JP5394265B2 - 可変の高さの手術用ファスナを形成する装置 - Google Patents
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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- A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
- A61B17/0684—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying above the tissue during stapling
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- 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
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- 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
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- 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
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Description
本開示は、手術用ファスナ装置に関する。より具体的には、本開示は、手術手順中、身体組織に対し高さを変えられる手術用ファスナを形成する装置に関する。
最初に、対向する顎部構造間に組織が把持または挟持され、次いで、手術用ファスナによって結合される手術デバイスは、当技術分野において周知である。いくつかの器具では、ファスナによって結合された組織を切断するために、メスが提供される。ファスナは、典型的には、手術用ステープルの形態である。
本目的のための器具は、２つの細長い部材を含んでもよく、それぞれ、組織を捕捉または挟持するために使用される。典型的には、部材の一方は、少なくとも２つの横列に配列される複数のステープルを格納するカートリッジを担持し、他方の部材は、ファスナがカートリッジから駆動されると、ステープル脚部を形成するための表面を規定するアンビルを含む。概して、ステープリング動作は、部材を担持するカートリッジを通して長手方向に移動するプッシャによって達成され、プッシャは、カートリッジからそれらを連続的に射出するためにステープルに作用する。メスは、ステープル列間のプッシャとともに移動し、ステープルの列間のステープリングされた組織を長手方向に切断および／または切開してもよい。
特許文献１に開示される最近のステープラは、二重列のステープルを切開の両側に適用する。これは、カートリッジアセンブリを提供することによって達成され、カム部材は、溝を担持する２セットの交互ステープル間の細長い誘導路を通して移動する。ステープル駆動部材は、溝内に位置し、長手方向に移動するカムによって接触され、ステープルの射出を達成するように位置付けられる。ステープラの他の実施例は、特許文献２、特許文献３および特許文献４に開示される。
本開示は、手術用ステープルを適用するための手術器具とともに使用するためのステープル固定アセンブリを対象とする。ステープル固定アセンブリは、協働する第１および第２の顎部と、顎部作動機構と、ステープル駆動アセンブリと、を含む。一方の顎部は、概して、細長く、ステープルマガジンを含む。ステープルマガジンは、顎部に固定して、または解除可能に取設されてもよく、少なくとも１列に配列される複数のステープルを含む。第１の組織接触表面は、ステープルマガジンの一方の面上に規定され、ステープルマガジン内に含まれるステープルの数に対応する複数の保持スロットを含む。複数列のステープルが提供され、長手方向列に配列されてもよいことが企図される。保持スロットは、長手方向に整合されるか、または互いからオフセットされてもよい。各保持スロットは、そのそれぞれのステープルを解除可能に受容するために、構成および適合される。各ステープルは、脚部のそれぞれに対して実質的に直角を形成するバックスパンによって接続される第１および第２の実質的に平行脚部を含む。
第２の顎部は、概して、細長く、開放位置と閉鎖位置との間の複数の位置を通して可動である。アンビル部材は、第２の顎部上に配置され、第２の組織接触表面を含む。第２の組織接触表面は、複数のステープルポケットを含み、ステープルポケットの数および配列は、ステープルマガジン内の保持スロットの数および配列に対応する。第２の組織接触表面は、第１の組織接触表面と並列となるように配向され、その間の組織間隔を規定する。
各ステープルポケットは、各ステープルの脚部を捕捉するための一対のステープル形成溝を含む。ステープル形成溝は、中間点を中心に実質的に対称であって、対向する傾斜表面を有する。実質的にレムニスケート（ｌｅｍｎｉｓｃａｔｅ）チャネリング表面は、各ステープルポケットの周縁を中心に形成される。各ステープル形成溝は、各ステープルの一方の脚部を他方の脚部へ付勢する一方、ステープル形成中および後の脚部の側方分離を維持する。
顎部作動機構は、ステープル固定アセンブリの近位部分に取設される筐体内に配置される。顎部作動機構は、筐体に回転可能に搭載されるカムと、ケーブルと、互いに協働可能に連結されるバネと、を含む。手術器具内の近接機構は、顎部作動機構に動作可能に連結され、バネの近位運動を生じさせる。バネの近位移動は、ケーブルを介して、カムに連結される。一実施形態では、カムは、カムの外側表面の少なくとも一部と第２の顎部の外側表面との間の接触を維持するための偏心外側表面を有する。カムは、反転防止アセンブリ（すなわち、自動ロック）を含み、カムの反時計回りの回転を許容する一方、カムの時計回りの回転を抑制してもよい。そのように構成されることによって、偏心カムの反時計回りの回転は、バネの近位移動の際、第２の顎部を第１の顎部へ継続的に付勢する。カムおよびケーブルの寸法、ならびにバネに対し選択される寸法および材料は、顎部作動機構の組織捕捉特徴に寄与する。顎部は、組織を捕捉し、定位置に保持する一方、組織への外傷を最小限にすることが望ましい。有利には、カム、ケーブル、およびバネの組み合わせは、ステープリング動作の際、異なる厚さの組織に適応するように、組織間隔の自動調節を可能にする。
