JPH06311988A - Excision instrument for surgery - Google Patents

Abstract

PURPOSE:To enable prompt dealing with even when bleeding arises by making it possible to execute high-frequency treatment without replacing a high-frequency treating device, etc. CONSTITUTION:This excision instrument for surgery is constituted by constituting an insertion part 2 connected to a body 1 contg. a motor 4 of an outside pipe 14 and an inside pipe 15 freely rotatable within this outside pipe 14 and providing the front end of this insertion part 2 with an excision part 19. This excision part 19 is provided with an active cord 20 as a high-frequency current impressing means for impressing a high-frequency current thereto.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical resecting instrument for resecting a tumor on a patella or a cartilage or bone damaged from a knee joint.

[0002]

2. Description of the Related Art A surgical method for resecting a tumor on a patella or excising cartilage, bone or the like damaged from a knee joint has been performed by an incision method (open surgery). A surgical excision instrument was devised that does not make an incision under endoscopic observation as disclosed in Japanese Patent Publication No. 0190000.

However, in this surgical cutting instrument, since the cutting blade formed on the outer tube constituting the insertion portion connected to the main body is exposed to the outside, the tip of this outer tube is inserted into the body. In doing so, there was a problem that damage to the internal tissues, cartilage, etc. due to the cutting blade occurred. Therefore, JP-A-2-
Japanese Patent No. 131757 discloses a surgical cutting instrument without damage.

[0004]

However, the above-mentioned Japanese Unexamined Patent Application Publication No.
In the case of Japanese Patent No. 131757/1993, although damage can be prevented, bleeding from it cannot be prevented because cartilage, bone, etc. are removed at the same time that capillaries are also removed. Therefore, in order to stop bleeding at the bleeding site, it is necessary to insert a hemostatic device such as a high-frequency treatment device and cauterize it to stop the bleeding, and the work of replacing the device is complicated and time-consuming.

The present invention has been made in view of the above-mentioned circumstances, and an object thereof is to provide a surgical cutting instrument capable of performing hemostasis work without replacing the hemostatic tool when bleeding occurs during resection. To do.

[0006]

A surgical instrument in which an outer tube and an insertion section composed of an inner tube rotatable in the outer tube are connected to a main body incorporating a motor, and a cutting section is provided at a distal end of the insertion section. In the cutting tool for use, a high-frequency current applying means for applying a high-frequency current to the cutting portion is provided. When bleeding occurs during the excision treatment of the affected part by the excision part, a high-frequency current is applied to the excision part to coagulate by the high-frequency current.

[0007]

Embodiments of the present invention will be described below with reference to the drawings. 1 to 4 show a first embodiment. As shown in FIG. 1, reference numeral 1 is a main body of the cutting instrument, which is formed in a substantially cylindrical shape,
An insertion portion 2 is detachably connected to the main body 1.
A fixed recess 3 having an opening 3a at the rear end is provided inside the main body 1, and a motor 4 inserted through the opening 3a is fixed to the fixed recess 3. The opening 3a is closed by the lid 5, and the power cord 4a of the motor 4 is also included.
Is extended through the lid body 5, and the motor 4 receives power from the power cord 4a.

On the other hand, a screw cylinder 7 having an outer peripheral thread is formed at the tip of the main body 1 so as to project, and the inside of the screw cylinder 7 is formed as a suction chamber 7a. The suction chamber 7a is communicated with the inside of the fixed recess 3 by a through hole 8, and the output shaft 4b of the motor 4 is inserted into the through hole 8.

As shown in FIG. 2, the output shaft 4b is covered with an insulator 4c, which is fixed to the output shaft 4b by a fixing screw 4d. An engaging pin 4e is provided at the tip of the insulator 4c so as to project in a direction orthogonal to the axial direction.

On the other hand, a connecting shaft 9 slidably connected to the output shaft 4b for a predetermined distance is rotatably disposed in the through hole 8, and the engaging pin 4e is attached to the connecting shaft 9. A locking groove 4f that engages with is provided. Then, the rotation of the insulator 4c is transmitted to the connecting shaft 9 via the engagement pin 4e. The connecting shaft 9 is constantly urged toward the tip end side by an elastic body 10 interposed between the connecting shaft 9 and the insulator 4c, and is movable to some extent in the axial direction.

The tip side of the connecting shaft 9 is exposed to the suction chamber 7a, and an engaging portion 9a such as a slit is formed on the exposed portion. A suction passage 7b extending to the rear end side of the main body 1 communicates with the suction chamber 7a. A connection fitting 7c is provided on the rear end side of the main body 1 of the suction passage 7b.
It is designed to be connected to a suction device (not shown) via a hose connected to c.

On the other hand, a connection cap 12 for connecting the insertion portion 2 to the main body 1 is fixed to the screw cylinder 7. The connection cap 12 is an outer cylinder 12a.
And an inner cylinder 12b provided inside the outer cylinder 12a,
The screw cylinder 12c is rotatably fixed to the outer cylinder 12a, and the like. The screw formed inside the screw cylinder 12c is screwed into the screw of the screw cylinder 7. The connection cap 12 is fixed to the main body 1.

