JPH0626812U - 外科手術用ステープル装置 - Google Patents

外科手術用ステープル装置

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JPH0626812U
JPH0626812U JP069591U JP6959192U JPH0626812U JP H0626812 U JPH0626812 U JP H0626812U JP 069591 U JP069591 U JP 069591U JP 6959192 U JP6959192 U JP 6959192U JP H0626812 U JPH0626812 U JP H0626812U
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JPH0731771Y2 (ja
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ヘクター・チャウ
ヒュー・メリング
デニース・エス・シャイルツ
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センメド・インコーポレイテッド
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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
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • 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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Abstract

(57)【要約】 【目的】 この考案は、綴とじすべき組織上にジョー部
材を正確に配置できてステープルが成形される時にジョ
ー部材に作用される力に耐えるようできる１列以上のス
テープルを造る改良された組織処理を達成するよう設計
された外科手術用ステープル装置を特徴としている。 【構成】 この考案の外科手術用ステープル装置は、ジ
ョー部材を互いに錠止する錠止位置に互いにジョー部材
を完全に解離できる解錠位置から作動できる改良された
ジョー錠止装置と、ジョー部材を互いに解離することな
く組織の位置をジョー部材が調節できるよう互いにゆる
く連結されたジョー部材によって部分錠止位置に錠止装
置を保持する装置の協同することを特徴としている。

Description

【考案の詳細な説明】
【０００１】
【産業上の利用分野】
この考案は改良された組織処理を達成するよう設計された外科手術用ステープ ル装置、特に綴とじすべき組織上にジョー部材を正確に配置できてステープルが 成形されるときにジョー部材に作用される力に耐えるようできる１列以上のステ ープルをつくるための改良された外科手術用ステープル装置に関するものである 。特に、この考案は、ステープルの形成前に細長いジョー部材の組織上の位置を 正確に調節するようできる錠止装置と、均一なステープル高さをつくるべくでき るようステープルが形成されるときにジョー部材の金敷およびステープルカート リッジ支持前部に作用される力に耐えるよう細長いジョー部材に締付力を作用す るジョー締着装置とを有した直線吻合ステープル装置に関するものである。
【０００２】 更に、この考案は単独患者使用のために好適に設計された処理可能な外科手術 用ステープル装置に係わる。ステープル装置は、同一患者の手術中にステープル 装置を再使用できるよう簡単に取換えられる処理可能なステープルカートリッジ を有している。
【０００３】
【従来の技術】
近年、肺、食道、胃、十二指腸や腸系統の他の人体器管等の様な人体器管およ び組織を縫合するようステープル装置を用いることが手術において増大する傾向 にある。多くの場合、適切なステープル装置の利用は良い仕事を短い時間で行い 、胃腸吻合の様な従来の困難な外科手処理を簡単にする。
【０００４】 従来技術において、初期の直線２列および４列の切断ステープル装置はステー プルが個別に手動装入される恒久的器具であった。この様なステープル装置は非 常に高価で、かさばり、重く、各外科手術に使用するために装入と清掃が困難で あった。１つの例が米国特許第3,315,105号明細書に記載されている。恒久型外 科手術用ステープル装置の改善は、消毒済みの使い捨て可能なステープル装入装 置と、組織を分断すると同時にステープルの列を形成する任意の刃物とを有した 基本的ステープル装置を設けることによってつくられた。一例が米国特許第3,49 9,591号明細書に記載されている。しかし、この様な改善は手によるステープル の装入に予め必要とされる時間の節約を主に達成した。ステープル装置自体に必 要とされる管理に加えて基本装置を分解し、洗浄し、再組立し、各外科手術処理 毎に新しいカートリッジと金敷を取付けることがまだ必要とされた。この種の装 置における別の問題は、ステープル列の近接端と末端の間の形成されたステープ ル高さの実質的な変化にもとづく繰返し使用の後に末端にジョーを拡げ離す傾向 である。
【０００５】 病院の費用が増大し続けるときに、不必要な仕事を省略し、外科手術と妥協す ることなく一層効果的に技術を発展することが必要である。従って、米国特許第 4,429,695号明細書に記載される型の使い捨て可能なステープル装置が開発され た。この特許の使い捨て可能なステープル装置においては、作動器と刃物装置が 刃物押棒カムの正域内のステープルジョーに部分的支持を設けている。しかし、 このステープル装置は、ステープルが形成される前に離れるジョーの傾向に抵抗 するようステープルジョーの金敷およびステープルカートリッジ支持部分の余長 に亘って締付力を同時に作用していない。
【０００６】
【考案が解決しようとする課題】
一般的に、直線吻合ステープル装置は一対の協同する細長いジョー部材を有し 、各ジョー部材が吻合すべき内部管状人体器管内に挿入できるようなっている。 一方のジョー部材は少なくとも２つの横方向に隔った列のステープルをもったス テープルカートリッジを支持し、他方のジョー部材はカートリッジ内のステープ ルの列と整列したステープル形成ポケットをもった金敷を支持している。整列し たステープルカートリッジと金敷と一緒にジョー部材を錠止すべく枢動可能な錠 止レバーまたはハンドルが設けられている。一般に、カートリッジにより支持さ れると共に金敷に対してステープルを閉鎖するよう各ステープルと関連した複数 個のステープルドライバを作動し且つジョー部材間に握持された組織にステープ ルの横方向に隔った列を形成するカム面を介してカートリッジからステープルを 連続的に放出するジョー部材に沿って長手方向に単一押棒刃物装置が滑動できる 。押棒に従動する刃物はステープル列間の線に沿って組織を切断する。この様な 吻合ステープル装置の例が米国特許第3,499,591号、第4,429,695号明細書に記載 されている。いずれの場合も、ステープルが形成されるときに作用される力に耐 えるよう金敷とステープルカートリッジを支持するジョー部材の全体に沿って同 時に締付力を作用すべくつくられた構成はない。また、ステープルの成形の前に 組織上の所要位置に正確にステープルカートリッジと金敷を位置できるよう互い にゆるく連結されたジョー部材によって部分的に解錠された位置に錠止レバーや ハンドルを保持するようつくられた構成もない。
【０００７】 上述の型のステープル装置の使用においては、ジョー部材間に固定される組織 の締付けと、ステープルカートリッジからのステープルの放出と、握持した組織 へのステープルの駆動と、金敷に対するステープルの形成に比較的大きな力が作 用される。この様な力はジョー部材を垂直方向に引き離してジョー部材を横方向 にゆがめる傾向があり、その結果形成されたステープル高さの一致が低下したり 或はステープルが時には金敷を完全にそれたりする。この様な問題は、ジョー部 材や他の部材の製造に比較的軽量の使い捨て可能な材料が用いられる使い捨て可 能なステープル装置の場合に強調される。従って、ステープル形成操作が行われ る際にジョー部材の正確な整列ができ、且つステープル装置の操作にてみられる 大きな力に耐えるよう細長いジョー部材の適切な支持を設ける使い捨て可能なス テープル装置が必要である。更に、ジョー部材間に握持された組織に均一な高さ のステープルの列をつくり、ジョー部材を互いに完全に離脱する必要なく組織の 位置を適当に調節できるステープル装置が必要である。
【０００８】
【課題を解決するための手段】
この考案は、ジョー部材を互いに錠止する錠止位置に互いにジョー部材を完全 に解離できる解錠位置から作動できる改良されたジョー錠止装置と、ジョー部材 を互いに解離することなく組織の位置をジョー部材が調節できるよう互いにゆる く連結されたジョー部材によって部分錠止位置に錠止装置を保持する装置の協同 によって従来技法の欠点を解決する外科手術用ステープル装置を達成している。 好適には、ステープル装置は、ステープル形成の際にジョー部材の金敷およびス テープルカートリッジ支持部に作用される力に抵抗するようジョー部材に締付力 を作用するジョー締着装置を有する。推奨実施例において、錠止装置は、ジョー 部材のステープルおよび金敷支持部に隣接して沿った中間位置にて一緒にジョー 部材を錠止するよう設けられている。カム装置は、ステープルが形成されるとき にジョー部材の金敷およびステープル支持部に作用される力に抵抗するよう錠止 装置から離れた位置にてジョー部材を離して押圧するべく設けられている。
