JP6224002B2 - 早期の顎開放を防ぐ組織ステープラーアンビル機構 - Google Patents
早期の顎開放を防ぐ組織ステープラーアンビル機構 Download PDFInfo
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
- A61B17/0686—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying below the tissue during stapling
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- 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
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
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- 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
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- 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
- A61B2017/0725—Stapler heads with settable gap between anvil and cartridge, e.g. for different staple heights at different shots
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
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- A61B2017/2946—Locking means
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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
- A61B90/08—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
図1〜6は、それぞれより詳細に後述される、ステープル留めヘッドアセンブリ(20)、軸アセンブリ(60)、及びアクチュエータハンドルアセンブリ(70)を有する、代表的な円形外科用ステープル留め器具(10)を示す。軸アセンブリ(60)は、アクチュエータハンドルアセンブリ(70)から遠位側に延在し、ステープル留めヘッドアセンブリ(20)は軸アセンブリ(60)の遠位端に連結される。概して、アクチュエータハンドルアセンブリ(70)は、ステープル留めヘッドアセンブリ(20)のステープルドライバ(24)を作動させて、複数のステープル(66)をステープル留めヘッドアセンブリ(20)から送り出すように動作可能である。ステープル(66)は曲げられて、器具(10)の遠位端に取り付けられたアンビル(40)によって完全なステープルを形成する。結果的に、図2A〜2Cに示される組織(2)が、器具(10)を使用してステープル留めされてもよい。
図1〜2Cに示されるように、アンビル(40)は、器具(10)に選択的に連結して表面を提供することができ、その表面に対抗してステープル(66)が曲げられて、ステープル留めヘッドアセンブリ(20)とアンビル(40)との間に収容された物質をステープル留めしてもよい。本実施例のアンビル(40)は、ステープル留めヘッドアセンブリ(20)に対して遠位側に延在する、トロカール又は先の尖ったロッド(38)に選択的に連結可能である。図2A〜2Cを参照すると、アンビル(40)は、アンビル(40)の近位軸(42)をトロカール(38)の遠位先端に連結することによって、選択的に連結可能である。アンビル(40)は、全体的に円形のアンビルヘッド(48)と、アンビルヘッド(48)から近位側に延在する近位軸(42)とを備える。図示される実施例では、近位軸(42)は、アンビル(40)をトロカール(38)に選択的に連結する、弾性的に付勢される保定クリップ(46)を有する管状部材(44)を備えるが、これは単に任意のものであり、アンビル(40)をトロカール(38)に連結する他の保定機構が同様に使用されてもよいことが理解されるべきである。例えば、C型クリップ、クランプ、ねじ切り、ピン、接着剤などが、アンビル(40)をトロカール(38)に連結するのに用いられてもよい。