JP2011135988A - Medical treatment instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To solve a problem in an actual clinical surgery that it is difficult to coagulate living tissue by microwave without giving an excessive damage to the living tissue and to certainly cut the living tissue. <P>SOLUTION: A medical treatment instrument coagulates the living tissue by the microwave without giving the excessive damage to the living tissue and seals a vascular structure, so that the living tissue can be cut certainly. On a cutting blade part of the medical treatment instrument, the medical treatment instrument has a movable first electrode 1 connected to an outer conductor, a fixed second electrode 2 connected to a center electrode, and an blade 17 composed of an insulator. The medical treatment instrument operates such that the living tissue is held between the movable first electrode and the blade composed of the insulator, the living body is coagulated by supplying the microwave to the fixed second electrode, and the living body is cut by turning the movable first electrode. In this case, the blade composed of the insulator is fixed to the fixed second electrode and positioned between the movable first electrode and the fixed second electrode. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention relates to a medical treatment tool for grasping, coagulating, and cutting a living tissue.

  As a surgical treatment apparatus, it is known to perform coagulation, hemostasis, incision, and the like on a biological part such as a digestive organ, liver, bladder, prostate, uterus, blood vessel, intestinal tract, etc. using a microwave.

  In a conventional electric knife or the like, the surface of a living tissue is heated and solidified by Joule heat using a high frequency voltage centered at a frequency of 500 kHz. In the conventional coagulation by Joule heat such as an electric knife, the living tissue is easily carbonized and solidified, so that the coagulated surface may be peeled off from the living tissue.

  On the other hand, in coagulation and hemostasis using microwaves, a living tissue is grasped between electrodes and microwaves are applied to the living tissue. When a microwave is applied to a living tissue, dielectric heat is generated due to a near electromagnetic field caused by the microwave power. This dielectric heat can evaporate the water in the living tissue and solidify the living tissue.

  In the case of coagulation and hemostasis using microwaves, it is possible to coagulate the living tissue at a relatively low temperature, and thus maintain a fixed state that stops the function of the living tissue while maintaining the cell morphology of the living tissue. be able to. For this reason, the situation where the coagulation | solidification surface peels and falls from a biological tissue can be suppressed.

  As described above, Patent Document 1 and Patent Document 2 disclose coagulation, hemostasis, incision, and the like of living tissue using microwaves. A problem in the treatment using microwaves is the generation of sparks due to contact between electrodes or the like, and the sparks cause excessive damage to living tissue. Patent Document 2 discloses a medical treatment instrument that is devised to prevent the occurrence of sparks by maintaining a parallel state without bringing two electrodes into contact with each other. However, the medical treatment instrument disclosed in this prior document has a problem that it is difficult to reliably cut biological tissue.

Japanese Patent Laid-Open No. 2005-21658 JP 2007-282666 A

  The present invention relates to a medical treatment instrument that can efficiently irradiate a living tissue with microwaves without causing excessive damage to the living tissue, coagulate the living tissue, and enable reliable cutting.

  In view of the above-described problems, the present invention has been intensively studied, found a structure that can solve the problems of the present invention, and completed the present invention.

The present invention comprises:
1. A cutting blade portion of a medical treatment instrument has a movable first electrode coupled to an outer conductor, a fixed second electrode coupled to a center electrode, and a blade made of an insulator, and the movable first electrode A medical tissue having an action of grasping a living tissue between a blade made of an insulator, supplying a microwave to the fixed second electrode to coagulate the living tissue, and cutting the living tissue by rotating the movable first electrode A medical treatment instrument, which is a treatment instrument, wherein a blade made of an insulator is fixed to a fixed second electrode, and is positioned between the movable first electrode and the fixed second electrode.
2. 2. The medical treatment tool according to item 1, wherein the upper edge of the fixed second electrode and the blade line of the blade made of an insulator are on the same plane.
3. The previous item in which a thick structure is provided between the conductive rod and the electrode portion, and energization from the fixed second electrode or the central electrode to the movable first electrode or the external conductor is eliminated without grasping the living tissue. The medical treatment tool according to 1 or 2.
4). 4. The medical treatment tool according to item 3, wherein the thickness is equal to or greater than the radius of the conductive rod.
5. 5. The medical treatment tool according to 3 or 4 above, wherein the thick structure is an insulator.
6). 6. The medical treatment instrument according to any one of the preceding items 1 to 5, wherein an outer conductor and a center electrode of a coaxial cable are directly connected to the movable first electrode and the fixed second electrode, respectively.
7). The medical treatment instrument according to any one of the preceding items 1 to 6, wherein the blade made of an insulator is a blade made of an insulator containing ceramic.
8). Any one of the preceding items 1 to 7, wherein the movable first electrode has a rotation axis on a surface that includes a blade cutting line of the movable first electrode and a center line of the blade made of an insulator and intersects at right angles to both blades. The medical treatment tool described in 1.
9. 9. The medical treatment tool according to any one of the preceding items 1 to 8, wherein the electrode opening / closing rod connecting point and the rotating shaft are connected by a connecting rod.
10. 10. The medical treatment instrument according to any one of the preceding items 1 to 9, wherein the blade made of the movable first electrode, the fixed second electrode, and the insulator is coated with a coating to which the solidified tissue is difficult to adhere.

