JP2003111770A - Treating instrument for surgery - Google Patents

Abstract

PROBLEM TO BE SOLVED: To allow one treating instrument to perform a proper treatment using respective merits in different treatment cases by imparting an ultrasonic wave treatment function, a high-frequency treatment function and a microwave treatment function to one treating instrument. SOLUTION: The operation part 15 of one surgical treating instrument 1 is provided with a part for performing treatments by an ultrasonic vibration, a high-frequency current and a microwave.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical treatment instrument for treating a living tissue.

[0002]

2. Description of the Related Art An ultrasonic treatment instrument is one of surgical devices for performing incision or coagulation of living tissue in a surgical operation. An example of an ultrasonic treatment tool is JP 2000-
This ultrasonic treatment device is proposed in Japanese Patent Laid-Open No. 197640, and a scissor-shaped distal treatment section, a vibrator unit incorporating an element for converting an electric signal into ultrasonic vibration, and a detachable unit attached to the vibrator unit with screws. The probe is mounted so that it can transmit ultrasonic vibrations, and a protective sheath that covers the probe while leaving the distal treatment section.
Further, the ultrasonic transducer unit is provided with a connection pin for attaching a cord for connecting to a high frequency power source. Further, this ultrasonic treatment tool can also perform high-frequency treatment by supplying a high-frequency current to the probe via an energization circuit inside the ultrasonic transducer. Therefore, the outer circumference of the protective sheath that covers the probe is covered with an insulating tube for insulating high-frequency current.

Further, an operating shaft extending to the hand side is connected to a gripping action portion in the distal treatment portion of the ultrasonic treatment instrument. This operating shaft engages with a handle on the proximal side, and by operating the handle, the operating shaft is advanced and retracted, and the gripping action portion in the distal treatment section is operated.

The gripping surface of the distal treatment section is made of a resin material such as PTFE as a gripping member facing the probe in order to prevent the adhesion of the tissue during coagulation and incision of the tissue and improve the wear resistance of the probe. ing.

In such a scissors-type ultrasonic treatment instrument, a living tissue such as a blood vessel or an organ can be sandwiched between the tip acting portion and the ultrasonic probe, and an incision can be made while coagulating a cut end. is there. In the case of bleeding etc., it was also possible to imitate with a high-frequency current as a monopolar high-frequency treatment tool.

On the other hand, there has been proposed a type of using a microwave as a surgical treatment tool for treatment using electric power. For example, JP-A-9-28716 and JP-A-8-
The surgical device shown in Japanese Patent No. 187297 uses microwaves, but this surgical device coagulates biological tissue.
Its main purpose was to make an incision, and the incision was made while cauterizing living tissue by generating microwaves from the tip of an applicator having a coaxial cable structure.

[0007]

By the way, while those that perform coagulation / incision using ultrasonic waves have the advantage of less thermal invasion of surrounding tissues as compared with high-frequency treatment tools and microwave treatment tools, It was unsuitable for the treatment of a site where the tissue cannot be pinched by the distal treatment section.

[0008] Further, the cutting ability of the treatment instrument for treating with ultrasonic waves is lower than that of treating with a high frequency current or a microwave, and the coagulation range is considerably narrow. For this reason, there has been a problem that a treatment tool for performing treatment by ultrasonic waves is not suitable for treatment of coagulative necrosis such as a tumor in a deep organ.

Further, the high-frequency treatment instrument has a higher coagulation / incision ability than the ultrasonic treatment instrument. Further, the incision ability is higher than that of the microwave treatment tool. However, the heat damage to the surrounding tissue is larger than that of the ultrasonic treatment tool, and therefore, it is unsuitable when there is a part around which heat damage is not desired. It was especially unsuitable for coagulation and incision of blood vessels at the distal end from the viewpoint of procedural action. The high-frequency treatment instrument has a weak coagulation ability and a low directivity as compared with the microwave treatment instrument, and thus has an inconvenience that it is likely to physically affect surrounding tissues.
Since the microwave treatment instrument has sharper directivity than the high-frequency treatment instrument, it has an advantage that it is less likely to physically affect surrounding tissues, has a high coagulation ability, and can easily perform coagulation and necrosis of a tumor in a deep organ. In addition, it has the advantages of a wider coagulation range and higher incision ability than ultrasonic treatment tools, but like high-frequency treatment tools, it is not suitable for coagulation and incision of blood vessels and is more localized than ultrasonic treatment tools. There were inconveniences such as difficulty in specific treatment.

