JPH07507707A - tissue removal - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

[Detailed description of the invention] tissue removal Related applications The present application is filed by Aziz Y, Anis entitled ``Tissue Removal''. Part of U.S. Patent Application No. 071,553.975, filed July 17, 990 Continuation Application, U.S. Patent Application No. 07/680,292, filed April 4, 1991 U.S. Patent Application No. 07/759, filed September 16, 1991, which is a continuation-in-part of This is a continuation-in-part application of No. 937.

Background of the invention The invention relates to the removal of tissue from the body, such as removing cataracts from the lens of the eye. Regarding.

The tissue is cut, crushed, or fluidized within the body and then It is well known to remove diseased tissue from the body by suctioning it. . One well-known surgical technique of the above type specifically intended to remove the crystalline lens In class, (1) along the upper limbus of the cornea from 10 o'clock to 2 o'clock (12 o'clock is also An incision is made by a chord length of approximately IQmm (the position closest to the top of the patient's head), and 2) make an incision in the capsular wall; and (3) remove the cataract. The anterior chamber of the eye is irrigated during surgery. By continuously flowing infusion or irrigating solution, the substantially formed shape is It is maintained in the state.

In one of the above classes of prior art techniques for removing cataracts, the nucleus of the crystalline lens is removed from the eye. The cortex is removed by a process of extrusion, irrigation and aspiration. Excluding cataracts In another conventional technique of the above class for removing the nucleus, the nucleus is Remove and inject approximately 0.1 milliliter of viscoelastic compound or irrigation fluid into the capsular sac. to separate the coating walls. Crab the cortical wedge with the capsular wall separated. Engage the suction port on the Yule and peel it towards its center, then suction to remove it. Remove. This process ensures that the intact capsular sac (except for the horizontal incision) is completely Each layer of the cortex is peeled off and passed through the cannula layer by layer until it is emptied and irrigated. This process is repeated until it is sucked inward.

The above technique for removing cataracts was developed by Azis Y, Ants. 1986 Obthalmology Seminar (Seminars in 0pth) a　I　omology) Volume 1 No. 2 (June), pages 113 to 129, “I IIustrated 5tep-byStep Description o fthe Anis Dry Extra Capsular Catarac tExtraction Technique With In-the-Ba g Lens Implementation”, and this technique The technique is compared with other techniques such as the above classes of techniques.

Conventional technology that assists in cutting and aspiration of the nucleus of the crystalline lens, allowing extraction through a small incision. Two instruments of technology are used outside Bank (Anton Banko et al.). National Patent No. 3,589.363, Steven N. Weiss' rice National Patent No. 3.902.495, Charles Kelmane U.S. Pat. No. 4,041,947 of N., Weiss et al. It is. This device, in the prior art, is used for irrigation/aspiration of the lens or crystalline lens. It is intended to use ultrasonic vibrations to help cut the nucleus of the lens. Up The ultrasonic vibrations cause the tip or tip of the instrument to reciprocate laterally, and then suction is applied. Destroy the cataract as much as possible.

Another type of instrument is published by Azis on March 13, 1990. Disclosed in US Pat. No. 4,908,015. This U.S. patent applies to rigid members describes an instrument for rotating the crystalline lens, and the above-mentioned member is used for polishing the crystalline lens. It has a blade or edge extending from it.

The above tissue removal technology uses (1) a reciprocating ultrasonic vibration tool or a rotating blade; (2) In some situations, large cuts may occur in the membrane wall. (3) some have some disadvantages, such as the need to use different equipment .

Yet another prior art technique for removing cataracts was published on December 14, 1976. No. 3,996.935 to B.A.N.K.O. It is. This type of instrument has cooperating jaw-like members that One of the jaw-like members rotates within the other and its sheared portion Disassemble. The one member suctions the cut piece through the instrument. this tie The drawbacks of these devices are that they can rupture the capsule wall and are relatively complex. have. Some of such drawbacks are due to the fact that one of the above members is not efficient to use. without using the corresponding rotational speed required for the This is due to the fact that it can be rotated mechanically.

Yet another prior art device uses a small rotating magnetic cup that is inserted through the membrane wall. and means for applying a magnetic field to control said cutter in place. .

A small magnetic cutter rotates as it moves from position to position within the capsular bag; Grind or cut the lens to be removed.

The above instruments are relatively complex because (1) a small cutter needs to be remotely controlled; (2) A device for suctioning lens particles ground from the crystalline lens. It has some drawbacks, such as not having any structure.

In yet another prior art device disclosed in U.S. Pat. No. 4,002,169 The retractable small wire runs from 5 rpm to 16. Rotates within the range of OOOrpm be done. There is no teaching of selecting speed to perform surface identification. Instead, the device has a blunt surface to prevent damage to the coating wall. depends on. This device (1) provides a relatively slow cutting speed range and , the blade has a shape that causes cavitation or turbulence. (2) small particles that can be sucked through small holes; (3) suction during the fracture is not possible. Therefore, it has the disadvantage of preventing observation of particles.

Summary of the invention It is therefore an object of the present invention to provide a novel technique for performing tissue removal. be.

Another object of the invention is that during cataract removal surgery, there is no risk of damaging the capsular wall. To provide a novel device for cutting and removing cataracts in low-level conditions. Ru.

Yet another object of the invention is to avoid damage to the capsular wall during, for example, cataract removal surgery. or remove cancerous tissue near veins or arteries In between, connect adjacent arteries or veins so as not to damage the wall of the artery or vein. presents a novel instrument designed to cut tissue without damaging it. It is to provide.

According to the above object as well as another object of the invention, a cutting tool or An incision is made for inserting a surface-sensitive cutting tool. Above surface knowledge Other types of cutting tools have higher mass, rougher surfaces, and more rigid structures. Damage to smooth, potentially low-mass walls adjacent to the It allows cutting and suction without any pressure. The above tools perform discrimination between organizations. This allows cutting of some tissues but preventing cutting of other tissues. The above identification is ( 1) Stiffness of the tissue, (2) Mass of the tissue, (3) Angle of the tissue with respect to the direction of tool movement. , (4) tissue surface roughness, and (5) surface roughness caused by suction and/or irrigation. Tissue to the extent that it affects the tendency of negative pressure to move the tissue towards the discriminative cutting tool. based on one or more of several factors including surface size and shape. I'm there.

The surface identification of the above tools is called phacotomesis, which cuts diseased tissue upon impact. controlled by moving the surface, which further cuts the tissue and cuts the tissue. Cavitation or hollowing forces called phacocoelosis that mix the pieces but is more integrated, more flexible, has less mass, and has a smoother The tissue moves at a slow enough speed to separate without being cut. The organization uses several conventional techniques Rather than being constrained by the opposing shear forces of the tool, as with rotary tools, Tissues with a greater amount of stiffness also do not move sufficiently as a mass.

