JPS63500850A - endoscopic ultrasonic aspirator - 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] Family celebration ultrasonic evacuation device Background of the invention field of invention The present invention relates to a method and apparatus for removing unwanted biological tissue. especially books The invention is an ultrasonic suction device equipped with a long hollow probe that performs liquid injection and suction at the same time. is used to cut grossly compromised tissue from deep within the body through a narrow surgical orifice. Relating to a surgical operation that removes or removes.

Conventional technology The endoscopic ultrasonic aspiration device (hereinafter abbreviated as EUA) according to the present invention is particularly suitable for removing the prostate gland. It is useful for transurethral resection (abbreviated as TUR), including removal of urethral stones.

More generally, the present invention is useful for surgical procedures performed deep within the body through narrow holes. It is used for arthritis surgery, discectomy, and other orthopedics. It is useful for plastic surgery, etc.

In a preferred embodiment of the invention, an ultrasonic probe with a high tip velocity is It is inserted into the body for at least 19 mm to remove unwanted tissue and at the same time inject fluid and aspirate the fluid and tissue through a surgical tubule with a circumference of less than 29 m++. , this size is the maximum size that can be inserted into the ureter. This dimension can also be 29mm. However, it is preferably 25III or less. Known as French The measuring devices used are indicated by their circumferential dimensions. Therefore, in French dimensions, the diameter of the sheath tube is A cladding tube with a circumference of 30 mm, which is indicated by 3 times, has a diameter of 30/π = 7.55, so The French size is 9.55 x 3 = 28.65.

Since 1950, TUR has become the procedure of choice for the removal of diseased prostate glands. Ta. In one of the traditional procedures.

After anesthesia of the spine, the patient lies in the traditional lithotomy position.

An elongated osteotomy with a light source, telescope, cutting electrode, and communicating irrigation source is inserted into the urethra. , and is advanced close to the prostate, where access to the prostate is achieved through the lining of the urethra. be done. The cutting electrode is placed at the anterior and posterior level, i.e. all forward and backward movements towards the patient. It is a semi-circular wire attached to the end of the slide shaft for use in moving objects. this electrode A pulsed RF lightning current is applied to cut and cauterize tissue.

This axis is spring-translated towards the back of the patient and removes a small slice of prostate tissue. As the electrodes slice, they are each pulled forward by a trigger-like lever.

As the tissue is sliced, it is exposed to continuous irrigation. It is washed into the bladder.

Fill the bladder approximately every 5 minutes. Accumulated water and waste are removed through a flexible plastic urinary tube Ellick eliminator with a squeeze bulb that engages the tube must be periodically removed using a suction device such as

The bone resection rust was removed, the bulb was compressed, and the plastic ureter was placed in the surgical position. inserted into the position. There, the tube is expanded to draw out water and tissue waste.

This conventional procedure has a number of deficiencies (disadvantages) that the present invention is intended to avoid. ing. In order for the surgeon to see (diagnose) the surgical site, the EUA provides diagnosis and illumination. It must be configured in some way in the system.

This is light that uses a lens with a diameter of approximately 2 = 5 mm at the current level of optical technology. It has been discovered that proper endoscopic diagnosis requires a surgical relay lens method. Ta.

Additionally, these lenses must be mounted inside a rigid tube containing luminescent fibers. Since there is no diameter, the total diameter of a typical finished telescope will be about 4+ nm. Furthermore A hollow ultrasound tip is used at a suitable speed (typically about 5 to about 10 grams per minute). With the endoscopic suction device, both the telescope and tip are covered. They are also lined up from side to side within the pipe. An endoscopic suction device is inserted into the patient's body At the same time, the cladding tube protects the surrounding tissue not only at the surgical end but also along its entire length. This prevents contact with the vibrating ultrasonic tip.

The use of axial-type electrodes for cutting requires cutting at the anterior level, so the removed assembly The fabric does not build up in front of the shaft or block the viewing lens.

However, in anterior level cuts, this ring is always below some tissue thickness. Hidden. This may prevent the surgeon from performing an autopsy, and may prevent the urethral sphincter, bladder, There is a risk that the walls of the bladder or the intestines themselves may become diseased and harmed. (sexuality). The surgeon also examines the prostrate, which is the tougher outer skin of the prostrate. It may penetrate the vertical capsule and may even damage the overlying blood vessels. electric Emotional amputation can occur very quickly and even with due care, as mentioned above. Accidents may occur.

Furthermore, when the EUA telescope is positioned next to the ultrasonic tip, the ultrasonic tip The end wall obstructs the surgeon's autopsy diagnosis of the affected area to be operated on.

In addition, evacuation must be performed 10 to 20 times with the osteotomy removed each time. No, this will probably take 20 to 50% of the time per hour of operation. cormorant.

Other disadvantages of the previous procedure are that the continuous irrigation flow described above may result in excessive pulse waves or Filling and distension of the bladder and inhalation of fluid into the blood leading to the risk of hyporheumemia Cause. Additionally, electrical disconnection can be used to reduce Requires the use of a conductive liquid medium. If you use electricity like Saline (contains alkaline) If a conductor fluid is used, the cutting current may short circuit the workpiece.

The fluid must be isodominant to avoid hemolysis (destruction of red blood cells) of the venous cells. No.

Additionally, the previous procedure may require only one surgery, but the bladder may require two surgeries. It is impossible to remove stones in the bladder.

Since EUA is often used for transverse urethral resection, EUA is often It must be inserted into the road. Therefore, the outer circumference size of the EUA tube is typically limited by elastic expansion of approximately 30 mm (or approximately 28 mm in French size) be done.

However, surgeons often suffer from urethral strictures or should be smaller like a French size 24 or 25 to avoid shrinkage. Prefer to use cladding tubes of appropriate size.

Endoscopic ultrasound tissue removal and aspiration avoids these inconveniences. ultrasound tissue removal have been used in the past to dissect and remove biological tissue.

However, any ultrasound equipment is extremely It is not used to remove primary tissue. The previous technology also had two flaws. ing. The first is the high tip speed that is necessary for rapid removal of such tissue. , there is no elongated probe capable of sustaining ultrasonic vibrations. Second, this technology The most effective method for tissue removal is ultrasonic vibration that creates a hollow space in the liquid inside the cell. Not accomplishing something.

Such frequencies are between 10 and 20kHz, although other frequencies may be used. A range must be preferred. The term "ultrasound" refers to frequencies within the audible range. It will be used for all frequency references that are useful including.

Regarding one previous development, I talked with Von Ardenne. Grorman uses a small wire probe and hollow needle under the skin. In 1960, he reported on ultrasonic vibrations that facilitated insertion. They are next to the needle Applied for injection into or withdrawal from liquids or other substances in contact with ( (subcutaneous) describes the fabrication of an ultrasonically vibrating needle that is coupled to a syringe. .

They adopted an exponential velocity transformer and had a tip vibration of about 10-100 microns. It operates at a frequency of approximately 20kHz.

Also, in 1960, Watkins et al. reported the use of an ultrasonic chisel to fracture and remove calcium precipitates from membranes. Ta. These authors expressed the belief at the time that such tissues could be created by ultrasonic vibrations. Because it was relatively undisturbed, their technique was soft and flexible. It states that it is not used on top of the organization.

Their device operates at approximately 26.5° with a tip amplitude of approximately 38 microns.

Ultrasonic energy can also be used for either disinfection or excision of the protoplasm. It has been used to disrupt and destroy tissue to contain liquid media. This technology Typically deposited in a liquid medium and with a stroke of about 20 to 40 microns (oscillation width) ) uses a hard round metal horn (square tube type) that vibrates at approximately 20kHz. . It works by hollowing out the water around the cells rather than the water between the cells. .

Previous patents described surgical instruments, in which ultrasonically vibrating machines While irrigating the operating area and suctioning out the liquid and removed material, Remove unwanted biological material. For example, Richards v. No. 2,874,470 to Balamuth. U.S. Pat. No. 3,526,219, Banko and Kellman. US Pat. No. 3,589,323 to See U.S. Pat. No. 4,063,557 to Uchinich et al. However, the Richards device has a preferred frequency of about 25 kHz with an amplitude of about 10 microns. A dental device that operates within hearing range.

Balamas' 219 device rotates at about 25kHz to cut tissue. A sharp-edged instrument is in direct contact with tissue. Vanco and Kerman 363 equipment In this case, a thin-walled tubular tip vibrating with a vibration width of approximately 50 to 70 microns is A relatively hard biological substance such as a substance that comes into contact with the lens is crushed into pieces, and remove. The '557 patent of Wishnick et al. Magnetic constriction vibrating at about 25kHz with an amplitude of about 25 microns for removal of sexual tissue has announced a device using a vibrator. Gradually tapered machine The mechanical transformer increases the amplitude of vibration from approximately 125 to 400 microns.

All of these devices are sufficiently fast and long and narrow to perform endoscopic surgery. It was not possible to provide a suitable probe. Can be used with previous ultrasonic surgical equipment The maximum possible insertion interval (distance) was about 7 to 8 cm. Even more special, Previous devices were designed to treat organisms such as glandular swellings, which create hollow spaces in the fluid between cells. Applying sufficient acoustic pressure to the primary cells in the biological tissue or any other Nor could they be broken down by law.

Summary of the invention Improvements in the speed and efficiency of tissue removal are desirable, as previous technological advances have been ineffective. Rare, but still more effective than previously available for endoscopic surgery. It was desired to provide a vibrating probe that was longer and faster.

