JP2000262528A - Laparoscopic surgical method and device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To improve the safeness of surgery by separating biological tissue after incising an organ serosa by passing a high frequency electrical current to the tip of a nozzle inserted into an abdominal cavity through a trocar and inserting the tip of the nozzle from the incision, and swelling the subserous layer by jetting a high pressure liquid of a specified pressure. SOLUTION: When carrying out laparoscopic cholecystotomy, after inserting a trocar from the lower portion of the navel and carrying out pneumoperitoneum by means of CO2 gas, a laparoscope is inserted, and a several number of trocars are arranged in prescribed positions for extraction of the cholecyst. Subsequently, the pipe portion of the nozzle 4 of a handpiece 1 is inserted into one trocar, and the serosa 31 is incised at the neck of the cholecyst using the tip 34 of the nozzle as an electrocautery, and a tiny hole 32 is opened. Subsequently the nozzle tip 34 inserted from the tiny hole 32, a water jet pressurized to 1 to 5 Mpa is injected under the serosa to swell it. After that, the swollen serosa 31 is incised with the nozzle tip 34, and a water jet is ejected again to separate the connective tissue around the cholcystic duct.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a laparoscopic surgical method and apparatus, and more particularly, to a trocar having a water jet injection function and a high-frequency current supply function and used for endoscopic surgical operations. TECHNICAL FIELD The present invention relates to a laparoscopic surgical operation method and apparatus for performing swelling, dissection, detachment, and the like of a serosa in an operation portion using a nozzle having a shape suitable for the operation.

[0002]

2. Description of the Related Art In the field of abdominal surgery, where surgery by laparotomy has conventionally been the mainstream, laparoscopic surgery has been performed due to the advantages of less pain for patients and quick recovery after surgery. It has become. This laparoscopic surgery is performed remotely, all through a trocar, and requires specially crafted instruments.

In addition, as a handpiece for laparoscopic surgery, a nozzle pipe having an electrode at the tip is connected to the handpiece body, and high-pressure water is jetted from the tip of the nozzle pipe to produce a living tissue (surgical site). There is a function having both the function of a so-called water jet knife for incising and peeling off the skin and the function of an electric knife for coagulating and incising the same tissue with the electrode at the tip of the nozzle pipe.

[0004]

In laparoscopic surgery, a surgical operation is performed from outside the body via a trocar while watching a TV monitor. Therefore, compared with open surgery, laparoscopic surgery has many limitations, and there has been a keen need for the development of new surgical instruments and peripheral devices in order to overcome these limitations and to operate safely and reliably. .

[0005] Further, many of the conventional laparoscopic surgical instruments have a single function, and it is necessary to change the instrument every time the incision or exfoliation is performed, which makes the operation complicated and lengthens the operation time. there were.

[0006] In addition, there is a case where a problem does not occur in the existing water jet scalpel handpiece for laparoscopic surgery, which may cause a problem in laparoscopic surgery. For example, when the water jet injected straight from the nozzle in the axial direction hits an organ, etc., or when it fills the gap of connective tissue, the jet water returns to the surgeon side along the nozzle outer periphery. In some cases, the visibility of the endoscope may be reduced. Further, in many cases, the angle range in which the tip of the nozzle protruding from the trocar can be moved is limited, and it is often not possible to sufficiently perform incision, peeling, and the like with only the water jet injected in the axial direction of the nozzle.

SUMMARY OF THE INVENTION The present invention has been made in view of the above problems, and provides a method of utilizing a water jet scalpel for laparoscopic surgery which is gentle to a patient and a laparoscopic surgical apparatus having a combined function suitable for the operation. The purpose is to provide.

[0008]

In order to solve the above-mentioned problems, the invention according to the first aspect is directed to an organ to be resected by applying a high-frequency current to a tip of a nozzle inserted into an abdominal cavity via a trocar. An incision is made in the serosa, and the tip of the nozzle is inserted below the serosa from the incision hole, and a high-pressure liquid of 1 to 5 MPa is jetted to swell the lower serosa layer. A laparoscopic surgical method characterized by cutting or exfoliating tissue at a surgical site in combination with a propellant.

