JP4477395B2 - Coagulation and incision device - Google Patents

Description

This invention utilizes a flop lobe about treatable coagulation dissector living tissue.

  For example, Patent Document 1 discloses an ultrasonic treatment instrument that performs a treatment such as coagulation and incision by ultrasonic vibration in a state where a living tissue is grasped by a distal treatment section. This ultrasonic treatment instrument is mainly composed of a main body unit, a probe unit, and a vibrator unit, and can be disassembled into parts so as to be easily cleaned so as to be used repeatedly.

  This type of ultrasonic treatment tool is provided in each main body unit, and includes a long insertion portion for performing treatment by being inserted into a body cavity, and an operation portion provided at a proximal end portion of the insertion portion. ing. A distal treatment section for grasping a living tissue is provided at the distal end of the insertion section of the ultrasonic treatment instrument. The distal treatment section is composed of a jaw and a distal treatment section of a probe unit, and the jaw is rotatably attached to the distal end of the insertion section through a pin so as to face the probe distal treatment section.

  Further, a gripping member made of a resin such as PTFE having a low friction coefficient is generally attached to the jaw at a portion in contact with the tip treatment portion of the probe unit in order to prevent wear due to ultrasonic vibration of the probe. In addition, an operation handle for opening and closing the tip jaw is attached to the operation portion via a pin so as to be rotatable. The operation handle and the jaw are connected by a drive shaft that passes through a channel in the insertion portion. The drive shaft advances and retracts in the direction of the insertion portion axis by operating the operation handle, and the jaw can be opened and closed by transmitting the drive force to the jaw.

  In addition, a transducer incorporating an element that converts high-frequency current into ultrasonic vibration can be attached to and detached from the proximal end of the operation unit, and a probe unit that transmits ultrasonic vibration can be attached to and detached from this transducer by screwing or the like. Connected as possible. The probe unit is inserted into a channel different from the drive shaft in the operation unit and the insertion unit of the main unit. When assembled, the treatment section at the tip of the probe unit protrudes from the insertion section and faces the jaw.

In such an ultrasonic treatment device, the jaw holding member is worn by repeated use. When the gripping member is completely worn out, the service life is reached. At this time, by exchanging with a new main body unit, the cost is reduced as compared with the case of exchanging the whole. For cleaning after use, cleaning is performed with a dedicated cleaning adapter for discharging the cleaning liquid to the channel of the drive shaft where the brush cannot be inserted.
JP 2002-224133 A

  In the ultrasonic treatment instrument as disclosed in Patent Document 1, the most force is applied to the drive shaft during normal use. In order to prevent parts from falling into the body cavity due to damage to the ultrasonic treatment instrument when a greater force than expected is applied to the ultrasonic treatment instrument, the connection pin on the distal end side of the drive shaft must be removed. The connecting portion in the handle on the proximal end side of the drive shaft is damaged.

  However, when the main body unit can be further disassembled into an insertion unit (treatment unit) having a handle unit and a drive shaft, the connection portion with the handle unit on the proximal end side of the drive shaft for easy disassembly and assembly. It is necessary to increase the strength. In such a case, it is conceivable that the tip end of the drive shaft is damaged first. For this reason, it is necessary to prevent parts from falling off even if the drive shaft is damaged on the tip side.

The present invention has been made to solve such problems, and an object, even if some of the units is broken, to provide a preventing possible coagulation dissector detachment of parts It is in.

In order to solve such a problem, a coagulation / cutting device according to the present invention has a long-axis-like shape having a distal end portion and a proximal end portion and having a treatment portion for treating a living tissue at the distal end portion. includes a probe, a grip portion treatment portion of the probe is positioned to be opposed to grip the openably provided living tissue to the treatment portion, the said probe interpolation possible pipe-like A driving member for opening and closing the gripping part that is pivotally connected to the gripping part and the tip part, and an outer periphery of the driving member that is connectable between the gripping part and the driving member. A treatment unit comprising a support member, a sheath unit that covers the outer periphery of the drive member, and is detachable from the treatment unit; and after a large force is applied to the treatment unit, At least one There a captive to prevent falling off from the treatment unit, the captive, the protruding said formed in the support member, and an inner projection which projects radially inward, radially outward An outer protrusion, a first recess formed on the drive member and engaged with the inner protrusion, and an inner peripheral surface of the sheath unit, and the outer protrusion is engaged. And a second recess .

For this reason, even if a large force is applied to the drive member and damage occurs, it is possible to prevent the component from falling off the treatment unit.

  As described above, since the treatment unit is engaged with the sheath unit at a plurality of locations, even if one location is damaged, parts are prevented from falling off at the other location.

  Preferably, the first recess includes a hole with which the inward protrusion is engaged.

  For this reason, since the inward projection is engaged with the first recess more deeply, it is possible to reliably prevent the component from falling off.

  Preferably, the second recess includes a cam groove with which the outer protrusion is engaged.

  For this reason, since the outward projection is more reliably engaged, it is possible to reliably prevent the parts from falling off.

  Preferably, the treatment unit includes a tubular member having an insulating property in close contact with an inner periphery of a distal end portion of the driving member, while the driving member has a pipe shape into which the probe unit can be inserted. ing. The drop-off prevention mechanism is formed by engaging at least a part of the outer circumferential surface of the cylindrical member with an inward protruding part in which at least a part of the driving member protrudes radially inward and the inward protruding part. And a formed groove.

  For this reason, by attaching a cylindrical member to the drive member, the drive member can be reinforced and prevented from falling off.

According to the present invention, even if some of the units is broken, it is possible to provide a preventing possible coagulation dissection device from falling off parts.

  The best mode for carrying out the present invention (hereinafter referred to as an embodiment) will be described below with reference to the drawings.

  First, a first embodiment will be described with reference to FIGS.

  As shown in FIG. 2 (A), the ultrasonic treatment instrument (ultrasonic coagulation / cutting device) 10 shown in FIG. 1 includes a main body unit 12, a probe unit 14, and a transducer unit 16 that are detachable from each other. Yes. The main unit 12 includes a handle unit 22, a sheath unit 24, and a jaw unit (treatment unit) 26. The sheath unit 24 and the jaw unit 26 can be attached to and detached from the handle unit 22. The jaw unit 26 can be attached to and detached from the sheath unit 24. When the sheath unit 24 and the jaw unit 26 are combined, the insertion unit 28 (see FIG. 1) is assembled. When the insertion unit 28 and the handle unit 22 are combined, the main unit 12 is assembled as shown in FIG.

  As shown in FIGS. 1 and 2A, the probe unit 14 can be attached to and detached from the transducer unit 16. The vibrator unit 16 is detachable from the handle unit 22 of the main unit 12. For this reason, the unit in which the probe unit 14 and the transducer unit 16 are combined is detachable from the main unit 12. That is, when the main body unit 12, the probe unit 14, and the transducer unit 16 are combined, the ultrasonic treatment instrument 10 is assembled as shown in FIG.

  As shown in FIG. 2A, the vibrator unit 16 includes a cylindrical vibrator cover 30 and an ultrasonic vibrator (not shown) that is built in the vibrator cover 30 and generates ultrasonic vibrations. ). The ultrasonic transducer includes a horn (not shown) that expands the amplitude of the generated vibration at the tip. The base end of the probe unit 14 can be attached to and detached from this horn. That is, the proximal end portion of the probe unit 14 can be attached to and detached from the distal end portion of the transducer unit 16.

  The vibrator cover 30 is provided with a unit connecting portion 32 at the distal end portion that can be attached to and detached from a vibrator connecting portion 99 (see FIG. 5) of the operation portion main body 54 (described later) of the main body unit 12. A C-shaped engagement ring (C ring) 34 with a part cut away is attached to the outer peripheral surface of the unit connecting portion 32. As shown in FIG. 1, a power connection cord 36 provided with a vibrator plug (not shown) is connected to the rear end portion of the vibrator cover 30.

  As shown in FIG. 2A, the probe unit 14 includes a vibration transmission member (probe) 40 in the form of an elongated straight stretch bar, a horn part 42 disposed at the base end of the vibration transmission member 40, and the horn part. A maximum diameter portion 44 disposed at the proximal end portion of 42, and a treatment portion 46 disposed at the distal end portion of the vibration transmitting member 40. As shown in FIG. 2 (B), a deformed cross-sectional shape portion (flange portion) 48 having a cross-sectional shape different from a circular shape is disposed at the connecting portion between the horn portion 42 and the maximum diameter portion 44. The probe unit 14 is positioned with respect to parallel planes 90a and 90b (see FIG. 7C) of a positioning member 90 to be described later by the deformed cross-sectional shape portion 48.

  As shown in FIG. 2A, a plurality of support bodies 50 each having a ring shape are disposed on the outer peripheral surface of the vibration transmitting member 40. These supports 50 are formed of an elastic member such as a rubber material, for example, and a standing wave node (hereinafter referred to as vibration) of ultrasonic vibration transmitted from the proximal end side to the distal end side of the outer peripheral surface of the vibration transmitting member 40. (Referred to as a node).

  A mounting screw 44 a is disposed at the base end of the maximum diameter portion 44. The mounting screw 44 a is screwed into a screw hole portion of the probe mounting portion at the tip of the horn of the vibrator unit 16. For this reason, the probe unit 14 and the vibrator unit 16 can be combined together. The horn portion 42 between the maximum diameter portion 44 and the vibration transmission member 40 expands the amplitude of ultrasonic vibration transmitted from the transducer unit 16. The vibration transmission member 40 transmits the ultrasonic vibration expanded by the horn unit 42 toward the treatment unit 46.

