JPH067357A - 検出手段を備えた内視鏡外科用システム - Google Patents
検出手段を備えた内視鏡外科用システムInfo
- Publication number
- JPH067357A JPH067357A JP5023314A JP2331493A JPH067357A JP H067357 A JPH067357 A JP H067357A JP 5023314 A JP5023314 A JP 5023314A JP 2331493 A JP2331493 A JP 2331493A JP H067357 A JPH067357 A JP H067357A
- Authority
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- instrument
- head
- procedure
- staples
- tissue
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- Pending
Links
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Classifications
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- 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
- A61B17/07207—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 the staples being applied sequentially
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/12—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord
- A61B17/128—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord for applying or removing clamps or clips
- A61B17/1285—Surgical instruments, devices or methods for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels or umbilical cord for applying or removing clamps or clips for minimally invasive surgery
-
- A—HUMAN NECESSITIES
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- A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
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Abstract
(57)【要約】 （修正有）
【目的】 内視鏡外科用システムは、内視鏡器械の活動
部分又は作業頭部の操作において高程度の制御を提供す
る。 【構成】 内視鏡手順において使用されるシステムにお
いて、（ａ）手順において一段階を行う際に使用される
器械と、（ｂ）器械を動作させ、手順において該段階を
行うために、該器械にパワーを供給するための手段と、
（ｃ）該段階を行う際に器械の動作を監視制御するため
に、該器械に取り付けられた検出及び制御手段とを具備
するシステム。
部分又は作業頭部の操作において高程度の制御を提供す
る。 【構成】 内視鏡手順において使用されるシステムにお
いて、（ａ）手順において一段階を行う際に使用される
器械と、（ｂ）器械を動作させ、手順において該段階を
行うために、該器械にパワーを供給するための手段と、
（ｃ）該段階を行う際に器械の動作を監視制御するため
に、該器械に取り付けられた検出及び制御手段とを具備
するシステム。
Description
【０００１】
【発明の分野】本発明は、内視鏡手順において使用され
るシステムに関する。さらに詳細には、この発明は、手
順が施される組織の物理的性質及び／又は内視鏡外科用
器械のパラメータを自動的に検出するシステムに関す
る。
るシステムに関する。さらに詳細には、この発明は、手
順が施される組織の物理的性質及び／又は内視鏡外科用
器械のパラメータを自動的に検出するシステムに関す
る。
【０００２】
【従来技術及びその課題】内視鏡外科手術は、外科手順
を行うために改良された費用効果のある技術として広く
受け入れられてきた。内視鏡外科手術において、尖端穿
刺装置である套管針は、套管を套管針の回りに置いて身
体に送り込まれる。套管針が腹腔壁の穿刺を達成した
後、それは除去され、套管が身体に残される。この套管
を通して、内視鏡手順が可能となる。しばしば、複数の
開口が套管針で身体に開けられ、内視鏡器械は、一套管
に置かれ、適切な視野機構が別の套管に置かれ、そして
外科手術部位を照らすためのファイバーオプティックス
がさらに別の套管に置かれる。一般に、これらの内視鏡
手順は、ガス注入下で行われる。内視鏡手順についてさ
らに知識が増し、さらに器械が発達すると、内視鏡的手
順の形式は増加する。現在、一般手順は、胆嚢除去、組
織修復、及びいろいろな滅菌手順である。
を行うために改良された費用効果のある技術として広く
受け入れられてきた。内視鏡外科手術において、尖端穿
刺装置である套管針は、套管を套管針の回りに置いて身
体に送り込まれる。套管針が腹腔壁の穿刺を達成した
後、それは除去され、套管が身体に残される。この套管
を通して、内視鏡手順が可能となる。しばしば、複数の
開口が套管針で身体に開けられ、内視鏡器械は、一套管
に置かれ、適切な視野機構が別の套管に置かれ、そして
外科手術部位を照らすためのファイバーオプティックス
がさらに別の套管に置かれる。一般に、これらの内視鏡
手順は、ガス注入下で行われる。内視鏡手順についてさ
らに知識が増し、さらに器械が発達すると、内視鏡的手
順の形式は増加する。現在、一般手順は、胆嚢除去、組
織修復、及びいろいろな滅菌手順である。
【０００３】広く、外科手術において使用される器械
は、２つに大分類される。一方のクラスは、操作装置で
ある。すなわち、組織を把持し、組織を位置付け、灌注
し、吸引を施する等の装置である。第２クラスは、活動
装置と言う。一般に、この装置は、組織を切り取る又は
ステープルで留めるものであり、さらに、これらの作用
を組み合わせた装置もある。そのような装置の例として
は、電気外科用器械、超音波器械、レーザー、円形ステ
ープル留め器械、直線ステープル留め器械、結紮及び切
断器械、等がある。
は、２つに大分類される。一方のクラスは、操作装置で
ある。すなわち、組織を把持し、組織を位置付け、灌注
し、吸引を施する等の装置である。第２クラスは、活動
装置と言う。一般に、この装置は、組織を切り取る又は
ステープルで留めるものであり、さらに、これらの作用
を組み合わせた装置もある。そのような装置の例として
は、電気外科用器械、超音波器械、レーザー、円形ステ
ープル留め器械、直線ステープル留め器械、結紮及び切
断器械、等がある。
【０００４】内視鏡外科手順は患者に有益なものである
が、手順を実施する外科医に幾つかの問題を与える。例
えば、器械の活動部分は、器械の操作部分から除去され
るために、操作部分のわずかな移動でさえも活動部分に
達した時拡大される。このため、ステープルを組織に配
設形成する時、外科医の手は、標準開放外科手術中より
も、内視鏡手順中ずっと安定していなければならない。
別の困難は、手順を行う外科医が直接的に操作している
部位を見ることができないが、適切なビデオ表示装置で
部位を眺め、ビデオ表示装置の映像に基づいて器械を操
作しているために発生する。こうして、内視鏡外科用器
械を設計する際に、器械を動作させるために必要とされ
る力を縮小し、外科医が器械をより良く制御できるよう
にするために、かなりの努力が為される。また、工学の
観点から、外科医の手の力と行程の物理的な限界内で器
械の活動部分の機能を許容するために、かなりの設計工
学が必要とされる。
が、手順を実施する外科医に幾つかの問題を与える。例
えば、器械の活動部分は、器械の操作部分から除去され
るために、操作部分のわずかな移動でさえも活動部分に
達した時拡大される。このため、ステープルを組織に配
設形成する時、外科医の手は、標準開放外科手術中より
も、内視鏡手順中ずっと安定していなければならない。
別の困難は、手順を行う外科医が直接的に操作している
部位を見ることができないが、適切なビデオ表示装置で
部位を眺め、ビデオ表示装置の映像に基づいて器械を操
作しているために発生する。こうして、内視鏡外科用器
械を設計する際に、器械を動作させるために必要とされ
る力を縮小し、外科医が器械をより良く制御できるよう
にするために、かなりの努力が為される。また、工学の
観点から、外科医の手の力と行程の物理的な限界内で器