A pair of engaging grooves 13 are formed in the inner cylinder 12b in the axial direction, and a fixing member 13a is provided in the engaging groove 13 so as to be retractable.
The pin or the like engaged with 3 is fixed by the fixing member 13a.

The insertion portion 2 connected to the main body 1 by the connection cap 12 is composed of an outer tube 14 and an inner tube 15 rotatably inserted in the outer tube 14. The outer tube 14
A large-diameter portion 14a fitted to the inside of the inner cylinder 12b is formed on the main body 1 side, and a pair of pins 14b engaged with the engaging groove 13 are formed to project from the large-diameter portion 14a. ing. Then, the pin 14b is fixed by the fixing member 13a, so that the insertion portion 2 and the main body 1 are fixed via the connection cap 12.

The inner pipe 15 is formed in a hollow shape,
One side of the inner pipe 15 is connected to the main body 1 via the large diameter portion 14a.
It is projected to the side. A large-diameter portion 15b that abuts the large-diameter portion 14a is formed in the projecting portion, and the suction port 1 that communicates with the inside of the inner pipe 15 is formed in the large-diameter portion 15b.
5c is formed. Further, at one end of the large-diameter portion 15b, the tongue piece 15 that engages with the engaging portion 9a of the connecting shaft 9 is provided.
b is formed, and the rotation of the motor 4 is transmitted to the inner pipe 15 via the connecting shaft 9.

On the other hand, as shown in FIG. 3, the tip of the outer cylinder 14 is cut out in the shape of an arrow, and a cutting blade 17 is provided inside the cutout. Similarly, the tip of the inner tube 15 inserted into the outer tube 14 is also cut out, and a cutting blade 18 that contacts the cutting blade 17 is formed in the cut-out portion.

The cutting blades 17 and 18 constitute a cutting portion 19. When the cutting blades 17 and 18 are brought into contact with cartilage or the like while rotating the inner tube 15, the cut portion of the cartilage is cut off. The inside of the inner pipe 15 is sucked into the suction port 15
It is designed to be conveyed in the c direction.

Further, as shown in FIG. 1, an active cord 20 is connected to a connecting shaft 9 made of a conductive material via a brush 20a, and a high frequency current is supplied from a high frequency ablation device (not shown). ing. The active cord 20 is provided with a cord passage 21 provided in the fixed recess 3.

On the other hand, a hand switch 12 is detachably provided on the main body 1. The hand switch 22 is provided with an incision switch 23 and a coagulation switch 24, and a signal cable 25 is used for high-frequency incision / induction to a high-frequency ablation device (not shown).
It transmits the ON / OFF signal of the coagulation current.

FIG. 4 shows a simplified electric circuit. 26a, 26b and 26c are terminals for turning on / off the high frequency cutting / coagulation current, 26d and 26e are driving terminals for the motor 4, and 26f. Is a terminal for the active cord 20 for transmitting a high-frequency incision / coagulation current, and each is connected to each device (not shown). The output shaft 4b is integrated with the insulator 4c and transmits its driving force to the inner pipe 15 via the connecting shaft 9.

When cutting cartilage and the like with the cutting instrument having such a structure, first, the threaded cylinder 12 of the connection cap 12 is cut.
By screwing the screw formed inside c into the screw formed outside the screw cylinder 7 of the main body 1,
The connection cap 12 is fixed to the tip of the.

Then, the insertion portion 2 is gripped to fit the large diameter portion 14a of the outer tube 14 into the inner cylinder 12b, and
The pin 14 b protruding from the large diameter portion 14 is engaged with the engagement groove 13. Then, the pin 14b is fixed by the fixing member 13a, and the large diameter portion 1 of the inner pipe 15 is
The tongue piece 15a formed on 5b is the engaging portion 9 of the connecting shaft 9.
a is engaged. Further, the suction port 15c formed in the large diameter portion 15b is located in the suction chamber 7a.

In this state, the body 1 is gripped and the tip of the insertion portion 2 is engaged with a puncture hole formed in a human body or the like, and the engagement portion 2 is gradually inserted to cut the cutting blade 17, 18 is made to reach the site to be excised such as the human body.

Then, the motor 4 is connected through the power cord 4a.
A current is supplied to rotate the motor 4 and at the same time, a hose or the like is connected to the connection fitting 7c of the suction passage 7b to connect the suction chamber 7a to a suction device (not shown) and operate the suction device.

When the motor 4 is rotated, this rotation is transmitted to the inner pipe 15 via the connecting shaft 9, and the inner pipe 1
The sliding of the cutting blade 18 of No. 5 and the cutting blade 17 of the outer pipe 14 is started.

Next, when the site where the cutting blades 17 and 18 are slid is brought into contact with the site to be excised such as cartilage, the cartilage is excised and conveyed toward the suction chamber 7 through the inside of the inner tube 15. To be done. The cut material that has reached the suction chamber 7 is moved to the suction device side through the suction passage 7b by the action of the suction device.

