JP2004329763A - Ultrasonic trocar puncture system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an ultrasonic trocar puncture system for raising safety and operability in puncturing to a body wall by ultrasonic vibration. <P>SOLUTION: This ultrasonic trocar puncture system 1 includes: a communication cable 4; a flow rate sensor 54; and a second CPU (central processing unit) 44. Communication is performed between an aeroperitoneum apparatus 40 and an ultrasonic oscillation device 9 through a communication cable 4. The flow rate sensor 54 is arranged in the aeroperitoneum apparatus 40, and measures a state in a ventral cavity to be changed by the supply of gas for aeroperitoneum to the ventral cavity. The second CPU 44 controls the output of the ultrasonic oscillation device 9, based on a measurement result, after the transmission of the measurement result in the flow rate sensor 54 from the aeroperitoneum apparatus 40 to the ultrasonic oscillation device 9 through the communication cable 4. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

[0001]
TECHNICAL FIELD OF THE INVENTION
The present invention relates to an ultrasonic trocar puncture system for puncturing a mantle tube into a body wall of a patient.
[0002]
[Description of the Prior Art]
In a conventional general trocar system, a handpiece unit which is indwelled in a patient's body wall (abdominal wall) and which has a sharp inner needle (puncture needle) inserted into an inner hole of the outer tube and having a sharp end at a distal end is provided. And are detachably assembled. When puncturing the inner needle into the patient's body wall, for example, a gas for insufflation is introduced into the abdominal cavity by an insufflation device to insufflate the abdominal cavity, thereby ensuring a sufficient cavity in the abdominal cavity. The inner needle of the handpiece unit is inserted into a body cavity by puncturing a body wall of a patient in a state where the handpiece unit is integrated with the mantle tube. When the inner needle is introduced into the body cavity, the outer tube is pierced into the body wall of the patient together with the inner needle and introduced into the body cavity. With the inner needle and the outer tube introduced into the body cavity, the inner needle is withdrawn from the outer tube and the outer tube is placed on the body wall. This mantle tube is used as a scope for observing various lesions and a guide tube for a treatment tool for performing a treatment.
[0003]
Various types of such trocar systems are conventionally known. For example, Patent Literature 1 discloses an ultrasonic trocar system that introduces a handpiece unit and a mantle tube into a patient's body wall while ultrasonically oscillating an inner needle of the handpiece unit in an assembled state. . This ultrasonic trocar system makes the inner needle ultrasonically oscillate by the output from the ultrasonic oscillating device, and punctures the inner needle safely and easily with a relatively light force by the ultrasonic vibration of the inner needle. Can be. Therefore, when the inner needle and the outer tube are punctured into the body wall and then the inner needle is removed from the outer tube, the outer tube can be placed on the body wall.
[0004]
Further, in Patent Document 2, an improved dilator in which a tip portion is formed in a substantially conical tapered shape is inserted between an outer tube indwelled on a body wall and an inner needle having a relatively small outer dimension. An ultrasonic trocar system is disclosed. In a state where the outer tube, the inner needle, and the dilator of this ultrasonic trocar system are assembled, the tapered tip of the dilator projects from the tip of the outer tube, and the puncture needle of the inner needle projects from the tip of the dilator. . In such a state, after the inner needle of the ultrasonic trocar system is punctured into the body wall using ultrasonic vibration, the dilator and the mantle tube are grasped, and the body wall of the patient is dilated to form the mantle tube. And put it in place.
[0005]
As described above, in order to puncture the inner needle and mantle tube of the conventional ultrasonic trocar system into the body wall, a gas for insufflation is introduced into the abdominal cavity by an insufflation device to insufflate the abdominal cavity to insufflate the abdominal cavity. Keep enough. Thereafter, it is common to puncture the inner needle by puncturing the body wall by ultrasonic vibration generated by the output from the ultrasonic oscillator, and then puncturing the mantle tube. By the way, in order to ensure the safety of the patient, the gas in the abdominal cavity is released to the outside so that the pressure in the abdominal cavity is reduced when the pressure in the abdominal cavity becomes excessively high during the puncture of the trocar to release the patient. The relief valve operates. In addition, the insufflation device includes a switch for forcibly opening the relief valve to release gas in the abdominal cavity, and has a function of reducing the pressure in the abdominal cavity.
[0006]
[Patent Document 1]
Japanese Patent Publication No. Hei 5-57863
[0007]
[Patent Document 2]
JP-A-2002-177293
[0008]
[Problems to be solved by the invention]
However, if the pressure in the abdominal cavity suddenly drops during the puncture of the trocar, the abdominal cavity may be reduced in size. When the abdominal cavity becomes deflated, the distance between the body wall and the organ decreases. Therefore, in order to prevent the tip of the inner needle from coming into contact with an organ or the like at the time of puncturing, the operator needs to carefully perform the operation of puncturing the mantle tube. This makes it difficult for the operator to operate the trocar system, which is not a favorable condition for the operator.
[0009]
There is another problem. To stop the output of the ultrasonic oscillator used to puncture the inner needle of the above-described ultrasonic trocar system into the body wall, first, the user visually or manually confirms that the tip of the inner needle has been punctured into the body wall. Confirm with a sense transmitted to. Thereafter, an electric energy output control device such as an ultrasonic output switch provided as a foot switch is turned off. When the output control device is turned off, the output from the ultrasonic oscillation device to the inner needle is stopped. Therefore, after the operator visually confirms that the tip of the inner needle has been punctured into the body wall, a slight time lag is required until the ultrasonic vibration output is stopped. If it becomes possible to stop the output of the ultrasonic oscillation device promptly and promptly after the tip of the inner needle is punctured into the body wall, a more secure system can be constructed.
[0010]
The present invention has been made in view of such circumstances, and an object of the present invention is to provide an ultrasonic trocar puncturing system that improves the safety and operability of puncturing a body wall by ultrasonic vibration. It is in.
[0011]
[Means for Solving the Problems]
In order to solve the above problems, the ultrasonic trocar puncture system of the present invention supplies an insufflation gas, an insufflation device for insufflating the patient's abdominal cavity, and an inner needle punctured in the patient's body wall. A handpiece unit having an ultrasonic transducer connected to the base end of the inner needle and transmitting ultrasonic vibration toward the distal end of the inner needle; and an ultrasonic oscillation energy supplied to the ultrasonic transducer. The apparatus includes an ultrasonic oscillator to be supplied, and an outer tube that is introduced into the body wall pierced by the inner needle and placed therein while the inner needle of the handpiece unit is inserted. The ultrasonic trocar puncturing system is provided with communication means for communicating with each other between the insufflation device and the ultrasonic oscillation device, and is provided in the insufflation device, and is changed by supplying insufflation gas into the abdominal cavity. The first feature is that the apparatus further comprises a measuring means for measuring a state in the abdominal cavity to be performed, and a control means for controlling an output of the ultrasonic oscillation device based on a measurement result of the measuring means.
