JPH08280700A - Surgical appliance - Google Patents

Abstract

PURPOSE: To easily treat different regions by one appliance by providing an opening and closing member to the leading end part of the insertion lever inserted in a communication pipe and providing a surgical operation means performing opening and closing or revolving operation to the leading end park of the opening and closing member. CONSTITUTION: A surgical appliance forceps 1 has the insertion lever 1a inserted in the trocar arranged so as to pierce the abdominal wall, a pair of the opening and closing members 2a, 2b provided to the leading end part of the insertion lever 1a and performing opening and closing operation, the first operation means 5 performing the opening and closing operation of the opening and closing member 2 remotely, the first and second surgical operation means 3, 4 provided to the leading end part of the opening and closing member 2 and performing opening and closing or revolving operation and a second operation means 6 remotely operating the first and second surgical operation means 3, 4. An operation device 1b is connected to the base end part of the insertion lever 1a and a drive member driving the opening and closing members 2a, 2b by the movement in a longitudinal direction is constituted of an operation lever 51 and shaking members 52a, 52b.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to surgical instruments such as forceps and scissors, and more particularly to a surgical instrument suitable for use in laparoscopic surgery.

[0002]

2. Description of the Related Art In recent years, in surgery for appendicitis, excision of gallbladder, etc., in addition to laparotomy, non-laparoscopic laparoscopic surgery performed without laparotomy may be performed. In this laparoscopic surgery, multiple tubes called trocar tubes are inserted into the abdominal cavity,
A forceps inserted into another trocar tube to monitor the inside of the abdominal cavity with a camera inserted from one trocar tube.
A desired surgical procedure is performed in the abdominal cavity while observing the monitor with an instrument such as scissors or an electric scalpel.

By the way, in the above laparoscopic surgery,
Usually, the inner diameter of the trocar tube is about 10 mm, and only one instrument can be inserted into one trocar tube. Therefore, when trying to perform an intestinal anastomosis by laparoscopic surgery,
The surgeon inserts two forceps into the abdominal cavity through different trocar tubes, reaches the intestinal anastomosis site, grasps the stumps of the two intestines to be anastomosed, and grasps the stumps of these intestines. Close up in parallel and perform an anastomosis operation.

However, since the two forceps do not pass through the same trocar tube, even if the forceps and the tips of the forceps can be brought close to each other, it is difficult to bring the stumps of the two intestines close to each other in parallel. However, it was very difficult to join the two layers of the intestinal mucosa, the intestinal muscle layer, and the intestinal serosa at the stumps.
Therefore, in the above-mentioned laparoscopic surgery, the intestinal anastomosis operation is very difficult, and it takes time and labor,
There are many opportunities for infection, the joining of the above layers is likely to be incomplete, and there is a risk that the anastomosis may be delayed in connection or anastomotic leakage may occur. Further, since at least two trocar tubes are required to insert the two forceps into the abdominal cavity, the number of trocar tubes pierced into the abdominal wall, that is, the puncture site on the abdominal wall becomes larger, and the burden on the patient is increased. It was causing an increase.

[0005]

SUMMARY OF THE INVENTION An object of the present invention is to provide a surgical instrument having excellent operability, which can easily treat different regions simultaneously or in parallel with one instrument. Moreover, the objective of this invention is to provide the surgical instrument which can perform an intestinal anastomosis operation easily with one instrument. Another object of the present invention is to provide a surgical instrument capable of further reducing the number of trocar tubes penetrating the abdominal cavity and further reducing the burden on the patient in laparoscopic surgery.

[0006]

[Means for Solving the Problems] The above-mentioned object is as follows (1)
It is achieved by the present invention of (12) to (12).

(1) An insertion rod to be inserted into a communication tube that communicates the inside of the body cavity with the outside of the body, and the insertion rod provided at the tip of the insertion rod,
A pair of opening / closing members for performing the opening / closing operation, a first operation means for remotely opening / closing the opening / closing member, and a first surgical operation for opening / closing or rotating operation provided on the distal end portion of the opening / closing member, respectively. A surgical instrument having means and a second surgical movement means and second operating means for remotely operating the first surgical movement means and the second surgical movement means.

(2) It has a third operating means for rotating the first surgical operating means and the second surgical operating means with the insertion rod as an axis through the opening / closing member. The surgical instrument according to (1) above.

(3) The third operating means is for rotating the insertion rod by rotating the first surgical operating means and the second surgical operating means. Surgical instruments.

(4) The insertion rod is composed of a first rod connected to one of the opening / closing members and a second rod connected to the other of the opening / closing members, and the third operating means. Is for independently rotating the first surgical operation means and the second surgical operation means by rotating the first rod and the second rod about their axes. The surgical instrument according to (2) above.

(5) The first operating means is provided from the base end portion to the tip end portion of the insertion rod, and drives the opening / closing member by movement in the longitudinal direction, and the base end portion of the insertion rod. The surgical instrument according to any one of the above (1) to (3), further comprising: a drive body moving means for moving the drive body in a longitudinal direction to remotely operate the opening / closing member.

(6) The first operating means is provided between the operating rod and the opening / closing member, the operating rod being provided along the insertion rod, and the operating rod and the opening / closing member. It is composed of a pair of swinging members that are swingably connected to the respective members, and operating rod moving means that is provided at the base end of the operating rod and that moves and operates the operating rod in the longitudinal direction. The surgical instrument according to (1) above.

(7) The first operating means is composed of two wires fixed to the opening / closing members and pulling means for pulling the wires respectively (1) to (4). The surgical instrument according to any one of 1.

(8) The first surgical operation means and the second surgical operation means each have a pair of opening / closing bodies that are opened and closed by driving at least one of them. The surgical instrument according to any one of (7).

(9) The first surgical operation means and the second surgical operation means are rotatable with respect to the opening / closing member at a position separated from the distal end of the opening / closing member and the distal end of the insertion rod. The surgical instrument according to any one of (1) to (7) above, which comprises a movable piece connected to.

(10) The surgical instrument according to the above (8), wherein an urging member for urging the opening / closing body in an opening direction is provided between the opening / closing bodies.

(11) The second operating means includes a first wire having a tip fixed to one of the movable pieces, a second wire having a tip fixed to the other of the movable pieces, and the second wire. The surgical instrument according to (9) above, which comprises one wire and a pulling means for pulling the second wire in a proximal direction.

(12) The forceps capable of gripping different treatment sites in a body cavity by the first and second surgical operation means, respectively (1) to (1) above.
The surgical instrument according to any one of 1).