The surface of the tool consists of (1) a structure with high stiffness and high shear modulus; 2) Tissues that have an angle close to 90° to the cutting edge and are subject to small moving forces. disconnect. Therefore, a surgeon removing a cataract must use a tool table that produces suction and irrigation forces. Leading edge and cavitation controlled by face velocity, tool surface position Adjust the rake angle of the level, especially the speed and shape of the trailing edge moving surface. This adjustment due to its large mass (bulk), elastic modulus, and protrusions in the path of the tool surface. The cortex is cut, but its small mass (volume), small modulus (coefficient), In addition, small protrusions at close to 90° prevent the coating wall from moving and being cut. It is done for the sake of

In a preferred embodiment, the moving cutting plane is at an angle perpendicular to the cataract surface. The angle is obtuse, usually close to a right angle, so that the trailing edge cavitation occurs, and the cavitation exerts a relatively small force on the cataract. Helps cut and mix cataract particles while feeding directly. Preferred embodiment In , the cut surface is moved by ultrasonic waves along a right angle, and at the same time, For example, by rotation, it moves at an angle with respect to the right angle.

In embodiments with a rotating tip that moves the cutting edge, the suction pressure It is more effective in the rolling tip movement surface. The suction pressure cuts the tissue and The capsular wall is low enough to pull on the cut tissue, but is smooth and flexible. This is enough pressure to be released from the moving surface of the tool. Rotating surfaces should be used outside smooth walls. in the cutting zone, creating a counterpressure that opposes the suction pressure in the cutting zone. In one example In this case, the edges extending radially inward pull the tissue into the cutting zone. Mix the tissues together.

For cataract removal surgery, 2 to 7 millimeters, preferably 3 millimeters. A small incision is made in the sclera at the 12 o'clock position along the limbus and Another incision or round hole with similar dimensions is also formed in the anterior wall of the capsule. This device The tool is inserted to rupture the lens material without cutting the capsular wall.

In one embodiment, the surface-discriminating cutting handpiece has one or more rotational A ring or hoop, or a cylinder with a suction port in the curved part of the cylinder. Equipped with a shaft. The rotation is done with sufficient speed and the opening between the cutting edges The surface area of the space is sufficiently small, which allows for relatively smooth and flexible surfaces as well as low inertia. No healthy tissue, such as a capsular wall with , remains in the path of the cutting surface. The reason Due to the large frequency during rotation, the cutting surface pushes against such healthy tissue. While doing so, close the opening leading to the cutting zone, while coarser or mass This is because it makes it possible to cut parts of the lens that are larger and more rigid. .

Factors that can be used for surface-discriminating cutting may vary from eye to eye or fiber to fiber. can be selected according to the surgeon's observation. Such factors are , the velocity of the moving surface relative to the tissue, the holding pressure due to suction vacuum and irrigating fluid, the moving surface position and orientation, rake angle of the cutting edge on the moving surface, and cavitation is the shape of the part of the moving surface most relevant to . These factors depend on the quality of the coating wall. volume and mass of tissue to be cut, stiffness of capsular wall or other healthy smooth tissue; Established by the surgeon as a function of stiffness and smoothness and tissue stiffness and flexibility be done.

The moving surface of the cutting tool hits the cell at a tangential angle and distorts the cell at its leading edge. The trailing edge, on the other hand, directs forces in a direction that damages the capsular wall. This creates cavitation that further breaks down and mixes the tissue.

The above shear forces and cavitation are caused by large, rigid surfaces or rough surfaces. For surfaces, it is sufficient to make cuts, while being more flexible and having a lower mass. For smoother surfaces, the leading edge and cavitation are keep away from rough surfaces, thus preventing cuts. One or more suction ports can be disconnected. It has a tendency to pull the severed material into the tool.

The crystalline lens disconnects when its mass (bulk) is reduced and its connection to the tissues of the eye is released. The tendency away from the cutting edge increases. This is because (1) the cutting edge hits the crystalline lens. Either change the barrel direction frequently enough to neutralize the tendency of the shock to move the crystalline lens in one direction, or Alternatively, (2) two cuts can be made by applying shock to the crystalline lens from both directions simultaneously. Compensation can be achieved by allowing the cutting edges to cancel each other out. By cutting edge to prevent the crystalline lens from moving in the same direction due to repeated tangential shocks. In embodiments that change direction, if such change of direction is not performed, the shock The crystalline lens rotates more. The change in the direction in which the cutting edge hits the crystalline lens is controlled by a reversing switch. This can be done by repeatedly reversing the motor by A reversing switch changes the polarity of the DC power supplied to the DC motor from the power supply, and to change the direction of rotation of the rotary tip. Also, with automatic reversing switch or, for example, ultrasonic or quasi-ultrasonic vibrations on the shaft holding the cutting surface. imparting substantially linear or curved reciprocating motion to the tip by imparting Tilt tangentially to the lens surface, first in one direction and then in the other direction. ・You can make the whelks move.

In a preferred embodiment, the tubular member has a central suction along its longitudinal axis. It has a drawing path, one end of which is provided with a cutting tip, and the other end of which is provided with the above-mentioned tube. It is designed to rotate. The cutting tip has at least one slot The slot has a cut surface of and extend generally parallel over at least a short distance. slot at the end of the tube Bend the part between the bits inward to form a blunt or top drill bit. A displacement portion can be formed. The longitudinal leading edge of the slot has a rake angle. and sharpen said surface to direct inwardly or outwardly. This fluid pressure creates large or small cavitations, thereby causing , allowing surgeons to select the tip according to their needs.

Shapes that increase cavitation to form the desired cavitation A blunt trailing edge is provided. The leading edge contains the lens material as well as the inside of the eye. smaller than the trailing edge with respect to viscous fluids or other fluids through which the leading edge passes. Provides strong resistance. The trailing edge is adapted to increase cavitation; The leading edge, on the other hand, compresses, deforms, and cuts the tissue to be removed. One example odor with the blunt end facing slightly outward from the tube's rotation circle and facing toward the tube's shell. Maximum cavitation forms on the outside rather than on the inside. The leading edge is also sharp. can be angled so that adjacent walls extend outward and inward. It creates a flow that holds the tissue and works with negative suction to pull the tissue inward.

The diameter of the tube and the number of slots are selected to reduce cavitation and cutting. Selected to result in sharpening. The width of the slot is determined by the cutting surface in front of the leading edge. is sufficient to prevent movement of tissues that are less flexible but heavier. , if the material to be cut has a rougher surface and/or is more rigid, its habit during rotation They are chosen not to separate based on their gender. In one embodiment, cavitation is at a lower frequency than the ultrasound frequency range. In a preferred embodiment, the chi The cup may be rotated continuously in one direction or initially rotated in one direction and Then reverse between clockwise and counterclockwise by rotating in the opposite direction. and thereby counteract the directional acceleration that is about to be applied to the tissue. .

In this embodiment, in addition to rotation, the tip is ultrasonically reciprocated.

As can be understood from the above description, the technology and apparatus of the present invention can (1) (2) cutting the tissue; Can be mixed and aspirated and, in case of cataract removal, does not damage the capsular wall. It has several advantages, such as the fact that the coating wall can also be cleaned.

