JPH0584252A - 組織内に挿入する外科用ステープル - Google Patents
組織内に挿入する外科用ステープルInfo
- Publication number
- JPH0584252A JPH0584252A JP4069883A JP6988392A JPH0584252A JP H0584252 A JPH0584252 A JP H0584252A JP 4069883 A JP4069883 A JP 4069883A JP 6988392 A JP6988392 A JP 6988392A JP H0584252 A JPH0584252 A JP H0584252A
- Authority
- JP
- Japan
- Prior art keywords
- staple
- legs
- staples
- cartridge
- rows
- 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.)
- Pending
Links
- 238000000034 method Methods 0.000 claims description 7
- 238000013459 approach Methods 0.000 claims description 6
- 210000001519 tissue Anatomy 0.000 abstract description 24
- 210000000713 mesentery Anatomy 0.000 abstract description 16
- 210000004204 blood vessel Anatomy 0.000 abstract description 10
- 210000000569 greater omentum Anatomy 0.000 abstract 1
- 210000002747 omentum Anatomy 0.000 description 11
- 210000000577 adipose tissue Anatomy 0.000 description 3
- 230000003872 anastomosis Effects 0.000 description 2
- 230000017531 blood circulation Effects 0.000 description 2
- 230000002496 gastric effect Effects 0.000 description 2
- 230000000968 intestinal effect Effects 0.000 description 2
- 210000002751 lymph Anatomy 0.000 description 2
- SESJCOBCXSACPH-UHFFFAOYSA-N (2,3-dichlorophenyl)methyl n-methylcarbamate Chemical compound CNC(=O)OCC1=CC=CC(Cl)=C1Cl SESJCOBCXSACPH-UHFFFAOYSA-N 0.000 description 1
- 210000001815 ascending colon Anatomy 0.000 description 1
- 230000000740 bleeding effect Effects 0.000 description 1
- 210000000621 bronchi Anatomy 0.000 description 1
- 210000001731 descending colon Anatomy 0.000 description 1
- 210000001035 gastrointestinal tract Anatomy 0.000 description 1
- 210000004907 gland Anatomy 0.000 description 1
- 230000035876 healing Effects 0.000 description 1
- 230000002439 hemostatic effect Effects 0.000 description 1
- 210000003405 ileum Anatomy 0.000 description 1
- 238000003780 insertion Methods 0.000 description 1
- 230000037431 insertion Effects 0.000 description 1
- 210000001630 jejunum Anatomy 0.000 description 1
- 210000002429 large intestine Anatomy 0.000 description 1
- 210000004185 liver Anatomy 0.000 description 1
- 235000020044 madeira Nutrition 0.000 description 1
- 238000005259 measurement Methods 0.000 description 1
- 210000001147 pulmonary artery Anatomy 0.000 description 1
- 210000003492 pulmonary vein Anatomy 0.000 description 1
- 238000007789 sealing Methods 0.000 description 1
- 210000000813 small intestine Anatomy 0.000 description 1
- 210000000952 spleen Anatomy 0.000 description 1
- 210000002784 stomach Anatomy 0.000 description 1
