JP5519354B2 - Electrode placement apparatus and electrode placement system - Google Patents

Description

  The present invention relates to an electrode indwelling apparatus and an electrode indwelling system for winding an electrode part around a linear object and placing it in place.

Conventionally, an electrode portion having an electrode is wound around an elongated linear object, and a predetermined voltage is applied to the linear object or a current flowing through the linear object is measured.
For example, in the medical field, electrical stimulation is directly or indirectly applied to biological tissues (linear objects) such as nerve tissue and muscle, such as nerve stimulation devices, pain relief devices, epilepsy treatment devices, and muscle stimulation devices. Stimulation generators that provide and treat are known. These stimulation generators have a power source inside and are used by being embedded in a living body together with an electrode lead for transmitting electrical stimulation.
In general, an electrode lead applies electrical stimulation to biological tissue, or detects at least one electrode part for detecting electrical excitation generated in the biological tissue, and an electrical connector for electrically connecting to the stimulation generator; A lead body is provided between the electrode unit and the stimulus generator for transmitting electrical stimulation.

  For example, the electrode assembly (electrode part) for nerve stimulation described in Patent Document 1 has a pair of electrodes formed in a spiral shape so as to extend in opposite directions, and the pair of electrodes are wound around the nerve. It is attached so as to be attached. In the electrode system (electrode part) described in Patent Document 2, a spine-like member extending in a predetermined direction and finger members alternately extending in a rib shape from the spine-like member are integrally made of a biocompatible polymer material. Is formed. An electrode is provided on the inner surface of the finger member, and the electrode contacts the nerve when the finger member of the electrode system is mounted so as to wrap around the nerve tissue.

However, it is not technically easy to attach these electrode parts to a linear tissue. Specifically, there are many blood vessels adjacent to the nerve tissue, and when the electrode part is wrapped around the nerve tissue, the tissue (connective tissue) that connects the nerve tissue and the blood vessel is partially peeled to release the nerve. It is necessary to separate the periphery of the tissue, insert the electrode portion into the separated portion, and wrap the electrode portion around the nerve tissue with a treatment tool such as a grasping forceps. However, the periphery of the nerve tissue is crowded, and it is difficult for the operator to have a certain level of skill to wind the electrode portion around the nerve tissue.
Furthermore, since the direction of the portion where the electrode portion is inserted into the body cavity is generally different from the direction suitable for winding the electrode around the tissue, the attaching operation of the electrode portion becomes more difficult. .

  On the other hand, the treatment instrument described in Patent Document 3 includes a bending portion (adjustment mechanism) that bends in a predetermined direction. According to this treatment tool, the direction of the distal end side can be freely adjusted by changing the bending state of the bending portion.

U.S. Pat. No. 4,920,979 US Pat. No. 5,095,905 JP 2005-211683 A

  However, although the treatment tool of Patent Document 3 can hold the electrode part, it is difficult to wrap the curved electrode part around the linear tissue using this treatment tool.

  This invention is made in view of such a problem, Comprising: While adjusting the direction of an electrode part, the electrode placement apparatus and electrode placement system which can wind an electrode part around a linear structure | tissue are provided. With the goal.

In order to solve the above problems, the present invention proposes the following means.
The electrode placement device of the present invention is formed at least partially so as to have a curved shape so as to be wound around a predetermined linear object in a natural state where no external force is applied, and at least part of the electrode placement device is flat. An electrode portion that can be switched to a flat shape, and an indwelling device that switches the shape of at least a part of the electrode portion from the curved shape to the flat shape, and the electrode portion is made of a sheet of elastic material. And an electrode provided on one surface side that becomes a curved inner surface when the insulating member has the curved shape, and the indwelling device has a long shape. An insertion portion, an extension mechanism provided on the distal end side of the insertion portion, holding the curved electrode portion by switching to the flat shape and releasing the holding, and the electrode held by the extension mechanism Adjustable part orientation And nodes mechanism, provided at the base end side of the insertion portion is characterized by having an operation portion for operating the extension mechanism and the adjustment mechanism.

