JP5465498B2 - 外科用切断・ステープル留め器具と共に使用するためのエンドエフェクタ - Google Patents

外科用切断・ステープル留め器具と共に使用するためのエンドエフェクタ Download PDF

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JP5465498B2
JP5465498B2 JP2009215194A JP2009215194A JP5465498B2 JP 5465498 B2 JP5465498 B2 JP 5465498B2 JP 2009215194 A JP2009215194 A JP 2009215194A JP 2009215194 A JP2009215194 A JP 2009215194A JP 5465498 B2 JP5465498 B2 JP 5465498B2
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end effector
anvil
light source
surgical cutting
staple cartridge
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フレデリック・イー・シェルトン・ザ・フォース
リチャード・エフ・シュエムバーガー
デビッド・シー・イェイツ
リチャード・シー・スミス
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Ethicon Endo Surgery Inc
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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
    • A61B17/068—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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • 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
    • A61B2017/07214—Stapler heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • 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
    • A61B2017/07214—Stapler heads
    • A61B2017/07271—Stapler heads characterised by its cartridge
    • 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
    • A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument

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Description

開示の内容
〔発明の分野〕
本発明は、概して、組織を扱うことができ、組織にステープルのラインを取り付けると共にそれらステープルライン間の組織を切断することができる、内視鏡的外科用器具に関し、より詳細には、そのような器具のためのエンドエフェクタに関する改善に関する。
〔発明の背景〕
外科用ステープラは、組織に長さ方向切開部を作り、その切開部の向かい合う側部にステープルのラインを取り付けることを同時に行うために先行技術で用いられている。このような器具は、一般に、一対の協働ジョー部材を含み、ジョー部材は、器具が内視鏡適用または腹腔鏡適用を目的としている場合は、カニューレ通路を通過することができる。ジョー部材のうち一方は、側方に離間したステープル列を備えたステープルカートリッジを受容するように構成される。もう一方のジョー部材は、一般に、ステープル成形ポケットが内部に形成されたアンビルを含み、ステープル成形ポケットは、カートリッジのステープル列と整列される。様々なカートリッジが楔形部（wedges）を有し、楔形部は、カートリッジを通って遠位に駆動されると、ドライバに係合する。このドライバ上ではステープルが支持されてアンビルに向かってステープルを発射させる。
使用の際、臨床医が、ステープラのジョー部材を開閉させて、発射前にジョー部材の中に組織を位置付けてクランプする。組織がジョー部材の中に適切にクランプされたといったん臨床医が判断したら、器具は、作動または「発射」され、それにより、組織を切断し、同時にその切断部の各側で組織をステープル留めする。同時の切断およびステープル留めは、切断のみまたはステープル留めのみをそれぞれ行う異なる外科用具でこのような行為を連続的に行った場合に生じうる合併症を回避する。
しかしながら、このような切り離し・切断器具（such cutting and severing instruments）を用いる場合、臨床医は、装置を発射する前に、切断すべき組織を、エンドエフェクタ内部に適切に位置付けなければならない。この仕事は、組織の場所および／または体腔内部におけるエンドエフェクタの位置により、複雑になりうる。
したがって、エンドエフェクタ内部における組織の位置の表示を臨床医に提供するように構成された、改良されたエンドエフェクタに対するかなりの必要性が存在する。
〔発明の概要〕
本発明の様々な実施形態によると、外科用切断・ステープル留め器具のためのエンドエフェクタが提供される。エンドエフェクタは、ステープルカートリッジを内部で支持するように構成された細長いチャネルであって、外科用切断・ステープル留め器具に動作可能に連結された、細長いチャネルを含みうる。アンビルが、開いた位置と閉じた位置との間で選択的に動くため、細長いチャネルに対して可動に支持されていてよい。組織は、外科用切断・ステープル留め器具からアンビルに適用された閉じる運動（closing motion）に応じて、アンビルと細長いチャネル内部で支持されるステープルカートリッジとの間でクランプされることができる。少なくとも１つの光源が、ステープルカートリッジおよび細長いチャネルのうち少なくとも一方に設けられてよい。光源は、アンビルとステープルカートリッジとの間における組織の位置の視覚表示を提供するために、アンビルと協調するように配列されてよい。
本発明の別の実施形態によると、外科用切断・ステープル留め器具と共に使用するためのステープルカートリッジが提供される。様々な実施形態では、ステープルカートリッジは、複数のステープル受容チャネルを内部に有するカートリッジ本体を含むことができる。各ステープル受容チャネルは、その内部で少なくとも１つの外科用ステープルを動作可能に支持することができる。ステープルカートリッジが外科用切断・ステープル留め器具内で動作可能に支持されて、アンビル部分が組織クランプ位置に向けられたときに外科用切断・ステープル留め器具のアンビル部分に向けて光を投射するように、複数の光源が、カートリッジ本体内部で支持されてよい。
