JP4157574B2 - 外科用処置具 - Google Patents
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Description
また、超音波振動による処置と高周波電流による処置とを組合わせた外科用処置装置は、例えば、特許文献1〜3で知られている。この外科用処置装置は、操作部に設けた超音波振動子で発生した超音波振動を振動伝達部材を介して超音波プローブの先端部に伝達させると共に、この超音波プローブに対して回動自在なジョーを備え、超音波プローブとの間で生体組織を把持するようになっている。さらに、外部に設けた高周波電源から超音波プローブに高周波電流を流し、把持した生体組織に高周波電流を流して凝固・切開を行うようになっている。
特許文献2及び3は、超音波振動を発生する丸棒状のホーンと、このホーンに対して開閉する把持部材とによって生体組織を把持し、ホーンからの超音波振動と把持部材に設けた電極からの高周波電流によって生体組織を凝固・切開するようになっている。したがって、丸棒状のホーンと把持部材とで生体組織を把持する構造であり、把持部材の把持方向に対して曲面で受けて生体組織を把持することになり、強い把持力(圧縮力)が得られないという問題がある。
本発明は、前記事情に着目してなされたもので、その目的とするところは、生体組織を確実に強い把持力で把持して凝固・切開でき、処置時間を短縮できる外科用処置具を提供することにある。
請求項2は、第1の把持部材と、前記第1の把持部材に対して開閉可能に設けられ、該第1の把持部材との間で生体組織を把持する第2の把持部材と、前記第1もしくは第2の把持部材の一方に設けられ、超音波振動子と接続されて超音波振動する超音波振動部と、前記第1もしくは第2の把持部材の他方に設けられ、前記超音波振動部と対向し、該超音波振動部との間で生体組織を押圧する押圧部と、前記超音波振動部と前記押圧部との間に設けられた切開面を有した超音波凝固切開手段と、前記第1の把持部材に設けられた第1電極部と、前記第2の把持部材に設けられた第2電極部と、前記第1電極部と前記第1電極部との間に設けられた凝固面を有し、第1電極部と第2電極部とを対向して設けて生体組織を凝固するとともに、前記第1と第2の把持部材との把持操作によって前記超音波凝固切開手段を構成する押圧部と前記超音波振動部とが接したとき、前記第1電極部と前記第2電極部の間に隙間を形成する位置関係にある高周波凝固手段と、を具備したことを特徴とする外科用処置具にある。
請求項3は、前記凝固面は、前記切開面以外の位置に設けられていることを特徴とする請求項2記載の外科用処置具である。
請求項4は、前記超音波凝固切開手段を構成する押圧部と超音波振動部の把持面は、凹部と凸部の組み合わせからなり、生体組織を把持したとき、生体組織が屈曲されて前記把持面に面接触することを特徴とする請求項1または2記載の外科用処置具である。
請求項5は、前記第2の把持部材は、前記第1の把持部材より左右方向の両側に張り出さない構造であることを特徴とする請求項1または2記載の外科用処置具である。
挿入部12について説明すると、挿入シース21が操作部本体14に着脱可能に接続されている。この挿入シース21は、外周面を絶縁層22bで被覆した導電性材料からなる管状部材22によって形成されている。この管状部材22の先端部には保持部材22aが設けられ、この保持部材22aには処置部23が設けられている。この処置部23には保持部材22aに対して枢支ピン24によって上下方向に回動自在に枢支した第1の把持部材25が設けられている。
図2〜図4を参照して操作部11の内部構造について説明する。図2及び図3は超音波処置具の操作部の縦断側面図、図4は図2のA−A線に沿う断面図である。操作部本体14のケーシング14aは合成樹脂材料等の絶縁部材によって形成され、第2電極ピン20が取付けられる電極取付け部33が設けられている。第2電極ピン20は、中間部が絶縁カバー34で被覆され、先端部はプラグ(図示しない)が接続される接続部20aに、基端部はケーシング14aの内部の接続部材35に電気的に接続する接点部20bに形成されている。
