JPH01146537A - Surgical resection device - Google Patents

Abstract

PURPOSE:To make inner and outer pipes easy to wash and to enhance resection efficiency, by mounting a shape holding member externally mounted to the splittable outer pipe having the inner pipe mounted therein to hold the shape of the outer pipe. CONSTITUTION:A surgical resection device is constituted of a main body 2 also used as the grasping part on this side in combination and the elongated insert part 3 inserted in the body cavity. A fixed curving part 7 bent, for example, at an angle of about 30 deg. so as to make the tissue take-in blade port 6 formed to the leading end thereof easy to approach tissue is formed to the insert part 3 on the side of the leading end part thereof. In assembling the insert part 3 to a main body 2, an outer pipe piece 4a is combined with the outer periphery of an inner pipe 5 to form an outer pipe 4 and a shape holding member 10 is externally mounted to the outer pipe 4 from the base part thereof and fixed to the outer pipe 4 by screwing a fixing screw 13 in a screw hole 11 to constitute the insert part 3. The base part of the insert part 3 is assembled in the main body 2 and the inner pipe 5 is engaged with an output shaft 25 through a connection member 27 and a fixing screw part 21 is screwed in the fixing part 18 of a front housing 17 to fix the inner pipe 51 Since the inner and outer pipes 5, 4 can be simply disassembled, this device is excellent in washability and the cutting blade of the inner pipe can be enlarged and resection efficiency can be enhanced.

Description

Detailed Description of the Invention [Industrial Application Field] The present invention can be used to remove cartilage (articular meniscus, articular cartilage) and one type of chondrocele from outside the body cavity to within the body cavity, for example, within the joint cavity of the knee, etc., without making an incision. This relates to a surgical excision instrument that excises a tumor or the like and drains it out of the body cavity.

[Problems to be solved by conventional techniques and inventions] Conventionally,
Joint surgery was primarily performed by incision (open surgery). For example, in general joint surgery,
These include removing a tumor on the B-cap and removing damaged cartilage, bone, etc. from the knee joint, but these surgeries require relatively large incisions. For this reason, the incision causes trauma, which is accompanied by pain and restriction of movement, and has the disadvantage that it takes a long time to completely heal.

Therefore, in recent years, surgical resection instruments have been developed that perform surgery by forming a small puncture hole in the joint without incising the joint and inserting the insertion part into this puncture hole under the observation of a septum scope (endoscope). is proposed. For example, Japanese Patent Application Laid-Open No. 170449/1983 discloses a surgical cutting instrument that has an insertion section inserted into a hard, linearly extending outer tube through which a hard, linearly extending inner tube is inserted, the tip of which is provided with a cutting section. is disclosed. However, this rigid, linearly extending insertion section has the problem that when performing resection within the joint cavity, there are areas that cannot be resected. To address this problem, US Pat. No. 4,646,738 discloses a surgical cutting instrument in which the outer tube forming the insertion portion is semi-rigid and has a tendency to bend. However, in this prior art example, the distal end of the insertion section is bent into an arbitrary shape, but during surgery, if it hits hard tissue such as bone while being inserted into a body cavity, for example a joint cavity, the insertion section will bend. There are problems in that the shape changes, making it difficult to insert, and in some cases, making it impossible to reach the target site.

Therefore, in Japanese Patent Application No. 1983, the present applicant provided a fixed curved portion at the distal end portion of the outer tube, while at least a portion of the inner tube opposite to the fixed curved portion of the outer tube was made flexible. Furthermore, the present invention proposes a surgical cutting instrument in which the outer tube and the inner tube are detachable from the main body. According to this related technology, the set bending shape of the insertion section is not changed by the hard set #1 etc. during insertion into the body cavity, and the insertion section is formed into a bending shape that makes it easy to approach the target tissue. It has the advantage of being able to choose what is available. However, in this related technology, in order to insert and remove the inner tube from the outer tube that has a fixed curved part, the inner tube needs to be flexible, and the inner tube is inserted into the outer tube. The problem remains that the inner tube gets caught on the inner wall of the outer tube at the fixed curved portion, making it difficult to insert and assemble. Furthermore, although it is desirable that the cutting blade provided at the distal end of the inner tube be large in order to improve cutting efficiency, there is a problem in that the ease of inserting and assembling the inner tube into the outer tube becomes difficult.

The present invention has been made in view of these circumstances, and it is possible to prevent the set bending shape of the insertion portion from being changed by hard tissue during insertion into a body cavity, and to fix the insertion portion easily to approach the target tissue. The insertion part can be set in a bent shape, the inner tube can be easily assembled to the outer tube, the inner tube and the outer tube can be easily cleaned, and the cutting edge of the inner tube can be sharpened. It is an object of the present invention to provide a surgical resection instrument capable of improving resection efficiency.