Experiments by the inventors have shown that the effectiveness of ultrasonic vibrations on biological tissues has been shown to reduce tissue moisture. I have made it clear that they are related. Tissues that have been dehydrated should be kept fresh and moist. The tissue may be attacked by vibration more than the tissue that has been retained, or may be more or less resistant to removal. He is obedient. The walls of tissue over blood vessels or connections extending to muscles and fibroids are mostly Ultrasonic vibration on soft, fresh samples such as tumor or muscle tissue unaffected by the tool used. Water between cells in unaffected tissues is large Significantly lower than the tissue moisture affected by the degree. This r organization…difference” or “ The "tissue sorting" effect appears to be related to the water content of the tissue.

Unwanted tissue may damage other structures in the visible range and under conditions where access to the surgical site is difficult. The inventors believe that the differential effects of tissue can be removed without the risk of The result is that ultrasonic aspiration offers unique convenience in endoscopic surgery. It occurred to me that it must be possible.

Due to tissue removal and water relations, the hollow space between the cells, i.e. the microscopic fluid between the cells, Partialization of the tissue was a destructive effect of the formation of rapidly changing pressures of vapor bubbles The inventor postulated that a physical mechanism could be used to generate the .

For a stated level of pressure in a liquid, the degree of hollowness depends on the physical properties of the liquid. For example, temperature, surface tension, vapor pressure and concentration.

What is very important is (1) the applied pressure and (2) the vibration applied there. This is a hollow dependence on the frequency at which Research shows that the strength of hollow vibrations in water It is implied that it increases as the frequency becomes lower. This hypothesis is exactly the same Set up two vibrator tips that are the same size but provide different frequencies of pressure vibrations Since the pressure generated in the 6wR dynamic motion tested is proportional to the speed of this motion, , both tips were actuated at the same speed at the point of contact with the tissue. One tip is 40 & oscillated while the other tip oscillated at 20 kHz.

On the same specimen, the use of 20°C vibrations approximately doubles the tissue removal speed. The relationship with the hollow space was confirmed, and the fracture of the tissue increased during vibration or This supports the suggestion that it is only elevated by acceleration. Similarly, the rate of hollowing is It was discovered that when the frequency is lowered to 10 kHz in early summer, it doubles.

At the entrances below 10 and below, the speed remains constant.

There is also a lower pressure inlet that cannot be hollowed out for a given liquid. this entrance Also reduce the frequency to about 10 & below the pressure inlet decreases further. Don't let it get smaller.

For these reasons, the range of frequencies preferably covered by this invention is 10k Ranges from Hz to 20 Hz and of course lower or higher frequencies can be used. However, this range encompasses parts of the auditory spectrum. . Audio frequencies were previously considered to be irritating and dangerous to surgeons. However, the frequency should be suppressed to the inaudible range of 18kHz or higher. it was thought. The longer wavelength is also 20 kl (a half-wavelength oscillator at z is about 5 cm long, which is about the maximum length that is convenient for hand-held use, so it does not require much force. I couldn't.

However, the present discoverer believes that due to the considerations previously known as a technique in endoscopic devices, Found the application of different considerations outside. In endoscopic surgery, most of the vibrating members is placed inside a natural body orifice, such as the urethra, so the echoes of audible sounds are absorbed by dry body tissue. It is greatly weakened by interference.

In some epidermal applications, such as arthrospore surgery, on the other hand only part of one instrument may be assembled. The sound radiated from exposed parts of the fabric is at least as small as the absorption of the jacket tube. can be effectively limited as desired by the use, and the vibrator and its tip. Surround the minutes.

Even using the most advantageous frequency, the maximum possible tip velocity is also It must be used to increase the hollowness there.

Since the pressure is related to the velocity of the oscillator by the conventional equation ρ = Zv, the hollow The relationship between hollowing and pressure can be directly expressed as the dependence of hollowing on velocity. Hollowing is.

It is believed that it should be relatively independent of both acceleration and vibration amplitude.

Velocity cannot be increased without μ bounds. However, the speed is Due to the physical limitations of Now you can safely vibrate. At a given point in the vibrating tip The mechanical stress applied is directly related to the tip velocity in that respect. Correspondingly and sharply As the speed of the tip increases, the stress within the tip increases as it increases the crystalline adhesion within the tip material and the tip. increases until it exceeds the edge crushing force. For a given maximum stress, a special design can be developed to accommodate large tip velocities. However, the previous technical design The cross-sectional size of the tip was increased without any change and was difficult to manufacture. Therefore In addition to lowering the frequency of vibration, an important objective of the invention is also to increase the maximum allowable Provides an improved device to increase applicable tip speed without exceeding carrying stress This will increase the rate of hollowing.

For a regular structure such as a tube with a constant cross-section, the velocity of the tip is , where V is the velocity (distance in unit time) and ρ is the density of the material from which the tip is made (unit C is the speed at which the extended sound wave travels through the tip (distance per unit time), and and S are the stress at the tip (force per unit area) related to the stress by the equation S=ρCv are doing.

Made of titanium, which can withstand the highest stresses of any commonly available material. Therefore, the above relation shows that the maximum allowable speed is approximately 1270 centimeters per second. It means that. However, the preferred living tissue removal requires at least It is well known that the United States also adopts a speed of 2540 centimeters per second.

For improved tissue removal, larger tip velocities can be used for velocities with non-uniform cross-sections. degree would be obtained by the use of a transformer. The above equation is apply. If the tube is made non-uniformly, the equation is Modified by a coefficient M of the type sometimes referred to as merit: how The mold modulus can be used for a given maximum stress depending on whether changes are made to increase or decrease the speed at which The interest here is which type coefficients are the other The goal is to discover a design with a tip that is larger than anything else.

For a given maximum allowable stress, the tip velocity is It is clear from the modified equation that the speed obtained can be increased even more.

The cross-sectional area of the tip varies with respect to its length giving an essentially larger value of M than others. There are changes in the design of the tip. For example, the cross-section of an exponential tip depends on its length. It changes as follows: Area = AI, e-aL In the above equation, e is the natural basis, Ao and a are constants, and L is the distance from the point in question to the end of the tip. and can theoretically give a coefficient of type equal to e or 2.7. Ru. However, in order to obtain this value of M, the tips must start with considerably different diameters. and request that it be terminated.

It has a coefficient of 2 of the type that can safely generate a tip velocity of 25.4 m/s. The tissue removal device, which uses an exponential design, is approximately five times the diameter for surgical purposes. It will start from the diameter of Must extend several inches into narrow human body orifices Exponential design is not possible for endoscopic devices that do not have a Meets the constraints of human anatomy Even if the tip is made to It would be too small.

The most space efficient design for increasing M numbers from 1 to about 2 is a constant diameter Employs the use of a constant...stress velocity coupled to a velocity transformer. exponential swing For a uniform type of tube undergoing motion, the stress follows the relationship: %formula% where X is the distance from one end of the tube to the point in question, and L is the total length of the tube. be. From this relational expression, we know that the stress is maximum when x = L/2. Can be done. The length L of the cross section above which the membrane area changes in this way It is desirable to mount a surgical probe with /2 at the working end, for which L For values of X greater than /2, the stress remains constant at the maximum allowed value.

Such a design also produces the maximum possible elongation for a given maximum stress. Obtain * Hooke's law states that the expansion of each part of the transformer is proportional to the stress. and since the stress is constant, the elongation increases the length of the tip beyond its center point. increases linearly along the

For a constant road force, such a tip in the designed section can be expressed by the following relation: It has a cross-sectional area according to: area = B, ″′ge In the above formula, B and b are constants, and y is the distance from the specified point to the tip of the cusp. be. The mathematician Gauss studied the properties of this mathematical function. After that, it is known as the Gaussian function.

Consequently, the constant force tip will be referred to as a Gaussian resonator. Gauss The resonator allows this machine to have a sufficiently large tissue contact area and effective tissue removal. Because the suction opening can be manufactured with a diameter that can be set according to the human anatomy and that speeds of 25.4 m/s are practically possible with endoscopic or percutaneous devices. Since we can show a coefficient of 2 of the type give good. Furthermore, this Gaussian design requires a wide disparity between the two end diameters. I don't ask.

The cross-sectional area is reduced sequentially along the length of the resonator to keep the stress constant However, the tip does not need to be very close to the tissue edge. Since there is no load at this point, the stress is zero (0), so the tip end itself is designed to support the same stress. It is not necessary for the outer shape to gradually reduce the stress to a zero value. Therefore, it will be necessary to make it more rounded.

The mathematical basis for providing the EUA with a Gaussian resonator is as follows: The set acoustic principle can be used from a long slender rod while making simple magnified vibrations Setting the coefficient that affects the maximum velocity 1For a constant type rod that is free to move at both ends, The maximum speed that can be obtained is determined by the maximum stress that the bar material is made to safely withstand. directly related.

In the above formula, V□8 (maximum) = speed (distance per unit time), and S□8 is safety. is the stress limit (force exerted on a unit area), and ρ is the density of the material (mass per unit volume). where C is the material and the velocity with elongated wave transition (distance per unit time), Metal is the only practical material capable of sustaining high levels of beneficial acoustic vibration. Since C is almost the same for all these materials, the possibility of V□8 is In order to obtain the maximum possible value, the highest possible force-to-weight ratio C5vn, x/ρ) is The material you have must be selected. This material is used as titanium in aircraft. It is set to minutes.

The safe value of vibration stress is the yield stress (at which stress the metal begins to deform irregularly) It has been experimentally determined to be one-third of the value of .

Aviation when vwax is calculated by computer using appropriate values of 8□8 and C. For a fixed type bar of machine titanium: V□x=1912 cm/sec is found.

(2) However, this speed is limited because the vibration frequency increases the hollowing of intercellular water. Even when lowered, it serves only a small amount of soft tissue ablation.

Approximately twice the value given in equation (2) to effectively ablate such tissue desirable.

