JP3310532B2 - Ultrasonic incision coagulation 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 incision coagulation apparatus for performing treatment such as incision or coagulation using ultrasonic waves.

[0002]

2. Description of the Related Art Conventionally, it is generally known to perform treatment on a living tissue using ultrasonic vibration. Among them, a living tissue is fixed to an ultrasonic treatment tool, for example, by sucking or grasping the living tissue. There was something to do.

[0003] has become a way to break, for example, holding the stones in special HirakiAkira 62-127042 by ultrasonic vibration,
In Japanese Patent Application Laid- Open No. 1-223944, a living tissue is grasped and fixed by grasping forceps, and cut by an ultrasonically vibrating probe. In Japanese Patent Application Laid- Open No. 1-223245, the living tissue is adsorbed and fixed, and the incision is made with a scalpel which is ultrasonically vibrated.

[0004] Further resection forceps in JP-A 1-232948 has become ablation of the biological tissue by applying ultrasonic vibration to the manner performed efficiently, gripping like the Hei 1-232949 In JP 1-232944 The living tissue is fixed by means, and the living tissue is treated by a treatment member to which ultrasonic vibration is applied.
In No. 055, a grasping member is provided above the probe, and the living tissue is fixed by the probe and the grasping member to perform the treatment.

[0005] Conventionally, a treatment tool used in endoscopic surgery generally has a sheath in which a treatment section for treating a living tissue is an insertion section for inserting the treatment section into a living body. And an operating means for operating the treatment section at the proximal end of the insertion section.

Among these treatment tools for endoscopic surgery, there are known treatment tools such as DE G92 14059.9 and US Pat. No. 5,290,308 in which an insertion portion and a treatment portion can be rotated with respect to operation means. And Japanese Patent Application No. 6-167728 and DE
In G91 14 306.3, a friction means is used to adjust the amount of rotation, and in Japanese Patent Publication No. 5-86223, a ball click is used to fix the rotation angle.

[0007]

However, as described above, there is an ultrasonic incision coagulation device which is used as an endoscopic surgical treatment device, such as grasping a living tissue. Operation means due to structural restrictions such as the presence of a transducer unit, the need to vibrate the probe and the sheath in a vibrational manner, or the inability to rotate the probe and the transmission means due to different center axes. There is no one that can rotate the treatment unit, and depending on the condition of the living tissue, unnatural operations such as twisting the hands that operate the operating means may be forced, and problems may occur in actual use conditions. there were.

Further, in order to solve these disadvantages, to make a good approach to the living tissue, and to improve the operability, the insertion part of the ultrasonic therapy apparatus was bent in Japanese Utility Model Publication No. 6-6809. However, this is because the handpiece, which is the operating means, is circular and has good operability because there is no directionality, and a directional handle is used as the operating means like an ultrasonic incision coagulator. However, the above-mentioned problem could not be completely solved.

SUMMARY OF THE INVENTION The present invention has been made in view of the above points, and is directed to an ultrasonic incision coagulation apparatus which is used as a surgical treatment tool under an endoscope or the like, for example, for grasping a living tissue. It is an object of the present invention to provide an ultrasonic incision coagulation device with good operability that can rotate a treatment section.

[0010]

SUMMARY OF THE INVENTION A first supersonic according to the present invention
Wave incision coagulation device is an ultrasonic vibrator that generates ultrasonic vibration
Is connected to the ultrasonic vibrator and transmits the ultrasonic vibration.
Reach the probe,
A holding member and an operation for operating the opening / closing operation of the gripping member.
Operating means, and can advance and retreat with respect to the probe, and
With the direction of extension of the probe as the axis of rotation,
Rotatably provided, and can be moved forward according to the operation of the operating means.
A driving means capable of driving the gripping member, and
Rotates coaxially with the rotation axis of the driving means with respect to the operating means
So that the probe and the driving means are engaged with each other.
A coupling member integrally coupled to the handle and the gripping member.
It rotates coaxially with the rotation axis of the driving means with respect to the operating means.
To connect the gripping member and the driving means
And a connecting member. In the present invention
Second ultrasonic incision coagulator generates ultrasonic vibrations
Ultrasonic transducer, connected to the ultrasonic transducer, the
A probe for transmitting ultrasonic vibration, and
A gripping member that can be opened and closed by operating the gripping member.
Operation means for making and moving forward and backward with respect to the probe
Function, and the extension direction of the probe is a rotation axis.
The operation means is provided rotatably with respect to the operation means.
Driving means for driving the gripping member in accordance with an operation;
The probe rotates the driving means with respect to the operating means.
The probe and the driving mechanism so as to rotate coaxially with an axis.
A coupling member that engages a step and integrally couples with each other;
A driving force of a moving means is provided to be able to be transmitted to the gripping member,
The driving means with respect to the operating means together with the gripping member
A transmission member rotatable coaxially with the rotating shaft of
And features. Third ultrasonic incision coagulator according to the present invention
The first or second ultrasonic incision coagulation device is
Further, when the driving means is connected so as to be able to advance and retreat,
Is supported rotatably with respect to the operating means, and
It is characterized by having a pipe joined to the joining means.
The fourth ultrasonic incision coagulation apparatus according to the present invention includes the first ultrasonic incision coagulation apparatus.
In the third ultrasonic incision coagulation apparatus, the driving means
Equipped with fixing means for making the rotation angle substantially fixed
It is characterized by that. Fifth ultrasonic incision coagulation according to the present invention
The fixing device includes: an ultrasonic vibrator that generates ultrasonic vibration;
A probe connected to the ultrasonic vibrator and transmitting the ultrasonic vibration.
Lobe and the probe
A gripping member that can be opened and closed with respect to the
Operating means for operating the closing operation;
Rotatable relative to the operating means with the exit direction as the axis of rotation
Provided with the probe and the gripping member.
A handpiece rotatable with respect to the operating means;
And the rotation axis of the handpiece
When provided rotatably with respect to the operation means coaxially with
Both, the operation of the operating means can be transmitted to the gripping member
And a transmission member. According to the invention
A sixth ultrasonic incision coagulation device is fixed in position,
An ultrasonic vibrator for generating ultrasonic vibration, and the ultrasonic vibration
Probe that transmits the signal, and can be opened and closed with respect to the probe
With a secure gripping member and a fixed positional relationship with the probe.
To operate the opening and closing operation of the gripping member.
An operating means, which can advance and retreat with respect to the probe, and
The operating means and the extension direction of the probe as a rotation axis;
The operation means is provided so as to be rotatable with respect to the probe.
A rotor capable of transmitting an operation to the gripping member;
The material rotates with respect to the operating means and the probe.
As described above, the gripping member and the probe are
And a connecting member that connects to the connecting member.
The seventh ultrasonic incision coagulation device according to the present invention
An ultrasonic transducer that is fixed and generates ultrasonic vibration,
A probe for transmitting ultrasonic vibration, and
A gripping member that can be opened and closed by
To operate the opening and closing operation of the gripping member
Operating means, and capable of moving back and forth with respect to the probe, and
The operating means and the
Operating means provided rotatably with respect to the probe
A rotor capable of transmitting the operation of
Pivotable with the gripper relative to the means and the probe
Function to transmit the operation of the rotor to the gripper.
And a transmission member that is capable of performing the following operations. The present invention
Eighth ultrasonic incision coagulation device generates ultrasonic vibration
An ultrasonic vibrator to be connected to the ultrasonic vibrator,
A probe for transmitting acoustic vibrations, and
An openable / closable gripping member and a position fixed to the probe
Operating the opening / closing operation of the gripping member.
Operating means for operating the probe, and a central axis in an extending direction of the probe.
With the rotation axis as the rotation axis, the gripping member is
A rotating mechanism for rotating relatively to the probe.
It is characterized by having.

[0011]

[0012]

[0013]

[0014]

[0015]

Embodiments of the present invention will be described below with reference to the drawings. (First Embodiment) FIGS. 1 to 9 relate to a first embodiment of the present invention, and FIG. 1 is an overall configuration diagram of the first embodiment of the present invention, and FIG. FIG. 3 is a sectional view taken along line D1-D2-D3-D4 of FIG. 2, FIG. 4 is a front view of the treatment section viewed from the front of FIG. 2, and FIG.
6 is a plan view showing the operation means, FIG. 7 is a partial cross-sectional view showing the operation means and a part thereof in an enlarged manner, and FIG. 8 is a sectional view taken on line H- of FIG. FIG. 9 is a sectional view taken along line H ′ and II ′, and FIG. 9 is a sectional view taken along line JJ′-MM ′ in FIG.

As shown in FIG. 1, an ultrasonic incision coagulation apparatus 31 according to a first embodiment of the present invention has an insertion section 57 provided with a treatment section 33 for performing a treatment at a distal end (tip), and this insertion section. 57
And an operating means 34 for operating the treatment section 33. The insertion portion 57 is formed with an elongated sheath 9 to form an insertion portion outer tube so that it can be inserted into a living body.

A sheath 22 having a diameter larger than that of the sheath 9 is provided on the proximal end side of the upper portion of the operation means 34. The treatment section 33 is provided at the proximal end of the sheath 22 for incision and coagulation treatment. A handpiece 32 is provided as a vibrator unit having a built-in ultrasonic vibrator 50 (see FIG. 7) for supplying ultrasonic vibration for the purpose.

As shown in FIG. 2, the sheath 9 constituting the insertion portion 57 has, for example, two independent upper and lower conduits protected by the sheath 9, and an incision and an incision are formed in the upper conduit. A forceps unit 58 as a treatment tool for performing coagulation treatment is inserted, and a probe 8 as a vibration transmitting member for transmitting ultrasonic vibration from the ultrasonic vibrator 50 in the handpiece 32 is inserted into a lower conduit. A tip member 7 which is detachably attached to the distal end of the probe 8 by screwing is inserted therethrough. The treatment section 33 and the insertion section 57 have a structure as shown in FIGS.

The forceps unit 58 has a substantially cylindrical movable member that transmits and retracts the operating force by the operating means 34 inserted into a pipe-shaped outer tube member, and further has a tip member provided at the distal end of the probe 8. 7, a gripping member 1 for gripping and releasing the living tissue is joined to the movable portion 3 at the distal end of the forceps unit 58 by a screw 2. That is, as shown in FIG. 4, the lower end of the gripping member 1 and the upper end of the distal end member 7 are substantially planar, so that the living tissue can be gripped and released on both planes. As shown in FIG. 3, a horizontal groove extending in the horizontal direction is provided on a lower surface of the grip member 1 to form a coagulation groove 61 for securely gripping the tissue and facilitating coagulation.

As shown in FIGS. 2 and 3, the movable portion 3 is a first transmission member 5 as a transmission member of the forceps unit 58.
Is rotatably supported about the pin 35 at the distal end side thereof, and is rotated about the pin 35 by the reciprocating movement of the pin 36 engaged in the elongated hole.

A connecting member 41 is screwed on the proximal end side of the first transmitting member 5, and a second member is attached to the connecting member 41.
The proximal end of the second transmission member 10 projects proximally (rearward) from the proximal end of the sheath 9 forming the insertion portion 57. The distal end of the engaging member 42 is screwed to the protruding proximal end. That is, the first transmission member 5 constituting the forceps unit 58 is screwed into the transmission member 10 on the proximal side thereof.
And (to be disassembled and assembled) with an engagement member 42 on the proximal side thereof.

