JP2005324050A - Surgical instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a surgical instrument which can surely fix the posture of a surgically operating means, has an operation part with a simple constitution, and is excellent in operability. <P>SOLUTION: The surgical instrument has a long instrument body 2, the surgically operating means such as, for example, a forceps mechanism disposed on its tip end, an operation part 9A disposed on the proximal end side of the instrument body 2, a transmission member 6 which is rotatably disposed in the instrument body 2 and is rotated by the operation at the operation part 9A, and a conversion means for converting the rotation of the transmission member 6 to an open-close or turning motion of the surgically operating means. The operation part 9A is equipped with an operation part body 90, a fixed handle 93, a movable handle 94 opening/closing (turning) relative to the fixed handle 93, an energizing member 944, a rotor driving member 943 of a circular arcuate shape provided on the end part opposite to the turning axis of the movable handle 94, and a rotor 931 which is connected to the proximal end of the transmission member 6 and is engaged to the rotor driving member 943. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to surgical instruments such as forceps and scissors, and more particularly to surgical instruments suitable for use in laparoscopic surgery.

  A forceps having a configuration in which a forceps mechanism provided at a distal end is remotely operated by an operation portion on a proximal end side is known (Japanese Utility Model Laid-Open No. 05-076413). This forceps has a forceps mechanism composed of a pair of claw members that can be opened and closed at the distal end. A fixed grip portion and a proximal end portion of a transmission shaft connected to the forceps mechanism are approached to the fixed grip portion.・ Provides claw operating means consisting of a rotating gripping part that can be rotated in the separating direction. By rotating this rotating gripping part, the transmission rod built in the transmission shaft is pulled and moved in the longitudinal direction. A forceps configured to open and close the claw member, wherein one of the fixed gripping portion and the rotating gripping portion has a ratchet member, and the other has an engaging member that engages with the teeth of the ratchet member. . Then, by adjusting the engagement position between the ratchet member and the engagement member, the opening angle of the rotating gripping portion with respect to the fixed gripping portion is arbitrarily set, and the opening angle of both the claw members of the forceps mechanism is fixed It has a configuration that can.

  By the way, in recent years, laparoscopic surgery that performs non-laparotomy instead of conventional laparotomy is attracting attention in excision of the appendix and gallbladder. In this laparoscopic surgery, as shown in FIG. 9, for example, four trocar tubes 107 are inserted into the abdominal cavity 101 through the abdominal wall 100, and inserted through one of the trocar tubes 107. The inside of the abdominal cavity 101 is projected on the monitor image 103 by the camera 102, and the forceps 104, the scissors 105 and the electric knife 106 inserted through the other trocar tubes 107 are appropriately operated while viewing the monitor image 103. A surgical procedure is performed in the abdominal cavity 101.

  In such laparoscopic surgery, the trocar tube 107, which is a straight tube, is penetrated and fixed to the abdominal wall 100, and the angle of the trocar tube 107 with respect to the abdominal wall 100 can hardly be changed to protect the tissue of the penetrating portion. Therefore, each of the forceps 104, the scissors 105, and the electric knife 106 is limited to a narrow range where surgical treatment is possible. Therefore, as a method for solving this, for example, after inserting the forceps 104 into the trocar tube 107, the vicinity of the distal end of the long instrument body (transmission shaft) 108 of the forceps 104 is bent or curved (a chain line in FIG. 9). It has been proposed to enlarge the area where the distal forceps mechanism reaches by combining with the rotation of the forceps 104.

  However, in the above-described conventional forceps, a ratchet mechanism (a ratchet member and an engaging member) for fixing the opening angle of both the claw members of the forceps mechanism is assumed on the premise of a linear transmission shaft that does not deform. Since it is provided in the operation unit, the following problems occur when the transmission shaft can be bent or curved.

  In other words, when the transmission shaft is bent or curved, the tension of the transmission rod built in the transmission shaft changes accordingly, and the opening angle and gripping force of both nail members change, which hinders the surgical procedure. May come. This problem is not limited to the case where the transmission shaft is bent or curved, but also occurs due to, for example, the extension of the transmission rod due to environmental changes, material characteristics, etc., play of the nail operation means, rattling, or the like.

  An object of the present invention is to provide a surgical instrument that can reliably fix the posture of a surgical operation means, has a simple operation unit configuration, and is excellent in operability.

Such an object is achieved by the present inventions (1) to (16) below.
(1) A long instrument main body, a surgical operation means provided on the distal end side of the instrument main body for opening / closing or rotating, and a proximal operation side of the instrument main body for remotely operating the surgical operation means An operating portion that is rotatably installed in the instrument main body, and is a long transmission member that rotates about its axis by the operation of the operating portion; Conversion means for converting into a rotating motion,
The operation unit includes an operation unit main body, a movable handle displaceable with respect to the operation unit main body, a rotor connected to a proximal end portion of the transmission member, and a rotor engaged with the operation of the movable handle. A rotor driving member for rotating the rotor, wherein one of the rotor and the rotor driving member is installed on the movable handle, and the other of the rotor and the rotor driving member is the operation One of the rotor and the rotor driving member installed on the movable handle is moved in accordance with the operation of the movable handle so that the rotor and the rotation are moved. A surgical instrument, wherein the rotor is rotated by engaging with a child driving member.

