JP2004041780A - Ultrasonic cutting and coagulation device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an ultrasonic cutting and coagulation device for employing a grip member most advantageously shaped for a treatment by freely exchanging the grip members. <P>SOLUTION: The ultrasonic cutting and coagulation device has a handpiece provided with a built-in ultrasonic oscillator, a probe connected to the oscillator, a sheath for covering the probe for protection, a grip member for gripping the living tissue in between with the distal end of the probe, an operation means, a transmission member and a movable member free to advance and retreat. The probe serves as a vibration transmission member which transmits the ultrasonic vibration to a treatment section in order to treat the living tissue. The operation means manipulates the distal end of the probe and the grip member to grip and release the living tissue and also the transmission member to drive the gripping member. The moving member conveys the operation force exerted by the operation means. The grip member is removably attached to the movable member. <P>COPYRIGHT: (C)2004,JPO

Description

The present invention relates to an ultrasonic incision coagulation apparatus for performing a treatment such as incision or coagulation using ultrasonic waves.

Conventionally, it is generally known to perform treatment on living tissue using ultrasonic vibration, and among them, there is one that performs treatment by fixing it to an ultrasonic treatment tool, such as sucking or gripping living tissue. there were.

For example, in Japanese Patent Application No. 62-127042, a calculus is grasped and crushed by ultrasonic vibration, and in Japanese Patent Application No. 1-223944, a living tissue is grasped and fixed with grasping forceps, and a probe that ultrasonically vibrates is used. She had to make an incision. In Japanese Patent Application No. 1-223945, a living tissue is adsorbed and fixed, and cut with an ultrasonically vibrating scalpel.

Further, in Japanese Patent Application No. 1-223948, a living tissue can be efficiently resected by applying ultrasonic vibration to the resection forceps. In Japanese Patent Application No. 1-223949, a grasping operation is performed in the same manner as in Japanese Patent Application No. 1-223944. The living tissue is fixed by means, and treatment is applied to the living tissue by a treatment member to which ultrasonic vibration is applied. In US Pat. No. 5,322,055, a grasping member is provided above a probe, and the living body is provided by the probe and the grasping member. The procedure was to fix the tissue. These treatments can be performed by grasping a living tissue like ordinary surgical forceps, so that it is generally easier to perform a better treatment than when treatment is performed with a single probe.

Some of the devices generally called an ultrasonic suction device, such as US Pat. No. 4,988,334 and Japanese Patent Application No. 2-203573, have a sheath that can be disassembled and assembled with a handpiece. Since there is no such thing with the gripping member as described above, and there is no one that can be disassembled and assembled in particular, it is necessary to wash and sterilize each part with great care during the washing and sterilization process. Yes, it was very time-consuming. Alternatively, they may be disposable in order to save time and effort, but there are problems in reducing the amount of medical care, reducing contaminated waste, and saving resources.

す る と Also, if any part was damaged, it was necessary to repair or replace the whole. Furthermore, several types of each part were prepared, and it was not possible to use the most suitable combination for the treatment, and it was necessary to prepare only the necessary types of ultrasonic treatment tools.

As described above, a device equipped with means capable of grasping a living tissue with an ultrasonic treatment device involves problems of manpower, time, and cost of a person who handles the treatment, and the burden is one of the causes of soaring medical costs as a result. Could be.

Conventionally, a treatment tool used in an endoscopic surgical operation generally has a treatment section for performing treatment on a living tissue, which is a distal end of a sheath which is an insertion section for inserting the treatment section into a living body. Operation means for operating the treatment section was provided at the end, and at the proximal end of the insertion section.

処置 Among these treatment tools for endoscopic surgery, there are known treatment tools which can be disassembled and assembled into an insertion portion, a treatment portion, an operation portion and the like, as in DE 7330291 and Japanese Patent Application No. 6-179049. This structure enables more reliable cleaning and sterilization of each part in the cleaning and sterilization process. In addition, for example, when only the treatment part is damaged, only the part can be replaced, or several types of each part are prepared. By doing so, there is an advantage that various components can be combined to prepare an optimal treatment tool for treatment, and the above-mentioned problems have been solved to some extent.

However, such a treatment tool can generally use only a high-frequency current when incising and coagulating a living tissue. However, since the high-frequency current has a wide range of protein denaturation of living tissue, it may cause excessive treatment in some cases.If possible, it is desirable to use it together with ultrasonic vibration and use it properly according to the situation. Such a treatment tool alone was not possible.

Since there was no ultrasonic treatment tool having a gripping member that could be disassembled and assembled in particular, it was necessary to carefully wash and sterilize each part during the cleaning and sterilization process. Was troublesome. Alternatively, they may be disposable in order to save time and effort, but there are problems in reducing the amount of medical care, reducing contaminated waste, and saving resources.

Also, if any part is damaged, it is necessary to repair or replace the whole. Furthermore, several types of each part were prepared, and it was not possible to use the most suitable combination for the treatment, and it was necessary to prepare only the necessary types of ultrasonic treatment tools.
For this reason, there are problems of manpower, time, and cost of the handling person, and the burden may possibly be one of the causes of a rise in medical expenses.

The present invention has been made in view of the above points, and an object of the present invention is to provide an ultrasonic incision coagulation device that can be reliably cleaned and sterilized without any trouble and can easily perform a part replacement or the like. And

The ultrasonic incision coagulation apparatus of the present invention includes an ultrasonic oscillator that generates ultrasonic vibration, and a handpiece that incorporates the ultrasonic oscillator, and transmits ultrasonic vibration generated by the ultrasonic oscillator to a living body. A probe, which is a vibration transmitting member for transmitting to a treatment section for performing a treatment on tissue, is connected to the ultrasonic vibrator, and has a sheath, which is a protective member that covers the probe, and the probe distal end and Operating means for gripping and releasing living tissue by the probe distal end and the gripping member, and a gripping member by operating the operating means. An ultrasonic incision coagulation device having a transmission member for driving a movable member that transmits and retracts an operation force by the operation means, wherein the gripping member is configured to be detachable from the movable portion. It is characterized in.

According to the present invention, it is possible to freely exchange the gripping member and use a gripping member having an optimal shape for treatment.

(First embodiment)
1 to 9 relate to a first embodiment of the present invention, FIG. 1 is an overall view of the first embodiment of the present invention, FIG. 2 is a sectional view showing the structure of a treatment section and an insertion section, and FIG. 4 is a sectional view taken along line D1-D2-D3-D4, FIG. 4 is a front view of the treatment section viewed from the front in FIG. 2, FIG. 5 is a sectional view taken along line AA 'to GG' in FIG. 2, and FIG. FIG. 7 is a plan view showing the operating means, FIG. 7 is a partial sectional view showing the operating means and a part thereof in an enlarged manner, FIG. 8 is a sectional view taken along the line HH ′ and II ′ in FIG. FIG. 8 is a sectional view taken along line JJ′-MM ′ in FIG.

As shown in FIG. 1, the ultrasonic incision coagulation apparatus 31 according to the first embodiment of the present invention has an insertion section 57 provided with a treatment section 33 for performing a treatment at a distal end (tip), and a proximal end of the insertion section 57. (Rear end), and has operation means 34 for operating the treatment section 33. The insertion portion 57 is formed with an elongated sheath 9 to form an insertion portion outer tube so that it can be inserted into a living body.