また、操作部本体14の内部に設けられたプローブ保持部材39にはスライダ48が前後方向にスライド自在に設けられ、このスライダ48は制限ばね49によって操作部本体14に後方に付勢されている。このスライダ48は操作部本体14に枢支軸17を支点として回動可能な可動ハンドル18と連結ピン50を介して連結され、可動ハンドル18によってスライダ48を介してスライダ取付け部材40が進退し、この進退運動は連結筒41を介して挿入シース21に内挿された駆動ロッド51に伝達されるようになっている。すなわち、可動ハンドル18の矢印a方向の回動によって駆動ロッド51が挿入シース21の内部を前進するようになっている。
次に、図5〜図7を参照して処置部23の構成を説明する。図5は処置部を示し、(a)は平面図、(b)は縦断側面図、図6は処置部を示し、(a)は図5のB−B線に沿う断面図、(b)はC−C線に沿う断面図、(c)はD−D線に沿う断面図、図7は処置部の横断面図である。
このように構成された第1の把持部材25には、前記振動子ユニット13のプローブ29を挿入シース21に挿入したとき、プローブ先端部31が保持部材22aから前方に突出して対向する。そして、このプローブ先端部31は第1の把持部材25とで生体組織を把持する第2の把持部材59を構成している。すなわち、第2の把持部材59は、丸棒状のプローブ先端部31を鍛造、切削等の加工によって非円形に形成され、第1の把持部材25の凹溝57に対向する把持面61と左右の第1電極部56(歯部58)に対向する第2電極部62が設けられている。
したがって、第1の把持部材25を第2の把持部材59に対して接近する方向に回動(把持操作)したとき、まず第1の把持部材25の凹溝57に対して第2の把持部材59の把持面61が接触し、続いて第1電極部52と第2電極部56とが接近するようになっている。
さらに、第1と第2の把持部材25,59の開閉方向と直交する方向に切開接合面と凝固接合面を設けることにより、プローブ先端部31によって構成される第2の把持部材59が第1の把持部材25より左右方向の両側に張り出さない細径な構造となり、体腔内の狭い腔部に挿入して処置できるように構成されていることも特徴である。
次に、前述のように構成された超音波処置具10の作用について説明する。
例えば、血管封止を目的とした処置を行うために、腹腔に穿刺したトラカール(図示しない)を介して超音波処置具10の挿入部12を腹腔内に挿入する。操作部11の固定ハンドル16と可動ハンドル18とに手指を掛け、固定ハンドル16に対して可動ハンドル18を矢印a方向に回動すると、駆動ロッド51を前進させることができる。駆動ロッド51が前進すると、枢支ピン24を支点として第1の把持部材25が回動し、第2の把持部材59に対して第1の把持部材25を接近させることができる。
したがって、生体組織の目的の部位に挿入部12の処置部23をアプローチし、第2の把持部材59に対して第1の把持部材25を閉じると、図8に示すように、生体組織Sは第1と第2の把持部材25,59間に把持される。つまり、生体組織Sは第1の把持部材25の凹溝57と把持面61との間の切開接合面に把持されるとともに、その把持部分の両側は第1電極部56と第2電極部62との間の凝固接合面で把持される。このとき、第1と第2の把持部材25,59の把持方向と切開接合面及び凝固接合面が同一方向となるため生体組織Sに対する強い把持力が得られ、しかも第1電極部56には歯部58が設けられているため生体組織Sが滑って逃げることも無く確実に把持できる。
この状態で、振動子ユニット13の超音波振動子を駆動すると、超音波振動がプローブ29を介してプローブ先端部31に伝達され、第2の把持部材59が超音波振動する。この超音波振動は、第1と第2の把持部材25,59とで把持された生体組織Sに伝達され、接触部位に摩擦熱が発生して凝固が開始されるとともに、凝固切開が開始される。
したがって、生体組織Sに高周波電流が流れて凝固が進み、生体組織Sが徐々に薄くなり、生体組織Sは第1の把持部材25の凹溝57と把持面61との間で切開されるとともに、第1電極部56と第2電極部62との間で凝固される。生体組織Sが血管の場合、切開部位の近傍が第1電極部56と第2電極部62との間で凝固されて止血状態となっているため、血管封止を目的とした処置が完了する。
さらに、第1の把持部材25が枢支ピン24を支点として回動し、生体組織Sを第2の把持部材59とで把持したとき、第1の把持部材25の凹溝57と把持面61とが面接触し、また、左右の歯部58は第2電極部62と略平行の面で対向する凝固接合面となるため、生体組織Sに対する十分な把持力が得られる。したがって、超音波振動と高周波電流との併用による凝固能力を上げることができ、処置時間も短縮できる。
