JPH11342135A - Treatment device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a treatment device capable of grasping an endotexture to coagulate it to securely achieve hemostasis or the like, and securely capable of feeding water to a treated part to wash blood of hemorrhage or the like. SOLUTION: In a treatment device having an insertion portion 2, an operation part 4 on the operator's side of the insertion portion 2, and a pair of holding members 11a and 11b at a distal end of the insertion portion 2 to grasp an organization by operation of the operation part 4, a tube cavity to be communicated with a feed water source is provided in the insertion portion 2, and a feed water nozzle 16 opened between the holding members 11a, 11b is provided on the distal end of the tube cavity.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a treatment instrument which can be inserted into a body cavity of a living body to grasp, peel, coagulate, and incise tissue.

[0002]

2. Description of the Related Art Generally, a pair of grasping members for grasping a living tissue is provided as a treatment tool which is inserted into a body cavity and grasps, separates, coagulates and dissects a living tissue. A set bipolar forceps is known. When using the bipolar forceps, a high-frequency current is applied between the electrodes of each gripping member to coagulate the living tissue between the gripping members while the living tissue to be treated is gripped between the pair of gripping members. Has become.

[0003] Bipolar forceps of this kind are usually used in various cases such as hemostasis of blood vessels contained in living tissue, lesions on the surface layer of living tissue, cauterization of bleeding points, occlusion of fallopian tubes for contraception, and the like. Can be Bipolar forceps are used for hemostasis of blood vessels and occlusion of fallopian tubes, so that a living tissue to be treated by a patient can be coagulated, and the coagulated living tissue can be incised. ing.

Conventionally, as this kind of endoscopic high-frequency treatment instrument, for example, US Pat. No. 5,071,419 and DE1966061
94 A1 and Japanese Utility Model Laid-Open No. 5-82401. The electrosurgical instrument disclosed in US Pat. No. 5,071,419 is provided with a hook-shaped electrode at the tip of an insertion portion to be inserted into a body cavity, a water pipe provided at the insertion portion, and the hook-shaped electrode at the tip of the water pipe. An opposed water supply nozzle is provided so that water can be supplied to the treatment section.

[0005] Further, the surgical medical device of DE 19606194 A1 is provided with a pair of openable and closable gripping members at a distal end of an insertion portion to be inserted into a body cavity, and a water pipe provided at the insertion portion. A water supply nozzle is provided at the tip of the water pipe and opens to the side of the pair of gripping members.

[0006] Therefore, in any of the high-frequency treatment instruments, the living tissue can be coagulated by high-frequency waves, and water can be supplied to the treatment section to wash out bleeding blood and the like.

[0007]

However, the above-mentioned US Pat. No. 5,071,419, which presses a hook-shaped electrode against a living tissue to coagulate by high frequency, does not have a function of gripping or peeling the living tissue. The lack of a gripping function makes it impossible to reliably stop bleeding. Also, DE1
9606194 A1 has a pair of openable and closable gripping members at the distal end of the insertion portion, and has a function of gripping and peeling tissue, but the water supply nozzle is opened at a position shifted on the side of the gripping members. doing. Therefore, it is necessary to move the gripping member after water supply and to adjust the position again. In Japanese Utility Model Laid-Open No. 5-82401, a water supply conduit is provided at an insertion portion so that water can be supplied from a water supply source and can be jetted from a distal end side of the insertion portion. The purpose of this is to keep the field of view by cleaning the observation window.

The present invention has been made in view of the above circumstances, and has as its object to wash out bleeding from tissue to confirm bleeding points. It is an object of the present invention to provide a treatment tool that can quickly stop bleeding by immediately grasping and coagulating.

[0009]

SUMMARY OF THE INVENTION In order to achieve the above object, the present invention has an insertion portion and an operation portion at a hand side of the insertion portion, and a distal end portion of the insertion portion is operated by operating the operation portion. In a treatment tool having a pair of energizable gripping members for gripping, a lumen communicating with a water supply source is provided in the insertion portion, and an opening is provided at a distal end portion of the lumen between the pair of gripping members. It is characterized by having provided a water supply nozzle which performs the following. Then, with respect to the bleeding from the tissue, the blood is washed away by water supply from the water supply nozzle, and the confirmed bleeding point can be quickly grasped and coagulated to stop the bleeding.

[0010]

Embodiments of the present invention will be described below with reference to the drawings. FIGS. 1 to 4 show a first embodiment, and FIGS. 1 and 2 are overall configuration diagrams of a high-frequency treatment instrument as an endoscopic surgical instrument. As shown in FIGS. 1 and 2, a bipolar forceps 1 as a high-frequency treatment instrument has an elongated insertion portion 2 inserted into a body cavity of a patient, and is disposed at a distal end portion of the insertion portion 2, and a biological tissue is inserted into the body cavity. There is provided a treatment section 3 that can be energized for grasping, peeling, and coagulating, and an operation section 4 connected to the base end of the insertion section 2.

The insertion section 2 comprises an outer sheath 5 and an inner sheath 6 which is inserted into the outer sheath 5 so as to be able to advance and retreat in the axial direction. The proximal end of the outer sheath 5 constitutes the operation section 4. The base portion of the inner sheath 6 is fixed to the extension portion 7 a of the grip 7, and the base end of the inner sheath 6 is fixed to the inner sheath driving member 8 provided in the operation portion 4.

The treatment section 3 includes a pair of gripping members 11a and 11b as gripping portions constituting an electrode, and an elastic member 1 for urging the gripping members 11a and 11b in a direction to expand.
2a and 12b are provided. Elastic members 12a, 1
2b is formed of spring steel or the like, and the elastic members 12a, 1
The surface of 2b is covered with the insulating material 14. Further, when the gripping members 11a and 11b are closed, saw-toothed portions are formed so as to mesh with each other, and are formed so as to reliably grip the living tissue.

