JPH1094544A - Surgical device for peeling - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a multifunctional treating device which accomplishes dull peeling and the feeding and suction of water both with one treating device alone by adding a water feeding/sucking function to a surgical device for peeling. SOLUTION: This surgical device includes an elastic member 10 having an opening 12 at the tip of an insertion part 1 and a mesh 11 covering the elastic member 10 and a water feeding/sucking pipe 5 which is provided in the insertion part 1 communicating with the opening 12. With such an arrangement, peeling is possible feeding or sucking water to check bleeding or the like. This achieves safety and eliminates the need for additional insertion of a fee water pipe. This also can minimize the number of puncturing holes and possible damage to a patient.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION The surgical instrument for exfoliation of the present invention comprises:
The present invention relates to a surgical instrument for exfoliation used for blunt excision of an organ.

[0002]

2. Description of the Related Art Conventionally, when an organ is bluntly peeled, a surgical swab-like surgical instrument has been used. However, since the distal end of the surgical instrument for stripping is cotton-like, when blood in the body cavity is sucked, the surgical instrument is fixed with the passage of time, and the surface becomes hard, so that the surgical instrument needs to be replaced.

[0003] As a solution, US Pat.
By providing a suction function to the surgical instrument for exfoliation,
A technique for preventing sticking is disclosed. Also, USP53
No. 10406 discloses a technique for sucking blood or physiological saline accumulated in a body cavity with a surgical instrument for exfoliation instead of a suction tube.

[0004]

SUMMARY OF THE INVENTION US Pat.
And the technology disclosed in US Pat. No. 5,310,406 can suction blood or physiological saline in a body cavity, but cannot absorb water or blood with a layer such as a sponge at the tip, and therefore cannot supply sufficient water. Therefore, when it is desired to clean the inside of the body cavity, it is necessary to insert a treatment tool for water supply into the body cavity, and the treatment tool must be replaced. If bleeding occurs at the time of peeling, it is necessary to insert a hemostatic electrode or the like into the body cavity.

The present invention has been made in view of the above problems, and a surgical instrument for exfoliation is provided with a water supply / suction function so that a single treatment tool can perform both blunt exfoliation and water supply suction. An object is to provide a multifunctional treatment tool.

[0006]

According to the present invention, there is provided an elongated insertion portion, a distal end portion having an opening disposed at a distal end side of the insertion portion, a main body portion disposed at a base end portion of the insertion portion, A structure is provided in the insertion portion, the device including at least one conduit communicating with the opening, and a mesh covering at least an outer surface of the distal end portion.

[0007] With this configuration, it is possible to perform water supply and suction in order to confirm a bleeding site while performing blunt peeling between the elastic member and the mesh portion.

[0008]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS <First Embodiment> An embodiment of the present invention will be described below with reference to the drawings.

(Structure) FIGS. 1 to 3 relate to a first embodiment of the present invention. FIG. 1 is an overall view of a surgical instrument for exfoliation, FIG. 2 shows a distal treatment section, and FIG. 2 (a) is an elastic member. Exterior view of FIG. 2
3B is a cross-sectional view showing the distal end of the insertion section and the treatment section, FIG. 3 shows a modified example of the elastic member, FIG. 3A is an explanatory view showing a substantially conical elastic member, and FIG. It is explanatory drawing which shows the state which provided the groove | channel in the spherical elastic member.

As shown in FIG. 1, the surgical instrument for exfoliation according to the first embodiment comprises an insertion portion 1, a main body 2 on the hand side, and a treatment portion 3 on the distal end side. It is detachably fixed at the connection part 4.

The insertion portion 1 is formed of a resin or metal pipe, and the inside thereof is used as a water supply / suction pipe 5.
The main body 2 is provided with a water supply pipe and a suction pipe (not shown) that communicate with the water supply / suction pipe 5 in the insertion section 1. Each pipe has a flow of liquid or gas flowing therein. Pipeline opening / closing buttons 6 and 7 to be controlled are connected. The conduit opening / closing button 6 is connected to a water supply tube 8 for introducing a liquid from a water supply source (not shown), and the conduit opening / closing button 7 is connected to a suction tube 9 for suctioning to a suction source (not shown).

