JP2001087278A - Ultrasonic operation device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an ultrasonic operation device capable of separating an internal gland of a wide range by expanding a treating part to an optional width when treating, for example, prostatic hypertrophy. SOLUTION: This ultrasonic operation device is composed of a slender hollow sheath 2 inserted into a celom, an ultrasonic probe 3 longitudinally movably inserted into this sheath 2 and a treating member 17 being fixed to the tip of this ultrasonic probe 3 and opening/closing by cooperating with the sheath 2 by ultrasonically vibrating.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an ultrasonic surgical apparatus for treating, for example, benign prostatic hyperplasia.

[0002]

2. Description of the Related Art The use of a resectoscope in the treatment of benign prostatic hyperplasia has been disclosed in, for example, Japanese Patent Application Laid-Open No. 9-262.
No. 245, for example. In this resectscope, a large-area electrode (P-plate) is attached to the external surface of the patient, the active terminal of the high-frequency power supply is connected to the resectoscope, and the P-plate is connected to the neutral terminal of the high-frequency power supply. High frequency was applied from the tip of the electrode attached to the scope to the P plate through the patient's body, and the tissue was excised at the tip of the electrode of the resectoscope.

However, in this case, since a high-frequency current flows through the patient's body, heat may be generated at an unintended part of the patient's body.

[0004] In addition, it has not been possible to reliably remove the internal gland from the external gland.

As a conventional method for solving the above-mentioned problem, there is an ultrasonic operation as shown in FIG. The sheath 51 is inserted into the urethra 50, and the ultrasonic probe 54 is pressed between the intraprostatic gland 52 and the extraprostatic gland 53 to perform blunt dissection.
At this time, an ultrasonic vibration that is not strong enough to cut the tissue is transmitted to the ultrasonic probe 54.

[0006]

However, according to this conventional method, the internal glands can be separated, but the distal end of the ultrasonic probe is relatively narrow (relating to reducing the outer diameter of the sheath), so that it can be widely used. It was not adopted as a general method because it took time and the operator was tired to perform extensive dissection.

SUMMARY OF THE INVENTION The present invention has been made in view of the above circumstances, and has as its object, for example, in the treatment of benign prostatic hypertrophy, a widening range of internal gland exfoliation to shorten the operation time. It is an object of the present invention to provide an ultrasonic surgical apparatus that can perform the operation.

[0008]

In order to achieve the above object, the present invention provides an elongated hollow sheath inserted into a body cavity, an ultrasonic probe inserted back and forth into the sheath, A treatment part fixed to the tip of the ultrasonic probe, opened and closed in cooperation with the sheath by ultrasonic vibration, and a wide range of internal glands can be detached by expanding the treatment part to an arbitrary size. An ultrasonic surgical apparatus characterized by the above.

[0009]

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

1 to 3 show a first embodiment, and FIG.
FIG. 2 is a longitudinal side view of the ultrasonic surgical apparatus, FIG. 2 is a perspective view of a distal end portion, and FIG. 3 is a block diagram of an electric circuit.

As shown in FIGS. 1 and 2, an ultrasonic surgical apparatus 1 comprises a hollow sheath 2 having a through hole,
Probe 3 for treating a lesion or the like placed in a hole
The ultrasonic probe 3 is configured to move back and forth with respect to the sheath 2 by operating the handle portion 4 constituting the operation portion.

The ultrasonic probe 3 is a hollow body having a through hole, into which a scope 5 for observing a lesion or the like is inserted, and is detachably attached to the ultrasonic probe 3. ing.

The sheath 2 comprises, for example, an insertion portion 6 inserted into a body cavity through the urethra, and a main body portion 7 provided at the rear end of the insertion portion 6. A water supply mouthpiece 8 with a cock for supplying a physiological saline solution having conductivity as a perfusate to the treatment section is provided on the side peripheral portion. A distal end member 9 which is an insulating member, for example, formed of a hard resin member or the like is provided on the inner periphery of the distal end of the insertion portion 6.

The scope 5 is a slender body having a built-in observation optical system, and has a rigid insertion tube 10 inserted through the ultrasonic probe 3 and a hand portion 11 disposed at the base end of the insertion tube 10. It is composed of An eyepiece 12 for visual observation by an operator is provided at a base end of the hand portion 11, and a side portion of the hand portion 11 supplies illumination light for observation to an observation site (not shown). A light guide connection portion 13 to which the light guide is detachably connected is provided.

