WO2014162343A1

WO2014162343A1 - Laser surgery device

Info

Publication number: WO2014162343A1
Application number: PCT/JP2013/002256
Authority: WO
Inventors: 繁大森
Original assignee: テルモ株式会社
Priority date: 2013-04-01
Filing date: 2013-04-01
Publication date: 2014-10-09

Abstract

The present invention reduces incomplete coagulation in a bipolar electrosurgical device that coagulates and cuts open living tissue. The present invention is a laser surgery device (100) that comprises a grip section (111) for gripping living tissue, and that coagulates and cuts open living tissue that is gripped by the grip section (111). The laser surgery device (100) is characterized by comprising: a laser output unit (212) that cuts open living tissue at an irradiation position and coagulates the living tissue in the vicinity of the irradiation position by moving linearly with respect to living tissue that is gripped by the grip section (111) while irradiating with laser light; a hollow needle (214) that moves at the same time that the laser output unit (212) moves, into which a suture thread (215) is inserted, and in which a suture needle (216) that is attached to the tip of the suture thread (215) is arranged so as to be exposed on the tip side; and a recovery section that holds the suture needle (216) that is arranged on the tip side of the hollow needle (214) that has moved.

Description

Laser surgical equipment

The present invention relates to a laser surgical apparatus for healing and incising a living tissue such as a digestive tract by irradiating the living tissue with a laser.

2. Description of the Related Art Conventionally, an automatic suturing device using a stapler is known as a device for suturing and cutting a living tissue without using a needle thread. This device is suitable mainly for suturing and separating a part of the digestive tract such as the stomach and intestine, and has a shorter treatment time and does not depend on the skill of the operator compared with the case of using a needle thread. There is a merit that quality is obtained. However, there are disadvantages in that many staplers remain in the body after the operation and it is difficult to reprocess the sutured portion.

On the other hand, a vessel sealer, which is a bipolar type healing device, is known as a device for healing and separating living tissues without using needle threads. The device is mainly suitable for healing and separating blood vessels and the like, and has a merit that nothing remains in the body because it is fused by applying high-frequency energy. However, there is a demerit that the force for maintaining the connected state of the living tissue immediately after the treatment is weaker than in the case of suturing using a stapler.

Similarly, a fusion device having a laser irradiation function is known as a device for fusion and separation of living tissues (for example, see Patent Document 2 below). Further, as a device capable of performing fusion and incision at the same time, a method in which a fenestration forceps and a laser knife are combined has been proposed (for example, see Non-Patent Document 1 below). According to this device, there is an advantage that a separating member is not required as compared with a bipolar fusion device.

For this reason, the applicant of the present application is considering the application of a laser-type fusion device as an alternative to an automatic suturing device using a stapler for the digestive tract such as the stomach and intestine.

US Pat. No. 8,147,489 JP-A-5-161659

However, even in the case where the living tissue is fused by laser irradiation, the force for maintaining the connected state of the living tissue immediately after the treatment is weaker than in the case of suturing using a stapler as in the case of the bipolar type fusion device. There is a demerit.

In particular, in the case of gastrointestinal tracts such as the stomach and intestines, intestinal obstruction occurs after surgery, and it is considered that the connection state cannot be maintained if the pressure in the tube rises, when using a laser type fusion device, There is a possibility of causing poor fusion after surgery.

For this reason, when applying a laser type fusion device to the fusion and incision of a living tissue such as the digestive tract, the connection state of the living tissue is reinforced, and the treatment time for the reinforcement is short. It is indispensable to add a configuration that does not depend on the skill of the present.

The present invention has been made in view of the above problems, and an object of the present invention is to reduce fusion failure in a laser surgical apparatus for healing and incising living tissue.

In order to achieve the above object, a laser surgical apparatus according to the present invention comprises the following arrangement. That is,
A laser surgical apparatus having a gripping part for gripping a biological tissue, and healing and incising the biological tissue gripped by the gripping part,
By irradiating the living tissue grasped by the grasping portion with the laser beam while moving linearly, the living tissue at the irradiation position of the laser light is incised, and the living tissue near the irradiation position of the laser light is removed. A laser output unit to unite,
A hollow needle that moves so as to penetrate the living tissue in synchronization with the movement of the laser output unit, wherein a suture is inserted, and the suture needle attached to the distal end of the suture is on the distal side A hollow needle arranged to be exposed in
And a collection unit for holding the suture needle disposed on the distal end side of the hollow needle moved in synchronization with the movement of the laser output unit.

According to the present invention, it is possible to reduce the failure of fusion in a laser surgical apparatus for healing and incising living tissue.

Other features and advantages of the present invention will become apparent from the following description with reference to the accompanying drawings. In the accompanying drawings, the same or similar components are denoted by the same reference numerals.

The accompanying drawings are included in the specification, constitute a part thereof, show an embodiment of the present invention, and are used to explain the principle of the present invention together with the description.
FIG. 1 is a diagram showing an external configuration of a laser surgical apparatus 100 according to the first embodiment of the present invention. FIG. 2A is a side view showing the internal configuration of the shaft portion 110 of the laser surgical apparatus 100. FIG. 2B is a side view showing the internal configuration of the shaft portion 110 of the laser surgical apparatus 100. FIG. 2C is a diagram illustrating a detailed configuration of the laser output unit 212. FIG. 3 is a perspective view showing a detailed configuration of the tip of the shaft portion 110. FIG. 4 is a plan view showing a detailed configuration of the tip of the shaft portion 110. FIG. 5 is a side view showing the internal configuration of the shaft portion 120 of the laser surgical apparatus 100. FIG. 6 is a plan view showing the internal configuration of the tip of the shaft portion 120. FIG. 7 is a view for explaining a suture needle collecting operation (suture needle holding and suture cutting operation). FIG. 8 is a view showing a structure of a suture thread. FIG. 9 is an enlarged side view of the tip of the shaft part 110 and the shaft part 120 that grasp the living tissue. FIG. 10A is a cross-sectional view showing a state in which a living tissue is sutured, fused, and incised using the laser surgical apparatus 100. FIG. 10B is a cross-sectional view showing a state in which a living tissue is sutured, fused, and incised using the laser surgical apparatus 100. FIG. 11 is a diagram showing an external configuration of a laser surgical apparatus 1100 according to the second embodiment of the present invention. FIG. 12 is a perspective view showing a detailed configuration of the gripping part 1110 of the laser surgical apparatus 1100. FIG. 13 is a diagram for explaining a configuration in which a living tissue is sutured, fused, and incised in the grip portion 1110. FIG. 14A is a diagram for explaining the configuration and operation of the drive unit. FIG. 14B is a diagram for explaining the configuration and operation of the drive unit. FIG. 15 is a view for explaining a suture needle collecting operation (suture needle holding and suture cutting operation). FIG. 16A is a diagram illustrating a state in which a living tissue is sutured, fused, and incised using the laser surgical apparatus 1100. FIG. 16B is a diagram illustrating a state in which a living tissue is sutured, fused, and incised using the laser surgical apparatus 1100. FIG. 17 is a diagram for explaining a configuration in which a living tissue is sutured, fused, and incised in the gripping portion 1710.

