JP2001061843A - Ultrasonic needling lifter - Google Patents

Abstract

PROBLEM TO BE SOLVED: To smoothly needle the highly elastic and slippery mucous membrane on the surface of the stomach wall without bleeding owing to the effect of ultrasonic vibrations. SOLUTION: This ultrasonic needling lifter has an ultrasonic needling unit 2 having a transducer 11 for transducing drive currents to ultrasonic vibrations, a needling probe 5 for transmitting the ultrasonic vibrations and a through hole 11B piercing through the transducer and the needling probe 5 coaxially with their center axes at the center. The ultrasonic needling lifter also has a lifting unit 3 which is comprised of a support thread 20 with one end fixed to the top of the lifting bar 21 and a staying bar 19 fixed to the other end of the support thread 20. The lifting unit 3 is disposed inside the through hole 11B in such a way that it can be inserted into the through hole 11B.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

TECHNICAL FIELD The present invention relates to a living body, for example,
Insert the endoscope inside the stomach, under the observation of the endoscope,
The present invention relates to an ultrasonic puncture lifting device that pierces and punctures a puncture needle percutaneously.

[0002]

2. Description of the Related Art Conventionally, for example, in Japanese Patent Application Laid-Open No. 8-150149, a lifting device for lifting an organ such as the stomach and intestine under endoscopic surgery is known. This lifting device inserts an endoscope inside the stomach,
Under observation with an endoscope, a puncture needle is punctured percutaneously, and the puncture needle is guided into the stomach by puncturing the abdominal wall and the stomach wall in this order. At this time, when puncturing the stomach wall, the puncture is performed while confirming the tumor on the stomach wall and the blood vessel running from the endoscope end in the stomach.

[0003]

However, since the stomach wall is slippery due to the surface mucous membrane, and the stomach wall is rich in elasticity, the puncture needle may not be able to puncture smoothly.

The present invention has been made in view of the above circumstances, and an object of the present invention is to provide an ultrasonic puncture lifting device which can smoothly puncture a stomach wall or the like which is rich in slippery elasticity. It is in.

[0005]

In order to achieve the above object, the present invention provides a transducer for converting a drive current into ultrasonic vibration, a probe for transmitting the ultrasonic vibration, and a probe for transmitting the ultrasonic vibration. An ultrasonic puncture lifting device having an ultrasonic puncture unit having a through-hole penetrating coaxially around a central axis, wherein a rod-shaped operation rod is provided inside the through-hole, and one end is provided at a tip of the operation rod. And a lifting unit consisting of a hanging string fixed to the other end of the hanging string and a rod-shaped hanging rod fixed to the other end of the hanging thread is disposed so as to be insertable.

[0006] An ultrasonic puncture unit is punctured in the vicinity of a target site such as a tumor under observation of an endoscope inserted into the stomach in advance and a rigid endoscope punctured the body wall. At this time, the ultrasonic puncturing unit converts the driving current into ultrasonic vibration in the transducer. By the action of this ultrasonic vibration, the abdominal wall can be punctured smoothly without bleeding. Further, the puncture can be smoothly performed on the stomach wall without applying any extra force.

[0007]

Embodiments of the present invention will be described below with reference to the drawings.

1 to 5 show a first embodiment, and FIG.
As shown in (1), the ultrasonic puncture lifting device 1 is a combination of an ultrasonic puncture unit 2, a lifting unit 3, and a guide sheath 4.

The ultrasonic puncturing unit 2 includes a transducer 11 for converting a driving current from a generator (not shown) into ultrasonic vibration, a sheath 6 covering the outer surface of the puncture probe 5 screwed to the tip of the transducer 11,
A front case 12 and a rear case 13 are provided to cover the transducer 11 on the proximal side of the sheath 6.

