US20030171747A1 - Medical treatment instrument - Google Patents
Medical treatment instrument Download PDFInfo
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- US20030171747A1 US20030171747A1 US09/793,431 US79343101A US2003171747A1 US 20030171747 A1 US20030171747 A1 US 20030171747A1 US 79343101 A US79343101 A US 79343101A US 2003171747 A1 US2003171747 A1 US 2003171747A1
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- treatment
- treatment instrument
- grasp
- portions
- patient
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3201—Scissors
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
- A61B18/082—Probes or electrodes therefor
- A61B18/085—Forceps, scissors
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B46/00—Surgical drapes
- A61B46/20—Surgical drapes specially adapted for patients
- A61B46/23—Surgical drapes specially adapted for patients with means to retain or hold surgical implements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2945—Curved jaws
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B2018/1405—Electrodes having a specific shape
- A61B2018/1425—Needle
- A61B2018/1432—Needle curved
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
- A61B2018/1455—Probes having pivoting end effectors, e.g. forceps including means for cutting having a moving blade for cutting tissue grasped by the jaws
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
- A61B2018/1457—Probes having pivoting end effectors, e.g. forceps including means for cutting having opposing blades cutting tissue grasped by the jaws, i.e. combined scissors and pliers
Definitions
- the present invention relates to a medical treatment instrument such as scissor forceps used for coagulating and cutting blood vessels or the like by inserting it into the patient's body cavity.
- a pair of electric heating type scissors is disclosed in German Patent DE 297 02 608 U1.
- This pair of electric heating type scissors is provided with two scissor constituent members rotatably coupled with each other around a rotating movement pin.
- a layer capable of electric heating is provided at a part of a dissection region disposed at the tip of these scissor constituent members.
- the two scissor constituent members are formed by relatively sharp cutting blades with thin plate thickness, respectively.
- a contact area between these two scissor constituent members and the patient's body tissue is reduced.
- the patient's body tissue such as blood vessel cannot be sufficiently compressed between the two scissor constituent members, and the patient's body tissue such as blood vessel cannot be thermally coagulated.
- U.S. Pat. No. 5,342,381 there is disclosed a treatment instrument in which a treatment portion comprising a pair of treatment members capable of being opened and closed is arranged at the tip of the main body of the treatment instrument, and a frontal operating portion for opening/closing a pair of treatment members is arranged at the proximal end of the main body of the treatment instrument.
- a grasp portion for grasping patient's body tissues is arranged at the tip side of the treatment section, and a dissection scissors section is arranged at the rear end of this grasp portion.
- a bipolar high-frequency current is supplied to the grasp portion during in use; the patient's body tissue grasped by the grasp portion is coagulated by this high-frequency current, and then, a coagulation section of this patient's body tissue is cut at the scissors section.
- the treatment instrument disclosed in U.S. Pat. No. 5,342,381 is configured to supply a bipolar high-frequency current to the grasp portion at the tip side of the treatment section, so that a portion of the scissors section at the rear end of the grasp portion cannot be made of metal. Therefore, in the treatment instrument disclosed in U.S. Pat. No. 5,342,381, the scissors portion of the treatment section is composed of an insulator consisting of ceramics. However, thus, there is a problem that, when a ceramic based scissors portion is used, the dissection capability is gradually degraded due to a friction between slide portions of the scissors portion during in use.
- the present invention has been achieved in view of the foregoing circumference. It is an object of the present invention to provide a medical treatment instrument capable of reliably thermally coagulating a patient's body tissue such as blood vessel grasped between a pair of treatment members and capable of reducing degradation of the dissection capability of a dissection portion due to a scissors during in use and maintaining sharpness of the dissection portion for a long period of time.
- a medical treatment instrument used for coagulating and cutting the patient's body tissue comprising:
- a frontal operating portion arranged at the proximal end of the treatment instrument, the operating portion opening and closing a pair of the grasp portions;
- a heat generating portion provided on at least one of the grasp portions, the heat generating portion current-carried and heated to coagulate the patient's body tissue grasped between the grasp portions;
- a cutting portion disposed at each of the grasp portions, the cutting portion cutting the patient's body tissue.
- the heat generating portion at the tip side in the treatment portion is current-carried and heated, and the patient's body tissue such as blood vessel wall grasped between a pair of grasp portions is coagulated by heat of the heat generating portion and is welded. Then, the coagulated site of the patient's body tissue is cut by the cutting portion with a pair of scissors on the rear side of the grasp portions in the treatment portion.
- the heat generating portion to be current-carried and heated is provided at least at one grasp portion on the tip side of the treatment portion; the patient's body tissue grasped between a pair of the grasp portions is coagulated by heat of the heat generating portion, and the cutting portion with the scissors and cutting the patient's body tissue on the rear side of the grasp portions is provided.
- the patient's body tissue such as blood vessel grasped between a pair of the grasp portions can be reliably thermally coagulated by heat of the heat generating portion.
- degradation of the cutting capability of the cutting portion due to the scissors during in use is reduced, and the sharpness of the cutting portion can be maintained for a long period of time.