As shown in FIG. 2, the treatment section 3 includes a substantially spherical elastic member 10 made of silicon or the like, and a mesh 11 attached so as to cover the outer periphery of the elastic member 10. The elastic member 10 has a spherical shape suitable for exfoliation of an organ, and a part of the elastic member 10 extends along the inner diameter of the water supply / suction pipe 5 of the insertion section 1. Further, the inside thereof is provided with a plurality of holes 12 communicating with the water supply / suction pipe line 5 and reaching the outer peripheral portion of the elastic member 10. The mesh 11 is made of nylon, metal, or the like, is non-adherent to blood, and is formed in a shape close to a finger cot. The end of the elastic member 10 inserted in the insertion portion 1 covered with the mesh 11 is fixed by a heat-shrinkable tube 13.

(Operation) When the distal end of the surgical instrument for dissection thus constituted is lightly pressed against a place in the body cavity where blunt dissection is desired, the adhered portion can be detached. Further, when the conduit opening / closing button 6 on the water supply side is pressed, a conduit (not shown) is opened, and the physiological saline sent from the water supply source is supplied with the water supply tube 8, the water supply suction conduit 5, the elastic member 1, and the like.
The water passes through the holes 12 and the mesh 11 sequentially and is fed into the body cavity. Further, when the conduit opening / closing button 7 on the suction side is pressed, a conduit (not shown) is opened, and physiological saline, blood, etc. remaining in the body cavity are removed from the mesh 11 and the hole 1 in the elastic member 10.
2. The water is sucked into the suction source through the water supply suction line 5 and the suction tube 9.

(Effect) The surgical instrument for peeling according to the present embodiment
Since the water supply / suction pipe line 5 is built in the insertion section 1 and the main body 2, the water supply / suction is performed to wash the inside of the body cavity, so that the peeling can be performed while confirming the bleeding site.
Further, since it is not necessary to insert or remove a treatment tool for water supply or suction, the operation time can be shortened. Further, since the insertion section 1 and the main body 2 are detachable, only the insertion section which is difficult to clean can be disposable, which is hygienic and requires no cleaning.

In this embodiment, the elastic member 10 at the distal end is used.
Has been described in the case of a spherical shape provided with a hole 12, but the shape is not limited to this shape. For example, as shown in FIG. And holes 12 are provided on the side surface and the bottom surface,
As shown in FIG. 3 (b), at least one groove 14 communicating with the water supply / suction pipe line 5 may be provided on the outer peripheral surface thereof in a substantially spherical shape, or a combination of the grooves may be provided. In this way, by changing the shape and hardness arbitrarily, it is possible to form a peeling section suitable for a part to be peeled.

Also, the description has been given of the case where there are two pipe opening / closing buttons 6 and 7. However, the number of buttons is limited to the case where only one pipe opening / closing button 6 for water supply is used and water is not supplied. May be set to a suction state at all times to suck physiological saline or blood remaining in the body cavity.

Further, as a method of fixing the insertion portion 1 and the mesh 11, a known bonding method such as bonding or welding may be used.

<Second Embodiment> (Configuration) FIGS. 4 and 5 relate to a second embodiment of the present invention.
FIG. 4 is an overall view of the surgical instrument for peeling, and FIG. 5 is a cross-sectional view of the distal end of the insertion section and the treatment section.

The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted. The second embodiment is different from the first embodiment in that a treatment tool can be inserted.

As shown in FIG. 4, the surgical instrument for exfoliation according to the second embodiment comprises an insertion portion 1, a main body 21 on the hand side, and a treatment portion 22 on the distal end side. Are fixed at the connection portion 4.

A rear end portion of the main body 21 is provided with a treatment instrument conduit 30 installed in the insertion portion 1 in parallel with the water supply / suction conduit 5,
A treatment tool port 23 having an inner diameter communicating with a substantially straight line is provided. A rubber cap 24 capable of maintaining airtightness is detachably attached to the treatment tool port 23.

The treatment section 22, as shown in FIG.
Elastic member 26 having a hole 25 communicating with straight line 0
And the mesh 27 that covers the inner peripheral surface of the hole 25 and the outer peripheral surface of the elastic member 26. After the elastic member 26 covered with the mesh 27 is inserted into the outer diameter of the distal end of the insertion portion 1, the heat-shrinkable tube 13 is used. It is fixed. A plurality of holes 28 communicating with the water supply / suction pipe 5 are provided on the side surface of the elastic member 26.

(Operation) The operation of the surgical instrument for exfoliation configured as described above is similar to the operation of the first embodiment, except that the rubber cap 24 is removed and the treatment tool 29 is inserted from the treatment tool port 23. Conduit 30 in section 1, hole 25 in elastic member 26
Can be inserted and protrude from the distal end of the treatment section 22 to be used as a treatment tool.

