JP2963313B2 - Surgical handpiece - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical handpiece for crushing and removing biological tissue or foreign matter in a body cavity by ultrasonic vibration.

[0002]

2. Description of the Related Art Surgical devices for crushing, cutting, or separating biological tissue by ultrasonic vibration are used in ophthalmology for crushing and removing a lens hardened by cataract, and in the brain, spine, digestive tract, and the like. 2. Description of the Related Art Surgical apparatuses for soft tissue for general surgery for crushing and aspirating and removing tumors and hematomas are known. More recently, an ultrasonic surgical apparatus capable of cutting and separating hard tissue by ultrasonic vibration has been used.

[0003] In addition, while various techniques and devices for performing treatment in a minimally invasive and non-invasive manner have been developed, the operation of removing the gallbladder using a laparoscope in the field of gastrointestinal tract is compared with the operation of open surgery. The recovery is fast because the surgery is less invasive.
It has been widely used due to short hospitalization days, quick rehabilitation, low postoperative pain, and extremely small surgical wounds.

In this operation, the abdominal cavity is insufflated with carbon dioxide or the like without opening the abdomen, and an endoscope, forceps,
An electric scalpel or the like is inserted, and the gall bladder is removed under the visual field of the endoscope. The point is to safely and accurately exfoliate the gallbladder duct and gallbladder artery from the Calot triangular part, cut and cut it, and then exfoliate the gallbladder base from the liver bed, remove the gallbladder with forceps and remove it from the body That is.

However, if this endoscopic surgery is applied to all cases of cholelithiasis, the degree of gallbladder inflammation, the position of gallstones, the shape of the gall bladder duct and the gallbladder artery, etc. can be reduced by using only ordinary treatment tools. Depending on conditions such as the age of the patient, problems such as heavy bleeding from the artery and the hepatic bed and difficulty in fixing the gallbladder duct and the gallbladder artery may occur, and there is a risk that it is necessary to switch to laparotomy during the operation.

On the other hand, measures have been taken to improve the hemostatic effect by improving the tip shape of the electric scalpel and to stop the bleeding by using a laser scalpel. In addition, since the mechanical tearing force of forceps is used for dissection of the gallbladder artery, it does not fundamentally prevent bleeding. In addition, while studying measures against hernia, early cancer of the stomach, and large intestine, etc., devices and instruments that are superior in preventing bleeding are desired.

[0007] Attempts have been made to carry out these operations using a surgical apparatus using ultrasonic vibration which can selectively preserve an elastic body such as a blood vessel. At present, these apparatuses and handpieces have been specialized for use in endoscopic surgery. Particularly in endoscopic surgery for children and patients who have already undergone surgery, trocars have been developed for use in surgical procedures and handpiece abdomen insertion in order to reduce the size of the surgical wound. Therefore, there is a high demand for reducing the diameter of the insertion portion of the handpiece.

[0008] However, there is a problem that the durability is reduced and the processing cost is increased by making the tip portion forming the tip portion of the handpiece thin, and the tip portion is reduced in diameter while maintaining the current crushing ability. Difficult to do. Further, the reduction in the diameter of the tip portion also leads to a reduction in the diameter of a passage for sucking the crushed tissue piece, and the suction passage may be clogged by the crushed piece.

Attempts have been made to make a part of the tip cover elastic, but as shown in FIG. 4A, the tip (5) is passed through an airtight valve (53) of a trocar (52).
1) When the elastic cover (50) is inserted, the thickness of the elastic cover (50) is thin and lacks rigidity, or the entire end face of the elastic cover (50) is simultaneously sealed with the airtight valve (53).
, And the airtight valve (53) is pushed and opened at the end face, so that only the tip (51) is inserted into the trocar (52), and the elastic body cover (50) as shown in FIG. It may be wrinkled (52) and cannot be inserted into the trocar (52).

