JPH08206120A - 外科用器械 - Google Patents

外科用器械

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Publication number
JPH08206120A
JPH08206120A JP6101728A JP10172894A JPH08206120A JP H08206120 A JPH08206120 A JP H08206120A JP 6101728 A JP6101728 A JP 6101728A JP 10172894 A JP10172894 A JP 10172894A JP H08206120 A JPH08206120 A JP H08206120A
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JP
Japan
Prior art keywords
mount
end effector
end effectors
instrument
tube
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English (en)
Inventor
William L Hassler
ウイリアム・エル・ハスラー
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Ethicon Inc
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Ethicon Inc
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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
    • 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
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • 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
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Medical Informatics (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Ophthalmology & Optometry (AREA)
  • Molecular Biology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Agricultural Chemicals And Associated Chemicals (AREA)
  • Manipulator (AREA)

Abstract

(57)【要約】 【目的】 端部効果器の角度調整を容易にする。 【構成】 管状部分と第１及び第２マウント部分と第２
マウント部分に関する第１マウント部分の角度定位の調
整を許容するために第１及び第２マウント部分に関連し
たリスト機構とを有する端部効果器マウントとを含む細
長い管状区分を具備する最小侵襲性外科用器械が記載さ
れる。管状部分は、第２マウント部分の近位端部に旋回
可能に連結される。第１及び第２端部効果器がさらに設
けられ、そして第１マウント部分の遠位端部に旋回可能
に連結される。

Description

【発明の詳細な説明】
【０００１】
【産業上の分野】一般に、本発明は、最小侵襲性外科用
器械に関する。さらに詳細には、本発明は、把持器、解
剖器具、及び鋏の如く、端部効果器を有する最小侵襲性
外科用器具に関する。最も詳細には、本発明は、端部効
果器部分に旋回可能に連結された細長い管状部分を有す
る最小侵襲性外科用器具に関し、後者は、第１及び第２
端部効果器と、第１及び第２マウント部分を有する端部
効果器マウントと、第２マウント部分に関する第１マウ
ント部分の角度位置の調整を許容するために第１及び第
２マウント部分に関連したリスト機構とを含む。
【０００２】
【従来技術及びその課題】最小侵襲性外科手術内に、把
持器、解剖器具、鋏と他の基本外科用器械の如く単純装
置の必要性が認識される。これらの器械は、手術手順
中、単純機能を行うために必要である。具体的に、把持
器の如く装置は、作用される組織が分離され、手術が行
われるように作用部位を適正に取り除くために必要であ
る。鋏は、組織に適切な切り込みを作るために必要とさ
れる。解剖器具は、組織の部分を分離するために必要で
ある。また、これらの器械は、ステープラと結紮用クリ
ップ適用器の如く他の大形器械に、虫垂切除、胆嚢切
除、ヘルニア縫合、等の如く手順中効果的にするために
十分な容積余地を与えることができる。
【０００３】伝統的に、把持器、解剖器具、鋏及び同等
物の如く最小侵襲性外科用器械は、一般直線シャフトに
おいて取り付けられた。これらのシャフトは、縦軸の回
りで回転することができる又はできない。それにも拘わ
らず、シャフトの端部効果器部分が、シャフトの縦軸に
関して角張ることができる必要性が認められた。これに
より、外科医は、斜角から操作される組織に着手するこ
とができる。事実、シャフトの縦軸に関して最大９０°
シャフトを角張らせることが望ましい。多くの点で、こ
の機能は、腕の「軸」の回りで回転し、また、手首の回
りで「角張る」人の手の能力に類似される。もちろん、
手は単なる回転で機能することができるが、手首作用に
よって与えられる自由度は、ずっと大きく、多くの点に
おいて、単純日常機能を行う手の能力を高める。
【０００４】こうして、器械の縦軸に関して角張ること
