JP4402313B2 - Surgical treatment tool and surgical treatment apparatus - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a surgical treatment instrument and a surgical treatment apparatus.
[0002]
[Prior art]
As a surgical treatment tool for performing a surgical operation, there is an apparatus shown in the specification of Japanese Patent Application No. 2000-128265.
[0003]
This is because a treatment part provided with a pair of grasping parts for grasping a living tissue and an opening / closing mechanism for opening and closing the grasping part at the distal end of the insertion part, and a state in which the direction of the treatment part is directed straight from side to side. A swing mechanism of the treatment section to be rotated is provided. In addition, an operation unit including a handle for operating the opening / closing mechanism of the treatment unit and a swing operation mechanism for operating the swing mechanism of the treatment unit is provided at the proximal end of the insertion unit. Furthermore, a transmission mechanism is provided between the treatment unit and the operation unit to transmit the operation force on the operation unit side to the treatment unit side.
[0004]
[Problems to be solved by the invention]
However, in this surgical treatment instrument, by operating the operation unit, the opening / closing mechanism and the swing mechanism of the treatment unit are operated using a transmission mechanism that uses a common transmission element, so the two mechanisms interfere with each other, There is a problem that the opening / closing direction and the direction of rotation and the amount of movement thereof are limited. In addition, since the two mechanisms on the distal end side of the insertion portion and the two mechanisms on the proximal end side of the insertion portion are integrally assembled in a narrow area, the configuration becomes complicated, and the durability is low. There was a problem that the washability of the part was low.
[0005]
In addition, when the treatment part of this surgical treatment instrument is swung, the treatment instrument is opened / closed in a state in which the treatment part is opened / closed in a direction that facilitates treatment, unlike when the treatment instrument is straight. There has been a problem that the relative positions of the treatment part and the affected part are shifted.
[0006]
Accordingly, an object of the present invention is to simplify the configurations of the opening / closing mechanism and the swing mechanism, and the opening / closing operation mechanism and the swing operation mechanism, and to improve the operability by increasing the direction and amount of movement of the opening / closing and rotation. The object is to provide a surgical instrument that can be used.
[0007]
Another object of the present invention is to provide a surgical treatment apparatus capable of preventing a relative positional shift from an affected part when the treatment part is opened and closed even when the surgical treatment tool is oriented in an arbitrary direction. There is.
[0008]
[Means for Solving the Problems]
  In order to solve the above problems, the present inventionPertaining toSurgical instruments areDriving means having a distal end portion and a proximal end portion, and a swing mechanism connected to the distal end portion of the driving means and capable of rotating around the direction perpendicular to the axial direction of the driving means at the distal end portion of the driving means A treatment section for treating the affected area, and a swing operation mechanism that is connected to the base end portion of the drive means and is rotatable around the direction orthogonal to the axial direction at the base end portion of the drive means. And an operation section having the operation mechanism, wherein the drive means is advanced and retracted in the axial direction by the rotation operation of the swing operation mechanism, and the swing mechanism is rotated in conjunction with the advance and retreat. To.
[0009]
  The driving means includes an opening / closing wire, and the treatment section includes an opening / closing element that opens and closes the treatment section via the opening / closing wire at a position different from the swing mechanism, and the operation section includes: It is preferable that an opening / closing operation mechanism for operating the opening / closing wire is provided at a position different from the swing operation mechanism.
  With such a configuration, the opening / closing mechanism and the swing mechanism are provided independently in the treatment section and the operation section, respectively, and thus operate without interference. For this reason, restrictions on the amount of rotation and the amount of opening and closing can be relaxed.
[0010]
  In order to solve the above problems,According to this inventionSurgical treatment deviceA long intermediate member; a distal-side deformable portion disposed at a distal end portion of the intermediate member; a proximal-side deformable portion disposed at a proximal end portion of the intermediate member; and the distal-side deformable portion A surgical treatment instrument having a treatment part disposed at a distal end part of the part, and an operation part disposed at a proximal end part of the proximal end side deformable part and operating the treatment part, and the surgical treatment instrument A bending mechanism portion disposed outside the distal-side deformable portion, a bending operation portion disposed outside the proximal-side deformable portion of the surgical treatment instrument, a bending mechanism portion, and the bending operation portion And a guide tube having a tube disposed outside the intermediate member, wherein the bending mechanism portion and the bending operation portion of the guide tube are connected to each other, and the bending operation is performed. The posture of the bending mechanism can be changed in conjunction by changing the posture of the part And wherein.
[0011]
  With this configuration, the guide tube is inserted into the body cavity and the surgical treatment instrument is inserted into the guide tube.In the stateWhen the bending operation unit is rotatedWhen the bending mechanism of the guide tube is deformed in conjunction with itIn both cases, the proximal side deformable part of the surgical instrumentAnd tip side deformable partWith the surgical tool in a deformed stateAround that axisRotate and the affected areaSurgical instrumentsRelative to the treatment sectionMisalignmentIs prevented.
[0012]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, embodiments of the present invention will be described with reference to the drawings.
[0013]
[First Embodiment]
First, a first embodiment will be described with reference to FIG.
[0014]
As shown in FIG. 1, the surgical treatment instrument 2 includes an elongated substantially rod-like rod-shaped portion 8 (intermediate member), a treatment portion 4 that is disposed on the distal end side of the rod-shaped portion 8 and performs a surgical treatment on the affected area, An operation unit 6 is provided on the base end side of the rod-shaped unit 8 and has a mechanism capable of opening / closing and rotating the treatment unit 4. A swing mechanism 10 for swinging the treatment section 4 is disposed on the distal end side of the rod-shaped portion 8, and a swing operation mechanism 12 for operating the swing mechanism 10 is disposed on the proximal end side of the rod-shaped portion 8. Is provided.
