JP2000116669A - High frequency treatment device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To incise a coagulated part and prevent bleeding without fail. SOLUTION: This device has an operating section near a user and a pair of jaws 8a and 8b to coagulate and incise tissue that can be opened and closed at the tip, and one jaw 8a has an incision electrode 14 and the other jaw 8b has coagulation electrodes 15a and 15b, and during coagulation, the tissue is coagulated by passing coagulation current to the electrode 14 and during incision, the tissue is incised by passing incision current to both electrodes. In this case, at least during incision, the distal end of the incision electrode 14 must be located nearer the proximal end than the distal end of the coagulation electrodes 15a and 15b.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a high-frequency treatment device capable of being inserted into a body cavity of a living body, coagulating and incising a tissue.

[0002]

2. Description of the Related Art In general, there is known a bipolar forceps having a pair of jaws as gripping members for gripping a living tissue, each of which is provided with an electrode for energizing a high frequency. When using the bipolar forceps, a high-frequency current is applied between the electrodes of each jaw to coagulate the living tissue between the jaws while the living tissue to be treated is held between the pair of jaws. .

[0003] Bipolar forceps of this kind are usually used in various cases such as hemostasis of blood vessels contained in living tissue, lesions on the surface layer of living tissue, cauterization of bleeding points, occlusion of fallopian tubes for contraception, and the like. Can be Bipolar forceps are used for hemostasis of blood vessels and occlusion of fallopian tubes, so that a living tissue to be treated by a patient can be coagulated, and the coagulated living tissue can be incised. ing.

Conventionally, as a high-frequency treatment instrument, for example, D
Although E4032471 C2 and DE4138116 A1 are known, it is provided with one incision electrode and two coagulation electrodes, and is configured to coagulate a tissue with two coagulation electrodes and then incision of the coagulated tissue with the incision electrode. . EP 0598348 A1 is a bipolar high-frequency incision instrument, and shows a treatment instrument only for incision.

[0005]

However, the above-mentioned DE 4032471 C2 is shown in FIG. 2, while DE 4138116 A1 is shown in FIGS.
As shown in (1), the distal end of the coagulation electrode and the distal end of the incision electrode are at the same position, and the entire coagulated area is incised. Furthermore, EP0598348A1 is a bipolar high-frequency incision instrument, which is a treatment instrument only for incision, but incises the entire grasped range.

The present invention has been made in view of the above circumstances, and an object of the present invention is to provide a high-frequency treatment device capable of incising coagulated tissue and preventing bleeding.

[0007]

In order to achieve the above-mentioned object, the present invention has an operating portion at the hand side and a pair of openable and closable jaws at the distal end for coagulating and incising tissue. One jaw has a first electrode, and the other jaw has a second electrode. During coagulation, a coagulation current is applied to the electrode to coagulate tissue, and at the time of incision, between the two electrodes. In a high-frequency treatment instrument for incising tissue by passing an incision current, at least at the time of incision, the distal end of the first electrode is connected to the second electrode.
The electrode is located closer to the proximal end than the distal end.
According to the configuration, the incision range is narrower than the coagulation range,
The incised area can always be incised at the time of incision.

[0008]

Embodiments of the present invention will be described below with reference to the drawings. 1 to 3 show a first embodiment, FIG. 1 shows the entire configuration of a three-pole high-frequency treatment device, and FIG. 2 shows a distal end portion of the high-frequency treatment device. As shown in FIG. 1, a bipolar forceps 1 as a high-frequency treatment instrument has an elongated insertion portion 2 inserted into a body cavity of a patient, and the insertion portion 2.
At the distal end of the body, grasping and coagulating living tissue in the body cavity,
An electrically operable treatment unit 3 for making an incision and an operation unit 4 connected to the base end of the insertion unit 2 are provided.

The insertion section 2 has a sheath 6 rotatably supported by a rotation operation section 5 provided on the operation section 4,
A drive shaft 7 extending to the inside of the operation unit 4 is inserted into the sheath 6 so as to be able to advance and retreat. The first and second jaws 8a and 8b formed of electrodes constituting the treatment section 3 are fixed to the distal end of the drive shaft 7 in a state where the first and second jaws 8a and 8b are urged in the expanding direction.

