JP4310509B2 - 吻合、ステープル、および切除器械とともに使用するための電気機械駆動機構装置 - Google Patents
吻合、ステープル、および切除器械とともに使用するための電気機械駆動機構装置 Download PDFInfo
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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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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
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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
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00039—Electric or electromagnetic phenomena other than conductivity, e.g. capacity, inductivity, Hall effect
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
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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
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/003—Steerable
- A61B2017/00318—Steering mechanisms
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- A—HUMAN NECESSITIES
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- A61B2017/00464—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable for use with different instruments
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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
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
- A61B2017/00473—Distal part, e.g. tip or head
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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
- A61B2017/07278—Stapler heads characterised by its sled or its staple holder
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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
- A61B2017/2901—Details of shaft
- A61B2017/2905—Details of shaft flexible
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Description
【発明の属する技術分野】
本発明は、概して、吻合手術用道具、ステープル手術用道具、および切除用道具と共に使用するための電気機械装置に関し、さらに特定すると、それにより吻合道具、ステープル道具、および切除道具などの手術用器械を遠隔で作動してよい電気機械装置に関する。
【0002】
【従来の技術】
胃腸管での癌性の組織、およびその他の異常組織の特定時、多くの場合、外科手術的な介入が処方される。癌手術およびさらに特定すると、癌性組織を含む胃腸管の部分を切除する外科手術的な処置は、数多くの独特に設計された器具を含む。本発明の計装およびそれらの機能に関する記述と組み合わされ、この外科手術的な処置の最先端の記述も提供されるものとする。
【0003】
胃腸管の癌の治療方法を決定する際に応えられなければならない第1の質問とは、癌性の組織の特定の場所に関係する。これは、現在の技術で提供されている器械が、それらがどの程度深くまで胃腸管の中に差し込まれてよいのかに関する制限を有する限り非常に重要である。癌性の組織が胃腸管の上部または下部に行きすぎた場合には、提供される標準的な計装は使用不可能であり、このようにして特殊な設備を必要とする。これらの設備は概して、腸の内容物による取り囲む組織の汚染のリスクを高め、手術の長さおよび麻酔に対する対応する必要性を増し、機械化された装置を活用することから生じる正確な吻合およびステープル留めの利点を排除する。
【0004】
さらに具体的には、癌性の組織が、本計装が接触できる腸内の位置に位置する場合、腸を露呈するために患者の胃が最初に開かれる。それから、外科医は、線形カッター、および癌性組織のどちらかの側にある結腸の管を切断し、それにより腸の2つのステープルで留められた端部(肛門に向けられる末端部および小腸に最も近い近端部)を作成するステープル装置を活用する。これは、汚染を一時的に最小限に抑えるために実行される。
【0005】
さらに特定すると、図1を参照して、腸は、線形ステープル器械10の先端にある鋏要素12、14の間に置かれる。装置のハンドル18でのトリガ16を握り締めることによって、外科医は、鋏要素12、14をいっしょにさせる。それから、第2トリガ(または同じトリガの二次的な動作)が作動され、一連のステープル20を、結腸の固定された端部を通して動かし、それにより端部を閉じ、端部を横に切開する。
【0006】
それから、外科医は、近端部を部分的に開き、吻合ステープル器械の取外し可能なアンビル部分を、露呈された近端部に挿入する。外科的な処置の残りのステップだけではなくこのステップも、この手術用の器械の機能に関する。さらに特定すると、および図2に関して、外科医は、器械30を取り、反対側の端部にあるアンビルヘッド36を前方に進ませるハンドル34の基部にあるダイヤル32を手で回すことにより開始する。外科医は、アンビルヘッド36がその最も極端に引き伸ばされた位置に進むまでダイヤル32を回し続ける。この手による回転には、ほぼ30回の完全な回転が必要とされる。
【0007】
いったん完全に引き伸ばされると、器械のアンビルヘッドはそこから切り離され、連結ポストがそこを通って外向きに伸びるように近端部の部分的な開口部の中に差し込まれる。近端部のこの部分的な開口部はそれから縫合され、閉じられる。それから、吻合およびステープル器械30の伸張する軸38は、その結合幹部40がステープルで留められる遠端部を通って伸張するまで、下部結腸の中に差し込まれ、経肛門的腫瘍摘出術が進められる。それから、外科医は、アンビルの結合端部と軸をまとめて接合し、ハンドル内のダイヤルをもう一度手で回転し始め、このときアンビルヘッドは軸の端部42により近くなる。
【0008】
いったんアンビルヘッドおよび軸が近くなると、外科医がダイヤルをさらに30回、手で回転した後に、ハンドルのグリップスタイルトリガ44が手で作動される。この作動により、円形の刃46は軸の先端部の中から軸に沿って進み、アンビル36の反対側の面48に接触するようになる。刃は、結腸の近端部および末端部のステープルで留められ、閉じられた端部を切り通し、それにより結腸の近端部と末端部の新しい組も切断する。切断された組織は、軸の端部の内部空間内に保持される。
