JPH08336544A - ロック機構付き外科用組織治療装置及び処置方法 - Google Patents

ロック機構付き外科用組織治療装置及び処置方法

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Publication number
JPH08336544A
JPH08336544A JP8147772A JP14777296A JPH08336544A JP H08336544 A JPH08336544 A JP H08336544A JP 8147772 A JP8147772 A JP 8147772A JP 14777296 A JP14777296 A JP 14777296A JP H08336544 A JPH08336544 A JP H08336544A
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Prior art keywords
tissue
therapeutic energy
handling
shaft
cutting
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JP8147772A
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JP3857357B2 (ja
Inventor
David C Yates
デビッド・シー・イエッツ
Iv Warren P Williamson
ウォーレン・ピー・ウィリアムソン、ザ・フォース
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Ethicon Endo Surgery Inc
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Ethicon Endo Surgery Inc
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    • 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
    • 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
    • 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
    • A61B18/1447—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 wherein sliding surfaces cause opening/closing of the end effectors
    • 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
    • A61B17/115—Staplers for performing anastomosis, e.g. in a single operation
    • 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
    • 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
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2923—Toothed members, e.g. rack and pinion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
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    • 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
    • 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
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00642—Sensing and controlling the application of energy with feedback, i.e. closed loop control
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    • A61B2018/00672—Sensing and controlling the application of energy using a threshold value lower
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    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00666—Sensing and controlling the application of energy using a threshold value
    • A61B2018/00678—Sensing and controlling the application of energy using a threshold value upper
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    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00684—Sensing and controlling the application of energy using lookup tables
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    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00696—Controlled or regulated parameters
    • A61B2018/00702—Power or energy
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    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00696—Controlled or regulated parameters
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    • A61B2018/00708—Power or energy switching the power on or off
