JPH08275950A - Ultrasonic dissecting and coagulating device - Google Patents

Abstract

PURPOSE: To provide an ultrasonic dissecting and coagulating device by which washing and sterilization can be performed certainly with less effort, and change or the like of a part of this device can be easily performed. CONSTITUTION: A forceps unit whose treatment part is provided on the distal end thereof is inserted into a tube pathway of an upper part side of a long- narrowed sheath 9, and the proximal end side thereof is engaged with a driving member 16 of an operating means 34 through a transmission member or the like, and the operating part can be made open/closed by operation of the operating means 34. A probe 8 is inserted into the tube pathway of the lower part side of the sheath 9, and the proximal end side of this probe 8 is connected with an ultrasonic vibrator 50 by means of a screw and the proximal end of the sheath 9 is connected with a handpiece 32 is which the ultrasonic vibrator 50 is built-in through a pipe 14 or the like and with the sheath 22 which moves freely-slidingly, and washing or the like can be easily performed because the forceps unit side, sheath 9 side, and the operating means 34 are formed into decomposable and composable constitution.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an ultrasonic incision coagulation apparatus for performing incision or coagulation using ultrasonic waves.

[0002]

2. Description of the Related Art Conventionally, it is generally known that a living tissue is treated by using ultrasonic vibration. Among them, the living tissue is adsorbed or grasped and fixed to an ultrasonic treatment tool. There was something to do.

For example, in Japanese Patent Application No. 62-127042, a calculus is grasped and crushed by ultrasonic vibration.
In Japanese Patent Application No. 1-232944, a living tissue is grasped and fixed by grasping forceps, and an incision is made with a probe that vibrates ultrasonically. Further, in Japanese Patent Application No. 1-232945, a biological tissue is adsorbed and fixed, and an incision is made with a knife that vibrates ultrasonically.

Further, in Japanese Patent Application No. 1-2232948, it is possible to efficiently excise living tissue by applying ultrasonic vibration to the excision forceps, and in Japanese Patent Application No. 1-2232949, Japanese Patent Application No. 1-232944. Similarly, the living tissue is fixed by the grasping means, and the living tissue is treated by the treatment member to which ultrasonic vibration is applied. USP 5,322,
In 055, a grasping member is provided on the upper part of the probe, and the living tissue is fixed by the probe and the grasping member to perform treatment. Since these can be treated by grasping a living tissue like ordinary surgical forceps, it is generally easier to perform a better treatment than a case where a treatment is performed with a probe alone.

USP 4,988,334 and Japanese Patent Application No. 2
Some of the devices generally referred to as an ultrasonic suction device, such as -203573, have a sheath that can be disassembled and assembled with respect to the handpiece. Since there is no such thing, and there is nothing that can be disassembled and assembled, it is necessary to wash and sterilize each part with great care during the washing and sterilizing process, which is very troublesome. Alternatively, it may be thrown away to save this time, but there is a problem in terms of reduction of medical amount, reduction of contaminated waste, and resource saving.

Further, if any part is damaged, the whole must be repaired or replaced. Furthermore, it is not possible to prepare several types of each part and use them in an optimal combination for treatment, and it is necessary to prepare ultrasonic treatment tools of the required types.

[0007] As described above, the ultrasonic treatment instrument provided with a means for grasping a living tissue has a problem of manpower, time, and cost of a person who handles it, and as a result, the burden causes increase in medical cost. There was a possibility of becoming one.

Conventionally, in a treatment tool used in endoscopic surgery, a treatment section for treating a living tissue is generally a sheath which is an insertion section for inserting the treatment section into a living body. And a manipulation means for manipulating the treatment portion was provided at the proximal end of the insertion portion.

Among these treatment tools for endoscopic surgery, there are known ones in which each part can be disassembled and assembled into an insertion part, a treatment part, an operation part and the like, as in DE 7330291 and Japanese Patent Application No. 6-179049. ing. This structure allows more reliable cleaning and sterilization of each part in the cleaning and sterilization process, and can replace only that part if, for example, only the treatment part is damaged, or prepare several types of each part. By doing so, there is a merit that an optimal treatment tool can be prepared by combining various parts, so that the above-mentioned problems have been solved to some extent.

However, such a treatment tool can generally use only high-frequency current when incising and coagulating a living tissue. However, since the high-frequency current has a wide range of protein denaturation in living tissues, it may cause excessive treatment in some cases.If possible, it was desirable to use it in combination with ultrasonic vibration and use it properly according to the situation. Such a treatment tool alone was not possible.

[0011]

Since none of the above-mentioned ultrasonic treatment tools having a gripping member can be disassembled and assembled in particular, each part should be carefully treated during the cleaning and sterilization steps. Needs to be washed and sterilized,
It was very troublesome. Alternatively, it may be thrown away to save this time, but there is a problem in terms of reduction of medical amount, reduction of contaminated waste, and resource saving.

Further, if any part is damaged, the whole must be repaired or replaced. Furthermore, it is not possible to prepare several types of each part and use them in an optimal combination for treatment, and it is necessary to prepare ultrasonic treatment tools of the required types. Therefore, there is a problem of manpower, time, and cost of the person who handles it, and the burden thereof may result in one of the causes of soaring medical cost.

The present invention has been made in view of the above-mentioned points, and provides an ultrasonic cutting and coagulating apparatus which can be surely washed and sterilized without any trouble and can be easily replaced partially. The purpose is to

[0014]

Means and Actions for Solving the Problems As means for solving the above-mentioned problems, an ultrasonic vibrator for generating ultrasonic vibration and a handpiece incorporating the ultrasonic vibrator are provided. A probe, which is a vibration transmission member that transmits the ultrasonic vibration generated by the ultrasonic vibrator to a treatment section for performing treatment on living tissue, is connected to the ultrasonic vibrator, and is a protective member that covers the probe. Have a sheath,
An operating unit that has a gripping member that grips a biological tissue between the probe distal end, and performs an operation for gripping and releasing the biological tissue by the probe distal end and the gripping member, and the operating unit. In the ultrasonic dissection and coagulation apparatus having the transmission member that drives the gripping member by the operation of 1, the sheath can be disassembled and assembled with respect to the operation means.

By disassembling, each part can be cleaned and sterilized easily and surely, parts can be easily replaced when broken, and various gripping members, sheaths, probes, etc. can be combined to make an ultrasonic incision suitable for treatment. A coagulation device can be constructed.

2. The gripping member and the transmission member are unit-shaped forceps units according to claim 1,
The sheath has a channel through which the probe communicates and a channel through which the forceps unit is inserted, the forceps unit can be disassembled and assembled with respect to the sheath, and both the sheath and the forceps unit perform the operation. The means can be disassembled and assembled.

The operation of this means is the same as that of claim 1.

3. In Claim 1 and Supplement 2, the handpiece can be disassembled and assembled with respect to the sheath and the operating means.

The operation of this means is the same as that of claim 1.

4. In Claim 1 and Supplementary Notes 2 and 3, the probe can be disassembled and assembled to the handpiece.

The operation of this means is the same as that of claim 1.

5. In Claim 1, the gripping member is rotatably attached to a tip provided at the distal end of the probe, and the transmission member and the probe are inserted in the same conduit in the sheath.

The operation of this means is the same as that of claim 1.

6. In Appendix 5, the transmission member is inserted inside the probe.

The operation of this means is the same as that of claim 1.

7. In additions 5 and 6, the handpiece and the transmission member can be disassembled and assembled with respect to the operation means and the sheath.

The operation of this means is the same as that of claim 1.

8. In additions 5 to 7, the tip can be disassembled and assembled to the probe, and the transmission member can be disassembled and assembled to the operating means.