【０００９】 この考案に依れば、外科手術用ステープル装置は、少なくとも１つの列に配置 された複数個のステープルを受けるようできるステープル支持装置を一方が有し ステープルを形成するようできる金敷装置を他方が有する第１、第２の協同する 細長いジョー部材、ジョー部材間に握持された組織内にステープル支持装置から ステープルを駆動して組織内に少なくとも１列のステープルをつくるよう金敷装 置に対してステープルを形成する押圧装置、ステープル支持装置と金敷装置間に 位置された組織と一緒にジョー部材を錠止する錠止装置、ステープル形成の際に ステープル支持装置と金敷装置を一緒に押圧するようジョー部材に締着力を作用 するジョー締着装置、ジョー部材を互いに解離せずに組織の位置をステープル支 持装置と金敷装置が調節できるよう互いにゆるく連結されたジョー部材によって 部分錠止位置に錠止装置を保持する装置を備えている。好適には、ステープル装 置は、ステープルの列に隣接した線に沿ってジョー部材間に握持された組織を切 断する刃物装置を有している。
【００１０】 ステープル装置の推奨実施例において、ジョー錠止装置は、ステープル支持装 置と金敷装置に隣接した中間位置にてジョー部材を互いに錠止するよう設けられ 、ステープルが形成されるときにステープル支持装置と金敷装置に作用される力 に抵抗するよう錠止装置から離れた位置にてジョー部材を離して押圧するべくカ ム装置が設けられている。好適には、カム装置は、錠止装置から離れた位置にて ジョー部材の１つに枢着されたカム部材を有する。カム部材は、離れた位置にて ジョー部材を動かすよう第１の不作動位置から第２作動位置に枢着できる。カム 部材を作動位置および不作動位置に夫々保持するよう第１、第２保持装置が設け られている。カム部材は第１不作動位置に位置されたカム部材と他方のジョー部 材を係合する第１の低カム面と、第２作動位置に位置されたカム部材と他方のジ ョー部材を係合する第２の高カム面とを有する。少なくとも１つのジョー部材は 可撓性で、ジョー部材の一部を離れた位置にて曲げ離すようできる。カム部材が 不作動位置から作動位置に枢動するときに、離れた位置のジョー部材の一部はジ ョー部材の金敷およびステープル支持部を押圧するよう曲げ離す。
【００１１】 好適には、カム部材は、押圧装置が前進されるときには不作動位置から作動位 置に、押圧装置が引込められるときには作動位置から不作動位置に、動かすよう 押圧装置によって作動できる。カム部材は、押圧装置が引込められたときには第 １保持装置によって不作動位置に、押圧装置が前進されたときには第２保持装置 によって作動位置に保持される。
【００１２】 この考案は、組織を間に握持すべく第１、第２の細長いジョー部材が設けられ た直線吻合ステープル装置に実施される。横方向に間隔を置いた長手方向の少な くとも２列のステープルを支持するステープルカートリッジは一方のジョー部材 の前部に取付けられ、ステープル形成金敷は他方のジョー部材の前部に設けられ る。押棒刃物装置はジョー部材に対して長手方向に動くべく滑動可能に取付けら れる。押棒刃物装置は、ジョー部材間に握持された組織内にステープルカートリ ッジからステープルを駆動して組織内に一対の横方向に隔ったステープルの列を つくるよう金敷に対してステープルを形成する押圧装置と、ジョー部材間に握持 された組織をステープル列間の線に沿って切断する刃物装置とを有している。ス テープル装置は、ステープルカートリッジと金敷の間に置かれた組織と一緒にス テープルカートリッジと金敷に隣接して沿った中間位置にて互いにジョー部材を 錠止する装置と、ジョー部材を互いに解離することなく組織の位置をカートリッ ジと金敷が調節できるよう互いにゆるく連結されたジョー部材と一緒に部分錠止 位置に錠止装置を保持する装置とを有している。
【００１３】 推奨実施例のステープル装置は、ステープル形成の際にジョー部材間に握持さ れた組織に対してステープルカートリッジと金敷を締着するよう互いにジョー部 材の前部を押圧するジョー締着装置を有する。ジョー締着装置は、ステープルが 形成されるときにステープルカートリッジと金敷に作用される力に抵抗するよう ジョー部材の前部を一緒に押圧するよう錠止装置から離れた位置にてジョー部材 の後部を離して押圧するカム装置として実施される。
【００１４】 推奨実施例において、カム装置は、ステープルカートリッジおよび金敷を一緒 に押圧するようジョー部材の後部を離して動くべく他方のジョー部材と係合でき る一方のジョー部材に取付けられている。好適には、カム部材は錠止装置から離 れた位置にて一方のジョー部材に枢着されている。カム部材は、ジョー部材の後 部を離して動かしてジョー部材の前部を一緒に押圧するよう第１の不作動位置か ら第２の作動位置に枢動できる。カム部材は、第１の不作動位置に位置されたカ ム部材と他方のジョー部材を係合する第１の下カム面と、第２の作動位置に位置 されたカム部材とジョー部材を係合する第２の高カム面とを有する。好適には、 カム部材は、押圧装置が前進されるときには不作動位置から作動位置に動かし押 圧装置が引込められるときには作動位置から不作動位置に戻るよう押圧装置によ って作動できる。少なくとも一方のジョー部材は、後部が他方のジョー部材の後 部から離れて湾曲して、ステープルカートリッジと金敷を一緒に押圧するよう前 部が他方のジョー部材の前部に向かって湾曲できるよう可撓性である。更に、間 隔装置は、ステープルカートリッジと金敷を予定の間隙を間にもって整列して維 持すべく一方のジョー部材に取付けられている。好適には、間隔ピンは、ステー プルカートリッジと金敷を間に予定の間隙をもって整列するよう組立てられたジ ョー部材と金敷を係合すべくステープルカートリッジに取付けられている。
【００１５】 好適には、押棒刃物装置は、一方のジョー部材に沿って長手方向に動くべく滑 動可能に取付けられてステープルカートリッジ内に滑動するようできる一対のス テープル押棒が設けられた押ブロックと、一方のジョー部材に沿って長手方向に 動くべく滑動可能に取付けられてステープル押棒内に滑動できる刃物が設けられ た刃物ブロックとを有している。カム装置はステープルカートリッジと金敷を一 緒に押圧するようステープルの形成の前に押ブロックによって作動できる。作動 装置は、刃物ブロックが固定している際にカム装置を作動して押棒をステープル カートリッジ内に初めに動かすように押ブロックをステープルカートリッジに向 かって初めに前進し、且つ押棒と刃物をステープルカートリッジ内に同時に動か すようにして押ブロックによる係合においてステープルカートリッジに向かって 刃物ブロックを連続して前進するために設けられている。刃物ブロック推奨実施 例において、カム装置は、ステープル装置を作動すべく初めに必要とされる力を 減少するよう刃物ブロックと押ブロックの係合の前に押ブロックによって作動さ れる。好適には、刃物ブロックは、カム装置を作動するよう押ブロックが前進さ れるときと、ステープルが形成された後に押ブロックが引込められるときに、刃 物ブロックに対して押ブロックが初めに滑動できるよう押棒を滑動可能に受ける べくできる。押棒は、ステープルカートリッジから刃物を引出すよう押ブロック が引込められるときに刃物ブロックを係合するようできる。
【００１６】 この考案の別の特長は単一患者利用のために好適に設計された使い捨て可能な 外科手術用ステープル装置の構成に関連している。好適には、ステープル装置は 同一患者の手術において多ステープル処置のために同一ステープル装置を使用で きるよう容易に取換えできる使い捨て可能なステープルカートリッジと協同し、 手術終了後に装置全体を処分できる。従って、推奨実施例において、ステープル カートリッジを取換えでき、ステープル装置が別のステープルカートリッジを再 使用できるようジョー部材の１つにステープルカートリッジを容易に取付けでき るための装置が設けられている。好適には、指握持装置はステープルカートリッ ジを手で取扱ってジョー部材の１つから取外しできるようステープルカートリッ ジに形成されている。
【００１７】 概略的には、この考案は直線胃腸吻合ステープル装置または刃物なしの直線ス テープル装置として実施できる改良された外科手術用ステープル装置を提供する ものである。
【００１８】 ステープル装置は、ステープルカートリッジおよび金敷と整列して細長いジョ ー部材を一緒に錠止でき且つ綴とじされる組織にステープルカートリッジと金敷 を正確に位置決めできるよう細長いジョー部材が一緒にゆるく連結される部分錠 止位置に作動できる錠止装置と好適に協同する。綴とじ処理が行われるときに所 要位置にステープルカートリッジと金敷を正確に配置できるようステープル装置 が組立てられた後に、錠止装置はジョー部材を組織上に再配置すべくできる。ま た、ステープル装置が初めに組立てられて組織上の位置に配置された後にジョー 部材が不用意に分解されることを錠止装置は防止する。また、ステープル装置は ステープル形成の際にステープルカートリッジと金敷を一緒に押圧するカム装置 と協同する。カム装置は、ステープルが形成されるときにステープルカートリッ ジと金敷を押し拡げて不均一な高さの閉じたステープルの形成の原因となる傾向 をなすステープルカートリッジと金敷に作用される力に抵抗するようジョー部材 に別の締付力を作用する。更に、ステープル装置は、同一患者における外科手術 のときに異なったステープルカートリッジをステープル装置が再使用するようで きて１つ以上のステープル装置の必要を避け患者の費用を最小にする使い捨ての ステープルカートリッジと協同する。