  The treatment portion 46 is provided to perform treatment in contact with a living tissue, and is formed in an asymmetric shape, for example, an arc shape, which is curved in a direction away from the central axis of the vibration transmitting member 40. Although the shape of the treatment portion 46 will be described later, an appropriate shape is used according to the purpose (see FIGS. 16A and 17).

  As shown in FIG. 4, the handle unit 22 includes an operation portion main body 54 having insulation properties. The operation portion main body 54 is a substantially cylindrical housing. A fixed handle 56 is integrally formed on the outer peripheral surface of the operation portion main body 54. A movable handle 58 that is rotatable with respect to the fixed handle 56 is disposed in the operation section main body 54. At the operation end (lower end) of the fixed handle 56, a finger hooking hole 56a for selectively placing a finger other than the thumb is formed. The operation end (lower end) of the movable handle 58 is formed with a finger hooking hole 58a for the thumb of the same hand to be hung.

  A pair of fulcrum pin receiving portions 54a and a working pin operation window 54b are formed on the outer peripheral surface of the operation portion main body 54, respectively. Since the action pin operation window 54b penetrates the wall portion of the operation portion main body 54, the operation portion main body 54 communicates with the lumen of the operation portion main body 54 from the side (see FIG. 7C). ). A connecting portion 58 b branched in a bifurcated shape is formed at the upper end of the movable handle 58. A fulcrum pin 60 disposed in the fulcrum pin receiving portion 54a is attached to the upper end portion of the movable handle 58. These fulcrum pins 60 are attached to the fulcrum pin receiving portion 54a through a collar (insulating cap) 54c formed of a member having a low coefficient of friction that smoothly rotates the movable handle 58. Therefore, the movable handle 58 can be opened and closed with respect to the fixed handle 56. These fulcrum pins 60 are connected to the operation portion main body 54 on the upper side in FIG. 5 with respect to the axis when an insulating tube 116 (described later) of the sheath unit 24 is attached to the handle unit 22.

  At the upper end of the movable handle 58 and below the fulcrum pin 60, an action pin 62 disposed in the action pin operation window 54b is mounted. An end portion of the action pin 62 disposed on the inner side of the operation portion main body 54 is disposed in a pin receiving portion 86a of the slider 86 described later. Therefore, when the movable handle 58 is opened and closed with respect to the fixed handle 56 with the fulcrum pin 60 as a fulcrum, the slider 86 is moved forward and backward by the action pin 62.

  As shown in FIGS. 4 and 5, a fixing ring 64 is mounted on the inner peripheral edge of the distal end portion of the operation portion main body 54. An internal thread portion is formed on the inner peripheral surface of the fixing ring 64. A cylindrical rotary connection member 66 is disposed inside the fixing ring 64. The rotary connecting member 66 has a small diameter portion at a distal end portion and a large diameter portion at a proximal end portion, and has a step portion between the small diameter portion and the large diameter portion. A male screw portion is formed at a position close to the step portion on the outer peripheral surface of the small-diameter portion at the distal end portion of the rotary connecting member 66. The male thread portion of the rotary connecting member 66 is screwed into the female thread portion of the fixing ring 64.

  On the outer peripheral surface of the small-diameter portion of the rotary connecting member 66, a pair of elongated holes 66a facing each other along the axial direction of the rotary connecting member 66 is formed on the tip side of the male screw portion. A cylindrical rotation fixing member 68 slidable in the axial direction of the rotary connecting member 66 is disposed inside the small diameter portion of the rotary connecting member 66. The rotation fixing member 68 is provided with a pair of first pins 70 a that pass through the long holes 66 a of the rotation connecting member 66. That is, these first pins 70 a are respectively held in the long holes 66 a of the rotary connecting member 66. For this reason, the rotation fixing member 68 is movable along the longitudinal axis of the long hole 66a of the rotation connecting member 66 by the first pin 70a. As shown in FIG. 6A, a pair of slit portions (first mounting mechanisms) 68a and 68b facing each other are formed at the distal end portion of the rotation fixing member 68.

  A tubular sheath connection member 72 is disposed outside the rotation fixing member 68 and on the distal end side of the position where the first pin 70a is disposed, and inside the small diameter portion of the rotation connecting member 66. ing. That is, a cylindrical sheath connection member 72 is disposed (fixed) on the outer side of the distal end portion of the rotation fixing member 68 together with the rotation connecting member 66.

  As shown in FIG. 6 (A), slits 72a and 72b are formed on the inner peripheral surface of the distal end portion of the sheath connecting member 72 at the opening edge portion having a circular cross section and at positions facing each other. Yes. These slits 72 a and 72 b are formed at positions inclined by 60 ° with respect to the center of the sheath connecting member 72. As shown in FIG. 4, a pair of arms 72c and 72d are disposed at the proximal end of the sheath connecting member 72 in order to position the rotation fixing member 68 with respect to the hole on the inner peripheral surface of the sheath connecting member 72 when assembled. Is formed.

  As shown in FIG. 5, a part of the base end surface of the sheath connection member 72 is positioned by contacting the rotation fixing member 68. As shown in FIG. 6B, parallel planes 68 c and 68 d facing each other are formed on the outer peripheral surface of the base end portion of the rotation fixing member 68. On the inner peripheral surface of the base end portion of the arms 72c and 72d of the sheath connection member 72, a plane that comes into contact with the parallel planes 68c and 68d is formed. The outer peripheral surfaces of the base end portions of the arms 72 c and 72 d of the sheath connecting member 72 are formed in a shape along the inner peripheral surface shape of the rotary connecting member 66.

  As shown in FIGS. 4 and 5, a ring-shaped (cylindrical) rotary knob 74 having a slip stopper 74 a on the outer peripheral surface is provided on the outer peripheral surface of the rotary connecting member 66 in the axial direction with respect to the rotary connecting member 66. It is slidably mounted. As shown in FIG. 6B, a pair of pin receiving portions 74a that engage with the first pins 70a are formed inside the rotary knob 74. As shown in FIG. For this reason, the rotation knob 74 is rotationally fixed with respect to the rotation fixing member 68 and the rotation connecting member 66. That is, when the rotary knob 74 is rotated, the rotary connecting member 66 also follows and rotates.

  A ring-shaped fixing member 76 is disposed at a position covering the distal end surfaces of the rotary connecting member 66 and the rotary knob 74. A male screw portion is formed on the outer peripheral surface of the fixing member 76. A female thread portion is formed on the inner peripheral surface of the rotary connecting member 66. For this reason, the fixing member 76 and the rotary connecting member 66 are screwed together by the screw portions.

  As shown in FIG. 5, a flange portion 66 b that protrudes inward in the radial direction is formed on the inner peripheral surface of the step portion of the rotary connecting member 66. A coil spring 78 is disposed between the base end portion of the rotation fixing member 68 and the flange portion 66 b of the rotation connecting member 66. The pair of first pins 70 a is normally disposed at the tip of the elongated hole 66 a of the rotary connecting member 66 because the rotation fixing member 68 is biased toward the tip of the rotary connecting member 66. Further, since the rotation knob 74 is also engaged with the pair of first pins 70a by the pin receiving portion 74a, the proximal end of the position where the rotation knob 74 is mounted is the tip of the elongated hole 66a of the rotation connecting member 66. Matches. For this reason, when the rotation knob 74 is pulled to the proximal end side with a force equal to or greater than the amount of the coil spring 78, the rotation knob 74 and the rotation fixing member 68 slide within the length range of the long hole 66a of the rotation connecting member 66.

  A cylindrical drive pipe connection member (drive shaft connection member) 80 is disposed on the proximal end side of the rotation fixing member 68 so as to be slidable in the axial direction with respect to the rotation connection member 66. A pair of drive pipe connection pins (first mounting mechanism) 80 a is disposed at the tip of the drive pipe connection member 80. These drive pipe connection pins 80a protrude radially inward, and can be engaged with a pair of cam grooves (second mounting mechanism) 126a described later of the jaw unit 26 described later. A slider receiving member 82 is further connected to the rear end side of the drive pipe connecting member 80 by a pair of second pins 70b. The distal end portion of the slider receiving member 82 is disposed inside the drive pipe connecting member 80, and PTFE is disposed inside the distal end portion so that the probe unit 14 does not come into contact with the surrounding hard portion when assembled to the main body unit 12. A protective ring 84 made of an insulating material with low friction such as the above is mounted.

  As shown in FIGS. 7A and 7B, the drive pipe connecting member 80 is formed with flange portions 80b and 80c projecting radially outward at an intermediate portion and a rear end portion. The flange portions 80b and 80c are notched in a circular arc shape at several locations on the circumference. For this reason, when the handle unit 22 is cleaned, the cleaning liquid can easily reach between the flange portions 80b and 80c, the front end side, and the rear end side, and the cleaning liquid can be easily discharged. Further, the mass of the drive pipe connecting member 80 can be reduced.

