JP6759228B2 - 外科用器具を作動させるための方法及び装置 - Google Patents
外科用器具を作動させるための方法及び装置 Download PDFInfo
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- 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
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- A61B17/295—Forceps for use in minimally invasive surgery combined with cutting implements
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
- A61B2017/291—Handles the position of the handle being adjustable with respect to the shaft
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
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- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
- A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
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- A—HUMAN NECESSITIES
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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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- A61B2017/2926—Details of heads or jaws
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- 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
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- 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
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- Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
- Y10T29/00—Metal working
- Y10T29/49—Method of mechanical manufacture
- Y10T29/49826—Assembling or joining
- Y10T29/49863—Assembling or joining with prestressing of part
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Description
(1) 作動機構が連結されているハンドルと、
前記ハンドルから遠位側に延在するシャフトアセンブリであって、前記シャフトアセンブリは、内腔を画定する細長い外殻を含み、前記シャフトアセンブリは、前記内腔内で長手方向に延在する第1及び第2の細長部材を含む、シャフトアセンブリと、
前記シャフトアセンブリの遠位端に連結されたエンドエフェクタと、を備え、
前記作動機構は、第1の力を前記第1及び第2の細長部材のうち一方に付与させることによって前記第1及び第2の細長部材のうち前記一方を前記内腔内で近位側かつ長手方向に摺動可能に移動させることと、第2の力を前記第1及び第2の細長部材のうち他方に付与させることによって前記第1及び第2の細長部材のうち前記他方を前記内腔内で遠位側かつ長手方向に摺動可能に移動させることと、を同時に行うようにユーザによって作動されるように構成され、前記第1及び第2の細長部材の前記移動は、前記エンドエフェクタの関節動作を引き起こす、外科用装置。