  With the medical treatment tool having the structure of the present invention, the living tissue is grasped between the movable first electrode and the blade made of an insulator without generating a spark that causes excessive damage to the living tissue, and the fixed second electrode Therefore, the microwave can be efficiently supplied and solidified to seal the vasculature, and the tissue can be cut more reliably.

Overall configuration of one embodiment of the medical treatment instrument of the present invention (reference diagram) The side view of the electroconductive rod and electrode opening-and-closing rod and electrode part which are installed in the inside of the outer tube | pipe tip part of the medical treatment tool of this invention is shown. Line L indicates the center line of the blade line of the movable first electrode and the blade line of the blade made of an insulator. The front view of the medical treatment tool of the present invention in the state of Drawing 2 is shown. It is sectional drawing of X1-X2 of FIG. The side view of an electroconductive rod, an electrode opening-and-closing rod, and an electrode part is shown. (A) The blade tip is open. (B) The blade line parallel state is shown. (C) The cutting edge is closed. The top view of an electroconductive rod, an electrode opening-and-closing rod, and an electrode part is shown.

  The medical treatment tool of the present invention has a movable first electrode coupled to an external conductor, a fixed second electrode coupled to a center electrode, and a blade made of an insulator at a cutting blade portion, and is movable. An action of grasping a living tissue between the first electrode and a blade made of an insulator, supplying a microwave to the fixed second electrode to coagulate the living tissue, and cutting the living tissue by rotating the movable first electrode A blade made of an insulator is fixed to the fixed second electrode, and is positioned between the movable first electrode and the fixed second electrode.

  In the present invention, the movable first electrode, the fixed second electrode, and the blade made of an insulator are provided in the cutting blade portion of the medical treatment instrument of the present invention, and the blade made of the movable first electrode and the insulator is Opposed to each other. The blade made of an insulator is bonded and fixed to the fixed second electrode, moves integrally with the fixed second electrode, and is positioned between the movable first electrode and the fixed second electrode in a series of operations. A portion composed of the movable first electrode, the fixed second electrode, and a blade made of an insulator is also referred to as an electrode portion. The movable first electrode is rotatable about a rotation axis. The rotation axis of the movable first electrode is on the surface of the outer conductor at a certain distance from the center electrode, and the movable first electrode is electrically coupled to the outer conductor by this rotation axis. The fixed second electrode is fixed and is directly connected to the center electrode.

  The medical treatment instrument of the present invention is capable of grasping a living tissue between a movable first electrode and a blade made of an insulator. The blade made of an insulator is bonded and fixed to the fixed second electrode, and has a size that covers the entire inside of the fixed second electrode so that the fixed second electrode does not directly contact the movable first electrode. is there. The blade line of the blade made of the insulator and the upper side of the fixed second electrode are on the same plane, and when the blade made of the insulator comes into contact with the living tissue, the living tissue can also come into contact with the fixed second electrode. The blade made of an insulator and the fixed second electrode are brought into contact with the biological tissue to be coagulated and cut, and then the blade of the movable first electrode is brought into contact with the biological tissue by the rotation of the movable first electrode. At this time, it is possible to secure a state where the blade line of the movable first electrode and the blade line of the insulator are separated from each other by a certain distance such as a parallel state, and the living tissue is grasped by the gap between the two blades. Good.

  Since the fixed second electrode of the present invention is directly connected to the center electrode, microwaves are efficiently supplied from the center electrode. When the blade made of an insulator and the fixed second electrode come into contact with the living tissue, the microwave is irradiated from the fixed second electrode to the living tissue, the movable first electrode is energized from the living tissue, and the microwave is applied to the external conductor. Will flow. Preferably, microwaves are irradiated from the fixed second electrode after grasping the living tissue between the blade made of an insulator and the movable first electrode.