  Further, in the above electrode placement device, the insulating member is formed with an electrode side engaging portion extending in parallel with a bending direction in which the insulating member is curved, and the extension mechanism has a tip portion engaged with the electrode side of the insulating member. An extension member that is detachably engaged with the joint portion and has a proximal end connected to the operation portion, and a holding portion that is connected to the distal end portion of the insertion portion and contacts the electrode portion More preferred.

  In the above-described electrode placement device, it is more preferable that the adjustment mechanism is configured so that the distal end side of the insertion portion can be bent in a direction away from the axis of the insertion portion.

  In the electrode placement device, the insertion portion is connected to a long insertion portion main body and a distal end of the insertion portion main body so as to be rotatable about a predetermined axis, and the holding portion is connected to the distal end side. More preferably, the adjustment mechanism has an operation member having a distal end side connected to the rotation member and a proximal end side connected to the operation portion.

  In the above electrode placement device, it is more preferable that the placement device has a fixing portion that fixes the position of the base end portion of the operation member with respect to the insertion portion and can release the fixation.

  In the above electrode placement device, it is more preferable that the extension member is disposed outside the curve formed by the operation member when the distal end side of the insertion portion is bent.

  In the electrode placement device, the adjustment mechanism is configured to be able to bend the distal end side of the insertion portion in a first direction and a second direction that are separated from the axis of the insertion portion and intersect each other. More preferably.

  In the above electrode placement device, the extension mechanism is more preferably configured to be rotatable about the axis of the extension member.

  In addition, an electrode placement system of the present invention is characterized by including the electrode placement device according to any one of the above and an observation device having a long observation insertion portion.

  According to the electrode placement device and the electrode placement system of the present invention, the electrode portion can be wound around the linear structure while adjusting the direction of the electrode portion.

1 is an overall view of an electrode placement system according to an embodiment of the present invention. It is a perspective view in the natural state where the external force of the electrode part of the same electrode placement system does not act. It is a perspective view when extending the curve of the electrode part to make it flat. It is a partial cross section figure at the front end side of the treatment tool of the electrode placement system. It is a front view of the front end side of the treatment tool of the electrode placement system. It is a side view of the front end side of the treatment tool of the electrode placement system. It is sectional drawing of the front of the base end side of the treatment tool of the electrode placement system. It is sectional drawing of the side surface in the base end side of the treatment tool of the electrode placement system. It is a figure explaining the position of the vagus nerve in a patient's chest cavity. It is a figure which shows the state which inserted the trocar in the opening formed in the patient's chest. It is a figure explaining the positional relationship of opening. It is a figure explaining the state which attached the electrode part to the holding | maintenance part of the treatment tool of the electrode placement system. It is a figure explaining the state which lifted the vagus nerve from the surrounding tissue with forceps. It is a figure explaining the state which bent the front end side of the insertion part of the treatment tool of the electrode placement system. It is a figure explaining the state where the electrode part of the electrode placement system was wound around the vagus nerve. It is a figure explaining the state which left the electrode part in the chest cavity. It is a general view of the electrode part in the modification of this embodiment. It is a perspective view of the electrode part in the modification of this embodiment. It is explanatory drawing of the front end side of the treatment tool in the modification of this embodiment.

Embodiments of an electrode placement system according to the present invention will be described below with reference to FIGS. In the following embodiment, a case where this electrode placement system is used with forceps for medical purposes will be described as an example.
As shown in FIG. 1, the electrode placement system 1 of the present embodiment is an electrode formed to have a curved shape that is wound around a nerve tissue (linear object) in a natural state where no external force is applied. An indwelling device 4 having a portion 2 and a treatment instrument (indwelling device) 3 for switching the shape of the electrode portion 2 from a curved shape to a flat shape, and a thoracoscope (observation device) 6 having a long observation insertion portion 5 And.
In this embodiment, the electrode placement system 1 is used together with a nerve stimulation device 7 that generates electrical stimulation to be applied to nerve tissue, and a lead body 8 that electrically connects the electrode unit 2 and the nerve stimulation device 7. .

The electrode portion 2 is capable of switching (deforming) the entire shape from a curved shape in a natural state shown in FIG. 2 curved so as to be wound around a nerve tissue to a flat shape shown in FIG.
As shown in FIG. 3, the electrode portion 2 becomes an inner surface of the curve when the electrode support (insulating member) 11 formed in a sheet shape with an elastic material and the electrode support 11 becomes a curved shape. And three electrodes 12 provided in a state of being exposed on one surface 11a.

