JPH0340615B2 - - Google Patents

Description

Detailed Description of the Invention [Technical Field of the Invention] The present invention provides a surgical resection instrument that can reliably and quickly perform resection of chondroceles, tumors, etc. within a joint cavity of a knee or the like without making an incision. Regarding.

[Technical background of the invention and its problems] Conventionally, joint surgery has been mainly performed by an incision method (open surgery). For example, common joint surgeries require relatively large incisions, such as removing tumors on the patella and cutting damaged cartilage, bone, etc. from the knee joint. Therefore, the incision causes trauma, which is accompanied by pain and restriction of movement, and has the disadvantage that it takes a long time to heal.

Therefore, in recent years, under observation using an arthroscope (endoscope), a small puncture hole is formed in the joint without incision, and a probe inserted into the puncture hole is used for surgery (closed surgery). equipment is proposed. For example, Japanese Patent Application Laid-Open No. 54-77493, U.S. Patent
These are disclosed in Publication No. 4246902 and the like. The former prior art instrument includes an elongated fixed jacket tube with a cutting opening extending in the axial direction formed on its outer periphery, and an internal rotary blade that is rotatably housed within the jacket tube and forms an internal rotary blade at the cutting opening. The device includes a tube-shaped inner member, a suction device, and a drive motor, and while the tissue pieces are suctioned into the cutting opening by vacuuming, the rotary blade is rotated by the drive motor to cut the cut pieces. It is configured to be sucked and discharged through a tube-shaped inner member.

However, with this configuration, the cutting opening is located on the outer periphery of the jacket tube, making it difficult to determine its position.
For this reason, it is difficult to target the tissue to be removed, and it also has poor bite into the tissue. Moreover, the tissue cannot be cut unless it is introduced into the cutting opening of the jacket tube using suction means.

The latter prior art instrument includes an elongated probe-shaped outer member having a cutting opening on its outer periphery, and an inner cutting member that is slidably housed within the outer member and has a blade at a position corresponding to the cutting opening at its tip. a member, a suction device, and a drive mechanism for an inner cutting member;
The tissue sucked into the cutting opening is cut by sliding of the inner cutting member, and the cut section is sucked and discharged. However, the resection instrument having this configuration also has the same disadvantages as the prior art described above.

For this reason, the present applicant has proposed, in Japanese Patent Application No. 58-74762, a surgical resection instrument 1 capable of reliably and efficiently resecting, for example, a damaged meniscus, tumor, etc. in a knee joint, as shown in FIG. proposed.

That is, the surgical resection instrument 1 includes a grip portion 2 on the proximal side, and an elongated insertion portion 3 that extends forward from the grip portion 2 and is inserted into a body cavity, for example, a joint cavity.
It is composed of. The insertion section 3 includes a mantle tube 4 whose base is fixed to the distal end of the gripping section 2 and whose front and rear ends are open, and a bottomed distal end which is internally placed inside the mantle tube 4 and which is connected to the distal end of the mantle tube 4. It is composed of a fixed inner tube 5 protruding from the opening, and a sliding body 7 that is slidably inserted in the axial direction between the inner circumference of the outer tube 4 and the outer circumference of the fixed inner tube 5. The fixed inner tube 5
In this example, a tissue-taking blade opening 8 is opened on the outer periphery of a protrusion having a bottomed tip, and an inner blade 9 is formed at the edge of the blade opening 8.
The fixed inner tube 5 is a suction tube with a section suction path 10 in the tube communicating with the blade opening 8, and its base is fixed to a fixing member 11 fixed within the gripping part 2. The fixing member 11 has a communication path 12 inside thereof that communicates with the suction path 10, and a joint 13 screwed from the outer periphery of the grip portion 2 communicates with the communication path 12. Note that this joint 13 can be communicated with a suction and recovery device via a connected tube (not shown). Furthermore, the shape of the intake opening 8 of the fixed inner tube 5 is as follows:
Depending on the type, size, etc. of the tissue to be resected, it is formed as shown in FIGS. 2A, B, C, and D, for example. Figure 2A
The shape shown in is a rectangular shape that is long in the axial direction, the shape shown in B is a rectangular shape that is long in the circumferential direction, and the protruding length of the tip of the fixed inner tube 5 is shortened, and the shape shown in C is a triangular shape with the front edge as the base. , D is a triangular shape with the tip as the apex.

