JP2011130796A - Surgical instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a surgical instrument used in an intraocular surgery and capable of easily and surely excising thin film-like tissue into a continuous circular shape in an excellent state without a fissure having a desired size with a sharp cut end, and improving visibility of an operative field. <P>SOLUTION: The surgical instrument for excising thin film-like tissue into a continuous circular shape includes: a blade part which can be rotated at least for 360 degrees centering on a rotary shaft disposed at the distal end; a rotary knob disposed near a holding part, for rotating it with fingers; and a wire for transmitting the rotating movement of the rotary knob to the blade part and rotating the blade part in a direction similar to the rotating direction of the rotary knob. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention relates to a surgical instrument capable of excising a thin membranous tissue in a continuous circle in a good state more easily and stably, and particularly for cataracts, glaucoma, retinal detachment, vitreous turbidity, vitreous membrane excision, etc. The present invention relates to a surgical instrument useful for internal eye surgery performed as a therapeutic action.

  In recent years, the technology in endoscopic surgery has been steadily advancing, and as research advances and the technology improves, new functions are also required for surgical instruments to be used, and new ophthalmic surgical instruments have been developed in response to these needs. It has been developed. Among these, a surgical instrument used for an anterior capsule (hereinafter referred to as an anterior lens capsule) constituting a lens capsule in a thin membranous tissue is operated in a small space in the eye. Therefore, it is necessary to perform detailed work more accurately, and at the same time, when performing the operation under a surgical microscope, it is required that the operator's visual field be not obstructed by the instrument as much as possible (called visibility). Needs for more delicate products are increasing. Typical surgical instruments used for the anterior lens capsule include an insulator and a scissors used for incision and excision. For example, a membranous tissue to be removed in cataract surgery (hereinafter referred to as an anterior capsule) The success or failure of continuous circular excision (cutting in a circular shape without causing a step) has a large effect on the entire operation, and the surgical instrument can be excised in a continuous and reliable manner in a better state. Development is required.

  In response to such a problem, for example, there is a proposal for an ophthalmic surgical scissors that can incise the iris of the small pupil and the anterior lens capsule from all directions during cataract surgery (see, for example, Patent Document 1). However, the anterior lens capsule forms a capsular capsule in a thin membranous tissue. In endoscopic surgery, the thin membrane of part of the membranous tissue is carefully detached or separated, It is necessary to perform a precise treatment such as cutting in a range or excising part of the membrane into a continuous circular shape without a step, and these precise treatments that require delicate force adjustment are There is a need for further development of surgical instruments that must be operated in a small space of the eye and that can perform these procedures better. On the other hand, the present applicant is already able to follow a delicate movement, making it possible to more easily and accurately perform a precise treatment performed in a small space as mentioned above. An ophthalmic surgical instrument used in internal eye surgery has been proposed (see Patent Document 2).

Utility Model Registration No. 3089244 Utility Model Registration No. 3101460

  However, as described above, the anterior lens capsule forms a lens capsule in a thin membranous tissue, and in intraocular surgery, a precise treatment requiring delicate force adjustment is performed. Therefore, further development of a surgical instrument that can perform these procedures better and stably is eagerly desired. In particular, in the continuous circular excision of the anterior capsule, it is important to excise a part of the membrane into a continuous circular shape without steps or cracks. On the other hand, as shown in FIG. 7, in a conventional instrument, the excision is performed by grasping the membrane at the tip of the instrument and tearing the membrane into a circle, and it is broken in a direction against the tissue. Ophthalmology that is difficult to cut into a continuous circular shape without cracks, requires advanced techniques, and can cut a thin membranous tissue into a continuous circle more easily and reliably. Development of surgical instruments for medical use is awaited. Furthermore, if a surgical instrument capable of excising a thin membranous tissue in a continuous circle more easily and more reliably is developed, not only ophthalmic surgery but also a thin membranous tissue in a continuous circle. It is also very useful in other surgeries that require resection.

  Accordingly, an object of the present invention is to provide a surgical instrument that can be used in intraocular surgery or the like to cut a thin membranous tissue more easily and more reliably into a continuous circle in a good state without cracks. It is to be.