The operating section 4 is provided with a fixed handle 11 provided integrally with the operating section body 9 and a movable handle 13 provided rotatably on the operating section body 9 with a pivot pin 12 as a fulcrum. ing. The drive shaft 7 is moved forward and backward by rotating the movable handle 13, so that the first and second jaws 8a and 8b can be opened and closed.

As shown in FIG. 2, the first jaw 8a is provided with an incision electrode 14 as a first electrode, and the second jaw 8b is provided with a first coagulation electrode 15a as a second electrode.
And a second coagulation electrode 15b. The incision electrode 14 bends a conductive wire such as a thin metal wire into a substantially U-shape,
By fixing both ends to the front and rear ends of the first jaw 8a, an incision 14a substantially parallel to the first jaw 8a is formed.

A flat plate-shaped insulating member 16 made of ceramic or synthetic resin material is fixed to the second jaw 8b. Notch steps 16a and 16b are provided on both side edges of the upper surface of the insulating member 16, a first coagulation electrode 15a is fixed to one notch step 16a, and a second coagulation electrode 15a is fixed to the other notch step 16b. Of the coagulation electrode 15b is fixed. Therefore, the first and second coagulated electrodes 15a and 15b are electrically insulated by the insulating member 16. Notch step 16
a, 16b are the first and second solidified electrodes 15a, 1
5b, approximately equal to the height of the first and second solidified electrodes 15
The solidified surfaces on the upper surfaces of the insulating members 16a and 15b are the upper surface 16c of the insulating member 16.
The cutout portion 14a of the cutout electrode 14 faces the upper surface 16c.

The length of the incision electrode 14 in the longitudinal direction is longer than the lengths of the first and second coagulation electrodes 15a and 15b in the longitudinal direction.
5a, 15b are located closer to the proximal end than the distal end, and the displacement L
The shift amount L is, for example, 0.5 to 2.0 m.
m. Also, the proximal end of the incision electrode 14 is the first and second
The coagulation electrodes 15a and 15b are located on the distal end side from the proximal end, and are configured such that the incision range is narrower than the coagulation range.

Next, the operation of the first embodiment will be described with reference to FIG. The bipolar forceps 1 is electrically connected to a high-frequency cautery power supply device (not shown), and the insertion section 2 of the bipolar forceps 1 is inserted into the body of the patient. The treatment section 3 at the distal end of the insertion section 2 serves as a treatment target in the body. It is guided to a position near the living tissue A. Therefore, as shown in FIG. 3A, the living tissue A to be treated is interposed between the opened first and second jaws 8a and 8b, and the movable handle 13 is rotated toward the fixed handle 11 side. When operated, the drive shaft 7 moves backward. The first and second jaws 8a, 8b close as the drive shaft 7 retreats, and the living tissue A is gripped between the incision electrode 14 and the first and second coagulation electrodes 15a, 15b.

In this state, when a high-frequency current is supplied from the high-frequency ablation power supply, a coagulation current flows between the first coagulation electrode 15a and the second coagulation electrode 15b, and the living tissue A is coagulated. The solidified portion is indicated by oblique lines, and the solidification range is L
1

Subsequently, when an incision current is applied to the incision electrode 14 and the first and second coagulation electrodes 15a and 15b, and the movable handle 13 is further rotated toward the fixed handle 11, the state shown in FIG. Thus, the incision electrode 14 and the first and second coagulation electrodes 15a and 15b are further closed. Therefore, the coagulated living tissue A is cut into the incision portion 14 of the incision electrode 14.
Incision is made by a. At this time, the distal end of the incision electrode 14 is located closer to the proximal end than the distal ends of the first and second coagulation electrodes 15a and 15b, and has a shift amount L, so that it is narrower than the coagulation range L1. This is the incision range L2, and the coagulated area is always incised, so that bleeding can be prevented.

