JP6110243B2 - MEDICAL TREATMENT TOOL AND MEDICAL TREATMENT DEVICE - Google Patents

Description

  The present invention relates to a medical treatment tool and a medical treatment apparatus for performing treatment using a laser beam and treatment using an electric scalpel in, for example, a coelomic surgery.

  Conventionally, for incision for excision of a treatment target site, a laser knife using a laser beam that is opened in a non-contact manner, an electric knife etc. that burns the incision site by energizing a high-frequency current, etc. are used. Each had its own characteristics, and was used properly according to the treatment content.

  Specifically, in the case of a laser knife, it is possible to perform a non-contact high-speed incision with a fine spot of laser light and to perform an incision while performing hemostasis. On the other hand, in the case of an electric scalpel, the incision site is burned out with the blade electrode for the electric scalpel, so that the cauterization and hemostasis action at the incision site is excellent.

  However, replacing the laser knife and the electric knife in the operation according to the operation contents has a problem that the burden on the patient becomes large. As a countermeasure, for example, in Patent Document 1, the electric knife and the laser knife can be switched. There has been proposed a minimally invasive medical treatment tool that can be used properly without replacing the laser scalpel and the electric scalpel during surgery by using the above-described medical surgical tool.

  Also, as a surgical procedure that can reduce the burden on the patient, a coelomic surgery is employed. For example, when performing a surgical operation on an organ in the abdomen, a body cavity endoscope is provided with several through holes in the abdomen, and surgical tools such as forceps and a scalpel and a body cavity mirror are inserted into the through hole, and a body cavity image is displayed. It is a method of treatment while confirming. Such a coelomic surgical operation is less burdensome on the patient and quicker to recover than an open operation in which the abdomen is largely opened as in the past. In such a luminoscopic surgery, in order to replace the laser knife and electric knife during the operation according to the contents of the operation, it is very complicated to remove the surgical instrument from the through hole and insert it again. It takes time and effort. Therefore, by using the medical surgical instrument that can switch between the electric knife and the laser knife proposed in the above-mentioned Patent Document 1, the burden on the patient compared with the case where the laser knife and the electric knife are replaced during the operation according to the contents of the operation. It is thought that it can be significantly reduced.

  However, in the medical surgical instrument proposed in Patent Document 1, the metal cover provided at the tip of the laser probe is a blade electrode of an electric knife, but since this metal cover is in front of the laser emission port, the cutting function by the laser There was a problem that was damaged.

JP 2012-105766 A

  In view of the above-described problems, the present invention provides a medical treatment tool and a medical treatment device that can be used by switching between the function of a laser knife and the function of an electric knife with a simple apparatus configuration. Objective.

  The present invention relates to a medical treatment instrument to be inserted into a body cavity, a hollow conductive hollow waveguide for guiding a laser beam that can be cut in a non-contact manner, and a distal end of the conductive hollow waveguide. A current-carrying means configured to pass a high-frequency current between the counter electrode that contacts the living body to be treated and the blade electrode for the electric scalpel. It is provided with. In addition, the present invention provides a laser oscillator that is a laser light source that generates laser light, a device body that includes a high-frequency oscillator that oscillates a high-frequency current, a medical treatment instrument, a counter electrode that contacts a living body, A medical treatment apparatus configured by a waveguide cable connecting the laser oscillator and the medical treatment instrument, each of the medical treatment instrument and the counter electrode, and a conductive line connecting the high-frequency oscillator. It is characterized by being.

  The above-mentioned counter electrode is arranged together with the blade electrode for the electric scalpel in the medical treatment instrument, and the counter electrode constituting the bipolar electric scalpel or the electrode electrode blade blade as a counter electrode plate separately from the medical treatment instrument And a counter electrode constituting a monopolar type electric knife.

