JP5287087B2 - forceps - Google Patents

Description

  The present invention relates to a surgical forceps and a needle holder (hereinafter, referred to as a forceps including a needle holder) used in laparoscopic surgery or the like.

Known as forceps for performing an operation under an endoscope such as a laparoscope, a forceps mechanism at the front end and an operation portion at the rear end are connected, and a pair of forceps pieces are opened and closed by the operation portion. .
In consideration of the operability of the surgical forceps, it is preferable to be able to perform the three operations of bending the tip, opening and closing the pair of forceps pieces, and around the bending axis of the forceps pieces.
For example, in US Pat. No. 5,254,130, an intermediate pipe to which a forceps piece is attached is elastically bent in advance, and the intermediate pipe is gradually exposed by pulling a straight outer pipe toward the hand, and the bending degree of the distal end portion Disclosed is a technique for adjusting the frequency.
However, such a structure has a problem that it is not easy to bend it to a desired angle.
Japanese Patent Application Laid-Open No. 2005-211683 discloses a technique having a double structure of an outer pipe for bending a distal end portion to which a forceps piece is attached and an intermediate pipe for transmitting rotation to the forceps piece. Since it is necessary to prevent interference between the bending operation knob that pulls the bending wire and the rotation transmission shaft that rotates in the circumferential direction by the rotation of the rotation operation ring, the bending wire is disposed outside the outer casing and the rotation transmission shaft. It is.
For this reason, while the diameters of the insertion part and the bent part are increased, the diameter of the rotation transmission shaft and the outer casing is reduced, and the forceps piece is easily twisted, whereby the rotation angle of the operation part and the rotation angle of the tip part are reduced. There is a problem that misalignment and delay are likely to occur between the two.
In the operation portion, a bending operation knob that bends the distal end portion and a rotation operation ring that rotates the distal end portion are separately disposed.
Therefore, for example, when the ring finger is inserted into the operation grip, the thumb is inserted into the operation handle, and the bending operation is performed using the index finger, the index finger that operated the bending operation knob the next time the rotation operation is performed. Since it is necessary to perform the rotation operation by moving the index finger up and down after separating the bending operation knob from the bending operation knob and moving it to the side of the rotation operation ring, the movement from the bending operation to the rotation operation is not smooth. There was a problem of being inferior.
Further, since the rotation operation is performed with one index finger, the entire forceps may be shaken in the left-right direction during the rotation operation, which is not suitable for an operation requiring a precise and delicate work.

US Pat. No. 5,254,130 JP 2005-211683 A

  In view of the technical problems described above, the present invention provides a forceps that can be easily operated with one hand for bending the tip, opening and closing the forceps piece, and rotating the forceps piece in the bending axis, and with less blurring in the bending axis. Objective.

The forceps used for laparoscopic surgery, etc., in which surgery is performed by inserting a forceps while observing with an endoscope (laparoscope) without incising the abdomen, has a thin insertion portion so that the operation can be performed minimally invasively. It is eagerly desired to be able to freely perform operations such as pinching, turning, or cutting with one hand.
The present invention has a structure in which the bent portion is flexible in the bending direction, has high bending accuracy, and has a high rigidity in the direction perpendicular to the bending direction, for example, and the outer pipe extends along the bending axis. The present invention has been achieved under the idea that if the inner rotation is made possible, the forceps have a smaller diameter and excellent operability.

  The forceps according to the present invention have a knob portion having a pair of forceps pieces that can be opened and closed by a link mechanism, a bending portion that can be bent only in one direction with the knob portion connected to the tip, and rotation within the bending axis. A forceps including a free connecting portion and an operation portion provided at a rear end of the connecting portion, wherein the connecting portion has an outer pipe having a bent portion and a center having a bent portion provided inside the outer pipe. The outer pipe has a shaft and a pulling wire, the tip of the outer pipe is pivotally supported by an opening / closing fulcrum of a pair of forceps pieces, and the rear end is connected to a dial provided in the operation unit. It is pivotally attached to the link base end of one piece, and the rear end is connected to the lever provided in the operation part, and the pulling wire is connected to the tip side of the outer pipe bending part, or the central axis is bent. Connected to the front end side of the unit, and the rear end connected to the advancing and retracting direction of the dial. The pair of forceps pieces are opened and closed by the lever advancement and retraction operation, the bending portion bends and stretches in one direction by the dial advancement and retraction operation, and the knob portion rotates within the bending axis by rotating the outer pipe by the dial rotation operation. Features.

