JPH0759789A - Handpiece for surgery - Google Patents

Abstract

PURPOSE:To provide a handpiece preventing the obstruction of the visual field of an endoscope due to the injection of an irrigation liquid in the operation under the visual field of the endoscope restricted in operation and capable of safely and certainly performing the selective peeling of the biological tissue of a blood vessel by ultrasonic vibration. CONSTITUTION:An ultrasonic vibrator 1, a joint part 2 and a tip part 3 are received in a protective cover consisting of a main body cover 5 and a tip cover 8 and the tip cover 8 is constituted so that the tip thereof has an inclined surface and a tip working part 14 curved so as to follow the arc shape of the tip part protrudes from the tip and is attached so as to be rotatable centering around the axis of a handpiece and, by rotating the tip cover 8, the protruding area of the working part is changed and the jet direction of an irrigation liquid is controlled and the scattering of the irrigation liquid can be prevented.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical handpiece for crushing and removing foreign matter in a biological tissue or a body cavity by ultrasonic vibration.

[0002]

2. Description of the Related Art As a surgical operating apparatus for crushing, cutting or separating biological tissue by ultrasonic vibration, it occurs in ophthalmology for crushing and sucking out the lens cured by cataract and in the brain, spine, digestive tract, etc. BACKGROUND ART A surgical operation device for soft tissue for crushing and removing tumors and hematomas for general surgery is known. More recently, an ultrasonic surgical apparatus has been used that can cut and separate hard tissue by ultrasonic vibration.

Further, among various techniques and devices for performing minimally invasive and non-invasive treatment, in particular in the gastrointestinal field, surgery for removing the gallbladder using a laparoscope is compared with open surgery. Since there is little surgical invasion, recovery is quick,
It is becoming widespread due to the short hospitalization days, quick return to society, light post-operative pain, and extremely small surgical wounds.

In this operation, the inside of the abdominal cavity is insufflated by carbon dioxide gas or the like without laparotomy, and an endoscope, forceps,
Insert an electric scalpel, etc., and remove the gallbladder under the field of view of the endoscope. The point is to safely and accurately remove the gallbladder duct and gallbladder artery from the Calot triangle, clip and cut, and further detach the gallbladder bottom from the liver bed to grasp the gallbladder with forceps and remove it outside the body. It is to be.

However, when the present endoscopic surgery is applied to all cases of cholelithiasis, if only ordinary treatment tools are used, the degree of gall bladder inflammation, the position of gall stones, the shape of gallbladder ducts and gallbladder arteries, etc. Depending on conditions such as the age of the patient and the like, there are problems such as heavy bleeding from the arteries and the hepatic bed, and difficulty in fixing the gallbladder duct and the gallbladder artery. On the other hand, measures such as improving the hemostatic effect by improving the shape of the tip of the electric scalpel and measures such as bleeding with a laser scalpel have been taken. Does not provide fundamental bleeding protection because it uses the mechanical tearing force of forceps.

Therefore, it has been attempted to carry out these operations using a surgical operation apparatus using ultrasonic vibration capable of selectively preserving elastic bodies such as blood vessels. However, since the operation is performed in a narrow field of view of the endoscope, it is not possible to change the insertion position by holding the handpiece as in the case of open surgery, and the distance between the endoscope and the objective lens is a few. cm
Because of the short length, the irrigation liquid ejected from the tip of the handpiece may impinge on the lens and obstruct the visual field.

For example, as shown in FIG. 7, gallbladder (3
When the gallbladder duct (36) connected to 7) is removed,
Since the insertion direction of the tip (100) at the tip of the handpiece is limited by the direction of the trocar puncturing the abdominal cavity from outside the body, it is difficult to peel off the bottom of the gallbladder duct (36). In the state shown in FIG. 8, the chip (10
The vibration of (0) causes the irrigation liquid ejected from the gap between the tip cover (101) and the tip (100) to spread over a wide range, causing the lens of the endoscope to become cloudy.

Further, in the operation under the endoscope, the vibrating body portion to be inserted into the body such as the tip becomes long, so that it is difficult to judge whether or not the irrigation liquid can be reliably supplied to the tip of the tip. If the tip is vibrated in a state where the amount of the irrigation liquid is insufficient, the high temperature irrigation liquid may be ejected to damage the tissue, and a countermeasure is required.