- 210000003384 transverse colon Anatomy 0.000 description 1
- 230000002792 vascular Effects 0.000 description 1
- 210000001835 viscera Anatomy 0.000 description 1
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
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/10—Surgical instruments, devices or methods for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
- A61B17/105—Wound clamp magazines
-
- 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
- A61B2017/07228—Arrangement of the staples
-
- 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
- A61B2017/07257—Stapler heads characterised by its anvil
- A61B2017/07264—Stapler heads characterised by its anvil characterised by its staple forming cavities, e.g. geometry or material
Landscapes
- 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】
【目的】 腸間膜及び大網において見られるような種々
の寸法の血管を満足に遮断するステープルの適切な配置
を持ったステープル器具を提供することが本発明の目的
である。 【構成】 本発明は、閉鎖された組織を把持している位
置において、脚の端部がクラウン部に接近するようにク
ラウン部の方に曲げられる脚をステープルが備え、2個
の脚に連結されたクラウン部を有する外科用ステープル
に関するものである。
の寸法の血管を満足に遮断するステープルの適切な配置
を持ったステープル器具を提供することが本発明の目的
である。 【構成】 本発明は、閉鎖された組織を把持している位
置において、脚の端部がクラウン部に接近するようにク
ラウン部の方に曲げられる脚をステープルが備え、2個
の脚に連結されたクラウン部を有する外科用ステープル
に関するものである。
Description
【0001】
【発明分野】本発明は組織内に挿入する外科用ステープ
ルに関する。より特別には、本発明は、ステープルの各
がクラウン部と1対の脚を有しその脚がその端部に沿っ
て互いに重なるような状態においての、ステープルの列
の患者の腸間膜における使用に関する。より特別には、
これは、2列、3列、又は4列のステープルを適用する
ステープラーにして、少なくも1列のステープルが、血
流を遮断するように平らにされかつ腸間膜の組織に適用
されるように設計されたステープラーに関する。更に特
別には、これは、あるステープル列の折り曲げられたス
テープル脚が隣のステープル列の折り曲げられたステー
プル脚と組み合うような外科用ステープルの適用方法に
関する。
ルに関する。より特別には、本発明は、ステープルの各
がクラウン部と1対の脚を有しその脚がその端部に沿っ
て互いに重なるような状態においての、ステープルの列
の患者の腸間膜における使用に関する。より特別には、
これは、2列、3列、又は4列のステープルを適用する
ステープラーにして、少なくも1列のステープルが、血
流を遮断するように平らにされかつ腸間膜の組織に適用
されるように設計されたステープラーに関する。更に特
別には、これは、あるステープル列の折り曲げられたス
テープル脚が隣のステープル列の折り曲げられたステー
プル脚と組み合うような外科用ステープルの適用方法に
関する。
【0002】
【発明の背景】胃、虫垂、空腸、回腸、上行結腸、横行
結腸、下行結腸、肝及び脾は、胃腸管と組み合わせられ
た内部器官である。構造の幾つか又は総ては、全体的に
又は部分的に腸間膜により吊され、更に腸間膜は血管、
リンパ管及びリンパ腺も含む。腸間膜は厚さに変動があ
るが、総てが脂肪組織及び直径1.0cmから直径0.1mm
以下に寸法の変化のある血管を収容する。大網は2重に
折られた腸間膜であり、これも種々の寸法の多数の血管
を支持し、かつ大網の厚さは患者間で非常に異なる。
結腸、下行結腸、肝及び脾は、胃腸管と組み合わせられ
た内部器官である。構造の幾つか又は総ては、全体的に
又は部分的に腸間膜により吊され、更に腸間膜は血管、
リンパ管及びリンパ腺も含む。腸間膜は厚さに変動があ
るが、総てが脂肪組織及び直径1.0cmから直径0.1mm
以下に寸法の変化のある血管を収容する。大網は2重に
折られた腸間膜であり、これも種々の寸法の多数の血管
を支持し、かつ大網の厚さは患者間で非常に異なる。
【0003】気管支、肺動脈、肺静脈の縫合、大腸又は
小腸の縫合、胃の縫合又は胃のステープル術、腸管の端
部対端部の吻合、腸管の側部対側部の吻合、並びに血管
の個々の結紮及び分割のためのステープル器具がある。
更に、血管用の種々の閉鎖用クリップ及び皮膚用ステー
プラーがある。腸間膜及び大網には脂肪組織及び種々の
寸法の血管があるので、入手可能なステープラーは腸間
膜及び大網をステープル作業するには満足ではない。現
在の適用具は一時に1本又は数本の血管しか結紮でき
ず、かつ通常はこれを使用した部位の近隣の血管に傷を
付け、予定の血管の結紮後の治療にかかる時間を要す
