JPS62101238A - 関節式外科用留め具付け装置 - Google Patents

関節式外科用留め具付け装置

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Publication number
JPS62101238A
JPS62101238A JP61203547A JP20354786A JPS62101238A JP S62101238 A JPS62101238 A JP S62101238A JP 61203547 A JP61203547 A JP 61203547A JP 20354786 A JP20354786 A JP 20354786A JP S62101238 A JPS62101238 A JP S62101238A
Authority
JP
Japan
Prior art keywords
fastener
assembly
actuator
shaft assembly
tube
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
JP61203547A
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English (en)
Other versions
JPH0468941B2 (ja
Inventor
ティー グリーン ディヴィッド
アラニー アーニー
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United States Surgical Corp
Original Assignee
United States Surgical Corp
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Publication date
Application filed by United States Surgical Corp filed Critical United States Surgical Corp
Publication of JPS62101238A publication Critical patent/JPS62101238A/ja
Publication of JPH0468941B2 publication Critical patent/JPH0468941B2/ja
Granted legal-status Critical Current

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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
    • 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
    • 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

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Molecular Biology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Materials For Medical Uses (AREA)
  • Manipulator (AREA)

Abstract

(57)【要約】本公報は電子出願前の出願データであるた
め要約のデータは記録されません。

Description

【発明の詳細な説明】 本発明は外科用留め具付け装置に関し、特に、相対的に
動（ことのできる留め具保持部品とアンビル部品との間
でクランプした身体組織に外科用留め具を付けるための
装置に関する。
相対的に動くことのできる留め具保持部品とアンビル部
品との間でクランプした身体組織に外科用留め具を付け
るための外科用留め具付け器具は種々の形式のものが知
られている。例えば、ヒルシュ（Ｈｉｒｓｃｈ　ｅｔ　
ａｌ）氏等に付与された米国特許第３２７５２１１号を
参照されたい。外科用留め具はヒルシュ氏等の特許に示
すように金属製のホチキス針であっても良いし、或いは
、例えばグリーン（Ｇｒｅｅｎ）氏に付与された米国特
許第４４０２４４５号に示すように非金属製樹脂材料で
あっても良い。金属製ホチキス針の場合、代表的にはホ
チキス針の脚部を組織に打ち込みこれら脚部をアンビル
部品で折り曲げてホチキス針を組織に固定する。非金属
製留め具の場合には、各留め具は当初は２つの別々の部
品、即ち、留め具付け装置の留め具保持部品内に配置さ
れた留め具部品と、装置のアンビル部品内に配置された
リテーナ部品とから成る。
留め具部品の脚部は組織に打ち込まれてリテーナ部品と
