JP6203729B2 - 流体を充填可能なバットレスを有する外科用器具 - Google Patents
流体を充填可能なバットレスを有する外科用器具 Download PDFInfo
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- A—HUMAN NECESSITIES
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- 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
- A61B17/07292—Reinforcements for staple line, e.g. pledgets
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Description
図1〜図6は、外科手術を行うために、図1Aに示すような非関節動作状態でトロカールカニューレ通路を通って患者の体内の手術部位まで挿入するように寸法決めされている、例示的な外科ステープル留め及び切断の器具(10)を図示している。外科手術及びステープル留め及び切断器具(10)は、実施部分(22)に接続されたハンドル部分(20)を含み、実施部分は、関節動作機構(11)において遠位に終端するシャフト(23)と、遠位に取り付けられたエンドエフェクタ(12)と、を更に備える。関節動作機構(11)及び遠位のエンドエフェクタ(12)がトロカールのカニューレ通路を通じて挿入された後、図1Bに図示されているように、関節動作制御部(13)によって関節動作機構(11)を遠隔的に関節動作操作することができる。そのようにして、エンドエフェクタ(12)は、所望の角度から又は他の理由のために、臓器の背後に到達する若しくは組織に近づくことができる。本明細書では、「近位」及び「遠位」といった用語は、器具(10)のハンドル部分(20)を握っている臨床医を基準として使用されていることを理解されたい。したがって、エンドエフェクタ(12)は、より近位のハンドル部分(20)に対して遠位である。便宜上、また説明を明確にするため、本願では「垂直」及び「水平」といった空間的な用語を図面に対して使用する点も更に認識されるであろう。しかしながら、手術器具は、多くの配向及び配置において使用され、これらの用語は、制限的及び絶対的であることが意図されない。
図7〜9は、ステープルカートリッジ(37)に取り付けられ得る、例示のステープルカートリッジ(37)保持具キャップ(180)を示す。保持具キャップ(180)は、その開示全体が参照することにより本明細書に組み込まれる、2010年9月30日に出願された「Implantable Fastener Cartridge Comprising a Support Retainer」という表題の米国特許出願第12/894,369号の教示のいずれかにより構成され、かつ動作可能であり得ることを理解されたい。保持具キャップ(180)は、ステープルカートリッジ(37)がエンドエフェクタ(12)の下部つかみ具(16)に挿入されるとき、医師の親指が、例えば、ステープルカートリッジ(37)内に位置するステープル(47)の先端に接触することを防ぐか、又は少なくとも抑制するように操作可能である。追加又は代替として、ステープル(47)がカートリッジから不用意に落ちることを防ぎ得る。ここで図7及び8を参照すると、本実施例の保持具キャップ(180)は、下面(181)及び上面(182)を含み、例えば、医師がそこに下向きの力を印加する押し込み面を提供することができる。1つのあくまで例示の使用において、医師は、保持具キャップ(180)のハンドル部分(184)をつかみ、ステープルカートリッジ(37)の支持部分(110)をエンドエフェクタ(12)の下部つかみ具(16)と整列させて、ステープルカートリッジ(37)をエンドエフェクタ(12)の下部つかみ具(16)内に少なくとも部分的に挿入してよい。その後、医師は、保持具キャップ(180)の上面(182)に下向きの力を印加することによって、エンドエフェクタ(12)の下部つかみ具(16)内にステープルカートリッジ(37)を完全に着座させることができ、これが下向きの力を支持部分(110)に直接伝達し得る。本実施例において、保持具キャップ(180)は、下向きに延在し、支持部分のデッキ表面(111)と接触する、近位支持体(187)を備える。保持具キャップ(180)は更に、ノーズ(103)に隣接する、遠位支持部分(183)を備える。下向きの力が保持具キャップ(180)に印加されると、その下向きの力は、近位支持体(187)及び/又は遠位支持部分(183)を通じて伝送され得る。幾つかの例示のバージョンにおいて、支持体の少なくとも一部は、下向きの力が保持具キャップ(180)に印加される前に、支持部分(110)の上部と接触していなくてもよいが、幾つかのバージョンでは、保持具キャップ(180)は、保持具キャップ(180)が支持部分(110)の上部に触れるまで、下向きに屈曲するか、又は動くように動作可能であり得る。かかる点において、保持具キャップ(180)の下向きの屈曲又は動きは、更に屈曲しないよう、妨げるか、又は少なくとも実質的に妨げることができる。
