JP5479970B2 - Surgical instrument - Google Patents

Description

  The present invention relates to a surgical treatment instrument that applies a current to a living tissue to perform a surgical treatment.

  In endoscopic surgery (also called laparoscopic surgery), a plurality of holes are opened in the patient's abdomen, etc., trocars (tubular instruments) are inserted into these holes, and then through each trocar, A laparoscope (camera) and a plurality of forceps are inserted into the body cavity. A gripper, a scissors, a blade of an electric knife, and the like are attached to the distal end portion of the forceps as an end effector for gripping a living tissue or the like. After the laparoscope and forceps are inserted into the body cavity, the operation is performed by operating the forceps while observing the inside of the abdominal cavity reflected on a monitor connected to the laparoscope. Since such an operation method does not require laparotomy, the burden on the patient is small, and the number of days until recovery and discharge from the operation is greatly reduced. For this reason, such an operation method is expected to expand the application field. For example, Patent Document 1 shown below is a document showing a conventional technique of forceps for endoscopic surgery.

  Of such forceps for endoscopic surgery, those having a pair of electrodes at the tip are called bipolar electric scalpels. A bipolar electric scalpel grips a living tissue with a pair of electrode members provided at the tip, and applies a high-frequency current to the living tissue to cause an incision action or a coagulation action (for example, see Patent Document 2 below). reference).

JP 2009-11698 A JP 2008-246222 A

  By the way, in the bipolar electric knife, it is desirable that the living tissue can be firmly grasped by the gripper in order to appropriately energize the living tissue. However, there are various shapes and sizes of living tissue to be grasped, and it can be said that conventional bipolar electric scalpel grippers can sufficiently cope with such differences in shape and size of living tissue. I want.

  The present invention has been made in view of the above circumstances, and is a surgical treatment instrument that functions as a bipolar electric scalpel and can appropriately cope with the shape and size of a living tissue to be grasped. It aims at providing the treatment tool.

In order to achieve the above object, the present invention is a surgical treatment instrument that applies a current to a grasped living tissue to perform a surgical treatment, and includes at least one of a pair of gripper members configured as a movable part, A gripper that can be opened and closed so as to grasp a living tissue, and one of the pair of gripper members has an arm part and a first electrode part that is swingably provided with respect to the arm part, The other of the pair of gripper members is configured as a second electrode portion facing the first electrode portion, and a portion on the proximal end portion side of the first electrode portion when the biological tissue is gripped by the distal end portion of the gripper And an insulating portion that insulates the second electrode portion from at least one of the first electrode portion and the second electrode portion , and the gripper includes a portion on the base end side of the first electrode portion and the second electrode portion. Connected to the proximal end of the second electrode Comprising a anchoring member having that flexible, characterized in that.

  According to the above configuration, when the living tissue is grasped by the pair of gripper members (first electrode portion and second electrode portion), the shape of the living tissue grasped by the first electrode portion provided so as to be swingable. Or change the posture according to the size. That is, the posture of the first electrode portion changes so as to adapt to the shape of the biological tissue to be grasped. Thereby, since it is possible to energize the living tissue while firmly grasping the living tissue, a stable cauterization action (incision action or coagulation action) can be generated. In addition, even when the living tissue is gripped by the tip of the gripper, short-circuiting due to direct contact between the first electrode portion and the second electrode portion is prevented by the insulating portion, so that the living tissue is appropriately energized. Is possible.

  The insulating part may constitute a part of a gripping surface of the first electrode part.

  According to said structure, since an insulation part is provided in the holding surface of the 1st electrode part rock | fluctuated with respect to a 2nd electrode part, when holding a biological tissue with the whole gripper, an insulation part also has a holding surface. Act as part of That is, when the living tissue is gripped by the tip of the gripper, the insulating portion prevents direct contact between the first electrode portion and the second electrode portion, while when the biological tissue is gripped by the entire gripper. The insulating part contacts the living tissue as a part of the gripping surface. Thus, since the gripper has both an insulating function and a gripping function, the gripper can be configured compactly.

  According to the surgical treatment instrument of the present invention, it is possible to appropriately cope with the shape and size of a living tissue to be grasped, and thereby energize the living tissue while firmly grasping the living tissue. Therefore, effects such as a stable cauterization action (incision action or coagulation action) can be obtained.