According to the present invention, the function of the laser knife and the function of the electric knife can be switched and used during the treatment with a simple device configuration.
Specifically, since it is composed of a hollow conductive hollow waveguide that guides laser light that can be cut in a non-contact manner and a blade electrode for an electric knife provided at the tip of the conductive hollow waveguide, Laser light can be guided directly into the tube of the conductive hollow waveguide, and the conductive hollow waveguide itself made of a metal material can be used as a conductor. Therefore, a simple device configuration can be achieved by applying a high-frequency current between the counter electrode that contacts the living body to be treated and the blade electrode for the electric knife by the energizing means provided in the conductive hollow waveguide. Thus, the function of the laser knife and the function of the electric knife can be switched and used. For example, it can be used by a method suitable for the treatment contents, such as incising efficiently with a laser scalpel and coagulation and hemostasis of the bleeding site with an electric scalpel.

  Therefore, even if the surgical tool replacement is very complicated and time-consuming, it can be performed using an appropriate scalpel according to the operation content without replacing the surgical tool, thereby reducing the burden on the patient. A minimally invasive medical treatment tool and medical treatment apparatus that can be configured can be configured.

  In addition, the laser beam can be guided directly into the hollow conductive hollow waveguide tube, and the conductive hollow waveguide itself made of a metal material can be used as a conductor. Compared to the case where the body and the body are separately provided, the shaft diameter is reduced, and the burden on the living body can be reduced.

  Further, as an aspect of the present invention, the blade electrode for the electric knife is arranged at a predetermined interval from an emission end of the conductive hollow waveguide that irradiates the laser light, and is disposed on the irradiation path of the laser light. it can.

According to the present invention, it is possible to prevent unintended burnout of the living body by the laser knife.
Specifically, the electric knife blade electrode is disposed at a predetermined interval from an emission end of the conductive hollow waveguide that emits the laser beam, and is disposed on the laser beam irradiation path. A site to be cut is disposed between the blade electrode and the exit end of the conductive hollow waveguide, and the laser beam can be used for efficient and accurate incision without contact.

  Further, by arranging the blade electrode for the electric knife on the irradiation path of the laser beam, the laser beam is blocked by the blade electrode for the electric knife, so that, for example, the laser beam reaches an unexpected deep part of the living tissue. Therefore, there is no risk of burning to an unintended depth or location, and the procedure can be performed safely. Therefore, even if a surgical operation with a narrow operative field is performed, there is no risk of incision to an unintended depth or location, and the operation can be performed safely.

Further, as an aspect of the present invention, the side exterior of the conductive hollow waveguide can be covered with an insulating coating having an insulating property.
According to the present invention, when used as a bipolar treatment instrument, it is possible to secure electrical insulation between the blade electrode and the hollow waveguide as the counter electrode, and to perform treatment more safely.

As an aspect of the present invention, a highly conductive metal layer having higher conductivity can be provided on the inner peripheral surface of the conductive hollow waveguide.
According to the present invention, it is possible to ensure reliable electrical continuity with the blade electrode for the electric knife and at the same time improve the waveguide efficiency of the conductive hollow waveguide that guides the laser beam inside. Further, the treatment instrument can be made compact without increasing the diameter of the conductive hollow waveguide. Therefore, the hole opened in the abdomen can be made into a small hole, and the hospitalization period by the operation can be shortened.

As an aspect of the present invention, a gas having a predetermined flow rate can flow into the conductive hollow waveguide.
As a result, it is possible to prevent the scattered matter and body fluid from the incised treatment site or the smoke filled in the body cavity from entering the inside of the conductive hollow waveguide. Accordingly, it is possible to prevent the scattering performance and the body fluid, the smoke filled in the body cavity, and the like entering the inside of the conductive hollow waveguide from entering the inside of the conductive hollow waveguide to deteriorate the waveguide performance. Furthermore, the visual field around the treatment site can be secured by the gas ejected from the conductive hollow waveguide under the body cavity mirror.

As an aspect of the present invention, the laser light guided in the conductive hollow waveguide can be constituted by, for example, carbon dioxide laser light.
Since carbon dioxide laser light has a small beam divergence angle and a high energy density, an incision with a small incision width can be performed at a higher speed. In addition, since the absorption rate of laser light by water is high and does not penetrate deeply into living tissue, there is little influence on normal tissue, and the post-operative patient burden can be further reduced.