本発明の別の実施形態によると、少なくとも１つの光源を内部に有する、外科用切断・ステープル留め器具と共に使用するためのステープルカートリッジが提供される。様々な実施形態は、複数のステープル受容チャネルを内部に有するカートリッジ本体を含むことができる。各ステープル受容チャネルは、内部で少なくとも１つの外科用ステープルを動作可能に支持することができる。ステープルカートリッジが外科用切断・ステープル留め器具内で動作可能に支持されて、アンビル部分が組織クランプ位置に向けられたときに光源から外科用切断・ステープル留め器具のアンビル部分に向けて光を投射するような位置で、複数の光投射開口部がカートリッジ本体を通って延びることができる。
本発明の別の実施形態によると、ハンドル組立体と、ハンドル組立体に動作可能に連結された細長いシャフトと、を含みうる、外科用切断・ステープル留め器具が提供される。細長いチャネルが、細長いシャフトに動作可能に連結されていてよく、ステープルカートリッジを内部で動作可能に支持するように構成されることができる。アンビルが、開いた位置と閉じた位置との間で選択的に動くように、細長いチャネルに対して可動に支持されていてよく、組織は、細長いシャフトからアンビルに適用される開く運動および閉じる運動に応じて、アンビルと細長いチャネル内部で支持されたステープルカートリッジとの間でクランプされる。少なくとも１つの光源が、ステープルカートリッジおよび細長いチャネルのうち少なくとも一方に設けられてよい。光源は、アンビルとステープルカートリッジとの間でクランプされた組織の位置を示すためアンビルの一部を通して見ることができる視覚表示を提供するよう、アンビルと協調する。
したがって、本発明の様々な実施形態は、組織をクランプし、かつ／または扱うのに用いられる他のエンドエフェクタ、ならびに組織を切断およびステープル留めするよう設計されたエンドエフェクタの欠点に対する解決策を提供する。しかしながら、当業者は、以下の詳細な説明が進むにつれて、これらおよび他の詳細、特徴、および利点がさらに明らかになるであろうことを容易に認識するであろう。
本明細書に組み込まれ、本明細書の一部を構成する添付図面は、本発明の実施形態を例証しており、前記の本発明の概説、および以下の実施形態の詳細な説明と共に、本発明の原理を説明するのに役立つ。
〔発明の詳細な説明〕
図面を見ると、いくつかの図面にわたって同様の符号が同様の構成要素を示しており、図１および図２は、本発明の独自の利点を実行することができる外科用ステープル留め・切断器具１０の一実施形態を表している。しかしながら、この詳細な説明が進むにつれて、読者は、本発明の独自かつ新奇な態様が、本発明の趣旨および範囲から逸脱することなく、様々な他のステープラ、ステープラ器具、および組織把持器具とさえ関連して、有利に利用されうることを認識するであろう。したがって、本発明の様々な実施形態に与えられる保護の範囲は、本明細書に記載される特定のタイプの外科用切断・ステープル留め器具のみと共に使用することに限定されるべきでない。
図１および図２は、概して１０と指定された、ある形態の外科用切断・ステープル留め器具を例証しており、この器具は、本発明の様々な実施形態と関連して有効に利用されうる。これらの図面から分かるように、外科用切断・ステープル留め器具１０は、用具部分（implement portion）２２に接続されたハンドル組立体２０を含むことができ、用具部分２２は、エンドエフェクタ１２において遠位に終端をなす細長いシャフト２３をさらに含む。ハンドル組立体２０は、ピストルグリップ２４を含んでよく、このピストルグリップ２４に向かって、閉鎖トリガー２６が臨床医により旋回可能に引っ張られて、エンドエフェクタ１２の細長いチャネル１６に向かってアンビル１８がクランプされるかまたは閉じられることができる。発射トリガー２８が、閉鎖トリガー２６のさらに外側（outboard）に動作可能に据え付けられていてよく、また、エンドエフェクタ１２においてクランプされた組織のステープル留めおよび切断を引き起こすように臨床医により旋回可能に引っ張られることができる。
用語「近位」および「遠位」は、器具のハンドルを握る臨床医に関して本明細書で用いられていることが認識されるであろう。ゆえに、エンドエフェクタ１２は、より近位のハンドル組立体２０に対して遠位である。便宜上、また明瞭化のため、「垂直な」および「水平な」などの空間用語は、図面に関して本明細書で使用されることがさらに認識されるであろう。しかしながら、外科用器具は、多くの向きおよび位置で使用され、これらの用語は、限定的となること、および絶対的であることを意図していない。
器具１０の様々な実施形態は、フレーム３４上に移動可能に据え付けられた閉鎖スリーブ３２も含んでよい。フレーム３４は、発射トリガー２８により作動される発射駆動部材３６を取り囲むことができる。フレーム３４は、ハンドル組立体２０をエンドエフェクタ１２に接続する。詳細には、フレーム３４の遠位端部は、ステープルカートリッジ３００を取り外し可能に支持するように構成されうるエンドエフェクタ１２の細長いチャネル１６に連結される。
図３で見ることができるように、ステープルカートリッジ３００は、このステープルカートリッジ３００を通って延びる細長い垂直スロット４９を有して、発射バー１４が垂直スロット４９を通過できるようにする。発射バー１４は、クランプされた組織を切断するための切断エッジ４８を有する。様々なタイプおよび構成の発射バーが知られている。例えば、開示内容が参照により全体として本明細書に組み込まれる、２００５年１２月２７日に発行された米国特許第６，９７８，９２１号に開示された発射バーが、有効に用いられうる。しかしながら、外科用切断・ステープル留め器具１０は、他の発射バー構造を用いてもよい。
図４〜図７を参照すると、ハンドル組立体２０は、第１の基部５０および第２の基部５２から成ることができ、これら基部は、ガラス充填ポリカーボネート（glass-filled polycarbonate）などのポリマー材料から成型されうる。第１の基部５０は、複数の円筒形ピン５４を備えていてよい。第２の基部５２は、複数の延長部材５６を含んでよく、延長部材５６はそれぞれ、六角形の開口部５８を有する。円筒形ピン５４は、六角形の開口部５８内部に受容されることができ、また第１の基部５０および第２の基部５２を組み立てられた状態に保つため、六角形の開口部５８の中に摩擦により保持されることができる。