- FIG. 1 is a schematic structural view illustrating an entire system of a medical treatment instrument according to a first embodiment of the present invention
- FIG. 2 is a perspective view of a scissor forceps in the medical treatment instrument according to the first embodiment
- FIG. 3 is a perspective view showing a tip grasp portion and a blade portion of the scissor forceps according to the first embodiment
- FIG. 4 is a longitudinal sectional view illustrating an internal structure of the tip grasp portion of the scissor forceps according to the first embodiment
- FIG. 5A is a view for illustrating a release process of a blood vessel using the scissor forceps according to the first embodiment
- FIG. 5B is a view for illustrating a coagulation process of a blood vessel
- FIG. 5C is a view for illustrating a dissection process of a blood vessel
- FIG. 6 is a perspective view showing a structure of essential portions of the scissor forceps according to a second embodiment of the present invention.
- FIG. 7 is a perspective view showing a scissor forceps according to a third embodiment of the present invention.
- FIG. 8A is a sectional perspective view showing a tip grasp portion of the scissor forceps according to the third embodiment
- FIG. 8B is a cross sectional view taken along the line VIIIB-VIIIB;
- FIG. 8C is a cross sectional view of essential portions showing a modified example of the scissor forceps according to the third embodiment
- FIG. 9A is a side view showing the entire surgical treatment instrument in a fourth embodiment of the present invention.
- FIG. 9B is a side view of essential portions showing an opened state of a tip grasp portion of the surgical treatment instrument according to the fourth embodiment
- FIG. 10 is a schematic structural view of essential portions showing a fifth embodiment of the present invention.
- FIG. 11 is a perspective view of the entire medical treatment instrument showing a sixth embodiment of the present invention.
- FIG. 12 is a schematic structural view showing the entire system of the medical treatment instrument according to a seventh embodiment of the present invention.
- FIG. 13 is a cross sectional view taken along the line XIII-XIII of FIG. 12;
- FIG. 14A is a longitudinal sectional view of essential portions showing an eighth embodiment of the present invention.
- FIG. 14B is a longitudinal sectional view of essential portions showing a ninth embodiment of the present invention.
- FIG. 14C is a longitudinal sectional view of essential portions showing a tenth embodiment of the present invention.
- FIG. 14D is a longitudinal sectional view of essential portions showing an eleventh embodiment of the present invention.
- FIG. 15 is a plan view of the entire forceps showing a twelfth embodiment of the present invention.
- FIG. 16A is a cross sectional view taken along the line 16 A- 16 A of FIG. 15 showing a state in which a heat generating section for dissection treatment in the forceps of the twelfth embodiment is maintained at a standby position departed from a heat generating section for coagulating treatment;
- FIG. 16B is a cross sectional view taken along the line 16 B- 16 B of FIG. 16A;
- FIG. 17A is a longitudinal sectional view of essential portions of scissor constituent members showing a state in which the heat generating section for dissection treatment in the forceps according to the twelfth embodiment is brought into contact with the heat generating section for coagulating treatment;
- FIG. 17B is a cross sectional view taken along the line 17 B- 17 B of FIG. 17A;
- FIG. 18 is a schematic structural view showing the entire system of a medical treatment instrument according to a thirteenth embodiment of the present invention.
- FIG. 19 is a schematic structural view showing an electric circuit of a power supply unit in the medical treatment instrument system according to the thirteenth embodiment
- FIG. 20A is a side view showing the entire medical treatment instrument according to a fourteenth embodiment of the present invention.
- FIG. 20B is a side view of essential portions showing an opened state of a grasp element of the treatment section in the medical treatment instrument according to the fourteenth embodiment
- FIG. 21 is an entire side view showing a medical treatment instrument according to a fifteenth embodiment of the present invention.
- FIG. 22A is a plan view of essential portions showing a curve portion of an opening/closing element of the medical treatment instrument according to the fifteenth embodiment of the present invention.
- FIG. 22B is a cross sectional view showing a treatment section of the medical treatment instrument according to the fifteenth embodiment
- FIG. 23A is a plan view of essential portions showing a curve portion of a grasp portion in a medical treatment instrument according to a sixteenth embodiment of the present invention.
- FIG. 23B is a cross sectional view of the curve portion in the medical treatment instrument according to the sixteenth embodiment.
- FIG. 24 is a cross sectional view of essential portions showing a medical treatment instrument according to a seventh embodiment of the present invention.
- FIG. 25 is a plan view of essential portions showing the curve portion of a grasp portion of a medical treatment instrument according to an eighteenth embodiment of the present invention.
- FIG. 26 is a cross sectional view of essential portions showing the medical treatment instrument according to a nineteenth embodiment of the present invention.
- FIG. 27 is a schematic structural view showing the entire system of a medical treatment instrument according to a twentieth embodiment of the present invention.
- FIG. 28 is an entire plan view showing the medical treatment instrument according to a twenty-first embodiment of the present invention.
- FIG. 29A is a plan view showing a state in which a scissor blade of the medical treatment instrument according to the twenty-first embodiment is slid to the tip side;
- FIG. 29B is a cross sectional view taken along the line 29 B- 29 B of FIG. 29A;
- FIG. 30 is a cross sectional view of essential portions showing a medical treatment instrument according to a twenty-second embodiment of the present invention.
- FIG. 31 is a cross sectional view of essential portions showing a medical treatment instrument according to a twenty-third embodiment of the present invention.
- FIG. 32 is a structural side view of essential portions showing a coagulating/dissection treatment instrument according to a twenty-fourth embodiment of the present invention.
- FIG. 33 is an entire plan view showing a coagulating/dissection treatment instrument according to a twenty-fifth embodiment of the present invention.