The proximal end of the engagement member 42 has a spherical portion 43
The spherical portion 43 is held by a locking mechanism on the upper side of the movable operation handle 30 constituting the operation means 34 shown in FIGS. 1 and 7 so as to be able to advance and retreat in the axial direction of the insertion portion 57. The opening / closing operation of the movable operation handle 30 causes the engagement member 42, the second transmission member 10, and the first transmission member 5 to move forward and backward, and the movable portion 3 can be opened and closed as described above.

The sheath 11 forming the outer tube-side member of the forceps unit 58 is connected (connected) to the pipe 14 via the connecting member 13 at a position inside the knob 12 together with the outer sheath 10. , This pipe 14 is the operating means 3
Fixed operation handle 29 serving as a fixed side operation member in 4
Attached to.

The gripping member 1 and the screw 2 are formed of an insulating material such as a resin material when a treatment is performed by applying a high-frequency current to the tip member 7 as will be described later. You may.

As shown in FIGS. 2 and 3, a substantially cylindrical meshing member 37 is inserted into the upper conduit of the sheath 9 through which the forceps unit 58 is inserted. A projection 39 protruding inward from the radius on the peripheral surface
(See FIGS. 2, 3, and 5 (F)). The protrusion 39 is engaged with a snap fit 38 provided at the proximal end of the tip cover 6, and The snap fit 38 is pushed into the proximal side beyond the protrusion 39 so that the two are engaged with each other to make the forceps unit 5.
8 can be fixed (locked) in the sheath 9. Then, by performing an operation of strongly pulling the forceps unit 58 toward the distal side of the sheath 9, the engagement between the two is released and disassembled, that is, the forceps unit 58 side can be removed from the sheath 9.

At this time, if the gripping member 1 is released even a little, the position of the connecting member 41 is advanced, so that the distal end of the connecting member 41 enters the inside of the snap fit 38. The snap fit 38 cannot be bent in the inner circumferential direction due to the intrusion, and the forceps unit 58 cannot be removed from the sheath 9.

That is, when the forceps unit 58 is detached, the grasping member 1 needs to be completely closed with respect to the distal end member 7, so that the living tissue is grasped during actual use, for example. If the forceps unit 58 is not completely closed, there is no danger of the forceps unit 58 dropping off, and the forceps unit 58 can be disassembled and assembled from the sheath 9 while ensuring safety.

At this time, the engagement member 37 and the tip cover 6
A portion that is not rotationally symmetrical (for example, is formed on the outer peripheral surface of the distal end cover 6 such that the position of the distal end of the step surface formed so that the engagement member 37 is fitted is different in the circumferential direction. ) (FIGS. 2, 3, and 5)
(F), the forceps unit 58 is prevented from rotating with respect to the sheath 9, and the operability is prevented from being reduced due to careless rotation when grasping a living tissue or the like. The proximal end of the engagement member 37 is connected to the sheath 11 interposed inside the sheath 9.

A distal end member 7 is provided in a conduit below the sheath 9.
The ultrasonic vibrator 50 is screwed to the proximal end of the tip member 7.
The probe 8 for transmitting the ultrasonic vibration from the to the tip member 7 is inserted. The upper end of the distal end of the tip member 7 is shown in FIG.
As shown in FIG. 2A, the living tissue is flat and easily grasped between the grasping member 1 and the living tissue. This tip member 7
2 and 5 (B) and FIG. 5 (C), the upper surface is formed to the proximal side of the gripping member 1, and the sectional shape of the proximal side is shown in FIG. 5 (D). ) To 5 (F).

The apex of the distal end of the tip member 7 is formed in a substantially conical shape and protrudes farther than the gripping member 1, so that the peeling operation can be performed at this portion. Tip member 7
Is detachable by screwing to the tip of the probe 8, and the gripping member 1 is also detachable from the movable part 3 by the screw 2. Therefore, each can be freely exchanged to optimize the treatment. The shaped tip member 7 and the gripping member 1 can be used.

As shown in FIG. 2, a protective member 4 such as PTFE or ceramics having heat resistance and resistance to ultrasonic vibration is provided at the distal opening of the lower conduit of the sheath 9. The tip member 7 and the sheath 9 are prevented from coming into contact with each other and being damaged when a downward bending stress is generated in the tip member 7 when the living tissue is grasped.

FIGS. 6 to 9 show the operating means 34. FIG. The operating means 34 is provided at the proximal end of the insertion portion 57, and the sheath 9 and the coupling member 13 are joined. The coupling member 13
The distal end of the pipe 14 is joined to the outer periphery of the knob 14, and the knob 12 is fitted to the outer periphery of the distal end of the pipe 14 and is connected (fixed) by the screw 44.

When the screw 44 is loosened, the knob 12 can be removed to the distal end side of the sheath 9, and the side of the sheath 9 (the sheath 9, the pipe 14 and the sheath 22) is disassembled with respect to the operating means 34 as described later. It can be assembled and can be assembled.

The pipe 14 penetrates through the inside of the first bearing 15 and the second bearing 19 which are respectively joined to the upper and lower branches of the fixed operation handle 29.
The pipe 14 is rotatably supported on the first bearing 15 and the second bearing 19 fixed to the fixed operation handle 29, and the outer peripheral surface of the pipe 14 and the first bearing 15 and the second bearing 19 An O-ring 45 and two O-rings 47 are provided on a sliding surface that is slidable at least in the circumferential direction with respect to the inner peripheral surface (also in the front-rear direction in this embodiment).
The amount of rotational power between the pipe 14, the bearing 15, and the bearing 19 can be adjusted.

Therefore, when the operation of rotating by grasping the knob 12 is performed, the pipe 14 together with the knob 12 is connected to the first bearing 1.
It rotates with respect to the fifth and second bearings 19. The probe 8 is inserted along the center axis of the pipe 14, and the forceps unit 58 is inserted into the sheath 9 eccentrically from the center axis. Therefore, the forceps unit 58 is connected to the center axis of the probe 8 (this center axis is (Coincides with the central axis of the acoustic transducer 50)
Is turned around.

Since the center axis of the sheath 9 is shifted from the center axis of the probe 8 as can be seen from FIG.
When the pipe 2 is rotated, the insertion section 57 (or the sheath 9 side) (in which the treatment section 33 is provided at the distal end) is eccentrically rotated in conjunction with the rotation of the pipe 14.

FIG. 8A shows the inside of the cylindrical pipe 14.
As shown in (B), a probe 8 is inserted along the central axis so as to be coaxial, and the proximal end of the probe 8 has a cylindrical outer peripheral surface fitted to a cylindrical sheath 22. It is connected to a vibration drive shaft of an ultrasonic vibrator 50 for generating ultrasonic waves provided inside a movable handpiece 32 via a detachable (disassembly and assemblable) connection member, for example, by screwing.

The pipe 14 is connected to a first bearing 15
As shown in FIG. 6, an elliptical groove 55 which penetrates in the vertical direction and is long in the front-rear direction is formed in a portion between the second bearing 19 and the groove 55. The driving members 16 and 17 (see FIGS. 7 and 8B) are movably engaged in the front-rear direction and are connected to each other by screws 53 as shown in FIG. 8B. These two driving members 16, 1
Numeral 7 drives the engaging member 42 to advance and retreat, and the gripping member 1 is opened and closed by the advance and retreat driving of the transmission members 10 and 5 as described above.

The engagement member 42 inserted eccentrically to the middle of the pipe 14 has a spherical portion 43 at the proximal end thereof.
6 are engaged and engaged in the engagement grooves provided in the radial direction.

The connecting member 20 is joined to the pipe 14 on the proximal side by a screw 46 for connecting the two (to be disassembled and assembled), and the handpiece 32 is fitted around the outer periphery of the connecting member 20 on the proximal side. The sheath 22 is joined by screws 49. A screw portion is provided on the outer peripheral surface on the proximal side of the sheath 22, and a ring 23 is attached so as to screw with the screw portion.

A backup ring 24 and an O-ring 59 are housed on the inner peripheral surface of the ring 23. The O-ring 59 is compressed by rotating the ring 23 in the fastening direction with respect to the operating portion sheath 22. Then, the outer periphery of the handpiece 32 is pressed, and the handpiece 32 can be fixed to the sheath 22.

Further, by rotating the ring 23 in the release direction by this structure, the handpiece 32 can be moved forward and backward with respect to the sheath 22. Therefore, by moving the handpiece 32 forward and backward, the treatment section 33 of the distal end member 7 can be moved. The protruding amount can be adjusted so that the target tissue is set to a protruding amount suitable for the treatment, and the treatment is performed. Adjustments such as setting an appropriate protrusion amount can be performed.

The handpiece 32 is provided with a guide sheath 21 extending to the distal end side.
An O-ring 48 is provided on the outer periphery on the distal side of the coupling member 20, and has an airtight structure with the coupling member 20.

Further, in order to shut off a pipe through which the probe 8 passes between the connecting member 13 and the connecting member 20, the connecting member 13 and the connecting member 20 are connected by a pipe 18 to be sealed. Constructing a pipeline.

As will be described later, when a high-frequency current is applied to the probe 8 to perform treatment, the sheath 9 and the coupling member 1 are used.
3. Connecting member 20, pipe 18, guide sheath 21
When molded with an insulating material such as TFE or polysulfone, high-frequency current does not leak and is safe.

With this structure, the forceps unit 58 and the probe 8 are completely insulated.
For example, if a connector to be connected to the movable part 3 or a high-frequency current is supplied directly, a high-frequency current is selectively supplied to the movable part 3 and the distal end member 7 to treat living tissue, or a high-frequency current is supplied to both to treat the living tissue. Or over both,
By applying a high-frequency current through a living tissue, the treatment can be performed in a bipolar manner.

In such a case, the driving member 16 and the driving member 1
7, the exposed surfaces of the fixed operation handle 29, the movable operation handle 30, the engagement member 42, the bearing 15, the bearing 19, the sheath 22, and the ring 23 are coated with an electrically insulating material such as a PTEE material. High frequency current should not leak to the user.

Since the pipeline through which the probe 8 is inserted and the pipeline on the proximal side of the probe 8 form a sealed pipeline, the water supply provided at the proximal end of the handpiece 32 is provided. A water supply / suction device (not shown) connected to the suction / suction base 51 allows a fluid (flow passage) through which a fluid can flow, such as water supply or suction, using a space around the probe 8 using this pipe line. ) Is formed so that the blood that has flowed out during a procedure such as an incision can be sucked and discharged to the outside.

At the proximal end of the handpiece 32, a connecting portion of a cord 52 is formed, and a driving power source for ultrasonically oscillating the ultrasonic vibrator 50 via the cord 52 (an ultrasonic drive (not shown)) is provided. Power supply).

As described above, the engaging member 42 is screwed on the proximal side of the transmission member 10 that penetrates the upper conduit of the sheath 9, and the proximal end of the engaging member 42 is A spherical portion 43 is formed, and the spherical portion 43 is engaged with the engagement groove of the driving member 16 as shown in FIG.

