JP6467018B2 - 内視鏡縫合システム - Google Patents
内視鏡縫合システム Download PDFInfo
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- JP6467018B2 JP6467018B2 JP2017209720A JP2017209720A JP6467018B2 JP 6467018 B2 JP6467018 B2 JP 6467018B2 JP 2017209720 A JP2017209720 A JP 2017209720A JP 2017209720 A JP2017209720 A JP 2017209720A JP 6467018 B2 JP6467018 B2 JP 6467018B2
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- needle
- tubular member
- distal end
- tissue
- endoscope
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Description
(1)ガイドチューブ及び/又は内視鏡を、内視鏡及び/又はガイドチューブに連結された縫合装置と共に体内に挿入する段階と、
(2)取り外し可能な針を有する縫合装置の針アームを開く段階と、
(3)所望の縫合部位において針を組織に押し当てる段階と、
(4)縫合装置の針アームを閉じる段階と、
(5)組織を針で穿刺する段階と、
(6)針捕捉装置を用いて針を回収する段階と、
(7)針を組織から抜去する段階と、
(8)針アームを開いて同針アームを組織から抜去する段階と、
(9)針アームを閉じる段階と、
(10)縫合装置を体内から取り出す段階と
を含む。
(1)ガイドチューブを体内に挿入する段階と、
(2)内視鏡に連結された縫合装置をガイドチューブ内及び体内に挿入する段階と、
(3)取り外し可能な針を有する縫合装置の針アームを開く段階と、
(4)組織捕捉器を用いて所望の縫合部位に隣接する組織に係合する段階と、
(5)所望の縫合部位において針を組織に押し当てる段階と、
(6)縫合装置の針アームを閉じる段階と、
(7)組織を針で穿刺する段階と、
(8)針捕捉装置を用いて針を回収する段階と、
(9)針を組織から抜去する段階と、
(10)針アームを開いて同針アームを組織から抜去する段階と、
(11)組織を組織捕捉器から解放する段階と、
(12)針アームを閉じる段階と、
(13)縫合装置を体内から取り出す段階と
を含む。
(1)ガイドチューブを体内に挿入する段階と、
(2)内視鏡に連結された縫合装置をガイドチューブ内に挿入し更に同縫合装置を体内に挿入する段階と、
(3)取り外し可能な針を有する縫合装置の針アームを開く段階と、
(4)所望の縫合部位において針を組織に押し当てる段階と、
(5)縫合装置の針アームを閉じる段階と、
(6)組織を針で穿刺する段階と、
(7)針捕捉装置を用いて針を回収する段階と、
(8)針を組織から抜去する段階と、
(9)針アームを開いて同針アームを組織から抜去する段階と、
(10)針アームを閉じる段階と、
(11)針捕捉装置を用いて内視鏡下で針を針アーム内に挿入する段階と、
(12)必要に応じて(3)乃至(11)の段階を遂行する段階と
を含む。
(1)ガイドチューブを体内に挿入する段階と、
(2)内視鏡に連結された縫合装置をガイドチューブ内に挿入し更に同縫合装置を体内に挿入する段階と、
(3)取り外し可能な針クリップを有する縫合装置の針保持アームを開く段階と、
(4)組織捕捉器を用いて所望の縫合部位に隣接する組織に係合する段階と、
(5)所望の縫合部位において針クリップを組織に押し当てる段階と、
(6)縫合装置の針保持アームを閉じる段階と、
(7)組織を針クリップで穿刺する段階と、
(8)針捕捉装置を用いて針クリップ先端部を捕捉する段階と、
(9)針保持アームを開いて同針保持アームを組織から抜去する段階と、
(10)針クリップを針捕捉装置から解放する段階と、
(11)組織を組織捕捉器から解放する段階と、
(12)針保持アームを閉じる段階と、
(13)縫合装置を体内から取り出す段階と
を含む。
Claims (14)