る。
小腸の縫合、胃の縫合又は胃のステープル術、腸管の端
部対端部の吻合、腸管の側部対側部の吻合、並びに血管
の個々の結紮及び分割のためのステープル器具がある。
更に、血管用の種々の閉鎖用クリップ及び皮膚用ステー
プラーがある。腸間膜及び大網には脂肪組織及び種々の
寸法の血管があるので、入手可能なステープラーは腸間
膜及び大網をステープル作業するには満足ではない。現
在の適用具は一時に1本又は数本の血管しか結紮でき
ず、かつ通常はこれを使用した部位の近隣の血管に傷を
付け、予定の血管の結紮後の治療にかかる時間を要す
る。
【0004】プルイットの米国特許第4848637号
及びプルイットの米国特許第4930503号は、3列
又はそれ以上の列のステープルを使用し、少なくも1列
のステープルのクラウン部の寸法が他の列のステープル
と比べて異なり、同一列の一つおきのステープルのクラ
ウン部寸法が前記一つおきのステープルの間のステープ
ルのクラウン部寸法とは異なるようなステープル配置を
含んだ腸間膜及び大網のステープル作業に適したステー
プラー及びカートリッジを説明している。この配列は、
大きい方のクラウン部を持ったステープルはより長いプ
ロング(又は脚)を有し、小さい方のクラウン部を持った
ステープルはより短いプロングを持つという事実に基づ
く。これは、プロング寸法がクラウン部の底面の半分に
達し更にクラウン部の下側でループを形成するに十分な
余分な長さを持つという要求により決定されることに基
づく。ループは、人間の組織を切開した後に、血管を密
閉するに使用される縫合又は結紮における縫合糸と同様
な機能を持つ。ループが大きくなると、クラウン部の長
さの半分に達するに必要な長さを越すプロングの長さが
大きなる。腸間膜及び大網については、切開により切断
された血管からの血液流を遮断するには、大きなループ
と小さなループとの組み合わせが望ましい。血管をしっ
かりと絞るには、各血管並びにある程度の脂肪組織をス
テープルのループで囲むことが有利である。
及びプルイットの米国特許第4930503号は、3列
又はそれ以上の列のステープルを使用し、少なくも1列
のステープルのクラウン部の寸法が他の列のステープル
と比べて異なり、同一列の一つおきのステープルのクラ
ウン部寸法が前記一つおきのステープルの間のステープ
ルのクラウン部寸法とは異なるようなステープル配置を
含んだ腸間膜及び大網のステープル作業に適したステー
プラー及びカートリッジを説明している。この配列は、
大きい方のクラウン部を持ったステープルはより長いプ
ロング(又は脚)を有し、小さい方のクラウン部を持った
ステープルはより短いプロングを持つという事実に基づ
く。これは、プロング寸法がクラウン部の底面の半分に
達し更にクラウン部の下側でループを形成するに十分な
余分な長さを持つという要求により決定されることに基
づく。ループは、人間の組織を切開した後に、血管を密
閉するに使用される縫合又は結紮における縫合糸と同様
な機能を持つ。ループが大きくなると、クラウン部の長
さの半分に達するに必要な長さを越すプロングの長さが
大きなる。腸間膜及び大網については、切開により切断
された血管からの血液流を遮断するには、大きなループ
と小さなループとの組み合わせが望ましい。血管をしっ
かりと絞るには、各血管並びにある程度の脂肪組織をス
テープルのループで囲むことが有利である。
【0005】市販のステープルのカートリッジにおいて
提供されるように、クラウン部の寸法が多数のステープ
ル列で同じであるときは、一つのステープル列が隣接ス
テープル列に関して互い違いにされる。各場合における
互い違いは、第2のステープル列の最初のステープルの
開始端を第1のステープル列の最初のステープルの中央
点と向かい合わせに位置決めすることにより行なわれ
る。これは、第2のステープル列の各ステープルの中央
点が第1のステープル列のステープル間の隙間と向かい
合うことを意味する。また、これは、第2列のステープ
ル間の隙間が第1列の隣接ステープルの中央点と向かい
合うことも意味する。ステープルの中央点はそのステー
プルの下側のプロングの端部が互いに近くに来る場所で
あり、多くの場合、プロング端部相互間、及びプロング
端部とクラウン部との間に隙間を遺す。ある場合には、
閉じられたステープル脚の端部の湾曲が形成され、形作
られた脚の間に隙間が存在する。これらの状態は、ある
列のステープル間の隙間にきた血管は隣接ステープル列
のループ内に囲まれないであろうということを意味す
る。
提供されるように、クラウン部の寸法が多数のステープ
ル列で同じであるときは、一つのステープル列が隣接ス
テープル列に関して互い違いにされる。各場合における
互い違いは、第2のステープル列の最初のステープルの
開始端を第1のステープル列の最初のステープルの中央
点と向かい合わせに位置決めすることにより行なわれ
る。これは、第2のステープル列の各ステープルの中央
点が第1のステープル列のステープル間の隙間と向かい
合うことを意味する。また、これは、第2列のステープ
ル間の隙間が第1列の隣接ステープルの中央点と向かい
合うことも意味する。ステープルの中央点はそのステー
プルの下側のプロングの端部が互いに近くに来る場所で
あり、多くの場合、プロング端部相互間、及びプロング
端部とクラウン部との間に隙間を遺す。ある場合には、
閉じられたステープル脚の端部の湾曲が形成され、形作
られた脚の間に隙間が存在する。これらの状態は、ある
列のステープル間の隙間にきた血管は隣接ステープル列
のループ内に囲まれないであろうということを意味す
る。
【0006】プルイットの米国特許第4941623号
においては、腸間膜及び大網での使用に適した方法、ス
テープラー及びステープルが開示され、その方法、ステ
ープラー及びステープルの使用は、切除された腸間膜又
は大網の部分にある血管の出血を効果的に停止できる。
