JPH0333012B2 - - Google Patents

Description

[Detailed Description of the Invention] [Industrial Application Field] The present invention relates to an ultrasonic surgical device, particularly an improved ultrasonic surgical device that can perform ultrasonic surgery while correctly identifying the affected area using an ultrasonic scalpel. Regarding the method, further, while directly displaying an image of the affected area from within the rectum using a transrectal ultrasound probe, an ultrasonic scalpel is guided to the affected area while observing the ultrasound image, and surgical operation is performed on the affected area using the ultrasonic scalpel. This relates to improvements to the equipment used.

[Prior art] A device that uses a horn that vibrates with ultrasonic waves as a surgical terminal, guides the ultrasonic horn surgical terminal to the affected area, and removes the affected tissue from the body while finely pulverizing the tissue has been put into practical use as an actual surgical device. It has been
Known as an ultrasonic scalpel.

Such an ultrasonic surgical device is effective for treating, for example, prostatic hypertrophy, and can efficiently destroy the affected area of the prostate while rapidly draining the affected tissue out of the body.

The ultrasonic scalpel can insert a tubular horn into the affected area and crush the internal tissue without the need for conventional incisional surgery, and the insertion hole is smaller than that in conventional incisional surgery. It has the advantage of leaving very small and minimal surgical scars.

Conventionally, such an ultrasonic scalpel has the above-mentioned advantages, but on the other hand, the position and insertion direction of the insertion hole must be set correctly, and such initial positioning conventionally requires the operator's experience. and relied heavily on skill.

In recent years, ultrasound probes have been widely used to correctly determine the initial position of the ultrasound scalpel mentioned above.The transrectal ultrasound probe displays an image of the affected area, such as the prostate, directly from the rectum, and then transmits ultrasound waves according to this image. By inserting the scalpel into the affected area, it is possible to easily and accurately position the ultrasonic scalpel, which has the advantage of increasing the reliability of surgery and significantly reducing the burden on the patient.

[Problems to be Solved by the Invention] However, in the past, an ultrasound scalpel and a transrectal ultrasound probe were used independently of each other, and as is well known, the ultrasound probe only observed images of the ultrasound radiation surface. Therefore, the insertion position of the ultrasonic scalpel does not necessarily match the ultrasonic transmitting/receiving plane, that is, the observation plane, and there is still a problem that requires experience and skill on the part of the operator. There was a risk that it would shift.

The present invention has been made in view of the above-mentioned conventional problems, and its purpose is to provide an improved ultrasonic surgical device that can reliably guide an ultrasonic scalpel into the observation plane while observing the affected area. be.

[Means for Solving the Problems] In order to achieve the above object, the device according to the present invention fixes the transrectal ultrasound probe with a gripper, and the operator grasps the gripper to emit an ultrasound beam. Both a puncture needle and an ultrasonic scalpel inserted into a puncture hole defined by the puncture needle are both capable of positioning and hold a sleeve holder so as to be positionally adjustable with respect to the gripper, and the sleeve holder is used to insert a puncture needle or a puncture hole defined by the puncture needle. The puncture needle and the ultrasonic scalpel are guided to be inserted into the affected area while being held in a fixed positional relationship with the transrectal ultrasound probe, and the ultrasound scalpel is pressed to the retracted position by a biasing spring.

[Operation] According to the present invention, a transrectal ultrasound probe is first inserted into the rectum to check the condition of the affected area, such as the prostate.
Display images on CRT, etc.

Next, while observing the condition of the affected area based on the image display, a puncture needle is attached to a sleeve holder provided on a gripper that fixes the ultrasound probe via a guide sleeve, and the puncture needle is inserted into the affected area. .

After the initial position is determined by the puncture needle, the ultrasound probe is once removed from the rectum, and thicker puncture needles are successively inserted into the affected area using the thin puncture needle as a guide to widen the puncture hole.

When the puncture hole is enlarged to the desired diameter, the guide shaft of the pipe holder that guides the ultrasonic scalpel is guided by the puncture needle and inserted into the affected area, and in this state, the puncture needle is pulled out and the ultrasonic scalpel is inserted in its place. Insert into pipe holder.

Therefore, it is understood that in this state, the surgical terminal of the ultrasonic scalpel can be accurately inserted into the affected area.

Furthermore, the ultrasound probe is inserted into the rectum again, the pipe holder of the ultrasound scalpel is attached to the grasper of the ultrasound probe via the sleeve holder, and the state of the affected area is again imaged by the ultrasound probe. While being displayed, the surgical terminal of the ultrasonic scalpel is slid back and forth within this image plane to perform a micro-fragmenting action on the affected area. At this time, the ultrasonic scalpel is pressed to the retracted position by the biasing spring and does not shift in the pushing direction.

