JP4253605B2 - Ultrasonic treatment device - Google Patents

Description

  The present invention relates to an ultrasonic treatment instrument that performs treatment such as incision or coagulation of a living tissue using ultrasonic waves.

  Conventionally, this type of ultrasonic treatment device is known in Patent Document 1 (Japanese Patent Laid-Open No. 2001-8493). Such a conventional ultrasonic treatment instrument includes a long insertion portion for insertion into a body cavity and an operation portion for an operator to hold and operate. A probe having a treatment section at the tip is disposed from the operation section to the insertion section. The operation unit is provided with a vibrator that generates ultrasonic vibrations having a frequency of about 20 kHz to 60 kHz. The ultrasonic vibration generated by the vibrator is transmitted to the distal treatment section via the probe, and treatment such as incision and coagulation of the living tissue is performed. The probe is required to transmit ultrasonic vibrations efficiently and at the same time have a predetermined strength. For this reason, a rod-shaped member made of a Ti alloy or the like having a certain degree of rigidity has been used for the probe.

On the other hand, a flexible member is used for the insertion portion of the ultrasonic treatment tool known in Patent Document 2 (Japanese Patent Publication No. 2001-502216). Thus, in the kind of ultrasonic treatment instrument provided with a flexible insertion part, it is set as the flexible rod member of the type arrange | positioned in the insertion part to the probe which transmits ultrasonic vibration. There is also a type in which a small vibrator is attached to the distal end portion of the insertion portion in order to avoid a reduction in vibration transmission efficiency in the case of using a flexible rod member.
JP 2001-8493 A JP-T-2001-502216

  In any of the above-described types of ultrasonic treatment tools for performing surgical operations such as incision or coagulation, it is necessary to use different probes with different shapes of the distal treatment section depending on the type and situation of the treatment target section. For this reason, it is necessary to replace the entire treatment instrument for each operation unit or to perform a troublesome replacement work for reassembling the probe to the vibrator.

  In an endoscopic surgical operation, a cylinder called a trocar is punctured into a body wall, and a treatment tool is inserted into the cylinder to perform the operation. For this reason, it exists in the situation where the freedom degree of the treatment tool is restrict | limited especially. Moreover, it may be difficult to treat depending on the surgical site, and a structure in which the insertion tip is curved has been desired.

  However, as described above, in the ultrasonic treatment instrument in which the probe is rigid and has a rod shape, it is structurally difficult to provide a bending mechanism in the middle of the insertion portion. In addition, in an ultrasonic treatment instrument of a type having a flexible insertion portion with no rigidity, there is a disadvantage that the transmission efficiency of ultrasonic vibration is reduced as a result of using a flexible ultrasonic transmission rod. there were.

  Conventionally, ultrasonic vibration having a frequency of about 20 kHz to 60 kHz has been given, but in order to obtain a sufficient therapeutic effect in this frequency range, it is necessary to enlarge the piezoelectric element. There is a drawback that the operation section to be incorporated is enlarged. On the other hand, when the vibrator is made small, there is a drawback that the therapeutic effect is lowered.

  Further, the type in which the vibrator is directly attached to the distal end portion of the insertion portion has the following drawbacks. That is, in order to increase the vibration efficiency of the vibrator, the vibrator itself is large, and accordingly, the outer diameter of the insertion portion needs to be increased. There is a drawback that the outer diameter of the insertion portion cannot be reduced because the treatment capability is not lowered.

  The present invention has been made paying attention to the above-described problems, and an object of the present invention is to provide an ultrasonic treatment instrument for a surgical operation that is more user-friendly and excellent in operability.

The invention according to claim 1 is a gripping portion gripped by an operator, an insertion portion connected to the gripping portion and one end, a vibrator mounting portion provided at the other end of the insertion portion, and the vibrator A mounting unit and a detachable probe unit ;
The probe unit is connected to the vibrator that generates vibration at a vibration frequency of 100 kHz or more, transmits ultrasonic vibration generated by the vibrator, and directly contacts the living tissue. An ultrasonic treatment instrument comprising: a treatment portion that performs the above treatment; and a terminal that electrically connects the vibrator to the vibrator attachment portion .

The invention according to claim 2 is the ultrasonic treatment instrument according to claim 1, wherein the vibration frequency of the vibrator is 100 kHz or more and 200 kHz or less .

