JPH06209947A - 組織保持用ばね - Google Patents
組織保持用ばねInfo
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- JPH06209947A JPH06209947A JP5286171A JP28617193A JPH06209947A JP H06209947 A JPH06209947 A JP H06209947A JP 5286171 A JP5286171 A JP 5286171A JP 28617193 A JP28617193 A JP 28617193A JP H06209947 A JPH06209947 A JP H06209947A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- 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
- A61B17/1155—Circular staplers comprising a plurality of staples
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
- Media Introduction/Drainage Providing Device (AREA)
Abstract
ラーと共に使用する組織保持用ばねである。この組織保
持用ばねはステープラーのアンビル軸上に取り付けられ
る。ばねは、これを通る軸方向通路を有する部材を定め
る多数の連結された螺旋コイルを持つ。このばねは、組
織の保持、組織と液体の流れ、及び改良されたステープ
ラーの閉鎖を提供する。
Description
外科用装置、特に円形外科用ステープラーである。
迅速かつ効果的な接合又は修復の方法として外科技術に
おいて永く知られてきた。ステープル術は縫合に代わっ
て認められる技術となった。ある種の外科処置において
は、外科用ステープルは組織の接合に好ましい方法とな
り、これらの用途に対して特別な形状にされた外科用ス
テープルが開発された。例えば、吻合術のような外科処
置における使用に対して管腔内ステープラー又は円形ス
テープラーが開発された。
知られている。吻合の実施に有用な円形ステープラー
は、参考文献として組み入れられた米国特許第5104
025号に明らかにされる。通常の円形ステープラー
は、典型的には、手元側の操作用機構と軸に取り付けら
れた端末部のステープル作業用機構とを有する細長い軸
よりなる。端末ステープル作業用機構は、通常は、同心
の円形アレイの形状にされた多数のステープルを収容し
ている固定のステープル作業用カートリッジからなる。
円形の切断用ナイフがカートリッジ内にステープルと同
心に取り付けられる。ナイフは軸方向で端末方向に動く
ことができる。カートリッジの中心から套管針の軸が軸
方向で伸びる。套管針軸は、カートリッジ及び細長い軸
に関して軸方向で動くことができる。套管針軸にアンビ
ル部材が取り付けられる。アンビル部材は、ステープル
の端部を成型するためにこれに取り付けられた普通のス
テープルアンビルを持つ。ステープルカートリッジの端
末面とステープルアンビルとの間の距離は、ステープラ
ー軸の手元側端部に取り付けられた調整機構により制御
することができる。ステープルカートリッジとステープ
ルアンビルとの間に含まれた組織は、外科医が作動用機
構を組み合わせたときに、同時にステープル連結されか
つ切断される。
された後に腸管部分を一緒に接合する外科処置である。
この処置は、連続した筒状通路を形成するために2個の
筒状部分の端部を一緒に連結することを要する。従来
は、この外科処置は労力と時間のかかる手術であった。
外科医は、腸管の端部を正確に切断し整列させ、更に、
幾針もの縫合で端部を連結する間、この整列を維持しな
ければならなかった。円形ステープラーの開発は、吻合
処置を非常に簡単にしかつ吻合の実施に要する時間も短
縮させた。
際は、典型的には、腸管は、通常の外科用ステープラー
を使用してステープル連結されるが、この際は腸管の目
標部分(即ち、検体)の両側に2列のステープルが設置
される。目標部分は、通常は、この部分がステープル連
結されると同時に切断される。次に、検体を除去した後
に、外科医は、通常は、ステープル線に近い管腔の手元
側端部の中にアンビルヘッド(アンビル部材)を挿入す
る。これは、外科医により手元側管腔に切り込まれたポ
ート全体にアンビルヘッドを挿入することにより行われ