ができる端部効果器部分を有する最小侵襲性外科用器械
の必要性が認められる。さらに、器械の縦軸に関して角
張ることができるほかに、端部効果器部分の中心軸の回
りの端部効果器の角度位置の調整を許容するための手段
を含む端部効果器部分を有することが望ましい。
【０００５】
【課題を解決するための手段】本発明の第１実施態様に
より、最小侵襲性外科用器械が提供され、器械の縦軸を
規定するシャフトを有する。シャフトは、器械の取手部
分から延びており、器械の縦軸の回りで回転することが
できる。そのような回転はまた、器械の遠位端部に置か
れた鋏又は把持器の如く端部効果器の回転を生じさせ
る。そのような回転は、器械の取手部分に隣接して置か
れたノブを回転させることにより行われる。つかみ又は
切断は、器械の後部に位置する一対の取手の鋏状動作に
よって達成される。一方の取手は、端部効果器に結合さ
れた駆動シャフトに関して固定される。他方の取手は、
固定取手に関して旋回することができる。この旋回移動
は、器械の外側管内に包含された駆動シャフトのすべり
動作を生じさせる。たわみケーブルは、移動のために駆
動シャフトに固定連結される。このたわみ性駆動ケーブ
ルは、Ｕ字形かぎ内で移動し、端部効果器の動作を生じ
させる。このように、器械の動作が達成され、外科医は
定置手位置を維持することができる。
【０００６】この器械はまた、シャフトの縦軸に関する
端部効果器部分の関節接合を提供する。関節接合は、螺
旋溝又はねじ山に機構に含まれた関節管に装着したちょ
う形ナットの直線移動を行わせる前方及び後方関節ノブ
の操作により達成される。移動により、関節管は、端部
効果器部分を外側管の縦軸に関して角張らせる。関節ノ
ブによって生成された関節量により、外側シャフトは、
器械の外側シャフトに関して０°〜９０°角張る。
【０００７】当然、いったん機構が関節でつながれたな
らば、器械が、続いて動作することができることは重要
である。これは、端部効果器と駆動シャフトに結合され
たたわみケーブルの使用により達成される。このたわみ
ケーブルは、関節角形成により生成された角度の回りで
端部効果器を操作することができる。ケーブルの駆動は
そのような角度の回りで達成されるために、端部効果器
は続いて動作することができる。このように、装置の使
用は、シャフトの縦軸の関して０°〜９０°の角度にお
いて為される。
【０００８】ロッキング機構が設けられ、シャフトと端
部効果器部分の回転中、関節接合を防止する。このよう
に、回転動作中、関節接合を行うための手段は、適所に
保持され、器械の縦軸に関する端部効果器部分の関節接
合はない。対照的に、関節接合中、回転機構は、相対回
転位置が維持される如く適所にロックされる。この「ク
ラッチ形式」機構により、使用者は、手術手順中、多く
の様々な機能を達成することができる。
【０００９】本発明の一層の実施態様により、外科用器
械が提供され、細長い管状又はシャフト区分と、第１及
び第２端部効果器と、第１及び第２端部効果器の旋回移
動を行うために第１及び第２端部効果器に連結されたア
クチェータ手段とを有する。細長い管状区分は、管状又
はシャフト部分と端部効果器マウントを含む。管状部分
は、外側管とそれに固定連結されたひじ継手を具備す
る。端部効果器マウントは、第１及び第２マウント部分
と、第２マウント部分に関する第１マウント部分の角度
定位の調整を許容するための第１及び第２マウント部分
に関連したリスト手段とを含む。管状部分は、第２マウ
ント部分の近位端部にひじ継手において旋回可能に連結
される。第１及び第２端部効果器は、第１マウント部分
の遠位端部に旋回可能に連結される。第１マウント部分
の角度定位がリスト手段を介して調整される時、第１及
び第２端部効果器の角度定位は、同様に変化される。
【００１０】リスト手段は、好ましくは、外側管と、バ
ネ保持ピンと、バネとを具備する。外側管は、第１マウ
ント部分の近位端部に固定連結される。それは、内部バ
ネ係合部材と位置係合歯を含む。バネ保持ピンは、外側
管内に位置付けられ、スリーブ部分とバネ接触部分を含
む。スリーブ部分は、第２マウント部分の遠位端部にお
けるボア内に固定して取り付けられる。バネは、バネ保
持ピンのスリーブ部分の回りに位置付けられ、そして第
２マウント部分の遠位端部の方に外側管の近位端部を片
寄らせるために内部バネ係合部材とバネ接触部分の間に
介在される。
【００１１】少なくとも第１及び第２凹部は、第２マウ
ント部分の遠位端部内に形成され、第２マウント部分の
遠位端部の回りで互いに周囲離間される。外側管は、位
置係合歯が第１凹部と係合する第１位置と位置係合歯が
第２凹部と係合する第２位置の間で中央軸の回りで回転
可能である。
【００１２】本発明のいろいろな実施態様は、発明の詳
細な説明に関連して取った添付の図面に関して最良に理
解されるであろう。
【００１３】
【実施例】本発明の第１実施態様により構成された最小
侵襲性外科用手順を行うための器械１が、ここで記載さ
れ、一般に図１に示される。この器械１は、シャフト又
は外側管１０の縦軸の回りで回転することができる端部
効果器部分１００を含み、その軸は器械１の縦軸を規定
する。同様に、端部効果器部分１００は、図４に最良に
示された如く、シャフト１０の縦軸に関して最大９０°
の角度に置かれる如く角張ることができる。
【００１４】図２に示された如く、器械１は、一般に円
筒形で、器械１のほぼ全長に走っている駆動棒３０を含
む。この駆動棒３０は、関節管２０内に位置付けられ
る。関節管２０はまた、円筒形であり、駆動棒３０に関
して縦に移動させることができる。さらに、関節管２０
と駆動棒３０は、器械１の外側管１０内にはまる。管１
０と２０は一般円形断面を有するとして例示の実施態様