The ultrasonic probe 3 includes an ultrasonic vibrator portion 14
And a vibration transmission member 15. The ultrasonic vibrator part 14 is installed inside an exterior cover as a gripping part. The ultrasonic vibrator portion 14 is, for example, a P (not shown).
A number of piezoelectric elements made of ZT (lead zirconate titanate) and a number of electrodes corresponding to the number of these piezoelectric elements are superimposed, and these are front metal blocks provided with a metamorphic action (vibration amplification action). And a rear metal block. Further, the piezoelectric element, the electrode, the front metal block, and the rear metal block have, at the axial center thereof, an insertion path for inserting the scope 5 in the axial direction thereof. I have.

A small diameter portion 16 is formed at the tip of the vibration transmitting member 15, and a treatment member 17 made of a superelastic alloy or the like for performing an ultrasonic treatment is inserted and fixed. The treatment member 17 includes an annular portion 18 whose end is fitted to the small-diameter portion 16 of the vibration transmitting member 15 and an extending portion 20 extending from the annular portion 18 and having a peeling portion 19 at a distal end. When the extension portion 20 is located in the sheath 6, the extension portion 20 has elasticity in an opening direction, and thus the end portion is in pressure contact with the inner periphery of the sheath 2.

A ring 21 made of rubber or the like is fixed to a node of the vibration transmitting member 15. The handle portion 4 includes a sheath connection portion 22 detachably connected to the main body 7 of the sheath 2, and a sheath connection portion 22.
The vibration transmitting member 15 and the ultrasonic vibrator portion 14 projecting rearward from the rear end face of the main body are mainly formed.

The ultrasonic vibrator portion 14 is provided with a ring-shaped thumb ring 23 on which the operator's thumb is hung.

The ultrasonic vibrator portion 14 and the sheath connection portion 22 are connected via a leaf spring 24. That is, one end of the leaf spring 24 is fixed to a lever-shaped thumb hook 25 integrally fixed to the sheath connection portion 22, and the other end is connected to the ultrasonic vibrator portion 14.
It is fixed to. Thus, the ultrasonic vibrator portion 14 is always urged rearward by the leaf spring 22.

Accordingly, by appropriately operating the thumb ring 23, the ultrasonic probe 3 and the scope 5 are advanced and retracted, and the peeling portion 19 of the treatment member 17 is moved to the sheath 6
Is made to move forward and backward from the opening at the tip of the camera.

Although the treatment member 17 made of a superelastic alloy or the like for performing the ultrasonic treatment has been described as being used for peeling, treatment such as excision at the peeling portion 19 can be performed by changing the frequency of the ultrasonic wave. it can.

Next, the basic circuit configuration shown in FIG. 3 will be described. The frequency oscillating means 26 has a plurality of frequency oscillating circuits for oscillating different oscillation frequencies. In the present embodiment, a basic circuit configuration for operating the treatment member 17 at two vibration frequencies is shown.

For example, the frequency oscillation circuit 27 oscillates a vibration frequency f1 for exfoliation, and the frequency oscillation circuit 28 oscillates an oscillation frequency f2 for excision. An output controller 29 that controls the output is connected to the frequency oscillation circuit 27 that outputs the vibration frequency f1 that is an electric signal. The output controller 29 is connected to a power amplifier circuit 30, and the power amplifier circuit 30 is connected to an output matching circuit 31 that performs impedance matching at an operating frequency. Similarly, an output controller 32 is connected to the frequency oscillation circuit 27 that outputs the vibration frequency f2, and a power amplifier circuit 33 is connected to the output controller 32. An output matching circuit 34 is connected to the power amplifier circuit 33. It is connected. The output matching circuits 31 and 34 are connected to a frequency selection switching circuit 35.

The frequency selection switching circuit 35 selects the vibration frequency f1 or f2 according to the surgeon's request, outputs an electric signal of the selected vibration frequency to the ultrasonic probe 3, and operates the treatment member 17. The affected tissue is dissected or excised.

Further, an output monitor circuit 36 is connected to the output matching circuit 31, and an output monitor circuit 37 is connected to the output matching circuit 34.