With such a configuration, the output of the ultrasonic oscillator is controlled based on the measurement result of the state change in the abdominal cavity.
[0012]
The ultrasonic trocar puncturing system may further include a gas passage for the insufflation gas provided inside the handpiece unit, and a gas outlet for discharging the insufflation gas in the gas passage at the tip of the inner needle. In addition, when the ultrasonic transducer is driven, the outflow state of the gas for insufflation from the gas outlet at the tip of the inner needle is measured, and the driving of the ultrasonic transducer is stopped based on the measurement result. A second feature is that a control means for making a determination is further provided.
With such a configuration, the ultrasonic needle continued to oscillate while the inner needle of the ultrasonic trocar system was pierced into the body wall, and the outflow state of the gas for insufflation changed due to the puncture of the inner needle into the body wall. When this is measured, the ultrasonic output is stopped quickly and promptly without the operator's operation.
[0013]
BEST MODE FOR CARRYING OUT THE INVENTION
Hereinafter, preferred embodiments of the present invention will be described with reference to the drawings. First, a first embodiment will be described with reference to FIGS.
[0014]
As shown in FIG. 1, an ultrasonic trocar puncture system 1 according to this embodiment transmits an ultrasonic trocar system 2, an insufflation system 3, and signals between the ultrasonic trocar system 2 and the insufflation system 3. A communication cable 4 is provided as communication means for performing the communication. The ultrasonic trocar system 2 is a system for placing the outer tube 26 after puncturing the inner needle 23 and the outer tube 26 described later. The insufflation system 3 is a system for insufflating the abdominal cavity when puncturing an inner needle 23 described later.
[0015]
The ultrasonic trocar system 2 mainly includes an ultrasonic trocar handpiece unit 8 and an ultrasonic oscillator 9 for supplying energy to the handpiece unit 8. An output control device (ultrasonic output switch) 10 for an operator to operate the ultrasonic oscillator 9 is connected to the ultrasonic oscillator 9. This output control device 10 is preferably provided as a foot switch or a hand switch, for example.
[0016]
As shown in FIG. 2, the handpiece unit 8 includes an ultrasonic transducer housing unit 13 which also serves as a holding unit that is held by an operator. Inside the ultrasonic vibrator housing 13, a Langevin type ultrasonic vibrator (which has a cylindrical appearance and converts energy supplied from the ultrasonic oscillator 9 into ultrasonic vibration (mechanical vibration)) An ultrasonic transducer 14 is provided. In the ultrasonic transducer 14, a plurality of donut-shaped piezoelectric elements 15 are arranged in parallel, electrodes (not shown) are arranged between the piezoelectric elements 15, and a lead wire 16 is connected to each electrode. . These leads 16 are collectively inserted into the cable 17 shown in FIG.
[0017]
On the other hand, a base end of a horn 21 for expanding the ultrasonic vibration generated by the ultrasonic vibrator 14 is provided at a distal end of the ultrasonic vibrator 14. The horn portion 21 is preferably tapered, for example, in a substantially truncated cone shape. A bolt 22 is provided which penetrates the piezoelectric element 15 and the electrode from the base end to the front end of the above-described ultrasonic vibrator 14 and is screwed to the base end of the horn 21. As described above, the piezoelectric element 15 and the electrode are in a state of being in tight contact with each other by the bolting of the bolt 22.
[0018]
An ultrasonic trocar inner needle (probe) 23 is detachably connected to the tip of the horn portion 21 as an ultrasonic vibration transmitting member for transmitting ultrasonic waves transmitted from the ultrasonic vibrator 14 by, for example, screw connection. Have been. Here, a male screw portion 24 is provided at a base end portion of the inner needle 23, and a female screw portion (not shown) is provided at a distal end portion of the horn portion 21. For this reason, the male thread 24 at the base end of the inner needle 23 and the female thread at the tip of the horn 21 are screwed together. Therefore, the ultrasonic vibration generated by the ultrasonic transducer 14 is transmitted to the tip of the inner needle 23 via the horn 21. In this embodiment, the inner needle 23 is provided with the male screw portion 24 and the horn portion 21 is provided with a female screw portion (not shown), but the male screw portion and the female screw portion are provided in reverse. Is also good.
[0019]
Further, as shown in FIG. 1, the inner needle 23 connected to the horn portion 21 is covered with a sheath 25 in close contact with the outer periphery thereof. A trocar mantle tube 26 to be indwelled on the body wall (abdominal wall) H is arranged on the outer periphery of the sheath 25. The inner circumference of the outer tube 26 is formed to have a slightly larger diameter than the outer circumference of the sheath 25 when the inner needle 23 is covered with the sheath 25. For this reason, the inner needle 23 whose outer periphery is covered with the sheath 25 and the outer tube 26 are removably assembled.
[0020]
The sheath 25 prevents contact between the outer tube 26 and the inner needle 23 to prevent, for example, the generation of a metallic sound or the like generated between the two during ultrasonic vibration. In addition, the space between the inner needle 23 and the outer tube 26 is buried to prevent the insufflation gas in the abdominal cavity from leaking from between the inner needle 23 and the outer tube 26 when the body wall H is punctured by ultrasonic vibration. . In addition, the sheath 25 ensures slipperiness when the sheath 25 and the inner needle 23 are removed from the outer tube 26. For this reason, the sheath 25 is formed of a material having good slipperiness such as, for example, polytetrafluoroethylene (PTFE).
[0021]
As shown in FIG. 3, the ultrasonic oscillation device 9 of the ultrasonic trocar system 2 includes a central processing unit (hereinafter, referred to as a first CPU) 30 inside a housing 27 thereof. The first CPU 30 is provided with a first switch detection circuit 31 for detecting ON / OFF switching of the ultrasonic output switch 10 between the first CPU 30 and the ultrasonic output switch 10 described above. The first CPU 30 is provided with a transformer 32 between the first CPU 30 and the ultrasonic vibrator 14 of the handpiece unit 8 of the ultrasonic trocar. That is, the first CPU 30 supplies, from the transformer 32, energy (power) for ultrasonic vibration for causing the ultrasonic transducer 14 to ultrasonically vibrate based on a signal from the first switch detection circuit 31. At that time, the first CPU 30 controls the transformer 32 and controls the energy input to the ultrasonic transducer 14. Further, between the first CPU 30 and the first switch detection circuit 31, one end of the communication cable 4 described above as communication means for communicating a signal from the ultrasonic oscillation device 9 to an insufflation device 40 described later. Are arranged.
