JPS6254011B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION The present invention relates to a surgical incision probe that utilizes an ultrasonic element and laser light.

2. Description of the Related Art Conventionally, there is a surgical incision probe using an ultrasonic element as shown in FIG. FIG. 1 is a perspective view showing a surgical incision probe using an ultrasonic element. In Figure 1, probe 1
A tube 6 containing cooling water return pipes 3, 4 and a conductive wire 5 is connected to one end of the tube 6 via a sealing plate 2, and the other end is conical and physiological saline is placed near the base of the conical shape. An ultrasonic transducer 10, a coil 11, and a tip 12 are mainly provided in a substantially cylindrical cover 9 made of transparent plastic, for example, which combines a pipe 7 for circulating water and a pipe for suctioning an incision piece. has been done. The conductive wire 5 is wound around the ultrasonic transducer 10 to form a coil 11, and one end of the transducer 10 is connected to the sealing plate 1.
Inside the transparent plastic cover 9, which is connected to the chip 13 that is inserted through the transducer 2 and is closed by the sealing plates 2 and 12, is a cooling water return pipe for cooling the heat-generating coil 11 and the ultrasonic transducer 10. 3 and 4 are opened through the sealing plate 2. The tip 13 has a bottomed cylindrical shape with an opening at its tip, and the tip opening is spaced apart from the conical tip opening of the transparent plastic cover 9 with a certain gap between the tip and the conical tip opening. The cylindrical interior of the tip 13 is in communication with the pipe 8.

The surgical dissection probe described above operates as follows. That is, when an electric signal of, for example, 23 KHz is applied from an electric circuit (not shown) to the coil 11 wound around the ultrasonic transducer 10 through the conductive wire 5, the ultrasonic transducer 10 undergoes magnetostrictive movement or electrostrictive movement. By generating high-frequency vibrations corresponding to the frequency of the electric signal and transmitting the high-frequency vibrations to the chip 13 coupled to one end of the ultrasonic transducer 10, the chip 13 generates high-frequency vibrations with an amplitude of, for example, 100 to 300μ. causes minute vibrations in the axial direction. When the distal opening of the tip 13, which is generating minute vibrations, is directly applied to the affected tissue to be removed, only the affected tissue that has come into contact with the distal opening of the tip 13 can be emulsified and fragmented. Physiological saline is supplied around the tip opening of the tip 13 from the pipe 7 through the gap between the conical tip opening of the transparent plastic cover 9 and the tip 13, and is emulsified together with the supplied physiological saline. The fragmented affected tissue is sucked into the tip 13 through the tip opening of the tip 13 and discharged from the pipe 8.

However, the surgical dissection probe described above has the following problems. That is, the surgical incision probe cannot, for example, emulsify and fragment blood vessels and constricted tissue to incise or excise them. Therefore, in liver resection, for example, after the liver parenchyma is excised using the surgical incision probe, the remaining blood vessels are ligated with hemostatic forceps and then cut with a scalpel; The area must be closed using, for example, an electric scalpel. That is, depending on the tissue content of the affected area to be excised, the surgeon must sequentially change hands and operate the surgical incision probe, hemostatic forceps, scalpel, or electric scalpel. Having to change surgical tools one by one and operate them is
It is extremely complicated and can cause delays in surgical time and surgical errors. This is a major problem in surgeries that require speed and reliability.

This invention has been made in view of the above circumstances, and allows a surgeon to excise the affected tissue with a single probe without having to change surgical tools for excision depending on the content of the tissue in the affected area to be excised.
Another object of the present invention is to provide a surgical incision probe that can stop bleeding by occluding a cut blood vessel.

Next, an embodiment of the present invention will be described with reference to the drawings.

FIG. 2 is a schematic cross-sectional view of a surgical incision probe that is an embodiment of the present invention.