Summary of drawings These and other features of the invention will be apparent from the following detailed description with reference to the accompanying drawings. In the drawings, FIG. Simplified handpiece and control panel according to embodiments of the invention for cutting and removing is an elevation, 2 is an enlarged perspective view showing a part of the embodiment of FIG. 1, and FIG. 3 is an enlarged perspective view of the embodiment of FIG. FIG. 4 is a partial cross-sectional view showing another part, and FIG. 4 is a substitute for the blade part of the embodiment of FIG. FIG. 6 is a partial perspective view of another embodiment of a blade portion that can be used as a 5 is a plan view of the embodiment of FIG. 4, and FIG. 6 is a plan view of another embodiment of the handpiece. FIG. 7 is a partial elevational view of another embodiment of a portion of a tool, and FIG. 8 is a partial elevation view of the embodiment of FIG. 9 is a right side elevational view of the embodiment of FIG. 7, and FIG. 10 is a top view of the embodiment of FIG. 10 is a partial elevational view of a tool tip showing a modification of the tool tip of FIG. 9, FIG. 11 is a tool diagram illustrating a first step useful in forming the embodiment of FIGS. 7-9. is a schematic plan view of the top; 12 is a partial elevational view of the tool tip shown in FIG. 11, and FIG. 13 is a partial elevational view of the tool tip shown in FIGS. FIG. 9 is an elevational view of the tool tip showing the second step in preparing Example 9; 14 is a plan view of the tool tip shown in FIG. 13, and FIG. 15 is a plan view of the tool tip shown in FIGS. FIG. 3 is a partial perspective view showing additional steps in preparing the example; FIG. 16 can be used to prepare a tool tip similar to the embodiments of FIGS. 7 to 9. FIG. 17 is a perspective view showing yet another process that can be performed to remove a cataract. 7 is a block diagram of a process using the apparatus of FIGS. 1-6; FIG. 18 shows an eye and cataract removal handpiece chip to illustrate some of the techniques of the present invention. FIG. FIG. 19 shows, partially in cross section and partially diagrammatically, a further embodiment of a handpiece. It is a partial elevation view, 20 is a cross-sectional view of another embodiment of the handpiece, and FIG. 21 is a cross-sectional view of the embodiment of FIG. 20. FIG. 2 is a cross-sectional view of a chip that can be used as an example.

detailed description FIG. 1 shows a surface-identifying cutting handpiece 10, a connecting tube 23, and a console. 2 is an elevational view showing the control panel 21. FIG. The handpiece 10 has a drive unit 11 and a surface-identifying cutting tool having a blade portion 14 and a tubular sleeve portion 12. It is equipped with tools. The tubular sleeve portion 12 has a tubular casing 13 and an inner and a tubular suction drive shaft or sleeve 18. The drive unit 11 , a motor, an on-off switch 20, and a four-way inlet for fluid injection and vacuum suction. It houses the connector for the

Blade portion 14 includes blades 17A and 17B, each of which The blades are located at diametrically opposed positions on the rotatable tubular shaft 18. and each blade is fixed to the shaft to avoid cutting. with a corresponding one of the blunt tips 15A, 15B bent inwardly to There is. The outer sleeve 13 has a movable sleeve 19A inside it. , whereby the button 19 is attached to the outer casing 13 of the tubular sleeve part 12. (and the blades 17A and 17B move in the longitudinal direction relative to the shaft 19 Depending on one direction of movement of A, move away to the cutting position and move in the other direction. When moved, movement within the tubular sleeve 12 against the pressure horns of the spring-like blades. into the possible sleeve 19A and into a small incision of e.g. 2 mm. Fit together. The blades 17A and 17B are narrow in the rotational direction and have a narrow cavity. The trailing edge is blunted to create traction.

Using the above configuration, blades 17A and 17B relatively move handpiece 10. move together to insert into the capsular sac through a small opening, then spread outwards This allows the coating and the The nucleus is cut inside the capsular sac. In the embodiment of FIG. 1, the handpiece 10 is , a motor to rotate the shaft, and a tubular connector to suction the cut pieces. 23. The control panel 21 has a standard for cooperating with the handpiece 10. a standard power source, a vacuum source, an irrigation fluid, and a pump for irrigating the fluid. can be done. These elements are conventional and cooperate with the handpiece 10. It is not part of this invention except that it does.

FIG. 2 is an enlarged, partial perspective view of the blade portion 14 of the tool assembly. The blade portions have first and second blade portions having corresponding blunt ends 15A, 15B. It is equipped with two blades 17A and 17B. In the embodiment of FIG. 2, the blade 17A and 17B have sufficient flexibility, which allows the blades to to form an outwardly curved cutting surface that extends beyond the surface of the shaft 13 (Figure 1). As the blades expand, they become tangent to the rotating circle formed when they rotate. direction or have sharp edges 32,34 directed inwardly from said rotation circle. ing. Blades 17A, 17B are moved by upward movement of sleeve 19A. When pulled inward, it fits into a cylinder with a diameter smaller than 2 mm. match.

The embodiments of FIGS. 1 and 2 extend tangentially to the direction of rotation, i.e. the rotation It has a blade with a sharp edge that extends inward from the direction; Sharp edges are not required and may form part of an embodiment. The angle of attack, or angle of attack, can be changed. However, the angle of attack tangential to the road or at a suitable angle on either side Can be done. For this purpose, multiple drive shafts 18 are attached. of the sleeve portion 12 and the drive portion 11. can be inserted inside. The plate portion is selected by the surgeon and One factor in such a selection is the angle of attack of the blade.

To allow blades 17A, 17B to be compressed into the protective sleeve. In this case, the tubular sleeve portion 12 includes three coaxial shafts arranged in sequence outwardly from the solid axis. It is equipped with shaped sleeves 18, 19A, 13 (FIG. 1). The blade is tubular attached to the drive sleeve 18 so as to rotate therewith; There is also a space between the sleeves 18 and 19A for flowing irrigation fluid. It is provided. Sleeve 19A is attached to button 19 (Fig. 1) and moves in the axial direction relative to the blade 13 and engages the blades 17A, 17B; These blades can be compressed inwardly.

FIG. 3 is a partial cross-sectional view in the longitudinal direction showing the sleeve portion 12 and the drive portion 11; (1) Inside the sleeve portion 12 is a rotatable tubular suction drive shaft 18; A tubular protective sleeve 19A and an outer sleeve 13 are provided, and (2) a driving Inside the moving part 11, a suction drive shaft 18 is rotated to provide blades 17A, 17B. (Fig. 1) and applies vacuum pressure to the inside of the shaft 18. A hollow suction tube 27 is connected to the tube 19A, and a hollow suction tube 27 is connected to the tube 19A. an irrigation tube 17 for providing irrigation fluid through the electrical wire for controlling the motor 40; 25 are provided. One end 42 of the shaft 18 is the output shaft 4 of the motor 40. ・Connected to the output shaft so as to rotate with 4, and also have a tubular shape for suction. It is connected to the connection part 45.

As shown in FIG. 3, the outer wall 13 supports a movable wall portion 19A inside thereof. the wall has a button passing through a slot in the outer wall 13; The wall portion 19A moves upward and downward due to the movement of the blades 17A and 17B. the blades in their normal positions. Expand outward to the cutting position so that it can rotate. In some embodiments When rotating, it is subject to centrifugal force. However, the moment of inertia of the blade is Centrifugal force does not push each point outward, only curved flat surfaces are pushed outward during rotation. Enough to be displayed on the side wall. The shaft is a movable tube 19 , spaced apart from each other to allow irrigation fluid to flow therebetween, and with a central The section has an opening 15 extending downward for suctioning tissue.

