JP2021013666A - Perfusion suction device and perfusion suction control program - Google Patents

Abstract

To provide a perfusion suction device and a perfusion suction control program capable of properly suppressing affection by change of an internal pressure of an eye of a patient.SOLUTION: A perfusion suction device comprises a surgical instrument, a suction pressure generation part, a perfusion pressure variable part, and an operation part. The surgical instrument has a breaking part for breaking a tissue, and sucks a fluid from a suction path. The suction pressure generation part generates a suction pressure for sucking the fluid. The perfusion pressure variable part changes a pressure of a perfusion liquid supplied into an eye. The operation part generates a signal according to an operation amount. The control part starts suction of the fluid when an operation amount of the operation part exceeds a suction start threshold. The control part starts breaking of a tissue while executing suction, when the operation amount exceeds a breaking start threshold which is greater than the suction start threshold. The control part increases the perfusion pressure when a difference between the operation amount and the breaking start threshold is a prescribed value and the operation amount exceeds a breaking time increase threshold greater than the suction start threshold.SELECTED DRAWING: Figure 2

Description

The present disclosure relates to a perfusion suction device that supplies a perfusion solution into the eye and sucks waste tissue in the eye together with the perfusion solution, and a perfusion suction control program executed by the perfusion suction device.

Perfusion suction devices may be used in ophthalmic surgery (eg, cataract surgery, vitrectomy). The perfusion suction device supplies the perfusate into the eye and sucks the supplied perfusion solution together with the waste tissue crushed by the crushed portion of the surgical instrument.

It is desirable that the perfusion suction device suppresses fluctuations in intraocular pressure (internal pressure). For example, the perfusion suction device described in Patent Document 1 starts suction of fluid from the inside of the eye by a suction pump, and at the same time, operates a pole vertical movement drive device to increase the perfusion pressure. As a result, it is possible to suppress a decrease in the internal pressure of the patient's eye during suction.

Japanese Unexamined Patent Publication No. 8-10281

In the conventional perfusion suction device, the process for suppressing the influence of the change in the internal pressure may not be able to follow the actual change in the internal pressure. For example, in a perfusion suction device, when a tissue or the like that has blocked a suction path (for example, a hole in a crushed portion provided at the tip of a surgical instrument) is crushed by the crushed portion, the blockage of the suction path is released. , Transient hypersuction may occur and the internal pressure of the patient's eye may decrease sharply (this phenomenon is called the "surge phenomenon"). The surge phenomenon can cause damage to the patient's eyes.

For example, it is conceivable to measure or estimate the internal pressure of the patient's eye and increase the perfusion pressure when a rapid decrease in the internal pressure is measured or assumed to suppress the effect of the surge phenomenon. However, since the surge phenomenon occurs in a very short period of time, even if the perfusion pressure is increased at the time when a sudden decrease in internal pressure is measured or assumed, the internal pressure only increases after the internal pressure decreases sharply. Become. Therefore, even when the internal pressure of the patient's eye changes suddenly, it is desirable that the influence of the change in the internal pressure can be appropriately suppressed.

A typical object of the present disclosure is to provide a perfusion suction device and a perfusion suction control program capable of appropriately suppressing the influence of changes in the internal pressure of the patient's eye.

The perfusion suction device provided by the typical embodiment in the present disclosure is a perfusion suction device that supplies a perfusate from a perfusate source into the eye and sucks the waste tissue in the eye together with the perfusate. A surgical instrument having a crushing portion for crushing the tissue in the eye adsorbed on the path and sucking fluid from the suction path, and a suction pressure generating section for generating suction pressure for sucking fluid from the suction path. A variable perfusion pressure unit that changes the perfusion pressure, which is the pressure of the perfusate liquid supplied into the eye from the perfusion solution source, an operation unit that is operated by the user and generates a signal according to the amount of operation, and the above. A control unit that controls the operation of the perfusion suction device is provided, and the control unit sucks fluid by the suction pressure generating unit when the operation amount of the operation unit increases and exceeds the suction start threshold. When the suction start step to be started and the operation amount of the operation unit increase and exceed the crushing start threshold value larger than the suction start threshold value, the suction pressure generating unit sucks the fluid while performing the suction. The difference S (S ≧ 0) between the crushing start step for starting the crushing of the tissue by the crushing portion and the operation amount of the operating portion is increased, and the difference S (S ≧ 0) from the crushing start threshold value is from the suction start threshold value. When the large crushing increase threshold is exceeded, the crushing perfusion pressure increasing step of increasing the perfusion pressure by the perfusion pressure variable portion is executed.

The perfusion suction control program provided by a typical embodiment in the present disclosure is performed by a perfusion suction device that supplies perfusate from a perfusion source into the eye and sucks the waste tissue in the eye together with the perfusate. A perfusion suction control program, wherein the perfusion suction device has a crushing portion that crushes the tissue in the eye adsorbed on the suction path, and a surgical instrument that sucks fluid from the suction path and a suction path. A suction pressure generating part that generates a suction pressure for sucking a fluid, and a perfusion pressure variable part that changes the perfusion pressure, which is the pressure of the perfusate liquid supplied from the perfusate source into the eye, are operated by the user. The operation unit that generates a signal according to the operation amount is provided, and the control unit of the perfusion suction device executes the perfusion suction control program, so that the operation amount of the operation unit increases and the suction start threshold value. When the suction start step of starting the suction of the fluid by the suction pressure generating unit and the operation amount of the operating unit increase and exceed the crushing start threshold value larger than the suction start threshold value. The difference S between the crushing start step of starting the crushing of the tissue by the crushing portion and the operation amount of the operating portion increasing while executing the suction of the fluid by the suction pressure generating portion. When (S ≧ 0) is a predetermined value and exceeds the crushing increase threshold larger than the suction start threshold, the crushing perfusion pressure increasing step of increasing the perfusion pressure by the perfusion pressure variable portion is performed. Let the suction device perform.

