JPH0557860B2 - - Google Patents

Description

Detailed Description of the Invention [Technical Field of the Invention] The present invention is directed to removing cartilage (articular meniscus, articular cartilage), chondrocele, tumor, etc. in a joint cavity of a knee or the like from outside the body cavity without making an incision. The present invention relates to a surgical resection instrument for cutting and expelling the body cavity.

[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 restricted 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, these are disclosed in Japanese Patent Application Laid-Open No. 54-77493. The device according to this prior art is
an elongated fixed outer tube having a cutting opening extending in the axial direction formed on its outer periphery; a tube-shaped inner member rotatably housed within the outer tube and forming an internal rotary blade at the cutting opening; , is equipped with a suction device and a drive motor, and while the tissue pieces, etc. are sucked into the cutting opening by vacuuming, the rotary blade is rotated by the drive motor to cut the cut pieces, and the cut pieces are passed through the tube-shaped inner member. It is configured to be sucked and discharged.

By the way, target tissues such as a damaged meniscus, cartilage, and tumor in a body cavity, for example, a knee joint, have elasticity and viscosity. However, since the cutting edge (cutting edge) of the prior art is only formed on the side surface of the distal end of the outer tube and the tube-like inner member, it is difficult to bite into the target tissue having elasticity and viscosity. Furthermore, there are problems in that tissue escape occurs during excision and cutting, and the ability to target the target tissue is poor, resulting in poor efficiency in excision and cutting.

[Objective of the Invention] The present invention has been made in view of these circumstances, and provides efficient resection by ensuring the bite of tissues in body cavities and preventing escape of the tissues during excision and cutting. The object of the present invention is to provide a surgical cutting instrument capable of cutting.

[Summary of the Invention] In order to achieve the above-mentioned object, the surgical cutting instrument according to the present invention includes an inner tube having a cutting edge that engages with a cutting edge of the outer tube, in an outer tube having a tissue intake opening at the distal end thereof. is installed rotatably around an axis, and by the rotation of the inner tube, the blade opening of the inner tube and the outer tube blade can be opened and closed, while the inner passage of the inner tube is communicated with the double blade opening. In the suction path, the double-edged opening is continuously formed from the bottomed tip portion of the outer tube and the inner tube to the tube side surface.

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

1 to 4 relate to a first embodiment of the present invention, in which FIG. 1 is a longitudinal sectional view, FIG. 2 is a shape of the outer tube cutting edge, A is a plan view, B is a side view, and FIG. The figures show the shape of the inner tube cutting edge, A is a plan view, B is a side view, and
The figure is an explanatory diagram showing an example of a usage state.

