JP2004255080A - Surgical treatment appliance - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a surgical treatment appliance capable of being operated while sensing the external force applied to a treatment part by fingers when the treatment part is operated by hand and having excellent operability for certainly operating the treatment part against the external force to accurately perform desired manipulation. <P>SOLUTION: A treatment unit 5 of the surgical treatment appliance 1 is constituted of treatment pieces 21 and 22, a treatment bases 23 connected to the base end parts of the treatment pieces 21 and 22, a leading end cover 24 arranged on an insertion pipe 31, a treatment part operation rod 51 formed of a rigid member being a first shaft and a treatment part base operation rod 52 formed of the rigid member being a second shaft. The treatment part base operation rod 52 integrated with a rotary base 61 is moved so as to advance and retreat by operating a turning knob 62 and the treatment part operation rod 51 is moved so as to advance and retreat by the rotary operation of a turning handle 42. <P>COPYRIGHT: (C)2004,JPO&NCIPI

Description

[0001]
TECHNICAL FIELD OF THE INVENTION
According to the present invention, a surgeon performs a surgical operation, particularly an endoscopic surgical operation, by operating a treatment member provided at a distal end portion by operating an operating portion provided at a proximal end portion of an insertion portion at hand. To a surgical treatment tool for
[0002]
[Prior art]
2. Description of the Related Art Endoscopes capable of observing a treatment site and performing various treatments while observing a subject image obtained by inserting an endoscope having a slender insertion portion into a body cavity or the like have been widely used. I have. Also, in recent years, without opening the laparotomy to reduce the invasion of the patient, the trocar that guides the observation endoscope into the body cavity and the trocar that guides the surgical treatment tool to the treatment site are punctured. Laparoscopic surgery for performing treatment and treatment while observing a surgical treatment tool and a treatment site is performed.
[0003]
The surgical treatment tool used in the laparoscopic surgery or the like is slender and is configured to operate by operating an operation unit provided on a hand side with a treatment member disposed at a distal end portion of an insertion portion. . In U.S. Pat. No. 5,275,608 (hereinafter abbreviated as "USP"), U.S. Pat. No. 5,330,502, U.S. Pat. No. 5,383,888, and U.S. Pat. The surgical treatment tool in which the treatment member is made rotatable is shown.
[0004]
Specifically, in the surgical treatment tool described in US Pat. No. 5,275,608, the opening / closing operation of the treatment member provided at the distal end portion is performed by opening / closing a pair of handles provided at the base end side, and A rotating operation for changing the arrangement position can be performed by rotating the pair of handles.
[0005]
Further, in the surgical treatment tools of USP 5,330,502, USP 5,383,888, and USP 5,549,637, opening and closing operations of a treatment member are performed by opening and closing a pair of handles provided on a proximal end side. The rotation of the treatment member can be performed by operating an operation unit individually provided on the base end side.
[0006]
[Patent Document 1] USP 5,275,608 (FIGS. 1A to 1C)
[0007]
[Patent Document 2] US Pat. No. 5,330,502 (FIGS. 1 and 4)
[0008]
[Patent Document 3] USP 5,383,888 (FIGS. 4 to 8)
[0009]
[Patent Document 4] US Pat. No. 5,549,637 (FIGS. 1 and 2)
[0010]
[Problems to be solved by the invention]
However, in the surgical treatment tools described in US Pat. No. 5,275,608, US Pat. No. 5,330,502 and US Pat. No. 5,383,888, the turning operation of the treatment member is realized by a rigid rod member, pipe member or the like. However, the opening / closing operation of the treatment member is constituted by a flexible cable or the like. This is to pass through the rotating joint, and by using this flexible cable, etc., it is possible to ensure that the reaction force received by the treatment member from the living tissue during a peeling operation or the like that requires delicate operation. Therefore, it is difficult to transmit the signal to the opening / closing operation system, and it is difficult to accurately feedback the force sense to the operator's finger, and improvement is required.
[0011]
Further, in the surgical treatment tool described in US Pat. No. 5,549,637, a rigid member is employed in the operation system for operating the treatment member. However, the rotation operation of the treatment member pulls a pair of flexible cables mutually. Therefore, the rigidity may be insufficient. In particular, it is considered that the rigidity is insufficient at the intermediate position of the rotation range, and the rigidity of the distal end portion may be insufficient in a gripping operation or the like that requires a strong traction force.
[0012]
The present invention has been made in view of the above circumstances, and when operating the treatment section by hand operation, the operation can be performed while feeling the external force applied to the treatment section with the fingers, and the treatment section is operated against the external force. It is an object of the present invention to provide a surgical treatment tool excellent in operability capable of performing a desired operation accurately by reliably operating a surgical instrument.
[0013]
[Means for Solving the Problems]
The surgical treatment tool according to the present invention includes an elongated tubular insertion portion forming tube member that forms an insertion portion, and is disposed so as to be able to advance and retreat in an inner hole of the insertion portion forming tube member. An elongated first shaft provided with a first operation portion for operating the surgical treatment portion at a base end portion, and a reciprocatingly disposed at an inner hole of the insertion portion forming tube member. A treatment section base member having a surgical treatment section is connected to the distal end, and the treatment section base member is rotated to the base end to change the arrangement position of the surgical treatment section provided on the treatment section base member. An elongated second shaft provided with a second operating portion to be rotated and arranged, and an area formed to be disposed in the insertion section forming pipe member and dividing an inner hole of the insertion section forming pipe member into a plurality of areas. And a member.
[0014]
According to this configuration, when the first operation unit is operated, the first shaft moves forward and backward by an amount corresponding to the operation amount of the first operation unit, so that the surgical operation unit performs a desired operation. On the other hand, when the second operating portion is operated, the second shaft advances and retreats by a predetermined amount corresponding to the operation amount of the second operating portion, and the treatment portion base member rotates by a predetermined amount, whereby the surgical treatment portion is rotated. Is arranged at a desired rotation position.
[0015]
BEST MODE FOR CARRYING OUT THE INVENTION
Hereinafter, embodiments of the present invention will be described with reference to the drawings.
