JPH10113351A - 外科用締付け機構 - Google Patents

外科用締付け機構

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Publication number
JPH10113351A
JPH10113351A JP9262941A JP26294197A JPH10113351A JP H10113351 A JPH10113351 A JP H10113351A JP 9262941 A JP9262941 A JP 9262941A JP 26294197 A JP26294197 A JP 26294197A JP H10113351 A JPH10113351 A JP H10113351A
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Japan
Prior art keywords
anvil
cartridge
tissue
jaw
alignment
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JP4044653B2 (ja
Inventor
Bryan D Knodel
ブライアン・デイ・ノデル
David J Hughett
ジエイ・デイビツド・ヒユーエツト
Anil K Nalagatla
アニル・ケイ・ナラガトラ
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Ethicon Endo Surgery Inc
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Ethicon Endo Surgery Inc
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Publication of JPH10113351A publication Critical patent/JPH10113351A/ja
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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
    • 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
    • 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
    • A61B17/068—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
    • A61B2017/07285—Stapler heads characterised by its cutter
    • 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
    • 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
    • A61B2017/2934—Transmission of forces to jaw members camming or guiding means arcuate shaped guiding means
    • 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
    • A61B2017/2944—Translation of jaw members
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S227/00—Elongated-member-driving apparatus
    • Y10S227/901—Surgical clip appliers

Landscapes

  • 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)

Abstract

(57)【要約】 【課題】 組織が締め付けられている時、アンビルとカ
ートリッジの不整合は、防止又はかなり縮小され、ステ
ープルを偽形成する機会を低下させる。 【解決手段】 アンビルは、後方から前方位置にカート
リッジに関して可動であり、これら２つの構成部分の間
に組織を挿入し、組織を締め付ける。一対の離間したリ
ブが、アンビルから突出し、アンビルが後方から前方位
置に移動された時、これらのリブは、カートリッジの表
面に埋め込まれた溝内に収容され、摺動する。