[0015]
The rod-shaped portion 8 includes an outer tube 22, and inside the outer tube 22, two drive shafts 18 and a bendable opening / closing operation wire 14 surrounded by a sheath 16 are inserted. These drive shafts 18 can be advanced and retracted inside the outer tube 22.
[0016]
The treatment section 4 includes a treatment section main body 26 (support mechanism). A distal end of the treatment section main body 26 has a pair of gripping portions 28 (opening / closing elements) and a distal end of an opening / closing link 30 that opens and closes the gripping portions 28. Are pivotally attached using rivets 23. The distal end of the sheath 16 is pivotally attached to the proximal end side of the treatment portion main body 26.
[0017]
The operation unit 6 includes a holding unit 36, and a long hole-shaped guide hole 34 that is long in the axial direction is provided on the rear end side of the holding unit 36. One end of a lever 38 (opening / closing operation mechanism) is pivotally attached to the front end side of the holding portion 36 using a rivet 20, and the lever 38 attaches the rivet 20 to the holding portion 36 using a spring 42. The center is normally biased in a direction that rotates in the opening direction. Further, one end of the opening / closing link 40 is pivotally attached to the intermediate portion of the lever 38 using the rivet 20, and the other end of the opening / closing link 40 is interposed via a pin 40 a that slides in the guide hole 34. It is slidably connected.
[0018]
The swing mechanism 10 is provided with a pair of swing links 24 a and 24 b, and the distal ends of the swing links 24 a and 24 b are pivotally attached to the rear end portion of the treatment portion body 26 using the rivet 20, Are pivotally attached to the tips of the two drive shafts 18 using rivets 20 respectively.
[0019]
The hand swing operation mechanism 12 is provided with a pair of swing links 32 a and 32 b and a single link member 33. The tip ends of the swing links 32a and 32b are pivotally attached to the base ends of the two drive shafts 18 using rivets 20, respectively. Further, both ends of the link member 33 are pivotally attached to the base ends of the swing links 32a and 32b using rivets 20, respectively. Near the center of the link member 33, the distal end of the holding portion 36 and the base end of the sheath 16 are pivotally attached using the rivet 20.
[0020]
Further, the distal end of the opening / closing operation wire 14 inserted through the sheath 16 is fixed to the proximal end of the opening / closing link 30, and the proximal end is fixed to a connecting pin 40 a with the guide hole 34 of the opening / closing link 40. .
[0021]
Next, operation | movement of this surgical treatment tool 2 is demonstrated.
[0022]
As shown in FIG. 1B, the lever 38 of the operation portion 6 is gripped against the bias of the spring 42, and the lever 38 is rotated in the closing direction so as to be close to the holding portion 36. Then, the pin 40a of the opening / closing link 40 moves to the rear end side of the holding portion 36 along the guide hole 34, and the opening / closing operation wire 14 is pulled to the rear end side. With the pulling operation of the opening / closing operation wire 14, the opening / closing link 30 of the treatment section 4 is pulled toward the operation section 6, and the gripping section 28 rotates in the closing direction about the rivet 23 via the opening / closing link 30. To do. Conversely, as shown in FIG. 1A, when the lever 38 of the operation unit 6 is released, the lever 42 is rotated in the opening direction to be separated from the holding unit 36 by the force of the spring 42. With the opening operation of the lever 38, the pin 40a of the opening / closing link 40 moves to the distal end side of the holding portion 36 along the guide hole 34, and the opening / closing operation wire 14 is pushed out to the distal end side. Along with the pushing operation of the opening / closing operation wire 14 at this time, the grip portion 28 is rotated in the opening direction about the rivet 23 via the opening / closing link 30 of the treatment portion 4, and the tip of the opening / closing link 30 is gripped. Part 28 opens.
[0023]
When the operation unit 6 is rotated counterclockwise from the position shown in FIG. 1A, the upper swing link 32a of the swing operation mechanism 12 is moved as shown in FIG. The lower swing link 32b on the treatment section 4 side moves to the operation section 6 side, and the drive shaft 18 pivotally attached to the swing links 32a and 32b respectively moves to the treatment section 4 side and the operation section 6 side. Moving. As the drive shaft 18 moves, the rotational force is transmitted to the swing mechanism 10, the upper swing link 24 a of the swing mechanism 10 is on the treatment section 4 side, and the lower swing link 24 b is on the operation section 6 side. Move to. The treatment portion body 26 pivotally attached to the swing links 24a and 24b rotates counterclockwise, and the grip portion 28 provided at the distal end of the treatment portion body 26 faces counterclockwise. Rotate.
[0024]
Therefore, the configuration described above has the following effects. In the present embodiment, in the surgical treatment instrument 2, the rotation operation force of the treatment section 4 is transmitted to the swing mechanism 10 via the drive shaft 18 by the operation of the swing operation mechanism 12 of the operation section 6. . Furthermore, the opening / closing operation force of the treatment unit 4 is transmitted through the opening / closing operation wire 14 by the opening / closing operation of the lever 38 of the operation unit 6. Therefore, since different transmission members are used for opening and closing the grasping portion 28 and swinging the treatment portion 4, the rotation and opening and closing operations of the surgical treatment instrument 2 operate independently without interfering with each other. Further, the opening / closing link 30 and the swing mechanism 10 of the treatment section body 26 are arranged at different positions, and the lever 38 and the swing operation mechanism 12 are arranged at different positions. The swing motion can be operated independently. In addition, since the structure is simpler than the conventional surgical instrument and the number of parts is small, there is an advantage that it is difficult to break and the cost is low.