[0022]
As shown in FIG. 1, the insufflation system 3 includes an insufflation device 40, an insufflation gas tube 41 having one end connected to the insufflation device 40, and the other end of the insufflation gas tube 41. And a trocar outer tube 42 pierced into the body wall H.
[0023]
As shown in FIG. 3, the insufflation device 40 of the ultrasonic trocar system 2 includes a central processing unit (hereinafter, referred to as a second CPU) 44 inside a housing 43 thereof. The second CPU 44 is connected to an on-off valve 46 which is preferably a check valve. A gas cylinder 45 for insufflation gas is further connected to the on-off valve 46 via a tube 48. By controlling the opening and closing of the on-off valve 46 by the second CPU 44, the supply (opening) / supply stop (closing) of the insufflation gas from the gas cylinder 45 is controlled.
[0024]
A relief valve (safety valve) 50 that opens when the pressure in the abdominal cavity becomes equal to or higher than a predetermined pressure and closes at other times is connected to the on-off valve 46 via a tube 51. The tube 51 is provided with a pressure sensor (measuring device) 53 as a measuring means for measuring the pressure in the abdominal cavity. The measurement result (measured value) of the pressure sensor 53 is input to the first logic circuit 55 as monitoring means for monitoring the pressure in the abdominal cavity.
[0025]
The first logic circuit 55 includes, for example, a NOT circuit 56 connected to the communication cable 4 described above. A signal from the first switch detection circuit 31 of the ultrasonic oscillation device 9 for detecting ON / OFF of the ultrasonic output switch 10 is input to the NOT circuit 56 via the communication cable 4 described above. The NOT circuit 56 is further connected in series with a NOR circuit 57. The above-described pressure sensor 53 is connected to the NOR circuit 57. For this reason, the first logic circuit 55 compares (monitors) the ON / OFF of the ultrasonic output switch with the measurement result of the pressure sensor 53 and outputs a signal. Here, the pressure sensor 53 compares whether the inside of the abdominal cavity is in an overpressure state or a normal state.
[0026]
An OR circuit 60 is provided as a second logic circuit at the output destination of the signal from the NOR circuit 57 of the first logic circuit 55. The OR circuit 60 includes a smoke exhaust switch 62 outside the casing 43 for forcibly discharging gas for insufflation from the abdominal cavity and other gases. Connected through. The output of the OR circuit 60 is connected to the relief valve 50 described above. Therefore, when the smoke exhaust switch 62 is turned ON, the relief valve 50 is forcibly opened through the second switch detection circuit 63 and the OR circuit 60. When the smoke exhaust switch 62 is turned off, the relief valve 50 is closed through the second switch detection circuit 63 and the OR circuit 60. Further, since the OR circuit 60 is connected to the first logic circuit 55, the relief valve 50 is opened and closed based on the output of the signal from the first logic circuit 55.
[0027]
The measurement result of the pressure by the pressure sensor 53 is obtained by providing “sound” such as a buzzer or “light” for blinking the display panel on either or both of the insufflation device 40 and the ultrasonic oscillation device 9. It is preferable to provide notification means for notifying the user. Here, for example, a notification means is provided in the insufflation device 40 so that the user can recognize with “light” and “sound” when the inside of the abdominal cavity becomes a normal state and an overpressure state.
[0028]
Next, the operation of the ultrasonic trocar puncturing system 1 according to this embodiment will be described.
First, the mantle tube 42 of the insufflation device 40 is left in the patient's body wall H (see FIG. 1). Thereafter, the gas for insufflation is supplied from the gas cylinder 45 of the insufflation device 40 to the patient's abdominal cavity through the tube 48, the on-off valve 46, the insufflation gas tube 41, and the mantle tube 42. Insufflate (pressurize). At this time, the pressure state in the abdominal cavity is measured one by one by the pressure sensor 53 of the insufflation device 40. When the pressure in the abdominal cavity measured by the pressure sensor 53 becomes normal, the display panel of the pneumoperitoneum device 40 is turned on (flashes), and the user is aware of that.
[0029]
When the pressure in the abdominal cavity is normal, the distal end of the inner needle 23 of the handpiece unit 8 attached to the outer tube 26 is appropriately pressed against the body wall H. Thereafter, when the ultrasonic output switch (foot switch) 10 of the ultrasonic oscillator 9 is switched from OFF (standby state) to ON, the signal is transmitted to the first switch detection circuit 31. The output of the switch detection circuit 31 is transmitted (transmitted) to the NOT circuit 56 (first logic circuit 55) of the insufflation device 40 through the communication cable 4.
[0030]
The first logic circuit 55 of the insufflation device 40 compares two states of the ultrasonic output switch 10 (ON / OFF) and whether the pressure in the abdominal cavity by the pressure sensor 53 is an overpressure state or a normal state. Here, the determination as to whether the pressure in the abdominal cavity is an overpressure state or a normal state is, for example, when the normal value is set to 6 mmHg to 10 mmHg, the pressure has risen to 13 mmHg (5 mmHg with respect to 8 mmHg which is the central value of the normal value). It is preferable for the user to set such that it is sometimes determined that the state is overpressure. Alternatively, a prescribed value may be set in the insufflation device 40 in advance.
[0031]
Next, the logic of the first and second logic circuits (monitoring means) 55 and 60 will be described with reference to FIG. First, in a state where the smoke exhaust switch 62 of the insufflation device 40 is OFF (a closed state in which the relief valve 50 is closed), the second switch detection circuit 63 outputs a signal indicating that the smoke exhaust switch 62 is OFF. The signal is transmitted to the OR circuit (second logic circuit) 60.
[0032]
When the ultrasonic output switch 10 of the ultrasonic oscillator 9 is turned off, for example, the first switch detection circuit 31 transmits a signal indicating that the ultrasonic output switch 10 is turned off to the first CPU 30. Further, the signal is communicated to the first logic circuit 55 of the insufflation device 40 via the communication cable 4. A signal indicating that the ultrasonic output switch 10 is OFF is transmitted to the NOR circuit 57 via the NOT circuit 56.
[0033]
At this time, when the pressure sensor 53 detects that the inside of the abdominal cavity is in an overpressure state, the measurement signal indicating that the pressure is in an overpressure state is sent to the NOR circuit 57 of the first logic circuit 55 by the pressure sensor 53. Is transmitted.
