JP5582788B2 - 電気外科手順を実施するための装置、システム、および方法 - Google Patents
電気外科手順を実施するための装置、システム、および方法 Download PDFInfo
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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
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
- A61B2017/00539—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated hydraulically
-
- 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
-
- 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
- A61B2017/2948—Sealing means, e.g. for sealing the interior from fluid entry
-
- 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
-
- 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
Description
本開示は、電気外科手順を実施するための装置、システム、および方法に関する。より特定すると、本開示は、種々のサイズのアクセスポートとともに使用するために構成されたエンドエフェクタアセンブリを備える電気外科装置を使用する、電気外科手順を実施するための装置、システム、および方法に関する。
電気外科装置（例えば、電気外科鉗子）は、医療分野において周知であり、そして代表的に、ハンドル、シャフトおよびエンドエフェクタアセンブリを備え、このエンドエフェクタアセンブリは、このシャフトの遠位端に作動可能に結合され、そして組織を操作するように（例えば、組織を把持および封止するように）構成される。電気外科鉗子は、機械的クランプ作用と電気エネルギーとの両方を利用して、組織および血管を加熱し、組織を凝固、焼灼、封止、切断、乾燥、および／または高周波治療することにより、止血を行う。
開腹外科手術手順と共に使用するための開腹外科手術鉗子の代用品として、多くの最近の外科医は、より小さい穿孔様の切開または天然の開口部を通して器官に遠隔アクセスするために、内視鏡および内視鏡電気外科装置（例えば、内視鏡鉗子）または腹腔鏡装置を使用する。その直接の結果として、患者は、より小さい瘢痕を形成すること、および治癒時間が短縮されることという利益を得る傾向がある。例えば、内視鏡鉗子は、トロカールを備えて作製された、１つ以上の種々の型のカニューレまたはアクセスポート（代表的に、約５ミリメートル〜約１２ミリメートルの範囲の開口部を有する）を通して患者に挿入される。理解され得るように、より小さいカニューレが、通常好ましい。
小さいカニューレ（例えば、５ミリメートルより小さいカニューレ）と共に使用するために構成される内視鏡鉗子は、内視鏡器具の製造業者に対して、設計の難点を提示し得る。
上記のように、より小さいカニューレまたはアクセスポートは、通常、内視鏡手順中に好ましい。しかし、カニューレまたはアクセスポートのサイズの制限に起因して、より小さいカニューレと共に使用されるように構成される内視鏡鉗子は、製造業者に対して、設計の難点を提示し得る（例えば、内視鏡鉗子のエンドエフェクタアセンブリを、その一体性および／または機能性を損なうことなく設計すること）。
上記課題を解決するために、本発明は、例えば、以下を提供する：
（項目１Ａ）
電気外科手順を実施するために電気外科エネルギーの供給源に接続されるように適合された鉗子であって、
ハウジングであって、該ハウジングは、該ハウジングから延びるシャフトを有し、該シャフトは、該シャフトを通る長手方向軸を規定する、ハウジング；
液圧機構であって、該液圧機構は、流体ライン、および該流体ラインに作動可能に結合されたプランジャーを備え、該プランジャーは、該シャフトの少なくとも一部の内部で並進可能である、液圧機構；ならびに
該シャフトの遠位端に作動可能に接続されたエンドエフェクタアセンブリであって、該エンドエフェクタアセンブリは、開構成に付勢された一対の第一の顎部材および第二の顎部材を有し、該第一の顎部材および該第二の顎部材の各々は、流体が該流体ライン内で流される場合に、該プランジャーの少なくとも一部分を受容するように構成されており、その結果、該第一の顎部材および該第二の顎部材は、開位置からクランプ位置へと移動し、該開位置において、該顎部材は互いに間隔を空けた関係で配置され、該クランプ位置において、該顎部材は協働して該顎部材の間に組織を把持する、エンドエフェクタアセンブリ、
を備える、鉗子。
（項目１Ａ）
電気外科手順を実施するために電気外科エネルギーの供給源に接続されるように適合された鉗子であって、
ハウジングであって、該ハウジングは、該ハウジングから延びるシャフトを有し、該シャフトは、該シャフトを通る長手方向軸を規定する、ハウジング；