On the other hand, the sliding body 7 (tubular body in the illustrated example) has an outer cutter 16 formed at its tip that engages with the inner cutter 9 of the intake blade opening 8, and when sliding forward, the outer blade 16 engages with the inner blade 9 of the intake blade opening. 8 is closed, and the intake blade opening 8 is opened when sliding backward. And this sliding body 7
The base side of is inserted into the hollow part 2a of the grip part 2 and connected to a drive transmission system 17 shown in FIG. 4, for example, which is installed inside the hollow part 2a. The drive transmission system 17 inserts the drive shaft 19 of the internal motor 18 into the rotation center hole 22 of the cam 21, which has a circumferential cam groove 20 on the outer periphery that slopes forward and backward, so that the splines 19a and 22a of the two mesh with each other. On the other hand, a cam guide pin 23 is engaged in the cam groove 20 so that the cam 21 rotates and slides along the cam groove 20, and a sliding shaft is provided in the rotation center hole 24 on the front surface of the cam 21. 25 is inserted and bearing it, and this sliding shaft 25 is branched and the branch shafts 25a, 25a are connected to the fixing member 11 as shown in FIG. It is constructed by passing through the through holes 26, 26 and fixing a sliding attachment 27 to the protruding portion thereof, and connecting the base of the sliding body 7 to this attachment 27 so that it can slide back and forth in the axial direction. ing. Incidentally, the motor 18 is
It is electrically connected to, for example, a control unit via a cable 28 extending from the gripping unit 2, and the rotation speed can be adjusted and controlled by current, voltage, frequency control, etc.
A foot switch (not shown) or a hand switch provided on the grip part 2 enables on/off and rotational speed control.

Although the conventional example described above has an excellent cutting function, it has the disadvantage that good cutting performance cannot be maintained because the blade part cannot be replaced. Furthermore, since the blade cannot be replaced, there is a drawback that a large number of surgical cutting instruments having blades suitable for cutting are required.

[Object of the Invention] The present invention has been made in view of the above-mentioned points, and provides a method for reliably and quickly resecting, for example, chondroceles or tumors within a joint, and by making the blade portion replaceable. , can maintain ablation performance, and
The purpose of the present invention is to provide a surgical cutting instrument that can be used with a cutting blade suitable for the purpose.

[Summary of the Invention] The surgical resection instrument of the present invention includes a fixed inner tube with a bottomed tip inside an outer tube with an open tip, and a tissue-taking blade opening on the outer periphery by protruding the tip of the fixed inner tube. is opened, an inner cutter is provided at the edge of the cutting edge, this fixed inner tube is used as a suction tube, the inside of the tube communicating with the cutting edge is used as a section suction path, and a sliding body is provided between the outer tube and the fixed inner tube. is arranged so as to be slidable in the axial direction so that the blade opening of the fixed inner tube can be opened and closed, and an outer cutter that engages with the inner cutter is provided at the tip of the sliding body,
The rear end of the fixed inner tube is configured to be detachably connected to a fixed member, and the sliding body to a sliding body attachment, respectively.

[Embodiments of the Invention] The present invention will be specifically described below with reference to the drawings.

5 to 12 relate to one embodiment of the surgical cutting instrument of the present invention, FIG. 5 is a longitudinal sectional view of one embodiment, FIG. 6 is a side view showing the proximal side of the fixed inner tube, and FIG. FIG. 7 is a sectional view showing the peripheral part of the fixed member in a state where the fixed inner tube of FIG. 6 is not attached, FIG. 8 is a side view showing the drive transmission system, and FIG. 9 is a side view of the base of the sliding body.
Figure A is a side view, Figure B is a sectional view taken along line B-B of Figure A, Figure 10 shows the sliding attachment, Figure A is a front view, Figure B is a side view, Figure 11 is is the first
FIG. 12 is an enlarged sectional view taken along the line C--C in FIG.