バットレス(200)は、図10〜13に示されるように、図1〜6に示される例示の外科用カッターのエンドエフェクタ部分とともに使用されてよい。以下に記載されるように、バットレス(200)の使用は、例えば、ステープル(47)が適用された領域を安定化させることによって、組織が切断及びステープル留めされた手術部位のより迅速な回復を促進し得ることが理解されるであろう。幾つかの例示のバージョンにおいて、バットレス(200)は、上記の保持具キャップ(180)とともに使用され得るか、又は代替として、バットレス(200)は、保持具キャップ(180)を使用せずに、上記の外科用切断及びステープル留め器具(10)とともに直接使用されてもよい。
図14〜16は、図1〜6に示される器具(10)のエンドエフェクタ(12)とともに使用され得るバットレス(300)を示す。バットレス(300)は、境界部分(302)と、接着剤領域(304)とを備える。境界部分(302)は、接着剤領域(304)の外辺部の周りに延在し、それによってバットレス(300)の第1の半分(306)及び第2の半分(308)を画定する。第1の半分(306)及び第2の半分(308)は、垂直スロット(49)が概ね第1の半分(306)と第2の半分(308)との間に位置付けられるように位置付けられる。切断線(314)は、図15に示されるように、切断エッジ(48)が切断線(314)に沿って境界部分(302)を切断し得るように、第1の半分(306)と第2の半分(308)との間に延在する。当然のことながら、切断線(314)は省略されてもよい。例えば、バットレス(300)は、垂直スロット(49)のどちらの側でも別個の部品内に提供されてもよい。更に、バットレス(300)は、個別の半分(306、308)を使用することなく、単一の単位として構成されてもよいことが理解されるであろう。同様に、本実施例では単一のバットレス(300)が使用されているが、2つ以上のバットレス(300)が、本明細書の教示を考慮して当業者に明らかとなるように使用されてもよいことを理解されてよい。例えば、図15は、2つのバットレス(300)、1つはカートリッジ(37)のデッキ(72)上のバットレス(300)、1つはアンビル(18)の下側のバットレス(300)の間にクランプされている組織(90)の断面図を示す。
(1) 装置であって、
(a)遠位端及び近位端を備える、外科用カッターであって、前記近位端がハンドルを備え、前記遠位端がアンビル及び下部つかみ具を備え、前記アンビル及び前記下部つかみ具が組織をクランプするように構成され、前記外科用カッターが前記アンビル及び前記下部つかみ具によってクランプされた組織を切断するように構成されている、外科用カッターと、
(b)液体で充填されたバットレスであって、前記バットレスが、前記アンビルと前記下部つかみ具との間に定置されるように構成され、前記バットレスが圧縮性部分及び圧力部分を備え、前記圧縮性部分が、前記アンビル及び前記下部つかみ具が該圧縮性部分をクランプすることによって前記外科用カッターの前記遠位端によって圧迫されるように構成され、前記圧力部分が、前記圧縮部分に対するクランプに反応して前記液体で加圧されるように構成され、前記バットレスが、前記外科用カッターが組織を切断するのとほぼ同時に、前記外科用カッターによって切断されかつステープル留めされるように構成され、前記圧力部分が、一旦前記バットレスが切断されると、前記圧縮性部分を通じて前記液体を押し出すように構成される、バットレスと、を備える、装置。
(2) 前記液体が2液型接着剤を含み、前記2液型接着剤が、前記2液型接着剤の2液が混合されたときに限って接着特性を有するように構成されている、実施態様1に記載の装置。
(3) 前記バットレスが、弾性材料を含む、実施態様1に記載の装置。
(4) 前記アンビルが、アンビル幅を画定し、前記バットレスが前記アンビル幅より広いバットレス幅を画定する、実施態様1に記載の装置。
(5) 前記バットレスが、弾力性材料を含む、実施態様1に記載の装置。
(7) 前記バットレスが、前記外科用カッターの中に予め装填されるように構成されている、実施態様1に記載の装置。
(8) 前記バットレスが、前記バットレスの実質的に等しい部分が前記下部つかみ具から外側に延在するように、前記下部つかみ具にまたがる、実施態様1に記載の装置。
(9) 前記バットレスが、前記下部つかみ具に連結されるように構成されている、実施態様1に記載の装置。
(10) 前記バットレスが、2つの実質的に同様の形状の流体充填部材を備え、前記2つの流体充填部材のそれぞれが液体接着剤を含む、実施態様1に記載の装置。
(12) 前記外科用カッターと連通する外科用ステープラーを更に備え、前記外科用ステープラーが、1つ又は2つ以上のステープルを備え、前記外科用ステープラーが、組織の一部分をステープル留めするように構成され、前記1つ又は2つ以上のステープルが、前記バットレスを破裂させるように構成されている、実施態様1に記載の装置。
