JP5624420B2 - Insulating cover and surgical instrument - Google Patents

Description

  The present invention relates to an insulating cover attached to a distal end working portion provided at a distal end portion of a surgical treatment instrument configured to function as an electric knife for laparoscopic surgery, and a surgical treatment instrument including the same. .

  In endoscopic surgery (also called laparoscopic surgery), a plurality of holes are opened in the patient's abdomen, etc., trocars (tubular instruments) are inserted into these holes, and then through each trocar, A laparoscope (camera) and a plurality of forceps are inserted into the body cavity. A gripper, a scissors, a blade of an electric knife, and the like are attached to the distal end portion of the forceps as an end effector for gripping a living tissue or the like.

  After the laparoscope and forceps are inserted into the body cavity, the operation is performed by operating the forceps while observing the inside of the abdominal cavity reflected on a monitor connected to the laparoscope. Since such an operation method does not require laparotomy, the burden on the patient is small, and the number of days until recovery and discharge from the operation is greatly reduced. For this reason, such an operation method is expected to expand the application field. For example, Patent Document 1 shown below is a document showing a conventional technique of forceps for endoscopic surgery.

  Some of such forceps for endoscopic surgery are configured to function as a monopolar electric knife. That is, such a forceps has an end effector that functions as an active electrode at the tip of the shaft, and uses a counter electrode plate that is in contact with the living body as a return electrode to apply a high-frequency current to a contact portion (biological tissue) of the end effector. When energized, the living tissue is cauterized (see, for example, Patent Document 1 below).

US Patent Application Publication No. 2006/0079884

  By the way, in the case of using a medical manipulator in which the end effector provided at the distal end portion has mobility of multiple degrees of freedom as a monopolar electric knife for endoscopic surgery, it is a posture changing mechanism of the end effector. When the structural member of the joint is a metal part, it is necessary to prevent the unintentional burn from coming into direct contact with the living tissue directly or indirectly through blood, body fluid, etc. It is conceivable to install an insulating cover.

  In this case, it is desirable that such an insulating cover is easy to attach before surgery and easy to remove after surgery. Further, when pulling out the shaft having the end effector at the tip from the trocar, there is a concern that the insulating cover may fall off the shaft if the insulating cover is caught on the trocar.

  The present invention has been made in view of such problems, and an object of the present invention is to provide an insulating cover that can be easily attached before the operation, is not easily detached during the operation, and can be easily removed after the operation, and a surgical treatment instrument including the same. And

In order to achieve the above object, the present invention provides a distal end working portion provided at a distal end portion of a shaft extending from a main body portion of a surgical treatment instrument configured to function as an electric knife for laparoscopic surgery. An insulating cover that can be attached to the distal end working portion, and has a distal end opening through which an end effector constituting the distal end portion of the distal end working portion can be inserted. A cylindrical cover main body made of a material, and a cylindrical collar member that surrounds the base end side of the cover main body and is disposed so as to be axially displaceable with respect to the cover main body, The cover body has a first taper portion whose outer diameter decreases toward the base end side, and a base end configuration portion that is inserted into the collar member on the base end side with respect to the first taper portion, collar member, the outer peripheral portion of the proximal component It has a cylindrical portion for slidably contacting the line direction, and a second tapered portion whose inner diameter is reduced toward the cylindrical portion base end side is provided on the distal end side than the distal direction said collar member The first taper portion is pressed by the second taper portion, and the first taper portion is pressed inward by moving the second taper portion.

  According to the above configuration, when the collar member is operated to move the collar member in the distal direction relative to the cover body, the axis of the cover body is caused by the wedge effect produced by the first taper portion and the second taper portion. Part of the direction (the portion where the first taper portion is formed) is pressed inward. Thereby, a cover main body can be clamp | tightened to the front-end | tip part of the shaft of a surgical treatment tool, and an insulating cover can be fixed to the front-end | tip part of the said shaft. Further, when the insulating cover comes into contact with the trocar and the collar member is pressed in the distal direction, the wedge effect is further exerted and the fixing force is increased, so that the insulating cover is not easily detached from the distal end portion of the shaft.

  In the above insulating cover, the first taper portion and the second taper portion may be formed on the entire circumference in the circumferential direction of the cover body and the collar member, respectively.

  According to said structure, when pressing a 1st taper part with a 2nd taper part, the inner peripheral surface of the part corresponding to a 1st taper part among base end formation parts is the circumference of a shaft over the perimeter of a circumferential direction. Since it is in close contact with the outer peripheral surface, it is possible to prevent liquid from entering the distal end working portion side through the base end constituting portion and the shaft, and the function of the insulating cover can be suitably secured.