An engaging groove 56 is provided on the outer peripheral surfaces of the driving members 16 and 17 in the circumferential direction, and the driving pin 25 is engaged with the engaging groove 56 from the left and right. Therefore, when the drive pin 25 moves back and forth, the drive members 16 and 17 also move back and forth. Each drive pin 25 is supported at both ends of a semicircular drive member 26, and the lower end of the drive member 26 is connected to the upper end of the movable operation handle 30 by a screw 54. Also, the movable operation handle 30 and the fixed operation handle 29 are
And 28, the movable operation handle 30 is rotatably held.

Therefore, by performing an operation of moving the movable operation handle 30 back and forth with respect to the fixed operation handle 29, the spherical portion 43 is moved back and forth via the drive pin 25 and the drive members 16 and 17, and the forceps unit is moved. 58 gripping members 1 can be opened and closed.

That is, when the finger hook on the lower end side of the movable operation handle 30 is opened / closed, the driving member 26 moves forward and backward with the screw 27 as a fulcrum, whereby the driving pin 25 is driven forward and backward. The drive member 16 and the drive member 17 are driven forward and backward by the forward and backward drive of the drive pin 25, and the transmission member 10, the connection member 41, and the transmission member 5 are driven forward and backward together with the engagement member 13, and the movable portion 3 is opened and closed as described above. By doing so, the gripping member 1 is opened and closed.

Further, by turning the knob 12 with respect to the operating means 34, the handpiece 32 is also rotated in conjunction therewith, and as a result, the treatment section 33 can be rotated with respect to the operating means 34. Thus, the operability at the time of performing the treatment by changing the direction in which the living tissue is grasped is improved.

In other words, when the treatment section 33 is rotated as described above, the drive member 16 and the drive member 17 are simultaneously rotated, but the outer periphery is circular and the drive pin 25 is circularly engaged with the engagement groove. Since they are engaged by 56, they can be rotated 360 ° with respect to the operation means 34 without any problem.

Next, an actual use method of the present embodiment will be described. First, the ultrasonic incision coagulation device 31 is opposed to a living tissue to be treated, and the knob 12 is rotated to adjust the direction of the treatment section 33 to a direction in which the treatment can be easily performed. At this time, as described above, the amount of turning power can be adjusted to an appropriate amount by the O-rings 45 and 47, so that the knob 12 can be turned when turning is necessary, and It can be set to a level that cannot be achieved.

Then, the movable operation handle 30 is operated in the opening direction to release the gripping member 1. The target living tissue is sandwiched between the gripping member 1 and the distal end member 7, the movable operation handle 30 is closed, and the living tissue is gripped by the gripping member 1 and the distal end member 7.

The driving power is supplied from the driving power supply of the ultrasonic vibrator 50 to the ultrasonic vibrator 50 by operating a foot switch or the like (not shown), and the ultrasonic vibrator 50 is excited. The ultrasonic vibration is transmitted from the probe 8 to the tip member 7.
To the living tissue grasped from the distal end member 7, and the living tissue grasped by frictional heat can be heated to a high temperature to perform incision or coagulation treatment. At this time,
By adjusting the time and amplitude of applying ultrasonic vibration to the living tissue and the amount of force for grasping the living tissue, the living tissue can be easily incised or coagulated.

For example, if the time is long, the amplitude is large, and the gripping force is high, the incision is convenient, and if the factor is reversed, the coagulation is convenient. When the living tissue is simply grasped, the living tissue can be grasped by the tip member 7 and the grasping member 1 as described above.

Further, when performing the peeling operation of the living tissue, the gripping member 1 is closed or opened and the peeling operation is bluntly performed using the substantially cone-shaped portion at the distal end of the tip member 7. Alternatively, the peeling operation can be performed by applying ultrasonic vibration as described above. Further, by injecting the ultrasonic vibration while pressing the tip member 7 alone against the living tissue, the incision and coagulation operation of the living tissue can be performed.

When a treatment using a high-frequency current is necessary, a high-frequency current is supplied to the handpiece 32 from a high-frequency power source (not shown), and the high-frequency current is supplied from the handpiece 32 to the tip member 7 via the ultrasonic vibrator 50. Supply.

Thus, a high-frequency current is applied to the living tissue from the distal end member 7, and the living tissue can be separated, cut, and coagulated by the high-frequency current in the same manner as in the case of using the ultrasonic vibration. At this time, the pipeline between the probe 8 and the forceps unit 58 is completely insulated as described above,
Is formed of an insulating member, so that there is no leakage of high-frequency current, and treatment with high-frequency current can be performed safely and efficiently. If necessary, the treatment by ultrasonic vibration and the treatment by high-frequency current may be used in combination.

Next, a method of disassembling and assembling the present embodiment will be described. First, with respect to the ultrasonic incision coagulation device 31 shown in FIG. 1 in an assembled state, two screws 53 connecting the drive members 16 and 17 on the upper part of the movable operation handle 30 are removed, and the drive member 16 and the drive member 17 are removed. The spherical portion 43 is removed from the pipe 14 up and down to release the spherical portion 43 from engagement by the engagement groove of the driving member 16. Thereby, the forceps unit 58
Side can be open.

Next, the gripping member 1 is set so as to be completely closed with respect to the tip member 7, and the gripping member 1 is pulled out in the distal direction with respect to the sheath 9. By this pulling-out operation, the snap fit 38 bends in the inner circumferential direction and gets over the projection 39, so that the forceps unit 58 can be disassembled from the sheath 9.

Subsequently, the ring 23 disposed at the proximal end of the sheath 22 is rotated in the opening direction to loosen the connection between the handpiece 32 and the sheath 22 and the handpiece 32 is operated by the operating means 34.
Pull out the back side of the. By this pulling-out operation, the handpiece 32 is inserted together with the probe 8 together with the insertion portion 57 and the operating means
From the rear side.

After that, the probe 8 is rotated with respect to the handpiece 32 to release the screw engagement, and the probe 8 is removed from the handpiece 32. Thereafter, the tip member 7 can be removed from the probe 8 by performing the operation of releasing the screwing in the same manner.

To disassemble the insertion portion 57 and the operating means 34, the screw 44 provided on the knob 12 is removed from the knob 12,
2 is removed from the distal end side of the sheath 9. Subsequently, by pulling out the unit including the sheath 9, the pipe 14, the sheath 22 and the like from the operation unit 34 toward the rear side of the operation unit 34, the drive member 26, the movable operation handle 30, and the fixed operation handle 29 are removed.

The ultrasonic incision coagulation device 31 is in a state where each part can be sufficiently cleaned and sterilized by a series of these operations. Further, by removing the screw 54 connecting the driving member 26 and the movable operation handle 30, The drive member 26 and the movable operation handle 30 can be disassembled.

Further, by disassembling the screws 27 and 28, the fixed operation handle 29 and the movable operation handle 30 can be disassembled. The guide sheath 21 and the handpiece 32 can also be disassembled by releasing the screw.

When the members disassembled in this way are washed and sterilized, and assembled again after washing and sterilization are completed, assembly is performed in the reverse order of the disassembly described above. Can be assembled. In addition, because it is structured to be disassembled and assembled in this way, it is possible to clean or sterilize it sufficiently or securely without disassembling each part by disassembly, and if some members are damaged, etc. the damaged parts only an outgoing exchange years, are economically continue to become a way can be used for.

Further, since the forceps unit 58 is connected to the transmission member 10 on the proximal side by screwing, the forceps unit 58 is different in shape or size suitable for the treatment by exchanging the forceps unit 58 or the like. Can be performed using the forceps unit 58, and the tip member 7 can be detached (disassembled and assembled) on the probe 8 side. Can be used to perform the procedure.

(Second Embodiment) FIGS. 10A and 10B show a main part of a second embodiment of the present invention. The present embodiment has substantially the same configuration as the first embodiment, except that the gripping member 1 is not provided mainly for the purpose of incision of living tissue. Instead, scissors are formed by the distal end of the movable section 3 and the tip member 7, so that the incision of the living tissue can be performed efficiently and safely.

The other structure is the same as that of the first embodiment. In this embodiment, the distal end of the movable portion 3 and the distal end of the distal end member 7 are pressed against the living tissue to be incised, and the movable portion 3 is moved from the open state to the closing direction so as to contact the sandwiched portion. The living tissue can be cut off by applying ultrasonic vibration to the living tissue.

In other words, instead of the function of grasping, incising and coagulating (at least one of them) of the first embodiment,
It is a function of cutting (or incising) by sandwiching. In addition, it is possible to rotate the treatment section 33 around the central axis of the probe 8 (that is, the central axis of the ultrasonic transducer 50) by operating the knob 12 not shown in FIG. The same is true. Further, since disassembly and assembly can be performed in the same manner as in the first embodiment, it is possible to disassemble and perform cleaning, sterilization, and the like. The effect of this embodiment is almost the same as that of the first embodiment.

(Third Embodiment) FIGS. 11A and 11B show a main part of a third embodiment of the present invention. This embodiment has substantially the same configuration as that of the first embodiment, except that a cut surface 62 is formed in a portion of the movable portion 3 which is sandwiched between the holding member 1 and the front cover 6 and faces the front member 7. Have been.

For this purpose, the living tissue is gripped by the gripping member 1 and the tip member 7, the living tissue is coagulated using the coagulated surface 61, and the width on the proximal side of the coagulated surface 61 is reduced to form the incision surface 62. The living tissue having a small width is formed so as to be gripped by the cut surface 62 and the distal end member 7. Other configurations are the same as those of the first embodiment.

According to this configuration , for example, in the case of performing incision while coagulating, the portion to be incised is always coagulated in advance by applying ultrasonic vibration while grasping sequentially from the end of the living tissue. So it ’s less likely to bleed,
A very safe incision can be made. Other functions and effects are the same as those of the first embodiment.

(Fourth Embodiment) FIG. 12 shows a main part of a fourth embodiment of the present invention. The present embodiment has substantially the same configuration as the first embodiment, but the method of fixing the forceps unit 58 and the sheath 9 is the snap fit 38.
Instead, as shown in FIG. 12 showing a cross section of a portion equivalent to the vicinity of the FF ′ cross section of FIG. 2, disassembly and assembly can be performed by the engagement screw portion 63 formed by the distal end cover 6 and the engagement member 37. It has a simple structure.

The other configuration is the same as that of the first embodiment. The operation of this embodiment is only partially different from the operation of releasing the fixing during disassembly and the operation of assembling, and the operation and effects are almost the same as those of the first embodiment.

(Fifth Embodiment) FIG. 13 shows a main part of a fifth embodiment of the present invention. The present embodiment has substantially the same configuration as the first embodiment, but the method of fixing the forceps unit 58 and the sheath 9 is the snap fit 38.
Instead, as shown in FIG. 13, the structure is such that it can be disassembled and assembled by the cam lock 64 provided on the distal end cover 6 and the protrusion 39 of the engagement member 37 (see FIGS. 2 and 5E). .

The rest of the configuration is similar to that of the first embodiment. The operation of this embodiment is only partially different from the operation of releasing the fixing during disassembly and the operation of assembling, and the operation and effects are almost the same as those of the first embodiment.