に示されるが、それらは、所与の応用又は外観目的のた
めに望ましい幾何断面を有しても良い。棒３０はまた、
合理的な断面を有するように形成される。しかし、棒３
０は、一般に、管２０と同一断面を有する。
【００１５】器械１の駆動部分と端部効果器が、以下に
記載される。駆動棒３０は、外側管１０に関して縦に移
動することができる。この駆動棒３０は、その遠位端部
において、クリンプ３２における駆動ケーブル５０に連
結される。この駆動ケーブル５０は、ケーブルスリーブ
１４０内に確実にはまる。駆動ケーブル５０の遠位部分
において、端部１０２において半田付けとクリンピング
を介して棒端部１０１が装着される。この棒端部１０１
は、端部効果器６０と７０の旋回移動を行うことができ
る。棒端部１０１は、Ｕ字形かぎ４０の縦中心４２内に
保持される。駆動ケーブル５０はまた、Ｕ字形かぎ４０
の中心４２内に確実にはまり、そして棒端部１０１と駆
動ケーブル５０の両方は、Ｕ字形かぎ４０に関して移動
することができる。
【００１６】駆動ケーブル５０がＵ字形かぎ４０に関し
て移動される時、それは、棒端部１０１をＵ字形かぎ４
０に関して縦に案内する。そうする際に、棒端部１０１
は、あごリンク８０の対を旋回させる。これらのあごリ
ンク８０は、旋回点１０３において棒端部１０１で回転
する。図２に最良に示された如く、あごリンク８０は、
駆動棒３０の中心軸から外側へ張り出すフレア端部８２
を含む。
【００１７】棒リンク８０の遠位端部において、器械の
端部効果器が装着される。例えば、この例において、つ
かみ機構の上あご６０と下あご７０を具備する端部効果
器が示される。しかし、これらの端部効果器は、鋏又は
解剖器具、若しくは他の外科用器具でもあることが理解
される。必要なものは、端部効果器６０、７０は、あご
リンク８０が端部効果器６０、７０を移動させるため
に、あごリンク８０の遠位端部８４にそれぞれの近位端
部６２、７２において装着されることである。
【００１８】こうして、駆動棒３０が使用者に向かって
近位に移動される時、駆動ケーブル５０も、同様に、近
位方向に引っ張られる。この駆動ケーブル５０は、同様
に近位方向に移動する如く、棒端部１０１を引っ張るこ
とができる。あごリンク８０は、旋回点１０３の対にお
いて棒端部１０１に連結されるために、あごリンク８０
は、同様に、近位方向に引っ張られる。このように、あ
ごリンク８０は、駆動棒３０の縦軸に関して、外側フレ
ア位置から内側フレア位置に回転する。これが行われる
時、遠位端部におけるあごリンク８０は、端部効果器６
０、７０の近位端部を器械の縦軸の方に回転させる。端
部効果器６０、７０は、Ｕ字形かぎ４０の遠位端部に含
めた旋回穴４４に装着した肩ねじ９０の回りで点６４、
７４において旋回される。こうして、端部効果器６０、
７０は、同様に、全機構が「閉じられる」如く、Ｕ字形
かぎ４０の回りで回転する。
【００１９】他方、駆動棒３０が遠位に押される時、棒
端部１０１は、あごリンク８０を駆動棒３０の縦軸から
外側に張り出させる。この外側フレアは、端部効果器６
０、７０の端部６６、７６を同様に外側に移動させる。
端部効果器６０、７０は、Ｕ字形かぎ４０の端部におい
て旋回穴４４に連結した肩ねじ９０の回りで点６４、７
４において旋回する。こうして、この回転により、端部
効果器６０、７０はまた旋回し、その結果、装置が
「開」になる。このため、この方式により、駆動棒３０
の往復動作は、器械１の端部効果器６０、７０を動作さ
せる。
【００２０】駆動棒３０は、器械１の関節管２０と外側
管１０の両方に関して移動することができることが理解
される。この方式で、駆動棒３０の動作は、関節管２０
又は外側管１０のいずれの相対位置付けに拘わらず行う
ことができる。こうして、駆動棒３０の動作は、器械１
の任意の回転位置において端部効果器６０、７０を性能
を生じさせることができる。
【００２１】端部効果器部分１００の関節接合が、以下
に記載される。この関節接合は、機構の外側管１０に関
して関節管２０の動作を観察することから最良に理解さ
れる。関節管２０は、その遠位端部２２において、摺動
ひじ継手１２０の内部室１２２に溶接により連結され
る。外側管１０の遠位端部１２は、固定ひじ継手１３０
の近位端部に含まれた小外周囲１３２にはまり、そして
硬直に連結される。このため、摺動ひじ継手１２０は、
器械１の縦軸に沿って外側管１０に関して移動すること
ができる。これは、例えば、図１と図４に見られる。そ
こでは、関節管２０は遠位に移動する。同様に、摺動ひ
じ継手１２０は、関節管２０によって遠位に移動されて
いる。以下にさらに議論される如く、このすべり動作
は、器械１の端部効果器部分１００の角張りを生じさせ
る。
【００２２】摺動ひじ継手１２０の遠位端部１２４は、
ピン１５０によってひじ継手リンク１１０の近位端部１
１２に連結される。このひじ継手リンク１１０は、その
反対又は遠位端部１１４において、Ｕ字形かぎ４０のタ
ブ１４６における旋回穴４６に類似ピン１５０によって
連結される。同様に、Ｕ字形かぎ４０は、固定ひじ継手
１３０に反対タブ１４８における旋回穴４８においてピ
ン１５０によって連結される。これらの連結部がこの方
式で配置されると、器械の縦軸に関する端部効果器部分
１００の角張りが達成される。こうして、関節管２０が
遠位に移動される時、摺動ひじ継手１２０はまた、遠位
に移動される。摺動ひじ継手１２０のこの遠位移動は、
摺動ひじ継手１２０に連結された近位端部１１２の回り
のひじ継手リンク１１０の回転を生じさせる。そのよう
な動作は、同様に、ひじ継手リンク１１０とＵ字形かぎ
４０を連結する遠位端部１１４の回りのひじ継手リンク
１１０の動作を生じさせる。しかし、Ｕ字形かぎ４０
は、外側管１０に連結された固定ひじ継手１３０にタブ
