JPH0856953A - 超音波止血および切断器具 - Google Patents

超音波止血および切断器具

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Publication number
JPH0856953A
JPH0856953A JP7211284A JP21128495A JPH0856953A JP H0856953 A JPH0856953 A JP H0856953A JP 7211284 A JP7211284 A JP 7211284A JP 21128495 A JP21128495 A JP 21128495A JP H0856953 A JPH0856953 A JP H0856953A
Authority
JP
Japan
Prior art keywords
tissue
elements
cutting
cutting element
transducer
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
JP7211284A
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English (en)
Inventor
Jeffrey J Vaitekunas
ジエフリー・ジエイ・バイテクナス
Louis F Cosentino
ルイス・エフ・コセンテイノ
Richard Van Zandt
リチヤード・バン・ザント
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Ethicon Endo Surgery Inc
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Ethicon Endo Surgery Inc
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Publication date
Application filed by Ethicon Endo Surgery Inc filed Critical Ethicon Endo Surgery Inc
Publication of JPH0856953A publication Critical patent/JPH0856953A/ja
Pending legal-status Critical Current

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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
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/295—Forceps for use in minimally invasive surgery combined with cutting implements
    • 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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • 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
    • A61B2017/2923—Toothed members, e.g. rack and pinion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2943—Toothed members, e.g. rack and pinion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320093—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw additional movable means performing cutting operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320095—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw with sealing or cauterizing means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320097—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw with stapling means

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Ophthalmology & Optometry (AREA)
  • Surgical Instruments (AREA)
  • Endoscopes (AREA)

Abstract

(57)【要約】 【課題】 配置されたステープルの線に隣接する切断通
路に沿って組織を焼灼および切断および／または凝固す
る。 【解決手段】 組織の止血切断および／または焼灼のた
めの治療用超音波器具が提供される。好ましい態様は、
組織が端エフェクターの組織つかみ部分により保持され
ている間、超音波エネルギーにより生かされる切断要素
が組織を通過して組織切断および焼灼するとき、組織を
つかむ端エフェクターを提供する。１つの態様は、さら
に、組織に同様によく適用されるステープルを包含す
る。