In conclusion, the speed transformer can be applied to V□8 without increasing the maximum stress beyond S + wax. It is desirable to approximately double the value of . In addition, in an endoscope device, the diameter is approximately 811I1. 1, of which approximately 4 mm is within the preferred narrow circular waterway constituting the circular suction hole. It is desirable that this speed transformer be set. Therefore, the velocity is given by the cross-sectional area It is important that the increase be made with minimal change and therefore at least about 17 The entire resonator can be installed within the endoscope over a length of 19c+o.

FIG. 1 shows a constant cross section of quarter wavelength length according to a second overall cross section of length L. A hypothetical speed transformer consisting of surfaces is shown.

Figure 2 shows the various possible variations in this rod for different hypothetical cross-sectional changes of the second cross-section. The distribution of stress is illustrated. The velocity at any point on the right side of a constant cross section is can be written like: v(X)=[-2x f/E] S×. S (x) dx (3) In this formula , s (x-o)” s m-x, S (x-L) = O1f is the vibration frequency (cycles per unit time), and E is an elastic constant or young modulus. force (force per unit area). In this way, the velocity distribution along the cross section is It can be calculated directly by computer from these stress distributions. which point Also, the velocity is proportional to the area based on the stress curve to that point. Figure 3 is , which illustrates the distribution of these corresponding velocities. Curve 1 is the maximum terminal velocity However, since it exceeds Smax, it is not a practical choice.

Curves 2 and 3 produce a safe stress distribution, but not the maximum available terminal velocity. It won't be.

The area under these curves in FIG. 2 is less than or equal to the area under curves 1 and 4.

Only curve 4 increases speed fastest while maintaining safe operating stresses.

Figure 4 shows a constant cross section, except for the ends which are free and therefore not subject to any forces. Showing stress level.

The question is how to determine the outer shape of the second cross section so as to produce this optimal stress distribution. It remains a question to be decided. The velocity distribution of a long thin rod vibrating extensionally is , is related to stress and cross-sectional area as in the following equation: where S(X)”5 For vn-0<X<L (5) Then, V (X) and S (x) are S (X)=Sl, 1. , 'is related in Equation 3, which is expressed as Substituting equations 5.6 and 7 into equation 4 yields the following situation: The above equation is integral between A(x=o)=A and A(x) and between X=0 and x=x. When O<x<L, A(x)=Aoe←K”X X”’2), K”=[2x f/C)” (9) In this way, the optimal In order to obtain the velocity transformation of , the cross-sectional area of the resonator can be calculated from its value at As specified in , the Gaussian function must be reduced aggressively.

There is no theoretical limit to the quantity, and the velocity can increase until A(x) satisfies Equation 9. Probably. As a practical matter, the resonator is hollow, and A is completely reduced without changing. Requiring a small wall thickness may result in a structure of insufficient strength for rigidity in medical use. It can be done. However, Gaussian resonators are not practical for tissue dissection with endoscopic devices. exhibiting a velocity conversion factor of at least 2 at an acceptable initial cross-sectional area while achieving are doing.

A constant stress amplitude is also an elastic constant E, or an elastic constant E and a density ρ By changing both the cross-sectional area over the entire length of the structure without changing the circular This can be achieved with a structure of a certain type, such as a cylindrical tube.

An example is the scheme in which the density is proportional to an elastic constant, i.e. ρ=nE, where , n are constants.

A constant stress can be expressed in this way if E is varied according to the number of Gaussian planes. Obtained: E+EoU-” (2πfx)2/2 (10) Here, E(x+- 0) = E0, thus the elastic constant E is from the vibration input to the free end of the resonator. Decrease. With these conditions: V(x)”−2πf　s　(S(x)/E(x))　d　x　(11) Constant road force In the formula, S (X) = S.

V(x)=2πf sS 1/E(x)dx (12) E(x) is a decreasing surface Since E is a number, the integration into equation (12) is , it increases at a faster rate, so a larger velocity amplitude more than in the manner in which the cross-sectional area is varied to achieve constant stress, could be expected under these conditions.

According to one aspect of the invention, a high frequency vibrating device is configured for vibrating with a first amplitude. A vibration source, a first transformer for amplifying the vibration, and a first transformer for amplifying the vibration. The elongated second transformer is composed of a second transformer, and when vibrating, It has an essentially constant mechanical stress all along its length. The second transformer is like this its output from its input end to provide an essentially constant mechanical stress level such as It will have a cross-sectional area that changes towards the ends. The cross-sectional area of the second nidorans is Gauss's basin It will vary according to the number. Instead, an essentially constant stress level The elastic constant of the lance material, or the elastic constant and density of the material, can be changed. Therefore, the cross-sectional area will remain unchanged.

Another form of invention is an armpit device with a selected wavelength and a first amplification. A vibration source for vibration, a first transformer for amplifying vibration from the vibration source, and a first transformer The second lance has a relatively large cross-sectional area and is used as a vibration source. Including the first transformer that is connected, and also the output cross section and the and has a corresponding output end vibration.

According to another form of invention. The endoscopic ultrasound aspirator is a hollow armpit device. hollow bore running from the inside of the armpit device to the working end and from the armpit device. A slender tube that has a casing, an alternating current vibration source, and a slender tube that is connected to this vibration source. This machine is designed to transmit such vibrations through the hollow bore of the tube. A viewing means and a side support device extending from the side support device to the operating position for the purpose of operation are provided. and means for supplying liquid to the liquid space between the mechanical means and the hollow bore of the tube; Detects the appearance of liquid in a liquid space and vibrates when no such liquid appears. consists of a liquid detection means for stopping the supply of alternating current electricity. There is.

Another type of invention is an apparatus for removing undesirable biological material. Container: An elongated tube with a hollow diameter that extends from the armpit device; armpit Equipment vibration sources; vibration amplification from sources to sufficient velocity to degrade undesirable tissues; The first and second lances of hollow bore for the purpose are mounted elongated with vibration means, and ( 1) a first liquid passage in the space defined between the transformer and the tube; (2) a common vertical passage; extending along a common longitudinal axis to form a second liquid passage along the axis two transformers with one continuous hollow bore; the operation of the second transformer Introducing liquid into one of the liquid channels in order to irrigate the surgical side M adjacent to the apex. Means: other fluids to remove fluid and dissected unwanted tissue from the surgical site. It consists of means for effecting suction into the passageway.

Another mode of performing inhalation is to select and redirect the fluid and tissue. a biopsy valve that is joined (occluded) to the fluid passageway through which suction is made to Accepts and filters selected and redirected preferred fluids and tissues Includes trap means.

Another aspect of the invention is to remove small particles from relatively deep primary tissue within an organism through a narrow hole. is a method of removing cell material; an actuator located in contact with the material to be removed; Insert an elongated surgical instrument into the hole with the pointed end and disintegrate such material. The actuation consists of vibrating the tip. Another method is to Remove cellular material from the primary tissue through a narrow hole at the surgical site to a depth of at least approximately 8 cm. If possible, the perimeter should be within 29mm of the material to be removed. The operating tip of the device is inserted through a hole into the human body to a depth of at least approximately 8 cn+ in a narrow elongated Inserting a surgical instrument and vibrating the working tip longitudinally to break up the material It consists of The vibration of the actuating tip causes the intercellular movement of such substances, which destroys the cells. Conveniently hollow out the liquid. The vibration is at least about 350 microns or at least About 10 to 20 kHz with a longitudinal stroke of about 700 microns is preferred; - about 1,000 cm per second or preferably at least 2,000 c per second is the maximum speed of m.

Another form of invention is to remove primary tissue at the surgical site deep within the organism through a narrow hole. A method for removing cellular material from This includes setting up a surgical instrument with an elongated cannula within the diameter of the The long and thin probe is placed inside the hollow hole, and the probe is placed over the tube and through the hollow hole. a first fluid passageway between the probe and the tube; Note that it forms a second liquid passage within the probe and is in contact with the substance to be removed. The active end of the probe inserts the tubing into the body orifice and connects it to the fluid to irrigate the surgical site. into one of the tracts; generates a pressure wave sufficient to break up the cells of the material to be removed. The probe is vibrated longitudinally for the purpose of extraction of fluid and material to be removed from the surgical site. Perform suction into other liquid passages for removal.

The adoption of the invention of transurethral electrolysis surgery for the prostate gland was based on (1) the effect of tissue differences, (2) (3) No thermal cauterization and gangrene occur, which greatly speeds up the treatment; (3) allows for direct procedure; (4) the ability to remove bladder stones or the like; and (5) duration of the procedure to increase tissue removal rate and allow continuous operation (and Achieving many benefits from it, such as increasing safety) and reducing

Tissue selection by endoscopic ultrasound procedures is difficult because the machine is forced by the operator. Reduces the risk of perforating the prostrate capsule or bladder unless moved do.

Obstacles like blood vessels can be easily sensed by the operator and removed from the handpiece ( armpit device) is directly mechanically connected to the working tip and requires a shorter sharpening than the previous procedure. guide you to the original safe procedures available for repair.

Ultrasound procedures, which allow for more accurate histological diagnosis, also reduce microscopic tissue distortions. minimize.

The aspirated tissue is quickly transferred to the biological tissue trap of the system and sent for analysis. removed for. Its advantages include the prevention of electric shock effects, burns, or impaired reflexes. To avoid risks, do not pass electrical current through the patient's body.

Adoption of continuous suction of waste and water reduces the surgical time to approximately 30 minutes. This is surgery generally reduces surgical risk to the patient as well as reducing bleeding caused by It turns out.

Additionally, reduced bleeding is achieved by ablation due to friction of the active tip on adjacent tissue. produce an effect.

Additionally, the use of ultrasound tissue removal combined with continuous irrigation and suction allows surgeons to Allows for rear level cutting, giving a better view of what is in the passageway. . Since the removed fragments are small, these are easily inhaled and removed by the surgeon It is possible to perform one continuous cut with good visibility for any length of prostate tissue to be do.

