JP3270415B2 - Ultrasonic coagulation incision device - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an ultrasonic coagulation and incision apparatus for performing treatment such as incision, resection or coagulation of a living tissue by using ultrasonic waves while grasping the living tissue outside or inside the body.

[0002]

2. Description of the Related Art As an ultrasonic coagulation and incision apparatus, an apparatus disclosed in US Pat. No. 5,322,055 is generally known. In this ultrasonic coagulation incision device,
An ultrasonic oscillator that generates ultrasonic vibration, a vibration transmitting member connected to the ultrasonic oscillator, a blade (probe) formed at the tip of the vibration transmitting member, and an opening and closing facing the blade A jaw supported so as to be able to be opened and a handle portion for opening and closing the jaw are provided.

In use, the jaws are opened and closed with respect to the blade by operating the handle of the handle. Here, the living tissue is grasped between the jaw and the blade by closing the jaw with respect to the blade.

Further, the ultrasonic vibrator is driven while the living tissue is grasped. Ultrasonic vibration from this ultrasonic vibrator is transmitted to the blade via a vibration transmitting member, and cuts the living tissue while coagulating the living tissue by frictional heat of the ultrasonic vibration generated at a contact portion with the living tissue. Is to be performed. At this time, a coagulation action and an incision action are simultaneously applied to the grasped portion of the living tissue, and the portion of the grasped living tissue portion is incised without causing bleeding.

Further, in US Pat. No. 5,322,055, a blade is provided with a knife-shaped incision and a solidified surface having a substantially arc-shaped cross section, and the incision of the blade is opposed to a jaw. The configuration in which the state in which the solidification surface is arranged and the state in which the solidification surface is opposed to each other can be switched is shown. here,
When the incision of the blade is set so as to face the jaw, the incision at the grasping portion of the living tissue is enhanced. Further, when the coagulation surface of the blade is set so as to face the jaw, the coagulation action at the grasping portion of the living tissue is enhanced.

In Japanese Patent Application Laid-Open No. 8-275951, a jaw is moved by a handle operation to grasp a living tissue between the blade and the jaw, and ultrasonic vibration is applied to the jaw to incise a grasping portion of the living tissue. An apparatus configured to perform a procedure such as excision or coagulation is shown.

Further, in the publication, a coagulated surface having a large contact area with the living tissue and an incision portion having a small contact area with the living tissue are provided on the jaw side, and the incision portion of the jaw is arranged to face the blade. A configuration in which a state and a state in which a solidification surface is opposed to each other can be switched is shown. In this case, in the state where the incised portion of the jaw is opposed to the blade, the incision action at the grasping portion of the living tissue is strong, and in the state where the coagulated surface of the jaw is opposed to the blade, the living tissue is not removed. The coagulation action at the grip site is enhanced.

Further, in the above-mentioned conventional apparatus, as shown in FIGS. 27 and 28, the gripping surfaces a1 and b1 of the living tissue in the blade a and the jaw b are set substantially in a substantially linear manner. Then, at the time of the coagulation and incision treatment of the living tissue, as shown in FIG. 29, an incised portion c1 having substantially the same shape as the gripping surfaces a1 and b1 of the living tissue in the blade a and the jaw b is formed in the living tissue c. .

[0009]

By the way, after cutting a blood vessel or a tubular tissue such as a large intestine, a small intestine, a bile duct or the like in a body, a vascular anastomosis for anastomosis between cut ends of the tubular tissue,
When performing procedures such as intestinal anastomosis, the anastomotic opening of the blood vessel is everted,
2. Description of the Related Art Generally, an operation of suturing an anastomotic opening by hand sewing with a needle and a thread so that the inner membranes are in contact with each other is generally performed. It has been considered that such a procedure as blood vessel anastomosis or the like is performed by using the ultrasonic coagulation and incision apparatus instead of the hand sewing operation using a needle and a thread. In this case, after a plurality of portions are coagulated and joined to the peripheral portion of the anastomotic hole along the circumferential direction, a trimming treatment is performed to cut off unnecessary portions around the joint. Therefore, during one procedure such as vascular anastomosis,
Coagulation of the living tissue and excision are performed respectively.

However, in the ultrasonic coagulation and incision apparatus having the above-described conventional configuration, the blade and the jaw are used in a state where they are set to either coagulation or resection, so that only one ultrasonic coagulation and incision apparatus is used. Thus, there is a problem that it is difficult to efficiently and simultaneously coagulate the living tissue and resect the living tissue.

SUMMARY OF THE INVENTION The present invention has been made in view of the above circumstances, and an object thereof is to provide an ultrasonic coagulation and incision apparatus capable of simultaneously and efficiently coagulating a living tissue and resecting the living tissue with a simple configuration. Is to provide.

[0012]

According to a first aspect of the present invention, there is provided an ultrasonic vibrator for generating ultrasonic vibration, and a treatment unit connected to the ultrasonic vibrator for performing treatment on a living tissue. A vibration transmitting member that transmits ultrasonic vibrations, a probe connected to a distal end portion of the vibration transmitting member, and a living tissue that is opposed to the probe and is openably and closably supported by the probe; Gripping member, operating means for opening and closing the gripping member with respect to the probe, and at least one of the gripping member or the probe
An opposing portion, the tip of which is in the longitudinal direction of the probe.
Provided on one side of the side or the rear end side, coagulates the treated part
And a non-contact portion formed in a concave shape for
On the side adjacent to the non-contact portion, and cuts the treatment target portion.
An ultrasonic coagulation and incision device comprising a contact portion for opening . According to the first aspect of the present invention, when the gripping member is closed on the probe side, the gripping portion is closed.
Tip between the material and the probe in the longitudinal direction of the probe
The concave or non-contact part on one side of the
Solidifies the part to be treated grasped between the probe and the grasping member,
The probe is grasped by the gripping member and the contact part with the probe.
By excising (cutting) the treatment target portion gripped between the holding member and the living tissue, coagulation of the living tissue and excision of the living tissue can be simultaneously and efficiently performed.
The invention according to claim 2 is an ultrasonic vibrator for generating ultrasonic vibration.
Connected to the ultrasonic transducer,
Transmission to transmit ultrasonic vibrations to the treatment section for placement
Member and a probe connected to the tip of the vibration transmitting member.
Probe and open to the probe facing this probe.
It is supported so that it can be closed, and grasps living tissue between the probe and the probe.
Holding member, and holding the holding member with respect to the probe.
Operating means for opening / closing operation by the gripping member or the professional
At least one opposing portion of the probe, wherein the probe
Is provided on one side along the long axis direction of the
A non-contact portion formed in a concave shape for solidification,
Provided on the other side of the portion adjacent to the non-contact portion,
And a contact portion for incising the mounting portion.
Ultrasonic coagulation and incision device. And of claim 2
In the invention, when the gripping member is closed to the probe side,
Along the length of the probe between the gripping member and the probe
The probe is gripped by the concave non-contact part on one side
The treatment target portion gripped between the members is solidified, and the gripping member is
And the probe and the gripping member by the contact portion with the probe.
By removing (dissecting) the part to be treated grasped during
Coagulation of living tissue and removal of living tissue at the same time
It is something that can be done well.

[0013]

DESCRIPTION OF THE PREFERRED EMBODIMENTS A first embodiment of the present invention will be described below with reference to FIGS. 1 to 13 (a) and 13 (b).
FIG. 1 is a perspective view showing an overall configuration of an ultrasonic coagulation / incision instrument 1 according to the present embodiment. The ultrasonic coagulation incision tool 1 includes a handle unit (operating means) 2 shown in FIG. 2A, a probe unit 3 shown in FIG. 2B, and a transducer unit 4 shown in FIG. It is designed to be assembled in the state shown by.