Description

【発明の詳細な説明】
【０００１】
【産業上の利用分野】本発明は、外科的処置、ことに内
視鏡を使用する処置の実行において組織の切断、焼灼、
凝固および／または組織の溶接のための治療的超音波器
具に関する。
【０００２】
【従来技術及びその課題】外科的処置は、切断部位にお
ける出血を引き起こす組織の切断を必要とする。こうし
て、止血は外科的処置において重要である。止血は内視
鏡または腹腔鏡を使用する手術においてなおいっそう重
要であり、出血が抑制下に保持されない場合、腹腔鏡検
査を放棄しなくてはならなず、そしてアクセス不可能な
出血を抑制できるように、開口手術を実行するために患
者の体を切断する。
【０００３】変化する成功度で出血を抑制するために種
々の技術、例えば、縫合、血管へのクリップの適用、サ
ンプリング、ならびに組織の加熱、レーザー、電気的焼
灼および超音波技術が採用されてきている。
【０００４】組織を接合しそして組織の切断と組み合わ
せて止血を提供するために、外科用ステイプラーが使用
されてきている。このような装置は、例えば、線状およ
び円形の切断およびスタンプリング器具を包含する。典
型的には、線状切断はカートリッジの中にスロットと整
合した平行の行のステープルを有し、このスロットを通
して切断手段はステープルの行の間を通ることができ
る。この型の外科用ステイプラーは、改良された切断の
ために組織を固定し、組織の層を接合し、そして平行の
行のステープルを取り囲む組織の層に適用することによ
って止血を提供し、このとき切断手段は平行の行の間を
切断する。これらの型の切断およびステープリング装置
は、筋肉組織、例えば、筋肉または腸に関係する処置、
とくに腸切除の処置において使用されてきている。同様
に、切断およびステープリング装置は、例えば、管腔を
再接合する吻合処置において首尾よくされてきている。
【０００５】しかしながら、とくに処置が、止血の問題
を有する傾向のある、高度に脈管化された組織、例え
ば、隔膜または付属器の切断を含む場合、止血を最適化
するこのような切断およびステープリング装置の改良が
望まれる。
【０００６】超音波で生かされた外科用器具は組織を切
断しかつ同時に凝固または焼灼するために使用されてき
ている。典型的には、このような装置は、治療的振幅ま
たは周波数の超音波エネルギーを受容しかつ伝送する器
具の端にナイフのブレードを含む。このような装置は組
織を切断および／または焼灼するために使用できる。し
かしながら、これらの装置は組織を操作しそして所望の
切断および／または焼灼効果を達成するために使用する
ことが時には困難である。
【０００７】したがって、本発明の目的は、超音波切断
器具により組織を切断および／または焼灼するとき、保
持またはつかむことができる、治療用超音波切断および
止血器具を提供することである。
【０００８】本発明の他の目的は、一般に配置されたス
テープルの線に隣接する切断通路に沿って組織を焼灼お
よび切断することができる超音波切断およびステープリ
ング装置を提供することである。
【０００９】本発明のなお他の目的は、その間でナイフ
のブレードを使用する血管を切断および凝固するステー
プルの平行の行を有する、線状切断およびステープル装
置を提供することである。
【００１０】本発明のなお他の目的は、配置されたステ
ープルに隣接する切断通路において組織を切断および凝
固するための、円形超音波切断要素またはブレードを有
する、円形切断およびステープリング装置を提供するこ
とである。
【００１１】
【発明が解決しようとする課題】これらおよび他の目的
は、組織とかみ合うことができる端エフェクター、およ
び端エフェクターとかみ合った組織を切断および焼灼す
るための端エフェクターに関連する超音波切断および凝
固要素を含む外科用器具において例示される。
【００１２】好ましくは、端エフェクターは、互いに関
して旋回式にまたは他の方法で動いて、それらの間で組
織とかみ合うことができる第１および第２の要素から構
成されている。
【００１３】１つの態様において、第１および第２の要
素は一緒に閉じて組織とかみ合う。次いで、端エフェク
ターに関連する超音波振動切断要素はかみ合った組織を
通過して、組織を切断および焼灼する。この要素の変形
において、第１および第２の要素は一緒に閉じて組織と
かみ合う。超音波切断ブレードは第１または第２の要素
から延び、そして要素が閉じたとき、組織とかみ合う。
組織が要素の間に適当に位置することが決定されたと
き、切断ブレードは生かされる。ブレードは、この特定
の態様において好ましくは鈍く、超音波的に振動すると
きかみ合った組織を切断するための切断要素として作用
