JPH0723969A - Ultrasonic treatment apparatus - Google Patents

Abstract

PURPOSE:To enable the proper coaptation strength for living tissues for treatment to be maintained immediately after treatment by application of ultrasonic vibration and to ensure that the living tissues for treatment are coapted. CONSTITUTION:A first 14a and second 14b coaptation area which have different coaptation effects are provided on the living-tissue coaptation face 14 of a nipping portion 13 installed at the end of a vibration-transmitting member 8.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an ultrasonic treatment apparatus which is used in intracavity surgery such as cholecystectomy using a laparoscope and which joins and anastomoses blood vessels and the like or living tissues.

[0002]

2. Description of the Related Art Conventionally, in this type of surgical procedure, a clip device or an anastomosis device using small clips and staples has been used. For example, US Pat. No. 46166
As shown in No. 50 and No. 4624254, there is known a clip applicator in which a plurality of metal clips are built in and a tube sandwiched at the tip of the clip applicator is clipped by a single operation.

These clip devices or anastomotic devices have a problem in that clips or staples made of metal or resin remain in the living body. Therefore, as shown in U.S. Pat. No. 3,898,992, a tissue joining apparatus has been developed, which is configured to join living tissues by utilizing ultrasonic vibration and thereby perform hemostasis and anastomosis of blood vessels without using clips or staples. Has been done.

In this tissue joining apparatus using ultrasonic vibration, a holding means for holding a living tissue is provided at the tip of the insertion portion inserted into the body. This holding means is provided at the tip of the vibration transmitting member that transmits the ultrasonic vibration from the ultrasonic vibrator that generates the ultrasonic vibration, as shown in FIGS.
Is formed by a tip chip a and a receiving member that is arranged to face the tip chip a at a distance. Here, as shown in FIGS. 11 (A) and 11 (B), the distal tip a has a living tissue bonding surface b in which concave groove portions are uniformly distributed over the entire distal end surface, or FIGS. As shown in D), a biological tissue joining surface c is formed on the entire tip surface in which pyramidal protrusions are uniformly distributed.

At the time of joining the living tissues, the living tissues to be treated are sandwiched between the tip a of the holding means and the receiving member, and ultrasonic vibration is applied while applying pressure to the treated tissues between the holding means. The living tissues held by the holding means are joined by ultrasonic emulsification and thermal denaturation. In this case, new living tissue is generated in the joined portion after the treatment, and the new living tissue is joined.

[0006]

In the above-mentioned structure, there is a problem that the living tissue to be treated is damaged by the application of ultrasonic vibration during the joining work of the living tissues.
Here, it suffices if the living tissue to be treated is relatively lightly damaged to the extent that it can be self-repaired. However, the degree of damage to the living tissue to be treated depends on the mechanical joining strength between the holding means operated by the operator. It changes as follows according to the size of (holding power).

That is, when the holding force between the holding means is larger than an appropriate value, the damage to the living tissue becomes unnecessarily large. In this case, the tissue at the joint portion of the living tissue to be treated is self-repairing. There is a problem that it becomes impossible and the joining becomes difficult. Further, when the holding force between the holding means is weaker than an appropriate value, the joint portion may be peeled off before the living tissue to be treated self-repairs.

In addition, the tip a of the conventional example is shown in FIG.
As shown in FIGS. 11A and 11B, a living tissue joining surface b in which concave groove portions are uniformly distributed over the entire tip surface, or FIG.
As shown in (C) and (D), since the living tissue joining surface c in which the pyramidal protrusions are evenly distributed is formed on the entire tip surface, the operator does not need to perform ultrasonic output / ultrasound application time. When various conditions such as tissue pressing pressure are increased and the joint strength of the living tissue is excessively increased, the entire contact site of the living tissue with the living tissue joint surfaces b and c is uniformly damaged,
There is a problem that it becomes difficult to properly join living tissues.

The present invention has been made in view of the above circumstances, and it is an object of the present invention to maintain the bonding strength of a living tissue to be treated immediately after treatment by application of ultrasonic vibration in an appropriate state and to ensure the reliability. Another object of the present invention is to provide an ultrasonic treatment device capable of joining biological tissues to be treated.