液圧機構であって、該液圧機構は、流体ライン、および該流体ラインに作動可能に結合されたプランジャーを備え、該プランジャーは、該シャフトの少なくとも一部の内部で並進可能である、液圧機構；ならびに
該シャフトの遠位端に作動可能に接続されたエンドエフェクタアセンブリであって、該エンドエフェクタアセンブリは、開構成に付勢された一対の第一の顎部材および第二の顎部材を有し、該第一の顎部材および該第二の顎部材の各々は、流体が該流体ライン内で流される場合に、該プランジャーの少なくとも一部分を受容するように構成されており、その結果、該第一の顎部材および該第二の顎部材は、開位置からクランプ位置へと移動し、該開位置において、該顎部材は互いに間隔を空けた関係で配置され、該クランプ位置において、該顎部材は協働して該顎部材の間に組織を把持する、エンドエフェクタアセンブリ、
を備える、鉗子。
（項目２Ａ）
上記第一の顎部材および上記第二の顎部材の各々が、上記シャフトの遠位端に位置する旋回ピンの周りで旋回可能である、上記項目に記載の双極鉗子。
上記第一の顎部材および上記第二の顎部材の各々が、上記シャフトの遠位端に位置する旋回ピンの周りで旋回可能である、上記項目に記載の双極鉗子。
（項目３Ａ）
上記第一の顎部材および上記第二の顎部材の各々が、該顎部材の近位端に位置する少なくとも１つの開口部分を備え、該開口部分は、上記プランジャーの少なくとも一部分を受容するように構成されている、上記項目のいずれか１項に記載の双極鉗子。
上記第一の顎部材および上記第二の顎部材の各々が、該顎部材の近位端に位置する少なくとも１つの開口部分を備え、該開口部分は、上記プランジャーの少なくとも一部分を受容するように構成されている、上記項目のいずれか１項に記載の双極鉗子。
（項目４Ａ）
上記プランジャーが、該プランジャーの近位部分から延びる少なくとも２つのプロングを備え、該プロングは、上記第一の顎部材および上記第二の顎部材の各々に関連する少なくとも１つの開口部分と係合するように構成されている、上記項目のいずれか１項に記載の双極鉗子。
上記プランジャーが、該プランジャーの近位部分から延びる少なくとも２つのプロングを備え、該プロングは、上記第一の顎部材および上記第二の顎部材の各々に関連する少なくとも１つの開口部分と係合するように構成されている、上記項目のいずれか１項に記載の双極鉗子。
（項目５Ａ）
上記プランジャーが、非圧縮状態において該プランジャーを近位に付勢する付勢部材を備える、上記項目のいずれか１項に記載の双極鉗子。
上記プランジャーが、非圧縮状態において該プランジャーを近位に付勢する付勢部材を備える、上記項目のいずれか１項に記載の双極鉗子。
（項目６Ａ）
上記プランジャーが、該プランジャーに作動可能に結合されたナイフ刃を備え、該ナイフ刃は、上記第一の顎部材および上記第二の顎部材のうちの少なくとも一方に規定されたナイフスロット内での並進運動のために構成されている、上記項目のいずれか１項に記載の双極鉗子。
上記プランジャーが、該プランジャーに作動可能に結合されたナイフ刃を備え、該ナイフ刃は、上記第一の顎部材および上記第二の顎部材のうちの少なくとも一方に規定されたナイフスロット内での並進運動のために構成されている、上記項目のいずれか１項に記載の双極鉗子。
（項目７Ａ）
上記第一の顎部材および上記第二の顎部材が、ばねによって付勢されている、上記項目のいずれか１項に記載の双極鉗子。
上記第一の顎部材および上記第二の顎部材が、ばねによって付勢されている、上記項目のいずれか１項に記載の双極鉗子。
（項目１Ｂ）
電気外科手順を実施するために電気外科エネルギーの供給源に接続されるように適合された鉗子であって、
ハウジングであって、該ハウジングは、該ハウジングから延びるシャフトを有し、該シャフトは、該シャフトを通る長手方向軸を規定する、ハウジング；
液圧機構であって、該液圧機構は、流体ライン、および該流体ラインに作動可能に結合されたプランジャーを備え、該プランジャーは、該シャフトの少なくとも一部の内部で並進可能である、液圧機構；ならびに
該シャフトの遠位端に作動可能に接続されたエンドエフェクタアセンブリであって、該エンドエフェクタアセンブリは、開構成に付勢された一対の第一の顎部材および第二の顎部材を有し、該第一の顎部材および該第二の顎部材の各々は、流体が該流体ライン内で流される場合に、該プランジャーの少なくとも一部分を受容するように構成されており、その結果、該第一の顎部材および該第二の顎部材は、開位置からクランプ位置へと移動し、該開位置において、該顎部材は互いに間隔を空けた関係で配置され、該クランプ位置において、該顎部材は協働して該顎部材の間に組織を把持する、エンドエフェクタアセンブリ、
を備える、鉗子。
電気外科手順を実施するために電気外科エネルギーの供給源に接続されるように適合された鉗子であって、
ハウジングであって、該ハウジングは、該ハウジングから延びるシャフトを有し、該シャフトは、該シャフトを通る長手方向軸を規定する、ハウジング；
液圧機構であって、該液圧機構は、流体ライン、および該流体ラインに作動可能に結合されたプランジャーを備え、該プランジャーは、該シャフトの少なくとも一部の内部で並進可能である、液圧機構；ならびに