A water pipe 15 as a lumen is inserted through the inner sheath 6 so as to be able to advance and retreat in the axial direction. The water supply pipe 15 is made of a thin metal tube, and has a base end extending to the inside of the operation unit 4 and a distal end extending to the treatment unit 3. Furthermore, the pair of gripping members 11
A water supply nozzle 16 that opens between the holes a and 11b is provided.

That is, as shown in FIG. 3, the water supply nozzle 16 has a shape in which the opening at the distal end of the water supply pipe 15 is tapered, and the gripping members 11a and 11b allow the position of the water supply nozzle 16 to be confirmed. A slit 17 is provided.

Further, as shown in FIG. 4, the operating section 4 is provided with a water pipe connecting member 18 for connecting the base end of the water pipe 15. The water supply pipe connecting member 18 is provided with a water supply path 19 including a horizontal hole 19a that opens in the axial direction of the water supply pipe 15, that is, a horizontal direction, and a vertical hole 19b that opens vertically at a right angle from an end of the horizontal hole 19a. I have. An elastic member 20 made of rubber or the like is fixed to the lateral hole 19a by a fixing ring 21, and an acute angle cut portion 15a formed at the base end of the water pipe 15 is pierced into the elastic member 20 so as to be able to advance and retreat in the axial direction. ing.

A threaded portion 23a at the base end of a tube connecting member 23 is screwed and fixed to the threaded portion 22 of the vertical hole 19a, and is attached to the distal end of the tube connecting member 23 projecting from the water pipe connecting member 18. Is connected to the base end of the water supply tube 24. Then, the liquid supplied through the water supply tube 24 is supplied to the water supply pipe 15 through the water supply passage 19.
And jetted from the water supply nozzle 16.

As shown in FIGS. 1 and 2, the extension 7a of the grip 7 is provided with a connection ring 25 which is connected and fixed to the base end of the outer sheath 5. Further, a treatment section unit connection section 26 for electrical and mechanical connection with the rear end of the treatment section 3 is provided behind the extension section 7a.

The treatment section unit connection section 26 is provided with connection means (not shown) for connecting to a pair of grip members 11a and 11b constituting the treatment section 3, and a rear end portion of the operation section 4 via this connection means. Is electrically connected to the cable connection portion 27 provided in the first connector. This cable connection portion 27 is connected to a high-frequency ablation power supply device (not shown) via a connection cable 28.

The grip 7 is provided with a trigger 30 as forceps operating means. The trigger 30 is connected to the upper end of the grip 7 so as to be rotatable around a rotation pin 31. Further, a long hole 32 is formed in the trigger 30 above the pivot point. An engagement pin 33 projecting from a side surface of the inner sheath driving member 8 is inserted into the long hole 32.

The trigger 30 is provided inside the grip 7.
There is provided an urging member (not shown) for urging the handle portion 30a at the lower end of the gripper 7 in a direction away from the grip 7 (clockwise around the pivot pin 31 in FIG. 1). The trigger 30 is always held at a fixed position (release position) farthest from the grip 7 by the spring force of the urging member.

Further, a water supply operation lever 34 as water supply operation means is provided on a side surface at an upper portion of a rear end of the grip 7. The water supply operation lever 34 is rotatably connected to the grip 7 around a rotation pin 35.
Further, a long hole 36 is formed above the center of rotation of the water supply operation lever 34, and an engagement pin 37 protruding from the rear end side surface of the water supply pipe 15 is inserted into the long hole 36.

The water supply operation lever 34 is provided with front and rear arm portions 38a and 38b arranged in a substantially V shape.
A finger hook 39 is in contact with one of the arms 38a, and the other arm 38b is in contact with a stopper pin 40 to play a role in restricting the rotation range of the water supply operation lever 34. Further, an urging member (not shown) for urging the water supply operation lever 34 in the clockwise direction is attached to the rotating pin 35.

Here, by pulling the handle portion 30a of the trigger 30 toward the grip 7 against the spring force of the biasing member, the inner sheath 6 is connected to the shaft of the outer sheath 5 via the inner sheath driving member 8. Move forward in the direction. As the inner sheath 6 advances, the elastic members 12a, 12b are relatively drawn into the inner sheath 6, and the grip members 11a, 1
1b closes. When the trigger 30 is released, the elastic member 12a, 12b relatively returns from the inner sheath 6 due to the spring force of the biasing member in the grip 7, and the grip members 11a, 11b become elastic members 12a, 11b. It is opened by the elastic restoring force of 12b.

Also, the finger hook 39 of the water supply operation lever 34
When the water supply operation lever 34 is rotated counterclockwise against the urging force of the urging member, the water supply pipe 15 is driven forward through the engagement pin 37 inserted into the elongated hole 36. Then, the water supply nozzle 16 of the water supply pipe 15 is connected to the gripping members 11a, 1
1b. When the water supply operation lever 34 is released, the water supply pipe 15 returns to the home position by the spring force of the urging member, and the water supply pipe 15 is retracted and drawn into the inner sheath 6,
When the arm portion 38b contacts the stopper pin 40, the arm portion 38b stops.

Next, the operation of the first embodiment will be described. The connection cable 28 is connected to the cable connection portion 27 of the bipolar forceps 1 to electrically connect the bipolar forceps 1 and the high-frequency ablation power supply device. In the initial state, the handle portion 30a of the trigger 30 of the operation section 4 is held at a fixed position farthest from the grip 7, and the treatment section unit connection section 26 is held at the rearmost position of the axial movement range of the insertion section 2. .
In this state, the pair of elastic members 12a and 12b of the treatment section 3 project from the inner sheath 6 and the grip members 11a and 11b are open as shown in FIG.

Then, by pulling in the handle 30a of the trigger 30 toward the grip 7 against the spring force of the biasing member, the inner sheath 6 is moved in the axial direction of the outer sheath 5 via the inner sheath driving member 8. Move forward. With the advance of the inner sheath 6, the elastic members 12a and 12b are relatively drawn into the inner sheath 6, and as shown in FIG.
The grip members 11a and 11b close.