  According to the present invention, it is possible to provide a medical treatment tool and a medical processing apparatus that can be used by switching the functions of a laser knife and an electric knife with a simple device configuration. As a result, the burden on the patient is reduced as compared with the prior art, and safer treatment can be performed.

Explanatory drawing about a monopolar type medical treatment tool. The perspective view of a monopolar type medical treatment device. Explanatory drawing of a hollow waveguide. The schematic diagram of the use condition of a monopolar type medical treatment device. Schematic explaining the use condition of a monopolar type medical treatment tool. Explanatory drawing about a monopolar-type holding | grip medical treatment tool.

This embodiment of the present invention will be described below with reference to the drawings.
FIG. 1 shows an explanatory view of a monopolar medical treatment instrument 10. Specifically, FIG. 1 (a) shows a cross-sectional view of the monopolar medical treatment instrument 10, and FIG. 1 (b) shows an AA arrow view in FIG. 1 (a).

  2 is a perspective view of the medical treatment apparatus 1, FIG. 3 is an explanatory view of the hollow waveguide 300, FIG. 4 is a schematic view of the medical treatment apparatus 1 in use, and FIG. 5 is a monopolar. The schematic diagram explaining the usage condition of the type medical treatment tool 10 is shown. Note that FIG. 3 illustrates a state where a part of the hollow waveguide 300 in the circumferential direction is transmitted in order to facilitate understanding of the layer configuration of the hollow waveguide 300.

  The medical treatment device 1 is a device having both the function of a laser knife and the function of an electric knife, and a high-frequency current for a laser oscillator 1a (FIG. 4) that is a laser light source that generates laser light from a carbon dioxide laser and an electric knife. A device main body 2 including a high-frequency oscillator 1b (FIG. 4) that oscillates, a monopolar medical treatment instrument 10 that functions as a laser knife and also functions as an electric knife, device main body 2, and monopolar medical treatment It comprises a waveguide cable 30 and a conductive cable 40 that connect the tool 10.

  As described above, the apparatus main body 2 is a rectangular parallelepiped casing having a laser oscillator 1a (FIG. 4) and a high-frequency oscillator 1b (FIG. 4) therein and extending in the depth direction and the vertical direction, as shown in FIG. A tilting operation panel 4 is provided on the front side of the upper surface 2a.

In addition, a caster 3 is provided at the lower part of the apparatus main body 2, and a handle 5 provided on the front side of the operation panel 4 can be gripped to easily move to a desired position and be fixed in position.
Further, a holder 6 for locking the monopolar medical treatment instrument 10 is provided on the side of the operation panel 4.

  A waveguide cable 30 whose proximal end projects vertically upward from the rear side of the upper surface 2a of the apparatus main body 2 is connected to the laser oscillator 1a inside the apparatus main body 2, and the carbon dioxide laser light oscillated by the laser oscillator 1a is Can be guided to the monopolar medical treatment instrument 10 attached to the device.

  Similarly to the waveguide cable 30, the conductive cable 40 whose proximal end protrudes vertically upward from the rear side of the upper surface 2 a of the apparatus main body 2 is connected to the high-frequency oscillator 1 b inside the apparatus main body 2, and the high-frequency oscillator 1 b The high-frequency current oscillated at is connected to the blade tip 20 disposed at the tip of the monopolar medical treatment instrument 10 through the connection terminal 13 connecting the tip of the conductive cable 40, the stainless steel tube 310, and the conductive metal layer 320. can do.

The waveguide cable 30 and the conductive cable 40 are supported by a support pole 2 b provided in the vertical direction on the upper surface 2 a of the apparatus main body 2.
Although not shown in FIG. 2, the counter electrode plate covered electric wire 41 (FIG. 4) having the counter electrode plate 42 (FIG. 4) connected to the tip is also connected to the high frequency oscillator 1 b of the medical treatment apparatus 1.