The present invention also allows the surgeon to use an inhaler with increased vision at the surgical site. The invention relates to an endoscopic ultrasonic inhaler with a tip having a reduced circumference.

The invention further provides a resonator having a vibrating tip for the removal of biological substances; means for delivering liquid to the tip, means for removing liquid and removed biological material; relating to improvements in types of endoscopic ultrasound inhalers including means for surgical fluoroscopy of vibrating tips; ing. This improvement is coupled to the tip of the resonator, making it easier to see through the tip during use. open channel means and means supporting the open channel and the liquid and biological tissue removed; in relation to the means forming the passageway which aids in the proper operation of the inhaler with respect to the removal of There is.

If desired, the total length of the resonator defines the contour and size in the form of an open channel means. so that the viewing means is partially received and supported by the open channel means. can be mounted and supported, thus minimizing the size of the inhaler. .

Preferably, the open channel support means is a resilient plug and the channel means comprises: It has a U or U-shaped cross section.

The tubular ultrasonic tip of the aspirator according to a preferred embodiment of the invention is cut along its length. It's open. There, the telescope is suspended in a cut-off section of its tip.

In this way, the end of the ultrasonic tip was cut off by a telescope suspended within the University of U. It has a U-shaped surface. As a result, the bottom surface of the U-shaped telescope has an opening at the U-shaped tip. Since the mouth is partially closed, the cross-section of the apical opening near the surgical end has a crescent shape. have.

Since the telescope is partially inserted into the distal end of the ultrasonic tip, the evacuation device of the present invention The entire circumference of the end is the cross section where the telescope is mounted in close proximity to the ultrasound tip. The ultrasonic tip is rounded smaller than the circumference of the distal end of the aspirator. On top of that, telephoto The upper part of the ultrasound tip, which is close to the speculum, is removed so that it can be removed by the surgeon at the surgical site. Fluoroscopy is not obstructed by this ultrasound tip.

One stopper is used to ensure that the relative position of the telescope and ultrasound tip does not change. is inserted between the telescope and the U-shaped tip. The ultrasonic tip and stopper are then inserted into the canal. or a lower lumen which is fitted into the upper lumen into which the telescope is mounted. It is attached.

Other objects, devices and advantages of the invention are described in detail with reference to the accompanying drawings. The current details below will be understood from the description.

Summary description of the drawing FIG. 1 shows a hypothetical expansive resonator for use illustrating the background of the invention; FIG. 2 shows a family of curves illustrating possible stress distributions within the resonator of FIG. 1: FIG. 3 shows a family of curves illustrating the velocity distribution corresponding to the stress distribution curve of FIG. 2; 4A and 4B both show a portion of an endoscope ultrasonic aspirator (EUA) according to an embodiment of the invention. form an analyzed diagram in parts; Figure 5A shows the use of the EUA of Figures 4A and 4B with the transducer and the first and second speed transformers. FIG. 2 is a front view of a resonator including; FIG. 5B is a graph showing the elongation and stress distribution of the member of FIG. 5A; FIG. 50 shows an alternative resonator assembly; FIG. 5D shows another alternative resonator assembly. Figure 6 is a terminal view of the EUA along line 6-6 of Figure 4B. Ru; Figure 7 is a detail of Figure 6 showing the end view of the EUA telescope; FIG. 8 is a plan view of the sealed port 112 used in the EUA; FIG. 9 is a front view of a portion of an alternative embodiment of the invention; FIG. 10A and IOB are both EU Form a block diagram of the ultrasonic power supply used in A; FIG. 11 is a cross-sectional view of the EUA along line 11-11 of FIG. 4A; FIG. 12A schematically shows an irrigation system (continuous) for use with an EUA; FIG. 12B schematically shows a suction system (continuous) for use with an EUA; FIG. 13 is a schematic diagram of a portion of an alternative ultrasonic power supply used for EU'A; FIG. 14 is a perspective view of an embodiment of the open channel endoscopic ultrasonic aspirator of the present invention; FIG. 15 is a cross-sectional view of the implementation of FIG. 14 along line 15-15; FIG. 16 is a cross-sectional view of the implementation of FIG. 15 along line 16-16: FIG. 17 is a cross-sectional view of the implementation of FIG. 15 along the line 17-17; FIG. 18 is a cross-sectional view of the embodiment of FIG. 15 along the line +18-18; 19 is a diagram of the input portion of the transformer of the invention; FIG. 20 is a diagram 20-2 of FIG. 21 is a view along the line 0; FIG. 21 shows the transformer of the invention when the telescope is inserted. A diagram of the input; FIG. 22 is an illustration of the input of the telescopic transformer inserted, and also includes an elastic Sealed with a polymeric material: Figure 24 is a cross-sectional view similar to Figure 15, but with an alternative to the invention. This diagram illustrates the implementation of the replacement. In addition, Figures 25, 26 and 27 are detailed views of the inventive resonator tip improvements.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 4A and 4B illustrate an endoscopic ultrasound evacuation device according to a preferred embodiment of the invention; The armpit piece 20 is located at what is referred to as the rear end of the device. covered A tube 22 extends from the handpiece towards what will be referred to as the working end of the device. It's long. A stop assembly 24, which is integral with the sheathing 22, It is interlocked with the base and the canal. Handpiece is a plastic stop assembly The tube and the tube are preferably made of metal.

The EUA also has a straight telephoto lens running horizontally from the rear end to the working end of the EUA. Includes mirror 28. The horizontal upper sheath 2G of the handpiece 20 allows the telescope to It includes a hole 30 that passes through to the outside of the base. The handpiece also has an outer jacket 2 in the upper part. It has a lower jacket 32 forming an accuracy A of 6. Accuracy A is approximately 20 to 45 degrees would be useful, the purpose of which is to not block the horizontal line of sight occupied by the telescope. A casing 22 for locating various components within the handpiece has five casings 22 at its rear end. assembled with the handpiece by means of a stop assembly 24, which is integral with the It will be done. Stop assembly 24 is generally cylindrical and inwardly threaded. It has a mountain 34 with a circular hole on its rear side. The handpiece is rounded at the forward end. Threads 3 facing outwards applied for screw mounting with threads 34 of stop 24 I have 6. The stop 24 has annular surfaces 40 and 42 facing forward and rearward, respectively. It has a front portion 38. The handpiece stops until it contacts the rear surface 40. It is screwed to the rear part 630 of the stop assembly. The front face 42 of the stop 24 is Limits the distance that the working end of the UA jacket 22 can be inserted into the surgical hole.

The telescope 28 has an eyepiece 50 at its rear end and an electrical connection to an optical light source 54. It has a cable 52 for energy supply. From the eyepiece to the telescope, the EU It extends forward in a straight line of sight to the operating end of A. The design of the telescope is detailed in Figure 7. shown in detail. The telescope is below the cylindrical interior surface 58 of the cylindrical telescope 28. It includes a cylindrical lens system located proximate the portion. Internal surface lens system and In the crescent-shaped space between is an optical fiber that carries light from the light source 54 to the working end of the telescope. A bar is set up. Other sources of proof are also provided. In this example, the telescope The outer diameter is about 3 to 4 mm, and the outer diameter of the lens system 56 is about 1.7 to 4 mm. 2.7 mm, depending on the overall telescope 28 size.

A generally defined resonator is installed inside the handpiece and the tube. This is assembly 68.

This resonator assembly 68 is shown more clearly in FIG. Motion element 70: A comparative element interlocking with the transducer for receiving vibrational energy therefrom. a first speed transformer 72 having a thick curved input section 74; an integral narrow output portion 76 extending forward of 74; and output portion 7; This assembly includes a second speed transformer 78 integrally connected to the forward end of the The assembly extends from the output section 76 to the working end of the EUA and overlies the cladding 22. It stands out slightly. The length of the transducer is essentially half the vibration wave used in the device. be. In this way, the oscillator has a vibration antinode (loop) at both ends, and a vibration antinode (loop) in the middle between the two ends. It has a vibration center point in between. Length of curved input portion 74 of first transformer 72 is one quarter of the wavelength; thus its point of connection with the oscillator 70 is at the antinode. , and the connection point with the output portion 76 is the vibration center point. In this way, the antinode of the wave is , and the center point is where it is connected to the second speed transformer 78. exist.

The second speed transformer 78 is of the above-mentioned Gauss type and is shown in the composition graph of FIG. As shown in Figure 2, the input part is relatively large and its essential amount of vibration is due to its flexibility. Because of this, there is almost no longitudinal elongation and stress in this input portion 74, and the stress is At both ends of the transformer, the speed of one is high, but at its center point it is O, which is the maximum It is a vibration antinode or loop due to longitudinal elongation. The stress at the output section 76 is the maximum allowable level for the materials and design used; in other words, as specified above. It is s wax as defined. Gaussian resonator 78 has almost its length At this same level SL, la 8 all the way up to almost tip 80 at its working tip. The stress near the cusp @80, which exhibits a constant stress, is essentially zero, so the cusp There is generally little load on the edge.

As shown in FIG. 6, the second transformer 78 and also the output section 76 are rounded. stomach. Rather, the tops of these members can be widened without essentially changing their vibrational characteristics. It is flattened 5 to provide a clear water passageway.

The central aperture 110, however, is essentially circular, with an internal diameter of 4.3 mm ( Lance size 13).

Working end 80 need not lie in a vertical plane as shown, but may be angled or, in special applications, may take other forms if desired.

The combined length of the output section 76 and the second transformer 78 is conveniently about 19 cm. stomach. If desired, the integral multiple of half the length of the wavelength of about 13 cm is set to about 20 & Therefore, it can be made longer.

Piezoelectric transducers like the one used here typically have a maximum vibration of about 23 microns. It has a wide range.