(Effect) The surgical instrument for peeling according to the present embodiment
In addition to the effects of the first embodiment, the treatment instrument operation can be performed even during the blunt stripping operation. For example, when bleeding is mistakenly performed during peeling, an electrode can be immediately inserted from the treatment instrument port 23 to stop bleeding, and bleeding can be minimized. In addition, since the inner diameter portion of the treatment tool port 23 and the conduit 30 are formed substantially linearly, the treatment tool and the like can easily reach the bleeding site without getting lost.

Further, even during an endoscopic surgical operation, the number of holes formed in the body cavity wall can be reduced by using the surgical instrument for exfoliation of the present embodiment, so that damage to the patient is minimized. Can be.

The case where the mesh 27 covers the inside diameter of the hole 25 of the elastic member 26 has been described.
7 may be shaped to cover only the outer periphery of the elastic member 26.
Moreover, the case where two pipes, that is, the water supply suction pipe 5 and the treatment tool pipe 30 are provided, has been described. However, even if three or more pipes are provided, the two pipes are made common, It may be constituted by one pipe. In this case, the configuration inside the insertion portion becomes simpler, and the manufacturing cost can be reduced.

<Modification of First Embodiment> (Configuration) FIGS. 6 to 8 relate to a modification of the first embodiment of the present invention. FIG. 6 is an overall view of a surgical instrument for exfoliation, and FIG. 7A is a detailed view of the distal end of the tube, FIG. 7B is an explanatory view showing a state in which the tube is attached to the insertion section, and FIG. 8 is an explanatory view showing a modification of the distal treatment section. is there.

The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted. This modification is different from the first embodiment in that the elastic member 10 and the mesh 11 of the first embodiment are constituted by tubes.

As shown in FIG. 6, the surgical instrument for exfoliation according to the present modification includes an insertion portion 1, a main body 2 on the proximal side, and a treatment portion 31 on the distal end side, and the insertion portion 1 and the main body 2 are connected. The part 4 is fixed.

As shown in FIG. 7A, the tube 32
Has a small diameter, the tip 33 has a substantially spherical shape slightly thicker than the outer diameter of the tube 32, and a small hole 34 communicating in the axial direction is provided inside.

As shown in FIG. 7B, the treatment section 31
The tubes 32 are bundled and inserted into the water supply / suction pipe line 5 of the insertion section 1, and the bundled distal end surface has a spherical shape. Each of the small holes 34 of the tubes 32 communicates with the water supply / suction pipe line 5.

(Function) When the distal end of the surgical instrument for dissection thus constructed is lightly pressed against a place in the body cavity where blunt dissection is desired, the distal end face of a plurality of adjacent tips 33 and a gap are formed. The bonded portion can be peeled off by the uneven portion to be formed.

When the pipeline opening / closing button 6 on the water supply side is pressed, a pipeline (not shown) is opened, and the physiological saline sent from the water supply source is supplied to the water supply tube 8, the water supply suction line 5, and the tube 32. Water passes through each of the small holes 34 sequentially and is fed into the body cavity. Further, when the conduit opening / closing button 7 on the suction side is pressed, a conduit (not shown) is opened, and physiological saline, blood, etc. remaining in the body cavity pass through the fine hole 34, the water supply / suction conduit 5, and the suction tube 9. Then, it is sucked into the suction source.

(Effect) The effect of using the surgical instrument for exfoliation of this modification is the same as that of the first embodiment.

The shape of the distal end 33 of the tube 32 is
Although the description has been made in the case of a substantially spherical shape, the effect is not changed even if the shape does not damage the part to be peeled. Also, as shown in FIG. 8, even if the shape of the tip surface of one tube is a hemisphere having the same diameter as the outer diameter, and the shape of the tip surface when the tubes are bundled is a substantially hemispherical shape, the effect can be obtained. does not change.

<Third Embodiment> (Configuration) FIG. 9 is an overall view of a surgical instrument for exfoliation according to a third embodiment of the present invention.

The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted. The third embodiment is different from the first embodiment in that a balloon is provided.

As shown in FIG. 9, the exfoliating surgical instrument according to the third embodiment has a balloon 37 provided at the distal end of the insertion section 1 and at the rear end of the treatment section 3. Air supply tube 38
Is connected to the balloon 37, communicates inside the insertion section 1 and extends from the connection section 4 to the outside. An air supply pipe that supplies gas from an air supply source (not shown) is connected to the air supply base 39.