様々な実施形態は、回転ノブ６０も含んでよく、回転ノブ６０は、用具部分２２に係合し、かつその長さ方向軸の周りで用具部分２２を回転させるための、回転ノブ６０を完全に貫通して延びるボア６２を有する。回転ノブ６０は、ボア６２の少なくとも一部に沿って延びる、内側に突出する隆起部６４を含むことができる。突出する隆起部６４は、閉鎖スリーブ３２の近位部分において形成された長さ方向スロット６６内部に受容されることができ、このため、回転ノブ６０が回転すると、閉鎖スリーブ３２が回転する。隆起部６４は、フレーム３４を通ってさらに延び発射駆動部材３６の一部と接触して、発射部材３６およびフレーム３４の回転も同様にもたらすことができる。ゆえに、エンドエフェクタ１２（図４〜図７では不図示）は、回転ノブ６０と共に回転されることができる。
フレーム３４の近位端部６８が、回転ノブ６０を近位に通り抜けていてよく、周辺ノッチ７０をさらに有してよい。周辺ノッチ７０は、基部５０および５２からそれぞれ延びる、向かい合うチャネル固定部材７２により係合される。第２の基部５２のチャネル固定部材７２のみが図示されている。基部５０、５２から延びるチャネル固定部材７２は、フレーム３４がハンドル組立体２０に対して長さ方向に動かないように、フレーム３４をハンドル組立体２０に固定するのに役立つ。
閉鎖トリガー２６は、ハンドル部分７４、ギアセグメント部分７６、および中間部分７８を有してよい。ボア８０が、中間部分７８を通って延びることができる。円筒形支持部材８２が、第２の基部５２から延びていてよく、また、閉鎖トリガー２６をハンドル組立体２０に旋回可能に据え付けるため、ボア８０を通り抜けていてよい。第２の基部５２から延びる第２の円筒形支持部材８３は、ハンドル組立体２０における旋回可能な据え付けのため、発射トリガー２８のボア８１を通り抜けていてよい。六角形開口部８４が、第１の基部５０から延びる固定ピン（不図示）を受容するため、円筒形支持部材８３に設けられてよい。
閉鎖ヨーク８６が、ハンドル組立体２０内で往復運動するよう、ハンドル組立体２０内部に収容されることができ、また、閉鎖トリガー２６から閉鎖スリーブ３２に運動を伝達するのに役立ちうる。第２の基部５２から延びる支持部材８８、およびヨーク８６の凹部８９を通って延びる固定部材７２が、ハンドル組立体２０内部でヨーク８６を支持することができる。閉鎖スリーブ３２の近位端部９０は、ヨーク８６の遠位端部９６に形成された受容凹部９４の中にスナップ嵌めされるフランジ９２を備えていてよい。ヨーク８６の近位端部９８は、閉鎖トリガー２６のギアセグメント部分７６により係合されるギアラック１００を有することができる。閉鎖トリガー２６がハンドル組立体２０のピストルグリップ２４に向かって動かされると、ヨーク８６、ゆえに閉鎖スリーブ３２は、遠位に動いて、ヨーク８６を近位に付勢するバネ１０２を圧縮する。以下に論じるように、閉鎖スリーブ３２の遠位への動きは、エンドエフェクタ１２の細長いチャネル１６に向けたアンビル１８の旋回並進運動を引き起こし、近位への動きにより、アンビル１８が開かれる。
閉鎖トリガー２６は、発射トリガー２８の係合面１２８と相互作用する前面１３０により、開いた位置まで前方に付勢されることができる。ピン１０６の周りでハンドル組立体２０において上部から後方へ（top to rear）旋回する第１のフック１０４は、閉鎖トリガー２６がその閉じた位置へクランプされるまで、ピストルグリップ２４に向かって発射トリガー２８が動くのを抑制することができる。フック１０４は、発射トリガー２８のロックアウトピン１０７に係合することにより、発射トリガー２８の運動を抑制することができる。フック１０４は、閉鎖トリガー２６と接触していてもよい。詳細には、フック１０４の前方突出部１０８は、閉鎖トリガー２６の中間部分７８上の部材１１０に係合することができ、部材１００は、ハンドル部分７４に向かってボア８０の外側にある。フック１０４は、解除バネ１１２によって、閉鎖トリガー２６の部材１１０との接触、および発射トリガー２８のロックアウトピン１０７との係合のために付勢されうる。閉鎖トリガー２６が押し下げられると、フック１０４は上部から後方へ動かされ、フック１０４上の後方突出部１１４と解除ボタン３０上の前方突出部１１６との間で捕捉された解除バネ１１２を圧縮する。
ヨーク８６が閉鎖トリガー２６の近位への動きに応じて遠位に動くと、解除ボタン３０の上方ラッチアーム１１８は、ヨーク８６の近位下部における、上方に向けられた凹部１２２の中に入るまで、ヨーク８６の上面１２０に沿って動く。解除バネ１１２は、解除ボタン３０を外側に動かし、これにより、上方ラッチアーム１１８が下方に旋回して、上方に向けられた凹部１２２と係合し、それによって、図６に表されるように、閉鎖トリガー２６が組織クランプ位置にロックされる。
ラッチアーム１１８は、解除ボタン３０を内側に押すことにより、アンビル１８を解放するように、凹部１２２から出ることができる。特に、上方ラッチアーム１１８は、第２の基部５２のピン１２３の周りで上方に旋回する。ヨーク８６は、次に、閉鎖トリガー２６が戻る動きに応じて近位に動くことができる。発射トリガー戻しバネ１２４が、ハンドル組立体２０内部に位置していてよく、バネ１２４の一端部は、第２の基部５２のピン１０６に取り付けられ、もう一方の端部は、発射トリガー２８のピン１２６に取り付けられている。発射戻しバネ１２４は、ハンドル部分２０のピストルグリップ２４から離れる方向に発射トリガー２８を付勢するため、ピン１２６に戻る力を加える。閉鎖トリガー２６もまた、閉鎖トリガー２６の前面１３０を付勢する発射トリガー２８の係合面１２８により、ピストルグリップ２４から離れるように付勢される。
閉鎖トリガー２６がピストルグリップ２４に向かって動かされると、その前面１３０は、発射トリガー２８の係合面１２８と係合し、発射トリガー２８をその「発射」位置まで動かす。発射位置にくると、発射トリガー２８は、ピストルグリップ２４に対して約４５°の角度で位置されうる。ステープル発射後、バネ１２４は、発射トリガー２８を、その初期位置に戻す。発射トリガー２８が戻る動きをしている間、その係合面１２８は、閉鎖トリガー２６の前面１３０を押し、閉鎖トリガー２６をその初期位置に戻す。停止部材１３２が、第２の基部５２から延びて、閉鎖トリガー２６がその初期位置を越えて回転するのを防ぐことができる。
外科用ステープル留め・切断器具１０は、往復運動部分１３４、倍率器（multiplier）１３６、および駆動部材１３８を追加的に含む。往復運動部分１３４は、用具部分２２における楔形スレッド（wedge sled）（図４〜図７では不図示）、および金属駆動ロッド１４０を含む。駆動部材１３８は、第１のギアラック１４１、および第２のギアラック１４２を含みうる。第１のノッチ１４４が、第１のギアラック１４１と第２のギアラック１４２との中間で、駆動部材１３８に設けられてよい。発射トリガー２８が戻る運動をする間、発射トリガー２８の歯１４６は、ステープル発射後に駆動部材１３８をその初期位置に戻すよう、第１のノッチ１４４と係合する。第２のノッチ１４８は、未発射位置において金属駆動ロッド１４０を解除ボタン３０の上方ラッチアーム１１８にロックするため、金属駆動ロッド１４０の近位端部に位置していてよい。
