JPH1147149A - Endoscopic surgery appliance - Google Patents

Abstract

PROBLEM TO BE SOLVED: To enable surely clamping and solidifying the part of a living tissue for treatment and incising the same. SOLUTION: An endoscopic surgery appliance has a pair of clamping members 11a, 11b which open and close relatively and an incising knife 16 moving in the gap between the clamping members 11a, 11b, the clamping members 11a, 11b and the incising knife 16 being formed as electrodes and provided with a current conduction means by which a solidifying current and an incising current are switchably conducted between the clamping members 11a, 11b and between each of the clamping members 11a, 11b and the incising knife 16.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an endoscopic surgical instrument provided with a grasping portion for grasping a living tissue and an incision portion for cutting the grasped living tissue.

[0002]

2. Description of the Related Art In general, there has been known a bipolar forceps having a pair of gripping members for gripping a living tissue, each of which is provided with an electrode for energizing a high frequency. 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 surgical instrument,
For example, it is known from U.S. Pat. No. 5,269,780, U.S. Pat. No. 5,445,638, and U.S. Pat. No. 5,267,998.

US Pat. No. 5,269,780 discloses a movable coagulation electrode with a pair of coagulation electrodes protruding from the distal end of a sheath.
With this incision electrode, after a coagulation current flows between a pair of coagulation electrodes to coagulate the living tissue, the incision current flows between the incision electrode and the coagulation electrode to cut the living tissue. I have.

US Pat. No. 5,445,638 has a pair of gripping members projecting from the distal end of a sheath, and a cutting knife which can be advanced and retracted between the gripping members. When the living tissue to be treated is closed and the living tissue is grasped, a coagulation current flows between the pair of grasping members to coagulate the living tissue, and then the cutting knife is advanced to cut the living tissue.

US Pat. No. 5,267,998 has a pair of coagulation electrodes fixed to the distal end of a sheath and a movable incision electrode, and coagulation current flows between the pair of coagulation electrodes to coagulate living tissue. After that, the incision electrode is moved by operating the hand operation unit, and an incision current is applied to incise the living tissue.

[0008]

However, the above-mentioned U.S. Pat. No. 5,269,780 has a pair of coagulation electrodes and a movable incision electrode, but has no function of gripping a living tissue. However, the incision cannot be reliably made while grasping the treatment target site.

US Pat. No. 5,456,638 is provided with a cutting knife that can be advanced and retracted between a pair of gripping members. When the sharpness of the cutting knife deteriorates, the cutting knife is gripped when the cutting knife is advanced and cut. There is a disadvantage that the living tissue is pushed out, and the cutting knife needs to be replaced frequently.

In US Pat. No. 5,267,998, the incision electrode is moved and an incision current is applied to incise the living tissue. The incision cannot be made reliably.

The present invention has been made in view of the above circumstances, and an object of the present invention is to provide an endoscopic surgical instrument capable of securely coagulating and incising a treatment target site of a living tissue. To provide.

[0012]

SUMMARY OF THE INVENTION In order to achieve the above object, the present invention provides an endoscopic surgical instrument having a pair of relatively openable and closable grippers and an incision for moving a gap between the grippers. In the above, the grip portion and the cutout portion are each configured as an electrode, and an energizing means for energizing between the grip portions and between the grip portion and the cutout portion is provided.

[0013] When a living tissue is grasped by a grasping portion during a treatment such as coagulation and hemostasis of the living tissue, a coagulation current is passed between the grasping portions to coagulate the living tissue, and then, between the grasping portion and the incision portion. The incision current is applied to the living tissue to cut the living tissue.

[0014]

Embodiments of the present invention will be described below with reference to the drawings. 1 to 4 show a first embodiment, and FIG. 1 is an overall configuration diagram of an endoscopic surgical instrument.
As shown in FIG. 1, the apparatus includes a bipolar forceps 1 as an endoscopic surgical instrument and a high-frequency ablation power supply device 2.

The bipolar forceps 1 has an elongated insertion portion 3 inserted into a body cavity of a patient, and a treatment portion disposed at the distal end of the insertion portion 3 and capable of conducting electricity for grasping and coagulating a living tissue in the body cavity. 4 and an operation unit 5 connected to the base end of the insertion unit 3.

