JPH09224949A - Dipole electric operation device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To prevent the body fluid from flowing backward and eliminate any reduction in its cutting force because of the leak between conductive wire elements by providing a sealing means which closes a near end of an outer tube lumen so as to slidably and closely engage the conductive wire elements. SOLUTION: An outer tube 1 of a dipole electric operation device has a lumen communicating the near end to the distant end and the first conductive wire element 2 and the second conductive wire element 3 in the lumen are electrically insulated with each other in the outer tube 1. A sealing means 20 is so provided as to close the close end of the lumen of the outer tube 1. Conductive rod elements 21 are slidably engaged into the sealing means 20. The shape of the sealing means 20 is set to a disc shape so as to be matched with the shape of the lumen of the outer tube 1 and slits are provided so that the rod elements can be engaged therein.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a dipole electrosurgical treatment instrument. More specifically, it relates to a treatment instrument for dipolar electrosurgical treatment that can effectively prevent backflow of body fluid.

[0002]

2. Description of the Related Art An electrosurgical treatment instrument is a surgical instrument utilizing high-frequency electrical energy, and can electrically incise a living tissue without giving an electric shock to the living body to reduce bleeding during surgery. Therefore, it has been widely used in recent years. The electrosurgical treatment instrument utilizes the action of high-frequency electrical energy between the electrode provided at the distal end of the instrument and the living tissue, and includes a monopolar electrosurgical treatment instrument and a dipole electrosurgical treatment instrument. There is.

The treatment instrument for monopolar electrosurgery has the advantages of excellent cutting power for living tissue and less bleeding when cut, but since the required power is high at about 100 W, the range of living tissue to be cut is limited. It is wide and therefore unsuitable for cutting small details of living tissue. On the other hand, the dipole electrosurgical treatment instrument can be operated with a low power requirement, and the range of the living tissue to be cut is narrow, so that it is suitable for cutting fine parts of the living tissue.

A dipole electrosurgical treatment instrument has a first conductive linear body and a second conductive linear body which are slidable in the axial direction in the lumen of the outer tube, and their proximal portions. It is known that the end is fixed to a molded slide member, and the slide member slides in the longitudinal direction along a housing provided with a longitudinal split groove. In this dipole electrosurgical treatment instrument, only the proximal end of the lumen of the outer tube is closed with the slide member,
Body fluid may ooze out through the gap between the outer peripheral surface of the slide member and the inner wall surface of the outer tube via the outer tube lumen. Bleeding body fluid makes it difficult for the outer surfaces of the slide member and the housing to slide. When the outer tube is filled with body fluid, electric leakage occurs between the conductive filaments and the cutting force of living tissue is reduced. Further, since the contact area between the slide member and the housing is large, the resistance when moving the slide member in the long axis direction becomes large.

[0005]

DISCLOSURE OF THE INVENTION An object of the present invention is to prevent body fluid from flowing back into a tube, to prevent bleeding of body fluid to the proximal end and to prevent the operating portion from slipping, and between conductive filaments. It is an object of the present invention to provide a dipole electrosurgical treatment instrument that does not reduce the cutting force due to electric leakage.

[0006]

The inventors of the present invention have conducted extensive studies to achieve the above object, and as a result, plugged the proximal end of the outer tube lumen and slidably attached the conductive filament body. It has been found that the above object can be achieved by providing a sealing means that can be fitted, and the present invention has been completed based on this finding.

[0007] That is, according to the present invention, (1) an outer tube having a lumen communicating from the proximal end to the distal end, and slidable in the axial direction within the lumen of the outer tube from the outer tube proximal end. A first conductive filament and a second conductive filament which are inserted through the distal end and whose distal end can be exposed from the distal end of the outer tube; and a first conductive filament And a second conductive wire member that can be slidably and closely fitted into the outer tube lumen, and sealing means for plugging the proximal end of the outer tube lumen, and the outer tube proximal end portion. (EN) A conductive filament body operating means connected to the proximal end of the two conductive filament bodies and having a mechanism for sliding the first conductive filament body and the second conductive filament body in the axial direction of the outer tube, Made of an electrical insulator and having a first conductive filament and And a spacer capable of electrically insulating and connecting the second conductive linear member, and the first conductive linear member and the second conductive linear member are electrically connected to each other in the outer tube. And a distal end portion of the first conductive linear body and the second conductive linear body are electrically insulated by a spacer and are connected to each other to form a loop. Will be provided.