- FIG. 34A is a perspective view showing a mount state of heating elements on a grasp surface of one jaw in the coagulating/dissection treatment instrument according to the twenty-fifth embodiment
- FIG. 34B is a perspective view showing a guide groove of a grasp surface of the other jaw in the coagulating/dissection treatment instrument according to the twenty-fifth embodiment
- FIG. 35A is a side view of the entire coagulating treatment instrument according to a twenty-sixth embodiment of the present invention.
- FIG. 35B is a plan view showing the curve shape of the jaw of the coagulating treatment instrument according to the twenty-sixth embodiment
- FIG. 35C is a perspective view showing a non-slip teeth section of the patient's body tissues of a heating element in the coagulating treatment instrument according to the twenty-sixth embodiment
- FIG. 36A is an enlarged side view showing the jaw section of the coagulating treatment instrument according to the twenty-sixth embodiment
- FIG. 36B is a cross sectional view taken along the line 36 B- 36 B of FIG. 36A;
- FIG. 37 is a perspective view of essential portions showing a modified example of the jaw of the coagulating treatment instrument according to the twenty-sixth embodiment
- FIG. 38 is a cross sectional view of essential portions of a coagulating treatment instrument showing a twenty-seventh embodiment of the present invention.
- FIG. 39A is a side view of the entire coagulating treatment instrument showing a twenty-eighth embodiment of the present invention.
- FIG. 39B is a sectional side view of essential portions showing a part of jaw of the coagulating treatment instrument according to the twenty-eighth embodiment
- FIG. 40A is a sectional side view partially showing a state before mounting an intermediate connecting member of the jaw in the coagulating treatment instrument according to the twenty-eighth embodiment
- FIG. 40B is a cross sectional view taken along the line 40 B- 40 B of FIG. 40A;
- FIG. 40C is a longitudinal section view showing a modified example of a structure for mounting the connection pin of the connection plate according to the twenty-eighth embodiment
- FIG. 41A is a longitudinal sectional view showing a first modified example of a structure for mounting the intermediate connecting member in the coagulating treatment instrument according to the twenty-eighth embodiment
- FIG. 41B is a longitudinal sectional view showing a second modified example of a structure for mounting the intermediate connecting member in the coagulating treatment instrument according to the twenty-eighth embodiment
- FIG. 42A is a sectional side view partially showing a state before mounting the intermediate connecting member of the jaw in the coagulating treatment instrument according to a twenty-ninth embodiment of the present invention
- FIG. 42B is a cross sectional view taken along the line 42 B- 42 B of FIG. 42A;
- FIG. 43 is a sectional side view partially showing a state before mounting the intermediate connecting member of the jaw in the coagulating treatment instrument according to a thirtieth embodiment of the present invention.
- FIG. 44 is a perspective view showing a schematic configuration of the entire system of a coagulating treatment instrument according to a thirty-first embodiment of the present invention.
- FIG. 45 is a schematic structural view showing an electric circuit of the coagulating treatment instrument system according to the thirty-first embodiment
- FIG. 46 is a flowchart showing an operation of the coagulation treatment instrument according to a thirty-second embodiment of the present invention.
- FIG. 47A is a perspective view showing a schematic configuration of the entire system of a coagulating treatment instrument in a thirty-third embodiment of the present invention.
- FIG. 47B is a schematic structural view showing an electric circuit of the coagulating treatment instrument system according to the thirty-third embodiment
- FIG. 48A is a front view of the entire coagulating treatment instrument showing a thirty-fourth embodiment of the present invention.
- FIG. 48B is a plan view showing a curve shape of the jaw of the coagulating treatment instrument according to the thirty-fourth embodiment
- FIG. 48C is a perspective view of a heater cover of an upper jaw according to the thirty-fourth embodiment
- FIG. 48D is a longitudinal sectional view of essential portions showing the tissue adhesion preventing treatment portion of the cover according to the thirty-fourth embodiment
- FIG. 49A is a perspective view of a heater cover of an upper jaw of a coagulating treatment instrument according to a thirty-fifth embodiment of the present invention.
- FIG. 49B is a longitudinal sectional view of the heater cover in the coagulating treatment instrument according to the thirty-fifth embodiment
- FIG. 50A is an enlarged perspective view showing a heater cover of a jaw of a coagulating treatment instrument according to a thirty-sixth embodiment of the present invention.
- FIG. 50B is a perspective view showing a modified example of the heater cover of the jaw of the coagulating treatment instrument according to the thirty-sixth embodiment
- FIG. 51A is a front view of the entire coagulating treatment instrument showing a thirty-seventh embodiment of the present invention.
- FIG. 51B is a front view of a heater unit according to the thirty-seventh embodiment
- FIG. 51C is a cross sectional view taken along the line 51 C- 51 C of FIG. 51B;
- FIG. 52A is a front view showing a state in which a heater unit is mounted on the coagulating treatment instrument according to the thirty-seventh embodiment
- FIG. 52B is a perspective view of essential portions showing a modified example of the coagulating treatment instrument according to the thirty-seventh embodiment
- FIG. 53A is a front view of the entire coagulating treatment instrument showing a thirty-eighth embodiment of the present invention.