【0009】
切断によるロックステップでは、新しく開放された端部が、軸の先端部の周縁部の穴を通して進められてきた(アンビルの反対側の面に押し付けられ、それにより閉じられる)一連のステープル50によってともに接合される。それから、結合された軸とアンビルは患者から引き出される。
【0010】
図1に示されている従来の技術の線形ステープル器械10の構造上の形状構成に関してさらに特定すると、装置は、細長い軸19および遠端部20を有するピストルグリップスタイルの構造18を備える。末端部は、閉じられた結腸の開放端部を固定する1組の鋏様式グリップ要素12、14を含む。事実上、2つの鋏様式グリップ要素の1つだけ、つまり上部ジョー部分12は、全体的な構造を基準として移動する(枢動する)。その他は固定されたままである。この鋏手段の作動(上部ジョー部分12の枢動)は、ハンドル内に維持されるグリップトリガ16によって制御される。数多くの異なる手段が、スナップ、クリップ、カラーらを含む、閉じられている鋏アームの先端を保持するために開示されていた。
【0011】
鋏手段に加えて、末端部は、ステープル機構も含む。鋏機構の非移動下部ジョー14は、ステープルカートリッジ受取り区域、およびアンビル部分に逆らってステープル20を結腸の固定された端部を通して上に動かし、それにより過去に開かれた端部を密封するための機構を含む。鋏要素は、軸と一体化して形成されてよいか、あるいは多様な鋏要素およびステープル要素が交換可能であるように着脱自在であってよい。
【0012】
図2に示される従来の技術の吻合およびステープル器械の構造上の形状構成に関してさらに特定すると、装置は、アンビル部分36、ステープル、刃と貯蔵器部分42、軸部分38およびハンドル部分34を備える。軸の先端から選択的に取り外すことができるアンビル部分36は、鈍い鼻部を有する上部、底部の平らな切断支持面48、および底部表面から軸に沿って伸張する連結ポスト41を有するカプセル形をしている。
【0013】
器械のステープル、刃、および貯蔵器部分42(SBR部分)は、器械の末端部に提供され、アンビル部分をその上で選択的に受け取るための、選択的に進めることが可能、かつ引っ込めることが可能な結合幹部40を含む。結合幹部のこの動作は、ねじ込まれた軸および(さらに完全に後述される)ハンドル34に取り付けられているウォーム機構によって提供される。SBR部分は形状が円筒形であり、中空の内部を有するハウジングを形成する。貯蔵器47を形成するのがこの中空の内部である。刃46は、同様に円筒形であり、その内壁に接してハウジングの内部にぴったり嵌る。
【0014】
刃は、ハンドルのトリガ44機構の作動に従って(再び、さらに完全に後述される)ハウジングから外向きに軸に沿って選択的に進めることができる。ハウジングの円筒形の壁の軸に沿って外向きに向く面上には、一連のステープルポートがあり、それを通って装置のステープル50が放出される。刃を前方に駆動する同じ作動は、同様にして、円筒形の壁の中で一連のステープル駆動機構を前方に駆動する。さらに正確には、ステープル駆動機構は、その軸に沿った端部での一連の突起を有する円筒形の構成部品であり、該突起は、ステープルおよび穴の配分に従って配置される。放出に先だってに、ステープルは穴の中に取り付けられ、ステープル駆動機構およびその突起の動作によって穴の中を進められる。
【0015】
器械の軸部分38は、1組の細長いロッド用の鎧装として意図される簡略な硬い伸張した構造である。第1ロッドは、前記に紹介され、ハンドル部分に関してさらに完全に後述されたウォーム機構に結合され、アンビル部分およびSBR部分の結合幹部を選択的に進め、引っ込める手段である。第2ロッドは、(やはり前記に紹介され、さらに完全に後述される)一方の端部でハンドルのトリガ44に、および他方の端部で刃46およびステープル駆動機構45に結合される。
【0016】
鎧装は、それが結腸の中に経肛門的腫瘍摘出術が進められるときに、患者および計器を保護する。しかしながら、作動機構の性質は、軸が堅いことを必要とする。この剛性が軸38の長さ、および組み合わせ、つまり器械の長さと剛性を制限し、これらの形状構成は、この装置を使用して治療されてよい結腸の部分を制限する。
【0017】
従来の技術によるこの器械のハンドル34は、蝶番(つまり、ハンドルが軸部分の接合部に向かい合う端部)に回転ダイヤル32、および指で作動されるトリガ44を有するピストルグリップスタイルの構造を備える。トリガは、緩衝位置から出ない限り、物理的に作動を防止する安全機構を含む。回転ダイヤル32は、軸部分の第1ロッドを進め(それにより、結合幹部およびアンビル36を進め)るために使用されるウォーム機構にすぐ作動自在に結合される。トリガは、第2ロッドを軸内で前方に押し進めるための基本的なレバーとして機能し、それにより刃46およびステープル駆動機構45を前進させる。
【0018】
従来の技術の多くのこのような装置でのように、これらの装置のすべてが完全に配置可能であると見なされ、事実上、1回だけ使用された後に投棄される。それらは、複数の移動パーツを有し、多大な構造上の完全性、それゆえ製造上の費用を必要とする複雑な装置である。それらが一度だけしか使用されず、どのパーツも再び使用できないという事実が、このような装置の使用を高価にし、資源を無駄使いさせる。
【0019】
この失敗に加え、前記記述から容易に認めることができるように、従来の技術による装置は、克服することが望ましいだろう多数のそれ以外の制約を被る。これらは、(吻合およびステープル器械のダイヤルとトリガ、および切断とステープル器械の複数のトリガに関連付けられた機能を含む)外科医が多くの異なる機能を手作業で作動するという要件だけではなく、(このような装置によって治療されてよい胃腸管の部分を制限する)吻合およびステープル器械の堅い、限られた長さの軸も含む。
【0020】
【発明が解決しようとする課題】
したがって、その部分の再利用を可能とすることによって、資源の無駄を削減する、結腸手術で使用するための、切断、吻合およびステープルで留めるための器械を提供することは本発明の主な目的である。
【0021】
それが使用されてよい胃腸管の区域を増やす器械を提供することも、本発明の主な目的である。
【0022】
相応じて、可撓軸構成部品を有する胃腸管手術器械アセンブリを提供することは、本発明の目的である。
【0023】
外科医が手作業でさまざまな構成部品および機構を作動する要件を削減する器械アセンブリを提供することは、本発明の追加の目的である。
【0024】
本発明のその他の目的は、後述されるその記述に従って、および残りの図と関連して好ましい実施形態の詳細な記述に認識されるものとする。
【0025】
【発明の要約】
本発明の前記目的は、線形ステープル付属装置と吻合ステープル付属装置の両方を結合し、作動する電気機械駆動機構アセンブリによって提供される。前述された従来の技術による機械の両方とも類似する二重動作を有することは、目先のきく読者によって認識されてよい。さらに特定すると、線形ステープル機械は、最初に固定してから、ステープルで留め、実質的には固定動作である、吻合ステープル計器はアンビル部分を前進させ、引っ込め、それから刃およびステープルを前方へ動かす。したがって、それぞれの機能を作動するために使用できる単一共通駆動機構アセンブリを構築することが可能であり、その結果、異なる機能は、装置全体に対してではなく、付属装置だけに特殊であってよい。
【0026】
さらに特定すると、本発明は、(1)電気機械駆動機構、(2)線形固定ステープル付属装置、および(3)吻合ステープル付属装置である3つの構成部品を備え、後者の2つの付属装置は、駆動機構構成部品と接合する1つの共通の設計された連結インターフェースを有する。しかしながら、その他の付属装置も使用されることが予想される。
【0027】
第1に、電気機械駆動機構に関して、駆動機構はハンドルおよび可撓駆動軸を有する。ハンドルは、それぞれが(これ以降にさらに詳細に記述される)別々の可撓駆動軸を回転する、少なくとも1つ、および好ましくは2つの別々のモータに独立して結合される、1つまたは複数の、および好ましくは2つのフィンガトリガを有するピストルグリップスタイルの設計を有する。モータは、それぞれ二重方向モータであり、ハンドル上部に取り付けられる手動駆動スイッチに結合され、それにより、ユーザは、それぞれのモータの回転方向を選択的に改変することができる。
