JP4267915B2 - 全層切除装置の切除処理におけるステープリングおよびカッティング - Google Patents
全層切除装置の切除処理におけるステープリングおよびカッティング Download PDFInfo
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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
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
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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
- A61B17/068—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
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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
- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
- A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
- A61B17/320783—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions through side-hole, e.g. sliding or rotating cutter inside catheter
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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
- A61B17/068—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
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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
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07221—Stapler heads curved
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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
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B2017/32004—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes having a laterally movable cutting member at its most distal end which remains within the contours of said end
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Description
(発明の分野)
本発明は、組織をステープリングする装置および方法、より詳細には、体腔内の組織を把持、ステープリングおよび切除するための装置および方法に関する。
【0002】
(発明の背景)
体腔を包囲する組織が、癌または他の疾病に犯された場合、しばしば分析または除去するために病変組織を切除する必要がある。従来の組織除去装置や方法は、患部に達するために切開手術を必要とすることも多々ある。
【0003】
さらに、管腔組織切除装置は周知であり、例えば、ソラー(Solar )他に付与された米国特許第5947983号は全文が本明細書に援用される。切除装置の多くは切除後の傷口を閉じるために縫合に頼る。しかしながら、身体の外側からの縫合処理が非常に困難なため、このような装置は一般に扱い難いとされてきた。
【0004】
(発明の簡単な概要)
本発明は、体腔内の所定位置まで内視鏡に沿って前進する第1ケーシングからなる内視鏡ステープリングシステムに使用されるステープリングユニットに関するものであり、同第1ケーシングは、先端部、基端部および第1ケーシングの外周面を貫通する第1ウインドウに近接して装着されたステープリング装置を有する。
【0005】
(発明の詳細な説明)
本発明は、切開手術に頼ることなく体腔内の組織のステープリングおよび除去を行い、体腔からステープリングおよび除去するために必要な組織の識別を行うものである。本装置は、正確に位置を限定して組織をステープリングし、かつ、ステープルラインより下で組織を切除することを可能にする。体腔壁の全層部分が、器官からの出血や漏れを最小限に抑えまたは排除して、迅速かつ簡潔に摘出される。
【0006】