[0019]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS The surgical instrument of the present invention will be described below in detail with reference to the preferred embodiments shown in the accompanying drawings.

FIG. 1 and FIG. 2 are overall side views showing an example of the configuration when the surgical instrument of the present invention is applied to forceps.
In addition, hereinafter, the right side in FIGS. 1 and 2 is referred to as a “base end side”, and the left side is referred to as a “distal end side”.

The surgical instrument (forceps) 1 of the present invention is installed through the abdominal wall and is inserted into a trocar tube as a communication tube for communicating the inside of the abdominal cavity which is a part of the body cavity with the outside of the body. A pair of opening / closing members 2a, 2b provided at the tip of the insertion rod 1a for performing an opening / closing operation, a first operation means 5 for remotely opening / closing the opening / closing member 2, and a tip of the opening / closing member 2. First provided for each to open / close or rotate
The surgical operating means 3 and the second surgical operating means 4 of
And second operating means 6 for remotely operating the surgical operating means 3 and the second surgical operating means 4.

The insertion rod 1a has a length and an outer diameter such that it can be inserted into a trocar tube, and its proximal end has
The operation device 1b described later is connected.

An opening / closing body 2 for performing an opening / closing operation is provided at the tip of the insertion rod 1a. The opening / closing body 2 is composed of a pair of elongated opening / closing members 2a and 2b. The open / close members 2a and 2b are connected at their base ends to the insertion rod 1a so as to be openable and closable by fulcrums 55a and 55b.

These opening / closing members are opened / closed by the first operating means 5. As shown in FIGS. 1 to 3, the first operating means 5 includes a long operating rod 51 provided along the insertion rod 1a, an operating rod 51, and an opening / closing member 2a, 2
b, and the operating rod 51 and the opening / closing member 2a,
2b, a driving body 50 including a pair of swing members 52a and 52b swingably connected to each other, and an operating rod 5
1 (driving body 50) and an operating rod moving means (transmission body moving means) for moving the driving body 50 in the longitudinal direction thereof.

The operating rod 51 penetrates from the front end to the base end of the insertion rod 1a, and is thus provided along the insertion rod 1a. On the other hand, as shown in FIG. 3, the rocking members 52a and 52b have pins 53a and 5b at their base ends, respectively.
It is swingably connected to the operating rod 51 by 3b.

These operating rod 51 and swing member 52
a and 52b, which are provided from the base end portion to the tip end portion of the insertion rod 1a, and are opened / closed by the movement in the longitudinal direction.
A driving body 50 that drives b is configured.

Further, as shown in an enlarged manner in FIGS. 3 and 4, the tip end portions of the swing members 52a and 52b are open / close members 2a and 2b at the base end portions of the open / close members 2a and 2b, respectively.
Are swingably connected to the opening / closing members 2a and 2b through guide slits 252 formed in the surfaces facing each other in the long side direction. A slider 57 is housed in the guide slit 252, and swing members 52a and 52b are swingably connected to the slider 57.

As shown in a further enlarged view in FIG. 5, a storage portion 251 which is an internal space communicating with the guide slit 252 is formed inside the opening / closing members 2a and 2b, and a slider is provided in the storage portion 251. 57 is accommodated so as to be slidable in the longitudinal direction of the opening / closing member 2b. The housing portion 251
From the position of the guide slit 252, extend in the distal direction,
It is formed up to the vicinity of a side hole 25 described later. In the slider 57, a spherical concave portion is formed in a portion protruding outward from the guide slit 252, and a joint portion 571 is provided. The swinging members 52a and 52b are provided on the joint portion 571.
A spherical connection portion 551b provided at the tip end of is fitted into the joint structure so as to be two-dimensionally swingable.

With such a structure, the opening / closing member 2 is
The operating rod 51 is closed by pulling it into the insertion rod 1a and opened by pushing it out toward the tip of the insertion rod 1a.

The slider 57 is formed in the same direction as the sliding direction of the slider 57.
Is provided with a hole 572 penetrating to the base end side and the tip end side of the wire.
b is inserted.

On the other hand, at the base end of the surgical instrument 1, an operating portion 1b is provided. The operation portion 1b has a fixed gripping member 11 and a movable gripping member 12. The fixed gripping member 11 and the movable gripping member 12 are swingably connected by a shaft member 18, and the operating rod connecting portion 13 located at the upper end of the movable gripping member 12 has the base end of the operating rod 51. It is connected.

Leaf springs 16a and 16b are fixed to the opposing surfaces of the fixed gripping member 11 and the movable gripping member 12, and the upper ends of the leaf springs 16a and 16b are in contact with each other.
As a result, the movable gripping member 12 is urged in a direction away from the fixed gripping member 11, that is, the operating rod connecting portion 13 is urged in a direction in which the operating rod 51 is pushed in the distal direction.

At the lower end of the fixed gripping member 11, a check member 14 having saw teeth formed on the upper surface is fixed by a shaft member 17. The lower end of the leaf spring 16a contacts the base end of the check member 14 and biases the tip of the check member 14 to swing upward. Further, the check member 14 can be rotated around the shaft member 17 with fingers or the like.

At the lower end of the movable grip member 12, a recess 12 is formed.
1 is formed, and the leaf spring 15 is accommodated in the recess 121. Further, the check member 14 is inserted through the recess 121, and the tip of the leaf spring 15 is in contact with the saw teeth on the upper surface.

In the above structure, the fixed gripping member 11
When both the movable gripping member 12 and the movable gripping member 12 are held inside the palm, the movable gripping member 12 swings with respect to the fixed gripping member 11 against the biasing force of the leaf springs 16a and 16b, and is connected to the upper end portion. The operated operating rod 51 is pushed out toward the tip side, and the opening / closing member 2 is opened as shown in FIG. At this time, the movable gripping member 12 moves in the proximal direction with respect to the check member 14, and the tip end of the leaf spring 15 moves with respect to the check member 14 while crossing the ridge of the sawtooth. When the gripping force of the hand is released, the movable gripping member 12 does not return to its original position due to the engagement between the saw teeth of the check member 14 and the leaf spring 15, and the state is maintained as it is. By such an operation, the open / close member 2 is maintained in the open state.

Further, from the state shown in FIG. 2, as shown by the broken line in FIG. 2, the check member 1 is resisted against the biasing force of the leaf spring 16a.
When 4 is rotated in a direction away from the leaf spring 15, the engagement between the leaf spring 15 and the saw teeth of the check member 14 is released, and the movable gripping member 12 is moved toward the front end by the biasing force of the leaf springs 16a and 16b. Moving. By this movement of the movable grip member 12, the operating rod connecting portion 13 moves in the proximal direction, and the operating rod 51
Is pulled toward the base end side, and as shown in FIG.
Is closed.

