JP2012070926A - Insulating cover and surgical treatment instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an insulating cover which is easy to attach before surgery and easy to remove after surgery, is not likely to come off during surgery or not likely to be caught in a trocar when a shaft is pulled out of the trocar, and to provide a surgical treatment instrument including it.SOLUTION: In a manipulator 1 (a surgical treatment instrument), the insulating cover 10 is mounted on the distal end of a shaft of a manipulator body 11. The insulating cover 10 includes: a cover body 102; and a base end member 104 connected to the base end of the cover body 102. The inner peripheral part of the base end member 104 is provided with a female screw part 120 to be screwed to a male screw part 27 provided on the distal end of the surgical treatment instrument. The most base end of the base end member 104 is provided with a tapered part 122 gradually decreased in outer diameter as it goes toward the base end.

Description

  The present invention relates to an insulating cover and a surgical treatment instrument to be attached to a distal end working unit provided at a distal end portion of a surgical treatment instrument configured to function as an electric knife for laparoscopic surgery.

  In endoscopic surgery (also called laparoscopic surgery), a plurality of holes are opened in the patient's abdomen, etc., trocars (tubular instruments) are inserted into these holes, and then through each trocar, A laparoscope (camera) and a plurality of forceps are inserted into the body cavity. A gripper, a scissors, a blade of an electric knife, and the like are attached to the distal end portion of the forceps as an end effector for gripping a living tissue or the like.

  After the laparoscope and forceps are inserted into the body cavity, the operation is performed by operating the forceps while observing the inside of the abdominal cavity reflected on a monitor connected to the laparoscope. Since such an operation method does not require laparotomy, the burden on the patient is small, and the number of days until recovery and discharge from the operation is greatly reduced. For this reason, such an operation method is expected to expand the application field. For example, Patent Document 1 shown below is a document showing a conventional technique of forceps for endoscopic surgery.

  Some of such forceps for endoscopic surgery are configured to function as a monopolar electric knife. That is, such a forceps has an end effector that functions as an active electrode at the tip of the shaft, and uses a counter electrode plate that is in contact with the living body as a return electrode to apply a high-frequency current to a contact portion (biological tissue) of the end effector. When energized, the living tissue is cauterized (see, for example, Patent Document 1 below).

US Patent Application Publication No. 2006/0079884

  By the way, in the case of using a medical manipulator in which the end effector provided at the distal end portion has mobility of multiple degrees of freedom as a monopolar electric knife for endoscopic surgery, it is a posture changing mechanism of the end effector. When the structural member of the joint is a metal part, it is necessary to prevent the unintentional burn from coming into direct contact with the living tissue directly or indirectly through blood, body fluid, etc. It is conceivable to install an insulating cover.

  In this case, it is desirable that such an insulating cover is easy to attach before surgery and easy to remove after surgery. Further, when pulling out the shaft provided with the end effector at the tip from the trocar, there is a concern that if the insulating cover is caught on the trocar, the insulating cover is detached from the shaft, the insulating cover is damaged, or the trocar is detached from the patient.

  The present invention has been made in consideration of such problems, and is an insulating cover that is easy to attach before surgery, difficult to remove during surgery, easy to remove after surgery, and not easily caught by the trocar when the shaft is pulled out from the trocar. An object of the present invention is to provide a surgical treatment instrument equipped with the same.

  In order to achieve the above object, the present invention provides a distal end working portion provided at a distal end portion of a shaft extending from a main body portion of a surgical treatment instrument configured to function as an electric knife for laparoscopic surgery. A cylindrical cover body made of a flexible material having a distal end opening through which an end effector constituting the distal end portion of the distal end working part can be inserted; and A cylindrical base end member connected to the base end portion and configured to be detachable from the tip end portion of the surgical treatment instrument, and the distal end portion of the surgical treatment instrument has a male structure that can be engaged with each other And the female structure is provided on the base end member, and the other of the male structure and the female structure is provided on the base end member, and the base end portion of the base end member faces the base end side. And a tapered portion whose outer diameter is reduced.

  The insulating cover configured as described above can be attached to the distal end portion of the surgical treatment instrument by engagement (fitting) with a male structure and a female structure, so that it can be easily attached before the operation and removed after the operation. Easy to do. Further, since the male structure and the female structure are attached to the tip of the shaft, the insulating cover does not come off the shaft even if the insulating cover and the trocar come into contact with each other when the shaft is pulled out from the trocar. Furthermore, even when the insulating cover and the trocar come into contact with each other when the shaft is pulled out from the trocar, the insulating cover is smoothly guided into the trocar by the action of the tapered portion provided at the most proximal end portion of the proximal end member. The trocar is not caught on the insulating cover, and the insulating cover can be prevented from falling off the shaft and the trocar from coming off the patient.

  In the above insulating cover, the engagement structure formed by the male structure and the female structure may be a screw structure or a latch structure.

  According to said structure, since an engagement or a disengagement is made | formed by rotating an insulation cover with respect to a shaft, attachment / detachment of an insulation cover is easy and it is hard to remove an insulation cover from a shaft.

  In the above-described insulating cover, it is preferable that at least one slit extending along the axial direction is formed in the base end portion of the base end member.