[0034]
The NOR circuit 57 uses a signal indicating that the ultrasonic output switch 10 is OFF and a measurement signal indicating that the pressure sensor 53 is in an overpressure state to output a signal for releasing the relief valve 50 using an OR circuit. Output to 60. Thus, the output from the OR circuit 60 releases the relief valve 50 to ensure patient safety. Then, the gas for insufflation in the abdominal cavity is discharged out of the body, and the overpressure state is automatically released.
[0035]
When the pressure sensor 53 detects that the pressure in the abdominal cavity is in a normal state, a detection signal indicating that the pressure in the abdominal cavity is in a normal state is transmitted to the NOR circuit 57 of the first logic circuit 55. .
[0036]
The NOR circuit 57 outputs a signal for keeping the relief valve 50 in a closed state by an OR circuit 60 by using both a signal indicating that the ultrasonic output switch 10 is OFF and a measurement signal indicating that the ultrasonic sensor is in a normal state according to the pressure sensor 53. Output to Since a signal indicating that the smoke exhaust switch 62 is OFF is input to the OR circuit 60, the relief valve 50 is kept closed by the output from the OR circuit 60. That is, since the pressure in the abdominal cavity is in a normal state, safety in the abdominal cavity is ensured, and there is no need to open the relief valve 50.
[0037]
On the other hand, when the ultrasonic output switch 10 is ON, the first switch detection circuit 31 transmits a signal indicating that the ultrasonic output switch 10 is ON to the first CPU 30. Further, the signal is communicated to the first logic circuit 55 via the communication cable 4. The first CPU 30 supplies desired energy for controlling the transformer 32 to generate ultrasonic vibrations toward the ultrasonic vibrator 14. In the first logic circuit 55 of the insufflation device 40, a signal indicating that the ultrasonic output switch 10 is ON is transmitted to the NOR circuit 57 via the NOT circuit 56.
[0038]
At this time, when the pressure sensor 53 detects that the abdominal cavity is in an overpressure state, a measurement signal indicating that the pressure sensor 53 is in an overpressure state is transmitted to the NOR circuit 57 of the first logic circuit 55. Is done.
[0039]
However, the NOR circuit 57 outputs a signal for keeping the relief valve 50 in the closed state to the OR circuit 60 according to the signal that the ultrasonic output switch 10 is ON. Since a signal indicating that the smoke exhaust switch 62 is OFF is input to the OR circuit 60, the relief valve 50 is kept closed by the output from the OR circuit 60. That is, the relief valve 50 keeps its closed state so that ultrasonic puncturing of the body wall by the inner needle 23 is performed with priority. By the way, even if the closed state is maintained without opening (releasing) the relief valve 50 in the overpressure state, the puncture time of the inner needle 23 into the body wall H is several seconds, so that the cavity is sufficiently large (wide). ) Puncture can be performed safely in the abdominal cavity. When the inner needle 23 and the outer tube 26 are punctured into the patient's body wall H while the ultrasonic transducer 14 is vibrated, if the gas for insufflation is removed from the abdominal cavity, the abdominal cavity may be rapidly narrowed. Something is prevented. Therefore, by adopting such a logic, it is possible to prevent the distance between the body wall and the organ from rapidly approaching in a state where the ultrasonic transducer 14 is vibrated.
[0040]
When the pressure sensor 53 detects that the pressure in the abdominal cavity is in a normal state, a detection signal indicating that the pressure sensor 53 is in a normal state is transmitted to the NOR circuit 57 of the first logic circuit 55.
[0041]
The NOR circuit 57 outputs a signal for keeping the relief valve 50 in a closed state to the OR circuit 60 by both the measurement signal indicating that the ultrasonic output switch 10 is ON and the pressure sensor 53 is in a normal state according to the pressure sensor 53. Since a signal indicating that the smoke exhaust switch 62 is OFF is input to the OR circuit 60, the relief valve 50 is kept closed by the output from the OR circuit 60. That is, since the pressure in the abdominal cavity is in a normal state, safety in the abdominal cavity is ensured, and there is no need to open the relief valve 50.
[0042]
After confirming the puncture of the inner needle 23 into the body wall H by visual or hand sensation, if the ultrasonic output switch 10 is quickly turned off, the first switch detection circuit 31 detects that the ultrasonic output switch 10 is off. A signal indicating the presence is transmitted to the first CPU 30. Then, the first CPU 30 stops supplying energy from the transformer 32 to the ultrasonic transducer 14.
[0043]
Then, after piercing the outer tube 26 into the body wall H using the inner needle 23 as a guide, the handpiece unit 8 covered with the sheath 25 is pulled out from the outer tube 26 to remove the inner needle 23. Then, only the mantle tube 26 is placed on the body wall H.
[0044]
As described above, according to the ultrasonic trocar puncturing system 1 according to this embodiment, the following effects can be obtained.
When the first CPU 30 outputs the vibration of the ultrasonic transducer 14, the relief valve 50 is not automatically opened regardless of whether the pressure in the abdominal cavity is normal or excessive. Therefore, the mantle tube 26 can be safely punctured and placed in the body wall H. That is, even if the inside of the abdominal cavity is over-pressurized, the relief valve 50 is opened without permission and the pressure in the abdominal cavity does not decrease when the ultrasonic vibrator 14 is output to vibrate. Therefore, the pressure in the abdominal cavity can be controlled to a desired state based on the presence or absence of the output of the ultrasonic oscillator 9 and the pressure in the abdominal cavity. That is, it is possible to provide the ultrasonic trocar puncturing system 1 that can safely puncture the abdominal cavity even when the inner needle 23 of the ultrasonic trocar system 2 punctures the body wall H even if the inside of the abdominal cavity is in an overpressure state. Then, when the inner needle 23 is ultrasonically punctured into the body wall, it can be safely performed.
[0045]
Next, a second embodiment will be described with reference to FIGS. In this embodiment, an ultrasonic trocar puncturing system 1 that can serially or parallel communicate an output signal of an ultrasonic output to an insufflation device 40 will be described. Since this embodiment is a modification of the first embodiment, the same members are denoted by the same reference numerals, and detailed description will be omitted.
[0046]
As shown in FIG. 5, a first switch detection circuit 31 is provided between the ultrasonic output switch 10 and the first CPU 30. An output signal of an ultrasonic output is input to the first CPU 30 from a first switch detection circuit 31 that outputs an ON / OFF state of the ultrasonic output switch 10. Further, the first CPU 30 is provided with a wireless first communication circuit 4 a for performing communication with the insufflation device 40 in the housing 27 of the ultrasonic oscillation device 9.