The output monitor circuits 36 and 37 detect actual output values (amplitude and frequency) at the distal end of the peeling section 19 connected to the treatment member 17 and output the frequency oscillation circuit 2.
7 and 28 and output controllers 29 and 32.

The frequency oscillation circuits 27 and 28 oscillate a reference oscillation frequency, and the output controllers 29 and 32
The output is controlled according to a set level input from an operation panel or the like (not shown), and the amplitude of the peeling unit 19 maintains the amplitude of the set level based on the load information fed back from the output monitor circuits 36 and 37. Control to do. If the surgeon desires to exfoliate or resect the affected tissue with a different vibration frequency during the operation, the changeover switch provided on the operation panel or the like of the ultrasonic surgical instrument operates the frequency selection switchover circuit 35 to set the desired vibrational frequency. Switch to the ultrasonic vibration generating circuit to generate.

FIG. 4 shows a second embodiment, which relates to the improvement of the peeling portion 19 in the example of the first embodiment. The extension 20 is opened by the operation of pushing the ultrasonic probe 3 into the sheath 6, and the extension 20 narrows when the probe is retracted. At this time, both ends of the exfoliated portion 19 are in contact with each other, and when ultrasonic waves are oscillated in that state, the tissue is cut off.

At this time, if the tissue is relatively tough, it takes a long time to cut off if the end of the exfoliated portion 19 is flat, so that the blade portion 38 is provided on this flat portion to shorten the cutting time. Note that the blade portion 38 may be provided on only one of the peeling portions 19.

FIG. 5 shows a third embodiment in which the ultrasonic probe 3 is a hollow body having a through hole, into which a puncture needle 39 for observing a lesion or the like is inserted. It is configured to be able to move back and forth with respect to.

A small diameter portion 16 is formed at the tip of the vibration transmitting member 15, and a treatment member 17 made of a superelastic alloy or the like for performing ultrasonic treatment is inserted and fixed. The treatment member 17 includes an annular portion 18 whose end is fitted to the small-diameter portion 16 of the vibration transmitting member 15 and an extending portion 20 extending from the annular portion 18 and having a peeling portion 19 at a distal end. When the extension portion 20 is located inside the sheath 6, the extension portion 20 has elasticity in the opening direction, and thus the end portion is in pressure contact with the inner periphery of the sheath 6.

When performing a treatment, the peeling portion 19 is opened by moving the vibration transmitting member 15 forward, and thereafter,
The puncture needle 39 is punctured into the affected part. With the puncture needle 39 punctured into the diseased part, the vibration transmitting member 15 is pulled back and
When 0 is closed, the affected part is pinched by the puncture needle 39 and the peeling part 19, and in this state, when ultrasonic waves are oscillated, the pinched part is coagulated and incised.

FIG. 6 shows a fourth embodiment, in which a pair of biopsy cups 40 are provided at the distal end of a vibration transmitting member 15 in an elastically extending extension 41 which is normally open. When ultrasonic waves are oscillated while the affected part is held between the biopsy cups 40, the affected part is excised and housed in the biopsy cup 40. By fixing a ring 42 made of Teflon or the like to the end of one biopsy cup 40, the biopsy cup 40 can be prevented from being broken or noise.

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

(Supplementary Note 1) An elongated hollow sheath to be inserted into a body cavity, an ultrasonic probe inserted into the sheath so as to be able to move back and forth, and fixed to the tip of the ultrasonic probe for ultrasonic vibration. An ultrasonic operation apparatus comprising: a treatment section that opens and closes in cooperation with the sheath.

(Supplementary note 2) An ultrasonic surgical apparatus according to supplementary note 1, wherein the ultrasonic probe is formed in a hollow shape so that an endoscope can be inserted therein.

(Supplementary Note 3) An ultrasonic surgical apparatus according to Supplementary Note 1, wherein a blade is provided at a portion facing the treatment unit to be opened and closed.

(Supplementary Note 4) The needle in Supplementary Note 1 is provided in the hollow part of the ultrasonic probe so as to be able to move back and forth, and while the needle is punctured in the affected part, the affected part is sandwiched between the needle and the treatment part to perform ultrasonic treatment. An ultrasonic surgical apparatus characterized by the above-mentioned.

