WO2023204233A1

WO2023204233A1 - Blood vessel extraction device

Info

Publication number: WO2023204233A1
Application number: PCT/JP2023/015553
Authority: WO
Inventors: 山木勇作; 藤井達徳
Original assignee: テルモ株式会社; テルモカーディオバスキュラーシステムズコーポレイション
Priority date: 2022-04-21
Filing date: 2023-04-19
Publication date: 2023-10-26

Abstract

A blood vessel extraction device (24) comprises: a tubular body (24a); a jaw structure (26) which is provided to a tip end of the tubular body (24a) and in which an upper jaw part (40) and a lower jaw part (50) open and close; and a cutter blade (34) which moves along cutter grooves (49) of the upper jaw part (40) and the lower jaw part (50). The jaw structure (26) has a pair of grasping surfaces (41) that are formed in portions of the upper jaw part (40) and the lower jaw part (50) which face each other in a closed state, and planar electrodes (48) that are respectively formed on the pair of grasping surfaces (41). The cutter grooves (49) are formed so as to pass through the planar electrodes (48) and have an insulating body that separates the planar electrodes (48) and the cutter blade (34).

Description

blood vessel sampling device

The present invention relates to a blood vessel collection device.

In coronary artery bypass surgery (CABG), blood vessels taken from a patient are connected so as to bypass the lesion site. The blood vessel used is collected, for example, from the lower limb of the patient. An endoscopic blood vessel harvesting system (EVH system) is used to harvest blood vessels.

The endoscopic blood vessel collection system includes an endoscope system, a pneumoperitoneum device, a blood vessel dissection device, and a blood vessel collection device. To collect a blood vessel, a blood vessel dissection device is advanced along the blood vessel while supplying carbon dioxide gas with an insufflation device, and the blood vessel is dissected from surrounding fat tissue. Thereafter, a blood vessel sampling device is used to cut the branch blood vessels branching from the blood vessel while stopping the bleeding. Branch blood vessels are cut while being observed with an endoscope. Thereafter, the blood vessel collection device is pulled out and the blood vessel is pulled out from the incision, thereby completing the collection of the blood vessel.

For example, Japanese Patent Application Publication No. 2011-229923 discloses an apparatus that cuts tissue under observation with an endoscope.

The device disclosed in Japanese Unexamined Patent Publication No. 2011-229923 has electrodes on the clamping surfaces of the jaw structure that clamps tissue. The electrode stops bleeding in the tissue by heating the tissue with electricity. A cutter groove through which a cutter blade passes is formed on the holding surface. In such devices, tissue that has been hemostatically heated by an electrode is cut by a cutter blade.

In the device disclosed in JP-A-2011-229923, the cutter blade can come into contact with the electrode. Therefore, when applying electricity between the electrodes, it is necessary to retract the cutter blade toward the proximal end side of the cutter groove in order to prevent a short circuit. However, in the process of performing a blood vessel cutting procedure, when a blood vessel is cut with a cutter blade, bleeding may occur due to insufficient hemostasis. In such a case, the device of Patent Document 1 cannot immediately energize, and requires an operation to retract the cutter blade toward the proximal end.

The present invention aims to solve the above problems.

One aspect of the following disclosure includes a cylindrical body extending along an axis, an upper jaw part and a lower jaw part attached to the tip of the cylindrical body, and the upper jaw part and the lower jaw part open and close. a jaw structure; a cutter blade disposed between the upper jaw part and the lower jaw part and moving in the direction of the axis along cutter grooves of the upper jaw part and the lower jaw part, the jaw structure; The cutter groove includes a pair of clamping surfaces formed at portions where the upper jaw part and the lower jaw part face each other in a closed state, and a flat electrode formed on each of the pair of clamping surfaces, and the cutter groove includes: The cutter groove is formed to penetrate through the planar electrode, and the width of the cutter groove of at least one of the planar electrodes is larger than the thickness of the cutter blade, and the insulator separating the planar electrode and the cutter blade is formed in the cutter groove. in a blood vessel harvesting device.