Therefore, according to the present invention, it is possible to perform a surgery while always correctly displaying the surgical position of the ultrasonic scalpel on the screen, and it is possible to perform an efficient surgery without damaging normal tissues.

[Embodiments] Preferred embodiments of the present invention will be described below based on the drawings.

Fig. 1 shows an image of the affected area of the prostate being displayed while micro-fragmentation surgery is being performed on the affected area using an ultrasonic scalpel, and Fig. 2 shows an initial stage for guiding the ultrasonic scalpel to a predetermined affected area. This shows a state in which a puncture needle serving as a position reference is inserted into the affected area.

As is well known, the transrectal ultrasound probe 10 has a relatively long outer tube 12, and at its tip is provided with, for example, an electronic scan type linear transducer 14 in which electroacoustic transducers are arranged in parallel.

A cable for inputting and outputting electrical transmission/reception signals is led to the base of the outer tube 12 via a connector 16, and commands are given to the transducer 14 to control transmission and reception of ultrasonic waves.

As shown in the figure, the tip of the ultrasound probe 10 is inserted into the rectum 100, and the tip of the ultrasound probe 10 is inserted into the rectum 100.
2, transmitting and receiving the ultrasonic beam indicated by reference numeral 104 is performed, and an external device (not shown)
An image of the prostate affected area 102 is displayed on the CRT.

The outer tube 12 of the ultrasonic probe is fixed to a gripper 18, and this fixing structure is shown in FIG.

That is, the gripper 18 is provided with a polygonal receiving groove 18a on its upper surface, and the fixing plate 2 is provided with a polygonal receiving groove 18a.
0 is removably fixed above the gripper 18 by a fixing screw 22.

Therefore, if the fixing plate 20 is tightened and fixed to the gripper 18 with the fixing screw 22 while the ultrasonic probe 10 is inserted into the polygonal receiving groove 18a, the ultrasonic probe 10 will be attached to the gripper 18. This makes it possible to reliably fix its movement in the axial and rotational directions.

In this state, the gripper 18 is attached to the ultrasonic probe 1.
0 into the rectum 100, it can be effectively used as a grasping part for the operator.

A characteristic feature of the present invention is that the gripper 1
A sleeve holder 24 is held at 8 so that its position can be adjusted, and the sleeve holder 24 securely holds a guide sleeve for a puncture needle and a pipe holder for an ultrasonic scalpel, which will be described later, to adjust the positional relationship with the ultrasonic probe 10. The goal is to be able to perform ultrasound surgery while maintaining the correct position.

Approximately U-shaped receiving portion 24a of sleeve holder 24
The apron 24c protrudes downward from its outer periphery and is firmly fixed to the upper end of the slider 26 shown in FIG. 1 by screws or other means.

The slider 26 can move in the vertical direction in FIG.
It is firmly fixed with screws 8.

Therefore, it is understood that the sleeve holder 24 can be freely adjusted in position in the vertical direction with respect to the gripper 18 in the embodiment.

In the present invention, it is important that the receiving portion 24a of the sleeve holder 24 has a U-shaped opening that opens on the opposite side of the ultrasound probe 10 as described above, and as a result, the puncture needle and the ultrasound scalpel described later can be The sleeve holder 24 can be freely attached to and detached from the ultrasound probe 10.

The sleeve holder 24 is attached to the U-shaped receiving portion 24a.
In order to securely fix the guide sleeve or pipe holder attached through the opening 24b to the sleeve holder 24, a presser plate 30 is rotatably supported on the sleeve holder 24 so as to be rotatable about a shaft 32. There is.

This presser plate 30 is firmly tightened and fixed to the sleeve holder 24 by a tightening screw 34 provided at its tip, as shown by the solid line in FIG.

The tightening screw 34 is rotatably held at the tip of the holding plate 30 by an E-ring 36, as shown by the chain line in FIG. There is no way to separate from it.

As described above, it is understood that a guide sleeve and a pipe holder, which will be described later, can be selectively and firmly held in the U-shaped receiving portion 24a of the sleeve holder 24.

2 and 3 show a state in which a puncture needle is attached to the sleeve holder 24 via a guide sleeve, and the puncture needle is inserted into the affected area while observing the affected area using the ultrasound probe 10.

The puncture needle 40 shown in FIG. 2 has the smallest diameter, for example, a needle of about 2 mm is selected.

In order to correctly position the puncture needle 40 in the sleeve holder 24, a guide sleeve 42 into which the puncture needle 40 is loosely fitted in the center is engaged with the receiving portion 24a of the sleeve holder 24, as shown in FIG.

The guide sleeve 42 has an outer shape that matches the receiving portion 24a, and has a groove portion (not shown in detail) that engages with the presser plate 30, and has a groove portion that engages with the presser plate 30 as shown by the solid line in FIG. With the plate 30 fixed to the sleeve holder 24 by the tightening screw 34, the guide sleeve 42 is held in its correct position.

