JPH06343644A - 外科用腹腔鏡器械 - Google Patents

外科用腹腔鏡器械

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Publication number
JPH06343644A
JPH06343644A JP6115917A JP11591794A JPH06343644A JP H06343644 A JPH06343644 A JP H06343644A JP 6115917 A JP6115917 A JP 6115917A JP 11591794 A JP11591794 A JP 11591794A JP H06343644 A JPH06343644 A JP H06343644A
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JP
Japan
Prior art keywords
jaw
jaws
actuator
housing
insertion tube
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English (en)
Inventor
Nigel M Goble
マーク ゴーブル ナイジェル
Colin C O Goble
チャールズ オーウェン ゴーブル コリン
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Gyrus Medical Ltd
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Gyrus Medical Ltd
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • 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
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2932—Transmission of forces to jaw members
    • A61B2017/2933—Transmission of forces to jaw members camming or guiding means
    • A61B2017/2936—Pins in guiding slots
    • 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
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00059—Material properties
    • A61B2018/00071—Electrical conductivity
    • A61B2018/00083—Electrical conductivity low, i.e. electrically insulating
    • 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
    • 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
    • A61B18/1206—Generators therefor
    • A61B2018/1246—Generators therefor characterised by the output polarity
    • A61B2018/126—Generators therefor characterised by the output polarity bipolar
    • 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
    • A61B2018/146—Scissors

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
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  • Plasma & Fusion (AREA)
  • Otolaryngology (AREA)
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Abstract

(57)【要約】 【目的】 比較的弱い力で機能でき、プラスチックの使
用を可能とし、安価で単純な方法でジョーを絶縁させる
ことができる腹腔鏡器械を供給することである。 【構成】 腹腔鏡器械は、かん子またはカッターの形状
を呈し、体腔へ挿入する中空の挿入管の端部に、ハウジ
ングと、一対の枢軸的に配された金属ジョーと、挿入管
内の往復運動可能な制御棒と、制御棒に固定されたアク
チュエータとを有する。アクチュエータは、器械の縦軸
に関して反対に傾斜した一対のガイドグルーブを有し、
各ジョーは、各グルーブに合うラグを有し、ラグは、ジ
ョー枢軸から離間し、制御棒の往復がジョーの開閉を引
き起こす。ハウジングとアクチュエータとは、絶縁さ
れ、ジョー枢軸は互いに離間し、絶縁をなし、双極外科
手術のためにジョーに高周波の電圧を供給する。