該シャフトの遠位端に作動可能に接続されたエンドエフェクタアセンブリであって、該エンドエフェクタアセンブリは、開構成に付勢された一対の第一の顎部材および第二の顎部材を有し、該第一の顎部材および該第二の顎部材の各々は、流体が該流体ライン内で流される場合に、該プランジャーの少なくとも一部分を受容するように構成されており、その結果、該第一の顎部材および該第二の顎部材は、開位置からクランプ位置へと移動し、該開位置において、該顎部材は互いに間隔を空けた関係で配置され、該クランプ位置において、該顎部材は協働して該顎部材の間に組織を把持する、エンドエフェクタアセンブリ、
を備える、鉗子。
（項目２Ｂ）
上記第一の顎部材および上記第二の顎部材の各々が、上記シャフトの遠位端に位置する旋回ピンの周りで旋回可能である、上記項目に記載の双極鉗子。
上記第一の顎部材および上記第二の顎部材の各々が、上記シャフトの遠位端に位置する旋回ピンの周りで旋回可能である、上記項目に記載の双極鉗子。
（項目３Ｂ）
上記第一の顎部材および上記第二の顎部材の各々が、該顎部材の近位端に位置する少なくとも１つの開口部分を備え、該開口部分は、上記プランジャーの少なくとも一部分を受容するように構成されている、上記項目のいずれか１項に記載の双極鉗子。
上記第一の顎部材および上記第二の顎部材の各々が、該顎部材の近位端に位置する少なくとも１つの開口部分を備え、該開口部分は、上記プランジャーの少なくとも一部分を受容するように構成されている、上記項目のいずれか１項に記載の双極鉗子。
（項目４Ｂ）
上記プランジャーが、該プランジャーの近位部分から延びる少なくとも２つのプロングを備え、該プロングは、上記第一の顎部材および上記第二の顎部材の各々に関連する少なくとも１つの開口部分と係合するように構成されている、上記項目のいずれか１項に記載の双極鉗子。
上記プランジャーが、該プランジャーの近位部分から延びる少なくとも２つのプロングを備え、該プロングは、上記第一の顎部材および上記第二の顎部材の各々に関連する少なくとも１つの開口部分と係合するように構成されている、上記項目のいずれか１項に記載の双極鉗子。
（項目５Ｂ）
上記プランジャーが、非圧縮状態において該プランジャーを近位に付勢する付勢部材を備える、上記項目のいずれか１項に記載の双極鉗子。
上記プランジャーが、非圧縮状態において該プランジャーを近位に付勢する付勢部材を備える、上記項目のいずれか１項に記載の双極鉗子。
（項目６Ｂ）
上記プランジャーが、該プランジャーに作動可能に結合されたナイフ刃を備え、該ナイフ刃は、上記第一の顎部材および上記第二の顎部材のうちの少なくとも一方に規定されたナイフスロット内での並進運動のために構成されている、上記項目のいずれか１項に記載の双極鉗子。
上記プランジャーが、該プランジャーに作動可能に結合されたナイフ刃を備え、該ナイフ刃は、上記第一の顎部材および上記第二の顎部材のうちの少なくとも一方に規定されたナイフスロット内での並進運動のために構成されている、上記項目のいずれか１項に記載の双極鉗子。
（項目７Ｂ）
上記第一の顎部材および上記第二の顎部材が、ばねによって付勢されている、上記項目のいずれか１項に記載の双極鉗子。
上記第一の顎部材および上記第二の顎部材が、ばねによって付勢されている、上記項目のいずれか１項に記載の双極鉗子。
（項目８Ｂ）
電気外科器具を提供する工程であって、該電気外科器具は、
液圧機構であって、該液圧機構は、流体ライン、および該流体ラインに作動可能に結合されたプランジャーを備える、液圧機構；および
エンドエフェクタアセンブリであって、該エンドエフェクタアセンブリは、開構成に付勢された一対の第一の顎部材および第二の顎部材を有する、エンドエフェクタアセンブリ、
を備える、工程；
該一対の第一の顎部材と第二の顎部材との間に組織を配置する工程；
該液圧機構を起動して、該第一の顎部材および該第二の顎部材を、該顎部材の間に組織が把持されるように互いの方へと移動させる工程；ならびに
該顎部材に電気外科エネルギーを印加して、該顎部材の間の組織を効果的に封止する工程、
を包含する、電気外科手順を実施する方法。
電気外科器具を提供する工程であって、該電気外科器具は、
液圧機構であって、該液圧機構は、流体ライン、および該流体ラインに作動可能に結合されたプランジャーを備える、液圧機構；および
エンドエフェクタアセンブリであって、該エンドエフェクタアセンブリは、開構成に付勢された一対の第一の顎部材および第二の顎部材を有する、エンドエフェクタアセンブリ、
を備える、工程；
該一対の第一の顎部材と第二の顎部材との間に組織を配置する工程；
該液圧機構を起動して、該第一の顎部材および該第二の顎部材を、該顎部材の間に組織が把持されるように互いの方へと移動させる工程；ならびに
該顎部材に電気外科エネルギーを印加して、該顎部材の間の組織を効果的に封止する工程、
を包含する、電気外科手順を実施する方法。
（項目９Ｂ）
上記プランジャーに関連するナイフ刃で上記組織を切断する工程をさらに包含する、上記項目に記載の方法。
上記プランジャーに関連するナイフ刃で上記組織を切断する工程をさらに包含する、上記項目に記載の方法。
（項目１０Ｂ）
上記提供する工程が、上記第一の顎部材および第二の顎部材に、該顎部材の近位端に位置する少なくとも１つの開口部分を提供する工程をさらに包含し、該開口部分は、上記プランジャーの少なくとも一部分を受容するように構成される、上記項目のいずれか１項に記載の方法。
上記提供する工程が、上記第一の顎部材および第二の顎部材に、該顎部材の近位端に位置する少なくとも１つの開口部分を提供する工程をさらに包含し、該開口部分は、上記プランジャーの少なくとも一部分を受容するように構成される、上記項目のいずれか１項に記載の方法。
