JPH08182684A - 外科用ファスナをつけるための自家動力付き外科装置 - Google Patents

外科用ファスナをつけるための自家動力付き外科装置

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Publication number
JPH08182684A
JPH08182684A JP7198896A JP19889695A JPH08182684A JP H08182684 A JPH08182684 A JP H08182684A JP 7198896 A JP7198896 A JP 7198896A JP 19889695 A JP19889695 A JP 19889695A JP H08182684 A JPH08182684 A JP H08182684A
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Prior art keywords
assembly
cartridge
anvil
self
elongated body
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Pending
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English (en)
Inventor
Frank J Viola
ジェイ ヴィオラ フランク
Wayne P Young
ピー ヤング ウェイン
Daniel E Alesi
イー アレッシー ダニエル
Richard N Granger
エヌ グレンジャー リチャード
L Mastri Dominick
エル マーストリ ドミニク
Kenneth E Toso
イー トーソ ケニス
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United States Surgical Corp
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United States Surgical Corp
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—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
    • A61B2017/0046—Surgical instruments, devices or methods with a releasable handle; with handle and operating part separable
    • 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
    • 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
    • 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

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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)
  • Endoscopes (AREA)

Abstract

(57)【要約】 【課題】 外科用ファスナを身体組織につけるための自
家動力付き外科装置の提供。。 【解決手段】 ハンドル組立体と、該ハンドル組立体内
に配置された歯車モータ組立体と、該モータ組立体に動
力を供給するためにハンドル組立体内に配置された動力
源と、ハンドル組立体から遠位端方向に延びる細長いボ
ディと、細長いボディの遠位端部分に着脱自在に取付け
られたカートリッジ組立体と、細長いボディの中を延び
且つモータ組立体をカートリッジ組立体に連結する細長
い駆動シャフトと、を有する身体組織に外科用ファスナ
を付けるための自家動力付き外科装置である。

Description

【発明の詳細な説明】
【０００１】
【発明の属する技術分野】本発明は外科装置に関し、よ
り詳細には、複数の外科用留め具（ファスナ）を身体組
織に次々につけ、そして、留められた組織を任意に切る
装置に関する。
【０００２】
【従来の技術】先ず、組織を対向するジョー構造体の間
で掴み或いはクランプし、次いで、外科用ファスナによ
って接合する外科具は、この分野で良く知られている。
幾つかの器具では、ファスナによって接合された組織を
切るためのナイフが設けられている。このファスナは、
典型的には、外科用ステープルの形態であるが、２部ポ
リマ(two part polymeric)のファスナも利用される。こ
