JPS58200739A - Incision apparatus - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

DETAILED DESCRIPTION OF THE INVENTION The present invention relates generally to medicine, and specifically to surgery, and relates to an apparatus for resecting human organs, particularly those located in difficult to access areas.

In the medical prior art, devices are known for suturing human organs with a metal stabilizer, in which the part of the organ to be excised is cut off mechanically, ie with a knife, after suturing (for example, in the Soviet Union). (See Inventor's Certificate No. 511.932).

However, when using such suturing devices, it is extremely difficult to use electrocution or plasma circular teeth, and it is even more difficult when using a laser beam as the cutting device. On the contrary, it is common knowledge that mechanical dissection cannot result in sterile-bloodless resection.

Other devices for stable suture and laser beam dissection, such as those described in U.S. Pat. They are brought into abutment and connected to each other by a special locking device and include a cutting tool, ie a mechanical knife movable along the optical waveguide of the laser beam or the stable body. However, it cannot be effectively applied to the resection of such difficult-to-place and difficult-to-access areas (e.g., the heart of the stomach, the small pelvis, the thoracic cavity, etc.).
Resection of human organs requires extensive immobilization of the organ being operated on, which involves considerable trauma to the surrounding tissue, and
It also increases blood loss and complicates surgery.

The device for suturing and resection of the gastric wall with a wedge-shaped stable, as described in USSR Inventor's Certificate No. 209.626, includes a cutting instrument and a unit for suturing the organ to be resected, which unit It includes a rectangular die with a recess for bending the table, a stable body with a magazine, and a stable ejector, the stable body being mounted on its holder, the holder being parallel to the die. and a water box 2 member disposed perpendicularly to the first member in the plane of movement of the stable body.

However, the structural characteristics of the device do not allow for a sterile/bloodless dissection of the operated tissue. This is because the member arranged parallel to the die and the second member arranged at right angles to the first member are connected at right angles to each other, so the first member and the stable body are , located in the same plane, ie in the plane of motion of the stable body. This precludes the use of replacement cutting instruments, especially laser beams, and therefore makes it impossible to make a bloodless incision.

It is an object of the present invention to enable easy replacement of the stable body of the suturing unit and the cutting instrument in difficult-to-access areas of surgery, to securely hold the organ to be resected, and to monitor the resection process. To provide an ablation device capable of

including a cutting instrument and a suturing unit for the organ to be excised;
The suturing unit includes a rectangular die with two rows of recesses for a bendable stable, and a rectangular removable stable body with a stable magazine and a stable ejector, the stable body being connected to its holder. The holder includes a first member rigidly connected parallel to the die and a second member rigidly held at right angles to the first member. In the resection device, according to the invention, said second member of the holder is laterally offset relative to the first member and located outside the plane of movement of the stable body, and said second member is located outside the plane of motion of the staple body; carrying a retainer for locking in place the second
Equipped with a hold-down frame mounted on the member,
The hold-down frame extends along the outer periphery of the die in one position, and
This object is achieved in a cutting device in which the member is provided with a guide groove for moving the cutting instrument.

The advantage of the above-mentioned resection device is that by laterally offsetting the position of the first member relative to the second member of the stable body holder, it is possible to suture the organ to be operated on and then use it in difficult-to-access areas of the surgical procedure. To effect a sterile resection, it is possible to remove the staple body and replace it with a cutting instrument, in particular an optical waveguide for laser radiation, while the retainer facilitates such rapid replacement. The hold-down frame can securely fix the tissue to the die after suturing, which prevents displacement of the sutured organ after removal of the staple body. A high degree of cutting precision is achieved in this way, which is particularly important when using laser beam cutting instruments. Furthermore, the guide groove provided in this cutting device eliminates deflection of the cutting instrument.

One preferred embodiment of the invention uses a laser beam cutting instrument known per se, in which the optical waveguide is housed in a head mounted in a guide groove and the laser beam An opening is provided in the guide groove for the passage of.

Embodiments of the present invention shown in the drawings will be explained in detail below with reference to FIGS.
FIG. 4 shows an ablation device according to the invention for ablation using both a knife and a laser beam as cutting instruments.

Referring to the accompanying figures, this equipment includes the following units and components: namely, a staple body 1, a staple body holder 2, a die 3 with a recess 3a, a bracket 4 with a slot 5, a bold down frame 6, and an optical waveguide 7 for the laser radiation, the laser beam being is used as a cutting instrument. Lasers are not shown for ease of illustration. Furthermore, the laser itself is not essential to the present invention, and any currently used laser capable of producing sufficient radiation power may be used, such as a "7 YAPRA 7" laser device. can be used.