As shown in FIG. 1, the monopolar medical treatment instrument 10 connected to the distal end of the waveguide cable 30 includes a grip 11, a laser probe 12, and a blade distal tip 20 disposed on the distal end side of the laser probe 12. It is composed.
The grip 11 is made of a resin formed in a grip shape that is easy for the practitioner to hold, and is disposed at the lower end of the rear end side (left side in FIG. 1A), that is, at the base of the grip 11 on the apparatus main body 2 side. The hollow waveguide 300 and the waveguide cable 30 are connected by the connected connector 14.

  A part of the laser probe 12 is inserted through the grip 11 and the outer peripheral surface of the straight tube portion of the hollow waveguide 300 that is not inserted is covered with an insulating coating 12a made of resin. Further, on the rear end side of the laser probe 12, that is, on the grip 11 side, a metal cylindrical shape that penetrates the insulating coating 12a and is physically and electrically connected and fixed to the stainless steel tube 310 of the hollow waveguide 300. The connection terminal 13 is provided.

  Note that a part of the hollow waveguide 300 of the laser probe 12 penetrates the inside of the grip 11, and as described above, the connection connector 14 disposed at the rear end side of the grip 11, that is, the lower end on the apparatus main body 2 side, is provided. And communicates with the waveguide cable 30.

  The blade tip 20 has a blade electrode 21 disposed at a predetermined interval in the irradiation direction of the carbon dioxide laser light emitted from the tip of the laser probe 12, and a stainless steel tube of the hollow waveguide 300 penetrating the insulating coating 12a. The support arm 22 is physically and electrically connected and fixed to 310 (FIG. 3) and supports the blade electrode 21 at the predetermined position described above. The support arm 22 and the blade electrode 21 are made of a conductive metal material.

  As shown in FIG. 1B, the blade electrode 21 is a substantially blade-shaped blade as viewed in the direction of arrows AA, that is, a substantially rectangular blade whose one end side in the longitudinal direction is narrowed in the width direction. ), The center of the blade electrode 21 is substantially aligned with the center of the laser probe 12 closer to the grip 11 than the arrow AA. Further, the length in the width direction of the blade electrode 21 is set to a length approximately equal to the outer diameter of the laser probe 12.

  As described above, the support arm 22 has a proximal end portion that is directly connected and fixed to the outer peripheral surface of the stainless steel tube 310 of the hollow waveguide 300 through the insulating coating 12a, and a part of the arm that is curved. The main body supports one end side of the blade electrode 21 in the longitudinal direction. The support arm 22 is also covered with an insulating coating 22a in the same manner as the insulating coating 12a in the laser probe 12. Further, the insulating coating 12a and the insulating coating 22a are integrated, and the connecting portion between the stainless steel tube 310 and the support arm 22 is not exposed.

  As described above, the waveguide cable 30 protruding in the vertical direction from the upper surface 2a of the apparatus main body 2 is a cable having a predetermined length and flexibility, and is a hollow or solid light that can transmit a carbon dioxide laser beam. It consists of a fiber and a protective tube that covers it.

  Subsequently, the hollow waveguide 300 constituting the laser probe 12 will be described. As shown in FIG. 3, the hollow waveguide 300 includes a stainless steel tube 310 serving as a base material, a conductive metal layer 320 disposed in order from the radially outward direction to the radially inward direction on the inner surface of the stainless steel tube 310, and a dielectric. The body thin film 330 is used. A waveguide space 300a is formed inside the hollow.

  Gold, silver or copper is suitable for the conductive metal layer 320 formed on the inner surface of the stainless steel tube 310. These metal materials have higher conductivity than stainless steel and have high reflectivity with respect to carbon dioxide laser light. Such a conductive metal layer 320 can be formed on the inner surface of the stainless steel tube 310 by plating or rolling.

The dielectric thin film 330 formed on the inner surface of the conductive metal layer 320 is a dielectric material having an appropriate film thickness for efficiently reflecting and transmitting carbon dioxide laser light in the hollow waveguide 300, and is formed of, for example, a cyclic olefin polymer. It is a thin film.
The hollow waveguide 300 configured as described above has high electrical conductivity due to the stainless steel tube 310 and the conductive metal layer 320, and can improve the transmission efficiency of the carbon dioxide laser light guided through the waveguide space 300a.