の目的の器具は、組織を捕らえ或いはクランプするため
にそれぞれ使用される２つの細長い部材を備える。典型
的には、一方の部材が、少なくとも２つの横列に配置さ
れた複数のステープルを収容する使捨てカートリッジを
支持し、他方の部材が、カートリッジから出されたとき
にステープルの脚を成形する表面を形成するアンビルを
備える。一般に、ステープル留め作業は、カートリッジ
支持部材の中を長手方向に進むプッシャによって行わ
れ、該プッシャはステープルに作用し、次いで、ステー
プルを次々にカートリッジから押出す。ナイフが、ステ
ープル列の間をプシャと共に進み、ステープルの間でス
テープル留めされた組織を長手方向に切り、そして／又
は、開いてもよい。そのような器具が、ボブロブ等(Bov
rov et al)の米国特許第3,079,606 号明細書、グリーン
(Green) の米国特許第3,490,675 号明細書に開示されて
いる。
【０００３】米国特許第3,499,591 号明細書で開示され
ているその後のステープラは、２列のステープルを切開
の各側につける。このことは、カム部材が２組の互い違
いにされたステープル支持溝の間の細長い案内通路の中
を動くカートリッジ組立体を設けることによって、成し
遂げられる。ステープル押出し部材は溝内に配置され、
そして、長手方向に動くカムに接触されステープルを押
出すように位置決めされる。このようなステープラの他
の例が、米国特許第4,429,695 号明細書及び米国特許第
5,065,929 号明細書に開示されている。上述の器具の各
々は、外科医が手術部位に手で直接アクセスする従来の
手術のために設計されたものである。しかしながら、内
視鏡又は腹腔鏡を用いた手術では、手術は、小さな切開
部を通して又は皮膚にあけられた小さな入口を通して投
入された狭いカニューレを通して行われる。内視鏡手術
及び／又は腹腔鏡手術における特有な要求に応えるため
に、内視鏡手術用ステープル留め用装置が開発されてお
り、米国特許第5,040,715 号明細書及び米国特許第5,31
8,221 号明細書に開示されている。一般に、これらの器
具は、アンビルの接近を行うためのクランプ用構造部材
と、その間に組織を固定するカートリッジと、組織を固
定した後にカートリッジから複数のファスナを次々に排
出するステープル押出構造部材とを備える。
【０００４】上述した器具は、組織をクランプし、固定
し、そして／又は切るために、手で所定の力を加える必
要がある。このため、外科医は、限られた大きさの物理
的な力だけで作動可能な自家動力付き器具を使用する利
点に気付いた。自家動力付き外科器具はこれらのニーズ
に応じて提供されてきており、このような器具には、例
えば米国特許第5,312,023 号明細書に記載された、気体
作動外科用ステープラや、例えば米国特許第4,365,638
号明細書、米国特許第5,258,007 号明細書及び欧州特許
出願第0552050 号明細書に記載された、電動外科用ステ
ープラがある。一般的に、従来の電動外科器具は、外部
電源によって駆動されている。
【０００５】
【発明が解決しようとする課題】これらの器具は、導線
ケーブルによって電源に接続されている。しかしなが
ら、このようなケーブルは、手術中に、からまり、これ
によって、操作を複雑にする。従って、外科用ファスナ
を身体組織につけるための自家動力付き外科装置を提供
することが有益である。又、そのような自家動力付き装
置が再装填可能であるならば、有益である。
【０００６】
【課題を解決するための手段】本出願の発明は、外科用
ファスナを身体組織につけるための自家動力付き即ち動
力源内蔵式外科装置を提供することを目的とする。本発
明の外科装置は、ハンドル組立体と、該ハンドル組立体
内に配置されたモータ組立体と、前記ハンドル組立体内
に配置されたモータ組立体に動力を供給する動力源と、
前記ハンドル組立体から遠位端方向に延びる細長いボデ
ィと、該細長いボディの遠位端部材に着脱自在に連結さ
れたカートリッジ組立体とを有する。カートリッジ組立
体は、複数の外科用ファスナを支持するハウジングと、
該ハウジングと関連し且つ開位置と閉位置との間を動け
るように取付けられたアンビルと、ハウジング及びアン
ビルに対して並進移動してアンビルを開位置から閉位置
に徐々に動かし且つアンビルに対して形成されるハウジ
ングから外科用ファスナを次々に排出するように構成さ
れた作動機構と、アクチュエータと螺合してこれを長手
方向に並進運動させる軸線方向駆動ネジとを有する。こ
の自家動力付き外科装置は、更に、細長いボディの中を
通り且つモータ組立体をカートリッジ組立体の軸線方向
駆動ネジに連結する細長い駆動シャフトを有する。
【０００７】ハンドル組立体は、内部にモータ組立体が