A sheath 22 having a diameter larger than that of the sheath 9 is provided on the proximal end side of the upper portion of the operation means 34. The proximal end of the sheath 22 is provided to the treatment section 33 for incision and coagulation treatment. A handpiece 32 is provided as a vibrator unit having a built-in ultrasonic vibrator 50 (see FIG. 7) for supplying sonic vibration.

As shown in FIG. 2, the sheath 9 constituting the insertion portion 57 has, for example, two independent upper and lower conduits protected by the sheath 9, and an incision and coagulation treatment is provided in the upper conduit. A forceps unit 58 as a treatment tool for performing the above-mentioned is inserted, and a probe 8 as a vibration transmitting member for transmitting ultrasonic vibration from the ultrasonic vibrator 50 in the handpiece 32 in a lower conduit, and the probe 8 A distal end member 8 detachably attached by screwing to the distal end of 8 is inserted therethrough.
The treatment section 33 and the insertion section 57 have a structure as shown in FIGS.

The forceps unit 58 is inserted into a pipe-shaped outer tube member through a retractable substantially cylindrical movable member that transmits the operating force of the operating means 34 and is connected to the tip member 7 provided at the distal end of the probe 8. A grasping member 1 for grasping and opening a living tissue between the two is joined to a movable portion 3 at a distal end of a forceps unit 58 by a screw 2. That is, as shown in FIG. 4, the lower end of the gripping member 1 and the upper end of the tip member 7 are substantially flat, and the living tissue can be gripped and released on both flat surfaces.
As shown in FIG. 3, a horizontal groove extending in the horizontal direction is provided on the lower end surface of the gripping member 1 to form a solidification groove 61 for securely gripping the tissue to facilitate coagulation.

As shown in FIGS. 2 and 3, the movable portion 3 is rotatably supported around a pin 35 at a distal end side of a first transmission member 5 as a transmission member of the forceps unit 58, and engages with a long hole. The pin 36 is rotated around the pin 35 by the reciprocating movement of the inserted pin 36.

A connection member 41 is screwed to the proximal end side of the first transmission member 5, and a distal end of the second transmission member 10 is screwed to the connection member 41. The proximal end side of the second transmission member 10 protrudes proximally (rearward) from the proximal end of the sheath 9 forming the insertion portion 57, and the distal end of the engaging member 42 is provided at the protruding proximal end. They are connected by screwing. That is, the first transmission member 5 constituting the forceps unit 58 is connected (by disassembly and assembly) to the transmission member 10 on the proximal side and the engagement member 42 on the proximal side by screwing.

A spherical portion 43 is formed at the proximal end of the engaging member 42. The spherical portion 43 is a locking mechanism on the upper side of the movable operation handle 30 which constitutes the operation means 34 shown in FIGS. The insertion portion 57 is held so as to be able to advance and retreat in the axial direction, and the opening and closing operation of the movable operation handle 30 drives the engagement member 42, the second transmission member 10 and the first transmission member 5 to advance and retreat, and is movable as described above. The part 3 can be opened and closed.

The sheath 11 forming the outer tube-side member of the forceps unit 58 is connected (connected) to the pipe 14 via the connecting member 13 at a position inside the knob 12 together with the outer sheath 10 thereof, 14 is attached to a fixed operation handle 29 which is a fixed operation member of the operation means 34.

The gripping member 1 and the screw 2 are formed of an insulating material such as a resin material when a high-frequency current is applied to the distal end member 7 for treatment as described later, but may be formed of a metal or the like in other cases. good.

As shown in FIGS. 2 and 3, a substantially cylindrical meshing member 37 is inserted into the upper channel of the sheath 9 through which the forceps unit 58 is inserted. Is provided with a projection 39 (see FIGS. 2, 3, and 5 (F)) protruding inward of the radius. The projection 39 is provided with a snap fit 38 provided at the proximal end of the distal end cover 6. Then, the snap fit 38 of the distal end cover 6 is pushed into the proximal side beyond the projection 39 so that both are engaged so that the forceps unit 58 can be fixed (locked) in the sheath 9. . Then, by performing an operation of strongly pulling the forceps unit 58 toward the distal side of the sheath 9, the two are disengaged by disengaging them, that is, the forceps unit 58 can be removed from the sheath 9.

At this time, if the gripping member 1 is released at all, the position of the connecting member 41 is advanced so that the distal end of the connecting member 41 enters the inside of the snap fit 38. The snap fit 38 cannot be bent in the inner circumferential direction due to the intrusion, so that the forceps unit 58 cannot be removed from the sheath 9.

That is, when removing the forceps unit 58 side, the gripping member 1 needs to be completely closed with respect to the distal end member 7, so that the gripping member 1 is completely closed as in a case where the living tissue is gripped during actual use. When the forceps unit 58 is not in the closed state, there is no danger that the forceps unit 58 will fall off, and the forceps unit 58 can be disassembled and assembled from the sheath 9 while ensuring safety.

Also, at this time, the portion where the engagement member 37 and the distal end cover 6 fit is not rotationally symmetrical (for example, the distal end of the step surface formed so that the engagement member 37 fits on the outer peripheral surface of the distal end cover 6). The rotation prevention mechanism 40 (see FIG. 2, FIG. 3, and FIG. 5 (F)) in which the end positions are formed differently in the circumferential direction prevents the forceps unit 58 from rotating with respect to the sheath 9. In addition, it is possible to prevent the operability from being reduced due to the careless rotation caused when the living tissue is grasped.
The proximal end of the meshing member 37 is connected to the sheath 11 interposed inside the sheath 9.

The distal end member 7 and a probe 8 which is screwed to the proximal end of the distal end member 7 and transmits the ultrasonic vibration from the ultrasonic transducer 50 to the distal end member 7 are inserted into a conduit below the sheath 9. I have. The upper end of the distal end of the distal end member 7 is flat as shown in FIG. 5A so that the living tissue can be easily gripped between the distal end member 7 and the gripping member 1. As shown in FIGS. 2, 5B, and 5C, the upper flat surface of the distal end member 7 is formed to a position closer to the proximal side than the gripping member 1. It is circular as shown in FIGS. 5 (D) to 5 (F).

遠 位 Moreover, the distal end apex of the tip member 7 is formed in a substantially conical shape and protrudes more distally than the gripping member 1, and the peeling operation can be performed at this portion. The distal end member 7 is detachably attached to the distal end of the probe 8 by screwing, and the gripping member 1 is detachably attached to the movable portion 3 by the screw 2. The tip member 7 and the gripping member 1 having optimal shapes can be used.

As shown in FIG. 2, a protective member 4 such as PTFE or ceramics having heat resistance and resistance to ultrasonic vibration is provided at a distal opening of the lower conduit of the sheath 9. The tip member 7 and the sheath 9 are prevented from coming into contact with each other and being damaged when a downward bending reaction occurs in the tip member 7 when gripped.