  As described above, the laser probe 12 is configured by covering the outer periphery of the side surface of the hollow waveguide 300 having the above configuration with the insulating coating 12a. However, the connection terminal 13 and the support arm 22 have the insulating coating 12a. Since it penetrates and is directly connected and fixed to the stainless steel tube 310 having conductivity, the connection terminal 13 and the blade electrode 21 are electrically connected.

  Since the outer periphery of the side surface of the stainless steel tube 310 is covered with the insulating coating 12a and the support arm 22 is covered with the insulating coating 22a, the laser probe 12 and the support arm 22 are electrically connected even if they contact the living body. The hollow waveguide 300 itself and the support arm 22 do not become an electrode of an electric knife.

As shown in FIG. 4, the medical treatment apparatus 1 configured as described above is first attached to the distal end of the counter electrode coated electric wire 41 connected to the high-frequency oscillator 1 b and attached to the patient M who is a treatment target. A counter electrode plate 42 constituting an electrode is attached.
Further, the conductive cable 40 connected to the high-frequency oscillator 1 b is connected to the connection terminal 13 of the monopolar medical treatment instrument 10.

  In this state, a high-frequency current is applied by the high-frequency oscillator 1b and the blade electrode 21 of the monopolar medical treatment instrument 10 is brought into contact with the treatment site of the patient M, whereby the high-frequency oscillator 1b, the conductive cable 40, and the connection terminal 13 are contacted. The energization circuit is constituted by the stainless steel tube 310 and the conductive metal layer 320 of the hollow waveguide 300 in the laser probe 12, the support arm 22, the blade electrode 21, the patient M, the counter electrode plate 42, and the counter electrode plate covered electric wire 41. An electric scalpel that is incised or cauterized and stopped by the blade electrode 21 that is energized by a high-frequency current and that contacts the patient M can be configured.

  Further, the monopolar medical treatment instrument 10 attached to the tip of the waveguide cable 30 connected to the laser oscillator 1a has the carbon dioxide laser beam output from the laser oscillator 1a as the waveguide cable 30 and the monopolar medical treatment instrument. 10 is guided through the waveguide space 300a of the hollow waveguide 300 mounted on the laser beam 10 and irradiated with carbon dioxide laser light forward from the tip of the laser probe 12, thereby functioning as a laser knife.

  Further, since the blade electrode 21 of the blade tip 20 is disposed in front of the laser probe 12 in the irradiation direction and on the optical axis of the laser light, the irradiated carbon dioxide laser light is blocked by the blade electrode 21. No irradiation is performed ahead of the blade electrode 21.

  Furthermore, in the laser probe 12, since the hollow waveguide 300 is covered with the insulating coating 12a and the support arm 22 is covered with the insulating coating 22a, the hollow waveguide 300 and the support arm 22 through which high-frequency current is conducted are Even if it touches an unintended location in M, the high frequency current does not conduct, and the contact location does not become an electrode of an electric knife.

A method of using the medical treatment apparatus 1 will be described with FIG. 5, which is a schematic view of a coelomic surgery using the medical treatment apparatus 1.
As described above, the counter electrode plate 42 is attached to the back of the patient M to establish continuity with the living body, and the conductive cable 40 is connected to the connection terminal 13 of the monopolar medical treatment instrument 10. After making the treatment possible, a hole for inserting the monopolar medical treatment instrument 10 and the body cavity endoscope 100 is opened in the body cavity endoscope, and the cylindrical trocar 110 is inserted.

  The body cavity mirror 100 is inserted into one trocar 110, and the monopolar medical treatment instrument 10 is inserted into the other trocar 110. Then, while confirming the image displayed on the monitor 101 connected to the body cavity mirror 100, a high-frequency current is applied to the periphery of the affected part P to be incised by the high-frequency oscillator 1b, so that the blade electrode 21 is an electrode of an electric knife. The blade electrode 21 is inserted into the lower part of the living tissue of the affected part P.