配置される細長いバレル部分と、内部に動力源が配置さ
れる付随的なハンドルグリップ部分とを有するのが好ま
しい。モータ組立体を選択的に作動させるために引き金
機構がハンドル組立体と関連し、そして、モータ組立体
の極性を選択的に逆転させるためにスイッチ機構が引き
金機構と関連する。細長いボディとカートリッジ組立体
とは、細長いボディの長手方向軸線に対して軸回転でき
るのが好ましい。このような回転を防止するために設け
られた手段は、ハンドル組立体の遠位端に形成され且つ
該遠位端の回りに円周方向に配置された複数の窪みと、
弾性材料で形成され且つ細長いボディの近位端部分の回
りに取付けられた環状カラーとを備えるのが好ましい。
環状カラーは、直径方向に対向し且つ半径方向内方に延
びる一対の突起を有し、該突起は円周方向に配置された
窪みに係合するように寸法決めされ且つ構成されてい
る。この突起がそれぞれの窪みと係合したとき、細長い
部分のハンドル組立体に対する回転は防止される。半径
方向内方に向けられた力を加えると、突起は窪みから係
合解除され、回転が可能になる。
【０００８】図面を関連した装置の詳細な説明によっ
て、本発明の動力付き外科装置の他の特徴が当業者にと
ってより明らかになるであろう。
【０００９】
【発明の実施の形態】以下、図面を参照して本発明の外
科装置の実施例を説明する。本明細書において「近位
側」とは、装置の操作者に最も近い側を指し、「遠位
側」とは装置の操作者から最も遠い側を指す。本発明の
装置を、内視鏡手術及び装置の両方と関連して説明す
る。しかしながら、「内視鏡による」、「内視鏡によ
り」及び「内視鏡部分」というような用語の本明細書に
おける使用は、本発明を内視鏡管と関連してのみ使用さ
れる装置に限定するために解釈されるべきでない。むし
ろ、関節鏡手術及び／或いは腹腔鏡手術を含むがこれに
限定されないアクセスが小さな切開に制限される処置で
の、本発明の用途が見つかるであろうと考えられる。
【００１０】同じ参照番号が本発明の同様の構造部分を
示す図面を参照すると、図１には、本発明の好ましい実
施形態に従って構成された自家動力付き外科用ファスナ
が図示され、その全体が参照番号１０で示されている。
外科用ステープラ１０は、腹腔鏡による手術中に、身体
組織をクランプし、複数の外科用ステープルを身体組織
につけ、留められた身体組織に切開部を形成するように
構成されている。概説すれば、外科用ステープラ１０
は、ハンドル部分１２と、ハンドル部分１２から遠位端
方向に延びる細長いボディ部分１４と、ボディ部分１４
の遠位端に連結されたカートリッジ組立体１６とを有す
る。図２及び図３を参照すると、外科用装置１０のハン
ドル部分１２は、２つのハウジング半部からなり、細長
いバレル部分１８とハンドルグリップ部分２０とを有す
る。出力シャフト（図示せず）を有するモータ組立体２
２がバレル部分１８内に配置され、該モータ組立体２２
は、出力シャフトの回転速度を落とし且つモータ組立体
によって送られるトルクを増大させるためのギアセット
２４を有する。ギアセット２４は、モータ組立体２２の
出力シャフトによって直接駆動されるピニオンギア２６
を有する。ピニオンギア２６は、キャリア３０に支持さ
れる第１の遊星歯車セット２８を駆動する。次いで、キ
ャリア３０のピニオン部分が、第２の遊星歯車セット３
４を駆動し、次いで、第２の遊星歯車セット３４がハブ
部材３６を駆動する。リングギア３２は静止したままで
あり、遊星歯車セット２８、３４の作用点として機能す
る。受入れポート３８が、細長い駆動シャフト４２の近
位端を受けれるためにハブ部材３６に形成されている。
駆動シャフト４２は、ハブ３６から、外科装置１０の細
長いボディ部分１４を通って、カートリッジ組立体１６
まで延びている。シャフトカップリングが、駆動シャフ
ト４２の遠位端に設けられ、カートリッジ組立体１６を
駆動シャフト４２に着脱自在に連結している。この構成
は、図８に関連して後に詳述する。
【００１１】引き続き図２及び図３を参照すると、モー
タ組立体２２は、ハンドル部分１２のハンドルグリップ
部分２０に内蔵された一対の電池４５ａ、４５ｂから動
力を供給される。図示するように、ハンドル部分１２
は、バレル部分１８に略垂直に延びている。電池４５
ａ、４５ｂは、リチウム、アルカリ、或いは、ニッケル
カドミウム型電池であるのがよい。トリガ即ち引き金４
４は、グリップ部分２０から突出し、モータ組立体２２
の作動を制御している。引き金４４は、リンクバー４８
によって、スイッチ組立体４６に連結されているのが好
ましい。スイッチ組立体は、二極双投(double-pole-dou
ble-throw:DPDT) スイッチであるのが好ましく、選択的
にモータ組立体に電気接続される。スイッチは、モータ
組立体の出力シャフトが第１の方向に回転するのに対応