倍率器１３６は、第１の一体ピニオンギア１５０、および第２の一体ピニオンギア１５２を含む。第１の一体ピニオンギア１５０は、金属駆動ロッド１４０上に設けられた第１のギアラック１５４と係合されうる。第２の一体ピニオンギア１５２は、駆動部材１３８上の第１のギアラック１４１と係合されうる。第１の一体ピニオンギア１５０は、第１の直径を有してよく、第２の一体ピニオンギア１５２は、第１の直径より小さい第２の直径を有してよい。
図４、図６、および図７は、それぞれ、開始位置（開いており未発射）、クランプ位置（閉じており未発射）、および発射位置にある、ハンドル組立体２０を表している。発射トリガー２８は、ギアセグメント部分１５６を備えていてよい。ギアセグメント部分１５６は、駆動部材１３８上の第２のギアラック１４２と係合してよく、発射トリガー２８の運動により、駆動部材１３８が、図８に示される第１の駆動位置と、図９に示される第２の駆動位置との間で前後に動く。組織のクランプが行われる前にステープルが発射されるのを防ぐため、解除ボタン３９の上方ラッチアーム１１８は、駆動部材１３８の第２のノッチ１４８と係合されることができ、金属駆動ロッド１４０が、図４に示されるように、その最も近位の位置でロックされる。上方ラッチアーム１１８が凹部１２２内に入ると、上方ラッチアーム１１８は、第２のノッチ１４８と係合解除し、図７に示されるような、金属駆動ロッド１４０の遠位への動きを許容する。
駆動部材１３８上の第１のギアラック１４１および金属駆動ロッド１４０上のギアラック１５４が倍率器１３６と係合されているので、発射トリガー２８の動きにより、金属駆動ロッド１４０が、図８に示される第１の往復運動位置と、図７に示される第２の往復運動位置との間で往復運動する。第１のピニオンギア１５０の直径が第２のピニオンギア１５２の直径より大きいので、倍率器１３６は、駆動部材１３８が発射トリガー２８により動かされるよりも長い距離にわたり往復運動部分１３４を動かす。第１のピニオンギア１５０および第２のピニオンギア１５２の直径は、発射トリガー２８のストロークの長さ、および発射トリガー２８を動かすのに必要な力を変えることを可能にするよう変更されてよい。ハンドル組立体２０は例証的なものであり、他の作動機構が用いられてよいことが認識されるであろう。例えば、閉じる運動および発射運動は、自動化手段で生成されることができる。
外科用切断・ステープル留め器具１０のエンドエフェクタ１２の一実施形態が、図３および図８〜図１０に表されている。前記のとおり、ハンドル組立体２０は、エンドエフェクタ１２を作動させる、独立した別個の閉じる運動および発射運動を生み出すことができる。エンドエフェクタ１２は、有利には、この独立した別個の閉鎖および発射（すなわちステープル留めおよび切断）の臨床的柔軟性を維持することができる。図９は、発射バー１４がその未発射の近位位置にある状態で、エンドエフェクタ１２の細長いチャネル１６に設置された本発明のステープルカートリッジの実施形態３００を表している。ステープルカートリッジ３００は、カートリッジ本体３０２を有し、カートリッジ本体３０２は、カートリッジ３００の近位端部３０４から先細の外側先端部３０６に向かって延びる細長いスロット３１０によって分割されている。複数のステープル受容チャネル３２０ａ〜３２０ｆが、ステープルカートリッジ本体３０２内部に形成されている。様々な実施形態では、例えば、ステープル受容チャネル３２０ａ〜３２０ｆは、側方に離間した長さ方向の６列に配列されていてよく、細長いスロット３１０の各側に３列ずつ設けられている。ステープル受容チャネル３２０ａ〜３２０ｆ内部にステープル２２２（図３）が位置付けられており、ステープル２２２は、既知のように、移動可能なドライバ３３０上で支持されうる。例えば、開示内容を参照により全体として本明細書に組み込む、「Staple Cartridges For Forming Staples Having Differing Formed Staple Heights」と題された、同一出願人の所有する（co-owned）米国特許出願公開第２００７／００４５３７９号に記載されたものなどの、ステープルドライバ構造が用いられてよい。しかしながら、他のタイプのステープルおよびステープルドライバ構造が、本発明の趣旨および範囲から逸脱することなく、有効に利用されてもよい。
アンビル１８は、様々な既知の構造で細長いチャネル１６の近位端部に可動に取り付けられてよく、開く運動および閉じる運動が例えば閉鎖スリーブ３２によってアンビル１８に適用されると、アンビル１８は、開いた位置と閉じた位置との間で動かされる。アンビル１８は、ステープル成形面２０２を有する本体部分２００を有してよく、ステープル成形面２０２は、ステープルカートリッジ３００に設けられたステープルチャネル３２０ａ、３２０ｂ、３２０ｃ、３２０ｄ、３２０ｅ、および３２０ｆと合致する複数のステープル成形ポケット（不図示）を内部に有する。アンビルは、上面すなわち外面２０４も有する。例えば、アンビル１８は、細長いチャネル１６の近位端部におけるスロット２３０に軸支された（journaled）トラニオン２３２（図１１）により細長いチャネルの近位端部に旋回可能に連結されることができ、開いた位置にある場合、アンビル１８のステープル成形面２０２は、細長いチャネル１６内部に据え付けられたステープルカートリッジ３００から離間しており、閉じる運動が閉鎖スリーブ３２によりアンビル２８に適用されると、アンビル１８のステープル成形面２０２は、ステープルカートリッジ３００と直面関係にされて、組織「Ｔ」が図８に示されるようにアンビルとステープルカートリッジとの間でクランプされることができる。しかしながら、アンビル１８は、様々な異なる既知のアンビル取り付け構造を用いて、ステープルカートリッジ３００に対して可動に支持されることができる。
図３および図１１で見ることができるように、カートリッジ本体３０２は、カートリッジトレー２２４内部に据え付けられうる。図３に例証されるように、カートリッジ本体３０２は、長さ方向に延びる２つの内側スロット３９０、および長さ方向に延びる２つの外側スロット３９２を備えて形成されうる。スロット３９０および３９２は、カートリッジの近位端部３０４から、その先細の外側先端部３０６まで延在している。このカートリッジの実施形態３００は、カートリッジトレー２２４上でスライド可能に支持される楔形スレッド４００をさらに含んでよい。１つの楔形スレッドの実施形態４００は、一対の内側スレッドカム４１０を含み、１つの内側スレッドカム４１０は、長さ方向に延びる内側スロット３９０のうちの１つに対応し、もう一方の内側スレッドカム４１０は、長さ方向に延びるもう一方の内側スロット３９０に対応する。図３を参照のこと。楔形スレッド４００は、一対の外側スレッドカム４２０をさらに含んでよく、図１９に示されるように、１つの外側スレッドカム４２０は、長さ方向に延びる外側スロット３９２のうちの１つに対応し、もう一方の外側スレッドカム４２０は、長さ方向に延びるもう一方の外側スロット３９２に対応する。組み立てられると、カートリッジトレー２２４は、楔形スレッド４００およびドライバ３３０を、カートリッジ本体３０２の内側で保持する。
