JPH0723971A - Ultrasonic treatment apparatus - Google Patents

Abstract

PURPOSE:To ensure and facilitate ligation or anastomosis of living tissue and hemostasis at a junction by passing a high-frequency current through the living tissue being nipped by a nip means. CONSTITUTION:During ultrasonic vibration by an utrasonic vibrator 6, living tissues for treatment are nipped by a support member 11 and an end tip 9 which constitute a nipping portion 14, and are held in that state for an appropriate period of time, so that the living tissues have their mating faces emulsified by the ultrasonic vibration, undergo protein denaturation with the heat generated by the ultrasonic vibration, and are coapted. Since this heat is derived from the ultrasonic vibration, the protein denaturation proceeds deep into the tissues and ligation or anastomosis of the living tissues is completed. Should bleeding occur during coaptation of the living tissues, the bleeding part is sandwiched between the end tip 9 and the support portion 11a of the support member 11 and compressed as a high-frequency current is passed therethrough, thus achieving hemostasis. Thus the living tissues are coapted firmly enough to achieve ligation or anastomosis, and hemostasis at the junction of the tissues is facilitated.

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 to perform anastomosis of blood vessels without using clips or staples. ing.

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, when the tissue to be treated has a relatively thick blood vessel or the like during the joining operation of the living tissue using ultrasonic vibration, the living tissue is Bleeding may occur at the interface between the joint and the non-joint part of the.

In this case, the bleeding site can be stopped by the joining work of the living tissues using ultrasonic vibration.
Since the thermal denaturation of the living tissue that occurs during the joining work of the living tissue using ultrasonic vibration is relatively small, depending on the type of the bleeding site, the joining work of the living tissue using ultrasonic vibration does not provide sufficient hemostasis at the bleeding site. It may be Therefore, in such a case, it is necessary to perform hemostasis work on the bleeding site using a dedicated hemostatic device different from the tissue joining device using ultrasonic vibration, which is a troublesome task. There is.

The present invention has been made in view of the above circumstances, and an object thereof is to enable ligation and anastomosis by reliably and sufficiently joining living tissues and to easily perform hemostasis treatment at the joining site. An object of the present invention is to provide an ultrasonic treatment device that can perform the treatment.

[0009]

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 a living tissue which is transmitted to the holding means via a vibration transmission member and held by the holding means is joined, a high frequency power supply for supplying a high frequency current is provided, and a high frequency current from the high frequency power supply is provided. Is provided to the holding means to supply a high frequency current to the living tissue held by the holding means.

[0010]

[Function] During joining work, when the bleeding site of the living tissue held by the holding means is to be stopped, a high-frequency current is supplied from the high-frequency current supply means to the holding means and a high-frequency current is supplied. By heating the bleeding site of the living tissue, the bleeding site is stopped.

[0011]

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. An insulating sheath 12 made of an insulating material is attached to the inner peripheral surface of the sheath 10, and the insulating sheath 12 electrically insulates the vibration transmitting member 8 from the sheath 10.

Further, a case 7 is provided at the proximal end of the sheath 10.
On the other hand, a slide member 13 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 13 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 portion (holding means) 14 is formed.

The ultrasonic treatment apparatus main body 1 is connected to an external control unit 15. This control unit 15
The ultrasonic transducer drive circuit 16 and the high frequency power source 17 are built in the.

Here, the ultrasonic transducer drive circuit 16 is connected to the ultrasonic transducer 6. Further, a drive signal generation circuit (not shown) is connected to the ultrasonic transducer drive circuit 16, and an operation switch (not shown) is connected to the drive signal generation circuit. Then, the drive signal generation circuit is driven in accordance with the operation of the operation switch, and the drive signal output from the drive signal generation circuit is amplified by the ultrasonic transducer drive circuit 16, and by this amplified drive signal, The ultrasonic oscillator 6 is driven.

Further, the vibration transmitting member 8 of the ultrasonic treatment apparatus main body 1 is connected to one terminal of the high frequency power source 17 via a lead wire, and the sheath 10 is lead to the other terminal of the high frequency power source 17. Connected via wires.