する。
【００１４】他の態様において、第１および第２の要素
は、それらを通して縦方向に延びるスロットを超音波切
断要素を通過する前に、あるいは通過するとき、組織と
かみ合いそしてステープルを適用する。こうして、切断
はステープル線に隣接してなされる。例えば、超音波的
に生かされるブレードを有する線状切断器具を使用する
ことができる。このような器具において、超音波的に生
かされるブレードが端エフェクター中のスロットを通し
てステープルの行の間を通るとき、定められた切断通路
の各側で、ステープルの１または２以上の行が適用され
る。あるいは、例えば、円形ステープリング器具は超音
波的に生かされるブレードを含むことができる。このよ
うな器具において、ステープルは組織の２つの管腔を接
続するために使用され、そして超音波の周波数で振動す
る円形切断要素は、ステープルに隣接する組織を切断し
て管腔を開くと同時に、組織の焼灼により止血を提供す
る。
【００１５】ナイフのブレードの機械的切断作用は機械
的にあるいは他の制御機構により制御することができ
る。例えば、電子的器具を使用して切断要素の動く速度
を制御して、焼灼を可能とするために十分な時間の間ナ
イフが組織と接触することを保証することができる。
【００１６】他の態様は、前もって決定した範囲外の異
常な負荷を検出する手段を提供する。この特徴は器具の
異常性を検出するために、ならびに処置されている組織
の状態に関するフィードバックをユーザーにを提供する
ために使用できる。
【００１７】１つの態様において、フィードバック機構
は音響的インピーダンスのフィードバックシステムから
なり、ここで器具の活性部分に位置する光センサーを使
用して光源から放射されそして活性部分、すなわち、器
具の超音波的に振動する部分から反射された光を検出し
て、切断要素への負荷または妨害作用を決定する。
【００１８】他の態様において、フィードバック機構は
超音波トランスデューサーの圧電スタック内に位置する
受動圧電要素からなることができる。受動要素はスタッ
クの他の圧電セラミック要素とともに振動するが、他の
要素と異なり、生かされない。受動要素の振動は、圧電
スタックの振動に相当する要素を横切って振動電圧をつ
くる。要素を横切る電圧から、切断要素への負荷はこの
分野においてよく知られている方法により決定すること
ができる。電気エネルギーを超音波トランスデューサー
に加えて振動を引き起こすために使用される発生器の制
御手段に、受動要素を連結することができる。
【００１９】他のフィードバックシステム、例えば、圧
力検出器を、また、使用することができるか、あるいは
歪ゲージを使用して組織の圧力、状態または種類を検出
することができる。電気的パラメーターを使用して切断
要素への負荷条件の変動を感知しそして音響的インピー
ダンスとして決定し、発生器および器具のシステムのイ
ンピーダンスに関係づける。このようなシステムにおい
て、電圧および電流の位相差あるいはトランスデューサ
ーに供給される電圧および電流の振幅比を使用してこの
決定を行う。
【００２０】
【実施例】本発明のこれらおよび他の目的は、本発明の
詳細な説明と関連するとき、図面の次の付属の詳細な説
明からよりよく理解されるであろう。
【００２１】図１〜図５を参照すると、本発明の止血カ
ッター３７の第１態様が図解されている。このカッター
は外側管３９に連結されたハンドル３８、および外側管
３９の末端から延びる端エフェクター４０からなる。端
エフェクター４０は２つのジョー部材４１を含み、それ
らのジョー部材４１は一緒に閉じてそれらの間に組織を
かみ合わせ、つかみ、あるいは保持することができる。
スロット４３はジョーを通して縦方向に延びて、端エフ
ェクターに関連した切断要素４９を受容する。ハンドル
３８は外側管３９を通して延びる内部の管４５に連結さ
れた閉鎖トリガー４４を含む。作動したとき、閉鎖トリ
ガー４４は内部の管４５を縦方向にジョー部材４１のラ
ンプ部分の上に動かして、ジョー部材４１を一緒に閉じ
る。
【００２２】ハンドル３８は、また、内部の管４５を通
して延びる軸４７に連結されている切断作動ボタン４６
を含む。軸４７は超音波圧電スタック４８を含み、スタ
ック４８は電気エネルギーを供給されたとき、軸４７に
沿って超音波の振動を伝播することができる。切断要素
４９は軸４７の末端に連結されている。
【００２３】絶縁体４２は実質的に軸４７の長さに沿っ
て延び、そして絶縁体４２の長さに沿って節点において
Ｏリング３４により軸４７から分離されている。切断要
素４９は波腹において終わる。
【００２４】操作において、ジョー部材４１は処置すべ
き組織の回りに配置される。閉鎖トリガー４４はジョー