[0010] The invention described in claim 2 is characterized in that in the surgical method, a high-pressure liquid is ejected from the tip of the nozzle in a direction intersecting the nozzle axis.

[0010] Further, according to the invention, a nozzle having a length and a shape capable of passing through a trocar used for endoscopic surgery and having a distal end portion capable of reaching a surgical site is provided. A surgical handpiece holding the nozzle,
A laparoscopic surgical operation comprising: a high-frequency power supply for supplying a high-frequency current to the tip of the nozzle; and a pressurizing device for supplying a pressurized liquid of 1 to 5 MPa provided in the nozzle. Provide equipment.

Further, the invention described in claim 4 provides a surgical apparatus characterized in that an injection port of the nozzle is provided at a position crossing a nozzle axis.

[0012]

According to the method and apparatus for laparoscopic surgery according to the present invention, a handpiece 1 having a shape capable of passing through a trocar and reaching a surgical site, having a nozzle capable of supplying a high-frequency current and ejecting a high-pressure liquid. With the use of a book alone, the incision of the serosa at the surgical site, swelling by injecting fluid below the serosa, and the incision / dissection or detachment of the tissue are possible, enabling efficient and safe laparoscopic surgery. .

Further, since the serosa is swollen by the injection solution, it can be easily cut and cut. After incising and dissecting the serosa,
By using the water jet and the tip of the nozzle appropriately between connective tissues including fatty tissue, the peeling operation can be performed efficiently.

Further, since the water jet is injected under the serosa to remove the fat tissue around the blood vessel without cutting the blood vessel, the characteristic of the water jet can be used. Can be reduced.

The pressure range of the water jet can be in the range of 1 MPa to 5 MPa, but preferably a pressure of 2 MPa or less, which is used for cutting the liver, can be generally recommended.

In addition, for various problems such as poor visibility and poor spray direction due to splashing of the sprayed water in endoscopic surgery, the direction intersecting the nozzle axis of the present invention, for example, 45 ° to 90 ° By injecting the water jet in the direction, incision, resection, and peeling at the surgical site can be efficiently and easily performed.

[0017]

DESCRIPTION OF THE PREFERRED EMBODIMENTS FIG. 1 is an explanatory view showing an example of a schematic overall configuration of an endoscopic surgical operation apparatus according to the present invention.
This surgical apparatus includes a handpiece 1 and a pressurizing device (water jet pump) 2 connected to the handpiece 1.
And a high frequency power supply 3. In order to insert and pass through a trocar having a diameter of 10 mm and 5 mm during an endoscopic surgical operation, a handpiece 1 is provided with a mantle of a linear shape having a diameter adapted to the thickness and a length of about 30 cm. A nozzle pipe portion 4 comprising a nozzle protruding about 3 cm further from the tip in consideration of operability.
It has.

Physiological saline is supplied from the physiological saline pack 5 through a supply hose 6 to the pressurizing device 2.
The pressurized liquid pressurized in the range of 1 to 5 MPa is supplied to the handpiece 1 via the flexible hose 7. By operating the switch 8 provided on the handpiece 1, pressurized liquid is ejected from the nozzle. The high-frequency power supply 3 is connected to the handpiece 1 by a power cord 9 and supplies a high-frequency current to the nozzle pipe 4 by a foot switch (not shown) or the like.