The surgical incision probe 21 shown in this embodiment is
It has a substantially cylindrical shape from one end to the middle part, and a substantially conical shape from the middle part to the other end opening. A tube 26 containing a conductive wire 25 is connected thereto, and a cover 29 made of transparent plastic, for example, is connected near the base of the conical shape in the intermediate portion to connect pipes 27 and 28 for refluxing physiological saline. Ultrasonic transducer 30, coil 31, chip 32
In addition to being equipped with a laser light guide tube 34 having an optical fiber 33 therein. The conductive wire 25 is wound as a coil 31 around an ultrasonic transducer 30 made of, for example, nickel plates bonded together, and one end of the ultrasonic transducer 30 is connected via a packing material 35. The transparent plastic cover 29 is connected to a chip 32 made of, for example, titanium alloy and inserted through the sealing plate 36, and is closed by the sealing plates 22, 36. Inside the transparent plastic cover 29, a coil 31 and an ultrasonic transducer that generate heat during operation are installed. 3
Cooling water return pipes 23 and 24 are inserted through the sealing plate 22 and arranged to flow water for cooling the water. The tip 32 has a substantially cylindrical shape with a bottom and an opening at its tip, and the tip opening is spaced apart from the conical tip opening of the transparent plastic cover 29 at a constant distance. It protrudes to a predetermined length, and inside the chip 32,
Laser light guiding section or optical fiber 33
The laser light guide tube 34 containing the laser light guide tube 34 has its tip surface positioned within the conical tip opening surface of the transparent plastic cover 29, and maintains a predetermined gap between the cylindrical inner wall surface of the chip 32 and the laser light guide tube 34. It is arranged like this. The other end of the laser light guide tube 34 disposed inside the chip 32 passes through the cylindrical wall at the approximate center of the chip 32 and near the base of the conical shape at the center of the transparent plastic cover 29. It is led out of the transparent plastic cover 29 and connected to a laser generating section (not shown) and a supply section for a liquid such as physiological saline or a gas such as carbon dioxide or nitrogen. Also,
A discharge pipe 37 is provided on the side wall of the chip 32 at approximately the center so as to pass through the vicinity of the base of the conical shape at the center of the transparent plastic cover 29.
A pipe 28 is attached to the discharge pipe 37. Here, the gap formed between the conical part of the transparent plastic cover 29 and the tip 32 becomes the first fluid flow section, and the space formed by the cylindrical interior of the chip 32 and the discharge pipe 37 becomes the second fluid flow region. Become.

Furthermore, the portion of the laser light guide tube 34 that houses the optical fiber 33, which is installed inside the chip 32, will be explained with reference to the drawings.

FIG. 3 is a schematic perspective view showing the structure of the laser light guide tube 34 installed within the chip 32.

The laser conduit tube 34 includes a first covering member 33 made of silicon and having a thickness of 75 μm, for example, inside a pipe 34a made of Teflon and having a diameter of 2.2 mm, for example.
an optical fiber 33 having a diameter of, for example, 400 μm and coated with a second covering member 33b made of Teflon and having a thickness of, for example, 125 μm in this order.
are arranged and formed so as to maintain a gap between the inner wall of the pipe 34a and the outer wall of the second covering member 33b through which a liquid such as physiological saline or a gas such as carbon dioxide gas can flow. has been done. Note that the optical fiber 33 is YAG
It can be formed of quartz glass, multi-component glass, or the like that can transmit laser light such as laser light, argon laser light, helium neon laser light, carbon dioxide laser light, or the like.

Here, it goes without saying that the laser light guided by the optical fiber 33 in the light guide tube 34 is guided in a focused state by the laser generating section (not shown).

The operation of the surgical incision probe constructed as described above will be described next.

That is, for example, from an electric circuit (not shown)
When a 23KHz electrical signal is applied to the coil 31 wound around the ultrasonic transducer 30 through the conductive wire 25, the ultrasonic transducer 30 generates high-frequency vibrations according to the frequency of the electrical signal due to magnetostrictive motion. By transmitting the high frequency vibrations to the chip 32 coupled to one end of the ultrasonic transducer 30, the chip 32 can be
A minute vibration is generated in the axial direction of the chip 32 with an amplitude of μm. Chip 32 causing minute vibrations
When the tip opening of the chip 32 is directly applied to the affected tissue to be removed, such as the tumor affected area of the liver, the tumor affected area that is in contact with the tip opening of the tip 32 is emulsified and fragmented, leaving the arteriovenous blood vessels. The heat generated by the high-frequency vibrations of the ultrasonic transducer 30 is absorbed by cooling water sent from a cooling pump (not shown) through cooling water return pipes 23 and 24, which are made of transparent plastic sealed with sealing plates 22 and 36. The liquid is refluxed into the cover 29 and removed. In addition, the heat generated by the high frequency vibration of the tip 32 causes, for example, physiological saline sent from the pipe 27 to enter the gap formed between the tip 32 and the conical portion of the transparent plastic cover 29, that is, the first liquid circulation portion. Eliminate by distributing it. Then, the physiological saline discharged from the conical tip opening of the transparent plastic cover 29, together with the emulsified and fragmented affected tissue, enters the gap formed between the cylindrical inner wall surface of the tip 29 and the laser light guide tube 34. The liquid is discharged outside the surgical area through the pipe 28, that is, the second liquid flow section.