According to a third aspect of the present invention, there is provided a detecting means for electrically detecting a mounting state of the probe unit when the probe unit is positioned and held on the vibrator mounting portion. The ultrasonic treatment device according to claim 2.

According to a fourth aspect of the present invention, when the probe unit is positioned and held on the vibrator mounting portion, the detection means is in a state where the electrode terminal of the probe unit comes into contact with the conductive portion of the insertion portion and becomes conductive. The ultrasonic treatment instrument according to claim 3, wherein an electrical impedance is detected to detect a mounting state of the probe unit .
According to a fifth aspect of the present invention, a gripping member that can be opened and closed facing the treatment portion is attached to the other end of the insertion portion, and the gripping member is opened and closed by an operating portion provided in the gripping portion. The ultrasonic treatment device according to any one of claims 1 to 4, wherein the ultrasonic treatment device is provided.

  ADVANTAGE OF THE INVENTION According to this invention, the ultrasonic treatment tool for surgical operations with sufficient operativity can be provided.

  An embodiment of the present invention will be described. As shown in FIG. 1, an ultrasonic treatment instrument 1 according to this embodiment includes a long insertion portion 2 that can be inserted into a body cavity, and an operation portion 3 that serves as a hand portion that can be held by a surgeon. And a probe unit 6 including a small vibrator 5 attached to the distal end of the insertion portion 2 of the handpiece unit 4.

  As shown in FIG. 1, the operation part 3 of the handpiece unit 4 forms a gripping part by a substantially cylindrical case member 3a, so that the handpiece unit 4 can be held by gripping this part by hand. It has become. A connection cord 7 for supplying a high-frequency current from a power supply device (not shown) is attached to the rear end of the operation unit 3.

  As shown in FIGS. 2A and 2B, the insertion portion 2 includes a metal rod 10 disposed at the axial center thereof, and a first electrically insulating tube 11 disposed outside the metal rod 10. And a metal pipe 12 disposed outside the first electrically insulating tube 11 and a second electrically insulating tube 13 disposed outside the metal pipe 12. These layers constitute a coaxial cable-like structure.

  A vibrator mounting portion 9 for detachably attaching the probe unit 6 to the probe unit 6 is fitted to the distal end portion of the insertion portion 2. The vibrator mounting portion 9 has the following structure. That is, as shown in FIGS. 2A and 2B, a hole 10a is provided at the tip of the metal rod 10, and the rear end portion of the vibrator 5 in the probe unit 6 is provided in the hole 10a. Is fitted relatively loosely. The distal end portion 11a of the first electrically insulating tube 11 located outside the metal rod 10 extends beyond the distal end of the metal rod 10 located inside thereof, and the distal end portion 12a of the metal pipe 12 is located inside thereof. The first electrically insulating tube 11 positioned extends beyond the tip. The tip of the second electrically insulating tube 13 extends beyond the tip of the metal pipe 12. A proximal end portion of a cylindrical electrically insulating distal end cap 14 is fitted into the distal end portion 13 a of the second electrically insulating tube 13, and the proximal end of the distal end cap 14 is connected to the metal pipe 12. The tip cap 14 is positioned by abutting against the tip. The tip cap 14 is fixedly attached to the second electrically insulating tube 13.

  The thickness of the proximal end portion of the distal end cap 14 fitted in the second electrically insulating tube 13 is as shown in FIG. 2B except for a part in the circumferential direction shown in FIGS. Further, it is formed to be equal to the thickness of the metal pipe 12. That is, as shown in FIG. 3, in the proximal end portion of the distal end cap 14, only the upper and lower portions are formed thicker than the other portions, and the thickness portion 2 is located at the distal end of the metal pipe 12. Two steps are formed. The two step end face portions serve as locking portions 15 for locking the probe unit 6 as described later.

  As shown in FIG. 2A, holes 16 used for inserting a tool when the probe unit 6 is removed from the insertion portion 2 are provided at two locations on the side wall of the vibrator mounting portion 9. The two holes 16 are provided at positions corresponding to locking pieces of the probe unit 6 described later, and penetrate through both the tip portion 12a of the metal pipe 12 and the second electrically insulating tube 13. Is formed.