[0009]

SUMMARY OF THE INVENTION An object of the present invention is to solve the above problems of the conventional surgical handpiece using ultrasonic vibration, and it is possible to solve the problems in a narrow endoscope field of view. To provide a surgical handpiece capable of preventing the visual field of an endoscope from being obstructed by jetting of an irrigation liquid in surgery and safely and accurately peeling blood vessels and the like, and capable of stable operation for a long time. .

[0010]

That is, the present invention is a surgical handpiece for crushing or cutting and separating foreign matter in a biological tissue or a body cavity by ultrasonic vibration and removing the ultrasonic vibration source. It is composed of a vibrating body that is connected to the ultrasonic vibration source to transmit and expand mechanical vibrations at ultrasonic frequencies, and a protective cover that houses and covers these.The ultrasonic vibration source and the vibrating body penetrate in the length direction. The surgical operation is characterized in that the protective cover is connected by a suction passage, the distal working portion of the vibrating body projects from the distal end of the protective cover, and the protective cover is attached so as to be rotatable about the axis of the vibrating body. It is a surgical handpiece.

Further, the tip of the vibrating body is curved in an arc shape, and the bending point is 3/100 or more wavelengths from the tip of the vibrating body and is 3 or more.
Within 0 mm, the bending angle is 35 degrees or less, and the protective cover covers the body cover that houses the ultrasonic vibration source and a part of the joint part, and the tip part and a part of the joint part. The tip cover is transparent or semi-transparent, and the tip cover is detachably formed, and the tip cover is attached. 1 from the tip
/ 2 has a cylindrical portion having a constant outer diameter of at least two wavelengths, and a protrusion is provided on the inner surface of the chip cover at a position corresponding to a node of vibration of the vibrating body to hold the chip cover. Characterize.

Furthermore, a ring-shaped projection is provided on the outer peripheral surface of the rear end portion of the chip cover to facilitate the rotation operation of the chip cover, and a plurality of recesses are provided at the tip of the main body cover so that the chip cover Protrusions are provided at positions corresponding to the recesses on the inner surface of the rear part to enable the batch rotation of the tip cover, or the body cover is provided with a grip that can be attached / detached, rotated, and moved back and forth. It is characterized by facilitating the holding and operation of the handpiece.

The present invention will be described in detail below with reference to the drawings. FIG. 1 is a view for explaining a basic structure of a surgical handpiece according to an embodiment of the present invention, FIG. 2 is a shape of a tip of a tip portion thereof, and FIG. 3 is a view showing a structure of a tip cover. Is.

As shown in FIG. 1 (a), the ultrasonic vibration source (1) is joined to a vibrating body composed of a joint portion (2) and a small-diameter tip portion (3) by means such as a screw, Inside these, a suction passage (4) is provided penetrating in the length direction. Although the joint part (2) and the tip part (3) may be separately manufactured as shown in the figure and joined by means such as a screw, the ultrasonic vibration source (1) and the joint part (2), or Joint part (2) and tip part (3)
It does not matter at all if it is formed integrally. The joint between the tip portion (3) and the joint portion (2) is located between the vibration node and the abdomen to reduce the stress applied to the node of the tip portion (3).

The surgical handpiece according to the present invention comprises:
It is used by inserting it into the abdominal cavity together with an endoscope or the like through a trocar installed through the abdominal wall, and usually has a length of the small diameter tip portion (3) of 220 to 270.
mm is required. Further, the joint portion of the joint portion (2) and the tip portion (3) needs to be provided in the vicinity of the node surface of ultrasonic vibration in consideration of the problem of material fatigue and damage due to vibration. The working part (14) at the tip of the tip is
Since it is necessary to maximize the amplitude, the antinode of vibration is used. The wavelength of ultrasonic vibration is determined by the frequency of vibration, the material (density) of the vibrating body, the outer diameter size, etc. As an example, in the case of a stainless steel chip with an outer diameter of 4 mmφ, the wavelength is about 211 mm and 38 kHz when the frequency is 24 kHz. Is about 133 mm. Taking these conditions into consideration, it is appropriate that the length of the tip of the handpiece be approximately 5/4 times or 7/4 times the wavelength.

Further, in order to increase the amplitude in the length axis direction of the working portion (14), it is effective to make the vicinity of the tip portion of the tip portion (3) thin and bend. Figure 2 (a)
As shown in, the bending point (25) at which the tip portion starts to bend from the longitudinal axis is located at a position separated by 3/100 wavelength or more from the tip portion of the tip portion, but the relationship with the tip cover (8) is Considering this, the distance should be within 30 mm. Further, the bending angle R formed by the tangent line (26) at the tip of the curved tip portion with respect to the axis in the length direction needs to be 35 degrees or less. It is also not preferable from the viewpoint of operability (14).

