Source: https://patents.google.com/patent/JP5608837B1/en
Timestamp: 2020-06-05 20:36:19
Document Index: 500672862

Matched Legal Cases: ['Application No. 61', 'art 50', 'art 40', 'art 60', 'art 50', 'art 70', 'art 10', 'art 101']

JP5608837B1 - Tissue excision device - Google Patents
Tissue excision device Download PDF
JP5608837B1
JP5608837B1 JP2014512964A JP2014512964A JP5608837B1 JP 5608837 B1 JP5608837 B1 JP 5608837B1 JP 2014512964 A JP2014512964 A JP 2014512964A JP 2014512964 A JP2014512964 A JP 2014512964A JP 5608837 B1 JP5608837 B1 JP 5608837B1
JP2014512964A
JPWO2014080862A1 (en
慎治 高橋
高康 三日市
2012-11-20 Priority to US61/728,507 priority
2013-11-18 Application filed by オリンパスメディカルシステムズ株式会社 filed Critical オリンパスメディカルシステムズ株式会社
2014-10-15 Publication of JP5608837B1 publication Critical patent/JP5608837B1/en
2017-01-05 Publication of JPWO2014080862A1 publication Critical patent/JPWO2014080862A1/en
238000007789 sealing Methods 0.000 claims abstract description 69
The tissue excision device includes a pair of gripping members that hold tissue and a cartridge that is replaceably attached to the pair of gripping members. The cartridge has a longitudinal axis and a slot that extends along the longitudinal axis. And a cartridge body for guiding a cutting member for cutting the tissue by the slot and defining a moving range of the cutting member; And a tissue sealing portion provided on the distal end side of the slot and on an extension line of the slot.
The present invention relates to a tissue excision device, and more particularly, to a tissue excision device used for so-called full-thickness excision in which a part of a luminal tissue is excised over the entire thickness direction.
This application claims priority based on US Patent Application No. 61 / 728,507, provisionally filed in the United States, on November 20, 2012, the contents of which are incorporated herein by reference.
Conventionally, in the treatment of gastric cancer and the like, the tumor and surrounding tissue are excised across the entire thickness of the stomach wall. Such full-thickness resection is often performed by laparotomy or laparoscopic surgery.
Further, Patent Document 1 describes a surgical stapler having a pair of jaws. A cartridge loaded with staples is attached to one of the pair of jaws, and an anvil member having a plurality of staple pockets is attached to the other jaw. When the jaw is closed with the tissue sandwiched between the pair of jaws, a part of the tissue can be incised through the entire layer by the built-in cutter while the tissue is sutured by the staple.
Japan Special Table 2010-201035
Conventionally, full-thickness resection has been performed under laparoscopic or laparoscopic procedures. However, this is not recommended in order to reduce patient invasion or reduce the risk of recurrence when tumors are removed. It is considered to perform from natural opening such as.
However, since the conventional tissue excision apparatus described in Patent Document 1 includes only the first staple row, when the suture and cut are performed along the first pull-in line, the tip of the cutting line of the cutting member On the side (front), the tissue between the first staple rows is unstitched, and a portion that is in a hole-like state remains. Therefore, when the internal pressure of the luminal tissue is increased, there is a problem that the state in which the content of the luminal tissue leaks out from the site may occur temporarily.
A tissue excision apparatus according to a first aspect of the present invention includes a pair of gripping members that hold tissue and a cartridge that is replaceably attached to the pair of gripping members, and the cartridge has a longitudinal axis. A main body and a slot extending along the longitudinal axis and having a predetermined width with respect to the longitudinal axis, guiding a cutting member for cutting tissue and defining a moving range of the cutting member in the longitudinal axis direction A first sealing portion that is provided at a position sandwiching the slot at an interval larger than the width of the slot, and extends in parallel with the slot; the distal end side of the cartridge body from the distal end of the slot; and the slot And a second sealing portion that is provided at a position in a range that coincides with the width of the slot at least on the extended line, and joins the tissue .
In the tissue excision apparatus according to the second aspect of the present invention, according to the first aspect, the second sealing portion may extend in a direction perpendicular to the longitudinal axis of the slot.