  A third pin 70 c is attached to the flange portion 80 c of the drive pipe connection member 80. The third pin 70c is engaged with a slit 66c extending in the axial direction on the rear end side of the rotary connecting member 66, and is slidable along the slit 66c in the axial direction. The rotation connection member 66 follows the rotation. Further, the rotary connecting member 66 and the drive pipe connecting member 80 are in contact with the outer periphery of the flange portion 66b of the rotary connecting member 66 and the outer periphery of the drive pipe connecting member 80, and further rotated with the outer periphery of the flange portions 80b and 80c. The inner periphery of the connecting member 66 is in contact. As a result, the drive pipe connecting member 80 can slide in the axial direction while suppressing the occurrence of looseness and the like.

  At the base end portion of the slider receiving member 82, a flange portion 82a protruding outward in the radial direction is formed. A substantially ring-shaped slider 86 having insulating properties is disposed on the outer peripheral surface of the slider receiving member 82. The slider 86 is movable along the axial direction of the slider receiving member 82 between the flange portion 80 c of the drive pipe connecting member 80 and the flange portion 82 a of the slider receiving member 82. On the outer peripheral surface of the slider 86, a groove-shaped pin receiving portion 86a in which the end portion of the action pin 62 of the movable handle 58 described above is disposed is formed.

  A coil-like driving force limiting spring 88 is disposed outside the slider receiving member 82. The driving force limiting spring 88 is disposed between the flange portion 80c of the driving pipe connecting member 80 and the slider 86 in a state of being shorter than the free length, and the slider 86 is located on the base end side (the flange of the slider receiving member 82). Part 82a) is biased with a constant force. For this reason, when the movable handle 58 is opened and closed with respect to the fixed handle 56, the slider 86, the slider receiving member, when the amount of force transmitted from the action pin 62 to the tip end in the axial direction is equal to or less than the amount of force of the driving force limiting spring 88. 82, the drive pipe connecting member 80 advances and retreats integrally. When the amount of force transmitted from the action pin 62 to the front end side in the axial direction is equal to or greater than the amount of force of the driving force limiting spring 88, the slider 86 resists / accords to the biasing force of the driving force limiting spring 88 and accordingly the slider receiving member 82 Advancing and retreating along the outer peripheral surface prevents a force exceeding a certain level from being transmitted to the tip end in the axial direction.

A cylindrical positioning member 90 having conductivity for positioning the probe unit 14 is disposed on the inner circumferential surface of the slider receiving member 82. The positioning member 90 is fixed by a fourth pin 70d on the further proximal end side of the flange portion 82a of the slider receiving member 82. As shown in FIG. 7C, parallel planes 90a and 90b facing each other are formed on the inner peripheral surface of the positioning member 90. Therefore, the parallel flat surfaces 48a and 48b of the deformed cross-sectional shape portion 48 of the probe unit 14 shown in FIG. 2B are mounted in a state where they are positioned at predetermined positions.
As shown in FIGS. 4 and 5, the distal end portion of the contact pipe 92 having conductivity is connected to the outer peripheral surface of the proximal end portion of the positioning member 90 by fitting.

  A high-frequency connection pin 94 connected to a high-frequency power source (electric knife power source) is attached above the proximal end portion of the operation unit main body 54 in a state of being tilted backward via an insulating cover 94a. The insulating cover 94a is disposed in order to enhance electrical safety when the high frequency connection pin 94 is disposed in the high frequency power source in an incomplete state, for example.

  The lower end portion of the high-frequency connection pin 94 is in contact with the inner peripheral surface of the proximal end portion of the operation portion main body 54, and the vibrator unit guide 96 is mounted in an electrically connected state. A C-ring receiving member 98 that receives the engagement ring (C-ring) 34 shown in FIG. 2 is screwed to the inner peripheral surface of the operation portion main body 54 on the outer peripheral surface of the base end portion of the vibrator unit guide 96. . For this reason, the C-ring receiving member 98 and the guide 96 form a vibrator connecting portion 99 with which the unit connecting portion 32 of the vibrator unit 16 is engaged.

  A connector 92a having an L-shaped cross section is attached to the base end portion of the guide 96 by a fifth pin 70e. The connector 92a is urged and brought into contact with the outer peripheral surface of the contact pipe 92 with a certain force while being elastically deformed. The connector 92 a has a distal end portion that is U-shaped in cross section, and the U-shaped bottom portion is designed to be inside the outside of the contact pipe 92. For this reason, the connector 92 a is elastically deformed outward with respect to the outer peripheral surface of the contact pipe 92 and is in line contact. With such a configuration, for example, when the probe unit 14 is mounted on the operation unit main body 54 of the handle unit 22, the contact pipe 92 or the positioning member 90 is not provided with a member projecting radially inward. It is possible to easily and reliably attach the front end of the 14 treatment sections 46 and the like.

  The high-frequency connection pin 94 described above is electrically connected to the contact pipe 92 by the connector 92a of the vibrator unit guide 96. Further, since the contact pipe 92 and the positioning member 90 are coupled by fitting, the high frequency connection pin 94 is also electrically connected to the positioning member 90.

  In this way, the handle unit 22 is configured (see FIG. 2A).

  As shown in FIG. 8, the sheath unit 24 includes a knob 112, a sheath unit connecting member 114, an insulating tube 116, a long pipe 118, and a tip cover 120.

  A pair of bifurcated pair of fixed arms 114 a and 114 b extend from the proximal end of the sheath unit connecting member 114. Fixing portions (fourth mounting mechanisms) 114c and 114d are formed at the base end portions of the fixing arms 114a and 114b as outward projecting portions projecting radially outward. These fixing portions 114c and 114d can be engaged with and disengaged from the sheath connecting member 72 of the handle unit 22 described above.

  As shown in FIG. 6A and FIG. 8, inward protruding portions 114e and 114f protruding inward in the radial direction are formed at the base ends of the fixed arms 114a and 114b. As shown in FIG. 8, a ring shape is provided on the inner side of the sheath unit connection member 114 so as to be in close contact with the outer peripheral surface of a jaw unit connection member 126 (see FIG. 9) described later of the above-described jaw unit 26. The packing 114g is attached. For this reason, in the assembled state, the insufflation gas used in, for example, endoscopic surgery from the gap between the sheath unit 24 and the jaw unit 26 is prevented from escaping to the handles 56 and 58 side.

  As shown in FIG. 8, a long pipe 118 is attached to the distal end side of the sheath unit connecting member 114. A pair of cam grooves (second recesses) 118 a are formed at the tip of the long pipe 118. These cam grooves 118 a are orthogonal to the portion extending in the axial direction from the distal end of the long pipe 118 toward the proximal end side, and the proximal end portion of this portion, and with respect to the axial center of the long pipe 118. And a portion extending to a position inclined about 60 °. In these cam grooves (fifth mounting mechanism) 118a, outward projections (third mounting) of arms 132c and 132d of a jaw support member (action portion support member) 132 (to be described later) of the jaw unit 26 (see FIG. 9). Mechanisms 132i and 132j (see FIGS. 8 and 10B) are engaged. A distal end cover 120 that covers the cam groove 118 a is disposed on the outer periphery of the distal end portion of the long pipe 118. The distal end surface of the distal end cover 120 includes an edge that protrudes radially outward.

  A male screw portion is provided on the outer periphery of the sheath unit connecting member 114, and this male screw portion is screwed to a female screw portion on the inner periphery of the cylindrical knob 112. An anti-slip 112 a is formed on the outer peripheral surface of the knob 112. The outer periphery of the tip cover 120 and the long pipe 118 is covered with an insulating tube 116. As shown in FIG. 10A, the distal end side of the insulating tube 116 is in contact with the edge portion at the distal end of the distal end cover 120. As shown in FIG. 5, the base end portion of the insulating tube 116 extends to the inner peripheral surface of the knob 112. In this way, the sheath unit 24 is configured. (See FIG. 2A).

  As shown in FIG. 9, the jaw unit 26 includes a jaw unit connection member 126, a drive pipe (drive shaft) 128, a protection member 130, a jaw support member 132, and a distal end working portion 134.

  The jaw support member 132 has a cylindrical shape, and includes a pair of arms 132a, 132b, 132c, and 132d at the distal end and the proximal end, respectively. The arms 132a and 132b on the distal end side are referred to as first arms, and the arms 132c and 132d on the proximal end side are referred to as second arms. Protrusions 132e and 132f are formed at the base ends of the second arms 132c and 132d. As shown in FIG. 10B, these projecting portions 132e and 132f project inwardly projecting outwardly from the second arms 132c and 132d of the jaw support member 132 and outward projecting portions 132g and 132h, respectively. The outward projecting portions 132i and 132j are provided. The inward protruding portions 132g and 132h are engaged with a long hole (first concave portion) 128a, which will be described later, of the drive pipe 128. On the other hand, the outward projecting portions 132 i and 132 j are engaged with a cam groove 118 a (see FIG. 8) at the distal end portion of the long pipe 118 of the sheath unit 24.

  The jaw unit connecting member 126 is formed in a cylindrical shape. A pair of cam grooves 126 a are formed at the base end portion of the connection member 126. These cam grooves 126a extend in a direction orthogonal to the axial direction of the connection member 126 from a portion extending obliquely from the proximal end of the jaw unit connection member 126 toward the distal end side and the distal end side end portion of this portion. And an extended portion. The drive pipe connection pins 80a (see FIG. 5) of the drive pipe connection member 80 of the handle unit 22 described above can be engaged with and disengaged from the cam grooves 126a. A pair of elongated holes 126b are formed along the axial direction of the connecting member 126 near the base end of the jaw unit connecting member 126. Inwardly projecting portions 114e and 114f (see FIG. 8) of the fixing arms 114a and 114b of the connection member 114 of the sheath unit 24 can be engaged and disengaged with these elongated holes 126b.