(1st Embodiment)
1 to 20 relate to a first embodiment of the present invention, and FIGS. 1 to 10 are views for explaining the configuration of a surgical treatment tool. FIG. 1 is a perspective view of the surgical treatment tool, and FIG. 3 is a perspective view illustrating the configuration of the treatment tool, FIG. 3 is a diagram illustrating the configuration of the treatment unit, FIG. 4 is a cross-sectional view illustrating the configuration of the treatment unit, FIG. FIG. 6 is a view for explaining the open / close state of the treatment piece when the treatment section is not rotating, FIG. 7 is a view for explaining the open / close state of the treatment piece when the treatment section is in the maximum rotation state, and FIG. 1 is a cross-sectional view taken along the line AA, FIG. 9 is a cross-sectional view illustrating the configuration of the insertion unit and the grip operation unit, and FIG. 10 is an enlarged view of the base end side of the insertion unit shown in FIG. 3A is a perspective view of the treatment section, FIG. 3B is a perspective view of the treatment section with the treatment section base removed, and FIG. 4A is a BB line of FIG. 3A. FIG. 4B is a cross-sectional view taken along line CC of FIG. 4A.
[0016]
11 to 19 are views for explaining the operation of the surgical treatment tool. FIG. 11 is a view for explaining the operation when the turning handle of the treatment section operating section is operated. FIG. 12 is a view of the turning handle. FIG. 13 is a view for explaining the movement of the treatment section operating rod operating in response to the operation. FIG. 13 shows the movement of the flat tip of the treatment section operation rod and the opening and closing of the treatment piece constituting the treatment section with the treatment section base removed. FIG. 14 is a view for explaining the relationship between the operations, FIG. 14 is a view for explaining the operation when the rotary knob is operated, and FIG. 15 is the movement of the rotary base and the treatment section base operating rod which operate in response to the operation of the rotary knob. FIG. 16 is a view for explaining the relationship between the movement of the distal end arrangement portion of the treatment section base operating rod and the rotation of the treatment section with the treatment section base removed, and FIG. 17 shows the operation of the rotation knob. The operation when operating the rotating handle of the treatment section operation section in the state will be described. FIG. 18 is a view for explaining the movement of a turning base and a treatment section base operating rod that operate in response to the operation of the turning knob, and the movement of the treatment section operating rod that operates in response to the operation of the turning handle; FIG. 19 is a view for explaining the opening and closing operation of the treatment piece constituting the treatment section when the treatment section is in the rotating state.
FIG. 20 is a diagram illustrating a configuration of an insertion portion that makes the treatment section operation rod and the treatment section base operation rod have substantially the same cross-sectional area.
[0017]
As shown in FIG. 1, a surgical treatment tool 1 of the present embodiment is a surgical treatment tool such as a peeling forceps in which a first treatment piece 21 and a second treatment piece 22 that are a pair of rigid treatment pieces are configured to be openable and closable. A treatment section (hereinafter abbreviated as a treatment section) 2, an insertion section 3 whose exterior is formed by an elongated insertion section forming tube member (hereinafter abbreviated as an insertion tube) 31, and a treatment section as a first operation section It mainly includes the grip operation unit 4 including the operation unit 40.
[0018]
As shown in FIG. 2, the surgical treatment tool 1 has a configuration that can be divided into a treatment unit 5, an insertion unit 6, and a grip operation unit 7.
The treatment section unit 5 includes the treatment pieces 21 and 22, a treatment section base 23 connected to base ends of the treatment pieces 21 and 22, a distal end cover 24 disposed on the insertion tube 31, The treatment section operation rod 51 is formed mainly of a rigid member, which is a shaft, having a predetermined length, and the treatment section base operation rod 52 is formed of a rigid member, which is a second shaft, having a predetermined length.
[0019]
The treatment section operation rod 51 and the treatment section base operation rod 52 are inserted and arranged in parallel in the insertion tube 31. A connecting rod 53 having a ball portion 53a is integrally arranged at the base end of the treatment section operation rod 51.
[0020]
The insertion unit 6 includes the insertion tube 31, a rotation base 61 disposed at a base end of the insertion tube 31, a rotation knob 62 as a second operation unit, and a rotation knob 63 as a third operation unit. It is mainly composed of Between the rotation knob 62 and the rotation knob 63, a removal button 70 used for removing the insertion unit 6 from the grip operation unit 7 is provided.
When assembling the treatment section unit 5 to the insertion section unit 6, the small diameter portion 24 a of the distal end cover 24 is engaged with the distal end side opening 31 a of the insertion tube 31. At this time, the treatment section operation rod 51 and the connecting rod 53 project from the base end surface of the insertion tube 31. The proximal end of the treatment section base operating rod 52 is configured to be integrally fixed to the rotation base 61 by a connection screw (reference numeral 67 in FIG. 10) described later.
[0021]
The grip operation unit 7 is mainly configured by a fixed handle 41 and a rotation handle 42 that constitute the treatment section operation section 40. The fixed handle 41 and the turning handle 42 are rotatably supported via a handle pin 43. The turning handle 42 turns in the directions indicated by arrows a and b in FIG. A connecting rod receiver 44 on which a ball portion 53a of the connecting rod 53 is detachably disposed is formed at a predetermined portion on the distal end side of the turning handle 42. On the other hand, an attachment / detachment portion 45 is provided at a predetermined portion on the distal end side of the fixed handle 41 so as to be detachably attached to the insertion portion unit 6.
[0022]
When assembling the treatment section unit 5 and the insertion section unit 6 integrally assembled to the grip operation unit 7, the base end of the insertion section unit 6 is attached to the attachment / detachment section 45 of the grip operation unit 7. And the ball portion 53a of the connecting rod 53 integrated with the treatment section operation rod 51 constituting the treatment section unit 5 is engaged with the connection rod receiver 44. Thus, the surgical treatment tool 1 shown in FIG. 1 is configured.
[0023]
The configuration of the surgical treatment tool 1 will be specifically described with reference to FIGS.
First, the treatment section unit 5 will be described with reference to FIGS. 3 (a) to 4 (b).
[0024]
The treatment section unit 5 includes an opening / closing link mechanism for opening and closing the first treatment piece 21 and the second treatment piece 22 constituting the treatment section 2, and a position of the insertion section 3 of the treatment section 2 in the axial direction. And a rotating link mechanism for changing.