Next, the application of an electric signal from an electric circuit (not shown) to the coil 31 is stopped, and a laser beam generated from a laser generating section (not shown) and focused is guided to the optical fiber 33, and the tip of the laser light guide tube 34 is For example, a laser beam is irradiated to the arteriovenous blood vessels remaining in the affected area to cut them and coagulate the blood to stop the bleeding. In this case, since the laser light is guided by the optical fiber 33, the affected area is irradiated with the focused laser light. Note that a liquid such as physiological saline or a gas such as carbon dioxide gas is caused to flow through the gap formed between the inner wall of the pipe 34a and the outer wall of the second covering member 33b of the laser light guide tube 34. Then,
By ejecting from the tip opening of the laser light guide tube 34,
Blood and tissue debris accumulated in the affected area can be removed.

Note that switching between the high frequency vibration of the chip 32 and the laser irradiation from the laser lead-out tube 34 is performed by a changeover switch (not shown) provided on the transparent plastic cover 21, a changeover switch (not shown) provided in a power supply control section (not shown), or a changeover switch (not shown) provided in the power supply control section (not shown). Needless to say, this can be done by any suitable method such as a changeover switch pulled out from the power supply control section.

When the surgical incision probe 21 having the configuration described in detail above is used, for example, a muscle can be incised using the tip 3.
During the incision, the remaining blood vessels can be cut by laser light irradiation, and bleeding can be stopped at the same time as the blood vessels are cut. Therefore, there is no need for the surgeon to change the use of forceps, electric scalpel, etc. depending on the tissue to be incised.

Although one embodiment of the present invention has been described in detail above, this invention is not limited to the above-mentioned embodiment unless the gist of the invention is changed, but includes various modifications as described below. .

That is, the laser light guide tube may be installed inside the transparent plastic cover 29 as shown in FIG. FIG. 4 shows an ultrasonic transducer 30
3 is a schematic cross-sectional view showing a portion of the surgical dissection probe from approximately the middle of the tip to the distal opening of the tip 32. FIG. This surgical incision probe is different from the surgical incision probe shown in FIG.
It is 0. The laser light guide tube 40 is a hollow tube disposed within the chip 32 such that its tip surface is located in the conical tip opening of the transparent plastic cover 29 and a predetermined distance is maintained from the cylindrical inner wall surface of the chip 32. The tube is bent into an L-shape at approximately the center inside the cylinder of the chip 32, and a reflective surface 40a, for example, a mirror, is provided on the inner surface of the bent portion so that the optical axis passing through the hollow tube is reflected in the bending direction. Further, at the point where the bent hollow tube passes through the tip 32 and the transparent plastic cover 29 and protrudes outside the transparent plastic cover 29, it is bent into an L-shape in the opposite direction from the tip opening of the tip 32. The tube is bent, and a reflective surface 40b such as a mirror is provided on the inner surface of the bent portion so that the optical axis passing through the hollow tube is reflected in the bending direction. Further, the laser light guide tube 40 includes a lens 40c that can focus the laser light transmitted inside the hollow tube at a predetermined position of the hollow tube disposed inside the chip 32.
It is formed to include the following. That is, even if a focused laser beam is generated in the laser generating section, it will diverge within the hollow tube, so it is necessary to refocus it using the above-mentioned focusing lens.

In the laser light guide tube 40 formed as described above, unfocused laser light transmitted from a laser generating section (not shown) is transmitted to the reflecting surfaces 40b and 40.
After being reflected by a, the laser beam is focused by a lens 40c, and then becomes a laser beam with high thermal energy density, which can be irradiated to the affected tissue from the opening at the tip of the laser light guide tube 40. Since the laser light guide tube 40 is formed using a hollow tube without using an optical fiber, the energy loss of the laser beam can be reduced.

Furthermore, the portion of the laser light guide shown by the dashed line in FIG. 4 may be formed as shown in FIG. Fifth
The figure is a schematic diagram of the portion of the laser light guide shown by the dashed line in FIG. 4. This laser light guide tube 41 is L
A hollow tube 41b is bent into a letter shape and has a reflective surface 41a on the inner surface of the bent portion to reflect the laser beam in the bending direction, and a hollow tube 41b is rotatably supported on the hollow tube 41b. The hollow tube 41d is bent into an L-shape and has a reflective surface 41c on the inner surface of the bent portion to reflect the laser beam in the bending direction.
1d and a hollow tube 41e that is rotatably supported and coupled to a laser generating section (not shown). Note that, instead of providing the reflective surfaces 41a and 41c at the bent portions of the hollow tubes 41b and 41d, refraction prisms 41f and 41g may be provided.

