JP2019126377A - High-frequency electrode and high-frequency incision instrument - Google Patents

Abstract

To provide a high-frequency electrode and a high-frequency incision instrument that can make a depth-wise incision of a predetermined depth in tissue in a short time by a simple operation.SOLUTION: A high-frequency electrode (1) includes an incision part formed of an insulating part and an electrode (21, 22) of which a conductor (2) is exposed from the insulating part and configured to able to incise, by a current flowing through the conductor, tissue in an incision direction (C) perpendicular to the longitudinal direction of the electrode. The electrode comprises a first electrode (21) and a second electrode (22) spaced apart and exposed from the first electrode. At least a portion of the first electrode is exposed from the insulating part at a position different from the second electrode in the incision direction.SELECTED DRAWING: Figure 3

Description

  The present invention relates to a high-frequency electrode and a high-frequency cutting tool.

  Conventionally, in the treatment of early malignancy and the like, for example, on the mucous membrane in a luminal organ such as the digestive tract such as EMR (endoscopic mucosal resection) and ESD (endoscopic submucosal dissection) A procedure to remove endoscopically the lesion that has occurred has been performed. As an endoscopic treatment tool for excising diseased tissue, a snare, which is a high frequency cutting tool, is used.

  The high frequency snare described in Patent Document 1 includes a flexible sheath, an elastic wire axially movably inserted in the flexible sheath, and a snare loop formed at the tip of the elastic wire. Is configured. In such a high frequency snare, when the elastic wire is advanced and retracted in the axial direction, the snare loop projects from the distal end of the sheath. When the snare loop protrudes from the tip of the sheath, the opening width of the snare loop is expanded by its own elasticity. The expanded snare loop is narrowed by being pulled into the sheath.

  Generally, in the case of transendoscopic excision of a lesion generated on a mucous membrane in a luminal organ, in the case of ESD, a bulging agent is injected into the lower part of the tissue to be resected as needed to raise the lesion. After that, the tissue around the lesion is incised using a high frequency knife, and then the incision is exfoliated little by little.

  Generally, in EMR, when endoscopically resecting a lesion generated on a mucous membrane in a luminal organ, after a swelling agent is injected to elevate the lesion, the operator removes the lesion to be resected. Apply a snare loop to the root and pull the elastic wire proximally. Thereby, a part of the snare loop is drawn into the sheath, and the opening width of the snare loop is reduced. As a result, the tissue to be excised surrounded by the snare loop is bound by the snare loop. When high frequency current is supplied to the snare loop in this bound state, the tissue to be ablated is ablated from the digestive tract.

  In the high-frequency snare of Patent Document 1, when removing polyps, the heat destruction due to the high-frequency snare is suppressed, and a section that can be used for cancer tissue examination etc. of sectioned polyps is secured. It has a coating for insulation only on one side.

JP 2002-102237 A

  In ESD, the mucosa and submucosa surrounding the lesion are incised. However, when performing ESD in the large intestine or the like, it is necessary to reliably prevent the incision from reaching the muscle layer because the intestinal wall is thin. Careful operation and advanced skills are required to incise the entire circumference of the lesion with a snare without damaging the muscle layer.

  In the high frequency snare of Patent Document 1, since the polyp is bound with a snare loop and then energized, the joule heat thermally destroys the tissue, so it takes time to remove the polyp. In addition, when EMR is performed in the large intestine, if too much tissue is bound with a snare loop, perforation may occur in the intestinal wall due to the incision operation. There was a problem of

  The present invention has been made in view of the above problems, and it is an object of the present invention to provide a high frequency electrode and a high frequency cutting tool which can cut a predetermined amount of tissue in a depth direction in a short time by a simple operation. .

  The high frequency electrode according to the first aspect of the present invention is formed of an insulating portion and an electrode in which a conductor is exposed from the insulating portion, and the conductor is energized in a cutting direction orthogonal to the longitudinal direction of the electrode. An incision part configured to be capable of incising tissue, wherein the electrode includes a first electrode and a second electrode exposed to be separated from the first electrode, wherein at least a part of the first electrode is The second electrode is exposed from the insulating portion at a position different from the incision direction.

  As a second aspect of the present invention, in the high-frequency electrode according to the first aspect, the first electrode and the second electrode may be exposed in different directions of the incision direction.

  As a third aspect of the present invention, in the high-frequency electrode according to the first aspect, the incision portion may have an annular shape, and the second electrode may be located outside the annular shape.

  As a fourth aspect of the present invention, in the high-frequency electrode according to the first aspect, the incision portion has an annular shape, the first electrode is located outside the annular shape, and the second electrode is , May be located inside the annular shape.

  As a fifth aspect of the present invention, in the high frequency electrode according to the first aspect, the cut portion has a cross section perpendicular to the longitudinal direction having a short side and a long side, and the cut direction is the long side. It may be a direction along the side.

  A high-frequency cutting tool according to a sixth aspect of the present invention includes the high-frequency electrode, and a power supply connector to which a base end portion of the high-frequency electrode is connected and supplies a high-frequency current to the conductor, and includes only the first electrode. The tissue is configured to be incisable when it comes into contact with the tissue.