The operation of this means is the same as that of claim 1.

9. 9. The disassembly according to claim 1 and claims 2 to 8, wherein when the sheath is disassembled with respect to the operating means, the sheath is disassembled by moving in a distal direction with respect to the operating means, and the sheath is separated from the operating means. When assembled, the sheath is adapted to be coupled by moving the sheath in the proximal direction with respect to the operating means.

The operation of this means is the same as that of claim 1.

10. In Claim 1, Supplementary Notes 2-9, the said handpiece is attached to the said operation means in the state equipped with the said probe and the said tip, and the said transmission member couple | bonded with the said operation means, The said sheath is the said. It can be disassembled and assembled to the operating means.

The operation of this means is the same as that of claim 1.

11. In claim 1 and supplementary notes 2 to 10,
A method of disassembling and assembling the sheath and the operating means is a screw and a screw hole.

The operation of this means is the same as that of claim 1.

12. In claim 1 and supplementary notes 2 to 10,
A method for disassembling and assembling the sheath and the operating means is such that the cross-section is made of an elastic member and a groove or a protrusion that meshes with the elastic member.

The operation of this means is the same as that of claim 1.

13. In claim 1 and supplementary notes 2 to 10,
The disassembling and assembling method of the sheath and the operating means is based on a male screw provided on either one of them and a female screw provided on the other.

The operation of this means is the same as that of claim 1.

14. In claim 1 and supplementary notes 2 to 10,
The disassembling and assembling method of the sheath and the operating means is based on a cam groove provided in either one of them and a pin which engages with the cam groove provided in the other.

The operation of this means is the same as that of claim 1.

[0042]

【Example】

(First Embodiment) FIGS. 1 to 9 relate to the first embodiment of the present invention, FIG. 1 is an overall view of the first embodiment of the present invention, and FIG. 2 is a sectional view showing the structure of a treatment portion and an insertion portion. , FIG. 3 shows D1-D2 of FIG.
-D3-D4 line sectional view, FIG. 4 is a front view of the treatment portion viewed from the front of FIG. 2, FIG. 5 is a sectional view taken along the line AA'-GG 'of FIG. 2, and FIG. FIG. 7 is a plan view, FIG. 7 is an enlarged partial cross-sectional view showing an operating means and a part thereof, and FIG.
H-H 'line and I-I' line sectional view of FIG. 9, FIG. 9 (A)
FIG. 6B is a sectional view taken along line JJ′-MM ′ of FIG.

As shown in FIG. 1, the ultrasonic incision coagulation apparatus 31 of the first embodiment of the present invention has an insertion portion 57 provided with a treatment portion 33 for treating at the distal end (tip), and the insertion portion 57. It has an operation means 34 which is formed at the proximal end (rear end) and operates the treatment portion 33. The insertion portion 57 is formed with an elongated sheath 9 so as to be inserted into a living body.

A sheath 22 having a diameter larger than that of the sheath 9 is provided on the proximal end side of the upper portion of the operating means 34, and the proximal end of the sheath 22 is used for incising and coagulating the treatment portion 33. The handpiece 32 is provided as a vibrator unit that incorporates an ultrasonic vibrator 50 (see FIG. 7) that supplies ultrasonic vibration for the purpose.

As shown in FIG. 2, the sheath 9 constituting the insertion portion 57 has, for example, two independent upper and lower conduits protected by the sheath 9, and an incision and a cutout are formed in the upper conduit. A forceps unit 58 as a treatment tool for coagulation treatment is inserted, and a probe 8 as a vibration transmission member for transmitting ultrasonic vibration from the ultrasonic transducer 50 in the handpiece 32 is inserted in the lower duct. The distal end member 7, which is detachably attached by screwing, is inserted into the distal end of the probe 8. The treatment portion 33 and the insertion portion 57 have a structure as shown in FIGS.

In the forceps unit 58, a movable columnar movable member for transmitting the operating force of the operating means 34 is inserted into a pipe-shaped outer tube member, and a tip member provided at the distal end of the probe 8. The gripping member 1 that grips and releases the living tissue with the gripping unit 7 is joined to the movable portion 3 at the distal end of the forceps unit 58 with the screw 2. That is, as shown in FIG. 4, the lower end of the grasping member 1 and the upper end of the tip member 7 are substantially flat, and the living tissue can be grasped and released on both planes. As shown in FIG. 3, a lateral groove extending in the lateral direction is provided on the lower end surface of the grip member 1 to form a coagulation groove 61 that reliably grips the tissue and facilitates coagulation.

As shown in FIGS. 2 and 3, the movable portion 3 is the first transmission member 5 as the transmission member of the forceps unit 58.
Is rotatably supported on the distal end side of the pin 35 about the pin 35, and is rotated about the pin 35 by the forward / backward movement of the pin 36 engaged in the elongated hole.

A connecting member 41 is screwed to the proximal end side of the first transmitting member 5, and the second connecting member 41 has a second connecting member 41.
The distal end of the second transmission member 10 is screwed, and the proximal end side of the second transmission member 10 projects proximally (rearward) from the proximal end of the sheath 9 forming the insertion portion 57. The distal end of the engaging member 42 is screwed to the protruding proximal end. That is, the first transmission member 5 forming the forceps unit 58 is screwed to the transmission member 10 on the proximal side thereof.
And further coupled to the engagement member 42 on the proximal side thereof (so as to be disassembled and assembled).

A spherical portion 43 is provided at the proximal end of the engaging member 42.
This spherical portion 43 is held by the locking mechanism on the upper side of the movable operating handle 30 constituting the operating means 34 shown in FIGS. 1 and 7 so as to be movable back and forth in the axial direction of the insertion portion 57. The engaging member 42, the second transmission member 10, and the first transmission member 5 are driven forward and backward by the opening and closing operation of the movable operation handle 30, and the movable portion 3 can be opened and closed as described above.

The sheath 11 forming the outer tube side member of the forceps unit 58 is connected (joined) to the pipe 14 via the connecting member 13 at the position inside the knob 12 together with the sheath 10 on the outside thereof. , This pipe 14 is the operating means 3
Fixed operation handle 29 serving as a fixed-side operation member in No. 4
Attached to.

The gripping member 1 and the screw 2 are made of an insulating material such as a resin material when a high-frequency current is applied to the tip member 7 for treatment as described later, but in other cases, they are made of metal or the like. You may.

As shown in FIGS. 2 and 3, a substantially cylindrical mating member 37 is inserted through the upper conduit of the sheath 9 through which the forceps unit 58 is inserted. Protrusions 39 protruding radially inward on the peripheral surface
(See FIGS. 2, 3, and 5 (F)), and the protrusion 39 is engaged with the snap fit 38 provided at the proximal end of the tip cover 6, and the tip cover 6 of the tip cover 6 is engaged. The snap fit 38 is pushed over the protrusion 39 toward the proximal side to bring the two into an engaged state and the forceps unit 5
8 can be fixed (locked) in the sheath 9. Then, by strongly pulling the forceps unit 58 toward the distal side of the sheath 9, the engagement between the two is released and disassembled, that is, the forceps unit 58 can be removed from the sheath 9.

At this time, if the gripping member 1 is opened even slightly, the position of the connecting member 41 is advanced so that the distal end of the connecting member 41 enters the snap fit 38. Due to this intrusion, the snap fit 38 cannot be bent in the inner peripheral direction, and the forceps unit 58 cannot be removed from the sheath 9.

That is, since the grasping member 1 needs to be completely closed from the tip member 7 when the forceps unit 58 side is detached, it is necessary to grasp living tissue during actual use. If the forceps unit 58 is not completely closed, there is no risk of the forceps unit 58 falling off, and the forceps unit 58 is constructed so that it can be disassembled and assembled from the sheath 9 while ensuring safety.

