JP5400098B2 - 細長いナイフストロークと切断機構のための安全装置とを有する、血管シーラーおよび分割器 - Google Patents
細長いナイフストロークと切断機構のための安全装置とを有する、血管シーラーおよび分割器 Download PDFInfo
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- 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
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
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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
- A61B17/32—Surgical cutting instruments
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00345—Vascular system
- A61B2018/00404—Blood vessels other than those in or around the heart
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- A—HUMAN NECESSITIES
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00601—Cutting
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/0063—Sealing
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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
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1412—Blade
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- 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
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
- A61B2018/1455—Probes having pivoting end effectors, e.g. forceps including means for cutting having a moving blade for cutting tissue grasped by the jaws
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- 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
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B2018/146—Scissors
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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
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
- A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
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Description
本出願は、2004年9月29日に出願された、Dycusによる「細長いナイフストロークと切断機構のための安全装置とを有する、血管シーラーおよび分割器」と題する米国特許出願第10/953,757号に対する利益および優先権を主張する。米国特許出願第10/953,757号は、2003年6月13日に出願された米国特許出願第10/460,926号の一部継続出願であり、その利益および優先権を主張する。これら出願の全体の内容は本明細書中に参考として援用される。
電気外科用鉗子は、機械的クランプ作用および電気的エネルギーの両方を利用し、組織および血管を加熱することにより止血を行い、組織を凝固、焼灼および/またはシールする。開放外科的手順との使用のための開放鉗子に対する代替として、多くの現代の外科医は、より小さな穿刺様切開を通り器官に遠隔から接近するために内視鏡および内視鏡器具を用いる。その直接的結果として、患者は、より少ない瘢痕および減少した治癒時間の利益を受ける傾向にある。
本開示は、5mmトロカールまたはカニューレとともに利用されるよう設計されている内視鏡双極性鉗子に関し、そしてハウジングおよびこのハウジングの遠位端に固定されたシャフトを含む。好ましくは、このシャフトは、このシャフトがトロカールを通って自由に挿入可能であるように減少した直径を含む。このシャフトはまた、それを通って規定される長軸方向軸、およびその遠位端に取り付けられた一対の第1および第2の顎部材を含む。上記鉗子は、この第1の顎部材を、第2の部材に対し、これら顎部材が互いに対して間隔を置いた関係で配置される第1の位置から、これら顎部材が協働してそれらの間に組織を握る第2の位置まで移動するための、駆動アセンブリを含む。上記シャフトの長軸方向軸の上に位置決めされる回動点の周りを回転可能である移動可能なハンドルが含められる。このハンドルの移動は、駆動フランジを、駆動アセンブリと機械的協働するように係合し、上記顎部材を開放位置から閉鎖位置まで移動する。有利には、上記回動点は、上記長軸方向軸の上に固定された距離に位置決めされ、上記駆動フランジにレバー様機械的利点を提供する。上記駆動フランジは、上記長軸方向軸にほぼ沿って位置決めされる。上記鉗子は、各顎部材に、これら顎部材が、それらの間に保持された組織を通して双極性エネルギーを伝導して組織シールを行い得るように、電位を運ぶ電気外科用エネルギーの供給源に接続される。