(2) A long instrument body, a surgical operation means provided on the distal end side of the instrument body for opening / closing or rotating, and a surgical operation means provided on the proximal end side of the instrument body for remotely operating the surgical operation means An operating portion that is rotatably installed in the instrument main body, and is a long transmission member that rotates about its axis by the operation of the operating portion; Conversion means for converting into a rotating motion,
The operation unit includes a fixed handle, a movable handle that rotates so as to change an opening angle with respect to the fixed handle, an end opposite to the rotation center of the movable handle, and the rotation center of the fixed handle. A rotor driving member provided near one end of the opposite side and having a plurality of recesses or openings formed at predetermined intervals along the longitudinal direction thereof; An end portion and an end portion of the fixed handle near the end opposite to the rotation center are provided on the side not having the rotor driving member, connected to a base end portion of the transmission member, and engaged with the recess or opening. A surgical instrument comprising: a rotor having a plurality of projecting portions formed on an outer periphery thereof, and the rotor being rotated by rotation of the movable handle.

  (3) The surgical instrument according to (2), wherein the operation unit includes a biasing member that biases the movable handle in a direction in which an opening angle between the fixed handle and the movable handle is increased.

  (4) The guide groove for inserting and guiding the rotor driving member is provided in the vicinity of the rotor of the handle provided with the rotor of the fixed handle and the movable handle. ) Or the surgical instrument according to (3).

  (5) The surgical instrument according to any one of (2) to (4), wherein the operation unit includes a stop mechanism that stops the rotation of the rotor.

  (6) The surgical instrument according to any one of (2) to (5), wherein the transmission member includes a gear mechanism that transmits a rotational force in the middle thereof.

  (7) The conversion means includes a rotating body installed at a tip of the transmission member and a counterpart thereof, and a recess is formed in one of the rotating body and the counterpart, and the recess is formed in the other. A convex portion that is fitted to the concave portion is formed, and the fitting position of the concave portion and the convex portion is moved with the rotation of the rotating body, whereby the rotating body and the counterpart body are relatively displaced, thereby The surgical instrument according to any one of (1) to (6), wherein the surgical operation means is configured to open, close, or rotate.

  (8) The conversion means includes a female screw formed at the tip of the instrument body, a rotary shaft installed at the tip of the transmission member, and an outer periphery of the rotary shaft, and is screwed with the female screw. The surgical instrument according to any one of (1) to (6), further including a male screw configured to move forward and backward with the rotation of the transmission member.

  (9) The conversion means includes a cam that rotates as the transmission member rotates and a driven member that contacts the cam, and the driven member is displaced by the rotation of the cam. The surgical instrument according to any one of (1) to (6) above.

  (10) The conversion means includes a cylindrical cam that rotates in accordance with the rotation of the transmission member, and a driven member having a protrusion that is inserted into a cam groove formed on the outer peripheral surface of the cam. The surgical instrument according to any one of (1) to (6), wherein the driven member is configured to move in an axial direction of the cam by the rotation of the cam.

  (11) The conversion unit includes a worm that rotates as the transmission member rotates, and a worm gear that meshes with the worm, and the worm gear rotates by the rotation of the worm. The surgical instrument according to any one of (1) to (6).

  (12) The surgical instrument according to any one of (1) to (11), further including an urging unit for removing backlash in the conversion unit.

  (13) The surgical instrument according to any one of (1) to (12), wherein at least a part of the transmission member is a linear body having flexibility.

  (14) The device according to any one of (1) to (13), further including a support portion that is provided at a distal end portion of the instrument body and supports the transmission member or the conversion unit so as not to move substantially in a longitudinal direction. Surgical instruments.

  (15) The surgical instrument according to any one of (1) to (14), wherein the surgical operation means includes a pair of opening and closing members that are driven to open and close at least one of them.

  (16) The surgical instrument according to any one of (1) to (15), wherein the instrument body is bendable or bendable.

  According to the surgical instrument of the present invention, since the surgical operation means is operated by the rotation of the transmission member, the tension of the transmission member has changed due to, for example, bending or bending of the instrument body or an environmental change. Even in this case, the posture of the surgical operation means is not affected. Therefore, for example, in the forceps, the gripping force can be kept constant.

  Moreover, since the operation part is a structure which has a fixed handle and a movable handle, it can be operated by holding them with one hand, and the operability is extremely excellent.

  Further, since the posture of the surgical operation means can be arbitrarily fixed without providing a lock means such as a ratchet mechanism in the operation part, the structure of the operation part is simplified, and the operation for operating the surgical operation means is performed. If easy.

  When the biasing means for removing the bag lash is provided, the bag lash in the converting means is removed, so that the followability of the operation in the operation section is improved, and the surgical operation means is more precise. It becomes possible.

  In addition, when the instrument body can be bent or bent, a region where a surgical procedure can be performed is expanded, and a surgical procedure can be performed in a more appropriate posture.

  Hereinafter, the surgical instrument of the present invention will be described in detail based on a preferred embodiment shown in the accompanying drawings.

  FIG. 1 is an overall side view showing a configuration example when a surgical instrument is applied to forceps, and FIGS. 2 and 3 are configuration examples (surgical operation means and conversion) in the vicinity of the distal end portion of the surgical instrument of the present invention, respectively. It is a fragmentary sectional side view which expands and shows the example of a structure of a means. In the following description, the right side in FIGS. 1 to 3 and FIGS. 4 to 6 to be described later is referred to as a proximal end, and the left side is referred to as a distal end.

  A surgical instrument (forceps) 1 shown in FIGS. 1 to 3 is mainly used in laparoscopic surgery, and has a long instrument body 2 and a distal end provided on the distal end side of the instrument body 2. 3, a surgical operation means 4 that is provided at the distal end portion 3 and that opens and closes or rotates, an operation portion 9 that is provided on the proximal end side of the instrument main body 2, and is rotatably installed in the instrument main body 2. A long transmission member 6 that connects between the distal end portion 3 and the operation unit 9, a conversion unit 5 that converts rotation of the transmission member 6 into opening / closing or turning operation of the surgical operation unit 4, and a coil spring 59. It is configured. Hereinafter, these components will be sequentially described.