- FIG. 53B is an enlarged front view showing the jaw at the tip of the coagulating treatment instrument according to the thirty-eighth embodiment
- FIG. 54A is a front view showing a state in which the coagulating treatment instrument according to the thirty-eighth embodiment is closed to a position at which the treatment instrument abuts against a stopper, and a closing force is applied to the jaw;
- FIG. 54B is an enlarged front view showing the jaw at the tip of the coagulating treatment instrument according to the thirty-eighth embodiment
- FIG. 54C is a front view of essential portions showing a modified example of the coagulating treatment instrument according to the thirty-eighth embodiment
- FIG. 55A is a front view of the entire coagulating treatment instrument showing a thirty-ninth embodiment of the present invention.
- FIG. 55B is an enlarged front view showing the jaw at the tip of the coagulating treatment instrument according to the thirty-ninth embodiment
- FIG. 55C is a cross sectional view taken along the line 55 C- 55 C of FIG. 55B;
- FIG. 55D is a cross sectional view taken along the line 55 D- 55 D of FIG. 55B;
- FIG. 55E is a cross sectional view taken along the line 55 E- 55 E of FIG. 55A;
- FIG. 55F is a cross sectional view taken along the line 55 F- 55 F of FIG. 55A;
- FIG. 55G is a cross sectional view of essential portions showing a modified example of the coagulating treatment instrument according to the thirty-ninth embodiment
- FIG. 56A is a front view of the entire coagulating treatment instrument showing a fortieth embodiment of the present invention.
- FIG. 56B is an enlarged front view showing the jaw at the tip of the coagulating treatment instrument according to the fortieth embodiment
- FIG. 56C is a cross sectional view taken along the line 56 C- 56 C of FIG. 56B;
- FIG. 56D is a cross sectional view taken along the line 56 D- 56 D of FIG. 56B;
- FIG. 56E is a cross sectional view taken along the line 56 E- 56 E of FIG. 56A;
- FIG. 56F is a cross sectional view taken along the line 56 F- 56 F of FIG. 56A;
- FIG. 57A is a front view of the entire coagulating treatment instrument showing a forty-first embodiment of the present invention.
- FIG. 57B is a plan view showing the coagulating treatment instrument according to the forty-first embodiment
- FIG. 57C is an enlarged front view showing the jaw at the tip of the coagulating treatment instrument according to the forty-first embodiment
- FIG. 57D is a cross sectional view taken along the line 57 D- 57 D of FIG. 57C;
- FIG. 57E is a cross sectional view taken along the line 57 E- 57 E of FIG. 57C;
- FIG. 57F is a cross sectional view taken along the line 57 F- 57 F of FIG. 57A;
- FIG. 58 is a general view of a coagulating/cutting system according to a forty-second embodiment of the invention.
- FIG. 59 is a perspective view of a treatment portion according to the forty-second embodiment.
- FIG. 60 is a sectional view taken along line 60 - 60 of FIG. 59;
- FIG. 61A is a longitudinal sectional view of a principal part of the system, showing a state in which an organism tissue is held stressed under a force of pressure that suits a coagulative treatment, by means of the treatment portion of the forty-second embodiment;
- FIG. 61B is a longitudinal sectional view of the principal part, showing a state in which a weakened organism tissue is cut and incised;
- FIG. 62 is a diagram showing an electric circuit of a power source unit according to the forty-second embodiment
- FIG. 63 is a sectional view of holding portions of a thermocoagulation cutting forceps according to a forty-third embodiment of the invention.
- FIG. 64 is a sectional view of holding portions of a thermocoagulation cutting forceps according to a forty-fourth embodiment of the invention
- FIG. 65 is a sectional view of holding portions of a thermocoagulation cutting forceps according to a forty-fifth embodiment of the invention.
- FIG. 66 is a sectional view of holding portions of a thermocoagulation cutting forceps according to a forty-sixth embodiment of the invention.
- FIG. 67 is a sectional view of a holding portion of a thermocoagulation cutting forceps according to a forty-seventh embodiment of the invention.
- FIG. 68A is a sectional view of a holding portion of a thermocoagulation cutting forceps according to a forty-eighth embodiment of the invention.
- FIG. 68B is a sectional view showing a modification of the heating portion of FIG. 68A;
- FIG. 68C is a sectional view showing another modification of the heating portion of FIG. 68A;
- FIG. 69 is a sectional view of a holding portion of a thermocoagulation cutting forceps according to a forty-ninth embodiment of the invention.
- FIG. 70A is a sectional view of a holding portion of a thermocoagulation cutting forceps according to a fiftieth embodiment of the invention.
- FIG. 70B is a perspective view showing holding portions of the forceps of the fiftieth embodiment
- FIG. 71A is a diagram showing bars indicative of the temperature level, on a display portion of a power source unit according to a fifty-first embodiment of the invention.
- FIG. 71B is a diagram showing a figure indicative of the temperature level, on the display portion of the power source unit of the fifty-first embodiment
- FIG. 72 is a graph showing the relation between the set level and the heating temperature displayed on the display portion of the power source unit of the fifty-first embodiment
- FIG. 73 is a perspective view of an operating portion of a thermocoagulation cutting forceps according to a fifty-second embodiment of the invention.
- FIG. 74 is a perspective view of a thermocoagulation cutting forceps according to a fifty-third embodiment of the invention.
- FIG. 75 is a perspective view of a thermocoagulation cutting forceps according to a fifty-fourth embodiment of the invention.