図1A乃至1Dは本発明による装置を示す。図1Aおよび1Bに示されるように、ステープリングユニット1は、内視鏡3、制御ユニット8およびシャフト210から成る内視鏡ステープリングシステム200の一部である。本発明と共に使用される内視鏡3は、体腔4の内部5を即時に観察するために、胃鏡(ガストロスコープ)あるいは端部観察用(end-viewing )内視鏡2であることが望ましい。ステープリングユニット1は、最初に体腔4に挿入され、内視鏡3を使って組織部分7の位置を視覚的に決めることにより、ステープルすべき組織に近接して配置される。次に、ステープリングユニットは、内視鏡3に沿って先端に向かい組織部分7に対して所望の箇所へ進む。ステープリングユニット1は、使用中は体外に配置される制御ユニット8を通して遠隔操作できる。
【0007】
図1Bは、例えば咬合処理において使用可能な一実施形態におけるステープリングユニット1の詳細を示す。ステープリングユニット1は、例えば部分的な管状部材11として形成される第1ケーシング10からなる。ステープリングユニット1は先端部15に形成されたウインドウ20を有する。同ウインドウ20により、ユニット1の内方16がユニット1の外方17から確認される。ステープリング装置50はウインドウ20に近接するユニット1に装着されている。端部観察用内視鏡2がステープルすべき組織部分7の位置を発見するために使用され、ステープリングユニット1がその発見した位置に配置されて、その後も同位置に留まると仮定する。すると、操作者はウインドウ20を通してステープリングユニット1の内方から体腔4の内部5までを確認することによって、組織部分7において処理が完了することを引き続き観察できる。図1Cおよび1Dはステープリングユニット1の各構成要素を詳述している。ウインドウ20は任意で、例えば長方形などの変化した周縁形状を有する。ウインドウ20の一縁部26はアンビル12を形成する。ステープリング装置50は移動可能なステープルヘッド52を有し、同ヘッドは、ステープリング装置50が第1ケーシング10に装着されると、アンビル12に対向するステープル発射縁部54を形成する。
【0008】
第1実施形態における構成要素の方向性および動作は図2Aに示されている。ステープルヘッド52は第1ケーシング10内に回転可能に配置されることにより、第1位置においてステープル発射縁部54はアンビル12に近接する。ステープリングユニット1は、例えば、第1ケーシング10の長手軸14とほぼ平行な軸線を中心に回転する。次に、ステープルヘッド52は、第1ケーシング10に対して第2位置まで回転する。
【0009】
構成要素の別の方向性および動作は、図2Bに示される本発明による装置の第2実施形態において示される。第2実施形態において、ステープルヘッド52’は、第1ケーシング10’内においての長手方向に移動可能に配置されることで、第1位置にてステープル発射縁部54’がアンビル12’に近接する。ステープリングユニット1は長手方向、例えば第1ケーシング10’の長手軸14’にほぼ平行な軸線に沿って移動する。次に、ステープルヘッド52’は、第1ケーシング10の長手方向において第2位置まで移動する。
【0010】
本発明による装置の第1実施形態における構成要素の方向性および動作に戻る。図3A乃至3Cに示されるように、ステープリング装置50は、ステープルヘッド52が第1ケーシング10に対して移動可能に連結され、ウインドウ20の一部を覆うように配置される。ウインドウ20において覆われる部分24の寸法は、ステープラ後退位置(図3Aに詳述)とステープラ係合位置(図3Bおよび3Cに詳述)との間において、ステープルヘッド52が第1ケーシング10に対して移動したか否かにしたがって変化する。ステープルヘッド52がステープラ後退位置にあるときは、ステープルヘッド52はウインドウ20のより小さい部分22を覆い、ステープルすべき組織部分7をウインドウ20の中に引き込むためのスペースを作る。ステープルヘッド52がステープリング位置に移動したときは、ステープルヘッド52はウインドウ20のより大きい部分23を覆い、ウインドウ20において受容された組織部分7をステープル発射縁部54とアンビル12との間で把持する。
【0011】
図3Bに示されるように、ステープルヘッド52がステープリング位置にあるとき、ステープル発射縁部54とアンビル12との間の距離は、所定のステープリング距離、即ち厚さ63である。ステープリング装置50は、制御ユニット8を使って操作される位置調整機構27(図1A)を備えるため、ステープル(図示せず)がステープル発射縁部54から組織7を経てアンビル12に向かって発射される前に、所定のステープリング距離63を調整することができる。ステープリングユニット1はまた、制御ユニット8を使って操作され、かつステープリング装置50とユニット1の基端部19との間に連結されるステープリング作動機構28(図1B)を備えること。したがって、ステープルヘッド52を作動させてステープル(図示せず)をステープル発射縁部54から組織7を経て、アンビル12に向かって発射させ、ステープル発射縁部54とアンビル12との間に把持された組織部分7をステープルすることができる。
【0012】