【００１９】 この考案の他の特長や利点は添付図面を参照しての以下の詳細な説明から明ら かになろう。
【００２０】
【実施例】
図１および図２を参照するに、この考案が実施される直線吻合ステープル装置 ２０は、細長い金敷支持用上ジョー部材２２と細長いステープルカートリッジ支 持用下ジョー部材２４とを有している。金敷支持用上ジョー部材２２はハンドル ２６により支持され、このハンドル２６から上ジョー部材２２の前部が前方に延 びている。ステープルカートリッジ支持用下ジョー部材２４はハンドル２８によ り支持され、このハンドル２８から下ジョー部材２４の前部が前方に延びている 。図３に示される様に、上のハンドル２６と下のハンドル２８は外科医によるス テープル装置２０の取扱い操作を容易にするための手動握り部を形成するよう適 宜形づくられている。大きな前突出部２７と小さな後突出部２９がこのために各 ハンドル２６，２８に設けられている。ハンドル２６，２８間に組織が挟持され るのを防止するために上のハンドル２６の両側に切欠き部２５を設けるようハン ドル２６の前端が切欠かれている。好適には、ハンドル２６，２８はプラスチッ クや他の軽量な材料で造られ、ジョー部材２２，２４はステンレス鋼や他の同様 な材料で造られる。
【００２１】 図５に示される様に、上ジョー部材２２は、頂壁３１により連接される一対の 相対する細長い側壁３０を有する一体的な細長い溝形フレームから成る。上ハン ドル２６は前端近くに上ハンドル２６の内側に設けられた垂下した一対の耳部３ ２を有する。上ジョー部材２２は、下方に突出する耳部３２が垂下する頂壁３１ に沿って中間位置に形成された溝３４（図４）を有する。錠止ピン３６は上ジョ ー部材２２の側壁３０に形成された丸孔を通り且つ垂下する耳部３２に形成され た丸孔を通って延び、上ジョー部材２２を上ハンドル２６に枢着連結している。 錠止ピン３６の両端は上ジョー部材２２から外方横方向に上ハンドル２６の前切 欠き部２５に延びている。上ハンドル２６の内側に形成された垂下する円形案内 棒３７（図４）はハンドル２６に上ジョー部材２２を整列維持するよう上ジョー 部材２２の頂壁３１に形成された丸い開口３９（図５）を通って下方に延びてい る。
【００２２】 図５を参照するに、上ジョー部材２２の前部にはステープル装置２０の金敷４ ０を形成する一対の細長い内方に延びるフランジ３８が設けられている。フラン ジ３８は金敷４０の全長に沿って延びる中央の長い溝４２によって分けられる。 中央の溝４２の近接端にて、フランジ３８には内方に傾斜した案内面４１が設け られている。また、各フランジ３８には２つの長い列の均一に隔ったステープル 形成ポケット４４が設けられている。中央の長い溝４２の末端にて、両フランジ ３８は溝４２の幅狭い前部４５を形成するよう幅が僅かに大きくなっている。図 ４および図５を参照するに、テーパ付金敷先端部４６は中空管状の身体器管内へ のジョー部材の挿入を容易にするように金敷支持用上ジョー部材２２の前部に取 付けられる。金敷先端部４６は、側壁と上ジョー部材２２のフランジ３８によっ て形成される金敷４０上の縦通路を通って挿入される細長い本体４８（図４）に 取外し自在に取付けられる。この細長い本体４８は錠止ピン３６の上の垂下する 耳部３２間に延びており、上ジョー部材２２上の所要場所に本体４８を保持する よう耳部３２の背後に設けられた大きな後部５０を有している。本体４８は、上 ジョー部材２２のフランジ３８の背後に設けられた両側部に位置する一対の垂下 するフランジ５１（図５）を有する。
【００２３】 図２および図６を参照するに、カートリッジ支持用下ジョー部材２４は底壁５ ３により連接された一対の相対する細長い側壁５２を有する一体的な細長い溝形 フレームを成している。下ジョー部材２４の後部に沿って、一対の間隔を置いた 細長い直立の側フランジ５４（図２）が相対する側壁５２から上方に延びている 。図５および図６に示される様に、側フランジ５４間の下ジョー部材２４の幅は 、ステープル装置２０が手術のために組立てられるときに下ジョー部材２４の側 フランジ５４間に上ジョー部材２２の後部を受けることができるように側壁３０ 間の上ジョー部材２２の幅よりも大きい。図２に示される様に、下ジョー部材２ ４の各側フランジ５４は上ジョー部材２２上に錠止ピン３６を整列して配置する 垂直な切欠き５６を有する。上下ジョー部材２２，２４が組立てられるときに、 錠止ピン３６の両端は切欠き５６に受けられる。図１８に示される様に、細長い 本体４８の各垂下するフランジ５１はジョー部材２２の側壁３０と高さが同じで ある。管状組織の一片が上ジョー部材２２の上に配置される時に、フランジ５１ は、金敷４０の近接端とステープルカートリッジ６０とにおける組織の挟込みを 避けるよう側壁３０間の空所内に組織が動き入るのを防止する。
【００２４】 図２および図６に示される様に、下ジョー部材２４は、少なくとも２つの横方 向に隔った縦の列に設けられた複数個の手術用ステープル６１（図１８）を受け るようできるステープルカートリッジ６０を支持する。好適には、ステープルカ ートリッジ６０は側壁５２間の下ジョー部材２４の前部に取外し可能に取付けら れる。ステープルカートリッジ６０は、末端部に向かってステープルカートリッ ジ６０の近接端から延びる中央の細長い溝（図６）によって長手方向に分けられ る。好適には、ステープルカートリッジ６０に形成された複数個のステープル開 口６４は２組の横方向に隔った列に設けられ、各組の列が中央の長手方向の溝６ ２の両側に配置されている。複数個の手術用ステープル６１（図１８）がステー プルカートリッジ６０のステープル開口６４内に取付けられる。図６に示される 様に、隣接した列のステープル開口６４は、ステープル装置２０が作動されると きに組織の一層有効な綴とじを設けるよう食い違っている。図１５および図１６ を参照するに、ステープルカートリッジ６０は、細長い中央の溝６２の両側に設 けられて中央溝６２の各々の側の食い違った列のステープル開口６４間に配置さ れた一対の長手方向の溝６６を有する。各長手方向の溝６６はステープルカート リッジ６０の近接端から末端部に向かって延びている。
【００２５】 図１７図に示される様に、ステープルカートリッジ６０に装入されたステープ ル６１を作動するために複数個のステープルドライバ６５がステープル開口６４ 内に滑動可能に取付けられている。図６図を参照するに、各ステープルドライバ ６５はステープルカートリッジ６０に設けられた隣接の列に配置された２つのス テープル６１を同時に作動するよう設計されている。従って、第１の組のステー プルドライバ６５は中央の長手方向の溝６２の一方の側に配置された食い違った 列のステープル６１を作動するよう設けられ、第２の組のステープルドライバ６ ５は中央の長手方向の溝６２の他方の側に配置された隣接の列の組のステープル ６１を作動するべく設けられている。
【００２６】 図２および図３に示される様に、ステープルカートリッジ６０の前端、すなわ ち末端部は中空管状の身体器管内への下ジョー部材２４の挿入を容易にするよう テーパー付先端部６８を有する。テーパー付先端部６８の直ぐ背後のステープル カートリッジ６０には下ジョー部材２４の側壁５２に設けられた対応する切欠き に受けられる一対の後方に伸びる突出部７０（図１４に１つだけ図示される）が 設けられている。図１４および図１５に示される様に、一対の間隔を置いた平行 なフランジ７１はステープルカートリッジ６０の両側から後方に延びる。一対の 垂下するアーム７２（図１４に１つ図示）はステープルカートリッジ６０の後部 にてフランジ７１から下方に延びている。各アーム７２には丸くなった下方を向 いた切欠き７４が設けられている。ステープルカートリッジ６０が下ジョー部材 ２４に組まれる時に、突部７０は側壁５２の前端部に設けられた対応する切欠き に受けられ、垂下するアーム７２は下ジョー部材２４の底壁５３に形成された開 口７６（図４）を通って下方に延びる。下ジョー部材２４は開口７６の両側の側 壁５２から下方に延びる一対の垂下する耳部７８（図１９）を有する。ピボット ピン８０は下ジョー部材２４の垂下する耳部７８に形成された孔を通ってステー プルカートリッジ６０の垂下するアーム７２の丸い切欠き７４内に延びている。 丸い切欠き７４はステープルカートリッジ６０を下ジョー部材２４に取外し自在 に取付けるようピボットピン８０とスナップ係合するよう設けられている。ピボ ットピン８０の両端は下ハンドル２８の内両側に沿って形成された溝８１（図３ および図６）に受けられ支持される。
【００２７】 推奨実施例において、ステープルカートリッジ６０は容易に取外して別のステ ープルカートリッジ６０と取換えできるよう下ジョー部材２４の前端部に取外し 可能に取付けられる。図１４および図１５に示される様に、一対のウィング８２ がステープルカートリッジ６０の後部にて両側から上外方に延びている。ウィン グ８２は、下ジョー部材２４にステープルカートリッジ６０を手で挿入したり、 別のステープルカートリッジ６０をステープル装置２０に組み込むよう所要され るときに下ジョー部材２４から手で取外しできるように指握持部として作用する 。更に、短い延長部８４（図１５）がステープルカートリッジ６０の後部の後方 に突出するフランジ７１間に形成配置されている。中央の刃形の溝６２は、溝６ ２の近接端の両側の内方に傾斜する案内面８６が設けられた延長部８４を通って 縦方向に延びている。ステープルカートリッジ６０が取外し自在であるために、 ステープル装置２０は同一患者における手術の際に再使用できる。従って、ステ ープル装置２０における使用にて１つ以上の使い捨てのステープルカートリッジ ６０を使用することによって、患者の費用を十分減少できる。