As is clear from Fig. 2, the ultrasonic probe 1
0 inserted into the rectum 100, the ultrasound beam 104 is used to identify the affected area, for example, the erect gland affected area 102.
is displayed as an image, and the operator adjusts the height of the sleeve holder 24 according to the depth of the affected area obtained from the image plane.

This height adjustment is performed by moving the slider 26 in the vertical direction, and the amount of movement at this time is adjusted by a scale carved on the surface of the slider 26.

Once the position of the sleeve holder 24 is determined as described above, the operator inserts the thinnest puncture needle 40 toward the affected area 102 as shown in FIG.

This insertion state is monitored on the image plane by the ultrasonic beam 104, so that the insertion position will not be mistaken.

When the thin puncture needle 40 is correctly inserted into the affected area as described above, the holding plate 30 is opened as shown in FIG. 3, and the ultrasonic probe 10 is extracted from the rectum 100 together with the gripper 18. And affected area 1
Only the puncture needle 40 inserted into the 02 remains, and a plurality of thick puncture needles are sequentially inserted into the affected area 102 using the puncture needle 40 as a guide, until the next ultrasonic scalpel is inserted. A puncture hole with a sufficient diameter is formed toward the affected area 102.

FIG. 1 shows a state in which an ultrasonic scalpel is inserted through the puncture hole formed in the affected area 102, and the ultrasonic scalpel 50 is guided by a pipe holder 52, and the left and right sides of FIG. The pipe holder 52 is firmly fixed to the sleeve holder 24.

FIG. 4 shows a sectional view of the internal structure of the ultrasonic scalpel 50 and the pipe holder 52, and FIG. 5 shows a plan view of the ultrasonic scalpel 50 and the pipe holder 52 fixed to the sleeve holder 24.

The pipe holder 52 includes a cylindrical part 52a that engages with the receiving part 24a of the sleeve holder 24, and a rectangular part 52 with a substantially square cross section that is integrally provided behind the cylindrical part 52a.
b, and the square portion 52b is shown in detail in the cross section of FIG.

Two cylindrical sliding surfaces 52c and 52d are provided on the inner wall of the square portion 52b, and the ultrasonic scalpel 50 is guided in the left-right direction by these sliding surfaces.

The ultrasonic scalpel 50 has a well-known structure, and ultrasonic vibrations generated inside the scalpel body 50a are transmitted to an elongated horn 50b, and the tip of the horn 50b performs a fine crushing action on tissue.

The ultrasonic scalpel 50 of the embodiment has a slide portion 50c at its base, and a slide sleeve 50d is screwed to the base of the horn 50b.

Therefore, the slide portion 50c and the slide sleeve 50d engage with the slide surfaces 52c and 52d inside the pipe holder 52, and the ultrasonic scalpel 50
can freely slide in the left and right directions within the pipe holder 52.

Further, according to the embodiment, a compression biasing spring 54 is inserted between the pipe holder 52 and the ultrasonic scalpel 50, so that the ultrasonic scalpel 50 always moves toward the retracted position toward the left in FIG. The tip of the ultrasonic scalpel 50 is pressed and biased, and in this state, the tip of the ultrasonic scalpel 50 is stored in the guide shaft 52e extending to the tip of the pipe holder 52.

The square part 52b of the pipe holder 52 is further provided with a groove 5.
2f is provided, and as is clear from FIG. 5, it is possible to move the suction tube 56 in the left-right direction for sucking out the tissue finely crushed by the ultrasonic scalpel.

Washing water is supplied to the tip of the ultrasonic scalpel 50 in order to suck out the tissue to the outside when the tissue is finely fragmented, and in the embodiment, this washing water is fixed to the tip of the pipe holder 52. Supplied by inlet 58 .

Therefore, the cleaning water injected from the injection port 58 is sent into the affected tissue from between the guide shaft 52e and the horn 50b, and is delivered to the horn 5 together with the crushed tissue.
The central axis of 0b is sucked out to the outside by the suction tube 56, and the finely crushed tissue is removed from the body.

In FIG. 4, the cylindrical portion 5 of the pipe holder 52
2a is provided with a groove 52g, which allows the holding plate 30 to securely hold the pipe holder 52 on the sleeve holder 24.

In this embodiment, as described above, the ultrasonic scalpel 50 can move in the left and right directions within the pipe holder 52, but in order to restrict the distance of movement, the square portion 50
2b, a stopper pin 60 is slidably held, and as shown in FIGS. 5 and 6, a stopper screw 62 is integrally fixed to the stopper pin 60.
Slide plate 6 that engages with grooves 52h and 52i of 2b
The position of the stopper pin 60 is determined by tightening the stopper screw 62 while holding the slide plate 64 in a predetermined position. Thus, it is positioned, and its movement in the left and right direction can be arbitrarily restricted within the range indicated by the stroke S in FIG.