  Next, the probe unit 6 will be described. That is, as shown in FIGS. 2 and 4, the probe unit 6 includes a vibrator unit 21 including a small vibrator 5 and a distal treatment section (tip action section) 22 protruding from the distal end of the insertion section 2. . The vibrator unit 21 includes a plurality of piezoelectric elements 25 that convert high-frequency current into ultrasonic vibration, a horn 26 and a back mass 27 having a distal treatment section 22, and a plurality of oscillating units 21 are provided between the horn 26 and the back mass 27. This is an ultrasonic transducer of a type in which a single piezoelectric element 25 is fastened and fixed. Between each piezoelectric element 25, an electrode plate 28 serving as a positive pole and an electrode plate 29 serving as a negative pole are attached.

  As shown in FIG. 4, the common electrode plates 28 and 29 are electrically connected to each other by bridge portions 28 a and 29 a so that the same pole current flows to the same pole side of each piezoelectric element 25. . The last electrode plate 28 is provided with a terminal 28b, and the front electrode plate 29 is provided with a terminal 29b.

  As shown in FIG. 4, when the probe unit 6 is removed from the insertion portion 2, the distance between the tip of the rear terminal 28b and the center of the insertion portion 2 is the inside of the hole 10a of the metal rod 10. It is larger than the radius and larger than the radius of the flange portion 32 described later. Further, the distance between the front end portion of the front terminal 29b and the center of the insertion portion 2 is larger than the inner radius of the metal pipe 12 and larger than the radius of the flange portion 31 described later. For this reason, as shown in FIG. 2, when the vibrator unit 21 is mounted in the insertion portion 2, the tip portion of the terminal 28 b contacts the inner surface of the hole 10 a of the metal rod 10 in the vibrator mounting portion 9 by elastic force. To do. Further, the tip of the terminal 29b contacts the exposed inner surface of the metal pipe 12 by elastic force.

  As shown in FIG. 2, flange portions 31 and 32 are separately provided at two vibration node portions of the vibrator unit 21. The flange portion 31 positioned on the distal end side has a substantially cylindrical shape, but two portions of the peripheral portion corresponding to the locking portion 15 are formed with mutually flat plane portions 31a. That is, only the two portions located above and below corresponding to each of the planar portions 31a are formed on the inner side of the tip cap 14 so as to be partially thicker than the other portions, and the small diameter portion 33 is formed on the planar portion 31a. Engage with. Due to the engagement of both the flat surface portion 31a and the small diameter portion 33, the vibrator unit 21 is prevented from rotating around the axis and positioned in the rotational direction.

  The small diameter portion 33 is smaller than the inner diameter of the metal pipe 12. Therefore, the wall portion of the small-diameter portion 33 is formed thicker than the other wall portions, and the end surface of the small-diameter portion 33 forms a step that is exposed between the metal pipes 12, and the locking portion is formed by the end surface of the step. 15 is formed. As shown in FIG. 2A, in the state where the vibrator unit 21 is assembled in the tip cap 14, the piece-like tip of the terminal 29 b of the vibrator unit 21 is engaged with the locking portion 15. 2A and 2B, the abdomen of the terminal 29b is located facing the hole 16 of the vibrator mounting portion 9.

  On the other hand, when the back mass 27 is fitted into the hole 10a in the metal rod 10, the stepped portion formed in the middle of the hole 10a is formed on the flange 32 located on the proximal side of the piezoelectric element 25. 35, the position of the insertion end of the vibrator unit 21 is determined. The metal rod 10 and the rear end portion of the metal pipe 12 are respectively electrically connected to two electric wires wired in a connection cord 7 (not shown) in the operation unit 3.

  Next, the case where the probe unit 6 having the above configuration is attached to the handpiece unit 4 will be described. First, when the transducer unit 21 side of the probe unit 6 is inserted into the distal end cap 14 of the insertion portion 2 and pushed in until the terminal 29 b passes through the distal end cap 14, the flange portion 32 becomes a step difference in the hole 10 a of the metal rod 10. The terminal 28b hits the portion 35 and extends to the inner diameter of the hole 10a of the metal rod 10 which has become wider, and contacts the inner surface by elastic force. On the other hand, the terminal 29 b comes into contact with the inner surface of the tip end portion of the metal pipe 12 by elastic force and is locked to the locking portion 15. For this reason, the vibrator unit 21 is engaged with the vibrator mounting portion 9 in a state of being positioned.