As shown in FIG. 2A, the handle unit 2 is provided with a front handle 13 fixed to an operation section main body 12 having a vibrator connection section 11, and a rotating rear handle 14. . The operation end of the front handle 13 is provided with a finger hole 15 for selectively inserting a plurality of fingers other than the thumb, and the operation end of the rear handle 14 is provided with a finger hole 16 for applying the same thumb. Is provided. The rear handle 14 is pivotally mounted on a shaft pin 17 screwed to the operation section main body 12 so as to be rotatable.

As shown in FIGS. 2 and 5, the rear handle 1
A fixing screw member 19 also serving as a locking pin is provided through the other end of 4. As shown in FIG.
As shown in FIG. 1, an engaging portion 21 for engaging with the probe unit 3 mounted on the operating portion main body 12 is provided, and an operation knob portion 22 is formed at the other end of the fixing screw member 19.
A play portion 24 is formed at an intermediate portion of the fixing screw member 19. A play portion 24 of the fixing screw member 19 is movably inserted into a through hole 23 formed at the other end of the rear handle 14. Further, an intermediate portion of the fixing screw member 19 is located on the outer end side of the play portion 24,
3 is formed with a male screw portion 26 which is screwed with the female screw portion 25 formed. The fixing screw member 19 can freely move forward and backward within a range where the play portion 24 is located in the through hole 23. For this reason, the engagement portion 21 can be retracted from an engagement position with the rotor described later. 6 by screwing the male screw portion 26 into the female screw portion 25 by advancing the fixing screw member 19 to the engaging position of the engaging portion 21.
As shown in (a), it can be fixed at the position of engagement with the rotor.

A spring member located between the operation knob 22 and the rear handle 14, for example, a coil spring 28 is wound around the fixing screw member 19. Then, as shown in FIG. 6B, when the male screw part 26 is removed from the female screw part 25, the fixed screw member 19 is resiliently driven by the elastic restoring force of the coil spring 28.
As shown in FIG. 5, it is automatically evacuated. For this reason, the insertion and mounting of the probe unit 3 and the disassembly / removal operation are not hindered.

A stopper piece 29 for fixing the probe unit 3 mounted on the operation section main body 12 at a mounting position is pivotally mounted on the upper portion of the operation section main body 12. The stopper piece 29 is made of metal for improving the durability, or is formed of an electrically insulating material for securing electrical insulation. Stopper piece 2
9 is locked to the probe unit 3 by a spring 30.
In the direction shown in FIG.
It is rotated in the direction shown in FIG.

As shown in FIG. 4A, an insertion sheath portion 31 is connected to a front end of the operation portion main body 12 via a member of a rotary knob 32 and a fixing nut 33. The insertion sheath portion 31 and the rotation knob 32 are coaxially rotatably attached to the operation portion main body 12. In other words, the rotation knob 32 is configured such that the collar 34 formed on the operation portion main body 12 is
It is rotatably supported by bearing means 35 configured to be sandwiched between the fixing nut 33. The insertion sheath portion 31 is always braked to some extent by the frictional force of the sliding contact portion, and cannot be easily rotated. However, when the front handle 13 and the rear handle 14 are strongly grasped, the frictional force therebetween increases. The brake is applied. That is, a braking means for reliably preventing the rotation of the insertion sheath portion 31 is incorporated.

As shown in FIG. 4A, the insertion sheath portion 31
Consists of a rigid metal pipe. It has a double tube structure of a core material 31a and an outer cover 31b of an electrically insulating resin covering the core material 31a. As shown in FIG. 4B, a pair of locking pieces 36 that engage with the probe unit 3 inserted through the insertion sheath portion 31 are provided at the distal end portion inside the insertion sheath portion 31. The locking piece 36 is formed by partially extending the member of the core material 31a and bending it inward. An index 38 indicating the locking position is provided on the upper surface of the rotary knob 32 corresponding to the locking position. When the probe unit 3 is inserted into the operation unit main body 12 with the index 38 positioned above, a part of a jaw holding member, which will be described later, provided at the tip of the probe unit 3 is locked to the locking piece 36, At the same time, the stopper piece 29 fixes the handpiece 41 of the vibrator unit 4 at the mounting position.

As shown in FIG. 7A, the vibrator unit 4 has an ultrasonic vibrator 43 disposed in a cylindrical cover 42 of a handpiece 41, and the front end of the ultrasonic vibrator 43 is
4 are connected. As shown in FIG. 7B, a female screw portion 45 into which the rear end of the probe unit 3 is screwed is formed at the tip of the horn 44. Ultrasonic transducer 43
Is supported by the cover 42 by supporting the horn 44 at the front end of the cover 42. That is, horn 4
4 closely fits the outer flange 46 to the inner periphery of the cover 42,
The outer flange 46 is held between an inner flange 47 formed on the inner periphery of the cover 42 and a fixing ring 48 screwed into the cover 42 by sandwiching and fixing the outer flange 46. FIG.
As shown in (b), an engagement receiving portion 51 formed of a notched concave portion is formed on a part of the outer flange 46 of the horn 44, while the engagement receiving portion 51 is fitted on the inner flange 47 of the cover 42. An engaging portion 52 formed of a convex portion that fits and engages is formed. A cushioning member 53 made of an elastic material is interposed between the outer flange 46 of the horn 44 and the inner flange 47 of the cover 42 sandwiching the horn 44 and the fixing ring 48 in the axial direction of the horn 44. Then, the outer flange 46 of the horn 44 is sandwiched and fastened via the buffer member 53.

Further, as shown in FIG.
A ring-shaped stopper receiving member 56 is screwed into and fixedly attached to the front end portion. Stopper receiving member 5
An annular orbital groove 57 is formed on the outer peripheral surface portion of 6.
The stopper piece 29 on the handle unit 2 side is fitted and locked in the stopper receiving member 56. The rear end portion of the rotor 78 of the probe unit 3 fits into the inner cavity 58 of the stopper receiving member 56.

As shown in FIG. 7, the ultrasonic vibrator 43
It is constituted by a Langevin type ultrasonic transducer in which a plurality of piezoelectric elements 61 are laminated, and these are clamped by a not-shown bolt which penetrates the central portion between the horn 44 and the rear member 62. An electrode 63 is interposed between each piezoelectric element 61, and a driving voltage is applied to each piezoelectric element 61 through this electrode 63. Also,
A lead wire 6 from a handpiece cord 64 is connected to the electrode 63.
5 is connected. Another lead 66 is further connected to the ground-side electrode 63, and this lead 66 is connected to a high-frequency connection pin 67. This connection pin 67
Is connected to a high-frequency supply cord (not shown) that is connected to a high-frequency power supply. The ground-side electrode 63 is electrically connected to the conductive horn 44 from the conductive bolt of the ultrasonic transducer 43. Further, a vibration transmitting member and a probe of the probe unit 3 described later connected to the distal end of the horn 44 are also conductive members, and are configured to be electrically connected to the distal treatment section through these members.

The handpiece cord 64 is long and flexible as shown in FIG. 3, and a handpiece plug 68 is provided at the extension end. A waterproof cap 69 is attached to the handpiece plug 68, and the vicinity of the terminal of the handpiece plug 68 is covered with the waterproof cap 69 when cleaning the vibrator unit 4.

The probe unit 3 is formed as shown in FIGS. That is, it has a rod-shaped vibration transmission member 71 that transmits ultrasonic vibrations, and an operation drive shaft 72 that is arranged substantially parallel along the rod-shaped vibration transmission member 71. Vibration transmitting member 71
Is made of a titanium material or an aluminum material having a high acoustic effect and good biocompatibility. The vibration transmission member 71 is composed of a front end portion 71a and a rear end portion 71b, and both are fixedly connected by screwing and bonding. A male screw 73 is formed at the rear end of the vibration transmitting member 71, and the male screw 73 is screwed into a female screw 45 formed at the tip of the horn 44. And
The stepped end surface 74 at the rear end of the vibration transmitting member 71 is screwed up to a position where it abuts on the front end surface of the horn 44 so as to be firmly connected. A spanner hooking surface 75 is formed on the peripheral surface of the rear end portion of the vibration transmitting member 71. An opening portion of a wrench described later is fitted on the wrench mounting surface 75 so as to hang it.

