JPH06296616A - 外科用縫合クランプ - Google Patents

外科用縫合クランプ

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Publication number
JPH06296616A
JPH06296616A JP6044034A JP4403494A JPH06296616A JP H06296616 A JPH06296616 A JP H06296616A JP 6044034 A JP6044034 A JP 6044034A JP 4403494 A JP4403494 A JP 4403494A JP H06296616 A JPH06296616 A JP H06296616A
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JP
Japan
Prior art keywords
clamp
suture
suture clamp
axis
tube
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English (en)
Inventor
Ferdinand Koeckerling
ケッカーリング フェルディナント
Ignaz Schneider
シュナイダー イグナーツ
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Individual
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/04—Surgical instruments, devices or methods for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469—Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • 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
    • A61B2017/1142—Purse-string sutures
    • 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

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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)
  • Materials For Medical Uses (AREA)

Abstract

(57)【要約】 【構成】 外科用縫合クランプは、鉗子状に相対的に可
動な位置関係にある２個のクランプあご部（３，４）を
備える。これは内視可能な縫合クランプとして形成さ
れ、套管針を介して体内へ挿入され、その内部管端部
（２）の近傍で体内に案内されるべき引込管（１）を備
える。少なくとも１個のクランプあご部（３）は第２ク
ランプあご部（４）に対して揺動可能に駆動されるよう
に位置決めされる。ドライブ（スピンドルホイール２
２）は体外にとどまった外部管端部（１５）の部分に配
置され、トランスミッション（ねじ付きボルト３１、押
し棒３４）を用いて、少なくとも１個の揺動可能に駆動
するクランプあご部（３）と連結する。 【効果】 内視鏡的外科手術の目的に適した一般的タイ
プの巾着縫合クランプが案出される。