Hereinafter, embodiments of the present invention will be described in detail with reference to the accompanying drawings. The embodiment described below is a preferred specific example of the present invention, and thus various technically preferable limitations are given. However, the scope of the present invention is particularly limited in the following description. Unless otherwise stated, the present invention is not limited to these embodiments.

[First Embodiment]
<1. External appearance of laser surgical device>
FIG. 1 is a diagram showing an external configuration of a laser surgical apparatus 100 according to the first embodiment of the present invention. As shown in FIG. 1, the laser surgical apparatus 100 has a scissors-like shape in which the grip portion 111 and the grip portion 121 open and close when the shaft portion 110 and the shaft portion 120 rotate around the fulcrum 130. 1a shows a state in which the gripping part 111 and the gripping part 121 are opened, and 1b shows a state in which the gripping part 111 and the gripping part 121 are closed.

As shown to 1a of FIG. 1, the holding part 111 is distribute | arranged to the front end side of the shaft part 110, and has the waveform holding surface 112 where a convex part and a recessed part continue. The gripping surface 112 is formed so as to mesh with the corrugated gripping surface 122 of the gripping portion 121 with the gripping portion 121 closed (see 1b).

The knob 114 applies a driving force for moving a suture member and a fusion / incision member (not shown) in a straight line. Specifically, by turning the knob 114 clockwise, a suture member and a fusion / incision member (not shown) move to the distal end side of the shaft portion 110 and rotate the knob 114 counterclockwise. The suture member (not shown) and the fusion / incision member are configured to move to the rear end side (details will be described later).

A finger ring portion 115 for inserting the operator's finger is arranged on the rear end side of the shaft portion 110. In addition, a cable 116 connected to a laser oscillation device for supplying a laser is arranged for a fusion / cutting member (not shown).

Similarly, a grip part 121 having a corrugated gripping surface 122 in which a convex part and a concave part are continuous is arranged on the tip side of the shaft part 120. A finger ring portion 124 is disposed on the rear end side.

<2. Internal Configuration of Shaft Part 110>
Next, the internal configuration of the shaft portion 110 will be described. FIG. 2A is a side view showing the internal configuration of the shaft portion 110.

In FIG. 2A, 211 is a support | pillar part and hold | maintains the laser output part 212 at the front-end | tip. The laser output unit 212 and the support column 211 function as a fusion / cutting member. The column portion 211 extends from the rod 213 and operates on the roller 219. As a result, the fusion / incision member moves linearly with the rod 213.

Reference numeral 212 ′ denotes a detailed configuration of part of the tip of the laser output unit 212 and the column unit 211. As indicated by 212 ′, an optical fiber 221 that transmits laser light is disposed in the column portion 211. The laser light emitted from the tip of the optical fiber 221 is reflected in the reflecting surface 222 to be guided in the vertical direction (upward on the paper surface), collected by the lens 223, and then to the living tissue through the opening 224. Irradiated.

214 is a hollow needle made of a hollow member, and a suture thread 215 is arranged inside. A suture needle 216 is attached to the distal end of the suture thread 215, and the suture needle 216 is disposed so as to be exposed on the distal end side of the hollow needle 214. The hollow needle 214, the suture thread 215, and the suture needle 216 function as a suture member. The hollow needle 214 is also extended from the rod 213, and the suture member moves linearly together with the rod 213. As a result, the suture thread 215 inserted in the hollow needle 214 and the suture needle 216 attached to the distal end also move linearly together with the rod 213.

A rack gear 220 is provided on the upper surface of the rod 213 and meshes with a pinion gear 217 that rotates as the knob 114 rotates. As a result, when the knob 114 is rotated clockwise, the pinion gear 217 is rotated clockwise, and the rack gear 220 is moved to the distal end side of the shaft portion 110. Further, when the knob 114 rotates counterclockwise, the pinion gear 217 rotates counterclockwise, and the rack gear 220 moves to the rear end side of the shaft portion 110.

The optical fiber 221 extends as a cable 116 to the outside of the shaft portion 110 and is connected to the laser oscillation device 230. As a result, the laser beam output from the laser oscillation device 230 is supplied to the laser output unit 212.

In the above description, the laser output unit 212 is described as an output unit that irradiates laser light from a position away from the living tissue by a predetermined distance. However, the present invention is not limited thereto, and for example, Alternatively, a laser output unit that irradiates a laser beam in contact may be used.

In FIG. 2B, 212 ″ indicates a detailed configuration of a part of the tip of the laser output unit 212 and the column unit 211 that irradiate the laser beam in contact. As indicated by 212 ″, an optical fiber 221 for transmitting laser light is disposed in the column portion 211. The laser output unit 212 is provided with a contact chip 225, and the laser light transmitted through the optical fiber 221 is irradiated from the contact chip 225 to the living tissue.