  When a living tissue is grasped between the movable first electrode and the blade made of an insulator, and microwaves are supplied from the fixed second electrode, the microwave formed between the movable first electrode and the fixed second electrode Dielectric heat is generated in the living tissue due to a near electromagnetic field caused by electric power. The living tissue is solidified by this dielectric heat. Then, when the movable first electrode is further rotated from the state of the coagulation treatment, the blade of the movable first electrode and the blade made of the insulator intersect and the living tissue is cut by shearing.

  When the movable first electrode and the fixed second electrode are too close to each other, a spark is generated, which causes excessive damage to the living tissue. In addition, when a part of the blade of the fixed second electrode comes into contact with the living tissue in a state where the movable first electrode and the living tissue are in contact with each other, microwaves concentrate on one portion of the blade and spark is generated due to excessive electric power. Cause excessive damage. A blade made of an insulator is present between the movable first electrode and the fixed second electrode in a series of operations, thereby ensuring a state in which the insulator is separated between the movable first electrode and the fixed second electrode, By avoiding sparks due to approach and grasping the living tissue to be coagulated and cut between the blade of the movable first electrode and the blade made of an insulator, coagulation can be achieved without causing excessive damage of the living tissue, and more Reliable cutting can be achieved.

  The shape of the blade made of both electrodes and insulator is not particularly limited as long as it has a gripping function, a coagulation function, and a cutting function, according to a known purpose. The contact portion of the blade made of the electrode and the insulator with the living tissue can be widely applied, such as a straight shape, a curved shape, and an uneven shape. The electrode is a general conductor, and is formed of a copper alloy such as gold or silver plated copper, gold or silver plated brass, or phosphor bronze. The blade made of an insulator is not limited as long as it has an insulator function, and is formed of a synthetic resin, glass fiber, earthenware, or the like. Preferred is ceramic or the like, and fine ceramic is particularly suitable.

  The blade made of an electrode or an insulator is more preferably coated so that the solidified tissue does not easily adhere to the living tissue. Coating is performed with gold, a Teflon (registered trademark) -based member, or the like. Thereby, the coagulation | solidification and cutting | disconnection process can be performed continuously, without the biological tissue after coagulation | attachment adhering.

  One preferable embodiment of the medical device of the present invention includes the blade line of the blade of the movable first electrode and the center line of the blade line made of an insulator, and the surface of the movable first electrode on a plane perpendicular to both blades. There is a pivot axis. If it is the position of this rotation axis | shaft, the cutting | disconnection of a biological tissue is more reliable. In addition, due to the presence of the blade made of an insulator, the occurrence of sparks can be avoided even if both blades overlap. “The center line of the blade line of the movable first electrode and the blade line of the blade made of an insulator” means the blade line of the movable first electrode and the blade line of the fixed second electrode as shown by the line L in FIG. It is a line located at the center. The movement of the blade line is determined by the position of the rotation axis of the movable first electrode and the position of the blade line. For example, the gap or overlap width when parallel to the blade line of the blade made of an insulator, the angle when the blade further rotates and intersects the blade made of the insulator, the contact position of both blades in the intersecting operation, etc. .

  In a preferred embodiment of the medical device of the present invention, the distance between the rotation axis of the movable first electrode and the electrode opening / closing rod connecting point is equal to or larger than the radius of the conductive rod. The connection point of the electrode opening / closing rod is the point of action of the reciprocating force of the opening / closing rod, and is the point where the force of the reciprocating motion is transmitted as the rotational force. The connection point of the electrode opening / closing rod and the rotation shaft are connected, and the force applied to the connection point of the electrode opening / closing rod is transmitted to the rotation shaft so that the movable first electrode rotates. At this time, the longer the distance between the connection point of the electrode opening / closing rod and the rotation shaft, the smaller the force can be rotated.

The distance between the connection point of the rotation shaft and the electrode opening / closing rod is a linear distance between the connection point of the rotation shaft and the electrode opening / closing rod. There is no particular limitation on the connection method as long as the connection point of the rotating shaft and the electrode opening / closing rod is connected by a plate-like object, rod-like object, linear object, etc., and the same plate on the same electrode plate or separated from the electrode For example, they are connected by a connecting rod or a connecting wire. It is preferably connected by a connecting rod.
The connecting plate, the bar, etc. may be a plane or a straight line, but may be a curved surface or a curve along the outer periphery of the conductive rod. The rotating shaft is connected to the conductive rod and is electrically connected to the outer conductor. The distance between the connection point of the rotating shaft and the electrode opening / closing rod is preferably not less than the radius of the conductive rod and not more than the diameter. The movable first electrode can be rotated with a smaller force than the radius. If the diameter is larger than the diameter, it is difficult to store in the outer tube.
The electrode opening / closing rod connection point may be on the same circumference as the rotation axis, or may be on the leading end side or the rear side of the conductive rod from the position.

