JPH0698148B2 - Hand piece - Google Patents

Description

The present invention relates to a surgical ultrasonic scalpel handpiece for crushing or cutting and separating biological tissue by ultrasonic vibration.

[Prior art]

As a surgical instrument applying cutting, cutting or crushing ability of living tissue by ultrasonic waves, orthopedic surgery, in general surgical field, cutting bones and joints, cutting out cancer cells, surgical tool for cataract in ophthalmology field, Also, in the dental field, ultrasonic surgical tools for removing tartar have been put into practical use.

These ultrasonic surgical instruments are basically in contact with an ultrasonic vibration source that converts high-frequency current into ultrasonic vibration, a horn that is connected to the vibration source and that amplifies and transmits ultrasonic vibration, and a biological tissue. It consists of a working part (female part) at the tip of the horn for crushing or cutting, and in addition to this, depending on the purpose of use, an irrigation mechanism that supplies and cleans an irrigation liquid (cleaning liquid) such as physiological saline around the surgical site, and a crushing device. It has a suction mechanism for sucking and removing the emulsified cell debris.

An example of the structure of the surgical ultrasonic scalpel handpiece having such an irrigation mechanism and suction mechanism will be described in some detail with reference to FIG.

This handpiece includes a cable 31, a connector 32, a grip 33, a protective tube 34, a horn 35, an irrigation pipe 36 for supplying a physiological saline solution or the like to a surgical site, and a horn 35 for the irrigation pipe. And a suction pipe 38 for sucking and removing the liquid substance and the like at the surgical site. The connection pipe 39 is a pipe that functionally connects the grip portion 33 and the protection pipe 34 with a screw or the like. The grip portion 33, the connection pipe 39, and the protection pipe 34 are made of a light and corrosion-resistant metal such as aluminum or duralumin, or a synthetic resin or the like, for easy and easy handling by an operator. The horn 35, which serves as the ultrasonic knife, is made of a material such as ultra-super duralumin, titanium alloy, etc., which has good transmission of high-frequency mechanical vibration and is strong against damage. Suction hole for sucking and removing blood, physiological saline for washing, cell debris crushed by horn 35, etc.
40 is provided, and this suction hole 40 is connected to the suction pipe 38 via a pipe joint 41 connected to the outside of the protection tube 34 by an appropriate method. The suction nipple 42 is connected to the other end of the suction pipe 38 by a suitable method such as welding. A suction device such as a vacuum pump is connected to the suction nipple 42 via a trap such as a glass bottle. Irrigation pipe 36
Is for supplying an irrigation liquid such as physiological saline to the surgical site, and has an open end near the tip of the horn 35 and is fixed or connected to the pipe joint 41 by an appropriate method. An irrigation nipple 43 is connected to the other end of the irrigation pipe 36 by an appropriate method such as welding, and is further connected to an irrigation device composed of a roller type pump such as a perister pump. The pipe stopper 44 is a stopper for fixing the suction pipe 38 and the irrigation pipe 36 to the grip portion 33.

Incidentally, FIG. 4 (b) is a view showing the internal structure of the handpiece, and is a vibrator 45 composed of an electrostrictive vibrator or a magnetostrictive vibrator.
Before and after (left and right in the figure), a backing plate 46 and a full-face plate 47 made of a high-tensile metal material such as duralumin or a high-strength aluminum alloy are provided. It is tightly connected and fixed by bolts made of material. The front plate 47 and the horn 35 are connected and fixed by screws such as a set screw 48 made of a high-tensile metal material.

However, in this handpiece, since the irrigation pipe 36 is along the outside of the horn 35 and the holder 37 is provided near the tip of the horn 35, the irrigation pipe 36 and the holder 37 prevent the field of view of the surgical target site. However, there is a drawback that the operation is rather difficult, and the operation time is long and it is difficult to perform an appropriate and accurate operation.

In order to eliminate these drawbacks of conventional handpieces,
The present inventors have found that the front plate 47 and the horn 35 connected to the oscillator 45.
A hand piece (Japanese Patent Laid-Open No. 60-236638) in which a joint corresponding to the length of an integral multiple of 1/2 wavelength is provided between the ends of the joint at a position corresponding to a length of 1/4 wavelength from the end of the joint. A handpiece (Japanese Patent Application No. 61-18055) in which the horn 35 is made thinner by providing a step or a diaphragm, and a horn 3
The object of the operation is to make the entire handpiece or the tip of the horn thinner, such as a handpiece (Japanese Patent Application No. 61-109671) in which the front part of 5 is bent according to the situation of the operation part, or to be bent. A series of inventions for making the parts easy to see are made and disclosed above.