械の活動部分の機能を許容するために、かなりの設計工
学が必要とされる。
【０００５】内視鏡手順に特異な別の問題は、外科医
が、厚さ、軟度、特質等を決定するために、もはや両手
で組織を感ずることができないことである。
が、厚さ、軟度、特質等を決定するために、もはや両手
で組織を感ずることができないことである。
【０００６】また、医療上の理由のために、内視鏡器械
を可処分にすることが、しばしば望ましいことが指摘さ
れる。この主な理由としては、小さな、複雑な、再使用
可能な器械は滅菌するのが困難であることであるが、器
械を可処分にするならば、これらの滅菌問題は除去され
る。しかし、器械を可処分にすると、しばしば器械の費
用を増大させ、この費用は医療上の利点と平衡されなけ
ればならない。内視鏡器械に関する別の問題は、アクセ
ス限界である。すなわち、套管に配置後に器械の頭部を
操作することは、困難であり、移動範囲は制限される。
を可処分にすることが、しばしば望ましいことが指摘さ
れる。この主な理由としては、小さな、複雑な、再使用
可能な器械は滅菌するのが困難であることであるが、器
械を可処分にするならば、これらの滅菌問題は除去され
る。しかし、器械を可処分にすると、しばしば器械の費
用を増大させ、この費用は医療上の利点と平衡されなけ
ればならない。内視鏡器械に関する別の問題は、アクセ
ス限界である。すなわち、套管に配置後に器械の頭部を
操作することは、困難であり、移動範囲は制限される。
【０００７】
【課題を解決するための手段】本発明の内視鏡外科用シ
ステムは、内視鏡器械の活動部分又は作業頭部の操作に
おいて高程度の制御を提供するシステムである。さら
に、新システムは、外科手術手順中、内視鏡器械の頭部
に対するアクセスを拡張する。新内視鏡システムは、外
科手術手順中、器械の頭部を安定な制御下に維持しなが
ら、頭部に加えられるより大きな力を許容する。新内視
鏡システムは、可処分であり、そして可処分でありなが
ら、設計により、かなりの費用削減をなす。新システム
では、外科医は、外科手術手順中エネルギー消費を縮小
でき、こうして、手順中器械の操作と制御が改良され
る。新内視鏡システムは、触覚フィードバックの損失を
補償するために、外科医へのフィードバックを検出す
る。新内視鏡システムの設計の中には、外科医に器械に
関する相当な知識を提供するものもある。例えば、外科
医は、手順において器械の位置、器械の動作に関して通
知される。すなわち、活動化される位置にあるか、正し
く活動化されるか、等である。
ステムは、内視鏡器械の活動部分又は作業頭部の操作に
おいて高程度の制御を提供するシステムである。さら
に、新システムは、外科手術手順中、内視鏡器械の頭部
に対するアクセスを拡張する。新内視鏡システムは、外
科手術手順中、器械の頭部を安定な制御下に維持しなが
ら、頭部に加えられるより大きな力を許容する。新内視
鏡システムは、可処分であり、そして可処分でありなが
ら、設計により、かなりの費用削減をなす。新システム
では、外科医は、外科手術手順中エネルギー消費を縮小
でき、こうして、手順中器械の操作と制御が改良され
る。新内視鏡システムは、触覚フィードバックの損失を
補償するために、外科医へのフィードバックを検出す
る。新内視鏡システムの設計の中には、外科医に器械に
関する相当な知識を提供するものもある。例えば、外科
医は、手順において器械の位置、器械の動作に関して通
知される。すなわち、活動化される位置にあるか、正し
く活動化されるか、等である。
【０００８】最も広い意味において、新内視鏡システム
は、内視鏡手順において一段階を行う際に使用される器
械を具備する。その器械には、手順において所望の段階
を行うために器械の活動又は作業頭部を動作させる適切
なパワー手段が連結される。器械はまた、手順において
所望の段階を行う間、器械の動作を制御及び／又は監視
し、かつ、外科医にフィードバック情報を設ける検出手
段を含む。本発明により、内視鏡手順において一段階を
実施するために頭部を有する内視鏡器械が設けられる。
段階は、組織の結紮、ステープル留め、切断、処理等、
あるいはこれらの段階の組み合わせである。この頭部に
は、軸が連結される。器械は、軸により又は通して頭部
にエネルギーを加えるための手段を含む。本発明の好ま
しい実施態様において、軸は、ハウジングに入れられ、
そして軸に動作が与えられる。すなわち、回転、縦移動
等である。手順における所望の段階を実施するために、
すなわち、ステープルを設定形成し、又は管を結紮し、
又は組織を切断する等のために、軸の動作を頭部におけ
る適切な力及び／又は動作に変換する手段が、器械の頭
部において配設される。また、頭部において、頭部のエ
ネルギー、力又は動作を測定する検出手段が配設され
る。ある場合には、検出手段は、それが作用する組織又
は周辺組織の一つ以上の物理的パラメータを測定する。
検出手段には、頭部のエネルギー、力及び／又は動作を
制御する手段が相互連結される。
は、内視鏡手順において一段階を行う際に使用される器
械を具備する。その器械には、手順において所望の段階
を行うために器械の活動又は作業頭部を動作させる適切
なパワー手段が連結される。器械はまた、手順において
所望の段階を行う間、器械の動作を制御及び／又は監視
し、かつ、外科医にフィードバック情報を設ける検出手
段を含む。本発明により、内視鏡手順において一段階を
実施するために頭部を有する内視鏡器械が設けられる。
段階は、組織の結紮、ステープル留め、切断、処理等、
あるいはこれらの段階の組み合わせである。この頭部に
は、軸が連結される。器械は、軸により又は通して頭部
にエネルギーを加えるための手段を含む。本発明の好ま
しい実施態様において、軸は、ハウジングに入れられ、
そして軸に動作が与えられる。すなわち、回転、縦移動
等である。手順における所望の段階を実施するために、
すなわち、ステープルを設定形成し、又は管を結紮し、
又は組織を切断する等のために、軸の動作を頭部におけ
る適切な力及び／又は動作に変換する手段が、器械の頭
部において配設される。また、頭部において、頭部のエ
ネルギー、力又は動作を測定する検出手段が配設され
る。ある場合には、検出手段は、それが作用する組織又
は周辺組織の一つ以上の物理的パラメータを測定する。
検出手段には、頭部のエネルギー、力及び／又は動作を
制御する手段が相互連結される。
【０００９】本発明は、発明の説明に関連して取られた
添付の図面を参照することにより次の説明においてさら
に明確に理解されるであろう。
添付の図面を参照することにより次の説明においてさら
に明確に理解されるであろう。
【００１０】
【実施例】図面を参照すると、図１において、本発明に
よる内視鏡システムの斜視図が示される。この図におい
て、内視鏡ステープル留め及び切断装置３０は、コント
ローラ３１とビデオ表示モニター３２に相互連結してあ
る。コントローラは、マイクロプロセッサー、電源、配
線論理、センサーインターフェース及びモニター駆動回
路を含む。器械は、コントローラに連結してあり、その
結果コントローラは、データを受信し、記憶し、処理
し、かつ提示する。コントローラは、器械を動作させる
ために、適切な信号を器械に帰還させる。コントローラ
はまた、適切なレベル、周波数、タイミング等において
パワーを器械に供給するために作用する。コントローラ
内に、重要な器械機能を制御する配線論理回路がある。
また、電圧、電流、パワー等を測定するために、検出回
路がコントローラに組み込まれる。コントローラはま
た、表示画面を含み、器械から受信したデータを提示
し、所望の方式でそれを処理する。
よる内視鏡システムの斜視図が示される。この図におい
て、内視鏡ステープル留め及び切断装置３０は、コント
ローラ３１とビデオ表示モニター３２に相互連結してあ
る。コントローラは、マイクロプロセッサー、電源、配
線論理、センサーインターフェース及びモニター駆動回
路を含む。器械は、コントローラに連結してあり、その
結果コントローラは、データを受信し、記憶し、処理
し、かつ提示する。コントローラは、器械を動作させる
ために、適切な信号を器械に帰還させる。コントローラ
はまた、適切なレベル、周波数、タイミング等において
パワーを器械に供給するために作用する。コントローラ
内に、重要な器械機能を制御する配線論理回路がある。
また、電圧、電流、パワー等を測定するために、検出回
路がコントローラに組み込まれる。コントローラはま
た、表示画面を含み、器械から受信したデータを提示
し、所望の方式でそれを処理する。
【００１１】図２において、図１に描かれた内視鏡器械
の斜視図が示される。器械は、取っ手部４０を有する。
取っ手部から軸部分４１が延在しており、軸部分の端部
に、器械の所望の頭部又は作業部４２がある。頭部又は
作業部は、組織の結紮、ステープル留め、切断、又は操
作、あるいはそのような段階の組み合わせで、外科手術
手順において一段階を達成する器械の部分である。器械
の頭部及び軸部分は、内視鏡検査法において非常に公知
な如く、套管針の套管を通して適用される如く構成され
る。
の斜視図が示される。器械は、取っ手部４０を有する。
取っ手部から軸部分４１が延在しており、軸部分の端部