  In the above insulating cover, a protrusion projecting outward is provided on the outer peripheral portion of the base end component, and the collar member is formed larger than the protrusion in the axial direction of the collar member. A hole is provided, and the collar member is slidably fitted to the base end component in a state in which the protrusion is inserted into the hole, and the axial movement range of the collar member is A movable range restricting means for restricting a range from an advance position that presses the first taper portion inward to a retracted position that releases the pressure on the first taper portion is configured by the protrusion and the hole. Good.

  By such a movable range restricting means, the movement of the color member to the tip side from the advance position is restricted, so that the user can easily recognize that the color member is at the advance position, and the color member covers it. Do not overtighten the body. Further, since the movement of the collar member to the base end side from the retracted position is restricted, the collar member is prevented from being detached from the cover body.

  In the above insulating cover, it is preferable that the base end portion of the collar member protrudes in the base end direction from the base end portion of the cover body in a state where the collar member has reached the advanced position.

  According to the above configuration, when the insulating cover comes into contact with the trocar when the shaft is pulled out from the trocar, the base end portion of the collar member always comes into contact with the trocar, and the collar member is pressed in the distal direction. Therefore, the cover body is further tightened by the wedge effect, so that the fixing force (fastening force) of the insulating cover with respect to the tip end portion of the shaft is further increased, and the insulating cover is more difficult to come off.

  The present invention also relates to a surgical treatment instrument configured to function as an electric knife for laparoscopic surgery, comprising a main body, a shaft extending from the main body, and a distal end of the shaft. A tip operating portion provided and an insulating cover that can be attached to the tip operating portion, wherein the insulating cover is one of the above-described insulating covers.

  The insulating cover according to the present invention is easy to attach before the operation, easy to remove after the operation, and does not easily come off from the distal end working part even if it comes into contact with the trocar when the shaft is pulled out from the trocar.

It is a perspective view of the medical manipulator which is a surgical treatment tool. It is a partially omitted side view showing the medical manipulator in a state where the operation unit and the working unit are separated. It is a perspective view of the insulating cover which concerns on the front-end | tip operation | movement part of a medical manipulator and one Embodiment of this invention. FIG. 4A is a vertical side view of an insulating cover in a state where it is attached to a distal end working unit of a medical manipulator, and FIG. 4A shows a state in which the collar member is in a retracted position, and FIG. Show. It is an expanded sectional view of the 1st taper part in the insulating cover, the 2nd taper part, and its peripheral part. It is a figure explaining the effect of an insulating cover.

  Hereinafter, preferred embodiments of an insulating cover according to the present invention and a surgical treatment instrument including the same will be described with reference to the accompanying drawings. FIG. 1 is a perspective view of a surgical treatment instrument to which an insulating cover 10 is attached. The surgical treatment instrument according to the illustrated example is a medical manipulator 1 (hereinafter referred to as a manipulator) that operates an end effector 19 provided at a distal end when a user (medical staff such as a doctor) holds and operates the surgical treatment instrument. It is configured.

  Before describing the configuration of the insulating cover 10, first, the configuration of the manipulator to which the insulating cover 10 is attached will be described.

  The manipulator 1 is a medical instrument for holding a part of a living body or touching the living body with a distal end working unit 12 provided at the tip, and usually performs grasping forceps or a needle driver (holding tool). It is also called a needle). The manipulator 1 includes a manipulator body 11 constituting a medical instrument, and a controller 29 connected to the manipulator body 11 via a cable 28. The manipulator body 11 includes a body 21, a shaft 18 extending from the body 21, and a distal end working unit 12 provided at the distal end of the shaft 18 and including an end effector.

  In the following description, the extending direction of the shaft 18 is defined as the Z direction, and the front (tip side) of the shaft 18 is defined as the Z1 direction and the rear (root side) is defined as the Z2 direction. Further, the right-and-left direction with respect to the manipulator body 11 when the manipulator body 11 is in the posture shown in FIG. 1 is the X direction, and in particular, the left side direction of the manipulator body 11 is the X1 direction, The right direction is defined as the X2 direction. Further, the vertical direction of the manipulator body 11 when the manipulator body 11 is in the posture shown in FIG. 1 is defined as the Y direction, and in particular, the upper direction is defined as the Y1 direction and the lower direction is defined as the Y2 direction. To do.