(Supplementary Note 5) An elongated hollow sheath inserted into a body cavity, an ultrasonic probe inserted into the sheath so as to be able to move back and forth, and an ultrasonic vibration fixed to the tip of the ultrasonic probe, An ultrasonic surgical apparatus, comprising: a treatment section that opens and closes in cooperation with a sheath, wherein a cup-shaped cutting section is provided at a distal end of the treatment section.

FIG. 8 shows a first disclosure example, in which the same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted.
As shown in FIG. 8, the tip of the ultrasonic probe 3 has a concave surface 6.
0 is provided. By vibrating the ultrasonic probe 3 with this configuration, cavitation occurs on the distal end surface of the ultrasonic probe 3 and a water flow (arrow) in a direction perpendicular to the concave surface 60 at the distal end of the ultrasonic probe 3. ) Occurs. As a result, an extremely strong water flow (arrow) is generated at the focal position O of the concave surface 60. The strong water flow (arrow) enables the detachment of the tissue, in particular, the detachment by blowing off loose connective tissue between different tissues.
Further, by bringing the tip of the ultrasonic probe 3 into direct contact with the tissue, the tissue itself can be emulsified and cut.

Therefore, conventionally, it was difficult to selectively remove the tissue only by pushing in the exfoliator, but by separating the tissue with the converged water flow, the bonding force can be reduced without damaging the tissue substance. Separation of a sparse boundary surface or the like is easily performed. Except where the water flow converges, the pressure of the water flow is weak and has little effect on the tissue, and it is possible to prevent unintentional exfoliation of parts other than the planned part.

FIG. 9 shows a second disclosure example, in which the same components as those in the first disclosure example have the same reference numerals and description thereof will be omitted. As shown in FIG. 9, an index 6 indicating the focal position O of the water flow (arrow) near the tip of the ultrasonic probe 3 is provided at the tip of the sheath 2.
1 is provided. With such a configuration, it is possible to peel while confirming the position to be peeled with the index 61, and it is easy to determine where the tissue is to be placed for effective peeling.

FIG. 10 shows a third disclosure example, in which the same components as those in the first and second disclosure examples are given the same reference numerals and description thereof is omitted. As shown in FIG. 10, an index 62 indicating the focal position O of the water flow (arrow) is provided at the distal end of the sheath 2.
With such a configuration, peeling can be performed by pressing the index 62 at the distal end of the sheath 2 to a position where peeling is desired, and the peeling operation is simplified.

FIG. 11 shows a fourth disclosure example, in which the same components as those in the first and second disclosure examples are assigned the same reference numerals and description thereof will be omitted. As shown in FIG. 11, the sheath 2 is slidable in the front-rear direction, and the distal end of the sheath 2 is moved between the focal position O of the water flow (arrow) and the position where at least a part of the distal end of the ultrasonic probe 3 is exposed. It can be fixed at any position. With this configuration, peeling or
The incision of the tissue can be selected by the sliding operation of the sheath 2, and a minimally invasive exfoliation and incision can be performed with one ultrasonic probe 3.

FIG. 12 shows a fifth disclosure example, in which the same components as those in the first disclosure example are assigned the same reference numerals and description thereof is omitted.
As shown in FIG. 12, the concave surface 63 at the distal end of the sheath 2 is directed obliquely forward, and the convergence position O is shifted from the axis of the ultrasonic probe 3 so that the sheath 2 can be peeled off diagonally.

FIG. 13 shows a sixth disclosure example, in which the same components as those in the first disclosure example have the same reference numerals and description thereof will be omitted.
As shown in FIG. 13, both ends of the concave surface 64 at the distal end of the sheath 2 are linear portions 64a, and the convergence position O is a straight line so that a wide range of peeling can be performed at once.

FIG. 14 shows a seventh disclosure example, in which the same components as in the first disclosure example are assigned the same reference numerals and explanations thereof are omitted.
As shown in FIG. 14, the ultrasonic probe 3 is provided with an enlarged diameter portion 65 at the distal end, a concave surface 66 is formed on the enlarged diameter portion 65, and a reflection surface 67 is provided on the inner surface at the distal end of the sheath 2. It is. With this configuration,
Ultrasonic waves radiated from the rear of the ultrasonic probe 3 can be focused on the front of the ultrasonic probe 3 using the reflection surface 67 provided at the tip of the sheath 2.

FIG. 15 shows an eighth disclosure example, in which the same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. FIG. 15A shows an ultrasonic prostate resection tool as an ultrasonic operation apparatus, and a resin member 69 is provided at one end of the treatment section 68 at the distal end of the ultrasonic probe 3.