Incidentally, members (almost) the same as those in the above-mentioned conventional example are designated by the same reference numerals.

As shown in FIG. 5, the surgical resection instrument 31 of the first embodiment has a grip part 2 on the proximal side and a part that extends forward from the grip part 2 to be inserted into a body cavity, for example, a joint. Elongated insertion section 3 inserted into the cavity
It is composed of. The insertion section 3 includes a mantle tube 4 whose base is fixed to the distal end of the gripping section 2 and whose front and rear ends are open, and a bottomed distal end which is internally placed inside the mantle tube 4 and which is connected to the distal end of the mantle tube 4. It is composed of a fixed inner tube 5 protruding from the opening, and a sliding body 7 that is slidably inserted in the axial direction between the inner circumference of the outer tube 4 and the outer circumference of the fixed inner tube 5. The fixed inner tube 5
In this example, a tissue-taking blade opening 8 is opened on the outer periphery of a protrusion having a bottomed tip, and an inner blade 9 is formed at the edge of the blade opening 8.
The fixed inner tube 5 is a suction tube with a section suction path 10 in the tube communicating with the blade opening 8, and its base can be detachably fixed to a fixing member 11 fixed in the grip part 2. It's getting old.

That is, as shown in FIG. 6, an inner tube sleeve 32 is fixed to the outer periphery of the base of the fixed inner tube 5, and the inner tube sleeve 32 has a substantially L-shaped mounting groove 32a provided at an appropriate position on the outer circumferential surface. As shown in the figure, since a pair of guide pins 33, 33 are provided protruding from the inner circumferential surface of the mounting hole of the fixing member 11, each of the grooves 32
a is engaged with the guide pin 33 and turned (rotated) counterclockwise after insertion so as to press the base side of the fixed inner tube 5. (as shown in the figure). Further, by rotating the fixed inner tube 5 clockwise, the fixed inner tube 5 can be easily removed.

The fixing member 11 has a communication passage 12 inside thereof that communicates with the suction passage 10, and a joint 13 screwed from the outer periphery of the gripping part 2 is connected to the communication passage 12.
It communicates with In addition, this joint 13 is
It can communicate with a suction and recovery device 15 via a connected tube 14 (see FIG. 12). In addition, several types of fixed inner tubes 5 are available in which the shape of the intake opening 8 is formed as shown in FIG. 2 A, B, C, and D depending on the type and size of the tissue to be excised. It can be used by attaching a fixed inner tube 5 with a cutting edge 8 suitable for the resection site.

On the other hand, the sliding body 7 (tubular body in the illustrated example) has an outer cutter 16 formed at its tip that engages with the inner cutter 9 of the intake blade opening 8, and when sliding forward, the outer blade 16 engages with the inner blade 9 of the intake blade opening. 8 is closed, and the intake blade opening 8 is opened when sliding backward. And this sliding body 7
The base side is inserted into the hollow part 2a of the gripping part 2 and can be connected to a drive transmission system 17 shown in FIG. Similar to the conventional example described above, the drive shaft 19 of the internal motor 18 is inserted into the rotation center hole 22 of the cam 21, which has a circumferential cam groove 20 on the outer periphery that slopes forward and backward, and the splines 19 of both are inserted.
a, 22a are engaged, while the cam groove 2
The cam guide pin 23 is engaged in the cam groove 20 so that the cam 21 rotates and slides along the cam groove 20.
5 is inserted and is bearing, and the sliding shaft 25 is branched and the branched shafts 25a, 25a are passed through the through holes 26, 26 of the fixing member 11, and the sliding attachment 27 is attached to the penetrating protrusion. It is structured like this. This sliding attachment 2
7, the base of the sliding body 7 can be detachably attached thereto.