[0025]
[Second Embodiment]
Next, a second embodiment will be described with reference to FIGS.
[0026]
As shown in FIGS. 2 and 3, the surgical treatment instrument 50 includes an elongated, substantially rod-shaped rod-like portion 56 (intermediate member) and a treatment portion that is disposed on the distal end side of the rod-like portion 56 and performs surgical treatment on the affected area. 52 and an operation portion 54 that is disposed on the proximal end side of the rod-like portion 56 and has a mechanism capable of opening / closing and rotating the treatment portion 52. A swing mechanism 58 that swings the treatment section 52 is disposed on the distal end side of the rod-shaped portion 56, and a swing operation mechanism 60 that operates the swing mechanism 58 is disposed on the proximal end side of the rod-shaped portion 56. Is provided.
[0027]
The rod-shaped portion 56 includes an outer tube 66, and a tubular member 68 is inserted into the outer tube 66. A pair of opposing ears 74 are provided at the distal end of the tubular member 68, and through-holes 72 are drilled in the ears 74. Further, two drive shafts 70 and a bendable opening / closing operation wire 62 surrounded by a sheath 64 are inserted into the tubular member 68. Further, the proximal end portion of the tightly wound coil 110 which is difficult to extend in the longitudinal direction and can be bent is connected to the distal end of the drive shaft 70 by welding. These drive shafts 70 can be advanced and retracted inside the tubular member 68. Further, a pair of U-shaped grooves 76 are provided on the outer peripheral surface of the tubular member 68 at positions facing the circumferential direction. The U-shaped groove 76 extends along the axial direction of the outer tube 66. Further, the other two drive shafts 70 are inserted between the U-shaped groove 76 and the outer tube 66. A proximal end portion of a tightly wound coil 108 that is difficult to extend in the longitudinal direction and is bendable is connected to the distal ends of the drive shafts 70 by welding.
[0028]
As shown in FIG. 2B, the treatment section 52 includes a treatment section main body 90 (support mechanism), and a grip section 92 (opening / closing element) and the grip section 92 are attached to the distal end of the treatment section main body 90. An opening / closing link 94 for opening and closing is pivotally attached. The distal end of the sheath 64 is fixed to the proximal end side of the treatment portion main body 90. Further, a through hole 95 is provided at the proximal end of the treatment portion main body 90.
[0029]
As shown in FIG. 2A, the swing mechanism 58 includes a hollow swing member 84, and a pair of opposing ears 88 are provided at the distal end of the swing member 84, and the proximal end Are provided with a pair of ears 82 facing the positions rotated by 90 ° with respect to the ears 88. These ears 88 and 82 have through holes 86 and 80, respectively.
[0030]
An ear 74 provided at the distal end of the tubular member 68 and an ear 82 provided at the proximal end of the swinging member 84 are pivotally attached to the through holes 72 and 80 so as to be rotatable by rivets 78. ing. Further, an ear 88 provided at the distal end of the swinging member 84 and a through-hole 95 provided at the proximal end of the treatment section main body 90 are pivoted so that the respective through-holes 86 and 95 can be rotated by rivets 78. It is worn.
[0031]
The tip of the closely wound coil 108 is fixed to the outer peripheral surface of the swing member 84. Here, the ears 88 of the swinging member 84 are disposed on the extension line of the closely wound coil 108. The tip of the closely wound coil 110 is fixed to the side wall of the treatment portion main body 90.
[0032]
As shown in FIG. 3, the operation unit 54 includes a sliding tube body 102, and a ring 104 is provided on the rear end side of the sliding tube body 102. The sliding tube 102 is provided with a flange 106 (open / close operation mechanism) that can slide along the sliding tube 102.
[0033]
The swing operation mechanism 60 is provided with four swing links 96 and a cross-shaped control rod 100. A base end of a swing link 96 is pivotally attached to each distal end portion of the control rod 100 using a rivet 98 at each end portion. The leading ends of the swing links 96 are pivotally attached to the base ends of the four drive shafts 70 using rivets 98, respectively. Further, the control rod 100 has a circular hole in the substantially center of the cross shape. In this circular hole, the distal end of the sliding tube 102 and the base end of the sheath 64 are arranged, and the opening / closing operation wire 62 is inserted therethrough. Has been.
[0034]
Further, the distal end of the opening / closing operation wire 62 inserted through the sheath 64 is fixed to the proximal end of the opening / closing link 94, and the proximal end is fixed to the flange 106.
[0035]
Next, operation | movement of this surgical treatment tool 50 is demonstrated.
[0036]
When an index finger and a middle finger are put between the flanges 106, a thumb is put in the ring 104, and the flange 106 is slid along the sliding tube 102 toward the ring 104 side, the flange 106 slides to open and close. The operation wire 62 is pulled toward the ring 104, and the grip portion 92 is rotated in the closing direction via the opening / closing operation wire 62. Further, when the flange 106 is slid in the direction separating from the ring 104, the opening / closing operation wire 62 moves to the treatment section 52 side and is rotated in the direction in which the grasping section 92 is opened.
[0037]
Further, when the thumb placed in the ring 104 is tilted sideways in an arbitrary direction, the control rod 100 tilts sideways. As the control rod 100 is tilted, the swing link 96 is moved to advance and retract the four drive shafts 70. The advancement / retraction of the drive shaft 70 is performed by a swinging operation in which the drive shaft 70 attached to the swing mechanism 58 is advanced / retracted, the tightly wound coils 108, 110 are advanced / retracted, and the treatment portion 52 is rotated sideways. It is.