（項目１１Ｂ）
上記提供する工程が、上記プランジャーに、該プランジャーの近位部分から延びる少なくとも２つのプロングを提供する工程をさらに包含し、該プロングは、上記第一の顎部材および第二の顎部材の各々に関連する少なくとも１つの開口部分に係合するように構成される、上記項目のいずれか１項に記載の方法。
上記提供する工程が、上記プランジャーに、該プランジャーの近位部分から延びる少なくとも２つのプロングを提供する工程をさらに包含し、該プロングは、上記第一の顎部材および第二の顎部材の各々に関連する少なくとも１つの開口部分に係合するように構成される、上記項目のいずれか１項に記載の方法。
（項目１２Ｂ）
上記提供する工程が、上記プランジャーに、非圧縮状態において該プランジャーを近位に付勢する付勢部材を提供する工程をさらに包含する、上記項目のいずれか１項に記載の方法。
上記提供する工程が、上記プランジャーに、非圧縮状態において該プランジャーを近位に付勢する付勢部材を提供する工程をさらに包含する、上記項目のいずれか１項に記載の方法。
（項目１３Ｂ）
上記提供する工程が、上記プランジャーにナイフ刃を提供する工程をさらに包含し、該ナイフ刃は、該プランジャーに作動可能に結合され、そして上記第一の顎部材および第二の顎部材のうちの少なくとも一方に規定されたナイフスロット内での並進運動のために構成される、上記項目のいずれか１項に記載の方法。
上記提供する工程が、上記プランジャーにナイフ刃を提供する工程をさらに包含し、該ナイフ刃は、該プランジャーに作動可能に結合され、そして上記第一の顎部材および第二の顎部材のうちの少なくとも一方に規定されたナイフスロット内での並進運動のために構成される、上記項目のいずれか１項に記載の方法。
（項目１４Ｂ）
上記提供する工程が、上記第一の顎部材および第二の顎部材をばねにより付勢する工程をさらに包含する、上記項目のいずれか１項に記載の方法。
上記提供する工程が、上記第一の顎部材および第二の顎部材をばねにより付勢する工程をさらに包含する、上記項目のいずれか１項に記載の方法。
鉗子が提供される。この鉗子は、ハウジングを備え、このハウジングは、このハウジングから延びるシャフトを有する。この双極鉗子はまた、液圧機構を備え、この液圧機構は、流体ライン、およびこの流体ラインに作動可能に結合されたプランジャーを備える。このプランジャーは、このシャフトの少なくとも一部の内部で、近位位置から遠位位置へと並進可能である。エンドエフェクタアセンブリが、このシャフトの遠位端に作動可能に接続され、そして開構成に付勢された、一対の第一の顎部材および第二の顎部材を備える。この第一の顎部材およびこの第二の顎部材の各々は、流体がこの流体ライン内で流される場合に、このプランジャーの少なくとも一部分を受容するように構成されており、その結果、この第一の顎部材およびこの第二の顎部材は、開位置から、組織を把持するための閉位置に位置するために移動する。
従って、５ミリメートルより小さいものを含めた種々の型のカニューレまたはアクセスポートと共に使用するために構成されたエンドエフェクタアセンブリを備える内視鏡鉗子は、有用性を提供し得る。この目的を考慮して、本開示は、鉗子を提供する。この鉗子は、ハウジングを備え、このハウジングは、このハウジングから延びるシャフトを有する。この双極鉗子はまた、液圧機構を備え、この液圧機構は、流体ライン、およびこの流体ラインに作動可能に結合されたプランジャーを備える。このプランジャーは、このシャフトの少なくとも一部の内部で、近位位置から遠位位置へと並進可能である。エンドエフェクタアセンブリが、このシャフトの遠位端に作動可能に接続され、そして開構成に付勢された、一対の第一の顎部材および第二の顎部材を備える。この第一の顎部材およびこの第二の顎部材の各々は、流体がこの流体ライン内で流される場合に、このプランジャーの少なくとも一部分を受容するように構成されており、その結果、この第一の顎部材およびこの第二の顎部材は、組織を配置するための開位置から、組織を把持するための閉位置に移動する。
本開示はまた、電気外科手順を実施する方法を提供する。この方法は、電気外科器具を提供する最初の工程を包含し、この電気外科器具は、流体ラインおよびこの流体ラインに作動可能に結合されたプランジャーを備える、液圧機構を備える。エンドエフェクタアセンブリは、開構成に付勢された一対の第一の顎部材および第二の顎部材を備える。この方法はまた、組織を一対の第一の顎部材と第二の顎部材との間に配置する工程；液圧機構を起動させて第一の顎部材および第二の顎部材を互いに方へと移動させ、その結果、これらの顎部材の間に組織が把持される、工程；ならびに電気外科エネルギーをこれらの顎部材に印加する工程であって、その結果、これらの顎部材の間で組織の封止が行われ得る、工程を包含する。
本開示の種々の実施形態が、図面を参照しながら本明細書中以下に記載される。
本発明により、設計の難点を提示しない、より小さいカニューレと共に使用されるように構成される内視鏡鉗子が提供される。
本開示の詳細な実施形態が、本明細書中に開示される。しかし、開示される実施形態は、本開示の単なる例示であり、本開示は、種々の形態で実施され得る。従って、本明細書中に開示される具体的な構造的細部および機能的細部は、限定と解釈されるべきではなく、単に、特許請求の範囲の基礎として、そして当業者が本開示を事実上任意の適切に詳述された構造で様々に使用することを教示するための代表的な基礎として、解釈されるべきである。