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 procedure such as joining tissues together, the holding section 13 at the tip of the insertion section 2 is brought close to the tissue to be treated. 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 13 is slid to the grip portion 4 side of the case 7. Thereby, the receiving member 1
Since the first receiving portion 11a is pulled toward the working surface side of the distal tip 9, the tissue to be treated is sandwiched between the distal tip 9 and the receiving portion 11a of the receiving member 11 with the operation of the receiving portion 11a.

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, when bleeding occurs when the living tissues are joined, the bleeding portion is sandwiched between the tip 9 and the receiving portion 11a of the receiving member 11, and an appropriate high-frequency current is applied while pressing to perform hemostatic treatment. To do. At this time, the tip 9
The tissue may be pressed between the receiving part 11a of the receiving member 11 and coagulation / protein denaturation by high frequency current, and emulsification / protein denaturation by ultrasonic vibration may be combined for hemostasis.

The operating surface of the tip 9 has a shape such that the living tissue is sandwiched between the tip 9 and the receiving portion 11a of the receiving member 11, and when ultrasonic vibration is applied, the tissue sandwiched by ultrasonic vibration is Since it has an arbitrary shape that does not deviate from the working surface of the distal tip 9 or an arbitrary shape that sufficiently causes protein denaturation even in the deep part of the living tissue, the distal tip 9 and the receiving portion 11a of the receiving member 11 are formed. The tissue in the region sandwiched between and does not slip out from the working surface of the tip 9, and protein denaturation occurs sufficiently to the deep portion, and reliable and sufficient joining is performed.

After the joining of the living tissues is completed, the slide member 13 is slid in a direction away from the case 7 so that the living tissue after the treatment is separated between 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 structure, the living body held between the tip portion 9 and the receiving portion 11a of the receiving member 11 of the holding portion 14 during the joining operation of the living tissues using the ultrasonic vibration. When stopping bleeding of a bleeding site in a tissue, the bleeding site is sandwiched between the tip 9 and the receiving portion 11a of the receiving member 11, and an appropriate high-frequency current is applied while applying pressure to heat the bleeding site. Since hemostasis is carried out, hemostasis can be easily performed at the joint site. Therefore, it is not necessary to perform a hemostasis work on the bleeding site by using a dedicated hemostasis device different from the ultrasonic treatment apparatus main body 1 as in the conventional case, so that the work efficiency of the hemostasis work can be improved.

Further, since living tissues can be joined and ligated or anastomosed 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 is completed in the form of adhesion between tissues at the same time as the completion of the joining process of the biological tissues, the change over time until the completion of the adhesion of the biological tissues is the same as with conventional clip devices and anastomotic devices. Ligation failure due to
It does not cause anastomotic failure.

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

3 and 4 show a second embodiment of the present invention. This is provided with a pressure or stress detecting means 21, such as a strain gauge, on the outer surface side of the receiving portion 11a of the receiving member 11 which the tip 9 faces.

The pressure / stress detecting means 21 is, for example,
One end of a bias / output cable 22 formed of a flexible substrate or the like is connected. The bias / output cable 22 is arranged along the axial direction of the sheath 10 and fixed to the outer peripheral surface of the sheath 10. Further, the other end of the cable 22 is connected to, for example, the external control unit 15
It is connected to a pressure / stress detection circuit (not shown).

Further, the high frequency power supply 17, the ultrasonic transducer drive circuit 16, the pressure / stress detection circuit and the drive time control circuit (not shown) (of ultrasonic wave and high frequency) are not shown in the CP.
It is configured to be connected to a control unit such as U and controlled by this control unit.

Therefore, even in the case of the above structure, the living tissue is joined by ultrasonic vibration as in the previous embodiment, and the tip portion 9 of the tip tip 9 and the receiving member 11 is joined.
A hemorrhage is sandwiched between 1a and, while being compressed, each treatment such as hemostasis by ultrasonic vibration or high frequency current alone, or hemostasis by combining ultrasonic vibration and high frequency current is performed. Be done.

In this case, the pressure / stress detecting means 21 measures the compressive force applied to the sandwiched living tissue during each treatment. Furthermore, the time for applying ultrasonic vibration or high frequency current is set to an appropriate state by the drive time control circuit, and each treatment such as joining and hemostasis is performed.