１４８において固定されるために、Ｕ字形かぎ４０は、
一般４バーリンク機構の方法で、外側管１０の縦軸に関
して回転させられる。これは、動作が達成されている図
４に最良に見られる。そこでは、摺動ひじ継手１２０の
遠位動作は、外側管１０の縦軸からのＵ字形かぎ４０の
角張りを生じさせていることが見られる。もちろん、関
節管２０の近位動作によって生じた摺動ひじ継手１２０
の近位動作は、Ｕ字形かぎ４０と外側管１０の縦軸の間
の角張りがない位置へのＵ字形かぎ４０の戻り回転を生
じさせる。
【００２３】外側管１０に関するＵ字形かぎ４０の角張
りにおいて器械１の動作を達成することが望ましい。こ
うして、駆動棒３０がＵ字形かぎ４０の角度位置におい
てＵ字形かぎ４０に関して移動することができることは
重要である。これは、駆動ケーブル５０への駆動棒３０
の装着により達成される。駆動ケーブル５０はたわみ性
であるために、それは、Ｕ字形かぎ４０が外側管１０、
関節管２０と駆動棒３０に対してある角度で位置付けら
れる時、Ｕ字形かぎ４０に関して移動することができ
る。駆動ケーブル５０の部分は、テフロンの如く低摩擦
材料から作製されたケーブルスリーブ１４０を通ってお
り、そしてこのため、Ｕ字形かぎ４０内の駆動ケーブル
５０の動作は、容易に達成される。ケーブルスリーブ１
４０は、代替的に、ワイヤ巻案内スリーブ（不図示）を
具備する。
【００２４】こうして、駆動ケーブル５０の動作は、関
節形式の最小侵襲性外科用器械にとって今まで可能でな
かった９０°においても、外側管１０に関してＵ字形か
ぎ４０の角度位置において達成される。
【００２５】器械の端部効果器部分１００が記載された
が、この器械１は、器械１の制御部分に関連して理解さ
れなければならない。端部効果器６０、７０の関節接合
と動作が達成されるが、３つの部分のみが取手内にある
ことが記憶しなければならない。すなわち、外側管１
０、関節管２０と駆動棒３０のみが、器械１の取手区分
内にある。重要なことには、外側管１０は、器械１の関
節ノブ２６０の前部に隣接して位置付けられた端部キャ
ップ２４０にそのフランジ１４を介して連結されること
が注目される。これは、図３〜図５に最良に見られる。
関節管２０は、ちょう形ナット２５０に圧入又は他の方
法で連結され、その結果、ちょう形ナット２５０の動作
は、管２０の動作を生じさせる。図５を参照せよ。駆動
棒３０は、全器械１を通っており、そして器械１の近位
端部において包含したトリガー３５０内に維持された駆
動ボール３１０にその近位端部において連結される。こ
の駆動ボール３１０は、止めねじ３２０によって駆動棒
３０に固着される。
【００２６】トリガー３５０は、旋回穴３５２、３６２
において取手とトリガーの両方を連結するピン３３０を
介して器械の取手３６０の回りで回転することができ
る。このピン３３０は、図３により良く見られる如く、
トリガーカバー３４０によって適所に保持される。こう
して、この器械の端部効果器６０、７０の駆動は、取手
３６０に関するトリガー３５０の鋏作用によってのみ達
成されることが容易に理解される。トリガー３５０が取
手３６０に接近するように回転される時、駆動ボール３
１０は、取手３６０に関して近以に旋回させられる。駆
動ボール３１０のこの近位動作は、駆動棒３０の近位動
作を生じさせ、結果的に、端部効果器６０、７０の閉鎖
を生じさせる。取手３６０からのトリガー３５０の動作
は、駆動棒３０の遠位動作が生じる如くピン３３０の回
りの旋回を生じさせる。このようにして、駆動棒３０の
遠位端部３２における遠位動作が生じ、端部効果器あご
６０、７０を互いに離反させ、そしてこのため、鋏又は
把持器又は他の外科用端部効果器の開放を達成する。
【００２７】器械１の駆動能力は、この器械１の回転に
関連してさらに取られた、上記の関節接合又は角張りに
関連して理解されなければならない。最初に、この器械
の関節接合の見地が記載される。関節接合は、関節ノブ
２６０と後部関節ノブ２７０を具備する関節ノブ組立体
によって達成され、このノブ２６０、２７０は、相互に
確実に固着される。この関節ノブ組立体内に位置付けら
れ、二重溝付き管１６０の溝穴１６４内にはめ合わされ
て、関節ちょう形ナット２５０がある。溝付き管１６０
は、ねじ山１６２においてキャップ２４０にねじ込めら
れる。バネ２３０は、溝穴１６４内の関節ちょう形ナッ
ト２５０の動作を規制する。関節ちょう形ナット２５０
は、上記の如く、関節駆動管２０に連結される。従っ
て、関節ちょう形ナット２５０の移動は、駆動管２０を
して器械１の遠位端部における端部効果器６０、７０と
Ｕ字形かぎ４０を移動させる。もちろん、外側管１０は
フランジ１４において端部キャップ２４０に連結される
ために、関節接合が達成される時、関節管２０は、外側
管１０に関して移動することができる。
【００２８】関節接合を行うことが望ましい時、使用者
は、関節ノブ組立体を回転させる。このようにして、前
方関節ノブ２６０の螺旋雌ねじ又は溝２６２と後方関節
ノブ２７０の螺旋雌ねじ又は溝２７０ａは、図５を参照
すると、関節ちょう形ナット２５０の翼２５２と器械１
の残部の間の相対動作を生じさせる。言い換えれば、時
計回り動作により、関節ちょう形ナット２５０は、使用
者の方に近位に引っ張られる。このようにして、関節管
２０は、同様に近位に移動し、このため、摺動ひじ継手
１２０はまた、近位に移動される。これは、器械１の外
側管１０の縦軸に関してＵ字形かぎ４０をまっすぐにす
る傾向がある。逆に、ノブ２６０、２７０が反時計回り
に移動される時、ノブ２６０、２７０の螺旋溝２６２、
２７０ａは、関節ちょう形ナット２５０を溝穴１６４内
で遠位に移動させる。この遠位動作は、摺動ひじ継手１
２０の遠位動作を生じさせ、そしてまた、外側管１０の