る。時には、ステープラーの末端部にアンビルヘッドを
置き、直腸を通して装置を挿入することによって、アン
ビルヘッドを経肛門的に置くことがある。典型的には、
ステープラーの端末部は経肛門的に挿入される。次い
で、外科医は、縫合糸又はその他の通常の結紮用器具を
用いてアンビル軸に手元側腸管の端部を結紮する。次
に、外科医は、その結紮に隣接した余剰組織を切り、そ
してアンビルをステープラーの套管針軸に取り付ける。
次いで、外科医は、アンビルとカートリッジとの間の間
隙を閉じ、これにより間隙内の腸管の手元側端部と端末
側端部とを組み合わせる。次に、外科医は、ステープラ
ーを操作して数列のステープルを腸管の両方の端部を貫
いて打ち込み成型させ、これにより両端を接合して筒状
の通路を形成する。ステープルが同時に打ち出されかつ
成型されるように、同心の円形の刃が腸管組織の端部を
通して駆動され、ステープルの内側列の論説した端部を
切断する。次に、外科医は腸管からステープラーを引き
抜き、吻合が完了する。
形ステープラーと共に使用する種々の付属品が開発され
た。かかる付属品の一つがアンビルブシュとして知ら
れ、米国特許第4592354号に明らかにされる。こ
の特許で開示されたアンビルブシュは、シャンク部材に
より分離された2個のフランジよりなる。シャンク部材
は、これを貫通する円筒状通路を持つ。この円筒状通路
の直径は、スプールがアンビル軸と摩擦結合状態である
ように寸法を決められる。スプールは組織の取付け用又
は保持用の手段として使用され、腸管はスプールの周り
で縫合され又は結紮され、更に、腸管はスプールに隣接
して切断される。
軸上に配置された把持用手段を有する改良された管腔内
ステープラーを開示する。この把持用手段は、腸管端部
をつかむように外向きに伸びている刺の円形アレイより
なる。
かつ円形ステープラーと共に使用されたとき便利である
ことは証明されているが、その使用に伴う欠点があるこ
ともまた知られている。アンビルブシュは、使用前に外
科医又は助手がアンビル軸に取り付ける必要がある。ア
ンビル軸上のブシュを結紮に有利な最適位置に正確に位
置決めすることはしばしば困難である。また、アンビル
ブシュの存在は、効果的なスプール連結と切断とができ
るようにアンビルをカートリッジ付近に位置決めするに
要する閉鎖力を増加させ得ることも知られている。更
に、外科医が腸管を切ろうとするとき、アンビルブシュ
の手元側端部を置くことが時には困難であることが知ら
れている。更に、腸管の粘膜が極めて滑り易いこと、及
び通常のアンビルブシュ上に腸管を保持することが困難
なことが知られている。
は、吻合処置における円形ステープラーの使用を容易に
しかつ現在のアンビルブシュの欠点を無くし円形ステー
プラーと共に使用する新規な装置である。
上に正確に置き得る吻合処置用の組織保持用ばねを提供
することが本発明の目的である。
アンビルの閉鎖に要する力を減少させる組織保持用ばね
を提供することが本発明の別の目的である。
提供することが本発明の更に別の目的である。
る組織の長さを付加する組織保持用ばねを提供すること
が本発明のなお別の目的である。
ー用の組織保持用ばねが明らかにされる。このばねは、
手元側端部、端末側端部、及びばね部材を定める隣接し
連結された複数のコイルを有する螺旋状コイルばね部材
を備える。コイルは軸方向空間で分離される。このばね
は、これを通る軸方向の通路を持つ。組織保持用ばね
は、円形ステープラーのアンビル部材の軸上に置かれ
る。
上述の組織保持用ばねとの組合せである。
ーにおける組織の保持方法である。この方法は、まず、
円形ステープラーのアンビル軸上に上述の組織保持用ば
ねを同心状に置くことを含む。次いで、組織がばねの周
りに置かれる。最後に、ばねが圧縮され、これにより組
織の少なくも幾分かをばねのコイル間に組み合わせる。
好ましくは、組織は、ばねの圧縮以前に少なくも1本の
縫合糸でばねに結紮される。
917号の開示事項が参照文献として組入れられる。
見られる。図1、2及び2Aを参照すれば、複数の連結
されたコイル15よりなる組織保持用ばね10が見られ
る。ばね10は軸を受け入れる内側の軸方向通路40を
有することが見られる。ばね10が手元側端部20と端
末側端部22及び手元側端部20と端末側端部22との
間の細長い部分24を有することが見られる。ばね10
はその長さに沿って一定の直径を有することができ、或
いは図1及び4に示されたように変動する直径を持つこ
とができる。例えば、手元側端部20と端末側端部22
