WO2011090291A2

WO2011090291A2 - Anastomosis device using the gear and cam method

Info

Publication number: WO2011090291A2
Application number: PCT/KR2011/000271
Authority: WO
Inventors: 김철웅; 조광현
Original assignee: (주)트리플씨메디칼
Priority date: 2010-01-25
Filing date: 2011-01-14
Publication date: 2011-07-28
Also published as: KR101111213B1; WO2011090291A3; KR20110086948A

Abstract

According to the one embodiment of the present invention, an anastomosis device includes: a first jaw and a second jaw opposite the first jaw and moves between an open position and a closed position with respect to said first jaw; a bracket, to which either the first jaw or the second jaw is fixed and which rotates together with the first and the second jaws; a supporting shaft, the distal end of which is connected to said bracket so as to rotate about a proximal end of said bracket; a drive shaft installed, in the same direction in which the first jaw extends, in a channel formed inside the first jaw; a plurality of anastomosis parts initially allocated on the first jaw; a blade allocated under the anastomosis part and installed on said drive shaft, which translates as the drive shaft rotates and cuts a part of tubular tissue by means of the translation; a wedge having an inclined plane that drives the anastomosis part such that the anastomosis part can pass tubular tissue toward the second jaw and connect said tubular tissue; a driving gear which includes a driving unit and which drives the drive shaft and said bracket, wherein said driving unit is provided with a driving gear that provides driving force; and a rotating gear connected to the bracket and rotatable together with the bracket by means of the driving force provided by said driving gear; and an anastomosis gear connected to the drive shaft and rotatable with said drive shaft.

Description

Gear and cam type anastomosis device

The present invention relates to a gear and cam type anastomosis device, and more particularly, to an anastomosis device capable of rotating the upper jaw and the lower jaw using the gear and cam as well as the anastomosis of the tubular structure.

If there is cancerous tissue in a location within the large intestine accessible by the tool, the patient's abdomen is first opened to expose the intestines. The surgeon then cuts the large intestine on either side of the cancerous tissue and at the same time the two open ends of the intestine (the distal end facing the anus and the proximal end closest to the lower intestine) Proximal end) anastomosis in a closed state. Such temporary closure is done to minimize contamination.

More specifically, this temporary closure allows the surgeon to place the cutting elements by pressing the trigger on the handle of the device after the colon is placed between the plurality of scissors cutting elements at the tip of the linear cutting and anastomosis tool. . Thereafter, another trigger (or secondary operation of the same trigger) is manipulated to drive a series of staples and cutting blades through the clamped ends of the colon, through which the ends are closed and cross cut.

Such a scissor cutting element is inserted into the abdominal cavity of the patient and then rotated along the direction of the large intestine to be perpendicular to the longitudinal direction of the large intestine. In this state, cutting and anastomosis are most preferably performed at once. However, the conventional anastomosis device has a problem in that the rotation angle is limited by the driving method, so that the cutting device is inclined in the longitudinal direction of the large intestine and thus the cutting and anastomosis cannot be performed at once.

In addition, the conventional anastomosis device was cut and anastomated by a trigger operation, but the same method has a disadvantage in that it requires a large force of the operator because it depends on the strength of the operator.

An object of the present invention is to provide an anastomosis device capable of cutting and anastomosis regardless of the rotation of the upper jaw and lower jaw.

Another object of the present invention is to provide an anastomosis device capable of securing sufficient rotational displacement of the upper jaw and the lower jaw.

Still another object of the present invention is to provide an anastomosis device that can smoothly cut and anastomosis without a large force by the operator through a separate driving force.

Still other objects of the present invention will become more apparent from the following detailed description and the accompanying drawings.

According to one embodiment of the invention, the anastomosis device comprises: a first jaw; A second jaw disposed so as to face the first jaw, the second jaw being relatively movable between an open position and a closed position with respect to the first jaw; Any one of the first and second jaws is fixedly installed, and the bracket rotates together with the first and second jaws; A support shaft having a distal end rotatably connected to the proximal end of the bracket; A drive shaft installed along a longitudinal direction of the first jaw on a channel formed inside the first jaw; At least one anastomosis member initially disposed in the first jaw; The blade and the anastomosis member disposed below the anastomosis member and installed on the driving shaft, and the translation shaft moves as the driving shaft rotates, and cuts a part of the tubular tissue by the translational movement. A wedge having an inclined surface for driving the anastomotic member to anastomize the tubular tissue through the tubular tissue toward the two jaws; And a drive unit for driving the drive shaft and the bracket, wherein the drive unit includes a drive gear for providing a driving force; A rotation gear connected to the drive gear and rotatable by the driving force and connected to the bracket and rotatable with the bracket; And an anastomosis gear connected to the drive gear and rotatable by the driving force and connected to the drive shaft to rotate together with the drive shaft.