At this time, the meshing member 37 and the tip cover 6
The portion to be fitted with is not rotationally symmetrical (for example, the outer peripheral surface of the tip cover 6 is formed such that the position of the distal end of the stepped surface formed so that the engaging member 37 fits is different in the circumferential direction. ) The anti-rotation mechanism 40 (see FIGS. 2, 3 and 5).
By (F), the forceps unit 58 is prevented from rotating with respect to the sheath 9 and the operability is prevented from being lowered due to careless rotation when grasping living tissue. The proximal end of the meshing member 37 is connected to the sheath 11 which is provided inside the sheath 9.

The tip member 7 is provided in the lower duct of the sheath 9,
The ultrasonic transducer 50 is screwed onto the proximal end of the tip member 7.
A probe 8 for transmitting the ultrasonic vibration from the to the tip member 7 is inserted. The distal end of the tip member 7 is shown in FIG.
As shown in (A), it has a flat surface so that the living tissue can be easily gripped with the gripping member 1. This tip member 7
As shown in FIGS. 2 and 5 (B) and 5 (C), the plane on the upper side of the is formed to be closer to the proximal side than the gripping member 1, and the cross-sectional shape on the proximal side thereof is shown in FIG. ) -It is circular as shown in FIG.

Further, the apex of the distal end of the tip member 7 is formed in a substantially cone shape and protrudes farther than the gripping member 1, and the peeling operation can be performed at this portion. Tip member 7
Is attachable to and detachable from the tip of the probe 8 and the gripping member 1 is also attachable to and detachable from the movable portion 3 with the screw 2. The shaped tip member 7 and the gripping member 1 can be used.

As shown in FIG. 2, a protective member 4 such as PTFE or ceramics having heat resistance and ultrasonic vibration resistance is provided at the distal opening of the lower conduit of the sheath 9, and by this means. This prevents the tip member 7 and the sheath 9 from being contacted and damaged when a downward bending reaction occurs in the tip member 7 when grasping a biological tissue.

6 to 9 show the operating means 34. The operation means 34 is provided at the proximal end of the insertion portion 57, and the sheath 9 and the coupling member 13 are joined to each other. The connecting member 13
The distal end of the pipe 14 is joined to the outer periphery of the pipe 14, and the knob 12 is fitted to the outer periphery of the distal end of the pipe 14 and is joined (fixed) by the screw 44.

When the screw 44 is loosened, the knob 12 can be removed to the distal end side of the sheath 9, and the sheath 9 side (sheath 9, pipe 14, sheath 22) is disassembled with respect to the operating means 34 as described later. It can be assembled and can be assembled.

The pipe 14 passes through the insides of the first bearing 15 and the second bearing 19 which are respectively joined to the upper portion of the fixed operation handle 29 which is branched to the front and rear.
The pipe 14 is rotatably supported by the first bearing 15 and the second bearing 19 fixed to the fixed operation handle 29, and the outer peripheral surface of the pipe 14 and the first bearing 15 and the second bearing 19 are fixed. An O-ring 45 and two O-rings 47 are provided on a sliding surface that is slidable at least in the circumferential direction (in this embodiment, the front-back direction) with the inner circumferential surface, and the pipe 14, the bearing 15, and the bearing are provided. The amount of turning power with 19 is adjustable.

Therefore, when the knob 12 is grasped and rotated, the pipe 14 is moved together with the knob 12 into the first bearing 1.
5 and the second bearing 19 are rotated. The probe 8 is inserted along the central axis of the pipe 14, and the forceps unit 58 is inserted into the sheath 9 eccentrically from the central axis. (It coincides with the central axis of the acoustic wave transducer 50)
It comes to be rotated around.

As can be seen from FIG. 7 and the like, since the central axis of the sheath 9 is deviated from the central axis of the probe 8, the knob 1
When 2 is rotated, the insertion portion 57 (or the sheath 9 side) (in which the treatment portion 33 is provided at the distal end) is eccentrically rotated in conjunction with the rotation of the pipe 14.

In the cylindrical pipe 14, FIG.
As shown in (B), the probe 8 is inserted along its central axis so as to be coaxial, and the proximal end of the probe 8 has a cylindrical outer peripheral surface that fits into the cylindrical sheath 22. It is connected to a vibration drive shaft of an ultrasonic transducer 50 that generates ultrasonic waves provided inside the movable handpiece 32, for example, via a detachable (disassembling and assembling) connecting member by screwing.

The pipe 14 has a first bearing 15
In the portion between the second bearing 19 and the second bearing 19, as shown in FIG. 6, an elliptical groove 55 penetrating in the up-down direction and long in the front-rear direction is formed. The drive members 16 and 17 (see FIGS. 7 and 8B) are movably engaged in the front-rear direction and are coupled to each other by screws 53 as shown in FIG. 8B. Both drive members 16, 1
7 is adapted to drive the engaging member 42 forward and backward, and to open and close the gripping member 1 by forward and backward driving the transmission members 10 and 5 as described above.

The engagement member 42 eccentrically inserted halfway through the pipe 14 has the spherical portion 43 at the proximal end thereof attached to the upper portion of the movable operation handle 30.
6 is engaged and locked in an engaging groove provided in the radial direction 6.

The coupling member 20 is joined to the proximal side of the pipe 14 by a screw 46 that couples the two together (so that they can be disassembled and assembled), and the handpiece 32 is fitted to the outer periphery of the coupling member 20 on the proximal side. The formed sheath 22 is joined by screws 49. A threaded portion is provided on the outer peripheral surface of the sheath 22 on the proximal side, and a ring 23 is attached so as to be screwed into the threaded portion.

A backup ring 24 and an O-ring 59 are housed on the inner peripheral surface of the ring 23, and the O-ring 59 is compressed by rotating the ring 23 with respect to the operating portion sheath 22 in the fastening direction. Thus, the outer circumference of the handpiece 32 can be pressed to fix the handpiece 32 to the sheath 22.

With this structure, the handpiece 32 can be moved back and forth with respect to the sheath 22 by rotating the ring 23 in the releasing direction. Therefore, by moving the handpiece 32 forward and backward in the treatment portion 33 of the distal end member 7. The amount of protrusion can be adjusted so that the target tissue can be treated with the amount of protrusion suitable for the treatment, or the tip member 7 can be replaced to treat the tip member 7 actually used. Adjustments such as setting an appropriate protrusion amount can be performed.

The handpiece 32 is provided with a guide sheath 21 extending toward the distal end side.
An O-ring 48 is provided on the outer periphery on the distal side of the, and forms an airtight structure with the coupling member 20.

The pipe between the connecting member 13 and the connecting member 20 through which the probe 8 passes is isolated from the outside by connecting the connecting member 13 and the connecting member 20 with a pipe 18 and sealed. The pipeline is being constructed.

As will be described later, when a high-frequency current is passed through the probe 8 for treatment, the sheath 9 and the connecting member 1 are used.
3, connecting member 20, pipe 18, guide sheath 21 P
Molding with an insulating material such as TFE or polysulfone is safe because there is no risk of high-frequency current leaking.

With this structure, the forceps unit 58 and the probe 8 are completely insulated from each other.
If a connector to be connected to is provided, or a high-frequency current is directly supplied, for example, a high-frequency current is selectively supplied to the movable portion 3 and the tip member 7 to treat living tissue, or a high-frequency current is supplied to both to perform treatment. Or both,
The treatment can be performed in a bipolar manner by passing a high-frequency current through the living tissue.