The operation drive shaft 72 is a wire-shaped member, which is formed of a material such as stainless steel (SUS) which is relatively rigid and has spring elasticity. A thin metal pipe 76 is fitted on the operation drive shaft 72. The pipe 76 is fitted from the base end of the operation drive shaft 72 to an intermediate portion just before the front end. The pipe 76 is the operation drive shaft 7
2 is adhered to the peripheral surface. A small notch 77 is formed at an appropriate position of the pipe 76, and an adhesive is injected from an opening of the notch 77 to bond the two.

A rotor 78 is fixedly attached to the rear end of the operation drive shaft 72. The rotor 78 is formed in a cylindrical rotating body shape having a center axis whose center coincides with the center axis of the vibration transmitting member 71. 2 on the outer circumference of the rotor 78
An annular groove 82 for engagement is formed by providing a ridge flange 81.
The fixed screw member 1 attached to the rear handle 14, which is a movable handle of the handle unit 2, is provided in the engagement annular groove 82.
9 are engaged with each other. O-rings 83 and 84 are mounted on the front and rear peripheral surfaces of the engagement annular groove 82. And when assembling units 2, 3, and 4,
The front end side peripheral portion 85 of the rotor 78 fits into the fitting hole 80 of the handle unit 2, and the rear end side peripheral portion 87 of the rotor 78.
Fits into the lumen 58 of the stopper receiving member 56 in the lumen of the operation section main body 12. Further, the stopper piece 29 is engaged with the circumferential groove 57 of the stopper receiving member 56 on the vibrator unit 4 side. The vibrator unit 4 can rotate integrally with the probe unit 3, and the operation drive shaft 72 of the probe unit 3 operates the handle 78 by the handle unit 2 to rotate the rotor 78.
Integrally with the vibrator unit 4 and the stationary member of the vibration transmitting member 71 can be moved in the front-rear axial direction.

The vibration transmitting member 71 and the operation drive shaft 72 are connected by a plurality of spacers 86. Each spacer 86 is mounted at a node of vibration of the vibration transmitting member 71. The spacer 86 is the vibration transmitting member 7
1 has a fitting groove 87 that slidably fits an intermediate portion of the first member 1, and a support hole (fitting groove) 88 that penetrates the operation drive shaft 72 fitted with the pipe 76. The operation drive shaft 72 is held in parallel at a predetermined interval. The operation drive shaft 72 fitted with the pipe 76 has
To prevent the spacer 86 from moving back and forth, a retaining ring 89 is provided so as to be fitted on the front and rear except for the one of the most advanced spacer. Each of the retaining rings 89 is fixed to the outer periphery of the pipe 76 fitted on the operation drive shaft 72 by bonding. A slit 90 for pouring the adhesive is formed in the retaining ring 89.

The foremost spacer 86 is provided at a node of the ultrasonic vibration closest to the distal end thereof, including the probe 113 described later. The foremost spacer 86 may be adhered and fixed to the outer periphery of the pipe 76 fitted to the operation drive shaft 72, but here, the spacer 86 is movably fitted in the axial direction to the outer periphery of the pipe 76. Have been. Further, the spacer 86 has a support member 89, and a stopper ring 91 is fitted on both of them, and both are fastened and integrally fixed by adhesion. That is, a flange 95 of the vibration transmitting member 71 described later is used.
The spacer 86 and the support member 89 from above and below
The stopper ring 91 is fitted to the spacer 86 and the support member 89 and fastened, and the spacer 86 and the stopper ring 91 are bonded. At this time, the support member 89 is a member included in the spacer 86, and both may be bonded and fixed.

The portion of the vibration transmitting member 71 located at the leading end spacer 86 is provided with a rotation restricting flange 95.
(See section DD in FIG. 10). This rotation restricting flange 95 has a rectangular cross-sectional shape, and is fitted into and engaged with a fitting groove 96 formed on the inner surface of the corresponding spacer 86, and the spacer 86 around the vibration transmitting member 71. The rotation is prevented. In the fitting groove 96 of the spacer 86, a vibration absorbing member 97 made of, for example, a rubber, which is a vibration absorbing member, is fitted between the rotation regulating flange 95 and the spacer 86 at the operation drive shaft 72 side.

The most distal spacer 86 also serves as a support base end of the jaw holding member 100 extending forward from this position. Since both the spacer 86 and the jaw holding member 100 are formed integrally, the jaw holding member 100 is formed. Member 10
Numeral 0 restricts the movement of the vibration transmitting member 71 in the axial direction and the rotation around the axis. The jaw holding member 100 has a front end extended to a position short of the front end of the vibration transmitting member 71,
A jaw (gripping member) 105 described later is connected to the distal end. The jaw holding member 100 is formed with a slit groove 101 extending from near the base end to the tip. A reinforcing bridge 102 that connects the left and right portions of the slit groove 101 is provided at the tip of the jaw holding member 100.

A pivot pin 103 is provided at the tip of the jaw holding member 100 and is located before the reinforcing bridge 102 and bridges the left and right portions of the slit groove 101. And
A jaw 105 is pivotally attached to the pivot pin 103. Here, the connecting hole 106 for the bearing of the jaw 105 is formed as an oblique long hole as shown in FIG.
The pivot pin 103 is inserted through the inside of the reference numeral 06. FIG.
As shown in FIG.
The tip of the operation drive shaft 72 is connected to a portion located below 06. The distal end portion of the operation drive shaft 72 is bent at a substantially right angle, and the bent portion 107 is inserted into the hole 108 formed in the jaw 105 from the side surface of the jaw 105 and is connected rotatably. The length (width) of the bent portion 107 is slightly shorter than the width of the slit groove 101 as shown in the cross section AA in FIG. 10, and the bent portion 107 is provided so as to be always located in the slit groove 101. . Therefore, even if the jaw 105 is broken from the root portion of the bent portion 107,
Is kept inserted in the hole 108, so that the broken fragments do not fall into the body cavity or the like.

The jaw 105 is connected to the base 111 and the contact member 11.
2 and both are integrated. Here, the base 111 is formed of a metal material, and the contact member 112 is formed of, for example, Teflon (trade name of ethylene tetrafluoride resin manufactured by DuPont). Further, the jaw 105 constitutes a so-called movable blade (movable-side gripping piece) that faces a probe (fixed-side gripping piece) 113 formed by directly using the tip of the vibration transmitting member 71. The portion of the probe 113 constitutes a so-called fixed blade having a vertically long sectional shape. The distal end peripheral portion of the probe 113 is rounded. Then, the jaw 105 pushes and pulls the operation drive shaft 72 so that the probe 113
The jaw 105 and the probe 113 constitute an openable and closable ultrasonic treatment unit (tip treatment unit). FIG. 8 shows a state in which the jaw 105 is closed by pulling the operation drive shaft 72 and is in contact with the upper surface of the probe 113.

The connecting hole 106 of the jaw 105 into which the pivot pin 103 fits is formed as an elongated hole having a width that allows the pivot pin 103 to move. As shown in FIG. 11, the longitudinal direction of the connection hole 106 is inclined at an angle θ with respect to a line perpendicular to the gripping surface of the probe 113. When the longitudinal direction of the connection hole 106 is oblique as described above, the engagement of the jaw 105 with the probe 113 is improved. That is,
As shown in FIGS. 12A to 12C, since the pivot pin 103 can relatively move within the connection hole 106 of the jaw 105, the operation process amount in which the jaw 105 is uniformly engaged with the probe 113 and gripped increases. At the same time, the contact at the time of holding and closing becomes uniform throughout.

In the case of this embodiment, the connecting hole 1
06 is set to be more than 0 ° and less than 90 °.
Further, it is preferable that the angle is 45 ° or less, and particularly, 12 °
When the angle is set to ± 10 °, the amount of gripping force is substantially the same on the front side and the near side.

