JP2009225989A - Ophthalmic surgical instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To achieve a minimally invasive surgery, improve operability and reduce a burden on a surgeon by reinforcing the rigidity of an insertion section to be stuck into an eyeball in vitreous surgery or the like and by reducing a diameter of a section to be inserted into the interior of the eye. <P>SOLUTION: This ophthalmic surgical instrument is provided with a tubular insertion member, a core member that is fitted in the insertion member so as to slidingly move in its axial direction, and a working section having a working tool at an opening/closing type spring member that is provided at the distal end of the core member and openingly/closingly driven by slidingly moving the core member inside the insertion member, wherein the insertion member has a working section storage for storing at least a part of the working section and a core slide section for slidingly moving the core member, at its distal end, and at least a part of the inside diameter of the working section storage is formed larger than the inside diameter of the core slide section. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to an instrument provided with a thin tubular insertion member that is inserted into the eyeball during vitrectomy, etc., and is used for the treatment of, for example, the macular epithelium, diabetic retinopathy, cataract, glaucoma, vitreous turbidity, etc. About things.

  In recent years, minimally invasive surgery is becoming mainstream in the field of ophthalmic surgery. This trial of minimally invasive surgery will be described taking vitrectomy as an example. Indications for vitreous surgery include diabetic retinopathy and age-related macular degeneration, which account for many causes of blindness in developed countries. For vitrectomy, 3 ports are generally created. These three ports are ports for taking in and out instruments such as (1) perfusion cannula, (2) light guide, (3) vitreous body setting, vitreous cutter, and the like.

  In actual surgery, a thin tubular instrument is inserted into a port where the instrument is taken in and out, the working part at the tip of the instrument is brought close to the affected part near the fundus, and the vitreous detachment and membrane treatment are performed while observing with a microscope.

  The port for inserting a vitreous surgery instrument is made in the sclera, but when using a conventional 20G instrument (diameter of the instrument: 0.9 mm), to make a hole in the sclera after performing a conjunctival incision After surgery, it was necessary to suture the sclera and conjunctiva. For this reason, the operation was accompanied by a lot of bleeding. In addition, since a conjunctival incision is performed, bacteria may easily enter between the sclera and the conjunctiva during or after surgery, which may cause infection and inflammation.

  In order to perform the above operation with minimal invasiveness, in recent years, the diameter has been reduced to 23G (diameter: 0.65 mm) or 25G (diameter: 0.5 mm), which is smaller than 20G (diameter: 0.9 mm). The instrument is being used, and the technique has been devised.

  Since surgical instruments such as 23G and 25G have a small outer diameter, the inside (outside) of the eye (eyeball) 10 is generally communicated using an instrument (penetration guide) called a trocar 41 as shown in FIG. And a surgical instrument 20 is taken in and out through the tunnel.

  The surgical instrument 20 has a working unit 21 at the distal end thereof. The distal end side of the working unit 21 is inserted into the eye 10, and the proximal end side outside the eye 10 is manually moved to operate the working unit 21. It leads to a predetermined target site and performs a predetermined treatment (or examination). The tool 20 is moved and operated with the insertion port into the eye 10 as a fulcrum P as shown in the figure.

  Since the perforation for installing the trocar 41 is performed on the conjunctiva, the conjunctiva can be preserved. In addition, when the trocar is removed by puncturing the conjunctiva at the time of perforation, the displaced conjunctiva is restored and the scleral perforation port can be protected. For this reason, there exists an effect which suppresses the postoperative infection and inflammation.

  However, in a surgical instrument with a reduced diameter such as 23G or 25G, the rigidity of the instrument decreases as the diameter decreases. Therefore, as shown in FIG. 10, when the proximal end side outside the eye 10 is manually moved in order to move the distal end of the instrument 20 to the target site in the eye 10, for example, as shown by a broken line in the figure. The device 20 is likely to be largely bent.

