JP2004154164A - Multi-degree-of-freedom type treating instrument - Google Patents

Multi-degree-of-freedom type treating instrument Download PDF

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Publication number
JP2004154164A
JP2004154164A JP2002319892A JP2002319892A JP2004154164A JP 2004154164 A JP2004154164 A JP 2004154164A JP 2002319892 A JP2002319892 A JP 2002319892A JP 2002319892 A JP2002319892 A JP 2002319892A JP 2004154164 A JP2004154164 A JP 2004154164A
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Japan
Prior art keywords
treatment
joint
unit
degree
posture
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JP2002319892A
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Japanese (ja)
Inventor
Daisaku Ikeda
大作 池田
Toshimi Shikumo
俊美 紫雲
Masao Watanabe
征男 渡辺
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Mizuho Ika Kogyo KK
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Mizuho Ika Kogyo KK
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Priority to JP2002319892A priority Critical patent/JP2004154164A/en
Publication of JP2004154164A publication Critical patent/JP2004154164A/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A61B2017/00305—Constructional details of the flexible means
    • A61B2017/00314—Separate linked members
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A61B2017/00318—Steering mechanisms
    • A61B2017/00323—Cables or rods
    • A61B2017/00327—Cables or rods with actuating members moving in opposite directions

Abstract

<P>PROBLEM TO BE SOLVED: To provide a multi-degree-of-freedom type treating instrument for performing various kinds of treatments such as clamping, peeling, excision, suture and ligature of tissues inside a living body performed in an endoscopic operation or the like. <P>SOLUTION: For the multi-degree-of-freedom type treating instrument, a treating part (2) is connected through a joint part (3) to a treating instrument main body (1) and the treating instrument main body is provided with a posture operation unit for operating the posture of the treating part and a treating operation unit (10) for performing the treating operation of the treating part. The posture operation unit is provided with a bending operation part (15) for performing the bending operation in a vertical direction and a horizontal direction of the treating part through the joint part and a rotating operation part (18) for performing the rotating operation of the treating part around the axis of the joint part. Since the treating part is bent in the vertical direction and horizontal direction through the joint part by the bending operation part of the posture operation unit and the treating part is rotated around the axis of the joint part by the rotating operation part of the posture operation unit, the treating part is easily set to a position and the posture desired by an operator. <P>COPYRIGHT: (C)2004,JPO

Description

【０００１】
【発明の属する技術分野】
本発明は、生体内組織の各種処置を行うための多自由度型処置具に関する。