  Unless otherwise specified, the description of these directions is based on the case where the manipulator body 11 is in the reference posture (neutral posture). These directions are for convenience of explanation, and it is needless to say that the manipulator body 11 can be used in any direction (for example, upside down).

  The manipulator main body 11 includes an operation unit 14 that is gripped and operated by a hand and a work unit 16 that is detachable from the operation unit 14. The operation unit 14 constitutes a part of the body 21 described above, constitutes a housing, and a pair of left and right upper covers 25a and 25b extending in a substantially L shape in the Z1 direction and the Y2 direction, and the upper covers 25a and 25b. It has the drive part 30 accommodated in the inside, and the composite input part 24 operated manually.

  The drive unit 30 includes two motors 50 a and 50 b as a drive source 50 for changing the posture of the tip operation unit 12, and the driving force of the drive source 50 is applied to the tip operation unit 12 provided at the tip of the shaft 18. By being transmitted mechanically, the posture of the end effector 19 can be changed.

  A portion extending in the Y2 direction on the proximal end side of the operation unit 14 is configured as a grip handle 26 that is gripped by a hand. The composite input unit 24 is provided on the upper inclined surface of the grip handle 26, and performs a tilt operation on the rotation operation unit 90 and the tilt operation unit 92 in the horizontal direction with respect to the rotation operation unit 90 singly or in combination. Thus, a signal corresponding to the operation is transmitted to the controller 29, and the controller 29 controls the drive of the drive unit 30, whereby the posture of the distal end working unit 12 is changed.

  The controller 29 is a control unit that comprehensively controls the manipulator body 11 and is connected to a cable 28 that extends from the lower end of the grip handle 26. A part or all of the functions of the controller 29 can be integrally mounted on the operation unit 14, for example.

  The working unit 16 includes a pair of lower covers 37a and 37b divided substantially symmetrically in the Z direction as a housing. The distal end working unit 12 and the long and hollow provided with the distal end working unit 12 at the distal end are provided. The shaft 18 made of resin, the base end side of the shaft 18 is fixed, the pulley box 32 accommodated in the lower covers 37a and 37b, the rear of the pulley box 32, and the trigger shaft 39 as a fulcrum in the X direction And a trigger lever 36 pivotally supported about an axis. The lower covers 37a and 37b, the pulley box 32, and the trigger lever 36 constitute a part of the body 21 described above.

  FIG. 2 is a partially omitted side view showing the manipulator body 11 in a state where the operation unit 14 and the working unit 16 are separated. As shown in FIG. 2, the drive unit 30 includes the above-described motors 50a and 50b, a drive bevel gear 58a (58b) fixed to each output shaft 56a (56b) of the motor 50a (50b), and a drive umbrella. A driven bevel gear 62a (62b) that meshes with the gear 58a (58b) and a drive shaft 60a (60b) to which the driven bevel gear 62a (62b) is fixed. At the lower end of the drive shaft 60a (60b), for example, an engaging convex portion 64a (64b) having a cross-sectional wave shape is provided. With this configuration, the rotational driving force of the motor 50a (50b) is transmitted to the drive bevel gear 58a (58b), the driven bevel gear 62a (62b), the drive shaft 60a (60b), and the engaging convex portion 64a (64b). The

  The pulley box 32 is provided with pulleys 70a and 70b. The pulley 70a (70b) is coaxial with the drive shaft 60a (60b) in a state where the working unit 16 is attached to the operation unit 14. At the upper end of the pulley 70a (70b), an engaging recess 74a (74b) having a corrugated cross section, for example, exposed from the upper surface of the pulley box 32 is provided. Therefore, when the operating portion 14 and the working portion 16 are mounted, the engaging convex portion 64a (64b) and the engaging concave portion 74a (74b) are engaged with each other, and thereby the rotational driving force from the drive shaft 60a (60b). Can be transmitted to the pulley 70a (70b). The engagement structure of the engagement convex part 64a and the engagement concave part 74a may be another structure.

  A wire (not shown) is wound around each of the pulleys 70a and 70b as a power transmission member. These wires are inserted into the shaft 18 and transmit driving force to the posture changing mechanism 13 provided in the distal end working unit 12 (see FIG. 1). Thereby, the rotational driving force from the drive shaft 60a (60b) is transmitted to the posture changing mechanism 13 via the pulley 70a (70b) and the wire, and the posture of the end effector 19 is changed.

