WO2014080862A1 - 組織切除装置 - Google Patents

組織切除装置 Download PDF

Info

Publication number
WO2014080862A1
WO2014080862A1 PCT/JP2013/081020 JP2013081020W WO2014080862A1 WO 2014080862 A1 WO2014080862 A1 WO 2014080862A1 JP 2013081020 W JP2013081020 W JP 2013081020W WO 2014080862 A1 WO2014080862 A1 WO 2014080862A1
Authority
WO
WIPO (PCT)
Prior art keywords
tissue
pair
slot
flow line
sealing portion
Prior art date
Application number
PCT/JP2013/081020
Other languages
English (en)
French (fr)
Inventor
宮本　学
萬壽　和夫
昌太郎 竹本
高橋　慎治
三日市　高康
聡子 鈴木
Original Assignee
オリンパスメディカルシステムズ株式会社
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by オリンパスメディカルシステムズ株式会社 filed Critical オリンパスメディカルシステムズ株式会社
Priority to EP13856141.0A priority Critical patent/EP2923656A4/en
Priority to JP2014512964A priority patent/JP5608837B1/ja
Priority to CN201380028616.3A priority patent/CN104334097B/zh
Publication of WO2014080862A1 publication Critical patent/WO2014080862A1/ja
Priority to US14/542,050 priority patent/US20150150620A1/en

Links

Images

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
    • A61B18/082—Probes or electrodes therefor
    • A61B18/085—Forceps, scissors
    • 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
    • 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
    • A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A61B17/105—Wound clamp magazines
    • 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
    • A61B17/3209—Incision instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00269—Type of minimally invasive operation endoscopic mucosal resection EMR
    • 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
    • A61B2017/07228—Arrangement of the 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
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder
    • 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
    • A61B2017/07285—Stapler heads characterised by its cutter
    • 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
    • A61B2017/320052—Guides for cutting instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/0063—Sealing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
    • A61B2090/309—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using white LEDs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/361—Image-producing devices, e.g. surgical cameras

Definitions

  • the present invention relates to a tissue excision device, and more particularly, to a tissue excision device used for so-called full-thickness excision in which a part of a luminal tissue is excised over the entire thickness direction.
  • Patent Document 1 describes a surgical stapler having a pair of jaws. A cartridge loaded with staples is attached to one of the pair of jaws, and an anvil member having a plurality of staple pockets is attached to the other jaw. When the jaw is closed with the tissue sandwiched between the pair of jaws, a part of the tissue can be incised through the entire layer by the built-in cutter while the tissue is sutured by the staple.
  • a tissue excision device includes a pair of gripping members that hold tissue, and a cartridge that is replaceably attached to the pair of gripping members.
  • the cartridge includes a longitudinal axis and the longitudinal direction.
  • a cartridge body that has a slot extending along an axis, guides a cutting member that cuts tissue by the slot, and defines a moving range of the cutting member, and is provided on both sides of the slot so as to sandwich the slot.
  • a pair of sealing portions each extending in parallel with the slot, and a tissue sealing portion provided on the distal end side of the slot and on an extension line of the slot.
  • the tissue sealing portion is held between the pair of grasping members and is located on the distal side of the slot. Tissues may be joined.
  • the pair of sealing portions extend to the tip side from the slot, and the tissue sealing portion is It may be provided between the pair of sealing portions.
  • the pair of sealing portions are a pair of staple rows composed of a plurality of staples arranged in the cartridge body. It may be.
  • the tissue sealing portion is a sealing staple disposed on the distal end side of the slot in the cartridge body. May be.
  • the tissue sealing portion is held between the pair of grasping members and is located on the distal side of the slot.
  • a pair of electrodes capable of contacting the tissue may be used.
  • the tissue sealing portion is held between the pair of grasping members and positioned on the distal end side with respect to the slot.
  • a pair of heating elements capable of contacting the tissue may be used.
  • an insertion portion that extends along the longitudinal axis, a pair of gripping members that are provided at the distal end of the insertion portion and grip tissue, and along a predetermined flow line
  • a cutting member that cuts the luminal tissue held between the pair of jaws by moving, and a pair of seals provided on both sides of the flow line so as to sandwich the flow line, and extending in parallel with the flow line, respectively.
  • a tissue sealing portion provided on the distal end side of the flow line and on an extension line of the flow line.
  • the tissue sealing portion is held between the pair of grasping members and positioned on the distal side with respect to the flow line.
  • the tissues to be joined may be joined.
  • the pair of sealing portions extend to the tip side from the flow line, and the tissue sealing portion is , And may be provided between the pair of sealing portions.
  • the pair of sealing portions are a pair of staples arranged on both sides of the flow line. It may be a staple row.
  • the tissue sealing portion may be a sealing staple disposed on the distal end side of the flow line. .
  • the tissue sealing portion is held between the pair of grasping members and more distal than the flow line. It may be a pair of electrodes that can be in contact with the tissue located. In the tissue excision apparatus according to the fourteenth aspect of the present invention, according to the eighth aspect, the tissue sealing portion is held between the pair of gripping members and more distal than the flow line. It may be a pair of heating elements that can be in contact with the tissue located.
  • tissue excision device since the tissue sealing portion is arranged in the cartridge, the tissue between the pair of sealing portions on the distal end side (front side) of the cutting line of the cutting member is the tissue sealing portion. Is securely stitched and sealed. Further, in a state where the tissue is drawn into the narrow gap between the pair of gripping members and gripped, the tissue is first sutured by the pair of sealing portions and the tissue sealing portion, and then the pair of gripping members after the cutting member cuts the tissue Holding by is released. Therefore, in a series of procedures using the tissue excision apparatus, tissue excision can be performed without causing any state in which the contents of the luminal tissue may leak to the outside.
  • FIG. 1 is a diagram illustrating an overall configuration of a tissue excision apparatus according to a first embodiment of the present invention. It is a figure which shows 1 operation
  • FIG. 1 is a diagram illustrating an overall configuration of a tissue excision apparatus 1 according to the present embodiment.
  • the tissue excision apparatus 1 is provided at the distal end and includes a treatment unit 10 for performing treatment on a target tissue.
  • the tissue excision apparatus 1 further includes a first operation unit 30 for operating the treatment unit 10, a long insertion unit 40 provided between the treatment unit 10 and the first operation unit 30, and an insertion
  • the observation part 50 inserted in the part 40, the 2nd operation part 60 for operating the observation part 50, and the 3rd operation part 70 for operating a treatment part are provided.
  • the treatment section 10 includes a first jaw (first gripping member) 11 and a second jaw (second gripping member) 12 as a pair of jaws that can be opened and closed, and a tissue using a cartridge 13 loaded with a staple 13A. Suture and detach.
  • the basic structure of the treatment part 10 is well-known as described in the above-mentioned patent document 1, for example.
  • the first operation unit 30 has a known configuration and includes two dial knobs 31 and 32 and a lock lever 33.
  • the dial knobs 31 and 32 are connected to a bending portion 41 described later by an operation member (not shown) such as a wire.
  • the third operation unit 70 is provided with a first trigger 34 for opening and closing the pair of jaws 11 and 12 and a second trigger 35 for performing a suturing and incising operation.
  • the insertion portion 40 has flexibility and is formed in a tubular shape extending along the longitudinal axis.
  • the treatment portion 10 is attached to the distal end side of the insertion portion 40, and the first operation portion 30 is attached to the proximal end side of the insertion portion 40.
  • the insertion portion 40 has a bending portion 41 having a known structure having a plurality of node rings or bending pieces on the tip side, and is bent by operating the dial knobs 31 and 32 of the first operation portion 30. be able to.
  • the curved state can be fixed by operating the lock lever 33.
  • An operation member is inserted into the lumen of the insertion portion 40 so as to be able to advance and retract in the axial direction.
  • a forceps port 42 is provided on the proximal end side of the insertion portion 40, and a general endoscopic treatment tool 100 or the like equipped with the forceps portion 101 is inserted into the forceps port 42, so that the first jaw 11 can protrude from the base end side.
  • the observation unit 50 is inserted into the insertion unit 40 so as to be able to advance and retreat, and includes an illumination unit 51 including an LED or the like at the tip and an imaging unit 52 such as a CCD. Further, a bending portion 53 having the same structure as that of the bending portion 41 is provided on the distal end side.
  • the distal end portion of the observation unit 50 can be protruded from the opening 43 provided on the distal end side of the insertion portion 40. Thereby, for example, as shown in FIG. 2, the distal end portion of the observation unit 50 is protruded and the bending portion 53 is appropriately bent, whereby the tissue or the like held by the treatment portion 10 can be preferably observed.
  • the second operation unit 60 is connected to the base end of the observation unit 50 that has come out from the base end side of the insertion unit 40.
  • the second operation unit 60 is provided with a dial knob 61, a button 62, and the like similar to those of the first operation unit 30.
  • the second operation unit 60 can perform a bending operation of the bending unit 53, an operation of the illumination unit 51 and the imaging unit 52, and the like.
  • the video signal acquired by the imaging means 52 is sent to an image processing unit (not shown) through the universal cable 63 and displayed on a display or the like (not shown).
  • a known endoscope apparatus or the like can be used by appropriately setting dimensions and the like.
  • FIG. 3 is a partially enlarged view showing a state where the first jaw 11 and the cartridge 13 are viewed from the second jaw 12 side.
  • the cartridge 13 includes a cartridge main body 14 having a longitudinal axis, a slot 14A for moving a cutter (cutting member) 20 extending along the longitudinal axis, and cutting the tissue, and both sides of the slot 14A in the width direction.
  • a pair of first staple rows (a pair of sealing portions) 15 extending in parallel with the slot 14A, and a second staple (tissue seal) disposed in front of the slot 14A (on the tip side of the slot 14A) and on an extended line of the slot 14A Stop portion, sealing staple) 16.
  • a plurality of staples 15A are arranged in the cartridge main body 14 in the first staple row 15, and extend to the tip side by a predetermined length, for example, 5 millimeters (mm) from the slot 14A.
  • the second staple 16 is disposed between the two first staple rows 15.
  • FIG. 3 shows an example in which two second staples 16 are arranged, the number of arranged second staples 16 is not particularly limited, and may be one or three or more.
  • the staples arranged as the second staples may be the same staple 15A as the first staple row or may be different.
  • the cutter 20 is inserted into the slot 14A from the inside of the cartridge 13 and moves in the slot 14A while protruding toward the second jaw 12.
  • the cutter 20 enters the slot 14A in a state where the protruding end of the cutter 20 enters a groove provided in an anvil member described later so that the tissue sandwiched between the pair of jaws 11 and 12 can be cut over all layers. Move along.
  • the blade span of the cutter 20 required for this is longer than the thickness of the two target tissues held in the folded state and longer than the distance between the pair of jaws 11 and 12 in the closed state.
  • FIG. 4A is a diagram showing a mechanism for ejecting staples from the cartridge 13.
  • a driver 17 made of resin or the like is disposed below the staple 15A.
  • a wedge 18 having a slope 18 ⁇ / b> A on the tip side is disposed.
  • the wedge 18 pushes the driver 17 in contact with the inclined surface 18A upward.
  • the staple 15A is sequentially ejected from the proximal end side by being pushed by the driver 17 and penetrates the tissue, and the penetrated end portion is pressed against the anvil member 21 provided in the second jaw 12 and folded back. .
  • the driver 17 is disposed in each of the two first staple rows 15, but in the region on the tip side of the slot 14A, as shown in FIG. 4B, the two first staple rows 15 and the second staple rows 15 are arranged.
  • a driver 19 that pushes up the staple 16 is disposed. Therefore, when the wedge 18 pushes up the driver 19, the staple 15A and the second staple 16 in the first staple row 15 are pushed up and ejected together.
  • tissue excision apparatus 1 First, the surgeon introduces the tissue excision apparatus 1 into the stomach from the patient's mouth and observes the tumor using the observation unit 50. Then, as shown in FIG. 5, a rough excision region R surrounding the tumor Tm is set.
  • the excision region R is preferably set so that the shortest distance from the tumor Tm is 5 millimeters (mm) or more so as not to damage the tumor Tm at the time of tissue excision.
  • the surgeon projects the endoscope treatment tool 100 from the first jaw 11 and grasps one point of the stomach wall away from the tumor Tm from the inside of the stomach Sm with the forceps 101 as shown in FIG. . Since this one point is a part of the periphery of the region to be actually excised, it is preferable to set it at a position corresponding to the peripheral portion of the set excision region R, for example, a location about 30 mm away from the center of the tumor Tm. Can be selected.
  • this gripped point is referred to as a first gripping point P1.
  • the surgeon retracts the endoscope treatment tool 100 that grasps the first grasping point P1, and appropriately operates the first trigger 34, as shown in FIG.
  • a part of the stomach wall tissue ST is drawn into the gap between the two.
  • the observation unit 50 observes the tumor Tm, and care is taken so that the tumor Tm does not touch the pair of jaws.
  • the stomach wall tissue ST is drawn between the first jaw 11 and the second jaw 12 along two first pull-in lines L1 extending from the first gripping point P1. That is, the stomach wall tissue ST to be drawn is bent with the outer surface of the stomach facing inward so that the outer surfaces of the stomach come into contact with each other, one of the first lead lines L1 faces the first jaw 11, and the other is the second jaw 12. It is drawn in the state facing to.
  • the gap between the pair of jaws is a narrow slit, and the distance between them is about two sheets of the stomach wall tissue. It is not drawn in.
  • the operator When the stomach wall tissue ST is sufficiently retracted between the pair of jaws 11 and 12, the operator operates the second trigger 35. As a result, the wedge 18 moves forward in the cartridge 13 toward the tip, and pushes up the driver 17 disposed below each staple 15A of the first staple row 15 in order from the base end side. As a result, the staple 15A is sequentially pressed against the anvil member 21 (see FIG. 4A) provided on the second jaw 12 from the proximal end side toward the distal end side, and both end portions of the staple 15A penetrating the stomach wall tissue ST are formed. Wrapped. As a result, the folded stomach wall tissue ST is sutured so as to be integrated over the thickness direction on both sides of the first lead-in line L1.
  • the cutter 20 advances slightly toward the tip after the wedge 18, and the stomach wall tissue located between the rows of the first staple rows 15 in which the stomach wall tissue ST is sutured is substantially the first lead-in line L1. Cut along. As a result, a part of the stomach wall is cut over the entire layer as shown in FIG.
  • the stomach wall tissue located between the rows of the first staple rows 15 in front of the extension line of the flow line of the cutter 20 is sutured together by the second staple 16.
  • the operator After cutting and suturing along the first lead-in line L1, the operator removes the tissue excision device 1 out of the body cavity, replaces the cartridge 13 with a new cartridge loaded with staples, and introduces it again into the stomach. To do. And as shown in FIG. 9, the forceps part 101 of the treatment tool 100 for endoscopes 100 is set as the second gripping point P2 at the end opposite to the first gripping point P1 of the cutting line along the first lead-in line L1. Grip with
  • the surgeon retracts the endoscope treatment tool 100, and, as shown in FIG. 10, the stomach wall tissue ST grasped by the forceps portion 101 is moved into the pair of jaws 11 and 12 along the second pull-in line L2. Pull in. At this time, the stomach wall tissue ST is drawn so that the ridge line rg of the stomach wall tissue bent so that the outer surfaces come into contact with each other passes through the pair of jaws 11 and 12.
  • the stomach wall tissue ST is cut and sutured along the second lead-in line L2. Further, since the first lead-in line L1 and the second lead-in line L2 form a closed quadrilateral as shown in FIG. 5, the stomach wall tissue ST in the resection region R including the tumor Tm By the cutting line formed along the two lead-in lines L2, it is cut off from the stomach Sm as shown in FIG. In this way, a part of the stomach wall tissue ST is excised across the entire layer without leaving a hole in the stomach Sm.
  • the operator After completion of the resection, the operator removes the tissue resection device 1, collects the resected stomach wall tissue ST (resection piece), and ends the procedure. At this time, the excision piece may be grasped by the forceps 101 and the tissue excision apparatus 1 may be removed and the excision piece may be collected simultaneously.
  • the tissue excision apparatus 1 of the present embodiment since the second staple 16 as the tissue sealing portion is arranged in the cartridge 13, the tissue between the first staple rows 15 in front of the cutting line of the cutter 20. Are securely stitched and sealed by the second staple 16.
  • the tissue in a state where the tissue is drawn into and held in the narrow gap between the pair of jaws 11 and 12, the tissue is first sutured by the first staple row 15 and the second staple 16, and the pair of jaws is cut after the cutter cuts the tissue. Holding by is released. Therefore, in a series of procedures using the tissue excision apparatus 1, tissue excision can be performed without causing any state in which the contents of the luminal tissue may leak out.
  • the staple and the second staple in the first staple row are ejected by a common driver on the tip side from the slot 14A
  • the structure for ejecting the staple is limited to this.
  • the driver that pushes up the second staple may be separated from the driver in the first staple row.
  • a second wedge 23 may be provided in front of the cutter 20, and the driver 22 that pushes up the second staple 16 may be pushed up by the second wedge 23.
  • the second wedge 23 may be configured to push up the common driver 19, or the second wedge 23 may be configured to push up all the drivers.
  • the stapling direction of the first stapling row and the second stapling direction are parallel to each other.
  • It may be arranged so as to be orthogonal to the moving slot 14A. In this way, the tissue in front of the slot can be joined in a wider range, and the tissue can be excised more reliably.
  • FIG. 15 is a partially enlarged view showing the first jaw 11 and the distal end side of the cartridge 72 in the tissue excision device 71.
  • a linear or belt-like first electrode 73 is provided in front of the slot 14A in place of the second staple.
  • An insulator 74 is disposed around the first electrode 73 and is insulated from other metal parts in the treatment portion 10.
  • the anvil member 75 provided in the second jaw 12 is provided with a second electrode 76 having the same structure as the first electrode 73 at a position corresponding to the first electrode 73.
  • the first electrode 73 and the second electrode 76 are connected to a high frequency power source 77. On / off of energization can be switched by an operation unit (not shown).
  • the tissue excision device 71 When using the tissue excision device 71, as in the first embodiment, the tissue is sutured and cut using the first staple row 15 and the cutter 20, and then the first jaws 11 and 12 are opened without first opening them.
  • a high frequency current is supplied from a high frequency power source 77 to the tissue sandwiched between the electrode 73 and the second electrode 76.
  • a pair of electrodes of the first electrode 73 and the second electrode 76 function as a so-called bipolar electrosurgical instrument.
  • the intracellular and extracellular components of the tissue that is energized in contact with the first electrode 73 and the second electrode 76 are made uniform (liquid). Then, the tissues are joined between the pair of jaws 11 and 12, and the hole caused by the remaining unstitched tissue is sealed.
  • the tissue excision apparatus 71 of the present embodiment can perform tissue excision without causing any state in which the contents of the luminal tissue may leak to the outside. Moreover, since the tissue sealing portion is constituted by the first electrode 73 and the second electrode 76, the sealing portion is joined in a planar shape. As a result, the hole can be closed more reliably.
  • the structure of the tissue sealing portion that seals the tissue that has been contacted by energization is not limited to the bipolar mechanism described above.
  • a heating element such as a heater that generates heat when energized is attached to the cartridge and the anvil member instead of the first electrode 73 and the second electrode 76, and the tissue sandwiched between the pair of jaws is heated from both sides. Good.
  • these heat generating elements function as a so-called thermal coagulation treatment instrument, and therefore tissues can be joined together by appropriately setting the temperature and heating time.
  • the shape of the electrode is not limited to the above-described linear shape, belt shape, or the like, and may be a spot shape like the electrode 73A shown in FIG.
  • the number of times of suturing and cutting is not limited to two.
  • the jaw may not be cut twice depending on the size of the jaw.
  • the second suture and cutting are performed with a part of the lumen tissue pulled in such a way that the ridge line of the folded lumen tissue does not pass through the slit, The tissue to be excised is not cut off.
  • the luminal tissue targeted by the tissue excision apparatus of the present invention is not limited to the stomach.
  • the diameter of the intestine is smaller than that of the stomach, but the tissue excision method of the present invention can be suitably performed on the intestine and the like by appropriately setting the size of a device to be used such as a stapler.
  • the target disease for tissue resection is not limited to the tumor described in the embodiment, and is naturally applicable to other diseases such as a severe ulcer.
  • tissue sealing portion since the tissue sealing portion is arranged in the cartridge, the tissue between the pair of sealing portions in front of the cutting line of the cutting member is securely sutured by the tissue sealing portion. And sealed. Further, in a state where the tissue is drawn into the narrow gap between the pair of gripping members and gripped, the tissue is first sutured by the pair of sealing portions and the tissue sealing portion, and then the pair of gripping members after the cutting member cuts the tissue Holding by is released. Therefore, in a series of procedures using the tissue excision apparatus, tissue excision can be performed without causing any state in which the contents of the luminal tissue may leak to the outside.
  • first jaw first gripping member
  • Second jaw second gripping member
  • Cartridge body 14A Slot 15 A pair of first staple rows (a pair of sealing portions)
  • Second staple tissue sealing part, sealing staple
  • Cutter Cutting member