[0025]
The opening / closing link mechanism and the rotating link mechanism include the first treatment piece 21 and the second treatment piece 22, the treatment portion base 23, the distal end cover 24, the first connection member 25, the second connection member 26, and various pins 8a and 8b. , 9a, 9b, 10a, 10b, 10c, the treatment section operation rod 51 and the treatment section base operation rod 52 are appropriately combined. The distal end cover 24, the first connecting member 25, the second connecting member 26, and the various pins 8a, 8b, 9a, 9b, 10a, 10b, 10c form a joint.
[0026]
The treatment portion base 23 and the distal end cover 24 are formed of a substantially tubular member having rigidity and flexibility. On the base end side of the distal end cover 24, there is provided a small diameter portion 24a that is engaged with and disposed in the distal end side opening 31a of the insertion tube 31 that forms the insertion portion 3. On the other hand, in the treatment section base 23, a pair of section sections 23a and 23b are formed on the distal side and the proximal side.
[0027]
The first connecting member 25 is formed of a plate-like rigid member. The second connection member 26 is formed of a rigid member having concave portions at both ends and a substantially H-shaped cross section (see FIG. 4A). A flat distal end 51a formed on the distal end side of the treatment section operation rod 51 is disposed in a concave portion on the proximal end side of the second connecting member 26, and the first connecting member 25 is formed in a concave portion on the distal end side. The base end is arranged.
[0028]
Between a pair of cover sections 24b formed on the distal cover 24, a pair of base section sections 23a formed on the base end side of the treatment section base 23 and the second connecting member 26 are arranged. Is done.
[0029]
The configuration of the rotation link mechanism will be described.
The cover section 24b of the distal end cover 24 and the base side section 23a of the treatment section base 23 are rotatable by a pair of first rotation pins 8a arranged orthogonally to the axial direction of the insertion section 3. Linked to The distal end portion 52a of the treatment portion base operating rod 52 is rotated at the base end of the treatment portion base 23 by a second rotation pin 8b arranged in parallel with the first rotation pin 8a. Freely connected.
[0030]
The treatment section base operation rod 52 is disposed in a notch groove 24 c formed at a predetermined position of the distal end cover 24. Further, the position of the second rotation pin 8b that supports the treatment section base operation rod 52 shown in FIG. 4B is referred to as a rotation zero end, and the treatment section base operation rod 52 shown in FIG. The position of the supporting second rotation pin 8b is referred to as a maximum rotation end.
[0031]
As shown in FIG. 5, by moving the distal end portion of the treatment section base operating rod 52 by a linear distance L1 from a zero rotation end shown by a dashed line to a maximum rotation end shown by a solid line which is a predetermined position, The treatment section base 23 pivotally moves about the pair of first pivot pins 8a and reaches the position shown by the solid line. As a result, the position of the treatment section 2 composed of the first treatment piece 21 and the second treatment piece 22 changes from the horizontal position indicated by the alternate long and short dash line to a rotation state inclined by the predetermined angle θ1. That is, the position of the treatment section 2 is set to a desired position within the range of the angle θ1 by appropriately arranging the position of the distal end portion of the treatment section base operation rod 52 between the zero rotation end and the maximum rotation end. Is done.
[0032]
The configuration of the opening / closing link mechanism will be described.
A first opening / closing pin 9a parallel to the first rotation pin 8a is fixed to the distal end section 23b of the treatment section base 23. An intermediate portion of the second treatment piece 22 is rotatably connected to the first opening / closing pin 9a. Therefore, the second treatment piece 22 rotates with respect to the treatment portion base 23 about the first opening / closing pin 9a.
[0033]
A second opening / closing pin 9b is provided at a base end of the second treatment piece 22. An intermediate portion of the first treatment piece 21 is rotatably connected to the second opening / closing pin 9b. As a result, the first treatment piece 21 and the second treatment piece 22 rotate relative to each other about the second opening / closing pin 9b. Then, the first treatment piece 21 and the second treatment piece 22 perform a rotating operation to change to a closed state and an open state.
[0034]
The proximal end of the first treatment piece 21 is rotatably connected to the distal end of the first connecting member 25 by a first connecting pin 10a. The side surfaces 25a, 25b of the first connecting member 25 are in contact with the contact surfaces 23c, 23d of the treatment section base 23. As a result, the first connecting member 25 always advances and retreats in the treatment section base 23 in parallel.
[0035]
The other end of the first connecting member 25 is disposed in a concave portion on the distal end side of the second connecting member 26, and in this state, the first connecting member 25 and the second connecting member 26 are connected by the second connecting pin 10b. It is rotatably connected. Further, a flat distal end portion 51a of the treatment section operating rod 51 is disposed in the other end of the second connecting member 26 and in a concave portion on the base end side of the second connecting member 26, and in this state, The treatment section operating rod 51 and the second connecting member 26 are rotatably connected by the connecting pin 10c. That is, the treatment section operation rod 51 and the treatment section 2 are connected via the second connection member 26 and the first connection member 25.
[0036]
The position of the third connecting pin 10c that supports the treatment section operation rod 51 shown in FIG. 4B is set to the first treatment piece 21 and the second treatment piece 22 that configure the treatment section 2 in the closed state. The first treatment piece 21 and the second treatment piece 22 that constitute the treatment section 2 determine the position of the third connection pin 10c that supports the treatment section operation rod 51 shown in FIG. 6 and FIG. It is described as the second terminal that is in the maximum open state.
[0037]
The distance between the through holes in which the second connection pin 10b and the third connection pin 10c of the second connection member 26 are arranged is set to a predetermined size, and the treatment section 2 is moved to the position shown in FIGS. 4 (a) and 4 (b). In the closed state shown, the central axis of the second connecting pin 10b and the central axis of the first rotating pin 8a are coaxially positioned, and the treatment unit 2 is positioned at a predetermined position as shown in FIGS. In the maximum open state, the central axis of the third connecting pin 10c and the central axis of the first rotating pin 8a are coaxially located.