At this time, the safety of the treatment, for example, conditions such as no perforation, no excessive protein denaturation, etc. are influenced by the action parameters relating to joining and hemostasis of living tissues. Note that FIG. 4 shows a safety treatment region R at the time of joining biological tissues and performing hemostasis. Here, P _max is the upper limit value of the compression pressure P of the living tissue, and Hi _max is the high frequency current H.
The upper limit value of i, Ua _max, is the upper limit value of the ultrasonic amplitude Ua.

Then, the control section determines whether or not each parameter is included in the safety treatment area R of FIG. 4, and if any of the parameters exceeds the upper limit value, the operator is informed of a warning. . Further, since the high-frequency current Hi, the ultrasonic amplitude Ua, the application time of the compression pressure P of the living tissue and the degree of the joining / hemostatic action are proportional, the above-mentioned safety treatment region R is converted by the control unit for each drive time. Is used.

Therefore, in the case of combining various energies and changing the application time thereof to perform the joining / hemostatic treatment of living tissues, even if the magnitude of each energy and the application time thereof are independently set, it is a safety measure. There is an effect that the optimum treatment can be performed safely and reliably in the region R.

FIG. 5 (A) shows the essential structure of the ultrasonic treatment apparatus according to the third embodiment of the present invention. This is the buffer member 31 formed of, for example, a conductive elastic body or a conductive viscoelastic body on the inner surface of the receiving portion 11a of the receiving member 11.
Is provided.

Therefore, in the above structure, when ultrasonic vibration is applied to the living tissue sandwiched between the cushioning member 31 and the tip 9, the cushioning member 31 acts to mechanically act on the living tissue. It is possible to prevent the generation of specific stress (for example, cutting force). Therefore, when performing joining by ultrasonic vibration, it is possible to prevent the living tissue from being cut by the edge or the like of the tip 9, and the joining procedure can be performed safely.

FIG. 5 (B) shows a first modification of the third embodiment. This is one in which a convex curved surface 42 having a gentle spherical curvature is formed on the inner surface of the receiving portion 11a of the receiving member 11 that acts as a contact surface with the biological tissue in the cushioning member 41.

Therefore, in the above-described structure, when the living tissue is held between the tip 9 and the receiving portion 11a of the receiving member 11, the apex of the convex curved surface 42 of the cushioning member 41 and the tip 9 of the buffer member 41 are held. Since the largest pressing force can be applied between the central part and the central part, it is possible to prevent the large pressing force from acting on the joint part between the edge part of the tip tip 9 and the living tissue, and the living tissue is the tip. It is possible to prevent the cutting by the contact with the edge portion of the chip 9.

FIG. 5C shows a second modification of the third embodiment. This is because the taper surface 51a is formed on the outer surface of the cushioning member 51 on the inner surface of the receiving portion 11a of the receiving member 11.
And a tapered surface 9a having a shape corresponding to the tapered surface 51a of the buffer member 51 is formed on the distal end surface of the distal tip 9.

Therefore, in the above-mentioned structure, when the biological tissue is held between the tip 9 and the receiving portion 11a of the receiving member 11, the taper surface 51a of the buffer member 51 and the taper surface of the tip 9 are held. It is possible to prevent the tissue (for example, tubular tissue) sandwiched between 9a and 9a from slipping out due to ultrasonic vibration. Therefore, even the living tissue having a smooth surface, the tip portion 9 and the receiving portion 11a of the receiving member 11
It can be stably sandwiched between and fixed and joined by ultrasonic vibration.

Further, FIG. 5D shows a third modification of the third embodiment. This is one in which a protrusion 52 for preventing slipping out is provided at the outer end of the tapered surface 51a of the cushioning member 51 of the second modification.

Therefore, in the above-mentioned structure, the taper surface 51a of the buffer member 51 and the taper surface of the tip end 9 when the living tissue is held between the tip end 9 and the receiving portion 11a of the receiving member 11. The tissue (for example, tubular tissue) sandwiched between 9a and 9a can be prevented from slipping out by ultrasonic vibration, and the protrusions 52 for retaining the cushioning member 51 further prevent the biological tissue from retaining. Can be increased.