する第１位置と、出力シャフトが第２の方向に回転する
のに対応する第２位置と、モータ組立体が作動しない第
３位置とを有するのが好ましい。このタイプのＤＰＤＴ
スイッチ組立体は、当業者に良く知られている。
【００１２】図４は、スイッチ機構の略図である。図示
するように、端子Ｔ３はモータの端子Ａに結線され、端
子Ｔ４はモータの端子Ｂに結線されている。電池４５ａ
の正極が、正極端子Ｔ５に結線され、電池４５ｂの負極
が負極端子Ｔ６に結線されている。引き金４４が引かれ
てリンクバー４８が近位端方向に動かされると、２つの
中間端子Ｔ３、Ｔ４が、それぞれの後方端子Ｔ５、Ｔ６
に接続される。従って、モータの端子Ａがスイッチの正
極側端子に接続されることになり、モータの端子Ｂがス
イッチの負極側端子に接続されることになり、これによ
って、モータシャフトを第１方向に回転させ、シャフト
４２を第１方向に回転させ、ファスナを押出す。押出し
を止めたいときには、引き金４４を放して端子Ｔ３、Ｔ
４のＴ５、Ｔ６との接続を断つ。押し出し行程が始まっ
た後に、組織のクランプを緩めたいなら、引き金４４を
遠位端方向に引き、中間端子Ｔ３、Ｔ４を前側端子Ｔ
１、Ｔ２に接続する。従って、モータの端子Ａがスイッ
チの負極側端子に接続されることになり、端子Ｂがスイ
ッチの正極側端子に接続されることになり、これによっ
て、モータ及び駆動シャフトの回転方向が逆転する。
【００１３】図２及び図３と共に図５及び図６を参照す
ると、動力付き外科用装置１０は、ボディ部分１４がハ
ンドル部分１２に対して軸線方向に回転できるように
し、装置の作動範囲を大きくするために、回転体機構５
０を備える。回転体機構５０は、弾性材料ででき且つネ
ジ山付き留め具５１によってボディ部分１４の近位端に
連結されたた環状カラー５２を有する。直径方向に対向
した一対の突起５６ａ、５６ｂが、カラー５２の内面５
２ａから半径方向内方に延び、該突起がバレル部分１８
の遠位端部分の周囲に形成された対応した形状の窪みと
選択的に係合するようになっている。突起５６ａ、５６
ｂがバレルの窪み５８に係合したとき、カラー５２は、
その位置にロックされ、ボディ部分１４は回転できなく
なる。このようにして、ファスナ付け作業中、その中を
延びる駆動シャフト４２が回転しているとき、ボディ部
分１４は固定状態に維持される。
【００１４】直径方向に対向した一対の係合解除パッド
６０ａ、６０ｂが、突起を解放し、カラー５２が回転で
きるようにするために、突起から９０°ずれて、カラー
５２の外周面５２ｂに設けられている。従って、ボディ
部分１４をハンドル部分１２に対して軸回転させるため
には、図６に示すように、半径方向に内方に向ってパッ
ド６０ａ、６０ｂに力を加え、弾性カラー５２の部分５
３ａ、５３ｂを半径方向外方に撓ませる。この撓みが、
突起５６ａ、５６ｂを対応する窪み５８ａ、５８ｂから
係合解除する。これにより、カラー５２が解放され回転
でき、これによって、ボディ部分１４をハンドル部分１
２に対して回転させ、カートリッジ組立体１６を所望位
置に配向できる。図７を参照してカートリッジ組立体１
６を見ると、カートリッジ組立体１６は、細長いボディ
部分１４の遠位端に着脱自在に連結される別体のユニッ
トとして構成されている。このことにより、この装置
は、追加のファスナ列を付けるために、新しいカートリ
ッジを再装填できる。着脱自在であるという特徴は、所
望なら、この器具を、使用後、ハンドル部分１２と細長
いボディ部分１４を再消毒し、カートリッジ組立体を廃
棄する半再使用可能器具として製造することを可能にす
る。器具全体を使い捨てにすることも考えられる。
【００１５】カートリッジ組立体１６は、２つの主構成
部分、即ち、カートリッジアダプタ７０と、細長いハウ
ジングチャネル８０とを有する。これらは、ネジ山付き
留め具７５によって互いに取付けられている。アダプタ
７０は、近位端に細長いボディ部分１４の遠位端内に収
容されるように寸法決めされた取付け部分７２を有す
る。軸線方向のボア７４が、円筒状カートリッジカップ
リング７６を回転可能に支持できるように、取付け部分
７２の中を延びている。カートリッジカップリング７６
は、その遠位端が軸線方向駆動ネジ７８の近位端に連結
するように構成されている。カップリング７６は、その
近位端が、駆動シャフト４２の遠位端に連結されたシャ
フトカップリング１４０に着脱自在に連結される。回転
運動を駆動シャフト４２から駆動ネジ７８まで伝えるこ
のカップリングについては、後に詳細に説明する。
【００１６】ハウジングチャネル８０は、対向する側壁
８０ａ、８０ｂと、床８０ｃとを有する。開口８２が、
チャネル８０の近位端に隣接した床８０ｃに形成され、
留め具７５を受入れるようになっている。対向する開口
８３ａ、８３ｂが、ハウジングチャネル８０の側壁８０