On the other hand, an example in which a method for forming a suction hole and a passage for an irrigation liquid is devised is well known. For example, as shown in FIG. 5, Japanese Patent Publication No. 47-39197 and US Pat. No. 35893.
In No. 63, while providing the suction hole 51 in the tool tip 50,
A plastic casing 52 is provided on the outside of the tool tip 50, and an annular space between the tool tip 50 and the casing 52 is provided with a cleaning liquid passage.
53. Also, US Pat. No. 3,562,219 shown in FIG.
In No. 5, the space of the horn 54 in the air is used as the cleaning liquid passage 53, and the space between the horn 54 and the jacket 52 is used as the suction passage 55. Further, in Japanese Examined Patent Publication No. 60-6654 shown in FIG. 7, the inside of the horn 54 is a suction hole 51, and the space between the horn 54 and the jacket 52 is a cleaning liquid passage 53.

However, in all of these examples, since the outer cover 52 is provided concentrically outside the horn 54 or the tool tip 50,
It has a drawback that the tip of the handpiece becomes unnecessarily large and difficult to handle, and it cannot be applied to the handpiece in which the tip of the horn according to the present invention is bent. Also, the tip working part of the horn is the blood vessel of the surgical site,
When the tip opening of the suction hole is closed and excessive suction pressure is applied to the nerve tissue or the like, there is a risk of damaging blood vessels, nerve tissue, or the like.

[Object of the Invention]

SUMMARY OF THE INVENTION The present invention is intended to solve the above-mentioned problems of the current state of the surgical operation tool utilizing ultrasonic vibration, that is, the ultrasonic scalpel handpiece, and the irrigation conventionally provided outside the horn. By eliminating the tube, it is intended to provide an ultrasonic scalpel handpiece that makes it easier to see the surgical target site and also has an engagement mechanism that can be applied to a new type handpiece with a bent horn tip. is there.

[Structure of Invention]

That is, the present invention provides an ultrasonic vibration source for crushing or cutting and separating biological tissue by ultrasonic vibration, a horn connected to the ultrasonic vibration source for mechanical vibration at an ultrasonic frequency, and an irrigation liquid is supplied to a surgical site. Irrigation tube for, aspiration of cell fragments crushed by horn from the surgical site,
In a surgical handpiece basically composed of a suction hole for removal and a cover for covering at least an ultrasonic vibration source, 1 is provided near the tip of a horn having a suction hole penetrating in the axial direction. One to four side holes are provided, an irrigation tube is disposed in at least a part of the suction hole including the tip working portion of the horn, and the tip is opened through the side hole to the side portion of the horn. It is a characteristic handpiece.

Hereinafter, the present invention will be described in detail with reference to the drawings.

FIG. 1 is a sectional view of an ultrasonic scalpel handpiece according to an embodiment of the present invention. By mechanically connecting the vibrator 11 and the horn 1 with a screw or the like, the suction hole 12 provided in the vibrator 11 and the suction hole 2 provided in the horn 1 are connected to penetrate the entire handpiece. The suction hole is provided. The oscillator 11 is fixed to the grip portion 14 at a point serving as a node of the amplitude mode of the oscillator 11 by a flange 13 by an appropriate method such as a screw.

A suction pipe 15 connected to the suction hole 12, an irrigation tube 16 arranged in the suction holes 2 and 12, and a cable 17 connected to the ultrasonic oscillator are provided from the rear end of the vibrator 11 and the grip 14. I'm out. The irrigation tube 16 has a hole on the side surface of the suction pipe 15 and is pulled out from the hole, and the gap between the holes is sealed with resin to prevent negative suction pressure leakage and to fix the irrigation tube 16. There is. At the rear end of the suction pipe 15, there is a nipple 18 for connecting to a suction device such as a vacuum pump with a flexible tube, and at the rear end of the irrigation tube 16 is a roller type pump such as a perister pump. ,
A nipple 19 for connecting a flexible tube of vinyl chloride resin, silicone resin or the like for supplying an irrigation liquid (cleaning liquid) such as physiological saline is attached.

Irrigation tube 16 arranged in the suction holes 2 and 12
Through the side hole provided in the vicinity of the tip of the horn 1 to the outside of the horn 1 and open. The side hole for passing the irrigation tube 16 is located 3 to 50 mm from the tip of the horn 1, preferably about 5 to 30 mm. Moreover, the diameter of the side hole is equal to that of the irrigation tube.
It is desirable to make it the same as or slightly smaller than 16. Further, the length of the opening end of the irrigation tube 16 which is exposed to the outside of the horn 1 is 0.1 to 30 mm, preferably 0.3 to 20.
It is good to set to about mm

The number of side holes provided in the vicinity of the tip of the horn 1 is preferably 1 or 2 or more, preferably 2 to 4. One of these side holes is used to bring the irrigation tube 16 out of the suction hole 2 to the outside of the horn 1 as described above, while the other side hole is used during surgery. A suction release hole 24 (see FIG. 1) is provided to prevent the distal end opening of the second portion 2 from being blocked and exerting an excessive suction pressure on the living tissue of the surgical site. The diameter of the side hole to be the suction release hole 24 depends on the suction pressure, but is preferably 0.7 to 1.2 mm in the case of one piece and 0.3 to 0.7 mm in the case of three pieces.