  As a seventh aspect of the present invention, in the high frequency cutting device according to the sixth aspect, the first electrode and the second electrode are made of different conductors, and the feeding connector, the first electrode, and the second electrode are provided. An operation unit having a switch connected to the power supply connector, the switch connecting the power supply connector, the first electrode, and the second electrode so that both the first electrode and the second electrode can be energized simultaneously. It is also good.

  According to the present invention, it is possible to provide a high frequency electrode and a high frequency cutting tool capable of cutting a predetermined amount of tissue in the depth direction in a short time by a simple operation.

BRIEF DESCRIPTION OF THE DRAWINGS It is a general view of the high frequency incision tool which concerns on 1st Embodiment of this invention. It is a perspective view which shows the front-end | tip part of the high frequency incision tool which concerns on 1st Embodiment of this invention. It is sectional drawing in the III-III line of FIG. It is a schematic diagram which shows the process of the tissue incision using the high frequency incision tool concerning 1st Embodiment of this invention. It is a schematic diagram which shows the process of the tissue incision using the high frequency incision tool concerning 1st Embodiment of this invention. It is a perspective view which shows the high frequency electrode of the 1st modification of 1st Embodiment of this invention. It is sectional drawing of the direction orthogonal to the longitudinal direction of the high frequency electrode of the 2nd modification of 1st Embodiment of this invention. It is sectional drawing of the direction orthogonal to the longitudinal direction of the high frequency electrode of the 3rd modification of 1st Embodiment of this invention. It is sectional drawing of the direction orthogonal to the longitudinal direction of the high frequency electrode of the 4th modification of 1st Embodiment of this invention. It is a schematic diagram which shows the process of the tissue incision using the high frequency incision tool of 2nd Embodiment of this invention. It is a schematic diagram which shows the process of the tissue incision using the high frequency incision tool of 2nd Embodiment of this invention. It is a schematic diagram which shows the process of tissue incision using the high frequency incision tool of the modification of 2nd Embodiment of this invention. It is a schematic diagram which shows the high frequency incision instrument which concerns on 3rd Embodiment of this invention. It is sectional drawing which shows typically the tissue incision method using the high frequency incision tool which concerns on 3rd Embodiment of this invention. It is sectional drawing of the direction orthogonal to the longitudinal direction of the high frequency electrode of the 1st modification of 3rd Embodiment of this invention. It is sectional drawing of the direction orthogonal to the longitudinal direction of the high frequency electrode of 2nd modification to 3rd Embodiment of this invention.

First Embodiment
The high-frequency electrode 1 and the high-frequency cutting tool 100 according to the present embodiment will be described with reference to FIGS. FIG. 1 is an overall view of a high frequency cutting tool 100 according to the present embodiment. FIG. 2 is a perspective view showing the distal end portion of the high frequency cutting device 100. FIG.

  As shown in FIG. 1, the high frequency cutting device 100 according to the present embodiment includes a sheath 10, a high frequency electrode 1, and an operation unit 40. The high-frequency dissection tool 100 is used by being inserted into a treatment tool channel 202 formed in the endoscope insertion portion 210 of the endoscope apparatus 200 (see FIG. 4).

  The sheath 10 is formed to extend along the longitudinal direction X, and is an elongated member that can be inserted into a body cavity. The sheath 10 is formed of an insulating material, for example, a fluorine resin such as PTFE (polytetrafluoroethylene). The sheath 10 has flexibility and is configured to be able to be inserted into and removed from a treatment instrument channel 202 of an endoscope meandering along a curved shape such as a luminal tissue in a body cavity. The sheath 10 has a lumen 12 formed over its entire length, and has a distal opening 11 and a proximal opening 13. An operating portion 40 is provided at the proximal end of the sheath 10, and the proximal end opening 13 and the distal end opening 44 of the operating portion 40 communicate with each other.

  As shown in FIGS. 1 and 2, the high frequency electrode 1 is a long member that can be elastically deformed. The longitudinal direction L indicates the direction in which the high frequency electrode 1 extends. The high frequency electrode 1 has a middle portion bent and folded back to the proximal side to form an annular loop, both ends of which are arranged in parallel, and insulating portions 3 to be described later abut each other toward the proximal side. It is stretched. The loop portion of the high frequency electrode 1 is an incision 20. Both end portions (proximal end portions) of the high frequency electrode 1 are connected to the distal end portion of the operation wire 30 so as to be conductive.

  The operation wire 30 is a metal stranded wire and is inserted into the lumen 12 of the sheath 10, and the proximal end portion is disposed in the operation portion 40. The proximal end of the operation wire 30 is electrically and physically connected to the power supply connector 43.