図１１で見ることができるように、細長いチャネル１６は、エンドエフェクタ１２をハンドル組立体２０に取り付けるためにフレーム３４の遠位端部上のチャネル繋留部材２２８を受容するための、近位に設置された取付空洞部２２６を有しうる。フレーム３４を包囲しうる閉鎖スリーブ３２は、遠位に向けられたタブ２３４を含み、タブ２３４は、アンビル１８上のアンビルピボット２３２のすぐ近くにあるが、アンビルピボット２３２の遠位にある、アンビル特徴部２３６に係合し、それにより、アンビル１８が開閉する。発射駆動部材３６は、ピン２４０により発射コネクタ２３８に取り付けられた発射バー１４から組み立てられるものとして図示され、発射コネクタ２３８は、金属駆動ロッド１４０に、回転により近位で取り付けられる。発射バー１４は、内部に挿入されたスロット付きガイド２３９によりフレームの遠位端部においてガイドされる。
図３および図８〜図１０に戻ると、本発明の様々な実施形態では、少なくとも１つの、好ましくは複数の、光源５００が、細長いチャネル１６内部で支持されている。一実施形態では、例えば、光源５００は、細長いチャネル１６およびフレーム３４を通って延びる伝導体６０２によりハンドル組立体２０内部に据え付けられた電気エネルギー源６００（図１）と電気的に連絡している、発光ダイオード（ＬＥＤ）を含んでよい。様々な実施形態では、例えば、電気エネルギー源は、１つ以上のバッテリーを含むことができる。しかしながら、さらに他の実施形態では、光源５００は、交流電流（ＡＣ）により電力供給されうる。より詳細には、ハンドル組立体２０は、ＡＣコンセントに差し込まれうる電源コード（不図示）を備えていてよい。さらに他の実施形態では、電気エネルギー源は、フレーム３４内部で動作可能に支持された１つ以上のバッテリーを含むことができる。
図３で見ることができるように、各光源５００は、細長いチャネル１６に設けられた受光ポート５１０内部に据え付けられていてよい。カートリッジトレー２２４およびカートリッジ本体３０２は、受光開口部または通路２２８、５２０をそれぞれ備えていてよく、これら開口部または通路は、各光源５００に対応しており、それによって、各光源５００により放射される光が、カートリッジ本体３０２を垂直に通る受光通路２２８、５２０を通過することを可能にする。ゆえに、臨床医が、組織を内部にクランプする前に、最初に組織「Ｔ」を把持し、動かし、扱っている場合、カートリッジ本体３０２を通過する光は、その領域および周囲組織を照らすのを助けることができる。
しかしながら、図３および図８で最も詳細に見ることができるように、本発明の様々な実施形態は、アンビル本体２００を通って延びる受光通路５３０を有することもできる。各受光通路５３０は、カートリッジ本体３０２の受光通路５２０に対応し、アンビル１８が図３に示されるように閉じた位置にくると、光は、カートリッジ本体３０２の受光通路５２０からアンビル本体２００の対応する受光通路５３０を通過するであろう。ゆえに、臨床医が、図８で見られるように、アンビル１８とカートリッジ３００との間に組織「Ｔ」をクランプすると、組織「Ｔ」により妨げられる受光通路２２８、５２０は、それらの対応する光源５００からの光を受けないであろう。しかしながら、光は、組織「Ｔ」により妨げられない通路２２８、５２０、５３０を通過するであろう。したがって、臨床医は、どの通路５３０が光を放射しているかに気づくことで、エンドエフェクタ１２の中にクランプされた組織「Ｔ」の位置を確かめることができるであろう。様々な実施形態では、アンビル１８は、少なくとも１つの、好ましくは２つの、下方に延びる組織位置測定器（downwardly extending tissue locators）１９を備えていてもよく、組織位置測定器１９は、エンドエフェクタ１２内部で組織「Ｔ」を位置付けるのを助けるのに役立つ。
図１２および図１３は、代替的なエンドエフェクタの実施形態１２’を有する代替的な外科用切断・ステープル留め器具１０’を例証しており、代替的なエンドエフェクタの実施形態１２’は、以下に述べる相違点を除いて、前記のエンドエフェクタ１２と実質的に同一であってよい。例えば、このエンドエフェクタの実施形態１２’では、図１３に示されるように、少なくとも１つの、好ましくは少なくとも２つの、光ファイバーケーブル７００が、細長いチャネル１６に設けられたチャネル７０２内部に据え付けられている。光ファイバーケーブル７００は、ハンドル組立体２０の中、またはフレーム３４の中に据え付けられた、少なくとも１つの光源８００と協働することができる。少なくとも１つの光源８００は、１つ以上の発光ダイオードなどを含むことができる。光ファイバーケーブル７００は、アンビル本体２００の受光通路５３０を通して放出するため、光源８００から、トレーカートリッジ２２４における対応する受光通路２２８およびカートリッジ本体３０２における受光通路５２０の中へ放射されている光を伝えるのに役立つ。
図１４〜図１７は、以下に記載する相違点を除いて、前記のエンドエフェクタ１２と実質的に同一であってよい、別の代替的なエンドエフェクタの実施形態１２”を例証している。例えば、このエンドエフェクタの実施形態１２”では、複数の光源８００がステープルカートリッジ本体３０２に据え付けられている。様々な実施形態では、光源８００は、発光ダイオードを含み、発光ダイオードは、対応する伝導体８０２によって、カートリッジ本体３０２の下面に据え付けられ、かつカートリッジトレー２２４を通って延びる接触部（contacts）８０４に、電気的に連結されている。図１７を参照のこと。ステープルカートリッジ３００が細長いチャネル１６内部に設置されると、第１の接触部が、細長いチャネル１６に据え付けられた対応する第２の接触部と電気的に接触した状態に、そして、電気エネルギー源、例えばフレーム３４もしくはハンドル組立体２０に据え付けられた１つまたは複数のバッテリー、と電気的に接触した状態に、保たれる。ゆえに、カートリッジ３００が細長いチャネル３００に設置されると、光源８００は、対応する第１の接触部８０４と第２の接触部８０６との間の電気的な相互接続により、電力供給される。
本明細書に開示される様々なエンドエフェクタの実施形態では、異なる色の発光ダイオードが用いられて、例えば、エンドエフェクタの異なる部分間の区別をつけて、エンドエフェクタ内部での組織の位置を判断する上で臨床医をさらに助けることができる。例えば、エンドエフェクタの遠位端部は、赤い光を備えていてよい。エンドエフェクタの中央部分は、緑の光を有してよく、近位端部は、黄色い光を有するなどしてよい。