According to the perfusion suction device and the perfusion suction control program according to the present disclosure, the influence of changes in the internal pressure of the patient's eye is appropriately suppressed.

It is a figure which shows the schematic structure of the perfusion suction device 1. It is explanatory drawing for demonstrating an example of the relationship of the control of the perfusion pressure, the control of suction, and the control of crushing with respect to the operation amount of the operation part. It is a flowchart which shows an example of the surgical process performed by the perfusion suction device 1. It is a graph comparing the change of the internal pressure of the patient's eye E when the conventional control is executed, and the change of the internal pressure of the patient's eye E when the control illustrated in this disclosure is executed.

<Overview>
The perfusion suction device supplies the perfusion solution into the eye from the perfusion solution source and sucks the waste tissue in the eye together with the perfusion solution. The perfusion suction device illustrated in the present disclosure includes a surgical instrument, a suction pressure generating part, a perfusion pressure variable part, an operating part, and a control part. The surgical instrument has a crushed portion that crushes the tissue in the eye adsorbed on the suction path and sucks the fluid from the suction path. The suction pressure generating unit generates a suction pressure for sucking the fluid from the suction path. The variable perfusion pressure changes the perfusion pressure of the perfusion solution supplied into the eye from the perfusion solution source. The operation unit is operated by the user and generates a signal according to the amount of operation. The control unit controls the operation of the perfusion suction device. The control unit performs a suction start step, a crushing start step, and a crushing perfusion pressure increasing step. In the suction start step, the control unit starts suction of the fluid by the suction pressure generating unit when the operation amount of the operation unit increases and exceeds the suction start threshold value. In the crushing start step, when the operation amount of the operating unit increases and exceeds the crushing start threshold value larger than the suction start threshold value, the control unit performs suction of the fluid by the suction pressure generating unit and causes the crushing unit to perform the suction. Initiate tissue crushing. In the step of increasing the perfusion pressure during crushing, the control unit increases the operation amount of the operation unit, and the difference S (S ≧ 0) from the crushing start threshold value is a predetermined value and is larger than the suction start threshold value. When the above is exceeded, the perfusion pressure is increased by the perfusion pressure variable part.

According to the perfusion suction device exemplified in the present disclosure, when the user increases the operation amount of the operation unit, the suction path is performed at the same time as the time when the tissue is crushed by the crushed part, or before and after the crushing is started. Perfusion pressure increases whether or not the obstruction is actually released. Therefore, the influence of the surge phenomenon is appropriately suppressed as compared with the case where the perfusion pressure increasing process is started when the obstruction of the suction path is actually released. Since the above control is smoothly executed according to the operation amount of the operation unit, it is unlikely that the operation is contrary to the intention of the user. Therefore, according to the perfusion suction device of the present disclosure, the influence of the change in the internal pressure of the patient's eye is appropriately suppressed. Further, in the vicinity of the suction port of the suction path, the tissue is easily attracted to the suction port due to the pressure difference between the suction pressure and the perfusion pressure. Therefore, it is easier to perform eye surgery more appropriately.

The crushing increase threshold value may be set to be equal to or lower than the crushing start threshold value. The timing at which the obstruction of the suction path is released and the internal pressure of the patient's eye decreases is after the tissue crushing is started. Therefore, when the crushing increase threshold value is set to be equal to or less than the crushing start threshold value, the perfusion pressure is always increased when the suction path is released, so that the influence of the surge phenomenon is more appropriately suppressed.

However, it is also possible to set the crushing increase threshold value to a value larger than the crushing start threshold value. For example, in order to crush the tissue while sufficiently holding it in the crushing part, the crushing part is driven by an energy weaker than the crushing energy before the crushing part is driven by the crushing energy at which the tissue is completely crushed. There is. In this case, if the crushing increase threshold is set so that the perfusion pressure is already increased when the crushing portion is driven by the crushing energy, the influence of the surge phenomenon is appropriately suppressed.

The control unit may set the difference S of the crushing increase threshold value with respect to the crushing start threshold value according to the instruction input by the user. The difference S between the crushing start threshold and the crushing increase threshold is desirable depending on the speed at which the user changes the operation amount of the operation unit and the response time from when the perfusion pressure variable unit is driven until the perfusion pressure actually changes. The value changes. Therefore, by setting the difference S according to the instruction input by the user, the perfusion suction device executes an appropriate operation according to various conditions.

The control unit further performs a suction start perfusion pressure increase step in which the perfusion pressure is increased by the perfusion pressure variable unit when the operation amount of the operation unit increases and exceeds the suction start increase threshold value smaller than the suction start threshold value. You may do it. For example, if there is a time lag between the start of driving the variable perfusion pressure and the actual increase in perfusion pressure, even if the control to increase the perfusion pressure is executed at the same time as the start of suction, after the start of suction. The internal pressure of the patient's eye may temporarily decrease. On the other hand, in the perfusion suction device of the present disclosure, when the user increases the operation amount of the operation unit, the control of increasing the perfusion pressure is executed in advance before the suction is started. Therefore, the effect of decreasing the internal pressure of the patient's eye with the start of suction is appropriately suppressed.

