JPS61199849A - 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 is directed to removing cartilage (articular meniscus, articular cartilage), chondrocele, tumor, etc. in a joint cavity of a knee or the like from outside the body cavity without making an incision. The present invention relates to a surgical resection instrument for cutting and expelling the body cavity.

[Technical background of the invention and its problems] Conventionally, 00m surgery has been mainly performed by an incision method (open surgery). For example, common joint surgeries require relatively large incisions, such as removing tumors on the patella and cutting damaged cartilage, bone, etc. from the *** joint.

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.

Therefore, 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 for surgery (closed surgery). equipment is proposed. For example, JP-A-54-774
These are disclosed in Publication No. 93 and the like. The device according to this prior art includes an elongated fixed jacket tube in which a cutting opening extending in the axial direction is formed on the outer periphery, and an internal rotating blade is rotatably installed inside the jacket tube and forming an internal rotary blade at the cutting opening. A tubular inner member, a main body, a suction device,
and a drive motor, the tissue fragments, etc. are suctioned into the cutting opening by vacuuming, and the rotary blade is rotated by the drive motor to perform the cutting, and the cut fragments are suctioned and discharged through the tubular inner member. It is something.

However, in the prior art example, since the motor shaft and the rotary blade side are directly connected, tissues in the body cavity, such as cartilage in the protoarticular joint cavity (meniscus III, articular cartilage), tumors, etc., can be removed or removed. There are problems in that the axial load during cutting is directly transmitted to the motor side, causing failure of the motor and shortening the life of the motor.

[Purpose of the Invention] The present invention has been made in view of these circumstances, and it is possible to absorb the axial load during resection or cutting of tissue in a body cavity so that the load is not applied to the motor side, thereby extending the life of the motor. The purpose of the present invention is to provide a surgical resection instrument that has been developed.

[Summary of the Invention] In order to achieve the above object, the surgical resection instrument according to the present invention includes an outer tube having a tissue-taking aperture at the distal end thereof, and an inner tube having a blade aperture that engages with the aperture of the outer tube. A tube is installed inside the tube so as to be freely rotatable around an axis, and the inner tube opening and the outer tube opening can be opened and closed by the rotation of the inner tube, and the inner passage of the inner tube is communicated with the double edge opening. The suction path is provided with a motor that rotationally drives the inner tube, and a rotational force transmission system that transmits the rotational force of the motor to the inner tube, wherein the rotational force transmission system is provided with a spline engagement part. to absorb the axial load on the inner tube.

[Embodiments of the Invention] Examples of the present invention will be specifically described below with reference to the drawings.

1 to 4 relate to one embodiment of the present invention, in which FIG. 1 is a longitudinal sectional view, FIG. 2 is a partially cutaway side view showing the spline engagement part, and FIG. 3 is A of FIG. 2. - A sectional view and FIG. 4 are explanatory diagrams showing an example of a usage state.

In these figures, reference numeral 1 denotes a surgical cutting instrument, which includes a main body 2 that also serves as a grip on the proximal side, and an elongated insertion device that extends forward from the main body 2 and is inserted into a body cavity, such as a joint cavity. It consists of Section 3. The insertion section 3 consists of an outer tube 4 whose open base is fixed to the distal end of the main body 2, and an inner tube 5 which is installed inside the outer tube 4 so as to be rotatable around an axis. has a tissue-taking blade opening 6 at its tip, while the inner tube 4 has a blade lower opening at its tip. Said outer tube cutting edge 6
For example, by cutting out a portion of the bottomed tip or tube side of the hemispherical outer tube and leaving a partially curved bottomed portion 8 at the tip,
It is formed continuously from the tube side surface to the bottomed portion 8 at the tip. Similarly to the outer tube cutting edge 6, the lower inner tube blade also cuts out a portion of the hemispherical inner tube bottomed tip or tube side, leaving a partially curved bottomed portion 9 at the tip. It is formed continuously so as to reach the bottomed portion 9 at the tip end. Said outer tube cutting edge 6
The lower inner tube blade rotates these blade openings 6,
It passes through when the two blades match and closes when they shift, and it bites into the tissue between the two blade openings 6 and 7, and when it is closed, it is cut and the section is taken into the inner tube blade lower. It looks like this. The inner path of the inner tube 5 is a section suction path 10 that communicates with the outer tube blade opening 6 and the inner tube blade lower, and also serves as a section suction path 10 that communicates with the section suction device 2.
is connected to.

The main body 2 is a part of the resection instrument 1 that is held and operated by an operator such as a surgeon, and includes a housing 11 that houses a drive part that rotationally drives the inner tube 5 and the like, and a suction path of the inner tube 5. a front housing 12 having a cavity 12a communicating with the tube 10 and having a suction tube mouthpiece 22 connected to a section suction device;
It is composed of. The front housing 12 is removably screwed to the housing 11 by, for example, screwing means. Further, the front housing 12 has an annular fixing part 12b extending in the front and a groove part 12c formed in the axial direction of the inner circumference thereof. On the other hand, on the outer periphery of the base of the outer tube 4,
A sleeve 13 having a flange 13a at the front is fitted therein, and a bottle 14 is planted on the outer periphery of the sleeve 13. Then, with the pin 14 engaged in the groove 12c, the sleeve 13 is fitted.1. : The base of the outer tube 4 is inserted into the fixing part 121), and the outer tube fixing screw body 15 is screwed onto the outer periphery of the fixing part 12b to detachably fix the base of the outer tube 4.