In this state, the insertion portion 2 of the bipolar forceps 1
Is inserted into the body of the patient, and the treatment section 3 at the distal end of the insertion section 2 guides the patient to a position near the living tissue to be treated in the body. When the trigger 30 is released, it returns to the home position by the spring force of the biasing member in the grip 7, and the elastic members 12a, 1
2b relatively protrudes from the inner sheath 6 and
a and 11b are opened by the elastic restoring force of the elastic members 12a and 12b.

Subsequently, the expanded gripping members 11a, 11b
After the living tissue is inserted (intervened) between the grips, the grip 30a of the trigger 30 is pressed against the spring force of the biasing member.
The inner sheath driving member 8
, The inner sheath 6 moves axially forward of the outer sheath 5. As the inner sheath 6 advances, the elastic members 12a, 12b
Are relatively drawn into the inner sheath 6, the gripping members 11a and 11b are closed, and the living tissue is gripped.

At this time, the gripping members 11a and 11b are formed as saw-toothed portions that mesh with each other when closed, so that the living tissue can be reliably gripped. In this state, a high-frequency current flows from the high-frequency ablation power supply device to the cord connection portion 27 via the connection cable 28, and a coagulation current flows between the grip members 11a and 11b, thereby coagulating the living tissue. After the coagulation is completed, when the trigger 30 is released, the inner sheath 6 returns to the initial position with respect to the outer sheath 5 by the spring force of the biasing member in the grip 7, and the elastic members 12a and 12b relatively move from the inner sheath 6. The holding members 11a and 11b project and open by the elastic restoring force of the elastic members 12a and 12b,
1a and 11b are released from the living tissue.

Here, the finger hook 3 of the water supply operation lever 34
When the water supply operation lever 34 is rotated counterclockwise against the urging force of the urging member, the water supply pipe 15 advances through the engagement pin 37 inserted into the long hole 36. And
As shown by a broken line in FIG.
a, protrudes between 11b. At this time, the protrusion amount of the water supply nozzle 16 can be confirmed from the slit 17 provided in the gripping members 11a and 11b. In this state, when the water supply cock (not shown) provided in the water supply source is operated to open the water supply cock, the liquid is supplied to the water supply path 19 via the water supply tube 24, and is further supplied to the water supply nozzle 16 via the water supply pipe 15. Squirted from. At this time, the water supply nozzle 16 is
Since it is located between 1a and 11b, it is possible to reliably send water to the treatment section of the living tissue, and to wash out bleeding blood and the like.

After the water supply is completed, when the water supply operation lever 34 is released, it returns to the home position by the spring force of the urging member,
The water supply pipe 15 is relatively drawn into the inner sheath 6, the water supply nozzle 16 is retreated, and the arm 38b is connected to the stopper pin 40.
Stops when it touches.

When the living tissue is to be peeled off, the trigger 30 is closed with the gripping members 11a, 11b closed, and the distal end of the gripping members 11a, 11b is pressed against the part where the living tissue is peeled off. When the release member 30 is released, the inner sheath 6 returns to the initial position with respect to the outer sheath 5 by the spring force of the biasing member in the grip 7, and the grip members 11a, 1
Since the opening 1b is opened by the elastic restoring force of the elastic members 12a and 12b, the living tissue can be separated by repeatedly opening and closing the gripping members 11a and 11b.

According to the present embodiment, grasping, peeling and coagulation of a living tissue can be performed by one bipolar forceps 1,
The number of replacements of the bipolar forceps 1 during the operation can be reduced to reduce the inconvenience, and the operation time can be shortened.
Since the water supply nozzle 16 projects between the pair of gripping members 11a and 11b and can supply water to the treatment section, water can be reliably supplied to the target portion.

FIG. 5 shows the second embodiment. The same components as those in the first embodiment are designated by the same reference numerals, and the description is omitted. In the present embodiment, a tubular elastic member 41 is inserted coaxially with the vertical hole 19b at the junction of the horizontal hole 19a and the vertical hole 19b provided in the water pipe connecting member 18, and faces the horizontal hole 19a of the elastic member 41. A hard spacer 42 is provided on the inner wall. Furthermore, the acute angle cut portion 15 of the water pipe 15
“a” punctures the side wall of the elastic member 41 and is in contact with the spacer 42, and the water pipe 15 communicates with the water path 19.
Therefore, similarly to the first embodiment, the water supply tube 2
When the liquid is sent from the tank 4, the liquid is guided to the water pipe 15 via the water path 19. By providing the spacer 42, the acute angle cut portion 15a does not penetrate the other side wall of the elastic member 41 and is not closed.

FIG. 6 shows a third embodiment. The same components as those in the first embodiment are designated by the same reference numerals, and the description will be omitted. In the present embodiment, a hollow rod 43 provided with a pair of gripping members 11a and 11b is provided inside the inner sheath 6 constituting the insertion section 2, and the hollow rod 43 is provided with a cutting knife 44 at the tip. A knife unit 45, a water supply pipe 15 provided with a water supply nozzle 16 at the tip, and a measurement unit 47 provided with a temperature sensor or a PH sensor 46 at the tip can be selectively removed and replaced. Therefore, the replacement of the bipolar forceps 1 during the operation can be reduced to reduce the inconvenience, and the operation time can be reduced.

FIG. 7 shows a fourth embodiment. 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, a water supply on / off valve 48 is detachably provided on the extension portion 7a of the grip 7 with a plurality of bolts 48a. This water supply on / off valve 4
8 is provided with a first connection pipe 49a, a second connection pipe 49b, and a cock 50.

The first connection pipe 49a is connected to a water supply tube 24 communicating with a water supply source, the second connection pipe 49b is connected to one end of a water supply communication tube 51, and the other end is connected to a water supply pipe connection. It is connected to the tube connecting member 23 of the member 18.