(Operation) When the insertion section 1 is inserted into the body cavity, the operation is performed with the balloon 37 contracted. After insertion,
The gas supplied from an air supply source (not shown)
9. The air is supplied to the balloon 37 closer to the base end than the treatment section 3 through the air supply tube 38, and the balloon 3
Expand 7 By expanding the balloon 37, an organ such as a liver is evacuated. Further, when performing a hernia repair operation by an extraperitoneal approach, a tunnel is formed by separating the peritoneum and the abdominal wall in the treatment section 3. The balloon 37 is expanded while the insertion section 1 is inserted into the tunnel, and at the same time, a wide area of the peritoneum is peeled off to secure a wide operation field.

(Effect) The surgical instrument for peeling according to the present embodiment
In addition to the effects of the first embodiment, the expansion means is provided at the distal end, so that the organ can be unnecessarily evacuated without damaging the organ. In addition, since a wide range of exfoliation can be performed at the same time, the operation time can be significantly reduced.

<Fourth Embodiment> (Configuration) FIGS. 10 to 12 relate to a fourth embodiment of the present invention. FIG. 10 is an overall view of a surgical instrument for exfoliation, and FIG. 11 is a cross-sectional view showing a distal treatment section. FIG. 11 (a) is a cross-sectional view showing a state at the time of insertion, FIG. 11 (b) is a cross-sectional view showing a state expanded after insertion, and FIG. 12 shows an appearance of the distal treatment section without the mesh 43. 12A is an explanatory diagram showing a state at the time of insertion, and FIG. 12B is an explanatory diagram showing a state expanded after insertion.

The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted. The present embodiment is different from the first embodiment in that the treatment section of the first embodiment can be expanded by an operation section on the base end side of the main body 2.

As shown in FIG. 10, the surgical instrument for exfoliation according to the present embodiment includes an insertion portion 41, a main body 2 on the hand side, and a treatment portion 42 on the distal end side. The part 4 is fixed.

As shown in FIG. 11, an outer surface of the treatment section 42 is covered with a mesh 43, and an elastic member 4 made of silicon rubber or a spring material or the like is provided inside the treatment section 42 in a substantially cylindrical shape.
4 are arranged.

The mesh 43 is made by knitting using a resin thread such as nylon, and has elasticity.

The base end of the elastic member 44 and the base end of the mesh 43 are fixed all around the distal end of the insertion portion 41 and the heat-shrinkable tube 45. The distal end side of the elastic member 44 is folded inward, and the folded portion 46 is fixed to the distal end of an operation rod 47 to be described later by a known means such as adhesion.

As shown in FIG. 12, the elastic member 44 has
A plurality of slits 48 are provided at regular intervals in the circumferential direction along the longitudinal axis direction.

As shown in FIG. 10, the operating rod 47 is
The insertion portion 41 and the inside of the main body 2 are inserted through each
Protruding from the rear end side and is connected to the operation unit 49. A rubber cap 50 through which the operation rod 47 can be inserted and which is kept airtight with the outer diameter of the operation rod 47 is fixed to the base end side of the main body 2.

(Operation) The treatment section 42 of the surgical instrument for exfoliation configured as described above has a cylindrical shape having substantially the same diameter as the insertion section 41 as shown in FIG. 11 (a) or 12 (a). In the inserted state, it is inserted into a body cavity using a trocar (not shown).

Next, when the operation unit 49 is pulled out at hand,
In conjunction with this, the operation rod 47 and the folded portion 46 move to the near side of the longitudinal axis. When the folded portion 46 moves to the near side, as shown in FIG. 11B or FIG.
The elastic member 44 expands in the radial direction to have a substantially spherical shape, and blunt peeling is possible.

Water supply / suction is performed through the slit 48 and the mesh 43 by operating the pipeline opening / closing buttons 6 and 7. After the peeling treatment is completed, the operation unit 49
Is pushed back to the distal end side, it is in the state before insertion, and the insertion portion 4
1 can be pulled out of the body from a trocar (not shown).

(Effect) The effect of using the surgical instrument for exfoliation of the present embodiment is similar to that of the first embodiment.
Is expandable, it can be configured to have a small diameter, and the pain of the patient can be reduced.

Although the elastic member 44 has been described as an example in which the slit 48 is provided in a cylindrical member, the elastic member 44 may be formed by forming a plurality of plate members into a cylindrical shape. Further, the elastic member 44 and the operation rod 47 may be integrally formed. Alternatively, the operation rod 47 may be formed of a pipe, into which a treatment tool such as a treatment tool is inserted, or may be used as a second water supply / suction pipe.

<Fifth Embodiment> (Configuration) FIGS. 13 to 15 relate to a fifth embodiment of the present invention. FIG. 13 is an overall view of a surgical instrument for exfoliation, and FIG. 14 shows a state before insertion. FIG. 15 is a cross-sectional view of the distal treatment section, showing a state where the mesh is expanded.

