JPH01146538A - Surgical resection device - Google Patents

Abstract

PURPOSE:To easily insert an insert part into a body cavity at the time of insertion, by mounting a curving operation means for changing a curving part from a linear state to a predetermined bent state by the operation of the operation part on this side. CONSTITUTION:An insert part 3 consists of the outer pipe 4 fixed to the leading end part of a main body 2 at the opened base part thereof and the inner pipe 5 mounted in the outer pipe 4 so as to be freely revolvable around the axis thereof, and the inner pipe 5 is constituted of a flexible shaft 11 capable of transmitting rotatory power and an inner blade member 12 having a blade port 7 provided to the leading end thereof so as to be capable of following the deformation of the curving part of the outer pipe 4 from a linear state to a predetermined curved state. The insert part 3 can be set to a state curved at a predetermined angle from a linear state by allowing the curving part 9 arranged to the leading end of the outer pipe 4 to advance and retract in the axial direction of a slide body 20 by the revolution of the curving operation knob 23 on this side to drawn and loosen an operating wire 22 and this set shape can be held by fixing the revolution of the curving operation knob 23 by a set screw 24. Therefore, the insert part can be set to a shape easy to insert when the insert part is inserted in the body cavity.

Description

Detailed Description of the Invention [Industrial Application Field] The present invention can be used to treat cartilage (articular meniscus, articular cartilage) and chondroceles in a joint cavity, such as a knee, from outside the body cavity without making an incision. This invention relates to a surgical excision instrument that excises and discharges the body cavity.

[Problems to be solved by conventional techniques and inventions] Conventionally,
Joint surgery was primarily performed by open surgery. For example, - In intrashell joint surgery,
These surgeries include removing BlA on the patella and removing damaged cartilage, bone, etc. from the knee joint.
It required a relatively large incision. This has the disadvantage that the incision causes trauma, tongue pain and restricted movement, and that it takes a long time for complete recovery.

Therefore, in recent years, surgical resection instruments have been developed that perform surgery by forming a small puncture hole in the joint and inserting the insertion part into the puncture hole without incising the joint under observation using an arthroscope (endoscope). 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, with this rigid and linearly extending insertion section, there is a problem in 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 a hard tissue such as a bone while being inserted into a body cavity, for example, the 11Qi cavity, the insertion part may change its curved shape, making it difficult to insert or, in some cases, not being able to reach the target site for resection.

The present invention has been made in view of these circumstances, and it prevents the set bending shape of the insertion portion from being changed due to hard tissue during insertion into a body cavity, and also allows the insertion portion to be bent when the target tissue is resected. The object of the present invention is to provide a surgical resection instrument that can be bent into a shape that facilitates hair broaching of the target tissue, and furthermore, can be bent into a shape that facilitates insertion of the insertion portion into a body cavity. .

[Means for Solving the Problems and Their Effects] In order to achieve the above object, the surgical resection instrument according to the present invention is provided with a curved part that can be bent into a predetermined bending shape in the middle of the insertion part. It is provided with a bending actuating means that changes from a straight state to a predetermined curved state by operating the hand-side operating section.

With this configuration, the curved part of the insertion section consisting of the outer tube and the inner tube can be
It is possible to change the shape from a straight line to a predetermined curved state by operating the hand-side operation part, and the insertion part can be bent into a bent shape that makes it easy to insert into a body cavity, and a bent shape that makes it easy to broach the hair of the target tissue. Furthermore, it is possible to maintain this set bending shape.

[Embodiments] Hereinafter, embodiments of the present invention will be specifically described with reference to the drawings.

1 to 4 relate to a first example of the surgical cutting instrument of the present invention, in which FIG. 1 is a sectional view, FIG. 2 is an enlarged sectional view showing the bending operation knob portion, and FIG. 3 is a curved FIG. 4 is a perspective view of the operation knob portion, and FIG. 4 is a side view showing the rest 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 a rope length that extends forward from the main body 2 and is inserted into a body cavity, such as a joint cavity. It is composed of an insertion section 3. The insertion section 3 is composed of an outer tube 4 having an open base fixed to the distal end of the main body 2, and an inner tube 5 installed inside the outer tube 4 so as to be rotatable around an axis. The one-way tube 5 has a lower blade opening 6 on the side surface near the bottomed tip, and the one-way tube 5 has a lower blade opening 6 in the vicinity of the bottomed tip at a position that coincides with the tissue intake opening 6 of the outer tube 4. is open. The outer tube 4 also includes a straight tube section 8 made of stainless steel or the like extending from the base side to the middle of the tip side, and a straight tube section 8 made of, for example, stainless steel, connected to the tip of the straight tube section 8, for example, a tightly wound coil, a flexible synthetic material, etc. Curved part (closely wound coil in the example shown) made of resin duplex (multi-gore tube, urethane tube, etc.)
9, and a tissue-taking blade opening 6 connected to the tip of the curved portion 9.
The distal end component 10 is made of stainless steel or the like. The inner tube 5 also includes, for example, a flexible shaft 11 that can transmit rotational force and is made of three layers of stainless steel wire, the inner layer and the outer layer are tightly wound in the same direction, and the middle layer is wound in the opposite direction. and an inner cutter member 12 made of stainless steel or the like, which is connected to the tip of the outer tube 4 and has the lower blade, and can follow the deformation of the curved portion of the outer tube 4 from a straight shape to a predetermined curved state.