  According to the above configuration, since the inner peripheral surface of the tapered portion is in close contact with the outer peripheral surface of the shaft, the step between the tapered portion and the outer peripheral surface of the shaft can be reduced, so that the shaft can be more smoothly removed from the trocar. It becomes.

  In the above insulating cover, the base end portion of the cover body has a base end insertion portion that fits into the inner peripheral portion of the base end member, and the inner peripheral portion of the base end insertion portion has a circumferential direction. It is preferable that an inner annular convex portion extending over the entire circumference of the inner annular projection is formed.

  According to said structure, it can prevent that a liquid permeates into the front-end | tip operation | movement part side through between a fitting part and a shaft, and can ensure the function of an insulating cover suitably.

  The present invention also relates to a surgical treatment instrument configured to function as an electric knife for laparoscopic surgery, comprising a main body, a shaft extending from the main body, and a distal end of the shaft. A tip operating portion provided and an insulating cover that can be attached to the tip operating portion, wherein the insulating cover is one of the above-described insulating covers.

  The insulating cover according to the present invention is easy to attach before the operation, easy to remove after the operation, and does not easily come off from the distal end working part even if it comes into contact with the trocar when the shaft is pulled out from the trocar. In addition, since this insulating cover is difficult to be caught by the trocar, the trocar is not easily detached from the patient.

It is a perspective view of the medical manipulator which is a surgical treatment tool. It is a partially omitted side view showing the medical manipulator in a state where the operation unit and the working unit are separated. It is a perspective view of the insulating cover which concerns on the front-end | tip operation | movement part of a medical manipulator and one Embodiment of this invention. It is a side view of the insulation cover of the state with which the front-end | tip operation | movement part of the medical manipulator was mounted | worn. It is sectional drawing of the insulation cover of the state with which the front-end | tip operation | movement part of the medical manipulator was mounted | worn. It is a figure explaining the effect of an insulating cover. It is a perspective view of the insulating cover which concerns on a 1st reference example. It is a side view of the insulating cover which concerns on the 1st reference example of the state with which the front-end | tip operation | movement part was mounted | worn. FIGS. 9A and 9B are diagrams for explaining the operation and effect of the insulating cover according to the first reference example, in which FIG. 9A is a diagram when the protruding portion of the insulating cover and the trocar are in contact, and FIG. 9B is other than the protruding portion of the insulating cover. It is a figure when the part of and a trocar contact. FIG. 10A is a longitudinal sectional view of an insulating cover according to the second reference example, and FIG. 10B is a longitudinal sectional view of the insulating cover according to the second reference example in a state of being attached to the distal end working unit.

  Hereinafter, preferred embodiments of an insulating cover according to the present invention and a surgical treatment instrument including the same will be described with reference to the accompanying drawings. FIG. 1 is a perspective view of a surgical treatment instrument to which an insulating cover 10 is attached. The surgical treatment instrument according to the illustrated example is a medical manipulator 1 (hereinafter referred to as a manipulator) that operates an end effector 19 provided at a distal end when a user (medical staff such as a doctor) holds and operates the surgical treatment instrument. It is configured.

  Before describing the configuration of the insulating cover 10, first, the configuration of the manipulator to which the insulating cover 10 is attached will be described.

  The manipulator 1 is a medical instrument for holding a part of a living body or touching the living body with a distal end working unit 12 provided at the tip, and usually performs grasping forceps or a needle driver (holding tool). It is also called a needle). The manipulator 1 includes a manipulator body 11 constituting a medical instrument, and a controller 29 connected to the manipulator body 11 via a cable 28. The manipulator body 11 includes a body 21, a shaft 18 extending from the body 21, and a distal end working unit 12 provided at the distal end of the shaft 18 and including an end effector.

  In the following description, the extending direction of the shaft 18 is defined as the Z direction, and the front (tip side) of the shaft 18 is defined as the Z1 direction and the rear (root side) is defined as the Z2 direction. Further, the right-and-left direction with respect to the manipulator body 11 when the manipulator body 11 is in the posture shown in FIG. 1 is the X direction, and in particular, the left side direction of the manipulator body 11 is the X1 direction, The right direction is defined as the X2 direction. Further, the vertical direction of the manipulator body 11 when the manipulator body 11 is in the posture shown in FIG. 1 is defined as the Y direction, and in particular, the upper direction is defined as the Y1 direction and the lower direction is defined as the Y2 direction. To do.

  Unless otherwise specified, the description of these directions is based on the case where the manipulator body 11 is in the reference posture (neutral posture). These directions are for convenience of explanation, and it is needless to say that the manipulator body 11 can be used in any direction (for example, upside down).

  The manipulator main body 11 includes an operation unit 14 that is gripped and operated by a hand and a work unit 16 that is detachable from the operation unit 14. The operation unit 14 constitutes a part of the body 21 described above, constitutes a housing, and a pair of left and right upper covers 25a and 25b extending in a substantially L shape in the Z1 direction and the Y2 direction, and the upper covers 25a and 25b. It has the drive part 30 accommodated in the inside, and the composite input part 24 operated manually.