ａ、８０ｂに形成され、アンビル部材８６の近位端に隣
接して形成された一対の外方に延びるフランジ８４ａ、
８４ｂを受け入れるようになっており、該フランジを中
心として、アンビル部材８６は開位置と閉位置の間を枢
動し、組織を掴んだり離したりする。一対のバネ部材５
８ａ、８５ｂが、アンビル８６を開位置に付勢するよう
に、開口８３ａ、８３ｂ内に配置されている。対向する
係合ノッチ８８ａ、８８ｂが、一方が図示され参照番号
８９で示される保持カートリッジ９０の一対の戻り止め
を受け入れるように、ハウジングチャネル８０の遠位端
に隣接して側壁８０ａ、８０ｂに設けられている。戻り
止めは、ファスナ保持カートリッジ９０と一体的に形成
され、ハウジングチャネル８０の遠位側部分内にカート
リッジを固定する。
【００１７】引き続き図７を参照すると、カートリッジ
組立体１６は、保持カートリッジ９０に対してアンビル
部材８６を開位置から閉位置まで徐々に動かし、付随し
て、保持カートリッジ９０から複数のカートリッジを次
々に排出させるための細長い作動ビーム１００を備え
る。作動ビーム１００は、上述のように駆動シャフト４
２によって駆動される軸線方向駆動ネジ７８によって駆
動される。作動スレッド即ち作動そり１２０が、保持カ
ートリッジ９０の中を並進移動し、そこから外科用ファ
スナを排出するように構成されている。作動そり１２０
は、基部１２２と、間隔をおいた複数の直立カムプレー
ト１２４と、中央駆動板１２５とを有する。各カムプレ
ート１２４は、外科用ファスナを保持カートリッジ９０
から身体組織の中に押出してアンビル部材８６に形成さ
れたアンビル窪みと係合させる複数のステープルドライ
バ（図示せず）に、順次、係合する角度付きカム面を有
する。作動ビーム１００の前縁１００ａは駆動プレート
１２５と係合し、作動そり１２０を保持カートリッジ９
０の中で駆動する。切断ブレード１３０が、前縁１００
ａに隣接して作動ビーム１００に取付けられ、該ブレー
ド１３０は、スレッド１２０の後についてカートリッジ
組立体１６の中を並進するように構成され、ステープル
留めした組織に切開部を形成する。
【００１８】静止支持体取付け部材９２が、カートリッ
ジ組立体１６の中に配置され、作動ビーム１００の長手
方向の並進運動を案内し、且つ、軸線方向駆動ネジ７８
の遠位端７８を支持している。駆動ネジ７８の近位端７
８ｂは、上述したように、カップリング１４０を介して
駆動シャフト４２に連結されているカップリング７６に
係合している。フォロワナット９４が、駆動ネジ７８と
螺合的に関連し、且つ、フォロワハウジング９５内に取
付けられている。フォロワハウジング９５は、駆動ネジ
７８の軸線方向の回転に応答して長手方向に並進運動す
るように取付けられている。作動ビーム１００の近位側
の細長いビーム延長部９６、９８は、作動ビーム１００
がフォロワハウジング９５と一緒に遠位方向に並進運動
するように、作動ビーム１００をフォロワハウジング９
５に作動的に連結させる。
【００１９】作動ビーム１００の遠位端は、略円筒状カ
ムフォロワ１０４を支持する保持フランジ１０２と、略
平らなカムビーム１０８を保持する係合スロット１０６
とを有する。カムローラ１０４は、フォロワハウジング
９５及び作動ビーム１００がハウジングチャネル８０の
中を並進運動しファスナを押し出するとき、アンビル部
材８６の上側カム面１１０と係合し且つこれに対して並
進運動してアンビル部材を徐々に閉じる。カムビーム１
０８は、ハウジングチャネル８０の床８０ｃの外側面と
係合しこれ対して並進運動し、閉じの間、カムフォロワ
１０４によってアンビル部材８６に加えられる力を調整
する。作動ビーム１００の長手方向の並進運動に適合す
るように、長手方向スロット１１２がハウジングチャネ
ル８０の床８９ｃに形成され、そして、アンビル部材８
６に対応する長手方向スロット１１４が形成されてい
る。横方向のスロット１１４ａが、カムローラ１０４を
その並進運動の終わりで受け入れるように、アンビルの
スロット１１４の遠位端に形成されており、これによっ
て、留め作業の後、アンビル部材８６が、バネ８５ａ、
８５ｂの付勢力によって開位置に戻る。
【００２０】図８乃至図１１を参照すると、上述したよ
うに、外科装置１０のカートリッジ組立体１６が、バヨ
ネットカップリング即ち差込みカップリングによって、
ボディ部分１４の遠位端に着脱自在に取付けられた別の
ユニットとして構成されている。加えて、上述したよう
に、軸線方向の駆動ネジ７８は、カートリッジカップリ
ング７８及びシャフトカップリング１４０を介して駆動
シャフト４２に着脱自在に連結されている。図８に示す
ように、シャフトカップリング１４０は、駆動シャフト
４２の遠位端に形成されたキャビティ１４２内に摺動自
在に支持されている。カップリング１４０の遠位端に、