  The conductive rod transmits the microwave from the microwave transmission source to the fixed second electrode through the connector portion. The conductive rod is preferably composed of a coaxial cable. The coaxial cable is composed of, for example, a center electrode of a conductor made of phosphor bronze, an insulating shield tube made of, for example, Teflon (registered trademark) covering the center electrode, and an earth pipe of an outer conductor (conductor) made of, for example, brass. Become. The outside of the conductive rod may be covered with a shield holder (also referred to as a guide tube). The shield holder is preferably made of a non-conductive member [for example, a non-magnetic coil such as Teflon (registered trademark) or phosphor bronze].

A structure having a thickness is preferably provided between the conductive rod used in the present invention and the electrode portion, and the movable first electrode or the center electrode can be moved from the fixed second electrode or the center electrode without grasping the living tissue. Electrical conduction to the outer conductor is eliminated. Preferably, the structure has a thickness equal to or greater than the radius of the conductive rod. If this structure is thin, microwaves may leak from the center electrode or the fixed second electrode to the outer conductor or the movable first electrode.
Preferably, the structure is an insulator. The insulator is preferably composed of a non-conductive member [for example, non-magnetic coil such as Teflon (registered trademark), phosphor bronze, polyether ether ether ketone resin, etc.].

  In the medical device of the present invention, the microwave is preferably transmitted by a coaxial cable until just before the electrode portions of the movable first electrode and the fixed second electrode. The outer conductor of the coaxial cable is directly connected to the movable first electrode, and the central electrode of the coaxial cable is directly connected to the fixed second electrode. With this structure, the microwave can be transmitted efficiently by energizing the microwave.

  The medical treatment tool of the present invention has an operation part for giving a back-and-forth movement to the electrode opening / closing rod. The operation unit carries, for example, a swingable movable handle, converts this movement into a front / rear movement by an operation such as pulling, grasping, and rotating, and transmits the movement to the electrode opening / closing rod to open / close the movable first electrode. Say part. Specifically, a widely known mechanism such as a slider crank is used to load an operation unit such as a movable handle to cause a swinging motion, convert this swinging into a back-and-forth motion, and transmit it to the electrode opening / closing rod. A mechanism can be used. The operation unit includes, for example, a main body portion including a movable handle portion and a fixed handle as main components, and includes an electrode opening / closing rod that transmits the movement of the movable handle as a back-and-forth movement in the fixed handle portion. An electrode operation adjusting unit that adjusts the movement may be included. The electrode operation adjusting unit has a function of adjusting the rotation of the movable first electrode. For example, the electrode operation adjusting unit adjusts the interval between the blade line of the movable first electrode and the blade line of the fixed second electrode when parallel. It may have a function that can.

  The medical treatment tool of the present invention has a tubular outer tube as a part connecting the operation unit and the electrode, the outer tube serves as a cover, and an electrode opening / closing rod is housed therein, A conductive rod for transmitting microwaves is accommodated. The length of the outer tube is about 10 to 25 cm, and is not particularly limited as long as it is long enough to connect between the operator's operation part and the electrode part that is a contact part between the surgical target tissue and the like. . The medical treatment instrument of the present invention is preferably formed using a non-magnetic metal as a whole, such as phosphor bronze. Thereby, for example, it can be suitably used even in a magnetic field environment by an MR system.

  In the present invention, the electrode opening / closing rod means an operation axis that links the movement generated by the operation unit as a back-and-forth movement to the movable first electrode, and is generally constituted by a wire, and the force from the operation unit is applied to the electrode. Tell the department. The electrode opening / closing rod is preferably guided outside by a guide tube. In the present invention, a microwave of 900 to 6000 MHz can be used equally.