That is, as shown in FIG. 9, a sliding body sleeve is provided on the outer periphery of the base of the sliding body 7 with arcuate grooves 37a, 37a formed near both ends of a substantially elliptical shape via a short cylindrical intervening member 36. 37 is fixed to the slide attachment 27, and as shown in FIG. It is formed like this. Therefore, by engaging the protruding step-like narrow diameter portions 38, 38 with the grooves 37a, 37a of the sliding body sleeve 37, the narrow diameter portions 38, 38 become the grooves 37.
a, 38a (the sliding body sleeve 37 in this state is shown in Fig. 10A).
), the sliding body sleeve 3
The opposite edges on which the grooves 37a, 37a of 7 are formed are accommodated in the holes 39, 39 of the sliding attachment 27, as shown in FIG. 11, and protruded by coil springs 40, 40, respectively. The balls 41, 41, which are biased in this manner, restrict the movement in the rotational direction and can be fixed. Each coil spring 40 is fixed by a screw 42 that is threaded into a screw hole formed at one end of the hole 39 so as to cause each ball 41 to protrude from the other open end. Also, the branch shaft 25 of the sliding shaft 25
The narrow diameter portion 38, 3 formed near the tip of a, 25a
The front end adjacent to 8 has a large diameter groove 37a, 37a.
It is designed so that it can be engaged with the sliding sleeve 37 in the peripheral portion in a state where it is in contact with the sliding sleeve 37 so that the sliding sleeve 37 does not come off.

The sliding body 7 can be easily disengaged from the attached sliding body 7 by pressing its base side backward and rotating clockwise (FIG. 9B or FIG. 10A). It is now possible to remove it.

Fixed inner tube 5 and sliding body 7 that can be detachably attached
By screwing the cap portion on the proximal side to which the mantle tube 4 is fixed to the distal end side of the gripping portion 2 after attaching the surgical resection instrument 31 of the first embodiment shown in FIG.
is starting to be assembled. Incidentally, the above-mentioned screwing position can also be formed at a rear portion than that shown in FIG. 5 to make it easier to attach and detach.

The operation of resecting target tissue within a body cavity, for example, within a joint cavity using one embodiment configured in this manner will be described below with reference to FIG. 12.

As shown in FIG. 12, in order to resect the target tissue within the target region, for example, the knee joint, a small hole into which the insertion section 3 of the surgical resection instrument 31 is inserted is inserted into the knee region 50 using a puncture operation such as a trocar. Therefore, the insertion section 3 is inserted through a trocar or the like or directly. or,
Before inserting the insertion section 3, the insertion section 52 of the arthroscope 51 is equipped with an illumination and observation optical system so that the target tissue can be removed while observing the inside of the joint cavity.
is inserted into the joint cavity by a puncture operation such as a trocar, and the display device 54 displays an image taken directly from the eyepiece of the arthroscope 51 or by a television camera 53 attached to the eyepiece. The joint cavity and the insertion portion 3 of the surgical resection instrument 31 inserted into the cavity are made observable. Furthermore, in order to inflate the inside of the joint cavity and facilitate resection surgery, physiological saline can be supplied into the joint cavity from the water supply source 55 through the water supply pipe 56 punctured into the joint cavity at controlled water pressure. . On the other hand, a tube 14 is connected to the joint 13 of the proximal grip part 2 of the surgical resection instrument 31, and connected to the suction and recovery device 15, and the cable 2
An unillustrated connector 8 is connected to the motor control unit 58 to set the state in which power can be supplied to the motor 18.

In this setting state, the operator uses the arthroscope 51 or the display device 54 to observe the inside of the joint cavity and the distal end of the insertion section 3 of the resection instrument 31, and selects the cutting edge 8 at the distal end of the insertion section 3 as the target for resection. The blade is brought into contact with the tissue and taken into the mouth 8, and in this state, the switch is turned on to drive the motor 18, and the sliding body 7 is slid back and forth in the axial direction via the drive transmission system 17, thereby forming the outer blade. 16 is engaged with the inner cutter 9 at the edge of the cutting edge 8 to cut or cut the tissue taken into the cutting edge 8, and when necessary or constantly actuating the suction and recovery device 15 to fix the section into the inner tube 5.
It can be collected and discharged to a collection device 15 through suction path 10, communication path 12 of fixing member 11, joint 13, and tube 14.