  As a mechanism for converting the operation of the trigger lever 36 into an opening / closing operation of the end effector 19 and a mechanism for converting the driving of the drive source 50 into an operation of changing the attitude of the end effector 19, for example, Japanese Patent Application Laid-Open No. 2008-104855. You may employ | adopt the structure similar to the structure described in gazette and Unexamined-Japanese-Patent No. 2009-106606.

  As shown in FIG. 1, the working unit 16 is connected and fixed to the operation unit 14 by a pair of left and right attachment / detachment levers 40, 40 provided in the operation unit 14, and is operated by opening the attachment / detachment lever 40. And can be easily exchanged at the operation site without using a special instrument.

  The distal end working unit 12 and the shaft 18 are configured to have a small diameter, and can be inserted into the body cavity 22 through a cylindrical trocar 20 attached to a patient's abdomen or the like. The distal end working unit 12 includes an end effector 19 that operates based on the operation of the trigger lever 36 and a posture changing mechanism 13 that changes the posture of the end effector 19 based on the operation of the composite input unit 24. In the illustrated configuration example, the end effector 19 includes a pair of gripper members 19a and 19b, and is configured as a gripper mechanism that opens and closes based on a predetermined opening and closing operation axis.

  The manipulator body 11 is configured to be electrically connectable to the high frequency power supply 23 via the cable C1. In the manipulator body 11, an energization path E <b> 1 electrically connected to the distal end working unit 12 is disposed along the shaft 18. The energization path E1 can be electrically connected to the cable C1 through an electrode plug 71 provided in the body 21. The electrode plug 71 is electrically connected to the wire 80b via the conductive portion E2, and thereby the wire 80b functions as the energization path E1 in the shaft 18.

  Note that the wire 80a may function as the energization path E1 by connecting the conductive portion E2 to the other wire 80a. Alternatively, the energization path E1 does not use the wire 80a or the wire 80b, but a conductive wire independent of the wires 80a and 80b is disposed in the shaft 18 along the axial direction, and such a conductive wire is disposed in the energization path E1. It is good.

  One cable C1 connected to the high-frequency power source 23 is electrically connected to the energization path E1, and the counter electrode 31 provided at the end of the other cable C2 connected to the high-frequency power source 23 is brought into contact with the patient M to The end effector 19 is brought into contact with the living tissue of the patient M in a state where a high frequency current is generated by the power source 23. Then, the end effector 19 is used as an active electrode, and the counter electrode plate 31 is used as a return electrode, so that a high-frequency current flows intensively in the contact site (biological tissue) of the end effector 19. Thereby, the living tissue contacted by the end effector 19 can be cauterized and incised or coagulated.

  When the working unit 16 having a gripper or gripper for gripping the affected part is attached to the operation unit 14 as the end effector 19, the manipulator 1 functions as a scissors or gripping forceps for performing work such as excision and gripping of the affected part. To do.

  The trigger lever 36 includes an arm portion 36a that is pivotally supported by a trigger shaft 39 provided at an end portion on the Z2 direction side in the lower covers 37a and 37b, and a trigger operator 36b that is provided below the arm portion 36a. Have The trigger shaft 39 is fixed to a support plate 45 (see FIG. 2) provided on the Z2 side of the pulley box 32.

  The opening / closing operation of the end effector 19 is performed by mechanically transmitting a force based on a manual operation (push / pull operation) of the trigger lever 36. The working unit 16 is provided with a transmission mechanism including a rod, a wire (power transmission member), a pulley, and the like. The push lever of the trigger lever 36 is operated to open and close the end effector 19 by the transmission mechanism. It has been converted to.

  FIG. 3 is a perspective view of the distal end working unit 12 including the posture changing mechanism 13. The posture changing mechanism 13 can perform a roll operation that rotates with a roll axis Or pointing toward the tip (Z axis in a neutral posture) as a reference and a yaw operation (tilt operation) that tilts with respect to the Y-direction yaw axis Oy as a reference. Yes, the roll operation and the tilting operation can be performed selectively or in combination. Therefore, the distal end working unit 12 can perform a three-axis operation including an opening / closing operation, a roll operation, and a yaw operation of the end effector 19.

  The posture changing operation (roll operation and yaw operation) of the tip operation unit 12 is driven by the drive source 50 based on the operation of the composite input unit 24 having the rotation operation unit 90 and the tilt operation unit 92, and the drive source 50 is driven. This is performed by mechanically transmitting the force to the distal end working unit 12. In the illustrated manipulator body 11, the tip operation unit 12 is rolled by performing a rotation operation in the left-right direction with respect to the rotation operation unit 90, and the tilting operation is performed on the tilting operation unit 92. The yaw operation of the tip operating unit 12 is performed.