Description

【発明の詳細な説明】
【０００１】
【産業上の利用分野】この発明は、外科手術を行うため
の器具に関する。さらに詳細には、発明は、内視鏡手術
中、外科医が身体組織を締め付け又はつかむ器具の締め
付け機構に関する。
【０００２】
【従来技術及びその課題】内視鏡手術中、体腔内の手術
部位への接近は、体壁において作られた小径の開口を通
して行われる。この接近を行うために頻繁に使用される
器具は、トロカールである。トロカールは、閉塞具とカ
ニューレを含む組立品である。閉塞具は、鋭い先端を有
し、体壁を穿刺し、接近開口を設けるために使用され
る。閉塞具は、中空の円筒形スリ―ブであるカニューレ
内を摺動する。閉塞具が、体壁を穿刺した時、閉塞具
は、カニューレから取り除かれる。しかし、カニューレ
は、閉塞具によって体壁に作られた開口内の適所にとど
まる。結果として、カニューレは、体腔内の手術部位に
接近するための円筒形通路を設ける。
【０００３】従って、多数の内視鏡手術器具の特性的特
徴は、トロカールカニューレを通って摺動することがで
きる長い円筒形シャフトである。体腔内の手術部位にお
いて組織と接触する器具の端部であるシャフトの鋭い端
部において、「末端効果器（ｅｎｄ ｅｆｆｅｃｔｏ
ｒ）」が、所望の手術を実施するために、あるやり方で
組織を巧みに扱うために提供される。末端効果器を含む
鋭い端部は、同様に、トロカールカニューレを通して摺
動することができなければならない。シャフトの反対端
部において、末端効果器の性能を遠隔制御するために、
鋭い端部に作動可能に連結されたアクチュエ−タがあ
る。アクチュエ−タは、一つ以上の旋回トリガを備えた
ピストル形握り取手を含むフレームにおいて都合よく収
容される。代替的に、アクチュエ−タは、レバー、もし
くは、旋回トリガとレバーの組合せを含む。アクチュエ
−タは、外科医が、トリガを旋回させるか、又はレバー
を押下する時、作動される。これらの作用はまた、末端
効果器にその所望の機能を行わせる。
【０００４】内視鏡手術器具の末端効果器の特に望まし
い機能は、組織を締め付ける又はつかむ末端効果器の能
力である。特別の手順を実施するために、組織が後引さ
れる又はそうでなければ正確に位置付けられる如く、組
織をつかむことが必要である。これらの機能を実施する
器具は、都合の良いことには、グラスパー及び開創器と
呼ばれる。いくつかの手順において、ステープルが組織
内へ発火された時、締め付けられた組織が締結される如
く、組織を締め付けることが、望ましい。ステープルを
締付けられた組織へ発火する末端効果器を備えた器具
は、直線ステープラー及びカッターと呼ばれる（カッタ
ーは、発火されたステープルの列の間でナイフで組織を
同時に切断するために、そのように名付けられる）。
【０００５】組織を締め付ける又はつかむ内視鏡手術器
具の末端効果器は、一般に、２つの対向した細長いあご
を有する。あごは、内部組織接触表面を有し、それらの
間で組織は締付けられ又はつかまれる。あごは、しばし
ば、下あごと上あごとして記載される。下及び上あご
は、相互に関して動く。あごが開位置に移動される時、
あごの組織締付け表面は、相互に離間され、組織は、２
つの表面の間に置かれる。あごが、閉位置に移動される
時、あごの組織接触表面は、相互に隣接して位置付けら
れ、あごの間に置かれた組織は、締付けられ又はつかま
れる。しばしば、グラスパーの組織接触表面は、組織を
つかむための強化表面を設けるためにぎざぎざをつけら
れ、両方のあごは、それらの開及び閉位置の間で旋回す
る。直線カッターとステープラーは、従来、固定下あご
と、下あごに関して開から閉位置に旋回する旋回上あご
を有する。固定下あごは、ステープルカートリッジを収
容するのための経路を含む。上あごは、一般に、アンビ
ルを含む。従って、直線ステープラー又はカッターが使
用される時、組織は、上あごを開位置において、カート
リッジとアンビルの間に置かれ、上あごは、カートリッ
ジとアンビルの間で組織を締め付けるために閉位置に旋
回され、続いて、ステープルは、カートリッジから締付
けられた組織へ発火され、アンビルに対して形成され
る。
【０００６】内視鏡手術器具の締付け及びつかみ機構の
重要な特徴は、上又は下あごを、あごの間に組織を置く
ための開位置からその組織を締め付けるための閉位置に
移動させる機構である。特に内視鏡直線カッターに対す
る共通な機構は、「カミング」閉止管の使用に係わる。
この管は、前後に往復運動する。後方位置において、あ
ごは、開位置である。その最前方位置において、上あご
は、閉位置へ旋回し、その結果、アンビルとカートリッ
ジは、互いに隣接する。後方位置において、管の遠位端
部は、上あごの近位に位置付けられる（言い替えれば、
管は、あごの後に位置する）。頻繁に単にアンビルと呼
ばれる上あごは、その近位端部において、所謂外側傾斜
カミング表面を有する。管が、後方から前方位置へ往復
運動する時、管の遠位端部は、アンビルの外側カミング
表面に沿って摺動し、又は「カム作用」する。このカミ
ング作用は、アンビルを開から閉位置へ旋回させる。
【０００７】残念なことに、対向あごの間で組織を締め
付ける又はつかむカミング機構は、非所望にも役に立た
ない。管の遠位端部が、アンビルの傾斜カミング表面に
対して摺動する時、カミング作用に付随した高摩擦損失
がある。これらの高摩擦損失は、機構の低効率を生ず
る。機構が非効率である時、より大きな力が、締付け機
構を作動させるために必要である。言い替えれば、器具
を使用する外科医は、トリガを圧搾し又はレバーを押下
し、締付け機構を作動させ、あごを閉じさせる時、より
大きな圧力を及ぼすことを必要とする。明らかに、末端
効果器の正確な位置付けは、阻害され、外科医が締め付
けのために加えなければならない圧力量が増大するにつ
れて、挫折が高まる。
【０００８】カミングのための閉止管の使用による別の
困難は、アンビルにおける傾斜カミング表面の要求であ
る。この表面が位置付けられるアンビルの部分は、ステ
ープルを形成するために使用されないために、この表面
は、実際、アンビルにおける「むだ（ｗａｓｔｅｄ）」
な表面領域である。内部組織接触表面であるアンビルの
ステープル形成表面は、埋め込まれたポケット又はくぼ
みを有し、ここで、カートリッジから発火されたステー
プルが、形成される。外側傾斜カミング表面と反対側の
アンビルの部分の内面は、その性質により、ステープル
形成のためのポケット又はくぼみを含む。このため、ス
テープルは、アンビルの内面の全長に沿って形成されな
い。これは、アンビルが必要なよりも長いことを意味す
る。結果として、組織があごの間で締付けられた時、あ
ごは、非所望にも、「曲がる（ｆｌｅｘ）」又はねじれ
る。厚い組織を締め付けるために必要な力は、薄い組織
を締め付けるために必要な力よりも大きいために、組織
があごの間で締付けられた時、これは、頻繁に問題にな
る。あごの曲がり又はねじりが発生する時、発火された
時、ステープルを偽形成させ、組織は不適当に締結され
る。
【０００９】傾斜カミング表面に関する別の問題は、カ
ートリッジの組織接触表面よりも長いアンビルの使用を
必要とするために、アンビル上に「組織止め（ｔｉｓｓ
ｕｅｓｔｏｐ）」を組み込むことが、必要になることで
ある。組織止めは、ステープルが発火されない傾斜カミ
ング表面と反対側のアンビルの部分へのあごの間に置か
れた組織の通過を遅らせる。組織止めは、一般に、細長
いアンビル本体から下行する一対の側面である。これら
の側面は、組織があごの間に置かれた時、組織と接触
し、このため、組織のさらに近位の移動を妨げる。残念
なことに、組織止めは、時々、組織の後方通過を防止す
るために効果がなく、これは、もちろん、ステープルさ
れていない組織を横切開させる。
【００１０】カム閉鎖機構に関連して観察される別の困
難は、あごが開位置にある時のあごの間の開口、又はア