In such a case, the driving member 16 and the driving member 1
7, fixed operation handle 29, movable operation handle 30, engaging member 42, bearing 15, bearing 19, sheath 22, the exposed surface of the ring 23, for example, by painting with an electrically insulating material such as PTEE material It is good to prevent high-frequency currents from leaking to people.

Further, since the pipe line through which the probe 8 is inserted and the pipe line on the proximal side of the probe 8 form a closed pipe line, water supply provided at the proximal end of the handpiece 32 is performed. A flow path (passage) through which a fluid can flow, such as water supply or suction using a void portion around the probe 8 by using this pipe by an unillustrated water supply / suction device connected to the suction mouthpiece 51. ) Is formed so that blood that has flowed out during treatment such as incision can be sucked and discharged to the outside.

A connecting portion of the cord 52 is formed at the proximal end of the handpiece 32, and a drive power source for ultrasonically vibrating the ultrasonic transducer 50 via the cord 52 (not shown in the figure). Power supply).

As described above, the engaging member 42 is screwed to the proximal side of the transmitting member 10 penetrating the upper side conduit of the sheath 9, and the proximal end of the engaging member 42 is attached. The spherical portion 43 is formed, and the spherical portion 43 meshes with the engagement groove of the drive member 16 as shown in FIG.

Engagement grooves 56 are provided on the outer peripheral surfaces of the drive members 16 and 17 in the circumferential direction, and the drive pins 25 are engaged in the engagement grooves 56 from the left and right. Therefore, when the drive pin 25 moves back and forth, the drive members 16 and 17 also move back and forth. Each drive pin 25 is supported by both ends of a semicircular drive member 26, and the lower end of the drive member 26 is connected to the upper end of a movable operation handle 30 by a screw 54. In addition, the movable operation handle 30 and the fixed operation handle 29 are screw 27
The movable operation handle 30 is rotatably held by and 28.

Therefore, by performing the operation of moving the movable operation handle 30 forward and backward with respect to the fixed operation handle 29, the spherical portion 43 is moved forward and backward via the drive pin 25 and the drive members 16 and 17, and the forceps unit. The gripping member 1 of 58 can be opened and closed.

That is, when the finger hook on the lower end side of the movable operation handle 30 is opened / closed, the drive member 26 is moved forward and backward with the screw 27 as a fulcrum, whereby the drive pin 25 is driven forward and backward. Then, the driving member 16 and the driving member 17 are driven forward and backward by the forward and backward driving of the driving pin 25, and the transmission member 10, the connecting member 41, and the transmission member 5 are forward and backward driven together with the engaging member 13, and the movable portion 3 is opened and closed as described above. By doing so, the gripping member 1 is opened and closed.

Further, by rotating the knob 12 with respect to the operation means 34, the handpiece 32 is also rotated in association with the operation means 34, and as a result, the treatment portion 33 can be rotated with respect to the operation means 34. Thus, the operability at the time of treatment is improved by changing the direction of grasping the living tissue.

That is, when the treatment portion 33 is rotated as described above, the drive member 16 and the drive member 17 are also rotated at the same time, but the outer circumference is circular and the drive pin 25 is circular in engagement groove. Since they are engaged by 56, they can be rotated 360 degrees with respect to the operating means 34 without any problem.

Next, an actual method of using this embodiment will be described. First, the ultrasonic incision coagulation apparatus 31 is made to face the living tissue to be treated, and the knob 12 is rotated to adjust the orientation of the treatment portion 33 to a direction in which the treatment can be performed easily. At this time, as described above, the O-ring 45 and the O-ring 4
Since the turning power amount can be adjusted to an appropriate amount by means of 7, the knob 12 can be turned when turning is necessary, and the turning force can be set so that it cannot be turned carelessly.

Then, the movable operation handle 30 is operated in the opening direction to open the grip member 1. The target living tissue is sandwiched between the grasping member 1 and the tip member 7, the movable operation handle 30 is closed, and the living tissue is grasped by the grasping member 1 and the tip member 7.

Then, by operating a foot switch (not shown) or the like, drive power is supplied from the drive power source for the ultrasonic oscillator 50 to the ultrasonic oscillator 50 to excite the ultrasonic oscillator 50. This ultrasonic vibration is transmitted from the probe 8 to the tip member 7.
To the living tissue grasped by the tip member 7, and the living tissue grasped by frictional heat can be heated to a high temperature to perform incision or coagulation treatment. At this time,
By adjusting the time and amplitude for applying ultrasonic vibration to the living tissue and the amount of force that grips the living tissue, the living tissue can be easily incised and coagulated.

For example, if the time is long, the amplitude is large, and the amount of gripping force is strong, the incision is convenient, and if the factor is the opposite, the setting is convenient for coagulation. Further, when simply grasping the biological tissue, the biological tissue can be grasped by the tip member 7 and the grasping member 1 as described above.

Further, when performing the peeling operation of the living tissue, the grasping member 1 is closed or opened, and the peeling operation is performed bluntly using the substantially cone-shaped portion of the distal end of the tip member 7. Alternatively, the peeling operation can be performed by applying ultrasonic vibration as described above. Furthermore, by pressing the tip member 7 alone against the living tissue and applying ultrasonic vibration, it is possible to perform an incision and coagulation operation of the living tissue.

If a treatment with a high frequency current is required, a high frequency current is supplied to the handpiece 32 from a high frequency power source (not shown), and the high frequency current is passed from the handpiece 32 to the tip member 7 via the ultrasonic transducer 50. To supply.

As a result, a high-frequency current is applied to the living tissue from the tip member 7, and the living tissue can be separated, incised and coagulated by the high-frequency current as in the case of using the ultrasonic vibration described above. At this time, as described above, the conduits of the probe 8 and the forceps unit 58 are completely insulated, and the gripping member 1
Since it is molded with an insulating member, there is no leakage of high frequency current, and safe and efficient treatment with high frequency current can be performed. If necessary, the ultrasonic vibration treatment and the high-frequency current treatment may be used together.

Next, the disassembly and assembly method of this embodiment will be described. First, with respect to the ultrasonic cutting and coagulating device 31 shown in FIG. 1 in the assembled state, the two screws 53 connecting the both drive members 16 and 17 on the upper part of the movable operation handle 30 are removed to remove the drive member 16 and the drive member 17. It is removed vertically from the pipe 14 and the spherical portion 43 is released from the engagement by the engagement groove of the drive member 16. Thereby, the proximal end side of the forceps unit 58 side can be opened.

Next, the grasping member 1 is set to be completely closed with respect to the tip member 7, and the grasping member 1 is pulled out in the distal direction with respect to the sheath 9. By this pulling-out operation, the snap fit 38 bends in the inner circumferential direction and rides over the projection 39, so that the forceps unit 58 can be disassembled from the sheath 9.

Subsequently, the ring 23 arranged at the proximal end of the sheath 22 is rotated in the opening direction to loosen the connection between the handpiece 32 and the sheath 22 and operate the handpiece 32 with the operating means 34.
To the rear side of. By this pulling-out operation, the handpiece 32 together with the probe 8, the insertion portion 57 and the operating means 34 are
Can be removed from the rear side.

Thereafter, the probe 8 is rotated with respect to the handpiece 32 to release the screwing of the two, and the probe 8 is removed from the handpiece 32. Thereafter, the tip member 7 can be removed from the probe 8 by similarly performing the operation of releasing the screwing.

To disassemble the insertion portion 57 and the operating means 34, the screw 44 provided on the knob 12 is removed from the knob 12, and the knob 1
2 is removed from the distal end side of the sheath 9. Subsequently, by pulling out the integrated operation unit 34 including the sheath 9, the pipe 14, the sheath 22 and the like to the rear side of the operation unit 34, the drive member 26, the movable operation handle 30 and the fixed operation handle 29 are removed.