As described above, the opening / closing of the opening / closing member 2 is interlocked with the movement of the movable gripping member 12, and the opening degree (opening angle) of the opening / closing member 2 corresponds to the moving amount of the movable gripping member 12. . Therefore, the opening degree of the opening / closing member 2 can be arbitrarily set by adjusting the moving amount of the movable grip member 12. In addition, the opening of the opening / closing member 2 at that time is maintained and fixed as it is by the engagement of the leaf spring 15 and the sawteeth of the check member 14.

The first surgical operation means 3 and the second surgical operation means 4 provided at the distal ends of the opening / closing members 2a, 2b are
A pair of opening / closing bodies, one of which is driven and opened / closed, that is, rotatably connected to the opening / closing members 2a and 2b at positions separated from the leading ends of the opening / closing members 2a and 2b and the leading end of the insertion rod 1a. It is composed of movable pieces 31 and 41. Hereinafter, these will be described focusing on the first surgical operation means 3.

The tip portion of the opening / closing member 2a shown in FIG. 6 (a) is located at a position separated from the tip by a predetermined length, and the shaft hole 2
3 and a bulging portion 21a having a slit 22 formed in a direction orthogonal to the shaft hole 23. Portions (portions having the slits 252) closer to the base end than the bulging portion 21a of the opening / closing member 2a are shifted from the center of the shaft hole 23 in directions opposite to each other and are connected to the bulging portion 21a, and are parallel to each other. It is provided in.

A side hole 25 is formed on the base end side of the swelling portion 21a of the opening / closing member 2a. The side hole 25 communicates with the housing portion 251 described above, and the wire 61 described later is arranged in the proximal direction through the side hole 25.

On the other hand, the movable piece 3 shown in FIG.
Reference numeral 1 is a bent portion 311 that is bent in a stepped manner at its base end portion. Further, a substantially cylindrical bulging portion 312 having a shaft hole 33 is formed in the middle of the movable piece 31.

A portion of the opening / closing member 2a closer to the tip than the bulging portion 21a, the bulging portion 21a and the bulging portion 31 of the movable piece 31.
A portion closer to the tip than 2 serves as a gripping portion for gripping the living tissue in the body cavity. In addition, on the surfaces of these parts facing each other, in order to easily grasp the biological tissue,
The unevenness is provided.

As shown in FIGS. 7 and 8, the bulging portion 33 of the movable piece 31 is inserted into the slit 22 of the opening / closing member 2a, and the bulging portion 21 is aligned with the shaft hole 23 and the shaft hole 33.
It is inserted in a. A shaft member 32 is inserted into the shaft hole 23 and the shaft hole 33, whereby the movable piece 31 is rotatably connected to the opening / closing member 2a.

The tip of the wire 61a is connected to the inside of the bent portion 311 of the movable piece 31. This wire 6
1a is a storage portion 251 through the side hole 25 of the opening / closing member 2a.
It enters, is inserted into the hole 572 of the slider 57, further passes through the inside of the insertion rod 1a, and is pulled by a traction mechanism 6a described later.
Has reached.

Further, between the opening / closing member 2a and the movable piece 31, a spring 68a, which is an urging means for urging the movable piece 31 in the opening direction, is installed. The wire 61a is
The tip of the spring 68a is fixed to the movable piece 31 through the inside of the spring 68a. In this way, the spring 68 is connected to the wire 61a.
By inserting the wire, the wire 61a is not exposed in the surgical operation means 3, and the cutting of the wire 61a can be prevented.

In the above structure, the wire 61
When almost no tension acts on a, the bending portion 311 of the movable piece 31 is moved by the urging force of the spring 68a.
The movable piece 31 is rotated in a direction away from the movable piece 31 (the state shown in FIG. 8). Further, when the wire 61a is pulled in the proximal direction from this state, the spring 6 as the urging member is
The bending portion 311 of the movable piece 31 is pulled toward the opening / closing member 2a against the biasing force of the moving piece 8a, and the movable piece 31 is closed (the state shown in FIG. 7).

The second surgical operation means 4 is also the first
Similar to the surgical operation means 3 of FIG. 1, the opening / closing member 2b and the movable piece 4 rotatably connected to the opening / closing member 2b by the shaft member 42.
The spring 6 which is a biasing means similar to the spring 68a is provided between the opening / closing member 2b and the movable piece 41.
8b is installed, and the tip of the wire 61b is fixed to the movable piece 41. In the second surgical operation means 4, the opening / closing member 2a and the opening / closing member 2b are opposed to each other, and the movable piece 41 is located on the side (outer side) opposite to the movable piece 31 in the first surgical operation means 3. It has the same structure as the first surgical operation means 3 except that it is connected to the insertion rod 1a, and opens and closes on the same principle as the first surgical operation means 3.

By providing biasing means for biasing the first surgical operation means 3 and the second surgical operation means 4 (movable pieces 31, 41 in the illustrated example) in the opening direction, the wire 61 is provided.
The surgical operation means 3 and 4 can be opened only by reducing or eliminating the tension (traction force) of the wires 61a and 61b without performing a special operation for loosening a and 61b. Easy to operate.

In the above structure, the movable pieces 31, 41 are
Is connected to the opening / closing members 2a, 2b (positions where the first surgical operation means 3 and the second surgical operation means 4 are formed) at the tip end portions of the opening / closing members 2a, 2b, that is, the opening / closing members 2a, 2b.
It is located at a position apart from the tip of the insertion rod 1a, which is the opening / closing center of b. Therefore, when the opening / closing members 2a and 2b are opened, the first surgical operation means 3 and the second surgical operation means 4 can be arranged apart from each other, and different treatment sites located apart from each other can be simultaneously or in parallel. Can be treated.

The surgical instrument 1 of the present invention has the second operating means 6 for remotely operating the first surgical operating means 3 and the second surgical operating means 4 independently of each other.

In the illustrated example, this second operating means 6 is
A first traction device 6a for remotely operating the first surgical operating means 3, a second traction device 6b for remotely operating the second surgical operating means 4, and the wires 61a, 61b.
It is composed of

As shown in FIGS. 1 and 9, the pulling means 6a, 6b are provided with housings 60a, 60b provided at the base end of the insertion rod 1a and housings 60a, 60b.
Each of the wires 61 is rotatably attached to the wire b.
Shaft members 62a, 62b in which the base ends of a and 61b are fixed
And the shaft members 62a and 62b are fitted and inserted,
saw gears 63a, 6 capable of rotating integrally with a, 62b
3b, the engaging claws 64a and 64b rotatably supported by the housings 60a and 60b, and the shaft members 62a and 62b fixed to or integrated with the portions of the shaft members 62a and 62b protruding from the housings 60a and 60b, and the shaft members 62a and 62b are rotated. It has handles 69a and 69b for dynamic operation.