これらは、同寸法の[クラウン部」又はステープルの主体
部分を持った3列又はそれ以上の列のステープルを適用
し、列は実質的に互いに平行であり、かつ各列のステー
プルは隣接列ステープルのステープルとはクラウン部の
長さの4分の1だけ食い違いにされるように設計され
る。ステープルのプロング長さが他の列のステープルの
プロング長さとは異なる列が少なくも1列ある。
においては、腸間膜及び大網での使用に適した方法、ス
テープラー及びステープルが開示され、その方法、ステ
ープラー及びステープルの使用は、切除された腸間膜又
は大網の部分にある血管の出血を効果的に停止できる。
これらは、同寸法の[クラウン部」又はステープルの主体
部分を持った3列又はそれ以上の列のステープルを適用
し、列は実質的に互いに平行であり、かつ各列のステー
プルは隣接列ステープルのステープルとはクラウン部の
長さの4分の1だけ食い違いにされるように設計され
る。ステープルのプロング長さが他の列のステープルの
プロング長さとは異なる列が少なくも1列ある。
【0007】
【発明の概要】腸間膜及び大網を効果的にステープル止
めする方法を提供することが本発明の目的である。
めする方法を提供することが本発明の目的である。
【0008】腸間膜及び大網のステープル作業に適した
ステープラー及びカートリッジを提供することが本発明
の目的である。
ステープラー及びカートリッジを提供することが本発明
の目的である。
【0009】腸間膜及び大網において見られるような種
々の寸法の血管を満足に遮断するステープルの適切な配
置を持ったステープル器具を提供することも本発明の目
的である。
々の寸法の血管を満足に遮断するステープルの適切な配
置を持ったステープル器具を提供することも本発明の目
的である。
【0010】典型的な外科用ステープルの緊密な閉鎖を
与えるステープルの配置を提供することも本発明の目的
である。
与えるステープルの配置を提供することも本発明の目的
である。
【0011】隣接列が互いに封鎖するステープルの閉鎖
を提供することもまた本発明の別の目的である。
を提供することもまた本発明の別の目的である。
【0012】ステープル列が腸間膜又は閉じられたその
他の組織を適切に保持するステープルカートリッジを提
供することが本発明の更に別の目的である。
他の組織を適切に保持するステープルカートリッジを提
供することが本発明の更に別の目的である。
【0013】本発明のこれらの目的は、閉鎖された組織
を把持している位置において、脚の端部がクラウン部に
接近するようにクラウン部の方に曲げられる脚をステー
プルが備え、2個の脚に連結されたクラウン部を有する
外科用ステープルにおいて達成される。更に、脚の端部
はクラウン部の長さに沿って互いに重なり合う。理想的
には、これら外科用ステープルの各は外科用ステープル
のカートリッジ内のステープル列に含まれる。これらス
テープル列の各は同寸法のステープルを有し、幾つかの
列は平らな状態になるように形成されたステープルを持
つ。別の実施例においては、かかる平型のステープルが
明らかにされる隣接した2列のステープル列が明らかに
される。最後に、カートリッジ内で角度を付けて配され
たステープルが明らかにされる。これは、ステープルの
脚が形成の際に列の隣接ステープルの脚内に組み合うよ
うにステープルを傾けさせる。従って、ステープル列の
脚は隣接列の脚と絡み合って腸間膜のより良い閉鎖を行
う。
を把持している位置において、脚の端部がクラウン部に
接近するようにクラウン部の方に曲げられる脚をステー
プルが備え、2個の脚に連結されたクラウン部を有する
外科用ステープルにおいて達成される。更に、脚の端部
はクラウン部の長さに沿って互いに重なり合う。理想的
には、これら外科用ステープルの各は外科用ステープル
のカートリッジ内のステープル列に含まれる。これらス
テープル列の各は同寸法のステープルを有し、幾つかの
列は平らな状態になるように形成されたステープルを持
つ。別の実施例においては、かかる平型のステープルが
明らかにされる隣接した2列のステープル列が明らかに
される。最後に、カートリッジ内で角度を付けて配され
たステープルが明らかにされる。これは、ステープルの
脚が形成の際に列の隣接ステープルの脚内に組み合うよ
うにステープルを傾けさせる。従って、ステープル列の
脚は隣接列の脚と絡み合って腸間膜のより良い閉鎖を行
う。
【0014】これらの目的及びその他の目的は、付属図
面及び詳細な説明により明瞭に説明される。
面及び詳細な説明により明瞭に説明される。
【0015】
【発明の詳細説明】図1に見られるように、代表的な外
科用ステープル10は、2本の先の尖った脚12に取り
付けられたクラウン部11を持つ。一般に好ましい状態
においては、これらの脚12はクラウン部11に垂直で
あり、かつ両脚12は等しい長さである。
科用ステープル10は、2本の先の尖った脚12に取り
付けられたクラウン部11を持つ。一般に好ましい状態
においては、これらの脚12はクラウン部11に垂直で
あり、かつ両脚12は等しい長さである。
【0016】図14は本発明の外科用ステープラー14
の正面図であり、これは銃と部分的に似ていて把手1
5、バーレル16及び引き金30を持つ。安全ガード2
9が後退位置において示される。アンビル17がバーレ
ル16の前端又は後端から延びているアーム18により
支持される。ステープルカートリッジ19がカートリッ
ジホルダー20により支持される。ステープル10の脚
11はカートリッジ19の内側にあり、この図では見え
ない。位置決め用のロッド21がカートリッジホルダー
20を通って延びている開口、並びに案内22及び22
を通過する。ロッド21の後端にノブ23が固定され、
ノブ23を前方に押すことによりロッド21の前端をア
ンビルに進め、ノブ23を後方に押すことによりアンビ
ルから離して後退させることができる。カートリッジ1