Another aspect of the present invention is a jaw structure that includes a cylindrical body extending along an axis, and an upper jaw part and a lower jaw part that are attached to the tip of the cylindrical body, and the upper jaw part and the lower jaw part open and close. and a cutter blade disposed between the upper jaw part and the lower jaw part, the cutter blade moving in the direction of the axis along the cutter grooves of the upper jaw part and the lower jaw part, and the jaw structure has a closed jaw structure. a pair of clamping surfaces formed at portions where the upper jaw part and the lower jaw part face each other in the state, and a flat electrode formed on each of the pair of clamping surfaces; A spacer is formed to pass through the electrode and is made of an insulating material and covers the inside of the cutter groove that passes through the planar electrode of either the upper jaw part or the lower jaw part, and the spacer is made of an insulating material. It has an insulated cutter groove through which the blade is inserted and is insulated from the planar electrode, and the width of the insulated cutter groove is equal to the width of the cutter groove that passes through the planar electrode of either the upper jaw part or the lower jaw part. Narrower than the width, located on the blood vessel harvesting device.

In the blood vessel collection device according to the above aspect, since the width of the cutter groove is larger than the thickness of the cutter blade, the cutter blade and the planar electrode can be separated and insulated. Therefore, the blood vessel sampling device can perform electrical heating with the cutter blade protruding into the cutter groove. This blood vessel sampling device is excellent in operability because, when bleeding is observed when cutting tissue with a cutter blade, the current supply can be immediately restarted to stop the bleeding.

FIG. 1 is a configuration diagram of a blood vessel collection system according to an embodiment. 2A is a side view of the vicinity of the distal end of the blood vessel sampling device of FIG. 1, and FIG. 2B is a perspective view of the jaw structure of FIG. 2A viewed from the distal end side. 3A is a plan view of the upper jaw portion of FIG. 2A viewed from the clamping surface, and FIG. 3B is an exploded perspective view of the lower jaw portion of FIG. 2A. FIG. 4A is an explanatory diagram showing the protruding operation of the cutter blade with the upper jaw part of FIG. 2A removed, and FIG. 4B is a side view of the jaw structure of FIG. 2A in a closed state. FIG. 5A is an explanatory diagram of the marking step of the blood vessel collection method, and FIG. 5B is an explanatory diagram of the step of dissecting the blood vessel with a blood vessel dissection device. FIG. 6 is an explanatory diagram of the process of collecting a blood vessel with the blood vessel collection device of FIG. 1.

The blood vessel harvesting system 10 shown in FIG. 1 is an EVH system used for EVH (Endoscopic Vessel Harvesting). The blood vessel collection system 10 includes a display device 12, a high-frequency power source 14, a pneumoperitoneum device 16, a trocar 18, an imaging device 20 (endoscope), a blood vessel dissection device 22, and a blood vessel collection device 24. . Of these, the display device 12 is connected to the imaging device 20. The display device 12 displays images captured by the imaging device 20. High frequency power supply 14 supplies high frequency power to blood vessel collection device 24 to ablate tissue (blood vessel 90 or branch blood vessel 96). The pneumoperitoneum device 16 supplies carbon dioxide gas to the blood vessel ablation device 22 . The imaging device 20 includes a cylindrical body 20a and a camera 20b attached to the tip of the cylindrical body 20a. The imaging device 20 is inserted into a patient's body together with a blood vessel dissection device 22 or a blood vessel harvesting device 24 to image the work site.

The trocar 18 is inserted into the incision near the blood vessel 90. Trocar 18 facilitates the introduction of imaging device 20, vessel ablation device 22, and vessel harvesting device 24 into the body. The trocar 18 is fixed to the skin by a clip 18a.

The blood vessel ablation device 22 includes a cylindrical body 22a and a conical ablation portion 22b attached to the tip of the cylindrical body 22a. The cylindrical body 22a has an ejection hole 22c near its tip for releasing carbon dioxide gas. The blood vessel dissection device 22 dissects the blood vessel 90 and the peripheral tissue 92 around it at the dissection portion 22b. The blood vessel ablation device 22 forms a cavity 94 around the blood vessel 90 by carbon dioxide ejected from the ejection hole 22c (see FIG. 5B).

The blood vessel sampling device 24 of this embodiment includes a cylindrical body 24a and a jaw structure 26 attached to the tip of the cylindrical body 24a. The cylindrical body 24a is a cylindrical member extending in the direction of the axis, and has wiring (not shown) for flowing high-frequency power therein and an operating wire (not shown) or an operating rod (not shown) for operating the jaw structure 26. accommodate.