[0010] Next, the speed of sound changes for each production lot from the size of the crystal grain size generated due to the subtle difference in the heat treatment state and forging conditions of the alloy used for the chip.
In endoscopic surgery, the vibrating body part to be inserted into the body such as a chip becomes thin and long, and has a plurality of antinodes and nodes of vibration, so the difference in sound speed is enlarged, and when an antinode of vibration is provided at the end, In addition, variation in the overall length of each chip is likely to be large.
As a result, when the tip of the tip is formed in a conical shape for amplitude expansion, as shown in FIG. 5, the tip end faces (56) and (5) of the tip length vary by the dimension (58).
The diameter of 7) is different, and the crushing force at the time of ultrasonic vibration is different, so that there is a drawback that the performance is difficult to stabilize.

[0011]

SUMMARY OF THE INVENTION An object of the present invention is to solve such a problem of a conventional surgical handpiece using ultrasonic vibration, and to reduce the ultrasonic vibration performance. It is an object of the present invention to provide a surgical handpiece that can improve the insertability without any problems, can accommodate children and patients who have a history of surgery, and can stabilize the tip end shape.

[0012]

SUMMARY OF THE INVENTION The present invention is directed to an ultrasonic vibration source for crushing, cutting, or separating and removing a biological tissue or a foreign substance in a body cavity by ultrasonic vibration, and an ultrasonic vibration source connected to the ultrasonic vibration source. In a surgical handpiece having a vibrating body that transmits and expands mechanical vibration at a frequency and a protective cover that stores and covers the vibrating body, and the surgical handpiece having a liquid passage inside the protective cover, the vibrating body is located near the distal end. A conical reduced diameter portion is provided, and further a cylindrical portion is provided on the distal end side thereof, which has a vibration abdominal surface at the distal end portion, and the protective cover is made of an elastic body at a peripheral portion of the vibrating body. The tip surface has an angle with respect to the longitudinal axis of the vibrating body, and a projection is provided on the inner surface so that the vibrating body comes into point or line contact with the vibrating body. From the tip Surgical operation, wherein the protective cover is formed by combining an ultrasonic vibration source and a body cover accommodating a part of the joint part, and a tip cover covering the tip part and a part of the joint part. Handpiece.

Hereinafter, the present invention will be described in detail with reference to the drawings. FIG. 1 is a view for explaining a basic structure of a surgical handpiece according to one embodiment of the present invention. FIG. 2 is a view showing a shape of a tip portion of a tip portion, and FIG. 3 is a view showing a structure of a tip cover. .

As shown in FIG. 1 (a), the ultrasonic vibration source (1) is joined to a vibrating body comprising a joint (2) and a tip (3) by means of screws or the like. Is provided with a suction passage (4) penetrating in the length direction.

The joint part (2) and the tip part (3)
As shown in the figure, the ultrasonic vibration source (1) and the joint (2) or the joint (2) and the tip (3) may be manufactured separately and joined by means such as screws. There is no problem even if they are formed integrally. Further, the joint part (2) may be divided into a plurality of parts and joined, which is effective when the vibration transmission loss is small. Furthermore,
The joint between the tip part (3) and the joint part (2) is located between the node of vibration and the abdomen to reduce the stress applied to the node of the tip part (3). When the tip (3) and the joint (2) are screwed together, the tip (3)
Is selected according to the vibration transmission loss and the processing cost.

The surgical handpiece according to the present invention is used by being inserted into the abdominal cavity together with an endoscope or the like through a trocar installed through the abdominal wall.
220 to 270 mm is required as the length of the tip part (3). In addition, joint part (2) and tip part (3)
In consideration of the problem of material fatigue and breakage due to vibration, it is necessary to provide a joint near the nodal surface of ultrasonic vibration,
On the other hand, the working portion (14) at the tip of the tip portion is used as the vibration surface because it is necessary to maximize the amplitude. The wavelength of ultrasonic vibration is
Determined by the frequency of vibration, the material (density) of the vibrating body, the outer diameter, etc. As an example, an outer diameter of stainless steel φ4m
In the chip part of m, the wavelength is about 2 at the frequency of 24 kHz.
At 11 mm and 38 kHz, it is about 133 mm. In consideration of these conditions, it is appropriate that the tip length of the handpiece is set to a length corresponding to approximately 5/4 or 7/4 of the wavelength.

Next, it is preferable that the opening of the suction passage at the tip of the working portion (14) is smaller than the diameter of the suction passage (4) inside the tip portion (3). This has the advantage that it is possible to prevent the suction object from clogging the vibration node of the tip part (3) and closing the passage.