Further, a horn 10 and a horn 1 provided at the tip of the transducer 11 for expanding the amplitude of the ultrasonic vibration.
0, a flange 11A for fixing the transducer 11 to a part thereof, an elastic support member 14 made of, for example, rubber or the like for supporting the flange 11A, and a rear case 13.
A fixing nut 15 for fixing the flange 11A and the elastic support member 14 is screw-fixed to the rear case 13.

The transducer 11 and the puncture probe 5 are provided with a through hole 11B penetrating the central axis over the entire length. An O-ring 9 for watertightness is provided between the base 16 and the base of the through hole 11B. The base 16 is provided with a through hole passing through the rear end of the transducer 11 and the surface of the rear case 13. An airtight cap 17 for maintaining airtightness is provided on the proximal side of the base 16.

As shown in FIG. 2, the tip of the puncture probe 5 has an obliquely cut end face 8, and a through hole 11 B communicates with the conduit 7. The lifting unit 3 includes a lifting rod 21 serving as an operating rod, and an indwelling rod 19 serving as a hanging rod freely fixed to a distal end of a supporting thread 20 serving as a hanging thread fixed to a distal end of the lifting rod 21.

The guide sheath 4 includes an operation section 22 and the sheath 2.
3. A conduit 23A passing through the center of the operation unit 22 and the sheath 23 is provided. Further, an airtight cap 24 for maintaining airtightness is provided on the hand side of the operation unit 22.

3 to 5 show the inside of the stomach and the abdominal cavity, an endoscope 31 orally inserted into the stomach cavity 30, a tumor 26 inside the stomach, a trocar 32 punctured in the abdominal wall,
A rigid endoscope 25 inserted into the trocar 32 is provided.

Next, the operation of the ultrasonic puncture lifting device 1 will be described with reference to FIGS.

The ultrasonic puncture unit 2 is punctured near the tumor 26 under observation of the endoscope 31 previously inserted into the stomach and the rigid endoscope 25 inserted into the trocar 32 punctured into the body wall. At this time, the ultrasonic puncturing unit 2 converts the drive current from the generator (not shown) into ultrasonic vibration in the transducer 11 via the cord 18 and expands the amplitude in the horn 10. By the action of the ultrasonic vibration, the abdominal wall 28 can be punctured smoothly without bleeding. Further, the puncture can be smoothly performed on the stomach wall 29 without applying any extra force.

Thereafter, as shown in FIG.
The lifting unit 3 arranged in 1B is inserted into the stomach, and the indwelling rod 19 is projected from the conduit 7. Detention rod 1
Since 9 is freely supported by the support thread 20, it is opened inside the stomach.

Thereafter, the ultrasonic puncture unit 2 is moved to the stomach wall 29.
And the guide sheath 4 is inserted while using the lifting rod 21 as a guide, and the indwelling rod 19 and the sheath 2 are removed.
The stomach wall 29 is fixedly supported by the distal end portion 3. The stomach wall 29 is raised by operating the sheath 23, and the linear cutter 33 is inserted from the trocar 32 punctured in another part of the abdominal wall 28.
The anvil 33A of the linear cutter 33 and the cartridge 33B are separated from the stomach wall 29 that has been lifted according to a desired cut line 34.
To cut off the stomach wall 29. The cartridge 33B of the linear cutter 33 is replaced a plurality of times, and
The partial resection of the stomach is completed.

FIGS. 6 to 10 show a second embodiment. The ultrasonic puncturing and lifting device 35 differs from the first embodiment only in the ultrasonic puncturing unit 36. FIG.

The ultrasonic puncturing unit 36 comprises an operating section 37, a transducer 37A for generating ultrasonic vibration, a probe 38, and a tip 38A having a slightly rounded tip.