The drive unit is connected to the rotation gear to rotate with the rotation gear, the rotation shaft is installed on the distal end of the support shaft; And a fixing member for converting the bracket into a restraining position at which the bracket is constrained to the pivot shaft and to a restraining position at which the bracket is restrained from the pivot shaft.

The fixing member is inserted into the center of the rotating shaft to rotate with the rotating shaft, the fixing bar to move in the longitudinal direction of the rotating shaft to switch to the restraining position and the restraining position; A fixing key protruding from an outer circumferential surface of the fixing bar and inserted into a fixing groove formed on an outer circumferential surface of the rotating shaft, and transmitting a rotational force of the rotating shaft to the fixing bar; And a first stopper installed at one end of the fixing bar and inserted into the first stopper groove formed in the bracket at the restraint position and drawn out from the first stopper groove at the restraint release position.

The drive unit further includes a conversion cam having a rotational driving surface for contacting the other end of the fixed bar and converting the fixed bar to a restraint position, wherein the conversion cam can switch the fixed bar by rotation.

The anastomosis device is installed inside the support shaft, the distal end is connected to the drive gear is a hollow outer shaft that rotates with the drive gear; And an inner shaft installed inside the outer shaft, the distal end being connected to the switching cam to rotate together with the switching cam, and the driving unit is installed at the proximal end of the outer shaft to rotate together with the outer shaft. Soccer gears; An inner shaft driving gear installed at a proximal end of the inner shaft to rotate together with the inner shaft; And a handle that is connected to the proximal end of the support shaft to provide a space in which the outer shaft driving gear and the inner shaft driving gear are installed.

The drive gear and the anastomosis gear may have the same first axis of rotation, and the anastomosis gear may have a second axis of rotation perpendicular to the first axis of rotation.

The drive unit rotates about the second rotation shaft, and is engaged with the drive gear and the anastomosis gear by a movement along the second rotation shaft to transmit a driving force of the drive gear to the anastomosis gear and the drive gear. And an intermittent gear that is switched to a delivery release position spaced apart from the anastomosis gear.

The drive unit is connected to the intermittent gear to rotate and move with the intermittent gear, the intermittent shaft is installed on the distal end of the support shaft; And a second stopper installed on the intermittent shaft and shifted together with the intermittent shaft to be switched to a pivoting limit position for limiting rotation of the bracket and a pivoting position for allowing rotation of the bracket.

The anastomotic gear has a disengaging position at which the tooth of the anastomosis gear is separated from the tooth of the rotating gear by the rotation, and the tooth of the anastomotic gear meshes with the tooth of the rotating gear. Can be switched to the rotating position.

The driving unit is connected to the anastomosis gear and the auxiliary drive shaft to rotate with the anastomosis gear; And an auxiliary drive gear connected to the auxiliary drive shaft to rotate in engagement with a connection gear connected to the drive shaft.

The upper jaw is connected to the bracket through a hinge to be switched to the open position and the closed position by the rotation, the drive unit is connected to the auxiliary drive shaft and the upper jaw to the open position and the closed position by rotation It may be further provided with an opening and closing cam to switch to.

The upper jaw has a guide groove formed along the longitudinal direction of the upper jaw, the blade enters the guide groove when the upper jaw is switched to the closed position to translate along the guide groove with the wedge It may have a guide protrusion.

The guide groove may be formed to be inclined upward toward the distal end of the upper jaw.

According to the present invention, even when the rotational displacement of the upper jaw and the lower jaw is large, cutting and anastomosis can be performed smoothly. In addition, the upper jaw and the lower jaw can secure a sufficient rotational displacement, it is possible to proceed smoothly cutting and anastomosis in a narrow space. In addition, since the driving force is transmitted by the gear system, accurate driving and anastomosis can be achieved by accurately transmitting the driving force.

Like reference numerals in the drawings provided below denote like elements.

1 is a perspective view schematically showing an anastomosis device according to an embodiment of the present invention.

FIG. 2 is a perspective view of the driving unit shown in FIG. 1. FIG.

3 is a view showing the upper jaw and the lower jaw and gears shown in FIG.

4 is an enlarged view of a connection state of the gears shown in FIG. 3.

FIG. 5 is a view illustrating switching of the control gear according to the operation of the switching cam shown in FIG. 4.

6A to 6C are diagrams showing the positional relationship between the anastomosis gear, the rotating gear, and the intermittent gear shown in FIG.

7 is a view showing an upper stopper installed between the bracket and the upper support plate shown in FIG.

FIG. 8 is a view illustrating a lower stopper inserted into the bracket illustrated in FIG. 4.

9 is a view showing a fixing member installed on the rotation shaft shown in FIG.

10 and 11 are views illustrating the operation of the upper stopper and the lower stopper according to the operation of the switching cam shown in FIG. 4.

12 and 13 are views showing the operation of the upper jaw according to the operation of the opening and closing cam and wedge shown in FIG.