Next, the opening of the suction passage at the tip of the working portion (14) is preferably smaller than the diameter of the suction passage (4) inside the tip portion (3). This has the advantage that it is possible to prevent the suction passages from being blocked by clogging of the vibration nodes of the tip portion (3) and blocking the passage.

On the other hand, these ultrasonically vibrating members are
It is stored and covered with a protective cover made of heat-resistant resin. As shown in FIGS. 1B and 1D, the protective cover includes a main body cover (5) for accommodating the ultrasonic vibration source (1) and a part of the joint portion (2), and a joint portion (2). ) Is a combination of a tip cover (8) covering the tip portion (3) and the tip portion (3), and a main body cover (5) of the ultrasonic vibration source (1).
There is no particular limitation on the fixing method to the ultrasonic vibration source (1). A cable (6) for supplying high frequency power to the suction nipple (7) communicating with the suction passage (4) and the ultrasonic vibration source (1) is attached to the rear end of the body cover (5). ing.

As shown in FIG. 3, the tip cover (8) has a lumen (16) for inserting the tip portion (3). An annular space formed between the tip portion (3) and the tip portion (3) when the tip portion (3) is inserted into the inner cavity (16) is used as a passage for supplying an irrigation liquid such as physiological saline, and the rear end of the tip cover (8). An irrigation nipple (9) serving as an inlet for irrigation liquid is provided near the part. Further, as shown in FIG. 3B, a tip cover (12) formed as a detachable separate component may be attached to the tip of the chip cover (8) to configure the tip cover (8) with two components. good.

The tip of the tip cover (8) is shown in FIG. 3 (a).
In the case of the structure shown in Fig. 3, it is preferable that the whole or at least the vicinity of the tip is made of a semitransparent or transparent material. In the case of the structure shown in Fig. 3B, the tip cover ( Only 12) should be made semi-transparent or transparent. By doing so, the tip cover (8) or its tip cover (12) is semi-transparent or transparent, so that the surgeon viewing the endoscopic image can check the supply status of the irrigation liquid by himself. Therefore, it is possible to prevent the damage to the tissue due to the increase in the liquid temperature due to the lack of the irrigation liquid. During operation, the tip cover (12) and the side surface of the tip portion (3) may come into contact with each other, and the tip cover (12) may be deformed. Also, in order to prevent infection, it is required to dispose the tip cover directly in contact with the affected area. Therefore, the tip cover attachment / detachment method is useful. Since the tip cover (12) is connected to the tip cover (8) with a screw or the like and is removable, there is also an advantage that the tip cover (12) having different opening dimensions can be replaced according to the surgical procedure.

As described above, the surgical handpiece according to the present invention is inserted into the abdominal cavity through the trocar to perform the operation, and therefore the forward and backward movements are repeated during the operation. Therefore, when the outer diameter of the chip cover is tapered, various problems occur. In order to make this forward / backward operation smooth and to prevent leakage of pneumoperitoneum gas at that time, it is desirable that the outer diameter of the tip cover be constant. The length is 1 from the tip of the tip cover.
/ 2 wavelengths or more is preferable.

The chip cover (8) is a body cover (5).
And is held by contact with a protrusion (11) provided on the inner surface of the tip cover (8) at a position corresponding to the node of vibration of the vibrating body, as shown in FIG. , Can be rotated around the axis of the vibrating body. The protrusion (11) may be formed integrally with the chip cover, or a member such as an elastic body may be bonded. The rotation torque is 2 to 150 cm · kg, preferably 4
It is good to set 0 to 60 cm · kg.

In order to easily rotate the tip cover (8), a ring-shaped protrusion (1
0) is provided and the tip cover is operated by the operator with one hand (8)
It is possible to rotate. Although the rotation may be free rotation, a plurality of depressions (21) are provided at the tip of the main body cover (5) (see FIG. 1a), while the tip cover (8) is provided at a position corresponding to the depression on the rear inner surface. By providing a protrusion (23) (FIG. 3c) to allow the tip cover to rotate in batches, it is possible to maintain its position at all times unless the operator intends to rotate it, and , It is also useful as a positioning mechanism for determining the relative orientation (angle) of the tip end portion and the tip cover.

