JPH0572819B2 - - Google Patents

Description

Detailed Description of the Invention [Industrial Application Field] The present invention can be used to remove cartilage (articular meniscus, articular cartilage), chondrocele, and canker sores from outside the body cavity to within the body cavity without making an incision, such as in the joint cavity of the knee. This invention relates to a surgical excision instrument that excises and discharges the body cavity.

[Prior Art and Problems to be Solved by the Invention] Conventionally, joint surgery has been mainly performed by an incisional method (open surgery). For example, common joint surgeries include removing a seed tumor on the patella and removing damaged cartilage, bone, etc. from the knee joint, but these surgeries require relatively large incisions. It was. For this reason, the incision causes trauma, which is accompanied by pain and restriction of movement, and has the disadvantage that it takes a long time to completely heal.

Therefore, in recent years, surgical resection instruments have been developed that perform surgery by forming a small puncture hole in the joint and inserting the insertion part into the puncture hole without incising the joint under observation using an arthroscope (endoscope). Proposed. for example,
JP-A-61-170449 discloses a surgical cutting instrument having an insertion portion inserted into a hard, linearly extending outer tube, through which a hard, linearly extending inner tube is inserted, the tip of which is provided with a cutting portion. has been done. However, this rigid, linearly extending insertion section has the problem that when performing resection within the joint cavity, there are areas that cannot be resected. To address this problem, US Patent No. 4,646,738 discloses a surgical resection instrument in which the outer tube forming the insertion portion is semi-rigid and has a tendency to bend. Moreover, when puncturing the resection site in the joint cavity where there is hard tissue such as bone, the curvature of the outer canal changes from its original shape before reaching the resection site.
In the end, there was a problem that the resection site could not be reached.

[Objective of the Invention] The present invention has been made in view of the above circumstances, and has good insertability even in complex shapes and in the presence of hard tissues such as bones, easy resection operation, and simple structure. The purpose is to provide inexpensive surgical cutting instruments.

[Means and effects for solving the problems] The surgical resection instrument according to the present invention includes a flexible portion in at least a portion of the inner tube, and a portion of the hard outer tube that is opposite to the flexible portion. Since a curved portion is formed and the opening of the outer tube is provided toward the inside of the curve of the curved portion, the tissue to be resected can be resected without missing.

[Example] Hereinafter, an example of the present invention will be described with reference to the drawings.

1 to 4 relate to the first embodiment of the present invention, in which FIG. 1 is an explanatory diagram of the configuration of a surgical cutting instrument, FIG. 2 is an explanatory diagram of the configuration of the distal end of the insertion section, and FIG. An explanatory diagram of the inner tube, and FIG. 4 is an explanatory diagram of the outer tube.

The surgical resection instrument 1 includes a main body 2 and an insertion section 3 inserted into a body cavity. The insertion section 3 consists of an outer tube 4 whose open base is fixed to the distal end of the main body 2, and an inner tube 6 rotatably inserted into the outer tube 4.

The outer tube 4 has an outer cutter 8 made of stainless steel, for example, with a cutting opening 7 opened on the outer periphery near the distal end, and the outer cutter 8 is fitted and fixed to the distal end, and the outer cutter 8 is applied to the tissue. A pipe 11 made of stainless steel, for example, with a curved part 9 curved at an angle of 30 degrees for easy contact.
It is composed of. The inner tube 6 also includes a flexible shaft 12 that can transmit rotational force and is made of, for example, three layers of stainless steel wire, and the inner layer and outer layer are tightly wound in the same direction and the middle layer is in the opposite direction. It is provided with an inner cutter 13 made of stainless steel, for example, provided at the tip thereof, and is formed to be freely curved as shown in FIG.
On the other hand, an inner path formed in the inner tube 6 serves as a suction path 14 that communicates with the cutting port 7 and suctions the section.

The main body 2 is a part of the surgical resection instrument 1 that is held and operated by an operator such as a surgeon, and the inner tube 6
a front housing 19 having a cavity 17 communicating with the suction pipe 14 of the outer tube 4 and having a suction pipe mouthpiece 18 connected to the section suction device; It consists of The front housing 19 is removably screwed to the housing 16 by, for example, screwing means. Further, this front housing 19 has an annular fixing portion 21 extending in the front thereof, and a groove portion 22 is formed in the inner circumferential axis direction thereof. On the other hand, a sleeve 24 having a flange 23 at the front is fitted onto the outer periphery of the base of the outer tube 4, and a pin 26 is installed on the outer periphery of the sleeve 24. Then, with the pin 26 engaged in the groove 22, the base of the outer tube 4 fitted with the sleeve 24 is inserted into the fixing part 21, and the outer tube fixing screw body 27 is screwed onto the outer periphery of the fixing part 21. The base of the outer tube 4 is removably fixed thereto.