例えば、本発明は以下の項目を提供する。
（項目１）
作動機構を含む筐体と、
該筐体から遠位に延びる細長い管状部材と、
該細長い管状部材の遠位端に位置するステープル固定アセンブリであって、第１の顎部および第２の顎部を含み、該第１の顎部は、複数のファスナおよび駆動アセンブリを含み、該第２の顎部は、アンビルを含む、ステープル固定アセンブリと、
顎部駆動アセンブリであって、該作動機構の作動によって、該第１および第２の顎部のうちの一方を該第１および第２の顎部のもう一方に向けて移動させるように、該作動機構に動作可能に連結され、該第１の顎部の組織接触表面は、該顎部間の距離が変動するとき、該第２の顎部の組織接触表面と実質的に平行のままである、顎部駆動アセンブリと
を備える、手術装置。
（項目２）
上記顎部駆動アセンブリは、上記第２の顎部に動作可能に連結され、該顎部駆動アセンブリは、カムを含み、該カムの回転によって、該第２の顎部を上記第１の顎部に向けて付勢するように、該カムの少なくとも一部は、該第２の顎部の外側表面と接触する、項目１に記載の手術装置。
（項目３）
上記顎部駆動アセンブリは、上記カムと上記作動機構とを動作可能に連結するバネをさらに含む、項目２に記載の手術装置。
（項目４）
第１の方向への上記バネの移動は、第１の方向に上記カムを回転させ、上記第２の顎部を上記第１の顎部に向けて付勢する、項目３に記載の手術装置。
（項目５）
リンキング部材は、上記カムと上記バネとを動作可能に接続する、項目３に記載の手術装置。
（項目６）
作動機構を含む筐体と、
該筐体から遠位に延びる細長い管状部材と、
該細長い管状部材の遠位端に位置するステープル固定アセンブリであって、該ステープル固定アセンブリは、第１の顎部および第２の顎部を含み、該第１の顎部は、複数のファスナおよび駆動アセンブリを含み、該第２の顎部は、アンビルを含み、該第１の顎部は、その中に配置された少なくとも１つの可動部材を含み、該少なくとも１つの可動部材は、手術用ファスナの一部と相互作用するために選択的に作動される、ステープル固定アセンブリと、
顎部駆動アセンブリであって、該顎部駆動アセンブリは、該作動機構の作動によって、該第１および第２の顎部のうちの一方を該第１および第２の顎部のもう一方に向けて移動させるように、該作動機構に動作可能に連結される、顎部駆動アセンブリと
を備える、手術装置。
（項目７）
少なくとも１つの滑動アセンブリをさらに含み、該滑動アセンブリは、第１および第２の滑動部を含む、項目６に記載の手術装置。
（項目８）
上記第１の滑動部は、上記第２の滑動部を摺動可能に受容するために、そこを通る長手方向通路を含む、項目７に記載の手術装置。
（項目９）
上記複数のファスナを通る上記第１の滑動部の長手方向の平行移動によって、上記手術用ファスナを連続的に射出する、項目８に記載の手術装置。
（項目１０）
上記複数のファスナを通る上記第２の滑動部の長手方向の平行移動は、上記少なくとも１つの可動部材を上記第１の顎部の組織接触表面に向けて移動させ、該少なくとも１つの可動部材は、該第１の顎部の長手方向軸を横断する方向に移動する、項目９に記載の手術装置。
（項目１１）
上記少なくとも１つの可動部材の上記横断方向の移動によって、上記手術用ファスナの一部と接触する、項目１０に記載の手術装置。
（項目１２）
上記第１の滑動部の長手方向の平行移動は、遅延を規定する上記第２の滑動部の長手方向の平行移動に先行する、項目１０に記載の手術装置。
（項目１３）
上記第２の滑動部の一部は、上記第１および該第２の滑動部の長手方向の平行移動の間に、該第１の滑動部の上記通路との接触を維持する、項目１０に記載の手術装置。
（項目１４）
各ファスナは、上記アンビルと相互作用し、完全なファスナを形成し、該完全なファスナは、上記第１および第２の顎部の組織接触表面の間の間隔に比例するサイズを有し、上記可動部材はそれぞれ、上記間隔が所定の量未満であるとき、対応するファスナのバックスパンを変形させる、項目６に記載の手術装置。
（項目１５）
作動機構を含む筐体と、
該筐体から遠位に延びる細長い管状部材と、
該細長い管状部材の遠位端に位置するステープル固定アセンブリであって、該ステープル固定アセンブリは、第１および第２の顎部を含み、該第１の顎部は、該作動機構に動作可能に関連付けられるファスナ駆動アセンブリを含み、該ファスナ駆動アセンブリは、第１および第２の滑動部を有し、該第１の滑動部は、該第２の滑動部を摺動可能に受容するために、そこを通る長手方向通路を有し、該第２の顎部は、アンビルを含む、ステープル固定アセンブリと、
該第１の顎部内に配置される複数のファスナおよび対応する数の射出アセンブリであって、各射出アセンブリは、ファスナ射出器および可動部材を含み、該第１の滑動部は、該ファスナ駆動アセンブリの作動に応答して、遠位に平行移動し、該第２の滑動部は、静止したままである、複数のファスナおよび対応する数の射出アセンブリと、
該作動機構に動作可能に連結される顎部駆動アセンブリと
を備える、手術装置。
（項目１６）
間隔は、上記第１および第２の顎部の組織接触表面間で規定され、該間隔は、該第１および第２の顎部間に捕捉される組織に比例する、項目１５に記載の手術装置。
（項目１７）
上記第１の滑動部の遠位移動は、上記第１の顎部の長手方向軸を横断する方向に上記射出器を移動させ、それによって、上記ファスナを上記アンビルに向けて駆動する、項目１６に記載の手術装置。
（項目１８）
各ファスナは、上記アンビルと相互作用し、完全なファスナを形成し、該完全なファスナは、上記間隔に比例するサイズを有する、項目１７に記載の手術装置。
（項目１９）