の直径を同じ寸法のものとし、部分24の直径をばね1
0の中央26で最大に増加するようにすることができ
る。即ち、両側の端部から出発して、続く各コイル15
はばね10の中央部26の最大直径まで直径が大きくな
るものである。コイル15間の距離28は有効な組織保
持を与えるに十分であろう。同様に、ばね10が非圧縮
状態のときの距離28は、一定でもよいし、或いはコイ
ル15間で変化してもよい。間隔28は、通常は、ばね
10が圧縮されると減少するであろう。
ことが知られ、組織保持用ばね10がアンビル部材の軸
196周りの腸管組織の保持を支援する。ステープラー
の間隙210が閉じられると、粘膜組織は、コイル15
の圧縮により少なくも1個の空間28内に確実に保持さ
れるであろう。ばね10の別の機能は、ステープラー1
00の閉鎖を容易にすることである。図4及び5を参照
すれば、ステープラー100が閉じられると、腸管組織
は、ステープルカートリッジ170の末端とアンビル部
材190のアンビル193との間の間隙210内で圧縮
される。コイル15間の空間28は組織、液体及びガス
の流入路を形成し、これにより、カートリッジ170の
末端とアンビル193との間の間隙210の閉鎖を容易
にする。前述のように、コイル15と空間28もまた、
ばね10が圧縮されたときの空間28内の粘膜の捕獲に
より腸管の粘膜の保持を助ける。
ね10が通常の円形ステープラー10に取り付けられて
見られる。円形ステープラー100は、細長い筒状フレ
ーム150に取り付けられた手元側のハンドル110を
持つ。カートリッジヘッド170が細長い筒状フレーム
150の端末155に取り付けられる。カートリッジヘ
ッド170は、同心列の成型ステープルを提供するよう
に円形アレイに配列された通常のステープル(図示せ
ず)を収容する。また、カートリッジ170は、成型さ
れたステープル列の内側の組織を切断するために、切断
用の刃を持った円筒状の円形ナイフ(図示せず)も収容
する。カートリッジヘッド170とアレイ部材190と
の間の間隙210を増加させ或いは減少させるように回
転できるノブ120を端部を取り付けられたハンドル1
10が見られる。ハンドル110には、ステープルの駆
動及びナイフの切込みを操作するために操作用レバー1
30も取り付けられる。カートリッジ170から套管針
軸180が伸びる。套管針軸180は、ノブ120の時
計方向又は反時計方向の回転により端末方向及び手元方
向に軸方向で動くことができる。
190は、テーパーにされた末端191及び円形の通常
のアンビル193を取り付ける平坦な手元側端部192
を持った円柱状部材であることが見られる。アンビル1
93はステープルの端部を成型する成型用凹所194を
有することが見られる。アンビル部材190の手元側端
部192にアンビル部材軸196が取り付けられ、これ
は、アンビル部材190の手元側端部192内に含まれ
る空洞部195から軸方向に伸びる。アンビル軸196
は、套管針軸180に取り付けられる円筒形の筒状部材
である。アンビル193の内側の空洞部195内に分離
ワッシャ200が同心に取り付けられる。分離ワッシャ
200は、ナイフが操作されたときに円形ナイフの切り
刃と組み合うような寸法にされる。好ましくは、ワッシ
ャ200は、ナイフと組み合ったときに、ワッシャの外
側環状部分が空洞部195内と組み合ったままで内側環
状部分がワッシャ200から分離するように割れるよう
に(即ち、降伏点を越すように)設計される。空洞部1
75内にショルダー212がこれも同心に取り付けられ
る。ショルダー212は、内部通路215と手前側の面
214とを有する筒状部材であることが見られる。アン
ビル軸196は、ショルダー212の通路215を通り
アンビル部材190に同心に取り付けられる。
2を軸196上で滑らし、末端22がショルダー212
の手元側の面214と接触するようにばね10を位置決
めすることにより軸196上に取り付けられ又は置か
れ、これによりアンビル軸196上でアンビルブッシュ
を適正に位置決めする。末端22をショルダー212の
付近に置くこともできる。アンビル軸196の套管針軸
180上への同心取付けによりアンビル部材190が套
管針軸180上に取り付けられると、円形ステープラー
が使用準備状態となる。図2及び図4を参照し説明すれ
ば、ノブ120の操作により間隙210が閉じられる
と、ばね10の手元側端部20がカートリッジ170の
端末の面と接触し、これによりばね10はアンビル軸1
96のアンビル部材190に関する端末方向への滑りに