Further, as shown in FIG. 1 (d), a grip (22) which can be attached / detached, rotated, and moved back and forth is attached to the main body cover (5) so that the handpiece can be held and one hand at the time of operation. Operation becomes easier. This grip (22) not only assists in one-handed operation of rotating the tip cover, but also has the advantage that the operator's fatigue can be reduced because it is possible to work only by supporting without holding the handpiece firmly. Hold together.

The shapes of the ring-shaped protrusion (10) and the grip (22) are not particularly limited, but the protrusion (10).
It is preferable to have a concave shape so that the operator's finger fits. Further, the shape of the grip (22) is preferably such that it fits in the palm of the hand. The protrusion (10) may be integrally formed as a part of the chip cover, or may be assembled as a separate component. The material of the ring-shaped protrusion and the grip is not particularly limited, but may be any material that can be sterilized under high pressure steam, such as fluorocarbon rubber, silicone rubber, fluorocarbon resin, polysulfone resin, and polyethersulfone resin.

As shown in FIG. 4, the method of using the surgical handpiece according to the present invention is as follows.
0) to ultrasonic vibration source (1) in handpiece (13)
High-frequency power of resonance frequency is supplied to the ultrasonic wave, where ultrasonic vibration is generated, and ultrasonic vibration is transmitted and expanded by a vibrating body that combines the joint part (2) and the tip part (3), and the tip part of the tip part (3) In the working section (14), the crushing work of biological tissue or the like is performed.

Simultaneously with the start of vibration, the roller pump (52) is operated to inject the irrigation liquid from the bottle (19) into the protective cover (8) through the irrigation tube (51) and the irrigation nipple (6). The irrigation liquid passes through the annular passage between the inner wall of the inner cavity (16) and the tip portion (3), and is jetted from the tip portion of the tip cover (8) toward the working portion (14) by ultrasonic vibration. Biological tissues and the like are crushed and emulsified by the irrigation liquid and ultrasonic vibration of the working unit (14). The emulsified crushed pieces pass through the suction passage (4) inside the tip portion (3), the joint portion (2) and the ultrasonic vibration source (1) by the suction pressure of the suction pump (53), and then the suction nipple (7). ), Through a suction tube (18) and collected in a suction bottle (17). In addition, smoke generated in the abdominal cavity when a laser knife or an electric knife is used together is used as a suction passage (4) inside the handpiece.
Since it can be exhausted to the outside of the body, it can reduce the obstruction of the visual field due to smoke.

Further, as shown in FIG. 2 (b), the tip portion of the tip cover (8) or the tip cover (12) is 10 to 80 degrees with respect to the longitudinal axis, and more preferably 45 to.
It is preferable that the inclined surface has an angle of 60 degrees. As a result, the ejection direction of the irrigation liquid due to ultrasonic vibrations in the working portion (14) at the tip of the tip portion (3) can be limited, and it can be prevented from scattering and adhering to the endoscope lens. Furthermore, as shown in FIG.
By providing 0), blood vessels and living tissues can be floated as shown in FIG. 5 or pressed and held as shown in FIG.
Vessels can be identified by ultrasonic vibration.

5 and 6 are views showing examples of use of the surgical handpiece according to the present invention. FIG. 5 shows the gallbladder (3
7) The lower part of the gallbladder duct (36) connected to 7) is peeled off by the working portion (14) at the tip of the arc-shaped tip, and FIG. 6 shows the same without changing the insertion position of the handpiece. , By changing the direction of the working part (14) by rotating the tip part (3) while holding the handpiece on the reflective side of the gallbladder duct (36) without removing it once and reinserting it from another puncture hole. , Peeling work is possible, and the inclined part (2
0) shows a situation in which the irrigation liquid can be prevented from scattering to the endoscope lens.

Further, the tip cover (8) is formed at the connecting portion of the main body cover (5) so that it can be rotated about the longitudinal axis of the vibrating body and positioned and fixed. During the operation, the tip cover (8) is rotated according to the situation of the surgical site, the direction of the surface of the inclined portion (20) at the distal end is changed, and the projecting area of the tip part (3) is changed to eject the irrigation liquid. It is possible to adjust the direction,
It is possible to avoid the influence of the scattering of the irrigation liquid on the field of view of the endoscope and to perform the operation more smoothly.