- 内視鏡と共に使用され前記内視鏡の器具チャネルを介して挿入される大きさを持つ針捕捉装置であって、前記針捕捉装置が、
a)近位端と遠位端とを有する可撓性管状部材と、
b)近位端と遠位端とを有する可撓性シャフトであって、前記シャフトが前記管状部材を貫通する、可撓性シャフトと、
c)前記シャフト及び管状部材を相互に対して長手方向に変位するための近位ハンドルと、
を備え、
前記針捕捉装置は、
d)前記可撓性管状部材の前記遠位端に固定された近位端と、遠位端とを有するハウジングと、
e)前記ハウジング内の3つの剛性管状部材であって、
i)前記可撓性管状部材の前記遠位端に固定された近位端と、前記ハウジングの前記遠位端に固定された遠位端と、外側管状体の内部へ向かって塑性変形した少なくとも1つの連結タブと、前記外側管状体の内部へ向かって塑性変形したラッチタブと、前記ラッチタブから近位方向へ変位しかつ前記外側管状体の内部へ延びるラッチ解除タブとを有する剛性外側管状部材であって、前記ラッチ解除タブを半径方向外向きに弾性的に移動させることによって前記ラッチタブを半径方向外向きに変位できる、剛性外側管状部材と、
ii)前記外側管状部材内に同軸的に設置された剛性中間管状部材であって、前記中間管状部材が、前記可撓性シャフトの前記遠位端に固定された近位端と、遠位端と、前記近位端と遠位端との間に延在する壁と、前記近位端と前記遠位端との間の前記壁に形成された少なくとも1つの長手方向に延びるスロットと、を有する、剛性中間管状部材と、
iii)前記中間管状部材内に同軸的に設置された剛性内側管状部材であって、前記内側管状部材が、遠位端と近位端とを有し、少なくとも1つの連結スロットを形成する、剛性内側管状部材と、
を含み、
前記中間管状部材の前記少なくとも1つの長手方向に延びるスロットの各々が、前記内側管状部材の前記少なくとも1つの連結スロットの長さより長く、
前記少なくとも1つの連結タブが塑性変形して前記中間管状部材の前記少なくとも1つの長手方向へ延びるスロットを通過して前記少なくとも1つの連結スロットの中へ延びて、前記外側管状部材に対して前記内側管状部材の位置を固定し、
前記中間管状部材が、前記近位ハンドルの操作に反応して前記外側及び内側管状部材に対して長手方向へ変位可能であり、前記外側管状部材内で前記中間管状部材を長手方向に遠位へ変位させるための前記近位ハンドルの操作によって、前記中間管状部材の一部が前記ラッチ解除タブを半径方向外向きに弾性的に移動させて、前記ラッチタブを半径方向外向きに変位させる、
3つの剛性管状部材と、
を備える、ことを特徴とする、
針捕捉装置。 - 前記可撓性管状部材が外径を有し、前記ハウジングが、前記可撓性管状部材の前記外径よりも大きい外径を有することを特徴とする、請求項1に記載の針捕捉装置。
- 前記ハウジングが、外面と、前記外面の周りに放射状に配列されたフライトとスペースの交互の配列体を含むことを特徴とする、請求項1に記載の針捕捉装置。
- 前記ハウジングが2組の前記フライト及びスペースを含み、第1組が前記ハウジングの前記遠位端に設置され、第2組が前記ハウジングの前記近位端に設置されることを特徴とする、請求項3に記載の針捕捉装置。
- さらに、
鋭利先端部と前記先端部に近接する捕捉凹部とを有する針と、前記針に固定された一端を有する縫合糸とを含む、外科用針アセンブリを備え、
前記針アセンブリが、前記先端部を先頭とする向きで前記ハウジングの中へ導入されるとき、前記針の先端部が前記内側管状部材の前記遠位端内において中心に配置され、
前記中間管状部材が前記外側管状部材内で相対的に近位に変位するとき、前記ラッチタブが前記捕捉凹部に係合して、前記ハウジングに対して前記針を保持し、
前記中間管状部材が前記外側管状部材内で相対的に遠位に変位するとき、前記ラッチタブが前記捕捉凹部から外れる、
ことを特徴とする、請求項1に記載の針捕捉装置。 - さらに、
鋭利先端部と前記先端部に近接する捕捉凹部とを有する針と、前記針に固定された一端を有する縫合糸とを含む、外科用針アセンブリを備え、
前記針アセンブリが、前記先端部を先頭とする向きで前記ハウジングの中へ導入されるとき、前記針の先端部が、前記内側管状部材の前記遠位端内において中心に配置され、
前記ハウジングが、外面と、前記外面の周りに放射状に配列されたフライトとスペースの交互の配列体を含み、前記スペースの幅が、前記スペースを長手方向に貫通する縫合糸を受け入れる大きさを持つ、