By these series of operations, the ultrasonic incision coagulation apparatus 31 can be sufficiently cleaned and sterilized in each part, but by further removing the screw 54 connecting the drive member 26 and the movable operation handle 30, The drive member 26 and the movable operation handle 30 can be disassembled.

Further, the fixed operation handle 29 and the movable operation handle 30 can be disassembled by disassembling the screws 27 and 28. Also, the guide sheath 21 and the handpiece 32 can be disassembled by releasing the screw engagement.

When each member disassembled in this manner is washed and sterilized, and then assembled again after washing and sterilization, the ultrasonic dissection and coagulation device 31 can be assembled by reversing the above-mentioned disassembly order. Can be assembled. In addition, since the structure allows disassembly and assembly in this way, it is possible to clean or sterilize each part sufficiently or reliably without disassembling each part by disassembly, and in the event that some parts are damaged, etc. Only the damaged parts can be replaced, and can be used economically continuously.

Further, since the forceps unit 58 is attached to the sheath 9 by the snap fit 38,
Another forceps unit 58 having a different shape, size, or the like suitable for the treatment such as exchanging the forceps unit 58.
The tip member 7 can be detached (disassembled and assembled) on the probe 8 side, so that the treatment can be performed using another tip member 7 having a different shape or size. It can be performed.

(Second Embodiment) FIG. 10A and FIG.
The main part of the second embodiment of the present invention is shown in FIG. This embodiment has a configuration similar to that of the first embodiment, but is mainly provided for the incision of living tissue, and the gripping member 1 is not provided. Instead, scissors are formed by the distal end of the movable portion 3 and the tip member 7, so that incision of living tissue can be performed efficiently and safely.

The other structure is similar to that of the first embodiment.
In this embodiment, the distal end of the movable part 3 and the tip of the tip member 7 are pressed against the living tissue to be incised to move the movable part 3 from the open state to the closed direction, thereby contacting the sandwiched part of the living body. Living tissue can be excised by applying ultrasonic vibration to the tissue.

That is, instead of the function of gripping and incising and / or coagulating (at least one of) in the first embodiment, the function of sandwiching and excising (or incising). Also, FIG.
The treatment section 33 is operated by operating the knob 12 (not shown by 0), that is, the central axis of the probe 8 (that is, the central axis of the ultrasonic transducer 50).
Similar to the first embodiment, it can be rotated around. Further, since it can be disassembled and assembled as in the first embodiment, it can be disassembled for cleaning and sterilization. The effect of this embodiment is almost the same as that of the first embodiment.

(Third Embodiment) FIGS. 11A and 11B.
(B) shows a main part of the third embodiment of the present invention. The present embodiment has substantially the same configuration as the first embodiment, but a cut surface 62 is formed on the surface of the movable portion 3 sandwiched between the grip member 1 and the tip cover 6 and facing the tip member 7. .

Therefore, the living tissue is grasped by the grasping member 1 and the tip member 7, the living tissue is coagulated by using the coagulation surface 61, and the width of the proximal side of the coagulation surface 61 is reduced to form the incision surface 62. The living tissue is formed so that it can be incised by the incision surface 62 and the tip member 7 having a narrow width. The other structure is the same as that of the first embodiment.

With this configuration, for example, when performing an incision while coagulating, the portion to be incised is surely coagulated in advance by grasping sequentially from the end of the living tissue and applying ultrasonic vibration. , Can reduce the chance of bleeding,
A very safe incision can be made. Other functions and effects are similar to those of the first embodiment.

(Fourth Embodiment) FIG. 12 shows a main part of a fourth embodiment of the present invention. This embodiment has almost the same configuration as the first embodiment, but the forceps unit 58 and the sheath 9 are fixed by the snap fit 38 instead of the snap fit 38.
As shown in FIG. 12 which shows a cross section of a portion similar to the F'cross section, the structure is such that it can be disassembled and assembled by the engagement screw portion 63 formed by the tip cover 6 and the engagement member 37.

Others are the same as those of the first embodiment.
The operation of this embodiment is partially different from the operation of releasing the fixing at the time of disassembly and the operation of assembly, and the operation and effect are the first.
It is almost the same as the embodiment.

(Fifth Embodiment) FIG. 13 shows a main part of a fifth embodiment of the present invention. This embodiment has substantially the same configuration as the first embodiment, but the forceps unit 58 and the sheath 9 are fixed by the cam lock 64 provided on the tip cover 6 as shown in FIG. 13 instead of the snap fit 38. The protrusion 39 of the meshing member 37 (see FIGS. 2 and 5E) allows disassembly and assembly.

Others are the same as those in the first embodiment.
The operation of this embodiment is partially different from the operation of releasing the fixing at the time of disassembly and the operation of assembly, and the operation and effect are the first.
It is almost the same as the embodiment.

(Sixth Embodiment) FIG. 14 shows a main part of a sixth embodiment of the present invention. This embodiment has substantially the same configuration as the first embodiment, but the method of fixing the forceps unit 58 and the sheath 9 is not the snap fit 38, but E- in FIG.
As shown in FIG. 14, which shows a cross section of a portion equivalent to the vicinity of the E ′ cross section, it has a structure that can be disassembled and assembled by the joining screw 65. That is, a screw hole is formed in the tip cover 6 through the sheath and the meshing member 37, and a joining screw 65 is screwed into this screw hole, and can be disassembled and assembled by the joining screw 65. It has a structure. In addition, if necessary, an O-ring for maintaining watertightness may be interposed and screwed by the joining screw 65.

Others are the same as those in the first embodiment.
The operation of this embodiment is partially different from the operation of releasing the fixing at the time of disassembly and the operation of assembly, and the operation and effect are the first.
It is almost the same as the embodiment.

(Seventh Embodiment) FIG. 15A and FIG.
FIG. 15B shows a fixing mechanism for rotation locking in the seventh embodiment of the present invention, and FIG. 15A shows a fixing mechanism for the pipe 14 and the first bearing 15 or the second bearing 19. FIG. 15 (B) shows a fixing mechanism portion for rotation locking using a ball click.

This embodiment has substantially the same structure as that of the first embodiment, but a bearing 15 or a bearing 19 and a pipe 14 are provided with a rotary locking fixing mechanism using a ball click. An elastic member 79 such as a spring is housed in a hole penetrating the inside and outside of the pipe 14, and a ball 78 housed outside the elastic member 79 is urged in the outer peripheral direction by the elastic force of the elastic member 79. Since the diameter of the hole at the outer end of the hole through which the ball 78 provided in the pipe 14 passes is set to have an inner diameter smaller than the diameter of the ball 78, the urged ball 78 projects from the hole and falls off. There is no danger of

A plurality of click grooves 80 are provided on the inner peripheral surface of the ball 78 and the bearing 15 or the bearing 19 along the direction parallel to the central axis, and the operating means 3 is operated at an arbitrary angle.
4. The treatment portion 33 is rotated by a small angle as a unit with respect to 4, and is fixed (locked) to an arbitrary angular position which is an integral multiple of the angle.
You can do it.

That is, in a normal use state, the projecting ball 78 can be set in the engaged state in which the click groove 80 is engaged, and the fixed state in which the rotation (rotation) is restricted can be set, and the engagement is released. The fixed position can be variably set by rotating with such a rotating force.

The other structure is the same as that of the first embodiment.
The operation of this embodiment is almost the same as that of the first embodiment except that the operation of releasing this fixing mechanism at the time of disassembly and the operation of assembly are partly different.

