JP2003079634A - Treatment instrument for surgical operation - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a treatment instrument for surgical operation performing the identification of SLN (sentinel lymph node) and capable of more simply approaching SLN to perform evulsion. SOLUTION: The treatment instrument 1 for surgical operation is equipped with a cylindrical insertion part 2 having a forceps part 12 connected to the leading end thereof and the proximal part 3 provided to the base end of the insertion part 2 and capable of operating the forceps part 12 through the wire 21 inserted in the insertion part 2. A scintillation crystal 24 capable of detecting the radiation emitted from SLN is provided to the forceps part 12. One end of a light guide optical fiber 26 is connected to the scintillation crystal 24 to transmit the signal of the detected radiation by the light guide optical fiber 26. This signal can be outputted by the radiation detector 30 connected to the other end of the light guide optical fiber.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical treatment tool.

[0002]

2. Description of the Related Art For example, in a surgical operation for cancer, it is standard to excise a tumor part and perform lymph node dissection to prevent postoperative metastasis. However, in so-called early-stage cancer, the frequency of lymph node metastasis is low, and dissection is performed even for patients who originally do not require lymph node dissection.
OL (quality of life)
It has become clear that it is decreasing.

Therefore, in recent years, for such an early stage cancer, a concept called a sentinel lymph node (hereinafter referred to as SLN), which is a lymph node that receives lymph flow from a cancer cell first, has been studied. The concept of this SLN is that if SLN causes lymph node metastasis first, it will be searched intraoperatively and removed, and if rapid pathological diagnosis is performed and there is no metastasis in SLN (if there are no cancer cells),
It is to improve the patient's QOL without dissection.

Magazine "Gastroenterological Surgery 2000-October issue"
(Vol.23, No.11, P1689 to 1696)
In "Detection of sentinel lymph node by radioisotope", radioisotope (radioactive drug) was injected into the vicinity of the tumor before surgery, and the lymph node where gamma rays were emitted intraoperatively, that is, the position of SLN was searched using a gamma ray detection probe. , A technique called a radioisotope method (RI method) for identifying the position of this SLN is disclosed. With this technique, more radiopharmaceutical is retained at the location of the tumor or SLN than at other locations,
The aim is to identify the location of these tumors and SLNs by utilizing the fact that more radiation is emitted from these tumors and SLN locations than at other locations.

Another technique is disclosed in Japanese Patent Laid-Open No. 6-25844.
No. 0 publication discloses a radiation detection probe for a laparoscope. U.S. Pat. No. 5,961,458 discloses a probe for radiation detection, which has a member for hooking and collecting tissue at its tip. Japanese Utility Model Laid-Open No. 4-7851 discloses a passage extending in the axial direction through which a treatment tool can be inserted in an elongated radiation detection probe. JP-A-2-
No. 80063 discloses a combination of radiation detecting means for identifying cancer cells and various treatment tools (ultrasonic suction device, heat probe, bipolar electrode, RF thermotherapy, biopsy forceps, cytodiagnosis brush, injection needle). It is shown.

[0006]

When performing the RI method by laparoscopic surgery, a radiation detection probe is inserted into a port to identify the position of the SLN that is the radiation source. After the is identified, this radiation detection probe is no longer needed. Since this radiation detection probe needs to be replaced with a treatment tool for extracting the SLN, the operation becomes complicated. Further, in order to eliminate the need for exchanging the radiation detection probe and the treatment tool, another port is required in addition to the cost of the port and the invasion of the patient can be further increased.

The radiation detecting probe disclosed in Japanese Utility Model Laid-Open No. 4-7851 has a large diameter because the treatment tool is inserted into the radiation detecting probe. Further, since the probe and the treatment tool are independent of each other, it is necessary to perform these operations separately. For example, the treatment tool is retracted from the tip of the probe while performing radiation detection work with the probe. This may complicate the work of the operator because of the necessity.

[0008] The probe described in US Pat. No. 5,961,458 is difficult to or cannot hook a wire to the SLN when the SLN is deep or inside adipose tissue, so that the SLN can be collected. There are things you can't do.

Further, in the radiation detecting and treating apparatus described in Japanese Patent Application Laid-Open No. 2-80063, a combination of this radiation detecting and treating apparatus and various treatment tools is disclosed. The purpose of this technology is to ablate and heat the tumor after it has been identified for diagnosis, diagnosis, and treatment, to perform crushing suction with ultrasonic waves, and to collect only a part of the target site with biopsy forceps or a brush. It is a thing.

By the way, in the pathological diagnosis of SLN, a plurality of pathological slices are generally prepared, and therefore it is desirable to remove them while keeping the shape of lymph nodes as much as possible.

The present invention has been made in order to solve such a problem, and is a surgical treatment capable of easily identifying a radiation source and extracting the radiation source. The purpose is to provide ingredients.

[0012]

In order to solve the above problems, according to the present invention, a surgical treatment instrument is provided with an insertion portion having a forceps portion connected to the distal end thereof and a proximal end of the insertion portion. And a hand part which is provided.

The forceps section is provided with a radiation detecting section for detecting the radiation emitted from the radiation source. Further, the radiation detecting section is characterized in that a detection signal transmitting means for transmitting this signal to a signal output means for outputting a signal of the detected radiation is connected.

Further, the forceps portion can be switched between a state in which the radiation emitted from the radiation generation source is directly incident on the radiation detecting portion and a state in which the incidence on the radiation detecting portion is restricted. It is preferably formed.

Further, the forceps section is preferably connected to a radiation source treatment means capable of transmitting energy.

[0016]

BEST MODE FOR CARRYING OUT THE INVENTION (First Embodiment) First, referring to FIG.
A surgical treatment tool (hereinafter referred to as a treatment tool) 1 according to the present embodiment will be described with reference to FIGS. As shown in FIG. 1, the treatment tool 1 includes a tubular insertion portion 2 and a proximal portion 3 connected to the proximal end of the insertion portion 2.
A first handle 4 having a finger hanging ring portion 4a at its tip is connected and extends below the hand portion 3. That is, the first handle 4 is preferably formed integrally with or fixed to the hand portion 3. Further, like the first handle 4, the finger hook ring portion 5 is attached to the tip.
The second handle 5 having a is the first handle 4
And are provided symmetrically downward from the hand portion 3. The first and second handles 4, 5 preferably have a pair of protrusions 6 projecting laterally toward the handles 4, 5 at symmetrical positions in the middle of the proximal and distal ends, respectively. Have eight. Pins 7 are inserted into holes (not shown) in the protrusions 6 and 8, and handles 4 and 5 are pivotally attached to each other. Therefore, the second handle 5 is rotatable with respect to the first handle 4 about the pin 7. The hand part 3 includes a guide part (not shown), and the base end of the second handle 5 is freely movable along the guide part to the distal end side and the base end side of the treatment instrument 1 around the pin 7. It is possible. Also, the second handle 5
A hole 23 to which a wire 21 described later is connected is provided at the base end of the.

The hand part 3 and the first and second handles 4 and 5 are made of a conductive material such as stainless steel, and the outer surfaces thereof are coated with an insulating material such as a fluororesin material. Is preferred.

As shown in FIGS. 1 to 3, a forceps portion 12 is provided at the tip of the insertion portion 2. An elongated fixed jaw 9 is fixedly connected to the forceps portion 12 at the tip of the insertion portion 2. A movable jaw 10 is pivotally attached to the fixed jaw 9 so as to be openable and closable with respect to the fixed jaw 9 by a pin 11 inserted into a hole 19 described later.

As shown in FIG. 2, the fixed jaw 9 comprises a gripping part 14 having a preferably flat tip and the gripping part 1
4 and extends rearward, and has a substantially cylindrical first connecting portion 15 connected to the tip of the insertion portion 2. As shown in FIG. 3, a slit 18 is provided in the upper front part of the first connecting portion 15. 2 and 3
As shown in FIG. 2, the movable jaw 10 has a grip portion 16 having a preferably flat tip, and an elongated second V-shaped second portion extending rearward from the grip portion 16 and fitted in the slit 18 of the fixed jaw 9. And a connecting portion 17 of The second connecting portion 17 has a hole 19 and a hole 20 provided slightly above the hole 19 in the direction orthogonal to the axial direction of the forceps portion 12. The pin 11 is inserted into the hole 19, and both ends of the pin 11 are fixed,
The movable jaw 10 is connected to the fixed jaw 9 so as to be rotatable (openable and closable). Further, one end of a wire 21, which will be described later, whose both ends are bent in an L shape is connected to the hole 20.

