JPH0690957A - Water jet operating device - Google Patents

Abstract

PURPOSE:To provide the water jet operating device which can prevent the incision of a biotissue deeper than desired without allowing water fluid to intrude deep into the biotissue. CONSTITUTION:The sectional shape of an injection nozzle 5 at the front end of a water jet catheter 2 having a flow passage in which high-pressure fluid is past is formed to a flat elliptical shape or rectangular shape. The high- pressure fluid is injected from the injection nozzle 5 when the high-pressure fluid is sent from the water jet catheter 2. Of this water flow, the water flow near the injection nozzle 5 has a high water density and the large energy per unit sectional area, thus having incision power but the part apart from the injection nozzle diffuses sectorially and is therefore small in the water density and the incision power therein is low so that only the biotissue near the injection nozzle 5 can be incised to the desired depth.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a water jet surgical apparatus for injecting a high-pressure fluid from an injection nozzle to incise or excise a living tissue.

[0002]

2. Description of the Related Art A water jet surgical apparatus for performing operations such as incision and excision of living tissue by jetting pressure of a high-pressure fluid is known, for example, from Japanese Patent Application Laid-Open No. 1-313047. This consists of a suction pipe provided so as to project from the handpiece body, and a water jet injection pipe concentrically provided inside the suction pipe. The injection nozzle at the tip of this injection pipe is It is provided slightly inside the suction port.

When high-pressure fluid is sent from the water jet jet pipe, the high-pressure fluid is jetted from the jet nozzle at the tip of the jet pipe toward the surgical site. on the other hand,
The fluid jetted to the surgical site and the fluid around it are sucked from the suction port of the suction pipe and discharged.

[0004]

However, in the water jet surgical apparatus configured as described above, the flow passage cross-sectional shape of the injection nozzle at the tip of the injection pipe is formed to be a perfect circle, and the injection is performed from this injection nozzle. The water flow is set to converge. Therefore, it is difficult to adjust the incision depth during incision because the injected water flow enters the tissue to incise the biological tissue, and since it changes depending on the type and state of the biological tissue, it makes an unexpected deep incision. In some cases, the treatment was hindered.

The present invention has been made in view of the above circumstances, and an object thereof is to prevent the water flow jetted from the jet nozzle from deeply entering a living tissue and preventing an unintended deep incision. It is to provide a water jet surgical device capable of performing.

[0006]

In order to achieve the above object, the present invention provides a water jet surgical apparatus including a water jet catheter having a flow passage for passing a high-pressure fluid and having an injection nozzle at a distal end thereof. This is because the cross-sectional shape of the flow path of the injection nozzle is flat.

[0007]

When the high-pressure fluid is sent from the water jet catheter, the high-pressure fluid is jetted from the jet nozzle. Of the water flow, the water density near the jet nozzle is large, the energy per unit cross-sectional area is large, and a cutting force is exerted. However, since the portion away from the injection nozzle diffuses in a fan shape, the water density is reduced and the incision force is reduced.

Therefore, by moving the ejection nozzle while contacting the living tissue, only the living tissue near the ejection nozzle can be incised to a desired depth.

[0009]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS An embodiment of the present invention will be described below with reference to the drawings.

FIG. 1 shows a water jet surgical apparatus 1 as a whole, which is composed of a water jet catheter 2 and a mantle tube 3. As shown in FIG. 1A, the water jet catheter 2 is inserted inside the outer tube 3 in an eccentric state.

The water jet catheter 2 is shown in FIG.
(B) As shown in (c), the injection flow path 4 through which a high-pressure fluid is passed.
Is a pipe or tube provided with. The tip side of the flow path 4 is formed to have a smaller diameter than the root side in order to increase the flow velocity, and an injection nozzle 5 having a flat cross section in the flow path is provided at the tip part. There is.

That is, the injection nozzle 5 is formed into an elliptical shape by flatly crushing one end of a pipe 6 made of metal such as stainless steel, and the outer peripheral portion of the water jet catheter 2 is fixed with a fixing agent 7 such as solder. It is formed by fixing it in the cavity. The cross-sectional shape of the flow path of the injection nozzle 5 is not limited to an elliptical shape and may be a rectangular shape.

The outer tube 3 is a hollow pipe or tube, and its inner peripheral surface and the water jet catheter 2
A suction flow path 8 is formed between the suction flow path 8 and the outer peripheral surface, and a suction port 9 is provided at the tip portion.

Further, the water jet catheter 2
The base end portion 10 of the is housed in the base end tube portion 11 of the outer tube 3. An annular groove 12 is formed on the outer periphery of the base end portion 10, and an O-ring 13 is fitted in the annular groove 12 to form the base end tubular portion 1.
1 is airtightly sealed and fixed by a fixing screw 14.