Therefore, when the cock 50 of the water supply on / off valve 48 is turned on, the water supply on / off valve 48 is turned on, and liquid is supplied from the water supply source to the water supply on / off valve 48 via the water supply tube 24, and further, The liquid is sent to the water pipe connection member 18 via the water communication tube 51.

In the present embodiment, the water supply on / off valve 48 is detachable from the operation unit 4 so that it can be retrofitted.
Is provided in the operation unit 4, so that operability can be improved.

According to the above-described embodiment, the following configuration is obtained. (Supplementary Note 1) An insertion section and an operation section near the insertion section are provided.
In a treatment tool having a pair of energizable gripping members for gripping tissue by operating the operation unit at the distal end of the insertion unit, the insertion unit includes a lumen communicating with a water supply source, and A treatment tool, wherein a water supply nozzle that opens between the pair of gripping members is provided at a distal end of the cavity.

(Supplementary Note 2) The treatment tool according to Supplementary Note 1, wherein the water supply nozzle is disposed so as to be able to advance and retreat in the axial direction between the holding surfaces of the pair of holding members. (Supplementary Note 3) The operating section has first operating means for opening and closing the pair of gripping members, and second operating means for moving the water supply nozzle forward and backward, and the second operating means is in communication with a water supply source. A first hole, and a second hole provided in parallel with an insertion portion communicating with the first hole, wherein the base end of a water pipe of a water nozzle communicates with the first hole. 2. The treatment tool according to claim 1, wherein the treatment tool is fixed to the second operation means in a watertight manner by being pressed into an elastic member fixed to the second hole in a watertight manner.

(Supplementary Note 4) The operating section has first operating means for opening and closing the pair of gripping members, and second operating means for moving the water supply nozzle forward and backward. A first hole communicating with the first hole, a second hole provided in parallel with the insertion portion communicating with the first hole, and a base end of a water pipe of the water nozzle communicates with the first hole. The treatment tool according to claim 1, wherein the treatment tool is watertightly fixed to the second operation means by being press-fitted in a state communicating with the space of the elastic member having the space.

(Supplementary note 5) The treatment tool according to Supplementary note 3 or 4, wherein the water supply nozzle is detachable from the second operation means. (Supplementary Note 6) The grip unit including the pair of grip members has a lumen that penetrates in the axial direction, and a water supply nozzle, a knife unit, and a measurement unit can be selectively attached to and detached from the lumen. The treatment tool according to claim 1, characterized in that:

(Supplementary Note 7) The water supply on / off valve for opening and closing a water supply conduit communicating with the water supply nozzle is detachably provided in the operation unit.
The treatment tool according to any one of items 3 and 4.

FIGS. 8 and 9 show a fifth embodiment, in which the same components as those in the first embodiment are designated by the same reference numerals and their description is omitted. In the present embodiment, at least two types of grip units having different structures are detachably provided inside the inner sheath 6 constituting the insertion section 2, and a first grip unit 61 and a second grip unit are provided. 62.

As shown in FIG. 9A, the first holding unit 61 is formed by a multi-lumen tube 63 having an outer diameter that can be inserted through the inner sheath 6 of the insertion section 2.
A hard coating 64 is provided on the outer peripheral surface. The multi-lumen tube 63 has a pair of parallel holes 65a, 65a.
b is provided in the axial direction, and the pair of holes 65a, 65
Wires 67a and 67b whose outer peripheral surfaces are covered with insulating tubes 66a and 66b are inserted into 5b.

The distal ends of the wires 67a and 67b correspond to those shown in FIG.
As shown in (1), gripping members 11a and 11b are provided via elastic members 12a and 12b, and a connection terminal 68 is provided on the base end side to be electrically connected to the cable connection 27. Further, a small-diameter insertion hole 69 is provided in the side portion of the pair of holes 65a and 65b in the axial direction, and the distal end side is opened to the distal end surface of the multi-lumen tube 63.

As shown in FIG. 9B, the second holding unit 62 is also formed by a multi-lumen tube 70 having an outer diameter that can be inserted through the inner sheath 6 of the insertion section 2.
A hard coating 71 is provided on the outer peripheral surface. The multi-lumen tube 70 has a pair of parallel holes 72a and 72a.
b is provided in the axial direction, and the pair of holes 72a, 7
Wires 74a and 74b whose outer peripheral surfaces are covered with insulating tubes 73a and 73b are inserted through 2b.

The distal ends of the wires 74a and 74b are connected to each other as shown in FIG.
As shown in (1), small holding members 76a and 76b are provided via elastic members 75a and 75b, and a connection terminal portion 77 that is electrically connected to the cable connection portion 27 is provided on the base end side. Further, a large-diameter water supply port 78 is provided in the side portion of the pair of holes 72a and 72b in the axial direction, and the distal end side is open to the distal end surface of the multi-lumen tube 70.

A knife unit 80 having an incision knife 79 at its tip is removably inserted into the insertion hole 69 of the first gripping unit 61, and a water supply port 78 of the second gripping unit 62 is It communicates with the water supply channel 19.

According to the present embodiment, by using the first gripping unit 61, the living tissue can be incised using the knife unit 80, and by using the second gripping unit 62, a sufficient amount of water can be supplied. Can be secured. In addition, the number of replacements of the bipolar forceps 1 during the operation can be reduced to reduce the inconvenience, and the operation time can be reduced.

FIG. 10 shows a sixth embodiment. The same components as those of the fifth embodiment are denoted by the same reference numerals and description thereof is omitted. In the present embodiment, the water supply port 7 of the second gripping unit 62
8, a water pipe 81 is inserted so as to be able to advance and retreat in the axial direction. According to the present embodiment, the distal end of the water supply pipe 81 can be moved toward and away from the target site by moving the water supply pipe 81 forward and backward, and the bleeding blood and the like can be reliably washed away.