相互に係止し、それによって留め具を′＋Ｊｉ織内に固
定する。たいていの金属製外科用ホチキス針は生物学的
に不活性であり、したがって身体内にいつまでも残るけ
れども、生物学的に吸収性の金属製外科用ホチキス針が
知られている。非金属製樹脂材料の外科用留め具も又、
生物学的に吸収性か或いは非吸収性がのいづれかにする
ことができる。
採用する留め具の形式又は形態は本発明の要部を成さな
い。「外科用留め具」という用語は本明細書で使用され
るとき、上述の留め具の形式の全ての総称である。同様
に、「留め具保持部品Ｊ、「アンビル部品」という用語
も又、本明細書で総称的に用いられている。
留め具保持部品とアンビル部品との間にクランプした組
織に外科用留め具を付けるための既知の外科用留め具付
け器具のうちのほとんどのものでは、器具の遠い方の留
め具付け組立体（この留め具付け組立体は留め具保持部
品とアンビル部品とを有する）は器具の近い方の作動器
部分にしっかりと連結されている。これは、例えば上述
のヒルシュ氏等の特許及びグリーン氏の特許に示す器具
にも当てはまる。
しかしながら、最近、留め具付け組立体と作動器組立体
との間の連結部かかんぜんにはしっかりとしていないよ
うな器具に関心が高まった。例えば、メイル氏等（Ｎｏ
ｉｌｅｓ　ｅｔ　ａｌ）に付与された米国特許第ｔ４７
３０７７号は、留め具付け組立体と作動器組立体との間
に連結されたシャフト組立体が一平面（即ち、ノイル氏
等の米国特許の第５図の紙面）において横に撓むことが
できるような外科用ホチキス針を示している。これは、
管状の身体器官の中に差し込まれるようになったメイル
氏等の米国特許に示す形式の器具では望まれる特徴であ
る。かかる用途では、器具の可撓性シャフトは周囲の身
体器官の曲率に順応する。しかしながら、通常、周囲の
身体構造では支持されない器具（例えば、ヒルシュ氏等
の特許及びグリーン氏の特許に示す形式の器具）では、
留め具付け組立体と作動器組立体との間の器具の可撓性
が過度であると、留め具付け組立体の位置を作動器組立
体からは調節できず、また、これら組立体の各々を、留
められるべき組織に器具を配置している間、別々に支持
しなければならない。これが意味することは、配置及び
取り外しの際に器具を取り扱うには二人の人間が必要で
あるということである。
上記のことを考慮して、本発明の目的は、留め具付け組
立体が作動器組立体にしっかりと連結されていないけれ
ども、留め具付け組立体の位置を実質的に作動器組立体
から調節することができるような上述の外科用留め具付
け装置を提供することにある。
本発明のもう一つの目的は、留め具付け組立体が作動器
組立体にしっかりと連結されていないけれども、留め具
付け組立体が作動器組立体に対して任意の位置にあって
も留め具付け組立体を作動器組立体から完全に調節でき
るような上述の形式の外科用留め具付け装置を提供する
ことにある。
衾所■景翌 本発明のこれらの目的及び他の目的は、本発明の原理に
従って、外科用留め具付け組立体が関節部を含む長さ方
向シャフト１立体によって作動器組立体に連結され、こ
の関節部がシャフト組立体の長さ方向線と直角な軸線の
周りに作動器組立体に対して外科用留め具付け組立体を
回転させることができるような外科用留め具付け装置を
提供することにより達成される。シャフト組立体は、関
節部の任意の回転位置で作用して、留め具付け組立体を
作動させるのに必要な力と運動じ仕事“）を、作動器組
立体から留め具付け組立体に伝達する。シャツ＋−）Ｊ
ｌ立体は、また、上述の関節部の回転軸線と平行な他の
すべての軸線の周りに剛性であることが好ましい。
好ましい実施態様においては、多位置戻り止め装置が、
関節部を複数の回転位置の何れかに解放可能に保持する
ように関節部と関連づけられている。関節部を複数の回
転位置の何れかに係止するため、係止装置を設けてもよ
い。関節部の運動を所定の回転範囲に制限するように、
ストップｇＭを関節部と関連づけてもよい。筋肉クラン
プ作用と留め具付け作用とは両方共、作動器組立体から
完全に制御されるのが好ましく、必要な仕事は、近い方
へ移動しうる張力伝達部材である軸組立体部材によって
、作動器組立体から留め具付け組立体へ伝達されるのが
好ましい。これらの部材は、好ましくは横に可撓性で関
節部に隣接し、関節部の回転軸線と一致する軸線に沿っ
て関節部を貫通する。装置の留め具付け部品は、好まし
くは、作動器組立体の本体から一定距離に取付けられ、
アンビル部品が作動器組立体の適切な作用に応答して留
め具保持部品の方へ移動するように、アンビル部品が取
付けである。
所望により、縦軸組立体は第２関節部を含むこともでき
、この第２関節部は、縦軸組立体の縦軸線の周りに、作
動器組立体に対して留め奥付げ組立体を回転させること
を可能とする。第１関節部の場合のように、縦軸組立体