ことを特徴とする、請求項1に記載の針捕捉装置。 - 外科用針と共に使用される内視鏡針交換システムであって、
a)近位端と、円周を形成する遠位端と、第1直径及び遠位端を持つ器具チャネルとを有する内視鏡であって、前記内視鏡が、体外から操作しながら哺乳類の体内の自然孔の中へ挿入されるサイズを持つ、内視鏡と、
b)針捕捉装置と、
を備え、
前記針捕捉装置は、
i)近位端と遠位端とを有する可撓性管状部材と、
ii)近位端と遠位端とを有する可撓性シャフトであって、前記シャフトが前記管状部材を貫通する、可撓性シャフトと、
iii)前記シャフト及び管状部材を相互に対して長手方向へ変位するための近位ハンドルと、
iv)前記可撓性管状部材の前記遠位端に固定された近位端と、遠位端と、内部と、外面と、前記外面の周りに放射状に配列されたフライト及びスペースの交互の配列体とを有するハウジングであって、前記ハウジングを前記器具チャネルと同軸の向きにするように前記フライトが前記器具チャネルの前記遠位端内にぴったりと受け入れられる寸法を持つ、ハウジングと、
v)前記可撓性シャフトに連結された第1要素と前記可撓性管状部材に連結された第2要素とを有する、前記ハウジングの前記内部内の捕捉機構であって、前記第1及び第2要素の第1形態において、前記捕捉機構が提供される前記針を前記器具チャネルの前記遠位端の中に受け入れ前記針を保持し、前記第1及び第2要素の第2形態において、前記捕捉機構が前記針を前記器具チャネルから解除する、捕捉機構と、
を備えることを特徴とする、
内視鏡針交換システム。 - 前記第2形態において、前記第1及び第2要素が前記第1形態に対して長手方向に変位することを特徴とする、請求項7に記載の針交換システム。
- 前記捕捉機構が、
A)前記可撓性管状部材の前記遠位端に固定された近位端と、前記ハウジングの前記遠位端に固定された遠位端と、外側管状体の内部へ向かって塑性変形した少なくとも1つの連結タブと、前記外科用針の捕捉凹部と係合するために前記外側管状体の内部へ向かって塑性変形したラッチタブと、前記ラッチタブから近位方向へ変位しかつ前記外側管状体の内部へ延びるラッチ解除タブとを有する剛性外側管状部材であって、前記ラッチ解除タブが半径方向外向きに弾性的に移動して、前記ラッチタブを半径方向外向きに変位させる、剛性外側管状部材と、
B)前記外側管状部材内に同軸的に設置された剛性中間管状部材であって、前記中間管状部材が、前記可撓性シャフトの前記遠位端に固定された近位端と、遠位端と、前記近位端と遠位端との間に延在する壁と、前記近位端と前記遠位端との間の前記壁に形成された少なくとも1つの長手方向に延びるスロットとを有する、剛性中間管状部材と、
C)前記中間管状部材内に同軸的に設置された剛性内側管状部材であって、前記内側管状部材が近位端と遠位端を有し、少なくとも1つの連結スロットを形成する、剛性内側管状部材と、
を備え、
前記中間管状部材の前記少なくとも1つの長手方向に延びるスロットの各々が、前記内側管状部材の前記少なくとも1つの連結スロットの長さより長く、
前記少なくとも1つの連結タブが塑性変形して、前記中間管状部材の前記少なくとも1つの長手方向に延びるスロットを通過して前記少なくとも1つの連結スロットの中へ延びて、前記外側管状部材に対する前記内側管状部材の位置を固定しながら、前記近位ハンドルの操作に反応して前記中間管状部材が前記外側管状部材及び内側管状部材に対して長手方向へ変位できるようにし、
前記外側管状部材内において前記中間管状部材を長手方向に遠位へ移動させるための前記近位ハンドルの操作によって、前記中間管状部材の一部が前記ラッチ解除タブを半径方向外向きに弾性的に移動させて、前記ラッチタブを半径方向外向きに変位させる、
ことを特徴とする、
請求項7に記載の針交換システム。 - さらに、
鋭利先端部と前記先端部に近接する捕捉凹部を有する前記外科用針と、前記針に固定された一端を有する縫合糸とを備え、
前記針が先端部を先頭とする向きで前記ハウジングに導入されたとき、前記針の先端部が前記内側管状部材の前記遠位端内の中心に配置され、
前記ラッチタブを前記捕捉凹部から解除する、
ことを特徴とする、請求項9に記載の針交換システム。 - 外科用針と共に使用される内視鏡針システムであって、