Description

【発明の詳細な説明】
【０００１】
【産業上の利用分野】本発明は、鉗子状に相対的に可動
な位置関係にある２個のクランプあご部を備えた外科用
縫合クランプ、特に胃、腸、肺の手術等を行う際の巾着
縫合を行うための巾着縫合クランプに関するものであ
る。
【０００２】
【従来の技術及び発明が解決しようとする課題】腹部の
壁への従来の比較的長い手術上の切り口は、腸の部分的
除去のような或る腸の手術を行う間、例えば結腸を閉じ
るために最初に記述した縫合クランプを用いて巾着縫合
を施すためにこれまでは必要であった。内視鏡のような
必要な観察器具と外科用器具とが腹部壁に刺し通される
套管針を介して挿入される所謂内視鏡的な外科手術にお
いては、縫合クランプの鋏状の外形のために、そのよう
な縫合を施すことがこれまでは可能でなかった。これに
関して、例えば巾着縫合を施すことが求められる或る手
術は、内視鏡的外科手術の手段を用いて実行できない。
【０００３】したがって、これらの問題に由来して、本
発明の目的は、外科的縫合クランプを案出すること、特
に内視鏡的外科手術の目的に適した一般的タイプの巾着
縫合クランプを案出することにある。
【０００４】
【課題を解決するための手段】この目的は、請求項１の
特徴部分に記載された構成要件によって達成される。従
って、当該縫合クランプは、内視可能な縫合クランプと
して、套管針を介して引込管とともに体内に案内される
ように構成される。引込管の体内へ導入される内部管端
部の近傍において、少なくとも１つのクランプあご部が
第２クランプあご部に対して揺動可能に動かされるよう
に位置決めされる。更に、ドライブは体の外側にとどま
っている外部管端部の近傍に配置され、トランスミッシ
ョンを介して、少なくとも１個の揺動可能な駆動クラン
プあご部と連結される。
【０００５】この外形のために、内視鏡的外科手術の目
的のために縫合クランプを用いることが可能であり、特
に内部管端部に配置されたクランプあご部とともに当該
管も、套管針の内側開口部を通してうまく取り付けられ
るように少なくともそれらの閉じ位置において配置され
寸法決めされ、それ故套管針は縫合クランプのための腹
部壁に備えられた樋管として供される。
【０００６】好適な実施例を維持しながら、内視鏡的縫
合クランプのクランプあご部は、その長手方向におい
て、引込管の長手方向軸線に対して小さな鋭角でもって
配置される。この傾きによって、クランプあご部に形成
されたニードル通路がクランプあご部の両端から容易に
アクセス可能となる。他方において、クランプあご部は
閉じられた時に引込管の長手方向軸線に関した当該管の
輪郭の範囲内にとどまり、その結果、縫合クランプはク
ランプあご部が傾きときですら套管針の内側開口部を通
すことが可能となる。
【０００７】
【実施例】本発明の更なる特徴、詳細及び利点は請求項
２以下の従属項並びに添付された図面に関連した本発明
のサブジェクトマターの実施例に関する以下の記載から
明らかとなる。
【０００８】図１〜図３に図示されるように、本発明に
係る内視鏡的巾着縫合クランプは、その主構成部分とし
て引込管１を有し、当該管は患者の腹部壁において套管
針（図示せず）を介して体内に案内されるようになって
いる。体内に挿入可能な内部管端部の近傍において、２
個のクランプあご部３，４は揺動可能に動かされるよう
に位置決めされ、各クランプあご部３，４は複アーム状
のクランプレバー７，８のアームとして形成される。当
該レバーは共通揺動軸線１０によって揺動可能なように
内部管端部２に固定された二叉のベアリングヘッド９の
分岐脚７，８の間に位置決めされる。
【０００９】クランプあご部３，４の相互に向き合った
クランプ面１１，１２は、従来と同じく波形に構成さ
れ、クランプ面１１，１２の隆起部１３は、クランプあ
ご部３，４の長手方向Ｌにおいて延在し図１及び２で鎖
線で示されたニードル通路１４によって突き抜けられ
る。クランプの閉じた位置において、縫い糸は、巾着縫
合を施すためにニードルによって一方向にこれらニード
ル通路１４を突き抜ける。
【００１０】閉じた位置（図１、２）において、２個の
クランプあご部３，４は、引込管の長手方向軸線Ａに対
して小さな鋭角Ｗをなしてその長手方向Ｌにおいて延在
する。この角度Ｗはおよそ１０°であり、閉じた位置
（図１、２）でクランプあご部３，４が、引込管１の長
手方向軸線Ａに平行に延在するクランプあご部３，４の
眺めの方向における引込管の円形輪郭の範囲内にあるよ
うに、当該角度は大きさを決められる。この傾きの結
果、ニードル管路１４の孔は楽々とアクセス可能とな
り、内視鏡的マニピュレーターを用いてニードルをニー
ドル管路１４内に入れる際に特別有利となる。