(Sixth Embodiment) FIG. 14 shows a main part of a sixth embodiment of the present invention. The present embodiment has substantially the same configuration as the first embodiment, but the method of fixing the forceps unit 58 and the sheath 9 is the snap fit 38.
Instead, as shown in FIG. 14 showing a cross section of a portion equivalent to the vicinity of the EE 'cross section of FIG. That is, a screw hole is formed in the distal end cover 6 through the sheath and the meshing member 37, and a joining screw 65 is screwed into the screw hole, and can be disassembled and assembled by the joining screw 65. It has a structure. In addition, if necessary, an O-ring for maintaining watertightness may be interposed and screwed with the joining screw 65.

The other configuration is the same as that of the first embodiment. The operation of this embodiment is only partially different from the operation of releasing the fixing during disassembly and the operation of assembling, and the operation and effects are almost the same as those of the first embodiment.

(Seventh Embodiment) FIGS. 15A and 15B show a fixing mechanism for rotational locking according to a seventh embodiment of the present invention. Shows a fixing mechanism of the pipe 14 and the first bearing 15 or the second bearing 19, and FIG. 15 (B) shows a fixing mechanism part of the rotation locking using a ball click.

The present embodiment has substantially the same configuration as the first embodiment, except that a bearing 15 or a bearing 19 and a pipe 14 are provided with a rotation locking fixing mechanism using a ball click. An elastic member 79 such as a spring is housed in a hole penetrating inside and outside of the pipe 14.
Is urged in the outer peripheral direction by the elastic force of the elastic member 79. Here, the diameter at the outer end of the hole through which the ball 78 provided in the pipe 14 passes is set to be smaller than the diameter of the ball 78, so that the biased ball 78 projects from the hole and falls off. There is no danger of doing.

The operating means 3 can be formed at an arbitrary angle by a large number of click grooves 80 provided on the inner peripheral surface of the ball 78 and the bearing 15 or the bearing 19 along the direction parallel to the central axis.
The treatment unit 33 is rotated and fixed at an arbitrary angle position that is an integral multiple of the small angle as a unit with respect to 4 (lock).
You can do it.

That is, in a normal use state, the protruding ball 78 can be set in the engaged state engaged with the click groove 80 to set the fixed state in which rotation (rotation) is restricted, and this engagement is released. By rotating with such a rotational force, the fixed position can be variably set.

The other configuration is the same as that of the first embodiment. The operation of this embodiment is only partially different from the operation of releasing the fixing mechanism during disassembly and the operation of assembly, and the operation and effects are almost the same as those of the first embodiment.

(Eighth Embodiment) FIGS. 16 and 17 relate to an eighth embodiment of the present invention, and FIG.
17 shows a fixing mechanism for rotationally locking the second bearing 19 and the sheath 22 as viewed from the rear side in FIG.

The present embodiment has substantially the same configuration as the first embodiment, except that the sheath 2 in the second bearing 19 is provided.
A large number of click grooves 80 are formed radially on the ring-shaped end face (proximal end face as can be seen from FIG. 16) facing the end face 2, while a click claw 81 is formed on the end face of the sheath 22 facing this end face. Are provided at, for example, two places, and a fixing mechanism for rotational locking is formed by engagement of the click groove 80 and the click claw 81. Also, knob 12
Is formed of an elastic member. Other configurations are the same as those of the first embodiment.

With these arrangements, when performing a rotating operation of the treatment section 33, the knob 12 is pressed to the operating means 34 in a proximal direction. As a result, the knob 12 comes into contact with the bearing 15 and is elastically deformed.
Get off.

Then, by turning the knob 12 with respect to the operating means 34, the treatment section 33 is rotated with respect to the operating means 34. Here, when the amount of force pressing the knob 12 against the operation means 34 is released, the click claw 81 can be engaged with the click groove 80 again to set a locked state in which rotation is restricted.

Even if the knob 12 is forcibly rotated with respect to the operating means 34 while the click claw 81 is engaged with the click groove 80, the knob 12 is not The elastic deformation as described above allows the treatment section 33 to be rotated with respect to the operation means 34. Other effects are the same as those of the first embodiment.

(Ninth Embodiment) FIGS. 18 to 23 relate to a ninth embodiment of the present invention. FIG. 18 shows the whole of the ninth embodiment, and FIG. Show,
20 (A) to 20 (D) show cross sections of respective parts in FIG. 19, FIG. 21 shows an insertion part, FIG. 22 shows operation means, and FIG.
(A) to (C) show cross sections of respective parts in FIG.

Ultrasonic incision coagulation device 3 of the first embodiment
In 1, two hollow conduits are formed in a sheath 9 having a function as a protective member, and one of the hollow conduits is passed through a forceps unit 58 provided with a treatment section 33, and an ultrasonic vibrator 50 is passed through the other conduit.
The proximal end side of the forceps unit 58 is locked to the movable operating means of the operating means 34 through the probe 8 side for transmitting ultrasonic waves from the probe 8, and by operating this movable operating means, the distal end member 7 of the probe 8 is In this embodiment, the sheath 9 has a function as a protection member.
Is a cylindrical hollow conduit (single conduit), a substantially cylindrical probe 8 is passed through the sheath 9, and the transmitting member side connected to the movable member of the treatment section 33 is inserted into the probe 8. Insertion,
The proximal end of the transmission member is connected to a ring-shaped ultrasonic vibrator 50.
Has a structure in which the inside of the hollow portion extends rearward and is connected to the movable operation means.

As shown in FIG. 18, the ultrasonic incision coagulation device 31 has a treatment section 33 and an insertion section 57 for inserting the treatment section 33 into a living body. Operation means 34 for operating the treatment section 33 is provided. A handpiece 32 having a built-in ultrasonic vibrator 50 for supplying ultrasonic vibration for treatment to the treatment section 33 is provided on the upper proximal side of the operation means 34.

The construction of the treatment section 33 and the probe 8 for transmitting the ultrasonic vibration from the ultrasonic transducer 50 to the treatment section 33 are as shown in FIGS. The treatment section 33 is screwed to the distal end of the probe 8 and provided with a distal end member 7 for treating a living tissue by ultrasonic vibration.

The distal end of the distal end member 7 is shaped like a forceps, and a distal end cover 6 that sandwiches the movable portion 3 is formed from the center to the proximal end. The movable portion 3 and the distal end of the distal end member 7 are engaged with each other so as to have a function as a forceps for grasping and opening tissue.

In this embodiment, the distal end, usually called a peeling forceps, is thin and has a shape effective for a peeling operation.
This shape may be, for example, a scissors shape as in the second embodiment or a shape like the movable portion 3 in the third embodiment, and the shape is not particularly limited.

The movable portion 3 is rotatably supported by the tip cover 6 by a pin 35, and is connected to the transmission member 5 by a pin 36. The transmission member 10 is the transmission member 5
Threaded to the proximal end.

The proximal side of the distal end cover 6 and the probe 8 are formed to be hollow, and the first transmission member 5 and the second transmission member 10 penetrate therethrough. The outer peripheral surface of the second transmission member 10 is covered with a tube 66 made of a material having heat resistance and ultrasonic vibration absorption such as PTFE material, and when ultrasonic vibration is applied to the probe 8. In addition, the contact between the probe 8 and the transmission member 10 prevents a danger such as generation of metal noise, generation of heat or breakage of the contact portion.

As in the first embodiment, an engaging member 42 is connected to the proximal end of the transmission member 10 by screwing.
A spherical portion 43 is formed at a proximal end of the engagement member 42. The engaging member 42 is driven forward and backward by the opening and closing operation of the movable operation handle 30, and the transmitting member 5 is driven forward and backward to transmit a force to the movable portion 3 through the pin 36,
The movable section 3 is driven to open and close with respect to the tip member 7.

The outer peripheral surface of the engaging member 42 is provided with an electrically insulating material such as a PTFE material in order to prevent a danger of the high-frequency current leaking to the surgeon's hand or the like during a treatment using the high-frequency current described later. It is covered with a tube 67 made of a material having the above. The probe 8 is formed of, for example, three parts, and Tig is used at the portions indicated by Q and R in FIG.
It is assembled by welding.

As shown in FIG. 20A, since the pin 35 for rotatably supporting the movable portion 3 is fixed to the end cover 6 by caulking or laser welding, it is integrated with the end cover 6, As described above, when the ultrasonic vibration is transmitted to the distal end cover 6, the ultrasonic vibration is transmitted to the movable portion 3 via the pin 35.

The treatment section 33 and the probe 8 having the above-described structures are inserted into an insertion section 57 described later, and connected to the ultrasonic vibrator 50 of the handpiece 32 of the operation means 34.

The insertion section 57 has a configuration as shown in FIG. 21. The insertion section 57 is formed by bringing the sheath 9 into contact with the distal end cover 6 and the distal end member 7 at the distal end of the sheath 9 composed of a plurality of parts. A protective member 4 made of a material having heat resistance and resistance to ultrasonic vibration, such as PTFE or ceramic, is provided in order to prevent a danger of generating metallic noise, generating heat, or damaging both. Have been.

An O-ring 68 and a C-ring 69 are provided on the outer periphery of the proximal end of the sheath 9.
2 is connected in a watertight manner. In the present embodiment, the connection between the sheath 9 and the screw ring 82 is detached by the C-ring 69. For example, the snap fit 3 of the first embodiment is used.
8 and the projection 39, the connection mechanism by the joint screw 63 as in the fourth embodiment, or the cam lock 64 as in the fifth embodiment, and the structure as in the eighth embodiment. A method using a joining screw 65 may be used, and the connection method is not particularly limited.

Next, the operation means 34 will be described. FIG.
As shown in the figure, the operating means 34 has a first bearing 15 joined to the distal side of the upper part of the support member 72 by a screw 71,
The second bearing 19 is joined by a screw 73 near the upper center.

A screw ring 82 is inserted on the distal side of the first bearing 15 and is screwed to the handpiece 32 with the bearing 15 interposed therebetween. The screw ring 82 is rotatable with the first bearing 15 together with the handpiece 32, and watertightness is maintained by the O-ring 45.

The above-mentioned sheath 9 is joined to the distal side of the screw ring 82 by a C-ring 69, and the water-tight state is maintained by a water-tight means such as an O-ring 68 so as to be rotatable with the first bearing 15. I'm dripping. In this embodiment, the first
A water supply / suction base 51 is provided on the upper part of the bearing 15. By connecting water supply / suction means (not shown) to the water supply / suction base 51, a pipe line from the first bearing 15 through the sheath 9 is provided. Water can be supplied or suction can be performed using.

The proximal side of the handpiece 32 is inserted into the second bearing 19 and is supported by the O-ring 47. The handpiece 32 can be rotated by the above-mentioned O-ring 45 and O-ring 47 when it is necessary to rotate the handpiece 32. On the other hand, it is rotatable.

The rotation locking fixing mechanism may use, for example, a ball click mechanism as in the seventh embodiment or a click mechanism as in the eighth embodiment, in addition to the O-ring 47.

As described above, a ring-shaped ultrasonic vibrator 50 for supplying ultrasonic vibration for performing treatment on a living tissue is provided inside the handpiece 32, and the ultrasonic vibrator 50 generates the ultrasonic vibration. The proximal end of the probe 8 is screwed to the distal end of the drive shaft (vibration shaft) of the ultrasonic vibration.

