KR101350203B1 - 문합을 위한 타원형 관강내 외과용 봉합기 - Google Patents

문합을 위한 타원형 관강내 외과용 봉합기 Download PDF

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KR101350203B1
KR101350203B1 KR1020070010422A KR20070010422A KR101350203B1 KR 101350203 B1 KR101350203 B1 KR 101350203B1 KR 1020070010422 A KR1020070010422 A KR 1020070010422A KR 20070010422 A KR20070010422 A KR 20070010422A KR 101350203 B1 KR101350203 B1 KR 101350203B1
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anvil
head
delete delete
opposing
surgical suture
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페데리코 빌로티
조지 엠. 포메로이
토드 피. 오메이츠
라즐로 취키
마크 에이. 뉴로
알레산드로 파스토렐리
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에디컨 엔도-서저리 인코포레이티드
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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
    • A61B17/11—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
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • 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
    • 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
    • A61B17/068—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
    • A61B2017/07214—Stapler heads
    • 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
    • A61B2017/07214—Stapler heads
    • A61B2017/07221—Stapler heads curved
    • 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
    • A61B2017/07214—Stapler heads
    • A61B2017/07257—Stapler heads characterised by its anvil

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Abstract

외과용 봉합기는 복수의 스테이플들이 저장되는 헤드를 포함한다. 상기 헤드는 대향 표면을 포함한다. 또한 상기 봉합기는 짝을 이루는 맞물림을 위한 상기 헤드의 상기 대향 표면에 대응하는 대향 표면을 포함하고, 상기 외과용 봉합기의 작동과 동시에 상기 스테이플들을 형성하기 위해 치수화되고 형상화된 앤빌 표면을 갖는 앤빌을 포함한다. 상기 헤드의 상기 대향 표면은 상기 헤드가 상기 외과용 봉합기의 작동 동안에 앤빌과 접하게 될 때, 타원형 스테이플 라인을 생성하는 상기 헤드의 길이방향 축에 대해 경사지게 배향된다.
Figure R1020070010422
외과용 봉합기, 헤드, 앤빌, 스테이플, 나이프

Description

문합을 위한 타원형 관강내 외과용 봉합기{ELLIPTICAL INTRALUMINAL SURGICAL STAPLER FOR ANASTOMOSIS}
도 1은 본 발명의 외과용 봉합기의 사시도.
도 2는 본 발명의 외과용 봉합기의 앤빌부와 헤드부의 사시도.
도 3, 4, 5 및 도 6은 본 발명의 폐쇄 및 봉합 조작의 측면도.
도 7은 본 발명의 앤빌, 앤빌 샤프트 및 투관침의 분해 사시도.
도 8은 도 2의 8-8선을 따라 취해진 앤빌의 부분 측면 단면도.
도 9는 본 발명에서 상술된 투관침 첨단에 배치된 폐쇄형 앤빌의 부분 측면 단면도.
도 10은 도 9의 10-10선을 따라 취해진 앤빌 샤프트의 단면 평면도.
도 11은 본 발명의 헤드부내에 포함된 투관침 외피 구조의 부분 절개 측면도.
도 12는 본 발명에 따른 대안적인 실시예의 개략도.
도 13 및 도 14는 양호한 실시예에 따른 헤드 및 앤빌의 상세도.
<도면의 주요 부분에 대한 부호의 간단한 설명>
10 ; 외과용 봉합기 12 ; 헤드
14 ; 앤빌 16 ; 조절 스크류
18 ; 트리거 28 ; 투관침 샤프트
본 발명은 문합용 외과용 봉합기에 관한 것이다. 보다 세부적으로, 본 발명은 문합 동안 타원 형상의 생성을 제공하는 관강내 외과용 봉합기에 관한 것이다.
