JP7167054B2 - 超弾性医療機器 - Google Patents
超弾性医療機器 Download PDFInfo
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- JP7167054B2 JP7167054B2 JP2019554590A JP2019554590A JP7167054B2 JP 7167054 B2 JP7167054 B2 JP 7167054B2 JP 2019554590 A JP2019554590 A JP 2019554590A JP 2019554590 A JP2019554590 A JP 2019554590A JP 7167054 B2 JP7167054 B2 JP 7167054B2
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/005—Flexible endoscopes
- A61B1/0051—Flexible endoscopes with controlled bending of insertion part
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- A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
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- A61B1/0058—Flexible endoscopes using shape-memory elements
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- A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
- A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
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- A61B1/2676—Bronchoscopes
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- A61B17/3403—Needle locating or guiding means
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- A61L2400/00—Materials characterised by their function or physical properties
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Description
は、前記針の前記遠位端から前記近位端までの長さが約4センチメートルであり、前記重なり領域の長さが約1センチメートルである。いくつかの実装では、前記針の長さが1センチメートルから6センチメートルである。いくつかの実装では、前記重なり領域の長さが0.5センチメートルから3センチメートルである。いくつかの実装では、前記ポリマーチューブの内面によって形成されるチャネルが、前記ルーメンと流体連通して前記開口を通じて圧力を与える。
行うことと、前記針の前記遠位端が前記ジャケット外に位置することを判定することと、前記針を前記生検部位に伸長させる前記針の第2の駆動を行うことと、を含む。いくつかの実装は、前記第1の駆動後であり、かつ、前記第2の駆動前に、前記重なり領域が依然として少なくとも部分的に前記ジャケット内に位置していることを判定することをさらに含む。いくつかの実装は、前記第1の駆動後であり、かつ、前記第2の駆動前に、前記重なり領域が依然として少なくとも部分的に前記内視鏡の前記ワーキングチャネル内に位置していることを判定することをさらに含む。いくつかの実装は、前記第2の駆動は、前記針の前記生検部位への伸長と前記針の前記生検部位からの後退とを交互に複数回行うことを含む。
成において、前記針の前記遠位端を前記管状のジャケットの前記遠位端を超えて最大2センチメートル前進させる。いくつかの実装では、前記針の長さが1センチメートルから6センチメートルである。いくつかの実装では、前記重なり領域の長さが0.5センチメートルから3センチメートルである。いくつかの実装では、前記ポリマーチューブの近位端に連結された圧力源をさらに有し、前記ロボットシステムは、前記針の前記ルーメンと流体連通する前記ポリマーチューブの内面によって形成されるチャネルを介して、前記針の前記遠位端の前記開口を通じて圧力を提供する。