  The proximal end portion of the high frequency electrode 1 and the distal end portion of the operation wire 30 are connected in close contact with the connection member 3 from the outside. The connecting member 32 is a metallic tubular member. A slight gap S is provided between the proximal end portion of the high-frequency electrode 1 and the distal end portion of the operation wire 30, and the connecting member 32 is tightly fixed to the conductor 2 and the operation wire 30 of the high-frequency electrode 1. Therefore, the high frequency electrode 1 is electrically and physically connected to the power supply connector 43 via the connection member 32 and the operation wire 32. The gap S may not be provided between the proximal end of the high frequency electrode 1 and the distal end of the operation wire 30, and both may be in contact with each other.

  FIG. 3 is a cross-sectional view in a direction orthogonal to the longitudinal direction L of the high frequency electrode 1 (a cross-sectional view along the line III-III in FIG. 2). As shown in FIG. 3, the high-frequency electrode 1 has a substantially rectangular cross section perpendicular to the longitudinal direction L. In the present embodiment, in the cross section orthogonal to the longitudinal direction L, the direction along the long side is the cutting direction C.

  The high frequency electrode 1 includes an insulating portion 3 and a conductor 2. The portion where the conductor 2 is exposed from the insulating portion 3 functions as an electrode. The electrode is an elongated member in which a first electrode 21 and a second electrode 22 whose conductors 2 are exposed on the surface of the high frequency electrode 1 extend in the longitudinal direction L and are formed. The high frequency electrode 1 is a monopolar electrode, and when the conductor 2 is energized, a high frequency current flows, and the tissue in contact with the electrode can be incised.

  The high frequency electrode 1 is configured to be able to cut tissue in a cutting direction C which is one direction orthogonal to the longitudinal direction L. The cutting direction C is a direction in which the first electrode 21 of the energized conductor 2 abuts on the tissue and advances while being incised. When the incision 20 is brought closer to the tissue side along the incision direction C, the portion that first comes in contact with the tissue is referred to as an incision tip 20 d. On the other hand, the side opposite to the cutting tip 20d in the cutting direction C of the cutting portion 20 is referred to as a cutting rear end 20b. The incision direction C is arbitrarily set in one direction orthogonal to the longitudinal direction L of the high-frequency electrode 1, and the electrodes are arranged along the incision direction C to define the direction in which the tissue is incised.

  The conductor 2 is a long conductor whose cross-sectional shape orthogonal to the longitudinal direction L is substantially rectangular. The conductor 2 is an elongated member made of a conductive material such as, for example, stainless steel, a nickel-titanium alloy, or tungsten.

  The conductor 2 is arranged such that the long side of the substantially rectangular cross section is disposed along the incision direction C, and the surface of the long side is covered with an insulator. The first electrode 21 and the second electrode 22 are exposed separately along the cutting direction C on the surface of the high frequency electrode 1. The first electrode 21 and the second electrode 22 are exposed in different directions in the incision direction C. At least a part of the first electrode 21 is exposed from the insulating portion 3 at a position different from the second electrode 22 in the cutting direction. The two end surfaces in the short side direction are exposed on the surface of the incision 20 to constitute the first electrode 21 and the second electrode 22. Of the two exposed end faces of the conductor 2, the surface exposed to the surface on the cutting tip 20d side is the first electrode 21 and the surface exposed to the surface on the cutting rear end 20b is the second electrode 22.

  The insulating portion 3 is made of an insulator and provided so as to cover a part of the conductor 2. In the present embodiment, the height in the cutting direction C is substantially equal between the insulating portion 3 and the conductor 2, and the two insulators are disposed so as to sandwich the conductor 2 and cover the two long sides of the conductor 2 . For example, the length of the long side of the conductor 2 (the height in the cutting direction C) is 1 mm, and the length of the short side is 50 μm. The insulating portion has a long side length (height in the cutting direction C) of 1 mm, and a pair of insulators having a short side length of 20 μm covers the two long sides of the conductor 2.

  Considering the output of the existing high frequency power supply device, a high frequency current of high density can be supplied to the first electrode 21 when the exposure width orthogonal to the longitudinal direction L of the first electrode 21 is 10 μm or more and 200 μm or less. In addition, since the size of the portion of the first electrode 21 in contact with the tissue to be ablated is extremely small, the high frequency current is concentrated and flows in a very narrow area, so the tissue is easily incised and sharply incised. . If the exposure width of the second electrode 22 is equal to or greater than that of the first electrode 21, when the tissue comes in contact with the second electrode 22, the current density of the high frequency current is reduced to half or less. Can prevent excessive incision.

  The insulating part 3 should just be the structure which covers the surface of the conductors 2 other than the 1st electrode 21 which is an exposed part, and the 2nd electrode 22 non-electroconductive. For example, an example in which an insulating film is formed on the surface of the conductor 2 to configure the insulating portion 3 or an example in which an insulator is adhered to the conductor 2 to configure the insulating portion 3 can be mentioned. Examples of the insulator include silicone, fluorine, polyimide, polyetheretherketone (PEEK), an oxide film and the like. The thickness of the insulating portion may be 1 μm to 100 μm.