上記第２の滑動部は、上記複数のファスナを通って遠位に平行移動し、上記第２の滑動部は、上記可動部材に係合し、上記第１の顎部の長手方向軸に対して直角の方向に上記可動部材を駆動させる、項目１７に記載の手術装置。
（項目２０）
上記可動部材はそれぞれ、その対応するファスナのバックスパンに接触する、項目１９に記載の手術装置。
（項目２１）
各ファスナは、上記アンビルと相互作用し、完全なファスナを形成し、該完全なファスナは、上記第１および第２の顎部の組織接触表面間の間隔に比例するサイズを有し、上記可動部材はそれぞれ、該間隔が所定の量未満であるとき、対応するファスナのバックスパンを変形させる、項目２０に記載の手術装置。
例えば、本発明は以下の項目を提供する。
（項目１）
作動機構を含む筐体と、
該筐体から遠位に延びる細長い管状部材と、
該細長い管状部材の遠位端に位置するステープル固定アセンブリであって、第１の顎部および第２の顎部を含み、該第１の顎部は、複数のファスナおよび駆動アセンブリを含み、該第２の顎部は、アンビルを含む、ステープル固定アセンブリと、
顎部駆動アセンブリであって、該作動機構の作動によって、該第１および第２の顎部のうちの一方を該第１および第２の顎部のもう一方に向けて移動させるように、該作動機構に動作可能に連結され、該第１の顎部の組織接触表面は、該顎部間の距離が変動するとき、該第２の顎部の組織接触表面と実質的に平行のままである、顎部駆動アセンブリと
を備える、手術装置。
（項目２）
上記顎部駆動アセンブリは、上記第２の顎部に動作可能に連結され、該顎部駆動アセンブリは、カムを含み、該カムの回転によって、該第２の顎部を上記第１の顎部に向けて付勢するように、該カムの少なくとも一部は、該第２の顎部の外側表面と接触する、項目１に記載の手術装置。
（項目３）
上記顎部駆動アセンブリは、上記カムと上記作動機構とを動作可能に連結するバネをさらに含む、項目２に記載の手術装置。
（項目４）
第１の方向への上記バネの移動は、第１の方向に上記カムを回転させ、上記第２の顎部を上記第１の顎部に向けて付勢する、項目３に記載の手術装置。
（項目５）
リンキング部材は、上記カムと上記バネとを動作可能に接続する、項目３に記載の手術装置。
（項目６）
作動機構を含む筐体と、
該筐体から遠位に延びる細長い管状部材と、
該細長い管状部材の遠位端に位置するステープル固定アセンブリであって、該ステープル固定アセンブリは、第１の顎部および第２の顎部を含み、該第１の顎部は、複数のファスナおよび駆動アセンブリを含み、該第２の顎部は、アンビルを含み、該第１の顎部は、その中に配置された少なくとも１つの可動部材を含み、該少なくとも１つの可動部材は、手術用ファスナの一部と相互作用するために選択的に作動される、ステープル固定アセンブリと、
顎部駆動アセンブリであって、該顎部駆動アセンブリは、該作動機構の作動によって、該第１および第２の顎部のうちの一方を該第１および第２の顎部のもう一方に向けて移動させるように、該作動機構に動作可能に連結される、顎部駆動アセンブリと
を備える、手術装置。
（項目７）
少なくとも１つの滑動アセンブリをさらに含み、該滑動アセンブリは、第１および第２の滑動部を含む、項目６に記載の手術装置。
（項目８）
上記第１の滑動部は、上記第２の滑動部を摺動可能に受容するために、そこを通る長手方向通路を含む、項目７に記載の手術装置。
（項目９）
上記複数のファスナを通る上記第１の滑動部の長手方向の平行移動によって、上記手術用ファスナを連続的に射出する、項目８に記載の手術装置。
（項目１０）
上記複数のファスナを通る上記第２の滑動部の長手方向の平行移動は、上記少なくとも１つの可動部材を上記第１の顎部の組織接触表面に向けて移動させ、該少なくとも１つの可動部材は、該第１の顎部の長手方向軸を横断する方向に移動する、項目９に記載の手術装置。
（項目１１）
上記少なくとも１つの可動部材の上記横断方向の移動によって、上記手術用ファスナの一部と接触する、項目１０に記載の手術装置。
（項目１２）
上記第１の滑動部の長手方向の平行移動は、遅延を規定する上記第２の滑動部の長手方向の平行移動に先行する、項目１０に記載の手術装置。
（項目１３）
上記第２の滑動部の一部は、上記第１および該第２の滑動部の長手方向の平行移動の間に、該第１の滑動部の上記通路との接触を維持する、項目１０に記載の手術装置。
（項目１４）
各ファスナは、上記アンビルと相互作用し、完全なファスナを形成し、該完全なファスナは、上記第１および第２の顎部の組織接触表面の間の間隔に比例するサイズを有し、上記可動部材はそれぞれ、上記間隔が所定の量未満であるとき、対応するファスナのバックスパンを変形させる、項目６に記載の手術装置。
（項目１５）
作動機構を含む筐体と、
該筐体から遠位に延びる細長い管状部材と、
該細長い管状部材の遠位端に位置するステープル固定アセンブリであって、該ステープル固定アセンブリは、第１および第２の顎部を含み、該第１の顎部は、該作動機構に動作可能に関連付けられるファスナ駆動アセンブリを含み、該ファスナ駆動アセンブリは、第１および第２の滑動部を有し、該第１の滑動部は、該第２の滑動部を摺動可能に受容するために、そこを通る長手方向通路を有し、該第２の顎部は、アンビルを含む、ステープル固定アセンブリと、
該第１の顎部内に配置される複数のファスナおよび対応する数の射出アセンブリであって、各射出アセンブリは、ファスナ射出器および可動部材を含み、該第１の滑動部は、該ファスナ駆動アセンブリの作動に応答して、遠位に平行移動し、該第２の滑動部は、静止したままである、複数のファスナおよび対応する数の射出アセンブリと、
該作動機構に動作可能に連結される顎部駆動アセンブリと
を備える、手術装置。
（項目１６）
間隔は、上記第１および第２の顎部の組織接触表面間で規定され、該間隔は、該第１および第２の顎部間に捕捉される組織に比例する、項目１５に記載の手術装置。
（項目１７）
上記第１の滑動部の遠位移動は、上記第１の顎部の長手方向軸を横断する方向に上記射出器を移動させ、それによって、上記ファスナを上記アンビルに向けて駆動する、項目１６に記載の手術装置。
（項目１８）