部材４１のランプ部分の上を末端方向に内部の管４５を
動かして、組織の上にジョー部材４１を閉じる。
【００２５】エネルギーは超音波スタック４８に、図６
〜図１１に図解する装置に類似する方法で、より詳細に
後述するように、すなわち、電線を通して発生器から超
音波スタック４８に電気エネルギーを送出すことによっ
て供給される。次いでユーザーは切断作動ボタン４６を
進行させ、これにより切断作動ボタン４６は末端方向に
軸４７を進行させ、そしてスロット４３およびつかんだ
組織を通して超音波振動切断要素４９を進行させて、組
織を切断しかつ同時に焼灼する。
【００２６】次に図６〜図１０を参照すると、本発明の
他の態様が図解されている。線状切断およびステープル
器具１００が示されており、これは外側管１２に連結さ
れた作用端またはハウジング２０を有し、そして外側管
１２から外に端エフェクター１１が延びる。端エフェク
ター１１は第１および第２の組織かみ合い要素１７、１
８を有し、第１および第２の要素１７、１８が開口して
組織を捕捉しそして互いに向かって閉じて組織を要素１
７、１８の間にかみ合わすことができるように、これら
の要素は互いに旋回式に接続されている。２つの要素の
開口および閉鎖はハウジング２０上の閉鎖トリガー２１
により作動され、そして閉鎖トリガー２１は要素１７、
１８の基部端の上に外側管１２を進行させる。
【００２７】圧電スタック２３から構成された超音波ト
ランスデューサーは、ハウジング２０内に含有されてい
る。圧電スタックは正電極および接地電極（図示せず）
により交互に生かされる圧電セラミックトランスデュー
サー要素から構成されている。スタック２３は軸１４に
連結されており、軸１４は外側管１２を通して延び、そ
して切断要素２８において終わる。スタック２３は軸１
４に転移するその末端に増幅器２４を含む。軸１４およ
び増幅器２４は好ましくは超音波エネルギーを効率よく
伝導する材料、例えば、チタンまたはアルミニウムの合
金から構成される。増幅器２４は超音波の波を増幅し、
次いでこの波は軸１４を通して切断要素２８に伝送され
る。
【００２８】軸１４はその外径を取り囲む絶縁体１５を
含む。絶縁体１５は好ましくは低い熱伝導性および導電
性および低い摩擦係数を有する材料、例えば、テフロン
またはポリカーボネートから構成される。軸１４は絶縁
体１５から節点においてＯリング２９により隔離されて
いる。Ｏリング２９は好ましくは非超音波エネルギー伝
導性材料、例えば、プラスチックからなる。節点１６は
超音波振動の振幅のサインが０に等しい点、すなわち、
超音波振動エネルギーが最小となる点である。正電極お
よび接地電極を表す電圧供給電線２５はハンドルを通し
て入り、そして超音波スタック２３に連結されている。
電線２５は互いに電気的に隔離されており、第１電線は
スタックの正電極に連結され、そして第２電線は接地電
極に連結されている。電線２５は、図２に概略的に示す
ように器具１００に対して外部の、発生器２６に導かれ
る。エネルギーが発生器２６を経てスタック２３に供給
されるとき、スタック２３は前もって決定した超音波周
波数で振動する。スタック２３はこうして超音波トラン
スデューサーとして作用する。他の超音波トランスデュ
ーサー、例えば、磁気抵抗要素を別に使用することがで
きる。
【００２９】節点１６は隣接する節点から等しい距離で
間隔を置いて位置する。圧電スタック２３それ自体は節
点１６上で中心をなす。節点１６は前もって決定した超
音波の周波数の１／２波長の整数倍に等しい軸に沿った
距離にある。フットスイッチ２７は、また概略的に図解
されており、発生器に接続されており、そして超音波ス
タック２３への電気エネルギーの供給を断続するために
使用できる。
【００３０】スタック２３および軸１４は末端方向およ
び基部方向に外側管１２を通して縦方向に動くことがで
きる。閉鎖トリガー２１を作動して要素１７、１８の間
に組織をかみ合わせた後、発射トリガー２２を使用して
ステープル３２を発射しそして切断要素２８を進行させ
る。発射トリガー２２は歯車３３を進行させ、歯車３３
は発射トリガー２２に加えられたユーザーの力をスタッ
ク２３、軸１４および切断要素２８の縦方向の動きに変
える。
【００３１】発射トリガー２２が作動されると、第１お
よび第２の要素１７、１８を通して縦方向に延びるスロ
ット３１内を切断要素２８は動く。また、かみ合った組
織を通してステープルを駆動するためのドライバー３０
が軸の末端に連結されている。ドライバー３０は第２要
素１８内を切断要素２８の動きと同時に動く。第２要素
１８はスロット３１の各側に平行の行で配置されたステ