The proximal end portion of the conductor 2 of the incision portion 20 is electrically connected to the feeding connector 43.
In the incision portion 20, the high frequency electrode 1 is disposed such that a toroidal loop opens in the incision direction C. As shown in FIG. 2, the long side of the high frequency electrode 1 having a substantially rectangular cross section orthogonal to the longitudinal direction L constitutes the inner and outer peripheral surfaces of the loop and the short sides constitute the upper and lower surfaces of the loop. .

  As shown in FIG. 1, the operation unit 40 includes an operation unit main body 41 connected to the proximal end portion of the sheath 10, a slider 42 attached to the operation unit main body 41, and a power supply connector 43.

  The operation wire 30 is connected to the slider 42. Therefore, by advancing and retracting the slider 42 with respect to the operating unit main body 41, the operating wire 30 advances and retracts with respect to the sheath 10. Since the incision 20 is connected to the distal end of the operation wire 30, the incision 20 is projected and retracted with respect to the sheath 10 on the distal end side of the sheath 10 in conjunction with the advancement and retraction of the operation wire 30. In the present embodiment, when the slider 42 is advanced with respect to the operation unit main body 41, the incision 20 is projected from the distal end opening 11 of the sheath 10. When the slider 42 is retracted with respect to the operation unit main body 41, the incisions 20 are sequentially accommodated in the sheath 10.

  The feed connector 43 can be connected to a high frequency power supply (not shown) and connected to the proximal end of the operation wire 30. The power supply connector 43 can supply the high frequency current supplied from the high frequency power supply device to the conductor 2 of the high frequency electrode 1. Since the high-frequency electrode 1 is electrically connected to the power supply connector 43 via the operation wire 30, the high-frequency current supplied from the high-frequency power supply device is energized to the conductor 2 via the power supply connector 43.

  Next, how to use the high-frequency incision tool 100 will be described by taking as an example a submucosal incision method for excising a lesioned part (early cancer or the like) P formed in the large intestine using the high-frequency incision tool 100. FIG. 4 is a schematic view showing a process of tissue incision using the high frequency dissection tool 100 according to the present embodiment.

  As preparation work, the operator identifies the lesion P by a known method and bulges the lesion P. Specifically, the endoscope insertion part 210 of the endoscope apparatus 200 is inserted into the large intestine, and the surgeon specifies the lesioned part P while observing an image obtained by the endoscope. Next, a known submucosal injection needle (not shown) is inserted into the treatment instrument channel 202 of the endoscope insertion portion 210, and a local injection between the lesion P and the muscle layer W3 is performed by the submucosal injection needle. The lesion P is inflated by injecting a liquid for injection (local injection). After injecting the local injection solution, the submucosal local injection needle is removed from the treatment instrument channel 202.

  Subsequently, the high-frequency dissection tool 100 is inserted into the treatment tool channel 202 and is projected from the tip of the endoscope insertion portion 210. While confirming the image of the endoscope, the distal end portion of the sheath 10 is protruded to the vicinity of the lesioned portion P. Thereafter, the slider 42 of the operation unit 40 is advanced with respect to the operation unit main body 41 and the tip of the incision 20 is protruded from the tip opening 11 of the sheath 10. It is arranged on the tip side. In this state, the endoscope insertion portion 210 or the endoscope treatment tool 1 is appropriately advanced and retracted to arrange the incision 20 so as to surround the lesion P, and the incision 20 is a mucous layer around the lesion P Contact W1.

  Subsequently, as shown in (S1) of FIGS. 4 and 5, the incision 20 is pressed on the tissue T to be dissected so as to surround the lesion P. The operator operates the high frequency power supply device to supply a high frequency current to the conductor 2 through the feed connector 43. At this time, first, the mucosal layer W1 in contact with the first electrode 21 is incised first. Subsequently, the first electrode 21 is incised in contact with the lower submucosa layer W2, which is the lower layer. In the incision 20, since the periphery of the first electrode 21 is the insulating portion 3 and only the first electrode 21 is in contact with the tissue, the density of the high-frequency current is increased even with the same amount of current as the conventional high-frequency incision tool. Therefore, in a short time (several seconds), the mucosal layer W1 and the submucosal layer W2 where the first electrode 21 is adhered are sequentially incised. That is, following the step of bringing the first electrode 21 of the incision portion 20 into contact with the mucosal layer W1, a step of supplying a high-frequency current to the conductor 2 is performed, as shown in FIG. 5 (S2). The layer W1 and the submucosal layer W2 are cut along the first electrode 21 in the cutting direction C.

  Subsequently, when the tissue is incised to a predetermined depth by the first electrode 21, as shown in (S3) in FIG. 5, the high frequency electrode 1 is buried in the mucous layer W1 and the mucous layer W2, and the second electrode 22 Tissue contacts When the tissue simultaneously contacts the first electrode 21 and the second electrode 22, the contact area of the conductor 2 with the tissue is doubled, so the current density in the first electrode 21 is halved and the tissue can not be cut by the first electrode 21 The incision stops. Also in the second electrode 22, the current density is low and the tissue is not incised.