It is a perspective view of the medical manipulator which is a surgical treatment tool concerning a 1st embodiment of the present invention. It is a partially omitted side view showing the medical manipulator in a state where the operation unit and the working unit are separated. It is a perspective view of the gripper concerning one example of composition, and its peripheral part. It is a partial cross section side view of the gripper concerning one example of composition. 5A is a side view of a gripper according to one configuration example in a state where a relatively thin biological tissue is gripped, and FIG. 5B is a side view of the gripper according to one configuration example in a state where a relatively thick biological tissue is gripped. is there. It is a side view of the gripper which concerns on one structural example in the state which hold | gripped the biological tissue with the front-end | tip part. It is a perspective view of the gripper concerning the 1st modification, and its peripheral part. FIG. 8A is a side view of the gripper according to the first modified example in a closed state, and FIG. 8B is a side view of the gripper according to the first modified example in an opened state. It is a side view of the gripper which concerns on a 2nd modification, and its peripheral part. 10A is a side view of the gripper according to the third modified example in the opened state and its peripheral part, and FIG. 10B is a gripper according to the third modified example and its peripheral part in a state where the living tissue is gripped by the tip part. FIG. It is a side view of the manual type bipolar electric knife which is a surgical treatment tool which concerns on 2nd Embodiment of this invention.

  Hereinafter, a preferred embodiment of a surgical treatment tool according to the present invention will be described with reference to the accompanying drawings. FIG. 1 is a perspective view of a surgical treatment instrument according to the first embodiment of the present invention. In the present embodiment, the surgical treatment instrument is a medical manipulator 10 (hereinafter referred to as a manipulator) that operates an end effector provided at the distal end by a user (a medical worker such as a doctor) holding and operating the surgical treatment instrument. It is configured as.

  The manipulator 10 is a medical instrument for performing a predetermined treatment by grasping or touching a part of a living body with a distal end working unit 12 provided at the distal end. Usually, the manipulator 10 is a grasping forceps or a needle driver (holding tool). It is also called a needle). The manipulator 10 includes a manipulator main body 11 constituting a medical instrument, and a controller 29 connected to the manipulator main body 11 via a cable 28. The manipulator body 11 includes a body 21, a shaft 18 extending from the body 21, and a distal end working unit 12 including a gripper 19 provided at the distal end of the shaft 18.

  In the following description, the extending direction of the shaft 18 is defined as the Z direction, and the front (tip side) of the shaft 18 is defined as the Z1 direction and the rear (root side) is defined as the Z2 direction. Further, the right-and-left direction with respect to the manipulator body 11 when the manipulator body 11 is in the posture shown in FIG. 1 is the X direction, and in particular, the left side direction of the manipulator body 11 is the X1 direction, The right direction is defined as the X2 direction. Further, the vertical direction of the manipulator body 11 when the manipulator body 11 is in the posture shown in FIG. 1 is defined as the Y direction, and in particular, the upper direction is defined as the Y1 direction and the lower direction is defined as the Y2 direction. To do.

  Unless otherwise specified, the description of these directions is based on the case where the manipulator body 11 is in the reference posture (neutral posture). These directions are for convenience of explanation, and it is needless to say that the manipulator body 11 can be used in any direction (for example, upside down).

  The manipulator main body 11 includes an operation unit 14 that is gripped and operated by a hand and a work unit 16 that is detachable from the operation unit 14. The operation unit 14 constitutes a part of the body 21 described above, constitutes a housing, and a pair of left and right upper covers 25a and 25b extending in a substantially L shape in the Z1 direction and the Y2 direction, and the upper covers 25a and 25b. It has the drive part 30 accommodated in the inside, and the composite input part 24 operated manually.

  The drive unit 30 includes two motors 50 a and 50 b as a drive source 50 for changing the posture of the tip operation unit 12, and the driving force of the drive source 50 is applied to the tip operation unit 12 provided at the tip of the shaft 18. By being transmitted mechanically, the posture of the gripper 19 can be changed.