Landscapes

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

Abstract

　組織切除装置は、組織を保持する一対の把持部材と、前記一対の把持部材に交換可能に取り付けられるカートリッジとを備え、前記カートリッジは、長手軸と、前記長手軸に沿って延びるスロットとを有し、前記スロットにより組織を切断する切断部材を案内するとともに前記切断部材の移動範囲を規定するカートリッジ本体と、前記スロットを挟むように前記スロットの両側に設けられ、それぞれ前記スロットと平行に延びる一対の封止部と、前記スロットより先端側かつ前記スロットの延長線上に設けられた組織封止部と、を有する。

Description

組織切除装置
　本発明は、組織切除装置、より詳しくは、管腔組織の一部を厚さ方向全体にわたり切除する、いわゆる全層切除に用いる組織切除装置に関する。
　本願は、２０１２年１１月２０日に、米国に仮出願された米国特許出願第６１／７２８，５０７号に基づき優先権を主張し、その内容をここに援用する。
　従来、胃癌等の治療において、腫瘍およびその周辺の組織を、胃壁の厚さ方向全体にわたり切除することが行われている。このような全層切除は、開腹手術あるいは腹腔鏡下手術により行われることが多い。
　また、特許文献１には、一対のジョーを備えた手術用ステイプラが記載されている。一対のジョーの一方には、ステイプルが装填されたカートリッジが装着され、他方には、複数のステイプルポケットを有するアンビル部材が取り付けられている。一対のジョーの間に組織を挟んでジョーを閉じると、ステイプルにより組織を縫合しつつ、内蔵されたカッターにより組織の一部を全層にわたって切開することができる。

日本国特表２０１０－５２２０３５号公報
　従来全層切除は、開腹手術下や腹腔鏡手術下で行われてきたが、患者の侵襲をより小さくしたり、腫瘍を切除する際の再発のリスクを低減したりする観点から、これを口等の自然開口から行うことが検討されている。
　しかしながら、特許文献１に記載されたような従来の組織切除装置では、第一ステイプル列しか備えていないため、第一の引き込み線に沿って縫合および切断を行うと、切断部材の切断線の先端側（前方）であって第一ステイプル列間の組織が未縫合となり、穴のような状態となった部位が残存する。そのため、管腔組織の内圧が高まった等の場合に、一時的ではあるが当該部位から管腔組織の内容物が外部に漏れ出る恐れがある状態が生じてしまうという問題がある。

　本発明の第一の態様に係る組織切除装置は、組織を保持する一対の把持部材と、前記一対の把持部材に交換可能に取り付けられるカートリッジとを備え、前記カートリッジは、長手軸と、前記長手軸に沿って延びるスロットとを有し、前記スロットにより組織を切断する切断部材を案内するとともに前記切断部材の移動範囲を規定するカートリッジ本体と、前記スロットを挟むように前記スロットの両側に設けられ、それぞれ前記スロットと平行に延びる一対の封止部と、前記スロットの先端側かつ前記スロットの延長線上に設けられた組織封止部と、を有する。