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    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
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    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/032—Automatic limiting or abutting means, e.g. for safety pressure limiting, e.g. hydrostatic

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Abstract

(57)【要約】 【課題】 電気手術エネルギー、超音波、熱、レーザ
ー、赤外線その他の組織処置用のエネルギー、特に組織
加熱エネルギーを利用する装置について、適切な連続的
な使用を確保するロック機構及び処置方法を提供するこ
と。 【解決手段】 本発明の一態様によれば、組織の熱処理
が所望の程度まで完了した後に使用される切断部材を含
む。また好ましい態様においては、組織処置の完了を指
示する信号を発するフィードバックモニタを備える。さ
らに、他の態様においては、組織処置の完了フィードバ
ック信号に応答し、組織の処置が完了したときはロック
解除するように構成されたメカトロ式のロック機構を具
備する。

Description

【発明の詳細な説明】
【０００１】
【発明の属する技術分野】本発明は、外科手術、特に内
視鏡手術において焼灼、凝集および／または組織溶接に
用いられる電気手術具のためのロック機構及び処置方法
に関する。
【０００２】
【従来の技術】組織の切開を要する外科手術において
は、その切開箇所において出血を余儀なくされ、出血の
制御に関しては、血管の縫合、クリップ止め、ホチキス
止め、あるいは電気焼灼や他の組織加熱技術など手術の
技術が開発され、それぞれ一定の成功を収めている。そ
して、組織のつなぎ合わせあるいは溶接、組織の修復お
よび創傷部の閉止技術が進歩したため、以前は不可能で
あるかあるいはきわめて危険の大きかった手術も行える
ようになった。
【０００３】外科用ホチキス装置は、組織の固着、接合
および近置のため、ならびに組織の切開時に止血を達成
するために使用されている。このホチキス装置には、例
えば直線状および円形の切断・ホチキス装置がある。直
線状の切断装置は、典型的には平行なステープル（ホチ
キス針）列と、このステープル列の間を行き来する切断
手段用のスロット（長細の溝）を具備する。この型の外
科用ホチキス装置は、切断手段が平行なステープル列の
間で切断を行う際に、切断をよりうまく行えるように組
織を固定し、組織の層をつなぎ合わせ、切断箇所を取り
囲む組織層に平行なステープル列を適用することによっ
て止血を与える。ところで、これらのホチキス装置にお
いては、単発型ステープルカートリッジの再射出を防止
するためにロック機構が提案されている。
【０００４】電気手術装置は、組織や血管を加熱して凝
集や焼灼を生じさせ、より良好な止血を与えるために用
いられる。米国特許第5,403,312 号は、組織を挟み付け
て、この組織に電気手術エネルギーを送り組織を切断す
るクランプ・切断装置を開示している。また、この装置
に挟み付けられて組織にステープルを適用するより好ま
しい態様も知られている。超音波、レーザ、熱線、赤外
線など他の組織加熱エネルギーを使って組織を切断・凝
集させる他の装置も使用されてきた。
【０００５】例えば、止血を与える前に、切断してしま
うなど、止血を与えながら切断および／またはホチキス
止め機能を発揮する組織加熱装置を用いる際、これらの
機能を不適切なまでに連続的に適用することのないよ
う、止血を与える組織加熱装置を制御する手段を開発す
ることが望ましい。また、組織加熱エネルギーを適用す
る前にステープルカートリッジが空になったり、組織の
処置が完了していないときには、装置の使用を停止させ
る手段も望まれている。
【０００６】
【発明が解決しようとする課題】そこで、本発明は、装
置の適切な連続作動を確保するため、止血を与えながら
組織を取扱うロック機構付きの装置及び処置方法を提供
することを目的とする。
【０００７】
【課題を解決するための手段】本発明の好ましい態様
は、治療エネルギーを組織と組織取扱い装置に供給する
治療用エネルギー供給装置を有する組織処置部を備えた
手術装置を提供する。治療用エネルギーは、組織に加
熱、切断、凝集、溶接、焼灼などの治療効果を与えるよ
う組織に処置を施すために用いられる例えば電気手術エ
ネルギー、熱エネルギー、光エネルギー、超音波エネル
ギーなどのエネルギーである。組織取扱い装置は、機械
的手段あるいは組織に切断、切開、つなぎ合わせ、締め
付け、クリップ止め、ホチキス止めなどの機械的効果を
もたらす手段を使って組織を治療し、また取扱うために
使用される装置である。
【０００８】この好ましい態様における組織治療部は、
シャフトに連結される。シャフトは、治療用エネルギー
を、組織治療部にある治療用エネルギー供給装置に送る
治療用エネルギー導通装置を備える。そのようなエネル
ギー導通装置は、電気エネルギーを電極あるいはヒータ
に送るワイヤあるいは導電体と、超音波エネルギーを送
る金属製のシャフト、レーザあるいは光エネルギーを送
る光ファイバなどを具備する。
【０００９】組織取扱い作動装置は組織取扱い装置を作
動させ、ロック機構は組織取扱い作動装置をロック位置
から非ロック位置へ、あるいはその逆方向に移動させ
る。好ましくは、この作動や移動は、組織に治療用エネ
ルギーを供給し始めるかあるいは供給を完了した後に行
うのがよい。
【００１０】この好ましい態様においてはさらに、組織
治療の状態（例えば溶接や凝集が完了したこと）を知ら
せるフィードバック信号を送る組織のパラメータを測定
し、装置を制御する装置を備える。この組織のパラメー
タを測定し、装置を制御する装置は、組織治療部に連結
され、エネルギー供給装置に供給されるエネルギーを制
御したり、組織取扱い装置を作動させたり、これらの特
徴のいずれか一つを発揮もしくは抑止することにより、
あるいは装置を連続的に操作したりあるいはユーザに操
作させることにより、これを直接または間接に制御す
る。以下には、本発明の種々の特徴を記載した。
【００１１】本発明の一様相によれば、特に切断路に沿
って組織溶接、凝集あるいは焼灼を行うエネルギー供給
手段を備えた切断装置が提供される。また、本発明は、
凝集、焼灼あるいは溶接が完了した後治療用エネルギー
が印加されるまで切断あるいは切断装置の作動を防止す
るロック機構も提供する。