Conduit 17 connects via cable 23 to the control panel (Figure 1) for providing irrigation fluid. The irrigation liquid is supplied from the control panel through a conduit 17 around the motor 40. is pumped into the space between the movable tube 19 and the shaft 18 and into the capsular bag. Supply irrigation fluid. To aspirate tissue, the central opening 15 of the shaft 18 is through an opening 29 in the wall of the shaft 18 and through a sealed circular ring 31. , which communicates with the suction conduit 25. The conduit 25 passes around the motor 40 and connects the cable. It is connected via a control panel 23 to a control panel 21 that provides a slight negative pressure to suction the tissue. It is. Cable 23 also carries electrical conductors for motor 40 and these The conductor is connected in series between the switch 20, the control panel 21, and the power source of the motor 40. has been done.

To use the embodiment of FIGS. 1-3, a surface-identifying cutting handpiece 10 is used. Make an incision for insertion. The surface identification type cutting handpiece 10 is assembled with The tissue is cut and the cut tissue is suctioned, but the adjacent smooth and flexible to prevent damage to the wall. In other words, the surface-identifying cutting handpiece is , cuts rougher and more rigid surfaces with larger mass. this table Surface identification is controlled by moving the surfaces of blades 17A and 17B, The blade deforms or allows the blade to cut the diseased tissue and , further cutting is performed by cavitation forces within each cutting zone, move at a certain speed. The blades have an opening between them, the dimensions of which are is more integrated and has less mass, i.e. is more flexible and has a lower mass. dimensioned so that smooth tissue does not enter the cutting zone and stays away from the moving surface. be. Suction pressure, cavitation and turbulence prevent tissue damage on flat surfaces In order to do so, they mutually interfere and attenuate within the sphere of the rotating ring.

For cataract removal surgery, 2 to 7 millimeters, preferably 3 millimeters. A small incision is made in the sclera at the 12 o'clock position along the limbus, and a similar Another incision is made in the capsule wall with dimensions of . More mass, more rigidity Insert the instrument into the taller and rougher lens and remove the crystal without cutting the capsular wall. mutilate the body.

To cut diseased tissue, the cutting zone can be adjusted without damaging the smooth wall. The actual time required to open varies from eye or lens to eye or from tissue to tissue. and can be selected according to the surgeon's observation before use. The actual time is , (1) stiffness of the tissue, (2) mass of the tissue, (3) stiffness of the tissue in the direction of tool movement. The effect depends on the angle, (4) surface roughness, and (5) size and shape of the structure. It is a function of the effect of negative pressure pulling the tissue inward, such as the varying suction vacuum pressure.

The surface identification of tools is characterized by impact called phacotomesis and phacocoelosis. controlled by moving the surface that cuts the diseased tissue due to cavitation forces but the surface is more integrated, more flexible and has less mass. Move at a slow enough speed so that the smoother tissues come apart without being cut.

The surface of the device (1) has rigidity and 2) has a large mass and large inertia. 3) Cut the tissue at an angle of close to 90° to the cutting edge.

It takes advantage of the difference between the tissue to be cut and the tissue that has a smaller mass and is more flexible. Surgeons removing cataracts must control the speed of tool surface movement, suction and irrigation , the rake angle of the leading edge of the blade surface, the position of the blade surface, and the moving table. Cavitation controlled by surface velocity and shape, especially the trailing edge of the blade Adjust the level. Its adjustment is due to its large mass, large elastic modulus as well as engineering The cortex is cut by a protrusion on the path of the tool surface, but its small mass and small The elastic modulus and the lack of protrusions close to 90' allow the coating wall to be easily bladed. It is done to separate from Chi to change the rake angle and cavitation surface. replacement.

Suction pressure is more effective within the moving surface of the rotating tip. suction pressure is sufficient to pull the tissue being cut and the tissue to be cut, and a smooth wall The pressure is low enough not to displace the wall, i.e. pull the wall inward. Ru. The rotating surface moves the smooth wall outward and applies suction pressure within the cutting zone. Bring about some kind of opposing pressure. In some preferred embodiments, the radial direction The inwardly extending edges further pull and mix the tissue within the cutting zone.

To better explain the above and pond embodiments, some special terminology will be used. is useful. For descriptive purposes, the term "low power" refers to 1 horsepower (1,341 kilowatts). means smaller than. As used herein, the term "kinetic resistance" , the movement caused by the inertia of the tissue and the inertia of other tissues connected to it. Refers to the resistance to movement of a portion of tissue when impacted by a moving tool surface. (taking into account the flexibility of the connecting tissue).

As used herein, the term "cutting speed" refers to the speed at which the moving surface of the tool means the minimum speed of the moving surface of the tool for a given stationary tissue that The cutting speed is at least 10 percent of the distance moved by the total mass of tissue. (1) the predetermined stationary tissue has a predetermined motion resistance; (2) the tool surface is sufficiently strong to maintain its speed constant regardless of the impact mentioned above; The combination of distortion, cutting and cavitation occurs when the kinetic energy is The effect is sufficient to destroy the above tissue. The above cutting speed is (1) (2) the angle that the movement of the moving surface makes with the tissue surface; and (2) the momentum of the moving surface. affected by.

In the embodiments of FIGS. 1 to 3, the widest distance perpendicular to the axis of rotation A ring or partial ring with a diameter of 2 mm is rotated at When the rotation is made, a rotating surface is formed, and the rotating surface is divided into an open space and a solid cutting surface each time. form a ring. The above ring has a rotation rate of approximately 120.00 Orpm (rpm per minute). rotation). The solid ring extends approximately 0.50 mm along the plane of rotation. width, slightly less than 9 square millimeters, more precisely, the widest point of the arc Also a long circle of 8,9 square millimeters with a length of 2.4 millimeters An open area is left on the surface.

The time during which the solid ring section sweeps in either plane of rotation is approximately 250 microns. every second, but not longer than every 3 milliseconds (1,000 rpm), and 0°7 It can be as short as 5 microseconds (400,00 Orpm). The above configuration and with adjustable parameters for specific situations, the coated wall can be Since it does not enter the cutting zone in and around the rotating surface, it will not be cut and the ring will not be cut. The crystalline lens can be cut for easy suction.

A second embodiment of the blade portion 14A is shown in FIG. The portion is formed as a portion of a circle or arc extending from the shaft 18A and is pear-shaped. It has a shaft 18A connected to a blade 17C having a shape, and (1) a blunt trailing edge 20; (2) a sharp inner edge 22; and (3) a It is attached to the tube 18A and is elongated along the axis of the tube 18A. When the blade rotates around the shaft 18A, the wide part has a blunt ridge and (4) a wide base formed with a sharp leading edge; and (4) a narrow upper part formed with the base. and a rotation axis along the shaft 18A. The apex is generally blunt, but some In some embodiments, apex 24A has the shape of a drill.

Sharp edges deform cells of a material with large mass and rigidity, making them elongated (but , was found to push away materials that are flexible and have a small mass. some situations , the leading edge removes fine particles that would otherwise block the suction passage. Cutting or scraping from harder materials, cavitation effects, easily sucked Cut the particles into smaller particles so that The blade is made of lens material and A viscous fluid can also be liquefied and compressed, and a more rigid fluid with a larger mass can also be liquefied and compressed. Shaped to maximize cavitation when cutting and mixing high quality materials ing. In the embodiment of Figure 4, the blade has two blunt sides and a blunt top. The bottom of the base, which is attached to the tube 18A, has a reinforced section 24. Also, a non-cutting surface is formed on the top.