(6) The operating means 34 is shown in FIGS. The operating means 34 is provided at the proximal end of the insertion portion 57, and the sheath 9 and the coupling member 13 are joined. The distal end of a pipe 14 is joined to the outer periphery of the coupling member 13, and the knob 12 is fitted to the outer periphery of the distal end of the pipe 14 and coupled (fixed) with a screw 44.

When the screw 44 is loosened, the knob 12 can be removed from the distal end side of the sheath 9, and the sheath 9 side (the sheath 9, the pipe 14, and the sheath 22) can be disassembled with respect to the operating means 34 as described later. It is configured so that it can be assembled.

The pipe 14 penetrates through the inside of the first bearing 15 and the second bearing 19 that are respectively joined to the upper and lower branches of the fixed operation handle 29, and is fixed to the fixed operation handle 29. The pipe 14 is rotatably supported with respect to the bearing 15 and the second bearing 19, and at least in the circumferential direction between the outer peripheral surface of the pipe 14 and the inner peripheral surfaces of the first bearing 15 and the second bearing 19. An O-ring 45 and two O-rings 47 are provided on a sliding surface that is slidable (in the front-rear direction in the embodiment) so that the amount of rotation of the pipe 14, the bearing 15, and the bearing 19 can be adjusted. I have.

Therefore, when the operation of rotating the knob 12 is performed, the pipe 14 rotates with respect to the first bearing 15 and the second bearing 19 together with the knob 12. The probe 8 is inserted along the center axis of the pipe 14, and the forceps unit 58 is inserted into the sheath 9 eccentrically from the center axis. Therefore, the forceps unit 58 is connected to the center axis of the probe 8 (this center axis is (Corresponding to the central axis of the acoustic transducer 50).

As can be seen from FIG. 7 and the like, the central axis of the sheath 9 is shifted from the central axis of the probe 8, so that when the knob 12 is rotated, it is interlocked with the rotation of the pipe 14 (the distal end is treated). The insertion portion 57 (provided with the portion 33) (or the sheath 9 side) is eccentrically rotated.

As shown in FIGS. 8A and 8B, a probe 8 is inserted through a cylindrical pipe 14 so as to be coaxial along a central axis thereof, and a proximal end of the probe 8 has a cylindrical shape. The vibration drive shaft of an ultrasonic vibrator 50 for generating ultrasonic waves, which is provided inside a slidable handpiece 32 having a cylindrical outer peripheral surface fitted to the sheath 22, is detachable by, for example, screwing (disassembly and assembly possible). ) Are connected via the connecting member.

Further, as shown in FIG. 6, the pipe 14 has an elliptical groove 55 which penetrates vertically and is long in the front-rear direction at a portion between the first bearing 15 and the second bearing 19. Drive members 16 and 17 (see FIGS. 7 and 8 (B)) having a substantially semi-disc shape are movably engaged in the front-rear direction from above and below, and are screwed with screws 53 as shown in FIG. 8 (B). Combined with each other. These drive members 16 and 17 drive the engaging member 42 forward and backward, and open and close the gripping member 1 by the forward and backward drive of the transmission members 10 and 5 as described above.

The engagement member 42 inserted eccentrically to the middle of the pipe 14 has a spherical portion 43 at the proximal end thereof in an engagement groove provided in the radial direction of one drive member 16 mounted on the upper part of the movable operation handle 30. And is locked.

A coupling member 20 is joined to the proximal side of the pipe 14 by a screw 46 that couples the two (to allow disassembly and assembly), and a sheath on which a handpiece 32 is fitted is attached to the outer periphery of the proximal side of the coupling member 20. 22 are joined by screws 49. A screw portion is provided on the outer peripheral surface on the proximal side of the sheath 22, and a ring 23 is attached so as to screw with the screw portion.

A backup ring 24 and an O-ring 59 are housed on the inner peripheral surface of the ring 23. The O-ring 59 is compressed by rotating the ring 23 in the fastening direction with respect to the operation portion sheath 22, and the hand The handpiece 32 can be fixed to the sheath 22 by pressing the outer periphery of the piece 32.

Further, by rotating the ring 23 in the release direction by this structure, the handpiece 32 can be made to advance and retreat with respect to the sheath 22. Therefore, by moving the handpiece 32 forward and backward, the amount of protrusion of the distal end member 7 in the treatment section 33 can be reduced. It is possible to perform the treatment by setting the amount of protrusion suitable for the treatment to the target tissue, or to replace the tip member 7 and to make the protrusion suitable for the treatment in the case of the actually used tip member 7 by changing the tip member 7. Adjustments such as setting the amount can be made.

The handpiece 32 is provided with a guide sheath 21 extending to the distal end side. An O-ring 48 is provided on the outer periphery of the distal side of the guide sheath 21, and the handpiece 32 has a sealing structure with the coupling member 20.

Further, in order to shut off a pipe through which the probe 8 passes between the connecting member 13 and the connecting member 20 from the outside, the connecting member 13 and the connecting member 20 are connected by a pipe 18, and a sealed pipe is connected. Building.

As will be described later, when a high-frequency current is applied to the probe 8 to perform a treatment, the sheath 9, the coupling member 13, the coupling member 20, the pipe 18, and the guide sheath 21 are molded from an insulating material such as PTFE or polysulfone. There is no fear of leaking and it is safe.

With this structure, the forceps unit 58 and the probe 8 are completely insulated. Therefore, if a connector to be connected to the forceps unit 58 is provided, or if a high-frequency current is supplied directly, for example, the movable section 3 and the distal end member 7 can be selectively connected. The treatment can be performed by applying a high-frequency current to the living tissue, treating the living tissue by applying a high-frequency current to both, or applying a high-frequency current to the living tissue through both living tissues.

In such a case, the exposed surfaces of the drive member 16, the drive member 17, the fixed operation handle 29, the movable operation handle 30, the engagement member 42, the bearing 15, the bearing 19, the sheath 22, and the ring 23 are made of, for example, PTEE material. It is preferable to prevent the high-frequency current from leaking to the surgeon by painting with an electric insulating material.

Further, since the pipeline through which the probe 8 is inserted and the pipeline on the proximal side of the probe 8 form a sealed pipeline, the water supply / suction base provided at the proximal end of the handpiece 32 is formed. Using a water supply / suction device (not shown) connected to 51, a flow path (passage) through which fluid can flow, such as water supply or suction, is formed by utilizing a space around the probe 8 using this conduit. For example, blood that has flowed out during a procedure such as an incision can be sucked and discharged to the outside.

A connecting portion of a cord 52 is formed at the proximal end of the handpiece 32, and a driving power source for ultrasonically oscillating the ultrasonic vibrator 50 through the cord 52 (from an ultrasonic driving power supply device (not shown)). ).

As described above, the engaging member 42 is screwed on the proximal side of the transmission member 10 penetrating the upper conduit of the sheath 9, and the spherical portion 43 is attached to the proximal end of the engaging member 42. The spherical portion 43 is engaged with the engaging groove of the driving member 16 as shown in FIG.