The connecting hole 106 for supporting the jaw 105
The relationship between the pivot pin 103 and the jaw 105 is
03 may be provided to form the connection hole 106 on the jaw holding member 100 side. In this case, the same function as described above is achieved.

Further, a stopper mechanism for regulating the operation amount of the jaw 105 when the operation of closing the jaw 105 by pulling the operation drive shaft 72 is provided at the place of the jaw holding member 100. That is, the stopper tube 121 is fitted in the middle of the operation drive shaft (movable member) 72 located in the slit groove 101 of the jaw holding member 100. The stopper tube 121 has a female screw formed on the inner surface, and is screwed and attached to a male screw formed on the outer periphery of the pipe 76 fitted on the operation drive shaft 72. By using this screwing attachment means, the position of the stopper tube 121 can be finely adjusted during the manufacturing process. Further, a tubular nut 122 is screwed into a male screw portion formed on the outer periphery of the pipe 76, and the stopper tube 121 is fixed in a double nut format. Stopper tube 121 and nut 12
A knurl is formed on the outer peripheral surface of 2 to prevent slipping when performing a rotation operation. Further, the stopper tube 121 and the stopper 122 are adhered to a pipe 76 for screwing them. A slit hole 124 for injecting an adhesive is formed in the stopper tube 121 and the nut 122.

When the operation drive shaft 72 is retracted and the jaws 105 are closed, the rear end of the stopper tube 121 hits the stopper receiving surface 125 formed by the rear end surface of the slit groove 101 formed on the stationary member side. And the operation amount of the jaw 105 is limited. With respect to the position of the stopper tube 121 with respect to the operation drive shaft 72, the stopper tube 121 is attached to the operation drive shaft 72 by screwing. Therefore, when assembling these components, their positions can be adjusted so as to eliminate component errors, and the components can be attached with high accuracy.

Further, the ultrasonic coagulation / incision device 1 of the present embodiment
1 of the distal treatment section of the probe unit 3 in FIG.
As shown in FIG. 11, a concave portion (non-contact portion) 131 cut out on a surface facing the jaw 105 and a contact portion 132 that comes into contact with the jaw 105 are provided at 13. Here, the concave portion 131 is disposed at the tip end of the probe 113, and the contact portion 132 is disposed at a position behind the concave portion 131. The concave portion 131 of the probe 113 is formed by cutting when the probe 113 is manufactured.

Further, the concave portion 131 of the probe 113 is held in a non-contact state with the jaw 105 when the jaw 105 is closed to the probe 113 side.
3 and the jaw 105 function as a portion that coagulates the treatment target portion of the living tissue that is grasped.
Further, the contact portion 132 of the probe 113 moves to a position where the jaw 105 comes into contact with the jaw 105 when the jaw 105 is closed to the probe 113 side, and cuts a living tissue gripped between the probe 113 and the jaw 105. It functions as a (cutting) part.

Next, the operation of the above configuration will be described.
When using the ultrasonic coagulation / incision instrument 1 of the present embodiment, the handles 13 and 14 of the handle unit 2 are gripped with one hand and the rear handle 14 is turned to open and close the jaws 105 of the distal treatment section. be able to. When the rear handle 14 is rotated, the jaw 105 is rotated with respect to the probe 113 which is fixed, and the living tissue is grasped or opened between the two to exfoliate the organ or remove the organ. Or you can.

When performing an ultrasonic treatment, the patient is guided into the abdominal cavity by using a trocar or the like, and the living tissue of the diseased part is gripped between the probe 113 and the jaw 105 of the distal treatment part. At this time, the concave portion 1 at the tip of the probe 113
At 31, the living tissue is grasped. In this case, the amount of grasping force becomes relatively small, and the amount of grasping force of the living tissue becomes large in the portion of the contact portion 132 behind the concave portion 131.

In this state, ultrasonic vibration is applied to the probe 113. At this time, the concave portion 131 of the probe 113
Is held between the probe 113 and the jaw 105. Living tissue is coagulated. Further, the probe 113
The probe 113 and the jaw 10
The living tissue grasped during the period 5 is cut (cut) while coagulating.

Therefore, the above configuration has the following effects. That is, in the ultrasonic coagulation / incision instrument 1 of the present embodiment, a concave portion 131 cut out on the surface of the probe 113 facing the jaw 105 and a contact portion 132 contacting the jaw 105 are provided.
When closed to the side, the concave portion 131 of the probe 113,
Coagulates living tissue at a non-contact portion between the jaw 105 and
In the contact portion 132, the probe 113 and the jaw 105
Excision (incision) while coagulating living tissue grasped during
can do. Therefore, with the ultrasonic coagulation incision tool 1 of the present embodiment, coagulation of the living tissue and excision of the living tissue can be performed simultaneously and efficiently.

Further, the ultrasonic coagulation / incision device 1 of the present embodiment
For example, when performing vascular anastomosis treatment in the body by using, the blood vessel H1 is cut as shown in FIG.
The peripheral portion H3 of the anastomotic opening H2 of the blood vessel H1 is turned over in a substantially flange shape, and the inner lining of the anastomotic opening H2 of the two cut blood vessels H1 is brought into contact with each other, so that the peripheral portion H of the anastomotic opening H2 is formed.
3 is joined all around. At this time, a ring-shaped joint H4 is formed, which joins between the peripheral portions H3 of the anastomotic port H2 of the two blood vessels H1.

Subsequently, two blood vessels H are placed between the probe 113 and the jaw 105 of the ultrasonic coagulation / incision instrument 1 of the present embodiment.
Part 1 of the joint H4 is gripped. In this state, ultrasonic vibration is applied to the probe 113. At this time, the joint H of the blood vessel H1 is formed at the concave portion 131 of the probe 113.
4 is coagulated, and a trimming treatment is performed in which the joint H4 of the blood vessel H1 is coagulated (cut) while coagulating at the contact portion 132. Therefore, the coagulation of the joint H4 of the blood vessel H1 and the trimming treatment of cutting off unnecessary portions around the joint H4 are performed at the same time.

This ultrasonic treatment is performed at a plurality of locations along the circumferential direction of the joint H4 of the blood vessel H1. When the ultrasonic treatment is completed in all the places, the anastomosis treatment of the joint H4 of the two blood vessels H1 is completed as shown in FIG. Therefore, when performing the vascular anastomosis treatment using the ultrasonic coagulation and incision instrument 1 of the present embodiment, the trimming of the extra portion and the anastomosis can be performed at the same time, and the vascular anastomosis treatment can be performed efficiently. .

FIG. 14 shows a second embodiment of the present invention. In this embodiment, the configuration of the distal end treatment section of the probe unit 3 in the ultrasonic coagulation incision instrument 1 of the first embodiment (see FIGS. 1 to 13A and 13B) is changed as follows. It is. The other portions have the same configuration as the ultrasonic coagulation / cutting instrument 1 of the first embodiment, and the same reference numerals are assigned to the same portions as the ultrasonic coagulation / cutting instrument 1 of the first embodiment. The description is omitted here.

That is, in the first embodiment, the configuration in which the concave portion 131 and the contact portion 132 are provided in the probe 113 is shown, but in the present embodiment, the contact member 11 of the jaw 105 is provided.
2, a notch (non-contact portion) 141 is formed at the end of the surface facing the probe 113.
A contact portion 142 that contacts the probe 113 at a position behind
Are formed. Here, the concave portion 141 of the jaw 105
Is held in a non-contact state with the probe 113 when the jaw 105 is closed to the probe 113 side, and functions as a portion for coagulating a treatment portion of a living tissue gripped between the probe 113 and the jaw 105. It is supposed to. Further, the contact portion 142 of the jaw 105 is
Is closed to the probe 113 side.
Is moved to a position where it comes into contact with the body, and the living tissue gripped between the probe 113 and the jaw 105 is cut (cut).
It is designed to function as a part to do.