The proximal end 10 of the water jet catheter 2 is connected to a high pressure resistant tube 16 via a removable connector 15. Further, a drainage suction pipe 17 that communicates with the suction flow path 8 is provided in the proximal end tube portion 11 of the outer tube 3,
A suction tube 18 is connected to the drainage suction pipe 17.

High pressure tube 16 and suction tube 18
Is connected to the control device 19 shown in FIG.

That is, the high pressure resistant tube 16 is connected to the pressurizing pump 2 via the first pressure gauge 20 provided in the controller 19.
Connected to 1. The suction tube 18 is connected to a suction pump 23 via a second pressure gauge 22.

The controller 24 provided in the control device 19 sets the outputs of the pressurizing pump 21 and the suction pump 23, displays the outputs of the first and second pressure gauges 20 and 22, and operates the limit switch 25. The integrated control circuit has a function of setting a value and stopping the pressurizing pump 21 when the pressure in the jetting channel 4 reaching the water jet catheter 2 rises abnormally.

The pressurizing pump 21 is connected to the liquid tank 26, and the suction pump 23 is connected to the drain tank 27.

Next, the operation of the water jet surgical operation apparatus 1 configured as described above will be described. The water jet surgical apparatus 1 is used for an abdominal surgery and a transabdominal surgery in which an abdominal incision is introduced into the abdominal cavity. Figure 3
The procedure for transabdominal surgery is shown in Fig. 4, but it is also used for open surgery.

For the affected tissue 30 such as liver and adhesion tissue,
A water jet surgical device 1, an endoscope 32, and grasping forceps 33 are passed through a guide tube 31 inserted transabdominally into the abdominal cavity.
a, 33b are guided and treated. A portion of the affected tissue 30 to be incised is spread by using the grasping forceps 33a and 33b, and the water jet surgical operation apparatus 1 is opposed to the portion.

The water jet catheter 2
The high-pressure fluid is injected from the injection nozzle 5 of. Injection nozzle 5
Since the cross section of the flow path of is flat, the injected water flow is
As shown in (1), the process proceeds in a flat fan shape that spreads in the longitudinal direction. The vicinity of the injection nozzle 5 has a high water density and a large energy per unit cross-sectional area of the water flow, so that it has a cutting force, and when the injection nozzle 5 is brought close to the affected tissue 30, The affected tissue 30 is incised to form an incision 34.

In this case, since the water flow diffuses in a fan shape in the portion away from the injection nozzle 5, the water density is reduced and the incision force is reduced, so that the diseased tissue 30 is incised to an incision depth of about several millimeters.

Foaming on the surface of the incision 34 and incision 3
The drainage fluid collected in 4 is sucked out of the abdominal cavity from the suction port 9 through the suction channel 8. This operation is performed while observing with the endoscope 32.

As described above, by moving the jet nozzle 5 of the water jet catheter 2 close to the affected tissue 30 and applying the water stream to the affected tissue 30, only the affected tissue 30 near the jet nozzle 5 can be incised. You can do it and make deep incisions unexpectedly like in the past,
The treatment can proceed smoothly without cutting the blood vessel unexpectedly and taking time to stop the bleeding. Furthermore, when it is not desired to make an incision, it suffices to separate the injection nozzle 5 from the affected tissue 30 to prevent an incision due to an erroneous injection.

When the diffused region of the water flow is used for detachment of connective tissue, edema is caused in connective tissue in a wider area than in the case of the water flow ejected in a straight line and separated from parenchymal tissue. Therefore, the treatment can be efficiently performed in a shorter time.

FIG. 5 shows a water jet operation apparatus 1 having a high-frequency treatment function, in which a high-frequency wave is passed through the mantle tube 35 so that the tissue can be incised and coagulated. Is attached and the description is omitted.

As shown in FIGS. 5 (a) to 5 (c), the outer tube 35 has a spatula formed by forming a notch 35a in a part of the tip of the outer tube 35, and this tip has an electrode portion. 36
Is formed, and the remaining portion of the outer tube 35 is covered with an insulating layer 37. An insulating layer (not shown) is also applied to the surface of the water jet catheter 2.

An inclined pin groove 38 is provided on the outer peripheral wall of the proximal tube portion 11 of the outer tube 35, and when the water jet catheter 2 is inserted into the outer tube 35, the proximal end portion 10 of the pin groove 38 is provided. The pin 39 projecting from the above is engaged.

Further, an electrode terminal 40 for energizing a high frequency is provided adjacent to the drainage suction pipe 17 provided in the proximal tube portion 11, and a high frequency electrocautery device (not shown) is provided.
You can connect to.

According to the water jet surgical operation apparatus 1 thus constructed, the water jet catheter 2
Is rotated to move the pin 39 along the pin groove 38 to move the water jet catheter 2 toward the proximal side with respect to the mantle tube 35 and expose the electrode portion 36, thereby incising and coagulating by high frequency. You can do it.