An engagement groove 56 is provided on the outer peripheral surfaces of the drive members 16 and 17 in the circumferential direction, and the drive pin 25 is engaged in the engagement groove 56 from the left and right. Therefore, when the drive pin 25 moves back and forth, the drive members 16 and 17 also move back and forth. Each drive pin 25 is supported at both ends of a semicircular drive member 26, and the lower end of the drive member 26 is connected to the upper end of the movable operation handle 30 by a screw 54.
The movable operation handle 30 and the fixed operation handle 29 hold the movable operation handle 30 rotatably by screws 27 and 28.

Therefore, by performing an operation of moving the movable operation handle 30 back and forth with respect to the fixed operation handle 29, the spherical portion 43 is moved back and forth via the drive pin 25 and the drive members 16 and 17, and the forceps unit 58 is gripped. The member 1 can be opened and closed.

That is, when the finger hook on the lower end side of the movable operation handle 30 is opened / closed, the drive member 26 moves forward and backward with the screw 27 as a fulcrum, whereby the drive pin 25 is driven forward and backward. The drive member 16 and the drive member 17 are driven forward and backward by the forward and backward drive of the drive pin 25, and the transmission member 10, the connection member 41, and the transmission member 5 are driven forward and backward together with the engagement member 13, and the movable portion 3 is opened and closed as described above. By doing so, the gripping member 1 is opened and closed.

In addition, by turning the knob 12 with respect to the operation means 34, the handpiece 32 also rotates in conjunction with the operation means 34. As a result, the treatment unit 33 can be rotated with respect to the operation means 34. The operability at the time of performing treatment by changing the direction in which the living tissue is grasped is improved.

In other words, the driving member 16 and the driving member 17 also rotate at the same time as the rotation operation of the treatment section 33 as described above, but the outer circumference is circular and the driving pin 25 is engaged by the circular engaging groove 56. Therefore, it can be rotated 360 ° with respect to the operation means 34 without any problem.

Next, an actual method of using the present embodiment will be described.
First, the ultrasonic incision coagulation device 31 is opposed to a living tissue to be treated, and the knob 12 is rotated to adjust the direction of the treatment section 33 to a direction in which treatment can be easily performed. At this time, as described above, the amount of turning power can be adjusted to an appropriate amount by the O-rings 45 and 47, so that the knob 12 can be turned when turning is necessary, and It is possible to make it to the extent that it is impossible.

Then, the movable operation handle 30 is operated in the opening direction to release the gripping member 1. The target living tissue is sandwiched between the grasping member 1 and the tip member 7, the movable operation handle 30 is closed, and the living tissue is grasped by the grasping member 1 and the tip member 7.

Therefore, the driving power is supplied from the driving power supply of the ultrasonic vibrator 50 to the ultrasonic vibrator 50 by operating a not-shown foot switch or the like, and the ultrasonic vibrator 50 is excited. Then, the ultrasonic vibration is transmitted from the probe 8 to the tip member 7, and is given to the living tissue gripped from the tip member 7, and the living tissue gripped by the friction heat is heated to perform incision or coagulation treatment. Can be. At this time, by adjusting the time and amplitude of applying ultrasonic vibration to the living tissue and the amount of force for gripping the living tissue, the living tissue can be easily incised or coagulated.

For example, if the time is long, the amplitude is large, and the gripping force amount is high, the incision is convenient, and if the factor is reversed, the setting is convenient for coagulation.
When the living tissue is simply grasped, the living tissue can be grasped by the distal end member 7 and the grasping member 1 as described above.

Further, when performing the detachment operation of the living tissue, whether the grasping member 1 is closed or the contact member is opened and the detachment operation is bluntly performed using the substantially cone-shaped portion at the distal end of the tip member 7 As described above, the peeling operation can be performed by applying ultrasonic vibration.
Further, by injecting the ultrasonic vibration by pressing the tip member 7 alone against the living tissue, the incision and coagulation operation of the living tissue can be performed.

When a treatment using a high-frequency current is necessary, a high-frequency current is supplied to the handpiece 32 from a high-frequency power supply (not shown), and the high-frequency current is supplied from the handpiece 32 to the tip member 7 via the ultrasonic vibrator 50. .

Thus, a high-frequency current is applied to the living tissue from the distal end member 7, and the living tissue can be separated, incised, and coagulated by the high-frequency current as in the case of using the above-described ultrasonic vibration. At this time, as described above, the conduit between the probe 8 and the forceps unit 58 is completely insulated, and the gripping member 1 is formed of an insulating member. Can be performed.
If necessary, the treatment by ultrasonic vibration and the treatment by high-frequency current may be used in combination.

Next, the disassembling and assembling method of this embodiment will be described.
First, with respect to the ultrasonic incision coagulation device 31 shown in FIG. 1 in the assembled state, two screws 53 connecting the drive members 16 and 17 on the upper part of the movable operation handle 30 are removed, and the drive member 16 and the drive member 17 are removed. The spherical portion 43 is released from the engagement by the engagement groove of the driving member 16 by being vertically removed from the pipe 14. As a result, the proximal end side of the forceps unit 58 can be opened.

Next, the gripping member 1 is set to be completely closed with respect to the tip member 7, and the gripping member 1 is pulled out in the distal direction with respect to the sheath 9. By this pulling-out operation, the snap fit 38 bends in the inner circumferential direction and gets over the projection 39, so that the forceps unit 58 can be disassembled from the sheath 9.

Subsequently, the ring 23 disposed at the proximal end of the sheath 22 is rotated in the opening direction, the connection between the handpiece 32 and the sheath 22 is loosened, and the handpiece 32 is pulled out to the rear side of the operation means 34. By this pulling-out operation, the handpiece 32 together with the probe 8 can be removed from the insertion portion 57 and the operating means 34 to the rear side.

Thereafter, the probe 8 is rotated with respect to the handpiece 32 to release the screw engagement, and the probe 8 is removed from the handpiece 32. Thereafter, the tip member 7 can be removed from the probe 8 by performing the operation of releasing the screwing in the same manner.

分解 To disassemble the insertion portion 57 and the operating means 34, remove the screw 44 provided on the knob 12 from the knob 12, and remove the knob 12 from the distal end side of the sheath 9. Subsequently, by pulling out the unit including the sheath 9, the pipe 14, the sheath 22 and the like from the operation unit 34 toward the rear side of the operation unit 34, the drive member 26, the movable operation handle 30 and the fixed operation handle 29 are removed.

Through these series of operations, the ultrasonic incision coagulation device 31 is in a state where each part can be sufficiently cleaned and sterilized. However, by further removing the screw 54 connecting the drive member 26 and the movable operation handle 30, the drive member 26 is removed. And the movable operation handle 30 can be disassembled.

The fixed operation handle 29 and the movable operation handle 30 can be disassembled by disassembling the screw 27 and the screw 28. The guide sheath 21 and the handpiece 32 can also be disassembled by releasing the screw.

The members disassembled in this way are subjected to washing and sterilization, etc., and after the washing and sterilization are completed, when assembling again, the assembling of the ultrasonic incision coagulator 31 can be performed by assembling in the reverse order of the disassembly described above. I can do it.
In addition, because it is constructed so that it can be disassembled and assembled in this way, it is possible to clean or sterilize it without any trouble by disassembling it. Only the damaged parts can be replaced and can be used economically.