(1)内視鏡双極性鉗子であって、以下:移動可能な顎部材と固定された顎部材とをその遠位端に有するシャフト;該移動可能な顎部材を、該固定された顎部材に対し、該移動可能な顎部材が該固定された顎部材に対して間隔を置いた関係で配置される第1の位置から、組織を操作するために該移動可能な顎部材が該固定された顎部材により近い第2の位置に移動するための駆動アセンブリ;該移動可能な顎部材を移動するために該駆動アセンブリを作動する移動可能なハンドル;該組織シールに沿って組織を切断するためのナイフアセンブリを選択的に進行するために、該移動可能なハンドルに対して作動可能に配置されたトリガーアセンブリであって、該ナイフアセンブリは、該トリガーアセンブリの作動に際し、ナイフシャフトと協働して組織を通してナイフを進行するほぼドーナッツ形状のカラーを含むトリガーアセンブリを備え、各顎部材は、該顎部材が、それらの間に保持された組織を通してエネルギーを伝導し組織シールを行い得るように、電気エネルギーの供給源に接続されるよう適合される、内視鏡双極性鉗子。
(2)上記トリガーアセンブリが、トリガーと、上記ナイフカラーの近位端に接するような形態である2つのC字形状脚を有するフランジとを、上記トリガーの回転が、次に、上記C字形状脚を回転し、そして上記ナイフカラーを遠位方向に押し、組織を通して上記ナイフを進行するように含む、項(1)に記載の内視鏡双極性鉗子。
(3)上記ナイフカラーおよび上記トリガーアセンブリを近位方向の非作動位置に付勢するためのスプリングをさらに備える、項(1)に記載の内視鏡双極性鉗子。
(4)上記フランジのC字形状脚の曲率半径が、処置されている組織のタイプに従う寸法である、項(1)に記載の内視鏡双極性鉗子。
(5)上記トリガーアセンブリを解放可能にロックするために、上記移動可能なハンドルに対して配置される安全機構をさらに備える、項(1)に記載の内視鏡双極性鉗子。
図1〜3を参照して、内視鏡双極性鉗子10の1つの実施形態が、種々の外科的手順との使用のために示され、そして一般に、ハウジング20、ハンドルアセンブリ30、回転アセンブリ80、トリガーアセンブリ70、および端部エフェクターアセンブリ100を含み、これらは、相互に協働して管状血管および血管組織420を握り、シールし、および分離する(図36)。図面の描写の大部分は、内視鏡外科的手順と組み合わせた使用のための双極性鉗子10を示すが、本開示は、より伝統的な開放外科的手順のために用いられ得る。本明細書の目的には、鉗子10は、内視鏡器具に関して説明されているが、この鉗子の開放バージョンもまた、以下に説明されるのと同じまたは類似の作動コンポーネントおよび特徴を含み得ることが企図される。
− すべての組織タイプを通じる一貫した臨床効果;
− 減少した熱拡散および側枝組織損傷のリスク;
− 「電源を調整」する必要性が少ないこと;ならびに
− 最小侵襲環境のために設計されていること。
内視鏡双極性鉗子は、ハウジングおよびこのハウジングに固定されたシャフトを含む。このシャフトは、それを通って規定される長軸方向軸、およびその遠位端に取り付けられた一対の顎部材を含む。この鉗子はまた、顎部材の1つを他方の顎部材に対して移動するための駆動アセンブリを含む。開放位置および閉鎖位置から顎部材を移動するための移動可能なハンドルが含められる。この鉗子は、電気外科用エネルギーの供給源に、顎部材が、それらの顎部材の間に保持された組織を通って双極性エネルギーを伝導して組織シールを接続するように適合されている。トリガーアセンブリが、組織シールに沿って組織を切断するためのナイフアセンブリを選択的に進行するために、この移動可能なハンドルに対して作動可能に配置される。このナイフアセンブリは、ナイフシャフトと協働して上記トリガーアセンブリの作動に際し組織を通ってナイフを進める、ナイフカラーを含む。
12 シャフト
14 近位端
16 遠位端
20 ハウジング
30、40 ハンドル
50 固定ハンドル
60 スリーブ
70 トリガーアセンブリ
80 回転アセンブリ
82 半分体
90、111 フランジ
94 ピン
91、97 アパーチャ
95 t形状遠位端
100 端部エフェクターアセンブリ
103 ピボットピン
112、122 電気的伝導性シーリング表面
114、124 絶縁体
115 ナイフチャネル
116 顎ハウジング
117 突出部
118 ピボットフランジ
119 ピンスロット
126 顎ハウジング
140 ナイフアセンブリ
150 駆動アセンブリ
160 回転チューブ
170 後部C形状カフ
175 ワイヤチャネル
180 ナイフアセンブリシャフト
182 ロッド
183 ナイフアセンブリシャフトの近位端
184 ナイフバー
200 ジョイスティック様トグルスイッチ200
310 電気外科用ケーブル
420 血管組織
600 鉗子
610 安全機構
Claims (8)
- 内視鏡双極性鉗子であって、以下:
ハウジング;
該ハウジングから延びるシャフトであって、移動可能な顎部材および固定された顎部材をその遠位端に有するシャフト;
該移動可能な顎部材を、該固定された顎部材に対し、該移動可能な顎部材が該固定された顎部材に対して間隔を置いた関係で配置される第1の位置から、組織を操作するために該移動可能な顎部材が該固定された顎部材により近い第2の位置に移動するための駆動アセンブリ;
該移動可能な顎部材を移動するために該駆動アセンブリを作動するよう構成された移動可能なハンドルであって、該顎部材が対応する第1の位置に配置される第1の位置から、該顎部材が該固定された顎部材により近い対応する第2の位置に移動可能であり、各々の顎部材が、該顎部材がそれらの間に保持された組織を通ってエネルギーを電導し得る電気エネルギーの供給源に接続されるように適合されている、移動可能なハンドル;および
組織シールに沿って組織を切断するためのナイフアセンブリを選択的に進行するために、該移動可能なハンドルに対して作動可能に配置されたトリガーアセンブリであって、該移動可能なハンドルと、該移動可能なハンドルが該第2の位置に移動されるとき、該トリガーアセンブリが退却位置から自動的に展開するように作動可能に協働する安全機構を含むトリガーアセンブリ;を備え、