【００１２】本発明は手術装置以外の装置も企図するも
のであるが、好ましい態様においては、電気手術エネル
ギーを用いる。したがって、以下では、本発明は電気手
術装置として使用するものとして記載を進める。
【００１３】本発明の種々の態様においては、電気手術
エネルギーは、ステープル、クリップ、生体吸収性ファ
スナなどの一もしくはそれ以上の組織用ファスナととも
に、ステープルを組織に打ち込むドライバなどのファス
ナを適用するアプライヤ(applier) を用いながら適用さ
れる。切断・ホチキス止め装置を用いるときは、ロック
機構は好ましくは、電気手術エネルギーが印加させるま
でステープルの射出を抑え、また一旦ステープルが射出
されたらサイドの射出を防止するのがよい。したがっ
て、本発明の一態様に係るロック機構は、高周波エネル
ギーの印加のない、あるいは適切な止血がない、切断部
材やステープルドライバの作動を防止し、また使用済み
のステープルカートリッジの再射出を防止する。
【００１４】これら本発明の目的は、電気手術装置が、
組織を間に挟むための相対向するインターフェース面と
二つの電気的に対極をなす電極、および対応する各極の
電圧を具備し、電極の少なくとも一方は、相対向するイ
ンターフェース面の一方もしくは両方に設けられる終端
効果器を備えた好ましい態様について説明される。好ま
しくは、二つの電極は、インターフェース面に関して互
いに食い違わせる。すなわち、両電極は、相対向するイ
ンターフェース面の上で径方向に向かい合うことのない
よう互いに食い違わせる。
【００１５】本発明の好ましい態様に係る電気手術装置
は、第１のインターフェース面と第２のインターフェー
ス面の間にある圧縮ゾーンで組織を圧縮し、圧縮ゾーン
を介して電気エネルギーを印加する。第１のインターフ
ェース面は、バイポーラ型エネルギー源の第１の極に対
応する第１の電極と、同じエネルギー源の第２の極に対
応する第２の電極を含む。第２の選挙区は、第１の電極
と同じインターフェース面あるいは反対のインターフェ
ース面に設けられる。この特別な態様においては、圧縮
ゾーンは、組織を他のインターフェース面に対して圧縮
する一または二個のインターフェース面に設けられる圧
縮用の突起によって区画される領域である。凝集ゾーン
は、第１の電極、第２の電極および、第１の電極と第２
の電極を絶縁する絶縁材によって区画される。
【００１６】好ましい態様の一つにおいては、線形切断
機械ホチキス装置に類似した直線状切断装置に止血装置
が組み込まれる。この態様の場合は、止血装置は、二つ
の長手電極棒と、切断手段が装置の終端効果器に把持さ
れている組織を切断するためのスロットを具備する。電
極棒は好ましくは、焼灼する組織を圧縮するための突起
を具備する絶縁材の横方向に隣接しているのがよい。所
望により、組織加熱中における機械的な組織の固定と近
置のため、一またはそれ以上のステープル列をスロット
と電極棒の各側に設ける。装置を扱う際には、組織を二
つの顎の間に挟み付ける。電気エネルギーは、焼灼のた
め、高周波の形で、圧縮された組織に印加される。この
場合、装置は、切断部材が通る道筋に隣接して止血線を
与える。本発明に関しては、管内円形切断装置など他の
切断・ホチキス止め装置も用いることができる。
【００１７】本発明のロックアウト機構は、機械的、電
気的および電気機械的ロック部材を備えることができ、
コントローラから送られてくる制御信号に応答して作動
される。
【００１８】本発明の一態様においては、組織が所望の
あるいは所定の程度まで焼灼されたことを、指示器がユ
ーザに伝える。好ましい態様においては、測定した組織
インピーダンスに基づいて組織の凝集状態を決定するた
め、組織インピーダンスのセンサが装置に組み込まれ
る。組織インピーダンスのセンサは、組織の治療状態に
基づいて制御信号を与えるコントローラを具備する。制
御信号は、電源装置の制御や、ロック機構の電気的制
御、および／またはユーザが感知できる信号を与えるの
に使用される。
【００１９】
【発明の実施の形態】本発明の上述の目的は、添付の図
面を参照した以下の発明の詳細な説明により、よりよく
理解できるであろう。
【００２０】本発明は、モノポーラ、バイポーラおよび
マルチポーラ（どの極からどの極まででも測定できる位
相関係をもつ波形のエネルギーを与える二個以上の治療
用電極を含む）を含む在来型および内視鏡手術用の種々
の電気手術装置に適用できるが、本明細書では内視鏡手
術用バイポーラ型直線状切断・ホチキス装置について説
明する。
【００２１】直線状切断・ホチキス装置の操作方法は業
界でよく知られており、例えば米国特許第4,408,981 号
および同第4,633,874 号に記載されている。
【００２２】図１〜１７には、インピーダンスフィード
バック回路とともに用いられる本発明の一態様に係る切
断・ホチキス装置を示す。この内視鏡手術用直線状切断
・ホチキス装置１０は、管腔が走る鞘３０に連結された
ハウジング１６と、鞘３０の遠方端から延びる終端効果
器１５を備える。終端効果器１５は、相対向する顎部材
３２，３４から構成される第１の部材と第２の部材を備
える。顎部材３２は、顎部材３４に対して移動可能に固
着される。ハウジング１６は、両顎部材３２，３４を閉
止するためのクランプトリガ１２と、高周波エネルギー
投入用のスイッチ５９に連結された高周波スイッチ戻り
止めアーム５８とスイッチ片６７ａ，６７ｂ、および切
断部材１１をステーション１７を適用するためのウェッ
ジ１３と組織を通して進める射出トリガ１４を有する。
顎部材３２，３４は、非クランプ位置にあるものが図１
に示してある。また、電気手術エネルギーの印加前で、
かつ切断とホチキス止めを行う前のクランプ位置にある
ものが図２に、電気手術エネルギーを印加した後で、か
つ切断とホチキス止めを行う前のクランプ位置にあるも
のが図３に、そして切断とホチキス止めを行った後のク
ランプ位置にあるものが図４にそれぞれ示してある。
【００２３】顎部材３２は、アンビル１８、顎部材３２
の長さ方向に延びるＵ字形治療用電極３９および、治療
用電極３９の外側を包囲するＵ字形絶縁材料３１を備え
る。顎部材３２は、顎部材３４の内面３５とほぼ向かい
合う内面３３を有する。Ｕ字形電極３９は、顎部材３２
の内面３３上にあってこの長さ方向にほぼ沿いながら延
びる第１の極を形成する二つの電気的に連通する電極棒
２７，２８を備える。Ｕ字形電極３９は、アルミニウム
あるいは手術用グレードのステンレススチール等の導体
から形成される。Ｕ字形絶縁材は、ポリフェニレンオキ
シドなどのポリマーで形成するのが好ましい。電極棒２
７，２８は、電極３９の中央部を通って軸方向に延びる
ナイフチャネル２９によって離隔される。アンビル１８
の上に位置するステーション端収納用のポケット３６
は、電極３９の各側上にステーション列を形成するよ
う、電極棒２７，２８の外側で長さ方向に沿って、また