[0038]
Here, for example, when the drive shaft 70 inserted through the U-shaped groove 76 advances and retreats, the tightly wound coil 108 advances and retreats while curving, so that the swinging member 84 is rotated as shown in FIG. Then, the treatment portion 52 rotates in the same direction as the opening / closing direction of the grip portion 92. On the other hand, when the other two drive shafts 70 advance and retract, the closely wound coil 110 advances and retracts while curving, and therefore, as shown in FIG. The treatment section 52 rotates in a direction substantially perpendicular to the opening / closing direction.
[0039]
Therefore, the configuration described above has the following effects. In the present embodiment, the surgical treatment instrument 50 is transmitted to the treatment unit 52 via the drive shaft 70 and the swing mechanism 58 by an operation of tilting the control rod 100 of the swing operation mechanism 60. Of the treatment section 52 transmitted to the treatment section 52 via the opening / closing operation wire 62 by the swinging movement of the operation section 54 and the slide operation of pulling (adjacent) and releasing (separating) the flange 106 of the operation section 54 with respect to the ring 104. Since the opening / closing operation is transmitted using different transmission members, the rotation and the opening / closing operation of the surgical treatment instrument 50 operate independently without interfering with each other. Further, since the treatment portion main body 90 and the swing mechanism 58 are disposed at different positions, and the slide mechanism of the flange 106 and the swing operation mechanism 60 are disposed at different positions, the opening / closing and swinging of each other can be performed. Each operation can be operated independently. In addition, there is an advantage that the structure is simple, the number of parts is smaller than that of a conventional surgical treatment instrument, and it is difficult to break. Further, since the treatment section 52 can be swung in accordance with the operation of moving the thumb sideways and tilting the control rod 100, the amount of twisting of the wrist can be reduced. Since the shaft for swinging the treatment portion is divided into four drive shafts (rotating shafts), the structure is simple. Furthermore, since the two sets of drive shafts 70 that are advanced and retracted are separated by the U-shaped groove 76 and the sheath 64, there is little interference and sliding resistance is also small. Furthermore, by changing the length of the drive shaft 70 and the flexure of the closely wound coils 108 and 110, the angle of the lateral curve can be changed.
[0040]
By the way, although the grasping forceps are used in the present embodiment, peeling forceps or scissors forceps may be used.
[0041]
[Third Embodiment]
Next, a third embodiment will be described with reference to FIG.
[0042]
This embodiment is a modification of the second embodiment. Hereinafter, the same reference numerals are used for the same members, and detailed description thereof is omitted.
[0043]
As shown in FIG. 4, the surgical treatment instrument 120 includes an elongated substantially rod-shaped rod-shaped portion 122 (intermediate member), a treatment portion 52 that is disposed on the distal end side of the rod-shaped portion 122 and performs a surgical treatment on the affected area, An operation unit 54 that is disposed on the proximal end side of the rod-like part 56 and has a mechanism that can open and close and turn the treatment part 52 is provided. A swing mechanism 124 that swings the treatment section 52 is disposed on the distal end side of the rod-shaped portion 122, and a swing operation mechanism 126 that operates the swing mechanism 124 is disposed on the proximal end side of the rod-shaped portion 122. Is provided.
[0044]
The rod-shaped portion 122 includes an outer tube 66, and four drive shafts 128 and a bendable opening / closing operation wire 62 surrounded by a sheath 64 are inserted into the outer tube 66. These drive shafts 128 can advance and retreat inside the outer tube 66. Also, tightly wound coils 134 and 142 that are difficult to extend in the longitudinal direction and that can be bent are connected to the distal end and the proximal end of the drive shaft 128 by welding.
[0045]
The swing mechanism 124 includes a ball joint 130, and the ball joint 130 has a concave hemispherical surface when viewed from the outer tube 66 side. The diameter of this hemispherical surface is approximately equal to the inner diameter of the outer tube 66. A through-hole 132 through which the opening / closing operation wire 62 and the sheath 64 storing the opening / closing operation wire 62 are inserted is formed at substantially the center of the hemispherical surface of the ball joint 130. The through-hole 132 is greatly opened in a conical shape toward the outer tube 66 side.
[0046]
The ball joint 130 and the outer tube 66 are fitted by fitting portions (not shown). Further, on the outer tube 66 side of the ball joint 130, a coil hole 136 is formed through which the closely wound coils 134 provided at the tips of the four drive shafts 128 are inserted. The tip of the closely wound coil 134 is attached to the hemispherical surface of the ball joint 130.
[0047]
The swing operation mechanism 126 includes a ball joint 138, and the ball joint 138 is formed with a spherical surface on a convex surface when viewed from the outer tube 66. The diameter of this spherical surface is larger than the inner diameter of the outer tube 66. A through-hole 140 through which the opening / closing operation wire 62 and the sheath 64 storing the opening / closing operation wire 62 are inserted is formed at substantially the center of the ball joint 138. The through hole 140 is greatly opened conically toward the operation unit 54.
[0048]
The ball joint 138 and the outer tube 66 are fitted by fitting portions (not shown). In addition, a coil hole 144 is formed on the outer tube 66 side of the ball joint 138 so that the closely wound coils 142 provided at the base ends of the four drive shafts 128 are inserted. The proximal end of the closely wound coil 142 is attached to the spherical surface of the ball joint 138.
