JPS61199851A - 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, joint 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 knee 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, a small puncture hole is formed in the joint without making an incision under observation using a vA sectoscope (endoscope), 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, JP-A-54-77
Kohera is disclosed in Publication No. 493 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. It includes a tubular inner member, a main body, a suction device, and a drive motor, and while the tissue pieces are sucked into the cutting opening by vacuuming, the rotary blade is rotated by the drive motor to cut the cut pieces. is configured to be sucked and discharged through a tubular inner member.

However, in the conventional device, the entire inner periphery of the jacket tube and the outer periphery of the tubular inner member rotatably housed within the jacket tube come into sliding contact, and the inner member rotates in this sliding state. , there are problems such as high rotational resistance. In addition, the tubular inner member is inserted into the jacket tube as described above and is in sliding contact with the entire part,
Because the bearings are not accurate, there may be vibrations in the rotation of the tip end of the inner member that has internal rotating blades, and due to this vibration, these internal rotations may be affected when the internal rotating blades engage with the cutting edge of the jacket tube. There is a problem that a gap is created between the blade and the cutting opening, resulting in poor cutting quality. Particularly in tissues within body cavities, such as damaged joint menisci in the knee joint cavity,
Target tissues such as cartilage and tumors are elastic and viscous, so if a gap is created when the outer blade and inner blade engage as described above, efficient resection and cutting will not be possible. .

[Object of the Invention] The present invention has been made in view of these circumstances, and it reduces the rotational resistance of the inner tube, and also has a method in which the distal end side of the inner tube having a cutting edge is made to bear against the inner periphery of the outer tube. A surgical device that eliminates rotational wobbling at the tip of the inner tube with the cutting edge, and allows the outer tube edge and the inner tube edge to engage without any gaps, improving sharpness and efficiently resecting and cutting tissue. The purpose is to provide cutting instruments.

[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 rotatably installed inside the tube around an axis, and the cutting edge of the inner tube and the outer tube edge can be opened and closed by the rotation of the inner tube, only on the edge forming part side of the tip of the inner tube. is fitted into the inner periphery of the outer tube and bears a bearing, and a space is provided toward the base side at the quotient of the inner tube and the outer tube on the rear side of this bearing part.

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

1 and 2 relate to a first embodiment of the present invention, with FIG. 1 being a longitudinal sectional view and FIG. 2 being an explanatory view 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 07 opened at its tip. Said outer tube cutting edge 6
For example, a portion of the tube side surface is cut from the bottomed tip of the outer tube, such as a hemispherical or arcuate surface, leaving a partially arcuate bottomed portion 8 at the tip, and the end portion 8 is reached from the tube side. It is formed continuously. Similarly to the outer tube cutting edge 6, the lower inner tube blade also has a partially curved bottomed portion 9 at the tip by notching a portion of the tube side surface from the hemispherical, arcuate, etc. bottomed tip of the inner tube. It is formed continuously from the tube side surface to the bottomed portion 9 at the tip.

The outer tube cutting edge 6 and the inner tube cutting edge lower communicate with each other by aligning these cutting edges 6 and 7 with each other due to the rotation of the inner tube 5, and when they shift, rF1 is emptied, and the double cutting edge 6.
．． When the communication opening of 7 is opened, the tissue is bitten, and when it engages, it is removed and cut, and the cut piece is taken into the lower inner tube blade. The inner path of the inner tube 5 serves as a section suction path 10 that communicates with the outer tube blade opening 6 and the inner tube blade lower, and also communicates with the proximal main body 2 to which a section suction device is connected.

The inner tube 5 is fitted with a bearing on the inner periphery of the outer tube 4 so that rotational wobbling does not occur at the distal end side having the lower blade, and at the same time, from the bearing portion 5a to the base side there is a portion inside the outer tube 4. A space G is formed between the inner tube 5 and the periphery to reduce rotational resistance of the inner tube 5. In this way, the inner tube 5 can be rotated without wobbling on the distal end side having the lower blade, and as a result, the outer tube blade opening 6 can be rotated without wobbling.
There is no gap when the blade engages with the lower inner tube blade, and the target tissue can be cut well.

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, this 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, and a bottle 14 is installed on the outside of the sleeve 13. Then, with the bottle 14 engaged in the groove 12C, the base portion of the outer tube 4 fitted with the sleeve 13 is attached to the fixing portion 12C.
b, and the outer tube fixing screw body 15 into the fixing part 12b.
The base of the outer tube 4 is fixed to the outer circumference in a detachable manner by being screwed onto the outer periphery.

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 and slidably supported in the axial direction at the front of the motor 16, 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 inner tube sleeve 21, into which the base of the inner tube 5 is fitted and fixed, is inserted and fixed into this protrusion, and the rotary saw 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.
A suction path 10 of the inner tube 5 is communicated 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 tube 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. In addition, the front housing 12 to which the suction pipe cap 22 is attached has its outer circumferential wall inclined downwardly toward the front, and has an opening at the inlet portion of the suction pipe cap 22 similar to the backward inclined mounting of the suction pipe cap 22. The area is enlarged.