[0010]

According to the present invention, a holding means for holding a living tissue is provided at the tip of an insertion portion to be inserted into the body, and ultrasonic vibration from an ultrasonic transducer for generating ultrasonic vibration is generated. In the ultrasonic treatment device, in which the living tissue transmitted to the holding means via the vibration transmitting member and held in the holding means is joined, the living tissue joining of the holding means arranged at the tip of the vibration transmitting member. A plurality of bonding regions having different bonding effects are provided on the surface.

[0011]

[Function] During ultrasonic treatment, by joining a plurality of joint regions having different joint effects formed on the joint surface of the living tissue of the holding means to the living tissue, the living body to be treated immediately after the treatment by the application of ultrasonic vibration. The joint strength of the tissue is kept in an appropriate state, and the living tissue to be treated is surely joined.

[0012]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS A first embodiment of the present invention will now be described with reference to FIGS.
This will be described with reference to (D). FIG. 1A shows a schematic configuration of the whole ultrasonic treatment apparatus. In FIG. 1 (A),
Reference numeral 1 is a main body of the ultrasonic treatment device. The ultrasonic treatment apparatus main body 1 is provided with an insertion portion 2 to be inserted into the body and an operation portion 3 on the hand side connected to the proximal end portion of the insertion portion 2.

Further, the operating portion 3 is provided with a grip portion 4 and a trigger portion 5. Here, the grip portion 4 is provided, for example, in a protruding manner on an ultrasonic transducer case 7 that houses an ultrasonic transducer 6 such as a bolted Langevin type having a horn at the tip.

Further, the base end of the vibration transmitting member 8 is connected to the tip of the horn of the ultrasonic transducer 6. A screw hole is formed at the tip of the vibration transmitting member 8, and a tip chip 9 having an arbitrary cross-sectional shape and an action surface shape of the tip is screwed into the screw hole.

Further, the insertion section 2 is provided with a tubular sheath 10 through which the vibration transmission member 8 is inserted. This sheath 1
A substantially L-shaped receiving member 11 is connected to the front end portion of 0. The receiving portion 11 has a receiving portion 11a which is connected to a receiving portion 11a which is arranged to face the working surface of the leading end of the leading end chip 9 so as to be spaced apart therefrom.

Further, a case 7 is provided at the proximal end of the sheath 10.
On the other hand, the slide member 12 mounted so as to be slidable along the axial direction of the insertion portion 2 is connected and fixed. A trigger portion 5 is provided on the slide member 12 so as to project therefrom. Then, the receiving portion 11a of the receiving member 11 is inserted through the sheath 10 along with the contact / separation operation between the grip portion 4 and the trigger portion 5.
Is operated to move back and forth with respect to the distal tip 9 along the axial direction of the insertion portion 2, and the holding portion 11a of the receiving member 11 and the distal tip 9 sandwich the living tissue. A part (holding means) 13 is formed.

The tip of the tip 9 is shown in FIG.
As shown in FIG. 5, a living tissue joining surface 14 that is an action surface that joins with living tissue is formed. This living tissue joining surface 14
Is provided with two shapes of bonding regions 14a and 14b having different bonding effects on both sides of the center line.

Here, as shown in FIG. 1C, a plurality of columnar projections 15 ... Are projectingly provided on one of the first joining regions 14a. Further, as shown in FIG. 1 (D), a large number of substantially triangular pyramid-shaped projections 16 ... Are arranged side by side in the other second bonding region 14b. Then, for example, the junction K of the body tissue H, as shown in FIG. 2 (B), weaker joint K ₁ mechanical strength by the first bonding region 14a, the second junction region 1
The joints K ₂ having high mechanical strength are formed by 4b.