(Eighth Embodiment) FIGS. 16 and 17 relate to an eighth embodiment of the present invention. FIG. 16 shows a main part of the operating means 34, and FIG. 17 shows a second part viewed from the rear side of FIG. A fixing mechanism for rotationally locking the bearing 19 and the sheath 22 is shown.

This embodiment has substantially the same structure as that of the first embodiment, but has a ring-shaped end face (proximal end face as seen in FIG. 16) of the second bearing 19 which faces the sheath 22. A large number of click grooves 80 are formed on the inner surface of the sheath 22. On the other hand, click claws 81 are provided at, for example, two positions on the end surface of the sheath 22 that faces this end surface. A fixing mechanism for locking is formed. The knob 12 is formed of an elastic member. The other structure is the same as that of the first embodiment.

With these configurations, when the treatment portion 33 is rotated, the knob 12 is pushed proximally to the operating means 34. As a result, the knob 12 comes into contact with the bearing 15 and is elastically deformed, and the click claw 81 becomes the click groove 80.
Get out of.

Then, by rotating the knob 12 with respect to the operating means 34, the treatment portion 33 is rotated with respect to the operating means 34. Here, when the amount of force that pushes the knob 12 against the operating means 34 is released, the click claw 81 is re-engaged with the click groove 80 and the locked state in which the rotation is restricted can be set.

Even if the click claw 81 is forcibly rotated with respect to the operating means 34 while the click claw 81 is meshed with the click groove 80, the knob 12 is moved when the click claw 81 gets over the ridge of the click groove 80. As it elastically deforms as described above,
The treatment portion 33 can be rotated with respect to the operation means 34. Other effects are similar to those of the first embodiment.

(Ninth Embodiment) FIGS. 18 to 23 relate to a ninth embodiment of the present invention, FIG. 18 shows the entire ninth embodiment, FIG. 19 shows a treatment portion and a probe, and FIG. ) ~
(D) shows the cross section of each part of FIG. 19, FIG. 21 shows the insertion part, FIG. 22 shows the operating means, and FIGS.
Shows a cross section of each part of FIG.

In the ultrasonic cutting and coagulating apparatus 31 of the first embodiment, two hollow conduits are formed in the sheath 9 having a function as a protective member, and the forceps unit 58 provided with the treatment portion 33 is inserted into one of the hollow conduits. , The probe 8 side that transmits the ultrasonic wave from the ultrasonic transducer 50 is passed through the other conduit, and the forceps unit 5
Locking the proximal end side of 8 to the movable operating means of the operating means 34,
Although the movable operating means is operated to open and close with respect to the tip member 7 of the probe 8, in this embodiment, the sheath 9 having a function as a protective member has a cylindrical hollow conduit (single member). A tubular path), and a substantially cylindrical probe 8 is passed through the sheath 9, and the treatment portion 33 is inserted in the probe 8.
The transmission member side connected to the movable member is inserted, and the proximal end of the transmission member is extended rearward in the hollow portion of the ring-shaped ultrasonic transducer 50 to be connected to the movable operation means. There is.

As shown in FIG. 18, the ultrasonic incision coagulation apparatus 31 has a treatment section 33 and an insertion section 57 for inserting the treatment section 33 into a living body, and the insertion section 57 has a proximal end at its proximal end. Operation means 34 for operating the treatment portion 33 is provided. A hand piece 32 having an ultrasonic transducer 50 for supplying ultrasonic vibration for treatment to the treatment section 33 is provided on the proximal side of the upper portion of the operating means 34.

The structures of the treatment portion 33 and the probe 8 for transmitting the ultrasonic vibration from the ultrasonic transducer 50 to the treatment portion 33 are as shown in FIGS. The treatment portion 33 is screwed onto the distal end of the probe 8 and is provided with a tip member 7 for treating living tissue by ultrasonic vibration.

The distal end of the tip member 7 is shaped like a forceps, and a tip cover 6 for sandwiching the movable portion 3 is formed from the center to the proximal end. The movable portion 3 and the distal end of the tip member 7 mesh with each other, and have a function as forceps for grasping or opening tissue.

In this embodiment, the distal end, which is usually called a peeling forceps, is thin and has a shape effective for peeling operation. However, this shape is scissors-like as in the second embodiment, or the third embodiment. The movable part 3 may have a shape like that, and the shape is not particularly limited.

The movable portion 3 is rotatably supported by the tip cover 6 by a pin 35, and is connected to the transmission member 5 by a pin 36. In addition, the transmission member 10 is the transmission member 5
Is screwed to the proximal end of the.

The proximal side of the tip cover 6 and the probe 8 are formed in a hollow shape, and the first transmission member 5 and the second transmission member 10 penetrate the inside thereof. When the outer peripheral surface of the second transmission member 10 is covered with a tube 66 made of a material having heat resistance and ultrasonic vibration absorption such as PTFE material, and ultrasonic vibration is applied to the probe 8. In addition, the contact between the probe 8 and the transmission member 10 prevents the risk of metal noise being generated, the contact portion being heated, or being damaged.

Similar to the first embodiment, an engaging member 42 is screwed to the proximal end of the transmitting member 10, and a spherical portion 43 is formed at the proximal end of the engaging member 42. There is.
The engaging member 42 is driven forward and backward by the opening and closing operation of the movable operation handle 30, and the transmission member 5 is driven forward and backward, whereby the force is transmitted to the movable portion 3 through the pin 36, and the movable portion 3 is moved with respect to the tip member 7. It is driven to open and close.

Further, the outer peripheral surface of the engaging member 42 is provided with an electrically insulating material such as a PTFE material in order to prevent the risk of the high frequency current leaking to the operator's hand or the like during the treatment using the high frequency current described later. It is covered with a tube 67 formed of a material having The probe 8 is formed of, for example, three parts, and the portion shown by Q and R in FIG.
It is connected and assembled by welding or the like.

As shown in FIG. 20 (A), the pin 35 that rotatably supports the movable portion 3 is fixed to the tip cover 6 by crimping or laser welding, so that it is integral with the tip cover 6. When the ultrasonic vibration is transmitted to the tip cover 6 as described above, the ultrasonic vibration is also transmitted to the movable portion 3 via the pin 35.

The treatment section 33 and the probe 8 having the above-mentioned structures are inserted into the inserting section 57 described later, and are connected to the ultrasonic transducer 50 of the hand piece 32 of the operating means 34.

The insertion portion 57 has a structure as shown in FIG. 21, and when the sheath 9 and the above-mentioned tip cover 6 and tip member 7 come into contact with the distal end of the sheath 9 composed of a plurality of parts. In order to prevent the risk of metal noise, heat generation, or damage to both, a protective member 4 made of a material having heat resistance and ultrasonic vibration such as PTFE or ceramic is provided. Has been.

An O-ring 68 and a C-ring 69 are provided on the outer circumference of the proximal end of the sheath 9, and the screw ring 8 to be described later is provided.
2 is watertightly connected. In the present embodiment, the connection between the sheath 9 and the screw ring 82 is detached by the C ring 69. However, for example, the structure of the snap fit 38 and the projection 39 of the first embodiment or the joining screw portion as in the fourth embodiment. Connection mechanism by 63 or cam lock 6 as in the fifth embodiment
4 and the method of using the joining screw 65 as in the eighth embodiment may be used, and the connecting method is not particularly limited.

Next, the operating means 34 will be described. FIG.
As shown in FIG. 7, the operating means 34 has the first bearing 15 joined to the distal side of the upper part of the support member 72 by screws 71,
The second bearing 19 is joined by a screw 73 near the upper center.