The present invention has been made in view of the above problems, and an object thereof is to add an ultrasonic treatment function, a high frequency treatment function, and a treatment function by microwaves to one treatment tool. Accordingly, it is possible to perform appropriate treatment using various advantages in various treatment scenes by using one treatment tool.

[0011]

The invention according to claim 1 is
It is a surgical treatment instrument characterized in that a construction capable of exhibiting a treatment function by ultrasonic vibration, a treatment function by high-frequency current and a treatment function by microwave is constructed in an action portion of one treatment instrument. The invention according to claim 2 is the ultrasonic wave,
The surgical treatment instrument according to claim 1, further comprising output control means capable of selectively outputting two or more high-frequency and microwave outputs simultaneously. The invention according to claim 3 is the surgical treatment instrument according to claim 1, which is configured as a microwave antenna member that opens and closes an opening and closing member for gripping a living tissue.

[0012]

BEST MODE FOR CARRYING OUT THE INVENTION A multifunctional surgical instrument for surgery 1 according to an embodiment of the present invention will be described below with reference to the drawings. The multifunctional treatment instrument 1 of the present embodiment is composed of three units, which are an ultrasonic transducer 2, a probe 3, and a handle unit 4, which can be disassembled.

The ultrasonic oscillator 2 has a piezoelectric element incorporated therein for converting an electric current (not shown) into ultrasonic vibration. The piezoelectric element is covered with a vibrator cover 5. At the rear end of the ultrasonic vibrator 2, a cord 6 for supplying a drive current for generating ultrasonic vibration to the piezoelectric element, a high frequency current, and power for generating microwaves from the power supply device main body extends. In the cord 6, a line for supplying a driving current to the piezoelectric element, a line for supplying a high frequency current, and a coaxial cable for supplying microwave power are arranged.

As shown in FIG. 5, the ultrasonic vibrator 2 uses a metal member such as a tightening bolt arranged at the center of a vibration element (not shown) as an inner conductor, and a dielectric is provided outside the vibration element (not shown). The body 7 is arranged, a cylindrical metal member 8 serving as an outer conductor is arranged on the outside thereof, and the outside of the metal member 8 is covered with the vibrator cover 5, thereby constructing a coaxial cable as a whole. The inner conductor and the outer conductor of the coaxial cable are connected to the corresponding inner and outer conductors of the coaxial cable in the cord 6, respectively.

Also, as shown in FIG. 5, at the other end of the ultrasonic transducer 2, a horn 9 and a handle unit 4 for transmitting the ultrasonic vibration to the probe 3 while enlarging the amplitude of the ultrasonic vibration to some extent. The attachment 10 for connecting is fixed. The attachment 10 is attached with a metal ring 11 which is partially cut away. A screw portion 12 for attaching the probe 3 is provided at the tip of the horn 9. The horn 9 is integrally formed with the central metal portion of the vibration element or is integrally connected to the metal portion.

The horn 9 is provided at the base end of the probe 3.
Is provided with a screw portion 13 for connecting to the screw portion 12 at the tip of the. The entire length of the probe 3 is designed to be an integral multiple of half a wavelength. Furthermore, probe 3
Has an amplification function by reducing the cross-sectional area in the axial direction at several nodes of the vibration in the middle so that the amplitude required for ultrasonic treatment at the probe tip can be obtained.

Rubber rings 37 for preventing interference between the probe 3 and the handle unit 4 are attached at several positions of vibration nodes in the middle of the probe 3.
It is more preferable that the surfaces of the probe 3 and the horn 9 are coated with a metal having high biocompatibility and high conductivity such as gold plating so that microwave power can be efficiently supplied.