それに加えて、アンビル(40)はトロカール(38)に選択的に連結可能なものとして記載されているが、いくつかの型においては、近位軸(42)は、アンビル(40)が一旦取り付けられるとアンビル(40)をトロカール(38)から除去できないような、一方向の連結機構を含んでもよい。単なる代表的な一方向の機構としては、返し、一方向のスナップ、コレット、カラー、タブ、バンドなどが挙げられる。当然ながら、アンビル(40)をトロカール(38)に連結するための更に他の構成が、本明細書の教示を考慮して当業者には明白となるであろう。例えば、トロカール(38)は、代わりに中空軸であってもよく、近位軸(42)は、中空軸に挿入可能な尖らせたロッドを備えてもよい。
本実施例のステープル留めヘッドアセンブリ(20)は、軸アセンブリ(60)の遠位端に連結され、スライド可能なステープルドライバ(24)を収納する管状ケーシング(22)と、ステープルポケット(32)内に収容された複数のステープル(66)とを備える。ステープル(66)及びステープルポケット(32)は、管状ケーシング(22)の周りの円形アレイ内に配設される。本実施例では、ステープル(66)及びステープルポケット(32)は、ステープル(66)及びステープルポケット(32)の同心の環状列の対の形で配設される。ステープルドライバ(24)は、アクチュエータハンドルアセンブリ(70)のトリガ(74)の回転に反応して、管状ケーシング(22)内で長手方向で作動するように動作可能である。図2A〜2Cに示されるように、ステープルドライバ(24)は、トロカール開口部(26)と、中央凹部(28)と、中央凹部(28)の周りに円周方向で配設されると共に、軸アセンブリ(60)に対して遠位側に延在する複数の部材(30)とを有する、フレア形状の円筒状部材を備える。各部材(30)は、複数のステープル(66)のうち対応するステープル(66)に接触し、それをステープルポケット(32)内で係合するように構成される。結果的に、ステープルドライバ(24)をアクチュエータハンドルアセンブリ(70)に対して遠位側に作動させると、各部材(30)が、管状ケーシング(22)の遠位端に形成されたステープルアパーチャ(34)を通して、対応するステープル(66)をそのステープルポケット(32)から送り出す。各部材(30)はステープルドライバ(24)から延在するので、複数のステープル(66)は、ほぼ同時にステープル留めヘッドアセンブリ(20)から送り出される。アンビル(40)が閉位置にあるとき、ステープル(66)はステープル形成ポケット(52)に送り込まれてステープル(66)の脚部(68)が曲がり、それによってアンビル(40)とステープル留めヘッドアセンブリ(20)との間に位置する物質をステープル留めする。図3は、部材(30)によってアンビル(40)のステープル形成ポケット(32)に送り込まれて脚部(68)を曲げる、1つの単なる代表的なステープル(66)を示す。
ステープル留めヘッドアセンブリ(20)及びトロカール(38)は、図2A〜2Cに示されるように、軸アセンブリ(60)の遠位端に位置付けられる。本実施例の軸アセンブリ(60)は、外側管状部材(62)及びドライバアクチュエータ(64)を備える。外側管状部材(62)は、ステープル留めヘッドアセンブリ(20)の管状ケーシング(22)に、かつアクチュエータハンドルアセンブリ(70)の本体(72)に連結され、それによって中の作動構成要素の機械的接地がもたらされる。ドライバアクチュエータ(64)の近位端は、後述するアクチュエータハンドルアセンブリ(70)のトリガ作動アセンブリ(84)に連結される。ドライバアクチュエータ(64)の遠位端は、トリガ(74)の回転によってステープルドライバ(24)を長手方向で作動させるように、ステープルドライバ(24)に連結される。図2A〜2Cに示されるように、ドライバアクチュエータ(64)は、トロカール(38)に連結されたアクチュエータ(39)がドライバアクチュエータ(64)内でそれに対して長手方向で作動してもよいように、開いた長手方向軸線を有する管状部材を備える。当然ながら、本明細書の教示を考慮して当業者には明白となるように、他の構成要素がドライバアクチュエータ(64)内に配設されてもよいことが理解されるべきである。