With this configuration, FIG.
(B) As shown in (c), when the resin member 69 provided at the tip of the ultrasonic probe 3 is used so as to face the external gland 71 when the external gland 71 and the internal gland 72 of the prostate are separated, The member 69 becomes difficult to transmit the ultrasonic vibration. Further, by providing the resin member 69 on one side, the treatment section 68 vibrates in a direction substantially perpendicular to the axis due to a difference in elasticity.

Therefore, the resin member 69 of the ultrasonic probe 3
Is directed to the external gland 71, the effect on the tissue by the ultrasonic vibration can be reduced, and the treatment section 68 is easily vibrated in the vertical direction to facilitate separation.

[0051]

As described above, according to the present invention, the ultrasonic probe inserted into the elongated hollow sheath inserted into the body cavity so as to be able to move back and forth is provided, and the ultrasonic vibration is applied to the tip of the ultrasonic probe. In addition, a treatment section that opens and closes in cooperation with the sheath is provided, for example, when performing treatment of prostatic hypertrophy, the treatment section can be expanded to an arbitrary size, thereby enabling a wide range of internal gland detachment. To play.

[Brief description of the drawings]

FIG. 1 is a longitudinal sectional side view of an ultrasonic surgical apparatus according to a first embodiment of the present invention.

FIG. 2 is a perspective view of a distal end portion of the ultrasonic surgical apparatus according to the embodiment.

FIG. 3 is an exemplary block diagram of an electric circuit according to the embodiment;

FIG. 4 shows a second embodiment of the present invention, and FIG.
Sectional drawing which follows the A line.

FIG. 5 is a perspective view of a distal end portion of an ultrasonic surgical apparatus according to a third embodiment of the present invention.

FIG. 6 is a partially cutaway side view of a distal end portion of an ultrasonic surgical apparatus according to a fourth embodiment of the present invention.

FIG. 7 is a diagram showing a state in which an ultrasonic probe is pressed between an intraprostatic gland and an external gland to perform blunt dissection.

FIG. 8 is a longitudinal side view of a distal end portion showing a first disclosed example of the ultrasonic surgical apparatus.

FIG. 9 is a longitudinal side view of a distal end portion showing a second disclosed example of the ultrasonic surgical apparatus.

FIG. 10 is a longitudinal sectional side view of a distal end portion showing a third disclosed example of the ultrasonic surgical apparatus.

FIG. 11 is a longitudinal sectional side view of a distal end portion showing a fourth disclosed example of the ultrasonic surgical apparatus.

FIG. 12 is a side view of a distal end portion showing a fifth disclosed example of the ultrasonic operating apparatus.

FIG. 13 is a perspective view of a distal end portion showing a sixth disclosed example of the ultrasonic operating apparatus.

FIG. 14 is a longitudinal sectional side view of a distal end portion showing a seventh disclosed example of the ultrasonic operating apparatus.

FIG. 15 shows an eighth disclosed example of the ultrasonic surgical apparatus,
(A) is a schematic configuration diagram of the whole, (b) (c) is a use state diagram.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Ultrasonic surgical device 2 ... Sheath 3 ... Ultrasonic probe 5 ... Scope 17 ... Treatment member

 ──────────────────────────────────────────────────続 き Continued on the front page (72) Inventor Toshihiko Suzuda 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Industrial Co., Ltd. (72) Ryoichi Ono 2-43-2 Hatagaya, Shibuya-ku, Tokyo No. Olympus Optical Kogyo Co., Ltd. (72) Inventor Hideto Yoshimine 2-43-2 Hatagaya, Shibuya-ku, Tokyo Tokyo (72) Inventor Eiji Murakami 2-43 Hatagaya, Shibuya-ku, Tokyo No. 2 Olympus Optical Co., Ltd. F term (reference) 4C060 EE04 EE19 JJ13 JJ23 JJ27

Claims (1)

[Claims] 1. An elongated hollow sheath inserted into a body cavity, an ultrasonic probe inserted into the sheath so as to be able to move back and forth, and fixed to a tip of the ultrasonic probe, ultrasonically vibrated and subjected to ultrasonic vibration. And a treatment unit that opens and closes in cooperation with the ultrasonic surgical device.