は、第２関節部の任意の回転位置で作用して、留め具付
は組立体を作動させるのに必要な仕事を、作動器組立体
から留め具付は組立体へ伝達する。戻り止め装置、係止
装置、及びストップ装置の何れか又は全部が、第１関節
部とこれらの要素との関連と類似の仕方で第２関節部と
関連づけられるのがよい。
本発明の他の特徴、その性質及び種々の利点は、添付図
面と以下の詳細な説明からより明らかになるであろう。
１、全体圧な構′　び作 第１図に示すように本発明の外科用留め具付は装置又は
器具１０の例示の実施例が、近い方の作動器組立体２０
と、遠い方の留め具付は組立体２００と、中間のシャフ
ト組立体１００とを有している。
留め具付は装置２００は、第１関節部１１０の回転軸線
である軸線１１２を中心として手で回転できるようにン
ヤフト組立体１００の遠い方の端に取付けられた近い方
の留め具保持部品２１０を有する。軸線１１２がシャフ
ト組立体１００の長手方向軸線１０２と直交しているこ
とに注意されたい。特に、軸線１１２は軸線１０２と垂
直である。ただし、これは必ずしも必要ではない。更に
、軸線１１２が留め具保持部品２１０の長手方向軸線と
平行であることに注意されたい。しかしながら、これ又
必ずしも必要であるという訳ではない。
関節部１１０のため、留め具付は組立体２００を第１図
において矢印１１４の両端で示す範囲内で軸線１１２を
中心に任意の回転位置まで動かすことができる。図示の
実施例では、留め具保持組立体２００を軸線１０２の両
側に約９０６　（全体として約１８０°）回転させるこ
とができる。
シャフト組立体１００は第２関節部１４０を有し、この
第２関節部の構成要素は第１６図乃至第２０図に最もよ
く示されており、以下に詳細に説明する。一般に、第２
関節部１４０のため、シャフト組立体１００の遠い方の
部分（関節部１１０を含む）を、長さ方向軸線１０２を
中心としてシャフト組立体の近い方の部分に対して手で
回転させることができる。かくして、関節部１４０のた
め、留め具付は組立体２００を第１図〜第２０図におい
て矢印１０４の両端で示す範囲内で軸線１０２を中心に
任意の回転位置まで動かすことができる。好ましくは、
作動器組立体２００を軸線１０２を中心として、第１図
に示す位置から両側に少なくとも約９０°　（全体とし
て少なくとも約１８０°）、更に好ましくは、第１図に
示す位置から両側に約１５０°　（全体として約３００
°）回転させることができる。
Ｕ形フレーム２８０は、留め具保持部品２１０に可動に
取付けられている。特に、フレーム２８０の近い方の脚
部２８２は留め具保持部品２１０と隣接しており、その
一方、フレーム２８０の遠い方の脚部２８４は留め具保
持部品２８０から遠い方に間隔を隔てられている。アン
ビル部品２９０は遠い方の脚部２８４に取付けられてい
る。
使用にあたっては、関節部１１０及び１４０を手で操作
して留め具付は組立体２００を正しく配向した後、第２
図に示すように間隔を隔てられた留め具保持部品２１０
とアンビル部品２９０との間に留めるべき組織１２を配
置する。次いでクランプ作動器５０を、第３図及び第４
図に順を追って示すように、作動器組立体２０の本体３
０に向かって手で下方に回動させる。このためフレーム
２８０が近い方すなわち手前の方向に移動し、その結果
、組ｉＬ２が留め具保持部品２１０とアンビル部品２９
０との間でクランプされる。次いで、この組織を留める
ことができる。これは、安全掛は金６０を第４図に一点
鎖線で示す位置まで手で下げ、留め具作動器７０を第４
図に一点鎖線で示す位置まで手で後方に回動させること
によって行なわれる。このため、留め具保持部品２１０
は、複数の外科用留め具部品２１２　（第９図乃至第１
３図及び第１５図参照）を留め具保持部品２１０から組
織１２を一部貫通して打ち込み、アンビル部品２９０に
取外し自在に取付けたリテーナ部品２１４と相互係止さ
せる。以上で組織留め手順が完了し、クランプ作動器５
０を手で回動させることによって本体３０から離してア
ンビル部品２９０を留め具保持部品９１０から遠い方に
移動させ、それによって、組織へのクランプ圧力を解放
することによって器具１０を！ｌＪ１ｍから外す。上述
のように使用した後、器具１０は廃棄される。
器具１０は、関節部１１０及び１４０がいかなる回転位
置にあっても十分に作動することができる。関節部１１
０及び１４０のため、外科医は、作動器組立体２０に対
する留め具保持組立体の広範囲に亘る位置のいずれでも
選択することができ、そのため、器具１０の配置及び使
用が非常に容易になる。関節部１１０及び１４０　（及
び組立体２０．１００、及び２００の各々と関連する可
動部品）がない場合には、器具１０は剛体構造である。
例えば、器具１０がそのまわりに任意の程度に撓むこと
のできる軸線が軸線１１２の他にない。
このため、各関節部と関連した以下に詳述する戻り止め
