JPH04309341A - 被吸収性フアスナー手段を有する引抜き式円形吻合用管腔内ステープラー - Google Patents

被吸収性フアスナー手段を有する引抜き式円形吻合用管腔内ステープラー

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Publication number
JPH04309341A
JPH04309341A JP4024317A JP2431792A JPH04309341A JP H04309341 A JPH04309341 A JP H04309341A JP 4024317 A JP4024317 A JP 4024317A JP 2431792 A JP2431792 A JP 2431792A JP H04309341 A JPH04309341 A JP H04309341A
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Japan
Prior art keywords
tissue
ring
piercing
plate
staple
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Inventor
Ronald J Brinkerhoff
ロナルド・ジエイ・ブリンカーホフ
Mark S Zeiner
マーク・エス・ゼイナー
Michael B Miller
マイケル・ビー・ミラー
James A Transue
ジエイムズ・エイ・トランスー
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Ethicon Inc
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Ethicon Inc
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Publication date
Application filed by Ethicon Inc filed Critical Ethicon Inc
Publication of JPH04309341A publication Critical patent/JPH04309341A/ja
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—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
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/11—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis
    • 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
    • A61B17/1114—Surgical instruments, devices or methods for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
    • 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
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00004—(bio)absorbable, (bio)resorbable or resorptive
    • 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
    • A61F2/30—Joints
    • A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
    • A61F2002/30316—The prosthesis having different structural features at different locations within the same prosthesis; Connections between prosthetic parts; Special structural features of bone or joint prostheses not otherwise provided for
    • A61F2002/30329—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2002/30476—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements locked by an additional locking mechanism
    • A61F2002/305—Snap connection
    • 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
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T24/00—Buckles, buttons, clasps, etc.
    • Y10T24/45—Separable-fastener or required component thereof [e.g., projection and cavity to complete interlock]
    • Y10T24/45225—Separable-fastener or required component thereof [e.g., projection and cavity to complete interlock] including member having distinct formations and mating member selectively interlocking therewith
    • Y10T24/45471—Projection having movable connection between components thereof or variable configuration
    • Y10T24/45524—Projection having movable connection between components thereof or variable configuration including resiliently biased projection component or surface segment
    • Y10T24/45529—Requiring manual force applied against bias to interlock or disengage
    • Y10T24/45534—Requiring manual force applied against bias to interlock or disengage having connected leading edge and separated trailing arms

