JP6027062B2 - フレーム装置 - Google Patents
フレーム装置 Download PDFInfo
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- JP6027062B2 JP6027062B2 JP2014166469A JP2014166469A JP6027062B2 JP 6027062 B2 JP6027062 B2 JP 6027062B2 JP 2014166469 A JP2014166469 A JP 2014166469A JP 2014166469 A JP2014166469 A JP 2014166469A JP 6027062 B2 JP6027062 B2 JP 6027062B2
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Classifications
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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
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
- A61B2017/0225—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery flexible, e.g. fabrics, meshes, or membranes
Description
この出願は、参照することによりその全体が本願に組み込まれる2007年4月9日に
出願された米国仮特許出願第60/922,515号の優先権を主張する。
に関する。
を形成して維持するために、臓器の内腔の拡張を必要とする。例えば、腸の一部の内腔を
内壁の一部に対して外科的処置を行なうために拡張させることが必要となる場合がある。
このプロセスは、技術的に要求が厳しく、目的を達成するために予備の人員が従来の開創
器または他の器具を保持しなければならなくなることさえある。そのような外科的処置は
、トロカールポートが必要とされる低侵襲手術(MIS)中にかなり困難を極める。
をかなり高めることができる。装置および方法は、臓器または対象物の切除、結紮、切開
、および、高周波療法などの、診断、生検、手術、または、治療を促すべく、医療処置中
において、臓器、柔軟な対象物、または、対象物群の内腔に作業空間を形成して維持する
ために使用できる。装置の柔軟性および細さ、ならびに、展開後の半硬質フレームの形成
は、装置を外科手術、特に低侵襲手術(MIS)に適するものとすることができる。装置
は、展開されるときに小さいチューブまたはトロカールを通して押し進められることがで
き、また、除去されるときに折り畳まれてチューブ内へ引き戻されることができる。展開
形態において、装置は、例えば円筒状または球状または何らかの他の3次元形状のフレー
ムを形成するように拡張できる。他の例において、拡張された細いワイヤ状のフレームは
、臓器の内腔の内側で展開される際に、手術器具を導入して操作できる作業空間を形成す
るために臓器の壁に押し付けることができる。装置は、例えば、切除、結紮、切開、およ
び高周波療法などの処置のために胃腸管、結腸、または、胃などの内腔に作業空間を形成
して維持するべく使用できる。切除、結紮、切開、および高周波療法などの外科処置は、
フレーム内の拡大された空間を通じて臓器の壁に対して行なうことができる。装置は、理
想的には、腔内手術または治療或いは経腔的手術または治療に用いるのに適している。ま
た、装置は、柔軟な対象物の内腔または柔軟な対象物間に作業空間を形成して維持するこ
とが望ましい非医療用途で用いることもできる。
を保持する必要性を排除できる。一人の術者が手術を行なって内部フレーム装置を使用・
展開することができる。術者は、片方の手だけを使用して内部フレーム装置を使用して展
開させることができる。また、外科処置のために単一の入口ポートを使用することができ
、それにより、処置を簡略化して、コストを低減できるとともに、感染を含む合併症の危
険を減らすことができる。
含むことができ、拡張形態は折り畳み形態よりも直径が大きい。折り畳み形態は、トロカ
ールを通じて内腔に挿入するのに差し支えない直径を有することができ、また、拡張形態