The outer tube cutting edge 6 and the inner tube cutting edge lower communicate with each other by aligning the cutting edges 6 and 7 with each other due to the rotation of the inner tube 5, and are closed by shifting, and the double cutting edge 6.
It bites into the tissue during the communication opening of 7, and when it is occluded, it is excised and cut and the cut piece is taken into the lower inner tube blade.

The inner path of the inner tube 5 serves as a section suction path 13 that communicates with the outer tube blade opening 6 and the inner tube blade lower, and also communicates with the proximal main body 2 to which a section suction device is connected.

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 a suction path of the inner tube 5. A front housing 1 with a suction tube mouthpiece 16 connected to a section suction device is mounted on the right side of a cavity 15 communicating with the section suction device 13.
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 a female thread on the inner periphery of the front part, into which a bearing pipe 18 for the bending operation knob is screwed, and the outer pipe 4 is installed through the bearing via 18. As shown in FIG. 3, this bearing via 18 has a slide groove 19 in the axial direction of its outer circumference, and a slide member 20 is slidably engaged in this groove 19, while this li!
The body layer 0 of the IE body 20 has a male thread 21 carved therein, and one end of an operating wire 22 is fixed thereto. Further, a ring-shaped bending operation knob 23 is externally mounted on the bearing pipe 18, and this bending operation knob 23 has a female thread 24 on the inner periphery and is screwed into the male thread 21 of the sliding body 20. , by rotating the knob 23 clockwise or counterclockwise, the sliding body 20 is slid in the axial direction tfr. The operating wire 22, which has one end fixed to the sliding body 20 that moves back and forth, is fixed to the base of the tip component 10 at the side of the blade 6, and is moved to the rear of the H moving body 20 by rotation of the bending operation knob 23. The operation wire 22 is pulled by sliding, for example, the bending part 9 is curved with the cutting edge 6 side of the tip structure part 10 facing inside, and P! As the moving body 20 slides forward, the operating wire 22 is relaxed, and the curved portion 9 is restored to a straight line by its own elastic restoring force. Further, the bending angle of the bending portion 9 can be set by the amount of retraction of the sliding body 20 caused by a predetermined rotation of the bending operation knob 23 and the pulling of the operating wire 22, and the bending angle of the bending portion 9 can be set by tightening the bending operation knob 23 at this time by, for example, a set screw. By fixing with fixing means such as 24,
The set curved state of the curved portion 9 can be maintained. Note that the fixing means such as the set screw 24 may be omitted.

A motor 25 as a driving part is housed in the rear part of the housing 14, and a male spline 27 is fixed to a motor @26 that projects forward of the motor 25. On the other hand, at the front of this motor 25, an output @28 is rotatably and axially movably supported, and at the rear thereof, a female spline 29 is formed, and this female spline 29 connects to the male spline 27. It meshes with the The output shaft 28 protrudes into the hollow gob 5 of the housing 14, and a sleeve 31 into which the rear end of the flexible shaft 11 is fitted and fixed is connected to this protrusion. This sleeve 31 is provided with a window 32 on its outer periphery that communicates with the suction path 13.

The suction pipe mouthpiece 16 is connected to the cavity 15 of the housing 14.
It is installed in communication with the This suction tube mouthpiece 16 is inclined rearward with respect to the axial direction of the housing 14 so that the opening area of its inlet portion can be increased. Further, the front housing 17 to which the suction pipe cap 16 is attached is formed in a tapered shape with a narrower diameter toward the front.
The frontage area of the suction pipe mouthpiece 16 is increased.

In such a configuration, the insertion section 3 pulls the operating wire 22 by moving the bending section 9 disposed on the distal end side of the outer tube 4 by moving the sliding body 20 back and forth in the axial direction by rotating the bending operation knob 23 on the proximal side. , it can be set from a relaxed straight shape to a curved state at a predetermined angle, and this set shape can be maintained by fixing the rotation of the bending operation knob 23 with a set screw 24, for example.

Therefore, the insertion section 3 can be set in a shape that makes it easy to insert into a body cavity, for example, a joint cavity, by rotating the operation knob 23, and when cutting or cutting tissue, the cutting edge at the tip can be set. 6 and 7 can be set in a shape that makes it easy to approach the target tissue.

5 and 6 relate to the second embodiment of the present invention, and FIG. 5 is a cross-sectional explanatory diagram showing the inner details of the insertion portion on the distal end side;
FIG. 6 is a sectional view taken along the line ■--■ in FIG. 5.