【００２８】 図２を参照するに、ステープル装置２０は上下ジョー部材２２，２４をジョー 部材２２，２４に沿って中間位置にて一緒に錠止する錠止装置９０を有する。好 適には、上下ジョー部材２２，２４は金敷４０とステープルカートリッジ６０の 近接端に隣接した位置にて一緒に錠止される。推奨実施例にて、錠止装置９０は ピボットピン８０（図４）を介して下ジョー部２４に枢着される錠止アーム９２ （図２）を有する。錠止アーム９２は溝形をなしており、下ジョー部材２４の側 壁５２に架かるよう十分な間隔をもって隔てられた一対の相対する細長い側壁９ ４（図６）を有する。錠止アーム９２の各側壁９４は、錠止ピン３６を受けるた めの前方を向いた溝９８が設けられた上前方に延びるフック部材９６を有する。 図２に示される様に、下方に傾斜したカム面９７はフック部材９６の前部から前 方を向いた溝９８内に後方に延びている。また、内方に延びるくぼみの形の丸い 止め９９が後に詳しく説明される様に部分錠止位置に錠止アーム９２を保持する ためにフック部材９６の後部に設けられる。
【００２９】 図２を参照するに、カバー１００は錠止アーム９２の下面に取付けられる。錠 止アーム９２が図３に示される様に閉じられる時に、カバー１００は下ハンドル ２８の底部と整列して外科医によるステープル装置２０の取扱い操作を容易にす るようなす。好適には、カバー１００はプラスチックや他の軽い材料でつくられ 、錠止アーム９２はステンレス鋼でつくられる。図７に示される様に、カバー１ ００は、錠止位置から解錠位置に錠止アーム９２が下方に枢動できるように指握 持部として作用するために両側から外方に延びる細長いフランジ１０２，１０４ を有する。錠止アーム９２が閉じた錠止位置に動かされる時に、フック部材９６ の溝９８の面は錠止ピン３６と協同して錠止位置に錠止アーム９２を維持するよ うオーバーセンターラッチとして作用する。
【００３０】 この考案に従えば、上下ジョー部材２２，２４を互いに離すことなく組織上の 所要位置にステープルカートリッジ６０と金敷４０を調節できるように互いにゆ るく連結されたジョー部材２２，２４と共に部分的に錠止された位置に錠止装置 ９０を保持する装置が設けられる。図２２および図２３を参照するに、保持装置 は、前方を向いた溝９８から後方に隔った位置にてフック部材９６に形成された 内方に延びるくぼみの形の丸い止め９９として実施されている。好適には、錠止 アーム９２は、ジョー部材２２，２４を互いに錠止する錠止位置（図３）にジョ ー部材２２，２４が完全に離れることができる解錠位置（図２）から動くことが できる。また、錠止アーム９２は、金敷４０とステープルカートリッジ６０が組 織上の所要位置に調節できるように錠止装置９０が上ジョー部材２２とゆるく係 合されると共に上下ジョー部材２２，２４が互いに連結されたままである部分錠 止位置（図２２）に動くことができる。
【００３１】 開いた解錠位置（図２）の錠止アーム９２によって、上下ジョー部材２２，２ ４の組立分解にて溝５６に対して錠止ピン３６を自由に動かすことができるよう 溝５６の後にフック部材９６が配置される。閉鎖位置に動かされた錠止アーム９ ２によって、フック部材９６は溝５６を横切って延びる位置に前方に動かされる 。錠止ピン３６が溝５６内に挿入された閉じた錠止位置に錠止アーム９２が動か されるときに、錠止ピン３６は傾斜したカム面９７と係合されて溝５６内を下方 に動かされる。錠止アーム９２が十分錠止された位置（図３）に達した時に、フ ック部材９６は前方を向いた溝９８内に受けられた錠止ピン３６の上の位置に動 かされる。この錠止位置の錠止アーム９２によって、錠止ピン３６は前方を向い た溝９８内に受けられ各溝５６の底部近くの位置に保持される。
【００３２】 更に、下ジョー部材２４の一方の側のフランジ５４に形成された細長い溝１２ ２の前端部に止め９９が受けられてフック部材９６の前端部が溝５６を横切って 位置された中間の部分錠止位置（図２２）に錠止アーム９２が動くようできる。 細長い溝１２２（図２３）に位置された止め９９によって、フック部材９６の傾 斜したカム面９７は溝５６を横切って位置されて錠止ピン３６を溝５６内に制限 し矢印１０６により示される様に垂直方向の錠止ピン３６の制限された動きを許 し、上下ジョー部材２２，２４が互いに離れることなくジョー部材２２，２４の 前端部が離れるようにできる。従って、錠止アーム９２の中間錠止位置は、ジョ ー部材２２，２４を完全に離すことなくジョー部材２２，２４間に位置された組 織上の所要位置にジョー部材２２，２４を調節できるようにする。
【００３３】 図６および図１０を参照するに、推奨実施例のステープル装置２０は、ステー プル６１をステープルカートリッジ６０からジョー部材２２，２４間に握持され た組織内に駆動して金敷４０に対してステープル６１を形づくって組織内に形成 されたステープルの列の間の線に沿って組織を切断するために上下ジョー部材２ ２，２４に対し長手方向に動くべく滑動可能に取付けられた改良された押棒刃物 装置１１０を有している。押棒刃物装置１１０は、直立する側フランジ５４間の 溝形の下ジョー部材２４内に滑動可能に受けられる押ブロック１１２（図６）を 有する。図１１に示される様に、押ブロック１１２は、頂面に長手方向に延びる 切欠き１１９が設けられた横方向に突出するフィンガ１１８を有するフランジ１ １６により作動ノブ１１４に取付けられている。フィンガ１１８は、押ブロック １１２と作動ノブ１１４を一緒に固着するよう長手方向の錠止棒１２１の下に切 欠き１１９を位置すべく押ブロック１１２に形成された横溝１２０内にスナップ 係合される。作動ノブ１１４のフランジ１１６は下ジョー部材２４の１つの側フ ランジ５４に形成された細長い溝１２２（図２）を通って延び、且つ溝１２２に 沿って載っている。
【００３４】 押棒刃物装置１１０は押ブロック１１２から前方に突出する一対のステープル 押棒１２４（図１０）を有する。押棒１２４は、ステープルカートリッジ６０の 細長い溝６６（図１６）と押棒１２４が整列するようステープルカートリッジ６ ０の後のフランジ７１間の下ジョー部材２４に取付けられた案内ブロック１２５ （図６）に形成された長手方向の溝内に滑動可能に受けられる。押ブロック１１ ２には押棒１２４が固着された一対の垂直な溝１２６（図１１）が設けられてい る。第１０図に示される様に、各ステープル押棒１２４の前端には、押棒１２４ がステープルカートリッジ６０内に進められるときにステープルドライバ６５と 係合すべく傾斜したカム面１３０を形成するくさび形の先端部１２８が設けられ ている。図２１に示される様に、各ステープルドライバ６５は、カム面１３０と 面１３２の間に平らな滑動接触を設けるよう各ステープル押棒１２４のカム面１ ３０に対して同じ角度が付けられた傾斜した面１３２が設けられる。
【００３５】 案内ブロック１２５は下ジョー部材２４の底壁５３の開講７６を通って下方に 延び且つピボットピン８０を受ける横方向の孔を有する垂下した中央部１３１を 有する。ピボットピン８０の両端部は下ハンドル２８に案内ブロック１２５と下 ジョー部材２４を取付けるよう下ハンドル２８に形成された溝８１（図３および 図６）によって支持されている。下ジョー部材２４の後端部は、底壁５３の孔を 通って上方に延び拡大された頭部１３５（図６）が形成されたピン１３３によっ て下ハンドル２８に固着されている。
【００３６】 図６および図１０を参照するに、押棒刃物装置１１０は、直立する側フランジ ５４間の下ジョー部材２４に沿って長手方向に動くべく滑動可能に取付けられた 刃物ブロック１３４を有する。刃物ブロック１３４は、ステープルカートリッジ ６０の中央の長手方向の溝６２と整列する案内ブロック１２５に形成された中央 の長手方向の溝１３７内に前方に延びる刃物支持棒１３６を有していた。傾斜し た切断縁１４０が設けられた傾斜した刃物１３８は刃物支持棒１３６の前端部に 設けられている。刃物１３８の傾斜した切断縁は細長いジョー部材２２，２４に 対して角度をもって向いており、案内ブロック１２５の中央長手方向の溝１３７ 内に滑動可能に受けられている。
【００３７】 図４および図６に示される様に、引込められた押棒刃物装置１１０によって、 刃物１３８は案内ブロック１２５の中央溝１３７内に位置される。押棒刃物装置 １１０が前進されるときに、刃物１３８は中央の溝１３７（図６）と傾斜した延 長部８４（図１５）によってステープルカートリッジ６０の中央長手方向の溝６ ２内に案内され、傾斜した案内面４１（図５）によって金敷４０の中央長手方向 の溝４２内に案内される。
【００３８】 ステープル装置２０の推奨実施例において、刃物ブロック１３４は、刃物ブロ ック１３４に対して押ブロック１１２が滑動できるようステープル押棒１２４を 滑動可能に受けるべく貫通して延びる一対の長手方向の溝１３５（図２０）を有 している。従って、押ブロック１１２が作動ノブ１１４によってステープルカー トリッジ６０に向かって進められるときに、ステープル押棒１２４は、押ブロッ ク１１２が刃物ブロック１３４と係合するよう動かされるまで固定されている刃 物ブロック１３４を通って滑動する。刃物ブロック１３４が押ブロック１１２に より係合された後に、刃物ブロック１３４と押棒１２４はステープルカートリッ ジ６０に向かって同時に進む。図１８に示される様に、刃物ブロック１３８は案 内ブロック１２５からステープルカートリッジ６０内にステープル押棒１２４に 沿って進められ、ジョー部材２２，２４間に握持された組織にステープル６１を 形成し、ステープル列の間の組織を切断する。その後、作動ノブ１１４が引込め られるときに、押ブロック１１２は固着されている刃物ブロック１３４を通って 後方にステープル押棒１２４を先ず滑動する。各ステープル押棒１２４は予定距 離引込められた後に刃物ブロック１３４と係合するよう動くずれ部１４２を有す る。刃物ブロック１３４と係合するステープル押棒１２４のずれ部１４２によっ て押ブロック１１２と刃物ブロック１３４は、押棒１２４と刃物ブロック１３８ を案内ブロック１２５の出発位置に戻すよう作動ノブ１１４により同時に引込め られる。