  Here, having a bent portion that can be bent only in one direction means that, for example, the operating portion is gripped with one hand, and the tip portion is bent only in the vertical direction so as to be bent only in the lower direction. “Inner rotation is free” means that the rotation is transmitted along the bending axis without being bent back and forth and right and left while being bent, and the knob connected to the bent tip is rotated around the bent axis.

The open / close fulcrum of the pair of forceps pieces that perform the pinch operation is pivotally supported at the tip of the outer pipe, and the tip of the center shaft is pivotally attached to the link base end linked to the pair of forceps pieces. By advancing and retracting with the lever, the base end part advances and retreats with respect to the outer pipe distal end, and the pair of forceps pieces open and close.
Moreover, since the rear end of the outer pipe is connected to the dial, turning the dial rotates the outer pipe and the pair of forceps pieces.
The pulling wire bends the tip of the forceps in one direction by advancing and retracting the dial connected to the rear end. When connecting the tip of the wire to the outer pipe, follow the rotation of the outer pipe, It will be movably connected.
Since the central axis only moves forward and backward and does not rotate, it is preferable that the structure of the bent portion bends and stretches only in one direction due to frame connection or the like and does not bend in the other direction.

As a method of arranging the pulling wire, the connecting portion is a triple structure of the outer pipe, the inner pipe provided inside the outer pipe, and the central shaft provided in the inner pipe, and the tip of the pulling wire is An example is a structure in which the rear end is connected in the dial advancing / retreating direction of the operation portion, connected to the front end portion of the inner pipe connected to the front end side of the bent portion of the central axis.
In this case, if the bent part of the inner pipe has an elastic structure and the rear end is fixed to the casing of the operation part, the dial can be moved forward, and if the pulling wire is loosened, the bent part of the inner pipe can be elastically restored. The connecting part returns in the linear direction.
As described above, if the bent portion of the inner pipe has an elastic structure, the bent portion of the outer pipe does not necessarily have an elastic structure.
Further, the outer pipe is rotated by the rotation of the dial, but the inner pipe is kept in a bent state and is connected to the operation portion so as not to rotate.

In addition, as a method of arranging the pulling wire, three or more wires are arranged in an equal division around the shaft along the guide groove or guide hole provided in the longitudinal direction of the outer pipe, and the three or more wires are arranged. the tip is connected to the bent tip end of the outer pipe, is fixed at the rotating member to rotate the rear about the axis, the rotating member is Yes and pivoted rotatably to tilting member, the inclined member, the The lower part of the inclined member is connected with the dial and an inclined arm so as not to prevent the dial from rotating. When the dial is moved backward, the inclined member is inclined so that the rotating member is inclined and the outer pipe is bent. May be.
In this case, the bent portion of the outer pipe has an elastic structure, and when the pulling wire is loosened, the connecting portion returns in the linear direction.
The reason why the number of pulling wires is three or more is to stabilize the rotation of the outer pipe in the bending axis, and the larger the number, the smoother the rotation of the rotating member.

  In order to make the bent part of the outer pipe flexible in the bending direction, durability of rotation and stability of elastic deformation, the bent part of the outer pipe is an elastic piece that crosses the outer periphery of the bent part vertically and horizontally. It is preferable to have a cross spring structure in the vertical and horizontal directions that are alternately connected.

  In order to improve flexibility of the inner pipe and rigidity in directions other than the bending direction, the bent part of the inner pipe is a vertical cross connected by an elastic piece that crosses the left and right of the outer periphery of the bent part in the vertical direction. A spring structure is preferred.