(2) 前記シャフトアセンブリは、第1及び第2の細長チューブを含み、前記第1の細長部材は、前記第1の細長チューブ内で、前記第1の細長チューブに対して固定位置に位置付けられ、前記第2の細長部材は、前記第2の細長チューブ内で、前記第2の細長チューブに対して固定位置に位置付けられ、前記作動機構は、前記作動機構の前記作動に応じて前記第1及び第2の細長チューブを動かすことによって前記第1及び第2の細長部材の前記移動を引き起こすように構成されている、実施態様1に記載の装置。
(3) 前記第1の細長部材は、溶接及び圧着のうち一方によって前記第1の細長チューブに取り付けられ、前記第2の細長部材は、溶接及び圧着のうち一方によって前記第2の細長チューブに取り付けられている、実施態様2に記載の装置。
(4) 前記外科用装置のデフォルト状態の前記第1及び第2の細長チューブは、遠位方向に張力付与され、前記デフォルト状態の前記第1及び第2の細長部材は、近位方向に張力付与されている、実施態様2に記載の装置。
(5) 第1及び第2の安定化部材を更に備え、前記第1の安定化部材は、前記第1の細長チューブに取り付けられ、前記第2の安定化部材は、前記第2の細長チューブに取り付けられ、前記作動機構の前記作動は、前記第1の安定化部材を長手方向に移動させることによって前記第1の細長部材の前記長手方向の移動を引き起こすことと、前記第2の安定化部材を長手方向に移動させることによって前記第2の細長部材の前記長手方向の移動を引き起こすことと、を同時に行うように構成されている、実施態様2に記載の装置。
(7) 前記第1の細長部材は、第1の細長い剛性ロッドを含み、前記第2の細長部材は、第2の細長い剛性ロッドを含む、実施態様1に記載の装置。
(8) 前記シャフトアセンブリは、前記第1の細長い剛性ロッドの遠位端に取り付けられた近位端を有する第1の細長い可撓性バンドを含み、前記第2の細長部材は、前記第2の細長い剛性ロッドの遠位端に取り付けられた近位端を有する第2の細長い可撓性バンドを含み、前記第1及び第2の細長い可撓性バンドは、前記エンドエフェクタの前記関節動作の間、屈曲するように構成されている、実施態様7に記載の装置。
(9) 第1及び第2の安定化部材を更に備え、前記第1の安定化部材は、溶接、圧着及び締り嵌めのうち1つによって前記第1の細長部材に取り付けられ、前記第2の安定化部材は、溶接、圧着及び締り嵌めのうち1つによって前記第2の細長部材に取り付けられ、前記作動機構の前記作動は、前記第1の安定化部材を長手方向に移動させることによって前記第1の細長部材の前記長手方向の移動を引き起こすことと、前記第2の安定化部材を長手方向に移動させることによって前記第2の細長部材の前記長手方向の移動を引き起こすことと、を同時に行うように構成されている、実施態様1に記載の装置。
(10) 前記シャフトアセンブリの遠位部分において屈曲領域を更に含み、前記シャフトアセンブリは、前記屈曲領域で屈曲し、前記エンドエフェクタを関節動作させるように構成されている、実施態様1に記載の装置。
(12) 前記作動機構は、第1及び第2のドラムを含み、前記第1のドラムは、前記第1の細長部材に連結され、前記第2のドラムは、前記第2の細長部材に連結され、前記作動機構の前記作動は、前記第1のドラムを第1の方向に動かすことによって前記第1の力を付与して前記第1の細長部材の前記長手方向の移動を引き起こすことと、前記第2のドラムを第2の方向に動かすことによって前記第2の力を付与して前記第2の細長部材の前記長手方向の移動を引き起こすことと、を同時に行うように構成され、前記第2の方向は、前記第1の方向とは反対である、実施態様1に記載の装置。
(13) 前記作動機構は、前記長手方向軸線を中心として360°連続回転するように構成され、
前記作動機構の前記360°の連続回転の間、前記第1及び第2の細長部材のうち一方がまず、前記内腔内で近位側かつ長手方向に移動するように構成され、前記第1及び第2の細長部材のうち他方が、前記内腔内で遠位側かつ長手方向に移動するように構成され、次いで、前記第1及び第2の細長部材のうち一方が、前記内腔内で遠位側かつ長手方向に移動するように構成され、前記第1及び第2の細長部材のうち他方が、前記内腔内で近位側かつ長手方向に移動するように構成されている、実施態様12に記載の装置。