  The outer peripheral surface of the proximal end portion of the drive pipe 128 is fixed to the inner peripheral surface of the distal end portion of the jaw unit connecting member 126 by, for example, adhesion or welding. The distal end portion of the drive pipe 128 is disposed inside the jaw support member 132 so as to be slidable in the longitudinal direction. A pair of elongated holes 128 a are formed in the vicinity of the tip of the drive pipe 128 along the axial direction of the drive pipe 128. As described above, inwardly protruding portions 132g and 132h of the second arms 132c and 132d of the jaw support member 132 are fitted into these elongated holes 128a. For this reason, the drive pipe 128 is slidable in the longitudinal direction with respect to the jaw support member 132, but is fixed in the rotational direction.

  As shown in FIG. 10A, on the inner peripheral surface of the drive pipe 128, an inward protruding portion 128b that protrudes radially inward is formed slightly closer to the tip than the elongated hole 128a. The outer peripheral surface of a cylindrical protective member (cylindrical member) 130 is fixed to the inner peripheral surface of the distal end portion of the drive pipe 128 by, for example, adhesion. An annular groove (groove portion) 130 a is formed on the outer peripheral surface of the protection member 130. An inward protruding portion 128b of the drive pipe 128 is engaged with the annular groove 130a.

  A pin receiving portion 128 c is formed at the distal end portion of the drive pipe 128 and extends from the distal end edge of the drive pipe 128 to the distal end side integrally with the drive pipe 128. That is, a part of the pin receiving portion 128 c extends in a tab shape from the end edge portion of the drive pipe 128. The tip of the pin receiving portion 128 c is rounded to the radially inner side of the drive pipe 128. For this reason, the pin receiving portion 128c is provided with a connecting pin 142, which will be described later, and the connecting pin 142 is provided on the jaw main body 136 so that the drive pipe 128 and the jaw main body 136 are connected.

  As shown in FIG. 9, the distal end working unit 134 includes a jaw body 136 having a base end portion with a substantially arch shape, and a gripping member 138 that grips an object (living tissue). The jaw main body 136 includes a pair of arms 136a and 136b that are bifurcated at the base end portion while being connected at the tip end portion. For this reason, a predetermined gap is formed at the proximal end portion of the jaw main body 136. The gripping member 138 is formed of a material that has heat resistance and lowers frictional resistance against a contacting member, such as PTFE. The gripping member 138 has a plurality of non-slip teeth arranged side by side on the gripping surface side that grips the living tissue to be coagulated and incised, and a non-slip tooth portion (gripping surface) 138a formed in a sawtooth shape is formed. . The grasping surface 138a of the grasping member 138 can grasp the living tissue to be coagulated and incised without slipping. On the opposite side of the gripping surface 138a of the gripping member 138, a protrusion 138b that is fitted between the pair of arms 136a and 136b of the jaw main body 136 is formed. Therefore, as shown in FIGS. 11B and 11C, the gripping member 138 is fitted into the gap of the jaw main body 136 and attached by, for example, adhesion.

  As shown in FIG. 9, leg portions 136 c and 136 d are formed at the base ends of the arms 136 a and 136 b of the jaw main body 136. The first arms 132a and 132b of the jaw support member 132 and the legs 136c and 136d at the base ends of the arms 136a and 136b of the jaw main body 136 are connected by pivot pins 140a and 140b. That is, the jaw main body 136 is connected to the jaw support member 132 by the pivot pins 140a and 140b. For this reason, the jaw main body 136 is rotatable with respect to the distal end portion of the jaw support member 132.

  At the base ends of the arms 136a and 136b of the jaw main body 136, pin holes are inserted into the upper edges of the legs 136c and 136d by a pin receiving portion 128c at the distal end of the drive pipe 128 and a connecting pin 142. The part is formed. For this reason, the pin receiving portion 128 c at the distal end portion of the drive pipe 128 and the proximal end portions of the arms 136 a and 136 b of the jaw main body 136 are connected by the connecting pin 142. Therefore, when the drive pipe 128 is advanced and retracted with respect to the jaw support member 132 along the axial direction of the jaw unit 26, the distal end action portion 134 moves relative to the distal end portion of the jaw support member 132 with the pivot pins 140a and 140b as fulcrums. It is rotated.

  Here, the distal end working portion 134 is closed by advancing the drive pipe 128 toward the distal end side. During the closing operation of the distal end working portion 134, the gripping member 138 of the distal end working portion 134 is pressed against the treatment portion 46 of the vibration transmitting member 40 of the probe unit 14, thereby holding the gripping member 138 of the treatment portion 46 and the distal end acting portion 134. The object (living tissue) is grasped between the two. In addition, the front-end | tip action part 134 is used also when peeling a biological tissue.

  Further, even if a part of the pin receiving portion 128c at the tip of the driving pipe 128 that is weakest in strength is broken, the jaw support member 132 and the driving pipe 128 are provided with the long hole 128a and the inward protruding portions 132g and 132h. Therefore, the jaw support member 132 is also rotationally fixed to the sheath unit 24 at the time of assembly. Therefore, the outward protrusion 132i. It is possible to prevent the engagement between 132j and the cam groove 118a of the sheath unit 24 from being disengaged.

  In this way, the jaw unit 26 is configured (see FIG. 2A).

  Incidentally, as shown in FIG. 11A, the base end surfaces of the base end portions of the arms 136a and 136b of the jaw main body 136 are formed in an arch shape as described above. For this reason, the strengths of the base end portions of the arms 136a and 136b and the leg portions 136c and 136d are higher than those of, for example, a substantially rectangular shape or a U-shape, as compared with the case of the same thickness. Then, the base end portions of the arms 136a and 136b and the leg portions 136c and 136d are formed thinner than in the case of a substantially rectangular shape or U shape while maintaining the same strength. For this reason, the base end surface of the base end part of the jaw main body 136 is formed smaller than the case of substantially rectangular shape or U shape, maintaining the same intensity | strength. As described above, the base end surface of the base end portion of the jaw main body 136 is formed small, so that the jaw main body 136 is formed small overall.

  On the outer peripheral surfaces of the arms 136a and 136b of the jaw main body 136, projections 136e are formed in front of the leg portions 136c and 136d. These protrusions 136e are formed thicker than the thicknesses of the leg portions 136c and 136d. As shown in FIGS. 11 (B) and 11 (C), the arms 132a and 132b at the tip of the jaw support member 132 are formed with protrusions 132k that come into contact with the protrusions 136e of the jaw body 136. Yes. For this reason, for example, as shown in FIG. 11C, even when the protrusion 136e and the protrusion 132k are brought into contact with each other, the thicker protrusion 136e of the jaw main body 136 is used for the jaw support member 132. Since the protrusion 132k can be received, a large force can be applied to the treatment portion 46 and the like even if the jaw body 136 is closed with nothing held between the gripping member 138 and the treatment portion 46 of the probe unit 14. Is prevented. That is, the stress on the treatment portion 46 due to the ultrasonic vibration is limited, and fatigue failure of the probe unit 14 is prevented.

  Next, the operation of the ultrasonic treatment instrument 10 according to this embodiment will be described.

  As shown in FIG. 2, the ultrasonic treatment instrument 10 is separated into a main body unit 12, a probe unit 14, and a transducer unit 16. The main unit 12 is separated into a handle unit 22, a jaw unit 26, and a sheath unit 24.

  When assembling the ultrasonic treatment instrument 10, here, the insertion unit 28 is assembled by assembling the sheath unit 24 and the jaw unit 26 shown in FIG.

  As shown by an arrow α in FIG. 13A, the jaw unit 26 is inserted from the distal end portion of the sheath unit 24 toward the proximal end portion. The jaw unit 26 is inserted into the sheath unit 24 until it cannot be inserted any more. Here, the outward projections 132i and 132j (see FIG. 10B) of the second arms 132c and 132d of the jaw support member 132 of the jaw unit 26 are connected to the cam groove 118a (see FIG. 10B) of the long pipe 118 of the sheath unit 24. 8)). In this way, the jaw unit 26 is positioned with respect to the sheath unit 24.

  In this state, the jaw unit 26 continues to be inserted into the sheath unit 24. The proximal end edge portion of the jaw unit connecting member 126 at the proximal end portion of the jaw unit 26 is an inward projecting portion of the fixed arms 114 a and 114 b at the proximal end portion of the sheath unit connecting member 114 at the proximal end portion of the sheath unit 24. 114e and 114f (see FIG. 8). Since the inward projecting portions 114e and 114f are formed at the base end portions of the pair of fixed arms 114a and 114b, they expand as the fixed arms 114a and 114b are pushed in with a predetermined force. That is, the inward projecting portions 114e and 114f are expanded in a direction away from each other by elastic deformation of the fixed arms 114a and 114b.

  On the other hand, the outward projecting portions 132 i and 132 j of the jaw support member 132 of the jaw unit 26 are inserted to a position where they are abutted against the proximal end portion of the cam groove 118 a of the long pipe 118 of the sheath unit 24. At this time, the stepped portion of the jaw support member 132 of the jaw unit 26 (the distal ends of the arms 132 c and 132 d) abuts against the distal end surface of the distal end cover 120 of the sheath unit 24.