内面３３に沿って配置される。電極棒２７，２８と絶縁
材３１は、内面３３（図１６）のアンビル部３３ａに対
して盛り上がった隆起線５６を形成する。電極３９は、
バイポーラ型組織処置あるいは治療システムの第１の極
として働く。アンビル１８は、導電材料から形成され、
バイポーラ型組織処置あるいは治療システムの第２の治
療極として働く。アンビル１８は処置電極３９とは電気
的に反対の極をなす。アンビル１８は、Ｕ字形絶縁材３
１によって電極３９から電気的に絶縁される。
【００２４】顎部材３４は、カートリッジチャネル２２
と、このカートリッジチャネル２２に取り外し可能に挿
入されるカートリッジ２３を備える。カートリッジ２３
は、ウェッジ１３用のトラック２５と、カートリッジ２
３の中心を通って軸方向に延びるナイフチャネル２６、
トラック２５まで延びる一連のドライバ２４、および単
一の列からなる二つのセットに構成されたステープル１
７を有する。
【００２５】鞘３０は絶縁材から形成され、その管腔を
通って延びる導電性の閉止チューブ３８を有する。好ま
しい態様においては、閉止チューブ３８は、顎閉止チュ
ーブおよび電気的接触片として働く。チャネル保持器２
７ａは、閉止チューブ３８の手前端から延び、チャネル
３７に固定されて、顎３４を形成するよう閉止チューブ
３８の残りの部分から遠方側に延びる。チャネル３７
は、閉止チューブ３８から遠方側に延びるカートリッジ
チャネル２２を含む。
【００２６】本体１６は、組織を間に挟んでこれに係合
する顎３２，３４を互いの方向に向けて閉止すべく、閉
止チューブを進めるためのクランプトリガ１２を備え
る。クランプトリガ１２が回転すると、閉止チューブ３
８は、顎３２のカム面３２ａの上方で鞘３０を通って同
軸的に進み、両顎３２と３４の間に位置する組織に対し
て、両顎３２，３４を閉止させる。
【００２７】チャネル保持器３７ａは、チャネル３７内
にあるドライブロッド４１の同軸的な動きを案内する。
ドライブロッド４１は、以下に詳述するように、射出ト
リガ１４の回転によって押し進められる。ドライブロッ
ド４１は、その遠方端で、ブロック４３に連結される。
ブロック４３は、切断手段１１とステープルドライブウ
ェッジ１３に連結され、ドライブロッド４１は、ブロッ
ク４３を介して終端効果器１５の中に入り込む。ウェッ
ジガイド４６は、ウェッジ１３をトラック２５へ案内す
るのに用いられる。顎部材３２は、チャネル３７を介し
て顎部材３４に固着される。
【００２８】ドライブロッド４１が切断部材１１を押し
進めると、切断部材１１は、組織の焼灼が済んだとき
は、両顎３２，３４に係合した組織を切断するよう、電
極棒２７と２８の間をナイフチャネル２６を通って進
む。したがって、切断線は、電極棒２７，２８によって
形成された凝集線の中間にできる。ドライブロッド４１
はブロック４３を進めるが、そうするとドライバ２４を
ステープルまで動かすウェッジ１３も同時に進んで、ス
テープルを組織を貫通して射出させ、アンビル１８のポ
ケット３６まで進める。ステープル１７は、切断部材１
１が組織を切断するとき、切断部材１１の各側において
長手の単一の列の形で適用される。
【００２９】本体１６の遠方端に位置するノブ４４は、
閉止チューブ３８、チャネル保持器３７ａ、チャネル３
７および終端効果器１５を回転させるが、これらは直線
間接にノブ４４に連結しており、ノブ４４は、終端効果
器である顎部材３２，３４を回転させるために使用され
る。ノブ４４は、刻み３８ａをもつ閉止チューブ３８に
合わさって係合するペグ（図示せず）を備える。閉止チ
ューブ３８は、その手前端において、ハウジング１６に
嵌る。
【００３０】電気エネルギーは、以下に説明する接続部
材や、例えば米国特許第5,403,312号にあるような他の
接続手段を介して、電極３９とアンビル１８，７０に供
給される。電源装置７０は、ハウジング１６にある高周
波スイッチ５９を介してユーザにより制御される。ワイ
ヤ１９ｃ，１９ｄは、スイッチ５９から下記の電源装置
７０内のコントローラまで延びる。
【００３１】ワイヤ１９ａと１９ｂは、装置の本体１６
まで延び、それぞれ電極３９と１８にエネルギーを供給
する。ワイヤ１９ａ，１９ｂはそれぞれ、低インピーダ
ンス接触部材２０ａ，２０ｂに接続され、一方この低イ
ンピーダンス接触部材２０ａ，２０ｂはそれぞれワイヤ
４７ａ，４７ｂに接続する。ワイヤ４７ａ，４７ｂは、
各遠方端４８ａ，４８ｂが露出する。ワイヤ４７ａと４
７ｂはそれぞれ、閉止チューブ３８と接触リング４９ｂ
と電気的に接触するよう、チャネル保持器３７ａの手前
端に位置する閉止チューブ３８と接触リング４９ｂに向
けて偏らされる。
【００３２】ワイヤ１９は、導電性の閉止チューブ３８
に接触する第１のワイヤ４７ａを介してアンビル１８に
電流を送る。閉止チューブ３８は、閉止チューブ３８が
両顎３２，３４を閉止するときに、導電性のアンビル１
８に接触する。
【００３３】ワイヤ１９ｂは、第２のワイヤ４７ｂを介
して電極３９に電流を送る。第１のワイヤ４７ｂは、閉
止チューブ３８を通って電極３９まで延びるワイヤ４０
ｂに連結する接触リング４９ｂに接触する。
【００３４】閉止チューブ３８とリング状接触片４９ｂ
は、閉止チューブ４８、リング状接触片４９ｂおよびワ
イヤ４７ａ，４７ｂとそれぞれ接触している間は、ノブ
４４を回転させる。リング状接触片４９ｂは、閉止チュ
ーブ３８からは電気的に絶縁される。
【００３５】ワイヤ４０ｂは、チャネル保持器３７ａに
嵌り込む封止部材４５を通って延びるが、チャネル保持
器３７ａは、閉止チューブ３８にはめ付けられる。
【００３６】クランプトリガ１２は、ヨーク６６の歯６
６ｂと噛み合う歯車の歯１２ａを備える。ヨーク６６
は、その遠方端で閉止チューブ３８に連結する。クラン
プトリガ１２が作動すると、歯車の歯１２ａは、ヨーク
６６の歯６６ｂに係合し、ヨーク６６を遠方側に進め
る。閉止チューブ３８は、顎３２のカム面３２ａの上方
に進むとき、両顎３２，３４を閉止する。
【００３７】高周波スイッチ５９は、治療電極に供給さ
れる高周波エネルギーを投入すべく回転する。高周波ス
イッチ５９が回転すると、スイッチ５９にある爪の突起
５９ａが戻り止めアーム５８の突起５８ａの下に引っ掛
かり、高周波スイッチ５９が手動で下の位置に戻される
場合以外は、スイッチ５９が高周波エネルギーの供給を
遮断するのを防止する。高周波エネルギーはまた、電気
的に遮断することもできる。
【００３８】スイッチ５９は、可動接触片６７ａと静止
接触片６７ｂを備える。可動接触片６７ａは、スイッチ
が投入されたときは、静止接触片５６ｂと接触するよ
う、スイッチ５９とともに回転する。信号は、静止接触
片６７ｂおよび可動接触片６７ａとそれぞれ連結してい
るワイヤ１９ｃ、１９ｄを通って電源装置７０に送られ
る。
【００３９】リリースボタン６０の棚６０ａは、ヨーク
６６の手前端にある階段状の棚６６ａに隣接するヨーク
