JPS59192361A - Surgical incision instrument - 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 [Technical Field of the Invention] The present invention provides a method for inserting into a body cavity without making an incision and observing it with an observation means such as an endoscope, while observing the inside of the body cavity from the outside, particularly the joint cavity of a knee or the like. cartilage (articular meniscus, articular cartilage), bone,
The present invention relates to a surgical resection instrument capable of reliably and easily cutting fibrous tissues, tumors, etc., and capable of suctioning and discharging the cut pieces while inserted into the body cavity.

[Technical background of the invention and its problems] Conventionally, joint surgery has been mainly performed by an incision method (open surgery). For example, in the case of general joints, it is necessary to remove a tumor on the operculum or remove damaged cartilage, bone, etc. from the opercular joint, but this requires a large incision. there was.

Therefore, the incision causes trauma, which is accompanied by pain and restricted movement, and has the disadvantage that it takes a long time to heal.

For this reason, in recent years, under observation using an arthroscope (endoscope), a small puncture hole is formed in the joint without incision, and a probe inserted into the puncture hole is used to perform surgery (closed surgery).
A device to do this has been proposed.

For example, Japanese Patent Application Laid-Open No. 54-77493, U.S. Patent No. 42
These are disclosed in Publication No. 46'90.2 and the like. The former prior art instrument includes an elongated fixed outer tube in which a cutting opening extending in the axial direction is formed on the outer periphery, and an internal rotary blade that is rotatably housed within the outer tube and forming an internal rotary blade at the cutting opening. The device includes a tubular inner member, a suction device, and a drive motor, and while the tissue pieces are suctioned into the cutting opening by vacuuming, the drive motor rotates the rotary blade to cut the cut pieces, and the cut pieces are cut into a tube shape. It is made of 4M so that it can be sucked and discharged through an inner member.

However, with this method, the cutting opening is located on the outer periphery of the jacket tube, making it difficult to determine its position, making it difficult to aim at the tissue to be excised. Not only is it difficult to absorb, but it also has a poor grip on tissues. Moreover, the blade (rotary blade) is located inside the cutting opening, and cutting cannot be performed unless the mH is taken into the jacket tube by suction means.

The device according to the latter prior art includes an outer member in the shape of a long probe having a cutting opening on the outer periphery, and an inner member that is slidably housed within the outer member and has a blade at a position corresponding to the cutting opening at the tip. The cutting member includes a cutting member, a suction device, and a drive mechanism for the inner cutting member, and the tissue sucked and taken into the cutting opening is cut by sliding of the inner cutting member, and the cut sections are sucked and discharged. It is configured to do so. However, the resection instrument having this configuration also has the same disadvantages as the prior art described above.

[Purpose of the Invention] The present invention has been made in view of these circumstances, and it is possible to detect the inside of a body cavity, especially a joint cavity such as a knee, under observation using an observation means such as an endoscope without making an incision. When cutting cartilage (articular meniscus, articular cartilage), bone, fibrous tissue, tumor, etc. and discharging the cut, the target tissue tends to bite without escaping, making it easy and reliable to target the target tissue. and
It is an object of the present invention to provide a surgical cutting instrument that can cut only the target tissue, and has no blade or drive system in the insertion section, making it easy to suction and discharge the sections.

[Summary of the Invention] In order to achieve the above object, the surgical cutting instrument according to the present invention has a cutting opening at or near the distal end of the hollow insertion portion, and has a cutting opening in front of the cutting opening. A cutting blade located on the outside and a regulating blade located on the inside are formed on the edge, and by pulling or pushing the insertion part, the cutting blade cuts the tissue surface while regulating the cutting depth with the regulating blade, and slices the tissue. is configured to be taken into the insertion portion from the cutting edge between the cutting blade and the regulating blade.

[Embodiments of the invention] The present invention will be described in detail below with reference to the drawings.

1 and 2 show a first embodiment of the surgical cutting instrument of the present invention, in which FIG. 1 is a longitudinal section of the tooth, and FIG. 2 is an enlarged plan view showing the distal end of the insertion section. .

In these figures, reference numeral 1 denotes a surgical resection instrument, which includes a grip part 2 on the proximal side and an elongated, e.g., cylindrical insertion part that extends forward from the grip part 2 and is inserted into a body cavity, especially a joint cavity. It is composed of 3.

