JPH1014929A - Forceps apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To secure certainty, safety and moreover, diversity in the treatment with forceps by building a drive shaft up with a hollow member to drive the opening or closing of a dog of forceps provided on an insertion shaft to allow the insertion of the forceps, a medical fluid supplying/discharging device and other treating devices thereinto for compound operation with a simple forceps device. SOLUTION: In first forceps 1 in which a pair of large dogs 3 and 3 as working part mounted on the tip of an insertion shaft 2 comprising a hard pipe through a link mechanism, a hollow drive shaft linked to the link mechanism is provided to open or close the large dogs 3. Second forceps 20 are inserted through the drive shaft and have a pair of small dogs 21 connected to a slide shaft 24 slidably provided within the drive shaft through the link mechanism. To operate the link mechanism, a drive rod is inserted through the slide shaft 24.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a forceps device which is inserted into a body cavity or the like and is used for grasping or extracting body tissue or the like. It concerns the device.

[0002]

2. Description of the Related Art A forceps inserted into a body cavity has a pair or three or more gripping claws as an operating member at an end of an insertion shaft. The gripping claw is operated to be opened and closed by remote operation. For this purpose, an operation member is inserted into the insertion shaft, and an opening and closing operation unit is connected to a base end of the operation member. The opening / closing operation section is for reciprocating the operating member in the axial direction.In order to convert the movement of the operating member in the axial direction to the opening / closing operation of the gripping claw, the opening and closing operation section is provided between the tip of the operating member and the gripping claw. A link mechanism is interposed.

[0003] The forceps having the above structure is guided into the body cavity directly or through a treatment tool insertion channel of an endoscope and the like, and the opening and closing operation section is appropriately operated to open and close the grasping claw, whereby the organ is opened. Or the like, and lift or remove or remove the affected tissue. Here, in a state where the insertion portion of the endoscope is guided to a predetermined position in the body cavity from the oral cavity or the like,
The forceps is inserted from the grasping claw side into the treatment instrument introduction section provided in the body operation section of the endoscope, and inserted into the treatment instrument insertion channel in the insertion section. In this case, the insertion shaft is flexible. It is necessary to provide. Therefore, the insertion shaft is formed by a close contact coil, and an operation wire for operating the link mechanism is inserted through the close contact coil.

[0004] Further, for example, it is also possible to form an insertion path from the body epidermis into the abdominal cavity and insert a treatment tool such as an endoscope or forceps through this insertion path to perform treatment or the like.
Here, as a guide member for securing an insertion path in the abdominal cavity, a plurality of trocars are inserted directly from the body epidermis to the abdominal cavity, and the abdominal cavity is inflated with pneumoperitoneum gas. Then, an endoscope is inserted into one trocar to observe the inside of the abdominal cavity, and various treatment tools are inserted into the abdominal cavity via other trocars, and under the monitoring by the endoscope, Treatment and examination are performed. In this case, the insertion shaft of the forceps does not need to have flexibility, and the insertion shaft is formed by a hard pipe, and the operation member for operating the rod-shaped or wire-shaped link mechanism is inserted through the insertion shaft. Can be configured.

[0005]

In a forceps used to remove an affected part, if there is a lesion in a body tissue, the lesion is grasped with a grasping claw, and the resection and removal are performed. Here, excision of diseased tissue with forceps
It must be done completely without leaving any lesions.
If the diseased part is left behind, there is a risk of metastasis from the remaining part.Therefore, it should be absolutely necessary to avoid it, and only the diseased part should be removed, not healthy tissue cells. You also need to do that.

[0006] If the lesion in the body tissue protrudes from the inner wall of the body cavity like a tumor or the like, the extraction process can be performed almost accurately using forceps. However, when the affected part does not protrude from the inner wall of the body cavity or is in a deep part, the range that can be grasped by the grasping claw of the forceps is considerably small because it depends on the angle when the grasping claw is expanded. It may not be possible to remove the part without leaving it, and depending on the operation, there is a risk that not only the affected part but also the surrounding healthy tissue may be damaged,
There is a problem that an advanced and skilled operation is required and the operability is poor.