The electrode support 11 is made of a soft insulating material such as silicone so as not to damage the nerve tissue.
The electrode support 11 is formed with a guide hole (electrode-side engagement portion) 13 that is a through hole having a rectangular cross section. The guide hole 13 is formed at an intermediate portion in the thickness direction of the electrode support 11 so as to extend in parallel with the bending direction D1 in which the electrode support 11 is bent. The guide hole 13 is opened only on the side of the electrode support 11 that is connected to the lead body 8.

  The three electrodes 12 are provided so as to extend in parallel to the bending direction D1 at intervals from each other in the direction of the axis C1 of bending when the electrode support 11 has a curved shape. The electrode 12 is formed of a metal having elasticity and high biocompatibility, and is formed in a curved shape in a natural state. That is, due to the elastic force of the electrode 12, the shape of the electrode part 2 can be naturally curved and deformed into a flat shape. As the electrode 12, it is desirable to use a metal such as platinum or iridium having high biocompatibility.

  As shown in FIGS. 1 and 4, the treatment instrument 3 is held by the elongated insertion portion 16, an extension mechanism 17 that is provided on the distal end side of the insertion portion 16 and holds the electrode portion 2, and the extension mechanism 17. An adjustment mechanism 18 that can adjust the orientation of the electrode unit 2 and an extension mechanism 17 and an operation unit 19 that operates the adjustment mechanism 18 are provided on the proximal end side of the insertion unit 16.

As shown in FIGS. 4 and 5, the insertion portion 16 has a long and tubular insertion portion main body 20 and a rotating member 22 connected to the distal end of the insertion portion main body 20 by a shaft member 21. doing.
In the present embodiment, the insertion portion 16 is formed of a material that has a certain rigidity and is difficult to bend, such as a highly biocompatible metal or resin.
The rotating member 22 includes a disk-shaped top plate portion 23 and a substantially cylindrical connection portion 24 connected to the base end surface of the top plate portion 23. The top plate part 23 and the connection part 24 are integrally formed. The top plate portion 23 is formed with a through hole 23a that penetrates the insertion portion 16 in the direction of the axis C2.
As shown in FIG. 6, a pair of shaft members 21 are provided on an axis (predetermined axis) C3 with a coil sheath 31 described later interposed therebetween. The rotation member 22 is connected to the insertion portion main body 20 by the shaft member 21, so that the rotation member 22 can rotate about the axis C <b> 3 of the shaft member 21.

As shown in FIGS. 4 and 6, the extension mechanism 17 is connected to an opening / closing bar (extension member) 27 that is formed in a rod shape and is inserted into the insertion portion main body 20, and the tip-side surface of the rotating member 22. Holding part 28.
The holding portion 28 includes a substantially cylindrical base body 29 and a tongue-like body 30 extending forward from the edge of the surface on the tip side of the base body 29. The base body 29 and the tongue-like body 30 are integrally formed of the same material as the insertion portion main body 20. A step portion 28 a is formed at a connection portion between the base body 29 and the tongue-like body 30. The base body 29 is formed with a through hole 29a that extends in the axial direction of the base body 29 and opens to the stepped portion 28a.
The step portion 28 a of the holding portion 28 is formed in a shape corresponding to the end portion 11 b on the side where the opening of the guide hole 13 is formed in the electrode support 11. When the end portion 11 b of the electrode support 11 is brought into contact with the step portion 28 a of the holding portion 28, the guide hole 13 of the electrode portion 2 communicates with the through hole 29 a of the holding portion 28.