The blood vessel harvesting device 24 cuts the branch blood vessel 96 of the blood vessel 90 separated by the jaw structure 26. The jaw structure 26 has a function of cutting the branch blood vessel 96 by ablating the branch blood vessel 96 using high-frequency power to stop bleeding. Details of the jaw structure 26 will be explained later.

The blood vessel sampling device 24 has a manipulation hub 28 at its proximal end. The operation hub 28 has a cutter operation section 28a, a jaw operation section 28b, and an energization switch 28c. The cutter operation section 28a performs a movement operation of the cutter blade 34 in the axial direction, which will be described later. The jaw operating section 28b opens and closes the jaw structure 26. The energization switch 28c switches between supplying and stopping high-frequency power to the jaw structure 26. In detail, the jaw structure 26 has the following configuration.

As shown in FIG. 2A, the jaw structure 26 is attached to the tip of the cylindrical body 24a. As shown in FIG. 2B, the cylindrical body 24a has a pair of notched grooves 24b, which are partially cut out in the circumferential direction, at the distal end thereof. The pair of notch grooves 24b are arranged 180 degrees apart in the circumferential direction. Each notch groove 24b extends in the direction of the axis. The jaw structure 26 is accommodated in the notch groove 24b.

The cylindrical body 24a has a pair of support portions 24c extending toward the tip between the pair of guide grooves 24d. The support portion 24c supports the jaw structure 26. The support portion 24c has a guide groove 24d and an opening/closing pin attachment hole 24e. The guide groove 24d is located on the tip side of the opening/closing pin attachment hole 24e. The guide groove 24d extends in the direction of the axis. The opening/closing pin attachment hole 24e has a circular shape. The center positions of the guide groove 24d and the opening/closing pin mounting hole 24e are offset by 90 degrees in the circumferential direction of the cylindrical body 24a with respect to the center of the notch groove 24b.

As shown in FIG. 2B, the jaw structure 26 includes an upper jaw assembly 30, a lower jaw assembly 32, and a cutter blade 34. The upper jaw assembly 30 and the lower jaw assembly 32 are connected via a shaft pin 36 and an opening/closing pin 38. Axial pin 36 is fixed to upper jaw assembly 30 and lower jaw assembly 32. Axial pin 36 provides a center of rotation for upper jaw assembly 30 and lower jaw assembly 32. The shaft pin 36 is inserted into the guide groove 24d of the cylindrical body 24a. The guide groove 24d is a groove extending in the axial direction, and allows the shaft pin 36 to move in the axial direction. The shaft pin 36 moves in the guide groove 24d as the jaw structure 26 is displaced in the axial direction.

The opening/closing pin 38 is a pin fixed to the cylindrical body 24a. The opening/closing pin 38 is displaced relative to the upper jaw assembly 30 and the lower jaw assembly 32 as the jaw structure 26 is displaced in the axial direction. As shown in FIG. 2B, the opening/closing pin 38 is inserted into the first sliding groove 30a of the upper jaw assembly 30 and the second sliding groove 32a of the lower jaw assembly 32. The opening/closing pin 38 slides in the first sliding groove 30a and the second sliding groove 32a when the jaw structure 26 moves forward or backward in the direction of the axis of the cylindrical body 24a. The upper jaw assembly 30 and the lower jaw assembly 32 rotate according to the position of the opening/closing pin 38 in the first sliding groove 30a and the second sliding groove 32a, and the jaw structure 26 opens and closes.

As shown in FIG. 2A, the upper jaw assembly 30 has an upper jaw portion 40 and a base portion 42. The upper jaw part 40 has a clamping surface 41 located on the distal end side and perpendicular to the rotation direction. The base portion 42 is located on the base end side of the upper jaw portion 40 and is integrally connected to the upper jaw portion 40. The base 42 has a flat sliding surface 42a in a direction perpendicular to the clamping surface 41. The sliding surface 42a has a shaft hole 42c and a first sliding groove 30a. The shaft pin 36 is inserted through the shaft hole 42c. The shaft hole 42c becomes the rotation center of the upper jaw assembly 30. The first sliding groove 30a extends obliquely with respect to the direction of the axis. The opening/closing pin 38 passes through the first sliding groove 30a.