カートリッジカップリング７６から延びる対応する歯１
４５に係合するように横方向のスロット１４４が形成さ
れている（図７も参照のこと）。対向するシャフトスロ
ット１４８ａ、１４８ｂに支持され且つシャフトカップ
リング１４０の開口１４１の中を通るピン１４６が、シ
ャフトカップリング１４０をキャビティ１４２に支持
し、カップリングバネ１５０の付勢力に抗してシャフト
カップリング１４０が長手方向に並進運動できるように
する。カップリングバネ１５０は２つの機能を有する。
第１には、カートリッジ組立体１６をボディ部分１４の
遠位端に挿入したとき、もしカップリング１４０のスロ
ット１４４とカップリング７６の歯１４５とが合わなか
ったら、カップリングバネ１５０は、この不整合を補償
し、駆動シャフト４２が初期回転したときに、カップリ
ングの係合を容易にする。これは、歯１４５がカップリ
ング１４０の面１４３に当接したときに、バネ１５０の
初期圧縮によって起こる。駆動シャフト４２が、最初に
回転し、スロット１４４が歯１４５と整合したとき、バ
ネ１５０が、カップリング１４０を遠位端方向に押しや
り、スロット１４４が歯１４５に係合する。カップリン
グ１５０の第２の機能は、図９及び図１０に最も良く示
すように、カートリッジ組立体１６をボディ部分１４に
維持している差込みカップリングを係合したときに、カ
ートリッジアダプタ７０を遠位端方向に付勢することで
ある。差込むカップリングは、ボディ部分１４に形成さ
れ、カートリッジアダプタ７０（図７参照）から半径方
向外方に延びる係合ピン１５８ａ、１５８ｂに対応する
略Ｊ字形状の係合スロット１５６を有する。カートリッ
ジ組立体１６を取付中、カートリッジアダプタ７０の近
位端を、ボディ部分１４の遠位端内に軸線方向に挿入し
て、そして、約２０°回転させてピン１５８ａ、１５８
ｂを対応するスロット１５６ａ、１５６ｂに係合させる
（図１）。そのとき、カップリングバネ１５０が、シャ
フトカップリング１４０とアダプタ７０を遠位端方向に
付勢し、ピン１５８ａ、１５８ｂをスロット１５６ａ、
１５６ｂ内の係合位置に維持する。
【００２１】図１１乃至図１３を参照すると、手術中、
手術部位にアクセスするために、本装置がトロカールニ
ュウーレ２００の中に挿入されている。身体組織をアン
ビル部材８６と保持カートリッジ９０の間で捕らえたと
き、引き金４４を引いてモータ組立体２２を作動させ、
ギアセット２４が駆動シャフト４２に回転運動を伝える
ようにさせ、次いで、駆動シャフト４２が回転運動を軸
線方向駆動ネジ７８に伝達する。そのとき、フォロワハ
ウジング９５が長手方向に並進運動し、作動ビーム１０
０を遠位端方向に駆動する。作動ビーム１００が、遠位
端方向に並進運動したとき、カムフォロワ１０４が、ア
ンビル部材８６を、図１１に示す通常付勢開位置から、
図１２に示す閉じたクランプ位置まで、徐々に動かす。
これに付随して、作動そり１２０が、図１１に示す近位
端位置から保持カートリッジ９０の中を図１２に示す最
も遠位側の位置まで動かされ、外科用ファスナを次々に
ボディ組織の中に押し出す。カムローラ１０４が細長い
スロット１１４の遠位端に到達したとき、カムローラは
横方向スロット１１４ａの中に落ち、アンビル８６が開
位置に戻り、ステープル留めされた身体組織を解放する
ようにする。ファスナ付け作業が終了すると、ピン１５
８ａ、１５８ｂをスロット１５６ａ、１５６ｂから係合
解除して、カートリッジアダプタ７０をボディ部分１４
から取り外すように、カートリッジ組立体１６を操作す
る。その後、複数の外科用ファスナを収容した新しいカ
ートリッジ組立体と、近位端側位置に配置されたステー
プル押出しそりとが、上述したのと同じ方法で、器具に
取付けらえ、もう一度ステープル留めができるようにす
る。
【００２２】好ましい実施態様に関連して本発明の器具
を説明してきたが、特許請求の範囲の記載の思想及び範
囲から逸脱することなく、この実施態様に変更し又は変
形することは、本発明の属する技術分野における当業者
にとって極めて明白なことであろう。
【図面の簡単な説明】
【図１】本発明の好ましい実施例によって構成された動
力付き外科用ステープル留め装置の斜視図である。
【図２】図１の動力付き外科用ステープル留め装置のハ
ンドル組立体の側断面図である。
【図３】モータ組立体を図示するためにハウジングの半
部の一方を取外した状態での、細長いボディ及びハンド
ル組立体の斜視図である。
【図４】外科用ステープル留め装置の作動を選択的に制
御するスイッチング機構を示す略図である。
【図５】回転カラーがハンドル組立体のバレル部分と係
合した状態での、図２のＡ−Ａ線に沿った断面図であ
る。
【図６】回転カラーがハンドル組立体から係合解除され
て細長いボディ部分の回転が可能となった状態での、図
２のＡ−Ａ線に沿った断面図である。
