JPS61159953A - Prostate cutting 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 (Technical Field) The present invention relates to a prostatectomy device, and more particularly to a prostatectomy device that excises prostate tissue while visually checking it with an optical viewing tube.

(Prior Art) As is well known, in recent years, urinary endoscopes such as cystourethroscopes and resectoscopes have come to be widely used for observation, diagnosis, and treatment of urinary system diseases. In order to remove the affected tissue of the prostate while visually checking the affected area using such a urinary endoscope, for example, lf! f 1977-1981
Using a resectoscope disclosed in Japanese Patent No. 029, the affected tissue is cauterized and resected with high-frequency current.

However, when ablation is performed using high-frequency current, the living tissue degenerates and becomes white due to the ablation, making it difficult to determine the range of ablation and resection, and there is a risk that normal tissue may also be ablated. Furthermore, if the cutting tool accidentally comes into contact with muscle tissue, there is a risk that the patient will cause a reflex action, resulting in perforation or the like, resulting in serious accidents such as excessive bleeding.

(Objective) An object of the present invention is to provide a prostate resection device that has less risk of erroneous resection and can easily distinguish between affected tissue and normal tissue during resection.

(Overview) The prostate resection device according to the present invention is characterized in that it performs prostate resection while applying ultrasonic vibrations to a resection blade that is inserted through an optical viewing tube.

(Example) Hereinafter, the present invention will be explained based on illustrated embodiments.

FIG. 1 shows a prostatectomy device according to an embodiment of the present invention, and this prostatectomy device 100 includes an optical viewing tube 10,
The prostate resection tool 20, the guide pipe 30 through which the optical viewing tube 10 and the prostate resection tool 20 are inserted, and the main body 4 of the working men 1 that supports the rear end of the guide pipe '50.
0, and an operating mechanism 50 connected to the working element main body 40.

As shown in FIG. 2, the optical viewing tube 10 includes an insertion section 11
A connecting portion 16 is provided to connect the image guide tube 12 to the working element body 40.
A connection pin 14 for click connection to a connection hole 41 (see FIG. 7) and a light guide base 15 for introducing illumination light from a light source device (not shown) are provided.

As shown in FIG. 3, the prostate resection tool 20 is composed of an ultrasonic vibrator section 21, an insertion section 22, and a power supply section (not shown). As shown in detail in FIG. 4, the ultrasonic vibration device section 21 has a bottomed cylindrical exterior member 23, and a male thread 23a is formed on the outer periphery of the open end of this exterior member 23. A female thread 24a formed on the inner periphery of a large-diameter opening of a conical cylindrical exterior member 240 with open ends is screwed into this male thread 23a, and both members 23 and 24 are integrated. On the inner surface of the small diameter opening of the exterior member 24, a tip of a horn 25c, which will be described later, is held airtight.
A 1J ring 24b is provided. In the interior space of the exterior member 23, a well-known screw-tight Langievan type ultrasonic transducer 25 is supported by an 01J ring 26.27, as described in Japanese Patent Publication No. 50-1875. One electrode 25a of the vibrator 25 is connected to the other electrode through the lead wire 28a. 25b is lead wire 2
A connecting cable 28 is drawn out to the outside of the exterior member 23 via a cable 8b, and this connecting cable 28 is supplied with an output from an ultrasonic power source (not shown).

On the other hand, the horn 25c of the ultrasonic transducer 25 is built inside the exterior member 24, and its small-diameter tip is formed into a short cylindrical shape, with a connecting hole 25d bored at the tip, and a male screw threaded on the outer periphery. 25e is formed.

In this connection hole 25d, there is a long-axis insertion portion 22 of the cutting member.
The flange portion 2 is formed near the base of the insertion portion 22, and the flange portion 2 is adapted to be fitted and coupled with the base portion 22a.
2b is brought into contact with the end face of the small-diameter tip portion, and then tightened and fixed with a ring nut 29.

A cutting blade 22c is provided at the distal end of the insertion portion 22, as shown in a side view and a plan view in FIGS. 5 and 6.

Furthermore, the insertion section 22 is detachably attached to the ultrasonic vibrator section 21 via the ring nut 29.

The insertion portion 11 of the optical viewing tube 10 and the cutting blade 22c and insertion portion 22 of the ultrasonic transducer 21 are inserted into the guide pipe 30, and the base thereof has a coupling portion. 61 is provided, and this joint portion 31 has a water supply and drainage portion? ila is attached, and the working element main body 40 is connected to the connecting portion 61.

The working element main body 40 is constructed as shown in detail in FIGS. 7 and 8. In other words, the main body portion 42 having the finger hook portion 46 is! l! A first guide hole 42 through which the insertion portion 11 of the optical viewing tube 10 is inserted, as shown in the cross section in FIG.
a, and a second portion through which the insertion portion 22 of the prostatectomy instrument 20 is inserted.
A guide hole 42b is formed, and this second guide hole 42b
A low-friction member 42c made of tetrafluoroethylene or the like is provided on the inner surface of the insertion portion 22 to prevent vibration loss and noise from the insertion portion 22 which vibrates ultrasonically. As shown in FIGS. 7 and 8, symmetrical guide arms 44 are provided on both sides of the rear end of the main body 42 and extend in opposite directions and then extend rearward. One end of each arm 44 is fixed, and the other end of the arm 44 is bent to face each other and fixed to a support ring 45 in which the ultrasonic vibrator section 21 is loosely fitted.