  A portion extending in the Y2 direction on the proximal end side of the operation unit 14 is configured as a grip handle 26 that is gripped by a hand. The composite input unit 24 is provided on the inclined surface of the upper part of the grip handle 26, and performs a rotation operation in the left-right direction with respect to the rotation operation unit 90 and a tilt operation with respect to the tilt operation unit 92, either alone or in combination. A signal corresponding to the operation is transmitted to the controller 29, and the controller 29 controls the driving of the driving unit 30, whereby the posture of the distal end working unit 12 is changed.

  The working unit 16 includes a pair of lower covers 37a and 37b divided substantially symmetrically in the Z direction as a housing. The distal end working unit 12 and the long and hollow provided with the distal end working unit 12 at the distal end are provided. The shaft 18, the base end side of the shaft 18 is fixed, the pulley box 32 accommodated in the lower covers 37a and 37b, the rear of the pulley box 32, and the axis in the X direction with the trigger shaft 39 as a fulcrum. And a trigger lever 36 pivotally supported at the center. The lower covers 37a and 37b, the pulley box 32, and the trigger lever 36 constitute a part of the body 21 described above.

  FIG. 2 is a partially omitted side view showing the manipulator body 11 in a state where the operation unit 14 and the working unit 16 are separated. As shown in FIG. 2, the drive unit 30 includes the motors 50a and 50b described above, the drive bevel gears 58a and 58b fixed to the output shafts 56a and 56b of the motors 50a and 50b, the drive bevel gears 58a, Two driven bevel gears 62a and 62b meshing with 58b, and drive shafts 60a and 60b to which the driven bevel gears 62a and 62b are fixed. At the lower end portions of the drive shafts 60a and 60b, for example, engaging convex portions 64a and 64b having a corrugated cross section are provided. With this configuration, the rotational driving force of the motor 50a (50b) is transmitted to the drive bevel gear 58a (58b), the driven bevel gear 62a (62b), the drive shaft 60a (60b), and the engaging convex portion 64a (64b). The

  The pulley box 32 is provided with pulleys 70a and 70b. The pulleys 70a and 70b are coaxial with the drive shafts 60a and 60b in a state where the working unit 16 is mounted on the operation unit 14. At the upper ends of the pulleys 70a and 70b, for example, engaging concave portions 74a and 74b having a corrugated cross-section exposed from the upper surface of the pulley box 32 are provided. Therefore, when the operating portion 14 and the working portion 16 are mounted, the engaging convex portions 64a and 64b and the engaging concave portions 74a and 74b are engaged, whereby rotational driving force from the drive shafts 60a and 60b is applied to the pulley 70a. , 70b. The engagement structure of the engagement convex part 64a and the engagement concave part 74a may be another structure.

  A wire (not shown) is wound around each of the pulleys 70a and 70b as a power transmission member. These wires are inserted into the shaft 18 and transmit driving force to the posture changing mechanism 13 provided in the distal end working unit 12 (see FIG. 1). Thereby, the rotational driving force from the drive shafts 60a and 60b is transmitted to the posture changing mechanism 13 through the pulleys 70a and 70b and the wire, and the posture of the gripper 19 is changed.

  As a mechanism for converting the operation of the trigger lever 36 into an opening / closing operation of the gripper 19 and a mechanism for converting the driving of the driving source 50 into an operation of changing the posture of the gripper 19, for example, Japanese Patent Application Laid-Open No. 2008-104855, You may employ | adopt the structure similar to the structure described in Unexamined-Japanese-Patent No. 2009-106606.

  As shown in FIG. 1, the working unit 16 is connected and fixed to the operation unit 14 by a pair of left and right attachment / detachment levers 40, 40 provided in the operation unit 14, and is operated by opening the attachment / detachment lever 40. And can be easily exchanged at the operation site without using a special instrument.

  The distal end working unit 12 includes a gripper 19 that opens and closes based on the operation of the trigger lever 36 and a posture changing mechanism 13 that changes the posture of the gripper 19 based on the operation of the composite input unit 24. The illustrated gripper 19 can be opened and closed with a predetermined opening and closing operation axis as a reference, and is configured as a gripper 19 that grips a living tissue. The gripper 19 has a pair of gripper members 19a and 19b.