According to the above-described embodiment, the following configuration is obtained. (Supplementary Note 8) A pair of gripping members provided at the distal end of the unit insertion portion so as to be openable and closable, operation means for opening and closing the pair of gripping members, and a treatment in which the unit insertion portion is detachable from the operation means Tool having a through hole provided in the unit insertion portion and through which a knife unit can be inserted and removed.
, And a second gripping unit provided in the unit insertion portion and provided with a water supply port, wherein the first and second gripping units are detachable from and replaceable with the operating means. Treatment tool.

(Supplementary note 9) The treatment tool according to Supplementary note 8, wherein the water supply port of the second gripping unit can be inserted so that a water supply pipe can advance and retreat. (Supplementary note 10) The treatment tool according to supplementary note 8, wherein the first and second gripping units are formed of a multi-lumen tube.

FIGS. 11 and 12 show a seventh embodiment. The same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. As shown in FIG. 11, a slider support member 91 is provided in the treatment section unit connection portion 26 of the bipolar forceps 1 along the front-rear direction, and a slider 92 is provided on the slider support member 91 so as to be movable in the front-rear direction. ing. A water pipe fixing member 93 is provided at the rear end of the slider 92.
The water pipe fixing member 93 is attached to the water pipe 15.
The rear end is locked and fixed.

At the front end of the slider 92, an engagement pin 94 is provided which protrudes left and right, and the elongated hole 36 of the water supply operation lever 34 is engaged with the engagement pin 94. The rotation of the water supply operation lever 34 causes the slider 92 to slide back and forth.

As shown in FIG. 12, a through hole 95 is provided in the slider 92 in a direction perpendicular to the axial direction, and a cylindrical water supply valve main body 96 is fixed to the through hole 95 in a penetrating state. . An insertion hole 97 is formed in the water supply valve main body 96 in a direction orthogonal to the insertion hole 97, and seal members 98 are attached to both ends of the insertion hole 97. The water pipe 15 is inserted into the insertion hole 97 and is sealed by a seal member 98.

A cylinder 99 is provided in the water supply valve body 96 in parallel with the insertion hole 97, and a piston 100 is inserted into the cylinder 99. The piston 100 includes a piston rod 101 and two flanges 102 provided at an interval on the piston rod 101, and the piston 100 is urged forward by a leaf spring 103.

Further, the water supply valve main body 96 is provided with a first port 104 communicating with the front side of the cylinder 99 and a second port 105 communicating with the rear side of the cylinder 99. The tube 24 is connected, and the second port 105 is in communication with the water pipe 15.

When the piston 100 is located on the front side as shown by the solid line in FIG.
2, the first port 104 and the second port 105 are shut off, so that the first port 104 and the second port 105 communicate with each other when located on the rear side as shown by the broken line in FIG. I have.

Further, a push pin 106 projecting rearward is provided on the slider support member 91 facing the front surface of the piston 100. When the slider 92 advances, that is, when the water supply pipe 15 advances, the push pin 106 100 is moved rearward against the urging force of the leaf spring 103. And the first port 10
4 and the second port 105 are communicated with each other.

Next, the operation of the seventh embodiment will be described. Put a finger on the finger hook 39 of the water supply operation lever 34,
When rotated counterclockwise, the slider 92 advances through the engaging pin 94, and the water pipe 15 advances integrally therewith. When the front surface of the piston 100 abuts on the push pin 106 and relatively moves rearward as the slider 92 advances, the position of the flange 102 of the piston 100 changes from the position where the first port 104 and the second port 105 are shut off. The connection is switched to the communication position, and the liquid supplied from the water supply tube 24 is supplied to the first port 104, the cylinder 99, the second port 1
The liquid is supplied in the order of 05, guided to the water supply pipe 15, and ejected from the water supply nozzle 16. Accordingly, the forward operation of the water supply nozzle 16 and the water supply operation are interlocked, and the water supply nozzle 16 projects between the pair of gripping members 11a and 11b, and water supply is started from the water supply nozzle 16 at the same time.

FIGS. 13 and 14 show the eighth embodiment. The same components as those in the seventh embodiment are denoted by the same reference numerals and description thereof is omitted. The water supply tube 24 connected to the water supply source is bent in a U-shape near the rotation pin 35 of the water supply operation lever 34 and is supported by a tube support member 110 provided below the rotation pin 35. The tube holding cam 1 that rotates integrally with the rotation pin 35
11 are provided.

Next, the operation of the eighth embodiment will be described. When the water supply operation lever 34 is urged clockwise by an urging member (not shown) as shown in FIG. 13A, the tube pressing cam 111 is downward as shown by the solid line in FIG. , Tube support member 1
10, the water supply tube 24 is crushed and closed.

For the water supply operation, as shown in FIG. 13B, a finger is put on the finger holding portion 39 of the water supply operation lever 34,
When rotated counterclockwise, the tube pressing cam 111 rotates integrally with the rotation pin 35 and rotates laterally as shown by a two-dot chain line in FIG. 24 is restored by water pressure and sent. Therefore, the water feeding nozzle 16 starts to feed water in a process in which the water feeding nozzle 16 projects between the pair of gripping members 11a and 11b in conjunction with the forward operation of the water feeding nozzle 16 and the water feeding operation.

FIGS. 15 to 17 show a ninth embodiment.
The same components as those of the seventh embodiment are denoted by the same reference numerals, and description thereof is omitted. In the present embodiment, a water supply tube connecting member 112 is provided in a direction perpendicular to the slider 92, and an insertion hole 113 through which the water supply pipe 15 is inserted is formed in the water supply tube connection member 112. A seal member 114 is provided at the open end. Further, the water supply tube connecting member 112 is provided with a water supply port 115 to which the water supply tube 24 is connected, and communicates with the water supply pipe 15.