【００３９】 この考案に従えば、ステープル装置２０は、ステープル６１の形成の際にステ ープルカートリッジ６０と金敷４０を一緒に押すようジョー部材２２，２４に締 付力を作用するジョー締着装置が設けられている。ジョー締着装置は、ステープ ル６１が形成されるときにステープルカートリッジ６０と金敷４０に作用される 力に抵抗するよう錠止装置から離れた位置にてジョー部材２２，２４を離して押 圧するカム装置を有する。推奨実施例にて、カム装置はジョー部材の１つに取付 けられ、ステープルカートリッジ６０と金敷４０を一緒に押圧するよう離れた位 置にてジョー部材を離して動かすべくジョー部材と係合できる。好適には、カム 部材は錠止装置から離れた位置にてジョー部材の１つに枢着されている。カム部 材はジョー部材の離れた端部を離して動かすよう第１の不作動位置から第２の作 動位置に枢動できる。カム部材は、押ブロック１１２が進められる時に作動位置 に動かして押ブロックが引込められる時に不作動位置に戻されるように押棒の押 ブロック１１２と押棒刃物装置１１０とによって作動できる。
【００４０】 ステープル装置２０の推奨実施例において、カム装置１５０は図４に示される 様に下ジョー部材２４の後端部に隣接配置されている。カム装置１５０は下ジョ ー部材２４の直立する側フランジ５４間に延びる横ピボットピン１５４に枢着さ れたカム部材１５２を有する。カム部材１５２は、上ジョー部材２２の頂壁３１ を第１の不作動位置（図１２）のカム部材１５２と係合するための第１の下カム 面１５６と、上ジョー部材２２の頂壁３１を第２の作動位置（図１３）に置かれ たカム部材１５２と係合するための第２の高カム面１５８とを有する。第１カム 面１５６は上下ジョー部材２２，２４を不作動位置のカム部材１５２と実質的に 平行に維持するよう設けられている。第２カム面１５８は、カム部材１５２が不 作動位置から作動位置に枢動するときに約３.２mm（０.１２５インチ）上ジョー 部材２２の後端部を持上げるよう設けられている。更に、上ジョー部材２２は、 カム部材１５２が不作動位置から作動位置に動かされるときに下ジョー部材２４ から離れて上方に上ジョー部材２２の後部を動かすことができるよう十分弾性的 になっている。
【００４１】 図４に示される様に、カム部材１５２は大きな前フィンガ１６２と小さな後フ ィンガ１６４にカム部材１５２を分ける放射方向に延びる切欠き１６０を有する 。前フィンガ１６２は後方を向いた平らな面１６５を有し、後フィンガ１６４は 前方を向いた傾斜した面１６６を有している。不作動位置のカム部材１５２によ って、前フィンガ１６２と後フィンガ１６４は下ジョー部２４の底壁５３に形成 された細長い溝１６８を通って下方に延びる。図１３に示される様に、カム部材 １５２は、カム部材１５２が作動位置に動かされるときに案内棒３７を受ける位 置の前フィンガ１６２に形成された半円形切欠き１６９を有する。案内棒３７は 後端がカム部材１５２によって上方に動かされるときに上ジョー部材２２の整列 を維持するよう作用する。
【００４２】 推奨実施例において、カム部材１５２は、押ブロック１１２が前進されるとき に不作動位置から作動位置に動くよう押ブロック１１２によって作動できる。図 １１に示される様に、押ブロック１１２は隙間１７２を間に形成するよう隔った 一対の後方に延びるアーム１７０を有する。アーム１７０の後端部は、隙間１７ ２を横切って延びるカム作動用ピン１７４によって連結される。図４および図１ １を参照するに、不作動位置に位置されたカム部材１５２によって、前フィンガ １６２は押ブロック１１２のアーム１７０間に延びる隙間１７２を通って延び、 カム作動用ピン１７４はカム部材１５２の前フィンガ１６２と後フィンガ１６４ の間の切欠き１６０に受けられる。
【００４３】 図１２に示される様に、第１の不作動位置に位置されたカム部材１５２によっ て、上ジョー部材２２の頂壁３１はカム部材１５２の第１下カム面１５６上に載 る。不作動位置のカム部材１５２によって、上ジョー部材２２の頂壁３１は下ジ ョー部材２４の底壁５３にほぼ平行である。更に、押ブロック１１２は刃物ブロ ック１３４から後方に隔った出発位置に位置される。押ブロック１１２が矢印１ ８２（図１３）により示される様に前進されるときに、カム作動用ピン１７４は 前フィンガ１６２の請う面１６５と係合してカム部材１５２を矢印１８４により 示される様に反時計方向に回転し、カム部材１５２を第２の作動位置に枢動して 第２のカム面１５８が上ジョー部材２２の頂壁３１と係合するよう動かす。作動 位置に枢動されたカム部材１５２によって、上ジョー部材２２の頂壁３１は下ジ ョー部材２４の底壁５３から離れて矢印１８６により示される様に上方に動かさ れる。カム部材１５２は上下ジョー部材２２，２４に力を作用して上下ジョー部 材２２，２４の後部を離すよう動かす。上下ジョー部材２２，２４の後部が離れ て動く結果、別の締着力が上下ジョー部材２２，２４の前部に作用され、金敷４ ０とステープルカートリッジ６０をジョー部材２２，２３間に握持された組織に 対して締着する。従って、金敷４０とステープルカートリッジ６０は、押棒刃物 装置１１０が前進されてステープル６１を成形し組織を切断する時に、金敷４０ とステープルカートリッジ６０に作用される力に抵抗するよう一緒に押される。
【００４４】 図１３を参照するに、ステープル６１が形成された後に押ブロック１１２が引 込められるときに、カム作動用ピン１７４は後フィンガ１６４の傾斜した面１６ ６と係合してカム部材１５２を時計方向に枢動する。カム作動用ピン１７４が傾 斜した面１６６に沿って切欠き１６０内に動くときに、カム部材１５２は時計方 向に枢動して上ジョー部材２２の頂壁３１と係合した第１の下カム面１５６と一 緒に第１の不作動位置（図１２）に戻る。結果的に、カム部材１５２によって上 下ジョー部材２２，２４の後部に作用される力は解除され、上ジョー部材２２の 頂壁３１は下ジョー部材２４の底壁５３とほぼ平行な関係に戻る。同様に、ジョ ー部材２２，２４の前部に作用される締着力が解除されて金敷４０とステープル カートリッジ６０を解放する。
【００４５】 ステープル装置２０の推奨実施例において、第１の一対の直立する可撓性の保 持アーム１９２（図１２および図２４）は、引込められた押ブロック１１２と一 緒に不作動位置（図１２）にカム部材１５２を保持するよう下ハンドル２８の内 側に設けられる。更に、第２の一対の直立する可撓性の保持アーム１９４（図１ ３および図２５）は前進された押ブロック１１２と共に作動位置にカム部材１５ ２を保持するよう下ハンドル２８の内側に設けられている。カム部材１５２は、 作動および不作動位置にカム部材１５２を夫々保持するよう保持アーム１９２， １９４と協同する後フィンガ１６４の両側から横外方に延びる一対の丸い耳部１ ９６が設けられている。また、カム部材１５２は丸い耳部１９６の後の後フィン ガ１６４上に位置された一対の停止ピン１９８を有する。停止ピン１９８の両端 は丸い耳部１９６を越えた後フィンガ１６４から横外方に延びている。
【００４６】 引込められた押ブロック１１２と不作動位置のカム部材１５２（図１２）によ って、後フィンガ１６４と丸い耳部１９６は保持アーム１９２の後に位置される 。図２４に示される様に、保持アーム１９２は後フィンガ１６４の厚さと丸い耳 部１９６よりも小さい間隔離れて横方向に隔てられている。結果的に、保持アー ム１９２は不作動位置から作動位置に向かうカム部材１５２の動きに抵抗する傾 向がある。しかし、保持アーム１９２は、不作動位置から作動位置にカム部材１ ５２を動かすよう押ブロック１１２が前進されるときに、丸い耳部１９６と後フ ィンガ１６４が間を通過できるように十分に可撓性である。同様に、保持アーム １９４は後フィンガ１６４の厚さと丸い耳部１９６よりも小さい間隔離れて横方 向に隔っている。しかし、保持アーム１９４は、カム部材１５２が作動位置に動 かされるときに、丸い耳部１９６と後フィンガ１６４が間を移動できるように十 分に可撓性である。
【００４７】 図１３および図２５を参照するに作動位置のカム部材１５２によって、後フィ ンガ１６４と丸い耳部１９６は可撓性の保持アーム１９４間に捕らえられ、前進 された押ブロック１１２と共にカム部材１５２を作動位置に保持する。停止ピン １９８は後フィンガ１６４から十分外方に延びて作動位置を越えるカム部材１５ ２の動きに抵抗するようなる。従って、押ブロック１１２が作動位置から不作動 位置にカム部材１５２を戻すよう引込められるまで、カム部材１５２は作動位置 に保持される。カム部材１５２が不作動位置（図１２および図２４）に戻る時に 、保持部材１９２は丸い耳部１９６によって一部撓められ、後フィンガ１６４が 保持アーム１９２間を通るよう許す。不作動位置に戻されたカム部材１５２によ って、丸い耳部１９６は、引込められた押ブロック１１２を保持するよう不作動 位置から離れるカム部材１５２の動きに抵抗する保持アーム１９２の背後に位置 される。