[0047]
On the other hand, a wireless second communication circuit 4b that communicates with the first communication circuit 4a of the ultrasonic oscillator 9 is provided in the housing 43 of the insufflation device 40. The second CPU 44 is connected to the second communication circuit 4b. The second CPU 44 is connected to an on-off valve 46, a relief valve 50, a pressure sensor 53, and a smoke exhaust switch 62 having a second switch detection circuit 63 therebetween. Then, the second CPU 44 sends a measurement value (measurement result) from the pressure sensor 53 and a second switch detection circuit 63 that outputs the ON / OFF state of the smoke exhaust switch 62 to the smoke exhaust switch 62. And an output signal. Therefore, the second CPU 44 controls the open / close valve 46 and the relief valve 50 based on various signals such as the pressure sensor 53 and the second switch detection circuit 63.
[0048]
FIG. 6 shows a processing flow of the second CPU 44 of the insufflation device 40. As shown in FIG. 6, the second CPU 44 detects ON / OFF of the smoke exhaust switch 62 via the second switch detection circuit 63 (S1).
[0049]
When the smoke exhaust switch 62 is OFF (NO), it is determined whether the pressure in the abdominal cavity is in an overpressure state or a normal state based on the measurement result by the pressure sensor 53 (S2). The criterion at this time is, for example, as described in the first embodiment.
[0050]
When it is determined that the pressure in the abdominal cavity is not in an overpressure state (NO), since the inside of the patient's abdominal cavity is within a safe range, the ON / OFF of the smoke exhaust switch 62 is again performed via the second switch detection circuit 63. Detect (S1). At this time, the state of the abdominal cavity is recognized by the user by the notification means described above. When the pressure in the abdominal cavity is in a normal state, the user is notified by “light” and “sound”. When the pressure in the abdominal cavity is in a normal state, the on-off valve 46 may be controlled to be closed, and the gas for insufflation may be further introduced into the abdominal cavity until the overpressure state (approach). That is, whether the introduction of the insufflation gas is continued or stopped when the pressure in the abdominal cavity is in a normal state is preset in the second CPU 44.
[0051]
On the other hand, when it is determined that the pressure in the abdominal cavity is in an overpressure state (YES), the second CPU 44 performs control to close the on-off valve 46. Then, the second CPU 44 requests the first CPU 30 to detect the ON / OFF of the ultrasonic output switch 10 by the first CPU 30 via the first switch detection circuit 31. At this time, the first CPU 30 transmits the detection result (signal) from the first CPU 30 to the second CPU 44 using the first communication circuit 4a and the second communication circuit 4b. After that, the output signal of the ultrasonic output switch is passed from the second communication circuit 4b to the second CPU 44. Then, the second CPU determines ON / OFF of the ultrasonic output switch 10 (S3).
[0052]
When the second CPU 44 determines that the ultrasonic output signal is in an OFF state (no ultrasonic output is output) (NO), the second CPU 44 automatically opens the relief valve 50 to open the insufflation gas in the abdominal cavity. Is discharged outside (S4).
[0053]
On the other hand, when determining that the ultrasonic output is oscillating (YES), the second CPU 44 determines ON / OFF of the smoke exhaust switch 62 again (S1). If necessary, when the user switches on the smoke exhaust switch 62, the relief valve 50 is forcibly opened and the gas in the abdominal cavity is exhausted (S4). That is, when the smoke exhaust switch 62 is turned on, the relief valve 50 is forcibly opened regardless of whether the pressure in the abdominal cavity is in an overpressure state or a normal state.
[0054]
As described above, according to this embodiment, the following effects can be obtained.
In the ultrasonic trocar puncturing system 1, the second CPU 44, that is, the on-off valve 46 and the relief valve 50 can be processed (controlled) by software. Therefore, the design is more flexible than the ultrasonic trocar puncturing system 1 described in the first embodiment, and maintenance and correction can be easily performed. Further, by controlling the on-off valve 46 and the relief valve 50 by the second CPU 44, the pressure in the abdominal cavity (pneumoperitoneum pressure) can be controlled as desired. Other effects are the same as those of the first embodiment.
[0055]
Next, a third embodiment will be described with reference to FIGS. Since this embodiment is a modification of the second embodiment, the same members are denoted by the same reference numerals, and detailed description will be omitted.
[0056]
FIG. 7 shows that a flow sensor (measuring device) 54 is provided in place of the pressure sensor 53 (see FIG. 5) described in the second embodiment. Other configurations are the same as those of the second embodiment. Therefore, the flow sensor 54 can measure the flow rate of the insufflation gas introduced into the abdominal cavity at predetermined intervals (time). Note that the flow sensor 54 can also measure the flow rate of gas discharged from the abdominal cavity to the outside through the relief valve 50. The measurement result of the flow sensor 54 is input to the second CPU 44. The second CPU 44 controls the opening and closing of the on-off valve 46 and the relief valve 50 based on various signals such as the input measurement result of the flow sensor 54 and the signal from the second switch detection circuit 63.
[0057]
FIG. 8 shows a processing flow of the second CPU 44 of the insufflation device 40. The description of the same flow as the processing flow described in the second embodiment will be omitted.
[0058]
When the smoke exhaust switch 62 is OFF (NO), it is determined whether the flow rate of the gas for insufflation fed into the abdominal cavity is in an over-inflation state or a normal state based on the measurement result by the flow rate sensor 54 (S12). ). The criterion at this time is appropriately set in the second CPU 44.
[0059]
When it is determined that the inside of the abdominal cavity is not in the over-inflation state (normal state) (NO), the inside of the patient's abdominal cavity is within a safe range, and the ON / OFF of the smoke exhaust switch 62 is controlled by the second switch detection circuit 63. Is detected again through (S1).
[0060]
On the other hand, when it is determined that the inside of the abdominal cavity is in the over-inflation state (YES), the second CPU 44 performs control to close the on-off valve 46. Then, the second CPU 44 requests the first CPU 30 to detect the ON / OFF of the ultrasonic output switch 10 by the first CPU 30 via the first switch detection circuit 31. At this time, the first CPU 30 transmits the detection result (signal) from the first CPU 30 to the second CPU 44 using the first communication circuit 4a and the second communication circuit 4b. After that, the output signal of the ultrasonic output switch is passed from the second communication circuit 4b to the second CPU 44. Then, the second CPU determines ON / OFF of the ultrasonic output switch 10 (S3).
Other flows are the same as in the second embodiment (see FIG. 6).
[0061]
As described above, according to this embodiment, the following effects can be obtained.