The tip of the insertion portion 3 is formed into a hemispherical shape, and a cutting edge 4 is formed near the tip. A cutting edge 5 is formed on the front edge of this cutting edge 4, and a regulating edge 6 is formed on the rear edge, which is located inside the cutting edge 5 of the front edge and is tapered inward. The blade opening 4 formed between the cutting blade 5 and the regulating blade 6 is narrow. Further, the inside of the insertion section 3 communicating with the blade opening 4 is a section suction path 7, and the suction path 7 communicates with a hollow portion 8 formed in the grip section 2 on the proximal side. A joint 9 is provided in the hollow part of the gripping part 2 to protrude from the outer periphery by screwing or the like.
As shown in the figure, it is connected to a suction and recovery device 11 via a tube 10.

An example of the operation of resecting a target tissue in a body cavity, for example, a joint cavity with such a configuration will be described with reference to FIG. As shown in FIG. 4, in order to resect the target tissue in the target region, for example, the knee joint, a small hole into which the insertion portion 3 of the surgical resection instrument 1 is inserted is made in the knee region 12 by a puncturing operation such as a trocar. The insertion section 3 is inserted through a trocar or the like or directly. In addition, before inserting the insertion section 3, the insertion section 14 of the arthroscope 13, which is equipped with an illumination and observation optical system, is inserted into the trocar so that the tissue to be imaged can be removed while observing the inside of the joint cavity. A display device that is inserted into the joint cavity by one puncture operation and displays images taken directly from the eyepiece of the arthroscope 13 or by the television camera 15 attached to the eyepiece.
At 16, the joint cavity and the insertion portion 3 of the surgical resection instrument 1 inserted into the cavity can be observed. Furthermore, in order to inflate the inside of the joint cavity and facilitate resection surgery, physiological saline can be supplied into the joint cavity from the water supply source 17 through the water supply pipe 18 punctured into the joint cavity at controlled water pressure. . On the other hand, the joint 9 of the proximal grip portion 2 of the surgical resection instrument 1
A tube 10 is connected to the suction 1 recovery device 11.

In this setting state, the operator can inspect the joint cavity and the insertion section 3 of the resection instrument 1 directly using the arthroscope 13 or using the display device 15.
While observing the distal end, the cutting edge 4 of the distal end of the insertion section 3 is brought into contact with the tissue to be resected, and in this state, the insertion section 3 is pulled toward the proximal side and the insertion section 3 is pulled in the axial direction. , the tissue surface is cut with the cutting blade 5 while regulating the cutting depth with the regulating blade 6, and the cut section is taken into the insertion section 3 through the cutting edge 4 between the cutting blade 5 and the regulating blade 6°. By the operation of the suction 9 collection device 11, the taken-in section is sequentially conveyed through the suction path 7 into the hollow part 8 of the gripping part 2 on the rear proximal side, and is transferred to the joint 1-9. It is collected and removed through the tube 10 to the suction 2 collection device 11. As described above, in this embodiment, the cutting edge 4 of the insertion section 3 of the resection instrument 1 is pressed against the tissue to be resected and pulled in the axial direction to cut the tissue and the cut piece is transferred to the cutting edge 4.
It can be taken into the insertion part 3 from the inside, and the required amount can be cut at the required part, and the cutting time can be reduced to 1 lat? A has good bite without escaping, and moreover, it is possible to reliably target the target tissue. Further, in this embodiment, cutting can be performed manually without using a power source, and therefore, the structure is an hour wheel, and the insertion section 3 etc. can be made small in diameter, and the suction path for the section can be widened. Sections can be easily collected by suction. Also, cutting blade 5
The cutting depth can be freely set by freely setting the direction of the cutting edge, the inclination of the regulating blade 6, and the width of the cutting edge 4.

FIG. 4 shows a second embodiment of the present invention in an enlarged sectional view of the distal end of the insertion portion. This example is.

The distal end of the insertion part 3 is curved, and a cutting edge 4, a cutting edge 5, and a regulating blade 6 are provided on the outer curved part of the curved part 3a, making it easy to bring the cutting edge 4 into contact with the target tissue. It is something. The other configurations and operations are the same as those of the first embodiment described above. In addition, in this second embodiment, the cutting edge 4 may be provided in the inner curved part of the curved part 3a.

FIG. 5 shows a third embodiment of the present invention in an enlarged sectional view of the distal end of the insertion portion. In this embodiment, the distal end of the insertion section 3 is tapered, and the tapered surface 3b is provided with a cutting edge 4, a cutting edge 5, and a regulating blade 6, making it easier to target the target tissue. There is. Further, in this embodiment, cutting can be performed by sliding the tip of the insertion portion 3 in the direction of the tapered surface shape. Other configurations and operations are the same as in the first embodiment. In this embodiment, the distal end surface of the insertion portion 3 may be formed into a flat surface. In addition, there is a cutting edge 4 on the outer periphery near the tip of the flat surface insertion part. A cutting blade 5 and a regulating blade 6 may be provided.

FIG. 6 shows a fourth embodiment of the present invention in an enlarged sectional view of the distal end of the insertion portion. In this embodiment, a cutting blade 5 is provided at the rear edge of the cutting edge 4, and a regulating blade 6 is provided at the front edge in a tapered shape toward the inside. Tissue can be cut by pushing the insertion section 3. Therefore, although the illustrated example of the fourth embodiment corresponds to the first embodiment, it is of course modified and configured to correspond to the second embodiment. Further, in the present invention, it may be configured such that the area around the cutting edge 4 is locally vibrated, or the entire insertion portion 3 is vibrated by a known vibration device (for example, an ultrasonic vibrator, an electromagnet, etc.). In this way, it becomes possible to reduce cutting resistance.

Furthermore, in the present invention, an outer tube is attached to the outer periphery of the insertion section 3.
s, and the distal end of the insertion section 3 is moved forward and backward from the outer tube. In this way, the blade opening 4 can be covered when the insertion section 3 is inserted into and removed from the body cavity. Further, in the present invention, the cutting pieces may be filled and collected in the insertion part without connecting to the suction 1 collection device, and the cutting pieces in the insertion part may be removed after the surgery (or during the operation).

Furthermore, although the above embodiments of the present invention specifically describe cutting tissue within a joint cavity, the surgical resection instrument of the present invention
Of course, it can also be applied to the resection of tissue within body cavities.

[Effects of the Invention] As explained above, according to the present invention, the target tissue does not escape and bites easily, the target tissue can be easily and reliably targeted, only the target tissue can be cut, and the structure is It's simple and has the effect of making JAM creation easy.

[Brief explanation of the drawing]

1 and 2 relate to the first embodiment of the present invention, FIG. 1 is a vertical view, FIG. 82 is an enlarged plan view of the tip of the insertion section, and FIG.
The figure is an explanatory view for explaining one example of the use of the cutting instrument of the present invention, FIG. 4 is an enlarged sectional view of the tip of the insertion portion showing the second embodiment, and FIG. 5 is an enlarged sectional view of the tip of the insertion portion showing the third embodiment. , FIG. 6 is an enlarged sectional view of the distal end of the insertion portion showing the fourth embodiment. 2... Gripping part 3... Insertion part 4... Cutting edge 5... Cutting blade 6... Regulating blade 71-Chango Agent Patent attorney Susumu Ishin 1/ , ”
"'":", :, ', t, °- Figure 4 Figure 5 Figure 6 Continued from page 1 0 Inventor Kazumasa Matsuo 2-43-2 Hatagaya, Shibuya-ku, Tokyo Lymphus Optical Industry Co., Ltd. 0 inventions within the company Author: Morihide Mizumoto 2-43-2 Hatagaya, Shibuya-ku, Tokyo Lymphus Optical Industry Co., Ltd. 0 inventors: Masahiko Kato 2-43-2 Hatagaya, Shibuya-ku, Tokyo Lymphus Optical Industry Co., Ltd. Author: Tadao Hagino, 2-43-2 Hatagaya, Shibuya-ku, Tokyo, Japan Lymphus Optical Industry Co., Ltd.

Claims (3)

[Claims] (1) A cutting edge is opened at or near the tip of the elongated hollow insertion portion to be inserted into the body cavity, and a cutting edge located on the outside and a regulating blade located on the inside are formed on the front and rear edges of the cutting edge. A surgical cutting instrument characterized by: (2) The surgical cutting instrument according to claim 1, wherein the cutting blade is provided at the front edge of the cutting edge, and the regulating blade is provided at the rear edge. (3) The surgical cutting instrument according to claim 1, wherein the cutting blade is provided at the rear edge of the cutting mouth, and the IA 1li11 blade is provided at the leading edge.