[0031]

According to the present invention, it is possible to safely and accurately identify a blood vessel or the like in an endoscopic operation using a surgical handpiece using ultrasonic vibration.
In addition, it is possible to prevent the fogging of the endoscope lens due to the scattering of the irrigation liquid, which not only enables smooth surgery, but also expands the number of indication cases.In addition, the tip cover can be rotated with one hand when using it. The angle of the tip portion is easy to understand, and holding of the handpiece is easy and the operator's fatigue is reduced, which is extremely useful as a surgical handpiece.

[Brief description of drawings]

FIG. 1 is a view showing a basic structure of a surgical handpiece according to an embodiment of the present invention, in which (a) is a cross-sectional view in which an ultrasonic vibration source and a vibrating body are connected, (b) and (c). 8A is a side view with the body cover attached, and FIG. 8D is a side view with the body cover and the chip cover attached.

FIG. 2 is a diagram for explaining the shape of the tip of the tip portion and the relationship with the tip of the tip cover in the present invention.

FIG. 3 is a sectional view showing a structure of a chip cover according to the present invention.

FIG. 4 shows an overall system using a surgical handpiece according to the present invention.

FIG. 5 is a diagram showing an example of use of the surgical handpiece according to the present invention.

FIG. 6 is a diagram showing an example of use of the surgical handpiece according to the present invention.

FIG. 7 is a diagram showing an example of use of a conventional surgical handpiece.

FIG. 8 is a diagram showing an example of use of a conventional surgical handpiece.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Ultrasonic vibration source 2 Joint part 3 Tip part 4 Suction passage 5 Main body cover 8, 101 Chip cover 10 Protrusion 11, 23 Protrusion part 12 Tip cover 14 Working part 20 Sloping part 21 Cavity 22 Grip 25 Curved point 26 Tangent line 36 Bile duct 37 Gallbladder R Curved angle

Claims (13)

[Claims] 1. A surgical handpiece for crushing or cutting, separating and removing a foreign substance in a biological tissue or a body cavity by ultrasonic vibration, the ultrasonic handpiece being an ultrasonic vibration source and an ultrasonic wave connected to the ultrasonic vibration source. It consists of a vibrating body that transmits and expands mechanical vibration of frequency, and a protective cover that houses and covers them.The ultrasonic vibration source and the vibrating body are connected by a suction passage that penetrates in the longitudinal direction. The surgical operation handpiece, wherein the protective cover has a distal end working portion of a vibrating body protruding from a distal end thereof and is attached so as to be rotatable about an axis of the vibrating body. 2. The surgical handpiece according to claim 1, wherein the tip of the vibrating body is curved in an arc shape. 3. The bending point of the tip of the vibrating body is 3 from the tip.
The surgical handpiece according to claim (2), wherein the handpiece for surgery is located at a position of not less than / 100 wavelength and not more than 30 mm, and has a bending angle of 35 degrees or less. 4. The vibrating body comprises a joint portion and a thin tip portion, wherein the vibrating body comprises a joint portion and a thin tip portion.
The surgical handpiece according to any one of 1. 5. The protective cover is a combination of a main body cover that houses an ultrasonic vibration source and a part of a joint part, and a tip cover that covers a tip part and a part of the joint part. The surgical handpiece according to claim (4). 6. The surgical handpiece according to claim 5, wherein the entire tip cover or the vicinity of the tip is transparent or translucent. 7. The surgical handpiece according to claim 5, wherein the tip portion of the tip cover is mounted with a detachable transparent or translucent tip cover. 8. The chip cover is held by providing a protrusion on the inner surface of the chip cover at a position corresponding to the node of vibration of the vibrating body. The surgical handpiece according to any one of claims. 9. The surgical operation according to claim 5, wherein the tip end surface of the tip cover has an angle with respect to the longitudinal axis of the vibrating body. Handpiece. 10. The chip cover according to claim 5, wherein the tip cover has a cylindrical portion having a constant outer diameter with a length of ½ wavelength or more from the tip. The surgical handpiece according to claim 2. 11. The surgical handpiece according to claim 5, wherein a ring-shaped protrusion is provided on the outer peripheral surface of the rear end portion of the tip cover. 12. A plurality of depressions are provided at the tip of the main body cover, and a protrusion is provided at a position corresponding to the depressions on the inner surface of the rear portion of the chip cover, so that the tip cover can be rotated in a batch manner. The surgical handpiece according to claim 11, characterized in that 13. The surgical handpiece according to claim 5, wherein the main body cover is provided with a grip that can be attached and detached, rotated, and moved back and forth.