JPH0340616B2 - - Google Patents

Description

[Detailed Description of the Invention] (a) Technical Field The present invention is intended for use in combination with an endoscope, a so-called resectoscope, used for the diagnosis and treatment of diseases of the urinary tract, such as the urethra and bladder. In particular, the present invention relates to a surgical instrument for detaching and removing the internal glands of an enlarged prostate (prostatic hyperplasia) from the external glands.

(b) Conventional technology In the past, enlarged intraprostatic glands were removed by opening the abdomen and using fingers or instruments, but recently, resectoscopes have been used to perform transurethral resection (TUR).
Now I can do it. however,
This transurethral resection of the prostate is generally performed by applying electricity to a resection loop attached to the tip while observing with a resectoscope, but it is extremely difficult to completely remove 100% of the intraprostatic glands as it is dangerous. However, the remaining prostate tissue has the disadvantage of becoming enlarged again.

(c) Purpose of the Invention The present invention involves inserting a dissecting device between the extraprostatic gland and the enlarged intraprostatic gland under direct vision with a resectoscope, and detaching the internal gland from the external gland to completely remove the internal gland. of
The present invention provides an easy-to-operate peeler that can remove 100%.

(d) Structure of the invention Figure 1 illustrates the general shape of the above-mentioned resectoscope.
A water intake port 3 communicating with the inside of the outer tube 1 is provided in a finger hook 2 formed at the base of the outer tube. Reference numeral 4 denotes an eyepiece section, which has a light source connection section 5 and is further attached with an optical viewing tube 6 of about 4 mm diameter, which is inserted into the outer tube 1 almost to the tip. The front end of the outer tube 1 can be viewed directly from the front. Reference numeral 7 denotes a sliding body which is provided with a current-carrying terminal 8 and a finger hook 11 and is supported by a guide 9 provided between the eyepiece part 4 and the outer tube 1 part and is movable back and forth. The sliding body 7 is biased to move backward toward the eyepiece 4 by a spring 10 whose other end is attached to the base of the outer tube 1. The base of the coagulation guide 13 etc. can be detachably fixed, and by moving the sliding body 7 forward, the resection loop, the coagulation guide etc. can be projected forward from the tip of the outer tube 1. There is.

Figures 2 and 3 show an embodiment of the present invention.
Reference numeral 12 denotes two chisel-shaped detachers fixedly protruding forward from the lower left and right inner sides of the tip of the outer tube 1. The detachers 12 are made of metal or hard resin, and thereby connect the intraprostatic glands and the external glands. It is designed so that it can be easily inserted and peeled off. 13 is the electrode 1 at the tip.
3a, the proximal end of the guide 13 is removably fixed to the sliding body 7, and the distal end of the guide 13 is fixed by hooking the thumb on the finger hook 11 and moving the sliding body 7 forward. The electrode 13a is configured to protrude forward from the peeler 12.

4 and 5 show another type of the present invention, in which the peeler 12 is formed into a generally gutter-like shape that can slide on the inner wall surface of the lower half of the distal end bulging portion 1a of the outer tube 1, and the distal end thereof is shaped like a tapered tongue. The peeler 12
At the base (not shown) is a rod-shaped member (numeral 1 in Figure 1).
3) is attached, and the proximal end of the member is detachably attached to the sliding body 7, and is configured so that it can protrude forward from inside the bulge 1a as the sliding body 7 moves forward.

In other examples shown in FIGS. 6 to 8, the stripper 12 is formed generally in the shape of a gutter as described above, but the bottom part is formed thickly and the tip part is formed into a tongue shape that gradually becomes thinner. It is curved, but formed relatively slowly. A through hole or a through groove 14 is formed in the front-rear direction within the wall thickness of the bottom of the peeler 12, and the through hole 1
4, the coagulation guide 13 is inserted so as to be slidable back and forth. The base end of the peeler 12 is detachably connected to the slider 7 via a rod-shaped or other connecting member, and the coagulation guide 13 passes through the peeler 12 and connects to the slider 7.
The tube passes through the inner tube, and its base portion is exposed to the outside, and the tip portion of the outer tube 1 can be independently moved back and forth in and out by operating the hand portion.