[0007] In a forceps for gripping a body tissue or an organ or the like, when performing a predetermined treatment, for example, injecting a chemical solution or suctioning a portion gripped by the gripper, the forceps gripper is used. In some cases, the treatment may be easier if the tissue is grasped and picked up by the method. To do this,
Since it is necessary to insert a chemical injection device, a suction device, and the like from a separate trocar and operate them individually, the operation becomes extremely difficult.

The present invention has been made in view of the above points, and an object of the present invention is to perform an operation of grasping or extracting internal tissues or organs with forceps and other operations and other operations. An object of the present invention is to make it possible to perform the treatment in a complex manner, thereby making it convenient for treatment and the like.

[0009]

In order to achieve the above-mentioned object, a gripper which can be opened and closed is provided on a hollow insertion shaft via a link mechanism, and a hollow drive shaft for driving the gripper to open and close is provided. A passage is formed inside the drive shaft so as to be slidably inserted into the insertion shaft, and a second treatment instrument having a predetermined operating portion at the tip is slidably inserted into the passage. It is characterized in that it is configured to be.

Here, as the second treatment tool, various devices such as a liquid injector, a suction device, and a high-frequency treatment tool can be used according to the purpose. When the main forceps is a forceps for removing an affected part, it may be configured as a second forceps, which is a grasping forceps for grasping and lifting a body tissue as a second treatment tool. And
In the case where the second treatment tool is the second forceps, the second gripping claw constituting the second forceps is placed inside the gripping claw with the gripping nail of the main forceps closed. The main forceps should be small enough to be accommodated, and can be projected forward with the gripping claws of the main forceps open.

[0011]

Embodiments of the present invention will be described below with reference to the drawings. 1 to 8
Has a second forceps provided as a second treatment tool attached to a main first forceps as a forceps device.

First, in FIG. 1, F is a forceps device, and this forceps device F includes a first forceps 1 and a second forceps 20. As is clear from FIGS. 2 and 3, the first forceps 1 has a pair of large gripping claws 3, 3 as an operating portion attached to the distal end of an insertion shaft 2 made of a hard pipe via a link mechanism. It becomes. The large gripping claws 3 have a concavely curved shape, and the tips of the two large gripping claws 3 are in contact with each other, that is, in a closed state, and the tips are separated from each other.
It can be displaced to the open state.

A link mechanism for opening and closing the large gripping claws 3, 3 is provided with a slot 2 a formed on the distal end side of the insertion shaft 2.
Is provided at the site. That is, a pair of support shafts 4 protrude from inner surfaces on both sides of the slit 2a, and pivotally support an intermediate position of the extending portion 3a of each large gripping claw 3. The end of the extending portion 3 a is pivotally connected to one end of the link plate 6 by a pivot pin 5. The other end of the link plate 6 is pivotally connected to a side surface of the drive shaft 7 by a pivot pin 8. Therefore, when the drive shaft 7 is advanced, the large gripping claws 3 are opened, and when the drive shaft 7 is retracted, the large gripping claws 3 are closed.

The drive shaft 7 is made of a hard pipe, and the mounting portion of the pivot pin 8 on the outer surface at the tip is flattened by chamfering. And the drive shaft 7
In the insertion shaft 2, a large diameter portion 7 a that is in contact with the inner surface of the insertion shaft 2 is provided at an intermediate position, and the large diameter portion 7 a
Is slidable with the inner surface of the insertion shaft 2, whereby the drive shaft 7 is aligned with the insertion shaft 2. As shown in FIG. 4, a connecting pin 9 is provided on the base end side of the drive shaft 7 so as to protrude in a direction orthogonal to the axis thereof. The connecting pin 9 protrudes to the outside through an elongated hole 10 provided in the base end side of the insertion shaft 2 toward the axial direction, and is connected to a slider 11 fitted to the insertion shaft 2. Accordingly, when the slider 11 is slid in the axial direction of the insertion shaft 2 by a finger or the like, the drive shaft 7 slides with respect to the insertion shaft 2 to operate the link mechanism. An opening and closing operation is performed.