【０００２】
【従来の技術】
胆のう摘出術などの腹腔鏡下手術に代表される内視鏡下外科手術は、体表に複数個の小さな穴を開け、各穴にトラカールを取り付け、各トラカールから観察用内視鏡、長鉗子等の処置具を挿入することにより行われる。この内視鏡下外科手術は、開腹しないで観察および処置を行うので、患者に与える負担を軽減することができる低侵襲な手術である。
【０００３】
この内視鏡下外科手術で用いられる処置具は、その処置部を処置具本体に関節部を介して接続し、処置部の姿勢を操作する姿勢操作装置と、処置部の処置操作を行う処置操作装置とを処置具本体に装着してなる構造であり、処置部をトラカールから体内に挿入し、姿勢操作装置を体外で操作しつつ処置部で生体内組織に所望の処置を行うようになっている（例えば、特許文献１，２，３参照。）。
【０００４】
【特許文献１】
特開２００１−２７６０９１号公報
【特許文献２】
特開２０００−３５０７３５号公報
【特許文献３】
特開平６−１９７９０６号公報
【０００５】
【発明が解決しようとする課題】
内視鏡手術において実施される生体内組織の把持、剥離、切除、縫合、結紮などの処置では非常に細かな動作が要求されるが、従来使用されている処置具は直線形状であり、その処置部の動きも一種又は二種に制約されるため操作性に乏しく微細な処置を行うことは非常に困難である。例えば、特許文献１，２の処置具は、トラカールを中心とする処置部の直線動作と、体内における処置部の上下左右の屈曲動作に限定されるので、操作性に乏しい。処置部をトラカールを中心として回転させるには処置具全体を回転させなければならず、術者に無理な姿勢を強要するという問題がある。特許文献３の処置具は、トラカールを中心とする処置部の直線動作と、左右いずれか一方への屈曲動作に限定されるので、操作性に乏しく、術者に無理な姿勢を強要するという問題がある。
【０００６】
従って、本発明はそのような問題点を解決することができる多自由度型処置具を提供することを目的とする。
【０００７】
【課題を解決するための手段】
上記課題を解決するため、請求項１に係る発明は、処置部（２）が関節部（３）を介して処置具本体（１）に接続され、処置部（２）の姿勢を操作する姿勢操作装置と、処置部（２）の処置操作を行う処置操作装置（１０）とが処置具本体（１）に設けられた多自由度型処置具であって、姿勢操作装置が、関節部（３）を介して処置部（２）を上下方向および左右方向に屈曲動作させる屈曲操作部（１５）と、処置部（２）を関節部（３）の軸心回りに回転動作させる回転操作部（１８）とを具備した多自由度型処置具を採用する。
【０００８】
この請求項１に係る発明によれば、姿勢操作装置の屈曲操作部（１５）により関節部（３）を介して処置部（２）を上下方向および左右方向に屈曲動作させることができ、姿勢操作装置の回転操作部（１８）により処置部（２）を関節部（３）の軸心回りに回転動作させることができるので、処置部（２）を術者の所望の位置及び姿勢に簡易に設定することができる。従って、操作性が向上し、術者は楽な姿勢で手術を行うことができる。
【０００９】
また、請求項２に係る発明は、請求項１に記載の多自由度型処置具において、関節部（３）が、互いに９０度位相がずれた枢軸（１４ａ，１４ｂ）を介して連結される複数個の関節部材（１４）により形成された多自由度型処置具を採用する。
【００１０】
この請求項２に係る発明によれば、関節部（３）の各関節部材（１４）が互いに９０度位相のずれた枢軸（１４ａ，１４ｂ）を有するので、処置部（２）の自由度が増大し、処置具の操作性がさらに向上する。
【００１１】
また、請求項３に係る発明は、請求項１又は請求項２に記載の多自由度型処置具において、回転操作部（１８）が筒状の関節部（３）内に直列状に挿入される複数個のコマ（２０）を備え、これらのコマ（２０）を介して処置部（２）に回転力を伝達するようにした多自由度型処置具を採用する。
【００１２】
この請求項３に係る発明によれば、回転操作部のコマ（２０）間の摩擦力により回転力が処置部（２）に伝達され、処置部（２）が関節部（３）の軸心の回りを回転する。従って、コマ（２０）のすべりクラッチ作用により、処置部（２）又は生体内組織に無理な力が掛からないようにすることができる。
【００１３】
また、請求項４に係る発明は、請求項１乃至請求項３のいずれかに記載の多自由度型処置具において、弾性体（１３）により処置部（２）を開動作または閉動作させる多自由度型処置具を採用する。
【００１４】
この請求項４に係る発明によれば、処置部（２）を弾性体（１３）により開動作または閉動作させるので、処置部（２）を開状態又は閉状態のいずれかにセットすることができ、術者の操作を簡易化することができる。
【００１５】
【発明の実施の形態】
以下、本発明の実施の形態について図面を参照して説明する。
【００１６】
図１に示すように、この鉗子の一種である多自由度型処置具の処置具本体１は、術者が把持するハンドル部１ａと、トラカール（図示せず）等に挿入可能な細長い筒部１ｂとを具備する。
【００１７】
図１及び図２に示すように、処置具本体１の筒部１ｂの先端には、処置部２が関節部３を介して接続される。
【００１８】
処置部２は、この実施の形態では鋏として構成される。鋏の二枚のブレード２ａ，２ｂがボス４ａ，４ｂの箇所で重ね合わされ、両ボス４ａ，４ｂに支点軸５が挿入される。支点軸５は筒状の支持体６の先端から突出するフォーク片６ａに支持される。支持体６の空洞内にはロッド状のスライダ７が挿入され、このスライダ７に二本の連接棒８ａ，８ｂの一端がピン結合され、各連接棒８ａ，８ｂの他端が二枚のブレード２ａ，２ｂの各ボス４ａ，４ｂにピン結合される。これにより、スライダ７が支持体６内で往復スライド運動をするとブレード２ａ，２ｂが開閉動作をすることになる。この実施の形態では、スライダ７が図２中左方にスライドするとブレード２ａ，２ｂが開くようになっているが、連接棒８ａ，８ｂを付け替えることによりスライダが図２中左方にスライドするとブレードが閉じるようにすることもできる。
【００１９】
処置部２の支持体６は、図２及び図４に示すように、支持筒９により回転可能に支持され、このため処置部２は支持筒９の軸心の回りで回転可能である。
【００２０】
図１及び図７に示すように、処置具本体１には、処置部２の処置操作すなわち鋏の開閉操作を行うための処置操作装置が設けられる。
【００２１】
処置操作装置は、入力部であるトリガー状のレバー１０と、伝動部であるワイヤ１１とを具備する。
【００２２】