に、器械の所望の頭部又は作業部４２がある。頭部又は
作業部は、組織の結紮、ステープル留め、切断、又は操
作、あるいはそのような段階の組み合わせで、外科手術
手順において一段階を達成する器械の部分である。器械
の頭部及び軸部分は、内視鏡検査法において非常に公知
な如く、套管針の套管を通して適用される如く構成され
る。
【００１２】図２〜図９に描かれた実施態様において、
頭部は、直線ステープラ及びカッターである。すなわ
ち、頭部は、ステープルを行においてオフセットさせ
て、ステープルの平行な並列行を配列させている。器械
はまた、ステープルの２つの隣接平行行の間を通過させ
てナイフを動作させる。そのような器械は、組織をステ
ープルで留め、ステープルで留められた部分の間の組織
を切断する。そのような器械は、腸と肺の切除の如く、
いろいろな形式の外科手術手順において使用される。
頭部は、直線ステープラ及びカッターである。すなわ
ち、頭部は、ステープルを行においてオフセットさせ
て、ステープルの平行な並列行を配列させている。器械
はまた、ステープルの２つの隣接平行行の間を通過させ
てナイフを動作させる。そのような器械は、組織をステ
ープルで留め、ステープルで留められた部分の間の組織
を切断する。そのような器械は、腸と肺の切除の如く、
いろいろな形式の外科手術手順において使用される。
【００１３】図３は、図２に描かれた器械の取っ手部の
拡大縦断面図である。この実施態様において、取っ手部
は、歯車箱４６に取り付けた小型直流モーターを含む。
歯車箱から回転駆動軸が延在している。回転駆動軸は、
取っ手のほぼ長さに延在している。また、モーターによ
って設けられるパワー供給を制御するために、適切なオ
ン／オフスイッチ４８とスイッチ４９が取っ手に包含さ
れ、直流モーターと相互連結してある。また、所望なら
ば、ビデオ表示スイッチを取っ手に設けても良い。この
実施態様においてモーター自体が取っ手に包含される
が、モーターは、適切な連結部で器械から分離され、そ
の結果、各種の器械が脱着可能なモーター又はパワー供
給で使用されることが認められる。また、器械がデータ
を受け入れ、記憶し、かつ処理するためにコントローラ
と相互連結されたならば、モーターは、コントローラに
連結され、そして電流入力、パワー出力、電圧の如く情
報と他のパラメータが、適切な方法における処理、表示
及び使用のために、コントローラによって監視される。
拡大縦断面図である。この実施態様において、取っ手部
は、歯車箱４６に取り付けた小型直流モーターを含む。
歯車箱から回転駆動軸が延在している。回転駆動軸は、
取っ手のほぼ長さに延在している。また、モーターによ
って設けられるパワー供給を制御するために、適切なオ
ン／オフスイッチ４８とスイッチ４９が取っ手に包含さ
れ、直流モーターと相互連結してある。また、所望なら
ば、ビデオ表示スイッチを取っ手に設けても良い。この
実施態様においてモーター自体が取っ手に包含される
が、モーターは、適切な連結部で器械から分離され、そ
の結果、各種の器械が脱着可能なモーター又はパワー供
給で使用されることが認められる。また、器械がデータ
を受け入れ、記憶し、かつ処理するためにコントローラ
と相互連結されたならば、モーターは、コントローラに
連結され、そして電流入力、パワー出力、電圧の如く情
報と他のパラメータが、適切な方法における処理、表示
及び使用のために、コントローラによって監視される。
【００１４】図４、図４ａと図４ｂの断面図に描かれた
如く、モーター軸５０は、歯車箱４６の中心に延びてい
る。歯車箱は、２つのセットの歯車５１と５２を具備
し、３６：１の比率又は所望ならば他の減速比において
モーターに関する軸４７の回転を減少させる。
如く、モーター軸５０は、歯車箱４６の中心に延びてい
る。歯車箱は、２つのセットの歯車５１と５２を具備
し、３６：１の比率又は所望ならば他の減速比において
モーターに関する軸４７の回転を減少させる。
【００１５】図５を参照すると、図２に示された器械の
軸部分の拡大縦断面図が示される。この実施態様におい
て、軸ハウジング６０はたわみ性である。ハウジングの
中心を通って、回転し、軸方向たわみ性で、ねじれ剛性
の軸６１が延在している。ハウジングは、器械の取っ手
を器械の頭部に連結し、そしてたわみ軸は駆動軸４７に
連結される。
軸部分の拡大縦断面図が示される。この実施態様におい
て、軸ハウジング６０はたわみ性である。ハウジングの
中心を通って、回転し、軸方向たわみ性で、ねじれ剛性
の軸６１が延在している。ハウジングは、器械の取っ手
を器械の頭部に連結し、そしてたわみ軸は駆動軸４７に
連結される。
【００１６】図６〜図１０は、図２に描かれた器械の頭
部の拡大縦断面図である。図は、組織に配置される前の
開位置（図６）、発射準備のできた閉位置（図７）、発
射作用中（図８）、発射作用の完了後（図９）及び器械
が除去される最終開位置（図１０）において器械の頭部
を描く。これらの図において、同様の部分は同一の番号
で識別される。頭部のハウジング７０は、圧入又は超音
波溶接又は他の類似手段により、軸ハウジング６０に適
切に連結してある。ねじ棒７１が頭部のほぼ長さに延在
していて、回転軸６１に連結してある。ねじ棒は、軸６
１に隣接した大直径部分７２とねじ棒の残部のための小
直径部分７３を有する。頭部は、ステープル又はステー
プルカートリッジ部７４とアンビル部７５を含む。ステ
ープル部とアンビル部は、アンビル旋回ピン７６により
相互に旋回可能に連結してある。ねじ棒の大直径部分に
は、クロージャーナット７７が取り付けられ、クロージ
ャーナット７７からは、頭部の旋回アンビル部に配設し
たスロット７９において移動するクロージャーピン７８
が延在している。たわみ軸が回転される時、ねじ棒がま
た回転され、そして回転により、クロージャーナット
は、ねじ棒を下降させ、クロージャースロットにおいて
クロージャーピンを移動させて、器械の頭部のステープ
ル部に対してアンビル部を閉じる。開位置において、処
置又は処理される組織は、器械の頭部のアンビル部とス
テープル部の間に置かれる。パワーが、軸とねじ棒を回
転させるためにたわみ軸に印加され、アンビル部を閉鎖
させる。認められる如く、旋回ピンの回りでアンビル部
を旋回させるために必要なトルク量が検出され、アンビ
ル部とステープル部の間の組織の厚さが決定される。コ
ントローラが、この情報を処理し、閉鎖により、器械の
頭部のアンビル部とステープル部の間に適切な量の組織
があるか、又は組織が過多又は過少であり、器械を再操
作するかを外科医に通知することは簡単な事である。一
定電圧駆動に対して、器械を閉鎖するために必要な力
が、モーター電流を監視することにより測定される。器
械に送り出されたパワーは、可変負荷により一定モータ
ー速度を達成するために、可変モーター電圧及び／又は
電流によって制御される。
部の拡大縦断面図である。図は、組織に配置される前の
開位置（図６）、発射準備のできた閉位置（図７）、発
射作用中（図８）、発射作用の完了後（図９）及び器械
が除去される最終開位置（図１０）において器械の頭部
を描く。これらの図において、同様の部分は同一の番号
で識別される。頭部のハウジング７０は、圧入又は超音
波溶接又は他の類似手段により、軸ハウジング６０に適
切に連結してある。ねじ棒７１が頭部のほぼ長さに延在
していて、回転軸６１に連結してある。ねじ棒は、軸６
１に隣接した大直径部分７２とねじ棒の残部のための小
直径部分７３を有する。頭部は、ステープル又はステー
プルカートリッジ部７４とアンビル部７５を含む。ステ
ープル部とアンビル部は、アンビル旋回ピン７６により
相互に旋回可能に連結してある。ねじ棒の大直径部分に
は、クロージャーナット７７が取り付けられ、クロージ
ャーナット７７からは、頭部の旋回アンビル部に配設し
たスロット７９において移動するクロージャーピン７８
が延在している。たわみ軸が回転される時、ねじ棒がま
た回転され、そして回転により、クロージャーナット
は、ねじ棒を下降させ、クロージャースロットにおいて
クロージャーピンを移動させて、器械の頭部のステープ
ル部に対してアンビル部を閉じる。開位置において、処
置又は処理される組織は、器械の頭部のアンビル部とス
テープル部の間に置かれる。パワーが、軸とねじ棒を回
転させるためにたわみ軸に印加され、アンビル部を閉鎖
させる。認められる如く、旋回ピンの回りでアンビル部
を旋回させるために必要なトルク量が検出され、アンビ
ル部とステープル部の間の組織の厚さが決定される。コ
ントローラが、この情報を処理し、閉鎖により、器械の
頭部のアンビル部とステープル部の間に適切な量の組織
があるか、又は組織が過多又は過少であり、器械を再操
作するかを外科医に通知することは簡単な事である。一
定電圧駆動に対して、器械を閉鎖するために必要な力
が、モーター電流を監視することにより測定される。器
械に送り出されたパワーは、可変負荷により一定モータ
ー速度を達成するために、可変モーター電圧及び／又は
電流によって制御される。
【００１７】器械のステープル保持部において、除去可
能なステープルカートリッジ８０が取り付けてある。カ
ートリッジは、４行のステープル８１を保持する。行