  The manipulator body 11 has a first energization path E1 electrically connected to one gripper member 19a and a second energization path E2 electrically connected to the other gripper member 19b along the shaft 18. It is arranged. The manipulator body 11 is electrically connected to the high-frequency power source 23 via cables C1 and C2. In the illustrated example, the first energization path E1 can be connected to the cable C1 in the vicinity of the proximal end portion of the shaft 18, and the second energization path E2 is electrically connected to the cable C2 via the electrode plug 71 provided in the body 21. Can be connected.

  When the cable C1 and the first energizing path E1 are electrically connected, the cable C2 and the second energizing path E2 are electrically connected, and a high-frequency current is generated by the high-frequency power source 23, the first energizing path E1 and the second energizing path The gripper 19 can be energized via the path E2, whereby the living tissue grasped by the gripper 19 can be cauterized and incised or coagulated. That is, the manipulator 10 functions as a bipolar electric knife because the operation unit 16 including the gripper 19 capable of energizing the living tissue is attached to the operation unit 14.

  The distal end working unit 12 and the shaft 18 are configured to have a small diameter and can be inserted into the body cavity 22 through a cylindrical trocar 20 attached to the patient's abdomen or the like, and by operation of the composite input unit 24 and the trigger lever 36. Various procedures such as suturing and ligation can be performed by grasping the needle in the body cavity 22. Note that when the operation unit 16 equipped with a scissors or gripper for gripping the affected part is attached to the operation unit 14 as an end effector, the manipulator 10 functions as a scissors or gripping forceps that perform operations such as excision and gripping of the affected part. .

  The trigger lever 36 includes an arm portion 36a pivotally supported by a trigger shaft 39 provided at an end of the lower cover 37a, 37b on the Z2 direction side, and a trigger operator 36b provided on the Y2 side of the arm portion 36a. And have. The trigger shaft 39 is fixed to a support plate 45 (see FIG. 2) provided on the Z2 side of the pulley box 32. The trigger operator 36b has a ring part 36c and a generally arcuate finger hooking projection 36d provided on the Y2 side of the ring part 36c.

  The opening / closing operation of the gripper 19 is performed by mechanically transmitting a force based on a manual operation (push / pull operation) of the trigger lever 36. Specifically, a transmission mechanism including a rod, a wire (power transmission member), a pulley, and the like is provided inside the working unit 16, and the trigger lever 36 is pushed and pulled by the transmission mechanism. It is converted to the opening and closing operation.

  The posture change mechanism 13 is capable of a roll operation that rotates with a roll axis pointing at the tip (Z axis in a neutral posture) as a reference and a yaw operation (tilt operation) that tilts with respect to the yaw axis in the Y direction. The roll operation and the tilting operation can be performed selectively or in combination. Therefore, the distal end working unit 12 can perform a three-axis operation including an opening / closing operation, a roll operation, and a yaw operation of the gripper 19. In the case of the present embodiment, the posture change operation (roll operation and yaw operation) of the gripper 19 is driven by the drive source 50 based on the operation of the composite input unit 24 having the rotation operation unit 90 and the tilt operation unit 92. This is done by mechanically transmitting the driving force of the driving source 50 to the distal end working unit 12. In the illustrated manipulator body 11, the tip operation unit 12 is rolled by performing a rotation operation in the left-right direction with respect to the rotation operation unit 90, and the tilting operation is performed on the tilting operation unit 92. The yaw operation of the tip operating unit 12 is performed.

  The controller 29 is a control unit that comprehensively controls the manipulator body 11 and is connected to a cable 28 that extends from the lower end of the grip handle 26. A part or all of the functions of the controller 29 can be integrally mounted on the operation unit 14, for example.

  FIG. 3 is a perspective view of the gripper 19 and its peripheral portion according to one configuration example. As shown in FIG. 3, the gripper 19 is supported by a gripper support portion 76 made of an insulating material. Of the pair of gripper members 19a and 19b constituting the gripper 19, one gripper member 19a is configured as a movable portion that can rotate around the gripper shaft 46, and the other gripper member 19b is a gripper support portion. It is configured as a fixed portion that does not operate with respect to 76. The gripper member 19a is rotated within a predetermined angle range about the gripper shaft 46, so that the gripper 19 is opened and closed.