Therefore, in this embodiment, when the living tissue of the diseased part is grasped between the probe 113 of the distal treatment section and the jaw 105, the concave part 141 at the foremost part of the jaw 105 is grasped when grasping the living tissue. Ability is relatively small,
At the portion of the contact portion 142 located behind the concave portion 141, the amount of grasping force of the living tissue increases. Therefore, when ultrasonic vibration is applied to the probe 113 in this state, the living tissue grasped between the probe 113 and the jaw 105 is coagulated in the concave portion 141 of the jaw 105 and the portion of the contact portion 142 of the jaw 105 is coagulated. In this case, the living tissue grasped between the probe 113 and the jaw 105 is cut (cut) while coagulating. Therefore, the same effects as those of the first embodiment can be obtained in the present embodiment.

FIG. 15 shows a third embodiment of the present invention. In the present embodiment, the probe 113 is provided with a concave portion 131 and a contact portion 132, similarly to the ultrasonic coagulation incision tool 1 of the first embodiment (see FIGS. 1 to 13A and 13B). , The second embodiment (FIG. 14)
Similarly, the contact member 112 of the jaw 105 has a notched concave portion 141 at the tip of the surface facing the probe 113, and a contact portion 142 that contacts the probe 113 is formed at a position behind the concave portion 141. Things.

Therefore, in the present embodiment, when the living tissue of the diseased part is grasped between the probe 113 of the distal treatment section and the jaw 105, the gap between the concave part 141 at the foremost part of the jaw 105 and the concave part 131 of the probe 113 is formed. In this case, the amount of gripping force when gripping the living tissue becomes relatively small,
In the portions of the contact portions 142 and 132 at positions rearward of the portions 1 and 131, the amount of grasping force of the living tissue increases. Therefore, when ultrasonic vibration is applied to the probe 113 in this state, the concave portion 141 of the jaw 105 and the concave portion 131 of the probe 113
The living tissue grasped between the probe 113 and the jaw 105 is coagulated in a portion between the probe 113 and the jaw 105, and a portion between the contact portion 142 of the jaw 105 and the contact portion 132 of the probe 113 is coagulated between the probe 113 and the jaw 105. The grasped living tissue is cut (cut) while coagulating. Therefore,
In this embodiment, the same effects as in the first embodiment can be obtained.

FIG. 16 shows a fourth embodiment of the present invention. In this embodiment, the configuration of the distal end treatment section of the probe unit 3 in the ultrasonic coagulation incision instrument 1 of the first embodiment (see FIGS. 1 to 13A and 13B) is changed as follows. It is.

That is, in this embodiment, the jaw 105 is attached to the probe 113 of the distal treatment section of the probe unit 3.
A notched concave portion (non-contact portion) 151 is formed on the rear side of the surface opposing the concave portion 151, and a contact portion 152 that contacts the jaw 105 is formed on the front side of the concave portion 151. The concave portion 151 of the jaw 105 is held in a non-contact state with the probe 113 when the jaw 105 is closed to the probe 113 side.
5 functions as a portion for coagulating the treatment target portion of the living tissue to be grasped. Also, Joe 10
The contact portion 152 of No. 5 moves to a position where the jaw 105 comes into contact with the probe 113 when the jaw 105 is closed to the probe 113 side, and cuts (dissects) a living tissue gripped between the probe 113 and the jaw 105. It is designed to function as a part to do. The concave portion 151 of the probe 113 is formed by cutting when the probe 113 is manufactured.

Therefore, in this embodiment, when the living tissue of the diseased part is grasped between the probe 113 of the distal treatment section and the jaw 105, the concave part 141 at the foremost part of the jaw 105 is grasped when grasping the living tissue. Ability is relatively small,
At the portion of the contact portion 142 located behind the concave portion 141, the amount of grasping force of the living tissue increases. Therefore, when ultrasonic vibration is applied to the probe 113 in this state, the living tissue grasped between the probe 113 and the jaw 105 is coagulated in the concave portion 141 of the jaw 105 and the portion of the contact portion 142 of the jaw 105 is coagulated. In this case, the living tissue grasped between the probe 113 and the jaw 105 is cut (cut) while coagulating. Therefore, the same effects as those of the first embodiment can be obtained in the present embodiment.

FIG. 17 shows a fifth embodiment of the present invention. In this embodiment, the configuration of the distal end treatment section of the probe unit 3 in the ultrasonic coagulation incision instrument 1 of the first embodiment (see FIGS. 1 to 13A and 13B) is changed as follows. It is.

That is, in the present embodiment, the contact member 112 of the jaw 105 of the distal treatment section of the probe unit 3 is formed with a concave portion (non-contact portion) 161 cut out on the rear side of the surface facing the probe 113, This recess 161
A contact portion 162 that contacts the probe 113 is formed on the front side. The concave portion 161 of the jaw 105 is held in a non-contact state with the probe 113 when the jaw 105 is closed to the probe 113 side, and the living tissue treated between the probe 113 and the jaw 105 is treated. The part functions as a solidifying part. The contact portion 162 of the jaw 105 is
Is closed to the probe 113 side.
, And functions as a portion for cutting (dissecting) the living tissue grasped between the probe 113 and the jaw 105.

Therefore, in the present embodiment, when the living tissue of the affected part is gripped between the probe 113 of the distal treatment section and the jaw 105, the amount of gripping force when gripping the living tissue is relatively small in the concave portion 161 of the jaw 105. This recess 1
In the portion of the contact portion 162 at the front position of 61, the amount of grasping force of the living tissue increases. Therefore, when ultrasonic vibration is applied to the probe 113 in this state, the living tissue grasped between the probe 113 and the jaw 105 is coagulated in the concave portion 161 of the jaw 105, and the contact portion 162 of the jaw 105 is coagulated. In this case, the living tissue grasped between the probe 113 and the jaw 105 is cut (cut) while coagulating. Therefore, the same effects as those of the first embodiment can be obtained in the present embodiment.

FIGS. 18 and 19A show a sixth embodiment of the present invention. In this embodiment, as shown in FIG. 18, a handpiece 171 of an ultrasonic coagulation and incision device having a substantially tweezers shape is provided.

The hand piece 171 of the present embodiment is provided with a grip portion 172. This grip part 17
Ultrasonic vibrator 43 for generating ultrasonic vibration inside 2
(See FIGS. 7A and 7B). The base of a horn 44 is connected to the vibrator 43. A probe portion 173 is provided at the tip of the horn 44. The ultrasonic vibration from the vibrator 43 is transmitted to the probe unit 173 in a state where the amplitude of the ultrasonic vibration is increased by the horn 44.

Further, the vibrator 43 is attached to the grip portion 172.
And a casing 175 that covers the horn 44 and the probe unit 173. Here, the casing 175 has a tapered horn cover portion 175a and the horn cover portion 175a.
And a small-diameter portion 175b connected to the distal end of the main body. The horn cover 1 of the casing 175
The base end of 75 a is connected to the opening at the end of the transducer cover 174. The distal end of the probe 173 is held in a state of protruding forward from the distal end opening of the small diameter portion 175b of the casing 175.

The base end of the vibrator cover 174 is fixed to the base end of a substantially L-shaped connection operation section (operation means constituting section) 176, and one end of a connection cord 177 is connected thereto. ing. The other end of the connection cord 177 is connected to a main body of an ultrasonic coagulation and incision device (not shown).

Further, the connecting operation part 176 includes a jaw 178 which is arranged to face the tip of the probe part 173 and is opposed to the tip part of the probe part 173.
An arm portion 179 extending from the jaw 178 toward the hand is provided. Here, a rib 180 for preventing slippage is provided on the surface of the arm portion 179. A stopper 181 is provided on the inner surface side of the arm portion 179 so as to project inward. When the arm 179 of the connection operation unit 176 is operated, the jaw 178 that is not in contact with or separated from the tip of the probe unit 173 (open / close). Here, the jaw 178 is connected to the probe unit 17.
3 and the probe unit 1
It is possible to move to an open position where the living tissue is opened apart from 73.