  The instrument body 2 is a hollow long member in which a space 21 in which the transmission member 6 can be accommodated is formed. The cross-sectional shape of the instrument main body 2 is not particularly limited, for example, a circle, an ellipse, a polygon, or the like, and in the case of a circle, the outer diameter is set to such a degree that it can be inserted into the trocar tube 107. Specifically, the outer diameter of the instrument body 2 is preferably about 5 to 18 mm.

  In the configuration shown in the figure, the instrument body 2 has a straight shape in consideration of insertion into the trocar tube 107. However, the configuration is not limited to this, and the instrument body 2 may be curved or bent into a desired shape in advance. Good.

  Moreover, you may have at least 1 curved part 23 which can be curvedly deformed to a desired shape so that it may mention later. In the case of such a configuration, an area where the surgical operation means 4 can perform a surgical procedure on the living tissue is expanded, and a surgical procedure can be performed in a more appropriate posture.

  The transmission member 6 is a member that transmits the rotational force at the operation portion, and preferably all or a part thereof (particularly, the portion corresponding to the curved portion 23 or the passage 901 in FIG. 6) is flexible. It is composed of a linear body (which can be bent). As this linear body, for example, metal wires made of stainless steel, tungsten, carbon steel, superelastic alloy, etc., polyamide (fully aromatic polyamide), polyester, ultrahigh molecular weight polyethylene, carbon fiber, etc. are relatively high. A fiber made of a polymer material that can withstand tension (high-tensile fiber), or an assembly of any of these strands or other composites can be used.

  As a linear body made up of an assembly of strands, for example, one or more of the same or different strands are wound around a circumference of one or more strands (especially metal wires) in a predetermined direction (for example, a coil shape) In addition, one in which one or more of the same kind or different kinds of strands are wound around the outer circumference in the opposite direction is preferably used. According to such a linear body, there is an advantage that the followability with respect to the rotation operation in the operation unit is excellent and a change (distortion) in length due to twisting or bending is suppressed. Although the outer diameter of the transmission member 6 by such a linear body is not specifically limited, In the case of a present Example, it is preferable to set it as about 1.0-2.5 mm, especially about 1.0-1.5 mm.

  Other examples of the configuration of the transmission member 6 include, for example, comparison of metal materials such as aluminum, brass, copper, stainless steel, tungsten, carbon steel, superelastic alloy, polycarbonate, polyethylene, polypropylene, rigid polyvinyl chloride, polyester, and the like. And a rotating shaft made of a hard resin or the like.

  As shown in FIGS. 2 and 3, the distal end portion 3 is provided between the surgical operation means 4 and the surgical operation means 4 and the transmission member 6, and the rotation of the transmission member 6 is opened or closed or A conversion means 5 for converting into a rotating motion is installed.

  The surgical operation means 4 constitutes a forceps mechanism that can clamp a living tissue, and a pair of opening / closing members that are driven and opened by one of them, that is, a fixed clamping piece 41, and rotate relative to the fixed clamping piece 41. And a movable clamping piece 42. The movable clamping piece 42 is pivotally attached to the base of the fixed clamping piece 41 by a pin 43 at its base end.

  In the tip 3, a notch 31 is formed in the upper portion of the pin 43 in FIG. 2, and a slider 45 slidable in the longitudinal direction of the tip 3 is installed in the notch 31. . A pin 46 protrudes from the distal end portion of the slider 45, and this pin 46 is inserted into a long hole 44 formed at the upper base end of the movable holding piece 42.

  When the slider 45 is positioned on the proximal end side in the notch 31, the fixed clamping piece 41 and the movable clamping piece 42 are closed (the state shown in FIG. 2), but the slider 45 moves to the distal end side in the notch 31. Then, the pin 46 presses the inner peripheral surface on the front end side of the long hole 44, the movable clamping piece 42 rotates around the pin 43, and the movable clamping piece 42 opens (state shown in FIG. 3). The long hole 44 may not be provided, and the slider 45 may be distorted with the movement of the slider 45 to absorb the vertical movement of the pin 46 in FIG.

  The converting means 5 includes a rotating shaft (rotating body) 51, a moving body 57 installed on the distal end side of the rotating shaft 51, and a support portion (a counterpart) of the rotating shaft 51 formed on the distal end portion 3 of the instrument body 2. 54 and a storage space 56 for the moving body 57.

  The base end of the rotating shaft 51 is connected to the tip of the transmission member 6, and a helical male screw (convex portion) 52 is formed on the outer periphery in the middle of the rotating shaft. On the other hand, the support portion 54 is formed with a female screw (concave portion) 55 that is screwed with the male screw 52, and the rotating shaft 51 is supported by the support portion 54 in a state where the male screw 52 and the female screw 55 are screwed together. ing.

  A storage space 56 for storing the movable body 57 so as to be movable in the axial direction is formed on the distal end side of the support portion 54 of the instrument body 2. The front end side of the storage space 56 communicates with the notch 31.

  The distal end of the moving body 57 is connected to or integrated with the slider 45. The rotating shaft 51 is rotatably connected to the moving body 57. That is, a disk-shaped head 53 is fixed to the tip of the rotating shaft 51, and the head 53 is rotatably inserted into, for example, a disk-shaped recess 58 formed in the moving body 57.