  In this state, the laser oscillator 1a oscillates the carbon dioxide laser light, propagates the carbon dioxide laser light into the waveguide space 300a, and irradiates the carbon dioxide laser light from the tip of the laser probe 12, and the laser probe 12 and the blade electrode An incision is made around the affected area P interposed between 21 and the affected area P is excised.

  In this way, the monopolar medical treatment instrument 10 inserted into the body cavity has a hollow waveguide 300 that guides carbon dioxide laser light that can be cut in a non-contact manner, and a blade that is disposed on the distal end extension of the hollow waveguide 300. A counter electrode plate 42 that is in contact with the living body of the patient M to be treated, and a blade, through a hollow waveguide 300 that includes the electrode 21 and the connection terminal 13 and has conductivity and also guides laser light. By applying a high-frequency current between the electrode 21 and the electrode 21, the function of the laser knife and the function of the electric knife can be switched and used with a simple device configuration.

  Specifically, since the hollow waveguide 300 that guides the carbon dioxide laser light that can be cut in a non-contact manner and the blade electrode 21 disposed on the distal end extension of the hollow waveguide 300, the waveguide of the hollow waveguide 300 is provided. Since the carbon dioxide laser light can be guided in the space 300a and the metal hollow waveguide 300 itself can be used as a current-carrying member, the connection terminal 13 that contacts the hollow waveguide 300 can be used for the living body of the patient M. By applying a high-frequency current between the contacted counter electrode plate 42 and the blade electrode 21, it is possible to switch between the function of the laser knife and the function of the electric knife with a simple device configuration. For example, it can be used in a method suitable for the operation content, such as making an incision efficiently with the function of the laser knife and suppressing the incision width to a small extent, and stopping bleeding in a wide range with the function of the electric knife. . When coagulating a living tissue with a carbon dioxide laser, the penetration force into the living tissue is weak, so that only the surface of the living tissue is coagulated, but the electrosurgical unit penetrates into the tissue and can easily coagulate and stop the tissue. .

  Further, since carbon dioxide laser light can be guided directly into the hollow hollow waveguide 300 and the hollow waveguide 300 itself made of a metal material can be used as a conductor, for example, the waveguide and the conductor. As compared with the case where these are separately provided, the shaft diameter is reduced, and the burden on the living body can be reduced.

  Therefore, in the above-described colostomy surgery, in general, replacement of a surgical instrument is very complicated and troublesome, but the surgical instrument can be replaced by using the monopolar medical treatment instrument 10 according to the present invention. In addition, it is possible to perform an operation using a suitable scalpel function according to the operation content, and to perform a highly invasive operation that can reduce the burden on the patient.

  In addition, the blade electrode 21 is spaced a predetermined distance from the tip of the hollow waveguide 300 that guides the carbon dioxide laser light, and is disposed at the tip of the irradiation path of the carbon dioxide laser light, thereby unintentional incision of the living body by the laser knife. Can be prevented.

  Specifically, the blade electrode 21 and the hollow waveguide 300 are spaced apart from each other by a predetermined distance from the tip of the hollow waveguide 300 that guides the carbon dioxide laser light and disposed on the irradiation path of the carbon dioxide laser light. The affected part P to be incised is disposed between the distal end and the incision can be performed efficiently and accurately without contact with the carbon dioxide laser beam.

  Further, since the blade electrode 21 is arranged on the irradiation path of the carbon dioxide laser light, the carbon dioxide laser light is blocked by the blade electrode 21, and therefore, for example, even in a body cavity endoscope surgical operation with a narrow surgical field, the carbon dioxide laser light is used. Can reach the deep part of the living tissue and can be safely operated without being exposed to an unintended depth or location.

  Thus, the blade electrode 21 acts not only as an electrode for an electric knife but also as a light shielding plate for shielding laser light. Therefore, when treating with a laser knife, the living body is disposed in the space between the exit of the hollow waveguide 300 and the blade electrode 21.