10: cutting anastomosis unit 11: bracket

12: upper jaw 14: lower jaw

16: drive shaft 18: auxiliary drive gear

19: opening and closing cam 20: connecting unit

21: support shaft 22: outer shaft

24: inner shaft 30: drive unit

32: Handle 34: Lower Drive Gear

34a: lower drive motor 36a: upper drive motor

35: external drive gear 36: upper drive gear

37: internal shaft drive gear 42: drive gear

44: rotational gear 45: conversion cam

452: anastomosis release side 453: anastomosis drive side

454: Hoedong Drive Mong 46: Intermittent Gear

48: anastomosis gear 49: rotating shaft

49a: fixing groove 492: fixing bar

494: Fixed Key 496: Lower Stopper

Hereinafter, preferred embodiments of the present invention will be described in more detail with reference to FIGS. 1 to 13. Embodiments of the invention may be modified in various forms, the scope of the invention should not be construed as limited to the embodiments described below. These embodiments are provided to explain in detail the present invention to those skilled in the art. Accordingly, the shape of each element shown in the drawings may be exaggerated to emphasize more clear explanation.

On the other hand, the following describes the anastomosis and cutting of the large intestine, but those skilled in the art to which the present invention pertains a variety of applications and modifications within the scope of the present invention based on the following description.

Also, hereinafter, "proximal" and "distal" are used based on the operator grabbing the handle of the tool. For example, the lower jaw 14 is distal to the handle 32. In addition, "upper" and "lower" used below are for convenience of description and are not intended to limit the content of the invention.

1 is a perspective view schematically showing an anastomosis device according to an embodiment of the present invention, Figure 2 is a perspective view showing a drive unit shown in FIG. The anastomosis device includes a cutting anastomosis unit 10 and a driving unit 30, and a connection unit 20 positioned between the cutting anastomosis unit 10 and the driving unit 30.

The cutting anastomosis unit 10 has an upper jaw 12 and a lower jaw 14, and like the scissors, the upper jaw 12 and the lower jaw 14 are rotated relatively to the upper jaw 12 and the lower jaw. Tissues (eg, tubular tissue such as intestines) located between 14 are clamped. As described later, the lower jaw 14 is provided with a wedge 13 for anastomosis and cutting, and the wedge 13 anastomizes and cuts tissue through movement.

The drive unit 30 includes a handle 32, an upper drive gear 36 and a lower drive gear 34, and an outer shaft drive gear 35 and an inner shaft drive gear 37. The operator grasps the handle 32 having a pistol grip shape and performs the operation. The upper driving gear 36 and the lower driving gear 34, the outer drive gear 35 and the inner drive gear 37 are handles 32. It is mounted in the installation space formed inside.

The outer shaft drive gear 35 is connected to the proximal end of the outer shaft 22 installed inside the hollow support shaft 21, and the support shaft 21 is fixed to the distal end of the handle 32. . The outer shaft 22 rotates together with the outer shaft driving gear 35, and the outer shaft driving gear 35 is engaged with the lower driving gear 34 to rotate by the lower driving gear 34. The inner shaft drive gear 37 is connected to the proximal end of the inner shaft 24 installed inside the hollow outer shaft 22, and the inner shaft 24 is rotatable independently of the outer shaft 22. The inner shaft 24 rotates together with the inner shaft drive gear 37, and the inner shaft drive gear 37 meshes with the upper drive gear 36 to rotate by the upper drive gear 36. On the other hand, the upper drive gear 36 is driven by the upper drive motor 36a, the lower drive gear 34 is driven by the lower drive motor 34a.

3 is a view showing the upper jaw and the lower jaw and the gears shown in Figure 1, Figure 4 is an enlarged view of the connection state of the gears shown in FIG. As described above, the upper jaw 12 and the lower jaw 14 rotate relative to the tissue (eg, intestines) located between the upper jaw 12 and the lower jaw 14. Clamp. The lower jaw 14 is fixedly installed on the lower plate of the bracket 11 having an 'I' shape, and the upper jaw 12 is fixed to the upper portion of the lower jaw 14 by a hinge h. The upper jaw 12 rotates around the hinge h, and is switched to the open position and the closed position by the rotation as described later. In the open position, the upper jaw 12 is at a predetermined angle with the lower jaw 14 (see FIG. 3), and in the closed position the upper jaw 12 is placed on top of the lower jaw 14 (see FIG. 12). Can be clamped.

On the other hand, as shown in Figure 3, the lower jaw 14 has a channel 15, which is formed along the longitudinal direction of the lower jaw (14). The tray 142 is installed on the upper part of the channel 15 and is detachable from the lower jaw 14, and a plurality of staples 152 are initially loaded. Staples 152 operate through wedges 13 that move along channel 15 and move toward top jaw 12 in a closed position. In this case, the upper jaw 12 may have a staple guide (not shown) corresponding to the staple 152 in the tray 142. The staples 152 in the tray 142 are moved toward the staple guides and then bent and deformed by the staple guides to close the open ends of the tissue placed between the upper jaw 12 and the lower jaw 14.