FIG. 5 shows a plan view of the embodiment of FIG. A portion 14A having a formed blade 20B is provided, and the thick portion The portion is provided at the upper end opposite to the direction of the tubular shaft 18A and rotates around it. It has a rolling blunt surface 24. However, in some embodiments, Allows to bring forward the grinding central area for positioning the point to be cut It has a cutting edge. This example has a unique shape that serves a specific purpose. It operates much like the previous embodiment, except that it allows for careful emplacement. Ru. Instead of a cutting edge, the top 24 may be bent inward or a Can be blunted to prevent cutting.

FIG. 6 shows a partially schematic and partially longitudinal section of another embodiment of a hand tool 10A. The hand tool is produced by a similar dental drill motor 40. and the end of the shaft 18 of the blade portion is configured in a different manner as will be explained later. The three embodiments are substantially similar to the embodiments of FIGS. 1-5, except that Receive the tool by inserting suction tube 18B of section 12C into it. It is designed to be inserted.

In addition to the motor 40 described above, the handpiece IOA includes a suction drive sleeve coupling. ring 18B1 outer housing 60 and motor tool sleeve coupling 6 (1) The motor 40 is connected to the tool sleeve via the coupling 62. 18B and is located inside the housing 60, and (2) Reef 18B is connected via coupling 62 during operation of the handpiece. It extends outwardly so as to be rotated by the motor 40.

A housing is provided to enclose the operable tool and connect the necessary fluids and vacuum to the tool. housing 60 includes a motor housing portion 70 and a tool and coupling housing. a housing portion 72 of the tool and coupling, the housing portion of the tool and coupling being A tubular connector 74 for fluid, a tubular connector 76 for suctioning negative pressure, and , are formed integrally with a ventilation hole 78 formed through the housing 60. . A vent port 78 extends into the motor housing portion 70 and connects the motor housing. This is an opening that communicates with the inside of the cooling part and cools the motor 40. irrigation fluid connector is an aperture communicating with the interior of housing portion 72 through which fluid is communicated. Once applied, this fluid protects the outside of tool sleeve 18B in a manner detailed below. It eventually passes through the sleeve 13A and reaches the operating point.

The suction connection opening is connected to the tool shaft 18 via the motor tool coupling 62. Apply negative pressure to B, which allows material to be pulled out during use of the handpiece. It is designed to accommodate the tube so that it can be moved. In front of housing portion 72 The other end has an external thread 82 that engages with the internal teeth of the protective sleeve 13A, and a thread provided therein. A shoulder portion having an O-ring 80 that protects the protective sleeve 13A. is screwed into the housing 60, sealingly surrounds a part of the housing 60, and will be described later. The outer end thereof can be penetrated in such a manner as to.

A motor/tool sleeve cover is used to connect motor 40 to sleeve portion 12B. The spring ring 62 includes a motor output shaft 90, a cylindrical boss 92, and a cylindrical support. the annular groove 96 in the boss 92 and the bottom of the annular a96. two counterbore holes 98 passing through the an opening 100 extending through port 94 and a circle sized to accommodate sleeve 18B; Brazing is used to firmly attach the cylindrical opening 95 and the post 92 to the sleeve 18B. A connecting portion 102 is provided. The support 100 rotates therein and It houses a motor shaft 90 and a post 92 that are supported by the port. The groove 96 is , due to its annular shape, communicates with the opening 100 when rotating and also provides vacuum pressure. the vacuum pressure is transmitted through opening 98 to sleeve 18B, and the A negative pressure is created on the operating tip through a long sleeve.

Using the above configuration, sleeve 18B rotates and transfers vacuum pressure to the chip.

The brazing connection 102 is the connection between the tool sleeve 18B and the shaft 80. By increasing the reliability, the output shaft 90 through the post 92 to the shaft 18 Helps transmit force to B.

To install and support the tool sleeve 18B, the implementation of FIG. The protective sleeve 13A in the example is adapted to engage internal teeth of the housing 72. It includes a cylindrical base member 110 having internal teeth 112 and is enlarged. O-ring 80 compressed between cylinder 110 and housing portion 72 , sealed against the flow of fluid through it. Narrow outer sheath portion 11 4 is formed integrally with the cylindrical portion 110 and the inner tool sleeve 18 A cylindrical passageway formed between B and its outer tubular surface, the outer protective strip being Irrigation fluid flowing into the capsular bag between the rib 13A and the inner tool sleeve 18B It contains a cylindrical passageway that allows the flow of.

Using the above configuration, the tool sleeve 18B can be rotated by the motor 40. (1) transfer the irrigation fluid to the tool sleeve and the outer protective sleeve 13; (2) Negative suction pressure can be applied to the cut piece in the longitudinal direction. can be pulled along the axis of At its outer end, in a manner to be described later, A cutting tip or blade is formed.

FIG. 7 is a front elevational view of one embodiment of the tool, which includes sleeve portion 1 2A and a blade portion 14B, the blade portion being formed at the outer end. The tool has two blade members that extend in the longitudinal direction of the tool. The sleeve 12 is separated by an aperture 120 extending longitudinally along the axis of the sleeve 12. The same cylinder forming A has a blade portion 14B formed at its end. Bree Both the sleeve portion 14A and the sleeve portion 12A are integrally formed to provide a suction drive shaft. 18B. The suction hole is in the longitudinal direction. through the tip of blade portion 14A perpendicular to the axis of the blade and slot 120. I'm passing through. To receive some material for suction, the holes 122, 123 are It is approximately 1.02 mm (approximately 0.04 inch) from the tip 24 of the board portion 14A, The diameter of tube 18B is approximately 1.07 mm (approximately 1042 inches). suction hole The diameter of 122.123 is approximately 0.457 mm (0.018 inch) and 7 It should not be larger than mm.

8 and 9 are a plan view and a right side elevation view, respectively, of the embodiment of FIG. It has a width of 203 mm (0,008 inch) and a width of approximately 1.78 mm (0.00 mm). (inch) downwardly extending slot 120 is shown. As best shown in Figure 8 In addition, the edges of the wall of the tube or sleeve 18B along the slot are thicker. that is, a blunter trailing edge 126 and a sharper leading edge 124; In one embodiment, it has a blunter edge 130 as well as a sharper edge 128. This causes the sharper edges to move counterclockwise as shown in Figure 8. As it rotates, it elongates or cuts the tissue inside the lens, cutting into the blunter edges. form cavitation.

FIG. 10 is a partial front elevation view of another embodiment, shown together along the slot. Tips that are removed, welded and displaced to yield sharper edges and blunter edges. , and the above edges can be fixed without changing the wall thickness of the tube. It is formed by largely displacing the section along the slot. This example is The walls of sleeve 18B form a 90° rake angle and two cutting edges. slots at three locations in place of two slots 180 180° apart. This allows a rake angle of 60° and three cutting edges to be or provides 4 slots resulting in a 45° rake angle and 4 cutting edges do. In addition, the above chips can be assembled to form a smooth protective dome as shown in Figure 10. It can be opened with a cutting edge or with a cutting edge. Also, twist the tip. By changing the rake angle along the slot, the pulling effect of a cyclone-like fan can be achieved. can bring.

To form the embodiments of FIGS. 7-10, as best shown in FIGS. Slots 120 can be formed in the tubular sleeves to lock them together.