　本発明の第二の態様に係る組織切除装置において、上記第一の態様によれば、前記組織封止部は、前記一対の把持部材間に保持されるとともに前記スロットよりも先端側に位置する組織を接合してもよい。
　本発明の第三の態様に係る組織切除装置において、上記第一の態様によれば、前記一対の封止部は、前記スロットよりも前記先端側まで延びており、前記組織封止部は、前記一対の封止部の間に設けられていてもよい。
　本発明の第四の態様に係る組織切除装置において、上記第一の態様によれば、前記一対の封止部は、前記カートリッジ本体内に配置された複数のステイプルから構成される一対のステイプル列であってもよい。
　本発明の第五の態様に係る組織切除装置において、上記第一の態様によれば、前記組織封止部は、前記カートリッジ本体内において前記スロットの前記先端側に配置された封止ステイプルであってもよい。
　本発明の第六の態様に係る組織切除装置において、上記第一の態様によれば、前記組織封止部は、前記一対の把持部材間に保持されるとともに前記スロットよりも先端側に位置する組織に接触可能な一対の電極であってもよい。
　本発明の第七の態様に係る組織切除装置において、上記第一の態様によれば、前記組織封止部は、前記一対の把持部材間に保持されるとともに前記スロットよりも先端側に位置する組織に接触可能な一対の発熱素子であってもよい。
　本発明の第八の態様に係る組織切除装置において、長手軸に沿って延びる挿入部と、前記挿入部の先端に設けられ、組織を把持する一対の把持部材と、所定の動線に沿って移動することにより前記一対のジョー間に保持された管腔組織を切断する切断部材と、前記動線を挟むように前記動線の両側に設けられ、それぞれ前記動線と平行に延びる一対の封止部と、前記動線の先端側かつ前記動線の延長線上に設けられた組織封止部と、を備える。
　本発明の第九の態様に係る組織切除装置において、上記第八の態様によれば、前記組織封止部は、前記一対の把持部材間に保持されるとともに前記動線よりも先端側に位置する組織を接合してもよい。
　本発明の第十の態様に係る組織切除装置において、上記第八の態様によれば、前記一対の封止部は、前記動線よりも前記先端側まで延びており、前記組織封止部は、前記一対の封止部の間に設けられていてもよい。
　本発明の第十一の態様に係る組織切除装置において、上記第八の態様によれば、前記一対の封止部は、前記動線の両側に配置された複数のステイプルから構成される一対のステイプル列であってもよい。
　本発明の第十二の態様に係る組織切除装置において、上記第八の態様によれば、前記組織封止部は、前記動線の前記先端側に配置された封止ステイプルであってもよい。
　本発明の第十三の態様に係る組織切除装置において、上記第八の態様によれば、前記組織封止部は、前記一対の把持部材間に保持されるとともに前記動線よりも先端側に位置する組織に接触可能な一対の電極であってもよい。
　本発明の第十四の態様に係る組織切除装置において、上記第八の態様によれば、前記組織封止部は、前記一対の把持部材間に保持されるとともに前記動線よりも先端側に位置する組織に接触可能な一対の発熱素子であってもよい。
　上記各態様の組織切除装置は、カートリッジに組織封止部が配置されているため、切断部材の切断線の先端側（前方）であって一対の封止部間の組織が、組織封止部により確実に縫合されて封止される。また、一対の把持部材の間の狭い間隙に組織を引き込み、把持した状態で、まず一対の封止部および組織封止部により組織が縫合され、切断部材が組織を切断した後に一対の把持部材による保持が解除される。したがって、組織切除装置を用いた一連の手技においては、管腔組織の内容物が外部に漏れ出る恐れがある状態を全く生じさせずに組織切除を行うことができる。
本発明の第一実施形態の組織切除装置の全体構成を示す図である。 同組織切除装置の使用時の一動作を示す図である。 同組織切除装置の第一ジョーおよびカートリッジを第二ジョー側から見た状態を示す部分拡大図である。 カートリッジからステイプルが射出される仕組みを示す図である。 カートリッジ内のドライバを示す図である。 切除領域および把持点を示す図である。 同組織切除装置の使用時の一動作を示す図である。 同組織切除装置の使用時の一動作を示す図である。 同組織切除装置の使用時の一動作を示す図である。 同組織切除装置の使用時の一動作を示す図である。 同組織切除装置の使用時の一動作を示す図である。 同組織切除装置の使用時の一動作を示す図である。 従来の組織切除装置を用いて縫合及び切断を行った後の状態を示す図である。 同実施形態の変形例におけるカッターを示す図である。 同実施形態の変形例における第一ジョーおよびカートリッジの先端側を示す部分拡大図である。 本発明の第二実施形態の組織切除装置における第一ジョーおよびカートリッジの先端側を示す部分拡大図である。 同組織切除装置における電気的なつながりを示す図である。 同実施形態の変形例における第一ジョーおよびカートリッジの先端側を示す部分拡大図である。
　以下、本発明の第一実施形態について、図１から図１４を参照して説明する。
　図１は、本実施形態の組織切除装置１の全体構成を示す図である。組織切除装置１は、先端に設けられ、対象組織に処置を行うための処置部１０を備えている。また、組織切除装置１は、さらに、処置部１０を操作するための第一操作部３０と、処置部１０と第一操作部３０との間に設けられた長尺の挿入部４０と、挿入部４０に挿通された観察部５０と、観察部５０を操作するための第二操作部６０と、処置部を操作するための第三操作部７０とを備えている。処置部１０は、開閉可能な一対のジョーとして、第一ジョー（第一把持部材）１１および第二ジョー（第二把持部材）１２を有し、ステイプル１３Ａが装填されたカートリッジ１３を用いて組織を縫合、および切離する。また、処置部１０の基本構造は、例えば、上述の特許文献１に記載のように公知である。
　第一操作部３０は、公知の構成を有し、２つのダイヤルノブ３１および３２と、ロックレバー３３とを有する。ダイヤルノブ３１および３２は、ワイヤ等の操作部材（不図示）により後述する湾曲部４１と接続されている。第三操作部７０には、一対のジョー１１、１２を開閉操作するための第一トリガー３４と、縫合および切開操作を行うための第二トリガー３５とが設けられている。
　挿入部４０は可撓性を有し、長手軸に沿って延びる管状に形成されている。挿入部４０の先端側に処置部１０が取り付けられ、挿入部４０の基端側に第一操作部３０が取り付けられている。挿入部４０は、複数の節輪または湾曲コマ等を有する公知の構造の湾曲部４１を先端側に有しており、第一操作部３０のダイヤルノブ３１および３２を操作することにより、湾曲させることができる。湾曲状態は、ロックレバー３３を操作することで固定することができる。挿入部４０の内腔には、操作部材が軸線方向に進退可能に挿通されている。また、挿入部４０の基端側には、鉗子口４２が設けられており、鉗子部１０１を備えた一般的な内視鏡用処置具１００等を鉗子口４２に挿入して、第一ジョー１１の基端側から突出させることができる。
　観察部５０は、挿入部４０に進退可能に挿通されており、先端部にＬＥＤ等を含む照明部５１と、ＣＣＤ等の撮像手段５２とを備えている。また、先端側に湾曲部４１と同様の構造の湾曲部５３を有している。観察部５０の先端部は、挿入部４０の先端側に設けられた開口４３から突没させることができる。これにより、例えば図２に示すように、観察部５０の先端部を突出させて湾曲部５３を適宜湾曲させることにより、処置部１０に保持された組織等を好適に観察することができる。
　第二操作部６０は、挿入部４０の基端側から外に出た観察部５０の基端に接続されている。第二操作部６０には、第一操作部３０と同様のダイヤルノブ６１やボタン６２等が設けられている。第二操作部６０は、湾曲部５３の湾曲操作や、照明部５１および撮像手段５２の操作等を行うことができる。撮像手段５２で取得された映像信号は、ユニバーサルケーブル６３を通って図示しない画像処理部に送られ、図示しないディスプレイ等に表示される。観察部５０および第二操作部６０としては、公知の内視鏡装置等を、寸法等を適宜設定して使用可能である。
　図３は、第一ジョー１１およびカートリッジ１３を第二ジョー１２側から見た状態を示す部分拡大図である。カートリッジ１３は、長手軸と、長手軸に沿って延び、かつ、組織を切断するカッター（切断部材）２０が移動するためのスロット１４Ａとを有するカートリッジ本体１４と、スロット１４Ａの幅方向両側でそれぞれスロット１４Ａと平行に延びる一対の第一ステイプル列（一対の封止部）１５と、スロット１４Ａの前方（スロット１４Ａよりも先端側）かつスロット１４Ａの延長線上に配置された第二ステイプル（組織封止部、封止ステイプル）１６とを備えている。
　第一ステイプル列１５には、複数のステイプル１５Ａがカートリッジ本体１４内に整列配置されており、スロット１４Ａよりも所定の長さ、例えば５ミリメートル（ｍｍ）だけ先端側まで延びている。第二ステイプル１６は、二列の第一ステイプル列１５の間に配置されている。図３では、第二ステイプル１６が二つ配置された例を示しているが、配置される個数には特に制限はなく、一つであっても、三つ以上であってもよい。第二ステイプルとして配置されるステイプルは、第一ステイプル列と同一のステイプル１５Ａであってもよいし、異なっていてもよい。
　カッター２０は、カートリッジ１３の内側からスロット１４Ａに挿通され、第二ジョー１２に向かって突出した状態でスロット１４Ａ内を移動する。カッター２０は、一対のジョー１１、１２間に挟まれた組織を全層にわたって切断できるように、カッター２０の突出端が、後述するアンビル部材に設けられた溝内に進入した状態でスロット１４Ａに沿って移動する。このために必要なカッター２０の刃渡りは、折り返された状態で保持される対象組織の２枚分の厚さよりも長く、かつ閉じた状態の一対のジョー１１、１２間の距離よりも長い。
　図４Ａは、カートリッジ１３からステイプルが射出される仕組みを示す図である。ステイプル１５Ａの下方には樹脂等で形成されたドライバ１７が配置されている。カートリッジ１３内には、先端側に斜面１８Ａを有するクサビ１８が配置されている。第二トリガー３５を操作してクサビ１８を前進させると、斜面１８Ａと接触したドライバ１７をクサビ１８が上方に押し上げる。その結果、ステイプル１５Ａは、ドライバ１７に押されることで基端側から順次射出されて組織を貫通し、貫通した端部が第二ジョー１２に設けられたアンビル部材２１に押し当てられて折り返される。
　ドライバ１７は、２列の第一ステイプル列１５のそれぞれに配置されているが、スロット１４Ａよりも先端側の領域には、図４Ｂに示すように、２列の第一ステイプル列１５および第二ステイプル１６を押し上げるドライバ１９が配置されている。したがって、クサビ１８がドライバ１９を押し上げると、第一ステイプル列１５のステイプル１５Ａと第二ステイプル１６とが一緒に押し上げられて射出される。
　次に、組織切除装置１の使用時の動作について、胃（管腔組織）の悪性腫瘍（以下、単に「腫瘍」と称する。）を全層切除する場合を例に取り説明する。
　まず、術者は、組織切除装置１を患者の口等から胃内に導入し、観察部５０を用いて腫瘍を観察する。そして、図５に示すように、腫瘍Ｔｍを取り囲む大まかな切除領域Ｒを設定する。切除領域Ｒは、組織切除時に腫瘍Ｔｍを損傷等しないように、腫瘍Ｔｍとの最短距離が５ミリメートル（ｍｍ）以上になるように設定されるのが好ましい。
　次に、術者は、内視鏡用処置具１００を第一ジョー１１から突出させ、図６に示すように、鉗子部１０１で腫瘍Ｔｍから離れた胃壁の一点を胃Ｓｍの内側から把持する。この一点は、実際に切除される領域の周縁の一部となるため、設定した切除領域Ｒの周縁部に相当する位置に設定するのが好ましく、例えば、腫瘍Ｔｍの中心から３０ｍｍ程度離れた箇所を選択することができる。以後、この把持された一点を、第一把持点Ｐ１と称する。
　続いて術者は、第一把持点Ｐ１を把持した内視鏡用処置具１００を後退させ、第一トリガー３４を適宜操作しながら、図７に示すように、第一ジョー１１と第二ジョー１２との間の間隙に胃壁組織ＳＴの一部を引き込む。引き込む際には、観察部５０で腫瘍Ｔｍを観察し、腫瘍Ｔｍが一対のジョーに触れないように注意して行う。
　胃壁組織ＳＴは、第一把持点Ｐ１から延びる２本の第一引き込み線Ｌ１に沿って第一ジョー１１と第二ジョー１２との間に引き込まれる。すなわち、引き込まれる胃壁組織ＳＴは、胃の外面どうしが接触するように胃の外面を内側にして折り曲げられ、第一引き込み線Ｌ１の一方が第一ジョー１１に対向し、他方が第二ジョー１２に対向した状態で引き込まれていく。一対のジョーの間隙は狭いスリット状であり、その間隔が胃壁組織の略２枚分の厚さとなっているため、胃に隣接する他の臓器等の組織が、胃壁組織とともに一対のジョー間に引き込まれることはない。
　胃壁組織ＳＴが一対のジョー１１、１２間に充分に引きこまれたら、術者は第二トリガー３５を操作する。これにより、カートリッジ１３内においてクサビ１８が先端に向かって前進し、第一ステイプル列１５の各ステイプル１５Ａの下方に配置されたドライバ１７を基端側から順に押し上げる。その結果、ステイプル１５Ａは、基端側から先端側に向かって順次第二ジョー１２に設けられたアンビル部材２１（図４Ａ参照）に押し当てられ、胃壁組織ＳＴを貫通したステイプル１５Ａの両端部が折り返される。その結果、第一引き込み線Ｌ１の両側において、折り曲げられた胃壁組織ＳＴが厚さ方向にわたって一体となるように縫合される。
　さらに、クサビ１８に少し遅れてカッター２０（図４Ａ参照）が先端に向かって前進し、胃壁組織ＳＴを縫合した第一ステイプル列１５の列間に位置する胃壁組織を、概ね第一引き込み線Ｌ１に沿って切断する。その結果、図８に示すよう胃壁の一部が全層にわたって切断される。ここで、カッター２０の動線（スロット１４Ａと実質的に同一）の延長線上の前方において第一ステイプル列１５の列間に位置する胃壁組織は、第二ステイプル１６により一体に縫合される。
　第一引込み線Ｌ１に沿った切断および縫合が終了した後、術者は組織切除装置１を体腔外に抜去してカートリッジ１３を、ステイプルが装填された新しいカートリッジと交換し、再度胃内に導入する。そして、図９に示すように、第一引込み線Ｌ１に沿った切断線の第一把持点Ｐ１と反対側の端部を第二把持点Ｐ２として、内視鏡用処置具１００の鉗子部１０１で把持する。
　次に、術者は内視鏡用処置具１００を後退させ、図１０に示すように、鉗子部１０１で把持した胃壁組織ＳＴを、第二引込み線Ｌ２に沿って一対のジョー１１、１２内に引き込む。このとき、外面どうしが接触するように折り曲げられた胃壁組織の稜線ｒｇが一対のジョー１１、１２内を通るように胃壁組織ＳＴを引き込む。
　その後、上述と同様の操作で縫合および切断を行うと、第二引込み線Ｌ２に沿って胃壁組織ＳＴが切断および縫合される。さらに、第一引込み線Ｌ１と第二引込み線Ｌ２とが図５に示すように閉じた四角形を形成するため、腫瘍Ｔｍを含む切除領域Ｒ内の胃壁組織ＳＴが、第一引込み線Ｌ１および第二引込み線Ｌ２に沿って形成された切断線によって、図１１に示すように胃Ｓｍから切り離される。このようにして、胃Ｓｍに穴を残すことなく、胃壁組織ＳＴの一部が全層にわたって切除される。
　切除終了後、術者は組織切除装置１を抜去し、切除された胃壁組織ＳＴ（切除片）を回収して手技を終了する。このとき、切除片を鉗子部１０１で把持し、組織切除装置１の抜去と切除片の回収とを同時に行ってもよい。
　冒頭説明したように、従来全層切除は、開腹手術下や腹腔鏡手術下で行われてきたが、患者の侵襲をより小さくしたり、腫瘍を切除する際の再発のリスクを低減したりする観点から、これを口等の自然開口から行うことが検討されている。
　しかしながら、上記特許文献１に記載されたような従来の組織切除装置では、第一ステイプル列しか備えていないため、第一の引き込み線に沿って縫合および切断を行うと、図１２に示すように、カッターの切断線の前方であって第一ステイプル列間の組織が未縫合となり、穴のような状態となった部位が残存する。そのため、管腔組織の内圧が高まった等の場合に、一時的ではあるが当該部位から管腔組織の内容物が外部に漏れ出る恐れがある状態が生じてしまうという問題がある。
　本実施形態の組織切除装置１によれば、カートリッジ１３に組織封止部としての第二ステイプル１６が配置されているため、カッター２０の切断線の前方であって第一ステイプル列１５間の組織が第二ステイプル１６により確実に縫合されて封止される。また、一対のジョー１１、１２の間の狭い間隙に組織を引き込み、把持した状態で、まず第一ステイプル列１５および第二ステイプル１６により組織が縫合され、カッターが組織を切断した後に一対のジョーによる保持が解除される。したがって、組織切除装置１を用いた一連の手技においては、管腔組織の内容物が外部に漏れ出る恐れがある状態を全く生じさせずに組織切除を行うことができる。
　また、閉じた一対のジョー１１、１２間の比較的狭いスリット状の間隙に組織を引き込んでから縫合及び切断が行われるため、胃等の管腔組織に隣接する他の臓器や組織等が一緒に引き込まれそうになっても、間隙の入口で阻止される。したがって、管腔組織の外部が視認できない経自然開口的アプローチであっても、これらの臓器、組織等を誤って管腔組織とともに縫合したり切断したりすることなく手技を行うことができる。
　本実施形態では、スロット１４Ａよりも先端側において、第一ステイプル列のステイプルと第二ステイプルとが共通のドライバにより射出される例を説明したが、ステイプルを射出するための構造はこれには限定されない。例えば、第二ステイプルを押し上げるドライバを第一ステイプル列のドライバと別体としてもよい。具体的には、図１３に示すように、カッター２０の前方に第二クサビ２３を設け、第二ステイプル１６を押し上げるドライバ２２を第二クサビ２３で押し上げる構造としてもよい。あるいは、第二クサビ２３で共通のドライバ１９を押し上げる構成にしたり、第二クサビ２３ですべてのドライバを押し上げる構造にしたりしてもよい。
　また、上述の例では、第一ステイプル列のステイプルの向きと第二ステイプルの向きとが平行であるが、図１４に示す変形例のように、第二ステイプル１６Ａの長手方向が、カッター２０の移動するスロット１４Ａと直交するように配置されてもよい。このようにすると、スロットの前方の組織をより広い範囲で接合することができ、より確実に組織切除を行うことができる。
　次に、本発明の第二実施形態について説明する。本実施形態の組織切除装置７１と第一実施形態の組織切除装置１との異なるところは、組織吻合部の構成である。なお、以降の説明において、すでに説明したものと共通する構成については、同一の符号を付して重複する説明を省略する。
　図１５は、組織切除装置７１における第一ジョー１１およびカートリッジ７２の先端側を示す部分拡大図である。スロット１４Ａの前方には、第二ステイプルに代えて、線状または帯状の第一電極７３が設けられている。第一電極７３の周囲には、絶縁体７４が配置され、処置部１０における他の金属製部位と絶縁されている。
　図１６に示すように、第二ジョー１２に設けられたアンビル部材７５には、第一電極７３と対応する位置に、第一電極７３と同様の構造を有する第二電極７６が設けられており、第一電極７３および第二電極７６は、高周波電源７７に接続されている。通電のオンオフは、操作部（不図示）で切り替え可能である。
　組織切除装置７１を使用する際は、第一実施形態と同様に、第一ステイプル列１５とカッター２０とを用いて組織を縫合、切断した後、一対のジョー１１、１２を開かずに第一電極７３と第二電極７６とに挟まれた組織に高周波電源７７から高周波電流を通電する。これにより、第一電極７３および第二電極７６の一対の電極が、いわゆるバイポーラ（双極性）のエレクトロサージカル器具（electrosurgical instrument）として機能する。その結果、日本国特開２００９－２４７８９３等に記載のように、第一電極７３および第二電極７６に接触して通電された組織の細胞内成分と細胞外成分とが均一化（リキッド化）し、一対のジョー１１、１２間において組織どうしが接合されて、未縫合組織の残存により生じた穴が封止される。
　本実施形態の組織切除装置７１においても、第一実施形態同様、管腔組織の内容物が外部に漏れ出る恐れがある状態を全く生じさせずに組織切除を行うことができる。
　また、組織封止部が第一電極７３および第二電極７６により構成されているため、封止部位が面状に接合される。その結果、さらに確実に穴を塞ぐことができる。
　本実施形態において、通電することにより接触した組織を封止する組織封止部の構成は、上述のバイポーラの機構に限定されない。例えば、通電により自身が発熱するヒータ等の発熱素子を第一電極７３および第二電極７６に代えてカートリッジおよびアンビル部材に取り付け、一対のジョー間に挟まれた組織を両側から加熱する構成としてもよい。この構成により、これら発熱素子がいわゆる熱凝固処置具として機能するため、温度や加熱時間を適切に設定することで、組織同士を接合することができる。
　また、電極の形状も上述の線状、帯状等に限られず、図１７に示す電極７３Ａのようなスポット状であってもよい。
　以上、本発明の各実施形態について説明したが、本発明の技術範囲は上記実施形態に限定されず、本発明の趣旨を逸脱しない範囲において構成要素の組み合わせを変えたり、各構成要素に種々の変更を加えたり、削除したりすることが可能である。
　例えば、上記実施形態では、縫合および切断を２回行って組織を切除する例を説明したが、縫合および切断の回数は２回に限られない。例えば、腫瘍が大きい等により大きな切除領域が設定された場合、ジョーの大きさによっては、２回では切断しきれない場合がある。このような場合は、折り曲げられた管腔組織の稜線がスリット内を通らないように管腔組織の一部を引き込んだ状態で２回目の縫合および切断を行うと、２回目の縫合および切断後も切除する組織は切り離されない。その後、必要に応じて同様の縫合および切断を繰り返し、最後に管腔組織の稜線がスリット内を通るようにして縫合および切断を行うことで、任意の大きさの領域を全層切除することができる。ここで、組織片が切除される最後の縫合及び切断においては、スロットの前方に組織が存在しないため、組織封止部を有さない従来のカートリッジが用いられてもよい。
　加えて、本発明の組織切除装置の対象となる管腔組織は、胃に限定されるものではない。例えば、腸は胃に比べて径が小さいが、ステイプラ等の、使用するデバイスのサイズを適切に設定することにより、腸等でも本発明の組織切除方法を好適に行うことが可能である。
　また、組織切除の対象疾患も、実施形態で説明した腫瘍には限定されず、例えば重度の潰瘍等の他の疾患等にも適用できることは当然である。
上記各実施形態によれば、カートリッジに組織封止部が配置されているため、切断部材の切断線の前方であって一対の封止部間の組織が、組織封止部により確実に縫合されて封止される。また、一対の把持部材の間の狭い間隙に組織を引き込み、把持した状態で、まず一対の封止部および組織封止部により組織が縫合され、切断部材が組織を切断した後に一対の把持部材による保持が解除される。したがって、組織切除装置を用いた一連の手技においては、管腔組織の内容物が外部に漏れ出る恐れがある状態を全く生じさせずに組織切除を行うことができる。
１，７１　組織切除装置
　１１　第一ジョー（第一把持部材）
　１２　第二ジョー（第二把持部材）
　１４　カートリッジ本体
　１４Ａ　スロット
　１５　一対の第一ステイプル列（一対の封止部）
　１６　第二ステイプル（組織封止部、封止ステイプル）
　２０　カッター（切断部材）