レバー１０は処置具本体１にハンドル部１ａよりやや前方にて枢ピン１２で回動自在に支持され、枢ピン１２を上方に超えるように突出する突出部１０ａに二本の中間リンク２５，２６を介してワイヤ１１の後端が連結される。すなわち、一方の中間リンク２５は突出部１０ａにピン結合され、一方の中間リンク２５の他端に他方の中間リンク２６の一端がピン結合され、この他方の中間リンク２６の他端がワイヤ１１の後端に接続される。また、他方の中間リンクの中央が処置具本体１に支持ピン２７で支持される。もちろん、このレバー１０とワイヤ１１との間の連動機構は他の機構で代替することができる。ワイヤ１１は可撓性を有する線材で形成され、レバー１０から処置具本体１の筒部１ｂ及び関節部３内を通って支持体６内へと貫通し、支持体６内のスライダ７の後端に連結される。図１及び図７の鋏が開いた状態においてハンドル部１ａを把持する術者の手の指がレバー１０を引き操作すると、ワイヤ１１が後方にスライドし、図２のごとくスライダ７を支持体６内で後退させる。これにより、連接棒８ａ，８ｂがボス４ａ，４ｂを支点軸５の回りで回転させ、ボス４ａ，４ｂと一体の二枚のブレード２ａ，２ｂが閉動作をする。
【００２３】
処置部の支点軸５には、図２に示すように、ブレード２ａ，２ｂを常時開状態に保持する弾性体が必要に応じて設けられる。図２はこの弾性体の付勢力に抗する力が加えられることでブレード２ａ，２ｂが閉じたものとして示されている。
【００２４】
弾性体としては望ましくはねじりコイルバネ１３が用いられ、支点軸５にねじりコイルバネ１３のコイル部が巻付けられ、ねじりコイルバネ１３の両端が二つのボス４ａ，４ｂにそれぞれ係止される。図示例ではブレード２ａ，２ｂが常時開くようにねじりコイルバネ１３が装着されているが、装着する向きを変更することによりブレード２ａ，２ｂが常時閉じるように付勢することも可能である。その場合は、例えば上記二本の中間リンク２５，２６が省略され、レバー１０の突出部１０ａにワイヤ１１の後端が連結され、レバー１０を引くとブレード２ａ，２ｂが開動作することになる。
【００２５】
このように、バネ力等の弾性力により処置部２である鋏を開動作または閉動作させるので、処置部２を開状態又は閉状態のいずれかにセットすることができ、術者の操作を簡易化することができる。すなわち、レバー１０から術者が手を離すと、ねじりコイルバネ１３のバネ力によりブレード２ａ，２ｂが閉じた状態から自動的に元の開いた状態に戻されるか、或いはブレード２ａ，２ｂが開いた状態から自動的に元の閉じた状態に戻される。
【００２６】
なお、この弾性体を省略し、ブレード２ａ，２ｂの開閉に対して開き用ワイヤと閉じ用ワイヤの二本を用意することによってもブレード２ａ，２ｂを開閉操作することが可能である。
【００２７】
関節部３は、図３に示すように複数個の同じ形状の関節部材１４を直列に接続した構造となっている。各関節部材１４は前後に互いに９０度位相がずれた枢軸を有し、複数個の関節部材１４がこの二種類の枢軸を交互に介するように連結される。具体的には、一つの関節部材１４が前後両端にそれぞれ軸心を水平と垂直に設定した凸状の軸部１４ａと凹状の軸受部１４ｂを備え、一方の関節部材１４の軸部１４ａを他方の関節部材１４の軸受部１４ｂに嵌め込むようにして枢軸が形成され、各枢軸を介して複数個の関節部材１４が連結される。そして、先頭の関節部材１４に図２及び図４に示すように処置部２の支持体６を保持する支持筒９が関節部材１４，１４同士の連結と同様にして連結され、後尾の関節部材１４に処置具本体１の筒部１ｂの先端が関節部材１４，１４同士の連結と同様にして連結される。関節部材１４は一個設けるだけでも処置部２を前後左右に屈曲させることができるが、望ましくは二個以上の関節部材１４が設けられる。関節部材１４を増設することにより、処置部２の自由度が増大し、処置具の操作性がさらに向上する。
【００２８】
処置具本体１には、処置部２の姿勢を操作する姿勢操作装置が設けられる。
【００２９】
姿勢操作装置は、関節部３を介して処置部２を上下方向および左右方向に屈曲動作させる屈曲操作部と、処置部２を関節部３の軸心回りに回転動作させる回転操作部とを具備する。
【００３０】
屈曲操作部は、術者が操作する入力部と、入力部での操作を処置部２に伝達して屈曲させる伝動部とを有する。
【００３１】
入力部は、図１、図６、図７及び図８に示すようにジョイスティック１５として構成され、処置具本体１におけるハンドル部１ａの背面上部に配置される。このジョイスティック１５は、図６に示すように、中心部に球体１５ａを有し、この球体１５ａが処置具本体１内の球軸受１ｃに回転自在に嵌め込まれている。ジョイスティック１５のスティック部１５ｂは処置具本体１の壁面に形成された穴から外側に露出し、穴とスティック部１５ｂとの間は柔軟性を有する変形可能なゴムリング１６で塞がれている。スティック部１５ｂは十字形または円形をしており、例えば処置具本体１の背後からスティック部１５ｂに正対して１２時、３時、６時、９時の方位において伝動部としての屈曲可能な四本の駆動ワイヤ１６がスティック部１５ｂに接続される。
【００３２】
伝動部である各駆動ワイヤ１６は、図２、図４及び図５に示すように、スティック部１５ｂから処置具本体１の筒部１ｂと関節部３の全関節部材１４の中を前方に伸び、処置部２の支持体６を保持する支持筒９の後端に連結される。図３に示すように、関節部材１４には、各駆動ワイヤ１６を通すための通し孔１７が設けられている。通し孔１７は駆動ワイヤ１６で関節部３を屈曲しやすくするため関節部材１４の表面に近い箇所に穿設される。
【００３３】
処置具本体１のハンドル部１ａを術者が握り、指でジョイスティック１５を操作すると、スティック部１５ｂが球体１５ａを支点にして揺動し、一部の駆動ワイヤ１６が引っ張られ、その駆動ワイヤ１６の引き量に応じて関節部３が屈曲する。この要領で四本の駆動ワイヤ１６を操作することにより、関節部３は上下方向と左右方向に屈曲し、処置部２は二自由度で位置及び姿勢を変える。
【００３４】
回転操作部は、術者が操作する入力部と、入力部での操作を処置部２に伝達して回転させる伝動部とを有する。
【００３５】
入力部は、図１、図７及び図８に示すようにダイアル１８を備える。ダイアル１８は、処置具本体１のハンドル部１ａを握る手の指で回転操作することができるように処置具本体１に取り付けられる。伝動部は、処置具本体１の筒部１ｂ内を貫通する筒状シャフト１９と、図２及び図４のごとく関節部３の全関節部材１４を貫通するように形成されたトンネル穴２４内に直列に並べられる回転伝達部材である複数個のコマ２０とを備える。筒状シャフト１９の中心には図示しないトンネル状の通孔が穿設され、図３乃至図５に示すように、コマ２０の中心には筒状シャフト１９の通孔に連なるトンネル状の通孔２１が穿設されており、この通孔２１内を上記処置操作装置のワイヤ１１が貫通している。筒状シャフト１９とダイアル１８とは、図７に示すように、歯車２２，２３等により動力的に連結され、ダイアル１８の回転が筒状シャフト１９に伝達されるようになっている。コマ２０は、図２、図４及び図５に示すように、円柱片の両端に円錐台形の隆起部が形成された形状のすべりクラッチ部材であり、先頭のコマ２０が処置部２の支持体６の後端に接触し、後尾のコマ２０が筒状シャフト１９の前端に接触する。ダイアル１８の操作により筒状シャフト１９が所望の向きに回転すると、これらのコマ２０の摩擦接触により処置部２に回転力が伝達され、処置部２が関節部３の軸心の回りを回転する。また、コマ２０の列は関節部３が屈曲してもこれに追従して屈曲し動力を処置部２に伝達し、この屈曲した関節部３の先端で処置部２のみが独立して所望の姿勢に回転する。