In the above-mentioned first embodiment, if the resection function deteriorates after long-term use, the fixed inner tube 5 (which can be easily attached and detached)
By simply replacing the slider 7 or, in some cases, replacing the sliding body 7 (which can be easily attached and detached), the cutting function can be made excellent again at low cost. or,
Since the fixed inner tube 5 having the intake cut 8 suitable for the resection site can be attached and used depending on the resection site, appropriate resection treatment can always be performed.

In addition, in order to obtain the sliding motion of the sliding body 7, the motor 1
As the means for converting the rotational force of 8 into reciprocating motion, it is possible to use not only the above-mentioned embodiment but also other, for example, various known means. Furthermore, in the above embodiment,
Although an example is given in which the sliding body 7 is a tubular body, only the tip side of the sliding body 7 may be tubular and the outer cutter 16 may be formed at the tip, or the tip side may close the blade opening 8. It does not need to be tubular as long as it has the appropriate width and shape. Further, the rear side of the sliding body 7 may be tubular, shaft-shaped, or plate-shaped. Further, in the present invention, the cross-sectional shape of the insertion portion 3 may be circular, oval, square, or triangular. Furthermore, the sliding body 7 is configured to be slid back and forth in the axial direction manually (back and forth movement means using a cross-shaped handle, a lever, etc.). Furthermore, the present invention can be applied to the resection of tissues not only in joint cavities but also in other body cavities.

Further, according to the present invention, it is possible to easily make the removable part, that is, the fixed inner tube 5, smaller in diameter or prepare a larger diameter part. This can be easily achieved by leaving the main body as it is by preparing the inner tube sleeve 32 with a smaller or larger inner hole for attaching the fixed inner tube 5. Furthermore, the sliding body 7 can be easily realized so as to be in sliding contact with the outer periphery of the fixed inner tube 5, and furthermore, the outer tube 4 can be easily realized so as to be in sliding contact with the outer periphery of the sliding body 7. Therefore, it can be used in the above-mentioned joint cavity and other body cavities with the appropriate thickness or cutting edge 8 for resection, allowing prompt and appropriate treatment.

Note that the removable connecting portion between the fixed inner tube 5 and the fixed member 11 has a replaced structure, that is, a pin is provided protruding from the inner tube sleeve 32 side, and a groove that engages with the pin is formed on the fixed member 11 side. It may be something you did. Furthermore, the connecting portion of the sliding body 7 to the sliding attachment 27 can also be constructed by substantially replacing the connecting portion. That is, the branch shafts 25a, 25a are fixed to the sliding attachment 27 (for example, as in the conventional example), and a groove is formed on the sliding attachment 27 side, while a pin that engages with the groove is formed in the sliding body sleeve 37. Just set it up.

Note that the biasing elastic body is not the coil spring 34, but
It may be a rubber body molded into a tubular shape (the same applies to the coil spring 40).

Further, the portion where the fixed inner tube 5 and the fixed member 11 are removably connected, or the portion where the sliding body 7 and the sliding attachment 27 are removably connected are as follows:
It is also possible to form a male thread on one side and a female thread on the other side and use screwing. or,
When using screws, it may be formed in the axial direction of the insertion section 3, or alternatively, it may be fixed removably from the side with screws with both members fitted together. You can also do it. In this case, for example, as shown in FIG. 5, the fixed inner tube 5 and the fixed member 11 can be removably fixed to each other with screws from the outer periphery of the gripping portion 2 (for example, from the position of the pin 33). or,
For the sliding body 7 and sliding attachment 27,
The sliding body 7 having a thickened base side can be fitted and removably fixed from the side with a screw. In this case, the threaded portion of the mantle tube 4 may be formed rearward from the position shown in FIG. others,
The present invention also includes devices that can be removably connected by many known means, such as fitting C-ring shapes with both ends protruding inward in the radial direction and removably connecting them. be.