That is, by setting the separation distance between the first electrode 21 and the second electrode 22 in the incision direction C according to the depth of the tissue to be incised, the tissue can be moved in the depth direction by a predetermined amount by a simple operation. I can make an incision. For example, when the separation distance between the first electrode 21 and the second electrode 22 is longer than the thickness of the mucous layer W1, the first electrode 21 can reliably reach the submucosal layer W2 at the time of dissection.
When the incision depth reaches a predetermined depth and the first electrode 21 and the second electrode 22 come in contact with the tissue, the current density is reduced and the tissue can not be incised. While the incision is advanced over time, excessive incisions can be prevented.

  When the incision in the incision direction C is completed and the tissue can be incised to a predetermined depth, the high-frequency incision instrument 100 is removed from the treatment instrument channel 202 and a conventional high-frequency snare is inserted. The lesion P can be excised by tightening the lesion P by narrowing the conventional high-frequency snare and energizing.

  In the present embodiment, an example in which the first electrode 21 and the second electrode 22 are formed by exposing the two side surfaces of the short side of one conductor 2 is shown. For convenience of explanation, one of the two side surfaces on the short side of the conductor 2 is described as the first electrode 21, and the other is described as the second electrode 22. However, in the incision portion 20 of the present embodiment, of the two side surfaces on the short side of the conductor 2, the side surface that comes into contact with the tissue first becomes the first electrode, and thus either surface can be the first electrode. For this reason, when the incision 20 protrudes from the sheath 10, it may be arranged so as to surround the lesion P with a loop, and the same effect can be obtained regardless of the direction of the incision direction C.

  According to the high-frequency electrode 1 and the high-frequency incision tool 100 according to the present embodiment, the tissue can be incised in the depth direction in a short time by a simple operation, and incision beyond a predetermined depth can be prevented.

  Although the example of the incision part 20 which formed the annular loop was shown in this embodiment, the shape of the incision part 20 is not limited to this. For example, as shown in FIG. 6, the example which has the high frequency electrode 1 of this embodiment along the longitudinal direction L, and has a termination | terminus at the front-end | tip part may be sufficient. The other configuration of the high-frequency electrode 1A of the modification shown in FIG. 6 is the same as that of the first embodiment. Even in the incision portion 20A using the high-frequency electrode 1A of this modification, the tissue can be incised in a short time along the incision direction C as in the present embodiment.

  In the present embodiment, the example in which the first electrode 21 and the second electrode 22 are exposed in different directions of the incision direction C is shown, but the arrangement of the first electrode 21 and the second electrode 22 is as follows. It is not limited to this. When at least a portion of the first electrode 21 is positioned closer to the cutting tip 20d in the cutting direction C than the second electrode 22, only the first electrode 21 contacts the tissue and a high density current flows to cut the tissue In addition, the first electrode 21 and the second electrode 22 can be in contact with the tissue to make the incision impossible.

  Although the cross-sectional shape orthogonal to the longitudinal direction L shows the example using the substantially rectangular shaped conductor 2 in this embodiment, the shape of the conductor 2 is not limited to this. For example, as in a second modified example shown in FIG. 7, a conductor 2B having a T-shaped cross section perpendicular to the longitudinal direction L may be used. In this example, the conductor 2B and the insulating part 3B are arranged so that the exposed area of the first electrode 21 is smaller than that of the second electrode 22. As a result, at the time of dissection in which only the first electrode 21 abuts on the tissue, the current density is high, and the dissection portion 20 can be easily and sharply incised. In addition, since the exposed area of the second electrode 22 is large, when the tissue is incised to a predetermined depth by the first electrode 21, the tissue around the rear end of the incision is likely to contact the second electrode 22, and it is possible to ensure in a short time Can stop the incision.

  In this embodiment, the cross-sectional shape of the conductor 2 in a cross section orthogonal to the longitudinal direction L is substantially rectangular, and the insulating portion 3 is provided to make the outer shape of the high frequency electrode 1 rectangular. The shape is not limited to this. For example, an insulator having a semicircular cross section may be disposed on the long side surface of the conductor 2 having a rectangular cross section according to the present embodiment, and the insulating section 3 may be provided so that the overall cross sectional shape is substantially circular. . Further, as in the third modified example shown in FIG. 8, two directions of the cutting direction C of the circular conductor 2 are exposed on the surface of the high frequency electrode 1, and the other surrounding portions are covered with an insulator. The high-frequency electrode 1C may have an elliptical outer shape in cross section. Besides, although not shown, the insulating portion 3 may be provided so that the cross-sectional shape orthogonal to the longitudinal direction L of the conductor 2 is substantially circular and the outer diameter is rectangular.

  As another example, as in the fourth modified example shown in FIG. 9, the conductor 2 is formed of stranded wire, and is two places in the circumferential direction of the stranded wire and separated in the cutting direction C. May be exposed, and other portions in the circumferential direction of the stranded wire may be covered with an insulator to form the first electrode 21 and the second electrode 22.