The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted. This embodiment is different from the first embodiment in that the treatment section of the first embodiment can be expanded by an operation section at the base end of the main body 2.

As shown in FIG. 13, the surgical instrument for exfoliation according to the present embodiment includes an insertion portion 41, a main body 2 on the hand side, and a treatment portion 52 on the distal end side, and the insertion portion 41 and the main body 2 are connected. The part 4 is fixed.

As shown in FIG. 14, the mesh 53 is formed by knitting using a resin thread such as nylon, and is formed in a bag shape having elasticity. Bag-shaped mesh 53
The entire periphery of the mouth is fixed by the distal end of the insertion portion 41 and the heat-shrinkable tube 45. The mesh 53 can be folded back into the distal end lumen of the insertion section 41 or pushed out of the lumen.

An operation pipe 54 is inserted through the lumen of the insertion section 41. The distal end side of the operation pipe 54 is fixed to one end of an expansion member 55 formed of an elastic member such as silicone rubber or latex rubber so that the lumen of the operation pipe 54 and the lumen of the expansion member 55 communicate with each other. . The inflation member 55 is provided with a plurality of openings 56, and is configured to supply air from an air supply tube described later into the body cavity through the lumen of the operation pipe 54 and the opening 56. ing.

As shown in FIG. 13, the base end side of the operation pipe 54 is inserted through the inside of the insertion portion 41 and the inside of the main body 2 and protrudes from the rear end side of the main body 2 and is connected to the operation section 57. . A rubber cap 50 through which the operation pipe 54 can be inserted and which is kept airtight with the outer diameter of the operation pipe 54 is fixed to the base end side of the main body 2.

One end of an air supply tube 58 communicating with the inner cavity of the operation pipe 54 is connected to the side surface of the operation section 57, and the other end of the air supply tube 58 is connected to an air supply source (not shown). Is fixed.

(Operation) The treatment section 52 of the surgical instrument for exfoliation configured as described above is, as shown in FIG.
The insertion part 3 is inserted into the body cavity by using a trocar (not shown) with the insertion part folded back into the distal end cavity of the insertion part 41.

Next, when the operating section 57 is pushed to the tip side,
In conjunction with this, the operation pipe 54 and the inflation member 55 move to the distal end side in the longitudinal axis direction, push the mesh 53 together with the inflation member 55 to the outside of the insertion portion 41, and the mesh 53 covers the outer surface of the inflation member 55. Become.

In this state, gas sent from an air supply source (not shown) passes through the air supply base 59, the air supply tube 58, and the lumen of the operation pipe 54, reaches the inside of the expansion member 55, and expands. By gradually inflating the member 55, the inflation member 55
The mesh 53 adheres to the outer surface of the substrate. Further, as the air supply is continued, as shown in FIG. 15, the treatment section 52 expands into a substantially spherical shape, and blunt peeling is possible.

The water supply / suction is performed by operating the conduit opening / closing buttons 6 and 7 so that the expansion member 55 is opened between the lumen of the insertion portion 41 and the outer diameter of the operation pipe 54 through the opening 56 a of the expansion member 55. This is performed via the opening 53 on the inside or the distal end or the outer surface of the expansion member 55, and the mesh 53.

When the exfoliation procedure is completed and the body is to be removed from the body, the inflatable member 55 is contracted, then the operating portion 57 is pulled back to the proximal end side, and the inflatable member 55 is drawn into the lumen of the insertion portion 41. Then, after the outer diameter portion of the mesh 53 becomes equal to or smaller than the outer diameter of the insertion portion 41, the insertion portion 41 is removed from the trocar (not shown) to the outside of the body. The expansion member 5
After contracting 5, the insertion section 41 may be pulled out of the body without being pulled back into the lumen of the insertion section 41.

(Effect) The effect obtained by using the surgical instrument for exfoliation of the present embodiment is the same as the effect of the first embodiment, except that the treatment section 52
Is expandable, it can be configured to have a small diameter, and the pain of the patient can be reduced. Further, before insertion into the body cavity, the mesh 53 is inserted in a state of being stored in the lumen of the insertion portion 41, so that the mesh 53 is protected until used,
The mesh 53 is not damaged.

<Sixth Embodiment> (Configuration) FIGS. 16 to 19 relate to a sixth embodiment of the present invention. FIG. 16 is an overall view of a surgical instrument for peeling, and FIG. FIG. 18 is an explanatory view showing a state where the electrodes protrude from the distal end of the treatment section, and FIG. 19 is a cross-sectional view showing the distal treatment section in the state of FIG.