A motor 28 as a driving part is installed in the rear part of the housing 16, and a male spline 31 is attached to a motor shaft 29 that projects forward of the motor 28.
is fixed. On the other hand, at the front of this motor 28, an output shaft 32 is rotatably and slidably supported in the axial direction, and a vertical spline 33 is formed at the rear of the output shaft 32, and this female spline 3
3 meshes with the male spline 31. The output shaft 32 protrudes into the cavity 17 of the housing 16, and the flexible shaft 1 is attached to this protrusion.
A sleeve 36 into which a connecting member 34 provided at the rear end of the two is fitted and fixed is connected. This sleeve 36 has a window portion 3 that communicates with the suction path 14.
7 is provided on the outer periphery.

The suction tube mouthpiece 18 is attached in communication with the cavity 17 of the housing 16. This suction tube mouthpiece 18 is inclined rearward with respect to the axial direction of the housing 16 so that the opening area of its inlet portion can be increased. In addition, this suction pipe mouthpiece 1
The front housing 19 to which the suction pipe cap 18 is attached is formed in a tapered shape so that the diameter becomes smaller toward the front, and the opening area of the suction tube mouthpiece 18 is increased.

The outer tube 4 has a 30° bend 9 as shown in FIG.
In addition to the outer tube 4 having the shape shown in FIG. 4, the outer tube 4 has the shape shown in FIG. The outer tube 4a in FIG. 4a is
It is formed in a straight line. Outer tube 4b in Figure 4b
has a curved portion 9 curved at 45°, and the cutting opening 7 provided at the tip opens in a direction opposite to the direction of the 45° angle. The outer tube 4c in FIG. 4C has a curved portion 9 curved at 90°,
The cutting opening 7 provided at the tip opens in a direction opposite to the 90° angle. Outer tube 4d in Figure 4d
has a curved portion 9 curved at 30°, and a cutting opening 7 provided at the tip opens in the 30° direction. The outer tube 4e in FIG. 4e has a curved portion 9 curved at an angle of 45°, and a cutting opening 7 provided at the tip portion opens in the direction of an angle of 45°.

Now, the operation of the surgical cutting instrument 1 constructed as described above will be explained.

As a step before inserting the surgical resection instrument 1, the outer tube 4 having the optimal curved portion 9 is selected depending on the puncturing direction of the insertion section 3 and the position of the region to be resected, and the outer tube fixing screw body of the main body 2 is Remove 27 and replace. Since the inner tube 6 to be inserted into the selected outer tube 4 is formed by the flexible shaft 12, it can be curved and inserted in accordance with any curve angle. After this operation is completed, the main body 2 of the surgical resection instrument 1 is grasped and the insertion portion 3 is inserted into the resection site through the puncture hole. On the other hand, physiological saline is supplied to the resection site, and an endoscope or the like is inserted so that the distal end of the insertion section 3 can be observed. In this setting state, the operator brings the cutting port 7 provided at the distal end of the insertion section 3 into contact with the resection site, drives the motor 28, and connects the output shaft 32 etc. to the flexible shaft 12 via the drive transmission system. Rotating around the axis, the tissue is cut or peeled by the cutting opening 7 and the inner cutter 13 rotating facing the cutting opening 7, and the sections generated by the cutting are passed through the suction path 14 and the window 37. The liquid can be discharged through a suction tube mouthpiece 18 connected to a suction device (not shown) through the cavity 17 and the suction tube 18 .

When resecting the target tissue in the joint cavity as in this embodiment, the surgical resection instrument 1 in which the insertion portion 3 has an unbent straight outer tube 4 is not suitable for hard tissues such as bones. If there is a part that cannot be reached or is difficult to excise, excision can be easily performed by replacing the outer tube 4 with an outer tube 4 having a curved portion 9 that is optimal for that area.

Since the cutting opening 7 of the outer tube 4 having the curved portion 9 is provided toward the inside of the curve of the curved portion 9, the outer tube 4
Even if it is removed while sliding in the axial direction, the cutting hole 7
The tissue to be resected will not be missed.

Note that the shape of the outer tube 4 is not limited to the above embodiment, and may be any shape as long as the inner tube 6 can be inserted therethrough.

5 to 7 relate to a second embodiment of the present invention, in which FIG. 5 is an explanatory diagram of the general configuration of the surgical cutting instrument, FIG. 6 is an explanatory diagram of the configuration of the distal end of the insertion section, and FIG.
The figure is an explanatory diagram of the outer tube.

The surgical resection instrument 1 includes a main body 41 and an insertion section 42 inserted into a body cavity. The insertion portion 42 opens forward and has a curved portion 4 near the tip.
3, and an insertion path 46 provided at the base of the outer tube 44 and formed within the outer tube 44.
and a holding part 48 having an opening 47 communicating with the holding part 48.

The main body 41 includes a housing 49 containing a motor and the like and provided with a suction tube mouthpiece 50, and an inner tube 51 extending forward. This inner tube 51 has an outer cutter 53 made of stainless steel, for example, with a cutting opening 52 opened on the outer periphery near the tip, and this outer cutter 53 is fitted and fixed to the tip, and can be bent freely using, for example, a stainless steel wire. Coil 5 formed in
It is composed of 4.