は、平行であり、隣接行において、ステープルは、技術
において非常に公知な如くオフセットされる。カートリ
ッジは、器械のアンビル部に対向する如く配置され、図
示の如く器械のステープル保持部に嵌入する。図に描か
れた如く、ねじ棒の小直径部分が器械のステープル部の
長さに延在している。この棒において、棒が回転する時
棒に沿って移動するように、相互連結されたナイフ部材
８２と駆動くさび部材８３が取り付けてある。くさび部
材は、ねじ棒に沿って移動する時、ナイフ部材に先行す
る。くさび部材がねじ棒を下降させる時、それは個別の
ステープルドライバー８４を介して、カートリッジから
ステープルを駆動する。ステープルは、組織を通過し、
アンビルに突き当たり、組織においてステープルを形成
する。駆動くさびに続くナイフ８２は、ステープルの隣
接行の間で組織を切断する。駆動くさびは、実際に２片
である。すなわち、ナイフの一方の側においてステープ
ルを駆動するためにナイフの一方の側における一くさび
片と、ナイフの反対側においてステープルを駆動するた
めにナイフの反対側における同様のくさび片である。
能なステープルカートリッジ８０が取り付けてある。カ
ートリッジは、４行のステープル８１を保持する。行
は、平行であり、隣接行において、ステープルは、技術
において非常に公知な如くオフセットされる。カートリ
ッジは、器械のアンビル部に対向する如く配置され、図
示の如く器械のステープル保持部に嵌入する。図に描か
れた如く、ねじ棒の小直径部分が器械のステープル部の
長さに延在している。この棒において、棒が回転する時
棒に沿って移動するように、相互連結されたナイフ部材
８２と駆動くさび部材８３が取り付けてある。くさび部
材は、ねじ棒に沿って移動する時、ナイフ部材に先行す
る。くさび部材がねじ棒を下降させる時、それは個別の
ステープルドライバー８４を介して、カートリッジから
ステープルを駆動する。ステープルは、組織を通過し、
アンビルに突き当たり、組織においてステープルを形成
する。駆動くさびに続くナイフ８２は、ステープルの隣
接行の間で組織を切断する。駆動くさびは、実際に２片
である。すなわち、ナイフの一方の側においてステープ
ルを駆動するためにナイフの一方の側における一くさび
片と、ナイフの反対側においてステープルを駆動するた
めにナイフの反対側における同様のくさび片である。
【００１８】アンビル部７５が図７に示された如く閉じ
られる時、クロージャーナット７７は、止め部材８５を
前方に移動させ、その結果、ナット８２とくさび８３が
配設された発射ナット８６は前方に移動され、棒に沿っ
て前方に移動するねじ棒の小直径部分７３のねじ部に係
合し、ステープル８１を駆動し、組織を切断する。発射
ナット８６は、止め部材８５が作動されるまで、ねじ棒
に係合しないように、適切な手段を使用して偏向され
る。いったん発射ナットが、ステープルのすべてを駆動
形成し、組織を切断するためにその最前方位置まで移動
したならば、それは適切な接点８７に係合し、即座にモ
ーターを逆転させ、発射ナットは引込められる。完全引
込み位置において、発射ナット８６は、止め部材８５を
後方に移動させ、クロージャーナット７７を引込めさ
せ、器械の頭部のアンビル部７５を開放させる。別の構
成は、器械の取っ手部において接点を設置し、位置監視
のために回転軸におけるフォロワナットを使用するもの
である。頭部又は作業端部をできる限り小さく維持しな
がら、手順において所望の段階をなお達成する如く、器
械の取っ手部においてできる限り多くの接点とセンサー
を設置することが望ましいことが指摘される。器械の頭
部と軸をできる限り小さく維持することにより、器械を
挿入するために必要な患者の開口が、小さく保持され、
こうして、内視鏡手順の利点を高める。認められる如
く、各種の情報が、器械の動作中伝達される。例えば、
移動のために、発射ナットをねじ棒に押しつける止め部
材の移動が検出される。くさびとナイフの最前方位置が
検出される。また、モーターの逆転が、アンビル部等を
開放するための止め部材の移動とともに、検出される。
さらに、所望ならば、カートリッジの存在とそのカート
リッジにおけるステープルの存在もまた検出される。こ
の情報のすべては、コントローラに帰還され、記憶さ
れ、制御部において処理され、その結果、器械を使用す
る外科医は、ステープルの配置、組織の切断、カートリ
ッジにおけるステープルの存在、等に関する情報を即座
に受け取る。
られる時、クロージャーナット７７は、止め部材８５を
前方に移動させ、その結果、ナット８２とくさび８３が
配設された発射ナット８６は前方に移動され、棒に沿っ
て前方に移動するねじ棒の小直径部分７３のねじ部に係
合し、ステープル８１を駆動し、組織を切断する。発射
ナット８６は、止め部材８５が作動されるまで、ねじ棒
に係合しないように、適切な手段を使用して偏向され
る。いったん発射ナットが、ステープルのすべてを駆動
形成し、組織を切断するためにその最前方位置まで移動
したならば、それは適切な接点８７に係合し、即座にモ
ーターを逆転させ、発射ナットは引込められる。完全引
込み位置において、発射ナット８６は、止め部材８５を
後方に移動させ、クロージャーナット７７を引込めさ
せ、器械の頭部のアンビル部７５を開放させる。別の構
成は、器械の取っ手部において接点を設置し、位置監視
のために回転軸におけるフォロワナットを使用するもの
である。頭部又は作業端部をできる限り小さく維持しな
がら、手順において所望の段階をなお達成する如く、器
械の取っ手部においてできる限り多くの接点とセンサー
を設置することが望ましいことが指摘される。器械の頭
部と軸をできる限り小さく維持することにより、器械を
挿入するために必要な患者の開口が、小さく保持され、
こうして、内視鏡手順の利点を高める。認められる如
く、各種の情報が、器械の動作中伝達される。例えば、
移動のために、発射ナットをねじ棒に押しつける止め部
材の移動が検出される。くさびとナイフの最前方位置が
検出される。また、モーターの逆転が、アンビル部等を
開放するための止め部材の移動とともに、検出される。
さらに、所望ならば、カートリッジの存在とそのカート
リッジにおけるステープルの存在もまた検出される。こ
の情報のすべては、コントローラに帰還され、記憶さ
れ、制御部において処理され、その結果、器械を使用す
る外科医は、ステープルの配置、組織の切断、カートリ
ッジにおけるステープルの存在、等に関する情報を即座
に受け取る。
【００１９】図１１〜図１６を参照すると、本発明の内
視鏡結紮システムが描かれる。結紮器は、適切なオン／
オフ８１及びパワー制御８２スイッチを有する取っ手部
８０を具備する。中空円形ケーシング８３が、取っ手部
から延在しており、クリップ適用頭部８４が、円形ケー
シングの反対端部に配設してある。図１２にさらに明確
に示された如く、取っ手部において、回転駆動軸８５が
ある。取っ手の後部における駆動軸の一方の端部は、直
流モーター又は他の適切なパワー手段に連結するための
連結部８６を含む。駆動軸の反対端部は、ねじ部８７で
ある。駆動軸のねじ部は、縦可動棒８９のねじ端部８８
に係合する。棒は、縦伸長軸９０に連結してある。軸
は、器械の取っ手から頭部又は作業端部に器械のほぼ全
長延在している。駆動軸８７が回転される時、棒８９と
縦伸長軸９０は、前方に移動し、そして駆動軸の回転が
逆転される時、棒と縦伸長軸は引込められる。
視鏡結紮システムが描かれる。結紮器は、適切なオン／
オフ８１及びパワー制御８２スイッチを有する取っ手部
８０を具備する。中空円形ケーシング８３が、取っ手部
から延在しており、クリップ適用頭部８４が、円形ケー
シングの反対端部に配設してある。図１２にさらに明確
に示された如く、取っ手部において、回転駆動軸８５が
ある。取っ手の後部における駆動軸の一方の端部は、直
流モーター又は他の適切なパワー手段に連結するための
連結部８６を含む。駆動軸の反対端部は、ねじ部８７で
ある。駆動軸のねじ部は、縦可動棒８９のねじ端部８８
に係合する。棒は、縦伸長軸９０に連結してある。軸
は、器械の取っ手から頭部又は作業端部に器械のほぼ全
長延在している。駆動軸８７が回転される時、棒８９と
縦伸長軸９０は、前方に移動し、そして駆動軸の回転が
逆転される時、棒と縦伸長軸は引込められる。
【００２０】図１３に示された如く、縦伸長軸が、適切
な支持管１１５に取り付けてある。軸は、縦可動カム溝
形材１１２、密閉部材１１３、密閉部材に対向した床１
１０、送りバー９９、端部キャップ１１４、及び結紮ク
リップを保持するための軌道９８を具備する。カム溝形
材内に器械のあご１１１が装着される。動作において、
カム溝形材が前方移動される時、それはあごを包囲し、
閉鎖させ、あごに配設されたクリップを閉じる。駆動軸
８７が逆転された時、溝形材は引込み、あごは開く。ま
た、軸には、軌道９８に保持したクリップ９７のマガジ
ン又はスタックが包含される。軌道はまた、フィーダー
バネ９４、ロックレバー９５と送りシュー９６を保持し
ている。クリップは、バネ９４によって送りバー９９の
経路に位置付けられる。リフタバネ９３は、囲い板９２
によってクリップ軌道９８上の適所に保持され、あごの