図4に示される第3実施形態ではステープリング装置50’’が第2ケーシング70上に装着されていることを除けば、第1実施形態に類似している。第2ケーシング70は、例えば、部分的に管状部材71でもよく、その先端部において形成されるウインドウ80を有する。ウインドウ80は、第2ケーシング70と第1ケーシング10’’とが互いに整合する所定の整合位置にあって、ステープリングユニット1’’の内部16’’からステープリングユニット1’’の外部17’’にかけて開口部を形成するとき、第1ケーシング10’’のウインドウ20’’に対向する。ステープル発射縁部54’’はウインドウ80の縁部84上に位置し、かつ、ウインドウ20’’の対峙する縁部26’’上に形成されるアンビル12’’に対向する。よって、ステープルヘッド52’’のステープラ後退位置からステープリング位置への移動が第2ケーシング70の先端部75の移動に変換され、ウインドウ20’’およびウインドウ80の所定の整合関係が変化することにより、ステープル発射縁部54’’がアンビル12’’に向かう方向77へ移動する。
【0013】
図5Aおよび5Bに示される第4実施形態において、ステープリングユニット1’’’が組織カッター90を備えていることを除けば、第1実施形態に類似している。組織カッター90は、例えば、ステープリングユニット1’’’を全層切除処理に使用でき、同処理中にステープルラインより下の組織部分を体腔4から検査用に切断および除去する。
【0014】
第4実施形態における構成要素の方向性および動作は図6Aに示される。切刃94は第1ケーシング10’’’内に回転可能に配置されて、第1位置において切刃94は第1ケーシング10’’’の長手軸14’’’とほぼ平行なウインドウ20’’’の側面25に近接する。組織カッター90は、例えば第1ケーシング10’’’の長手軸14’’’にほぼ平行な軸線を中心に回転する。次に、切刃94はステープル装置50’’’とアンビル12との間に把持された組織を切断すべく第1ケーシング10’’’に対して相対回転する。
【0015】
構成要素の別の方向性および動作は、図6Bに示される本発明による装置の第5実施形態において示される。第5実施形態において、組織カッター90’’’’が第1ケーシング10’’’’内において長手方向に移動可能に配置されることで、第1位置において切刃94’’’’は第1ケーシング10’’’’の外周18’’’’にほぼ平行なウインドウ20’’’’の側面25に近接する。組織カッター90’’’’が、第1ケーシング10’’’’およびにステープリング装置50’’’’に対して、第1ケーシング10’’’’の長手軸14’’’’に沿って軸線方向に移動すると、切刃94’’’’は、ステープル装置とアンビルによって把持された組織を切除する。
【0016】
本発明の第4実施形態における構成要素の方向性および動作に戻る。図7A乃至7Cに示されるように、組織カッター90は、ウインドウ20’’’に近接してステープリング装置50’’’および第1ケーシング10’’’に対して相対移動可能に設置される。組織カッター90は後退位置(図7A)と組織切断位置(図7B)との間を移動可能であり、後退位置では組織カッター90はウインドウ20’’’から引き下げられ、組織切断位置では組織カッター90は切除すべき組織部分9に係合される。組織カッター90は切刃94を備え、切刃94は、その第1部分が第2部分に先立って切除すべき組織部分9に接触するように角度をつけられている。すなわち、切刃94は、望ましくは角度のついた刃として形成される。
【0017】
組織部分が切除されると、組織カッター90は、第1ウインドウ20’’’を完全に覆いかつ切除した組織部分を第1ケーシング10’’’内に収納して、カッター完了位置(図7C)に移動する。組織カッター90が収納されると、ステープリングユニット1’’’は体腔4’’’から離れて、切除した組織部分を検査用に取り出すために開く。したがって、本発明による組織カッター90は、操作者が体腔から清浄な組織サンプルを取り出すことを可能にする。
【0018】
組織カッター90の動きは、ユニット1の基端部19と組織カッター90との間に連結されたカッティング駆動機構99(図1A)によって制御され、かつ制御ユニット8を介して遠隔操作される。組織カッター90はまた、操作者が全てのステープルが正しく発射されたことを確認するまでは組織カッター90の係合を防止する安全手段を有する。
【0019】
図8に示される第6実施形態は組織カッター90’’’’’が第3ケーシング11 0上に装着されていることを除けば、第4実施形態に類似している。第3ケーシング110は、例えば、部分的に管状の部材111であってもよく、その先端部115において形成されるウインドウ120を有する。ウインドウ120は、第3ケーシング110、ステープリング装置50’’’’’および第1ケーシング10’’’’’が互いに所定の配置にあって、ステープリングユニット1’’’’’の内側16’’’’’からステープリングユニット1’’’’’の外側17’’’’’にかけて開口部を形成するとき、第1ケーシング10’’’’’のウインドウ20’’’’’に対向する。切刃94’’’’’はウインドウ120の縁部124に近接して配置され、切刃94’’’’’は図5Aおよび7Bに示されるように、その第1部分97’’’’’が第2部分98’’’’’に先立って切除すべき組織に接触するように角度をつけられている。組織カッター90’’’’’の後退位置から組織カッティング位置までの回転運動が、第3ケーシング110の先端部115の回転運動に変換されることで、ウインドウ20’’’’’およびウインドウ120間の所定の整合関係が変化し、方向117において切刃94’’’’’が第1ケーシング10’’’’’上のウインドウ20’’’’’の対峙する縁部21’’’’’に向かって移動する。