In the medical treatment instrument of the present invention, the outer tube and the electrode part may be connected by a bent holder. The length of the bent holder is approximately 3 to 6 cm, and the angle is 1 to 90 degrees, preferably 5 to 85 degrees. The bent holder may be a bent portion integrally with the outer tube, and may mean a bent portion near the tip electrode, that is, the neck portion in the same outer tube.
The bent holder has a cylindrical shape, and includes a conductive rod that may be covered with a shield holder therein and an electrode opening / closing rod that may be installed in the guide tube. The conductive rod and the electrode opening / closing rod installed in the bent holder have a curvature of approximately the same angle in the same direction as that of the bent holder.

  The medical treatment instrument of the present invention can freely rotate the outer tube and / or the bent holder so that the operator can easily perform the upper, lower, and lateral surgical procedures. For this rotation, a rotator for rotating the outer tube and / or the bent holder can be provided at the connecting portion between the outer tube and the operation unit.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. FIG. 1 is a reference diagram, and FIGS. 2 to 6 are diagrams of features of the present invention.

  FIG. 1 shows one embodiment of the medical treatment instrument of the present invention. In FIG. 1, 11 is a main body. A connector 12 is disposed at the rear end of the main body 11. For example, a microwave of 2.45 GHz band is supplied via the connector 12. An outer tube 13 is led out from the main body 11. Housed in the outer tube 13 are a conducting wire rod 6 for transmitting the microwave power from the connector 12 and an electrode opening / closing rod 5 for transferring the movement of the movable handle 14 to the movable first electrode 1 to open and close the electrode. .

  A movable handle 14 is swingably attached to the lower side of the main body 11. A slider crank mechanism that converts the swinging movement of the movable handle 14 into the back-and-forth movement of the electrode opening / closing rod 5 is provided in the main body 11. The main body 11 is provided with a rotator 15. By rotating the rotator 15, the outer tube 13 fixed to the rotator 15 can be rotated to a desired angle.

  As shown in FIG. 2, the movable first electrode 1 and a blade 17 made of an insulator are provided at the tip of the outer tube 13 so as to face each other. The movable first electrode 1 is provided so as to be rotatable about a rotation shaft 3. When the movable handle 14 is swung, the electrode opening / closing rod 5 in the outer tube 13 moves back and forth, and this force acts on the electrode opening / closing rod connection point 4. The electrode 1 rotates. The microwave from the connector 12 is supplied to the fixed second electrode through the center electrode 7 at the center of the conductor rod 6. The blade 17 made of an insulator is bonded and fixed to the fixed second electrode 2 and is positioned between the movable first electrode 1 and the fixed second electrode 2 (FIG. 3).

  When no force is applied to the movable handle 14, the movable handle 14 is urged in the direction of arrow A1 in FIG. At this time, as shown in FIG. 5A, the movable first electrode 1 is separated from the blade 17 and the fixed second electrode 2 made of an insulator, and the blade edge is in an open state. When the movable handle 14 is swung in the arrow A2 direction, the electrode opening / closing rod moves in the B2 direction shown in FIG. 5B, and the movable first electrode 1 and the blade 17 made of an insulator approach each other. When the movable handle 14 is further swung in the arrow A2 direction, the electrode opening / closing rod further moves in the B2 direction, and the blade edge is closed as shown in FIG.

  The medical treatment tool of one embodiment of the present invention is used as follows. First, the movable first electrode 1 and the blade 17 made of an insulator are set in an open state as shown in FIG. 5A, and the blade 17 made of an insulator and the fixed second electrode 2 are guided to a target living tissue. To do. When the movable first electrode 1, the fixed second electrode 2, and the blade 17 made of an insulator are guided to the biological tissue to be treated, first, the blade 17 made of the insulator and the blade of the fixed second electrode are coagulated and cut. Then, the movable handle 14 is swung in the direction of arrow A2. When the movable handle 14 is swung in the direction of the arrow A2, the movable first electrode 1 is rotated, and the living tissue can be grasped between the movable first electrode 1 and the blade 17 made of an insulator. A microwave is supplied from the fixed second electrode 2 while grasping the living tissue. As a result, dielectric heat is generated in the living tissue due to a near electromagnetic field formed by the microwave power formed between the movable first electrode 1 and the fixed second electrode 2. The living tissue is solidified by this dielectric heat. Then, the movable handle 14 is further gripped from the state of the coagulation treatment, and further swung in the direction of the arrow A2. By this operation, the movable first electrode 1 and the blade 17 made of an insulator are in a state as shown in FIGS. 5B and 5C, and the living tissue is cut by shearing.