位置への送りバーの平面にマガジンの第１クリップを配
置するために作用する。器械のこの部分の動作は、図１
４、図１５と図１６において最良に見られる。カム溝形
材１１２が前方に推進される時、それはあご１１１の外
面に係合し、あごを相互に押し合わせ、組織１２１の回
りでクリップ１２０を閉じる。カム溝形材が引込む時、
あごは開く。クリップマガジン９７は、前進され、そし
て別のクリップがあご内に配置される。これは、バネ９
４が解放される時行われ、、送りシューは、バネによっ
て送りシューの経路に位置付けられた次クリップをクリ
ップのスタックから前進させ、その結果、別のクリップ
が配置される。あごにおける適切な検出手段１２３と１
２４は、あごに適切なクリップがあるか否か、クリップ
が適切に閉鎖されるか否か、そしてクリップのスタック
が空であるかを決定する。この情報のすべては、コント
ローラに帰還され、記憶され、処理され、適切な情報が
器械の操作者に報告される。
な支持管１１５に取り付けてある。軸は、縦可動カム溝
形材１１２、密閉部材１１３、密閉部材に対向した床１
１０、送りバー９９、端部キャップ１１４、及び結紮ク
リップを保持するための軌道９８を具備する。カム溝形
材内に器械のあご１１１が装着される。動作において、
カム溝形材が前方移動される時、それはあごを包囲し、
閉鎖させ、あごに配設されたクリップを閉じる。駆動軸
８７が逆転された時、溝形材は引込み、あごは開く。ま
た、軸には、軌道９８に保持したクリップ９７のマガジ
ン又はスタックが包含される。軌道はまた、フィーダー
バネ９４、ロックレバー９５と送りシュー９６を保持し
ている。クリップは、バネ９４によって送りバー９９の
経路に位置付けられる。リフタバネ９３は、囲い板９２
によってクリップ軌道９８上の適所に保持され、あごの
位置への送りバーの平面にマガジンの第１クリップを配
置するために作用する。器械のこの部分の動作は、図１
４、図１５と図１６において最良に見られる。カム溝形
材１１２が前方に推進される時、それはあご１１１の外
面に係合し、あごを相互に押し合わせ、組織１２１の回
りでクリップ１２０を閉じる。カム溝形材が引込む時、
あごは開く。クリップマガジン９７は、前進され、そし
て別のクリップがあご内に配置される。これは、バネ９
４が解放される時行われ、、送りシューは、バネによっ
て送りシューの経路に位置付けられた次クリップをクリ
ップのスタックから前進させ、その結果、別のクリップ
が配置される。あごにおける適切な検出手段１２３と１
２４は、あごに適切なクリップがあるか否か、クリップ
が適切に閉鎖されるか否か、そしてクリップのスタック
が空であるかを決定する。この情報のすべては、コント
ローラに帰還され、記憶され、処理され、適切な情報が
器械の操作者に報告される。
【００２１】直線ステープラ／カッター器械と結紮クリ
ップ適用器を特に参照して新システムを記載したが、も
ちろん、他の内視鏡器械でも使用される。例えば、新シ
ステムは、電気焼灼器械を制御するために使用される。
新システムは、そのような器械の作動とともに、焼灼器
械で使用される灌注と吸引を制御するために使用され
る。
ップ適用器を特に参照して新システムを記載したが、も
ちろん、他の内視鏡器械でも使用される。例えば、新シ
ステムは、電気焼灼器械を制御するために使用される。
新システムは、そのような器械の作動とともに、焼灼器
械で使用される灌注と吸引を制御するために使用され
る。
【００２２】前実施態様のすべてにおいて、検出機構
が、器械の動作を検出し、適切な組織が適切な位置にあ
るか、等を検出するために使用された。器械はまた、周
囲環境の物理パラメータを検出するように設計されるこ
とが認められる。例えば、それらは、血液酸素含有量を
検出し、あるいは隣接組織の組織濃度又は隣接組織の多
様な鬱血特性等を使用しても良い。
が、器械の動作を検出し、適切な組織が適切な位置にあ
るか、等を検出するために使用された。器械はまた、周
囲環境の物理パラメータを検出するように設計されるこ
とが認められる。例えば、それらは、血液酸素含有量を
検出し、あるいは隣接組織の組織濃度又は隣接組織の多
様な鬱血特性等を使用しても良い。
【００２３】図１７において、隣接組織の血液酸素含有
量を検出するために使用される検出部材を含む器械の頭
部が描かれる。この実施態様において、器械は、直線ス
テープル留め器械であるが、他の器械もまた、この実施
態様において包含されることが意図される。図１７は、
そのような器械の頭部又は作業端部１６０を描く。頭部
は、ステープル又はステープルカートリッジ保持部材１
６１と、図６に関連して描かれ記載されたものに類似す
る旋回式アンビル部材１６２とを具備する。発光ダイオ
ード（ＬＥＤ）１６３とフォトトランジスタ受信器１６
４が、ステープル保持部材に配設してある。トランジス
タ受信器は、一つ以上のフォトトランジスタと適切な抵
抗器を具備する。処理対象組織がステープル部材とアン
ビル部材の間に置かれる時、電気パルスが、ＬＥＤに印
加され、ＬＥＤは発光する。発光は、組織に接触し、そ
して組織の特性により、光の一部は、組織からフォトト
ランジスタに反射され、これにより、受信光信号に正比
例する電気信号を生成する。フォトトランジスタに打ち
当たる光量は、測定され、酸素含有量の如く組織の所望
の特性に相関される。光電信号変換を介した組織穿通の
間接測定は、器械の所望の動作を制御するために使用さ
れる。制御される動作は、アンビル部材の開放と閉鎖及
び／又はステープルの発射である。これは、光測定値を
器械の動作用パワー供給を制御するコントローラに送る
ことにより達成される。また、この情報は、ビデオ表示
装置を介して外科医に供給される。外科医は、器械の適
正な位置付け又は他の手順関連操作を決定するためにこ
の情報を使用する。
量を検出するために使用される検出部材を含む器械の頭
部が描かれる。この実施態様において、器械は、直線ス
テープル留め器械であるが、他の器械もまた、この実施
態様において包含されることが意図される。図１７は、
そのような器械の頭部又は作業端部１６０を描く。頭部
は、ステープル又はステープルカートリッジ保持部材１
６１と、図６に関連して描かれ記載されたものに類似す
る旋回式アンビル部材１６２とを具備する。発光ダイオ
ード（ＬＥＤ）１６３とフォトトランジスタ受信器１６
４が、ステープル保持部材に配設してある。トランジス
タ受信器は、一つ以上のフォトトランジスタと適切な抵
抗器を具備する。処理対象組織がステープル部材とアン
ビル部材の間に置かれる時、電気パルスが、ＬＥＤに印
加され、ＬＥＤは発光する。発光は、組織に接触し、そ
して組織の特性により、光の一部は、組織からフォトト
ランジスタに反射され、これにより、受信光信号に正比
例する電気信号を生成する。フォトトランジスタに打ち
当たる光量は、測定され、酸素含有量の如く組織の所望
の特性に相関される。光電信号変換を介した組織穿通の
間接測定は、器械の所望の動作を制御するために使用さ
れる。制御される動作は、アンビル部材の開放と閉鎖及
び／又はステープルの発射である。これは、光測定値を
器械の動作用パワー供給を制御するコントローラに送る
ことにより達成される。また、この情報は、ビデオ表示
装置を介して外科医に供給される。外科医は、器械の適
正な位置付け又は他の手順関連操作を決定するためにこ
の情報を使用する。
【００２４】図１８は、本発明によるシステムの一形式
を簡略ブロック図で描く。この実施態様において、内視
鏡器械は、ステープラ及びカッター２００である。器械
の状態といろいろなメッセージが、内視鏡ビデオカメラ
２０１とモニターシステム２０２とのインターフェース
により使用者に通信される。システムはまた、器械マイ
クロプロセッサー／コントローラ２０３を含む。内視鏡
器械は、直流モーター２０４によってパワーを供給さ
れ、ケーブル２０５によってコントローラに連結され
る。コントローラは、マイクロプロセッサーに基づき、
検出回路、モーター制御、センサーインターフェース、
ビデオインターフェースと電源を含む。器械は、使用パ
ワー及び／又は力を検出する小型センサーと、所定位置
においてモーターをオン／オフするためのリミットスイ
ッチと接点を含む。リミットスイッチはまた、器械にお
いて使用される各種のインターロックを検出するために
使用される。器械はまた、カートリッジに対するアンビ
ルの位置と、ステープルがカートリッジに存在するかを
決定するためのセンサーを含む。すべてのセンサー、ス
イッチとモーターは、インターフェースケーブル２０５
を介して、コントローラに連結される。適切なコントロ
ーラに送り込まれた情報は、記憶され、処理され、かつ
中央処理通信システムに送られる。ある情報は、配線回
路で直接処理される。可能な時は常にコントローラの配
線論理に決定的な器械機能を組み込むことが望ましいこ
とに注目することは重要である。その時、コントローラ
は、非決定的な機能と情報処理のために使用される。処
理操作情報は、ビデオ表示画面及び／又は適切な文字又
は音声表示機構に送られる。情報はまた、器械機能の一
部又はすべてを制御するために器械コントローラに帰還
される。
を簡略ブロック図で描く。この実施態様において、内視