  As indicated by an arrow β in FIG. 13B, the gripping surface 138 a of the jaw unit 26 is on the near side with respect to the sheath unit 24 with the gripping surface (tooth portion) 138 a of the gripping member 138 facing the near side. Rotate downward from That is, the sheath unit 24 is rotated inward (clockwise) relative to the jaw unit 26. In other words, the jaw unit 26 is rotated forward (counterclockwise) relative to the sheath unit 24.

  Then, the outward projecting portions 132 i and 132 j of the jaw support member 132 of the jaw unit 26 are rotated by about 60 ° and are brought into contact with and engaged with the innermost position of the L-shaped cam groove 118 a of the sheath unit 24. .

  At this time, the pair of inward projecting portions 114e and 114f of the fixing arms 114a and 114b of the sheath unit 24 are fitted into the pair of elongated holes 126b of the connection member 126 at the base end portion of the jaw unit 26 from the outside, respectively. (See FIGS. 5 and 6A). That is, the elastic deformation of the fixed arms 114a and 114b is returned to the original state.

  Therefore, the jaw unit 26 is assembled to the sheath unit 24 at two positions to constitute the insertion unit 28 shown in FIG. In this state, the jaw unit 26 is prevented from falling off the sheath unit 24 except when the jaw unit 26 is rotated counterclockwise with a certain force or more with respect to the sheath unit 24.

  Next, the insertion unit 28 in which the sheath unit 24 and the jaw unit 26 are integrated is assembled to the handle unit 22. In this case, as shown by an arrow γ in FIG. 14A, the insertion unit 28 is inserted through the inside of the distal end portion of the sheath connecting member 72 at the distal end portion of the handle unit 22.

  The fixing portions (outward projections) 114c and 114d of the connection member 114 at the proximal end of the sheath unit 24 are inserted into the slits (expansion holes) 72a and 72b of the sheath connection member 72 shown in FIG. Insert with matching. For this reason, the insertion unit 28 is positioned with respect to the handle unit 22.

  If the fixing portions 114 c and 114 d of the connection member 114 of the sheath unit 24 are not matched with the slits 72 a and 72 b of the sheath connection member 72 of the handle unit 22, the sheath unit 24 can be smoothly inserted into the handle unit 22. I can't.

  In the assembly of the insertion unit 28 described above, after the jaw unit 26 is inserted until it hits the sheath unit 24, the jaw unit 26 is not rotated with respect to the sheath unit 24, or is rotated incompletely. In this case, the inward projecting portions 114e and 114f of the fixed arms 114a and 114b at the base ends of the sheath unit 24 are not fitted into the elongated holes 126b of the connection member 126 at the base end of the jaw unit 26, and the fixed arms 114a. 114b remain spread in the direction of isolation from each other. In this case, the outer diameters of the fixing portions 114c and 114d are larger than the slits 72a and 72b (see FIG. 6A) inside the sheath connection member 72 and cannot be inserted.

  In the insertion unit 28 positioned on the handle unit 22, the fixing portions 114 c and 114 d of the sheath unit connection member 114 are abutted against the distal end portion of the rotation fixing member 68. In this state, the insertion unit 28 is further inserted into the handle unit 22. The rotation fixing member 68 is moved against the urging force of the coil spring 78 to the proximal end side of the operation portion main body 54, and the proximal end portion of the rotation fixing member 68 is abutted against the outer peripheral surface of the drive pipe connecting member 80.

  Then, the drive pipe connection pin 80 a at the distal end portion of the drive pipe connection member 80 is disposed in the opening at the rear end of the cam groove 126 a of the connection member 126 at the proximal end portion of the jaw unit 26. On the other hand, the fixing portions 114c and 114d of the sheath unit connection member 114 can rotate about the axis by passing through the positioning slits 72a and 72b in the rotation direction in the sheath connection member 72 toward the base end side.

  As indicated by an arrow δ in FIG. 14B, the gripping surface 138a of the insertion unit 28 faces downward from the front side with respect to the handle unit 22 in a state where the gripping surface 138a of the distal end working portion 134 faces the front side. Turn to. That is, the handle unit 22 is rotated to the back side (clockwise) relative to the insertion unit 28. In other words, the insertion unit 28 is rotated relatively to the front side (counterclockwise) relative to the handle unit 22.

  Then, as shown in FIG. 6A, when the fixed arms 114a and 114b are aligned with the slit portions 68a and 68b at the distal end of the rotation fixing member 68 in the rotational direction around the axis, the fixed springs 114a and 114b are attached to the distal end side by the coil spring 78. The biased rotation fixing member 68 returns to a position where the first pin 70a abuts against the distal end side of the slit 66c of the rotation connecting member 66, and the slit portions 68a and 68b of the rotation fixing member 68 and the sheath unit connecting member 114. The fixed portions 114c and 114d of the fixed arms 114a and 114b mesh with each other. For this reason, the sheath unit 24 is rotationally fixed around the axis to the rotational fixing member 68. As shown in FIG. 5, at the same time, the drive pipe connection pin 80a is pulled into the back position by the cam groove 126a at the base end portion of the connection member 126 of the jaw unit 26 and is fixed in the axial direction.

  Further, the fixing portions (outward projections) 114c, 114d of the fixing arms 114a, 114b of the sheath unit connection member 114 are displaced from the slits 72a, 72b of the sheath connection member 72 in the rotational direction around the axis (FIG. 6 ( A), the sheath unit 24 is fixed to the handle unit 22 in the axial direction (longitudinal direction). Furthermore, since the outer periphery of the fixed arms 114a and 114b of the sheath unit connecting member 114 is restrained from being deformed radially outward by a hole inside the sheath connecting member 72 of the handle unit 22, the insertion unit 28 and the handle unit In the assembled state, the jaw unit 26 is completely rotationally fixed with respect to the sheath unit 24. Therefore, the outward protrusions 132 i and 132 j of the jaw support member 132 and the cam groove 118 a of the long pipe 118 of the sheath unit 24 are not disengaged, and the jaw support member 132 is pivoted with respect to the sheath unit 24. Fully fixed in direction. As a result, the insertion unit 28 is rotationally fixed about the axis relative to the rotational fixing member 68. Accordingly, the drive pipe connecting member 80 is rotationally fixed around the axis by the first pin 70a via the rotary connecting member 66 and the third pin 70c. As a result, the drive pipe connection pin 80a of the drive pipe connection member 80 moves the rotation fixing member 68 to the proximal end side, so that the insertion unit 28 and the drive pipe connection member 80 are not rotatable to each other. Disengagement from the handle unit 22 is prevented.

  Therefore, the insertion unit 28 is assembled at two positions with respect to the handle unit 22 to constitute the main unit 12 shown in FIG.

  Further, as shown in FIG. 2, the probe unit 14 and the transducer unit 16 are connected. In this case, the attachment screw 44a at the base end portion of the probe unit 14 is screwed into the screw hole portion of the probe attachment portion at the distal end portion of the horn of the transducer unit 16.

  The probe unit 14 in this state is inserted from the proximal end portion of the handle unit 22 toward the distal end portion of the insertion unit 28. When inserted, the parallel planes 48a and 48b (see FIG. 2B) of the deformed cross-sectional shape portion 48 of the probe unit 14 are positioned at positions determined by the parallel planes 90a and 90b of the positioning member 90 of the handle unit 22. Positioned. For example, in this embodiment, it can be inserted at two positions symmetrically by 180 °, but the operator inserts the treatment unit 46 of the probe unit 14 and the distal end working unit 134 of the jaw unit 26 in a direction in which the shapes match. To do.

  Further, the probe unit 14 is inserted to the proximal end portion, and the unit connecting portion 32 (see FIG. 2A) of the transducer unit 16 is attached to the proximal end portion of the handle unit 22. Then, the unit connecting portion 32 of the vibrator unit 16 is engaged with the vibrator connecting portion 99 formed by the vibrator unit guide 96 of the handle unit 22 and the C ring receiving member 98. Then, the treatment portion 46 of the probe unit 14 protrudes to a position facing the distal end working portion 134, and the ultrasonic treatment instrument 10 (see FIG. 1) is assembled.

  The operation of the ultrasonic treatment instrument 10 assembled in this way will be described.

When the surgeon rotates the rotary knob 74, the rotary connecting member 66 follows and rotates through the first pin 70a rotatably fixed to the rotary knob 74. When the rotary connecting member 66 rotates, the sheath connecting member 72 and the fixed member 76 fixed on the inner peripheral surface of the distal end portion of the rotary connecting member 66 rotate.
Further, the drive pipe connecting member 80 connected to the third pin 70c engaged with the slit 66c of the rotary connecting member 66 rotates. When the drive pipe connecting member 80 rotates, the slider receiving member 82 connected by the second pin 70b rotates. When the slider receiving member 82 rotates, the positioning member 90 connected by the fourth pin 70d rotates. Furthermore, the rotation fixing member 68 connected to the first pin 70a, the sheath unit connection member 114 of the sheath unit 24 engaged with the slit portions 68a and 68b of the rotation fixing member 68, and the sheath unit connection member 114 The jaw unit connecting member 126 of the jaw unit 26 engaged with the inward protruding portions 114e and 114f also rotates. Other members fixed integrally with these members also follow and rotate. That is, when the surgeon rotates the rotation knob 74, the rotation fixing member 68, the rotation connection member 66, the sheath connection member 72, the drive pipe connection member 80, the slider receiving member 82, the positioning member 90, the contact pipe 92, the transducer unit The guide 96 rotates relative to the operation unit main body 54. For this reason, when the rotation knob 74 is rotated, the sheath unit 24 and the jaw unit 26 also rotate following the rotation of the rotation knob 74.