Further, since the forceps unit 58 is attached to the sheath 9 by the snap fit 38, the forceps unit 58 can be replaced with another forceps unit 58 having a different shape or size suitable for the treatment. Since the treatment can be performed and the distal end member 7 is detachable (disassembly and assemblable) on the probe 8 side, the treatment can be performed using another distal end member 7 having a different shape or size. it can.

(Second embodiment)
FIGS. 10A and 10B show a main part of a second embodiment of the present invention.
This embodiment has substantially the same configuration as that of the first embodiment, except that the gripping member 1 is not provided mainly for incision of a living tissue. Instead, scissors are formed by the distal end of the movable portion 3 and the tip member 7, so that the incision of the living tissue can be performed efficiently and safely.

Other configurations are the same as in the first embodiment. In this embodiment, the distal end of the movable portion 3 and the distal end of the distal end member 7 are pressed against the living tissue to be incised, and the movable portion 3 is moved from the open state to the closing direction to thereby move the living body in contact with the sandwiched portion. A living tissue can be excised by applying ultrasonic vibration to the tissue.

In other words, instead of the function of holding and cutting and coagulation (at least one of them) of the first embodiment, the function of cutting and clipping (or cutting) with a pinch is provided. In addition, as in the first embodiment, the treatment section 33 can be rotated around the central axis of the probe 8 (that is, the central axis of the ultrasonic transducer 50) by operating the knob 12 not shown in FIG. is there.
Further, since disassembly and assembly can be performed in the same manner as in the first embodiment, it is possible to disassemble and perform cleaning, sterilization, and the like. The effect of this embodiment is almost the same as that of the first embodiment.

(Third embodiment)
FIGS. 11A and 11B show a main part of a third embodiment of the present invention.
This embodiment has substantially the same configuration as that of the first embodiment, except that a cut surface 62 is formed on a portion of the movable portion 3 which is sandwiched between the grip member 1 and the front cover 6 and faces the front member 7. .

For this purpose, the living tissue is gripped by the gripping member 1 and the tip member 7, and the living tissue is coagulated using the coagulation surface 61, and the width of the coagulation surface 61 on the proximal side is reduced to form an incision surface 62. The incision can be performed on a living tissue of a small width grasped by the incision surface 62 and the distal end member 7. Other configurations are the same as those of the first embodiment.

With this configuration, for example, in the case of performing incision while coagulating, the portion to be incised is always coagulated in advance by grasping sequentially from the end of the living tissue and applying ultrasonic vibration, so that bleeding occurs The likelihood is low and a very safe incision can be made.
Other functions and effects are the same as those of the first embodiment.

(Fourth embodiment)
FIG. 12 shows a main part in a fourth embodiment of the present invention.
The present embodiment has substantially the same configuration as the first embodiment, but the fixing method of the forceps unit 58 and the sheath 9 is not the snap fit 38, but shows a cross section of a portion equivalent to the vicinity of the FF 'cross section in FIG. As shown in FIG. 12, the structure is such that it can be disassembled and assembled by an engagement screw portion 63 formed by the distal end cover 6 and the engagement member 37.

Others are the same as those of the first embodiment. The operation of this embodiment is different from that of the first embodiment only in the operation of releasing the fixing during disassembly and the operation of assembling.

(Fifth embodiment)
FIG. 13 shows a main part in a fifth embodiment of the present invention.
This embodiment has substantially the same configuration as the first embodiment, but the method of fixing the forceps unit 58 and the sheath 9 is not the snap fit 38 but the cam lock 64 provided on the distal end cover 6 as shown in FIG. The structure is such that it can be disassembled and assembled by the projection 39 of the engaging member 37 (see FIGS. 2 and 5E).

Others are the same as those of the first embodiment. The operation of this embodiment is different from that of the first embodiment only in the operation of releasing the fixing during disassembly and the operation of assembling.

(Sixth embodiment)
FIG. 14 shows a main part in a sixth embodiment of the present invention.
The present embodiment has substantially the same configuration as the first embodiment, but the fixing method of the forceps unit 58 and the sheath 9 is not the snap fit 38, but shows a cross section of a portion equivalent to the vicinity of the EE 'cross section in FIG. 14, it can be disassembled and assembled by a joining screw 65. That is, a screw hole is formed in the distal end cover 6 through the sheath and the meshing member 37, and a joining screw 65 is screwed into the screw hole, and can be disassembled and assembled by the joining screw 65. It has a structure. In addition, if necessary, an O-ring for maintaining watertightness may be interposed and screwed with the joining screw 65.

Others are the same as those of the first embodiment. The operation of this embodiment is different from that of the first embodiment only in the operation of releasing the fixing during disassembly and the operation of assembling.

(Seventh embodiment)
15 (A) and 15 (B) show a fixing mechanism for rotational locking in a seventh embodiment of the present invention, and FIG. 15 (A) shows a pipe 14 and a first bearing 15 or a second bearing. FIG. 15 (B) shows a fixing mechanism of the rotation locking using a ball click.

The present embodiment has substantially the same configuration as the first embodiment, except that a bearing 15 or a bearing 19 and a pipe 14 are provided with a rotation locking fixing mechanism using a ball click.
An elastic member 79 such as a spring is accommodated in a hole penetrating inside and outside of the pipe 14, and a ball 78 accommodated outside the elastic member 79 is urged in the outer peripheral direction by the elastic force of the elastic member 79. Here, the diameter at the outer end of the hole through which the ball 78 provided in the pipe 14 passes is set to be smaller than the diameter of the ball 78, so that the biased ball 78 projects from the hole and falls off. There is no danger of doing.

The treatment section 33 can be set at a small angle with respect to the operation means 34 at an arbitrary angle by a large number of click grooves 80 provided on the inner peripheral surface of the ball 78 and the bearing 15 or the bearing 19 along a direction parallel to the central axis. It can be rotated and fixed (locked) to an arbitrary angular position that is an integral multiple of that angle.

In other words, in the normal use state, the protruding ball 78 can be set in the fixed state in which the rotation (rotation) is restricted by being engaged with the click groove 80 and the rotation is released. The fixed position can be variably set by rotating with force.

Others are the same as those of the first embodiment. The operation of this embodiment is different from that of the first embodiment only in that the operation of releasing the fixing mechanism during disassembly is partially different from the operation of assembly.

(Eighth embodiment)
16 and 17 relate to the eighth embodiment of the present invention. FIG. 16 shows a main part of the operation means 34, and FIG. 17 shows the rotation of the second bearing 19 and the sheath 22 as viewed from the rear side in FIG. 3 shows a locking mechanism for locking.

This embodiment has substantially the same configuration as that of the first embodiment. However, a ring-shaped end face (a proximal end face as can be seen from FIG. 16) of the second bearing 19 facing the sheath 22 radially has a large number. A click groove 80 is formed, and click claws 81 are provided at, for example, two places on an end surface of the sheath 22 opposite to this end surface. A fixing mechanism is formed. The knob 12 is formed of an elastic member. Other configurations are the same as those of the first embodiment.

に よ り With these configurations, when performing the turning operation of the treatment section 33, the knob 12 is pressed to the operating means 34 in the proximal side. As a result, the knob 12 comes into contact with the bearing 15 and is elastically deformed, so that the click claw 81 comes off the click groove 80.