Claims (14)


  1. 　組織を保持する一対の把持部材と、
    　前記一対の把持部材に交換可能に取り付けられるカートリッジとを備え、
    　前記カートリッジは、
    　　長手軸と、前記長手軸に沿って延びるスロットとを有し、前記スロットにより組織を切断する切断部材を案内するとともに前記切断部材の移動範囲を規定するカートリッジ本体と、
    　　前記スロットを挟むように前記スロットの両側に設けられ、それぞれ前記スロットと平行に延びる一対の封止部と、
    　　前記スロットより先端側かつ前記スロットの延長線上に設けられた組織封止部と、
    　を有する
    組織切除装置。

  2. 　前記組織封止部は、前記一対の把持部材間に保持されるとともに前記スロットよりも先端側に位置する組織を接合する
    請求項１に記載の組織切除装置。

  3. 　前記一対の封止部は、前記スロットよりも前記先端側まで延びており、
    　前記組織封止部は、前記一対の封止部の間に設けられている
    請求項１に記載の組織切除装置。

  4. 　前記一対の封止部は、前記カートリッジ本体内に配置された複数のステイプルから構成される一対のステイプル列である
    請求項１に記載の組織切除装置。

  5. 　請求項１に記載の組織切除装置であって、
    　前記組織封止部は、前記カートリッジ本体内において前記スロットの前記先端側に配置された封止ステイプルである
    請求項１に記載の組織切除装置。

  6. 　前記組織封止部は、前記一対の把持部材間に保持されるとともに前記スロットよりも先端側に位置する組織に接触可能な一対の電極である
    請求項１に記載の組織切除装置。

  7. 　前記組織封止部は、前記一対の把持部材間に保持されるとともに前記スロットよりも先端側に位置する組織に接触可能な一対の発熱素子である
    請求項１に記載の組織切除装置。

  8. 　長手軸に沿って延びる挿入部と、
    前記挿入部の先端に設けられ、組織を把持する一対の把持部材と、
    　所定の動線に沿って移動することにより前記一対のジョー間に保持された管腔組織を切断する切断部材と、
    　前記動線を挟むように前記動線の両側に設けられ、それぞれ前記動線と平行に延びる一対の封止部と、
    　前記動線の前方かつ前記動線の延長線上に設けられた組織封止部と、
    　を備える組織切除装置。

  9. 　前記組織封止部は、前記一対の把持部材間に保持されるとともに前記動線よりも先端側に位置する組織を接合する
    請求項８に記載の組織切除装置。

  10. 　前記一対の封止部は、前記動線よりも先端側まで延びており、
    　前記組織封止部は、前記一対の封止部の間に設けられている
    請求項８に記載の組織切除装置。

  11.   前記一対の封止部は、前記動線の両側に配置された複数のステイプルから構成される一対のステイプル列である
    請求項８に記載の組織切除装置。

  12. 　前記組織封止部は、前記動線の前記先端側に配置された封止ステイプルである
    請求項８に記載の組織切除装置。

  13. 　前記組織封止部は、前記一対の把持部材間に保持されるとともに前記動線よりも先端側に位置する組織に接触可能な一対の電極である
    請求項８に記載の組織切除装置。

  14. 　前記組織封止部は、前記一対の把持部材間に保持されるとともに前記動線よりも先端側に位置する組織に接触可能な一対の発熱素子である
    請求項８に記載の組織切除装置。
PCT/JP2013/081020 2012-11-20 2013-11-18 組織切除装置 WO2014080862A1 (ja)

Priority Applications (4)

Application Number Priority Date Filing Date Title
EP13856141.0A EP2923656A4 (en) 2012-11-20 2013-11-18 APPARATUS FOR ABLATION OF FABRIC
JP2014512964A JP5608837B1 (ja) 2012-11-20 2013-11-18 組織切除装置
CN201380028616.3A CN104334097B (zh) 2012-11-20 2013-11-18 组织切除装置
US14/542,050 US20150150620A1 (en) 2012-11-20 2014-11-14 Tissue resection apparatus

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US201261728507P 2012-11-20 2012-11-20
US61/728,507 2012-11-20

Related Child Applications (1)

Application Number Title Priority Date Filing Date
US14/542,050 Continuation US20150150620A1 (en) 2012-11-20 2014-11-14 Tissue resection apparatus

Publications (1)

Publication Number Publication Date
WO2014080862A1 true WO2014080862A1 (ja) 2014-05-30

Family

ID=50776045

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/JP2013/081020 WO2014080862A1 (ja) 2012-11-20 2013-11-18 組織切除装置

Country Status (5)

Country Link
US (1) US20150150620A1 (ja)
EP (1) EP2923656A4 (ja)
JP (1) JP5608837B1 (ja)
CN (1) CN104334097B (ja)
WO (1) WO2014080862A1 (ja)

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP3009080A1 (en) * 2014-10-13 2016-04-20 Ethicon Endo-Surgery, Inc. Staple cartridge
JP2017131637A (ja) * 2016-01-07 2017-08-03 コヴィディエン リミテッド パートナーシップ 外科手術ファスナー装置
JP2018501039A (ja) * 2015-01-12 2018-01-18 エピゴン 三角切除術下における経カテーテル心臓弁修復のためのデバイスおよび方法
JP2018532494A (ja) * 2015-10-15 2018-11-08 エシコン エルエルシーＥｔｈｉｃｏｎ ＬＬＣ 湾曲部に沿って変動するステープル頭頂幅を伴う外科用ステープルカートリッジ
CN112754576A (zh) * 2021-01-23 2021-05-07 常州安康医疗器械有限公司 一种便于定位的微创腔镜吻合器