In the tissue excision apparatus according to the third aspect of the present invention, according to the first aspect, the second sealing portion is held between the pair of gripping members and more distal than the slot. Positioned tissues may be joined.
In the tissue excision apparatus according to the fourth aspect of the present invention, according to the first aspect, the first sealing portion extends to the distal end side from the slot, and the second sealing is performed. The portion may be provided between the first sealing portions.
In the tissue excision apparatus according to the fifth aspect of the present invention, according to the first aspect, the first sealing portion is a pair of staples composed of a plurality of staples arranged in the cartridge body. It may be a column.
In the tissue excision apparatus according to the sixth aspect of the present invention, according to the first aspect, the second sealing portion is a sealing staple disposed on the distal end side of the slot in the cartridge body. It may be.
In the tissue excision apparatus according to the seventh aspect of the present invention, according to the first aspect, the second sealing portion is held between the pair of gripping members and more distal than the slot. It may be a pair of electrodes that can be in contact with the tissue located.
In the tissue excision apparatus according to the eighth aspect of the present invention, according to the first aspect, the second sealing portion is held between the pair of gripping members and more distal than the slot. It may be a pair of heating elements that can be in contact with the tissue located.
A tissue excision apparatus according to a ninth aspect of the present invention includes an insertion portion extending along the longitudinal axis, a pair of grasping members provided at the distal end of the insertion portion, and grasping the tissue, and a flow line having a predetermined width. A cutting member that cuts the luminal tissue held between the pair of jaws by moving along, and a first sealing portion that is provided at a position sandwiching the flow line and extends parallel to the flow line A second sealing portion that is provided at a position in a range that coincides with at least the width of the flow line on the distal side of the flow line and on an extension line of the flow line, and that joins the tissue. .
In the tissue excision apparatus according to the tenth aspect of the present invention, according to the ninth aspect, the second sealing portion may extend in a direction orthogonal to the flow line.
In the tissue excision apparatus according to the eleventh aspect of the present invention, according to the ninth aspect, the second sealing portion is held between the pair of gripping members and is more distal than the flow line. The tissue located on the side may be joined.
In the tissue excision apparatus according to the twelfth aspect of the present invention, according to the ninth aspect, the first sealing portion extends to the distal end side with respect to the flow line , The sealing part may be provided between the first sealing parts.
In the tissue excision apparatus according to the thirteenth aspect of the present invention, according to the ninth aspect, the first sealing portion is a pair of staples disposed on both sides of the flow line. It may be a staple line.
In the tissue excision apparatus according to the fourteenth aspect of the present invention, according to the ninth aspect, the second sealing portion is a sealing staple disposed on the distal end side of the flow line. Also good.
In the tissue excision apparatus according to the fifteenth aspect of the present invention, according to the ninth aspect, the second sealing portion is held between the pair of gripping members and is more distal than the flow line. It may be a pair of electrodes that can contact the tissue located on the side.
In the tissue excision apparatus according to the sixteenth aspect of the present invention, according to the ninth aspect, the second sealing portion is held between the pair of gripping members and is more distal than the flow line. A pair of heating elements capable of contacting the tissue located on the side may be used.
In the tissue excision device according to each aspect described above, since the tissue sealing portion is arranged in the cartridge, the tissue between the pair of sealing portions on the distal end side (front side) of the cutting line of the cutting member is the tissue sealing portion. Is securely stitched and sealed. Further, in a state where the tissue is drawn into the narrow gap between the pair of gripping members and gripped, the tissue is first sutured by the pair of sealing portions and the tissue sealing portion, and then the pair of gripping members after the cutting member cuts the tissue Holding by is released. Therefore, in a series of procedures using the tissue excision apparatus, tissue excision can be performed without causing any state in which the contents of the luminal tissue may leak to the outside.
