JP7076130B2 - Bipolar scissors knife - Google Patents

Description

The present invention relates to a bipolar scissors knife that uses a high frequency current to make an incision in a tissue in the body, for example, under an endoscope.

The scope of application of endoscopic treatment for early gastrointestinal cancer has been expanded, and endoscopic mucosal resection (ESD) has come to occupy a large weight in, for example, treatment of early colorectal cancer.

In ESD, a so-called monopolar high-frequency knife having one electrode is common, and a counter electrode plate as another electrode is contact-arranged on the body surface of the patient. For example, Non-Patent Document 1 describes a monopolar needle-type knife.

However, with a monopolar knife, a high-frequency current flows through the patient's body between the electrode and the counter electrode as a conductor, so the high-frequency current energizes other than the tissue to be excised around the knife, causing complications such as bleeding and perforation. May occur. Perforation is a serious complication that requires emergency surgery. In particular, large intestine ESD is excised by moving the endoscope with a needle-type knife, which requires advanced skills and increases the risk of perforation.

Therefore, a monopolar type scissors type knife has been proposed. Non-Patent Document 2 describes that a monopolar scissors-type knife was used when performing ESD for colorectal tumors. Further, Patent Document 1 describes a monopolar scissors-type knife that stabilizes the degree of cauterization of the incised portion and the tissue around the incised portion. Such a scissor-shaped knife can be used with the same simple endoscopic operation as a biopsy operation, and since the tissue is grabbed and then pulled to energize, the possibility of perforation can be reduced without damage to the muscle layer. However, the possibility of perforation still remains, and there is a need to develop a knife with even higher safety.

Japanese Unexamined Patent Publication No. 2008-272393

ESD of cardia, ESD of pyloric ring, Mitsuru Matsuda, Journal of Japan Gastroenterological Endoscopy Society, Vol.53 (12), Dec.2011 Attempt of colon ESD traction method (3ch method) using SB knife, Progress of Digestive Endoscopy Vol.79 No.2 (2011)

However, there are cases where perforation cases are experienced even with ESD using a monopolar scissors-type knife, and a new scissors-type knife that can further prevent the occurrence of perforation is required in order to further improve the safety of ESD.

The present invention has been made in view of such problems, and an object of the present invention is to provide a scissors-shaped knife that further reduces the possibility of perforation.

The scissors-shaped knife according to the present invention is a bipolar type scissors-shaped knife. Specifically, it is provided with a pair of blades that grip and cut the tissue by opening and closing in a beak shape, and the first blade is provided with a bipolar electrode connected to one pole of a high-frequency power supply. The second blade is a bipolar shear-type knife in which a bipolar electrode connected to the other pole of the high-frequency power supply is arranged. It has an insulator and a first electrode whose cross section is a quadrangular prism having an equilateral trapezoidal shape, which is a plane having a short side among two parallel sides of the equipedular trapezoidal shape. The first slope of the 1 insulator and the 1st slope of the 1st electrode are on the same plane, and the 2nd slope facing the 1st slope of the 1st insulator and the 1st slope of the 1st electrode The second blade portion is on the same plane as the second slope facing the surface, and the second blade portion has a second insulator which is a pillar body having a concave groove portion having an isosceles triangular cross section, and a cross section provided at the bottom of the concave groove portion. Has a second electrode which is a triangular column of an isosceles triangle, the first slope of the concave groove portion and the first slope of the second electrode are on the same plane, and on the first slope of the concave groove portion. When the second slope facing each other and the second slope facing the first slope of the second electrode are on the same plane and the pair of blades are in the open state, the first blade and the second blade On the other hand, when the pair of blades is closed, at least a part of the first insulator is fitted into the concave groove portion, and the first electrode is separated from the second electrode. It is fitted into the concave groove portion in the state.

According to the present invention, a scissors-shaped knife used for ESD or the like, which can further suppress the possibility of perforation, can be obtained.

It is a figure explaining the bipolar scissors type knife which concerns on this embodiment used for ESD. It is a figure explaining the bipolar scissors type knife which concerns on this embodiment from the side surface direction. It is a figure explaining the appearance of the bipolar scissors type knife which concerns on this embodiment. It is a figure explaining the usage mode of the bipolar scissors type knife which concerns on this embodiment, of which (A) is an open state and (B) is a closed state.

Hereinafter, embodiments of the present invention will be specifically described with reference to the accompanying drawings, but the embodiments are for facilitating the understanding of the principles of the present invention, and the scope of the present invention is as follows. The present invention is not limited to the embodiments, and other embodiments in which those skilled in the art appropriately replace the configurations of the following embodiments are also included in the scope of the present invention.

FIG. 1 is a bipolar scissors knife 900 used, for example, for ESD, in which the flexible sheath 800 is inserted and removed from the hemostatic forceps insertion channel of the endoscope. The flexible sheath 800 is formed, for example, by an electrically insulating tube of ethylene tetrafluoride resin tube, having a diameter of, for example, 2 to 3 mm and a length of, for example, 1 to 2 m.

A support body 810 made of electrically insulating hard plastic is connected and fixed to the tip of the flexible sheath 800, and a slit 820 having a constant width is formed in the support body 810 in the longitudinal direction.

As shown in FIG. 2, the bipolar scissors-type knife 900 according to the present embodiment has a first blade portion 110 and a second blade portion, which are a pair of blade portions that grip and cut tissue by opening and closing in a beak shape. It is equipped with 120.