As shown in FIG. 19A, the jaw 178 is provided with a concave portion (non-contact portion) 182 cut out on the surface facing the probe portion 173, and a contact portion 183 that contacts the probe portion 173. Have been. Here, the concave portion 182 is disposed at the foremost portion of the jaw 178, and the contact portion 183 is disposed at a position behind the concave portion 182. The concave portion 182 of the probe 173 is formed by cutting when the probe 173 is manufactured.

Further, the concave portion 182 of the jaw 178 is held in a non-contact state with the probe portion 173 when the jaw 178 is closed to the probe portion 173 side, and is held between the probe portion 173 and the jaw 178. The portion to be treated of the living tissue to be coagulated functions as a coagulating portion. Further, the contact portion 183 of the jaw 178 is
Is closed to the probe unit 173 side when the probe unit 1 is closed.
73 to the position where it comes into contact with
It functions as a portion for cutting (dissecting) the living tissue grasped between the third jaw 178 and the jaw 178.

Next, the operation of the above configuration will be described.
When using the ultrasonic coagulation and incision apparatus of the present embodiment, first, the handpiece 171 is placed in a state where a living tissue is inserted between the probe 173 and the jaw 178 at the distal end.
Then, by gripping the arm 179 of the connection operation unit 176, the vibrator cover 174, and the casing 175, the jaw 178 at the tip of the arm 179 is moved in a direction to approach the probe 173, and the probe The living tissue is sandwiched between the portion 173 and the jaw 178. At this time, the amount of gripping force when gripping the living tissue is relatively small in the concave portion 182 at the foremost portion of the jaw 178, and the amount of gripping force of the biological tissue is large in the portion of the contact portion 183 behind the concave portion 182.

In this state, ultrasonic vibration is applied to the probe section 173. At this time, the concave portion 182 of the jaw 178
In the part, the living tissue grasped between the probe part 173 and the jaw 178 is coagulated. Further, the probe unit 17
At the third contact portion 183, the living tissue grasped between the probe portion 173 and the jaw 178 is cut (cut) while coagulating.

Therefore, in this embodiment, when the living tissue of the diseased part is grasped between the probe part 173 of the distal treatment part and the jaw 178, the concave part 182 at the foremost part of the jaw 178 is used for grasping the living tissue. The amount of gripping force is relatively small, and the amount of gripping force of the living tissue is large at the portion of the contact portion 183 behind the concave portion 182. Therefore, when ultrasonic vibration is applied to the probe unit 173 in this state,
The probe portion 173 is formed at the concave portion 182 of the jaw 178.
The living tissue grasped between the and the jaw 178 is coagulated,
In the portion of the contact portion 183 of the jaw 178, the probe portion 17
The living tissue grasped between the third and the jaws 178 is cut (cut) while coagulating. Therefore, the same effects as those of the first embodiment can be obtained in the present embodiment.

FIG. 19 (b) shows a modification of the sixth embodiment. In this modification, a concave portion 191 is formed at the distal end of the probe portion 173 in the handpiece 171 of the ultrasonic coagulation / cutting apparatus according to the sixth embodiment (see FIGS. 18 and 19A), A contact portion 192 that contacts the jaw 178 is formed at the site.

The concave portion 191 of the probe portion 173 is held in a non-contact state with the jaw 178 when the jaw 178 is closed to the probe portion 173, and is held between the probe portion 173 and the jaw 178. The portion to be treated of the living tissue to be coagulated functions as a coagulating portion. Further, the contact portion 192 of the probe portion 173 is
When 78 is closed to the probe part 173 side, the jaw 1
Contact 78. Move to the position and probe unit 1
It functions as a portion for cutting (dissecting) the living tissue gripped between the 73 and the jaw 178.

Therefore, in this embodiment, when the living tissue of the diseased part is grasped between the probe part 173 of the distal treatment part and the jaw 178, the concave part 19 at the foremost part of the probe part 173 is held.
In No. 1, the amount of grasping force when grasping the living tissue is relatively small, and the amount of grasping force of the living tissue is large in the portion of the contact portion 192 behind the concave portion 191. Therefore, when ultrasonic vibration is applied to the probe portion 173 in this state, the living tissue grasped between the probe portion 173 and the jaw 178 is coagulated in the concave portion 191 of the probe portion 173, and the contact of the probe portion 173 occurs. In the portion 192, the living tissue grasped between the probe portion 173 and the jaw 178 is cut (cut) while coagulating. Therefore,
In this embodiment, effects similar to those of the sixth embodiment can be obtained.

FIGS. 20 to 22 (a) to 22 (c) show a seventh embodiment of the present invention. This embodiment is similar to the first embodiment (FIGS. 1 to 13A,
(Refer to (b)) The configuration of the distal treatment section of the probe unit 3 in the ultrasonic coagulation / incision instrument 1) is changed as follows.

That is, as shown in FIG. 20, a jaw 105 is provided at the distal end of the probe 113 of the distal treatment section of the probe unit 3 in the ultrasonic coagulation / incision instrument 1 of the present embodiment.
A protruding portion 201 protrudes toward the side. Further, the protruding portion 201 of the probe 113 is provided at the tip of the jaw 105.
A similar protruding portion 202 is protruded at a position corresponding to. Then, when the jaw 105 is closed to the probe 113 side, as shown in FIG. 21A, the living tissue to be treated is moved between the protruding portion 201 of the probe 113 and the protruding portion 202 of the jaw 105. It is designed to be gripped. Here, a non-contact portion 203 that does not contact the living tissue is formed in a portion other than the protruding portion 201 of the probe 113.

When the ultrasonic coagulation / incision instrument 1 according to the present embodiment is used, when the jaw 105 is closed to the probe 113 side as shown in FIG.
The treatment target portion of the living tissue is gripped between the protruding portion 201 of the jaw 105 and the protruding portion 202 of the jaw 105. At this time, the portion of the non-contact portion 203 other than the protruding portion 201 of the probe 113 is held in a state where a space having a length L that does not contact the living tissue is formed.

In this state, when ultrasonic vibration is applied to the probe 113, an ultrasonic wave is applied to the treatment target of the living tissue gripped between the projecting portion 201 of the probe 113 and the projecting portion 202 of the jaw 105. A procedure, that is, a procedure such as coagulation or incision is performed. Therefore, at the time of ultrasonic treatment using the ultrasonic coagulation / incision device 1 of the present embodiment, for example, as shown in FIG. 21B, for example, the peripheral portion H3 of the anastomotic opening H2 of the blood vessel H1
Then, local treatment such as coagulation or incision is performed to form a local punch-shaped ultrasonic treatment section H5.

Therefore, the above configuration has the following effects. That is, in the present embodiment, the probe 11
3, a protruding portion 201 is protruded toward the jaw 105, and a probe 11 is attached to the distal end of the jaw 105.
3 and a similar projecting portion 202 at a position corresponding to the projecting portion 201.
When the jaw 105 is closed to the probe 113 side, as shown in FIG. 21A, the living tissue is covered between the protruding portion 201 of the probe 113 and the protruding portion 202 of the jaw 105. The treatment section was gripped. For this reason, a coagulation (incision) can be made in a narrow area at a point to be treated in a living tissue as in a local punch-shaped ultrasonic treatment section H5 shown in FIG. Can be crimped at a narrow point as described above.

FIGS. 22 (a) to 22 (c) show a procedure for performing an anastomosis of a blood vessel using the ultrasonic coagulation / incision instrument 1 of the present embodiment. First, as shown in FIG. 22 (a), the thread 204 is temporarily fixed to a ring-shaped joint H4 in which the peripheral portion H3 of the anastomotic port H2 of the blood vessel H1 is joined. At this time, the yarn 204 is temporarily fixed at two points 180 ° in the circumferential direction of the joint H4.

Subsequently, as shown in FIG. 22 (b), the ultrasonic coagulation and incision instrument 1 of the present embodiment is used to locally connect the ring-shaped joint H4 between the peripheral portions H3 of the anastomotic opening H2. Punch-shaped ultrasonic treatment section (coagulation section) H5 is formed. FIG. 22 (c) shows an anastomotic portion of the blood vessel H1 after the blood vessel anastomosis operation using the ultrasonic coagulation / incision instrument 1 of the present embodiment has been completed.

FIG. 23 shows an eighth embodiment of the present invention. In the present embodiment, the configuration of the distal end treatment section of the probe unit 3 in the ultrasonic coagulation incision instrument 1 of the seventh embodiment (see FIGS. 20 to 22A to 22C) is changed as follows. It is.

That is, in the present embodiment, the jaw 105
In this embodiment, the projecting portion 202 at the distal end is omitted, and a flat contact member 112 is mounted on the surface of the jaw 105 facing the probe 113. In the present embodiment, the protruding portion 201 is protruded only at the tip of the probe 113.

Therefore, in the present embodiment, as in the seventh embodiment, the portion of the non-contact portion 203 other than the protruding portion 201 of the probe 113 has a length L that does not contact the living tissue.
21B is held in a state in which the space is formed, as in the case of the seventh embodiment, the portion to be treated of the living tissue shown in FIG.
As shown in a local punch-shaped ultrasonic treatment section H5 shown in FIG. Therefore, similarly to the seventh embodiment, crimping of a narrow point such as vascular anastomosis or vascular suture can be performed.

FIG. 24 shows a ninth embodiment of the present invention. In the present embodiment, the configuration of the handpiece 171 of the substantially tweezers-shaped ultrasonic coagulation and incision apparatus of the sixth embodiment (see FIGS. 18 and 19A) is changed as follows.

That is, in this embodiment, the probe 1
A protruding portion 211 protrudes toward the jaw 178 side at the tip of 73. Further, a similar protruding portion 212 protrudes from the tip of the jaw 178 at a position corresponding to the protruding portion 211 of the probe portion 173. And Joe 178
Is closed to the probe unit 173 side when the probe unit 1 is closed.
The portion to be treated of the living tissue is grasped between the projecting portion 211 of 73 and the projecting portion 212 of the jaw 178.
Here, a non-contact portion 213 that does not contact the living tissue is formed in a portion other than the protruding portion 211 of the probe portion 173.

Therefore, in this embodiment, as in the seventh embodiment (see FIGS. 20 to 22 (a) to (c)), non-contact portions other than the protruding portion 211 of the probe portion 173 are provided. Since the portion of the portion 213 is held in a state where it does not come into contact with the living tissue, a local punch-like ultrasonic treatment portion shown in FIG. H
Coagulation (incision) can be performed in a narrow range as in point 5. Therefore, as in the seventh embodiment, vascular anastomosis,
It is possible to crimp a narrow point like a vascular suture.

FIGS. 25A and 25B and FIG.
Shows a tenth embodiment of the present invention. This embodiment is similar to the first embodiment (FIGS. 1 to 13A,
(Refer to (b)) The configuration of the distal treatment section of the probe unit 3 in the ultrasonic coagulation / incision instrument 1) is changed as follows.

That is, in this embodiment, the jaw 105 is attached to the probe 113 of the distal treatment section of the probe unit 3.
A notched concave portion (non-contact portion) 221 is formed on one side of the surface opposing the contact portion, and a contact portion 222 that contacts the jaw 105 is formed on the other side (side of the concave portion 221). The recess 221 of the jaw 105 is
Is closed to the probe 113 side.
Is held in a non-contact state, and functions as a portion for coagulating a treatment target portion of a living tissue gripped between the probe 113 and the jaw 105. Also, the contact portion 222 of the jaw 105 is
When it is closed to the third side, it moves to a position where it comes into contact with the probe 113, and functions as a part for cutting (dissecting) the living tissue gripped between the probe 113 and the jaw 105. .

Therefore, in this embodiment, the living tissue H6 of the diseased part is located between the probe 113 of the distal treatment part and the jaw 105.
When gripping the living tissue H6, the amount of gripping force when gripping the living tissue H6 is relatively small in the concave portion 221 on one side of the jaw 105, and the gripping of the living tissue H6 is performed in the contact portion 222 on the side portion of the concave portion 221. The ability becomes large. Therefore, when ultrasonic vibration is applied to the probe 113 in this state,
In the concave portion 221 of the jaw 105, the living tissue H 6 gripped between the probe 113 and the jaw 105 is coagulated to form a coagulated portion H 7, and the contact portion 222 of the jaw 105 is formed.
In the part, the living tissue H6 grasped between the probe 113 and the jaw 105 is cut (cut) while coagulating.
Therefore, the same effects as those of the first embodiment can be obtained in the present embodiment. Further, in the present embodiment, as shown in FIG. 26, it is possible to perform a trimming process in which a part of the living tissue H6 is solidified firmly at the concave portion 221 on one side of the jaw 105 and unnecessary portions are cut off.

Further, the present invention is not limited to the above-described embodiment, and it goes without saying that various modifications can be made without departing from the spirit of the present invention. Next, other characteristic technical matters of the present application will be additionally described as follows. (Appendix 1) An ultrasonic vibrator for generating ultrasonic vibration,
A vibration transmitting member connected to the ultrasonic vibrator and transmitting ultrasonic vibration to a treatment section for performing treatment on living tissue, a probe connected to a distal end of the vibration transmitting member, and a probe facing the probe A movable member and a gripping member for gripping a living tissue between the probe and an operating means for opening and closing the gripping member, wherein the probe and the gripping member are closed. In some cases, a non-contact portion is provided in at least a part between the probe and the gripping member, and the ultrasonic coagulation and incision apparatus is characterized in that it is provided.

(Additional Item 2) The ultrasonic coagulation and incision device according to additional item 1, wherein the non-contact portion is formed by a step of the probe.

(Supplementary item 3) The ultrasonic coagulation and incision device according to supplementary item 1, wherein the non-contact portion is formed by a step of the gripping member.

(Supplementary Item 4) The ultrasonic coagulation and incision apparatus according to supplementary item 1, wherein the non-contact portion is formed by a step of the gripping member and the probe.

(Additional Item 5) An ultrasonic coagulation and incision apparatus according to additional item 1, wherein the non-contact portion is located on the distal end side of the contact portion.

(Supplementary Item 6) The ultrasonic coagulation and incision device according to Supplementary Item 1, wherein the contact portion is located on the tip side from the non-contact portion.

(Supplementary Item 7) The ultrasonic coagulation and incision apparatus according to supplementary item 1, wherein a contact portion between the probe and the holding member is formed of a soft member.

(Supplementary Item 8) An ultrasonic vibrator that generates ultrasonic vibration, and a vibration transmitting member that is connected to the ultrasonic vibrator and transmits the ultrasonic vibration to a treatment section for performing treatment on a living tissue A probe connected to a distal end of the vibration transmitting member, a gripping member that is movable to face the probe and grips living tissue between the probe, and an operating unit that opens and closes the gripping member. In the ultrasonic coagulation and incision apparatus provided with a projection, a projection is provided at the foremost portion of the probe, and a living tissue is sandwiched between the projection and a gripping member facing the projection to perform a treatment. Sonic coagulation incision device.

(Supplementary Item 9) The ultrasonic coagulation and incision apparatus according to supplementary item 1, wherein the holding member is also provided with a convex portion, and the convex portion of the holding member faces the convex portion of the probe.

[0096] In the ultrasonic coagulation and incision device, the tissue at the contact surface portion between the probe and the gripping member is incised, so that the coagulation width is from the contact surface to the adjacent tissue by the incision. Determined by heat conduction.