ープル３２を含有するカートリッジ３５を含むが、第１
要素１７はステープル３２を閉じるためのアンビル３６
からなる。
【００３２】超音波エネルギーはスタック２３から軸１
４に沿って切断要素２８の中に伝送され、切断要素２８
はこのエネルギーを要素１７、１８とかみ合った組織に
伝送する。軸１４が末端方向に動くとき、超音波振動切
断要素２８は第１および第２の要素１７、１８がかみ合
った組織を切断しかつ焼灼し、その間ドライバー３０は
切断線の各側でステープルを同時に発射する。超音波エ
ネルギーは組織を切断または切開ならびに焼灼を引き起
こす。組織が所望の程度に焼灼されたとき、組織は最初
に組織と接触する切断要素から分離すると信じられる。
ユーザーまたは制御機構は切断要素２８の作動速度を制
御するので、切断要素２８は組織を焼灼するために十分
な接触時間を有するであろう。
【００３３】図１１〜図１５を参照すると、本発明の他
の態様が図解されている。円形ステープル器具５０が示
されており、この器具５０は発射トリガー５３および閉
鎖ノブ５２を含むハウジング部分５１；ハウジング５１
に連結された中空外側管５４；および外側管５４の末端
に連結された端エフェクター５８を有する。
【００３４】閉鎖ノブ５２はハンドル５１に関して回転
可能であり、そして縦方向に外側管５４を通して端エフ
ェクター５８に延びる閉鎖軸６９に連結されている。発
射トリガー５３は作動軸７６を縦方向に外側管５４を通
して動かすことができる。この態様において、軸７６は
中空であり、閉鎖軸６９は縦方向に軸７６を通して延び
そして節点５７においてＯリング７７により軸７６から
適当に絶縁されている。これらのＯリング７７は、ま
た、軸７６の外径を取り囲む絶縁体５６を軸と分離す
る。別の態様は超音波の振動を切断要素に送出すための
充実軸を含むことができ、ここで閉鎖軸は軸の外径を取
り囲む中空管である。
【００３５】端エフェクター５８は第１要素５９および
第２要素６０からなる。第１要素５９は第１組織かみ合
い表面７０および開口７１を含む。切断要素５５は前記
第１要素５９の中に含有され、そして前記第１要素５９
の末端から開口７１を通して延びることができる。第２
要素６０は第１要素５９から末端方向に延び、そして第
２組織かみ合い表面７２をその基部端に含む。第２組織
かみ合い表面７２はアンビル７３を含み、このアンビル
７３は第１要素５９から第１および第２の要素５９、６
０によりかみ合わされた組織を通して推進されたステー
プル６２を受容する。
【００３６】切断要素５５は、その基部端に向かって、
超音波の振動を発生するための超音波圧電スタック６４
を含む。１対の電線６６はスタック６４と電気的に連絡
する。電線６６はハンドル５１の中から外に延びそし
て、図１１に概略的に図解されている、発生器６７と連
絡する。発生器６７は電気エネルギーを電線６６を通し
て超音波圧電スタック６４に供給して、前もって決定し
た超音波の周波数でスタックを振動させる。フットスイ
ッチ６８は、また、図１１に概略的に図解されており、
発生器６７に連結されている。フットスイッチ６８を使
用して発生器６７を断続することができる。
【００３７】使用において、第１および第２の要素５
９、６０は互いに分離されている。第１管腔を形成する
組織は第１要素５９とかみ合う。典型的には、第１管腔
は第１要素５９から末端方向に延びるコネクターピン７
５の回りに巾着型縫合糸により閉じられている。第１管
腔は第２管腔を形成する組織により再接合されるべきで
ある。第２管腔は第２要素６０から基部方向に延びる軸
コネクター７４の回りに巾着型縫合糸により閉じられ
る。閉鎖軸６９は第１要素５９から末端方向に延びるコ
ネクターピン７５において終わる。コネクターピン７５
はそれを受容することができる軸コネクター７４の中に
挿入されそしてその中にロックされる。次いで、第２要
素６０は閉鎖ノブ５２の回転により基部方向に第１要素
５９に向かって動かされ、閉鎖ノブ５２は引き続いて閉
鎖軸６９を回転しかつ後退させる。閉鎖軸６９は外側管
５４を通して延び、そして第２要素６０の回転可能に連
結されている。閉鎖軸６９の回転は、第１要素５９とか
み合った組織の管腔を第２要素６０とかみ合った組織の
管腔に接近させる。これが起こったとき、器具は発射可
能な状態にある。
【００３８】器具の発射は発射トリガー５３により作動
され、発射トリガー５３は基部方向に軸７６を動かし、
こうして切断要素５５を動かす。同時に、発射トリガー
５３はドライバーベース６１を末端方向に動かす。ドラ
イバーベース６１は引き続いてドライバー６３を進行さ
せて、ステープル６２を第１要素５９から組織を通し
て、第２要素６０のアンビル７３の中に推進させる。こ