Further, as shown in FIGS. 1 and 4, the insertion portion 2 has an elongated tubular shape, and the outer peripheral surface of a hard material such as stainless steel is coated with an insulating material such as fluororesin. It is preferable to be formed of a hard resin material.

As shown in FIGS. 5 and 6, the inside of the grip portion 14 of the fixed jaw 9 is penetrated in the axial direction. A passage 22 penetrating in the axial direction is provided inside each of the first connecting portion 15 and the insertion portion 2 to which the connecting portion 15 is connected. In this passage 22, the hand part 3
The wire 21 (operating force transmitting member) through which the operating force by operating the first and second handles 4 and 5 is transmitted to the forceps portion 12 is inserted. The other end of the wire 21 is L-shaped as described above, and is connected to the hole 23 shown in FIG. 1 formed in the base end of the second handle 5. Therefore, centering around the pin 7 shown in FIG.
Is rotated with respect to the first handle 4 and the finger hooking ring portions 4a, 5a of the handles 4, 5 are operated in a direction in which they are separated from each other, the wire 21 is pulled toward the hand portion 3 side. The movable jaw 10 of the forceps portion 12 is rotated about the pin 11 and opened with respect to the fixed jaw 9. On the other hand, the finger-holding ring portions 4a, 5a of the handles 4, 5 of each other
Are operated in a direction in which they approach each other, the wire 21 is pushed toward the forceps portion 12 side, and the movable jaw 10 is rotated about the pin 11 with respect to the fixed jaw 9 and closed. In this way, the forceps 12 is opened and closed.

By the way, as shown in FIG. 5, on the upper surface of the fixed jaw 9 and the lower surface of the movable jaw 10, a plurality of fine serrated portions 13 having a saw-tooth shape are formed in a direction orthogonal to the axial direction of the insertion portion 2. Are provided so that the concavo-convex portions 13 mesh with each other when the forceps portion 12 is closed. Therefore, when the tissue is placed between the fixed jaw 9 and the movable jaw 10 and the tissue is grasped, the tissue can be made less slippery.

As shown in FIGS. 5 and 6, a first cylindrical collimator 25, which is preferably cylindrical, is disposed inside the grip portion 14 of the fixed jaw 9, and the inner cavity of the first collimator 25 is arranged. A columnar scintillation crystal 24 is embedded in this. The scintillation crystal 24 is made of, for example, a transparent crystal having a high light transmission property such as BGO or CWO, and acts as a radiation detection unit (radiation detection sensor) that emits light when radiation is incident.

Further, the first collimator 25 is hard to transmit radiation such as tungsten or lead,
It is made of a material that restricts (limits) the incidence of radiation, and an open slot 28 is provided in the upper part of this cylindrical collimator 25. Therefore, a large amount of radiation can enter the scintillation crystal 24 from the opening at the tip of the collimator 25 and the slot 28. A gap is filled in the opening on the tip side of the first collimator 25 with a sealing material 37 such as silicon.

As shown in FIGS. 5 and 7, at the base end of the scintillation crystal 24, the signal of the emitted light is transmitted to the position where it is internally penetrated in the axial direction as described above. A detection signal transmission member including the light guide optical fiber 26 is connected. In addition, as shown in FIG. 1, the light guide optical fiber 26 is introduced into the proximal portion 3 through a passage 22 that penetrates the inside of the insertion portion 2.

On the distal end side of the hand portion 3, the light guide optical fiber 26 is axially drawn from the passage 22 penetrating the insertion portion 2. The light guide optical fiber 26 is curved upward and penetrates the inside of the hand portion 3 to extend. At the top of this hand part 3, the base 2
9 is provided, and the light guide optical fiber 26 is
It is guided to the outside of the treatment tool 1 through the base 29 and is connected to a radiation detector 30 described later.

The light guide optical fiber 26
As shown in FIG. 5 and FIG. 7, the outer circumference of the light guide optical fiber 2 is covered with a covering tube 27 to prevent unnecessary light.
6 is prevented.

By the way, the radiation detector 30 (signal output means), as shown in FIG. 1, is a photoelectric conversion means for converting the light sent through the light guide optical fiber 26 into an electric signal, and amplifies this electric signal. And a measuring means for measuring the value of the radiation, and this value can be output. A foot switch 36 is connected to the radiation detector 30, and when the foot switch 36 is stepped on, the value of radiation is measured once. In this radiation detector 30, a threshold value can be set arbitrarily, and when the value of radiation exceeds the threshold value, a predetermined caution sound is emitted.

Further, as shown in FIGS. 5 to 7, a second plate collimator 38, which is preferably plate-shaped, is provided inside the grip portion 16 of the movable jaw 10. A gap is filled in the opening with a sealing material 39. The second collimator 38 is preferably made of a material, such as tungsten or lead, which is difficult for radiation to pass therethrough and whose incidence of radiation is restricted. As shown in FIG. 5 and FIG. 6, when the forceps portion 12 is closed, the upper slot 28 of the first collimator 25 is sized so as to be covered by the second collimator 38. Has been.

Therefore, as shown in FIGS. 5 and 6, when the movable jaw 10 is closed, the slot 28 of the first collimator 25 covers the scintillation crystal 24 and the second collimator 38 covers it. Therefore, it is difficult for the radiation to enter. That is, almost no radiation is incident on the scintillation crystal 24.

On the other hand, as shown in FIG.
When radiation is incident on the scintillation crystal 24 from the direction of the concave-convex portion 13 of the fixed jaw 9, the radiation is directly incident on the scintillation crystal 24 from the slot 28 of the first collimator 25. That is, the movable jaw 1
By opening or closing 0, whether or not the radiation is directly incident on the scintillation crystal 24 is controlled.

As shown in FIG. 1, an active plug 31 is connected to the tip of the finger ring 4a of the first handle 4, and the active plug 31 is connected via an active cord 32 to an electric knife power source 33. It is connected to the. A counter electrode plate 34 attached to the patient and a foot switch 35 are connected to the electric knife power source 33. When the foot switch 35 is stepped on, the forceps 12
The target site of the patient is cauterized by the high-frequency current, and the current is collected by the counter electrode plate 34 so that incision and coagulation are performed.

Further, the radiation detector 30 and the electric knife power source 3
A system controller 40 is connected to each of the terminals 3 and 3 via a serial interface cable 43. Therefore, the radiation detector 30 and the electric knife power source 3
Communication can be performed bidirectionally with 3. The system controller 40 includes a television camera device (not shown),
A plurality of devices for performing endoscopic surgery such as a light source device and a pneumoperitoneum device can be connected.

A centralized display panel 41 and a centralized operation panel 42 are connected to the system controller 40 via serial interface cables 43, respectively. The centralized operation panel 42 includes a display unit including, for example, a liquid crystal display, and a touch sensor integrally provided on the display unit. Therefore, the centralized operation panel 42 has, for example, a display function in which the states of the radiation detector 30 and the electric knife power source 33, operation switches, and the like are displayed as a setting screen, and an operation function operated by touching a predetermined area. It has and. By such a remote operation, the radiation detector 30 and the electric knife power source 33 can be set via the system controller 40, and the electric knife power source 33 is not output while radiation is detected.
For example, the radiation detection mode can be set.

As shown in FIG. 8, the centralized display panel 41 is composed of a display unit such as a liquid crystal display, and only the information that the operator wants to monitor while advancing the surgery is extracted from the system. The information of the device to be displayed is displayed. Here, an electric knife information display unit 44 that displays information on the electric scalpel (forceps part) 12, a radiation information display unit 45 that displays radiation information, and the contents of the abnormality are displayed when an abnormality is detected. An abnormality content display section 46 is provided. For example, the “mode 1” of the radiation information display unit 45, regardless of the operating state of the radiation detector 30,
It is assumed that the electric knife power source 33 is capable of outputting at any time. Further, it is assumed that "mode 2" indicates that the electric knife power source 33 cannot output only when the radiation detector 30 is in the operating state. Furthermore, it is assumed that "mode 3" is a mode used particularly when searching for a radiation source, and indicates that the electrosurgical knife power source 33 cannot always output.