  The terminal 28b is electrically connected to the metal rod 10, and the terminal 29b is electrically connected to the metal pipe 12. Both terminals 28b and 29b are in a state of being electrically connected to the respective electrical current paths. As a result, high frequency current is supplied to each piezoelectric element 25 through two electric wires (not shown) wired inside the connection cord 7, the metal rod 10, the metal pipe 12, the terminal 28 b, the terminal 29 b, the electrode plate 28, and the electrode plate 29. Is possible. When a high-frequency current is supplied to the piezoelectric element 25, ultrasonic vibration is generated in the vibrator 5 of the vibrator unit 21, and the ultrasonic vibration is transmitted to the distal treatment section 22 as a probe to be treated.

  Further, when the probe unit 6 is attached to the handpiece unit 4, since the terminal 29 b is engaged with the locking portion 15 at the inner end of the tip cap 14, the vibrator unit 21 is moved toward the tip end in the axial direction. The movement is blocked, and the flange portion 32 hits the stepped portion 35 in the hole portion 10a in the metal rod 10, so that the vibrator unit 21 is also restricted from moving toward the proximal end in the axial direction. The radial movement is also restricted by the flange portions 31 and 32. Moreover, since each flange part 31 and 32 is arrange | positioned at the node part of a vibration, especially support stability is favorable.

  Further, when the vibrator unit 21 is attached to the vibrator attachment portion 9, it can be confirmed whether or not the vibrator unit 21 is attached in a predetermined attachment state. This is determined by measuring the electrical impedance of the current path. That is, when the vibrator unit 21 is not mounted in a predetermined state, the terminal 28b or the terminal 29b is not in contact with the corresponding metal rod 10 or metal pipe 12, and the impedance value of the current path is It can be determined by measuring this with the power supply main body.

  On the other hand, when removing the vibrator unit 21 from the handpiece unit 4, it is convenient to use a dedicated disassembly jig 40 as shown in FIG. The dedicated disassembling jig 40 is arranged so that the pins 42 having a diameter smaller than the diameter of the hole 16 of the vibrator mounting portion 9 are opposed to the inner portions of both ends of the U-shaped plate-like member 41 that can be elastically deformed. It is attached.

  Then, as shown in FIG. 5, each pin 42 is inserted into each hole 16 so as to sandwich the distal end portion of the insertion portion 2 with the dedicated disassembly jig 40. Then, the terminal 29b is deformed inward and is disengaged from the engaging portion 15, so that the vibrator unit 21 can move in the distal direction. For this reason, the probe unit 6 can be pulled out from the handpiece unit 4 and removed.

  The frequency of the ultrasonic vibration used in the present embodiment is particularly 100 kHz or more, and preferably a frequency close to 200 kHz. Thus, since the frequency is 100 kHz or more, the vibrator unit 21 can be downsized without deteriorating the treatment function. Further, the interval between the flange portions 31 and 32 provided corresponding to the two vibration node portions of the vibrator unit 21 can be reduced, and the vibrator unit 21 can be more compactly attached by the plurality of flange portions 31 and 32. Can do.

  6, 7 and 8 show variations of the probe unit 6 in which the shape of the distal treatment section 22 is different. The probe unit 6 shown in FIG. 6 has a distal treatment portion 22 formed in a hook shape. The probe unit 6 shown in FIG. 7 has a distal treatment section 22 formed in a knife shape. The probe unit 6 shown in FIG. 8 has a distal treatment section 22 formed in a spherical shape.

  Moreover, in this embodiment, it is applicable also to the handpiece unit 4 of the type which provided the curved part 45 in the middle of the elongate insertion part 2 as shown in FIG. The handpiece unit 4 is provided with a knob 46 for bending the bending portion 45 to the operation portion 3 attached to the proximal end portion of the insertion portion 2, and the rotation operation is performed by rotating the knob 46. The bending portion 45 can be bent in conjunction with the movement.

  In each configuration described above, a unit having a bipolar treatment function may be attached and used instead of the vibrator unit 21. In this case, it is possible to function as a normal bipolar treatment instrument by flowing a high-frequency current using two poles in the vibrator mounting portion 9.