Families Citing this family (441)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9060770B2 (en) 2003-05-20 2015-06-23 Ethicon Endo-Surgery, Inc. Robotically-driven surgical instrument with E-beam driver
US20070084897A1 (en) 2003-05-20 2007-04-19 Shelton Frederick E Iv Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism
US8215531B2 (en) 2004-07-28 2012-07-10 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having a medical substance dispenser
US11998198B2 (en) 2004-07-28 2024-06-04 Cilag Gmbh International Surgical stapling instrument incorporating a two-piece E-beam firing mechanism
US11896225B2 (en) 2004-07-28 2024-02-13 Cilag Gmbh International Staple cartridge comprising a pan
US9072535B2 (en) 2011-05-27 2015-07-07 Ethicon Endo-Surgery, Inc. Surgical stapling instruments with rotatable staple deployment arrangements
US9237891B2 (en) 2005-08-31 2016-01-19 Ethicon Endo-Surgery, Inc. Robotically-controlled surgical stapling devices that produce formed staples having different lengths
US11484312B2 (en) 2005-08-31 2022-11-01 Cilag Gmbh International Staple cartridge comprising a staple driver arrangement
US10159482B2 (en) 2005-08-31 2018-12-25 Ethicon Llc Fastener cartridge assembly comprising a fixed anvil and different staple heights
US11246590B2 (en) 2005-08-31 2022-02-15 Cilag Gmbh International Staple cartridge including staple drivers having different unfired heights
US7934630B2 (en) 2005-08-31 2011-05-03 Ethicon Endo-Surgery, Inc. Staple cartridges for forming staples having differing formed staple heights
US7669746B2 (en) 2005-08-31 2010-03-02 Ethicon Endo-Surgery, Inc. Staple cartridges for forming staples having differing formed staple heights
US20070106317A1 (en) 2005-11-09 2007-05-10 Shelton Frederick E Iv Hydraulically and electrically actuated articulation joints for surgical instruments
US11793518B2 (en) 2006-01-31 2023-10-24 Cilag Gmbh International Powered surgical instruments with firing system lockout arrangements
US11224427B2 (en) 2006-01-31 2022-01-18 Cilag Gmbh International Surgical stapling system including a console and retraction assembly
US8820603B2 (en) 2006-01-31 2014-09-02 Ethicon Endo-Surgery, Inc. Accessing data stored in a memory of a surgical instrument
US8186555B2 (en) 2006-01-31 2012-05-29 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting and fastening instrument with mechanical closure system
US11278279B2 (en) 2006-01-31 2022-03-22 Cilag Gmbh International Surgical instrument assembly
US20110290856A1 (en) 2006-01-31 2011-12-01 Ethicon Endo-Surgery, Inc. Robotically-controlled surgical instrument with force-feedback capabilities
US20110024477A1 (en) 2009-02-06 2011-02-03 Hall Steven G Driven Surgical Stapler Improvements
US7845537B2 (en) 2006-01-31 2010-12-07 Ethicon Endo-Surgery, Inc. Surgical instrument having recording capabilities
US7753904B2 (en) 2006-01-31 2010-07-13 Ethicon Endo-Surgery, Inc. Endoscopic surgical instrument with a handle that can articulate with respect to the shaft
US8708213B2 (en) 2006-01-31 2014-04-29 Ethicon Endo-Surgery, Inc. Surgical instrument having a feedback system
US20120292367A1 (en) 2006-01-31 2012-11-22 Ethicon Endo-Surgery, Inc. Robotically-controlled end effector
US8992422B2 (en) 2006-03-23 2015-03-31 Ethicon Endo-Surgery, Inc. Robotically-controlled endoscopic accessory channel
US8322455B2 (en) 2006-06-27 2012-12-04 Ethicon Endo-Surgery, Inc. Manually driven surgical cutting and fastening instrument
US8348131B2 (en) 2006-09-29 2013-01-08 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with mechanical indicator to show levels of tissue compression
US10568652B2 (en) 2006-09-29 2020-02-25 Ethicon Llc Surgical staples having attached drivers of different heights and stapling instruments for deploying the same
US11980366B2 (en) 2006-10-03 2024-05-14 Cilag Gmbh International Surgical instrument
US8652120B2 (en) 2007-01-10 2014-02-18 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between control unit and sensor transponders
US8684253B2 (en) 2007-01-10 2014-04-01 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor
US8632535B2 (en) 2007-01-10 2014-01-21 Ethicon Endo-Surgery, Inc. Interlock and surgical instrument including same
US11291441B2 (en) 2007-01-10 2022-04-05 Cilag Gmbh International Surgical instrument with wireless communication between control unit and remote sensor
US11039836B2 (en) 2007-01-11 2021-06-22 Cilag Gmbh International Staple cartridge for use with a surgical stapling instrument
US20080169333A1 (en) 2007-01-11 2008-07-17 Shelton Frederick E Surgical stapler end effector with tapered distal end
US20090001130A1 (en) 2007-03-15 2009-01-01 Hess Christopher J Surgical procedure using a cutting and stapling instrument having releasable staple-forming pockets
US8893946B2 (en) 2007-03-28 2014-11-25 Ethicon Endo-Surgery, Inc. Laparoscopic tissue thickness and clamp load measuring devices
US11564682B2 (en) 2007-06-04 2023-01-31 Cilag Gmbh International Surgical stapler device
US8931682B2 (en) 2007-06-04 2015-01-13 Ethicon Endo-Surgery, Inc. Robotically-controlled shaft based rotary drive systems for surgical instruments
US7753245B2 (en) 2007-06-22 2010-07-13 Ethicon Endo-Surgery, Inc. Surgical stapling instruments
US11849941B2 (en) 2007-06-29 2023-12-26 Cilag Gmbh International Staple cartridge having staple cavities extending at a transverse angle relative to a longitudinal cartridge axis
US8758391B2 (en) 2008-02-14 2014-06-24 Ethicon Endo-Surgery, Inc. Interchangeable tools for surgical instruments
US8636736B2 (en) 2008-02-14 2014-01-28 Ethicon Endo-Surgery, Inc. Motorized surgical cutting and fastening instrument
US11986183B2 (en) 2008-02-14 2024-05-21 Cilag Gmbh International Surgical cutting and fastening instrument comprising a plurality of sensors to measure an electrical parameter
BRPI0901282A2 (pt) 2008-02-14 2009-11-17 Ethicon Endo Surgery Inc instrumento cirúrgico de corte e fixação dotado de eletrodos de rf
US7866527B2 (en) 2008-02-14 2011-01-11 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with interlockable firing system
US7819298B2 (en) 2008-02-14 2010-10-26 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with control features operable with one hand
US9179912B2 (en) 2008-02-14 2015-11-10 Ethicon Endo-Surgery, Inc. Robotically-controlled motorized surgical cutting and fastening instrument
US8573465B2 (en) 2008-02-14 2013-11-05 Ethicon Endo-Surgery, Inc. Robotically-controlled surgical end effector system with rotary actuated closure systems
US9770245B2 (en) 2008-02-15 2017-09-26 Ethicon Llc Layer arrangements for surgical staple cartridges
US11272927B2 (en) 2008-02-15 2022-03-15 Cilag Gmbh International Layer arrangements for surgical staple cartridges
US9386983B2 (en) 2008-09-23 2016-07-12 Ethicon Endo-Surgery, Llc Robotically-controlled motorized surgical instrument
US8210411B2 (en) 2008-09-23 2012-07-03 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting instrument
US11648005B2 (en) 2008-09-23 2023-05-16 Cilag Gmbh International Robotically-controlled motorized surgical instrument with an end effector
US9005230B2 (en) 2008-09-23 2015-04-14 Ethicon Endo-Surgery, Inc. Motorized surgical instrument
US8608045B2 (en) 2008-10-10 2013-12-17 Ethicon Endo-Sugery, Inc. Powered surgical cutting and stapling apparatus with manually retractable firing system
US20110278343A1 (en) * 2009-01-29 2011-11-17 Cardica, Inc. Clamping of Hybrid Surgical Instrument
US8517239B2 (en) 2009-02-05 2013-08-27 Ethicon Endo-Surgery, Inc. Surgical stapling instrument comprising a magnetic element driver
US8444036B2 (en) 2009-02-06 2013-05-21 Ethicon Endo-Surgery, Inc. Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector
JP2012517287A (ja) 2009-02-06 2012-08-02 エシコン・エンド−サージェリィ・インコーポレイテッド 被駆動式手術用ステープラの改良
US8851354B2 (en) 2009-12-24 2014-10-07 Ethicon Endo-Surgery, Inc. Surgical cutting instrument that analyzes tissue thickness
US8220688B2 (en) 2009-12-24 2012-07-17 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting instrument with electric actuator directional control assembly
US8783543B2 (en) 2010-07-30 2014-07-22 Ethicon Endo-Surgery, Inc. Tissue acquisition arrangements and methods for surgical stapling devices
US9211120B2 (en) 2011-04-29 2015-12-15 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising a plurality of medicaments
US11925354B2 (en) 2010-09-30 2024-03-12 Cilag Gmbh International Staple cartridge comprising staples positioned within a compressible portion thereof
US11298125B2 (en) 2010-09-30 2022-04-12 Cilag Gmbh International Tissue stapler having a thickness compensator
US9386988B2 (en) 2010-09-30 2016-07-12 Ethicon End-Surgery, LLC Retainer assembly including a tissue thickness compensator
US9517063B2 (en) 2012-03-28 2016-12-13 Ethicon Endo-Surgery, Llc Movable member for use with a tissue thickness compensator
US11812965B2 (en) 2010-09-30 2023-11-14 Cilag Gmbh International Layer of material for a surgical end effector
US9301755B2 (en) 2010-09-30 2016-04-05 Ethicon Endo-Surgery, Llc Compressible staple cartridge assembly
US9282962B2 (en) 2010-09-30 2016-03-15 Ethicon Endo-Surgery, Llc Adhesive film laminate
US9629814B2 (en) 2010-09-30 2017-04-25 Ethicon Endo-Surgery, Llc Tissue thickness compensator configured to redistribute compressive forces
US10945731B2 (en) 2010-09-30 2021-03-16 Ethicon Llc Tissue thickness compensator comprising controlled release and expansion
US9364233B2 (en) 2010-09-30 2016-06-14 Ethicon Endo-Surgery, Llc Tissue thickness compensators for circular surgical staplers
US8695866B2 (en) 2010-10-01 2014-04-15 Ethicon Endo-Surgery, Inc. Surgical instrument having a power control circuit
RU2606493C2 (ru) 2011-04-29 2017-01-10 Этикон Эндо-Серджери, Инк. Кассета со скобками, содержащая скобки, расположенные внутри ее сжимаемой части
US11207064B2 (en) 2011-05-27 2021-12-28 Cilag Gmbh International Automated end effector component reloading system for use with a robotic system
US9044230B2 (en) 2012-02-13 2015-06-02 Ethicon Endo-Surgery, Inc. Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status
JP6224070B2 (ja) 2012-03-28 2017-11-01 エシコン・エンド−サージェリィ・インコーポレイテッドＥｔｈｉｃｏｎ Ｅｎｄｏ−Ｓｕｒｇｅｒｙ，Ｉｎｃ． 組織厚さコンペンセータを含む保持具アセンブリ
CN104334098B (zh) 2012-03-28 2017-03-22 伊西康内外科公司 包括限定低压强环境的胶囊剂的组织厚度补偿件
BR112014024102B1 (pt) 2012-03-28 2022-03-03 Ethicon Endo-Surgery, Inc Conjunto de cartucho de prendedores para um instrumento cirúrgico, e conjunto de atuador de extremidade para um instrumento cirúrgico
US9101358B2 (en) 2012-06-15 2015-08-11 Ethicon Endo-Surgery, Inc. Articulatable surgical instrument comprising a firing drive
US9226751B2 (en) 2012-06-28 2016-01-05 Ethicon Endo-Surgery, Inc. Surgical instrument system including replaceable end effectors
BR112014032776B1 (pt) 2012-06-28 2021-09-08 Ethicon Endo-Surgery, Inc Sistema de instrumento cirúrgico e kit cirúrgico para uso com um sistema de instrumento cirúrgico
US20140005718A1 (en) 2012-06-28 2014-01-02 Ethicon Endo-Surgery, Inc. Multi-functional powered surgical device with external dissection features
US11197671B2 (en) 2012-06-28 2021-12-14 Cilag Gmbh International Stapling assembly comprising a lockout
US9282974B2 (en) 2012-06-28 2016-03-15 Ethicon Endo-Surgery, Llc Empty clip cartridge lockout
CN104487005B (zh) 2012-06-28 2017-09-08 伊西康内外科公司 空夹仓闭锁件
US20140001231A1 (en) 2012-06-28 2014-01-02 Ethicon Endo-Surgery, Inc. Firing system lockout arrangements for surgical instruments
US9289256B2 (en) 2012-06-28 2016-03-22 Ethicon Endo-Surgery, Llc Surgical end effectors having angled tissue-contacting surfaces
MX368026B (es) 2013-03-01 2019-09-12 Ethicon Endo Surgery Inc Instrumento quirúrgico articulable con vías conductoras para la comunicación de la señal.
BR112015021082B1 (pt) 2013-03-01 2022-05-10 Ethicon Endo-Surgery, Inc Instrumento cirúrgico
US9883860B2 (en) 2013-03-14 2018-02-06 Ethicon Llc Interchangeable shaft assemblies for use with a surgical instrument
US9629629B2 (en) 2013-03-14 2017-04-25 Ethicon Endo-Surgey, LLC Control systems for surgical instruments
US10149680B2 (en) 2013-04-16 2018-12-11 Ethicon Llc Surgical instrument comprising a gap setting system
BR112015026109B1 (pt) 2013-04-16 2022-02-22 Ethicon Endo-Surgery, Inc Instrumento cirúrgico
MX369362B (es) 2013-08-23 2019-11-06 Ethicon Endo Surgery Llc Dispositivos de retraccion de miembros de disparo para instrumentos quirurgicos electricos.
US10624634B2 (en) 2013-08-23 2020-04-21 Ethicon Llc Firing trigger lockout arrangements for surgical instruments
US20150173756A1 (en) 2013-12-23 2015-06-25 Ethicon Endo-Surgery, Inc. Surgical cutting and stapling methods
US9839428B2 (en) 2013-12-23 2017-12-12 Ethicon Llc Surgical cutting and stapling instruments with independent jaw control features
US9724092B2 (en) 2013-12-23 2017-08-08 Ethicon Llc Modular surgical instruments
US9549735B2 (en) 2013-12-23 2017-01-24 Ethicon Endo-Surgery, Llc Fastener cartridge comprising a firing member including fastener transfer surfaces
US9962161B2 (en) 2014-02-12 2018-05-08 Ethicon Llc Deliverable surgical instrument
JP6462004B2 (ja) 2014-02-24 2019-01-30 エシコン エルエルシー 発射部材ロックアウトを備える締結システム
US9826977B2 (en) 2014-03-26 2017-11-28 Ethicon Llc Sterilization verification circuit
US20150272580A1 (en) 2014-03-26 2015-10-01 Ethicon Endo-Surgery, Inc. Verification of number of battery exchanges/procedure count
BR112016021943B1 (pt) 2014-03-26 2022-06-14 Ethicon Endo-Surgery, Llc Instrumento cirúrgico para uso por um operador em um procedimento cirúrgico
US10004497B2 (en) 2014-03-26 2018-06-26 Ethicon Llc Interface systems for use with surgical instruments
BR112016023698B1 (pt) 2014-04-16 2022-07-26 Ethicon Endo-Surgery, Llc Cartucho de prendedores para uso com um instrumento cirúrgico
CN106456158B (zh) 2014-04-16 2019-02-05 伊西康内外科有限责任公司 包括非一致紧固件的紧固件仓
US10426476B2 (en) 2014-09-26 2019-10-01 Ethicon Llc Circular fastener cartridges for applying radially expandable fastener lines
US20150297225A1 (en) 2014-04-16 2015-10-22 Ethicon Endo-Surgery, Inc. Fastener cartridges including extensions having different configurations
US9833241B2 (en) 2014-04-16 2017-12-05 Ethicon Llc Surgical fastener cartridges with driver stabilizing arrangements
CN106456159B (zh) 2014-04-16 2019-03-08 伊西康内外科有限责任公司 紧固件仓组件和钉保持器盖布置结构
US20160066913A1 (en) 2014-09-05 2016-03-10 Ethicon Endo-Surgery, Inc. Local display of tissue parameter stabilization
US11311294B2 (en) 2014-09-05 2022-04-26 Cilag Gmbh International Powered medical device including measurement of closure state of jaws
BR112017004361B1 (pt) 2014-09-05 2023-04-11 Ethicon Llc Sistema eletrônico para um instrumento cirúrgico
US10105142B2 (en) 2014-09-18 2018-10-23 Ethicon Llc Surgical stapler with plurality of cutting elements
US11523821B2 (en) 2014-09-26 2022-12-13 Cilag Gmbh International Method for creating a flexible staple line
BR112017005981B1 (pt) 2014-09-26 2022-09-06 Ethicon, Llc Material de escora para uso com um cartucho de grampos cirúrgicos e cartucho de grampos cirúrgicos para uso com um instrumento cirúrgico
US9924944B2 (en) 2014-10-16 2018-03-27 Ethicon Llc Staple cartridge comprising an adjunct material
US11141153B2 (en) 2014-10-29 2021-10-12 Cilag Gmbh International Staple cartridges comprising driver arrangements
US10517594B2 (en) 2014-10-29 2019-12-31 Ethicon Llc Cartridge assemblies for surgical staplers
US9844376B2 (en) 2014-11-06 2017-12-19 Ethicon Llc Staple cartridge comprising a releasable adjunct material
US10736636B2 (en) 2014-12-10 2020-08-11 Ethicon Llc Articulatable surgical instrument system
US9844375B2 (en) 2014-12-18 2017-12-19 Ethicon Llc Drive arrangements for articulatable surgical instruments
US9987000B2 (en) 2014-12-18 2018-06-05 Ethicon Llc Surgical instrument assembly comprising a flexible articulation system
US10117649B2 (en) 2014-12-18 2018-11-06 Ethicon Llc Surgical instrument assembly comprising a lockable articulation system
US10004501B2 (en) 2014-12-18 2018-06-26 Ethicon Llc Surgical instruments with improved closure arrangements
MX2017008108A (es) 2014-12-18 2018-03-06 Ethicon Llc Instrumento quirurgico con un yunque que puede moverse de manera selectiva sobre un eje discreto no movil con relacion a un cartucho de grapas.
US9844374B2 (en) 2014-12-18 2017-12-19 Ethicon Llc Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member
US10085748B2 (en) 2014-12-18 2018-10-02 Ethicon Llc Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors
US10188385B2 (en) 2014-12-18 2019-01-29 Ethicon Llc Surgical instrument system comprising lockable systems
US11154301B2 (en) 2015-02-27 2021-10-26 Cilag Gmbh International Modular stapling assembly
US20160249910A1 (en) 2015-02-27 2016-09-01 Ethicon Endo-Surgery, Llc Surgical charging system that charges and/or conditions one or more batteries
US10180463B2 (en) 2015-02-27 2019-01-15 Ethicon Llc Surgical apparatus configured to assess whether a performance parameter of the surgical apparatus is within an acceptable performance band
US10687806B2 (en) 2015-03-06 2020-06-23 Ethicon Llc Adaptive tissue compression techniques to adjust closure rates for multiple tissue types
JP2020121162A (ja) 2015-03-06 2020-08-13 エシコン エルエルシーＥｔｈｉｃｏｎ ＬＬＣ 測定の安定性要素、クリープ要素、及び粘弾性要素を決定するためのセンサデータの時間依存性評価
US9808246B2 (en) 2015-03-06 2017-11-07 Ethicon Endo-Surgery, Llc Method of operating a powered surgical instrument
US10245033B2 (en) 2015-03-06 2019-04-02 Ethicon Llc Surgical instrument comprising a lockable battery housing
US10052044B2 (en) 2015-03-06 2018-08-21 Ethicon Llc Time dependent evaluation of sensor data to determine stability, creep, and viscoelastic elements of measures
US9993248B2 (en) 2015-03-06 2018-06-12 Ethicon Endo-Surgery, Llc Smart sensors with local signal processing
US9901342B2 (en) 2015-03-06 2018-02-27 Ethicon Endo-Surgery, Llc Signal and power communication system positioned on a rotatable shaft
US10617412B2 (en) 2015-03-06 2020-04-14 Ethicon Llc System for detecting the mis-insertion of a staple cartridge into a surgical stapler
US9924961B2 (en) 2015-03-06 2018-03-27 Ethicon Endo-Surgery, Llc Interactive feedback system for powered surgical instruments
US10441279B2 (en) 2015-03-06 2019-10-15 Ethicon Llc Multiple level thresholds to modify operation of powered surgical instruments
US10390825B2 (en) 2015-03-31 2019-08-27 Ethicon Llc Surgical instrument with progressive rotary drive systems
CN107231792B (zh) * 2015-04-20 2020-10-27 美迪涂丽普有限公司 外科线性缝合器
US10405863B2 (en) 2015-06-18 2019-09-10 Ethicon Llc Movable firing beam support arrangements for articulatable surgical instruments
DE102015113307A1 (de) * 2015-08-12 2017-02-16 Charité - Universitätsmedizin Berlin Vorrichtung zur Durchtrennung von Gewebeteilen
US10617418B2 (en) 2015-08-17 2020-04-14 Ethicon Llc Implantable layers for a surgical instrument
RU2725081C2 (ru) 2015-08-26 2020-06-29 ЭТИКОН ЭлЭлСи Полоски с хирургическими скобами, допускающие наличие скоб с переменными свойствами и обеспечивающие простую загрузку кассеты
US10213203B2 (en) 2015-08-26 2019-02-26 Ethicon Llc Staple cartridge assembly without a bottom cover
MX2022009705A (es) 2015-08-26 2022-11-07 Ethicon Llc Metodo para formar una grapa contra un yunque de un instrumento de engrapado quirurgico.
MX2022006192A (es) 2015-09-02 2022-06-16 Ethicon Llc Configuraciones de grapas quirurgicas con superficies de leva situadas entre porciones que soportan grapas quirurgicas.
US10238390B2 (en) 2015-09-02 2019-03-26 Ethicon Llc Surgical staple cartridges with driver arrangements for establishing herringbone staple patterns
US10363036B2 (en) 2015-09-23 2019-07-30 Ethicon Llc Surgical stapler having force-based motor control
US10076326B2 (en) 2015-09-23 2018-09-18 Ethicon Llc Surgical stapler having current mirror-based motor control
US10085751B2 (en) 2015-09-23 2018-10-02 Ethicon Llc Surgical stapler having temperature-based motor control
US10327769B2 (en) 2015-09-23 2019-06-25 Ethicon Llc Surgical stapler having motor control based on a drive system component
US10238386B2 (en) 2015-09-23 2019-03-26 Ethicon Llc Surgical stapler having motor control based on an electrical parameter related to a motor current
US10105139B2 (en) 2015-09-23 2018-10-23 Ethicon Llc Surgical stapler having downstream current-based motor control
US10299878B2 (en) 2015-09-25 2019-05-28 Ethicon Llc Implantable adjunct systems for determining adjunct skew
US10271849B2 (en) 2015-09-30 2019-04-30 Ethicon Llc Woven constructs with interlocked standing fibers
US11890015B2 (en) 2015-09-30 2024-02-06 Cilag Gmbh International Compressible adjunct with crossing spacer fibers
US10980539B2 (en) 2015-09-30 2021-04-20 Ethicon Llc Implantable adjunct comprising bonded layers
US10603039B2 (en) 2015-09-30 2020-03-31 Ethicon Llc Progressively releasable implantable adjunct for use with a surgical stapling instrument
US10952730B2 (en) 2015-10-15 2021-03-23 Ethicon Llc End effector for surgical stapler with varying curve and taper
US10342535B2 (en) 2015-10-15 2019-07-09 Ethicon Llc Method of applying staples to liver and other organs
US10265073B2 (en) * 2015-10-15 2019-04-23 Ethicon Llc Surgical stapler with terminal staple orientation crossing center line
US10499917B2 (en) 2015-10-15 2019-12-10 Ethicon Llc Surgical stapler end effector with knife position indicators
US11141159B2 (en) 2015-10-15 2021-10-12 Cilag Gmbh International Surgical stapler end effector with multi-staple driver crossing center line
US10226251B2 (en) 2015-10-15 2019-03-12 Ethicon Llc Surgical staple actuating sled with actuation stroke having minimized distance relative to distal staple
US10368865B2 (en) 2015-12-30 2019-08-06 Ethicon Llc Mechanisms for compensating for drivetrain failure in powered surgical instruments
US10265068B2 (en) 2015-12-30 2019-04-23 Ethicon Llc Surgical instruments with separable motors and motor control circuits
US10292704B2 (en) 2015-12-30 2019-05-21 Ethicon Llc Mechanisms for compensating for battery pack failure in powered surgical instruments
CN108882932B (zh) 2016-02-09 2021-07-23 伊西康有限责任公司 具有非对称关节运动构造的外科器械
US11213293B2 (en) 2016-02-09 2022-01-04 Cilag Gmbh International Articulatable surgical instruments with single articulation link arrangements
US10653413B2 (en) 2016-02-09 2020-05-19 Ethicon Llc Surgical instruments with an end effector that is highly articulatable relative to an elongate shaft assembly
US10448948B2 (en) 2016-02-12 2019-10-22 Ethicon Llc Mechanisms for compensating for drivetrain failure in powered surgical instruments
US11224426B2 (en) 2016-02-12 2022-01-18 Cilag Gmbh International Mechanisms for compensating for drivetrain failure in powered surgical instruments
US10258331B2 (en) 2016-02-12 2019-04-16 Ethicon Llc Mechanisms for compensating for drivetrain failure in powered surgical instruments
US10617413B2 (en) 2016-04-01 2020-04-14 Ethicon Llc Closure system arrangements for surgical cutting and stapling devices with separate and distinct firing shafts
US11064997B2 (en) 2016-04-01 2021-07-20 Cilag Gmbh International Surgical stapling instrument
US10456137B2 (en) 2016-04-15 2019-10-29 Ethicon Llc Staple formation detection mechanisms
US11179150B2 (en) 2016-04-15 2021-11-23 Cilag Gmbh International Systems and methods for controlling a surgical stapling and cutting instrument
US10828028B2 (en) 2016-04-15 2020-11-10 Ethicon Llc Surgical instrument with multiple program responses during a firing motion
US10405859B2 (en) 2016-04-15 2019-09-10 Ethicon Llc Surgical instrument with adjustable stop/start control during a firing motion
US10492783B2 (en) 2016-04-15 2019-12-03 Ethicon, Llc Surgical instrument with improved stop/start control during a firing motion
US10335145B2 (en) 2016-04-15 2019-07-02 Ethicon Llc Modular surgical instrument with configurable operating mode
US11607239B2 (en) 2016-04-15 2023-03-21 Cilag Gmbh International Systems and methods for controlling a surgical stapling and cutting instrument
US10426467B2 (en) 2016-04-15 2019-10-01 Ethicon Llc Surgical instrument with detection sensors
US10357247B2 (en) 2016-04-15 2019-07-23 Ethicon Llc Surgical instrument with multiple program responses during a firing motion
US11317917B2 (en) 2016-04-18 2022-05-03 Cilag Gmbh International Surgical stapling system comprising a lockable firing assembly
US20170296173A1 (en) 2016-04-18 2017-10-19 Ethicon Endo-Surgery, Llc Method for operating a surgical instrument
US10426469B2 (en) 2016-04-18 2019-10-01 Ethicon Llc Surgical instrument comprising a primary firing lockout and a secondary firing lockout
JP6957532B2 (ja) 2016-06-24 2021-11-02 エシコン エルエルシーＥｔｈｉｃｏｎ ＬＬＣ ワイヤステープル及び打ち抜き加工ステープルを含むステープルカートリッジ
USD847989S1 (en) 2016-06-24 2019-05-07 Ethicon Llc Surgical fastener cartridge
US10702270B2 (en) 2016-06-24 2020-07-07 Ethicon Llc Stapling system for use with wire staples and stamped staples
USD826405S1 (en) 2016-06-24 2018-08-21 Ethicon Llc Surgical fastener
USD850617S1 (en) 2016-06-24 2019-06-04 Ethicon Llc Surgical fastener cartridge
US10736629B2 (en) 2016-12-21 2020-08-11 Ethicon Llc Surgical tool assemblies with clutching arrangements for shifting between closure systems with closure stroke reduction features and articulation and firing systems
US10485543B2 (en) 2016-12-21 2019-11-26 Ethicon Llc Anvil having a knife slot width
US10426471B2 (en) 2016-12-21 2019-10-01 Ethicon Llc Surgical instrument with multiple failure response modes
US11160551B2 (en) 2016-12-21 2021-11-02 Cilag Gmbh International Articulatable surgical stapling instruments
US10687810B2 (en) 2016-12-21 2020-06-23 Ethicon Llc Stepped staple cartridge with tissue retention and gap setting features
US10758229B2 (en) 2016-12-21 2020-09-01 Ethicon Llc Surgical instrument comprising improved jaw control
US10568625B2 (en) * 2016-12-21 2020-02-25 Ethicon Llc Staple cartridges and arrangements of staples and staple cavities therein
US10945727B2 (en) 2016-12-21 2021-03-16 Ethicon Llc Staple cartridge with deformable driver retention features
US10537325B2 (en) 2016-12-21 2020-01-21 Ethicon Llc Staple forming pocket arrangement to accommodate different types of staples
JP6983893B2 (ja) 2016-12-21 2021-12-17 エシコン エルエルシーEthicon LLC 外科用エンドエフェクタ及び交換式ツールアセンブリのためのロックアウト構成
US20180168625A1 (en) 2016-12-21 2018-06-21 Ethicon Endo-Surgery, Llc Surgical stapling instruments with smart staple cartridges
CN110087565A (zh) 2016-12-21 2019-08-02 爱惜康有限责任公司 外科缝合系统
JP7010956B2 (ja) 2016-12-21 2022-01-26 エシコン エルエルシー 組織をステープル留めする方法
US20180168647A1 (en) 2016-12-21 2018-06-21 Ethicon Endo-Surgery, Llc Surgical stapling instruments having end effectors with positive opening features
US10695055B2 (en) 2016-12-21 2020-06-30 Ethicon Llc Firing assembly comprising a lockout
US20180168615A1 (en) 2016-12-21 2018-06-21 Ethicon Endo-Surgery, Llc Method of deforming staples from two different types of staple cartridges with the same surgical stapling instrument
US10980536B2 (en) 2016-12-21 2021-04-20 Ethicon Llc No-cartridge and spent cartridge lockout arrangements for surgical staplers
US11419606B2 (en) 2016-12-21 2022-08-23 Cilag Gmbh International Shaft assembly comprising a clutch configured to adapt the output of a rotary firing member to two different systems
US10687809B2 (en) 2016-12-21 2020-06-23 Ethicon Llc Surgical staple cartridge with movable camming member configured to disengage firing member lockout features
MX2019007295A (es) 2016-12-21 2019-10-15 Ethicon Llc Sistema de instrumento quirúrgico que comprende un bloqueo del efector de extremo y un bloqueo de la unidad de disparo.
US11684367B2 (en) 2016-12-21 2023-06-27 Cilag Gmbh International Stepped assembly having and end-of-life indicator