  Further, since the side surface of the hollow waveguide 300 is covered with an insulating coating 12a having an insulating property, and the support arm 22 to which a high-frequency current is supplied is also covered with the insulating coating 22a, the high-frequency current is connected via the connection terminal 13. The hollow waveguide 300 and the support arm 22 that are energized in contact with an unintended living body part at the treatment site, and act as an electrode of an electric knife to prevent unintentional burnout and perform a safer treatment. Can do.

  Further, since the hollow waveguide 300 is composed of the stainless steel tube 310 and the conductive metal layer 320 having higher conductivity than the stainless steel covering the inner peripheral surface, the electrical conduction to the blade electrode 21 is ensured. At the same time, the conductive metal layer 320 also acts to increase the reflectivity of the inner wall of the hollow waveguide 300, so that the waveguide performance of the hollow waveguide 300 that guides the carbon dioxide laser light inside can be improved.

  In addition, a carbon dioxide laser is used as the laser light guided in the hollow waveguide 300. Since the carbon dioxide laser light has a small divergence angle and a high energy density, an incision that is more efficient and has a narrow incision width is performed. Can do. Further, since the laser beam absorbability by water is high and does not penetrate deeply into the living tissue, there is little influence on the normal tissue and the post-operative patient burden can be further reduced.

  In the above description, the carbon dioxide laser light is guided to the waveguide space 300a of the hollow waveguide 300 constituting the laser probe 12. However, in addition to the carbon dioxide laser light, a predetermined gas is allowed to flow at a predetermined flow rate. Also good. In this case, in addition to the optical fiber for transmitting the carbon dioxide laser beam in the waveguide cable 30, a gas introduction tube is separately inserted to connect the flexible optical fiber in the waveguide cable 30 and the laser probe 12. A gap for introducing gas is provided in the connector 14, and gas flows into the waveguide space 300 a of the hollow waveguide 300.

  Note that as the gas flowing into the waveguide space 300a, air, nitrogen, an inert gas, or a gas containing carbon dioxide in these gases is preferable. Since carbon dioxide is highly bioabsorbable, carbon dioxide supplied into the body cavity is absorbed quickly after the operation, so the burden on the patient is low and the degree of low invasiveness is high.

  As described above, by flowing a gas at a predetermined flow rate into the waveguide space 300a of the hollow waveguide 300, scattered matter and body fluid of the incised affected part P, smoke filling the body cavity, etc. It is possible to prevent the waveguide efficiency of laser light from being lowered without entering the waveguide space 300a. Furthermore, a visual field around the affected area P can be secured under a body cavity endoscope.

  In addition, as a monopolar medical treatment tool, a grasping function as grasping forceps may be provided. As shown in FIG. 6, the monopolar gripping medical treatment instrument 10a includes a scissor-like gripping operation unit 15 instead of the grip 11 in the monopolar medical treatment instrument 10 described above, and is insulated. A hollow gripping shaft portion 16 is provided, and the hollow waveguide 300 is inserted into the gripping shaft portion 16 so that the tip of the hollow waveguide 300 is exposed from the tip of the gripping shaft portion 16. Further, the connection terminal 13 is provided on the rear end side of the hollow waveguide 300, that is, on the hand side.

  Furthermore, the grasping-type medical treatment instrument 10a includes a blade tip chip 23 with a gripping function instead of the blade tip chip 20 described above. As shown in FIG. 6B, which is a BB arrow view in FIG. 6A, the blade tip tip 23 with the gripping function is pivoted on the side of the blade electrode 21 in the blade tip tip 23 with the gripping function. A gripping arm 24 that can pivot about a moving shaft 23a is provided.