手段及び係止手段と組合わせることによって、外科医は
、最初に組立体２０及び２００の相対的な回転位置を選
定し、その後器具の遠い方の端部から器具を十分に制御
することのできる位置に配置し、操作することができる
。
上述の実施例では、代表的には非金属の樹脂材料ででき
た２部品相互係止留め具によって、組織は留められるけ
れども、当業者は金属製の外科用ホチキス針を使用して
もよいことがわかる。同様に、上述の器具１０は１度使
用したら廃棄されるように設計されている（そのため病
院は、再使用のため器具を゛清浄にしたり、殺菌したり
、再装填したりすることに伴なう全ての困難及び費用を
回避することができる）けれども、当業者は、所望であ
わば、本装置を耐久性のあるもの、すなわち再使用でき
るものにつくることができることがわかる。
ｌ器組立　２０の詳細な十わ支ζ憬ゴを今、第２図〜第
５図について作動器組立体２０の構造と操作を考えると
、本体３０は、２つの鏡像関係をなしたシェル部材３４
．３６によって取り囲まれた内部フレーム構造体３２で
構成されている。クランプ作動器５０はピボットピン４
２によって本体３０に連結されている。クランプ作動器
５０はピボットピン５２によってトグルリンク５４の一
端にも回動可能に連結されている。トグルリンク５４の
他端は、ピボットピン５６によってクランプ作動器のケ
ーブルアンカー５８に回動可能に連結されている。軸線
１０２と平行に往復運動可能なアンカー５８は、本体３
０に取付けられている。クランプ作動器のケーブル１０
６の近い方の端はアーンカー５８にしっかりと取付けら
れている。
第２図〜第４図に順次示すようにクランプ作動器５０が
本体３０へ回動して下がるとき、トグルリンク５４は、
アンカー５８を手元の方向に移動させる。ケーブル１０
６は、アンカー５８によって手元の方向に引張られる。
アンカー５８は、アンカーの歯５９とフレームステップ
５８との保合によって第３図に示す中間体止位置に解放
自在に保持されている。これにより作動器組立体２００
は、手動による回動力がクランプ作動器から取り除かれ
ても第３図に示す位置に保持される。これにより外科医
は組織が留め具付け組立体２００内に実質的に納められ
る間で、しかしながら最大留め圧力が組織に加えられる
前に、組織１２に対する装置の配置を点検し、必要なら
ば調整する機会を得ることができる。望むならばクラン
プ作動器５０の上に持つ上げ、これによりアンカーの歯
５９をステップ３８の上に上昇させることによって装置
を再び開くことができる。アンカー５８は又、第４図に
示す近い方の位置で回動ビン５２が僅かに中心の上にあ
る（即ち、第４図に示すように、ピボットピン４２．５
６をむすぶ線の僅かに下にある）という事実によって、
第４図に示す近い方の位置に解除自在に保持されている
。もう一度装置は、クランプ作動器５０の上に持つ上げ
られることによってこの位置から再度開くことができる
。
安全掛は金６０はピボットピン４４によって本体３０に
回動自在に連結され、留め具作動器７０は、回動ピン４
６によって本体３０に回動自在に連結されている。留め
具作動器のケーブル１０８の近い方の端は、留め具作動
器７０にしっかりと取付けられている。ケーブル１０８
は留め具作動器７０が第４図に示すように回動するとき
手元の方向に引張られる。
■、シャフト、立　１００のニ　な（′告と品シャフト
組立体１００の構造は、第１６図〜第２０図に最も良く
示されている。シャフト組立体１００の主要な構造部材
は管状部材１６０でありこの管状部材１６０は、シャフ
ト組立体の近い方の端の近（で作動器組立体２０のフレ
ーム構造体３２にしっかりと連結されている。ケーブル
１０６．１０８は管状部材１６０を自由に貫通している
。
管状ステム部材１４２の近い方の部分は管状部材１６０
の遠い方の端に嵌合し、関節１４０をつくるため管状部
材１６０に対して回転可能である。
ケーブル１０６．１０８はステム１４２から留め一具保
持部品２１０へ自由に通っており、部品２１０は、関節
部１１０をつくるためステム１４２の遠い方の端に回動
自在に取付けられている。
ステム１４２は、内側に延びた管肩部１６２を環状ステ
ム溝１４４に突出させることによって管状部材１６０内
に保持される。もう一つの内側に延びた管状肩１６４が
ステム溝１４６に延びている。溝１４６は一例でストッ
プ部材によって中断している。従って、ステム１４２は
、ストップ部材１４８が肩１６４に当たるまで管状部材
１６０に対していずれの方向に回転することができる。
要素１４８．１６４は従って関節部１４０のためのステ
ップ部材をつくるために協働する。
管状部材１６０は、管１７０、カラー１８０、ブツシュ
１８４．１８６、スラストリング１８８及び係止リング
１９０から成る他の管状構造体により取り囲まれている
。管１７０、及び係止リング１９０は、管１６０に対し