- FIG. 76 is a sectional view taken along line 76 - 76 of FIG. 75;
- FIG. 77A is a side view, partially in section, showing an open state of holding portions of a thermocoagulation cutting forceps according to a fifty-fifth embodiment of the invention.
- FIG. 77B is a side view, partially in section, showing a closed state of the holding portions of the forceps of the fifty-fifth embodiment
- FIG. 78A is a side view, partially in section, showing an open state of holding portions of a thermocoagulation cutting forceps according to a fifty-sixth embodiment of the invention.
- FIG. 78B is a side view, partially in section, showing a closed state of the holding portions of the forceps of the fifty-sixth embodiment
- FIG. 79A is a side view, partially in section, showing an open state of holding portions of a thermocoagulation cutting forceps according to a fifty-seventh embodiment of the invention.
- FIG. 79B is a side view, partially in section, showing a closed state of the holding portions of the forceps of the fifty-seventh embodiment
- FIG. 80A is a side view, partially in section, showing an open state of holding portions of a thermocoagulation cutting forceps according to a fifty-eighth embodiment of the invention.
- FIG. 80B is a side view, partially in section, showing a closed state of the holding portions of the forceps of the fifty-eighth embodiment
- FIG. 81 is a schematic structural view illustrating an entire system of a surgical instrument denoting a thermocoagulation cutting forceps according to a fifty-ninth embodiment of the present invention
- FIG. 82 is a side view showing the thermocoagulation cutting forceps according to the fifty-ninth embodiment of the present invention.
- FIG. 83 is a perspective view of the holding portion of the thermocoagulation cutting forceps according to the fifty-ninth embodiment of the present invention.
- FIG. 84 is a cross sectional view along the line 84 - 84 shown in FIG. 83;
- FIG. 85 is an electrical circuit diagram of the fifty-ninth embodiment of the present invention.
- FIG. 86 of a graph relating to the fifty-ninth embodiment of the present invention.
- FIG. 87A is a cross sectional view showing the state that a ceramic heater is arranged in a treatment portion included in the thermocoagulation cutting forceps according to a sixtieth embodiment of the present invention.
- FIG. 87B is a cross sectional view showing a first modification of the treatment portion included in the thermocoagulation cutting forceps according to the sixtieth embodiment of the present invention.
- FIG. 87C is a cross sectional view showing a second modification of the treatment portion included in the thermocoagulation cutting forceps according to the sixtieth embodiment of the present invention.
- FIG. 87D is a cross sectional view showing a third modification of the treatment portion included in the thermocoagulation cutting forceps according to the sixtieth embodiment of the present invention.
- FIG. 87E is a cross sectional view of a gist portion exemplifying another construction of a third modification of the second holding portion included in the thermocoagulation cutting forceps according to the sixtieth embodiment of the present invention.
- FIG. 87F is a cross sectional view of a gist portion exemplifying still another construction of a third modification of the second holding portion included in the thermocoagulation cutting forceps according to the sixtieth embodiment of the present invention.
- FIG. 88 is a perspective view showing a thermocoagulation cutting forceps according to a sixty-first embodiment of the present invention.
- FIG. 89A is a side view showing the entire scissors type coagulation treating instrument according to a sixty-second embodiment of the present invention.
- FIG. 89B is a plan view showing the treatment portion of the scissors type coagulation treating instrument according to the sixty-second embodiment of the present invention.
- FIG. 89C is a perspective view showing the jaw of the scissors type coagulation treating instrument according to the sixty-second embodiment of the present invention.
- FIG. 90 is a side view showing the entire thermocoagulation cutting forceps according to a sixty-third embodiment of the present invention.
- FIG. 91 is a cross sectional view, partly broken away, showing the treatment portion included in the thermocoagulation cutting forceps according to the sixty-third embodiment of the present invention.
- FIG. 92 is a perspective view showing a housing case for housing the coagulation treating instrument according to a sixty-fourth embodiment of the present invention.
- FIG. 93 is a perspective view showing how to use the housing case according to the sixty-fourth embodiment of the present invention.
- FIG. 94 is a side view showing the entire ultrasonic wave coagulation cutting instrument according to a sixty-fifth embodiment of the present invention.
- FIG. 95 is a perspective view showing the treatment portion according to the sixty-fifth embodiment of the present invention.
- FIG. 96 is a cross sectional view at the time when the treatment portion according to the sixty-fifth embodiment of the present invention is closed.
- FIG. 1 shows a schematic configuration of the entire system of a medical treatment instrument 1 according to the present embodiment.
- the medical treatment instrument 1 of the present embodiment is provided with a pair of scissor forceps 2 and a generator 3 connected to this scissor forceps 2 .
- a forceps main body (treatment instrument main body) 4 of the scissor forceps 2 is provided with two scissor constituent members 5 and 6 as shown in FIG. 2. These scissor constituent members 5 and 6 are placed so that their intermediate portions substantially cross with each other. Further, a support shaft 7 rotatably linking the scissor constituent members 5 and 6 with each other is arranged at a cross section of both of these scissor constituent members 5 and 6 .
- a treatment portion 10 comprising a pair of opening/closing elements 8 and 9 capable of being opened or closed is formed at the tip of the forceps main body 4 .
- This treatment portion 10 is molded in the substantially same shape as that in a release forceps.
- substantially elliptical rings 11 and 12 for receiving fingers are formed at the proximal ends of the scissor constituent members 5 and 6 , respectively.
- a frontal operating portion 13 for opening/closing a pair of opening/closing elements 8 and 9 is formed by portions of these rings 11 and 12 .
- a grasp portion 14 for grasping patient's body tissues is disposed at the tip side, for example, with a length of about 2 cm from the tips of the opening/closing elements 8 and 9 , respectively.
- a substantially planar wide contact plate 15 is arranged at the inner surface side of this grasp portion 14 (an opposite surface to the other grasp portion 14 ), as shown in FIG. 3.
- This contact plate 15 is formed by a metal material with its high thermal conductivity, for example, brass.
- a substantially serrate grasp surface 16 having a plurality of protrusions and recesses arranged thereon is formed on the outer surface of this contact plate 15 .
- a Teflon-coating layer 17 preventing a scorch of patient's body tissues is formed on the outer surface of the contact plate 15 (contact surface with the patient's body tissues).
- a heating element (heat generating section) 18 is arranged inside the grasp portion 14 of each of the opening/closing elements 8 and 9 , as shown in FIG. 4.
- This heating element 18 is formed, for example, by a ceramic heater or a heating element current-carried and heated to generate heat such as metal resistor.
- This heating element 18 is fixed to the inner surface of each contact plate 15 . In this manner, when the heating element 18 is current-carried, heat of the heating element 18 is transmitted via the contact plate 15 so that the patient's body tissue grasped between the grasp portions 14 is coagulated.
- a stainless back plate member 19 is arranged at an opposite side to that of the contact plate 15 in each grasp portion 14 .
- a coat layer 20 to which a heat resistance coating is applied is formed on the outer surface of this stainless back plate member 19 .
- a lead wire 21 is connected to the heating element 18 . At the other end, this lead wire 21 is extended to the frontal operating portion 13 side.
- a cable connection portion 22 is protruded on the peripheral surface of one ring 11 at the operating portion 13 . At the other end, the lead wire 21 is connected to the inner end of the cable connection portion 22 .
- a connector 24 arranged at the other end of the connector cable 23 connected to the generator 3 at one end is detachably connected to this cable connection portion 22 .
- the heating element 18 is current-carried from the generator 3 via the connector cable 23 and the lead wire 21 , and the heating element 18 is current-carried so as to generate heat.
- an ON/OFF operation switch 25 for heat generation due to the heating element 18 is arranged in the vicinity of the ring 11 .
- a single-blade scissor blade (dissection portion) 26 is formed on the rear side of the grasp portion 14 in each of the opening/closing elements 8 and 9 .
- This scissor blade 26 is molded integrally with the back plate member 19 in each grasp portion 14 by a stainless material, for example.
- a coat layer 20 is not formed at a portion of this scissor blade 26 , and a stainless metal surface is exposed.
- a metal scissors dissection portion 27 for cutting a patient's body tissue by the scissor blades 26 of both of the opening/closing elements 8 and 9 is provided.
- a portion other than each grasp portion 14 and scissor blade 26 is formed by heat resistance plastic, for example.
- a treatment portion 10 at the tip of the scissor forceps 2 is inserted between a blood vessel Hi brought in close contact with a patient's body tissue H such as internal organs and the patient's body tissue H.
- a pair of opening/closing elements 8 and 9 of the treatment portion 10 is closed in advance, these elements are both inserted between the blood vessel Hi and the patient's body tissue H.
- an interval between the blood vessel H 1 and the patient's body tissue H is released by opening a pair of the opening/closing elements 8 and 9 .
- the blood vessel H 1 released as shown in FIG. 5B is grasped between the grasp portions 14 of the opening/closing elements 8 and 9 .
- the blood vessel H 1 is maintained while being compressed between the grasp portions 14 at a proper pressure.
- a switch 25 is turned ON, and the heating element 18 is current-carried and heated. At this time, heat of the heating element 18 is transmitted to the blood vessel H 1 between the grasp portions 14 via the contact plate 15 . In this manner, a wall of the blood vessel H 1 grasped between the grasp portions 14 is coagulated and welded, and a coagulated-welded portion H 2 is formed.
- the coagulated-welded portion H 2 of this blood vessel H 1 is separated by the scissor blade 26 of the dissection portion 27 on the rear side of the grasp portion 14 in each of the opening/closing elements 8 and 9 .
- a substantially planar wide contact plate 15 is arranged at the grasp portion 14 of each of the opening/closing elements 8 and 9 of the forceps main body 4 , so that the blood vessel H 1 is grasped between the two contact plates 15 .
- the heating element 18 on the tip of the treatment portion 10 is current-carried and heated, whereby the patient's body tissue such as blood vessel Hi grasped between a pair of the grasp portions 14 can be thermally coagulated reliably by heat of the heating element 18 .
- the patient's body tissue such as blood vessel H 1 has been thermally coagulated, the coagulated-welded portion H 2 is cut by the dissection portion 27 using the metal scissor blade 26 on the rear side of the grasp portion 14 in the treatment portion 10 .
- the dissection capability is gradually degraded due to a friction between the slide portions of the scissors portion during in use.
- the degradation of the dissection capability of the dissection portion 27 due to the scissor blade 26 while the scissor forceps 2 is used is minimized, and the sharpness of the dissection portion 27 can be maintained for a long period of time.