The above-described second transmission member 10 is inserted into the inside of the probe 8, and protrudes rearward from the proximal end of the handpiece 32 through a conduit inside the ultrasonic vibrator 50. At this time, in order to prevent insufflation gas and the like from leaking through the conduit through which the transmission member 10 extending to the proximal end side of the handpiece 32 is inserted, the transmission member 10 and the second transmission member 10 are connected to each other. A substantially tubular airtight member 74 is provided near the proximal end, and the airtight member 74 is formed of, for example, an elastic member such as rubber or a seal member such as PTFE material.

An engagement member 42 is connected to the proximal end of the second transmission member 10 by screwing, and an outer periphery of the engagement member 42 is supplied with a high-frequency current during a treatment with a high-frequency current described later. It is covered with a tube 67 made of an electrically insulating material such as a PTFE material in order to prevent an electric leakage.

At the proximal end of the engaging member 42, a spherical portion 43 is provided.
And is engaged with an engagement receiving member 75 inserted above the movable operation handle 30 as shown in FIG. As shown in FIGS. 23A and 23B, the engagement receiving member 75 has a groove shape in the vertical direction, and the spherical portion 43 can slide in the groove. I have.

Here, the groove opening of the engagement receiving member 75 has an upper opening with a width allowing the spherical portion 43 to pass through, and a lower opening with a width not allowing the spherical portion 43 to pass through. The root of the spherical portion 43 is sandwiched in the lower opening, and the spherical portion 43 is normally engaged in the lower groove.

By opening and closing the movable operation handle 30 with respect to the fixed operation handle 29 by this structure, the engagement member 4
The transmission member 10 and the transmission member 5 screwed to the engagement member 42 are driven forward and backward by driving the engagement member 42 forward and backward, whereby the movable portion 3 is moved to the front end member 7.
Is driven to open and close.

A fixed operation handle 29 is connected to a proximal end of the support member 72 by a screw 76 and a nut 77.
Since the movable operation handle 30 is rotatably supported on the fixed operation handle 29 as shown in FIG. 23B, the movable operation handle 30 can be opened and closed with respect to the fixed operation handle 29 as described above. Can be done.

Next, an actual use example of the present embodiment will be described. First, the treatment section 33 is made to face the living tissue to be treated. Next, the handpiece 32 is rotated with respect to the operation means 34, and the treatment section 33 is oriented in a direction convenient for treating the living tissue.

Then, the movable operation handle 30 is turned in the opening direction to open the movable portion 3. The living tissue to be treated is gripped with an appropriate force. Thereafter, the ultrasonic vibrator 50 is driven by a driving power supply for the ultrasonic vibrator 50 (not shown),
Ultrasonic vibration is transmitted to the distal end member 7 and the movable section 3 to apply ultrasonic vibration to the living tissue.

At this time, if the treatment is performed with factors such as increasing the amplitude of the ultrasonic vibration, increasing the amount of gripping force, and increasing the time for applying the ultrasonic vibration as described above, it is convenient to incise the living tissue. If the factor is reversed, coagulation is performed, which is convenient. Therefore, appropriate treatment is performed in consideration of the condition of the living tissue.

By applying a high-frequency current supply power source (not shown) to the ultrasonic vibrator 50, a high-frequency current is supplied from the ultrasonic vibrator 50 to the living tissue through the probe 8, the tip cover 6, the tip member 7, and the movable part 3. And treatment using high-frequency current can be performed.

At this time, the outer periphery of the engaging member 42 exposed to the outside is covered with the electrically insulating tube 67 as described above, and the movable operation handle 30, the sheath 9,
By molding the screw ring 82, the bearing 15, the handpiece 32, the casing, and the like from an electrically insulating material such as PEEK or polysulfone, leakage of high-frequency current can be prevented, so that safe treatment can be performed.

Since the treatment by ultrasonic vibration and the treatment by high-frequency current can be performed independently, the treatment may be performed by using each separately or may be performed simultaneously.

Next, a method of disassembling and assembling the present embodiment will be described. First, the sheath 9 is pulled out from the screw ring 82 in the distal direction. Next, the fixing operation handle 29 is
Is removed from the support member 72 downward. As a result, the movable operation handle 30 also moves downward, so that the spherical portion 43 engaged with the engagement receiving member 75 comes off the groove, and the engaging member 42 falls off the movable operation handle 30. . As a result, the integrated operation of the fixed operation handle 29 and the movable operation handle 30 is disassembled by the operation means 34.

Subsequently, the screw ring 82 is connected to the handpiece 32.
From the bearing 15, thereby being disassembled from the bearing 15. Thereafter, the handpiece 32 is moved to the bearing 15 proximally,
By pulling it out of the bearing 19, the integrated handpiece 32 and probe 8 are disassembled from the operating means 34.

The probe 8 is removed from the handpiece 32, and the engaging member 42 is removed from the transmission member 10. Thereafter, the tip member 7 is removed from the probe 8. By the above disassembling operation, the ultrasonic incision coagulation apparatus 31 is in a state where cleaning and sterilization can be performed well, and each part can be cleaned and sterilized.

When assembling the ultrasonic incision coagulation apparatus 31 again, it is possible to assemble it in the reverse order of the above disassembly procedure. In addition, since the disassembly and assembly can be performed in this manner, if any part is damaged, the part can be used again by replacing only the part.

(Tenth Embodiment) FIG. 24 shows a tenth embodiment of the present invention. The configuration of the present embodiment is ninth.
In this embodiment, the probe 8 is curved, and the sheath 9 and the transmission member 10 inserted therein are formed of an elastic member. The transmission member 10 is formed of, for example, a super-elastic wire made of a Ni-Ti alloy or the like. The sheath 9 is formed of a flexible member such as a PTFE material.

As a result, the curved probe 8 can be inserted into the sheath 9 and the transmission member 10 can be driven forward and backward in the probe 8. With these configurations, the treatment section 33 can be rotated with respect to the operation means 34, so that good operability is obtained. Other configurations, operations, and the like are the same as in the ninth embodiment.

(Eleventh Embodiment) FIGS. 25 to 34 relate to an eleventh embodiment of the present invention, FIG. 25 is a perspective view showing a schematic configuration of an ultrasonic incision coagulation apparatus, and FIG. FIG. 27 is a perspective view showing the ultrasonic incision coagulation apparatus in a state where it is detached from the operation unit. FIG. 27 is a perspective view showing the ultrasonic incision coagulation apparatus in a state where the probe and the rotor are removed from the operation unit.
8 illustrates an example of a locked state between the operation unit and the rotor, FIG. 29 illustrates another locked state between the operation unit and the rotor, and FIG. 30 illustrates another relation between the operation unit and the rotor. FIG. 31 illustrates a stop state, FIG. 31 illustrates a connecting member and a probe, FIG. 32 illustrates a connecting member and an operating rod, FIG.
Is an explanatory view showing a fixed blade, a probe, and a horn, and FIG.
FIG. 4 is an explanatory diagram showing the relationship between the handpiece and the vibrator cover forming the operation unit.

In the ultrasonic incision coagulation apparatus 31 of the first embodiment, a forceps unit in which two hollow conduits are formed in the sheath 9 having a function as a protection member, and the treatment section 33 is provided on one of the hollow conduits. 58, the probe 8 for transmitting ultrasonic waves from the ultrasonic transducer 50 to the other conduit, and the proximal end side of the forceps unit 58 is locked to the movable operating means of the operating means 34. It is a structure that can be opened and closed with respect to the distal end member 7 of the probe 8 by operating the operating means. In the ultrasonic incision coagulation device 31 of the ninth embodiment, the sheath 9 having a function as a protection member has a cylindrical shape. A substantially tubular probe 8 is passed through the sheath 9 and the transmission member side connected to the movable member of the treatment section 33 is inserted into the probe 8. Connect the proximal end of the transmission The hollow portion of the ultrasonic transducer 50 is extended to the rear side but which was structurally linked to the movable operating means,
In the ultrasonic incision coagulation apparatus of the present embodiment, the sheath having a function as a protective member is a hollow conduit (single conduit) having a through-hole having a substantially oval cross-sectional shape. While disposing a tip connector and a plurality of connectors provided with detents on the outer shape, the tip connector and the connector are provided with a probe that is a vibration transmitting member and an operating rod that is a transmitting member, By rotating the sheath, the structure in which the positional relationship between the operation unit and the treatment unit is improved without rotating the operation unit provided with the ultrasonic transducers.

[0134] As shown in FIG.
Reference numeral 00 denotes a handpiece 102 having a built-in ultrasonic vibrator for generating ultrasonic vibration.
1 and an operation unit 103 having a movable operation handle 132
And the handpiece 1 disposed on the operation unit 103.
The fixed blade 141 is a fixed member to which the ultrasonic vibration for performing treatment on the living tissue is transmitted by the ultrasonic vibration generated at 02.
And a treatment section 104 having a movable blade 142 which is a gripping member facing the fixed blade 141 and gripping and releasing the biological tissue between the fixed blade 141 and the treatment section 104.
A vibration transmitting member for transmitting vibration of the handpiece 102 to the fixed blade 141 of the movable operation handle 1
32 by the movable blade 142
And a sheath 111 which is a protection member for covering a transmission member described later.

The fixed operation handle 13 of the operation section 103
1 is a tubular window 13 containing an ultrasonic unit 102.
3a is formed integrally with the vibrator cover 133 formed on the side surface. On the other hand, the movable operation handle 132
Is rotatably mounted on the vibrator cover 133 via a handle fulcrum pin 134. The movable operation handle 132 is provided with a locking body 135 provided with a locking claw 135a for detachably locking a rotor, which will be described later, inserted into the vibrator cover in the vibrator cover.
33 are formed so as to be rotatable in the direction of the central axis facing the window 133a.

A rotation knob 112 is integrally fixed to an end of the sheath 111 on the operation portion side. This rotary knob 1
12 is a movable blade 142 constituting the treatment section 104,
This is for rotating the fixed blade 141 with respect to the central axis. Reference numeral 113 denotes an electrode plug to which a power supply for high-frequency treatment is connected.

As shown in FIG. 26, the sheath 111 is configured to be detachable from a vibrator cover 133 constituting the operation section 103.
By removing the 11, the probe 143, which is a vibration transmitting member for transmitting the vibration of the handpiece 102 to the fixed blade 141, and a transmitting member for transmitting the gripping or releasing operation instruction from the movable operation handle 132 to the movable blade 142. A certain operation stick 144 appears. The sheath 111 has a through-hole 111a having a substantially oval cross-sectional shape.
The probe 143 and the operating rod 1 are inserted into the through hole 111a.
The distal end connector 145 and the plurality of connectors 146 and 146 are holding means for preventing the contact of the sheath 44 with the sheath 111.
Are arranged. The probe 143 and the operating rod 144 are inserted through through holes, which will be described later, formed in the tip connector 145 and the plurality of connectors 146. The outer shape of the tip connector 145 and the plurality of connectors 146 is as follows. The through-hole 111a formed in the sheath 111 has a substantially same cross-sectional shape as that of the through-hole 111a. For this reason, the tip connector 145 and the plurality of connectors 146, 14
The sheath 6 is provided integrally with the through-hole 111a with the straight portion having the oval cross section serving as a detent.
The tip connector 145 and the plurality of connectors 146 also rotate in the same direction integrally with the rotation of the eleventh connector.