1 is a diagram illustrating an overall configuration of a tissue excision apparatus according to a first embodiment of the present invention. It is a figure which shows 1 operation | movement at the time of use of the tissue excision apparatus. It is the elements on larger scale which show the state which looked at the 1st jaw and cartridge of the tissue excision device from the 2nd jaw side. It is a figure which shows the mechanism in which the staple is ejected from the cartridge. It is a figure which shows the driver in a cartridge. It is a figure which shows an excision area | region and a holding | grip point. It is a figure which shows 1 operation | movement at the time of use of the tissue excision apparatus. It is a figure which shows 1 operation | movement at the time of use of the tissue excision apparatus. It is a figure which shows 1 operation | movement at the time of use of the tissue excision apparatus. It is a figure which shows 1 operation | movement at the time of use of the tissue excision apparatus. It is a figure which shows 1 operation | movement at the time of use of the tissue excision apparatus. It is a figure which shows 1 operation | movement at the time of use of the tissue excision apparatus. It is a figure which shows the state after performing suturing and cutting | disconnection using the conventional tissue excision apparatus. It is a figure which shows the cutter in the modification of the embodiment. It is the elements on larger scale which show the front end side of the 1st jaw and cartridge in the modification of the embodiment. It is the elements on larger scale which show the front end side of the 1st jaw and cartridge in the tissue resection apparatus of 2nd embodiment of this invention. It is a figure which shows the electrical connection in the same tissue excision apparatus. It is the elements on larger scale which show the front end side of the 1st jaw and cartridge in the modification of the embodiment.
FIG. 1 is a diagram illustrating an overall configuration of a tissue excision apparatus 1 according to the present embodiment. The tissue excision apparatus 1 is provided at the distal end and includes a treatment unit 10 for performing treatment on a target tissue. In addition, the tissue excision apparatus 1 further includes a first operation unit 30 for operating the treatment unit 10, a long insertion unit 40 provided between the treatment unit 10 and the first operation unit 30, and an insertion The observation part 50 inserted in the part 40, the 2nd operation part 60 for operating the observation part 50, and the 3rd operation part 70 for operating a treatment part are provided. The treatment section 10 includes a first jaw (first gripping member) 11 and a second jaw (second gripping member) 12 as a pair of jaws that can be opened and closed, and a tissue using a cartridge 13 loaded with a staple 13A. Suture and detach. Moreover, the basic structure of the treatment part 10 is well-known as described in the above-mentioned patent document 1, for example.
The first operation unit 30 has a known configuration and includes two dial knobs 31 and 32 and a lock lever 33. The dial knobs 31 and 32 are connected to a bending portion 41 described later by an operation member (not shown) such as a wire. The third operation unit 70 is provided with a first trigger 34 for opening and closing the pair of jaws 11 and 12 and a second trigger 35 for performing a suturing and incising operation.
The insertion portion 40 has flexibility and is formed in a tubular shape extending along the longitudinal axis. The treatment portion 10 is attached to the distal end side of the insertion portion 40, and the first operation portion 30 is attached to the proximal end side of the insertion portion 40. The insertion portion 40 has a bending portion 41 having a known structure having a plurality of node rings or bending pieces on the tip side, and is bent by operating the dial knobs 31 and 32 of the first operation portion 30. be able to. The curved state can be fixed by operating the lock lever 33. An operation member is inserted into the lumen of the insertion portion 40 so as to be able to advance and retract in the axial direction. Further, a forceps port 42 is provided on the proximal end side of the insertion portion 40, and a general endoscopic treatment tool 100 or the like equipped with the forceps portion 101 is inserted into the forceps port 42, so that the first jaw 11 can protrude from the base end side.
The observation unit 50 is inserted into the insertion unit 40 so as to be able to advance and retreat, and includes an illumination unit 51 including an LED or the like at a distal end portion and an imaging unit 52 such as a CCD. Further, a bending portion 53 having the same structure as that of the bending portion 41 is provided on the distal end side. The distal end portion of the observation unit 50 can be protruded from the opening 43 provided on the distal end side of the insertion portion 40. Thereby, for example, as shown in FIG. 2, the distal end portion of the observation unit 50 is protruded and the bending portion 53 is appropriately bent, whereby the tissue or the like held by the treatment portion 10 can be preferably observed.