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

Abstract

(57)【要約】本公報は電子出願前の出願データであるた
め要約のデータは記録されません。

Description

【発明の詳細な説明】
【０００１】
【発明の分野】一般に、本発明は円形の外科的ステープ
ル作業用の装置に関する。より特別には、本発明は被吸
収性ステープルを使用した吻合ステープル作業に関する
。より特別には、本発明は吻合ステープルを使った円形
吻合ステープル作業、及びかかるステープルを適用する
手段に関する。
【０００２】
【発明の背景】現在、多くの外科吻合術用の円形ステー
プラーがある。一般に、これらステープラーは、組織を
接合するように円周状に配置されたステープルの円形リ
ングによる被切断管腔の接合に使用される。殆どの場合
、ステープルのリングの外周内で組織を切断するために
ナイフ機構が使用される。ステープルのリングは一般に
多数の、通常２０個から４０個の小さな金属製の外科用
ステープルであり、これらは直径がほぼ２ｃｍから４ｃ
ｍのリングを形成する。円形ステープルによる治癒後の
組織の狭窄を最小にしなければならないため、管腔は、
液体が正常に通過できるように処置前にできるだけ接近
させて維持しなければならないことは当然である。
【０００３】この形式のステープルにより接合した管腔
間に隙間が無いように、組織は完全に３６０°封鎖され
ねばならない。更に、組織が接合されたとき、切断され
た組織の大きさは、液体が狭窄組織に遭遇することなく
連続的に通過しうるように維持されることが望ましいこ
とは当然である。
【０００４】更に、かかる環状の吻合用ステープラーで
は使捨て式ステープラーとすることが望ましい。即ち、
使捨て式ステープラーは、現在、外科医によりよく受け
入れられる。また使捨て式外科用ステープラーは細菌又
は微生物の拡散防止を支援する。当然、外科医は、常に
入手可能でありかつ管理された片手作業ができる手動操
作式ステープラーを希望する。
【０００５】最も重要なことは、円形ステープル市場に
おいて被吸収性ステープラーの要求があることである。 これは、部分的には、ステープルを受容部内に受け入れ
ることができかつ組織を一緒に保持しかつステープルを
つかむために十分な力を発生しうる円形の吻合ステープ
ル機構を作ることが従来はできなかったによる。更にこ
のシステムにおいては、受容部内にステープル又はファ
スナーを揃えうる許容差を維持することが重要である。 被吸収性円形吻合用ステープラーにおいてこれを達成す
ることは、到達の困難な、又は縁のしなやかな管腔内で
のかかるステープラーの使用の可能性を増加させる。か
かる部位における使用を妨げている大きな寸法を代表的
な被吸収性ファスナーが持つことが実現される。
【０００６】更に、標準のステープル線を適切に連結可
能な２個のファスナーで置換することが望まれる。この
方法で、ステープルを曲げる必要が無くなり、しかも閉
鎖と止血とが可能である。勿論、標準ステープル線を置
換するシステムを公式化する試みによりかかるステープ
ラーを公式化して、ステープラーのアンビル部分を外す
必要なしにステープル自体を組織の接合部分を通して引
っ張りうるようにすることが望ましい。これによりステ
ープラー除去の迅速かつ効果的な方法が得られる。この
ような順応性のある連結可能な組み合わせ式のファスナ
ー創成の希望に際しては、当然、これらファスナーは双
方が確実に揃えられて噛み合うこと、及び装置がある一
定の調整可能な閉鎖圧力での閉鎖を行うことが望まれる
。噛み合い部材を一緒に取り付けるに要する圧力が一定
であるならば、滑らかで効果的な１回の行程で装置を閉
鎖し噛み合わせることがより容易となる。あるいは、一
定の閉鎖圧力により、組織を貫いてファスナーを取り付
け次いで別の作動で装置により組織を実際に閉鎖するこ
とが望まれる。
【０００７】かかるシステムにおいては、ファスナーが
連結されたか否か、及び組織が適切に閉鎖されたか否か
を容易に見うることもまた望まれる。このことは、装置
が接合された組織を通して引かれるときに特に然りであ
る。また、これらの形式の接合は、湾曲軸を有するもの
あるいは套針管又はフレキシブル軸を有する装置を含む
総ての円形型式の装置で利用可能であるべきである。
【０００８】
【発明の概要】従って、ステープルと受容部との間の良
好な一致を与える円形の吻合用ステープラーを提供する
ことが本発明の目的である。かかる一致を与える被吸収
性円形吻合用ステープラーを提供することが本発明の別
の目的である。
【０００９】かかる被吸収性ステープルを使用し、しか
もステープルと受容部との間の一致を維持する手段を提
供することが本発明のなお別の目的である。
【００１０】連結された管腔を通る液体の通過を阻害す
る組織内部部分及び又はステープルを使用者が切除でき
ると共に、前記の特徴を達成する外科用の吻合用ステー
プラーを創成することが更に望ましい。
【００１１】標準ステープル線が２個の分離可能に連結
しうるファスナー部品により置換される円形吻合用ステ
ープラーを提供することもまた望ましい。
【００１２】分離可能に連結しうる部品は、ファスナー
の連結後に装置を通して引かれる分離可能の中心部分を
有することが更に望ましい。
【００１３】ある場合には被吸収性手段より本発明のフ
ァスナーを形成することが望ましく、また形成された機
構が、一緒に組み合いかつ自己整列するファスナーを有
することもより望ましい。
【００１４】１回又は２回の行程のいずれかで予定閉鎖
量の閉鎖が行なわれることが更に望ましい。
【００１５】装置は、閉鎖及び止血のために残っている
連結された組織を容易に検査できるフィードバックを迅
速、即応的かつ正確に使用者に提供すると同時に装置の
残りの部分を部位から迅速に除去しうることが更に望ま
しい。
【００１６】得られた被吻合組織を通して引くことので
きるステープラーによりステープル作業を遂行できるこ
ともまた望ましい。
【００１７】最後に、装置は、真っ直ぐな軸又は曲がっ
た軸のいずれとも、また軸の頭部に取り付けられた套針
管の有無に拘わらず使用しうることが望ましい。
【００１８】本発明のこれ等の目的及びその他の目的は
、被吸収性ファスナーにより吻合された二つの管腔に配
置された機構において達成される。ファスナーは２個の
ワッシャー状の片より作られる。ワッシャー状の片の一
方は他方のワッシャー状の片から突出している組み合い
用の尖端部を受け入れるように作られた穴を持つ。結合
作用は、尖端部が組織を切断し次いで受容部の穴の中に
組み合う単一の直線運動により達せられる。最後に、組
織内にファスナーの最終のリング状の形を作る円形ナイ
フにより組織が切断される。装置が管腔から除去される
とき、ワッシャー状の片の各の内側部分が切断された組
織と共に除去される。
【００１９】組み合った後でナイフがばね力に打ち勝ち
、ナイフは組織及びワッシャー状の片の各の内部部分の
両者を切断させられ、ナイフは組織を型に押し付け剪断
できる。型又はナイフを更に進めることにより、装置の
末端から閉鎖部が解放されるので除去は容易である。 かかる機構は、使用前にファスナーの尖端部を適宜の方
向に向けうるように受容部及びフランジの位置を逆にす
ることができる。
【００２０】
【発明の詳細説明】本発明は付属図面によってよく理解
されるであろう。
【００２１】図１ないし図１２に見られるように、外科
的な吻合用円形ステープル作業をなしうる外科用ステー
プル装置が明らかにされる。図３に見られるように、こ
のステープラー１０は、図１に示されるようなファスナ
ー又は板材２０、３０を保持できる。
【００２２】図１及び２、１１及び１２に見られるよう
にこのファスナー２０、３０は、一般に被吸収性であり
生物と両立可能な公知の材料で形成される。言うまでも
なく、本発明から離れることなくこの材料を金属となし
うることが認識される。これらのファスナー２０、３０
は標準の吻合用ステープル線の代わりをする。これらフ
ァスナーの各は板状であり、かかるファスナーの少なく
も一方は板材２０、３０から除去すべき中央円環状部分
２２、３２を含む。この円環状部分がファスナーシステ
ムの引抜き機能を許す。また、一方のファスナー２０は
組織を刺すように鋭くされた尖端部２４を持つ。他方の
ファスナー３０は板材２０の尖端部２４より多数の複合
受容部３４を持つ。この配置により、僅かの困難で、又
は困難なしで尖端部２４の各を他方のファスナー３０の
受容部３４内に揃えることができる。それにも拘わらず
、各板材２０、３０は、一般に、少なくも８個のかかる
尖端部２４及び受容部３４を持つだけである。
【００２３】これらファスナー２０、３０に関しては整
列の様相が非常に重要である。普通のステープル及び普
通のステープラーにおいては、ステープルは、これが組
織を刺し通した後で容易に成形されるように、予めアン
ビルと揃えられる。対照的に、これらのファスナー２０
、３０は、ファスナー自体が他方のファスナーと出会う
ように自己整列することが必要である。従って、尖端部
２４は、これらを受け入れる受容部３４の各の中に容易
に入れられるような形状にされる。例えば、図１１及び
１２に見られるように、尖端部２４の２倍の数の受容部
３４が配置され、従って整列にはごく僅かのファスナー
２０の回転しか必要でない。受容部３４は尖端部２４と
同数か又はより多い数であり、かつ尖端部２４が受容部
３４の各の中に適合するに十分な幅である。また、この
整列が生ずるように、いずれのファスナーも、それが保
持された頭部又はアンビル部分の中で僅かに回転できる
。これは、ステープラー１０が本明細書の後の部分で更
に説明されたときにより容易に理解されるであろう。
【００２４】板材２０、３０は、装置のハウジング内又
は組織間に多くの空間を取らないように、また板材２０
、３０を組み合わせるに要する力を減らして外科的使用
を容易にするように、一般に薄く（厚さ約０．２５４−
０．７６２ｍｍ（０．０１０−０．０３０インチ））形
成される。このように薄くされた厚さのため、ファスナ
ー２０、３０はその強度を保つことを妨げないような形
状にされることが当然である。
【００２５】各板材２０、３０は、板の周辺内に折り易
いリング２６、３６を有することが図１及び２より注意
されるであろう。これらリング２６、３６はナイフ４０
の力で破れるようにされ、従ってファスナー２０、３０
は破られ、板材２０、３０の各の折り易いリング２６、
３６は装置１０の頭部５０内に引かれる（図６に最もよ
く見られる）。次いで、間に置かれた組織に固定され連
結された板材２０、３０の外側部分２３、３８を残して
、ステープラー１０が切断部位から取り出される。
【００２６】ファスナー２０、３０は中心部無し、又は
折り易いリング２６、３６付きの中心部有りのいずれに
も形成され、後者の場合、リング２６、３６は切断され
た組織と同様に装置１０の頭部５０内で集められる。こ
れにより、図９に最もよく見られるように、装置１０の
アンビル６０を通る引き抜きができる。従来は、接合さ
れた組織を通して装置を引き抜く前に、アンビル６０を
ステープルから外すことが必要であった。ステープラー
１０からのアンビル６０の「ボタン外し」を不要とする
能力により、従来のある種の円形吻合用ステープラーに
比して大きな改良が得られる。
【００２７】これら板材２０、３０が使用される装置１
０が図３に見られる。ステープラー１０は通常吻合用に
使われる型式の一般に円形断面を持ったステープラーで
ある。しかし、図６、７、８及び９に最もよく見られる
ように、このステープラー１０はステープル作業域内に
据えられた１対の板材２０、３０を備える。一方の板材
３０はアンビル部分６０内に置かれ、一方は頭部又は作
動部分５０内に置かれる。装置１０自体は、通常のステ
ープルではなくて板材２０、３０を取り付けることによ
り吻合を行う。
【００２８】図６、７、８及び９の作動分解図に最もよ
く見られるように、まず、頭部５０の回りに保持された
組織は、これが吻合される準備として、アンビル６０の
頭部に保持された組織に近付けられる。次に、一方のフ
ァスナー２０の尖端部２４が双方の組織の層を刺し、他
方のファスナー３０の受容部３４内で固定される。
【００２９】固定後に、ハンドル機構１００の更なる圧
迫により装置のナイフ４０が前方に押される。まず一方
の板材２０が、次いで組織が、次に最後の板材３０が切
断される。図９に見られるように、アンビル６０の内側
に保持されて、破られた内側の折り易いリング２６、３
６と切断された組織を保持している中央の円環状部分２
２、２３とを含んだ纏まりが形成される。外側部分２８
、３８の残ったファスナー２０、３０は、その間に組織
を保持して互いに固定される。このとき、装置１０は、
切断された組織を通ってこれを引き吻合部位から離すこ
とにより、引き抜くことができる。
【００３０】図４、５、６の及び１０に最もよく見られ
るように、装置は多くの異なった形状を取ることができ
る。まず、図６によく見られるように、雄型７０を装置
１０のアンビル６０内に保持するように機構を形成する
ことができる。この方法ではアンビル６０は装置内に引
かれるであろう。図４及び５の機構に見られるように、
ハンドル１００を矢印の方向に逆転させると、アンビル
６０はハンドルの方に引かれる。これにより、アンビル
６０から板材２０に加わる力が生ずる。板材２０は、こ
れに加えられた力を受け、外側部分２８を残して板材２
０の内側の折り易いリング２６を折り易いリング２６に
おいて破る。
【００３１】これは、板材２０の尖端部２４が組織を刺
し板材３０の端部の受容部３４内に受け入れられ装置１
０の頭部５０の連結用ブロック５５内に収容された後に
行なわれることは勿論である。連結用ブロック５５はタ
イミング用ばね５７により前方に保持される。このタイ
ミング用ばね５７は、尖端部２４が組織を刺し受容部３
４を板材２０に固定させるに十分な力を有し、従って組
織は両板材２０、３０間に適切に保持される。
【００３２】このため、タイミング用ばね５７は組織の
閉鎖及び切断を通じて一定の閉鎖圧力を与えうることが
注意される。これにより、設計者は、閉鎖と組合い及び
切断が機構の単一の行程で達成し十分に機械的に有利と
なるように、容易にステープラー１０を適合させうる。 あるいは、機構の１行程で最初に組織を刺しかつ組み合
うことが望ましい。次いで、更に第２の行程で組織の閉
鎖と切断とを完了することが望ましい。これは機構の信
頼性と作業の容易さとをもたらす。
【００３３】次に、アンビル６０からの力が組織並びに
板材２０、３０及びばね５７の力に打ち勝ち、板材３０
とナイフ４０とが付き当たる。ナイフ４０は、まず折り
易いリング３６を切断し、次いで組織の２個の層を切断
する。次に板材２０の折り易いリング２６が、設計仕様
に応じてナイフ４０により切断され、あるいはアンビル
６０により破られる。
【００３４】このため、ナイフ４０の方に引かれ保持さ
れた組織及び板材２０、３０を含んだアンビル６０全体
が残り、これがハンドルの頭部５０内に保持される。こ
れは、次いで連結された組織から引き離される。従って
、残っている外側部分２８、３８は、その中に保持され
かつアンビルに押し付けられ固定された組織と共に、適
正に吻合された管腔が創成されるように保持される。
【００３５】一方、図１０に見られるように、尖端部の
ある板材２０が装置１０の頭部５０にあるように板材２
０、３０を逆にすることもまた可能である。この方法で
は、力はナイフ４０が板材２０に対して押すように矢印
の方向に生ずる。次いで板材２０が組織の両方の層を刺
す。
【００３６】組織は、受容部３４と雌型８０とを有する
上方受容用板材３０内に固定される。固定後、ナイフ４
０が進められ、まず尖端部付き板材２０を折り易いリン
グ２８において破り、次に組織の層を、次に下方板材３
０を折り易いリング３６において破る。このようにして
組織の切断された部分の総てがアンビル６０内に保持さ
れる。次に、適正に吻合された組織を残してアンビルが
頭部部分５０を通り後方に移動される。
【００３７】図３、４及び５の機構を更に調べれば、リ
ンク１１５とスライド１２０とを備えた組み合わせ機械
要素により、ハンドル１００が装置１０の頭部５０内に
収容されたナイフ４０を前進させることに注意される。 別のリンク１１５が加えられると、ナイフ４０がステー
プラー１１０内に後退するようにナイフ４０の位置と運
動を逆にしうることが認識されるであろう。この方法で
、２個の板材２０、３０の希望の形状のいずれによって
も吻合を行うことができる。
【００３８】勿論、板材の形状が僅かに異なることに注
意すべきである。例えば、予め２個の板材の内側部分２
３、２３の一方を除去することにより組織を通して切断
するに要する力を低減させることが望ましい。この方法
で、外側リング２２、３２の閉鎖が生じ、かつナイフ機
構４０は組織のみに突き当たる。板材２０、３０の内側
部分２８、３８は存在さえもせず尖端部２４と受容部３
４とだけで閉鎖を作るリング状の機構の使用が更に想像
できる。このとき、別の方法を使用してナイフ作用をさ
せることことは勿論である。この方法においては、要素
２４、３４を有するリングを適切な向きに維持すると同
時に、装置１０を作動させる力を減らすことができる。 従って、これらいずれの実施例においても、最適の確か
な要求は、ファスナーの整列、板材２０、３０を保持す
るに十分な力の創成、及び吻合を作るときのナイフ４０
による適正な切断である。
【００３９】従って、ステープラー１０が、取り付けら
れたアンビル６０及び切断された間の組織と共に閉鎖さ
れた組織から引かれた後で、より正確かつ確実な使用者
へのフィードバックが得られる。使用者はステープラー
１０内に残っているドーナッツ状の組織及びファスナー
を点検できる。また、装置は閉鎖された組織を通して引
かれるので、装置が閉鎖により得られた結果を不明瞭に
することがなく、使用者は残った組織の部分を点検でき
る。これは、より信頼性がありかつ正確な閉鎖システム
を作る。
【００４０】あるいは、本発明のステープル用の構成に
現在のステープルを組み入れうることは言うまでもない
。図１３及び１４に見られるように、現在製造されてい
るステープラー１００、２００に本発明の頭部５０を組
み入れることができ、更にファスナー２０、３０を備え
ることもできる。従って、本発明は、これを現在の使用
に組み入れるには比較的費用がかからない。
【００４１】本発明の種々の実施例が以上のように説明
された。言うまでもなく、本発明の意図から離れること
なく、本発明のステープラー及びファスナーを変更する
ことができる。例えば、湾曲した長手方向軸を有し、又
はフレキシブルの軸を有する装置、あるいは軸の端末付
近に套針管器具を収容した装置を作ることが可能である
。実現すべきものは以下の実施態様、及び本発明の限界
を包含するその相当事項である。
【００４２】
【実施態様】本発明の実施態様につき説明すれば次の通
りである。
【００４３】
【実施態様１】（ａ）　　組織を貫いて挿入する複数の
組織突き刺し用尖端部を持つ円形の組織突き刺し用リン
グ；及び （ｂ）　　前記尖端部を内部に固定しうる複数の受容部
を持つ円形の受容用リング；を備え、組織は前記受容部
内に固定された前記尖端部上に維持されていることによ
り前記突き刺し用リングと前記受容用リングとの間に保
持される吻合用組織ファスナー。
【００４４】
【実施態様２】前記リングが被吸収性材料で作られる実
施態様１のファスナー。
【００４５】
【実施態様３】前記尖端部が組織を容易に刺せるように
形作られる実施態様１のファスナー。
【００４６】
【実施態様４】前記尖端部が戻り止め手段を有し、前記
受容部が前記尖端部を前記保持用リングに固定するため
に前記戻り止め手段と組み合いうる固定用手段を有する
実施態様３のファスナー。
【００４７】
【実施態様５】少なくも６個の尖端部と受容部とがある
実施態様１のファスナー。
【００４８】
【実施態様６】（ａ）　　組織を貫いて挿入する複数の
組織突き刺し用尖端部を持つ組織突き刺し用板；及び（
ｂ）　　前記尖端部を内部に固定しうる複数の受容部を
持つ受容用板；を備え、前記組織は前記受容部内に固定
された前記尖端部上に維持されていることにより前記突
き刺し用板と前記受容用板との間に保持される被吸収性
の吻合用組織ファスナー。
【００４９】
【実施態様７】前記板が円形状であり、かつ前記尖端部
と受容部とが前記板の周囲に位置決めされる実施態様６
のファスナー。
【００５０】
【実施態様８】前記板が人体により吸収可能である実施
態様７のファスナー。
【００５１】
【実施態様９】前記突き刺し用板が破れたとき前記尖端
部は前記周囲のリングに含まれかつ前記受容用板が破れ
たとき前記受容部は前記周囲のリングに含まれるように
前記板が前記周囲の内側で折り取られる実施態様７のフ
ァスナー。
【００５２】
【実施態様１０】前記尖端部が組織を容易に刺せるよう
に形作られる実施態様７のファスナー。
【００５３】
【実施態様１１】前記尖端部が戻り止め手段を有し、前
記受容部は前記戻り止め手段を固定用手段上に固定する
ように前記固定用手段を有する実施態様１０のファスナ
ー。
【００５４】
【実施態様１２】前記板が一般に平坦である実施態様７
のファスナー。
【００５５】
【実施態様１３】前記板の各はこれを前記板の弱くされ
た部分に沿って折り取ることができ、前記弱くされた部
分の各は、前記板に置かれ厚さの薄くされた前記板に剪
断力が加えられたときに破れうるリングを含む実施態様
９のファスナー。
【００５６】
【実施態様１４】第１の被吸収性ステープルリングを保
持しうるアンビル；前記第１の被吸収性ステープルリン
グと出会いこれを固定する第２の被吸収性ステープルリ
ングを保持しうる駆動用機構、前記駆動用機構は前記リ
ングを互いに接近して置くことができ；及び組織切断用
のナイフ手段、前記ナイフ手段は前記駆動用手段内に保
持され；を備え、前記被吸収性ステープルリングの一方
は組織を通して刺すための複数の組織突き刺し用尖端部
を有しまた前記被吸収性ステープルリングの他方は前記
両リングと前記尖端部の間に置かれた組織と共に内部に
前記尖端部を固定しうる複数の受容部を有し、更に前記
ナイフ手段は前記被吸収性ステープルリングの周囲の内
側にありかつ連結されたステープルリングにより引かれ
ている余分の組織を切断できる吻合用の組織接合用装置
。
【００５７】
【実施態様１５】前記尖端部が戻り止め手段を有し、前
記受容部は前記駆動用手段が前記リングを互いに接近し
た位置に持ってきたときに前記受容部を固定する固定用
手段を有する実施態様１４の装置。
【００５８】
【実施態様１６】前記アンビルは前記ナイフ手段がその
中に作動しうる型を更に有し、前記ナイフ手段は前記組
織を前記型に押し付けて前記組織に剪断力を加える実施
態様１５の装置。
【００５９】
【実施態様１７】前記型が雄型であり前記駆動用手段は
ばねが前記リングを互いに押し付けて保持することによ
り前記リングを互いに固定させるようなばねを更に有す
る実施態様１５の装置。
【００６０】
【実施態様１８】前記型が雌型であり前記ナイフは前記
組織を前記雌型に押し付けて剪断する実施態様１６の装
置。
【００６１】
【実施態様１９】前記リングを接近状態にし、組織を刺
し、リングを固定し、次いで余分の組織を切断する作動
手段を更に有する実施態様１５の装置。
【００６２】
【実施態様２０】前記アンビルと駆動用手段とは前記装
置の後退の際に前記リングが内部の接近した組織を維持
するように前記リングの中心部を通って取り出しうる実
施態様１９の装置。
【００６３】
【実施態様２１】第１の被吸収性ステープル板を保持し
うるアンビル；前記第１の被吸収性ステープル板と自己
整列しこれを固定する第２の被吸収性ステープル板を保
持しうる駆動用機構、前記駆動用手段は前記板を互いに
接近して置くことができ；及び組織切断用のナイフ手段
、前記ナイフ手段は前記駆動用手段内に保持され；を備
え、前記板の一方は組織を貫いて差し込むための複数の
組織突き刺し用尖端部を有しまた前記板の他方は前記両
方の板と前記尖端部の間に置かれた組織と共に内部に前
記尖端部を固定しうる複数の受容部を有し、更に前記ナ
イフ手段は前記両方の板の間に保持された余分の組織を
切断できる管腔組織接合用装置。
【００６４】
【実施態様２２】前記尖端部が戻り止め手段を有し、前
記受容部は前記駆動用手段が前記板を互いに接近した位
置に持ってきたときに前記受容部を固定する固定用手段
を有する実施態様２１の装置。
【００６５】
【実施態様２３】前記アンビルは前記ナイフ手段がその
中に作動しうる型を更に有し、前記ナイフ手段は前記組
織を前記型に押し付けて前記組織に剪断力を加える実施
態様２２の装置。
【００６６】
【実施態様２４】前記型が雄型であり前記駆動用手段は
ばねが前記板を互いに押し付けて保持することにより前
記リングを互いに固定させるようなばねを更に有する実
施態様２２の装置。
【００６７】
【実施態様２５】前記型が雌型であり前記ナイフは前記
組織を前記雌型に押し付けて剪断する実施態様２３の装
置。
【００６８】
【実施態様２６】前記板を接近状態にし、組織を刺し、
板を固定し、次いで余分の組織を切断する作動手段を更
に有する実施態様２３の装置。
【００６９】
【実施態様２７】前記アンビルと駆動用手段とは前記装
置の後退の際に前記リングが内部の接近した組織を維持
するように前記リングの中心部分を通って取り出しうる
実施態様２６の装置。
【００７０】
【実施態様２８】前記板が円形状であり、かつ前記尖端
部と受容部とが前記板の周囲に位置決めされる実施態様
２１の装置。
【００７１】
【実施態様２９】前記突き刺し用板が破れたとき前記尖
端部は前記周囲のリングに含まれかつ前記受容用板が破
れたとき前記受容部は前記周囲のリングに含まれるよう
に前記板が前記周囲の内側で折り取られる実施態様２８
の装置。
【００７２】
【実施態様３０】前記アンビルは前記ナイフ手段がその
中に作動しうる型を更に有し、前記ナイフ手段は前記組
織を前記型に押し付けて前記組織に剪断力を加える実施
態様２９の装置。
【００７３】
【実施態様３１】前記尖端部が組織を容易に刺せるよう
に形作られる実施態様３０の装置。
【００７４】
【実施態様３２】前記尖端部が戻り止め手段を有し、前
記受容部は固定用手段を有し前記戻り止め手段が前記固
定用手段上で固定する実施態様３１の装置。
【００７５】
【実施態様３３】前記板が一般に平坦である実施態様３
０の装置。
【００７６】
【実施態様３４】前記板の各はこれを前記板の弱くされ
た部分に沿って折り取ることができ、前記弱くされた部
分の各は前記板に置かれた厚さが薄くされ前記板に剪断
力が加えられたときに破れうるリングを含む実施態様３
０の装置。
【００７７】
【実施態様３５】前記型が雄型であり、前記駆動用手段
は、ばねが前記板を互いに押し付けて保持することによ
り前記板を互いに固定させ、前記固定の発生後、前記ナ
イフ手段が組織を切断し、更に前記板の弱くされた部分
を雄型に押し付けるばねを更に有する実施態様３４の装
置。
【００７８】
【実施態様３６】前記型が雌型であり前記ナイフは前記
組織及び前記板の弱くされた部分を前記雌型に押し付け
て剪断する実施態様３４の装置。
【００７９】
【実施態様３７】前記板を接近状態にし、組織を刺し、
前記板を固定し、次いで余分の組織及び前記板の弱くさ
れた部分を切断する作動手段を更に有する実施態様３４
の装置。
【００８０】
【実施態様３８】前記アンビルと駆動用手段とは前記装
置の後退の際に前記リングが内部の接近した組織を維持
するように前記リングの中心部を通って取り出しうる実
施態様３７の装置。
【００８１】
【実施態様３９】円形断面を有する頭部；駆動用機構、
前記駆動用機構は長手方向軸により前記頭部に連結され
；及びアンビル部分、前記アンビル部分は前記頭部に連
結可能でありかつ前記頭部より直径が小さい円形断面を
持つを備えたステープラー。
【００８２】
【実施態様４０】前記頭部と前記アンビル部分との間に
挿入されたファスナー手段を更に有する実施態様４０の
ステープラー。
【００８３】
【実施態様４１】前記ファスナー手段は円形でありかつ
外側部分と内側部分とに円周方向で壊れることができ、
前記アンビル部分は前記ファスナー手段の外側円周部分
の間に適合する実施態様４０のファスナー。
【００８４】
【実施態様４２】外科用ステープル作業具のアンビルと
外科用ステープル作業具の頭部との間に組織を把持し、
複数の組織突き刺し用の尖端部を有する円形の突き刺し
用リングを前記組織を貫いて駆動し；内部に前記尖端部
を固定しうる複数の受容部を有する円形の受容用リング
を通して前記円形突き刺し用リングを取り付け；装置の
頭部内に保持された円形ナイフ上の把持された組織を切
断し；前記組織の切断と同時に前記ファスナーの内側円
形リングを切断し；更にステープル作業用アンビル装置
を組織と共にステープルを通って引く諸段階を包含する
組織を一緒に接合する方法。
【図面の簡単な説明】
【図１】本発明のファスナー及び受容部の斜視図である
。
【図２】管腔内で連結された図１の要素の斜視図である
。
【図３】図１のファスナーを適用するための手段の側面
図である。
【図４】図３の手段のハンドル機構を示す。
【図５】図３の手段のハンドル機構を示す。
【図６】図３の装置に使用されたときの図１の手段の適
用の部分的な断面図である。
【図７】図３の装置に使用されたときの図１の手段の適
用の部分的な断面図である。
【図８】図３の装置に使用されたときの図１の手段の適
用の部分的な断面図である。
【図９】図３の装置に使用されたときの図１の手段の適
用の部分的な断面図である。
【図１０】図３の手段の別の実施例の断面図である。
【図１１】本発明のファスナー及び受容部の斜視図であ
る。
【図１２】図１及び図１１に示す本発明のファスナー及
び受容部の斜視図の部分的に断面とした斜視図である。
【図１３】図３の手段の別の実施例の断面図である。
【図１４】図３の手段の別の実施例の断面図である。

Claims (6)

    【特許請求の範囲】
  1. 【請求項１】（ａ）　　組織を貫いて挿入する複数の組
    織突き刺し用尖端部を持つ円形の組織突き刺し用リング
    ；及び （ｂ）　　前記尖端部を内部に固定しうる複数の受容部
    を持つ円形の受容用リング；を備え、組織は前記受容部
    内に固定された前記尖端部上に維持されていることによ
    り前記突き刺し用リングと前記受容用リングとの間に保
    持される吻合用組織ファスナー。
  2. 【請求項２】（ａ）　　組織を貫いて挿入する複数の組
    織突き刺し用尖端部を持つ組織突き刺し用板；及び（ｂ
    ）　　前記尖端部を内部に固定しうる複数の受容部を持
    つ受容用板；を備え、前記組織は前記受容部内に固定さ
    れた前記尖端部上に維持されていることにより前記突き
    刺し用板と前記受容用板との間に保持される被吸収性の
    吻合用組織ファスナー。
  3. 【請求項３】第１の被吸収性ステープルリングを保持し
    うるアンビル；前記第１の被吸収性ステープルリングと
    出会いこれを固定する第２の被吸収性ステープルリング
    を保持しうる駆動用機構、前記駆動用機構は前記リング
    を互いに接近して置くことができ；及び組織切断用のナ
    イフ手段、前記ナイフ手段は前記駆動用手段内に保持さ
    れ；を備え、前記被吸収性ステープルリングの一方は組
    織を通して刺すための複数の組織突き刺し用尖端部を有
    しまた前記被吸収性ステープルリングの他方は前記両リ
    ングと前記尖端部の間に置かれた組織と共に内部に前記
    尖端部を固定しうる複数の受容部を有し、更に前記ナイ
    フ手段は前記被吸収性ステープルリングの周囲の内側に
    ありかつ連結されたステープルリングにより引かれてい
    る余分の組織を切断できる吻合用の組織接合用装置。
  4. 【請求項４】第１の被吸収性ステープル板を保持しうる
    アンビル；前記第１の被吸収性ステープル板と自己整列
    しこれを固定する第２の被吸収性ステープル板を保持し
    うる駆動用機構、前記駆動用手段は前記板を互いに接近
    して置くことができ；及び組織切断用のナイフ手段、前
    記ナイフ手段は前記駆動用手段内に保持され；を備え、
    前記板の一方は組織を貫いて差し込むための複数の組織
    突き刺し用尖端部を有しまた前記板の他方は前記両方の
    板と前記尖端部の間に置かれた組織と共に内部に前記尖
    端部を固定しうる複数の受容部を有し、更に前記ナイフ
    手段は前記両方の板の間に保持された余分の組織を切断
    できる管腔組織接合用装置。
  5. 【請求項５】円形断面を有する頭部；駆動用機構、前記
    駆動用機構は長手方向軸により前記頭部に連結され；及
    びアンビル部分、前記アンビル部分は前記頭部に連結可
    能でありかつ前記頭部より直径が小さい円形断面を持つ
    を備えたステープラー。
  6. 【請求項６】外科用ステープル作業具のアンビルと外科
    用ステープル作業具の頭部との間に組織を把持し、複数
    の組織突き刺し用の尖端部を有する円形の突き刺し用リ
    ングを前記組織を貫いて駆動し；内部に前記尖端部を固
    定しうる複数の受容部を有する円形の受容用リングを通
    して前記円形突き刺し用リングを取り付け；装置の頭部
    内に保持された円形ナイフ上の把持された組織を切断し
    ；前記組織の切断と同時に前記ファスナーの内側円形リ
    ングを切断し；更にステープル作業用アンビル装置を組
    織と共にステープルを通って引く諸段階を包含する組織
    を一緒に接合する方法。
JP4024317A 1991-01-17 1992-01-16 被吸収性フアスナー手段を有する引抜き式円形吻合用管腔内ステープラー Pending JPH04309341A (ja)

Applications Claiming Priority (2)

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US642496 1991-01-17
US07/642,496 US5222963A (en) 1991-01-17 1991-01-17 Pull-through circular anastomosic intraluminal stapler with absorbable fastener means

Publications (1)

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JPH04309341A true JPH04309341A (ja) 1992-10-30

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ID=24576806

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US (1) US5222963A (ja)
EP (1) EP0495673B1 (ja)
JP (1) JPH04309341A (ja)
AU (1) AU1015592A (ja)
BR (1) BR9200118A (ja)
CA (1) CA2059458A1 (ja)
DE (1) DE69218268T2 (ja)
ZA (1) ZA92328B (ja)

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DE69218268T2 (de) 1997-07-03
US5222963A (en) 1993-06-29
CA2059458A1 (en) 1992-07-18
EP0495673B1 (en) 1997-03-19
BR9200118A (pt) 1992-10-06
AU1015592A (en) 1992-07-23

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