The slider 92 is provided with a small-diameter portion 116, and the small-diameter portion 116 has
17 are fitted movably in the front-rear direction. Engagement pins 118 project from right and left sides of the knife lever connection member 117, and the long holes 36 of the water supply operation lever 34 are engaged with the engagement pins 118. Further, the small diameter portion 116 is provided with an urging spring 119 for urging the knife lever connecting member 117 in the retreating direction.

Further, the inside of the grip 7 located on the rotation locus of the water supply operation lever 34 is
The rod 120 supports an L-shaped tube holding member 121 movably in the axial direction of the rod 120. The holding part 122 at the base end of the tube holding member 121 is separated from the tube support part 123, and an intermediate part of the water supply tube 24 is interposed between them. The distal end of the tube pressing member 121 faces an opening 124 formed in the side wall of the grip 7, and an inclined portion 125 is formed at the distal end.

Further, the urging spring 1 is attached to the rod 120.
26 is wrapped and urges the inclined portion 125 at the distal end of the tube pressing member 121 in a direction protruding from the opening 124. Therefore, as shown in FIG. 17A, the pressing portion 122 of the tube pressing member 121 and the tube supporting portion 123
However, the middle part of the water supply tube 24 is crushed and closed. The operation of the ninth embodiment will be described. When the water supply operation lever 34 is rotated from the state shown in FIG. 15A to the state shown in FIG. 15B, the water supply pipe 15 moves forward,
The leading end of the slider 92 contacts the rear end of the treatment unit connection portion 26 and stops. When the water supply operation lever 34 is further rotated from this state to the two-dot chain line in FIG. 15B, the knife lever connecting member 11 is stopped with the slider 92 stopped.
7 moves forward against the biasing spring 119. At this time, when the water supply operation lever 34 and the inclined portion 125 of the tube pressing member 121 slide due to the rotation of the water supply operation lever 34, as shown in FIG. The tube pressing member 121 is pushed in, the pressing portion 122 is separated from the tube support portion 123, and the water supply tube 24 is restored by water pressure and is supplied. Therefore, when the water supply nozzle 16 is moved forward and positioned, the water supply nozzle 1 is turned by rotating the water supply operation lever 34.
6 can start water supply between the pair of gripping members 11a and 11b.

According to the above-described embodiment, the following configuration is obtained. (Supplementary Note 11) A pair of gripping members provided at the distal end of the insertion portion so as to be openable and closable, operating means for opening and closing the pair of gripping members, interlocking means for interlocking the gripping members with the operating means, In a treatment tool comprising a water supply probe provided in an insertion portion and capable of moving back and forth to the vicinity of the pair of gripping members, advancing / retreating operation means for moving the water supply probe forward and backward, and an open / close valve capable of controlling water supply to the water supply probe. An opening / closing valve that opens and closes in conjunction with advance and retreat of the water supply probe.

(Supplementary Note 12) The advance / retreat operation means includes a water supply operation lever, and a slider that slides on a slider support member in conjunction with the water supply operation lever to move the water supply probe forward and backward. Wherein a part of the slider support member comes into contact with the flow path closing member when the slider moves, whereby the flow path closing member moves to open the flow path. 1
The treatment tool according to 1.

(Supplementary Note 13) The reciprocating operation means includes a water supply operation lever pivotally supported by a rotating pin, and a slider to which the water supply operation lever, the water supply probe, and the water supply tube are connected. The treatment tool according to claim 11, further comprising a flow path closing member provided on the rotation pin, wherein the flow path closing member moves to open the flow path when the water supply operation lever rotates.

(Supplementary Note 14) The advance / retreat operating means includes a water supply operation lever having a plate-like wall surface, and a slider to which the water supply operation lever, the water supply probe, and the water supply tube are connected. The flow path closing member according to claim 11, further comprising a flow path closing member provided within a movement range of the lever, wherein when the knife lever moves, the plate-like wall surface and the flow path closing member come into contact to open a flow path. Treatment tools.

(Supplementary note 15) The treatment tool according to any one of supplementary notes 12 to 14, wherein the flow path closing member is a cylinder and a piston provided in the cylinder so as to be able to advance and retreat.

(Supplementary Note 16) The flow passage closing member normally closes a middle part of the water supply tube by crushing it, and opens the water supply tube when moved.
15. The treatment tool according to any one of items 14 to 14.

(Supplementary Note 17) The open / close valve is at least open at a first position where the slider is closest to the holding member, and is closed at a second position farthest from the holding member. The treatment tool according to any one of supplementary notes 12 to 16, characterized in that:

(Supplementary Note 18) The open / close valve is located at a position closer to the first position than substantially halfway between the first position and the second position.
17. The treatment tool according to any one of supplementary notes 12 to 16, wherein the treatment tool is at least open and closed at the second position.

(Supplementary Note 19) Supplementary notes 12 to 12, characterized in that a knife rod can be inserted instead of the water supply probe.
19. The treatment tool according to any one of 18. 18 and 19 show a bipolar cutter as a first disclosure example. The bipolar cutter 131 has an elongated insertion portion 132, a treatment portion 133 disposed at the distal end of the insertion portion 132, and capable of energizing and coagulating and incising a living tissue in a body cavity.
An operation section 134 connected to the base end of the insertion section 132 is provided.

A pair of jaws 135 and a knife 136 that can be opened and closed are provided at the distal end of the insertion portion 132. A jaw 135 is provided on a grip 137 constituting the operation unit 134.
An opening / closing trigger 138 for opening and closing the knife and a knife lever 139 for moving the knife 136 forward and backward are provided.

The opening / closing trigger 138 is connected to the upper end of the grip 137 so as to be rotatable around a rotation pin 141. Further, the opening / closing trigger 138 has an elongated hole 142 formed above the pivot point. The long hole 142 is provided with an engagement pin 144 protruding from a side surface of the jaw driving member 143.
Is inserted.