の手前端と整合する。ヨーク６６がクランプトリガ１２
によって押し進められると、棚６０ａはヨーク６６の手
前端の背後へ下向きに回転し、リリースボタン６０が押
されるまで、ヨーク６６が後退するのを防止する。した
がって、顎３２，３４は、ユーザがリリースボタン６０
を押して両顎３２，３４を開放するまで、閉止位置にと
どまる。
【００４０】スイッチ５９は、ヨーク６６の手前端のち
ょうど上に載るフィンガー５９ｃを備える。リリースボ
タン６０の棚６０ａは、フィンガー５９ｃの間にちょう
ど嵌る。高周波スイッチ５９は、スイッチ５９のフィン
ガー５９ｃがヨーク６６の手前端の後方へ自由に回転で
きるようヨーク６６が遠方側に押し進められるまで、投
入、すなわち前方に回転させることはできない。
【００４１】スイッチ５９はまた、射出ラック５３の溝
５３ａに係合する下方フック５９ｂを有する。射出ラッ
ク５３は、射出トリガ１４の歯１４ａが係合する歯車の
歯５３ｂを具備する。射出ラック５３は、その遠方端
で、ピニオン５４と噛み合い、ピニオン５４はドライブ
ロッド４１に係合する。
【００４２】射出トリガ１４が引かれると、射出ラック
５３は遠方側に進み、ドライブロッド４１を遠方側に進
めるピニオン５４を回転させる。すると切断部材１１が
作動し、ステープル１７は終端効果器１５が係合する組
織に向けて打ち込まれる。
【００４３】しかし、射出ラック５３は、高周波スイッ
チの下方フック５９ｂが射出ラック５３の溝５３ａから
外れるまで前進することはできない。これは、高周波ス
イッチ５９が投入された後にのみ生ずる。
【００４４】したがって、本明細書で述べる装置は、両
顎３２，３４が閉止するまで、高周波の印加、ステーシ
ョンあるいはナイフの作動を防止するロック機構を備え
る。このロック機構を扱うには、図１〜４と図１８に示
し、また以下に詳しく述べる適切な手順を踏むことが必
要である。
【００４５】本発明はまた、高周波エネルギーが連続的
に印加されるように、スイッチ５９が手動で解除される
かあるいは高周波エネルギーが例えば電源装置７０に送
られる電気的なフィードバック制御信号によってスイッ
チを遮断されるまで、爪付きの高周波スイッチを提供す
る。
【００４６】閉止トリガ１２と射出トリガ１４はインタ
ーロックされ、ばね５７は両トリガ１２，１４に機械的
に連結される。
【００４７】組織が両顎３２，３４の間に挟み付けら
れ、高周波エネルギーが印加されると、ハウジング１６
にある射出トリガ１４は、切断部材１１を係合した組織
を貫通して進め組織を切断すべく作動される。同時に、
射出トリガ１４が作動されると、ウェッジ１３は、トラ
ックを通って押し進められ、ドライバ２４をステーショ
ン１７に向けて変位させる。この結果、ステーション１
７は組織を貫通して、アンビルのポケット３６まで押し
出される。
【００４８】本発明の好ましい態様は、所望のあるいは
所定の組織に対する効果が得られたらこれを知らせるべ
く設計されたフィードバックシステムを含む。高周波エ
ネルギーを遮断してもよい十分な焼灼が得られたときに
これを知らせるフィードバックシステムとしては、聴取
可能、視覚でとらえ得る、触ることができるあるいはそ
の他のフィードバックシステムを用いることができる。
特別な態様においては、フィードバックシステムは、組
織の特性、例えば凝集が完了したかを判断するため、シ
ステムの一またはそれ以上の電気的なパラメータ、例え
ば電気エネルギーを印加する組織のインピーダンスなど
を測定する。そのようなフィードバックシステムの例
は、米国特許出願第08/311,297号（１９９４年９月２３
日出願）に記載してある。
【００４９】そのようなフィードバックシステムを使う
と、高周波エネルギーを遮断するため、電気信号が与え
られる。そのような電気信号は、ロック機構を電気的に
解放するために用いられ、切断部材を作動させ、あるい
はステープルを適用させる。高周波が遮断された後は、
射出トリガ１４を使うことにより、切断部材１１を前進
させ、ステープル１７を射出させることができる。
【００５０】ある態様においては、カートリッジは、ス
テープルについて、これまでの腹腔鏡手術用ホチキス止
め・切断装置で用いられている二重列ではなく、単一列
を備えることによってステープルの多重射出能力をも
つ。よりよい止血を与えるため、この種のホチキス装置
は、これまで互いに平行なステープルの二重列を用いる
よう設計されていた。すなわち、ステープルの二重列を
納めるために必要なスペースの大きさを考えて、ステー
プルのスタックを形成するためにはさらにスペースが必
要となることから、スタック状のステープルを納めた再
射出可能なカートリッジは、好ましいものとはされてい
なかった。しかし、ステープルを多重射出する態様にお
いては、ステープルの単一列を用いる。ステープルの単
一列を用いると、以前はステープルの第２列に占有され
ていたスペースに、ステープルのスタックを形成するこ
とが可能になり、多重射出能力が得られる。しかし、本
発明の装置は、所望ならば、二重、三重その他のステー
プル列を納めることもできる。また、ステープルが必要
なく、電気凝集線が必要な止血あるいは組織の溶接硬化
を与える態様もある。カートリッジは、本明細書では、
ステープル収納機構を意味する。
【００５１】図１８は、図１〜１７に示した装置の好ま
しい操作方法である。装置１０の両顎３２，３４は、ボ
タン６０を押すことによって開放される（ブロック５０
１）。カートリッジ２２は、使い切った場合は、交換す
る（ブロック５０１，５０２）。ついで、両顎３２，３
４を組織にあてがう（ブロック５０３）。装置１０（両
顎３２，３４）はついで、トリガ１２を作動して閉止さ
せる（ブロック５０４）。装置が完全に閉止されていな
い場合は、高周波ロックアウト機構はそのままの位置に
とどまり、高周波は印加されない（ブロック５０５）。
そして装置は、組織に再配置されるか、またはもう一度
閉止される。装置が完全に閉止されている場合は、高周
波スイッチ５９を投入して高周波を印加する（ブロック
５０６）。高周波スイッチ５９を印加すると、切断・ホ
チキス止めロック機構は解除される（ブロック５０
７）。高周波エネルギーが印加されると、組織の処置が
行われ、処置の完了が監視される。そして、組織の処置
が完了するとこれを組織処置完了信号がユーザに知ら
せ、電源装置から出力される高周波エネルギーは対応す
る電源装置制御信号によって制御される。（ブロック５
０８）。こうして、ユーザは、トリガ１４を引くことに
より、切断とホチキス止めを行うことができる（ブロッ
ク５０９）。
【００５２】図１９〜２１は、本発明に係るロック機構
のもう一つの態様を示す。ハンドルあるいはハウジング
１１６は、クランプトリガ１１２と射出トリガ１１４を
備える。クランプトリガ１１２は、図１〜１７に示した
閉止チューブと同じような閉止チューブ（図示せず）