US10918385B2 (en) 2016-12-21 2021-02-16 Ethicon Llc Surgical system comprising a firing member rotatable into an articulation state to articulate an end effector of the surgical system
US10499914B2 (en) 2016-12-21 2019-12-10 Ethicon Llc Staple forming pocket arrangements
US11134942B2 (en) 2016-12-21 2021-10-05 Cilag Gmbh International Surgical stapling instruments and staple-forming anvils
US10993715B2 (en) 2016-12-21 2021-05-04 Ethicon Llc Staple cartridge comprising staples with different clamping breadths
US11382638B2 (en) 2017-06-20 2022-07-12 Cilag Gmbh International Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified displacement distance
US10881396B2 (en) 2017-06-20 2021-01-05 Ethicon Llc Surgical instrument with variable duration trigger arrangement
USD890784S1 (en) 2017-06-20 2020-07-21 Ethicon Llc Display panel with changeable graphical user interface
US11517325B2 (en) 2017-06-20 2022-12-06 Cilag Gmbh International Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured displacement distance traveled over a specified time interval
US10888321B2 (en) 2017-06-20 2021-01-12 Ethicon Llc Systems and methods for controlling velocity of a displacement member of a surgical stapling and cutting instrument
US10368864B2 (en) 2017-06-20 2019-08-06 Ethicon Llc Systems and methods for controlling displaying motor velocity for a surgical instrument
US11090046B2 (en) 2017-06-20 2021-08-17 Cilag Gmbh International Systems and methods for controlling displacement member motion of a surgical stapling and cutting instrument
USD879808S1 (en) 2017-06-20 2020-03-31 Ethicon Llc Display panel with graphical user interface
USD879809S1 (en) 2017-06-20 2020-03-31 Ethicon Llc Display panel with changeable graphical user interface
US10813639B2 (en) 2017-06-20 2020-10-27 Ethicon Llc Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on system conditions
US10624633B2 (en) 2017-06-20 2020-04-21 Ethicon Llc Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument
US10779820B2 (en) 2017-06-20 2020-09-22 Ethicon Llc Systems and methods for controlling motor speed according to user input for a surgical instrument
US10646220B2 (en) 2017-06-20 2020-05-12 Ethicon Llc Systems and methods for controlling displacement member velocity for a surgical instrument
US11071554B2 (en) 2017-06-20 2021-07-27 Cilag Gmbh International Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on magnitude of velocity error measurements
US11653914B2 (en) 2017-06-20 2023-05-23 Cilag Gmbh International Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument according to articulation angle of end effector
US10327767B2 (en) 2017-06-20 2019-06-25 Ethicon Llc Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation
US10881399B2 (en) 2017-06-20 2021-01-05 Ethicon Llc Techniques for adaptive control of motor velocity of a surgical stapling and cutting instrument
US10390841B2 (en) 2017-06-20 2019-08-27 Ethicon Llc Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation
US10980537B2 (en) 2017-06-20 2021-04-20 Ethicon Llc Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified number of shaft rotations
US10307170B2 (en) 2017-06-20 2019-06-04 Ethicon Llc Method for closed loop control of motor velocity of a surgical stapling and cutting instrument
US10993716B2 (en) 2017-06-27 2021-05-04 Ethicon Llc Surgical anvil arrangements
US10772629B2 (en) 2017-06-27 2020-09-15 Ethicon Llc Surgical anvil arrangements
US11324503B2 (en) 2017-06-27 2022-05-10 Cilag Gmbh International Surgical firing member arrangements
US11090049B2 (en) 2017-06-27 2021-08-17 Cilag Gmbh International Staple forming pocket arrangements
US10856869B2 (en) 2017-06-27 2020-12-08 Ethicon Llc Surgical anvil arrangements
US11266405B2 (en) 2017-06-27 2022-03-08 Cilag Gmbh International Surgical anvil manufacturing methods
US10758232B2 (en) 2017-06-28 2020-09-01 Ethicon Llc Surgical instrument with positive jaw opening features
US11058424B2 (en) 2017-06-28 2021-07-13 Cilag Gmbh International Surgical instrument comprising an offset articulation joint
US10903685B2 (en) 2017-06-28 2021-01-26 Ethicon Llc Surgical shaft assemblies with slip ring assemblies forming capacitive channels
US10765427B2 (en) 2017-06-28 2020-09-08 Ethicon Llc Method for articulating a surgical instrument
US10211586B2 (en) 2017-06-28 2019-02-19 Ethicon Llc Surgical shaft assemblies with watertight housings
EP4070740A1 (en) 2017-06-28 2022-10-12 Cilag GmbH International Surgical instrument comprising selectively actuatable rotatable couplers
USD906355S1 (en) 2017-06-28 2020-12-29 Ethicon Llc Display screen or portion thereof with a graphical user interface for a surgical instrument
USD869655S1 (en) 2017-06-28 2019-12-10 Ethicon Llc Surgical fastener cartridge
US11564686B2 (en) 2017-06-28 2023-01-31 Cilag Gmbh International Surgical shaft assemblies with flexible interfaces
US11259805B2 (en) 2017-06-28 2022-03-01 Cilag Gmbh International Surgical instrument comprising firing member supports
US10716614B2 (en) 2017-06-28 2020-07-21 Ethicon Llc Surgical shaft assemblies with slip ring assemblies with increased contact pressure
USD854151S1 (en) 2017-06-28 2019-07-16 Ethicon Llc Surgical instrument shaft
US11246592B2 (en) 2017-06-28 2022-02-15 Cilag Gmbh International Surgical instrument comprising an articulation system lockable to a frame
USD851762S1 (en) 2017-06-28 2019-06-18 Ethicon Llc Anvil
US10398434B2 (en) 2017-06-29 2019-09-03 Ethicon Llc Closed loop velocity control of closure member for robotic surgical instrument
US10932772B2 (en) 2017-06-29 2021-03-02 Ethicon Llc Methods for closed loop velocity control for robotic surgical instrument
US10898183B2 (en) 2017-06-29 2021-01-26 Ethicon Llc Robotic surgical instrument with closed loop feedback techniques for advancement of closure member during firing
US11007022B2 (en) 2017-06-29 2021-05-18 Ethicon Llc Closed loop velocity control techniques based on sensed tissue parameters for robotic surgical instrument
US10258418B2 (en) 2017-06-29 2019-04-16 Ethicon Llc System for controlling articulation forces
US11471155B2 (en) 2017-08-03 2022-10-18 Cilag Gmbh International Surgical system bailout
US11304695B2 (en) 2017-08-03 2022-04-19 Cilag Gmbh International Surgical system shaft interconnection
US11974742B2 (en) 2017-08-03 2024-05-07 Cilag Gmbh International Surgical system comprising an articulation bailout
US11944300B2 (en) 2017-08-03 2024-04-02 Cilag Gmbh International Method for operating a surgical system bailout
USD907647S1 (en) 2017-09-29 2021-01-12 Ethicon Llc Display screen or portion thereof with animated graphical user interface
US10729501B2 (en) 2017-09-29 2020-08-04 Ethicon Llc Systems and methods for language selection of a surgical instrument
US11399829B2 (en) 2017-09-29 2022-08-02 Cilag Gmbh International Systems and methods of initiating a power shutdown mode for a surgical instrument
US10796471B2 (en) 2017-09-29 2020-10-06 Ethicon Llc Systems and methods of displaying a knife position for a surgical instrument
US10765429B2 (en) 2017-09-29 2020-09-08 Ethicon Llc Systems and methods for providing alerts according to the operational state of a surgical instrument
USD907648S1 (en) 2017-09-29 2021-01-12 Ethicon Llc Display screen or portion thereof with animated graphical user interface
US10743872B2 (en) 2017-09-29 2020-08-18 Ethicon Llc System and methods for controlling a display of a surgical instrument
USD917500S1 (en) 2017-09-29 2021-04-27 Ethicon Llc Display screen or portion thereof with graphical user interface
US11134944B2 (en) 2017-10-30 2021-10-05 Cilag Gmbh International Surgical stapler knife motion controls
US11090075B2 (en) 2017-10-30 2021-08-17 Cilag Gmbh International Articulation features for surgical end effector
US10779903B2 (en) 2017-10-31 2020-09-22 Ethicon Llc Positive shaft rotation lock activated by jaw closure
US10842490B2 (en) 2017-10-31 2020-11-24 Ethicon Llc Cartridge body design with force reduction based on firing completion
US10966718B2 (en) 2017-12-15 2021-04-06 Ethicon Llc Dynamic clamping assemblies with improved wear characteristics for use in connection with electromechanical surgical instruments
US10779825B2 (en) 2017-12-15 2020-09-22 Ethicon Llc Adapters with end effector position sensing and control arrangements for use in connection with electromechanical surgical instruments
US10828033B2 (en) 2017-12-15 2020-11-10 Ethicon Llc Handheld electromechanical surgical instruments with improved motor control arrangements for positioning components of an adapter coupled thereto
US10779826B2 (en) 2017-12-15 2020-09-22 Ethicon Llc Methods of operating surgical end effectors
US11071543B2 (en) 2017-12-15 2021-07-27 Cilag Gmbh International Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges
US10687813B2 (en) 2017-12-15 2020-06-23 Ethicon Llc Adapters with firing stroke sensing arrangements for use in connection with electromechanical surgical instruments
US11033267B2 (en) 2017-12-15 2021-06-15 Ethicon Llc Systems and methods of controlling a clamping member firing rate of a surgical instrument
US11006955B2 (en) 2017-12-15 2021-05-18 Ethicon Llc End effectors with positive jaw opening features for use with adapters for electromechanical surgical instruments
US11197670B2 (en) 2017-12-15 2021-12-14 Cilag Gmbh International Surgical end effectors with pivotal jaws configured to touch at their respective distal ends when fully closed
US10743874B2 (en) 2017-12-15 2020-08-18 Ethicon Llc Sealed adapters for use with electromechanical surgical instruments
US10743875B2 (en) 2017-12-15 2020-08-18 Ethicon Llc Surgical end effectors with jaw stiffener arrangements configured to permit monitoring of firing member
US10869666B2 (en) 2017-12-15 2020-12-22 Ethicon Llc Adapters with control systems for controlling multiple motors of an electromechanical surgical instrument
US10716565B2 (en) 2017-12-19 2020-07-21 Ethicon Llc Surgical instruments with dual articulation drivers
US11045270B2 (en) 2017-12-19 2021-06-29 Cilag Gmbh International Robotic attachment comprising exterior drive actuator
US10729509B2 (en) 2017-12-19 2020-08-04 Ethicon Llc Surgical instrument comprising closure and firing locking mechanism
US10835330B2 (en) 2017-12-19 2020-11-17 Ethicon Llc Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly
US11020112B2 (en) 2017-12-19 2021-06-01 Ethicon Llc Surgical tools configured for interchangeable use with different controller interfaces
USD910847S1 (en) 2017-12-19 2021-02-16 Ethicon Llc Surgical instrument assembly
US11311290B2 (en) 2017-12-21 2022-04-26 Cilag Gmbh International Surgical instrument comprising an end effector dampener
US11076853B2 (en) 2017-12-21 2021-08-03 Cilag Gmbh International Systems and methods of displaying a knife position during transection for a surgical instrument
US11129680B2 (en) 2017-12-21 2021-09-28 Cilag Gmbh International Surgical instrument comprising a projector
US10682134B2 (en) 2017-12-21 2020-06-16 Ethicon Llc Continuous use self-propelled stapling instrument
CN108742722A (zh) * 2018-06-27 2018-11-06 江苏天邦医疗科技股份有限公司 一种头部特殊的采集人体组织的器械
US11253256B2 (en) 2018-08-20 2022-02-22 Cilag Gmbh International Articulatable motor powered surgical instruments with dedicated articulation motor arrangements
US11039834B2 (en) 2018-08-20 2021-06-22 Cilag Gmbh International Surgical stapler anvils with staple directing protrusions and tissue stability features
US10779821B2 (en) 2018-08-20 2020-09-22 Ethicon Llc Surgical stapler anvils with tissue stop features configured to avoid tissue pinch
US11291440B2 (en) 2018-08-20 2022-04-05 Cilag Gmbh International Method for operating a powered articulatable surgical instrument
US11045192B2 (en) 2018-08-20 2021-06-29 Cilag Gmbh International Fabricating techniques for surgical stapler anvils
USD914878S1 (en) 2018-08-20 2021-03-30 Ethicon Llc Surgical instrument anvil
US11083458B2 (en) 2018-08-20 2021-08-10 Cilag Gmbh International Powered surgical instruments with clutching arrangements to convert linear drive motions to rotary drive motions
US10856870B2 (en) 2018-08-20 2020-12-08 Ethicon Llc Switching arrangements for motor powered articulatable surgical instruments
US10842492B2 (en) 2018-08-20 2020-11-24 Ethicon Llc Powered articulatable surgical instruments with clutching and locking arrangements for linking an articulation drive system to a firing drive system
US10912559B2 (en) 2018-08-20 2021-02-09 Ethicon Llc Reinforced deformable anvil tip for surgical stapler anvil
US11324501B2 (en) 2018-08-20 2022-05-10 Cilag Gmbh International Surgical stapling devices with improved closure members
US11207065B2 (en) 2018-08-20 2021-12-28 Cilag Gmbh International Method for fabricating surgical stapler anvils
US11717292B2 (en) * 2019-03-01 2023-08-08 Boston Scientific Scimed, Inc. Systems, devices, and related methods for fastening tissue
US11172929B2 (en) 2019-03-25 2021-11-16 Cilag Gmbh International Articulation drive arrangements for surgical systems
US11147551B2 (en) 2019-03-25 2021-10-19 Cilag Gmbh International Firing drive arrangements for surgical systems
US11147553B2 (en) 2019-03-25 2021-10-19 Cilag Gmbh International Firing drive arrangements for surgical systems
US11696761B2 (en) 2019-03-25 2023-07-11 Cilag Gmbh International Firing drive arrangements for surgical systems
US11432816B2 (en) 2019-04-30 2022-09-06 Cilag Gmbh International Articulation pin for a surgical instrument
US11426251B2 (en) 2019-04-30 2022-08-30 Cilag Gmbh International Articulation directional lights on a surgical instrument
US11471157B2 (en) 2019-04-30 2022-10-18 Cilag Gmbh International Articulation control mapping for a surgical instrument
US11253254B2 (en) 2019-04-30 2022-02-22 Cilag Gmbh International Shaft rotation actuator on a surgical instrument
US11648009B2 (en) 2019-04-30 2023-05-16 Cilag Gmbh International Rotatable jaw tip for a surgical instrument
US11452528B2 (en) 2019-04-30 2022-09-27 Cilag Gmbh International Articulation actuators for a surgical instrument
US11903581B2 (en) 2019-04-30 2024-02-20 Cilag Gmbh International Methods for stapling tissue using a surgical instrument
US11660163B2 (en) 2019-06-28 2023-05-30 Cilag Gmbh International Surgical system with RFID tags for updating motor assembly parameters
US11259803B2 (en) 2019-06-28 2022-03-01 Cilag Gmbh International Surgical stapling system having an information encryption protocol
US11219455B2 (en) 2019-06-28 2022-01-11 Cilag Gmbh International Surgical instrument including a lockout key
US11298132B2 (en) 2019-06-28 2022-04-12 Cilag GmbH Inlernational Staple cartridge including a honeycomb extension
US11376098B2 (en) 2019-06-28 2022-07-05 Cilag Gmbh International Surgical instrument system comprising an RFID system
US11426167B2 (en) 2019-06-28 2022-08-30 Cilag Gmbh International Mechanisms for proper anvil attachment surgical stapling head assembly
US11224497B2 (en) 2019-06-28 2022-01-18 Cilag Gmbh International Surgical systems with multiple RFID tags
US11246678B2 (en) 2019-06-28 2022-02-15 Cilag Gmbh International Surgical stapling system having a frangible RFID tag
US11298127B2 (en) 2019-06-28 2022-04-12 Cilag GmbH Interational Surgical stapling system having a lockout mechanism for an incompatible cartridge
US11638587B2 (en) 2019-06-28 2023-05-02 Cilag Gmbh International RFID identification systems for surgical instruments
US11478241B2 (en) 2019-06-28 2022-10-25 Cilag Gmbh International Staple cartridge including projections
US11684434B2 (en) 2019-06-28 2023-06-27 Cilag Gmbh International Surgical RFID assemblies for instrument operational setting control
US11464601B2 (en) 2019-06-28 2022-10-11 Cilag Gmbh International Surgical instrument comprising an RFID system for tracking a movable component
US11291451B2 (en) 2019-06-28 2022-04-05 Cilag Gmbh International Surgical instrument with battery compatibility verification functionality
US11553971B2 (en) 2019-06-28 2023-01-17 Cilag Gmbh International Surgical RFID assemblies for display and communication
US11350938B2 (en) 2019-06-28 2022-06-07 Cilag Gmbh International Surgical instrument comprising an aligned rfid sensor
US11627959B2 (en) 2019-06-28 2023-04-18 Cilag Gmbh International Surgical instruments including manual and powered system lockouts
US11523822B2 (en) 2019-06-28 2022-12-13 Cilag Gmbh International Battery pack including a circuit interrupter
US12004740B2 (en) 2019-06-28 2024-06-11 Cilag Gmbh International Surgical stapling system having an information decryption protocol
US11051807B2 (en) 2019-06-28 2021-07-06 Cilag Gmbh International Packaging assembly including a particulate trap
US11771419B2 (en) 2019-06-28 2023-10-03 Cilag Gmbh International Packaging for a replaceable component of a surgical stapling system
US11399837B2 (en) 2019-06-28 2022-08-02 Cilag Gmbh International Mechanisms for motor control adjustments of a motorized surgical instrument
US11497492B2 (en) 2019-06-28 2022-11-15 Cilag Gmbh International Surgical instrument including an articulation lock
US11911032B2 (en) 2019-12-19 2024-02-27 Cilag Gmbh International Staple cartridge comprising a seating cam
US11607219B2 (en) 2019-12-19 2023-03-21 Cilag Gmbh International Staple cartridge comprising a detachable tissue cutting knife
US11446029B2 (en) 2019-12-19 2022-09-20 Cilag Gmbh International Staple cartridge comprising projections extending from a curved deck surface
US11304696B2 (en) 2019-12-19 2022-04-19 Cilag Gmbh International Surgical instrument comprising a powered articulation system
US12035913B2 (en) 2019-12-19 2024-07-16 Cilag Gmbh International Staple cartridge comprising a deployable knife
US11701111B2 (en) 2019-12-19 2023-07-18 Cilag Gmbh International Method for operating a surgical stapling instrument
US11504122B2 (en) 2019-12-19 2022-11-22 Cilag Gmbh International Surgical instrument comprising a nested firing member
US11931033B2 (en) 2019-12-19 2024-03-19 Cilag Gmbh International Staple cartridge comprising a latch lockout
US11576672B2 (en) 2019-12-19 2023-02-14 Cilag Gmbh International Surgical instrument comprising a closure system including a closure member and an opening member driven by a drive screw
US11291447B2 (en) 2019-12-19 2022-04-05 Cilag Gmbh International Stapling instrument comprising independent jaw closing and staple firing systems
US11529137B2 (en) 2019-12-19 2022-12-20 Cilag Gmbh International Staple cartridge comprising driver retention members
US11844520B2 (en) 2019-12-19 2023-12-19 Cilag Gmbh International Staple cartridge comprising driver retention members
US11559304B2 (en) 2019-12-19 2023-01-24 Cilag Gmbh International Surgical instrument comprising a rapid closure mechanism
US11464512B2 (en) 2019-12-19 2022-10-11 Cilag Gmbh International Staple cartridge comprising a curved deck surface
US11529139B2 (en) 2019-12-19 2022-12-20 Cilag Gmbh International Motor driven surgical instrument
US11234698B2 (en) 2019-12-19 2022-02-01 Cilag Gmbh International Stapling system comprising a clamp lockout and a firing lockout
USD967421S1 (en) 2020-06-02 2022-10-18 Cilag Gmbh International Staple cartridge
USD966512S1 (en) 2020-06-02 2022-10-11 Cilag Gmbh International Staple cartridge
USD975851S1 (en) 2020-06-02 2023-01-17 Cilag Gmbh International Staple cartridge
USD975278S1 (en) 2020-06-02 2023-01-10 Cilag Gmbh International Staple cartridge
USD975850S1 (en) 2020-06-02 2023-01-17 Cilag Gmbh International Staple cartridge
USD974560S1 (en) 2020-06-02 2023-01-03 Cilag Gmbh International Staple cartridge
USD976401S1 (en) 2020-06-02 2023-01-24 Cilag Gmbh International Staple cartridge
US11638582B2 (en) 2020-07-28 2023-05-02 Cilag Gmbh International Surgical instruments with torsion spine drive arrangements
US11534259B2 (en) 2020-10-29 2022-12-27 Cilag Gmbh International Surgical instrument comprising an articulation indicator
USD1013170S1 (en) 2020-10-29 2024-01-30 Cilag Gmbh International Surgical instrument assembly
US11844518B2 (en) 2020-10-29 2023-12-19 Cilag Gmbh International Method for operating a surgical instrument
US11896217B2 (en) 2020-10-29 2024-02-13 Cilag Gmbh International Surgical instrument comprising an articulation lock
US11931025B2 (en) 2020-10-29 2024-03-19 Cilag Gmbh International Surgical instrument comprising a releasable closure drive lock
US11717289B2 (en) 2020-10-29 2023-08-08 Cilag Gmbh International Surgical instrument comprising an indicator which indicates that an articulation drive is actuatable
US12053175B2 (en) 2020-10-29 2024-08-06 Cilag Gmbh International Surgical instrument comprising a stowed closure actuator stop
USD980425S1 (en) 2020-10-29 2023-03-07 Cilag Gmbh International Surgical instrument assembly
US11517390B2 (en) 2020-10-29 2022-12-06 Cilag Gmbh International Surgical instrument comprising a limited travel switch
US11779330B2 (en) 2020-10-29 2023-10-10 Cilag Gmbh International Surgical instrument comprising a jaw alignment system
US11452526B2 (en) 2020-10-29 2022-09-27 Cilag Gmbh International Surgical instrument comprising a staged voltage regulation start-up system
US11617577B2 (en) 2020-10-29 2023-04-04 Cilag Gmbh International Surgical instrument comprising a sensor configured to sense whether an articulation drive of the surgical instrument is actuatable
US11744581B2 (en) 2020-12-02 2023-09-05 Cilag Gmbh International Powered surgical instruments with multi-phase tissue treatment
US11653920B2 (en) 2020-12-02 2023-05-23 Cilag Gmbh International Powered surgical instruments with communication interfaces through sterile barrier
US11890010B2 (en) 2020-12-02 2024-02-06 Cllag GmbH International Dual-sided reinforced reload for surgical instruments
US11653915B2 (en) 2020-12-02 2023-05-23 Cilag Gmbh International Surgical instruments with sled location detection and adjustment features
US11737751B2 (en) 2020-12-02 2023-08-29 Cilag Gmbh International Devices and methods of managing energy dissipated within sterile barriers of surgical instrument housings
US11849943B2 (en) 2020-12-02 2023-12-26 Cilag Gmbh International Surgical instrument with cartridge release mechanisms
US11678882B2 (en) 2020-12-02 2023-06-20 Cilag Gmbh International Surgical instruments with interactive features to remedy incidental sled movements
US11627960B2 (en) 2020-12-02 2023-04-18 Cilag Gmbh International Powered surgical instruments with smart reload with separately attachable exteriorly mounted wiring connections
US11944296B2 (en) 2020-12-02 2024-04-02 Cilag Gmbh International Powered surgical instruments with external connectors
JP2024502283A (ja) * 2020-12-28 2024-01-18 ボストン サイエンティフィック サイムド，インコーポレイテッド エンドエフェクタの制御機構
US11864757B2 (en) * 2021-01-15 2024-01-09 Lexington, Medical, Inc. Reloadable cartridge assembly
US11925349B2 (en) 2021-02-26 2024-03-12 Cilag Gmbh International Adjustment to transfer parameters to improve available power
US11751869B2 (en) 2021-02-26 2023-09-12 Cilag Gmbh International Monitoring of multiple sensors over time to detect moving characteristics of tissue
US11701113B2 (en) 2021-02-26 2023-07-18 Cilag Gmbh International Stapling instrument comprising a separate power antenna and a data transfer antenna
US11980362B2 (en) 2021-02-26 2024-05-14 Cilag Gmbh International Surgical instrument system comprising a power transfer coil
US11950777B2 (en) 2021-02-26 2024-04-09 Cilag Gmbh International Staple cartridge comprising an information access control system
US11950779B2 (en) 2021-02-26 2024-04-09 Cilag Gmbh International Method of powering and communicating with a staple cartridge
US11696757B2 (en) 2021-02-26 2023-07-11 Cilag Gmbh International Monitoring of internal systems to detect and track cartridge motion status
US11744583B2 (en) 2021-02-26 2023-09-05 Cilag Gmbh International Distal communication array to tune frequency of RF systems
US11723657B2 (en) 2021-02-26 2023-08-15 Cilag Gmbh International Adjustable communication based on available bandwidth and power capacity
US11749877B2 (en) 2021-02-26 2023-09-05 Cilag Gmbh International Stapling instrument comprising a signal antenna
US11730473B2 (en) 2021-02-26 2023-08-22 Cilag Gmbh International Monitoring of manufacturing life-cycle
US11812964B2 (en) 2021-02-26 2023-11-14 Cilag Gmbh International Staple cartridge comprising a power management circuit
US11793514B2 (en) 2021-02-26 2023-10-24 Cilag Gmbh International Staple cartridge comprising sensor array which may be embedded in cartridge body
US11826042B2 (en) 2021-03-22 2023-11-28 Cilag Gmbh International Surgical instrument comprising a firing drive including a selectable leverage mechanism
US11826012B2 (en) 2021-03-22 2023-11-28 Cilag Gmbh International Stapling instrument comprising a pulsed motor-driven firing rack
US11723658B2 (en) 2021-03-22 2023-08-15 Cilag Gmbh International Staple cartridge comprising a firing lockout
US11806011B2 (en) 2021-03-22 2023-11-07 Cilag Gmbh International Stapling instrument comprising tissue compression systems
US11737749B2 (en) 2021-03-22 2023-08-29 Cilag Gmbh International Surgical stapling instrument comprising a retraction system
US11717291B2 (en) 2021-03-22 2023-08-08 Cilag Gmbh International Staple cartridge comprising staples configured to apply different tissue compression
US11759202B2 (en) 2021-03-22 2023-09-19 Cilag Gmbh International Staple cartridge comprising an implantable layer
US11786239B2 (en) 2021-03-24 2023-10-17 Cilag Gmbh International Surgical instrument articulation joint arrangements comprising multiple moving linkage features
US11786243B2 (en) 2021-03-24 2023-10-17 Cilag Gmbh International Firing members having flexible portions for adapting to a load during a surgical firing stroke
US11857183B2 (en) 2021-03-24 2024-01-02 Cilag Gmbh International Stapling assembly components having metal substrates and plastic bodies
US11896218B2 (en) 2021-03-24 2024-02-13 Cilag Gmbh International Method of using a powered stapling device
US11793516B2 (en) 2021-03-24 2023-10-24 Cilag Gmbh International Surgical staple cartridge comprising longitudinal support beam
US11744603B2 (en) 2021-03-24 2023-09-05 Cilag Gmbh International Multi-axis pivot joints for surgical instruments and methods for manufacturing same
US11849944B2 (en) 2021-03-24 2023-12-26 Cilag Gmbh International Drivers for fastener cartridge assemblies having rotary drive screws
US11832816B2 (en) 2021-03-24 2023-12-05 Cilag Gmbh International Surgical stapling assembly comprising nonplanar staples and planar staples
US11896219B2 (en) 2021-03-24 2024-02-13 Cilag Gmbh International Mating features between drivers and underside of a cartridge deck
US11903582B2 (en) 2021-03-24 2024-02-20 Cilag Gmbh International Leveraging surfaces for cartridge installation
US11944336B2 (en) 2021-03-24 2024-04-02 Cilag Gmbh International Joint arrangements for multi-planar alignment and support of operational drive shafts in articulatable surgical instruments
US11849945B2 (en) 2021-03-24 2023-12-26 Cilag Gmbh International Rotary-driven surgical stapling assembly comprising eccentrically driven firing member
US11826047B2 (en) 2021-05-28 2023-11-28 Cilag Gmbh International Stapling instrument comprising jaw mounts
US11877745B2 (en) 2021-10-18 2024-01-23 Cilag Gmbh International Surgical stapling assembly having longitudinally-repeating staple leg clusters
US11980363B2 (en) 2021-10-18 2024-05-14 Cilag Gmbh International Row-to-row staple array variations
US11957337B2 (en) 2021-10-18 2024-04-16 Cilag Gmbh International Surgical stapling assembly with offset ramped drive surfaces
US11937816B2 (en) 2021-10-28 2024-03-26 Cilag Gmbh International Electrical lead arrangements for surgical instruments

Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH11506943A (ja) * 1994-12-07 1999-06-22 マックグッキン、ジェイムス、エフ、ジュニア 外科手術装置および方法
JP2004305740A (ja) * 2003-04-02 2004-11-04 Ethicon Endo Surgery Inc 組織の壁を有する２つの体の内腔の間に吻合を形成する方法
JP2005021703A (ja) * 1993-07-22 2005-01-27 Ethicon Inc 外科用電気止血装置
JP2006506106A (ja) * 2002-04-16 2006-02-23 タイコ ヘルスケア グループ エルピー 手術用ステープラーおよび手術方法
JP2008514319A (ja) * 2004-09-30 2008-05-08 エシコン・エンド−サージェリィ・インコーポレイテッド 外科用ステープル止め器械
JP2009247893A (ja) 2008-04-01 2009-10-29 Olympus Medical Systems Corp 治療用処置システム
JP2010522035A (ja) 2007-03-22 2010-07-01 タイコ ヘルスケア グループ リミテッド パートナーシップ 可変の高さの手術用ファスナを形成する装置
JP2010240419A (ja) * 2009-04-01 2010-10-28 Ethicon Endo Surgery Inc 組織を切断し締結するための方法及びデバイス

Family Cites Families (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5364003A (en) * 1993-05-05 1994-11-15 Ethicon Endo-Surgery Staple cartridge for a surgical stapler
US7213736B2 (en) * 2003-07-09 2007-05-08 Ethicon Endo-Surgery, Inc. Surgical stapling instrument incorporating an electroactive polymer actuated firing bar track through an articulation joint
US7632269B2 (en) * 2004-01-16 2009-12-15 Ethicon Endo-Surgery, Inc. Electrosurgical instrument with replaceable cartridge
US7578819B2 (en) * 2005-05-16 2009-08-25 Baxano, Inc. Spinal access and neural localization
US7784663B2 (en) * 2005-03-17 2010-08-31 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having load sensing control circuitry
US7328828B2 (en) * 2005-11-04 2008-02-12 Ethicon Endo-Surgery, Inc, Lockout mechanisms and surgical instruments including same
US20090048589A1 (en) * 2007-08-14 2009-02-19 Tomoyuki Takashino Treatment device and treatment method for living tissue
CN201127630Y (zh) * 2007-12-24 2008-10-08 赵仰光 医用直线电凝切割缝合器
DE102009059195A1 (de) * 2009-12-17 2011-06-22 Aesculap AG, 78532 Chirurgisches System zum Verbinden von Körpergewebe und Verfahren zum Abtrennen überstehenden Gewebes
US20120016413A1 (en) * 2010-07-14 2012-01-19 Ethicon Endo-Surgery, Inc. Surgical fastening devices comprising rivets
CN202313537U (zh) * 2011-11-07 2012-07-11 苏州天臣国际医疗科技有限公司 直线型缝切器的钉仓组件