The insertion section 3 comprises an outer sheath 6 and an inner sheath 7 which is inserted into the outer sheath 6 so as to be able to advance and retreat in the axial direction. The proximal end of the outer sheath 6 constitutes the operation section 5. The proximal end of the inner sheath 7 is fixed to a grip 8, and is fixed to an inner sheath driving member 9 provided in the operation section 5.

The treatment section 4 is provided with an elongated rod 10 inserted into the inner sheath 7. A pair of gripping members 1 as gripping portions constituting an electrode are provided at the distal end of the rod 10.
1a and 11b, and elastic members 12a and 12b for urging the gripping members 11a and 11b in a direction for expanding the gripping members 11a and 11b are provided. The elastic members 12a and 12b are formed of spring steel or the like, and have bent portions 13a and 13b which are bent in a substantially U-shape at the tips, and the surfaces are covered with an insulating coating.

As shown in FIG. 2, the holding members 11a, 11
b has a substantially U-shaped cross section so that a space portion 14 is formed inside when closed, and saw-toothed portions that mesh with each other when closed are formed to close the living tissue. It is formed so that it can be securely gripped.

Further, as shown in FIG. 2, a knife rod 15 is provided in parallel with the rod 10 of the treatment section 4, and an incision knife 16 as an incision section is provided at the tip of the knife rod 15. The cutting knife 16 has a cutting blade 16a extending perpendicularly to the axial direction of the knife rod 15 and in the vertical direction, and is formed in a size that can enter the space 14 when the gripping members 11a and 11b are closed. .

The thus configured rods 10 of the gripping members 11a and 11b of the treatment section 4 and the knife rod 15 of the cutting knife 16 are inserted into the inner sheath 7 of the insertion section 3, and The knife rod 15 protrudes from the base end of the inner sheath 7 and extends to the operation section 5.

The grip 8 of the operation section 5 is provided with a distal extension 17 extending toward the distal end. The distal extension 17 is provided with a connection ring 18 that is connected and fixed to the base end of the outer sheath 6. Further, a treatment section unit connection section 19 for electrically and mechanically connecting to the rear end of the treatment section 4 is disposed behind the distal side extension section 17. Here, the treatment section unit connection section 19 is provided with a lumen for accommodating the rear end of the rod 10 of the treatment section 4 and connection means connected to the rear end of the rod 10 accommodated in this lumen. ing.

The treatment unit connection section 19 is provided with a cable connection section 20 via an electrode switching section 38 which will be described later.
Is connected. This cable connection portion 21 is connected to the high-frequency ablation power supply device 2.

The grip 8 is provided with a trigger 22 for operating the treatment unit connection 19. The trigger 22 is connected to the upper end of the grip 8 so as to be rotatable around a rotation pin 23. Further, a long hole 24 is formed in the trigger 22 above the pivot point.
An engagement pin 25 projecting from a side surface of the inner sheath driving member 9 is inserted into the elongated hole 24.

The trigger 22 is provided inside the grip 8.
There is provided an urging member (not shown) for urging the handle portion 22a at the lower end of the gripper 8 in the direction away from the grip 8 (clockwise around the pivot pin 23 in FIG. 1). The trigger 22 is always held at a fixed position (release position) farthest from the grip 8 by the spring force of the urging member.

Further, a knife operation lever 27 is provided on a side surface at an upper portion of a rear end of the grip 8. The knife operating lever 27 is pivotally connected to the grip 8 by a rotating pin 28.
Are connected so as to be rotatable around the center. Further, a long hole 29 is formed above the center of rotation of the knife operation lever 27, and an engagement pin 30 protruding from the rear end side surface of the knife rod 15 is inserted into the long hole 29.

The knife operating lever 27 is provided with upper and lower arms 31 and 32 arranged in a substantially V shape. A finger hook 33 is in contact with one arm 31 and the other arm 32 is in contact with a stopper pin 34 to play a role in restricting the rotation range of the knife operation lever 27. further,
An urging member (not shown) for urging the knife operation lever 27 in a clockwise direction is attached to the rotating pin 28.

Here, by pulling the handle portion 22a of the trigger 22 toward the grip 8 against the spring force of the biasing member, the inner sheath 7 is driven by the inner sheath driving member 9 to rotate the shaft of the outer sheath 6. And moves forward in the direction to protrude from the front end of the outer sheath 6. The elastic member 1 is moved with the advance of the inner sheath 7.
2a and 12b are relatively drawn into the inner sheath 7, and the gripping members 11a and 11b are closed. When the trigger 22 is released, the elastic member 12a, 12b returns to the home position by the spring force of the biasing member in the grip 8, and the elastic members 12a, 12b relatively protrude from the inner sheath 7 to hold the holding members 11a, 11b.
b is opened by the elastic restoring force of the elastic members 12a and 12b.