て回転することができる。
カラー１８０は、カラーのキー１８１を管のキー溝１６
６に突出させることによって管１６０に対して回転でき
ないようになっている。ブツシュ１８４．１６６はゴム
のような圧縮性材料で作られている。スラストリング１
８８は、要素１８０．１８４．１８６に対する係止リン
グ１９０の回転を容易にするためにポリテトラフルオロ
エチレンのような比較的低摩擦性材料で作られている。
管１７０は管の遠い方の端付近でステムのキー１５０を
キー溝１７２へ突出させることによって、ステム１４２
との回転が阻止されている。管１７０の遠い方の端付近
の弧状歯付ラック１７４は留め具保持部品２１０の歯付
ピニオンセグメント１１６と係合する。要素１１６．１
７０は軸線１１２と同心である。管１７０の近い方の端
の手元に向いた歯１７６はカラー１８０の遠い方に向く
歯１８２と係合する。ラック１７４の端面１７８　ａ　
、１７８ｂは留め具保持部品２１０の２つの側板２１８
と夫々協働して、組立体２００が軸線１０２のいずれか
の側に約９０°回転したとき、軸線１１２まわりの留め
具付は組立体２００の回動を止める。従って、面１７８
及び板２１８は、関節部１１０のためのストップ手段を
つくるように協働する。
非係止位置においては、手元に近い方に延びる歯１９２
が、本体３０の手元から遠い端部の比較的深いノツチ４
０ａ内に延入するように、係止リング１９０が回転され
る。係止リング１９０のこの位置において、ブツシュ１
８４．１８６は、スラストリング１８８とカラー１８０
との間でごく僅かに圧縮される。従って、カラー１８０
およびチューブ１７０は、手元から遠い方向に比較的軽
くかつ弾性的に押しつけられる。従って、歯１８２．１
７６は互いに係合するように軽く保持され、この係合は
、留め具付は組立体２００を軸線１０２の回りで作動器
組立体２０に対しゆっくりと回転することによって比較
的容易に解除される。しかしながら、歯１８２および歯
１７６は、これらの歯１８２．１７６が係合するいかな
る回転位置においても関節部１４０を解放自在に保持す
るのに充分に係合している。従って、歯１８２．１７６
およびこれらの歯の関連要素は、？！ｆ数の回転位置の
いずれかの位置において、関節部１４０を解放自在に保
持するための戻り止めを構成する。一方、歯１９２が比
較的深いノツチ４０ａから変位（例えば、比較的浅いノ
ツチ４０ｂに変位）するように係止リング１９０が回転
されると、係止リング１９０は手元から遠い方向に幾分
移動する。この結果、ブツシュ１８４．１８６がより強
く圧縮され、カラー１８０およびチューブ１７０が手元
から遠い方向に強く押される。これにより、歯１８２．
１７６が互いに一層強固に係合し、従って、関節部１４
０をその現在の回転位置に係止する。
上記構造体は、ラック１７４およびピニオン１１６に対
し同様な方法で作動する。係止リングの歯１９２がノツ
チ４０ａと整合すると、ラック１７４はピニオン１１６
のみと比較的軽く係合し、従って、要素１１６．１７４
は、複数の回転位置のいずれかの位置で関節部１１０を
解放自在に保持するための戻り止め手段として作用する
。係止リングの歯１９２がノツチ４０ａと係合しないと
きは、ラック１７４はピニオン１１６とより強固に係合
し、関節部１１０をその現在位置に係止する。
使用に際しては、外科医が、関節部の軸線１０２．１１
２′のいずれか一方または両方の回りで作動器組立体２
０に対し留め具付は組立体２００を手で回転する。戻り
止め要素１１６．１７４．１７６および１８２は、作動
２Ｓ＆ｆｌ立体２ｏおよび留め具付は組立体２００を選
定された相月位置において解放自在に保持する。外科医
が作動器組立体２゜および留め具付は組立体２００の相
対位置に満足するときは、歯１９２をノツチ４０ａがら
ノツチ４０ｂに移動させるべく係止リング１９０を回転
し、関節部１１０．１４０をこれらの現在位置に係止す
る。更に調整したいときは、再び係止リング１９０を回
転して歯１９２をノツチ４０ａに整合させ、関節部１１
０．１４０の係止を解除する。
第６図〜第１５図に示した留め具付は組立体゛２００の
詳細な構造および操作について説明すると、留め具保持
部品２１０は上記のごとく、ステム１４２の手元から遠
い端部に枢着されていて、関節部１１０を構成している
。留め具保持部品２１０の各側には、フレーム取り付は
カム板２６０ａ又は２６０ｂが移動自在に取り付けられ
ている。
各カム板２６０は、留め具保持部品２１０と、フレーム
構造体２８０の手元に近い方の脚部２８２の隣り合う側
横部との間に挟持されている。カム板２６０は、留め具
保持部品２１０の側部のカムスロット２１６内へのカム
フォロワー２６２の突出部により、留め保持部品２１０
に対して垂直に往復運動するように案内される。フレー
ム２８０は、カム板２６０のカムスロット２１６内への