According to the second embodiment, the tumor 26 is observed under the observation of the endoscope 31 orally inserted into the stomach and the rigid endoscope 25 inserted into the percutaneously punctured trocar 32. The abdominal wall 28 and the stomach wall 29 with the probe 38 inserted in the vicinity of the conduit 23A of the guide sheath 4 in advance.
Puncture. At this time, the ultrasonic vibration generated by the transducer 37A is transmitted to the probe 38 and the distal end 38A, and the ultrasonic vibration can puncture the abdominal wall 28 and the stomach wall 29 smoothly without bleeding. Thereafter, the ultrasonic puncture unit 36 is removed from the guide sheath 4, the lifting unit 3 is inserted into the conduit 23A instead, the indwelling rod 19 is opened in the gastric lumen 30, and the indwelling rod 1 is removed.
The stomach wall 29 is supported and fixed by the end surfaces of the stomach wall 9 and the sheath 23.
9 can be raised. Other operations are the same as those of the first embodiment.

According to the first and second embodiments, the elastically slippery mucous membrane on the surface of the stomach wall can be punctured smoothly without bleeding by the action of ultrasonic vibration.

FIGS. 11 to 18 show a third embodiment.
The ultrasonic puncturing unit 2 is shown in FIGS. 11 (a) to 11 (d).
As shown in FIG. The function is to puncture the living tissue 39 with the puncture probe 5, enclose a part of the living tissue in the conduit 7, and remove the puncture probe 5, thereby obtaining a biopsy sampled tissue 39 A. Can be.

The collected tissue 39A in the conduit 7 can be removed by sending compressed air 40 or the like from the base 16. Further, as a modified example of the distal end shape of the puncture probe 5, the puncture probe 5 provided with a warp 41 on the end face of the conduit 7 as shown in FIG. 12, and a tissue at the distal end of the conduit 7 as shown in FIG. A puncture probe 5 provided with a sampling chamber 42, and a probe 5 provided with a spiral groove 43 inside the conduit 7 as shown in FIG.

These probes 5 can remove living tissue firmly. In particular, those provided with the spiral groove 43 can collect a necessary amount of living tissue according to the puncturing depth. As shown in FIG. 13, the puncture probe 5 provided with the tissue sampling chamber 42 at the distal end is more excellent in workability than the pipe-shaped probe.

In FIG. 15, a puncture needle 45 is provided inside a sheath type probe 44 that vibrates ultrasonically. In the case of this type, the puncture is performed only with a sharp puncture needle 45 and coagulates on the side surface of the sheath-type probe 44 when careless bleeding occurs. At the time of biopsy, effective living tissue with little thermal influence can be collected.

FIG. 16 shows a pulse waveform 46 of the ultrasonic vibration waveform in order to reduce the thermal influence of the tissue at the time of the biopsy.

FIG. 17 shows the tissue sampling chamber 4 of the puncture probe 5.
A capsule 47 is provided inside 2. By collecting the living tissue in the capsule inner chamber 47A and exchanging the capsule 47, the tissue can be easily recovered and at the same time, the influence of heat can be prevented.

FIG. 18 shows a shape 48 in which the tip of the puncture probe 5 is blunt. For ultrasonically vibrating probes,
Even if the tip is dull, it can be punctured smoothly.

FIGS. 19 to 26 show a fourth embodiment.
The ultrasonic needle holder 49A shown in FIG.
A probe 50, a vibration jaw 51 provided at the tip of the probe 50, a sheath 63 covering the probe 50, a movable handle 62A rotatably fixed to the sheath 63, and a jaw 52 provided at a distal end of the movable handle 62A; Joe 52
The rubber damper 52A controls the release and fixing when the jaws 52 and the vibration jaws 51 are opened and closed, a generator 56 that generates a drive current, and a cable 55 that transmits the drive current to the vibrator. Become. FIG.
9 (b), the cable 55 is omitted and the battery 58
Is shown in the figure.