In the ultrasonic trocar puncturing system 1, the second CPU 44, that is, the on-off valve 46 and the relief valve 50 can be processed (controlled) by software. Therefore, the design is more flexible than the ultrasonic trocar puncturing system 1 described in the first embodiment, and maintenance and correction can be easily performed.
[0062]
Although the pressure sensor 53 (see FIG. 5) is used in the second embodiment and the flow sensor 54 (see FIG. 7) is used in the third embodiment, it is preferable to use both at the same time. . At this time, the overpressure state and the over-inflation state in the abdominal cavity are each determined, so that the state in the abdominal cavity when the second CPU 44 controls the opening and closing of the on-off valve 46 and the relief valve 50 more accurately is determined. Can be.
[0063]
Next, a fourth embodiment will be described with reference to FIGS. This embodiment is a modification of the first and third embodiments. Therefore, the same members as those described in the first and third embodiments are denoted by the same reference numerals, and detailed description thereof will be omitted.
[0064]
As shown in FIG. 9, the handpiece unit 8 includes an ultrasonic vibrator 14 and an inner needle 23 as in the first embodiment. The outer periphery of the inner needle 23 is covered with a sheath 25. Then, the inner needle 23 is ultrasonically punctured into the body wall H in a state in which such a handpiece unit 8 is inserted into the outer tube 26 and assembled.
The handpiece unit 8 includes a base 65 at the base end of the ultrasonic transducer 14, and a side hole 23 a near the distal end of the inner needle 23. The base 65 and the side hole 23 a of the handpiece unit 8 are communicated with each other through a communication passage inside the handpiece unit 8. In this embodiment, a communication path is formed between the ultrasonic transducer 14 and the inner needle 23 on the central axis of the inner needle 23.
[0065]
An insufflation gas tube 41 extending from the insufflation device 40 is connected to a base 65 provided at the base end of the ultrasonic transducer 14. Therefore, the insufflation gas from the gas cylinder flows into the communication passage of the handpiece unit 8 from the base 65 through the insufflation gas tube 41. Then, the insufflation gas that has flowed into the communication passage flows out (inhales) to the outside of the handpiece unit 8 from the side hole 23 a provided near the distal end of the inner needle 23.
[0066]
FIG. 10 shows a circuit configuration of the ultrasonic oscillation device 9 and the insufflation device 40. As shown in FIG. 10, in this embodiment, instead of the pressure sensor 53 described in the first embodiment, a flow sensor (measurement device) that measures the flow rate of insufflation gas flowing into the abdominal cavity from the on-off valve 46. ) 54 are provided. Note that the flow sensor 54 can also measure the flow rate of gas discharged from the abdominal cavity to the outside through the relief valve 50. Further, in this embodiment, the output of the second logic circuit 60 is branched, and a feedback circuit for inputting the output to the first CPU 30 via the communication cable 4 is formed. Other configurations are the same as those of the first embodiment.
[0067]
Next, the operation of the ultrasonic trocar puncturing system 1 according to this embodiment will be described.
[0068]
The gas for insufflation is allowed to flow out of the side hole 23a near the tip of the inner needle 23 before the inner needle 23 punctures the body wall. Thereafter, after appropriately pressing the distal end of the inner needle 23 against the body wall, the ultrasonic output switch 10 is turned on to start ultrasonic puncturing at the distal end of the inner needle 23.
[0069]
While the tip of the inner needle 23 passes through the body wall, the gas for insufflation does not flow into the abdominal cavity. However, as soon as the distal end of the inner needle 23 penetrates the body wall and the side hole 23a also enters the abdominal cavity (in the body cavity), gas for insufflation is blown out from the side hole 23a of the inner needle 23.
[0070]
At this time, a signal from the flow rate sensor 54 that measures the variation in the amount of insufflation gas flowing out from the side hole 23a of the inner needle 23 is input to the monitoring means (first logic circuit) 55 shown in FIG. You. The measurement signal of the flow rate sensor 54 is fed back from the insufflation device 40 to the first CPU 30 of the ultrasonic oscillation device 9 by a second logic circuit (OR circuit) 60. The first CPU 30 controls the transformer 32 based on the signal fed back. Here, when the fluctuation amount of the measurement result measured by the flow sensor 54 becomes larger than a predetermined value (reference value) within a predetermined time, the supply of energy from the transformer 32 to the ultrasonic transducer 14 is performed. Force stop. On the other hand, when the fluctuation amount is small, the supply of the energy from the transformer 32 to the ultrasonic vibrator 14 is continued.
[0071]
For this reason, immediately after the tip of the inner needle 23 penetrates the body wall, the fluctuation of the flow rate of the gas for insufflation becomes large, so that the ultrasonic output is automatically stopped by the flow rate change of the outflow amount of gas for insufflation. can do. That is, it is possible to automatically control whether the output of the ultrasonic output is continued or stopped in accordance with the fluctuation of the flow rate in the predetermined time measured by the flow rate sensor 54. For this reason, after the inner needle 23 is punctured into the body wall H, the tip of the inner needle 23 is not ultrasonically vibrated. Can be minimized.
[0072]
As described above, according to this embodiment, the following effects can be obtained.
As soon as the tip of the inner needle 23 penetrates the body wall H, the ultrasonic output can be stopped, and the gas for insufflation can be introduced from near the tip of the inner needle 23 (side hole 23a). For this reason, it is not necessary for the operator to monitor that the tip of the inner needle 23 has penetrated the body wall H, and it is possible to save the trouble of subsequently turning off the ultrasonic output switch 10. Then, since the user can concentrate on the treatment of the patient, erroneous operation can be prevented. That is, it is possible to prevent the organ from being damaged by the ultrasonic vibration at the tip of the inner needle 23.
[0073]
Therefore, by controlling the output of the ultrasonic oscillator 9 based on a change in the state of the abdominal cavity (change in gas flow rate), the safety and operability of the puncture by the ultrasonic vibration can be improved.
[0074]
In this embodiment, the insufflation device 40 measures the flow rate of the gas for insufflation discharged from the side hole 23a of the inner needle 23 using the flow rate sensor 54, and determines whether the ultrasonic output is continued or stopped. Between the second CPU 44 of the ultrasonic oscillator 9 and the first CPU 30 of the ultrasonic oscillator 9. Alternatively, the control may be similarly performed using a circuit configuration using the pressure sensor 53 (see FIG. 3) instead of the flow sensor 54. Since the response of the change in the gas pressure is faster than the change in the gas flow rate, the continuation / stop of the ultrasonic output can be determined more quickly.