Further, the finger hook 3 of the knife operating lever 27
When a finger is put on the knife 3 and the knife operation lever 27 is rotated counterclockwise against the urging force of the urging member, the knife rod 15 advances through the engaging pin 30 inserted into the elongated hole 29. Drive the knife 1 at the tip of the knife rod 15
6 advances into the space 14 formed by the gripping members 11a and 11b. When the knife operation lever 27 is released, the knife rod 15 returns to the home position by the spring force of the urging member, the knife rod 15 is relatively drawn into the inner sheath 7, the cutting knife 16 is retracted, and the arm 32 is moved to the stopper pin 34. It stops when it touches.

A foot switch 36 is connected to the high-frequency ablation power supply 2. The foot switch 36 has a first switch 37 a for flowing a coagulation current and a second switch 37 for flowing an incision current. 37b is provided.

Further, the electrode switching section 38 of the operation section 5 will be described. As shown in FIG.
1b, and the incision-side contacts 35 that conduct with the incision knife 16, and the cable-side connection contacts 40a, 4 that conduct with the connection cable 21.
0b.

As shown in FIG. 3A, at the time of coagulation, the grip-side contacts 39a, 39b and the cable-side connection contacts 40a, 4b.
0b, and the incision side contact 35 is opened to release the gripping member 1
A coagulation current is passed between 1a and 11b. As shown in FIG. 3B, at the time of incision, the grip-side contacts 39a and 39b are connected to the cable-side connection contact 40a, and the incision-side contact 35 and the cable-side connection contact 40b are connected to hold the gripping members 11a and 11b.
A cutting current flows between the cutting knife 11b and the cutting knife 16.

The coagulation current is, as shown in FIG.
This is an output in a mode having a load characteristic in which the output decreases when the impedance increases with cauterization. The incision current is a constant power output mode in which the output does not decrease even if the impedance rises, as shown in FIG. FIG.
As shown in (c), in the impedance control, the coagulation mode can be automatically switched from the coagulation mode to the incision mode by judging the completion of coagulation at the time point a at which the impedance once lowered again with the elapse of the cauterization time.

Next, the operation of the first embodiment will be described. The connection cable 21 is connected to the cable connection part 20 of the bipolar forceps 1, and the bipolar forceps 1 and the high-frequency ablation power supply device 2 are electrically connected. Operation unit 5 in the initial state
The handle portion 22a of the trigger 22 is held at a fixed position farthest from the grip 8 as shown in FIG. 1, and the treatment section unit connection portion 19 is held at the rearmost position of the axial movement range of the insertion section 3. . In this state, the pair of elastic members 12a and 12b of the treatment section 4 protrude from the inner sheath 7 and the grip members 11a and 11b are open.

Then, by pulling the handle portion 22a of the trigger 22 toward the grip 8 against the spring force of the leaf spring member, the inner sheath 7 is moved in the axial direction of the outer sheath 6 via the inner sheath driving member 9. It moves forward and protrudes from the front end of the outer sheath 6. As the inner sheath 7 advances, the elastic members 12a and 12b are relatively drawn into the inner sheath 7, and the grip members 11a and 11b are closed.

In this state, the insertion portion 3 of the bipolar forceps 1
Is inserted into the body of the patient, and the treatment section 4 at the distal end of the insertion section 3 guides the patient to a position near the living tissue to be treated in the body. In this state, when the trigger 22 is released, it returns to the home position by the spring force of the biasing member in the grip 8, the elastic members 12a and 12b relatively protrude from the inner sheath 7, and the grip members 11a and 11b become elastic members. It is opened by the elastic restoring force of 12a and 12b.

Subsequently, the expanded gripping members 11a, 11b
After inserting the living tissue A between the inner sheath 7 and the inner sheath 7 via the inner sheath driving member 9, the handle portion 22 a of the trigger 22 is pulled toward the grip 8 against the spring force of the biasing member. It moves axially forward of the outer sheath 6 and protrudes from the front end of the outer sheath 6. As the inner sheath 7 advances, the elastic members 12a and 12b are relatively drawn into the inner sheath 7, and the gripping members 11a and 11b are closed.
As shown in FIG. 2, the living tissue A has a pair of gripping members 11.
a and 11b.