  The drive unit 30 includes two motors 50 a and 50 b as a drive source 50 for changing the posture of the tip operation unit 12, and the driving force of the drive source 50 is applied to the tip operation unit 12 provided at the tip of the shaft 18. By being transmitted mechanically, the posture of the end effector 19 can be changed.

  A portion extending in the Y2 direction on the proximal end side of the operation unit 14 is configured as a grip handle 26 that is gripped by a hand. The composite input unit 24 is provided on the inclined surface of the upper part of the grip handle 26, and performs a rotation operation in the left-right direction with respect to the rotation operation unit 90 and a tilt operation with respect to the tilt operation unit 92, either alone or in combination. A signal corresponding to the operation is transmitted to the controller 29, and the controller 29 controls the driving of the driving unit 30, whereby the posture of the distal end working unit 12 is changed.

  The controller 29 is a control unit that comprehensively controls the manipulator body 11 and is connected to a cable 28 that extends from the lower end of the grip handle 26. A part or all of the functions of the controller 29 can be integrally mounted on the operation unit 14, for example.

  The working unit 16 includes a pair of lower covers 37a and 37b divided substantially symmetrically in the Z direction as a housing. The distal end working unit 12 and the long and hollow provided with the distal end working unit 12 at the distal end are provided. The shaft 18, the base end side of the shaft 18 is fixed, the pulley box 32 accommodated in the lower covers 37a and 37b, the rear of the pulley box 32, and the axis in the X direction with the trigger shaft 39 as a fulcrum. And a trigger lever 36 pivotally supported at the center. The lower covers 37a and 37b, the pulley box 32, and the trigger lever 36 constitute a part of the body 21 described above.

  FIG. 2 is a partially omitted side view showing the manipulator body 11 in a state where the operation unit 14 and the working unit 16 are separated. As shown in FIG. 2, the drive unit 30 includes the above-described motors 50a and 50b, a drive bevel gear 58a (58b) fixed to each output shaft 56a (56b) of the motor 50a (50b), and a drive umbrella. A driven bevel gear 62a (62b) that meshes with the gear 58a (58b) and a drive shaft 60a (60b) to which the driven bevel gear 62a (62b) is fixed. At the lower end of the drive shaft 60a (60b), for example, an engaging convex portion 64a (64b) having a cross-sectional wave shape is provided. With this configuration, the rotational driving force of the motor 50a (50b) is transmitted to the drive bevel gear 58a (58b), the driven bevel gear 62a (62b), the drive shaft 60a (60b), and the engaging convex portion 64a (64b). The

  The pulley box 32 is provided with pulleys 70a and 70b. The pulley 70a (70b) is coaxial with the drive shaft 60a (60b) in a state where the working unit 16 is attached to the operation unit 14. At the upper end of the pulley 70a (70b), an engaging recess 74a (74b) having a corrugated cross section, for example, exposed from the upper surface of the pulley box 32 is provided. Therefore, when the operating portion 14 and the working portion 16 are mounted, the engaging convex portion 64a (64b) and the engaging concave portion 74a (74b) are engaged with each other, and thereby the rotational driving force from the drive shaft 60a (60b). Can be transmitted to the pulley 70a (70b). The engagement structure of the engagement convex part 64a and the engagement concave part 74a may be another structure.

  A wire (not shown) is wound around each of the pulleys 70a and 70b as a power transmission member. These wires are inserted into the shaft 18 and transmit driving force to the posture changing mechanism 13 provided in the distal end working unit 12 (see FIG. 1). Thereby, the rotational driving force from the drive shaft 60a (60b) is transmitted to the posture changing mechanism 13 via the pulley 70a (70b) and the wire, and the posture of the end effector 19 is changed.

  As a mechanism for converting the operation of the trigger lever 36 into an opening / closing operation of the end effector 19 and a mechanism for converting the driving of the drive source 50 into an operation of changing the attitude of the end effector 19, for example, Japanese Patent Application Laid-Open No. 2008-104855. You may employ | adopt the structure similar to the structure described in gazette and Unexamined-Japanese-Patent No. 2009-106606.

  As shown in FIG. 1, the working unit 16 is connected and fixed to the operation unit 14 by a pair of left and right attachment / detachment levers 40, 40 provided in the operation unit 14, and is operated by opening the attachment / detachment lever 40. And can be easily exchanged at the operation site without using a special instrument.

  The distal end working unit 12 and the shaft 18 are configured to have a small diameter, and can be inserted into the body cavity 22 through a cylindrical trocar 20 attached to a patient's abdomen or the like. The distal end working unit 12 includes an end effector 19 that operates based on the operation of the trigger lever 36 and a posture changing mechanism 13 that changes the posture of the end effector 19 based on the operation of the composite input unit 24. In the illustrated configuration example, the end effector 19 includes a pair of gripper members 19a and 19b, and is configured as a gripper mechanism that opens and closes based on a predetermined opening and closing operation axis.

  The manipulator body 11 is configured to be electrically connectable to the high frequency power supply 23 via the cable C1. In the manipulator body 11, an energization path E <b> 1 electrically connected to the distal end working unit 12 is disposed along the shaft 18. The energization path E1 can be electrically connected to the cable C1 through an electrode plug 71 provided in the body 21. The electrode plug 71 is electrically connected to the wire 80b via the conductive portion E2, and thereby the wire 80b functions as the energization path E1 in the shaft 18.