The handle unit 4 is provided with an insertion portion 14 which is inserted into a body cavity of a patient during an operation, and an operation portion 16 for operating an action portion 15 provided at the tip of the insertion portion 14. The operation unit 16 has a fixed handle 27 that is detachably attached to the ultrasonic transducer 2 and a movable handle 29 that is rotatably attached via a fulcrum pin 28 provided on the fixed handle 27. As shown in FIG. 6, a bush 53 made of PTFE or the like having a low coefficient of friction is arranged on the outer periphery of the pin 28 to improve slidability.

The fixed handle 27 and the movable handle 29 are provided with finger hooks 30 and 31, respectively. When the fingers are gripped by the finger hooks 30 and 31, the movable handle 29 rotates around the fulcrum pin 28. To do.

As shown in FIGS. 2 and 5, the insertion portion 14 of the handle unit 4 has a long-axis outer pipe 17 and an operating portion 1.
6, the base end of the outer pipe 17 is fixed to the pipe fixing member 25. As shown in FIG. 2, a channel for passing the probe 3 is formed inside the outer pipe 17, and a coaxial cable as a microwave supply path is configured inside the outer pipe 17 when outputting a microwave. In order to do so, an inner tube 18 which is a dielectric when the probe 3 is used as a central conductor is provided. In addition, the outer circumference of the outer pipe 17 is an insulating tube 38.
Is covered with. The probe 3 is made of metal and is made of a conductor. Therefore, a high frequency current can be passed through the probe 3.

As shown in FIG. 5, the pipe fixing member 25 for fixing the base end portion of the insertion portion 14 is connected and fixed to a conductive jumper member 44 made of metal through a fixing pin 35.
Further, the pipe fixing member 25 is attached to the resin fixed handle 27 together with the brim member 44 by a fixing ring 45 so as to be rotatable around the insertion portion axis. The rotation knob 26 made of resin is fixedly attached to the outer periphery of the tip end side of the jumper member 44. Further, the jumper member 44 and the driving force transmission intermediate member 48 are connected by a pin 46, both of which are integrally rotatable in the rotational direction around the axis, and the driving force transmission intermediate member 48 is movable in the axial direction. By rotating the rotary knob 26 with the above configuration, the insertion portion 14 can rotate around the axis with respect to the handle unit 4.

As shown in FIG.
A tip cover 19 is attached to the tip of the outer pipe 17. Tip cover 19 and resin inner tube 18
The probe 3 and the outer pipe 17 are insulated from each other between them, and a resin-made member 39 made of a resin which becomes a dielectric like the inner tube 18
Is attached.

As shown in FIG. 4, a metal jaw 20 for holding an openable / closable member for gripping a living tissue to be treated is provided on the distal end cover 19 via two fulcrum pins 21 arranged on the left and right. It is rotatably attached. The metal jaw 20 is configured as a microwave antenna member that opens and closes. Further, the tip of a conductive drive shaft 23 made of metal is connected to the rear end of the jaw 20 via a pin 22. This drive shaft 23 has a tip cover 19
It passes through the outer side of the above and passes between the outer pipe 17 and the inner tube 18 in the insertion portion 14, and extends to the operation portion 16.
As shown in FIG. 3, the jaw 20 has a gripper attachment member 24.
A gripping member 42 made of resin such as PTFE is rotatably attached by a pin 43.

Further, as shown in FIG. 5, the base end portion of the drive shaft 23 is connected to the drive force transmission intermediate member 48 in the operation portion 16 via the pin 40. A slider receiving member 49 is attached to the driving force transmitting intermediate member 48 by a pin 50.

Further, on the outer periphery of the slider receiving member 49, a slider member 41 slidable in the axial direction and a spring 51 with a fixed amount of equipment are provided. The spring 51 is arranged so as to be sandwiched between the slider member 41 and the driving force transmission intermediate member 48.

Inside the slider receiving member 49, a substantially cylindrical intermediate member 52 made of resin, which serves as a dielectric, is attached so as to cover the entire circumference of the probe 3. This intermediate member 5
The tip end side portion of 2 is in a state of overlapping with the inner tube 18, and can slide in the axial direction within a certain range. Further, a packing 56 is attached to the driving force transmission intermediate member 48 to prevent pneumoperitoneum gas or the like from leaking from the distal end of the insertion portion through the internal gap during laparoscopic surgery.

An action pin 34 is attached to the movable handle 29 and engages with a slider member 41 in the handle (see FIG. 6).

