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JP2006034975A - ツーピースのeビーム発射機構を含む関節運動外科用ステープラ - Google Patents

ツーピースのeビーム発射機構を含む関節運動外科用ステープラ Download PDF

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JP2006034975A
JP2006034975A JP2005216951A JP2005216951A JP2006034975A JP 2006034975 A JP2006034975 A JP 2006034975A JP 2005216951 A JP2005216951 A JP 2005216951A JP 2005216951 A JP2005216951 A JP 2005216951A JP 2006034975 A JP2006034975 A JP 2006034975A
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anvil
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Frederick E Shelton Iv
フレデリック・イー・シェルトン・ザ・フォース
Kevin R Doll
ケビン・ドール・ロス
Jerry R Morgan
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Michael Earl Setser
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Abstract

【課題】エンドエフェクタのクランプされたジョー間の間隔を正確に維持する発射バーを備えると共にシャフトの関節運動を容易にした外科器具を提供すること。
【解決手段】腹腔鏡処置及び内視鏡処置に適した外科用ステープル止め/切断器具であって、エンドエフェクタの細長い溝と回動可能に対向したアンビルとの間に組織をクランプする。Eビーム発射バーが、クランプされたエンドエフェクタ内を先端側に移動して組織を切断し、切断された組織の両側をステープル止めする。Eビーム発射バーは、たとえクランプされた組織の量がエンドエフェクタの間隔を維持するのに不十分であっても、アンビルと細長い溝との間隔を確実に維持してステープル止めすることができる。発射バーの上部ピンが、アンビルスロット内を長手方向に移動し、発射バーの下側脚と中間ピンとの間に溝スロットを保持して最小の間隔を維持できる。
【選択図】図1

Description

本願は、2004年7月28日出願の米国仮特許出願第60/591,694号(名称「電気的に作動する関節機構を含む外科器具(SURGICAL INSTRUMENT INCORPORATING AN ELECTRICALLY ACTUATED ARTICULATION MECHANISM)」)の恩典を請求するものである。本願はまた、言及することを以ってその開示内容の全てを本明細書の一部とする、2003年5月20日出願のシェルトン(Shelton)らによる最近の米国特許出願第10/443,617号(名称「Eビーム発射機構を含む外科用ステープラ(SURGICAL STAPLING SNSTRUMENT INCORPORATING AN E-BEAM FIRING EMCHANISM)」)の一部継続出願である。
本発明は、長手方向に移動する発射部材によって作動されるエンドエフェクタを内視鏡的に挿入するのに適した外科器具に関し、詳細には、関節運動するシャフトを備えた外科用ステープル止め/切断器具に関する。
内視鏡外科器具は、切開部が小さく術後の回復が早く合併症のリスクが低いため、従来の開放外科手術よりも好まれる傾向にある。従って、トロカールのカニューレを介して所望の外科部位に先端部のエンドエフェクタを正確に配置するのに適した一定の内視鏡器具が進歩した。このような先端部のエンドエフェクタは、様々な方法(例えば、エンドカッター、把持具、カッター、ステープラ、クリップアプライヤー、アクセス装置、薬物/遺伝子治療送達装置、及び超音波、無線周波、及びレーザーなどを用いるエネルギー装置)で組織にアクセスして診断したり治療効果を得ることができる。
エンドエフェクタの位置合わせはトロカールによって一定範囲に制限される。一般に、このような内視鏡外科器具は、医師が操作するハンドル部分とエンドエフェクタとの間に長いシャフトを有する。この長いシャフトにより、所望の深さに挿入して、その長軸を中心にエンドエフェクタを回動させ、ある程度の位置合わせが可能である。トロカールを慎重に配置して把持具を用いれば、例えば別のトロカールを介した位置合わせで十分な場合が多い。特許文献1に開示されているような外科用ステープル止め/切断器具が、挿入と回動によりエンドエフェクタを正確に配置できる内視鏡外科器具の一例である。
言及することを以ってその開示内容の全てを本明細書の一部とする、2003年5月20日出願のシェルトン(Shelton)らによる最近の米国特許出願第10/443,617号(名称「Eビーム発射機構を含む外科用ステープラ(SURGICAL STAPLING SNSTRUMENT INCORPORATING AN E-BEAM FIRING EMCHANISM)」)に、組織の切断及びステープル止め用の改良された「Eビーム」発射バーが開示されている。この器具に特有の利点は、たとえクランプした組織の量がステープル成形に最適な組織の量と多少異なっていたとしても、エンドエフェクタ、つまりステープル止め組立体のジョーとジョーの間の空間を確実に維持できることである。更に、Eビーム発射バーが、複数の有利なロックアウトを含むことができるようにエンドエフェクタ及びステープルカートリッジに係合する。
