JP3399651B2 - 外科用電気ステープル装置 - Google Patents

外科用電気ステープル装置

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Publication number
JP3399651B2
JP3399651B2 JP19017894A JP19017894A JP3399651B2 JP 3399651 B2 JP3399651 B2 JP 3399651B2 JP 19017894 A JP19017894 A JP 19017894A JP 19017894 A JP19017894 A JP 19017894A JP 3399651 B2 JP3399651 B2 JP 3399651B2
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Prior art keywords
tissue
pole
interface surface
surgical
end effector
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JPH07171159A (ja
Inventor
デビット・シー・ヤッツ
ジェシー・ジェイ・クーンズ
スティーブン・エイチ・マーシュ
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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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A61B18/1447—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod wherein sliding surfaces cause opening/closing of the end effectors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
    • A61B17/1155—Circular staplers comprising a plurality of staples
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1402—Probes for open surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00491—Surgical glue applicators
    • A61B2017/00504—Tissue welding
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00404—Blood vessels other than those in or around the heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00601—Cutting

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Molecular Biology (AREA)
  • Public Health (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Veterinary Medicine (AREA)
  • Physics & Mathematics (AREA)
  • Plasma & Fusion (AREA)
  • Otolaryngology (AREA)
  • Surgical Instruments (AREA)
  • Massaging Devices (AREA)

Description

【発明の詳細な説明】
【０００１】
【産業上の利用分野】この発明は、ステープル手段と発
熱エネルギーを用いる、外科処置での焼灼，凝固及び／
又は組織の結合又は溶接用装置に関するものである。
【０００２】
【従来の技術】組織の切開を伴う外科処置では、切開部
で出血する。外科医が出血を制御する手段を有する前
は、血液が過剰に損失するため多くの外科処置を達成す
るのは非常に困難であった。内視鏡手術や復腔鏡手術で
は止血はさらに重要である。出血を制御できないのな
ら、復腔鏡処置は中止し、出血を制御するために、患者
の体に切開手術をしなければならない。
【０００３】従って、成功の度合いは様々であるが、出
血制御のために種々の技術が用いられてきた。例えば、
単極，二極電気焼灼器等の発熱技術の他、縫合、血管で