9はバーレル16の内側を延びているアーム(図示せず)
に連結され、ノブ24に間接的に連結される。ノブ24
は、図示されないねじ配置により、カートリッジ及びカ
ートリッジホルダーを前進及び後退させることができ
る。中心軸回りの時計方向回転がカートリッジホルダー
とカートリッジとをアンビルの方に進め、反時計方向の
回転はこれらをアンビルから遠ざける。隙間設定具25
がアンビルとステープルカートリッジとの間の隙間の計
測を許す。引き金30の把手15に向かう閉鎖がプラン
ジャーを前進運動させ、ステープル10をアンビルの溝
の中に強制する。
の正面図であり、これは銃と部分的に似ていて把手1
5、バーレル16及び引き金30を持つ。安全ガード2
9が後退位置において示される。アンビル17がバーレ
ル16の前端又は後端から延びているアーム18により
支持される。ステープルカートリッジ19がカートリッ
ジホルダー20により支持される。ステープル10の脚
11はカートリッジ19の内側にあり、この図では見え
ない。位置決め用のロッド21がカートリッジホルダー
20を通って延びている開口、並びに案内22及び22
を通過する。ロッド21の後端にノブ23が固定され、
ノブ23を前方に押すことによりロッド21の前端をア
ンビルに進め、ノブ23を後方に押すことによりアンビ
ルから離して後退させることができる。カートリッジ1
9はバーレル16の内側を延びているアーム(図示せず)
に連結され、ノブ24に間接的に連結される。ノブ24
は、図示されないねじ配置により、カートリッジ及びカ
ートリッジホルダーを前進及び後退させることができ
る。中心軸回りの時計方向回転がカートリッジホルダー
とカートリッジとをアンビルの方に進め、反時計方向の
回転はこれらをアンビルから遠ざける。隙間設定具25
がアンビルとステープルカートリッジとの間の隙間の計
測を許す。引き金30の把手15に向かう閉鎖がプラン
ジャーを前進運動させ、ステープル10をアンビルの溝
の中に強制する。
【0017】図2に見られるように、外科用ステープラ
ー14のアンビル8のポケットは、脚12をクラウン部
11の中央点の方に曲げて脚がB字形に曲げられるよう
にステープル10を形成することが普通である。しか
し、本発明により説明されるように、図3に示されたよ
うに変更されたアンビル9は、ステープルを脚12が重
なりうるように形成する。事実、変更されたアンビル9
は、脚12が外科用ステープルのクラウン部11の約4
分の1の重なりを作るように形成させる。従って、一般
に約2.5から4.5mm、好ましくは3から4mmのクラウ
ン部に対しては、重なりは約0.6mmから1mmの範囲の
長さである。典型的なプロング長さはクラウン部の長さ
に応じて選定され、1から6mm、好ましくは2から5mm
の範囲にあるのが有利である。従って、これらステープ
ルにより形成され図2の側方に記号G'で示された隙間
は、典型的には、図2におけると同様にステープルに形
成され図3の側方に記号Gで示された隙間の寸法の約2
倍である。一般に、この隙間G'は約0.25から0.5m
mである。
ー14のアンビル8のポケットは、脚12をクラウン部
11の中央点の方に曲げて脚がB字形に曲げられるよう
にステープル10を形成することが普通である。しか
し、本発明により説明されるように、図3に示されたよ
うに変更されたアンビル9は、ステープルを脚12が重
なりうるように形成する。事実、変更されたアンビル9
は、脚12が外科用ステープルのクラウン部11の約4
分の1の重なりを作るように形成させる。従って、一般
に約2.5から4.5mm、好ましくは3から4mmのクラウ
ン部に対しては、重なりは約0.6mmから1mmの範囲の
長さである。典型的なプロング長さはクラウン部の長さ
に応じて選定され、1から6mm、好ましくは2から5mm
の範囲にあるのが有利である。従って、これらステープ
ルにより形成され図2の側方に記号G'で示された隙間
は、典型的には、図2におけると同様にステープルに形
成され図3の側方に記号Gで示された隙間の寸法の約2
倍である。一般に、この隙間G'は約0.25から0.5m
mである。
【0018】図14のような外科用ステープラー14に
おいては、図4のように組織を互い違いに横断する平行
な4列のステープルを置くことがある。小刀の刃を選択
的に4列の中央に降ろすことができる。本発明の1態様
は、図2のようなステープルの列と図3のようなステー
プルの列との異なったステープル列を組み合わせること
である。図5ないし13は組織の縫合を有利に作ること
が見出だされた。
おいては、図4のように組織を互い違いに横断する平行
な4列のステープルを置くことがある。小刀の刃を選択
的に4列の中央に降ろすことができる。本発明の1態様
は、図2のようなステープルの列と図3のようなステー
プルの列との異なったステープル列を組み合わせること
である。図5ないし13は組織の縫合を有利に作ること
が見出だされた。
【0019】図5に見られるように、外側のステープル
列は図2におけるように隙間G'で形成され、内側のス
テープル列は図3におけるように隙間Gで形成された。
密な内側ステープル列を有する縫合を行う機構は、組織
の外側部分をより多く露出させて、密に縫合された組織
の内側部分に比べて迅速に治癒させる。一般に、このよ
うな情況は、ステープル線の右側又は左側のいずれかに
より大きな縫合をしたい場合に選択されるであろう。
列は図2におけるように隙間G'で形成され、内側のス
テープル列は図3におけるように隙間Gで形成された。
密な内側ステープル列を有する縫合を行う機構は、組織
の外側部分をより多く露出させて、密に縫合された組織
の内側部分に比べて迅速に治癒させる。一般に、このよ
うな情況は、ステープル線の右側又は左側のいずれかに
より大きな縫合をしたい場合に選択されるであろう。
【0020】ステープル列間に保持された組織の列を完