使用の際、外科用ステープル留め・切断器具１０は、図１〜図２に示されたように使用される。図１〜図２では、器具１０は、その開始位置にあり、未発射の、完全に装填されたステープルカートリッジ３００を、細長いチャネル１６の遠位端部の中にスナップ嵌めさせている。エンドエフェクタ１２をトロカールもしくは体腔内への他の開口部に挿入した後に典型的であるように、双方のトリガー２６、２８は進められ、エンドエフェクタ１２は開かれている。器具１０は、その後、臨床医により操作され、ステープル留めおよび切断されるべき組織「Ｔ」が、図８および図１４に表されるように、ステープルカートリッジ３００とアンビル１８との間に位置付けられる。次に臨床医は、ピストルグリップ２４に直接隣接して位置付けられるまで閉鎖トリガー２６を近位に動かし、ハンドル部分２０を、閉じたクランプ位置にロックする。エンドエフェクタ１２内の後退した発射バー１４は、エンドエフェクタ１２の選択的な開閉を妨げないが、アンビルポケット４０内部に位置する。アンビル１８が閉じられクランプされると、発射バー１４は、エンドエフェクタ１２を通って発射されるように整列される。組織のクランプが行われた後、臨床医は、発射トリガー２８を近位に動かし、発射バー１４をエンドエフェクタ１２内へと遠位に動かす。臨床医は、閉鎖トリガー２６およびピストルグリップ２４に対して近位にくるまで、発射トリガー２８を動かし続ける。それによって、ステープル２２２の端部すべてが、アンビル１８と係合した結果、曲げられる。切断エッジ４８は、組織を完全に横切っている。このプロセスは、発射トリガー２８を解除することによって、そしてその後、解除ボタン３０を押し下げると同時に閉鎖トリガー２６を強く握ってエンドエフェクタ１２を開くことによって、完了する。
本発明は、いくつかの実施形態の説明により例証されており、例証的な実施形態は、非常に詳細に説明されてきたが、添付の請求項の範囲をそのような詳細に限定するか、または何らかの方法で制限することは、出願人の意図するところではない。さらなる利点および改変が、当業者には容易に明らかとなるであろう。本発明の様々な実施形態は、先のエンドエフェクタに対して大きな改善を示す。
したがって、本発明は、内視鏡的処置および装置に関して論じられてきた。しかしながら、「内視鏡的（endoscopic）」などの用語を本明細書で使用することは、本発明を、内視鏡チューブ（すなわちトロカール）のみと共に使用する外科用ステープル留め・切断器具に限定すると解釈されるべきではない。それどころか、本発明は、腹腔鏡処置ならびに切開処置（open procedures）を含むがこれらに限定されない、アクセスが小さな切開部に限定されるあらゆる処置における用途を見出すことができると考えられる。さらに、本発明の様々なエンドエフェクタの実施形態の独自かつ新奇の態様は、本発明の趣旨および範囲から逸脱せずに、他の形態のエンドエフェクタおよびステープル留め装置と共に使用される際の有用性を見出すことができる。例えば、本発明の様々な実施形態の様々な独自かつ新奇の特徴は、組織を把持し組織を扱う他の形態のエンドエフェクタと共に有効に利用されてよい。したがって、本明細書で使用されるように、用語「エンドエフェクタ」は、切断・ステープル留めエンドエフェクタに限定されるべきでない。加えて、本明細書に開示された様々なエンドエフェクタは、外科用切断・ステープル留め器具の一部を含み、かつ、使用済みステープルカートリッジと共に処分されない再利用可能な発射バー／ナイフ構造と共に使用されるように設計される。しかしながら、本発明の様々な実施形態の独自かつ新奇の利点および特徴は、「使い捨ての装填ユニット」、すなわち、例えばナイフバーが使用済みステープルカートリッジと共に処分されるユニット、として当技術分野で既知のエンドエフェクタと関連して有効に用いられることもできることを、当業者は認識するであろう。したがって、本明細書で使用される用語「エンドエフェクタ」はまた、そのような使い捨ての装填ユニットも包含することを意図している。
さらに、本明細書に開示された装置は、１回使用した後で処分されるように設計されてよく、あるいは、複数回使用されるように設計されてよい。しかしながら、いずれの場合も、装置は、少なくとも１回使用した後で、再利用のため再調整されることができる。再調整には、装置の分解ステップ、それに続く、特定の部品の洗浄もしくは取替ステップ、およびその後の再組み立てステップのあらゆる組み合わせが含まれうる。詳細には、装置は、分解されてよく、装置の、任意の数の特定の部品または部分が、任意の組み合わせで選択的に取り替えられるかまたは取り外されうる。特定の部分が洗浄され、かつ／または取り替えられると、装置は、再調整施設で、または、外科処置の直前に外科チームによって、次の使用のため再組み立てされることができる。当業者は、装置の再調整が、分解、洗浄／取替、および再組み立てのための様々な異なる技術を用いてよいことを認識するであろう。そのような技術の使用、および結果として生じる、再調整された装置はすべて、本出願の範囲内である。
好ましくは、本明細書に記載された発明は、手術前に処理される。まず、新しい器具もしくは使用済み器具を手に入れ、必要であれば洗浄する。器具は次に滅菌されうる。一滅菌技術では、器具は、プラスチックバッグまたはＴＹＶＥＫ（登録商標）バッグなど、閉鎖および密封された容器の中に入れられる。容器および器具は次に、γ放射線、ｘ線、または高エネルギー電子など、容器を貫通できる放射線の場に置かれる。放射線が、器具上および容器内の細菌を死滅させる。滅菌された器具は、その後、滅菌容器内で保管されうる。密封された容器は、医療施設で開けられるまで、器具を滅菌状態に保つ。
参照により本明細書に組み込まれると述べたあらゆる特許、刊行物または他の開示資料は、全体または一部において、組み込まれる資料が、本開示に記載された既存の定義、声明、または他の開示資料と矛盾しない範囲でのみ、本明細書に組み込まれる。したがって、必要な範囲で、本明細書で明らかに述べた開示内容は、参照により本明細書に組み込まれるあらゆる矛盾する資料に取って代わるものである。参照により本明細書に組み込まれると述べたが、本明細書に記載された既存の定義、声明、もしくは他の開示資料と矛盾しているあらゆる資料、またはその一部は、その組み込まれた資料と、既存の開示資料との間で矛盾が生じない範囲において組み込まれるにすぎない。
保護されることを意図する本発明は、開示された特定の実施形態に限定されるものと解釈されるべきでない。したがって、実施形態は、限定的なものではなく、例証的なものとみなされるものである。本発明の趣旨から逸脱せずに、他者が変形および修正を行ってもよい。したがって、請求項で定められる本発明の趣旨および範囲内におさまるそのような等価物、変形および修正はすべて、本発明に含まれることが明らかに意図される。