The drive shaft 16 is installed under the tray 142, the drive shaft 16 is disposed substantially parallel to the longitudinal direction of the lower jaw (14). The drive shaft 16 has a thread formed on the outer circumferential surface, and the wedge 13 is provided on the drive shaft 16. At this time, since the wedge 13 is installed on the drive shaft 16 through a bore formed with a thread on the inner circumferential surface, the wedge 13 moves along the channel 15 on the drive shaft 16 as the drive shaft 16 rotates. .

The wedge 13 has an inclined surface 13a and a blade 13b. The inclined surface 13a is formed to be inclined upward toward the proximal end of the lower jaw 14, and the blade 13b extends from the upper end of the inclined surface 13a toward the upper jaw 12. Staple 152 has a base that protrudes below tray 142 and a fork that extends toward the top of tray 142. As the wedge 13 moves along the channel 15, the blade 13b cuts the tissue, and the inclined surface 13a of the wedge 13 presses the base of the staple 152. The forked of staple 152 passes through the open end of the tissue to contact the staple guide, and the staple guide curves the staple 152 to close the open end. Thus, the open end of the tissue is closed with the cut, and when the wedge 13 has moved to the end of the channel 15, the staples 152 are pushed all the way through the tray 142 to be closed. The open end is anastomated. The wedge 13 then returns to its original position.

As shown in FIG. 3, the support shaft 21 has an upper support plate 23 and a lower support plate 25 formed at the distal end, and the proximal end of the bracket 11 has an upper support plate 23 and a lower support plate ( 25) is pivotally connected. At this time, as shown in Figure 4, between the upper support plate 23 and the lower support plate 25, the drive gear 42, the rotation gear 44, the intermittent gear 46, and the anastomosis gear 48 is installed The switching cam 45 is installed between the intermittent gear 46 and the anastomosis gear 48.

As shown in FIG. 4, the drive gear 42 is installed at the distal end of the outer shaft 22, and the drive gear 42 is connected to the outer shaft 22 when the outer shaft driving gear 35 is rotated. Rotate together. The shift cam 45 is installed at the distal end of the inner shaft 24 installed inside the outer shaft 22, and the shift cam 45 rotates together with the inner shaft 24 when the inner shaft drive gear 37 is rotated. do.

Rotating gear 44 is installed on the upper support plate 25 to maintain a state engaged with the drive gear 42, and has a rotation axis substantially perpendicular to the rotation axis of the drive gear 42. Rotating gear 44 is connected to the bracket 11 through the lower support plate 25, the bracket 11 is rotated with respect to the lower support plate 25 when the rotation gear 44 rotates the upper portion connected to the bracket (11) The jaw 12 and the lower jaw 14 are rotated.

The intermittent gear 46 is installed below the upper support plate 23 and has the same rotation axis as the rotation gear 44. The intermittent gear 46 may intermittently drive the driving force of the drive gear 42 according to the operation of the switching cam 45.

FIG. 5 is a view illustrating switching of the control gear according to the operation of the switching cam shown in FIG. 4. As shown in Figures 4 and 5, the switching cam 45 is located on the upper portion of the rotary gear 44 and the lower portion of the intermittent gear 46, the anastomosis release surface 452 and the anastomosis driving surface 453 formed on the outer peripheral surface. ) And a rotation driving surface 454 formed therein.

The intermittent gear 46 is switched to the transfer position and the release position by the switching cam 45. The intermittent gear 46 is supported by the switching cam 45, and as the switching cam 45 rotates, the intermittent gear 46 moves along the outer circumferential surface of the switching cam 45. As shown in FIG. 5A, when the intermittent gear 46 contacts the anastomosis release surface 452 of the switching cam 45, the intermittent gear 46 is positioned at the transfer release position, and As shown in b), when the intermittent gear 46 contacts the anastomosis drive surface 453 of the switching cam 45, the intermittent gear 46 is positioned at the transfer position.

At this time, the anastomosis release surface 452 has a first distance r1 from the rotational center of the conversion cam 45, and the anastomosis driving surface 453 has a second distance r2 from the rotational center of the conversion cam 45. , The first distance r1 is greater than the second distance r2. Therefore, the intermittent gear 46 is raised and spaced apart from the drive gear 42 and the anastomosis gear 48 at the disengaged position, and the intermittent gear 46 is lowered to the drive gear 42 and the anastomosis gear 48 at the delivered position. ) The driving force of the drive gear 42 in the transfer position is transmitted to the anastomosis gear 48 via the intermittent gear 46.

Meanwhile, as shown in FIGS. 4 and 5, a fixing bar 492 is installed at a lower portion of the conversion cam 45, and a lower stopper 496 (see FIG. 10) is connected to a lower end of the fixing bar 492. do. An elastic body 116 is installed below the lower stopper 496, and the elastic body 116 provides an elastic force in a rising direction of the fixing bar 492.