  The distal end working unit 12 is at least a cylindrical first cover member 94 fixed to the distal end portion of the shaft 18, and is rotatable about the yaw axis Oy with respect to the first cover member 94 and a roll shaft. It has a cylindrical second cover member 96 that can rotate around Or, and an end effector 19 connected to the second cover member 96.

  The first cover member 94, the second cover member 96, and the end effector 19 are all metal parts, and the wire 80 b is a component part of the posture changing mechanism 13 inside the distal end portion of the first cover member 94. Is wound around a rotating body 98. The rotating body 98 is made of metal and is electrically connected to the first cover member 94 and the second cover member 96. For this reason, if the 1st cover member 94 or the 2nd cover member 96 contacts living tissue at the time of energization, it will have cauterization ability like an electric knife. In addition, since at least the outer peripheral surface of the shaft 18 is made of a resin material (insulating material), even if the living tissue comes into contact with the outer peripheral surface of the shaft 18 when energized, the living tissue is not cauterized. .

  Therefore, when performing laparoscopic surgery using the manipulator 1 in order to prevent the first cover member 94 or the second cover member 96 of the distal operation section 12 from contacting the living tissue, the distal operation section 12 is attached with an insulating cover 10 shown in FIGS. 3 and 4.

  In FIG. 3, the insulating cover 10 that is not attached to the distal end working unit 12 is indicated by a solid line, and the insulating cover 10 that is attached to the distal end working unit 12 is indicated by a virtual line. 4A and 4B are vertical cross-sectional views of the insulating cover 10 in a state where it is mounted on the distal end working unit 12. In particular, FIG. 4A shows a state in which the collar member 104 is in the retracted position, and FIG. The state where the collar member 104 is at the advanced position is shown. 4A and 4B, only the first cover member 94 is shown in the members constituting the distal end working unit 12, and the other constituent members are not shown.

  As shown in FIGS. 3 and 4, the insulating cover 10 according to an embodiment of the present invention includes a cover body 102 and a collar member 104.

  The cover body 102 is a hollow cylindrical member as a whole, and has a size that allows the distal end working unit 12 to be inserted. A round dome 106 is formed at the tip of the cover body 102. The dome part 106 has a tip opening part 108 through which the end effector 19 can be inserted. The tip opening 108 in the illustrated example is formed as a slit-like cut, but the present invention is not limited to this, and a configuration in which a circular hole is formed at the tip may be used. The cover main body 102 is made of a flexible material (for example, silicon rubber) so as to allow the posture changing operation of the distal end working unit 12, that is, deformable following the posture changing operation of the distal working unit 12. Has been. The material constituting the cover main body 102 is preferably biocompatible.

  The cover main body 102 has the dome part 106, the body part 110, the enlarged diameter part 112, and the base end constituting part 114 in the above order from the front end side to the base end side, and these are integrated. Is formed. The body part 110 is a cylindrical part having a substantially constant outer diameter and inner diameter.

  The enlarged diameter portion 112 includes a tapered portion 112a whose outer diameter increases toward the proximal end side, a parallel portion 112b whose outer diameter is substantially constant along the axial direction, and a first portion whose outer diameter decreases toward the proximal end side. 1 taper portion 102a. The tapered portion 112a, the parallel portion 112b, and the first tapered portion 102a are provided in this order from the distal end side to the proximal end side.

  Due to the presence of the tapered portion 112 a constituting the most distal portion of the enlarged diameter portion 112, when the shaft 18 with the insulating cover 10 is inserted through the trocar 20, the enlarged diameter portion 112 is not easily caught by the trocar 20, Insertion can be performed smoothly. The outer diameter of the parallel part 112b is larger than the outer diameters of the body part 110 and the base end component part 114 (the part excluding the protruding part 116). The first taper portion 102a is formed over the entire circumference in the cover body 102, that is, over a range of 360 °.

  In the illustrated configuration example, the base end component 114 has an outer diameter that is approximately the same as the outer diameter of the body 110. Note that the outer diameter of the base end component 114 means the outer diameter of the cylindrical outer peripheral surface (portion excluding the protrusion 116) in the base end component 114. On the outer peripheral portion of the base end component 114, a protrusion 116 protruding outward (radially outward) is provided. Moreover, the opening part of the base end side of the base end structure part 114 has the internal diameter gradually increased toward the base end side.