上記のように、種々のアクセスポート（５ミリメートルより大きいものおよび／または小さいものが挙げられるが、これらに限定されない）と共に使用するために適切な電気外科装置を提供することは、有用性を提供し得る。この目的を考慮して、本開示は、電気外科鉗子を包含し、この電気外科鉗子は、液圧起動式エンドエフェクタアセンブリを備え、このエンドエフェクタアセンブリは、一対の顎部材を有し、これらの顎部材は、液圧機構に作動可能に結合されており、この液圧機構は、これらの顎部材を、組織を配置するための開位置から、組織を把持して顎部材の間で組織効果を生じるための閉位置へと移動させる。本開示の液圧起動式エンドエフェクタアセンブリは、電気外科鉗子が関節付きではない構成または関節付きの構成のいずれか一方である場合に、組織を融合または封止するために必要とされる力を提供する。
図１を参照すると、電気外科手順を実施するための電気外科装置（例えば、双極鉗子１０）の例示的な実施形態が示されている。双極鉗子１０は、電気外科手順を実施するために、電気外科発電機（発電機２００、例えば、図２を参照のこと）に作動可能に選択的に結合される。上記のように、電気外科手順は、組織を封止すること、切断すること、焼灼すること、凝固させること、乾燥させること、および高周波治療することを包含し得、これらの全ては、ＲＦエネルギーを使用し得る。発電機２００は、単極モードおよび／または双極モードの操作のために構成され得る。発電機２００は、１つ以上のプロセッサを備え得るシステム（システム４００、図２を参照のこと）を備え得るか、またはこのシステムと作動可能に通信し得る。このプロセッサは、このプロセッサで実行可能な１つ以上の制御モジュールと作動可能に通信する。制御モジュール（明白には図示せず）は、１つ以上のモジュールに、１つ以上のケーブル（例えば、ケーブル３１０）を介してシールプレート１１８、１２８のうちの一方または両方に、電気外科エネルギー（波または信号／パルスの形態であり得る）を伝達するよう指示する。発電機２００および／またはシステム３００のより詳細な説明については、共有に係る米国出願番号１０／４２７，８３２が参照される。
図１を再度参照すると、種々の電気外科手順と共に使用するための双極鉗子１０が示されており、この双極鉗子は一般に、ハウジング２０、ハンドルアセンブリ３０、回転アセンブリ８０、トリガアセンブリ７０、駆動アセンブリ１３０、および駆動アセンブリ１３０に作動可能に結合されるエンドエフェクタアセンブリ１００を備える。駆動アセンブリ１３０は、エンドエフェクタアセンブリ１００の一対の顎部材１１０、１２０のうちの一方または両方の動きを付与するための液圧機構２００と作動可能に連絡する。エンドエフェクタアセンブリ１００は、対向する顎部材１１０および１２０を備え（図１）、これらの顎部材は、大きい管状脈管および大きい脈管組織を把持し、封止し、そしていくつかの場合には分割するように、相互に協働する。図面の大部分は、腹腔鏡外科手術手順に関連して使用するための双極鉗子１０を図示するが、本開示は、より伝統的な開腹外科手術手順または内視鏡手順のために使用され得る。本明細書中での目的で、鉗子１０は、腹腔鏡器具の観点で記載される。しかし、開腹バージョンまたは内視鏡バージョンの鉗子もまた、以下に記載されるものと同じかまたは類似の作動構成要素および特徴を備え得る。
鉗子１０は、図３Ａ〜図３Ｂを参照しながら以下により詳細に記載されるように、シャフト１２を備え、このシャフトは、エンドエフェクタアセンブリ１００と機械的に係合するように構成された遠位端１４、およびハウジング２０と機械的に係合する近位端１６を有する。図面および以下の説明において、用語「近位」は、慣習的であるように、鉗子１０の、使用者に近い方の端部をいい、一方で、用語「遠位」は、使用者から遠い方の端部をいう。
図１の参照を続けると、ハンドルアセンブリ３０は、固定ハンドル５０および可動ハンドル４０を備える。固定ハンドル５０は、ハウジング２０に一体的に関連し、そしてハンドル４０は、固定ハンドル５０に対して移動可能である。固定ハンドル５０は、取り扱いを容易にするための１つ以上の人間工学的増強要素（例えば、スカラップ、隆起部、エラストマー材料など）を備え得る。
ハンドルアセンブリ３０の可動ハンドル４０は、最終的に、駆動アセンブリ１３０に接続される。この可動ハンドルと駆動アセンブリとは一緒になって協働して、液圧機構２００の動きを付与する。液圧機構２００の動きは、顎部材１１０および１２０を、開位置（この位置において、顎部材１１０と１２０とは互いに対して間隔を空けた関係で配置される）からクランプ位置または閉位置（この位置において、顎部材１１０と１２０とは協働してこれらの顎部材の間に組織を把持する）へと移動させる。
回転アセンブリ８０は、ハウジング２０に作動可能に関連しており、そしてシャフト１２を通して規定される長手方向軸「Ａ−Ａ」（図１を参照のこと）の周りで約１８０度回転可能である。