各ファスナは、上記アンビルと相互作用し、完全なファスナを形成し、該完全なファスナは、上記間隔に比例するサイズを有する、項目１７に記載の手術装置。
（項目１９）
上記第２の滑動部は、上記複数のファスナを通って遠位に平行移動し、上記第２の滑動部は、上記可動部材に係合し、上記第１の顎部の長手方向軸に対して直角の方向に上記可動部材を駆動させる、項目１７に記載の手術装置。
（項目２０）
上記可動部材はそれぞれ、その対応するファスナのバックスパンに接触する、項目１９に記載の手術装置。
（項目２１）
各ファスナは、上記アンビルと相互作用し、完全なファスナを形成し、該完全なファスナは、上記第１および第２の顎部の組織接触表面間の間隔に比例するサイズを有し、上記可動部材はそれぞれ、該間隔が所定の量未満であるとき、対応するファスナのバックスパンを変形させる、項目２０に記載の手術装置。
本開示される手術器具の実施形態は、図面を参照して本明細書で説明される。
図１は、開放位置にある、本開示の実施形態によるステープル固定アセンブリの側断面図である。
図２は、中間位置にある、図１のステープル固定アセンブリの側断面図である。
図３は、閉鎖位置にある、図１のステープル固定アセンブリの側断面図である。
図４は、図１のステープル固定アセンブリのステープルマガジンの上平面図である。
図５は、いくつかの構成要素間の関係を示す、ステープル駆動アセンブリの分解斜視図である。
図６は、アンビル部材の底平面図である。
図６Ａは、ステープルポケットの上平面図である。
図７Ａは、未形成ステープルの側面図である。
図７Ｂは、本開示による、第１の構成に形成される図７Ａのステープルの側面図である。
図７Ｃは、本開示による、第２の構成に形成される図７Ａのステープルの側面図である。
図７Ｄは、本開示による、第３の構成に形成される図７Ａのステープルの側面図である。
図７Ｅは、本開示による、第４の構成に形成される図７Ａのステープルの側面図である。
図７Ｆは、ステープルの第１と第２の脚部との間に重複を示す、図７Ｂのステープルの平面図である。
図８Ａは、ステープルポケット、未形成ステープル、ステープル滑動部、およびロッド滑動部の拡大側面図である。
図８Ｂは、第１の構成に形成されるステープルを示す、図８Ａの構成要素の拡大側面図である。
図８Ｃは、ディンプリングロッドによってディンプリングされるステープルのバックスパンを示す、図８Ｂの構成要素の拡大側面図である。
次に、図面を参照して、本開示される手術器具の実施形態を説明するが、同一参照番号は、いくつかの図面のそれぞれにおける同等または対応する要素を指す。本明細書で使用されるように、用語「遠位」は、ユーザからより遠い器具の部分またはその構成要素を指し、用語「近位」は、ユーザにより近い器具の部分またはその構成要素を指す。
手術用ステープリング装置の実施例は、Ｂｌｅｗｅｔｔの米国特許第５，４８０，０８９号（現在は、Ｔｙｃｏ Ｈｅａｌｔｈｃａｒｅの子会社であるＵｎｉｔｅｄ Ｓｔａｔｅｓ Ｓｕｒｇｉｃａｌに所有および譲渡されている）に開示されており、その内容は、参照することによって全体として本明細書に援用される。図１を参照すると、概して、１００と示されるステープル固定アセンブリは、固定された第１の顎部１０４と、可動である第２の顎部１４０と、顎部作動機構１６０と、を含む。一実施形態では、ステープル固定アセンブリ１００は、当技術分野において周知のように、内視鏡下または腹腔鏡下ステープリング器具と併用するために適合される。
第１の顎部１０４は、第１の組織接触表面１２２を有するステープルマガジン１２０を含む。複数の保持スロット１２４は、ステープルマガジン１２０内に含められ、第１の組織接触表面１２２上の列１２６に配列される（図４参照）。各列１２６は、概して、第１の顎部１０４の長手方向軸に沿って延びる。第１の組織接触表面１２２は、実質的に細長い。各保持スロット１２４は、ステープル１１０と、ステープル射出アセンブリとを受容するために構成される。ステープル射出アセンブリは、ステープル射出器１３２と、ディンプリングロッド１３８（図５参照）と、ステープル滑動部１３４と、ロッド滑動部１３６と、を含む。ステープルマガジン１２０は、第１の顎部１０４に可撤的に取設されてもよいことが企図される。ステープルマガジン１２０が取り外し可能な構造である構成では、ステープル１１０のその補充が使い果たされると、除去され、新しいステープルマガジン１２０が第１の顎部１０４に取設されてもよい。各ステープルマガジン１２０は、完全補充ステープル１１０と、少なくとも１つのステープル駆動アセンブリ１３０（図５に図示され、以下に詳述される）とを含む。
ステープルマガジン１２０は、ステープル滑動部１３４およびロッド滑動部１３６を摺動可能に受容するために適合される複数の長手方向チャネル１２８（図３および４参照）を含む。チャネル１２８の数は、ステープルマガジン１２０内に含まれるステープル１１０の列１２６の数に対応する。一実施形態では、ステープルマガジン１２０は、ステープル１１０の少なくとも２つの列１２６を含むが、施行される手順、固定される組織の特徴、および他の配慮事項、ならびに各ステープルマガジン１２０内に含まれるステープル１１０の数は、列１２６の数を決定する際の要因となる。複数の列内の各列１２６は、同等数量のステープル１１０を有する。
次に、図１−３と併せて、図５および８Ａ−８Ｃを参照すると、ステープル駆動アセンブリ１３０が示され、ステープル射出器１３２と、ステープル滑動部１３４と、ロッド滑動部１３６と、ディンプリングロッド１３８と、を含む。各ステープル滑動部１３４は、当技術分野において周知の構造を使用する手術用ステープリング器具の駆動機構（図示せず）に動作可能に連結される。駆動機構および作動機構を含むそのような器具の実施例は、Ｍｉｌｌｉｍａｎらの米国特許第６，６６９，０７３号（現在は、Ｔｙｃｏ Ｈｅａｌｔｈｃａｒｅの子会社であるＵｎｉｔｅｄ Ｓｔａｔｅｓ Ｓｕｒｇｉｃａｌに所有および譲渡されている）に開示されており、その内容は、参照することによって全体として本明細書に援用される。複数の列１２６を含む実施形態では、作動シーケンスの際、実質的に同時にステープル１１０の長手方向列１２７（図４参照）を射出するために、その長手方向移動が同期するように、ステープル滑動部１３４は、駆動機構に動作可能に連結される。駆動機構の動作は、作動機構の作動に応答して、それぞれのカムの近位および遠位移動をもたらす。