  In such a conversion means 5, when the rotation shaft 51 rotates in a predetermined direction by the rotation of the transmission member 6, the screwing position of the male screw 52 and the female screw 55 moves, and the rotation shaft 51 moves relative to the instrument body 2. Advances and retracts in the axial direction. Thereby, the moving body 57 and the slider 45 move in the axial direction, and the movable holding piece 42 opens and closes.

  In the storage space 56, a coil spring 59 is provided as an urging means for removing backlash (play between parts) between the rotating shaft 51 and the moving body 57 in the conversion means 5, and the inner wall on the proximal end side of the storage space 56. And the base end face of the moving body 57 are housed in a compressed state. Due to the elastic force of the coil spring 59, the moving body 57 is always urged toward the distal end, and the base end surface of the head 53 and the inner wall on the distal end side of the concave portion 58 are pressed and in close contact with each other. Is removed, and the movable holding piece 42 can be opened and closed more precisely.

  As shown in FIG. 1, on the proximal end side of the instrument main body 2, an operation unit 9 for remotely operating opening / closing of the surgical operation means 4 is provided. The operation unit 9 includes an operation unit main body 90 having a grip 91 and a disk-shaped knob 92 that is rotatably supported on the proximal end side of the operation unit main body 90. The rotary shaft 921 of the knob 92 is inserted into the operation unit main body 90, and the distal end thereof is connected to the proximal end of the transmission member 6. Further, on the outer periphery of the knob 92, a non-slip unevenness 922 is formed along the axial direction thereof. In the operation unit 9 having such a configuration, for example, the grip unit 91 is gripped with one hand, and the knob 92 is rotated with the other hand. In the present invention, the operation unit 9 is configured as an operation unit 9A or 9B described later.

  Next, the operation of the surgical instrument 1 will be described. When the knob 92 is rotated in a predetermined direction from the state in which the movable clamping piece 42 is open (the state shown in FIG. 3), the rotational force is transmitted to the rotary shaft 51 via the rotary shaft 921 and the transmission member 6, and the rotary shaft 51 rotates in the same direction. Thereby, the rotating shaft 51 moves in the tip direction, and the moving body 57 and the slider 45 move in the tip direction. By the movement of the slider 45, the pin 46 presses the inner peripheral surface on the tip side of the long hole 44, the movable clamping piece 42 rotates around the pin 43, and the movable clamping piece 42 closes (state shown in FIG. 2). ).

  When the knob 92 is rotated in the reverse direction, the rotary shaft 51 rotates in the reverse direction. As a result, the rotation shaft moves in the proximal direction, and the moving body 57 and the slider 45 move in the proximal direction. By the movement of the slider 45, the pin 46 presses the proximal inner surface of the long hole 44, the movable clamping piece 42 rotates about the pin 43, and the movable clamping piece 42 opens (shown in FIG. 3). Status).

  As described above, the opening and closing of the movable holding piece 42 is interlocked with the rotation of the knob 92, and the opening degree (gripping force) of the fixed holding piece 41 and the movable holding piece 42 corresponds to the rotation amount of the knob 92. . Therefore, the opening degree of the fixed clamping piece 41 and the movable clamping piece 42 can be arbitrarily set by adjusting the rotation amount of the knob 92. Further, since the transmission member 6 is supported by the support portion 54, even when the knob 92 is released, the opening degrees of the fixed holding piece 41 and the movable holding piece 42 at that time are maintained and fixed as they are.

  In particular, even when the instrument body 2 is bent or curved and the tension of the transmission member 6 changes and expands and contracts as in the case where the bending portion 23 described later is provided, the rotating shaft 51, the moving body 57, and the slider 45. Does not move, the posture of the surgical operation means 4, that is, the opening degree of the movable clamping piece 42 does not change. The opening / closing operation of the surgical operation means 4 can be performed in any of a straight state, a bent state, and a curved state of the instrument body 2.

  FIG. 4 is a partial cross-sectional side view showing another configuration example of the surgical operation means and the conversion means in the surgical instrument of the present invention. As shown in the figure, the surgical operation means 4A constitutes a forceps mechanism that can clamp a living tissue, and a pair of movable clamping pieces that rotate around a pin 477 provided at the distal end of the instrument body 2. 42a and 42b.

  An extension portion 471 is formed on the base end side of the pin 477 of the one movable holding piece 42a, and the base end portion is rotatably supported on the tip end portion of the link 473 by the pin 475. Further, an extension portion 472 is formed on the proximal end side of the pin 477 of the other movable holding piece 42b, and the proximal end portion is rotatably supported by the distal end portion of the link 474 by the pin 476. The base end portions of the links 473 and 474 are rotatably supported by the distal end portion of a driven member 74 described later by pins 478, respectively.

  The link mechanism 47 that converts the linear motion of the driven member 74 into the rotational motion of the movable clamping pieces 42a and 42b is configured by the extension portions 471 and 472, the links 473 and 474, and the pins 475, 476, 477, and 478. The

  The conversion means 7 includes a cylindrical cam (rotary body) 71, a driven member (a counterpart body) 74 that moves in the longitudinal direction as the cam 71 rotates, and a cam formed on the distal end portion 3 of the instrument body 2. A support portion 76 that rotatably supports the rotation shaft 72 of 71, a storage space 77 of the cam 71, and a support portion 78 that supports the driven member 74 movably in the longitudinal direction thereof.