鉗子１０はまた、電気外科ケーブル３１０を備え、この電気外科ケーブルは、鉗子１０を電気外科エネルギーの供給源（例えば、発電機２００）に接続する。ケーブル３１０は、内部でケーブルリード線３１０ａ、３１０ｂ、３１０ｃ、および３２５ｂに分割され（図２を参照のこと）、これらのケーブルリード線は、それぞれの給電路を通し、鉗子１０を通してエンドエフェクタアセンブリ１００へと電位を伝達するように設計される。より具体的には、ケーブル給電線３２５ｂは、鉗子ハウジング２０を通し、そして回転アセンブリを通して、顎部材１２０へと接続される。リード線３１０ａは、スイッチ（図示せず）の片側に接続され、そしてリード線３１０ｃは、このスイッチの反対側に接続され、その結果、このスイッチの起動の際に、エネルギーがリード線３１０ａから３１０ｃへと伝達される。リード線３１０ｃは、リード線３１０ｂに接続される。リード線３１０ｂは、回転アセンブリを通して顎部材１１０へと接続される。
ハンドルアセンブリ３０、稼動ハンドル４０、回転アセンブリ８０、電気外科ケーブル３１０（ライン−給電線の構成および／または接続を含む）、ならびに駆動アセンブリ１３０のより詳細な説明については、共有に係る米国出願番号１０／３６９，８９４が参照される。
ここで図３Ａを参照すると、シャフト１２は、エンドエフェクタアセンブリ１００および液圧機構２００に作動可能に接続された、遠位端１４を備える。シャフト１２は、駆動アセンブリ１３０および液圧機構２００、またはその一部分を収容するように構成される。シャフト１２の遠位端１４において、顎部材１１０および１２０、またはその一部分が、シャフト１２の内側表面に、任意の適切な取り付け手段（かしめ、溶接、鋲、成型またはオーバーモールディングが挙げられるが、これらに限定されない）を介して取り付けられる。
シャフト１２の遠位端１４は、液圧機構２００の１つ以上のプランジャー２０２および／またはナイフ刃２１２の往復を提供するように適合される。さらに、遠位端１４は、（以下でより詳細に説明されるような）内部でのプランジャー２０２の並進中に、顎部材１１０および１２０が開構成から閉構成へと旋回することを可能にするように構成される。シールまたは密封構造体（明白には図示せず）（例えば、ガスケット）が、シャフト１２の遠位端１４またはその近くに作動可能に配置され得、そしてエンドエフェクタアセンブリ１００とプランジャー２０２との間に実質的に流体密なシールを提供するように構成される。
図３Ａの参照を続けると、液圧機構２００が示されている。液圧機構２００は、プランジャー２０２のうちの１つ以上と流体連絡する流体ライン２０４を備える。液圧機構２０（およびこれに関連する構成要素）は、任意の適切な生体適合性材料から作製され得る。
流体ライン２０４は、内部に１種以上の適切な生体適合性流体「Ｆ」を含む。液圧機構２００の流体ライン２０４と共に使用するために適切な流体「Ｆ」としては、合成化合物、鉱油、水、および水ベースの混合物が挙げられ得る。流体ライン２０４、および／または流体ライン内に含まれる流体「Ｆ」は、駆動アセンブリ１３０、プランジャー２０２、および／またはシャフト１２の遠位端１４と、１つ以上の適切な内部接続部および／または構成要素により、作動可能に連絡する。駆動アセンブリ１３０および／または流体ライン２０４に関連する、機械的に協働する内部構成要素は、エンドエフェクタアセンブリ１００の顎部材１００、１２０の動きを付与する。適切な構成要素としては、任意の数の減圧ブースターまたはサーボ、シリンダー、ピストン、ドラム、歯車、リンク、弁、ばね、および／または棒が挙げられ、その結果、鉗子１０が意図されるように機能し得る。力が液圧機構２００に関連する１つ以上の構成要素（例えば、ピストン）に付与される場合、この液圧機構内の圧力が増加し、流体「Ｆ」に力を加えて流体ライン２０４に通し、１つ以上のプランジャー２０２に至らせる。
プランジャー２０２は、流体ライン２０４および／または流体「Ｆ」と作動可能に連絡し、その結果、プランジャー２０４は、シャフト１２内で近位部分から遠位部分へと（例えば、顎部材１１０、１２０のうちの一方または両方と係合して）選択的に並進可能である。図３Ａおよび図３Ｂに図示される実施形態において、プランジャー２０２は、シャフト１２の遠位端１４に作動可能に配置され、そして顎部材１１０、１２０の各々の近位端に隣接して示されている。プランジャー２０２は、近位端を備え、この近位端は、基部２０８を規定し、この基部は、この基部から延びる１つ以上のプロング２１０を備え（２つのプロング２１０が示されている）、そして顎部材１１０、１２０のうちの一方または両方の近位端に位置する１つ以上の対応する開口部分１１２、１２２とそれぞれ係合するように構成される。プロング２１０は、プランジャー２０２の基部２０８から長手軸方向に延び、そして互いに対して実質的に平行な関係で配置される。１つ以上のばね２０６が、プランジャー２０２を近位方向に付勢する。図示される図に示されるように、ばね２０６は、プランジャー２０２に作動可能に配置される。しかし、いくつかの実施形態において、ばね２０６は、顎部材１１０、１２０および／またはエンドエフェクタアセンブリ１１０の近位端に作動可能に結合され得る。
図３Ａおよび図３Ｂに図示される実施形態において、プランジャー２０２は、ナイフ刃またはカッター２１２と作動可能に結合するプランジャー２１２を含み、このナイフ刃またはカッターは、顎部材１１０、１２０のうちの一方または両方に作動可能に配置されたナイフチャネル４０１内で並進可能である。プランジャー２１２は、プランジャー２０２に対して近位位置から遠位位置へと移動可能であり、そして組織効果が達成された後に組織を離断または切断するために、ナイフを並進させるように構成される。