Next, referring to FIGS. 9 to 12,
A case will be described in which an endoscopic surgical operation is performed on early gastric cancer that is assumed to have no lymph node metastasis using the treatment tool 1.

As shown in FIG. 9, usually, a flexible endoscope 52 is orally inserted before the operation, and the flexible endoscope 52 is made to reach the inside of the stomach 53 to confirm the tumor part 55. Then, radioisotopes (radiopharmaceuticals) are locally injected in three or four places under the mucous membrane of the stomach wall 54 around the tumor part 55 using the injection needle 56.

The radiation detector 30 shown in FIG.
In this case, a desired threshold value is input, and the operation mode of the radiation information display unit 45 shown in FIG. 8 is set to “mode 3” so that the electric knife power source 33 cannot be output.

Next, as shown in FIG. 9, for example, two first and second trocars 48a and 48b are inserted into the abdominal wall 47 to secure the abdominal cavity 49 by pneumoperitoneum. Although the two trocars 48a and 48b are pierced here, a trocar may be pierced as needed, and the tractor may be pierced by a retractor or a surgeon who grasps and pulls the liver. Forceps or the like may be inserted.

The endoscope 50 having the television camera head 51 connected to the proximal side is inserted into the first trocar 48a to observe the inside of the abdominal cavity 49. The television camera head 51 is connected to a CCU (camera control unit) (not shown), and the CCU outputs a video signal to a monitor (not shown) to display an image observed by the endoscope 50 on the monitor. Is able to.

Further, the insertion portion 2 of the above-described treatment instrument 1 is inserted into the abdominal cavity 49 in the other second trocar 48b with the forceps portion 12 closed, and the second handle 5 is attached to the first handle 4. The foot switch 36 shown in FIG. 1 is opened while rotating the treatment tool 1 with the movable jaw 10 opened with the movable jaw 10 open.
The operator steps on and measures the amount of radiation as appropriate. And
Recognize areas with high radiation values. When it is difficult to recognize a part having a high radiation value, the insertion part 2 is swung back and forth and left and right to perform the above operation.

In the case of this embodiment, there is a tumor part 55 on the back wall of the stomach 53, and a plurality of lymph nodes 57,
Suppose there is 58. Then, for example, one lymph node 57
Is SLN (radiation source), the tumor part 55
Radiation is emitted not only from the lymph node 57, but a region having high radiation is recognized. This SLN is tumor part 55
It is often located near However, it may be located far from the tumor site 55. Therefore, the forceps unit 1
With 2 open, measure the amount of radiation as appropriate and
Make sure there are no SLNs away from 5.

Then, as shown in FIG.
In order to approach the SLN 57 and the SLN 57, the operation mode shown in FIG.
3 can be output. And stomach 53
A membrane called an omentum 59 extending downward from the greater curvature is sandwiched between the fixed jaw 9 and the movable jaw 10 of the treatment instrument 1 and cauterized to make an incision.

After incising the omentum 59, as shown in FIG.
Further, a third trocar 61 inserted into the abdominal cavity 49
The grasping forceps 60 is inserted into the region, and the stomach wall 54 is grasped and pulled upward. Then, the treatment instrument 1 with the forceps portion 12 opened is inserted into the incision portion of the omentum 59, and is rotated while being moved back and forth in the axial direction to appropriately measure the value of radiation. With the sound of caution and the display of the centralized display panel 41, the region where the radiation value is higher than the threshold
Understand in more detail. At the same time, a portion having a high radiation value is observed with the endoscope 50 to confirm whether there is a lymph node. Therefore, the lymph node 5 is observed under the observation of the endoscope 50.
7, 58 can be confirmed, and one of the lymph nodes 57 has a high radiation value and is recognized and identified as SLN. Further, by grasping the lymph node 57 between the fixed jaw 9 and the movable jaw 10, the value of radiation can be measured with higher accuracy,
It can also be determined whether or not it is an SLN. And FIG.
As shown in FIG. 2, the treatment tool 1 is used to remove the SLN from the stomach wall 54.
Cut 57 so as not to damage it as much as possible. Also, this S
When the LN 57 is covered with fat or the like, the adipose tissue cannot be confirmed even by using the endoscope 50.
Then, the lymph node 57 is found by exfoliation, and the value of radiation is confirmed again to identify this SLN 57. After that, treatment tool 1
This SLN57 is excised by using so as not to damage it as much as possible.

The excised SLN 57 is subjected to pathology to perform partial excision or local excision of the tumor part 55 during the rapid pathological diagnosis. If the result of the rapid pathological diagnosis is positive, the conventional lymph node dissection is performed, and if the result is negative, the lymph node dissection is not performed and the operation is terminated, and the operation is terminated.

The surgical operation under the endoscope according to the present embodiment is an example, and when another surgical method is suitable,
Such a method can be appropriately adopted.

As described above, the following can be said with respect to the surgical treatment tool of the first embodiment. (1) Since the surgical treatment instrument that can be incised and peeled is provided with the radiation detection means, it is not necessary to replace the radiation detection probe and the surgical treatment instrument with a trocar, and the operation time can be greatly shortened. Further, in the case where the radiation detection probe and the surgical treatment tool are inserted into the abdominal cavity at the same time, at least one trocar can be reduced, so that the patient can be less invaded. (2) By setting the mode in which the electric scalpel power supply is not output while detecting radiation, the electric scalpel power supply is inadvertently output and the forceps of the surgical treatment tool damages normal tissue in the body. It can be prevented. (3) The direction of the radiation source can be more easily recognized and the position of the radiation source can be identified by rotating the insertion portion of the surgical treatment tool within the body cavity and opening and closing the movable jaw. , SLN can be found more efficiently. Further, by grasping the target site with the forceps part, the SLN can be identified more reliably.

(Second Embodiment) Next, a second embodiment will be described with reference to FIGS. 13 to 15.

As shown in FIG. 13, a surgical treatment tool (hereinafter, referred to as a treatment tool) 68 according to the present embodiment includes the treatment tool 1 to the active plug 3 according to the first embodiment.
1, the active code and the light guide optical fiber are arranged on the same axis. Also, FIG.
As shown in FIG. 4, the slot 28 provided in the first collimator 25 of the fixed jaw 9 to the treatment tool 1 according to the first embodiment, and the second slot provided in the movable jaw 10 are shown.
The collimator 38 of FIG. The configuration of the treatment tool 68 other than these is the same as that of the treatment tool 1 according to the first embodiment, and the same members are denoted by the same reference numerals as those used in the first embodiment. Is omitted.

As shown in FIG. 14, the forceps portion 70 of the treatment tool 68 includes a fixed jaw 9 and a movable jaw 69. The first collimator 9a in the fixed jaw 9
Is preferably cylindrical, and the first collimator 9a is made of a material such as tungsten or lead that is hard to transmit radiation. Then, in the first collimator 9a, as in the first embodiment, a scintillation crystal 24 is provided as a radiation detecting section. Therefore, the radiation can be incident from the direction of the tip of the forceps portion 70 in which the sealing material 37 is placed.

On the other hand, the movable jaw 69 does not include the second collimator 38 of the first embodiment. Both the fixed jaw 9 and the movable jaw 69 are preferably made of a conductive material such as stainless steel.

The insertion part 2 is preferably made of a conductive metal tube such as stainless steel, and its outer surface is preferably coated with an insulating material such as a fluororesin material. A passage 62, which can be inserted in the axial direction of the insertion portion 2, is provided in the hand portion 3, and the passage 62 is connected to the insertion portion 2 and connected to the base end of the scintillation crystal 24. The optical fiber 26 (detection signal transmitting means) and the wire 21 (operating force transmitting means) are inserted. Further, the hand portion 3 is provided with a hole 63 that communicates with the passage 62 in the vertical direction. The hand portion 3 is preferably made of a conductive material such as stainless steel, and it is preferable that only the outer surface thereof is coated with an insulating material such as a fluororesin material.
Therefore, the forceps portion 70, the insertion portion 2, and the hand portion 3 can be energized.