At frequencies of interest, tip vibration at the required speed has an amplitude of about 350 microns. I need. The resonator assembly 68 increases this by a factor of 15 in vibration amplitude. .

The groove 90 is formed in the upper part of the transformer input portion 74 and is located at the mounting size of the telescope. It has become

The groove 90 is! The input portion 74 is blocked to achieve a compact and narrow tube. A telephoto lens is placed in the forward end of the tube without being stopped, close to and parallel to transformer portions 76 and 78. A mirror can be placed.

The letter R to FIG. 5 refers to the radius of the curve of the curved input portion 74. The radius must be small enough so that the machine is compact and easy to handle. At least about 20 degrees is desirable to achieve a The beam is bent well below the line of sight of the telescope. The radius R of approximately 5 cm is , conveniently giving an angle of about 40 degrees. At an operating frequency of 20kHz, 5cm is the wavelength It is about 0.2 times that of Radius R is 0 working frequency to avoid excessive energy loss Preferably, it is no less than about 0.1 times the length. This radius is also approximately 6 cm Over the length of one input section 74, the zero wavelength ．． Must be smaller than 5 times. The input curve is not necessarily circular. In this way, the radius R is now determined approximately.

Figures 5C and 5D are Figure 50 showing alternative resonator assemblies 68c and 68d. In this case, the first transformer 72 is engaged with the vibrator 70. As in the previous example The first transformer is a half wave stage transformer. working end of first transformer Engaged in this is a second transformer with a constant cross-sectional area.

The speed amplification is from the point of continuum in the second transformer to the first transformer and its peak. This is obtained by increasing the elastic constant of the material up to the end 80c.

Optionally, the density of the material of the first transformer is determined by the distance between the first transformer and the tip. can be reduced according to the function of

In the embodiment of Figure 5D, a second transformer just described and described is employed. There is. However, the first part of this embodiment is curved as in the previous embodiment. The transformer 72d is not a one-stage transformer.

Rather, the speed amplification of the first transformer is a function of its distance from the oscillator. obtained by increasing the elasticity of the lance material and optionally decreasing the density of the material. Ru.

As can be seen from FIG. 5D, the oscillator 70 and the first transformer are Not necessarily requiring that they have the same cross-sectional area in their occlusion for the transmission of energy Not done.

Due to the curve of section 74, sections 74, 76 and 78 of the transformer are transverse, flexible However, portions 76 and 7 may be subject to a somewhat smaller amount of Any lateral member vibration at 8 will result in the emergence of irrigation fluid in the surrounding space 98 within the canal. Therefore, it is weakened.

Irrigation fluid is supplied through hose 90 and controlled by valve 94. irrigation The injection fills the radial cavity 96 in the external portion of the section 38 in front of the stop assembly 24. flows through. It is then the space 9 surrounding the resonators 76 and 78 in the tube. Pass 8.

The casing has a generally oval cross-section, as shown generally in FIG.

Its circumference is preferably about 25 mm, similar to the circumference of a circular device with a diameter of 8 mm. Such a size is known in the art as a French size 24. too If necessary, a circumference of approximately 29 mm, which corresponds to the French 28, can be used. Probably. For French 28 or larger devices, a narrow hole such as the urethra There is a risk of injury. The telescope 28 is arranged in the narrower part of the oval tube 22. Ru. This forms a compartment 100 which forms a watertight compartment for an ebony or telescope. It is enclosed in a similar material that runs along the inside of the tube that forms the tube.

The irrigant will be exposed to any lateral vibrations of transformer portions 76 and 78 as well as to the tip. through the space 98 from near the stop 24 which also reduces irrigation of the surgical site adjacent to the and flows toward the working end of the EUA.

Auxiliary liquid passages are also established. The flow of liquid to the handpiece is shown in Figure 8. The zero wheel that is prevented by the sealed shaft 112 is generally Q-shaped, but when the telescope is It has a small hole formed in its upper part for attachment. Sealing port 1 12 seals an annular space surrounding the input quadrangle portion 74 in the handpiece. In addition, a hole 114 for a watertight passage of the telescope is provided.

Additional sealing and struts are provided on the side of the transducer in the inner wall of the lower handpiece jacket 32. provided by an O-ring located at The O-ring 120 is the vibrator. Vibration at the center is located at the center point.

The engagement between the transducer and the input section 74 is such that the transducer and input section suction passages are adjacent to each other. Female screws and hollow threads, studded bolts with holes drilled against the terminals Thread cutting advantageously includes both of these. Such a connection provides good sound between the surfaces. Due to the acoustic occlusion, a smooth and subtle finishing of the adjacent surfaces of these two resonator elements is possible. do.

Further referring again to FIGS. 4A and 4B, the suction is transferred from the tip 80 to the second transformer 7. 8, through the first transformer 72 and the vibrator 70; It is carried out through a continuous convergent lumen extending to the space 122.

Other passages are similarly provided. These measures remove fluid from the surgical site. The removed tissue is either disposed of from the surgical site through EUA or for histological analysis. The crab sucks it out.

At tip 80, the end of the working tip of the second transformer is rounded. That is before As discussed, inadvertently scarring tissue that should not be removed by tip 80. The water between the cells should be hollowed out and removed to avoid unnecessary cuts that may cause This is for the purpose of

Transverse portions 76 and 78 of the transformer to be weakened by the flow of liquid in space 98 If no liquid appears, the vibration will stop. It is important to. For this purpose, a liquid sensor (sensor) is placed along the telescope. It is provided in the form of a single insulated wire 124 disposed on one side and It is separated from the space 98 by a partition wall 100 . Wire 124 connects sealing ring 112 through the hole 114 in the input portion 74 and the groove 90 in the input portion 74 to the inside of the handpiece. There is. This wire may also be placed in a groove in the septum 100 or in a cavity enclosing the telescope. Set to one of the following. If properly insulated, it should not be exposed to liquids. There is no problem. The wire is thin enough that it is not provided by the sealing ring 112. There is no interference with the sealed seal.

The wire 124 then passes around the O-ring 120 to the outside of the handpiece. do. Further, as explained below, this wire 124 and the ground means in the high frequency power circuit to sense the capacitance (of the conductor) between the second transformer is provided. If the capacitance increases and indicates the appearance of water, then the oscillator 70 The vibration is.

prohibited to prevent excessive lateral vibrations and possible damage to the resonator components. Ru.

FIG. 9 shows the gist of an alternative embodiment of the invention, in this embodiment with a telescope 28a. There is no partition between shaker 76a and the irrigant-containing space enclosing 78a.

Biologically inert silicone rubber adhesive or similar to support the telescope A quantity 82 is provided between the telescope and the connection of resonators 76a and 78a.

Even if this connection is the center point of vibration, each point of each resonator is undergoing extensional vibration. It follows a small degree of radial vibration that is innate within the body, so there is a certain relationship. It is important to use a flexible adhesive to achieve the action.

As each increasing portion of the resonator is compressed, it immediately expands slightly. child As such, each point of each velocity transformer undergoes constant slight radial expansion and contraction. conduct. These radial oscillations must be isolated from the telescope, but et al., due to severe size limitations on the tube, the distance between the telescope and the resonator is about 250 to 500. Separation of more than 0.00 microns is not possible, contact with further necessary view of vibration isolation. This need for closeness is solved by joining the materials with a flexible adhesive. Ru.

The related circuits for feeding and controlling the ultrasonic oscillator and the ultrasonic transducer 70 are shown in FIG. 10A and FIG. Shown in IOB.

The vibrator 70 has five cylindrical high-voltage electrodes 84 and a ring-shaped ground electrode 86. The piezoelectric crystal 71 includes an elongated annular piezoelectric crystal 71 driven by (Also see Figures 4A and 11. (see).

The ground electrode 86 is coupled to an electrically conductive lining 116. There is. This lining 116 lines the suction passage and runs the length of the vibrator 70. and is electrically connected to the speed transformer. The vibrator is Cylindrical insulators 88a, 88b, and 880 located on the faces of electrodes 84 and 86 Insulated.

The piezoelectric vibrator and tip are driven by a generator through two conductor coaxial cables 130. It is. This is controlled by a converter 132 whose magnitude and frequency are from DC to AC. It is energized by an alternating current signal. This converter uses input DC voltage , the control input 13 of the DC signal and its magnitude supplied to the frequency control human power 134 Controlled by the magnitude controlled by the DC voltage level supplied to the converter at 6 converts it into an alternating current signal with a frequency of

The frequency provided to input 134 is the frequency at which the transducer causes vibration. . The DC voltage supplied to input 136 maintains the selected amplitude of the oscillations at the frequency of the oscillations. This is the voltage required to maintain the voltage.

The excitation frequency and excitation voltage are two signals that are proportional to the voltage and current input to the oscillator. is derived from the feedback signal obtained by adding .

In Figure 10, C1 and 02 are the resonator voltages applied to C2, which is directly proportional to the electric phase. form a capacitive voltage divider that yields a voltage.

The voltage of C1 is proportional to the current of the vibrator, but it is shifted (changed) by 90 degrees in the electric phase. The voltage between the mover of potentiometer R1 and ground constitutes the sum of these two potentials. This is the feedback signal. The feedback signal oscillates at resonance when the R is properly set. Since the voltage and current of the transducer have a phase difference of 90 degrees, everything except the resonant frequency of the transducer Very low at all excitation frequencies.

When a feedback signal appears due to resonance, its magnitude is proportional to the vibration width, and its phase is , exactly equal to the phase of the commutator output signal.

The inductance L inefficiently cancels the capacitance of the resonator, i.e., the capacitance of the cable 130. This is the net capacity of the capacity and voltage branchers C□ and C2. This capacity is conveniently neutralized. Therefore, the voltage at the movable element of R1 is proportional to the vibration width, and at frequencies other than resonance. The wave number will be very small.