  According to the high-frequency electrode 1 according to the present embodiment, the sectional shape orthogonal to the longitudinal direction L of the incision 20 is a shape having short sides and long sides, and the incision direction C is a direction along the long sides. When cutting along the cutting direction C, the high frequency electrode 1 tends to advance in the cutting direction C, and can be cut smoothly.

Second Embodiment
A high-frequency cutting tool 100E according to the second embodiment will be described. In the second embodiment, the same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. 10 and 11 are schematic views showing a process of tissue incision using the high-frequency incision tool 100E of the second embodiment.

  The high frequency cutting tool 100E according to the present embodiment differs from the first embodiment in the configuration of the high frequency electrode 1E. The high frequency electrode 1E of this embodiment differs from the first embodiment in the positions of the first electrode 21E and the second electrode 22E and the position of the insulating portion 3E. The dimensions and configuration of the conductor 2 are the same as in the first embodiment.

  Unlike the first embodiment, the high frequency electrode 1E according to the present embodiment includes the entire surface of one of the two surfaces on the long side of the conductor 2 and the entire surface of the short side on the cutting rear end 20b side in the cutting direction C; The insulating portion 3 covers a part of the other of the two surfaces on the long side of the conductor 2. The entire surface of the short side on the cutting tip 20d side in the cutting direction C is exposed to form the first electrode 21E. The second electrode 22E is formed by exposing the end on the rear end 20b side of the other side of the long side of the conductor 2 to the surface. The first electrode 21E and the second electrode 22E are separated in the cutting direction C, and the exposed directions are different.

  The aspect in which the high frequency electrode 1E of this embodiment incises a tissue is the same as that of the first embodiment. That is, as shown in (S1) of FIG. 10, when the incision portion 20E is abutted against the tissue in the dissection direction C and the first electrode 21E is in contact with the tissue to be incised, the conductor 2 is energized. As shown in FIG. 10 (S2), the first electrode 21 advances in the tissue depth direction while incising the tissue and incising the tissue in the incision direction C. As shown in (S3) of FIG. 10, when the high-frequency electrode 1E enters the tissue in the depth direction and the tissue comes into contact with the second electrode 22E, the current density decreases to the first as in the first embodiment. The incision by the electrode 21E is stopped.

  Similarly to the first embodiment, the incision 20E using the high-frequency electrode 1E of this embodiment can incise the tissue in a short time, and can prevent excessive incision in the depth direction.

  According to the high frequency cutting tool 100E using the high frequency electrode 1E of the present embodiment, since the second electrode 22E is formed to be exposed on the side surface along the cutting direction C of the high frequency electrode 1E, the cutting in the depth direction of the tissue After proceeding, the second electrode 22E smoothly contacts the tissue. Therefore, the incision can be smoothly made in the depth direction only by pressing the incision 20E and energizing the conductor 2.

  In addition, the incision portion 20E according to the present embodiment can be used for excision after binding the tissue. As in the first embodiment, the high frequency electrode 1E of the present embodiment is formed into an annular loop shape. As shown in FIG. 11, the cutout 20E is arranged such that the second electrode 22E faces the outside of the toroidal loop (outside of the toroidal shape).

  After the incision end state shown in (S3) of FIG. 10 is reached, energization of the conductor 2 is stopped. Thereafter, the operator retracts the slider 42 of the operation unit 40 with respect to the operation unit main body 41 to reduce the diameter of the loop of the incision 20E, and ties the tissue to be excised as shown in FIG. When the binding proceeds, the second electrode 22E in contact with the tissue in the process of (S3) in FIG. 10 is separated from the tissue and does not come in contact with the tissue. As described above, when the diameter of the incision 20 is reduced to a position where the second electrode 22E separates from the tissue, the current supply to the conductor 2 is resumed and further binding is performed. That is, since the incision 20 gradually shrinks while being energized while only the first electrode 21E is in contact with the tissue, the tissue is incised in the diametrical direction, that is, in the direction intersecting the incision direction C, and finally The tissue to be excised is excised.

  According to the high frequency cutting tool 100E according to the present embodiment, the step of cutting the periphery of the tissue to be resected in the depth direction and the step of tightening and resecting the tissue to be resected can be performed successively.

  In the present embodiment, the short side on the cutting tip 20d side is exposed to form the first electrode 21E, and the second electrode 22E is exposed to the outside of the loop of the cutting portion 20E. The configuration of the second electrode 22E is not limited to this. For example, FIG. 12 shows a modification of the high frequency electrode 1E of the present embodiment. The conductor 2 of this modification is the same as that of the first embodiment and the second embodiment, but the first electrode 21F and the second electrode 22F are respectively on the long side surface of the conductor 2 as shown in FIG. It differs from the above embodiment in that it is formed. The first electrode 21F and the second electrode 22F of this modification are also separated in the cutting direction C. The incision 20F is formed in an annular loop shape, the first electrode 21F is exposed outside the loop, and the second electrode 22F is exposed inside the loop (inside the annular shape).

  The high frequency cutting tool 100F using the high frequency electrode 1F of this modification can also cut tissue in a short time, and can prevent excessive cutting in the depth direction, as in the above embodiment.