該安全機構が、少なくとも、2つのバーのリンクシステムを含む、内視鏡双極性鉗子。 - 前記顎部材を前記シャフトを通って規定される長軸方向軸の周りで回転するための回転アセンブリをさらに備える、請求項1に記載の内視鏡双極性鉗子。
- 前記ハウジング内に配置され、そして前記電気外科用エネルギーの供給源と電気機械的に協働するハンドスイッチをさらに備え、該ハンドスイッチが、使用者がシールを行うために前記顎部材に双極性エネルギーを選択的に供給することを可能にする、請求項1に記載の内視鏡双極性鉗子。
- 前記ハンドスイッチが、前記移動可能なハンドルの近位方向に配置される、請求項3に記載の内視鏡双極性鉗子。
- 前記移動可能な顎部材が第1の電位を含み、そして前記固定された顎部材が第2の電位を含み、該第2の電位が、前記シャフトを通って配置される導電性チューブによって該固定された顎部材に伝導される、請求項1に記載の内視鏡双極性鉗子。
- 前記顎部材の少なくとも1つが、その上に、シーリングの間に該顎部材間の距離を調節する少なくとも1つの停止部材を含む、請求項1に記載の内視鏡双極性鉗子。
- 前記顎部材が、約3kg/cm2〜約16kg/cm2の範囲の所定の閉鎖力内で組織の周りで閉鎖される、請求項1に記載の内視鏡双極性鉗子。
- 前記ハンドスイッチが、切断プロセスの間にデバイスが意図されずに作動されることをなくすように前記トリガーアセンブリが作動されるとき、閉じられる、請求項3に記載の内視鏡双極性鉗子。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US10/953,757 US7150749B2 (en) | 2003-06-13 | 2004-09-29 | Vessel sealer and divider having elongated knife stroke and safety cutting mechanism |
US10/953,757 | 2004-09-29 |
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JP2005283135A Division JP4906300B2 (ja) | 2004-09-29 | 2005-09-28 | 細長いナイフストロークと切断機構のための安全装置とを有する、血管シーラーおよび分割器 |
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JP2013047573A Division JP2013144126A (ja) | 2004-09-29 | 2013-03-11 | 細長いナイフストロークと切断機構のための安全装置とを有する、血管シーラーおよび分割器 |
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JP2011212458A JP2011212458A (ja) | 2011-10-27 |
JP5400098B2 true JP5400098B2 (ja) | 2014-01-29 |
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JP2005283135A Active JP4906300B2 (ja) | 2004-09-29 | 2005-09-28 | 細長いナイフストロークと切断機構のための安全装置とを有する、血管シーラーおよび分割器 |
JP2011146434A Expired - Fee Related JP5400098B2 (ja) | 2004-09-29 | 2011-06-30 | 細長いナイフストロークと切断機構のための安全装置とを有する、血管シーラーおよび分割器 |
JP2013047573A Withdrawn JP2013144126A (ja) | 2004-09-29 | 2013-03-11 | 細長いナイフストロークと切断機構のための安全装置とを有する、血管シーラーおよび分割器 |
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JP2005283135A Active JP4906300B2 (ja) | 2004-09-29 | 2005-09-28 | 細長いナイフストロークと切断機構のための安全装置とを有する、血管シーラーおよび分割器 |
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US (2) | US7150749B2 (ja) |
EP (2) | EP2942025B1 (ja) |
JP (3) | JP4906300B2 (ja) |
AU (1) | AU2005218010B2 (ja) |
CA (1) | CA2521413C (ja) |
Families Citing this family (539)
Publication number | Priority date | Publication date | Assignee | Title |
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AU2005218010B2 (en) | 2011-05-19 |
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EP1642543B1 (en) | 2015-05-27 |
US20060129146A1 (en) | 2006-06-15 |
JP2006095316A (ja) | 2006-04-13 |
AU2005218010A1 (en) | 2006-04-13 |
JP4906300B2 (ja) | 2012-03-28 |
JP2013144126A (ja) | 2013-07-25 |
EP2942025A1 (en) | 2015-11-11 |
CA2521413A1 (en) | 2006-03-29 |
EP1642543A1 (en) | 2006-04-05 |
US7771425B2 (en) | 2010-08-10 |
US7150749B2 (en) | 2006-12-19 |
EP2942025B1 (en) | 2020-07-29 |
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