[Means for Solving the Problems and Their Effects] In order to achieve the above object, the surgical resection instrument according to the present invention has a tissue-taking opening in the distal end, a fixed curved part on the distal end side, and a surgical cutting instrument according to the present invention. Inside the outer tube, which is configured to be splittable in the longitudinal direction, there is an inner tube, which has a cutting edge at the tip facing the cutting edge and is flexible at least from the part corresponding to the fixed curved part, about the axis. A shape-retaining member that is rotatably installed inside the tube, and a shape-retaining member that is attached to a separable outer tube that has the inner tube inside, and that maintains the shape of the outer tube.

With this configuration, the outer tube is formed by combining the divided outer tube pieces around the outer circumference of the inner tube, and then the insertion portion is formed by covering the outer tube with a shape-retaining member from the base side.

[Example] Hereinafter, an example of the present invention will be specifically described with reference to the drawings.

Figures 1 to 3 relate to one embodiment of the surgical cutting instrument of the present invention, in which Figure 1 is a cutaway side view of the main part, Figure 2 is a sectional view showing the outer tube, and Figure 3 is an exploded view of the insertion part. It is a perspective view which does not show a state.

In these figures, reference numeral 1 denotes a surgical resection instrument, which includes a main body 2 that also serves as a grip on the proximal side, and an elongated body 2 that extends forward from the main body 2 and is inserted into a body cavity, for example, an open cavity. It is composed of an insertion section 3. The insertion section 3 is composed of an outer tube 4 whose open base is fixed to the distal end of the main body 2, and an inner tube 5 housed within the outer tube 4 so as to be rotatable about an axis. The outer tube 4 is made of, for example, stainless steel, and in the example shown, has a tissue-taking opening 6 at its tip, and is bent at an angle of, for example, about 30 degrees to make it easier to approach the tissue. A fixed curved portion 7 is formed on the distal end side. Further, this outer tube 4 is configured to be able to be divided into a plurality of pieces in the longitudinal direction, and into two in the illustrated example, each of which has an outer tube piece 4.
It is a.

On the other hand, the inner tube 5 is made of a coiled coil or a flexible synthetic resin tube (multi-gore tube, urethane tube, etc.), and has a cutting blade member 8 fixed to its tip. This cutting blade member 8 has a communication hole 8b that communicates with the inner tube 5 from the cutting blade 8a side.
is formed, and the 4111 intake blade opening 6 of the outer tube 4 communicates with the inside of the inner tube 5 through this communication hole 8b. This inner tube 5
The inner path serves as a section suction passage 9 and communicates with the proximal main body 2 to which the section suction neck is connected.

The outer tube 4, which has an inner tube 5 inside and is combined with an outer tube piece 4a to form a vibrator, is covered with a pipe-shaped shape retaining member 10 in the illustrated example so that the outer shape of the outer tube 4 is retained. It has become. Further, a screw hole 11 is formed on the outer periphery of the base side of the shape-retaining member 10 toward the inner periphery, and an engagement recess 12 is formed on the outer periphery of the outer tube piece 4a corresponding to the screw hole 11, and a fixing screw 13 is formed on the outer periphery of the outer tube piece 4a. The shape retaining member 10 is fixed to the outer tube 4 by screwing into the screw hole 11 and engaging the tip of the screw 13 into the recess 12 of the outer tube piece 4a and tightening it. A flange 10a and a fixing sleeve 10b are formed on the base side of the shape retaining member 10.

The main body 2 is a part of the surgical resection instrument 1 that is held and operated by an operator such as a surgeon, and includes a housing 14 that houses a driving part that rotationally drives the inner tube 5 and the like, and a suction passage of the outer tube 4. Front housing 1 has a cavity 15 communicating with 9 and is fitted with a suction tube mouthpiece 16 connected to a section suction device.
It consists of 7. This front housing 17 is
For example, it is removably screwed to the housing 14 by screwing means. Further, the front housing 17 has an annular fixing part 18 at the front and a groove part in the axial direction of the inner circumference thereof. On the other hand, a sleeve 10b having a flange 10a at the front is integrally formed on the outer periphery of the base of the shape-retaining member 10 that internally holds the outer tube 4, and a pin 20 is installed on the outer periphery of the sleeve 10b. Then, with the bottle 20 engaged in the groove 19, the sleeve 10 is
The base of the outer tube 4, which is fitted with one screw b, is inserted into the fixing part 18, and the fixing screw body 21 is screwed onto the outer periphery of the fixing part 18, thereby removably fixing the base of the shape retaining member 10.