ンビルが傾斜カミング表面を有する時創成された「ギャ
ップ（ｇａｐ）」が、所望のものよりも小さいことであ
る。ギャップは大きいほど、良い。これは、広いギャッ
プにより、外科医は、締め付けの前に、あごの間で組織
をさらに容易に位置付けることができるためである。適
正な組織位置付けは、適正なステープル形成の見込みを
増大させる。さらに、ステープルが発火された後に、あ
ごは、開位置に戻され、しばしば、消費したステープル
カートリッジを取り除き、続く発火のために、それに新
しいもの再装填することが必要となる。もう一度、大き
なギャップは、外科医又は手術室助手が消費したカート
リッジを取り除き、それに新しいものを再装填すること
を容易にする。
【００１１】最後に、カム閉鎖機構は、さらに他の欠点
を有する。末端効果器が、体腔内の手術部位に位置付け
られた時、下方力がアンビルの遠位端部に加えられたな
らば、アンビルは、その開から閉位置へ旋回する。これ
は、アンビルが身体組織又は器官に対して改めてみがき
をかける時、頻繁に発生する。この不注意の閉鎖は、手
術中、破裂と時間の損失を生じさせる。さらに、アンビ
ルは「正（ｐｏｓｉｔｉｖｅ）」の開位置、又は確実に
固定された開位置を有さないために、末端効果器は、解
剖器具として効果的でない。これは、全体として、器具
のたわみ性と所望性を制限する。
【００１２】別の締付け機構は、ロシア特許Ｎｏ．７２
８、８４８において記載される。この機構はまた、開か
ら閉位置にアンビルを旋回させるために後方から前方位
置に移動する往復閉止管を有する。横ピンは、アンビル
に添着され、閉止管は、閉止管におけるスロット内でこ
れらのピンに載上する。この機構は、アンビルにおいて
傾斜カミング表面を有する閉鎖機構に付随したいくつか
の欠点を避けるが、それは、閉止管とアンビルの間の相
対移動を必要とする。結果として、アンビルのすべて
が、ステープル形成のために使用されるわけではない。
大きなアンビル長は、厚い組織が締付けられた時、曲が
り又はねじりを生じさせ、潜在的にステープルの偽形成
に帰着する。アンビルが開位置にある時、組織接触表面
の間のギャップは、望ましいよりも小さい。
【００１３】組織がアンビルとステープルカートリッジ
の間で締付けられた時生ずる別の問題は、アンビルが開
から閉位置に移動される時、アンビルがカートリッジに
関して不整合にされることである。これは、結果とし
て、組織の不適当な締め付けを生じさせ、究極的に、組
織においてステープルを偽形成又は誤配置させる。
【００１４】このため、前述の内視鏡手術器具のための
締付け機構において固有の欠点を考慮して、より良い締
付け又はつかみ機構を備えた内視鏡手術器具が、望まれ
る。この締付け機構は、組織があごの間に置かれた開位
置からその組織の締め付け又はつかみのための閉位置
へ、器具の末端効果器のあごの相対移動を生じさせる。
機構は、摩擦損失を低減させ、このため、文献等におい
て記載された機構よりも、大きい効率を設ける。それは
また、しばしばアンビルを表現する上あごの全長を完全
に利用し、結果として、組織が締付けられた時、あごの
曲がり又はねん回を縮小する。さらに、開位置において
あごの間の広いギャップの創成を可能にする効率的な締
付け機構は、カートリッジ除去及び再装填とともに、あ
ごにおける組織の位置付けを容易にする。あごが切開の
ために使用されるように、開位置においてあごの間に正
の開口を設けるそのような締付け機構が開発されたなら
ば、望ましい。さらに、アンビルが組織を締め付けるた
めに閉じられるために、あごの間に適正な整合を保証す
る機構が提供されたならば、望ましい。
【００１５】
【課題を解決するための手段】一実施態様において、発
明は、６つの基本要素を具備する手術器具である。これ
らの要素は、次のものである。ａ）器具を把持するため
の剛性フレーム、ｂ）フレームから細長いし、遠位端部
を有する細長いシャフト、ｃ）近位及び遠位端部を有す
る第１及び第２あごを含むシャフト遠位端部から細長い
する末端効果器、ｄ）第２あごの近位端部と協働的に掛
合された第１支柱、ｅ）第２あごの近位端部に添着され
たプッシャー部材、ｆ）フレームにおいて少なくとも部
分的に収容されたアクチュエ−タ。
【００１６】末端効果器のあごは、身体組織を収容する
ための開位置からこの組織を締め付け又はつかむための
閉位置へ、相互に関して可動である。第１あごは、基部
と第１及び第２側壁を有する細長い経路を含む。各側壁
は、近位及び遠位端部を有し、側壁は、基部から第２あ
ごに向って配される。各側壁は、相互に対向した細長い
スロットを有する。各スロットは、側壁の近位端部に隣
接した最下端部から、側壁の遠位端部に向った最上端部
へ、上方に斜め表示される。さらに、第２あごは、組織
接触表面を含む。
【００１７】第２あごに協働的に掛合された第１支柱
は、相互に対向した細長いスロット内に収容され、ここ
で、それはスロット内で摺動することができる。
【００１８】第２あごに添着されたプッシャー部材は、
第２あごの組織接触表面に隣接して配設される。或る実
施態様において、細長いシャフトの遠位端部は、プッシ
ャー部材として作用する。プッシャー部材は、後方位置
から前方位置に可動である。プッシャー部材が後方位置
にある時、第１ピンは、スロットの最下端部において位
置付けられ、第２あごの遠位端部は、第１あごの遠位端
部の後方に表示される。支柱と第２あごが、このように
して位置付けられた時、第１及び第２あごは、それらの
開位置において表示される。プッシャー部材が前方位置
にある時、第１支柱は、スロットの最上端部に移動し、
第２あごの遠位端部は、第１あごの遠位端部に隣接す
る。この位置において、第１及び第２あごは、閉位置に
おいて表示される。
【００１９】アクチュエ−タは、細長いシャフトと協働
したプッシャー部材に作動可能に連結される。それは、
前方位置から後方位置へプッシャー部材の移動を行わせ
る。結果として、第２あごは、定置した第１あごに対し
て、開から閉位置に移動される。
【００２０】この発明の手術器具は、末端効果器のあご
の間で組織をより効率的に締め付ける又はつかむための
機構を含む。プッシャー部材は、第１あごから離間した
位置から第１あごに隣接した位置に第２あごを移動させ
るために、第２あごに関して移動しない。むしろ、プッ
シャー部材は、第２あごの近位端部に当接し、その結
果、プッシャー部材が後方に移動する時、第２あごは、
連繋して後方に移動する。同様に、プッシャー部材が前
方に移動する時、第２あごは、それと共に前方に移動す
る。基本的に、第１及び第２あごの開及び閉位置は、側
壁の近位端部に隣接した最下端部から側壁の遠位端部に
向った最上端部への、第１側壁のスロットに載上する第
１支柱の移動により、創成される。
【００２１】重要なことに、締付け又はつかみ機構は、
開から閉位置に第２あごを移動させるために、従来の傾
斜カミング表面を使用しない。従って、第２あごは、近
位端部において傾斜カミング表面を必要とせず、閉鎖を
行うために、プッシャー部材が第２あごに関して前方に
移動し、このあごにカミング力を設けることは、不必要
である。このため、第２あごをその閉位置に向ってカム
作用させるために必要な摩擦力を生ずる際に固有の非効
率性は、除去された。究極的に、摩擦力は低下されるた
めに、この発明の手術器具における締付け機構では、使
用者は、従来のカミング機構に対して必要とされた力と
比較して、あごの間で組織を締付けるために小さな力し
か必要とされない。
【００２２】締め付けのための従来のカミング機構の除
去は、別の有意義な利益を提供する。第２あごにおける
カミング表面は、取り除かれたために、第２あごのほぼ
全長が、組織を締め付けるために使用される。実際に、
開から閉位置にあごを移動させるプッシャー部材は、第
２あごの組織接触表面に隣接して位置付けられる。第２
あごの操作長は、結果として、あごの実長とほぼ同一で