The movable blade 142 is rotatably mounted on a distal end connector 145 by a pin 147. The distal end of an operating rod 144 is connected to the movable blade 142, and a rear end of the operating rod 144. Is the inner hole 1 of the vibrator cover 133
The movable operation handle 132 is connected to a rotor, which will be described later, which is inserted through the movable handle 33b. For this reason,
By operating the movable operation handle 132 to the fixed handle side, the operation rod 144 is retracted to move the movable blade 14
2 moves to the fixed blade side.

Further, the fixed blade 141 protruding from the distal end connector 145, the distal end of the probe 143, the rear end of the probe 143, and the distal end of the horn 121 located on the distal side of the handpiece 102 are screwed. It is configured to be removable by joint connection.

As shown in FIG. 27, the probe 143 to which the fixed blade 141 is connected and the operation rod 144 to which the movable blade 142 is connected are detachable from the operation section 103.

The probe 143 is
Since the rear end of the horn 3 and the front end of the horn 121 located on the front end side of the vibration unit 102 are connected by screwing, it is possible to easily remove the operating unit 103 by removing the screw connection. Has become. In addition, the probe 14
When attaching the horn 3 to the horn 121 provided on the operation unit 103, the horn 121 is easily connected by screw connection.

On the other hand, the rear end of the operation rod 144 is connected to a rotor 148, and the rotor 148 is
03 is detachable. The rotor 14
Reference numeral 8 denotes a tubular member in which a through hole 148a through which the horn 121 is inserted is formed.
A protrusion 148b that slides into the inner hole 133b is formed,
The protruding portion 148b has a locking claw 135a provided on a locking body 135 formed on the movable operation handle 132.
Is formed in the groove 148c.

For this reason, as shown in FIG. 28, the rotor 148 inserted into the inner hole 133b of the vibrator cover 133
Locking claw 135a provided on the locking body 135 of the movable operation handle 132 engaged with the groove 148c
To remove the inner hole 133 of the vibrator cover 133.
The rotor 148 inserted in b can be easily removed.

When connecting the rotor 148 to the vibrator cover 133 provided on the operation section 103, first,
4 has a protruding portion 14 of the rotor 148 to which the rear end is connected.
8b is inserted in accordance with the through hole 133b of the vibrator cover 133. Next, as shown in FIG.
The groove 148c formed on the vibrator cover 13
3 is opposed to the window 133a. Next, the rotatable locking body 135 provided on the movable operation handle 132 is rotated, and the locking claw 135a provided on the locking body 135 is engaged with the groove 148c. This allows the rotor 1
Reference numeral 48 is slidably locked in the longitudinal direction and the circumferential direction of the inner hole 133b of the vibrator cover 133 constituting the operation section 103.

At this time, a protrusion 148d is provided at the tip of the rotor 148 as a rotation stopper. This convex part 14
8d engages with an engaging groove formed in an inner peripheral surface (not shown) of an engaging portion 112a located on the hand side of the rotary knob 112 in an assembled state, and the rotor 1
By integrally engaging the projection 148d of the 48 and the rotary knob 112, the rotor 148 rotates in response to the rotational operation of the rotary knob 112.

As shown in FIG. 29, the rotor 148 is slidably locked in the longitudinal direction and the circumferential direction of the inner hole 133b of the vibrator cover 133. The groove 148c of the rotor 148 is opposed to the formed window 133a.
By moving the locking rod 136 movable vertically in the direction c, the locking rod 136 may be engaged with the groove 148c. Further, as shown in FIG. 30, the movable operation handle 132 has a locking claw 135a and a locking hole 137.
a and a hole 37b for attachment / detachment, the handle fulcrum pin 134 is moved from a state inserted through the hole 137b for attachment / detachment of the movable operation handle 132 to a state inserted through the hole 137a for engagement of the movable operation handle 132. Let's make the locking claw 1
Various forms are conceivable, such as engaging 35a with groove part 148c.

As shown in FIGS. 31 (A) and 32, the probe 143 and the operating rod 144 are detachable from the distal end connecting member 145 and the plurality of connecting members 146, 146, respectively. A groove 145 for disposing the movable blade 142 and the operating rod 144 in the tip connector 145.
a, a through hole 145b for disposing the fixed blade 141 and the probe 143, and a slit 145c for attachment / detachment. Further, the coupling tool 146 has a small hole 146a for disposing the operation rod 144 and a slit 146b for attachment and detachment, and a through hole 146c and a slit 146d for attachment and detachment for disposing the probe 143. Have been. The tip connector 145 and the connector 14 in which the probe 143 and the operation rod 144 are detachably provided.
Numeral 6 is made of a fluororesin material such as Teflon having high slidability, heat resistance and ultrasonic vibration absorption.

As shown in FIG. 31 (B), the tip connector 145 and the connector 146 are arranged in grooves 143a and 143b formed at predetermined positions of the probe 143. As shown in FIG. 31 (C), the grooves 143a and 143b of the probe 143 are provided at portions corresponding to nodes of the vibration wave so as not to be affected by the vibration generated from the ultrasonic vibrator. On the other hand, a threaded portion for threadingly connecting the probe 143 to the fixed blade 141 and the horn 121 is provided at a portion corresponding to an antinode of a vibration wave in which stress due to vibration is not concentrated.

As shown in FIGS. 33A and 33B, external threads 143c and 143d are formed at both ends of the probe 143, and the external threads 143c and 143d are formed on the fixed blade 141. Illustrated) and horn 12
1 is screwed into a female screw (not shown) formed on the horn 121 and the probe 14 and the vibration generated by the ultrasonic vibrator.
3 to the fixed blade 141.

As a member for transmitting the vibration generated by these ultrasonic transducers, a titanium material, an aluminum material, or an alloy thereof having a high acoustic effect and good biocompatibility is used. Strong in breaking strength,
Although it is optimal as a member because of its good biocompatibility, it is difficult to process and expensive. On the other hand, the aluminum material has relatively good workability and is inexpensive, but has problems such as strength and weakness against heat generated by vibration.

For this reason, the horn 121, the probe 143, and the fixed blade 141 may be formed of an aluminum member when used in a disposable manner. It was desired that the blade 141 be made of a titanium material. Further, when the ultrasonic incision coagulation apparatus 100 has a structure that can be disassembled and assembled, it is desirable to form the ultrasonic incision coagulation apparatus 100 from a titanium material having high strength and high durability, but it is expensive.

Therefore, in this embodiment, the fixed blade 141 as the treatment section and the horn 121 for supplying the ultrasonic vibration generated by the ultrasonic vibrator to the probe 143 are formed of a durable titanium material. The probe 143 which is a relay member for connecting the horn 121 and the fixed blade 141 is formed of an inexpensive aluminum member.

As shown in FIG. 33C, the probe 143 may be formed with female threads 143e and 143f at both ends. At this time, the fixed blade 141
A male screw 141a corresponding to the female screw 143e of the probe 143 is formed on the horn 121, while the male screw 12a corresponding to the female screw 143f of the probe 143 is formed in the horn 121.
1a is formed.

As shown in FIG. 34A, the handpiece 102 is arranged in a through hole 133b of the vibrator cover 133. At this time, a positioning portion 133c is provided in the through-hole so that the handpiece 102 is stably disposed at a predetermined position in the through-hole 133b, and a positioning notch is formed in the flange portion 122 of the handpiece 102. A portion 122a is formed. And
The handpiece 102 inserted into the through hole 133b of the vibrator cover 133 is stably fixed at a predetermined position by a fixed body 124 via a packing 123 such as an O-ring.

Further, as shown in FIG. 34B, an operation handle 133d in which a fixed handle and a movable operation handle are integrated with each other may be provided on the vibrator cover 133. Ultrasonic incision coagulation device 1 configured as described above
00 is inserted into the abdominal cavity to perform the treatment.

First, the living tissue is fixed to the fixed blade 141 to be treated.
The movable operating handle 132 provided on the operating section 103 of the ultrasonic incision coagulation apparatus 100 is operated to the fixed handle side in order to hold the movable operating handle 132 between the movable cutting blade and the movable blade 142. Then, the rotor 148 locked in the through-hole of the vibrator cover 133 by the locking claw 135a formed in the movable operation handle 132 retreats in the through-hole and is connected to the rotor 148. The operating rod 144 similarly moves backward, and the movable blade 142 moves to the fixed blade side to grip the living tissue between the fixed blade 141 and the movable blade 142.

Next, in this state, the ultrasonic vibrator (not shown) of the handpiece 102 is driven by the ultrasonic vibrator driving power source to generate ultrasonic waves. This handpiece 10
The ultrasonic vibration generated by the horn 121 and the probe 1
The light is transmitted to the fixed blade 141 via the reference numeral 43. This fixed blade 1
When the ultrasonic vibration is transmitted to 41, the fixed blade 141 vibrates, and this vibration is transmitted to the grasped living tissue, and generates frictional heat to coagulate the living tissue. Also, by applying ultrasonic vibration to the living tissue and operating the movable operation handle 132 further toward the fixed handle to increase the amount of gripping force for gripping the living tissue, the movable blade 142 approaches the fixed blade 141. By doing so, the incision is completed without bleeding from the living tissue.

Next, the treatment section 104 is moved to a place where there is a living tissue to perform a new treatment. At this time, the operation unit 1
Since the positional relationship between the treatment unit 03 and the treatment unit 104 replaces the positional relationship at the time of the previous treatment, the rotation knob 112 is rotated to improve workability. Then, the sheath 111 to which the rotary knob 112 is fixed rotates together with the rotor 148 locked in the through hole of the vibrator cover 133.

As the sheath 111 rotates, the distal end connector 145 and the connector 146 provided in the through hole 111a of the sheath 111 rotate with respect to the center axis of the fixed blade 141 and the probe 143. Then, when the movable blade 142 moves to a desired position, the rotation knob 1
As described above, the operation section 103 of the ultrasonic incision coagulation apparatus 100 is provided between the fixed blade 141 and the movable blade 142 to stop the rotation of the movable blade 12 and to grasp living tissue for treatment. By operating the movable operation handle 132 to the fixed handle side, the living tissue is grasped and the treatment is performed.

As described above, by providing the detents on the outer shapes of the tip connector and the plurality of connectors on which the probe and the operating rod are disposed, the tip connector and the connector are integrally formed with the inner hole of the sheath. And the rotor is integrally disposed on the rotary knob, so that the tip connector and the plurality of connectors and the rotor are rotated in the same direction in accordance with the rotation of the sheath by operating the rotary knob. In addition, the position of the movable blade with respect to the center axis of the fixed blade can be rotated to a desired position.
This makes it possible to improve the positional relationship between the operation unit and the treatment unit without rotating the operation unit on which the ultrasonic vibrator is arranged, thereby greatly improving the workability of the operator. In addition, the code extending from the operation unit is not entangled.

By the way, as shown in FIG.
2a without using the operating rod 144 as described above.
When performing the operation of grasping and opening the treatment section 104 formed between the fixed blade 141 and the fixed section 141 by moving the 5 forward and backward, the treatment section 104 is formed as shown in FIG. 36 to configure the ultrasonic incision coagulation apparatus 100A. Accordingly, the same function and effect as those of the above embodiment can be obtained.