  Next, the operator holds the finger hook holes 56 a and 58 a of the fixed handle 56 and the movable handle 58 and rotates the movable handle 58 with respect to the fixed handle 56. The finger hook hole 58 a of the movable handle 58 is brought close to the finger hook hole 56 a of the fixed handle 56. That is, the fixed handle 56 and the movable handle 58 are relatively closed.

  The movable handle 58 rotates with the fulcrum pin 60 of the operation unit main body 54 as a fulcrum. In conjunction with the operation of the movable handle 58, the action pin 62 moves in an arc shape with the fulcrum pin 60 as a fulcrum. Since the end portion of the action pin 62 is engaged with the pin receiving portion 86a of the slider 86 inside the operation portion main body 54, the slider 86 is pushed to the tip end side in the axial direction, and the force for closing the movable handle 58 is the shaft. It is converted into the force at the direction tip side. On the contrary, when the operation of opening the movable handle 58 is performed, the slider 86 is pushed out to the rear end side in the axial direction, and the force for opening the movable handle 58 is converted into the force on the rear end side in the axial direction.

  Since the slider 86 is biased to the slider receiving member 82 by a driving force limiting spring 88 with a constant force toward the rear end side in the axial direction, the force on the front end side in the axial direction due to the closing operation of the movable handle 58 is the driving force limiting spring. When the amount of power is 88 or less, the slider receiving member 82 and the drive pipe connecting member 80 are integrally slid in the distal direction. When the force on the distal end side in the axial direction due to the closing operation of the movable handle 58 becomes equal to or greater than the installation force amount of the driving force limiting spring 88, the slider 86 is connected to the slider receiving member 82 and the driving pipe against the driving force limiting spring 88. It slides to the axial direction front end side with respect to the member 80, and it is prevented that the axial force of the axial direction front end side more than fixed is transmitted to the drive pipe connection member 80.

  When the force on the axial front end side due to the closing operation of the movable handle 58 is less than or equal to the amount of force of the driving force limiting spring 88, the drive pipe connecting member 80 also slides integrally to the front end side as described above. The axially distal force is transmitted via the drive pipe connecting pin 80a to the jaw unit connecting member 126 at the base end of the jaw unit 26 engaged therewith. Since the jaw support member 132 is fixed in the axial direction by engagement with the sheath unit 24, the drive pipe 128 coupled to the jaw unit connection member 126 slides in the distal direction with respect to the jaw support member 132. . Further, the drive pipe 128 is connected to the jaw main body 136 by a pin receiving portion 128c at the tip, and the jaw main body 136 is further rotatably attached by the jaw support member 132 and the pivot pins 140a and 140b. Pivots downward with pivot pins 140a and 140b as fulcrums (see FIG. 11C).

  Accordingly, the living tissue is grasped by sandwiching the living tissue between the grasping surface 138a of the grasping member 138 of the distal end working portion 134 and the treatment portion 46 of the probe unit 14 and closing the movable handle 58. On the contrary, when the movable handle 58 is operated in the opening direction with respect to the fixed handle 56, the jaw main body 136 is rotated upward with the pivot pins 140a and 140b as fulcrums due to the reverse action to the above-described action. 136, the operation of opening the gripping member 138 becomes possible.

  When the ultrasonic transducer of the transducer unit 16 is vibrated while grasping the living tissue, the ultrasonic vibration is transmitted from the maximum diameter portion 44 of the probe unit 14 to the treatment portion 46 through the horn portion 42 and the vibration transmitting member 40. . The living tissue receives a force in a closing direction from the gripping surface 138 a of the gripping member 138 via the jaw main body 136 with respect to the treatment portion 46 of the probe unit 14. When ultrasonic vibration is transmitted in this state, frictional heat is generated on the surface where the living tissue is in contact with the treatment portion 46, and a coagulation action is produced. Furthermore, the biological tissue that has become brittle due to the coagulation action is mechanically cut by ultrasonic vibration, and treatment for coagulation and incision is performed.

  On the other hand, a cord for supplying a high-frequency current from a high-frequency power source (not shown) is connected to the high-frequency connection pin 94, and the high-frequency current is supplied from the high-frequency power source. Then, a high-frequency current flows from the deformed cross-sectional shape portion 48 of the probe unit 14 to the probe unit 14 through the high-frequency connection pin 94, the vibrator unit guide 96, the connector 92a, the contact pipe 92, and the positioning member 90. Therefore, the high-frequency current is transmitted to the treatment section 46 through the deformed cross-sectional shape section 48, the horn section 42, and the vibration transmission member 40. Therefore, a state in which the living tissue is gripped between the gripping surface 138a of the gripping member 138 of the distal end working unit 134 and the treatment unit 46 of the probe unit 14 opposed to the gripping surface 138a, or the treatment unit 46 is used as the living tissue. When a high-frequency current is supplied in the contact state, the living tissue is subjected to high-frequency treatment by the treatment unit 46 by Joule heat.

  Further, even if the pin receiving portion 128c, which is the weakest in strength of the drive pipe 128 of the jaw unit 26, is broken, the inwardly projecting portions 132g and 132h of the jaw support member 132 and the elongated hole 128a of the drive pipe 128 are engaged. The jaw support member 132 is rotationally fixed to the sheath unit 24 via the drive pipe 128 and the jaw unit connection member 126 because the jaw support member 132 is fixed in the rotational direction. Therefore, the engagement between the outward projecting portions 132 i and 132 j of the jaw support member 132 and the cam groove 118 a at the distal end portion of the long pipe 118 of the sheath unit 24 is not released, and the distal end portion is detached from the jaw support member 132. Is prevented.

  After the above-described ultrasonic treatment and high-frequency treatment are completed, the ultrasonic treatment instrument 10 is disassembled in order to clean the units 14, 16, 22, 24, and 26. In this case, first, the probe unit 14 and the transducer unit 16 are removed from the handle unit 22 by the action reverse to the action described above.

  As shown by an arrow ε in FIG. 15A, the rotation knob (lock release mechanism) 74 of the handle unit 22 is pulled toward the proximal end side of the operation unit main body 54. Since the rear end surface of the rotation knob 74 is in contact with the head of the first pin 70 a, the rotation fixing member 68 reduces the coil spring 78 toward the flange portion 66 b of the rotation connecting member 66, and the base of the operation unit main body 54. Move to the end side. At this time, the engagement between the slit portions 68a and 68b (see FIG. 6A) at the distal end portion of the rotation fixing member 68 and the fixing portions 114c and 114d of the fixing arms 114a and 114b is released. That is, the engagement between the rotation fixing member 68 and the sheath unit connection member 114 is released, and the insertion unit 28 can rotate with respect to the sheath connection member 72.

  In this state, the knob 112 of the sheath unit 24 is gripped, and the insertion unit 28 in which the sheath unit 24 and the jaw unit 26 are integrated is opposite to the operation when the ultrasonic treatment instrument 10 is assembled. Rotate about 60 °. That is, it is rotated as indicated by an arrow ζ in FIG. Then, the fixing portions (outward protruding portions) 114c and 114d of the sheath unit connection member 114 and the positions of the slits 72a and 72b of the sheath connection member 72 are aligned.

  At the same time, the drive pipe connection pin 80a of the drive pipe connection member 80 is disposed in the opening of the cam groove 126a at the proximal end of the jaw unit connection member 126 and disengages in the axial direction. In this state, the insertion unit 28 is removed from the sheath connection member 72 as indicated by an arrow η in FIG.

Next, the insertion unit 28 is disassembled into the sheath unit 24 and the jaw unit 26. In this case, an operation reverse to the operation of assembling the sheath unit 24 and the jaw unit 26 is performed. Then, the insertion unit 28 is disassembled into the sheath unit 24 and the jaw unit 26.
Next, the probe unit 14 and the vibrator unit 16 are disassembled. For this reason, the operation | work which disassembles the ultrasonic treatment tool 10 into five units, the probe unit 14, the vibrator | oscillator unit 16, the handle unit 22, the sheath unit 24, and the jaw unit 26, is complete | finished.

  In this state, each unit 14, 16, 22, 24, 26 is cleaned and disinfected so that it can be reused. When reusing, the ultrasonic treatment instrument 10 is assembled as described above.

As described above, according to this embodiment, the following effects can be obtained.
For example, even if any one of the handle unit 22, the sheath unit 24, and the jaw unit 26 is worn or damaged, the ultrasonic treatment instrument 10 is again obtained by replacing and reassembling only the worn or damaged unit. Therefore, the cost associated with replacement can be kept low.

  Further, in the main unit 12, the sheath unit 24 and the jaw unit 26 can be removed from the handle unit 22, so that each unit 22, 24, 26 can be reliably cleaned in a short time without using a special dedicated cleaning tool. can do. For this reason, the cost for cleaning the main unit 12 can be kept low.