は、内腔の壁に押し付けて作業空間を形成するための十分な剛性を有することができる。
折り畳み形態は、シースチューブを挿通するように構成することができる。拡張形態は円
筒形状を有することができる。柔軟構造は、円筒形状の端部に円形リングを含むことがで
きる。柔軟構造は、円形リングを接続する長手方向支柱または開放編み込みメッシュを含
むことができる。長手方向支柱はスプリングスチールを含むことができる。円形リングは
、中空の円周空間を有する金網ばねを含むことができる。円形リングは、中空の円周空間
内に超弾性金属ワイヤまたは形状記憶金属ワイヤを含むことができる。柔軟構造は開放端
部と開放側面とを有することができる。
を巻回し或いは巻解するように構成されるローラシステムを含む長手方向支柱とを含むこ
とができる。スクロール内部フレームはプッシャチューブを含むことができ、該プッシャ
チューブは、内側にワイヤを有しており、ローラシステムにシート材料を巻回させ或いは
巻解させるように構成される。シート材料はコイル状のワイヤ格子シートであってもよい
。シート材料は、スプリングスチールまたはニチノールなどの任意の適切な材料を含むこ
とができる。長手方向支柱は、磁気結合によってプッシャチューブ/ワイヤに接続したり
或いはプッシャチューブ/ワイヤから外したりすることができる。
通じて患者の内腔へ導入し、内腔の内側で内部フレームを拡張させることを含むことがで
きる。一人の人が内部フレームを導入して拡張させることができる。人は片手で内部フレ
ームを導入して拡張させることができる。
され、また、部分的には前述したことを検討することにより当業者に明らかになり、ある
いは、本発明の実施によって認知されてもよい。
中に臓器の内腔内において、或いは2つまたは3つ以上の臓器間において、あるいは組織
構造間において作業空間を形成して維持するために使用できる。例えば、内部フレーム装
置は、小径の柔軟なチューブを挿通して展開された後にかなり大きい直径の円筒状、球状
、または他の形状のフレームへと拡張することができる柔軟な構造を有することができる
。他の例において、内部フレーム装置は、拡張されると、円筒状、球状、円錐状、または
他の3次元形状の中空半硬質構造を形成することができる。内部フレーム装置は、拡張さ
れた形態では、臓器の壁を押圧するために十分な力を与えることができ、それにより、内
腔内空間を形成する。また、装置は、2つ或いは3つ以上の柔軟な対象物間に作業空間を
形成して維持するために使用することもできる。拡張された内部フレームは、各端部で開
放可能であり、また、外科的または診断的干渉を許容するために側部に開口を有すること
ができる。内部フレームは、除去するために折り畳んで柔軟チューブ内へ引き戻すことが
できる。装置は、例えば、切除、結紮、切開、および高周波療法などの処置のために胃腸
管、結腸、または胃などの内腔に作業空間を形成して維持するべく使用できる。折り畳ま
れた内部フレームの柔軟性およびサイズにより、内部フレームは低侵襲手術中にトロカー
ルを通して押し進められたり、また除去されたりすることができる。また、装置は、内腔
内手術または治療或いは経腔的手術または治療のため、および、非外科的用途のために使
用することもできる。装置の柔軟性および細さと、展開後の硬質フレームの形成により、
装置を、医療処置中、特に低侵襲手術中に内腔空間を拡張するのに適するものとする。
形態は折り畳み形態よりも直径が大きい。折り畳み形態は、トロカールを通じて内腔に挿
入するのに差し支えない直径を有することができ、また、拡張形態は、作業空間を形成す
るために内腔の壁を押圧するのに十分な剛性を有することができる。折り畳み形態は、シ
ースチューブを挿通するように構成することができる。拡張形態は円筒形状を有すること
ができる。柔軟構造は、円筒形状の端部に円形リングを含むことができる。柔軟構造は、
円形リングを接続する長手方向支柱または開放編み込みメッシュを含むことができる。長
手方向支柱はスプリングスチールを含むことができる。端部リングの外周にわたる長手方
向支柱の数は、変えることができるとともに、用途に依存することができる。円形リング
は、中空の円周空間を有する金網ばねを含むことができる。円形リングは、中空の円周空
間内に超弾性金属ワイヤまたは形状記憶金属ワイヤを含むことができる。柔軟構造は開放