The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted. In the present embodiment, the treatment section and the main body 6 of the second embodiment are used.
2 is different.

As shown in FIG. 16, the surgical instrument for exfoliation according to the present embodiment includes an insertion portion 61, a main body 62 on the hand side, and a treatment portion 63 on the distal end side. The insertion portion 61 and the main body 62 are connected. It is fixed by the part 64.

As shown in FIG. 19, the treatment section 63 includes an elastic member 65, a connecting member 66, and a mesh 67. The elastic member 65 and the connecting member 66 are fixed by the engagement of the flange 66a of the connecting member 66 and the groove 65a of the elastic member 65. The mesh 67 covers the outer surface of the elastic member 65, and its base end side is sandwiched between the elastic member 65 and the connecting member 66 and is adhesively fixed.

The elastic member 65 and the connecting member 66 of the treatment section 63
Is provided with a conduit communicating with the conduit 68 of the insertion portion 61. The distal end of the elastic member 65 communicates with an opening 69 through which a treatment tool insertion portion described later can be inserted, and the conduit 68. Further, a plurality of holes 70 reaching the outer peripheral portion of the elastic member 65 are provided.

The insertion portion 6
There is provided a screw portion 71 which can be removably screwed to the inner diameter of the distal end portion.

At least a part of the material of the elastic member 65 and the connecting member 66 is added or coated with a contrast agent.

As shown in FIG. 16 and FIG.
The distal end portion of the treatment tool insertion portion 72 that can be inserted into the inside 8 is connected to a substantially L-shaped electrode 73, and the base end portion is inserted through a conduit 68 provided in the main body 62. It protrudes from the rear end side of the main body 62. A plug 75 for connecting to an unillustrated electric knife power supply is connected to the protruding portion via a flange portion 74 having a diameter larger than the outer diameter of the treatment instrument insertion portion 72. A rubber cap 76 through which the treatment tool insertion portion 72 can be inserted and which is kept airtight with the outer diameter portion of the treatment tool insertion portion 72 is fixed to the base end side of the main body 62.

A coil spring 77 is provided between the flange portion 74 and the rubber cap 76 so as to be inserted into the treatment instrument insertion portion 72. The coil spring 77 connects the electrode 73 at the distal end of the treatment instrument insertion section 72 via the flange section 74 to the conduit 68.
It is urged to be held within.

As shown in FIG. 16, a substantially rectangular elastic plate 78 made of an elastic member extends in a direction substantially parallel to the longitudinal axis direction of the treatment instrument insertion section 72 on the rear end side surface of the main body 62. Is fixed. The base end side of the elastic plate 78 extends in the direction of the treatment instrument insertion section 72, and its tip has a claw-shaped projection 79 slightly curved to the front end side, and the opposite direction becomes L-shaped toward the base end side. Operating pieces 80 are connected.

The main body 62, the elastic plate 78, the protrusion 79, and the operation piece 80 may be integrally formed of the same elastic member, or only an arbitrary part may be formed of the elastic member. Examples of the elastic member include a metal plate spring and a thin resin plate, but any material may be used as long as it has elasticity. Further, the insertion section 61, the main body 62 and the treatment section 63 are formed of an insulating member.

(Operation) A cable from an electric scalpel power supply (not shown) is connected to the plug 75 to the surgical instrument for exfoliation configured as described above. As shown in FIGS. 17 and 19,
The coil spring 77 extends, and the distal electrode 73 is connected to the treatment section 6.
3 and inserted into the body cavity. After the insertion, the target site in the body cavity is meshed with the mesh 67 of the distal treatment section 63.
To perform blunt stripping, and if necessary, open and close the pipeline
To perform water supply and suction.

When a thin blood vessel or a cord-like object that cannot be bluntly peeled comes out, the flange portion 74 is pushed out to the distal end side. First, the front surface of the flange portion 74 and the projection portion 79 abut against each other, and when the flange portion 74 is further pressed, the projection portion 79 is pushed by the flange portion 74, the elastic plate 78 bends outward, and the flange portion 74 engages the projection portion 79. pass. Flange part 74
Is passed, the projection 79 returns to the original position by the urging force of the elastic plate 78. As shown in FIG.
The flange portion 74 engages with the protrusion 79, and the treatment instrument insertion portion 7
The electrode 73 at the second tip is stopped at a position protruding from the opening 69 of the treatment section 63.