Description

【発明の詳細な説明】
【０００１】
【産業上の利用分野】本発明は、互いに枢転可能な一対
のジョーを有する外科用腹腔鏡器械に関する。
【０００２】
【従来の技術】上記の使い捨て腹腔鏡器械は、ＥＰ−Ａ
−０５０７６２２に開示されている。体腔挿入管の端部
には、挟み作用で共通の旋回軸の回りを互いに枢転でき
る一対のジョーが設けられている。このジョーは、挿入
管内の押棒によって作動し、押棒の端部は、一対のリン
クにより挿入管の端部を越えてジョーの基端方向の延長
部と接続しているので、押棒の往復運動によってジョー
は枢軸旋回する。
【０００３】腹腔鏡器械であるこの従来の装置は、トロ
カールを用いて体腔壁内に設けられたいわゆる「キーホ
ール」孔または口から導入するように設計されている。
組織の損傷を最小限に抑えるため、これらの口は一般的
に５ｍｍ〜１２．５ｍｍの大きさで出来るだけ小さく作
られる。その結果、この装置はジョーとその作動機構と
を狭いトロカールに挿通するために必要とするコンパク
トな構成としなければならないことから、特に、使用中
における、ジョーによって加えることのできる力の限界
及び作動機構の変形という欠点が生じる。
【０００４】電気外科エネルギーを用いる場合、腹腔鏡
器械の設計者が直面する問題は複雑となる。開口外科手
術は、かん子アプリケータを用いる双極電器外科手術が
最も一般的である。治療すべき組織は手術者の手に近接
しているので、かん子は、絶縁され後部にヒンジで取り
付けられた長いアームとして構成されている。かん子の
各アームは、電気外科用高周波（ＲＦ）発生器の正及び
負(active and returen)の出力ラインに接続している。
この方法では、かん子で把持されたすべての組織を乾燥
させる。双極かん子の最も有用な利用方法は、切断した
血管から流れる血流を止めることである。このような利
用方法では、ＲＦ出力を作動させる前に、かん子に閉止
圧を加えることにより血管を閉止できるので、特に有用
である。作動中、血管の内壁は粘着性となるので、血管
内の血液が凝塊を形成して互いにくっつく。こうして、
切断した血管からの血液損失を迅速に止めることができ
る。
【０００５】腹腔鏡器械による電気外科エネルギーの伝
達は、組織を分けたり、解体する場合に特に有利であ
る。これは、離れて行った場合、難しい手術であり、覆
われた血管を破壊し易い。換言すれば、焼灼や解体前の
乾燥のために、エネルギー及びその装置、すなわちＲＦ
エネルギー、を使用できるという利点がある。解体作業
のため制御可能な開口力を加える必要から、その性質上
ＲＦエネルギーの単極用途に使用し易い挟み又は把持器
が望ましい。総局電気外科手術用の腹腔鏡器械はこれま
で従来の設計を修正するだけであった。ある公知の器械
は作業端に近い点において、弾力的に別々にバイアスを
かけた２つのかん子アームを利用している。かん子の閉
鎖は、外側管を付勢したアーム上に通して両者を同時に
押圧することにより行われる。
【０００６】
【発明が解決しようとする課題】上述した設計の欠点
は、主としてスプリングによる弱い力の他は制御可能な
開口力がないことである。このため装置を解体器として
利用できず、これまで双極技術の開発を制限していた。
【０００７】上記欠点を鑑み、本発明の第一の技術的課
題は、比較的弱い力で機能でき、プラスチックの使用を
可能とし、安価で単純な方法でジョーを絶縁させること
ができる器械を提供することである。
【０００８】また本発明の第２の技術的課題は、同様の
絶縁の利点を有し、ジョーを同時にだけでなく、別々に
駆動することが可能な双極電気外科切断器を提供するこ
とである。
【０００９】
【上記課題を解決するための手段】本発明の一例によれ
ば、体腔内導入管と、この導入管の端部にあるハウジン
グと、ハウジングから末梢端方向に延在した一対のジョ
ーであり少なくともひとつのジョーはハウジングに枢軸
的に取り付けられもう一方のジョーに対して旋回開閉を
許容するところの一対のジョーと、導入管の内側に延在
し導入管及びハウジングに対して縦方向に往復運動可能
な細長い制御部材と、制御部材の末梢端部にありこれと
往復運動可能なアクチュエータとを備え、アクチュエー
タはガイドトラックを有し、枢軸的に取り付けられた少
なくともひとつのジョーは旋回軸から離間し、ガイドト
ラックに係合するガイドトラック従動体を有するととも
に、ガイドトラックはアクチュエータの縦方向の往復運
動が旋回軸の周りの少なくともひとつのジョーの旋回運
動に変換するように向いていることを特徴とする腹腔鏡
器械を提供する。後者は、枢軸的取り付けの末梢端側の
ジョー間に配されている。