In the forceps according to the present invention, the dial can be connected to the rear end portion of the outer pipe, and the lever can be connected to the central axis protruding from the rear end of the outer pipe. By providing the finger within the reach of one hand and holding it, the three operations of opening and closing the forceps piece by the lever, bending and stretching by the advancement and retraction of the dial, and in-axis rotation of the forceps piece by rotating the dial can be easily performed with one hand.
In addition, since the outer pipe can be rotated in the bending axis, the diameter of the insertion portion is small, and the size can be reduced.

An embodiment of a forceps 10 according to the present invention will be described below with reference to the drawings.
FIG. 1 shows an appearance example of forceps used for surgery.
The tip portion has a knob portion 20 for opening and closing a pair of forceps pieces, the knob portion 20 is connected to a connecting portion 40 having a bent portion 30, and an operation portion 90 that can be operated with one hand at the rear end of the connecting portion 40. Have.
First, an overall operation example will be described.
Close the lever -70 to a housing 50 provided on the operation unit 90 with one hand in the operation unit 90 as the knob unit 20 and the operation grip in the direction of f ₁ is shown in V _1, when the free lever 70 spring The knob is opened by urging.
A dial 60 provided on the operation unit 90 of the f ₂ direction, i.e., the bent portion 30 pulls the proximal side is curved in the direction of V ₂ (downward direction in FIG. 1), up and down to indicate the dial 60 with f ₃ turning to, unchanged the angle knob 20 has the bent and direction, along the curved axis rotates as indicated by V ₃ about its axis (referred to as the bending axis rotation.).
In this specification, as shown in FIG. 1, the operation unit 90 is grasped with one hand, the direction in which the knob is bent and stretched is defined as the vertical direction, and the front-rear direction in FIG. 1 is defined as the horizontal direction.
Further, the direction in which the dial 60 and the lever 70 are pulled toward the proximal side is defined as the backward direction, the direction in which the dial 60 and the lever 70 are moved toward the distal end portion is defined as the forward direction, and the forward / backward direction is indicated by an arrow in FIG.

Next, a structural example of each main part will be described.
FIG. 2 shows an example in which the connecting portion 40 has a triple structure of the outer pipe 100, the inner pipe 200, and the central shaft 300.
2A is an enlarged view of the knob portion 20 and the bent portion 30. FIG. 2B shows a state in which only the outer pipe 100 is shown, FIG. 2C shows only the inner pipe 200, and FIG. 2D shows a state in which only the inner pipe 200 is bent. (E) represents only the central axis 300.
The knob portion 20 is opened and closed by a pair of forceps pieces 21 a and 21 b at an opening and closing fulcrum 22.
As shown in FIG. 2A, the opening / closing fulcrum 22 is pivotally supported by a pin hole 103 provided at the tip of the outer pipe 100.
The pair of forceps pieces 21a and 21b has a link mechanism in which link arms 23a and 23b extend on the operation portion 90 side of the opening / closing fulcrum 22 and are axially attached (25a and 25b) to the link members 24a and 24b. The end 26 is pivotally attached to the tip of the central axis.
In FIG. 2 (e), reference numeral 303 denotes a pivot pin.
A plurality of pieces 301 are axially connected 302 so that the bent portion 30 of the central shaft 300 bends and stretches only in the vertical direction.
Note that the number of connecting pieces 301 is appropriately set according to the length and radius of the bent portion.
The inner pipe 200 is made of an elastic material, and a notch 201 is partially formed on the inner side of the bent portion 30, and a pulling wire 203 is provided on the inner side of the inner pipe 200 on the notch side. .
The tip of the traction wire 203, Yes coupled to the distal end portion 203a of the inner pipe 200, the distance between pull the traction wire 203 in the direction of _{f 2} bent portion the pipe wall 202, 202 inside the adjacent narrower, downwardly To curve.
When the pull of the pulling wire 203 is loosened, it returns to a straight line due to the elasticity of the inner pipe 200.
The outer pipe 100 is made of an elastic material, and the bent portion 30 is formed by alternately forming vertical cutouts 102 and horizontal cutouts 101, and has bending flexibility and rotational durability. .