외과용 봉합기는 오랜기간 외과분야에서 조직을 접합하고 치유하는 신속하고 효율적인 방법으로 공지되어 있다. 봉합은 꿰맴(sutur) 대신에 사용되고 있다. 외과 시술의 특정 타입에서, 외과용 봉합기의 사용은 조직 접합의 양호한 방법이 되었으며, 특별하게 구성된 외과용 봉합기들이 이러한 응용예를 위해 개발되었다.
외과 시술시 사용하기 위한 문합(anstomosis)으로서 공지된 관강내(intraluminal), 또는 원형, 봉합기들이 개발되어 있다. 문합에 사용되는 관강내 외과용 봉합기의 예는 본원에 참조로서 통합되어 있는 미국 특허 제5,104,025호에 개시되어 있다.
종래 관강내 외과용 봉합기들은 전형적으로 근위 작동 메카니즘(mechanism)과 샤프트에 장착된 원위 봉합 메카니즘을 갖는 세장형 샤프트(shaft)를 포함한다. 원위 봉합 메카니즘은 전형적으로 동심 원형 어레이(array)내에 구성된 복수의 스테이플(staple)들을 포함하는 고정식 봉합 카트리지(cartridge)를 포함한다. 둥근 절개 나이프(knife)는 카트리지 내부 스테이플들에 동심으로 장착된다. 작동 동안, 나이프는 원위 축 방향으로 이동된다. 투관침 샤프트는 카트리지의 중심으로부터 축방향으로 연장한다. 투관침 샤프트는 카트리지에 대해 축방향으로 이동가능하다. 앤빌(anvil) 부재는 투관침 샤프트에 장착된다. 앤빌 부재는 스테이플들의 단부들을 형성하기 위해 앤빌에 장착된 종래 스테이플 앤빌 표면을 갖는다. 스테이플 카트리지의 원위면과 스테이플 앤빌 표면 사이의 간격은 투관침 샤프트의 근위 단부에 장착된 조정 메카니즘에 의해서 제어될 수 있다. 외과의사가 작동 메카니즘을 작동시킬 때, 스테이플 카트리지와 스테이플 앤빌 표면 사이에 포함된 조직은 동시에 봉합되고 절개된다.
상기에서 간단하게 언급된 바와 같이, 문합은 연결 섹션(section)이 절개된 후에 창자 섹션들을 함께 접합하는 외과 시술을 포함한다. 이 시술은 연속적인 관형 통로를 형성하기 위한 2개의 관형 섹션들의 단부들의 접합을 요구한다. 관강내 외과용 봉합기의 소개에 앞서, 외과 시술은 고되고 많은 시간을 요하는 시술이다. 외과의사는 수많은 봉합으로 관형 섹션들의 단부들을 접합하면서 창자의 단부들을 정교하게 절개하고 정렬하여 정렬을 유지해야 한다. 관강내 외과용 봉합기들의 개발은 문합 시술을 크게 간소화시켰으며, 또한 문합 수행에 요구되는 시간을 감소시켰다.
관강내 외과용 봉합기를 사용하는 문합 수행시, 창자는 창자의 목표 섹션중 일 측부상에 위치하는 스테이플들의 복렬(double rows)를 갖는 종래 외과용 봉합기를 사용하여 일반적으로 봉합된다. 표본 추출후, 외과의사는 일반적으로 관강내 외과용 봉합기의 앤빌을 스테이플 라인의 근위측 내강의 근위 단부속으로 삽입한다. 이는 외과의사가 근위 내강을 자른 도입부로 앤빌을 삽이하여 이뤄진다. 때때로, 앤빌은 직장을 통해 기구를 삽입하고 봉합기의 원위 단부상에 앤빌을 위치하여 항문을 통해서(transanally) 배치될 수 있다. 이후에 외과의사는 봉합사 또는 다른 결속 장치를 사용하여 창자의 근위 단부를 앤빌 샤프트에 결속한다. 이후 외과의사는 잘라낸 조직을 결속부(tie)에 인접하게 절개하고, 외과의사는 관강내 외과용 봉합기의 투관침 샤프트에 앤빌을 부착한다. 다음, 외과의사는 앤빌과 카트리지 사이의 간격을 폐쇄하여 간격내의 창자의 근위 및 원위 단부들을 맞물린다. 다음, 외과의사는 창자의 양 단부들을 통해 수개의 스테이플들 열들이 전진되게 하는 관강내 외과용 봉합기를 작동하여 단부들을 접합하고 관형 통로를 형성한다. 동시에, 스테이플들이 전진되고 형성될 때, 동심 원형 블레이드는 스테이플들의 내부 열에 인접한 단부들을 절개하면서 창자 조직을 통해서 전진된다. 이후 외과의사는 봉합기를 창자로부터 회수하고 문합은 완료된다.