【００１０】往復運動を旋回運動に変えるには、制御棒
の往復運動の方向に対して角度をもったそれぞれのガイ
ドトラックと、ガイドトラックに沿って摺動可能なガイ
ドトラック従動体との組み合わせによって旋回ジョーま
たは各旋回ジョーをアクチュエータの頭部に接続すれば
よい。この場合、ガイドトラックはアクチュエータと結
合させ、従動体はそれぞれのジョーと接合させるのが好
ましい。この方法で、ガイドトラックは、ガイドトラッ
ク従動体を最大限に横断移送するため制御棒の中心線の
反対側へ延在してもよい。ガイドトラックは、好ましく
は止め釘またはピン状で従動体を摺動可能に収容する溝
または溝穴である。ひとつの好ましい実施例では、ジョ
ーのアクチュエータ頭部及び接続部品（すなわち止め釘
またはピン）は、導入管の範囲の外側にある。その結
果、全体としての機構内の力は例えば５ｍｍの管内です
べての動作を制限する場合に必要な力よりも弱い力でジ
ョーをきわめて良好な範囲に移動させることができる。
特に、一方ではジョー取り付け用旋回軸間の範囲内で、
またもう一方ではジョーの端部間の範囲内で移動可能な
ガイドトラック付きアクチュエータ部分を備えることに
より、例えば、旋回軸の基端に配されたアクチュエータ
からジョーを駆動する挟み作用のジョーに比べて所定の
大きさでいっそう丈夫なジョー構造及びジョー取り付け
を得ることができる。ガイドトラックの横の長さ及び角
度は、それぞれジョーの動作範囲及びこの機構の機械的
利点を決定する。好ましい実施例では、まっすぐなガイ
ドトラックを有しているが、異なるジョーの一に体する
機械的利点を変更するために、曲げてもよく、例えば動
作範囲を減少させずに切断された血管に対する閉止圧を
増大させることができる。この機構により往復動作を用
いて把持部で開口及び閉止の両方の力を適用することが
できる。両方のジョーが旋回可能な実施例では、アクチ
ュエータは、縦方向に往復運動可能な要素であって、一
方のガイドトラックは移動方向に対してある角度方向に
傾斜し、他方のガイドトラックは、アクチュエータの移
動に従って一方のジョーの止め釘またはピンが他方のジ
ョーの止め釘またはピンとは反対方向に移動するよう
に、異なったまたは反対の角度方向に傾斜している。こ
れらのトラックはアクチュエータの対向面または対向側
面に形成されているのが好ましい。
【００１１】上記構成は、特に電気外科用の双極かん子
に好適であり、各ジョーが金属材料で形成され、挿入管
と結合した供給導体に接続し、ハウジング及びアクチュ
エータが共にプラスチックのような絶縁体からなる。両
方のジョーが旋回可能な場合、ハウジングの旋回軸はこ
れらのジョー間の電気絶縁性を維持する手段として離れ
ていてもよい。この機構の設計により許容された比較的
弱い力によって、この機構へのプラスチックの使用が可
能となり、安価で単純な方法でジョーを絶縁させること
ができる。
【００１２】双極電気外科切断器は、同様に構成され、
絶縁の同様の利点を有し、ジョーを同時にだけでなく、
別々に駆動することが可能となる。本発明の第２の例で
は、体腔壁内の穴に挿通して体腔に挿入される挿入管
と、挿入管の端部におけるハウジングと、ハウジングか
ら末梢端方向に延在する一対のジョーであって少なくと
もひとつのジョーはハウジングに枢軸的に取り付けられ
もう一方のジョーに対して開閉を許容するところの一対
のジョーと、挿入管内で往復運動可能な制御部と、制御
部の端部にあるアクチュエータとを備え、アクチュエー
タはジョー間に、及び、枢軸的に取り付けられた少なく
ともひとつのジョーの枢軸的取り付けの末梢端方向に設
けられた作動変換器を有し、作動変換器は制御部の往復
運動をジョーの旋回運動に変換することを特徴とする外
科用腹腔鏡器械を提供する。
【００１３】本発明はさらに第三の例で、体腔壁内の穴
に挿通して体腔に挿入される挿入管と、挿入管の端部に
おけるハウジングと、ハウジングから末梢端方向に延在
する一対のジョーであって各ジョーは導電部を有し且つ
少なくともひとつのジョーがハウジングに枢軸的に取り
付けられ横(transverse)枢軸の周りを他方のジョーに対
して枢軸的開閉を許容するところの一対のジョーと、導
入管の内側に延在し導入管に対して縦方向に往復運動可
能な細長い制御部と、制御部の末梢端部と前記少なくと
もひとつのジョーとに連結し制御部の縦方向の往復運動
を枢軸の周りの前記少なくともひとつのジョーの旋回運
動に変換するアクチュエータ手段と、ひとつのジョーを
他方から電気的に絶縁させる手段と、ジョーの導電部に
それぞれ連結した電気供給導体であって少なくともひと
つの導体は挿入管内部に配されるところの電気供給導体
とを備え、ジョーが閉止状態にあるときもう一方のジョ