As shown in FIG. 2A, the upper jaw part 40 has a support body 44, a main body part 46, and a flat electrode 48. As shown in FIG. 2B, the support 44 is integrally connected to the base 42 and is made of the same material (for example, metal) as the base 42. The support body 44 supports the main body portion 46 . The main body portion 46 is formed of an insulating material such as resin. The main body portion 46 occupies most of the upper jaw portion 40. As shown in FIG. 3A, the main body portion 46 extends slightly inclined with respect to the direction of the axis.

As shown in FIG. 3A, the upper jaw part 40 has a first side surface 43a in a first direction perpendicular to the axis, and has a second side surface 43b in a second direction opposite to the first direction. The centerline of the main body portion 46 is inclined toward the first direction with respect to the axis of the cylindrical body 24a. The first side surface 43 a has a gently arcuate curved surface 45 a that is convex with respect to the cutter groove 49 . The curved surface 45a of the first side surface 43a has a top portion 45b closest to the cutter groove 49 at the base end. The second side surface 43b extends parallel to the cutter groove 49 (in the direction of the axis of the cylindrical body 24a).

The main body portion 46 has a distal end portion 46c that protrudes beyond the support body 44 at its distal end. The tip portion 46c has a first inclined surface 47a and a second inclined surface 47b that are inclined with respect to the direction of the axis, and a ridgeline portion 47c. The first inclined surface 47a is a surface inclined toward the first direction, and is adjacent to the first side surface 43a. The second inclined surface 47b is a surface inclined toward the second direction, and is adjacent to the second side surface 43b. The ridgeline portion 47c is formed as a side where the first inclined surface 47a and the second inclined surface 47b intersect. The ridgeline portion 47c is located at the tip of the upper jaw assembly 30 and extends in a direction perpendicular to the clamping surface 41.

As shown in FIG. 3A, the first inclined surface 47a and the second inclined surface 47b intersect at an acute angle at the ridge line portion 47c. Such a ridgeline portion 47c can suitably separate the blood vessel 90 and the surrounding tissue 92. In the upper jaw part 40, the position of the ridgeline part 47c at the tip is spaced apart from the direction of the axis toward the first direction. In the upper jaw part 40 of this embodiment, the position of the ridge line part 47c is close to the position of the first side surface 43a, so that the visibility of the position where the peeling operation is performed is improved.

As shown in FIG. 3A, the upper jaw part 40 has a clamping surface 41 facing the lower jaw part 50. The clamping surface 41 of the upper jaw part 40 has a flat electrode 48 . The plane electrode 48 is made of a plate-shaped metal plate attached to the main body 46 . The surface of the planar electrode 48 constitutes the clamping surface 41 .

The clamping surface 41 of the upper jaw part 40 has an upper cutter groove 49a extending along the axis. The upper cutter groove 49a penetrates the planar electrode 48 and reaches the inside of the main body portion 46. The width (dimensions in the first and second directions) of the upper cutter groove 49a is larger than the thickness of the cutter blade 34. The upper cutter groove 49a extends along the axis of the cylindrical body 24a when the jaw structure 26 is closed. The upper cutter groove 49a guides the movement of the cutter blade 34 in the axial direction. In the following description, the term cutter groove 49 will be used to collectively refer to the upper cutter groove 49a, the lower cutter groove 49b, and the insulating cutter groove 49c.

As shown in FIGS. 2B and 3B, the lower jaw assembly 32 includes a lower jaw portion 50 and a base portion 52. The lower jaw part 50 is located on the distal end side of the base part 52 and has a clamping surface 41 facing the upper jaw part 40 . The base portion 52 is located on the base end side of the lower jaw portion 50 and is integrally connected to the lower jaw portion 50. The base 52 has a flat sliding surface 52a in a direction perpendicular to the clamping surface 41. The sliding surface 52a slides on the sliding surface 42a of the upper jaw assembly 30. The base 52 has a shaft hole 52c and a second sliding groove 32a. The shaft pin 36 is inserted through the shaft hole 52c. The shaft hole 52c becomes the rotation center of the lower jaw assembly 32. The second sliding groove 32a extends obliquely in the opposite direction to the first sliding groove 30a. The opening/closing pin 38 passes through the second sliding groove 32a.