(14) 休止状態の前記第1及び第2の細長部材は、非ゼロ荷重で張力付与されている、実施態様1に記載の装置。
(15) 前記作動機構は、回転可能ノブ、摺動可能レバー及び可動ハンドルのうち1つを含む、実施態様1に記載の装置。
前記第1の細長部材を前記シャフトアセンブリの第1のチューブの第1の通路の中へと前進させることと、
前記第1の細長部材を前記エンドエフェクタに連結させることと、
前記第1の細長部材が前記エンドエフェクタに連結された状態で、前記第1の通路内において、前記第1のチューブが前記作動機構を近位側に押し、かつ前記第1の細長部材及び前記第1のチューブが同時に張力付与されるように、前記第1の細長部材を遠位方向に張力付与し、前記第1のチューブを近位方向に張力付与することと、
前記張力付与された第1の細長部材及び前記張力付与された第1のチューブが互いに対して固定位置にあるように、前記張力付与された第1の細長部材を前記張力付与された第1のチューブに取り付けることと、
前記第2の細長部材を前記シャフトアセンブリの第2のチューブの第2の通路の中へと前進させることと、
前記第2の細長部材を前記エンドエフェクタに連結させることと、
前記第2の細長部材が前記エンドエフェクタに連結された状態で、前記第2の通路内において、前記第2のチューブが前記作動機構を近位側に押し、かつ前記第2の細長部材及び前記第2のチューブが同時に張力付与されるように、前記第2の細長部材を前記遠位方向に張力付与すること及び前記第2のチューブを前記近位方向に張力付与することを同時に行うことと、
前記張力付与された第2の細長部材及び前記張力付与された第2のチューブが互いに対して固定位置にあるように、前記張力付与された第2の細長部材を前記張力付与された第2のチューブに取り付けることと、を含む、方法。
(17) 前記第1の細長部材及び前記第1のチューブの前記同時の張力付与に先立って、第1の細長い可撓性バンドの近位端を前記第1の細長部材の遠位端に取り付けることと、
前記第2の細長部材及び前記第2のチューブの前記同時の張力付与に先立って、第2の細長い可撓性バンドの近位端を前記第2の細長部材の遠位端に取り付けることと、
前記第1の細長い可撓性バンドの遠位端を前記エンドエフェクタに取り付けることと、
前記第2の細長い可撓性バンドの遠位端を前記エンドエフェクタに取り付けることと、を更に含む、実施態様16に記載の方法。
(18) 作動機構と、
内腔を画定する細長い外殻を含むシャフトアセンブリであって、前記シャフトアセンブリは、前記内腔内で長手方向に延在する第1の剛性細長部材を含み、前記シャフトアセンブリは、前記内腔内で長手方向に延在する第1の可撓性細長部材を含み、前記第1の可撓性細長部材は、前記第1の剛性細長部材の遠位端に取り付けられた近位端を有する、シャフトアセンブリと、
前記第1の可撓性細長部材の遠位端に取り付けられたエンドエフェクタと、を備え、
前記作動機構は、前記第1の剛性細長部材及び前記第1の可撓性細長部材を前記内腔内で長手方向に摺動可能に移動させるように、ユーザによって作動されるように構成され、前記第1の剛性細長部材及び前記第1の可撓性細長部材の前記移動により、前記エンドエフェクタが作動し、前記エンドエフェクタの前記作動は、開放位置と閉鎖位置との間で前記エンドエフェクタを動かすことと、前記エンドエフェクタを関節動作させることと、前記エンドエフェクタに沿って切断要素を移動させることと、のうち1つを含む、外科用装置。
(19) 外科用装置を組み立てる方法であって、
第1の管状部材を通って延在する第1の内腔内で第1の細長部材の位置を摺動可能に調節することと、
第2の管状部材を通って延在する第2の内腔内で第2の細長部材の位置を摺動可能に調節することと、
エンドエフェクタを前記第1及び第2の細長部材に連結させることであって、前記エンドエフェクタは、組織を操作するように構成されている、ことと、
作動機構を前記第1及び第2の管状部材に連結させることと、
前記第1の細長部材の前記位置を調節した後、第1の引張荷重を得るために、前記第1の細長部材を前記エンドエフェクタに連結させ、作動機構を前記第1及び第2の管状部材に連結させ、前記第1の細長部材を近位方向に動かし、前記第1の管状部材を遠位方向に動かすことと、
前記得られた第1の引張荷重において、前記第1の細長部材及び前記第1の管状部材を互いに対して固定位置に固定することと、