A screw ring 82 is inserted on the distal side of the first bearing 15, and is screwed to the handpiece 32 with the bearing 15 sandwiched therebetween. The screw ring 82, together with the handpiece 32, is rotatable about the first bearing 15, and is kept watertight by the O-ring 45.

Further, the above-mentioned sheath 9 is joined to the distal side of the screw ring 82 by a C ring 69, and the first bearing 15 is rotatably held in a watertight state by a watertight means such as an O ring 68. Is dripping In this embodiment, a water supply / suction mouthpiece 51 is provided on the upper portion of the first bearing 15, and by connecting a water supply / suction means (not shown) to the water supply / suction mouthpiece 51, Sheath 9
Water can be sent or suctioned using a pipeline that goes through.

The proximal side of the handpiece 32 is inserted into the second bearing 19 and is supported by the O-ring 47. The handpiece 32 can be rotated by the above-mentioned O-ring 45 and O-ring 47 when it needs to be rotated, and has a proper rotation resistance so that it does not rotate carelessly. It can rotate freely.

In addition to the O-ring 47, this rotary locking fixing mechanism is, for example, a ball click mechanism as in the seventh embodiment or an eighth ring.
A click mechanism such as that in the embodiment may be used.

Inside the handpiece 32, the ultrasonic vibrator 50 for supplying ultrasonic vibration for treating the living tissue is provided in a ring shape as described above. The ultrasonic vibrator 50 generates the ultrasonic vibration. The proximal end of the probe 8 is screwed to the distal end of the drive shaft (vibration shaft) for ultrasonic vibration.

The above-mentioned second transmission member 10 is inserted into the inside of the probe 8 and projects to the rear side of the proximal end of the handpiece 32 through the conduit inside the ultrasonic transducer 50. At this time, for the purpose of preventing leakage of pneumoperitoneum gas or the like through the conduit through which the transmission member 10 extending to the proximal end side of the handpiece 32 is inserted, the conduit and the second transmission member 10 are prevented. A substantially tube-shaped airtight member 74 is provided near the proximal end, and the airtight member 74 is formed of, for example, an elastic member such as rubber or a seal member such as PTFE material.

An engagement member 42 is connected to the proximal end of the second transmission member 10 by screwing, and a high frequency current is applied to the outer periphery of the engagement member 42 during a treatment with a high frequency current described later. In order to prevent leakage, the tube 67 is covered with a tube 67 made of an electrically insulating material such as a PTFE material.

A spherical portion 43 is provided at the proximal end of the engaging member 42.
Is provided, and is engaged with the engagement receiving member 75 inserted in the upper portion of the movable operation handle 30 as shown in FIG. As shown in FIGS. 23 (A) and 23 (B), the engagement receiving member 75 has a groove shape in the vertical direction, and the spherical portion 43 can slide in the groove. There is.

Here, the groove opening of the engagement receiving member 75 has an upper portion having a width that allows the spherical portion 43 to pass therethrough, and a lower portion having a width that does not allow the spherical portion 43 to pass therethrough. The root portion of the spherical portion 43 is sandwiched between the lower openings, and the spherical portion 43 is normally engaged in the lower groove.

With this structure, the movable operating handle 30 is opened and closed with respect to the fixed operating handle 29, whereby the engaging member 4
2 can be driven back and forth, and by moving the engaging member 42 forward and backward, the transmission member 10 and the transmission member 5 screwed thereto are driven forward and backward, whereby the movable part 3 is moved forward and backward.
Is driven to open and close.

A fixed operation handle 29 is connected to the proximal end of the support member 72 by a screw 76 and a nut 77.
Since the movable operation handle 30 is rotatably supported by the fixed operation handle 29 as shown in FIG. 23B, the movable operation handle 30 can be opened and closed with respect to the fixed operation handle 29 as described above. Can be done.

Next, an actual use example of this embodiment will be described. First, the treatment section 33 is opposed to the living tissue to be treated. Next, the hand piece 32 is rotated with respect to the operating means 34, and the treatment portion 33 is aligned in a direction convenient for treating the living tissue.

Then, the movable operation handle 30 is rotated in the opening direction to open the movable portion 3. The living tissue to be treated is grasped with an appropriate force. After that, the ultrasonic oscillator 50 is driven by a drive power source for the ultrasonic oscillator 50 (not shown),
The ultrasonic vibration is transmitted to the tip member 7 and the movable portion 3 to give the ultrasonic vibration to the living tissue.

At this time, as described above, if the treatment is performed with a factor of increasing the amplitude of ultrasonic vibration, increasing the amount of gripping force, and lengthening the time of applying ultrasonic vibration, it is convenient to incise the living tissue. Good and reverse factors are convenient because they cause coagulation. Therefore, appropriate treatment is performed in consideration of the condition of living tissue.

By applying a high-frequency current supply power source (not shown) to the ultrasonic transducer 50, a high-frequency current is supplied from the ultrasonic transducer 50 to the living tissue through the probe 8, the tip cover 6, the tip member 7 and the movable portion 3. It can be given, and treatment using high frequency current can also be performed.

At this time, as described above, the outer periphery of the engaging member 42 exposed to the outside is covered with the electrically insulating tube 67, and the movable operation handle 30, the sheath 9,
By molding the screw ring 82, the bearing 15, the handpiece 32, the casing, and the like with an electrically insulating material such as PEEK and polysulfone, it is possible to prevent leakage of high-frequency current, so that safe treatment can be performed.

Since the treatment with ultrasonic vibration and the treatment with high-frequency current can be carried out independently, the treatment may be carried out separately, or the treatments may be carried out simultaneously.

Next, the disassembly and assembly method of this embodiment will be described. First, the sheath 9 is pulled out from the screw ring 82 in the distal direction. Next, the fixing operation handle 29 is removed downward from the support member 72 by removing the screw 76. Along with this, the movable operation handle 30 also moves downward, so that the spherical portion 43 engaged with the engagement receiving member 75 described above.
The engaging member 42 comes off from the movable operation handle 30 by being removed from the groove. As a result, the one in which the fixed operation handle 29 and the movable operation handle 30 are integrated is disassembled from the operation means 34.

Subsequently, the screw ring 82 is attached to the handpiece 32.
The bearing 15 is also disassembled. After that, the handpiece 32 is placed on the proximal side of the bearing 15,
When the handpiece 32 and the probe 8 and the like are integrated, the operation means 34 is disassembled by pulling out the bearing 19.

The probe 8 is removed from the handpiece 32, and the engagement member 42 is removed from the transmission member 10. Then, the tip member 7 is removed from the probe 8. By the above disassembling operation, the ultrasonic dissection and coagulation apparatus 31 is brought into a state where it can be properly cleaned and sterilized, and each part can be cleaned and sterilized.

When assembling the ultrasonic cutting and coagulating apparatus 31 again, it is possible to assemble it in the reverse order of the disassembling procedure. Further, since it can be disassembled and assembled in this way, in the event that a part is damaged, it can be used again by replacing only that part.

(Tenth Embodiment) FIG. 24 shows a tenth embodiment of the present invention.
An example will be described.

The structure of this embodiment is almost the same as that of the ninth embodiment, but the probe 8 is curved, and the sheath 9 and the transmission member 10 inserted through the inside thereof are formed of elastic members. . The transmission member 10 is formed of, for example, a super elastic wire or the like made of Ni-Ti alloy or the like. The sheath 9 is formed of a flexible member such as PTFE material.

As a result, the curved probe 8 can be inserted into the sheath 9 and the transmission member 10 can be moved back and forth in the probe 8.

With these constructions, the treatment section 33 can be rotated with respect to the operating means 34, and good operability is obtained. Other configurations, operations, etc. are similar to those of the ninth embodiment.