カムフォロワー２６２の突出部により、留め具保持部品
２１０の側板２１８の間のフィンガの突出部により、お
よび板２１８のスロノｌ−２２０内へのピン２８９の突
出部により、留め具保持部品２１０に対して位置決めさ
れている。
フレーム２８０は、留め具保持部品２１０とフレーム２
８０との間で作用するプレストレス圧縮コイルスプリン
グ２２４により、手元から遠い方向に弾性押圧されてい
る。
各カム板２６０はフィンガ２６６を有し、該フィンガ２
６６は留め具保持部品２１０の後部近くの垂直開口部２
２２内に延入している。フィンガ２６６は開口部２２２
の内側で互いに重なり合っており、クランプ作動器のケ
ーブル１０６の手元から遠い端部が、フィンガの重なり
合う所で該フィンガに係止されている（第７図参照）。
カム板２６０は、フィンガ２６６留め具保持部品２１０
と留め具保持部品２１０の表面との間で作用するプレス
トレス圧縮コイルスプリング２２６によって、留め具保
持部品２１０に対して上向きに弾性押圧されている。
フィンガ２６６に届くために、ケーブル１０６の手元か
ら遠い端部は、ステム１４２の手元から遠い端部によっ
て、軸線１０２に平行なシャフト組立体１００の整合位
置から軸ｖＡｌ１２に平行な留め具保持部品２１０の整
合位置まで、約９０゜回転される（第７図および第６図
〜第１５図参にａ）。
従って、クランプ作動器５０がケーブル１０６を手元か
ら遠い方向に引っ張るとき、第９図〜第１２図に順次示
すように、ケーブル１０６の手元から遠い端部はカム板
２６０を留め具保持部品２１０に対して垂直下向きに引
っ張る。スロット２２０内にピン２８９が存在するため
、フレーム２８０がカム板２６０と共に下方に移動する
ことが防止される。従って、カムフォロワー２８６がカ
ムスロ、ｌ−２６４に沿って上向きに移動することが制
止され、フレーム２８０は手元に近い方に移動さレル。
ピン２８９は、スロット２２０を横切ってフレーム２８
０と共に手元に近い方向に移動する。
カムスロット２６４の形状は、フレームの手元から遠い
脚部２８４が初めに回動して、留め具保持部品２１０の
手元から遠い面と共に平行四辺形を形成し、次いで、ク
ランプ作動器５０のストロークの柊時において組織１２
が留め具保持部品２１０の手元から遠い面とアンビル部
品２９０の手元に近い平行な面との間でクランプされる
ように、留め具保持部品２１０の手元に近い方に移動さ
せる形状になっている。
留め具保持部品２１０とアンビル部品２９０の一心合せ
は、組織１２をクランプしたときに留め具保持部品２１
０から延びてアンビル部品２９０に自動的に入る心合せ
ピン２３０によって適切におこなわれる。心合せピン２
３０は、留め具保持部品２１０の後部に軸支されたピン
キャリヤ２３２によって往復運動する。ビンキャリヤ２
３２は、心合せピン２３０を引き込めるために、第９図
に示すように、仮バネ２３４によって近い方に弾性的に
付勢されている。ビンキャリヤ２３２の下部には、カム
板２６０の近い方のカム面２６８と接触するカムフォロ
ア面２３６が設けられている。
面２３６．２６８は、協働的に形作られて、カム板２６
０が最上位置に存る時、板バネ２３４が心合せピン２３
０を近い方に引き込め、またカム板２６０がケーブル１
０６によって引き下げられた時、ビンキャリヤ２３２を
旋回させて心合せピン２３０が遠い方に延びるようにす
る。クランプ作動器５０が第３図に示す中間体止位置（
歯部５９が段部３８と係合している）となるまでに、゛
心合せピン２３０は充分に延びて、第１０図に示すよう
に、アンビル開口２９２に入り始める。従って、外科医
が装置の位置を調整したいとき、及び′ＫＪｉ１８１２
を最終的にクランプするとき、心合せピン２３０は組織
１２を留め具保持部品２１０とアンビル部品２９０との
間に保つことを助ける。第１１図に示すように、組織１
２をクランプし続けるときには、アンビル開口２９２は
心合せピン２３０の遠い方の端部上にさらに引張られ、
留め具保持部品２１０とアンビル部品２９０との心合が
適切に行われることを確保する。
組織１２を上述のようにクランプした後、留め異部品２
１２を、第７図乃至第１３及び第１５図に最も良く示さ
れる要素によって駆動する。留め異部品２１２は、最初
、留め具保持部品２１０の遠い方の部分を形成する保持
装置２４０の開口２４２内に配置される。プッシャフィ
ンガ２４４は延在して各開口２４２の後部に入っている
。プッシャフィンガ２４４は、小グループ（例えば、複
数の対）をなすように連結して分離した部品の点数を減
少させ、開口２４２内を閉ざしがちな大きな単一のプッ
シャ構造を設けることなしに個々のプッシャフィンガ２
４４を安定させることが有利である。プッシャフィンガ
２４４の全ての近い方の端部は、剛体で単一のフォロア
部材２４６によって当接させられている。プッシャ作動
器２４８はフォロア２４６の近い側に配置され、留め具