The second operation unit 60 is connected to the base end of the observation unit 50 that has come out from the base end side of the insertion unit 40. The second operation unit 60 is provided with a dial knob 61, a button 62, and the like similar to those of the first operation unit 30. The second operation unit 60 can perform a bending operation of the bending unit 53, an operation of the illumination unit 51 and the imaging unit 52, and the like. The video signal acquired by the imaging means 52 is sent to an image processing unit (not shown) through the universal cable 63 and displayed on a display or the like (not shown). As the observation unit 50 and the second operation unit 60, a known endoscope apparatus or the like can be used by appropriately setting dimensions and the like.
FIG. 3 is a partially enlarged view showing a state in which the first jaw 11 and the cartridge 13 are viewed from the second jaw 12 side. The cartridge 13 includes a cartridge main body 14 having a longitudinal axis, a slot 14A for moving a cutter (cutting member) 20 extending along the longitudinal axis, and cutting the tissue, and both sides of the slot 14A in the width direction. A pair of first staple rows (a pair of sealing portions) 15 extending in parallel with the slot 14A, and a second staple (tissue seal) disposed in front of the slot 14A (on the tip side of the slot 14A) and on an extended line of the slot 14A Stop portion, sealing staple) 16.
In the first staple row 15, a plurality of staples 15A are arranged in the cartridge main body 14 and extend to the front end side by a predetermined length, for example, 5 millimeters (mm) from the slot 14A. The second staple 16 is disposed between the two first staple rows 15. Although FIG. 3 shows an example in which two second staples 16 are arranged, the number of arranged second staples 16 is not particularly limited, and may be one or three or more. The staples arranged as the second staples may be the same staple 15A as the first staple row or may be different.
The cutter 20 is inserted into the slot 14 </ b> A from the inside of the cartridge 13, and moves in the slot 14 </ b> A while protruding toward the second jaw 12. The cutter 20 enters the slot 14A in a state where the protruding end of the cutter 20 enters a groove provided in an anvil member described later so that the tissue sandwiched between the pair of jaws 11 and 12 can be cut over all layers. Move along. The blade span of the cutter 20 required for this is longer than the thickness of the two target tissues held in the folded state and longer than the distance between the pair of jaws 11 and 12 in the closed state.
FIG. 4A is a diagram showing a mechanism for ejecting staples from the cartridge 13. A driver 17 made of resin or the like is disposed below the staple 15A. In the cartridge 13, a wedge 18 having a slope 18 </ b> A on the tip side is disposed. When the wedge 18 is moved forward by operating the second trigger 35, the wedge 18 pushes the driver 17 in contact with the inclined surface 18A upward. As a result, the staple 15A is sequentially ejected from the proximal end side by being pushed by the driver 17 and penetrates the tissue, and the penetrated end portion is pressed against the anvil member 21 provided in the second jaw 12 and folded back. .
The driver 17 is disposed in each of the two first staple rows 15, but in the region on the tip side of the slot 14A, as shown in FIG. 4B, the two first staple rows 15 and the second staple rows 15 are arranged. A driver 19 that pushes up the staple 16 is disposed. Therefore, when the wedge 18 pushes up the driver 19, the staple 15A and the second staple 16 in the first staple row 15 are pushed up and ejected together.
Next, the operation during use of the tissue excision apparatus 1 will be described by taking as an example the case of removing all the layers of a malignant tumor (hereinafter simply referred to as “tumor”) of the stomach (luminal tissue).
First, the surgeon introduces the tissue excision apparatus 1 into the stomach from the patient's mouth and observes the tumor using the observation unit 50. Then, as shown in FIG. 5, a rough excision region R surrounding the tumor Tm is set. The excision region R is preferably set so that the shortest distance from the tumor Tm is 5 millimeters (mm) or more so as not to damage the tumor Tm at the time of tissue excision.
Next, the surgeon projects the endoscope treatment tool 100 from the first jaw 11 and grasps one point of the stomach wall away from the tumor Tm from the inside of the stomach Sm with the forceps 101 as shown in FIG. . Since this one point is a part of the periphery of the region to be actually excised, it is preferable to set it at a position corresponding to the peripheral portion of the set excision region R, for example, a location about 30 mm away from the center of the tumor Tm. Can be selected. Hereinafter, this gripped point is referred to as a first gripping point P1.
