JPS6143452Y2 - - Google Patents

Description

[Detailed description of the invention] [Technical field] This invention is particularly suitable for use in conjunction with an endoscope, a so-called resectoscope, used for the diagnosis and treatment of diseases of the urinary tract, such as the urethra and bladder. The present invention relates to a surgical instrument for detaching and removing the internal glands of an enlarged prostate (prostatic hyperplasia) from the external glands.

[Prior art]

Traditionally, enlarged intraprostatic glands were removed by opening the abdomen and using fingers or instruments, but recently it has become possible to perform transurethral resection (TUR) using a resectoscope. Summer. However, this transurethral resection of the prostate is generally performed by applying electricity to a resection loop attached to the tip while viewing directly with a resectoscope, but it is risky to completely remove 100% of the intraprostatic glands. It was extremely difficult and had the disadvantage that the remaining prostate tissue would enlarge again.

[Purpose of invention]

This invention involves inserting a stripper between the extraprostatic glands and the enlarged intraprostatic glands under direct vision with a resectoscope, and removing the internal glands from the outside to completely remove the internal glands.
The object of the present invention is to provide an easy-to-operate peeling device that can remove 100% and makes it easy to check the field of view.

[Summary of the idea]

A resect comprising an outer tube inserted into the urethra, a sliding body provided at the rear of the outer tube to be moved back and forth with respect to the outer tube, and a scope inserted and attached from the rear of the sliding body to the tip of the outer tube. A device used for a scope, which is provided with a detacher inserted between the intraprostatic gland and the external gland to separate the internal gland from the external gland,
This separator is provided with irrigant holes or grooves that pass through it in the front-rear direction.

[Example of idea]

Figure 1 illustrates the general shape of the above-mentioned resectoscope.
The outer tube 1 is made of metal and has a finger hook 2 protruding from the base thereof, and the finger hook 2 is provided with a water intake port 3 that communicates with the inside of the outer tube 1. Reference numeral 4 denotes an eyepiece, and the eyepiece 4 has a light source connection part 5 and is further fitted with an optical viewing tube 6 with a diameter of about 4 mm that is inserted into the outer tube 1 almost to the tip. The front end of the outer tube 1 can be viewed directly from the portion 4.
Reference numeral 7 denotes a sliding body that is supported by a guide 10 provided between the eyepiece section 4 having a current-carrying terminal 8 and a finger hook 9 and the base of the outer tube 1 and is movable back and forth.
is always urged to retreat toward the eyepiece 4 by a spring 11 which has one end attached to the sliding body 7 and the other end attached to the base of the outer tube 1. The sliding body 7 is designed to be able to removably fix the base of a resection loop assembly inserted into the outer tube 1 and a peeler to be described later.
By moving the slider 7 forward against the biasing force of the spring 11, the resection loop and the peeler can be projected forward from the distal end of the outer tube 1.

2 and 3 show a first embodiment of the present invention, and 12 is a separator in which the inner wall surface of the lower half of the distal end bulge 1a of the outer tube 1 is formed into a slidable substantially gutter shape. ,
The peeler 12 is made of metal or hard resin. The distal end of the separator 12 is shaped into a tapered tongue that facilitates ablation of the intraprostatic glands and does not damage the prostatic capsule. In addition, the stripper 12 has a groove 1 in the recess.
3 is formed, and in this groove 13 an outer tube 1 shown in FIG.
It communicates with the water inlet 3 of the finger hook 2 provided at the base so that water can flow in when opened. A rod-shaped or other connecting member 14 (FIG. 1) is attached to the base of the peeler 12, and the base end of the member is adapted to be detachably attached to the slider 7. In addition to the stripper 12, an optical viewing tube 6 is provided in the outer tube 1 at the top of the stripper 12, as shown in FIG. 3, so that the front of the stripper 12 and the outer tube 1 can be observed. .

Next, the function of this prostatic ablation device will be explained.

First, in order to remove most of the enlarged intraprostatic gland, as in the conventional method, it is inserted under direct vision with a resectoscope, removed with a resection loop resectator that is energized with high-frequency current, and then the external tube 1 Remove the handle including the finger hook 9, remove the cutter from the sliding body 7 of the handle, and attach the stripper 12 to this part.
Attach the base of the stripper, insert the stripper 12 and the optical tube 6 into the outer tube 1, insert it into the prostate while observing with the optical tube 6, and remove the finger hook 2 and the handle. The expansion of the outer tube 1 is caused by placing a finger on the finger hook 9 of the sliding body 7 and moving the slide body 7 forward against the finger hook 2 provided at the base of the outer tube 1 against the biasing force of the spring 11. A stripper 12 is protruded from within the protruding portion 1a, and while being inserted between the intraprostatic gland and the external gland, the intraprostatic gland is peeled off from the outside, and the blood etc. that are bled at that time are stored in the finger hook portion 2. By opening the water intake port 3, water flows into the groove 13 of the stripper 12, improving the field of view of the optical viewing tube 6 and making observation easier.

Figures 4 and 5 show a second embodiment of the present invention, in which a plurality of irrigant holes or grooves 13 are provided that penetrate the stripper 12 in the front and back direction of the first embodiment. . Each hole or groove 13 is adapted to communicate with a water intake 3. This action involves inserting the resectoscope into the urethra, advancing the dissecting element 12 provided with an irrigation fluid hole or groove 13, flowing irrigation fluid from the water intake port 12, and inserting the intraprostatic gland between it and the external line. By doing so, the internal glands can be separated from the external line and kept in a state where they can be easily observed at all times. In this case, the peeler 1 is more suitable than the first embodiment.
Since more perfusate flows in the second embodiment, it is easier to observe the front than in the first embodiment.