As shown in FIG. 9, housings 60a, 6a
0b is fixed to both side surfaces of the base end portion of the insertion rod 1a, and has holes 601a and 601b on the side facing the operation rod 1a. On the other hand, the insertion rod 1a
The base end portion of the hole 101a communicating with the hole 601a.
And a hole 102a facing the hole 601b is provided,
As a result, the inside of the insertion rod 1a and the housings 60a, 6
The inside of 0b communicates. The base end portion of the wire 61a passes through the hole 11 and the hole 601a, and the housing 68
It is inserted in a and is wound around the shaft member 62a,
The base end is fixed to the shaft member 62a. Similarly, the base end portion of the wire 61b is also inserted into the housing 68b via the hole 12 and the hole 601b and wound around the shaft member 62b, and the base end is fixed to the shaft member 62b.

The first traction device 6a will be mainly described below.

A groove 602 is formed on the base end side of the housing 60a as shown in FIG. 10, and the engaging claw 64a is formed.
Is pivotally supported by a pin 65 so that it can be rotated in the groove 602. The portion of the engaging claw 64a that protrudes outward from the groove 602 is formed to have a length that allows the engaging claw 64a to be easily rotated by a finger or the like. The spring 66 is fixed between the inner surface of the housing 60a and the engaging claw 64a, and urges the engaging claw 64a in a direction in which the engaging claw 64a engages the saw teeth of the saw gear 63a.

In the state shown in FIG. 10, the shaft member 62a
In the saw gear 63a, the engaging claw 64a can be rotated in the clockwise direction in FIG. 9 over the saw tooth crest of the saw gear 63, but in the counterclockwise direction in FIG. It cannot rotate due to the engagement with the saw teeth. Therefore, the rotation direction of the shaft member 62a and the saw gear 63a is restricted to only one direction (clockwise in FIG. 9).

On the other hand, from this state, the groove 6 of the engaging claw 64a is
When the portion projecting from 02 is rotated counterclockwise in FIG. 9, the tip of the engaging claw 64a moves away from the saw teeth against the biasing force of the spring 66, and as shown in FIG.
And the saw gear 63a are disengaged, and the shaft member 62a and the saw gear 63a can rotate freely.

As described above, the engaging claw 64a and the saw gear 6
When the handle 69a is rotated in the base end direction in a state of being engaged with 3a (a state shown by a solid line in FIG. 1), the saw gear 63a is formed.
And the shaft member 62a rotates clockwise in FIG. 9, the wire 61a is wound around the shaft member 62a and pulled in the proximal direction, and the movable piece 31 is closed.

Thus, the closing operation of the movable piece 31 is interlocked with the rotation of the handle 69a, and the opening degree of the movable piece 31,
That is, the gripping force corresponds to the amount of rotation of the handle 69a. Therefore, by adjusting the amount of rotation of the handle 69a, the opening degree (grasping force) of the movable piece 31 can be adjusted.
It can be set to an arbitrary opening degree corresponding to the engagement position between 3a and the engaging claw 64a. Since the rotation of the shaft member 62a is locked by the engagement of the saw gear 63a and the engaging claw 64a, the opening of the movable piece 31 at that time is maintained as it is even if the handle 69a is released. Fixed.

When the movable piece 31 is opened, the engaging claw 64a
Is operated to rotate as shown in FIG. 11, and the saw gear 63a is rotated.
And the engagement claw 64a are disengaged. As a result, the tension (traction force) applied to the wire 61a is reduced or eliminated, and the wire 61a is urged by the urging force of the spring 68a.
Is extended in the front end direction, the handle 69a rotates in the front end direction (indicated by the one-dot chain line in FIG. 1), and the movable piece 31 is opened.

The second traction device 6b also has the same structure as the first traction device 6a except that the second traction device 6b has a symmetrical shape with the operating rod 51 as a boundary in FIG. In this traction device 6b, when the handle 69b is rotated in the proximal direction (state shown by the solid line in FIG. 2), the saw gear 63b and the shaft member 62b rotate in the direction opposite to the traction device 6a, and the wire 61b. Is wound around the shaft member 62b and pulled in the proximal direction, and the movable piece 41 is closed. Further, the engaging claw 64a is operated to operate the saw gear 63a and the engaging claw 6a.
When the engagement with 4a is released, the tension (traction force) applied to the wire 61b decreases or disappears, and the urging force of the spring 68b causes the wire 61b to be extended in the distal direction and the handle 69b to rotate in the distal direction. At the same time (the state indicated by the alternate long and short dash line in FIG. 2), the movable piece 41 opens.

Next, the operation of the surgical instrument 1 of the present invention will be described with reference to the case where it is applied to an intestinal anastomosis operation in a laparoscopic operation.

[1] As shown in FIG. 1, by engaging the saw teeth of the check member 14 of the surgical instrument 1 with the leaf spring 15, the fixed gripping member 11 and the movable gripping member 12 are placed in the palm of the hand. While grasping and fixing the opening / closing member 2 in the closed state, operating the engaging claws 64a, 64b and the handles 69a, 69b to close the first surgical operation means 3 and the second surgical operation means 4 in the closed state. Fix it. In this state, the surgical instrument 1 is inserted through the trocar tube which is pierced and fixed in the abdominal wall of the patient.

[2] The check member 14 is rotated to move the leaf spring 15
And the opening / closing member 2 is opened and the pulling means 6a,
The engaging claws 64a, 64b of 6b are operated to move the engaging claws 64a,
The engagement between 64b and the saw gears 63a, 63b is released, and the first surgical operation means 3 and the second surgical operation means 4 are opened. In this state, the first surgical operation means 3 is positioned so that one stump 9A of the intestine to be anastomosed enters between the movable piece 31 and the opening / closing member 2a (see FIG. 12).

At this time, the saw teeth of the check member 14 of the surgical instrument 1 and the leaf spring 15 are re-engaged, and the fixed gripping member 11 and the movable gripping member 12 are slightly gripped in the palm of the hand. It is preferable to adjust the opening degree of the opening / closing members 2a, 2b according to the distance between the two intestinal stumps 9A, 9B.