縦軸に関するＵ字形かぎ４０の角張りを生じさせる。
【００２９】螺旋溝２６２と２７０ａは、ノブ２６０、
２７０の回転動作を関節管２０の直線動作に変換する。
この回転動作は、動作と関節接合の間に一般１対１比を
与える。こうして、ほぼ１２０°のノブ回転が、９０°
のシャフト関節接合のために必要とされる。こうして、
使用者は、（使用者の展望から）比較的容易な動作長で
Ｕ字形かぎ４０の角張りに対して一般的「感じ」を得る
ことができる。
【００３０】次に、この器械１の回転動作を記載するこ
とが必要である。しかし、そうするために、器械１の関
節部分と器械１の回転部分の間の相互関係を理解するこ
とが、まず、必要である。一般に、図から見られる如
く、回転バネ２２０は、回転ノブ２９０を器械１内で近
位に移動させる。この回転ノブ２９０は、一連のロッキ
ングつめ車をその内部に含む。これらのロッキングつめ
車２９２は、回転ロック３００のつめ車３０２とかみ合
うことができる。回転ロック３００は、取手３６０にお
ける開口３６４内に接着固定される。ロック３００の近
位端部における開口３６４内に、取手３６０における開
口３６４内の適所に管１８０を固定するために役立つ保
持リング２００が位置付けられる。図５を参照せよ。
【００３１】回転バネ２２０が回転ノブ２９０を押す
時、それは、回転ノブ２９０におけるロッキングつめ車
２９２を回転ロックつめ車３０２とかみ合わせ、その結
果、回転ノブ２９０は、取手３６０に関して静的に保持
される。こうして、一般に、使用者が関節ノブ２６０、
２７０を回転させる時、これは、定置外側管１０に関す
る関節ちょう形ナット２５０とその付随する関節管２
０、端部キャップ２４０、定置取手３６０、トリガー３
５０、及び回転ノブ２９０の動作を生じさせる。
【００３２】後部関節ノブ２７０と回転ノブ２９０の間
に、関節つめ車ロック２８０が介在される。それは、後
部関節ノブ２７０の近位部分２７４に含まれたローレッ
ト２７２と相互作用する一連のローレット２８２を含
む。回転ノブ２９０の中心を通って、管１８０がある。
この管１８０は、上記の如く、保持リング２００によっ
て固定取手３６０内に保持される。管１８０は、確実に
固定されるように溝付き管１６０のねじ１６６にかみ合
わせるその遠位端部においてねじ１８４を有する。関節
ノブ２６０、２７０は、取手３６０に関して自由に回転
し、このため、関節ちょう形ナット２５０は、取手３６
０／トリガー３５０の組み合わせに関して移動すること
ができる。駆動管３０は、前述の如く、約１０ｍｍの管
１８０の中心１８６を通って取手３６０内に達する。
【００３３】関節バネ２１０は、関節つめ車ロック２８
０とバネ保持器１７０の間に置かれる。関節つめ車ロッ
ク２８０、バネ２１０とバネ保持器１７０は、一緒に、
止め輪１９０の間に位置付けられる。後部関節ノブ２７
０は、最遠位止め輪１９０の遠位側に位置し、そして止
め輪１９０によって近位に移動するのを防止される。回
転バネ２２０よりも剛性の関節バネ２１０は、自由浮動
関節つめ車ロック２８０におけるローレット２８２を後
部関節ノブ２７０におけるローレット２７２と係合させ
る。こうして、回転ノブ２９０がロック３００と係合さ
れ、関節ノブ２６０、２７０が定置回転ノブ２９０に関
して回転される時、関節ノブ２７０は、そのローレット
２７２がつめ車ロック２８０におけるローレット２８２
上をすべる如く、定置つめ車ロック２８０に関して移動
する。回転バネ２２０は、関節つめ車ロック２８０と回
転ノブ２９０の間に位置付けられ、回転つめ車ロック３
００との係合に回転ノブ２９０を付勢する。図５を参照
せよ。
【００３４】取手３６０に関して管１０、２０と駆動棒
３０を回転させることが望まれる時、使用者は、遠位力
を回転ノブ２９０に課し、同ノブを回転させる。回転ノ
ブ２９０における遠位力は、回転ノブ２９０におけるロ
ッキングつめ車２９２をロック３００における回転ロッ
クつめ車３０２から解除させる。回転ノブ２９０には、
ノブ２９０がロック３００と係合される時も、溝付き管
１６０における溝穴１６８内に入り込む２つの耳部２９
０ａを設けてある。図５を参照せよ。つめ車ロック２８
０はまた、溝付き管１６０における溝穴１６８内に入り
込む耳部２８０ａを含む。ロックつめ車３０２とロッキ
ングつめ車２９２の解除と回転ノブ２９０の回転によ
り、溝付き管１６０は、回転され、関節ちょう形ナット
２５０とその付随する関節管２０、端部キャップ２４０
と外側管１０、及びつめ車ロック２８０の回転を生じさ
せる。つめ車ロック２８０の回転は、ローレット２８２
とローレット２７２の係合により、関節ノブ２６０と２
７０の回転を行わせる。こうして、回転ノブ２９０の遠
位動作は、全回転機構の「ロッキングアップ(locking-u
p)」を生じさせる。このようにして、回転ノブ２９０の
回転は、溝付き管１６０の回転を生じさせ、また、端部
キャップ２４０と外側管１０の回転とともにちょう形ナ
ット２５０と関節管２０の回転を生じさせる。この回転
は、さらに、固定ひじ継手１３０、Ｕ字形かぎ４０と端
部効果器６０、７０の同時回転を生じさせる。
【００３５】端部効果器６０、７０は駆動ケーブル５０
を介して駆動棒３０に連結されるために、これは、全機
構内に駆動棒３０の回転を生じさせる。（通常、駆動棒
３０は関節管２０と外側管１０に独立に移動することを
記憶しておくべきである。）駆動管３０の回転は、取手
３６０内のボール３１０の回転を生じさせる。こうし
て、駆動棒３０の方向付けは、取手３６０内で行われ
る。しかし、トリガー３５０は、駆動棒３０の任意の回
転位置において駆動棒３０の動作を生じさせることがで
きるために、取手３６０／トリガー３５０の組み合わせ
は使用されない。
【００３６】本発明の第２実施態様により構成された端