An upper end of the fixing bar 492 is located inside the conversion cam 45. The switching cam 45 has an opening formed on the rotation driving surface 454 and the side surface corresponding to the upper end of the fixing bar 492, and the fixing bar 492 may be elevated according to the operation of the switching cam 45.

As shown in FIG. 5A, when the rotation driving surface 454 of the switching cam 45 is positioned above the fixing bar 492, the rising of the fixing bar 492 is limited, and the lower portion described below. The stopper 496 is inserted into the lower stopper groove 114 ('restraining position'), and the fixing bar 492 is constrained to the bracket 11. Accordingly, the rotational force of the rotation gear 44 is transmitted to the bracket 11 through the fixing bar 492 and the lower stopper 496, and the bracket 11 rotates together with the fixing bar 492.

As shown in (b) of FIG. 5, when the switching cam 45 rotates and the opening is positioned above the fixing bar 492, the fixing bar 492 is raised, and the lower stopper 496 described later is The fixing bar 492 is drawn out from the lower stopper groove 114 ('restraining release position') and released from the bracket 11. Therefore, when the rotation gear 44 rotates, the fixing bar 492 rotates together with the rotation gear 44, but the bracket 11 does not rotate.

On the other hand, as shown in Figure 4, the anastomosis gear 48 is installed on the side wall of the bracket 11 is installed on the proximal end of the front shaft 482 having the same rotation axis as the outer shaft 22, the front shaft 482 ) Can rotate freely on the side wall of the bracket (11). 6A to 6C are diagrams showing the positional relationship between the anastomosis gear, the rotating gear, and the intermittent gear shown in FIG.

As shown in FIG. 6A, the anastomotic gears 48 are arranged in a row so that the teeth are spaced apart from each other, and the columns are arranged so as to be conformal to the center of the anastomotic gear 48. The initial position of the anastomosis gear 48 is arranged such that the rotational gear 44 is located between the rows, and the teeth of the rotational gear 44 are arranged in the anastomosis gear 48 because the rotational gear 44 is disposed between the rows. Do not mesh with each other's teeth. In other words, the rotation gear 44 is positioned between the rows of the anastomosis gear 48 such that the teeth of the rotation gear 44 corresponding to the anastomosis gear 48 are positioned between the rows of the anastomosis gear 48. Therefore, the rotation gear 44 is not in engagement with the anastomosis gear 48. Therefore, as described above, when the bracket 11 is rotated by the rotation of the rotation gear 44, the anastomosis gear 48 cannot be rotated by the rotation gear 44.

As shown in FIG. 6B, when the intermittent gear 46 is switched to the transfer position by the rotation of the switching cam 45, the rows of teeth of the anastomotic gear 48 are connected to the intermittent gear 46. Since it is arranged to correspond, the anastomosis gear 48 and the intermittent gear 46 mesh with each other, and the driving force of the drive gear 42 is transmitted to the anastomosis gear 48 through the intermittent gear 46. Thus, the anastomosis gear 48 can rotate.

As shown in FIG. 6C, when the anastomosis gear 48 is rotated so that the intermittent gear 46 is positioned between the rows of teeth of the anastomosis gear 48, the intermittent gear as described in FIG. 6A. 46 can no longer drive the anastomosis gear 48. However, on the contrary, since the rows of teeth of the anastomosis gear 48 are arranged to correspond to the rotational gear 44, the anastomosis gear 48 meshes with the rotational gear 44, and the drive gear 42. The driving force of is transmitted to the anastomosis gear 48 through the rotation gear (44). Thus, the anastomosis gear 48 can rotate.

As described above, the anastomosis gear 48 alternately engages with the intermittent gear 46 and the rotational gear 44, and the driving force of the drive gear 42 is alternately through the intermittent gear 46 or the rotational gear 44. Since the anastomosis gear 48 is transmitted, the anastomosis gear 48 can rotate continuously.

FIG. 7 is a view showing an upper stopper installed between the bracket and the upper support plate shown in FIG. 4, and FIG. 8 is a view showing a lower stopper inserted into the bracket shown in FIG. 4. 9 is a view showing a fixing member installed on the rotation shaft shown in FIG. As described above, the intermittent gear 46 is moved up and down by the rotation of the switching cam 45 to be transferred to the transfer position and the release position, and the fixed bar 492 is raised and lowered by the rotation of the switching cam 45. The stopper 496 is switched to the restraint position and the restraint position.

As shown in FIG. 7, the intermittent gear 46 is connected to the lower end of the intermittent shaft 47, and the intermittent shaft 47 is installed on the through hole 234 formed in the upper support plate 23. At this time, the upper stopper 472 is installed on the intermittent shaft 47, the intermittent shaft 47 may be disposed to penetrate the upper stopper 472, and may freely rotate on the intermittent shaft 47.