鏡器械は、ステープラ及びカッター２００である。器械
の状態といろいろなメッセージが、内視鏡ビデオカメラ
２０１とモニターシステム２０２とのインターフェース
により使用者に通信される。システムはまた、器械マイ
クロプロセッサー／コントローラ２０３を含む。内視鏡
器械は、直流モーター２０４によってパワーを供給さ
れ、ケーブル２０５によってコントローラに連結され
る。コントローラは、マイクロプロセッサーに基づき、
検出回路、モーター制御、センサーインターフェース、
ビデオインターフェースと電源を含む。器械は、使用パ
ワー及び／又は力を検出する小型センサーと、所定位置
においてモーターをオン／オフするためのリミットスイ
ッチと接点を含む。リミットスイッチはまた、器械にお
いて使用される各種のインターロックを検出するために
使用される。器械はまた、カートリッジに対するアンビ
ルの位置と、ステープルがカートリッジに存在するかを
決定するためのセンサーを含む。すべてのセンサー、ス
イッチとモーターは、インターフェースケーブル２０５
を介して、コントローラに連結される。適切なコントロ
ーラに送り込まれた情報は、記憶され、処理され、かつ
中央処理通信システムに送られる。ある情報は、配線回
路で直接処理される。可能な時は常にコントローラの配
線論理に決定的な器械機能を組み込むことが望ましいこ
とに注目することは重要である。その時、コントローラ
は、非決定的な機能と情報処理のために使用される。処
理操作情報は、ビデオ表示画面及び／又は適切な文字又
は音声表示機構に送られる。情報はまた、器械機能の一
部又はすべてを制御するために器械コントローラに帰還
される。
【００２５】図１９において、本発明のシステムにおい
て使用されるハードウェアの構成が描かれる。使用され
た特定の内視鏡器械からのセンサー入力から、制御論理
は、組織圧縮、位置と近接、電気特性、化学特性、温
度、等の事項について決定及び／又は作用を行う。
て使用されるハードウェアの構成が描かれる。使用され
た特定の内視鏡器械からのセンサー入力から、制御論理
は、組織圧縮、位置と近接、電気特性、化学特性、温
度、等の事項について決定及び／又は作用を行う。
【００２６】制御論理は、アナログ計算、ゲートアレイ
論理、配線組合せ論理、又は逐次埋込形マイクロプロセ
ッサー制御等、あるいは電気、機械、油圧又は空気論理
の組み合わせに基づく。
論理、配線組合せ論理、又は逐次埋込形マイクロプロセ
ッサー制御等、あるいは電気、機械、油圧又は空気論理
の組み合わせに基づく。
【００２７】図２０、２１は、図１８と図１９に関連し
て記載された上記の制御論理のための簡略流れ図であ
る。
て記載された上記の制御論理のための簡略流れ図であ
る。
【００２８】こうして、高度の制御と信頼性を具現し、
特定器械によって達成される作用の範囲を拡大すること
で、改良内視鏡手順を設ける改良内視鏡システムが記載
された。
特定器械によって達成される作用の範囲を拡大すること
で、改良内視鏡手順を設ける改良内視鏡システムが記載
された。
【００２９】発明が好ましい実施態様の実施例を通して
記載されたが、他の適合と修正が、発明の精神と範囲に
反することなく使用されるものである。
記載されたが、他の適合と修正が、発明の精神と範囲に
反することなく使用されるものである。
【００３０】本発明の主なる特徴及び態様は以下のとお
りである。
りである。
【００３１】１．内視鏡手順において使用されるシステ
ムにおいて、（ａ）手順において一段階を行う際に使用
される器械と、（ｂ）器械を動作させ、手順において該
段階を行うために、該器械にパワーを供給するための手
段と、（ｃ）該段階を行う際に器械の動作を監視制御す
るために、該器械に取り付けられた検出及び制御手段と
を具備するシステム。
ムにおいて、（ａ）手順において一段階を行う際に使用
される器械と、（ｂ）器械を動作させ、手順において該
段階を行うために、該器械にパワーを供給するための手
段と、（ｃ）該段階を行う際に器械の動作を監視制御す
るために、該器械に取り付けられた検出及び制御手段と
を具備するシステム。
【００３２】２．該器械形式を識別し、該識別を検出
し、該識別により器械の使用を制御するための手段を含
む上記１に記載のシステム。
し、該識別により器械の使用を制御するための手段を含
む上記１に記載のシステム。
【００３３】３．器械が、手順における段階中器械によ
って保持された組織にステープルを適用し、パワーを器
械に供給するための手段が、ステープルを組織に駆動す
るために使用され、そして検出手段が、器械におけるス
テープルの存在又は不在を決定する上記１に記載のシス
テム。
って保持された組織にステープルを適用し、パワーを器
械に供給するための手段が、ステープルを組織に駆動す
るために使用され、そして検出手段が、器械におけるス
テープルの存在又は不在を決定する上記１に記載のシス
テム。
【００３４】４．器械によって保持された組織の少なく
とも一つの特性を決定するための検出手段を含む上記１
に記載のシステム。
とも一つの特性を決定するための検出手段を含む上記１
に記載のシステム。
【００３５】５．器械が、手順における段階中器械によ
って保持された組織を切断するためのナイフを含み、器
械にパワーを供給するための手段が、器械によって保持
された組織を切断するためにナイフを動作させ、そして
検出手段が、器械におけるナイフの位置を決定する上記
１に記載のシステム。
って保持された組織を切断するためのナイフを含み、器
械にパワーを供給するための手段が、器械によって保持
された組織を切断するためにナイフを動作させ、そして
検出手段が、器械におけるナイフの位置を決定する上記
１に記載のシステム。
【００３６】６．組織厚を測定するための検出手段を含
む上記５に記載のシステム。
む上記５に記載のシステム。
【００３７】７．器械が、手順における段階中、管を結
紮するために使用される複数のクリップを適用し、器械
にパワーを供給するための手段が、管の回りにクリップ
を閉じさせ、そして検出手段が、器械におけるクリップ
の存在又は不在を決定する上記１に記載のシステム。
紮するために使用される複数のクリップを適用し、器械
にパワーを供給するための手段が、管の回りにクリップ
を閉じさせ、そして検出手段が、器械におけるクリップ
の存在又は不在を決定する上記１に記載のシステム。
【００３８】８．器械にパワーを供給するための手段
が、直流モーターである上記１に記載のシステム。
が、直流モーターである上記１に記載のシステム。
【００３９】９．直流モーターが器械に解放可能に連結
される上記８に記載のシステム。
される上記８に記載のシステム。
【００４０】１０．内視鏡手順において使用されるシス
テムにおいて、 ａ）手順において一段階を実施するための頭部と、取っ
手部と、該頭部と該取っ手部を連結する回転軸とを有す
る内視鏡器械と、 ｂ）該回転軸を回転させるための手段と、 ｃ）手順における段階を実施する際に使用される所望の
力に軸の回転動作を変換するために器械の頭部に配設し
た手段と、 ｄ）手順における段階を実施する際に使用される力を測
定するために該器械に取り付けた検出手段と、 ｅ）手順における段階を実施する間、器械の動作を制御
するために、該検出手段に相互連結した制御手段とを具
備するシステム。
テムにおいて、 ａ）手順において一段階を実施するための頭部と、取っ
手部と、該頭部と該取っ手部を連結する回転軸とを有す
る内視鏡器械と、 ｂ）該回転軸を回転させるための手段と、 ｃ）手順における段階を実施する際に使用される所望の
力に軸の回転動作を変換するために器械の頭部に配設し
た手段と、 ｄ）手順における段階を実施する際に使用される力を測
定するために該器械に取り付けた検出手段と、 ｅ）手順における段階を実施する間、器械の動作を制御
するために、該検出手段に相互連結した制御手段とを具
備するシステム。
【００４１】１１．該回転軸を回転させるための手段
が、直流モーターである上記１０に記載のシステム。
が、直流モーターである上記１０に記載のシステム。
【００４２】１２．直流モーターが器械に解放可能に連
結される上記１１に記載のシステム。
結される上記１１に記載のシステム。
【００４３】１３．該器械が、切断及びステープル留め
器械であり、そして該頭部が、ステープル保持部材と、
該ステープル保持部材の一方に旋回連結されたアンビル
部材とを具備する上記１０に記載のシステム。
器械であり、そして該頭部が、ステープル保持部材と、
該ステープル保持部材の一方に旋回連結されたアンビル
部材とを具備する上記１０に記載のシステム。
【００４４】１４．該回転軸を回転させるための手段
が、直流モーターである上記１３に記載のシステム。
が、直流モーターである上記１３に記載のシステム。
【００４５】１５．直流モーターが器械に解放可能に連
結される上記１３に記載のシステム。
結される上記１３に記載のシステム。
【００４６】１６．該器械が、切断及びステープル留め
器械であり、該頭部が、ステープル保持部材と、該ステ
ープル保持部材の一方に旋回連結されたアンビル部材と
を具備し、回転軸を回転させるための手段が、直流モー
ターであり、そして検出手段が、器械の頭部に配設さ