According to the present embodiment, at the time of suturing the living tissue, the movable handle 62A and the vibrator 53 are grasped, and the suturing needle 57 is grasped between the vibration isolating rubber 52A and the vibrating jaw 51.
At this time, the drive current generated from the generator 56 is converted into ultrasonic vibration by the vibrator 53 via the cable 55, transmitted through the probe 50, and reaches the vibration jaw 51. The ultrasonic vibration is transmitted from the vibration jaw 51 to the suturing needle 57, and the ultrasonic vibration is applied to the living tissue, so that the amount of force required for puncturing at the time of suturing can be reduced, and the operation can be performed smoothly.
In the ultrasonic needle holder 49B, the operability is improved because there is no cable.

As a modification of the ultrasonic needle holders 49A and 49B, an ultrasonic needle holder 59 for an endoscopic surgical operation is shown in FIG. The difference is that the movable jaw 61 is provided at the tip of the elongated sheath 63, the driving rod 60 for moving the movable jaw 61 is arranged inside the sheath 63, and the movable handle 62B is arranged on the hand side. . As a result, it can be used as a needle holder even during endoscopic surgery.

In FIG. 19C, the vibrator 53 is disposed on the movable handle 62A. As a result, the action of the ultrasonic vibration increases, so that the suture needle 57 can be punctured more smoothly.

In FIG. 21, the probe 64 is provided separately from the jaw 51. Thereby, it is only necessary to process the titanium alloy, which is a difficult-to-process material, into the shape of a round bar.

The effect at the time of suturing is the same.

In FIG. 22, the movable jaw 61 is provided with a blade 61A for cutting a suture, and the vibrating jaw 51 is provided with a blade receiving portion 51A for receiving the blade. Thus, after the suturing is completed, the suture can be cut without using scissors forceps.

FIG. 23 shows a modification of FIG. That is, a needle receiving groove 51B for receiving the suturing needle 57 is provided in the vibration jaw 51. Thereby, the suture needle 57 can be securely grasped.

In FIG. 24, instead of the movable jaw 61,
A hook type jaw 65 for holding the suture needle 57 was provided. The suture needle 57 includes a probe 64 and a hook type jaw 65.
The number of parts can be reduced.

FIGS. 25 (a), 25 (b), 26 (a),
26 (b) shows a modification in which coagulation and incision and suturing of a living tissue can be performed with one ultrasonic needle holder. Living tissue 68A
When performing coagulation and incision, the ultrasonic vibration waveform is vibrated at the wavelength indicated by the waveform 67 at the time of suturing, so that the incision 68B of the living tissue is formed.
26A and 26B, the waveform of the ultrasonic vibration is vibrated at the wavelength shown by the waveform 66 at the time of coagulation and incision of the living tissue (an integer multiple of the waveform 67 at the time of suturing).

The wavelength (frequency) of the ultrasonic vibration is not necessarily the same as described above, and may be low during suturing and high during coagulation and incision.

FIGS. 27 (a) and 27 (b) show an ultrasonic combined marking clip 69A. A metal member 71 having a rhombus is provided at the tip of a soft or rigid transmission rod 70 for transmitting ultrasonic waves. At the tip of the metal member 71, a hook portion 71A for a tissue is provided. Transmission rod 7
0 is inserted into a pipe member 72 made of resin or hard rubber, and by squeezing a rhombus,
The hook 71A is closed.

A projection 70A is provided at the base end of the transmission rod 70, and is connected to a wire member 74 in the sheath.

FIGS. 28 (a) and 28 (b) show an ultrasonic combined marking clip 69B. A soft or rigid transmission rod 70 for transmitting ultrasonic waves has a fixed portion 73 at the distal end thereof, and And a closing portion 71B which is rotatable and has a hook portion at a tip end portion. The fixing portion 73 including the transmission rod 70 and the closing portion 71B are inserted into the pipe member 72, and are closed to close the closing portion 71B.

FIG. 29A shows a vascular anastomosis needle. An anastomosis needle 75 is provided at the distal end of the wire member 74. A curved portion 75A is provided at the distal end of the anastomotic needle 75, and the curved portion 75A at the distal end of the anastomotic needle 75 is pierced into the anastomotic portion of the blood vessel 76 so that ultrasonic energy can be transmitted to the anastomotic needle 75. The member 74 is connected to the generator 56 via the vibrator 53.