Subsequently, the surgeon retracts the endoscope treatment tool 100 that grasps the first grasping point P1, and appropriately operates the first trigger 34, as shown in FIG. A part of the stomach wall tissue ST is drawn into the gap between the two. When retracting, the observation unit 50 observes the tumor Tm, and care is taken so that the tumor Tm does not touch the pair of jaws.
The stomach wall tissue ST is drawn between the first jaw 11 and the second jaw 12 along two first pull-in lines L1 extending from the first gripping point P1. That is, the stomach wall tissue ST to be drawn is bent with the outer surface of the stomach facing inward so that the outer surfaces of the stomach come into contact with each other, one of the first lead lines L1 faces the first jaw 11, and the other is the second jaw 12. It is drawn in the state facing to. The gap between the pair of jaws is a narrow slit, and the distance between them is about two sheets of the stomach wall tissue. It is not drawn in.
When the stomach wall tissue ST is sufficiently drawn between the pair of jaws 11 and 12, the operator operates the second trigger 35. As a result, the wedge 18 moves forward in the cartridge 13 toward the tip, and pushes up the driver 17 disposed below each staple 15A of the first staple row 15 in order from the base end side. As a result, the staple 15A is sequentially pressed against the anvil member 21 (see FIG. 4A) provided on the second jaw 12 from the proximal end side toward the distal end side, and both end portions of the staple 15A penetrating the stomach wall tissue ST are formed. Wrapped. As a result, the folded stomach wall tissue ST is sutured so as to be integrated over the thickness direction on both sides of the first lead-in line L1.
Further, the cutter 20 (see FIG. 4A) advances slightly toward the tip after the wedge 18, and the stomach wall tissue located between the rows of the first staple rows 15 in which the stomach wall tissue ST is sutured is substantially the first lead-in line L1. Cut along. As a result, a part of the stomach wall is cut over the entire layer as shown in FIG. Here, the stomach wall tissue located between the rows of the first staple rows 15 in front of the extension line of the flow line of the cutter 20 (substantially the same as the slot 14 </ b> A) is sutured together by the second staple 16.
After cutting and suturing along the first lead-in line L1, the operator removes the tissue excision device 1 out of the body cavity, replaces the cartridge 13 with a new cartridge loaded with staples, and introduces it again into the stomach. To do. And as shown in FIG. 9, the forceps part 101 of the treatment tool 100 for endoscopes 100 is set as the second gripping point P2 at the end opposite to the first gripping point P1 of the cutting line along the first lead-in line L1. Grip with
Next, the surgeon retracts the endoscope treatment tool 100, and, as shown in FIG. 10, the stomach wall tissue ST grasped by the forceps portion 101 is moved into the pair of jaws 11 and 12 along the second pull-in line L2. Pull in. At this time, the stomach wall tissue ST is drawn so that the ridge line rg of the stomach wall tissue bent so that the outer surfaces come into contact with each other passes through the pair of jaws 11 and 12.
Thereafter, when suturing and cutting are performed by the same operation as described above, the stomach wall tissue ST is cut and sutured along the second lead-in line L2. Further, since the first lead-in line L1 and the second lead-in line L2 form a closed quadrilateral as shown in FIG. 5, the stomach wall tissue ST in the resection region R including the tumor Tm is converted into the first lead-in line L1 and the second lead-in line L1. By the cutting line formed along the two lead-in lines L2, it is cut off from the stomach Sm as shown in FIG. In this way, a part of the stomach wall tissue ST is excised across the entire layer without leaving a hole in the stomach Sm.
After the excision is completed, the operator removes the tissue excision apparatus 1, collects the excised stomach wall tissue ST (excision piece), and finishes the procedure. At this time, the excision piece may be grasped by the forceps 101 and the tissue excision apparatus 1 may be removed and the excision piece may be collected simultaneously.
As explained at the beginning, full-thickness resection has traditionally been performed under laparoscopic or laparoscopic procedures, but it can reduce patient invasion and reduce the risk of recurrence when the tumor is removed. From the viewpoint, it has been studied to perform this through a natural opening such as a mouth.