FIG. 2 is a schematic sectional view showing a schematic configuration of the handpiece 1. This handpiece 1 has a grip 21
And a nozzle pipe portion 4. A pipe 27 for passing a pressurized liquid is disposed in the holding portion 21 of the handpiece 1, and is connected to a nozzle 24 via an on / off valve 22. Accordingly, the operation of the switch 28 provided on the grip portion 21 causes the on / off valve 22 to operate,
The structure is such that the pressurized liquid is supplied to the tip of the nozzle 24. Further, the power cord 29 is connected to the pipe 27 by the terminal 23.
Connected to. The nozzle pipe section 4 is composed of a metallic nozzle 24 for injecting a pressurized liquid and a resin jacket 25 in consideration of electric insulation, and is fixed to the tip of the grip 21. The nozzle 24 protruding from the tip of the nozzle pipe part 4 ejects pressurized liquid from the tip or the side thereof to serve as a water jet knife, and also functions as an electrode for high-frequency current and serves as an electric knife. The multi-functionalization that fulfills the requirements has been completed. An outer jacket 25 fixed to the tip of the grip 21 is directly inserted into the trocar and serves to maintain airtightness and as an electrical insulator.

A case in which laparoscopic cholecystectomy is performed using the endoscopic surgical apparatus configured as described above will be described.

After a trocar is inserted from the lower navel and insufflation is performed with CO ₂ gas, a laparoscopic is inserted from here and observation is performed, and three trocars are arranged at predetermined positions of the cholecystectomy. Up to this point, the operation is the same as the conventional operation method.

Hereinafter, in order to clarify the features of the present invention, description will be made with reference to FIG. 3 which shows an enlarged view of a surgical site in the body. Note that the nozzle 34 shows a state where the trocar has passed.

As shown in FIG. 3A, the nozzle pipe portion 4 of the handpiece 1 is inserted and passed through one trocar, the nozzle tip portion 34 is made to function as an electric knife, and the serosa 31 is incised at the neck of the gallbladder. Drill a small hole 32. Thereafter, as shown in FIG. 3B, the nozzle tip 34 is inserted through the small hole 32 and a water jet pressurized to 2 MPa is injected under the serosa to expand the serosa. At this time, since the workability at the time of expansion is affected by the jet direction and the number of jets of the water jet from the nozzle tip 34, expansion and peeling may be advanced as shown in FIG. .

Regarding the shape of the nozzle tip, the nozzle tip 44 intersects the nozzle axis at the nozzle tip 44 as shown in FIGS. Some have jets in the direction. As the crossing direction, for example, the water jets 41a and 41b or 42a and 42b for jetting the water jet in the direction of 45 ° to 90 ° are provided, so that the injection amount of the water jet liquid below the serosa can be increased, and the expansion can be achieved. Can be shortened. Also, the nozzle tip 44
A high-frequency current is applied to the nozzle to perform incision and separation, but there is almost no clogging of the nozzle due to the adhesion of carbide in the case of the nozzle with a crossing injection port.

Now, after the swollen serosa 31 is cut at the nozzle tip 34 of the handpiece 1 having the electric knife function, the water tip knife function is used.
A water jet is spouted to exfoliate the connective tissue and adipose tissue around the gallbladder duct. Since the water jet flows around the wall of the gallbladder, the gallbladder can be easily and cleanly released. After that, it was possible to dissect the gallbladder duct with the end clip applied as usual.

Similarly, the gallbladder artery can be treated.

Next, the liver bed is dissected, and a small incision is made in the serosa using the handpiece 1 as in the case of the neck of the gallbladder, and a water jet is injected to expand the serosa. Combining the electric scalpel function and the water jet scalpel function of the handpiece 1, the detachment and separation of the connective tissue and adipose tissue of the liver bed are repeated.

When the angle of the water jet is bad at the position of the normal operation trocar, it is effective to use a nozzle having an intersecting injection port or a trocar at another position. If it is sufficiently expanded by the injection of the water jet, the peeling can be safely and easily performed.

This operation is also performed at the transition between the gallbladder serosa and the liver bed, and the gallbladder can be removed by separating connective tissue toward the bottom of the gallbladder.

In this example, the effectiveness in cholecystectomy was described. However, the abdominal cavity was exposed, exposing and releasing blood vessels, nerves and ureters, dissecting lymph nodes, incising and opening the mesentery, and detaching connective tissue. It can be applied in various fields of mirror surgery.