ステープル滑動部１３４は、ステープルマガジン１２０の遠位端へ配向される一対の傾斜表面１３５ａ、１３５ｂを有する概して細長い構造である。傾斜表面１３５ａ、１３５ｂは、側方に離間し、その間に通路１３５ｃを規定する。通路１３５ｃは、実質的に平坦であって、ロッド滑動部１３６を摺動可能に受容するために定寸される。ロッド滑動部１３６は、ステープル滑動部１３４と実質的に類似傾斜を有する略傾斜構造である。さらになお、ステープル射出器１３２は、傾斜表面１３５ａ、１３５ｂに容易に係合するために、側方に離間し、その遠位端で角度を成す一対の脚部１３２ａ、１３２ｂを含む。貫通孔１３２ｃは、ステープル射出器１３２の本体１３２ｄ内の中心に配置され、ディンプリングロッド１３８を摺動可能に受容するために定寸される。
作動機構の作動に応じて、ステープル滑動部１３４は、駆動機構によって、ステープルマガジン１２０を通して、概して、遠位方向に駆動される。ステープルマガジン１２０を通る平行移動に伴って、ステープル滑動部１３４は、各ステープル射出器１３２に連続的に係合する。ステープル滑動部１３４の遠位水平運動によって、ステープル射出器１３２の垂直運動が生じ、順に、アンビル部材１４２へステープル１１０をほぼ垂直方向に駆動するように、ステープル滑動部１３４およびステープル射出器１３２は、余角を伴う係合表面を有する。ステープル滑動部１３４の遠位移動の際、ロッド滑動部１３６は、マガジンの近位領域内に静止したままである。組織間隔１０２によって判断されるように、約２．５ｍｍ未満のステープルの高さが望ましい場合、以下に詳述されるように、作動機構は、駆動機構を作動し、ロッド滑動部１３６を遠位に駆動する。
図２および３を参照すると、間隔センサ１０６は、ステープル固定アセンブリ１００の近位部分に配置される。間隔センサ１０６は、一端近傍に配置される貫通孔１０９を有する概して細長い構造である。さらになお、間隔センサ１０６は、第２の顎部１４０に固定して取設され、開口部１０５内に摺動可能に受容される。ディンプリング窓１０３は、第１の顎部１０４の近位部分近傍に配置され、ディンプリングロッド駆動部１０７を摺動可能に受容するために構成される。ディンプリングロッド駆動部１０７は、作動機構に動作可能に連結され、ディンプリング窓１０３がディンプリングロッド駆動部１０７と整合されると、ステープルディンプリングカム１３６に係合する。組織間隔１０２が、約２．５ｍｍ未満のステープルの高さが望ましいことを示す場合のみ、ディンプリング窓１０３がディンプリングロッド駆動部１０７と整合するように、間隔センサ１０６は、構成および定寸される。
約２．５ｍｍ未満のステープルの高さを有する実施形態では、ステープル滑動部１３４は、ステープルマガジン１２０を通るその移動の際、ロッド滑動部１３６（図５）を誘導する。ステープル滑動部１３４がステープルマガジン１２０を通して遠位に平行移動すると、ロッド滑動部１３６は、所定の時間遅延後、それに追従する。ロッド滑動部１３６は、ステープル滑動部１３４の通路１３５ｃによって、その経路に沿って誘導される。したがって、ステープル滑動部１３４は、ステープル１１０を射出し、それをアンビル部材１４２に対し駆動し、前述のように、約２．５ｍｍ未満の高さを有するステープルを形成する。ステープル１１０がステープルポケット１５０内に駆動され、ステープル滑動部１３４がステープル射出器１３２を通過する前に（すなわち、滑動部間の遅延）、滑動部１３６は、ディンプリングロッド１３８に係合する。ロッド滑動部１３６がステープル滑動部ｌ３４とともに遠位に平行移動すると、ディンプリングロッド１３８と接触し、その垂直運動によって、バックスパン１１６に係合させる。バックスパン１１６の中心に陥没を形成し、形成されたステープル１１０の保持強度をさらに向上させるように、ロッド滑動部１３６は、ディンプリングロッド１３８を駆動する。
図４に示されるように、ステープルマガジン１２０は、複数の列１２６を有してもよく、各列１２６内の保持スロット１２４は、隣接する列１２６内の保持スロット１２４から長手方向にオフセットされてもよい。保持スロット１２４が長手方向にオフセットされるため、ステープル挟持カム１３４は、動作可能に配列および同期され、第１のステープル１１０を各列１２６から射出し、ステープルマガジン１２０の遠位端へ連続的に前進させ、ステープル１１０を各列１２６から連続的に射出する。
図１−３に示されるように、第２の顎部１４０は、第１の顎部１０４から離間して、その間の組織間隔１０２を規定する。第２の顎部１４０は、開放位置と閉鎖位置との間の複数の位置を通して可動である。一実施形態では、第１の顎部１０４および第２の顎部１４０は、複数の位置を通して互いに実質的に平行である。以下に詳述されるように、ステープル固定アセンブリ１００の動作の際、第２の顎部１４０は、顎部１０４と１４０との間の実質的に平行な関係を維持する顎部作動機構１６０によって、第１の顎部１０４へ移動される。
図１を参照すると、顎部作動機構１６０は、筐体１７０内に配置され、カム１６２と、ケーブル１６４と、バネ１６６と、を含む。カム１６２、ケーブル１６４、およびバネ１６６は、互いに動作可能に接続される。第２の顎部１４０の近位部分は、筐体１７０内に配置され、そこに固着される。特に、バネ１６６は、当技術分野において周知の構造によって、ステープリング器具の近接機構（図示せず）に動作可能に連結される。近接機構は、バネ１６６を近位に移動させる。ケーブル１６４がバネ１６６に動作可能に接続されるため、バネ１６６のこの近位移動は、ケーブル１６４の近位移動およびカム１６２の反時計回りの回転をもたらす。