a)ハンドルを持つ近位端と、円周を形成する遠位端と、第1長さ及び第1直径を持つ器具チャネルと、を有する内視鏡であって、前記内視鏡が、体外から操作しながら、哺乳類の体内の自然孔の中へ挿入される大きさを持つ、内視鏡と、
b)針捕捉装置であって、
i)近位端と遠位端とを有する可撓性管状部材と、
ii)近位端と遠位端とを有する可撓性シャフトであって、前記シャフトが前記管状部材を貫通する、可撓性シャフトと、
iii)前記シャフト及び管状部材を相互に対して長手方向へ変位させるための近位ハンドルと、
を備える、針捕捉装置と、
を備え、
前記針捕捉装置が、更に、
iv)前記可撓性管状部材の前記遠位端に固定された近位端と、遠位端と、内部と、ハウジングが前記器具チャネルと同軸の向きになるように前記器具チャネルの前記遠位端内にぴったりと受け入れられる寸法を持つ外面と、を有する前記ハウジングと、
v)前記可撓性シャフトに連結された第1要素と前記可撓性管状部材に連結された第2要素とを有する、前記ハウジングの前記内部内の捕捉機構であって、前記第1及び第2要素が互いに同軸に配置されており、前記第1及び第2要素の第1形態において、前記捕捉機構が提供された前記針を前記器具チャネルの前記遠位端の中に受け入れ前記針を保持し、前記第1及び第2要素の第2形態において、前記捕捉機構が前記針を前記器具チャネルから解除する、捕捉機構と、
を備え、
前記可撓性シャフト及び前記可撓性管状部材の前記長さが、前記針捕捉装置が前記内視鏡の前記器具チャネルの中へ完全に挿入されたとき、前記器具チャネルの前記遠位端から突出することなく前記ハウジングの前記遠位端を前記器具チャネルの前記遠位端内に配置するように選択される、
ことを特徴とする、内視鏡針システム。 - 前記ハウジングが、外面と、前記外面の周りに放射状に配列されたフライト及びスペースの交互の配列体とを含むことを特徴とする、請求項11に記載の内視鏡針システム。
- さらに、
鋭利先端部と前記先端部に近接する捕捉凹部を有する前記外科用針と、前記針に固定された一端を有する縫合糸と、
を備える、請求項11に記載の内視鏡針システム。 - 前記捕捉機構が、
A)前記可撓性管状部材の前記遠位端に固定された近位端と、前記ハウジングの前記遠位端に固定された遠位端と、外側管状体の内部へ向かって塑性変形した少なくとも1つの連結タブと、前記外科用針の捕捉凹部と係合するために前記外側管状体の内部へ向かって塑性変形したラッチタブと、前記ラッチタブから近位方向へ変位しかつ前記外側管状体の内部へ延びるラッチ解除タブとを有する剛性外側管状部材であって、前記ラッチ解除タブを半径方向外向きに弾性的に移動させることによって前記ラッチタブを半径方向外向きに変位できる、剛性外側管状部材と、
B)前記外側管状部材内に同軸的に設置された剛性中間管状部材であって、前記中間管状部材が、前記可撓性シャフトの前記遠位端に固定された近位端と、遠位端と、前記近位端と遠位端との間に延在する壁と、前記近位端と前記遠位端との間の前記壁に形成された少なくとも1つの長手方向に延びるスロットと、を有する、剛性中間管状部材と、
C)前記中間管状部材内に同軸的に設置された剛性内側管状部材であって、前記内側管状部材が、遠位端と近位端とを有し、少なくとも1つの連結スロットを形成する、剛性内側管状部材と、
を含み、
前記中間管状部材の前記少なくとも1つの長手方向に延びるスロットの各々が、前記内側管状部材の前記少なくとも1つの連結スロットの長さより長く、
前記少なくとも1つの連結タブが塑性変形して、前記中間管状部材の前記少なくとも1つの長手方向へ延びるスロットを通過して前記少なくとも1つの連結スロットの中へ延びて、前記外側管状部材に対して前記内側管状部材の位置を固定しながら、前記近位ハンドルの操作に反応して前記外側及び内側管状部材に対して前記中間管状部材が長手方向へ変位できるようにし、
前記外側管状部材内で前記中間管状部材を長手方向に遠位へ変位させるための前記近位ハンドルの操作によって、前記中間管状部材の一部が前記ラッチ解除タブを半径方向外向きに弾性的に移動させて、前記ラッチタブを半径方向外向きに変位させる、
ことを特徴とする、請求項11に記載の内視鏡針システム。
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