【0028】
この二重方向容量は、電流の方向に対応する方向で回転するモータを選択することによって最も簡略に達成されてよく、駆動スイッチの作動が相応して電流の方向を改変する。この例では、モータに供給する電源は、電池パック(および最も望ましくは、再充電可能な電池パック)などの直流ソースでなければならない。装置が交流で使用可能でなければならない場合には、変圧器を含むことができるか、あるいはさらに精密な中間ギヤアセンブリを提供してよいかのどちらかである。本発明と関連して、記述される本発明の実施形態は、直流を提供する再充電可能な電池パックを活用する。
【0029】
モータ構成部品に加えて、ハンドルは、さらに(1)リモートステータスインジケータ、(2)軸ステアリング手段、および(3)少なくとも1つの追加電気供給を含む、いくつかのその他の機能を含む。最初に、リモートステータスインジケータは、ユーザが構成部品の位置に関する知識(例えば、固定要素が、ステープルの駆動の前に適切な位置にあるかどうか)をそれによって獲得してよいLCD(または類似する読出し装置)を備えてよい。
【0030】
第2に、ハンドルは、可撓軸の(下記にさらに完全に後述される軸部分に埋め込まれるガイドワイヤによって)移動を向けるための、例えば、ジョイスティックまたはトラックボールなどの手動で作動可能なステアリング手段も含む。最後に、ハンドルは、追加電源、および電力を付属装置に選択的に供給するためのオンオフスイッチを含む。
【0031】
可撓軸に関してさらに特定すると、軸は、好ましくは、組織互換性があり、滅菌可能である(つまり、加圧減菌器に耐えるほど十分に堅牢である)簡略なエラストマ材から形成される管状の鎧装を備える。この軸の多様な長さは、本発明と関連して提供されてよい。この場合、可撓軸およびハンドル部分は分離できなければならない。分離可能な場合、軸の近端部とハンドルの末端部間の界面は、駆動構成部品用の結合手段を含まなければならない。
【0032】
特に、軸の駆動構成部品に関しては、それぞれが、管の中で回転できる可撓駆動軸を含む1組の小さい方の固定された管が、エラストマ鎧装内にある。可撓駆動軸自体は、外科医が、患者の結腸を通って「くねくね進む」のに必要と見なすにつれて、曲げる、傾斜させる、曲げる等に十分なほど依然として可撓である一方、ただハンドル内のモータから軸の末端部にトルクを中継できなければならない。例えば、駆動軸は、織られた鋼ファイバケーブルを備えてよい。他の駆動軸がこの目的にとって適切であってよいことが認識されるものとする。
【0033】
しかしながら、(さらに詳しく後述されるように)駆動軸の末端部が、本発明の固定ステープル装置などの付属装置と結合するために、駆動軸の末端部は、トルクの続行する中継を可能とする構造を有さなければならない。例えば、駆動軸の末端部は六角であり、それにより付属装置の連結インターフェース内の六角凹部に嵌ってよい。適切なギヤ機構が、適切なトルクが付属装置に提供されることを確実にするために、軸の末端部に、あるいは付属装置の界面部分内に備えられてよい。
【0034】
前述されたように、ハンドルに取り付けられる相互に作動可能なステアリング手段に関連して、鎧装は、さらに、可撓であるが、その末端部近くの鎧装の内面に結合される少なくとも2本のガイドワイヤを含む。ガイドワイヤは、ステアリング手段の作動により互いを基準にして軸に沿って並進されてよく、その動作により鎧装は相応して曲がり、カーブする。
【0035】
また、前記に示唆されるように、ハンドルのLCDインジケータと関連して、軸は、さらに、付属装置に結合するための電気導線も含む。該電気導線は、付属装置のステータス(例えば、固定機能が当てはまっているかどうか)を示すために付属装置からハンドルに信号を運ぶ。同様に、第2電気導線が、そのように必要とされる(例えば、線形ステープル付属装置の1つの実施形態に関してさらに完全に後述されるように、ステープルプロセスを通して続行する固定を確実にするために選択的に係合可能な電磁シールの使用が提供され、ハンドルの電源から選択的に提供される電力を必要としてよい)のであれば、電力を付属装置の別個の態様に供給するために備えられてよい。
【0036】
さらに特定すると、複数の異なる潜在的な実施形態を有し、その内の2つが例としてここに開示される線形固定ステープル付属装置に関して、付属装置は、運転において、電気駆動機構の可撓駆動軸の伸張部として機能する2つの駆動伸張部が付いている。すなわち、付属装置が電気駆動機構に合わされるとき、駆動伸張部は、駆動軸モータの起動が、線形固定ステープル付属装置内での駆動伸張部を起動するように、可撓駆動軸と機械的に連絡している。付属装置のそれぞれの実施形態では、第1駆動伸張部は線形固定機構を可能にするが、第2駆動伸張部はステープル機構を可能にする。
【0037】
1つの実施形態では、線形固定機構は、鋏の枢着する上部ジョーが、鋏の長さを囲むカフが、鋏の閉じる端部に向かって鋏の枢着端部から移動されるにつれて、鋏の固定された下部ジョーに固定される鋏−カフシステムを備える。鋏は、カフがその元の位置に戻されるにつれて留め金を外すことができる。この実施形態では、第1駆動伸張部は、電気機械駆動機構内での対応するモータの回転方向に応じて、前方または後方へカフを移動する。
【0038】
第2実施形態では、線形固定機構は、それにより上部ジョーが持ち上げられ、その後で下部ジョーに出会い、固定を達成するために引き下げられる分離ジョーシステムを備える。この実施形態では、第1駆動伸張部は、電気機械駆動機構内での対応するモータの回転方向に応じて、上部ジョーを引き上げる、または引き下げる1組のねじ込まれた垂直軸を係合する。
【0039】
これらの実施形態のそれぞれで、ステープル機構は、下部ジョー内の開放ステープルセットの交換可能なトレイ、および上部ジョー上に付けられる対応ステープルガイドのセットを備え、その結果、線形固定機構が閉鎖位置にあるときには、開放ステープルがただちに対応するステープルガイドを対抗する。ステープル機構は、さらに、それによりいったん線形固定機構が閉鎖位置にあるときには、開放ステープルのトレイの下にある流路に載る楔が流路を通して押される楔プッシュシステムを備える。
【0040】
楔が流路を通って移動するにつれて、楔の傾斜面が対応するステープルガイドに開放楔を押し付け、それによりステープルを閉じる。刃部分は、この傾斜する表面におさめられ、腸の組織を切り通す。ステープルが閉じられた後、楔は流路を通して引き戻される。第2駆動伸張部は、一致する内側ねじ山を有する楔がその上に載るねじ込まれた水平軸を係合することによって、電気機械駆動機構内の対応するモータの回転方向に応じて、流路を通る楔と刃の機構を押す、または引っ張る。
【0041】
鋏または線形閉鎖ジョーの末端部は、さらに、ステープルステップの間にジョーの末端部をともに保持するのに役立つ電磁保護機構を含んでよい。これは、ステープルを上部ジョーのステープルガイドに接して上方へ動かす動作がジョーを開くのに役立つ限り好まれる。加えて、電磁保護機構は、装置を操作する外科医が、いつ、ジョーが閉じ、装置が安全なステープル駆動(stapledriving)位置にあるのかを知らされるように、(前述された)ハンドルのLCDインジケータ機構と電気的に通信して結合されてよい。
【0042】
今度は吻合およびステープル付属装置を参照すると、好ましい実施形態は、同等な目的のために構築できるだろう異なる種類の単一の例として後述される。しかしながら、前述された線形付属装置でのように、この例は、本発明の相対的な電気機械駆動機構の汎用的な応用性を立証する。この付属装置は、アンビル部分、ならびに前述あれた軸要素の駆動構成部品に結合可能である1組の回転駆動軸を含むステープル、刃および貯蔵器部分、ならびに回転駆動軸に取り付けられているが、回転するのを妨げられ、したがってそれらが回転するときに軸に沿って線形に進み、引っ込む1組の対応する前進ナットおよび後退ナットを備える。