〔実施の態様〕
（１） 外科用切断・ステープル留め器具用のエンドエフェクタにおいて、
内部でステープルカートリッジを支持するように構成され、前記外科用切断・ステープル留め器具に動作可能に連結された、細長いチャネルと、
開いた位置と閉じた位置との間で選択的に動くように前記細長いチャネルに対して可動に支持されたアンビルであって、組織が、前記外科用切断・ステープル留め器具から前記アンビルに適用された閉じる運動に応じて、前記アンビルと前記細長いチャネル内部で支持されたステープルカートリッジとの間でクランプされる、アンビルと、
前記ステープルカートリッジおよび前記細長いチャネルのうち少なくとも一方に設けられた少なくとも１つの光源であって、前記少なくとも１つの光源は、前記アンビルと前記ステープルカートリッジとの間にクランプされた組織の位置を示すため前記アンビルの一部を通して見ることができる視覚表示を提供するよう前記アンビルと協調する、少なくとも１つの光源と、
を含む、エンドエフェクタ。
（２） 実施態様１に記載のエンドエフェクタにおいて、
前記アンビルは、前記アンビルを通る複数の光観察開口部を有し、前記少なくとも１つの光源は、前記アンビルが前記閉じた位置にくると、前記光観察開口部を通して投射することができる、エンドエフェクタ。
（３） 実施態様１に記載のエンドエフェクタにおいて、
前記少なくとも１つの光源は、前記ステープルカートリッジにおいて複数の発光ダイオードを含む、エンドエフェクタ。
（４） 実施態様１に記載のエンドエフェクタにおいて、
前記アンビルは、前記アンビル上に少なくとも１つの組織位置測定器を有する、エンドエフェクタ。
（５） 実施態様１に記載のエンドエフェクタにおいて、
前記少なくとも１つの光源は、前記外科用切断・ステープル留め器具により支持された電気エネルギー源に電気的に連結される、エンドエフェクタ。
（６） 実施態様１に記載のエンドエフェクタにおいて、
前記細長いチャネルは、内部で前記電気エネルギー源を支持する、前記外科用器具の細長いフレームに連結される、エンドエフェクタ。
（７） 実施態様１に記載のエンドエフェクタにおいて、
前記少なくとも１つの光源は、前記細長いチャネル内部で支持された少なくとも１つの光ファイバー部材であって、前記細長いチャネルおよび前記外科用切断・ステープル留め器具のうち一方において支持された光源と動作可能に連絡している、少なくとも１つの光ファイバー部材を含む、エンドエフェクタ。
（８） 実施態様１に記載のエンドエフェクタにおいて、
前記細長いチャネルは、前記光源を支持する、前記外科用切断・ステープル留め器具の細長いフレームに動作可能に連結されている、エンドエフェクタ。
（９） 実施態様８に記載のエンドエフェクタにおいて、
前記細長いフレームは、前記光源を支持する、前記外科用切断・ステープル留め装置のハンドル組立体に動作可能に連結されている、エンドエフェクタ。
（１０） 手術のためにエンドエフェクタを処理する方法において、
実施態様１に記載のエンドエフェクタを入手することと、
前記エンドエフェクタを滅菌することと、
前記エンドエフェクタを、滅菌容器内で保管することと、
を含む、方法。
（１１） 外科用切断・ステープル留め器具と共に使用するためのステープルカートリッジにおいて、
複数のステープル受容チャネルを内部に有するカートリッジ本体であって、各前記ステープル受容チャネルは、内部で少なくとも１つの外科用ステープルを動作可能に支持する、カートリッジ本体と、
前記ステープルカートリッジが前記外科用切断・ステープル留め器具内で動作可能に支持されて前記外科用切断・ステープル留め器具のアンビル部分が組織クランプ位置に向けられたときに前記アンビル部分に向けて光を投射するために、前記カートリッジ本体内部で支持される、複数の光源と、
を含む、ステープルカートリッジ。
（１２） 実施態様１１に記載のステープルカートリッジにおいて、
前記複数の光源は、複数の発光ダイオードを含む、ステープルカートリッジ。
（１３） 実施態様１２に記載のステープルカートリッジにおいて、
前記発光ダイオードは、カートリッジ本体が前記外科用切断・ステープル留め器具に動作可能に連結されると、前記外科用切断・ステープル留め器具における電力源に電気的に連結される、ステープルカートリッジ。
（１４） 少なくとも１つの光源を内部に有する外科用切断・ステープル留め器具と共に使用するためのステープルカートリッジにおいて、
複数のステープル受容チャネルを内部に有するカートリッジ本体であって、各前記ステープル受容チャネルは、内部で少なくとも１つの外科用ステープルを動作可能に支持している、カートリッジ本体と、
前記ステープルカートリッジが前記外科用切断・ステープル留め器具内で動作可能に支持されて、前記外科用切断・ステープル留め器具のアンビル部分が組織クランプ位置に向けられたときに、前記光源から前記アンビル部分に向けて光を投射するような位置で、前記カートリッジ本体を通って延びる、複数の光投射開口部と、
を含む、ステープルカートリッジ。
（１５） 外科用切断・ステープル留め器具において、
ハンドル組立体と、
前記ハンドル組立体に動作可能に連結された細長いシャフトと、
前記細長いシャフトに動作可能に連結され、内部でステープルカートリッジを動作可能に支持するように構成された、細長いチャネルと、
開いた位置と閉じた位置との間で選択的に動くため前記細長いチャネルに対して可動に支持されたアンビルであって、組織が、前記細長いシャフトから前記アンビルに適用された開く運動および閉じる運動に応じて、前記アンビルと、前記細長いチャネル内部で支持されたステープルカートリッジとの間でクランプされる、アンビルと、
前記ステープルカートリッジおよび前記細長いチャネルのうち少なくとも一方に設けられた少なくとも１つの光源であって、前記少なくとも１つの光源は、前記アンビルと前記ステープルカートリッジとの間でクランプされた組織の位置を示すため前記アンビルの一部を通して見ることができる視覚表示を提供するように前記アンビルと協調する、少なくとも１つの光源と、
を含む、外科用切断・ステープル留め器具。
（１６） 実施態様１５に記載の外科用切断・ステープル留め器具において、
前記アンビルは、前記アンビルを通る複数の受光通路を有し、前記少なくとも１つの光源は、前記アンビルが前記閉じた位置にくると、前記複数の受光通路を通して投射することができる、外科用切断・ステープル留め器具。
（１７） 実施態様１５に記載の外科用切断・ステープル留め器具において、
前記少なくとも１つの光源は、
前記細長いシャフトおよび前記ハンドル組立体のうち一方において支持された、少なくとも１つの光放射部材と、
前記少なくとも１つの光源からの光を受けるように前記少なくとも１つの光源と動作可能に連絡している、前記細長いチャネル内部で支持された少なくとも１つの光ファイバーケーブルと、
を含む、外科用切断・ステープル留め器具。