FIG. 2C is a diagram illustrating a detailed configuration of the laser output unit 212. The upper side of the drawing shows the cross-sectional configuration of the laser output unit 212 and the support column 211, and the lower side of the drawing shows the detailed configuration of the optical fiber 221. . As shown in FIG. 2C, a reflection surface 231 that is mirror-polished at an angle of 45 degrees is formed at the tip of the optical fiber 221, so that the laser light transmitted through the optical fiber 221 is reflected on the reflection surface. The light is reflected at 231 and is incident on the contact chip 225 after the 90-degree optical path is changed. The upper surface 232 of the optical fiber 221 from which the laser light whose 90-degree optical path has been changed is emitted is roughly polished, and reflection loss when the laser light is emitted from the optical fiber 221 in the direction of the arrow 233 is suppressed. The contact chip 225 is a chip that irradiates a laser beam with a contact-type irradiation method. By using the contact chip 225, an incision can be made using a laser beam with a near-infrared wavelength that is difficult to be absorbed by a living tissue. Therefore, there is an advantage that the wavelength selectivity is improved.

<3. Detailed Configuration of Tip of Shaft Part 110>
Next, the detailed configuration of the tip of the shaft portion 110 will be described. FIG. 3 is a perspective view showing a detailed configuration of the tip of the shaft portion 110. As shown in FIG. 3, at the tip of the shaft portion 110, the center region in the width direction of the grip portion 111 has a flat grip for gripping a living tissue near the irradiation position irradiated with laser light or contacted. A surface 301 is formed, and a groove 302 for moving the laser output unit 212 to the tip side is further provided in the center of the flat gripping surface 301 (note that the opposing shaft 120 is gripped). The part 121 is also provided with a gripping surface similar to the gripping surface 301).

Further, in the central area of each of the gripping portions 111 divided into two with the gripping surface 301 in between, there are

groove portions

311 and 321 for moving the suture needles 216 and 216 ′ and the

hollow needles

214 and 214 ′ to the distal end side. Each is provided.

The

hollow needles

214 and 214 ′ are arranged substantially in parallel with the laser output part 212 interposed therebetween, and the two

hollow needles

214 and 214 ′ and the suture are moved by the rod 213 moving to the distal end side of the shaft part 110. The thread and the two

suture needles

216 and 216 ′ move to the distal end side in the

grooves

311 and 321 respectively. At this time, the laser output unit 212 also moves in the groove 302 to the tip side in synchronization.

FIG. 4 is a plan view showing a detailed configuration of the tip of the shaft portion 110. As shown in FIG. 4, the rod 213 can move to the front of the grip portion 111. The lengths of the

hollow needles

214 and 214 ′ are such that the suture needles 216 and 216 ′ protrude beyond the tip of the gripping surface 301 in the central region of the gripping part 111 when the rod 213 is moved to the front of the gripping part 111. It shall be prescribed to In addition, the length of the support column 211 is defined so that the laser output unit 212 reaches the tip of the gripping surface 301 in the central region of the gripping part 111 in a state where the rod 213 moves to the front of the gripping part 111. It shall be.

<4. Internal configuration of shaft portion 120>
Next, the internal configuration of the shaft portion 120 will be described. FIG. 5 is a side view showing the internal configuration of the shaft portion 120. As shown in FIG. 5, the collection region 500 for collecting the suture needles 216, 216 ′ exposed from the tips of the

hollow needles

214, 214 ′ is provided in the tip region of the gripping surface 122. The collection unit 500 includes a needle holding unit (not shown in FIG. 5) for holding the suture needles 216 and 216 ′, and a cutting unit 502 for cutting the suture thread 215.

Further, a wire 503 stretched between

rollers

511, 512, and 513 is connected to the cutting unit 502 between the cutting unit 502 and the operation end 505, and the operation end 505 is moved in the direction of the arrow 504. Thus, the cutting unit 502 can cut the suture thread 215.

FIG. 6 is a plan view for explaining the internal configuration of the grip portion 121 of the shaft portion 120. As shown in FIG. 6, two

wires

503 and 503 ′ are stretched between the cutting portion 502 and the operation end 505 (not shown in FIG. 6). 511 and 512 and rollers 511 ′ and 512 ′.

As shown in FIG. 5, when the operation end 505 is operated in the direction of the arrow 504, the cutting unit 502 is cut from the non-cutting position to the cutting position (position indicated by the dotted line) in the collecting unit 500 as shown in FIG. 6. Move up. Thereby, the suture thread 215 is cut.

<5. Retrieval operation of suture needle>
Next, the collection operation of the suture needle 216 (the holding operation of the suture needle 216 and the cutting operation of the suture thread 215) will be described. FIG. 7 is a view for explaining the recovery operation of the suture needle 216.

7a of FIG. 7 shows a state in which the suturing member is moved by the movement of the rod 213 with the gripping portion 111 and the gripping portion 121 being closed. As described above, the length of the hollow needle 214 is defined such that the suture needle 216 protrudes from the tip of the gripping surface 301 in the central region of the gripping part 111 in a state where the rod 213 has moved to the front of the gripping part 111. ing. Therefore, as shown in 7b of FIG. 7, when the rod 213 moves to the front of the gripping portion 111 in a state where the gripping portion 111 and the gripping portion 121 are closed, the suture needle 216 disposed at the tip of the hollow needle 214 is used. Is accommodated in a collection unit 500 disposed at the tip of the gripping unit 121.

In the collection unit 500, flexible

needle holding units

701 and 702 are attached. The

needle holding portions

701 and 702 are configured to expand outward when the suture needle 216 is inserted, and not to expand when the inserted suture needle 216 is pulled out.

7c in FIG. 7 shows a state in which the suture needle 216 disposed at the tip of the hollow needle 214 is accommodated in the collection unit 500 and held by the

needle holding units

701 and 702. In this state, when the rod 213 is moved to the rear end side, the hollow needle 214 connected to the rod 213 also moves to the rear end side together with the rod 213. At this time, since the suture needle 216 is held by the

needle holding portions

701 and 702, the state of being accommodated in the collection portion 500 can be maintained.

When the operation end 505 is operated after the movement to the rear end side of the rod 213 is completed, the cutting unit 502 moves to the cutting position. 7d of FIG. 7 shows a state in which the cutting unit 502 has moved to the cutting position. As shown in 7d of FIG. 7, when the cutting unit 502 moves to the cutting position, the suture 215 is cut.

As described above, by executing the operations shown in FIGS. 7a to 7d, the suture thread 215 can be placed in the living tissue while the suture needle 216 is recovered.