  The collar member 104 is a cylindrical member that surrounds the proximal end side of the cover main body 102 and is disposed so as to be displaceable in the axial direction with respect to the cover main body 102. The collar member 104 in the illustrated example has a straight pipe shape with a substantially constant outer diameter. The inner diameter of the collar member 104 is the base end of the cover body 102 so that the collar member 104 can slide smoothly with respect to the base end constituent portion 114 and the radial play relative to the base end constituent portion 114 does not become excessive. It is set to be substantially the same as the outer diameter of the component 114 or slightly larger than that.

  The color member 104 is made of a hard resin material. The resin material constituting the color member 104 is preferably biocompatible. Further, when the insulating cover 10 is provided to the user in a usage form in which the insulating cover 10 is sterilized before use, the collar member 104 is preferably heat resistant to withstand the high temperature during the sterilization process. For example, PEEK (polyether ether ketone) is suitable as a constituent material of the color member 104 because it has excellent heat resistance.

  Further, when the insulating cover 10 is provided to the user in a sterilized state, the user can reuse the PEEK by using autoclave sterilization by replacing PEEK with a resin that is deformed by heat. Can be prevented in advance. In this case, it is preferable that the above-mentioned resin is a kind of resin that can withstand electron beam sterilization.

  As shown in FIGS. 4A and 4B, the collar member 104 is formed with a second taper portion 104a whose inner diameter decreases toward the base end side. The second taper portion 104a is formed over the entire circumference in the circumferential direction on the inner peripheral surface of the distal end portion of the collar member 104, that is, over a range of 360 °.

  When the collar member 104 is operated and the collar member 104 is moved in the distal direction with respect to the cover main body 102, as shown in FIG. 4B, the second taper portion 104a comes into contact with the first taper portion 102a, and due to the wedge effect, The first tapered portion 102a is pressed inward in the radial direction. At this time, the inclination angle of the second taper portion 104a with respect to the axis of the insulating cover 10 is set so that the second taper portion 104a is in close contact with the first taper portion 102a and can effectively press the first taper portion 102a. It may be set to be the same as that of the one taper portion 102a.

  When the inclination angles of the first taper portion 102a and the second taper portion 104a are set to the same level, the inclination angles of the first taper portion 102a and the second taper portion 104a are set to about 2 to 45 °. Is good. If the tilt angle is greater than 45 °, the operating force required to move the collar member 104 in the distal direction in order to tighten the cover main body 102 increases, and the operability decreases. If the inclination angle is smaller than 2 °, the amount of movement when the collar member 104 is moved in the distal direction to tighten the cover main body 102 becomes large, and the operability is lowered. Accordingly, the operability of the color member 104 can be obtained by setting the inclination angle to about 5 to 20 °.

  In addition, although not shown, an escape portion that does not contact the second taper portion 104a is formed at the base end of the first taper portion 102a. Thereby, since the pressure is dispersed, the durability of the cover main body 102 can be improved.

  The collar member 104 is provided with a hole 118 that is formed larger than the protrusion 116 in the axial direction of the collar member 104. The hole 118 in the illustrated example is configured as a long hole having a long axis in the axial direction of the collar member 104. Since the collar member 104 is slidably fitted to the base end component 114 in a state in which the projection 116 is inserted into the hole 118, the movable range in the axial direction of the collar member 104 with respect to the cover body 102 is It is regulated within the range of the length of the hole 118 in the axial direction.

  In the illustrated configuration example, the width of the hole 118 in the circumferential direction of the collar member 104 is set to be approximately the same as or slightly larger than the width of the protrusion 116 in the circumferential direction of the base end component 114. For this reason, the protrusion 116 and the hole 118 function as a linear guide mechanism when the collar member 104 is moved in the axial direction. Note that such a linear guide mechanism may be arbitrarily provided in the insulating cover 10, that is, the circumferential width of the hole 118 may be larger than that of the protrusion 116.

  The height of the projection 116 is set so that the most distal portion of the projection 116 (the most distal portion in the radial direction of the base end component 114) is the same as the outer peripheral surface of the collar member 104 or is located in the hole 118. It is good to be done. By setting the height of the protrusions 116 in this way, the protrusions 116 do not protrude from the outer peripheral surface of the collar member 104. Therefore, when the shaft 18 is inserted into the trocar 20, the protrusions 116 become trocars 20. Therefore, the shaft 18 can be smoothly inserted into and pulled out from the trocar 20.