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 A can be reliably gripped. In this state, when the first switch 37a of the foot switch 36 is turned on, a high-frequency current flows from the high-frequency ablation power supply device 2 to the cord connection section 20 via the connection cable 21, and furthermore, the gripping member 11a via the electrode switching section 38. Coagulation current flows between
Coagulation of the living tissue A is performed.

After a coagulation current is passed for a predetermined time to coagulate the living tissue A, the first switch 37a is turned off. Then, as shown in FIG. 3B, the electrode switching unit 38 connects the grip-side contacts 39a and 39b to the cable-side connection contacts 40a.
And the incision side contact 35 and the cable side connection contact 40b
Is connected, and the second switch 37b is turned on to cause a cutting current to flow between the holding members 11a and 11b and the cutting knife 16.

Further, the finger hook 3 of the knife operating lever 27
When a finger is put on the knife 3 and the knife operation lever 27 is rotated counterclockwise against the urging force of the urging member, the knife rod 15 advances through the engaging pin 30 inserted into the elongated hole 29. Drive the knife 1 at the tip of the knife rod 15
6 moves forward. Therefore, the living tissue A gripped between the gripping members 11a and 11b is
Is mechanically dissected, and electrically dissected by the dissection current.

After the incision is completed, the knife operating lever 27
Is released, the knife rod 15 is returned to the home position by the spring force of the urging member, the knife rod 15 is relatively drawn into the inner sheath 7, the cutting knife 16 is retracted, and stops when the arm portion 32 contacts the stopper pin 34. . When the trigger 22 is released, the elastic member 12a, 12b relatively returns from the inner sheath 7 by the spring force of the urging member in the grip 8, and the grip members 11a, 11b
The gripping member 11 is opened by the elastic restoring force of 2a, 12b.
a and 11b are released from the living tissue A.

In the above embodiment, the first switch 37a of the foot switch 36 and the second switch 3
The coagulation current and the incision current are switched by turning on / off the switch 7b. However, as shown in FIG. 4C, in the impedance control, the coagulation completion is determined at a time point a at which the impedance once decreased again with the elapse of the cauterization rises. By doing so, it is possible to automatically switch from the coagulation mode to the incision mode.

FIG. 5 shows a second embodiment, in which the same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. This embodiment is similar to the foot switch 3 of the first embodiment.
Instead of 6, the grip 8 of the operation unit 5 is provided with a first switch 41a for flowing a coagulation current and a second switch 41b for flowing an incision current.

FIG. 6 shows a third embodiment. The same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. This embodiment is similar to the foot switch 3 of the first embodiment.
Instead of 6, the grip 8 of the operation unit 5 is provided with a first switch 41a for flowing a coagulation current and a second switch 41b for flowing an incision current. The second switch 41b is turned on by the arm 32 when the knife operating lever 27 is operated to advance the cutting knife 16, and a cutting current flows in synchronization with the knife operating lever 27. .

FIG. 7 shows a fourth embodiment, in which the same components as those in the first embodiment are assigned the same reference numerals and description thereof is omitted. In the present embodiment, a pair of wire rods 42a and 42a is used instead of the cutting knife 16 having the cutting blade 16a of the first embodiment.
A wire cutter 42 composed of a wire loop is provided between 42b.

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, as shown in FIG. 8, a first electrode 43a having a wire stretched between a pair of wire rods 42a and 42b of the fourth embodiment is provided, and a second electrode 43b is provided on the wire rod 42b. Is provided. FIG. 9 shows an electrode switching section, and as shown in FIG. 9A, at the time of coagulation, the grip side contacts 39a and 39b and the cable side connection contacts 40 are provided.
a, 40b and the first and second electrodes 43a, 43a
The contacts 44a and 44b, which are electrically connected to 3b, are opened to allow a coagulation current to flow between the holding members 11a and 11b. As shown in FIG. 4B, the first and second electrodes 43a, 43a at the time of incision.
b are independently connected to the cable side connection contacts 40a, 40b, and the first and second electrodes 4
An incision current flows between 3a and 43b.

FIG. 10 shows a sixth 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 first wire electrode 45a and a second wire electrode 45b composed of a pair of wire loops are provided instead of the cutting knife 16 having the cutting blade 16a of the first embodiment. At the time of cutting, a cutting current is caused to flow between the first and second wire electrodes 45a and 45b.