[0038]
Therefore, as shown in FIGS. 6 and 7, the distal end of the treatment section operation rod 51 is moved by a linear distance L2 from the first end indicated by a dashed line to the second end indicated by a solid line that is a predetermined position. As a result, the first connecting member 25 moves in parallel within the treatment portion base 23, and the first treatment piece 21 and the second treatment piece 22 rotate about the axes 9b and 9a, so that the treatment section 2 has one point. The state changes from the closed state shown by the dashed line to the maximum open state, which has been opened at the predetermined angle θ2. That is, by appropriately arranging the position of the distal end of the treatment section operation rod 51 between the first end and the second end, the opening of the treatment section 2 formed by the first treatment piece 21 and the second treatment piece 22 is performed. The state angle is set to a desired angle within the range of angle θ2.
[0039]
Note that the first treatment piece 21 and the second treatment piece 22 are provided with opposing gripping surfaces 21a, 22a, and in the present embodiment, predetermined unevenness processing is performed. Further, the treatment pieces 21 and 22 are not limited to the illustrated shapes and the irregularities, and the treatment section 2 may be, for example, scissors forceps, grasping forceps, a stapler, or the like. Further, instead of a configuration in which the side surface of the first connection member 25 is brought into contact with the contact surfaces 23c and 23d of the treatment portion base 23, for example, a guide groove is formed in the treatment portion base 23, and the first connection member 25 is formed. Alternatively, the same action may be obtained by providing a guide pin engaged with the guide groove.
[0040]
Next, the insertion unit 6 will be described with reference to FIGS.
The insertion section 3 constituting the insertion section unit 6 is provided so that a treatment section operation rod 51 constituting the opening / closing link mechanism and a treatment section base operation rod 52 constituting the rotary link mechanism are inserted in parallel so as to be movable forward and backward. As shown in FIG. 8, an insertion tube 31 constituting an exterior, and a region forming tube 32 which is an elongated region forming member having a predetermined sectional shape formed by dividing an inner hole of the insertion tube 31 into a plurality of sections. Make up. The insertion tube 31 and the region forming tube 32 are made of a rigid member such as a stainless steel member.
[0041]
The region forming tube 32 of the present embodiment has a treatment section base operating rod having a rectangular cross-sectional shape formed by an outer curved surface portion 32 a closely attached to the inner peripheral surface of the insertion tube 31 and the inner peripheral surface of the insertion tube 31. And a straight portion 32b forming a through-hole for inserting and disposing the through hole 52. Then, the region forming tube 32 is disposed in a predetermined state on the inner peripheral surface of the insertion tube 31, and the first through hole 33 through which the treatment portion operation rod 51 is inserted into the insertion portion 3, and the treatment portion base The second through hole 34 through which the operation rod 52 is inserted is formed.
[0042]
In the second through hole 34 of the present embodiment, the opening dimension on the side corresponding to the thickness dimension of the treatment section base operating rod 52 is set to be substantially the same as the thickness dimension for the purpose of preventing buckling. . Thereby, buckling is prevented when a member having a relatively small thickness such as the treatment section base operation rod 52 and transmitting a force in the axial direction by moving a long and thin member in the longitudinal direction is prevented. Power can be transmitted reliably.
[0043]
The region forming member is not limited to the region forming tube 32 but may be a plate member or the like. The plate member is disposed in the inner hole of the insertion tube 31, and the first through hole 33 and the second through hole are formed. The through holes 34 may be formed.
[0044]
As shown in FIGS. 9 and 10, the rotation knob 62 and the rotation knob 63 are close to the proximal end of the insertion portion 3 so as to be operated by fingers holding the treatment portion operation portion 40. It is arranged near the treatment section operation section 40.
[0045]
The insertion tube 31 and the region forming tube 32 constituting the insertion portion 3 are set to have predetermined lengths, and a tubular first base tube 64 is provided at the base end of the insertion tube 31 and the region forming tube 32. It is fixed. A tubular second base tube 65 is integrally fixed to the base end of the first base tube 64 via a first fixing member 91.
[0046]
The rotation base 61 is disposed on the outer peripheral surface of the first base tube 64 so as to be able to advance and retreat. The turning knob 62 is rotatably disposed with respect to a tube formed by the first base tube 64 and the second base tube 65. The turning knob 62 and the turning base 61 are integrated in a screwed state. The rotation knob 63 is integrally fixed to the second base tube 65. The rotation knob 62 is held by a flange 66a provided on the rotation knob 63 so as not to move with respect to the pipe portion. The rotation base 61 and the rotation knob 63 are formed of a resin member.
[0047]
A specific configuration will be described with reference to the drawings.
The treatment section operation rod 51 is inserted through the first base tube 64 and the base ends of the insertion tube 31 and the region forming tube 32 are respectively disposed in stepped holes formed in the inner peripheral surface. Have been. A long hole 64 a communicating with the second through hole 34 through which the treatment section base operating rod 52 is inserted is formed at a predetermined position on the side surface of the first base tube 64. Thus, the base end of the treatment section base operating rod 52 inserted through the second through hole 34 can be accessed from the outer peripheral surface side of the first base tube 64 via the elongated hole 64a. . Further, a screw arrangement hole 61a communicating with the long hole 64a is formed at a predetermined position on a side surface portion of the rotating base 61 which is arranged on the outer peripheral surface of the first base tube 64 so as to be able to advance and retreat.
[0048]
Therefore, the connection screw 67 is inserted and arranged with the screw arrangement hole 61a aligned with the elongated hole 64a, and the connection screw 67 is formed at the proximal end of the treatment section base operating rod 52. The treatment section base operation rod 52 is integrally connected and fixed to the rotation base 61 by being screwed into the screw section 52b. Thus, the connecting screw 67 moves in the elongated hole 64a by moving the rotating base 61 forward and backward with respect to the first base tube 64, and the connecting screw 67 integrally treats the rotating base 61 with the treatment. The section base operating rod 52 advances and retreats, and the position of the tip arrangement section 52a changes within the range shown in FIG.
[0049]
An O-ring 93 is provided at a predetermined position on the inner peripheral surface of the rotating base 61 as airtight means for preventing the inside of the abdominal cavity from communicating with the outside through the long hole 64a and the second through hole 34. Is arranged.
[0050]
On the other hand, a flange member 66 having a flange 66a for holding the rotary knob 62 is provided at the tip of the rotary knob 63 fixed integrally to the second base tube 65. The flange portion 66a of the flange member 66 is disposed in a small-diameter hole 62a of a stepped hole formed with a predetermined depth size and a predetermined diameter size on the rotation knob 63 side which is a base end surface side of the rotation knob 62. It has become so.