(13) 前記バットレスが、可溶性材料を含む、実施態様1に記載の装置。
(14) 前記バットレスが、2液型流体凝固剤を含み、前記2液型流体の一方がフィブリンを含み、前記2液型流体の他方がトロンビンを含む、実施態様1に記載の装置。
(15) 前記バットレスが、前記バットレスを前記外科用カッターの一部分に接着するように動作可能な接着剤を前記バットレスの外側に含む、実施態様1に記載の装置。
(a)カッター及びステープラーを備える外科用器具であって、前記外科用器具が、組織が切断されかつステープル留めされるときに前記組織を圧縮するように動作可能なアンビル及び下部つかみ具を更に備え、前記カッターが、前記組織の少なくとも一部分を切断するように構成され、前記ステープラーが前記組織の少なくとも一部分をステープル留めするように構成されている、外科用器具と、
(b)一対のブラダーであって、該一対のブラダーの少なくとも一部分が、前記アンビルと前記下部つかみ具との間に位置付けられ、前記一対のブラダーが、第1のブラダー及び第2のブラダーを含み、前記第1のブラダーが、第1の凝固剤成分を収容し、前記第2のブラダーが、第2の凝固剤成分を収容し、前記カッターが、前記第1のブラダー及び前記第2のブラダーの両方を同時に破裂させ、それによって前記第1の凝固剤成分の少なくとも一部分を前記第2の凝固剤成分の少なくとも一部分と混合するように動作可能である、一対のブラダーと、を備える、装置。
(17) 前記一対のブラダーのうちの少なくとも片方が、流体接着剤を更に収容する、実施態様16に記載の装置。
(18) 前記アンビル及び前記下部つかみ具が、前記一対のブラダーの少なくとも一部分を圧縮するように構成されている、実施態様16に記載の装置。
(19) 前記一対のブラダーのそれぞれが、弾性材料を含む、実施態様16に記載の装置。
(20) 外科用器具を使用して同時に切断された組織に流体を分配するように1つ又は2つ以上のブラダーを加圧及び切断するための方法であって、前記外科用器具が、アンビル及び下部つかみ具を備え、前記外科用器具が、前記アンビル及び前記下部つかみ具に関連して移動可能なナイフを更に備え、前記1つ又は2つ以上のブラダーが、前記アンビルと前記下部つかみ具との間に位置付け可能であり、前記1つ又は2つ以上のブラダーのうちの少なくとも一部分が、前記流体を収容し、前記方法が、
(a)前記アンビルと前記下部つかみ具との間に組織を整列させることと、
(b)前記アンビルと前記下部つかみ具との間で前記1つ又は2つ以上のブラダーの一部分を圧縮することと、
(c)前記外科用器具の一部分を作動させることであって、前記外科用器具の一部分を作動させる行為が、前記アンビル及び前記下部つかみ具に関連して前記ナイフを動かすように動作可能である、作動させることと、
(d)組織を前記ナイフで切断することと、
(e)前記1つ又は2つ以上のブラダーを前記ナイフで切断することと、
(f)前記切断された組織の近位にある領域に前記流体を分配することと、を含む、方法。
Claims (9)
- 装置であって、
(a)遠位端及び近位端を備える、外科用カッターであって、前記近位端がハンドルを備え、前記遠位端がアンビル及び下部つかみ具を備え、前記アンビル及び前記下部つかみ具が組織をクランプするように構成され、前記外科用カッターが前記アンビル及び前記下部つかみ具によってクランプされた組織を切断するように構成されている、外科用カッターと、
(b)液体で充填されたバットレスであって、前記バットレスが弾性材料を含み、前記バットレスが、前記アンビルと前記下部つかみ具との間に定置されるように構成され、前記バットレスが第1の構成および第2の構成間で変化するように構成され、前記第1の構成において、前記バットレスの高さは、前記バットレスの幅に沿って略一定であり、前記アンビル及び前記下部つかみ具が前記バットレスをクランプすることによって、前記バットレスは前記第2の構成に変化し、前記第2の構成において、前記バットレスが圧縮性部分及び圧力部分を備え、前記圧力部分は、前記圧縮性部分よりも大きい高さを有し、前記圧縮性部分は、前記アンビルおよび前記下部つかみ具により圧迫されている部分を含み、前記圧力部分が、前記圧縮性部分に対するクランプに反応して前記液体で加圧されるように構成され、前記圧力部分は、前記液体で加圧されることにより、拡張するように構成され、前記バットレスが、前記外科用カッターが組織を切断するのとほぼ同時に、前記外科用カッターによって切断されかつステープル留めされるように構成され、前記圧力部分が、一旦前記バットレスが切断されると、前記圧縮性部分を通じて前記液体を押し出すように構成される、バットレスと、を備え、