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. In the present embodiment, as shown in FIG. 11, a first gripping member 46a and a second gripping member 46b are used instead of the pair of gripping members 11a and 11b constituting the treatment section 4 of the first embodiment. An incision member 48 is provided inside the second gripping member 46b and protrudes upward via an insulating member 47.

FIG. 12 shows an electrode switching section, and FIG.
As shown in FIG. 7, during coagulation, the gripping contacts 39a, 39b and the cable-side connecting contacts 40a, 40b are connected, and the contact 49, which is electrically connected to the cutting member 48, is opened to release the first and second gripping members 46a, 46b. A coagulation current is passed during. As shown in FIG. 3B, at the time of cutting, the grip-side contact 39a and the cutting member 48 are independently connected to the cable-side connection contacts 40a, 40a.
b, so that a cutting current flows between the first holding member 46a and the cutting member 48.

FIG. 13 shows the eighth embodiment.
This is a modified example. That is, the first gripping member 50a and the second gripping member 50b
Inside has a triangular cross section, and an incision 5 protruding upward.
1 are provided integrally. When the distance between the inner surface and the top portion of the incision 51 of the first gripping member 50a g _1, first and second gripping members 50a, the distance between the edges of 50b and g _2,
g ₁ <g ₂ . According to the present embodiment, by switching the coagulation current to the incision current without switching the electrodes, the current concentrates on the top of the incision 51, so that when the incision current flows, only the central portion can be incised.

FIGS. 14 and 15 show a ninth embodiment. FIG. 14 shows the high-frequency ablation power supply device 2, and FIG. 15 is a graph showing an example of a change in impedance with time. In the first embodiment, it has been described that in the impedance control, the coagulation mode is automatically switched from the coagulation mode to the incision mode by determining the completion of coagulation at the time point a at which the impedance once decreased again with the elapse of the cauterization time elapses. However, in the present embodiment, the impedance change amounts ΔZ _{1 to} ΔZ ₂ due to changes in the ablation time t _{1 to} t ₃ are measured,
By storing the information, the control can be performed for the second time and thereafter.

That is, the high-frequency ablation power supply device 2 is provided with an output circuit 53 for outputting a high-frequency current according to a control signal from the control circuit 52 and a detection circuit 54 for detecting the ablation time and impedance at the time of output. 52 is input. Further, setting means 55 is provided,
By selecting the cauterization time t _{1 to} t ₃ by the setting means 55, when the desired impedance is reached,
By outputting a cauterization stop signal to the control circuit 52, the output of the high-frequency current can be stopped.

[0052] Thus, ablation time t ₁ ~t ₃ and the impedance change amount [Delta] Z 2 based on _{1 ~ΔZ 2} parameters
Can be performed times subsequent control accurately and even if there is a difference in level of the coagulation by the surgeon, by selecting the ablation time t ₁ ~t ₃ by setting means 55, upon reaching a desired impedance Cauterization can be stopped and the mode can be automatically switched from coagulation mode to incision mode.

FIGS. 16 to 19 show a tenth embodiment, FIG. 16 is an overall configuration diagram of an endoscopic surgical instrument, and FIG. 17 is a longitudinal sectional side view of a distal end side of the endoscopic surgical instrument. The endoscopic surgical instrument 61 includes a pipe-shaped insertion section 62 and an operation section 63 provided on the hand side of the insertion section 62. The operation section 63 is provided with an insertion section rotation knob 64 for rotating the insertion section 62 about its axis.

An operation shaft 65 and a rotation shaft 66 which are movable in the axial direction are inserted into the insertion portion 62. A first jaw 67a constituting a grip is provided at the distal end of the insertion portion 62 so as to be rotatable about a pivot pin 68 as a fulcrum. The part protrudes from the front end of the insertion part 62. The base end of the operation shaft 65 is connected to a movable handle 70 provided on the operation unit 63.

The tip of the rotary shaft 66 projects from the front end of the insertion portion 62, and the projection has a second
Are provided integrally with each other. And the first
And the second jaws 67a and 67b constitute a treatment section for grasping and treating the living tissue A.

