JPH0723970A - Ultrasonic treatment apparatus - Google Patents

Abstract

PURPOSE:To coapt living tissues firmly enough in a treatment such as ligation or anastomosis to complete adhesion immediately after the treatment by using an adhesive application means to supply a biocompatible adhesive to a portion near a nip means, and applying the biocompatible adhesive to the living tissues being nipped by the nip means. CONSTITUTION:A nipping portion 13 at the end of an insertion portion 2 is brought close to tissues for treatment, and the tissues for treatment are located between the end tip 9 and the support portion 11 a of a support member 11. Under these conditions, a biocompatible adhesive is supplied into a small- diameter tube 14 and dropped from an opening 16 at the end of the tube 14 onto the tissues for treatment which are located between the end tip 9 and the support portion 11a of the support member 11. Next, a trigger portion 5 is controlled to sandwich the tissues for treatment between the end tip 9 and the support portion 11a of the support member 11. Then an ultrasonic vibrator 6 is driven to cause ultrasonic vibration of the end tip 9. During the ultrasonic vibration, the living tissues have their mating faces emulsified, undergo protein denaturation with heat generated by the vibration, and are coapted.

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 that clips or staples made of metal or synthetic resin remain in the living body. Therefore, US Pat. No. 38
As shown in Japanese Patent No. 98992, a tissue joining apparatus has been developed which is configured to perform hemostasis and anastomoses of blood vessels by joining living tissues by utilizing ultrasonic vibration without using clips or staples.

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. The holding means is constituted by a tip chip provided at the tip of a vibration transmitting member for transmitting ultrasonic vibrations from an ultrasonic vibrator that generates ultrasonic vibrations, and a receiving member that is arranged so as to be spaced apart and opposed to the tip chip. Has been formed.

Then, at the time of joining the living tissue, the living tissue to be treated is sandwiched between the tip of the holding means and the receiving member, and ultrasonic vibration is applied while applying pressure to the treated tissue 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, during the joining work of the living tissues using the ultrasonic vibration, the transformation due to the ultrasonic waves is too strong depending on the kind of the living tissues to be joined and the joining cannot be performed. On the other hand, there is something that cannot be joined because the transformation by ultrasonic waves is too weak. Therefore, depending on the type of the living tissue, there are tissues that are difficult to perform such as ligation and anastomosis, so that there is a problem that the living tissues cannot be reliably and sufficiently joined to perform the treatment such as ligation and anastomosis.

The present invention has been made in view of the above circumstances, and its purpose is to reliably and sufficiently join living tissues to perform ligation, anastomosis and the like, and to complete adhesion immediately after the treatment. An object of the present invention is to provide an ultrasonic treatment device that can be used.

[0008]

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 an ultrasonic treatment device in which biological tissue transmitted to the holding means via a vibration transmitting member and joined to the holding means is joined, a biocompatible adhesive is supplied to a portion in the vicinity of the holding means, An adhesive attaching means for attaching a biocompatible adhesive to the living tissue held by the holding means is provided.

[0009]

[Function] When joining biological tissues, the biocompatible adhesive is supplied to the region near the holding means by the adhesive attaching means,
By attaching the biocompatible adhesive to the living tissue held by the holding means, the ultrasonic wave vibration rapidly accelerates the curing of the biocompatible adhesive and strengthens the joining / anastomosis of the living tissue. It is the one.

[0010]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS A first embodiment of the present invention will be described below with reference to FIGS. FIG. 1 shows a schematic configuration of the whole ultrasonic treatment apparatus. In FIG. 1, reference numeral 1 is a main body of the ultrasonic treatment apparatus. 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. The vibration transmitting member 8 is set to a length such that the amplitude of ultrasonic vibration becomes maximum (antinode of vibration) on the working surface at the tip of the tip 9.

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 the distal end portion of the receiving member 11 in parallel with the working surface of the distal end of the distal end tip 9 so as to be opposed to and spaced from it.

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.

Further, the slide member 12 and the sheath 10
As shown in Fig. 2, a small-diameter tube (adhesive attachment means)
14 are provided. One end of the small diameter tube 14 is connected to an injection port 15 protruding from the slide member 12,
The tip end opening 16 on the other end side is arranged so as to face the gap between the acting surface of the tip 9 and the receiving portion 11a of the receiving member 11. The injection port 15 is connected to a biocompatible adhesive supply means such as a syringe filled with the biocompatible adhesive through a connecting tube (not shown).

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 according to the operation of the operation switch, the drive signal output from the drive signal generation circuit 18 is amplified by the ultrasonic transducer drive circuit 17, and the amplified drive signal causes The ultrasonic oscillator 6 is driven.

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 a treatment such as joining tissues together, the grasping portion 13 at the tip of the insertion portion 2 is brought close to the treatment target tissue, and the treatment target tissue is positioned between the tip chip 9 and the receiving portion 11a of the receiving member 11. .