In order to treat a target site using such a reduced-diameter instrument 20, the instrument 20 is used.
Therefore, it was necessary to perform an operation based on experience and intuition while taking into account the flexure. For this reason, in order to perform a fine treatment in the eye, a very highly skilled technique is required.

  In addition, by reducing the outer diameter on the working part side at the tip compared to the outer diameter on the grip part side (base end side), the visibility and operability in the eye are improved, and a delicate movement is achieved. As an ophthalmic surgical instrument that enables precise processing, one disclosed in Patent Document 1 is known (paragraphs 0005 to 0007 of Patent Document 1). According to the ophthalmic surgical instrument disclosed in Patent Document 1, since the outer diameter on the gripping portion side (base end side) is thicker than the outer diameter on the working portion side of the thin tip, As a result, the rigidity of the portion is enhanced.

Utility model registration No. 3101460

  However, in the device disclosed in Patent Document 1, as shown in FIG. 11, in order to insert the working unit 21 of the instrument 20 into a predetermined position inside the eye 10, the gripping part side (base end side) of the instrument 20 is used. The portion 22 having a large outer diameter is also inserted into the eye 10, and a large wound is required for that purpose. That is, the thing of patent document 1 is the same as what used the conventional thing with a large outer diameter, and is only what thinned only the vicinity of the work part of the tip side, and postoperative infection disease and In that the risk of inflammation increases and minimally invasive surgery is not achieved, it is not different from the conventional thick type.

  As described above, when a conventional ophthalmic surgical instrument is reduced in diameter to perform a minimally invasive surgery, the instrument is easily bent and the operability in the operation is reduced, thereby increasing the burden on the operator. In addition, there is a problem that the treatment range is narrowed, and it has not yet been considered what can solve this problem.

  The present invention has been made in view of the above problems, and its purpose is to reduce the diameter of a portion to be inserted into the eye to enable minimally invasive surgery and to ensure a wide range of treatment within the eye. It is also possible to provide an ophthalmic surgical instrument that can be further improved in operability and enables fine surgery without increasing the burden on the operator.

As means for solving the above-mentioned problems, the present inventor proposes the following means.
(1) An insertion member that is composed of a tubular member and is inserted into the eyeball during ophthalmic surgery,
A wire-like core member inserted into the insertion member so as to be slidable in the axial direction within the insertion member;
A working portion provided at a distal end portion of the core member, comprising an openable and closable spring member that is driven to open and close by sliding the core member within the insertion member, and a working tool is provided on the spring member. And a working part
The insertion member includes a working portion storage portion that houses at least a part of the working portion at a distal end portion thereof, and a core slide portion that slides the core member.
An ophthalmic surgical instrument, wherein an inner diameter of at least a part of the working section storage section is made larger than an inner diameter of the core slide section.
(2) An insertion member configured with a tubular member and inserted into the eyeball during ophthalmic surgery,
A wire-shaped core member fitted in the insertion member so as to be slidable in the axial direction in the insertion member;
A working part provided at the tip of the core member, comprising an open / close-type spring member whose opening amount is adjusted by adjusting the amount of insertion into the insertion member, and the spring member is provided with a working tool And a working part provided with
By reducing the thickness of the core material within a range in which the strength capable of sliding in the axial direction in the insertion member can be maintained, and by increasing the thickness of the insertion member in the core slide portion accordingly. When the outer diameter of the insertion member is the same, in the state where the core member is inserted, the total rigidity of the rigidity of the insertion member and the rigidity of the core material is increased.
On the other hand, in the working part storage member, an ophthalmic surgical instrument characterized in that a necessary part of the working part can be stored by reducing the thickness of the insertion member and increasing the inner diameter.
(3) The ophthalmic surgical instrument according to 1 or 2, wherein the core slide part and the working part storage part are integrally formed of the same material.
(4) The core slide portion has a double structure in which an inner tubular member is fitted in an outer tubular member, and the working portion storage portion is constituted by the outer tubular member. The ophthalmic surgical instrument according to any one of 3 above.
(5) The working portion storage portion is a concave portion provided inside the insertion member, and the shape of the concave portion is formed in the outer shape of the working portion. The ophthalmic surgical instrument according to any one of the above.