  The gripper member 19b may also be configured as a movable portion, and the gripper 19 may be configured to open and close when both gripper members 19a and 19b rotate. Moreover, you may comprise the gripper member 19a as a movable part which adjoins and separates from the gripper member 19b, maintaining parallel with the gripper member 19b comprised as a fixed part. Or you may comprise both gripper members 19a and 19b as a movable part which adjoins and leaves | separates, maintaining a mutually parallel.

  The pair of gripper members 19a and 19b are provided with gripping surfaces 47 that face each other and grip biological tissue. Each gripping surface 47 is knurled to prevent slipping. In addition to the knurling process, a number of anti-slip irregularities may be formed on the gripping surface 47 by electric discharge machining or the like.

  The gripper member 19 a configured as a movable portion is configured to swing (tilt) with respect to the arm portion 77 that can rotate around the gripper shaft 46 (axial center Og) fixed to the gripper support portion 76. It has the 1st electrode part 80a provided freely. The arm portion 77 is a member having a substantially U-shaped cross section including a side wall portion 78 positioned on both sides of the first electrode portion 80 a and a connecting portion 79 that connects the both side wall portions 78. A pin 84 is installed and fixed between the tip portions. The first electrode portion 80a is made of a conductive material, and is swingable about a shaft center a1 parallel to the shaft center Og by a pin 84 fixed to the arm portion 77.

  A concave portion 78a is provided on the side of the gripper member 19b of each side wall portion 78 so that the proximal end portion of the gripping surface 47 of the first electrode portion 80a is exposed in a side view. That is, the base end side portion of the gripping surface 47 of the first electrode portion is located closer to the gripper member 19 b than the concave portion 78 a of the side wall portion 78. In addition, you may comprise so that the base end side part of the holding surface 47 of the 1st electrode part 80a may be exposed by bending or curving the side wall part 78. FIG.

  FIG. 4 is a partial cross-sectional side view of the gripper 19. Since the arm portion 77 is provided so as to cover the first electrode portion 80a, when the first electrode portion 80a rotates clockwise to a certain degree in FIG. 4, it is closer to the tip side than the pin 84 of the first electrode portion 80a. When the portion abuts against the inner surface of the connecting portion 79, further rotation is prevented, and when the first electrode portion 80 a rotates counterclockwise to some extent in FIG. 4, the first electrode portion 80 a is more base than the pin 84. Since the end portion abuts against the inner surface of the connecting portion 79, further rotation is prevented. Thus, since the movable range of the first electrode unit 80a is restricted to a predetermined angle range, the first electrode unit 80a can be maintained in a posture suitable for grasping when grasping the living tissue. In addition, since the living tissue can be gripped in parallel from above and below, the possibility of damage when gripping and peeling the living tissue can be minimized.

  One gripping surface 47 is provided on the first electrode portion 80a. An insulating portion 82 is provided at the base end portion (the end portion on the gripper shaft 46 side) of the gripping surface 47 of the first electrode portion 80a. The insulating part 82 can be made of an insulating material such as resin or ceramics. As the configuration of the insulating portion 82, a configuration in which the surface of the base end portion of the gripping surface 47 is covered with a cover made of an insulating material, or a configuration in which the base end portion of the gripping surface 47 itself is a member made of an insulating material can be adopted. .

  As shown in FIG. 3, the gripper shaft 46 that pivotally supports the arm portion 77 is connected to the above-described first energization path E1, and the gripper shaft 46, the arm portion 77, the pin 84, and the first electrode portion 80a are All are made of conductive material. The gripper member 19b configured as a fixed portion is a component configured as a second electrode portion 80b made of a conductive material, and is supported and fixed to the gripper support portion 76. Hereinafter, the gripper member 19b is also referred to as a second electrode portion 80b. The root portion 83 of the second electrode portion 80b is fitted to the gripper support portion 76, and the root portion 83 is connected to the above-described second energization path E2. Therefore, a high-frequency current is guided from the above-described high-frequency power source 23 (see FIG. 1) to the first electrode unit 80a and the second electrode unit 80b via the first energization path E1 and the second energization path E2, and the first electrode unit 80a A living tissue can be cauterized by supplying a high-frequency current to the living tissue held between the second electrode portions 80b.

  The manipulator 10 which is the surgical treatment tool according to the first embodiment is configured as described above, and the operation and effect thereof will be described next.