操作方法によるが、内視鏡外科器具のエンドエフェクタの位置合わせを更に調節できるようにするのが望ましいであろう。特に、器具のシャフトの長軸の横断方向に対してエンドエフェクタを向き合わせできるのが望ましい場合が多い。器具のシャフトに対するエンドエフェクタの横断方向の移動は、従来より「関節運動」と呼ばれている。この関節運動は通常、ステープル止め組立体のすぐ基端側のシャフト延長部に設けられたピボット(または関節運動)接合部によって達成される。これにより、外科医が、より良くステープルラインの外科的に配置するため及び容易な組織の操作及び向き合わせのために、ステープル止め組立体を遠隔的に左右何れかの方向に関節運動させることができる。この関節運動位置合わせにより、外科医は、例えば臓器の後側などの位置の組織に容易に係合させることができる。加えて、関節運動位置合わせにより、内視鏡を器具のシャフトに妨害されずにエンドエフェクタの後側に有利に配置することができる。
外科用ステープル止め/切断器具の関節動の方法は、関節運動の制御と組織をクランプするためのエンドエフェクタの開閉及びエンドエフェクタの動作(すなわち、ステープル止めと切断)の全てを内視鏡器具の小さな直径の制限の中で行わなければならないため複雑である。一般に、3つの制御運動全てが、長手方向の運動としてシャフトを介して伝達される。例えば、特許文献2に、アコーディオンのような関節運動機構(フレックスネック)が開示されている。この関節運動機構は、実施シャフトを介して、2つの連結ロッドの一方を選択的に引き戻して関節運動させることができる。各連結ロッドは、シャフトの中心線に対して両側にそれぞれずれている。この連結ロッドは、ラチェット式に一連の個々の位置に移動できる。
特許文献3に、関節運動機構の長手方向の制御の別の例が開示されている。この機構は、カム動作ピボットからずれた関節運動リンクを含み、この関節運動リンクを長手方向に押したり引いたりして所望の側に関節運動を行うことができる。同様に、特許文献4に、関節運動のためにシャフトを通過する同様のロッドが開示されている。
言及することを以ってその開示内容の全てを本明細書の一部とする、同時係属中の自己のケネス・ウェールズ(Kenneth Wales)らによる米国特許出願第10/615,973号(名称「長軸を中心とした回動を利用する関節運動機構を含む外科器具(SURGICAL INSTRUMENT INCORPORATING AN ARCTICULATION MECHANISM HAVING ROTATION ABOUT THE LONGITUDINAL AXIS)」)では、長手方向の運動の代わりに回動運動を利用して関節運動を伝達する。
言及することを以ってその開示内容の全てを本明細書の一部とする、2003年5月20日出願のシェルトン(Shelton)らによる最近の米国特許出願第10/443,617号(名称「Eビーム発射機構を含む外科用ステープラ(SURGICAL STAPLING SNSTRUMENT INCORPORATING AN E-BEAM FIRING EMCHANISM)」)では、腹腔鏡下及び内視鏡下外科処置に適した外科用ステープル止め/切断器具は、細長い溝に対してアンビルが回動可能なエンドフェクタ内で組織をクランプする。Eビーム発射バーが、クランプされたエンドエフェクタ内を先端側に移動して組織を切断し、その切断部の両側をステープル止めする。具体的には、発射バーの上部ピンが、アンビルスロット内を長手方向に移動し、溝スロットが、発射バーの中間ピンと下側キャップとの間に挟まれて間隔が確実に維持される。Eビーム発射バーは様々な利点を有するが、操作性を高めるため及び寸法の変動を最小限にするために追加の機能を有するのが望ましい。
米国特許第5,465,895号明細書 米国特許第5,673,840号明細書 米国特許第5,865,361号明細書 米国特許第5,797,537号明細書
従って、エンドエフェクタのクランプされたジョー間の間隔を正確に維持する発射バーを備えると共にシャフトの関節運動を容易にした外科器具が強く要望されている。
本発明は、従来技術の上記した欠点及び他の欠点を解消するべく、外科用ステープル止め/切断器具のエンドエフェクタの垂直方向の間隔を確実に維持する発射機構を提供する。従って、この外科器具は、たとえエンドエフェクタにクランプされた組織の量が不十分であっても、適切なステープル止めに十分な間隔を構造的に保証する。刃先を含むEビームにこのような構造を一体形成して、ステープル止め/切断器具などのエンドエフェクタ内をEビームが移動する時に間隔を一定に維持し機能を果たすことができる。更に、Eビームの基端側に別の薄い発射バーを取り付けて、断面積を小さくし、関節運動平面で曲げられるようにして、関節運動する外科器具を利用し易くすることができる。