Here, when the slider 11 is advanced along the insertion shaft 2, the drive shaft 7 connected to the slider 11 via the connection pin 9 projects in the insertion shaft 2 toward the distal end. The large gripping claw 3 is opened by the action of the link mechanism, and when it is retracted, the driving shaft 7 moves in the direction of being pulled into the insertion shaft 2 in conjunction with the large gripping claw 3, so that the large gripping claw 3 is closed. Can be

The pair of large-sized gripping claws 3 have cutouts 3b at the bases near the portions connected to the extending portions 3a.
Are formed. As a result, even when the pair of large gripping claws 3 and 3 are closed, that is, when their distal ends are joined, a void is formed at the base end side in a region including the axis of the insertion shaft 2. You. The base ends of the insertion shaft 2 and the drive shaft 7 are open, the drive shaft 7 is hollow, and the link plate 6, the support shaft 4, and the pivot pins 5, 8 are arranged on both left and right sides. Therefore, a passage of a predetermined size is formed in the axis of the drive shaft 7 and in front of the axis. When the large gripping claw 3 is closed, a dead end occurs at the joining position of the distal end of the large gripping claw 3, and when the large gripping claw 3 is opened, the front of the passage is opened.

The second forceps 20 is inserted through the drive shaft 7 which is a hollow member. The second forceps 20 has substantially the same configuration as the first forceps 1. That is, a pair of gripping claws 21 and 21 is provided at the distal end.
Reference numeral 1 denotes a small gripping claw which is considerably smaller than the gripping claw 3 of the first forceps 1. An extension 21a is continuously provided on the base end side of the small gripping claw 21.
A link plate 23 is pivotally connected to an end of the shaft 1a by a pivot pin 22. The other end of the link plate 23 is connected to an outer surface of a distal end portion of a hollow slide shaft 24 inserted into the drive shaft 7. It is pivotally attached to the provided chamfered portion using a pivot pin 25. Further, a drive rod 26 is provided in the slide shaft 24.
Is inserted, and the tip of the drive rod 26 is connected to a support shaft 27 provided at an intermediate position of the extending portion 21 a of the gripping claw 21.

The slide shaft 24 protrudes from the base end of the drive shaft 7 by a predetermined length. The entire second forceps 20 including the slide shaft 24 is slid in the drive shaft 7 in the axial direction. It can be displaced. When the large gripping claws 3 are closed, the two large gripping claws 3 are closed.
When the small gripping claws 21 are arranged in the space surrounded by 3 and the large gripping claws 3 are opened and the slide shaft 24 is displaced so as to be pushed out, the small gripping claws 21 can protrude forward. I have.

In order to open and close the small gripping claws 21 by remote control, at the protruding portion on the base end side of the slide shaft 24,
A connecting pin 28 is provided on the drive rod 26 so as to protrude in a direction orthogonal to the axis thereof. The connecting pin 28 is protruded to the outside through an elongated hole 29 having a predetermined length in the axial direction on the slide shaft 24. I have. A slider 30 is connected to the connecting pin 28, and the small gripping claw 21 can be opened and closed by moving the slider 30. Further, a holding ring 31 is provided at the tip of the slide shaft 24 so as to be connected thereto. Further, in order to align the slide shaft 24 with respect to the drive shaft 7, an inner diameter reducing portion 7 b is formed at the distal end portion of the drive shaft 7, and near the base end side end portion of the slide shaft 24, A large diameter portion 24a is formed. Therefore, the slide shaft 24 is displaced while sliding with the drive shaft 7. Also, small gripping claws 2
1 can be drawn into the drive shaft 7 in the closed state.

Here, the drive rod 26 is mounted on the small gripper 21.
When the driving rod 26 is advanced, the small gripping claws 21 and 21 are closed, and when the driving rod 26 is retracted, The small gripping claws 21 and 21 are opened. Therefore, the large gripping claws 3 and the small gripping claws 21 have opposite operation directions. However, it is also possible to make the operating directions of both large gripping claws 3 and 21 the same by using a link mechanism having the same structure.