FIG. 4 shows a second embodiment, in which the same components as those in the first embodiment have the same reference numerals and description thereof will be omitted. This embodiment is provided with an incision electrode 17 having a thin plate-shaped, knife-edge-shaped incision portion 17a, and the distal end of the incision electrode 17 is provided with first and second coagulation electrodes 15a, 1a.
5b is located closer to the proximal end than the distal end, and has a shift amount L, so that it has the same operational effects as in the first embodiment.

FIG. 5 shows a third embodiment, in which the same components as those in the first embodiment have the same reference numerals and description thereof will be omitted. This embodiment has a rod-like shape, the tip of which is bent to form an incision 1.
8a, the distal end of which is provided with first and second coagulation electrodes 15a, 15a.
Since b is located closer to the proximal end than the distal end and has a shift amount L, it has the same operational effects as in the first embodiment.

FIGS. 6 to 8 show a fourth embodiment, and FIGS.
FIG. 7A is a cross-sectional view at the time of coagulation, FIG. 7B is a cross-sectional view at the time of incision, and FIG. 8 is a vertical sectional side view of a distal end portion of the high-frequency treatment instrument. The high-frequency treatment instrument 21 includes a pipe-shaped insertion portion 22 and an operation portion 23 provided near the insertion portion 22. Operation unit 23
Is provided with an insertion section rotation knob 24 for rotating the insertion section 22 about its axis.

An operation shaft 25 and a rotation shaft 26 which can move back and forth in the axial direction are inserted into the insertion portion 22. A first jaw 27a forming a grip is provided at the distal end of the insertion portion 22 so as to be rotatable about a pivot pin 28 as a fulcrum. The part protrudes from the front end of the insertion part 22. The base end of the operation shaft 25 is connected to a movable handle 30 provided on the operation unit 23.

The tip of the rotating shaft 26 projects from the front end of the insertion portion 22, and this projection has a second
Jaws 27b are provided integrally. And the first
And the second jaws 27a and 27b constitute a treatment section for grasping and treating the living tissue A.

As shown in FIG. 7, the second jaw 27b has a trapezoidal or substantially triangular cross section, a solidified electrode 31 is formed at the bottom, and an incision electrode 32 is formed at the top. That is, as shown in FIG. 7A, the rotation shaft 26 rotates about the axis, and the second jaw 27
The living tissue A can be coagulated by gripping the living tissue A with the coagulation electrode 31 b facing upward and facing the first jaw 27a. Further, as shown in FIG. 7B, the living tissue A is rotated by rotating the rotation shaft 26 around the axis, facing the first jaw 27a with the cutting electrode 32 of the second jaw 27b facing upward. By grasping, the living tissue A can be incised.

As shown in FIG. 8, a notch 32a is provided at the tip of the incision electrode 32 of the second jaw 27b, and the length of the incision 32b in the longitudinal direction is shortened by the notch 32a. ing. That is, the distal end of the incision 32b of the incision electrode 32 is located closer to the proximal end than the distal end of the coagulation electrode 31, and has a displacement L.

The rotary shaft 26 integral with the second jaw 27b is rotatably supported by a support pipe 33 in the insertion section 22, and its base end is a jaw rotation knob 34 provided on the operation section 23. And the jaw rotation knob 34
, The direction of the second jaw 27b can be arbitrarily changed.

Next, the operation of the fourth embodiment will be described. First, the jaw rotation knob 34 is operated to rotate the rotation shaft 26.
Is rotated so that the coagulation electrode 31 of the second jaw 27b faces upward and faces the first jaw 27a. In this state,
When the operating shaft 25 is moved backward by operating the movable handle 30, the first jaw 27a rotates about the pivot pin 28 as a fulcrum, and the first jaw 27a and the coagulation electrode 31 of the second jaw 27b move as shown in FIG.
As shown in (a), the living tissue A is gripped. Therefore,
When a coagulation current is applied between the first and second jaws 27a and 27b, coagulation of the living tissue A is performed.

Next, the first and second jaws 27a, 27b
Once, the jaw rotation knob 34 is operated to rotate the rotation shaft 26 by 180 °, and the incision electrode 32 of the second jaw 27b faces upward to face the first jaw 27a to grip the living tissue A. Thereby, the living tissue A is gripped between the incision electrode 32 of the first jaw 27a and the second jaw 27b. Therefore, the first and second jaws 27a, 27
When an incision current is passed between b, incision of the living tissue A is performed.