部効果器部分４００が、図６〜図１４を参照して記載さ
れる。この場合同様の要素は、同様の番号によって参照
される。この実施態様において、端部効果器部分４００
は、端部効果器マウント４２４と、マウント４２４の遠
位端部に旋回可能に連結された第１及び第２端部効果器
６０と７０とを含む。端部効果器マウント４２４には、
３位置リスト４１０と、リスト４１０に関連した第１及
び第２マウント部分４２０と４２２とを設けてある。図
６を参照せよ。以下にさらに明確に記載された如く、リ
スト４１０を回転させることにより、端部効果器６０と
７０は、図７に示された軸４３０に対して、それぞれ、
０°、４５°と９０°の角度において位置する第１、第
２及び第３位置の間の端部効果器部分４００の中心軸の
回りで回転される。端部効果器部分４００の中心軸の回
りの端部効果器６０と７０の回転は、回転ノブ２９０を
旋回させることにより行われる取手３６０に関する管１
０、２０と駆動棒３０の回転から独立である。
【００３７】図１０〜図１３を参照すると、リスト４１
０は、外側管４１２、バネ４１４とバネ保持ピン４１６
を具備する。外側管４１２の遠位端部４１２ａは、第１
マウント部分４２０の近位端部において拡張部分４２０
ａに圧入されるか、又は他の方法で確実に固定される。
外側管４１２は、内部バネ係合部材を含み、例示の実施
態様において、外側管４１２における内周凹部４１２ｂ
内に位置する止め輪４１２ｃを具備する。止め輪４１２
ｃの代わりに、外側管４１２は、内部バネ係合部材とし
て機能する一体肩（不図示）を有して形成される。外側
管４１２は、さらに、内部位置係合歯４１２ｄを含む。
【００３８】バネ保持ピン４１６は、外側管４１２内に
位置付けられ、そしてスリーブ部分４１６ａとバネ接触
部分４１６ｂを含む。スリーブ部分４１６ａは、第２マ
ウント部分４２２の遠位端部において拡張部分４２２ｂ
のボア４２２ａ内に圧入されるか、又は他の方法で固定
して取り付けられる。バネ４１４は、バネ保持ピン４１
６のスリーブ部分４１６ａの回りに位置付けられ、内部
バネ係合部材４１２ｃとバネ接触部分４１６ｂの間に介
在され、外側管４１２の近位端部４１２ｅを第２マウン
ト部分４２２の遠位側壁４２２ｃの方に片寄らせる。図
１０と図１１を参照せよ。
【００３９】３つの凹部４４０ａ〜４４０ｃは、第２マ
ウント部分４２２の拡張部分４２２ｂにおいて形成さ
れ、拡張部分４２２ｂの回りで互いに周囲離間される。
図１４を参照せよ。内部位置係合歯４１２ｄは、リスト
４１０をロックするために、３つの凹部４４０ａ〜４４
０ｃの一つと係合し、このため、軸４３０に対してそれ
ぞれ０°、４５°と９０°の角度において離間された３
つの位置の一つにおいて、端部効果器６０と７０と係合
する。図７と図１２を参照せよ。３つの凹部４４０ａ〜
４４０ｃは、第２マウント部分４２２の拡張部分４２２
ｂにおいて壁４２２ｄと４２２ｅと歯４２２ｆと４２２
ｇによって規定される。
【００４０】外科医は、第２マウント部分４２２に関し
て外側管４１２の角度位置を変更することにより、管１
０をトロカール（不図示）に挿入する前に、端部効果器
６０と７０の角度位置を変化させる。これは、まず、外
側管４１２をつかみ、第２マウント部分４２２の遠位側
壁４２２ｃから矢印４３２によって表記された縦方向に
おいてそれを移動させることにより達成され、その結
果、歯４１２ｄが係合した凹部から回収される。図１１
を参照せよ。それから、外科医は、外側管４１２を新所
望位置に回転させ、そしてその近位端部４１２ｅがバネ
４１４によって第２マウント部分４２２の遠位端壁４２
２ｃの方に戻される如く、管４１２を解放させる。管４
１２が第２マウント部分４２２の方に移動される時、歯
４１２ｄは、新位置において凹部と係合する。
【００４１】外側管４１２の遠位端部４１２ｅは、イン
デントマーク４１２ｆを設けられ、そして第２マウント
部分４２２は、３つのインデントマーク４２２ｇ〜４２
２ｉを設けられる。第２マウント部分４２２に関する外
側管４１２の位置は、第２マウント部分４２２における
３つのマーク４２２ｇ〜４２２ｉのどれが外側管４１２
におけるマーク４１２ｆから位置付けられるかを観察す
ることにより決定される。
【００４２】図８と図１０〜図１２に示された如く、駆
動ケーブル５０は、リスト４１０を通っており、棒端部
１０１とあごリンク８０を介して端部効果器６０と７０
に結合される。端部効果器部分４００の関節接合は、本
発明の第１実施態様に関して上記と同様の方法において
ノブ２６０と２７０を介して行われる。取手３６０に関
する管１０と２０及び駆動棒３０の回転は、本発明の第
１実施態様に関して上述されたと同様の方法で回転ノブ
２９０を介して行われる。
【００４３】例示の実施態様において、３つの凹部４４
０ａ〜４４０ｃが開示されたが、２つ又は４つ以上の凹
部が設けられることが、本発明によって考えられる。
【００４４】代表的な実施態様と詳細が発明を例示する
目的のために示されたが、ここで開示された方法と装置
における多様な変化が、添付のクレイムにおいて規定さ
れた発明の範囲に反することなく行われることは、技術
における当業者には明らかである。
【００４５】本発明の主なる特徴及び態様は以下のとお
りである。
【００４６】１．管状部分と端部効果器マウントを含む
細長い管状区分であり、該端部効果器マウントは、第１
及び第２マウント部分と、該第２マウント部分に関する
該第１マウント部分の角度位置の調整を許容する該第１
及び第２マウント部分に関連したリスト手段とを有し、
該管状部分は該第２マウント部分の近位端部に連結され
る細長い管状区分と、該第１マウント部分の遠位端部に
旋回可能に連結された第１及び第２端部効果器と、該第
１及び第２端部効果器の旋回移動を行わせるために該第