The control unit may set the difference D of the suction start increase threshold value from the suction start threshold value according to the instruction input by the user. The difference D between the suction start threshold and the suction start increase threshold depends on the speed at which the user changes the operation amount of the operation unit, the response time from when the perfusion pressure variable unit is driven until the perfusion pressure actually changes, and the like. The desired value varies. Therefore, by setting the difference D according to the instruction input by the user, the perfusion suction device executes an appropriate operation according to various conditions.

However, it is also possible to change the threshold setting method. For example, a table in which each threshold value (at least one of a suction start threshold value, a suction start time increase threshold value, a crushing start threshold value, and a crushing time increase threshold value) is set for each surgical condition may be stored in the storage device. .. The surgical conditions include, for example, the type of crushed part (specifically, the diameter of the ultrasonic tip or the diameter of the vitreous cutter), the type of the variable perfusion pressure part, the type of the suction pressure generating part, and the route of the perfusion solution. It may be at least one of the types of tubes constituting the tube, the types of tubes constituting the path of the suction liquid, and the like. The control unit may acquire the surgical conditions related to the surgery to be performed and set the threshold value according to the table corresponding to the acquired surgical conditions. In this case, an appropriate threshold value is appropriately set according to the surgical conditions. Further, the threshold value may be fixed in advance.

The perfusion suction device is a source of perfusion pressure that generates perfusion pressure: perfusion pressure by weight generated according to the height of the perfusion solution source, perfusion pressure by a perfusion pressurization mechanism that pressurizes the perfusion solution, and perfusion pressure by gravity. And any combination of perfusion pressures by the perfusion pressurization mechanism may be selectively used. Depending on the content of the ophthalmic surgery, it may be desirable to stop the supply of the perfusate, or it may be desirable to stop the supply of the perfusate as appropriate. When gravitational perfusion pressure is used, it is unlikely that the perfusate supply will stop. On the other hand, when the perfusion pressure by the perfusion pressurization mechanism is used, it is easy to stop the supply of the perfusion solution. Therefore, the user can perform the operation more appropriately by selectively using a plurality of types of perfusion pressures.

When the operation amount of the operation unit exceeds the suction start threshold value, the control unit determines the suction pressure generated in the suction pressure generating unit and the perfusion pressure changed by the perfusion pressure variable unit according to the operation amount of the operation unit. , May be increased or decreased in synchronization with each other. In this case, the user can increase or decrease the suction pressure according to the operation amount of the operation unit. Furthermore, since the perfusion pressure also increases or decreases in synchronization with the increase or decrease in the suction pressure, fluctuations in the internal pressure of the patient's eye are suppressed. Therefore, the surgery is performed more appropriately.

<Embodiment>
Hereinafter, one of the typical embodiments in the present disclosure will be described with reference to the drawings. The perfusion suction device 1 of the present embodiment is an ophthalmic surgery device that supplies the perfusion solution from the perfusion solution source 5 into the eye of the patient eye E and sucks the waste tissue in the eye together with the perfusion solution.

(Outline configuration)
The schematic configuration of the perfusion suction device 1 of the present embodiment will be described with reference to FIG. The perfusion suction device 1 of the present embodiment includes a surgical instrument connection part 3, a perfusion liquid source connection part 4, a perfusion pressure variable part (pole vertical movement motor 6 and a perfusion pressure variable pump 7), a suction pressure generating part 8, and a perfusion path 10. , A suction path 11, a vent path 12, a vent valve 14, a perfusion valve 15, a pressure sensor 18, a control unit 20, and an operation unit 28.

The surgical instrument connection 3 connects one or more surgical instruments 50 to the perfusion suction device 1. The surgical instrument 50 is manipulated by the operator and inserted into the patient's eye E. In the example shown in FIG. 1, an ultrasonic handpiece (US handpiece) used in cataract surgery is connected to a surgical instrument connection 3 as a surgical instrument 50. The ultrasonic handpiece includes a tubular crushing portion (ultrasonic tip) 51 in which a suction port and a suction path are formed at the tip. An oscillator 52 is built in the ultrasonic handpiece. The oscillator 52 generates ultrasonic vibration. The generated ultrasonic vibration is amplified and transmitted to the crushing section 51. When the crushing portion 51 performs ultrasonic vibration, the crystalline lens nucleus of the patient eye E is crushed and emulsified. Also, the perfusate is supplied to the patient's eye E via the ultrasonic handpiece. Further, the discarded tissue of the patient's eye E (for example, in the case of cataract surgery, the crushed lens nucleus, etc.) is aspirated from the eye together with the perfusate via the ultrasonic handpiece.

In this embodiment, the case where the ultrasonic handpiece for cataract surgery is used as the surgical instrument 50 is illustrated. However, the techniques exemplified in the present disclosure can also be applied when a surgical instrument 50 other than the ultrasonic handpiece is used. For example, a vitreous cutter or the like used in vitreous surgery may be used as a surgical instrument 50. Further, a plurality of surgical instruments may be connected to the surgical instrument connecting portion 3. For example, the surgical instrument for supplying the perfusate to the living body and the surgical instrument 50 for crushing the tissue and sucking it from the eye may be separately connected to the surgical instrument connection portion 3.