The feedback signal is sent in two control loops, one for setting the correct frequency and the other for setting the correct frequency. One is for setting the desired vibration width. When the extractor is disconnected from energy , of course the feedback signal is gone and still some means of oscillation initiation must be provided. . The predetermined starting frequency is determined by a voltage controlled oscillator 140. provided.

In the absence of any feedback, this oscillator is and operates at a frequency adjusted by variable resistor R8.

Generally, this initial excitation frequency is not the resonant frequency, so the essential feedback signal is Not sent. However, acoustic resonators provide significantly reduced levels of vibration. The vibrations are shown at frequencies within about 5% of their actual resonance. small for that reason A return signal is generated that can be detected.

In the frequency control loop, when the feedback signal enters the highly sensitive phase comparator instrument 142, the feedback signal A direct current whose voltage is proportional to the difference between the phase of the feedback signal and the phase of the output of the controlled oscillator. Generates voltage. The frequency of the feedback signal is the same as the oscillator frequency, but The phases are not the same because one frequency has not yet become the resonant frequency of the vibrator.

The output from the phase comparison instrument is greatly amplified by phase error amplifier 144. ing. Limiters 14 are placed above and below and are constrained by the output of the amplifier. Pass 6.

This amplified signal generates a voltage... control flow according to the limiter constraints. is supplied to the operating input 148 of the vibrator 140 and further provides feedback of its output frequency. The correction is made until the phase difference between the output signal of the vCO and the output signal of the vCO is minimized. produce this result The frequency of Zuru vCO is the actual resonant frequency of the oscillator.

The result of limiting the range of operating voltages applied to the oscillator at input and output 148 is that the frequency can be switched. The goal is to limit the extent to which it can be done. Typically, complex acoustic resonance such as the transducer 70 The vessel has more than one extensional resonance, only one of which can produce the desired effect.

Excitation at other resonant frequencies results in lower vibration levels and very poor tissue It will end in excision. Since the vibration level is quite low at these parasitic resonances, Constitutes a lower overall energy of vibration and, if care is not taken, can cause damage to the system. Naturally, the system tends to operate at a frequency where the operating effect is not good. Li The transmitter 146 has a predetermined band (bandwidth) in which the bracket resonates. Prevents driving at a frequency outside of .

In an amplitude control loop, the feedback signal is proportional to the magnitude of the feedback signal. It is sent to a rectifier 150 which generates the DC voltage in the example. Low pass filter 152 is provided to exclude any alternating current components and extract only direct current components.

This signal is then subtracted by a summer 154 from the preselected DC voltage. I am drawn to it. The difference between these two voltages is large and is caused by amplitude error amplifier 156. The DC output voltage is amplified and input to the main power supply 160, which controls its DC output voltage. this The DC output voltage is the power source to current transformer 132. It is the DC output signal of the current transformer which, in turn, is proportional to the vibration width of the vibrator 70. This amplitude control The loop remains operational regardless of the power drawn from current transformer 132 by oscillator 70. The desired vibration amplitude of the oscillator is consistent with respect to the emergence of resistant tissues as well as primary ones. maintain while giving the desired working effect. The power that can be obtained from a current transformer is not infinite. In order to safely limit the maximum power dissipation by the resonator to this component, the internal circuitry is established in In addition, in this way, there will be no damage due to intentional or unintentional abuse. Preempt safe power requirements. If the power limit of the current transformer is reached, the output oscillation The dynamic width is automatically reduced. Once the amplitude is re-achieved by the control settings, Excessive power requirements are eliminated.

Also, as can be seen from the figure, IOA is the capacitance ( It is a capacitive sensor that measures electrical conductivity. This capacitance is the circumference of speed transformers 72 and 78. When the capacitive sensor 162 increases substantially indicating the absence of water in the current transformer 13 Input 138 of 2 inhibits the input level to the current transformer and terminates the AC output to the vibrator. Set the level to the desired level.

FIG. 12 illustrates the entire endoscopic ultrasound evacuation system. Irrigation fluid source 170 is located 1 to 2 m above the EUA. At this distance, the bladder will neither expand nor worsen. Provide sufficient water pressure to keep it from overflowing.

The aspirated liquid and tissue are passed through the aspirate hose 122 to the biological tissue testing valve in two positions. Pass through 172.

Normally waste is directed by a valve 172 and sucked through a straight hose 174. Head to source.

However, when the surgeon discovers problem tissue for which histology is desired, the valve 72 can discharge waste directly into the tissue test trap.

This histology trap consists of a horizontal mesh through which the aspirated waste must pass. (Screen) It is a watertight container with 178 screens. Desired organization quickly can be collected on a screen and removed for histological analysis. .

The tissue test trap must be relatively close to the EUA. for example, Approximately 0.3 to O-5 m　e Because it is close, the hose 122 is very quickly , the tissue in question can be cleared, and the substance in the tissue test is therefore can be collected without unnecessary delay after being created.

This trap can also be used to sterilize the sample itself or the surgeon's hands. Can be collected without contamination in bags.

The vacuumed waste then passes through line 179 to main vacuum trap 180. pass Trap 180 is surrounded by a telescoping screen 184 that filters waste. It is a closed container with an inlet 182 that is closed. Tissue remains intact after filtration May be removed for medical audit.

Trap 186 has an outlet separate from screen 184.

Screens 178 and 184 are not particularly small.

These openings are preferably about 1 mm in diameter so that blood clots can pass through without blocking them. This is the case. On the one hand, the gauge of the screen is approximately the same as the inner diameter of the working tip. This size is selected to allow a piece of tissue to fall off, depending on the size of the organ to be dissected. This is approximately the same size as the tissue from which the core was removed.

After filtration, the waste passes via line 188 to vent valve 190. The valve 190 is If the pressure in line 188 drops to the previously determined low level, then has a valve that opens to pass pressure to the vacuum switch, which means that the system is closed. Indicates that it is stopped.

If the vacuum switch opens, solenoid 196 opens; Wind line 198 is opened, which delivers the suction pressure to the atmosphere.

Overall control of the suction pressure is provided by a main valve 200 operated by a solenoid 202. It will be done.

Pumping is done with a dynamic pump 210.

Inhalation waste fluid is received in a collector.

Figure 13 outlines an alternative generator for driving EUA in tissue electrocautery surgery. show.

A double pole, two position switch 230 is to be applied to the transducer cable 130. Set for signal source selection. In one position, the switch is in one generator system Transducer drive signals to capacitors C1 and C2 of 1. Referring to Figure 10A and IOB. Select as previously discussed. Conductor and coaxial shield of cable 130 at other locations are tied together and coupled to a radiotelephone-frequency source 232.

RF multiplied signal, conveniently pulsed RF lightning current, 1500 volts maximum It has high amplitude.

The waveform is a sharp, decaying sinusoidal waveform at a frequency of approximately 500kHz.

A grounded distributed electrode 234 completes the circuit from the RF source to ground. come into contact with someone's skin. The surface area of contact is small to avoid burning and shock effects. Make it as wide as possible. In this way, the RF applied to the tip 80 is transmitted from the patient to the ground. , passed for endoscopic tissue ablation. The generator is conveniently operated by the following operators: Has controls: 0N10FF foot switch for vibration, suction device , a light; a continuous/pulsed ultrasonic vibration method; optionally coupling the EUA to an RF source; Switch 230, with reference to FIG. Consists of a telescope 312 and a resonator 314, commonly designated as 310.

The telescope 312 is embedded inside a hermetically sealed tube or upper lumen 316. There is. Telescope 312 includes a cylindrical lens system (not shown) and a telescope end. At least one optical fiber (not shown) transmits light from the light source to the surgical site. ). Other radiation sources may be used. Far from the surgery location At a distant point, through the eyepiece the surgeon locates the surgical site with a cylindrical lens system. You can see it.

The resonator 314 is located inside another hermetically sealed tube or lower lumen 318. It is attached. The resonator 314 receives at least the vibration of the suction body 310 from its working end. Suitable for dynamic center point.

A tube being cut open. The importance of vibration center point 332 is discussed in detail below. Ru. To select one or the other, the resonator 314 is cut along its entire length. It might be opened. As a result, the cut portion of the resonator 314 has a cross section of It is inside a U-shaped groove.

When the resonator 314 and lower lumen 318 are cut open along their entire length, , the telescope 312 is partially suspended inside this aperture, and the smallest dimension evacuation is achieved along its entire length. Although the storage container 320 is made of a hard material, Position the telescope 312 correctly over the cut portion of the resonator 314 and lower lumen 318. It primarily serves to keep it in place.

The opening of the working tip of the resonator 314 is such that even if at least half of the tip remains, Only the lower half of the tip touches tissue during normal use, which does not affect its ultrasonic effect. Since the tip is tactile, cutting speed is not affected and a fully tubular tip is used. Hyper The strip of tissue removed by sonic dissection is never the full diameter dimension.

In one implementation, the resonator 314 is cut only to the vibration center point 332. This way In addition, the operative portion of the evacuation device is smaller than the opposite end, which includes the inferior lumen 318. It is small in size. surrounded by a telescope 312, as shown in FIGS. 14-18. Although the tubular housing and resonator 314 are not circular, to a preferred minimum extent the EUA It has an oval shape to maintain its circumference.

Oval storage is designed to accommodate work equipment with the smallest possible circumference. do.

A telescope 312 is housed. Upper lumen 316 is an opening at the end of resonator 314. It fits inside. Like the resonator 314, the lower lumen 318, from its working end, at least.

The lower lumen 318, which is a tube that is cut open to the center of the vibrating body of the suction body 310, is Tie into the upper lumen 316 with two beads of adhesive sealant 326, such as poxy. Can be attached.