As shown in FIG. 3B, the lower jaw portion 50 includes a support body 44, a main body portion 46, a flat electrode 48, a lower cutter groove 49b, and a spacer 60. Since the lower jaw part 50 has a vertically symmetrical shape with respect to the upper jaw part 40, a detailed description of its shape will be omitted. In the lower jaw part 50, the same components as in the upper jaw part 40 are given the same reference numerals. The lower jaw portion 50 is formed on the flat electrode 48 and has a lower cutter groove 49b. The lower cutter groove 49b extends in the direction of the axis. The lower cutter groove 49b penetrates the flat electrode 48 of the lower jaw portion 50 in the thickness direction. The width of the lower cutter groove 49b is larger than the width of the upper cutter groove 49a. Therefore, the lower cutter groove 49b forms a gap with the cutter blade 34, and enables electrical insulation between the cutter blade 34 and the flat electrode 48 of the lower jaw portion 50.

The spacer 60 is arranged inside the lower cutter groove 49b and covers the inside of the lower cutter groove 49b. The spacer 60 has a pair of side wall portions 60a that protrude from the main body portion 46. The spacer 60 has an insulating cutter groove 49c between a pair of side wall portions 60a. As shown in FIG. 4A, the insulating cutter groove 49c extends in the axial direction and guides the movement of the cutter blade 34 in the axial direction. The width of the insulating cutter groove 49c is the same as or slightly larger than the thickness (dimension in the width direction) of the cutter blade 34. Spacer 60 is disposed between cutter blade 34 and planar electrode 48 of mandible 50 to insulate cutter blade 34 from planar electrode 48 of mandible 50 .

The width of the insulating cutter groove 49c is narrower than the width of the upper cutter groove 49a. Such an insulating cutter groove 49c restricts displacement of the cutter blade 34 in the width direction when the cutter blade 34 slides along the insulating cutter groove 49c and the upper cutter groove 49a. Therefore, the insulating cutter groove 49c prevents the cutter blade 34 from coming into contact with the upper cutter groove 49a. Therefore, the cutter blade 34 is kept separated from the planar electrode 48 forming the upper cutter groove 49a, and the cutter blade 34 can be insulated from the planar electrode 48.

As shown in FIG. 3B, the height of the pair of side walls 60a of the spacer 60 protruding from the main body 46 is set to a value greater than the thickness of the flat electrode 48. In a state where the flat electrode 48 is assembled to the main body part 46 of the lower jaw part 50, the spacer 60 protrudes above the flat electrode 48. As shown in FIG. 4B, when the jaw structure 26 is in the closed state, the spacer 60 prevents the planar electrodes 48 of the upper jaw 40 from contacting the planar electrodes 48 of the lower jaw 50.

As shown in FIG. 2B, the upper jaw assembly 30 and the lower jaw assembly 32 are rotatably connected at their

respective bases

42 and 52 by a shaft pin 36 and an opening/closing pin 38. As shown in FIG. 2B, a cutter blade 34 is disposed between the base 42 of the upper jaw assembly 30 and the base 52 of the lower jaw assembly 32. The jaw structure 26 is movable in the axial direction with respect to the cylindrical body 24a. When the jaw structure 26 is located on the proximal side, the jaw structure 26 opens and the upper jaw portion 40 and the lower jaw portion 50 are separated, as shown in FIG. 2A. Displacing the jaw structure 26 axially to the distal end causes the jaw structure 26 to close, as shown in FIG. 4B. Movement of the jaw structure 26 is effected by the jaw operating portion 28b of the operating hub 28 in FIG.

As shown in FIG. 4B, when the jaw structure 26 is in the closed state, the clamping surface 41 of the upper jaw part 40 and the clamping surface 41 of the lower jaw part 50 come into contact with each other via the spacer 60. The spacer 60 prevents short circuit between the planar electrode 48 of the upper jaw part 40 and the plane electrode 48 of the lower jaw part 50. Note that the clamping surface 41 of the upper jaw part 40 and the clamping surface 41 of the lower jaw part 50 may have an inclination angle such that the gap becomes wider toward the base end side. In this case, when the upper jaw part 40 and the lower jaw part 50 are brought into strong contact, the clamping surfaces 41 are aligned substantially parallel to each other.