【0043】
アンビル部分は、鈍い鼻のついた上部、底部の平坦な切断支持面、および底面から軸に沿って伸張する自由に回転する連結ポストを有するカプセル形状である。この連結ポストは、回転する駆動軸の1つに取り付けられている対応するナットに選択的に結合可能、および取り外し可能に設計される。
【0044】
ステープル、刃および貯蔵器部分(SBR部分)は円筒形状であり、中空の内部を有するハウジングを形成する。貯蔵器を形成するのはこの中空の内部である。ハウジングの円筒形の壁の軸に沿って外向きに面する表面の上には、一連のステープルポートがあり、それらを通して装置のステープルは放出される。
【0045】
一連のステープル駆動機構が、そこを通してステープルを駆動するために、ステープルポートの下にある円筒形の壁の中に取り付けられている。さらに正確には、ステープル駆動機構は、SBR部分の壁部にぴったり嵌る単一の円筒形の構成部品の外側端縁上の一連の突起である。放出に先だって、ステープルは穴の中に取り付けられる。そして、それらはステープル駆動機構およびその突起の前方運動により穴を通して進められる。
【0046】
刃は、同様に円筒形であり、その壁の内面に接してハウジングの内部にぴったり嵌る。刃とステープル駆動機構の両方とも、その結果その他の回転駆動軸に取り付けられる第2ナットに取り付けられる。回転駆動軸が回転するにつれて、(回転に逆らって抑制される)ナットが軸に沿って進み、このようにして刃およびステープル駆動機構を線形に進める。したがって、刃およびステープル駆動機構は、ハンドルでの適切なトリガの作動に従って、ハウジングから軸に沿って外向きに選択的に前進可能である。
【0047】
好ましい実施形態では、アンビル部分およびSBR部分が、さらに、ハンドルのLCDインジケータに結合される電磁センサ機構を備え、そのセンサは、2つの部分が安全なステープル発射に必要な範囲まで互いに近づいたときに、起動され、それにより外科医は結腸内に置かれる付属装置の状態に関する遠隔知識を有してよい。
【0048】
実際問題として、この付属装置は、いったん切除されなければならない結腸の部分が一部切除されると(しかし、線形固定およびステープルステップが完了する前に)、以下の方法で活用される。
【0049】
外科医は、吻合およびステープル付属装置を電気機械駆動機構に結合し、アンビル部分をそ最大範囲まで進めることによって始める。それから、アンビルヘッドが取り外され、露呈される近端部に挿入される。それから、前述されたように、この近端部は縫合され、閉じられる。その後、外科医は軸および付属装置のSBR部分を、それがステープルで止められている結腸の末端部を通って伸張するまで上方へ進める。外科医は、それから、アンビルを対応する駆動軸の前進後退ナットに結合する。ハンドル内でのモータのそれ以降のトリガにより、アンビルはSBR部分に向かって引っ込められる。
【0050】
前述されたように、好ましい実施形態では、アンビルの基部およびSBRハウジングの外側端縁が、ハンドルのLCDインジケータに結合される電磁センサを備え、それにより外科医が、アンビルおよびSBRがいつ刃およびステープルを駆動するのに十分に近くなるのかを知ることができるようにする。ハンドルでのその他のトリガのそれ以降の作動により、対応するその他の回転駆動軸は、刃およびステープル駆動装置をアンビルの反対側の面に接触させる。
【0051】
刃は、結腸のステープルで留められ、閉じられた端部を切り通して、内部貯蔵器内で切断される組織を離れる。切断と同時に、新しく開かれた端部は、(アンビルの反対側の面に押しつけられ、それにより閉じられる)SBRの周縁部端縁内の穴を通って進められる一連のステープルによってともに結合される。その後で、付属装置および可撓軸は患者から引っ込められる。
【0052】
【発明の好ましい実施の形態】
本発明は、特定の実施形態が示される添付図面に関して、および埋め込みの方法に関してさらに詳細にこれ以降記述されるだろうが、当業者が、本発明の機能および結果を達成する一方で、ここに記述されている発明を変更してよいことが、最初に理解されるべきである。したがって、後続の記述は、本発明の幅広い範囲内で特定の構造、態様および形状構成に関して例示的かつ典型的であり、このような幅広い範囲に関して制限的ではないとして理解されなければならない。類似の番号は、全体を通して類似の要素の同様の特徴を指す。
【0053】
さらに特定すると、本発明は(1)電気機械駆動機構、(2)線形固定ステープル付属装置、および(3)吻合ステープル付属装置である3つの構成要素を備え、後者2つの付属装置は、駆動機構構成要素と接合する1つの共通の設計された連結インターフェースを有する。
【0054】
図3を参照すると、電気機械駆動機構100に関して、駆動機構はハンドル部分102および可撓駆動軸部分104を有する。該ハンドル102は、外科手術オペレータによって容易に握られる方法で形成される部分を含む。例えば、ここに提供されている実施形態において、ハンドルは、ピストルグリップ様式部分106を備える。グリップ部分106は、少なくとも2つ、および本実施形態においては、正確に2つの、個別に指で作動可能なトリガ108a、108bを備える。フィンガトリガ108a、108bは、ハンドル100の内部空間内に収容される別個のモータ110、112に独立して結合される。それぞれのモータ110、112は、(これ以降、さらに詳細に記述される)別個の可撓駆動軸を回転する。
【0055】
さらに特定すると、モータ110、112に関して、それぞれは二重方向モータである。指で作動可能なスイッチに結合されることに加えて、モータはそれぞれ別々に(本実施形態においては1つの共通ソースである)電源114および手動駆動スイッチ116に結合される。該手動駆動スイッチ116は、ハンドル100の上部に備えられ、その結果外科手術オペレータは、各モータの回転方向を選択的に改変できる。好ましい実施形態においては、モータ110、112に供給する電源114は、単一直流供給取外し可能、再充電可能電池パックである。
【0056】
二重直流源または(標準米国120ボルト、60ヘルツの壁のコンセントから提供される交流のような)単一リモート交流源を含む代替電源が、代替実施形態と関連して使用されてよいことが理解されるものとする。駆動機構装置が、交流と使用可能でなければならない場合には、どちらかの変圧器をモータと電源の間に含むことができるか、あるいはさらに精密な中間ギアアセンブリが、モータと拡張される回転駆動軸の間に備えられてよい。
【0057】
モータ110、112構成部品、および関連する電力要素および駆動スイッチ要素に加えて、ハンドル100は、さらに以下を含む。つまり、(1)リモートステータスインジケータ118と関連付けられた電気回路120、および(2)可撓駆動軸122の末端部の遠隔移動を引き起こすための手動ステアリング手段である。最初に、リモートステータスインジケータ118に関しては、本実施形態の中で、インジケータ手段は、ハンドルの上部に取り付けられるLCDを備える。同等な機能が、可聴警報を、あるいはその他の単純なセンサ刺激機構をハンドル上に取り付けることによって達成可能であるが理解されるものとする。
【0058】
ステータスインジケータ118は、ハンドルおよび軸に沿って伸張し、選択された付属装置の対応する電気回路に結合する回路に結合される(図4から図6)。例えば、閉鎖位置または開放位置での付属装置の配置は、開回路または閉回路状態にある付属装置内の回路に関連付けられる。閉回路状態により、リモートステータスインジケータLCDが点灯するが、開回路状態がOCDを消灯させる。
【0059】
第2に、ハンドルは、本実施形態の中では、複数のガイドワイヤ126に結合されるトラックボール124を備える手動で作動可能なステアリング手段も含む。ガイドワイヤ126は、(以下にさらに完全に記述される)可撓軸部分122に沿って伸張し、軸122の先端に結合される。トラックボール124が回転すると、ガイドワイヤ126が引っ張られ、軸の先端が相応して回転する。
【0060】