At this time, the distal end of the incision 32b of the incision electrode 32 is located closer to the proximal end than the distal end of the coagulation electrode 31.
Since it has the shift amount L, the same operation and effect as in the first embodiment can be obtained.

FIGS. 9 and 10 show a fifth embodiment.
9A is a vertical side view of the distal end portion during coagulation, FIG. 9B is a vertical side view of the distal end portion at the time of incision, and FIG. 10 is a vertical side view of the operation unit. The same components as those of the fourth embodiment are denoted by the same reference numerals, and description thereof is omitted. In the present embodiment, the incision electrode 32 is not provided with the notch 32a, and the entire length of the incision electrode 32 is the incision 32b.

A large diameter portion 35 is integrally provided at the base end of the rotating shaft 26 connected to the second jaw 27b and rotatably supported by the support pipe 33. The large diameter portion 35 is provided with a cam groove 36 in the circumferential direction and a key groove 37 in the axial direction. A cam pin 38 projecting from the inner wall of the support pipe 33 is engaged with the cam groove 36, and a jaw rotation knob 34 is engaged with the key groove 37.

By operating the jaw rotation knob 34, the direction of the second jaw 27b can be changed via the rotation shaft 26, and the rotation of the rotation shaft 26 engages with the cam pin 38. The rotating shaft 26 is retracted in the axial direction by the cam groove 36 that is present, and the second jaw 27b is drawn toward the hand side.

Therefore, during coagulation, the second jaw 27b is protruded, and a wide range of coagulation can be performed by the coagulation electrode 31. In addition, when the jaw rotation knob 34 is operated at the time of the incision, the rotation shaft 26 is retracted in the axial direction by the cam groove 36 engaged with the cam pin 38, and the second jaw 27b is pulled toward the hand side. Therefore, the incision range by the incision electrode 32 provided on the second jaw 27b is
Since it becomes narrower than the coagulation range by the amount of the retraction b, and the coagulation range is always incised, bleeding can be prevented. That is, at the time of incision, the distal end of the incision electrode 32 is
Since it is located closer to the proximal end than the distal end and has a shift amount L, it has the same operational effects as the first embodiment.

According to the first to fifth embodiments, the following configuration is obtained. (Supplementary Note 1) Having an operation unit on the proximal side, a pair of openable and closable jaws for performing coagulation and incision of tissue at the distal end,
One jaw has a first electrode, and the other jaw has a second electrode. During coagulation, a coagulation current is applied to the electrode to coagulate tissue, and at the time of incision, an incision current is applied between the two electrodes. A distal end of the first electrode is closer to a proximal end than a distal end of the second electrode at least at the time of incision.

(Supplementary Note 2) An operation unit is provided on the proximal side, and a pair of openable and closable jaws for coagulating and incising tissue is provided at the distal end, and one jaw has at least one incision electrode. The other jaw has at least two coagulation electrodes. During coagulation, a coagulation current flows between the coagulation electrodes to coagulate the tissue. At the time of incision, an incision current flows between the incision electrode and the coagulation electrode to coagulate the tissue. In the high-frequency treatment instrument to be incised,
A high-frequency treatment instrument wherein the distal end of the incision electrode is closer to the proximal end than the distal end of the coagulation electrode.

(Supplementary Note 3) An operation unit is provided on the proximal side, and a pair of openable and closable jaws for coagulating and incising tissue is provided at the distal end, and one jaw has at least one incision electrode. The other jaw has at least two coagulation electrodes. During coagulation, a coagulation current flows between the coagulation electrodes to coagulate the tissue. At the time of incision, an incision current flows between the incision electrode and the coagulation electrode to coagulate the tissue. In the high-frequency treatment instrument to be incised,
The distal end of the incision electrode is closer to the distal end than the distal end of the coagulation electrode, and the proximal end of the incision electrode is closer to the distal end than the proximal end of the coagulation electrode. High-frequency treatment tool.