[3] The engaging claw 64a is operated to operate the engaging claw 64a.
a is engaged with the saw gear 63a, and then the handle 69a
Is rotated in the proximal direction to close the movable piece 31 and grip the stump 9A. At this time, by adjusting the rotation amount of the handle 69a, the grasping force of the surgical operating means 3 is appropriately adjusted in consideration of the thickness and size of the intestinal stump 9A.

[4] Subsequently, the first surgical operation means 4 is
The intestine stump 9B is positioned so as to enter between the movable piece 41 and the tip of the opening / closing member 2b (see FIG. 13).

[5] The engaging claw 64b is operated to operate the engaging claw 64b.
After engaging b with the saw gear 63b, the handle 69b
Is rotated in the proximal direction to close the movable piece 41 and grasp the stump 9B of the intestine (see FIG. 14). Also at this time, the surgical operation means 4 is adjusted by adjusting the rotation amount of the handle 69b.
The gripping force is appropriately adjusted in consideration of the thickness and size of the intestinal stump 9B.

[6] The check member 14 is rotated in the opposite direction to the above [2] to re-engage with the leaf spring 15, and then the fixed gripping member 11 and the movable gripping member 12 are gripped to open and close the opening / closing member. Two
Close a and 2b. As a result, the stumps 9A and 9B of the intestine come close to each other in parallel (see FIG. 15).

[7] A suture instrument (not shown) inserted through another trocar tube is used to join the intestinal mucosa, the intestinal muscular layer and the intestinal serosa of the intestinal stumps 9A and 9B to each other to perform the intestinal anastomosis operation. Complete.

Next, another embodiment of the surgical instrument of the present invention will be described. 16 and 17 are overall side views showing a second configuration example when the surgical instrument of the present invention is applied to forceps. Note that, hereinafter, the same components as those in the above-described first configuration example are denoted by the same reference numerals, and description thereof will be omitted.

The surgical instrument (forceps) 1'of the second embodiment.
Is an insertion rod 1'a that is installed through the abdominal wall and is inserted into a trocar tube as a communication pipe that communicates between the inside of the abdominal cavity that is a part of the body cavity and the outside of the body, and the tip of the insertion rod 1'a. A pair of opening / closing members 2'a, 2'b that are provided to perform opening / closing operations;
First operating means 7 for remotely opening / closing the opening / closing means 2'a, 2'b and first opening / closing means 2'a, 2'b for opening / closing or rotating operation respectively Surgical operating means 3 and second surgical operating means 4, second operating means 6 ′ for remotely operating the first surgical operating means 3 and the second surgical operating means 4, and opening / closing members 2′a, 2 through'b,
Third operation means 8 for rotating the first surgical operation means 3 and the second surgical operation means 4 about the insertion rod 1'a as an axis.
And have.

In this embodiment, the insertion rod 1'a is composed of two rods 10'a and 10'b. These rods 10'a, 10'b are hollow, elongated plate-shaped members, and as shown in FIG.
When one of the 0'b is rotated, it is arranged in parallel with a predetermined distance from each other so that it does not come into contact with the other rod and hinder its rotation. Also, the rods 10'a, 1
The length and thickness of 0'b are such that both of them can be inserted into the trocar tube. Further, the base end portions of the rods 10'a, 10'b are fitted into tubular members 82a, 82b whose outer peripheral contours are circular, respectively, and through the tubular members 82a, 82b, an operating device 1 described later is provided. Each of them is rotatably connected to the main body 19 of'b.

On the other hand, an opening / closing body 2'for performing an opening / closing operation is provided at the tip of the insertion rod 1'a. The opening / closing body 2 ′ is composed of a pair of elongated opening / closing members 2′a and 2′b. These opening / closing members 2′a and 2′b are the first
The opening / closing members 2a and 2b have the same configuration except that the configuration of the base end portion connected to the operating means 7 is different.

The base ends of the opening / closing members 2'a and 2'b are openable and closable by fulcrums 74a and 74b, respectively.
It is connected to 0'a and 10'b.

On the other hand, the first operating means 7 for opening and closing the opening / closing members 2'a, 2'b is provided from the base end portion to the tip end portion of the insertion rod 1'a, and is opened / closed by moving in the longitudinal direction. Wire 711 that is a driving body that drives a and 2'b
a, 712a, 711b, 712b and wire 711
a, 712a, 711b, 712b (driving body) in the longitudinal direction, and pulling reels 7a, 7b which are driving body moving means for remotely operating the opening / closing member.

As shown in FIGS. 16 to 18, the tip of the wire 711a is fixed to the outer surface of the opening / closing member 2'a by the fixing portion 731a. This wire 71
1a extends toward the base end side along the opening / closing member 2'a, and the rod 1
After passing through the side hole 721a formed on the outer surface of 0'a,
It passes through the inside of the rod 10'a and reaches the base end of the rod 10'a. On the other hand, the tip of the wire 712a is fixed to the inner surface of the opening / closing member 2'a by the fixing portion 732a. The wire 712a extends in the proximal direction along the opening / closing member 2'a, passes through the side hole 722a formed on the inner surface of the rod 10'a, passes through the inside of the rod 10'a, It reaches the base end of 10'a.

The side holes 721a and 722a are provided at positions separated from the fulcrum 74a toward the base end side. Thus, when the wire 711a is pulled in the proximal direction, the opening / closing member 2'a is rotated outward (on the wire 711a side) about the fulcrum 74a so that the distance from the side hole 721a of the wire 71a to the fixing portion 731a is shortened. Move. When the wire 712a is pulled in the proximal direction, the wire 71
The opening / closing member 2'a pivots inward (on the wire 712a side) around the fulcrum 74a so that the distance from the side hole 722a of 2a to the fixed portion 732a is shortened.

The tip of the wire 711b is fixed to the outer surface of the opening / closing member 2'b by the fixing portion 731b. The wire 711b extends toward the base end side along the opening / closing member 2'b, passes through the side hole 721b formed on the outer surface of the rod 10'b, and passes through the inside of the rod 10'b.
It reaches the base end of the rod 10'b. On the other hand, the tip of the wire 712b is fixed to the inner surface of the opening / closing member 2'b by the fixing portion 732a. This wire 712
b extends along the opening / closing member 2′b in the proximal direction, passes through the side hole 722b formed on the inner side surface of the rod 10′b, passes through the inside of the rod 10′b, and then the rod 10 ′. It reaches the base end of b.