１及び第２端部効果器に連結されたアクチュエータ手段
とを具備する外科用器械。
【００４７】２．該端部効果器マウントが、該管状部分
に旋回可能に連結される上記１に記載の外科用器械。
【００４８】３．該管状部分に関する該端部効果器マウ
ントの旋回移動を行わせるために該端部効果器マウント
に連結された手段をさらに含む上記２に記載の外科用器
械。 ４．該管状部分に関する該端部効果器マウントの旋回移
動を行わせるための該手段が、該第２マウント部分の近
位端部にその遠位端部において連結された関節管と、該
関節管を往復移動させるために該関節管の近位端部に連
結された手段とを具備する上記３に記載の外科用器械。
【００４９】５．該管状部分の縦軸の回りの該第１及び
第２端部効果器、該端部効果器マウント、及び該管状部
分の同時回転を行わせるための手段をさらに含む上記４
に記載の外科用器械。
【００５０】６．該リスト手段が、該第１マウント部分
の近位端部に固定連結された外側管であり、内部バネ係
合部材と内部位置係合歯を含む外側管と、該外側管内に
位置付けられ、スリーブ部分とバネ接触部分を含むバネ
保持ピンであり、該スリーブ部分は、該第２マウント部
分の遠位端部におけるボア内に固定して取り付けられる
バネ保持ピンと、該バネ保持ピンの該スリーブ部分の回
りに位置付けられ、該内部バネ係合部材と該バネ接触部
分の間に介在され、該外側管の近位端部を該第２マウン
ト部分の該遠位端部の方に片寄らせるバネと、該第２マ
ウント部分の該遠位端部内に形成され、該第２マウント
部分の該遠位端部の回りで互いに周囲離間された少なく
とも第１及び第２凹部であり、該外側管は、該位置係合
歯が該第１凹部と係合する第１位置と該位置係合歯が該
第２凹部と係合する第２位置の間で該端部効果器マウン
トの中心軸の回りで回転可能であり、該第２マウント部
分に関する該第１マウント部分の角度位置の調整を行わ
せる少なくとも第１及び第２凹部とを具備する上記１に
記載の外科用器械。
【００５１】７．該内部バネ係合部材が、該外側管にお
ける内周凹部内に位置する止め輪を具備する上記６に記
載の外科用器械。
【００５２】８．該リスト手段が、該第２マウント部分
の該遠位端部内に形成された第３凹部をさらに含み、該
第２及び第３凹部が、該第１凹部から、それぞれ、約４
５°と９０°離間される上記６に記載の外科用器械。
【００５３】９．該アクチュエータ手段が、第２取手区
分に関する旋回移動のために連結された第１取手区分
と、該第２取手区分に関する該第１取手区分の旋回移動
により、該第１及び第２端部効果器の旋回移動を行わせ
るために、該第１及び第２端部効果器の近位端部と該第
１取手区分とに連結された手段とを具備する上記１に記
載の外科用器械。
【００５４】１０．該第１及び第２端部効果器が、相互
に旋回可能に連結された第１及び第２切刃を具備する上
記１に記載の外科用器械。
【００５５】１１．管状部分、及び第１及び第２マウン
ト部分と該第２マウント部分に関する該第１マウント部
分の角度定位の調整を許容する該第１及び第２マウント
部分に関連したリスト手段とを有する端部効果器マウン
トを含む細長い管状区分であり、該管状部分は該第２マ
ウント部分の近位端部に旋回可能に連結される細長い管
状区分と、該第１マウント部分の遠位端部に旋回可能に
連結された第１及び第２端部効果器と、該第１及び第２
端部効果器の旋回移動を行わせるために該第１及び第２
端部効果器に連結されたアクチュエータ手段とを具備す
る外科用器械。
【００５６】１２．該管状部分に関する該端部効果器マ
ウントの旋回移動を行わせるために該端部効果器マウン
トに連結された手段をさらに含む上記１１に記載の外科
用器械。
【００５７】１３．該管状部分に関する該端部効果器マ
ウントの旋回移動を行わせるための該手段が、該第２マ
ウント部分の近位端部にその遠位端部において連結され
た関節管と、該関節管を往復移動させるために該関節管
の近位端部に連結された手段とを具備する上記１２に記
載の外科用器械。
【００５８】１４．該管状部分の縦軸の回りの該第１及
び第２端部効果器、該端部効果器マウント、及び該管状
部分の同時回転を行わせるための手段をさらに含む上記
１３に記載の外科用器械。
【００５９】１５．該リスト手段が、該第１マウント部
分の近位端部に固定連結された外側管であり、内部バネ
係合部材と位置係合突起を含む外側管と、該外側管内に
位置付けられ、スリーブ部分とバネ接触部分を含むバネ
保持ピンであり、該スリーブ部分は、該第２マウント部
分の遠位端部におけるボア内に固定して取り付けられる
バネ保持ピンと、該バネ保持ピンの該スリーブ部分の回
りに位置付けられ、該内部バネ係合部材と該バネ接触部
分の間に介在され、該外側管の近位端部を該第２マウン
ト部分の遠位端部の方に片寄らせるバネと、該第２マウ
ント部分の該遠位端部内に形成され、該第２マウント部
分の該遠位端部の回りに互いに周囲離間された少なくと
も第１及び第２凹部であり、該外側管は、該位置係合突
起が該第１凹部と係合する第１位置と該位置係合突起が
該第２凹部と係合する第２位置の間で該端部効果器マウ
ントの中心軸の回りで回転可能であり、該第２マウント
部分に関する該第１マウント部分の角度定位の調整を行
わせる少なくとも第１及び第２凹部とを具備する上記１
１に記載の外科用器械。 １６．該内部バネ係合部材が、該外側管における内周凹
部内に位置する止め輪を具備する上記１５に記載の外科
用器械。
【００６０】１７．該リスト手段が、該第２マウント部
分の該遠位端部内に形成された第３凹部をさらに含み、
該第２及び第３凹部が、該第１凹部から、それぞれ、約
４５°と９０°離間される上記１５に記載の外科用器
械。
【００６１】１８．該アクチュエータ手段が、第２取手
区分に関する旋回移動のために連結された第１取手区分
