CN101516276A - 改进的超声外科手术器具 - Google Patents

改进的超声外科手术器具 Download PDF

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CN101516276A
CN101516276A CNA2007800345236A CN200780034523A CN101516276A CN 101516276 A CN101516276 A CN 101516276A CN A2007800345236 A CNA2007800345236 A CN A2007800345236A CN 200780034523 A CN200780034523 A CN 200780034523A CN 101516276 A CN101516276 A CN 101516276A
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waveguide
output device
extension component
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CN101516276B (zh
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迈克尔·约翰·拉德利·扬
斯蒂芬·迈克尔·拉德利·扬
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/22004—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves
    • A61B2017/22005—Effects, e.g. on tissue
    • A61B2017/22007—Cavitation or pseudocavitation, i.e. creation of gas bubbles generating a secondary shock wave when collapsing
    • A61B2017/22008—Cavitation or pseudocavitation, i.e. creation of gas bubbles generating a secondary shock wave when collapsing used or promoted
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320069—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic for ablating tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320072—Working tips with special features, e.g. extending parts
    • A61B2017/320078—Tissue manipulating surface
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320082—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic for incising tissue

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  • Surgery (AREA)
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  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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Abstract

构成的输出装置被用于可以扭振形式振动的超声手术器具。该输出装置具有基本上呈圆柱状的第一波导(1)，该第一波导在远端具有直径减小的第二波导延伸部件(3)。第二波导(3)从第一波导的轴线在一个平面中弯曲。其具有至少两个从其远端径向延伸的刀片面(4)。

Description

改进的超声外科手术器具
本发明涉及一种用于可扭转振动的超声手术器具的改进波导输出装置，具体地但不排他地，如从英国专利2333709B已知的器具。
上述专利记载了一种手术器具，其包括用于生成超声扭振形式振动的装置，和波导，该波导在近端运转地连接至所述生成装置并从该处延伸距离nλT/2(其中λT是所述波导材料内超声振动的波长)至设置有输出装置的远端。
纯粹用于切割目的的、具有输出装置的手术器具在我们的英国专利2365775B中已有记载。然而，这些器具并非总是容易使用并且不适用于实施焊接和/或切除过程。
现已发现可以对这种器具的输出装置的构造进行进一步改进。
本发明的目的是提供一种改进的用于所述器具的波导输出装置。
根据本发明的第一方面，提供了一种用于可以扭振形式振动的超声手术器具的输出装置，所述输出装置包括基本上呈圆柱状的第一波导，该第一波导在远端设有直径减小的第二波导延伸部件，并且所述第二波导延伸部件从所述第一波导的轴线在一个平面中弯曲，并且有至少两个刀片装置从所述第二波导延伸部件的远端径向延伸。
优选地，所述输出装置设置有两个基本上径向相反地径向延伸的刀片装置。
优选地，所述刀片装置在基本上与所述波导延伸部件的弯曲平面垂直的平面中延伸。
所述延伸部件的远端是圆的，所述刀片装置可逆向地运动。
所述延伸部件的直径不大于所述第一波导的直径的一半。
所述波导延伸部件被弯曲成使得其远端和由其携带的所述刀片装置从所述第一波导的轴线延伸距离不超过所述第一波导的半径。
根据本发明的第二方面，提供了一种手术器具，该手术器具包括用于生成扭振形式超声振动的装置以及与之运转地连接的上述波导输出装置。
现将通过举例并参考附图对本发明的实施方式作更具体的说明，附图中：
图1是一种输出装置的俯视图；
图2是该输出装置的侧视图；
图3a是一种输出装置的俯视图；
图3b是该输出装置的侧视图；
图3c详细示出了生成能量的方向特性；
图4是示出了所述输出装置的远端的俯视图；以及
图5是所述输出装置的远端的侧视图。
扭振形式的振动提供了围绕所述波导的轴线的同心运动。与该运动不平行的刀片的部分提供振动面，该振动面能够将能量直接施加到被支承在该面上的组织内，而不是象现有的平行运动装置中那样引起摩擦。
一个点到所述纵轴的距离越大，其振动的振幅越大。
现参照附图，图1是远端处具有波导1的输出装置的俯视图，而图2是侧视图，波导1可在其纵轴线2附近扭转振动。
波导1的一体延伸部3在远端方向纵向延伸。该延伸部的直径为D2，该直径差不多是初始输出装置直径D1的一半。
延伸部3于靠近其远端处在一平面内弯曲，弯曲形态为在其远端处的工作表面从轴2延伸不超出初始输出装置D1的投影。
一对朝向相反的刀片4从该基本上为圆柱状的波导延伸部3的远端径向向外突出，并能产生高的角振动位移。波导延伸部3和刀片4在它们的远端进行机加工以形成光滑的圆形头部5，该圆形头部连续围绕刀片4的外边缘。
图2示出了弯曲形状的输出装置延伸部3的侧视图。所述弯曲在一个基本上与径向延伸刀片4的总平面垂直的平面上。弯曲程度是，使刀片4的工作边缘延伸不超出初始输出装置1的直径D1的投影。输出装置延伸部3的直径D2满足D1≥2D2。
如从图3可见，头部具有四个切入其中的、廓线基本呈圆柱的凹槽，各个凹槽成形为在扭转超声振动模式下生成集中压缩波进入周围组织，更具体地是被切割的组织。这种压缩波及其相关空穴效应形成了局部加热，这有助于在切割时止血。
所述输出装置的使用提供了了一些重要的特征。
第一，在径向离开绕轴线2的振动轴线的刀片4处有高转动位移，这给出了振幅增大的振动。一个点离纵轴线的距离越大，振动的振幅越大。
从平面6到平面7的旋转运动随直径的增大而成比例地增大；这个区域中形成的位移梯度使得接触物料被从远端区域(该区域与高振幅和高能量相关联)拉拽至较低振幅低能量的排出面6，从而形成聚焦效应。高度定向的空穴区域(具有关联加热)定向为如图3所示。
第二，朝向相反的刀片4使得所述器具可在任一方向使用而勿需外科医生过度地操控该器具。刀片4形成为允许使用时后移所述波导，用以，在使该组织与切割刃紧密接近时，通过往后拉所述器具来切割组织，就像现有非电动解剖刀的惯常操作那样。
输出装置延伸部3的弯曲形状更加符合人体工程学，尤其是用于一些组织面时。
第三，集中的能量使得工作头部可由外科医生导向，以在目标组织位点形成有效止血。输出部在径向延伸波瓣的平面中的弯曲使得可以接近诸如具有关节囊的股骨头部之类的弯曲结构(如图3b所示)。
缘于其横截面变化，形成在刀片4和波导的主轴体3之间的连结部的厚度代表最大位移的区域，其具有沿所述切割刃的最小厚度，以及朝向所述基本为圆柱形的波导延伸部3的更大的厚度。
通过在目标组织上转动所述器具和/或压迫径向延伸刀片4的横截面，使所述目标组织经受高振幅压缩波，可以实现组织或血管的焊接和/或切除。
从平面6至平面7的旋转运动随所述头部直径的增大而成比例地增大。这个区域中形成的位移梯度使得接触物料被从远端区域(该区域与高振幅和高能量相关联)拉拽至较低振幅的低能量排出面6，从而形成聚焦效应。高度定向的空穴区域(具有关联加热)定向为如图3所示，就切割期间的止血而言其结果具有相当的改进。
如图4和图5可见，形成切割刀片的弓形表面是两个加工成圆柱形的表面之间的交叉线。这已通过球头加工机床沿与在刀片对称的垂直平面中的纵轴线倾斜角度为β1和β2的轴的运动而形成。当所述器具的远端被正确地成形时，波导可以弯曲，优选地在两个方向弯曲，从而所述器具表面能以最有利的方位施用于组织。