<6. Suture structure>
Next, the structure of the suture thread 215 will be described. FIG. 8 is a view showing a structure of a suture thread. As shown in FIG. 8, a plurality of cut portions 811 and cut portions 812 are formed on the peripheral surface of the suture thread 215. The cut portion 811 is a locking portion for the living tissue so that the suture 215 does not come out of the living tissue even when a tensile force in the direction of the arrow 802 is applied to the suture 215. Function as.

Similarly, the notch portion 812 prevents the suture thread 215 from coming out of the living tissue even when a tensile force in the direction of the arrow 801 is applied to the suture thread 215. It functions as a locking part.

In this way, by applying a special process to the peripheral surface, the suture 215 is simply left in the living tissue, and the suture 215 comes out of the living tissue without performing a ball stop or the like. It becomes possible to avoid the situation.

As described with reference to FIG. 7, when the suture thread 215 is placed in the living tissue, the suture thread 215 penetrates the living tissue while being inserted into the hollow needle 214. At this time, the

cut portions

811 and 812 are inserted. However, it does not come into contact with the living tissue, and therefore, the

cut portions

811 and 812 do not prevent the suture needle 216 from moving toward the distal end side in the living tissue.

<7. Examples of suture, fusion and incision of living tissue>
Next, an example of a process in which a part of living tissue (gastrointestinal tract such as stomach and intestine) is fused and incised and sutured using a suture is described with reference to FIGS. 9, 10A, and 10B. FIG. 9 is an enlarged side view showing the grip portion 111 at the tip of the shaft portion 110 and the grip portion 121 at the tip of the shaft portion 120, and the living tissue 900 is interposed between the grip portion 111 and the grip portion 121. A state is shown in which a part of the living tissue 900 is grasped by arranging a part and closing the grasping part 111 and the grasping part 121.

As shown in FIG. 9, a part of the biological tissue 900 is arranged between the gripping part 111 and the gripping part 121 and is held by the gripping part 111 and the gripping part 121. The part is pressed and deformed into a waveform with a predetermined thickness. Further, the inside of the region deformed into a waveform (that is, the central region in the width direction of the gripping portion 111 and the gripping portion 121) is deformed flat with a predetermined thickness.

In this state, when the laser output unit 212 is moved to the distal end side while emitting laser light from the laser output unit 212, the living tissue 900 irradiated or contacted with the laser light is fused and incised at the irradiation position. .

FIG. 10A shows a state in which laser light is irradiated on the living tissue 900 by the laser output unit 212 shown in FIG. 2A in a state where a part of the living tissue 900 is held between the holding unit 111 and the holding unit 121. It is sectional drawing at the time of seeing toward the front end side. FIG. 10B illustrates a state in which a part of the living tissue 900 is gripped between the gripping unit 111 and the gripping unit 121, and the laser output unit 212 illustrated in FIG. It is sectional drawing when a mode is seen toward the front end side.

As shown in FIGS. 10A and 10B, the living tissue 900 gripped between the gripping surface 301 in the center region in the width direction of the gripping portion 111 and the gripping surface 1001 in the center region in the width direction of the gripping portion 121. The laser output unit 212 irradiates or contacts the laser beam, so that the living tissue at the irradiation position of the laser beam is incised. In addition, living tissues in the vicinity of the laser light irradiation position (biological tissues on both sides of the incised position) are fused by heat.

Thereafter, the biological tissue 900 is sequentially fused and incised by moving the rod 213 toward the distal end and moving the irradiation position of the laser light toward the distal end.

Note that the hollow needle 214 penetrates the living tissue deformed into a waveform as the laser output unit 212 moves toward the distal end side. Then, when the rod 213 moves to a position before the grip portion 111, the suture needle 216 is accommodated in the recovery portion 500 (see FIG. 9). That is, at this point, the living tissue 900 has been sutured, fused, and incised.

Then, when the hollow needle 214 moves to the rear end side of the shaft portion 110 by moving the rod 213 to the rear end side, the suture thread 215 is exposed and contacts the living tissue 900 (see FIG. 9). Further, the suture thread 215 is cut at the root of the suture needle 216 by the cutting section 502, whereby the suture needle 216 is collected by the collection section 500 and the suture thread 215 is left in the living tissue 900.

As described above, since the

cut portions

811 and 812 are formed in the suture thread 215, the suture thread 215 is locked by the living tissue 900, and the suture thread 215 does not come out of the living tissue 900. Note that the biological tissue 900 through which the suture thread 215 passes is deformed into a waveform, and thus the biological tissue 900 is wave-sewn with the suture thread 215.

That is, since the living tissue 900 that has been fused and incised is reinforced by the suture thread 215, the force for maintaining the connected state of the living tissue 900 is increased. As a result, it becomes possible to reduce the failure of fusion of living tissue.

As is clear from the above description, in the laser surgical apparatus 100 according to the present embodiment, the suture 215 is used to reduce the failure of fusion when a part of the digestive tract such as the stomach or intestine is fused and incised. It was configured to sew and reinforce.

In particular,
The gripping surface of the gripping part that grips the living tissue was formed into a waveform, and the gripping surface at the irradiation position (center region) where the laser beam was irradiated or contacted was formed flat.
-It was set as the structure which collect | recovers the suture needle used at the time of wave sewing in a collection | recovery part.
A cut was formed in the peripheral surface of the suture so that the wave-sewn suture was locked to the living tissue.
In order to allow the suture thread with the cuts to penetrate through the living tissue, the suture thread is inserted into the hollow needle and moved along the gripping surface formed in a waveform together with the hollow needle.
-It was set as the structure which implements a suture, fusion, and incision in parallel by moving a laser output part and a hollow needle synchronously.

This makes it possible to perform fusion and incision by laser light, reinforcement with a suture of living tissue fused and incised by laser light, and recovery of the suture needle by only reciprocating the rod once.

That is, reinforcement of the connection state of the living tissue can be realized in a short time and with a configuration that does not depend on the skill of the operator. As a result, it has become possible to reduce the failure of fusion of living tissues.

In addition, according to the said structure, the demerit that many staplers remain in a body after an operation can also be avoided compared with the case where the structure of the automatic suturing device using a stapler is added to the laser type fusion device.

[Second Embodiment]
In the first embodiment, the rod is moved manually. However, the present invention is not limited to this. For example, a motor is mounted and the rod is driven to the front end / rear end side by the driving force of the motor. The movement may be realized.