エンドエフェクタアセンブリ１００は、対向する顎部材１１０および１２０を備え、これらの顎部材は、シャフト１２に固定的に取り付けられる。顎部材１１０、１２０は、互いに作動可能に旋回可能に結合され得、そしてシャフト１２の遠位端１４に隣接して位置し得る。
顎部材１１０は、絶縁顎ハウジング１１７および導電性シールプレート１１８（本明細書中以下で、シールプレート１１８）を備える。絶縁体１１７は、導電性シールプレート１１８にしっかりと係合するように構成される。これは、スタンピングすること、オーバーモールディングすること、スタンピングされた導電性シールプレートをオーバーモールディングすること、および／または金属射出成型されたシールプレートをオーバーモールディングすることにより、達成され得る。これらの製造技術の全ては、絶縁基材により実質的に囲まれたシールプレート１１８を有する電極を作製する。本開示の範囲内で、顎部材１１０は、シールプレート１１８と一体的に形成された顎ハウジング１１７を備え得る。
顎部材１２０は、シールプレート１２８を捕捉するようにオーバーモールドされ得る外側絶縁ハウジング１２７を有する類似の構造を備える。
顎部材１１０、１２０の各々は、プランジャー２０２のそれぞれのプロング２１０と係合するように構成され、その結果、顎部材１１０、１２０の各々は、開位置（この位置において、顎部材１１０および１２０は互いに対して間隔を空けた関係で配置される）から閉位置（この位置において、顎部材１１０および１２０は顎部材の間に組織を把持するように協働する）へと移動可能である。この目的を考慮して、顎部材１１０、１２０の各々は、その近位端に位置するそれぞれの開口部分１１２、１２２を備える。開口部分１１２、１２２は、それぞれ顎１１０、１２０の各々の内部に、プランジャー２０２のプロング２１０が内部で並進することを可能にする距離だけ延びる。この並進の結果、顎部材１１０、１２０は、開位置から閉位置へと移動させられる。実質的に流体密なシール構造体が、開口部分１１２、１２２に作動可能に配置され得、そして流体ライン２０４内の一定の圧力を維持するように構成され得る。上記のように、顎部材１１０、１２０の各々の近位端の一部分は、ばね２０６と係合または接触する構造体を備え得る。
使用において、組織を封止する前に、顎部材１１０および１２０は、最初、開位置に付勢される（図３Ａ）。使用者は、組織を顎部材１１０と１２０との間に配置し得る。組織が顎部材１１０と１２０との間に適切に配置されたら、使用者は、液圧機構２００を、例えば、可動ハンドル４０により起動させ得る。可動ハンドル４０が近位に移動させられると、てこ比（リンク機構（明白には図示せず）により提供される）が、液圧機構２００に関連する１つ以上の構成要素（例えば、ピストン（明白には図示せず））への力（近位に移動する可動ハンドル４０により提供される）を増幅する。ピストンに付与される力は、液圧機構２００の流体ライン２０４内の圧力を増加させ、これは、流体「Ｆ」を流体ライン２０４を通してプランジャー２０２の方へと流す。この流体の流れは、プランジャー２０２をシャフト１２および／または流体ライン２０４内で遠位に並進させる。プランジャー２０２のこの並進は、プロング２１０を顎部材１１０、１２０の近位端の開口部分１１２、１２２とそれぞれ係合させ、これは次に、顎部材１１０、１２０を開位置から閉位置へと移動させ、この閉位置において、顎部材１１０、１２０は協働して組織を把持する。
一旦、組織が把持されると（図３Ｂ）、使用者は、発電機２００を、例えばボタン６０により起動させ得、その結果、所望の組織効果（例えば、組織の封止）が達成され得る。所望の組織効果が達成された後に、使用者は、可動ハンドル４０を解放し得、これは次に、可動ハンドル４０を遠位に移動させる。可動ハンドル４０のこの遠位への移動は、流体ライン２０４に蓄積した圧力の全てでなければいくらかを解放し、その結果、ばね２０６の不勢力下にあるプランジャー２０２が近位に移動させられ、そして顎部材１１０、１２０のそれぞれの開口部分１１２、１２２との係合から外れ、これによって、それらの最初の開位置へと戻る。
いくつかの実施形態において、所望の組織効果が達成された後に、使用者はまた、ナイフ刃２１２を起動させて、効果を受けた組織を離断または切断し得る。より具体的には、組織が顎部材１１０と１２０との間に把持され、そしてプランジャーが遠位位置にある間に、使用者は、例えば、可動ハンドル４０にさらなる圧力を加え得、その結果、プランジャー２１２が遠位に並進させられる。この例において、プランジャー２０２は、顎部材１１０、１２０の近位端により固定された位置に維持され、そしてプランジャー２１２は、ナイフチャネル４００内で自由に並進し、その結果、組織が切断され得る。
上記のことから、種々の図面を参照して、当業者は、特定の改変がまた、本開示の範囲から逸脱することなく本開示に対して行われ得ることを理解する。例えば、空気圧機構が、液圧機構２００の代わりに使用され得る。この例において、空気圧機構、およびそれに関連する作動可能な構成要素は、液圧機構２００を参照しながら本明細書中で上に記載されたような様式で機能するように、相互に協働する。