ーの内部表面に係合する内部表面を有し、各内部表面は
各ジョーの導電部の導電表面部により又介在する絶縁表
面部（Ｃ）により形成され、ふたつのジョー上の導電及
び絶縁部の配置はジョーの閉止位置において一方のジョ
ーの導電表面部は他方のジョーの導電表面と隣接するが
触れることはないことを特徴とする外科用腹腔鏡器械を
提供する。
【００１４】ジョーは、一対の刃で構成され、挟み作用
を行う。内部表面は、閉止位置にあるとき互いに向き合
い、各相互係合する切断エッジにより境を接(bound)す
る刃の表面である。導電および絶縁表面部は、切断エッ
ジまで及び切断エッジの周囲に完全に延在しなければな
らない。
【００１５】
【作用】上記構成により、比較的弱い力で機能でき、プ
ラスチックの使用を可能とし、安価で単純な方法でジョ
ーを絶縁させることができる。
【００１６】さらに、同様の絶縁の利点を有し、ジョー
を同時にだけでなく、別々に駆動することができる。
【００１７】
【実施例】これから説明する本発明の第一の好ましい実
施例は、双極電気外科手術に使用される一対の腹腔鏡か
ん子である。器械は、体腔の壁に用意されたトロカール
をから挿入する挿入管の形状をしたシャフトの端部に設
けられた一対のヒンジで取り付けられたかん子ジョーを
有する。また、挿入管の外端部には、ＲＦ発電器に接続
されたハンドグリップがある。シャフトは、一般的に２
８０乃至３６０ｍｍの長さを有する。説明及び図面が体
腔内部で使用される器械の一部に関してされていること
が理解されるべきである。かん子ジョーは、代わりに切
断器の刃でもよいことが理解されるべきである。
【００１８】図面の図１から図４までを参照すると、ス
テンレススチール製挿入管１０である器械シャフトは、
その端部に一対のスチール製かん子ジョー１２Ａ，１２
Ｂを設けている。各ジョーは、挿入管１０の端部に適合
した２つのプラスチック製コレット半体１４Ａ，１４Ｂ
を有するジョーハウジングの基端部に別々に枢軸的に設
けられており、プラスチック製のアクチュエータ１６に
より開口位置及び閉止位置との間で旋回可能である。ア
クチュエータ１６は、ジョー１２Ａと１２Ｂとの間にそ
れらの枢軸の末梢端方向に配されたアクチュエータ頭部
１６Ｈと、コレット半体１４Ａと１４Ｂとの間を通過
し、ハンドグリップ（図示せず）との接続のため挿入管
１０の長さ移動する約１ｍｍの直径を有する制御棒１８
に接続している。図１及び図２において、ジョーは、そ
の開口位置にて図示されている。図３において、ジョー
は、その閉止位置にて図示されている。
【００１９】図２において一部のみ図示され、挿入管１
０の長さ延在する２つの電気供給導体２０Ａ，２０Ｂが
挿入管１０内に配されている。それらは、挿入管１０内
の主要部内で自由にねじれ、ハンドグリップに関してか
ん子の回転を許容する。各導体は、熱収縮性絶縁体を有
するステンレススチール製ストリップを有し、挿入管１
０を通る。グルーブ１４Ｇは、コレット半体１４Ａ，１
４Ｂのそれぞれに設けられ、ジョー１２Ａ，１２Ｂの凹
部内へコレットの末梢端方向に通る導体を受ける。それ
らは、ジョーの物質に溶接されている。ジョー１２Ａ，
１２Ｂの詳細については、図５、６及び７により明らか
に示されている。
【００２０】図５、６及び７を参照すると、各ジョー１
２Ａ，１２Ｂは、ＳＵＳ３０４の単一金属の射出成形で
あり、把持表面１２Ｇ及び図６及び７が示すようにジョ
ー１２Ａの外部リセス（１２Ｏ）へ開口する内側に向か
うリセス１２Ｒの導電部を除いてほぼ全ての表面上にＰ
ＴＦＥのような絶縁コンパウンドでコーティングされ
る。そのコーティングにより、手術部位に近接した組織
の不慮の焼しゃくを防止する。各ジョーは、末梢端方向
に先の細くなった本体を有する。本体は、基端におい
て、それぞれ器械の縦軸に垂直な共通の偏芯ヒンジ軸を
規定する２つの突出するヒンジピン１２Ｐを有し、コレ
ット半体１４Ａ，１４Ｂの内の対応する穴内に受けられ
る（図１参照）。コレット半体は、しっかりとジョー１
２Ａ，１２Ｂのヒンジピン１２Ｐが挿入管１０の端部に
隣接して迅速に取り付けられるように形成されている。
その端部の中間では、以下に述べるように、各ジョー
は、縦軸から離間した内側に向かって延在する耳部１２
Ｅを有する。耳部１２Ｅは、アクチュエータ１６のガイ
ド溝に係合するための内向きのアクチュエーチョンペグ
１２Ｆを有する。外形に関しては、図７に示すように、
ジョーは円形封体２４内に適合するよう形作られ寸法付
けられている。円形封体２４は、ジョーが閉止状態にあ
るとき、挿入管１０の外形に適合する。従って、完成体
は、適合する内径を有するトロカールを挿通することが