より圧縮される。ばね10が滑ると、コイル15は互い
に長手方向に変位し、コイル15間の空間28の幅を縮
小させ、コイル15間の組織を圧縮する。端末22は
(予めショルダー212に周りに置かれないとすれば)
ショルダー212の上方及び周りを滑るが、端末22
は、これがショルダー212の周りを滑れないようにシ
ョルダー212の直径よりも小さい開口を有するように
設計することもできる。間隙210は、ばね10が実質
的に完全に圧縮されるまで減少する。コイル間に組み合
わせられた組織なしで完全圧縮されたばね10の長さは
各コイルの厚さの和に等しいであろう。しかし、組織が
存在すると、この長さは、コイル15間の空間内に組み
合わせられた組織の型と量とに応じて増加するであろ
う。
96との効果的な適合を与えるに十分な寸法のものであ
ろう。内部通路40の寸法はアンビル軸196の大きさ
により変わるであろうし、かつ典型的にはばね10の軸
方向長さに沿って変化するであろうが、これもまた一定
とすることができる。例えば、通路40の最大直径は、
約8.890mm(約0.350インチ)から約9.144m
m(約0.360インチ)、より典型的には約9.017m
m(約0.355インチ)、そして好ましくは約9.01
7mm(約0.355インチ)である。同様に、ばね10
のその他の寸法は使用される特定の円形ステープラーの
大きさにより変化するであろうし、また同様にばね10
の効果的な機能に対して十分であろう。例えば、ある特
定の円形ステープラーについて、ばね10の長さは、約
22.225mm(0.875インチ)から約25.400m
m(約1インチ)、より典型的には約22.352mm(約
0.880インチ)から約22.860mm(約0.900
インチ)、好ましくは約22.479mm(0.885イン
チ)である。例えば、手元側端部20及び端末22の直
径は、約9.779mm(約0.385インチ)から約1
0.160mm(約0.400インチ)、より典型的には約
9.906mm(約0.390インチ)から約10.160m
m(約0.400インチ)、そして好ましくは10.08
4mm(約0.397インチ)である。
な通常の方法、例えば、ワイヤー又はその他の円柱状部
材をマンドレルなどに巻くことにより作られる。ワイヤ
ーは、典型的には、所望のばね特性を提供するに効果的
な直径を有するであろう。コイル15間の空間28は、
組織の保持及び通気を効果的に提供するために十分な軸
方向長さのものであろう。典型的には、空間28の大き
さは、装置の大きさ及びばね10のコイル15の数を含
んだ要因により決定されるであろう。空間28を一定と
し或いはコイル15間で変更することができる。本発明
のばね10のばね定数は、ステープラー100の効果的
な閉鎖を許すに十分なものであろう。
れるように、次の方法で吻合を行うにために円形ステー
プラー100により使用することができる。患者が通常
の外科処置に従って準備されかつ麻酔をかけられた後
に、外科医は、通常の外科技術を使用して、円形ステー
プラー100のアンビル部材190及びカートリッジ1
70を、除去対象の腸管部分に近い腸管の部分内に挿入
する。間隙210は最大に開かれることが普通である。
アンビル部材190及びカートリッジ170の挿入より
前に、外科医は、ばね10の末端22をアンビル軸19
6上に滑らし、末端22がショルダー212と組み合う
ようにばね10を置き、ばね10をアンビル軸196上
に位置決めすることにより、組織保持用ばね10をアン
ビル軸196上に置く。次いで、外科医は、結紮された
腸管がコイル15に接触し少なくも幾分かの組織が少な
くも1個の空間28内に押し込まれるように、通常の縫
合糸(又はその同等品)を使用して腸管の部分をばね1
0に結紮する。次に、外科医は、ループ300内に捕捉
され固定された腸管の近くに次のコイル15を置き、次
いでばね10の次のコイル15を切断用案内として使用
し腸管を切断する。ばね10の手元側端部20は末端部
22より大きな直径を持つ。より大きな直径の手元側端
部20の存在により、外科医はばね10の手元側端部2
0を容易に認識できる。次に、腸管の目標部分が外科的
に除去され、除去された目標部分に近い腸管の端部が、
巾着縫合のような通常の縫合方法を使ってアンビル軸1
96又はばね10に結紮される。次いで、間隙210が
閉じられ、ばね10を圧縮し、これにより間隙210内
及び少なくも1個の空間28のコイル15間に組織が組
み合う。次いで、ステープラー100のレバー130を