  In order to cauterize the biological tissue 85 with the manipulator 10 having the gripper 19 configured as described above, first, as shown in FIGS. 5A and 5B, the gap between the first electrode portion 80a and the second electrode portion 80b. The biological tissue 85 is gripped. Here, FIG. 5A shows a case where a relatively thin living tissue 85A is gripped by the gripper 19, and FIG. 5B shows a case where a relatively thick living tissue 85B is gripped by the gripper 19.

  As described above, when the biological tissue 85 is gripped by the gripper 19, the first electrode unit 80 a provided so as to be swingable changes its posture according to the shape and size of the biological tissue 85 to be gripped. That is, the posture of the first electrode portion 80a changes so as to adapt to the shape of the biological tissue 85 to be grasped. Thereby, the biological tissue 85 can be firmly grasped. In addition, since the recessed part 78a is provided in the side wall part 78 of the arm part 77, even when hold | gripping the comparatively thick biological tissue 85B, the arm part 77 does not contact the biological tissue 85B.

  When the living tissue 85 is grasped, a high-frequency current is applied to the living tissue 85 by the first electrode portion 80a and the second electrode portion 80b. Then, the living tissue 85 gripped by the first electrode portion 80a and the second electrode portion 80b generates Joule heat, and thereby the living tissue 85 is cauterized. At this time, since the living tissue 85 can be energized while firmly holding the living tissue 85, it can be cauterized stably.

  FIG. 6 shows a case where the living tissue 85 is grasped by the distal end portion of the gripper 19 (a portion closer to the distal end side than the pin 84). Since the first electrode portion 80a is swingable with respect to the arm portion 77, as shown in FIG. 6, when the living tissue 85 is gripped by the tip of the gripper 19, the gripping surface 47 of the first electrode portion 80a is The proximal end portion is in contact with the second electrode portion 80b. Here, if the insulating portion 82 is not provided at the base end portion of the gripping surface 47 of the first electrode portion 80a, the first electrode portion 80a and the second electrode portion 80b come into contact with each other to cause a short circuit. Arise. On the other hand, according to the gripper 19 in which the insulating portion 82 is provided at the proximal end portion of the grasping surface 47 of the first electrode portion 80a, even when the living tissue 85 is grasped at the distal end portion, the first electrode portion is caused by the insulating portion 82. Since a short circuit due to the direct contact between 80a and the second electrode portion 80b is prevented, the living tissue 85 can be appropriately energized.

  In the gripper 19, as shown in FIG. 5A, when the living tissue 85 is gripped by the gripper 19 as a whole, the insulating portion 82 also functions as a part of the gripping surface 47. That is, when the living tissue 85 is gripped by the tip of the gripper, the insulating portion 82 prevents the first electrode portion 80a and the second electrode portion 80b from coming into direct contact, while the entire gripper 19 When the finger is gripped, the insulating portion 82 contacts the living tissue 85 as a part of the gripping surface 47. Thus, since the gripper 19 has both an insulating function and a gripping function, the gripper 19 can be configured compactly.

  In the manipulator 10 which is an embodiment of the surgical treatment tool, the gripper 100 according to the first modification shown in FIG. 7 may be employed instead of the gripper 19 described above. The gripper 100 according to the first modification is obtained by replacing the arm portion 77 in the gripper 19 according to the basic shape described above with an arm portion 102 having a different configuration and adding a mooring member 104, and other portions. The gripper 19 is configured similarly. In the configuration example shown in FIG. 7, one mooring member 104 is provided on each side of the gripper 19, but only one mooring member 104 may be provided on one side of the gripper 19.

  The arm portion 102 has a pair of side wall plates 106 positioned on both sides of the first electrode portion 80 a, but an element corresponding to the connecting portion 79 of the arm portion 77 is not provided. That is, the arm portion 102 corresponds to a form in which the connecting portion 79 is omitted from the arm portion 77. The anchoring member 104 is a flexible cord-like body, for example, a wire. The anchoring member 104 has one end connected to the base end portion of the first electrode portion 80a and the other end connected to the base end portion of the second electrode portion 80b. Accordingly, the mooring member 104 regulates the swing range of the first electrode portion 80a.