The holder 2 includes a first member 8 parallel to the die 3 and rigidly connected to the die 3, and a second member 9 rigidly connected to the first member 8. Since the first member 8 and the die 3#'i are formed integrally with each other, this integral part forms a yoke shape. The die 3 is provided with a plurality of recesses 3a for bending the staple fed from the staple body 1, and also has a slot 1O2 for passing the cutting instrument and a supporting plastic insert (
(not shown for simplicity of illustration). The shape of the support insert is slot 11
It is used when cutting tissue with a knife according to its shape. The first part 8 of the holder 2 comprises a guiding groove 12 for laterally guiding the optical waveguide 7 as well as an opening 13 for centering and guiding the staple body 1. In order to increase the rigidity during suturing, the first member 8 and the die 3 are connected with a screw 14.
(Fig. 1). This screw is inserted into a screw hole 15 (FIG. 2) of the die 3 located in the middle of the row of recesses. This screw hole 15 is closed by a plate 16 to prevent the laser beam from damaging adjacent tissues and organs (Figs. 3 and 4).
.

The second part 9 of the holder 2 has a T-shaped profile and is rigidly connected to the first part 8 of the holder 2 and along its transverse axis, in this case are offset by the length necessary to set the laser waveguide into the guide groove 12 of the first member 8.

A handle 17 is integrally provided on the top of the second member of the holder 2. A slot 18 is provided in the handle 17 for passing a rod 19 through which the rod 19 can be stapled onto the second member 9 of the holder 2 by having one end of the rod 19 enter the slot 5 of the bracket 4. Main body 1 is locked.

The rod 19 is movable along the slot 18 of the handle 17 under the action of a spring centered around the stud 21. The slot 18 in the handle 17, which accommodates the rod 19 and the spring head, is closed on both sides by side members A. A grip is provided for pulling the rod 19 back into the slot 17 of the handle 17.

The top end of the second member 9 of the holder 2 carries a bracket 4 for fixing the stable body 1. This bracket 4 is provided with a slot U for receiving the nut δ. Since the center of the slot U coincides with the center of the opening 13 of the first member 8 and also coincides with the center of the slot 10 of the die 3, the staple body 1 is inserted into the opening of the first member 8 and the die 3. It is centered on the target.

The second member 9 carries the linkage of the hold-down frame 6, which allows it to move independently of the staple body 1 into the plane of movement of the staple body. When fixing the organ to be resected, the hold-down frame 6 is fixed by means of a spring-actuated latch n when the hold-down frame 6 is in one of its positions. In this extreme position, the hold-down frame 6 surrounds the die 3 along its outer circumference such that the edge of the hold-down frame 6 contacts the tissue of the organ 4 and fixes this tissue on the bevel green I of the die 3. At the same time, this tissue is expanded and brought into contact with the die 3.

In order to allow the links of the hold-down frame 6 to be easily moved, a flange 31 is provided at the upper end of the link I. A screw 32 is also provided to lock the hold down frame 6 in its upper end position.

The staple body 1 has a tail piece and a staple head trail. The upper part of the tailpiece has a male thread which engages the nut 5 to move the staple body 1 relative to the bracket 4. Further, the tail piece 33 is provided with a female screw hole, and this screw hole is
It engages with a screw 37 for actuating the staple ejector connection.

The staple head is equipped with a T-shaped slot 39 for accommodating a replacement stable magazine.
0 is locked against the staple body 1 by a slider 41 which is actuated by a leaf spring 42 which is fixed onto the staple body 1 by a screw 43.

The staple head of the staple body 1 enters into the opening 13 of the first member 8 of the holder 2, and as it passes through this opening 13, it rests with its legs 44 on the upper surface of the first member, and thus Therefore, a certain gap is defined between the magazine 40 and the dice 3.

The ejector is provided with a slot 45 for receiving the pressure head 46 of the screw 37, and the ejector is provided with a knuckle joint 47 in its central part for removing the ejector from the staple body 1. The threading is inserted into the slot 49 of the staple body 1 to prevent the knuckle joint 47 from coming off naturally from the screw 37. The ejector section carries two rows of ejector blades 50 for ejecting the π-shaped staples from the magazine 40.

A replaceable knife 51 is interposed between the ejector plates. Due to the replaceability of the knife, the surgery can be performed with any technique without changing the ejector. That is, a knife can be used for the tissue incision, or any other cutter can be used instead of a knife, in this case a laser beam.

The laser waveguide 7 includes a head provided with a T-shaped end piece made of polytetrafluoroethylene which engages in a guide groove 12 of the first member 8 of the holder 2. However, this first member 8 is the die 3
is placed parallel to.

A tube is held relative to the head 52 by a thread (not shown), and this tube is held via a thread (not shown) to a focusing objective 55 of the laser device.

Now consider the case where a surgical procedure is performed using a laser beam as a cutting instrument. In this case, the knife 51 must also be cleaned of ejector dirt.

The apparatus assembled as shown in FIGS. 1 and 3 and the required number of replacement magazines loaded with staples are then placed in a conventional manner, e.g. in an autoclave.
Perform sterilization. Separately, the optical waveguide is sterilized with 96% ethanol. The surgical steps are performed as follows.

A staple body 1 with a bracket 4 is fixed on the holder 2, and the bracket 4 is locked by a rod 19. The hold down frame 6 is fixed at its upper end position. After bringing the genus device behind the organ to be excised, the hold-down frame 6 is moved downward by pushing the flange 31, and the organ hole is fixed against the die 3. Next, the staple body 1 is lowered by the nut B until it comes into contact with the upper surface of the member 8, and the staple body 1
is connected to the die 3 by a screw 14.