  The above object is achieved by the present invention described below. That is, the present invention is [1] a surgical instrument for excising a thin membranous tissue in a continuous circle, a blade that can rotate at least 360 degrees around a rotation axis arranged at the tip, A rotation knob for rotating with a finger arranged in the vicinity of the wire, a wire for transmitting the rotational movement of the rotation knob to the blade part, and rotating the blade part in the same direction as the rotation direction of the rotation knob; And a surgical instrument characterized by comprising:

  As preferred embodiments of the present invention described above, the following [2] to [5] may be mentioned. [2] The blade portion is composed of a flat portion having a shape that becomes narrower as it becomes the tip, and a blade that is continuously formed on the flat portion, and the blade has a tip whose width is reduced. The surgical instrument as described above, wherein the distal end is bent at a substantially right angle to the side opposite to the side where the rotary knob is disposed, and a sharp cutting edge is formed at the most distal portion of the bent portion. . [3] Further, it has a rod-like arm portion for attaching the blade portion to the tip, has a structure that can slide along the arm portion, and a recess for accommodating the blade portion is formed at the tip. Any one of the above-mentioned surgical instruments provided with the blade fixing tool. [4] The surgical instrument according to any one of the above, wherein the wire is wound one or more times around the rotation shaft of the rotary knob and the rotation shaft that rotates the blade portion. [5] The surgical instrument according to any one of the above, wherein the surgical instrument is for ophthalmic surgery, and the width of the cutting edge is 1 mm or less.

  ADVANTAGE OF THE INVENTION According to this invention, the surgical instrument applicable to various surgery which can excise a thin film-like structure | tissue more easily and more reliably in the continuous circle shape of the favorable state without a crack is provided. According to the present invention, a thin membranous tissue can be excised more easily and more reliably into a continuous circle in a good state without cracks, particularly in endoscopic surgery performed as a treatment for cataracts and the like. In addition, an extremely useful surgical instrument with high visibility of the surgical field is provided.

It is a schematic perspective view which shows an example of the surgical instrument of this invention. 1 is an overall structural diagram of an example of a surgical instrument of the present invention. It is the elements on larger scale of the front-end | tip of an example of the surgical instrument of this invention. It is the elements on larger scale of the blade part of an example of the surgical instrument of this invention. It is a conceptual diagram which shows the drive structure of an example of the surgical instrument of this invention. It is a schematic diagram for demonstrating the use condition of an example of the surgical instrument of this invention. It is a schematic diagram for demonstrating the use condition of an example of the conventional surgical instrument.

Hereinafter, the present invention will be described in detail by way of preferred embodiments with reference to the drawings.
As shown in FIGS. 1 and 2, the surgical instrument 20 of the present invention has the blade portion 1 arranged at the forefront, and the blade portion 1 is placed in the same direction as the rotation direction of the rotary knob 2 in FIG. 5 has a structure that can rotate at least 360 degrees around the rotation axis B shown in FIG. FIG. 5 schematically shows the rotation mechanism of the blade portion 1, but between the rotation axis B and the rotation axis A (4 in FIG. 2) that forms an integral structure with the rotatable rotary knob 2. When the rotary knob 2 is rotated with a finger by spanning the wire 3, the blade portion 1 rotates in the same direction as the rotary knob 2 around the rotation axis B in conjunction with the rotation. It has become. In order to rotate the blade portion 1 more stably and more reliably 360 degrees, the single wire 3 is rotated with the rotary knob 2 and the rotation axis A integrally formed, and the blade portion 1 is rotated. It is preferable that one or more turns are wound around each of the rotating shafts B and both ends of the wire 3 are joined (9 in FIG. 2: connecting portion) to form a continuous ring shape. FIG. 3 shows an example in which the wire 3 is wound around the axis of the rotary shaft B. However, as shown in FIG. 3, the wire 3 is accommodated in a groove 11 provided in a rod-shaped arm portion 10 described later, The groove 11 is preferably structured so that the wire 3 slides.

  In the surgical instrument illustrated in FIGS. 1 and 2, the rotary knob 2 can be screwed with a fixing screw 8 at an appropriate position of the gripping portion 7 so that an optimum tension can be always applied to the wire 3. It has a structure. For this reason, the tension of the wire 3 stretched between the rotating shaft B and the rotating shaft A can be adjusted to a more suitable state. By finely adjusting the position of the rotary knob 2 to an appropriate position of the gripping portion 7 to optimize the tension applied to the wire 3 and fixing with the fixing screw 8, the operator can turn the rotary knob 2 of the surgical instrument 20 of the present invention. By rotating the blade with a finger, the blade 1 is rotated 360 degrees, and the treatment of cutting the membrane tissue into a circular shape with the cutting edge provided at the forefront of the blade 1 can be performed more smoothly.

