JPS61265134A - Incision instrument for surgery - 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] [Industrial Application Field] The present invention can be used to remove cartilage (articular meniscus, articular cartilage), chondrocele, tumor, etc. from outside the body cavity to within the body cavity without making an incision, for example, in the joint cavity of the knee etc. This relates to a surgical resection instrument that excises and expels the body from the body cavity.

[Problems to be solved by conventional techniques and inventions] Conventionally,
Joint surgery was primarily performed by open surgery. For example, in general joint surgery, '
In order to remove a tumor in the ``mM bone'' or to remove damaged cartilage, bone, etc. from a knee joint, relatively large incisions were required to remove tissue within a narrow cavity.

As a result, the incision causes trauma, which is accompanied by pain and restricted movement, and 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, U.S. Patent 42101
The prior art example disclosed in No. 16 is a flexible tube in which the distal end side of the outer tube is tapered and an open window is formed, and the tissue that enters the open window can be deformed according to changes in the shape of the inside of the outer tube tip. It cuts efficiently by reciprocating the inner shaft attached to the tip of the blade back and forth.

However, since the area of the opening window in this prior art example is small, a resection portion larger than the frontage window cannot be efficiently resected.

Therefore, the present applicant has proposed a surgical resection instrument in Japanese Patent Laid-Open No. 183743/1983 in order to solve the above-mentioned problems. This is done by attaching a mantle cover, which has two thin plates with openings that pass through it vertically, to the tip of an elongated outer tube, and attaching a flexible plate-like blade so that both sides touch these two thin plates. is arranged to be slidable, and the openings of the two thin plate parts are opened and closed by the sliding of the blade, and the tissue piece is taken into the opening and cut by the sliding blade. .

Although this prior art example has relatively good resection efficiency,
Depending on the shape of the target tissue site and its surroundings, for example, it may be difficult to bite into areas with continuous unevenness. Furthermore, since the tissue piece is cut outside the outer tube, it may be difficult to take the cut section into the outer tube depending on its positional relationship.

[Purpose of the Invention] The present invention has been made in view of these circumstances, and thus enables tissue having elasticity and viscosity to be resected safely, reliably, and efficiently. The purpose of the present invention is to provide a surgical resection instrument that can be used to reliably perform surgical resection.

[Means for Solving the Problems and Their Effects] In order to achieve the above object, the surgical cutting instrument according to the present invention curves the bottomed tip of the elongated outer tube that forms the outer shape of the insertion portion,
A tissue-taking blade opening communicating with the inside of the outer tube, which is a section suction path, is opened on the side surface of this curved part, while a drive shaft is installed inside the outer tube so as to be able to freely slide back and forth in the axial direction. The blade is equipped with a thin plate-shaped blade and is disposed within the distal end of the outer tube so as to slide back and forth along the tissue-taking opening to open and close the opening.

With this configuration, the I-weave inlet opening on the side surface of the tip of the outer tube is curved, so it is possible to select and use an instrument with a direction and degree of curvature that match the shape of the target tissue site and its surrounding areas. It has a good grip on tissues with elasticity and viscosity, and also prevents escape, making it possible to perform efficient resection. Further, since the tissue is cut and cut while the tissue is taken into the cutting edge, the section can be reliably collected regardless of the positional relationship.

[Embodiments of the Invention] Hereinafter, embodiments of the present invention will be specifically described with reference to the drawings.

Figures 1 to 5 relate to one embodiment of the present invention, with Figure 1 being a sectional view showing the entire cutting instrument, and Figure 2 showing the distal end of the insertion section with the blade and drive shaft removed. 3 shows the drive shaft, the booklet, and the plate-shaped blade part, (A) is a side view thereof, (B') is a plan view, and FIG. 4 is a plan view of the tip of the insertion part. FIG. 5 is an explanatory diagram showing an example of a usage state.

In these figures, reference numeral 1 denotes a surgical resection instrument, which includes an operating section 2 that is a proximal grip section, and an elongated insertion section that extends forward from the operating section 2 and is inserted into a body cavity, for example, a joint cavity. It consists of Section 3. The insertion section 3 has an outer tube 4 whose open base is fixed to the fixed handle 2a of the operation section 2.
and a drive shaft 5 that is slidably installed in the outer tube 4 in the axial direction. The lower tissue-taking blade is formed with a curved opening in the front-rear direction of the inner curved side surface. A pair of guide grooves 8, 8 are formed in the distal end portion of the outer tube 4 or the inner wall of the curved portion 6 along the lower tissue-taking blade. On the other hand, a flexible thin plate-shaped blade part 10 is detachably attached to the tip of the drive shaft 5 via a connecting member 9, and this blade part 10 has guide groove engaging parts 10a, 10a on both sides thereof.
is engaged with the guide groove 8.8 on the inner wall of the distal end of the outer tube 4,
By sliding the drive shaft 5 back and forth in the axial direction, the thin plate-shaped blade portion 10
is configured to slide back and forth along the guide groove 8.8 to open and close the lower tissue-taking blade which is curved inward and opened in the front-back direction. Further, this blade portion 10 has a blade 10b formed at its tip so as to cut the tissue taken into the lower taking blade.

Further, although not shown, the blade 10 may be attached to the abutting portion of the inner wall of the tip end of the curved portion 6 where the blade 10b of the blade portion 10 comes into contact.
A blade is formed that meshes with b.

-〇- The inner path of the outer tube 4 serves as a section suction path 11 for suctioning and recovering the tissue section taken into the blade lower and cut to the proximal side.