【0020】
図9において示される第7実施形態では、ステープリングユニット1’’’’’’は、上述した実施形態と同様の機能を果たすが、同ユニット1の内側16’’’’’’から外側17’’’’’’にかけて開口部124’’’’’’を形成するウインドウ20’’’’’’、ウインドウ80’’’’’’およびウインドウ120’’’’’’をそれぞれ有する3つの同心管11’’’’’’、71’’’’’’および111’’’’’’からなる。第1管11’’’’’’上のウインドウ20’’’’’’の縁部26’’’’’’はアンビル12’’’’’’を形成する。ステープリング装置50’’’’’’は、第1管11’’’’’’内に移動可能にはめ込まれた第2管71’’’’’’に装着され、第2管71’’’’’’のウインドウ80’’’’’’上の縁部84’’’’’’は、アンビル12’’’’’’に対向するステープル発射縁部54’’’’’’を形成する。組織カッター90’’’’’’は、第2管71’’’’’’および第1管11’’’’’’内に移動可能にはめ込まれた第3 管111’’’’’’に装着され、第3管111’’’’’’上のウインドウ120’’’’’’の縁部124’’’’’’は、切刃94’’’’’’を形成する。
【0021】
本発明のいずれの実施形態も、任意にステープリングユニット1内に組織把持具60(図1B)を備えてもよく、ステープリング装置50および組織カッター90が後退位置に引き下げられたときに、ステープルすべき組織部分7および切断すべき組織部分がウインドウ20からステープリングユニット1の内側16まで引き込まれる。先行技術において周知なように、組織把持具60は組織部分7を例えば1対の把持部61で掴み、その一方で吸引管(図示せず)が、ウインドウ20内に負圧を生じさせて組織7をウインドウ20から吸引する。代わりに、装置を介して吸引を行い、ステープルすべき組織部分7および切断すべき組織部分9をウインドウ20からステープリングユニット1の内側16まで引き込んでもよい。
【0022】
本発明は、体腔内から病変組織を低侵襲的に把持して、ステープルし、かつ除去するための装置および方法を提供する。当業者には本願に記載した実施形態の様々な変更が認識される。そのような変更は、添付のクレームの内容および範囲に包含されることを意図する。
【図面の簡単な説明】
【図1A】本発明による装置の第1実施形態を示す図。
【図1B】図1Aと同様に第1実施形態を示す図。
【図1C】図1Aと同様に第1実施形態を示す図。
【図1D】図1Aと同様に第1実施形態を示す図。
【図2A】図1Aと同様に第1実施形態を示す図であって、構成要素は互いに回転移動する。
【図2B】本発明の第2実施形態の示す図であって、構成要素は互いに垂直移動する。
【図3A】ステープラ後退位置にあるステープリング装置を示す図。
【図3B】ステープラ係合位置にあるステープリング装置を示す図。
【図3C】ステープラ係合位置にあるステープリング装置を示す図。
【図4】本発明による装置の第3実施形態を示す図。
【図5A】本発明による装置の第4実施形態を示す図。
【図5B】図5Aと同様に第4実施形態を示す図。
【図6A】図5Aと同様に第4実施形態を示す図であって、構成要素は互いに回転移動する。
【図6B】本発明の第5実施形態の配置を示す図であって、構成要素は互いに垂直移動する。
【図7A】カッター後退位置における組織カッターを示す図。
【図7B】カッター係合位置における組織カッターを示す図。
【図7C】カッター完了位置における組織カッターを示す図。
【図8】本発明による装置の第6実施形態を示す図。
【図9】本発明による装置の第7実施形態を示す図。
Claims (16)
- 体腔内で組織をステープリングするための装置であって、
基端部から先端部へ延在する第1のチューブと、操作位置において先端部はステープルすべき組織部分に近接して体腔内に配置されることと、同第1のチューブは先端部の内側へ延在する第1ウインドウを有することと、同第1ウインドウの少なくとも一方の側縁はアンビルを形成することと、
先端部内において回動可能に装着され、同アンビルと協働して組織をステープリングするステープリング機構と、同ステープリング機構は、ステープルすべき組織部分を第1ウインドウを介して第1のチューブ内へ引き込むための組織引込機構とを備えることと、
ステープリング機構の回動量によって決定されるウインドウの開口量を変えるべく第1のチューブに対してステープリング機構を相対移動させるために、第1のチューブとステープリング機構との間に連結された位置調整機構とからなる装置。 - 前記組織引込機構は、吸引による組織引込機構を含む請求項1に記載の装置。
- ステープリング機構がステープラ後退位置からステープラ係合位置まで移動するとき、第1ウインドウの第1部分が増加する請求項1に記載の装置。