前記バットレスは、第1の流体充填可能部材および第2の流体充填可能部材を備え、前記第1の流体充填可能部材および前記第2の流体充填可能部材は、上下に並んで一緒に接着された状態で、前記アンビルまたは前記下部つかみ具の何れか一方に取り付けられており、前記第1の流体充填可能部材は第1の液体を収容し、前記第2の流体充填可能部材は、前記第1の液体とは異なる第2の液体を収容し、前記第1の流体充填可能部材および前記第2の流体充填可能部材の双方が、前記第2の構成において、前記圧縮性部分及び前記圧力部分を備えており、前記第1の流体充填可能部材および前記第2の流体充填可能部材の双方が、前記外科用カッターが組織を切断するのとほぼ同時に、前記外科用カッターによって切断されると、前記第1の流体充填可能部材の前記圧縮性部分を通じて前記第1の液体が押し出され、前記第2の流体充填可能部材の前記圧縮性部分を通じて前記第2の液体が押し出され、前記第1の液体および前記第2の液体が混合されて、接着剤が形成されるようになっている、装置。 - 前記アンビルが、アンビル幅を画定し、前記バットレスが前記アンビル幅より広いバットレス幅を画定する、請求項1に記載の装置。
- 前記バットレスが、略長方形の形状を有する、請求項1に記載の装置。
- 前記バットレスが、前記下部つかみ具から外側に延在するように、前記下部つかみ具にまたがる、請求項1に記載の装置。
- 前記バットレスが、前記下部つかみ具に連結されるように構成されている、請求項1に記載の装置。
- 前記外科用カッターと連通する外科用ステープラーを更に備え、前記外科用ステープラーが、1つ又は2つ以上のステープルを備え、前記外科用ステープラーが、組織の一部分をステープル留めするように構成され、前記1つ又は2つ以上のステープルが、前記バットレスを破裂させるように構成されている、請求項1に記載の装置。
- 前記バットレスが、可溶性材料を含む、請求項1に記載の装置。
- 前記第1の液体がフィブリンを含み、前記第2の液体がトロンビンを含む、請求項1に記載の装置。
- 前記バットレスが、前記バットレスを前記外科用カッターの一部分に接着するように動作可能な接着剤を前記バットレスの外側に含む、請求項1に記載の装置。
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US13/232,401 US9999408B2 (en) | 2011-09-14 | 2011-09-14 | Surgical instrument with fluid fillable buttress |
US13/232,401 | 2011-09-14 | ||
PCT/US2012/054401 WO2013039820A1 (en) | 2011-09-14 | 2012-09-10 | Surgical instrument with fluid fillable buttress |
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JP2014531240A JP2014531240A (ja) | 2014-11-27 |
JP6203729B2 true JP6203729B2 (ja) | 2017-09-27 |
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JP2014530717A Active JP6203729B2 (ja) | 2011-09-14 | 2012-09-10 | 流体を充填可能なバットレスを有する外科用器具 |
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US (1) | US9999408B2 (ja) |
EP (1) | EP2755560B1 (ja) |
JP (1) | JP6203729B2 (ja) |
CN (1) | CN103917170A (ja) |
BR (1) | BR112014006216B1 (ja) |
MX (1) | MX358403B (ja) |
RU (1) | RU2610199C2 (ja) |
WO (1) | WO2013039820A1 (ja) |
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MX2014002976A (es) | 2015-04-13 |
BR112014006216A2 (pt) | 2017-04-11 |
US9999408B2 (en) | 2018-06-19 |
BR112014006216B1 (pt) | 2021-06-08 |
RU2610199C2 (ru) | 2017-02-08 |
US20130062391A1 (en) | 2013-03-14 |
EP2755560B1 (en) | 2021-07-28 |
EP2755560A1 (en) | 2014-07-23 |
WO2013039820A1 (en) | 2013-03-21 |
MX358403B (es) | 2018-08-16 |
JP2014531240A (ja) | 2014-11-27 |
CN103917170A (zh) | 2014-07-09 |
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