(Supplementary note 4) The supplementary note 2 or 3, wherein the incision electrode is formed of a conductive wire.
The high-frequency treatment device as described in the above. (Supplementary note 5) The high-frequency treatment instrument according to Supplementary note 2 or 3, wherein the incision electrode is formed in a substantially plate shape.

(Supplementary note 6) The high-frequency treatment instrument according to supplementary note 2 or 3, wherein the incision electrode is formed in a substantially rod shape. (Supplementary Note 7) First and second jaws that relatively open and close are provided at the distal end of the insertion section, the first jaw has a treatment section for treating tissue, and the second jaw has a coagulation section. And an incision are formed on different surfaces, and the second jaw is selectively rotated about an axis parallel to the insertion portion, so that the first jaw and the coagulation portion
A high-frequency treatment device in which one of the incisions faces one another, wherein the distal end of the incision is closer to the proximal end than the distal end of the coagulation portion.

(Supplementary Note 8) First and second relatively opened and closed
The first jaw has a treatment section for treating a tissue, the second jaw has a coagulation section and an incision section formed on different surfaces, and the second jaw has a second section. In a high-frequency treatment instrument in which the first jaw and one of the coagulation portion and the incision portion face each other by selectively rotating the jaw about an axis parallel to the insertion portion, the second jaw retreats at the time of incision, and the incision A high-frequency treatment instrument wherein the distal end of the part is located closer to the proximal end than the distal end of the coagulation part.

FIGS. 11 and 12 show a sixth embodiment, in which the same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. 11A and 11B show the treatment section 3, wherein FIG. 11A is a side view, FIG. 11B is a plan view of the second jaw 8 b partially cut away, FIG. 11C is a cross-sectional view along line AA, and FIG. FIG. The second jaw 8b is provided with a first coagulation electrode 40a and a second coagulation electrode 40b as second electrodes.

The heights of the first and second coagulated electrodes 40a and 40b are larger than the steps of the notch step portions 16a and 16b, and the upper surfaces of the first and second coagulated electrodes 40a and 40b are higher than the upper surface 16c of the insulating member 16. The cutout portion 14a of the cutout electrode 14 is protruded and faces a lower surface 16c that is one step lower.

Further, the first and second coagulation electrodes 40a,
The distal end of the solidified surface of 40b is cut out in an arc shape to form a chamfered portion 41, and both side corners at the distal end of the solidified surface are cut out in an arc shape to form a chamfered portion 42. . Further, the first and second coagulated electrodes 40a, 40
0b and the upper surface 16 of the insulating member 16 facing the outside.
c is cut off in an arc shape to form a chamfer 43,
44 are formed.

Next, the operation of the sixth embodiment will be described with reference to FIG. As in the first embodiment, after a coagulation current is passed between the first coagulation electrode 40a and the second coagulation electrode 40b to coagulate the living tissue A, as shown in FIG. , Incision electrode 14 and first and second coagulation electrodes 4
When the incision current starts flowing through the incision electrodes 0a and 40b and the movable handle 13 is further rotated toward the fixed handle 11, the incision electrode 14 and the first and second coagulations are formed as shown in FIG. The electrodes 40a and 40b are further closed. Therefore, the coagulated living tissue A is cut into the incision portion 14 of the incision electrode 14.
Incision is made by a.

At this time, the first and second coagulation electrodes 40
A tension is applied to the living tissue A so as to spread to both sides with the incision electrode 14 as a boundary by the chamfered portions 43 and 44 provided at the ridges of the a and 40b. At this time, the tension acting on the distal end side is efficiently transmitted to the proximal end side by the chamfered portions 41, 42 of the first and second coagulated electrodes 40a, 40b. Therefore, the incision a of the living tissue A separates from the incision electrode 14 while gradually expanding as the incision proceeds. further,
As shown in FIG. 12C, the first and second coagulated electrodes 4
Owing to the chamfered portions 41 and 42 at the distal ends of 0a and 40b, the terminal end b of the incision flaw a of the living tissue A slides on the chamfered portions 41 and 42 as shown by arrows and separates from the incision electrode 14,
The completion of the incision can be easily understood, and the operation for separating the treatment section 3 from the living tissue A becomes easy.