  Further, when the ultrasonic treatment instrument 10 is used, even if the pin receiving portion 128c at the distal end that is weakest in strength is broken in the drive pipe 128 of the jaw unit 26 to which a large force is applied, the jaw support member 132 remains in the drive pipe 128. Therefore, the engagement of the distal end portion of the long pipe 118 of the sheath unit 24 with the cam groove 118a is not released, and the distal end portion is prevented from falling off from the jaw support member 132.

  In this embodiment, the operation of assembling the main body unit 12 by mounting the insertion unit 28 on the handle unit 22 after the insertion unit 28 is configured has been described. For example, the sheath unit 24 is mounted on the handle unit 22. After that, the jaw unit 26 may be attached to the sheath unit 24 and the handle unit 22 to assemble the main body unit 12.

  Further, when the main unit 12 is disassembled into three units 22, 24, 26, the operation of disassembling the insert unit 28 into two units 24, 26 after disassembling the insert unit 28 from the handle unit 22 has been described. However, for example, after the jaw unit 26 is separated from the handle unit 22, the sheath unit 24 may be separated from the handle unit 22.

  Next, a second embodiment will be described with reference to FIGS. This embodiment is a modification of the first embodiment. The same members as those described in the first embodiment are denoted by the same reference numerals, and detailed description thereof is omitted.

  In this embodiment, for example, instead of the curved type treatment section 46 (see FIG. 2A) of the probe unit 14 described in the first embodiment, as shown in FIG. A treatment portion 46A of the type extending in the above is used. When the shape of the treatment portion 46 at the tip of the probe unit 14 is different, and when the resonance frequency is designed to be the same, the lengths of the probe units 14 are different. In order to be able to use the common sheath unit 24, the handle unit 22 in which the assembly position of the transducer unit 16 and the handle unit 22 is shifted is necessary. Therefore, as shown in FIG. 17, various lineups are required for the handle unit 22 and the jaw unit 26 according to the probe unit 14 to be used. FIG. 17 shows an example thereof.

  In the column of the probe unit 14 in FIG. 17, four types of treatment portions 46 and deformed cross-sectional shape portions 48 for the treatment portions 46 are illustrated. The treatment part 46 is, in order from the top, a straight type 46A, a deformed straight type 46B having a different tip, and curved types 46C and 46D that are curved in different directions. The upper side of each column is a top view and the lower side is a side view. An irregular cross-sectional shape portion 48A of the straight type treatment portion 46A is the same as that shown in FIG. Although not shown here, the deformed cross-sectional shape portion 48A of the straight type treatment portion 46A may be the same as that shown in FIG. The deformed straight type and curved type treatment sections 46B, 46C, and 46D have deformed cross-sectional shape sections 48B including three plane sections 48f, 48g, and 48h, which will be described later, and one curved section.

  In the column of the jaw unit 26, three types are shown. In the uppermost column, a straight-type distal end working portion 134A in which the treatment portion 46 of the probe unit 14 is suitable for the probe units 14A and 14B having the straight type 46A and the deformed straight type 46B, and a jaw unit 26A having such a distal end working portion 134A. It shows. In the middle column and the lower column, curved type tip action portions 134B and 134C in which the treatment portion 46 of the probe unit 14 shown on the left side in FIG. 17 is adapted to the probe units 14C and 14D having the curved types 46B and 46C, respectively. The jaw units 26B and 26C having such tip action portions 134B and 134C are shown. The upper stage of each column is a top view of the distal end working part 134, the middle stage is a side view of the distal end working part 134, and the lower stage is a side view of the jaw unit 26.

  In the column of the handle unit 22, four types are shown. The handle unit 22A in the uppermost column and the handle unit 22C at the third stage from the top are the same type in appearance, but have different internal configurations such as the positioning member 90 and the drive pipe connecting member 80, for example. Similarly, the handle unit 22B in the second stage and the handle unit 22D in the lowermost column are the same type in appearance but have different internal configurations. In these handle units 22B and 22D, the movable handle 58 is arranged on the upper side in FIG.

  The handle unit 22 has an erroneous mounting prevention mechanism that prevents the wrong combination of units in the lineup from being assembled. Hereinafter, the erroneous mounting prevention mechanism will be exemplified.

  As described above, when the probe unit 14 is designed to match the resonance frequency with respect to the different shape of the treatment portion 46 at the tip, the length in the axial direction differs by several millimeters. Therefore, the length of the treatment section 46 of the probe unit 14 shown in FIG. 17 is different between the straight type 46A and the modified straight type 46B. The bending types 46C and 46D have the same length because they have the same degree of bending. Further, even when the straight type 46A and the modified straight type 46B are compared with the curved types 46C and 46D, the lengths are different.

  In order to make it possible to use one kind of sheath unit 24 for a plurality of probe units 14A, 14B, 14C, and 14D having different lengths, the length of the distal end working portion 134 of the jaw unit 26, the handle The abutting position between the unit 22 and the vibrator unit 16 is adjusted. For example, in the probe unit 14 of this embodiment provided with the treatment part of the straight type 46A and the deformable straight type 46B, the same tip action part 134 of the jaw unit 26 can be used.

  However, since the length of the probe unit 14 is different, in order to combine with the jaw unit 26 and the sheath unit 24 having the same length, it is necessary to change the abutting position of the transducer unit 16 with respect to the handle unit 22. For example, in the present embodiment, one of the handle units 22A and 22B is required for the probe unit 14A, and one of the handle units 22C and 22D is required for the probe units 14B, 14C, and 14D. Further, the jaw unit 26 corresponding to the length of the probe unit 14 having the treatment portion 46 of the deformed straight type 46B and the curved type 46C, 46D is the tip action portions 134A, 134B, 134C of the jaw units 26A, 26B, 26C, respectively. The only difference is the length. For this reason, the abutting positions (mounting positions) of the handle units 22C and 22D and the vibrator unit 16 are the same. Then, the handle units 22C and 22D can be used for the jaw units 26A, 26B, and 26C. Further, the handle units 22C and 22D can be used for the probe units 14B, 14C and 14D.

  A probe unit 14A shown in FIG. 16A includes a straight type cylindrical treatment portion 46A shown in FIG. In this case, since the treatment portion 46A has a complete cylindrical shape, the treatment portion 46A functions regardless of the position around the axis with respect to the gripping member 138 in the distal end working portion 134A of the jaw unit 26A. Therefore, as shown in FIG. 16B, the outer peripheral surface of the irregular cross-sectional shape portion 48A is provided with three plane portions 48c, 48d, and 48e that are equally divided into three on the circumference. That is, the plane portions 48c, 48d, and 48e are formed symmetrically with respect to the center of the deformed cross-sectional shape portion 48A.

  Although not shown, the handle units 22A and 22B to which the probe unit 14A is attached are formed with a positioning member (first attaching / detaching mechanism) 90A having a hole having the same shape as the deformed cross-section 48A. For this reason, the probe unit 14A can be assembled every 60 ° around the axis with respect to the positioning member 90A of the handle units 22A and 22B.

  The treatment units 46B, 46C, and 46D of the probe units 14B, 14C, and 14D shown in FIG. 17 are positioned so as to come into contact with the tip action portions 134A, 134B, and 134C of the corresponding jaw units 26A, 26B, and 26C, respectively. Necessary. Therefore, as shown in FIG. 17, flat portions 48f, 48g, and 48h are provided at three positions of 90 ° on the outer peripheral surface of the deformed cross-sectional shape portion 48B. The surface connecting the flat portions 48f and 48h is preferably formed on a surface other than one plane such as a curved surface or a plurality of planes.

  The handle units 22C, 22D to which the probe units 14B, 14C, 14D are attached are formed with positioning members (first attaching / detaching mechanisms) 90B having holes having the same shape as the deformed cross-section 48B, although not shown. ing. For this reason, the probe units 14B, 14C, and 14D can be assembled only once with respect to the positioning member 90B, the slider receiving member 82, and the drive pipe connecting member 80 of the handle units 22C and 22D.

  Further, in the present embodiment, as shown in FIGS. 18A and 18B, a drive pipe connection pin (secondary) is provided at the tip of the drive pipe connection member 80 of the handle units 22A, 22B, 22C, 22D. 1) 80a is provided. The jaw unit connection member 126 of the jaw units 26A, 26B, and 26C is provided with only one cam groove 126a that engages with the one drive pipe connection pin 80a. With this configuration, the insertion unit 28 in which the jaw unit 26 and the sheath unit 24 are assembled can be assembled to the drive pipe connecting member 80, the slider receiving member 82, and the positioning member 90 of the handle unit 22 only at one location. Is positioned.

  For this reason, as shown in FIG. 17, the deformed cross-sectional shape portion 48A of the probe unit 14A and the deformed cross-sectional shape portion 48B of the probe units 14B, 14C, and 14D have different shapes. For this reason, the probe unit 14A cannot be assembled with the handle units 22C and 22D. The probe units 14B, 14C, and 14D cannot be assembled with the handle units 22A and 22B.

  In order to completely prevent the erroneous combination of the probe units 14A, 14B, 14C, 14D and the jaw units 26A, 26B, 26C, the jaw units 26A, 26B, 26C are assembled to the corresponding handle unit 22 only at one place. As shown in FIG. 5 and FIG. 6B, the drive pipe connection pins 80a in the handle unit are created in two or more different numbers and positions. On the other hand, the jaw unit connection member 126 on the jaw units 26A, 26B, and 26C is also provided with cam grooves 126a that are adjusted in number and position so as to engage with the drive pipe connection pins 80a. Then, the jaw units 26A, 26B, and 26C can be assembled with the corresponding handle unit 22 only at one place.