  The cam 71 can rotate in the storage space 77, but it cannot move in the direction of the rotation axis, or even if it moves, it moves only a small distance so that the posture of the surgical operation means 4A does not substantially change. Is installed to get. The proximal end of the rotating shaft 72 of the cam 71 is connected to the distal end of the transmission member 6. A spiral cam groove 73 is formed on the outer peripheral surface of the cam 71. A protrusion 75 is formed at the base end of the driven member 74, and the protrusion 75 is inserted into the cam groove 73. The support 76 may be provided with a bearing (not shown).

  Similarly to the above, when the knob 92 is rotated in a predetermined direction, the transmission member 6, the rotating shaft 72, and the cam 71 are rotated. Thereby, the protrusion 75 moves along the cam groove 73, the driven member 74 moves in the direction of the rotation axis of the cam 71, and the action of the link mechanism 47 causes the movable holding pieces 42a and 42b of the surgical operation means 4A to move. Open and close.

  FIG. 5 is a partial sectional side view showing another configuration example of the surgical operation means and the conversion means in the surgical instrument of the present invention. As shown in the figure, the surgical operation means 4B constitutes a forceps mechanism that can clamp a living tissue, and a fixed clamping piece 41 similar to the above, and a movable clamping piece that rotates relative to the fixed clamping piece 41 42c. The movable clamping piece 42 c is rotatably installed at the tip of the instrument body 2 by a pin 48.

  The conversion means 8 is formed on the worm (rotary body) 81, the worm gear (partner body) 83 that is connected to or integrated with the proximal end of the movable holding piece 42c, and the distal end portion 3 of the instrument body 2. Further, the storage space 84 of the worm 81 and the support portions 85 and 86 that rotatably support the rotating shaft 82 of the worm 81 are configured.

  The worm 81 can rotate in the storage space 84, but cannot move in the direction of the rotation axis, or even if it moves, the worm 81 moves by a small distance so that the posture of the surgical operation means 4B does not substantially change. Is installed to get.

  The proximal end of the rotating shaft 82 of the worm 81 is connected to the distal end of the transmission member 6. The worm gear 83 rotates around the pin 48. In addition, you may provide a bearing (not shown) in the support parts 85 and 86, respectively.

  Similarly to the above, when the knob 92 is rotated in a predetermined direction, the transmission member 6, the rotating shaft 82 and the worm 81 are rotated. Thereby, the worm gear 83 rotates around the pin 48, and the movable clamping piece 42c opens and closes.

  In the configuration shown in FIG. 5, the movable clamping piece 42 c is directly rotated by the rotation of the worm gear 83, but the configuration of the conversion means is not limited to this. A structure in which a similar slider 45 moves, a structure that includes a pinion gear that rotates by rotation of the transmission member 6 and a rack gear that meshes with the pinion gear, a structure that includes at least a pair of bevel gears that mesh with each other, Any structure may be used as long as it can convert the rotation of the transmission member into the opening / closing or turning operation of the surgical operation means, such as a combination of mechanisms. 4 and 5 may be provided with the same urging means as described above for removing the backlash between the rotating body and the counterpart.

  FIG. 6 is a partial cross-sectional side view illustrating a configuration example of an operation unit in the surgical instrument of the present invention. 9A includes a fixed handle 93 that is fixed or integrally provided with respect to the operation unit main body 90, a movable handle 94 that opens and closes (rotates) with respect to the fixed handle 93, and the movable handle 94. Of the arcuate rotor driving member 943 provided at the end opposite to the rotation center of the rotor, the rotor 931 connected to the base end of the transmission member 6, and the opening of the movable handle 94 and the fixed handle 93. And an urging member 944 that urges the movable handle 94 in the direction of increasing the angle.

  The proximal end portion 22 of the instrument main body 2 is fitted into the distal end portion of the operation section main body 90, and from this portion to the lower end portion of the fixed handle 93 in FIG. 6 along the inside of the fixed handle 93. A curved passage 901 communicating with the space 21 is formed. The transmission member 6 is inserted into the passage 901.

  A guide groove 933 that penetrates the fixed handle 93 is formed at the lower end of the fixed handle 93 in FIG. 6, and a rotor 931 is rotatably installed in the guide groove 933. That is, both ends of the rotating shaft 932 of the rotor 931 are supported by the pair of bearings 934. Further, on the outer peripheral surface of the rotor 931, a plurality of convex portions (sprockets) 935 that are inserted (engaged) into an opening 945 described later are radially formed.

  The movable handle 94 is rotatably attached to the operation unit main body 90 by a shaft member 95 at the upper end in FIG. At the lower end of the movable handle 94 in FIG. 6, the base end of a rotor driving member 943 made of an arc-shaped plate piece with the shaft member 95 as the center is fixed or integrated. A plurality of openings 945 are preferably formed at regular intervals along the longitudinal direction of the rotor driving member 943. The distal end portion of the rotor driving member 943 is inserted near the bottom portion in the guide groove 933, and the opening 945 and the convex portion 935 are engaged with each other.

  A biasing member 944 using a torsion spring is installed between the fixed handle 93 and the movable handle 94. By this urging member 944, the movable handle 94 is urged in a direction in which the opening angle with the fixed handle 93 increases.

  From the state shown in FIG. 6, when the fixed handle 93 and the movable handle 94 are grasped by hand and the movable handle 94 is rotated clockwise in FIG. 6, the rotor driving member 943 moves in the longitudinal direction in the guide groove 933. Then, due to the engagement between the opening 945 and the convex portion 935, the rotor 931 rotates. As a result, the transmission member 6 rotates and operates at the distal end 3 such that the surgical operating means 4, 4A or 4B are preferably closed via the converting means 5, 7 or 8 as described above.