As a result 1, as shown in detail in FIG. 16, the upper lumen 316 is inserted into the opening of the lower lumen 318. are combined. Upper lumen 316 and lower lumen 318 may be made of any semi-rigid material. however, the upper and lower lumens 316, 318 are electrically isolated. When constructed of materials, the upper and lower lumens 316, 318 are electrically connected to the aspirator 310. The resonator 314 is isolated from the rest of the resonator 314. For this purpose, patients and doctors It is safe for a targeted ablation current to be applied to the resonator 314.

To keep the tip of the resonator 314 in close proximity to the upper lumen 316, Lug 322 is inserted between the lower surface of resonator 314 and the upper inner surface of lower lumen 31g.

Since the plug 322 has a crescent shape in cross section, its surface is below the resonator 314. The surface and the upper inner surface of the lower lumen 318 are engaged. In addition, as shown in Figures 14 and 16, The upper lumen 316 is positioned within the opening of the U-shaped tip of the resonator 314 so that the upper lumen 316 is positioned within the opening of the U-shaped tip of the resonator 314. Up In addition to maintaining the tip position of resonator 314 adjacent lumen 316, the plug The tube 322 also connects the cavity of the aspirator 310 between the lower surface of the upper lumen 316 and lower lumen 318. Seal the suction groove 328 between the resonator 314 and the upper lumen 316 into its cavity. Leave as the only opening to facilitate sealing of the cavity. As shown in Figures 22 and 23 Another seal 346 is located at the input portion of the transformer, as shown in FIG. This completely prevents the removed material from coming into contact with other parts of the suction device.゛ Even without a plug 322 in place, fluid can enter the groove at that point in the tissue anatomy. I don't think there will be. There is a very small gap between the resonator 314 and the upper lumen 316 Therefore, flow is primarily restricted to the tip end. Feed it so that it flows under and outside the groove. The closed hydrodynamic resistance is greater than the open groove resistance, therefore completely reducing the total flow is aspirated in a manner that opposes natural flow, e.g., through the lower lumen 318. arises in form.

It is made of a material that collapses when it comes into contact with the ultrasonically vibrating tip of the resonator 314. Plug 312 is preferably made.

In some embodiments, the plug 322 is made of epoxy or polyester resin and is a thermoplastic material. is an elastomeric material.

By using such collapsible materials, plug 322 and resonator 314 Any mechanical interference between the ultrasonic vibrating tip and the After the tip of the resonator 314 starts to vibrate, it may be completely removed due to physical abrasion. It will be done. During surgery, the tissue is aspirated in the same way as if it were a tube with a closed tip. continues. Furthermore, the dissecting end of the tip is viewed through the telescope 312. Look directly at the entire cutting surface as it will look like a U to the surgeon is possible.

Even with a closed tube suction tip, such desirable observations cannot be made.

Era's trend toward using electrocautery may prove an adjunct procedure advantageous to ultrasound endosurgery Electrocautery has a metal tip, and other surgical needle-like instruments have a spark gap. communicates with a high voltage radio frequency current source generated by a top oscillator or generator. ing. The oscillator or generator generates the same pulse of current with oscillator-like characteristics. Produces depression current. When this needle-like instrument makes contact with tissue, it causes In case of direct contact with skin.

This current flows through the tissue into large clusters of electrodes.

When the ultrasonic tip is effectively isolated from the telescope and sheath, the electrocautery potential can be In addition to supplying directly to the tip, if an insulated transducer is used to vibrate the tip, If used for dissection and paralysis in the same way, it would reduce surgical time. It is possible to use ultrasonic vibration and electric scalpel at the same time as a ceremonial device for shrinking. It is possible.

Upper lumen 316 and lower lumen 318 are sealed within a somewhat rigid tubular case 320. It is sealed. The shape of the upper and lower lumens 316 and 318 and their connection to each other 14 and 16, the upper and lower lumens 316 and 318 are installed in the cased 320, a pair of cleaning fluid grooves 324 is configured.

As discussed above, the resonator 314 has a U-shaped cross section at its end in use. ing. However, according to the chosen embodiment, the resonator is closed to the node 332. It has a tube-like shape that is spaced apart. Figure 7 shows a cross-sectional view of the Kui@332 suction device. is shown. In the tubercle 332, the resonator 314 and the lower lumen 318 are both tubular in shape. I am doing.

The suction groove 328 has a circular cross section. Resonator 314 does not vibrate at node 332 Therefore, the resonator 314 does not adversely affect the vibration of the aspirator at its operational end. can contact the inner surface of the lower lumen 318. However, the resonator 314 Since it vibrates from the end of the length other than the node 332, the resonator 314 is vibrated. The remainder of the resonator 314 between the nodule 332 and the transducer is connected to the inner surface of the lumen below. Therefore, as shown in FIGS. 15 and 18, the node 332 and the transducer There is a space between the lower lumen and the resonator in the aspirator.

During surgery, the operative end of the aspirator is positioned following the tissue being removed by the aspirator. As shown in the figure, after the current invention's suction device is partially inserted into the patient's body, The vibrating body 314 is caused to vibrate at the frequency of the ultrasound generated by the transducer. resonance When the body 314 vibrates at the ultrasonic frequency, the vibration of the tip of the resonator causes the tip to touch the tissue. Leave it cut through. Remove the cut tissue from the patient's body To clean the area, the irrigation fluid is pumped through the irrigation fluid channel 324 of the aspirator at the surgical site. Pumped up. Cleaning is performed by suction supplied to the suction groove 328 of the resonator 314. Cleaning fluid is removed from the surgical field.

The end of the resonator near the operational end is U-shaped in cross-section so that the inside of the lower lumen 318 is On the side, along the entire cut-open cross-section of the resonator 314, the cleaning fluid flows into the suction groove 3. You can enter 24. Therefore, at any point along the cut-open section Reduce the amount of suction. However, the terminal cross section of the lower lumen 328 is 5, since only the U-shaped opening of the suction groove remains, the U-shaped opening of the resonator 314 Suction is maintained inside the inferior lumen so that there is sufficient suction at the tip.

The most preferred resonator shape is semicircular or U-shaped in cross section, but other shapes may also be used. For example, a V shape with straight, curved or rounded corners, an open rectangular shape, etc. Rui and square shapes are also used. The shape of the groove (e.g. a two-part foundation part) and open tops) are within the scope of this invention. Also Plug 322 may be designed to match the shape of the resonator tip. .

When an optimal fine suction device is desired, the cut resonator 314 and lower lumen 318 can be used for suction. An embodiment of this invention may be extended from corner to corner over the entire length of the vessel. are shown in Figures 19-24. After that, the telescope 312 connects the resonator 314 and the lower tube. It may be located partially inside cavity 318. Thus, all of the aspirators A device that may be similar in cross section to that shown in Figure 16, except that it is extended from one corner to the other, is It may be prepared. The resonator is secured to the node 332 by a seal 340 .

This seal, molded from rubber or other elastomeric material, is also resonant. May prevent fluid from seeping into the space between body 314 and lower lumen 318 .

Figures 19-21 show the arrangement of the telescope 312 and the resonator 314 in the area of the transformer input section. It shows. As best shown in FIG. A groove 344 is cut into the top of the transformer input section to provide space for the input.

Telescope 312 is inserted into the groove as shown in FIG. O of the resonator 314 This groove 344 in the transformer input section 342 along with the open groove In order to minimize the overall suction French dimensions in that respect, the telescope 312 Make it partially compatible.

In this embodiment, the biology of the aspirator to the waste container, accumulation container or trap Open grooves to closed tubes and passageways for the removal of substances and fluids At some point, an open groove resonator requires a communicating mechanism. Figure 19-23 The transformer input section described in , to make room for the telescope 312, bent at a predetermined angle. The resonator groove 314 and the telescope 312 are also Separate at the point. Fluids and biological tissue flow back to the telescope 312 and the surgical armpit. An elastomer or thermoplastic material that can be cast to seal this area used for.

Figures 23 and 24 show the sealing material 346 and outer sheath 3 in this area of the aspirator. 48 is explained. This sealing material 346 is typically an elastomer or a thermal A plastic, self-hardening material of relatively low hardness that is removed through the lower lumen. to prevent the desired fluid from contaminating or seeping into the aspirate. It is important to During the manufacture of the aspirator, the telescope 312 is placed inside the resonator groove 314. After the sheath 348 is placed around the connection area. And synthetic resin gills Stomers and thermoplastic materials are cast between them. Preferably, this casting will last about 40 series. It is a synthetic rubber with a hardness of Yoar A. Surprisingly, such an arrangement requires a high Although large friction losses may be expected, the losses actually encountered are very small. The reason is that the actual frequency and vibration speed are very low in the encapsulated area. It is the body. Therefore, the separation of things from the fluid removed from the patient's body This is done without reducing the vibrational forces transmitted to the working tip of the suction device. Seal 3 46 also separates a quantity from the atmosphere.

Now, with reference to Figure 24, seal 340 indicates that fluid removed from the patient is Avoid flowing under or outside the resonator, such as between the vibrator 14 and the lower lumen 314. protect people. However, this seal 340 is not compatible with the cast sealing material 346. does not eliminate the need to This is because the cast sealing material prevents fluids from entering. used for.

It is located in the lower lumen 318 and prevents contamination of the side of the entire suction device. There is.

Now referring to Figures 25-27, an illustrated illustration of the resonator 314 of the present invention is provided. There are various complementary modified working tip devices and arrangements. As shown in Figure 27, The working tip is partially bent, which gives benefits, allowing for precise cutting of biological materials. It can be a lost groove.

This same effect can be achieved by tapering the tip and by narrowing the groove media. However, other arrangements can be made by reducing the cross-sectional area. example For example, by gradually reducing the cross-sectional area or dimensions of the groove media, or by reducing the By arranging the open area of the working tip in a different manner with dimensions smaller than 14 can.