前記第2の細長部材の前記位置を調節した後、第2の引張荷重を得るために、前記第2の細長部材を前記エンドエフェクタに連結させ、作動機構を前記第1及び第2の管状部材に連結させ、前記第2の細長部材を前記近位方向に動かし、前記第2の管状部材を前記遠位方向に動かすことと、
前記得られた第2の引張荷重において、前記第2の細長部材及び前記第2の管状部材を互いに対して固定位置に固定することと、を含み、前記第1及び第2の管状部材に連結された前記作動機構は、前記第1の細長部材及び前記第1のチューブを一体として前記近位方向及び前記遠位方向のうち一方に動かし、かつ前記第2の細長部材及び前記第2のチューブを一体として前記近位方向及び前記遠位方向のうち他方に動かすことによって前記エンドエフェクタの関節動作を引き起こすように、選択的に作動されるように構成されている、方法。
(20) 前記第1の細長部材及び前記第1の管状部材を互いに対して前記固定位置に固定することは、前記第1の細長部材及び前記第1の管状部材を共に圧着することと、前記第1の細長部材及び前記第1の管状部材を共に溶接することと、のうち一方を含む、実施態様19に記載の方法。
前記第1の可撓性バンドの遠位端を前記エンドエフェクタに固定することと、
第2の剛性ロッドの遠位端を第2の可撓性バンドの近位端に固定して、前記第2の細長部材を形成することと、
前記第2の可撓性バンドの遠位端を前記エンドエフェクタに固定することと、を更に含み、前記第1のバンドは、前記第1の細長部材及び前記第1のチューブと共に一体として前記近位方向及び前記遠位方向のうち前記一方に動くように構成され、前記第2のバンドは、前記第2の細長部材及び前記第2のチューブと共に一体として前記近位方向及び前記遠位方向のうち前記他方に動くように構成されている、実施態様19に記載の方法。
Claims (15)
- 作動機構が連結されているハンドルと、
前記ハンドルから遠位側に延在するシャフトアセンブリであって、前記シャフトアセンブリは、内腔を画定する細長い外殻を含み、前記シャフトアセンブリは、前記内腔内で長手方向に延在する第1及び第2の細長部材を含む、シャフトアセンブリと、
前記シャフトアセンブリの遠位端に連結されたエンドエフェクタと、を備え、
前記作動機構は、第1の力を前記第1及び第2の細長部材のうち一方に付与させることによって前記第1及び第2の細長部材のうち前記一方を前記内腔内で近位側かつ長手方向に摺動可能に移動させることと、第2の力を前記第1及び第2の細長部材のうち他方に付与させることによって前記第1及び第2の細長部材のうち前記他方を前記内腔内で遠位側かつ長手方向に摺動可能に移動させることと、を同時に行うようにユーザによって作動されるように構成され、前記第1及び第2の細長部材の前記移動は、前記エンドエフェクタの関節動作を引き起こし、
前記シャフトアセンブリは、第1及び第2の細長チューブを含み、前記第1の細長部材は、前記第1の細長チューブ内で、前記第1の細長チューブに対して固定位置に位置付けられ、前記第2の細長部材は、前記第2の細長チューブ内で、前記第2の細長チューブに対して固定位置に位置付けられ、前記作動機構は、前記作動機構の前記作動に応じて前記第1及び第2の細長チューブを動かすことによって前記第1及び第2の細長部材の前記移動を引き起こすように構成されている、外科用装置。 - 前記第1の細長部材は、溶接及び圧着のうち一方によって前記第1の細長チューブに取り付けられ、前記第2の細長部材は、溶接及び圧着のうち一方によって前記第2の細長チューブに取り付けられている、請求項1に記載の装置。
- 前記外科用装置のデフォルト状態の前記第1及び第2の細長チューブは、遠位方向に張力付与され、前記デフォルト状態の前記第1及び第2の細長部材は、近位方向に張力付与されている、請求項1に記載の装置。
- 第1及び第2の安定化部材を更に備え、前記第1の安定化部材は、前記第1の細長チューブに取り付けられ、前記第2の安定化部材は、前記第2の細長チューブに取り付けられ、前記作動機構の前記作動は、前記第1の安定化部材を長手方向に移動させることによって前記第1の細長部材の前記長手方向の移動を引き起こすことと、前記第2の安定化部材を長手方向に移動させることによって前記第2の細長部材の前記長手方向の移動を引き起こすことと、を同時に行うように構成されている、請求項1に記載の装置。
- 第2の作動機構を更に備え、前記第2の作動機構は、前記第1及び第2の安定化部材を前記細長い外殻の長手方向軸線を中心として回転させて、前記エンドエフェクタを前記長手方向軸線を中心として回転させるように、前記ユーザによって作動されるように構成されている、請求項4に記載の装置。