Claims (7)

1.一种用于可以扭振形式振动的超声手术器具的输出装置，所述输出装置包括基本上呈圆柱状的第一波导，该第一波导在远端处设有直径减小的第二波导延伸部件，并且所述第二波导延伸部件从所述第一波导的轴线在一个平面中弯曲，并且有至少两个刀片装置从所述第二波导延伸部件的远端径向延伸。
2.如权利要求1所述的输出装置，其中所述输出装置设置有两个基本上径向相反地径向延伸的刀片装置。
3.如权利要求1或2所述的输出装置，其中所述刀片装置在基本上与所述波导延伸部件的弯曲平面垂直的平面中延伸。
4.如前述任一项权利要求所述的输出装置，其中所述延伸部件的远端是圆的，所述刀片装置可逆向地运动。
5.如前述任一项权利要求所述的输出装置，其中所述延伸部件的直径不大于所述第一波导的直径的一半。
6.如前述任一项权利要求所述的输出装置，其中所述波导延伸部件被弯曲成使得其远端和其携带的所述刀片装置从所述第一波导的轴线延伸距离不超过所述第一波导的半径。
7.一种手术器具，其包括用于生成扭振形式超声振动的装置以及如前述任一项权利要求所述的波导输出装置。
CN2007800345236A 2006-09-19 2007-09-18 改进的超声外科手术器具 Active CN101516276B (zh)

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GB0618366.9 2006-09-19
GBGB0618366.9A GB0618366D0 (en) 2006-09-19 2006-09-19 Improved ultrasonic surgical tool
GBGB0704823.4A GB0704823D0 (en) 2006-09-19 2007-03-13 Improved ultrasonic surgical tool
GB0704823.4 2007-03-13
PCT/GB2007/003560 WO2008065323A1 (en) 2006-09-19 2007-09-18 Improved ultrasonic surgical tool

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AU2007327371A1 (en) 2008-06-05
EP2392273A2 (en) 2011-12-07
GB0718476D0 (en) 2007-10-31
EP2068731B1 (en) 2011-11-16
GB0704823D0 (en) 2007-04-18
GB2442137A (en) 2008-03-26
GB0618366D0 (en) 2006-10-25
ATE533416T1 (de) 2011-12-15
US20120010537A1 (en) 2012-01-12
EP2392273A3 (en) 2013-08-14
ES2377417T3 (es) 2012-03-27
WO2008065323A1 (en) 2008-06-05
JP5138689B2 (ja) 2013-02-06
CA2663444A1 (en) 2008-06-05
AU2007327371B2 (en) 2013-03-07
EP2068731A1 (en) 2009-06-17

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