An ultrasonic oscillator drive circuit 17 is connected to the ultrasonic oscillator 6. A drive signal generation circuit 18 is connected to the ultrasonic transducer drive circuit 17. An operation switch (not shown) is connected to the drive signal generation circuit 18. Then, the drive signal generation circuit 18 is driven in accordance with the operation of the operation switch, and when the drive signal generation circuit 18 is driven, the drive signal output from the drive signal generation circuit 18 is amplified by the ultrasonic transducer drive circuit 17. The ultrasonic transducer 6 is driven by the amplified drive signal.

Next, the operation of the above configuration will be described.
First, using the ultrasonic treatment apparatus main body 1, for example, a blood vessel,
When performing treatment such as joining on the living tissue H to be treated such as a bile duct, the holding portion 13 at the tip of the insertion portion 2 is brought close to the living tissue H to be treated, and the holding portion is held as shown in FIG. 2 (A). Thirteen
The living tissue H to be treated is inserted between the receiving portion 11a of the receiving member 11 and the tip 9 in the above. In this state, the trigger portion 5 of the operating portion 3 on the hand side is pulled, and by operating the trigger portion 5, the slide member 12 is slid to the grip portion 4 side of the case 7.

As a result, the receiving portion 11a of the receiving member 11
Is drawn toward the biological tissue joining surface 14 side of the tip 9, so that the tissue H to be treated is sandwiched between the tip 9 and the receiving portion 11a of the receiving member 11 with the operation of the receiving portion 11a.

Subsequently, the ultrasonic transducer 6 is driven. When the ultrasonic transducer 6 is driven, the signal from the drive signal generation circuit 18 is amplified by the ultrasonic transducer drive circuit 17, and the ultrasonic transducer 6 is driven by the amplified drive signal.
Further, the vibration transmitting member 8 is ultrasonically vibrated by the ultrasonic vibration excited by the ultrasonic vibrator 6, and
The ultrasonic vibration excited by the ultrasonic vibrator 6 is transmitted to the tip chip 9 through the vibration transmission member 8, and the tip chip 9 is ultrasonically vibrated.

During this ultrasonic oscillation, the tissue H to be treated between the receiving member 11 and the tip 9 is kept sandwiched by an appropriate pressing pressure for an appropriate time, whereby the tissue H to be treated is ultrasonically vibrated. Protein denaturation occurs due to, and the work of joining the target tissue H is performed.

Further, at the time of joining the tissue H to be treated, the living tissue joining surface 14 of the tip 9 of the living tissue H is joined.
A part of the joint surface with is joined to the first joint region 14a,
The rest is bonded to the second bonding region 14b. for that reason,
After the joining operation of the treatment target tissue H is completed, for example, in the joining portion K of the living tissue H, for example, the joining portion K _{1 having} a low mechanical strength by the first joining region 14 a in the living tissue joining surface 14 of the tip 9 is used. The two joint regions 14b form joints K ₂ having high mechanical strength.

Therefore, in the above-mentioned structure, the joining region 14 of two shapes having different joining effects on both sides of the biological tissue joining surface 14 of the tip of the tip tip 9 with the center line as a boundary.
Since a and 14b are provided, the mechanical strength is weak at the joint portion K of the living tissue H, for example, due to the first joint region 14a in the living tissue joint surface 14 of the tip 9 after the clip treatment of the blood vessel / bile duct. Joint K ₁ , second joint region 14
b can form the joints K ₂ having high mechanical strength.

At this time, since the biological tissue H is relatively damaged at the joint portion K _{2 having} a high joint strength, there is a low possibility that the biological tissue H will be joined by regeneration, but the joint portion K having a weak joint strength.
_{In the case of 1} , the binding due to the regeneration of the biological tissue H can be expected. Therefore, the strong joint K _{2 functions} to maintain the mechanical bond between the living tissues H and to assist the regeneration and bonding of the living tissue H at the weak joint K ₁ . Even when the operator mistakenly raises the ultrasonic output or the holding force of the holding portion 13 to a value higher than an appropriate value when performing a clip treatment on the vascular tissue, the joint portion K ₁ having a weak joining strength is properly used. The living tissue H can be joined.