As shown in FIG. 4A, the cutter blade 34 extends in the direction of the axis of the cylindrical body 24a. The cutter blade 34 protrudes toward the tip in the axial direction by the cutter operation portion 28a of the operation hub 28 shown in FIG. 1 while sliding in the upper cutter groove 49a and the insulating cutter groove 49c. The cutter blade 34 is biased toward the proximal end, and is located at the proximal end in an initial state, as shown in FIG. 2B. When the cutter blade 34 is projected with the jaw structure 26 closed, the cutter blade 34 is displaced toward the tip, as shown in FIG. 4A. The cutter blade 34 cuts the branch blood vessel 96 or blood vessel 90 sandwiched between the jaw structures 26 .

The blood vessel sampling device 24 of this embodiment is configured as described above. The blood vessel sampling system 10 is used, for example, in the following blood vessel sampling method.

The blood vessel collection method includes a marking step, as shown in FIG. 5A. This process includes the step of confirming the position of the saphenous vein on the shin and the step of making a marking of approximately 2.5 cm at the lower part of the knee joint.

Next, the blood vessel sampling method proceeds to the step of inserting the trocar 18. In this step, an incision is made at the marked location, and then the trocar 18 is inserted. The trocar 18 is fixed to the skin by a clip 18a.

Next, the blood vessel collection method proceeds to a blood vessel dissection step, as shown in FIG. 5B. In this step, a blood vessel ablation device 22 and an imaging device 20 are inserted through the trocar 18. This step includes an operation of peeling off the surrounding tissue 92 from the blood vessel 90 with the peeling section 22b while imaging the blood vessel 90 with the imaging device 20. The blood vessel 90 is ablated by the blood vessel ablation device 22 while ejecting carbon dioxide gas from the ejection hole 22c near the ablation portion 22b. This step forms a cavity around the blood vessel 90. After a predetermined range of the blood vessel 90 has been ablated from the surrounding tissue 92, the blood vessel ablation device 22 and the imaging device 20 are removed from the body.

Next, the blood vessel sampling method proceeds to a blood vessel sampling step, as shown in FIG. The blood vessel sampling step is performed using the blood vessel sampling device 24. This step includes cutting the branch blood vessel 96 with the blood vessel harvesting device 24. Blood vessel harvesting device 24 and imaging device 20 are inserted into a cavity around blood vessel 90 through trocar 18 . The imaging device 20 is disposed on the proximal side of the blood vessel sampling device 24 and images the jaw structure 26 of the blood vessel sampling device 24 from the proximal side.

Cutting the branch blood vessel 96 using the blood vessel collection device 24 is performed by the following steps. First, a step of placing the jaw structure 26 in an open state at the position of the branch blood vessel 96 is performed while observing with the imaging device 20. Thereafter, a step is performed in which the jaw structure 26 is closed and the branch blood vessel 96 is sandwiched between the upper jaw part 40 and the lower jaw part 50. A step of supplying high frequency power to the blood vessel sampling device 24 is then performed. High frequency power is supplied between the flat electrode 48 of the upper jaw 40 and the flat electrode 48 of the lower jaw 50 to ablate the pinched branch blood vessel 96 and stop bleeding. Next, the step of cutting the branch blood vessel 96 is performed by advancing the cutter blade 34 along the cutter groove 49.

Thereafter, an operation is performed in which the blood vessel collection device 24 is further advanced to cut another branch blood vessel 96. In the blood vessel sampling device 24 of this embodiment, when the jaw structure 26 is closed, a ridgeline portion 47c appears at the tip. Therefore, in the blood vessel harvesting process, if a part of the blood vessel 90 is found where the surrounding tissue 92 is not sufficiently peeled off, the surrounding tissue 92 can be peeled off using the ridge line portion 47c.