(Purpose of Additional Items 1 to 7) Provided is an ultrasonic coagulation and incision apparatus capable of coagulation reliably.

(Means for Solving the Problems of Supplementary Items 1 to 7) In the present invention, by providing a non-contact portion between the probe and the gripping portion facing each other, it is possible to obtain a reliable coagulation width at the end face of the incised portion. Possible.

(Effects of Additional Items 1 to 7) Only coagulation is possible without resection. 2. Trimming is possible.

(Conventional Techniques in Supplementary Items 8 and 9) Scissors performed a line-shaped excision of about 15 mm.

(Problems to be Solved by Additional Items 8 and 9)
However, no point coagulation or resection could be performed.

(Purpose of Additional Items 8 and 9) Coagulation (dissection) of a narrow area.

(Means for Solving the Problems in Additional Items 8 and 9) A convex portion is provided at the tip of a vibration transmission rod connected to an ultrasonic vibrator, and the convex portion faces the convex portion. The living tissue can be inserted between the jaws.

(Effects of Additional Items 8 and 9) Since point-like coagulation can be performed, crimping of narrow points such as vascular anastomosis is possible.

[0105]

According to the present invention, coagulation of living tissue and excision of living tissue can be simultaneously and efficiently performed with a simple structure.

[Brief description of the drawings]

FIG. 1 is a perspective view showing an assembled state of an ultrasonic coagulation incision device according to a first embodiment of the present invention.

FIG. 2A is a perspective view of a handle unit of the ultrasonic coagulation / incision instrument according to the first embodiment, and FIG. 2B is a perspective view of a probe unit.

FIG. 3 is a perspective view of a vibrator unit of the ultrasonic coagulation / cutting instrument according to the first embodiment.

FIG. 4 (a) is a longitudinal sectional view of a handle unit of the ultrasonic coagulation / incision tool according to the first embodiment, and FIG. 4 (b) is a perspective view showing a locking piece at a distal end portion of an insertion sheath portion.

FIG. 5 is a cross-sectional view of the handle unit of the ultrasonic coagulation / cutting instrument according to the first embodiment.

FIG. 6 is a perspective view for explaining an attaching / detaching operation of the handle unit according to the first embodiment.

FIG. 7A is a longitudinal sectional view of a transducer unit according to the first embodiment, and FIG. 7B is a perspective view of the ultrasonic transducer.

FIG. 8 is a vertical cross-sectional view of a tip side portion of the probe unit according to the first embodiment.

FIG. 9 is a longitudinal sectional view of a rear end side portion of the probe unit according to the first embodiment.

FIG. 10 is a cross-sectional view of each part of the probe unit according to the first embodiment.

FIG. 11 is an explanatory diagram of a distal treatment section of the probe unit according to the first embodiment.

FIG. 12 is an explanatory diagram of the operation of the distal end treatment section of the probe unit according to the first embodiment.

FIG. 13 (a) is an explanatory diagram for explaining a blood vessel anastomosis operation using the ultrasonic coagulation and incision device according to the first embodiment,
(B) is a longitudinal sectional view showing the anastomotic portion of the blood vessel after the blood vessel anastomosis operation has been completed.

FIG. 14 is a side view of a distal treatment section showing a main part configuration of an ultrasonic coagulation incision tool according to a second embodiment of the present invention.

FIG. 15 is a side view of a distal treatment section showing a main configuration of an ultrasonic coagulation / incision device according to a third embodiment of the present invention.

FIG. 16 is a side view of a distal treatment section showing a main configuration of an ultrasonic coagulation / incision device according to a fourth embodiment of the present invention.

FIG. 17 is a side view of a distal treatment section showing a main configuration of an ultrasonic coagulation / incision instrument according to a fifth embodiment of the present invention.

FIG. 18 is a perspective view of the entire ultrasonic coagulation incision device according to the sixth embodiment of the present invention.

FIG. 19 (a) is a side view showing a configuration of a main part of an ultrasonic coagulation and incision tool according to the sixth embodiment, and FIG. 19 (b) shows a modification of the ultrasonic coagulation and incision tool according to the sixth embodiment. The side view of the principal part.

FIG. 20 is a side view of a distal treatment section showing a main configuration of an ultrasonic coagulation / incision instrument according to a seventh embodiment of the present invention.

FIG. 21 (a) is a side view of a main part showing a use state of an ultrasonic coagulation incision instrument according to a seventh embodiment, and FIG. 21 (b) is a plan view showing an incision formed in a living tissue.

FIG. 22 is an explanatory diagram illustrating a blood vessel anastomosis operation using the ultrasonic coagulation / incision device according to the seventh embodiment.

FIG. 23 is a side view of a distal treatment section showing a main part configuration of an ultrasonic coagulation / incision tool according to an eighth embodiment of the present invention.

FIG. 24 is a perspective view showing an ultrasonic coagulation incision device according to a ninth embodiment of the present invention.

FIG. 25 (a) is a side view of a distal treatment section showing a main part configuration of an ultrasonic coagulation / incision instrument according to a tenth embodiment of the present invention;
(B) is a front view of the probe.

FIG. 26 is a front view of a distal treatment section showing an ultrasonic coagulation and incision treatment state using the ultrasonic coagulation and incision device according to the tenth embodiment;

FIG. 27 is a side view of a distal treatment section of an ultrasonic coagulation / incision instrument showing a conventional example.

FIG. 28 is a side view showing an opening state of the jaws of the ultrasonic coagulating / cutting instrument of FIG. 28;

FIG. 29 is a plan view showing an incision portion of the living tissue cut by the ultrasonic coagulation incision instrument of FIG. 28;

[Explanation of symbols]

2 Handle unit (operating means) 13 Front handle 43 Ultrasonic transducer 71 Vibration transmitting member 105, 178 Jaw (gripping member) 113 Probe 131, 141, 151, 161, 182, 191, 2
21 concave part (non-contact part) 173 probe part

──────────────────────────────────────────────────続 き Continuation of front page (56) References JP-A-10-127654 (JP, A) JP-A-9-98979 (JP, A) JP-A-9-38099 (JP, A) JP-A-11-111 89852 (JP, A) Special Table Hei 8-505801 (JP, A) (58) Fields investigated (Int. Cl. ⁷ , DB name) A61B 18/00 A61B 17/28 310

Claims (2)

(57) [Claims] An ultrasonic transducer for generating ultrasonic vibration, a vibration transmitting member connected to the ultrasonic transducer and transmitting ultrasonic vibration to a treatment section for performing treatment on a living tissue, A probe connected to the distal end of the vibration transmitting member, a gripping member facing the probe, openably and closably supported by the probe, and gripping a living tissue between the probe and the probe; Operating means for opening and closing the probe, and opposing at least one of the gripping member and the probe
Part of the probe with respect to the longitudinal direction of the probe,
Is provided on one side of the rear end to coagulate the part to be treated
A non-contact portion formed in a concave shape on the other side, and a non-contact portion provided adjacent to the non-contact portion on the other side of the facing portion.
An ultrasonic coagulation and incision device , comprising: a contact portion for incising a treatment portion . 2. An ultrasonic vibrator for generating ultrasonic vibration, and connected to the ultrasonic vibrator to perform treatment on a living tissue.
Vibration transmitting member that transmits ultrasonic vibration to the treatment section for performing
And a probe connected to the tip of the vibration transmitting member, and openable and closable with respect to the probe in opposition to the probe.
Is gripped with a living tissue between the probe and the probe
A gripping member and an operation of opening and closing the gripping member with respect to the probe
Means and at least one of the gripping member and the probe facing each other
Part, along one longitudinal side of the probe in the longitudinal direction.
And formed in a concave shape to coagulate the treatment target.
A non-contact portion provided on the other side of the facing portion adjacent to the non-contact portion.
It is, that it has and a contact portion for cutting portion being treated
Ultrasonic coagulation and incision apparatus characterized by the above-mentioned.