全に縫合したい場合には、ステープル列の各に密な縫合
を作る図8のようなステープル列を設けることが望まし
い。あるいは、図9又は13におけるように平らにされ
た3列が置かれた配置もまた有効である。最後に、縫合
が主要な事項ではないが必要な場合は、図10及び12
におけるように1列だけが密に縫合されるステープル列
を置くことを推奨できる。
全に縫合したい場合には、ステープル列の各に密な縫合
を作る図8のようなステープル列を設けることが望まし
い。あるいは、図9又は13におけるように平らにされ
た3列が置かれた配置もまた有効である。最後に、縫合
が主要な事項ではないが必要な場合は、図10及び12
におけるように1列だけが密に縫合されるステープル列
を置くことを推奨できる。
【0021】最後に、図15及び16に見られるよう
に、ステープルの各の密な縫合に加えてステープルの絡
みを有することが望ましいことがある。
に、ステープルの各の密な縫合に加えてステープルの絡
みを有することが望ましいことがある。
【0022】このため、ステープルが一般に平行列に置
かれたとしても、ステープル脚はステープルカートリッ
ジの面と交差する面に揃えられるように置かれることが
望ましいことがある。これは図15に最もよく見られ、
ここではステープルはカートリッジから射出されて交差
面に沿って進められ、ステープル列の少なくも1列、恐
らくは各列が別の列に面する。この方法では、ステープ
ル脚が閉じられた後、ステープル脚は図16に見られる
ように組み合う。勿論、図3のアンビルを使用したとき
のようにステープルが密に固定されれば、縫合は事実上
は連続である。組織の止血封鎖が支援され、しかもステ
ープル止めされた組織の望ましい柔軟性はなお存在す
る。
かれたとしても、ステープル脚はステープルカートリッ
ジの面と交差する面に揃えられるように置かれることが
望ましいことがある。これは図15に最もよく見られ、
ここではステープルはカートリッジから射出されて交差
面に沿って進められ、ステープル列の少なくも1列、恐
らくは各列が別の列に面する。この方法では、ステープ
ル脚が閉じられた後、ステープル脚は図16に見られる
ように組み合う。勿論、図3のアンビルを使用したとき
のようにステープルが密に固定されれば、縫合は事実上
は連続である。組織の止血封鎖が支援され、しかもステ
ープル止めされた組織の望ましい柔軟性はなお存在す
る。
【0023】特別な発明のこれらの実施例及びその他の
実施例がここに説明された。勿論その他の実施例が含ま
れるものと考えられる。例えば、本発明のカートリッジ
は6列のステープル、又は奇数列のステープルを含むこ
とができる。本発明は、特許請求の範囲及びその相当事
項により限定される意向であることを理解すべきであ
る。
実施例がここに説明された。勿論その他の実施例が含ま
れるものと考えられる。例えば、本発明のカートリッジ
は6列のステープル、又は奇数列のステープルを含むこ
とができる。本発明は、特許請求の範囲及びその相当事
項により限定される意向であることを理解すべきであ
る。
【0024】本発明の特徴及び態様につき説明すれば次
の通りである。
の通りである。
【0025】1.2本の脚に連結されたクラウン部を有
する外科用ステープルにして、前記ステープルは、閉じ
られた組織把持位置において、前記脚の端部が前記クラ
ウン部に接近するように前記クラウン部の方に曲げられ
た前記脚を備え、前記脚の端部が前記クラウン部の長さ
に沿って互いに重なり合う外科用ステープル。
する外科用ステープルにして、前記ステープルは、閉じ
られた組織把持位置において、前記脚の端部が前記クラ
ウン部に接近するように前記クラウン部の方に曲げられ
た前記脚を備え、前記脚の端部が前記クラウン部の長さ
に沿って互いに重なり合う外科用ステープル。
【0026】2.複数のステープル列を収容している外
科用ステープルのカートリッジにおいて、前記ステープ
ル列の各が組織を把持するように形成され、前記ステー
プル列の少なくも一つがステープルを持ち、前記列の前
記ステープルの各は2本の脚に連結されたクラウン部を
有し、閉じられた組織把持位置において、前記脚の端部
が前記クラウン部に接近するように前記クラウン部の方
に曲げられた前記脚を備え、前記脚の端部が前記クラウ
ン部の長さに沿って互いに重なり合う外科用ステープル
のカートリッジ。
科用ステープルのカートリッジにおいて、前記ステープ
ル列の各が組織を把持するように形成され、前記ステー
プル列の少なくも一つがステープルを持ち、前記列の前
記ステープルの各は2本の脚に連結されたクラウン部を
有し、閉じられた組織把持位置において、前記脚の端部
が前記クラウン部に接近するように前記クラウン部の方
に曲げられた前記脚を備え、前記脚の端部が前記クラウ
ン部の長さに沿って互いに重なり合う外科用ステープル
のカートリッジ。
【0027】3.4列のステープルがある上記2のカー
トリッジ。
トリッジ。
【0028】4.2列のステープルがある上記2のカー
トリッジ。
トリッジ。
【0029】5.6列のステープルがある上記2のカー
トリッジ。
トリッジ。
【0030】6.前記列の少なくも二つがステープルを
持ち、前記列の前記ステープルの各は2本の脚に連結さ
れたクラウン部を有し、閉じられた組織把持位置におい
て、前記脚の端部が前記クラウン部に接近するように前
記クラウン部の方に曲げられた前記脚を備え、前記脚の
端部が前記クラウン部の長さに沿って互いに重なり合う
上記3のカートリッジ。
持ち、前記列の前記ステープルの各は2本の脚に連結さ
れたクラウン部を有し、閉じられた組織把持位置におい
て、前記脚の端部が前記クラウン部に接近するように前
記クラウン部の方に曲げられた前記脚を備え、前記脚の
端部が前記クラウン部の長さに沿って互いに重なり合う
上記3のカートリッジ。
【0031】7.前記列の少なくも三つがステープルを