In each of the above-described embodiments, for example, in a structure that can be disassembled and assembled by screwing or screwing a screw and a screw hole or a male screw and a female screw, a member provided with a screw or a male screw and a screw hole. Alternatively, it is clear that the member provided with the female screw may be exchanged, and the same applies to the case where the protrusion or the claw or the pin and the like are engaged with the recess or the groove or the like.

As described above, the gist of the present invention is to rotate the sheath of the insertion portion for inserting the treatment portion for treating the living tissue of the ultrasonic dissection coagulator into the living body with respect to the operating means. Other configurations may have any meaning as long as they are within the range of being freely set, and the contents are not limited.

[Additional Notes] 2. The gripping member and the transmission member are unitary forceps units according to claim 1, wherein the sheath has a channel through which the probe is inserted and a channel through which the forceps unit is inserted, The forceps unit can be disassembled and assembled to the sheath, and both the sheath and the forceps unit can be disassembled and assembled to the operating means. 3. The handpiece according to claim 1 or claim 2, wherein the handpiece can be disassembled and assembled with the sheath and the operating means.

4. The probe according to claim 1 or 2 or 3, wherein the probe can be disassembled and assembled to the handpiece. 5. The gripping member according to claim 1, wherein the gripping member is rotatably attached to a tip member provided at the distal end of the probe,
The transmission member and the probe are inserted in the same conduit in the sheath. 6. In Appendix 5, the transmission member is inserted inside the probe.

7. In additions 5 and 6, the handpiece and the transmission member can be disassembled and assembled with respect to the operation means and the sheath. 8. In additions 5 to 7, the tip member can be disassembled and assembled to the probe, and the transmission member can be disassembled and assembled to the operating means. 9. In Claim 1 to Appendix 8, when the sheath is disassembled with respect to the operation means, the sheath is disassembled by moving in a distal direction with respect to the operation means, and the sheath is disassembled with respect to the operation means. When assembled by assembling, the sheath is coupled by moving it in the proximal direction with respect to the operating means.

10. The handpiece according to claim 1 or 2 to 9, wherein the handpiece is attached to the operating means in a state where the handpiece is equipped with the probe and the tip member, and the sheath is attached when the transmission member is coupled to the operating means. It can be disassembled and assembled to the operating means. 11. The method of disassembling and assembling the sheath and the operating means by using a screw and a screw hole according to claim 1 and claims 2 to 10. 12. The method of disassembling and assembling the sheath and the operating means by an elastic member and a groove or a protrusion meshing with the elastic member according to claim 1 and the supplementary notes 2 to 10.

13. In claim 1 and supplementary notes 2 to 10,
A method for disassembling and assembling the sheath and the operating means is a male screw provided on either of the two and a female screw provided on the other. 14. The method for disassembling and assembling the sheath and the operating means according to claim 1 and the supplementary notes 2 to 10, wherein the cam groove provided in either of the two and the cam groove provided in the other mesh with each other. By pins.

[0168]

As described above, according to the present invention, an ultrasonic transducer for generating ultrasonic vibration, a handpiece incorporating the ultrasonic transducer, and the ultrasonic transducer are connected to the ultrasonic transducer. A probe serving as a vibration transmitting member that transmits the ultrasonic vibration generated by the ultrasonic transducer to a treatment portion for performing treatment on living tissue, a sheath that is a protective member that covers the probe, and the probe distal end. A gripping member for gripping a biological tissue between the end and the end, an operating means for performing an operation for gripping and releasing the biological tissue by the probe distal end and the gripping member, and the gripping member by the operation of the operating means. In the ultrasonic dissection and coagulation apparatus having a transmission member for driving the above, since the sheath has a structure capable of being disassembled and assembled with respect to the operating means, disassembling allows easy and reliable cleaning of each part. Sterilization with it, to facilitate part replacement at failure, and further it is also possible to construct an optimal ultrasonic dissection coagulation apparatus for the treatment in combination various gripping member and the sheath, the probe or the like.

[Brief description of drawings]

FIG. 1 is an overall view of a first embodiment of the present invention.

FIG. 2 is a cross-sectional view showing the structures of a treatment section and an insertion section.

3 is a sectional view taken along line D1-D2-D3-D4 of FIG.

FIG. 4 is a front view of the treatment section viewed from the front of FIG.

5 is a sectional view taken along the line AA ′ to GG ′ in FIG.

FIG. 6 is a plan view showing operating means.

FIG. 7 is a partial cross-sectional view showing an operating means and a part thereof in an enlarged manner.

FIG. 8 is a cross-sectional view taken along line HH 'and line II' of FIG.

FIG. 9 is a cross-sectional view taken along line JJ ′ to MM ′ of FIG.

FIG. 10 is a diagram showing the front and side shapes of the treatment portion according to the second embodiment of the present invention.

FIG. 11 is a diagram showing a shape of a treatment portion and a part of a movable portion in a third embodiment of the present invention.

FIG. 12 is a sectional view showing a part of an insertion portion in the fourth embodiment of the present invention.

FIG. 13 is a perspective view showing a treatment portion in a fifth embodiment of the present invention.

FIG. 14 is a sectional view showing a part of an insertion portion in a sixth embodiment of the present invention.

FIG. 15 is a view showing a bearing portion and a ball click mechanism of the operating means in the seventh embodiment of the present invention.

FIG. 16 is a sectional view showing an operating means in an eighth embodiment of the present invention.

FIG. 17 is a perspective view showing a bearing portion of the operating means in the eighth embodiment.

FIG. 18 is an overall view of a ninth embodiment of the present invention.

FIG. 19 is a view showing a cross section of a treatment section, a probe, and a part of the treatment section.

FIG. 20 is a line NN ′ to PP ′ line and SS ′ of FIG. 19;
FIG.

FIG. 21 is a sectional view showing an insertion portion.

FIG. 22 is a sectional view showing an operating means.

23 is a cross-sectional view taken along the line TT ′ to VV ′ of FIG.

FIG. 24 is an overall view of a tenth embodiment of the present invention.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Gripping member 2 ... Screw 3 ... Movable part 4 ... Protective member 5, 10 ... Transmission member 6 ... Tip cover 7 ... Tip member 8 ... Probe 9, 11, 22 ... Sheath 12 ... Knob 13, 20 ... Coupling member 14, 18 ... Pipes 15, 19 ... Bearings 16, 17 ... Drive member 21 ... Guide sheath 23, 24 ... Ring 25 ... Drive pin 26 ... Drive member 27, 28 ... Screw 29 ... Fixed operation handle 30 ... Movable operation handle 31 ... Ultrasonic wave Incision coagulation device 32 ... Handpiece 33 ... Treatment part 34 ... Operating means 38 ... Snap fit 39 ... Projection part 40 ... Rotation preventing mechanism 41 ... Connecting member 42 ... Engaging member 43 ... Spherical part 45, 47, 48 ... O-ring 50 … Ultrasonic transducer 56… Engagement groove 57… Insertion part

Claims (1)

[Claims] 1. An ultrasonic transducer for generating ultrasonic vibration, a handpiece having the ultrasonic transducer built-in, and a treatment connected to the ultrasonic transducer for treating the living tissue with the ultrasonic vibration. A probe as a vibration transmitting member for transmitting to a treatment section for performing, a sheath that is a protective member that covers the probe, a gripping member that grips biological tissue between the probe distal end, and the probe distal end. And an operating means for performing an operation for gripping and releasing the biological tissue by the gripping member, and a transmission member for driving the gripping member by the operation of the operating means, wherein the operating means On the other hand, an ultrasonic incision coagulating apparatus having a structure in which the sheath can be disassembled and assembled.