Further, FIGS. 3A to 3C show the second embodiment of the present invention.
FIG. As shown in FIG. 3 (A), this is because a plurality of cylindrical protrusions 22 ... As shown in FIG. The first joint region 21a arranged in a dense state, and the second joint region 21 in which a plurality of columnar protrusions 22 ... Are arranged in a high density state on the other side as shown in FIG. 3 (C).
b are provided respectively. In this case, each cylindrical protrusion 22 of the first joint region 21a and each cylindrical protrusion 22 of the second joint region 21b are formed in the same shape.

Therefore, in the above-mentioned structure, the joining region 21 of two shapes having different joining effects on both sides of the living tissue joining surface 21 of the tip of the tip tip 9 with the center line as a boundary.
a and 21b are provided, and after the clip treatment of blood vessels, bile ducts, etc., the joint portion K of the living tissue H has, for example, a joint portion having a weak mechanical strength due to the first joint region 21a in the joint portion 21 of the body tissue of the distal tip 9. Since the joint portion K ₂ having high mechanical strength can be formed by K ₁ and the second joint region 21b, the same effect as in the first embodiment can be obtained in this case as well.

Further, FIGS. 4A to 4C show the third embodiment of the present invention.
FIG. As shown in FIG. 4 (A), this is a plurality of cylindrical projections 32 with a small diameter as shown in FIG. The first joining region 31 with the protrusion
a, the first bonding area 3 on the other side as shown in FIG.
A plurality of cylindrical protrusions 33 having a diameter larger than that of each cylindrical protrusion 32 of 1a.
The second joining regions 31b are provided so as to project. In this case, the same number of the cylindrical protrusions 32 of the first joint area 31a and the respective cylindrical protrusions 33 of the second joint area 31b are arranged.

Therefore, in the above-mentioned structure, the joining region 31 of two shapes having different joining effects on both sides of the living tissue joining surface 31 of the tip of the tip tip 9 with the center line as a boundary.
a and 31b are provided, and after the clip treatment of the blood vessel, bile duct, etc., the joint portion K of the living tissue H has, for example, a joint portion having a weak mechanical strength due to the first joint region 31a in the joint surface 31 of the living tissue of the distal tip 9. Since the joint portion K ₂ having high mechanical strength can be formed by K ₁ and the second joint region 31b, the same effect as that of the first embodiment can be obtained in this case as well.

Further, FIGS. 5A and 5B show the fourth embodiment of the present invention.
FIG. This is because the body tissue joint surface 41 at the tip of the tip 9 is connected to the three joint regions 41a, 41a.
It is divided into b and 41c. In this case, the first joint region 41a near the center line on the living tissue joint surface 41
Is provided with a large number of substantially triangular pyramid-shaped projections 42.
Further, a plurality of columnar projections 43 ... Are provided in the respective second and third joining regions 41b and 41c on both sides of the first joining region 41a. In this case, the cylindrical protrusions 43 of the second joint region 41b and the cylindrical protrusions 43 of the third joint region 41c are formed in the same shape and arranged in the same number.

Then, as shown in FIG. 5 (B), in the joint portion J of the living tissue H, for example, the joint portion J _{1 having} a high mechanical strength, the second joint portion J, and the second joint portion 41a are formed by the first joint region 41a. 41b and 41c provide a joint J _{2 having} a low mechanical strength,
J ₃ is formed respectively.

Therefore, in the above-mentioned structure, the living tissue joining surface 41 at the tip of the tip 9 is connected to the three joining regions 4.
1a, 41b, 41c, and after the clip treatment of blood vessels, bile ducts, etc., the joint J of the biological tissue H is, for example, the joint J ₁ , the second, the third with high mechanical strength by the first joint region 41a. Since the joints J ₂ and J ₃ having low mechanical strength are formed by the respective joint regions 41b and 41c, the damage to the living tissue H is caused at the joint J ₁ at the center of the joint J of the living tissue H. Is large, and the living tissue H after treatment is large.
Of the joints J ₂ and J _{3 on} both sides
Has weak bonding strength, but little damage,
Regenerate and join and ligation of the tube is achieved. for that reason,
Also in this case, the same effect as that of the first embodiment can be obtained.