When the hand switch 22 is turned ON / OFF, the high-frequency cutting / coagulating current transmitted from the active cord 20 to the brush 20a is transmitted to the connecting shaft 9 and the connecting pipe 9 because the inner pipe 15 is a conductive material. It is transmitted to the insertion section 2. High-frequency incision / coagulation can be performed by pressing the high-frequency incision / coagulation current transmitted to the insertion part 2 from the excision part 19 of the insertion part 2 to the treated part.

Further, since the hand switch 22 is constructed so as to be detachable, it can be arranged at any position of the user. Further, since the connecting shaft 9 is connected by the brush 20a, even if the inner tube 15 is rotating and stopped at any position, high-frequency current can be transmitted.

As described above, high-frequency treatment can be performed by passing the high-frequency incision / coagulation current through the insertion portion 2. Therefore, it is possible to perform an operation without losing the continuity of the operation without exchanging the treatment tool, and in the case of bleeding that is competing for time, there is an effect that the hemostasis operation can be performed promptly and it is safe. Further, since the high-frequency ON / OFF hand switch 22 is detachable and can be positioned freely, there is an effect that the operability according to the operator's preference is good.

The hand switch 22 need not be removable but may be fixed to the main body 1. In this case, the signal cable 25 may be built in the main body 1 and arranged on the power cord 4a. Then, since the signal cable 25 does not go out, a simple cord configuration is provided and operability is improved.

Although the high frequency ON / OFF is performed by the hand switch 22, it may be performed by a dedicated foot switch. Then, since the main body 1 does not need to be provided with the hand switch, the main body 1 becomes simple and the operability is improved.

Further, as described above, since the high frequency ON / OFF is performed by the foot switch, the function of the hand switch is not available. Therefore, the hand switch can be used as a switch for increasing / decreasing the number of revolutions and for switching the rotation forward / reverse. It may be a switch or a suction ON / OFF switch. Therefore, the operator can operate the main body 1 at his / her hand, and the operability can be improved.

FIG. 5 shows a second embodiment and shows an electric circuit. 29 is a plug of the main body 1, 30 is a plug of the main body 29
It is a V receptacle for mounting the. This V receptacle 30
The drive device 31 of the main body 1 having a drive circuit 32 for driving and controlling the motor 4, a high frequency circuit 33 for supplying a high frequency current, a switch circuit 34 for obtaining a signal from the hand switch 22 and selecting a type of the high frequency current, Further, a high frequency cutoff circuit 35 for cutting off the high frequency current is provided.

Therefore, in response to the signal from the hand switch 22, the switch circuit 34 selects the type of high frequency current, and causes the high frequency current selected from the high frequency circuit 33 to flow through the active cord 20 in the inner tube 15 of the insertion section 2. At that time, the high-frequency current does not pass through the high-frequency cutoff circuit 35 so that the high-frequency current does not sneak into the signal cable 25 of the hand switch 22 or the power cord 4a of the motor 4 and acts as noise on the drive circuit 32 and the switch circuit 34. It has become.

As a result, malfunction due to high-frequency current can be prevented, and safe and reliable treatment can be performed. FIG. 6 shows a modification of the second embodiment, in which the signal cable 25 of the hand switch 22 and the power cord 4 of the motor 4 provided on the main body 1 are provided.
This is a structure in which a and the motor 4 are covered with a shield 36. By changing the clothes in this way, it is possible to prevent a malfunction due to a high-frequency current, as in the second embodiment, so that safe and reliable treatment can be performed.

FIG. 7 shows a modification of the second embodiment, in which FIG. 7A shows the outer periphery of the main body 1 with an insulating coating 27a, and FIG. The outer periphery of the tube 14 is provided with an insulating coating 27b.

Insulating coatings 27a and 27b
May be coated with, for example, Teflon, ceramic coating, insulating paint, etc., and the body 1 and the outer tube 14 of the insertion portion 2 may be made of an insulating material, specifically, a resin material.

[0038]

As described above, according to the present invention,
Since the high-frequency treatment can be used together, the high-frequency treatment can be performed without replacing the high-frequency treatment instrument. As a result, the operability is improved, and even when bleeding that contends for a minute occurs, it is possible to immediately respond.

[Brief description of drawings]

FIG. 1 is a vertical sectional side view of a surgical cutting instrument according to a first embodiment of the present invention.

FIG. 2 is a vertical cross-sectional side view showing an enlarged part A of FIG.

FIG. 3 is a side view of the cutting portion and the entire instrument of the surgical cutting instrument of the embodiment.

FIG. 4 is an electric circuit diagram of the embodiment.

FIG. 5 is an electric circuit diagram showing a second embodiment of the present invention.

FIG. 6 is a schematic configuration diagram showing a modification of the second embodiment.

FIG. 7 is a schematic configuration diagram of the entire device showing a modified example of the second embodiment.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Main body 2 ... Insertion part 4 ... Motor 14 ... Outer tube 15 ... Inner tube 19 ... Excision part 20 ... Active cord (high-frequency current application means)

Claims (1)

[Claims] 1. A main body having a built-in motor, an outer tube connected to the main body, an insertion section composed of an inner tube rotatable in the outer tube, and a cutting section provided at the tip of the insertion section. A surgical cutting instrument having a structure, wherein high-frequency current applying means for applying a high-frequency current is provided to the cutting portion.