In the laser light guide tube 41 formed as described above, the hollow tubes 41b, 41d, and 41e can freely rotate in the directions of arrows A and B in the figure, so that when operating the surgical incision probe, the extending laser beam The light guide tube 41 can be easily handled without interfering with the surgery.

Further, the laser light guiding section may be arranged as shown in FIG. FIG. 6 is a partially sectional perspective view showing a portion of the surgical dissection probe in which the tip is housed. This surgical incision probe 50 mainly includes a tip 51, a laser light guide path 52, an ejection tube 53 for ejecting a liquid such as physiological saline or a gas such as carbon dioxide, and a transparent plastic cover 54 that houses these. Equipped with. The laser light guide path 52 housed in the transparent plastic cover 54 surrounds the outer surface of the chip 51, and the annular tip of the laser light guide path 52 is positioned within the conical tip opening surface of the transparent plastic cover 54. On the other hand, the end of the laser light guide 52 opposite to the annular tip is converged and drawn out of the transparent plastic cover 54, and is coupled to a laser generator (not shown). Further, the ejection pipe 53 is arranged between the laser light guide path 52 and the transparent plastic cover 54 so as to provide a gap 55, that is, a first circulation part, for distributing physiological saline and a gap 56 for distributing liquid or gas. At the same time, the annular ejection hole of the ejection pipe 53 is located within the conical tip opening surface of the transparent plastic cover 54, and on the other hand, a supply pipe 53a is provided on the side surface near the bottom of the ejection pipe 53. It is formed so as to be drawn out from the transparent plastic cover 54 and connected to a pipe from a liquid or gas supply section (not shown). In addition,
It is the same as in the previous embodiment that the chip 51 is shaped into a cylinder and a pipe is provided at the bottom of the cylinder to form the second flow section.

The laser light guide path 52 can be formed by focusing a large number of glass fibers each having a diameter of about 10 μm, for example.

In addition, in the drawings showing the embodiments and modified examples of the present invention detailed above, the center lines of the laser light guide tube, the laser light guide path, the chip, the ejection tube, and the transparent plastic cover are shown to coincide. , their center lines do not necessarily have to coincide.

As described above, according to the present invention, the following effects can be achieved. That is, a single surgical dissection probe can be used to incise tissue regardless of the tissue content to be incised. Therefore, there is no need to switch to forceps or an electric scalpel depending on the tissue content, so the surgical time can be shortened and simplified, and surgical errors can be eliminated. In particular, if high-frequency vibration of the tip and laser beam irradiation are performed simultaneously, tissue incision and hemostasis can be achieved.

[Brief explanation of the drawing]

FIG. 1 is a perspective view showing a conventional surgical incision probe, FIG. 2 is a schematic cross-sectional view of a surgical incision probe according to an embodiment of the present invention, and FIG. 3 is a diagram of a laser light guide tube in the above embodiment. A schematic perspective view showing the structure;
FIG. 4 is a schematic sectional view showing a part of a surgical incision probe according to another embodiment of the present invention, FIG. 5 is a schematic view of the portion of the laser light guide shown by the dashed line in FIG. 4,
FIG. 6 is a partially sectional perspective view showing a part of a surgical incision probe according to another embodiment of the present invention. 21...Surgical incision probe, 29...Cover, 3
0... Ultrasonic transducer, 31... Coil, 3
2... Chip, 34... Laser light guide tube, 40, 41...
Laser light guide tube, 50...Surgical incision probe, 51
...chip, 52...laser light guide path, 54...cover.

Claims (1)

[Scope of Claims] 1. A chip having one end coupled to the ultrasonic transducer and the other end protruding from the distal opening of the cover, and a physiologically active liquid such as physiological saline flowing through the tip. a first liquid that cools the tip and causes the physiologically active liquid to flow into the surgical field;
In a surgical incision probe comprising a flow section and a second liquid flow section for discharging the physiologically active liquid that has flowed into the surgical field to the surgical field, emitting focused laser light into the tip or onto the outer peripheral surface of the tip. A surgical incision probe characterized by being provided with a laser light guiding portion having a surface. 2. The surgical incision probe according to claim 1, wherein the surgical incision probe has a gas or liquid ejection part on the outer periphery of the laser light guiding part having the laser light emitting surface.