As shown in FIG. 5, the fixed handle 2
At the rear end of 7, connecting members 32 and 33 having grooves formed on the outer circumference for engaging with the ring 11 of the ultrasonic transducer 2 are fixed, and the ring 11 is elastically deformed to connect the connecting members 32 and 33. The connection member 3 is fitted into the groove of the
The ultrasonic transducer 2 is detachably engaged with the second and the third portions 33.

The rear end portion of the slider receiving member 49 is formed in a slit shape, and the projection 36 is provided on the outer periphery of this end portion.
Is provided. The protrusion 36 has an outer diameter larger than the inner diameter of the connecting member 32, and is in contact with the inside of the connecting member 32 in a state of being elastically deformed by the slit structure of the slider receiving member 49. This slider receiving member 49 is
Although it slides in the rotation direction around the axis, the projection 36 and the connection member 32 always maintain a contact state and are electrically connected.

When the movable handle 29 is rotated, the action pin 34 is rotated around the fulcrum pin 28 as the movable handle 29 is rotated, and the slider member 41 in the movable handle 29 is moved. Then, the driving force in the axial direction is transmitted to the driving force transmission intermediate member 48 within the range of the equipment force of the spring 51 or less.

That is, the movable handle 2 having the above structure
When 9 is gripped, the action pin 34 fixed to the movable handle 29 is rotated via the fulcrum pin 28, and the slider member 41 engaged with this is moved back and forth in the axial direction. further,
The driving force transmission intermediate member 48 connected to the slider member 41 via the spring 51 also moves back and forth in the same direction, whereby the jaw 20 at the tip of the insertion portion rotates via the fulcrum pin 21. By such an operation, the living tissue can be sandwiched between the grasping member 42 of the action portion 15 and the probe 3.

Further, when the living tissue is sandwiched, the gripping member 42 rotates around the pin 43 as a fulcrum by a certain angle in accordance with the bending of the probe 3, so that the force is uniformly applied over the entire length of the gripping portion. When ultrasonic vibration is output to the probe 3 in this state, the ultrasonic vibration of the probe 3 enables coagulation and incision of living tissue such as a blood vessel.

Further, the multifunctional treatment instrument 1 of this embodiment has a probe member 3 for transmitting ultrasonic vibration as a central conductor and a handle member 4 in combination therewith, and a peripheral member 39, an inner tube 18, and an intermediate member around the handle member 4. 52, the dielectric 7 forms a dielectric called a coaxial cable over the entire length. Further, on the outside thereof, the outer pipe 17,
An outer conductor is formed by the metal member inside the handle and the metal member 8 inside the ultrasonic transducer 2 including the tip cover 19 and the jaw 20. As a result, the structure of the coaxial cable that can supply microwaves to the tip of the probe 3 is provided, and microwaves of several GHz can be output from the tip of the probe 3. That is, the action portion 15 can exert a treatment function by the microwave.

Since the multifunctional treatment instrument 1 of this embodiment is used as a high-frequency treatment instrument, a high-frequency current supply path is formed up to the probe 3 via the central metal part of the piezoelectric element and the horn 9, and the high-frequency current supply is performed. A high-frequency current is supplied to the tip of the probe 31 through the path so that a treatment function by the high-frequency current is exerted. In the present embodiment, the action portion 15
The probe 31 can be made to function as a monopolar electrode.

Next, the operation of the multi-function treatment instrument 1 of this embodiment in use will be described. First, the case of treatment using microwaves will be described. FIG. 7 and FIG. 8 show a usage state when outputting a microwave. FIG. 7 shows the action part 15.
The microwaves are output with the jaw 20 closed. ． In this case, the electric field Ea that wraps around the living tissue H from the outer conductor becomes weak, the incision ability for the tissue H becomes weak, and sufficient coagulation becomes possible over time.

In FIG. 8, microwaves are output with the jaw 20 open. In this case, the jaw 20 that is electrically connected to the tip cover 19 serving as an outer conductor is opened, and the opened jaw 20 faces the living tissue H to be treated.
The living tissue H is in a state of being sufficiently capacitively coupled with the outer conductor. Therefore, the electric field Eb is strongly formed, and the incision ability thereof is improved.