  When the hand holding both handles 93 and 94 is released or the gripping force is loosened, the urging force of the urging member 944 causes the movable handle 94 to rotate counterclockwise in FIG. Rotate in the opposite direction. As a result, the transmission member 6 rotates in the opposite direction, and the surgical operating means 4, 4 </ b> A or 4 </ b> B is preferably opened at the distal end portion 3.

  In the operation unit 9A having such a configuration, the fixed handle 93 and the movable handle 94 can be operated with one hand, and the operability is extremely excellent.

  FIG. 7 is a partial cross-sectional side view showing another configuration example of the operation unit in the surgical instrument of the present invention. In this configuration example, the fixed handle 93 and the movable handle 94 are reversed from the configuration example of FIG. 7 includes a fixed handle 93 that is fixed to or integrally with the operation unit main body 90, a movable handle 94 that opens and closes (rotates) with respect to the fixed handle 93, and the fixed handle 93. A rotor driving member 943 provided at the end of the rotor, a rotor 931 connected to the base end of the transmission member 6a provided in the passage 901 in the movable handle 94, and the rotation of the rotor 931 Is constituted by a gear mechanism 99 for transmitting to the transmission member 6b provided in the space 21 of the instrument body 2.

  A pair of shaft members 95 are provided at the upper end portion of the movable handle 94 in FIG. 7 so as to protrude from the outer surface on the front side and the back side of the paper surface, and are formed on the outer surface on the front side and the back side of the paper surface of the operation unit main body 90. The shaft hole is rotatably attached. A guide groove 933 that penetrates the movable handle 94 is formed at the lower end in FIG. 7 of the movable handle 94, and a rotor 931 is rotatably installed in the guide groove 933. A plurality of projections (sprockets) 935 that are inserted (engaged) into the opening 945 of the rotor driving member 943 are radially formed on the outer peripheral surface of the rotor 931. Further, the rotor 931 is stopped by a stop mechanism 946. The stop mechanism 946 is provided with a stop piece 948 that can swing around a pin 947. By operating the protrusion piece 949, the stop piece 948 is formed on the outer peripheral surface of the rotor 931. 935 is engaged, and the rotation of the rotor 931 is stopped. As a result, the opening / closing operation of the surgical operation means 4 is stopped and the opening degree is maintained.

  On the other hand, the base end of the rotor driving member 943 is fixed to or integrated with the lower end of the fixed handle 93 in FIG. A plurality of openings 945 are preferably formed at regular intervals along the longitudinal direction of the rotor driving member 943. The distal end portion of the rotor driving member 943 is inserted near the bottom portion of the guide groove 933, and the opening 945 and the convex portion 935 are engaged with each other.

  6, a biasing member (not shown) that biases the movable handle 94 between the fixed handle 93 and the movable handle 94 in a direction in which the opening angle of the movable handle 94 with respect to the fixed handle 93 increases. ) May be provided.

  The gear mechanism 99 includes a first gear 991 to which an end portion of the transmission member 6a in the movable handle 94 is connected, and a second gear 992 to which an end portion of the transmission member 6b in the instrument body 2 is connected. The gears 991 and 992 are rotatably supported in the case 993 in a state of being engaged with each other, and transmit the rotation of the rotor 931 from the transmission member 6a to the transmission member 6b. . As shown in FIG. 7, the gear mechanism 99 includes two gears 991 and 992 that mesh with each other, so that the rotation directions of the transmission members 6 a and 6 b are reversed. It is also possible to change the speed according to the number of teeth of the gears 991 and 992.

  When the movable handle 94 is rotated counterclockwise in FIG. 7 by grasping the fixed handle 93 and the movable handle 94 with the hand from the state shown in FIG. 7, the guide groove 933 is guided along the rotor driving member 943. The movable handle 94 moves, and the rotor 931 rotates due to the engagement between the opening 945 and the convex portion 935. As a result, the transmission member 6 a rotates, and this rotation is transmitted to the transmission member 6 b via the gear mechanism 99. At the tip 3, the surgical operating means 4, 4A or 4B are preferably operated to close via the converting means 5, 7 or 8 as described above.

  When the movable handle 94 is rotated clockwise in FIG. 7 or when the movable handle 94 is rotated clockwise by the urging force of the urging member between the two handles 93, 94, the rotor 931 is rotated in the opposite direction. Rotate. As a result, the transmission member 6 rotates in the opposite direction, and the surgical operating means 4, 4 </ b> A or 4 </ b> B is preferably opened at the distal end portion 3.

  In the operation unit 9B having such a configuration, not only can the fixed handle 93 and the movable handle 94 be operated with one hand, but also the movable handle 94 is attracted and the operability is further improved. In the operation units 9A and 9B, the movable handle 94 may move in parallel with the fixed handle 93, and a desired mechanism is interposed between the movable handle 94 and the rotor driving member 943. It may be. Further, the engagement of the rotor driving member 943 and the rotor 931 is not limited to the configuration shown in the figure, and for example, engagement by a rack gear and a pinion gear meshing with the rack gear, a pressing surface, and a roller pressure-bonded to the pressing surface. The engagement may be an engagement by a string and a take-up reel of the string.

  In the present invention, the urging member 944 is not provided in the operation portion 9A. For example, a urging member (not shown) such as a spring that urges the transmission member 6 to rotate in a predetermined direction near the distal end portion 3 is used. ) May be provided, and further, such an urging member may not be provided at all. Further, in the configuration example of FIG. 7, the transmission member is not only composed of two transmission members 6 a and 6 b that are connected via a gear mechanism 99, but also from the rotor 931 side, similar to FIG. A single member may be used.