However, since the conventional tissue excision apparatus as described in Patent Document 1 includes only the first staple row, as shown in FIG. 12, when the suture and cut are performed along the first pull-in line. The tissue between the first staple rows is unstitched in front of the cutting line of the cutter, and a part that is in a hole-like state remains. Therefore, when the internal pressure of the luminal tissue is increased, there is a problem that the state in which the content of the luminal tissue leaks out from the site may occur temporarily.
According to the tissue excision apparatus 1 of the present embodiment, since the second staple 16 as the tissue sealing portion is arranged in the cartridge 13, the tissue between the first staple rows 15 in front of the cutting line of the cutter 20. Are securely stitched and sealed by the second staple 16. In addition, in a state where the tissue is drawn into and held in the narrow gap between the pair of jaws 11 and 12, the tissue is first sutured by the first staple row 15 and the second staple 16, and the pair of jaws is cut after the cutter cuts the tissue. Holding by is released. Therefore, in a series of procedures using the tissue excision apparatus 1, tissue excision can be performed without causing any state in which the contents of the luminal tissue may leak out.
In addition, since the tissue is drawn into a relatively narrow slit-shaped gap between the pair of closed jaws 11 and 12, suturing and cutting are performed, so that other organs and tissues adjacent to the luminal tissue such as the stomach are joined together. Will be blocked at the entrance of the gap. Therefore, even a trans-natural opening approach in which the outside of the luminal tissue cannot be visually recognized can be performed without erroneously suturing or cutting these organs and tissues together with the luminal tissue.
In the present embodiment, an example in which the staple and the second staple in the first staple row are ejected by a common driver on the tip side from the slot 14A has been described, but the structure for ejecting the staple is limited to this. Not. For example, the driver that pushes up the second staple may be separated from the driver in the first staple row. Specifically, as shown in FIG. 13, a second wedge 23 may be provided in front of the cutter 20, and the driver 22 that pushes up the second staple 16 may be pushed up by the second wedge 23. Alternatively, the second wedge 23 may be configured to push up the common driver 19, or the second wedge 23 may be configured to push up all the drivers.
Further, in the above example, the stapling direction of the first stapling row and the second stapling direction are parallel to each other. However, as in the modified example shown in FIG. It may be arranged so as to be orthogonal to the moving slot 14A. In this way, the tissue in front of the slot can be joined in a wider range, and the tissue can be excised more reliably.
Next, a second embodiment of the present invention will be described. The difference between the tissue excision apparatus 71 of the present embodiment and the tissue excision apparatus 1 of the first embodiment is the configuration of the tissue anastomosis part. In the following description, components that are the same as those already described are assigned the same reference numerals and redundant description is omitted.
FIG. 15 is a partially enlarged view showing the first jaw 11 and the distal end side of the cartridge 72 in the tissue excision device 71. A linear or belt-like first electrode 73 is provided in front of the slot 14A in place of the second staple. An insulator 74 is disposed around the first electrode 73 and is insulated from other metal parts in the treatment portion 10.
As shown in FIG. 16, the anvil member 75 provided in the second jaw 12 is provided with a second electrode 76 having the same structure as the first electrode 73 at a position corresponding to the first electrode 73. The first electrode 73 and the second electrode 76 are connected to a high frequency power source 77. On / off of energization can be switched by an operation unit (not shown).
When using the tissue excision device 71, as in the first embodiment, the tissue is sutured and cut using the first staple row 15 and the cutter 20, and then the first jaws 11 and 12 are opened without first opening them. A high frequency current is supplied from a high frequency power source 77 to the tissue sandwiched between the electrode 73 and the second electrode 76. Accordingly, the pair of electrodes of the first electrode 73 and the second electrode 76 functions as a so-called bipolar electrosurgical instrument. As a result, as described in Japanese Patent Application Laid-Open No. 2009-247893, the intracellular and extracellular components of the tissue that is energized in contact with the first electrode 73 and the second electrode 76 are made uniform (liquid). Then, the tissues are joined between the pair of jaws 11 and 12, and the hole caused by the remaining unstitched tissue is sealed.
Similarly to the first embodiment, the tissue excision apparatus 71 of the present embodiment can perform tissue excision without causing any state in which the contents of the luminal tissue may leak to the outside.
Moreover, since the tissue sealing portion is constituted by the first electrode 73 and the second electrode 76, the sealing portion is joined in a planar shape. As a result, the hole can be closed more reliably.
In the present embodiment, the structure of the tissue sealing portion that seals the tissue that has been contacted by energization is not limited to the bipolar mechanism described above. For example, a heating element such as a heater that generates heat when energized is attached to the cartridge and the anvil member instead of the first electrode 73 and the second electrode 76, and the tissue sandwiched between the pair of jaws is heated from both sides. Good. With this configuration, these heat generating elements function as a so-called thermal coagulation treatment instrument, and therefore tissues can be joined together by appropriately setting the temperature and heating time.
Further, the shape of the electrode is not limited to the above-described linear shape, belt shape, or the like, and may be a spot shape like the electrode 73A shown in FIG.
The embodiments of the present invention have been described above. However, the technical scope of the present invention is not limited to the above embodiments, and combinations of components may be changed or various components may be used without departing from the spirit of the present invention. Changes can be made and deleted.
For example, in the above-described embodiment, an example in which the tissue is excised by performing suturing and cutting twice has been described, but the number of times of suturing and cutting is not limited to two. For example, when a large excision region is set due to a large tumor or the like, the jaw may not be cut twice depending on the size of the jaw. In such a case, when the second suture and cutting are performed with a part of the lumen tissue pulled in such a way that the ridge line of the folded lumen tissue does not pass through the slit, The tissue to be excised is not cut off. After that, if necessary, the same stitching and cutting are repeated, and finally the ridgeline of the luminal tissue passes through the slit, and then the stitching and cutting is performed, so that an area of any size can be completely removed. it can. Here, in the final suturing and cutting in which the tissue piece is excised, since there is no tissue in front of the slot, a conventional cartridge having no tissue sealing portion may be used.
In addition, the luminal tissue targeted by the tissue excision apparatus of the present invention is not limited to the stomach. For example, the diameter of the intestine is smaller than that of the stomach, but the tissue excision method of the present invention can be suitably performed on the intestine and the like by appropriately setting the size of a device to be used such as a stapler.
In addition, the target disease for tissue resection is not limited to the tumor described in the embodiment, and is naturally applicable to other diseases such as a severe ulcer.
According to each of the above embodiments, since the tissue sealing portion is arranged in the cartridge, the tissue between the pair of sealing portions in front of the cutting line of the cutting member is securely sutured by the tissue sealing portion. And sealed. Further, in a state where the tissue is drawn into the narrow gap between the pair of gripping members and gripped, the tissue is first sutured by the pair of sealing portions and the tissue sealing portion, and then the pair of gripping members after the cutting member cuts the tissue Holding by is released. Therefore, in a series of procedures using the tissue excision apparatus, tissue excision can be performed without causing any state in which the contents of the luminal tissue may leak to the outside.
1,71 tissue resection device 11 first jaw (first gripping member)
12 Second jaw (second gripping member)
14 Cartridge body 14A Slot 15 A pair of first staple rows (a pair of sealing portions)
16 Second staple (tissue sealing part, sealing staple)
20 Cutter (Cutting member)
A pair of grasping members for holding tissue;
A cartridge that is replaceably attached to the pair of gripping members,
A cartridge body having a longitudinal axis;
A slot that extends along the longitudinal axis and has a predetermined width with respect to the longitudinal axis, guides a cutting member that cuts tissue, and defines a range of movement of the cutting member in the longitudinal axis direction;
A first sealing portion provided at a position sandwiching the slot at an interval larger than the width of the slot and extending in parallel with the slot;
Provided in a position within the range consistent with the width of at least the slot in an extension of the distal end side and the slots of the cartridge body than a distal end of said slot, and a second sealing portion for joining said tissue,
A tissue excision device.
The tissue excision device according to claim 1, wherein the second sealing portion extends in a direction orthogonal to a longitudinal axis of the slot.
The tissue excision apparatus according to claim 1, wherein the second sealing portion is held between the pair of gripping members and joins tissues located on a distal end side with respect to the slot.
The first sealing portion extends to the tip side from the slot,
The tissue excision apparatus according to claim 1, wherein the second sealing portion is provided between the first sealing portions.
The tissue excision apparatus according to claim 1, wherein the first sealing portion is a pair of staple rows including a plurality of staples arranged in the cartridge body.
The tissue excision apparatus according to claim 1, wherein the second sealing portion is a sealing staple disposed on the distal end side of the slot in the cartridge main body.
2. The tissue excision apparatus according to claim 1, wherein the second sealing portion is a pair of electrodes that are held between the pair of grasping members and are capable of contacting a tissue located on a distal side of the slot.
2. The tissue excision apparatus according to claim 1, wherein the second sealing portion is a pair of heat generating elements that are held between the pair of gripping members and are capable of contacting a tissue located on a distal side of the slot.
An insert extending along the longitudinal axis;
A pair of grasping members provided at the distal end of the insertion portion and grasping the tissue;
A cutting member that cuts the lumen tissue held between the pair of jaws by moving along a flow line having a predetermined width;
A first sealing portion provided at a position sandwiching the flow line, and extending in parallel with the flow line;
A second sealing portion that is provided at a position in a range that coincides with at least the width of the flow line on the distal side from the distal end of the flow line and on an extension line of the flow line, and joins the tissue ;
A tissue excision apparatus comprising:
The tissue excision device according to claim 9, wherein the second sealing portion extends in a direction orthogonal to the flow line.
The tissue excision apparatus according to claim 9, wherein the second sealing portion is held between the pair of grasping members and joins a tissue located on a distal end side with respect to the flow line.
The first sealing portion extends to the tip side from the flow line,
The tissue excision apparatus according to claim 9, wherein the second sealing portion is provided between the first sealing portions.
The tissue excision apparatus according to claim 9, wherein the first sealing portion is a pair of staple rows composed of a plurality of staples arranged on both sides of the flow line.
The tissue excision apparatus according to claim 9, wherein the second sealing portion is a sealing staple disposed on the distal end side of the flow line.
The tissue excision apparatus according to claim 9, wherein the second sealing portion is a pair of electrodes that are held between the pair of gripping members and are capable of contacting a tissue located on a distal side of the flow line.
The tissue excision device according to claim 9, wherein the second sealing portion is a pair of heating elements that are held between the pair of gripping members and are capable of contacting a tissue located on a distal end side with respect to the flow line. .
JP2014512964A 2012-11-20 2013-11-18 Tissue excision device Active JP5608837B1 (en)
US61/728,507 2012-11-20
JP5608837B1 true JP5608837B1 (en) 2014-10-15
JPWO2014080862A1 JPWO2014080862A1 (en) 2017-01-05
JP2014512964A Active JP5608837B1 (en) 2012-11-20 2013-11-18 Tissue excision device
US10568625B2 (en) * 2016-12-21 2020-02-25 Ethicon Llc Staple cartridges and arrangements of staples and staple cavities therein
JPH11506943A (en) * 1994-12-07 1999-06-22 マックグッキン、ジェイムス、エフ、ジュニア Surgical apparatus and method
JP2004305740A (en) * 2003-04-02 2004-11-04 Ethicon Endo Surgery Inc Method of forming anastomosis between two lumens each having tissue wall
JP2005021703A (en) * 1993-07-22 2005-01-27 Ethicon Inc Electrosurgical hemostatic device
JP2006506106A (en) * 2002-04-16 2006-02-23 タイコ ヘルスケア グループ エルピー Surgical stapler and surgical method
JP2008514319A (en) * 2004-09-30 2008-05-08 エシコン・エンド−サージェリィ・インコーポレイテッドＥｔｈｉｃｏｎ Ｅｎｄｏ−Ｓｕｒｇｅｒｙ，Ｉｎｃ． Surgical stapling instrument
JP2010522035A (en) * 2007-03-22 2010-07-01 タイコ ヘルスケア グループ リミテッド パートナーシップ Device for forming surgical fasteners of variable height
JP2010240419A (en) * 2009-04-01 2010-10-28 Ethicon Endo Surgery Inc Method and device for cutting and fastening tissue
DE102009059195A1 (en) * 2009-12-17 2011-06-22 Aesculap AG, 78532 Surgical system for connecting body tissue and method for separating protruding tissue
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