うして、組織はステープルにより接合されそして、同時
に切断要素は過剰の組織を第１および第２の組織の管腔
から切断して、新しく形成されたから動きをブロックす
る。円形カッターはこの分野において知られている機械
的円形カッターのそれに類似する方法で操作される。こ
のような装置の例は、例えば、米国特許第５，１０４，
０２５号（ここに引用によって加える）に記載されてい
る。
【００３９】超音波スタック６４は切断要素５５上の節
点５７上で中心をなす。切断要素５５は、節点５７にお
ける切断要素５５とのみ接触する絶縁体５６により取り
囲まれている。
【００４０】器具が発射されるとき、フットスイッチ６
８をまた使用して発生器６７を活性化して、電気エネル
ギーを超音波スタック６４に供給する。スタック６４は
前もって決定した超音波の周波数で振動する。超音波の
振動は軸７６を下方に切断要素５５に伝播する。発射ト
リガー５３が作動されるとき、前述したように切断要素
５５は第２要素の末端から延びて組織を切断する。フッ
トスイッチが活性化される場合、超音波エネルギーは切
断要素５５を下方に切断要素５５の末端に伝送される。
超音波エネルギーは切断エネルギーおよび焼灼エネルギ
ーの両方を切断される組織に提供することができる。
【００４１】本発明のいくつかの変化を内視鏡の切断お
よびステープルを包含する２つの特定の態様に関連して
説明した。当然、本発明は止血を望む多数の用途におい
て使用することができる。超音波で生かされる組織つか
み切断および／または焼灼要素をもつ他の器具は本発明
の範囲内に入ることを意図する。したがって、当業者は
理解するように、本発明の精神および範囲から逸脱しな
いで種々の変化および変更が可能である。
【００４２】本発明の主な特徴および態様は次の通りで
ある。
【００４３】１．第１および第２の要素を含む端エフェ
クター、前記第１および第２の要素の少なくとも一方は
他方の要素に関して動いて前記第１および第２の要素の
間に組織をかみ合わせることができる；前記端エフェク
ターに関連する切断要素、前記切断要素は前記第１およ
び第２の要素とかみ合った組織を切断および／または焼
灼することができる；前記切断要素に連結された軸；前
記軸に連結された超音波トランスデューサー、前記トラ
ンスデューサーは超音波の振動を前記軸に沿って前記切
断要素に伝播させることができる；電気エネルギーを前
記トランスデューサーに送出して前記トランスデューサ
ーをある超音波の周波数で振動させる電気エネルギー伝
達手段；からなる外科用器具。
【００４４】２．前記第１および第２の要素が前記切断
要素の前記超音波の振動から隔離されている上記第１項
記載の外科用器具。
【００４５】３．第１および第２の要素の一方がステー
プルを含有するカートリッジからなり；そして前記第１
および第２の要素の他方が前記カートリッジから前記第
１および第２の要素とかみ合った組織を通して推進され
たステープルを受容しそして閉じることができるアンビ
ルからなる；上記第１項記載の外科用器具。
【００４６】４．作動端；前記作動端に連結された中空
管；前記管から末端方向に延びる端エフェクター；前記
端エフェクターは第１および第２の要素からなり、前記
第１および第２の要素の少なくとも一方は前記第１およ
び第２の要素の他方に関して動いてそれらの間に組織を
かみ合わせることができる；前記第１要素を通して縦方
向に延びる軸；前記管内の軸、前記軸は末端を有する；
軸の前記末端に連結された切断要素、前記切断要素は前
記開口を通して動いて前記第１および第２の要素とかみ
合った組織を切断および／または焼灼することができ
る；および前記軸に関連する超音波トランスデューサ
ー、前記トランスデューサーは超音波の振動を前記切断
要素に伝播させることができる；からなる外科用器具。
【００４７】５．前記第１および第２の要素の一方がス
テープルを含有するカートリッジからなり；そして前記
第１および第２の要素の他方が前記カートリッジから前
記第１および第２の要素とかみ合った組織を通して推進
されたステープルを受容しそして閉じることができるア
ンビルからなる；上記第４項記載の外科用器具。
【００４８】６．前記ステープルが前記スロットに隣接
する少なくとも１つの平行の行で配置されている上記第
５項記載の外科用器具。
【００４９】７．前記切断要素が前記スロットにより定
められた切断通路をたどり、前記切断通路は対向する縦
方向の側面を有し；そして前記ステープルが前記切断通
路の前記側面の各々に隣接して配置されている；上記第
５項記載の外科用器具。
【００５０】８．第１および第２の要素を含む端エフェ
クター、ここで前記第１および第２の要素の少なくとも