On the other hand, these ultrasonically vibrating members are housed and covered by a protective cover made of a heat-resistant resin and an elastic body. As shown in FIGS. 1B and 1C, the protective cover includes a main body cover (5) for housing the ultrasonic vibration source (1) and a part of the joint (2), and a joint (2). )
And a method of fixing the ultrasonic vibration source (1) to the main body cover (5) is not particularly limited. It is preferable to provide a flange at the node of the ultrasonic vibration source (1) and fix it.

At the rear end of the body cover (5), a suction nipple (7) communicating with the suction passage (4) and a cable (6) for supplying high-frequency power to the ultrasonic vibration source (1). Is attached. The tip cover (8) is shown in FIG.
As shown in (a) and (b), there is a lumen (7) for inserting the tip (3). An annular space created between the tip portion (3) when the tip portion (3) is inserted into the lumen (7) is used as a passage for supplying an irrigation liquid such as saline, and the rear end of the tip cover (8). An irrigation nipple (9) serving as an inlet for the irrigation liquid is provided near the portion. In addition, chip cover (8)
As shown in FIG. 3 (b), the front cover (12) formed of an elastic body as a detachable and separate component, and the base cover (13) are configured by combining two components. Is also good.
From the viewpoint of preventing infection, it is useful to attach and detach the tip cover (12) that directly contacts the affected part.

When the tip cover (8) is made of one component, only silicone or fluorine-based elastic material is used in consideration of high-pressure steam sterilization. If you choose to use the top cover (1
Preferably, only 2) is made of a silicone-based or fluorine-based elastic body, and the base end cover (13) is made of a heat-resistant resin such as polysulfone or polyethersulfone from the viewpoint of mounting properties. Further, at least the vicinity of the tip of the chip cover (8) is preferably made of a transparent or translucent material.

As described above, since the surgical handpiece according to the present invention is inserted into the abdominal cavity through the trocar to perform the operation, the surgical handpiece repeatedly moves forward and backward during the operation. Therefore, when the outer diameter of the chip cover is tapered, various problems occur. It is desirable that the outer diameter of the insertion portion of the tip cover (8) is constant in order to smoothly perform the forward / backward operation and to prevent leakage of insufflation gas at that time. It is preferable that the length be equal to or more than 波長 wavelength from the tip of the chip cover (8).

The chip cover (8) is provided with a main body cover (5).
As shown in FIG. 3, the projections (11) and (1) provided on the inner surface at positions corresponding to the nodes of vibration of the vibrating body and the vicinity of the tip end surface of the chip cover (8).
0) and can be rotated about the axis of the vibrating body. Projection (1
1) and (10) may be formed integrally with the chip cover (8), or another member may be bonded.

As shown in FIG. 2, the shape near the tip of the tip portion (3) is such that a conical reduced diameter portion (25) is provided, and a cylindrical portion (26) is further provided at the tip side. Department (1
4) is formed. By adopting such a shape, the sound speed that fluctuates due to the shape and size of the crystal grain size, which is generated by the heat treatment of the alloy used for the tip portion (3) and the delicate difference in the forging conditions, is reduced. The size of the working section (14) of the section (3) is prevented from being changed. That is, the variation in the overall length generated between the chips due to the difference in sound speed can be absorbed in the range of the cylindrical portion (26), so that the diameter of the working portion (14) does not change. Thereby, the fluctuation of the crushing performance of the vibrating body can be prevented.

As described above, the tip portion (3) has the same dimensions as the conventional one and the tip portion has a small-diameter cylindrical portion (26).
On the other hand, the thickness of the chip cover (8) is reduced, and as shown in FIG. 3 (c), the tip of the chip cover (8) is set at 10-80 with respect to the longitudinal axis. By adopting an inclined surface having an angle of 45 to 60 degrees, it is possible to reduce the diameter as a whole while solving the above-mentioned problems.

That is, since the tip cover (8) has an inclined surface at the tip, when the tip cover is inserted into the trocar, the tip can be inserted without receiving the airtight valve of the trocar over the entire end face. Due to the contact resistance between the reduced diameter portion (25) and the protruding portion (10) of the shape, the chip portion (3) and the chip cover (8) are not stiff due to the small thickness of the chip cover (8). This can prevent the chip cover (8) from being displaced and causing wrinkles in the chip cover (8).