Further, the following are provided as preferred embodiments of the treatment device for dipolar electrosurgical operation of the present invention. (2) The dipole electrosurgical treatment instrument according to (1), wherein the outer tube is made of a fluororesin. (3) Insert one inner tube into the outer tube lumen and fix it, insert one conductive wire into this inner tube, and place the other conductive wire inside the outer tube lumen and outside the inner tube. The treatment instrument for dipole electrosurgical operation according to (1), which is inserted.

(4) Two dipole electrosurgical treatments, wherein two inner tubes are inserted and fixed in the outer tube lumen, and one conductive filament is inserted into each of the inner tubes. Equipment. (5) The treatment instrument for dipole electrosurgical operation according to (1) above, wherein an outer tube having two lumens is used and one conductive filament is inserted into each lumen.

(6) The treatment instrument for dipolar electrosurgical operation according to (3) or (4), wherein the inner tube is made of a fluororesin. (7) The dipole electrosurgical treatment instrument according to the above (1), wherein the sealing means has a disk-like shape, and a slit into which a conductive rod-shaped body can be inserted is provided on the disk surface. (8) The dipole electrosurgical treatment according to (1), wherein the sealing means has a hole into which a conductive rod-shaped body can be fitted, and an annular elastic member is fitted to the inner wall of the hole. Equipment.

(9) The outer diameters of the proximal end portions of the first conductive filament and the second conductive filament are larger than those of the distal ends thereof (1). Dipole electrosurgical instrument.

[0012]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Hereinafter, the present invention will be described in detail with reference to the drawings. FIG. 1 is an external view showing an embodiment of a treatment instrument for dipolar electrosurgical operation according to the present invention. FIG. 2 is an enlarged view of a spacer portion of the treatment instrument of FIG. FIG. 3 is FIG.
3 is an enlarged cross-sectional view of the proximal end of the treatment instrument of FIG. FIG. 4 is a diagram showing a mode of the sealing means used in the treatment instrument.

The dipole electrosurgical treatment instrument of the present invention comprises an outer tube 1, a first conductive filament body 2, a second conductive filament body 3, a sealing means, a conductive filament body operating portion 4 and a spacer. It is composed of 5. The outer tube has a lumen 8 that communicates from the proximal end 6 to the distal end 7, and a conductive filament body or the like is inserted into the lumen. The material of the outer tube is not particularly limited. Plastics such as polyethylene, polypropylene, polyvinyl chloride, polyurethane, polyamide, polyester, polycarbonate, polyether sulfone, and fluororesin can be used, and one having an appropriate elastic modulus can be selected according to the purpose. . For example, the modulus of elasticity may be small at the distal end and large at the proximal end to allow the distal end to softly contact the living body lumen wall and to facilitate manipulation at the proximal end to the distal end. can do. It is also possible to use a braided fiber in which the outer tube wall is embedded. Further, a fluororesin is preferably used in order to reduce the sliding resistance of the conductive filament.

In the dipolar electrosurgical treatment instrument of the present invention, the length of the first conductive filament and the second conductive filament is longer than that of the outer tube, and is longer in the lumen of the outer tube. The outer tube is slidably inserted in the axial direction from the proximal end to the distal end, and the distal end is exposed from the distal end of the outer tube. Further, the first conductive filament and the second conductive filament are electrically insulated from each other in the outer tube. The method for electrically insulating the two conductive filaments from each other is not particularly limited. For example, as shown in FIG. 1, one inner tube 9 is inserted and fixed in the outer tube lumen,
Insert one conductive filament into this inner tube,
By inserting the other conductive wire into the outer tube lumen, insert and fix two inner tubes into the outer tube lumen, and insert one conductive wire into each of the inner tubes. Due to
Alternatively, by using an outer tube having two lumens, one conductive filament is inserted into each lumen, or by providing an insulating film layer on the surface of the conductive filament, two conductors are provided. The conductive filaments can be insulated from each other. In order to prevent the first conductive linear body and the second conductive linear body from twisting and causing an electrical short circuit, it is preferable to insert and fix the inner tube into the outer tube.

In the dipole electrosurgical treatment instrument of the present invention, the materials of the first conductive filament and the second conductive filament are:
Any electrically conductive material can be used without particular limitation,
Examples of the conductive material include simple metals such as gold, silver, platinum, nickel, iron, aluminum, tin, zinc and copper, and alloys such as stainless steel and nichrome. The structure of the conductive filament may be either a single wire or a stranded wire, and the stranded wire includes a core wire made of a single wire and a coil surrounding the core wire.