操作して、ステープルをカートリッジヘッド170から
アンビル193の凹所194内に打ち出しステープルを
成型することにより、腸管の2部分がステープル連結さ
れ、同時に腸管端部が切断される。同時に、ナイフが前
方に駆動され、アンビル193に隣接した腸管の内部部
分を切断する。アンビル部材190、カートリッジヘッ
ド170、ステープラー100及び組織保持用ばね10
と一緒の腸管端部の切断片と縫合糸が患者から取り出さ
れる。このとき、吻合は完了し、どの接近用開口も通常
の外科処置により縫合され又はステープル連結される。
腸管を縫合糸でばね10に結紮することが好ましいが、
縫熟練技術者は、縫合糸の結紮の存在が不具合であると
思われるならばこれを無くすことができることを認める
であろう。
ましい方法は2重ステープル術による方法であり、これ
は、管腔の目標部分、又は検体をステープルの2重列に
よりその部分の両側でステープル連結した後で、腸管か
ら切除する方法である。適正に取り付けられた組織保持
用ばね10を有するアンビル部材190が、腸管を切開
した後で手元側ステープル線に隣接した手元側の管腔内
に挿入される。図3及び図4を参照すれば、縫合糸、好
ましくはニュージャージー州サマービルのエチコン・イ
ンク製造のエンドループ(ENDOLOOP 商品名)のような
予備成形されたループ縫合糸300を使用して管腔がば
ね10に固定される。次いで、切断用案内として次のコ
イル15を使って余剰組織が切り揃えられる。次に、カ
ートリッジ170及びステープラー100のフレーム1
50の端末部155が手元側管腔に切られたポート全体
に挿入され、又は、典型的には、患者の肛門内に挿入さ
れ、管腔内で末端側ステープルの前方に位置決めされ
る。ステープラーの套管針軸180が末端側ステープル
線に隣接した管腔を通して延ばされる。次いで、套管針
軸180がアンビル軸196内に挿入される。次に、腸
管の2個の部分が操作され前述のようにステープル連結
され、更に分離ワッシャ200のどの部分とも一緒にス
テープルを含んだ切断腸管の部分がステープラー100
と共に腸管から取り出される。
点がある。コイル15間の空間28は、間隙210が短
くされ又は閉じられるときの組織と液体の流れを許す。
円形ステープラー100における間隙210の閉鎖は、
通常、間隙210内における組織と液体の圧縮をもたら
す。通常のアンビルブシュの存在は、このアンビルブシ
ュが空間を占有し、この空間を組織又は液体の流入に利
用できないので、この問題を更に悪化させる。ばね10
のこの流入特性は、典型的には、通常のアンビルハウジ
ングを有するステープラーと比較して、間隙210を閉
じ又は小さくするに要する力を少なくする。本発明のば
ね10の別の利点は、手元側部20が末端部22よりも
大きな半径又は直径を有し得ることである。これによ
り、外科医は、触覚又はその他により容易にコイル15
を置くことができ、更に切断用案内としてのその使用を
便利にする。ばね10の更に別の利点は、コイル15が
腸管の滑り易い内側粘膜層の把持及び確実な保持を容易
にすることである。組織保持用ばね10のなお別の利点
は、ばね10が圧縮可能であるため、通常のアンビルブ
シュよりも長い長さを持ち得ることであり、これによ
り、腸管の一方の端部又は両方の端部を結紮するための
付加的な長さを外科医に提供する。長すぎる通常のアン
ビルブシュは、閉じるときのステープラーの最小間隙に
悪影響を与えるため、通常のアンビルブシュの長さは本
質的に限定される。上述のように、本発明の組織保持用
ばね10の利点は、ばね10により通常のアンビルブシ
ュ使用のときよりも小さな力でステープラー100を閉
じ得ることである。
ち、鋳造及び同様な方法を含んだ普通の製造技術を使っ
て製造できる。組織保持用ばね10は、ワイヤーのよう
な細長い円柱状の材料から作ることができる。本発明の
ばね10は、組織ばね10の機能を許す十分な機械特性
及び生体適合性を有する医用級の適宜の材料で作ること
ができる。材料には、ポリマープラスチック、ステンレ
ス鋼、合金、金属、メッキ炭素鋼、メッキ金属、メッキ
合金及び同等品にような生体適合性材料が含まれる。ス
テンレス鋼のような生体適合性材料の使用が特に好まし
い。
ないが本発明の原理及び実際の説明である。
麻酔が掛けられた。臍において腹腔内にベレス(Veres
s)針が挿入された。腹部はCO2で通気された。処置
中、通気は維持された。通常の10/11mm套管針が臍
において挿入された。通常の10mm内視鏡が10/11mm套