  The protrusion 116 and the hole 118 described above constitute a movable range restricting means 120 that restricts the movable range of the collar member 104 relative to the cover main body 102 to a range from the advanced position to the retracted position. Here, the advance position is a position where the second tapered portion 104a presses the first tapered portion 102a inward by the wedge effect (see FIG. 4B). The retracted position is a position where the pressing of the first taper portion 112a by the second taper portion 104a is released (see FIG. 4A).

  In a state in which the collar member 104 is located at the advanced position, the length of the collar member 104 and the base end constituting portion 114 so that the base end portion of the color member 104 protrudes in the base end direction from the base end portion of the cover main body 102. And the position and size of the movable range regulating means 120 are preferably set. That is, regardless of the position of the collar member 104 in the movable range, the base end portion of the color member 104 is preferably configured to protrude in the base end direction from the base end portion of the base end constituting portion 114. With this configuration, when the insulating cover 10 comes into contact with the trocar 20 when the shaft 18 is pulled out from the trocar 20, the collar member 104 always comes into contact with the trocar 20, and the collar member 104 receives a pressing force in the distal direction. The wedge effect described above is further exhibited.

  The insulating cover 10 according to an embodiment of the present invention is basically configured as described above, and the operation and effect thereof will be described below.

  When the above-described manipulator 1 is used as an electric knife, in order to prevent a portion excluding the end effector 19 of the distal end working unit 12 from contacting the living tissue and causing unintended burns, the distal end working unit 12 and the distal end of the shaft 18 are prevented. The insulating cover 10 is attached to the part. In order to attach the insulating cover 10 to the distal end working portion 12 and the distal end portion of the shaft 18, first, as shown in FIG. 4A, the insulating cover 10 is first moved to a position where the base end constituting portion 114 covers the distal end portion of the shaft 18. 10 is put on the tip of the shaft 18. At this time, since the inner diameter of the opening portion on the base end side of the base end constituting portion 114 gradually increases toward the base end side, the shaft 18 can be easily mounted.

  Next, as shown in FIGS. 4B and 5, when the collar member 104 is operated to move the collar member 104 in the distal direction relative to the cover body 102, the first taper portion 102a and the second taper portion 104a Due to the wedge effect, a portion of the base end component 114 in the axial direction (the portion where the first taper portion 102a is formed) is pressed radially inward. In FIG. 5, the color member 104 indicated by the phantom line is the color member 104 in a state of being positioned at the advanced position. Further, the portion 112c indicated by the phantom line is a portion corresponding to the first taper portion 102a (hereinafter referred to as a press portion 112c) on the inner peripheral surface of the base end component 114 when the first taper portion 102a is pressed radially inward. It is said).

  When a part of the base end constituting portion 114 is pressed radially inward, the pressing portion 112c presses the outer peripheral portion of the shaft 18 positioned inside thereof. As a result, the cover main body 102 is fastened to the distal end portion of the shaft 18, and the insulating cover 10 can be fixed to the distal end portion of the shaft 18. Thus, since the insulating cover 10 can be fixed by sliding the collar member 104 to the distal end side with the insulating cover 10 covered on the shaft 18, the mounting operation is easy, and it is attached before the operation. Cheap.

  In the present embodiment, the first taper portion 102a and the second taper portion 104a are formed on the entire circumference in the circumferential direction of the cover body 102 and the collar member 104, respectively, so the first taper portion 102a is the second taper portion 104a. When pressing the pressing portion 112c, the pressing portion 112c is in close contact with the outer peripheral surface of the shaft 18 over the entire circumference in the circumferential direction. Thereby, it can prevent that a liquid penetrate | invades into the front end operation | movement part 12 side through between the base end structure part 114 and the shaft 18, and can ensure the function of the insulating cover 10 suitably.

  When the collar member 104 is moved to the front end side, the movement of the color member 104 from the advance position to the front end side is restricted by the above-described movable range restricting means 120 (projection 116 and hole 118). It is easy for the user to recognize that 104 is in the advanced position, and the cover body 102 is not over-tightened by the collar member 104.

  When the insulating cover 10 is attached to the distal end working unit 12, the insulating cover 10 covers the entire portion of the distal end working unit 12 excluding the end effector 19 from the outside. That is, the portions other than the end effector 19 (the first cover member 94 and the second cover member 96) of the distal end working unit 12 are covered with the insulating cover 10, so that the metal portions other than the end effector 19 are not exposed to the outside. Thereby, in a procedure, it is prevented suitably that metal parts other than the end effector 19 contact a biological tissue.