In these figures, reference numeral 1 denotes a surgical cutting instrument, which includes a main body 2 that also serves as a grip on the proximal side, and an elongated insertion device that extends forward from the main body 2 and is inserted into a body cavity, such as a joint cavity. It consists of Section 3. The insertion section 3 consists of an outer tube 4 whose open base is fixed to the distal end of the main body 2, and an inner tube 5 which is installed inside the outer tube 4 so as to be rotatable around an axis. The inner tube 4 has a tissue intake opening 6 at its tip, while the inner tube 4 has a blade opening 7 at its tip. As shown in FIG. 2, the outer tube cutting edge 6 is formed by cutting out a portion of the tube side surface from the bottomed tip of the outer tube, such as a hemispherical or arcuate surface, and forming a bottomed portion 8 with a partially arcuate surface at the tip. It is formed continuously from the tube side surface to the bottomed portion 8 at the tip. This outer tube cutting edge 6 has an arcuate front edge 6.
a, side edges 6b, 6b, and a rear edge 6c, and the rear edge 6c is formed to be inclined slightly rearward. Further, a blade 6d is formed from the front edge 6a to the side edges 6b, 6b. Also, like the outer tube cutting edge 6, the inner tube cutting edge 7 has a hemispherical, arcuate, etc. inner tube bottomed tip with a portion of the tube side surface cut out to form a partially curved bottomed portion 9 at the tip. It is formed continuously from the tube side surface to the tip bottomed part 9, leaving . This inner tube cutting edge 7 also consists of an arcuate leading edge 7a, side edges 7b, 7b, and a trailing edge 7c, and the inner tube cutting edge 7 has a side edge 7 compared to the outer tube cutting edge 6.
b, 7b are formed long. The outer tube cutting edge 6 and the inner tube cutting edge 7 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 being shifted, forming a double cutting edge. It bites into the tissue when the communicating holes 6 and 7 are opened, and when it is closed, it is removed and cut, and the cut piece is taken into the inner tube cutting edge 7. The inner path of the inner tube 5 forms a section suction path 10 that communicates with the outer tube cutting edge 6 and the inner tube cutting edge 7, 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 resection instrument 1 that is held and operated by an operator such as a surgeon, and includes a housing 11 that houses a drive part that rotationally drives the inner tube 5 and the like.
and a cavity 12 communicating with the suction path 10 of the inner tube 5.
The front housing 12 is provided with a suction tube mouthpiece 22 connected to a section suction device. The front housing 12 is removably screwed to the housing 11 by, for example, screwing means. Further, this front housing 12 has an annular fixing part 12b extending in the front thereof, and a groove part 12c is formed in the axial direction of the inner circumference thereof. On the other hand, a sleeve 13 having a flange 13a at the front is fitted onto the outer periphery of the base of the outer tube 4, and a pin 14 is installed on the outer periphery of the sleeve 13. and,
With the pin 14 engaged in the groove 12c, the base of the outer tube 4 fitted with the sleeve 13 is attached to the fixing part 12b.
Insert the outer tube fixing screw body 15 into the fixing part 1.
The base of the outer tube 4 is fixed to the outer circumference of the tube 2b in a detachable manner by screwing the outer circumference of the tube 2b.

A motor 16 is installed in the rear part of the housing 11, and the motor shaft 17 is connected to a male spline 18.
is fixed. On the other hand, an output shaft 19 is rotatably and slidably supported in the axial direction at the front of the motor 16, and a male spline 20 is formed at the rear thereof, and the female spline 20 meshes with the male spline 18. are doing. The output shaft 19
protrudes into the cavity 12a of the front housing 12,
An inner pipe sleeve 21, into which the base of the inner pipe 5 is fitted and fixed, is inserted and fixed into this protrusion, and the motor 16
The rotational force is transmitted to the inner tube 5 to rotate the inner tube 5. The inner tube sleeve 21 is formed into a cylindrical shape with an open front, and communicates the suction path 10 of the inner tube 5 into the sleeve 21 . The sleeve 21 also has an opening 21a on its side and communicates with the cavity 12a of the front housing 12.

The suction tube mouthpiece 22 is attached to the outer periphery of the front housing 12 in communication with the cavity 12a. This suction tube mouthpiece 22 is inclined rearward with respect to the axial direction of the housing 12a so that the opening area of its inlet portion can be increased. Further, the front housing 12 to which the suction pipe cap 22 is attached has its outer peripheral wall inclined downwardly toward the front, and the opening at the inlet portion of the suction pipe cap 22 is made similar to the case where the suction pipe cap 22 is mounted at a backward angle. The area is enlarged.

The operation of resecting target tissue within a body cavity, for example within a joint cavity, using the first embodiment configured as described above will be described below with reference to FIG. 4.

As shown in FIG. 4, 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 1 is inserted is inserted into the knee region 31 using a puncture operation such as a trocar. Therefore, the insertion section 3 is inserted through a trocar or the like or directly. In addition, before inserting the insertion section 3, the insertion section 33 of the arthroscope 32, which is equipped with an illumination and observation optical system, is punctured with a trocar or the like so that the surgical resection of the target tissue can be performed while observing the inside of the joint cavity. The arthroscope 33 is inserted into the joint cavity by operation, and the display device 35 displays an image taken directly from the eyepiece of the arthroscope 33 or by a television camera 34 attached to the eyepiece. Insertion part 3 of the surgical cutting instrument 1 inserted into the cavity
make it 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 36 through the water supply pipe 37 punctured into the joint cavity at controlled water pressure. . On the other hand, the tube 38 is connected to the suction tube mouthpiece 22 of the proximal grip main body 2 of the surgical resection instrument 1,
It is connected to the suction and recovery device 39, and a connector (not shown) of the cable 40 is connected to the motor control unit 41, so that the motor 16 can be supplied with electric power.