As shown in FIGS. 18 and 19, the second jaw 67b has a trapezoidal or substantially triangular cross section, a solidified portion 71 formed at the bottom, and an incision 72 at the top.
Are formed. That is, the living tissue A is coagulated by rotating the rotating shaft 66 about the axis and holding the living tissue A while facing the first jaw 67a with the coagulation portion 71 of the second jaw 67b facing upward. The first jaw 67 can be rotated by rotating the rotation shaft 66 about the axis, with the cutout 72 of the second jaw 67b facing upward.
The living tissue A can be incised by gripping the living tissue A so as to face the living tissue A.

A rotary shaft 66 integral with the second jaw 67b is rotatably supported by a support pipe 73 in the insertion portion 62, and its base end is connected to a jaw rotation knob 74 provided on the operation portion 63. By operating the jaw rotation knob 74, the direction of the first jaw 70 can be arbitrarily changed.

Next, the operation of the tenth embodiment will be described. First, the jaw rotation knob 74 is operated to rotate the rotation shaft 6.
6 is rotated so that the solidified portion 71 of the second jaw 67b faces upward and faces the first jaw 67a. In this state,
When the operating shaft 65 is moved backward by operating the movable handle 70, the first jaw 67a rotates around the pivot pin 68 as a fulcrum, and the first jaw 67a and the solidified portion 71 of the second jaw 67b move as shown in FIG.
The living tissue A is gripped as shown in FIG. Therefore, when a coagulation current is applied between the first and second jaws 67a and 67b, coagulation of the living tissue A is performed.

Next, the first and second jaws 67a, 67b
Is opened, the jaw rotation knob 74 is operated to rotate the rotation shaft 66 by 180 °, and the cutout portion 72 of the second jaw 70 is
The living tissue A is gripped between the first jaw 67a and the cutout portion 72 of the second jaw 67b by gripping the living tissue A while facing the first jaw 67a with the body facing upward. Therefore, when a cutting current is passed between the first and second jaws 67a and 67b, the living tissue A is cut.

The cross section of the second jaw 67b is trapezoidal or substantially triangular, and a solidified portion 71 is formed at the bottom and a cutout 72 is formed at the top.
2 and 2 may be provided at two positions and rotated by 90 ° to switch between coagulation and incision.

FIG. 20 shows an eleventh embodiment.
The same components as those of the first embodiment are denoted by the same reference numerals, and description thereof is omitted. In the present embodiment, a protective cover 75 having a substantially arc-shaped cross section is provided at the distal end of the insertion portion 62 to cover the second jaw 67b. In this way, the protection cover 75 allows the second
By covering the jaw 67b, it is possible to prevent the second jaw 67b from damaging the living body during insertion into the body cavity.

FIG. 21 shows a twelfth embodiment.
The same components as those of the first embodiment are denoted by the same reference numerals, and description thereof is omitted. In the present embodiment, a distal end pipe 76 made of an insulating member is provided at the distal end of the insertion portion 62, the operation shaft 65 and the rotating shaft 66 are covered by insulating covers 65a, 66a, and the first and second jaws 67a, 67b are It is configured in an electrically insulated state.

FIGS. 22 and 23 show a thirteenth embodiment. The same components as those of the tenth embodiment are denoted by the same reference numerals and description thereof is omitted. In the present embodiment, a current switching mechanism 77 is provided in the operation unit 63. Second jaw 67b
A switch operating cam 78 is provided at the base end of the rotating shaft 66 integrated with the
Is provided. The switch operation cam 78 is provided with a large diameter portion 78a corresponding to the solidified portion 71 of the second jaw 67b and a small diameter portion 78b corresponding to the cutout portion 72.

On the other hand, the switch operation cam 7 is
8, a through hole 79 is provided, and a plunger 81 urged by a spring 80 in a direction in which the spring comes into contact with the cam surface of the switch operation cam 78 is provided in the through hole 79. A current switch 82 is provided above the through hole 79 so as to face the plunger 81.

By operating the jaw rotation knob 74, the rotation shaft 66 is operated.
Is rotated, the switch operation cam 78 rotates integrally, and when the plunger 81 is pushed up by the large diameter portion 78a, the current switch 82 is turned on, and the small diameter portion 78b is turned on.
Is pressed down by the spring 81 in opposition to the plunger 81, the current changeover switch 82 is turned off. The current changeover switch 82 is connected to a current changeover circuit (not shown) built in the high-frequency ablation power supply 2 via a current changeover cord 83, and is output from the high-frequency ablation power supply 2 by turning on and off the current changeover switch 82. Current can be switched from coagulation current to incision current or vice versa.