管針を通して差し込まれ、投光器に接続された。内視鏡
の頭部にカメラが取り付けられた。カメラにより、腹腔
及び続く総ての套管針挿入部位の(TVモニターを使用
しての)観察及び(VCRを使用した)記録ができた。
2次の5mm又は10mmの普通の套管針が必要に応じて腹
腔下側に挿入された。結腸間膜は離され、通常のクリッ
プ又は電気焼灼器を使用して結紮され又は凝固された。
た。即ち、通常の内視鏡式直線カッターで腸が横方向に
切断された。アンビル部材190の挿入ができるように
手元側のステープル線が切り揃えられた。アンビル部材
190がステープラー100から外され套管針ポートを
通して挿入された。組織保持用ばね10の取り付けられ
たアンビル部材190は腸の手元側部分内に置かれ、エ
ンドループ(商品名)縫合糸により固定された。余分な
組織は、切断用案内として組織保持用ばね10のコイル
15を使って切り揃えられた。円形ステープラー100
の端末部が肛門を経て挿入された。套管針軸180が端
末側のステープル線の近くに延ばされた。アンビル軸1
96が套管針軸180上に置かれ、適所に揃えられ、止
められ、そして確認試験が行われた。ステープラー10
0の間隙210が閉じられてばね10を圧縮し、適切な
ステープルを設定高さに締め付け、結腸吻合を行うため
に射出された(fired)。ステープラー100が結腸か
ら取り出された。得られたドーナツ状の組織は完全性を
検査された。結腸吻合は開通性と漏洩の検査を受けた。
ステープラー100に加えて通常の具体例の円形ステー
プラーと共に使用し得ることが熟練技術者により認めら
れるであろう。例えば、円形ステープラー100は軸1
96を有するアンビル部材190を使用するが、その他
の通常のステープラーはアンビル軸を持たないアンビル
部材を使用する。この形式のステープラーにおいては、
套管針軸がアンビル部材と直接出会う。本発明のばね1
0がこの形式のステープラーにより使用し得ること及び
同様な利点を提供することが信じられる。
示され説明されたが、請求された本発明の精神及び範囲
から離れることなく、その形式及び詳細における種々の
変化をなし得ることが熟練技術者により理解されたであ
ろう。
ねを備え、このばねはばね部材を定める多数の連結螺旋
コイル部材を備えこのコイルは軸方向空間により離さ
れ、前記部材は手元側端部と末端側端部及び軸方向長さ
を有し、前記ばね部材は軸上に取り付けるためにこれを
通る軸方向通路を有する組合せ。
する上記1のばね。
って変化する上記1のばね。
定である上記1のばね。
一定である上記1のばね。
変化する上記1のばね。
アンビル軸、ステープルカートリッジ及び作動用手段を
有する円形ステープラーを使用する方法にして、組織保
持用ばねをアンビル軸上に位置決めし、このばねはばね
部材を定める多数の連結螺旋コイル部材を備え、このコ
イルは空間により離され、前記ばね部材は手元側端部と
末端側端部及び軸方向長さを有し、前記ばね部材は軸上
に取り付けるためにこれを通る軸方向通路を有し;アン
ビルとカートリッジとを腸管の隣接部分内に挿入し;腸
管の少なくも一方の部分をばねに結紮し;そして腸管の
両部分を一緒にステープル連結するように作動用手段を
作動することを含んだ方法。
する上記7の方法。
って変化する上記7の方法。
一定である上記7の方法。
て一定である上記7の方法。
て変化する上記7の方法。
ーに組織を保持する方法にして、アンビル軸に組織保持
用ばねを同心に取り付け、前記組織保持用ばねは、部材
を定める多数の連結螺旋コイル部材を備え、このコイル
は空間により離され、前記部材は手元側端部と末端側端
部及び軸方向長さを有し、前記ばね部材は軸上に取り付
けるためにこれを通る軸方向通路を有し;ばねの周りに
組織を置き;そして少なくも組織の幾分かがコイル間の
空間内でばねと組み合うようにばねを圧縮することを含
んだ方法。
縫合糸で組織をばねに結紮する段階を更に含んだ上記1
3の方法。
有する上記13の方法。
沿って変化する上記13の方法。
一定である上記13の方法。
て一定である上記13の方法。
て変化する上記13の方法。
明の組織保持用ばねの斜視図であり、Aは、円形ステー
プラーのアンビル部材の拡大断面部分図である。
前における腸管の部分内のアンビル軸上の本発明の組織
保持用ばねを示す。
の腸管の断面図内の円形ステープラーのアンビル軸上に
取り付けられた本発明の組織保持用ばねを示す。
と切断用の刃の作動の直前における図4の組織保持用ば
ねを示す。
Claims (3)
