JP5129258B2 - 骨盤疾患を治療する手術装置および方法 - Google Patents
骨盤疾患を治療する手術装置および方法 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
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/0004—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse
- A61F2/0031—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra
- A61F2/0036—Closure means for urethra or rectum, i.e. anti-incontinence devices or support slings against pelvic prolapse for constricting the lumen; Support slings for the urethra implantable
- A61F2/0045—Support slings
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/06—Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
- A61B17/06066—Needles, e.g. needle tip configurations
- A61B17/06109—Big needles, either gripped by hand or connectable to a handle
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/08—Muscles; Tendons; Ligaments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00743—Type of operation; Specification of treatment sites
- A61B2017/00805—Treatment of female stress urinary incontinence
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0412—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having anchoring barbs or pins extending outwardly from suture anchor body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
- A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
- A61B2017/0427—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors having anchoring barbs or pins extending outwardly from the anchor body
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- General Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Animal Behavior & Ethology (AREA)
- Urology & Nephrology (AREA)
- Transplantation (AREA)
- Molecular Biology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Cardiology (AREA)
- Vascular Medicine (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Rheumatology (AREA)
- Rehabilitation Therapy (AREA)
- Prostheses (AREA)
- Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
- Surgical Instruments (AREA)
- Pretreatment Of Seeds And Plants (AREA)
Description
1.鈍的解離
a.クラスケ切開口と同様に、肛門の略々2cm下位にて3cm長の横方向切開口を作成する。
i.此処では、肛門尾骨靱帯を貫通してまたはその表面的に解離を行うという選択肢がある。上記靱帯の表面的に解離を行うと、直腸を緊張させずにまたは侵食のリスクなしで、直腸に対する補助材が提供され得る。但し、深刻な大便失禁に対し、または、更に大きな張力が必要とされるなら、上記靱帯が解離され、その背後にメッシュが載置され得る。
b.患者の左側にて、切開口、および、坐骨棘に向かう通道内へと指を挿入する。操作者の指により鈍的解離を使用し、脊柱に至る空間を開く。指は、挙筋(中央)と脂肪組織(側方)との間に位置する。
c.その指により掃引動作を行い、坐骨棘と、恥骨下行枝上の閉鎖孔の後方縁部との間において、脂肪と筋肉との間に空間を生成する。
d.患者の右側で、BおよびCを反復する。
2.ニードルによるメッシュの載置:
a.一方のメッシュ・アーム上のアンカを貫通させて、ニードルを挿入する。
b.操作者の指を閉鎖孔の近傍の恥骨下行枝上に載置し、上記アンカを備えた端部が組織内へと押し進められるまで、操作者の指に沿い、ニードルを内閉鎖筋内へと延在させる。
c.上記ニードルを上記切開口から引き抜くことにより取出す。上記アンカが組織を捕捉したことを確実とすべく、上記メッシュを強く引張る。他方のメッシュ・アーム上のアンカに対し、ニードルを挿入する。
d.操作者の指を坐骨棘上に載置し、上記アンカを備えた端部が挙筋における組織であって坐骨棘の近傍であるとうい組織内へと押し進められるまで、操作者の指に沿いニードルを延在させる。
e.ニードルを取出す。
f.メッシュに沿い掃引を行うことで各アンカ間の領域を円滑化し、且つ、直腸の下方の末端部を掃引する。
g.反対側にて、段階A〜Fを反復する。
3.縫合糸による切開口の閉成
a.上記靱帯が解離されたなら、上記切開口を閉じる前に、上記メッシュの全体に亙り該靱帯の各端部を再結合する。
本出願は、2006年10月26日に出願されると共に“肛門挙筋欠陥および大便失禁を治療するためのメッシュ・インプラント”と称された米国仮出願第60/863,049号、および、2007年6月29日に出願されると共に“骨盤底治療および関連するインプラント”と称された米国仮出願第60/947,044号の特典を主張するものであり、これらの出願は言及したことにより全体的に本出願中に援用される。
Claims (9)
- 挙筋組織を支持する骨盤用インプラントであって、
該インプラントは、
骨盤領域の前部領域から、中央挙筋組織の領域まで延在し得る前側辺であって、上記前部領域は、閉鎖孔の領域、腱弓の領域、および、恥骨直腸筋の領域から選択されるという前側辺と、
骨盤領域の後部領域から中央挙筋組織の領域まで延在し得る後側辺であって、上記後部領域は、坐骨棘、坐骨結節、仙棘靭帯、仙結節靭帯、および、仙骨の領域から選択されるという後側辺と、
上記前部領域から上記後部領域まで延在し得る側辺端部と、
により境界付けられる組織支持部分を備えて成り、
上記組織支持部分は挙筋組織の領域に配置され、
前記組織支持部分は実質的に、正方形、菱形、対称的台形、非対称的台形、対称的矩形、および、非対称的矩形から選択された図形の形状を有し、
前記側辺端部に沿い前記組織支持部分の角隅部に配置された1個または2個の延長部分を備え、かつ、
索環を備えて成り、