A cylindrical base 64 made of a conductive material such as stainless steel is installed in the hole 63 and extends in the axial direction of the hole 63. Through passage 62
The light guide optical fiber 26 is curved and guided to the hole 63, and is further guided from the hole 63 to the inside of the base 64. The cover tube 27 covering the light guide optical fiber 26 is covered with a blade 65 made of a metal material outside the treatment tool 68 from the portion of the base 64, and the light guide optical fiber 26 extends outward from the hand portion 3. It is extended. The blade 65 extends outward from the treatment instrument 68 and is connected to the inner cavity of the attachment / detachment portion 66 having a substantially cylindrical shape.

The light guide optical fiber 26 extends to the tip of the attachment / detachment portion 66, is fixed, and is connected to a radiation detection circuit 74 described later. A grip portion 67 is externally inserted and fixed to the outer circumference of the attachment / detachment portion 66 on the proximal side.
It is preferable that the attaching / detaching portion 66 is made of a conductive material such as stainless steel, and the grip portion 67 is made of an insulating material such as a resin material. Therefore, the forceps portion 70 and the attachment / detachment portion 66 of the treatment tool 68 can be energized.

By the way, it is preferable that the periphery of the base 64, the blade 65 and the grip 67 be covered with an insulating tube 71 made of an insulating material such as silicon.

The attaching / detaching portion 66 is attachable / detachable to / from the receiving portion 73 of the main body 72, which is a housing. When the attaching / detaching portion 66 is attached to the main body 72, the light guide optical fiber 26 at the tip of the attaching / detaching portion 66 is connected to the radiation detection circuit 74. The radiation detection circuit 74 (signal output means) includes a photoelectric conversion means for converting the light sent through the light guide optical fiber 26 into an electric signal and a measurement means for amplifying the electric signal to measure the value of the radiation. It is possible to output this value.

The radiation detection circuit 74 is a control circuit 75.
The control circuit 75 is connected to the foot switch detection circuit 76 and the front panel 79 also shown in FIG. Further, the foot switch detection circuit 76 is connected to the foot switch 77, and when the radiation detection pedal 78 of the foot switch 77 shown in FIG. 13 is depressed, a detection signal is sent to the control circuit 75 via the foot switch detection circuit 76. Sent. Therefore, the radiation detection circuit 74
The control circuit 75 issues a radiation detection command to the radiation detection circuit 74, the radiation detection circuit 74 measures the radiation, and the measured radiation value is returned to the control circuit 75.
Values are displayed on the front panel 79 shown in FIG. In addition,
Using the front panel 79 to enter the radiation threshold value in advance,
This value can be set by the control circuit 75, and when the measured value exceeds the threshold value, a caution sound is emitted.

Further, as shown in FIG. 14, in the main body 72, an oscillating circuit 82 consisting of a crystal oscillator and a driving circuit, in which oscillation / stopping of a high frequency pulse can be controlled by a control circuit 75, and a variable power source thereof are provided. Operation is control circuit 75
The power supply circuit 83 controlled by the control circuit 75 and the waveform generation circuit 85 which controls the amplification circuit 84 based on the high frequency pulse from the oscillation circuit 82 are generated, and the signal is controlled by the control circuit 75. It is set up.
Then, an amplifier circuit 84 having a resonance circuit to which the power supplied from the power supply circuit 83 is input and various abnormality detection circuits
Is provided. The amplifying circuit 84 includes a return electrode plate 34 attached to a patient, and the return electrode plate 34 is attached to the treatment instrument 6.
The high frequency current from 8 is recovered. Further, the amplifier circuit 84 is connected to the attachment / detachment portion 66 for supplying a high-frequency current to the forceps portion 70 of the treatment instrument 68.

When the incision pedal 80 or the coagulation pedal 81 of the foot switch 77 shown in FIG. 13 is depressed, FIG.
A detection signal is transmitted to the control circuit 75 from the foot switch detection circuit 76 shown in FIG. Then, as shown in FIG.
Under the control of the control circuit 75, the oscillation circuit 82 vibrates the crystal oscillator and starts the oscillation of the high frequency pulse. Further, the waveform generation circuit 85 creates a control signal for the amplification circuit 84 by the high frequency pulse from the oscillation circuit 82 and the waveform selection signal which is the control signal from the control circuit 75.
In the power supply circuit 83, the power supply voltage supplied to the amplification circuit 84 is determined by the control signal from the control circuit 75, and the amplification circuit 84 is supplied with the power supplied from the power supply circuit 83 and the control supplied from the waveform generation circuit 85. High-frequency power is supplied to the attachment / detachment unit 66 by the signal. Therefore, the forceps 70
In the radiation source treatment means such as cutting and cauterizing the SLN by using, energy is generated by the oscillation circuit 82, the waveform generation circuit 85, and the amplification circuit 84, and these energy are respectively conductive to the detachable portion 66 and the blade. The force is applied to the forceps part 70 through the 65, the base 64, the hand part 3, and the insertion part 2 in this order.

Next, referring to FIG. 15, an endoscopic surgical operation with a small laparotomy is performed on an early gastric cancer which is assumed to have no lymph node metastasis, using such a treatment tool 68. The case will be described.

First, as in the first embodiment, a flexible endoscope is orally inserted into the stomach 90 shown in FIG. 15 before the operation, and the radioisotope is locally injected around the tumor site 91. Then, a trocar (not shown) is inserted into the abdominal wall 86 to inflate the stomach to secure a cavity, and then a membrane such as omentum is treated with the treatment tool 68 as necessary. Further, the front panel 79 is operated to set the radiation threshold.

Subsequently, as shown in FIG. 15, the trocar and treatment instrument 68 are once removed from the body cavity, and the abdominal wall 86 is removed.
A small incision portion 87 is provided in the upper portion, and a plurality of lifting hooks 88 are hooked on the small incision portion 87 to lift the abdominal wall 86. Trocar 8
Under the observation of the endoscope 89 through the 9a, the treatment instrument 68 is inserted into the abdominal cavity from the small incision portion 87, and the treatment instrument 68 is appropriately moved in the abdominal cavity as indicated by a chain double-dashed line. The radiation detection pedal 78 of the foot switch 77 shown in FIG.
Step on to measure the radiation value and measure this value on the front panel 7
9 is displayed. By performing a series of these operations, the radiation of the lymph node 92 shown in FIG. 15 has a high directivity and is easy to detect. By directing the radiation toward the portion 91, the value of this radiation can be measured. The radiation value of the lymph node 92 is set to the tumor part 91.
It is possible to measure from the direction where there is no influence of.

Further, for example, if the radiation value of the lymph node 92 is higher than the threshold value as a result, it can be identified as SLN, and the lymph node 93 similarly measures the radiation value from each direction. If the value is below the threshold,
It can be determined that it is not an SLN.

Then, both the incision pedal 80 and the coagulation pedal 81 of the foot switch 77 are properly used so that a high-frequency current is passed through the forceps portion 70 of the treatment instrument 68 so that the lymph node 92 which is the SLN is not damaged as much as possible. Excised and removed outside the body. Then, as in the first embodiment, the extracted lymph node 92 is submitted for rapid pathological diagnosis, and the tumor site 9
After partial excision or local excision of 1, if the result of the rapid pathological diagnosis is positive, the conventional lymph node dissection is performed, and if negative, the operation is terminated without performing lymph node dissection.

The surgical operation under the endoscope according to the present embodiment is an example, and when another surgical method is appropriate,
Such a method can be appropriately adopted.

As described above, the following can be said in the second embodiment. (1) Since the surgical instrument that can be incised and peeled is provided with the radiation detection means, the operator does not need to switch the treatment instrument and the radiation detection probe, and the peeling or incising operation is performed to reach the target site. Immediately after that, the operation for identifying the SLN can be started. Therefore, if the SLN can be identified, the extraction operation can be performed as it is, and the operation time can be greatly shortened. (2) Since the light guide optical fiber for radiation detection (radiation detection cable) and the active cord (energy transmission cable) are integrally arranged on the same axis, at least one cable protruding from the treatment tool is It is possible to reduce the number of cables, the cables are less obstructed, and the operability of the treatment tool can be improved.
Further, a radiation detection device (radiation detection circuit) and an energy generation device (oscillation circuit, waveform generation circuit, and amplification circuit)
Since the and are arranged in the same housing, these devices can be made compact, which contributes to space saving around the operating table and can be made inexpensive in total.