As shown in FIG. 4, the coil sheath 31 is disposed in the insertion portion main body 20, and the distal end portion of the coil sheath 31 is attached to the inner peripheral surface of the through hole 23 a of the rotating member 22.
The distal end side of the opening / closing rod 27 extends forward of the holding portion 28 through the through hole 29 a of the holding portion 28. On the other hand, the proximal end side of the opening / closing rod 27 is connected to the operation unit 19 together with the coil sheath 31 through the coil sheath 31. The open / close bar 27 is disposed so as to be able to advance and retract within the holding portion 28 and the coil sheath 31. The opening / closing bar 27 is set so that the tip end portion is detachably engaged with the guide hole 13 of the electrode support 11.
According to the open / close bar 27 configured as described above, the open / close bar 27 is brought into contact with the insertion part 16 in a state where the end part 11b of the electrode part 2 is brought into contact with the step part 28a of the holding part 28. By pushing, the open / close bar 27 is inserted into the guide hole 13. Thereby, the open / close bar 27 switches and holds the shape of the electrode part 2 from the curved shape to the flat shape. In addition, by pulling the opening / closing rod 27, the opening / closing rod 27 can be removed from the guide hole 13 of the electrode portion 2, and the holding of the electrode portion 2 can be released.

As shown in FIG. 4, the adjustment mechanism 18 includes an operation member 34 having a distal end side connected to the rotation member 22 and a proximal end side connected to the operation unit 19. The operation member 34 includes a rod 35 whose tip is connected to the turning member 22 so as to be rotatable around the axis C4, and an operation wire that is connected to the proximal end of the rod 35 and is inserted through the insertion portion main body 20. 36. As shown in FIG. 5, a convex portion 37 is formed on the proximal end side of the rod 35 so as to protrude substantially parallel to the axis C4.
A guide hole 20a extending in the direction of the axis C2 is formed in the insertion portion main body 20, and the convex portion 37 of the rod 35 is configured to engage with the guide hole 20a and move in the guide hole 20a in the direction of the axis C2. Has been.

  As shown in FIG. 4, in the adjustment mechanism 18 configured as described above, when the operation wire 36 is pulled with respect to the insertion portion 16, the rotation member 22 rotates about the axis C3, and the rod 35 rotates. 22, the rod 35 is moved to the position A, and the operation member 34 is bent. In the present embodiment, the open / close bar 27 is disposed so as to be positioned outside the curved portion B formed by the operation member 34 when the operation wire 36 is pulled.

As shown in FIG. 7, the operation unit 19 is connected to the operation unit main body 40 connected to the proximal end of the insertion unit main body 20 and is slidably connected to the operation unit main body 40 in the direction of the axis C2. An extension handle 41 and an adjustment handle 42 are provided.
The operation unit main body 40 is fixed to the outer peripheral surface on the proximal end side of the insertion unit main body 20, and the distal end part is attached to the distal end side fixing member 43, and is arranged in parallel with a predetermined distance from each other. And a pair of guide rods 44 extending in the direction of the axis C2 and a base end side fixing member 45 for fixing the base end portions of the pair of guide rods 44.

The extension handle 41 is formed in a substantially cylindrical shape, and the extension handle 41 is formed with an insertion hole 41a through which a pair of guide rods 44 are inserted in the axial direction of the extension handle 41. A base end portion of the opening / closing rod 27 is fixed to the extension handle 41, and the opening / closing rod 27 is pulled or pushed into the coil sheath 31 by sliding the extension handle 41 with respect to the pair of guide rods 44. can do.
The adjustment handle 42 is formed in a substantially columnar shape like the extension handle 41, has an insertion hole 42 a through which the pair of guide rods 44 are inserted, and is disposed on the distal end side of the extension handle 41. The proximal end portion of the operation wire 36 is fixed to the adjustment handle 42, and the operation wire 36 can be pulled or pushed into the insertion portion 16 by sliding the adjustment handle 42.
Note that a finger hooking portion 46 is provided on the base end side of the base end side fixing member 45 for the operator to put his / her finger.