端部と開放側面とを有することができる。
グなどのコイル状ワイヤを含むことができる2つの円形リングを含むことができる。連続
した長さのニチノールなどの超弾性ワイヤがスプリングコイルリングを挿通できる。超弾
性ワイヤは、端部リングがアプライヤ内に装着されるときに確実に捲縮されないようにす
るのに役立つことができる。また、形状記憶形態のニチノールワイヤは、体温との接触時
に強度を高めることもできる。2つの円形リングが半硬質の長手方向ワイヤ支柱を用いて
接続されることにより、円筒形状の内部フレームを形成できるとともに、展開されるとき
に組織支持を確保できる。
合には、展開時に所望の形状を形成するように多数の円形リングを互いに接続できる。他
の形状としては、円錐形状、砂時計形状、または、他の3次元形状を挙げることができる
。
レーム装置は、折り畳んで小さいチューブまたはトロカールに挿通することができる。拡
張された細いワイヤ状の内部フレームは、臓器の内腔の内側で展開した後、手術器具を導
入して操作できる作業空間を形成するために臓器の壁を押圧することができる。外科処置
の最後に、内部フレームが除去のために折り畳まれてチューブまたはトロカール内に引き
戻される。
を保持する必要性を排除できる。一人の術者が手術を行なって内部フレーム装置を使用・
展開することができる。術者は、片手だけを用いて内部フレーム装置を使用して展開させ
ることができる。また、外科処置のために単一の入口ポートを使用することができ、それ
により、処置を簡略化して、コストを低減できるとともに、感染を含む合併症の危険を減
らすことができる。
コイルリングなどのコイル状ワイヤから成る2つの円形リング1を含むことができ、この
場合、ニチノールなどの連続する長さの超弾性ワイヤがスプリングコイルリングを挿通す
る。超弾性ワイヤは、円形リングがアプライヤ内に装着されるときに確実に捲縮されない
ようにするのに役立つことができる。また、形状記憶形態のニチノールワイヤは、体温と
の接触時に強度を高めることもできる。2つの円形リングが半硬質の長手方向ワイヤ支柱
3を用いて接続されることにより、円筒形状の構造体を形成できるとともに、内部フレー
ムが展開されるときに組織支持を確実にできる。装置は、小さいチューブまたはトロカー
ル2を挿通して展開することができ、その後、除去されるときに折り畳まれてチューブ内
へ引き戻されることができる。展開形態において、装置は、例えば円筒状または球状のフ
レームを形成するように拡張する。球形状の内部フレームの場合には、展開時に所望の形
状を形成するように多数の円形リングを互いに接続できる。拡張された細いワイヤ状の内
部フレームは、臓器の内腔内で展開される際に、手術器具を導入して操作できる作業空間
を形成するために臓器の壁を押圧する。
挿通することができる。装置は、折り畳まれてシースチューブ2内に引き戻され、フック
状のガイドワイヤまたは類似の器具によって除去されることができる。展開形態において
、装置は、円筒形状または球形状のフレームを形成するように拡張できる。拡張された細
いワイヤ状の内部フレームは、臓器の内腔の内側で展開される際に、手術器具を導入して
操作できる作業空間を形成するために臓器の壁を押圧する。
コイル状ワイヤから成る2つの円形リングを含むことができ、この場合、ニチノールなど
の連続する長さの超弾性ワイヤ5がスプリングコイルリングを挿通する。超弾性ワイヤは
、端部リングがアプライヤ内に装着されるときに確実に捲縮しないようにするのに役立つ
ことができる。また、形状記憶形態のニチノールワイヤは、体温との接触時に強度を高め
且つ形状を維持するのに役立つことができる。半硬質の長手方向ワイヤ支柱3が2つの円
形端部リングに接続されることにより、展開時に円筒形状の構造体と、組織支持を形成で
きる。
押し出すことができ、また、円筒状の内部フレームへと安全に展開させることができる。
は巻解するように構成されるローラシステムを含む長手方向支柱と、を含むことができる
スクロール内部フレームとなり得る。スクロール内部フレームはプッシャチューブを含む
ことができ、該プッシャチューブは、内側にワイヤを有しており、ローラシステムにシー
ト材料を巻回させ或いは巻解させるように構成される。シート材料は、コイル状のワイヤ
格子シートであってもよく、スプリングスチールまたはニチノールなどのスプリング金属