As shown in FIG. 11, a low-friction member 45a similar to the low-friction member 42C is formed on the inner surface of the support ring 45. Returning to FIGS. 7 and 8 again, a support portion 47 for fixing one end of a leaf spring 46 for connecting the slider 4 is formed near the center of the finger hook portion 45. The other end of this leaf spring 46 is connected to the guide arm 44,
It is fixed to a support part 49 fixed to a slider 48 that slides along the long sides of the slider 44 . Furthermore, the slider 48
A finger rest 48A is attached to the.

The slider 48 is formed into an annular shape, as shown in FIG.
a, 48b are attached.

Therefore, since this slider 48 is connected to the working element main body 40 by the leaf spring 46, the insertion portion 22 can be slid against the guide pipe 50K by varying the distance of the finger hook portion 45.48A. can be done.

Further, a pipe 42d for guiding the insertion portion 11 of the optical viewing tube 10 is fixed to the distal end of the main body portion 42,
The inner hole of this pipe 42d forms the first guide hole 42a (see FIG. 9).

In order to remove the affected part of the prostate using the prostate resection device 100 configured as described above, the guide pipe 30 is inserted into the urethra with an insertion aid (not shown) attached to the urethra. Next, the insertion aid is removed, and then the insertion portion 11 of the optical viewing tube 10 is inserted into the guide pipe 30, and the insertion portion 22 of the prostatectomy tool 20 is further inserted into the teacup pipe 30. Then, while observing the lower part with the optical viewing tube 10, adjust the distance of the finger hook 43.48A, and move the cutting blade 22c at the tip of the cutting blade 22c to the affected area as shown by the two-dot chain line in FIG. Position at the tip of the tissue. When coupled to the ultrasonic vibrator section 21 in this state, the ultrasonic vibrations generated in the vibrator 25 are intensified by the horn 25c.

This strengthened ultrasonic vibration is transmitted to the cutting blade 22c via the insertion portion 22.

Thereafter, when the pressing force of the finger hook 43.48A is released, the distance of the finger hook 45.48A becomes longer due to the spring force of the leaf spring 46, and the cutting blade 22c is moved to the position shown by the solid line in FIG. Affected tissue can be removed.

At this time, since degeneration and whitening of the tissue does not occur during resection with the resection blade 22c, normal tissue and diseased tissue can be clearly distinguished, and erroneous resection is prevented.

(Effects of the Invention) As described above, according to the present invention, since the affected tissue of the prostate is excised by ultrasonic vibration, there is no degeneration and whitening of the tissue, the resection range is easily identified, and erroneous excision can be prevented.

Furthermore, even if the cutting blade comes into contact with muscle tissue during cutting, a high-frequency current will not flow as in the conventional case, so serious accidents such as perforation can be prevented.

[Brief explanation of the drawing]

Fig. 1 is a side view of a prostatectomy device showing an embodiment of the present invention, Fig. 2 is a side view of the optical viewing tube shown in Fig. 1 above, and Fig. 3 is a side view of the prostatectomy device shown in Fig. 1 above. FIG. 5 is a side view of the resection blade shown in FIG. 3, FIG. 6 is a plan view of the resection blade shown in FIG. 5, 70 is a side view of the working element body shown in FIG. 1, FIG. 8 is a plan view of the working element body shown in FIG. 7, and the ninth factor is A in FIG. - An enlarged sectional view taken along the line A; FIG. 10 is an enlarged sectional view taken along the line B-B in the WJ1 diagram; FIG. 11 is an enlarged sectional view taken along the line CC in FIG. FIG. 12 is a side view showing the state of the cutting blade when cutting the affected tissue with the cutting device according to the present invention. 100...Prostate resection device 10...Optical viewing tube 20...Ultrasonic vibration device section 30...Guide pipe 40...Working element main body 42a...
... 1st guide hole 42b ... 2nd guide hole 2 wards Ma 3 figure/N'4 figure 35 figure 1.1 Confucian '6 figure award 9 wards Xiu 1゜ ward % 11 wards %) 12th Ward, 11 2nd C and 2=

Claims (1)

[Scope of Claims] A first guide hole through which an insertion portion of an optical viewing tube is inserted, and a second guide hole through which a prostatectomy tool is inserted, and a guide pipe communicating with both guide holes is fixed. a working element main body; a slider that slides along the central axis of the guide pipe with respect to the working element main body; a connecting means for connecting the slider and the working element main body; and a first guide hole of the working element main body. an optical viewing tube which is inserted into the insertion section and fixed to the working element main body; an ultrasonic vibrator section is removably attached to the slider, and the second guide hole of the working element main body; 1. A prostatectomy device comprising: a prostatic resection tool through which a resection member having a resection blade at its tip is inserted, and ultrasonic vibrations are applied to the resection member from the ultrasonic vibrator section.