  FIG. 10 shows an ultrasonic coagulation / cutting device 50 having a distal treatment section 22 that grasps a living tissue and performs coagulation / cutting by ultrasonic vibration. The probe unit 6 as described above is attached to the distal end of the insertion portion 51 of the ultrasonic coagulation / cutting device 50, and the distal end of the insertion portion 51 faces the distal treatment portion 22 of the transducer unit 21 of the probe unit 6. Then, a gripping member 52 that opens and closes is rotatably attached. In addition, an operation portion 54 having a handle 53 for opening and closing the gripping member 52 is provided at the proximal end portion of the insertion portion 51. A living tissue is sandwiched between the gripping member 52 and the distal treatment section 22 and coagulated and incised by ultrasonic vibration.

The operation unit 54 is provided with a knob 55 for rotating the insertion unit 51 about its axis.
Further, the operation unit 54 is provided with a power supply terminal 56, and is constructed so as to supply a high frequency current to the probe unit 6 through the power supply terminal 56 as described above. Treatment can also be performed at the same time.

  Also, what is shown in FIG. 11 is one in which a bending portion 57 is provided in the vicinity of the distal end of the insertion portion 51 of the ultrasonic coagulation / cutting device 50. The operation portion 54 is provided with a knob 58 for bending the bending portion 57 as in the handpiece unit shown in FIG.

  According to the above-described embodiment, the size of the vibrator is smaller than the outer diameter (φ12 mm or less) of the insertion portion of the treatment instrument used in endoscopic surgery by using ultrasonic vibration having a frequency exceeding 100 kHz. The vibrator unit is made detachable at the distal end of the insertion portion.

  This transducer unit has a distal treatment section, and creates a treatment section unit integrated with a horn section for transmitting ultrasonic vibration to the distal treatment section while amplifying ultrasonic vibration. This makes it easy to replace the tip treatment shape. In addition, since the operation unit is not affected by the size of the vibrator as in the prior art, it can be created in a shape with good operability. Further, it is possible to provide a curved portion in the middle of the elongated insertion portion in the case of endoscopic surgery. When such a unit is detachable at the tip, the mounting state can be confirmed by detection of electrical impedance.

  In addition, this invention is not limited to the thing of the form mentioned above. Moreover, according to what was mentioned above, the following matters are obtained. It is also possible to appropriately combine items from different groups.

1. A handpiece unit having a vibrator unit for generating ultrasonic vibration, a vibrator unit integrally provided with a horn and a distal treatment part, and a long insertion part and an operation part provided at a proximal end part of the insertion part An ultrasonic treatment instrument, wherein the transducer unit is detachably attached to a distal end portion of the insertion portion.
2. 2. The ultrasonic treatment instrument according to claim 1, wherein an outer diameter of the vibrator unit is smaller than an outer diameter of the insertion portion.
3. The ultrasonic treatment instrument according to any one of Items 1 and 2, wherein the transducer unit is detachable from the operation unit on the distal end side.
4). The ultrasonic treatment instrument according to any one of Items 1 to 3, wherein an electrode portion and a detachable engagement portion of the vibrator unit are integrated.
5. The ultrasonic treatment instrument according to any one of Items 1 to 4, wherein a dedicated jig is required to remove the transducer unit.
6). The ultrasonic treatment instrument according to any one of Items 1 to 5, wherein a bending portion is provided in the insertion portion of the handpiece unit.
7). The ultrasonic treatment instrument according to any one of Items 1 to 6, wherein the attachment state of the transducer unit is detected by electrical impedance.
8). The ultrasonic treatment device according to any one of Items 1 to 7, wherein the ultrasonic vibration is 100 kHz or more.
9. The treatment tool according to claim 1, wherein a treatment unit using a bipolar high-frequency current can be attached to the handpiece unit.
10. The operation portion is provided with a handle portion that can be rotated, and a jaw that opens and closes is attached to the distal end portion of the insertion portion so as to face the distal treatment portion in the vibrator unit. 2. The ultrasonic treatment apparatus according to claim 1, wherein the jaw can be opened and closed in conjunction with the turning operation of the handle, and the vibrator unit is detachably attached.
11. The ultrasonic treatment instrument according to item 9, wherein an outer diameter of the vibrator unit is smaller than an outer diameter of the insertion portion.
12. The ultrasonic treatment instrument according to any one of Items 9 to 10, wherein the vibrator unit is attachable / detachable on the distal end side with respect to the operation unit.
13. The ultrasonic treatment instrument according to any one of Items 9 to 11, wherein an electrode portion and a detachable engagement portion of the vibrator unit are integrated.
14 The ultrasonic treatment instrument according to any one of Items 9 to 12, wherein a dedicated jig is required to remove the transducer unit.
15. The ultrasonic treatment device according to any one of Items 9 to 13, wherein a bent portion is provided in the middle of the insertion portion of the handpiece unit.
16. 15. The ultrasonic treatment instrument according to any one of Items 9 to 14, wherein the attachment state of the transducer unit is detected by electrical impedance.
17. The ultrasonic treatment device according to any one of Items 9 to 15, wherein the ultrasonic vibration is 100 kHz or more.
18. 2. The ultrasonic treatment instrument according to claim 1, wherein a treatment unit using bipolar high-frequency current can be attached to the handpiece unit.
19. 20. The ultrasonic treatment instrument according to any one of items 1 to 19, wherein the transducer unit is engaged with the transducer unit mounting portion of the insertion portion using an electrode terminal of the transducer unit.