Next, a structural example of the operation unit 90 will be described with reference to FIGS.
FIG. 3 shows an example of the internal structure of the housing 50. The outer pipe 100 is rotatably supported by a bush 110, and is provided on the outer periphery of the outer pipe between a flange 114 provided on the housing 50 and the bush 110. The ring 113 is supported so as not to move in the forward / backward direction.
Note that the ring 113 rotates together with the outer pipe 100.
A dial 60 is connected to the outer pipe 100, and when the dial 60 is rotated, the outer pipe 100 rotates.
The inner pipe 200 disposed on the inner side of the outer pipe 100 penetrates the dial 60 in the forward / backward direction, and the rear end portion is fixed by a fixing bracket 230.
A central shaft 300 provided on the inner side of the inner pipe protrudes from the rear end of the inner pipe, penetrates the fixed bracket 230 in the forward / backward direction, and has a pin connection 72 between the grip portion of the lever 70 and the rotation fulcrum 71.
In the present embodiment, the lever 70 has a substantially T-shape, and a spring member 75 is connected to the return arm 73.
One end of the spring member 75 is fixed to the fixing pin 74 of the housing 50 and the other end is connected to the vicinity of the distal end 73a of the return arm 73. When the surgeon holds the lever 70, the lever 70 moves the rotation fulcrum 71. With the center of rotation, it rotates toward the hand while facing the spring member 75.
Accordingly, the central axis 300 is pulled in the direction of f _1, a pair of forceps in the handle portion is closed.
When the lever 70 is released, the lever is restored by the urging force of the spring member 75, and the pair of forceps pieces are opened.
Note that the present invention is not limited to this embodiment as long as the central axis moves forward and backward by lever operation.

The dial 60 is movable forward and backward along the slit 120 in the longitudinal direction of the outer pipe, and is attached to an arm 61 connected to a support ring 112 attached to the outer periphery of a support shaft 111 connected to the dial 60 so as to be relatively rotatable. rear end be coupled puller wire 203 and pull the dial 60 in the direction of f _2, the traction wire 203 is pulled, the bending portion is bent.
FIG. 4 shows a state where the dial 60 is retracted.
The dial 60 moves along the slit 120 of the outer pipe.
In addition, a latch mechanism 80 including a movable latch piece 81 and a fixed latch piece 82 is provided so that the bent state by a predetermined angle can be maintained.
As shown in FIG. 5, when the latch lever 83 is pulled, the engagement of the latch is released, and the bent portion 30 is elastically restored to the direction of the straight line by the elasticity of the bent portion 30.
The outer pipe 100 and turning the dial 60 in one of the vertical direction as indicated by f ₃ is constrained to the dial 60 at the slit portion 120, the outer pipe 100 rotates in the direction of the dial 60, the bent portion 30 the inner pipe It is elastically deformed following the 200 bend and rotates into the bend axis.
Thereby, the knob part 20 rotates.
The member denoted by reference numeral 210 in FIG. 4 is a sliding member for holding the support ring 112 and the arm 61 pulling the wire so as not to rotate together with the dial 60 when the dial is rotated.

6 and 7 show modifications of the bent portion of the outer pipe.
FIG. 6 shows that the outer pipe 100a easily rotates following the bent portion of the inner pipe, and a plurality of hollow pieces 101a and 102a are alternately pivotally mounted on the left and right side surfaces and the upper and lower horizontal surfaces so as to improve durability. 101b and 102b) are connected examples.
FIG. 6B shows a perspective view of the state in which the hollow piece 101a and the hollow piece 102a are disassembled.
The hollow piece 101a has connecting protrusions (101c, 101d) alternately at four locations, upper and lower, and left and right, and has a hollow portion 101g in which an inner pipe is disposed.
The corresponding hollow piece 102a has a hollow portion 102g and upper and lower and left and right connecting surfaces. The connecting hole 101f provided in the connecting protrusion of the hollow piece 101a and the connecting hole 102f of the hollow piece 102a are pin-pinned using pins or the like. (101b, 102b).
The connecting facing surface 101e of the hollow piece 101a is a concave surface that protrudes on the side of the connecting protrusion so as not to interfere with the hollow piece 102a when it is turned and bent around the connecting holes of the left and right connecting protrusions 101d and 101d.
In this way, if the left and right side surfaces and the upper and lower horizontal planes are pivoted alternately, the upper and lower and left and right bending points can be at the same position with respect to the forward / backward direction.
FIG. 7 shows an example of an elastic structure that improves the flexibility and durability of the bent portion 30 and can suppress the vertical and horizontal blurring by rotation within the bending axis.
The outer pipe 100b is made of an excellent elastic alloy called a super elastic alloy material. As shown in a side view of FIG. 7A and a plan view of FIG. 7B, a substantially U-shaped notch 107 is formed. A so-called cross spring structure in which the outer pipe peripheral wall is crossed so that the elastic pieces 106a and 106b overlap is formed alternately.
An enlarged view of the crossed cross spring portion is shown in FIG.
The elastic pieces 106a and 106b overlap in a separated state.
In addition, although the rotational deviation is small even in the cloth where the overlapping portions are connected, the rotational deviation can be further reduced by separating the overlapping portions.
When such a cross spring structure in the left and right vertical directions and the horizontal direction in the upper and lower directions is adopted, the bending point becomes the same position on the left and right and the upper and lower sides, and rotation blur is further reduced.

8 and 9 show a modification of the inner pipe.
FIG. 8 is an example in which the bendability of the inner pipe 200a is improved, in which a notch 204 is formed in the upper and lower sides, and a pulling wire 203 is provided along the inner wall on the inner side of the bend.
The horizontal wall 205 bears the rigidity and elastic force in the horizontal direction.
The inner pipe 200b shown in FIG. 9 bends and stretches flexibly in the vertical direction, and has notches 207 in the upper and lower portions so as to have high rigidity in the horizontal direction, and elastic pieces 206a and 206b are overlapped on the left and right peripheral walls. This is an example in which a cross spring structure is used.
FIGS. 9C and 9D show a state where the overlapping portions of the elastic pieces 206a and 206b are crossed but separated from each other.
When such a cross spring structure is used, the bending flexibility is improved, and when the pulling wire 203 is pulled, it can be bent to a small R and has a large elastic restoring force.
In the present embodiment, the crossed overlapping portions are separated from each other, but may be deformed by being connected in a cross shape without necessarily separating them.

10 to 12 show an embodiment in which a pulling wire is provided on the outer pipe without providing the inner pipe.
In the present embodiment, as shown in FIG. 11B, an example of the cross-sectional structure of the outer pipe 100c, four pulling wires 241, 242, 243, and 244 are vertically and horizontally arranged along the inner peripheral surface of the outer pipe. This is an example in which they are arranged evenly around.
As shown in FIG. 11C, the four pulling wire tips are connected to the vicinity of the tip of the outer pipe 100c.
In addition, since the knob part 20 pivotally supported by the front-end | tip part of an outer pipe is the same as that of FIG. 2, description is abbreviate | omitted.
As shown in FIGS. 11A and 12A, the rear ends of the four pulling wires are evenly connected around the shaft to the rotating member 260 via the connecting arm 261.
The rotating member 260 is pivotally attached to the inclined member 250 so as to be relatively rotatable, and a positional deviation with respect to the connection arm 261 caused by the rotation of the rotating member 260 is adjusted by the adjusting arm 262.
The other end of the inclined arm 245 fixedly connected to the dial 60 and the lower portion 246 of the inclined member 250 are pin-connected 246a.
If such a structure is adopted, for example, in the state of FIG. 12A, the inclined member 250 is pushed by the inclined arm 245 and is inclined by the movement of the dial 60 on the proximal side, thereby lowering the pulling wire on the lower side. 241 is pulled the most, and the horizontal pull wires 242 and 244 are pulled according to the inclination angle of the inclined member.
Thereby, as shown in FIG. 12B, the bent portion 30 is bent downward, but when the outer pipe 100c is rotated by turning the dial 60, the rotating member 260 follows the rotation while keeping the inclination angle constant. The bending angle is kept constant.

FIG. 13 shows an example in which the connecting portion 40 and the operation portion 90 are detachable.
Although the drawing of the traction wire disposed on the inner pipe 200 or the outer pipe is omitted, if the rear end of the traction wire can be attached to and detached from the dial 60 side, the outer pipe 100 and the central shaft 300 can be made detachable. .
Various structures can be adopted as the detachable structure. For example, as long as the central axis is screwed and the outer pipe can be engaged in the rotation direction, the concave / convex fitting may be used.
In addition, a method of hooking the pulling wire can be considered.
Thereby, cleaning of a knob part etc. becomes easy.

  If the forceps structure according to the present invention is employed, the outer diameter of the pipe can be suppressed to 5 mm or less, and the durability of the bent portion is excellent, so that the present invention is not limited to laparoscopic surgery but can be used for surgery utilizing other endoscopes. Can be used widely.

The external appearance of the 1st Example of the forceps which concerns on this invention is shown. The structural example of a knob part and a bending part is shown. The structural example of an operation part is shown. An example of bending the tip is shown. An explanatory view for releasing a latch is shown. Another embodiment of the outer pipe is shown. The other structural example of an outer pipe is shown. Another embodiment of the inner pipe is shown. The other structural example of an inner pipe is shown. 2 shows a second embodiment of the present invention. The principal part explanatory drawing of 2nd Example is shown. An example of dial operation is shown. An example of attaching and detaching the connecting part and the operation part will be shown.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Forceps 20 Knob part 21a, 21b Forceps piece 22 Opening / closing fulcrum 26 Link base end part 30 Bending part 40 Connection part 50 Case 60 Dial 70 Lever 73 Return arm 75 Spring member 90 Operation part 100 Outer pipe 120 Slit 200 Inner pipe 203 Towing Wire 245 Inclined arm 250 Inclined member 260 Rotating member

Claims (5)

A knob portion having a pair of forceps pieces that can be opened and closed by a link mechanism;
A bending portion that can be bent only in one direction with the knob portion connected to the tip, and a connecting portion that is rotatable within the bending axis;
A forceps comprising an operating portion provided at the rear end of the connecting portion,
The connecting portion has an outer pipe having a bent portion and a central shaft and a pulling wire each having a bent portion provided inside the outer pipe,
The outer pipe is pivotally supported at the opening and closing fulcrum of the pair of forceps pieces, and the rear end is connected to a dial provided on the operation part.
The center axis is pivotally attached to the link proximal end of the pair of forceps pieces, and the rear end is connected to a lever provided in the operation part,
The puller wire is pivotally connected at the tip to the tip side of the outer pipe bent part, or connected to the tip side of the bent part of the central axis, and the rear end is connected in the advancing and retracting direction of the dial,
A pair of forceps pieces are opened and closed by lever advancement and retraction, a bending part bends and stretches in one direction by dial advancement and retraction operation, and a knob part rotates in a bending axis by rotating an outer pipe by rotation operation of the dial Forceps. The connecting portion has a triple structure of an outer pipe, an inner pipe provided inside the outer pipe, and a central axis provided in the inner pipe.
The tip of the pulling wire is connected to the tip of the inner pipe connected to the tip of the bent part of the central axis, and the rear end is connected in the advancing / retreating direction of the dial of the operation part. The forceps according to claim 1, wherein the forceps is fixed to the case. Three or more wires are arranged in equal divisions around the shaft along the guide groove or guide hole provided in the longitudinal direction of the outer pipe, and the tips of the three or more wires are connected to the distal end side of the bent portion of the outer pipe. The rear end is fixed to a rotating member that rotates around the axis.
The rotating member is pivotally attached to the inclined member,
The inclined member is connected to the lower part of the inclined member by the inclined arm so as not to hinder the rotation of the dial. When the dial is moved backward, the inclined member is inclined by tilting the inclined member, and the outer pipe The forceps according to claim 1, wherein the forceps are bent .   The bent portion of the outer pipe has a cross spring structure in the vertical and horizontal directions in which the outer periphery of the bent portion is alternately connected by elastic pieces crossed in the vertical and horizontal directions. The forceps according to crab.   3. The forceps according to claim 2, wherein the bent portion of the inner pipe has a cross spring structure in the vertical direction in which the left and right sides of the outer periphery of the bent portion are connected by an elastic piece crossed in the vertical direction.

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