【図７】図１に示す動力付き外科用装置のカートリッジ
組立体の分解斜視図である。
【図８】図７のカートリッジ組立体を駆動シャフトに着
脱自在に連結する連結構成を示す、図１の動力付き外科
用装置の駆動シャフトの遠位端の斜視図である。
【図９】図７のカートリッジ組立体の細長いボディ部分
への連結を示す、装置ボディの遠位端を部分的に断面に
した正面図である。
【図10】図７のカートリッジ組立体の細長いボディ部分
への連結を示す、装置ボディの遠位端を部分的に断面に
した正面図である。
【図11】ファスナを出す前の図１の外科用装置のカート
リッジ組立体を示す断面図である。
【図12】ファスナを出した図１の外科用装置のカートリ
ッジ組立体を示す断面図である。
【図13】トロカールカニューレの中に挿入された図１の
動力付き外科用ステープル留め装置の斜視図である。
【符号の説明】
１０ 外科用ステープラ（外科装置） １２ ハンドル部分 １４ ボディ部材 １６ カートリッジ組立体 ５２ 環状カラー ５６ａ 突起 ５６ｂ 突起 ５８ａ 窪み ５８ｂ 窪み ６０ａ 係合解除パッド ６０ｂ 係合解除パッド ７０ カートリッジアダプタ ７６ カートリッジカップリング ７８ 軸線方向駆動ネジ ８０ ハウジングチャネル ８６ アンビル部材 ９０ ファスナ保持カートリッジ １００ 作動ビーム
───────────────────────────────────────────────────── フロントページの続き (72)発明者 ウェイン ピー ヤング アメリカ合衆国 ニューヨーク州 10509 ブルースター オールヴィュー アベニ ュー （番地なし) (72)発明者 ダニエル イー アレッシー アメリカ合衆国 コネチカット州 06784 シャーマン ルート 39 ノース 38 (72)発明者 リチャード エヌ グレンジャー アメリカ合衆国 コネチカット州 06484 ハンティングトン アローヘッド レー ン 18 (72)発明者 ドミニク エル マーストリ アメリカ合衆国 コネチカット州 06606 ブリッジポート ケンブリッジ ストリ ート 302 (72)発明者 ケニス イー トーソ アメリカ合衆国 コネチカット州 06897 ウィルトン オールド ハイウェイ 32

Claims (15)

    【特許請求の範囲】
  1. 【請求項１】 ａ）ハンドル組立体と、 ｂ）該ハンドル組立体から遠位端方向に延び且つハンド
    ル組立体に対して軸回転可能に取付けられた細長いボデ
    ィと、 ｃ）該細長いボディの遠位端部分に着脱自在に取付けら
    れた留め組立体であって、複数のファスナを収容するカ
    ートリッジと、ファスナを次々に出すアクチュエータ
    と、開位置と閉位置との間で相対運動可能に該カートリ
    ッジに取付けられたアンビルとを有する留め組立体と、 ｄ）前記ハンドル組立体から前記細長いボディの中を前
    記留め組立体まで延びる作動機構であって、前記留め組
    立体が前記細長いボディに取付けられたとき、前記留め
    組立体のアクチュエータが該作動機構と作動的に関連す
    る、 身体組織に外科用ファスナをつけるための自家動力付き
    外科装置。
  2. 【請求項２】 前記ハンドル組立体内に配置された、前
    記作動機構を駆動するためのモータ組立体と、 前記ハンドル組立体内に配置された、前記モータ組立体
    に動力を供給する動力源と、 を有する請求項１に記載の自家動力付き外科装置。
  3. 【請求項３】 前記ハンドル組立体が、前記モータ組立
    体を内部に配置する細長いバレル部分と、前記動力源を
    内部に配置する付随的なハンドルグリップ部分と、前記
    ハンドル組立体と関連し、モータ組立体を選択的に作動
    させる引き金機構と、 を有する請求項２に記載の自家動力付き外科装置。
  4. 【請求項４】 前記細長いボディとカートリッジ組立体
    とが、前記ハンドル組立体に対して回転可能である、 請求項１に記載の自家動力付き外科装置。
  5. 【請求項５】 前記細長いボディとカートリッジ組立体
    との回転を防止する手を更に有する、 請求項４に記載の自家動力付き外科装置。
  6. 【請求項６】 前記防止手段が、前記ハンドル組立体の
    遠位端部分の回りに円周方向に配置された複数の窪み
    と、弾性材料で形成され且つ前記細長いボディ近位端部
    分の回りに取付けられた環状カラーとを有し、 該環状カラーが、直径方向に対向し且つ内方に延びそし
    て前記ハンドル組立体に形成された窪みに通常係合する
    ように寸法決めされた一対の突起を有し、これらの突起
    は、半径方向内方に向う力をカラーに加えることによっ
    て窪みから係合解除される、 請求項５に記載の自家動力付き外科装置。