前記索環は当該インプラントの角隅部に置かれ、且つ、
当該インプラントは、繋止要素を備えた固定手段であって、上記索環を貫通通過し得るという固定手段を更に備えて成る、
骨盤用インプラント。 - 対置された2個の組織支持部分であって、各組織支持部分は、
骨盤領域の前部領域であって、閉鎖孔の領域、腱弓の領域、および、恥骨直腸筋の領域から選択されるという前部領域から、中央挙筋組織の領域まで延在し得る前側辺と、
骨盤領域の後部領域であって、坐骨棘、坐骨結節、仙棘靭帯、仙結節靭帯、および、仙骨の領域から選択されるという後部領域から、中央挙筋組織の領域まで延在し得る後側辺と、
上記前部領域から上記後部領域まで延在し得る側辺端部と、
を備えて成るという2個の組織支持部分を備えて成る、請求項1に記載のインプラント。 - 前記対置された2個の組織部分は中央部分にて接続され、
当該インプラントは14〜18センチメートルの範囲の全長を有し、
上記中央部分は2〜3センチメートルの範囲の寸法を有し、且つ、
側辺部は4〜5センチメートルの範囲の長さを有する、請求項2記載のインプラント。 - 電極を備えて成る、請求項1から3のいずれか一項に記載のインプラント。
- 幹細胞を備えて成る、請求項1から4のいずれか一項に記載のインプラント。
- 身体による内方成長を増進する被覆を備えて成る、請求項1から5いずれか一項に記載のインプラント。
- 請求項1から6のいずれか一項に記載のインプラントを備えるキットであって、
上記インプラントは自己定着式先端部を備え、且つ、
該キットは上記自己定着式先端部に係合する挿入ツールを更に備えて成る、キット。 - 前記ツールは深度制限特定構造を有する、請求項7に記載のキット。
- 前記深度制限特定構造は、ニードルにおける鞘体、機械的停止部、屈曲部、および、これらの組み合わせから選択される、請求項8に記載のキット。
Applications Claiming Priority (5)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US86304906P | 2006-10-26 | 2006-10-26 | |
US60/863,049 | 2006-10-26 | ||
US94704407P | 2007-06-29 | 2007-06-29 | |
US60/947,044 | 2007-06-29 | ||
PCT/US2007/022689 WO2008057269A1 (en) | 2006-10-26 | 2007-10-26 | Surgical articles and methods for treating pelvic conditions |
Publications (2)
Publication Number | Publication Date |
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JP2010516299A JP2010516299A (ja) | 2010-05-20 |
JP5129258B2 true JP5129258B2 (ja) | 2013-01-30 |
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Application Number | Title | Priority Date | Filing Date |
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JP2009534668A Expired - Fee Related JP5129258B2 (ja) | 2006-10-26 | 2007-10-26 | 骨盤疾患を治療する手術装置および方法 |
Country Status (10)
Country | Link |
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US (2) | US8517914B2 (ja) |
EP (1) | EP2086465B1 (ja) |
JP (1) | JP5129258B2 (ja) |
KR (1) | KR101169317B1 (ja) |
CN (1) | CN101600402B (ja) |
AT (1) | ATE554725T1 (ja) |
BR (1) | BRPI0718177A2 (ja) |
CA (1) | CA2667193C (ja) |
HK (1) | HK1139030A1 (ja) |
WO (1) | WO2008057269A1 (ja) |
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2007
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- 2007-10-26 JP JP2009534668A patent/JP5129258B2/ja not_active Expired - Fee Related
- 2007-10-26 KR KR1020097008889A patent/KR101169317B1/ko active IP Right Grant
- 2007-10-26 US US12/447,073 patent/US8517914B2/en active Active
- 2007-10-26 EP EP07861526A patent/EP2086465B1/en not_active Not-in-force
- 2007-10-26 BR BRPI0718177-9A patent/BRPI0718177A2/pt not_active Application Discontinuation
- 2007-10-26 CN CN2007800400661A patent/CN101600402B/zh not_active Expired - Fee Related
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Also Published As
Publication number | Publication date |
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CN101600402B (zh) | 2012-12-05 |
CN101600402A (zh) | 2009-12-09 |
KR20090080953A (ko) | 2009-07-27 |
US20120323067A1 (en) | 2012-12-20 |
US10034733B2 (en) | 2018-07-31 |
KR101169317B1 (ko) | 2012-07-30 |
WO2008057269A1 (en) | 2008-05-15 |
AU2007318079A2 (en) | 2009-07-16 |
US8517914B2 (en) | 2013-08-27 |
EP2086465A1 (en) | 2009-08-12 |
CA2667193C (en) | 2016-02-16 |
CA2667193A1 (en) | 2008-05-15 |
WO2008057269A9 (en) | 2008-10-16 |
ATE554725T1 (de) | 2012-05-15 |
BRPI0718177A2 (pt) | 2013-12-17 |
HK1139030A1 (en) | 2010-09-10 |
EP2086465B1 (en) | 2012-04-25 |
JP2010516299A (ja) | 2010-05-20 |
US20100174134A1 (en) | 2010-07-08 |
AU2007318079A1 (en) | 2008-05-15 |
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