カム１６２の少なくとも一部は、第２の顎部１４０の外側表面１４６と接触し、反時計回り方向の回転に自動ロックする。カム１６２は、筐体１７０に回転可能に取設するために、中心に配置されるオリフィス１６３を有する。オリフィス１６３は、実質的に円形であるが、カムｌ６２の反時計回りの回転によって、カム１６２の少なくとも一部が外側表面１４６との接触を維持し、それによって、反時計回りの回転の際、第２の顎部１４０を第１の顎部１０４へ付勢するように、カム１６２は、特に外側表面に沿って、ほぼ偏心形状を有する。カム１６２が所望の量だけ回転した後、時計回りの回転が不可能となるように（すなわち、自動ロック）、定位置にロックされるが、付加的反時計回りの回転は可能である。当技術分野において周知の解放機構は、顎部作動機構１６０を手術用ステープリング器具に動作可能に連結する。完全作動シーケンス後、解放機構が作動され、カム１６２のロックを解除し、カム１６２の時計回りの回転を可能にする。したがって、第２の顎部１４０は、当技術分野において周知の偏向機構によって、第１の顎部１０４から付勢され、顎部を分離し、手術用ステープリング器具の除去を可能にする。
一実施形態では、印加される圧力の最小量を使用して、組織Ｔが捕捉され顎部１０４、１４０間に維持されるように、カム１６２、ケーブル１６４、およびバネ１６６は選択される。カム１６２、ケーブル１６４、およびバネ１６６の有利な組み合わせは、異なる厚さの組織Ｔ（すなわち、各組織厚は、特定の組織間隔１０２に対応）を捕捉する一方、顎部１０４、１４０がその間の組織Ｔを捕捉するための組織Ｔへの外傷を最小限にする。
次に、図６を参照すると、アンビル部材１４２が示される。アンビル部材１４２は、概して、細長く、第２の組織接触表面１４４上に配置される複数のステープルポケット１５０（図６Ａ参照）を含み、ステープルポケット１５０の数および配列は、第１の組織接触表面１２２内の保持スロット１２４の数および配列に対応する。ステープルポケットの実施例は、Ｂｌｅｗｅｔｔの米国特許第５，４８０，０８９号に開示される。次に、図６Ａを参照すると、各ステープルポケット１５０は、ステープル１１０のそれぞれの脚部１１２、１１４（図７Ａ参照）を形成するために、第１のステープル脚部形成溝１５２と、第２のステープル脚部形成溝１５４と、を有する。各ステープル形成溝１５２、１５４は、それぞれ、脚部１１２、１１４に適応するように定寸される。
ステープル脚部形成溝１５２および１５４は、中間点１５６を中心として対称である。また、実質的にレムニスケート（８の字形形状湾曲）チャネリング表面１５８は、ステープルポケット１５０の周縁の周囲の第２の組織接触表面１４４内に形成される。各チャネリング表面１５８は、第２の組織接触表面１４４によって規定される平面に対し、角度θを形成し、ここでは、０°＜θ＜９０°である。各ステープル形成溝１５２、１５４は、隣接するチャネリング表面１５８と異なる勾配を有する。より具体的には、各ステープル形成溝１５２、１５４は、勾配端１５２ａ、１５４ａを有し、対応するステープル脚部１１２、１１４をステープル１１０のバックスパン１１６へ指向する。勾配端１５２ａ、１５４ａは、互いに長手方向に対向する。
作動シーケンスの際、ステープル１１０は、保持スロット１２４から射出されて、アンビル部材１４２へ指向され、それによって、組織Ｔを通して脚部１１２および１１４を駆動し、それぞれ、ステープル形成溝１５２、１５４に進入する。ステープル１１０がステープルポケット１５０と接触すると、ステープル形成溝１５２、１５４は、脚部１１２、１１４を互いに向かって指向する一方、図７Ｆに示されるように、互いに重複するように、脚部１１２、１１４の側方分離を維持する。特に、図７Ｂ−７Ｄを参照すると、ステープル１１０の形成の際、ステープル形成溝１５２は、チャネリング表面１５８と協働して、脚部１１４の未形成部分に沿って、かつ実質的に平行に、脚部１１２をバックスパン１１６へ指向する。同様に、ステープル形成溝１５４は、チャネリング表面１５８と協働して、脚部１１２の未形成部分に沿って、かつ実質的に平行に、脚部１１４をバックスパン１１６へ指向する。脚部１１２と脚部１１４の未形成部分との平行重複量は、組織間隔１０２に応じる。同様に、脚部１１４と脚部１１２の未形成部分との平行重複量もまた、組織Ｔの厚さおよび顎部作動機構１６０の動作によって制御される組織間隔１０２に応じる。
したがって、組織間隔１０２が大きい程、ステープル１１０の高さは高くなる（例えば、図７Ｂに示されるように、約４．８ｍｍ）一方、組織間隔１０２が小さい程、ステープル１１０の高さは低くなる（例えば、図７Ｄに示されるように、約２．５ｍｍ）。一実施形態では、作動機構は、ステープルマガジン１２０およびアンビル部材１４２と協働して、組織Ｔの厚さおよび組織間隔１０２によって判断されるように、約４．８ｍｍ（すなわち、第２の顎部１４０の開放位置）〜約２．５ｍｍ（すなわち、第２の顎部１４０の閉鎖位置）の高さを有するステープル１１０を形成する。ことを理解されたいステープル１１０は、組織Ｔの厚さによって判断されるように、約４．８ｍｍ〜約２．５ｍｍの範囲の任意の高さを有するように形成されてもよい（実施例は、図７Ｃに示される）。組織Ｔ厚が、より低いステープル１１０の高さ（すなわち、約２．５ｍｍ未満または図７Ｅに示されるディンプリング位置）の必要性を示す場合、上述のように、ステープリング器具の作動機構は、ロッド滑動部１３６に動作可能に連結される第２の駆動部材を作動する。
種々の修正が、本明細書に開示される実施形態に成され得ることを理解されるであろう。したがって、上述の説明は、制限として解釈されるべきではなく、単に、好ましい実施形態の例証として解釈されたい。例えば、本明細書に開示される構造を形成するステープルは、類似効果を有するＥＥＡ、ＴＡ、および内視鏡下ステープラにおける使用のために適合および構成されることが可能である。当業者は、本明細書に添付の特許請求の範囲および精神内で他の修正を想定するであろう。
Claims (14)
- 作動機構を含む筐体と、
該筐体から遠位に延びる細長い管状部材と、