내강(lumen)의 길이방향 축에 수직한 평면을 따라 새롭게 형성된 내강의 스테이플 라인을 생성함으로써, 내강내에 상당한 압력이 발생한다. 특히, 내강을 통과하는 재료는 동시에 스테이플 라인의 모든 에지들과 대면하게 된다. 이는 스테이플 라인을 따라 큰 압력을 초래한다. 추가로, 스테이플 라인의 강도는 스테이플 라인의 위치에서 내강의 직경, 따라서 원주에 의해 제한된다.
이를 유념하여, 관강내 외과용 봉합기에 의해 생성된 스테이플 라인의 기능성과 강도를 최적화하는 메카니즘이 현재 필요하다. 본 발명은 이러한 장치를 제공한다.
따라서 본 발명의 목적은 복수의 스테이플들이 저장되는 헤드를 포함하는 타원형 외과용 봉합기를 제공하는 것이다. 헤드는 대향 표면을 포함한다. 또한 외과용 봉합기는 외과용 봉합기의 작동과 동시에 스테이플들을 형성하기 위해 형상화되고 치수화된 앤빌 표면을 갖으며, 짝을 이루는 맞물림을 위한 헤드의 대향 표면에 대응하는 대향 표면을 포함하는 앤빌을 포함한다. 헤드의 대향 표면은 헤드가 외과용 봉합기의 작동 동안 앤빌이 접하게 될 때 타원형 스테이플 라인을 생성하는 헤드의 길이방향 축에 대해 경사지게 배향된다.
또한 본 발명의 목적은 복수의 스테이플들이 저장되는 헤드를 포함하는 외과용 봉합기를 제공하는 것이다. 헤드는 대향 표면을 포함한다. 또한 외과용 봉합기는 외과용 봉합기의 작동과 동시에 스테이플들을 형성하기 위해 형상화되고 치수화된 앤빌 표면을 포함하며, 짝을 이루는 맞물림을 위한 헤드의 대향 표면에 대응하는 대향 표면을 포함하는 앤빌을 포함한다. 앤빌과 헤드의 경사진 타원형상으로 인하여 앤빌과 헤드의 대향 표면들은 짝을 이루는 경사 평면을 형성하고, 이 평면상에 앤빌과 헤드가 타원형 스테이플 라인을 생성한다.
본 발명의 다른 목적들과 장점들은 본 발명의 특정 실시예를 설명하는 도면들과 관련한여 보여질 때 하기의 상세한 설명으로부터 명백해 질 것이다.
본 발명의 세부 실시예들이 본원에 개시된다. 그러나, 개시된 실시예들은 단지 본 발명의 예시이며, 다양한 형태들로 구현될 수 있는 것으로 이해되어야 한다. 그러므로, 본원에 개시된 상세들은 제한이 아닌 단지 청구항들을 위한 기초로 서 해석되고 당업자에게 본 발명의 제조 방법 및/또는 사용 방법을 교지하기 위한 기초로서 해석되어야 한다.