【００３６】
次に、上記構成の多自由度型処置具の作用について説明する。
【００３７】
内視鏡下外科手術を行うに際して、体表に複数個の小さな穴を開け、各穴にトラカールを取り付け、各トラカールから観察用内視鏡、多自由度型処置具の処置部２及び筒部１ｂを体内に挿入する。
【００３８】
術者は処置具のハンドル部１ａを把持し、指で姿勢操作装置の屈曲操作部又は回転操作部を操作する。
【００３９】
術者が屈曲操作部のジョイスティック１５を操作すると、スティック部１５ｂが球体１５ａを支点にして揺動し、一部の駆動ワイヤ１６が引っ張られ、その駆動ワイヤ１６の引き量に応じて関節部３が処置具本体１に対し上下方向と左右方向に二自由度で屈曲する。
【００４０】
また、術者が回転操作部のダイアル１８を操作すると、筒状シャフト１９が所望の向きに回転し、コマ２０の摩擦接触により処置部２に回転力が伝達され、処置部２が関節部３の軸心の回りを回転する。コマ２０の列は関節部３が屈曲してもこれに追従して屈曲し、回転力を処置部２に伝達し、この屈曲した関節部３の先端で処置部２が独立して所望の姿勢へと回転する。
【００４１】
回転操作部の操作に際し、処置部２等にコマ２０，２０間の摩擦力により回転力が伝達されるが、処置部２に大きな力が掛かった場合はコマ２０，２０間がすべり、そのため処置部２又は生体内組織には無理な力が掛からない。
【００４２】
このように、姿勢操作装置の屈曲操作部と回転操作部を指で操作することにより、上下方向および左右方向の二自由度の屈曲動作と回転動作とを合わせた計三自由度で処置部２が体腔内において位置と姿勢を変える。殊に処置部２の回転動作が可能であると、縫合などの回転を必要とする処置に有利である。
【００４３】
処置部２の位置と姿勢が定まると、術者はハンドル部１ａを把持する手の指で処置操作装置のレバー１０を引いたり離したりする操作をして処置部２を動作させる。レバー１０を引くと、ワイヤ１１が後方にスライドし、図１の鋏が開いた状態においてスライダ７を支持体６内で後退させる。スライダ７が後退すると、図２に示すように、連接棒８ａ，８ｂがねじりコイルバネ１３の付勢力に抗してボス４ａ，４ｂを支点軸５の回りで回転させ、ボス４ａ，４ｂと一体の二枚のブレード２ａ，２ｂが閉動作をする。レバー１０を開放すると、ねじりコイルバネ１３のバネ力によりブレード２ａ，２ｂが閉じた状態から自動的に元の開いた状態に復帰する。このレバー１０の操作により処置部２が開閉動作を繰り返し患部に所定の処置を行う。
【００４４】
かくて、術者は任意の方向から患部にアプローチし、正確で安全な手術等の生体内組織の処置を終了する。
【００４５】
なお、上記実施の形態では、処置部２を鋏として説明したが、鋏に代えて掴み具、生検具、切開具等を用いることも可能である。
【００４６】
【発明の効果】
請求項１に係る発明によれば、処置部が関節部を介して処置具本体に接続され、処置部の姿勢を操作する姿勢操作装置と、処置部の処置操作を行う処置操作装置とが処置具本体に設けられた多自由度型処置具であって、姿勢操作装置が、関節部を介して処置部を上下方向および左右方向に屈曲動作させる屈曲操作部と、処置部を関節部の軸心回りに回転動作させる回転操作部とを具備した多自由度型処置具であるから、姿勢操作装置の屈曲操作部により関節部を介して処置部を上下方向および左右方向に屈曲動作させることができ、姿勢操作装置の回転操作部により処置部を関節部の軸心回りに回転動作させることができる。従って、処置部を術者の所望の位置及び姿勢に簡易に設定することができ、処置具の操作性を高めて術者の楽な姿勢での手術を可能にすることができる。また、現在の一般的な内視鏡手術において使用される鉗子類の操作と大きく違わず、確立された従来の術式で手術を行うことができるため、安全であると同時に術者に対しても特別なトレーニングを必要としないなど多くの利点を有する。
【００４７】
請求項２に係る発明によれば、請求項１に記載の多自由度型処置具において、関節部が、互いに９０度位相がずれた枢軸を介して連結される複数個の関節部材により形成された多自由度型処置具であるから、処置部の自由度が増大し、処置具の操作性がさらに向上する。
【００４８】
請求項３に係る発明によれば、請求項１又は請求項２に記載の多自由度型処置具において、回転操作部が筒状の関節部内に直列状に挿入される複数個のコマを備え、これらのコマを介して処置部に回転力を伝達するようにした多自由度型処置具であるから、回転操作部のコマ間の摩擦力により回転力が処置部に伝達され、処置部が関節部の軸心の回りを回転する。従って、コマのすべりにより、処置部又は生体内組織に無理な力が掛からないようにすることができる。
【００４９】
請求項４に係る発明によれば、請求項１乃至請求項３のいずれかに記載の多自由度型処置具において、弾性体により処置部を開動作または閉動作させる多自由度型処置具であるから、処置部を開状態又は閉状態のいずれかにセットすることができ、術者の操作を簡易化することができる。
【図面の簡単な説明】
【図１】本発明に係る多自由度型処置具の正面図である。
【図２】図１に示す多自由度型処置具の処置部及び関節部の断面図である。
【図３】図１に示す多自由度型処置具の関節部の分解斜視図である。
【図４】関節部の拡大断面図である。
【図５】（Ａ）は図４中Ａ−Ａ線矢視断面図、（Ｂ）は図４中Ｂ−Ｂ線矢視断面図である。
【図６】図１に示す多自由度型処置具の屈曲操作部の一部を示す部分断面図である。
【図７】図１に示す多自由度型処置具の処置操作装置の一部と姿勢操作装置の回転操作部の一部を示す部分図である。
【図８】図７に示す部分の平面図である。
【符号の説明】
１…処置具本体
２…処置部
３…関節部
１０…レバー
１３…ねじりコイルバネ
１４…関節部材
１４ａ…軸部
１４ｂ…軸受部
１５…ジョイスティック
１８…ダイアル
２０…コマ[0001]
TECHNICAL FIELD OF THE INVENTION
The present invention relates to a multi-degree-of-freedom treatment device for performing various treatments on a tissue in a living body.