れ、該頭部と該アンビル部の間に置かれた組織の少なく
とも一つの特性を検出する上記１６に記載のシステム。
器械であり、該頭部が、ステープル保持部材と、該ステ
ープル保持部材の一方に旋回連結されたアンビル部材と
を具備し、回転軸を回転させるための手段が、直流モー
ターであり、そして検出手段が、器械の頭部に配設さ
れ、該頭部と該アンビル部の間に置かれた組織の少なく
とも一つの特性を検出する上記１６に記載のシステム。
【００４７】１７．該ステープル保持部材におけるステ
ープルの存在又は不在を検出するために、該頭部におい
て配設した検出手段を含む上記１２に記載のシステム。
ープルの存在又は不在を検出するために、該頭部におい
て配設した検出手段を含む上記１２に記載のシステム。
【００４８】１８．内視鏡手順において一段階を実施す
るための頭部と、該頭部に連結した軸と、動作を該軸に
適用するための手段と、手順における段階を実施するた
めに、軸に加えられた動作を頭部の適切な力及び／又は
動作に変換するために該頭部に配設した手段と、動作を
測定するために該頭部に配設した検出手段と、頭部の力
及び／又は動作の制御を行うために該検出手段に相互連
結した手段とを具備する内視鏡器械。
るための頭部と、該頭部に連結した軸と、動作を該軸に
適用するための手段と、手順における段階を実施するた
めに、軸に加えられた動作を頭部の適切な力及び／又は
動作に変換するために該頭部に配設した手段と、動作を
測定するために該頭部に配設した検出手段と、頭部の力
及び／又は動作の制御を行うために該検出手段に相互連
結した手段とを具備する内視鏡器械。
【００４９】１９．動作を軸に適用するための手段が、
直流モーターである上記１９に記載の器械。
直流モーターである上記１９に記載の器械。
【００５０】２０．直流モーターが器械に解放可能に連
結される上記１９に記載の器械。
結される上記１９に記載の器械。
【００５１】２１．器械が、管を閉じるために、複数の
結紮クリップを管に適用するためのクリップ適用器であ
る上記１８に記載の器械。
結紮クリップを管に適用するためのクリップ適用器であ
る上記１８に記載の器械。
【００５２】２２．頭部が、結紮クリップを保持するた
めの一対の対向あごを具備し、そして該頭部に配設した
検出手段が、あごが開放又は閉鎖される時を検出する上
記２１に記載の器械。
めの一対の対向あごを具備し、そして該頭部に配設した
検出手段が、あごが開放又は閉鎖される時を検出する上
記２１に記載の器械。
【００５３】２３．頭部が、結紮クリップを保持するた
めの一対の対向あごを具備し、そして該頭部に配設した
検出手段が、該あごにクリップがあるか否かを検出する
上記２１に記載の器械。
めの一対の対向あごを具備し、そして該頭部に配設した
検出手段が、該あごにクリップがあるか否かを検出する
上記２１に記載の器械。
【００５４】２４．内視鏡手順において使用されるステ
ープル留め器械において、頭部と、取っ手部と、該頭部
を該取っ手部に連結する連結部であり、該頭部が、ステ
ープルのカートリッジを保持するための手段と、該カー
トリッジからステープルを放出するための発射手段と、
該ステープルを形成するためのアンビル手段とを具備
し、該アンビル手段が、該カートリッジと該アンビル手
段の間に組織を配置させるために該カートリッジ保持手
段に関して配設される頭部と、取っ手部と連結部分と、
該連結部に配設した回転軸と、該回転軸の一方の端部に
配設した変換手段であり、カートリッジから該ステープ
ルを放出し、組織において該ステープルを形成するため
の力に軸の動作を変換するために該発射手段を該軸に連
結する変換手段と、該軸を回転させるために該回転軸の
他方の端部に配設した手段と、該カートリッジと該アン
ビル手段の間に配置した組織の物理的特性を検出するた
めに、該頭部に配設した第１検出手段と、ステープルを
放出し、形成するために必要な力を決定するための第２
検出手段と、ステープルの放出と形成を制御するため
に、該第１及び第２検出手段に相互連結した制御手段と
を具備するステープル留め器械。
ープル留め器械において、頭部と、取っ手部と、該頭部
を該取っ手部に連結する連結部であり、該頭部が、ステ
ープルのカートリッジを保持するための手段と、該カー
トリッジからステープルを放出するための発射手段と、
該ステープルを形成するためのアンビル手段とを具備
し、該アンビル手段が、該カートリッジと該アンビル手
段の間に組織を配置させるために該カートリッジ保持手
段に関して配設される頭部と、取っ手部と連結部分と、
該連結部に配設した回転軸と、該回転軸の一方の端部に
配設した変換手段であり、カートリッジから該ステープ
ルを放出し、組織において該ステープルを形成するため
の力に軸の動作を変換するために該発射手段を該軸に連
結する変換手段と、該軸を回転させるために該回転軸の
他方の端部に配設した手段と、該カートリッジと該アン
ビル手段の間に配置した組織の物理的特性を検出するた
めに、該頭部に配設した第１検出手段と、ステープルを
放出し、形成するために必要な力を決定するための第２
検出手段と、ステープルの放出と形成を制御するため
に、該第１及び第２検出手段に相互連結した制御手段と
を具備するステープル留め器械。
【００５５】２５．アンビル手段が、一方の端部におい
てステープルのカートリッジを保持するための手段に旋
回連結される上記２４に記載のステープル留め器械。
てステープルのカートリッジを保持するための手段に旋
回連結される上記２４に記載のステープル留め器械。
【００５６】２６．ステープルのカートリッジが、少な
くとも２行のステープル平行行を含む上記２４に記載の
ステープル留め器械。
くとも２行のステープル平行行を含む上記２４に記載の
ステープル留め器械。
【００５７】２７．頭部が、２行のステープルの間に往
復可動な切断手段を含む上記２６に記載のステープル留
め器械。
復可動な切断手段を含む上記２６に記載のステープル留
め器械。
【００５８】２８．器械の物理的特性を測定するために
該器械に配設した第３検出手段を含む上記２４に記載の
ステープル留め器械。
該器械に配設した第３検出手段を含む上記２４に記載の
ステープル留め器械。
【００５９】２９．アンビル手段が、一方の端部におい
てステープルのカートリッジを保持するための手段に旋
回連結され、ステープルのカートリッジが、少なくとも
２行のステープル平行行を含み、頭部が、切断手段を含
み、該切断手段が、ステープルの隣接行の間で可動なナ
イフを具備し、そして変換手段がまた、該ナイフを移動
させるために、軸の動作を力に変換する上記２４に記載
のステープル留め器械。
てステープルのカートリッジを保持するための手段に旋
回連結され、ステープルのカートリッジが、少なくとも
２行のステープル平行行を含み、頭部が、切断手段を含
み、該切断手段が、ステープルの隣接行の間で可動なナ
イフを具備し、そして変換手段がまた、該ナイフを移動
させるために、軸の動作を力に変換する上記２４に記載
のステープル留め器械。
【００６０】３０．ナイフの位置を決定するために該器
械に配設した第３検出手段を含む上記２９に記載のステ
ープル留め器械。
械に配設した第３検出手段を含む上記２９に記載のステ
ープル留め器械。
【００６１】３１．発射手段が直流モーターである上記
２４に記載のステープル留め器械。 ３２．直流モーターが、器械に解放可能に取り付けられ
る上記３１に記載のステープル留め器械。
２４に記載のステープル留め器械。 ３２．直流モーターが、器械に解放可能に取り付けられ
る上記３１に記載のステープル留め器械。
【図１】マイクロプロセッサー／コントローラとビデオ
表示画面に相互連結した、本発明の内視鏡外科システム
の略図である。
表示画面に相互連結した、本発明の内視鏡外科システム
の略図である。
【図２】本発明による内視鏡ステープル留め及び切断シ
ステムの斜視図である。
ステムの斜視図である。
【図３】本発明の内視鏡ステープル留め及び切断システ
ムの一実施態様の取っ手部の縦断面図である。
ムの一実施態様の取っ手部の縦断面図である。
【図４】歯車減速アセンブリの詳細図、線Ａ−Ａに沿っ
て取られた断面図、及び線Ｂ−Ｂに沿って取られた断面
図である。
て取られた断面図、及び線Ｂ−Ｂに沿って取られた断面
図である。
【図５】図２に描かれたシステムの軸の縦断面図であ
る。
る。
【図６】図２に描かれたシステムの活動又は作業頭部の
拡大縦断面図である。
拡大縦断面図である。
【図７】頭部が閉位置にある、図６に描かれたシステム
の頭部の拡大縦断面図である。
の頭部の拡大縦断面図である。
【図８】頭部がステープル発射位置にある、図６に描か
れたシステムの頭部の拡大縦断面図である。
れたシステムの頭部の拡大縦断面図である。
【図９】ステープル発射後、頭部が閉位置にある、図６
のシステムの頭部の拡大縦断面図である。
のシステムの頭部の拡大縦断面図である。
【図１０】ステープルが発射された後に頭部が開位置に
ある、図６に描かれたシステムの頭部の拡大縦断面図で
ある。
ある、図６に描かれたシステムの頭部の拡大縦断面図で
ある。
【図１１】結紮クリップを配置する際に使用される本発
明の内視鏡システムの別の実施態様の斜視図である。