Next, as shown in FIGS. 13 and 14, a plane passing through the center of the slot and a sleeve Displace the two sides laterally in the direction along the longitudinal axis of the They are fastened together and brazed to form a chip as shown in FIG. Chi Tubu 14 Remove the 0 with a reverse cut on the other side of the edge to form a flat cut and a sharp edge. This allows the narrow edges and blunt edges to be further shaped. Ru.

form other rake angles so that the blade pulls the viscous fluid or other viscous fluids In order to form the mold, as shown in FIGS. 15 and 16, both ends are displaced, twisted, and braze and first align the two slots and the longitudinal axis or Displaced along a plane and then twisted at slightly different angles, which results in different scoops. forming a sharp angle and a cyclone-like pumping effect. The above chip is Chi Tsubu 140 It is normally smooth in the radial direction, but has a cutting effect when moving radially outward.

In some forms of preferred embodiments, the tubes are diametrically opposed. It has a slot of approximately 1.07 mm (42/1000 inch or 0.04 2 inches). Both ends move together in a curved manner, and their most A slot with a width of approximately 0.203 mm (approximately 8/1000 inch) at the widest point and extend approximately 1.78 mm (approximately 70/1000 inch) from the top. (length approximately 1.78mm). The 90° removed from the two slots is There is a suction opening in the center, and these suction openings are approximately 0.457 mm (1/1000 8 inches) in diameter, and its cross section is circular. The above suction opening The bottom edges of each are positioned generally adjacent the ends of the slots.

Typically, the tube rotates at about 1600 hertz when cutting the nucleus, which is preferred in practice. In the example, it has two cutting edges, and the wedge-shaped surface of the slot is The surface is approximately 0.025 mm (1/1000 inch) to approximately 0.508 mm ( one edge with a thickness of approximately 20/1000ths of an inch); Thickness from 1.27 mm (10,000ths of an inch) to approximately 1.27mm (50/1000ths of an inch) and a trailing edge having a trailing edge. The range is between 300 hertz and 4000 hertz. Preferred, but faster if the location within the capsular bag is not close to the tissue to be preserved. or slower (can be moved to change to another organization) can. In a preferred embodiment, the slot and rotational speed are curved movement tables. yields a surface moving 200 centimeters per second at the fastest point on the surface more preferably between 5 and 4 meters per second at the fastest point. The fastest pointing movement in the range of 0 cm (selected to yield a surface , can move slower or faster in some situations.

Since it is the rotating surface that curves inward towards the center, its speed is Very slow in the center, in some situations almost impossible to cut in the center As the radius of rotation increases to the radius of the sleeve, more cuts are made. Ru. Slots are assembled over very short periods of time, such as 10ms to 1ms. Adjacent to the weave. Each cutting edge is cut once every approximately 625 microseconds, preferably , sweep the points in the normal range from once every 3 milliseconds to once every 400 microseconds. Ru.

zone consisting of spherical and cylindrical parts intended for use in the crystalline lens In addition, other shapes of moving surfaces can be used and the tool can also be used for vascular surgery. It is also used for purposes other than cataract removal. For example, if you want to create multiple zones of spheres, spaced apart from each other by a shorter distance, which eliminates the need for the tools to rotate as quickly. , it is also possible to use motions other than rotational motions to prevent tissue from entering the cut zone. I can do it. Convenient for removing tissue around veins or arteries during vascular surgery A good embodiment has a dumbbell shape, which allows the recess to fit around the vessel. while the spherical cutting zones are located on both sides of the vessel.

In some embodiments, the moving surface is attached to a rotatable shaft. The rotatable shaft formed by a curved member has an angle of 0 to 60°; The rotating surface preferably has a sharp edge at an angle of 45°, and the rotating surface It has a center of rotation aligned with . The sharp edges of the curved member are opposite to the center of rotation. facing contralaterally, this allows the cutting action of the sharp surfaces to be applied to the cortex and core material of the cataract. You can make it go inside.

Figure 17 is a block diagram schematically showing each step in cataract extraction and lens implantation techniques. The technique is (1) maintaining the anterior chamber and forming an incision in the capsular wall; (2) step 5 of cutting and removing the crystalline lens; 4, and (3) a sub-step 56 necessary for embedding the crystalline lens.

When performing the above technique, use the necessary Step 52 including a sub-step, and Step 5 including a sub-step necessary for performing embedding. 6 Not new in itself, many such processes Y., Anis), 1986 Obthalmology Seminar (Semina rs in Opthalomology) Volume 1 No. 2 (June) 113- “l1lustrated 5tep-by-3tep Descr” on page 129 iption of the Ants Dry Extra Capsula r　Cataract　Extraction　Technique　With In-the-Bag Lens Implementation” It is. Also, implantation should not be performed after removal of the crystalline lens (although it may be possible to avoid aphakia). Can be part of a treatment treated with contact lenses or glasses .

The step 54 of cutting and removing the crystalline lens includes (1) inserting a handpiece; (2) in some embodiments, extending the blade into the front of the coating; 3) breaking and removing the hardened portion of the core. All of these processes , is performed through a small incision while maintaining the anterior chamber with a viscoelastic medium. US No. 4,908,015, if necessary. Ni-L-noyon (hydrodel 1neat 1on) can be performed, but , such hydrodeliniants do not constitute part of the present invention.

Step 52, which includes the substep of maintaining the anterior chamber and forming an incision in the anterior capsule, includes a 3 mm preferably has a length in the range of 1 to 2 mm. a sub-step of forming a small incision in the pre-capsulation having a . This incision The anterior chamber is formed to maintain as much of the previous structure as possible. this Cutting and removing the crystalline lens through the incision 54 and implanting the crystalline lens Step 56 is performed. In some situations, the incision may be 4 or 5 mm. but should always be less than 7 millimeters.

The posterior capsule is shown at 220 in FIG. 13 with it in focus at the focal plane of the microscope. The handpiece 10 is inserted into the anterior wall of the capsule through the incision. hand piece 1 0 tip into the lens through the incision in the anterior wall of the capsule.

Rotate the blade rapidly while applying some negative pressure to suction the cut pieces. . Gradually insert the rotating blade into the cortex and nucleus, occasionally injecting a small amount of irrigation fluid. Enter. Aspirate the cut cortical or nuclear material. The front part of the capsule is relatively intact, After removing the cataract and handpiece, as described in the above Annis US patent. As such, the lens implant is inserted through a relatively small opening.

Generally, the nucleus is removed first, then the cortex. Surface identification type /% The base should be removed without damaging the adjacent smooth wall in front of the capsule (cutting the cortex and nucleus). This allows for cutting and suction. Such a handpiece has its cutting edge This prevents cutting smooth walls with rougher, more rigid, and larger mass. A large amount of tissue is cut and the cut piece is moved to a negative pressure zone and suction is applied. Smooth and good A surface that is highly flexible and has a low mass will cause the brake to hit the surface at an angle. driven by The tissue being cut is struck at an angle and cut should not be used to cut the cortex without damaging the capsular wall or other healthy tissue. Rapid and repeated cavitation is caused by forces that do not move the entire material. receive.