In the meantime, make sure that the ejector is in the highest position. Then, the screw 37 is rotated to completely lower the ejector, and suturing is performed using the staples arranged in two rows.

A suture is performed around the screw 14, where the retainer'd
! The bamboo rod 19 is pushed out and the bracket 4 is removed from the holder 2 together with the staple body 1. An optical waveguide 7 connected to a laser device (not shown) is introduced into the guide groove 12 of the member 8 . Upon activating the laser, a focused laser beam is directed by the waveguide through the middle of the row of staples and into the organ to be ablated. In this way, by moving the waveguide 7 along the guide groove 12 of the member 8, a sterile and bloodless resection of the organ to be operated on is carried out. The laser is then turned off, the hold-down frame 6 is fully raised and locked by the screws 32, and the entire device is removed from the excised organ. This is the end of the surgical sequence.

When mechanical ablation of tissue is performed, the knife 51 is not removed from the ejector 31 and is inserted into the slot 1 of the die.
1 into which a plastic insert (not shown) is fitted. While being moved by the screw 37, the organ is excised by the knife 51 and stapled at the same time.

In this way, the ablation device according to the invention causes minimal damage to the surrounding tissue and is virtually non-bleeding.
Enables sterile/atraumatic removal of human organs that are difficult to access.

The use of this device simplifies surgical operations, avoids complications due to infection of the surgical site, reduces operating time, eases the surgeon's labor, and improves the surgical conditions as a whole. .

This device is not only applied to the removal of human organs (X
It can be applied to form grafts from the stomach to form psdiculats gsstrova.

Although the preferred embodiments of the present invention have been described with reference to specific drawing pressures, it must be understood that the invention can be modified and implemented as desired within the scope of the spirit of the present invention. That is, in order to create a pie-shaped protection, one end face can be provided with stable recesses arranged at right angles to said rows. ° This is useful for performing a graft formation procedure by using the device several times in succession against the stomach to form a graft from the stomach, e.g. by the Gabrilin method, or from the large curvature of the skull. Convenient for forming veristasis tubes.

[Brief explanation of the drawing]

FIG. 1 is a perspective view showing the resection device according to the present invention assembled and placed on the organ to be resected, and FIG. 2 shows the staple body removed and the laser beam optical waveguide inserted into the stable body holder. 1 is a perspective view of the device shown in FIG. 1 installed in a guide groove of one member; FIG. 3 is a side view showing a partial cross section of this device; and FIG. 4 is a front view showing a partial cross section of this device. It is. DESCRIPTION OF SYMBOLS 1... Staple main body, 2... Staple main body holder, 3... Dice, 4... Bracket, 6...
Hold down frame, 8... First member of stable body holder 2, 9... Second member, 12... Guide groove, 19... Lock rod, 7... Laser waveguide,
52...Head. Applicant's agent Kiyoshi Inomata Continued from page 1 @ Inventor Polis Nikolaevitsch Malysyev Soviet Union Moscow Ulitsua Butlerova 24 Kabe 19 ■ Inventor Viktor Afanasyevitsch Salzuk Soviet Union Moscow Ulitsua・Ostrovitwyana 26 Korpus 2 Kabe 153 (Inventor: Oren Ksenofontwytschiskobelkin, Soviet Union, Moscow, Ulitsa, Vesnina, 30 Kabe, 27 @ Inventor: Evgeny Ivanovich, Blevov, Soviet Union, Moscow, Ulitza, Marshala, Timosienko 44 Carvey 76

Claims (1)

[Claims] 1. A cutting instrument and a suturing unit for resected organs, the suturing unit comprising a rectangular die with a plurality of recesses for bendable staples, a staple magazine and a staple ejector. a rectangular removable staple body mounted on a holder, the holder having a first member rigidly locked parallel to the die; a second member rigidly attached at right angles to the first member (8), the second member (9) of the holder (2) being located outside the plane of movement of the staple body; a second member (9) which is laterally offset in the direction of the staple body (1) and also carries a retainer (4, 19) for locking the staple body (1) and is movable in the plane of movement of the staple body (1);
A hold-down frame (6) is provided mounted above, which hold-down frame (6) is adapted to surround the die (3) along its outer edge in one position thereof, and which is adapted to surround the die (3) along its outer edge. 1 on top of 1 member (8)
, a cutting device, characterized in that it is provided with a guide groove (12) for moving the cutting instrument. 2. A laser beam is used as the cutting instrument, and an optical waveguide (7) is used to direct the laser beam toward the ablation site.
) is a movable head (5) along the guide groove (12).
2) Resection device according to claim 1, characterized in that it is installed in a. 3. The second member (9) of the staple body holder (2) is arranged longitudinally with respect to the plane of movement of the staple body (1), and this second member is slightly spaced apart from the first member in the perpendicular direction. The resection device according to claim 1, characterized in that: