JPH0468941B2 - - Google Patents

Info

Publication number
JPH0468941B2
JPH0468941B2 JP61203547A JP20354786A JPH0468941B2 JP H0468941 B2 JPH0468941 B2 JP H0468941B2 JP 61203547 A JP61203547 A JP 61203547A JP 20354786 A JP20354786 A JP 20354786A JP H0468941 B2 JPH0468941 B2 JP H0468941B2
Authority
JP
Japan
Prior art keywords
fastener
assembly
tube
actuator
shaft assembly
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
JP61203547A
Other languages
English (en)
Other versions
JPS62101238A (ja
Inventor
Teii Guriin Deiuitsudo
Aranii Aanii
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
United States Surgical Corp
Original Assignee
United States Surgical Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by United States Surgical Corp filed Critical United States Surgical Corp
Publication of JPS62101238A publication Critical patent/JPS62101238A/ja
Publication of JPH0468941B2 publication Critical patent/JPH0468941B2/ja
Granted legal-status Critical Current

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Classifications

    • 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
    • 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
    • A61B2017/07214—Stapler heads
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • 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
    • 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

Landscapes

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

Description

【発明の詳細な説明】 本発明は外科用留め具付け装置に関し、特に、
相対的に動くことのできる留め具保持部品とアン
ビル部品との間でクランプした身体組織に外科用
留め具を付けるための装置に関する。
相対的に動くことのできる留め具保持部品とア
ンビル部品との間でクランプした身体組織に外科
用留め具を付けるための外科用留め具付け器具は
種々の形式のものが知られている。例えば、ヒル
シユ（Hirsch et al）氏等に付与された米国特許
第3275211号を参照されたい。外科用留め具はヒ
ルシユ氏等の特許に示すように金属製のホチキス
針であつても良いし、或いは、例えばグリーン
（Green）氏に付与された米国特許第4402445号に
示すように非金属製樹脂材料であつても良い。金
属製ホチキス針の場合、代表的にはホチキス針の
脚部を組織に打ち込みこれら脚部をアンビル部品
で折り曲げてホチキス針を組織に固定する。非金
属製留め具の場合には、各留め具は当初は２つの
別々の部品、即ち、留め具付け装置の留め具保持
部品内に配置された留め具部品と、装置のアンビ
ル部品内に配置されたリテーナ部品とから成る。
留め具部品の脚部は組織に打ち込まれてリテーナ
部品と相互に係止し、それによつて留め具を組織
内に固定する。たいていの金属製外科用ホチキス
針は生物学的に不活性であり、したがつて身体内
にいつまでも残るけれども、生物学的に吸収性の
金属製外科用ホチキス針が知られている。非金属
製樹脂材料の外科用留め具も又、生物学的に吸収
性か或いは非吸収性のいづれかにすることができ
る。
採用する留め具の形式又は形態は本発明の要部
を成さない。「外科用留め具」という用語は本明
細書で使用されるとき、上述の留め具の形式の全
ての総称である。同様に、「留め具保持部品」、
「アンビル部品」という用語も又、本明細書で総
称的に用いられている。
留め具保持部品とアンビル部品との間にクラン
プした組織に外科用留め具を付けるための既知の
外科用留め具付け器具のうちのほとんどのもので
は、器具の遠い方の留め具付け組立体（この留め
具付け組立体は留め具保持部品とアンビル部品と
を有する）は器具の近い方の作動器部分にしつか
りと連結されている。これは、例えば上述のヒル
シユ氏等の特許及びグリーン氏の特許に示す器具
にも当てはまる。
しかしながら、最近、留め具付け組立体と作動
器組立体との間の連結部がかんぜんにはしつかり
としていないような器具に関心が高まつた。例え
ば、ノイル氏等（Noiles et al）に付与された米
国特許第4473077号は、留め具付け組立体と作動
器組立体との間に連結された軸組立体が一平面
（即ち、ノイル氏等の米国特許の第５図の紙面）
において横に撓むことができるような外科用ホチ
キス針を示している。これは、管状の身体器官の
中に差し込まれるようになつたノイル氏等の米国
特許に示す形式の器具では望まれる特徴である。
かか用途では、器具の可撓性軸は周囲の身体器官
の曲率に順応する。しかしながら、通常、周囲の
身体構造では支持されない器具（例えば、ヒルシ
ユ氏等の特許及びグリーン氏の特許を示す形式の
器具）では、留め具付け組立体と作動器組立体と
の間の器具の可撓性が過度であると、留め具付け
組立体の位置を作動器組立体からは調節できず、
また、これら組立体の各々を、留められるべき組
織に器具を配置している間、別々に支持しなけれ
ばならない。これが意味することは、配置及び取
り外しの際に器具を取り扱うには二人の人間が必
要であるということである。
上記のことを考慮して、本発明の目的は、留め
具付け組立体が作動器組立体にしつかりと連結さ
れていないけれども、留め具付け組立体の位置を
実質的に作動器組立体から調節することができる
ような上述の外科用留め具付け装置を提供するこ
とにある。
本発明のもう一つの目的は、留め具付け組立体
が作動器組立体にしつかりと連結されていないけ
れども、留め具付け組立体が作動器組立体に対し
て任意の位置にあつても留め具付け組立体を作動
器組立体から完全に調節できるような上述の形式
の外科用留め具付け装置を提供することにある。
発明の概要 本発明のこれらの目的及び他の目的は、本発明
の原理に従つて、外科用留め具付け組立体が関節
部を含む長さ方向軸組立体によつて作動器組立体
に連結され、この関節部が軸組立体の長さ方向線
と直角な軸線の周りに作動器組立体に対して外科
用留め具付け組立体を回転させることができるよ
うな外科用留め具付け装置を提供することにより
達成される。軸組立体は、関節部の任意の回転位
置で作用して、留め具付け組立体を作動させるの
に必要な力と運動（“仕事”）を、作動器組立体か
ら留め具付け組立体に伝達する。軸組立体は、ま
た、上述の関節部の回転軸線と平行な他のすべて
の軸線の周りに剛性であることが好ましい。
好ましい実施態様においては、多位置戻り止め
装置が、関節部を複数の回転位置の何れかに解放
可能に保持するように関節部と関連づけられてい
る。関節部を複数の回転位置の何れかに係止する
ため、係止装置を設けてもよい。関節部の運動を
所定の回転範囲に制限するように、ストツプ装置
を関節部と関連づけてもよい。組織クランプ作用
と留め具付け作用とは両方共、作動器組立体から
完全に制御させるのが好ましく、必要な仕事は、
近い方へ移動しうる張力伝達部材である軸組立体
部材によつて、作動器組立体から留め具付け組立
体へ伝達されるのが好ましい。これらの部材は、
好ましくは横に可撓性で関節部に隣接し、関節部
の回転軸線と一致する軸線に沿つて関節部を貫通
する。装置の留め具付け部品は、好ましくは、作
動器組立体の本体から一定距離に取付けられ、ア
ンビル部品が作動器組立体の適切な作用に応答し
て留め具保持部品の方へ移動するように、アンビ
ル部品が取付けてある。
所望により、長さ方向軸組立体は第２関節部を
含むこともでき、この第２関節部は、長さ方向軸
組立体の縦軸線の周りに、作動器組立体に対して
留め具付け組立体を回転させることを可能とす
る。第１関節部の場合のように、長さ方向軸組立
体は、第２関節部の任意の回転位置で作用して、
留め具付け組立体を作動させるのに必要な仕事
を、作動器組立体から留め具付け組立体へ伝達す
る。戻り止め装置、係止装置、及びストツプ装置
の何れか又は全部が、第１関節部とこれらの要素
との関連と類似の仕方で第２関節部と関連づけら
れるのがよい。
本発明の他の特徴、その性質及び種々の利点
は、添付図面と以下の詳細な説明からより明らか
になるであろう。
全体的な構成及び作用 第１図に示すように本発明の外科用留め具付
け装置又は器具１０の例示の実施例が、近い方
の作動器組立体２０と、遠い方の留め具付け組
立体２００と、中間の軸組立体１００とを有し
ている。
留め具付け装置２００は、第１関節部１１０
の回転軸線である軸線１１２を中心として手で
回転できるように軸組立体１００の遠い方の端
に取付けられた近い方の留め具保持部品２１０
を有する。軸線１１２が軸組立体１００の長手
方向軸線１０２と直交していることに注意され
たい。特に、軸線１１２は軸線１０２と垂直で
ある。ただし、これは泌ずしも必要ではない。
更に、軸線１１２が留め具保持部品２１０の長
手方向軸線と平行であることに注意されたい。
しかしながら、これ又必ずしも必要であるとい
う訳ではない。関節部１１０のため、留め具付
け組立体２００を第１図において矢印１１４の
両端で示す範囲内で軸線１１２を中心に任意の
回転位置まで動かすことができる。図示の実施
例では、留め具保持組立体２００を軸線１０２
の両側に約90°（全体として約180°）回転させる
ことができる。
軸組立体１００は第２関節部１４０を有し、
この第２関節部の構成要素は第１６図乃至第２
０図に最もよく示されており、以下に詳細に説
明する。一般に、第２関節部１４０のため、軸
組立体１００の遠い方の部分（関節部１１０を
含む）を、長さ方向軸線１０２を中心として軸
組立体の近い方の部分に対して手で回転させる
ことができる。かくして、関節部１４０のた
め、留め具付け組立体２００を第１図〜第２０
図において矢印１０４の両端で示す範囲内で軸
線１０２を中心に任意の回転位置まで動かすこ
とができる。好ましくは、作動器組立体２００
を軸線１０２を中心として、第１図に示す位置
から両側に少なくとも約90°（全体として少なく
とも約180°）、更に好ましくは、第１図に示す
位置から両側に約150°（全体として約300°）回
転させることができる。
Ｕ形フレーム２８０は、留め具保持部品２１
０に可動に取付けられている。特に、フレーム
２８０の近い方の脚部２８２は留め具保持部品
２１０と隣接しており、その一方、フレーム２
８０の遠い方の脚部２８４は留め具保持部品２
８０から遠い方に間隔を隔てられている。アン
ビル部品２９０は遠い方の脚部２８４に取付け
られている。
使用にあたつては、関節部１１０及び１４０
を手で操作して留め具付け組立体２００を正し
く配向した後、第２図に示すように間隔を隔て
られた留め具保持部品２１０とアンビル部品２
９０との間に留めるべき組織１２を配置する。
次いでクランプ作動器５０を、第３図及び第４
図に順に追つて示すように、作動器組立体２０
の本体３０に向かつて手で下方に回動させる。
このためフレーム２８０が近い方すなわち手前
の方向に移動し、その結果、組織１２が留め具
保持部品２１０とアンビル部品２９０との間で
クランプされる。次いで、この組織を留めるこ
とができる。これは、安全掛け金６０を第４図
に一点鎖線で示す位置まで手で下げ、留め具作
動器７０を第４図に一点鎖線で示す位置まで手
で後方に回動させることによつて行なわれる。
このため、留め具保持部品２１０は、複数の外
科用留め具部品２１２（第９図乃至第１３図及
び第１５図参照）を留め具保持部品２１０から
組織１２を一部貫通して打ち込み、アンビル部
品２９０に取外し自在に取付けたリテーナ部品
２１４と相互係止させる。以上で組織留め手順
が完了し、クランプ可動器５０の手で回動させ
ることによつて本体３０から離してアンビル部
品２９０を留め具保持部品２１０から遠い方に
移動させ、それによつて、組織へのクランプ圧
力を解放することによつて器具１０を組織から
外す。上述のように使用した後、器具１０は廃
棄される。
器具１０は、関節部１１０及び１４０がいか
なる回転位置にあつても十分に作動することが
できる。関節部１１０及び１４０のため、外科
医は、作動器組立体２０に対する留め具保持組
立体の広範囲に亘る位置のいずれでも選択する
ことができ、そのため、器具１０の配置及び使
用が非常に容易になる。関節部１１０及び１４
０（及び組立体２０，１００、及び２００の
各々と関連する可動部品）がない場合には、器
具１０は剛性構造である。例えば、器具１０が
そのまわりに任意の程度に撓むことのできる軸
線が軸線１１２の他にない。このため、各関節
部と関連した以下に詳述する戻り止め手段及び
係止手段と組合わせることによつて、外科医
は、最初に組立体２０及び２００の相対的な回
転位置を選定し、その後器具の遠い方の端部か
ら器具を十分に制御することのできる位置に配
置し、操作することができる。
上述の実施例では、代表的には非金属の樹脂
材料でできた２部品相互係止留め具によつて、
組織は留められるめれども、当業者は金属製の
外科用ホチキス針を使用してもよいことがわか
る。同様に、上述の器具１０は１度使用したら
廃棄されるように設計されている（そのため病
院は、再使用のため器具を清浄にしたり、殺菌
したり、再装填したりすることに伴なう全ての
困難及び費用を回避することができる）けれど
も、当業者は、所望であれば、本装置を耐久性
のあるもの、すなわち再使用できるものにつく
ることができることがわかる。
作動器組立体２０の詳細な構造と操作 今、第２図〜第５図について作動器組立体２
０の構造と操作を考えると、本体３０は、２つ
の鏡像関係をなしたシエル部材３４，３６によ
つて取り囲まれた内部フレーム構造体３２で構
成されている。クランプ作動器５０はピボツト
ピン４２によつて本体３０に連結されている。
クランプ作動器５０はピボツトピン５２によつ
てトグルリンク５４の一端にも回動可能に連結
されている。トグルリンク５４の他端は、ピボ
ツトピン５６によつてクランプ作動器のケーブ
ルアンカー５８に回動可能に連結されている。
軸線１０２と平行に往復運動可能なアンカー５
８は、本体３０に取付けられている。クランプ
作動器のケーブル１０６の近い方の端はアンカ
ー５８にしつかりと取付けられている。
第２図〜第４図に順次示すようにクランプ作
動器５０が本体３０へ回動して下がるとき、ト
グルリンク５４は、アンカー５８の手元の方向
に移動させる。ケーブル１０６は、アンカー５
８によつて手元の方向に引張られる。アンカー
５８は、アンカーの歯５９とフレームステツプ
５８との係合によつて第３図に示す中間体止位
置に解放自在に保持されている。これにより作
動器組立体２００は、手動による回動力がクラ
ンプ作動器から取り除かれても第３図に示す位
置に保持される。これにより外科医は組織が留
め具付け組立体２００内に実質的に納められる
間で、しかしながら最大留め圧力が組織に加え
られる前に、組織１２に対する装置の配置を点
検し、必要ならば調整する機会を得ることがで
きる。望むならばクランプ作動器５０の上に持
つ上げ、これによりアンカーの歯５９をステツ
プ38の上に上昇させることによつて装置を再び
開くことができる。アンカー５８は又、第４図
に示す近い方の位置で回動ピン５２が僅かに中
心の上にある（即ち、第４図に示すように、ピ
ボツトピン４２，５９をむすぶ線の僅かに下に
ある）という事実によつて、第４図に示す近い
方の位置に解除自在に保持されている。もう一
度装置は、クランプ作動器５０の上に持つ上げ
られることによつてこの装置から再度開くこと
ができる。
安全掛け金６０はピボツトピン４４によつて
本体３０に回動自在に連結され、留め具作動器
７０は、回動ピン４６によつて本体３０に回転
自在に連結されている。留め具作動器のケーブ
ル１０８の近い方の端は、留め具作動器７０に
しつかりと取付けられている。ケーブル１０８
は留め具作動器７０が第４図に示すように回動
するとき手元の方向に引張られる。
軸組立体１００の詳細な構造と操作 シヤフト組立体１００の構造は、第１６図〜
第２０図に最も良く示されている。軸組立体１
００の主要な構造部材は管状部材１６０であり
この管状部材１６０は、軸組立体の近い方の端
の近くで作動器組立体２０のフレーム構造体３
２にしつかりと連結されている。ケーブル１０
６，１０８は管状部材１６０を自由に貫通して
いる。管状ステム部材１４２の近い方の部分は
管状部材１６０の遠い方の端に嵌合し、関節１
４０をつくるため管状部材１６０に対して回転
可能である。ケーブル１０６，１０８はステム
１４２から留め具保持部品２１０へ自由に通つ
ており、部品２１０は、関節部１１０をつくる
ためステム１４２の遠い方の端に回動自在に取
付けられている。
ステム１４２は、内側に延びた管肩部１６２
を環状ステム溝１４４に突出させることによつ
て管状部材１６０内に保持される。もう一つの
内側に延びた管状肩１６４がステム溝１４６に
延びている。溝１４６は一側でストツプ部材に
よつて中断している。従つて、ステム１４２
は、ストツプ部材１４８が肩１６４に当たるま
で管状部材１６０に対していずれの方向に回転
することができる。要素１４８，１６４は従つ
て関節部１４０のためのステツプ部材をつくる
ために協働する。
管状部材１６０は、管１７０、カラー１８
０、ブツシユ１８４，１８６、スラストリング
１８８及び係止リング１９０から成る他の管状
構造体により取り囲まれている。管１７０、及
び係止リング１９０は、管１６０に対して回転
することができる。
カラー１８０は、カラーのキー１８１を管の
キー溝１６６に突出させることによつて管１６
０に対して回転できるようになつている。ブツ
シユ１８４，１６６はゴムのような圧縮性材料
で作られている。スラストリング１８８は、要
素１８０，１８４，１８６に対する係止リング
１９０の回転を容易にするためにポリテトラフ
ルオロエチレンのような比較的低摩擦性材料で
作られている。管１７０は管の遠い方の端付近
でステムのキー１５０をキー溝１７２へ突出さ
せることによつて、ステム１４２との回転が阻
止されている。管１７０の遠い方の端付近の弧
状歯付ラツク１７４は留め具保持部品２１０の
歯付ピニオンセグメント１１６と係合する。要
素１１６，１７０は軸線１１２と同心である。
管１７０の近い方の端の手元に向いた歯１７６
はカラー１８０の遠い方に向く歯１８２と係合
する。ラツク１７４の端面１７８ａ，１７８ｂ
は留め具保持部品２１０の２つの側板２１８と
夫々協働して、組立体２００が軸線１０２のい
ずれかの側に約90°回転したとき、軸線１１２
まわりの留め具付け組立体２００の回動を止め
る。従つて、面１７８及び板２１８は、関節部
１１０のためのストツプ手段をつくるように協
働する。
非係止位置においては、手元に近い方に延び
る歯１９２が、本体３０の手元から遠い端部の
比較的深いノツチ４０ａ内に延入するように、
係止リング１９０が回転される。係止リング１
９０のこの位置において、ブツシユ１８４，１
８６は、スラストリング１８８とカラー１８０
との間でごく僅かに圧縮される。従つて、カラ
ー１８０およびチユーブ１７０は、手元から遠
い方向に比較的軽くかつ弾性的に押しつけられ
る。従つて、歯１８２，１７６は互いに係合す
るように軽く保持され、この係合は、留め具付
け組立体２００を軸線１０２の回りで作動器組
立体２０に対しゆつくりと回転することによつ
て比較的容易に解除される。しかしながら、歯
１８２および歯１７６は、これらの歯１８２，
１７６が係合するいかなる回転位置においても
関節部１４０を解放自在に保持するのに充分に
係合している。従つて、歯１８２，１７６およ
びこれらの歯の関連要素は、複数の回転位置の
いずれかの位置において、関節部１４０を解放
自在に保持するための戻り止めを構成する。一
方、歯１９２が比較的深いノツチ４０ａから変
位（例えば、比較的浅いノツチ４０ｂに変位）
するように係止リング１９０が回転されると、
係止リング１９０は手元から遠い方向に幾分移
動する。この結果、ブツシユ１８４，１８６が
より強く圧縮され、カラー１８０およびチユー
ブ１７０が手元から遠い方向に強く押される。
これにより、歯１８２，１７６が互いに一層強
固に係合し、従つて、関節部１４０をその現在
の回転位置に係止する。
上記構造体は、ラツク１７４およびピニオン
１１６に対し同様な方法で作動する。係止リン
グの歯１９２がノツチ４０ａと整合すると、ラ
ツク１７４はピニオン１１６のみと比較的軽く
係合し、従つて、要素１１６，１７４は、複数
の回転位置のいずれかの位置で関節部１１０を
解放自在に保持するための戻り止め手段として
作用する。係止リングの歯１９２がノツチ４０
ａと係合しないときは、ラツク１７４はピニオ
ン１１６とより強固に係合し、関節部１１０を
その現在位置に係止する。
使用に際しては、外科医が、関節部の軸線１
０２，１１２のいずれか一方または両方の回り
で作動器組立体２０に対し留め具付け組立体２
００を手で回転する。戻り止め要素１１６，１
７４，１７６および１８２は、作動器組立体２
０および留め具付け組立体２００を選定された
相対位置において解放自在に保持する。外科医
が作動器組立体２０および留め具付け組立体２
００の相対位置に満足するときは、歯１９２を
ノツチ４０ａからノツチ４０ｂに移動させるべ
く係止リング１９０を回転し、関節部１１０，
１４０をこれらの現在位置に係止する。更に調
整したときは、再び係止リング１９０を回転し
て歯１９２をノツチ４０ａに整合させ、関節部
１１０，１４０の係止を解除する。
留め具付け組立体２００の詳細な構造および
操作 第６図〜第１５図に示した留め具付け組立体
２００の詳細な構造および操作について説明す
ると、留め具保持部品２１０は上記のごとく、
ステム１４２の手元から遠い端部に枢着されて
いて、関節部１１０を構成している。留め具保
持部品２１０の各側には、フレーム取り付けカ
ム板２６０ａ又は２６０ｂが移動自在に取り付
けられている。各カム板２６０は、留め具保持
部品２１０と、フレーム構造体２８０の手元に
近い方の脚部２８２の隣り合う側横部との間に
挟持されている。カム板２６０は、留め具保持
部品２１０の側部のカムスロツト２１６内への
カムフオロワー２６２の突出部により、留め保
持部品２１０に対して垂直に往復運動するよう
に案内される。フレーム２８０は、カム板２６
０のカムスロツト２１６内へのカムフオロワー
２６２の突出部により、留め具保持部品２１０
の側板２１８の間のフインガの突出部により、
および板２１８のスロツト２２０内へのピン２
８９の突出部により、留め具保持部品２１０に
対して位置決めされている。
フレーム２８０は、留め具保持部品２１０と
フレーム２８０との間で作用するプレストレス
圧縮コイルスプリング２２４により、手元から
遠い方向に弾性押圧されている。
各カム板２６０はフインガ２６６を有し、該
フインガ２６６は留め具保持部品２１０の後部
近くの垂直開口部２２２内に延入している。フ
インガ２６６は開口部２２２の内側で互いに重
なり合つており、クランプ作動器のケーブル１
０６の手元から遠い端部が、フインガの重なり
合う所で該フインガに係止されている（第７図
参照）。カム板２６０は、フインガ２６６留め
具保持部品２１０と留め具保持部品２１０の表
面との間で作用するプレストレス圧縮コイルス
プリング２２６によつて、留め具保持部品２１
０に対して上向きに弾性押圧されている。
フインガ２６６に届くために、ケーブル１０
６の手元から遠い端部は、ステム１４２の手元
から遠い端部によつて、軸線１０２に平行な軸
組立体１００の整合位置から軸線１１２に平行
な留め具保持部品２１０の整合位置まで、約
90°回転される（第７図および第９図〜第１３
図参照）、従つて、クランプ作動器５０がケー
ブル１０６を手元から遠い方向に引つ張ると
き、第９図〜第１２図に順次示すように、ケー
ブル１０６の手元から遠い端部はカム板２６０
を留め具保持部品２１０に対して垂直下向きに
引つ張る。スロツト２２０内にピン２８９が存
在するため、フレーム２８０がカム板２６０と
共に下方に移動することが防止される。従つ
て、カムフオロワー２８６がカムスロツト２６
４に沿つて上向きに移動することが制止され、
フレーム２８０は手元に近い方に移動される。
ピン２８９は、スロツト２２０を横切つてフレ
ーム２８０と共に手元に近い方向に移動する。
カムスロツト２６４の形状は、フレームの手元
から遠い脚部２８４が始めに回動して、留め具
保持部品２１０の手元から遠い面と共に平行四
辺形を形成し、次いで、クランプ作動器５０の
ストロークの終時において組織１２が留め具保
持部品２１０の手元から遠い面とアンビル部品
２９０の手元に近い平面な面との間でクランプ
されるように、留め具保持部品２１０の手元に
近い方に移動させる形状になつている。
留め具保持部品２１０とアンビル部品２９０
の心合せは、組織１２をクランプしたときに留
め具保持部品２１０から延びてアンビル部品２
９０に自動的に入る心合せピン２３０によつて
適切におこなわれる。心合せピン２３０は、留
め具保持部品２１０の後部に軸支されたピンキ
ヤリア２３２によつて往復運動する。ピンキヤ
リア２３２は、心合せピン２３０を引き込める
ために、第９図に示すように、板バネ２３４に
よつて近い方に弾性的に付勢されている。ピン
キヤリア２３２の下部には、カム板２６０の近
い方のカム面２６８と接触するカムフオロア面
２３６が設けられている。面２３６，２６８
は、協働的に形作られて、カム板２６０が最上
位置に有る時、板バネ２３４が心合せピン２３
０を近い方に引き込め、またカム板２６０がケ
ーブル１０６によつて引き下げられた時、ピン
キヤリヤ２３２を旋回させて心合せピン２３０
が遠い方に延びるようにする。クランプ作動器
５０が第３図に示す中間休止位置（歯部５９が
段部３８と係合している）となるまでに、心合
せピン２３０は充分に延びて、第１０図に示す
ように、アンビル開口２９２に入り始める。従
つて、外科医が装置の位置を調整したとき、及
び組織１２を最終的にクランプするとき、心合
せピン２３０は組織１２を留め具保持部品２１
０とアンビル部品２９０との間に保つことを助
ける。第１１図に示すように、組織１２をクラ
ンプし続けるときには、アンビル開口２９２は
心合せピン２３０の遠い方の端部上にさらに引
張られ、留め具保持部品２１０とアンビル部品
２９０との心合が適切に行われることを確保す
る。
組織１２を上述のようにクランプした後、留
め具部品２１２を、第７図乃至第１３図及び第
１５図に最も良く示される要素によつて駆動す
る。留め具部品２１２は、最初、留め具保持部
品２１０の遠い方の部分を形成する保持装置２
４０の開口２４２内に配置される。プツシヤフ
インガ２４４は延在して各開口２４２の後部に
入つている。プツシヤフインガ２４４は、小グ
ループ（例えば、複数の対）をなすように連結
して分離し部品の点数を減少させ、開口２４２
内を閉ざしがちな大きな単一のプツシヤ構造を
設けることなしに個々のプツシヤフインガ２４
４を安定させることが有利である。プツシヤフ
インガ２４４の全ての近い方の端部は、剛体で
単一のフオロア部材２４６によつて当接させら
れている。プツシヤ作動器２４８はフオロア２
４６の近い側に配置され、留め具保持部品２１
０の側板２１８のカムスロツト２５２まで延び
たカムフオロアピン２５０によつて支持されて
いる。
留め具作動ケーブル１０８は、プツシヤ作動
器２４８に取りつけられている。ケーブル１０
６の場合のように、ケーブル１０６の遠い方の
端部は、プツシヤ作動器２４８に届かせるため
に、ステム１４２の遠い方の端部によつて軸線
１０２と平行な軸組立体１００との心合せの状
態から、軸線１１２と平行な留め具保持部品２
１０との心合せの状態まで、約90°方向が変え
られる。留め具作動器７０が作動してケーブル
１０８の近い方に引張ると、ケーブル１０８の
遠い方の端部はプツシヤ作動器２４８上を引き
下げる。プツシヤ作動器２４８が下へ移動する
と、プツシヤ作動器２４８は要素２５０及び２
５２の協働により（第１２図参照）遠くの方向
に移動させられる。プツシヤ作動器２４８の遠
くの方向への移動は、プツシヤフオロア２４６
を介してプツシヤフインガ２４４に伝えられ、
これによつて留め具部品２１２を組織１２を通
して少し動かし、リテーナ２１４と係合させて
組織１２をクランプする。
組織１２を上述したようにしてクランプした
後、組織１２のクランプ圧力はクランプ作動器
５０を持ち上げることにより解放される。スプ
リング２２４及び２２６はカム板２６０及びフ
レーム２８１を最初の位置に戻し、スプリング
２３４は心合せピン２３０を近い方に戻す。従
つて、クランプした組織１２は、第１３図に示
すように、装置から外され、装置は外科手術の
場所から片づけられる。
組織をクランプして留て具を付けるために必
要な力は、横断方向及び捩じり方向の両方に可
撓性を有する張力伝達部材１０６及び１０８を
近くの即ち手前の方向に移動させることによ
り、作動器２０から留め具付け組立体へ伝えら
れることに注意すべきである。ケーブル１０６
及び１０８の横断方向の可撓性は、ステム１４
２の遠い方の端部に近接した位置での方向変え
を可能にする。ケーブル１０６及び１０８の行
路長は、関節部１１０及び１４０の回転部分に
よつてとんど影響されないことにも注目すべき
であり、それは、各ケーブルが、関節部の回転
部分において軸線１０２又は１１２とほぼ一致
しているからである。例えば、ケーブル１０６
及び１０８は共に、ステム１４２がチユーブ１
６０に対して回転する位置において軸線１０２
と一致している。従つて、関節部１４０を関節
運動させるとき、ケーブル１０６及び１０８は
僅かに捩れるが、ケーブル１０６及び１０８の
行路長は大きくは変しない。同様に、ケーブル
１０６及び１０８は共に、留め具保持部品２１
０がステム１４２に回転自在に取りつけられた
位置において軸線１１２とほぼ一致している。
したがつて、関節部１４０を関節運動させる
と、ケーブル１０６及び１０８は僅かに捩じら
れるが、両ケーブルの行路長が大きく変化する
ことはない。（本明細書において、用語「一致」
は、ケーブル１０６及び１０８の両者が概ね交
差するか、又は特定の位置において特定の軸線
とほぼ共軸であることを意味する。）ケーブル
１０６及び１０８の横方向及び捩れ方向の可撓
性を有すること及び行路長が変化しないこと
は、上述したように装置の関節運動を容易に
し、関節部１１０及び１４０が任意の回転位置
にあつても装置の作動を可能にする。
【図面の簡単な説明】
第１図は本発明の外科用留め具付け装置を説明
する実施例の斜視図、第２図は本装置の操作手順
の最初の段階を示す第１図の装置の部分断面立面
図、第３図および第４図は第１図の装置の操作手
順の連続した段階を示す第２図と同様の図、第５
図は第２図に示す状態での第１図の装置の部分分
解斜視図、第６図は第１図の装置の遠方部分の部
分分解斜視図、第７図は第１図の装置の遠方部分
の部分斜視図、第８図は第１図の装置の遠方部分
の詳細分解斜視図、第９図は第２図に示す状態で
の第１図の装置の遠方部分の部分断面立面図、第
１０図乃至第１３図は第１図の装置の操作手順の
連続した段階を示す第９図と同様の図、第１０図
および第１１図は第３図および第４図に夫々示し
たものと同じ操作手順の段階を示す図、第１４図
は第１０図の線１４−１４における断面図、第１
５図は第１２図の線１５−１５における断面図、
第１６図は第１図の装置の中間部分の分解斜視
図、第１７図は第１図の装置の中間部分の部分断
面立面図、第１８図は第１図の装置の異なつた操
作状態を示す第１７図と同様の図、第１９図は第
１７図に示す状態での第１図の装置の中間部分の
部分断面底面図、第２０図は第１７図の線２０−
２０における断面図、第２１図は第１図の装置の
遠方部分の底面図である。 １０……外科用留め具付け装置、２０……近い
方の作動器組立体、１００……軸組立体、１０２
……長さ方向軸線、１１２……第２の軸線、２０
０……遠い方の留め具付け組立体。