In this state, for example, a biocompatible adhesive such as fibrin glue mainly containing fibrinogen is attached to the thin tube 14 from a biocompatible adhesive supply means (not shown) connected to the injection port 15. It is supplied, and the tip end 9 of the small-diameter tube 14 and the receiving portion 11 of the receiving member 11
A biocompatible adhesive is dropped on the tissue to be treated between a and a.

Next, 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 pulled toward the working surface side of the distal tip 9, so that the tissue to be treated is moved between the distal tip 9 and the receiving portion 11a of the receiving member 11 with the operation of the receiving portion 11a. It gets caught.

Then, the ultrasonic transducer 6 is driven. When the ultrasonic transducer 6 is driven, the signal from the drive signal generation circuit is amplified by the ultrasonic transducer drive circuit 16, 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 through the vibration transmitting member 8 to the tip chip. 9, and the tip 9 is ultrasonically vibrated.

During the ultrasonic wave oscillation, the tissue to be treated between the receiving member 11 and the tip 9 is held with an appropriate pressing pressure for a proper time, whereby the biological tissue is ultrasonically vibrated to form a joint surface. Are emulsified, and the protein is denatured by heat generated by ultrasonic vibration and bonded. The heat that causes this tissue degeneration is caused by ultrasonic vibration, so protein denaturation occurs even deep inside the tissue, and the joining and joining of biological tissues
The anastomosis is completed.

Further, at the same time as the joining / anastomosis work of the living tissues, the curing of the biocompatible adhesive dropped on the joining site of the living tissues is rapidly accelerated by the ultrasonic vibration, and the living tissues are joined more firmly. Anastomosed.

When the ultrasonic vibration is applied while the shape of the working surface, which is the joint surface of the tip of the tip 9 with the living tissue, is sandwiched between the receiving portion 11a of the receiving member 11 of the living tissue. The tip 1 and the receiving portion 1 of the receiving member 11
1a has an arbitrary shape that prevents the living tissue sandwiched between 1a and 1a from deviating from the working surface of the tip 9 due to ultrasonic vibration, or an arbitrary shape that sufficiently causes protein denaturation in the deep portion of the living tissue. By setting, the biological tissue sandwiched between the distal tip 9 and the receiving portion 11a of the receiving member 11 is sufficiently denatured to the deep portion without slipping from the working surface of the distal tip 9 due to ultrasonic vibration, and thus the reliable In addition, sufficient bonding can be performed.

After the joining of the living tissues is completed, the slide member 12 is slid in the direction away from the case 7 so that the living tissue after the treatment has the working surface of the tip 9 and the receiving portion 11a of the receiving member 11. By removing it from the space, the joining process of the biological tissues is completed.

Therefore, in the above-mentioned structure, the thin tube 14 is arranged inside the slide member 12 and the case 10 of the ultrasonic treatment apparatus main body 1, and one end of the thin tube 14 is slid. While being connected to the injection port 15 of the member 12, the distal end opening 16 of the small diameter tube 14 is arranged so as to face the gap between the working surface of the distal tip 9 and the receiving portion 11a of the receiving member 11. Since the biocompatible adhesive is provided, a biocompatible adhesive is supplied to a portion near the living tissue between the working surface of the tip 9 and the receiving portion 11a of the receiving member 11 by the thin tube 14 at the time of joining the biological tissues. The biocompatible adhesive can be attached to the living tissue held between the working surface of the chip 9 and the receiving portion 11a of the receiving member 11. Therefore, ultrasonic vibration can accelerate rapid curing of the biocompatible adhesive dropped at the joint site of the biological tissues at the same time when the biological tissues are joined / anastomized by the ultrasonic vibration. The biocompatible adhesive can reinforce the joint / anastomosis part of the biological tissues by ultrasonic vibration, and can easily bond even the biological tissues that were difficult to bond by applying the ultrasonic vibration alone. it can.

Further, by adding a biocompatible adhesive when the living tissues are joined by ultrasonic vibration, the living tissues can be surely denatured in a state in which the living tissues are less transformed than when the living tissues are joined by ultrasonic vibration alone. Can be joined.

Furthermore, since it is possible to immediately confirm whether or not the adhesion between the living tissues after the treatment is complete,
Even if the adhesion is incomplete, the procedure can be repeated until the adhesion is completed immediately.

Further, since the living tissues can be joined and ligation or anastomosis can be performed without using clips or staples made of metal or resin, no foreign matter remains in the body even after the treatment. Furthermore, since the ligation / anastomosis can be completed in the state where the tissues are adhered to each other at the same time as the end of the joining process of the biological tissues, the ligation failure due to the change over time until the completion of the adhesion like a clip device or an anastomosis device, Anastomotic failure can be prevented in advance.

In this embodiment, the thin tube 14 for supplying the biocompatible adhesive to the tip portion of the tip 9 is arranged inside the case 10. The arrangement structure of the conduit for supplying the adhesive to the joining portion can be appropriately changed and is not particularly limited to the above embodiment.