[Effects of the Invention] As described above, according to the present invention, the fixed inner tube and the sliding body can be detachably attached and can be resected by reciprocating motion, so that the target tissue can be resected. It is possible to perform cutting by attaching a suitable cutting edge, and even if the cutting function deteriorates due to repeated cutting, it can be easily replaced, and the cutting function can always be used with sufficient cutting function. In addition, by preparing materials with different thicknesses, appropriate resection can be performed on a wide range of sites at low cost. In addition, it has good targeting properties and bites into the resected tissue, making it possible to reliably perform resection.

[Brief explanation of drawings]

Figures 1 to 4 relate to a conventional example, where Figure 1 is a longitudinal sectional view, Figure 2 is a plan view showing the shape of the intake blade, and Figure 3 is a sectional view taken along the line A-A in Figure 1. , FIG. 4 is a side view showing the drive transmission system, FIGS. 5 to 12 relate to one embodiment of the surgical cutting instrument of the present invention, FIG. 5 is a longitudinal cross-sectional view of one embodiment, and FIG. 6 is a side view showing the base side of the fixed inner tube, FIG. 7 is a cross-sectional view showing the surrounding area of the fixed member in a state where the fixed inner tube of FIG. 6 is not attached, and FIG. 8 is a side view showing the drive transmission system. Figure 9 shows the base side of the sliding body, Figure A is a side view, Figure B
is a cross-sectional view taken along line B-B in Figure A, Figure 10 shows the sliding attachment, Figure A is a front view, Figure B is a side view, and Figure 11 is taken along line CC in Figure 10A. FIG. 12 is an explanatory diagram showing a state in which one embodiment is used. 2... Grasping part, 3... Insertion part, 4... Mantle tube,
5...Fixed inner tube, 7...Sliding body, 8...Intake blade opening, 9...Inner blade, 10...Suction path, 11...Solid member, 12...Communication path, 13...Joint, 1
6... Outer blade, 17... Drive transmission system, 18... Motor, 19... Drive shaft, 20... Cam groove, 21...
Cam, 25...Sliding shaft, 25a...Branch shaft, 26
...Through hole, 27...Sliding attachment, 31
... Surgical cutting instrument, 32 ... Inner tube sleeve, 3
2a...Groove, 33...Pin, 34...Coil spring, 37...Sliding body sleeve, 37a...Groove, 3
8...Small diameter part, 40...Coil spring, 41...Ball, 51...Arthroscope, 53...TV camera,
54...Display device, 58...Motor control unit.

Claims (1)

[Scope of Claims] 1. A fixed inner tube is housed in an outer tube with an open tip, and the tip of the fixed inner tube is made to protrude to open a tissue-taking blade opening on the outer periphery, and an inner tube is inserted into the edge of the blade edge. A blade is provided, and the inside of the fixed inner tube is used as a section suction path, and a sliding body is installed between the outer tube and the fixed inner tube so as to be slidable in the axial direction, so that the blade opening of the fixed inner tube can be opened and closed. In a surgical cutting instrument, the sliding body has an outer cutter that engages with the inner cutter at the tip thereof, the fixed inner tube rear end is connected to a fixed member, and the sliding body rear end is connected to a sliding attachment. , the fixed inner tube is detachably attached to the fixed member by a connecting means,
A surgical cutting instrument characterized in that the sliding body is detachably attached to the sliding attachment by means of a connecting means. 2. At least one of the two connecting means has a pin protruding from one side of both members, a groove that engages with the pin on the other side, and a biasing force of an elastic body such as a coil spring to connect the pin to the groove. The surgical resection instrument according to claim 1, wherein the surgical cutting instrument is detachably formed by maintaining the engaged state with the surgical cutting instrument. 3. The surgical resection instrument according to claim 1, wherein at least one of the two connecting means is formed using a threaded connection. 4. The surgical cutting instrument according to claim 1, wherein the fixed inner tube has a different cutting edge and can be attached to the fixed member. 5. Claim 1, characterized in that the fixed inner tube, the sliding body, and the outer tube can be removably connected to each other by combining the fixed inner tube, the sliding body, and the outer tube with different diameters.
Surgical resection instruments as described in Section.