When the multifunctional treatment instrument 1 of this embodiment is used as a high-frequency treatment instrument, the acting portion 15 functions as a monopolar electrode. That is, a counter electrode (not shown) is placed in contact with the external surface of the patient, and 350 kH is set.
A high-frequency current of 1 MHz or less from z is passed through the high-frequency current supply path to the probe 3 through the central metal part of the piezoelectric element and the horn 9, and the high-frequency current is caused to flow to the tip of the probe 31 to exert a treatment function by the high-frequency current, thereby making Used as a treatment tool.

When the multifunctional treatment instrument 1 of this embodiment is used as an ultrasonic treatment instrument, the handle is operated to
The living tissue is sandwiched between the grasping member 42 of the action portion 15 and the probe 3. Further, when the living tissue is sandwiched, the gripping member 42 rotates around the pin 43 as a fulcrum by a certain angle in accordance with the bending of the probe 3, and the force is uniformly applied over the entire length of the gripping portion. When ultrasonic vibration is output to the probe 3 in this state, the ultrasonic vibration of the probe 3 enables coagulation and incision of a living tissue such as a blood vessel.

The present invention is not limited to the above-described embodiment, but can be applied to other forms.

[0040]

As described above, according to the present invention, an appropriate treatment can be performed according to the purpose of the situation of use by combining the respective energies of ultrasonic waves, high frequencies and microwaves. For example, when it is desired to make an incision while surely coagulating a blood vessel, or to minimize the thermal invasion of surrounding organs, ultrasonic vibration is used for treatment. In addition, the tip of the probe is punctured into the organ while ultrasonically vibrating, and the lesion part in the deep part of the organ is cauterized by the microwave. If fast dissection ability is required, microwave treatment is performed in a high frequency while coagulating and when relatively fast dissection ability is required. Microwave, coagulation by high frequency, ultrasonic waves can be oscillated at the same time during incision to enable treatment while preventing tissue from sticking to the probe.
One treatment tool can handle various treatments. As a result, the burden on the operator is reduced, and various effects such as reducing the burden on the patient by shortening the operation time can be obtained.

[Brief description of drawings]

FIG. 1 is a schematic view of an entire multifunctional treatment instrument according to an embodiment of the present invention.

FIG. 2 is a vertical cross-sectional view of a distal end of an insertion portion of the multifunctional treatment instrument.

3 is a sectional view taken along the line AA of FIG.

4 is a sectional view taken along the line BB of FIG.

FIG. 5 is a vertical cross-sectional view of an operating portion of the multifunctional treatment instrument.

6 is a cross-sectional view taken along the line CC of FIG.

FIG. 7 is an explanatory diagram of a usage state of the multifunctional treatment instrument according to the present embodiment.

FIG. 8 is an explanatory diagram of a usage state of the multifunctional treatment instrument according to the present embodiment.

[Explanation of symbols]

H ... Living tissue 1 ... Multi-function treatment tool 2 ... Ultrasonic transducer 3 ... probe 4 ... Handle unit 15 ... Tip action part

   ─────────────────────────────────────────────────── ─── Continued front page    (72) Inventor ▲ Taka ▼ Hiroyuki Hashi             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. (72) Inventor Koji Iida             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. (72) Inventor Kenji Noda             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. (72) Inventor Akihisa Ogawa             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. (72) Inventor Takeaki Nakamura             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. (72) Inventor Seiichi Hosoda             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. F-term (reference) 4C060 JJ12 JJ22 JJ29 KK03 KK04                       KK09 KK13 KK47 MM24

Claims (3)

[Claims] 1. A surgical treatment instrument characterized in that a construction capable of exhibiting a treatment function by ultrasonic vibration, a treatment function by high-frequency current and a treatment function by microwave is constructed in an action portion of one treatment instrument. 2. The surgical treatment instrument according to claim 1, further comprising output control means capable of selectively outputting two or more outputs of each of the ultrasonic wave, the high frequency wave and the microwave. 3. The surgical treatment instrument according to claim 1, wherein the surgical operation instrument is configured as a microwave antenna member that opens and closes an opening and closing member for gripping a biological tissue.