明の内視鏡システムの別の実施態様の斜視図である。
【図１２】図１１に描かれた器械の取っ手の縦断面図で
ある。
ある。
【図１３】図１１に描かれたシステムの軸部分の組み立
て図である。
て図である。
【図１４】開放した状態の、図１１に描かれたシステム
の頭部に配設されたクリップの平面図である。
の頭部に配設されたクリップの平面図である。
【図１５】閉鎖状態の、図１１に描かれたシステムの頭
部に配設されたクリップの平面図である。
部に配設されたクリップの平面図である。
【図１６】全閉鎖状態の、図１１に描かれたシステムの
頭部に配設されたクリップの平面図である。
頭部に配設されたクリップの平面図である。
【図１７】周囲環境における特性を検出するための検出
手段を描く、本発明のシステムの頭部の縦断面図であ
る。
手段を描く、本発明のシステムの頭部の縦断面図であ
る。
【図１８】本発明によるシステムの一実施態様の主な構
成要素の相互関係を示すブロック図である。
成要素の相互関係を示すブロック図である。
【図１９】本発明のシステムのためのハードウェアアー
キテクチャーの可能なセットを描くブロック図である。
キテクチャーの可能なセットを描くブロック図である。
【図２０】本発明によるシステムのための制御論理のた
めの一つの可能な流れの簡略流れ図である。
めの一つの可能な流れの簡略流れ図である。
【図２１】本発明によるシステムのための制御論理のた
めの一つの可能な流れの簡略流れ図である。
めの一つの可能な流れの簡略流れ図である。
３０ 切断装置 ３１ コントローラ ３２ 表示モニター ４０ 取っ手部 ４１ 軸部分 ４２ 頭部 ４６ 歯車箱 ４８ スイッチ ４９ スイッチ ５０ モーター軸 ７５ アンビル部 ８１ スタープル
Claims (4)
- 【請求項１】 内視鏡手順において使用されるシステム
において、 （ａ）手順において一段階を行う際に使用される器械
と、 （ｂ）器械を動作させ、手順において該段階を行うため
に、該器械にパワーを供給するための手段と、 （ｃ）該段階を行う際に器械の動作を監視制御するため
に、該器械に取り付けられた検出及び制御手段とを具備
するシステム。 - 【請求項２】 内視鏡手順において使用されるシステム
において、 ａ）手順において一段階を実施するための頭部と、取っ
手部と、該頭部と該取っ手部を連結する回転軸とを有す
る内視鏡器械と、 ｂ）該回転軸を回転させるための手段と、 ｃ）手順における段階を実施する際に使用される所望の
力に軸の回転動作を変換するために器械の頭部に配設し
た手段と、 ｄ）手順における段階を実施する際に使用される力を測
定するために該器械に取り付けた検出手段と、 ｅ）手順における段階を実施する間、器械の動作を制御
するために、該検出手段に相互連結した制御手段とを具
備するシステム。 - 【請求項３】 内視鏡手順において一段階を実施するた
めの頭部と、該頭部に連結した軸と、動作を該軸に適用
するための手段と、手順における段階を実施するため
に、軸に加えられた動作を頭部の適切な力及び／又は動
作に変換するために該頭部に配設した手段と、動作を測
定するために該頭部に配設した検出手段と、頭部の力及
び／又は動作の制御を行うために該検出手段に相互連結
した手段とを具備する内視鏡器械。 - 【請求項４】 内視鏡手順において使用されるステープ
ル留め器械において、頭部と、取っ手部と、該頭部を該
取っ手部に連結する連結部であり、該頭部が、ステープ
ルのカートリッジを保持するための手段と、該カートリ
ッジからステープルを放出するための発射手段と、該ス
テープルを形成するためのアンビル手段とを具備し、該
アンビル手段が、該カートリッジと該アンビル手段の間
に組織を配置させるために該カートリッジ保持手段に関
して配設される頭部と、取っ手部と連結部分と、該連結
部に配設した回転軸と、該回転軸の一方の端部に配設し
た変換手段であり、カートリッジから該ステープルを放
出し、組織において該ステープルを形成するための力に
軸の動作を変換するために該発射手段を該軸に連結する
変換手段と、該軸を回転させるために該回転軸の他方の
端部に配設した手段と、該カートリッジと該アンビル手
段の間に配置した組織の物理的特性を検出するために、
該頭部に配設した第１検出手段と、ステープルを放出
し、形成するために必要な力を決定するための第２検出
手段と、ステープルの放出と形成を制御するために、該
第１及び第２検出手段に相互連結した制御手段とを具備
するステープル留め器械。
Applications Claiming Priority (6)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US82247892A | 1992-01-17 | 1992-01-17 | |
| US822478 | 1992-01-17 | ||
| US93732492A | 1992-08-31 | 1992-08-31 | |
| US937324 | 1992-08-31 | ||
| US07/991,619 US5383880A (en) | 1992-01-17 | 1992-12-16 | Endoscopic surgical system with sensing means |
| US991619 | 1992-12-16 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| JPH067357A true JPH067357A (ja) | 1994-01-18 |
Family
ID=27406277
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP5023314A Pending JPH067357A (ja) | 1992-01-17 | 1993-01-18 | 検出手段を備えた内視鏡外科用システム |
Country Status (11)
| Country | Link |
|---|---|
| US (4) | US5383880A (ja) |
| EP (1) | EP0552050B1 (ja) |
| JP (1) | JPH067357A (ja) |
| AT (1) | ATE192639T1 (ja) |
| AU (1) | AU670051B2 (ja) |
| CA (1) | CA2087221C (ja) |
| DE (1) | DE69328576C5 (ja) |
| DK (1) | DK0552050T3 (ja) |
| ES (1) | ES2146216T3 (ja) |
| GR (1) | GR1001562B (ja) |
| PT (1) | PT552050E (ja) |
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| JP2006334417A (ja) * | 2005-06-03 | 2006-12-14 | Tyco Healthcare Group Lp | センサを使用する外科手術用器具 |
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- 1993-01-15 PT PT93300254T patent/PT552050E/pt unknown
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Also Published As
| Publication number | Publication date |
|---|---|
| DK0552050T3 (da) | 2000-08-07 |
| EP0552050A3 (ja) | 1994-03-23 |
| EP0552050A2 (en) | 1993-07-21 |
| US5383880A (en) | 1995-01-24 |
| US5518163A (en) | 1996-05-21 |
| CA2087221C (en) | 2004-03-30 |
| PT552050E (pt) | 2000-08-31 |
| AU3117893A (en) | 1993-07-22 |
| DE69328576D1 (de) | 2000-06-15 |
| US5667517A (en) | 1997-09-16 |
| ATE192639T1 (de) | 2000-05-15 |
| DE69328576C5 (de) | 2008-08-28 |
| ES2146216T3 (es) | 2000-08-01 |
| AU670051B2 (en) | 1996-07-04 |
| CA2087221A1 (en) | 1993-07-18 |
| GR1001562B (el) | 1994-04-29 |
| DE69328576T2 (de) | 2001-01-04 |
| US5518164A (en) | 1996-05-21 |
| EP0552050B1 (en) | 2000-05-10 |
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