In the first embodiment, the gripping surface for gripping the position to be sutured by the suture is formed in a corrugated shape, and the hollow needle is linearly moved. However, the present invention is not limited to this. . For example, as a configuration in which a gripping surface for gripping a position to be sutured by a suture thread is formed flat, a hollow needle is formed in a spiral shape, and the hollow needle is rotated and moved linearly while rotating. Also good.

Hereinafter, in this embodiment, a laser surgical apparatus using a driving force of a motor and a spiral hollow needle will be described when the rod is moved to the front end / rear end side.

<1. External appearance of laser surgical device>
FIG. 11 is a diagram showing an external configuration of a laser surgical apparatus 1100 according to the second embodiment of the present invention. As shown in FIG. 11, a laser surgical apparatus 1100 includes a gripping part 1110 for gripping, suturing, healing, and incising a living tissue, and a drive part for driving the gripping part 1110. And an operation unit 1130 to which an operation member for inputting an instruction for operation is attached. In addition, the grip unit 1110 and the operation unit 1130 are connected to each other, and a shaft unit 1120 including a transmission mechanism that transmits the operation of the drive unit built in the operation unit 1130 to the grip unit 1110 is provided.

The gripping part 1110 includes an opening / closing part 1111 and a base part 1112. The base portion 1112 extends substantially parallel to the long axis direction of the shaft portion 1120. The opening / closing part 1111 is rotatably attached to the base part 1112 via a turning shaft 1113, and opens / closes by operating a lever 1134 of the operation part 1130.

In the gripping part 1110, the living tissue is disposed between the gripping surface 1114 of the opening / closing part 1111 and the gripping face 1115 of the base part 1112 in a state where the opening / closing part 1111 is moved to the open position (in a state indicated by a dotted line). Then, the living tissue is grasped by moving the opening / closing part 1111 to the closed position. The detailed configuration of the grip portion 1110 will be described later with reference to FIGS.

The operation unit 1130 includes a drive region 1131 in which a drive unit for driving the gripping unit 1110 is incorporated, and an instruction region 1132 to which an operation member for inputting an instruction for operating the drive unit is attached.

In the indication area 1132, reference numeral 1133 denotes a holding unit for the operator to hold the laser surgical apparatus 1100. Reference numeral 1134 denotes a lever for opening and closing the opening / closing part 1111. When the lever 1134 is pulled toward the holding part 1133, the opening / closing part 1111 moves to the closed position. On the contrary, when the lever 1134 is returned in the direction away from the holding portion 1133, the opening / closing portion 1111 moves to the open position. Reference numeral 1135 denotes a button for instructing suture, fusion, and incision with respect to the living tissue grasped between the opening / closing part 1111 and the base part 1112. While the operator presses the button 1135, the grasping part 1110 The suturing, fusion and incision operations proceed.

The drive region 1131 includes a mechanism for opening / closing the opening / closing part 1111 in accordance with the operation of the lever 1134, a mechanism for performing stitching, fusion, and incision in the gripping part 1110 in accordance with the operation of the button 1135. Drive unit is built-in. The detailed configuration of the drive unit built in the drive region 1131 will be described later with reference to FIGS. 14A and 14B. However, since the mechanism for opening / closing the opening / closing part 1111 among the mechanisms included in the drive part is a general-purpose technique, FIGS. 14A and 14B will be described with respect to a mechanism for performing suturing, fusion, and incision.

<2. Detailed configuration of gripping part>
Next, the detailed configuration of the grip portion 1110 will be described. 12A and 12B are diagrams for explaining the detailed configuration of the gripping part 1110. 12a shows a perspective view of the state where the opening / closing part 1111 has moved to the closed position, and 12b shows the state where the opening / closing part 1111 has been removed. The perspective view of the base 1112 is shown.

First, the configuration of the base 1112 will be described with reference to 12b. As shown in 12b, the base 1112 has a fusion portion 1210.

The fusion part 1210 has a flat upper surface and a gripping surface 1115 is formed. A groove 1220 is provided in the central region of the fusion part 1210 in the width direction, and a laser output unit (not shown) moves through the groove 1220. Thereby, the living tissue grasped between the fusion part 1210 and the fusion part provided at the position (opening / closing part 1111 side) facing the fusion part 1210 can be fused and incised.

The base portion 1112 further includes

storage portions

1230 and 1232 for storing hollow needles (details will be described later) for inserting a suture thread with a suture needle attached to the tip.

The

storage units

1230 and 1232 are connected to the hollow shaft portion 1120 and store the hollow needle together with the shaft portion 1120. The hollow needles stored in the

storage units

1230 and 1232 move to the outside through the

openings

1231 and 1233, respectively. Then, it moves linearly along the longitudinal direction of the fusion part 1210 in the

spaces

1240 and 1241 provided on the side surfaces of the fusion part 1210.

Note that a space 1242 is provided at the distal end of the fusion unit 1210, and does not interfere with the collection unit 1203 provided at the distal end of the opening / closing unit 1111 when the opening / closing unit 1111 moves to the closed position. Has been.

Next, the configuration of the opening / closing part 1111 will be described with reference to 12a. As described above, the opening / closing portion 1111 is rotatably attached to the base portion 1112 via the rotation shaft 1113, and the central portion 1201 is similar to the position facing the fusion portion 1210 of the base portion 1112. A fusion part (not shown) is provided. In addition, a collection unit 1203 is disposed at the distal end of the opening / closing unit 1111 to hold the suture needle at the distal end of the hollow needle moving in the space 1240 and the space 1241, and to hold the suture thread inserted into the hollow needle. The suture needle is collected by cutting.

<3. Operation in gripping part>
Next, operations for suturing, healing, and incising a living tissue in the grasping portion 1110 will be described. FIG. 13 is a diagram for explaining a configuration in which a living tissue is sutured, fused, and incised in the grip portion 1110.

Among these, 13a is a plan view of the base portion 1112 and the shaft portion 1120 (part) before the operations of suturing, healing, and incising the living tissue are performed. As shown in 13a, the suture member 1300 is housed in the housing portion 1230 and the shaft portion 1120 in a state before the operations of suturing, healing, and incising the living tissue are performed. Similarly, a suture member 1310 is stored in the storage portion 1232 and the shaft portion 1120. Further, a fusion / incision member 1320 is housed in the shaft portion 1120 and between the suture member 1300 and the suture member 1310.