The perfusion solution source connecting portion 4 connects the perfusion solution source 5 to the perfusion suction device 1. In the present embodiment, a perfusion bottle filled with a perfusion solution (for example, physiological saline or the like) is used as the perfusion solution source 5. The perfusion suction device 1 includes a perfusion pressure variable portion that changes the pressure of the perfusion solution supplied into the eye from the perfusion solution source 5 (hereinafter, referred to as “perfusion pressure”). As an example, the perfusion suction device 1 of the present embodiment includes a pole vertical movement motor 6 and a perfusion pressure variable pump 7 as a perfusion pressure variable unit. The pole vertical movement motor 6 changes the perfusion pressure by moving the pole on which the perfusion liquid source 5 is suspended up and down to change the height of the perfusion liquid source 5. That is, the pole vertical movement motor 6 uses the gravity generated according to the height of the perfusion liquid source 5 as the perfusion pressure. The variable perfusion pressure pump 7 changes the perfusion pressure by changing the pressure of the gas sent into the container of the perfusion liquid source 5 having a constant volume. That is, the perfusion pressure variable pump 7 is an example of a perfusion pressurization mechanism that generates perfusion pressure by pressurizing the perfusion solution.

In the perfusion suction device 1 of the present embodiment, as the perfusion pressure generating source for generating the perfusion pressure, the perfusion pressure by gravity generated according to the height of the perfusion liquid source 5, the perfusion pressure by the perfusion pressurization mechanism, and the perfusion by gravity Any combination of pressure and perfusion pressure by a perfusion pressurization mechanism can be selectively used. Specifically, when the perfusion pressure due to gravity is used, the perfusion suction device 1 stops the operation of the perfusion pressurization mechanism. When the perfusion pressure by the perfusion pressurization mechanism is used, the perfusion suction device 1 positions the height of the perfusion liquid source 5 at a height at which the perfusion pressure does not occur. When using a combination of the perfusion pressure by gravity and the perfusion pressure by the perfusion pressurization mechanism, the perfusion suction device 1 positions the height of the perfusion solution source 5 at the height at which the perfusion pressure is generated, and the perfusion pressurization mechanism. To drive. Depending on the content of the ophthalmic surgery, it may be desirable to stop the supply of the perfusate, or it may be desirable to stop the supply of the perfusate as appropriate. When the perfusion pressure due to gravity is used, it is unlikely that the supply of the perfusion solution will be stopped due to a failure of the perfusion pressurization mechanism or the like. On the other hand, when the perfusion pressure by the perfusion pressurization mechanism is used, it is easy to stop the supply of the perfusion solution. Therefore, the user can perform the operation more appropriately by selectively using a plurality of types of perfusion pressures.

It is also possible to change the specific configuration of the perfusion pressure variable portion. For example, as the perfusion pressurization mechanism, a configuration other than the perfusion pressure variable pump 7 (for example, a configuration in which a perfusion pressure is generated by pressing a pack containing a perfusion solution, or a turbo pump provided in the path of the perfusion solution). A configuration in which perfusion pressure is generated by a liquid pump such as) may be adopted. In addition, the user may manually change the height of the perfusate source 5. Even in this case, the perfusion suction device 1 can change the perfusion pressure by the perfusion pressurizing mechanism (perfusion pressure variable pump 7 in this embodiment). It is also possible to omit the perfusion pressurization mechanism and change the perfusion pressure only by the pole vertical movement motor 6.

The suction pressure generating unit 8 generates a suction pressure for sucking the fluid containing the waste tissue from the inside of the patient's eye E. In this embodiment, a peristaltic pump (peristaltic pump) is used as the suction pressure generating unit 8. The peristaltic pump can change the pressure of the fluid in the path by rotating while pressing the flexible path. The peristeric pump can suppress a sudden increase in suction pressure when the suction path 11 is not blocked. Although not shown in detail, the peristaltic pump of the present embodiment includes a turntable having a pump roller on the outer periphery. The pump roller comes into contact with the suction path 11 made of a flexible material (eg rubber). When the turntable is rotated by the motor, the pump roller travels while crushing the suction path 11, and the pressure of the fluid in the suction path 11 changes. Of course, it is also possible to change the configuration of the peristalic pump. For example, a peristeric pump or the like that presses a flexible elastomer sheet with a roller against a hard substrate may be adopted. Further, a configuration other than the peristaltic pump (for example, a Venturi pump or the like) may be adopted as the suction pressure generating unit 8.

The perfusion path 10 is a fluid path connecting the surgical instrument connected to the surgical instrument connection portion 3 and the perfusion fluid source 5 connected to the perfusion fluid source connection portion 4. That is, the perfusion route 10 allows the movement of fluid between the surgical instrument and the perfusion source 5.

The suction path 11 is a fluid path that connects the suction pressure generating portion 8 and the surgical instrument connected to the surgical instrument connecting portion 3. The suction path 11 of the present embodiment extends from the surgical instrument to the waste liquid bag 9 for storing the sucked waste liquid. The suction pressure generating portion 8 is installed between the surgical instrument connecting portion 3 and the waste liquid bag 9 in the suction path 11.

The vent path 12 is a fluid path connecting the perfusion path 10 and the suction path 11. That is, the vent path 12 branches from the middle of the perfusion path 10 and is connected between the surgical instrument connecting portion 3 and the suction pressure generating portion 8 in the suction path 11.