含み、前記列の前記ステープルの各は2本の脚に連結さ
れたクラウン部を有し、閉じられた組織把持位置におい
て、前記脚の端部が前記クラウン部に接近するように前
記クラウン部の方に曲げられた前記脚を備え、前記脚の
端部が前記クラウン部の長さに沿って互いに重なり合う
上記3のカートリッジ。
含み、前記列の前記ステープルの各は2本の脚に連結さ
れたクラウン部を有し、閉じられた組織把持位置におい
て、前記脚の端部が前記クラウン部に接近するように前
記クラウン部の方に曲げられた前記脚を備え、前記脚の
端部が前記クラウン部の長さに沿って互いに重なり合う
上記3のカートリッジ。
【0032】8.前記ステープル列の総てがステープル
を含み、前記列の各の前記ステープルの各は2本の脚に
連結されたクラウン部を有し、閉じられた組織把持位置
において、前記脚の端部が前記クラウン部に接近するよ
うに前記クラウン部の方に曲げられた前記脚を備え、前
記脚の端部が前記クラウン部の長さに沿って互いに重な
り合う上記3のカートリッジ。
を含み、前記列の各の前記ステープルの各は2本の脚に
連結されたクラウン部を有し、閉じられた組織把持位置
において、前記脚の端部が前記クラウン部に接近するよ
うに前記クラウン部の方に曲げられた前記脚を備え、前
記脚の端部が前記クラウン部の長さに沿って互いに重な
り合う上記3のカートリッジ。
【0033】9.前記少なく2列が隣接する上記6のカ
ートリッジ。
ートリッジ。
【0034】10.前記少なくも2列は内側の2列のス
テープル列であり、外側ステープル列は異なった形状に
閉じられたステープルを持った上記9のカートリッジ。
テープル列であり、外側ステープル列は異なった形状に
閉じられたステープルを持った上記9のカートリッジ。
【0035】11.前記少なくも2列がカートリッジの
長手方向の半分を形成し、前記カートリッジの長手方向
の別の半分は異なった形状に閉じられるステープルを持
った上記9のカートリッジ。
長手方向の半分を形成し、前記カートリッジの長手方向
の別の半分は異なった形状に閉じられるステープルを持
った上記9のカートリッジ。
【0036】12.小刀の刃がステープルの内側列の間
に適合しうる上記3のカートリッジ。 13.外科用ステープル列のカートリッジにして、前記
ステープル列は前記カートリッジ内で傾けられて隣接列
の方を向き、組織を把持するために前記ステープルが前
記カートリッジから出るとき、前記傾けられた列を形成
している前記ステープルの各の脚の各が前記隣接列のス
テープルの脚の一つと組み合うカートリッジ。
に適合しうる上記3のカートリッジ。 13.外科用ステープル列のカートリッジにして、前記
ステープル列は前記カートリッジ内で傾けられて隣接列
の方を向き、組織を把持するために前記ステープルが前
記カートリッジから出るとき、前記傾けられた列を形成
している前記ステープルの各の脚の各が前記隣接列のス
テープルの脚の一つと組み合うカートリッジ。
【0037】14.4列のステープル列がある上記13
のカートリッジ。
のカートリッジ。
【0038】15.前記列の少なくも二つが前記カート
リッジ内で傾けられて隣接列の方を向いたステープルを
含み、組織を把持するために前記ステープルが前記カー
トリッジから出るとき、前記傾けられた列を形成してい
る前記ステープルの各の脚の各が前記隣接列のステープ
ルの脚の一つと組み合う上記14のカートリッジ。
リッジ内で傾けられて隣接列の方を向いたステープルを
含み、組織を把持するために前記ステープルが前記カー
トリッジから出るとき、前記傾けられた列を形成してい
る前記ステープルの各の脚の各が前記隣接列のステープ
ルの脚の一つと組み合う上記14のカートリッジ。
【0039】16.前記少なくも2列が互いに隣接しか
つ互いに向かい合う上記15のカートリッジ。
つ互いに向かい合う上記15のカートリッジ。
【0040】17.前記少なくも2列が内側の2ステー
プル列であり、外側ステープル列は異なった形状に閉じ
られるステープルを持った上記15のカートリッジ。
プル列であり、外側ステープル列は異なった形状に閉じ
られるステープルを持った上記15のカートリッジ。
【0041】18.前記少なくも2列がカートリッジの
長手方向の半分を形成し、前記カートリッジの長手方向
の別の半分は異なった形状に閉じられるステープルを持
った上記15のカートリッジ。
長手方向の半分を形成し、前記カートリッジの長手方向
の別の半分は異なった形状に閉じられるステープルを持
った上記15のカートリッジ。
【0042】19.前記列の総てが前記カートリッジ内
で傾けられて隣接列の方を向いたステープルを含み、組
織を把持するために前記ステープルが前記カートリッジ
から出るとき、前記傾けられた列を形成している前記ス
テープルの各の脚の各が前記隣接列のステープルの脚の
一つと組み合う上記13のカートリッジ。
で傾けられて隣接列の方を向いたステープルを含み、組
織を把持するために前記ステープルが前記カートリッジ
から出るとき、前記傾けられた列を形成している前記ス
テープルの各の脚の各が前記隣接列のステープルの脚の
一つと組み合う上記13のカートリッジ。
【0043】20.互いに向かい合う列が2対ある上記
19のカートリッジ。
19のカートリッジ。
【0044】21.脚を有する外科用ステープルの列を
組織内に置くこと、及び前記ステープルを折り曲げるこ
とを含み、前記折り曲げの際に隣接ステープル内の前記
ステープル脚が折り曲げられる組織閉鎖方法。
組織内に置くこと、及び前記ステープルを折り曲げるこ
とを含み、前記折り曲げの際に隣接ステープル内の前記
ステープル脚が折り曲げられる組織閉鎖方法。
【図1】典型的な外科用ステープルの立面図である。
【図2】典型的なアンビルで形成されたステープルの図
面である。
面である。
【図3】変更されたアンビルで形成された本発明のステ
ープルの図面である。
ープルの図面である。