を含むこともできる。長手方向支柱は、磁気結合によってプッシャチューブ/ワイヤに接
続でき或いはプッシャチューブ/ワイヤから外すことができる。
むことができ、該格子シートは、巻解されるときに、内腔の壁を押圧することができる円
筒状のワイヤフレームを形成し、それにより、作業空間を形成する。格子シートは、シー
スの使用によってそのコイル状の姿勢に保持させることができる。コイル状の格子フレー
ムは、小径のプッシャチューブによってシースから押し出されることができる。プッシャ
チューブは内部にワイヤを有することができ、該ワイヤは、捩じられる際に、長手方向主
支柱の内部の小さいローラシステムに格子フレームを巻解させる。半硬質スクロール内部
フレームの円形形状は、弾力のある格子シートに蓄えられたエネルギーによって維持させ
ることができる。格子シートの他端は、長手方向主支柱に恒久的に取り付けることができ
る。格子シートの長手方向主支柱内のローラシステムは、磁気結合/ロック装置によって
柔軟なプッシャチューブ/捩じれワイヤに接続することができる。
ことができる。スクロール内部フレーム装置は、シースチューブ内でそのコイル状形態に
保持させることができる。スクロール内部フレームは、プッシャチューブを使用してシー
スチューブから押し出すことができるとともに、臓器の内腔内で展開させることができる
。スクロール内部フレームは、長手方向支柱に接続されるシート材料を含むことができる
。プッシャチューブ内のワイヤは、長手方向主支柱内のローラシステムにシート材料を展
開させることができる。プッシャチューブは、磁気結合によって長手方向支柱から外すこ
とができ且つ長手方向支柱に再接続することができる。展開されたスクロール内部フレー
ムは、手術器具を導入して操作できる作業空間を形成するために臓器の壁を押圧すること
ができる。外科処置の最後に、プッシャチューブを長手方向支柱に再び接続することがで
き、また、プッシャチューブ内のワイヤを捩じってシート材料をその元のコイル状形態へ
と巻回することができる。その後、スクロール内部フレームを除去のためにチューブまた
はトロカール内に引き戻すことができる。
創器を用いて組織を保持する必要性を排除することもできる。一人の術者が手術を行なっ
てスクロール内部フレーム装置を使用・展開することができる。術者は、片手だけを用い
て内部フレーム装置を使用して展開させることができる。さらに、外科処置のために単一
の入口ポートを使用することができ、それにより、処置を簡略化して、コストを低減でき
るとともに、感染を含む合併症の危険を減らすことができる。
ト7を使用し、該格子シートは、展開されるときに、前述したように機能する円筒状のワ
イヤフレームを形成する。格子シートは、薄壁シース8の使用によってそのコイル状の姿
勢に保持される。コイル状の格子フレームは、小径のプッシャチューブ10によってシー
スから押し出されることができる。プッシャチューブは内部にワイヤ11を有することが
でき、該ワイヤは、捩じられる際に、長手方向主支柱9の内部の小さいローラシステム1
2に格子フレームを巻解させる。半硬質スクロール内部フレームの円形形状は、ニチノー
ルまたはスプリング金属から形成され得る弾力のある格子材料に蓄えられたエネルギーに
よって維持させることができる。格子シートの他端14は、長手方向主支柱9に恒久的に
取り付けられることができる。格子シート7の長手方向主支柱内のローラシステム12は
、磁気結合/ロック装置13によって柔軟なプッシャチューブ/捩じれワイヤに接続され
ることができる。
長手方向主支柱に保持させることができる。プッシャチューブ/捩じれワイヤは、スクロ
ール内部フレームの展開を完了させるために捩じれワイヤの押し出しによって主支柱から
分離させることができる。長手方向主支柱に対するプッシャチューブ/捩じれワイヤの再
取り付けは、スクロール内部フレームの巻回および除去中に磁気吸引力によって補助され
得る。
き、トロカールから押し出すことができ、また、完全に展開させることができる。シート
材料15はスプリングスチールまたはニチノールから形成することができる。スクロール
内部フレームは、完全に展開されると、内腔の壁を押圧することができ、それにより、手
術器具を導入して操作できる作業空間が形成される。
ためにプッシャチューブの内側にノブシャフト16を含むことができる。長手方向支柱1