  Further, when determining the thicknesses of the rotary shaft B and the rotary shaft A, when rotating the blade portion 1 following the rotation of the rotary knob 2, for example, the rotary knob 2 is rotated by 90 to 180 degrees with a finger. By doing so, it is preferable to design the blade portion 1 to rotate 360 degrees. In any case, it is preferable that the doctor can experience the feeling of rotating the blade portion 1 by rotating the rotary knob 2 with a finger. In particular, it is preferable to design the blade portion 1 to rotate 360 degrees by rotating the rotary knob 2 by 90 degrees with a finger. Specifically, the design can be easily performed by appropriately determining the thickness of each of the rotation axis A and the rotation axis B.

  As shown in FIG. 4, the blade portion 1 constituting the surgical instrument 20 of the present invention includes a flat portion 1a having a shape that becomes narrower toward the tip, and a blade that is formed continuously with the flat portion 1a. 1b. Since the flat portion 1a and the rotation shaft B are integrated, the blade portion 1 rotates by rotating the rotation shaft B. Further, the blade 1b is provided not at the rotation axis B side but at the tip position where the width of the flat portion 1a is narrowed. As shown in FIG. 4, the tip is arranged with the rotary knob 2. It is formed by bending at a substantially right angle to the opposite side to the side. And the sharp blade edge | tip 1c is formed by sharpening the most advanced part of the bent part. The size of the surgical instrument 20 of the present invention is not particularly limited, and the width of the blade edge 1c and the distance from the center of the rotation axis B to the blade edge 1c may be appropriately determined as necessary during surgery. For example, in cataract surgery, it is necessary to form a resected portion in a circular shape with a diameter of 6 mm in the anterior lens capsule of a thin membranous tissue. In this case, the distance from the center of the rotation axis B to the cutting edge 1c is as follows. The width of the cutting edge 1c is preferably about 1 mm or less at 3 mm. Further, as shown in FIGS. 1 and 2, the blade portion 1 is preferably attached to the tip of an elongated rod-like arm portion 10 and has a structure in which the rotary knob 2 is provided in the vicinity of the grip portion 7. With such a structure, the operation of rotating the rotary knob 2 with a finger, which is performed at the time of excision, can be performed on the hand side. Furthermore, since the blade portion 1 having the minimum necessary size is provided at the tip of the elongated rod-shaped arm portion 10 and the position of the rotary knob 2 to be operated can be on the operator's hand side, securing the operator's visual field is conventionally achieved. Compared to the one, it is improved in each stage.

  Although the material of the blade part 1 which comprises the surgical instrument 20 of this invention is not specifically limited, In order not to rust and to form the sharp cutting edge 1c with a sharpness, it is preferable that it is stainless steel. Similarly, other portions may be formed of a stainless material or the like. In recent years, gas sterilization has been widely performed, and the material for forming the surgical instrument 20 of the present invention is not particularly limited also in this respect.

  Since the surgical instrument 20 of the present invention has the above-described structure, as shown in FIG. 6, the doctor can smoothly rotate the blade portion 1 by a simple operation of rotating the rotary knob 2 with a finger. Accordingly, the thin film-like tissue can be cut out in a continuous circle with a sharp cut surface having no step, accurately and without a crack, with the cutting edge 1c provided at the forefront of the blade portion 1. it can. Moreover, since the size of the part to be excised is determined by the distance from the center of the rotation axis B to the blade edge 1c, if the surgical instrument 20 of the present invention in which the blade portion 1 is a desired size is used, In addition, a thin membranous tissue can be accurately excised in a continuous circular shape having a desired size without a step having a sharp cut without a crack.

  The surgical instrument 20 of the present invention can be suitably used for intraocular surgery or the like, but as shown in FIG. 4 (a), the blade 1b is formed by bending substantially at right angles to the insertion direction. Therefore, even if the blade 1b is rotated and placed on the arm portion 10, it cannot be said that there is no risk of tissue being damaged by the blade tip 1c provided at the tip when inserted into the eye. For this reason, preferably, the surgical instrument 20 of the present invention is provided with the blade fixing tool 6 as shown in FIGS. 3 and 4 so that the tissue is not damaged by the cutting edge 1c during insertion into the eye. It is preferable. It is preferable that the fixture 6 has a structure in which the blade 1, in particular, the blade 1 b can be accommodated without exposing the blade 1, particularly the blade tip 1 c, with a recess formed at the tip. An example is shown in FIGS. 3 and 4, a recess having a width capable of accommodating the blade 1b is provided at the tip, and the tip portion provided with the recess is, for example, as shown in FIG. It is preferable to have a structure that allows the blade edge 1c to be high enough not to be exposed. If the blade portion 1 is fixed by the concave portion provided in the blade portion fixing tool 6 as described above, the blade portion 1 cannot be rotated as shown in FIG. 4B, and as shown in FIG. Since the cutting edge 1c at the forefront of the blade portion 1 is not exposed, the tissue is not damaged by the cutting edge 1c at the time of insertion.