[0002]
[Prior art]
Endoscopic surgery represented by laparoscopic surgery such as cholecystectomy involves making multiple small holes in the body surface, attaching trocars to each hole, and observing an endoscope and long forceps from each trocar. This is performed by inserting a treatment tool such as. This endoscopic surgery is a minimally invasive surgery that can reduce the burden on the patient because observation and treatment are performed without laparotomy.
[0003]
The treatment tool used in the endoscopic surgery includes a treatment device for connecting the treatment section to the treatment instrument body via a joint, and operating a posture of the treatment section, and a treatment for performing a treatment operation of the treatment section. The treatment device is attached to the treatment instrument body, and the treatment section is inserted into the body from the trocar, and the treatment section performs desired treatment on the tissue in the living body while operating the posture manipulation device outside the body. (For example, see Patent Documents 1, 2, and 3).
[0004]
[Patent Document 1]
JP 2001-276091 A [Patent Document 2]
JP 2000-350735 A [Patent Document 3]
JP-A-6-197906
[Problems to be solved by the invention]
In procedures such as grasping, peeling, excision, suturing, and ligating in-vivo tissue performed in endoscopic surgery, very fine operations are required, but treatment tools conventionally used have a linear shape. Since the movement of the treatment section is restricted to one or two kinds, it is very difficult to perform a fine treatment with poor operability. For example, the treatment tools disclosed in Patent Literatures 1 and 2 are limited to a linear operation of the treatment section centering on the trocar and a bending operation of the treatment section in the body in up, down, left, and right directions, and thus have poor operability. In order to rotate the treatment section around the trocar, the entire treatment tool must be rotated, and there is a problem that the operator is forced to take an unreasonable posture. The treatment tool disclosed in Patent Literature 3 is limited to a linear operation of the treatment section centering on the trocar and a bending operation to one of the right and left, so that the operability is poor and the operator is forced to take an unreasonable posture. There is.
[0006]
Accordingly, an object of the present invention is to provide a multi-degree-of-freedom treatment instrument that can solve such a problem.
[0007]
[Means for Solving the Problems]
In order to solve the above problem, the invention according to claim 1 is a posture in which the treatment section (2) is connected to the treatment instrument main body (1) through the joint section (3) and the posture of the treatment section (2) is operated. An operation device and a treatment operation device (10) for performing a treatment operation of the treatment section (2) are a multi-degree-of-freedom treatment device provided in the treatment device main body (1), and the posture operation device includes a joint portion ( A bending operation section (15) for bending the treatment section (2) vertically and horizontally via 3), and a rotation operation section for rotating the treatment section (2) about the axis of the joint section (3). (18) is adopted.
[0008]
According to the first aspect of the present invention, the treatment section (2) can be bent in the up-down direction and the left-right direction via the joint section (3) by the bending operation section (15) of the posture operation apparatus. Since the treatment section (2) can be rotated around the axis of the joint section (3) by the rotation operation section (18) of the operation device, the treatment section (2) can be easily moved to a desired position and posture of the operator. Can be set to Therefore, the operability is improved, and the operator can perform the operation in a comfortable posture.
[0009]
According to a second aspect of the present invention, in the multi-degree-of-freedom treatment instrument according to the first aspect, the joints (3) are connected via pivots (14a, 14b) that are 90 degrees out of phase with each other. A multi-degree-of-freedom treatment instrument formed by a plurality of joint members (14) is employed.
[0010]
According to the second aspect of the present invention, since each joint member (14) of the joint part (3) has the pivots (14a, 14b) that are out of phase with each other by 90 degrees, the degree of freedom of the treatment unit (2) is increased. The operability of the treatment tool is further improved.
[0011]
According to a third aspect of the present invention, in the multi-degree-of-freedom treatment instrument according to the first or second aspect, the rotary operation portion (18) is inserted in series into the cylindrical joint portion (3). A multi-degree-of-freedom treatment instrument having a plurality of tops (20) and transmitting rotational force to the treatment section (2) via these tops (20) is employed.
[0012]
According to the third aspect of the invention, the rotational force is transmitted to the treatment section (2) by the frictional force between the tops (20) of the rotary operation section, and the treatment section (2) is connected to the axis of the joint section (3). Rotate around. Therefore, an unreasonable force can be prevented from being applied to the treatment section (2) or the tissue in the living body by the slip clutch action of the top (20).
[0013]
According to a fourth aspect of the present invention, there is provided the multi-degree-of-freedom treatment instrument according to any one of the first to third aspects, wherein the elastic body (13) causes the treatment section (2) to open or close. Use a degree-of-freedom treatment tool.
[0014]
According to the fourth aspect of the invention, since the treatment section (2) is opened or closed by the elastic body (13), the treatment section (2) can be set to either the open state or the closed state. The operation can be simplified by the operator.
[0015]
BEST MODE FOR CARRYING OUT THE INVENTION
Hereinafter, embodiments of the present invention will be described with reference to the drawings.
[0016]
As shown in FIG. 1, a treatment instrument main body 1 of a multi-degree-of-freedom treatment instrument, which is a kind of forceps, has a handle portion 1a gripped by an operator and an elongated tubular portion that can be inserted into a trocar (not shown) or the like. 1b.
[0017]
As shown in FIGS. 1 and 2, the treatment section 2 is connected to the distal end of the tubular section 1 b of the treatment instrument main body 1 via the joint section 3.
[0018]
The treatment section 2 is configured as scissors in this embodiment. The two blades 2a and 2b of the scissors are overlapped at the bosses 4a and 4b, and the fulcrum shaft 5 is inserted into both bosses 4a and 4b. The fulcrum shaft 5 is supported by a fork piece 6a projecting from the tip of a cylindrical support 6. A rod-shaped slider 7 is inserted into the cavity of the support 6, and one end of two connecting rods 8a, 8b is pin-connected to the slider 7, and the other end of each connecting rod 8a, 8b has two blades. Pins are connected to the bosses 4a and 4b of 2a and 2b. As a result, when the slider 7 reciprocates in the support 6, the blades 2a and 2b open and close. In this embodiment, when the slider 7 slides to the left in FIG. 2, the blades 2a and 2b open. However, when the connecting rods 8a and 8b are replaced, the blade slides to the left in FIG. Can be closed.