を、ヨーク１１６の歯１１６ｂとクランプトリガの歯車
の歯１１２ａを噛み合わせることによって、押し進める
よう設計される。ヨーク１１６が遠方側に進むと、閉止
チューブは終端効果器の両顎を、図１〜１７に示した顎
部材と同様な方法で閉止する。
【００５３】高周波スイッチ１５９は、高周波エネルギ
ーを装置の終端効果器（図示せず）に供給するため、ユ
ーザが操作する。（この態様における装置の終端効果器
は、図１〜１７のそれと同じである。）高周波スイッチ
は、例えばハンドル１１６に取り付けることもできる
し、フットスイッチにすることもできる。高周波スイッ
チ１５９は、電源装置に、終端効果器にエネルギーを送
るよう信号を出す。
【００５４】高周波装置はまた、両顎が閉止、すなわち
ヨークが遠方側へ進むまで、ハンドル上のスイッチを作
動させることができない図１〜１７のスイッチと同じよ
うな働きをする高周波スイッチを備えることもできる。
【００５５】電源装置は、終端効果器で処置している組
織のインピーダンス情報を受け取るように構成される。
そのような装置と方法は、本出願人の米国特許出願第08
/311,297号（１９９４年９月２３日出願）に記載してあ
る。電源装置が組織インピーダンスのフィードバックを
使って凝集完了の条件を検出すると、下記のメカトロ式
ロックアウト機構に信号が送られる。
【００５６】この態様におけるメカトロ式ロックアウト
機構は、電源装置１７０からワイヤ１８１を通じて電気
信号を受け取る電磁操作機構（ソレノイド）１８０を備
える。ソレノイド１８０は、ワイヤ１８１を通じて送ら
れてくる適当な信号に応答して下降する可動端１８２を
含む引張り式ソレノイドである。ソレノイド１８０の端
１８２は、ピン１８４を通じて機械式のレバー１８３に
連結される。レバー１８３は、爪のついたノブ１８６に
引っ掛かるフック１８５を備える。ロック位置において
は、フック１８５は、射出ラック１５３の溝１５３ａに
係合する。射出ラック１５３は、射出トリガ１１４の歯
車の歯１１４ａに係合する歯車の歯１５３ｂを具備す
る。射出ラック１５３は、終端効果器における切断部材
とステープルドライバを、図１〜１７について説明した
方法とほぼ同じ方法で前進させる役割を果たす。
【００５７】クランプトリガ１１２を使って両顎が閉じ
られ、フットスイッチ１５９を使って高周波エネルギー
が投入されると、ソレノイド１８０がレバー１８３を引
っ張り、フック１８５を射出ラック１５３の溝１５３か
ら離れる方向に回転させるよう、ワイヤ１８１を使って
ソレノイド１８０へ信号を送らなければならない。こう
すると、射出ラック１５３が解放されて遠方側へ進める
ようになる。電源装置１７０に組み込まれた組織モニタ
は、インピーダンスフィードバックモニタを使って、凝
集が完了したかどうかを決定する。凝集が完了したらす
ぐに、ワイヤ１８１からソレノイド１８０へ制御信号を
送り、ソレノイドの端部１８２をソレノイド１８０の中
へ引き込ませる。こうなると、レバー１８３がフック１
８５をラック１５３から離れるように回転させる。レバ
ー１８３にある爪１８６は、ハウジングにある爪１８７
に係合し、レバー１８３をラック１５３から引き離した
状態で保持する。
【００５８】ステープルが射出された後は、両顎を閉止
位置から解放し、装置を組織から引き離すため、リリー
スボタン１６０を押さなければならない。リリースボタ
ン１６０は、これを押したときレバー１８３にある棚１
６２に係合するフィンガー１６１を備える。フィンガー
１６２は、棚１６２に上向きの力を与えるが、こうする
とレバー１８３は爪１８７から解放され、射出ラック１
５３の溝１５３ａをレバー１８３のフック１８５と再度
係合させる。
【００５９】図２２には、図１９〜２１に示した装置を
操作する方法を示す。装置１１０の両顎は、リリースボ
タン１６０を押すことによって開放される（ブロック６
００）。カートリッジは、使い終わったら交換する（ブ
ロック６０１，６０２）。ついで、装置の両顎を組織に
あてがい（ブロック６０３）、トリガ１１２によって閉
止する（ブロック６０４）。そして、ユーザが両顎が組
織に適切にあてがわれていると判断したら（ブロック６
０５）、フットスイッチ１５９を投入して高周波エネル
ギーを印加する。組織は、組織モニタフィードバック装
置（例えば米国特許出願第08/311,297号に記載した装
置）を使って、処理が完了したかどうかを監視される
（ブロック６０６，６０７）。そして、処理が完了した
ときは、組織処理完了信号が送られる。さらに、組織処
理が完了したときは、高周波エネルギーも遮断され（ブ
ロック６０９）、ソレノイド１８０も切断・ホチキス止
めロックアウト機構を解除すべく作動される（ブロック
６１０）。この後、切断・ホチキス止め機構が作動され
る（ブロック６１０）。
【００６０】以上、電気手術用止血装置と内視鏡手術用
切断・ホチキス止め装置を含む本発明の特定の態様に関
連して、種々の変形例も説明してきた。当然のことなが
ら、本発明は、止血が求められる多くの用途に適用する
ことができる。また、ここで説明したロック機構は、装
置で組織を切断・ホチキス止めする前に組織処置エネル
ギーを使用するような多くの装置に使用することができ
る。組織の切断、ホチキス止めあるいは他の組織の機械
的な操作の前に、超音波エネルギー、熱エネルギー、レ
ーザエネルギー、赤外線エネルギー等、種々の止血エネ
ルギーが使用される。また、応答性の電気−機械フィー
ドバック信号を与えるため、種々の組織モニタ用パラメ
ータあるいは手段が用いられる。例えば、電気インピー
ダンス、機械インピーダンス、温度あるいは光の吸収も
しくは反射などがフィードバック信号を生成するための
フィードバック用パラメータとして用いられる。したが
って、特許請求の範囲に謳った本発明の範囲内で、種々
の変更・変形例を生み出すことができることは、当業者
ならば理解できるであろう。
【００６１】本発明の具体的な実施態様は以下の通りで
ある。 １）前記手術装置はさらに、前記治療用エネルギー供給
装置によって処置を施されている組織の処置状態を表す
フィードバック信号を与えるよう構成され、前記装置の
組織処置部と連結する、組織パラメータの測定と組織の
制御を行う装置を備える請求項１記載の手術装置。 ２）前記手術装置はさらに、組織の処置状態を指示する
ユーザが感知可能な信号を与える、前記組織パラメータ
の測定と組織の制御を行う装置に連結される状態指示器
を備える上記実施態様１）記載の手術装置。 ３）前記組織の処置状態は凝集が完了したかどうかであ
る上記実施態様２）記載の手術装置。 ４）前記ロック機構は、前記組織パラメータの測定と組
織の制御を行う装置に操作可能に連結され、前記フィー
ドバック信号を受け取って、このフィードバック信号が
組織状態が適当との指示した場合は、このフィードバッ
ク信号に応答して前記組織取扱い作動装置を前記ロック
位置から非ロック位置へ移動させる電気機械式装置を備