In the treatment using the water jet catheter 2, a high frequency is usually used together for the purpose of removing and removing connective tissue, hemostasis, etc., but the electrode portion 36 is provided on the outer tube 35 of the water jet catheter 2 as described above. As a result, they can be combined into one, and the operability can be improved as compared with the conventional separate one.

Further, if the electrode portion is provided at the tip of the water jet catheter 2, the cauterized tissue or the like may be attached and the injection nozzle 5 may be clogged, but the outer tube 35 is provided with the electrode portion 36. Therefore, there is no need to worry about the above.

FIG. 6 also shows a water jet operation apparatus 1 having a high-frequency treatment function, in which a high frequency is applied to the mantle tube 41 so that the tissue can be incised and coagulated. The same components are designated by the same reference numerals. The description is omitted.

As shown in FIGS. 6A to 6C, an opening 42 is provided in a part of the outer tube 41 in the axial direction, and an outer tube sliding portion 43 is provided in the opening 42. ing. An opening edge of the opening portion 42 of the outer tube 41 and both side edges of the outer tube sliding portion 43 are engaged with each other by an uneven portion (not shown), and the outer tube sliding portion 43 slides in the axial direction of the outer tube 41. It is movably formed.

A sliding operation portion 44 is provided on the proximal side of the outer tube sliding portion 43 so as to project, and an electrode terminal 45 is provided adjacent to the sliding operation portion 44. Furthermore, an electrode portion 46 is provided at the tip of the outer tube sliding portion 43, and the other portions are provided with the insulating layer 4.
It is covered by 7. An insulating layer (not shown) is also applied to the surface of the water jet catheter 2.

According to the water jet surgical operation apparatus 1 constructed as described above, the outer tube sliding portion 43 is moved forward by the sliding operation portion 44 to expose the electrode portion 46 in front of the water jet catheter 2. By doing so, incision and coagulation can be performed with a high frequency, and the same effect as in the example of FIG.

FIG. 7 also shows a water jet operation apparatus 1 having a high-frequency treatment function, which is capable of incising and coagulating tissue. The same components are designated by the same reference numerals and their description is omitted.

As shown in FIGS. 7 (a) to 7 (d), the water jet catheter 2 is inserted into the outer tube 48 so as to be movable back and forth in the axial direction, and the drainage suction pipe 49 is fixed. There is. A pin 50 is projectingly provided on the proximal end portion 10 of the water jet catheter 2, and the pin 5
0 is a pin groove 51 provided in the proximal end cylinder portion 11 of the outer tube 48.
Is engaged and positioned.

An electrode terminal 52 is provided at the proximal end of the drainage suction pipe 49, and an electrode portion 53 is provided at the distal end. The other part of the drainage suction pipe 49 is covered with an insulating layer 54. An insulating layer (not shown) is also applied to the surface of the water jet catheter 2.

According to the water jet surgical operation apparatus 1 thus constructed, the water jet catheter 2
If the electrode portion 53 of the drainage suction pipe 49 is exposed by moving to the proximal side, the cutting and coagulation can be performed by high frequency, and the same effect as the example of FIGS. 5 and 6 can be obtained.

[0042]

As described above, according to the present invention, by making the flow passage cross-sectional shape of the jet nozzle of the water jet catheter flat, the water flow jetted from the jet nozzle is diffused into a fan shape. There is an effect that the water flow does not deeply enter the living tissue and it is possible to prevent an unexpected deep incision.

[Brief description of drawings]

1A and 1B show a water jet surgical apparatus according to an embodiment of the present invention, FIG.
Is a front view of the water jet catheter, and (c) is an enlarged vertical side view of the injection nozzle.

FIG. 2 is a configuration diagram of a control device of the same embodiment.

FIG. 3 is a perspective view showing a usage state of the embodiment.

FIG. 4 is a perspective view showing a state of water flow jetted from the jet nozzle of the embodiment.

5A and 5B show a water jet surgical apparatus having a high-frequency treatment function, where FIG. 5A is an overall vertical side view, FIG. 5B is a side view of an electrode portion, and FIG. 5C is a plan view of an electrode terminal portion.

6A and 6B show a water jet surgical apparatus having a high-frequency treatment function, wherein FIG. 6A is an overall plan view, FIG. 6B is an overall vertical side view, and FIG.

7A and 7B show a water jet surgical apparatus having a high-frequency treatment function, where FIG. 7A is an overall vertical side view, FIG. 7B is a vertical side view of an electrode portion, and FIG. The side view seen, (d) is the side view seen from the arrow d direction of (a).

[Explanation of symbols]

1 ... Water jet surgical device, 2 ... Water jet catheter, 5 ... Injection nozzle.

Claims (1)

[Claims] 1. A water jet surgical apparatus including a water jet catheter having a flow passage for passing a high-pressure fluid and having an injection nozzle at a tip end thereof, wherein a cross-sectional shape of the flow passage of the injection nozzle is flat. Waterjet surgical device.