  Note that the wire 80a may function as the energization path E1 by connecting the conductive portion E2 to the other wire 80a. Alternatively, the energization path E1 does not use the wire 80a or the wire 80b, but a conductive wire independent of the wires 80a and 80b is disposed in the shaft 18 along the axial direction, and such a conductive wire is disposed in the energization path E1. It is good.

  One cable C1 connected to the high-frequency power source 23 is electrically connected to the energization path E1, and the counter electrode 31 provided at the end of the other cable C2 connected to the high-frequency power source 23 is brought into contact with the patient M to The end effector 19 is brought into contact with the living tissue of the patient M in a state where a high frequency current is generated by the power source 23. Then, the end effector 19 is used as an active electrode, and the counter electrode plate 31 is used as a return electrode, so that a high-frequency current flows intensively in the contact site (biological tissue) of the end effector 19. Thereby, the living tissue contacted by the end effector 19 can be cauterized and incised or coagulated.

  When the working unit 16 having a gripper or gripper for gripping the affected part is attached to the operation unit 14 as the end effector 19, the manipulator 1 functions as a scissors or gripping forceps for performing work such as excision and gripping of the affected part. To do.

  The trigger lever 36 includes an arm portion 36a that is pivotally supported by a trigger shaft 39 provided at an end portion on the Z2 direction side in the lower covers 37a and 37b, and a trigger operator 36b that is provided below the arm portion 36a. Have The trigger shaft 39 is fixed to a support plate 45 (see FIG. 2) provided on the Z2 side of the pulley box 32.

  The opening / closing operation of the end effector 19 is performed by mechanically transmitting a force based on a manual operation (push / pull operation) of the trigger lever 36. The working unit 16 is provided with a transmission mechanism including a rod, a wire (power transmission member), a pulley, and the like. The push lever of the trigger lever 36 is operated to open and close the end effector 19 by the transmission mechanism. It has been converted to.

  FIG. 3 is a perspective view of the distal end working unit 12 including the posture changing mechanism 13. The posture changing mechanism 13 can perform a roll operation that rotates with a roll axis Or pointing toward the tip (Z axis in a neutral posture) as a reference and a yaw operation (tilt operation) that tilts with respect to the Y-direction yaw axis Oy as a reference. Yes, the roll operation and the tilting operation can be performed selectively or in combination. Therefore, the distal end working unit 12 can perform a three-axis operation including an opening / closing operation, a roll operation, and a yaw operation of the end effector 19.

  The posture changing operation (roll operation and yaw operation) of the tip operation unit 12 is driven by the drive source 50 based on the operation of the composite input unit 24 having the rotation operation unit 90 and the tilt operation unit 92, and the drive source 50 is driven. This is performed by mechanically transmitting the force to the distal end working unit 12. In the illustrated manipulator body 11, the tip operation unit 12 is rolled by performing a rotation operation in the left-right direction with respect to the rotation operation unit 90, and the tilting operation is performed on the tilting operation unit 92. The yaw operation of the tip operating unit 12 is performed.

  The distal end working unit 12 is at least a cylindrical first cover member 94 fixed to the distal end portion of the shaft 18, and is rotatable about the yaw axis Oy with respect to the first cover member 94 and a roll shaft. It has a cylindrical second cover member 96 that can rotate around Or, and an end effector 19 connected to the second cover member 96.

  The first cover member 94, the second cover member 96, and the end effector 19 are all metal parts, and the wire 80 b is a component part of the posture changing mechanism 13 inside the distal end portion of the first cover member 94. Is wound around a rotating body 98. The rotating body 98 is made of metal and is electrically connected to the first cover member 94 and the second cover member 96. For this reason, if the 1st cover member 94 or the 2nd cover member 96 contacts living tissue at the time of energization, it will have cauterization ability like an electric knife. In addition, since at least the outer peripheral surface of the shaft 18 is made of a resin material (insulating material), even if the living tissue comes into contact with the outer peripheral surface of the shaft 18 when energized, the living tissue is not cauterized. .

  Therefore, when performing a laparoscopic operation using the manipulator 1 in order to prevent the first cover member 94 or the second cover member 96 of the distal end working unit 12 from contacting the living tissue and causing unintended burns. In addition, the insulating cover 10 shown in FIGS. 3 and 4 is attached to the distal end working unit 12.

  In FIG. 3, the insulating cover 10 that is not attached to the distal end working unit 12 is indicated by a solid line, and the insulating cover 10 that is attached to the distal end working unit 12 is indicated by a virtual line. FIG. 4 is a side view of the insulating cover 10 in a state where it is mounted on the distal end working unit 12. As shown in FIGS. 3 and 4, the insulating cover 10 according to the embodiment of the present invention includes a cover body 102 and a base end member 104.

  The cover main body 102 is a hollow cylindrical member as a whole, and a round dome portion 106 is formed at the tip thereof. The dome part 106 has a tip opening part 108 through which the end effector 19 can be inserted. The tip opening 108 in the illustrated example is formed as a slit-like cut, but the present invention is not limited to this, and a configuration in which a circular hole is formed at the tip may be used. The cover main body 102 is made of a flexible material (for example, silicon rubber) so as to allow the posture changing operation of the distal end working unit 12, that is, deformable following the posture changing operation of the distal working unit 12. Has been. The material constituting the cover main body 102 is preferably biocompatible.

  The proximal end member 104 is a cylindrical member that is connected to the proximal end portion of the cover main body 102 and is configured to be detachable from the distal end portion of the shaft 18. The base end member 104 is made of a hard resin material. The resin material constituting the base end member 104 preferably has biocompatibility. In addition, when the insulating cover 10 is provided to the user in a usage form in which the insulating cover 10 is sterilized before use, the proximal end member 104 should have heat resistance that can withstand high temperatures during sterilization. For example, PEEK (polyether ether ketone) is suitable as a constituent material of the base end member 104 because it has excellent heat resistance.

  Further, when the insulating cover 10 is provided to the user in a sterilized state, the user can reuse the PEEK by using autoclave sterilization by replacing PEEK with a resin that is deformed by heat. Can be prevented in advance. In this case, it is preferable that the above-mentioned resin is a kind of resin that can withstand electron beam sterilization.

  As shown in FIG. 4, a slit 109 extending in the axial direction is formed at the base end portion of the base end member 104. The slit 109 is a notch that penetrates between the inside and outside of the base end member and opens in the base end direction. In the illustrated configuration, only one slit 109 is provided in the circumferential direction at the proximal end portion of the proximal end member 104, but may be provided at a plurality of locations spaced in the circumferential direction. Due to the presence of the slit 109, when the proximal end member 104 is fitted to the distal end portion of the shaft 18, the proximal end portion of the proximal end member 104 and the outer peripheral surface of the shaft 18 are easily brought into close contact with each other.

  Further, as another form in which the base end member 104 and the shaft 18 are in close contact with each other, a configuration in which the outer diameter of the distal end portion of the shaft 18 is reduced may be used. In this case, since the base end portion of the base end member 104 is fitted in a state where it is abutted against the stepped portion having the reduced diameter of the shaft 18, the base end portion of the base end member 104 is not provided with a slit, and the base end portion is not provided. The end member 104 and the shaft 18 can be brought into close contact with each other.

  FIG. 5 is a longitudinal sectional view of the insulating cover 10 in a state where it is mounted on the distal end working unit 12. For ease of understanding, in FIG. 5, only the first cover member 94 is shown in the members constituting the distal end working unit 12, and other components are not shown.

  The cover body 102 has the dome portion 106, the body portion 110, the tapered portion 111, the reduced diameter portion 112, and the proximal end insertion portion 114 in the above order from the distal end side to the proximal end side. These are integrally formed. The body part 110 is a cylindrical part having a substantially constant outer diameter and inner diameter. The taper portion 111 is a portion where the outer diameter gradually increases toward the base end side. The reduced diameter portion 112 has an outer diameter smaller than that of the body portion 110, the tapered portion 111, and the proximal end insertion portion 114, whereby an annular groove 113 is formed. The annular groove 113 is a portion that protrudes inwardly at the inner periphery of the distal end portion of the base end member 104 and engages with an inner peripheral rib 118 that extends in the circumferential direction. The inner circumferential rib 118 may not be formed in a circular shape that makes one round in the circumferential direction, that is, may be formed so as to protrude inward at intervals in the circumferential direction.

  The proximal end insertion portion 114 has an outer diameter that is substantially the same as or slightly smaller than the outer diameter of the body portion 110. The inner peripheral portion projects inwardly and extends over the entire circumference in the circumferential direction. An extending inner annular protrusion 116 is provided. The inner annular convex portion 116 in the natural state has an inner diameter that is smaller than the outer diameter of the portion of the shaft 18 that is inserted into the proximal end insertion portion 114, and the distal end portion of the shaft 18 is inserted into the proximal end insertion portion 114. The inner annular protrusion 116 is sandwiched between the base end member 104 and the shaft 18 and is elastically compressed and deformed. Thereby, the gap between the proximal end insertion portion 114 and the shaft 18 is sealed in a liquid-tight manner.

  Further, as another form for liquid-tight sealing between the proximal end insertion portion 114 and the shaft 18, an outer annular shape is provided at the distal end of the shaft 18 instead of the inner annular convex portion 116 provided on the cover body 102. It is good also as a structure which has a convex part. By adopting such a configuration, the compression by the outer annular convex portion is performed only at the final stage, not at the initial stage at the time of mounting the cover by screw fitting. It becomes possible.

  An annular groove 117 extending in the circumferential direction is formed in the inner peripheral portion on the distal end side of the proximal end member 104, and the proximal end insertion portion 114 of the cover body 102 is fitted into this annular groove 117 and fixed (adhered). Has been. The base end member 104 and the cover main body 102 may be fixed to each other by adhesion or welding.

  A female screw portion (female structure) 120 is formed on the inner peripheral portion on the proximal end side of the proximal end member 104. The female screw portion 120 is a portion near the distal end portion of the shaft 18 and is a male screw portion (male structure) formed on the outer peripheral portion of the portion closer to the base end side than the portion inserted into the base end insertion portion 114 described above. 27 can be screwed together. The male thread portion 27 may be either a single thread or a multiple thread, but when a multiple thread having two or more threads is employed, the number of rotations required to attach the insulating cover 10 is reduced. be able to.