A first joint region 41a forming a joint portion J ₁ having high mechanical strength at the center of the biological tissue joint surface 41 at the tip of the tip 9 and joint portions J _{2 having} weak mechanical strength on both sides thereof are formed. , J ₃ forming the second and third joining regions 41b and 41c, the escape of the living tissue H from the joining surface 41 of the living tissue when ultrasonic vibration is applied can be suppressed.

FIG. 6 shows a modification of the fourth embodiment. This is one in which a plurality of corrugated protrusions 44 ... Are projectingly provided in each of the second and third bonding regions 41b, 41c of the biological tissue bonding surface 41 at the tip of the tip 9. in this case,
The corrugated protrusions 44 of the second joint region 41b and the cylindrical protrusions 43 of the second joint region 41c are formed in the same shape and arranged in the same number. Also in this case, the same effect as that of the first embodiment can be obtained.

Further, FIG. 7A shows a fifth embodiment of the present invention. In this structure, a corrugated protrusion 45 is provided on the tip of the tip 9, and a biological tissue joining surface 46 is provided on the tip surface of the corrugated protrusion 45.

Therefore, in the above-mentioned structure, since the area of the biological tissue joining surface 46 at the tip of the distal tip 9 is small, the contact area with the biological tissue H at the time of the treatment can be made small. Even if the output and the pressing force against the living tissue H are the same, stronger joining can be locally performed. In addition, since it is corrugated, the joint portion can be made longer than that which is simply thin.

As in the modified example shown in FIG. 7B, the biological tissue joint surface 46 of the corrugated protrusion 45 may be formed by the triangular pyramidal protrusion 47 having a high joint strength. The same effect as the embodiment can be obtained.

Further, FIGS. 8A to 8C show the tip 9
FIG. 6 shows different modified examples of the above. Figure 8
(A) is a columnar distal end tip body 51 with a plurality of triangular pyramid-shaped protrusions 55 projectingly provided on the distal end surface thereof to form a first biological tissue joining surface 51a, and the outer periphery of the distal end portion of the distal tip body 51. The second living tissue joining surface 51b is formed by projecting a plurality of triangular pyramidal protrusions 52 on the surface.

Therefore, in the above-mentioned structure, the living tissue H can be clipped by the first living tissue joining surface 51a of the tip body 51, and the living body tissue 51b can be clipped by the second living tissue joining surface 51b. Since the tissue H can be removed, the biological tissue H can be easily clipped and separated with the same tip 9.

Further, FIG. 8B shows a tip chip body 61.
A spatula-shaped protruding portion 62 is provided at the tip of the
Is provided with a plurality of triangular pyramid-shaped projections 63 on its side surface. Further, FIG. 8C is a spatula-shaped protruding portion 62 of FIG.
A plurality of triangular pyramid-shaped projections 64 are provided on the tip end surface, and a plurality of triangular pyramid-shaped projections 65 are provided on both side ends of the spatula-shaped protruding portion 62.

FIG. 9 shows a modification of the ultrasonic treatment device. This is because the lattice-shaped grooves 71 are provided on the living tissue joining surface at the tip of the tip 9, and the receiving member 1 is provided.
The engaging member 72 is fixed to the inner surface of the receiving portion 11a of No. 1, and the engaging member 72 is formed with a lattice-shaped projection 73 that engages with the lattice-like groove 71 of the tip 9.

Therefore, in the above-described structure, the grid-like grooves 71 of the tip chip 9 and the grid-like projections 73 of the meshing member 72 of the receiving member 11 mesh with each other.
The living tissue H sandwiched during the ultrasonic treatment does not slip and escape from the holding portion 13, and a reliable treatment can be performed.

FIG. 10 shows another modification of the ultrasonic treatment apparatus. This is because the ultrasonic oscillation is turned on at the rear end side of the operation unit 3 on the hand side of the ultrasonic treatment apparatus.
A / OFF switch 81 is provided so that the operator can operate it with his / her thumb.