[0019]
As shown in FIGS. 2 and 4, the support 6 of the treatment section 2 is rotatably supported by the support tube 9, so that the treatment section 2 can rotate around the axis of the support tube 9.
[0020]
As shown in FIGS. 1 and 7, the treatment tool main body 1 is provided with a treatment operation device for performing a treatment operation of the treatment section 2, that is, an opening / closing operation of scissors.
[0021]
The treatment operation device includes a trigger-shaped lever 10 as an input unit and a wire 11 as a transmission unit.
[0022]
The lever 10 is rotatably supported by the treatment instrument main body 1 by a pivot pin 12 slightly ahead of the handle portion 1a, and has two intermediate links 25, 26 at a projection 10a projecting beyond the pivot pin 12 upward. The rear end of the wire 11 is connected via. That is, one intermediate link 25 is pin-coupled to the protruding portion 10a, one end of the other intermediate link 26 is pin-coupled to the other end of one intermediate link 25, and the other end of the other intermediate link 26 is Connected to rear end. In addition, the center of the other intermediate link is supported by the treatment tool main body 1 with the support pin 27. Of course, the interlocking mechanism between the lever 10 and the wire 11 can be replaced with another mechanism. The wire 11 is formed of a flexible wire, passes through the cylindrical portion 1 b and the joint portion 3 of the treatment instrument main body 1, penetrates into the support 6 through the lever 10, and passes through the slider 7 in the support 6. Connected to the end. When the fingers of the operator's hand gripping the handle portion 1a pull the lever 10 while the scissors in FIGS. 1 and 7 are open, the wire 11 slides backward, and the slider 7 is attached to the support 6 as shown in FIG. Retreat within. Thereby, the connecting rods 8a and 8b rotate the bosses 4a and 4b around the fulcrum shaft 5, and the two blades 2a and 2b integrated with the bosses 4a and 4b perform the closing operation.
[0023]
As shown in FIG. 2, an elastic body that holds the blades 2a and 2b in a normally open state is provided on the fulcrum shaft 5 of the treatment section as necessary. FIG. 2 shows that the blades 2a and 2b are closed by applying a force against the urging force of the elastic body.
[0024]
Preferably, a torsion coil spring 13 is used as the elastic body, and the coil portion of the torsion coil spring 13 is wound around the fulcrum shaft 5, and both ends of the torsion coil spring 13 are locked by the two bosses 4a and 4b, respectively. In the illustrated example, the torsion coil spring 13 is mounted so that the blades 2a and 2b are always open, but it is also possible to urge the blades 2a and 2b to be always closed by changing the mounting direction. In this case, for example, the two intermediate links 25 and 26 are omitted, the rear end of the wire 11 is connected to the protrusion 10a of the lever 10, and when the lever 10 is pulled, the blades 2a and 2b open. .
[0025]
As described above, since the scissors as the treatment section 2 are opened or closed by the elastic force such as the spring force, the treatment section 2 can be set to either the open state or the closed state, and the operation of the operator can be performed. It can be simplified. That is, when the operator releases the hand from the lever 10, the blades 2a and 2b are automatically returned from the closed state to the original open state by the spring force of the torsion coil spring 13, or the blades 2a and 2b are opened. It is automatically returned from the state to the original closed state.
[0026]
It is also possible to open and close the blades 2a and 2b by omitting this elastic body and preparing two wires for opening and closing for opening and closing the blades 2a and 2b.
[0027]
The joint 3 has a structure in which a plurality of joint members 14 having the same shape are connected in series as shown in FIG. Each joint member 14 has pivots that are 90 degrees out of phase with each other in the front and rear directions, and a plurality of joint members 14 are connected so as to alternately pass through these two types of pivots. Specifically, one joint member 14 is provided with a convex shaft portion 14a and a concave bearing portion 14b whose axes are set horizontally and vertically at both front and rear ends, and the shaft portion 14a of one joint member 14 is connected to the other. A pivot is formed so as to fit into the bearing portion 14b of the joint member 14 of the first embodiment, and the plurality of joint members 14 are connected via each pivot. Then, as shown in FIGS. 2 and 4, a support cylinder 9 for holding the support 6 of the treatment section 2 is connected to the leading joint member 14 in the same manner as the joint members 14 and 14, and the tail joint member is connected. The distal end of the cylindrical portion 1b of the treatment instrument main body 1 is connected to the joint member 14 in the same manner as the joint members 14, 14. Although the treatment section 2 can be bent back and forth and left and right by providing only one joint member 14, preferably two or more joint members 14 are provided. By adding the joint member 14, the degree of freedom of the treatment section 2 is increased, and the operability of the treatment tool is further improved.
[0028]
The treatment tool main body 1 is provided with a posture operation device that operates the posture of the treatment section 2.
[0029]
The posture operating device includes a bending operation unit that causes the treatment unit 2 to bend vertically and horizontally via the joint unit 3, and a rotation operation unit that rotates the treatment unit 2 about the axis of the joint unit 3. I do.
[0030]
The bending operation unit includes an input unit operated by an operator, and a transmission unit that transmits an operation on the input unit to the treatment unit 2 and bends the operation unit.
[0031]
The input unit is configured as a joystick 15 as shown in FIGS. 1, 6, 7, and 8, and is arranged on the upper rear surface of the handle 1 a in the treatment tool main body 1. As shown in FIG. 6, the joystick 15 has a sphere 15a at the center thereof, and the sphere 15a is rotatably fitted into a ball bearing 1c in the treatment instrument main body 1. The stick portion 15b of the joystick 15 is exposed to the outside from a hole formed in the wall surface of the treatment instrument main body 1, and the gap between the hole and the stick portion 15b is closed with a flexible and deformable rubber ring 16. The stick portion 15b has a cross shape or a circular shape. For example, the stick portion 15b can be bent from the back of the treatment instrument main body 1 at 12 o'clock, 3 o'clock, 6 o'clock, and 9 o'clock, facing the stick portion 15b. The drive wires 16 are connected to the stick 15b.