The vent valve 14 is installed in the vent path 12. The vent valve 14 opens and closes the vent path 12 to switch between allowing and blocking fluid movement in the vent path 12. The perfusion valve 15 is installed in the perfusion path 10. Specifically, the perfusion valve 15 is provided at a position closer to the surgical instrument connection portion 3 than the portion of the perfusion route 10 where the vent route 12 branches. The perfusion valve 15 switches between supplying and blocking the perfusion solution to the surgical instrument through the perfusion route 10 by opening and closing the perfusion route 10.

A pressure sensor 18 is installed between the surgical instrument connecting portion 3 and the suction pressure generating portion 8 in the suction path 11 via the sensor connecting portion 19. The pressure sensor 18 detects the pressure of the fluid in the suction path 11. Therefore, the control unit 20 can also determine (although not essential) whether or not the suction path 11 is blocked based on the pressure detection result of the pressure sensor 18.

The control unit 20 includes a CPU 21, a ROM 22, and a RAM 23. The CPU 21 controls various controls of the perfusion suction device 1 (for example, control of a pole vertical movement motor 6, a perfusion pressure variable pump 7, a suction pressure generating unit 8, a vent valve 14, a perfusion valve 15, and an oscillator 52 of a surgical instrument 50, etc. ) Is the controller. The ROM 22 stores various programs, initial values, and the like for controlling the operation of the perfusion suction device 1. The RAM 23 temporarily stores various types of information.

A non-volatile memory 25, an input unit 26, and an operation unit 28 are connected to the control unit 20. The non-volatile memory 25 is a non-transient storage medium capable of retaining the stored contents even when the power supply is cut off. The perfusion suction control program for executing the surgical process (see FIG. 3) described later may be stored in the non-volatile memory 25. The input unit 26 receives input of various operation instructions from a user (for example, an operator or an assistant). As the input unit 26, various devices such as a touch panel, operation buttons, a keyboard, and a mouse can be adopted. The operation unit 28 is operated by a user (for example, an operator) and generates a signal according to the amount of operation. The signal generated by the operation unit 28 is input to the control unit 20. In the present embodiment, a foot switch operated by a user's foot is used as the operation unit 28. The foot switch outputs a signal with the amount of depression depressed by the user as the amount of operation. A device other than the foot switch may be used as the operation unit 28.

(Surgical treatment)
An example of the surgical procedure performed by the perfusion suction device 1 of the present embodiment will be described with reference to FIGS. 2 and 3. The CPU 21 of the perfusion suction device 1 of the present embodiment is based on the perfusion pressure variable unit (in this embodiment, the pole vertical movement motor 6 and the perfusion pressure variable pump 7) by comparing the operation amount of the operation unit 28 with various threshold values. The perfusion pressure is controlled, the suction pressure is controlled by the suction pressure generating unit 8, and the tissue crushing is controlled by the crushing unit 51.

First, with reference to FIG. 2, various threshold values referred to by the CPU 21 in the surgical process will be described. In the surgical treatment of the present embodiment, the perfusion pressure addition start threshold T1, the suction start increase threshold T2, the suction start threshold T3, the crushing increase threshold T4, and the crushing start threshold T5 are set.

The perfusion pressure addition start threshold value T1 is for determining whether or not to start (execute) the addition of perfusion pressure by the perfusion pressure variable portion with respect to the initial perfusion pressure P0 due to gravity from the perfusion solution source 5 at the initial position. Referenced to. When the manipulated variable exceeds the perfusion pressure addition start threshold T1, the perfusion pressure is added to the initial perfusion pressure P0 (that is, the perfusion pressure is increased), and the perfusion pressure is adjusted to the base pressure P1 (> P0). When only the perfusion pressure by the perfusion pressurization mechanism is used, the initial perfusion pressure P0 is "0 mmHg".

The suction start increase threshold T2 is referred to to determine whether to increase the perfusion pressure from the base pressure P1 to the suction pressure P2 (P2> P1). When the manipulated variable exceeds the suction start increase threshold T2, the perfusion pressure is added to the base pressure P1 (that is, the perfusion pressure is increased), and the perfusion pressure is adjusted to the suction pressure P2.

The suction start threshold value T3 is referred to for determining whether or not to start (execute) suction of the fluid by the suction pressure generating unit 8. When the operation amount exceeds the suction start threshold value T3, the suction pressure generating unit 8 executes suction of the fluid through the suction path 11.

Here, the suction start increase threshold value T2 is set to a value smaller than the suction start threshold value T3. Therefore, when the amount of operation of the operation unit 28 gradually increases (that is, when the user gradually depresses the foot switch), the perfusion pressure changes from P1 to P2 before the timing when the suction of the fluid is actually started. Increase to. The difference D between the suction start threshold value T3 and the suction start increase threshold value T2 is preset at the time when the surgical process (see FIG. 3) is executed.

The crushing increase threshold T4 is referred to for determining whether to increase the perfusion pressure from the suction pressure P2 to the crushing pressure P3 (> P2). When the manipulated variable exceeds the crushing increase threshold T4, the perfusion pressure is added to the suction pressure P2 (that is, the perfusion pressure is increased), and the perfusion pressure is adjusted to the crushing pressure P3.

The crushing start threshold value T5 is referred to for determining whether or not to start (execute) crushing the tissue by the crushing portion 51 and the vibrator 52. When the manipulated variable exceeds the crushing start threshold value T5, the crushing portion 51 and the vibrator 52 crush the tissue (the lens nucleus of the patient's eye in this embodiment).