The operation of resecting a target tissue in a body cavity 9, for example, a joint cavity, using the first embodiment configured as described above will be described below with reference to FIG.

As shown in FIG. 2, 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 joint 1132, which is equipped with an illumination and observation optical system, is punctured with a trocar or the like so that the target tissue can be removed while observing the inside of the joint cavity. The arthroscope 33 is inserted into the joint cavity by a display device 35 that displays an image taken directly from the eyepiece of the arthroscope 33 or by a 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 uses the mirror 33 or the display device 35 to check the joint cavity and the insertion portion 3 of the resection instrument 1.
While observing the tip, insert the tissue inlet opening 6 at the tip 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. At the same time, the blade opening 6.7 is opened and closed to cut or cut the tissue taken into the blade opening 6.7, and the suction 8 collection device 39 is activated whenever necessary or constantly to cut the tissue into sections. The inner tube 5
suction path 10. Inner tube sleeve 21. Front housing 12
cavity 12a, suction tube mouthpiece 22. It can be collected and discharged via a tube 38 to a suction 9 collection device 39.

In addition, the center mark @42 in Figure 2 is the light source device, 43 is the light guide cable, and 44 is the TV 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.
Cut with the blade tips 6 and 7 at the tips of the outer tube 4 and inner tube 5 that constitute the
The outer tube cutting edge 6 and the inner tube cutting edge lower are able to engage without any gap because there is no rotational wobbling at the tip of the inner tube 5, exhibiting good cutting quality, and efficiently cutting the target tissue. It can be removed or cut.

FIG. 3 shows the tip of the insertion portion according to the second embodiment of the present invention,
(A) is a sectional view, and (B) is a side view.

In this second embodiment, the cutting edge portion or bearing portion at the tip of the outer tube 4 and the cutting edge portion or bearing portion at the tip of the inner tube 5 are made into separate members. That is, the outer tube blade portion 51 is provided at the tip of the outer tube 4.
The outer tube blade section 51 has a base side open and communicating with the outer tube inner passage, and a tip end side formed in an arcuate bottomed shape having a lower blade. The lower blade is formed substantially the same as in the first embodiment. On the other hand, an inner tube blade part 52 is connected to the tip of the inner tube 5, the base side of this inner tube blade part 52 is open and communicates with the inner tube inner path, and the tip side has a blade opening 8. It is formed in an arcuate shape with a bottom, and the cutting edge 8 is formed substantially the same as in the first embodiment. The outer periphery of the inner tube blade part 52 is fitted and bearing on the inner periphery of the outer tube blade part 51, and there is a space between the inner tube 5 and the outer tube 4 behind the inner tube blade part 52. space G
is formed. In this embodiment, the outer tube blade portion 51. is provided with blade openings 6, 7 and is fitted with a bearing. Since the inner tube blade part 52 can be manufactured separately from the outer tube 4 and the inner tube 5, the blade parts 6 and 7 can be manufactured separately.
It is easier to process the bearing, and it is also easier to achieve bearing accuracy to prevent rotational wobbling.

FIG. 4 shows the tip of the insertion portion according to the third embodiment of the present invention,
(A) is a sectional view, and (B) is a side view.

In this third embodiment, the outer tube blade part 5 is similar to the second embodiment.
1 and the inner tube blade portion 52 respectively. It is manufactured from a separate member from the inner tube 5 and is connected to the inner tube 5. In this third embodiment, the outer tube cutter opening 6 and the inner tube cutter lower are formed on the side surface, and the hemispherical, arcuate bottomed portion 53 of the outer tube 4 is left as is. Further, the tip of the inner tube blade portion 52 is opened and brought into contact with the inner wall of the tip of the outer tube blade portion 51.

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

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

[Effects of the Invention] As explained above, according to the present invention, the rotational resistance of the inner tube is reduced, and the tip side of the inner tube having a cutting edge is made to bear against the inner periphery of the outer tube. This has the effect of eliminating rotational wobbling at the tip of the inner tube and eliminating the generation of gaps when the outer tube cutting edge and the inner tube cutting edge engage, resulting in good cutting quality and efficient tissue removal and cutting.

[Brief explanation of the drawing]

1 and 2 relate to a first embodiment of the present invention, FIG. 1 is a longitudinal sectional view, FIG. 2 is an explanatory diagram showing an example of a usage state, and FIG. 3 is a second embodiment of the present invention. Indicates the tip of the insertion tube according to (
A) is a sectional view, (B) is a side view, and FIG. 4 is a third embodiment of the present invention.
The tip of the insertion portion according to the example is shown, (A) is a cross-sectional view, (B
) is a side view. 2... Main body 3... Insertion part 4... Outer tube 5... Inner tube 6... Blade mouth 7... Blade mouth G... Space

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 edge forming part side of the inner tube tip is fitted to the inner periphery of the outer tube so that the cutting edge of the inner tube and the outer tube edge can be opened and closed, and the tip of the inner tube having the cutting edge does not rotate. A surgical cutting instrument characterized in that, while the inner tube and the outer tube are jointly supported, a space is formed between the inner tube and the outer tube extending from the rear of the bearing toward the base side.