【００４８】 推奨実施例のステープル装置２０は、ステープル装置のステープルカートリッ ジ６０と金敷４０の間に予定された間隙を維持すべく上下ジョー部材２２，２４ の１つに取付けられた間隔装置を有する。図４および図６を参照するに、この間 隔装置はステープルカートリッジ６０の末端部に隣接して取付けられた間隔ピン ２００として実施されている。間隔ピン２００は下ジョー部材２４の底壁５３か らステープルカートリッジ６０を通って上方に垂直に延び、ステープルカートリ ッジ６０の頂部から予定の間隔上方に突出している。図２６に示される様に、金 敷４０のフランジ３８は、間隔ピン２００を受けるべく中央の長手方向の溝４２ の幅狭い前部４５を形成する内方にずれたフランジ２０２を有する。間隔ピン２ ００（図２２）は、金敷４０とステープルカートリッジ６０の末端部を間に予定 の間隔を置いて整列維持するよう溝４２（図２６）の幅狭い前部に受けられる丸 い尖端部を有している。手術のために組立てられたステープル装置（図４）によ って、間隔ピン２００は金敷４０とステープルカートリッジ６０の間に予定の間 隙と整列を維持するようフランジ２０２（図２６）と係合する。
【００４９】 ステープル装置２０の作動において、綴とじおよび切断される組織はジョー部 材２２，２４間に先ず位置されてこれらジョー部材２２，２４により締着されね ばならない。従って、ハンドル２６，２８は解錠位置（図２）に対する下方への 錠止アーム９２の枢動によって解錠される。結果として、錠止ピン３６の両端部 は錠止アーム９２のフック部材９６に形成された溝９８から解放される。その後 に、上下ジョー部材２２，２４は下ジョー部材２４の側フランジ５４に形成され た溝５６から錠止ピン３６を解放することによって分離できる。
【００５０】 次に、綴とじおよび切断される組織はジョー部材２２，２４の上に位置される 。例えば、図１７に示される様に、一片の管状の腸組織を各ジョー部材２２，２ ４の前部の上を滑動できる。組織がジョー部材２２，２４の上に置かれた後に、 ステープル装置２０が再組立てされる。再組立は錠止ピン３６をジョー部材２４ の直立する側フランジ５４に形成された垂直な切欠き５６と整列することによっ て達成できる。その後に、下ジョー部材２４の側フランジ５４は上ジョー部材２ ２の側壁３０に跨がる上ハンドル２６の内側に位置され、錠止ピン３６の両端部 が垂直な溝５６に挿入される。終わりに、錠止アーム９２は、下ハンドル２８の 底部と同じ高さのカバー１００と一緒に錠止位置（図３）に上方に枢動される。 結果として、フック部材９６は錠止ピン３６の上を枢動され、溝９８は錠止ピン ３６の両端部を受ける。従って、上下ジョー部材２２，２４は金敷４０とステー プルカートリッジ６０に隣接して中間位置において一緒に錠止される。更に、間 隔ピン２００は身体組織を通って金敷４０のフランジ２０２（図２６）と係合し 金敷４０とステープルカートリッジ６０の間に予定の間隙と整列を維持する。
【００５１】 ジョー部材２２，２４の組織上の位置を調節するように必要とされれば、錠止 アーム９２は互いにゆるく連結されたジョー部材２２，２４によって部分的に錠 止された位置（図２２）に枢動される。錠止アーム９２は下ジョー部材２４の細 長い溝１２２内に位置された止め９９によって部分錠止位置に保持される。図２ ６に示される様に、各フック部材９６は、溝５６内に錠止ピン３６を抑制するよ う溝５６を横切って延びる傾斜したカム面９７によって部分錠止位置に保持され る。結果として、錠止ピン３６は図２２に示される様にジョー部材２２，２４の 前端部を離すことができるように切欠き５６内の制限された垂直な動きが可能で 、他方ジョー部材２２，２４は互いにゆるく連結されたままである。従って、部 分錠止位置の錠止装置９０によって、ジョー部材２２，２４を完全に分解するこ となく組織上の位置にジョー部材２２，２４は調節できる。ジョー部材２２，２ ４が組織上の所要位置に位置された後に、錠止アーム９２はジョー部材２２，２ ４を互いに錠止するよう十分錠止された位置（図３）に戻される。
【００５２】 組織がジョー部材２２，２４間に締着された後に、ステープル装置２０は押棒 刃物装置１１０を作動するよう作動ノブ１１４を前進させることによって発射さ れる。先ず、カム装置１５０の作動において、押ブ１１２と押棒１２４（図４） が前進され、他方刃物ブロック１３４は固定されたままである。押ブロック１１ ２と押棒１２４が前進されてカム部材１５２が作動されるだけなので、ステープ ル装置２０を作動するよう必要とされる初期の力が最小にされる。
【００５３】 図１２を参照して、押ブロック１１２の初期前進の間に、押棒１２４は刃物ブ ロック１３４を通って滑動し、押棒１２４のくさび形の先端部１２８はステープ ルカートリッジ６０の溝６６を通って前進するよう始める。押棒１２４のくさび 形の先端部１２８は案内ブロック１２５とステープルカートリッジ６０（図６） の後のフランジ７１によって溝６６内に案内される。押ブロック１１２が刃物ブ ロック１３４に向かって前進するときに、カム作動用ピン１７４は前フィンガ１ ６２の後面１６５と係合して図１３の矢印１８４により示される様にカム部材１ ５２を反時計方向に枢動し、カム部材１５２の第２のカム面１５８を上ジョー部 材２２の頂壁３１と係合するよう動かす。カム部材１５２は力を上下ジョー部材 ２２，２４に作用してジョー部材２２，２４の後部が離れるよう動かす。結果と して、上ジョー部材２２の頂壁３１の後端部は下ジョー部材２４の底壁５３の後 端部材に対して約３.２mm（０.１２５インチ）上方に動かされる。ジョー部材２ ２，２４の後端部材が離れる動きは、ジョー部材２２，２４間に握持される組織 に対して金敷４０とステープルカートリッジ６０を締着するようジョー部材２２ ，２４の全部の別の締着力に基づいている。これら別の締着力は金敷４０とステ ープルカートリッジ６０に作用される力に抵抗する傾向があり、他方組織は切断 されてステープル６１は金敷４０に対して形成されて所要の間隔を金敷４０とス テープルカートリッジ６０の間に維持し、実質的に高さが均一になった形成ステ ープル６１を造るようになる。
【００５４】 図１３の参照にて、カム装置１５０が作動された後に、押ブロック１１２は刃 物ブロック１３４と実際に係合して刃物ブロック１３４をステープルカートリッ ジ６０に向かって長手方向に動かし始める。好適には、押ブロック１１２と刃物 ブロック１３４間の初期間隔は、カム部材１５２が作動位置に達する僅か前に押 ブロック１１２が刃物ブロック１３４と係合するように設けられている。また、 押ブロック１１２と刃物ブロック１３４間の初期間隔は、作動位置に対するカム 部材１５２の動きが完了した後に押ブロック１１２が先ず刃物ブロック１３４に 係合するような具合に設けることができる。押ブロック１１２が刃物ブロック１ ３４と係合するときに、金敷４０とステープルカートリッジ６０の中央長手方向 の溝４２，６２に沿った刃物１３８の前進が始められる。その後に、押棒１２４ と刃物１３８は金敷４０とステープルカートリッジ６０の間に握持された組織を 綴込んで切断するよう同時に前進される。
【００５５】 押ブロック１１２が前進される場合に、ステープル押棒１２４はステープルカ ートリッジ６０内に設けられた溝６６に沿って長手方向に動かされる。ステープ ル押棒１３４の２つのくさび形カム面１３０はステープルドライバ６０の傾斜面 と係合するよう溝６６を通って動いてステープルカートリッジ６０からステープ ル６１を連続的に駆動してステープル６１を金敷用フランジ３８に対してＢ型形 状に形成するようになす。カム面１３０は、中央長手方向の溝６２の両側に位置 されたステープルドライバ６５を同時に作動するよう押ブロック１１２から同一 間隔をもって配置される。同時に、刃物ブロック１３４は案内ブロック１２５の 中央の溝１３７から金敷４０の中央の長手方向の溝４２を通り且つステープルカ ートリッジ６０の中央の長手方向の溝６２を通って刃物１３８を動かしてジョー 部材２２，２４間に握持された組織を切断するように前進される。カム装置１５ ０を介して上下ジョー部材２２，２４の前部に作用される別の締着力はステープ ル６１が形成されるときに金敷４０とステープルカートリッジ６０に作用される 力に抵抗するようなす。
【００５６】 先ず、図１２および図２４に示される様に、引込められた押ブロック１１２に よって第１の組の可撓性の保持アーム１９２の背後に位置された丸い耳部９６に よってカム部材１５２は不作動位置に保持される。押ブロック１１２が前進を始 めるときに、保持アーム１９２は後フィンガ１６４が間を通過できる様に丸い耳 部９６によって離れるよう屈曲される。図１３および図２５に示される様に、カ ム部材１５２が作動位置に動かされるときに、後フィンガ１６４と丸い耳部１９ ６は第２の組の可撓性の保持アーム１９４間に捕らえられてカム部材１５２を作 動位置に保持するようなし、他方押ブロック１１２は前進される。後フィンガ１ ６４上の停止ピン１９８は作動位置を越えるカム部材１５２の動きに抵抗する。 従って、カム部材１５２は、押ブロック１１２が引込められるまで作動位置に保 持される。
【００５７】 ステープルカートリッジ６０内の全ステープル６１を形成する押ブロック１１ ２が十分前進された後に、押ブロック１１２は作動ノブ１１４の引込みにより出 発位置に向かって引込められる。先ず、まだ固定されたままの刃物ブロック１３ ４を通ってステープル押棒１２４が滑動するために押ブロック１１２がステープ ルカートリッジ６０から後方に動くだけである。ステープル押棒１２４のずれ部 １４２が刃物ブロック１３４の前部と係合するときに、刃物ブロック１３４は押 ブロック１１２と共にステープルカートリッジ６０から後方に動かされる。結果 として、押棒１２４と刃物１３８はステープルカートリッジ６０と金敷４０から 同時に引込められる。