  According to the above means, the thickness of the core member is reduced within a range in which the strength capable of sliding in the axial direction in the insertion member can be maintained, and accordingly, the thickness of the insertion member is reduced in the core slide portion. By increasing the thickness, when the outer diameter of the insertion member is the same, the total rigidity obtained by adding the rigidity of the insertion member and the rigidity of the core member is increased in a state where the core member is inserted. On the other hand, in the working part storage member, the core member is inserted by reducing the thickness of the insertion member and enlarging the inner diameter so that the necessary part of the working part can be stored. Thus, the total rigidity obtained by adding the rigidity of the insertion member and the rigidity of the core member can be remarkably increased as compared with the conventional case. As a result, the rigidity of the portion of the other insertion member excluding the vicinity of the working portion storage portion, that is, the vicinity of the distal end portion of the insertion member can be increased as compared with the conventional case. As a result, when the working unit is moved in the eyeball, the deformation caused by the low rigidity of the insertion member, that is, the phenomenon that the insertion member deforms with the incision as a fulcrum can be suppressed very effectively. In the case of a surgical instrument mainly for performing work near the fundus, the portion where this deformation is likely to occur is an area of about 20 to 40 mm from the distal end of the insertion member. According to the above means, the strength of this portion Can be sufficiently strengthened. In this case, since there is almost no force having a component perpendicular to the axial direction when moving the working part in the vicinity of the working part, for example, within about 20 mm from the tip of the insertion member, the strength of this part is not so strong. There is almost no risk of deformation. This makes it possible to further reduce the diameter of the portion to be inserted into the eye, enable minimally invasive surgery, secure a wide range of treatment within the eye, and further improve its operability. , Detailed surgery is possible without increasing the burden on the surgeon.

  FIG. 1 is a longitudinal sectional view of an essential part of an ophthalmic surgical instrument according to an embodiment of the present invention, FIG. 2 is an enlarged view of a part A in FIG. 1, and FIG. 3 is an essential part of an ophthalmic surgical instrument according to another embodiment. FIG. 4 to FIG. 6 are perspective views showing examples of work tools, FIG. 7 is a longitudinal sectional view of main parts of an ophthalmic surgical instrument according to still another embodiment, and FIG. 8 is VII- in FIG. It is a VII line cross section.

The ophthalmic surgical instrument shown in FIG. 1 is an example in which the present invention is applied to a vitreous body. The ophthalmic surgical instrument is fitted into the main body gripping portion 5, the piston member 3 movably attached to the main body gripping portion 5, and the mounting hole 31 formed along the central axis of the piston member 3. An insertion member 2 that is a thin tubular member that is fixed to the piston member 3 and a core member that is fitted into the tube portion of the insertion member 2 so that the insertion member 2 is movable in the axial direction. And a core member 6 having a proximal end portion fixed to the main body operation portion 5 and a working portion 60 provided at the distal end portion. The working unit 60 includes a set 61 provided at the forefront of the insertion member 2 and an open / close spring member 62 connected to the set 61 to open and close the set 61. The insertion member 2 is brazed and fixed to an attachment hole of a fixing member 33 having a distal end formed in a bowl shape and threaded on the outer periphery, and this fixing member 33 is shown in the figure of the piston member 3. It is fixed to the piston member 3 by being screwed into a fixing screw hole 32 having a slightly larger inner diameter formed below.

  The insertion member 2 is provided at its distal end portion with a working portion accommodating portion 22 for accommodating a working portion 60 provided at the distal end portion of the core member 6. The slide part 21 is configured. The working portion storage portion 22 has a larger inner diameter than the core slide portion 21. That is, the outer diameter of the insertion member 2 is the same in all parts, but the inner diameter of the insertion member 2 is formed to be larger than the inner diameter of the core slide part 21. In other words, the thickness of the core slide portion 21 is formed to be thicker than the thickness of the working portion storage portion 22, and the strength of the portion (rigidity against an acting force having a component in a direction perpendicular to the axial direction) is increased. It is configured as follows.