The outer diameter of the conductive filament can be arbitrarily selected according to the surgical site, but is usually 0.1 to 1 mm,
It is preferably 0.2 to 0.6 mm. By setting the inner diameter of the inner tube through which the conductive filament is inserted to be larger than the outer diameter of the conductive filament, the conductive filament can be slidable in the longitudinal direction within the lumen. Examples of the material of the inner tube through which the conductive linear member is inserted include polyolefin such as polyethylene and polypropylene, and fluororesin such as polytetrafluoroethylene. Of these, fluororesins are preferable because they reduce the sliding resistance of the filaments.

In the dipolar electrosurgical treatment instrument of the present invention, the proximal ends of the first conductive filament and the second conductive filament are thicker than the outer diameters of the distal ends thereof. Is preferred. The thick portions of the first conductive filament and the second conductive filament are hereinafter referred to as the first conductive rod-shaped body and the second conductive rod-shaped body. The rod-shaped body is formed of a rod or pipe made of a conductive metal such as stainless steel. Since the rod-shaped body has a larger outer diameter than the linear body, it is hard to buckle. The length of the conductive rod-shaped body is set to be longer than the length range in which it is slid in the axial direction by the conductive linear body operating portion described later. Usually 1
It is 0 mm to 400 mm. The outer diameter of the conductive rod-shaped body can be appropriately selected according to the size of the hole or slit provided in the sealing means. Usually, it is 0.3 to 10 mm, preferably 0.5 to 5 mm.

In the dipole electrosurgical instrument according to the present invention, the sealing means is provided so as to plug the proximal end of the outer tube lumen. By blocking the outer tube lumen, backflow of body fluid can be prevented. Further, a conductive rod-shaped body is slidably fitted in the sealing means. The rod-shaped body can be slid in the long axis direction by the operating means described later. Since the outer peripheral surface of the rod-shaped body fitted in the sealing means is in close contact with the sealing means, the gap between the rod-shaped body and the sealing means is narrow, and it is possible to prevent body fluid from oozing out. The shape of the sealing means is usually disk-shaped so as to match the shape of the lumen of the outer tube, and a slit 22 is provided so that the rod-shaped body can be fitted therein. It is also possible that a hole 23 is provided so as to fit the outer diameter of the rod-shaped body, and an annular elastic member is embedded in the inner wall of the hole so that the elastic member (O-ring) 24 is in close contact with the rod-shaped body. The contact area between the rod-shaped body and the sealing means is smaller than that of the conventional one that seals with the slide member and the housing, so that the operating resistance by the operating means is low. The sealing means is usually formed by an elastic member. Examples of the elastic member include polyurethane, styrene-butadiene rubber, silicone rubber, fluororubber, natural rubber, chloroprene rubber and isoprene rubber.

The dipole electrosurgical treatment instrument of the present invention comprises:
It is installed on the proximal end side of the outer tube and is connected to the proximal end of the first conductive rod-shaped body and the proximal end of the second conductive rod-shaped body, and the first conductive filament and the second conductive filament. A conductive wire body operating means 4 having a mechanism for sliding the body in the longitudinal direction of the outer tube is provided. By operating the conductive filament operating means, the conductive filament is slid in the outer tube lumen, and the conductive filament exposed at the distal end is exposed from the lumen or is housed in the lumen. be able to. The structure of the conductive filament operating means can be used without particular limitation as long as it can slide two conductive filaments in the outer tube lumen in the major axis direction, for example, as shown in FIG. Such an operating means 10 movable in the long axis direction and a moving member that moves in the long axis direction in conjunction with the operation means 10 are provided, and the proximal end of the conductive rod-like body is connected to the moving member. Or, it is provided with a rotating member and a moving member that moves in the long axis direction in conjunction with the rotation of the rotating member, and the proximal end of the conductive rod-shaped body is connected to the moving member. It may be. The proximal end of the first conductive rod-shaped body and the proximal end of the second conductive rod-shaped body or the proximal end of the moving member connecting them are further provided with the terminal 11 and the cord 1.
2 is connected to the high frequency current generator 13.

The spacer used in the dipole electrosurgical treatment instrument of the present invention is made of an electrical insulator, and has a distal end of the first conductive filament and a distal end of the second conductive filament. It has two holes for inserting the respective.

Further, as shown in FIG. 2, the treatment instrument shown in FIG. 1 has a margin 1 for fixing the conductive filament on the distal end side of the hole 15.
6 are provided. A protrusion 18 protruding from the distal end of the conductive filament in a direction perpendicular to the longitudinal axis of the conductive filament.
Is provided. When the protrusion is housed in the fixing space, the conductive filament is prevented from coming out of the hole of the spacer and rotating in the hole, and the loop is cut during operation or the loop is twisted and short-circuited. Less to do.

The material of the spacer is an electrically insulating material, preferably an electrically insulating material having heat resistance. Examples thereof include ceramics such as alumina and zirconia, and heat resistant plastics such as polybenzimidazole and polyether sulfone. The shape of the spacer can be appropriately selected depending on the portion to be cut off, but usually a spindle shape (bullet shape), an elliptic cylinder shape, a cylinder shape, an umbrella shape, or the like is used. The size of the spacer is such that the diameter of the circle or the major axis of the ellipse is usually 0.5 to 5 mm, preferably 1 to 3 mm, and the axial length is usually 0.5 to 5 mm, preferably 1 to 3 mm.
mm.

In the dipole electrosurgical treatment instrument of the present invention, the distal end of the first electrically conductive filament and the distal end of the second electrically conductive filament exposed from the distal end of the outer tube are spacers 5. Are fitted into two holes respectively, and are electrically insulated from each other through a spacer to form a loop 14 between the spacer and the distal end of the outer tube.

The method of connecting the spacer and the conductive linear member is not particularly limited, but is usually connected using an adhesive. As the adhesive to be used, a three-dimensional cross-linking adhesive such as an epoxy adhesive, a polyisocyanate adhesive, or a cross-linking acrylic adhesive can be preferably used.

The treatment instrument for dipolar electrosurgery according to the present invention operates the electrically conductive filament body operating section to store the electrically conductive filament body in the outer tube lumen, and directly or through the lumen of the endoscope. After inserting into the lumen, the operating portion is operated to slide the conductive filamentous body toward the distal end to enlarge the loop. Then, place the loop around the tissue to be excised (for example, polyp),
By operating the operation portion, the conductive filament is slid toward the proximal end to make the loop smaller and tightened around the living tissue, and then the high frequency current generator is activated to generate electrical energy in the conductive filament. Can be supplied to excise living tissue.

[0026]

The dipole electrosurgical treatment instrument of the present invention comprises:
Since the contact area between the conductive rod-shaped body and the sealing means is small, the resistance to sliding of the linear member in the long axis direction in the operating means is small. In addition, the body fluid does not flow back due to the sealing means, leakage of electric current between the conductive filaments can be prevented, and it is not difficult to operate because the outer surface of the operating means gets wet with body fluid.

[Brief description of drawings]

FIG. 1 is an external view showing an embodiment of a treatment instrument for dipolar electrosurgical operation according to the present invention.

FIG. 2 is an enlarged view of a spacer portion of the treatment instrument of FIG.

3 is an enlarged cross-sectional view of the proximal end of the treatment instrument of FIG.

FIG. 4 is a diagram showing an aspect of a sealing means used for a treatment instrument.

[Explanation of symbols]

 1 ... Outer tube 2, 3 ... Conductive filament body 4 ... Conductive filament body operating part 9 ... Inner tube 10 ... Operating means 20 ... Sealing means 21 ...・ Bar 22 ... Slit 23 ... Hole 24 ... Elastic member (O-ring)

Claims (1)

[Claims] 1. An outer tube having a lumen that communicates from a proximal end to a distal end, and an outer tube that is slidable in a longitudinal direction within the lumen of the outer tube and that is inserted from the outer tube proximal end to the distal end. A first conductive filament and a second conductive filament whose end portions are exposed from the outer tube distal end, and a first conductive filament and a second conductive filament. A sealing means that can be slidably and closely fitted, and that closes the proximal end of the outer tube lumen, and a proximal end of the first conductive wire and the second conductive wire provided at the outer tube proximal end. An electrically conductive filament body operation means connected to the end and having a mechanism for sliding the first electrically conductive filament body and the second electrically conductive filament body in the axial direction of the outer tube; Of the conductive filament and the second conductive filament The first conductive wire and the second conductive wire are electrically insulated from each other in the outer tube. A treatment instrument for dipolar electrosurgical operation, wherein the body and the distal ends of the second conductive filaments are electrically insulated and connected by a spacer to form a loop.