As the irrigation tube 46, it is necessary to use a tube having a small diameter having flexibility, and such a material is particularly limited as long as it is flexible and has excellent wear resistance and heat resistance. Although not limited to them, examples thereof include a fluorine resin and a polyimide resin. Further, the irrigation tube 16 is to be passed through the suction holes 2 and 12, and since the irrigation tube 16 needs to have a thickness that does not hinder suction of crushed cell debris, the inner diameter of the suction holes 2 and 12 Is 2
Since it is about 3 mm, the outer diameter of the irrigation tube 16 is preferably about 0.7-1.5 mm. The irrigation tube 16 is free in the suction hole, and the irrigation tube 16 and the suction holes 2 and 12 do not have to be concentric. In the suction holes 2 and 12, there is no particular problem even if they are not fixed, but if necessary, at the junction between the vibrator 11 and the horn 1, the node becomes the amplitude mode node of the vibrator 11 or the suction hole. The irrigation tube 16 may be fixed to the outside of the horn 1 from the inside by means of an adhesive or the like at a side hole.

FIG. 2 shows that the suction hole 21 is extended from the middle of the handpiece to the side, and the horn 11 is provided with a horn cover 20 having a length up to a position for covering the tip opening of the irrigation tube that is exposed to the side. In another covered embodiment, the present invention can be applied to such a case in the same manner as the example of FIG. Oscillator
A suction hole 21 is formed on the horn 1 side of 11 at an angle of about 20 to 50 ° with respect to the axis of the handpiece up to the central portion, and the suction hole 21 is penetrated through the suction holes 2 and 12 in the axial direction. The suction hole 21 is connected to the suction pipe 22 via a pipe joint 23 connected to the outside of the cover 3 by an appropriate method.

The horn cover 20 is attached to the cover 3 by an appropriate method so as not to come into contact with the vibrator 11, but it may be formed integrally with the cover 3. It is desirable that the tip of the horn 1 projects 5 to 20 mm from the tip of the horn cover 20. On the other hand, the open end of the irrigation tube 16 may be located on the tip end side not covered by the horn cover 20, but at the position covered by the horn cover 20, the horn 1 and the horn cover 20 are If it is in the gap between them, the phenomenon that the irrigation liquid is ejected in a mist state can be avoided, which is preferable.

Figure 3 shows the tool tip 25 at the tip of the horn 1 of the handpiece.
This is an example in which the irrigation tube 16 is passed through the suction hole 2 without any influence on the degree of bending of the tip portion of the horn 1 without hindering the field of view of the surgical site. An irrigation liquid can be supplied.

〔The invention's effect〕

According to the ultrasonic scalpel handpiece of the present invention, the site to be operated is not blocked by the irrigation tube or the suction pipe, the holder that holds these at the tip, and the horn tip has a bent handpiece. By the combination, even when the operation target site is a deep part in the living body and the operative field is extremely narrow, the operation can be advanced without obstructing the operative field, and therefore an appropriately qualified operation can be performed in a short time without any trouble.

[Brief description of drawings]

1 and 2 are sectional views of an ultrasonic scalpel handpiece according to an embodiment of the present invention, and FIG. 3 is a sectional view of a horn tip portion of a handpiece according to another embodiment of the present invention. . FIG. 4 is a diagram showing an example of a conventional ultrasonic scalpel handpiece, (a) is an external view, and (b) is a diagram showing an internal structure. Also, FIGS. 5 to 7 are views showing the structure of the front part of the conventional ultrasonic scalpel handpiece, and the arrows in each figure
The flow direction of the irrigation liquid or the discharged liquid is shown.

Claims (3)

[Claims] 1. An ultrasonic vibration source for crushing or cutting and separating biological tissue by ultrasonic vibration, a horn connected to the ultrasonic vibration source to perform mechanical vibration of ultrasonic frequency, and an irrigation liquid is supplied to a surgical site. For irrigation tube, to aspirate cell fragments crushed by horn from surgical site,
In a surgical handpiece basically composed of a suction hole for removal and a cover for covering at least an ultrasonic vibration source, 1 is provided near the tip of a horn having a suction hole penetrating in the axial direction. One to four side holes are provided, an irrigation tube is disposed in at least a part of the suction hole including the tip working portion of the horn, and the tip is opened through the side hole to the side portion of the horn. Characteristic handpiece. 2. The handpiece according to claim 1, wherein the cover has a length up to a position where it covers the distal end opening of the irrigation tube protruding to the side of the horn. 3. The irrigation tube is made of a thin tube having flexibility and excellent in heat resistance and wear resistance, as claimed in claim 1. The handpiece described in paragraph.