該細長い管状部材の遠位端に位置するステープル固定アセンブリであって、該ステープル固定アセンブリは、第１の顎部および第２の顎部を含み、該第１の顎部は、複数のファスナおよび駆動アセンブリを含み、該第２の顎部は、アンビルを含む、ステープル固定アセンブリと、
カムを含む顎部駆動アセンブリであって、該顎部駆動アセンブリは、該作動機構の作動が該第１の顎部および該第２の顎部のうちの一方を該第１の顎部および該第２の顎部のうちの他方に向けて移動させるように、該第２の顎部および該作動機構に動作可能に結合されてており、該カムの少なくとも一部は、該カムの回転が該第２の顎部を該第１の顎部に向けて付勢するように、該第２の顎部の外側表面に接触し、該第１の顎部の組織接触表面は、該顎部間の距離が変動するとき、該第２の顎部の組織接触表面に平行のままである、顎部駆動アセンブリと
を備える、手術装置。 - 前記顎部駆動アセンブリは、前記カムと前記作動機構とを動作可能に結合するバネをさらに含む、請求項１に記載の手術装置。
- 第１の方向への前記バネの移動は、第１の方向に前記カムを回転させ、前記第２の顎部を前記第１の顎部に向けて付勢する、請求項２に記載の手術装置。
- リンキング部材は、前記カムと前記バネとを動作可能に接続する、請求項２または３に記載の手術装置。
- 作動機構を含む筐体と、
該筐体から遠位に延びる細長い管状部材と、
該細長い管状部材の遠位端に位置するステープル固定アセンブリであって、該ステープル固定アセンブリは、第１の顎部および第２の顎部を含み、該第１の顎部は、複数のファスナおよびファスナ駆動アセンブリを含み、該第２の顎部は、アンビルを含み、該第１の顎部は、その中に配置された少なくとも１つの可動部材を含み、該少なくとも１つの可動部材は、手術用ファスナの一部と相互作用するために選択的に作動される、ステープル固定アセンブリと、
カムを含む顎部駆動アセンブリであって、該顎部駆動アセンブリは、該作動機構の作動が該第１の顎部および該第２の顎部のうちの一方を該第１の顎部および該第２の顎部のうちの他方に向けて移動させるように、該第２の顎部および該作動機構に動作可能に結合されており、該カムの少なくとも一部は、該カムの回転が該第２の顎部を該第１の顎部に向けて付勢するように、該第２の顎部の外側表面に接触し、該第１の顎部の組織接触表面は、該顎部間の距離が変動するとき、該第２の顎部の組織接触表面に平行のままである、顎部駆動アセンブリと
を備える、手術装置。 - 前記ファスナ駆動アセンブリは、少なくとも１つの滑動アセンブリを有し、該滑動アセンブリは、第１の滑動部および第２の滑動部を含む、請求項５に記載の手術装置。
- 前記第１の滑動部は、前記第２の滑動部を摺動可能に受容するための該第１の滑動部を通る長手方向通路を含み、前記複数のファスナの下を通る該第１の滑動部の長手方向の平行移動は、前記手術用ファスナを連続的に射出する、請求項６に記載の手術装置。
- 前記複数のファスナの下を通る前記第２の滑動部の長手方向の平行移動は、前記少なくとも１つの可動部材を前記第１の顎部の組織接触表面に向けて移動させ、該少なくとも１つの可動部材は、該第１の顎部の長手方向軸を横断する方向に移動し、該少なくとも１つの可動部材の該横断する方向の移動によって、前記手術用ファスナの一部と接触する、請求項６または７に記載の手術装置。
- 前記第１の滑動部の長手方向の平行移動は、前記第２の滑動部の長手方向の平行移動に先行する、請求項７または８に記載の手術装置。
- 各ファスナは、第１の脚部と、バックスパンと、第２の脚部とを含み、該第２の脚部が該第１の脚部と接触するように該各ファスナが前記アンビルと相互作用するとき、該ファスナは、前記第１の顎部および前記第２の顎部の組織接触表面の間の間隔に比例するサイズを有し、前記可動部材はそれぞれ、前記間隔が所定の量未満であるとき、対応するファスナのバックスパンを変形させる、請求項５、７、または８に記載の手術装置。
- 作動機構を含む筐体と、
該筐体から遠位に延びる細長い管状部材と、
該細長い管状部材の遠位端に位置するステープル固定アセンブリであって、該ステープル固定アセンブリは、第１の顎部および第２の顎部を含み、該第１の顎部は、該作動機構に動作可能に関連付けられるファスナ駆動アセンブリを含み、該ファスナ駆動アセンブリは、第１の滑動部および第２の滑動部を有し、該第１の滑動部は、該第２の滑動部を摺動可能に受容するために、そこを通る長手方向通路を有し、該第２の顎部は、アンビルを含む、ステープル固定アセンブリと、
該第１の顎部内に配置される複数のファスナおよび対応する数の射出アセンブリであって、各射出アセンブリは、ファスナ射出器および可動部材を含み、該第１の滑動部は、該ファスナ駆動アセンブリの作動に応答して、遠位に平行移動し、該第１の滑動部の遠位移動の間、該第２の滑動部は、静止したままである、複数のファスナおよび対応する数の射出アセンブリと、
カムを含む顎部駆動アセンブリであって、該顎部駆動アセンブリは、該作動機構の作動が該第１の顎部および該第２の顎部のうちの一方を該第１の顎部および該第２の顎部のうちの他方に向けて移動させるように、該第２の顎部および該作動機構に動作可能に結合されており、該カムの少なくとも一部は、該カムの回転が該第２の顎部を該第１の顎部に向けて付勢するように、該第２の顎部の外側表面に接触し、該第１の顎部の組織接触表面は、該顎部間の距離が変動するとき、該第２の顎部の組織接触表面に平行のままである、顎部駆動アセンブリと
を備える、手術装置。 - 間隔は、前記第１の顎部および前記第２の顎部の組織接触表面間で規定され、該間隔は、該第１の顎部および該第２の顎部の間に捕捉される組織に比例し、前記第１の滑動部の遠位移動は、該第１の顎部の長手方向軸を横断する方向に前記射出器を移動させ、それによって、前記ファスナを前記アンビルに向けて駆動し、各ファスナは、第１の脚部と、バックスパンと、第２の脚部とを含み、該第２の脚部が該第１の脚部と接触するように該各ファスナが該アンビルと相互作用するとき、該ファスナは、該間隔に比例するサイズを有する、請求項１１に記載の手術装置。