次に図4A〜5を参照すると、アクチュエータハンドルアセンブリ(70)は、本体(72)、トリガ(74)、ロックアウト機構(82)、トリガ作動アセンブリ(84)、及びトロカール作動アセンブリ(90)を備える。本実施例のトリガ(74)は、本体(72)に枢動可能に装着され、トリガ(74)を発射されてない位置(図4Aに示される)から発射した位置(図4Bに示される)へと回転させることによって、上記のドライバアクチュエータ(64)を作動させるように、トリガ作動アセンブリ(84)に連結される。ばね(78)は、本体(72)及びトリガ(74)に連結されて、トリガ(74)を発射されてない位置に向かって付勢する。ロックアウト機構(82)は、本体(72)に連結される枢動可能な部材である。第1のロック位置では、ロックアウト機構(82)は、ロックアウト機構(82)がトリガ(74)を係合し、ユーザによるトリガ(74)の作動に機械的に抵抗するように、上方へと本体(72)から離れる方向に枢動される。図1及び4Bに示されるような、第2のロック解除位置では、ロックアウト機構(82)は、トリガ(74)をユーザによって作動させてもよいように、下方へと枢動される。結果的に、ロックアウト機構(82)が第2の位置にあると、トリガ(74)はトリガ作動アセンブリ(84)を係合して、器具(10)を発射することができる。
場合によっては、アンビル(40)がトロカール(38)に十分に連結されるとユーザがそれを検出するのが望ましいことがある。かかる検出によって、器具(10)を発射したときにアンビル(40)がステープルドライバ(24)に対して遠位側に移動しないように、アンビル(40)がトロカール(38)に対して適切に連結されていることを確認することができる。かかる検出のインジケータは、感覚インジケータアセンブリ(例えば、視覚、聴覚、触覚など)によって、かつ/又はトリガ(74)がユーザによって作動可能であることを防ぐトリガロックアウトアセンブリによって提供されてもよい。結果的に、ユーザは、アンビル(40)が適切に取り付けられているか、又はトロカール(38)上に完全に着座するか否かを、器具(10)の発射に先立って判断することができ、あるいは、場合によっては、アンビル(40)が適切に取り付けられるまで、器具(10)がユーザによる発射を防ぐ。結果的に、様々なアンビル検出アセンブリ、インジケータアセンブリ、及びトリガロックアウトアセンブリについて以下に記載する。
図7は、代表的なトロカール(220)に組み込まれた代表的なアンビル配備ロッド(230)を含む、外科用器具(200)を示す。本実施例では、外科用器具(200)は、本体(202)、トリガ(204)、ロックアウト機構(210)、調節ノブ(216)、トロカール(220)、及びアンビル配備ロッド(230)を備える。本体(202)、トリガ(204)、ロックアウト機構(210)、調節ノブ(216)、及びトロカール(220)は、上記の本体(72)、トリガ(74)、ロックアウト機構(82)、調節ノブ(98)、及びトロカール(38)にほぼしたがって構築されてもよい。外科用器具(200)は、更に、上記の外科用器具(10)にほぼしたがって、あるいは参照により開示が本明細書に組み込まれる、米国特許第5,205,459号、米国特許第5,271,544号、米国特許第5,275,322号、米国特許第5,285,945号、米国特許第5,292,053号、米国特許第5,333,773号、米国特許第5,350,104号、及び/又は米国特許第5,533,661号の教示の少なくとも一部にしたがって構築されてもよい。
図8は、上記の外科用器具(10、200)などの外科用器具に組み込まれてもよい、代替のアンビル検出アセンブリ(300)を示す。図示される実施例では、アンビル検出アセンブリ(300)は、トロカール(302)から外向きに延在するヒンジ付きタブ(310)を備える。トロカール(302)は、上記のトロカール(38、220)の教示の少なくとも一部にしたがって構築されてもよい。本実施例において図示されるように、ばね(312)は、タブ(310)をトロカール(302)から外向きに付勢するが、これは単に任意のものである。例えば、1つの代替例では、ばね(312)は省略されてもよく、タブ(310)は、タブ(310)が弾性的に付勢されるタブであるように、トロカール(302)と一体的に形成されてもよい。それに加えて、単一のタブ(310)が例証されるが、複数のタブ(310)がトロカール(302)の周りに位置付けられてもよいことが理解されるべきである。タブ(310)がトロカール(302)から離れる方向に延在すると、本実施例のタブ(310)は、ステープルドライバ(308)と機械的に干渉して、ステープルドライバ(308)がトロカール(302)に対して遠位側に作動するのを実質的に防ぐ。結果的に、タブ(310)がトロカール(302)に押し付けられるか又はその中に押し込まれるまで、ユーザが、上記のトリガ(74)などのトリガを動作させることによってステープルドライバ(308)を発射することが防止されてもよい。