【００１１】実質的にシリンダ状のハンドル部材１６
は、引込管１の体外にとどまった外部管端部１５にねじ
連結部１７を用いて同軸状にねじ締めされる。このハン
ドル部材１６は管孔１８と同軸状に延在する連続的内側
孔１９を有している。スピンドルホイール２２がそのシ
リンダ状内部開口２３とともに回転可能に配置されるよ
うになった同様に同軸状に延在する環状肩部２１が、引
込管１から離れた側のハンドル部材１６の前端部２０に
備えられる。突起部としての頭なしねじ２５と係合する
周囲溝２４が更に環状肩部２１の周囲に備えられる。こ
れら頭なしねじは、スピンドルホイール２２のシリンダ
状内部開口２３の周りの環状つば部２７での対応するね
じ付き孔２６を介してねじ締めされ、引込管１の長手方
向軸線の方向においてスピンドルホイールを抑止する。
真鍮からなる摺動リング２８は環状つば部２７の前側と
ハンドル部材１６の間に挿入される。
【００１２】内部開口２３から始まって引込管１の長手
方向軸線Ａに同軸状に配置され、雌ねじ部３０を有した
有底孔２９で、スピンドルホイール２２は、ハンドル部
材１６の内側孔１９でのねじ付きボルト３１とともに、
クランプあご部３，４用のスピンドルドライブを形成す
る。この端部で、ねじ付きボルト３１の雄ねじ部３２が
スピンドルホイール２２での雌ねじ部３０と係合する。
スピンドルホイール２２から離れた側のその端部３３
で、ねじ付きボルト３１は更に、２本の分岐脚７，８の
範囲で終端する二叉状のベアリングヘッド９に繋がる押
し棒３４と連結する。２本の関節レバー棒３６，３７
は、その端部で、共通の関節軸３８を用いて押し棒３４
のこの対応端部３５と関節状につながっている。関節レ
バー棒３６，３７の他の端部は、関節軸４１，４２を介
して関節接合のためにクランプレバー５，６の２本の操
作アーム３９，４０と連結する。上記構成のために、押
し棒３４と２本の関節レバー棒３６，３７とともにねじ
付きボルト３１が、スピンドルホイール２２から始まる
回転動作を２本のクランプレバー５，６へ伝達するトラ
ンスミッションを形成する。この場合、ねじ付きボルト
３１と押し棒３４のユニットは更に、回転方向において
抑止される。回転のこの抑止の目的のために、ねじ付き
ボルト３１が、その外側で、ねじ付きボルト内に半径方
向にねじ込まれたスクリューのスクリューヘッド４３の
形状において半径方向に突出した隆起部を備え、このス
クリューヘッド４３は、引込管１においてその長手方向
軸線Ａに平行に延在する長円孔４４と係合する。
【００１３】クランプあご部３，４の開閉は次のように
なされる。
【００１４】図１及び２に示されるように、関節レバー
棒３６，３７と操作アーム３９，４０とが二叉状のベア
リングヘッド９の２本の分岐脚７，８の範囲内にある状
態での２個のクランプあご部３，４の閉じ位置からスタ
ートし、スピンドルホイール２２が回転し始める。ねじ
付きボルト３１と押しロッド３４の回転の抑止のため
に、スピンドルホイール２２の回転運動はスピンドル駆
動として、引込管１の内部管端部２への方向においてね
じ付きボルト３１と押しロッド３４との押し運動に移行
する。この押しと、２本のクランプレバー５，６の揺動
軸線１０に向いた関節軸３８の接近との結果として、２
本の関節レバー棒３６，３７は外方へ離れるように動
き、それ故、クランプレバー５，６の２本の操作アーム
３９，４０を開拡する（図３）。クランプあご部３，４
はそれ故、その開き位置に動かされる。
【００１５】クランプあご部３，４を閉じるために、ス
ピンドルホイール２２が反対の回転方向に動かされ、ね
じ付きボルト３１が長手方向軸線Ａに対して同軸状で反
対方向に押し棒３４でずらされ、それ故、２本のクラン
プレバー５，６が関節レバー棒３６，３７によって引っ
込められる。
【００１６】
【発明の効果】本発明によって、内視鏡的外科手術の目
的に適した一般的タイプの巾着縫合クランプが案出され
る。
【図面の簡単な説明】
【図１】本発明に係る巾着縫合クランプの側面図であ
る。
【図２】クランプあご部が閉じた状態での図１の矢印II
の方向から見たクランプの側面図である。
【図３】クランプあご部が開いた状態での矢印IIの方向
からの図１のIII-III 断面線に沿って部分的に切り取ら
れたクランプの側面図である。
【符号の説明】
１ 引込管 ２ 内部管端部 ３ クランプあご部 ４ 第２クランプあご部 １５ 外部管端部 ２２ スピンドルホイール
───────────────────────────────────────────────────── フロントページの続き (72)発明者 イグナーツ シュナイダー ドイツ デー・91301 フォルヒハイム ハウプトシュトラーセ 52