(Third Embodiment) Next, a third embodiment will be described with reference to FIGS.

A surgical treatment instrument (hereinafter referred to as a treatment instrument) 100 according to the present embodiment is different from the treatment instrument 1 according to the first embodiment in the following parts. The same members as those in the first embodiment are designated by the same reference numerals as those used in the first embodiment, and detailed description thereof will be omitted.

As shown in FIG. 16, the treatment instrument 100 according to the present embodiment has a cylindrical insertion portion 101 and the insertion portion 1
01 comprises a fixed jaw 106 arranged at the distal end, a movable jaw 105 rotatably connected to the fixed jaw 106 via a pin 11, and a hand portion 103 arranged at the proximal end of the insertion portion 101. .

The fixed jaw 106 and the movable jaw 10
5 and 5 are the same as the fixed jaw 9 and the movable jaw 10 of the first embodiment, respectively. Further, the fixed jaw 106 and the movable jaw 105 are made of a material such as tungsten that is hard to transmit radiation and regulate the incidence of radiation, and serve as a collimator for blocking radiation as much as possible. Preferably.

It is preferable that the insertion portion 101 has a cylindrical shape made of an insulating material such as a fluororesin material, and its base end is fixedly connected to an operation knob 102 described later.

At the tip of the hand portion 103, the inside extending in the axial direction is penetrated in the axial direction, and a male screw 104 is provided on the outside. The male screw 104 is, as will be described later, the operating knob 10.
It is threadedly connected to 2.

Then, from the hand portion 103 downward,
Similar to the treatment tool 1 of the first embodiment, a first handle 4 having a finger hooking ring portion 4a at its tip is connected and extends. Further, like the first handle 4, the second handle 5 having the finger hook ring portion 5a at its tip is paired with the first handle 4 and is substantially symmetrical to the hand portion 10.
It is provided from 3 downward.

The active plug 31 is projected from the tip of the first handle 4, and the active plug 31 is
Is detachably connected to the active cord 32. Although not shown, the active cord 32 is connected to the electric knife power source 33 as in the first embodiment.

As shown in FIG. 17, the base end of the fixed jaw 106 is connected to the distal end of the cylindrical inner insertion portion 108, and the base end of this inner insertion portion 108 is connected to the inner cavity of the proximal portion 103. ing.

The inner insertion portion 108 is preferably made of a superelastic alloy, and its shape is stored so that its tip is curved with a predetermined radius of curvature. The outer diameter of the inner insertion portion 108 is slightly smaller than the inner diameter of the insertion portion 101,
The inner insertion portion 108 is slidable in the axial direction with respect to the insertion portion 101.

A female screw 1 to be screwed with a male screw 104 of the hand portion 103 is provided in the inner cavity of the operation knob 102 on the hand side.
09 are provided. This male screw 104 and female screw 10
As shown in FIG. 16 (a), the treatment instrument 100 has an insertion portion 10 depending on the axial extent (length) with which the screw 9 is screwed.
The distal end of 1 abuts on the proximal end of the fixed jaw 106, and the forceps portion 107 is straight and straight with respect to the insertion portion 101. As shown in FIG. The internal insertion portion 108 is exposed and the forceps portion 107 is curved with respect to the insertion portion 101.

As shown in FIG. 17, a cylindrical scintillation crystal 24 is arranged in the inner cavity of the tip of the fixed jaw 106.
A light guide optical fiber 26 is connected to the rear end of the optical fiber 4. At the position where the scintillation crystal 24 of the fixed jaw 106 contacts the movable jaw 105 directly above,
For example, an incident portion 110 made of a material such as a fluororesin material that transmits radiation is provided.

As shown in FIGS. 17 and 18,
The movable jaw 105 is provided with a cylindrical scintillation crystal 111 at a position eccentric from the center of its tip. The tip of the scintillation crystal 111 is opened, and the opening is filled with a sealing material 113 such as silicon. A light guide optical fiber 112 is connected to the rear end of the scintillation crystal 111. The light guide optical fiber 112 extends from the base end of the movable jaw 105 and is integrated with the light guide optical fiber 26 in the inner cavity of the inner insertion portion 108 to form one light guide optical fiber 114. The outer peripheries of these light guide optical fibers 26, 112 and 114 are covered with coating tubes 115 to prevent extra light from entering the light guide optical fibers 26, 112 and 114 on the way.

Further, this light guide optical fiber 11
4, the passages inside the insertion portion 101 and the inner insertion portion 108 are penetrated, curved at the hand portion 103, led out to the outside through the inside of the base 29, and the radiation detection not shown in the same manner as the first embodiment. Connected to the container 30.

Since the radiation detector 30 and the electric knife power source 33 are connected in the same manner as in the first embodiment, the description thereof will be omitted.

Next, referring to FIG. 19 and FIG. 20, a case where an endoscopic surgical operation is performed for early gastric cancer which is considered to have no lymph node metastasis using such a treatment instrument 100 explain.

As in the first embodiment, before the operation,
As shown in FIGS. 19 and 20, the radioisotope is locally injected into the tumor site 118 on the posterior wall of the stomach 117 using a flexible endoscope. It is assumed that there are a plurality of lymph nodes 119 and 120 near the tumor site 118. After a certain period of time, radiation is emitted from the tumor part 118 and the SLN, for example, the lymph node 119.

As shown in FIG. 19A, the two first
And the second trocars 121a and 121b to the abdominal wall 11
After being inserted into the abdominal cavity 123 through 6 to secure a cavity, the endoscope 122 and the treatment instrument 100 are inserted into the abdominal cavity 123 via the first and second trocars 121a and 121b, respectively. The treatment tool 100 at this time is shown in FIG.
6 and FIG. 17 is rotated in a predetermined direction to insert the inner insertion portion 108 into the insertion portion 101 in a straight state shown in FIG. To do.

Then, as in the first embodiment, in consideration of the position of the tumor part 118, the treatment instrument 100 is used to cut off an omentum or the like as necessary.

Observing the inside of the abdominal cavity 123, particularly in the vicinity of the tumor site 118, with the endoscope 122, the lymph nodes 119, 1 are preferable.
Check 20. Movable jaw 105 of treatment instrument 100
In the closed state, the insertion portion 101 is directed to an appropriate direction inside the abdominal cavity 123, the value of radiation is measured, and the position of the radiation source is roughly specified.

As shown in FIG. 19B, while observing the specified direction with the endoscope 122, FIG.
The operation knob 102 shown in is rotated to expose the inner insertion portion 108 from the insertion portion 101 and bend the forceps portion 107. In this state, the forceps 107 are brought close to each other from various directions as indicated by a chain double-dashed line to measure the value of radiation,
Finely identify the location of the radiation source.

Thereafter, the movable jaw 105 is attached to the fixed jaw 1
20A, the lymph node 120 confirmed by the endoscope 122 is grasped between the fixed jaw 106 and the movable jaw 105 as shown in FIG. The value of the radiation of 120 is measured. Lymph node 120
Since the radioisotope is not stored in, the measured radiation value does not exceed the threshold value. Therefore, this lymph node 120 is not an SLN and is not excised.

Next, as shown in FIG. 20B, the lymph node 119 is grasped between the fixed jaw 106 and the movable jaw 105, and similarly, the lymph node 11 is fixed by the fixed jaw 106.
Even if the radiation value of 9 is measured, the threshold value is exceeded because the radioisotope is introduced. Therefore, since this lymph node 119 can be determined to be SLN, the lymph node 119 is treated by using the treatment tool 100 and the stomach 117.
Remove and remove as much as possible without damaging. If there is another portion where the radiation value is recognized to be high, the same operation as above is performed. The process after removing the lymph node 119 is the same as that in the first embodiment, and thus the description thereof is omitted.

The surgical operation under the endoscope according to the present embodiment is an example, and when another surgical method is appropriate,
Such a method can be appropriately adopted.

As described above, the following can be said in the third embodiment. (1) The forceps portion of the treatment tool can be freely bent with respect to the insertion portion, and the same target site can be approached from various directions. Therefore, the position of the background such as the tumor part injected with the radioisotope is identified,
Since this can be eliminated, the direction and position of the radiation source can be specified more easily and reliably.