できる。把持表面１２Ｇは、平坦であり、ジョーは、そ
の表面が互いに面接触するように取り付けられている。
【００２１】図１と相まって図８を参照すると、コレッ
ト１４Ａ，１４Ｂは、３つの主要機能を有する。その３
つの主要機能とは、ジョー１２Ａ、１２Ｂを絶縁して枢
軸的に取り付けること、アクチュエータ１６を摺動可能
に収納すること、及び、電気伝導体２０Ａ，２０Ｂを収
納することである。２つのコレット半体１４Ａ，１４Ｂ
は、同一であり、そのひとつは、図８に図示されてい
る。各半体は、挿入管１０の内径と対応する外径となる
部分的円筒状の本体を有する。半体は、直径にわたって
面接触により他方の半体と対になる。縦方向のインター
ロックは、凸部及び凹部１４Ｐ，１４Ｒを対応させるこ
とによりなし得る。中央内部溝１４Ｃは、アクチュエー
タ１６のシャフト１６Ｓを摺動可能に収納し、狭いグル
ーブ１４Ｇは、伝導体２０Ａ，２０Ｂを収納する。末梢
端部において、コレット半体は、増加した直径を有する
ところに、挿入管１０の端部に接触するショルダーを有
し、各ジョー１２Ａ，１２Ｂの枢軸ピン１２Ｐを収納す
るための２つの穴１４ＰＢにより深く貫かれた扇型断面
の枢軸ハウジングを供給する。その穴１４ＰＢの軸は、
器械の中央線の対向両面で中心から外れて位置し、これ
により絶縁のためジョーを離間させることが分かる。
【００２２】アクチュエータ１６は、図９にさらに明確
に示されており、アクチュエータ頭部１６Ｈが長方形断
面であり、その面のひとつに、器械の縦軸に対して傾斜
しその軸の両側に延在するガイドグルーブ１６ＧＧの形
式のガイドトラックを有する。同様にしかし反対に傾斜
するグルーブが、図１及び図２の点線で示されるように
頭部１６Ｈの対向する面に形成される。各グルーブは、
各ジョー１２Ａ，１２Ｂの各ガイドペグ１２Ｆを受け
る。シャフト１６Ｓの他端部においてコネクタ１６Ｃが
制御棒１８を受ける（図２および３参照）。これによ
り、アクチュエータ１６はジョー１２Ａ，１２Ｂを確実
に開閉するように往復することができる。制御棒の押し
引きの力は、ジョーのペグ１２Ｆ上の横方向の力、すな
わちジョーの開閉力に変換される。図９に示されるひと
つの追加の特徴は、アクチュエータ１６のシャフト１６
Ｓ内に洗浄溝１６Ｇを備え、挿入管１０に圧送される洗
浄流体が、かん子のクリーニングと手術部位の洗浄のた
めに導かれることである。
【００２３】図面の図１０、１１及び１２は、器械の構
成要素の形態を理解しやすくする。図１２に特に見られ
るように、ジョーが閉止状態にあるかん子を示してお
り、アクチュエータ１６は、ジョーが閉止状態にあると
きにジョー１２Ａと１２Ｂとの間のギャップをほぼ完全
に埋める。閉止時、ジョーは、アクチュエータ頭部１６
Ｈの外形寸法及び形状に適合した約長方形の断面穴を備
え、ピン１２Ｐにより規定される枢軸に直角のジョーの
内側表面は、アクチュエータ頭部１６Ｈの対向する上方
面及び下方面に摺動し、ガイドペグ１２Ｆのオフセット
配置の特性により引き起こされる捩り閉止力を防ぎ、ジ
ョーの閉止時にジョーの末梢端部において不整合を引き
起こす２つのジョーの捩れを防ぐ。捩れ力の影響は、縦
軸の両側において、各ジョーのヒンジピン１２Ｐの隙間
と、コレット半体１４Ａ，１４Ｂの内側に向いた面と穴
１４ＰＢとの各隙間とにより限定される。ジョーとアク
チュエータ頭部１６Ｈとの相互配置の別の特性は、器械
を初めて体腔に挿入したとき、組織のトラッピングの可
能性がかなり減少される。
【００２４】器械は、種々の出力インピーダンスと周波
数を有する発生器と共に使用されてもよい。英国特許第
２２１４４３０号に、１５０ボルトの領域における電圧
で通常使用可能であることが開示されている。
【００２５】ある状況下では、コレット内のジョー枢軸
の基端側にアクチュエータを配することが好ましい。図
１３乃至図１５を参照すると、本発明の第２の実施例
は、上述したかん子の第一の実施例と似ており、端部に
設けられた挿入シャフトであるステンレススチール製挿
入管１１０と、一対のスチール製ジョー（１１２Ａ，１
１２Ｂ）とを備える。ジョーは切断刃１１２Ａ，１１２
Ｂの形状を呈しているが、末梢アクチュエータは、かん
子ジョーと共に使用されることができる。各ジョーはそ
の末梢端部において挿入管１０の端部に適合した２つの
プラスチック製コレット半体１１４Ａ，１１４Ｂを有す
るジョーハウジングに別々に枢支される。この場合、絶
縁プラスチック製アクチュエータ１１６は、刃１１２
Ａ，１１２Ｂの枢軸ピン１１２Ｐの基端部側に配された
アクチュエータ頭部１１６Ｈとともにコレット半体に摺
動可能に取り付けられている。各刃１１２Ａ，１１２Ｂ