- 【請求項1】 円形ステープラー;及び組織保持用ばね
を備え、このばねはばね部材を定める多数の連結螺旋コ
イル部材を備え、このコイルは軸方向空間により離さ
れ、前記部材は手元側端部と末端側端部及び軸方向長さ
を有し、前記ばね部材は軸上に取り付けるためにこれを
通る軸方向通路を有する組合せ。 - 【請求項2】 腸管部分の連結のために、アンビル、ア
ンビル軸、ステープルカートリッジ及び作動用手段を有
する円形ステープラーを使用する方法にして、 組織保持用ばねをアンビル軸上に位置決めし、このばね
はばね部材を定める多数の連結螺旋コイル部材を備え、
このコイルは空間により離され、前記ばね部材は手元側
端部と末端側端部及び軸方向長さを有し、前記ばね部材
は軸上に取り付けるためにこれを通る軸方向通路を有
し;アンビルとカートリッジとを腸管の隣接部分内に挿
入し;腸管の少なくも一方の部分をばねに結紮し;そし
て腸管の両部分を一緒にステープル連結するように作動
用手段を作動することを含んだ方法。 - 【請求項3】 アンビル軸を有する円形ステープラーに
組織を保持する方法にして、 アンビル軸に組織保持用ばねを同心に取り付け、前記組
織保持用ばねは、部材を定める多数の連結螺旋コイル部
材を備え、このコイルは空間により離され、前記部材は
手元側端部と末端側端部及び軸方向長さを有し、前記ば
ね部材は軸上に取り付けるためにこれを通る軸方向通路
を有し;ばねの周りに組織を置き;そして少なくも組織
の幾分かがコイル間の空間内でばねと組み合うようにば
ねを圧縮することを含んだ方法。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US964734 | 1992-10-22 | ||
US07/964,734 US5309927A (en) | 1992-10-22 | 1992-10-22 | Circular stapler tissue retention spring method |
Publications (2)
Publication Number | Publication Date |
---|---|
JPH06209947A true JPH06209947A (ja) | 1994-08-02 |
JP3350868B2 JP3350868B2 (ja) | 2002-11-25 |
Family
ID=25508908
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP28617193A Expired - Lifetime JP3350868B2 (ja) | 1992-10-22 | 1993-10-22 | 組織保持用ばね |
Country Status (7)
Country | Link |
---|---|
US (1) | US5309927A (ja) |
EP (1) | EP0594436A3 (ja) |
JP (1) | JP3350868B2 (ja) |
AU (1) | AU672236B2 (ja) |
CA (1) | CA2108805A1 (ja) |
GR (1) | GR930100418A (ja) |
IL (1) | IL107319A (ja) |
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US4120489A (en) * | 1970-06-22 | 1978-10-17 | Bebrueder Ahle | Double truncoconical spring of wire with circular cross section |
BR7506004A (pt) * | 1974-09-18 | 1976-08-03 | Stumpp & Schuele Kg | Mola de pressao aperfeicoada |
US4476863A (en) * | 1981-03-09 | 1984-10-16 | Kanshin Nikolai N | Surgical instrument for establishing circular coloanastomoses |
US4592354A (en) * | 1983-10-11 | 1986-06-03 | Senmed, Inc. | Tissue retention spool for intraluminal anastomotic surgical stapling instrument and methods |