The leaf spring 1 is provided inside the grip 137.
45 is provided, and when the load receiving pin 146 protruding from the opening / closing trigger 138 is pressed, the opening / closing trigger 1
38, the jaw drive member 143 is retracted in a direction in which the grip portion 138a at the lower end of the 38 is separated from the grip 137,
The jaws 135 are biased in the closing direction.

The knife lever 139 is connected to the grip 13
7 is rotatably connected around a rotation pin 147. Further, a long hole 148 is formed above the center of rotation of the knife lever 139, and an engagement pin 1 protruding from the rear end side surface of the knife driving member 149 is formed in the long hole 148.
50 has been inserted.

Further, the rotating pin 1 of the knife lever 139
47, an urging spring 151 is wound around the knife lever 13
9 is urged clockwise, and the knife 136 is urged backward. In addition, the connecting rod 1 is attached to the knife lever 139.
52 is connected to one end, and the other end of the connecting rod 152 is provided with a hook 152a. And
The hook portion 152a is hooked on a hook pin 153 protruding from a side surface of the opening / closing trigger 138.

Therefore, as shown in FIG. 18, the opening / closing trigger 138 is moved by the knife lever 139 to the leaf spring 14.
The jaw drive member 143 is pulled slightly counterclockwise against the urging force of No. 5 to hold the jaw drive member 143 in a slightly advanced position. Therefore, the pair of jaws 135 is
5a, and the gap 135a prevents a short circuit when an extremely thin tissue is grasped. But,
If the jaw 135 has the gap 135a, there is a problem that the tissue gripped by the knife 136 escapes when the tissue gripped by the jaw 135 is cut by the knife 136.
According to the example of the present disclosure, the knife lever 139 is pressed by the urging spring 15.
1 and the knife 136 is advanced through the knife driving member 149, the knife lever 13
9, the connecting rod 152 is also moved forward, and as shown in FIG.
And the restriction of the opening / closing trigger 138 is released. Therefore, the opening / closing trigger 138 is rotated clockwise by the urging force of the leaf spring 145, and the jaw 135 is pulled into the insertion portion 32 via the jaw driving member 143.
5 is closed, the grasped tissue does not escape at the time of incision, and the incision can be reliably performed.

FIGS. 20 to 22 show an electrocautery device with a water supply function as a second disclosed example. This type of device is conventionally known from DE 19606194 A1. This instrument has a valve provided in the handle, which can shut off a suction and washing pipe, and a handle for moving the coagulation electrode in the axial direction. In the case of coagulation after water supply, this device draws the coagulation electrode by the handle, pushes the water supply valve and sends water, then protrudes the coagulation electrode again and outputs it, and the operability is very troublesome, many times There is a problem that efficiency is poor when coagulating.

The present disclosure solves the above-described problem. The description of the bipolar forceps 1 is omitted because it is the same as that of the first embodiment. The cable connection portion 27 of the bipolar forceps 1 is connected to a high-frequency ablation power supply device 160 via a connection cable 28, and the water supply tube 24 is connected to a roller pump 161 as a perfusion device.

The high-frequency ablation power supply unit 160 includes an output oscillation unit 162 and an output control unit 163 connected to a power supply.
The output control unit 163 is connected to the foot switch 164. The roller pump 161 includes a pump unit 166 connected to the water reservoir 165, a setting panel 167, and a pump control unit 168 as an output-linked water supply means.
The water supply amount, water supply timing, water supply time, and the like can be set by 67. Further, the output control unit 163 of the high-frequency ablation power supply device 160 and the pump control unit 168 of the roller pump 161 are connected by a communication cable 169.

Therefore, as shown in FIG. 22, when the operator turns on the foot switch 164, the output control section 1
63 detects the ON signal, and a high frequency is oscillated from the output oscillating section 162 and guided to the bipolar forceps 1. At the same time, a pump operation signal is transmitted from the output control unit 163 to the pump control unit 168 via the communication cable 169, so that the pump unit 166 operates. Therefore, the bipolar forceps 1 are supplied from the pump section 166 via the water supply tube 24.
Liquid.

By connecting the high-frequency ablation power supply device 160 and the roller pump 161 by the communication cable 169 in this way, the surgeon can operate the foot switch 164 and output a high-frequency signal to obtain a specified water supply amount.
There is no need to operate the water supply switch, and operability can be improved.

It is to be noted that water can be supplied to the jaws before high-frequency cauterization to prevent scorching, and that suction can also be performed by the roller pump 161. Further, by mounting the high-frequency ablation power supply device 160 and the roller pump 161 on the same carriage, the routing of the communication cable 169 is simplified.

FIG. 23 shows a third disclosed example, in which a relay box 171 is provided in the middle of a water supply tube 24 connected to a physiological saline bag 170, and an electromagnetic valve 172 for opening and closing the water supply tube 24 in the relay box 171. Is provided. The solenoid valve 172 is connected to the foot switch 164 via the relay panel 173 and to the high-frequency ablation power supply device 160. Therefore, the surgeon merely operates the foot switch 164 to output a high frequency to open the electromagnetic valve 172 and obtain a prescribed water supply amount, thereby improving operability. In addition, a pump is not required, and can be provided at a low cost, and can be carried to any place.

FIG. 24 shows a fourth disclosure example, in which only one side of a pair of jaws is shown. A plurality of water supply holes 177 are provided on the gripping side of the jaw body 175 in the electrode portion 176, and the water supply holes 177 communicate with a water supply source through a water supply pipe 179 of a stainless steel pipe 178 supporting the jaw body 175. The stainless steel pipe 178 is covered with an insulating tube 180. Therefore,
Water can be supplied from the water supply hole 177 before the high frequency ablation to prevent the jaws from sticking.

FIG. 25 shows a fifth disclosed example, in which a pair of jaw bodies 181 are formed of a transparent synthetic resin material, and an electrode portion 182 is provided on a gripping surface of the jaw body 181. With this configuration, the cautery portion of the tissue can be observed through the jaw body 181 during high-frequency cauterization, and the cauterization time can be controlled.