  As shown in FIG. 8A, when the gripper 100 is closed or when the opening degree of the gripper 100 is small, the mooring member 104 loosens (bends), so that the position and posture of the first electrode portion 80a are regulated by the mooring member 104. It will never be done. On the other hand, since the position of the base end portion of the first electrode portion 80a is fixed by the mooring member 104 when the opening degree of the gripper 100 is increased to a predetermined value and the mooring member 104 is in a tensioned state, The rotation of the first electrode portion 80a in the direction in which the portion approaches the second electrode portion 80b is prevented. Accordingly, as shown in FIG. 8B, the hole 85a can be easily expanded by inserting the gripper 100 into the hole 85a of the living tissue 85 and opening the gripper 100.

  In the manipulator 10 which is an embodiment of the surgical treatment tool, the gripper 110 according to the second modification shown in FIG. 9 may be employed instead of the gripper 19 according to the basic shape. The gripper 110 according to the second modification is obtained by adding an elastic member 112 that stabilizes the posture of the first electrode portion 80a to the gripper 19 according to the basic shape, and the other parts are configured in the same manner as the gripper 19. Has been.

  The elastic member 112 elastically biases the first electrode portion 80a so that the first electrode portion 80a maintains the basic posture with respect to the arm portion 77. In the illustrated example, the elastic member 112 is configured as a leaf spring. Yes. The elastic member 112 has an arm so that one end presses the tip end side of the pin 84 of the first electrode portion 80a and the other end presses the base end side of the pin 84 of the first electrode portion 80a. It is disposed between the portion 77 (specifically, the connecting portion 79) and the first electrode portion 80a.

  In this manner, by providing the elastic member 112 that stabilizes the posture of the first electrode portion 80a, the posture of the first electrode does not greatly tilt with respect to the arm portion 77 without gripping the biological tissue 85. For this reason, it is easy to grip the living tissue 85 with the gripper 110.

  In the manipulator 10 which is an embodiment of the surgical treatment tool, the gripper 114 according to the third modification shown in FIGS. 10A and 10B may be employed instead of the gripper 19 according to the basic shape. The gripper 114 according to the third modification is obtained by adding an elastic member 116 to the gripper 19 according to the basic form, and the other parts are configured in the same manner as the gripper 19.

  As shown in FIG. 10A, in the elastic member 116, the angle formed between the extending direction of the second electrode portion 80b and the extending direction of the first electrode portion 80a in a state where the arm portion 77 is opened is the second electrode portion. The first electrode portion 80a is elastically supported so as to be larger than the angle formed by the extending direction of 80b and the extending direction of the arm portion 77, and is configured as a coil spring in the illustrated example. One end of the elastic member 116 is fixed to a portion closer to the base end side than the pin 84 of the first electrode portion 80 a, and the other end portion is fixed to the arm portion 77.

  By arranging the elastic member 116 in this manner, as shown in FIG. 10A, the tip of the first electrode portion 80a is connected to the second electrode portion 80b with the arm portion 77 opened around the gripper shaft 46. On the other hand, a stable open state can be realized. As a result, as shown in FIG. 10B, it is easy to approach the living tissue 85 that is the object to be grasped. However, it is important that the first electrode portion 80a is opened too much so that the insulating portion 82 does not contact the second electrode portion 80b at an early stage. Therefore, it is preferable to limit the angle at which the tip of the first electrode portion 80a opens.

  In the grippers 19, 100, 110, and 114 described above, the insulating portion 82 is provided on the first electrode portion 80a side. However, instead of providing the insulating portion 82 on the first electrode portion 80a, the insulating portion 82 is provided on the second electrode portion side. The first electrode portion 80a and the second electrode portion 80b may be prevented from being short-circuited when the living tissue 85 is gripped by the distal ends of the grippers 19, 100, 110, and 114. Or you may provide the insulation part 82 in both the 1st electrode part 80a and the 2nd electrode part 80b.

  In the first embodiment described above, the configuration example in which the present invention is applied to the manipulator 10 (see FIG. 1) including the drive source 50 has been described. However, the present invention can also be applied to a manual bipolar electric knife. . FIG. 11 is a side view of a manual bipolar electric scalpel 120 that is a surgical treatment instrument according to the second embodiment of the present invention. In the manipulator 10 described above, a part of the operation is performed by the driving force of the motors 50a and 50b. However, the bipolar electric knife 120 is not equipped with a motor and operates only by manual operation. It is. The bipolar electric knife 120 has a hollow shaft 122, an operation part 124 provided at the base end part of the shaft 122, and a gripper 19 provided at the distal end part of the shaft 122 that can be opened and closed.

  The operation portion 124 is provided with a trigger lever 126 that can move in the Z direction, which is the extending direction of the shaft 122, and finger hook portions 128 and 130, and is inserted into the shaft 122 according to the movement of the trigger lever 126. The gripper 19 opens and closes when the wire (not shown) moves in the Z direction. In the illustrated bipolar electric knife 120, when the operation of pulling the trigger lever 126 with the fingers in the Z2 direction, which is the direction toward the proximal end of the shaft 122, is performed, the gripper 19 is closed and the fingers are separated from the trigger lever 126. The trigger lever 126 moves forward in the Z1 direction and the gripper 19 opens by the elastic force of the spring that does not. The gripper 19 has the same configuration as the gripper 19 according to the basic form shown in FIG.

  The configuration of the opening / closing operation of the gripper 19 is not limited to the above configuration, and the gripper 19 at the tip may be opened / closed by gripping the finger hooks 128 and 130 and performing an operation like a scissors. In this case, the living tissue can be selectively cauterized by adopting a configuration in which energization is performed by pulling the trigger lever 126 with a finger.

  In the bipolar electric knife 120, instead of the gripper 19, the gripper 100 according to the first modified example (see FIG. 7), the gripper 110 according to the second modified example (see FIG. 9), or the gripper 114 according to the third modified example (see FIG. 10A and FIG. 10B) may be employed. In the illustrated bipolar electric knife 120, the gripper 19 is not configured to be capable of posture changing operations such as a roll operation and a yaw operation, but a mechanism for performing a gripper posture changing operation mechanically by a finger operation. May be provided.

  As with the manipulator 10 that is the surgical treatment tool according to the first embodiment, the bipolar electric knife 120 that is the surgical treatment tool according to the second embodiment described above is adapted to the shape of the living tissue to be grasped. The posture of the first electrode unit 80a is changed, whereby the living tissue can be firmly grasped. In addition, even when the living tissue is grasped at the distal end portion, a short circuit due to the direct contact between the first electrode portion 80a and the second electrode portion 80b is prevented by the insulating portion 82 (see FIG. 3). The effect that it becomes possible to perform electricity supply appropriately is acquired. In the second embodiment, the same components and the same effects as those provided by the respective components in the first embodiment are the same as or similar to those in the first embodiment. Of course.

  In the above-described embodiment, only the gripper member 19a is configured as the movable portion. However, the present invention is not limited to this, and both the gripper member 19a and the gripper member 19b may be configured as the movable portion. In this case, the effect of adapting to the shape of the living tissue is remarkably exhibited, and the risk of damage to the living tissue can be reduced.

  In the above description, the present invention has been described with reference to preferred embodiments. However, the present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the scope of the present invention. Needless to say.

DESCRIPTION OF SYMBOLS 10 ... Medical manipulator 18, 122 ... Shaft 14, 124 ... Operation part 19, 100, 110, 114 ... Gripper 19a, 19b ... Gripper member 77 ... Arm part 80a ... 1st electrode part 80b ... 2nd electrode part 82 ... Insulation Part 120: Bipolar electric knife

Claims (2)

A surgical treatment instrument that applies a current to a grasped living tissue to perform a surgical treatment,
It comprises a pair of gripper members, at least one of which is configured as a movable part, and includes a gripper that can be opened and closed so as to grasp a living tissue,
One of the pair of gripper members has an arm part and a first electrode part provided swingably with respect to the arm part,
The other of the pair of gripper members is configured as a second electrode part facing the first electrode part,
An insulating portion that insulates the second electrode portion from the portion on the proximal end side of the first electrode portion when the biological tissue is grasped by the distal end portion of the gripper, the first electrode portion and the second electrode The gripper includes a flexible anchoring member that connects a proximal end portion of the first electrode portion and a proximal end portion of the second electrode portion. ,
A surgical treatment instrument characterized by that. The surgical instrument according to claim 1, wherein
The insulating portion constitutes a part of a gripping surface of the first electrode portion;
A surgical treatment instrument characterized by that.

Images