表面にて光ファイバーの組に対向する場合に第1の色を示し、弁尖が内側表面にて光ファイバーの組に対向しない場合に第2の色を示すことによって、弁尖が第1のクランプ顎部及び第2のクランプ顎部の内側表面間に把持されたか否かを二者択一的に示すことを特徴とする請求項3に記載の器具。
- 前記シャフトは該縫合糸を受容する第1のチャネル及び該針を受容する第2のチャネルを含み、該ハンドルアセンブリは縫合糸保持機構を更に含み、
該縫合糸保持機構は針による係合に先立って針ヘッドを通じた針の移動通路を横断して縫合糸を選択的に張引することを特徴とする請求項1に記載の器具。 - 前記ハンドルアセンブリ及び前記捕捉アセンブリの少なくとも1つは付勢部材を含み、第1のクランプ顎部及び第2のクランプ顎部の内側表面間に空隙が形成されるか閉じられるに先立ってアクチュエータ機構の選択的な駆動が付勢部材が圧倒するように、付勢部材は第1のクランプ顎部及び第2のクランプ顎部のうち少なくとも1つを相互に付勢することを特徴とする請求項1に記載の器具。
- 前記シャフトの一部分及び前記捕捉アセンブリの一部分を含む交換可能な縫合糸カートリッジであって、同交換可能な縫合糸カートリッジは、ハンドル及びアクチュエータに解放自在に連結可能な基端部を有し、前記シャフトの一部分はシャフトの主部に沿って形成される構造体に摺動して係合するように構成される、前記交換可能な縫合糸カートリッジを更に備え、同交換可能な縫合糸カートリッジは縫合糸が内部にて搬送されるチャネルを形成する構造体を含み、該縫合糸は交換可能な縫合糸カートリッジがシャフトの主部と係合する場合に捕捉アセンブリの基端側に示すループ部を有することを特徴とする請求項1に記載の器具。
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Application Number | Priority Date | Filing Date | Title |
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US99943107P | 2007-10-18 | 2007-10-18 | |
US60/999,431 | 2007-10-18 | ||
US99963507P | 2007-10-19 | 2007-10-19 | |
US60/999,635 | 2007-10-19 | ||
US99987307P | 2007-10-22 | 2007-10-22 | |
US60/999,873 | 2007-10-22 | ||
PCT/US2008/080560 WO2009052528A2 (en) | 2007-10-18 | 2008-10-20 | Minimially invasive repair of a valve leaflet in a beating heart |
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JP2011500228A JP2011500228A (ja) | 2011-01-06 |
JP2011500228A5 JP2011500228A5 (ja) | 2011-06-30 |
JP5357167B2 true JP5357167B2 (ja) | 2013-12-04 |
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US (5) | US9192374B2 (ja) |
EP (1) | EP2219530B1 (ja) |
JP (1) | JP5357167B2 (ja) |
CN (1) | CN101902975B (ja) |
AU (1) | AU2008311754B2 (ja) |
CA (1) | CA2703129C (ja) |
HK (1) | HK1149183A1 (ja) |
WO (1) | WO2009052528A2 (ja) |
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US9192374B2 (en) | 2015-11-24 |
WO2009052528A3 (en) | 2009-09-24 |
EP2219530A2 (en) | 2010-08-25 |
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CN101902975B (zh) | 2014-06-04 |
US20200138430A1 (en) | 2020-05-07 |
AU2008311754A1 (en) | 2009-04-23 |
US10507018B2 (en) | 2019-12-17 |
AU2008311754B2 (en) | 2012-10-04 |
EP2219530B1 (en) | 2013-06-19 |
CA2703129C (en) | 2016-02-16 |
WO2009052528A2 (en) | 2009-04-23 |
JP2011500228A (ja) | 2011-01-06 |
US20140364875A1 (en) | 2014-12-11 |
HK1149183A1 (en) | 2011-09-30 |
US11419602B2 (en) | 2022-08-23 |
US11911023B2 (en) | 2024-02-27 |
CN101902975A (zh) | 2010-12-01 |
US20090105751A1 (en) | 2009-04-23 |
US20230091251A1 (en) | 2023-03-23 |
EP2219530A4 (en) | 2010-10-20 |
US20090105729A1 (en) | 2009-04-23 |
CA2703129A1 (en) | 2009-04-23 |
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