The anastomotic needle 75 is not limited to a single needle, but is shown in FIG.
, A fork-shaped anastomotic needle 77 may be used. Further, as shown in FIG. 29 (c), the holding portion 78 connecting the wire member 74 and the anastomotic needle 75 is provided at a "node" of vibration, and is formed of polytetrafluoroethylene or silicon rubber. Accordingly, it is possible to prevent oscillation failure, heat generation, breakage, and the like when gripping with a needle holder or the like.

According to the above embodiments, the following configuration is obtained.

(Supplementary Note 1) A transducer having a transducer for converting a drive current into ultrasonic vibration, a probe for transmitting the ultrasonic vibration, and a through hole penetrating coaxially about the center axis of the transducer and the probe. A sonic puncture unit, wherein a rod-shaped operation rod is provided inside the through-hole,
An ultrasonic puncture lifting device, wherein a lifting unit comprising a hanging thread having one end fixed to the tip of the operating rod and a rod-shaped hanging rod fixed to the other end of the hanging thread is arranged to be insertable.

(Supplementary note 2) The ultrasonic puncture lifting device according to supplementary note 1, wherein the probe distal end face is formed in an acute slope.

(Supplementary Note 3) The ultrasonic puncture lifting device according to supplementary note 2, wherein a sheath covering a part of the outer surface of the probe is provided.

(Supplementary Note 4) The ultrasonic puncture lifting device according to Supplementary Note 3, wherein a seal member for maintaining airtightness is provided at a proximal portion of the through hole near the side.

(Supplementary Note 5) An ultrasonic puncture lifting device according to supplementary note 1, wherein the manipulating tube is configured such that an operating rod can be inserted through a mantle tube whose inner diameter is larger in the radial direction than the outer diameter of the operating rod of the lifting unit.

(Supplementary note 6) An ultrasonic puncture lifting device according to supplementary note 5, wherein an airtight holding seal member is provided on the outer tube.

(Supplementary Note 7) In an ultrasonic unit including a transducer for converting a drive current into ultrasonic vibration, a probe for transmitting ultrasonic vibration from the transducer, and an outer tube through which the probe can be inserted, After removing the probe from the rod, a lifting unit composed of a rod-shaped operating rod, a hanging string having one end fixed to the tip of the operating rod, and a rod-shaped hanging rod fixed to the other end of the hanging thread was arranged to be insertable. An ultrasonic puncture lifting device, characterized in that:

(Supplementary Note 8) A vibrator that generates ultrasonic vibration, a cover that covers the vibrator, a probe that transmits ultrasonic vibration capable of transmitting ultrasonic waves, and a coaxial shaft centered on the vibrator and the center axis of the probe An ultrasonic biopsy needle, wherein an ultrasonic unit having a penetrating through-hole has a probe distal end face formed into an acute slope.

(Supplementary note 9) The ultrasonic biopsy needle according to supplementary note 8, wherein a sheath covering a part of the probe is provided.

[0056]

As described above, according to the present invention, it is possible to smoothly puncture even the elastic and slippery mucosa on the surface of the stomach wall without bleeding by the action of ultrasonic vibration.

[Brief description of the drawings]

FIG. 1 is an exploded longitudinal side view of an ultrasonic puncture hanging device according to a first embodiment of the present invention.

FIG. 2 is a vertical side view of a distal end portion of the puncture probe according to the embodiment.

FIGS. 3A and 3B show the same embodiment, and FIGS.

FIG. 4 is an explanatory diagram of a use state showing the embodiment.

FIG. 5 is an explanatory diagram of a use state showing the embodiment.

FIG. 6 is an exploded side view of an ultrasonic puncture hanging device according to a second embodiment of the present invention.