なお、超音波と高周波を併用するタイミングは同時でも良いし、切開を優位にする場合は超音波を先行させても良いし、凝固を優位にする場合は高周波を先行させても良い。
図9は第2の実施形態を示し、第1の実施形態と同一構成部分は同一番号を付して説明を省略する。図9(a)は処置部の縦断側面図、(b)はE−E線に沿う断面図である。本実施形態は、第1の把持部材71におけるパッド部材72の両側に、第1の把持部材71の回動方向の軸線CLに対して角度(例えば、45°)を持った傾斜面73aを有する第1電極部73を設けたものである。この第1電極部73の生体組織の把持面側には生体組織と滑ることなく把持できるように略鋸歯状の歯部74が形成されている。
さらに、第1の把持部材71とで生体組織を把持する第2の把持部材75は、丸棒状のプローブ先端部31を鍛造、切削等の加工によって非円形(略八角形)に形成され、第1の把持部材71に対向する把持面76と左右の第1電極部73(歯部74)に対向する傾斜面77aを有する第2電極部77が設けられている。第2電極部77は把持面76より第1と第2の把持部材71、75との把持方向から退避して連続しない面に設けられ、しかも、把持面76が第1の把持部材71のパッド部材72に接触したとき、第2電極部77は第1電極部73(歯部74)に対して隙間gが形成される位置関係にある。
そして、第1の把持部材71を生体組織を把持する方向に回動して第2の把持部材75とで生体組織を把持する位置関係にあるとき、第1の把持部材71のパッド部材72は把持面76と面接触して切開接合面となる。また、左右の歯部74は第2電極部77と略平行の面で対向する凝固接合面となる。つまり、第1と第2の把持部材71,75の開閉方向(軸線CL)と直交する方向に切開接合面があり、凝固接合面は略45°の傾斜しており、生体組織に強い把持力が得られるようになっている。さらに、プローブ先端部31によって構成される第2の把持部材75が第1の把持部材71より左右方向の両側に張り出さない細径な構造であり、体腔内の狭い腔部に挿入して処置できるように構成されている。
そして、第1の把持部材81を生体組織を把持する方向に回動して第2の把持部材85とで生体組織を把持する位置関係にあるとき、第1の把持部材81のパッド部材82は把持面86と面接触して切開接合面となる。また、左右の第1電極部83は第2電極部87と略平行の面で対向する凝固接合面となる。つまり、第1と第2の把持部材81,85の開閉方向(軸線CL)と直交する方向に切開接合面があり、凝固接合面は略平行面にあり、生体組織に強い把持力が得られる。さらに、プローブ先端部31によって構成される第2の把持部材85が第1の把持部材81より左右方向の両側に張り出さない構造であり、体腔内の狭い腔部に挿入して処置できるように構成されている。
そして、第1の把持部材25を生体組織を把持する方向に回動して第2の把持部材88とで生体組織を把持する位置関係にあるとき、第1の把持部材25のパッド部材55は把持面89と隙間hが形成される。また、把持面89の左右の第1電極部56は第2電極部90と略平行の面で対向する凝固接合面となる。つまり、第1と第2の把持部材25,88の開閉方向と直交する方向に切開接合面があり、凝固接合面は略平行面にあり、生体組織に強い把持力が得られるようになっている。さらに、プローブ先端部31によって構成される第2の把持部材88が第1の把持部材25より左右方向の両側に張り出さない構造であり、体腔内の狭い腔部に挿入して処置できるように構成されている。
図12は第5の実施形態を示し、第1の実施形態と同一構成部分は同一番号を付して説明を省略する。図12(a)は処置部の斜視図、(b)は処置状態の横断面図である。本実施形態は、第1の把持部材91は平板状に形成され、この把持面側には凸円弧状のパッド部材92が設けられている。第1の把持部材91におけるパッド部材92の両側には第1電極部93が設けられている。第1の把持部材91とで生体組織Sを把持する第2の把持部材94は、丸棒状のプローブ先端部31を鍛造、切削等の加工によって非円形に形成され、第1の把持部材91に対向する把持面95はパッド部材92と嵌合するように凹円弧状に形成され、把持面95の左右には第1電極部93に対向する稜線からなる第2電極部96が設けられている。