In this setting state, the operator uses the arthroscope 33 or the display device 35 to observe the inside of the joint cavity and the distal end of the insertion section 3 of the resection instrument 1.
The tissue-taking blade openings 6 and 7 at the tip are brought into contact with the tissue to be resected, and in this state, the switch is turned on and the motor 16 is turned on.
is driven to rotate the inner tube 5 around the axis via a drive transmission system such as the output shaft 19 to engage the outer tube cutting edge 6 and the inner tube cutting edge 7 and opening and closing the cutting edges 6 and 7. The tissue taken into the blade openings 6 and 7 is cut or cut, and the suction and collection device 39 is activated when necessary or constantly to remove the sections from the suction path 10 of the inner tube 5 and the inner tube sleeve 2.
1. Suction and recovery device 39 via the cavity 12a of the front housing 12, the suction tube mouthpiece 22, and the tube 38
can be collected and discharged.

In FIG. 4, reference numeral 42 indicates a light source device, 43 indicates a light guide cable, and 44 indicates a television camera cable.

As described above, in the present invention, the target tissue in a body cavity, for example, a joint cavity, is excised and cut with the blade openings 6 and 7 at the tip of the insertion part 3 of the surgical resection instrument 1 inserted from outside the body cavity, and the cut tissue is removed outside the body cavity. During excision and cutting of the tissue, the blade openings 6 and 7, which are formed from the curved tip end portions 8 and 9 of the outer tube 4 and the inner tube 5 to the tube side surfaces, reliably bite into the tissue. In addition, it is possible to perform resection and cutting while preventing escape, and it is easy to aim the target tissue with the blade openings 6 and 7.

5 and 6 show a second embodiment of the invention. In this embodiment, the outer tube cutting edge 6 is formed in a circular shape from the tip of the arcuate bottomed part to the tube side surface as shown in FIG. 5A, and the inner tube cutting edge 7 is formed as shown in FIG. 6. The shape is the same as that of the first embodiment, and a serrated blade 7d is formed from the front edge 7a to the side edges 7b, 7b.

In addition, in the present invention, the outer tube cutting edge 6 and the inner tube cutting edge 7 in the first and second embodiments are not limited to the above-mentioned combination, but also the outer tube cutting edge 6 and the sixth one shown in FIG.
It is used in combination with the inner tube cutting edge 7 shown in the figure, the outer tube cutting edge 6 shown in FIG. 5, and the inner tube cutting edge 7 shown in FIG. 3.

Further, the present invention is applicable not only to the joint cavity but also to other body cavity sites.

[Effects of the Invention] As explained above, according to the present invention, it is possible to reliably bite into the tissue in the body cavity, prevent the tissue from escaping during excision or cutting, and perform efficient excision or cutting. There is.

[Brief explanation of the drawing]

1 to 4 relate to the first embodiment of the present invention, in which FIG. 1 is a longitudinal sectional view, FIG. 2 is a shape of the outer tube cutting edge, A is a plan view, B is a side view, and FIG. The figures show the shape of the inner tube cutting edge, A is a plan view, B is a side view, and
The figure is an explanatory diagram showing an example of the usage state, Figures 5 and 6 relate to the second embodiment, Figure 5 shows the outer tube cutting edge, A is a plan view, B is a side view, and Figure 6 is A is a plan view and B is a side view showing the inner tube cutting edge. 2... Main body part, 3... Insertion part, 4... Outer tube, 5
...Inner pipe, 6...Blade mouth, 7...Blade mouth.

Claims (1)

[Claims] 1 Inside the outer tube with a tissue inlet opening at the tip,
An inner tube having a cutting edge that engages with the cutting edge of the outer tube is rotatably installed around an axis, and the rotation of the inner tube allows the cutting edge of the inner tube and the outer tube to be opened and closed. On the other hand, the inner path of the inner tube is a suction path communicating with the double blade opening, and the outer tube cutting opening and the inner tube cutting opening are connected to a bottomed tip portion having a curved surface of the outer tube and the inner tube. A surgical cutting instrument characterized in that an opening is formed continuously from the tube to the side surface of the tube.