According to the above embodiment, the following configuration is obtained. (Supplementary Note 1) In an endoscopic surgical instrument including a pair of grippers that relatively open and close and an incision that moves in a gap between the grips, the grip and the incision are each configured as an electrode, and An endoscope-operated surgical instrument, comprising an energizing means for energizing between parts and between the grip part and the incision part.

(Supplementary Note 2) In an endoscopic surgical instrument provided with a pair of gripping portions that open and close relatively and an incision portion that moves in a gap between the gripping portions, the gripping portion and the incision portion are each configured as an electrode. An endoscopic surgical instrument, comprising: an electrode switching unit that switches between energization between grip portions and between the grip portion and the incision portion.

(Supplementary note 3) An endoscopic surgical instrument characterized in that the endoscopic surgical instrument according to Supplementary note 1 or 2 is provided with operation switches for incision output and coagulation output of a high-frequency ablation power supply device. (Supplementary Note 4) The endoscopic surgical instrument according to Supplementary Note 1 or 2, further comprising an operation switch that performs coagulation output in synchronization with the gripping operation of the operation unit and performs incision output in synchronization with the incision operation of the operation unit. Endoscopic surgical instrument featuring. (Supplementary note 5) The endoscopic surgical instrument according to Supplementary note 1 or 2, wherein the electrode at the incision is formed in a wire shape.

(Supplementary Note 6) In an endoscopic surgical instrument provided with a pair of gripping portions that open and close relatively and an incision portion that moves in a gap between the gripping portions, the gripping portion and the incision portion are each configured as an electrode. An endoscopic surgical instrument comprising: a grip portion; and an electrode switching portion that switches between energization between electrodes and between incision portion electrodes.

(Supplementary Note 7) A pair of gripping portions that open and close relatively, and a cutout portion electrically insulated on one gripping portion,
An endoscopic surgical instrument comprising: the grip section and the incision section each configured as an electrode; and an electrode switching section configured to switch energization between the grip sections and between the grip section and the incision section.

(Supplementary Note 8) In the high-frequency ablation power supply device,
A high-frequency ablation power supply device comprising: means for outputting a coagulation current; means for detecting coagulation completion; and means for stopping coagulation current upon detection of coagulation completion and outputting an incision current at the same time.

(Supplementary Note 9) In an endoscopic surgical instrument used in combination with the high-frequency ablation power supply device according to supplementary note 8,
It has a pair of grips that open and close relatively, and further has an incision in one of the grips, and the contact area between the incision and the other grip is relative to the contact area between the grips. An endoscopic surgical instrument characterized by being small.

(Supplementary Note 10) A high-frequency ablation power supply apparatus, comprising: means for storing measurement and report of a living tissue; and means for reproducing tissue ablation in accordance with the stored conditions. .

(Supplementary Note 11) In an endoscopic surgical instrument having a pair of jaws that relatively open and close at the distal end of an insertion portion,
The first jaw has a treatment section for treating a tissue, and the second jaw has a coagulation section and an incision section formed on different surfaces, and the second jaw is centered on an axis parallel to the insertion section. An endoscopic surgical instrument capable of treating tissue by selectively rotating the first jaw and one of a coagulation portion and an incision portion and applying a high-frequency current to each jaw.

(Supplementary note 12) The endoscopic surgical instrument according to supplementary note 11, wherein only the first jaw is opened and closed. (Supplementary note 13) The endoscopic surgical instrument according to supplementary note 11 or 12, wherein the area of the coagulation part is larger than the area of the incision part. (Supplementary note 14) The endoscopic surgical instrument according to Supplementary note 11, 12, or 13, wherein a cross-sectional shape of the second jaw is trapezoidal. (Supplementary note 15) The endoscopic surgical instrument according to Supplementary note 11, 12, or 13, wherein a cross-sectional shape of the second jaw is substantially triangular.

(Supplementary note 16) The endoscopic surgical instrument according to any one of supplementary notes 11 to 15, further comprising means for insulating the first jaw from the second jaw, wherein each jaw has a different pole. An endoscopic surgical instrument characterized by being capable of conducting a high-frequency current. (Supplementary Note 17) In the endoscopic surgical instrument according to any one of Supplementary Notes 11 to 16, when the coagulation portion of the second jaw faces the gripping surface of the first jaw, the coagulation current is supplied. An endoscopic surgical instrument characterized in that when an incision is made to face the gripping surface of the first jaw, tissue can be continuously coagulated and incised by applying an incision current.