Here, the crushing increase threshold value T4 is set to a value larger than the suction start increase threshold value T2 and the suction start threshold value T3. Further, the difference S (≧ 0) of the crushing increase threshold value T4 with respect to the crushing start threshold value T5 is before the tissue obstructing the suction path of the surgical instrument 50 is crushed by the crushing portion 51 and the obstruction is released. In addition, the perfusion pressure is preset so as to be increased to the crushing pressure P3. As an example, in the present embodiment, the crushing increase threshold value T4 is set to be equal to or lower than the crushing start threshold value T5 (in the example shown in FIG. 2, T4 = T5 is set). In this case, when the obstruction of the suction path of the surgical instrument 50 is released, the process of increasing the perfusion pressure to the crushing pressure P3 is always executed. Therefore, the influence of the surge phenomenon is suppressed more appropriately.

In addition, the speed at which the user changes the operation amount of the operation unit 28, the response time from the start of driving the perfusion pressure variable unit to the actual change of the perfusion pressure, various configurations for sucking the fluid, etc. Correspondingly, the desired value of the difference S of the crushing increase threshold value T4 with respect to the crushing start threshold value T5 changes. Similarly, the speed at which the user changes the operation amount of the operation unit 28, the response time from the start of driving the perfusion pressure variable unit to the actual change of the perfusion pressure, various configurations for sucking the fluid, etc. The desired value of the difference D of the suction start increase threshold value T2 with respect to the suction start threshold value T3 also changes accordingly. In the present embodiment, the user operates the input unit 26 to set the value of the crushing increase threshold value T4 and the value of each threshold value T1 to T5 including the value of the suction start increase threshold value T2 within the above-mentioned range. You can enter it as appropriate. The CPU 21 sets the difference S of the crushing start threshold value T4 with respect to the crushing start threshold value T5 and the difference D of the suction start time increase threshold value T2 with respect to the suction start threshold value T3 according to the instruction input by the user. Therefore, an appropriate operation according to various conditions is performed by the perfusion suction device 1. The user may directly input the difference S of the crushing start threshold value T4 with respect to the crushing start threshold value T5 and the difference D of the suction start increase threshold value T2 with respect to the suction start threshold value T3 by operating the input unit 26. Good. In this case, the CPU 21 sets the crushing start threshold T5 and the crushing increase threshold T4 according to the input difference S, and sets the suction start threshold T3 and the suction start increase threshold T2 according to the input difference D. It may be set.

In addition, the respective thresholds were set for the response time from the start of driving the variable perfusion pressure to the actual change in the perfusion pressure, and for each surgical condition related to various configurations for sucking the fluid. The table may be stored in a storage device (for example, a non-volatile memory 25 or the like). The surgical conditions include, for example, the type of the crushed portion 51 (specifically, the diameter of the ultrasonic tip or the diameter of the vitreous cutter), the type of the variable perfusion pressure portion, the type of the suction pressure generating portion 8, and the perfusion route 10. It may be at least one of the types of tubes constituting the above, the types of tubes constituting the suction path 11. The CPU 21 may acquire surgical conditions related to the surgery to be performed and set at least one of various threshold values T1 to T5 according to the table corresponding to the acquired surgical conditions. In this case, an appropriate threshold value is appropriately set according to the surgical conditions.

The surgical process executed by the CPU 21 of the present embodiment will be described with reference to FIG. When the user inputs an instruction to execute the operation, the CPU 21 executes the operation process illustrated in FIG. 3 according to the perfusion suction control program stored in the non-volatile memory 25. At the start of the surgical process, the operation amount of the operation unit 28 is "0".

First, the CPU 21 determines whether or not the operation amount of the operation unit 28 exceeds the perfusion pressure addition start threshold value T1 (S1). If the manipulated variable does not exceed the perfusion pressure addition start threshold value T1 (S1: NO), the CPU 21 is in a state where the perfusion pressure addition by the perfusion pressure variable portion is stopped (S2). The process returns to S1. When the operation amount exceeds the perfusion pressure addition start threshold value T1 (S1: YES), the CPU 21 determines the perfusion pressure by the perfusion pressure variable portion with respect to the initial perfusion pressure P0 due to gravity from the perfusion liquid source 5 at the initial position. Is performed to adjust the perfusion pressure to the base pressure P1 (> P0) (S3).

Next, the CPU 21 determines whether or not the operation amount of the operation unit 28 exceeds the suction start increase threshold value T2 (S4). If the operation amount does not exceed the increase threshold value T2 at the start of suction (S4: NO), the process returns to S1. When the operation amount exceeds the suction start increase threshold value T2 (S4: YES), the CPU 21 executes the addition of the perfusion pressure by the perfusion pressure variable portion to the base pressure P1 and applies the perfusion pressure to the suction pressure P2 (Suction pressure P2). > Adjust to P1) (S5).

Next, the CPU 21 determines whether or not the operation amount of the operation unit 28 exceeds the suction start threshold value T3 (S6). If the operation amount does not exceed the suction start threshold value T3 (S6: NO), the process returns to S4. When the operation amount exceeds the suction start threshold value T3 (S6: YES), the CPU 21 causes the suction pressure generating unit 8 to execute suction of the fluid through the suction path 11 (S7).