Then, by turning the knob 12 with respect to the operating means 34, the treatment section 33 is rotated with respect to the operating means 34. Here, when the amount of force pressing the knob 12 against the operating means 34 is released, the click claw 81 can be engaged with the click groove 80 again to set the locked state in which the rotation is restricted.

Even if the knob 12 is forcibly rotated with respect to the operating means 34 while the click claw 81 is engaged with the click groove 80, when the click claw 81 gets over the peak of the click groove 80, the knob 12 Therefore, the treatment section 33 can be rotated with respect to the operation means 34. Other effects are the same as those of the first embodiment.

(Ninth embodiment)
18 to 23 relate to the ninth embodiment of the present invention, FIG. 18 shows the whole of the ninth embodiment, FIG. 19 shows a treatment section and a probe, and FIGS. 20 (A) to (D) show FIGS. 21 shows a cross section of each part, FIG. 21 shows an insertion part, FIG. 22 shows an operation means, and FIGS. 23 (A) to 23 (C) show cross sections of each part in FIG.

In the ultrasonic incision coagulation device 31 of the first embodiment, two hollow conduits are formed in the sheath 9 having a function as a protective member, and one of the hollow conduits is passed through the forceps unit 58 provided with the treatment section 33 on one side, and the other is passed through. By passing the probe 8 side transmitting the ultrasonic wave from the ultrasonic vibrator 50 through the conduit, locking the proximal end side of the forceps unit 58 to the movable operation means of the operation means 34, and operating this movable operation means In this embodiment, the sheath 9 having a function as a protective member is a cylindrical hollow conduit (single conduit). 9, a substantially cylindrical probe 8 is inserted into the probe 8, and the transmitting member side connected to the movable member of the treatment section 33 is inserted into the probe 8. The proximal end of the transmitting member is connected to the ring-shaped ultrasonic transducer 50. To extend rearward in the hollow part of It is a structure coupled to the means.

As shown in FIG. 18, the ultrasonic incision coagulation apparatus 31 has a treatment section 33 and an insertion section 57 for inserting the treatment section 33 into a living body. Is provided. A handpiece 32 having an ultrasonic vibrator 50 for supplying ultrasonic vibration for treatment to the treatment section 33 is provided on the upper proximal side of the operation means 34.

The configurations of the treatment section 33 and the probe 8 for transmitting the ultrasonic vibration from the ultrasonic transducer 50 to the treatment section 33 are as shown in FIGS. The treatment section 33 is screwed to the distal end of the probe 8 and provided with a distal end member 7 for performing treatment on a living tissue by ultrasonic vibration.

遠 位 The distal end of the distal end member 7 is shaped like a forceps, and a distal end cover 6 that sandwiches the movable portion 3 is formed from the central portion to the proximal end. The movable part 3 and the distal end of the tip member 7 are engaged with each other, and have a function as a forceps for grasping and opening tissue.

In this embodiment, usually, the distal end called a peeling forceps is thin and has a shape effective for a peeling operation. This shape may be, for example, a scissors shape as in the second embodiment, or a movable portion in the third embodiment. The shape may be as shown in FIG.

The movable part 3 is rotatably supported by the tip cover 6 by a pin 35 and is connected to the transmission member 5 by a pin 36. The transmission member 10 is screwed to the proximal end of the transmission member 5.

近 The proximal side of the distal end cover 6 and the probe 8 are formed to be hollow, and the first transmission member 5 and the second transmission member 10 penetrate the inside. The outer peripheral surface of the second transmission member 10 is covered with a tube 66 made of a material having heat resistance and ultrasonic vibration absorption such as PTFE material, and when ultrasonic vibration is applied to the probe 8. In addition, the contact between the probe 8 and the transmission member 10 prevents a danger such as generation of metal noise, heat generation or breakage of the contact portion.

As in the first embodiment, an engagement member 42 is screwed to the proximal end of the transmission member 10, and a spherical portion 43 is formed at the proximal end of the engagement member 42. The engaging member 42 is driven forward and backward by the opening and closing operation of the movable operation handle 30, and the transmitting member 5 is driven forward and backward, whereby the amount of force is transmitted to the movable portion 3 through the pin 36, and the movable portion 3 is It is driven to open and close.

The outer peripheral surface of the engaging member 42 is made of a material having an electrical insulation property such as PTFE material in order to prevent a danger of the high-frequency current leaking to a surgeon's hand or the like during a treatment using a high-frequency current described later. It is covered with the formed tube 67.
The probe 8 is formed of, for example, three parts, and is assembled by connecting the portions indicated by Q and R in FIG. 19A by Tig welding or the like.

As shown in FIG. 20 (A), the pin 35 for rotatably supporting the movable portion 3 is fixed to the end cover 6 by caulking or laser welding or the like, so that the pin 35 is integrated with the end cover 6 as described above. When the ultrasonic vibration is transmitted to the front end cover 6, the ultrasonic vibration is also transmitted to the movable portion 3 via the pin 35.

処置 The treatment section 33 and the probe 8 having the above structures are inserted into the insertion section 57 described later, and are connected to the ultrasonic vibrator 50 of the handpiece 32 of the operation means 34.

The insertion portion 57 has a configuration as shown in FIG. 21. When the sheath 9 and the above-described distal end cover 6 or the distal end member 7 come into contact with the distal end of the sheath 9 composed of a plurality of components, In order to prevent the risk of generation of heat, heat generation, or damage to both, a protection member 4 made of a material having heat resistance and resistance to ultrasonic vibration, such as PTFE material or ceramic, is provided. .

An O-ring 68 and a C-ring 69 are provided on the outer periphery of the proximal end of the sheath 9 and are connected to a screw ring 82 described later in a watertight manner. In the present embodiment, the connection between the sheath 9 and the screw ring 82 is detached by the C-ring 69. However, for example, the structure of the snap fit 38 and the projection 39 of the first embodiment, or the joint screw portion like the fourth embodiment. A connection mechanism 63, a cam lock 64 as in the fifth embodiment, or a joining screw 65 as in the eighth embodiment may be used, and the connection method is not particularly limited.

Next, the operation means 34 will be described. As shown in FIG. 22, the operating means 34 has a first bearing 15 joined to the upper end of the support member 72 by a screw 71, and a second bearing 19 joined by a screw 73 near the upper center. .

ネ ジ A screw ring 82 is inserted into the distal side of the first bearing 15 and screwed to the handpiece 32 with the bearing 15 interposed therebetween. The screw ring 82 is rotatable with the first bearing 15 together with the handpiece 32, and watertightness is maintained by the O-ring 45.

The above-mentioned sheath 9 is joined to the distal side of the screw ring 82 by a C-ring 69, and the water-tight state is maintained with the first bearing 15 by a water-tight means such as an O-ring 68 so as to be rotatable. . In this embodiment, a water supply / suction base 51 is provided above the first bearing 15, and a water supply / suction unit (not shown) is connected to the water supply / suction base 51 so that the water supply / suction base is connected to the first bearing 15. Water supply or suction can be performed using a conduit passing through the sheath 9.