保持部品２１０の側板２１８のカムスロット２５２まで
延びたカムフォロアピン２５０によって支持されている
。
留め具作動ケーブル１０８は、プッシャ作動器２４８に
取りつけられている。ケーブル１０６の場合のように、
ケーブル１０６の遠い方の端部は、プッシャ作動器２４
８に届かせるために、ステム１４２の遠い方の端部によ
って軸線１０２と平行なシャフト組立体１００との心合
せの状態から、軸線１１２と平行な留め具保持部品２１
０との心合せの状態まで、約９０°方向が変えられる。
留め具作動器７０が作動してケーブル１０８を近い方に
引張ると、ケーブル１０８の遠い方の端部はプッシャ作
動器２４８上を引き下げる。プッシャ作動器２４８が下
へ移動すると、プッシャ作動器２４８は要素２５０及び
２５２の協働により（第１２図参照）遠くの方向に移動
させられる。プ。
シャ作動器２４８の遠くの方向への移動は、プッシャフ
ォロア２４６を介してプッシャフィンガ２４４に伝えら
れ、これによって留め異部品２１２を組織１２を通して
少し動かし、リテーナ２１４と係合させて組織１２をク
ランプする。
＆［１ｉ１２を上述したようにしてクランプした後、［
１ｉ１２のクランプ圧力はクランプ作動器５０を持ち上
げることにより解放される。スプリング２２４及び２２
６はカム板２６０及びフレーム２８１を最初の位置に戻
し、スプリング２３４は心合せピン２３０を近い方に戻
す。従って、クランプした組織１２は、第１３図に示す
ように、装置から外され、装置は外科手術の場所から片
づけられる。
組織をクランプして留で具を付けるために必要な力は、
横断方向及び捩じり方向の両方に可撓性を有する張力伝
達部材１０６及び１０８を近くの即ち手前の方向に移動
させることにより、作動器２０から留め具付は組立体へ
伝えられることに注意すべきである。ケーブル１０６及
び１０８の横断方向の可撓性は、ステム１４２の遠い方
の端部に近接した位置での方向度えを可能にする。ケー
ブル１０６及び１０８の行路長は、関節部１１０及び１
４０の回転部分によってほとんど影響されないことにも
注目すべきであり、それは、各ケーブルが、関節部の回
転部分において軸線１０２又は１１２とほぼ一致してい
るからである。例えば、ケーブル１０６及び１０８は共
に、ステム１４２がチューブ１６０に対して回転する位
置において軸線１０２と一致している。従って、関節部
１４０を関節運動させるとき、ケーブル１０６及び１０
８は僅かに捩れるが、ケーブル１０６及び１０８の行路
長は大きくは変しない。同様に、ケーブル１０６及び１
０８は共に、留め具保持部品２１０がステム１４２に回
転自在に取りつけられた位置において軸線１１２とほぼ
一致している。したがって、関節部１４０を関節運動さ
せると、ケーブル１０６及び１０８は僅かに捩じられる
が、両ケーブルの行路長が大きく変化することはない。
（本明細書において、用語「一致」は、ケーブル１０６
及び１０８の両者が概ね交差するか、又は特定の位置に
おいて特定の軸線とほぼ共軸であることを意味する。）
ケーブル１０６及び１０８の横方向及び捩れ方向の可撓
性を有すること及び行路長が変化しないことは、上述し
たように装置の関節運動を容易にし、関節部１１０及び
１４０が任意の回転位置にあっても装置の作動を可能に
する。
【図面の簡単な説明】
第１図は本発明の外科用留め具付は装置を説明する実施
例の斜視図、第２図は本装置の操作手順の最初の段階を
示す第１図の装置の部分断面立面図、第３図および第４
図は第１図の装置の操作手順の連続した段階を示す第２
図と同様の図、第５図は第２図に示す状態での第１図の
装置の部分分解斜視図、第６図は第１図の装置の遠方部
分の部分分解斜視図、第７図は第１図の装置の遠方部分
の部分斜視図、第８図は第１図の装置の遠方部分の詳細
分解斜視図、第９図は第２図に示す状態での第１図の装
置の遠方部分の部分断面立面図、第１０図乃至第１３図
は第１図の装置の操作手順の連続した段階を示す第９図
と同様の図、第１０図および第１１図は第３図および第
４図に夫々示したものと同じ操作手順の段階を示す図、
第１４図は第１０図の線１４−１４における断面図、第
１５図は第１２図の線１５−１５における断面図、第１
６図は第１図の装置の中間部分の分解斜視図、第１７図
は第１図の装置の中間部分の部分断面立面図、第１８図
は第１図の装置の異なった操作状態を示す第１７図と同
様の図、第１９図は第１７図に示す状態での第１図の装
置の中間部分の部分断面底面図、第２０図は第１７図の
線２（１−２０における断面図、第２１図は第１図の装
置の遠方部分の底面図である。 １０・・・・外科用留め具付は装置、 ２０・・・・近い方の作動器組立体、 １００・・・・シャフト組立体、 １０２・・・・長さ方向軸線、 １１２・・・・第２の軸線、 ２００・・・・遠い方の留め具付は組立体。