다양한 도면들을 참조하여, 본 발명에 따른 관강내 외과용 봉합기(10)가 개시된다. 외과용 봉합기(10)는 메인 이티 에이엘(Main et al.,) 소유로서 미국 특허 제 5,104,025호에 개시된 발명의 명칭 " 분리식 앤빌을 구비한 관강내 문합 외과용 봉합기(INTRALUMINAL ANASTOMOTIC SURGICAL STAPLER) " 와 웰치(Welch) 소유로서 제 5,309,927호에 개시된 " 원형 봉합기 조직 유지 스프링 방법(CIRCULAR STAPLER TISSUE RETENTION SPRING METHOD)" 과 같은 관강내 문합 외과용 봉합기와 실질적으로 구조면과 작동면에서 유사하고, 두 발명은 모두 본원에 참조로서 통합되어 있다. 양호한 봉합기 디자인이 양호한 실시예에 따라 개시되어 있는 반면에, 본 발명의 기초를 이루는 개념은 본 발명의 기술적 사상을 벗어나지 않고 봉합기 디자인의 변형에 적용될 수 있다. 예를 들어, 본 발명은 분리식 또는 비 분리식 앤빌을 채택하는 봉합기에 동일하게 적용될 수 있는 것으로 생각된다. 당업자들이 인식하듯이, 관강내 외과용 봉합기 용어는 문합 동안에 도관의 전체 원주 또는 장기에 대하여 링에서 스테이플을 적용하도록 구성된 외과용 봉합기의 종류를 뜻한다.
대체로, 외과용 봉합기(10)는 헤드(12), 앤빌(14), 조절 스크류(16) 및 트리거(18)를 포함한다. 트리거(18)는 안전장치가 해제될 때 봉합기(10)을 작동시키기 위해 작용한다. 트리거(18)가 작동되면, 발사 메카니즘(firing mechanism ; 미 도시)은 샤프트(22)내에서 작동하여 스테이플들은 헤드(12)에서 배출된다. 이러한 스테이플들은 앤빌 본체(26)에 대해 원주 방향으로 위치된 앤빌 표면들(24)에 대해서 클린치(clinch)된다. 동시에, 헤드(12)내에 수용된 나이프(13 ; 파선으로 도시)는 외과용 봉합기(10)의 원주내 앤빌(14)과 헤드(12) 사이에 수용된 조직을 절개하도록 작용한다. 봉합기(10)는 이후에 봉합된 조직을 그 자리에 남기고 조직을 통해서 인출된다.
도 1, 도 2 및 도 7에 도시된 바와 같이, 본 발명의 외과용 봉합기(10)가 개시된다. 보다 세부적으로는, 도 1 및 도 2에 도시된 바와 같이, 투관침 첨단(30)을 포함하는 투관침 샤프트(28)가 도시되어 있다. 투관침 샤프트(28)는 헤드(12)에 일체되며 조직을 천공할 수 있다. 투관침 샤프트(28)는 헤드(12)의 내부 및 외부로 왕복운동하는 투관침 슬리브(32)로 둘러싸인다. 자체 복원력을 생성하고 투관침 샤프트(28)에 대해 투관침 슬리브(32)를 왕복운동시키는 스프링(34)에 의해서 투관침 슬리브(32)는 헤드(12)상에 유지된다.
도 3 및 도 11에 도시된 바와 같이, 쌈지 봉합된 조직(purse-stringed tissue)이 투관침 슬리브(32) 전체에 배열되도록 투관침 샤프트(28)는 일반적으로 슬리브(32)로 피복된다. 그럼에도 불구하고, 투관침 첨단(30)은 압력이 가해지면 조직을 천공할 수 있다. 이는 쌈지 봉합된 조직을 연결하는 경우에 특히 유용하다. 이런 식으로, 노출된 첨단(30)을 구비한 투관침 슬리브(32)는 쌈지 봉합된 조직을 통해 전진되어서 쌈지 봉합이 파열되지 않는다. 투관침 슬리브(32)가 조직을 통해 전진된 후, 투관침 슬리브(32)는 투관침 첨단(30)을 둘러싸서 더 이상의 손상을 입지 않고, 내강(lumen)은 투관침 슬리브(32) 전체에 적절히 부착된다.