Inside the outer cutter 53, a cylindrical inner cutter 56 made of stainless steel, for example, is provided so that cutting can be performed with the outer cutter 53. At the rear end of the inner blade 56, there is a flexible shaft 57 that can transmit rotational force, which is made of three layers of stainless steel wire, the inner layer and the outer layer are tightly wound in the same direction, and the middle layer is in the opposite direction. 54 and is fitted and fixed. Further, an inner path formed in the flexible shaft 57 communicates with the cutting port 52,
A suction path 58 is configured to aspirate the section, and the section suctioned from the suction tube mouthpiece 50 can be discharged.

Note that when the inner tube 51 is inserted into the insertion section 42, the outer blade 53 provided at the tip of the inner tube 51 is
It is designed to protrude from the insertion portion 46 so that it can come into contact with and cut the resection site.

The outer tube 44 has a uniform shape as shown in FIG. Outer tube 44a in Figure 7a
is formed in a straight line. Outer tube 44 in Figure 7b
b has a curved portion 43 curved at 30°. The outer tube 44c in FIG. 7c is a curved portion 43 curved at 45°.
have. The outer tube 44d of FIG. 7d has a curved portion 43 curved at 90 degrees.

By the way, when inserting the surgical resection instrument 1 into the joint cavity, first insert the outer tube 44, and then insert the outer tube 44.
Insert the inner tube 51 through the opening 47 using as a guide. Since the inner tube 51 is formed of the coil 54 and the flexible shaft 57, it can be freely curved and can be easily inserted into the outer tube 44 having the curved portion 43. At this time, depending on the bending angle of the outer tube 44, it may not be possible to reach the resection site, but by replacing the outer tube 44 with an appropriate curved angle, the resection site can be reached and removed.

Other configurations, operations, and effects are the same as in the first embodiment.

FIG. 8 is an explanatory diagram of the configuration of the distal end of the insertion portion which is a modification of the second embodiment.

A cutting edge 62 is formed at the tip of the outer cutter 61 that opens forward in the direction of the tree. Inside the outer cutter 61, an inner cutter 64, which is formed in a spiral shape and has a cutting edge 63 on its outer peripheral surface and tip end surface, is rotatably provided by a flexible shaft (not shown). With this configuration, the resection site can be cut in both the axial and radial directions.

FIG. 9 is an explanatory diagram of the configuration of the distal end of the insertion portion, which is another modification of the second embodiment.

A spherical inner cutter 67 having a cutting edge formed on its outer circumferential surface is provided in a pipe 66 made of stainless steel, for example, which is open to the front. A flexible shaft 68 is rotatably connected to the rear end of the inner cutter 67. This eliminates the need for an outer cutter and simplifies the configuration.

The flexible shaft of each of the above embodiments does not need to be a triple tightly wound coil; for example, it may have a double or a single coil.
It can be heavy. Furthermore, if the shaft is capable of transmitting rotational driving force and is bendable, for example, a spiral tube made of closely wound stainless steel plates, a tube made of ultra-thin stainless steel wire, or a metal coil inside a plastic tube. It is also possible to embed .

Further, the material of the inner cutter and outer cutter is not limited to stainless steel (for example, SUS420F), but any material that is effective as a cutter may be used.

Furthermore, the outer tube is not limited to a stainless steel pipe, but may be made of any hard material that can be plastically deformed, such as a plastic tube. Furthermore, the structure of the outer tube may be such that a flexible portion is provided near the distal end so that it can be bent to a desired angle by operation from the proximal side.

[Effects of the Invention] As explained above, according to the present invention, it is easy to insert even if the shape is complex or there is hard tissue such as bone, and the outer tube can be removed even if it is removed while sliding in the axial direction. The tissue to be resected does not escape from the opening, the resection operation is easy, and the structure is simple and inexpensive.

[Brief explanation of drawings]

1 to 4 relate to the first embodiment of the present invention, in which FIG. 1 is an explanatory diagram of the configuration of a surgical cutting instrument, FIG. 2 is an explanatory diagram of the configuration of the distal end of the insertion section, and FIG. 4 is an explanatory diagram of the outer tube; FIGS. 5 to 7 relate to the second embodiment of the present invention; FIG. 6 is an explanatory diagram of the configuration of the distal end of the insertion section, FIG. 7 is an explanatory diagram of the outer tube, FIG. 8 is an explanatory diagram of the configuration of the distal end of the insertion section which is a modification of the second embodiment, and FIG. 9 is an explanatory diagram of the configuration of the distal end of the insertion section. FIG. 7 is an explanatory diagram of the configuration of the distal end of the insertion portion which is another modification of the embodiment. 1... Surgical resection instrument, 2... Main body, 3... Insertion part,
4... Outer tube, 6... Inner tube, 9... Curved part, 12... Flexible shaft.

Claims (1)

[Scope of Claims] 1. A hard outer tube with an opening near the tip, an inner tube inserted into the outer tube and having a rotatable cutting edge at the tip, and the outer tube and the inner tube. In the surgical cutting instrument, the inner tube has a flexible portion at least in part, and the outer tube has a flexible portion in a portion opposite to the flexible portion of the inner tube. A surgical cutting instrument characterized in that a curved section is formed, and the opening of the outer tube is provided toward the inner side of the curve of the curved section.