[0051]
An annular regulating ring 68 for holding the flange 66a is arranged in the large diameter hole 62b of the stepped hole. The restriction ring 68 is integrally fixed to the rotation knob 62 by a fixing screw 94. Thus, the rotation knob 62 is rotatably disposed with respect to the flange 66a in a state where the movement of the insertion portion 3 in the axial direction is restricted.
[0052]
A female screw portion 62c is formed in a through hole of the rotary knob 62. A male screw portion 61b is formed at the base end of the rotation base 61. The male screw part 61b and the female screw part 62c are screwed together, so that the rotary knob 62 and the rotary base 61 are integrated. Therefore, by rotating the rotation knob 62 in a desired direction, the rotation base 61 can be moved forward and backward with respect to the first base tube 64. As a result, as described above, the treatment section base operation rod 52 integrated with the rotation base 61 is moved forward and backward by the connection screw 67, and the position of the distal end placement section 52a changes within the range shown in FIG.
When the rotation base 61 is at the position shown in FIG. 9, the distal end of the treatment section base operation rod 52 is located at the zero rotation end shown in FIGS. 4 and 6.
[0053]
The depth of the small-diameter hole 62a is set to be larger than the thickness of the flange 66a by a predetermined dimension, and a step portion is provided at the bottom of the small-diameter hole 62a of the rotary knob 62 so that the flange 66a and the flange 66a can be narrowed. The contact area with the bottom surface of the diameter hole 62a is set to a necessary minimum to reduce the amount of friction, and the rotating knob 62 is easily rotated with the fingers holding the surgical treatment tool 1 to advance and retreat the rotating base 61. Can be done.
[0054]
Furthermore, the axis of the treatment section operation rod 51 is made substantially coincident with the axis of the rotation knob 63, thereby enabling the insertion section 3 to rotate around the rotation knob axis center.
[0055]
Further, the removal button 70 is located between the rotation knob 62 and the rotation knob 63, and includes a first engagement member 71 having a locking claw 71a on the rotation knob 63, an engagement pin 72, and an elastic material. The release mechanism is configured by arranging the formed button portion 73, and is configured to be detachable from the gripping operation unit 4 indicated by a two-dot chain line.
[0056]
Next, the grip operation unit 7 will be described with reference to FIG.
The fixed handle 41 and the turning handle 42 that constitute the treatment section operation section 40 are formed of a resin member. Ring members 41a and 42a are mounted on the fixed handle 41 and the rotating handle 42 to reduce the burden on the operator's fingers during operation.
[0057]
A connecting rod receiver 44 on which the ball portion 53a of the connecting rod 53 is disposed is formed on the tip side of the turning handle 42. On the other hand, an attachment / detachment portion 45 having a through hole through which the treatment section operation rod 51 with which the connecting rod 53 is integrated is provided at the distal end side of the fixed handle 41. An engagement portion 45a is provided at a tip end of the attachment / detachment portion 45 so that the engagement claw 71a of the first engagement member 71 is engaged. The fixed handle 41 has a through hole through which a connecting rod 53 integrated with the treatment section operating rod 51 is inserted.
[0058]
In the through hole of the attaching / detaching part 45, a treatment part operating rod receiver 46 is disposed so as to be rotatable around an axis. The treatment portion operation rod receiver 46 has a guide portion 46a on the distal end side, and receives the rotation guide pin 65a provided at the distal end portion of the second base tube 65 with the guide portion 46a. The smooth side surface 53b of the connecting rod 53 integrated with the proximal end of the treatment section operation rod 51 is joined to the treatment section operation rod receiver 46.
[0059]
Therefore, when the rotation knob 63 is rotated and the treatment section operation rod receiver 46 rotates together with the second base tube 65 constituting the insertion section unit 6, the treatment section operation rod 51 follows the rotation. Rotate. That is, by appropriately rotating the rotation knob 63, the position of the treatment section 2 with respect to the treatment section operation section 40 can be changed.
[0060]
The fixed handle 41 is provided with an airtight cap 47 for preventing the pressure in the abdominal cavity from being reduced via the inside of the first through hole 33. The fixed handle 41 is provided with a high-frequency input pin 48. The first through-hole 33 is formed to have an outer diameter dimension that allows an insulating tube (not shown) to be disposed on the outer peripheral side, and is configured to cover the insulating tube. Becomes possible.
[0061]
The operation of the surgical instrument 1 configured as described above will be described.
First, the turning operation of the turning handle 42 will be described.
As shown in FIGS. 3 (a) and 3 (b) and FIGS. 4 (a) and 4 (b), the treatment section 2 is in a non-rotating state in a straight line with respect to the insertion section 3, and When the first treatment piece 21 and the second treatment piece 22 are closed, when the rotating handle 42 is rotated around the handle pin 43 in the direction of arrow a as shown in FIGS. 11 and 12, The rotating handle 42 located at the one-dot chain line moves to, for example, the position indicated by the solid line.
[0062]
As a result, the position of the ball portion 53a of the connecting rod 53 disposed in the treatment section operation rod receiver 46 changes, and the treatment section operation rod 51 having the integrated connection rod 53 moves along the insertion axis in the direction of arrow e. Move forward as shown. Then, as shown in FIG. 6, the flat distal end 51a of the treatment section operation rod 51 moves forward, and the second connection member 26 and the first connection member 25 move inside the treatment section base 23. Moving forward, the first treatment piece 21 and the second treatment piece 22 constituting the treatment section 2 change to an open state as shown in FIGS. 6, 11, and 13.
[0063]
Then, as shown in FIG. 12, by rotating the rotating handle 42 to move the ball portion 53a along the insertion axis by the linear distance L2, the third connecting pin is formed as shown in FIG. The center position of 10c moves by the linear distance L2, and the first treatment piece 21 and the second treatment piece 22 are in the maximum open state in which they open at an angle θ2.
[0064]
On the other hand, by operating the rotation handle 42 in the direction of arrow b which is the opposite direction to the above, the center position of the ball portion 53a and the third connection pin 10c moves rearward along the insertion axis, The treatment unit 2 that has been in the open state gradually changes to a closed state.