When the operation amount exceeds the suction start threshold value T3, the CPU 21 determines the suction pressure generated by the suction pressure generating unit 8 and the perfusion pressure changed by the perfusion pressure variable unit each time the operation amount increases. It may be increased in synchronization with each other. In this case, the user can increase or decrease the suction pressure according to the operation amount of the operation unit 28. Furthermore, since the perfusion pressure also increases or decreases in synchronization with the increase or decrease in the suction pressure, fluctuations in the internal pressure of the patient's eye E are suppressed. Therefore, the surgery is performed more appropriately.

Next, the CPU 21 determines whether or not the operation amount of the operation unit 28 exceeds the crushing increase threshold value T4 (S8). If the manipulated variable does not exceed the crushing increase threshold T4 (S8: NO), the process returns to S6. When the manipulated variable exceeds the crushing increase threshold value T4 (S8: YES), the CPU 21 executes the addition of the perfusion pressure by the perfusion pressure variable portion to the suction pressure P2, and changes the perfusion pressure to the crushing pressure P3 (S8: YES). > Adjust to P2) (S9).

Next, the CPU 21 determines whether or not the operation amount of the operation unit 28 exceeds the crushing start threshold value T5 (S10). If the operation amount does not exceed the crushing start threshold value T5 (S10: NO), the operation of crushing the tissue is not executed and the process returns to S8 as it is. When the operation amount exceeds the crushing start threshold value T5 (S10: YES), the CPU 21 causes the crushing unit 51 and the vibrator 52 to crush the tissue (S11). The process returns to S10. In S11, the CPU 21 increases the energy for driving the crushing unit 51 each time the operation amount of the operating unit 28 increases. Therefore, the user can crush the tissue with an appropriate energy according to the state of the tissue to be crushed.

As described above, in the examples shown in FIGS. 3 and 4, the crushing increase threshold value T4 is set to be equal to or lower than the crushing start threshold value T5. However, it is also possible to set the crushing increase threshold value T4 to a value larger than the crushing start threshold value T5. In this case, the order of S8 and S9 may be replaced with S10 and S10.

Further, in the present embodiment, the CPU 21 continuously measures or estimates the internal pressure of the patient's eye E, and performs feedback control for controlling the drive of the perfusion pressure variable portion and the suction pressure generating portion 8 so that the internal pressure approaches the target value. Execute. Therefore, the internal pressure of the patient's eye E becomes more stable.

(Changes in internal pressure of the patient's eye)
With reference to FIG. 4, the comparison result of the change in the internal pressure of the patient's eye E when the conventional control is executed and the change in the internal pressure of the patient's eye E when the control in the surgical treatment of the present embodiment is executed will be described. .. The graph on the left side of FIG. 4 shows the change in the internal pressure of the patient's eye E when the conventional control is performed. The graph on the right side of FIG. 4 shows the change in the internal pressure of the patient's eye E when the surgical treatment of the present embodiment is performed. The horizontal axis of the graph shows time, and the vertical axis shows the internal pressure of the patient's eye E. Further, in order to facilitate comparison, in FIG. 4, the timing at which the suction of the fluid is started, the timing at which the tissue blocks the suction path, the timing at which the crushed portion 51 of the blocked tissue starts crushing, and the timing at which the tissue is crushed. It shows the change in the internal pressure between the conventional case and the present embodiment when the timing at which the blockage is released is the same.

When the user increases the operation amount of the operation unit 28 and the operation amount exceeds the suction start threshold value T3 (see FIG. 2), the suction of the fluid is executed. As shown on the left side of FIG. 4, in the conventional control, the internal pressure of the patient's eye E decreases by the value AD1 with respect to the base value B with the start of suction. Further, in addition to the control shown on the left side of FIG. 4, even if the control for increasing the perfusion pressure is executed at the same time as the start of suction, there is a time lag between the start of driving the variable perfusion pressure portion and the actual increase in the perfusion pressure. In some cases, the internal pressure of the patient's eye E drops significantly after the start of suction. On the other hand, in the present embodiment, when the user increases the operation amount of the operation unit 28, the control for increasing the perfusion pressure is executed in advance before the start of suction. As a result, as shown on the right side of FIG. 4, the decrease in the internal pressure of the patient's eye E accompanying the start of suction is appropriately suppressed, and the amount of decrease in the internal pressure is AD2, which is smaller than the value AD1.

When suction is executed, the tissue blocks the suction path of the crushed portion 51, and the internal pressure rises. The user increases the operation amount of the operation unit 28 in order to release the blockage, and causes the crushing unit 51 to execute the crushing operation. When the tissue that has blocked the suction path is crushed and the blockage is released, transient oversuction occurs and the internal pressure drops sharply (this phenomenon is called the "surge phenomenon"). As shown on the left side of FIG. 4, in the conventional control, the internal pressure of the patient's eye E is lowered by SD1 with respect to the base value B due to the influence of the surge phenomenon. On the other hand, in the present embodiment, when the user increases the operation amount of the operation unit 28, the obstruction of the suction path is actually released at the time when the crushing unit 51 starts crushing the tissue or before or after the crushing of the tissue is started. Perfusion pressure increases, whether or not. As a result, as shown on the right side of FIG. 4, the decrease in the internal pressure of the patient's eye E due to the surge phenomenon is appropriately suppressed, and the amount of decrease in the internal pressure is SD2, which is smaller than the value SD1.