The surface identification of an instrument is a moving surface that moves at a certain speed and cuts through a large mass of diseased tissue. and has an aperture between them, and the dimensions of the aperture are controlled by the The cut zone is flexible enough to prevent smooth tissue with small mass from entering the cutting zone. The dimensions are as follows. The tissue will not be trapped by the opposing shear forces of the instrument. The cutting edge of the instrument has (1) high rigidity and high shear modulus; (2) has an angle close to 90° to the cutting edge and is separated from the Cut tissue that receives less force in the direction of

Therefore, a surgeon removing a cataract should adjust the speed of movement of the cutting edge and A certain mass cuts a cortex with a large coefficient of force and a high protrusion, but the coefficient and mass is small and has a small protrusion close to 90° and therefore easily separates from the cutting edge. Do not cut the coated wall. The suction pressure pulls the cut tissue but smooths the wall. is low enough to not pull. The rotating surface moves the smooth wall outward and cuts Provides a counter pressure opposing the suction pressure within the zone.

When using this device, the crystalline lens loses its mass due to cutting, and Tendency to move away from the cutting edge as its connection to the structure of the lens is severed increases. One way to ensure this effect is to ensure that the cutting edge hits the crystalline lens. By changing direction frequently enough to neutralize the tendency of impulses to move the crystalline lens in one direction. be. The above direction means that the crystalline lens repeats tangentially in the same direction to the cutting edge. By colliding with the robot, it is changed to prevent it from moving. line change of direction If not, such collisions can be avoided, for example by rotating the crystal. Move your body. Ike's method involves simultaneously applying shocks in opposite directions to the crystalline lens. be.

The direction in which the cutting edge collides with the crystalline lens is controlled by a manually operated reversing switch. This can be done by repeatedly reversing the motor, and the reversing switch described above is Changes the polarity of the DC power supplied from the power supply to the DC motor, thereby causing rotation The direction of rotation of the tip changes. Also, use an automatic reversing switch or The tip has a substantially linear back and forth reciprocating motion or a curved reciprocating motion; Move tangentially in one direction to the surface of the lens, then in the opposite direction Such reciprocating motion can be made to move, and the shaft that holds the cutting surface This can be done by applying ultrasonic or quasi-ultrasonic vibrations to the target.

FIG. 19 shows another embodiment of a nose tool 1 that is particularly useful after the size of the crystalline lens has been reduced. 0B is a partial view, partly diagrammatically and partly in longitudinal section; FIG. This node Instead of being operated by a dental drill motor 40, the tool 40A, the piebreak is driven by the above-mentioned U.S. Pat. No. 589.363, Weiss U.S. Patent No. 3.902.495, U.S. outside Kerman National Patent No. 3,693.613, U.S. Patent No. 4.041.947 to Weiss et al. The usual type of pie break, such as those used to operate chips in It can be done. Except for the drive mechanism, this handpiece is similar to the embodiment of FIG. They are the same, and the same parts are given the same reference numerals.

In addition to the pie break 40A mentioned above, the handpiece IOB has a suction drive sleeve. 18B, the outer housing 60, and the motor/tool sleeve coupling 62. (1) The vibrator 40A is connected to the tool stand via the coupling 62. It is connected to the rib 18B and is located within the housing 60, ( 2) Sleeve 18B is connected via coupling 62 during operation of the handpiece. and extends outward so as to be vibrated in a curved manner by the pie break 40A.

The pie break 40A includes a normal oranator 130, a DC power supply 132, and a voltage The switch 20 (FIG. 1) is energized as described in connection with the embodiment of FIG. The cutting edge (Fig. 19) is vibrated. The shaft 90A rotates in the bearing 13-8. with welded arms extending orthogonally in the radial direction. The arm contacts the movable part of the pie break 134. This causes the vibration of the pie break to cause rotational movement on the shaft 90A. give.

To connect the pie break 40A to the sleeve portion 12C, install the motor/tool slide. The pipe coupling 62 connects the output shaft 90A of the pie break and the cylindrical boss 92. a cylindrical support member 94; an annular groove 96 in the boss 92; Two counterbore holes 98 passing through the boss 92 at the bottom of the an opening 100 passing through the cylindrical support 94 and accommodating the sleeve 18B. The cylindrical opening 95 and the boss 92 are fixed by the sleeve 18B. The brazing device is provided with a connecting portion 102.

The support 100 accommodates the shaft 90 and boss 92 of the pie break, and the shaft and The boss is supported by the support and vibrates therein in the direction of rotation. Groove 96 Due to its annular shape, it communicates with the opening 100 and receives vacuum pressure when moving. and transmit the vacuum pressure through the opening 98 to the sleeve 18B to remove the elongated strip. Create a negative pressure on the chip operating through the sleeve.

Using the above configuration, when switch 20 (FIG. 1) is closed, the Power is connected to the generator 130. Next, pie break 134 is performed by the surgeon. It vibrates at a frequency tuned to the Onolta 130 and is excited via the conductor 139. Ru. Pie break 134 reciprocates lever 136 and reverses shaft 188. Repeatedly rotate in alternate directions. This allows the lens to be aligned with the surface of the lens at first. The cutting edge touches the lens tangentially in one direction and then rapidly in the opposite direction. impact, but the angle and velocity are such that it will damage the coating wall if it is adjacent to the coating wall. The angle and speed are such that it cuts the crystalline lens without giving any damage.

The above movement occurs first clockwise and then counterclockwise, so the crystalline lens rotates. do not. The reason is that the two impacts are close enough in time with respect to the inertia of the crystalline lens. This ensures that the impact does not substantially apply acceleration in one direction to the crystalline lens. It is the body. Generally, the frequency is ultrasonic or quasi-ultrasonic, but Two sets of juxtaposed cutting edges are used to impact the crystal from opposite directions at the same time. Rotate in opposite directions or one set of cutting edges and The other set of cutting edges can be rotated in opposite directions.

FIG. 20 shows the handpiece 10C in a simplified partial longitudinal section. This handpiece has an ultrasonic pie break 40C as its basic component. , an electric rotation motor 40D, and a suction tube 18C. motor 40D is connected to the ultrasonic pie break 40C, and the ultrasonic pie break is connected to the suction tube 18C to provide a combined rotational and longitudinal ultrasonic wave. A return motion is applied to the suction tube 18C.

Using the above mechanism, the suction tube 18C can be attached to the cutting tip 14C (not shown in FIG. 20). Rotate the cutting tip rapidly by moving the For each increment of rotational movement in the direction of degrees, e.g. The cutting tip is moved in and out of the tissue ultrasonically. Therefore, this mechanism is similar to that of the previous embodiment. It combines rotational movement and ultrasonic movement. For example, the motor 40D may rotate clockwise or means rotating the suction tube 18C in a single direction, such as counterclockwise. 19, but alternate between clockwise and counterclockwise directions, as in the embodiment of FIG. It can be rotated to

Embodiment 10C of FIG. 20 includes a tubular suction connector 74 and an irrigation connector 76. However, in the manner described with respect to the previous embodiment, suction is applied through the center of suction tube 18C. The upper This is similar to the embodiment described above.

In the embodiment of FIG. 20, the outer shell 60C has a suction tip connected to the cutting tip. Tube 18C in a direction aligned with the longitudinal axis of the handpiece and the tip. an ultrasonic pie break configured to cause reciprocating vibration, and a connection mechanism 150 Together, they surround a rotary motor 40D connected to the rotary motor 40D. The necessary electrical connections are This is done through an opening in the rear bulkhead 152.

FIG. 21 is a partial cross-sectional view showing a cutting tip 14C of another embodiment. The cap surrounds a suction portion 162 that communicates with the interior of suction tube 18C (FIG. 20). A tubular cylindrical wall 164 is provided. The tip end 158 is round. In one embodiment, the surface can be roughened. The opening 156 is It communicates with section 162 and pulls the tissue slightly inward.