本発明の別の態様では、外科器具は、実施部分を作動させる発射運動を起こすことができるハンドル部分を含む。この実施部分は、回動可能に取り付けられたアンビルに対向したステープルカートリッジを受容する細長い溝を有する。発射装置は、細長い溝とアンビルとの間に長手方向に受容された先端側を向いた刃先、アンビル溝に係合可能な上側部材、溝スロットに係合可能な下側部材、及びステープルカートリッジと一体のウェッジスレッドを作動させることができる中間部材を含む。この中間部材は、エンドエフェクタの締め付けに有利に対抗し、たとえクランプされた組織の量が不十分であっても適切なステープル止めを確実に行うことができる。このような間隔を維持する構造及び切断構造をEビーム内に有利に形成して、Eビームに取り付けられる薄い発射バーによって関節運動の柔軟性が得られる。
本発明のこれら及び他の目的及び利点は、添付の図面及び以下の説明から明らかになるであろう。
エンドエフェクタのクランプされたジョー間の間隔を正確に維持する発射バーを備えると共にシャフトの関節運動を容易にした外科器具が提供される。
本明細書に含まる本明細書の一部を成す添付の図面は、本発明の実施形態を例示するものであり、これを参照しながら本発明の概要及び実施形態の詳細な説明を読めば、本発明をより良く理解できるであろう。
図1‐図3に示されているように、外科用ステープラ10が、その先端部に、細長いシャフト16によってハンドル14(図2)から離間したステープル止め組立体12として示されているエンドエフェクタを有する。ステープル止め組立体12は、交換可能なステープルカートリッジ20を受容するためのステープル溝18を含む。ステープル溝18にアンビル22が回動可能に取り付けられている。アンビル22は、ステープルカートリッジ20に対して組織をクランプして切断し、ステープル23(図3)を閉じた形状に成形する。具体的には、ステープル23(図3)がステープルカートリッジ20のステープル孔24からアンビル下面28のステープル成形凹部26(図6)に対して押し上げられて成形される。ステープル止め組立体12が閉じると、その断面積及び細長いシャフト16が、トロカールのカニューレ(不図示)を用いるなどして小さな外科的開口を通過するのに適した大きさとなる。
特に図1を参照されたい。ステープル止め組立体12の正確な配置及び向き合わせが、ハンドル14の制御部によって容易に行うことができる。具体的には、回動ノブ30により、シャフト16をその長軸を中心に回動させてステープル組立体12を回動させることができる。シャフト16の関節運動接合部32で別の位置合わせが可能である。関節運動接合部32は、シャフト16の長軸からステープル止め組立体12を弧状に回動させて、臓器の後側に配置したり、またはステープル組立体12の後側に向けられる内視鏡(不図示)などの他の器具を配置することができる。この関節運動は、ハンドル14の関節運動制御スイッチ34で有利に行うことができる。関節運動制御スイッチ34は、電気信号を関節運動接合部32の電気活性ポリマー(EAP)アクチュエータ36に送信する。EAPアクチュエータ36は、ハンドル14内のEAP制御部及び電源38によって電力が供給される。
組織をステープル止め組立体12内に配置したら、外科医が、閉止トリガー40をピストルグリップ42に向かって基端側に引いてアンビル22を閉止する。組織がクランプされたら、外科医は、更に先端側にある発射トリガー44を基端側に引いてステープル止め組立体12を発射する。ある適用例では、この発射は、シングル発射ストロークで行われ、別の適用例では、マルチ発射ストロークで行われる。発射は、少なくとも2列のステープル止めと同時にそれらの間の組織を切断して完了する。
発射要素の引き戻しは、完全に移動した後に自動的に開始することができる。別法では、引き戻しレバー46を後側に引いて引き戻しを行うことができる。発射要素が引き戻された状態で、外科医が閉止トリガー40をピストルグリップ42に向かって後方に軽く引き、閉止解除ボタン48を押し、次いで閉止トリガー40を解放して、ステープル止め組立体12のクランプを解除し、これにより切断された組織のステープル止めされた2つの端部をステープル止め組立体12から解放する。
ステープル止め組立体
図1には関節運動接合部32が示されているが、分かり易くするためまたは代替の適用例として、図2‐図14の外科用ステープラ10には関節運動接合部32が示されていない。しかしながら、本発明の態様は、図15‐図18を用いて後述する関節運動の特定の利点を有することを理解されたい。
図1‐図3では、ステープル止め組立体12は、シャフト16からシャフトフレーム70に長手方向に伝達される2つの異なった運動によって組織のクランプ、ステープル止め、及び切断を行う。このシャフトフレーム70は、基端側がハンドル14に取り付けられ、回動ノブ30により回動するように結合されている。図1の外科用ステープル止め/切断器具10の例示的なマルチストロークハンドル14は、言及することを以ってその開示内容の全てを本明細書の一部とするスウェイズ(Swayze)及びシェルトン(Shelton)による同時係属中の自己の米国特許出願第10/374,026号(名称「マルチストローク発射位置表示器及び引き戻し機構を含む外科用ステープラ(SURGICAL STAPLING INSTRUMENT INCORPORATING A MULTISTROKE FIRING POSITION INDICATOR AND RETRACTION MECHANISM)」)に詳細に開示されている。追加の特徴及び形態については後述する。マルチストロークハンドル14は、長い距離のために大きな発射の力を用いる適用例に有利に役立ち、本発明に一致した適用例は、言及することを以ってその開示内容の全てを本明細書の一部とするフレデリック E.シェルトン4世(Frederick E. Shelton IV)、マイケル E.セッツァー(Michael E. Setser)、及びブライアンJ.ヘムメルガン(Brian J. Hemmelgarn)による同時係属中の自己の米国特許出願第10/441,632号(名称「閉止システム及と発射システムを別々に有する外科用ステープラ(SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS)」に開示されているようなシングルストローク発射を用いることができる。
図3を参照すると、シャフトフレーム70の先端部がステープル溝18に取り付けられる。アンビル22は、ステープル溝18とシャフトフレーム70の係合部のすぐ先端側のステープル溝18の基端部74内に回動可能に受容された基端部72を有する。アンビル22の回動可能な基端部72は、ステープル溝18との回動取付け部近傍の先端側に閉止構造76を含む。従って、先端部にこの閉止構造76に係合する馬蹄形開口80を備えた閉止チューブ78が、長手方向基端側への移動の際にアンビル22に対して開く運動、及び閉止トリガー40に応答したシャフトフレーム70をスライドする閉止チューブ78の長手方向先端側への運動の際にアンビル22に対して閉じる運動を選択的に付与する。
シャフトフレーム70は、ツーピースナイフ/発射バー90が長手方向に往復運動するハンドル14からの発射運動を受容して案内する。具体的には、シャフトフレーム70は、具体的にはラミネートテーパ発射バー94であるツーピースナイフ/発射バー90の基端部分を受容する長手方向発射バースロット92を含む。図2‐図14に示されているような関節運動接合部を通過しない適用例に用いられる他の材料からなる発射バーまたは無垢の発射バーをラミネートテーパ発射バー94の代わりに用いることができることを理解されたい。
ツーピースナイフ/発射バー90の先端部分であるEビーム102が、別々の閉止運動及び発射運動、並びに発射の際の細長いステープル溝18とアンビル22の間隔の維持を改善する。特に図3及び図4を参照すると、ろう付けまたは接着などの任意の取付け方法に加えて、ツーピースナイフ/発射バー90は、ラミネートテーパ発射バー94の先端側の雄型取付け部材106、及びこれを受容するEビーム102の基端側に形成された雌型垂直取付け開口104から構成されており、これらの各部分は、選択された材料から個別の機能(例えば、強度、柔軟性、摩擦など)に適した方法で形成することができる。Eビーム102は、一対の上部ピン110、一対の中間ピン112、及び下部ピンすなわち下部脚114を形成するのに好適な材料特性を有する材料から有利に形成することができ、また鋭利な刃先も有することできる。加えて、刃先116の垂直方向の両端部を覆っている一体形成された基端側の延出した上部ガイド118と中間ピン112が、切断される前に鋭利な刃先116に対して組織を案内する組織準備領域122を画定している。また中間ガイド120は、詳細を後述するようにステープル止め組立体12によるステープル成形を行うウェッジスレッド126(図5)の段中心部材124に当接して、ステープル止め組立体12に係合し、このステープル止め組立体12を発射させる。
これらの構造(例えば、上部ピン110、中間ピン112、下部脚114)をEビーム102と一体に形成することにより、複数の部品から形成される構造に比べて小さな誤差での製造が容易となり、ステープル止め組立体12の様々なロックアウト構造との効果的な相互作用及び/または発射の際の所望の動作が確実になる。
図6及び図7に、Eビーム102が完全に引き戻され、開いた外科用ステープラ10が示されている。組立ての際は、Eビーム102の下部脚114を、ステープル溝18の幅広開口130から落下させ、次いで、Eビーム102がステープル溝118に形成された下側トラック132に沿って先端側にスライドするようにEビーム102を前進させる。具体的には、下側トラック132は、ステープル溝18の下面の上の幅広スロット134として開口している幅狭スロット133を含み、幅広開口130に連通した逆T字型の横方向の断面を形成している(図7及び図8)。一旦組み立てられると、ラミネートテーパ発射バー94の基端側に結合された構成要素が、下部脚114が基端側に移動して幅広開口130に戻るのを防止し、これにより下部脚114が外れない。
図9に示されているように、ラミネートテーパ発射バー94が、トロカールを介したステープル止め組立体12の挿入を容易にしている。具体的には、先端側の下側突出部136が、完全に引き戻されるとEビーム102を持ち上げる。これは、ステープル溝18の幅広開口130の基端縁で上方にカム動作する点に下側突出部136を配置して達成することができる。
図10に示されているように、ラミネートテーパ発射バー94に発射行程の初めの段階でシャフトフレーム70によって下方に付勢される基端側の上側突出部138を形成して、ステープル溝18に含めることができるある種のロックアウト機構の動作を改善することもできる。具体的には、横バー140が、シャフトフレーム70の一対の矩形開口142(図3)の間に画定されている。横バー140を取り囲むクリップばね144が、長手方向発射バースロット92から先端側に延出したラミネートテーパ発射バー94の部分を下方に付勢し、有利なロックアウト構造を適宜確実に係合させることができる。この付勢は、上側突出部138がクリップばね144に接触する発射行程の一部分に限定されている。
図6及び図7に示されているように、Eビーム102は、アンビル22の回動基端部に近接したアンビルポケット150内に配置された上部ピン110で引き戻される。下方に開口した垂直アンビルスロット152(図2)が、アンビル22内で横方向に広がってアンビル内部トラック154を形成している。アンビル内部トラック154は、図9及び図10に示されているように、発射によりEビーム102が先端側に移動する時に上部ピン110を保持してアンビル22とステープル溝18の間隔を維持する。従って、Eビーム102が引き戻された状態で、外科医が、ステープル止め及び切断のために組織を適切に保持できるまでステープル組立体12を繰り返し開閉することができる。Eビーム102は、直径が小さくそれに伴って強度が低下したステープル止め組立体12に対しても、組織の適切な配置に役立つ。
図2、図3、図5、図6、及び図8‐図14に示されているように、ステープル止め組立体12は、ウェッジスレッド126を含む交換可能なステープルカートリッジ20を有する。長手方向に整合した平行な複数の下方に開口したウェッジスロット202(図8)が、ウェッジスレッド126と一体のウェッジ204を受容する。図8‐図10に示されているように、ウェッジスレッド126が、ステープルドライバ凹部208内を垂直方向にスライド可能な複数のステープルドライバ206をカム動作により上方に持ち上げる。この例示されている形態では、それぞれのステープルドライバ206は2つの垂直プロングを含む。それぞれのプロングが、それぞれのステープル孔210内を上方に移動し、アンビル22のステープル成形面214(図10)に対してステープル23が成形される。ステープルカートリッジ20内に画定されたステープル溝18に近接した中心発射凹部216(図3)により、ウェッジスレッド126の底部水平部分218(図5)及びEビーム102の中間ピン112が通過することができる。具体的には、ステープルカートリッジトレイ220が、ステープルドライバ凹部208、ステープル孔210、及び内部に形成された中心発射凹部216を有するポリマーステープルカートリッジ本体222の下側に取り付けられる。ステープル23が両側で成形される際に、鋭利な刃先116が、その最も先端側の部分を除いて、ステープルカートリッジ20の長手方向の軸を通る垂直貫通スロット230内に進入する。
ステープル止め組立体12の発射は、図10に示されているように、まずツーピースナイフ/発射バー90を基端側に引いて、下側突出部136のカム動作でEビーム102の中間ガイド120が上方後部に持ち上げられるようにして、図2及び図6に示されているようにアンビル22が開いて、新しいステープルカートリッジ20をステープル溝18内に挿入できるようにする。
次いで図11に示されているように、ツーピースナイフ/発射バー90を先端側に僅かに前進させ、クリップばね144によるラミネートテーパ発射バー94の上側突出部138の付勢で下側突出部136が下側トラック132の幅広開口130内に落下するようにする。中間ガイド120が、ウェッジスレッド126の段中心部材124に当接して下方への更なる回動が防止され、これにより中心発射凹部216内にEビームの中間ピン112が維持される。
次いで図12に示されているように、ツーピースナイフ/発射バー90を先端側に発射させ、ウェッジスレッド126の前進によりステープル23を成形すると共に、アンビル22とステープルカートリッジ20との間にクランプされた組織242を鋭利な刃先116で切断する。次いで図13に示されているように、ツーピースナイフ/発射バー90を引き戻し、ウェッジスレッド126を先端側に残す。
次いで図14に示されているように、中間ピン112をステープル溝18に形成されたロックアウト凹部240内に移動させることができる(図7及び図10を参照)。従って、ウェッジスレッド126(図14には不図示)が基端側にない場合は(すなわち、ステープルカートリッジ20が存在しないまたはステープルカートリッジ20が使用された後)、使用者が、ロックアウト凹部240の先端縁に中間ピン112が接触するのを感じることができる。
図1では、関節運動接合部32がツーピースナイフ/発射バー90の柔軟な強度から利点を有すると示されているが、図15‐図18では、関節運動平面で関節運動を可能にする横方向に対称な対になった弧状凹部304を有する脊柱本体302によって形成されたフレックスネック接合部300として示されている。それぞれの側部306及び308を長手方向に通過する制御ロッド(不図示)の選択的な運動によってそれぞれの側部306及び308を同時に収縮及び伸長させることができることが一般に知られている。しかしながら、図示されているEAPプレートアクチュエータ310及び312はそれぞれ、電力の供給により一方または両方の横方向に曲げることができる。
脊柱本体302によって長手方向に画定された中心通路320(図16)が、ラミネートテーパ発射バー94の座屈及び引掛かりを防止する一対の支持プレート322及び324を受容する。例示されている形態では、それぞれの支持プレート322及び324が、関節運動の際の径方向の距離の差に対応できるようにスライド端部328及び固定基端部326(図15)を有する。このようにして、厚みの薄い発射バー94が支持される。
複数の実施形態を用いて本発明を例示し、例示的な実施形態をかなり詳細に説明したが、出願者は、このような詳細に添付の特許請求の範囲が限定されることを意図するものではない。当業者であれば、別の利点及び改良に容易に想到するであろう。
例えば、ステープルカートリッジと一体のウェッジスレッドを有することで様々な利点を有するが、本発明の態様に従ったある適用例では、ウェッジスレッドをEビームと一体にすることができる。例えば、ステープルカートリッジだけではなくエンドエフェクタ全体を交換可能にすることができる。
本発明の実施態様は以下の通りである。
(1)発射運動を起こすことができるハンドル部分と、前記ハンドル部分の前記発射運動に応答する実施部分を含む外科器具であって、
前記実施部分が、
前記ハンドル部分に結合された、溝スロットを含む細長い溝と、
ステープルを支持するドライバをカム動作で上方に移動できるように整合したウェッジ部材を基端側に備えた、前記細長い溝に受容されたステープルカートリッジと、
細長い溝に回動可能に結合された、アンビル溝を含むアンビルと、
前記細長い溝と前記アンビルとの間に長手方向に受容された先端側を向いた刃先、前記アンビル溝に係合可能な上側部材、前記溝スロットに係合する下側部材、前記ステープルカートリッジの前記ウェッジ部材を先端側に移動させて前記ステープルカートリッジを作動させることができる中間部材を含み、長手方向の発射行程の際に前記細長い溝と前記アンビルの両方に係合して、これらの間にステープル成形のための空間を提供する発射装置と、
前記細長い溝の基端側に結合した関節運動接合部と、
前記ハンドル部分から前記関節運動接合部を介して前記発射運動を伝達するために前記発射装置の基端側に取り付けられた薄い発射ストリップとを含むことを特徴とする外科器具。
(2)前記ステープルカートリッジの作動の際に前記発射装置が前記アンビルと前記細長い溝との間隔を確実に維持するように、前記アンビルが、ぞれぞれの先端部で内側に付勢される前記細長い溝に対する回動取付け部を形成することを特徴とする実施態様(1)に記載の外科器具。
(3)前記ステープルカートリッジが複数のタイプのステープルカートリッジから選択され、前記複数のタイプのステープルカートリッジがそれぞれ、前記アンビルと前記細長い溝との所望の間隔を得るために選択される厚みと、前記所望の間隔に適した長さを有するステープルとによって特徴付けられることを特徴とする実施態様(1)に記載の外科器具。
(4)前記ウェッジ部材が、複数の連結されたカム動作ウェッジを有するウェッジスレッドを含み、前記カム動作ウェッジのそれぞれが、前記選択されたタイプのステープルカートリッジに適するよう予め選択された高さを有しており、
前記発射装置の前記中間部材が、前記複数のタイプのステープルカートリッジのそれぞれに当接するように構成されていることを特徴とする実施態様(3)に記載の外科器具。
(5)外科器具であって、
発射運動及び閉止運動を起こすことができるハンドル部分と、前記ハンドル部分からの前記発射運動に応答する、直径がエンドサージェリー(endo-surgery)に適した寸法を有する実施部分とを含む外科器具であって、
前記実施部分が、
前記発射運動及び前記閉止運動を別々に伝達することができる前記ハンドル部分に結合されたシャフトと、
前記シャフトに結合された、溝スロットを含む細長い溝と、
アンビル溝を含み、前記シャフトからの前記閉止運動に応答する、前記細長い溝に回動可能に結合されたアンビルと、
前記細長い溝と前記アンビルとの間に長手方向に受容された先端側を向いた刃先、前記細長い溝にスライド可能に係合する下側部分、及び発射の際に前記アンビルにスライド可能に係合するように配置された上側部分を含み、前記細長い溝と前記アンビルとの間隔を維持するように前記細長い溝及び前記アンビルに係合する発射装置と、
前記発射装置の基端側に取り付けられた、前記発射運動を前記発射装置に伝達できる薄いストリップとを含むことを特徴とする外科器具。
(6)更に、前記細長い溝に係合するステープルカートリッジを含み、このステープルカートリッジが、前記発射装置の前記刃先を受容するための基端側に開口したスロット、及び発射機構の長手方向先端側への運動によって上方にカム動作する複数のステープルを含むことを特徴とする実施態様(5)に記載の外科器具。
(7)前記ステープルカートリッジが更に、前記複数のステープルを支持する複数のドライバ、前記発射機構の前記長手方向先端側への運動に応答して前記ドライバを上方にカム動作させて前記アンビルに対して前記複数のステープルを成形するウェッジスレッドを含むことを特徴とする実施態様(6)に記載の外科器具。
(8)前記シャフトが関節運動機構を含み、前記薄いストリップが前記関節運動機構内で曲がって長手方向に移動することを特徴とする実施態様(5)に記載の外科器具。
(9)前記ステープルカートリッジが複数のタイプのステープルカートリッジから選択され、前記複数のタイプのステープルカートリッジがそれぞれ、前記アンビルと前記細長い溝との所望の間隔を得るために選択される厚みと、前記所望の間隔に適した長さを有するステープルとによって特徴付けられることを特徴とする実施態様(6)に記載の外科器具。
(10)前記ウェッジスレッドが複数の連結されたカム動作ウェッジを含み、前記カム動作ウェッジのそれぞれが、前記選択されたタイプのステープルカートリッジに適するよう予め選択された高さを有しており、
前記発射装置の前記中間部材が、前記複数のタイプのステープルカートリッジのそれぞれに当接するように構成されていることを特徴とする実施態様(9)に記載の外科器具。
(11)前記発射装置が、前記細長い溝にスライド可能に係合する上面及び下面を有する下側部分を含み、これにより前記アンビルと前記細長い溝との間の長手方向の運動の際に前記アンビルと前記細長いシャフトの間隔を確実に維持できるように構成されていることを特徴とする実施態様(5)に記載の外科器具。