After treating a blood vessel or a cord-like object using the electrode 73, when the operation piece 80 is moved in the direction of the arrow in FIG. 18, the engagement between the projection 79 and the flange 74 is released, and the coil spring 77 is released. The electrode 73 at the distal end of the treatment instrument insertion section 72 is retracted into the treatment section 63 together with the flange section 74 by the urging force.

(Effect) The effect of using the surgical instrument for exfoliation of the present embodiment is, in addition to the effect of the first embodiment, that the treatment tool inserted into the conduit 68 is moved to the retracted position in the treatment section 63. Since operation and holding can be performed at a position protruding from the distal end of the treatment section 63, operability is improved, and surgery can be performed in a short time.

Further, a contrast agent is added to the material of the treatment section 63,
Alternatively, since the application is performed, even if the treatment section 63 at the distal end falls, the location can be easily confirmed using X-rays or the like, so that it can be reliably collected in a short time. Also, since only the treatment section can be disposable, it is hygienic and can be configured at low cost. Further, since the insertion portion 61, the main body 62, and the treatment portion 63 are all formed of insulating members, the electrodes 7
Even if the power is supplied to 3, it is safe without electric shock.

As described above, the surgical instruments for exfoliation described in detail in each embodiment can be used in any combination without departing from the gist of the present invention.

[Appendix] As described in detail above, according to the embodiment of the present invention, the following configuration can be obtained.
That is,

[Supplementary Note 1] An elongated insertion portion, a distal end portion having an opening disposed at the distal end side of the insertion portion, a main body portion disposed at a base end portion of the insertion portion, and disposed inside the insertion portion. A surgical instrument for exfoliation, comprising: at least one conduit communicating with the opening; and a mesh covering at least an outer surface of the distal end.

[Supplementary Note 2] An elongated insertion portion having at least one conduit therein, and a distal end side of the insertion portion,
A distal end having an opening communicating with the conduit, a body disposed at a proximal end of the insertion portion and having a communicating portion communicating with the conduit, and a mesh covering at least an outer surface of the distal end A surgical instrument for exfoliation, comprising:

[Supplementary Note 3] A slender insertion portion, a distal end portion having an opening disposed on the distal end side of the insertion portion, a main body portion disposed at a base end portion of the insertion portion, and disposed inside the insertion portion. A surgical instrument for exfoliation, comprising: at least one conduit for supplying and sucking water to the opening; and a mesh covering at least an outer surface of the distal end.

[Supplementary Note 4] The exfoliating surgical instrument according to any one of Supplementary notes 1 to 3, wherein the distal end of the treatment tool can be held at a position protruding from the distal end portion and a position retracting into the distal end portion. .

[Supplementary Note 5] The surgical instrument for detachment according to any one of supplementary notes 1 to 3, wherein the insertion portion and the distal end portion are arbitrarily detachable.

[Supplementary Note 6] The surgical instrument for detachment according to any one of Supplementary Notes 1 to 3, wherein at least a part of the distal end portion is made of a radiopaque material.

[Supplementary Note 7] In the surgical instrument for detachment according to any one of Supplementary Notes 1 to 3, at least a part of the insertion portion or the distal end portion has an inflating means.

[Supplementary Note 8] The exfoliating surgical instrument according to any one of Supplementary notes 1 to 3, wherein the distal end portion has expansion / contraction means for expanding and contracting.

[Supplementary Note 9] The surgical instrument for exfoliation according to any one of Supplementary notes 1 to 3, wherein the insertion portion, the main body, and the distal end are all formed of insulating members.

[Supplementary Note 10] In the surgical instrument for detachment according to any one of Supplementary notes 1 to 3, at least a part of the distal end portion is formed of an elastic member.

[Supplementary Note 11] The surgical instrument for exfoliation according to any one of Supplementary notes 1 to 3, wherein a base end of the conduit is
The water supply means and the suction means are connected.

[Supplementary Note 12] The surgical instrument for detachment according to any one of Supplementary notes 1 to 4, wherein a second conduit for inserting a treatment tool is provided in the insertion portion.

[Supplementary Note 13] The surgical instrument for exfoliation according to any one of Supplementary notes 1 to 4, wherein the pipe for inserting the treatment tool and the water supply / suction pipe are combined into one pipe.

[Supplementary Note 14] The surgical instrument for detachment according to Supplementary Note 11, wherein at least one conduit switching means for selectively switching water supply or suction to the conduit is provided.

[Supplementary Note 15] The surgical instrument for detachment according to supplementary note 10, wherein the elastic member has at least one hole communicating with the conduit.