(Fourth Embodiment) Next, a fourth embodiment will be described with reference to FIGS. In the present embodiment, a handpiece 131 for incising and coagulating an affected area by using ultrasonic waves is used instead of the electric knife of the treatment tool 68 of the second embodiment.

The handpiece 131 shown in FIG. 21 is the same as that shown in FIG.
The external unit 132 shown in FIG. 2B and the internal unit 133 shown in FIG. 22A that is detachably mounted in the external unit 132 are provided. As shown in FIGS. 21 and 22B, this external unit 132
An elongate and tubular insertion portion sheath 134, which is a member for protecting the insertion portion, and a tubular grip portion sheath 135 attached to the proximal end portion of the insertion portion sheath 134 are provided in the There is. The grip handle sheath 135 has a fixed handle 1
A gripping member operating means 138 having a movable operation handle 137 and a handle 36 is provided.

Here, the fixed handle 136 is fixed to the grip portion sheath 135, and the movable operation handle 137.
Is a pin 143 attached to the grip sheath 135.
Is pivoted by. Furthermore, finger hooking ring portions 139 and 140 are formed at the tips of the fixed handle 136 and the movable operation handle 137, respectively.

Further, FIG. 21 and FIG. 22B and FIG.
As shown in FIG. 3A, a rotation operation knob 141 is fixed to the proximal end of the insertion portion sheath 134. As shown in FIG. 23 (A), a tubular connecting portion 142 is provided at the rear end portion of the rotary operation knob 141. The distal end of the grip sheath 135 is rotatably connected to the connecting portion 142. Therefore, the proximal end portion of the insertion portion sheath 134 is attached to the grip portion sheath 135 via the coupling portion 142 of the rotation operation knob 141 so as to be rotatable about its axis. Then, by rotating the rotation operation knob 141, the insertion portion sheath 134 is moved to the grip portion sheath 1.
35 is rotated about the axis.

As shown in FIG. 22A, the internal unit 133 has an ultrasonic transducer unit 144,
A gripping member unit 152 is provided. here,
The ultrasonic transducer unit 144 includes a cover sheath 145 containing an ultrasonic transducer (not shown) and the horn 1.
46 and a slender probe 147 which is a vibration transmitting member and extends in the distal direction. A flange 194 is provided on the outer circumference of the front end side of the cover sheath 145. Further, an ultrasonic treatment section 148 is formed at the tip of the probe 147. The ultrasonic vibration generated by the ultrasonic vibrator is magnified by the horn 146 and transmitted to the ultrasonic treatment section 148 at the tip of the probe 147.

This ultrasonic treatment section 148 has a fixed blade 151.
Have. The fixed blade 151 preferably has a circular cross-sectional shape, but in addition to a rectangular shape with a narrow blade width,
A blade having various desired shapes such as an elliptical shape or a triangular shape is desirable in order to improve the treatment efficiency and make the treatment working unit compact. It should be noted that various types of fixed blades 151 are used depending on the balance between the incision action and the coagulation action, and in general, a different shape from the ultrasonic treatment portion 148 is used. Further, it is preferable that the fixed blade 151 is not formed integrally with the probe 147 but is formed as another member. Therefore, it is preferable that the fixed blade 151 is connected to the probe 147 by, for example, a screw (not shown) or the like so that the fixed blade 151 can be replaced.

Further, FIG. 22 (A), FIG. 24 (A),
25A, the holding member unit 152 has a fixed blade 151 facing the fixed blade 151.
1, a movable blade (grasping member) 153 made of metal, which is a jaw that grips and releases biological tissue, and an operating rod (grasping member driving means) 154 as an operation force transmission member that drives the movable blade 153 to open and close. And are provided. further,
In this gripping member unit 152, as shown in FIG. 24A, spacers 155 are provided at positions corresponding to the nodes n shown in FIG. 24C of the ultrasonic vibration of the probe 147. ing. Also, the operating rod 1
At the tip of 54, a gripping member support base 156 is arranged corresponding to the node portion n at the most tip position of the probe 147.

Further, as shown in FIG. 24A, groove portions 157 are provided in the upper portion of each spacer 155, and operation rods 154 are fitted and held in these groove portions 157. Here, an outer stop member 158 formed of a small-diameter pipe is fitted in each groove 157. The operating rod 154 is inserted into and fixed to the outer retaining members 158. That is, it is preferable that the operation rod 154 is fixed by the spacers 155 so as not to move in the axial direction. The spacers 155 are arranged so that the operating rod 154 does not shift from the predetermined position of each node n of the ultrasonic vibration in the probe 147.
May only be held against.

Therefore, it is preferable that the spacer 155 and the operating rod 154 be fixed directly or by the external stop member 158 as a means for attaching the operating rod 154. As long as they are not displaced from the position, they may be held by a locking means that does not fix them. Thus, these spacers 15
Since No. 5 is attached to a predetermined position of the operation rod 154, it is not necessary to process, for example, an uneven portion in order to install the spacer 155 on the probe 147 at the predetermined position. Therefore, the structures of the spacer 155 and the operating rod 154 can be simplified, the cost can be reduced, and the strength of the probe 147 and the spacer 155 can be increased.

Further, as shown in FIG. 24A, at the bottom of each spacer 155, there is a through hole 159 into which the probe 147 is inserted and held, and a slit 160 for attaching and detaching the probe 147. Has been formed. The probe 147 is slidably inserted in the through hole 159 in the axial direction. In addition, each spacer 155
Is preferably made of a material having a high slidability, such as a fluororesin material, so that it can easily slide on the probe 147.

The horn 146 and the probe 147 for transmitting the vibration generated by the above-mentioned ultrasonic transducer.
Are preferably formed of a titanium material, an aluminum material, a titanium alloy material, an aluminum alloy material, or the like, which has a high acoustic effect and good biocompatibility.

Further, as shown in FIG. 24B, a screw portion 149 is formed at the base end portion of the probe 147. The probe 147 is screwed and fastened to the base end of the horn 146 using the screw portion 149. Further, the probe 147, which is a vibration transmitting member, is formed of a substantially straight rod without a step or a groove-shaped small diameter portion, although the tapered horn portion 150 is formed in a part thereof. Due to such a structure, the strength of the probe 147 is increased.

Further, as shown in FIG. 25A, the base end portion of the movable blade 153 is pivotally attached to the tip end portion of the grip member supporting base 156 by a pin 161. Further, at the base end portion of the movable blade 153, the tip end portion of the operation rod 154 is rotatably connected. As shown in (A) of FIG. 24, the slide ring 162 is provided at the proximal end of the operating rod 154.
Are connected. The slide ring 162 is slidably fitted in the grip sheath 135. Further, an insertion hole 163 through which the probe 147 is inserted is provided at the axial center of the slide ring 162. Also, the slide ring 162
An annular groove 164 connected to the movable operation handle 137 shown in FIG. 22B is formed on the outer peripheral surface of the.

Here, as shown in FIG. 22B, the movable operation handle 13 is provided on both side surfaces of the grip portion sheath 135.
A window portion 165 for 7 is formed. A locking pin (locking body) 166 provided at the tip of the movable operation handle 137 is inserted into the window portion 165. FIG. 24 (A)
As shown in, the tip of the locking pin 166 is fitted and locked in the annular groove 164 of the slide ring 162. Then, with the operation of rotating the movable operation handle 137 around the pin 143 shown in FIG.
By sliding the slide ring 162 in the axial front-rear direction via 66 and sliding the operation rod 154 in the front-rear direction together with the slide ring 162, the movable blade 153 facing the fixed blade 151 is opened and closed.

The locking pin 16 shown in FIG.
6 is screwed into the tip of the movable operation handle 137. Then, the head 193 of the locking pin 166 is rotated in a predetermined direction, for example, by turning it to the right, so that the tip of the locking pin 166 is pushed inward to form an annular groove of the slide ring 162. 164. Further, when the head 193 of the locking pin 166 is rotated in the opposite direction, the tip is retracted, and the locking pin 166 can be removed from the annular groove 164 of the slide ring 162.

Further, as shown in FIGS. 26 and 27,
The movable blade 153 has a curved surface 16 that directly contacts the fixed blade 151 on the contact surface side of the probe 147 with the fixed blade 151.
7 are formed. This curved surface 167 has a fixed blade 151.
It is preferable that the shape can be changed according to the shape of. Further, the movable blade 153 is formed with a wavy tooth-shaped portion 168 on both sides of a curved surface 167 that is in direct contact with the fixed blade 151. Therefore, the movable blade 153 and the fixed blade 151
The living tissue is easily grasped between the and. The curved surface 167 and the tooth-shaped portion 168 of the movable blade 153 are preferably made of a fluororesin material having high slidability.

Further, as shown in FIG. 24B, a circular flange 169 is attached to the tip side of the probe 147 at the position of the node n at the tip of the ultrasonic vibration. Here, as shown in FIG. 25 (C), the movable blade 15
An engaging groove 170 having a shape corresponding to the flange 169 is formed on the lower surface of the gripping member support base 156 that supports the groove 3.
Are formed. The flange 169 is fitted and locked in the engagement groove 170. Therefore, the probe 147 is rotatably held by the gripping member support base 156.

Therefore, the gripping member support base 156
Is incorporated so that it can rotate around the axis of the probe 147 together with the insertion portion sheath 134. Therefore, the direction of the fixed blade 151 with respect to the movable blade 153 is 3
It may be at any position of 60 ° and can be used by rotating it to a position that is convenient for the operator.

Further, as shown in FIGS. 23A and 24A, the slide ring 162 has a distal end portion with
A protrusion 171 is provided on one side of the central axis of the slide ring 162. Here, as shown in FIG. 23 (B), the probe 147 is provided at the axial center of the rotary operation knob 141.
Further, a shaft hole 172 through which the operation rod 154 is inserted is formed. Further, an engagement groove 173 having a shape corresponding to the protrusion 171 is formed on one side of the shaft center hole 172. The projection 171 is engaged with the engagement groove 173 to prevent relative rotation between the slide ring 162 and the rotary operation knob 141 in the axial direction. For this reason, the protrusion 171 of the slide ring 162 has the rotation operation knob 1
Since it rotates by being engaged with the engaging groove 173 of 41, it is always rotated at the same time except for the insertion portion sheath 134 and the probe 147 of the internal unit 133.

Further, as shown in FIG. 27B, a substantially flat engaging end surface 174 is formed on the lower surface of the grip member supporting base 156. The locking end surface 174 is provided on the inner surface of the insertion portion sheath 134 to prevent the rotation stopper member 17 from being attached.
It is locked to 5. Then, this insertion portion sheath 134
When the gripping member support base 156 is rotated about the axis, the internal unit 133 is not twisted because it is rotated together with the locking member of the rotation operation knob 141.

As shown in FIG. 25A, the fixed blade 1 of the probe 147 is attached to the holding member support base 156.
In order to prevent the vibration of the portion 51, a vibration damping member 176 coated with a material having a good sliding property such as a fluororesin material is integrally provided. This swing stop member 1
Reference numeral 76 supports the horn portion 150 on the tip side of the probe 147 to prevent bending.

Further, as shown in FIGS. 22 to 28,
The ultrasonic oscillator of the ultrasonic oscillator unit 144, the horn 146, and the probe 147 are provided with through holes 177 at their axial centers.

As shown in FIG. 28, a ring-shaped receiving member 178 made of a heat-resistant elastic material such as a fluororesin material or silicon is provided at the position of the flange 169 inside the through hole 177 of the probe 147. It is inserted and fixed. Inside the receiving member 178, a cylindrical collimator 179 made of a material such as a tungsten material that is hard to transmit radiation is held. A radiation detecting element 180 such as a silicon P-N junction element as a radiation detecting means is provided in the inner cavity of the collimator 179. Behind the radiation detecting element 180, a radiation detecting element 180 is provided.
A signal wire 181 extending from the rear end of the collimator 179 is connected, penetrates through the through hole 177 and extends to the proximal side, and the cover sheath 1 shown in FIGS.
It extends from the rear end of 45. The through hole 177 on the tip side of the collimator 179 is sealed with a sealing material 196 such as silicon.

As shown in FIG. 29, the signal line 181
Are connected to the radiation detector 182. The radiation detector 182 receives an output from the amplification circuit that amplifies the signal output from the radiation detection element 180 shown in FIG. 28, measures the detection output, and displays a signal representing the amount of radiation. And a display circuit for outputting to the device. The radiation detector 182 is connected to the foot switch 183,
The amount of radiation can be measured by stepping on the foot switch 183.

Further, as shown in FIGS. 21 and 29,
To the rear end of the hand piece 131, one end of each of the ultrasonic drive power cord 187 and the electric scalpel treatment power cord 186 is connected. As shown in FIG. 29, the other ends of the ultrasonic driving power cords 187 are
It is connected to a power supply 184 for ultrasonic treatment. The other end of the power cord 186 for electric scalpel treatment is connected to the power cord 1
Power supply for high-frequency treatment (electric knife power supply) 185 via 88
It is connected to the. The ultrasonic treatment power supply 184 is connected to a foot switch 189 for ultrasonic control,
A foot switch 190 for high frequency control is connected to the electric knife power source 185. Further, a counter electrode plate 192 is connected to the electric knife power source 185 via a lead wire 191.

When the ultrasonic incision coagulator is used, the movable operation handle 137 is attached to the pin 1 with respect to the fixed handle 136.
The movable blade 153 facing the fixed blade 151 is opened and closed with respect to the fixed blade 151 in accordance with the operation of rotating around the center 43. Then, with the living tissue sandwiched between the fixed blade 151 and the movable blade 153, the living tissue is coagulated and / or incised by ultrasonic vibration.

As described above, the following can be said in the fourth embodiment. (1) Since the radiation detecting means is provided in the handpiece of the ultrasonic incision coagulator capable of incision / peeling, the operator does not need to hold the handpiece and the radiation detection probe with each other, and peeling or incision to reach the target site. Immediately after performing the operation, the operation for identifying the SLN can be started. Therefore, if the SLN can be identified, the extraction operation can be performed as it is, and the operation time can be greatly shortened. (2) Since a semiconductor detector such as a silicon P-N junction element is used to detect radiation, a light guide optical fiber is not used, and a simpler structure such as a conductive wire can be used. Easy to manufacture,
It can be provided at a lower cost.

As described above, according to the first to fourth embodiments, the following can be said.

RI using RI (radioisotope)
When SLN of an early stage cancer is identified by the endoscopic method, especially, the state in which the radiation is incident on the radiation detection part of the treatment tool is switched to the state in which the radiation is shielded and made difficult to be incident. be able to. Then, by changing the directivity of the radiation detection unit and measuring this radiation, the incident direction of the radiation can be easily recognized, so that S
Even if the LN is in the vicinity of the tumor site where RI is injected, the position of the SLN can be identified easily and surely from the tumor site. Further, since the SLN can be excised and excised by operating this treatment tool, the burden on the operator can be greatly reduced and the operation time can be shortened.

Although some embodiments have been specifically described with reference to the drawings, the present invention is not limited to the above-described embodiments and is carried out without departing from the scope of the invention. Includes all implementations.

According to the above description, the invention of the following matters can be obtained. Also, a combination of each term is possible.

[Supplementary Note] (Supplementary Note 1) A radiation instrument is provided in a treatment instrument having a pair of openable and closable forceps portions for exfoliating and incising tissue at the tip.

[Problems and Objectives] Same as the above-mentioned “Problems to be solved by the invention”.

[Effect] Since the incision / peelable treatment tool is provided with the radiation detecting means, it is not necessary to replace the radiation detection probe and the treatment tool from the trocar, and the operation time can be greatly shortened. Further, in the case where both are inserted into the abdominal cavity at the same time, at least one extra trocar can be reduced, and invasion to the patient can be further reduced.

(Supplementary Note 2) In Supplementary Note 1, the radiation detecting means is provided with a radiation detecting section on at least one forceps section, and a display for displaying radiation information connected via a treatment tool and a cable. It is characterized by comprising means.

[Problems and Objectives] Same as in Appendix 1.

[Effect] Since the radiation detector is arranged at the tip of the treatment instrument, the intended radiation source can be identified more easily.

(Supplementary Note 3) In Supplementary Note 2, a plurality of incident portions on which the radiation is incident are provided in the forceps portion provided with the radiation detecting portion, and at least one incident portion can be opened and closed by a radiation shielding member. Characterize.