位置する放射線不透過性材料をさらに有する。いくつかの実装では、前記放射線不透過性材料は、金バンドを有する。いくつかの実装では、前記放射線不透過性材料の厚さは、少なくとも200マイクロインチである。
延伸するルーメンを形成する内面を有し、前記ルーメンおよび前記開口が組織の生検試料を採取するよう構成されている、針を有する。
医療手技は、例えば患者の体内に挿入されたチャネル(例えば、トロカール、カテーテル、内視鏡など)を通して配置された、オペレータから遠隔に配置された器具の操作を伴い得る。こうした手技の一例として、経気管支針生検(Transbronchial Needle Aspiration;TBNA)が、肺がんなどの気管支疾患の診断やステージ特定を目的とした低侵襲の気管支鏡手法として用いることができる。TBNA法には、軟性の気管支鏡を経由した生検針の操作が含まれることがある。例えば、術者は、胸部スキャンを用いて生検対象の腫瘤の位置を特定し、患者の気道内の気管支鏡の位置を腫瘤に向けてガイドすることができる。気管支鏡のワーキングチャネルの遠位端が気道内の特定した腫瘤に近接する位置に移動した後、生検針を備えた長尺管状のジャケットがワーキングチャネルを通って採取領域に到達される。そして、ジャケットから針が伸びて対象の組織に穿刺され、試料の採取の補助として吸引が用いられる。通常は、吸引を行う場合は、針に備わる管の遠位端を手で把持して、気管支鏡に対して管を前後に手動で動かして組織の部位を針で繰り返し刺す。試料の採取後は、針はジャケット内へと後退され、ワーキングチャネルから回収される。一部の手技では、TBNA手技と同じ室内で試料分析が行われ、分析結果に応じて追加のTBNAによる試料採取および/または他の組織の採取や治療を行うこともできる。
性気管支鏡と共に針を使用する上での課題は、針が目標の組織部位への気管支鏡の湾曲した経路内を操作可能なほど柔軟であるとともに、直線的に展開して目標の組織への貫入を可能にするほど硬質でもあるべきことであり、さらに、針が好ましくは肺周囲に達するのに十分な距離にわたって直線軌道で展開することである。
することができる。
図1Aおよび図1Bは、本明細書に述べるような超弾性針120の実施形態を示す。図1Aは、針アセンブリ100の2つの構成要素、超弾性針120と、針120に連結された長尺のシャフト110とを示す。
mまでの遠位端125の延出中にスコープ内にとどまる「アンカ」部を提供するために、針を例えば5cm~6cmなどより長くすることができる。これにより、有益には目標の組織部位への針の直線的な展開に安定性を与えることができる。したがって、種々の実施形態では、重なり領域130は、長さ2~3cmとすることができ、スコープのワーキングチャネル内にとどまるように意図されたアンカ部を形成することができ、重なり領域120を越えて遠位に延出する針120の部分は長さ約3cm~4cmとすることができる。
成されている。先鋭先端140は、1つのゾーン144が第1の角度で平らに研削され、第2のゾーン142が異なる角度で平らに研削された、ランセット設計を含む。第2のゾーン142は、針120の全直径と交わる先鋭先端140の端部への直線傾斜をもたらす。針120の直径は、放射線不透過性材料123の位置で再び増加する。
つかの実施形態では、針220の露出部分250は、ジャケット225と同一平面上に位置することができ、すなわち、重なり領域215の遠位縁245がジャケット225の遠位端235に位置することができる。図2Cに示すように、また図3Cに関して以下でさらに詳細に論じるように、重なり領域215は、針の完全露出長250がジャケットの遠位端235を越えて延出したときでも、ジャケット225がスコープ内に位置した状態で、針220が依然としてジャケット225の中央に配置され、したがってスコープのワーキングチャネルの中央に配置されそれに固定されるのを助けることができる。針220は、シャフト210の遠位移動によって部分的に延出した形態205Bから完全に延出した形態205Cに駆動させることができ、シャフト210の近位移動によって完全に延出した形態205Cから部分的に延出した形態205Bに駆動させることができる。
コープを通って急な湾曲部を通り抜け、スコープのワーキングチャネルから延出しながら長手方向軸に沿って依然として実質的に直線的に展開することが可能となる。こうした展開により、予め特定した目標の組織領域のサンプリングに関する精度が向上する。