のクリップの使用，ステープルがある。組織結合，修復
や損傷閉塞においても進歩したためかつては危険で不可
能であった外科処置が可能となった。
【０００４】先ず初めに、縫合が、止血や組織結合のた
めの主な手段の一つであった。他の止血，組織修復手段
が導入される前は、外科医は患者の組織を縫い合わすの
に多くの時間を費やしていた。
【０００５】外科用クリップが、高度に血管化した組織
を切開するときに血管を閉じる手段として導入された。
しかしながら、処置によっては、外科用クリップは扱い
ずらい。血管を同定しなければならない。その後に、ク
リップは、同定された各血管の意図する切開の両側に個
々に用いなくてはならない。特に血管が脂肪組織に囲ま
れている場合は血管を見つけることも難しい。
【０００６】外科用ステープラは組織を合わせて固定す
る時間を減らせる。種々のタイプの外科用ステープラが
ある。ステープラは組織結合のために用いられ組織切開
と共に止血する。この装置は例えば線状又は円状切開器
具とステープル器具を有する。一般的には、線状切開器
具にはステープルの平行な列があり、ステープルの列の
間に切開手段が入る隙間がある。この種の外科用ステー
プラは切開しやすいように組織を固定し、切開手段がス
テープルの平行列の間を切るときステープルの平行列を
周りの組織の層に留めて組織の層を合わせ止血する。こ
の種の切開ステープル装置は、筋肉や腸等の肉質組織の
処置、特に腸切除処置で、効果的に用いられる。円状切
開及びステープル器具は例えば管状器官を再結合する吻
合術で効果的に用いられる。しかし、ステープルに対し
て組織は均一な厚さではないので、特に厚い組織では、
ステープルは十分に血管を圧縮することができない恐れ
がある。また、脆い組織は、完全に止血するためにステ
ープルで十分に組織を圧縮するのは望ましくない。
【０００７】従って、外科用ステープルを用いたより優
れた止血が望まれている。
【０００８】
【発明が解決しようとする課題】以上述べたように、従
来のステープルによる止血は、特に厚い組織の止血が不
十分であり、また、脆い組織では破壊され易く十分に圧
縮して止血ができない等の問題点があった。
【０００９】この発明は上記のような問題点を解消する
ためになされたもので、厚さが厚く又は不均一な組織，
脆い組織でも十分に止血ができる外科用電気装置を提供
することを目的とする。
【００１０】本発明の他の目的は、止血，組織結合又は
溶接を補助するために発熱エネルギー、好ましくは二極
エネルギーを用いる改善されたステープル装置を提供す
ることである。
【００１１】本発明の他の目的は、比較的厚い組織の面
又は線上で用いることができる装置を提供することであ
る。
【００１２】本発明の他の目的は、長形又は棒状電極を
有する二極電気焼灼器を提供することである。
【００１３】本発明の他の目的は、切開ラインや路の横
に組織溶接又は焼灼するための電気焼灼手段を有する切
開及びステープル装置を提供することである。
【００１４】
【課題を解決するための手段及び作用】本発明の上述の
目的及び他の目的は、間に組織を入れてステープルで留
める顎にある相対するインターフェイス面と、その相対
する面にある２つの電気的に反対のポール（極）を含む
末端効果器を有する外科用電気ステープル装置で説明さ
れる。
【００１５】一実施例の外科用電気器具は、第一のイン
ターフェイス面と第二のインターフェイス面の間の圧縮
ゾーンにある組織を圧縮し、圧縮ゾーンを通して電気エ
ネルギーを与える。第一のインターフェイス面は、圧縮
ゾーンで圧縮された組織を調整する二極エネルギー源の
第一のポールと、相反するインターフェイス面にある第
二のポールを有する。
【００１６】一実施例では、圧縮ゾーンは、１つのイン
ターフェイス面上で圧縮隆起により形成される域であ
り、他のインターフェイス面に対して組織を圧縮する。
また、両方のインターフェイス面に圧縮隆起があっても
よい。凝固ゾーンは、第一の及び第二のポール間の組織
に流れる電流から挾まる組織に放散する熱によって形成
される。
【００１７】組織圧縮は、インピーダンスの違いの原因
となる組織の構造の違いを少なくすることによって、組
織インピーダンスを標準化すると考えられる。また、圧
縮は、特に血管に流れる場合は、血流を止め、吸込み装
置として機能し血液を絞り出す。従って、圧縮は、エネ
ルギー伝達速度を血流によるエネルギーの消失速度より
大きくして、幾分組織への伝達を最適化する。２つの電
極間を流れる電流が確実に圧縮ゾーンに流れるために、
電極の配列が重要である。
【００１８】好ましくは、末端効果器による圧縮は過剰
の圧縮により組織が破壊されないように調整される。圧
縮ゾーンを形成するインターフェイス面間の隙間は、器
具の用途や器具を使用する組織の厚みによって、変える
ことができる。
【００１９】方法によっては、組織は、末端効果器のみ
ならずステープルによっても、簡単に圧縮によって破壊
される恐れがある。例えば、肺組織は脆く破壊される恐
れがある。その様な組織では、好ましくは、末端効果器
やステープルと組織の係合による圧縮は最少に維持され
るべきである。このような条件では、ステープル留め
は、止血が必要な血管を、十分に圧縮できない可能性が
ある。本発明はこのような条件下の使用に特に適してい
る。また、本発明の装置は、一般に約２〜５ｍｍの厚み
を有する腸間膜組織等の厚い組織に適している。この種
の組織には、顎間の隙間は約１．５〜２ｍｍであること
が好ましい。
【００２０】本発明の好ましい実施例は、互いに重なる
第一と第二のポールを有する。即ち、ポールの導電性面
の一部が、２つのポールの電極に共通の面と垂直に横切
る。この実施例は、特に、厚く圧縮が不充分で組織イン
ピーダンスが高く不均一な組織において、凝固ゾーンと
組織インピーダンスを制御するのに有用である。
【００２１】本発明は、また、切開ライン又は切開路の
横の組織のライン又は路を、切開ライン又は切開路の片
側又は両側にあるステープル手段によって、凝固できる
装置を提供する。一実施例では、第一のポールは長形の
電極からなる。長形の電極は隣の絶縁体と共に隆起を形
成し、焼灼すべき組織を圧縮する。
【００２２】他の一実施例では、切開手段の作動即ち機
械的切開の前に、凝固が完了する。使用者に組織が所望
又は所定の程度まで焼灼されたことを知らせるために、
指示手段を使用できる。組織が焼灼されると、切開手段
が作動し、ステープル列が組織に適合している間平行バ
ー間を切る。もちろん、焼灼又は溶接の前，間，後のい
つでも切開はできる。
【００２３】他の一実施例では、線状切開機構ステープ
ラと同様に、止血装置が線状カッターに取り込まれる。
この実施例では、止血装置は、１つのポールを形成する
２つの平行な結合した長形電極バー及び切開手段がバー
間に入る隙間からなる。さらに止血するために、１以上
のステープル列を、隙間とバーの各側に取り付けてもよ
い。作用機構は、組織を２つの顎間で締める。好ましく
は無線周波数エネルギーの電気エネルギーを圧縮組織に
かけ、２つの平行バーに添った血管を焼灼する。
【００２４】同様に、他の一実施例では、イントラルミ
ナルステープラと同様な、組織溶接焼灼切開装置を提供
する。好ましくは、ポールは２つの同心円に形成され、
カートリッジとアンビルインーフェイス面で互いに相対
する。
【００２５】他の一実施例では、異常なインピーダンス
や所定の域から外れる他の電気因子の検出手段を有す
る。例えば、検出手段は、器具が良好な凝固が期待でき
る範囲外のインピーダンスを示す組織に使用されたこと
を示すために、使用できる。また、他の器具の異状を検
出するために使用できる。例えば、インターフェイスエ
レクトロニクスにおける組織の最初の正常範囲のインピ
ーダンスと比較する事によって、異常な状態を検出でき
る。これは無線周波エネルギーをかける最初の数ミリ秒
で感知でき、有効なエネルギー治療量ではない。警告機
構も、インピーダンスが範囲から外れたことを使用者に
警告するために、使用できる。器具の配置を変えても、
同じ測定基準が適用され、組織インピーダンスが再度範
囲から外れると使用者は再度警告される。この工程は、
正常なインピーダンス範囲を満足させ良好な凝固が期待
できるまで、続けられる。
【００２６】本発明の好ましい実施例では、二極エネル
ギーを組織焼灼の手段として使用したが、レーザーエネ
ルギー，超音波エネルギー又は他の組織加熱手段等の他
の熱発生手段も同様に使用できる。
【００２７】本発明の上記及びその他の目的は、以下の
実施例と図面によって更に理解できるであろう。
【００２８】
【実施例】以下、本発明を添付の図面と共に詳細に説明
する。
【００２９】図１〜９に本発明の好ましい一実施例を示
す。図１及び図２に示すように、内視鏡電気焼灼線状切
開ステープル器具１０は、軸３０に結合した本体１６及
び軸３０の遠位端２１から延びる効果器５０を有する。
軸３０は中に延びている管を有する。軸３０は絶縁物質
から形成され、管に延びている導電性鞘３８を有する。
鞘３８の中に延びている溝３９は、溝３９内の駆動手段
４４の同軸の動きを誘導する。この実施例では、駆動手
段４４は本体１６と結合する発射引金１４を含み、発射
引金１４は可撓性発射ロッド４０に連結し、発射ロッド
４０は駆動ロッド４１に連結し、駆動ロッド４１はブロ
ック４３に連結している。ブロック４３は切開手段１１
とステープル駆動楔１３に連結し、駆動手段４４はステ
ープル駆動楔１３をブロック４３によって末端効果器５
０の中へ進める。
【００３０】末端効果器５０は２つの顎３２，３４から
なる。末端効果器５０は顎３４によって溝３９に固定さ
れる。顎３２は顎３４に運動可能に取り付けられる。本
体１６は、顎３２，３４を閉じるための掴み引金１２を
有し、引金１２は鞘３８の近位端に連結している閉じ台
４５を長手方向に進める。閉じ台４５は鞘３８を軸３０
内で同軸的に進める。鞘３８は顎３２のカム面２７の上
を進み、顎３２，３４は顎間にある組織上で閉じる。以
下に詳細に述べるように、閉じ台４５はまたスイッチと
して作用し、電気エネルギーを末端効果器５０に伝える
回路を閉じる。
【００３１】図３〜９に拡大された末端効果器５０を示
す。図３は顎３２，３４が締め付けていない状態を示
し、図４は締め付けて発射してない状態を示し、図５は
締め付けて発射している状態を示している。図６に示す
ように、顎３２は、アンビル１８，顎３２に対して長手
方向に延びるＵ形第一のポール５２（図７，９）及び第
一のポール５２の外側を囲むＵ形絶縁物質５５からな
る。顎３２の内面３３は、顎３４の内面３５に面する。
内面３３は、２つの電気的に繋がる電極バー５３，５４
からなり、大体内面３３の長さに添って延びている第一
のポール５２を含み、電極バー５３，５４はステンレス
鋼から形成される。電極バー５３，５４は第一のポール
の中央を長手方向に延びているナイフ溝４２により離さ
れ、Ｕ形を形成する。バーの表面は平らな片状であり組
織に接する表面の面積を増やしている。ステープル端を
受けるアンビル１８上の２組のポケット３６，３７は、
内面３３に添って、バー５３，５４の外側の横に延びて
いる。電極バー５３，５４と絶縁物質５５は、内面３３
のアンビル部３３ａに対して外へ延びている隆起５６を
形成する。アンビル１８は不導電性物質で形成される。
第二のポール５１は電極バー５３，５４と反対の顎３４
上にある。
【００３２】顎３４はカートリッジ溝２２とカートリッ
ジ２３からなる。カートリッジ２３は、楔１３用トラッ
ク２５，ナイフ溝２６，一連の駆動体２４及びステープ
ル１００からなる。ナイフ溝２６はカートリッジ２３の
中央を長手方向に延び（図８）、駆動体２４はトラック
２５に延び、ステープル１００は２組の平行な２列に配
置している。組織が顎３２，３４の間に係合したとき、
引金１４によって駆動手段４４は作動発射し、切開手段
１１と楔１３を係合した組織内に進め、組織をステープ
ルで留め切る。発射機構１４が作動すると、楔１３がト
ラック２５の中を前進し、駆動体２４をステープル１０
０の方に動かし、それによってステープル１００が組織
を通ってアンビルポケット３６，３７に入る。
【００３３】図３，７，９に示されるように、ギャップ
ピン２９は内面３３のアンビル１８の先端方向にある。
図８に示されるように、ギャップピン２９は、カートリ
ッジ２３の内面３５に形成されるギャップ２８の中へ入
る。ギャップ２８とギャップピン２９は、ナイフ溝４
２，２６が互いに整列しステープル１００がポケット３
６，３７と一列に並ぶように作用する。
【００３４】図２に示されるように、本体１６の遠位端
にあるノブ１５は、ノブ１５に直接又は間接に連結して
いる軸３０，鞘３８，溝３９及び末端効果器５０を回
し、末端効果器の顎３２，３４の回転方向の配置に使用
できる。
【００３５】二極エネルギーが、本体１６内に延びてい
るワイヤ１９，２０を介して、外科用発電機６０から末
端効果器５０に与えられる。発電機６０は足踏スイッチ
６５によって使用者が制御できる。
【００３６】電流エネルギーを第一のポールに供給する
ワイヤ１９は、ワイヤや他の電気接触手段６１を介し
て、閉じ台４５の遠位端にある接触子６２に連結してい
る。反対の極の電流を運ぶワイヤ２０は、ワイヤや他の
電気接触手段６６を介して、閉じ台４５の遠位端にあり
接触子６２から電気的に分離しているディスク接触子６
７に連結している。
【００３７】第一のポール５２に連結し本体１６の遠位
端にあるディスク接触子６３は、ワイヤや他の接触手段
６４と電気的に繋がっている。接触手段６４は、溝３９
を通って、顎３２まで延びて第一のポール５２に接触す
る。ディスク接触子６３はノブ１５の回転を阻害しない
が、ディスク接触子６３と接触手段６４の間の接触は維
持される。接触手段６４は鞘３８から電気的に絶縁され
る。
【００３８】掴み引金１２が作動すると、閉じ台４５は
遠位方向に動き、第一のポールに連結する接触子６２は
ディスク接触子６３と電気的に繋がり、第二のポール５
１に連結するディスク接触子６７は導電性鞘３８と電気
的に繋がる。鞘３８は不導電性カム面２７の上を動き、
導電性カートリッジ溝２２と接触する。カートリッジ溝
２２は、第一のポールと電気的に反対の第二のポール５
１と、電気的に繋がる。従って、掴み引金１２が閉じる
ときのみ電気回路が閉じる。
【００３９】操作では、末端効果器５０を組織の切られ
る部位に配置する。解放ボタン７０を押すと、ボタンス
プリング７１が解放され閉じ台４５が近位方向に動き、
顎３２，３４が開く。その後、組織を顎３２，３４の夫
々のインターフェイス内面３３，３５の間に置く（図
３）。掴み引金１２を握り締め、鞘３８をカム面２７上
に動かし、顎３２，３４が閉じ（図４）、同時に上記の
電気回路が閉じる。ギャップピン２９は、アンビル１８
をカートリッジ２３と略平行に保持させる。共に隆起５
６を形成する電極バー５３，５４と絶縁物質５５が、電
極５１を含む顎３４の内面３５に対して組織を圧縮す
る。約１．５ｍｍ〜２．０ｍｍの隙間が圧縮ゾーンの顎
間にある。その後、使用者は、足踏スイッチ６５等のス
イッチによって、発電機６０から無線周波エネルギーを
かける。電流が、圧縮された組織を通って、第二のポー
ル５１と第一のポールのバー５３，５４の間に流れる。
【００４０】好ましくは、二極エネルギー源は、約３０
０ｋＨｚから３ＭＨｚの無線周波数エネルギーを提供す
る低インピーダンス源である。好ましくは、組織に流れ
る電流は０．１から１．５アンペアであり、電圧は３０
から２００ボルトＲＭＳである。
【００４１】十分な焼灼が成され無線周波エネルギーを
止めてもよいことを示すために、可聴、可視、触知又は
他のフィードバックシステムを使用できる。この様なフ
ィードバックシステムの例を以下に説明する。無線周波
エネルギーが止まった後、発射引金１４によって切開手
段１１は前進しステープル１００は発射する。ピボット
１４ａの周りにレバーアームとして機能する発射引金１
４を回転させて、発射させる。駆動手段４４は切開手段
１１と楔１３を前進させる（図５）。図６に示されるよ
うに、切開手段１１はバー５３，５４間の焼灼された組
織を切る。従って、切開ラインは、バー電極によって形
成される凝固ラインの横である。同時に、楔１３は駆動
体２４をステープル１００の方へ前進させ、ステープル
１００を組織を通ってアンビル１８のポケット３６，３
７の中へ発射させる。切開手段が組織を切ると、ステー
プル１００は、２つの長手方向の２列の状態で、切開手
段１１の各側に入る。
【００４２】線状ステープルの操作はこの技術分野では
既知であり、例えば米国特許第 4,608,981号，第 4,63
3,874号，米国特許出願第07/917,636号に記載されてい
る。
【００４３】一実施例では、二列のステープルを一列に
置き換えて、カートリッジを多発射ステープル機能とす
る。現在使用されている腹腔鏡ステープル切開装置で
は、単発射置換可能カートリッジが使用されている。よ
り良く止血するために、このタイプのステープラは、２
列のステープルが各々平行列となるように、設計され
た。２列のステープルを含むのに空間が必要となるの
で、積み重ねたステープルを有する再発射可能カートリ
ッジは、積み重ねたステープルに追加の空間が必要なの
で好ましくない。多発射ステープルの実施例では、一列
のステープルを使用する。一列のステープルを使用する
ことにより、かつて２列のステープルが占めていた空間
に、ステープルを積み重ねることが可能となり、多発射
ステープル機能が得られる。他の実施例では、ステープ
ルは必要とされず、電流が必要な止血をする。
【００４４】本発明の好ましい実施例は、所望又は所定
の程度まで凝固がなされた時を示すように設計されたフ
ィードバックシステムを有する。特に、凝固ゾーンが使
用者に見えないときに有効である。特定の実施例では、
凝固の程度を示す電気因子を測定する。
【００４５】フィードバックシステムは、凝固の程度を
示す凝固ゾーンの又は近くの組織の特性を測定してもよ
い。電気エネルギーがかかる組織の電気インピーダンス
も、凝固を示すために使用できる。一般にエネルギーが
組織にかかると、インピーダンスは初めは低下し、その
後凝固が発生するにつれ増加する。組織の経時的電気イ
ンピーダンスと凝固の関係は、バエルフォーズ(Vaellfo
rs),ベルティル(Bertil), ベルダール(Bergdahl), ジョ
ーン(Bjoern)「オートマティカリィ コントロールド
バイポラー エレクトロコアギュレーション(Automatic
ally controlled Bipolar Electrocoagulation) 」（ニ
ューロシュグ(Neurosurg) Rev.187〜190頁、１９８４
年）に記載されている。乾燥するとインピーダンスは増
加する。高電圧の過剰印加による組織の炭化及び／又は
器具への焼付きは、組織インピーダンス特性に基づくフ
ィードバックシステムによって防ぐことができる。凝固
を示す組織特性の他の例は、温度や光反射率である。
【００４６】図１０は、本発明の好ましい実施例に含ま
れるフィードバックシステムを示すフローチャートであ
る。初めに、エネルギーが組織にかかる。次に、組織に
印加されたシステム電流と電圧が測定される。インピー
ダンス値が計算され、記憶される。例えばインピーダン
ス，インピーダンス変化及び／又はインピーダンス変化
率等を含むインピーダンスの関数に基づき、所望の凝固
が発生したか否か測定する。所望の程度まで凝固が発生
すると、指示手段がエネルギーを止めるよう指示する。
このような指示手段は、例えば可視光や可聴音を用い
る。フィードバック手段は発電機もまた制御でき、所定
のインピーダンスレベルでエネルギーを止める。他の実
施例では、インピーダンスレベルによってトーンが変化
する連続した可聴音を出す。さらに、インピーダンスが
通常の最小以下及び／又は最大以上であるとき、エラー
や装置の誤操作を示すエラー指示手段を設けてもよい。
【００４７】図１１は他の実施例を示す。ポール１５
１，１５２は図６と同様に配置されているが、各ポール
は、ナイフ溝１４２の長さに沿った電気的に接続してい
る一連のスタガー電極である。スタガー電極の間には絶
縁物質がある。ナイフ溝１４２はポール１５１，１５２
を二つの長形の電極の組に分離する。
【００４８】図１２，１３は、本発明のステープル手段
を有する円状カッターを示す。図１２はインターフェイ
ス面２３３を有するステープラカートリッジ２００を示
す。２列のステープル開口２０１は面２３２の外周付近
に乱して配置される。ステープル開口２０１を通ってス
テープルは組織の中に入る。第一のポール２５２は面２
３３の内周を囲んでいる。円状切開ナイフ２１１は、面
２３３の内周の中の方に放射状にカートリッジ２００の
窪みに置かれる。
【００４９】図１３はアンビル２１８を示し、アンビル
２１８は第一のポール２５２と電気的に反対の第二のポ
ール２５１を有する。カートリッジ２００にある絶縁体
２５５は第一のポールを第二のポールから電気的に分離
する。アンビル２１８は、ステープルを受けるポケット
２３７，第一のポール２５２に対して組織を圧縮する圧
縮隆起２５６及びカートリッジの絶縁体２５５を有す
る。円状カッターは米国特許第 5,104,025号に記載され
ている円状ステープラと同様に作用する。ステープルや
切開する前に、組織溶接電流を、第一のポール２５２と
第二のポール２５１を通して組織に送ることもできる。
【００５０】他の実施例では、円状カッターはステープ
ルなしで使用できる。電流はポールを通して送られ、組
織を溶融し凝固する。その後、ナイフを前進させ吻合等
の方法で組織を切る。
【００５１】内視鏡切開及びステープルを含む特別の実
施例を用いて本発明の幾つかの形態を説明した。しか
し、本発明は止血が求められる多くの用途に使用でき
る。従って、当業者は、特許請求の範囲とその均等範囲
によって定義される本発明の範囲から離れることなく、
本発明に種々の変更を加えることが可能である。
【００５２】本発明の具体的な実施態様は、次の通りで
ある。 （１）前記第一及び第二のインターフェイス面の少なく
とも一面の一部は、前記第一及び第二のインターフェイ
ス面の間に組織圧縮ゾーンを形成する隆起を含む請求項
１記載の外科用電気装置。 （２）前記第一のポールと前記第二のポールは、前記第
一及び第二のポール間に電流が流れると前記圧縮ゾーン
に凝固を形成するように配置される上記実施態様（１）
記載の外科用電気装置。 （３）前記第一のインターフェイス面の一部は前記イン
ターフェイス面間に組織圧縮ゾーンを形成する隆起を含
み、前記第二のインターフェイス面の一部は組織圧縮ゾ
ーンを形成する隆起を含む上記実施態様（１）記載の外
科用電気装置。 （４）前記隆起は前記第二のインターフェイス面に位置
付けられ、前記第一のポールに対して組織を圧縮する上
記実施態様（１）記載の外科用電気装置。
【００５３】（５）少なくとも１つの前記ポールは、前
記第一及び第二のインターフェイス面の少なくとも１つ
の面上の一連の電気的に繋っているスタガー電極からな
る請求項１記載の外科用電気装置。 （６）前記少なくとも１つのポールは、前記電気的に反
対のポールに対して平行に配置されてる上記実施態様
（５）記載の外科用電気装置。
【００５４】（７）前記第一のポールは一連の第一電極
からなり、前記第二のポールは一連の第二電極からな
り、前記第一及び第二の各インターフェイス面におい
て、前記第一電極は前記第二電極と互い違いである請求
項１記載の外科用電気装置。 （８）前記第一のポールは長形電極を含む請求項１記載
の外科用電気装置。 （９）前記装置は組織を溶接する請求項１記載の外科用
電気装置。 （１０）さらに、前記末端効果器に連結する切開要素を
有し、前記切開要素は前記末端効果器により係合される
組織を切開ラインで切る請求項１記載の外科用電気装
置。 （１１）前記末端効果器は前記切開ラインの横で止血す
る上記実施態様（１０）記載の外科用電気装置。 （１２）前記ステープル手段は前記切開ラインの横にス
テープルを留める上記実施態様（１０）記載の外科用電
気装置。 （１３）前記切開要素は切開路で可動で、前記切開ライ
ンを形成する上記実施態様（１０）記載の外科用電気装
置。 （１４）前記第一のポールは第一及び第二の電極を有
し、前記切開要素が前記第一及び第二の電極の間を動く
上記実施態様（１０）記載の外科用電気装置。 （１５）前記第一及び第二の電極はそれぞれ、電気的に
繋がっている平行長形バー電極を有し、前記末端効果器
はさらに前記切開要素を受ける隙間を有し前記切開要素
は前記バー電極間に前記隙間を動く上記実施態様（１
４）記載の外科用電気装置。
【００５５】（１６）前記ステープル手段はステープル
の平行列及び、前記切開手段が前記ステープル列間を動
けるカートリッジの中を長手方向に延びる隙間を有し、
前記第二のインターフェイス面を形成するカートリッ
ジ、前記インターフェイス面間の組織をステープルで留
める駆動手段、及び前記第一のインターフェイス面の一
部を形成し、前記ステープルを受け形成するアンビル、
を有する請求項１記載の外科用電気装置。 （１７）前記切開手段が平行列間を切ると、前記駆動手
段が組織をステープルで留める上記実施態様（１６）記
載の外科用電気装置。 （１８）前記切開手段が前進する前に、二極エネルギー
がかかる上記実施態様（１６）記載の外科用電気装置。
【００５６】（１９）前記切開ラインがほぼ円形である
上記実施態様（１０）記載の外科用電気装置。 （２０）前記第一のポールが大体円形であり、前記第一
のインターフェイス面の外周に配置され、前記切開ライ
ンが前記第一のポールの内方向に放射状にある上記実施
態様（１９）記載の外科用電気装置。 （２１）前記ステープル手段を管腔を再結合するために
使用する請求項１記載の外科用電気装置。
【００５７】（２２）前記ステープル手段はカートリッ
ジの外周付近にステープルを有するカートリッジ、前記
ステープルの内方向に放射状に組織を切るための切開手
段、前記インターフェイス面間の組織をステープルで留
める駆動手段、及び前記第一のインターフェイス面の一
部を形成し、前記ステープルを受け形成するアンビル、
を有する請求項１記載の外科用電気装置。 （２３）前記切開手段が組織を切ると、前記駆動手段が
組織をステープルで留める上記実施態様（２２）記載の
外科用電気装置。 （２４）前記切開手段が組織を切る前に、二極エネルギ
ーがかかる上記実施態様（２２）記載の外科用電気装
置。
【００５８】（２５）さらに、範囲から外れた電気因子
を検出する手段を有する請求項１記載の外科用電気装
置。 （２６）さらに、組織が所定の程度まで焼灼された時を
測定するフィードバック手段を有する請求項１記載の外
科用電気装置。 （２７）前記フィードバック手段は、組織の電気因子の
測定に基づいて、組織が所定の程度まで焼灼された時を
測定する上記実施態様（２６）記載の外科用電気装置。 （２８）前記フィードバック手段は、凝固ゾーンの組織
の１以上の特性の測定に基づいて、所定の程度の焼灼が
成された時を測定する上記実施態様（２６）記載の外科
用電気装置。 （２９）前記組織の特性が組織インピーダンスである上
記実施態様（２８）記載の外科用電気装置。
【００５９】（３０）さらに、組織が所定の程度まで焼
灼されたことを使用者に伝える指示手段を有する請求項
１記載の外科用電気装置。 （３１）前記指示手段が可聴シグナルを用いる上記実施
態様（３０）記載の外科用電気装置。 （３２）前記指示手段が可視シグナルを用いる上記実施
態様（３０）記載の外科用電気装置。 （３３）前記指示手段が触知フィードバックを用いる上
記実施態様（３０）記載の外科用電気装置。
【００６０】
【発明の効果】以上のように、本発明によれば、厚さが
厚く又は不均一な組織にも脆い組織にも十分止血できる
効果がある。本発明によれば、ステープルだけの装置に
比べ、電極からの二極エネルギーにより、厚さが不均一
な組織にもより確実に止血できる効果がある。
【図面の簡単な説明】
【図１】本発明の一実施例による内視鏡電気焼灼線状ス
テープル切開器具の側面図である。
【図２】図１の器具の側断面図である。
【図３】図１の器具の遠位端の開いた状態の部分断面図
である。
【図４】図１の器具の遠位端の閉じて発射してない状態
の部分断面図である。