  According to the high frequency cutting tool 100F using the high frequency electrode 1F of the present embodiment, since the second electrode 22F is formed to be exposed on the side surface along the cutting direction C of the high frequency electrode 1E, cutting in the tissue depth direction After proceeding, the second electrode 22F smoothly contacts the tissue. Therefore, the incision can be smoothly made in the depth direction only by the operation of pressing the incision 20F and energizing the conductor 2.

  Similarly to the second embodiment, the high-frequency cutting tool 100F of this modification may continuously perform the step of cutting the periphery of the tissue to be excised in the depth direction and the step of tightening and resecting the tissue to be excised. it can.

  The incision in the depth direction of the tissue of the high frequency dissection tool 100F of this modification is the same as that of the second embodiment. After completion of the incision in the depth direction of the tissue, energization to the conductor 2 is stopped, and the diameter of the loop of the incision 20F is reduced as in the second embodiment. Since the first electrode 21F is exposed to the outside of the loop of the incision portion 20F, the first electrode 21F is separated from the tissue in the high-frequency incision tool 100F according to this modification. Since the second electrode 22F is exposed to the inside of the loop of the incision 20F, binding the tissue holds the second electrode 22F in contact with the tissue. Therefore, when the conductor 2 is energized while only the second electrode 22F is in contact with the tissue, the current density of the second electrode 22F is increased, and the tissue is cut in the binding direction by the second electrode 22F, and finally the target tissue Is cut out.

  When the second electrode 22F is configured to cut tissue at the time of binding of tissue as in the present modification, tissue shallower than the deepest position cut by the first electrode 21F is cut away. Therefore, even if tissue in a deeper region such as the muscle layer W3 is accidentally caught during binding, the second electrode 22F located on the rear end 20b side of the incision 20F cuts the tissue in the binding direction, There is no worry of incising the layer W3, and a predetermined range can be incised and excised reliably with a simple operation.

  In the second embodiment, an example is shown in which the positions of the first electrodes 21E and 21F and the second electrodes 22E and 22F in the cutting direction C are separated, but the present invention is not limited to this example. It is only necessary that the two electrodes are separated from each other. For example, as in the modification shown in FIG. 12, the first electrode is provided on one of the two different surfaces on the long side of the conductor 2, and the second electrode is provided on the other surface different from the first electrode. When it exists, the position (position of the height direction of an incision part) of the 1st electrode and the 2nd electrode in the incision direction C may overlap partially. In this case, if at least a part of the first electrode is positioned closer to the incision tip 20d in the incision direction C than the second electrode, only the first electrode comes into contact with the tissue first as in the above embodiment. Can be cut in the depth direction.

Third Embodiment
A high-frequency cutting tool 100G according to the third embodiment will be described. In the second embodiment, the same parts as the constituent elements in the first or second embodiment are denoted by the same reference numerals, and the description thereof will be omitted. FIG. 13 is a schematic view showing the configuration of the high frequency cutting device 100G according to the third embodiment. In FIG. 13, only the high-frequency electrode 1G shown at the left end shows a cross-sectional shape orthogonal to the longitudinal axis direction. FIG. 14 is a schematic view showing a process of tissue incision using the high frequency dissection tool 100E of the third embodiment. The configuration of the conductor 2G of the high frequency electrode 1G in the high frequency cutting device 100G of the present embodiment is different from that of the first embodiment and the second embodiment.

  The high frequency electrode 1G of the present embodiment is configured of two independent conductors 23 and 24. Two conductors 23, 24 extend along the longitudinal direction L from the distal end to the proximal end. The two conductors 23 and 24 are arranged side by side in the incision direction C, and the insulating portion 3 is provided between the two conductors 23 and 24. The external shape of the cross section orthogonal to the longitudinal direction L of the high frequency electrode 1G is a rectangle long in the cutting direction C. The two conductors 23 and 24 of FIG. 13 are exposed and arranged along the surfaces of the two short sides of the high frequency electrode 1G. That is, the conductors 23 and 24 are embedded in the two short side surfaces of the long insulating portion 3 having a substantially rectangular cross section. Of the two conductors 23 and 24, the cutting tip 20d side in the cutting direction C is the first electrode 21G, and the cutting back end 20b side is the second electrode 22G.

  The proximal ends of the conductors 23 and 24 extend to the operation unit 40, respectively. The operation unit 40 includes a switch 5, and proximal ends of the two conductors 23 and 24 are connected to the switch 5. The switch 5 is connected to the power supply connector 43. The switch 5 is provided with a switching circuit that switches the connection state between the connection portion with the feed connector 43 and the conductors 23 and 24.

  By operating the switch 5, the conduction state of the conductors 23 and 24 can be selected from any one of three modes A to C. Mode A is a mode in which both of the two conductors 23 and 24 are connected to the connection with the feed connector 43. Mode B is a mode in which only the conductor 23 constituting the first electrode 21 G is connected to the connection portion with the feed connector 43. Mode C is a mode in which only the conductor 24 constituting the second electrode 22G is connected to the connection with the feed connector 43. After the mode A to mode C are selected by the operation unit 40, when the high frequency power supply device is operated and energized, the conductors 23 and 24 are energized according to each mode.