[0049]
Since the opening / closing operation of the surgical treatment instrument 120 operates in the same manner as the surgical treatment instrument 50 shown in the second embodiment, the description thereof will be omitted.
[0050]
Further, when the thumb placed in the ring 104 is moved sideways, the ball joint 138 is tilted with the movement, and the four drive shafts 128 are connected via the closely wound coil 142 according to the tilt of the ball joint 138. Advance and retreat. The drive shaft 128 is moved back and forth by swinging the tightly wound coil 134 attached to the swing mechanism 124 so that the treatment section 52 is rotated sideways.
[0051]
Therefore, the configuration described above has the following effects. In the present embodiment, the surgical treatment instrument 120 has the swinging motion of the treatment portion 52 transmitted to the swing mechanism 124 via the drive shaft 128 by the tilting operation of the ball joint 138 of the swing operation mechanism 126. Since the opening / closing operation of the treatment portion 52 transmitted through the opening / closing operation wire 62 is transmitted using different transmission members by the sliding operation of the flange 106 of the operation portion 54, the swing of the surgical treatment instrument 120 is swung. The operation and the opening / closing operation operate independently without interference. Further, the opening / closing link 94 and the swing mechanism 124 of the treatment section main body 90 are arranged at different positions, and the flange 106 and the swing operation mechanism 126 are arranged at different positions. The swing motion can be operated independently. In addition, there is an advantage that the structure is simple, the number of parts is smaller than that of a conventional surgical treatment instrument, and the structure is difficult to break. In particular, in the present embodiment, since the ball joints 130 and 138 are used, the movement of the treatment section 52 becomes smoother than the rotation mechanism using the link mechanism. Since it is constructed with almost no link mechanism or rivets, it is easy to wash. Further, when the treatment portion 52 is rotated by moving the ring 104, since the conical through holes 132 and 140 opened on the rear end side are formed, the opening / closing operation wire 62 is curved but is not easily cut.
[0052]
By the way, the ball joint is not limited to a combination of spherical surfaces formed into a concave surface and a convex surface when viewed from the outer tube 66, but in the closely wound coil so as to further reduce the longitudinal extension of the closely wound coil. A wire may be inserted and both ends of the wire may be welded to the ball joint.
[0053]
[Fourth Embodiment]
Next, a fourth embodiment will be described with reference to FIG.
[0054]
As shown in FIG. 5 (a), the guide tube 150 of the present embodiment preferably includes a stainless steel tube body 152, and a bendable bending mechanism portion 154 is provided at the distal end of the tube body 152. I have. In addition, a bending operation unit 156 is provided at the proximal end of the tubular body 152, and the bending operation unit 156 can bend the bending mechanism unit 154.
[0055]
The tubular body 152 has an inner diameter through which a surgical treatment instrument 190 described later can be inserted, and a pair of opposed ear portions 158 are provided at the distal end of the tubular body 152, and these ear portions 158 have through holes. Is perforated. In addition, a pair of opposed ear portions 160 are provided at the proximal end of the tube body 152, and through holes are drilled in the ear portions 160.
[0056]
Four guide tubes 162, preferably made of polyimide material, are arranged at intervals of approximately 90 ° inside the tube body 152. Inside the guide tubes 162, bending wires 164, which can be bent, which face each other, are arranged. 165 is inserted in such a manner that it can freely advance and retract.
[0057]
The bending mechanism portion 154 includes a hollow swing member 172 and a hollow joint tube 184 provided at the tip of the swing member 172. A pair of opposing ears 176 are provided at the tip of the swing member 172. In addition, a pair of ear portions 168 are provided at the proximal end so as to face the positions rotated by 90 ° with respect to the ear portions 176. Each of the ear portions 176 and 168 has a through hole. Further, a pair of ears 180 is provided at the proximal end of the joint tube 184, and through-holes are drilled in the ears 180, respectively.
[0058]
The swinging member 172 and the joint tube 184 are pivotally attached to the through-holes penetrating the respective ear portions 176 and 180 by using rivets 166. Further, the swinging member 172 and the tubular body 152 are pivotally attached to the through holes that penetrate the respective ear portions 168 and 158 by using rivets 166 so as to be rotatable.
[0059]
The bending operation unit 156 includes a hollow swing member 174 and a hollow joint tube 186 provided at the proximal end of the swing member 174. A pair of opposing ears 178 are provided at the proximal end of the swing member 174. In addition, a pair of ears 170 are provided at the tip so as to face the positions rotated by 90 ° with respect to these ears 178. Each of these ears 178 and 170 has a through hole. Further, a pair of ear portions 182 is provided at the distal end of the joint tube 186, and through holes are respectively drilled in the ear portions 182.
[0060]
The swinging member 174 and the joint tube 186 are pivotally attached to the through-holes penetrating the respective ear portions 178 and 182 by using rivets 166. Further, the swinging member 174 and the tubular body 152 are pivotally attached to the through-holes penetrating the respective ear portions 170 and 160 using rivets 166 so as to be rotatable.
[0061]
The pair of opposed drive shafts 164 extend along ears 158 and 160 provided at both ends of the tube body 152. Both ends of the drive shaft 164 are attached to the distal ends and proximal ends of the joint tubes 184 and 186, respectively. Further, the other pair of opposed drive shafts 165 extend so that the positions of the drive shafts 165 on the extension lines are along the ear portions 176 and 178 of the swinging members 172 and 174, respectively. Both ends of the drive shaft 165 are attached to the inner walls of the swing members 172 and 174.