US4665917A (en) * | 1985-01-28 | 1987-05-19 | Ethicon, Inc. | Tissue gripper for use with intraluminal stapling device |
US4703887A (en) * | 1985-01-28 | 1987-11-03 | Ethicon, Inc. | Collapsible purse string aid for use with intraluminal stapling device |
SU1509052A1 (ru) * | 1988-01-18 | 1989-09-23 | С. А. Попов | Хирургический сшивающий аппарат |
US5104025A (en) * | 1990-09-28 | 1992-04-14 | Ethicon, Inc. | Intraluminal anastomotic surgical stapler with detached anvil |
-
1992
- 1992-10-22 US US07/964,734 patent/US5309927A/en not_active Expired - Lifetime
-
1993
- 1993-10-18 IL IL107319A patent/IL107319A/xx not_active IP Right Cessation
- 1993-10-20 CA CA002108805A patent/CA2108805A1/en not_active Abandoned
- 1993-10-21 EP EP19930308392 patent/EP0594436A3/en not_active Withdrawn
- 1993-10-21 GR GR930100418A patent/GR930100418A/el not_active IP Right Cessation
- 1993-10-22 JP JP28617193A patent/JP3350868B2/ja not_active Expired - Lifetime
- 1993-10-22 AU AU50217/93A patent/AU672236B2/en not_active Expired
Cited By (5)
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JP2006149676A (ja) * | 2004-11-29 | 2006-06-15 | Jms Co Ltd | 腸吻合術用補助具 |
US8231642B2 (en) | 2004-11-29 | 2012-07-31 | Jms Co., Ltd. | Intestinal anastomotic surgery aid |
JP2006312056A (ja) * | 2005-05-03 | 2006-11-16 | Ethicon Endo Surgery Inc | 吻合リング供給装置用のばね式発射機構 |
KR101213413B1 (ko) * | 2005-05-03 | 2012-12-18 | 에디컨 엔도-서저리 인코포레이티드 | 문합 링 적용기를 위한 스프링 기반 발사 메커니즘 |
JP2006312051A (ja) * | 2005-05-05 | 2006-11-16 | Ethicon Endo Surgery Inc | 吻合リング供給装置のためのねじ先端部分の制御 |
Also Published As
Publication number | Publication date |
---|---|
GR930100418A (el) | 1994-06-30 |
US5309927A (en) | 1994-05-10 |
EP0594436A3 (en) | 1994-10-12 |
AU672236B2 (en) | 1996-09-26 |
IL107319A (en) | 1997-03-18 |
CA2108805A1 (en) | 1994-04-23 |
EP0594436A2 (en) | 1994-04-27 |
AU5021793A (en) | 1994-05-05 |
IL107319A0 (en) | 1994-01-25 |
JP3350868B2 (ja) | 2002-11-25 |
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