- ステープリング機構が第1のチューブの長手軸に沿って第1のチューブに対して相対移動する請求項1に記載の装置。
- ステープリング機構が第1のチューブの長手軸を中心として第1のチューブに対して相対回転する請求項1に記載の装置。
- ステープリング機構が第1のチューブ内に配置された少なくとも部分的に筒状をなす第1筒状部材上に装着され、同第1筒状部材は同第1筒状部材から延びる第2ウインドウを有し、ステープリング機構と第1のチューブが所定の第1の整合位置にあるとき、第2ウインドウは第1筒状部材の内部から第1のチューブの外部に延びる開口部を形成する第1ウインドウに対向する請求項1に記載の装置。
- 第2ウインドウがアンビルに対向するステープル発射縁部を有する請求項6に記載の装置。
- 第1のチューブ内に移動可能に装着された組織カッターを有する請求項6に記載の装置。
- カッター後退位置とカッター係合位置との間において、第1のチューブに対して組織カッターを移動させるために、装置の基端部と組織カッターとの間に連結された切断駆動機構を有し、装置使用中においては装置の基縁部は患者の体外に留まる請求項8に記載の装置。
- 組織カッターがカッター後退位置からカッター係合位置へ移動するとき、組織カッターに覆われる第1ウインドウの第2部分の量が増す請求項9に記載の装置。
- 第1ウインドウ内に受容された組織を切除するために、組織カッターがカッター係合位置からカッター完了位置まで移動するとき、第1ウインドウ全体が覆われる請求項10に記載の装置。
- 第1のチューブの長手軸に沿って第1のチューブに対して相対移動することによって、切断作動機構が第1ウインドウの第2部分を覆う請求項11に記載の装置。
- 第1のチューブの長手軸を中心として第1のチューブに対して相対回転することによって、切断作動機構が第1ウインドウの第2部分を覆う請求項11に記載の装置。
- 組織カッターが第1のチューブと、同第1筒状部材内に配置されている少なくとも部分的に筒状の第2筒状部材上に装着され、同第2筒状部材は同第2筒状部材から延びる第3ウインドウを有し、組織カッター、第1筒状部材および第1のチューブが互いに整合する所定の第2整合位置にあるとき、第3ウインドウは第2筒状部材の内方から第1のチューブの外方に延びるカッター開口部を形成すべく第1ウインドウおよび 第2ウインドウに対向する請求項13に記載の装置。
- 第3ウインドウが少なくとも一つの切刃を有する請求項14に記載の装置。
- 切刃の第1部分が切刃の第2部分より先に切断される組織部分に接触するように、切刃に角度がつけられている請求項15に記載の装置。
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US09/727,051 US6398795B1 (en) | 2000-11-30 | 2000-11-30 | Stapling and cutting in resectioning for full thickness resection devices |
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JP2004514497A JP2004514497A (ja) | 2004-05-20 |
JP4267915B2 true JP4267915B2 (ja) | 2009-05-27 |
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JP2002545580A Expired - Fee Related JP4267915B2 (ja) | 2000-11-30 | 2001-10-05 | 全層切除装置の切除処理におけるステープリングおよびカッティング |
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US (5) | US6398795B1 (ja) |
EP (1) | EP1337187B1 (ja) |
JP (1) | JP4267915B2 (ja) |
AU (2) | AU2001296783B2 (ja) |
CA (1) | CA2429706C (ja) |
DE (1) | DE60129834T2 (ja) |
WO (1) | WO2002043596A1 (ja) |
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- 2001-10-05 JP JP2002545580A patent/JP4267915B2/ja not_active Expired - Fee Related
- 2001-10-05 WO PCT/US2001/031683 patent/WO2002043596A1/en active IP Right Grant
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- 2001-10-05 EP EP01977683A patent/EP1337187B1/en not_active Expired - Lifetime
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