To cut tissue, a slot 156 is inserted into the downwardly extending wall of the rotating section. It forms a leading edge and a cutting edge. This slot is located in the cavitation area can be extended to different depths as required. Also, tubular A slot is also provided on one side of the wall, and the slot communicates with the suction interior of the cutting tip. Also, the cavitation edge can be or only part of its length. Up The slot provides an opening for receiving tissue particles, but the tube suction An opening provided in combination with an edge formed on the surface without penetrating the interior of the drawer is can perform the same function. During operation, ultrasonic vibrations are generated along the axis of rotation. Rotate the tube while applying motion, which causes the tube to reciprocate and It moves in and out of the tissue multiple times with each rotation. For example, the rotation is 10 kilohertz 3.0 kHz per minute while applying ultrasonic vibrations in the range of up to 50 kHz. 00 It can be rotated from 0 to 15,000 rotations. Accurate reciprocating vibration frequency and rotation The speed can be selected by the surgeon and depending on the nature of the cataract to be cut. Extending to lower speeds and frequencies or higher speeds and frequencies You can also do it.

The vibration frequency and rotation speed should be checked at small rotation parts, such as at each rotation angle. The powder enters the tissue and removes the tissue as a fine powder without excessive movement of the tissue. selected so that it can be removed.

As can be understood from the above description, the technology and device of the present invention can (1) (2) cutting the tissue without damaging the tissue (selectively cutting a certain tissue; Can be mixed and aspirated as well as damage the capsular wall in case of cataract removal The coated wall can be cleaned without giving any It has several advantages, such as being able to be performed with instruments.

Although preferred embodiments of the invention have been described in detail, preferred embodiments may be described without departing from the invention. Many modifications and variations to the preferred embodiment are possible. Therefore, the attached The present invention may be practiced in a manner other than as specifically stated in the claims and within the scope of the claims. It can be implemented.

Claims (20)

[Claims] 1. a surface-identifying cut having a cutting surface and having at least one movable cutting surface; The cutting tip is inserted into the lens and capsular wall of the eye with cataract through the opening of the eye. The process of inserting; moving the cut surface in a first direction and at least a second direction. , The step of moving the cut surface in a first direction includes rotating the cut surface, The step of moving the cut surface in the second direction includes reciprocating the cut surface at an ultrasonic speed. A method characterized in that it includes the step of: 2. The method of claim 1, The moving surface discriminating cutting tip is moved at a speed greater than the cutting speed with respect to the coating wall. impact the cataract tissue at a certain speed and by positioning it at an angle relative to the cataract. a position that allows the cataract to be cut but not the capsular wall. The decision process and The method further comprises the step of aspirating the cut tissue. 3. 2. The method of claim 1, wherein the step of rotating the cut surface rotates the cut surface. A method comprising the steps of rotating clockwise and one of clockwise. 4. 2. The method of claim 1, wherein the step of rotating the cut surface rotates the cut surface. A method characterized in that it comprises the steps of rotating clockwise and alternately clockwise. 5. The method of claim 3, The moving surface discriminating cutting tip is moved at a speed greater than the cutting speed with respect to the coating wall. impact the cataract tissue at a certain speed and by positioning it at an angle relative to the cataract. and thereby cut the cataract but not the capsular wall. The decision process and The method further comprises the step of aspirating the cut tissue. 6. The method of claim 4, The moving surface discriminating cutting tip is moved at a speed greater than the cutting speed with respect to the coating wall. impact the cataract tissue at a certain speed and by positioning it at an angle relative to the cataract. a position that allows the cataract to be cut but not the capsular wall. The decision process and The method further comprises the step of aspirating the cut tissue. 7. The method of claim 5, Make a small incision with a diameter smaller than 7 mm along the edge of the capsular bag. a step of forming; inserting a cutting tip and rotating the cutting tip to cut the cataract; A method characterized by providing. 8. The method of claim 7, The step of rotating the cut surface includes rotating the cut surface with the length of the surface identification type cutting tip. The step of inserting the tip includes the step of rotating about a manual axis. The rotating cutting plane impacts the cataract tissue at an angle. , the tip is inserted with its longitudinal axis at an acute angle to the coating wall. A method characterized in that it includes the step of: 9. The method of claim 6, Make a small incision with a diameter smaller than 7 mm along the edge of the capsular bag. a step of forming; inserting a cutting tip and rotating the cutting tip to cut the cataract; A method characterized by providing. 10. The method of claim 6, The step of rotating the cut surface includes rotating the cut surface with the length of the surface identification type cutting tip. The step of inserting the tip includes the step of rotating about a manual axis. The rotating cutting plane impacts the cataract tissue at an angle. , the tip is inserted with its longitudinal axis at an acute angle to the coating wall. A method characterized in that it includes the step of: 11. The method of claim 1, wherein the cutting tip has a power of less than 1 horsepower. A method characterized by being rotated in levels. 12. A device for removing tissue from a patient, the device having an actuatable tip; comprising means for cutting tissue and aspirating the tissue, prior to cutting and separating the tissue; means for directing the actuatable tip in a first direction and a second direction under control of an electrical signal; at least a means for repetitive movement at a low power level in at least a second direction; The actuatable tip has at least one cutting edge and has a cutting surface. the means for moving in a first direction includes means for rotating the cutting surface; The means for moving the cut surface in a second direction reciprocates the cut surface at an ultrasonic speed. An apparatus for removing tissue from a patient, characterized in that the device comprises means for removing tissue from a patient. 13. 13. The apparatus for removing tissue from a patient of claim 12, wherein the operable The chip has at least two cut surfaces, and these cut surfaces include at least one and a cavitation forming surface. A device for removing tissue from a patient. 14. 14. The apparatus for removing tissue from a patient of claim 13, wherein the actuatable The tip has at least two cutting edges and a space between the cutting edges. for removing tissue from a patient characterized in that it is smaller than 5 mm; equipment. 15. 15. The apparatus for removing tissue from a patient of claim 14, wherein the operable The patient tip is characterized in that it has a diameter smaller than 7 mm. device for removing tissue. 16. 13. The apparatus for removing tissue from a patient of claim 12, wherein the operable The tip is hollow and lies approximately in a plane parallel to the longitudinal axis during surgery. the slots have leading edges and trailing edges; A device for removing tissue from a patient, characterized in that: 17. 17. The apparatus for removing tissue from a patient of claim 16, wherein the actuatable device for removing tissue from a patient, characterized in that the tip is replaceable . 18. 18. The apparatus for removing tissue from a patient of claim 17, wherein the actuatable The tip is hollow and lies approximately in a plane parallel to the longitudinal axis during surgery. the slots have leading edges and trailing edges; A device for removing tissue from a patient, characterized in that: 19. 13. The apparatus for removing tissue from a patient according to claim 12, wherein the cutting surface is The rotating means rotates the cut surface in one of a counterclockwise direction and a clockwise direction. An apparatus for removing tissue from a patient, characterized in that it comprises means for removing tissue from a patient. 20. 13. The apparatus for removing tissue from a patient according to claim 12, wherein the cutting surface is The rotating means rotates the cut surface alternately in a counterclockwise direction and a clockwise direction. An apparatus for removing tissue from a patient, characterized in that it comprises means for removing tissue from a patient.