On the other hand, the hand-side operating section 2 consists of a fixed handle 2a that opens and closes around a fulcrum 2b and a drive handle 2C,
As described above, the base of the outer tube 4 is fixed to the fixed handle 2a side, and the base of the drive shaft 5 is fixed to the drive handle 2C, and the drive shaft 5 is opened and closed by opening and closing movement around the fulcrum 2b of the drive handle 2C. is adapted to slide back and forth in the axial direction within the outer tube 4. The fixed handle 2a has a cylindrical fixing part 2d extending in the same axial direction as the outer tube 4, and the base of the outer tube 4 is fitted and fixed to this fixing part 2d, and the base end of the outer tube 4 is fixed. A suction cap 12 is provided on this protrusion, which protrudes rearward from the portion 2d and is connected to the section suction device via, for example, a tube. The drive shaft mounting portion 2e of the drive handle 2C is inserted into the outer tube 4 through a slit 4a provided in the axial direction of the base of the outer tube 4, and connects and fixes the base of the drive shaft 5. This slit 4a is formed over a range in which the engagement portion of the drive shaft attachment portion 2e of the drive handle 2C slides. Furthermore, the fixed handle 2a is connected to the outer tube 4.
slit 4a and drive shaft attachment part 2 of drive handle 2C
A bag-shaped portion 2f is formed to cover the e side and prevent the suction fluid or a portion of the section from leaking out from the slit 4a. Further, a spring body 1 is provided between the fixed handle 2a and the drive handle 2C.
For example, a blade portion 10 at the tip of the drive shaft 5 urges the drive handle 2C so that the drive shaft 5 slides in the direction to open the lower tissue-taking blade. Note that some of these settings may be reversed.

The operation of resecting a target tissue within a body cavity, for example, within a joint cavity using one embodiment configured in this manner will be described below with reference to FIG. 5.

As shown in FIG. 5, 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 21.
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 23 of the arthroscope 22, 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 into the display device 25 that displays images taken directly from the eyepiece of this arthroscope 23 or by the television camera 24 attached to the eyepiece. The inserted portion 3 of the surgical resection instrument 1 is made observable. moreover,
In order to inflate the joint cavity and facilitate resection surgery, physiological saline can be supplied into the joint cavity from a water supply source 26 through a water supply pipe 27 punctured into the joint cavity at controlled water pressure.

On the other hand, a tube 28 is connected to the suction tube mouthpiece 12 on the proximal operating section 2 side of the surgical resection instrument 1, and connected to the suction 1 recovery device 29.

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 23 or the display device 25 while observing the tissue removal section provided at the curved section 6 at the distal end of the insertion section 3. The lower blade is brought into contact with the tissue to be resected, and the tissue to be resected is taken into the lower blade. In this state, the drive handle 2c of the operating part 2 is operated to open in the closing direction around the fulcrum, and the thin plate-shaped blade part 10 is slid through the drive shaft 5 in the direction in which the blade lower is closed. This is to cut the tissue that has been taken into the body. This cut section is removed from the suction path 11 of the outer tube 4 by operating the suction 9 collection device @ 29 whenever necessary or at all times. Suction pipe cap 12. It can be collected and discharged through a tube 28 to a suction 1 collection device 29 .

In FIG. 5, reference numeral 30 indicates a light source device, 31 indicates a light guide cable, and 32 indicates a television camera cable.

In this way, in the present invention, since the tissue is cut with the tissue taken into the blade lower, the cut section can be cut regardless of the positional relationship of the blade lower at the tip of the insertion section, that is, whether it is upward, lateral, or downward. can be collected without missing anything. Also, the degree of curvature of the curved portion 6 having the lower tissue-taking blade provided at the tip of the outer tube 4.

Alternatively, it is possible to prepare multiple pieces with various lengths, curved directions, etc., and select and use the one that matches the shape of the tissue to be resected and its surrounding area, so that the target tissue with elasticity and viscosity can be used. It has good bite and prevents escape, allowing for efficient resection.

The shape of the distal end of the insertion portion shown in the drawings is merely an example, and various degrees of curvature, length, and direction of curvature may be formed, or the tissue-intake opening may also be formed on the outer curved side surface.

Further, the circumferential movement of the blade portion or the drive shaft can be performed not only manually as in the illustrated example, but also by using an electric motor.

[Effects of the Invention] As explained above, according to the present invention, tissue having elasticity and viscosity can be resected safely, reliably, and efficiently, and the cut pieces can be collected and removed reliably regardless of their position. There are effects that can be achieved.

[Brief explanation of the drawing]

Figures 1 to 5 relate to one embodiment of the present invention, with Figure 1 being a sectional view showing the entire cutting instrument, and Figure 2 showing the distal end of the insertion section with the blade and drive shaft removed. 3 shows the drive shaft and the thin plate-like blade, (A) is a side view thereof, (B) is a plan view, FIG. 4 is a plan view of the tip of the insertion section, and FIG. It is an explanatory view showing an example of a usage state.

Claims (1)

[Claims] The bottomed tip of the elongated outer tube that forms the outer shape of the insertion part is curved, and a tissue intake opening communicating with the inside of the outer tube, which is a section suction path, is opened on the side surface of this curved portion. A drive shaft is installed inside the drive shaft so as to be slidable back and forth in the axial direction, and a thin plate-like blade is attached to the tip of the drive shaft, and this blade is slid back and forth along the tissue-taking blade opening to open the blade. A surgical resection instrument, characterized in that it is disposed within the distal end of an outer tube so as to open and close.