は、アクチュエータ頭部１１６Ｈの各ガイドグルーブも
しくはスロット１１６ＧＧ（図１４）に配されたガイド
トラック従動体１１２Ｆを有する基端側に延在するレバ
ーを有する。前記実施例において、それらのグルーブ１
１６ＧＧは、アクチュエータの中央線の両側に配され、
同方向に向いている。すなわち、アクチュエータ１１６
の移動方向に対して傾斜して、アクチュエータの中心線
の両側に延在する。この傾斜は、相対的に対向方向に傾
斜しており、アクチュエータが縦方向に移動すると、一
方の刃のレバーアーム１１２Ｌは、ある方向に横へ付勢
され、一方、他方の刃のレバーアーム１１２Ｌは、対向
する横方向に移動する。これにより、アクチュエータ頭
部の移動方向に従って刃を枢軸開閉させる。また、その
前に、ジョー１１２Ａ，１１２Ｂは、制御棒を介しアク
チュエータ１１６に加えられる縦方向の力により開閉が
確実に行われる。
【００２６】図１３から１５に図示された実施例では、
図１３に見られるように、レバーアーム１１２Ｌは、刃
１１２Ａ，１１２Ｂが完全に開口した時、５ｍｍの外形
寸法内すなわち挿入管１１０の直径内に収まる。しかし
ながら、別の実施例では、アクチュエータ頭部１１６Ｈ
は、器械の側面に移動範囲の全体にわたってみられるよ
うに延在し、挿入管１１０により規定される円筒状封体
に近づき、挿入管から末梢端方向に延在するように図示
されたより広くてもよい。更に、より重要に、各ガイド
トラック従動体１１２Ｆは、刃の開口状態で円筒状封体
を越えてレバーアーム１１２Ｌが突出する範囲に、図１
３に示されたようにレバーアーム１１２Ｌが交差すると
き、機器の内側に面するレバーアーム１１２Ｌの側面に
配されてもよい。効果上、従動体１１２Ｆは、レバーア
ーム上に非対称的に配される。その結果、刃１１２Ａ，
１１２Ｂの旋回運動のより広い範囲は、ある状況におい
て優位となる。
【００２７】本実施例において、コレット半体１１４
Ａ，１１４Ｂを有するコレット１１４は、第一の実施例
のコレットよりも長い。各コレット半体１１４Ａ，１１
４Ｂは、挿入管１１０内に取り付けられているが、挿入
管１１０を越えて延在し、更に刃１１２Ａ，１１２Ｂを
設けるフィンガ部１１４Ｇに末梢方向に延在する細長い
部分円筒状部を有する。各刃１１２Ａ、１１２Ｂは、コ
レットフィンガ部１１４Ｆ内の穴に配される一対の枢軸
ピン１１２Ｐを有する（図１５参照）。フィンガ部１１
４Ｆは、コレット半体の部分円筒状部の外側表面と同様
で、狭いトロカールを挿通するに適した直径を有する器
械の外側円筒状封体の少なくとも一部を規定する外側表
面を有する。ジョー１１２Ａ，１１２Ｂは、コレット半
体１１４Ａ，１１４Ｂのフィンガ部１１４Ｆ間に取り付
けられる。フィンガ部１１４Ｆは、側面図に示される場
合Ｕ字形状を有する（図１５参照）。本実施例におい
て、フィンガ部１１４Ｆの端部は、図１３及び図１４に
見られる各内側に延在する先端突出部１１４Ｎにより互
いに結合される。先端部１１４Ｎは、ジョー枢軸ピン１
１２Ｐの末梢端に接して保持される。
【００２８】アクチュエータシャフト１１６Ｓ上のアク
チュエータ頭部１１６Ｈの位置とのコレット半体１１４
Ａ，１１４Ｂの配置は、アクチュエータ頭部１１６Ｈが
刃１１２Ａ、１１２Ｂの開口形状に対応する位置にある
とき、コレットフィンガ部１１４Ｆ間に配されることに
より各側面上に部分的に露出される。従って、移動範囲
の少なくとも一部において、縦方向の移動を旋回運動に
変換するアクチュエータ１１６の部分は、側面に開口す
るコレット半体間の隙間内で、すなわちジョーの枢軸に
垂直な方向で移動する。本実施例でのアクチュエータ頭
部１１６Ｈの部分は図１３に示されている。制御棒１１
６Ｈ及びアクチュエータコネクタ１１６Ｃ上に引き力が
加えられる場合、アクチュエータ頭部１１６Ｈは、コレ
ットフィンガ部１１４Ｆ間の位置から図１４に示される
ようにフィンガ部１１４Ｇへの挿入管１１０の端部から
延在する部分円筒状コレット部に封された位置に引かれ
る。
【００２９】電気外科ＲＦ電力は、電源（図示せず）か
ら挿入管１１０を介して刃１１２Ａ，１１２Ｂ上の溶接
された接続部に延在する各柔軟な導体ストリップ１２０
Ａ，１２０Ｂを介して刃１１２Ａ，１１２Ｂに供給され
る。第一実施例のかん子ジョーに関して、双極エネルギ
ーが供給されてもよいように、刃１１２Ａ，１１２Ｂ
は、それぞれ絶縁されるように取り付けられ、アクチュ
エータ１１６は、絶縁プラスチック材料で形成される。
図１３、１４及び１５の相互の比較により、挟み作用を
行えるように刃１１２Ａ，１１２Ｂが取り付けられてい
ることが説明されている。各刃は、一般的に断面上でＬ
字型を呈しており、枢軸ピン１１２Ｐと強化ウェブ１１