The suture member 1300 includes a spiral hollow needle 1301, and a suture thread 1302 is inserted into the hollow needle 1301. A suture needle 1303 is attached to the distal end of the suture thread 1302, and the suture needle 1303 is exposed from the distal end of the hollow needle 1301. Thereby, the hollow needle 1301 can be easily moved spirally in the living tissue.

Similarly, the suture member 1310 includes a spiral hollow needle 1311, and a suture thread 1312 is inserted into the hollow needle 1311. A suture needle 1313 is attached to the distal end of the suture thread 1312, and the suture needle 1313 is exposed from the distal end of the hollow needle 1311. Thereby, the hollow needle 1311 can be easily moved spirally in the living tissue.

On the other hand, the fusion / incision member 1320 includes a laser output unit 1322 that heals and incises a living tissue by irradiating or contacting with laser light, and a column unit 1321 that moves the laser output unit 1322 to the distal end side along the groove 1220. With.

13b is a plan view of the base portion 1112 and the shaft portion 1120 (a part) in a state after performing operations for suturing, healing, and incising a living tissue. As shown in FIG. 13 b, the

suture members

1300, 1310 and the fusion / incision member 1320 have moved to the distal end position of the base portion 1112 in a state after performing operations for suturing, fusion, and incision of living tissue.

13b, the

suture members

1300 and 1310 move spirally (the spiral

hollow needles

1301 and 1311 move linearly to the distal end side while rotating, respectively), so that the opening / closing portion 1111 and the base portion 1112 A living tissue held between them can be sutured.

Further, the laser output unit 1322 moves in a straight line while irradiating or touching the living tissue with laser light, so that the living tissue held between the opening / closing unit 1111 and the base unit 1112 is fused and incised. Can do.

13c is a view showing the suture member 1300. FIG. As shown in FIG. 13c, the hollow needle 1301 constituting the suturing member 1300 has a helical range in a length range (for example, 50 to 60 mm) substantially equal to the length in the longitudinal direction of the fusion portion 1210. The rear end side of the region has a linear shape. The rear end of the hollow needle 1301 is connected to a drive unit (not shown).

Note that the diameter of the spiral shape of the hollow needle 1301 is approximately 2 mm to 5 mm, and more preferably 3 mm to 4 mm. Further, the helical pitch of the hollow needle 1301 is approximately 2 mm to 6 mm, and more preferably 3 mm to 4 mm. The tube diameter of the hollow needle 1301 is approximately 0.6 mm to 0.8 mm.

<4. Configuration of drive area>
Next, a detailed configuration of the drive region 1131 will be described with reference to FIGS. 14A and 14B. 14A and 14B are diagrams showing a mechanism for suturing, healing, and incising a living tissue in the drive unit of the drive region 1131. FIG. 14A shows an internal configuration when the drive region 1131 is viewed from above. FIG. 14B shows the internal configuration when the drive region 1131 is viewed from the side.

Among these, 141a and 142a show a state before the operation of suturing, healing and incising the living tissue. In 141a, 1401 is a shaft portion, and a hollow needle 1301 is connected to the tip side. A gear 1402 is attached to the rear end side. Similarly, in 141a, 1411 is a shaft portion, and a hollow needle 1311 is connected to the tip side. A gear 1412 is attached to the rear end side.

Here, the gear 1402 and the gear 1412 are engaged with each other. When the shaft 1411 is rotated by the rotation of the motor 1434, the rotational force is transmitted to the shaft 1401 via the gear 1412 and the gear 1402. The As a result, the shaft portion 1401 and the shaft portion 1411 rotate in synchronization (that is, the sewing member 1300 and the sewing member 1310 rotate in synchronization).

Further, as shown in 141a, the shaft portion 1401 is supported by

bearings

1403, 1435, and 1436, and the shaft portion 1411 is supported by

bearings

1413, 1435, and 1436.

Here, the shaft portion 1411 has a screw thread structure and meshes with the bearing 1413. For this reason, when the shaft portion 1411 rotates, the shaft portion 1411 moves to the tip side. When the shaft portion 1411 moves to the tip side, the moving table 1433 to which the motor 1434 to which the shaft portion 1411 is connected and the

bearings

1435 and 1436 that support the shaft portion 1411 are attached moves on the rail 1432 on the tip side. (Refer to 142a in FIG. 14B).

As a result, the shaft portion 1401 supported by the

bearings

1435 and 1436 also moves to the tip side. Further, the support column 1321 whose end is attached to the moving table 1433 also moves to the tip side. That is, the suture member 1300, the suture member 1310, and the fusion / incision member 1320 move in a straight line toward the distal end side in synchronization.

141b and 142b show a state after performing operations of suturing, healing, and incising a living tissue. As shown in FIGS. 141b and 142b, when the shaft 1411 moves to the tip side, the moving table 1433 moves on the rail 1432 to the tip side and reaches a predetermined position. Stop.

In addition, the shaft portion 1411 moves to the rear end side by rotating the motor 1434 in the direction opposite to the rotation direction of the motor 1434 when moving to the front end side. When the shaft portion 1411 moves to the rear end side, the moving table 1433 to which the motor 1434 to which the shaft portion 1411 is connected and the

bearings

1435 and 1436 that support the shaft portion 1411 are attached is moved rearward on the rail 1432. It will move to the end side.

As a result, the shaft portion 1401 supported by the

bearings

1435 and 1436 also moves to the rear end side. Further, the support column 1321 having an end attached to the moving table 1433 also moves to the rear end side. That is, the suturing member 1300, the suturing member 1310, and the fusion / incision member 1320 move in a straight line to the rear end side in synchronization. Note that the movement toward the rear end side is also configured to automatically stop when the moving table 1433 reaches a predetermined position.

<5. Retrieval operation of suture needle>
Next, the collection operation of the suture needle 1303 (the holding operation of the suture needle 1303 and the cutting operation of the suture thread 1302) will be described. FIG. 15 is a view for explaining the holding operation of the suture needle 1303 and the cutting operation of the suture thread 1302. In FIG. 15, the holding operation of the suturing needle 1303 of the suturing member 1300 and the cutting operation of the suturing thread 1302 will be described, but the holding operation of the suturing needle 1313 of the suturing member 1310 and the cutting operation of the suturing thread 1312 are the same.