[0032]
As shown in FIGS. 2, 4, and 5, each drive wire 16 as a transmission portion extends forward from the stick portion 15b through the cylindrical portion 1b of the treatment instrument main body 1 and the entire joint member 14 of the joint portion 3. , Is connected to the rear end of the support cylinder 9 that holds the support 6 of the treatment section 2. As shown in FIG. 3, the joint member 14 is provided with a through hole 17 through which each drive wire 16 passes. The through hole 17 is formed at a position near the surface of the joint member 14 so that the joint 3 can be easily bent by the drive wire 16.
[0033]
When the operator grips the handle portion 1a of the treatment instrument main body 1 and operates the joystick 15 with a finger, the stick portion 15b swings around the sphere 15a as a fulcrum, and a part of the drive wire 16 is pulled. The joint 3 is bent according to the amount of pulling. By operating the four drive wires 16 in this manner, the joint 3 is bent in the up-down direction and the left-right direction, and the treatment unit 2 changes its position and posture with two degrees of freedom.
[0034]
The rotation operation unit includes an input unit operated by an operator, and a transmission unit that transmits an operation of the input unit to the treatment unit 2 and rotates the treatment unit 2.
[0035]
The input unit includes a dial 18 as shown in FIGS. The dial 18 is attached to the treatment tool main body 1 so that the dial 18 can be rotated by a finger of a hand that grasps the handle 1a of the treatment tool main body 1. The transmission portion is provided in a cylindrical shaft 19 penetrating through the cylindrical portion 1b of the treatment instrument main body 1 and a tunnel hole 24 formed so as to penetrate through all the joint members 14 of the joint portion 3 as shown in FIGS. A plurality of tops 20 which are rotation transmitting members arranged in series. A tunnel-shaped through hole (not shown) is formed at the center of the cylindrical shaft 19, and as shown in FIGS. 3 to 5, a tunnel-shaped through hole connected to the through hole of the cylindrical shaft 19 is formed at the center of the top 20. 21 is bored, and the wire 11 of the treatment operating device passes through the through hole 21. As shown in FIG. 7, the cylindrical shaft 19 and the dial 18 are dynamically connected by gears 22 and 23 and the like, and the rotation of the dial 18 is transmitted to the cylindrical shaft 19. As shown in FIGS. 2, 4 and 5, the top 20 is a slip clutch member having a shape in which truncated cone-shaped protrusions are formed at both ends of a cylindrical piece, and the top top 20 is a support for the treatment section 2. 6 comes into contact with the rear end, and the tail piece 20 comes into contact with the front end of the cylindrical shaft 19. When the cylindrical shaft 19 rotates in a desired direction by the operation of the dial 18, the rotational force is transmitted to the treatment section 2 by the frictional contact of these pieces 20, and the treatment section 2 rotates around the axis of the joint section 3. . In addition, even if the joint section 3 bends, the row of the tops 20 bends and follows the joint section 3 to transmit power to the treatment section 2, and only the treatment section 2 is independently provided at a desired end at the tip of the bent joint section 3. Rotate to posture.
[0036]
Next, the operation of the multi-degree-of-freedom treatment instrument having the above configuration will be described.
[0037]
When performing endoscopic surgery, a plurality of small holes are made in the body surface, trocars are attached to each hole, and the endoscope for observation, the treatment section 2 of the multi-degree-of-freedom treatment instrument, and the cylindrical section are inserted from each trocar. 1b is inserted into the body.
[0038]
The surgeon grasps the handle 1a of the treatment tool and operates the bending operation unit or the rotation operation unit of the posture operation device with a finger.
[0039]
When the operator operates the joystick 15 of the bending operation unit, the stick unit 15b swings around the sphere 15a as a fulcrum, and a part of the drive wire 16 is pulled. Is bent with respect to the treatment instrument body 1 in two directions of up and down and left and right.
[0040]
Further, when the operator operates the dial 18 of the rotary operation unit, the cylindrical shaft 19 rotates in a desired direction, the rotational force is transmitted to the treatment unit 2 by frictional contact of the top 20, and the treatment unit 2 is moved to the joint unit 3. Rotate around the axis of. Even if the joint section 3 bends, the row of the tops 20 bends following the joint section 3, transmitting the rotational force to the treatment section 2, and the treatment section 2 is independently moved to a desired posture at the distal end of the bent joint section 3. Rotate to.
[0041]
When operating the rotary operation unit, the rotational force is transmitted to the treatment unit 2 and the like by the frictional force between the tops 20 and 20. When a large force is applied to the treatment unit 2, the tops 20 and 20 slide, and thus the treatment is performed. No excessive force is applied to the part 2 or the tissue in the living body.
[0042]
Thus, by operating the bending operation unit and the rotation operation unit of the posture operation device with a finger, the treatment unit 2 has a total of three degrees of freedom in which the bending operation and the rotation operation in the vertical and horizontal directions are combined. Changes position and posture within the body cavity. In particular, if the treatment section 2 can be rotated, it is advantageous for a treatment requiring rotation such as suturing.
[0043]
When the position and posture of the treatment unit 2 are determined, the operator operates the treatment unit 2 by pulling and releasing the lever 10 of the treatment operation device with the finger of the hand gripping the handle 1a. When the lever 10 is pulled, the wire 11 slides backward, and the slider 7 is retracted in the support 6 with the scissors in FIG. 1 open. When the slider 7 retreats, the connecting rods 8a and 8b rotate the bosses 4a and 4b around the fulcrum shaft 5 against the biasing force of the torsion coil spring 13 as shown in FIG. The two blades 2a and 2b perform the closing operation. When the lever 10 is opened, the blades 2a and 2b automatically return to the original open state from the closed state by the spring force of the torsion coil spring 13. By operating the lever 10, the treatment section 2 repeats the opening and closing operations to perform a predetermined treatment on the affected part.