- 前記第２の滑動部は、前記複数のファスナの下を通って遠位に平行移動し、前記第２の滑動部は、前記可動部材に係合し、前記第１の顎部の長手方向軸を横断する方向に前記可動部材を駆動させ、該可動部材はそれぞれ、対応するファスナの前記バックスパンに接触する、請求項１１または１２に記載の手術装置。
- 各ファスナは、第１の脚部と、バックスパンと、第２の脚部とを含み、該第２の脚部が該第１の脚部と接触するように該各ファスナが前記アンビルと相互作用するとき、該ファスナは、前記第１の顎部および前記第２の顎部の組織接触表面間の間隔に比例するサイズを有し、前記可動部材はそれぞれ、該間隔が所定の量未満であるとき、対応するファスナのバックスパンを変形させる、請求項１１または１３に記載の手術装置。
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| US60/919,381 | 2007-03-22 | ||
| PCT/US2008/057599 WO2008118728A1 (en) | 2007-03-22 | 2008-03-20 | Apparatus for forming variable height surgical fasteners |
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-
2008
- 2008-03-20 JP JP2009554726A patent/JP5394265B2/ja not_active Expired - Fee Related
- 2008-03-20 CA CA2681186A patent/CA2681186C/en not_active Expired - Fee Related
- 2008-03-20 AU AU2008231109A patent/AU2008231109B2/en not_active Ceased
- 2008-03-20 EP EP08744103.6A patent/EP2139411B1/en not_active Revoked
- 2008-03-20 ES ES08744103.6T patent/ES2627617T3/es active Active
- 2008-03-20 WO PCT/US2008/057599 patent/WO2008118728A1/en active Application Filing
- 2008-03-20 EP EP17158316.4A patent/EP3195814A1/en not_active Withdrawn
- 2008-03-20 US US12/529,576 patent/US8205780B2/en not_active Expired - Fee Related
-
2012
- 2012-01-05 US US13/343,743 patent/US8403198B2/en not_active Expired - Fee Related
- 2012-12-26 JP JP2012282273A patent/JP5683564B2/ja not_active Expired - Fee Related
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2013
- 2013-02-27 US US13/778,735 patent/US9597073B2/en not_active Expired - Fee Related
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2014
- 2014-03-31 JP JP2014071628A patent/JP5685334B2/ja not_active Expired - Fee Related
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2017
- 2017-02-07 US US15/426,497 patent/US20170143338A1/en not_active Abandoned
Also Published As
| Publication number | Publication date |
|---|---|
| US20100006620A1 (en) | 2010-01-14 |
| US9597073B2 (en) | 2017-03-21 |
| JP2010522035A (ja) | 2010-07-01 |
| JP5685334B2 (ja) | 2015-03-18 |
| CA2681186A1 (en) | 2008-10-02 |
| US20170143338A1 (en) | 2017-05-25 |
| ES2627617T3 (es) | 2017-07-28 |
| EP2139411B1 (en) | 2017-05-03 |
| EP2139411A4 (en) | 2013-08-14 |
| EP3195814A1 (en) | 2017-07-26 |
| US8205780B2 (en) | 2012-06-26 |
| US8403198B2 (en) | 2013-03-26 |
| CA2681186C (en) | 2015-07-21 |
| JP2014144365A (ja) | 2014-08-14 |
| AU2008231109B2 (en) | 2013-01-10 |
| JP2013078621A (ja) | 2013-05-02 |
| JP5683564B2 (ja) | 2015-03-11 |
| EP2139411A1 (en) | 2010-01-06 |
| AU2008231109A1 (en) | 2008-10-02 |
| WO2008118728A1 (en) | 2008-10-02 |
| US20130233905A1 (en) | 2013-09-12 |
| US20120145768A1 (en) | 2012-06-14 |
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