  The main body gripping part 5 inserts the insertion member 2 into the eye by gripping and operating this part by hand, and a set 61 provided exposed from the distal end of the insertion member 2 is a predetermined part in the eye. For example, it is positioned on the surface of the retina, the piston member 3 is moved, and the insertion member 2 is moved downward in the figure with respect to the core member 6, thereby driving the opening / closing spring member 62 in the closing direction. Narrowing the surface of the retinal surface to remove the tissue.

  The main body gripping part 5 has a structure in which the base 51 and the base 51 are divided into three parts by cutting in the vertical direction from the middle toward the lower part in the figure, and are formed on the left and right in the figure. Two leaf spring portions 52 and 53, a central support portion 54, and a piston receiving portion 55 provided continuously from the lower portion of the central support portion 54 are integrally provided.

  The leaf spring portions 52 and 53 are formed so as to expand to the left and right as they go downward in the figure, and are terminated at the front of the piston receiving portion 55. The left and right leaf springs 52 and 53 need to be narrowed with a force in order to narrow the distance between them. The distance between each other can be reduced until it collides with the central column portion 54. One ends of cranks 57 and 58 are rotatably attached to the lower portions of the leaf springs 52 and 53, respectively. The other ends of the cranks 57 and 58 are rotatably attached to the upper end of the piston member 3, respectively. The piston member 3 is movably fitted in the piston receiving hole 56 of the piston receiving portion 55. Thus, by narrowing the left and right leaf springs 52 and 53, the movement can be converted into an axial movement by the cranks 57 and 58 and transmitted to the piston member 3, and the piston member 3 can be moved in the axial direction. The sushi 61 is opened and closed by moving the insertion member 2 fixed to the piston member 3 in the axial direction.

  In the above embodiment, the insertion member 2 is fixed to the piston member 3, and the insertion member 2 is moved by moving the piston member 3. However, this may be as follows. That is, the piston member 3 is fixed to the main body gripping portion 5, one end of the cranks 57 and 58 is attached to the insertion member 2 instead of being attached to the piston member 3, and the insertion member 2 is slidable on the piston member 3. The insertion member 2 may be moved directly by being attached to.

In the ophthalmic surgical instrument according to the above embodiment, the thickness of the core member 2 is reduced within a range in which the strength capable of sliding in the insertion member 2 in the axial direction can be maintained. In the portion 21, by increasing the thickness of the insertion member 2, when the outer diameter of the insertion member 2 is the same, the rigidity of the insertion member 2 and the core member 6 can be reduced with the core member 6 inserted. In addition, the total rigidity of the working unit storage member 22 is increased by reducing the thickness of the insertion member 2 and increasing the inner diameter thereof. Since the necessary part can be stored, the total rigidity of the insertion member 2 and the rigidity of the core member 6 in a state in which the core member 6 is inserted is significantly higher than that of the conventional case. Can be bigger It was. As a result, the rigidity of the portion of the other insertion member 2 excluding the vicinity of the working portion storage portion 22, that is, the vicinity of the distal end portion of the insertion member 2, can be increased compared to the conventional case.

  Accordingly, when the working unit 60 is moved in the eyeball, it is possible to very effectively suppress the deformation caused by the low rigidity of the insertion member 2, that is, the phenomenon that the insertion member 2 is deformed with the incision as a fulcrum. became. Note that in the case of a surgical instrument for mainly performing work in the vicinity of the fundus, the portion where this deformation is likely to occur is an area of about 20 to 40 mm from the distal end of the insertion member 2. Can be sufficiently strengthened. Further, in this case, in the vicinity of the working unit 60, for example, within about 20 mm from the distal end of the insertion member 2, when the working unit 60 is moved, there is almost no force having a component perpendicular to the axial direction. There is almost no risk of deformation even if it is not so strong. This makes it possible to further reduce the diameter of the portion to be inserted into the eye, enable minimally invasive surgery, secure a wide range of treatment within the eye, and further improve its operability. , Detailed surgery is possible without increasing the burden on the surgeon.