In this embodiment, the first and second coagulated electrodes 40a and 40b are formed by notching the chamfered portion 41.
Although the shapes of Nos. To 44 are arc-shaped, they may be substantially triangular. Further, the chamfered portions 43 and 44 are provided on the outer and inner ridges of the first and second coagulated electrodes 40a and 40b, respectively, but may be provided on at least one of them. Furthermore, although the description has been given of the tripolar high-frequency treatment device, the present invention can be applied to a bipolar type.

FIG. 13 shows a seventh embodiment, in which the same components as those in the sixth embodiment are denoted by the same reference numerals and description thereof is omitted. In the present embodiment, the first and second coagulated electrodes 40a, 4
The solidified surface 0b is provided with a saw-toothed uneven portion 45. By providing the concavo-convex portion 45 on the coagulated surface in this way, the living tissue A can be prevented from escaping toward the distal end of the treatment section 3 during coagulation and incision, and in addition to the effects of the sixth embodiment, the living tissue A This has the effect that the target part can be surely grasped.

According to the sixth and seventh embodiments, the following configuration is obtained. (Supplementary Note 9) An operation unit is provided on the proximal side, and a pair of openable and closable jaws for performing coagulation and incision of tissue is provided at the distal end,
One jaw has at least one incision electrode, the other jaw has at least two coagulation electrodes, and a coagulation current flows between the coagulation electrodes during coagulation to coagulate tissue, and the incision electrode during incision. A high-frequency treatment instrument for incising a tissue by passing an incision current between the coagulation electrode and a coagulation electrode, wherein a chamfer is provided at a distal end of the coagulation electrode.

(Supplementary note 10) The high-frequency treatment instrument according to supplementary note 9, wherein the chamfered portion has a substantially arc shape. (Supplementary Note 11) The high-frequency treatment instrument according to Supplementary Note 9, wherein the chamfered portion has a substantially triangular shape.

(Supplementary Note 12) An operating portion is provided on the proximal side, and a pair of openable and closable jaws for coagulating and incising tissue is provided at the distal end portion. One jaw has at least one incision electrode. The other jaw has at least two coagulation electrodes insulated by an insulating member. During coagulation, a coagulation current flows between the coagulation electrodes to coagulate tissue, and at the time of incision, an incision is made between the incision electrode and the coagulation electrode. A high-frequency treatment device for incising tissue by passing an electric current, wherein a chamfer is provided on at least one of a ridge portion facing the outside of the coagulation electrode and a ridge portion facing the insulating member.

(Supplementary Note 13) The high-frequency treatment instrument according to supplementary note 12, wherein the chamfered portion has a substantially arc shape. (Supplementary note 14) The high-frequency treatment instrument according to supplementary note 12, wherein the chamfered portion has a substantially triangular shape.

(Supplementary note 15) The high-frequency treatment instrument according to any one of Supplementary notes 9 to 14, wherein a serrated shape is provided on at least a part of the solidified surface of the coagulation electrode.

On the other hand, DE 403 mentioned in the section of the prior art
2471 C2 has a structure in which an incision electrode and a pair of coagulation electrodes constituting a gripping portion of a high-frequency treatment instrument have a wire bent. Therefore, the incision electrode and the coagulation electrode may be short-circuited due to torsion or deformation of the distal end portion of the high-frequency treatment instrument, or bleeding may occur because the target site in the center of the coagulation range cannot be incised when closing the incision electrode. is there. Further, Japanese Unexamined Patent Application Publication No. 10-0001
FIG. 10 of Japanese Patent Publication No. 99 discloses a structure in which an insulating material is provided between electrodes, but there is a similar problem because the incision electrode does not have a structure to be centered on the center of the insulating material at the time of cutting. .