투관침 샤프트(28), 투관침 첨단(30) 및 투관침 슬리브(32)에 대응하는 앤빌(14)이 존재한다. 상기에서 언급한 바와 같이, 앤빌(14)은 앤빌 본체 둘레에 원주방향으로 위치하는 앤빌 표면들(24)을 포함한다. 앤빌 표면들(24)은 헤드(12)내에 원주방향으로 수용된 스테이플들에 대응한다. 도 3에서 알 수 있듯이, 앤빌(14)은 조직의 내강내에 배열될 수 있고, 이후에 앤빌 샤프트(36)에 대해 쌈지 봉합된 조직내에 배열될 수 있다. 정렬 메카니즘(도 8에 도시)은 앤빌(14)내에 포함된다. 도 8에 도시된 바와 같이, 톱니부(38)는 앤빌 본체(26)를 따라서 형성된다. 이러한 톱니부(38)는 투관침 첨단(30)에 포함된 후퇴부(52) 또는 압입부와 일치한다. 앤빌(14)이 투관침 샤프트(28)에 걸쳐 배열될 때, 톱니부(38)는 대응 후퇴부(52)에 도달하고, 따라서 헤드(12)에 대해 원주방향으로 배열된 스테이플들과 함께 앤빌 표면들(24)을 정렬할 수 있다.
본 발명의 제 1 및 제 2 실시예에 따라서, 각 헤드(12, 12')의 타원형, 환형 대향 면들(40, 40', 42, 42')과 앤빌(14, 14')은 통과하는 내강의 길이방향 축에 대해 경사진 각도로 배향된다. 외과용 봉합기가 길이방향 축의 직선형 지지 샤프트를 구비한 경우(도 1 내지 도 11), 헤드(12)의 대향 면(40, 42)과 앤빌(14)은 지지 투관침 샤프트(28)의 길이방향 축에 대해 경사진 각도로 배향된다. 이렇게 헤드(12)의 대향 면(40, 42)과 앤빌(14)을 배향함으로써, 외과용 봉합기(10)에 의해 작용된 조직의 최종 절개 에지들은 절개 평면에 수직으로 바라볼 때 실제 타원방향으로 배향된다.
내강의 길이방향 축에 경사지게 절개된 타원형 링은 동일한 내강에 수직하게 절개된 원보다 더 큰 표면적을 갖기 때문에, 본 발명에 따른 생성된 절개표면들은 인접 조직의 봉합에서 더 큰 표면적을 제공한다. 이는 체액이 내강의 절개된 표면들을 통과할 때 내강의 인접 섹션들의 보다 강화된 결합과 감소된 간섭 결과를 가져온다.
도 1 내지 도 11을 참조하고 본 발명의 제 1 실시예에 따라서, 헤드(12)와 앤빌(14) 각각의 근위 단부들과 원위 단부들은 짝을 이루는 경사 평면을 형성하는 경사진 대향 표면들(40, 42)로 형성되며, 이 경사 평면상에서 앤빌(14)과 헤드(12)가 만난다. 이런 식으로 경사진 대향 표면들(40, 42)을 사용함으로써, 앤빌(14)의 근위 단부와 헤드(12)의 원위 단부의 기울어진 타원형상으로 인해 타원형 스테이플 라인이 생성된다. 타원의 원호는 기울기 각도의 역 코사인의 함수이고, 당업자는 앤빌(14)과 헤드(12)의 각 원위 및 근위 대향 표면들(40, 42)이 안치되는 각을 간단히 변경하여 상기 타원이 확대 및/또는 감소될 수 있음을 인지할 것이다. 달리 표현하면, 기울어질수록 타원면적은 확대되며, 따라서 장치에 의해 내강의 확대된 면적이 남겨지게 된다.