  In addition, as shown in FIGS. 6 and 7, in the present invention, the rotor and the rotor drive member may be installed on the fixed handle or the movable handle, and the order of the fixed and movable handles before and after is also determined. Either is acceptable. Therefore, in addition to the examples shown in the drawings, the movable handle is on the distal end side, the fixed handle is on the proximal end side, the transmission member and the rotor are installed on the fixed handle, and the rotor drive member is installed on the movable handle. Various things can be considered.

  FIG. 8 is an exploded perspective view partially showing a configuration example of the bending portion 23 of the instrument body 2. As shown in the figure, the bending portion 23 is formed by joining a plurality of node ring rings 24 that can rotate with each other. In FIG. 8, three node ring rings 24 are shown, but the number of node ring rings 24 is not limited to this, and may be, for example, about 4 to 30.

  A pair of V-shaped grooves 25 facing each other via the center of the node ring 24 are formed on one surface of each node ring 24, and the center of the node ring 24 is formed on the other surface. A pair of opposed semi-cylindrical protrusions 26 are formed at positions shifted from the groove 25 by 90 °. Adjacent node ring rings 24 are arranged such that their grooves 25 are shifted from each other by 90 °, and both protrusions 26 of one node ring ring 24 are in the corresponding grooves 25 of the other node ring ring 24. Each node ring 24 is joined so as to be inserted into the ring.

  In addition, through holes 27 are formed at the positions of both grooves 25 and both protrusions 26 of each node ring 24, and if necessary, four flexible wire rods 28 are connected to each node ring 24. Each node ring 24 can be assembled by being inserted through the corresponding through hole 27.

  In a state in which the protrusion 26 is inserted into the groove 25, a gap is formed between the adjacent node ring rings 24, so that the protrusion 26 can rotate in the groove 25, so that the adjacent The node ring rings 24 rotate. The rotation angle between a pair of adjacent node ring rings 24 is slight, but when the angle is accumulated for a plurality of sets of node ring rings 24, a desired curve (for example, about 80 to 120 °) is obtained as a whole bending portion. Is obtained. In this embodiment, the bendable directions are four directions, up, down, left, and right on the cross section of the instrument body 2. Although not shown, the outer periphery of each node ring 24 may be covered with a layer made of a material having elasticity or flexibility, for example.

  Such a bending portion 23 may be bent or bent actively by pulling the wire 28, for example, or may be bent or bent passively by applying stress from the outside. Further, the bending direction and the number (degree of freedom) thereof are not particularly limited. Moreover, the structure of the bending part 23 is not limited to the thing of illustration, For example, the structure which has a bellows tube or a flexible tube may be sufficient. Further, the instrument body is composed of a hard tube on the distal end side and a hard tube on the proximal end side, and the two hard tubes are bent by being connected to each other by one or a plurality of axes. Also good.

  The surgical instrument of the present invention has been described with reference to the illustrated embodiments. However, the present invention is not limited thereto. For example, the biasing means such as the coil spring 59 can be replaced by a spring of another form such as a torsion spring or a leaf spring, an elastic material such as rubber, a permanent magnet, or an electromagnet.

  Further, the configurations of the conversion means and the operation unit are not limited to the configurations shown in the respective drawings. Further, in the present invention, the surgical operation means is not limited to rotating, and may be configured to open and close by parallel movement, for example. Furthermore, it may have a configuration in which one member rotates, such as a bowing forceps, an electric knife, and an ultrasonic knife.

  The type of surgical instrument of the present invention is not limited to forceps, and may be, for example, scissors such as scissors, ligators, needle holders, electric scalpels, ultrasonic scalpels, and laser scalpels. In addition, the use is not limited to that used for laparoscopic surgery, and can be applied to, for example, brain surgery, thoracoscopic surgery, urological surgery, and the like.

It is a whole side view which shows the structural example of a surgical instrument. It is a fragmentary sectional side view which expands and shows the structure of the front-end | tip part vicinity in the surgical instrument of this invention. It is a fragmentary sectional side view which expands and shows the structure of the front-end | tip part vicinity in the surgical instrument of this invention. It is a fragmentary sectional side view which shows the other structural example of the surgical operation means in the surgical instrument of this invention, and the conversion means. It is a fragmentary sectional side view which shows the other structural example of the surgical operation means in the surgical instrument of this invention, and the conversion means. It is a fragmentary sectional side view which shows the structural example of the operation part in the surgical instrument of this invention. It is a fragmentary sectional side view which shows the other structural example of the operation part in the surgical instrument of this invention. It is a disassembled perspective view which shows the structural example of the bending part of the instrument main body in this invention. It is sectional drawing which shows the state of a laparoscopic surgery.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Surgical instrument 2 Instrument main body 21 Space 22 Base end part 23 Curved part 24 Node ring 25 Groove 26 Projection part 27 Through hole 28 Wire rod 3 Tip part 31 Notch 4, 4A, 4B Surgical operation means 41 Fixed clamping piece 42, 42a, 42b, 42c Movable clamping piece 43 Pin 44 Long hole 45 Slider 46 Pin 47 Link mechanism 471, 472 Extension part 473, 474 Link 475, 476, 477, 478 Pin 48 pin 5 Conversion means 51 Rotating shaft 52 Male screw 53 Head 54 support portion 55 female screw 56 storage space 57 moving body 58 concave portion 59 coil spring 6, 6a, 6b transmission member 7 conversion means 71 cam 72 rotation shaft 73 cam groove 74 driven member 75 protrusion 76 support portion 77 storage space 78 support portion 8 Conversion means 81 Worm 82 Rotating shaft 83 Worm gear 84 Storage space 85 86 Supporting portion 9, 9A, 9B Operation portion 901 Passage 90 Operation portion main body 91 Holding portion 92 Knob 921 Rotating shaft 922 Concavity and convexity 93 Fixed handle 931 Rotor 932 Rotating shaft 933 Guide groove 934 Bearing 935 Protruding portion 94 Movable handle 943 Rotor drive Member 944 Biasing member 945 Opening 946 Stop mechanism 947 Pin 948 Stop piece 949 Projection piece 95 Shaft member 99 Gear mechanism 991 First gear 992 Second gear 993 Case 100 Abdominal wall 101 Abdominal wall 102 Small camera 103 Monitor image 104 Forceps 105 １０６ 106 Electric Female 107 Trocar tube 108 Instrument body