さらに特定すると、可撓軸122に関して、軸は、簡略な、組織に互換性のあるエラストマ材から形成される管状の鎧装128を備える。この装置は再利用されなければならないため、材料が滅菌可能である(つまり、オートクレーブに耐えるほど十分に堅牢である)ことが重要である。
【0061】
図解される実施形態は、隣接するハンドル100および軸122を備えるが、当分野の当業者が、分離可能なハンドルおよび軸を有する代替実施形態を提供し、このようにして代替目的の代替の軸長さを可能にすることが理解されるものとする。このような場合には、可撓軸122部分およびハンドル100部分が、軸の近端部と、駆動構成部品用の結合手段を含まなければならないハンドルの末端部の間に界面を含む必要がある。
【0062】
特に、軸122の駆動構成部品130a、130bに関しては、エラストマ鎧装128は、それぞれが対応する管134a、134b内で回転することができる、可撓駆動軸136a、136bを含む、1組の小さい方の固定管134a、134bである。可撓駆動軸122それ自体は、外科医が患者の結腸を通して「くねくね進む」ことを必要とみなすために、依然として曲げる、傾斜させる、カーブする等に十分なほど可撓である一方、単に、ハンドルの中のモータから軸122の末端部138a、138bにトルクを中継できなければならない。例えば、駆動軸は、織られた鋼ファイバケーブル、高い引っ張り強さの重合材、あるいは十分に可撓な単体状の金属軸を備えてよい。
【0063】
駆動軸136a、136bの末端部138a、138bが、固定ステープル装置などの本発明の付属装置(図4と図5を参照すること)と結合するために、駆動軸の末端部138a、138bは、トルクの続行する中継を可能にする構成を有さなければならない。本実施形態では、この結合は、幾何学的な取付部品によって達成され、さらに正確には、駆動軸の末端部は六角であり、それにより付属装置の連結インターフェースの六角凹部に嵌る。
【0064】
好ましい実施形態においては、付属装置および軸の末端部は、付属装置の軸の末端部への取付けを容易にするために、カラーまたはその他の値合わせ手段を含まなければならない。加えて、軸の先端は、LCD118に結合される回路120の末端部を含む。
【0065】
今度は図4と図5を参照すると、本発明に従った2つの代替線形固定ステープル付属装置が図示されている。図4に示されている第1線形固定機構は、下部ジョー150と上部ジョー152、および近端接続端部材154を備える分離ジョーシステムを備える。この近端部材154は、その中に駆動装置の駆動軸の末端部138a、138bが結合する2つの六角形をした受け口、156a、156bを含む。受け口のそれぞれは、対応する水平回転軸158a、158bの端部に形成される。
【0066】
上部水平回転軸158aは、横断方向のギヤ部材によって、上部ジョー152の相応してねじ込まれる穴162を通って伸張するねじ込み垂直軸160に結合される。上部ジョー152は、駆動機構結合受け口156a、156bの反対側にある界面端部部材154の側面に形成される線形トラック168に結合する、線形トラック結合手段166を有する。上部水平回転軸158aのそれ以後の回転により、垂直回転軸160は回転する。この軸160が回転するについれて、上部ジョー152が、端部材154の追跡調査中に上下に浮かぶ。
【0067】
下部水平回転軸158bは、結果的に近端部材154に固定される下部ジョー150を通って軸に沿って伸張する。この軸に沿って伸張する軸158bの回りに取り付けられているのは、ねじ込み穴を含む楔駆動機構166である。このねじ込み部材166は、軸158bが回転するときに、部材166が回転するのを防ぐ、トラック167内に固定される。むしろ、楔部材166は、トラック167に沿って、および軸158bのねじ込みに沿って直線状に乗る。
【0068】
上部ジョー152に対向する下部ジョー150の面の凹部168の中には、ステープルの交換可能なトレイであり、じかに楔部材166の上にあるのは、ステープルの交換可能なトレイである。楔駆動機構は、ステープル174に接触し、それをトレイ170の中から上方へ動かす傾斜前面172を有する。上部ジョー152が下部ジョー150に密接に近接するとき、ステーブルは、それらが(その中に形成されるステープル閉鎖ガイド凹部176の作用により)上部ジョー152の対向面に接触すると閉じられる。
【0069】
上部ジョーおよび下部ジョーの末端部は、それぞれがLCDインジケータ118回路120の末端部に合う回路構成要素に結合される、2つの向かい合う磁気センサ178a、178bである。ジョーがいっしょになると、回路は閉じられ、LCDが点灯し、ステープルが安全に発射されてよいことを示す。
【0070】
運転において、外科医は、癌性組織のどちらかの側での結腸の管を切断し、それにより腸の2つの端部を作る。外科医は、露呈された端部を一時的にステープルで留めるために、線形固定ステープル付属装置を使用する。
【0071】
さらに特定すると、線形固定ステープル付属装置は、駆動機構軸の末端部に合わせられる。1つのトリガ(上部軸136aの回転を引き起こすトリガ)を手作業で作動することにより、上部ジョー152は下部ジョー150を基準にして開く。それから、結腸の開放端部は、ジョー150、152の間に置かれ、ジョーは上部軸136aの駆動方向を切り替え、反対方向で上部ジョーを動かすことによって閉じられる。ジョーは、それにより結腸の端部で塞がれる。この時点で、ハンドル内のLCDインジケータ118は点灯し、ステープルが安全に進められてよいことを示すはずである。
【0072】
第2軸136bを回転にトリガすると、楔駆動機構166が、下部ジョー150内のトラック168に沿って滑動する。これが、ステープル174を結腸の端部を通して動かし、それらをステープル閉鎖ガイド凹部176に接して閉じる。それから、ジョーは再び開かれ、楔駆動機構166が、下部ジョー150の中で引っ込められ、ステープル174のトレイ170が置換され、プロセスは、結腸の他方の開放端部に関して繰り返される。
【0073】
今度は図5を参照すると、本発明の線形固定ステープル付属装置の第2実施形態180が記述される。本実施形態では、軸部分の六角端部が付属装置の対応する受け口端部156a、156bに差し込まれる限り、連結インターフェース154は第1実施形態に十分に同等である。前記のように、駆動機構構成要素の軸は、付属装置内の回転部材を回転する。しかしながら、この実施形態においては、回転部材158a、158bは水平である。軸インターフェース部材に取り付けられるのは、固定下部ジョー150および移動上部ジョー152である。
【0074】
この実施形態では、上部ジョー152は、上部ジョーを、下部ジョーを基準にして開かれた配置に偏向するばね式ピボットによって下部ジョー150に取り付けられる。しかしながら、上部回転軸に取り付けられるのは、上部ジョーと下部爪の回りにぴったりと嵌り、その前進によりジョーがいっしょになる線形追跡調査済みカフ187である。下部ジョーは、正確に同じステープル174トレイ凹部、および直線状に動かされるねじ込み楔ステーブルプッシュ機構166を含む。また、第1実施形態の電磁センサおよび回路は、いつ結腸の部分が完全に固定され、ステープルが動かされなければならないのかを外科医に示すために含まれる。
【0075】
さらに特定すると、外科医が、結腸の病んでいる部分を切除した後に、結腸の端部が付属装置のジョーの間に配置される。第1トリガを作動(し、上部軸を動かす)することによって、カフ部材187は、上部ジョーおよび下部ジョー150、152の外側に沿って軸に沿って前進し、このようにして上部ジョーを結腸および下部ジョーの上に閉じる。いったん完全に閉じられると、電磁センサ回路は、外科医オペレータに、ステープルが発射されてよいことを示し、相応して第2トリガの作動により、楔駆動機構が前進し、結腸の部分を通してステープルを動かす。上部回転軸用のモータを逆偏向すると、カフが引っ込み、上部ジョーが開き、このようにして、現在密封されている結腸端部を解放する。
【0076】