1 is an external view showing an entire ultrasonic treatment device according to an embodiment of the present invention. (A) (b) is a longitudinal cross-sectional view of the front-end | tip part of the ultrasonic treatment tool which concerns on the embodiment. It is a cross-sectional view which follows the AA line of Fig.2 (a). It is explanatory drawing of the state which removed the vibrator | oscillator unit of the ultrasonic treatment tool which concerns on one Embodiment of this invention from the handpiece unit. It is explanatory drawing of the use condition of the disassembly jig | tool at the time of removing a vibrator unit in the ultrasonic treatment tool which concerns on one Embodiment of this invention. The shape of the front-end | tip treatment part of the vibrator | oscillator unit of the ultrasonic treatment tool which concerns on one Embodiment of this invention is shown, (a) is the side view, (b) is the top view. The other shape of the front-end | tip treatment part of the vibrator | oscillator unit of the ultrasonic treatment tool which concerns on one Embodiment of this invention is shown, (a) is the side view, (b) is the top view. It is a side view of the thing of still another shape of the tip treatment part of the vibrator unit of the ultrasonic treatment instrument concerning one embodiment of this embodiment. It is an external view which shows the whole ultrasonic treatment tool of the type which provided the bending mechanism in the insertion part as other embodiment of this invention. It is an external view which shows the whole ultrasonic treatment tool provided with the holding part for hold | gripping a tissue to the front-end | tip treatment part and coagulating and incising as other embodiment of this invention. FIG. 10 is an external view showing an entire ultrasonic treatment instrument provided with a grasping portion for grasping tissue and coagulating and incising a tip treatment portion as still another embodiment of the present invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Ultrasonic treatment tool, 2 ... Insertion part, 3 ... Operation part, 4 ... Handpiece unit 5 ... Vibrator, 6 ... Probe unit, 9 ... Vibrator attachment part, 15 ... Locking part 16 ... Hole part, 21 ... vibrator unit, 22 ... tip treatment section, 25 ... piezoelectric element

Claims (5)

A grasping portion grasped by the surgeon;
An insertion part having one end connected to the grip part;
A vibrator mounting portion provided at the other end of the insertion portion;
A probe unit that is detachable from the vibrator mounting portion;
With
The probe unit includes a vibrator that generates vibration at a vibration frequency of 100 kHz or more;
A treatment unit that is connected to the vibrator, transmits ultrasonic vibration generated by the vibrator, and directly treats the living tissue to treat the living tissue;
A terminal for electrically connecting the vibrator to the vibrator mounting portion;
An ultrasonic treatment instrument comprising:   The ultrasonic treatment instrument according to claim 1, wherein a vibration frequency of the vibrator is 100 kHz or more and 200 kHz or less. 3. The ultrasonic wave according to claim 1, further comprising a detection unit that electrically detects a mounting state of the probe unit when the probe unit is positioned and held on the vibrator mounting portion. 4. Treatment tool. When the probe unit is positioned and held on the vibrator mounting portion, the detection means detects an electrical impedance in a state where the electrode terminal of the probe unit is in contact with the conductive portion of the insertion portion and is conductive, and The ultrasonic treatment instrument according to claim 3, wherein the mounting state of the probe unit is detected.   A gripping member that can be opened and closed facing the treatment portion is attached to the other end of the insertion portion, and the gripping member is opened and closed by an operating portion provided in the gripping portion. The ultrasonic treatment instrument according to any one of claims 1 to 4.

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