  As shown in FIG. 6, when the shaft 18 is pulled out from the trocar 20, the insulating cover 10 and the distal end opening 20 a (opening on the body cavity 22) of the trocar 20 may come into contact with each other. Since the insulating cover 10 is fixed with respect to the distal end portion of the shaft 18 by the wedge effect described above, even if it contacts the trocar 20, it is difficult to come off from the distal end operating portion 12. Moreover, since the collar member 104 is pressed in the distal direction by the trocar 20, the above-described wedge effect is further exhibited and the fixing force is increased, so that the insulating cover 10 is less likely to be detached from the distal end portion of the shaft 18.

  In the present embodiment, the base end portion of the collar member 104 protrudes in the base end direction from the base end portion of the cover main body 102 in a state where the collar member 104 has reached the advanced position. The end portion always comes into contact with the trocar 20, and the collar member 104 is pressed in the distal direction. Therefore, the cover body 102 is further tightened by the wedge effect described above, so that the fixing force (fastening force) of the insulating cover 10 with respect to the tip end portion of the shaft 18 is further increased, and the insulating cover 10 is further less likely to come off.

  When the collar member 104 is moved in the proximal direction with respect to the cover main body 102, the pressure on the first tapered portion 102a by the second tapered portion 104a is released, and thereby, the tightening of the shaft 18 by the proximal end constituting portion 114 is released. Is done. That is, the fixed state (fastened state) can be easily released simply by retracting the collar member 104 with respect to the cover main body 102. Therefore, the insulating cover 10 can be easily removed from the distal end working unit 12 after the operation.

  When the collar member 104 is moved to the proximal end side, the movement of the collar member 104 from the retracted position to the proximal end side is restricted by the movable range restricting means 120 (protrusion 116 and hole 118) described above. The collar member 104 is prevented from being detached from the cover main body 102.

  In the above description, the present invention has been described with reference to preferred embodiments. However, the present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the scope of the present invention. Needless to say.

DESCRIPTION OF SYMBOLS 1 ... Medical manipulator 10 ... Insulating cover 18 ... Shaft 102 ... Cover main body 102a ... 1st taper part 104 ... Collar member 104a ... 2nd taper part 114 ... Base end structure part 116 ... Protrusion part 118 ... Hole

Claims (5)

An insulating cover that can be attached to a distal end working portion provided at a distal end portion of a shaft extending from a main body portion of a surgical treatment instrument configured to function as an electric knife for laparoscopic surgery,
A cylindrical cover having a distal end opening portion through which an end effector constituting the distal end portion of the distal end working portion can be inserted, configured to be able to insert the distal end portion of the surgical treatment instrument, and composed of a flexible material. The body,
A cylindrical collar member that surrounds the base end side of the cover body and is disposed so as to be displaceable in the axial direction with respect to the cover body,
The cover body has a first taper portion whose outer diameter decreases toward the base end side, and a base end configuration portion inserted into the collar member on the base end side with respect to the first taper portion,
The collar member includes a cylindrical portion that is slidably in contact with an outer peripheral portion of the base end configuration portion in an axial direction, and a first inner diameter that decreases toward the base end side. and a second tapered portion,
By moving the collar member in the distal direction, the first taper portion is pressed by the second taper portion, and the first taper portion is pressed inward.
An insulating cover characterized by that. The insulating cover according to claim 1,
The first taper portion and the second taper portion are formed on the entire circumference in the circumferential direction in the cover body and the collar member, respectively.
An insulating cover characterized by that. The insulating cover according to claim 1 or 2,
On the outer peripheral portion of the base end component portion, a protruding portion protruding outward is provided,
The collar member is provided with a hole formed larger than the protrusion in the axial direction of the collar member,
The collar member is slidably fitted to the base end component in a state where the protrusion is inserted into the hole,
Movable range restricting means for restricting the movement range of the collar member in the axial direction to a range from an advancing position that presses the first tapered portion inward to a retracted position that releases the pressing to the first tapered portion; , Constituted by the protrusion and the hole,
An insulating cover characterized by that. The insulating cover according to claim 3,
With the collar member in the advanced position, the base end portion of the collar member protrudes in the base end direction from the base end portion of the cover body.
An insulating cover characterized by that. A surgical treatment instrument configured to function as an electric knife for laparoscopic surgery,
The main body,
A shaft extending from the main body,
A tip working portion provided at the tip of the shaft;
An insulating cover attachable to the distal end working unit,
The insulating cover is the insulating cover according to any one of claims 1 to 4.
A surgical treatment instrument characterized by that.

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