本開示はまた、電気外科手順を実施する方法５００を提供する。図４に図示されるように、工程５０２において、双極鉗子が提供される。工程５０４において、組織が第一の顎部材および第二の顎部材の対の間に配置され、その結果、組織の封止が行われ得る。工程５０６において、駆動アセンブリが起動されて起動管を動かし、カムピンを第一の顎部材および第二の顎部材に対してカム作用させて、一体蝶番の周りで旋回させ、そして互いの方向へとカム作用し、その結果、組織がこれらの顎部材の間に把持される。そして工程５０８において、電気外科エネルギーがこれらの顎部材に印加され、その結果、組織の封止がこれらの顎部材の間で行われ得る。
本開示の数個の実施形態が図面に示されたが、本開示はこれらの実施形態に限定されることは意図されない。なぜなら、本開示は、当該分野が許容すると同程度に広いこと、および本明細書はそのように読まれることが意図されるからである。従って、上記説明は限定と解釈されるべきではなく、単に、特定の実施形態の例示と解釈されるべきである。当業者は、添付の特許請求の範囲の趣旨および範囲内である、他の改変を予測する。
１０ 双極鉗子
２０ ハウジング
３０ ハンドルアセンブリ
７０ トリガアセンブリ
８０ 回転アセンブリ
１００ エンドエフェクタアセンブリ
１１０、１２０ 顎部材
１１８、１２８ シールプレート
１３０ 駆動アセンブリ
２００ 液圧機構
３１０ ケーブル
２０ ハウジング
３０ ハンドルアセンブリ
７０ トリガアセンブリ
８０ 回転アセンブリ
１００ エンドエフェクタアセンブリ
１１０、１２０ 顎部材
１１８、１２８ シールプレート
１３０ 駆動アセンブリ
２００ 液圧機構
３１０ ケーブル
Claims (7)
- 電気外科手順を実施するために電気外科エネルギーの供給源に接続されるように適合された鉗子であって、
ハウジングであって、該ハウジングは、該ハウジングから延びるシャフトを有し、該シャフトは、該シャフトを通る長手方向軸を規定する、ハウジング；
液圧機構であって、該液圧機構は、流体ライン、および該流体ラインに作動可能に結合されたプランジャーを備え、該プランジャーは、該シャフトの少なくとも一部の内部で並進可能である、液圧機構；ならびに
該シャフトの遠位端に作動可能に接続されたエンドエフェクタアセンブリであって、該エンドエフェクタアセンブリは、開構成に付勢された一対の第一の顎部材および第二の顎部材を有し、該第一の顎部材および該第二の顎部材の各々は、流体が該流体ライン内で流される場合に、該プランジャーの少なくとも一部分を受容するように構成されており、その結果、該第一の顎部材および該第二の顎部材は、開位置からクランプ位置へと移動し、該開位置において、該顎部材は互いに間隔を空けた関係で配置され、該クランプ位置において、該顎部材は協働して該顎部材の間に組織を把持する、エンドエフェクタアセンブリ、
を備える、鉗子。 - 前記第一の顎部材および前記第二の顎部材の各々が、前記シャフトの遠位端に位置する旋回ピンの周りで旋回可能である、請求項１に記載の双極鉗子。
- 前記第一の顎部材および前記第二の顎部材の各々が、該顎部材の近位端に位置する少なくとも１つの開口部分を備え、該開口部分は、前記プランジャーの少なくとも一部分を受容するように構成されている、請求項１に記載の双極鉗子。
- 前記プランジャーが、該プランジャーの近位部分から延びる少なくとも２つのプロングを備え、該プロングは、前記第一の顎部材および前記第二の顎部材の各々に関連する少なくとも１つの開口部分と係合するように構成されている、請求項１に記載の双極鉗子。
- 前記プランジャーが、非圧縮状態において該プランジャーを近位に付勢する付勢部材を備える、請求項１に記載の双極鉗子。
- 前記プランジャーが、該プランジャーに作動可能に結合されたナイフ刃を備え、該ナイフ刃は、前記第一の顎部材および前記第二の顎部材のうちの少なくとも一方に規定されたナイフスロット内での並進運動のために構成されている、請求項１に記載の双極鉗子。
- 前記第一の顎部材および前記第二の顎部材が、ばねによって付勢されている、請求項１に記載の双極鉗子。
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2009
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2010
- 2010-01-13 JP JP2010005275A patent/JP5582788B2/ja not_active Expired - Fee Related
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2014
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| US8114122B2 (en) | 2012-02-14 |
| US20100179539A1 (en) | 2010-07-15 |
| US20120143185A1 (en) | 2012-06-07 |
| US8852228B2 (en) | 2014-10-07 |
| JP2010162349A (ja) | 2010-07-29 |
| EP2206474A3 (en) | 2010-07-28 |
| US20150018827A1 (en) | 2015-01-15 |
| EP2206474A2 (en) | 2010-07-14 |
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