The side hole 721b is provided at a position separated from the fulcrum 74b toward the base end side. As a result, when the wire 711b is pulled in the proximal direction, the wire 711b
The opening / closing member 2'b pivots outward (on the wire 711b side) around the fulcrum 74b so as to reduce the distance from the side hole 721b to the fixed portion 731b. Also, wire 7
When 12b is pulled in the proximal direction, the opening / closing member 2'b rotates inward (the wire 712b side) around the fulcrum 74b so as to reduce the distance from the side hole 722b of the wire 712b to the fixed portion 732b.

The opening / closing members 2'a and 2'b and the rod 1 are
An urging means (not shown) such as a spring for urging the opening / closing members 2′a and 2′b is provided between 0′a and 10′b to reduce the tension (traction force) of the wires 711a and 711b. Alternatively, the opening / closing members 2′a and 2′b may be closed by the urging force of the urging means upon disappearance.

On the other hand, at the base end of the surgical instrument 1 ', the operating portion 1'b for remotely operating the opening / closing members 2'a, 2'b and the first and second surgical operation means 3, 4. Is provided. The operation unit 1'b includes an operation unit main body 19, pulling reels 7a and 7b which are pulling means for pulling the wires 711a, 712a, 711b and 712b in the proximal direction, and pulling wires 61a and 61b to be described later. Device 6 '
It has a and 6'b and rotation knobs 81a and 81b.

The base ends of the rods 10'a and 10'b penetrate the main body 19 from the front end side of the operating portion main body 19 to form the main body 1
9 projecting toward the base end side of the cylindrical member 82a, 82b
It is provided rotatably around the axis of the operation section main body 19 via. At the base end portions of the rods 10'a, 10'b protruding from the operation portion main body 19, the reels 7a, 7b are attached.
Are rotatably supported, respectively.

On the tow reel 7a, the base ends of the wires 711a and 712a extending from the base end of the rod 10'a are wound in opposite directions. The base ends of the wires 711b and 712b extending from the base end of the rod 10'b are wound around the tow reel 7b in opposite directions.

Although not shown, the reels 7a,
It is preferable to provide a lock mechanism for locking the rotational position of 7b. By providing the lock mechanism, the opening / closing members 2′a and 2′b can be set to an arbitrary opening degree and fixed. As this locking mechanism, for example, a known mechanism such as the one shown in FIG. 10 in which the saw teeth and the engaging claw are engaged can be used.

When the pulling reels 7a and 7b are respectively rotated in predetermined directions, the wire 711a and the wire 71 are
1b is pulled, the wire 712a and the wire 712b are loosened, and the opening / closing members 2'a and 2'b rotate in a direction in which they are separated from each other.
Is in an open state (states shown in FIGS. 17 and 18). Further, when the pulling reels 7a and 7b are respectively rotated in the opposite directions, the pulling force (tension) of the wire 711a and the wire 711b is reduced or eliminated, and the wire 712a and the wire 712b are pulled, so that the opening / closing member 2'a. 2'b rotates in the opposite direction to the above, and the opening / closing members 2'a, 2'b are closed (state shown in FIG. 16). With such a configuration, the wires 711a, 71
When one of the wire 1b and the wires 712a and 712b is pulled, the other is loosened, and the other wire is not stretched and does not interfere with the rotation (open / close) operation of the opening / closing members 2′a and 2′b.

Then, the surgical instrument 1'remotely operates the first surgical operation means 3, the second surgical operation means 4, and the first surgical operation means 3 and the second surgical operation means 4. It has a second operating means 6'for operating. The first surgical operation means 3, the second surgical operation means 4 and the second operation means 6'have the same structure as that of the first embodiment except for the following points. .

As shown in FIGS. 17 and 19, on the base end side of the swelling portion 21a of the opening / closing members 2'a, 2'b, from the inner side surface to the outer side surface of the opening / closing members 2'a, 2'b. Holes 25 ', 25' penetrating to are formed.

The ends of the wires 61a and 61b are fixed inside the bent portions 311 and 411 of the movable pieces 31 and 41, respectively, and pass through the holes 25 'and 25' to open / close the members 2'a and 2'b. Exposed on the opposite side of the open / close member 2'a,
Opening / closing members 2'a, 2'b extending toward the base end side along 2'b
Passing through the side holes 723a and 723b formed in the rods and passing through the inside of the rods 10'a and 10'b.
0'b through the side hole (not shown) provided in the base end portion protruding from the operation portion main body 19 and connected to the traction devices 6'a and 6'b provided in the operation portion 1'b. ing. The traction devices 6'a and 6'b are installed on the outer surfaces of the rods 10'a and 10'b, respectively, except that the traction devices 6a and 6b are installed.
It has the same configuration as.

The wires 61a, 61b, 7 as described above
11a, 711b, 712a and 712b are rods 10 '.
Since the wires 10a and 10'b are housed in the rods 10'a and 10'b, the wires are not exposed on the outer surfaces of the rods 10'a and 10'b, and there is no risk of the wires being broken or cut. It is possible to smoothly perform the rotation operation of'a, 10'b.

By operating the pulling devices 6'a and 6'b, the first principle is obtained by the same principle as that of the above-described embodiment.
The surgical operating means 3 and the second surgical operating means 4 are opened and closed.

Further, the surgical instrument 1'includes the opening / closing member 2 '.
It has the 3rd operation means 8 which rotates the 1st surgical operation means 3 and the 2nd surgical operation means 4 centering | focusing on the insertion rod 1'through a, 2'b.

The third operating means 8 comprises knobs 81a, 81b for rotating the insertion rod 1'a to rotate the first surgical operating means 3 and the second surgical operating means 4. The knobs 81a and 81b are the rod 10 '.
They are fixed or integrated to the outer surfaces of the base end portions of a and 10'b, respectively, and are rotatably supported by the operation portion main body 19. The outer peripheral surfaces of the knobs 81a and 81b project to the outside of the operation portion main body 19 and can be operated by fingers.

By rotating the knob 81a, the rod 10'a rotates about its axis. As a result, the first surgical operation means 3 rotates about the axis of the rod 10'a via the opening / closing member 2'a. That is, the knob 81
The operation direction of the first surgical operation means 3 (in the illustrated example, the opening / closing direction) can be changed by the operation of a.

By rotating the knob 81b, the rod 10'b rotates about its axis. As a result, the first surgical operation means 4 rotates about the axis of the rod 10'b via the opening / closing member 2'b. That is,
By operating the knob 81b, the operation direction of the first surgical operation means 4 (in the illustrated example, the opening / closing direction) can be changed.

As shown in the figure, the insertion rod 1'a is composed of two rods 10'a, 10'b, and the third operating means 8 independently connects these rods 10'a, 10'b. The first surgical operation means 3,
The second surgical operation means 4 can be independently rotated, and the operability of the surgical instrument 1'is further improved.