える上記実施態様１）記載の手術装置。 ５）前記組織状態は凝集が所望の程度まで完了したかど
うかである上記実施態様４）記載の手術装置。
【００６２】６）前記組織取扱い装置は組織切断装置を
備える請求項１記載の手術装置。 ７）前記組織取扱い装置はさらに、組織にファスナを適
用する装置を備える上記実施態様６）記載の手術装置。 ８）前記組織にファスナを適用する装置は組織ホチキス
止め装置である上記実施態様７）記載の手術装置。 ９）前記治療用エネルギー供給装置は、前記電気手術系
電極における電極の少なくとも一個を備え、またこの少
なくとも一個の電極に電気手術エネルギーを供給するた
めの電気手術エネルギー導通手段を具備する請求項１記
載の手術装置。 １０）前記組織パラメータの測定と組織の制御を行う装
置は組織の電気インピーダンスを測定する装置である上
記実施態様１）記載の手術装置。
【００６３】１１）前記ロック機構は電気機械式の装置
を具備する請求項２記載の手術装置。 １２）前記手術装置はさらに、前記少なくとも一個の電
極によって処置を施されている組織の処置状態を表すフ
ィードバック信号を与えるよう構成され、前記装置の終
端効果器と連結する、組織パラメータの測定と組織の制
御を行う装置を備える請求項２記載の電気手術装置。 １３）前記手術装置はさらに、組織の処置状態を指示す
るユーザが感知可能な信号を与える、前記組織パラメー
タの測定と組織の制御を行う装置に連結される状態指示
器を備える上記実施態様１２）記載の電気手術装置。 １４）前記組織の処置状態は凝集が完了したかどうかで
ある上記実施態様１３）記載の電気手術装置。 １５）前記ロック機構は、前記組織パラメータの測定と
組織の制御を行う装置に操作可能に連結され、前記フィ
ードバック信号を受け取って、このフィードバック信号
が組織状態が適当との指示をした場合は、このフィード
バック信号に応答して前記ロック機構を前記第１の位置
から第２の位置へ移動させる電気機械式装置を備える上
記実施態様１２）記載の電気手術装置。 １６）前記方法はさらに、電気手術エネルギーが印加さ
れる組織の電気インピーダンスを測定する工程と、この
組織を切断する前に、前記装置のユーザに組織が所望の
程度まで凝集した時期を指示する工程を含む請求項５記
載の方法。
【００６４】
【発明の効果】以上のように、本発明によれば、装置の
適切な連続作動を確保するため、止血を与えながら組織
を取扱う、ロック機構付きの装置及び処置方法を提供す
ることができる。
【図面の簡単な説明】
【図１】本発明の一態様に係る内視鏡電気手術装置の斜
視図。
【図２】図１の装置が切断あるいはホチキス止めに用い
られる前に、閉止・クランプ位置にあるときの側面図。
【図３】図１の装置が、組織にＲＦエネルギーを適用す
る状態にあるときの側面図。
【図４】図１の装置が、組織にＲＦエネルギーを適用し
て、組織をホチキス止めし切断した後の状態にあるとき
の側面図。
【図５】図１に示した装置の手前側ハンドル部分の拡散
分解図。
【図６】図１に示した装置の中間部分と遠方側部分の拡
散分解図。
【図７】図１に示した装置の手前側ハンドル部分が第１
の開放位置にあるときの状態を、左側ハンドルカバーと
ワイヤを取り外した状態で示す側面図。
【図８】本発明で使用されるワイヤとコネクタの配置を
示す左側ハンドル部分の内側を見た図。
【図９】図１に示した装置の中間部分の軸方向断面図。
【図１０】図１に示した装置の中間部分手前端における
各部材のワイヤとの接触の模様を示す図。
【図１１】（ａ）は図１に示した装置の中間部分手前端
の拡大断面図、（ｂ）は図１１（ａ）の１１ｂ−１１ｂ
方向断面図。
【図１２】各接触部位に接触したワイヤの斜視図。
【図１３】ワイヤの各接触部位に対する押圧の元となる
わずかな偏りを示す図１１（ａ）の端面図。
【図１４】閉止・クランプ位置にある図１に示した装置
の遠方側端面の軸方向断面図。
【図１５】図１３に示した遠方側部分の拡大部分断面
図。
【図１６】図１４の１６−１６線断面図。
【図１７】図１４の１７−１７線断面図。
【図１８】図１に示した装置を使用する際の流れ図。
【図１９】他の態様に係るロック機構のロック位置にお
けるハンドル部材の側面図。
【図２０】図１９のハンドル部材の、ロック機構が非ロ
ック位置にあるときの側面図。
【図２１】図１９と図２０に示したハンドル部材の、ロ
ック機構が射出後リセット状態にあるときの側面図。
【図２２】図１９〜２１に示したロック機構の好ましい
使用態様を示す流れ図。
フロントページの続き (72)発明者 ウォーレン・ピー・ウィリアムソン、ザ・ フォース アメリカ合衆国、45140 オハイオ州、ラ ブランド、サウスベンド・コート 101

Claims (5)

    【特許請求の範囲】
  1. 【請求項１】 手術装置であって、 組織に治療用エネルギーを供給する治療用エネルギー供
    給装置と組織取扱い装置を備える組織処置部と、 前記組織処置部に連結されるシャフトであって、前記治
    療用エネルギー供給装置に操作可能に連結され、組織に
    治療用エネルギーを供給するため前記治療用エネルギー
    供給装置とともに作動される治療エネルギー導通装置を
    備えるシャフトと、 ロック位置と非ロック位置を有し、前記シャフトを通っ
    て延びながら前記組織取扱い装置に操作可能に連結され
    る組織取扱い作動装置と、 組織に治療用エネルギーを供給するため前記治療用エネ
    ルギー供給装置と治療用エネルギー導通装置が作動され
    た後、前記組織取扱い作動装置を前記ロック位置から非
    ロック位置まで移動させるため、前記組織取扱い装置に
    連結されるロック機構を備える装置。
  2. 【請求項２】 電気手術装置であって、 遠方端を有するシャフトと、 前記シャフトの遠方端に位置し、電気手術用のエネルギ
    ーを受け取る終端効果器であって、 それぞれ第１および第２の相対向する組織接触面を有す
    る第１および第２の部材であって、前記二つの組織接触
    面は、組織を間に置く開放・離隔位置から、組織に係合
    する閉止位置まで互いに移動可能であり、これら組織接
    触面の一方の少なくとも一部は導電性で電気手術用エネ
    ルギーを受け取るべく配置される第１および第２の部材
    ならびに、 前記終端効果器に係合した組織を切断すべく移動する切
    断部材を備える終端効果器と、 前記切断部材に操作可能に連結される作動装置であっ
    て、前記シャフトを通って前記切断部材まで延び、組織
    を切断するよう前記切断部材を作動させるべく配置され
    る作動装置と、 前記作動装置に操作可能に連結されるロック機構であっ
    て、前記切断部材の作動を防止するため前記作動装置に
    係合する第１の位置と、前記切断部材を作動させるため
    前記作動装置を解除する第２の位置を有するロック機構