  In mode A, since the conductors 23 and 24 are connected to the power supply connector 43, a high-frequency current is supplied to the first electrode 21G and the second electrode 22G when the power is supplied from the high-frequency power supply device. As in the first and second embodiments, when only the first electrode 21G is in contact with the tissue, a high density high frequency current flows, and the incision proceeds and the first electrode 21G and the second electrode 22G contact the tissue The current density flowing from each electrode 21G, 22G is reduced, and incision becomes impossible.

  Since the mode B is energized only to the first electrode 21G, it is energized at the time of tissue incision in the depth direction. When energization is stopped in mode B, the incision is stopped. Therefore, mode B is suitable when an incision is desired at an arbitrary depth. Besides, after the incision is made in the dissection direction C in mode A or mode B first, energization is stopped, and tying is continuously performed at the incision 20, mode B is selected, and only the first electrode 21G is energized. It is used when removing the lesion P.

  In mode C, after the incision is made in the dissection direction C in mode A or mode B, energization is stopped, and tying is continuously performed at the incision 20, and only the second electrode 22G is energized to make the lesion P Used when performing resection.

  Note that, for the purpose of the high frequency electrode 1G of the present invention, mode A is essential, and mode B and mode C are not essential components.

  In the present embodiment, an example is shown in which the two conductors 23 and 24 are partially exposed and embedded in the insulating section 3 having a rectangular cross-sectional shape, but the present invention is not limited to this. For example, only a part of each conductor 23, 24 in the circumferential direction is exposed, and the other part may be configured to run two wires that are insulated in parallel.

  As described above, even in a configuration including a plurality of conductors, it is possible to cut the tissue in a short time as in the above embodiment, and to prevent excessive cutting in the depth direction.

  Similarly to the second embodiment, the high-frequency cutting tool 100G of this embodiment continuously performs the step of cutting the periphery of the tissue to be excised in the depth direction and the step of tightening and resecting the tissue to be resected it can.

  In the present embodiment, an example is shown in which the conductors 23 and 24 are provided on the two short-side surfaces of the high-frequency electrode 1G, respectively, but the configuration and arrangement of the two conductors 23 and 24 are not limited thereto. For example, as in the first modified example shown in FIG. 15, a long plate-like electrode may be disposed long in the cutting direction C. Further, as in the second modified example shown in FIG. 16, the conductors 23I and 24I may be the high frequency electrodes 1I disposed with two surfaces exposed on the surface. In this case, at least the exposed portion of the electrode 23I constituting the first electrode 21I may be located closer to the cutting tip 20d than the exposed portion of the electrode 24I constituting the second electrode 22I.

  Although the said each embodiment showed the example of the high frequency electrode 1 whose cross-sectional shape orthogonal to the longitudinal direction L is substantially rectangular, the longitudinal cross-sectional shape of the high frequency electrode 1 is not limited to this. For example, it may be a triangular, trapezoidal, or T-shaped vertical cross-sectional shape.

1, 1A to 1F High-frequency electrodes 2, 2B, 2G, 23, 24 Conductor 3 Insulating part 5 Switch 20d Incision tip part 20b Incision rear end part 20, 20A, 20E, 20F, 20G Incision part 43 Feed connector 100 High-frequency incision tool 102 Treatment tool channel (channel)

Claims (7)

It comprises an insulating portion and an electrode in which a conductor is exposed from the insulating portion, and the conductive portion is energized to cut the tissue in a cutting direction perpendicular to the longitudinal direction of the electrode.
The electrode is
A first electrode, and a second electrode exposed apart from the first electrode;
A high-frequency electrode in which at least a part of the first electrode is exposed from the insulating portion at a position different from the second electrode in the incision direction.   The high frequency electrode according to claim 1, wherein the first electrode and the second electrode are exposed in different directions in the cutting direction. The incision is annular in shape;
The high frequency electrode according to claim 1, wherein the second electrode is located outside the annular shape. The incision is in the form of a torus, and the first electrode is located outside the torus;
The high frequency electrode according to claim 1, wherein the second electrode is located inside the annular shape. The cut-out portion has a cross section perpendicular to the longitudinal direction having a short side and a long side,
The high frequency electrode according to claim 1, wherein the cutting direction is a direction along the long side. A high frequency electrode according to any one of claims 1 to 5;
A base connector of the high-frequency electrode is connected, and a power supply connector for supplying a high-frequency current to the conductor,
The high frequency cutting tool configured to be able to incise the tissue when only the first electrode contacts the tissue. The first electrode and the second electrode are made of different conductors,
An operation unit having a switch connected to the power supply connector, the first electrode, and the second electrode;
The high-frequency incision tool according to claim 6, wherein the switch connects the power supply connector, the first electrode, and the second electrode so that both the first electrode and the second electrode can be energized simultaneously.

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