ある。第２あごは、このため、器具の重量を低減させる
ために、薄いビームから作製され、組織が締付けられた
時あごが曲がる又はねじれる傾向は、縮小される。
【００２３】この発明の手術器具の締付け機構に対する
別の付加的利益は、あごが開位置にある時、あごの間に
組織を都合良く位置付ける能力である。これは、あごが
開位置にある時、第２あごが、第１あごの遠位端部の後
方に位置付けられるためである。第２あごの後方位置付
けは、開位置においてあごの間に広いギャップを生成
し、このため、あごの間に組織を位置付ける器具の使用
者の能力を高める。第１あごが、第１あごの細長い経路
において収容されたステープルカートリッジを含む時、
それはまた、経路から消費したカートリッジを取り除
き、それに新しいものを再装填する使用者の能力を高め
る。
【００２４】最後に、プッシャー部材は、第２あごの近
位端部に添着されるために、第２あごは、アクチュエ−
タがプッシャー部材を移動させるために操作されるま
で、その開位置にとどまる。対照的に、先行技術のカミ
ング機構は、一般に、第２あごを離間位置において維持
するために、ばね押圧にたよった。それ自体、使用者
が、第２あごを第１あごに隣接した閉位置に移動させる
ことを望む時、それは、容易にこの位置に移動される。
言い替えれば、この発明の手術器具へ組み込まれた締付
け又はつかみ機構は、確実な開口を設け、このため、あ
ごが、手術中、様々な方法で組織を操作するために位置
付けられている時、大きな信頼性を提供する。
【００２５】別の実施態様において、発明は、細長いス
テープルカートリッジと細長いアンビルを具備する外科
用ステープリング器具である。細長いステープルカート
リッジは、カートリッジ締付け表面と、カートリッジ整
合表面を細長いステープルカートリッジの近位端部にお
いて有する。カートリッジ整合表面は、カートリッジ締
付け表面に隣接する。カートリッジ整合表面は、表面内
に埋め込まれた整合溝を含む。細長いアンビルは、カー
トリッジ締付け表面に面するアンビル締付け表面を有す
る。それはまた、表面の近位端部においてアンビル整合
表面を有する。アンビル整合表面は、アンビル締付け表
面に隣接する。アンビル整合表面は、表面からつき出る
一対の離間された整合リブを含む。
【００２６】細長いアンビルは、カートリッジ及びアン
ビル締付け表面が表面の間の組織の挿入のために相互に
離間された後方位置から、カートリッジ及びアンビル締
付け表面が組織の締め付けのために互いに隣接する前方
位置に、細長いステープルカートリッジに関して可動で
ある。細長いアンビルが、後方位置から前方位置に移動
される時、アンビル整合表面における整合リブは、カー
トリッジ整合表面における整合溝内に収容され、摺動す
る。
【００２７】アンビルが、後方から前方位置に移動され
る時、カートリッジのカートリッジ整合表面内の整合溝
とアンビルのアンビル整合表面における整合リブの間の
相互作用は、組織が締付けられた時、２つのあごのミス
整合をかなり最小化又は防止する。結果として、組織
は、あごの間に適正に締付けられ、器具が発火された
時、ステープルの誤発火又は偽形成は、かなり縮小され
る。
【００２８】この発明の手術器具は、その最大の利益を
引き出し、内視鏡手術法のために主に適合される。しか
し、内視鏡手術法だけでなく、従来の開手術法において
も、この発明の手術器具の応用を見いだすことは、完全
に予知でき、この発明の範囲内にある。
【００２９】
【実施例】最初に図１を参照すると、この発明の好まし
い手術器具である、内視鏡直線カッター１０の一般図
が、示される。カッターは、器具を把持するための剛性
フレーム１１と、フレームから配された円筒管の形式に
おける細長いシャフト１２と、シャフトの遠位端部１４
に取り付けられた末端効果器１３を有する。フレーム
は、末端効果器の締め付け及び発火機構を作動させるた
めに、末端効果器に作動可能に連結されたアクチュエ−
タ１５を有する。アクチュエ−タは、パームグリップハ
ンドル１６、締付けトリガ１７と発火（ｆｉｒｉｎｇ）
トリガ１８を含む。末端効果器は、それぞれ、近位及び
遠位端部２０と２１を有する第１あご１９を含む。同様
に、末端効果器は、それぞれ、近位及び遠位端部２３と
２４を有する第２あご２２を含む。第１あごは、ステー
プルカートリッジ２５を収容するための細長い経路の形
式において形状付けられる（ステープルのためのスロッ
トは不図示）。ステープルカートリッジは、形成された
ステープルの列の間で締結された組織を切り取るため
に、ナイフ刃（不図示）の通過のための縦スロット２６
を有する。第２あごは、ステープルが形成されるアンビ
ルを表現する。締付けトリガが、パームグリップハンド
ルに対して圧搾された時、カートリッジとアンビルの間
に位置付けられた組織が、締付けられる。一旦、組織が
締付けられたならば、発火トリガが、締付けトリガに対
して圧搾され、カートリッジから組織を通ってステープ
ルを発火させ、アンビルに対してステープルを形成す
る。内視鏡手術法においてカッターの使用を容易にする
ために、細長いシャフト１２は、トロカールカニューレ
に嵌通される細長い円筒管である。内視鏡直線カッター
は、非常に公知であり、特別な締め付け及び発火機構の
詳細は、多数の特許において記載された。例えば、米国
特許Ｎｏ．５、０４０、７１５とＮｏ．５、３０７、９
７６を参照せよ。
【００３０】図２と図３を参照すると、末端効果器１３
の細部が、図示される。末端効果器の主要構成部分は、
第１あごを表現する細長い経路１９、第２あごを表現す
るアンビル２２、一対のアンビル案内スロット２８と２
９内の協働すべり移動のためにアンビルの近位端部２３
に取り付けられた第１スロット支柱２７、及び、この特
に好ましい実施態様において、開から閉位置に経路に関
してアンビルを動かすためのプッシャー部材として作用
する円筒管１２である。単純性と明瞭性のために、細長
い経路に嵌込む図１に示されたステープルカートリッジ
２５は、示されない。
【００３１】細長い経路１９は、基部３０と第１及び第
２側壁３１と３２をそれぞれ有する。第１側壁は、近位
及び遠位端部３３と３４をそれぞれ有する。同様に、第
２側壁は、近位及び遠位端部３５と３６をそれぞれ有す
る。側壁は、互いに対向し、アンビルに向って一般平行
関係において基部から配設される。ステープルカートリ
ッジは、カートリッジの底部が基部上に据えられ、カー
トリッジの側部が、経路の側壁の内壁に対して居心地よ
く収まる如く、経路へ挿入される。側壁の遠位端部にお
ける第１及び第２カートリッジクリップ３７と３８は、
それぞれ、経路へ納められた時、カートリッジの締まり
ばめを保証する。第１及び第２の細長いアンビル案内ス
ロット２８と２９は、それぞれ、第１及び第２側壁にお
いて表示される。各側壁は、側壁の近位端部３３に隣接
した最下端部から最下端部の遠位に位置付けられた最上
端部へ上方に斜めに配される。各側壁の近位端部に隣接
して、第１及び第２保持スロット３９と４０と第１及び
第２保持クリップ４１と４２がある。
【００３２】アンビルは、細長い経路に面する組織接触
表面４３を有する。組織接触表面の近位端部に隣接し
て、アンビルに取り付けられた２つの支柱がある。第１
支柱２７は、アンビルにおける最近位の位置において取
り付けられ、経路の第１及び第２アンビル案内スロット
において収容された長スロット支柱である。第２支柱４
４は、第１支柱の遠位に位置付けられた短いすべり支柱
である。第２支柱は、組織があごの間に存在しない時、
経路の側壁の第１及び第２すべり表面４５と４６にそれ
ぞれ載置される。組織接触表面と反対側のアンビルの表
面において、閉止管支持表面４７と傾斜面４８がある。
【００３３】閉止管１２の遠位端部１３は、細長い経路
に関して開から閉位置にアンビルを移動させるために、
アンビルと協働する。従って、それは、アンビルの閉止