(Supplementary note 18) The endoscopic surgical instrument according to any one of Supplementary notes 11 to 16, further comprising means for changing a current from a coagulation current to an incision current in accordance with rotation of the second jaw. Characteristic endoscopic surgical instrument.

[0078]

As described above, according to the present invention, there are provided a pair of gripping portions which are relatively opened and closed, and a cutout portion which moves in a gap between the gripping portions, and each of the gripping portion and the cutout portion is formed as an electrode. By providing an energizing means for energizing between the gripping portions and between the gripping portion and the incision portion, the treatment target site of the living tissue can be reliably gripped and coagulated, and can also be incised,
Furthermore, since the incision performance can be maintained for a long time, there is an effect that the running cost can be reduced.

[Brief description of the drawings]

FIGS. 1A and 1B show a first embodiment of the present invention, in which FIG. 1A is a side view of an entire endoscopic surgical instrument, and FIG. 1B is a side view of a state in which a gripping member is closed.

FIG. 2 is a longitudinal sectional side view of a state where the living tissue is gripped by the gripping member according to the embodiment.

FIG. 3 is an explanatory diagram of an electrode switching unit of the embodiment.

FIGS. 4A and 4B show the same embodiment, wherein FIG. 4A is an explanatory diagram of load characteristics at the time of coagulation, FIG. 4B is an explanatory diagram of load characteristics at the time of incision, and FIG.
FIG. 4 is an explanatory diagram of impedance control.

FIGS. 5A and 5B show a second embodiment of the present invention, wherein FIG. 5A is a side view of the entire endoscopic surgical instrument, and FIG. 5B is a side view of a state in which a gripping member is closed.

6A and 6B show a third embodiment of the present invention, wherein FIG. 6A is a side view of the entire endoscopic surgical instrument, and FIG. 6B is a side view of a state in which a gripping member is closed.

FIG. 7 is a longitudinal sectional side view of a state where a living tissue is gripped by a gripping member according to a fourth embodiment of the present invention.

FIG. 8 is a longitudinal sectional side view of a state where a living tissue is gripped by a gripping member according to a fifth embodiment of the present invention.

FIG. 9 is an explanatory diagram of an electrode switching unit of the embodiment.

FIG. 10 is a longitudinal sectional side view showing a state where a living tissue is gripped by a gripping member according to a sixth embodiment of the present invention.

FIG. 11 is a longitudinal sectional side view of a state where a living tissue is gripped by a gripping member according to a seventh embodiment of the present invention.

FIG. 12 is an explanatory diagram of an electrode switching unit of the embodiment.

FIG. 13 is a longitudinal sectional front view showing a state where a living tissue is gripped by a gripping member according to an eighth embodiment of the present invention.

FIG. 14 is a block diagram of a high-frequency ablation power supply device showing a ninth embodiment of the present invention.

FIG. 15 is an explanatory diagram of impedance control.

FIG. 16 is an overall side view of an endoscopic surgical instrument showing a tenth embodiment of the present invention.

FIG. 17 is a longitudinal sectional side view showing a treatment section on the distal end side of the embodiment.

FIG. 18 is a vertical sectional front view of the embodiment at the time of solidification.

FIG. 19 is a vertical sectional front view of the embodiment at the time of incision.

FIG. 20 shows an eleventh embodiment of the present invention, in which (a)
FIG. 3 is a vertical front view at the time of coagulation, and FIG.

FIG. 21 is a longitudinal side view of a distal end portion of an endoscopic surgical instrument according to a twelfth embodiment of the present invention.

FIG. 22 is a side view of an operation unit of an endoscopic surgical instrument according to a thirteenth embodiment of the present invention.

FIG. 23 is a sectional view taken along the line XX in FIG. 22;

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Endoscopic surgical instrument 2 ... High frequency ablation power supply device 3 ... Insertion part 4 ... Treatment part unit 5 ... Operation part 11 ... Grip member 16 ... Incision knife

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

Claims (1)

[Claims] 1. An endoscopic surgical instrument comprising a pair of grippers that relatively open and close and an incision that moves in a gap between the grips, wherein the gripper and the incision are each configured as an electrode, An endoscopic surgical instrument, characterized in that an energizing means for energizing between grip portions and between the grip portion and the incision portion is provided.