図10A〜10Bは、上記の外科用器具(10)などの外科用器具に組み込まれてもよい、代替のアンビル検出アセンブリ(500)を示す。最初に図10Aを参照すると、トロカール(510)及びステープルドライバ(520)は、アクチュエータハンドルアセンブリ(図示なし)から遠位側に延在する。トロカール(510)及びステープルドライバ(520)は、本明細書に記載されるトロカール(38)及びステープルドライバ(24)の教示の少なくとも一部にしたがって構築されてもよい。一対の弾性部材(530)も、アクチュエータハンドルアセンブリから遠位側に延在し、トロカール(510)から離れる方向で外向きに付勢される。弾性部材(530)の近位端(図示なし)は、アクチュエータハンドルアセンブリの一部分に連結されて、弾性部材(530)を機械的に接地する。例えば、弾性部材(530)は、アクチュエータハンドルアセンブリの本体と一体的に形成されるか、又はねじ、ボルト、接着剤などの取付け部材を介して機械的に連結されてもよい。いくつかの型においては、弾性部材(530)の近位端はトロカール(510)に連結されてもよい。別の型においては、弾性部材(530)の近位端はステープルドライバ(520)に連結されてもよい。当然ながら、弾性部材(530)をそれらの近位端で連結する更なる別の構成は、本明細書の教示を考慮して当業者には明白となるであろう。
図11〜12は、トロカール(602)の周りにスライド可能に配設されたアンビル感知チューブ(622)を備える、外科用器具(600)の更に別のアンビル検出アセンブリ(620)を示す。図11に示されるように、アンビル感知チューブ(620)は、アクチュエータハンドルアセンブリ(610)内へと近位側に延在する。本実施例のアクチュエータハンドルアセンブリ(610)は、本体(612)に対して枢動可能なトリガ(614)を含む。トリガ(614)は、アーム(616)がトリガ(614)と共に枢動するように、トリガ(614)の枢動点から外向きに延在するアーム又は機構(616)を含む。いくつかの型においては、上記のトリガアーム(76)などの、一対のアーム(616)が提供されてもよい。別の方法として、又はそれに加えて、アーム(616)は、トリガアーム(76)と区別される別個の特徴であってもよい。器具(600)、トロカール(602)、及び/又はアクチュエータハンドルアセンブリ(610)は、更に、上記の器具(10)、トロカール(38)、及び/又はアクチュエータハンドルアセンブリ(70)に対する教示の少なくとも一部にしたがって構築されてもよい。
前述の実施例は様々なアンビル検出アセンブリについて実証してきたが、前述のアセンブリが、1つ以上のロックアウト機構を係合して、トリガ(74)を解除して器具(10)を発射するのが好ましいことがある。例えば、いくつかの型においては、アンビル検出機構が、トリガ(74)を解放するのにユーザが押し下げるか又は操作しなければならないロックアウトボタンを飛び出し、それによって、アンビル(40)がトロカール(38)に適切に連結されると共にロックアウトボタンがユーザによって操作されるまで、器具(10)が発射されるのを防ぐのが好ましいことがある。あるいは、アンビル(40)がトロカール(38)上に完全に着座しており、ロックアウト機構を係脱してトリガ(74)を動作させることができることをインジケータが視覚的に指示するように、アンビル検出アセンブリがインジケータを解放し、ロックアウト機構(82)を解放するのが好ましいことがある。結果的に、以下の実施例は、前述のアンビル検出アセンブリの1つ以上と、かつ/又は本明細書の教示を考慮して当業者には明白となるような他の任意のアンビル検出アセンブリと、組み合わされてもよいことが理解されるべきである。
図16A〜17は、代表的なロックアウトボタンアセンブリ(950)を有する代表的な外科用器具(900)を示す。最初に図16Aを参照すると、ロックアウトボタンアセンブリ(950)は、アクチュエータハンドルアセンブリ(930)内へと長手方向で延在してボタン(970)を係合する、アンビル感知軸(960)を備える。アンビル感知軸(960)は、ボタン(970)を係合するように構成された、斜角を付けたカム面(964)を有する近位端(962)を含む。アンビル感知軸(960)は、更に、本明細書に記載されるアンビル感知チューブ(622)に関する教示にしたがって構築されてもよいが、前述のアンビル検出アセンブリのいずれかが、アンビル感知軸(960)に加えて、又はその代わりに使用されてもよいことが理解されるべきである。