Claims (16)

A long instrument body, a surgical operation means that is provided on the distal end side of the instrument body and that opens and closes or rotates, and an operation unit that is provided on the proximal end side of the instrument body and that remotely operates the surgical operation means A long transmission member that is rotatably installed in the instrument main body and rotates about its axis by an operation in the operation unit, and the rotation of the transmission member opens or closes or rotates the surgical operation means. Conversion means for converting into
The operation unit includes an operation unit main body, a movable handle displaceable with respect to the operation unit main body, a rotor connected to a proximal end portion of the transmission member, and a rotor engaged with the operation of the movable handle. A rotor driving member for rotating the rotor, wherein one of the rotor and the rotor driving member is installed on the movable handle, and the other of the rotor and the rotor driving member is the operation One of the rotor and the rotor driving member installed on the movable handle is moved in accordance with the operation of the movable handle so that the rotor and the rotation are moved. A surgical instrument, wherein the rotor is rotated by engaging with a child driving member. A long instrument body, a surgical operation means that is provided on the distal end side of the instrument body and that opens and closes or rotates, and an operation unit that is provided on the proximal end side of the instrument body and that remotely operates the surgical operation means A long transmission member that is rotatably installed in the instrument main body and rotates about its axis by an operation in the operation unit, and the rotation of the transmission member opens or closes or rotates the surgical operation means. Conversion means for converting into
The operation unit includes a fixed handle, a movable handle that rotates so as to change an opening angle with respect to the fixed handle, an end opposite to the rotation center of the movable handle, and the rotation center of the fixed handle. A rotor driving member provided near one end of the opposite side and having a plurality of recesses or openings formed at predetermined intervals along the longitudinal direction thereof; An end portion and an end portion of the fixed handle near the end opposite to the rotation center are provided on the side not having the rotor driving member, connected to a base end portion of the transmission member, and engaged with the recess or opening. A surgical instrument comprising: a rotor having a plurality of projecting portions formed on an outer periphery thereof, and the rotor being rotated by rotation of the movable handle.   The surgical instrument according to claim 2, wherein the operation unit includes a biasing member that biases the movable handle in a direction that increases an opening angle between the fixed handle and the movable handle.   4. The guide groove for inserting and guiding the rotor driving member is provided in the vicinity of the rotor of the handle provided with the rotor of the fixed handle and the movable handle. The surgical instrument as described.   The surgical instrument according to any one of claims 2 to 4, wherein the operation unit includes a stop mechanism that stops the rotation of the rotor.   The surgical instrument according to any one of claims 2 to 5, wherein the transmission member includes a gear mechanism that transmits a rotational force in the middle thereof.   The converting means includes a rotating body installed at a tip of the transmission member and a counterpart thereof, and a recess is formed in one of the rotating body and the counterpart, and the other is fitted in the recess. The surgical operating means is formed by forming a convex portion that moves, and a fitting position between the concave portion and the convex portion is moved with the rotation of the rotating body, and the rotating body and the counterpart body are relatively displaced. The surgical instrument according to any one of claims 1 to 6, wherein the surgical instrument is configured to open, close, or rotate.   The conversion means includes a female screw formed at the tip of the instrument body, a rotary shaft installed at the tip of the transmission member, and a male screw formed on the outer periphery of the rotary shaft and screwed into the female screw. The surgical instrument according to any one of claims 1 to 6, wherein the rotation shaft is configured to advance and retract as the transmission member rotates.   The conversion means includes a cam that rotates as the transmission member rotates and a driven member that contacts the cam, and the driven member is configured to be displaced by the rotation of the cam. The surgical instrument according to any one of 1 to 6.   The conversion means includes a cylindrical cam that rotates as the transmission member rotates, and a driven member having a protrusion that is inserted into a cam groove formed on an outer peripheral surface of the cam. The surgical instrument according to any one of claims 1 to 6, wherein the driven member is configured to move in the axial direction of the cam by rotation.   2. The conversion means includes a worm that rotates as the transmission member rotates and a worm gear that meshes with the worm, and the worm gear rotates by the rotation of the worm. The surgical instrument according to any one of 6.   The surgical instrument according to any one of claims 1 to 11, further comprising biasing means for removing backlash in the conversion means.   The surgical instrument according to claim 1, wherein at least a part of the transmission member is a linear body having flexibility.   The surgical instrument according to any one of claims 1 to 13, further comprising a support portion which is provided at a distal end portion of the instrument main body and supports the transmission member or the conversion means so as not to move substantially in a longitudinal direction.   The surgical instrument according to any one of claims 1 to 14, wherein the surgical operation means includes a pair of opening and closing members that are driven to open and close at least one of them. The surgical instrument according to claim 1, wherein the instrument body is bendable or bendable.

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