That is, when the operator appropriately rotates the rotating handle 42, the flat distal end portion 51a moves forward and backward as shown by the arrow in FIG. 13, and the first treatment piece 21 and the second treatment piece are moved. 22 to change the open / closed state of the treatment section 2 to a desired state.
[0065]
Next, the turning operation of the turning knob 62 will be described.
As shown in FIGS. 3 (a) and 3 (b) and FIGS. 4 (a) and 4 (b), the treatment section 2 is in a non-rotating state in a straight line with respect to the insertion section 3, and When the first treatment piece 21 and the second treatment piece 22 are closed, the rotation knob 62 is rotated around the insertion axis, for example, in the direction of arrow d (or in the direction of c) as shown in FIG. The rotation base 61 screwed to the rotation knob 62 moves forward along the insertion axis in accordance with the amount of rotation of the rotation knob 62. Then, as shown in FIG. 15, with the movement of the rotation base 61 to the front side, the treatment section base operation rod 52 integrally fixed by the connecting screw 67 moves to the front side. At this time, the position of the connection screw 67 with respect to the long hole 64a changes.
[0066]
When the treatment section base operating rod 52 moves forward, as shown in FIG. 16, the distal end placement section 52a moves forward, and the second pivot pin 8b also moves. Thereby, the treatment section base 23 on which the first treatment piece 21 and the second treatment piece 22 are arranged is rotated about the first rotation pin 8a as an axis, and the rotation angle is increased. It changes gradually. Then, as shown in FIG. 15, the turning knob 62 is turned to move the turning base 61 along the insertion axis by the linear distance L <b> 1, thereby performing the second rotation as shown in FIG. 5. The center position of the moving pin 8b moves by the linear distance L1, and the treatment section 2 rotates from the horizontal position indicated by the dashed line to the position where the treatment section 2 is inclined at the maximum rotation angle of the angle θ1.
[0067]
Next, a rotation operation in which the rotation knob 62 and the rotation handle 42 are combined will be described.
For example, as shown in FIGS. 17 and 18, the rotation knob 62 is rotated to operate the treatment section 2 as shown in FIG. When the rotary handle 42 is rotated in the direction of arrow a, the flat distal end 51a of the treatment section operation rod 51 moves from the position shown by the dashed line to the position shown by the solid line as shown in FIG. As shown in FIGS. 17 and 19, the first treatment piece 21 and the second treatment piece 22 constituting the treatment section 2 are in the open state.
[0068]
That is, by operating the rotation handle 42 in a state where the treatment base 2 is rotated by moving the rotation base 61 by an arbitrary amount, the opening and closing operation of the first treatment piece 21 and the second treatment piece 22 is performed. Can be performed. At this time, the turning operation of the treatment section 2 and the opening / closing operation of the first treatment piece 21 and the second treatment piece 22 constituting the treatment section 2 can be performed in any combination.
[0069]
Finally, the operation of the rotary knob 63 will be described.
When the rotation knob 63 is rotated around the insertion axis, the integrated second base tube 65, first base tube 64, first through hole 33, and second through hole 34 rotate around the insertion axis, and simultaneously rotate. The treatment portion operation rod receiver 46 having the guide portion 46a received by the guide pin 65a is integrated with the connecting rod 53 by the smooth side surface 53b, and rotates the treatment portion operation rod 51 about the insertion axis. That is, by rotating the entire insertion section 3 around the insertion axis, the opening and closing directions of the first treatment piece 21 and the second treatment piece 22 can be arbitrarily changed.
[0070]
The insertion unit 6 and the gripping operation unit 7 are integrated by engaging the engaging claw 71a of the first engaging member 71 constituting the button 70 for removal with the engaging portion 45a of the attaching / detaching portion 45. Configuration. Therefore, the button portion 73 of the removal button 70 is depressed to move the first engagement member 71 toward the center of the insertion axis, whereby the engagement between the locking claw 71a and the engagement portion 45a is established. The state is released. In this state, the ball handle 53a of the connecting rod 53 is removed from the treatment section operation rod receiver 46 by simultaneously rotating the rotation handle 42 about the handle pin 43 and moving the treatment section operation rod 51. With this, the insertion unit 6 and the grip operation unit 7 are disassembled.
[0071]
Further, by loosening the connection screw 67 disposed on the rotation base 61, the treatment section base operation rod 52 becomes detachable from the rotation base 61, and in this state, the treatment section operation rod 51 and the treatment section The base operation rod 52 is removed from the first through hole 33 and the second through hole 34. As a result, the insertion unit 6 and the treatment unit 5 are disassembled.
[0072]
As described above, the treatment section operating section including the rotation knob for rotating the treatment section of the surgical treatment tool and the rotation handle for opening and closing the first treatment piece and the second treatment piece constituting the treatment section, for example. The treatment section base operation rod for transmitting the operation of the rotation knob to the treatment section and the treatment section operation rod for transmitting the operation of the rotation handle to the treatment section are made of rigid members. When the operator operates the rotation knob or the rotation handle, the treatment section can be rotated or opened and closed as intended by the operator.
[0073]
As a result, even when an external force is applied to the treatment section, the treatment section base operation rod and the treatment section operation rod move without being deformed against the external force, so that the rotation operation and the treatment piece constituting the treatment section can be performed. Opening and closing operations can be performed reliably and accurately.
[0074]
In addition, since the treatment section is connected to the rotation knob and the rotation handle with rigid members, the external force applied to the treatment section can be directly sensed by the rotation knob or the finger operating the rotation handle while the rotation force is felt. The operation of the moving knob or the rotating handle can be performed.
[0075]
This allows the closing operation to be performed to reliably grip the living tissue to be gripped on the gripping surface subjected to the unevenness processing while obtaining a response, while the opening operation ensures the tissue peeling operation while obtaining the response. I can do it.
[0076]
Furthermore, since the surgical treatment tool can be separated into the treatment section unit, the insertion section unit, and the grip operation unit, cleaning after using the surgical treatment tool can be performed easily and in a short time.
[0077]
The cross-sectional shape of the treatment section base operation rod inserted and arranged in the second through-hole is not limited to a rectangular shape. For example, as shown in FIG. In order to change the external dimensions, for example, by setting the length of the linear portion 32b to be longer, the cross-sectional shape of the second through hole 34a is changed, and for example, the treatment section operation rod 51 and the treatment section base operation rod 52A are changed. The surgical treatment tool may be configured by setting the cross-sectional areas to be substantially the same.