  As described above, in the medical treatment instrument according to the embodiment of the present invention, by operating the movable handle 14, the blade edge is opened to the blade edge closed state as shown in FIGS. 5 (A) to 5 (C). Become. Accordingly, the living tissue is grasped by the movable first electrode 1 and the blade 17 made of an insulator, and the living tissue is solidified by applying a microwave between the movable first electrode 1 and the fixed second electrode 2. The living tissue can be cut by shearing with the first electrode 1 and the blade 17 made of an insulator in a closed state.

  Moreover, the medical treatment tool of one Embodiment of this invention is formed using nonmagnetic metals for the whole structure, such as phosphor bronze. Thereby, for example, it can be suitably used even in a magnetic field environment by an MR system.

  In the outer tube 13, the conductive rod 6 and the electrode opening / closing rod 5 shown in FIGS. 2 to 6 are accommodated. The conductive rod 6 includes, for example, a conductor center electrode 7 made of phosphor bronze, an insulator 9 made of Teflon (registered trademark) covering the center electrode, and an outer conductor (conductor) pipe made of, for example, brass (earth). Pipe) 8 (FIG. 4).

  An insulator 10 made of, for example, polyether, ether, or ketone resin is attached to the tip of the conducting wire 6, and the fixed second electrode 2 is fixed to the insulator 10. The fixed second electrode 2 is directly connected to the center electrode 7 of the conducting wire rod 6. The insulator has a thickness between the radius and the diameter of the conductive rod.

  On the other hand, as shown in FIGS. 2 and 5, the movable first electrode 1 is pivotally supported by a pivot shaft 3. The end of the electrode opening / closing rod 5 is connected to the electrode opening / closing rod connection point 4. The electrode opening / closing rod connection point 4 is connected to the rotating shaft 3 by a connecting rod 16.

  The movable first electrode 1, the fixed second electrode 2, and the blade made of an insulator are coated with a Teflon (registered trademark) -based member, gold plating, or other anti-adhesion coating so that the living tissue after coagulation adheres. Continuously solidification and cutting can be performed.

  The present invention is not limited to the above-described actual form, and various modifications and applications are possible without departing from the gist of the present invention. For example, a non-magnetic metal is used as a medical treatment tool used in MRI, but a magnetic metal can be applied as a medical treatment tool used in X-rays.

1: movable first electrode 2: fixed second electrode 3: rotating shaft 4: electrode open / close rod connection point 5: electrode open / close rod 6: conductive rod 7: center electrode 8: external conductor 9: insulator 10: insulator 11 : Main body 12: Connector 13: Outer tube 14: Movable handle 15: Rotor 16: Connecting rod 17: Blade made of an insulator

Claims (10)

  A cutting blade portion of a medical treatment instrument has a movable first electrode coupled to an outer conductor, a fixed second electrode coupled to a center electrode, and a blade made of an insulator, and the movable first electrode A medical tissue having an action of grasping a living tissue between a blade made of an insulator, supplying a microwave to the fixed second electrode to coagulate the living tissue, and cutting the living tissue by rotating the movable first electrode A medical treatment instrument, which is a treatment instrument, wherein a blade made of an insulator is fixed to a fixed second electrode, and is positioned between the movable first electrode and the fixed second electrode.   The medical treatment tool according to claim 1, wherein the upper side of the fixed second electrode and the blade line of the blade made of an insulator are on the same plane.   A structure having a thickness is provided between the conductive rod and the electrode portion, and energization from the fixed second electrode or the center electrode to the movable first electrode or the external conductor is eliminated without grasping the living tissue. Item 3. A medical treatment instrument according to item 1 or 2.   The medical treatment instrument according to claim 3, wherein the thickness is equal to or greater than the radius of the conductive rod.   The medical treatment instrument according to claim 3 or 4, wherein the thick structure is an insulator.   The medical treatment instrument according to any one of claims 1 to 5, wherein an outer conductor and a center electrode of a coaxial cable are directly connected to the movable first electrode and the fixed second electrode, respectively.   The medical treatment tool according to any one of claims 1 to 6, wherein the blade made of an insulator is a blade made of an insulator containing ceramic.   8. The rotating shaft of the movable first electrode is located on a plane that includes the blade line of the blade of the movable first electrode and the center line of the blade line of the insulating blade and intersects the blades at right angles. A medical treatment device according to any one of the above.   The medical treatment tool according to any one of claims 1 to 8, wherein the electrode opening / closing rod connecting point and the rotation shaft are connected by a connecting rod.   The medical treatment instrument according to any one of claims 1 to 9, wherein the blade made of the movable first electrode, the fixed second electrode, and the insulator is coated with a solidified tissue that hardly adheres. .