The upper stopper 472 has a ring-shaped cylinder 472a, an upper protrusion 472b protruding from the outer circumferential surface of the cylinder 472a, and an upper protrusion surface 472c formed on one surface corresponding to the upper support plate 23. In addition, the bracket 11 has an upper stopper groove 112 of a shape corresponding to the upper stopper 472. The upper stopper groove 112 has a cylindrical groove 112a corresponding to the cylinder 472a and a protrusion groove 112b corresponding to the upper protrusion 472b. The upper support plate 23 has a lower protrusion surface 232 formed on one surface corresponding to the upper protrusion surface 472c, and the lower protrusion surface 232 is disposed around the through hole 234.

As shown in Fig. 8 and 9, the rotation gear 44 is installed on the upper end of the rotation shaft 49, the rotation shaft 49 is fixed to the outer peripheral surface (49a) extending from the lower end to the upper spaced from each other It has grooves 49a. The fixed bar 492 is generally parallel with the rotation shaft 49 and is installed to penetrate the center of the rotation shaft 49 and the rotation gear 44. The fixing key 494 has fixing keys 494 protruding from the outer circumferential surface of the fixing bar 492, and the fixing keys 494 are inserted into the fixing grooves 49a to fix the fixing bars 492 to the pivot shaft 49. Restrain. Therefore, when the rotating gear 44 rotates, the rotating shaft 49 rotates together with the fixing bar 492. The lower stopper 496 is connected to the lower end of the fixing bar 492 and has a plurality of tip portions 496a spaced apart around the center thereof. As shown in FIG. 8, the racket 11 has a lower stopper groove 114 corresponding to the lower stopper 496, and the lower stopper groove 114 corresponds to the tip groove 114a corresponding to the tip portions 496a. Has

10 and 11 are views illustrating the operation of the upper stopper and the lower stopper according to the operation of the switching cam shown in FIG. 4. Hereinafter, operations of the upper stopper and the lower stopper according to the operation of the switching cam will be described with reference to FIGS. 10 and 11.

First, as shown in FIG. 10, when the anastomosis release surface 452 of the switching cam 45 supports the intermittent gear 46, the upper stopper 472 is constrained to the intermittent shaft 47, and thus the lower protruding surface. It is withdrawn from 232 and positioned (rotating position) in the upper stopper groove 112 of the bracket 11. Therefore, the rotation of the bracket 11 is not limited by the upper stopper 472.

In addition, as shown in FIG. 10, when the rotation driving surface 454 supports the fixing bar 492, the lower stopper 496 maintains a state of being inserted into the lower stopper groove 114 (restraining position). , The bracket 11 is constrained by the lower stopper 496. Therefore, when the rotating gear 44 rotates, the lower stopper 496 rotates the bracket 11 and rotates the upper jaw 12 and the lower jaw 14 fixed to the bracket 11 in a desired direction. Can be.

Next, as shown in FIG. 11, when the anastomosis driving surface 453 of the switching cam 45 supports the intermittent gear 46, the upper stopper 472 descends together with the intermittent shaft 47, and the upper portion The stopper 472 is positioned on the upper stopper groove 112 and the lower protrusion surface 232 (rotational limit position). At this time, since the upper protrusion 472b of the upper stopper 472 is inserted into the protrusion groove 112b of the upper stopper groove 112, the upper stopper 472 is constrained to the bracket 11. In addition, since the upper protrusion surface 472c of the upper stopper 472 is inserted into the lower protrusion surface 232, the upper stopper 472 restrains the upper support plate 23. Therefore, the upper support plate 23 maintains the state constrained to the bracket 11 through the upper stopper 472, and thus the bracket 11 cannot be rotated.

In addition, as shown in FIG. 11, when the rotation driving surface 454 is separated from the upper portion of the fixing bar 492 by the rotation of the switching cam 45, the fixing bar 492 is formed of the lower stopper 496. Due to the elastic force of the elastic body 116 located at the lower side, the lower stopper 496 is drawn out from the lower stopper groove 114 (restrained position). Therefore, the bracket 11 is not restrained by the lower stopper 496, and the bracket 11 does not rotate when the rotation gear 44 rotates.

12 and 13 are views showing the operation of the upper jaw according to the operation of the opening and closing cam and wedge shown in FIG. As described above, when the intermittent gear 46 is switched to the intermittent position, the anastomosis gear 48 rotates together with the front shaft 482 when the drive gear 42 rotates.

The auxiliary driving gear 18 and the opening and closing cam 19 are installed at the distal end of the front shaft 482, and the auxiliary driving gear 18 and the opening and closing cam 19 are the front shaft 482 when the anastomosis gear 48 rotates. Rotate with). The opening and closing cam 19 has an open driving surface 19a having a third distance r3 from the rotation axis and a closed driving surface 19b having a fourth distance r4, r4> r3. The opening / closing cam 19 supports the proximal end 12a of the upper jaw 12, and the elastic body S is installed between the proximal end 12a and the bracket 11 to apply an elastic force to open the upper jaw 12. to provide.