  Further, as described above, the surgical instrument 20 of the present invention preferably has an elongated rod-like arm portion 10 for attaching the blade portion 1 to the tip. However, the blade portion fixture 6 described above has the arm portion 10. It is good to have a structure that can be slid along. If comprised in this way, as shown to Fig.3 (a), after the blade part 1 was first rotated and the blade part 1 was located on the arm part 10, and it was set as this state, the blade part fixing tool 6 is set. Can be easily accommodated in the recess provided in the blade fixture 6 in the vicinity of the blade 1b at the tip of the blade 1 (see FIG. 4 (b)). . As a result, accidents such as accidentally damaging the cutting edge 1c with the blade fixing tool 6 are prevented, and the blade 1 can be fixed reliably and simply. At the same time, since the cutting edge 1c is not exposed by the above-described recess provided at the tip of the blade fixture 6, it is possible to reliably prevent the tissue from being damaged when the surgical instrument 20 of the present invention is inserted.

  Below, the specific usage pattern and effect of the surgical instrument of this invention are demonstrated. The surgical instrument of the present invention cuts out the anterior capsule forming the front surface of the lens in a circular shape so that the cured lens nucleus can be removed in ophthalmic surgery for cataract, for example. preferable. When using the surgical instrument of the present invention, the rotation axis B for rotating the blade portion 1 is arranged at the center of the portion of the anterior capsule to be cut, and the cutting edge 1c is inserted into the membrane at the portion to be cut off. This is the starting point. Next, the rotary knob 2 is rotated with a finger, and the blade portion 1 is rotated 360 degrees from the starting point of excision around the rotation axis B. By this series of operations, a part of the thin membranous tissue is obtained in a desired size. Cut into continuous circles. As a result of observing in detail the part cut into a circle as described above, the cut edge cut into a circle was sharp without cracks, despite the fact that it was simply formed, and the shape of the cut was uneven. It was cut into a clean circle.

  FIG. 7 shows an example in which a conventional surgical instrument is used. The leading edge of the insulator used in this case was pointed, and this part was pierced into the anterior capsule. Subsequently, a part of the anterior capsule was pinched, and the anterior capsule was torn in that state. In this case as well, it is desirable to excise into a clean circle. However, as compared with the case where the surgical instrument of the present invention described above is used, the conventional instrument has cracks outside the planned direction of the planned circular excision, and the entire incision is It was not a continuous, clean circle. In addition, since the surgical instrument of the present invention has a thin tip, the field of view of the operator is improved as compared with the conventional one, the visibility is high, and the rotary knob 2 operated by the operator is provided by the operator. This point was also extremely useful.

1: Blade part 2: Rotating knob 3: Wire 4: Rotating axis A
5: Rotating shaft B
6: Blade portion fixing tool 7: Holding portion 8: Fixing screw 9: Connection portion 10: Arm portion 11: Groove 20: Surgical instrument of the present invention (this product)

Claims (5)

  A surgical instrument for excising a thin membranous tissue in a continuous circle, which is rotated by a blade disposed at least 360 degrees around a rotation axis disposed at the tip and a finger disposed in the vicinity of the grasping portion. And a wire for transmitting the rotational movement of the rotary knob to the blade portion and rotating the blade portion in the same direction as the rotation direction of the rotary knob. Instruments.   The blade portion is composed of a flat portion having a shape that becomes narrower toward the tip, and a blade that is formed continuously on the flat portion, and the blade is positioned at the tip where the width of the flat portion is reduced. The sharp tip is formed in the most advanced part of the bent part by bending the tip at a substantially right angle to the side opposite to the side where the rotary knob is arranged. Surgical instruments.   Furthermore, it has a rod-like arm portion for attaching the blade portion to the tip, has a structure that can slide along the arm portion, and a recess for accommodating the blade portion is formed at the tip. The surgical instrument according to claim 1, wherein a blade fixing tool is provided.   The surgical instrument according to any one of claims 1 to 3, wherein the wire is wound around one or more turns on a rotating shaft of a rotary knob and a rotating shaft that rotates a blade portion.   The surgical instrument according to any one of claims 1 to 4, wherein the surgical instrument is for ophthalmic surgery, and the width of the cutting edge is 1 mm or less.