The step of cutting the branch blood vessel 96 includes an operation of sandwiching it between the upper jaw part 40 and the lower jaw part 50 of the jaw structure 26. By this operation, the branch blood vessel 96 is clamped between the pair of clamping surfaces 41 of the jaw structure 26. The spacer 60 protruding from the clamping surface 41 can reliably clamp even the thin branch blood vessel 96. Thereafter, an operation is performed to flow high frequency power between the flat electrode 48 of the upper jaw part 40 and the flat electrode 48 of the lower jaw part 50. The branch blood vessels 96 between the planar electrodes 48 are ablated by the high frequency power to stop bleeding.

Thereafter, the supply of high-frequency power to the jaw structure 26 is stopped, and the cutter blade 34 is advanced to cut the branch blood vessel 96. This intersection causes the branch blood vessel 96 to be severed. At that time, if the hemostasis of the branch blood vessel 96 is insufficient, bleeding may occur. In the blood vessel sampling method using the blood vessel sampling device 24 of this embodiment, when such bleeding is observed, an operation is performed to immediately restart the supply of high-frequency power. Since the cutter blade 34 is insulated from the flat electrode 48 of the mandibular portion 50 by the spacer 60, even if the cutter blade 34 is located in the cutter groove 49, the branch blood vessel 96 can be ablated with high frequency power. In this manner, the blood vessel sampling device 24 of this embodiment can perform hemostasis on the branch blood vessel 96 using high-frequency power while minimizing bleeding.

Thereafter, after the desired range of branch blood vessels 96 and blood vessels 90 have been cut, the blood vessel collection device 24 and the imaging device 20 are pulled out of the patient's body. Thereafter, the blood vessel collection method is completed by pulling out the blood vessel 90 from the incision.

The blood vessel sampling device 24 of this embodiment described above is summarized below.

One aspect of the invention is to have a cylindrical body 24a extending along the axis, and a jaw that is attached to the tip of the cylindrical body and includes an upper jaw part 40 and a lower jaw part 50, and the upper jaw part and the lower jaw part open and close. a structure 26; a cutter blade 34 disposed between the upper jaw part and the lower jaw part and moving in the direction of the axis along a cutter groove 49 of the upper jaw part and the lower jaw part; has a pair of clamping surfaces 41 formed at portions where the upper jaw part and the lower jaw part face each other in a closed state, and a flat electrode 48 formed on each of the pair of clamping surfaces, The cutter groove is formed to penetrate the planar electrode, and the width of the cutter groove of at least one of the planar electrodes is larger than the thickness of the cutter blade, and the cutter groove is an insulator separating the planar electrode and the cutter blade. The blood vessel harvesting device 24 has a cutter groove in the cutter groove.

In the above blood vessel sampling device, since the width of the cutter groove is larger than the thickness of the cutter blade, the cutter blade and the planar electrode can be separated and insulated. Therefore, the blood vessel sampling device can perform electrical heating with the cutter blade protruding into the cutter groove. This blood vessel sampling device is excellent in operability because, when bleeding is observed when cutting tissue with a cutter blade, the current supply can be immediately restarted to stop the bleeding.

The blood vessel sampling device described above may include a spacer 60 made of an insulating material and covering the inside of the cutter groove that passes through the flat electrode of at least one of the upper jaw and the lower jaw. In the above-described blood vessel sampling device, the spacer can prevent the pair of planar electrodes from shorting through the cutter blade, and even when the cutter blade is located in the cutter groove, high-frequency power can be applied to the planar electrode.

In the above-mentioned blood vessel collection device, the spacer has a pair of side wall portions 60a that protrude from the surface of the planar electrode and prevent a short circuit between the planar electrode of the upper jaw portion and the planar electrode of the lower jaw portion. Good too.

In the blood vessel sampling device described above, the spacer has an insulated cutter groove 49c between the pair of sidewall portions, through which the cutter blade is inserted, and the width of the insulated cutter groove extends through the planar electrode. The width may be narrower than the width of the cutter groove. In this blood vessel collection device, the cutter blade can be insulated from the flat electrode through the insulating cutter groove, so high-frequency power can be applied even when the cutter blade is protruded.

In the blood vessel sampling device described above, the clamping surface of the upper jaw and the clamping surface of the lower jaw may abut with each other via the spacer. In this blood vessel sampling device, the spacer can prevent a short circuit between the flat electrode on the upper jaw and the flat electrode on the lower jaw.