In the forceps device F configured as described above, the second forceps 20 is inserted through the hollow drive shaft 7 of the first forceps 1 as shown in FIG. Then, the grip claws 3 and 21 of the first and second forceps 1 and 20 are closed, and the notches 3b of the large grip claws 3 and 3,
The small gripping claw 2 of the second forceps 20 is moved from the space formed by the small gripping claw 3 to the portion surrounded by the large gripping claw 3.
1 is arranged. In this state, it can be guided to the inside of the abdominal cavity via guide means such as a trocar.

With the distal end of the forceps device F protruding from the above-described guide means to a position near a body tissue to be treated, such as an affected part in the abdominal cavity, the slider 11 is first operated to push out the drive shaft 7. To be displaced. As a result, the large grasping claw 3 of the first forceps 1 is expanded. Then, the slide shaft 24 is slid in the direction in which the inside of the drive shaft 7 is pushed out, the entire second forceps 20 is projected from the first forceps 1, and the small gripping claws 21 are advanced toward the treatment target portion. . At the same time, by operating the slider 30 to retreat, as shown in FIG. 5, the drive rod 26 is displaced in the direction of being drawn into the slide shaft 24, and is connected thereto via a link mechanism. The small gripping claws 21 and 21 are opened. Therefore,
The small shame claws 21 are used to surround the treatment target portion, and then the slider 30 is returned to close the small grasping claws 21 to reduce a part of the body tissue to be treated as shown in FIG. The user is caused to grip between the grip claws 21 and 21.

The small grasping claw 21 is closed, and the body tissue is held in a grasped state, and the whole second forceps 20 is pulled into the first forceps 1. As a result, the body tissue is pulled up by the second forceps 20, as shown in FIG. As a result, a large area in the body tissue can be grasped by the large grasping claw 3 of the first forceps 1. By adjusting the degree of pulling up of the body tissue by the second forceps 20, the affected part having a predetermined spread is raised to a height position where the large grasping claw 3 of the first forceps 1 can resect. In this state, FIG.
By operating the slider 11 and retreating the drive shaft 7 as shown in (1), the link mechanism operates, the large gripping claws 3 and 3 close, and their tips join. The affected part can be resected and removed.

As described above, the body tissue is grasped and pulled up by the second forceps 20, and an operation is performed so that a predetermined position of the body tissue pulled up to a predetermined height by the first forceps 1 is cut off. Thus, even in a non-bulging state, only a necessary portion can be accurately resected and extracted from a treatment target portion such as an affected part which needs to be resected and extracted over a wide range. Therefore, there is no possibility that a part of the affected part is left or healthy tissue is cut off more than necessary.

As described above, the forceps device may be composed of two types of forceps having large and small gripping claws 3 and 21, but as shown in FIG.
May be configured as a forceps device F 'in which a suction means 50 is provided.

The forceps 40 of the forceps device F 'have a pair of gripping claws 41, 41.
Has a notch 41a for forming a void at the base end side.
An extension portion 41b is continuously provided on the base end side. An intermediate portion of the extension portion 41b is pivotally connected to an inner surface of a slot provided in the holding cylinder 42 by a support shaft 43. Supported. One end of a link plate 45 is pivotally connected to the other end of the extending portion 41b via a pivot pin 44, and the other end of the link plate 45 is further pivotally connected to the slide cylinder 4 by a pivot pin 46.
It is pivoted to 7. The slide cylinder 47 slides along the inner surface of the holding cylinder 42.
When the is moved forward, the gripping claw 41 is opened, and when it is retracted, the gripping claw 41 is closed.

A flexible cord 48 composed of a close contact coil is connected to the holding cylinder 42. In the flexible cord 48, a slide cylinder 47 is slid with respect to the holding cylinder 42 by remote control. A flexible tube 49 whose tip is fixed to the slide cylinder 47 is inserted into the flexible cord 48. Therefore, the forceps device F 'has flexibility to bend freely along the insertion path and the like except for the distal end portion. The flexible cord 48 constitutes a flexible insertion shaft, and the flexible tube 49 and the slide tube 47 provided at the distal end of the flexible tube 49 have a passage through which another treatment tool is inserted. Configure the drive shaft.