That is, as shown in FIG.
First, the movable blade 142a is connected to the tip connector 14
5 is rotatably mounted on a pin 147. At this time, the torsion coil spring 1 for urging the movable blade 142a to the open side
49 is provided. Next, the through-hole 145b provided in the distal end connector 145 provided with the movable blade 142a and the torsion coil spring 149 is inserted into the groove 143 of the probe 143.
a to constitute the treatment section 104.

Then, the treatment section 104 is connected to the sheath 115
Through the through-hole 115a. At this time, the distal end connector 145 formed at the distal end of the sheath 115
Is inserted into the fitting groove 115b which is a detent for integrally disposing the sheath 115 on the sheath 115, thereby constituting the ultrasonic incision coagulation apparatus 100A. As a result, the ultrasonic incision coagulation apparatus 100A
Moving the fixed blade 141 and the movable blade 142
The gripping and releasing operations can be performed between the two. Further, as shown in FIG. 37, by rotating the sheath 115, the distal end connector 145 rotates in the same direction in response to the rotation of the sheath 115, and the position of the movable blade 142a with respect to the center axis of the fixed blade 141 is changed. It can be in the desired position.

[0164] As shown in FIG.
When the protective tube 5 is further covered with the protective tube 116 or the like, the detent 1 comprising a concave portion and a convex portion as shown in the drawing so that the protective tube 116 and the sheath 115 rotate integrally.
17, the sheath 115 and the tip connector 145 are rotated in the same direction in response to the rotation of the protection tube 116, and the movable blade 1 with respect to the central axis of the fixed blade 141 is rotated.
The position of 42a may be moved to a desired position.

Next, a method of disassembling and assembling the present embodiment will be described. First, the sheath 111 is removed from the ultrasonic incision coagulation device 100 shown in FIG. 25 in the assembled state as shown in FIG. As a result, the sheath 111 becomes a separate body, and the probe 143, the operating rod 144, and the treatment unit 10 attached to the distal end connector 145 and the plurality of connectors 146 provided in the through hole 111a of the sheath 111.
4 appears.

Next, the screw portion between the probe 143 and the horn 121 is loosened and released, and the rotor 148 locked on the operation portion 103 is removed. At this time, the operation unit 1
The rotor 148 having the locking claw 135a inserted into the vibrator cover is moved by moving the locking body 135 formed on the movable operation handle 132 which is pivotally attached to the vibrator cover 133 of FIG. From the groove 148c of
The rotor 148 is pulled out as shown in FIG. Thereby, the operation unit 103 is separate.

Subsequently, as shown in FIGS. 31A and 32, the probe 143 and the operating rod 144 are removed from the distal end connector 145 and the plurality of connectors 146. Thereafter, by releasing the screw engagement between the probe 143 and the fixed blade 141, the fixed blade 141 is not removed from the probe 143,
Further, the movable blade 142 can be removed from the distal end connector 145 by pulling out the pin 147 of the distal end connector 145.

Through these series of operations, the ultrasonic incision coagulation apparatus 100 is in a state where each part can be sufficiently cleaned and sterilized. However, if necessary, the movable operation handle 132 constituting the operation part 103 is removed, and the handpiece is removed. 102 can be removed. Then, the members disassembled in this way are cleaned and sterilized, and when the assembly is performed again after the cleaning and sterilization is completed, the assembly of the ultrasonic incision coagulation apparatus 100 can be performed in the reverse order of the disassembly described above. Assembly is possible.

As described above, since the structure is such that it can be disassembled and assembled, it is possible to clean and sterilize each part sufficiently or securely without taking any trouble by disassembling.
If such a part of the member is damaged come out replace only the damaged parts, it is economically continue to become like can be used.

Further, a fixed blade as a treatment section and a horn for supplying ultrasonic vibration generated by an ultrasonic vibrator to a probe are formed of a durable titanium material, and the horn and the fixed blade are connected. Ultrasonic waves that can transmit ultrasonic vibrations from the ultrasonic transducer to the fixed blade without lowering treatment performance such as incision or coagulation by forming the probe that is a relay member with an inexpensive aluminum member An incision coagulation device can be provided at low cost.

Further, the treatment can be performed efficiently by replacing the fixed blade screwed to the distal end of the probe with one having a shape, size, or surface treatment suitable for the treatment. Other configurations, operations, and effects are the same as those of the above-described embodiment.

(Twelfth Embodiment) FIGS. 39 to 4
1 relates to the twelfth embodiment of the present invention, and FIG.
2 is a perspective view showing an ultrasonic incision coagulation apparatus according to the second embodiment,
FIG. 40 shows the structure inside the sheath, and FIGS. 41 (A) and 41 (B) show the front and WW ′ cross sections of FIG. The ultrasonic incision coagulation apparatus 100B of the present embodiment has a configuration basically similar to that of the eleventh embodiment.

Ultrasonic incision coagulation device 100 of the present embodiment
B shows the vibrator cover 133 in the ultrasonic incision coagulation apparatus 100 according to the eleventh embodiment with the adapter 1 on the front side.
55 and a vibrator cover 157 on the rear side that covers the internal vibrator.

The front end of the adapter 155 has a sheath 11
A rotation knob 112 provided near the rear end of the adapter 1 is detachably attached by screwing, and a front end of the vibrator cover 157 is detachably attached to the rear end of the adapter 155 by screwing.

The fixed operation section unit 131 is integrally attached to the adapter 155, and the movable operation handle 1 is rotatably attached by the handle fulcrum pin 134.
Each of the engaging members 35 near the upper end of the engaging member 32 has an engaging claw 13
5a are provided, and the windows 133 on both sides of the adapter 155 are provided.
a engages with a groove of a rotor disposed inside the rotor. Adapter 155 and fixed and movable operation handle 13
The operation unit unit 156 is formed by the first and the 132.

This rotor is mounted movably back and forth on the outside of a horn whose rear end is connected to the vibrator, as in the eleventh embodiment, and is moved back and forth by operating the movable operation handle 132. The movable blade 142 is opened and closed via an operation rod whose rear end is fixed to the front end of the movable blade 142. The horn passes through the inside of the adapter 155 and is connected to the vibrator inside the vibrator cover 133 at the rear end.
The rear end of the probe 143 is detachably connected to the front end of the horn by screwing.

Also, as shown in FIG.
The front and rear sides of a flange 152 provided at the position of the vibration node 151 closest to the forefront of the movable blade 142 are sandwiched and fixed between a tip connector 153 to which a movable blade 142 is rotatably connected and a tightening ring 154. . When sandwiching, an elastic member such as a packing for preventing the vibration of the flange portion 152 from being transmitted to the distal end connector 153 and the fastening ring 154 may be sandwiched.

As shown in FIGS. 41A and 41B, the movable blade 142 constituting the treatment section 104 is rotatably supported near the distal end of the distal end connector 153 by a pin 147 above the fixed blade 141. The distal end of the operating rod 144 is connected near the distal end of the distal end connector 153.

As described above, the unit of the probe 143 is designed so as not to rotate relative to the sheath 111. The vibrator to which the probe 143 is coupled via the horn is integrated with the vibrator cover 157. Connected to each other and does not rotate relatively. That is, this portion (the unit portion of the probe 143) has the same configuration (although the outer shape is different) as in the first embodiment.

Operation unit 1 having adapter 155
56 is a locking claw 135a for the probe, sheath 111,
In addition to being directly connected to the unit composed of the vibrator cover, the vibrator cover 157 and the rotary knob 112 are connected to each other by rotatable connecting means provided at both ends of the adapter 155.

In this embodiment, by rotating the rotary knob 112, the vibrator cover 157, the sheath 111, the movable blade 142, the fixed blade 14
1 has the effect of rotating. This embodiment has substantially the same effects as the other embodiments.

In the above-described embodiments, for example, in a structure in which a screw or a screw hole or a male screw and a female screw can be disassembled and assembled by screwing or screwing, a member provided with a screw or a male screw can be used. It is clear that the member with the hole or the female screw may be exchanged,
The same applies to the case of engagement or engagement between a projection, a claw, a pin, or the like and a recess, groove, or the like.

The present invention also includes an embodiment configured by partially combining the above-described embodiments. As described above, the sheath of the insertion portion for inserting the treatment portion for performing treatment on the living tissue of the ultrasonic incision coagulation device, which is the gist of the present invention, into the living body is made rotatable with respect to the operation means. The other configuration may be of any purpose as long as it is within the range described above, and the content thereof is not limited.

2. In claim 1, the treatment section including the probe and the gripping member rotates together with the probe and the handpiece about the center axis of the probe . The purpose of 2 to 8 is the same as that of claim 1. 3. 2. The device according to claim 1, wherein the gripping member rotates about a central axis of the probe. 4. 2. The device according to claim 1, further comprising a transmission member for driving the gripping member by operating the operation means, wherein an axis of the transmission member does not coincide with a center axis of the rotation, and the transmission member is driven. A drive member is disposed in the operating means, the drive member is substantially circular about the center axis of the rotation, and a drive pin that meshes with and drives the drive member is provided on the outer periphery of the drive member. And the drive pin is rotatably arranged about the central axis of the drive member, and the drive pin is driven by operation of an operation means. 5. 4. The device according to claim 4, wherein a conduit through which the transmission member passes through the sheath and a conduit through which the probe passes are formed independently.

6. 6. The device according to claim 1, wherein the sheath is rotated in conjunction with the rotation operation. 7. 7. The device according to claim 1, wherein a knob for performing the rotation operation is provided on a sheath or a handpiece.

8. 8. The apparatus according to claim 1, wherein a fixing means for setting a turning angle to a substantially fixed state at the time of the turning operation is provided between the sheath or the handpiece and the operating means. 9. 8. In Addition 8, the fixing means is a click means by meshing an uneven part provided on the sheath or the handpiece with an uneven part provided on the operation means. 9-1
Third object: In addition to the object of the first aspect, when the treatment means is rotatable with respect to the operation means, the treatment means can not be rotated when unnecessary but can be rotated only when necessary. To provide an ultrasonic incision coagulation device having better operability.

10. In the supplementary note 8, the fixing means is engaged with a plane provided with a concave portion in a part provided on the sheath or the handpiece or the operating means, and the concave portion provided at a position facing the flat surface of the operating means. One having a meshing member and an elastic member for pressing the meshing member against the concave portion. 11. 8. A device according to claim 8, further comprising a frictional force generating means between the sheath or the handpiece and the operation means for preventing unexpected rotation in the rotation operation. 12. In addition 11, the frictional force generating means is formed by an elastic member and a surface facing the elastic member. 13. In addition 12, the frictional force generating means is formed by an O-ring and a surface facing the O-ring.

14. 3. The probe according to claim 3, wherein the probe has a shape of a rotating body around an axis.

15. In Supplementary Note 3, the transmission member is a rod-shaped member, and the gripping member is rotated by an advance / retreat operation of the transmission member.

16. In the supplementary note 3, the transmission member is a tubular member that covers the probe.

17. 3. The device according to claim 3, further comprising a protection member that covers the probe and the transmission member.

18. In Appendix 15, the rod-shaped member and the probe are connected by a connecting member at at least one location.

19. Appendix 17 and Appendix 18, wherein a rotation preventing means for preventing rotation of the connecting member and the protection member is provided.