  The outer diameter (maximum outer diameter) of the base end member 104 is larger than the outer diameter (maximum outer diameter) of the shaft 18. A taper portion 122 whose outer diameter decreases toward the proximal end side is provided at the most proximal end portion of the proximal end member 104. Of the shaft 18, the portion inserted into the insulating cover 10 (hereinafter referred to as the small diameter portion 18 a) is set to have a smaller outer diameter than the proximal end portion (hereinafter referred to as the large diameter portion 18 b). .

  The rear end surface of the base end member 104 abuts on a step 18c (the front end surface of the large diameter portion 18b) formed by the outer diameter difference between the small diameter portion 18a and the large diameter portion 18b, so that the insulating cover 10 is moved from the position to the shaft. The movement to the proximal end side of 18 is prevented. That is, the step 18 c formed on the shaft 18 functions as a positioning means for the mounting position of the insulating cover 10.

  In the illustrated configuration example, the male screw portion 27 is provided in the vicinity of the tip portion of the shaft 18, but the male screw portion 27 may be provided on the outer peripheral portion of the first cover member 94. In this case, the length of the base end member 104 and the position of the male screw portion 27 in the base end member 104 are determined so that the base end member 104 is screwed into the first cover member 94 and the base end of the first cover member 94. The part is set not to be exposed.

  In addition, the fitting by the screw structure including the male screw portion 27 and the female screw portion 120 has been described so far, but is not necessarily limited to this configuration, and a latching structure is formed instead of the male screw portion 27 and the female screw portion 120. May be. When such a latching structure is employed as the engagement (fitting) between the tip cover 10 and the shaft 18, an elastic protrusion is provided on the outer periphery of the tip of the shaft 18 as a male structure, An engagement hole or an engagement groove is provided in the base end portion of the end member 104 or the inner peripheral surface of the base end portion. The engagement hole or the engagement groove extends in the circumferential direction from the longitudinal end portion (axial direction portion) that extends in the axial direction at the proximal end portion of the proximal end member 104 and is open on the proximal end side, and the distal end portion of the longitudinal portion. It consists of a horizontal part (circumferential part). In the latching structure configured as described above, the tip cover 10 is moved (covered) in the axial direction with respect to the shaft 18 to insert the convex portion of the shaft 18 into the vertical portion of the tip cover 10. By rotating the tip cover 10 about the axis with respect to the shaft 18, the convex portion and the lateral portion are engaged. As a result, the latching structure is brought into an engaged state (fitted state), and the movement of the tip cover 10 in the axial direction is prevented (restrained). However, the tip cover 10 does not come off the shaft 18.

  The insulating cover 10 according to an embodiment of the present invention is basically configured as described above, and the operation and effect thereof will be described below.

  When the above-described manipulator 1 is used as an electric knife, the insulating cover 10 is attached to the distal end working unit 12 in order to prevent a portion excluding the end effector 19 of the distal end working unit 12 from contacting the living tissue and causing unintended burns. Installing. In this case, the insulating cover 10 is screwed with the internal thread portion 120 formed on the inner peripheral portion of the base end member 104 and the external thread portion 27 formed on the outer peripheral portion of the shaft 18, so that the insulating cover 10 is in the distal end portion of the shaft 18. Fixed to. Thus, since the insulating cover 10 can be attached to the distal end portion of the manipulator 1 by screw fitting, the attaching operation is easy and it is easy to attach it before the operation.

  When the insulating cover 10 is attached to the distal end working unit 12, the insulating cover 10 covers the entire portion of the distal end working unit 12 excluding the end effector 19 from the outside. That is, the portions other than the end effector 19 (the first cover member 94 and the second cover member 96) of the distal end working unit 12 are covered with the insulating cover 10, so that the metal portions other than the end effector 19 are not exposed to the outside. Thereby, in a procedure, it is prevented suitably that metal parts other than the end effector 19 contact a biological tissue and cause an unintended burn.

  As shown in FIG. 6, when the shaft 18 is pulled out from the trocar 20, the proximal end member 104 of the insulating cover 10 and the distal end opening 20 a (opening on the body cavity 22 side) of the trocar 20 may come into contact with each other. In this case, the proximal end member 104 is guided in the lateral direction by the taper portion 122 provided at the proximal end portion of the proximal end member 104 coming into contact with the distal end opening 20 a of the trocar 20. Therefore, it is difficult for the insulating cover 10 to be caught on the trocar 20, and the shaft 18 can be smoothly pulled out from the trocar 20.

  As shown in FIG. 4, due to the presence of the slit 109 provided at the proximal end portion of the proximal end member 104, the proximal end portion of the proximal end member 104 and the outer peripheral surface of the shaft 18 are easily brought into close contact with each other. Since the step between the outer periphery of the shaft 18 and the outer peripheral surface of the shaft 18 is kept small, the insulating cover 10 is less likely to be caught on the trocar 20.