The peeler 12 shown in FIG. 9 has a shape similar to that of the gutter-shaped peeler 12 shown in FIGS.
A connecting member 15 fixed to the stripper 12 is connected and configured to be movable back and forth, and the lower side of the base of the peeler 12 is pivoted to the lower part of the member 15, and above the base of the peeler 12 there is a The tip of the inserted wire 16 is attached, and by pulling the wire 16 by operating another sliding member (not shown) at the hand, the stripper 12 is configured to be able to freely pivot in the vertical direction. This is an example.

As mentioned above, in the present invention, the tip of the detacher 12 is formed into a tongue shape, and in order to detach the intraprostatic gland from the external gland, first, as in the conventional method, the enlarged prostate is removed. Most of the internal glands are removed with a resectoscope while being viewed with a resectoscope, and then the urethral mucosa at the distal end (front) of the prostate gland is incised with a TUR knife, and the above stripper is inserted through this incision. 12 is inserted while viewing directly with a resectoscope, and the internal glands are removed.

If the separator 12 is of a back-and-forth movable type, it can be easily inserted between the intraprostatic gland and the external gland and removed by operating the hand portion. The bleeding part of the incision wound and abrasion wound is covered with a coagulation guide 13.
energizes and moves it forward to apply it to the area to coagulate and stop bleeding.

(E) Effects of the Invention The present invention is constructed as described above and is equipped with a tongue-shaped detachment tip, which makes it possible to completely detach and remove the intraprostatic glands from the external glands, which is different from the conventional method. When used in conjunction with urethral resection, 100% of the intraprostatic glandular tissue can be removed.
The surgery is complete, reliable, and easy, and there is no fear of recurrence of prostatic hypertrophy, making it a great contribution to patients.

[Brief explanation of the drawing]

Figure 1 is an overall view of a typical resectoscope.
FIG. 2 is a perspective view showing an example of a peeler according to the present invention, FIG. 3 is a front view of the same, FIG. 4 is a perspective view showing another type of the present invention, FIG. 5 is a front view of the same, and FIG. The figures are a perspective view of another type, FIG. 7 is a front view of the same, FIG. 8 is a sectional view of the same, and FIG. 9 is a side view of another type. Explanation of symbols, 1... Outer tube, 4... Eyepiece, 6...
Optical viewing tube, 7...Sliding body.

Claims (1)

[Scope of Claims] 1. An instrument for detaching the internal gland from the external gland by inserting it between the intraprostatic gland and the external gland while viewing directly with a resectoscope having an external tube inserted into the urethra. 1. A transurethral prostate dissection device, comprising: a dissection device having a tongue-shaped tip. 2. The resectoscope according to claim 1, wherein a tubular coagulation guide having an electrode at its tip that can be freely advanced and retracted by operating a hand portion is inserted into the outer tube of the resectoscope so as to be able to protrude from the tip of the outer tube. Peeler. 3. The stripper is formed into a generally gutter-like shape that is capable of sliding on the inner wall surface of the lower half of the tip of the outer tube, and its tip is shaped into a tapered tongue shape, and the base of the stripper is detachable via a rod-shaped member. 2. The peeler according to claim 1, wherein the peeler is detachably attached to a sliding body provided in the proximal portion of the scope, and configured to be capable of protruding forward from the distal end of the outer tube by advancing the sliding body. 4. The stripper is formed generally in the shape of a gutter, and has a thick bottom and a thin tip, but is formed relatively bluntly, and has a through hole in the front-rear direction within the thickness of the bottom. Claim 1, wherein a groove or a groove is provided, through which the coagulation guide is inserted so as to be freely retractable, and the peeling element and the coagulation guide are each configured to be able to independently protrude from the inner end of the outer tube by operating a hand portion. The peeler according to item 1 or 2. 5. The stripper according to claim 1, wherein the stripper is configured to be pivotable in the vertical direction. 6. The peeling device according to claim 1 or 2, wherein the peeling elements are two pieces fixed in a chisel shape protruding forward from the lower left and right inner sides of the distal end portion of the outer tube.