JP2002119518A - Ultrasonic treating instrument for surgery - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an ultrasonic treating instrument for surgery for detecting the incised state of viable tissues or the service life of a clamping member by electric impedance change and easily understandably notifying a user in an operation using a so-called scissor type ultrasonic treating instrument. SOLUTION: In the treating instrument for the surgery utilizing ultrasonic vibration, the wear state of a part abutted to a probe 10 for transmitting the ultrasonic vibration in the clamping member 32 for clamping the tissues with the probe 10 is detected by measuring the change of electric impedance between the probe 10 and the clamping member 32.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an ultrasonic surgical instrument for performing procedures such as incision and coagulation of living tissue using ultrasonic vibration.

[0002]

2. Description of the Related Art An ultrasonic treatment tool is known as one of devices for performing treatments such as incision and coagulation of living tissue. As this type of device, for example, as shown in Japanese Patent Application Laid-Open No. 2000-197640, a device in which the distal end treatment section has a scissor type has been proposed. In this conventional ultrasonic treatment instrument, a vibrator incorporating an element for converting an electric signal into ultrasonic vibration, a probe attached to the vibrator by a screw to transmit ultrasonic vibration, and a distal treatment portion are excluded. And a sheath covering the probe.

[0003] A jaw for grasping a living tissue between the probe and the probe is rotatably provided at the distal end of the treatment tool. The jaw is rotated by moving an operating shaft extending from the proximal side by a handle provided on the proximal side, so that a living tissue can be gripped between the jaw and the probe, and treatments such as incision and coagulation can be performed.

[0004] A resin gripping member such as PTFE is attached to a portion of the jaw opposed to the probe in order to prevent adhesion of tissue during coagulation and incision and to improve wear resistance of the probe.

[0005]

The conventional scissors-type ultrasonic treatment instrument described above coagulates by ultrasonic vibration while sandwiching a living tissue to be treated between an ultrasonic probe and a resin gripping member provided on a jaw. Perform procedures such as incision. For this reason, the grasping member that sandwiches the living tissue presses the ultrasonic probe that is ultrasonically vibrated when the tissue is completely cut. However, when the gripping member is repeatedly pressed against the ultrasonic probe that is ultrasonically vibrated, the gripping member gradually wears.

Conventionally, when the degree of wear of the gripping member has advanced, it is determined that the life of the gripping member has expired. However, the wear state of the gripping member needs to be visually confirmed by the user, which is troublesome. . Also, the jaws must be opened with the tissue completely incised, but it is difficult to understand that the jaws must be actually opened when the tissue is completely incised. In order to avoid opening the jaws when the incision cannot be completely made, the user tends to continue oscillating the ultrasonic vibration more than necessary. In other words, even when the tissue is completely incised and the gripping member is in direct contact with the probe, the time during which oscillation continues is prolonged. For this reason, there was a drawback that the wear of the gripping member progressed and the life of the gripping member was shortened.

The present invention has been made in view of the above problems, and an object thereof is to reduce the incision state of a living tissue or the life of a gripping member in an operation using a so-called scissor-type ultrasonic treatment instrument. It is an object of the present invention to provide an ultrasonic treatment instrument for a surgical operation, which is detected by a change in electrical impedance, notifies the user in an easy-to-understand manner, and controls oscillation.

[0008]

The invention according to claim 1 is
An ultrasonic surgical instrument using ultrasonic vibration has a gripping member for gripping tissue between a probe that transmits ultrasonic vibrations, and an electrical impedance between the gripping member and the probe. And a means for detecting a change in

According to a second aspect of the present invention, there is provided a surgical treatment instrument utilizing ultrasonic vibration, wherein a portion of the gripping member for gripping the tissue between the probe and the probe transmitting ultrasonic vibration is in a worn state. Is provided by detecting a change in electrical impedance between the gripping member and the probe.

[0010] The invention according to claim 3 is characterized in that a function of controlling the oscillation of ultrasonic vibration transmitted to the probe by measuring the change in the electrical impedance between the gripping member and the probe is provided. An ultrasonic surgical instrument according to claim 2.