[0078]
As described above, by appropriately setting the outer shape of the region forming tube disposed in the insertion tube constituting the insertion portion, and setting the cross-sectional areas of the treatment section operation rod and the treatment section base operation rod to be substantially the same, the treatment section It is possible to reliably prevent a failure due to buckling of the operation rod and the treatment section base operation rod, and to surely prevent the treatment section that is rotating or opening / closing from returning to the straightened state unintentionally. Can be.
[0079]
(2nd Embodiment)
21 and 22 relate to a second embodiment of the present invention, and FIG. 21 illustrates a surgical treatment tool in which a treatment section characteristic of the second connecting member is rotated and a pair of treatment pieces is closed. FIG. 22 is a view for explaining a surgical treatment tool in which a pair of treatment pieces are opened in a state where a treatment section characteristic of the second connecting member is rotated.
[0080]
As shown in FIGS. 21 and 22, in the surgical treatment tool 1 of the present embodiment, a first inclined contact surface 26c and a second inclined contact surface 26d are provided at the center of the second connecting member 26A. The proximal end surface of the first connecting member 25 abuts on the first inclined contact surface 26c, and the flat distal end 51a provided on the distal end of the treatment section operating rod 51 on the second inclined contact surface 26d. The tip surface is configured to abut.
[0081]
Therefore, when the treatment section operating rod 51 is advanced and the first connection member 25 is pushed up by the second connection member 26A while the treatment section 2A is rotating, the vertical reaction force of the first inclined contact surface 26c is reduced. The direction is made closer to the main shaft of the treatment section 2 to reduce the resistance.
[0082]
Further, in a state where the treatment section 2A is rotated and the first treatment piece 21 and the second treatment piece 22 are open, the first treatment piece 21 and the second treatment piece 22 are closed by an external force, and Even when the second connecting member 26A is pushed down by the first connecting member 25 and the treatment section operation rod 51 is retracted to the proximal end side, the direction of the vertical force on the first inclined contact surface 26c is changed by the treatment section operation rod 51. To reduce the resistance by approaching the main shaft.
[0083]
Thereby, resistance when the second connecting member 26A pushes up or pushes down the first connecting member 25 is reduced, and opening and closing of the first treatment piece 21 and the second treatment piece 22 constituting the treatment section 2A are smoothly performed. Can be done.
The pin receiving hole for receiving the second connecting pin 10b of the first connecting member 25 may have a larger diameter than the outer diameter of the second connecting pin 10b. Further, the pin accommodation hole for accommodating the third connecting pin 10c of the treatment section operation rod 51 may be configured to have a larger diameter than the outer diameter of the third connecting pin 10c. Other configurations and operations are the same as those of the first embodiment, and the same members are denoted by the same reference numerals and description thereof is omitted.
[0084]
Thus, the second connecting member is provided with the inclined contact surface with which the distal end surface of the flat distal end of the treatment section operating rod contacts and the inclined contact surface with which the proximal end surface of the first coupling member contacts. Thereby, the direction of the normal reaction applied from the first connection member to the second connection member or from the second connection member to the first connection member can be made closer to the axis of the treatment section operation rod, thereby improving operability.
[0085]
It should be noted that the present invention is not limited to only the above-described embodiments, and various modifications can be made without departing from the spirit of the invention.
[0086]
[Appendix]
According to the above-described embodiment of the present invention as described in detail above, the following configuration can be obtained.
[0087]
(1) an elongated tubular insertion portion forming tube member constituting the insertion portion;
A surgical operation portion is provided at the distal end portion via a joint portion, and a first operation portion for operating the surgical operation portion is provided at a proximal end portion. A first shaft formed in an elongated shape;
A treatment section base member, which is disposed in the inner hole of the insertion section forming tube member so as to be able to advance and retreat and has a surgical treatment section at its distal end, is connected to the treatment section base member at a base end thereof. An elongated second shaft provided with a second operation unit for rotating and moving the arrangement position of the surgical treatment unit provided on the base member;
An area forming member disposed in the insertion portion forming tube member, and dividing an inner hole of the insertion portion forming tube member into a plurality of regions;
A surgical treatment tool comprising:
[0088]
(2) Appendix 1, wherein the first shaft is disposed so as to be able to advance and retreat in a first region formed by the region forming member, and the second shaft is disposed so as to be able to advance and retreat in a second region formed by the region forming member. Surgical treatment tools.
[0089]
The purpose of this appendix is to reliably advance and retreat a plurality of shafts arranged in the inner hole of the insertion portion forming tube member, and to use each shaft for each purpose in each region divided by the region forming member. By arranging, the shafts are prevented from interfering with each other and move forward and backward reliably.
[0090]
(3) The surgical treatment tool according to Supplementary Note 1 or 2, wherein the region forming member is a tubular member disposed in the insertion portion forming tubular member.
[0091]
The purpose of this is to divide the inner hole of the insertion section forming tube member into a predetermined form, and by arranging the tubular member considering the outer diameter shape in the insertion section forming tube member in a predetermined positional relationship, the insertion section forming tube member Is divided into a region where the inner hole of the tubular member is formed, and a region where the outer peripheral surface of the tubular member and the inner peripheral surface of the insertion portion forming tube member are formed. It is formed.
[0092]
(4) an elongated first tube member constituting the insertion portion;
An elongated second pipe member inserted through the inner hole of the first pipe member to divide the inner hole of the first pipe member into a plurality of regions;
An elongated first shaft which is disposed to be able to advance and retreat in a region formed by an inner hole of the second pipe member;
An elongated second shaft which is disposed so as to be able to advance and retreat in a region formed by an outer peripheral surface of the second tubular member and an inner peripheral surface of the insertion portion forming tubular member;
A surgical treatment unit connected to a distal end of the first shaft via a joint,
A treatment section base member including the surgical treatment section, the treatment section base member being coupled to a distal end of the second shaft;
A first operation unit that operates the surgical treatment unit by moving the first shaft forward and backward;
A second operation unit configured to rotate the treatment section base member by the reciprocating operation of the second shaft to pivotally move an arrangement position of a surgical treatment section provided on the treatment section base member;
A surgical treatment tool comprising:
[0093]
The purpose of this appendix is to provide a surgical treatment tool excellent in operability that can accurately perform a desired procedure by operation of the operation unit at hand, and according to this configuration, by operating the first operation unit at hand. The first shaft moves forward and backward, and the surgical treatment section performs a desired operation. On the other hand, by operating the second operation unit at hand, the second shaft moves forward and backward, and the treatment unit base member rotates by a predetermined amount.