  In the present embodiment, the outer diameter of the insertion member 2 is 0.5 mmφ (25 G), the inner diameter of the core slide portion 21 is 0.3 mmφ, the inner diameter of the working portion storage portion 22 is 0.4 mmφ, and the shaft of the working portion storage portion 22 The length in the direction was 3.5 mm, and the outer diameter of the core member 6 was 0.25 mmφ. Hereinafter, the rigidity of the ophthalmic surgical instrument according to the present embodiment is compared with the rigidity of the conventional ophthalmic surgical instrument.

Table 1 shows general formulas relating to beam deflection. Equation (a) in Table 1 calculates the distance δ that the other end moves in the load direction when one end of the insertion member of length L is fixed and the other end is loaded with a load W as the amount of deflection in the elastic range. It is an expression to do. When this formula is transformed into a formula for obtaining the load W, the formula (b) is obtained.

Table 2 shows a comparison of the load W in the case of only the insertion members of 20G, 25G (conventional product), and 25G (improved product; the present invention) obtained by the equation (b) in Table 1. Here, it is assumed that the material is SUS304, the length L of the beam is 10 mm, and the deflection amount δ is 2 mm. The longitudinal elastic modulus E is a constant based on the material. The cross-sectional secondary moment I is calculated by the outer diameter and inner diameter of the insertion member, and the constant β is a constant in the case of a cantilever as in this use state. It can be seen that the insertion member of 25G (improved product; the present invention) is larger than the load of 25G (conventional product).

Table 3 shows a comparison of the load W in the case of only the core members of 20G, 25G (conventional product), and 25G (improved product; the present invention) obtained by the formula (b) in Table 1. Here, the material is
Assuming SUS304, the case where the length L of the beam is 10 mm and the deflection amount δ is 2 mm is shown. The longitudinal elastic modulus E is a constant based on the material. The cross-sectional secondary moment I is calculated from the outer diameter of the core member, and the constant β is a constant in the case of a cantilever as in this use state. It can be seen that the insertion member of 25G (improved product; the present invention) is smaller than the load of 25G (conventional product).

In an actual ophthalmic surgical instrument (for example, vitreous body setting), the core member shown in Table 3 is inserted into the insertion member shown in Table 2. That is, the sum of the load of the insertion member and the load of the core member becomes the load as an ophthalmic surgical instrument. The results are shown in Table 4. It can be seen that the load of 25G (improved product; the present invention) exceeds the load of 25G (conventional product).

Table 5 shows the result of measuring the maximum load until plastic deformation when the core member is inserted into the insertion member having the dimensions shown in Table 2. Here, the material is SUS304, the material hardness is about 400 HV, the length L of the beam is 10 mm, the thickness of the core member is 0.2 G for 25 G (improved product; the present invention), and 25 G (conventional product). The result when 0.35 mm is shown. It can be seen that the load of 25G (improved product; the present invention) is larger than the load of 25G (conventional product).

  FIG. 3 is a longitudinal sectional view of a main part of an ophthalmic surgical instrument according to another embodiment. In the example shown in FIG. 3, the core slide portion has a double structure in which the inner tubular member 21a is fitted in the outer tubular member 22a, and the working portion storage portion is constituted by the outer tubular member 22a. It is an example. It has been confirmed that even in such a configuration, the same effect as in the case of the above-described embodiment can be obtained. The working tool provided in the working unit 60 includes, for example, the scissors 61 shown in FIG. 4, the forceps shown in FIG. 5, and the setting tool shown in FIG. Etc. can be used.