당업자는 본 발명의 명세에 따른 특정 스테이플이 개시되지 않은 것을 명화히 인지할 것이다. 그러나, 스테이플들이 앤빌의 대향 표면에 수직하게 앤빌과 만나도록 스테이플들은 헤드의 대향 표면으로부터 수직하게 헤드를 나가는 것이 바람직한 것으로 이해되어야 한다. 이런 식으로 스테이플 등은 기구의 마우스의 가변적인 개방을 허용하면서 대칭적으로 구성된 상태로 유지될 수 있고, 여전히 발사될 때 앤빌과 만나게 된다. 이러한 디자인은 투관침 또한 기구(스테이플들이 헤드로부터 나가는)를 나가는 것과 경사진 절개 표면(앤빌의 포켓(pocket)들이 형성된)으로부터 수직하게 앤빌과 만나게 되는 것을 요구할 것이다.
이를 유념하고, 도 13 및 도 14를 참조하여 개시된 바와 같이 본 발명의 양호한 실시예에 따라서, 짝을 이루는 앤빌(114)과 헤드(112)의 표면들은 본 발명에 따른 소정의 타원형 표면을 생성하기 위해서 계단식 또는 다르게는 오프셋된다. 보다 세부적으로는, 헤드(112)와 앤빌(114)의 각 근위 단부들 및 원위 단부들은 짝을 이루는 경사 평면을 형성하는 경사진 대향 표면들(140, 142)로 형성되고, 이 평면에서 앤빌(114)과 헤드(112)가 만나게 된다. 각각의 경사진 대향 표면들(140, 142)은 일련의 랜드들(143 ; land) 및 상승부들(145 ; riser)로 구성된 계단식 구조를 포함한다. 외과용 봉합기(110)의 길이방향 축에 대해 경사지게 배향되는 평면내에 놓이는 대향 표면을 생성하는 방법으로 랜드들(143) 및 상승부들(145)은 경사진 대향 표면들(140, 142) 각각에 대하여 연장한다.
이 실시예에 따라 사용된 스테이플들은 헤드(112)와 관계된 랜드(143)에 수직 방향으로 헤드(112)에서 나가고, 정렬된 앤빌(114)의 랜드(143)에 대해 형성한다. 결과로서, 계단식 구조의 사용은 앤빌(114)의 접촉 표면과 헤드(112)의 출구 표면에 수직하게 배향된 스테이플 엑추에이션(actuation)을 제공하여 상기 언급된 스테이플 형태 관계에 대처한다.
상기에서 언급된 바와 같이, 이런 식으로 경사진 대향 표면들(140, 142)을 사용함으로써, 타원형 스테이플 라인은 생성되고, 타원체의 원호는 기울기 각도의 역 코사인의 함수이다. 계단식 구조의 사용은 랜드들(143)의 적절한 정렬과 경사진 대향 표면들(140, 142)을 구성하는 상승부들(145)에 근거한 헤드(112) 및 앤빌(114)의 확실하고 일정한 폐쇄 성능을 더욱 강화한다.
계단식 표면이 본 발명의 양호한 실시예에 따라서 상기에 개시됨에도 불구하고, 당업자는 타원형 구성을 달성하는 다른 오프셋 구조들이 본 발명의 기술적 사상을 벗어나지 않으면서 사용될 수 있음을 인지할 것이다.