図13は第6の実施形態を示し、第1の実施形態と同一構成部分は同一番号を付して説明を省略する。図13は処置部の斜視図である。本実施形態は、第1の把持部材101は断面が略半円状で、把持面側には凹溝102が形成され、この凹溝102にはパッド部材103が埋設されている。第1の把持部材101におけるパッド部材103の両側には第1電極部104が設けられている。第1の把持部材101とで生体組織を把持する第2の把持部材105は、丸棒状のプローブ先端部31を鍛造、切削等の加工によって非円形に形成され、第1の把持部材101に対向する把持面106はパッド部材103と接触する例えば波形の凹凸部に形成され、この把持面106の左右には第1電極部104に対向する平坦面からなる第2電極部107が設けられている。
図14は第7の実施形態を示し、第1の実施形態と同一構成部分は同一番号を付して説明を省略する。図14(a)は処置部の斜視図、(b)はH−H線に沿う断面図である。本実施形態は、第1の把持部材111は断面が円柱状で、把持面側には逆三角形状の凹溝112が形成され、この凹溝112にはパッド部材113が埋設されている。第1の把持部材111におけるパッド部材113の両側にはV字状に突出する第1電極部114が設けられている。第1の把持部材111とで生体組織を把持する第2の把持部材115は、丸棒状のプローブ先端部31を鍛造、切削等の加工によって非円形に形成され、第1の把持部材111に対向する把持面116はパッド部材113と接触する三角形状の凸部に形成され、この把持面116の左右には第1電極部114に対向するV字状の凹部からなる第2電極部117が設けられている。
さらに、第1の把持部材131とで生体組織を把持する第2の把持部材135は、丸棒状のプローブ先端部31を鍛造、切削等の加工によって非円形に形成され、第1の把持部材131のパッド部材133に対向する把持面136は稜線によって形成され、把持面136の左右には傾斜面137aを有する第2電極部137が設けられている。
図18は第11の実施形態を示し、第1の実施形態と同一構成部分は同一番号を付して説明を省略する。図18は処置部の横断面図である。本実施形態の第1の把持部材151は、パッド部材152を挟んで左右に第1電極部153を設けたサンドイッチ構造の外側には合成樹脂材料からなる絶縁ブロック154が一体的に設けられている。絶縁ブロック154は第1電極部153より把持方向に突出しており、この絶縁ブロック154の突出部には歯部155が形成されている。
図19は開示例を示し、第1の実施形態と同一構成部分は同一番号を付して説明を省略する。図19(a)は処置部の縦断側面図、(b)はI−I線に沿う断面図である。第1の把持部材161は断面が矩形状の部材であり、その把持面側には鋸歯状の歯部162が形成されている。第1の把持部材161には軸方向に凹溝163が設けられ、この凹溝163には第1電極部164が埋設されている。第1の把持部材161における第1電極部164の両側にはパッド部部材165が設けられている。第1の把持部材161とで生体組織を把持する第2の把持部材166は、丸棒状のプローブ先端部31によって形成され、第1の把持部材161に対向する把持面167はパッド部材165と接触するようになっている。把持面167の左右には第1電極部164に対向する円弧面からなる第2電極部168が設けられている。
Claims (5)
- 第1の把持部材と、
前記第1の把持部材に対して開閉可能に設けられ、該第1の把持部材との間で生体組織を把持する第2の把持部材と、
前記第1もしくは第2の把持部材の一方に設けられ、超音波振動子と接続されて超音波振動する超音波振動部と、
前記第1もしくは第2の把持部材の他方に設けられ、前記超音波振動部と対向し、該超音波振動部との間で生体組織を押圧する押圧部と、
前記超音波振動部と前記押圧部との間に設けられた切開面を有した超音波凝固切開手段と、
前記第1の把持部材に設けられた第1電極部と、
前記第2の把持部材に設けられた第2電極部と、
前記第1電極部と前記第2電極部との間に設けられかつ前記切開面以外の位置に設けられた凝固面を有し、該第1電極部と前記第2電極部とを対向して設けて生体組織を凝固する高周波凝固手段と、
を具備したことを特徴とする外科用処置具。 - 第1の把持部材と、
前記第1の把持部材に対して開閉可能に設けられ、該第1の把持部材との間で生体組織を把持する第2の把持部材と、
前記第1もしくは第2の把持部材の一方に設けられ、超音波振動子と接続されて超音波振動する超音波振動部と、
前記第1もしくは第2の把持部材の他方に設けられ、前記超音波振動部と対向し、該超音波振動部との間で生体組織を押圧する押圧部と、
前記超音波振動部と前記押圧部との間に設けられた切開面を有した超音波凝固切開手段と、