As described above, the suction device 50 is detachably inserted as another treatment tool into the hollow passage inside the slide tube 47 and the flexible tube 49 connected thereto. The suction device 50 has a flexible suction tube 51 connected to a tip of a hard pipe made of a hard pipe and having a sharpened tip, which are inserted into the flexible tube 49 and the slide tube 47. It has a possible outer diameter. Then, a negative pressure source (not shown) is connected to the base end of the suction tube 51.

The needle 52 of the suction device 50 is connected to the slide cylinder 47.
And the holding claws 41 are closed. In this state, the forceps device F ′ is guided into the body cavity through guide means such as a treatment tool insertion channel of an endoscope. Then, the gripper 41 of the forceps 40 is opened and closed to grip the affected part to be treated. When the affected part is grasped, the flexible tube 4 in the suction device 50 is
9 is pushed out, the needle tip 52 is inserted into the portion gripped by the gripping claws 41, and the inside of the body tissue gripped by the gripping claws 41 is created by applying a negative pressure to the inside of the flexible tube 49. The body fluid such as a bleeding part and lymph fluid can be removed by suction.

[0030]

As described above, according to the present invention, the drive shaft for driving the grasping claw of the forceps provided on the insertion shaft to open and close is formed by a hollow member so that another treatment tool can be inserted therein. Therefore, the composite operation can be performed by a single forceps device, and effects such as the certainty and safety of the treatment by the forceps, and further, the diversity are ensured.

[Brief description of the drawings]

FIG. 1 is an external view of a forceps device showing an embodiment of the present invention.

FIG. 2 is an enlarged plan view showing a tip portion of FIG. 1;

FIG. 3 is a sectional view of a distal end portion of the forceps device of FIG. 1;

FIG. 4 is a sectional view of a proximal end portion of the forceps device of FIG. 1;

FIG. 5 is an operation explanatory view showing an operation state of the forceps device.

FIG. 6 is an operation explanatory view showing a state in which a body tissue is gripped by the forceps device.

FIG. 7 is an operation explanatory view showing a state where a body tissue is pulled up by the forceps device.

FIG. 8 is an operation explanatory view showing a state in which a body tissue is excised and extracted by the forceps device.

FIG. 9 is a cross-sectional view of a distal end portion showing a state in which a suction device is mounted as another treatment tool on the forceps device of the present invention.

[Explanation of symbols]

 Reference Signs List 1 first forceps 2 insertion shaft 3 large gripping claw 7 drive shaft 20 second forceps 21 small gripping claw 24 slide shaft 26 drive rod 40 forceps 41 gripping claw 42 holding cylinder 47 slide cylinder 48 flexible cord 49 flexible tube 50 Suction device 51 Suction tube 52 Needle point F, F 'Forceps device

Claims (5)

[Claims] An openable / closable gripping claw is provided on a hollow insertion shaft via a link mechanism, and a hollow drive shaft for driving the gripping claw to open / close is provided so as to be slidably inserted into the insertion shaft. A forceps device, wherein a passage is formed inside the drive shaft, and a second treatment instrument having a predetermined operating portion at its tip is slidably inserted into the passage. 2. The forceps device according to claim 1, wherein the grasping claw is provided with a cutout at a portion at a base end side of the grasping claw at least including a shaft center of an insertion shaft. 3. The second treatment instrument is a second forceps,
The second forceps has a second gripping claw, and the second gripping claw is formed to have a size that can be accommodated in the gripping claw when the gripping claw is in the closed state. The forceps device according to claim 1, wherein: 4. The forceps device according to claim 1, wherein the second treatment tool is a liquid supply / discharge device, and the liquid supply device has a needle tip provided at a distal end of a tube. 5. The forceps device according to claim 1, wherein the second treatment tool is provided so as to be insertable into and removable from a passage inside the drive shaft.