【図4】図14のステープラーより適用しうるステープ
ルの典型的なパターンである。
ルの典型的なパターンである。
【図5】外科用ステープルの改良されたパターンの断面
図である。
図である。
【図6】本発明における外科用ステープルの典型的なパ
ターンである。
ターンである。
【図7】本発明における外科用ステープルの典型的なパ
ターンである。
ターンである。
【図8】本発明における外科用ステープルの典型的なパ
ターンである。
ターンである。
【図9】本発明における外科用ステープルの典型的なパ
ターンである。
ターンである。
【図10】本発明における外科用ステープルの典型的な
パターンである。
パターンである。
【図11】本発明における外科用ステープルの典型的な
パターンである。
パターンである。
【図12】本発明における外科用ステープルの典型的な
パターンである。
パターンである。
【図13】本発明における外科用ステープルの典型的な
パターンである。
パターンである。
【図14】典型的な線状外科用ステープラーである。
【図15】ステープの絡みを示す。
【図16】ステープの絡みを示す。
───────────────────────────────────────────────────── フロントページの続き (72)発明者 フエデリコ・ビロツテイ アメリカ合衆国オハイオ州45243マデイ ラ・ジエスブ7266 (72)発明者 ロナルド・ジエイ・ブリンカーホフ アメリカ合衆国オハイオ州45102アメリ ア・フオーレンツリーウエイ3731 (72)発明者 マーチン・マデン アメリカ合衆国オハイオ州45244シンシナ テイ・ランセロツトドライブ8040 (72)発明者 リチヤード・エル・グラント アメリカ合衆国オハイオ州45244シンシナ テイ・ナツトメグノール4945
Claims (4)
- 【請求項1】 2本の脚に連結されたクラウン部を有す
る外科用ステープルにして、前記ステープルは、閉じら
れた組織把持位置において、前記脚の端部が前記クラウ
ン部に接近するように前記クラウン部の方に曲げられた
前記脚を備え、前記脚の端部が前記クラウン部の長さに
沿って互いに重なり合う外科用ステープル。 - 【請求項2】 複数のステープル列を収容している外科
用ステープルのカートリッジにおいて、前記ステープル
列の各が組織を把持するように形成され、前記ステープ
ル列の少なくも一つがステープルを持ち、前記列の前記
ステープルの各は2本の脚に連結されたクラウン部を有
し、閉じられた組織把持位置において、前記脚の端部が
前記クラウン部に接近するように前記クラウン部の方に
曲げられた前記脚を備え、前記脚の端部が前記クラウン
部の長さに沿って互いに重なり合う外科用ステープルの
カートリッジ。 - 【請求項3】 外科用ステープル列のカートリッジにし
て、前記ステープル列は前記カートリッジ内で傾けられ
て隣接列の方を向き、組織を把持するために前記ステー
プルが前記カートリッジから出るとき、前記傾けられた
列を形成している前記ステープルの各の脚の各が前記隣
接列のステープルの脚の一つと組み合うカートリッジ。 - 【請求項4】 脚を有する外科用ステープルの列を組織
内に置くこと、及び前記ステープルを折り曲げることを
含み、前記折り曲げの際に隣接ステープル内の前記ステ
ープル脚が折り曲げられる組織閉鎖方法。
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US64138091A | 1991-02-19 | 1991-02-19 | |
| US641380 | 2000-08-17 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| JPH0584252A true JPH0584252A (ja) | 1993-04-06 |
Family
ID=24572109
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP4069883A Pending JPH0584252A (ja) | 1991-02-19 | 1992-02-19 | 組織内に挿入する外科用ステープル |
Country Status (7)
| Country | Link |
|---|---|
| EP (1) | EP0505036B1 (ja) |
| JP (1) | JPH0584252A (ja) |
| AU (1) | AU1102192A (ja) |
| BR (1) | BR9200543A (ja) |
| CA (1) | CA2061319A1 (ja) |
| DE (1) | DE69202292T2 (ja) |
| ZA (1) | ZA921173B (ja) |
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Also Published As
| Publication number | Publication date |
|---|---|
| EP0505036B1 (en) | 1995-05-03 |
| EP0505036A3 (en) | 1992-12-16 |
| EP0505036A2 (en) | 1992-09-23 |
| CA2061319A1 (en) | 1992-08-20 |
| AU1102192A (en) | 1992-08-27 |
| BR9200543A (pt) | 1992-10-27 |
| DE69202292T2 (de) | 1995-10-12 |
| ZA921173B (en) | 1993-08-18 |
| DE69202292D1 (de) | 1995-06-08 |
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