と、該第２取手区分に関する該第１取手区分の旋回移動
により、相互に関する該第１及び第２端部効果器の接離
移動を行わせるために、該第１及び第２端部効果器の近
位端部と該第１取手区分とに連結された手段とを具備す
る上記１１に記載の外科用器械。
【００６２】１９．細長いシャフト部分と、第１及び第
２マウント部分と、該第２マウント部分に関する該第１
マウント部分の角度位置の調整を許容するために該第１
及び第２マウント部分に関連したリスト手段とを有する
端部効果器マウントを含む端部効果器部分であり、該端
部効果器部分は、さらに、該第１マウント部分の遠位端
部に旋回可能に連結された第１及び第２端部効果器を含
み、該シャフト部分は、該第２マウント部分の近位端部
に連結される端部効果器部分と、該第１及び第２端部効
果器の旋回移動を行わせるために該第１及び第２端部効
果器に連結されたアクチュエータ手段とを具備する外科
用器械。
【００６３】２０．該シャフト部分が、該第２マウント
部分の該近位端部に旋回可能に連結される上記１９に記
載の外科用器械。
【図面の簡単な説明】
【図１】本発明の第１実施態様により構成された最小侵
襲性外科用器械の斜視図である。
【図２】図１に示された器械の端部効果器部分、外側
管、関節管と駆動棒を示す分解組立て図である。
【図３】図１に示された器械の取手部分の分解組立て図
である。
【図４】図１に示された器械の関節端部の斜視図であ
る。
【図５】図１に示された器械の部分断面側面図である。
【図６】本発明の第２実施態様により構成された外科用
器械の斜視図である。
【図７】端部効果器が第１角度位置において示され、２
つの付加的角度位置において仮線でさらに示された、図
６に示された器械の端部効果器部分の端面図である。
【図８】図６に示された器械の端部効果器部分、外側
管、関節管と駆動棒を示す分解組立て図である。
【図９】図６に示された器械のリストの斜視図である。
【図１０】図９における切断線１０−１０に沿って一般
に取られた図である。
【図１１】図１０に類似するが、第２マウント部分の遠
位端部から変位されたリストの外側管を示す断面図であ
る。
【図１２】図９における切断線１２−１２に沿って一般
に取られた断面図である。
【図１３】図６に示された器械のリストの分解図であ
る。
【図１４】図１３における線１４−１４に沿って取られ
た図である。
【符号の説明】
１０ 外側管 ２０ 間接管 ３０ 駆動棒 ４０ Ｕ字形かぎ ５０ 駆動ケーブル ６０ 端部効果器 ７０ 端部効果器 ８０ あごリンク

Claims (3)

    【特許請求の範囲】
  1. 【請求項１】 管状部分と端部効果器マウントを含む細
    長い管状区分であり、該端部効果器マウントは、第１及
    び第２マウント部分と、該第２マウント部分に関する該
    第１マウント部分の角度位置の調整を許容する該第１及
    び第２マウント部分に関連したリスト手段とを有し、該
    管状部分は該第２マウント部分の近位端部に連結される
    細長い管状区分と、 該第１マウント部分の遠位端部に旋回可能に連結された
    第１及び第２端部効果器と、 該第１及び第２端部効果器の旋回移動を行わせるために
    該第１及び第２端部効果器に連結されたアクチュエータ
    手段とを具備することを特徴とする外科用器械。
  2. 【請求項２】 管状部分、及び第１及び第２マウント部
    分と該第２マウント部分に関する該第１マウント部分の
    角度定位の調整を許容する該第１及び第２マウント部分
    に関連したリスト手段とを有する端部効果器マウントを
    含む細長い管状区分であり、該管状部分は該第２マウン
    ト部分の近位端部に旋回可能に連結される細長い管状区
    分と、 該第１マウント部分の遠位端部に旋回可能に連結された
    第１及び第２端部効果器と、 該第１及び第２端部効果器の旋回移動を行わせるために
    該第１及び第２端部効果器に連結されたアクチュエータ
    手段とを具備する外科用器械。
  3. 【請求項３】 細長いシャフト部分と、 第１及び第２マウント部分と、該第２マウント部分に関
    する該第１マウント部分の角度位置の調整を許容するた
    めに該第１及び第２マウント部分に関連したリスト手段
    とを有する端部効果器マウントを含む端部効果器部分で
    あり、該端部効果器部分は、さらに、該第１マウント部
    分の遠位端部に旋回可能に連結された第１及び第２端部
    効果器を含み、該シャフト部分は、該第２マウント部分
    の近位端部に連結される端部効果器部分と、 該第１及び第２端部効果器の旋回移動を行わせるために
    該第１及び第２端部効果器に連結されたアクチュエータ
    手段とを具備することを特徴とする外科用器械。
JP6101728A 1993-04-20 1994-04-18 外科用器械 Pending JPH08206120A (ja)

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US5374277A (en) 1994-12-20
DE69404526D1 (de) 1997-09-04
ATE155989T1 (de) 1997-08-15
AU6055394A (en) 1994-10-27
EP0621009A1 (en) 1994-10-26
EP0621009B1 (en) 1997-07-30
DE69404526T2 (de) 1997-12-18
CA2121533A1 (en) 1994-10-21
ES2105517T3 (es) 1997-10-16

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