A motor 16 is housed in the rear part of the housing 11, and a male spline 18 is fixed to the motor shaft 17. On the other hand, an output shaft 19 is rotatably supported at the front of the motor 16 so as to be movable in the axial direction, and a female spline 20 is formed at the rear of the output shaft 19.
0 meshes with the male spline 18. The output shaft 19 projects into the cavity 12a of the front housing 12,
An internal sleeve 21, in which the base of the inner tube 5 is fitted and fixed, is inserted and fixed into this protrusion, and the rotational force of the motor 16 is transmitted to the inner tube 5 to rotate the inner tube 5.

The inner tube sleeve 21 is formed into a cylindrical shape with an open front, and communicates the suction path 10 of the inner tube 5 into the sleeve 21 .

The sleeve 21 also has an opening 21a on its side and communicates with the cavity 128 of the front housing 12.

The suction tube mouthpiece 22 is attached to the outer periphery of the front housing 12 in communication with the cavity 12a.

This suction pipe mouthpiece 22 is inclined rearward with respect to the axial direction of the housing 12a so that the opening area of its inlet portion can be increased, for example. In addition, the front housing 12 to which the suction tube cap 22 is attached has its outer circumferential wall tilted downward toward the front, and the inlet portion of the suction tube cap 22 is tilted downward in the same way as when the suction tube cap 22 is mounted at a backward angle. The opening area is increased.

An embodiment configured in this manner is used within a body cavity.

For example, the operation of resecting target tissue within a joint cavity will be described below with reference to the first figure.

As shown in the first diagram, in order to remove a target tissue within a target region, for example, a knee joint, a surgical resection instrument 1 is attached to the knee region 31.
A small hole into which the insertion portion 3 is inserted is provided by a puncturing operation using a trocar or the like, and the insertion portion 3 is inserted directly or through the trocar or the like. In addition, before inserting the insertion section 3, the insertion section 33 of the arthroscope 32, which is equipped with an illumination and observation optical system, is punctured with a trocar or the like so that the surgical resection of the target tissue can be performed while observing the inside of the joint cavity. It is inserted into the joint cavity by operation and inserted into the joint cavity and the display device 35 that displays the image taken directly from the eyepiece of this joint ti33 or by the television camera 34 attached to the eyepiece. The insertion portion 3 of the surgical resection instrument 1 is made observable. 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 36 through the water supply pipe 37 punctured into the joint cavity at controlled water pressure. .

On the other hand, the tube 38 is connected to the suction tube mouthpiece 22 of the proximal grip main body 2 of the surgical resection instrument 1, and suction is performed.

The cable 40 is connected to the collection device 39, and a connector (not shown) of the cable 40 is connected to the motor control unit 41, so that the motor 16 can be supplied with electric power.

In this setting state, the operator observes the inside of the joint cavity and the distal end of the insertion section 3 of the resection instrument 1 using the arthroscope 33 or the display device 35 while observing the tissue-taking blade opening 6 at the distal end of the insertion section 3.
7 is brought into contact with the tissue to be resected, and in this state, the switch is turned on to drive the motor 16 to rotate the inner tube 5 around the axis via the drive transmission system such as the output shaft 19, thereby cutting the outer tube blade tip 6. and the lower inner tube blade are engaged with each other, the blade openings 6 and 7 are opened and closed to cut or cut the tissue taken into the blade opening 6.7, and the suction 1 collection device 39 is operated whenever necessary or constantly to cut the tissue into sections. the suction path 10 of the inner tube 5. Inner tube sleeve 21. Cavity 12a of front housing 12, suction tube mouthpiece 22. The tube 38 can be collected and discharged into the suction 9 collection device 39 using rattan.

In the figure, reference numeral 42 indicates a light source device, 43 indicates a line 1 to guide cable, and 44 indicates a television camera cable.

As described above, in the present invention, the insertion portion 3 of the surgical resection instrument 1 into which the target tissue in a body cavity, for example, a joint cavity, is inserted from outside the body cavity.
The blades 6 and 7 at the tip perform excision and cutting, and the cut pieces are discharged.
An axial load is applied to the inner tube sleeve 21.
The rotational force is about to be transmitted to the motor shaft 17 via the output shaft 19, but there are spline meshing parts (18, 20) in the rotational force transmission system.
), the spline engagement portion (18°2
0), the axial load is absorbed and is not applied to the motor shaft 17° motor 6 side.

In the present invention, the shapes of the outer tube cutting edge and the inner tube cutting edge are appropriately selected and used.

Further, the present invention is applicable not only to the joint cavity but also to other body cavity sites.

[Effects of the Invention] As explained above, the present invention has the effect of lengthening the life of the motor by absorbing the axial load during resection or cutting of tissue in the body cavity so that it does not apply to the motor side. .

[Brief explanation of the drawing]

1 to 4 relate to one embodiment of the present invention, in which FIG. 1 is a longitudinal sectional view, FIG. 2 is a partially cutaway side view showing the spline engagement part, and FIG. 3 is A of FIG. 2. - A sectional view and FIG. 4 are explanatory diagrams showing an example of a usage state. 2...Main body 3...Insertion part 4...Outer tube 5...Inner tube 6...Blade mouth 7...Blade mouth 10...Suction path 16...Motor 17... motor shaft

Claims (1)

[Claims] An inner tube having a cutting edge that engages with the cutting edge of the outer tube is rotatably installed around an axis in an outer tube having a tissue-taking edge opening at the tip thereof, and the rotation of the inner tube causes The cutting opening of the inner tube and the cutting opening of the outer tube can be opened and closed, and the inner passage of the inner tube is made into a suction passage communicating with the double cutting opening, and a motor for rotationally driving the inner tube, and A surgical resection instrument comprising a rotational force transmission system for transmitting the rotational force of a motor, and a spline engagement part for absorbing the axial load of the inner tube is interposed in the rotational force transmission system. .