The eighth embodiment solves the above-mentioned problem. FIG. 14 is a sectional view showing a grip portion as a treatment portion of the high-frequency treatment instrument, and FIG. 15 is an operation explanatory view. The basic configuration of the high-frequency treatment device is the same as that of the first embodiment, and a description thereof will be omitted. Grasping part 50 for gripping living tissue A
Is provided with an incision electrode 52 as a first electrode, and a second jaw 51b is provided with a second incision electrode 52 as a first electrode.
A first coagulation electrode 53a and a second coagulation electrode 53b are provided. The incision electrode 52 is composed of a plate-like body 54 whose surface is coated with an insulating material, and a conductive wire 55 in which a thin metal wire or the like is bent in a substantially U-shape and both ends are fixed to the front and rear ends of the plate-like body 54. Have been.

The second jaw 51b is composed of a plate-like body 56 whose surface is insulated and coated, and an insulating member 5 made of ceramic or synthetic resin material fixed to the center of the plate-like body 56.
7 is comprised. First and second coagulated electrodes 53a and 53b are fixed to both sides of the insulating member 57. Therefore, the first and second coagulation electrodes 53a, 53b
Are electrically insulated by an insulating member 57.

The upper surface of the insulating member 57 is substantially flush with the solidified surfaces of the first and second solidified electrodes 53a and 53b. A wide-angle V-shaped guide portion 58 for guiding the incision electrode 52 is provided on the upper surface.
When the first and second jaws 51a and 51b are closed, the incision electrode 52 is connected to the first and second coagulation electrodes 53a and 53a.
The position is adjusted to the center of the axis between 53b.

Next, the operation of the eighth embodiment will be described with reference to FIG. As shown in FIG. 15A, the living tissue A to be treated is between the first and second jaws 51a and 51b.
When the living tissue A is grasped with the interposition of the incision electrode 52 and the insulating member 57, the first and second coagulation electrodes 53a, 53
b. At this time, since the wide-angle V-shaped guide portion 58 is formed on the upper surface of the insulating member 57, the living tissue A follows the guide portion 58, and the living tissue A also has a substantially wide-angle V shape.

In this state, when a high-frequency current is supplied from the high-frequency ablation power supply, a coagulation current flows between the first coagulation electrode 53a and the second coagulation electrode 53b, and the living tissue A is coagulated. Subsequently, when an incision current is applied to the incision electrode 52 and the first and second coagulation electrodes 53a and 53b, and the incision electrode 52 and the first and second coagulation electrodes 53a and 53b are further closed, coagulated biological tissue is obtained. A is cut by the cutting electrode 52.

At this time, the incision electrode 52 is positioned at the center between the first and second coagulation electrodes 53a and 53b by the guide portion 58 provided on the upper surface of the insulating member 57. That is, even if the incision electrode 52 is slightly deformed in the left-right direction, the conductive wire 55 is corrected by the guide portion 58 toward the center between the first and second coagulation electrodes 53a and 53b. Therefore, the incision electrode 52 and the first and second coagulation electrodes 53a,
A short circuit with 53b can be prevented, and the target site of the living tissue A can be reliably incised.

In this embodiment, the insulating member 5
7 is provided with a wide-angle V-shaped guide portion 58 on the upper surface.
As shown in FIG. 6A, an arcuate concave guide portion 59 may be provided, and as shown in FIG. 16B, an inverted trapezoidal guide portion 60 may be provided. Further, FIG. 16C shows that the first and second solidified electrodes 53a, 53a,
The height of the solidified surface of 53b is slightly increased to provide a step H. When formed in this manner, tension is applied to the living tissue A to facilitate incision, and the incision flaw is easily separated from the incision electrode 52.

FIG. 17 shows an example of disclosure of the treatment section, which comprises an incision jaw 61 and a coagulation jaw 62.
An electrode support 63 is provided at the distal end and the proximal end of the incision jaw 61.
a and 63b are protruded, and these electrode support portions 63a and 63b are provided.
A conductive wire 64 as an incision electrode is stretched between b. Further, at the distal end and the proximal end of the coagulation jaw 62, escape grooves 65a and 65b are provided, which face the tip portions of the electrode support portions 63a and 63b, and into which they fit. According to the present disclosure, the rigidity of the incision electrode is increased, and deformation during incision can be prevented.