近 The proximal side of the handpiece 32 is inserted into the second bearing 19 and is supported by the O-ring 47. The handpiece 32 can be rotated by the above-mentioned O-ring 45 and O-ring 47 when it is necessary to rotate the handpiece 32. On the other hand, it is rotatable.

The fixing mechanism for the rotation locking may be a mechanism using a ball click mechanism as in the seventh embodiment or a click mechanism as in the eighth embodiment, other than the O-ring 47, for example.

As described above, the ultrasonic vibrator 50 for supplying ultrasonic vibration for performing treatment on the living tissue is provided in a ring shape inside the handpiece 32, and the ultrasonic vibration generated by the ultrasonic vibrator 50 is provided. The proximal end of the probe 8 is screwed to the distal end of the drive shaft (vibration axis).

The second transmission member 10 described above is inserted into the inside of the probe 8, and protrudes rearward from the proximal end of the handpiece 32 through a pipeline inside the ultrasonic transducer 50.
At this time, in order to prevent insufflation gas and the like from leaking through the conduit through which the transmission member 10 extending to the proximal end side of the handpiece 32 is inserted, the pipe and the second transmission member 10 are connected to each other. A substantially tubular airtight member 74 is provided near the proximal end, and the airtight member 74 is formed of, for example, an elastic member such as rubber or a sealing member such as PTFE material.

An engaging member 42 is connected to the proximal end of the second transmission member 10 by screwing, and the outer periphery of the engaging member 42 is susceptible to leakage of high-frequency current during treatment with high-frequency current described later. In order to prevent this, a tube 67 made of an electrically insulating material such as a PTFE material is used.

球状 A spherical portion 43 is provided at the proximal end of the engagement member 42, and meshes with an engagement receiving member 75 inserted above the movable operation handle 30 as shown in FIG. The engagement receiving member 75 is vertically grooved as shown in FIGS. 23A and 23B, and the spherical portion 43 can slide in the groove. I have.

Here, the upper part of the groove opening of the engagement receiving member 75 is opened with a width that allows the spherical part 43 to pass through, and the lower part is opened with a width that does not allow the spherical part 43 to pass. The base of the spherical portion 43 is sandwiched in the lower opening, and the spherical portion 43 is normally engaged in the lower groove.

By opening and closing the movable operation handle 30 with respect to the fixed operation handle 29 by this structure, the engagement member 42 can be driven forward and backward, and the engagement member 42 is driven forward and backward to transmit the screw screwed to this. The member 10 and the transmission member 5 are driven forward and backward, whereby the movable section 3 is driven to open and close with respect to the tip member 7.

A fixed operation handle 29 is connected to the proximal end of the support member 72 by a screw 76 and a nut 77, and the movable operation handle 30 is rotatably supported on the fixed operation handle 29 as shown in FIG. Thus, the movable operation handle 30 can be opened and closed with respect to the fixed operation handle 29 as described above.

Next, an actual use example of the present embodiment will be described.
First, the treatment section 33 is made to face the living tissue to be treated. Next, the handpiece 32 is rotated with respect to the operation means 34, and the treatment section 33 is oriented in a direction convenient for treating the living tissue.

(5) Then, the movable operation handle 30 is rotated in the opening direction, and the movable portion 3 is opened. The living tissue to be treated is gripped with an appropriate force. Thereafter, the ultrasonic vibrator 50 is driven by a drive power supply for the ultrasonic vibrator 50 (not shown), and the ultrasonic vibration is transmitted to the distal end member 7 and the movable portion 3 to apply ultrasonic vibration to the living tissue.

At this time, if the treatment is performed with factors such as increasing the amplitude of the ultrasonic vibration, increasing the amount of gripping force, and increasing the time for applying the ultrasonic vibration as described above, it is convenient to incise the living tissue, and conversely. Since the coagulation is performed when the factor is used, it is convenient. Therefore, an appropriate treatment is performed in consideration of the condition of the living tissue.

Also, by applying a high-frequency current supply power source (not shown) to the ultrasonic vibrator 50, it is possible to apply a high-frequency current to the living tissue from the ultrasonic vibrator 50 through the probe 8, the tip cover 6, the tip member 7, and the movable part 3. Yes, it is possible to perform treatment using high-frequency current.

At this time, as described above, the outer periphery of the engaging member 42 exposed to the outside is covered with the electrically insulating tube 67, and the movable operation handle 30, the sheath 9, the screw ring 82, the bearing 15, the handpiece 32, By molding the casing or the like with an electrically insulating material such as PEEK or polysulfone, leakage of high-frequency current can be prevented, so that safe treatment can be performed.

(4) Since the treatment by the ultrasonic vibration and the treatment by the high-frequency current can be performed independently, the treatment may be performed by using each separately or may be performed simultaneously.

Next, the disassembling and assembling method of this embodiment will be described.
First, the sheath 9 is pulled out from the screw ring 82 in the distal direction. Next, the fixing operation handle 29 is removed downward from the support member 72 by removing the screw 76. Accordingly, the movable operation handle 30 also moves downward, so that the spherical portion 43 engaged with the engagement receiving member 75 comes off the groove, and the engaging member 42 falls off the movable operation handle 30. .
As a result, the unit in which the fixed operation handle 29 and the movable operation handle 30 are integrated is disassembled by the operation means 34.

Then, the screw ring 82 is removed from the handpiece 32, whereby the screw ring 82 is disassembled from the bearing 15. Thereafter, by pulling the handpiece 32 proximally from the bearings 15 and 19, the handpiece 32 and the probe 8 and the like are disassembled from the operating means 34.

The probe 8 is removed from the handpiece 32, and the engaging member 42 is removed from the transmission member 10. Thereafter, the tip member 7 is removed from the probe 8.
By the above disassembling operation, the ultrasonic incision coagulation device 31 can be cleaned and sterilized satisfactorily, and each part can be cleaned and sterilized.

When assembling the ultrasonic incision coagulation device 31 again, it is possible to assemble the ultrasonic incision coagulation device 31 in a procedure reverse to the above disassembly procedure.
In addition, since the disassembly and the assembly can be performed in this manner, if any part is damaged, the part can be replaced with another part to be used again.

(Tenth embodiment)
FIG. 24 shows a tenth embodiment of the present invention.

構成 The configuration of the present embodiment is almost the same as that of the ninth embodiment, except that the probe 8 is curved, and the sheath 9 and the transmission member 10 inserted therein are formed of elastic members. The transmission member 10 is formed of, for example, a super-elastic wire made of a Ni-Ti alloy or the like. The sheath 9 is formed of a flexible member such as a PTFE material.

Thereby, the curved probe 8 can be inserted into the sheath 9 and the transmission member 10 can be driven forward and backward within the probe 8.

With these configurations, the treatment section 33 can be rotated with respect to the operation means 34, so that good operability is obtained.
Other configurations and operations are the same as those of the ninth embodiment.

In each of the above embodiments, for example, in a structure that can be disassembled and assembled by screwing or screwing a screw and a screw hole or a male screw and a female screw, a member provided with a screw or a male screw and a screw hole or a female screw It is obvious that the member provided with the groove may be replaced, or the like, and the same applies to the case where the projection, the claw, the pin, or the like is engaged with the concave portion, the groove, or the like.