Next, the operation of the surgical operating means 1'of the second embodiment will be described by taking as an example the case where it is applied to intestinal anastomosis surgery in laparoscopic surgery.

[1] The pulling reels 7a, 7b and the pulling devices 6'a, 6'b are appropriately operated to open / close the members 2'a, 2'b and the first surgical operating means as shown in FIG. 3. With the second surgical operation means 4 closed, the surgical instrument 1'is inserted through the trocar tube that is pierced and fixed in the abdominal wall of the patient.

[2] Operate the pulling reels 7a, 7b respectively to open the opening / closing members 2'a, 2'b and operate the engaging claws (not shown) of the pulling devices 6'a, 6'b. Then, the engagement between the engaging claw and the saw gear (not shown) is released to open the first surgical operation means 3 and the second surgical operation means 4.

[3] The knob 81a is rotated clockwise toward the distal end so that the inside of the surgical operating means 3 (the movable piece 31) is rotated.
The first surgical operating means 3 is inclined so that the side) is on the lower side (see FIG. 20). In this state, one stump 9A of the intestine to be anastomosed by the first surgical operation means 3 is moved by the movable piece 31.
And the opening / closing member 2a.

[4] The engaging claw of the towing device 6'a is operated to engage the engaging claw with the saw gear, and then the handle 69'a is rotated in the proximal direction to move the handle 69'a. The piece 31 is closed and the stump 9A of the intestine is grasped. At this time, handle 6
By adjusting the rotation amount of 9'a, the surgical operating means 3
The gripping force is adjusted appropriately in consideration of the thickness and size of the stump 9A.

[5] Subsequently, the knob 81a is rotated in the opposite direction to [3] to return the first surgical operating means 3 to the original position. Subsequently, the second surgical operating means 4 is brought closer to the stump 9B of the other intestine, and the knob 81b is rotated counterclockwise in the distal direction to match the cross section of the stump 9B and the second
In this state, the second surgical operation means 4 is moved to the other end of the intestine stump 9 by inclining the surgical operation means 3 of FIG.
B is positioned so as to enter between the movable piece 41 and the opening / closing member 2b.

[6] The engaging claw (not shown) of the pulling device 6'b is operated to engage the engaging claw with the saw gear (not shown), and then the handle 69'b is moved. The movable piece 41 is closed by rotating in the proximal direction, and the intestinal stump 9B is gripped.
At this time, by adjusting the amount of rotation of the handle 69′b, the grasping force of the surgical operating means 4 is changed to the thickness of the intestinal stump 9B,
Adjust appropriately considering size and other factors.

[7] Then, the knob 81b is rotated in the opposite direction to [5] to return the second surgical operation means 4 to the original position (see FIG. 22).

[8] The reels 7a and 7b are rotated to close the opening / closing members 2'a and 2'b. As a result, the intestinal stumps 9A and 9B come close to each other in parallel (see FIG. 23).

[9] By using a suturing device (not shown) inserted from another trocar tube, the intestinal mucosa, the intestinal muscular layer and the intestinal serosa of the intestinal stumps 9A and 9B are joined together, and the intestinal anastomosis operation is performed. To complete.

The operation procedure in the above-mentioned two embodiments is an example, and various modifications can be made, without being limited thereto. For example, the first surgical movement means 3,
The order of gripping the intestinal stumps 9A and 9B by the second surgical operation means 4 may be reversed from the above, and the intestinal stump 9 may be reversed.
After adjusting the opening degree of the opening / closing member 2 according to the separation distance of A and 9B, the first surgical operation means 3 and the second surgical operation means 4 are simultaneously opened / closed, and the intestinal stumps 9A, 9B are operated. May be simultaneously gripped.

The surgical instrument of the present invention is not limited to the above-mentioned embodiments, and for example, the opening / closing member, the first surgical operation means, the second surgical operation means, the first operation means and the second operation means.
The operating means (traction device) or the like can be replaced with an arbitrary shape or structure having an equivalent function. For example, the first and second surgical operation means may be a pair of movable pieces (opening and closing bodies) rotatably attached to the tip of the opening and closing member, and both movable pieces may be driven to open and close. Alternatively, the wire pulling device may be a mechanism that pulls or loosens the wire by operating a pulling tool (not shown) slidably provided in the longitudinal direction of the wire.

In the present invention, the surgical operation means is
The structure is not limited to the one that rotates, but may be a structure that moves in parallel and opens and closes. Further, one member may be configured to rotate, such as a bow forceps, an electric knife, and an ultrasonic knife.

The type of surgical instrument of the present invention is not limited to forceps, and may be, for example, scissors, a ligature device, a needle holder, or a knife such as an electric knife, an ultrasonic knife, or a laser knife. Further, its application is not limited to that used for laparoscopic surgery, and can be applied to, for example, brain surgery, thoracoscopic surgery, urological surgery, and the like.

[0111]

As described above, the surgical instrument of the present invention is provided with an insertion rod to be inserted into a communication tube that communicates the inside of the body cavity with the outside of the body and the opening and closing operation provided at the tip of the insertion rod. A pair of opening / closing members to be performed, a first operating means for remotely opening / closing the opening / closing member, a first surgical operation means provided at the tip of the opening / closing member, and performing an opening / closing operation or a rotating operation. Since it has two surgical operating means and second operating means for remotely operating the first surgical operating means and the second surgical operating means, it is possible to simultaneously or simultaneously operate different parts with one instrument. Can be easily treated in parallel and has excellent operability.

When applied to laparoscopic surgery, the number of trocar tubes penetrating the abdominal cavity can be reduced and the burden on the patient can be further reduced.

If a third operation means for rotating the first surgical operation means and the second surgical operation means with the insertion rod as an axis is provided via the opening / closing member, the procedure is performed. The operation directions of the first surgical operation means and the second surgical operation means can be arbitrarily adjusted according to the posture of the site, and the surgical procedure can be performed more appropriately.

Further, the insertion rod is composed of a first rod body connected to one of the opening / closing members and a second rod body connected to the other of the opening / closing members, and the third operating means is A case in which the first surgical operation means and the second surgical operation means are independently rotated by rotating the first rod and the second rod about their axes. Includes a first surgical motion means,
The operation direction of the second surgical operation means can be adjusted independently, and the operability is extremely excellent.

[Brief description of drawings]

FIG. 1 is an overall perspective view showing a configuration example of a surgical instrument of the present invention.

FIG. 2 is an overall perspective view showing a configuration example of a surgical instrument of the present invention.