- work of releasing the blood vessel H 1 brought into close contact with the patient's body tissue H such as internal organ from the patient's body tissue H; work of coagulating and welding the wall of the blood vessel H 1 ; or work of separating the suspected coagulated-welded portion H 2 of the blood vessel H 1 can be performed by a single scissor forceps 2 .
- work of replacing one treatment instrument with another can be eliminated, thus improving usability.
- the number of treatment instruments used in the above treatments can be reduced, making it advantageous in cost efficiency.
- a portion other than each grasp portion 14 and scissor blade 26 is formed by heat resistance plastic, for example.
- FIG. 6 shows a second embodiment of the present invention.
- a configuration of the scissor forceps 2 in the medical treatment instrument 1 according to the first embodiment is modified as follows:
- a curve portion 31 gently curved in the substantial arc shape is formed at the grasp portion 14 disposed at the tip of the forceps main body 4 .
- a configuration of the other portion is similar to that of the first embodiment.
- Like elements identical to those in the first embodiment is represented by like reference numerals, and a description thereof will be omitted here.
- a curve portion 31 gently curved in the substantial arc shape is formed at the grasp portion 14 disposed at the tip of the forceps main body 4 of the scissor forceps 2 .
- FIG. 5A work of inserting the treatment portion 10 at the tip of the scissor forceps 2 between the blood vessel H 1 brought into close contact with the patient's body tissue H such as internal organ and the patient's body tissue H can be performed more easily.
- FIGS. 7, 8A and 8 B show a third embodiment of the present invention.
- a configuration of the scissor forceps 2 in the medical treatment instrument 1 according to the first embodiment is modified as follows:
- grasp portions 41 a and 41 b gently curved in the substantial arc shape are formed, respectively, at the portions of a pair of opening/closing elements 8 and 9 at the tip side of the forceps main body a rather than the support shaft 7 .
- the heating element 18 shown in FIG. 4 is arranged inside each of the grasp portions 41 a and 41 b of each of the opening/closing elements 8 and 9 .
- the heating element 18 is current-carried, heat of this heating element 18 is transmitted to the surface side of the grasp portions 41 a and 41 b via the contact plate 15 so that the patient's body tissue grasped between the grasp portions 41 a and 41 b of each of the opening/closing element 8 and 9 is coagulated.
- a dissection blade portion 42 for cutting the patient's body tissue toward one grasp portion 41 a side is protruded toward the other grasp portion 41 b side.
- this blade portion 42 is disposed at the substantial center site of the opposite surface 41 b 1 to the other grasp portion 41 a , and is extended in longitudinal direction of this grasp portion 41 b.
- a recess-shaped long groove portion (recess portion) 43 meshed with the blade portion 42 of the grasp portion 41 b is formed on the other grasp portion 41 a side.
- a depth L 1 of the long groove portion 43 is set to be lower than a height L 2 of the blade portion 42 of the grasp portion 41 b (L 1 ⁇ L 2 ).
- the blood vessel H 1 released as shown in FIG. 5B is grasped between the grasp portions 41 a and 41 b of the opening/closing elements 8 and 9 respectively in the scissor forceps 2 .
- the blood vessel H 1 is compressed between the grasp portions 41 a and 41 b with a relatively gentle pressure to an extent such that the blood vessel H 1 is not cut by the blade portion 42 of the grasp portion 41 b.
- the heating element 18 is current-carried and heated, whereby heat of the heating element 18 is transmitted to the blood vessel H 1 between the grasp portions 41 a and 41 b via the contact plate 15 .
- the wall of the blood vessel H 1 grasped between the grasp portions 41 a and 41 b is coagulated and welded, and the coagulated-welded portion H 2 is formed.
- the frontal operating portion 13 is firmly gripped, and is moved in a direction in which an interval between the grasp portions 41 a and 41 b is closed. At this time, a top part of the blade portion 42 of the grasp portion 41 b is strongly pressed in a direction in which the top part abuts against the inner bottom of the long groove portion 43 , whereby the coagulated-welded portion H 2 is separated by the blade portion 42 of the grasp portion 41 b as shown in FIG. 5C.
- the following effect is obtained. That is, in the scissor forceps 2 of the present embodiment, when the released blood vessel H 1 is grasped between the grasp portions 41 a and 41 b of the opening/closing elements 8 and 9 respectively, the blood vessel H 1 is compressed between the grasp portions 41 a and 41 b with a relatively gentle pressure to an extent such that the blood vessel H 1 is not cut by the blade portion 42 of the grasp portion 41 b . In this state, the heating element 18 is current-carried and heated, whereby the wall of the blood vessel H 1 grasped between the grasp portions 41 a and 41 b can be coagulated and welded.
- the frontal operating portion 13 is firmly gripped, and is further moved in a direction in which an interval between the grasp portions 41 a and 41 b is closed. Then, the top part of the blade portion 42 of the grasp portion 41 b is strongly pressed in a direction in which the top part abuts against the inner bottom of the long groove portion 43 of the grasp portion 41 a , whereby the coagulated-welded portion H 2 of the blood vessel H 1 can be separated by the blade portion 42 of the grasp portion 41 b.
- the coagulated-welded portion H 2 of the blood vessel H 1 is cut by the metal blade portion 42 .