今度は図6に関して、吻合ステープル付属装置200の好ましい実施形態が記述される。この付属装置は、アンビル部分202、およびステープル、刃、および図3に関して前述された駆動機構構成要素の駆動構成部品136a、136bに結合可能である1組の回転駆動軸206a、206bを、および対応する1組のトラック内に、およびそれにより回転するのを防がれ、そのため、それらが回転するとき軸206a、206bに沿って直線状に前進し、引っ込む回転駆動軸に取り付けられている対応する組の前進部材および後退部材208a、208bを含む貯蔵器(SBR)部分204を備える。さらに具体的には、SBR部分204の基部は、ねじ込み回転軸206a、206bの基部の中に形成される1組の六角凹部205a、205bを含む連結インターフェース203を含む。
【0077】
アンビル部分202は、鈍い鼻のついた上部、底部の平坦な切断支持面、および底面から軸に沿って伸張する自由に回転する連結ポストを有するカプセル形状をしている。連結ポスト214は、線形トラック内に取り付けられる第1の前進および後退部材208aに取り付き、それにより軸206aの回転によって部材208aおよびそこに結合されるアンビル202が、回転自在にではなく、軸に沿って移動する。
【0078】
ステープル、刃および貯蔵器部分(SBR)部分204は円筒形状をしており、中空の内部216を有するハウジングを形成する。貯蔵器を形成するのは、この中空の内部である。ハウジングの円筒形の壁220の軸に沿って外向きに向く面218の上には、それを通って装置のステープル224が放出される一連のステープルポートがある。単体の刃および円筒形のステープル駆動機構構成要素226が、ハウジング内にぴったりと嵌る。さらに特定すると、刃およびステープル駆動機構構成要素が、2つの同心円筒部分を有する単一の要素を備える。刃部分228は、その内部壁230に接して中空の内部216内にぴったりと嵌る。ステープル駆動機構部分232は、SBR部分の壁230内にぴったりと嵌り、ステープルポート内に取り付けられているステープルを押す一連の外向きに突出する突起を含む。
【0079】
刃228およびステープル駆動機構232は、その内部端部で、回転軸206bの回りにぴったりと嵌るねじ込み部材208bに結合される。ねじ込み部材208bは、刃およびステープル駆動機構が、回転軸206bの回転時に直線状に前進するように線形トラック内に抑制される。
【0080】
加えて、アンビル202およびSBR部分204は、それぞれ、ハンドル内のLCDインジケータ118に結合する対応する電磁センサ回路構成部品240a、240bを備える。
【0081】
実際問題として、この付属装置は、切除されなければならない結腸の部分が、次のようにしていったん切除され、ステープルで留められ、塞がれると活用される。
【0082】
外科医は、吻合ステープル付属装置200を電気機械駆動機構に結合し、アンビル部分202をその再考範囲まで進めることによって開始する。それから、アンビルヘッド202が第1前進後退歩合208から切り離され、露呈されている近端部の中に差し込まれる。前述されたように、その後で、腸のステープルで留められた近端部が部分的に開かれ、アンビルヘッドが挿入される。それから、腸は縫合され、閉じられる。それから、外科医は、それが結腸のステープルで留められた末端部を通って伸びるまで、軸206aをおよび接続装置のSBR部分204を結腸上部に前進させる(代わりに、外科医は、可撓軸だけを結腸上部に前進させてから、いったんそれが腸の末端部から出現すると、SBR部分を末端部に再び付着してよい)。その後で、外科医は、アンビル22を、対応する駆動軸136aの回転によって前進後退部材208aに結合する。
【0083】
ハンドル100内のその後の逆偏向および同じモータのトリガにより、アンビル202は、SBR部分204に向かって後退する。いったんアンビル202の下面およびSBRハウジングの外側端縁に取り付けられる電磁センサ240a、240bが、LCDインジケータ回路120を閉じるほど十分に隣接するようになると、LCDがハンドル上で点灯する。これが、外科手術オペレータに、第2軸136bおよび206bを回転にトリガするように信号で知らせ、ステープル駆動機構、刃およびステープルを同時に前進させる。
【0084】
刃は、結腸のステープルで止められ、閉じられた端部を切り通し、内部貯蔵器内に切断された組織を残す。切断と同時に、新しく開かれた端部は、(アンビルの向かい合う面に押し付けられ、アンビルの向かい合う面により閉じられる)SBRの周辺部端縁内の穴を通して進めっれる位置連のステープルによってともに接合される。それから、付属装置および可撓軸は患者から引き出される。
【0085】
線形固定ステープル付属装置および吻合ステープル付属装置などの外科手術用付属装置とともに使用するための新しい、新規の電磁駆動機構が記述、図解されてきたが、ここに添付されるクレームの範囲によってのみ制限されるものとする、本発明の幅広い精神および原理から逸脱することなく、変形および修正が可能であることは当業者に明らかだろう。
【図面の簡単な説明】
【図1】 図1は、従来の技術の線形固定ステープル器械の側面透視図である。
【図2】 図2は、従来の技術の吻合ステープル器械の側面透視図である。
【図3】 図3は、本発明のハンドルおよび可撓軸の側面図であり、そこでは要素の内部形状構成は、想像線で提供される。
【図4】 図4は、本発明のある態様である線形固定ステープル付属装置の1つの実施形態の側面図であり、そこでは要素の内部形状構成は想像線で提供される。
【図5】 図5は、本発明の態様である、線形固定ステープル付属装置の第2実施形態の側面図であり、そこでは要素の内部形状構成は想像線で提供される。
【図6】 図6は、本発明の1つの態様である、吻合ステープル付録装置の側面カッタウェイ図である。
Claims (40)
- 複数の旋回部材を内部に含んだ外科手術用アタッチメントを遠隔駆動させるための電気機械駆動機構アセンブリであって、
軸線方向に沿って回転する少なくとも二つの可撓性回転部材が内部に配置された可撓性シャフトと、
前記可撓性シャフトに沿って配置されて前記可撓性シャフトをステアリングするよう構成された少なくとも一つのステアリングワイヤーと、
ハンドル部を有し、
前記回転部材が、夫々、遠位端部と近位端部とを有し、
前記回転部材の各々が、前記近位端部に付加されるトルクを前記回転部材に沿って前記遠位端部へ伝達可能に構成され、
前記遠位端部が、前記外科手術用アタッチメントの前記旋回部材との接続のための手段を有し、
前記ハンドル部が、前記ハンドル部内に配置されて前記少なくとも二つの回転部材に対応して夫々接続される少なくとも二つの選択的係合可能なモータを有し、それにより、前記少なくとも二つのモータのいずれかが対応の回転部材と選択的に係合することにより同回転部材を回転させて、前記外科手術用アタッチメントの対応の旋回部材にトルクを伝達するよう構成されている、複数の旋回部材を内部に含んだ外科手術用アタッチメントを遠隔駆動させるための電気機械駆動機構アセンブリ。 - 前記ハンドル部が、前記少なくとも二つのモータを個別に駆動させるために前記少なくとも二つのモータに接続された電源を含んでいる、請求項1に記載の電気機械駆動機構アセンブリ。
- 前記電源が直流電源である、請求項2に記載の電気機械駆動機構アセンブリ。
- 前記モータに逆バイアスがかけられて前記モータを反対方向へ駆動させるように、前記電源が可逆に構成されている、請求項2に記載の電気機械駆動機構アセンブリ。
- 前記電源を選択的に逆駆動させるために前記電源に接続された手動操作可能なスイッチを有している、請求項4に記載の電気機械駆動機構アセンブリ。
- 活性電気回路とそれに接続されたインジケータ手段とを有し、前記活性電気回路が、前記アタッチメントに設けられたセンサと接続可能に構成され、それにより、前記インジケータ手段が、前記電気回路の状態に応答して前記アタッチメントの状態を表示可能になっている、請求項1に記載の電気機械駆動機構アセンブリ。
- 前記インジケータ手段がLCDを含んでいる、請求項6に記載の電気機械駆動機構アセンブリ。