Therefore, in the above-mentioned structure, the ON / OFF switch 8 of the operation section 3 on the near side of the ultrasonic treatment apparatus is used.
When the surgeon operates 1 with his thumb, the ultrasonic oscillation O
Since the N / OFF operation can be performed, the operator can perform the operation more easily than when operating the foot switch during the ON / OFF operation of the ultrasonic oscillation, and there is no risk of misstepping with other foot switches.

The present invention is not limited to the above embodiment. For example, the living tissue H to be treated can be applied not only to a clip of a tubular tissue but also to joining of tissue ends. Furthermore, it goes without saying that various modifications can be made without departing from the scope of the present invention.

[0047]

According to the present invention, since a plurality of bonding regions having different bonding effects are provided on the biological tissue bonding surface of the holding means arranged at the tip of the vibration transmitting member, immediately after the treatment by the application of ultrasonic vibration. The joint strength of the living body tissue to be treated can be maintained in an appropriate state, and the living body tissue to be treated can be reliably joined.

[Brief description of drawings]

FIG. 1 shows a first embodiment of the present invention (A)
Is a schematic configuration diagram of the entire ultrasonic treatment apparatus, (B) is a plan view showing a living tissue joining surface of the distal tip, (C) is a side view showing a first joining region of the living tissue joining surface, and (D) is The side view which shows the 2nd joint area | region of a biological tissue joint surface.

FIG. 2A is a perspective view showing a usage state of the ultrasonic treatment apparatus, and FIG. 2B is a schematic configuration diagram showing a joint state of treatment target tissues.

FIG. 3 shows a second embodiment of the present invention (A)
Is a plan view showing a living tissue joining surface of the tip, (B) is a side view showing a first joining region of the living tissue joining surface, (C)
[Fig. 4] is a side view showing a second joint region of a joint surface of living tissue.

FIG. 4 shows a third embodiment of the present invention, (A)
Is a plan view showing a living tissue joining surface of the tip, (B) is a side view showing a first joining region of the living tissue joining surface, (C)
[Fig. 4] is a side view showing a second joint region of a joint surface of living tissue.

FIG. 5 shows a fourth embodiment of the present invention (A)
Is a plan view showing a living tissue joining surface of the distal end tip, and (B) is a schematic configuration diagram showing a joined state of treatment target tissues.

FIG. 6 is a plan view showing a modification of the fourth embodiment.

FIG. 7 (A) is a plan view showing a biological tissue joining surface of a distal tip according to a fifth embodiment of the present invention, and FIG. 7 (B) is a plan view showing a modification of (A) of the distal tip.

FIG. 8 is a perspective view showing different modified examples of the tip.

FIG. 9 is a side view of a main part showing a modified example of the ultrasonic treatment device.

FIG. 10 is a side view showing still another modified example of the ultrasonic treatment apparatus.

11A and 11B are views for explaining a conventional example, where FIG. 11A is a side view of a tip, FIG. 11B is a plan view showing a living tissue joining surface of the tip, and FIG. 11C is a tip different from FIG. The side view of a chip | tip, (D) The top view which shows the biological tissue joining surface of a front-end | tip tip.

[Explanation of symbols]

2 ... insertion part, 6 ... ultrasonic transducer, 8 ... vibration transmission member, 1
3 ... Holding part (holding means), 14, 21, 31, 41 ... Living tissue joint surface, 14a, 21a, 31a, 41a ... 1st
Bonding regions, 14b, 21b, 31b, 41b ... Second bonding region, 41c ... Third bonding region.

Claims (1)

[Claims] 1. A holding means for holding a living tissue is provided at a distal end portion of an insertion portion to be inserted into a body, and ultrasonic vibration from an ultrasonic vibrator for generating ultrasonic vibration is transmitted through a vibration transmitting member. In the ultrasonic treatment device, which is transmitted to the holding means and is joined to the living tissue held in the holding means,
An ultrasonic treatment device comprising a plurality of bonding regions having different bonding effects, which are provided on a living tissue bonding surface of the holding means arranged at the tip of the vibration transmitting member.