A motor 22 as a driving portion is housed in the rear part of the housing 14, and a male spline 24 is fixed to a motor shaft 23 that projects forward of the motor 22. On the other hand, in front of this motor 22, an output shaft 25 is rotatably and slidably supported in the axial direction.
A female spline 26 is formed at this rear portion, and this female spline 26 meshes with the male spline 24. The output shaft 25 protrudes into the cavity 15 of the housing 14, and the connecting member 2 has a rear end portion of the inner tube 5 fitted into this protrusion.
7 are connected. This sleeve-shaped connecting member 27 is provided with a window portion 28 on its outer periphery that communicates with the suction path 9 .

Further, a semi-rigid cover 29 is attached to the outer periphery of the fitting connection portion between the rear end portion of the flexible inner tube 5 and the connecting member 27 for reinforcement. As this semi-rigid cover 29, a tightly wound coil, Teflon, heat-shrinkable dupe, or the like is used.

In this configuration, in order to assemble the insertion portion 3 to the main body 2, first, the outer tube piece 4a divided in the longitudinal direction is combined with the outer periphery of the inner tube 5 to form the outer tube 4, and in this state, the outer tube piece 4a is assembled to the outer circumference of the inner tube 5. The shape retaining member 10 is mounted from the base side, the screw hole 11 and the insertion recess 12 are aligned, the fixing screw 13 is screwed into the screw hole 11, and the tip of the screw 13 is inserted into the recess 12. By tightening the shape retaining member 10 to the outer tube 4,
This constitutes the insertion section 2. Then, the base side of the insertion portion 2 is assembled into the main body 2, the inner tube 5 is engaged with the output shaft 25 via the connecting member 27, and the fixed screw body 21 is attached to the front housing 17.
It is screwed into the fixing part 18 of and fixed.

As described above, since the outer tube 4 is formed to be splittable in the axial direction, the fixed curved portion 7 is formed on the distal end side of the outer tube 4, but it is easy to assemble the inner tube 1 of the inner tube 5. Moreover, since the inner tube 5 and outer tube 4 can be easily disassembled, cleaning is excellent. Furthermore, as described above, the distal end of the insertion section 2 is bent at an angle that makes it easy to approach the tissue due to the presence of the curved section 7, so that it is easy to broach the tissue hair with the tissue inlet opening 6 at the distal end.

In the present invention, the shape 1 position of the internal cutting blade and the shape 9 position of the tissue intake opening of the outer tube are not limited to the embodiments, and can be set and formed in various ways.

Furthermore, the position of the fixed curved portion of the outer tube and its curved angle can be freely set. Therefore, it is possible to prepare a large number of outer tubes with different curved angles, select the outer tube with a curved angle that facilitates the insertion of the insertion section into the body cavity and approach the tissue, and use it in combination with the inner tube and shape-retaining member. .

Furthermore, in the embodiment, the inner tube is entirely flexible; however,
It is sufficient that at least the front portion of the outer tube from the position corresponding to the curved portion is flexible.

Furthermore, the shape-retaining member is not in the shape of a vibrator as in the embodiment, but in the form of a band, and the outer tube is held by a plurality of band-like members.

[Embodiments of the Invention] As explained above, according to the present invention, the set bending shape of the insertion section is not changed by hard tissue etc. during insertion into a body cavity, and the target tissue can be easily approached. The insertion part can be set in a fixed bending shape, the inner tube can be easily assembled to the outer tube, the inner tube and the outer tube can be easily cleaned, and the cutting edge of the inner tube can be made larger, improving cutting efficiency. It has the effect of increasing the

[Brief explanation of the drawing]

Figures 1 to 3 relate to one embodiment of the present invention, with Figure 1 being a cutaway side view of essential parts, Figure 2 being a sectional view showing the outer tube, and Figure 3 being an exploded perspective view of the insertion section. . 2... Main body 3... Insertion part 4... Outer tube 4a... Outer tube piece 5... Inner tube
6... Tissue taking blade lower... Fixed curved part 8.
... Cutting blade member 10 ... Shape retaining member

Claims (1)

[Scope of Claims] An outer tube having a fixed curved portion on the distal end side so that the distal end has a tissue-taking blade opening and bends the distal end at a predetermined angle, and is formed to be splittable in the longitudinal direction; having a cutting edge opposite to the cutting edge of the outer tube at the tip;
A shape that maintains the shape of the outer tube by having an inner tube whose front part is flexible from at least a portion corresponding to the fixed curved portion, and a splittable outer tube with the inner tube rotatable around an axis. A surgical cutting instrument comprising: a holding member.