- 作動機構が連結されているハンドルと、
前記ハンドルから遠位側に延在するシャフトアセンブリであって、前記シャフトアセンブリは、内腔を画定する細長い外殻を含み、前記シャフトアセンブリは、前記内腔内で長手方向に延在する第1及び第2の細長部材を含む、シャフトアセンブリと、
前記シャフトアセンブリの遠位端に連結されたエンドエフェクタと、を備え、
前記作動機構は、第1の力を前記第1及び第2の細長部材のうち一方に付与させることによって前記第1及び第2の細長部材のうち前記一方を前記内腔内で近位側かつ長手方向に摺動可能に移動させることと、第2の力を前記第1及び第2の細長部材のうち他方に付与させることによって前記第1及び第2の細長部材のうち前記他方を前記内腔内で遠位側かつ長手方向に摺動可能に移動させることと、を同時に行うようにユーザによって作動されるように構成され、前記第1及び第2の細長部材の前記移動は、前記エンドエフェクタの関節動作を引き起こし、
前記第1の細長部材は、第1の細長い剛性ロッドを含み、前記第2の細長部材は、第2の細長い剛性ロッドを含む、外科用装置。 - 前記シャフトアセンブリは、前記第1の細長い剛性ロッドの遠位端に取り付けられた近位端を有する第1の細長い可撓性バンドを含み、前記第2の細長部材は、前記第2の細長い剛性ロッドの遠位端に取り付けられた近位端を有する第2の細長い可撓性バンドを含み、前記第1及び第2の細長い可撓性バンドは、前記エンドエフェクタの前記関節動作の間、屈曲するように構成されている、請求項6に記載の装置。
- 第1及び第2の安定化部材を更に備え、前記第1の安定化部材は、溶接、圧着及び締り嵌めのうち1つによって前記第1の細長部材に取り付けられ、前記第2の安定化部材は、溶接、圧着及び締り嵌めのうち1つによって前記第2の細長部材に取り付けられ、前記作動機構の前記作動は、前記第1の安定化部材を長手方向に移動させることによって前記第1の細長部材の前記長手方向の移動を引き起こすことと、前記第2の安定化部材を長手方向に移動させることによって前記第2の細長部材の前記長手方向の移動を引き起こすことと、を同時に行うように構成されている、請求項1に記載の装置。
- 作動機構が連結されているハンドルと、
前記ハンドルから遠位側に延在するシャフトアセンブリであって、前記シャフトアセンブリは、内腔を画定する細長い外殻を含み、前記シャフトアセンブリは、前記内腔内で長手方向に延在する第1及び第2の細長部材を含む、シャフトアセンブリと、
前記シャフトアセンブリの遠位端に連結されたエンドエフェクタと、を備え、
前記作動機構は、第1の力を前記第1及び第2の細長部材のうち一方に付与させることによって前記第1及び第2の細長部材のうち前記一方を前記内腔内で近位側かつ長手方向に摺動可能に移動させることと、第2の力を前記第1及び第2の細長部材のうち他方に付与させることによって前記第1及び第2の細長部材のうち前記他方を前記内腔内で遠位側かつ長手方向に摺動可能に移動させることと、を同時に行うようにユーザによって作動されるように構成され、前記第1及び第2の細長部材の前記移動は、前記エンドエフェクタの関節動作を引き起こし、
前記シャフトアセンブリの遠位部分において屈曲領域を更に含み、前記シャフトアセンブリは、前記屈曲領域で屈曲し、前記エンドエフェクタを関節動作させるように構成されており、
前記第1の細長部材は、第1の細長い剛性ロッドを含み、前記第2の細長部材は、第2の細長い剛性ロッドを含み、前記シャフトアセンブリは、それぞれ前記屈曲領域にまたがる第1及び第2の細長い可撓性バンドを含み、前記第1の細長いバンドは、前記第1の細長い剛性ロッドの遠位端に取り付けられた近位端を有し、前記第2の細長部材は、前記第2の細長い剛性ロッドの遠位端に取り付けられた近位端を有する第2の細長い可撓性バンドを含み、前記第1及び第2の細長い可撓性バンドは、前記エンドエフェクタの前記関節動作の間、前記屈曲領域で屈曲するように構成されている、外科用装置。 - 作動機構が連結されているハンドルと、
前記ハンドルから遠位側に延在するシャフトアセンブリであって、前記シャフトアセンブリは、内腔を画定する細長い外殻を含み、前記シャフトアセンブリは、前記内腔内で長手方向に延在する第1及び第2の細長部材を含む、シャフトアセンブリと、