２Ｗとにより規定される回転軸に関して一般的に垂直に
延在する刃本体１２ＢＢを有する。強化ウェブ１１２Ｗ
は、回転軸に一般的に平行な方向に刃本体１１２ＢＢか
ら外に延在する。各刃本体は、本実施例において器械の
縦軸と交差する共通の平面に実質的に横たわる一般的に
平らな内側表面１１２ＩＳにを有する。平面１１２ＩＳ
は、刃が閉止位置にあるとき互いに面し係合する。内側
表面１１２ＩＳは、それぞれ切断エッジ１１２Ｃを終端
とする（図１３参照）。切断エッジ１１２Ｃは、刃が閉
止したとき挟み作用を行う。電気ショートを防止するた
め、各は１１２Ａ，１１２Ｂの内側表面１１２ＩＳは、
図１３から１５において記号「Ｃ」で示される絶縁セラ
ミック製インレイにより形成される絶縁表面部を有す
る。それらのインレイＣは、各刃１１２Ａ，１１２Ｂの
長さに沿って交換関係に配されている。各刃の介在する
導電表面部は、刃が閉止状態にあるとき、他の刃のセラ
ミック製インレイＣとして使用されている。事実、各刃
の縦方向に各セラミック製インレイＣの範囲は、他の刃
の適合導電表面部の縦方向の範囲よりも多少広いので、
刃が閉止状態にあるとき、セラミック製インレイＣは図
１５に示されたように重なる。刃１１２Ａ，１１２Ｂの
内側表面１１２ＩＳ間の導電表面部に対する絶縁表面部
の関係は、内側表面１１２ＩＳの嵌合部全体を横切っ
て、図１４に示されるように、刃が閉止状態にあると
き、重畳する刃の範囲を越えて延在する各セラミック製
インレイＣを維持する。好ましくは、刃の外側表面、す
なわち切断エッジ１１２Ｃから離れた外側表面は、刃の
外側の組織を不慮に焼しゃくさせてしまうことから防止
する。
【００３０】使用において、刃１１２Ａ，１１２Ｂは、
切断エッジ間にトラップされる組織を焼しゃくするため
にＲＦ電気エネルギーを供給し、組織を両刃の導電部と
接続させる。
【００３１】上述した絶縁表面部及び導電表面部の差し
込み形状の代わりとして、刃１１２Ａ，１１２Ｂの一つ
を絶縁材料でコーティングされた全内側表面１１２ＩＳ
を有する。そのコーティングは、切断エッジ１１２Ｃの
まわりの規定された範囲に延在する。一方、他方の刃
は、内側表面１１２ＩＳの少なくとも主要部を上に、内
側表面の実質的に全体と切断エッジは導電するようなコ
ーティングはされない。焼しゃくもしくは乾燥電流通路
を、第一の前記刃の表面に見える導電材料と第二の前記
刃の切断エッジの範囲内の導電材料との間に設けること
ができる。
【００３２】
【発明の効果】上述したように本発明によれば、比較的
弱い力で機能でき、プラスチックの使用を可能とし、安
価で単純な方法でジョーを絶縁させることができる腹腔
鏡器械が得れる。
【００３３】さらに、本発明によれば、同様の絶縁の利
点を有し、ジョーを同時にだけでなく、別々に駆動する
ことができる腹腔鏡器械が得れる。
【図面の簡単な説明】
本発明は、次に説明される図面を参照して例により記述
される。
【図１】開口状態のジョーを示した本発明による腹腔鏡
器械の平面図である。
【図２】図１に対応する部分縦断面図である。
【図３】閉止状態のジョーを有するかん子の平面図であ
る。
【図４】かん子の側面図である。
【図５】かん子のジョーの内のひとつの平面図である。
【図６】ジョーの外側側面図である。
【図７】図６の線ＶＩＩ−ＶＩＩに沿ったジョーの断面
図である。
【図８】ジョーハウジングの片半分の透視図である。
【図９】かん子のアクチュエータの透視図である。
【図１０】図３の線ＩＸ−ＩＸに沿った断面図である。
【図１１】図３の線Ｘ−Ｘに沿った断面図である。
【図１２】図３の線Ｘ−Ｘに沿った断面図である。
【図１３】開口状態のジョーを示した本発明による腹腔
鏡切断器の部分縦断面図である。
【図１４】閉止状態のジョーを示した図１３と同様の図
である。
【図１５】閉止状態のジョーを示した切断器の側面図で
ある。
【符号の説明】
１０ 挿入管 １２Ａ、１２Ｂ ジョー １２Ｅ 耳部 １２Ｇ 把持表面 １２Ｐ ヒンジピン １２Ｒ リセス １４Ａ、１４Ｂ コレット半体 １２Ｆ ペグ １４Ｇ グルーブ １６ アクチュエータ １６Ｈ アクチュエータ頭部 １８ 制御棒 ２０Ａ、２０Ｂ 電気供給導体 ２４ 円形封体 １１２Ａ，１１２Ｂ 刃 １１２Ｃ 切断エッジ １１２ＩＳ 内側表面 １１６ アクチュエータ １１６Ｃ アクチュエータコネクタ
───────────────────────────────────────────────────── フロントページの続き (72)発明者 コリン チャールズ オーウェン ゴーブ ル イギリス，ＣＦ５ ４ＨＪ，カーディフ, キャントン，クライブ ロード，ベーカー ズ コート ４番地