도 12를 참조하면, 또한 본 발명에 따라서 제공된 타원형상은 헤드(12') 및 앤빌(14')이 봉합기(10')의 샤프트의 길이방향 축에 대해 경사지게 배향되는 평면에서 만나도록 스테이플의 전체 원위 단부를 기울여서 제공될 수 있다. 보다 세부적으로, 헤드(12')의 원위 단부에서 타원, 환형 대향 표면(40')은 전체적으로 이 표면이 통과하는 내강의 길이방향 축과 헤드(12')의 길이방향 축에 대해 경사지게 배향된다. 앤빌(14')의 근위 단부에서 타원, 환형 대향 표면(42')은 이 표면이 통과하는 내강의 길이방향 축에 대해 경사지게 배향되나, 그 자체는 앤빌(14')의 길이방향 축에 대해 수직이다. 이처럼, 앤빌(14')은 헤드(12')의 원위 단부를 따라서 대향 표면(42')이 놓이는 평면에 실질적으로 수직인 라인을 따라서 이동되고 헤드(12')와 접하게 된다.
도 3, 도 4, 도 5 및 도 6에 도시된 작동에서, 각각 투관침 샤프트(28)와 관형 앤빌 연장부(36)에 부착된 2개의 내강들과 함께 앤빌(14)은 수술할 준비가 된다. 도 4에 도시된 바와 같이, 투관침 첨단(30)이 노출되고 앤빌 샤프트(36)내에 끼워 맞춰지도록 앤빌(14)은 투관침 샤프트(28)상에 배치된다. 투관침 슬리브(32)는 노출 위치로 추진되어 헤드(12)내에 끼워 들어간다. 투관침이 앤빌 헤드(26)내에 적절히 안치될 때, 쐐기형 스프링을 포함하는 로킹 클립(46 ; locking clip)은 개방되고 이후 압입부(50)에 대해 파지되는 것이 야기된다. 후퇴부들(52)은 그 자체가 투관침 샤프트(28)내에 정렬된 톱니부들(38)을 구비하기 때문에, 앤빌 표면들(24)이 헤드(12)내에 포함된 스테이플들로 정렬되는 것을 보장한다. 도 7에 더욱 잘 도시된 바와 같이, 앤빌 헤드(26)를 관형 앤빌 연장부(36)로 연결할 때 돌기들(52)을 구멍들(54) 속으로 정확하게 배치하여, 톱니부들(38)은 제조하는 동안 앤빌 표면들(24)로 정렬된다. 도 5에서와 같이, 기구는 이제 내강의 투피스(two pieces)들에 가장 근접한 것으로 보인다. 그 다음에 조절 스크류(16)는 조직을 상호간에 더욱 근접하게 인출한다.
도 6에 도시된 바와 같이, 스테이플들은 조직을 통해서 앤빌 표면들(24)속으로 발사된다. 일단 스테이플들이 클린치되면, 나이프(13)는 스테이플들의 원주내에 수용된 조직을 절개한다. 이러한 절개가 발생하면, 내부 관형 개구를 가진 원주 방향으로 폐쇄된 내강이 이제 생성되도록 봉합기(10)는 내강을 통해 헤드(12)방향으로 인출된다.
봉합기(10)를 제거한 후, 봉합기(10)에 수용된 초과 내강은 처리된다. 도 2 및 도 10에 도시된 바와 같이, 앤빌(14)의 릴리스(44 ; release)는 눌린다. 도 9에 도시된 것처럼, 이는 잠겨진 메카니즘을 도 7에 암시된 바와 같이 개방되게 한다. 사용자로 하여금 앤빌 샤프트(36)를 봉합기 헤드(12)로부터 활주되게 하면서, 로킹 클립(46)은 이제 개방한다. 조직은 앤빌(14)내에 유지되고, 헤드(12)는 이후에 제거된다.
이렇게 하여, 투관침 샤프트(28)에 의한 적절한 쌈지 봉합 및 천공, 후퇴부들(52)과 톱니부들(38) 사이의 정렬, 앤빌 본체(26)의 인출, 압입부에 대한 로킹 클립(46), 및 조직의 적절한 봉합과 절개가 행해진다.