As shown in FIG. 8, the treatment instrument 3 of the present embodiment is provided with a fixing portion 49 that fixes the position of the proximal end portion of the operation wire 36 to the insertion portion 16 and can release this fixing. Yes.
The fixing portion 49 is fixed to the outer peripheral surface on the proximal end side of the insertion portion main body 20, and is rotated around the base member 51 provided with a plurality of locked portions 50 arranged in the direction of the axis C <b> 2 on the outer peripheral surface. A locking portion 52 that is movably supported and provided on the distal end side has a switching lever 53 that locks to the locked portion 50. The switching lever 53 is provided with a biasing spring (not shown), and the biasing spring biases the locking portion 52 of the switching lever 53 toward the locked portion 50. When the locking portion 52 is locked between the locked portions 50, the adjustment handle 42 is fixed in the direction of the axis C2 with respect to the insertion portion 16. On the other hand, when the locking portion 52 is separated from the locked portion 50, this fixing is released.
In the present embodiment, when the position where the locking portion 52 is locked to the locked portion 50 moves by one width of the locked portion 50 in the direction of the axis C <b> 2, the rotating member 22 with respect to the insertion portion main body 20. The angle around the axis C3 is set to change by 10 °, for example.

The thoracoscope 6 emits illumination light forward from the distal end portion of the observation insertion portion 5 and observes reflected light reflected forward by an observation unit (not shown) provided at the distal end portion of the observation insertion portion 5. it can.
The nerve stimulation device 7 has a power source (not shown), detects an electrical signal generated by the nerve tissue, and generates an electrical stimulation having a predetermined waveform. Thereby, the nerve stimulation apparatus 7 can detect the signal of the nerve tissue acquired with the electrode part 2, and can apply electrical stimulation to this nerve tissue as needed.
The lead body 8 has a known configuration, and includes a coil (not shown) that electrically connects the electrode 12 and the nerve stimulation device 7 and an insulating and flexible tube 54 that covers the outer periphery of the coil (see FIG. 1).

Next, referring to FIG. 9 to FIG. 16, a technique for placing an electrode portion on the vagus nerve (linear object) N in the chest cavity of the patient P, which is performed using the electrode placement system 1 configured as described above. I will explain.
This procedure includes an opening forming step for forming an opening in the body wall of a patient, an attachment / introduction step for attaching the electrode portion 2 to the treatment instrument 3 and introducing the electrode portion 2 into the inside through the opening, and an electrode portion 2 for the vagus nerve N. There are four steps: a position adjusting step for adjusting the orientation of the vagus and an indwelling step in which the electrode unit 2 is wound around the vagus nerve N.

First, as shown in FIG. 10, the surgeon forms three openings (not shown) with a scalpel or the like in the chest of the patient P, and inserts the trocar T into these openings (opening forming step).
As shown in FIG. 11, the positions Q1 to Q3 of these openings are preferably arranged at substantially equal angles around the reference axis J when viewed from the center of the reference axis J extending perpendicular to the paper surface. By arranging the positions Q1 to Q3 in this way, it becomes easy to perform treatment with the treatment tool 3 or the like while observing the inside of the chest cavity with the thoracoscope 6 in a later step.

Next, the electrode part 2 is attached to the treatment instrument 3, and the electrode part 2 is introduced into the thoracic cavity through the trocar T (attachment / introduction step).
First, the observation insertion part 5 of the thoracoscope 6 is introduced from the trocar T arranged at the position Q1 to observe the inside of the thoracic cavity, and a peeling forceps (not shown) is introduced from the trocar T arranged at the position Q2 to obtain the vagus nerve. The membrane around N is cleaved to expose the vagus nerve N. Thereafter, the peeling forceps are pulled out from the trocar T.
Then, outside the body, as shown in FIG. 12, the extension handle 41 is moved to the distal end side with respect to the operation portion main body 40 with the end portion 11 b of the electrode portion 2 engaged with the step portion 28 a of the holding portion 28. Then, the opening / closing rod 27 is pushed out from the holding portion 28 toward the distal end side, and the opening / closing rod 27 is inserted into the guide hole 13 of the electrode portion 2. Thereby, the shape of the electrode part 2 extends according to the shape of the opening / closing bar 27 and is switched from a curved shape to a flat shape, and the electrode part 2 is mounted on the holding part 28.
Subsequently, the insertion portion 16 of the treatment instrument 3 attached with the electrode portion 2 having a flat shape is introduced into the thoracic cavity from the trocar T disposed at the position Q2.