管支持表面４７と接触しているアンビルスラスト表面４
９と、アンビルの傾斜面と同様に協働する閉止管（不図
示）の遠位端部の内部において埋め込まれた傾斜面を有
する。第１及び第２固定スロット５０と５１が、それぞ
れ、アンビルに管を固定するために使用される閉止管の
遠位端部において表示される。固定スロットがアンビル
に管を固定するために使用される方法は、下記の図４と
図５の議論に関連して例示され、さらに詳細に記載され
る。
【００３４】細長い経路１９は、保持棒５２への器具の
シャフトの遠位端部に添着される。保持棒は、細長いシ
ャフト内に収容され、言い替えれば、それは、プッシャ
ー部材として機能する円筒管の中空内部にはめ込まれ
る。保持棒は、その遠位端部において経路リテ―ナ５３
を有する。経路リテ―ナは、第１及び第２保持壁５６と
５７からそれぞれ放射状外側に配された第１及び第２固
形弧状表面５４と５５を有する。経路リテ―ナはまた、
第１及び第２保持壁内にそれぞれ配された第１くぼみ部
分５８と第２くぼみ部分（不図示）を含む。経路リテ―
ナは、細長い経路の近位端部において第１及び第２保持
スロット３９と４０へはめ込まれ、第１及び第２保持ク
リップ４１と４２は、保持壁における第１及び第２くぼ
みに対して偏向される。このようにして、保持棒の遠位
端部は、細長い経路の近位端部に取り付けられる。最後
に、保持棒（図３）の近位端部において、棒保有溝５９
がある。この溝は、棒の軸方向移動を防止し、同時に、
回転移動を許容するために、器具のフレーム１１内の棒
の近位端部の取付けを容易にする。
【００３５】図４と図５は、開及び閉位置における細長
い経路１９とアンビル２２の間の位置関係を示す。最初
に、あごが開から閉位置へ移動された時、閉止管とアン
ビルの間に実質的に相対移動がないことが強調されるべ
きである。言い替えれば、閉止管が、前方に移動する
時、アンビルは、連繋して前方に移動する。同様に、閉
止管が後方に移動する時、アンビルは、同様に後方に移
動する。アンビルリテーナ戻り止め６０は、第１及び第
２固定スロット５０と５１（図２）の間に位置付けられ
た閉止管の部分がクリンピングされた時、アンビルに閉
止管の遠位端部１４を添着するために創成される。
【００３６】特に図４を参照すると、閉止管１３が、そ
の後方位置において示される。この位置において、第１
スロット支柱は、経路の側壁におけるアンビル案内スロ
ットの最下端部内に位置付けられ、あごは、開位置にあ
る。開位置において、アンビルは、細長い経路から離間
され、アンビルの遠位端部２４は、経路の遠位端部２１
の後方にある。図５を参照すると、閉止管が、前方位置
まで前方に移動された時、あごは、閉位置にある。第１
スロット支柱は、側壁における最下端部から最上端部へ
アンビル案内スロットに載上し、第２すべり支柱は、組
織が存在しない時、あごの開放中、遠位方向において経
路の第１及び第２すべり表面４５と４６において摺動す
る。あごが、閉位置にある時、アンビルは、経路に隣接
する。組織が存在する時、第２すべり支柱は、締め付け
に対する組織の抵抗により、経路のすべり表面４５と４
６から引き上げられる。さらに、閉止管とアンビルは、
連繋して前方に移動したために、アンビルの遠位端部
は、経路の遠位端部の後方にもはやなく、むしろ、アン
ビルと経路の遠位端部は、互いにほぼ一致する。
【００３７】図６と図７を参照すると、あごの間に身体
組織を挿入するための開位置から、組織を締め付けるた
めの閉位置にあごを移動させる締付けシ−ケンスが、示
される。アクチュエ−タ１５の締付けトリガ１７が、パ
ームグリップハンドル１６に対して圧搾された時、閉止
管１２は、後方位置から前方位置に移動させられ、結果
として、カートリッジ充填経路から離間された位置から
経路に隣接した位置にアンビルを移動させる。図６と図
７において、フレームの下半分が、図示される。フレー
ムの上半分は、下半分に単純に成形され、締め付けと発
火のための機構を完全に取り囲む。締付けトリガ１７が
圧搾された時、それは、軸受けピン６１の周りで旋回す
る。クロ−ジュアピニオン６２は、アクチュエ−タラッ
ク６３と協働し、アクチュエ−タラックは、縦前方に移
動する。アクチュエ−タラックは、閉止管アクチュエ−
タ６４の構成部分である。閉止管アクチュエ−タは、そ
の遠位端部において、閉止管の近位端部６７に添着され
た第１及び第２腕６５と６６をそれぞれ有する。結果と
して、締付けトリガが圧搾され、アクチュエ−タラック
が前方に移動する時、閉止管アクチュエ−タは、同様
に、前方に移動し、閉止管を後方から前方位置に移動さ
せる。棒保有溝５９が、フレームの下及び上半分におけ
る第１及び第２嵌合ボス（不図示）と接触するために、
保持棒５２は、フレームに固定される。この特別な構成
により、保持棒は、軸方向固定位置にとどまるが、使用
者は、回転ノヴ６８を回すことにより、保持棒、閉止管
と末端効果器を回転させることができる。一旦、締付け
トリガが、あごの間で組織を締付けるために圧搾された
ならば、発火トリガは、続いて、組織へステープルを発
火するために圧搾され、同時に、ステープルの列の間で
切断する。あごの間で組織を締め付けるための機構と、
発火し組織を切断するための構造及び機構の一層の詳細
は、一般に譲渡された、米国特許Ｎｏ．５、４６５、８
９５において記載される。
【００３８】図８は、外科用締結組立品６９の形式にお
けるこの発明の内視鏡直線カッターの好ましい末端効果
器を示す。組立品は、カートリッジ経路７１へはめ込ま
れた細長いステープルカートリッジ７０を有する。ステ
ープルカートリッジは、細長いアンビル７２に面する。
【００３９】細長いステープルカートリッジの詳細が、
図１２〜図１４と関連して、図８において例示される。
カートリッジは、その近位端部においてカートリッジ整
合表面７３を有する。カートリッジ整合表面から遠位
に、一般平面のカートリッジ締付け表面７４が配設され
る。ステープルスロット７５の３つのオフセット垂直列
が、カートリッジ締付け表面内に同様に埋め込まれたナ
イフスロット７６の各側においてカートリッジ締付け表
面内に埋め込まれる。各ステープルスロットは、ステー
プル（不図示）を収納し、カッターが発火された時、排
出され、アンビルに対して形成される。
【００４０】ステープルカートリッジは、カートリッジ
のカートリッジ整合表面７３内に埋め込まれた整合溝７
７を含む。カートリッジナイフスロット７６は、同様
に、整合溝内に埋め込まれ、結果として、カートリッジ
整合表面の近位端部からカートリッジのカートリッジ締
付け表面の遠位端部の隣接まで配設される。カッターが
発火された時、切削ナイフ（不図示）は、カートリッジ
を通ってナイフスロット内を遠位にすべり、組織を締結
するために発火された３列のステープルのセットの各々
の間で組織を切断する。
【００４１】締結組立品６９の細長いアンビル７２が、
図１５〜図１７と関連して、図８において詳細に示され
る。細長いアンビルは、近位端部におけるアンビル整合
表面７８と、整合表面から遠位のアンビル締付け表面７
９を有する。アンビル及びステープルカートリッジの整
合及び締付け表面は、互いに面するように位置付けら
れ、各構成部分の表面は、相互に対向する。アンビル整
合表面は、カートリッジの嵌合表面と直接に相互作用し
ないが、次の如く整合機能を起こす。アンビル整合表面
は、アンビル整合表面からカートリッジ整合表面の方へ
つき出る一対の離間された整合リブ８０を有する。整合
リブは、好ましくは、互いに全く同じ形状及び大きさに
され、カートリッジ整合表面における整合溝内に収容さ
れ、摺動するように設計される。アンビル締付け表面
は、カートリッジのカートリッジ締付け表面内に埋め込
まれた対応するステープルスロットと嵌合する３つのオ
フセット垂直列のステープル形成ポケット８１の２つの
セットを有する。ステープルが、カートリッジにおける