As described above, the sheath of the insertion section for inserting the treatment section for performing treatment on the living tissue of the ultrasonic incision coagulation apparatus, which is the gist of the present invention, into the living body is made rotatable with respect to the operation means. The other configuration may be of any purpose as long as it is within the range described above, and the content is not limited.

[Appendix]
1. An ultrasonic transducer for generating ultrasonic vibration, and a handpiece incorporating the ultrasonic transducer, a treatment for applying ultrasonic vibration generated by the ultrasonic transducer to a living tissue A probe, which is a vibration transmitting member for transmitting to the portion, is connected to the ultrasonic vibrator, has a sheath, which is a protective member for covering the probe, and holds a living tissue between the probe and a distal end of the probe; An ultrasonic incision having operating means for performing an operation for gripping and releasing living tissue by the probe distal end and the gripping member, and a transmission member for driving the gripping member by operating the operating means In the coagulation device, the sheath can be disassembled and assembled with respect to the operation means.

By disassembling, each part can be washed and sterilized easily and reliably, and parts can be easily replaced in the event of breakage.Furthermore, by combining various gripping members, sheaths, probes, etc., an ultrasonic incision coagulation device optimal for treatment is provided. Can be built.

2. In Appendix 1,
The gripping member and the transmission member are a unit-shaped forceps unit,
The sheath is a conduit through which the probe is inserted,
Having a conduit through which the forceps unit is inserted,
The forceps unit can be disassembled and assembled with the sheath,
Both the sheath and the forceps unit can be disassembled and assembled with respect to the operating means.
3. In Supplementary Notes 1 and 2,
The handpiece can be disassembled and assembled with respect to the sheath and the operating means.

4. In Supplementary Notes 1, 2 and 3,
The probe can be disassembled and assembled with the handpiece.
5. In Appendix 1,
The gripping member is rotatably attached to a tip member provided at the probe distal end,
The transmission member and the probe are inserted into the same conduit in the sheath.
6. In Appendix 5,
One in which the transmission member is inserted inside the probe.

7. In Supplementary Notes 5 and 6,
The handpiece and the transmission member can be disassembled and assembled with respect to the operating means and the sheath.
8. In Supplementary Notes 5 to 7,
The tip member can be disassembled and assembled with the probe,
The transmission member can be disassembled and assembled with the operation means.
9. In Supplementary Notes 1 to 8,
When disassembling the sheath with respect to the operating means,
The sheath is disassembled by moving in a distal direction with respect to the operating means,
When assembling the sheath to the operating means,
The sheath is connected by moving the sheath in a proximal direction with respect to the operating means.

10. In Supplementary Note 1, Supplementary Notes 2 to 9,
The handpiece is attached to the operating means in a state equipped with the probe and the tip member,
In a state where the transmission member is coupled to the operation means,
The sheath can be disassembled and assembled with the operating means.
11. In Supplementary Note 1, Supplementary Notes 2 to 10,
The method of disassembling and assembling the sheath and the operating means is based on screws and screw holes. 12. In Supplementary Note 1, Supplementary Notes 2 to 10,
The method of disassembling and assembling the sheath and the operating means is performed by using an elastic member and a groove or a projection that meshes with the elastic member.

13. In Supplementary Note 1, Supplementary Notes 2 to 10,
A male screw provided with a disassembly and assembly method of the sheath and the operating means,
The female screw provided on the other side.
14． In Supplementary Note 1, Supplementary Notes 2 to 10,
A cam groove in which the disassembling and assembling method of the sheath and the operating means is provided in one of them;
The pin provided on the other side engages with the cam groove.

1 is an overall view of a first embodiment of the present invention. Sectional drawing which shows the structure of a treatment part and an insertion part. FIG. 3 is a sectional view taken along line D1-D2-D3-D4 in FIG. 2. The front view of the treatment part seen from the front of FIG. FIG. 3 is a sectional view taken along line AA ′ to GG ′ in FIG. 2. FIG. 3 is a plan view showing an operation unit. FIG. 3 is a partial cross-sectional view showing the operation means and a part thereof in an enlarged manner. FIG. 8 is a sectional view taken along line HH ′ and line II ′ in FIG. FIG. 8 is a sectional view taken along line JJ′-MM ′ in FIG. The figure which shows the front and side shape of the treatment part in 2nd Example of this invention. The figure which shows the shape of the treatment part and a part of movable part in the 3rd Example of this invention. FIG. 14 is a sectional view showing a part of an insertion portion according to a fourth embodiment of the present invention. FIG. 14 is a perspective view showing a treatment section according to a fifth embodiment of the present invention. FIG. 14 is a sectional view showing a part of an insertion portion according to a sixth embodiment of the present invention. FIG. 17 is a diagram showing a bearing portion and a ball click mechanism of an operation means according to a seventh embodiment of the present invention. Sectional drawing which shows the operating means in the 8th Example of this invention. The perspective view showing the bearing part of the operation means in an 8th example. FIG. 19 is an overall view of a ninth embodiment of the present invention. The figure which shows the treatment part and the cross section of a probe and a part of treatment part. FIG. 20 is a sectional view taken along lines NN ′ to PP ′ and SS ′ in FIG. 19. Sectional drawing which shows an insertion part. Sectional drawing which shows an operation means. FIG. 23 is a sectional view taken along line TT ′ to VV ′ in FIG. 22. FIG. 14 is an overall view of a tenth embodiment of the present invention.

Explanation of reference numerals

DESCRIPTION OF SYMBOLS 1 ... Grip member 2 ... Screw 3 ... Movable part 4 ... Protective member 5, 10 ... Transmission member 6 ... Tip cover 7 ... Tip member 8 ... Probe 9, 11, 22 ... Sheath 12 ... Knob 13, 20 ... Coupling member 14, 18 ... Pipe 15, 19 ... Bearing 16, 17 ... Driving member 21 ... Guide sheath 23, 24 ... Ring 25 ... Driving pin 26 ... Driving member 27, 28 ... Screw 29 ... Fixed operation handle 30 ... Movable operation handle 31 ... Ultrasonic wave Incision coagulation device 32 ... handpiece 33 ... treatment unit 34 ... operating means 38 ... snap fit 39 ... protrusion 40 ... rotation prevention mechanism 41 ... connecting member 42 ... engagement member 43 ... spherical part 45, 47, 48 ... O-ring 50 … Ultrasonic transducer 56… Engagement groove 57… Insertion part agent Patent Attorney Susumu Ito

Claims (1)

An ultrasonic vibrator for generating ultrasonic vibration,
A handpiece incorporating the ultrasonic transducer,
A probe as a vibration transmission member that is connected to the ultrasonic transducer and transmits the ultrasonic vibration to a treatment unit for performing a treatment on a living tissue,
A sheath that is a protective member that covers the probe,
A gripping member for gripping a living tissue between the probe distal end,
Operating means for performing an operation for gripping and opening a living tissue by the probe distal end and the gripping member,
A transmission member for driving the gripping member by operating the operation means,
In an ultrasonic incision coagulation device having
It has a movable member that can move forward and backward to transmit the operation force by the operation means,
The ultrasonic incision coagulation device, wherein the gripping member is configured to be detachable from the movable portion.

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