  As described above, since the insulating cover 10 is not easily caught by the trocar 20, the trocar 20 is preferably prevented from being detached from the patient M when the shaft 18 is pulled out from the trocar 20. Further, since the insulating cover 10 is fixed to the distal end portion of the shaft 18 with a sufficient fastening force by screw fitting, the insulating cover 10 does not come off from the distal end operating portion 12 even when contacting the trocar 20.

  Since the insulating cover 10 is fixed by screw fitting, the fastening state can be easily released simply by rotating it with respect to the shaft 18. Therefore, it can be easily detached from the distal end working unit 12 after the operation.

  As described above, the insulating cover 10 is easy to attach before the operation, easy to remove after the operation, and does not come off the distal end working unit 12. Further, since the insulating cover 10 is not easily caught by the trocar 20 when the shaft 18 is pulled out from the trocar 20, the trocar 20 is difficult to come off from the patient M. Even when the above-described latching structure is employed as the engagement structure (fitting structure) between the tip cover 10 and the shaft 18, it is the same as when the screw structure using the male screw portion 27 and the female screw portion 120 is employed. The effect is obtained.

  In the embodiment described above, as an example of the engagement structure including the male structure (the male screw portion 27, the protrusion) and the female structure (the female screw portion 120, the engagement hole, the engagement groove), the male structure is used as the distal end portion of the shaft 18. However, the arrangement of the male structure and the female structure may be reversed from the above structure. That is, the male structure may be provided on the base end member 104 and the female structure may be provided on the distal end portion of the shaft 18.

  7 and 8 are views showing the insulating cover 10A according to the first reference example. FIG. 7 is a perspective view of the insulating cover 10A. FIG. It is a side view of cover 10A. The insulating cover 10 </ b> A includes a cover body 102 and a base end member 130. Since the cover main body 102 of the insulating cover 10A has the same configuration as the cover main body 102 of the above-described insulating cover 10A, description of the detailed configuration is omitted.

  The proximal end member 130 is a cylindrical member that is connected to the proximal end portion of the cover body 102 and is configured to be detachable from the distal end portion of the shaft 18. Although not shown, an annular groove similar to the annular groove 117 shown in FIG. 5 is formed in the inner peripheral portion on the distal end side of the proximal end member 130, and the proximal end insertion portion 114 of the cover main body 102 is formed in the annular groove. (See FIG. 5) are fitted and fixed (fixed). Unlike the base end member 104, an internal thread portion is not formed on the inner peripheral portion of the base end member 130. However, similarly to the base end member 104, an internal thread portion may be formed on the inner peripheral portion of the base end member 130. The constituent material of the base end member 130 can be the same material as the constituent material of the base end member 104 described above.

  The outer diameter (maximum outer diameter) of the base end member 130 is larger than the outer diameter (maximum outer diameter) of the shaft 18. The base end portion of the base end member 130 is inclined with respect to the axial direction. That is, the base end member 130 has a shape in which the base end portion is cut in a direction inclined in the axial direction. For this reason, the base end portion of the base end member 130 is provided with a protruding portion 138 that protrudes in the base end direction. A tapered portion 140 whose outer diameter decreases toward the proximal end side is provided at the most proximal end portion of the protruding portion 138.

  The insulating cover 10A configured as described above can be easily attached to the distal end working unit 12 by moving (sliding) in the axial direction relative to the distal end working unit 12, and can be easily removed from the distal end working unit 12. Can be removed.

  As shown in FIGS. 9A and 9B, when the shaft 18 is pulled out from the trocar 20, the base end member 130 of the insulating cover 10 </ b> A and the distal end opening 20 a (opening on the body cavity 22 side) of the trocar 20 come into contact with each other. There is.

  In such a case, as shown in FIG. 9A, when the protruding portion 138 comes into contact with the distal end opening 20 a of the trocar 20, the proximal end member 130 is laterally moved by the tapered portion 140 provided in the protruding portion 138. Guided by Therefore, the insulating cover 10 </ b> A is not easily caught on the trocar 20, and the shaft 18 can be smoothly pulled out from the trocar 20.

  On the other hand, as shown in FIG. 9B, when the proximal end member 130 contacts the distal end opening 20 a of the trocar 20 at a portion other than the protruding portion 138, the proximal end member 130 is already present when such contact occurs. A part of the lens enters the trocar 20, and the base end member 130 and the trocar 20 are in contact at one point. For this reason, the insulating cover 10 </ b> A is not easily caught on the trocar 20, and the shaft 18 can be smoothly pulled out from the trocar 20.

  As described above, since the insulating cover 10A is not easily caught by the trocar 20, when the shaft 18 is pulled out from the trocar 20, the trocar 20 is hardly detached from the patient, and the insulating cover 10A is not easily detached from the distal end working unit 12.

  10A and 10B are configuration diagrams of the insulating cover 10B according to the second reference example. FIG. 10A is a longitudinal sectional view of the insulating cover 10. FIG. 10B shows the insulating cover 10B on the distal end working unit 12. It is a longitudinal cross-sectional view of the mounted state. For easy understanding, FIG. 10B shows only the first cover member 94 of the distal end working unit 12 and omits the other constituent members of the distal end working unit 12.