本実施例のアクチュエータハンドルアセンブリ(930)は、第1の横孔(940)(図17に仮想線で示される)と、第2の横孔(942)と、第1のチャネル(944)(図17に仮想線で示される)と、第2のチャネル(946)と、垂直スロット(948)とを有する本体(938)を含む。ボタン(970)は、内側部材(972)、中間部材(974)、中間アクスル(976)、及び外側部材(978)を備える。本実施例では、第1の横孔(940)は、ボタン(970)の中間部材(974)が貫通できるようにサイズ決めされる。第2の横孔(942)は、外側部材(978)が貫通できるようにサイズ決めされるが、中間部材(974)は貫通できないようにサイズ決めされる。第1のチャネル(944)は、内側部材(972)が第1のチャネル(944)に沿って垂直に作動できるように構成される。第2のチャネル(946)は、中間アクスル(976)が第2のチャネル(946)に沿って垂直に作動できるように構成される。最後に、垂直スロット(948)は、中間部材(974)が中で垂直に駆動できるように構成される。当然ながら、ボタン(970)及び/又は本体(938)の更なる別の構成が、本明細書の教示を考慮して当業者には明白となるであろう。
図20A〜20Cは、代表的なロックアウトボタンアセンブリ(1250)を有する代表的な代替の外科用器具(1200)を示す。最初に図20Aを参照すると、本実施例の外科用器具(1200)は、ステープル留めヘッドアセンブリ(図示なし)、軸アセンブリ(1220)、及びアクチュエータハンドルアセンブリ(1230)を備える。軸アセンブリ(1220)は、アクチュエータハンドルアセンブリ(1230)から遠位側に延在し、ステープル留めヘッドアセンブリは軸アセンブリ(1220)の遠位端に連結される。簡潔に、アクチュエータハンドルアセンブリ(1230)は、ステープル留めヘッドアセンブリのステープルドライバ(図示なし)を作動させて、複数のステープル(図示なし)をステープル留めヘッドアセンブリから送り出すように動作可能なトリガ(1232)を含む。ステープルは、器具(1200)の遠位端から外に延在するトロカールに取り付けられた、アンビル(40)などのアンビル(図示なし)によって、完成したステープルを形成するように曲げられる。結果的に、器具(1200)を利用して組織がステープル留めされてもよい。ステープル留めヘッドアセンブリ、軸アセンブリ(1220)、及びアクチュエータハンドルアセンブリ(1230)は、更に、上記のステープル留めヘッドアセンブリ(20)、軸アセンブリ(60)、及びアクチュエータハンドルアセンブリ(70)にしたがって構築されてもよい。
図21A〜23は、ばね仕掛けのプッシュロッド(1310)、ばね仕掛けのピン(1320)、及び枢動可能なロックアウト機構(1340)を備える、更に別の代表的なロックアウトボタンアセンブリ(1300)を示す。図21Aは、初期又はロック位置で示されると共に、上記の器具(10)などの代表的な外科用器具の本体(1350)内に収容された、ばね仕掛けのプッシュロッド(1310)、ばね仕掛けのピン(1320)、及び枢動可能なロックアウト機構(1340)を示す。本実施例では、本体(1350)は、ピン(1320)の外側部分(1338)が中を通って延在できるようにサイズ決めされたピン孔(1352)を含む。いくつかの型においては、ピン孔(1352)は、外側部分(1338)が中を通って延在できるようにサイズ決めされてもよいが、中間部分(1332)よりも小さい直径を含み、それによって外側部分(1338)のみがそこを通って突出することができる。当然ながら、ピン孔(1352)は単なる任意のものであり、いくつかの型においては省略されてもよいことが理解されるべきである。本体(1350)は、更に、上記の本体(72)に関する教示の少なくとも一部にしたがって構築されてもよい。
(1) 組織をステープル留めする装置であって、
(a)本体に枢動可能に装着されたトリガを有するアクチュエータハンドルアセンブリと、
(b)ステープル留めヘッドアセンブリであって、
i.ステープルドライバ、
ii.先の尖ったロッド、及び
iii.アンビル検出機構を含む、ステープル留めヘッドアセンブリと、を含み、
前記トリガが、前記ステープルドライバを前記アクチュエータハンドルアセンブリに対して遠位側に作動させるように動作可能であり、
前記アンビル検出機構が、着座したアンビルが存在しない状態で前記トリガが枢動するのを防ぐように動作可能である、装置。