[0075]
Further, not only the flow sensor 54 but also the pressure sensor 53 may be provided. Then, both the flow rate and the pressure are measured, and the state of puncture of the tip of the inner needle 23 into the body wall H is determined. Therefore, for example, when the tip of the inner needle 23 enters the skin, the gas for insufflation flows out of the side hole 23a, but the pressure in the gas tube 41 for insufflation sharply increases. Therefore, when the determination is made based on the results of both the flow rate and the pressure, it is possible to more clearly determine whether or not the tip of the inner needle 23 has been punctured into the abdominal cavity.
[0076]
As described above, according to the above-described embodiment, by controlling the output of the ultrasonic oscillator based on the state change in the abdominal cavity, it is possible to improve the safety and operability of puncturing by ultrasonic vibration. An ultrasonic trocar puncture system capable of performing the above-described operation can be provided.
[0077]
So far, some embodiments have been specifically described with reference to the drawings. However, the present invention is not limited to the above-described embodiments, and all the embodiments may be performed without departing from the gist thereof. Including implementation.
[0078]
According to the above description, the following inventions can be obtained. Further, a combination of each item is also possible.
[0079]
[Appendix]
(Appendix 1) An inner needle punctured in the body wall,
A transducer having an ultrasonic vibrator capable of generating ultrasonic vibration on the inner needle,
A sheath covering the inner needle along the longitudinal direction,
A mantle tube introduced into the body wall and detained,
An ultrasonic oscillator for supplying energy to the transducer,
A pneumoperitoneum device to insufflate the abdominal cavity
In an ultrasonic trocar system equipped with
The insufflation device and the ultrasonic oscillation device have a communication unit capable of communication,
The insufflation device has detection means for detecting a change in the state of the abdominal cavity,
Means for controlling the output of the ultrasonic output according to the detection result of the insufflator
Ultrasonic trocar system equipped with.
[0080]
(Supplementary note 2) In Supplementary note 1,
The insufflation device has means for detecting a pressure state in the abdominal cavity,
Means for controlling the output of the ultrasonic output according to the pressure detection result of the insufflator
Ultrasonic trocar system equipped with.
[0081]
(Supplementary note 3) In Supplementary note 1,
Detection of the intraperitoneal cavity in the insufflation device has means for detecting a flow rate,
Means for controlling the output of the ultrasonic output according to the flow detection result of the insufflator
Ultrasonic trocar system equipped with.
[0082]
(Supplementary note 4) In Supplementary note 1,
The insufflation device has a means for detecting a pressure state and a means for detecting a flow rate in the abdominal cavity,
A means for controlling the output of the ultrasonic output according to the pressure detection result of the insufflator and the flow detection result
Ultrasonic trocar system equipped with.
[0083]
(Supplementary note 5) In Supplementary note 1,
The insufflation device has means for notifying the detection result in the abdominal cavity by sound or light.
[0084]
(Supplementary note 6) In Supplementary note 1,
Open / close control of the relief valve is performed according to the detection result of the insufflator.
[0085]
(Appendix 7) An inner needle punctured in the body wall,
A transducer having an ultrasonic vibrator capable of generating ultrasonic vibration on the inner needle,
A sheath covering the inner needle along the longitudinal direction,
A mantle tube introduced into the body wall and detained,
An ultrasonic oscillator for supplying energy to the transducer,
A pneumoperitoneum device to insufflate the abdominal cavity
In an ultrasonic trocar system equipped with
The inner needle and transducer have inflow and outflow paths for pneumoperitoneum gas,
The insufflation device and the ultrasonic oscillation device have a communication unit capable of communication,
The insufflation device has detection means for detecting a change in the state of the abdominal cavity,
Means for controlling the output of the ultrasonic output according to the detection result of the insufflator
Ultrasonic trocar system equipped with.
[0086]
(Supplementary note 8) In Supplementary note 7,
The insufflation device has means for detecting a pressure state in the abdominal cavity,
Means for controlling the output of the ultrasonic output according to the pressure detection result of the insufflator
Ultrasonic trocar system equipped with.
[0087]
(Supplementary note 9) In Supplementary note 7,
Detection of the intraperitoneal cavity in the insufflation device has means for detecting a flow rate,
Means for controlling the output of the ultrasonic output according to the flow detection result of the insufflator
Ultrasonic trocar system equipped with.
[0088]
(Supplementary note 10) In Supplementary note 7,
The insufflation device has a means for detecting the pressure state and a means for detecting the flow rate in the abdominal cavity,
A means for controlling the output of the ultrasonic output according to the pressure detection result of the insufflator and the flow detection result
Ultrasonic trocar system equipped with.
[0089]
(Supplementary note 11) In Supplementary note 7,
The insufflation device has means for notifying the detection result in the abdominal cavity by sound or light.
[0090]
(Supplementary Item 12) An insufflation device that supplies insufflation gas for insufflating the patient's abdominal cavity,
An inner needle that is punctured from the tip of the insufflation device into the abdominal cavity so as to communicate between the abdominal cavity and the outside of the abdominal cavity through the patient's body wall in a state of insufflation of the abdominal cavity by supplying gas for insufflation from the insufflation device,
An ultrasonic transducer connected to the proximal end of the inner needle and transmitting ultrasonic vibrations toward the distal end of the inner needle,
An ultrasonic oscillator that supplies energy for ultrasonic oscillation to the ultrasonic transducer,
An assembled tube in which the inner needle is inserted and which can be switched between a withdrawn state and a withdrawn state where the inner needle is introduced into the body wall and placed in the assembled state in the assembled state.
An ultrasonic trocar puncture system comprising:
The insufflation device,
Communication means capable of communicating with the ultrasonic oscillator whether the supply of energy for ultrasonic oscillation from the ultrasonic oscillator to the ultrasonic transducer,
Measuring means for measuring the state in the abdominal cavity based on the supply of gas for insufflation from the insufflator to the abdominal cavity of the patient,
Control means for selectively controlling the state in the abdominal cavity based on the measurement result of the measurement means and the presence / absence of supply of ultrasonic oscillation energy communicated from the ultrasonic oscillation device to the insufflation device by the communication means; When
An ultrasonic trocar puncture system, further comprising:
[0091]
(Issues in Appendix 12)
Provided is an ultrasonic trocar puncturing system that can safely puncture the abdominal cavity even when the inside of the abdominal cavity is in an overpressure state when the inner needle of the ultrasonic trocar system punctures the body wall.
[0092]
(Additional Item 13) The ultrasonic trocar puncture system according to Additional Item 12, wherein the measuring means includes a pressure detecting means for detecting a pressure state in the abdominal cavity due to the gas for insufflation.