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2005021703A (ja) * 1993-07-22 2005-01-27 Ethicon Inc 外科用電気止血装置
JPH11506943A (ja) * 1994-12-07 1999-06-22 マックグッキン、ジェイムス、エフ、ジュニア 外科手術装置および方法
JP2006506106A (ja) * 2002-04-16 2006-02-23 タイコ ヘルスケア グループ エルピー 手術用ステープラーおよび手術方法
JP2004305740A (ja) * 2003-04-02 2004-11-04 Ethicon Endo Surgery Inc 組織の壁を有する２つの体の内腔の間に吻合を形成する方法
JP2008514319A (ja) * 2004-09-30 2008-05-08 エシコン・エンド−サージェリィ・インコーポレイテッド 外科用ステープル止め器械
JP2010522035A (ja) 2007-03-22 2010-07-01 タイコ ヘルスケア グループ リミテッド パートナーシップ 可変の高さの手術用ファスナを形成する装置
JP2009247893A (ja) 2008-04-01 2009-10-29 Olympus Medical Systems Corp 治療用処置システム
JP2010240419A (ja) * 2009-04-01 2010-10-28 Ethicon Endo Surgery Inc 組織を切断し締結するための方法及びデバイス

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See also references of EP2923656A4

Cited By (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP3009080A1 (en) * 2014-10-13 2016-04-20 Ethicon Endo-Surgery, Inc. Staple cartridge
WO2016060790A1 (en) * 2014-10-13 2016-04-21 Ethicon Endo-Surgery, Inc. Staple cartridge
JP2018501039A (ja) * 2015-01-12 2018-01-18 エピゴン 三角切除術下における経カテーテル心臓弁修復のためのデバイスおよび方法
US10702252B2 (en) 2015-01-12 2020-07-07 Epygon Device and method for transcatheter heart valve repair under triangular resection technique
JP2018532494A (ja) * 2015-10-15 2018-11-08 エシコン エルエルシーＥｔｈｉｃｏｎ ＬＬＣ 湾曲部に沿って変動するステープル頭頂幅を伴う外科用ステープルカートリッジ
JP2017131637A (ja) * 2016-01-07 2017-08-03 コヴィディエン リミテッド パートナーシップ 外科手術ファスナー装置
US10966717B2 (en) 2016-01-07 2021-04-06 Covidien Lp Surgical fastener apparatus
CN112754576A (zh) * 2021-01-23 2021-05-07 常州安康医疗器械有限公司 一种便于定位的微创腔镜吻合器
CN112754576B (zh) * 2021-01-23 2022-04-15 常州安康医疗器械有限公司 一种便于定位的微创腔镜吻合器

Also Published As

Publication number Publication date
JP5608837B1 (ja) 2014-10-15
CN104334097A (zh) 2015-02-04
US20150150620A1 (en) 2015-06-04
EP2923656A1 (en) 2015-09-30
CN104334097B (zh) 2017-02-22
EP2923656A4 (en) 2016-07-13
JPWO2014080862A1 (ja) 2017-01-05

Similar Documents

Publication Publication Date Title
JP5608837B1 (ja) 組織切除装置
US9827002B2 (en) Tissue removal and closure device
US9028510B2 (en) Tissue excision method
US10226251B2 (en) Surgical staple actuating sled with actuation stroke having minimized distance relative to distal staple
US20090143794A1 (en) Tissue resection device
JP4566500B2 (ja) 手術用ステープリング器具
US20110112434A1 (en) Kits and procedures for natural orifice translumenal endoscopic surgery
JP6211541B2 (ja) 循環ワイヤを備える切断具
EP1948027B1 (en) Tissue cutting devices having hemostasis capability
KR102583753B1 (ko) 조직 절제를 위한 디바이스 및 시스템
EP1928291A2 (en) Endoluminal treatment method and associated surgical assembly including tissue occlusion device
EP2979658B1 (en) High-frequency treatment tool with two rotatable members and with an insulating chip
JP2018535738A (ja) 内視鏡治療用の偏向チャネルを有する内視鏡キャップ
WO2015194280A1 (ja) マーキングシステム
JP6559889B2 (ja) 格納式の組織切断デバイス
US10363087B2 (en) Tissue resection device
US10864038B2 (en) Digestive-tract treatment method
JP6184647B2 (ja) 組織切除システム
JP2003111763A (ja) 組織縫合結紮器
US20240081796A1 (en) Full-thickness resection method
US20190290282A1 (en) Procedure for endoscopic full-thickness resection
US20230218336A1 (en) Lesion resection method
JP7459311B2 (ja) 処置具
CN215018125U (zh) 一种圈套器和切开刀
AU2012244280B2 (en) An endoscopic method and device for treatment of hemorrhoids without cutting of rectal tissue

Legal Events

Date Code Title Description
ENP Entry into the national phase

Ref document number: 2014512964

Country of ref document: JP

Kind code of ref document: A

121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 13856141

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

WWE Wipo information: entry into national phase

Ref document number: 2013856141

Country of ref document: EP