Claims (20)

    【特許請求の範囲】
  1. 【請求項１】 体腔壁内の穴に挿通して体腔に挿入され
    る挿入管と、 前記導入管の端部にあるハウジングと、 前記ハウジングから末梢端方向に延在した一対のジョー
    であり、少なくともひとつの前記ジョーは前記ハウジン
    グに枢軸的に取り付けられ、もう一方の前記ジョーに対
    して旋回開閉を許容するところの一対のジョーと、 前記導入管の内側に延在し前記導入管及び前記ハウジン
    グに対して縦方向に往復運動可能な細長い制御部材と、 前記制御部材の末梢端部にあり、往復運動可能なアクチ
    ュエータとを備え、 前記アクチュエータはガイドトラックを有し、枢軸的に
    取り付けられた前記少なくともひとつのジョーは旋回軸
    から離間しガイドトラックに係合するガイドトラック従
    動体を有するとともに、前記ガイドトラックは前記アク
    チュエータの縦方向の往復運動が旋回軸の周りの前記少
    なくともひとつのジョーの旋回運動に変換するように向
    いていることを特徴とする腹腔鏡器械。
  2. 【請求項２】 各前記ジョーは、各電気供給導体と対に
    なった導電部を有し、前記電気供給導体のうち少なくと
    もひとつは、挿入管内に配され、前記アクチュエータは
    絶縁材料で形成されてなることを特徴とする請求項１記
    載の器械。
  3. 【請求項３】 両前記ジョーは前記ハウジングに枢軸的
    に取り付けられ、前記アクチュエータは一対のガイドト
    ラックを有し、各ジョーは前記ガイドトラックのそれぞ
    れと係合する各ガイドトラック従動体を有し、前記ガイ
    ドトラックは、前記アクチュエータの縦方向の往復運動
    が前記ジョーの対向する旋回運動に変換するように向け
    られていることを特徴とする請求項１または２記載の器
    械。
  4. 【請求項４】 前記ジョーは、交差枢軸からそれぞれ離
    間して前記ハウジング上で旋回可能であることを特徴と
    する請求項３記載の器械。
  5. 【請求項５】 前記ハウジングは、絶縁材料で形成され
    てなることを特徴とする請求項４記載の器械。
  6. 【請求項６】 前記ジョーは、かん子ジョーであること
    を特徴とする請求項１乃至５いずれか記載の器械。
  7. 【請求項７】 前記ジョーは、切断器の刃であることを
    特徴とする請求項１乃至５いずれか記載の器械。
  8. 【請求項８】 前記ジョーは、切断刃と切断アンビルと
    を備えることを特徴とする請求項１乃至５いずれか記載
    の器械。
  9. 【請求項９】 前記アクチュエータは頭部を有し、前記
    ガイドトラックは前記頭部上に形成され、前記頭部は前
    記枢軸および各前記枢軸の末梢端側に配されてなること
    を特徴とする請求項１乃至８いずれか記載の器械。
  10. 【請求項１０】 前記ガイドトラックもしくは各前記ガ
    イドラックは、縦方向および横方向の両方に延在するこ
    とを特徴とする請求項１乃至９いずれか記載の器械。
  11. 【請求項１１】 前記ガイドトラックもしくは各前記ガ
    イドラックは、スロットもしくは溝であることを特徴と
    する請求項１０記載の器械。
  12. 【請求項１２】 前記アクチュエータは頭部を有し、前
    記ガイドトラックもしくは各前記ガイドラックは、前記
    頭部上に形成され、前記頭部は挿入管の範囲の外側であ
    ることを特徴とする請求項１０または１１記載の器械。
  13. 【請求項１３】 体腔壁内の穴に挿通して体腔に挿入さ
    れる挿入管と、 前記挿入管の端部におけるハウジングと、 前記ハウジングから末梢端方向に延在する一対のジョー
    であって、少なくともひとつの前記ジョーはハウジング
    に枢軸的に取り付けられ、もう一方の前記ジョーに対し
    て開閉を許容するところの一対のジョーと、 前記挿入管内で往復運動可能な制御部と、 前記制御部の端部にあるアクチュエータとを備え、 前記アクチュエータはジョー間に、及び、枢軸的に取り
    付けられた少なくともひとつのジョーの枢軸的取り付け
    の末梢端方向に設けられた作動変換器を有し、前記作動
    変換器は前記制御部の往復運動をジョーの旋回運動に変
    換することを特徴とする外科用腹腔鏡器械。
  14. 【請求項１４】 各前記ジョーは、各電気供給導体と対
    になった導電部を有し、前記電気供給導体のうち少なく
    ともひとつは、挿入管内に配され、前記アクチュエータ
    の運動変換部は絶縁材料で形成されることを特徴とする
    請求項１に記載の器械。
  15. 【請求項１５】 前記ハウジングは、絶縁材料で形成さ
    れることを特徴とする請求項１４記載の器械。
  16. 【請求項１６】 両前記ジョーは前記ハウジングに枢軸
    的に取り付けられ、前記アクチュエータ運動変換部は一
    対のガイドトラックを有し、各ジョーは前記ガイドトラ
    ックのそれぞれと係合する各ガイドトラック従動体を有
    し、前記ガイドトラックは、前記アクチュエータの縦方
    向の往復運動が前記ジョーの対向する旋回運動に変換す
    るように向けられていることを特徴とする請求項１３乃
    至１５いずれか記載の器械。
  17. 【請求項１７】 前記ジョーは、交差枢軸からそれぞれ
    離間して前記ハウジング上で旋回可能であることを特徴
    とする請求項１６記載の器械。
  18. 【請求項１８】 体腔壁内の穴に挿通して体腔に挿入さ
    れる挿入管と、 前記挿入管の端部におけるハウジングと、 前記ハウジングから末梢端方向に延在する一対のジョー
    であって、各ジョーは導電部を有し且つ少なくともひと
    つのジョーがハウジングに枢軸的に取り付けられ、横(t
    ransverse)枢軸の周りを他方のジョーに対して枢軸的開
    閉を許容するところの一対のジョーと、 前記導入管の内側に延在し導入管に対して縦方向に往復
    運動可能な細長い制御部と、 前記制御部の末梢端部と前記少なくともひとつのジョー
    とに連結し、前記制御部の縦方向の往復運動を枢軸の周
    りの前記少なくともひとつのジョーの旋回運動に変換す
    るアクチュエータ手段と、 ひとつの前記ジョーを他方から電気的に絶縁させる手段
    と、 前記ジョーの導電部にそれぞれ連結した電気供給導体で
    あって少なくともひとつの導体は前記挿入管内部に配さ
    れるところの電気供給導体とを備え、 前記ジョーが閉止状態にあるとき、もう一方の前記ジョ
    ーの内部表面に係合する内部表面を有し、各内部表面は
    各ジョーの導電部の導電表面部により又介在する絶縁表
    面部（Ｃ）により形成され、両前記ジョー上の導電及び
    絶縁部の配置はジョーの閉止位置において一方のジョー
    の導電表面部は他方のジョーの導電表面と隣接するが触
    れることはないことを特徴とする外科用腹腔鏡器械。
  19. 【請求項１９】 前記ジョーは、挟み作用を行うよう配
    された一対の刃を有し、前記内部表面は、刃が閉止状態
    にあるとき面接触し、各嵌合する切断エッジにより接す
    るする刃の表面であり、前記導電及び絶縁表面部は、切
    断エッジまで延在することを特徴とする請求項１８記載
    の器械。
  20. 【請求項２０】 各前記ジョーの前記導電及び絶縁表面
    部は、ジョーの長さに沿って交換関係にあり、各ジョー
    の前記導電表面部は、ジョーが閉止状態にあるとき、他
    方のジョー絶縁表面部として使用（ｉｎ ｒｅｇｉｓｔ
    ｒｙ）されていることを特徴とする請求項１８または１
    ９記載の器械。
JP6115917A 1993-05-04 1994-05-03 外科用腹腔鏡器械 Pending JPH06343644A (ja)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GB9309142.9 1993-05-04
GB939309142A GB9309142D0 (en) 1993-05-04 1993-05-04 Laparoscopic instrument

Publications (1)

Publication Number Publication Date
JPH06343644A true JPH06343644A (ja) 1994-12-20

Family

ID=10734887

Family Applications (1)

Application Number Title Priority Date Filing Date
JP6115917A Pending JPH06343644A (ja) 1993-05-04 1994-05-03 外科用腹腔鏡器械

Country Status (5)

Country Link
US (1) US5496317A (ja)
EP (2) EP0623316B1 (ja)
JP (1) JPH06343644A (ja)
DE (2) DE69417464T2 (ja)
GB (1) GB9309142D0 (ja)

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EP0623316A1 (en) 1994-11-09
DE69432937D1 (de) 2003-08-14
DE69432937T2 (de) 2004-05-27
EP0887046A2 (en) 1998-12-30
EP0887046B1 (en) 2003-07-09
GB9309142D0 (en) 1993-06-16
DE69417464T2 (de) 1999-09-09

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