一方は他方の要素に関して動いてそれらの間に組織をか
み合わせることができる；前記第１要素から延びて前記
第１および第２の要素とかみ合った組織と接触すること
ができる切断要素；前記切断要素に連結された軸；前記
軸に連結された超音波トランスデューサー、前記トラン
スデューサーは超音波の振動を前記軸に沿って前記切断
要素に伝播させて、前記切断要素が組織を切断および／
または焼灼するようにさせることができる；電気エネル
ギーを前記トランスデューサーに送出して前記トランス
デューサーを超音波で振動させる電気エネルギー伝達手
段；からなる外科用器具。
【００５１】９．ハンドル；前記ハンドルに連結された
中空管；前記管から末端方向に延びる端エフェクター、
前記端エフェクターは第１および第２の要素からなり、
前記第１および第２の要素の少なくとも一方は他方の要
素に関して動いてそれらの間に組織をかみ合わせること
ができる；前記第１要素を通して縦方向に延びる開口；
前記第１要素に関連する切断要素、前記切断要素は前記
第１要素から前記開口を通して延びて前記第１および第
２の要素とかみ合った組織を切断および／または焼灼す
ることができる；および超音波の振動を前記切断要素に
伝播させることができる超音波トランスデューサー；か
らなる外科用器具。
【００５２】１０．前記第１要素はステープルを含有す
るステープルのカートリッジからなり；前記第２要素は
前記カートリッジから前記第１および第２の要素とかみ
合った組織を通して推進されたステープルを受容しそし
て閉じることができるアンビルからなり；前記第１要素
は第１管腔とかみ合いそして前記第２要素は第２管腔と
かみ合うことができ；前記ステープルは第１管腔を第２
管腔に接合するように配置されており；そして前記切断
要素はほぼ円形の形状である；上記第９項記載の外科用
器具。
【図面の簡単な説明】
【図１】本発明の超音波止血切断器具の側面図である。
【図２】図１の器具の破断斜視図である。
【図３】図１における器具の端エフェクターの末端の側
面図である。
【図４】図１における器具の端エフェクターの末端の上
面図である。
【図５】図１における器具の端エフェクターの末端の前
面図である。
【図６】本発明の第１態様の内視鏡の超音波線状ステー
プルおよび切断の器具の斜視図である。
【図７】図６の器具の側断面図である。
【図８】図７の器具の器具のハウジングの拡大側断面図
である。
【図９】図７に図解する器具の端エフェクターの拡大側
断面図である。
【図１０】図６の器具の端エフェクターの第２組織かみ
合い要素の上面図である。
【図１１】本発明の第２態様の円形切断器具の側面部分
切断図である。
【図１２】図１１に図解する器具の端エフェクターの拡
大断面図である。
【図１３】図１１に図解する器具の取り扱いの拡大断面
図である。
【図１４】線１４−１４に沿った図１１における器具の
端エフェクターの切断部分の前端面図である。
【図１５】図１１における器具の端エフェクターのアン
ビル部分の背端面図である。
【符号の説明】
１１ 端エフェクター １２ 外側管 １４ 軸 １５ 絶縁体 １６ 節点 １７ 組織かみ合い要素 １８ 組織かみ合い要素 ２０ 作用端またはハウジング ２１ トリガー ２２ 発射トリガー ２３ 圧電スタック ２４ 増幅器 ２５ 電圧供給電線 ２６ 発生器 ２７ フットスイッチ ２８ 超音波振動切断要素 ２９ Ｏリング ３０ ドライバー ３２ ステープル ３４ Ｏリング ３５ カートリッジ ３６ アンビル ３７ 止血カッター ３８ ハンドル ３９ 外側管 ４０ 端エフェクター ４１ ジョー部材 ４２ 絶縁体 ４３ スロット ４４ 閉鎖トリガー ４５ 内部の管 ４６ 切断作動ボタン ４７ 軸 ４８ 超音波圧電スタック ４９ 超音波振動切断要素 ５０ 円形ステープル器具 ５１ ハウジング部分、ハンドル ５２ 閉鎖ノブ ５３ 発射トリガー ５４ 中空外側管 ５５ 切断要素 ５６ 絶縁体 ５７ 節点 ５８ 端エフェクター ５９ 第１要素 ６０ 第２要素 ６１ ドライバーベース ６２ ステープル ６４ 超音波圧電スタック ６６ 電線 ６７ 発生器 ６８ フットスイッチ ６９ 閉鎖軸 ７０ 第１組織かみ合い表面 ７１ 開口 ７２ 第２組織かみ合い表面 ７３ アンビル ７４ 軸コネクター ７５ コネクターピン ７６ 作動軸 ７７ Ｏリング １００ 線状切断およびステープル器具
───────────────────────────────────────────────────── フロントページの続き (72)発明者 リチヤード・バン・ザント アメリカ合衆国オハイオ州45249シンシナ テイ・ハンブルトニアンドライブ8349