  7. 【請求項７】 前記留め組立体において、前記アクチュ
    エータがアンビルを開位置から閉位置に徐々に動かしそ
    してカートリッジから外科用ファスナを次々に排出する
    ために、前記カートリッジ及びアンビルに対して並進運
    動する、 請求項１に記載の自家動力付き外科装置。
  8. 【請求項８】 留め組立体のアクチュエータが、作動機
    構の遠位端部分に着脱自在に連結されている、 請求項７に記載の自家動力付き外科装置。
  9. 【請求項９】 前記留め組立体が、更に、前記アクチュ
    エータを長手方向に並進運動させる軸線方向駆動ネジを
    有し、 該軸線方向駆動ネジが、前記作動機構の遠位端部分に着
    脱自在に取付けられ、、 前記細長いボディの中を延びる細長い駆動シャフトの遠
    位端が、バネによって付勢されたカップリング機構によ
    って、前記軸線方向駆動ネジの近位端に着脱自在に連結
    され、 前記バネが、軸線方向の駆動ネジの近位端と細長い駆動
    シャフトの遠位端との軸線方向の整合を容易にする、 請求項８に記載の自家動力付き外科装置。
  10. 【請求項10】 前記留め組立体が、差し込み型カップリ
    ング機構によって細長いボディに着脱自在に取付けられ
    ている、 請求項１に記載の自家動力付き外科装置。
  11. 【請求項11】 複数の外科用ファスナを身体組織に次々
    につけるように構成され、ハンドル組立体と該ハンドル
    組立体から延びる細長いボディと該細長いボディ内で動
    けるように取付けられたアクチュエータとを有する外科
    用装置用のカートリッジ組立体であって、 ａ）複数の外科用ステープルを支持し且つ前記装置の細
    長いボディの遠位端部分に着脱自在に取付けられたハウ
    ジングと、 ｂ）前記ハウジングと関連し且つ開位置と閉位置との間
    で相対移動可能に前記ハウジングに取付けられたアンビ
    ルと、 ｃ）前記ハウジング及びアンビルに対して並進移動して
    且つ前記アンビルを開位置から閉位置に徐々に動かし且
    つアンビルに対して形成されたハウジングから外科用フ
    ァスナを次々に排出するように構成され作動組立体と、 ｄ）前記作動組立体を並進運動させるために作動組立体
    と関連する手段であって、該手段の近位端が、前記カー
    トリッジ組立体を装置に取付けたときに、前記アクチュ
    エータの遠位端に係合するように構成され、これによっ
    て、アクチュエータの動きが、作動組立体の長手方向の
    並進運動を起こす、手段と、 を備えたカートリッジ組立体。
  12. 【請求項12】 前記並進運動させるための手段が、軸線
    方向駆動ネジを備え、該駆動ネジの近位端が前記アクチ
    ュエータの遠位端と着脱可能に連結するよう構成され、
    これによって、アクチュエータの軸回転が、作動組立体
    を並進運動させる、 請求項１１に記載のカートリッジ組立体。
  13. 【請求項13】 前記作動組立体に関連して、前記カート
    リッジ組立体の中を並進運動し、ステープル留めされた
    身体組織に切開部を形成するように構成された切断ブレ
    ードを備える、 請求項１１に記載のカートリッジ組立体。
  14. 【請求項14】 通常、前記アンビルが開位置に付勢さえ
    ている、 請求項１１に記載のカートリッジ組立体。
  15. 【請求項15】 前記アンビルが、ファスナがハウジング
    から排出されたとき該ファスナが押しつけられるファス
    ナ成形面と、対向するカム面とを備え、 前記作動組立体が、アンビルの外側カム面と係合して、
    作動組立体の長手方向並進運動中に、アンビルを徐々に
    閉じさせるように、寸法決めされ且つ構成された円筒状
    ロラーカムを有する、 請求項１４に記載のカートリッジ組立体。
JP7198896A 1994-10-07 1995-08-04 外科用ファスナをつけるための自家動力付き外科装置 Pending JPH08182684A (ja)

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CA2155476A1 (en) 1996-04-08
AU3294195A (en) 1996-04-18
JP3955611B2 (ja) 2007-08-08
AU707847B2 (en) 1999-07-22
EP0705571A1 (en) 1996-04-10
JP2006116331A (ja) 2006-05-11
CA2155476C (en) 2007-05-01

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