양호한 실시예들이 도시되고 설명되었으나, 이러한 명세로 본 발명을 제한할 의도는 없는 것으로 이해될 것이며, 오히려 본 발명의 기술적 사상과 범주내에 속하는 모든 대안적인 구조들과 변형들을 포함하는 것으로 의도된다.
본 발명은 복수의 스테이플들이 저장되는 헤드를 포함하는 타원형 외과용 봉합기를 제공한다. 헤드는 대향 표면을 포함한다. 또한 외과용 봉합기는 외과용 봉합기의 작동과 동시에 스테이플들을 형성하기 위해 형상화되고 치수화된 앤빌 표면을 갖으며, 짝을 이루는 맞물림을 위한 헤드의 대향 표면에 대응하는 대향 표면을 포함하는 앤빌을 포함한다. 헤드의 대향 표면은 헤드가 외과용 봉합기의 작동 동안 앤빌가 접하게 될 때 타원형 스테이플 라인을 생성하는 헤드의 길이방향 축에 대해 경사지게 배향된다.

Claims (16)

  1. 타원형 외과용 봉합기로서,
    복수의 스테이플(staple)들이 저장되며 대향 표면을 포함하는 헤드; 및
    상기 외과용 봉합기의 작동시에 상기 스테이플들을 형성하기 위해 치수화되고 형상화된 앤빌(anvil) 표면을 포함하는 상기 헤드에 결합되는 앤빌로서, 상기 헤드의 상기 대향 표면과의 짝을 이루는 맞물림을 위한 상기 헤드의 상기 대향 표면에 대응하는(opposed to) 대향 표면을 포함하는, 상기 앤빌을 포함하며;
    상기 헤드가 상기 외과용 봉합기의 작동 동안 상기 앤빌과 접촉하게 될 때, 상기 헤드의 상기 대향 표면은 상기 헤드의 길이방향 축에 대해 경사지게 배향되어 타원형 스테이플 라인을 생성하고,
    상기 앤빌의 상기 대향면은 상기 앤빌의 상기 대향면의 원주(circumference)에 대하여 교대로 연장하는 일련의 제 1 랜드(land)들 및 일련의 제 1 상승부(riser)들을 갖는 제 1 계단식 구조를 포함하며,
    상기 헤드의 상기 대향면은 상기 헤드의 상기 대향면의 원주에 대하여 교대로 연장하는 일련의 제 2 랜드들 및 일련의 제 2 상승부들을 갖는 제 2 계단식 구조를 포함하고,
    상기 앤빌과 상기 헤드가 결합할 경우에, 상기 앤빌의 상기 대향면의 상기 일련의 제 1 랜드들은 상기 헤드의 상기 대향면의 상기 일련의 제 2 랜드들과 정렬하도록 구성된, 타원형 외과용 봉합기.
  2. 제 1 항에 있어서,
    상기 앤빌과 상기 헤드 사이에 수용된 조직을 절개하기 위해 상기 헤드내에 수용된 나이프(knife)를 부가로 포함하는 타원형 외과용 봉합기.
  3. 제 1 항에 있어서,
    상기 앤빌의 상기 대향 표면은 상기 앤빌의 길이방향 축에 대해 경사 각도로 배향되는 타원형 외과용 봉합기.
  4. 제 1 항에 있어서,
    상기 외과용 봉합기는 길이방향 축을 포함하고, 상기 헤드의 상기 대향 표면은 상기 외과용 봉합기의 길이방향 축에 대해 경사 각도로 배향되는 타원형 외과용 봉합기.
  5. 제 4 항에 있어서,
    상기 앤빌의 상기 대향 표면은 상기 외과용 봉합기의 길이방향 축에 대해 경사 각도로 배향되는 타원형 외과용 봉합기.
  6. 삭제
  7. 삭제
  8. 삭제
  9. 삭제
  10. 삭제
  11. 삭제
  12. 삭제
  13. 삭제
  14. 삭제
  15. 삭제
  16. 삭제
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