(2) アクチュエータハンドルアセンブリがロックアウト機構を更に備え、前記ロックアウト機構が第1の位置から第2の位置へと移動可能であり、前記第1の位置にある前記ロックアウト機構が、前記トリガを係合して前記トリガの枢動を防ぎ、前記第2の位置にある前記ロックアウト機構によって前記トリガの枢動が可能になり、前記アンビル検出機構が、前記ロックアウト機構が前記第1の位置から前記第2の位置へと枢動するのを防ぐように動作可能である、実施態様1に記載の装置。
(3) 前記アンビル検出機構が、突起を有する並進可能な部材を含む、実施態様2に記載の装置。
(4) 前記並進可能な部材が、前記アクチュエータハンドルアセンブリに対して遠位側に付勢される、実施態様3に記載の装置。
(5) 前記先の尖ったロッドにアンビルを取り付けることによって、前記並進可能なロッドが近位側に作動する、実施態様4に記載の装置。
(7) 前記アンビル感知チューブが前記先の尖ったロッドの周りに同軸で配設される、実施態様6に記載の装置。
(8) 前記トリガがトリガアームを含み、前記アンビル感知チューブが第1の位置にあるとき、前記トリガアームが前記アンビル感知チューブに当接する、実施態様6に記載の装置。
(9) 前記アンビル感知チューブが凹部を含み、前記凹部が、前記アンビル感知チューブが第2の位置にあるときにトリガアームを前記凹部の中を通して枢動させることができるようにサイズ決めされる、実施態様8に記載の装置。
(10) 前記アンビル感知チューブが、アンビルの軸を受け入れるように構成された遠位側のカップを備える、実施態様6に記載の装置。
(12) 前記タブが、前記ステープルドライバの遠位端を係合するように動作可能である、実施態様11に記載の装置。
(13) 前記タブが、前記先の尖ったロッドが前記アクチュエータハンドルアセンブリに対して近位側に作動するのを防ぐように動作可能である、実施態様11に記載の装置。
(14) 前記先の尖ったロッドに選択的に連結可能なアンビルを更に備え、前記アンビルが、前記先の尖ったロッドに対して前記タブを押し付けるように動作可能である、実施態様11に記載の装置。
(15) 前記アンビル検出機構が一対のばねクリップを備え、前記ばねクリップが前記先の尖ったロッドに形成されたスロット内に配設され、着座したアンビルが存在しないとき、前記ばねクリップの少なくとも一部分が前記先の尖ったロッドの外に横方向で延在する、実施態様1に記載の装置。
(a)プッシュロッドと、
(b)枢動可能なロックアウト機構と、
(c)前記プッシュロッド及び前記ロックアウト機構を通して挿入されるボタンであって、前記ボタンは、
i.第1の部分と、
ii.第2の部分と、
iii.第3の部分と、を含む、ボタンと、を含み、
前記ボタンの前記第2の部分が、ボタンが第1の横方向位置にあるとき、前記ロックアウト機構が枢動するのを防ぐように動作可能であり、
前記プッシュロッドが、アンビルの連結に反応して長手方向で作動するように動作可能である、ロックアウトアセンブリ。
(17) 前記プッシュロッドが遠位孔及び長手方向のスロットを備え、前記孔が、前記ボタンの前記第2の部分が前記孔の中を通って横方向でスライドできるようにサイズ決めされ、前記スロットが、前記ボタンの前記第1の部分が前記スロットの中を通って延在しているとき、前記プッシュロッドを長手方向で作動させることができるようにサイズ決めされる、実施態様16に記載のロックアウトアセンブリ。
(18) 前記ボタンの前記第3の部分に連結されたばねを更に備え、前記ばねが前記ボタンを横方向で付勢し、前記ボタンが第1の位置にあるとき、前記第2の部分が前記プッシュロッドの側面に当接する、実施態様17に記載のロックアウトアセンブリ。
(19) 前記ロックアウト機構が近位孔及び弓状のスロットを備え、前記孔が、前記ボタンの前記第2の部分が前記孔の中を通って横方向でスライドできるようにサイズ決めされ、前記スロットが、前記ボタンの前記第3の部分が前記スロットの中を通って延在しているとき、前記ロックアウト機構を枢動させることができるようにサイズ決めされる、実施態様16に記載のロックアウトアセンブリ。
(20) 組織をステープル留めする装置であって、
(a)アクチュエータハンドルアセンブリであって、
i.本体、
ii.前記本体に枢動可能に装着されるトリガ、及び、
iii.前記本体に連結されたボタン、を含む、アクチュエータハンドルアセンブリと、
(b)ステープル留めヘッドアセンブリであって、
i.ステープルドライバ、
ii.先の尖ったロッド、及び
iii.アンビル感知軸、を含む、ステープル留めヘッドアセンブリと、を含み、
前記トリガが、前記ステープルドライバを前記アクチュエータハンドルアセンブリに対して遠位側に作動させるように動作可能であり、
前記アンビル感知軸が、前記アンビル感知軸を近位側に作動させたとき、前記ボタンを前記本体から外向きにカム動作させるように動作可能である、装置。