As described above, in the present invention, the ultrasonic scalpel 50 can move in the axial direction within the pipe holder 52, and as described above, the ultrasonic scalpel 50 can be moved in the axial direction within the pipe holder 52, and as described above, the The guide shaft 52e of the pipe holder 52 is inserted into the affected area 102 using the puncture needle as a guide, and in this state, the ultrasound probe 10 is inserted into the rectum 100 again, and the ultrasound probe 10 and the pipe holder 52 are inserted into the rectum 100.
The sleeve holder 24 is easily connected to the sleeve holder 24.

In the present invention, at this time, the sleeve holder 2
An opening 24c is provided above the pipe holder 4, and the pipe holder 52 can be fixed to the sleeve holder 24 very easily using the presser plate 30.

Then, in this state, the ultrasonic scalpel 50 is inserted into the pipe holder 52 as shown in FIG.
Break down the affected area while moving it in the left and right direction as shown in the figure.
This crushed tissue can be removed externally.

According to this embodiment, the ultrasonic scalpel 50 is always urged by the urging spring 54 toward the retracted position leftward from the pipe holder 52 when the ultrasonic scalpel 50 is used to crush the ultrasonic scalpel. sonic scalpel 5
When the operating end of the ultrasonic scalpel 50 is released, the tip of the ultrasonic scalpel 50 can always be retracted into the guide shaft 52e of the pipe holder 52.

As described above, according to the present invention, it is possible to operate the ultrasonic scalpel 50 within the display screen of the ultrasonic probe 10 to accurately perform surgery on the affected area.

According to the embodiments described above, non-invasive observation of the affected area is performed using an ultrasonic probe, but in the present invention, observation can be performed while observing any image using, for example, an X-ray or the like.

Furthermore, in the examples, a transrectal probe is preferred as the ultrasound probe, but in the present invention,
It is also possible to use any other method, for example, irradiating an ultrasonic beam from outside the body.

Furthermore, although the present invention is suitable for prostate tumors, the affected area to which the present invention is applied can be selected arbitrarily.

[Effects of the Invention] As described above, the present invention can guide the insertion of a puncture needle and an ultrasonic scalpel into an affected area such as the prostate while observing the affected area with an ultrasound probe inserted into the rectum. By correctly maintaining the positional relationship between the needle, the ultrasonic scalpel, and the ultrasonic probe, it becomes possible to perform accurate and reliable ultrasonic surgery without requiring any skill. In addition, the ultrasonic scalpel is pushed to the retracted position by the biasing spring,
It is possible to prevent the ultrasonic scalpel from shifting in the pushing direction.

[Brief explanation of drawings]

Fig. 1 is an explanatory diagram showing a state in which the ultrasonic scalpel of the ultrasonic surgical device according to the present invention is inserted into an affected area, and Fig. 2 shows a state in which a puncture needle is inserted into the affected area while observing the affected area with an ultrasonic probe. FIG. 3 is a side view of the device in FIG. 2, FIG. 4 is a sectional view showing the pipe structure of the ultrasonic scalpel and pipe holder in FIG. 1, and FIG. 5 is a plan view in FIG. 1. ,
FIG. 6 is a cross-sectional view of FIG. 4. 10... Transrectal ultrasound probe, 18... Grasper, 24... Sleeve holder, 30... Holding plate,
40...Puncture needle, 42...Guide sleeve, 50
... Ultrasonic scalpel, 52 ... Pipe holder, 100
...Rectum, 102...affected area.

Claims (1)

[Claims] 1. In an ultrasonic surgical device that displays an image of the affected area using a transrectal ultrasound probe and performs surgery on the affected area by inserting an ultrasonic scalpel into the affected area while viewing the displayed image,
a grasper to which the transrectal ultrasound probe is fixed;
a sleeve holder that is held in a position adjustable manner with respect to the gripper and has a receiving part that is open on the opposite side of the transrectal ultrasound probe; and a sleeve holder that is detachably attached to the receiving part of the sleeve holder and that is used to puncture the affected area. a guide sleeve that guides a puncture needle to the affected area; a pipe holder that is removably attached to a receiving portion of the sleeve holder and pivotally supports a surgical terminal of an ultrasonic scalpel at a position that matches the puncture hole of the puncture needle; A guide sleeve provided in the holder or a holding plate that fixes the pipe holder in the sleeve holder when it is attached to the receiving part, and a biasing spring provided in the pipe holder that presses the ultrasonic scalpel to the retracted position. What is claimed is: 1. An ultrasonic surgical device comprising: an ultrasonic surgical device capable of performing ultrasonic surgery on an affected area while positioning a puncture needle and an ultrasonic scalpel at predetermined positions with respect to a transrectal ultrasonic probe.