- 軸線方向に沿って回転可能な前記可撓性回転部材の前記遠位端部が六角形状に形成され、前記外科手術用アタッチメントの前記旋回部材が対応の六角形状に形成されたソケットを有し、それ故、前記回転部材が、前記旋回部材との干渉係合により前記旋回部材に接続されてトルクを前記旋回部材に伝達するようになっている、請求項1に記載の電気機械駆動機構アセンブリ。
- 電磁駆動機構と線形クランピング/ステープリングアタッチメントとの組み合わせアセンブリであって、
前記電磁駆動機構が、
軸線方向に沿って回転する少なくとも二つの可撓性回転部材を含んだ可撓性シャフトと、
前記可撓性シャフトに沿って配置されて前記可撓性シャフトをステアリングするよう構成された少なくとも一つのステアリングワイヤーと、
ハンドル部を有し、
前記回転部材が遠位端部と近位端部とを有し、
前記回転部材の各々が、前記近位端部に付加されるトルクを前記回転部材に沿って前記遠位端部へ伝達可能に構成され、
前記遠位端部が、前記線形クランピング/ステープリングアタッチメントとの接続のための手段を有し、
前記ハンドル部が、前記ハンドル部内に配置されて前記少なくとも二つの回転部材に対応して夫々接続される少なくとも二つの選択的係合可能なモータを有し、それにより、前記少なくとも二つのモータのいずれかが対応の回転部材と選択的に係合することにより同回転部材を回転させるよう構成され、
前記線形クランピング/ステープリングアタッチメントが、
前記少なくとも二つの可撓性回転部材と夫々個別に接続可能な少なくとも二つの旋回部材を有するインターフェース部と、
前記少なくとも二つの旋回部材の一方の回転に従って選択的に分離及び閉成可能な一対の対向したジョーと、
複数のステープルと、
ステープル駆動機構を有し、
前記ステープル駆動機構が、ステープルを駆動させる関係を持って、前記少なくとも二つの旋回部材の他方と選択的に接続されるようになっている、電磁駆動機構と線形クランピング/ステープリングアタッチメントとの組み合わせアセンブリ。 - 前記ハンドル部が、前記少なくとも二つのモータを個別に駆動させるために前記少なくとも二つのモータに接続された電源を含んでいる、請求項9に記載のアセンブリ。
- 前記電源が直流電源である、請求項10に記載のアセンブリ。
- 前記モータに逆バイアスがかけられて前記モータを反対方向へ駆動させるように、前記電源が可逆に構成されている、請求項11に記載のアセンブリ。
- 前記電源を選択的に逆駆動させるために前記電源に接続された手動操作可能なスイッチを有している、請求項12に記載のアセンブリ。
- 活性電気回路とそれに接続されたインジケータ手段とを有し、前記活性電気回路が、前記アタッチメントに設けられたセンサと接続可能に構成され、それにより、前記インジケータ手段が、前記電気回路の状態に応答して前記アタッチメントの状態を表示可能になっている、請求項9に記載のアセンブリ。
- 前記インジケータ手段がLCDを含んでいる、請求項14に記載のアセンブリ。
- 軸線方向に沿って回転可能な前記可撓性回転部材の前記遠位端部が六角形状に形成され、前記外科手術用アタッチメントの前記旋回部材が対応の六角形状に形成されたソケットを有し、それ故、前記回転部材が、前記旋回部材との干渉係合により前記旋回部材に接続されてトルクを前記旋回部材に伝達するようになっている、請求項9に記載のアセンブリ。
- 電磁駆動機構と線形クランピング/ステープリングアタッチメントとの組み合わせアセンブリであって、
前記電磁駆動機構が、
軸線方向に沿って回転する少なくとも二つの可撓性回転部材を含んだ可撓性シャフトと、
前記シャフトに沿って配置されて前記可撓性シャフトをステアリングするよう構成された少なくとも一つのステアリングワイヤーと、
ハンドル部を有し、
前記回転部材が遠位端部と近位端部とを有し、
前記回転部材の各々が、前記近位端部に付加されるトルクを前記回転部材に沿って前記遠位端部へ伝達可能に構成され、
前記遠位端部が、前記線形クランピング/ステープリングアタッチメントとの接続のための手段を有し、
前記ハンドル部が、前記少なくとも二つの可撓性回転部材に対応して夫々接続される少なくとも二つの選択的係合可能なモータを有し、それにより、前記少なくとも二つのモータが対応の回転部材と選択的に係合することにより同回転部材を回転させるよう構成され、
前記線形クランピング/ステープリングアタッチメントが、
前記少なくとも二つの可撓性回転部材の対応の回転部材と夫々接続可能な少なくとも二つの旋回部材を有するインターフェース部と、
前記少なくとも二つの旋回部材の一方の回転に従って選択的に前進及び後退可能なアンビル部と、
前記アンビル部と選択的に接続可能な刃/ステープルハウジング部を有し、
前記ハウジング部が、刃/ステープル駆動アセンブリを有し、
前記刃/ステープル駆動アセンブリが、前記少なくとも二つの旋回部材の他方の選択的駆動によって前記刃/ステープル駆動アセンブリを前記ハウジングの外方へ前記アンビル部に向かって前進させるように、前記刃/ステープル駆動アセンブリが前記少なくとも二つの旋回部材の前記他方に接続されている、電磁駆動機構と線形クランピング/ステープリングアタッチメントとの組み合わせアセンブリ。 - 外科手術用アタッチメントを駆動させるための電気機械駆動機構であって、
長尺なシャフトと、
前記長尺シャフト内に配置されて軸線方向に沿って回転可能な少なくとも二つの駆動シャフトと、
前記長尺なシャフトに沿って配置されて、前記長尺シャフトをステアリングするよう構成された少なくとも一つのステアリングワイヤーと、
前記駆動シャフトを駆動させるためのモータ機構を有し、
前記外科手術用アタッチメントを駆動させるために、前記駆動シャフトの各々の遠位端部が前記外科手術用アタッチメントに接続されるよう構成されている、外科手術用アタッチメントを駆動させるための電気機械駆動機構。 - 前記モータ機構が、前記駆動シャフトの各々用のモータを含んでいる、請求項18に記載の電気機械駆動機構。
- 前記モータ機構が、前記駆動シャフトを個別に駆動させるよう構成されている、請求項18に記載の電気機械駆動機構。
- 前記長尺シャフト及び前記駆動シャフトが、可撓性シャフトである、請求項18に記載の電気機械駆動機構。
- 前記駆動シャフトの各々に対応のトリガーを含み、そのトリガーが前記駆動シャフトを個別にコントロールできるように構成されている、請求項18に記載の電気機械駆動機構。
- 前記駆動シャフトの各々の遠位端部が、前記外科手術用アタッチメントに着脱自在に接続されるよう構成されている、請求項18に記載の電気機械駆動機構。
- 前記長尺シャフトの遠位端部が、前記外科手術用アタッチメントに接続されるよう構成されている、請求項18に記載の電気機械駆動機構。
- 前記長尺シャフトの遠位端部が前記外科手術用アタッチメントに着脱自在に接続されるよう構成されている、請求項24に記載の電気機械駆動機構。
- 前記駆動シャフトの各々の遠位端部が、前記外科手術用アタッチメントに設けられた対応のソケット内に受け入れられるよう構成されている、請求項18に記載の電気機械駆動機構。
- 前記駆動シャフトの各々の遠位端部が、前記外科手術用アタッチメントの前記ソケット内に着脱自在に受け入れられるよう構成されている、請求項26に記載の電気機械駆動機構。
- 電気機械駆動機構と外科手術用アタッチメントとが組み合わされたアセンブリであって、
前記電気機械駆動機構が、
長尺なシャフトと、
前記長尺シャフト内に配置されて軸線方向に沿って回転可能な少なくとも二つの駆動シャフトと、
前記長尺なシャフトに沿って配置されて、前記長尺シャフトをステアリングするよう構成された少なくとも一つのステアリングワイヤーと、
前記駆動シャフトを駆動させるためのモータ機構を有し、
前記外科手術用アタッチメントを駆動させるために、前記駆動シャフトの各々の遠位端部が前記外科手術用アタッチメントに接続されている、電気機械駆動機構と外科手術用アタッチメントとが組み合わされたアセンブリ。 - 前記外科手術用アタッチメントが、
互いに対向配置されて開成位置と閉成位置との間を相対移動可能な第一のジョーと第二のジョーと、
組織を貫通させて前記第一のジョーに向かってステープルを駆動させるためのステープルドライバーを有し、
前記駆動シャフトの一方が、前記第一のジョーと前記第二のジョーとの相対移動を実行させるよう構成され、