15a of FIG. 15 shows a state in which the suture member 1300 rotates and moves linearly toward the tip side. The right side of the drawing shows the collection unit 1203 when viewed from the side, and the left side of the drawing shows the collection unit 1203. The case where it sees from the front toward the front end side is each shown.

As shown to 15a, the collection | recovery part 1203 is provided with the opening part 1501, and by moving to the front end side (arrow 1510 direction), the front-end | tip of the suturing member 1300 passes through the opening part 1501 in the collection | recovery part 1203. Is housed.

Needle holding members

1502 and 1503 are arranged in the collection unit 1203, and the suture needle 1303 is held when the distal end of the suture member 1300 is accommodated in the collection unit 1203.

Further, the recovery unit 1203 is provided with a first blade part 1504 and a second blade part 1505, and the suture thread is moved in the horizontal direction along the opening 1501 by a motor (not shown) or the like. 1302 can be cut.

15b shows a state in which the suture needle 1303 at the tip is in contact with the

needle holding members

1502 and 1503 as the suture member 1300 rotates and moves in the direction of the arrow 1510. As the suturing member 1300 further rotates, the suturing needle 1303 is held by the

needle holding members

1502 and 1503.

15c shows a state in which, after the suture needle 1303 is held by the

needle holding members

1502 and 1503, the suture member 1300 is rotated in the reverse direction, thereby moving the hollow needle 1301 to the rear end side (arrow 1511 direction). . 15c, since the suture needle 1303 is held by the

needle holding members

1502 and 1503, even if the suture member 1300 is rotated in the reverse direction and the hollow needle 1301 is moved in the arrow 1511 direction, the suture needle 1303 is It does not move in the 1511 direction. Therefore, the suture thread 1302 also does not move in the direction of the arrow 1511 and remains in the living tissue.

On the other hand, by rotating the suture member 1300 in the reverse direction, the hollow needle 1301 moves in the arrow 1511 direction while rotating in the reverse direction. That is, the suture thread 1302 inserted in the hollow needle 1301 is exposed in the living tissue.

Furthermore, as shown in 15c, as the suture thread 1302 is sequentially exposed from the distal end side, the first blade portion 1504 and the second blade portion 1505 are started to move in the horizontal direction.

15d shows a state in which the suture 1302 is completely exposed in the living tissue and the first blade 1504 and the second blade 1505 are in contact with each other. When the first blade portion 1504 and the second blade portion 1505 come into contact with each other, the suture thread 1302 between the first blade portion 1504 and the second blade portion 1505 is cut.

15e shows a state in which the suture thread 1302 is cut by the first blade portion 1504 and the second blade portion 1505.

As described above, by performing the operations from 15a to 15e in FIG. 15, the suture 1302 can be placed in the living tissue while the suture needle 1303 is recovered.

<6. Examples of suture, fusion and incision of living tissue>
Next, an example in which a part of living tissue (gastrointestinal tract such as stomach and intestine) is sutured, fused, and incised will be described with reference to FIGS. 16A and 16B.

FIG. 16A is a schematic diagram when the grasping unit 1110 performs an operation of grasping a living tissue, suturing, fusion, and incision (when a laser output unit 1322 similar to the laser output 212 shown in FIG. 2A is used). ). Among these, 16a is a sectional view of the

gripping part

1110, and 16b is a side view of the gripping part 1110. FIG. 16B is a schematic diagram when the grasping unit 1110 performs the operations of grasping the living tissue, suturing, fusion, and incision (using the laser output unit 1322 similar to the laser output 212 shown in FIG. 2B). If you have). Among these, 16a is a sectional view of the

gripping part

1110, and 16b is a side view of the gripping part 1110.

16a, the biological tissue 1600 is compressed by being grasped by the grasping surface 1114 of the opening / closing part 1111 and the grasping surface 1115 of the base part 1112 and deformed to a predetermined thickness.

In this state, when the laser output unit 1322 is moved to the distal end side while emitting laser light from the laser output unit 1322, the living tissue 1600 irradiated with or irradiated with the laser light is fused and incised. Specifically, the laser output unit 1322 irradiates or contacts the laser beam to the living tissue 1600 gripped between the gripping surface 1115 of the base portion 1112 and the gripping surface 1114 of the opening / closing portion 1111, so that the laser The living tissue at the light irradiation position is cut open. In addition, living tissues near the irradiation position of the laser light (biological tissues on both sides of the incised position) are fused.

Thereafter, the suture member 1300 and the suture member 1310 are linearly moved to the distal end side while rotating, so that the suture member 1300 and the suture member 1310 advance spirally while penetrating the living tissue 1600 up and down.

At this time, since the laser output unit 1322 also moves to the distal end side, the living tissue 1600 is scanned with the laser light, the living tissue is incised at each irradiation position, and further, the living tissue (incised) in the vicinity of each irradiation position. The biological tissues on both sides of the position) are fused.

Then, when the fusion / incision member 1320 reaches a predetermined position at the tip, the suture needles 1303 and 1313 are held by the collection unit 1203.

Then, when the

hollow needles

1301 and 1311 move to the rear end side, the

sutures

1302 and 1312 are exposed and come into contact with the living tissue. Further, the

sutures

1302 and 1312 are cut in the collection unit 1203, the suture needles 1303 and 1313 are collected in the collection unit 1203, and the

sutures

1302 and 1312 are left in the living tissue (see 16b).

Similarly to the suture thread 215 described with reference to FIG. 8, the

suture threads

1302 and 1303 are provided with

cut portions

811 and 812 and are locked by the living tissue, so that the

suture threads

1302 and 1312 may not come off. Absent.

As is clear from the above description, in the laser surgical apparatus 1100 according to the present embodiment, the

sutures

1302 and 1312 are used in order to reduce fusion failure when a part of the digestive tract such as the stomach and intestine is fused and incised. It was set as the structure which reinforces by sewing.