As described above, according to this embodiment, the following effects can be obtained.
Since various units are provided with an erroneous mounting prevention mechanism that can mount only units that can be adapted to various units, it is possible to prevent erroneous mounting of various units.

  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 described. Including implementation.

  According to the above description, the following matters can be obtained. Combinations of the terms are also possible.

[Appendix]
(Additional item 1)
A transducer for converting current into ultrasonic vibration;
A probe for transmitting ultrasonic vibrations, a treatment portion is provided at the probe tip, and the probe tip treatment is interlocked with a handle, an elongated insertion portion, and an opening / closing operation of the handle at the tip of the insertion portion. In the ultrasonic coagulation and incision device having a gripping part that opens and closes against the part,
A treatment unit in which the handle is integrated with the gripping unit and a drive shaft for transmitting a driving force generated by opening and closing the handle to the gripping unit;
A sheath unit that covers from the proximal end portion of the distal treatment section of the treatment section unit to the handle;
A handle unit that is held by the operator's hand and can be opened / closed can be disassembled into three parts, and a mechanism is provided that prevents parts from falling off easily when only one part of the drive shaft is damaged in the assembled state. And

1 is a schematic side view of an ultrasonic treatment device according to a first embodiment. (A) is an outline showing a state in which the ultrasonic treatment instrument according to the first embodiment is disassembled into a main unit, a probe unit, and a transducer unit, and the main unit is further disassembled into a handle unit, a sheath unit, and a jaw unit. A side view, (B) is a sectional view which meets a 2B-2B line in (A). The perspective view of the main-body unit in the ultrasonic treatment tool which concerns on 1st Embodiment. The disassembled perspective view of the handle unit of the main body unit in the ultrasonic treatment apparatus according to the first embodiment. The longitudinal cross-sectional view of the handle | steering-wheel unit of the main body unit in the ultrasonic treatment tool which concerns on 1st Embodiment. The cross-sectional view of the handle | steering-wheel unit of the main body unit in the ultrasonic treatment tool which concerns on 1st Embodiment is shown, (A) is sectional drawing which follows the 6A-6A line in FIG. 5, (B) is in FIG. Sectional drawing which follows a 6B-6B line. The cross-sectional view of the handle | steering-wheel unit of the main body unit in the ultrasonic treatment tool which concerns on 1st Embodiment is shown, (A) is sectional drawing which follows the 7A-7A line in FIG. 5, (B) is in FIG. Sectional drawing which follows the 7B-7B line, (C) is sectional drawing which follows the 7C-7C line in FIG. The disassembled perspective view of the sheath unit of the main body unit in the ultrasonic treatment instrument according to the first embodiment. The disassembled perspective view of the jaw unit of the main body unit in the ultrasonic treatment apparatus according to the first embodiment. The front-end | tip part of the main body unit in the ultrasonic treatment tool which concerns on 1st Embodiment is shown, (A) is a longitudinal cross-sectional view, (B) is a cross-sectional view which follows the 10B-10B line in (A). 1A is a schematic perspective view showing a jaw body of a distal end working portion of a jaw unit of a main unit, and FIG. 1B is a perspective view of a distal end working portion of a jaw unit according to the ultrasonic treatment instrument according to the first embodiment. The schematic side view which shows the state which separated the projection part of the jaw main body from the protrusion part of the jaw support member, (C) is abutting the protrusion part of the jaw main body of the front-end | tip action part of a jaw unit to the protrusion part of a jaw support member. The schematic side view which shows the state made to do. The schematic perspective view which shows the state which attaches / detaches a sheath unit, a jaw unit, and a probe unit to the handle | steering-wheel main body of the ultrasonic treatment tool which concerns on 1st Embodiment. The assembly procedure of the ultrasonic treatment device concerning a 1st embodiment is shown, and (A) shows the state which moves a jaw unit in the direction of arrow alpha to a sheath unit, and assembles a jaw unit and a sheath unit. (B) is a schematic perspective view showing a state in which the jaw unit is rotated in the direction of arrow β and assembled to the sheath unit, and (C) is a state in which the jaw unit is assembled to the sheath unit. FIG. The assembly procedure of the ultrasonic treatment tool according to the first embodiment is shown, and (A) shows the insertion unit by moving the insertion unit in which the sheath unit and the jaw unit are integrated with respect to the main body unit in the arrow γ direction. FIG. 4B is a schematic perspective view showing a state in which the unit and the handle unit are assembled, FIG. 5B is a schematic perspective view showing a state in which the insertion unit is rotated with respect to the handle unit in the direction of the arrow δ, and FIG. The schematic perspective view which shows the assembled main body unit. The disassembling procedure of the ultrasonic treatment apparatus according to the first embodiment is shown, in which (A) moves the rotation knob of the handle unit in the arrow ε direction and rotates the insertion unit in the arrow ζ direction with respect to the handle unit. The perspective view which shows a state, (B) is a schematic perspective view which shows the state which rotated the insertion part unit to the arrow ζ direction in (A) with respect to a handle unit, (C) is a handle unit. On the other hand, a schematic perspective view showing a state in which the insertion unit is pulled out in the direction of arrow η and disassembled. (A) is a schematic side view of the probe unit in the ultrasonic treatment apparatus according to the second embodiment, and (B) is a cross-sectional view taken along the line 16B-16B in (A). Schematic which shows an example of each lineup of a probe unit, a jaw unit, a sheath unit, and a handle unit in the ultrasonic treatment apparatus according to the second embodiment. (A) is a longitudinal cross-sectional view of the handle unit of the main body unit in the ultrasonic treatment apparatus according to the second embodiment, and (B) is a cross-sectional view taken along the line 18B-18B in (A).

Explanation of symbols

  24 ... Sheath unit, 26 ... Jaw unit, 28 ... Insertion unit, 116 ... Insulating tube, 118 ... Long pipe, 120 ... End cover, 128 ... Drive pipe, 128a ... Long hole, 128b ... Inward projection, 128c ... Pin receiving part, 130 ... Protection member, 130a ... Annular groove, 132 ... Jaw support member, 132e, 132f ... Projection part, 132g, 132h ... Inward projection part, 132i, 132j ... Outward projection part, 134 ... Tip action Part, 136 ... jaw body, 138 ... gripping member, 138a ... gripping surface, 140a, 140b ... pivot pin, 142 ... connecting pin

Claims (8)

Has a distal end and a proximal end, a long shaft-shaped probe having a treatment portion for treating the living tissue in the tip portion,
A gripping part for gripping a living tissue disposed at a position where the treatment part of the probe is opposed to the treatment part and capable of being opened and closed with respect to the treatment part; A driving member for opening and closing the gripping portion that is pivotally connected at the tip, and a support member disposed on the outer periphery of the driving member so as to be connectable between the gripping portion and the driving member; A treatment unit comprising:
A sheath unit that covers the outer periphery of the drive member and is detachable from the treatment unit;
A dropout prevention mechanism for preventing at least a part of the constituent members of the treatment unit from falling off the treatment unit after a large force is applied to the treatment unit ;
The drop-off prevention mechanism is
An inward projection formed on the support member and projecting radially inward;
An outward projection projecting radially outward;
A first recess formed in the drive member and engaged with the inward projection;
A second recess formed on the inner peripheral surface of the sheath unit and engaged with the outer protrusion;
It characterized in that it comprises a coagulation Setsu閉device. It said first recess, coagulation dissection apparatus according to claim 1, wherein the inner protrusion and a engaged hole. It said second recess, coagulation dissection apparatus according to claim 1, characterized in that the outer protrusion is provided with the engaged cam groove. The treatment unit includes a tubular member having an insulating property in close contact with an inner periphery of a distal end portion of the drive member, while the drive member has a pipe shape into which the probe can be inserted.
The drop-off prevention mechanism is formed by engaging at least a part of the outer circumferential surface of the cylindrical member with an inward protruding part in which at least a part of the driving member protrudes radially inward and the inward protruding part. coagulation dissection apparatus according to claim 1, characterized in that it comprises a formed groove. A long-axis probe having a distal end portion and a proximal end portion, and having a treatment portion for treating a living tissue at the distal end portion ;
A treatment member including a drive member and an action portion arranged at a position facing the treatment portion of the probe, the treatment portion being rotatable at the tip portion of the drive member; Unit,
A dropout prevention mechanism for preventing at least a part of the constituent members of the treatment unit from falling off the treatment unit after a large force is applied to the treatment unit ;
The treatment unit includes a support member disposed on an outer periphery of the drive member so as to be connectable between the action portion and the drive member.
The drop-off prevention mechanism is
An inward projection formed on the support member and projecting radially inward;
An outward projection projecting radially outward;
A first recess formed in the drive member and engaged with the inward projection;
A second recess formed on the inner peripheral surface of the sheath unit and engaged with the outer protrusion;
It characterized in that it comprises a coagulation dissection device. It said drive member, coagulation dissection apparatus according to claim 5, characterized in that it comprises a interpolation capable tubular the probe. Said first recess, coagulation dissection apparatus according to claim 5 or claim 6, wherein the inner protrusion and a engaged hole. It said second recess, coagulation dissection apparatus according to claim 5 or claim 6, characterized in that the outer protrusion is provided with the engaged cam groove.

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