In this embodiment, the inner tube 5 is formed of a flexible duplex, for example, a synthetic resin duplex such as a marzigore tube or a urethane tube, and the distal end side of the inner tube 5 is formed with a curved portion 40.
A shape memory alloy (or resin) 41 is used to cause the bending portion 40 to perform the bending operation. In this case, at the position of the outer tube 4 that coincides with the curved portion 9 of the inner tube 5, the curved portion 9 is formed of a tightly wound coil, resin, etc., as in the first embodiment. In the illustrated example, four shape memory alloys 41 each having a different shape memory state (bending angle) are used, and all of them are unidirectional and are attached in the inner axial direction of the curved portion 40 to be energized. J = sea urchin that undergoes metamorphosis due to the heat generated by the sea urchin.

Among the shape memory alloys 41, one tree 41a is transformed and curved by, for example, 30 degrees, and the other one 41b is transformed and curved by, for example, 45 degrees.
The other one 41C is transformed and curved by 60 degrees, and the remaining one 41G is transformed to return from the curved state to the straight state. In addition, by stopping the heat generation of current to the shape memory alloys 41a, 41b, and 41G that form the curved portions due to the transformation, the elastic restoring force of the curved portions 40 (and of the curved portions of the outer tube 4) causes the curved portions 40 to If the shape memory alloy 41 (1) is made to return to a straight line, the shape memory alloy 41 (1) for making it straight becomes unnecessary. In addition, in the illustrated example, the shape memory alloy 41 is attached to the inner periphery of the curved part 40. However, the curved part 4
It may be embedded within the 0 or may be attached to the outer periphery. Further, in this embodiment, switches for turning ON and OFF energization to each of the shape memory alloys 41a to 41d are provided in the main body on the hand side, although not shown. Furthermore, in the embodiment, the curved portion 40 is connected to the inner tube 5.
However, similar to the first actual droplet example, it is provided only on the outer tube 4,
A shape memory alloy 41 may be provided in the curved portion 9 of the outer tube 4.

FIG. 7 is a modification of the second embodiment of the present invention. In this modification, a bidirectional shape memory alloy 42 is used, and a large number of shape memory alloys are embedded around the cross section of the curved portion 40. In the illustrated example, the shape memory alloy 42a is held at an angle of 80 degrees, 42 degrees, for example.
b is 70 degrees, 42c is 60 degrees, 42b is 50 degrees, 42e
is 40 degrees, 42r is 30U, 42g is 20U42h is 1
0 [It is designed to curve due to heat generated by energization.

FIG. 8 is an explanatory diagram showing still another modification of the second embodiment of the present invention, in which the shape memory alloy 43 is formed into a coil spring shape,
The bending angle is changed by changing the length or winding method of each shape memory alloy 43a, 43b, 43C.

In the embodiment of the present invention, the flexible shaft of the inner tube is formed of a tightly wound coil, but instead of this, a flexible synthetic resin tube may be used. Only the opposing inner tube portions may be made flexible, and the rest may be made of a rigid member.

In the present invention, the shapes and positions of the cutting edges of the outer tube and inner tube are not limited to the illustrated example, and may be formed in various ways as required.

[Effects 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 blade tip is not changed when resecting the target tissue. The bending shape can be set so that hair broaching of the target tissue is easy, and furthermore, the bending shape can be set so that the insertion portion can be easily inserted when inserted into a body cavity.

[Brief explanation of the drawing]

1 to 4 relate to a first embodiment of the surgical cutting instrument of the present invention, in which FIG. 1 is a sectional view, FIG. 2 is an enlarged sectional view showing the bending operation knob portion, and FIG. 3 is the bending operation knob. FIG. 4 is a perspective view of the part, FIG. 4 is a perspective view showing the whole, FIG. 5 and FIG. 6 are related to the second embodiment of the present invention, and FIG. Cross-sectional explanatory diagram, Fig. 6 is v-v of Fig. 5
A line sectional view, FIG. 7 is an explanatory cross-sectional view showing a modification of the second embodiment, and FIG. 8 is an explanatory cross-sectional view showing still another modification of the second embodiment. 2...Main body 3...Insertion part 4...Outer tube 5...Inner tube 6...Tissue take-in blade a...Blade mouth 9...Curved part 13...Suction path 18... Bearing vibrator for curved operation knob 19... Slide groove 20... FM body 22... Operation wire 23...
・Bending operation knob 40...Bending portion 42.43...Shape memory alloy

Claims (1)

[Claims] An insertion section is constructed by arranging an inner tube having a cutting blade facing the cutting edge of the outer tube inside the elongated outer tube that has a tissue-taking edge at the tip thereof so as to be rotatable around an axis. The inner path of the outer tube is used as a suction path communicating with the tissue intake blade opening of the outer tube, and a curved part that can be bent into a predetermined shape is provided in the middle of the insertion part. 1. A surgical cutting instrument characterized by comprising a bending actuator that bends the tool from a straight line to a predetermined curved angle when operated.