FIG. 6 shows a schematic construction of the whole ultrasonic treatment apparatus according to the fourth embodiment of the present invention. this is,
An external electrode P is provided outside the ultrasonic treatment apparatus main body 1 and a first energization state in which a high frequency current is passed between the tip 9 and the external electrode P, and a receiving portion 11a of the high frequency current receiving member 11 and the outside are provided. A changeover switch 64 for changing over to the second energized state in which the current is passed between the electrode P and the electrode P is provided.

In this case, the output of the high frequency power supply 17 is connected to the primary side of the insulating transformer 62 via the amplifier 61. Further, one terminal on the secondary side of the insulation transformer 62 is connected to the external electrode P via the first coupling capacitor 63a.
It is connected to the. Further, the other terminal on the secondary side of the insulating transformer 62 is connected to the common contact 64a of the changeover switch 64 via the second coupling capacitor 63b.

The vibration transmitting member 8 is connected to one of the first switching contacts 64b of the changeover switch 64 via a lead wire 65, and the other second switching contact 64c is connected to the sheath via a lead wire 66. 10 are connected.

Therefore, in the case of the above structure, when the hemostatic treatment is performed with the high frequency current, the high frequency current is passed between the tip 9 and the external electrode P by switching the changeover switch 64. Can be switched to the second energized state in which the high-frequency current is passed between the receiving portion 11a of the receiving member 11 and the external electrode P. Therefore, an appropriate energized state can be selected to effectively perform the hemostatic treatment. Can be done.

FIG. 7 shows a schematic configuration of the whole ultrasonic treatment apparatus according to the fifth embodiment of the present invention. Here, the changeover switch 6 is connected to one terminal on the secondary side of the isolation transformer 62 via the first coupling capacitor 63a.
The four common contacts 64a are connected. The sheath 10 is connected to one of the first switching contacts 64 b of the changeover switch 64 via a lead wire 71. Further, the external electrode P is connected to the other second switching contact 64c of the changeover switch 64 via a lead wire 72. Further, the vibration transmitting member 8 is connected to the other terminal on the secondary side of the insulating transformer 62 via a second coupling capacitor 63b and a lead wire 73.

Therefore, in the case of the above-described structure, when the hemostatic treatment is performed with the high frequency current, the changeover switch 64 is changed over, whereby the monopolar / bipolar of the high frequency current can be selectively changed over. Furthermore, an appropriate high frequency hemostatic treatment can be performed. 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.

[0050]

According to the present invention, a high-frequency power source for supplying a high-frequency current is provided, and the high-frequency current from the high-frequency power source is supplied to the holding means to supply the high-frequency current to the living tissue held by the holding means. Since the current-carrying means is provided, the living tissues can be reliably and sufficiently joined to perform ligation or anastomosis, and hemostasis treatment at the joining site can be easily performed.

[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 a distal end portion of an insertion portion.

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

FIG. 4 is a characteristic diagram showing a safety treatment region at the time of joining biological tissues and performing hemostasis.

5A is a vertical cross-sectional view showing the main configuration of an ultrasonic treatment apparatus according to a third embodiment of the present invention, and FIG. 5B is a vertical cross-sectional view showing a first modification of the third embodiment. FIG. 6C is a vertical sectional view showing a second modification of the third embodiment, and FIG. 9D is a vertical sectional view showing a third modification of the third embodiment.

FIG. 6 is a schematic configuration diagram of an entire ultrasonic treatment apparatus according to a fourth embodiment of the present invention.

FIG. 7 is a schematic configuration diagram of an entire ultrasonic treatment apparatus according to a fifth embodiment of the present invention.

[Explanation of symbols]

2 ... insertion part, 6 ... ultrasonic transducer, 8 ... vibration transmission member, 1
4 ... Holding part (holding means), 17 ... High frequency power supply.

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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,
A high-frequency power supply for supplying a high-frequency current is provided, and a high-frequency current supply means for supplying a high-frequency current from the high-frequency power supply to the holding means to supply the high-frequency current to the biological tissue held by the holding means is provided. A characteristic ultrasonic treatment device.