FIGS. 6 and 7 show a third embodiment of the present invention, and the stripper 12 of this embodiment is formed into a substantially gutter-like shape as in the first embodiment, and the bottom of the recess is formed into a thick wall. , and the tip has a tongue-like shape that gradually becomes thinner, but is relatively blunt. A through hole or a through groove 15 is formed in the thickness of the bottom of the peeler 12 in the front-rear direction, and 16 is a tubular coagulation guide with a tip electrode 16a at the tip.
A coagulation guide 16 is inserted through the coagulation guide 16 so as to be slidable back and forth.

In this case, the coagulation guide 16 passes through the peeler 12 and inside the slider 7, and although not shown in the figure, its base is brought out to the outside, and the tip of the outer tube 1 is independently controlled by the operation of the hand part. It is now possible to move back and forth in and out of the room. Further, the separator 12 is provided with a plurality of irrigating liquid holes or grooves 13 penetrating in the front-rear direction as shown in the second embodiment, and the proximal end of the separator 12 is shaped like a rod as shown in FIG. Connecting member 14
It is detachably connected to the sliding body 7 via.

In such a configuration, by moving the sliding body 7 shown in FIG.
2 is inserted between the enlarged internal and external prostate glands to separate the internal glands from the external glands and allow perfusion fluid to flow through the grooves and holes 13, making it easier to observe the visual field. Bleeding during ablation surgery can also be quickly stopped by moving the coagulation guide 16 by external operation using the tip electrode 16a of the coagulation guide 16.

8 to 9 show a fourth embodiment of the present invention, in which a stripping element 12 and a coagulation guide 17 are integrally constructed, and the periphery of the stripping element 12 is extended in the front and back direction. Solidified conductor 17 surrounded by an insulating layer 18
is incorporated, and a coagulation electrode 17a connected to the coagulation guide 17 is fixed to the tip of the peeler 12. Note that the separator 12 is also provided with irrigation holes or grooves 13 as required.

In this configuration, since the coagulation electrode 17a is attached to the distal end of the separator 12, the intraprostatic glands can be visually separated and bleeding can be stopped on the spot. Perfusion can also be performed in the same manner as described above.

As described above, in the present invention, since the peeler 12 is formed into a tongue shape, the peeler 12
To remove the external appearance of the intraprostatic glands using the conventional method, first, as in the conventional method, most of the enlarged intraprostatic glands are removed using a resection loop resection device that is energized with high-frequency current while directly viewing them with a resectoscope. Next, the urethral mucosa at the distal end (front) of the prostatic gland is incised with a TUR knife, and the above-mentioned stripper 12 is inserted through this incision.
is inserted while viewing directly with a resectoscope, and the internal glands are detached from the external glands. Thus, the detachment element 12 can be moved back and forth by manipulating the hand portion, and can be easily inserted between the inner and outer glands of the prostate and detached from the outer glands. Bleeding parts of incision wounds and abrasion wounds can be easily coagulated and stopped by applying a high frequency current to the bleeding parts by applying coagulation electrodes 16a and 17a to the bleeding parts. Also, if necessary, remover 1
By flowing irrigation fluid through irrigation fluid holes or grooves 13 provided in 2, it is possible to easily observe the field of view.

[Effect of idea]

This device is equipped with a tongue-shaped detacher at the tip, which makes it possible to completely detach and remove the intraprostatic glands from the external glands, and when used in conjunction with conventional transurethral resection, it is possible to remove the intraprostatic glands from the external glands. It is now possible to remove 100% of the glandular tissue, and since multiple irrigation fluid holes are provided in the stripper, the field of view of the optical viewing tube can be maintained in good condition by flowing irrigation fluid while resecting. In addition, since the bleeding part of the avulsion wound can be coagulated and hemostasis, the surgery can be performed completely, reliably and safely without fear of recurrence of prostate hypertrophy, making a great contribution to the patient.

[Brief explanation of the drawing]

Figure 1 is an overall view of a typical resectoscope.
Fig. 2 is a perspective view of the first embodiment of the invention, Fig. 3 is a front view of the same, Fig. 4 is a perspective view of the second embodiment of the invention, Fig. 5 is a front view of the same, and Fig. 6 is a perspective view of the first embodiment of the invention. is the third part of this invention
FIG. 7 is a perspective view showing the embodiment, FIG. 7 is a front view thereof, FIG. 8 is a perspective view showing a fourth embodiment of the present invention, and FIG. 9 is a front view thereof. DESCRIPTION OF SYMBOLS 1...Outer tube, 12...Separator, 13...Irrigation liquid hole or groove, 15...Through hole or groove, 16, 17...
...Coagulation conductor, 16a, 17a... Coagulation electrode.

Claims (1)

[Scope of Claim for Utility Model Registration] (1) A resectoscope with an external tube inserted into the urethra, and the tip inserted between the intraprostatic gland and the external line to detach the internal gland from its appearance. What is claimed is: 1. A transurethral prostate dissection device comprising a tongue-shaped detachment device, characterized in that the detachment device is provided with irrigation holes or grooves formed in the front-back direction of the detachment device. (2) The transurethral prostate ablation device according to claim 1, wherein a coagulation electrode is incorporated in the distal end of the ablation device.