[0044]
Thus, the operator approaches the affected area from any direction, and ends the treatment of the in-vivo tissue such as accurate and safe surgery.
[0045]
In the above-described embodiment, the treatment section 2 is described as scissors. However, instead of the scissors, a grasping tool, a biopsy tool, an incision tool, or the like can be used.
[0046]
【The invention's effect】
According to the first aspect of the present invention, the treatment unit is connected to the treatment instrument main body via the joint unit, and the posture operation device that operates the posture of the treatment unit and the treatment operation device that performs the treatment operation of the treatment unit A multi-degree-of-freedom treatment tool provided in a tool body, wherein a posture operation device is configured to bend an operation part in a vertical direction and a left and right direction through a joint part, and a bending operation part. Since it is a multi-degree-of-freedom treatment instrument including a rotation operation unit that rotates around the center, the treatment unit can be bent vertically and horizontally via the joint by the bending operation unit of the posture operation device. The treatment section can be rotated around the axis of the joint section by the rotation operation section of the posture operation device. Therefore, the treatment section can be easily set to a desired position and posture of the operator, and the operability of the treatment tool can be enhanced to enable the operator to perform an operation in a comfortable posture. In addition, the operation can be performed using established conventional procedures without significantly differing from the operation of forceps used in current general endoscopic surgery. It also has many advantages, such as not requiring special training.
[0047]
According to the second aspect of the present invention, in the multi-degree-of-freedom treatment instrument according to the first aspect, the joint portion is formed by a plurality of joint members connected via pivots that are 90 degrees out of phase with each other. Since the multi-degree-of-freedom treatment instrument is used, the degree of freedom of the treatment section is increased, and the operability of the treatment instrument is further improved.
[0048]
According to a third aspect of the present invention, in the multi-degree-of-freedom treatment instrument according to the first or second aspect, the rotary operation unit includes a plurality of pieces inserted in series in the cylindrical joint. However, since the multi-degree-of-freedom treatment tool transmits torque to the treatment section via these frames, the rotational force is transmitted to the treatment section by frictional force between the frames of the rotary operation section, and the treatment section is moved. Rotate around the axis of the joint. Therefore, it is possible to prevent an excessive force from being applied to the treatment section or the tissue in the living body due to the sliding of the top.
[0049]
According to a fourth aspect of the present invention, there is provided the multi-degree-of-freedom treatment instrument according to any one of the first to third aspects, wherein the treatment section is opened or closed by an elastic body. Therefore, the treatment section can be set to either the open state or the closed state, and the operation of the operator can be simplified.
[Brief description of the drawings]
FIG. 1 is a front view of a multi-degree-of-freedom treatment instrument according to the present invention.
FIG. 2 is a sectional view of a treatment section and a joint section of the multi-degree-of-freedom treatment instrument shown in FIG.
FIG. 3 is an exploded perspective view of a joint of the multi-degree-of-freedom treatment tool shown in FIG. 1;
FIG. 4 is an enlarged sectional view of a joint.
5A is a sectional view taken along line AA in FIG. 4, and FIG. 5B is a sectional view taken along line BB in FIG.
6 is a partial sectional view showing a part of a bending operation section of the multi-degree-of-freedom treatment instrument shown in FIG. 1;
7 is a partial view showing a part of a treatment operation device of the multi-degree-of-freedom treatment device shown in FIG. 1 and a part of a rotation operation unit of a posture operation device.
FIG. 8 is a plan view of the portion shown in FIG. 7;
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 ... Treatment tool main body 2 ... Treatment part 3 ... Joint part 10 ... Lever 13 ... Torsion coil spring 14 ... Joint member 14a ... Shaft part 14b ... Bearing part 15 ... Joy stick 18 ... Dial 20 ... Top

Claims (4)

処置部が関節部を介して処置具本体に接続され、処置部の姿勢を操作する姿勢操作装置と、処置部の処置操作を行う処置操作装置とが処置具本体に設けられた多自由度型処置具であって、姿勢操作装置が、関節部を介して処置部を上下方向および左右方向に屈曲動作させる屈曲操作部と、処置部を関節部の軸心回りに回転動作させる回転操作部とを具備したことを特徴とする多自由度型処置具。A multi-degree-of-freedom type in which a treatment unit is connected to a treatment instrument main body via a joint unit, and a posture operation device for operating the posture of the treatment unit and a treatment operation device for performing a treatment operation of the treatment unit are provided on the treatment instrument body. A treatment device, wherein the posture operation device is a bending operation unit that performs bending operation of the treatment unit in the vertical and horizontal directions via the joint unit, and a rotation operation unit that rotates the treatment unit around the axis of the joint unit. A multi-degree-of-freedom treatment instrument comprising: 請求項１に記載の多自由度型処置具において、関節部が、互いに９０度位相がずれた枢軸を介して連結される複数個の関節部材により形成されたことを特徴とする多自由度型処置具。2. The multi-degree-of-freedom treatment instrument according to claim 1, wherein the joint is formed by a plurality of joint members connected via pivots that are 90 degrees out of phase with each other. Treatment tools. 請求項１又は請求項２に記載の多自由度型処置具において、回転操作部が筒状の関節部内に直列状に挿入される複数個のコマを備え、これらのコマを介して処置部に回転力を伝達するようにしたことを特徴とする多自由度型処置具。The multi-degree-of-freedom treatment instrument according to claim 1 or 2, wherein the rotation operation unit includes a plurality of frames inserted in series into the cylindrical joint, and the rotation unit is connected to the treatment unit via these frames. A multi-degree-of-freedom treatment instrument characterized by transmitting torque. 請求項１乃至請求項３のいずれかに記載の多自由度型処置具において、弾性体により処置部を開動作または閉動作させることを特徴とする多自由度型処置具。4. The multi-degree-of-freedom treatment instrument according to claim 1, wherein the treatment section is opened or closed by an elastic body.
JP2002319892A 2002-11-01 2002-11-01 Multi-degree-of-freedom type treating instrument Pending JP2004154164A (en)

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