FIG. 7 is a longitudinal sectional view of an essential part of an ophthalmic surgical instrument according to still another embodiment, and FIG. 8 is a sectional view taken along line VII-VII in FIG. As shown in FIGS. 7 and 8, in this embodiment, the working portion storage portion 22 b is a concave portion 22 c provided inside the insertion member 2, and the shape of the concave portion is the outer shape of the working portion 60. It is the example formed in the shape. According to this example, the rigidity of the working unit storage unit 22b can be increased as compared with the case of the above embodiment. In addition, since the shake in the rotation direction of the working unit can be suppressed, the work can be performed more accurately.

  The present invention can be widely applied to instruments using a thin tubular insertion member that is inserted into the eyeball during vitrectomy, etc., and by reinforcing the rigidity of the insertion member, the portion to be inserted into the eye is thinned. The diameter can be reduced to enable minimally invasive surgery, a wide range of treatment within the eye can be ensured, and the operability can be improved, and fine surgery can be performed without increasing the burden on the operator.

It is a principal part longitudinal cross-sectional view of the ophthalmic surgical instrument concerning one embodiment of this invention. It is the A section enlarged view of FIG. It is a principal part cutaway longitudinal view of the ophthalmic surgical instrument concerning other embodiment of this invention. It is a figure which shows the example of a work tool. It is a figure which shows the example of a work tool. It is a figure which shows the example of a work tool. It is a principal part cutaway longitudinal view of the ophthalmic surgical instrument concerning other embodiment of this invention. It is the VII-VII sectional view taken on the line in FIG. It is explanatory drawing of a prior art. It is explanatory drawing of a prior art. It is explanatory drawing of a prior art.

Explanation of symbols

2 Insertion member 3 Piston member 5 Main body gripping part 6 Core member 21 Core slide part 22 Working part storage part 60 Working part 61 Setty 62 Opening and closing type spring member

Claims (5)

An insertion member configured with a tubular member and inserted into the eyeball during ophthalmic surgery;
A wire-like core member inserted into the insertion member so as to be slidable in the axial direction within the insertion member;
A working portion provided at a distal end portion of the core member, comprising an openable and closable spring member that is driven to open and close by sliding the core member within the insertion member, and a working tool is provided on the spring member. And a working part
The insertion member includes a working portion storage portion that houses at least a part of the working portion at a distal end portion thereof, and a core slide portion that slides the core member.
An ophthalmic surgical instrument, wherein an inner diameter of at least a part of the working section storage section is made larger than an inner diameter of the core slide section. An insertion member configured with a tubular member and inserted into the eyeball during ophthalmic surgery;
A wire-like core member inserted into the insertion member so as to be slidable in the axial direction within the insertion member;
A working portion provided at a distal end portion of the core member, comprising an openable and closable spring member that is driven to open and close by sliding the core member within the insertion member, and a working tool is provided on the spring member. And a working part
The insertion member includes a working portion storage portion that houses at least a part of the working portion at a distal end portion thereof, and a core slide portion that slides the core member.
By reducing the thickness of the core member within a range in which the strength capable of sliding in the axial direction within the insertion member can be maintained, and by increasing the thickness of the insertion member in the core slide portion accordingly. When the outer diameter of the insertion member is the same, in the state where the core member is inserted, the total rigidity of the rigidity of the insertion member and the rigidity of the core material is increased.
On the other hand, in the working part storage member, an ophthalmic surgical instrument characterized in that a necessary part of the working part can be stored by reducing the thickness of the insertion member and increasing the inner diameter.   The ophthalmic surgical instrument according to claim 1 or 2, wherein the core slide part and the working part storage part are integrally formed of the same material.   4. The core slide portion has a double structure in which an inner tubular member is fitted in an outer tubular member, and the working portion storage portion is constituted by the outer tubular member. The ophthalmic surgical instrument according to any one of the above. 4. The working portion storage portion according to claim 1, wherein the working portion storage portion is a concave portion provided inside the insertion member, and the shape of the concave portion is formed in the outer shape of the working portion. The ophthalmic surgical instrument according to any one of the above.

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