    を具備する電気手術装置。
  3. 【請求項３】 組織に手術によって処置を施す方法であ
    って、 組織に治療用エネルギーを供給する治療用エネルギー供
    給装置と組織取扱い装置を備える組織処置部と、 前記組織処置部に連結されるシャフトであって、前記治
    療用エネルギー供給装置に操作可能に連結され、組織に
    治療用エネルギーを供給するため前記治療用エネルギー
    供給装置とともに作動される治療エネルギー導通装置を
    備えるシャフトと、 ロック位置と非ロック位置を有し、前記シャフトを通っ
    て延びながら前記組織取扱い装置に操作可能に連結され
    る組織取扱い作動装置と、 組織に治療用エネルギーを供給するため前記治療用エネ
    ルギー供給装置と治療用エネルギー導通装置が作動され
    た後、前記組織取扱い作動装置を前記ロック位置から非
    ロック位置まで移動させるため、前記組織取扱い装置に
    連結されるロック機構を備える手術装置を提供する工程
    と、 組織を前記組織処置部に係合させる工程と、 前記組織に処置を施すため治療エネルギーを印加する工
    程と、 組織の処置が完了したことを決定する工程と、 前記ロック機構を前記ロック位置から非ロック位置まで
    移動させる工程と、 前記組織を組織取扱い装置によって取扱う工程を含む方
    法。
  4. 【請求項４】 組織に手術によって処置を施す方法であ
    って、 組織に治療用エネルギーを供給する治療用エネルギー供
    給装置と組織取扱い装置を備える組織処置部と、 前記組織処置部に連結されるシャフトであって、前記治
    療用エネルギー供給装置に操作可能に連結され、組織に
    治療用エネルギーを供給するため前記治療用エネルギー
    供給装置とともに作動される治療エネルギー導通装置を
    備えるシャフトと、 ロック位置と非ロック位置を有し、前記シャフトを通っ
    て延びながら前記組織取扱い装置に操作可能に連結され
    る組織取扱い作動装置と、 組織に治療用エネルギーを供給するため前記治療用エネ
    ルギー供給装置と治療用エネルギー導通装置が作動され
    た後、前記組織取扱い作動装置を前記ロック位置から非
    ロック位置まで移動させるため、前記組織取扱い装置に
    連結されるロック機構を備える手術装置を提供する工程
    と、 組織を前記組織処置部に係合させる工程と、 前記組織に処置を施すため治療エネルギーを印加し、前
    記ロック機構を前記ロック位置から非ロック位置まで移
    動させる工程と、 組織の処置が完了したことを決定する工程と、 前記組織を組織取扱い装置によって取扱う工程を含む方
    法。
  5. 【請求項５】 組織に手術によって処置を施す方法であ
    って、 遠方端を有するシャフトと、 前記シャフトの遠方端に位置し、電気手術用のエネルギ
    ーを受け取る終端効果器であって、 それぞれ第１および第２の相対向する組織接触面を有す
    る第１および第２の部材であって、前記二つの組織接触
    面は、組織を間に置く開放・離隔位置から、組織に係合
    する閉止位置まで互いに移動可能であり、これら組織接
    触面の一方の少なくとも一部は導電性で電気手術用エネ
    ルギーを受け取るべく配置される第１および第２の部材
    ならびに、 前記終端効果器に係合した組織を切断すべく移動する切
    断部材を備える終端効果器と、 前記切断部材に操作可能に連結される作動装置であっ
    て、前記シャフトを通って前記切断部材まで延び、組織
    を切断するよう前記切断部材を作動させるべく配置され
    る作動装置と、 前記作動装置に操作可能に連結されるロック機構であっ
    て、前記切断部材の作動を防止するため前記作動装置に
    係合する第１の位置と、前記切断部材を作動させるため
    前記作動装置を解除する第２の位置を有するロック機構
    を具備する電気手術装置を提供する工程と、 組織を組織接触面の間に挟み付ける工程と、 前記組織に処置を施すため治療エネルギーを印加する工
    程と、 組織の処置が完了したことを決定する工程と、 前記ロック機構を前記ロック位置から非ロック位置まで
    移動させる工程と、 前記組織を前記切断装置によって切断する工程を含む方
    法。
JP14777296A 1995-05-08 1996-05-08 手術機器 Expired - Lifetime JP3857357B2 (ja)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US08/437,262 US5807393A (en) 1992-12-22 1995-05-08 Surgical tissue treating device with locking mechanism
US437262 1995-05-08

Publications (2)

Publication Number Publication Date
JPH08336544A true JPH08336544A (ja) 1996-12-24
JP3857357B2 JP3857357B2 (ja) 2006-12-13

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US (2) US5807393A (ja)
EP (1) EP0741996B1 (ja)
JP (1) JP3857357B2 (ja)
AU (1) AU722398B2 (ja)
CA (1) CA2175870C (ja)
DE (1) DE69631613T2 (ja)
ES (1) ES2216038T3 (ja)

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DE69631613D1 (de) 2004-04-01
AU722398B2 (en) 2000-08-03
AU5213596A (en) 1996-11-21
JP3857357B2 (ja) 2006-12-13
CA2175870A1 (en) 1996-11-09
EP0741996B1 (en) 2004-02-25
DE69631613T2 (de) 2004-12-16
EP0741996A2 (en) 1996-11-13
EP0741996A3 (en) 1997-04-23
US5807393A (en) 1998-09-15
US6024741A (en) 2000-02-15
CA2175870C (en) 2007-01-02
ES2216038T3 (es) 2004-10-16

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