【００５８】 押ブロック１１２が出発位置に向かって戻る場合に、カム作動ピン１７４は不 作動位置に向かって時計方向にカム部材１５２を枢動するように後フィンガ１６ ４の傾斜した面１６６に係合する。この結果、後フィンガ１６４の丸い耳部１９ ６は可撓性の保持アーム１９４から解放される。カム作動用ピン１７４が前後フ ィンガ１６２，１６４間の溝１６０内に傾斜した面１６６に沿って動いてカム部 材１５２を不作動位置に戻す。結果的に、カム部材１５２の第２のカム面１５８ が上ジョー部材２２の頂壁３１から離脱されて、上ジョー部材２２の頂壁３１の 後端部が第１のカム面１５６と係合するよう下方に動く。同時に、前フィンガ１ ６２は押ブロック１１２上のアーム１７０間の隙間１７２内に下方に枢動し、前 後両フィンガ１６２，１６４は下ジョー部材２４の底壁５３に形成された溝１６ ８内に下方に枢動する。その後に、不作動位置のカム部材１５２によって、錠止 アーム９２は上下ジョー部材２２，２４を分解できるよう図２に示される如く下 方に枢動できる。このために、切断され且つ綴とじされた組織はジョー部材２２ ，２４から離れることができる。
【００５９】 不作動位置（図１２および図２４）にカム部材１５２を戻す押ブロック１１２ の引込みの際に、保持アーム１９２は丸い耳部１９６によって離れるよう屈曲さ れ、後フィンガ１６４が保持アーム１９２の間を後方に通過するようできる。不 作動位置に戻されたカム部材１５２によって、丸い耳部１９６は保持アーム１９ ２の背後に位置されて不作動位置から離れるカム部材１５２の動きに抵抗すると 共に引込められた押ブロック１１２を保持する様になす。
【００６０】 また、この考案は組織の綴とじだけが必要とされる外科的処理を行うための刃 物のない外科用ステープル装置にも実施できる。図２７乃至図２９を参照して、 ４列の直線外科用ステープル装置２２０は、刃物支持棒１３６および刃物１３８ （図４乃至図６に図示される）が省略されていることを除いて直線吻合ステープ ル装置２０（図１乃至図２６）の全ての特長と関連する。他の点で、刃物のない ４列の直線外科用ステープル装置２２０の構造は上述した直線吻合ステープル装 置２０と大体同じである。従って、直線吻合ステープル装置２０に関連して上述 に使われた同じ符号が４列の直線外科用ステープル装置２２０の同一である部分 に同じに使用される。
【００６１】 ４列の直線外科用ステープル装置２２０の作用は、組織の切断が行われないこ とを除いては上述した直線吻合ステープル装置２２０と実質的に同じである。金 敷４０とステープルカートリッジ６０が組織上の所要位置に位置された後に、ジ ョー部材２２，２４を一緒に錠止するよう錠止アーム９２が閉鎖位置に枢動され る。もし必要ならば、金敷４０およびステープルカートリッジ６０を組織上の位 置に調節できるよう互いにゆるく連結されたジョー部材２２，２４によって錠止 アーム９２は部分錠止位置に動かすことができる。作動ノブ１１４と押ブロック １１２が前進される時に、カム部材１５２は不作動位置から作動位置に動かされ て付加的な締着力をジョー部材２２，２４の前部に作用して組織を金敷４０とス テープルカートリッジ６０の間に握持するようなす。４列の成形されたステープ ルは、作動ノブ１１４と押ブロック１１２が押棒１２４をステープルカートリッ ジ６０内に動かすよう完全に前進される時に造くられる。４列の直線ステープル 装置２２０の刃物ブロック１３４は、押ブロック１１２とステープル押棒１２４ の前方移動の大きさを制限するよう案内ブロック１２５と係合すべく押ブロック １１２により前進されるスペーサすなわち間隔体として作用する。作動ノブ１１ ４と押ブロック１１２が引込められるときに、刃物ブロック１３４はステープル 押棒１２４のずれ部１４２によって出発位置に戻される。押ブロック１１２が十 分引込められるときに、カム部材１５２が作動位置から不作動位置に戻されてジ ョー部材２２，２４に作用された締着力を解放するようになす。その後に、錠止 アーム９２が解錠位置に動かされてジョー部材２２，２４を離脱して綴とじした 組織から除去される。
【００６２】 この考案の外科用ステープル装置は、効率的で且つ費用的に有効な外科手術を 設けるよう単一患者利用を容易にすべく好適に設計される。好適に、直線吻合ス テープル装置２０と４列直線ステープル装置２２０は、単一患者における外科手 術の際に他列ステープル処置のために同一装置を再使用できるよう１つ以上の処 理可能なステープルカートリッジ６０と共に使用されるよう設計されている。例 えば、同一患者において１つ以上の直線吻合を行うよう外科手術処置が必要であ れば、処理可能なステープルカートリッジ６０を各々の時に取換えでき、新しい 吻合がステープル装置全体の取換えの必要なしに行われる。処理可能なステープ ルカートリッジを設けることによって、ステープル装置は同一患者に１つ以上多 数のステープル装置を使用することに関連した費用を避ける。更に、処理可能な ステープルカートリッジは、使用済みのステープルカートリッジを取外して新し いステープルカートリッジをステープル装置に装入するよう要する時間を最小に すべく便宜と取換え容易なために設計されている。従って、ステープル装置は外 科手術に必要な時間と費用の両方を助けることによって経済性を達成する。
【００６３】 一般に、ステープル装置２０は、一組のステープル６１が装着されたステープ ルカートリッジ６０を有する無菌パックに包装される。従って、第１の直線吻合 を行うように、ステープル装置２０は簡単に包装を解いて直線吻合を行うよう元 のステープルカートリッジ６０が用いられる。もし何等別の直線吻合が必要でな ければ、ステープルカートリッジ６０を有するステープル装置２０全体を破棄で きる。他方、別の直線吻合が同一患者に行われねばならなければ、同一ステープ ル装置によって同一患者に別の直線吻合を外科医が行うことができるよう一連の ステープルが装入された別のステープルカートリッジと使用済みのステープルカ ートリッジ６０を取換えできる。ステープル装置２０は、直線吻合が同一患者の 外科手術に必要とされる場合に何回も同一状態にて再使用できる。
【００６４】 広い概念でのこの考案は図示説明の特別な詳細に制限されることがなく、この 考案の要旨から逸脱することなく直線吻合ステープル装置の構成の変更と説明さ れたステープル装置の他の実施例がなし得る。
【図面の簡単な説明】
【図１】この考案の要旨を実施した直線吻合ステープル
装置の全体斜視図である。
【図２】ステープルカートリッジ支持用下ジョー部材か
ら取外された金敷支持用上ジョー部材とが一部分解され
た吻合ステープル装置の側面図である。
【図３】組合された状態の吻合ステープル装置の側面図
である。
【図４】上下ジョー部材の後部を離して押圧するカム装
置を示す吻合ステープル装置の側断面図である。
【図５】吻合ステープル装置の金敷支持用ジョー部材の
底面図である。
【図６】吻合ステープル装置のステープルカートリッジ
支持用ジョー部材の平面図である。
【図７】吻合ステープル装置の底面図である。
【図８】吻合ステープル装置の前端面図である。
【図９】吻合ステープル装置の後端面図である。
【図１０】吻合ステープル装置の押棒刃物装置の拡大斜
視図である。
【図１１】吻合ステープル装置の押棒刃物装置の構成部
材である押ブロックと作動ノブの拡大斜視図である。
【図１２】不作動位置のカム装置を示す吻合ステープル
装置の後部の拡大断面図である。
【図１３】作動位置のカム装置を示す吻合ステープル装
置の後部の拡大断面図である。
【図１４】吻合ステープル装置のステープルカートリッ
ジの拡大側面図である。
【図１５】吻合ステープル装置のステープルカートリッ
ジの拡大平面図である。
【図１６】吻合ステープル装置のステープルカートリッ
ジの拡大底面図である。
【図１７】吻合ステープル装置の金敷およびステープル
カートリッジ支持用ジョー部材の拡大断面図である。
【図１８】押棒刃物装置の作動を示す金敷およびステー
プルカートリッジ支持用ジョー部材の拡大断面図であ
る。
【図１９】図４の１９−１９線に沿った吻合ステープル
装置の拡大垂直断面図である。
【図２０】図４の２０−２０線に沿った吻合ステープル
装置の拡大垂直断面図である。
【図２１】図１８に示される金敷およびステープルカー
トリッジの一部の拡大断面図である。
【図２２】互いにゆるく連結されたジョー部材の部分錠
止位置での吻合ステープル装置の錠止装置を示す側面図
である。
【図２３】部分錠止位置の錠止装置の拡大概要図であ
る。
【図２４】不作動位置に保持されたカム装置を示す図１
２の２４−２４線に沿った拡大平面図である。
【図２５】作動位置に保持されたカム装置を示す図１３
の２５−２５線に沿った拡大平面図である。
【図２６】金敷支持用ジョー部材の末端部の拡大底面図
である。
【図２７】この考案の要部を実施する刃物のない外科用
ステープル装置の側断面図である。
【図２８】図２７の外科用ステープル装置の金敷支持用
ジョー部材の底面図である。
【図２９】図２７の外科用ステープル装置のステープル
カートリッジ支持用ジョー部材の平面図である。
【図３０】図１４乃至図１６のステープルカートリッジ
の拡大背面図である。
【符号の説明】
２０，２２０ ステープル装置 ２２，２４ ジョー部材 ２６，２８ ハンドル ３４，４２，６２，６６，８１，９８，１２２，１３５