FIG. 3 shows a second embodiment of the present invention. This forms the two lumens 22 and 23 partitioned by the partition wall 21 in the sheath 10 of the first embodiment, and the receiving member 24 is provided at the tip in one of the first lumens 22.
The blade 25 to which is connected is inserted, and the vibration transmitting member 8 is inserted into the second lumen 23.

In this case, the sheath 10 is the operating portion 3 on the hand side.
The slide member 1 is fixed to the case 7 of
2 is attached to the sheath 10 so as to be slidable in the axial direction, and the base end of a blade 25 is connected to the slide member 12.

Therefore, in the above structure, the slide member 12 is slid to the case 7 side,
Through the blade 25, the receiving member 24 can be moved in a direction in which the receiving member 24 comes in contact with and separates from the tip 9 at the tip of the vibration transmitting member 8. Therefore, even when the sheath 10 is fixed to the case 7 side of the operation portion 3, the biological tissue to be joined can be sandwiched between the tip working surface of the tip 9 and the receiving portion 24a of the receiving member 24. In endoscopic surgery in the abdominal cavity, even when the insertion portion 2 of the ultrasonic treatment apparatus main body 1 is inserted into the tracarl and used in the abdominal cavity, the tissue 10 does not move and the living tissue tip tip. It can be sandwiched and joined between the distal end working surface of 9 and the receiving portion 24a of the receiving member 24, and the operability of the operator is significantly improved.

4A and 4B show a modification of the ultrasonic treatment apparatus main body 1. This is one in which the base end portion of the blade 25 of the second embodiment is connected to the trigger portion 26 of the operating portion 3 on the near side through an operating lever 27.

FIGS. 5A and 5B show another modification of the ultrasonic treatment apparatus main body. In this case, the first electric circuit 31 including a constant current circuit and a matching inductance is incorporated in the case 7 in which the ultrasonic transducer 6 is incorporated, and the case 4 is held by the operator. 7 is detachably connected to the inside of the grip 4
By incorporating the second electric circuit 32 including an LL circuit, a switching amplifier, etc., the ultrasonic transducer drive circuit 17 and the drive signal generated outside the ultrasonic treatment apparatus main body 1 of the first embodiment are generated. The circuit 18 and the ultrasonic treatment apparatus main body 1 are integrally incorporated.

Further, the second electric circuit 32 of the grip portion 4
5A, an external power supply unit 33 is connected via a connector 35 at the tip of a connection cable 34, as shown in FIG.

Incidentally, instead of the power supply unit 33, FIG.
As shown in (B), the battery unit 41 may be connected to the second electric circuit 32 of the grip portion 4 via the connector 43 at the tip of the connection cable 42. In this case, a battery charger 44 is connected to the battery unit 41 via a connector 46 at the tip of the connection cable 45.

Therefore, in the above-mentioned structure, the ultrasonic treatment apparatus main body 1 can be easily handled, and
The external housing to which the handpiece of the ultrasonic treatment apparatus main body 1 is connected can be downsized, which makes it extremely easy to use in the operating room. It should be noted that the present invention is not limited to the above-mentioned embodiments, and it is needless to say that various modifications can be made without departing from the gist of the present invention.

[0038]

According to the present invention, the biocompatible adhesive is supplied to the vicinity of the sandwiching means, and the adhesive attaching means for attaching the biocompatible adhesive to the living tissue held in the sandwiching means is provided. Therefore, it is possible to join the living tissues reliably and sufficiently to perform a ligation, anastomosis, or the like, and complete the adhesion immediately after the treatment.

[Brief description of drawings]

FIG. 1 is a schematic configuration diagram of an entire ultrasonic treatment apparatus according to a first embodiment of the present invention.

FIG. 2 is a vertical cross-sectional view showing an arrangement state of a biocompatible adhesive supply pipeline.

FIG. 3 is a perspective view showing a main part of an ultrasonic treatment apparatus according to a second embodiment of the present invention.

FIG. 4 shows a modification of the ultrasonic treatment apparatus main body,
(A) is a side view of the ultrasonic treatment apparatus main body showing a part of the cross section, and (B) is a perspective view showing a joint between a receiving member and a blade.

5A and 5B show another modification of the ultrasonic treatment apparatus main body, in which FIG. 5A is a schematic configuration diagram showing a connecting portion between the ultrasonic treatment apparatus main body and a power supply unit, and FIG. 5B is an ultrasonic treatment apparatus main body. FIG. 3 is a schematic configuration diagram showing a connecting portion between the battery unit and the battery unit.

[Explanation of symbols]

2 ... insertion part, 6 ... ultrasonic transducer, 8 ... vibration transmitting member, 9
a ... Living tissue joining surface, 13 ... Holding part (holding means), 14
... Thin tube (adhesive attachment means).

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,
Supplying a biocompatible adhesive to the vicinity of the holding means,
An ultrasonic treatment device comprising an adhesive attaching means for attaching a biocompatible adhesive to a living tissue held by the holding means.