Since an elastic body is used for the chip cover (8), the chip portion in contact with the projections (10) and (11) is not damaged. At the tip of the chip cover (8), as shown in FIG. 3D, a groove between the projections (10) is formed with a gap (27) between the projection (10) and the cylindrical portion (26).
From which the irrigation liquid is ejected. Further, the vicinity of the tip working portion (14) of the tip portion (3) may have an angle with respect to the vibration direction.

[0027]

According to the present invention, in an operation under an endoscope using a surgical handpiece using ultrasonic vibration, the insertability into a small diameter trocar can be improved without lowering the ultrasonic vibration performance. Thus, for children and patients with a history of surgery, surgery can be performed with a smaller surgical wound than before, and the tip end shape can be stabilized,
It can be used as a handpiece for surgery because it can expand the indication cases.

[Brief description of the drawings]

1A and 1B are diagrams showing a basic structure of a surgical handpiece according to an embodiment of the present invention, wherein FIG. 1A is a cross-sectional view in which an ultrasonic vibration source and a vibrating body are connected, and FIG. (C) is a side view in which the main body cover and the chip cover are mounted.

FIG. 2 is an enlarged side view of a tip of a tip portion in the present invention.

FIGS. 3A and 3B are diagrams showing the structure of a chip cover according to the present invention, wherein FIGS. 3A and 3B are side sectional views, FIG. 3C is an enlarged sectional view of a tip mounted on a chip portion, and FIG. It is a front view of the tip part in the state attached to the tip part.

FIG. 4 is a diagram showing a situation in which a conventional handpiece having an elastic cover attached thereto is inserted into a trocar.

FIG. 5 is a diagram for explaining the influence of variations in chip length.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Ultrasonic vibrator 2 Joint part 3 Tip part 4 Suction passage 5 Main body cover 8 Tip cover 10, 11 Projection part 12 Front cover 13 Base end cover 14 Working part 25 Reduced diameter part 26 Cylindrical part

──────────────────────────────────────────────────続 き Continuation of the front page (56) References JP-A-1-198540 (JP, A) JP-A-4-329943 (JP, A) JP-A-2-99050 (JP, A) JP-A-1-1985 135342 (JP, A) Japanese Utility Model Application Hei 4-92211 (JP, U) Japanese Utility Model Application Hei 2-123216 (JP, U) Japanese Utility Model Application Hei 2-135006 (JP, U) (58) Fields surveyed (Int. ⁶ , DB name) A61B 17/22 A61B 17/36

Claims (5)

(57) [Claims] 1. An ultrasonic vibration source for crushing, cutting or separating and removing a biological tissue or a foreign substance in a body cavity by ultrasonic vibration, and connected to the ultrasonic vibration source to transmit and expand mechanical vibration at an ultrasonic frequency. In a surgical handpiece comprising a vibrating body and a protective cover for accommodating and covering them, and having a liquid passage inside the protective cover,
The vibrating body is provided with a conical diameter-reduced portion in the vicinity of the distal end, a cylindrical portion is provided on the distal end side, and has a vibration abdominal surface at the distal end. Is made of an elastic body, its tip end surface has an angle with respect to the longitudinal axis of the vibrating body, and a projection is provided on its inner surface so as to come into point or line contact with the vibrating body. Features a surgical handpiece. 2. The surgical handpiece according to claim 1, wherein the vibrator comprises a joint portion and a small-diameter tip portion. 3. A protection cover comprising: a main body cover for accommodating an ultrasonic vibration source and a part of a joint; and a chip cover for covering the tip and a part of the joint. The surgical handpiece according to claim 2, wherein 4. The surgical handpiece according to claim 3, wherein the tip cover has a detachable transparent or translucent tip cover attached to the periphery of the tip portion. . 5. The chip cover according to claim 2, wherein a protrusion is provided on the inner surface of the chip cover at a position corresponding to a node of vibration of the vibrating body to hold the chip cover. The surgical handpiece according to any one of the above.