[Problems and Objectives] Same as in Appendix 1.

[Effect] By opening and closing the forceps, the intended radiation source can be identified more easily.

(Supplementary Note 4) In Supplementary Note 1, the treatment tool is characterized in that it is connected to the forceps portion at the distal end via an energy generating means for generating energy such as high-frequency current and ultrasonic vibration through a cable.

[Problems and Objectives] Same as in Appendix 1.

[Effect] Same as in Supplementary Note 1, further, since energy can be transmitted to the forceps portion, various living tissues can be incised, peeled and coagulated. The possibility of doing so can be increased.

(Supplementary Note 5) In Supplementary Note 4, the control means for stopping the energy generating means during the operation of the radiation detecting means is provided.

[Problems and Objectives] Same as in Appendix 1.

[Effect] Since no energy is generated during radiation detection, careless or unnecessary tissue damage can be prevented.

(Supplementary Note 6) In Supplementary Note 4, the radiation and energy cables extending from the treatment tool are arranged on the same axis and integrated.

[Problem and Objective] Same as in Appendix 1.

[Effect] Since the single cable is used, the treatment tool can be easily handled, and the operability can be improved.

(Supplementary Note 7) In Supplementary Note 1, a bending means for bending the forceps portion is provided.

[Problem and Objective] Same as in Appendix 1.

[Effect] By bending the forceps,
Since the directivity of the radiation detector can be easily changed, the target radiation source can be identified more easily.

(Supplementary Note 8) A forceps portion that opens and closes at the tip, a radiation detection portion at the tip, and surrounds the radiation detection portion,
In a treatment tool provided with a radiation opaque part for controlling the incidence of radiation, a plurality of entrances through which the radiation is incident from the radiation opaque part to the radiation detection part are provided, and at least one opening part is transparent It is characterized in that means for switching between the state and the opaque state is provided.

[Problems and Objectives] Same as the above-mentioned “Problems to be solved by the invention”.

[Effect] Since the incision / peelable treatment tool is provided with the radiation detecting means, it is not necessary to replace the radiation detection probe and the treatment tool from the trocar, and the operation time can be greatly shortened. Further, in the case where both are inserted into the abdominal cavity at the same time, at least one extra trocar can be reduced, and invasion to the patient can be further reduced.

(Supplementary Note 9) In a surgical treatment instrument having an insertion portion having a forceps portion connected to a tip thereof and a hand portion provided at a proximal end of the insertion portion, the forceps portion has a radiation source. A radiation detection unit for detecting the radiation emitted from the radiation detection unit is provided, and the radiation detection unit is connected to a detection signal transmission unit that transmits the signal to the signal output unit that outputs the detected radiation signal. It is characterized by

[Problem and Purpose] Same as in Appendix 1.

[Effect] Same as in Appendix 8.

[0150]

As described above, according to the present invention,
The radiation source can be easily identified, and
It is possible to provide a surgical treatment tool capable of extracting such a radiation source.

[Brief description of drawings]

FIG. 1 is a schematic view showing a surgical treatment tool according to a first embodiment and a device connected to operate the treatment tool.

FIG. 2 is a schematic enlarged view of the forceps portion shown in FIG.

FIG. 3 is a schematic top view of the forceps portion viewed from the direction A shown in FIG.

FIG. 4 is a schematic view of a forceps part and an insertion part as seen from the direction B shown in FIG.

5 is a cross-sectional view taken along the line parallel to the paper surface along the axial direction of the insertion portion of the forceps portion shown in FIG.

6 is a cross-sectional view of the forceps portion shown in FIG. 5 as seen in the distal direction along the line CC.

7 is a cross-sectional view showing a state in which the forceps portion shown in FIG. 5 is opened.

FIG. 8 is a schematic diagram showing the centralized display panel shown in FIG. 1.

FIG. 9 is a schematic diagram when endoscopic surgery is performed for early gastric cancer that is assumed to have no lymph node metastasis.

FIG. 10 is a schematic diagram when performing endoscopic surgery for early gastric cancer that is assumed to have no lymph node metastasis.

FIG. 11 is a schematic diagram when endoscopic surgery is performed for early gastric cancer which is assumed to have no lymph node metastasis.

FIG. 12 is a schematic diagram when endoscopic surgery is performed for early gastric cancer that is assumed to have no lymph node metastasis.

FIG. 13 is a schematic view showing a surgical treatment tool according to a second embodiment and a device connected to operate the treatment tool.

FIG. 14 is a cross-sectional view of a surgical treatment tool according to a second embodiment, and a schematic diagram showing a circuit connected to operate the treatment tool.

FIG. 15 is a schematic diagram when performing endoscopic surgery for early gastric cancer that is assumed to have no lymph node metastasis.

16 (a) and 16 (b) are schematic views showing a surgical treatment tool according to a third embodiment.

FIG. 17 is a cross-sectional view taken along the line parallel to the paper surface along the axial direction of the insertion portion of the treatment tool shown in FIG.

FIG. 18 is a cross-sectional view of the forceps portion shown in FIG. 17 as seen in the distal direction along the line DD.

19 (a) and 19 (b) are schematic views when endoscopic surgery is performed for early gastric cancer that seems to have no lymph node metastasis.

20 (a) and 20 (b) are schematic diagrams when endoscopic surgery is performed for early gastric cancer that is assumed to have no lymph node metastasis.

FIG. 21 is a schematic perspective view showing a hand piece of an ultrasonic incision coagulation apparatus according to a fourth embodiment.

22 (A) is a schematic perspective view showing an internal unit of the handpiece shown in FIG. 21, and FIG. 22 (b) is a schematic perspective view showing an external unit of the handpiece shown in FIG. Perspective view.

23 (A) is a cross-sectional view taken along a line parallel to the paper surface along the axial direction of the insertion-portion sheath of the handpiece shown in FIG. 21, and FIG. 23 (B).
[Fig. 4] is a schematic cross-sectional view of the operation knob shown in (A) as seen in the distal direction along the line BB.

24 (A) is a schematic exploded perspective view of the internal unit shown in FIG. 22 (A) when disassembled, FIG.
4 (B) is a schematic perspective view of the probe of the internal unit shown in FIG. 22 (A), and FIG. 24 (C) is a schematic view showing ultrasonic vibration of the probe 147 at each node n. Perspective view.

25 (A) is a schematic view seen from a side when (A) and (B) of FIG. 24 are attached to each other, and FIG. 25 (B) is B shown in (A). 25 is a cross-sectional view of the fixed blade taken along line -B, and FIG. 25C is a cross-sectional view taken along line CC of FIG. 25A.

FIG. 26 is a schematic enlarged view of the tip of the handpiece shown in FIG. 21.

27 (A) is a schematic cross-sectional view of the tip of the handpiece when the handpiece shown in FIG. 26 is closed with respect to the fixed blade, and FIG. 27 (B) is FIG. FIG. 6 is a schematic view of the handpiece when the movable blade shown in FIG.

28 is a cross-sectional view of the probe shown in FIG. 25A taken along the axial direction and taken along a line parallel to the paper surface.

FIG. 29 is a schematic view of the entire system of an ultrasonic incision coagulation apparatus.

[Explanation of symbols]

1 ... Treatment tool, 2 ... Insertion part, 3 ... Hand part, 12 ... Forceps part,
21 ... Wire, 24 ... Scintillation crystal, 2
6 ... Light guide optical fiber, 30 ... Radiation detector

Claims (3)

[Claims] 1. A surgical treatment tool having an insertion portion having a forceps portion connected to a distal end thereof, and a proximal portion provided at a proximal end of the insertion portion, wherein the forceps portion is emitted from a radiation source. A radiation detection unit for detecting the detected radiation is provided, and a detection signal transmission unit for transmitting this signal to a signal output unit for outputting a signal of the detected radiation is connected to the radiation detection unit. A surgical treatment instrument characterized by the following. 2. The forceps part is switchable between a state in which the radiation emitted from the radiation source is directly incident on the radiation detection part and a state in which the incidence on the radiation detection part is restricted. The surgical treatment tool according to claim 1, wherein the surgical treatment tool is formed. 3. The surgical treatment instrument according to claim 1, wherein the forceps portion is connected to a radiation source treatment means capable of transmitting energy.