[0062]
As shown in FIG. 5B, the surgical treatment instrument 190 includes a long outer tube 192 and a bellows-like serpentine tube 194 at the distal end of the outer tube 192. A treatment portion 198 is provided at the distal end of the serpentine tube 194.
[0063]
In addition, a bellows-shaped bellows tube 200 is provided at the base end of the outer tube 192, and an operation unit 204 is provided at the base end of the bellows tube 200. These serpentine tubes 194, 200 can be deformed in an arbitrary direction. The serpentine tubes 194, 200 are not shown, but a stainless steel mesh tube is coated on a steel strip spiral tube, and a flexible rubber material (for example, polyurethane) is melted on the mesh tube, and the serpentine tube 194 is melted. , 200 are integrally formed with the outer tube 192.
[0064]
When the surgical instrument 190 is inserted through the guide tube 150, the snake tube 194 corresponds to the bending mechanism portion 154, and the snake tube 200 corresponds to the bending operation portion 156.
[0065]
A bendable opening / closing operation wire (not shown) is inserted into the outer tube 192, and the opening / closing operation wire is surrounded by a sheath (not shown). The opening / closing operation wire is slidable inside the sheath.
[0066]
The treatment portion 198 includes a treatment portion main body 195 and a grip portion 196 provided at the distal end of the treatment portion main body 195.
[0067]
The operation unit 204 includes a handle 202. The handle 202 includes a movable handle 202a and a fixed handle 202b. The handles 202a and 202b are pivotally supported at a pivot point 203. The operation unit 204 is provided with a cleaning port 206 for introducing a cleaning liquid for cleaning the inside of the surgical treatment instrument 190.
[0068]
The open / close operation wire has a distal end fixed to the treatment portion main body 195 and a proximal end fixed to the pivot point 203 of the handle 202 of the operation portion 204. When the handle 202 is opened, the grip portion 196 is also opened, and when the handle 202 is closed, the grip portion 196 is also closed. The opening / closing operation wire is formed and connected with a sufficient length so that the opening / closing operation wire is not pulled and the gripping portion 196 is not opened / closed even if the serpentine tubes 194, 200 are curved.
[0069]
Next, the operation when the surgical treatment tool 190 is inserted into the guide tube 150 to form a surgical treatment apparatus will be described.
[0070]
The bending mechanism 154 and the tube body 152 of the guide tube 150 are inserted and fixed in the body cavity, and the surgical treatment instrument 190 is inserted into the guide tube 150. When the handle 202 of the operation unit 204 is opened and closed, the treatment unit 198 is opened and closed by pulling and releasing the opening / closing operation wire.
[0071]
When the bending operation unit 156 that is not inserted into the body cavity is rotated, the bending mechanism unit 154 is rotated in the direction opposite to the bending operation unit 156 by the rotation wires 164 and 165. Further, as the bending mechanism portion 154 and the bending operation portion 156 rotate, the serpentine tubes 194 and 200 of the surgical treatment instrument 190 are deformed. Further, when the surgical instrument 190 is rotated in this state, the serpentine tubes 194 and 200 are rotated while being deformed along the state where the guide tube 150 is rotated.
[0072]
Therefore, the configuration described above has the following effects. In the present embodiment, when the surgical treatment instrument 190 is rotated in a state where the bending mechanism unit 154, the bending operation unit 156, and the serpentine tubes 194, 200 are rotated, the serpentine tubes 194, 200 are freely movable along with the rotation. Therefore, the relative positional relationship between the affected part and the treatment part 198 does not change. For this reason, it is easy to control the opening and closing direction of the gripping portion 196, and the treatment performance can be improved. Further, since the rotation operation and the opening / closing operation are made independent of each other by the guide tube 150 and the surgical treatment instrument 190, the structure can be simplified.
[0073]
By the way, the surgical treatment instrument 190 is provided with an outer tube 192, and the distal and proximal ends of the outer tube 192 are provided with snake tubes 194 and 200. However, the outer tube 192 is excluded and the erection tubes 194 and 200 are provided. May be integrated.
[0074]
In addition, the operation unit 204 is not provided with a mechanism for performing a rotation operation, but may be provided with a mechanism for rotating the treatment unit as described in the first to third embodiments. . Further, the number of swinging members 172 and 174 and joint tubes 184 and 186 provided at both ends of the tube body 152 is not limited to one as in this embodiment, and it is desired to increase the radius of rotation. In this case, the number of the swinging members 172, 174, the articulated tubes 184, 186 may be increased and rotated. Further, the treatment section 198 of the surgical treatment instrument 190 is not limited to the gripping section 196 (gripping forceps) as shown in FIG. 5B, and a biopsy forceps, a high-frequency treatment tool, or the like may be used.
[0075]
In addition, since the surgical treatment instrument 190 is provided with a cleaning port 206, cleaning inside the surgical treatment instrument 190 is easy. Furthermore, the inside of the guide tube 150 can be easily cleaned.
[0076]
[Fifth Embodiment]
Next, a fifth embodiment will be described with reference to FIG.
[0077]
The guide tube 210 of the present embodiment is a modification of the guide tube 150 shown in the fourth embodiment. As shown in FIG. 6, the guide tube 210 includes a tube body 212, a first loosely wound coil 214 (bending mechanism) disposed at one end of the tube body 212, and the other end of the tube body 212. And a second sparsely wound coil 216 (bending operation unit). The first and second sparsely wound coils 214 and 216 are provided so as to be rotatable around the tube body 212 of the guide tube 210, respectively.
[0078]
The tubular body 212 is preferably made of a polyetherimide resin material that is hard and slippery and has autoclave resistance, and the tubular body 212 and the insertion hole 220 are integrally formed. The rotating wire 218 is preferably coated on the surface with a polytetrafluoroethylene resin material in order to prevent contamination and improve sliding.
[0079]
The tube body 212 is provided with insertion holes 220 of the rotation wire 218 every 90 ° along the longitudinal direction. The rotation wire 218 is inserted into and extends through the insertion holes 220.
[0080]
The first and second sparsely wound coils 214 and 216 are each formed in a spiral shape. On the outside of the first and second sparsely wound coils 214 and 216, a rotating wire 218 is fixed at each intersection.
[0081]
Next, the operation when the surgical treatment instrument 190 shown in FIG. 5B is inserted into the guide tube 210 to form a surgical treatment apparatus will be described.
[0082]
The first loosely wound coil 214 and the tube body 212 of the guide tube 210 are inserted and fixed in the body cavity, and the surgical treatment instrument 190 is inserted into the guide tube 210.
[0083]
Further, when the second loosely wound coil 216 that is not inserted into the body cavity is rotated, the first loosely wound coil 214 is rotated in the opposite direction to the second loosely wound coil 216 by the turning wire 218. . Further, as the first and second sparsely wound coils 214 and 216 rotate, the serpentine tubes 194 and 200 of the surgical treatment instrument 190 rotate.
[0084]
Further, when the surgical instrument 190 is rotated in this state, the serpentine tubes 194 and 200 are rotated while being deformed along the state where the guide tube 210 is rotated.
[0085]
Therefore, the configuration described above has the following effects. In the present embodiment, when the surgical treatment instrument 190 is rotated with the first and second sparsely wound coils 214 and 216 and the serpentine tubes 194 and 200 being rotated, the serpentine tubes 194 and 200 are brought into this rotation. Accordingly, the relative positional relationship between the affected part and the treatment part 198 does not change. For this reason, it is easy to control the opening and closing direction of the gripping portion 196, and the treatment performance can be improved. Further, since the rotation operation and the opening / closing operation are made independent of each other by the guide tube 210 and the surgical treatment instrument 190, the structure can be simplified. Further, according to the present embodiment, the number of parts of the guide tube 210 can be suppressed, and the cost is low.
[0086]
By the way, although the present embodiment has been described using the loosely wound coils 214 and 216, the serpentine tubes shown in the fourth embodiment may be used instead of the loosely wound coils 214 and 216.
[0087]
Although several embodiments have been specifically described so far with reference to the drawings, the present invention is not limited to the above-described embodiments, and all the embodiments performed without departing from the scope of the invention are not limited thereto. Including implementation.
[0088]
Therefore, the following can be said about the first to fifth embodiments.
[0089]
(1) The surgical treatment instrument operates independently without interfering with the swinging and opening / closing operations.
[0090]
(2) The structure is simple and difficult to break, and the number of parts can be reduced as compared with a conventional surgical treatment instrument, so that the cost can be reduced.
[0091]
(3) In the above (2), when a surgical instrument such as a scissor forceps, biopsy forceps, etc. that cuts the tissue cutting function is used, it can be made disposable.
[0092]
(4) In the surgical treatment apparatus, when the surgical treatment instrument is rotated in a state in which the guide tube provided with the rotation wire is rotated, the swivel connected to the surgical treatment instrument is pivotable. Since the mechanism is deformed as the surgical treatment tool rotates, the relative positional relationship between the affected area and the treatment area does not change.
[0093]
(5) In the above (4), it is possible to improve the treatment performance by adjusting the opening / closing direction of the treatment portion by rotating the surgical treatment tool.
[0094]
(6) By providing a cleaning port in the surgical treatment instrument, the inside of the surgical treatment instrument can be easily cleaned.
[0095]
(7) Since the guide tube can easily pass running water, it is easy to wash.
[0096]
According to the above description, the following matters can be obtained. Combinations of the terms are also possible.
[0097]
[Appendix]
1. An openable / closable opening / closing element is provided, and a treatment section for performing surgical treatment on the affected area by opening / closing the opening / closing element is disposed at a distal end portion of a long intermediate member. A support mechanism that supports the head and a swing mechanism that supports the orientation of the treatment unit so as to be changeable with respect to the distal end of the intermediate member;
In a surgical treatment instrument in which an opening / closing operation mechanism for opening / closing an opening / closing element of the treatment portion and a swing operation mechanism for operating the swing mechanism are incorporated at the proximal end of the intermediate member,
The support mechanism and the swing mechanism on the treatment section side are respectively arranged at different positions along the axial direction of the intermediate member,
A surgical treatment tool, wherein the opening / closing operation mechanism and the swing operation mechanism on the proximal end side of the intermediate member are arranged at different positions along the axial direction of the intermediate member.
[0098]
2. The surgical treatment instrument according to appendix 1, wherein the swing mechanism and the swing operation mechanism are connected by a rod-shaped drive shaft.
[0099]
3. The surgical treatment instrument according to appendix 1, wherein the swing mechanism and the swing operation mechanism are connected by a bendable wire.
[0100]
4). The surgical treatment tool according to any one of additional items 1 to 3, wherein the support mechanism and the opening / closing operation mechanism are connected by a bendable wire.
[0101]
5. The surgical treatment tool according to any one of additional items 1 to 4, wherein the support mechanism, the swing mechanism, the opening / closing operation mechanism, and the swing operation mechanism are link mechanisms.
[0102]
6). The surgical instrument according to any one of items 1 to 5, wherein the swing mechanism and the swing operation mechanism are ball joints.