According to a fourth aspect of the present invention, at least one conductive member having a constant electrical impedance is disposed on the gripping member, and the conductive member is used to move the probe between the gripping member and the probe. The ultrasonic treatment device for surgical operation according to claim 2 or 3, wherein a change in electrical impedance is generated.

According to the above configuration, it is possible to positively inform the user of the incision state and the replacement time. In addition, extra oscillation can be prevented by detecting the incision state, and the life of the ultrasonic treatment instrument can be extended. As a result, it is possible to save the trouble of confirming the use state of the ultrasonic surgical instrument and extend the life.

[0013]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS (First Embodiment) An ultrasonic surgical instrument according to a first embodiment of the present invention will be described with reference to FIGS.

The ultrasonic treatment device 1 of the present embodiment comprises a transducer unit 2, a probe unit 3, and a handle unit 4.
Are constituted by three units which are detachable from each other. The transducer unit 2 incorporates a piezoelectric element (not shown) for converting a current into ultrasonic vibration. The piezoelectric element is covered by a transducer cover 5. Transducer unit 2
A cord 6 for supplying a current to the piezoelectric element by a power supply device main body 80 described later extends to the rear end.

A horn 7 for transmitting the ultrasonic vibration to the probe unit 3 while increasing the amplitude of the ultrasonic vibration to some extent is provided at the output end of the piezoelectric element.
An attachment 8 for connecting the handle unit 4 is fixed to a front end of the handle (see FIG. 4).

A metal ring 9 partially cut away is attached to the outer periphery of the attachment 8. Further, a screw portion 7 a for attaching the probe unit 3 is provided at a tip portion of the horn 7.

At the base end of the probe 10 of the probe unit 3, a screw portion 10a for connecting to the screw portion 7a of the horn 7 is provided. The probe 10 is designed so that the entire length from the horn 7 is an integral multiple of a half wavelength. Further, the probe unit 3 has a reduced axial cross-sectional area at several points corresponding to vibration nodes in the middle of the probe 10 so that an amplitude required for ultrasonic treatment can be obtained at the tip of the probe 10. Further, rubber rings 11 for preventing interference between the probe unit 3 and the handle unit 4 are attached at several positions at the joint positions (see FIG. 4).

The handle unit 4 is provided with a cylindrical insertion portion 12 to be inserted into a body cavity of a patient during an operation, and an operation portion 14 for operating an operation portion provided at a distal end of the insertion portion 12. ing. The insertion section 12 has a long axis outer pipe 15 extended from the operation section 14, and a base end portion of the outer pipe 15 is fixed to a pipe fixing member 16. Outer pipe 15
Inside, a first inner pipe 17 for passing the probe unit 3 and a second inner pipe 19 for passing a drive shaft 18 for transmitting an operation driving force to the operating portion at the distal end are provided. A distal end cover 20 is attached to a distal end portion of the outer pipe 15. End cover 20 and first inner pipe 17
A cylindrical probe holding member 21 for preventing the probe 10 from directly interfering with a metal part is attached to the inner surface of the probe. The probe holding member 21 is fixed with its intermediate outer surface portion sandwiched between the tip cover 20 and the inner pipe 17.

An operating portion for holding tissue between the probe 10 and the probe 10 is attached to the distal end cover 20. That is, the jaw 25 for grasping the tissue is rotatably attached via the two fulcrum pins 26 located coaxially.
The drive shaft 1 is connected to the rear end of the jaw 25 via a pin 27.
8 are fixedly connected to each other. The drive shaft 18 passes through the end cover 20 and the second inner pipe 19 and passes through the operation unit 14.
The base end of the drive shaft 18 is connected to a slider member 29 disposed in the operation unit 14 via a pin 28. The slider member 29 is slidable in the axial direction of the insertion portion. That is, in the present embodiment, the scissors-type ultrasonic treatment tool 1 is configured.

As shown in FIG. 2, a conductive gripping member mounting member 31 and a non-conductive gripping member 32 made of resin such as PTFE are rotatably mounted on the jaw 25 by a conductive pin 33. Have been. The gripping member 32
Is the distal treatment section 13 of the probe 10 of the probe unit 3
It is designed to engage with itself in a closed state. When the jaw 25 is closed, the distal treatment section 1 of the probe 10
Only the grip member 32 comes into contact with 3 (see FIG. 2B).