  The insulating cover 10B is made of a flexible material (for example, silicon rubber) so that the posture changing operation of the distal end working unit 12 can be allowed, that is, can be deformed following the posture changing operation of the distal working unit 12. Has been. The material constituting the insulating cover 10B preferably has biocompatibility. The insulating cover 10 </ b> B has a cover main body portion 144 and a base end configuration portion 146. The cover body 144 and the base end component 146 are not formed of separate members, but are integrally formed by injection molding or the like.

  The cover main body portion 144 has a hollow cylindrical shape as a whole, and a dome portion 148 formed in a round shape is provided at the tip thereof. The dome portion 148 is formed with a tip opening 150 through which the end effector 19 can be inserted. The tip opening 150 in the illustrated example may be formed as a slit-like cut or may be formed with a circular hole.

  The base end constituting portion 146 is a portion having a substantially constant outer diameter along the axial direction extending from the base end portion of the cover main body portion 144 to the base end side. The proximal end component 146 has an inner diameter that is substantially the same as the outer diameter of the shaft 18 so that the distal end of the shaft 18 can be inserted. The outer diameter of the base end component 146 in the natural state (a state in which no external force is applied) is slightly larger than the outer diameter of the cover main body 144.

  On the other hand, on the outer peripheral portion of the first cover member 94a shown in FIG. 10B, two ribs 152, 154 are provided at locations spaced apart from each other in the axial direction, and the end surfaces of these ribs 152, 154 on the sides facing each other. And an annular recess 158 extending over the entire circumference in the circumferential direction (that is, in the range of 360 °) by the portion 156 between the rib 152 and the rib 154 in the outer peripheral portion of the first cover member 94a. Is formed. The inner diameter of the cover main body 144 is set smaller than the ribs 152 and 154. The outer diameters of the ribs 152 and 154 are set to be equal to or smaller than the outer diameter of the shaft 18 so that the ribs 152 and 154 do not protrude radially outward from the outer peripheral surface of the shaft 18. It is good.

  As shown in FIG. 10B, the distal end working portion 12 and the distal end portion of the shaft 18 are inserted into the insulating cover 10B, and the proximal end constituting portion 146 is tightened from the outside by a tightening member 160 (for example, an O ring or a C ring). At this time, the tightening member 160 is attached to the proximal end component 146 at a position between the rib 152 and the rib 154.

  Since the proximal component 146 is made of a flexible material, the tightened portion 160 is reduced in diameter when the tightening member 160 is attached. As a result, the tightening member 160 is disposed in the annular recess 158. It will be dressed. Therefore, it is difficult for the tightening member 160 to protrude radially outward with respect to the front and rear portions in the axial direction. Further, even when the tightening member 160 protrudes radially outward with respect to the front and rear portions in the axial direction, the amount of the protrusion can be suitably suppressed.

  In the insulating cover 10 </ b> B configured as described above, the base end constituting portion 146 is fastened by the fastening member 160 and fixed to the distal end working portion 12, so that a strong fixing force is obtained. Accordingly, when the shaft 18 is pulled out from the trocar 20, the insulating cover 10B does not come off the distal end working portion 12 even if the base end constituting portion 146 contacts the distal end opening 20a (see FIG. 6) of the trocar 20. Or hard to come off.

  In the above description, the present invention has been described with reference to preferred embodiments. However, the present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the scope of the present invention. Needless to say.

DESCRIPTION OF SYMBOLS 1 ... Medical manipulator 10, 10A, 10B ... Insulating cover 18 ... Shaft 102 ... Cover main body 104 ... Base end member 109 ... Slit 120 ... Female thread part 122, 140 ... Tapered part

Claims (5)

An insulating cover that can be attached to a distal end working portion provided at a distal end portion of a shaft extending from a main body portion of a surgical treatment instrument configured to function as an electric knife for laparoscopic surgery,
A cylindrical cover body made of a flexible material having a tip opening through which an end effector constituting the tip portion of the tip working portion can be inserted;
A cylindrical base end member connected to the base end portion of the cover body and configured to be detachable from the distal end portion of the surgical treatment instrument;
The distal end portion of the surgical treatment instrument is provided with one of a male structure and a female structure that can be engaged with each other,
The base end member is provided with the other of the male structure and the female structure,
At the most proximal end portion of the proximal end member, a tapered portion whose outer diameter decreases toward the proximal end side is provided.
An insulating cover characterized by that. The insulating cover according to claim 1, wherein the engagement structure by the male structure and the female structure is a screw structure or a latch structure.
An insulating cover characterized by that. The insulating cover according to claim 1 or 2,
At least one slit extending along the axial direction is formed at the base end portion of the base end member.
An insulating cover characterized by that. In the insulating cover according to any one of claims 1 to 3,
The base end portion of the cover body has a base end insertion portion that fits into the inner peripheral portion of the base end member,
On the inner peripheral part of the proximal end insertion part, an inner annular convex part extending over the entire circumference in the circumferential direction is formed,
An insulating cover characterized by that. A surgical treatment instrument configured to function as an electric knife for laparoscopic surgery,
The main body,
A shaft extending from the main body,
A tip working portion provided at the tip of the shaft;
An insulating cover attachable to the distal end working unit,
The insulating cover is the insulating cover according to any one of claims 1 to 4.
A surgical treatment instrument characterized by that.

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