Claims (8)

    【特許請求の範囲】
  1. （１）近い方の作動器組立体（２０）と、前記作動器組
    立体（２０）に連結されたシャフト組立体（１００）と
    、前記シャフト組立体（１００）に、前記シャフト組立
    体（１００）の長さ方向軸線（１０２）を中心に回転可
    能にかつ前記長さ方向軸線（１０２）と直角な第２の軸
    線（１１２）を中心に回転可能に設けられた遠い方の留
    め具付け組立体（２００）とを有することを特徴とする
    外科用留め具付け装置。
  2. （２）前記長さ方向軸線（１０２）を中心に回転できる
    ようにするために、前記シャフト組立体（１００）と前
    記留め具付け組立体（２００）との間に第１の関節部（
    １４０）を有する、特許請求の範囲第（１）項に記載の
    外科用留め具付け装置。
  3. （３）前記シャフト組立体（１００）は、前記第１の関
    節部（１４０）を回転自在に受け入れる第１の管（１６
    ０）と、前記関節部（１４０）にキー止めされ、前記第
    １の管（１６０）に回転自在に設けられた第２の管（１
    ７０）と、前記作動器組立体（２０）と前記第２の管（
    １７０）との間で前記第１の管（１６０）に設けられた
    回転可能な係止リング（１９０）とを有し、前記係止リ
    ング（１９０）は前記管（１６０、１７０）間の相対的
    な回転を可能にする第１の位置と前記管（１６０、１７
    ０）を係止関係に解放自在に保持する第２の位置との間
    を回転できる、特許請求の範囲第（２）項に記載の外科
    用留め具付け装置。
  4. （４）前記第２の管（１７０）の歯（１７６）と噛み合
    う歯（１８２）をもったカラー（１８０）を有し、前記
    係止リング（１９０）の前記第２の位置で前記カラーを
    押して前記第２の管（１７０）と係合させるために前記
    カラー（１８０）と前記係止リング（１９０）との間に
    設けられた少なくとも１つの圧縮可能なブッシュ（１８
    ４）を有する、特許請求の範囲第（３）項に記載の外科
    用留め具付け装置。
  5. （５）前記係止リング（１９０）は、前記作動器組立体
    （２０）の本体（３０）の切欠き部（４０ａ、４０ｂ）
    に選択的に受入れ可能な近い方に延びた歯（１９２）を
    有している、特許請求の範囲第（３）項に記載の外科用
    留め具付け装置。
  6. （６）前記第２の軸線を中心に前記シャフト組立体（１
    ００）と前記留め具付け組立体（２００）との間の回転
    を可能にするために、前記シャフト組立体（１００）と
    前記留め具付け組立体（２００）との間に第２の関節部
    （１１０）を有し、前記第２の関節部（１１０）は前記
    第１の関節部（１４０）を回転自在に受入れ、かつピニ
    オン（１１６）を有し、前記第２の管（１７０）は、前
    記係止リング（１９０）の前記第２の位置で前記ピニオ
    ンと噛み合うための歯付ラック（１７４）を有している
    、特許請求の範囲第（１）項乃至第（５）項のいずれか
    １項に記載の留め具付け装置。
  7. （７）前記留め具付け組立体（２００）は、留め具保持
    部品（２１０）と、この留め具保持部品（２１０）に面
    しているアンビル（２９０）とを有し、前記留め具保持
    部品（２１０）と前記アンビルとの間に組織を締めつけ
    るために、前記留め具保持部品（２１０）を前記アンビ
    ルに対して移動させるための第１のケーブル（１０６）
    が前記作動器組立体（２０）と前記留め具保持部品（２
    １０）との間で前記シャフト組立体（１００）を通して
    延びている、特許請求の範囲第（１）項に記載の留め具
    付け装置。
  8. （８）前記留め具保持部品（２１０）は前記留め具保持
    部品（２１０）から留め具（２１２）を押し出すための
    プッシャ作動器（２４８）を有し、前記留め具（２１２
    ）を押し出して前記アンビル（２９０）と前記留め具保
    持部品（２１０）との間で組織を留めるために、前記プ
    ッシャ作動器（２４８）を移動させるための第２のケー
    ブル（１０８）が前記作動器組立体（２０）と前記プッ
    シャ作動器（２４８）との間で前記シャフト組立体（１
    ００）を通って延びている、特許請求の範囲第（７）項
    に記載の留め具付け装置。
JP61203547A 1985-08-30 1986-08-29 関節式外科用留め具付け装置 Granted JPS62101238A (ja)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US06/771,845 US4728020A (en) 1985-08-30 1985-08-30 Articulated surgical fastener applying apparatus
US771845 1996-12-23

Publications (2)

Publication Number Publication Date
JPS62101238A true JPS62101238A (ja) 1987-05-11
JPH0468941B2 JPH0468941B2 (ja) 1992-11-04

Family

ID=25093116

Family Applications (1)

Application Number Title Priority Date Filing Date
JP61203547A Granted JPS62101238A (ja) 1985-08-30 1986-08-29 関節式外科用留め具付け装置

Country Status (8)

Country Link
US (2) US4728020A (ja)
EP (1) EP0216532B1 (ja)
JP (1) JPS62101238A (ja)
AT (1) ATE61514T1 (ja)
AU (1) AU586882B2 (ja)
BR (1) BR8604158A (ja)
CA (1) CA1270170A (ja)
DE (1) DE3678080D1 (ja)

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EP0216532B1 (en) 1991-03-13
EP0216532A1 (en) 1987-04-01
JPH0468941B2 (ja) 1992-11-04
AU6188586A (en) 1987-03-05
CA1270170A (en) 1990-06-12
BR8604158A (pt) 1987-04-28
US4728020A (en) 1988-03-01
ATE61514T1 (de) 1991-03-15
AU586882B2 (en) 1989-07-27
US4869414A (en) 1989-09-26
DE3678080D1 (de) 1991-04-18

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