【図５】図１の器具の遠位端の閉じて発射する状態の部
分断面図である。
【図６】線６−６についての図４の器具の遠位端の断面
図である。
【図７】図１の器具のアンビル顎の底面図である。
【図８】図１の器具のカートリッジの平面図である。
【図９】線９−９についての図７の顎の側断面図であ
る。
【図１０】本発明のフィードバックシステムを示すフロ
ーチャート図である。
【図１１】本発明の他の実施例のアンビルの底面図であ
る。
【図１２】本発明の円状カッターのカートリッジの平面
図である。
【図１３】本発明の円状カッターのアンビルの底面図で
ある。
【符号の説明】
１０ 外科用電気装置 １２ 掴み引金 ３３ 第一のインターフェイス面 ３５ 第二のインターフェイス面 ４４ 駆動手段 ５０ 末端効果器 ５２ 第一のポール ５１ 第二のポール １００ ステープル
フロントページの続き (72)発明者 スティーブン・エイチ・マーシュ アメリカ合衆国、45237 オハイオ州、 ジャーマンタウン、ウィーバー・ロード 7347 (56)参考文献 特開 平４−33653（ＪＰ，Ａ) 米国特許2031682（ＵＳ，Ａ) 国際公開93／8754（ＷＯ，Ａ１) 国際公開93／8741（ＷＯ，Ａ１) 欧州特許出願公開210125（ＥＰ，Ａ １) (58)調査した分野(Int.Cl.7，ＤＢ名) A61B 17/115 A61B 18/04

Claims (2)

    (57)【特許請求の範囲】
  1. 【請求項１】 末端効果器を有する外科用電気装置にお
    いて、前記末端効果器は、 第一及び第二のインターフェイス面の間に組織を係合
    し、末端効果器はその中で二極エネルギーを受ける、対
    向する第一及び第二のインターフェイス面、 二極エネルギーを伝えることができ、電気的に相反する
    電極からなる、電気的に分離されてる第一及び第二のポ
    ール、及び前記インターフェイス面に係合される組織を
    ステープルで留めるステープル手段を有し、 前記第一のポールは前記第一のインターフェイス面にあ
    り、前記第二のポールは前記第二のインターフェイス面
    にあるので、前記二極エネルギーは前記インターフェイ
    ス面に係合される組織を通って前記ポール間に伝わる、
    外科用電気装置。
  2. 【請求項２】 ハンドル、 前記ハンドルに連結する作動手段、 前記作動手段の遠位端に連結する末端効果器、 電気エネルギーを二極エネルギー源から前記末端効果器
    に伝える伝達手段からなり、 前記末端効果器は、 第一のインターフェイス面、 第二のインターフェイス面、 前記第一のインターフェイス面にある第一のポール、 前記第二のインターフェイス面にある第二のポール、及
    び前記インターフェイス面に係合される組織をステープ
    ルで留めるステープル手段からなり、 前記作動手段は前記末端効果器を作動させ、組織を前記
    第一のインターフェイス面と前記第二のインターフェイ
    ス面の間に係合させ、 前記第一のポールと前記第二のポールは、前記伝達手段
    から供給される電気エネルギーを、前記第一のポールと
    前記第二のポールに隣接する組織を通って伝えることが
    できる電気的に相反する電極であり、 前記ステープル手段は組織を固定できる、外科用電気装
    置。
JP19017894A 1993-07-22 1994-07-21 外科用電気ステープル装置 Expired - Fee Related JP3399651B2 (ja)

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US096154 1993-07-22

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JPH07171159A (ja) 1995-07-11
CA2128136A1 (en) 1995-01-23
AU679999B2 (en) 1997-07-17
ATE175090T1 (de) 1999-01-15
ES2124848T3 (es) 1999-02-16
EP0640315A1 (en) 1995-03-01
CA2128136C (en) 1999-10-26
EP0640315B1 (en) 1998-12-30
DE69415613T2 (de) 1999-07-22
DE69415613D1 (de) 1999-02-11
US5735848A (en) 1998-04-07
AU6862394A (en) 1995-02-02

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