Another aspect of the present invention is a jaw structure that includes a cylindrical body extending along an axis, and an upper jaw part and a lower jaw part that are attached to the tip of the cylindrical body, and the upper jaw part and the lower jaw part open and close. and a cutter blade disposed between the upper jaw part and the lower jaw part, the cutter blade moving in the direction of the axis along the cutter grooves of the upper jaw part and the lower jaw part, and the jaw structure has a closed jaw structure. a pair of clamping surfaces formed at portions where the upper jaw part and the lower jaw part face each other in the state, and a flat electrode formed on each of the pair of clamping surfaces; A spacer is formed to pass through the electrode and is made of an insulating material and covers the inside of the cutter groove that passes through the planar electrode of either the upper jaw part or the lower jaw part, and the spacer is made of an insulating material. It has an insulated cutter groove 49c into which the blade is inserted and is insulated from the planar electrode, and the width of the insulated cutter groove is equal to the width of the cutter groove that passes through the planar electrode of either the upper jaw part or the lower jaw part. narrower than the width of the vessel sampling device.

In the blood vessel sampling device described above, when the cutter blade slides in the cutter groove, displacement of the cutter blade in the width direction can be regulated by the insulating cutter groove. Therefore, the blood vessel sampling device can separate and insulate the cutter blade and the planar electrode.

Note that the present invention is not limited to the embodiments described above, and can take various configurations without departing from the gist of the present invention.

Claims

a cylindrical body extending along the axis;
a jaw structure that is attached to the tip of the cylindrical body and has an upper jaw part and a lower jaw part, and the upper jaw part and the lower jaw part open and close;
a cutter blade disposed between the upper jaw part and the lower jaw part, the cutter blade moving in the direction of the axis along the cutter groove of the upper jaw part and the lower jaw part;
The jaw structure includes:
a pair of clamping surfaces formed at portions where the upper jaw part and the lower jaw part face each other in a closed state;
a flat electrode formed on each of the pair of sandwiching surfaces;
The cutter groove is formed to penetrate through the planar electrode, and the width of the cutter groove of at least one of the planar electrodes is larger than the thickness of the cutter blade, and the cutter groove is provided with an insulator separating the planar electrode and the cutter blade. A blood vessel harvesting device having a body in the cutter groove.
The blood vessel sampling device according to claim 1, further comprising a spacer made of an insulating material and covering the inside of the cutter groove passing through the planar electrode of at least one of the upper jaw and the lower jaw.
3. The blood vessel sampling device according to claim 2, wherein the spacer includes a pair of side wall portions that protrude from the surface of the planar electrode and prevent a short circuit between the planar electrode of the upper jaw and the planar electrode of the lower jaw. A blood vessel collection device having:
4. The blood vessel sampling device according to claim 3, wherein the spacer has an insulated insulating cutter groove through which the cutter blade is inserted between the pair of side walls, and the width of the insulated cutter groove is equal to or smaller than the flat surface. A blood vessel harvesting device that is narrower than the width of the cutter groove passing through the electrode.
The blood vessel sampling device according to any one of claims 2 to 4, wherein the clamping surface of the upper jaw and the clamping surface of the lower jaw are in contact with each other via the spacer. .
a cylindrical body extending along the axis;
a jaw structure that is attached to the tip of the cylindrical body and has an upper jaw part and a lower jaw part, and the upper jaw part and the lower jaw part open and close;
a cutter blade disposed between the upper jaw part and the lower jaw part, the cutter blade moving in the direction of the axis along the cutter groove of the upper jaw part and the lower jaw part;
The jaw structure includes:
a pair of clamping surfaces formed at portions where the upper jaw part and the lower jaw part face each other in a closed state;
a flat electrode formed on each of the pair of sandwiching surfaces;
The cutter groove is formed to penetrate the planar electrode,
a spacer made of an insulating material that covers the inside of the cutter groove that passes through the flat electrode of either the upper jaw part or the lower jaw part;
The spacer has an insulating cutter groove through which the cutter blade is inserted and is insulated from the planar electrode,
A blood vessel sampling device, wherein the width of the insulating cutter groove is narrower than the width of the cutter groove passing through the planar electrode of either the upper jaw portion or the lower jaw portion.