7は、プッシャチューブから長手方向支柱を分離する取り外し/再接続ポイントを含むこ
とができる。
ートは、スプリングスチールまたはニチノールなどの任意の適した材料を含むことができ
る。
きる。また、アセンブリ全体を適切な容器内に滅菌して包装することができる。
他の実施形態は以下の請求項の範囲内である。
Claims (11)
- シースチューブによって折り畳み状態に保持され且つチューブの直径よりも大きい直径を有するフレームへと拡張されるように構成される、開放端部と開放側面とを有する円筒形状の柔軟構造を備える内部フレーム装置であって、該柔軟構造は、円形リングを接続する開放編み込みメッシュ又は長手方向支柱を含み、該拡張されたフレームは、該円筒形状を有する内部フレームの長手方向軸に実質的に垂直な該円形リングを含み、該折り畳み状態は、該拡張されたフレームに変わる前に、チューブ又はトロカールを通じて内腔に挿入するのに差し支えない直径を有し、該拡張されたフレームは、チューブ又はトロカールを通じて該内腔から除去するために該折り畳み状態に変わり、該折り畳み状態において、該円形リングは、該内部フレームの長手方向軸に実質的に平行であり、かつ少なくとも1つの端部リングは、実質的に該内部フレームの長手方向軸の方向に向けられた長軸を有する長円形状であり、かつ該内部フレームは、医療処置中に体内に作業空間を形成して維持する、前記内部フレーム装置。
- 前記フレームは、円筒形状の端部に円形形状の2つのリングを含む請求項1に記載の装置。
- 前記円形リングは、中空の円周空間を有する目の詰んだ金網ばねである請求項2に記載の装置。
- 前記目の詰んだ金網ばねの中空の円周空間を超弾性金属ワイヤが占めている請求項3に記載の装置。
- 前記目の詰んだ金網ばねの中空の円周空間を形状記憶金属ワイヤが占めている請求項3に記載の装置。
- 硬質直線状の長手方向ワイヤ部材が前記2つの円形リングを接続して前記フレームを完成する請求項2〜5のいずれか一項に記載の装置。
- 大きな開いた編み込みメッシュが前記2つの円形リングを接続して前記フレームを完成する請求項2〜5のいずれか一項に記載の装置。
- 前記フレームは、前記折り畳まれた装置が臓器内への挿入および適切な位置決めのための小径の柔軟チューブ内に配置されるように十分な柔軟性を有するとともに、前記展開された装置が内腔壁に対して適切な反力を与えて装置の3次元フレーム形状を維持できる十分な剛性を有する請求項4〜7のいずれか一項に記載の装置。
- 前記フレームの2つの円形リングを接続する前記硬質直線状の長手方向ワイヤ部材が超弾性金属を含む請求項6に記載の装置。
- 前記フレームの2つの円形リングを接続する前記硬質直線状の長手方向ワイヤ部材が形状記憶金属を含む請求項6に記載の装置。
- 前記フレームの2つの円形リングを接続する前記硬質直線状の長手方向ワイヤ部材がスプリングスチールを含む請求項6に記載の装置。
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US92251507P | 2007-04-09 | 2007-04-09 | |
US60/922,515 | 2007-04-09 |
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EP (1) | EP2144660A4 (ja) |
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WO (1) | WO2008124748A1 (ja) |
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JP2010523278A (ja) | 2010-07-15 |
JP5602010B2 (ja) | 2014-10-08 |
JP2015037553A (ja) | 2015-02-26 |
EP2144660A4 (en) | 2016-05-04 |
EP2144660A1 (en) | 2010-01-20 |
US20100249519A1 (en) | 2010-09-30 |
US9427223B2 (en) | 2016-08-30 |
WO2008124748A1 (en) | 2008-10-16 |
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