Then, the direction of the electrode part 2 with respect to the vagus nerve N is adjusted (position adjustment process).
First, as shown in FIG. 13, the forceps K is introduced into the thoracic cavity from the trocar T arranged at the position Q2, and the vagus nerve N is held from the surrounding tissue by the tip K1 of the forceps K.
Then, the surgeon moves the treatment tool 3 to bring the electrode portion 2 closer to the vagus nerve N.
Here, when the adjustment handle 42 is moved to the proximal end side with respect to the operation portion main body 40, the operation wire 36 is pulled with respect to the insertion portion 16. At this time, as shown in FIG. 14, the rod 35 connected to the operation wire 36 also moves to the proximal end side. The convex portion 37 formed on the base end side of the rod 35 moves to the base end side in the direction of the axis C2 in the guide hole 20a, and the rotating member 22 can rotate about the axis C3. The distal end side of the rod 35 moves in a direction away from the axis C2, and the rotating member 22 bends (rotates) in the bending direction E1.
When the adjustment handle 42 is moved toward the distal end side with respect to the operation unit main body 40, the operation wire 36 is pushed in and the rotating member 22 is bent in a bending direction E2 opposite to the bending direction E1.
In this way, by adjusting the orientation of the electrode portion 2 relative to the vagus nerve N by the adjustment handle 42 or adjusting the orientation of the insertion portion 16, the one surface 11 a side of the electrode portion 2 faces the vagus nerve N. At the same time, the orientation of the electrode unit 2 is adjusted so that the vagus nerve N is substantially parallel to the direction of the axis C1 of the curve when the electrode unit 2 has a curved shape.

Subsequently, the electrode unit 2 is wound around the vagus nerve N and placed (placement step).
First, the tip K1 of the forceps K is removed from the vagus nerve N. Then, the open / close bar 27 is removed from the guide hole 13 of the electrode unit 2 by moving the extension handle 41 to the proximal end side with respect to the operation unit main body 40. Then, as shown in FIG. 15, the electrode part 2 that has been extended into a flat shape by the opening / closing rod 27 returns to its natural curved shape by its own elastic force and wraps around the vagus nerve N. At the same time, the electrode part 2 It is removed from the treatment tool 3.

Thereafter, the forceps K and the treatment tool 3 are pulled out from the trocar T, the membrane around the vagus nerve N is sutured, the trocar T is removed from the patient P, and the opening formed in the chest is sutured.
Further, the lead body 8 and the nerve stimulation device 7 are implanted under the skin of the patient P, and the series of procedures is completed.

As described above, according to the electrode placement system 1 of the present embodiment, the surgeon switches the electrode portion 2 that is curved in the natural state to the flat shape by the extension mechanism 17 and also uses the adjustment mechanism 18 to switch the electrode portion 2 to the flat shape. Is adjusted so that the one surface 11a side of the electrode portion 2 faces the vagus nerve N. Then, the electrode portion 2 is wound around the nerve tissue N while the electrode 12 is brought into contact with the vagus nerve N by switching the shape of the electrode portion 2 to a curved shape by the extension mechanism 17.
For this reason, for example, even when the vagus nerve N is between crowded tissues, the electrode portion 2 is switched to a flat shape, and the orientation of the electrode portion 2 is adjusted and then brought closer to the vagus nerve N. The electrode part 2 can be reliably and easily wound around the vagus nerve N.

The electrode support 11 is formed with a guide hole 13 extending parallel to the bending direction D1. The extension mechanism 17 includes an opening / closing bar 27 whose tip is removably engaged with the guide hole 13, and a tip of the insertion portion 16. And a holding portion 28 connected to the. Therefore, the shape of the electrode portion 2 can be easily switched between the curved shape and the flat shape by inserting the opening / closing rod 27 into the guide hole 13 of the electrode portion 2 or removing it from the guide hole 13.
Moreover, the opening / closing rod 27 can be easily removed from the guide hole 13 by bringing the holding portion 28 into contact with the electrode portion 2.

The adjustment mechanism 18 is configured such that the distal end side of the insertion portion 16 can be bent in a direction away from the axis C2 of the insertion portion 16. Thereby, the direction of the electrode part 2 with which the front end side of the insertion part 16 was mounted | worn can be adjusted easily.
The insertion portion 16 includes an insertion portion main body 20 and a rotation member 22 connected to the distal end of the insertion portion main body 20 so as to be rotatable around the axis C3. The adjustment mechanism 18 has a distal end side as a rotation member. The operation member 34 is connected. Therefore, by advancing and retracting the operation member 34, the distal end side of the insertion portion 16 can be bent around the axis C3.