When the proximal end 12a of the upper jaw 12 is supported by the open driving surface 19a of the opening and closing cam 19 by the rotation of the front shaft 482, the upper jaw 12 is placed in the open position. As shown in FIG. 12, when the proximal end 12a of the upper jaw 12 is supported by the closing driving surface 19b of the opening and closing cam 19 by the rotation of the front shaft 482, the proximal end 12a. The elastic body S is compressed and the upper jaw 12 is placed in the closed position as) is raised.

On the other hand, the upper jaw 12 has a guide groove 122 formed along the longitudinal direction of the upper jaw 12, the guide protrusion 13c formed on the upper end of the blade 13b is a guide groove (when the wedge 13 is moved) 122). At this time, as shown in Figure 12, the proximal end of the guide groove 122 has a first separation distance (d1) from the lower surface of the upper jaw 12, the distal end of the guide groove 122 is the upper jaw (12) ) Has a second separation distance d2, d2 <d1. That is, the guide groove 122 is formed to be inclined upward based on the lower surface of the upper jaw 12.

As described above, when the proximal end 12a of the upper jaw 12 is supported by the closing driving surface 19b of the opening / closing cam 19 by the rotation of the front shaft 482, the upper jaw 12 is closed. The guide protrusion 13c enters the guide groove 122 through the inlet 122a formed at the proximal end of the guide groove 122 while being switched to the position. Subsequently, when the front shaft 482 is continuously rotated, the auxiliary drive gear 18 is engaged with the driven gear 17 fixed to the proximal end of the drive shaft 16, so that the wedge 13 is advanced. As the wedge 13 moves forward, the guide protrusion 13c moves along the guide groove 122.

In this case, as shown in FIG. 13, the opening driving surface 19a of the opening / closing cam 19 may be positioned to face the proximal end 12a of the upper jaw 12 by the rotation of the front shaft 482. The upper jaw 12 is constrained by the guide protrusion 13c moving along the guide groove 122 and thus cannot be switched to the open / close position.

On the other hand, as described above, the guide groove 122 is formed to be inclined upward relative to the lower surface of the upper jaw 12, while the length of the blade (13b) is constant, the wedge 13 is lower jaw (14) As it moves toward the distal end of the upper jaw 12 approaches the lower jaw 14, the tissue located between the upper jaw 12 and the lower jaw 14 can be clamped with great force.

In summary, the operator drives the lower drive motor 34a to drive the external drive shaft 35, and is driven by the rotation of the external shaft 22 when the external drive shaft 35 is rotated. The gear 42 rotates. At this time, the anastomosis release surface 452 of the conversion cam 45 supports the intermittent gear 46 and the rotation driving surface 454 supports the fixed bar 492. In this state, the rotation gear 44 is rotated by the rotation of the drive gear 42, and the lower stopper 496 is inserted into the lower stopper groove 114 so that the bracket 11 can rotate. At this time, despite the rotation of the rotating gear 44, the anastomosis gear 48 does not rotate.

When the rotation is completed, the operator drives the upper drive motor 36a to drive the inner shaft gear 37, the rotation cam 45 may be rotated when the inner shaft gear 37 rotates. By the rotation of the switching cam 45, the anastomosis driving surface 453 of the switching cam 45 supports the intermittent gear 46, and the intermittent gear 46 meshes with the drive gear 42 and the anastomosis gear 48. All. At this time, the upper stopper 472 limits the rotation of the bracket (11). In addition, since the rotation driving surface 454 is separated from the upper portion of the fixing bar 492, the lower stopper 496 is withdrawn from the lower stopper groove 114, so that the bracket 11 is rotated despite the rotation of the rotation gear 44. Do not rotate.

Subsequently, when the driving gear 42 is driven again, the anastomosis gear 48 is rotated by the intermittent gear 46 and the rotational gear 44, and the opening / closing cam 19 is rotated by the rotation of the front shaft 482. Switch jaw 12 to closed position. In this process, the tissue may be clamped between the upper jaw 12 and the lower jaw 14. At this time, the guide protrusion 13c positioned at the upper end of the blade 13b enters through the inlet 122a of the guide groove 122. As the front shaft 482 continues to rotate, the auxiliary drive gear 18 drives the driven gear 17 to rotate the drive shaft 16, whereby the wedge 13 is distal end of the lower jaw 14. Move towards.

Although the present invention has been described in detail with reference to preferred embodiments, other forms of embodiments are possible. Therefore, the spirit and scope of the claims set forth below are not limited to the preferred embodiments.

The present invention can be applied to various types of microsurgeries requiring reconstruction by cutaneous flap, anastomosis of amputated blood vessels, and anastomosis of heart disease and other coronary organs.