[Supplementary Note 16] In the surgical instrument for removal according to Supplementary Note 10, the elastic member has at least a groove communicating with the conduit.

[Supplementary Note 17] The surgical instrument for detachment according to any one of Supplementary notes 1 to 3, wherein the mesh is made of a non-adhesive material.

[Supplementary Note 18] An elongated insertion portion, a tube bundle which is inserted through the insertion portion and bundles a plurality of tubes arranged on the distal end side, and a main body portion arranged at the base end of the insertion portion; A surgical instrument for exfoliation, comprising a water feeding means and a suction means connected to the plurality of tube inner holes.

[0103]

As described above, according to the surgical instrument for exfoliation of the present invention, the portion for exfoliating the tissue is constituted by the distal end having the opening communicating with the duct and the mesh, so that sufficient exfoliation is achieved. Has performance. In addition, since the mesh has many gaps, sufficient water supply and suction can be performed, and blunt peeling and water supply / suction can be performed with a single surgical instrument, so that there is little damage to the patient and the operation time is reduced. Can be shortened, so that the operator's fatigue can be reduced.

[Brief description of the drawings]

FIG. 1 is an overall view of a surgical instrument for exfoliation according to a first embodiment of the present invention.

FIG. 2 shows a distal treatment section, FIG. 2 (a) is an external view of an elastic member, and FIG. 2 (b) is a sectional view showing a distal end of an insertion section and a treatment section.

3A and 3B show a modified example of the elastic member, FIG. 3A is an explanatory diagram showing a substantially conical elastic member, and FIG. 3B is an explanatory diagram showing a state where a groove is provided in the substantially spherical elastic member. It is.

FIG. 4 is an overall view of a surgical instrument for exfoliation according to a second embodiment of the present invention.

FIG. 5 is a cross-sectional view of a distal end of an insertion section and a treatment section.

FIG. 6 is an overall view of a surgical instrument for exfoliation according to a modification of the first embodiment of the present invention.

7A and 7B show a distal treatment section, wherein FIG. 7A is a detailed view of a distal end portion of a tube, and FIG. 7B is an explanatory diagram showing a state where the tube is mounted on an insertion portion.

FIG. 8 is an explanatory view showing a modification of the distal treatment section.

FIG. 9 is an overall view of a surgical instrument for exfoliation according to a third embodiment of the present invention.

10 to 12 are general views of a surgical instrument for exfoliation according to a fourth embodiment of the present invention.

11A and 11B are cross-sectional views showing a distal treatment section, wherein FIG. 11A is a cross-sectional view showing a state at the time of insertion, and FIG. 11B is a cross-sectional view showing a state expanded after insertion.

12A and 12B are explanatory views showing the appearance of the distal treatment section without the mesh 43, FIG. 12A is an explanatory view showing a state at the time of insertion, and FIG. 12B is a view showing an expanded state after insertion. FIG.

13 to 15 are general views of a surgical instrument for exfoliation according to a fifth embodiment of the present invention.

FIG. 14 is a cross-sectional view of the distal treatment section, showing a state before insertion.

FIG. 15 is a cross-sectional view of the distal treatment section, showing a state where the mesh is expanded.

16 to 19 are general views of a surgical instrument for exfoliation according to a sixth embodiment of the present invention.

FIG. 17 is an explanatory diagram showing a state in which an electrode is inside an insertion portion.

FIG. 18 is an explanatory view showing a state in which the electrodes protrude from the distal end of the treatment section.

19 is a cross-sectional view showing the distal treatment section in the state shown in FIG. 17;

[Explanation of symbols]

 1, 41, 61 Insertion section 2, 21, 62 Main body 3, 22, 31, 35, 42, 52, 63 Treatment section 4, 64 Connection section 5 Water supply suction pipe 6, 7 Pipe open / close button 8 Water supply tube 9 Suction Tube 10, 26, 44, 65 Elastic member 11, 27, 43, 53, 67 Mesh 12, 25, 28, 70 hole 13, 45 Heat shrink tube 14 Groove 23 Treatment tool port 24, 50, 76 Rubber cap 29 Treatment tool 30, 68 Pipeline 32 Tube 33 Tip 34 Fine hole 37 Balloon 38 Air supply tube 39 Air supply mouthpiece 46 Folding part 47 Operation rod

Claims (1)

[Claims] An elongated insertion portion, a distal end having an opening disposed on a distal side of the insertion portion, a main body disposed at a base end of the insertion portion, and disposed inside the insertion portion; A surgical instrument for exfoliation, comprising: at least one conduit communicating with the opening; and a mesh covering at least an outer surface of the distal end.