The holding member mounting member 31 and the holding member 32 held by the holding member 31 are
When gripping the living tissue, the gripping member 32 follows the bending of the probe 10 and rotates so as to uniformly hit the living tissue over the entire length of the distal treatment section 13 when gripping the living tissue. It has become.

The pipe fixing member 16 which is a member on the handle unit 4 side includes an outer pipe 15, an end cover 20,
Both the fulcrum pin 26 and the jaw 25 are electrically connected to the conductive holding member mounting member 31 via a conductive member.

The gripping member 32 is made of an electrically insulating member. The probe unit 3 is electrically insulated from members electrically connected to each other on the handle unit 4 side by a rubber ring 11 provided at a node of vibration. The probe unit 3 is electrically connected to the cord 6 via a horn 7 and an internal circuit (not shown) of the vibrator unit 2.

As shown in FIG. 4, the operating unit 14 has the mounting unit 4 in which the vibrator unit 2 is fitted and detachably mounted.
1, a movable handle 44 is rotatably attached to the mounting portion 41 via a fulcrum pin 43, as shown in FIG. As shown in FIG. 1, the fixed handle 42 and the movable handle 44 are provided with finger hooks 45 and 46, respectively. As a result, the movable handle 44 rotates.

As shown in FIG. 4, the pipe fixing member 16 supporting the insertion portion 12 is attached to the mounting portion 41 by a fixing ring 51 so as to be rotatable around the axis of the insertion portion. A rotary knob 5 is provided on the outer peripheral portion of the tip of the pipe fixing member 16.
3 is fitted and fixedly attached. A slider member 54 is slidably fitted in the pipe fixing member 16 in the axial direction of the insertion portion. A long guide groove 55 is formed in the rear end portion of the pipe fixing member 16 along the insertion portion axial direction, and a pin 56 provided in the slider member 54 is fitted into the guide groove 55, and the pipe fixing member 16 and the slider member Relative rotation about the axis of 54 is regulated. By rotating the rotary knob 53 with the above configuration, the insertion portion 1
Numeral 2 indicates that the transducer unit 2 and the probe unit 3 can rotate around an axis with respect to the operation unit 14 of the handle unit 4.

Further, as shown in FIG.
Packings 58 and 59 are attached to 4 to prevent, for example, insufflation gas or the like during laparoscopic surgery from leaking from the distal end of the insertion section 12 through the internal gap.

Two driving force transmitting pins 61 are mounted on the movable handle 44 coaxially. The two driving force transmitting pins 61 are fitted into and engaged with a circumferential groove 62 formed on the outer periphery of the slider member 54 (see FIG. 5).

As shown in FIG. 4, connecting members 66 and 67 for forming a groove 65 for engaging with the ring 9 of the vibrator unit 2 are formed at the rear end of the mounting portion 41 of the handle unit 4. Has been fixed. The ring 9 is removably engaged with the groove 65 by the elastic deformation of the ring 9, and the handle unit 4 and the vibrator unit 2 are detachably engaged.

The mounting portion 41 of the handle unit 4 is provided with a terminal 70 electrically connected to the pipe fixing member 16 attached thereto. This connection terminal 70
Has an electrically insulating pipe 71 attached to a member of the mounting portion 41, and a connector 73 of a cord 72 is detachably connected to the pipe 71. An electrically conductive contact ball 74 and a spring 75 are provided in the pipe 71. When the connector 73 of the cord 72 is connected to the pipe 71, the contact ball 74 is pressed against the surface of the pipe fixing member 16 on the handle unit 4 side by a constant force by the spring 75, thereby ensuring electrical connection. Note that a configuration in which the cord 72 is fixedly connected to the terminal 70 may be employed. The cord 72 is connected to the power supply main body 80. The power supply device main body 80 is provided with an output switch 81 and a power cord 82.