According to the eighth embodiment, the following configuration is obtained. (Supplementary Note 16) A grip part having an operation part on the hand side and being insulated from each other which is relatively opened and closed by operation of the operation part on the tip side, and one or more independent electrodes and at least one of An insulating part is provided in a part of the grip, and a high-frequency treatment instrument that coagulates and dissects tissue by energizing a high frequency between the electrodes, wherein when the grip is closed, one electrode is the other electrode. A high-frequency treatment instrument comprising a guide portion that is positioned at the axis of the grip portion.

(Supplementary Note 17) The high-frequency treatment instrument according to Supplementary Note 16, wherein the guide portion has a substantially wide-angle V-shape. (Supplementary note 18) The high-frequency treatment instrument according to supplementary note 16, wherein the guide portion has a substantially arc-shaped concave shape. (Supplementary note 19) The high-frequency treatment instrument according to supplementary note 16, wherein the guide portion has a substantially inverted trapezoidal shape.

[0061]

As described above, according to the present invention, at least at the time of incision, the distal end of the first electrode for incision is closer to the distal end than the distal end of the second electrode for coagulation. Therefore, there is an effect that a coagulated part can be incised without fail and bleeding can be prevented.

[Brief description of the drawings]

FIGS. 1A and 1B show a first embodiment of the present invention, wherein FIG. 1A is an overall configuration diagram of a high-frequency treatment device, and FIG. 1B is a side view of a treatment unit in an open state.

FIG. 2 shows a treatment section of the embodiment, wherein (a) is a side view,
(B) is a partially cutaway plan view of the second jaw, and (c) is a front view.

FIG. 3 is an operation explanatory view of the embodiment.

FIG. 4 shows a treatment section according to a second embodiment of the present invention,
(A) is a side view, (b) is a front view.

FIG. 5 shows a treatment section according to a third embodiment of the present invention,
(A) is a side view, (b) is a front view.

FIG. 6 is an overall configuration diagram of a high-frequency treatment instrument according to a fourth embodiment of the present invention.

7A and 7B show a treatment section of the embodiment, wherein FIG. 7A is a cross-sectional view at the time of coagulation, and FIG. 7B is a cross-sectional view at the time of incision.

FIG. 8 is a longitudinal sectional side view of the treatment section of the embodiment.

FIG. 9 shows a treatment section according to a fifth embodiment of the present invention,
(A) is a longitudinal side view at the time of coagulation, (b) is a longitudinal side view at the time of incision.

FIG. 10 is a vertical side view of the operation unit of the embodiment.

FIG. 11 shows a treatment section according to a sixth embodiment of the present invention;
(A) is a side view, (b) is a partially cutaway plan view of the second jaw, and (c) is a cross-sectional view along the line AA.

FIG. 12 is an operation explanatory view of the embodiment.

13A and 13B show a seventh embodiment of the present invention, wherein FIG. 13A is a side view of a treatment section, and FIG. 13B is a cross-sectional view taken along line BB.

FIG. 14 is a sectional view of a treatment section according to an eighth embodiment of the present invention.

FIG. 15 is an operation explanatory view of the embodiment.

FIGS. 16A to 16C are cross-sectional views of a treatment section showing a modification of the embodiment.

FIG. 17 is a side view showing a disclosure example of a treatment unit.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... High frequency treatment tool 3 ... Treatment part 4 ... Operation part 14 ... Incision electrode 15a, 15b ... Coagulation electrode

 ────────────────────────────────────────────────── ─── Continued on the front page (72) Inventor Koji Yamauchi 2-43-2, Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. F-term (reference) 4C060 KK03 KK04 KK10 KK14 KK22 KK23

Claims (1)

[Claims] An operation portion is provided on the proximal side, a pair of openable and closable jaws for coagulating and incising tissue are provided at a distal end portion, one jaw has a first electrode, and the other has a first electrode. A jaw having a second electrode, a coagulation current is applied to the electrode during coagulation to coagulate the tissue, and at the time of incision, an incision current is applied between the two electrodes to incise the tissue; A high-frequency treatment device wherein the distal end of the first electrode is sometimes closer to the proximal end than the distal end of the second electrode.