溝 ３２，７８，１９６ 耳部 ３６ 錠止ピン ３７ 案内棒 ４０ 金敷 ４１，８６ 案内面 ４４ ：ポケット ５６，７４，１１９，１６０ 切欠き ６０ ステープルカートリッジ ６１ ステープル ６５ ステープルドライバ ７０ 突出部 ７２ アーム ８０ ピボットピン ９０ 錠止装置 ９２ 錠止アーム ９６ フック部材 ９７，１３０ カム面 ９９ 止め １００ カバー １１０ 押棒刃物装置 １１２ 押ブロック １１４ 作動ノブ １１８ フィンガ １２１ 錠止棒 １２４ 押棒 １２５ 案内ブロック １３４ 刃物ブロック １３６ 刃物支持棒 １３８ 刃物 １５０ カム装置 １５２ カム部材 １５４ ピボットピン １５６ 下カム面 １６２ 前フィンガ １６４ 後フィンガ １７０ アーム １７４ ピン １９２，１９４ 保持アーム １９８ 停止ピン ２００ 間隔ピン
フロントページの続き (72)考案者 デニース・エス・シャイルツ アメリカ合衆国、オハイオ州、シンシナテ ィ、サバンナ・アベニュー 6229

Claims (10)

    【実用新案登録請求の範囲】
  1. 【請求項１】 少なくとも１つの列に配置された複数個
    のステープルを受けるようできるステープル支持装置を
    一方が有しステープルを形成するようできる金敷装置を
    他方が有する連動した第１，第２の細長いジョー部材、 ジョー部材間に握持された組織内にステープル支持装置
    からステープルを駆動して組織内に少なくとも１列のス
    テープルを造るよう金敷に対してステープルを形成する
    押圧装置、 ステープル支持装置および金敷間に位置された組織と一
    緒にジョー部材を錠止する錠止装置、 ステープル形成の際にステープル支持装置および金敷装
    置を押圧するようジョー部材に締付力を作用するために
    錠止装置から離れた位置にてジョー部材を押圧するカム
    装置を有するジョー締着装置、 ジョー部材を互いに分解することなく組織上のステープ
    ル支持装置と金敷装置の位置を調節できるよう一緒にゆ
    るく連結されたジョー部材と錠止位置に錠止装置を維持
    する装置、 を備えた外科手術用ステープル装置。
  2. 【請求項２】 ジョー部材間に握持された組織をステー
    プルの列に隣接した線に沿って切断する刃物装置を有し
    ている請求項１記載の外科手術用ステープル装置。
  3. 【請求項３】 錠止装置は、一方のジョー部材に取付け
    られ該ジョー部材を錠止するよう他方のジョー部材と係
    合できて両ジョー部材を錠止する錠止位置に、完全にジ
    ョー部材を分離できる解錠位置から移動できる錠止部材
    を有し、該錠止部材は組織上のステープル支持装置と金
    敷装置の位置を調節できるよう他方のジョー部材とゆる
    く係合された部分錠止位置に移動でき、他方両ジョー部
    材は互いに連結維持されている請求項１記載の外科手術
    用ステープル装置。
  4. 【請求項４】 一方のジョー部材に取付けられた錠止ピ
    ンと、ジョー部材が組立てられる時に錠止ピンを滑動可
    能に受けるべく他方のジョー部材に形成された溝とを有
    し、錠止装置は、両ジョー部材を錠止するよう溝内の錠
    止ピンと係合すべく他方のジョー部材に枢着された錠止
    アームを有し、錠止アームは、ジョー部材の組立分解に
    て溝の内外に錠止ピンが自由に動くようできる開放位置
    から、両ジョー部材を錠止するよう該溝内に錠止ピンを
    抑制する閉鎖位置に移動でき、且つ錠止アームは、錠止
    ピンを該溝内に抑制して組織に対してジョー部材の位置
    を調節できるよう該溝内の錠止ピンの制限された動きを
    許す中間位置に移動できる請求項１記載の外科手術用ス
    テープル装置。
  5. 【請求項５】 錠止装置はステープルカートリッジおよ
    び金敷に隣接して沿った中間位置にて両ジョー部材を錠
    止するようでき、ジョー締着装置は、ステープルが形成
    される時にステープル支持装置と金敷装置に作用される
    力に抵抗するよう錠止装置から離れた位置にてジョー部
    材を押圧するカム装置を有する請求項１記載の外科手術
    用ステープル装置。
  6. 【請求項６】 カム装置は、錠止装置から離れた位置に
    て一方のジョー部材に枢着され且つ該離れた位置にて両
    ジョー部材を離して動かすよう第１不作動位置から第２
    作動位置に枢動されるカム部材を有している請求項５記
    載の外科手術用ステープル装置。
  7. 【請求項７】 カム部材を不作動位置に保持する第１の
    装置と、カム部材を作動位置に保持する第２の装置とを
    有する請求項６記載の外科手術用ステープル装置。
  8. 【請求項８】 カム部材は、他方のジョー部材を第２不
    作動位置に位置されたカム部材に係合する第１低カム面
    と、他方のジョー部材を第２作動位置に位置されたカム
    部材に係合する第１高カム面とを有している請求項６記
    載の外科手術用ステープル装置。
  9. 【請求項９】 押圧装置が前進される時には不作動から
    作動位置に動かされて押圧装置が引込められるときには
    作動位置から不作動位置に動かされるよう押圧装置によ
    ってカム部材が作動される請求項６記載の外科手術用ス
    テープル装置。
  10. 【請求項１０】 引込められた押圧装置によってカム装
    置を不作動位置に保持する第１装置と、前進された押圧
    装置によってカム装置を作動位置に保持する第２装置と
    を有している請求項９記載の外科手術用ステープル装
    置。
JP1992069591U 1984-10-19 1992-10-06 外科手術用ステープル装置 Expired - Lifetime JPH0731771Y2 (ja)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US06/662,622 US4633861A (en) 1984-10-19 1984-10-19 Surgical stapling instrument with jaw clamping mechanism
US662622 1984-10-19
US712201 1985-03-15
US06/712,201 US4633874A (en) 1984-10-19 1985-03-15 Surgical stapling instrument with jaw latching mechanism and disposable staple cartridge

Publications (2)

Publication Number Publication Date
JPH0626812U true JPH0626812U (ja) 1994-04-12
JPH0731771Y2 JPH0731771Y2 (ja) 1995-07-26

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Application Number Title Priority Date Filing Date
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Country Status (10)

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US (1) US4633874A (ja)
EP (2) EP0340803B1 (ja)
JP (1) JPH0731771Y2 (ja)
AT (1) ATE56352T1 (ja)
AU (1) AU575693B2 (ja)
BR (1) BR8505118A (ja)
CA (1) CA1261226A (ja)
DE (2) DE3587528T2 (ja)
ES (1) ES8707854A1 (ja)
MX (1) MX161963A (ja)

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EP0178942B1 (en) 1990-09-12
BR8505118A (pt) 1986-07-29
DE3579666D1 (de) 1990-10-18
EP0340803B1 (en) 1993-08-11
DE3587528T2 (de) 1994-01-05
EP0178942A3 (en) 1986-12-17
JPH0731771Y2 (ja) 1995-07-26
ATE56352T1 (de) 1990-09-15
AU575693B2 (en) 1988-08-04
AU4877185A (en) 1986-04-24
EP0178942A2 (en) 1986-04-23
MX161963A (es) 1991-03-08
ES548037A0 (es) 1987-09-01
US4633874A (en) 1987-01-06
EP0340803A2 (en) 1989-11-08
ES8707854A1 (es) 1987-09-01
EP0340803A3 (en) 1989-11-29
CA1261226A (en) 1989-09-26
DE3587528D1 (de) 1993-09-16

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