In other embodiments, as shown in FIGS. 25 and 27, the tip is at the working tip. to form part of a tubular device whose diameter is also reduced or limited. The end of the tube may have one end with a tube limiting the outer diameter at the working tip. limited by the method of pleating over the ends of the web or the overlap 350. can be done. This tubular design prevents occlusion of the resonator tube 314. benefits are being brought about. The reason is that which biological material was removed However, in order to pass through the tube 314, a smaller hole in the open tip is passed through. Because it has to pass. Biological material removed such as suction When used to recover material, the removed material is thus removed from the tube 14. may not be able to block it.

The invention disclosed in this document is well designed to carry out the objectives stated above. Although it is clear that the It is understood that this may be amended with further skill. Additionally, additional requests may apply to current inventions. It covers all such modifications and embodiments as come within the true spirit and scope of the Terms.

E 2 Diagram Rishichi's residence φτ face is V I O Kar ° T residence Hajika naru pIG6 Engraving (no changes to the content) Fang 13 diagram FIG. 21 FIG. 25 Procedural amendment C′j5 illusion January 20, 1986 Mr. Kunio Kogawa, Commissioner of the Patent Office 1. International application number PCT/US 861017382, title of invention Endoscopic ultrasound wave extractor 3. Person who makes corrections Relationship to the incident: Patent applicant Name: Sonomed Technology, Incorporated 4, Agent Address (100) Shin-Marunouchi Building, 5-1 Marunouchi-chome, Chiyoda-ku, Tokyo 3rd floor, Ward 44 (telephone 214-0502) 6, Subject of amendment (1) Patent Law Article 184 5. The columns for the name of the invention, inventor, and patent applicant in the document pursuant to the provisions of Paragraph 1.

(2) Translations of the specification and claims, and translations of drawings.

(3) Power of attorney.

Contents of correction (1) The name of the invention and the inventor in writing pursuant to the provisions of Article 184-5, Paragraph 1 of the Patent Act. Correct the name as shown in the attached request for correction and fill in the name of the representative in the patent applicant column.

(2) Attach a translation of the specification on page 1, a translation of the claims on page 66, and a translation of the drawings. Correct as indicated.

(3) Submit a power of attorney (original text and translation).

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Claims (25)

[Claims] 1. In the vibration device, a vibration source emitting a high frequency and a first amplitude, an input terminal and an output terminal; The terminal is connected to the vibration source vibrated by it, and the output terminal responds to this vibration. a first transformer that vibrates to produce vibrations with a second amplitude greater than the first amplitude; an input terminal and an output terminal, the input terminal being connected to a first transformer vibrated by the input terminal; coupled to an output terminal, the output terminal being coupled to a second or greater amplitude in response to the vibration; a second transformer vibrating with a third amplitude of vibration; When stretched and vibrating, all wavelengths are exposed to a sufficient degree of constant mechanical pressure. have a good relationship. 2. The vibrating device according to claim 1 further forms a side part, and the above-mentioned vibration source is The first transformer input part mentioned above is embedded in the side part, and the cross section is relatively large, and the transformer output section described above has a relatively small cross-section. 3. In the vibrating device according to claim 1 or 2, the first and second transformers and the vibrating The source is elongated and has a longitudinal axis, at least Due to the selected angle of cancellation, the section is moved from the longitudinal axis of the vibration source to a second transformer. It is curved to compensate for the longitudinal axis of the vessel. 4. In claim 1, 2 or 3, the vibration source and the two transformers are It vibrates in relation to the stationary point and antinodes of the alternating vibrating body, and the source of the vibration is A flexible means is used between the inside of the armpit and the vibration source at the rest point of the vibrating body of the vibration source. It is fitted into the armpit. And the first transformer is inside the armpit and , separated by flexible means between the rest point of the vibrating body of the first transformer and the first transformer. It can be fitted inside. The stationary point of the second vibrator is at the input of the first transformer. It is near the connection point between the force and the output part. 5. The vibrating device of claims 2, 3, or 4 further comprises an output of a second transformer. In order to see the working position leading to the terminal from the side part, insert it into the side part. It forms a medium through which images are viewed. 6. The medium defined in claim 5 has been extended for a long time, but from the sidebar, the above two transformer and extend into an operating position along a path almost parallel to the first output section mentioned above. , and passes through the groove forming in the input section of the first transformer mentioned above. 7. Endoscopic ultrasound aspirator including: hollow surgical armpit; There is a hollow hole that leads to the inside of the armpit and an active terminal that is separated from the armpit. Stretched sheath. A side arm that generates mechanical vibrations in response to alternating current supplied to the vibration source described above. Internal vibration source. Means for supplying such alternating current electricity to the above-mentioned vibration source. To send such mechanical vibrations to the work area, a working Extended tool means passed through a hollow hole in the sheath and connected to a vibration source to a moving location . In order to consider the operating location from the side, A means of viewing that extends the range to the operating location. directing fluid into a delimited fluid space between said tool means and said sheath hollow hole; Means of supply. terminating such supplied alternating current, thereby when there is no such fluid , to stop such mechanical vibrations, connect to a method of supplying alternating current, and fluid detection means for detecting the presence of fluid between the fluids; 8. 8. The apparatus of claim 7 for sensing power capacitance in a fluid space. capacitance below a predetermined level to indicate the absence of fluid. to terminate the alternating current thus supplied, the fluid detection means , including electrical means coupled to the fluid space. 9. In a device as claimed in claim 8, a conductive probe is provided by electrical means as described above. The above-mentioned capacitance also includes the above-mentioned stylet and the above-mentioned tool means. Measured between. 10. In the device as claimed in claim 9, the above-mentioned stylet is located inside the sheath. It is operated as an analogue of tool means. 11. In the device as claimed in claim 9, the fluid is exposed to the fluid from the fluid space mentioned above. In the sheath, through the second hole, the means of viewing is widened. In other words, The needle is located inside the second hole mentioned above. 12. In the device as claimed in claim 7, 8, 9, 10 or 11, the above-mentioned The tool means and the working tip means described above each include an open groove means and a resilient plug. In the shape thereof, means for supporting the above-mentioned open groove means are formed. Furthermore, that forming means for sealing a pair between said open groove means and said vibration source; There is. 13. In the device as claimed in claim 7, 8, 9, 10 or 11, the above-mentioned the tool means form a cylindrical tubular means, the said working tip being the said smaller tool means; tapered, pleated, or along the outer diameter to provide a hole. The cylindrical tubular shape means described above increases the diameter of the hole by blocking it. It's small. 14. An undesirable biological substance removal device consisting of: (a) Surgical armpit (b) Extending from the surgical armpit, thereby providing a hollow-hole elongated The scabbard. (c) located within the surgical armpit; is a vibration device of 5; the first and second transformers are in the sheath and within a certain distance from it; It is located inside a hollow hole. Also, the second transformer is The first one is used to amplify the vibrations to a speed sufficient to break down unwanted tissues. Connected to a transformer. (d) said second transformer extends beyond the end of the sheath away from the surgical armpit; It has an extended working tip. (e) The above-mentioned vibration source and the above-mentioned two transformers are stretched, so that and for that purpose a continuous line extending along a general longitudinal axis forming a It has a hollow hole. : (i) an initial fluid passage in a defined space between the transformer and the sheath; (ii) a second fluid passageway secondary to the above-mentioned general longitudinal axis; (f) Fluid communication as described above to clean the surgical site, which is land-locked to the second working tip. passage means for introducing into one of the channels; and (g) suction into another of the above-mentioned fluid passages to remove such fluid; a means of providing relief and disintegrating unwanted tissue from such surgical sites. 15. 15. The apparatus of claim 14, further comprising applying suction to said other fluid passageway. The method described above includes hose means for receiving such fluid and tissue. ; The biopsy valve means is a fluid hose with a selectable direction from the above-mentioned hose means. coupled with said hose means to the tissue; a fluid selected from the hose means described above to filter the selected tissue; a biopsy trap for receiving tissue; and a pump for applying suction to the above-mentioned biopsy trap means and the above-mentioned hose means. method. 16. In the device according to claim 15, the hose means does not allow selection of direction change. It consists of a primary trapping method for receiving fluid and tissue. with that device The above-mentioned operating tip is dull. 17. In claim 14 or 15, while using the suction device, viewing the tip as described above. In order to facilitate this, open groove means are further formed in the above-mentioned working tip. 18. In claim 14, 15, or 16, the vibration source and transformer described above The entire length of the continuous hollow hole is such that it partially receives, retains and supports the aforementioned observation means. , shaped and dimensioned in the form of an open groove method. and the above Aspirator means are kept to a minimum. 19. In claim 17 or 18, the above-mentioned open groove means is U or V. It has a cross-sectional shape of 20. In claim 14, 15 or 16, the actuating tip means as described above is separate from the armpit and extend beyond the edge of the sheath; i.e. the second mentioned above. The aforementioned actuating tip means of smaller dimensions than the output terminals of the transformer. 21. According to claim 20, said second transformer comprises a first cylindrical tubular means. and said working tip is of a smaller diameter than said first tubular means. A second cylindrical tubular means is formed. 22. In claim 20, the second transformer is a second transformer of smaller diameter. The dimensions of the tubular means taper in diameter. 23. relatively deep and flexible within the biological body through narrow holes that form How to remove cellular material from tissues: This causes a build-up of pressure inside the working tip of the orifice near the material being removed. Plug in the device according to one of the requirements range 8 to 22; and , to hollow out the intracellular fluid in such substances in order to destroy the cells. vibrate the working tip described above. 24. 24. The method of claim 23, at a frequency of about 10-20 kHz. This includes vibrating the actuating tip described above. 25. 24. The method of claim 23, wherein the longitudinal swath is at least about 350 microns. the above-mentioned working tip at a maximum speed of at least 1,000 cm/sec. It includes vibrating.