Claims

First jaw;

A second jaw disposed so as to face the first jaw, the second jaw being relatively movable between an open position and a closed position with respect to the first jaw;

Any one of the first and second jaws is fixedly installed, and the bracket rotates together with the first and second jaws;

A support shaft having a distal end rotatably connected to the proximal end of the bracket;

A drive shaft installed along a longitudinal direction of the first jaw on a channel formed inside the first jaw;

At least one anastomosis member initially disposed in the first jaw;

The second jaw is disposed below the anastomotic member and is installed on the drive shaft, and the blade and the anastomotic member are disposed to translate as the driving shaft rotates and cut a portion of the tissue by the translational movement. A wedge having an inclined surface that drives the anastomotic member so as to pass through the tissue toward the anastomosis; And

It includes a drive unit for driving the drive shaft and the bracket,

The drive unit,

A drive gear providing a driving force;

A rotation gear connected to the drive gear and rotatable by the driving force and connected to the bracket and rotatable with the bracket; And

And an anastomosis gear connected to the drive gear and rotatable by the driving force and connected to the drive shaft to rotate together with the drive shaft.
The method of claim 1,

The drive unit,

A rotation shaft connected to the rotation gear to rotate together with the rotation gear and installed on the distal end of the support shaft; And

And a fixing member configured to move to a restraint position at which the bracket is restrained by the pivot shaft and a restraint position at which the bracket is restrained from the pivot shaft by movement.
The method of claim 2,

The fixing member,

A fixed bar inserted into the center of the rotation shaft to rotate together with the rotation shaft and shifted along the longitudinal direction of the rotation shaft to switch to the restraint position and the restraint position;

A fixing key protruding from an outer circumferential surface of the fixing bar and inserted into a fixing groove formed on an outer circumferential surface of the rotating shaft, and transmitting a rotational force of the rotating shaft to the fixing bar; And

And a first stopper installed at one end of the fixing bar and inserted into the first stopper groove formed in the bracket at the restraint position and withdrawn from the first stopper groove at the restraint release position.
The method of claim 3,

The driving unit further includes a conversion cam having a rotational driving surface for contacting the other end of the fixed bar to convert the fixed bar to a restrained position.

The conversion cam anastomosis device, characterized in that for switching the fixed bar by rotation.
The method of claim 4, wherein

The anastomosis device,

A hollow outer shaft installed inside the support shaft and having a distal end connected to the drive gear to rotate together with the drive gear; And

Is installed inside the outer shaft, the distal end is connected to the conversion cam further comprises an inner shaft that rotates with the conversion cam,

The drive unit,

An outer shaft driving gear installed at the proximal end of the outer shaft to rotate together with the outer shaft;

An inner shaft driving gear installed at a proximal end of the inner shaft to rotate together with the inner shaft; And

And a handle connected to the proximal end of the support shaft to provide a space in which the outer shaft drive gear and the inner shaft drive gear are installed.
The method of claim 1,

The drive gear and the anastomosis gear have the same first axis of rotation,

The anastomosis gear is an anastomosis device characterized in that it has a second rotation axis perpendicular to the first rotation axis.
The method of claim 6,

The driving unit rotates about the second rotation shaft, and is engaged with the driving gear and the anastomosis gear by a movement along the second rotation shaft to transmit a driving force of the driving gear to the anastomosis gear and the driving gear. And an intermittent gear that is switched to a delivery release position spaced apart from the anastomosis gear.
The method of claim 7, wherein

The drive unit further includes a switching cam for switching the intermittent gears to the transfer position and the release position by rotation,

The conversion cam is anastomosis device characterized in that it has an anastomosis driving surface and anastomosis release surface supporting the intermittent gear.
The method of claim 7, wherein

The drive unit,

An intermittent shaft connected to the intermittent gear to rotate and move together with the intermittent gear and installed on the distal end of the support shaft; And

And a second stopper installed on the intermittent shaft and shifted together with the intermittent shaft to switch to a pivoting limit position for limiting rotation of the bracket and a pivoting position for allowing rotation of the bracket. Device.
The method of claim 7, wherein

The anastomotic gear has a disengaging position at which the tooth of the anastomotic gear is separated from the tooth of the rotating gear by the rotation and the tooth of the anastomotic gear meshes with the tooth of the rotating gear. Anastomosis device, characterized in that switched to the rotation position.
The method of claim 7, wherein

The drive unit,

An auxiliary drive shaft connected to the anastomosis gear and rotating together with the anastomosis gear; And

And an auxiliary driving gear connected to the auxiliary driving shaft to rotate in engagement with the connecting gear connected to the driving shaft.
The method of claim 11,

The second jaw is connected to the bracket via a hinge and is switched to the open position and the closed position by a rotation,

The drive unit is an anastomosis device connected to the auxiliary drive shaft and further comprises an opening and closing cam for switching the second jaw to the open position and the closed position by rotation.
The method of claim 12,

The second jaw has a guide groove formed along the longitudinal direction of the second jaw,

The blade anastomosis device characterized in that it has a guide protrusion to enter the guide groove and translate along the guide groove with the wedge when the second jaw is switched to the closed position.
The method of claim 13,

And the guide groove is formed to be inclined upwardly toward the distal end of the second jaw.