前記第1の把持部材に設けられた第1電極部と、
前記第2の把持部材に設けられた第2電極部と、
前記第1電極部と前記第1電極部との間に設けられた凝固面を有し、第1電極部と第2電極部とを対向して設けて生体組織を凝固するとともに、前記第1と第2の把持部材との把持操作によって前記超音波凝固切開手段を構成する押圧部と前記超音波振動部とが接したとき、前記第1電極部と前記第2電極部の間に隙間を形成する位置関係にある高周波凝固手段と、
を具備したことを特徴とする外科用処置具。 - 前記凝固面は、前記切開面以外の位置に設けられていることを特徴とする請求項2記載の外科用処置具。
- 前記超音波凝固切開手段を構成する押圧部と超音波振動部の把持面は、凹部と凸部の組み合わせからなり、生体組織を把持したとき、生体組織が屈曲されて前記把持面に面接触することを特徴とする請求項1または2記載の外科用処置具。
- 前記第2の把持部材は、前記第1の把持部材より左右方向の両側に張り出さない構造であることを特徴とする請求項1または2記載の外科用処置具。
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US11/459,411 US7905881B2 (en) | 2006-07-04 | 2006-07-24 | Surgical instrument |
EP07012598.4A EP1875875B1 (en) | 2006-07-04 | 2007-06-27 | Surgical instrument |
KR1020070066361A KR101353757B1 (ko) | 2006-07-04 | 2007-07-03 | 수술 기구 |
CNA2007101229696A CN101099691A (zh) | 2006-07-04 | 2007-07-04 | 外科用处理器具 |
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JP3826141B2 (ja) | 2004-04-15 | 2006-09-27 | オリンパス株式会社 | 超音波切開凝固装置 |
EP1757242B1 (en) * | 2004-06-15 | 2013-06-05 | Olympus Corporation | Ultrasonic tool |
JP4300169B2 (ja) | 2004-09-10 | 2009-07-22 | アロカ株式会社 | 超音波手術器 |
JP4402629B2 (ja) | 2005-08-19 | 2010-01-20 | オリンパスメディカルシステムズ株式会社 | 超音波凝固切開装置 |
-
2006
- 2006-07-04 JP JP2006184663A patent/JP4157574B2/ja active Active
- 2006-07-24 US US11/459,411 patent/US7905881B2/en active Active
-
2007
- 2007-06-27 EP EP07012598.4A patent/EP1875875B1/en active Active
- 2007-07-03 KR KR1020070066361A patent/KR101353757B1/ko not_active IP Right Cessation
- 2007-07-04 CN CNA2007101229696A patent/CN101099691A/zh active Pending
Also Published As
Publication number | Publication date |
---|---|
EP1875875A1 (en) | 2008-01-09 |
US7905881B2 (en) | 2011-03-15 |
KR20080005083A (ko) | 2008-01-10 |
EP1875875B1 (en) | 2017-04-26 |
JP2008011987A (ja) | 2008-01-24 |
US20080132887A1 (en) | 2008-06-05 |
CN101099691A (zh) | 2008-01-09 |
KR101353757B1 (ko) | 2014-01-21 |
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