As shown in FIG. 3, the first blade portion 110 is a plane having a first insulator 112, which is a quadrangular prism having an isosceles trapezoidal cross section, and a short side of two parallel sides of the isosceles trapezoidal shape. It has a first electrode 111 whose cross section is an isosceles trapezoidal quadrangular prism provided on the short side plane. The first electrode 111 is a bipolar electrode connected to one pole of a high frequency power supply. The first slope of the first insulator 112 and the first slope of the first electrode 111 are on the same plane, and the second slope facing the first slope of the first insulator 112 and the first electrode 111 are the first. It is on the same plane as the second slope facing the first slope.

The second blade portion 120 has a second insulator 122 which is a pillar having a concave groove portion 123 having an isosceles right triangle in cross section, and a second electrode having a triangular prism whose cross section is an isosceles right triangle provided at the bottom of the concave groove portion 123. 121 and. The second electrode 121 is a bipolar electrode connected to the other pole of the high frequency power supply. The first slope of the concave groove portion 123 and the first slope of the second electrode 121 are on the same plane, and face the second slope facing the first slope of the concave groove portion 123 and the first slope of the second electrode 121. It is on the same plane as the second slope.

The frequency of the high frequency power supply is not particularly limited, but is, for example, 200 kHz to 3 MHz, and is, for example, 800 kHz to 1 MHz. The voltage between the first electrode 111 and the second electrode 121 is not particularly limited, but is, for example, 500V to 800V, and is, for example, 600V to 700V.

In the vicinity of the tip of the support body 810, a pair of shaft holes 830 are formed in a direction orthogonal to the direction of the slit 820, parallel to positions separated from each other with the central axis of the support body 810 in between. A stainless steel support shaft 840 is inserted through each shaft hole 830.

The first blade portion 110 and the second blade portion 120 are supported by the support main body 810 independently of each other by two support shafts 840 so as to be openable and closable in a beak shape.

Returning to FIG. 2, the rotary support hole 190 is a hole formed in the first blade portion 110 and the second blade portion 120 so that the support shaft 840 is rotatably fitted. In the rear portions of the first blade portion 110 and the second blade portion 120, the drive arm portion 180 is integrally extended behind the rotation support hole 190, and the through hole 170 formed in the vicinity of the protruding end thereof is formed. The tips of the two conductive wires 700 are passed through and connected. One of the conductive wires 700 is connected to the first electrode 111, and the other is connected to the second electrode 121.

At the tip of the support main body 810, a spacer 600 located between the first blade portion 110 and the second blade portion 120 is arranged. The spacer 600 is integrally formed with the support body 810 as a single component. A shaft hole 830 through which two support shafts 840 are individually passed is formed through the spacer 600 in parallel in a direction perpendicular to the slit 820.

Next, a mode of use of the bipolar scissors type knife according to the present embodiment will be described.

As shown in FIG. 4A, when the first blade portion 110 and the second blade portion 120 are in the open state, the first blade portion 110 and the second blade portion 120 are separated from each other. On the other hand, as shown in FIG. 4B, when the pair of blade portions is in the closed state, at least a part of the first insulator 112 is fitted into the concave groove portion 123, and the first electrode 111 is the second electrode. It is fitted into the concave groove portion 123 in a state of being separated from the 121.

As described above, according to the bipolar scissors type knife according to the present embodiment, it is possible to reduce the risk of cauterizing the surroundings when a high-frequency current is passed between the pair of blades, and further, the pair of blades has a pair of blades. In the closed state, at least a part of the first insulator 112 is fitted into the concave groove portion 123 and cannot be closed any more. Therefore, the separated state between the first electrode 111 and the second electrode 121 should be stably maintained. This makes it possible to accurately prevent short circuits between the electrodes.

It can be used for endoscopic mucosal resection.

110: 1st blade 111: 1st electrode 112: 1st insulator 120: 2nd blade 121: 2nd electrode 122: 2nd insulator 123: concave groove 170: through hole 180: drive arm 190: rotation Support hole 600: Spacer 700: Conductive wire 800: Possibility sheath 810: Support body 820: Slit 830: Shaft hole 840: Support shaft 900: Bipolar scissors type knife

Claims (2)

It is equipped with a pair of blades that grip and cut tissue by opening and closing in a beak shape, and the first blade is provided with a bipolar electrode connected to one pole of a high-frequency power supply, and the second blade is provided. Is a bipolar scissors-type knife with a bipolar electrode connected to the other pole of the high frequency power supply.
The first blade portion has a cross section provided on a first insulator having an equilateral trapezoidal square pillar and a short side plane which is a plane having a short side among two parallel sides of the equilateral trapezoid. It has a first electrode, which is an equilateral trapezoidal square pillar, and the first slope of the first insulator and the first slope of the first electrode are on the same plane, and the first insulator is provided. The second slope facing the first slope of the above and the second slope facing the first slope of the first electrode are on the same plane.
The second blade portion includes a second insulator which is a pillar having a concave groove portion having an isosceles triangle in cross section, and a second electrode having a triangular pillar having an isosceles triangle in cross section provided at the bottom of the concave groove portion. The first slope of the concave groove portion and the first slope of the second electrode are on the same plane, and the second slope facing the first slope of the concave groove portion and the first of the second electrode. It is on the same plane as the second slope facing the slope,
When the pair of blades is open, the first blade and the second blade are separated from each other, while when the pair of blades are closed, at least one of the first insulators is used. A bipolar scissors-type knife characterized in that a portion is fitted into the concave groove portion and the first electrode is fitted into the concave groove portion in a state where the first electrode is separated from the second electrode. The bipolar scissors knife according to claim 1, wherein the frequency of the high frequency power supply is 200 kHz to 3 MHz, and the voltage between the first electrode and the second electrode is 500 V to 800 V.

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