  The gripping medical treatment instrument 10a configured as described above operates the gripping operation unit 15 by a gripping mechanism (not shown) to pivot the gripping arm 24 of the blade tip chip 23 with a gripping function, thereby causing the affected part P to move. Etc. can be gripped. That is, the grasping-type medical treatment instrument 10a functions as a laser knife by irradiating a carbon dioxide laser beam from the tip of the hollow waveguide 300, and the blade electrode 21 of the blade tip chip 23 with a grasping function functions as an electric knife. In addition to the effects similar to those of the monopolar medical treatment instrument 10 in the medical treatment apparatus 1, the medical treatment apparatus 1 has a gripping function, and can cope with a more multifunctional treatment.

In correspondence between the configuration of the present invention and the above-described embodiment,
The medical treatment tool of the present invention corresponds to the monopolar medical treatment tool 10 and the grip-type medical treatment tool 10a,
Similarly,
The conductive hollow waveguide corresponds to the hollow waveguide 300 in which the conductive metal layer 320 is further formed on the inner surface of the stainless steel tube 310 or the stainless steel tube 310.
The blade electrode for the electric knife corresponds to the blade electrode 21,
The counter electrode corresponds to the counter electrode plate 42,
The energization means corresponds to the connection terminal 13,
The highly conductive metal layer corresponds to the conductive metal layer 320 made of gold, silver, or copper having higher conductivity than stainless steel,
The gas corresponds to either air, nitrogen, an inert gas, or a gas containing carbon dioxide in these gases,
The laser beam corresponds to the carbon dioxide laser beam,
The conductive line corresponds to the conductive cable 40 and the coated electrode 41 for the counter electrode,
The present invention is not limited only to the configuration of the above-described embodiment, and many embodiments can be obtained.

  For example, in the above description, the monopolar medical treatment instrument 10 that functions as a monopolar electric knife by energizing between the blade electrode 21 and the counter electrode 42 attached to the patient M has been described. In addition, a bipolar medical treatment instrument in which a bipolar electrode functioning as a counter electrode is disposed in the treatment instrument body may be used.

DESCRIPTION OF SYMBOLS 1 ... Medical treatment apparatus 1a ... Laser oscillator 1b ... High frequency oscillator 2 ... Apparatus main body 10 ... Monopolar type medical treatment instrument 10a ... Gripping medical treatment instrument 12a, 22a ... Insulation coating 13 ... Connection terminal 21 ... Blade electrode 30 ... Waveguide cable 40 ... Conductive cable 41 ... Counter electrode plate coated wire 42 ... Counter electrode plate 300 ... Hollow waveguide 320 ... Conductive metal layer

Claims (7)

A medical treatment instrument inserted into a body cavity,
A hollow conductive hollow waveguide that guides laser light that can be cut in a non-contact manner;
A blade electrode for an electric knife provided at the tip of the conductive hollow waveguide,
In the conductive hollow waveguide,
A medical treatment instrument comprising an energizing means for energizing a high-frequency current between a counter electrode that contacts a living body to be treated and the blade electrode for an electric knife. The electric knife blade electrode,
The medical treatment instrument according to claim 1, wherein the medical treatment instrument is arranged on the irradiation path of the laser light while being spaced apart from a light emitting end of the conductive hollow waveguide that emits the laser light. A side exterior of the conductive hollow waveguide,
The medical treatment instrument according to claim 1, wherein the medical treatment instrument is covered with an insulating coating having insulating properties. On the inner peripheral surface of the conductive hollow waveguide,
The medical treatment instrument according to any one of claims 1 to 3, further comprising a highly conductive metal layer having high conductivity. Inside the conductive hollow waveguide,
The medical treatment tool according to any one of claims 1 to 4, wherein a gas having a predetermined flow rate is introduced. The medical treatment instrument according to any one of claims 1 to 5, wherein the laser light guided in the conductive hollow waveguide is constituted by carbon dioxide laser light. An apparatus main body internally provided with a laser oscillator that is a laser light source that generates laser light, and a high-frequency oscillator that oscillates high-frequency current
The medical treatment instrument according to any one of claims 1 to 6,
A counter electrode in contact with the living body;
A waveguide cable connecting the laser oscillator and the medical treatment instrument;
A medical treatment apparatus configured with each of the medical treatment tool and the counter electrode and a conductive line connecting the high-frequency oscillator.

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