Claims (1)

  1. 【特許請求の範囲】 １ 複数の外科用留め具を有する留め具保持部品
    と、前記留め具保持部品と向かい合わせに配置さ
    れた留め具受け入れ部品とを含む遠い方の留め具
    付け組立体２００と、前記留め具保持部品と前記
    留め具受け入れ部品とを接近させるための手段
    と、複数の留め具を前記留め具保持部品から組織
    を通して前記留め具受け入れ部品の方へ打ち込む
    第１の手段と、前記第１の手段を作動するのに必
    要な仕事を発生させるための第２の手段を含む近
    い方の作動器組立体２０と、作動器組立体２０に
    対して留め具付け組立体２００を支持し、前記第
    ２の手段によつて発生された仕事を前記第１の手
    段に伝達するための長さ方向軸組立体１００と、
    を含む、外科用留め具付け装置であつて、軸組立
    体１００は、留め具付け組立体２００が作動器組
    立体２０に対して軸組立体１００の長さ方向軸線
    と垂直な第１の軸線のまわりに回転することがで
    きるようにする第１の関節部１１０を含み、軸組
    立体１００は前記第１の関節部のいかなる回転位
    置においても仕事を前記第２の手段から前記第１
    の手段に伝達するように作動し、軸組立体１００
    は、前記第１の軸線と平行なその他すべての軸線
    のまわりで実質的に剛性であり、軸組立体１００
    はさらに、留め具付け組立体２００が作動器組立
    体２０に対して軸組立体１００の長さ方向軸線の
    まわりに回転することができるようにする第２の
    関節部１４０を含み、軸組立体１００は前記第２
    の関節部のいかなる回転位置においても仕事を前
    記第１の手段から前記第２の手段に伝達するよう
    に作動することを特徴とする外科用留め具付け装
    置。 ２ 前記軸組立体１００は、前記第２の関節部１
    ４０を回転自在に受け入れる第１の管１６０と、
    前記第２の関節部１４０にキー止めされ、前記第
    １の管１６０に回転自在に設けられた第２の管１
    ７０と、前記作動器組立体２０と前記第２の管１
    ７０との間で前記第１の管１６０に設けられた回
    転可能な係止リング１９０とを有し、前記係止リ
    ング１９０は前記管１６０，１７０間の相対的な
    回転を可能にする第１の位置と前記管１６０，１
    ７０を係止関係に解放自在に保持する第２の位置
    との間を回転できる、特許請求の範囲第１項に記
    載の外科用留め具付け装置。 ３ 前記第２の管１７０の歯１７６と噛み合う歯
    １８２をもつたカラー１８０を有し、前記係止リ
    ング１９０の前記第２の位置で前記カラーを押し
    て前記第２の管１７０と係合させるために前記カ
    ラー１８０と前記係止リング１９０との間に設け
    られた少なくとも１つの圧縮可能なブツシユ１８
    ４を有する、特許請求の範囲第２項に記載の外科
    用留め具付け装置。 ４ 前記係止リング１９０は、前記作動組立第２
    ０の本体３０の切欠き部４０ａ，４０ｂに選択的
    に受入れ可能な近い方に延びた歯１９２を有して
    いる、特許請求の範囲第２項に記載の外科用留め
    具付け装置。 ５ 前記第１の関節部１１０は前記第２の関節部
    １４０を回転自在に受入れ、かつピニオン１１６
    を有し、前記第２の管１７０は、前記係止リング
    １９０の前記第２の位置で前記ピニオンと噛み合
    うための歯付ラツク１７４を有している、特許請
    求の範囲第１項乃至第４項のいずれか１項に記載
    の留め具付け装置。 ６ 前記留め具付け組立体２００は、留め具保持
    部品２１０と、この留め具保持部品２１０に面し
    ているアンビル２９０とを有し、前記留め具保持
    部品２１０と前記アンビルとの間に組織を締めつ
    けるために、前記留め具保持部品２１０を前記ア
    ンビルに対して移動させるための第１のケーブル
    １０６が前記作動器組立体２０と前記留め具保持
    部品２１０との間で前記軸組立体１００を通して
    延びている、特許請求の範囲第１項に記載の留め
    具付け装置。 ７ 前記留め具保持部品２１０は前記留め具保持
    部品２１０から留め具２１２を押し出すためのプ
    ツシヤ作動器２４８を有し、前記留め具２１２を
    押し出して前記アンビル２９０と前記留め具保持
    部品２１０との間で組織を留るために、前記プツ
    シヤ作動器２４８を移動させるための第２のケー
    ブル１０８が前記作動器組立体２０と前記プツシ
    ヤ作動器２４８との間で前記軸組立体１００を通
    つて延びている、特許請求の範囲第６項に記載の
    留め具付け装置。
JP61203547A 1985-08-30 1986-08-29 関節式外科用留め具付け装置 Granted JPS62101238A (ja)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US06/771,845 US4728020A (en) 1985-08-30 1985-08-30 Articulated surgical fastener applying apparatus
US771845 1996-12-23

Publications (2)

Publication Number Publication Date
JPS62101238A JPS62101238A (ja) 1987-05-11
JPH0468941B2 true JPH0468941B2 (ja) 1992-11-04

Family

ID=25093116

Family Applications (1)

Application Number Title Priority Date Filing Date
JP61203547A Granted JPS62101238A (ja) 1985-08-30 1986-08-29 関節式外科用留め具付け装置

Country Status (8)

Country Link
US (2) US4728020A (ja)
EP (1) EP0216532B1 (ja)
JP (1) JPS62101238A (ja)
AT (1) ATE61514T1 (ja)
AU (1) AU586882B2 (ja)
BR (1) BR8604158A (ja)
CA (1) CA1270170A (ja)
DE (1) DE3678080D1 (ja)

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JPS62101238A (ja) 1987-05-11
EP0216532B1 (en) 1991-03-13
EP0216532A1 (en) 1987-04-01
AU6188586A (en) 1987-03-05
CA1270170A (en) 1990-06-12
BR8604158A (pt) 1987-04-28
US4728020A (en) 1988-03-01
ATE61514T1 (de) 1991-03-15
AU586882B2 (en) 1989-07-27
US4869414A (en) 1989-09-26
DE3678080D1 (de) 1991-04-18

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