Next, the operation of the ultrasonic surgical instrument 1 will be described. When the movable handle 44 of the operation unit 14 is gripped and the movable handle 44 is rotated, the driving force transmission pin 61 fixed to the movable handle 44 is rotated, and the slider member 54 engaged with this is axially moved. The drive shaft 18 connected to the slider member 54 advances and retreats at the same time. For this reason, the jaw 25 at the distal end of the insertion portion rotates about the fulcrum pin 26. By this operation, the living tissue is sandwiched between the distal treatment section 13 of the probe 10 and the gripping member 32, and the treatment can be performed by ultrasonically oscillating the probe 10.

The gripping member mounting member 31 and the gripping member 32 are rotatable with respect to the jaws 25 via pins 33. Therefore, when the living tissue is grasped, the grasping member 32 follows the bending of the probe 10 of the probe unit 3 and uniformly hits the living tissue over the entire length.

The pipe fixing member 16 of the operation section 14 is electrically connected to the holding member attaching member 31 via the outer pipe 15, the tip cover 20, the fulcrum pin 26, the jaw 25 and the like. The probe unit 3 and the handle unit 4 are electrically insulated by a rubber ring 11 provided at a node of the vibration. Further, since the gripping member 32 is made of a member having electrical insulation, the probe unit 3 and the handle unit 4 are normally electrically disconnected. Further, the probe 10 of the probe unit 3
Are electrically connected to the cord 6 via a horn 7 and an internal circuit (not shown) of the vibrator unit 2.

With the above configuration, when the jaw 25 is closed, the cord 6 and the cord 72 are normally electrically insulated. However, the gripping member 32 wears due to repeated use, and the gripping member mounting member 31 comes into direct contact with the distal treatment section 13 of the probe 10. Then, both are electrically connected, and the electrical impedance value Z between the cord 6 and the cord 72 decreases.

The change in the impedance value Z between the cord 6 and the cord 72 is detected by an internal circuit of the power supply unit 80. That is, according to the program of the flow of the output control flowchart shown in FIG. 7, when the impedance value Z falls below a certain value (prescribed value) Z1, the operation of stopping the oscillation operation and sounding a warning sound is performed.

This makes it possible to clearly notify the user of the fact that the gripping member 32 has worn. At the same time, by preventing oscillation in a state where the probe unit 3 is in direct contact with the metal member, wear of the gripping member 32 and the probe 10 can be suppressed as much as possible, and their life can be extended.

The vibrator unit 2 is provided with connection pins for attaching a cord for connecting to a high-frequency power supply, and a high-frequency current is supplied to the probe through a circuit inside the vibrator to perform high-frequency treatment. It is possible.
In this case, the outer circumference of the outer pipe 15 of the insertion portion 12 is covered with an insulating tube for insulating high-frequency current.

(Second Embodiment) With reference to FIGS. 8 and 9, a description will be given of an ultrasonic surgical instrument according to a second embodiment of the present invention.

In this embodiment, the gripping member 32 of the first embodiment is provided with a conductive contact pin 90. The contact pins 90 are particularly made of a conductive resin. Here, the contact pin 90 has a certain electrical impedance, and is fixedly embedded in a state penetrating toward the probe 10 at three positions of the front end portion, the intermediate portion, and the rear end portion of the gripping member 32. . Also, each contact pin 90
Are exposed on the gripping surface of the gripping member 32. Each contact pin 90 is connected to the conductive gripping member mounting member 3.
1 directly or through a conductive pin 33. The other structure of the present embodiment is the same as the structure of the above-described first embodiment.

In the above configuration, the jaw 25 is closed and the living tissue is sandwiched between the gripping member 32 and the distal treatment section 13 of the probe 10, and all three contact pins 90 are connected to the distal treatment section 13 of the probe 10. The electric impedance value in the initial state of use, which is in contact with the peripheral surface, is such that when the gripping member 32 and the contact pins 90 are completely worn away during use, the three contact pins 90 are treated at the distal end of the probe 10. It has a value equal to or greater than the electrical impedance value Z1 in the state where the portion 13 is in contact, but has a value equal to or less than a certain constant electrical impedance value Z2.

The impedance value is measured by the circuit of the power supply device main body 80, and according to the impedance control value Z1 ≦ Z <Z2 and the impedance value Z <Z1 according to the program of the output control flowchart shown in FIG. When the incision has been made, the oscillation is stopped, and when the gripping member 32 is completely worn, the oscillation is stopped and an operation is performed to sound a warning sound. That is, when the living tissue is completely incised,
The output is stopped according to the relationship of Z1 ≦ Z <Z2. When the gripping member 32 is worn out to the end of its service life, the output is stopped and an alarm is sounded because the electrical impedance value becomes less than Z1.

Thus, the user can be clearly notified that the living tissue has been completely incised, and the life of the gripping member 32 can be extended by avoiding unnecessary oscillation operation as much as possible. Further, when the gripping member 32 is completely worn, the user can be positively notified of the replacement time by a warning sound, similarly to the first embodiment.

The present invention is not limited to the above embodiments.

[0043]

As described above, according to the present invention, the user is positively incised, or the grip member 32 is opened.
It becomes possible to notify the exchange time of the etc. Further, it is possible to prevent unnecessary oscillation from continuing by detecting the incision state, and it is possible to extend the life of the ultrasonic treatment instrument.
Thereby, the trouble of visually confirming the wear state of the ultrasonic treatment instrument for a surgical operation can be omitted, and the life can be extended.

[Brief description of the drawings]

FIG. 1 is an external view of an entire ultrasonic treatment device according to a first embodiment of the present invention.

2A is a vertical cross-sectional view of the vicinity of the distal end of the insertion portion of the ultrasonic treatment tool according to the first embodiment, FIG. 2B is a horizontal cross-sectional view along line XX in FIG. 2A, and FIG. (A) is a cross-sectional view along the line Y-Y, and (d) is a cross-sectional view along the line Z-Z in (a).

FIG. 3 is a longitudinal cross-sectional view of the vicinity of a rear end of an insertion portion of the ultrasonic treatment device according to the first embodiment.

FIG. 4 is a longitudinal sectional view of an operation unit of the ultrasonic treatment device according to the first embodiment.

FIG. 5 is a cross-sectional view of a portion along the line AA in FIG. 4;

FIG. 6 is an explanatory diagram showing a connection state of the ultrasonic treatment tool, the power supply device main body, and the foot switch according to the first embodiment.

FIG. 7 is a flowchart showing a process for detecting impedance and stopping oscillation of the ultrasonic treatment device in the first embodiment.

FIG. 8A is a longitudinal sectional view of the vicinity of a distal end of an insertion portion of the ultrasonic treatment device according to the second embodiment, and FIG. 8B is a transverse sectional view taken along line XX in FIG.

FIG. 9 is a flowchart showing a process for detecting impedance, stopping oscillation of the ultrasonic treatment device, and notifying the life of the ultrasonic treatment device in the second embodiment.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... Ultrasonic treatment tool, 2 ... Transducer unit, 3 ... Probe unit, 4 ... Handle unit, 80 ... Power supply main body, 7 ... Horn, 10 ... Probe unit probe,
18: drive shaft, 25: jaw, 31: gripping member mounting member, 32: gripping member.

Claims (4)

[Claims] 1. An ultrasonic surgical instrument utilizing ultrasonic vibration, comprising: a grasping member for grasping a tissue between the probe and a probe transmitting the ultrasonic vibration. An ultrasonic treatment instrument for a surgical operation, comprising: means for detecting a change in electrical impedance between the two. 2. In a surgical treatment instrument utilizing ultrasonic vibration, a wear state of a portion of a grip member for gripping tissue between the probe and a probe transmitting ultrasonic vibration is determined by using the grip member and the probe. A means for detecting by measuring a change in electrical impedance between the ultrasonic treatment instrument and the ultrasonic treatment instrument. 3. The apparatus according to claim 2, wherein a function of controlling the oscillation of ultrasonic vibration transmitted to the probe by measuring a change in electrical impedance between the gripping member and the probe is provided. An ultrasonic treatment tool for surgery. 4. A method according to claim 1, wherein the gripping member includes at least one conductive member having a predetermined electrical impedance, and the conductive member controls a change in electrical impedance between the gripping member and the probe. The ultrasonic treatment device for surgical operation according to claim 2, wherein the ultrasonic treatment device is formed.