The treatment instrument 3 fixes the position of the proximal end portion of the operation member 34 with respect to the insertion portion 16 and has a fixing portion 49 capable of releasing this fixation. The shape can be easily retained.
Further, when the distal end side of the insertion portion 16 is bent, the opening / closing rod 27 is disposed so as to be outside the curved portion B formed by the operation member 34. For this reason, the bending radius of the opening / closing rod 27 can be made larger than the bending radius of the curved portion B, and it is possible to prevent the opening / closing rod 27 from coming into contact with the surrounding thing such as the coil sheath 31 and to hardly move forward and backward. .

  In this embodiment, since the electrode placement system 1 includes the electrode placement device 4 and the thoracoscope 6, the electrode placement device 4 applies the vagus nerve N while observing the inside of the chest cavity with the observation insertion portion 5 of the thoracoscope 6. The electrode part 2 can be wound.

As mentioned above, although embodiment of this invention was explained in full detail with reference to drawings, the concrete structure is not restricted to this embodiment, The change of the structure of the range which does not deviate from the summary of this invention, etc. are included.
For example, the electrode placement system 1 of the above embodiment includes the electrode part 2 that is curved around the axis C1 in a natural state as an electrode part. However, as shown in FIG. 17, an electrode unit 61 configured to spirally wind around the vagus nerve N around a predetermined direction in a natural state where no external force is applied may be provided.
The electrode portion 61 has a configuration in which a spiral guide hole 63 is formed in a spiral electrode support 62 and an electrode 64 is provided on an inner surface 62 a of the electrode support 62. Yes.

Furthermore, it may replace with the electrode part 2 of the said embodiment, and may provide 2 A of electrode parts shown in FIG. In addition to the components of the electrode unit 2, the electrode unit 2 </ b> A includes a spring material 65 formed of, for example, a nickel titanium superelastic wire in the electrode support 11. The spring member 65 includes a pair of arm portions 65a that are curved around the axis C1 and are spaced from each other in the direction of the axis C1, and a connection portion 65b that connects the ends of the pair of arm portions 65a. . The arm portion 65a is formed in a curved shape in a natural state where no external force is applied, and is deformed into a substantially linear shape when the electrode portion 2A is deformed into a flat shape.
2 A of electrode parts can improve the holding | maintenance force wound around linear objects, such as the vagus nerve N, by providing the spring material 65. FIG. Thus, the holding force of the electrode part may be appropriately adjusted according to the characteristics of the linear object to be placed.

In the electrode placement system 1 of the above embodiment, the holding portion 28 is connected to the turning member 22 so as to be rotatable about the axis of the through hole 23 a of the turning member 22, and the extension handle 41 is connected to the center of the opening / closing rod 27. You may comprise so that rotation around an axis line is possible.
With this configuration, the extension mechanism 17 including the opening / closing bar 27 and the holding portion 28 can be rotated around the central axis of the opening / closing bar 27. Therefore, by rotating the extension handle 41 around the central axis of the opening / closing rod 27, the electrode portion 2 attached to the holding portion 28 is rotated around the central axis of the opening / closing rod 27, and the orientation of the electrode portion 2 is adjusted. can do.

Furthermore, in the above embodiment, as shown in FIG. 19, the distal end side of the insertion portion 67 can be bent in a first direction F and a second direction G that are separated from the direction of the axis C5 of the insertion portion 67 and intersect each other. In addition, an adjustment mechanism (not shown) may be configured. With this configuration, the distal end side of the insertion portion 67 can be bent with a higher degree of freedom.
In the above embodiment, the thoracoscope 6 may not be used when the vagus nerve N is directly visible. Further, when the field of view of the thoracoscope 6 can be enlarged and observed, a small electrode portion can be placed with a smaller linear object.