スロットから排出された時、ステープルは、それぞれの
ステープル形成ポケット内のアンビルに対して形成され
る。アンビルナイフスロット８２は、アンビル内に埋め
込まれ、アンビル整合表面の近位端部からアンビル締付
け表面の遠位端部の隣接まで配設される。アンビルナイ
フスロットは、離間された整合リブの間に位置し、アン
ビル締付け表面内に埋め込まれた３列のステープル形成
ポケットの２つのセットを分離する。
【００４２】図９〜図１１と図１３を簡単に参照する
と、使い捨てカートリッジを除去可能に収容するための
カートリッジ経路７１が、示される。経路は、カートリ
ッジ取付表面８４によって分離された第１及び第２の離
間側壁８３を有する。経路は、第１及び第２側壁の間の
カートリッジ取付表面においてカートリッジを確実に位
置させるような大きさにされる。カートリッジ経路にお
けるカートリッジの適正な配置を容易にするために、カ
ートリッジ経路は、カートリッジ７０の側面において表
示された対応する位置決めタブ９１を収容する２つのノ
ッチ９０を有する。適正な配置をさらに容易にするため
に、カートリッジ取付表面は、カートリッジの下側にお
いて表示されたピン８６を収容するカートリッジクリア
ランスホール８５を有する。
【００４３】図４〜図７において図示の如く、アンビル
とカートリッジの締付け表面の間で組織を締め付けるた
めに、アンビルが前方に移動された時、アンビル整合表
面からつき出る整合リブの対は、カートリッジのカート
リッジ整合表面内に埋め込まれた整合溝に収容され、摺
動する。このようにして、組織の締め付けに応答して、
開位置から閉位置へ移動された時、アンビルが不整合に
なる傾向は、縮小される。アンビルが閉位置にあり、ア
ンビルとカートリッジの締付け表面が、組織を締め付け
るために互いに隣接する時、ステープリング器具は、発
火される用意が整う。発火された時、ステープルは、組
織を締結するために排出されるだけでなく、ナイフは、
スライド整合溝内に埋め込まれたナイフスロットのため
に、カートリッジと整合表面の離間された整合リブの間
を、締結組立品を通って遠位に摺動する。
【００４４】好ましい締結組立品６９の別の潜在的に有
益な特徴が、図８と図１５〜図１７において例示され
る。特に、所望時に、アンビル７２の近位端部は、アン
ビルが開から閉位置に移動された時、カートリッジ経路
にまたがる一対の外側組織止め具８７を含む。各外側組
織止め具は、止め前縁８８を有し、アンビルの整合リブ
の対における前縁８９と組み合わせて、アンビルとカー
トリッジの締付け表面の近位の組織の「ミルキング」を
かなり縮小又は防止する。この特定の実施態様におい
て、外側組織止め具前縁が整合リブの前縁の遠位に位置
するために、前縁の位置付けは、特に望ましい。
【００４５】この発明が、最も好ましい実施態様に関連
して記載されたが、読者は、この説明により、下記のク
レームに関連して主張された発明の範囲を制限するべき
ではない。明らかに、多数の付加的な実施態様が、技術
における当業者に容易に明らかになり、本発明の範囲及
び精神内に入るであろう。例えば、発明は、内視鏡の応
用に特に適合されるが、開手術におけるこの発明の多数
の応用が、見いだされることは十分に可能であると考え
られる。さらに、末端効果器が、内視鏡直線カッターに
関連して記載されたが、多数の末端効果器構成が、使用
され、次のクレイムの範囲内に入ることは容易に明らか
になる。
【００４６】本発明の主なる特徴及び態様は以下のとお
りである。
【００４７】１．ａ）カートリッジ締め付け表面と、該
カートリッジ締め付け表面に隣接した近位端部における
整合溝を埋め込んだカートリッジ整合表面とを有する細
長いステープルカートリッジと、 ｂ）該カートリッジ締め付け表面に面するアンビル締め
付け表面と、該アンビル締め付け表面に隣接した近位端
部における突出する一対の離間整合リブを含むアンビル
整合表面とを有する細長いアンビルとを具備し、該細長
いアンビルは、該カートリッジ及びアンビル締め付け表
面が組織の挿入のために互いに離間された後方位置か
ら、該カートリッジ及びアンビル締め付け表面が組織の
締め付けのために互いに隣接した前方位置へ、該細長い
ステープルカートリッジに関して可動であり、該細長い
アンビルが、該後方位置から該前方位置に移動された
時、該アンビル整合表面における該整合リブは、該カー
トリッジ整合表面における該整合溝内に収容され、摺動
する外科用ステープリング器具。
【００４８】２．該細長いステープルカートリッジの該
カートリッジ締め付け及び整合表面が、カートリッジナ
イフスロットを埋め込み、該カートリッジナイフスロッ
トが、該カートリッジ整合表面において埋め込まれた該
整合溝内に埋め込まれる上記１に記載の器具。
【００４９】３．該細長いアンビルの該アンビル締め付
け及び整合表面が、アンビルナイフスロットを埋め込
み、該アンビルナイフスロットが、該離間整合リブの間
に位置する上記２に記載の器具。
【００５０】４．該細長いアンビルが、該アンビル締め
付け表面の近位端部において一対の外側組織止めを配設
し、該細長いアンビルが該前方位置にある時、該外側組
織止めは、該カートリッジ締め付け表面の近位端部に隣
接して該細長いカートリッジにまたがる上記３に記載の
器具。
【００５１】５．該外側組織止めの各々が、止め前縁を
有し、該整合リブの各々が、リブ前縁を有し、該止め前
縁が、該リブ前縁の遠位に位置する上記４に記載の器
具。
【図面の簡単な説明】
【図１】内視鏡直線カッターである、発明の最も好まし
い手術器具の斜視図である。
【図２】直線カッターの末端効果器の分解斜視図であ
る。
【図３】直線カッターの末端効果器の組立て斜視図であ
る。
【図４】後方位置におけるプッシャー部材と身体組織を
収容するための開位置におけるあごを含む末端効果器の
組立て斜視図である。
【図５】前方位置におけるプッシャー部材と身体組織を
締め付けるために閉位置におけるあごを含む末端効果器
の組立て斜視図である。
【図６】取り除かれたプッシャー部材に対して成形フレ
ームの上半分とアクチュエ−タの上半分を有する内視鏡
直線カッターの側面図である。器具は、あごを開位置に
して示される。遠位端部は、明瞭性のために短縮され
た。
【図７】取り除かれたプッシャー部材に対して成形フレ
ームの上半分とアクチュエ−タの上半分を有する内視鏡
直線カッターの側面図である。器具は、締付けトリガを
圧縮させ、発火トリガを発火位置において示される。従
って、器具は、あごを閉位置にして示される。遠位端部
は、明瞭性のために短縮された。
【図８】カートリッジ経路において正しく込められたス
テープルカートリッジとアンビルを含む外科用締結組立
品の形式における内視鏡直線カッターのための好ましい
末端効果器の斜視図である。
【図９】図８に例示されたカートリッジ経路の平面図で
ある。
【図１０】明瞭性のために前壁の左端部分が取り壊され
た、図９のカートリッジ経路の側面図である。
【図１１】図１０の線１１−１１に沿って取ったカート
リッジ経路の端部図である。
【図１２】図８に例示されたステープルカートリッジの
平面図である。
【図１３】図１２のステープルカートリッジの側面図で
ある。
【図１４】図１３の線１４−１４に沿って取ったステー
プルカートリッジの端面図である。
【図１５】アンビルが組織の締め付けから負荷を受けた
時、図８に例示されたアンビルの側面図である。負荷が
存在しない時、アンビルの形状は、仮線で示される。
【図１６】図１５のアンビルの底面図である。
【図１７】図１５の線１７−１７に沿って取った断面図
である。
【符号の説明】
１０ カッター １１ フレーム １２ シヤフト １３ 効果器 １５ アクチユエータ １６ ハンドル １７ トリガ
フロントページの続き (72)発明者 アニル・ケイ・ナラガトラ アメリカ合衆国オハイオ州45449ウエスト キヤロルトン・シヨーニーラン341シー

Claims (1)

    【特許請求の範囲】
  1. 【請求項１】 ａ）カートリッジ締め付け表面と、該カ
    ートリッジ締め付け表面に隣接した近位端部における整
    合溝を埋め込んだカートリッジ整合表面とを有する細長
    いステープルカートリッジと、 ｂ）該カートリッジ締め付け表面に面するアンビル締め
    付け表面と、該アンビル締め付け表面に隣接した近位端
    部における突出する一対の離間整合リブを含むアンビル
    整合表面とを有する細長いアンビルとを具備し、該細長
    いアンビルは、該カートリッジ及びアンビル締め付け表
    面が組織の挿入のために互いに離間された後方位置か
    ら、該カートリッジ及びアンビル締め付け表面が組織の
    締め付けのために互いに隣接した前方位置へ、該細長い
    ステープルカートリッジに関して可動であり、該細長い
    アンビルが、該後方位置から該前方位置に移動された
    時、該アンビル整合表面における該整合リブは、該カー
    トリッジ整合表面における該整合溝内に収容され、摺動
    する外科用ステープリング器具。
JP26294197A 1996-09-12 1997-09-11 外科用締付け機構 Expired - Lifetime JP4044653B2 (ja)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US08/713,055 US5814055A (en) 1995-09-19 1996-09-12 Surgical clamping mechanism
US08/713055 1996-09-12

Publications (2)

Publication Number Publication Date
JPH10113351A true JPH10113351A (ja) 1998-05-06
JP4044653B2 JP4044653B2 (ja) 2008-02-06

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Country Status (7)

Country Link
US (1) US5814055A (ja)
EP (1) EP0829235B1 (ja)
JP (1) JP4044653B2 (ja)
AU (1) AU716012B2 (ja)
CA (1) CA2215636C (ja)
DE (1) DE69722540T2 (ja)
ES (1) ES2201248T3 (ja)

Cited By (10)

* Cited by examiner, † Cited by third party
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JP2006501954A (ja) * 2002-10-04 2006-01-19 タイコ ヘルスケア グループ エルピー 外科的ステープルデバイスのためのツールアセンブリ
JP2007105471A (ja) * 2005-10-11 2007-04-26 Ethicon Endo Surgery Inc エンド・エフェクター支持部付き手術用ステープラー
JP2009165717A (ja) * 2008-01-18 2009-07-30 Hoya Corp スライド部材の進退機構
JP2009189843A (ja) * 2008-02-15 2009-08-27 Ethicon Endo Surgery Inc 外科的な切開およびステープル縫合装置用の使い捨て装填ユニット
JP2010508873A (ja) * 2006-11-06 2010-03-25 ジョンソン・エンド・ジョンソン株式会社 ステープル装置
KR101141030B1 (ko) 2004-06-30 2012-07-12 에디컨 엔도-서저리 인코포레이티드 회전 전동부를 갖는 불균일 다중 스트로크 발사 기구를구비한 수술용 스테이플링 도구
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EP0829235B1 (en) 2003-06-04
ES2201248T3 (es) 2004-03-16
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AU716012B2 (en) 2000-02-17

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