FIG. 3 is a partially enlarged perspective view showing a configuration example of first operating means.

FIG. 4 is a partially enlarged perspective view showing the structure of the first operating means shown in FIG.

5 is a partially enlarged perspective view showing the structure of the first operating means shown in FIG.

FIG. 6 is a partial perspective view showing the configuration of surgical operation means.

FIG. 7 is a partial perspective view showing the configuration of surgical operation means.

FIG. 8 is a partial perspective view showing the configuration of surgical operation means.

FIG. 9 is a partially enlarged cross-sectional view showing a configuration of a traction device that is a second operating means.

10 is an enlarged cross-sectional view of the traction device shown in FIG.

11 is an enlarged cross-sectional view of the traction device shown in FIG.

FIG. 12 is an explanatory diagram showing a procedure for performing intestinal anastomosis surgery using the surgical instrument shown in FIG. 1.

FIG. 13 is an explanatory diagram showing a procedure for performing intestinal anastomosis surgery using the surgical instrument shown in FIG. 1.

FIG. 14 is an explanatory diagram showing a procedure for performing intestinal anastomosis surgery using the surgical instrument shown in FIG. 1.

FIG. 15 is an explanatory diagram showing a procedure for performing intestinal anastomosis surgery using the surgical instrument shown in FIG. 1.

FIG. 16 is an overall perspective view showing a second configuration example of the surgical instrument of the present invention.

FIG. 17 is an overall perspective view showing a second configuration example of the surgical instrument of the present invention.

18 is a plan view showing a configuration of an insertion rod of the surgical instrument shown in FIG.

19 is a plan view showing the configuration of an insertion rod of the surgical instrument shown in FIG.

20 is an explanatory diagram showing a procedure for performing intestinal anastomosis surgery using the surgical instrument shown in FIG.

FIG. 21 is an explanatory diagram showing the procedure for performing intestinal anastomosis surgery using the surgical instrument shown in FIG. 16.

22 is an explanatory diagram showing a procedure for performing intestinal anastomosis surgery using the surgical instrument shown in FIG. 16. FIG.

FIG. 23 is an explanatory diagram showing a procedure for performing intestinal anastomosis surgery using the surgical instrument shown in FIG. 16.

[Explanation of symbols]

 1, 1'surgical instrument 1a, 1'a insertion rod 1b, 1'b operation part 10'a, 10'b rod 11 fixed gripping member 12 movable gripping member 13 operation rod connection part 2a, 2b, 2'a, 2'b Opening / closing member 3 First surgical operation means 31 Movable piece 4 Second surgical operation means 41 Movable piece 5 First operating means 50 Driving body 51 Operating rod 52 Swing member 6 Second operating means 6a, 6b , 6'a, 6'b Traction device 61a, 61b Wire 68a, 68b Spring 7 First operating means 711a, 712a, 711b, 712b Wire 8 Third operating means 82a, 82b Knob

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[Procedure amendment]

[Submission date] August 4, 1995

[Procedure Amendment 1]

[Document name to be corrected] Drawing

[Correction target item name] All drawings

[Correction method] Change

[Correction content]

FIG.

[Fig. 2]

[Figure 3]

[Figure 4]

[Figure 7]

[Figure 5]

[Figure 6]

[Figure 8]

[Figure 9]

[Figure 10]

FIG. 11

[Fig. 12]

[Fig. 13]

FIG. 14

FIG. 15

FIG. 16

FIG. 17

FIG. 18

FIG. 19

FIG. 20

FIG. 21

FIG. 22

FIG. 23

Claims (12)

[Claims] 1. An insertion rod that is inserted into a communication tube that communicates the inside of the body cavity with the outside of the body, a pair of opening and closing members that are provided at the tip of the insertion rod and that perform an opening and closing operation, and the opening and closing member remotely. First operating means for opening and closing, first surgical operating means and second surgical operating means, which are respectively provided at the distal end of the opening and closing member and perform opening and closing or rotating operations, and the first surgical operating means And second operating means for remotely operating the second surgical operation means. 2. A third operation means for rotating the first surgical operation means and the second surgical operation means through the opening / closing member with the insertion rod as an axis. The surgical instrument according to claim 1, characterized in that 3. The third operating means is configured to rotate the insertion rod so as to rotate the insertion rod and the second surgical operating means.
The surgical instrument according to claim 2, wherein the surgical operation means is rotated. 4. The insertion rod is composed of a first rod connected to one of the opening / closing members and a second rod connected to the other of the opening / closing members, and the third operating means is ,
The first surgical operation means and the second surgical operation means are independently rotated by rotating the first rod and the second rod about their axes. The surgical instrument according to 2. 5. The first operating means is provided from a base end portion to a tip end portion of the insertion rod, and is provided on a drive body that drives the opening / closing member by movement in a longitudinal direction, and a base end portion of the insertion rod. The surgical instrument according to any one of claims 1 to 3, wherein the surgical instrument is provided and is configured to move the driving body in a longitudinal direction to remotely operate the opening / closing member. 6. The first operating means is provided between the operating rod and the opening / closing member, and an elongated operating rod provided along the insertion rod, and the operating rod and the opening / closing member. A pair of swinging members that are swingably connected to each other, and an operating rod moving means that is provided at a base end portion of the operating rod and that moves and operates the operating rod in a longitudinal direction. Item 2. The surgical instrument according to Item 1. 7. The first operation means comprises two wires fixed to each of the opening / closing members, and a pulling means for pulling the wires, respectively. The surgical instrument described. 8. The first surgical movement means and the second surgical movement means.
8. The surgical instrument according to any one of claims 1 to 7, wherein each of the surgical operation means has a pair of opening / closing bodies that are opened and closed by driving at least one of them. 9. The first surgical movement means and the second surgical movement means.
8. The surgical operation means according to claim 1 is composed of a tip end portion of the opening / closing member and a movable piece rotatably connected to the opening / closing member at a position separated from the tip end portion of the insertion rod. The surgical instrument according to any one of claims. 10. The surgical instrument according to claim 8, wherein a biasing member that biases the opening / closing body in the opening direction is provided between the opening / closing bodies. 11. The second operating means includes a first wire having a tip fixed to one of the movable pieces, a second wire having a tip fixed to the other of the movable pieces, and the first wire. 10. The surgical instrument according to claim 9, wherein the surgical instrument and the second wire are respectively retracted in the proximal direction. 12. The surgical instrument according to claim 1, wherein the first and second surgical operation means constitute forceps capable of grasping different treatment sites in a body cavity.