(12)前記発射装置の前記下側部分が、前記細長い溝に当接する上面を有する下側ピン、及び前記細長い溝の反対側に当接する下面を有する中間ピンを含むことを特徴とする実施態様(11)に記載の外科器具。
(13)前記発射装置が更に、前記アンビルに対して長手方向にスライド可能に係合する上面及び下面を有する上側部材を含むことを特徴とする実施態様(12)に記載の外科器具。
(14)前記アンビルが、幅狭垂直スロットを有する内部長手方向スロットを含み、
前記発射装置が、前記幅狭垂直スロット内を移動し、前記アンビルと前記細長い溝との間隔を確実に維持するために前記内部長手方向スロット内に配置された上面及び下面を有する上側部材を含むことを特徴とする実施態様(13)に記載の外科器具。
(15)前記発射装置が、前記アンビルに対して長手方向にスライド可能に対向して係合する上面及び下面を有する上側部材を含み、これにより前記アンビルと前記細長い溝との間の長手方向の運動の際に前記アンビルと前記細長い溝との間隔を確実に維持できるように構成されていることを特徴とする実施態様(5)に記載の外科器具。
(16)前記アンビルが、前記発射装置の前記上側部材の前記下面及び前記上面のそれぞれにスライド可能に当接する上面及び下面を有する長手方向スロットを含むことを特徴とする実施態様(15)に記載の外科器具。
(17)前記長手方向スロットが、幅狭垂直スロットに連通した内部長手方向溝を含み、
前記発射装置が、前記幅狭垂直スロット内を移動し、前記アンビルと前記細長い溝との間隔を確実に維持するために前記内部長手方向スロット内に配置された上面及び下面を有する上側部材を含むことを特徴とする実施態様(16)に記載の外科器具。
(18)外科器具であって、
発射運動及び閉止運動を起こすためのハンドル手段と、
前記閉止運動に応答して組織をクランプするクランプ手段と、
前記発射運動に応答して、前記クランプ手段の垂直方向の間隔を維持し、前記クランプ手段内のクランプされた組織の切断及びステープル止めをするための発射手段と、
前記ハンドル手段に対して前記クランプ手段を関節運動させるように機能的に構成された関節運動機構と、
前記関節運動機構内で曲がり、前記発射運動を長手方向に伝達するための、前記発射手段の基端側に取り付けられた薄い発射ストリップとを含むことを特徴とする外科器具。
(19)前記クランプ手段のアンビルが、内側を向いた細い開口を有する内部長手方向スロットを含み、
前記発射手段が、前記内側を向いた細い開口内を移動し、前記長手方向スロット内に長手方向にスライド可能に係合する上側部材を含むことを特徴とする実施態様(18)に記載の外科器具。
(20)更に、前記閉止運動をエンドエフェクタまで伝達して前記クランプ手段の前記アンビルの先端部及び細長い溝を内側に付勢し、これにより前記ステープルカートリッジの作動の際に前記アンビルと前記細長い溝との間隔を確実に維持するように機能的に構成された閉止部材を含むことを特徴とする実施態様(19)に記載の外科器具。
関節運動していない開いた状態の、ステープル止め及び切断に用いられる内視鏡外科用ステープラの斜視図である。 交換可能なステープルカートリッジの右半分がステープル溝内に配置されている、図1の外科用ステープラの開いたステープル止め組立体の左前方からの斜視図である。 交換可能な完全なステープルカートリッジ及び代替の関節運動していないシャフト構造を示す、図2のステープル止め組立体の組立分解斜視図である。 図2のステープル止め組立体のツーピースナイフ/発射バー(Eビーム)の斜視図である。 図1のステープル止め組立体のステープルカートリッジのウェッジスレッドの斜視図である。 図2のステープル止め組立体の線6‐6に沿って見た左側面図である。 ステープル止め組立体の先端部分が切断され、ステープルカートリッジを含まない、図2の開いたステープル止め組立体の斜視図である。 ステープルカートリッジの内部ステープルドライバ及びツーピースナイフ/発射バーの一部を示す、図2のステープル止め組立体の線8‐8に沿って見た断面図である。 ツーピースナイフとウェッジスレッドの間の中心接触点を示すように図2の線6‐6に沿っているが、ステープルカートリッジ内のステープルドライバ及びステープルを示すために横方向にずらした、図2の閉じたステープル止め組立体の左側断面図である。 ステープルカートリッジの交換では一般的なようにツーピースナイフをやや引き戻した状態の図9のステープル止め組立体の詳細な左側断面図である。 図9に示されている構造に一致した、発射を開始した状態のツーピースナイフを示す、図10のステープル止め組立体の詳細な左側断面図である。 ツーピースナイフ/発射バーが先端側に発射された後の図9の閉じたステープル止め組立体の左側断面図である。 ステープルカートリッジが発射され、ツーピースナイフが引き戻された後の図12の閉じたステープル止め組立体の左側断面図である。 ツーピースナイフがロックアウト位置に進入可能な状態の図13のステープル止め組立体の左側断面図である。 図1の外科用ステープラの関節運動接合部(フレックスネック)の断面図である。 電気活性ポリマー(EAP)プレート関節運動アクチュエータ及び発射バーのためのEAP支持プレートを示す、図15の線16‐16に沿って見た関節運動接合部の断面図である。 関節運動した後の図16の関節運動接合部の断面図である。 図15の関節運動接合部の斜視図である。
符号の説明