[0103]
7). The surgical treatment instrument according to any one of appendices 1 to 5, wherein the swing mechanism and the swing operation mechanism are a hollow swing member or a joint tube.
[0104]
8). A surgical treatment tool in which a treatment part for performing a surgical treatment on an affected part is disposed at a distal end of a long intermediate member, and an operation mechanism for operating the treatment part is disposed at a proximal end of the intermediate member, and the surgical treatment tool A guide tube through which the treatment tool can be inserted,
A deformable portion that can be flexibly deformed is disposed at least at both ends of the intermediate member in the surgical treatment instrument;
A bending mechanism portion that can bend in any direction at a portion corresponding to the deformable portion on the front side of the surgical treatment instrument in the guide tube, and the deformable portion on the rear side of the surgical treatment instrument in the guide tube. A surgical treatment apparatus, wherein a bending operation section for bending the bending mechanism section is disposed in a corresponding portion.
[0105]
9. 9. The surgical treatment apparatus according to appendix 8, wherein the treatment section and the operation section are connected to a tubular body via a bellows-shaped snake tube in which a flexible resin is coated on a spiral tube and a mesh tube, respectively. .
[0106]
10. The surgical treatment apparatus according to appendix 9, wherein the serpentine tube is made of a rubber material.
[0107]
11. The surgical treatment apparatus according to any one of additional items 8 to 10, wherein the tubular body is formed of a stainless material.
[0108]
【The invention's effect】
As described above, according to the present invention, the configurations of the opening / closing mechanism and the swing mechanism, the opening / closing operation mechanism and the swing operation mechanism are simplified, and the opening / closing and turning directions and the amount of movement are increased. A surgical treatment instrument that can enhance operability can be provided.
[0109]
In addition, according to the present invention, it is possible to provide a surgical treatment apparatus that can prevent a relative position shift from an affected part when the treatment part is opened and closed even when the surgical treatment tool is oriented in an arbitrary direction. it can.
[Brief description of the drawings]
1A and 1B show an overall configuration of a surgical treatment instrument according to a first embodiment, wherein FIG. 1A is a side view showing a state where a treatment unit is opened and the surgical treatment instrument is straightened, and FIG. The side view which shows the state which closed the part and rotated the surgical treatment tool.
FIG. 2 shows a front portion of a surgical treatment instrument according to a second embodiment, wherein (a) is a partial exploded view of a swing mechanism that is pivotally connected between a treatment section and a mantle tube. Exploded perspective view, (b) is a side view showing a state in which the treatment section is rotated in the same direction as the opening / closing direction of the gripping section, and (c) is a rotation of the treatment section in a direction perpendicular to the opening / closing direction of the gripping section. The side view which shows the state made to move.
FIG. 3 is a perspective view showing an oscillating operation mechanism that shows a rear portion of the surgical treatment instrument according to the second embodiment and is rotatably connected between an outer tube and an operation unit.
FIG. 4 is a cross-sectional view of a surgical treatment instrument according to a third embodiment.
5A and 5B show a surgical treatment apparatus according to a fourth embodiment, wherein FIG. 5A is a cross-sectional view of a guide tube, and FIG.
FIG. 6 is a perspective view of a guide tube according to a fifth embodiment.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 4 ... Treatment part, 6 ... Operation part, 8 ... Bar-shaped part, 10 ... Swing mechanism, 14 ... Opening / closing operation wire, 18 ... Drive shaft, 24a, 24b ... Turning link, 30 ... Opening / closing link, 52 ... Treatment part 54 ... Operation part 56 ... Bar-shaped part 58 ... Swing mechanism 62 ... Opening / closing operation wire 70 ... Drive shaft 94 ... Link for opening / closing 128 ... Drive shaft

Claims (3)

Drive means having a distal end and a proximal end;
A treatment section that is connected to the distal end portion of the drive means and has a swing mechanism that can rotate around the direction perpendicular to the axial direction of the drive means at the distal end portion of the drive means;
An operation unit having a swing operation mechanism coupled to a base end portion of the drive means and capable of rotating around the direction orthogonal to the axial direction at the base end portion of the drive means;
Comprising
The surgical instrument according to claim 1, wherein the driving means is advanced and retracted in the axial direction by the rotation operation of the swing operation mechanism, and the swing mechanism is rotated in conjunction with the advance and retreat . The driving means has an open / close wire,
The treatment portion has an opening / closing element that opens and closes the treatment portion via the opening / closing wire at a position different from the swing mechanism,
The operation unit has an opening / closing operation mechanism for operating the opening / closing wire at a position different from the swing operation mechanism.
The surgical treatment instrument according to claim 1, wherein A long intermediate member; a distal end deformable portion disposed at a distal end portion of the intermediate member; a proximal end deformable portion disposed at a proximal end portion of the intermediate member; and the distal end deformable portion A surgical treatment instrument having a treatment portion disposed at a distal end portion of the portion, and an operation portion disposed at a proximal end portion of the proximal end side deformable portion and operating the treatment portion;
A bending mechanism portion arranged outside the distal-side deformable portion of the surgical treatment instrument, a bending operation portion arranged outside the proximal-side deformable portion of the surgical treatment instrument, and a bending mechanism portion And a guide tube that is disposed between the bending operation portions and has a tube disposed outside the intermediate member;
Comprising
The surgical treatment apparatus characterized in that the bending mechanism portion and the bending operation portion of the guide tube are connected, and the posture of the bending mechanism portion can be changed in conjunction by changing the posture of the bending operation portion. .

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