（１８） 実施態様１５に記載の外科用切断・ステープル留め器具において、
前記少なくとも１つの光源は、前記ステープルカートリッジ内に、電気で動く複数の光源を含み、
前記外科用切断・ステープル留め器具は、前記細長いチャネルにおいて支持された少なくとも１つの電気接触部であって、前記ステープルカートリッジが前記細長いチャネル内部で動作可能に支持されている場合、前記少なくとも１つの電気接触部が、前記ステープルカートリッジ内の前記複数の光源に電力を送るため前記ステープルカートリッジにおける対応する少なくとも１つの電気接触部と電気的に協調するように、電気エネルギー源と電気的に連絡している、少なくとも１つの電気接触部をさらに含む、外科用切断・ステープル留め器具。
（１９） 実施態様１８に記載の外科用切断・ステープル留め装置において、
前記電気で動く複数の光源は、複数の発光ダイオードを含む、外科用切断・ステープル留め装置。
（２０） 実施態様１９に記載の外科用切断・ステープル留め装置において、
前記複数の発光ダイオードは、少なくとも２つの異なる色で提供される、外科用切断・ステープル留め装置。

図１は、開いた位置における、本発明のある実施形態の外科用切断・ステープル留め器具の、部分的に切り取られた側面図を表す。 図２は、図１の線２−２に沿った、外科用切断・ステープル留め器具のエンドエフェクタの断面側面詳細図を表す。 図３は、アンビルが閉じた位置にある、図２のエンドエフェクタの断面図である。 図４は、図１の外科用切断・ステープル留め器具の近位端部のハンドル部分の側面図を表しており、左側が除去されて、クランプされていない未発射（「開始」）位置で、内部部品が露出されている。 図５は、図１の外科用切断・ステープル留め器具の近位端部のハンドル部分の分解組立斜視図を表す。 図６は、図１の外科用切断・ステープル留め器具の近位端部のハンドル部分の側面図を表しており、左側が除去されて、閉じた（「クランプされた」）位置で、内部部品が露出されている。 図７は、図１の外科用切断・ステープル留め器具の近位端部のハンドル部分の側面図を表しており、左側が除去されて、ステープル留めおよび切断された（「発射された」）位置で、内部部品が露出されている。 図８は、組織「Ｔ」の一部をアンビルとステープルカートリッジとの間でクランプする、本発明の図１のエンドエフェクタの実施形態の斜視図である。 図９は、明瞭にするためエンドエフェクタからアンビルが除去されている、図８のエンドエフェクタの斜視図である。 図１０は、図９に表されたステープルカートリッジの一部の斜視図である。 図１１は、図１の外科用切断・ステープル留め器具の用具部分の等角分解組立図である。 図１２は、開いた位置における、本発明の別の実施形態の外科用切断・ステープル留め器具の、部分的に切り取られた側面図を表す。 図１３は、アンビルが閉じた位置にある、図１２のエンドエフェクタの断面図である。 図１４は、組織「Ｔ」の一部をアンビルとステープルカートリッジとの間でクランプする、本発明の別のエンドエフェクタの実施形態の斜視図である。 図１５は、明瞭化のためアンビルがエンドエフェクタから除去された、図１４のエンドエフェクタの斜視図である。 図１６は、図１５に表されたステープルカートリッジの一部の斜視図である。 図１７は、アンビルが閉じた位置にある、図１４〜図１６のエンドエフェクタの断面図である。

Claims (8)

  1. 外科用切断・ステープル留め器具用のエンドエフェクタにおいて、
    内部でステープルカートリッジを支持するように構成され、前記外科用切断・ステープル留め器具に連結された、細長いチャネルと、
    開いた位置と閉じた位置との間で選択的に動くように前記細長いチャネルに対して可動に支持されたアンビルであって、組織が、前記外科用切断・ステープル留め器具から前記アンビルに適用された閉じる運動に応じて、前記アンビルと前記細長いチャネル内部で支持されたステープルカートリッジとの間でクランプされる、アンビルと、
    前記ステープルカートリッジおよび前記細長いチャネルのうち少なくとも一方に設けられた少なくとも１つの光源であって、前記少なくとも１つの光源は、前記アンビルと前記ステープルカートリッジとの間にクランプされた組織の位置を示すため前記アンビルの一部を通して見ることができる視覚表示を提供するよう前記アンビルと協調する、少なくとも１つの光源と、
    を含み、
    前記アンビルは、前記アンビルを通る複数の光観察開口部を有し、前記少なくとも１つの光源は、前記アンビルが前記閉じた位置にくると、前記光観察開口部を通して投射することができる、エンドエフェクタ。
  2. 請求項１に記載のエンドエフェクタにおいて、
    前記少なくとも１つの光源は、前記ステープルカートリッジにおいて複数の発光ダイオードを含む、エンドエフェクタ。
  3. 請求項１に記載のエンドエフェクタにおいて、
    前記少なくとも１つの光源は、前記外科用切断・ステープル留め器具により支持された電気エネルギー源に電気的に連結される、エンドエフェクタ。
  4. 請求項１に記載のエンドエフェクタにおいて、
    前記細長いチャネルは、内部で前記電気エネルギー源を支持する、前記外科用器具の細長いフレームに連結される、エンドエフェクタ。
  5. 請求項１に記載のエンドエフェクタにおいて、
    前記少なくとも１つの光源は、前記細長いチャネル内部で支持された少なくとも１つの光ファイバー部材であって、前記細長いチャネルおよび前記外科用切断・ステープル留め器具のうち一方において支持された光源と連絡している、少なくとも１つの光ファイバー部材を含む、エンドエフェクタ。
  6. 請求項１に記載のエンドエフェクタにおいて、
    前記細長いチャネルは、前記光源を支持する、前記外科用切断・ステープル留め器具の細長いフレームに連結されている、エンドエフェクタ。
  7. 請求項６に記載のエンドエフェクタにおいて、
    前記細長いフレームは、前記光源を支持する、前記外科用切断・ステープル留め装置のハンドル組立体に連結されている、エンドエフェクタ。
  8. 手術のためにエンドエフェクタを処理する方法において、
    請求項１に記載のエンドエフェクタを入手することと、
    前記エンドエフェクタを滅菌することと、
    前記エンドエフェクタを、滅菌容器内で保管することと、
    を含む、方法。
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US20100065605A1 (en) 2010-03-18
US8083120B2 (en) 2011-12-27
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EP2165654B1 (en) 2017-12-13
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