Claims (4)

    【特許請求の範囲】
  1. 【請求項１】 第１および第２の要素を含む端エフェク
    ター、前記第１および第２の要素の少なくとも一方は他
    方の要素に関して動いて前記第１および第２の要素の間
    に組織をかみ合わせることができる；前記端エフェクタ
    ーに関連する切断要素、前記切断要素は前記第１および
    第２の要素とかみ合った組織を切断および／または焼灼
    することができる；前記切断要素に連結された軸；前記
    軸に連結された超音波トランスデューサー、前記トラン
    スデューサーは超音波の振動を前記軸に沿って前記切断
    要素に伝播させることができる；電気エネルギーを前記
    トランスデューサーに送出して前記トランスデューサー
    をある超音波の周波数で振動させる電気エネルギー伝達
    手段；からなる外科用器具。
  2. 【請求項２】 作動端；前記作動端に連結された中空
    管；前記管から末端方向に延びる端エフェクター；前記
    端エフェクターは第１および第２の要素からなり、前記
    第１および第２の要素の少なくとも一方は前記第１およ
    び第２の要素の他方に関して動いてそれらの間に組織を
    かみ合わせることができる；前記第１要素を通して縦方
    向に延びる軸；前記管内の軸、前記軸は末端を有する；
    軸の前記末端に連結された切断要素、前記切断要素は前
    記開口を通して動いて前記第１および第２の要素とかみ
    合った組織を切断および／または焼灼することができ
    る；および前記軸に関連する超音波トランスデューサ
    ー、前記トランスデューサーは超音波の振動を前記切断
    要素に伝播させることができる；からなる外科用器具。
  3. 【請求項３】 第１および第２の要素を含む端エフェク
    ター、ここで前記第１および第２の要素の少なくとも一
    方は他方の要素に関して動いてそれらの間に組織をかみ
    合わせることができる；前記第１要素から延びて前記第
    １および第２の要素とかみ合った組織と接触することが
    できる切断要素；前記切断要素に連結された軸；前記軸
    に連結された超音波トランスデューサー、前記トランス
    デューサーは超音波の振動を前記軸に沿って前記切断要
    素に伝播させて、前記切断要素が組織を切断および／ま
    たは焼灼するようにさせることができる；電気エネルギ
    ーを前記トランスデューサーに送出して前記トランスデ
    ューサーを超音波で振動させる電気エネルギー伝達手
    段；からなる外科用器具。
  4. 【請求項４】 ハンドル；前記ハンドルに連結された中
    空管；前記管から末端方向に延びる端エフェクター、前
    記端エフェクターは第１および第２の要素からなり、前
    記第１および第２の要素の少なくとも一方は他方の要素
    に関して動いてそれらの間に組織をかみ合わせることが
    できる；前記第１要素を通して縦方向に延びる開口；前
    記第１要素に関連する切断要素、前記切断要素は前記第
    １要素から前記開口を通して延びて前記第１および第２
    の要素とかみ合った組織を切断および／または焼灼する
    ことができる；および超音波の振動を前記切断要素に伝
    播させることができる超音波トランスデューサー；から
    なる外科用器具。
JP7211284A 1994-08-02 1995-07-28 超音波止血および切断器具 Pending JPH0856953A (ja)

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Application Number Priority Date Filing Date Title
US28433894A 1994-08-02 1994-08-02
US284338 1994-08-02

Publications (1)

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JPH0856953A true JPH0856953A (ja) 1996-03-05

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US (1) US6004335A (ja)
EP (1) EP0695535B1 (ja)
JP (1) JPH0856953A (ja)
AT (1) ATE213610T1 (ja)
AU (1) AU694225B2 (ja)
CA (1) CA2155078C (ja)
DE (1) DE69525573T2 (ja)
ES (1) ES2172556T3 (ja)

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AU2501495A (en) 1996-02-15
US6004335A (en) 1999-12-21
ES2172556T3 (es) 2002-10-01
EP0695535A1 (en) 1996-02-07
DE69525573D1 (de) 2002-04-04
CA2155078C (en) 2006-12-05
CA2155078A1 (en) 1996-02-03
AU694225B2 (en) 1998-07-16
DE69525573T2 (de) 2002-07-04
ATE213610T1 (de) 2002-03-15

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