20. 3. The device according to claim 3, further comprising a connecting member at a rear end of the transmitting member, the connecting member being locked by the operating means.

21. Appendix 17 and Appendix 20, wherein a rotation preventing means for preventing rotation of the protection member and the connection member is provided.

22. Appendix 17, wherein a rotation operating means is provided at a rear end of the protection member.

23. Appendix 16, wherein a rotation preventing means for preventing rotation of the transmission member and the connecting member is provided.

24. Appendix 17, wherein a rotation preventing means for preventing rotation of the protection member and the transmission member is provided.

25. Item 16. The device according to supplementary note 16, wherein the connecting member is a sliding member.

26. Appendix 25, wherein the connecting member is made of a fluororesin material.

27. Appendix 25, wherein a probe is detachable from the connecting member.

28. Appendix 25, wherein the transmission member is detachable from the connection member.

29. Appendix 16 wherein the connecting member is provided near a node of vibration of the probe.

30. In addition 27 and 28, attachment and detachment from the connecting member is one-touch.

31. To an operation unit having an inner hole that incorporates an ultrasonic vibrator that generates ultrasonic vibration, and to a fixing member that is connected to the ultrasonic vibrator and that constitutes a treatment unit that performs ultrasonic vibration on living tissue A vibration transmission member for transmitting, and a gripping member that constitutes the treatment section that faces the fixing member of the treatment section and grips and releases an ecological tissue with the fixing member, and an operation section provided on the gripping member. An operation member for transmitting a grip and release operation instruction from the operation instruction member,
An ultrasonic incision coagulation device having a protection member for covering the operation member and the vibration transmitting member, wherein the operation portion is provided with a fixed operation member integrally formed with the operation portion and an operation instruction member for giving an operation instruction. .

32. Appendix 31, wherein the operation instructing member is formed integrally with the operation unit.

[0207]

As described above, according to the present invention, the grip
Unit and the treatment unit with the ultrasonic probe
Operation means depending on the condition of the living tissue.
Unnatural operation such as twisting the hand that is operating
Ultrasonic incision coagulation with good operability
A solid device can be provided.

[Brief description of the drawings]

FIG. 1 is an overall view of a first embodiment of the present invention.

FIG. 2 is a sectional view showing the structure of a treatment section and an insertion section.

FIG. 3 is a sectional view taken along line D1-D2-D3-D4 of FIG. 2;

FIG. 4 is a front view of the treatment section as viewed from the front in FIG. 2;

FIG. 5 is a sectional view taken along line AA ′ to GG ′ of FIG. 2;

FIG. 6 is a plan view showing operation means.

FIG. 7 is an enlarged partial cross-sectional view showing an operation unit and a part thereof.

FIG. 8 is a cross-sectional view taken along line HH ′ and II ′ of FIG.

FIG. 9 is a sectional view taken along line JJ ′ to MM ′ in FIG.

FIG. 10 is a diagram showing the front and side shapes of a treatment section according to a second embodiment of the present invention.

FIG. 11 is a diagram showing a shape of a treatment section and a part of a movable section according to a third embodiment of the present invention.

FIG. 12 is a sectional view showing a part of an insertion portion according to a fourth embodiment of the present invention.

FIG. 13 is a perspective view showing a treatment section according to a fifth embodiment of the present invention.

FIG. 14 is a sectional view showing a part of an insertion portion according to a sixth embodiment of the present invention.

FIG. 15 is a diagram showing a bearing unit and a ball click mechanism of an operation unit according to a seventh embodiment of the present invention.

FIG. 16 is a sectional view showing an operation means according to an eighth embodiment of the present invention.

FIG. 17 is a perspective view showing a bearing portion of an operation means according to the eighth embodiment.

FIG. 18 is an overall view of a ninth embodiment of the present invention.

FIG. 19 is a diagram showing a cross section of a treatment section and a part of the probe and the treatment section.

FIG. 20 shows the NN ′ to PP ′ lines and SS ′ in FIG.
Line sectional view.

FIG. 21 is a sectional view showing an insertion portion.

FIG. 22 is a cross-sectional view showing the operation means.

FIG. 23 is a sectional view taken along line TT′-VV ′ of FIG. 22;

FIG. 24 is an overall view of a tenth embodiment of the present invention.

FIG. 25 is a perspective view showing a schematic configuration of an ultrasonic incision coagulation apparatus.

FIG. 26 is a perspective view showing the ultrasonic incision coagulation device with the sheath removed from the operation unit.

FIG. 27 is a perspective view showing the ultrasonic incision coagulation device with the probe and the rotor removed from the operation unit.

FIG. 28 is a diagram illustrating an example of a locked state between the operation unit and the rotor.

FIG. 29 is a view for explaining another locked state of the operation unit and the rotor.

FIG. 30 is a diagram illustrating another locked state of the operation unit and the rotor.

FIG. 31 is a diagram illustrating a connecting member and a probe.

FIG. 32 is a diagram illustrating a connecting member and an operating rod.

FIG. 33 is an explanatory view showing a fixed blade, a probe, and a horn.

FIG. 34 is an explanatory diagram showing a relationship between a handpiece and a vibrator cover forming an operation unit.

FIG. 35 is a sectional view showing a schematic configuration of an ultrasonic incision coagulation device.

FIG. 36 is a diagram illustrating a configuration of a treatment unit of the ultrasonic incision coagulation device.

FIG. 37 is a diagram illustrating a rotational relationship between a movable blade and a sheath with respect to a fixed blade.

FIG. 38 is a view for explaining a rotational relationship of a movable blade, a sheath, and a protective tube with respect to a fixed blade.

FIG. 39 is a perspective view showing the entire twelfth embodiment of the present invention.

FIG. 40 is a sectional view showing the structure on the distal end side inside the sheath.

FIG. 41 is a front view and a sectional view taken along line WW ′ of FIG. 40;

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Grip member 2 ... Screw 3 ... Movable part 4 ... Protective member 5, 10 ... Transmission member 6 ... Tip cover 7 ... Tip member 8 ... Probe 9, 11, 22 ... Sheath 12 ... Knob 13, 20 ... Coupling member 14, 18 ... Pipe 15, 19 ... Bearing 16, 17 ... Driving member 21 ... Guide sheath 23, 24 ... Ring 25 ... Driving pin 26 ... Driving member 27, 28 ... Screw 29 ... Fixed operation handle 30 ... Movable operation handle 31 ... Ultrasonic wave Incision coagulation device 32 ... handpiece 33 ... treatment section 34 ... operating means 38 ... snap fit 39 ... protrusion 40 ... rotation prevention mechanism 41 ... connecting member 42 ... engagement member 43 ... spherical part 45, 47, 48 ... O-ring 50 … Ultrasonic transducer 56… engaging groove 57… insertion part

──────────────────────────────────────────────────続 き Continued on front page (58) Field surveyed (Int.Cl. ⁷ , DB name) A61B 18/00

Claims (8)

(57) [Claims] 1. An ultrasonic transducer for generating ultrasonic vibration, a probe connected to the ultrasonic transducer and transmitting the ultrasonic vibration, a holding member that can be opened and closed with respect to the probe, and the holding Operating means for operating the opening / closing operation of the member, and capable of moving back and forth with respect to the probe, and
Rotable with respect to the operation means with the extension direction as the rotation axis
The gripping member is provided in accordance with the operation of the operating means.
A driving means for driving the driving means, and the probe rotates the driving means with respect to the operating means.
The probe and the drive so as to rotate coaxially with the turning axis.
A coupling member that engages with the means and integrally couples with the operating means;
The gripping member and the drive so as to rotate coaxially with the rotation axis.
Ultrasonic dissection coagulation apparatus characterized by comprising a connecting member for connecting the unit. 2. An ultrasonic transducer for generating ultrasonic vibration, and connected to said ultrasonic transducer for transmitting said ultrasonic vibration.
Probe, a gripping member that can be opened and closed with respect to the probe , operating means for operating the opening and closing operation of the gripping member ,
Rotable with respect to the operation means with the extension direction as the rotation axis
The gripping member is provided in accordance with the operation of the operating means.
A driving means for driving the driving means, and the probe rotates the driving means with respect to the operating means.
The probe and the drive so as to rotate coaxially with the turning axis.
A coupling member that engages with the unit and integrally couples the driving member, and a driving force of the driving unit that can be transmitted to the gripping member.
And the driving means together with the gripping member with respect to the operating means.
A transmission member rotatable coaxially with a rotation axis of the moving means . 3. The apparatus according to claim 2 , wherein said driving means is connected to move back and forth.
And is rotatably supported with respect to the operating means.
And a pipe joined to the coupling means.
The ultrasonic incision coagulation apparatus according to claim 1 or 2, wherein: 4. A rotation angle of said driving means is substantially fixed.
Claims comprising fixing means for performing
Item 7. An ultrasonic incision coagulation device according to any one of Items 1 to 3
Place. 5. An ultrasonic vibrator for generating ultrasonic vibration, and connected to said ultrasonic vibrator for transmitting said ultrasonic vibration.
And a probe connected to the probe and
A gripping member that can be opened and closed , operating means for operating the opening and closing operation of the gripping member, and the operating means with the extending direction of the probe as a rotation axis.
The probe and the grip
A handpiece rotatable with respect to the operating means together with a member
With respect to the probe, and the handpiece
Rotatable with respect to the operating means, coaxially with the rotation axis of the motor.
And the operation of the operating means is applied to the gripping member.
An ultrasonic incision coagulation device comprising: a transmission member capable of transmitting . 6. An ultrasonic vibration is generated by being fixed at a predetermined position.
An ultrasonic transducer to be transmitted, a probe for transmitting the ultrasonic vibration, a gripping member that can be opened and closed with respect to the probe, and having a positional relationship fixed with the probe,
Operating means for operating the opening / closing operation of the gripping member, capable of moving back and forth with respect to the probe, and
The operating direction and the probe are
The operation means is provided so as to be rotatable.
A rotor that can be transmitted to a holding member, and wherein the gripping member is
The gripping member is engaged with the probe so as to rotate.
And a connecting member for integrally connecting the ultrasonic incision and coagulation device. 7. An ultrasonic vibration is generated by being fixed at a predetermined position.
An ultrasonic vibrator, a probe transmitting the ultrasonic vibration, a gripping member that can be opened and closed with respect to the probe, and a positional relationship fixed to the probe;
Operating means for operating the opening and closing operation of the material, and capable of moving back and forth with respect to the probe, and
The operating direction and the probe are
The operation means is provided so as to be rotatable.
A rotor that can be transmitted to a holding member, and the operating unit and the probe share the gripper.
The operation of the rotor is provided on the gripping portion.
An ultrasonic incision coagulation apparatus, comprising: 8. An ultrasonic vibrator for generating ultrasonic vibration, and a probe connected to said ultrasonic vibrator and transmitting ultrasonic vibration.
A lobe, a gripping member that can be opened and closed with respect to the probe, and a fixed positional relationship with the probe,
Operating means for operating the opening and closing operation of the gripping member, and the center axis in the extending direction of the probe as a rotation axis;
Hold the gripping member relative to the operating means and the probe
An ultrasonic incision coagulation device, comprising: a rotation mechanism configured to perform a rotation .