10 外科用ステープラ
12 ステープル止め組立体
14 ハンドル
16 細長いシャフト
18 ステープル溝
20 ステープルカートリッジ
22 アンビル
23 ステープル
24 ステープル孔
26 ステープル成形凹部
28 アンビル下面
30 回動ノブ
32 関節運動接合部
34 関節運動制御スイッチ
36 EAPアクチュエータ
40 閉止トリガー
42 ピストルグリップ
44 発射トリガー
46 引き戻しレバー
48 閉止解除ボタン
76 閉止構造
80 馬蹄形開口
90 発射バー
94 ラミネートテーパ発射バー
102 Eビーム
110 上部ピン
112 中間ピン
114 下部脚
118 上部ガイド
120 中間ガイド
126 ウェッジスレッド
130 幅広開口
132 下側トラック
133 幅狭スロット
134 幅広スロット
136 下側突出部
138 上側突出部
144 クリップばね
154 アンビル内部トラック
202 ウェッジスロット
204 ウェッジ
206 ステープルドライバ
214 ステープル成形面
220 ステープルカートリッジトレイ
240 ロックアウト凹部
322、324 支持プレート
326 固定端部
328 スライド端部

Claims (6)

  1. 発射運動を起こすことができるハンドル部分と、前記ハンドル部分の前記発射運動に応答する実施部分を含む外科器具であって、
    前記実施部分が、
    前記ハンドル部分に結合された、溝スロットを含む細長い溝と、
    ステープルを支持するドライバをカム動作で上方に移動できるように整合したウェッジ部材を基端側に備えた、前記細長い溝に受容されたステープルカートリッジと、
    細長い溝に回動可能に結合された、アンビル溝を含むアンビルと、
    前記細長い溝と前記アンビルとの間に長手方向に受容された先端側を向いた刃先、前記アンビル溝に係合可能な上側部材、前記溝スロットに係合する下側部材、前記ステープルカートリッジの前記ウェッジ部材を先端側に移動させて前記ステープルカートリッジを作動させることができる中間部材を含み、長手方向の発射行程の際に前記細長い溝と前記アンビルの両方に係合して、これらの間にステープル成形のための空間を提供する発射装置と、
    前記細長い溝の基端側に結合した関節運動接合部と、
    前記ハンドル部分から前記関節運動接合部を介して前記発射運動を伝達するために前記発射装置の基端側に取り付けられた薄い発射ストリップとを含むことを特徴とする外科器具。
  2. 前記ステープルカートリッジの作動の際に前記発射装置が前記アンビルと前記細長い溝との間隔を確実に維持するように、前記アンビルが、ぞれぞれの先端部で内側に付勢される前記細長い溝に対する回動取付け部を形成することを特徴とする請求項1に記載の外科器具。
  3. 前記ステープルカートリッジが複数のタイプのステープルカートリッジから選択され、前記複数のタイプのステープルカートリッジがそれぞれ、前記アンビルと前記細長い溝との所望の間隔を得るために選択される厚みと、前記所望の間隔に適した長さを有するステープルとによって特徴付けられることを特徴とする請求項1に記載の外科器具。
  4. 前記ウェッジ部材が、複数の連結されたカム動作ウェッジを有するウェッジスレッドを含み、前記カム動作ウェッジのそれぞれが、前記選択されたタイプのステープルカートリッジに適するよう予め選択された高さを有しており、
    前記発射装置の前記中間部材が、前記複数のタイプのステープルカートリッジのそれぞれに当接するように構成されていることを特徴とする請求項3に記載の外科器具。
  5. 外科器具であって、
    発射運動及び閉止運動を起こすことができるハンドル部分と、前記ハンドル部分からの前記発射運動に応答する、直径が内視鏡などの外科手術に適した寸法を有する実施部分とを含む外科器具であって、
    前記実施部分が、
    前記発射運動及び前記閉止運動を別々に伝達することができる前記ハンドル部分に結合されたシャフトと、
    前記シャフトに結合された、溝スロットを含む細長い溝と、
    アンビル溝を含み、前記シャフトからの前記閉止運動に応答する、前記細長い溝に回動可能に結合されたアンビルと、
    前記細長い溝と前記アンビルとの間に長手方向に受容された先端側を向いた刃先、前記細長い溝にスライド可能に係合する下側部分、及び発射の際に前記アンビルにスライド可能に係合するように配置された上側部分を含み、前記細長い溝と前記アンビルとの間隔を維持するように前記細長い溝及び前記アンビルに係合する発射装置と、
    前記発射装置の基端側に取り付けられた、前記発射運動を前記発射装置に伝達できる薄いストリップとを含むことを特徴とする外科器具。
  6. 外科器具であって、
    発射運動及び閉止運動を起こすためのハンドル手段と、
    前記閉止運動に応答して組織をクランプするクランプ手段と、
    前記発射運動に応答して、前記クランプ手段の垂直方向の間隔を維持し、前記クランプ手段内のクランプされた組織の切断及びステープル止めをするための発射手段と、
    前記ハンドル手段に対して前記クランプ手段を関節運動させるように機能的に構成された関節運動機構と、
    前記関節運動機構内で曲がり、前記発射運動を長手方向に伝達するための、前記発射手段の基端側に取り付けられた薄い発射ストリップとを含むことを特徴とする外科器具。

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