Claims (9)

    【特許請求の範囲】
  1. 【請求項１】 鉗子状に相対的に可動な位置関係にある
    ２個のクランプあご部（３，４）を備えた外科用縫合ク
    ランプにおいて、当該縫合クランプが、内視可能な縫合
    クランプとして、套管針を介して引込管（１）とともに
    体内に案内されるように構成され、引込管の体内へ導入
    される内部管端部（２）の近傍において、少なくとも１
    個のクランプあご部（３）が第２クランプあご部（４）
    に対して揺動可能に動かされるように位置決めされるこ
    と、及びドライブ（スピンドルホイール２２）が体の外
    側にとどまっている外部管端部（１５）の近傍に配置さ
    れ、トランスミッション（ねじ付きボルト３１，押し棒
    ３４）を介して、少なくとも１個の揺動可能な駆動クラ
    ンプあご部（３，４）と連結されて縫合クランプを開閉
    することを特徴とする縫合クランプ。
  2. 【請求項２】 ドライブ及びトランスミッションが、管
    軸（長手方向軸線Ａ）に関して長手方向に軸線方向に抑
    止されこれに対して回転可能に同軸状に位置決めされた
    スピンドルホイール（２２）及び回転方向に抑止され引
    込管（１）内で長手方向に軸線方向に変位可能な押し棒
    （３４，ねじ付きボルト３１）を備えたスピンドルドラ
    イブとして形成され、押し棒（３４，ねじ付きボルト３
    １）が、その外端で雄ねじ部３２で、スピンドルホイー
    ル２２の雌ねじ部（３０）と係合し、その内端で、少な
    くとも１個の揺動可能に位置決めされたクランプあご部
    （３，４）との関節結合のために連結することを特徴と
    する請求項１に記載の縫合クランプ。
  3. 【請求項３】 クランプあご部（３，４）がおのおの複
    アーム状クランプレバー（５，６）のアームとして形成
    され、クランプレバーが軸線（揺動軸線１０）回りに揺
    動可能な内部管端部（２）で位置決めされ、その操作ア
    ーム（３９，４０）が、押し棒（３４）の内部端部（３
    ５）との関節結合のために関節レバー棒（３６，３７）
    を経て結合されていることを特徴とする請求項２に記載
    の縫合クランプ。
  4. 【請求項４】 二叉状ベアリングヘッド（９）が内部管
    端部（２）に備えられ、当該二叉状ベアリングヘッド
    （９）の分岐脚（７，８）の間で、クランプレバー
    （５，６）が共通軸線（揺動軸線１０）回りに揺動可能
    に位置決めされていることを特徴とする請求項３に記載
    の縫合クランプ。
  5. 【請求項５】 少なくともクランプあご部（３，４）が
    閉じられていて、押し棒（３４）の内部端部（３５）と
    関節レバー棒（３６，３７）とが、二叉状ベアリングヘ
    ッド（９）の分岐脚（７，８）の間に配設されることを
    特徴とする請求項４に記載の縫合クランプ。
  6. 【請求項６】 その長手方向（Ｌ）においてクランプあ
    ご部（３，４）が、引込管（１）の長手方向軸線（Ａ）
    に対して小さな鋭角（Ｗ）をなして延在することを特徴
    とする請求項１〜５のいずれか一項に記載の縫合クラン
    プ。
  7. 【請求項７】 実質的にシリンダ状のハンドル部材（１
    ６）が外部管端部（１５）に配設されていることを特徴
    とする請求項１〜６のいずれか一項に記載の縫合クラン
    プ。
  8. 【請求項８】 スピンドルホイール（２２）がハンドル
    部材（１６）上に揺動可能に支持され、ハンドル部材
    （１６）上の環状周囲溝と係合するスピンドルホイール
    （２２）上の突出部（２６）によって長手方向に軸線方
    向に抑止されることを特徴とする請求項７に記載の縫合
    クランプ。
  9. 【請求項９】 回転の抑止のために、押し棒（３４，ね
    じ付きボルト３１）が半径方向に突出する隆起部（スク
    リューヘッド４３）を備え、当該隆起部が、引込管
    （１）の長手方向軸線（Ａ）に平行に延在する長円孔
    （４４）と係合することを特徴とする請求項１〜８のい
    ずれか一項に記載の縫合クランプ。
JP6044034A 1993-03-17 1994-03-15 外科用縫合クランプ Pending JPH06296616A (ja)

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DE4308454A DE4308454A1 (de) 1993-03-17 1993-03-17 Chirurgische Nahtklemme, insbesondere Tabaksbeutel-Nahtklemme
DE4308454.0 1993-03-17

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EP (1) EP0615724B1 (ja)
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EP0615724A3 (de) 1995-02-15
EP0615724B1 (de) 1998-06-10
DE59406160D1 (de) 1998-07-16
US5474570A (en) 1995-12-12
EP0615724A2 (de) 1994-09-21
DE4308454A1 (de) 1994-09-22
ATE167036T1 (de) 1998-06-15

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