前記シャフトアセンブリの遠位端に連結されたエンドエフェクタと、を備え、
前記作動機構は、第1の力を前記第1及び第2の細長部材のうち一方に付与させることによって前記第1及び第2の細長部材のうち前記一方を前記内腔内で近位側かつ長手方向に摺動可能に移動させることと、第2の力を前記第1及び第2の細長部材のうち他方に付与させることによって前記第1及び第2の細長部材のうち前記他方を前記内腔内で遠位側かつ長手方向に摺動可能に移動させることと、を同時に行うようにユーザによって作動されるように構成され、前記第1及び第2の細長部材の前記移動は、前記エンドエフェクタの関節動作を引き起こし、
前記作動機構は、第1及び第2のドラムを含み、前記第1のドラムは、前記第1の細長部材に連結され、前記第2のドラムは、前記第2の細長部材に連結され、前記作動機構の前記作動は、前記第1のドラムを第1の方向に動かすことによって前記第1の力を付与して前記第1の細長部材の前記長手方向の移動を引き起こすことと、前記第2のドラムを第2の方向に動かすことによって前記第2の力を付与して前記第2の細長部材の前記長手方向の移動を引き起こすことと、を同時に行うように構成され、前記第2の方向は、前記第1の方向とは反対である、外科用装置。 - 前記作動機構は、前記長手方向の軸線を中心として360°連続回転するように構成され、
前記作動機構の前記360°の連続回転の間、前記第1及び第2の細長部材のうち一方がまず、前記内腔内で近位側かつ長手方向に移動するように構成され、前記第1及び第2の細長部材のうち他方が、前記内腔内で遠位側かつ長手方向に移動するように構成され、次いで、前記第1及び第2の細長部材のうち一方が、前記内腔内で遠位側かつ長手方向に移動するように構成され、前記第1及び第2の細長部材のうち他方が、前記内腔内で近位側かつ長手方向に移動するように構成されている、請求項10に記載の装置。 - 休止状態の前記第1及び第2の細長部材は、非ゼロ荷重で張力付与されている、請求項1に記載の装置。
- 前記作動機構は、回転可能ノブ、摺動可能レバー及び可動ハンドルのうち1つを含む、請求項1に記載の装置。
- 請求項1に記載の外科用装置を組み立てる方法であって、前記方法は、
前記第1の細長部材を前記シャフトアセンブリの第1のチューブの第1の通路の中へと前進させることと、
前記第1の細長部材を前記エンドエフェクタに連結させることと、
前記第1の細長部材が前記エンドエフェクタに連結された状態で、前記第1の通路内において、前記第1のチューブが前記作動機構を近位側に押し、かつ前記第1の細長部材及び前記第1のチューブが同時に張力付与されるように、前記第1の細長部材を遠位方向に張力付与し、前記第1のチューブを近位方向に張力付与することと、
前記張力付与された第1の細長部材及び前記張力付与された第1のチューブが互いに対して固定位置にあるように、前記張力付与された第1の細長部材を前記張力付与された第1のチューブに取り付けることと、
前記第2の細長部材を前記シャフトアセンブリの第2のチューブの第2の通路の中へと前進させることと、
前記第2の細長部材を前記エンドエフェクタに連結させることと、
前記第2の細長部材が前記エンドエフェクタに連結された状態で、前記第2の通路内において、前記第2のチューブが前記作動機構を近位側に押し、かつ前記第2の細長部材及び前記第2のチューブが同時に張力付与されるように、前記第2の細長部材を前記遠位方向に張力付与すること及び前記第2のチューブを前記近位方向に張力付与することを同時に行うことと、
前記張力付与された第2の細長部材及び前記張力付与された第2のチューブが互いに対して固定位置にあるように、前記張力付与された第2の細長部材を前記張力付与された第2のチューブに取り付けることと、を含む、方法。 - 前記第1の細長部材及び前記第1のチューブの前記同時の張力付与に先立って、第1の細長い可撓性バンドの近位端を前記第1の細長部材の遠位端に取り付けることと、
前記第2の細長部材及び前記第2のチューブの前記同時の張力付与に先立って、第2の細長い可撓性バンドの近位端を前記第2の細長部材の遠位端に取り付けることと、
前記第1の細長い可撓性バンドの遠位端を前記エンドエフェクタに取り付けることと、
前記第2の細長い可撓性バンドの遠位端を前記エンドエフェクタに取り付けることと、を更に含む、請求項14に記載の方法。
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