々なプルワイヤまたは作動ケーブルへの張力の値を変化させることができる。例えば図6に関して以下でより詳細に論じるようなロボット制御システムが、この張力変化を検知し、これを用いて、より大きな張力または力をある特定のプルワイヤまたは作動ケーブルに加えることによってスコープの撓みを補償することができる。いくつかの制御システム実施態様は、スコープをできるだけその非撓み位置405Aに近く保つために張力変化を補償し得る。他の制御システム実施態様は、目標の組織部位のサンプリングの許容角度を超える撓み角θに対応する所定の範囲外のどんな張力変化も補償し得る。自動制御手法の代わりに、他の実施形態は、医師によるスコープの調整に基づいて撓みを補正し得る。
る米国出願第15/937516号明細書に記載されている。駆動部材530は、以下でより詳細に説明するように、作動スリーブ520の様々な運動様式により、ハンドル505の長手方向軸に沿って直線的に駆動させることができる。針556に取り付けられたシャフト554は、例えば接着剤を介して接合することにより、駆動部材530の凹部537内に固着させることができる。したがって、駆動部材530の直線運動がシャフト554を介して針556に伝達することができ、ハンドル505の操作によってジャケット550からの針556の延出および後退を駆動することが可能になる。いくつかの実施形態では、凹部537は、ハンドル505をいくつかの異なる導管および器具と共に使用することを容易にするために、シャフト554上の対応する特徴と機械的に嵌合するように構築することができる。したがって、いくつかの実施形態では、ハンドル505は滅菌可能かつ再利用可能であり得、一方、導管、針、およびジャケットは使い捨てであり得る。種々の他の実施形態では、機器500全体が完全に滅菌可能かつ再利用可能であるか、または使い捨ての単一ユニットとして設計され得る。
図6は、本明細書に述べるような針アセンブリ605を作動させるためのロボット手術システム600の概略図を示す。針アセンブリは、ジャケット630と、針635と、針に接続された管状の長尺のシャフト640とを含み、上述の針アセンブリ200とすることができる。他の実施形態では、ロボットシステム600は代わりに、シャフト640を操作するためのハンドル、例えば図5に関して述べたようなハンドル505と連動し得る。他の実施形態は、シャフト640およびジャケット630の近位端に接合された支持部材と連動し得る。
の)プロセッサ645は、これらの命令を実行して、本明細書に述べるような安定した正確な方法で針を延出させるシステム600の動作を引き起こすことができる。例えば、(1つまたは複数の)プロセッサ645は、これらの命令を実行して、針の延出駆動中または後に、ジャケットおよびワーキングチャネル/内視鏡の一方または両方に対する針とシャフトとの間の重なり領域の位置決めをロボットシステムに監視させることができる。いくつかの実施形態では、命令は、こうした重なりをなくすことになる所定の地点を越えてロボット手術システム600が針の延出を駆動するのを防止することができる。他の実施形態では、命令は、ロボット手術システム600に、さらなる延出がこうした重なりをなくすことになるときにロボット手術システム600のオペレータに警告を与えさせることができるが、オペレータが針の延出駆動を続行することを可能とし得る。
他の超弾性医療器具を制御するために使用することができ、本明細書に述べるような任意のタイプの医療手技において使用することができる。
図7は、本明細書に述べるような針、例えば上述の針120,220,420,556,635を使用して組織試料を採取するためのプロセス700の実施形態のフローチャートを示す。プロセス700は、針に固着されたチューブを、例えば図5に示すようなハンドル505によって手動で操作する人間のオペレータ、チューブを人間のオペレータによる指示通りに機械的にもしくは自律的に操作するロボット制御システムオペレータ(上述のシステム600など)、またはそれらの組合せによって実施することができる。気管支鏡検査で組織試料を採取するために針を制御するという例示的な文脈において説明したが、他の超弾性医療器具を使用して、また本明細書に述べるような他のタイプの医療手技において、プロセス700の変形形態を実施することができることが理解されよう。
およびジャケットの遠位部の間の重なりを内視鏡のワーキングチャネル内に維持することができる。こうした重なりは、針をワーキングチャネルに対して中央に保つことによって針展開の精度を向上させることができる。
本件開示の実施態様は、超弾性針アセンブリおよびその使用方法を提供する。
でき、コンピュータによってアクセス可能な任意の他の媒体を備えることができる。コンピュータ読み取り可能媒体は、有形かつ非一時的であってもよいことに留意されたい。本明細書で使用される「コード」という用語は、コンピューティングデバイスまたはプロセッサによって実行可能なソフトウェア、命令、コード、またはデータを意味することがある。