[0093]
(Additional Item 14) The ultrasonic trocar puncture according to Additional Item 12, wherein the measuring means includes a flow rate detecting means for detecting a flow rate of the insufflation gas flowing into the abdominal cavity by the insufflation gas. system.
[0094]
(Supplementary Note 15) The measuring means includes a measuring device that measures a pressure state in the abdominal cavity by the gas for insufflation and a flow rate of the gas for insufflation flowing in the abdominal cavity. The ultrasonic trocar puncture system according to 1.
[0095]
(Supplementary Note 16) The control unit closes the intraperitoneal gas to prevent the insufflation gas from being discharged to the outside when the ultrasonic oscillation energy is being output, and the ultrasonic oscillation energy is The ultrasonic trocar puncture system according to any one of the additional items 12 to 15, wherein the ultrasonic trocar puncture system is connected to a relief valve that opens and closes based on a state in the abdominal cavity when stopped.
[0096]
(Supplementary Note 17) The supply of the ultrasonic oscillation energy is stopped, and the relief valve is opened when an intraperitoneal state is in an overpressure state and is kept closed in a normal state. Item 17. The ultrasonic trocar puncture system according to item 16.
[0097]
(Additional Item 18) The ultrasonic trocar puncturing system according to Additional Item 16 or 17, wherein the control means includes software for controlling opening and closing of the relief valve.
[0098]
(Additional Item 19) The ultrasonic trocar puncturing system according to Additional Item 16 or 17, wherein the control means includes a logic circuit for selecting whether to open or close the relief valve.
[0099]
(Supplementary note 20) The ultra-insufflation device according to any one of Supplementary notes 12 to 19, wherein the insufflation device includes a notifying unit that notifies a result of measurement by the measuring unit by sound or light. Sonic trocar puncture system.
[0100]
(Supplementary Note 21) a step of opening the on-off valve and allowing gas to flow into the abdominal cavity from the cylinder;
A step of opening and closing the on-off valve based on a signal detected by a measuring instrument when the gas flows into the abdominal cavity, the state in the abdominal cavity,
Outputs a signal that closes while the predetermined signal is being delivered, and a signal that opens while the delivery of the predetermined signal is stopped and the pressure sensor detects that the pressure in the abdominal cavity is in an overpressure state. To open and close the safety valve
A pneumoperitoneum pressure control method, comprising:
[0101]
【The invention's effect】
As described above, according to the present invention, it is possible to provide an ultrasonic trocar puncturing system that improves the safety and operability of puncturing a body wall by ultrasonic vibration.
[Brief description of the drawings]
FIG. 1 is a diagram showing a schematic configuration of an ultrasonic trocar puncturing system according to a first embodiment.
FIG. 2 is a schematic exploded view showing a handpiece unit of the ultrasonic trocar in the ultrasonic trocar puncturing system according to the first embodiment.
FIG. 3 is a block circuit diagram showing configurations of an ultrasonic oscillator and an insufflation device in the ultrasonic trocar puncturing system according to the first embodiment.
FIG. 4 is a view for explaining logic of a relief valve in the ultrasonic trocar puncture system according to the first embodiment;
FIG. 5 is a block circuit diagram showing a configuration of an ultrasonic oscillation device and an insufflation device in the ultrasonic trocar puncturing system according to the second embodiment.
FIG. 6 is a flowchart in a second CPU of the ultrasonic trocar puncturing system according to the second embodiment.
FIG. 7 is a block circuit diagram showing the configurations of an ultrasonic oscillator and an insufflation device in the ultrasonic trocar puncturing system according to the third embodiment.
FIG. 8 is a flowchart in a second CPU of the ultrasonic trocar puncturing system according to the third embodiment;
FIG. 9 is a diagram showing a schematic configuration of an ultrasonic trocar puncturing system according to a fourth embodiment.
FIG. 10 is a block circuit diagram showing the configurations of an ultrasonic oscillation device and an insufflation device in an ultrasonic trocar puncturing system according to a fourth embodiment.
[Explanation of symbols]
4 ... communication cable, 9 ... ultrasonic oscillator, 23 ... ultrasonic trocar inner needle, 26 ... trocar mantle tube, 28 ... first switch detection circuit, 30 ... first CPU (central processing unit), 31 ... First switch detection circuit, 32 Transformer, 40 Insufflation device, 41 Insufflation gas tube, 42 Mantle tube, 44 Second CPU (central processing unit), 45 Gas cylinder, 46 On-off valve, 48 ... tube, 50 ... relief valve, 51 ... tube, 53 ... pressure sensor, 55 ... first logic circuit (monitoring means), 60 ... second logic circuit, 63 ... second switch detection circuit

Claims (2)

A pneumoperitoneum device that supplies insufflation gas to insufflate the patient's abdominal cavity;
A handpiece unit having an inner needle pierced into a patient's body wall and an ultrasonic transducer connected to the proximal end of the inner needle and transmitting ultrasonic vibrations toward the distal end of the inner needle;
An ultrasonic oscillation device that supplies ultrasonic oscillation energy to the ultrasonic transducer,
In the state where the inner needle of the handpiece unit is inserted, in the ultrasonic trocar puncturing system comprising an outer tube that is introduced and placed in the body wall punctured by the inner needle,
Communication means for communicating with each other between the insufflation device and the ultrasonic oscillation device,
Measuring means provided in the insufflation device, for measuring a state in the abdominal cavity that changes due to supply of gas for insufflation into the abdominal cavity,
A control unit for controlling an output of the ultrasonic oscillation device based on a measurement result of the measurement unit, the ultrasonic trocar puncture system. A pneumoperitoneum device that supplies insufflation gas to insufflate the patient's abdominal cavity;
A handpiece unit having an inner needle pierced into a patient's body wall and an ultrasonic transducer connected to the proximal end of the inner needle and transmitting ultrasonic vibrations toward the distal end of the inner needle;
An ultrasonic oscillation device that supplies ultrasonic oscillation energy to the ultrasonic transducer,
In the state where the inner needle of the handpiece unit is inserted, in the ultrasonic trocar puncturing system comprising an outer tube that is introduced and placed in the body wall punctured by the inner needle,
A gas passage for the insufflation gas is provided inside the handpiece unit, and a gas outlet for allowing the insufflation gas in the gas passage to flow out is provided at the tip of the inner needle,
At the time of driving the ultrasonic transducer, the outflow state of the gas for insufflation from the gas outlet at the distal end of the inner needle is measured, and based on the measurement result, it is determined that the driving of the ultrasonic transducer is stopped. An ultrasonic trocar puncture system, further comprising control means.

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