Claims (6)
- 組織をステープル留めする装置であって、
(a)アクチュエータハンドルアセンブリであって、
i.本体に枢動可能に装着されたトリガと、
ii.前記本体に回転可能に装着されたノブと、
を含む、アクチュエータハンドルアセンブリと、
(b)ステープル留めヘッドアセンブリであって、
i.ステープルドライバ、
ii.先の尖ったロッド、及び
iii.アンビル検出機構を含む、ステープル留めヘッドアセンブリと、を含み、
前記トリガが、前記ステープルドライバを前記アクチュエータハンドルアセンブリに対して遠位側に作動させるように動作可能であり、
前記ノブは、開口部を画定し、
前記先の尖ったロッドの位置は、少なくとも着座したアンビルの存在下で、前記ノブによって調節可能であり、
前記検出機構はアンビル配備ロッドを含み、
前記アンビル配備ロッドは、前記ノブの前記開口部の中に延在し、
前記アンビル検出機構が、着座したアンビルが存在しない状態で前記トリガが枢動するのを防ぐように動作可能であり、
アクチュエータハンドルアセンブリがロックアウト機構を更に備え、前記ロックアウト機構が第1の位置から第2の位置へと移動可能であり、前記第1の位置にある前記ロックアウト機構が、前記トリガを係合して前記トリガの枢動を防ぎ、前記第2の位置にある前記ロックアウト機構によって前記トリガの枢動が可能になり、前記アンビル配備ロッドが、前記ロックアウト機構が前記第1の位置から前記第2の位置へと枢動するのを防ぐように動作可能であり、
前記アンビル配備ロッドが、突起を有する並進可能な部材を含み、
前記アンビル配備ロッドが、前記アクチュエータハンドルアセンブリに対して遠位側に付勢され、
前記先の尖ったロッドにアンビルを取り付けることによって、前記アンビル配備ロッドが近位側に作動する、装置。 - 前記アンビル検出機構がアンビル感知チューブを含む、請求項1に記載の装置。
- 前記アンビル感知チューブが前記先の尖ったロッドの周りに同軸で配設される、請求項2に記載の装置。
- 前記トリガがトリガアームを含み、前記アンビル感知チューブが第1の位置にあるとき、前記トリガアームが前記アンビル感知チューブに当接する、請求項2に記載の装置。
- 前記アンビル感知チューブが凹部を含み、前記凹部が、前記アンビル感知チューブが第2の位置にあるときにトリガアームを前記凹部の中を通して枢動させることができるようにサイズ決めされる、請求項4に記載の装置。
- 前記アンビル感知チューブが、アンビルの軸を受け入れるように構成された遠位側のカップを備える、請求項2に記載の装置。
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EP (3) | EP4101396A1 (ja) |
JP (1) | JP6224002B2 (ja) |
CN (1) | CN104039244B (ja) |
BR (1) | BR112014016658B1 (ja) |
MX (1) | MX345532B (ja) |
RU (1) | RU2619382C2 (ja) |
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EP4101396A1 (en) | 2022-12-14 |
MX2014008262A (es) | 2014-09-22 |
CN104039244B (zh) | 2016-11-16 |
RU2619382C2 (ru) | 2017-05-15 |
EP3895630A1 (en) | 2021-10-20 |
BR112014016658A8 (pt) | 2017-07-04 |
BR112014016658A2 (pt) | 2017-06-13 |
WO2013103505A3 (en) | 2013-11-28 |
US20130175318A1 (en) | 2013-07-11 |
BR112014016658B1 (pt) | 2021-06-29 |
US20160030038A1 (en) | 2016-02-04 |
US10226246B2 (en) | 2019-03-12 |
EP2800526B1 (en) | 2021-02-17 |
CN104039244A (zh) | 2014-09-10 |
EP2800526A2 (en) | 2014-11-12 |
WO2013103505A2 (en) | 2013-07-11 |
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