[0094]
(5) The surgical treatment tool according to any one of supplementary notes 1 to 4, wherein the first shaft and the second shaft are members having rigidity and flexibility.
[0095]
The purpose of this supplementary note is that when operating the operating unit at hand and operating the surgical treatment unit or the treatment unit base member, it is possible to operate while reliably feeling the external force applied to the treatment unit or the treatment unit base member with the fingers, And, without buckling due to the external force, it is possible to reliably perform the desired procedure, since the shaft inserted and arranged in a predetermined area has rigidity and flexibility, the external force is transmitted to the hand, It moves forward and backward with a predetermined amount and high precision without being deformed against this external force.
[0096]
(6) The surgical treatment instrument according to any one of supplementary notes 1 to 4, wherein the first shaft extends on a rotation axis of the insertion portion.
[0097]
The purpose of this appendix is to change the direction of the surgical treatment portion by rotating the surgical treatment portion. When the extension position of the first shaft is located on the rotation axis of the insertion portion, the rotation of the insertion portion causes the surgical treatment portion to rotate. The direction changes.
[0098]
(7) The surgical procedure according to any one of supplementary notes 1 to 6, wherein an effective cross-sectional area of the area where the second shaft is arranged is smaller than an effective cross-sectional area of the area where the first shaft is arranged. Utensils.
[0099]
The purpose of this appendix is to cause the surgical treatment section and the treatment section base member to perform a desired operation by the reciprocating movement of the first shaft and the second shaft, and by arranging the shaft in consideration of the effective cross-sectional area of the region. The surgical treatment section and the treatment section base member operate more reliably.
[0100]
【The invention's effect】
As described above, according to the present invention, when the treatment section is operated by a hand operation, the operation can be performed while feeling the external force applied to the treatment section with the finger, and the treatment section can be reliably operated against the external force. It is possible to provide a surgical treatment tool which is excellent in operability that can be operated to accurately perform a desired procedure.
[Brief description of the drawings]
FIGS. 1 to 20 relate to an embodiment of the present invention, and FIG. 1 is a perspective view of a surgical treatment tool.
FIG. 2 is a perspective view illustrating the configuration of a surgical treatment tool.
FIG. 3 is a diagram illustrating a configuration of a treatment unit.
FIG. 4 is a cross-sectional view illustrating a configuration of a treatment unit.
FIG. 5 is a view for explaining a rotating state of the treatment section.
FIG. 6 is a diagram illustrating an open / closed state of a treatment piece in a state where the treatment unit is not rotating.
FIG. 7 is a diagram illustrating an open / closed state of a treatment piece when the treatment unit is in a maximum rotation state.
FIG. 8 is a sectional view taken along line AA of FIG. 1;
FIG. 9 is a cross-sectional view illustrating a configuration of an insertion unit and a grip operation unit.
FIG. 10 is an enlarged view of a base end side of the insertion unit shown in FIG. 9;
FIG. 11 is a view for explaining the operation when the rotating handle of the treatment section operation section is operated.
FIG. 12 is a view for explaining the movement of a treatment section operating rod which operates in response to the operation of the rotating handle.
FIG. 13 is a view for explaining the relationship between the movement of the flat distal end of the treatment section operation rod and the opening and closing operation of the treatment piece constituting the treatment section with the treatment section base removed.
FIG. 14 is a diagram illustrating an operation when a rotation knob is operated.
FIG. 15 is a view for explaining movements of a rotation base and a treatment section base operation rod which operate in response to operation of a rotation knob.
FIG. 16 is a view for explaining the relationship between the movement of the distal end arrangement portion of the treatment section base operation rod and the rotation operation of the treatment section with the treatment section base removed.
FIG. 17 is a view for explaining the operation when operating the rotation handle of the treatment section operation section while operating the rotation knob.
FIG. 18 is a view for explaining the movement of the rotation base and the treatment section base operation rod that operate in response to the operation of the rotation knob, and the movement of the treatment section operation rod that operates in response to the operation of the rotation handle.
FIG. 19 is a view for explaining the opening / closing operation of a treatment piece constituting the treatment section when the treatment section is in a rotating state.
FIG. 20 is a view for explaining a configuration of an insertion portion for making the treatment section operation rod and the treatment section base operation rod have substantially the same cross-sectional area.
FIGS. 21 and 22 show a second embodiment of the present invention. FIG. 21 shows a surgical operation in which a pair of treatment pieces are in a closed state while a treatment section characteristic of a second connecting member is rotated. Diagram for explaining the treatment tool
FIG. 22 is a view for explaining a surgical treatment tool in which a pair of treatment pieces is opened in a state where a treatment section characteristic of the second connecting member is rotated.
[Explanation of symbols]
1. Surgical treatment tool
2. Treatment unit
3. Insertion part
4 ... Grip operation unit
23… Treatment unit base
31 ... insertion tube
40 ... treatment section operation section
42 ... Rotating handle
51 ... treatment section operation stick
52 ... treatment section base operation stick
61 ... Rotating base
62 ... Rotation knob

Claims (1)

An elongated and tubular insertion portion forming tube member constituting the insertion portion,
A surgical operation portion is provided at the distal end portion via a joint portion, and a first operation portion for operating the surgical operation portion is provided at a proximal end portion. A first shaft formed in an elongated shape;
A treatment section base member, which is disposed in the inner hole of the insertion section forming tube member so as to be able to advance and retreat and has a surgical treatment section at its distal end, is connected to the treatment section base member at a base end thereof. An elongated second shaft provided with a second operation unit for rotating and moving the arrangement position of the surgical treatment unit provided on the base member;
An area forming member disposed in the insertion portion forming tube member, and dividing an inner hole of the insertion portion forming tube member into a plurality of regions;
A surgical treatment tool comprising:

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