FIG. 26 shows a sixth disclosure example, in which only one side of a pair of jaws is shown. An insulating portion 185 is provided on the back side of the electrode portion 184 of the jaw main body 183, and a hardness sensor 186 for oscillating ultrasonic waves or the like to detect the hardness of the tissue is provided on the insulating portion 185. A sensor cable 188 is inserted through a stainless steel pipe 187 supporting the jaw body 183, and the stainless steel pipe 187 is covered with an insulating tube 189.

Accordingly, the hardness of the tissue is detected by the hardness sensor 186 before the high frequency ablation, and the hardness of the tissue after the high frequency ablation is detected by the hardness sensor 186, whereby the tissue has a predetermined hardness. Sometimes, high-frequency output is stopped to prevent excessive cauterization.

According to the above-described embodiment, the following configuration is obtained. (Supplementary Note 20) An electrocautery device having a water supply function, comprising: an electrocautery device having an electrode and a water supply hole at a tip, an electric ablation device for supplying high-frequency output to the electrode, and a perfusion device for supplying water to the water supply hole. The electrocautery device with a water supply function, further comprising an output-linked water supply means for controlling the supply of water from the perfusion device in conjunction with the output of the electric ablation device.

(Supplementary note 21) The water supply function according to supplementary note 20, wherein the electric cautery apparatus and the perfusion apparatus are connected by a communication cable, and the output interlocking water supply means is operated by an output signal of the electric cautery apparatus. Electric cautery instrument.

(Supplementary Note 22) An electrocautery device with a water supply function, wherein the output interlocking means can set a water supply amount, a water supply time, a water supply start timing, and the like. (Supplementary Note 23) The electrocautery device with a water supply function, wherein the electrocautery device is a bipolar device.

[0099]

As described above, according to the present invention, a living tissue can be grasped and coagulated, blood stasis can be reliably performed, and water can be reliably supplied to the treatment section, and bleeding blood and the like can be washed out. There is an effect that can be.

[Brief description of the drawings]

FIG. 1 is a side view of a bipolar forceps according to a first embodiment of the present invention with a gripping member opened.

FIG. 2 is a side view of the bipolar forceps showing the same embodiment with the gripping member closed.

FIG. 3 is a view showing the embodiment, viewed from a direction of an arrow A in FIG. 1;

FIG. 4 is a longitudinal sectional side view showing the same embodiment and enlarging a portion B in FIG. 1;

5 shows the second embodiment of the present invention, and is a vertical sectional side view of the same portion as FIG. 4. FIG.

FIG. 6 is an overall configuration diagram of a bipolar forceps showing a third embodiment of the present invention.

FIG. 7 is an overall configuration diagram of a bipolar forceps showing a fourth embodiment of the present invention.

FIG. 8 is an overall configuration diagram of a bipolar forceps showing a fifth embodiment of the present invention.

9A and 9B show the same embodiment, in which FIG. 9A is a cross-sectional view taken along line CC of FIG. 8, and FIG. 9B is a cross-sectional view taken along line DD of FIG.

FIGS. 10A and 10B show a sixth embodiment of the present invention, wherein FIG. 10A is an overall configuration diagram of a bipolar forceps, and FIG. 10B is a cross-sectional view taken along line EE.

11A and 11B show a seventh embodiment of the present invention, wherein FIG. 11A is a plan view of a bipolar forceps, FIG. 11B is a side view, and FIG. 11C is a side view at the time of water supply.

FIG. 12 is a vertical cross-sectional view illustrating the same embodiment and enlarging a portion F in FIG. 11;

13A and 13B show an eighth embodiment of the present invention, wherein FIG. 13A is a side view of a bipolar forceps, and FIG. 13B is a side view of the bipolar forceps during a water supply operation.

FIG. 14 is a sectional view of the same embodiment taken along line GG of FIG. 13;

15A and 15B show a ninth embodiment of the present invention, wherein FIG. 15A is a side view of a bipolar forceps, and FIG. 15B is a side view of the bipolar forceps during a water supply operation.

16 is an enlarged view of a portion H in FIG. 15, (a) is a longitudinal plan view in a state where the water pipe is retracted, and (b) is a longitudinal plan view in a state where the water pipe is advanced.

FIG. 17 is a sectional view taken along the line JJ of FIG.
(A) is a longitudinal sectional side view in a state where the water supply tube is closed,
(B) is a vertical sectional side view in a state where the water supply tube was opened.

FIG. 18 is a side view of the bipolar cutter showing the first disclosure example.

FIG. 19 is a side view of the disclosed example at the time of incision.

FIG. 20 is an overall configuration diagram of an electrocautery device with a water supply function, showing a second disclosure example.

FIG. 21 is a block diagram of the disclosure example.

FIG. 22 is a flowchart of the disclosure example.

FIG. 23 is a configuration diagram showing a third disclosure example.

FIG. 24 is a longitudinal side view of a jaw showing a fourth disclosure example.

FIG. 25 is a perspective view of a jaw showing a fifth disclosure example;

26A and 26B show a sixth disclosure example, in which FIG. 26A is a perspective view of a jaw, and FIG. 26B is a cross-sectional view taken along the line KK.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Bipolar forceps 2 ... Insertion part 4 ... Operation part 11a, 11b ... Grip member 16 ... Water supply nozzle

 ────────────────────────────────────────────────── ─── Continuing on the front page (72) Inventor Naoki Sekino 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd.

Claims (1)

[Claims] 1. A treatment having an insertion portion and an operation portion at a hand side of the insertion portion, and a pair of energizable grip members at an end portion of the insertion portion for gripping tissue by operating the operation portion. A treatment instrument, wherein a lumen communicating with a water supply source is provided in the insertion portion, and a water supply nozzle opened between the pair of gripping members is provided at a distal end of the lumen.