In particular,
-It was set as the structure which arrange | positions the spiral shaped sewing member and moves the said sewing member linearly, rotating.
-It was set as the structure which collect | recovers in the collection | recovery part the suturing needle used at the time of suturing.
A cut was formed in the peripheral surface of the suture so that the suture used for the suture was locked to the living tissue.
-In order to penetrate the living tissue through the suture with the cut formed therein, the suture was inserted into the hollow needle and moved together with the hollow needle.
-It was set as the structure which implements a stitch | suture, fusion, and incision in parallel by moving a laser output part with the movement of a suturing member.

As a result, the fusion and incision by the laser beam and the reinforcement of the living tissue fused and incised by the laser beam by the suture can be performed in parallel and the suture needle can be collected.

For the same purpose, a configuration of an automatic suturing device using a stapler as a laser-type fusion device is also conceivable, but in this case, the disadvantage that many staplers remain in the body after the operation cannot be avoided.

[Third Embodiment]
In the first embodiment, the incision portion of each incised biological tissue is configured to be fused and sutured. However, the present invention is not limited to this, and one of the incised biological tissues It is good also as a structure which performs fusion | fusion and a stitch | suture about, and performs only fusion about the other. This is because when the affected part is incised in the digestive tract such as the stomach or the intestine, it is not necessary to reinforce the incised part of the affected part to be incised.

FIG. 17 is a view for explaining the configuration of the base 1710 of the laser surgical apparatus according to this embodiment. Of the components shown in FIG. 17, the same components as those described with reference to FIG. 13 in the second embodiment are denoted by the same reference numerals, and the description thereof is omitted here.

The difference from FIG. 13 is that the suturing member 1310 is not provided and the space 1241 in which the suturing member 1310 moves is not provided. Thus, by setting it as the structure which distribute | arranges only one suturing member, it can be set as the structure which performs a fusion | fusion and a suturing about one among the biological tissues to be cut | disconnected, and performs only the union about the other.

In the example of FIG. 17, the suture member 1300 is arranged as one suture member, but the suture member 1310 may be arranged as one suture member.

FIG. 17 shows a modification of the second embodiment, but the first embodiment can be similarly modified.

[Fourth Embodiment]
In the second embodiment, by continuing to press the button 1135, from the fusion and incision of the living tissue to the suturing (movement of the suture member and the fusion / incision member to the distal end side, the collection of the suture needle by the collection unit The suture member and the fusion / incision member are moved continuously to the rear end side), but the present invention is not limited to this.

The movement of the fusion / incision member and the suture member to the distal end side, the collection of the suture needle by the collection unit, and the movement of the fusion / incision member and the suture member to the rear end side are realized by instructions with different operation buttons. It is good also as a structure.

[Fifth Embodiment]
In the third embodiment, only one suture member is provided, but the present invention is not limited to this. For example, after arranging two suturing members, only one suturing member may be operated in accordance with an operator's instruction.

[Sixth Embodiment]
In the first to fifth embodiments, the laser output unit is configured to emit laser light from the bottom to the top. However, the present invention is not limited to this and may be configured to emit from the top to the bottom. Also, two laser output units are provided at opposing positions, and one laser output unit emits laser light from the bottom to the top, and the other laser output unit emits laser light from the top to the bottom. May be.

This is because the time required for fusion and incision can be shortened by irradiating the living tissue with laser light or contact irradiation from above and below.

[Seventh Embodiment]
In the first to sixth embodiments, the collection unit holds the suture needle and cuts the suture. However, the present invention is not limited to this, and a separate jig is provided for cutting the suture. However, you may make it carry out using the said jig. Further, the jig may be configured not only to cut the suture, but also to perform suture knotting (thread fixing).

[Other Embodiments]
The present invention is not limited to the above-described embodiment, and various changes and modifications can be made without departing from the spirit and scope of the present invention. Therefore, in order to make the scope of the present invention public, the following claims are attached.

Claims

A laser surgical apparatus having a gripping part for gripping a biological tissue, and healing and incising the biological tissue gripped by the gripping part,
By irradiating the living tissue grasped by the grasping portion with the laser beam while moving linearly, the living tissue at the irradiation position of the laser light is incised, and the living tissue near the irradiation position of the laser light is removed. A laser output unit to unite,
A hollow needle that moves so as to penetrate through the living tissue in synchronization with the movement of the laser output unit, wherein the suture thread is inserted, and the suture needle attached to the distal end of the suture thread A hollow needle arranged to be exposed on the side;
A laser surgical apparatus, comprising: a collection unit that holds the suture needle disposed on a distal end side of the hollow needle moved in synchronization with the movement of the laser output unit.
The said collection | recovery part hold | maintains the said suture needle distribute | arranged to the front end side of the said hollow needle moved in synchronization with the said laser output part moving, and cut | disconnects the said suture thread. 2. The laser surgical apparatus according to 1.
The gripping part is
A flat gripping surface for gripping the living tissue in the vicinity of the irradiation position;
The laser surgical apparatus according to claim 1, further comprising: a grasping surface that grasps a living tissue near a position where the hollow needle moves, and a convex portion and a concave portion are continuous.
Two hollow needles are arranged substantially in parallel,
The laser surgical apparatus according to claim 3, wherein the laser output unit is disposed between the two hollow needles.
With the linear movement toward the distal end side of the hollow needle, the suture needle and the suture thread penetrate through the living tissue,
The laser surgical apparatus according to claim 4, wherein the hollow needle is pulled out from the living tissue with a linear movement toward the rear end side of the hollow needle.
The hollow needle has a part on the tip side formed in a spiral shape,
The laser surgical apparatus according to claim 1, wherein the hollow needle moves linearly toward the distal end side while rotating.
As the hollow needle rotates, the suture needle and the suture thread penetrate through the living tissue as the needle moves linearly toward the distal end.
The hollow needle is pulled out from the living tissue as it is linearly moved to the rear end side while rotating in a rotation direction opposite to the rotation direction when moved to the distal end side. The laser surgical apparatus according to claim 6.
Two hollow needles are arranged substantially in parallel,
The laser surgical apparatus according to claim 7, wherein the laser output unit is disposed between the two hollow needles.
The laser surgical apparatus according to claim 2, wherein a plurality of cut portions having different cut directions are provided on a peripheral surface of the suture thread.