FIG. 7 is an explanatory diagram of a use state showing the embodiment.

FIG. 8 is an explanatory diagram of a use state showing the embodiment.

FIG. 9 is an explanatory diagram of a use state showing the embodiment.

FIG. 10 is a perspective view of a guide sheath showing the same embodiment.

FIGS. 11A and 11B show a third embodiment of the present invention, wherein FIGS.
(D) is a use state diagram of the puncture probe.

FIG. 12 is a longitudinal sectional side view showing a modification of the distal end portion of the puncture probe of the embodiment.

FIG. 13 is a vertical cross-sectional side view showing a modification of the distal end portion of the puncture probe of the embodiment.

FIG. 14 is a vertical cross-sectional side view showing a modification of the distal end portion of the puncture probe of the embodiment.

FIG. 15 is a vertical cross-sectional side view showing a modification of the distal end portion of the puncture probe of the embodiment.

FIG. 16 shows the same embodiment, and shows a pulse waveform of an ultrasonic wave.

FIG. 17 is a vertical cross-sectional side view showing a modification of the distal end portion of the puncture probe of the embodiment.

FIG. 18 is a longitudinal sectional side view showing a modification of the distal end portion of the puncture probe of the embodiment.

FIGS. 19A and 19B show a fourth embodiment of the present invention, wherein FIGS.
(C) is a perspective view of the state of use of the ultrasonic needle holder.

FIG. 20 is a side view showing a modified example of the ultrasonic needle holder of the embodiment.

FIG. 21 is a side view showing a modified example of the ultrasonic needle holder of the embodiment.

FIG. 22 is a side view showing a modified example of the ultrasonic needle holder of the embodiment.

FIG. 23 is a side view showing a modified example of the ultrasonic needle holder of the embodiment.

FIG. 24 is a side view showing a modified example of the ultrasonic needle holder of the embodiment.

FIG. 25 is a side view showing a modified example of the ultrasonic needle holder of the embodiment.

FIG. 26 is a diagram showing a waveform of ultrasonic vibration of the ultrasonic needle holder of the embodiment.

FIG. 27 is a longitudinal sectional side view of the usage state showing the clip for marking combined with ultrasonic waves.

FIG. 28 is a longitudinal sectional side view of the use state showing the clip for marking combined with ultrasonic waves.

FIG. 29 is a perspective view showing a vascular anastomosis needle.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Ultrasonic puncture lifting tool 2 ... Ultrasonic puncture unit 3 ... Hanging unit 4 ... Guide sheath 5 ... Puncture probe 19 ... Indwelling rod (suspension rod) 20 ... Support thread (suspension thread)

 ──────────────────────────────────────────────────続 き Continuing on the front page (72) Inventor Mitsumasa Okada 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd. (72) Inventor Masaaki Ueda 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd. (72) Inventor Hiroshi Okabe 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd. (72) Kenichi Kimura 2-43-2, Hatagaya, Shibuya-ku, Tokyo Within Olympus Optical Co., Ltd. (72) Takahiro Ogasaka, Inventor 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd. (72) Akira Shiga 2-43-2, Hatagaya, Shibuya-ku, Tokyo (72) Inventor Takeaki Nakamura 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Industry Co., Ltd. in the F-term (reference) 4C060 FF35 JJ13 MM26

Claims (1)

[Claims] 1. An ultrasonic puncture having a transducer for converting a driving current into ultrasonic vibration, a probe for transmitting the ultrasonic vibration, and a through-hole penetrating coaxially with the transducer and the probe around a central axis. An ultrasonic puncture lifting device comprising a unit, a rod-shaped operation rod, a suspension string having one end fixed to a tip of the operation rod, and a second end fixed to the other end of the suspension thread inside the through-hole. An ultrasonic puncture lifting device characterized by disposing a lifting unit composed of a rod-shaped lifting rod so as to be inserted therethrough.