In the above embodiment, when viewed in the direction of the axis C3 defined by the shaft member 21, the operation members 34 are arranged on both sides of the axis C3, and the distal end side of each operation member 34 is located on the rotating member 22, respectively. You may comprise so that it may be connected.
Generally, when an operation wire is used as the operation member 34, it is easier to operate by pulling the operation wire. With this configuration, even when an operation wire is used for the operation member 34, the rotating member 22 can be suitably operated in the bending direction E1 and the bending direction E2 shown in FIG.

Moreover, although the case where the electrode placement system of the present embodiment is used for medical purposes has been described, the electrode placement system can be used not only for medical purposes but also for industrial purposes. For example, when a cable (a linear object) through which a predetermined current flows is provided in a space communicated with a narrow opening, an electrode portion serving as a probe for measuring the current flowing through the cable, and an electrode through the opening An electrode indwelling system including an indwelling device for winding the part around the cable can be cited as an industrial application.
In this case, the electrode may be provided in an embedded state in the electrode portion without being exposed on one surface side of the electrode support.

DESCRIPTION OF SYMBOLS 1 Electrode indwelling system 2, 2A, 61 Electrode part 3 Treatment tool (Indwelling tool)
4 Electrode placement device 5 Thoracoscope (observation device)
6 Observation insertion part 11, 62 Electrode support (insulating member)
11a One surface 12, 64 Electrode 13, 63 Guide hole (electrode side engaging portion)
16, 67 Insertion part 17 Extension mechanism 18 Adjustment mechanism 19 Operation part 20 Insertion part main body 22 Rotating member 27 Opening / closing rod (extension member)
28 Holding part 34 Operating member 49 Fixed part C2 Axis C3 Axis (predetermined axis)
F First direction G Second direction N Vagus nerve (linear object)

Claims (9)

At least a part is formed so as to be curved so as to wrap around a predetermined linear object in a natural state where no external force is acting, and the shape can be switched to a flat shape where at least a part is flat The electrode part,
An indwelling device for switching the shape of the at least part of the electrode portion from the curved shape to the flat shape;
With
The electrode part is
An insulating member formed into a sheet of elastic material;
An electrode provided on one surface side that becomes an inner surface of the curve when the insulating member has the curved shape;
Have
The detainer is
A long insertion part,
An extension mechanism that is provided on the distal end side of the insertion portion, and that holds the curved electrode portion by switching to the flat shape and is capable of releasing the holding;
An adjustment mechanism capable of adjusting the orientation of the electrode portion held by the extension mechanism;
An operation unit that is provided on a proximal end side of the insertion unit and operates the extension mechanism and the adjustment mechanism;
An electrode indwelling device comprising: The insulating member is formed with an electrode side engaging portion extending in parallel with a bending direction in which the insulating member is bent,
The extension mechanism is
A distal end portion detachably engages with the electrode side engaging portion of the insulating member, and a proximal end side is connected to the operation portion, and an extension member;
A holding portion connected to the distal end portion of the insertion portion and contacting the electrode portion;
The electrode indwelling device according to claim 1, comprising:   2. The electrode placement device according to claim 1, wherein the adjustment mechanism is configured to bend a distal end side of the insertion portion in a direction away from an axis of the insertion portion. The insertion part is
A long insertion body,
A rotation member connected to the distal end of the insertion portion main body so as to be rotatable around a predetermined axis, and having the holding portion connected to the distal end side;
Have
The electrode placement device according to claim 2 , wherein the adjustment mechanism includes an operation member having a distal end side connected to the rotating member and a proximal end side connected to the operation portion.   The electrode indwelling device according to claim 4, wherein the indwelling device includes a fixing portion that fixes a position of a base end portion of the operation member with respect to the insertion portion and can release the fixing.   The electrode placement device according to claim 4, wherein when the distal end side of the insertion portion is bent, the extension member is disposed outside the curve formed by the operation member.   2. The adjustment mechanism is configured to be able to bend the distal end side of the insertion portion in a first direction and a second direction that are separated from the axis of the insertion portion and intersect each other. The electrode placement apparatus described in 1. The electrode indwelling device according to claim 2 , wherein the extension mechanism is configured to be rotatable around an axis of the extension member. The electrode placement device according to any one of claims 1 to 8,
An observation device having a long observation insertion portion;
An electrode indwelling system comprising:

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