Further, as described above, in the present embodiment, as the amount of operation of the operation unit 28 increases, a process for increasing the perfusion pressure is executed before the crushing operation by the crushing unit 51 is started. Will be done. Therefore, the perfusion suction device 1 can more reliably increase the perfusion pressure at the time when the obstruction of the suction path is released. Therefore, the influence of the surge phenomenon is suppressed more appropriately.

The techniques disclosed in the above embodiments are merely examples. Therefore, it is possible to modify the techniques exemplified in the above embodiments. For example, only some of the plurality of techniques exemplified in the above embodiments may be adopted. As an example, in the above embodiment, both the treatment of increasing the perfusion pressure at the start of crushing the tissue and the treatment of increasing the perfusion pressure before the start of suction are executed according to the amount of operation of the operation unit 28. However, it is also possible to have the perfusion suction device 1 perform only one of these treatments. Further, in the above embodiment, the suction start increase threshold value T2 is set to a value smaller than the suction start threshold value T3. Therefore, as the user increases the amount of operation of the operation unit 28, the perfusion pressure increases before the timing of starting suction. However, the suction start threshold increase threshold value T2 may be set to a value equal to or higher than the suction start threshold value T3.

The process of starting the suction of the fluid in S6 and S7 of FIG. 3 is an example of the “suction start step”. The process of starting the crushing of the tissue by the crushing portion 51 in S10 and S11 of FIG. 3 is an example of the “crushing start step”. The process of increasing the perfusion pressure in S8 and S9 of FIG. 3 is an example of the “step of increasing the perfusion pressure during crushing”. The process of increasing the perfusion pressure in S4 and S5 of FIG. 3 is an example of the “step of increasing the perfusion pressure at the start of suction”.

1 Perfusion suction device 5 Perfusion liquid source 6 Pole vertical movement motor 7 Perfusion pressure variable pump 8 Suction pressure generator 21 CPU
25 Non-volatile memory 28 Operation unit 50 Surgical instrument 51 Crushing unit

Claims (6)

A perfusion suction device that supplies a perfusion solution into the eye from a perfusion solution source and sucks the waste tissue in the eye together with the perfusion solution.
A surgical instrument having a crushing portion that crushes the tissue in the eye adsorbed on the suction path and sucking a fluid from the suction path.
A suction pressure generating part that generates a suction pressure for sucking a fluid from the suction path,
A variable perfusion pressure portion that changes the perfusion pressure, which is the pressure of the perfusion solution supplied into the eye from the perfusion solution source.
An operation unit that is operated by the user and generates a signal according to the amount of operation,
A control unit that controls the operation of the perfusion suction device,
With
The control unit
A suction start step of starting the suction of the fluid by the suction pressure generating unit when the operation amount of the operation unit increases and exceeds the suction start threshold value.
When the amount of operation of the operation unit increases and exceeds the crushing start threshold value larger than the suction start threshold value, the tissue is crushed by the crushing unit while sucking the fluid by the suction pressure generating unit. The crushing start step to start and
When the amount of operation of the operation unit increases and the difference S (S ≧ 0) from the crushing start threshold value exceeds a predetermined value and exceeds the crushing increase threshold value larger than the suction start threshold value, the perfusion A step of increasing the perfusion pressure during crushing, which increases the perfusion pressure by the variable pressure part,
A perfusion suction device characterized by performing. The perfusion suction device according to claim 1.
A perfusion suction device, wherein the crushing increase threshold value is set to be equal to or lower than the crushing start threshold value. The perfusion suction device according to claim 1 or 2.
A perfusion suction device, wherein the difference S between the crushing start threshold and the crushing increase threshold is set according to an instruction input by the user. The perfusion suction device according to any one of claims 1 to 3.
The control unit
A step of increasing the perfusion pressure at the start of suction, in which the perfusion pressure is increased by the variable perfusion pressure when the operation amount of the operation unit increases and exceeds the increase threshold at the start of suction, which is smaller than the suction start threshold.
A perfusion suction device characterized by further performing. The perfusion suction device according to claim 4.
The control unit
A perfusion suction device, wherein a difference D between the suction start threshold and the suction start increase threshold is set according to an instruction input by a user. A perfusion suction control program executed by a perfusion suction device that supplies perfusion fluid into the eye from a perfusion fluid source and sucks the waste tissue in the eye together with the perfusion fluid.
The perfusion suction device is
A surgical instrument having a crushing portion that crushes the tissue in the eye adsorbed on the suction path and sucking a fluid from the suction path.
A suction pressure generating part that generates a suction pressure for sucking a fluid from the suction path,
A variable perfusion pressure portion that changes the perfusion pressure, which is the pressure of the perfusion solution supplied into the eye from the perfusion solution source.
An operation unit that is operated by the user and generates a signal according to the amount of operation,
With
When the control unit of the perfusion suction device executes the perfusion suction control program,
A suction start step of starting the suction of the fluid by the suction pressure generating unit when the operation amount of the operation unit increases and exceeds the suction start threshold value.
When the amount of operation of the operation unit increases and exceeds the crushing start threshold value larger than the suction start threshold value, the tissue is crushed by the crushing unit while sucking the fluid by the suction pressure generating unit. The crushing start step to start and
When the amount of operation of the operation unit increases and the difference S (S ≧ 0) from the crushing start threshold value exceeds a predetermined value and exceeds the crushing increase threshold value larger than the suction start threshold value, the perfusion A step of increasing the perfusion pressure during crushing, which increases the perfusion pressure by the variable pressure part,
A perfusion suction control program, characterized in that the perfusion suction device is executed.

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