[0031]

As described above, according to the laparoscopic surgical apparatus and technique of the present invention, the water jet scalpel function, which cannot be used in the conventional laparoscopic surgical operation, is fully utilized to reduce bleeding. And making it easier to perform incisions and dissections, enabling safer surgery. The weakest layer of the coarse bonded fabric is the most suitable release layer, but the jet injected under the serosa spreads to the weak layer and acts as a liquid release, so that an ideal release operation can be performed. became.

Further, since one handpiece is provided with an electric scalpel function in addition to the above-mentioned water jet scalpel function, it becomes a multifunctional instrument, and the number of times of changing the instrument to the trocar in laparoscopic surgery is small. As a result, the efficiency is improved and the operation time is shortened, which is also effective in reducing the fatigue of the operator (doctor).

According to the second aspect of the present invention, since the injection port is provided in the direction intersecting the nozzle axis, the amount of liquid flowing backward along the outer diameter of the nozzle is reduced, and the amount of liquid injected below the serosa is increased. As a result, the time required for expansion can be reduced. In addition, the clogging of the nozzle due to the adhesion of carbide to the nozzle by the electric knife function can be reduced, and even if it is necessary to remove the carbide by filing, there is almost no effect on the nozzle injection port, and the nozzle tip The shape may be any shape such as a hook shape or a spherical shape.

[Brief description of the drawings]

FIG. 1 is an explanatory diagram showing a schematic overall configuration of a laparoscopic surgical operation apparatus according to an embodiment of the present invention.

FIG. 2 is a schematic cross-sectional view showing an example of a schematic configuration of the handpiece shown in FIG.

FIG. 3 is a schematic view showing a part of a laparoscopic cholecystectomy according to an example of an embodiment of the present invention.

FIG. 4 is an enlarged sectional view of a nozzle portion according to a second embodiment of the present invention.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Handpiece 2 Pressurizing device (water jet pump) 3 High frequency power supply 4 Nozzle pipe part 5 Physiological saline pack 8, 28 Switch 21 Grip part 22 On / off valve 24, 34, 44 Nozzle 31 Serosa 41a, 41b, 42a, 42b injection port

 ──────────────────────────────────────────────────続 き Continuing on the front page (72) Inventor Ryoji Muratsubaki 2410 Motoe Uezu City, Toyama Prefecture Inside Sugino Machine Co., Ltd. (72) Inventor Tadashi Urasawa 2410 Motoe Uozu City Toyama Prefecture F-term in Sugino Machine Co., Ltd. Reference) 4C060 FF10 FF19 KK08 KK13 KK20

Claims (4)

[Claims] 1. A high-frequency current is applied to the tip of a nozzle inserted into the abdominal cavity via a trocar to make an incision in the serosa of an organ to be resected, and the tip of the nozzle is inserted below the serosa through an incision hole. A high pressure liquid of ~ 5 MPa is jetted to expand the serosal lower layer, and the tissue at the surgical site is separated or peeled off in combination with the energized nozzle tip and the jet liquid from the nozzle tip. Laparoscopic surgery method. 2. The laparoscopic surgical method according to claim 1, wherein a high-pressure liquid is ejected from the tip of the nozzle in a direction intersecting a nozzle axis. 3. A nozzle having a length and shape capable of passing through a trocar used for laparoscopic surgery and having a tip end capable of reaching a surgical site, a surgical handpiece holding the nozzle, A laparoscopic apparatus comprising: a high-frequency power supply for supplying a high-frequency current to the tip of the nozzle; and a pressurizing device for supplying a pressurized liquid of 1 to 5 MPa to an injection hole formed in the nozzle. Surgical equipment. 4. The laparoscopic surgical apparatus according to claim 3, wherein one or more injection ports of the nozzle are provided at positions intersecting the nozzle axis.