前記駆動シャフトの他方が、前記ステープルドライバーを駆動させるよう構成されている、請求項28に記載のアセンブリ。 - 前記モータ機構が、前記駆動シャフトの各々用のモータを含んでいる、請求項28に記載のアセンブリ。
- 前記モータ機構が、前記駆動シャフトを個別に駆動させるよう構成されている、請求項28に記載のアセンブリ。
- 前記長尺シャフトと前記駆動シャフトが可撓性シャフトである、請求項28に記載のアセンブリ。
- 前記駆動シャフトの各々に対応のトリガーを含み、そのトリガーが前記駆動シャフトを個別にコントロールできるように構成されている、請求項28に記載のアセンブリ。
- 前記駆動シャフトの各々の遠位端部が、前記外科手術用アタッチメントに着脱自在に接続されるよう構成されている、請求項28に記載のアセンブリ。
- 前記長尺シャフトの遠位端部が、前記外科手術用アタッチメントに接続されるよう構成されている、請求項18に記載のアセンブリ。
- 前記長尺シャフトの遠位端部が、前記外科手術用アタッチメントに着脱自在に接続されるよう構成されている、請求項35に記載のアセンブリ。
- 前記駆動シャフトの各々の遠位端部が、前記外科手術用アタッチメントに設けられた対応のソケット内に受け入れられるよう構成されている、請求項28に記載のアセンブリ。
- 前記駆動シャフトの各々の遠位端部が、前記外科手術用アタッチメントの前記ソケット内に着脱自在に受け入れられるよう構成されている、請求項37に記載のアセンブリ。
- 前記外科手術用アタッチメントが、軸線方向へ移動可能なアンビルと、組織を貫通させて前記アンビルに向かってステープルを駆動させるためのステープルドライバーとを有し、前記駆動シャフトの一方が前記アンビルを移動させ、前記駆動シャフトの他方が前記ステープルドライバーを駆動させるよう構成されている、請求項28に記載のアセンブリ。
- 前記長尺シャフトが第一のカップリング機構を有し、前記外科手術用アタッチメントが前記第一のカップリング機構と相補的な第二のカップリング機構を有している、請求項28に記載のアセンブリ。
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US09/324,452 US6443973B1 (en) | 1999-06-02 | 1999-06-02 | Electromechanical driver device for use with anastomosing, stapling, and resecting instruments |
PCT/US2000/015311 WO2000072765A1 (en) | 1999-06-02 | 2000-06-02 | An electromechanical driver device for use with anastomosing, stapling, and resecting instruments |
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EP (5) | EP1191883B1 (ja) |
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1999
- 1999-06-02 US US09/324,452 patent/US6443973B1/en not_active Expired - Lifetime
-
2000
- 2000-06-02 EP EP00939537A patent/EP1191883B1/en not_active Expired - Lifetime
- 2000-06-02 DE DE60044815T patent/DE60044815D1/de not_active Expired - Lifetime
- 2000-06-02 JP JP2000620880A patent/JP4310509B2/ja not_active Expired - Lifetime
- 2000-06-02 ES ES10003726T patent/ES2373780T3/es not_active Expired - Lifetime
- 2000-06-02 AU AU54612/00A patent/AU5461200A/en not_active Abandoned
- 2000-06-02 AT AT10003726T patent/ATE525965T1/de not_active IP Right Cessation
- 2000-06-02 KR KR1020017015511A patent/KR100778729B1/ko not_active IP Right Cessation
- 2000-06-02 EP EP10010188.0A patent/EP2298189B1/en not_active Expired - Lifetime
- 2000-06-02 ES ES10010188.0T patent/ES2545233T3/es not_active Expired - Lifetime
- 2000-06-02 WO PCT/US2000/015311 patent/WO2000072765A1/en active Application Filing
- 2000-06-02 EP EP10010187.2A patent/EP2292156A3/en not_active Withdrawn
- 2000-06-02 AT AT00939537T patent/ATE476921T1/de not_active IP Right Cessation
- 2000-06-02 EP EP10010186.4A patent/EP2732774B1/en not_active Expired - Lifetime
- 2000-06-02 EP EP10003726A patent/EP2215978B1/en not_active Expired - Lifetime
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Also Published As
Publication number | Publication date |
---|---|
EP2298189B1 (en) | 2015-07-29 |
EP2298189A2 (en) | 2011-03-23 |
EP2298189A3 (en) | 2013-09-11 |
WO2000072765A1 (en) | 2000-12-07 |
JP2003500153A (ja) | 2003-01-07 |
KR100778729B1 (ko) | 2007-11-27 |
US6443973B1 (en) | 2002-09-03 |
EP1191883A1 (en) | 2002-04-03 |
EP2292156A3 (en) | 2014-04-16 |
EP2215978A1 (en) | 2010-08-11 |
EP2732774B1 (en) | 2019-04-10 |
EP2292156A2 (en) | 2011-03-09 |
EP2215978B1 (en) | 2011-09-28 |
ATE476921T1 (de) | 2010-08-15 |
KR20020036782A (ko) | 2002-05-16 |
ES2545233T3 (es) | 2015-09-09 |
ES2373780T3 (es) | 2012-02-08 |
ATE525965T1 (de) | 2011-10-15 |
DE60044815D1 (de) | 2010-09-23 |
EP1191883A4 (en) | 2006-05-31 |
EP2732774A1 (en) | 2014-05-21 |
AU5461200A (en) | 2000-12-18 |
EP1191883B1 (en) | 2010-08-11 |
ES2347131T3 (es) | 2010-10-26 |
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