Claims (23)
- 生検針アセンブリであって、
超弾性合金から形成される針であって、前記針は、
前記針の遠位端から前記針の近位端まで延伸する本体部と、
少なくとも前記本体部の一部を通って前記遠位端の開口まで延伸するルーメンを形成する前記針の内面であって、前記ルーメンおよび前記開口は組織の生検試料を採取するよう構成されている、内面と、
を有する針と、
前記針の前記近位端に取り付けられた長尺の部材と、
内部チャネルを有する管状のジャケットであって、
第1の構成において、前記針の前記遠位端が前記内部チャネル内に位置し、
第2の構成において、前記内部チャネルを通った前記長尺の部材の遠位端側への移動に応じて、前記針の前記遠位端が前記管状のジャケットの遠位端を超えて延伸する、
管状のジャケットと、
を有し、
前記長尺の部材は、前記針の前記近位端に位置する重なり領域の周りでリフローされたポリマーチューブを有することを特徴とするアセンブリ。 - 前記超弾性合金は、ニチノールを含むことを特徴とする請求項1に記載のアセンブリ。
- 前記針は、約0.0015インチの厚さの壁を有することを特徴とする請求項1に記載のアセンブリ。
- 前記針の前記遠位端に先鋭先端をさらに有することを特徴とする請求項1に記載のアセンブリ。
- 前記先鋭先端の近傍の前記針の周りに位置する放射線不透過性材料をさらに有することを特徴とする請求項4に記載のアセンブリ。
- 前記放射線不透過性材料は、金を含むことを特徴とする請求項5に記載のアセンブリ。
- 前記放射線不透過性材料の厚さは、少なくとも200マイクロインチであることを特徴とする請求項5に記載のアセンブリ。
- 前記ポリマーチューブは、前記重なり領域の周りでリフローされる前または後において、その遠位端に円錐部分を有することを特徴とする請求項1に記載のアセンブリ。
- 前記ポリマーチューブは、軟質熱可塑性樹脂を有することを特徴とする請求項1に記載のアセンブリ。
- 前記針の前記遠位端から前記近位端までの長さが約5センチメートルであり、前記重なり領域の長さが約2センチメートルであることを特徴とする請求項1に記載のアセンブリ。
- 前記針の前記遠位端から前記近位端までの長さが約4センチメートルであり、前記重なり領域の長さが約1センチメートルであることを特徴とする請求項1に記載のアセンブリ。
- 前記針の長さが1センチメートルから6センチメートルであることを特徴とする請求項1に記載のアセンブリ。
- 前記重なり領域の長さが0.5センチメートルから3センチメートルであることを特徴とする請求項1に記載のアセンブリ。
- 前記ポリマーチューブの内面によって形成されるチャネルが、前記ルーメンと流体連通して前記開口を通じて圧力を与えることを特徴とする請求項1に記載のアセンブリ。
- 前記重なり領域において前記針上に形成される複数の表面特徴をさらに有し、前記ポリマーチューブは前記表面特徴の周りでリフローされていることを特徴とする請求項1に記載のアセンブリ。
- 前記複数の表面特徴は、前記針のグリットブラスト仕上げされた外面を含むことを特徴とする請求項15に記載のアセンブリ。
- 前記複数の表面特徴は、それぞれ前記針の壁を通って延伸するレーザ切断された孔を含むことを特徴とする請求項15に記載のアセンブリ。
- 前記重なり領域は、前記ポリマーチューブの遠位端に位置することを特徴とする請求項1に記載のアセンブリ。
- 前記針の前記近位端は、第1の螺旋チャネルまたは螺旋切削を有し、前記ポリマーチューブの前記遠位端は、前記第1の螺旋チャネルまたは螺旋切削と機械的に嵌合する第2の螺旋チャネルまたは螺旋切削を有することを特徴とする請求項18に記載のアセンブリ。
- 前記針の前記近位端および前記ポリマーチューブの前記遠位端が、前記重なり領域において軟質接着剤によって固定されていることを特徴とする請求項18に記載のアセンブリ。
- 前記針の前記近位端および前記ポリマーチューブの前記遠位端が、前記重なり領域においてねじによって固定されていることを特徴とする請求項18に記載のアセンブリ。
- 前記超弾性合金は、オーステナイト相において、前記本体部が直線状となる元の形状になることを特徴とする請求項1に記載のアセンブリ。
- 前記超弾性合金は、マルテンサイト相において、前記本体部が直線状となる元の形状から可逆的に最大10%変形することを特徴とする請求項1に記載のアセンブリ。
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US20190328213A1 (en) | 2019-10-31 |
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