- the dissection capability is gradually degraded due to a friction between the slide portions of the scissors portion while in use when a ceramic scissors portion is used. Therefore, in the scissor forceps 2 of the present embodiment also, as is substantially similar to the first embodiment, the degradation of the dissection capability of the blade portion 42 while the scissor forceps 2 is used can be reduced, and the sharpness of the blade portion 42 can be maintained for a long period of time.
- FIG. 8C shows a modified example of the scissor forceps 2 according to the third embodiment (refer to FIGS. 7, 8A and 8 B).
- the dissection blade portion 42 for cutting the patient's body tissue is protruded toward the other grasp portion 41 a side.
- this blade portion 42 is disposed at the substantial center of an opposite surface to the other grasp portion 41 a , and is extended in longitudinal direction of this grasp portion 41 b.
- a smooth contact surface 41 a 1 is formed on the other grasp portion 41 a side.
- FIG. 9A shows a schematic structure of the entire surgical treatment instrument 51 used for surgical operation under endoscope that is a medical treatment instrument of the present embodiment.
- a treatment instrument 51 of the present embodiment is provided with an elongated insert portion 52 to be inserted into the patient body through trocar (not shown); and a frontal operating portion 53 coupled with the proximal end of this insert portion 52 .
- the insert portion 52 is provided with a tubular insert tube body 54 .
- a driving shaft 55 relatively driven in axial direction of the insert portion 52 is inserted into this insert tube body 54 .
- a treatment portion 56 is arranged at the tip of the insert portion 52 .
- This treatment portion 56 is provided with a pair of grasp members (opening/closing elements) 57 a and 57 b capable of being opened and closed.
- a pair of the grasp members 57 a and 57 b is coupled with the tip of the driving shaft 55 via a driving mechanism (not shown) such as cam mechanism.
- An interval between the grasp members 57 a and 57 b of the treatment portion 56 is driven to be opened and closed via the driving mechanism together with retracting movement of the driving shaft 55 .
- the grasp member 57 of the present embodiment is structured in a manner substantially similar to that in the grasp portion 14 of each of the opening/closing elements 8 and 9 of the scissor forceps 2 in the first embodiment (refer to FIGS. 1 to 4 ).
- the heating element 18 shown in FIG. 4 is arranged inside the grasp members 57 a and 57 b of the present embodiment.
- heat of this heating element 18 is transmitted to the surface side of the grasp members 57 a and 57 b via the contact plate 15 so that the patient's body tissue grasped between the grasp members 57 a and 57 b is coagulated.
- each single-blade scissor blade (dissection portion) 26 ′ is formed on the rear side of the grasp members 57 a and 57 b.
- the frontal operating portion 53 is provided with an operating portion main body 58 for rotatably holding the proximal end of the insert portion 52 .
- a fixing handle 59 is formed integrally with this operating portion main body 58 .
- a rotation operation knob 60 for rotating the proximal end of the insert portion 52 is arranged at the tip of the operating portion main body 58 .
- a link portion of a movable handle 61 is rotatably linked with the fixing handle 59 via-the support shaft 62 .
- the proximal end of the driving shaft 55 is coupled with this movable handle 61 .
- a first finger receiving ring 59 a capable of inserting the operator's finger thereinto is formed at the end of the fixing handle 59 .
- a second finger receiving ring 61 a capable of inserting the operator's finger thereinto is formed similarly at the end of the movable handle 61 .
- the driving shaft 55 is driven to be retracted along axial direction together with opening/closing (rotating movement) operation of the movable handle 61 for the fixing handle 59 so that an interval between the grasp members 57 a and 57 b of the treatment portion 56 is driven to be opened and closed.
- the blood vessel H 1 released as shown in FIG. 5B is grasped between the grasp members 57 a and 57 b in the treatment instrument 51 .
- the blood vessel H 1 is maintained while it is compressed between the grasp members 57 with a proper pressure.
- the heating element 18 is current-carried and heated, whereby heat of the heating element 18 is transmitted to the blood vessel H 1 between the grasp members 57 via the contact plate 15 .
- the wall of the blood vessel H 1 grasped between the grasp members 57 is coagulated and welded, and the coagulated-welded portion H 2 is formed.
- the coagulated-welded portion H 2 is separated by the scissor blade 26 ′ on the rear side of the grasp members 57 a and 57 b.
- the coagulated-welded portion H 2 of the blood vessel H 1 is cut by the metal scissor blade 26 ′ on the rear side of the grasp members 57 a and 57 b .
- the dissection capability is gradually degraded due to a friction between the slide portions of the scissors portion during in use.
- FIG. 10 shows a fifth embodiment of the present 45 invention.
- control means 71 of the heating element 18 of the scissor forceps 2 in the medical treatment instrument 1 is provided according to the first embodiment.
- the control means 71 of the present embodiment is provided with a temperature control portion 72 connected to the heating element 18 of the scissor forceps 2 .
- a CPU 74 is connected to this temperature control portion 72 via an amplifier 73 .
- an operating panel 75 for temperature setting is connected to the CPU 74 .
- the heating element 18 mounted on the scissor forceps 2 of the present embodiment is formed by a metal resistor such as molybdenum in which a resistance value is changed due to a temperature, and the temperature and resistance value change linearly.
- a current amplified by the amplifier 73 is controlled, whereby the resistance value of the heating element 18 of the scissor forceps 2 , i.e., the temperature of the heating element 18 can be adjusted within an arbitrary temperature range, for example, within the range from 60° C. to 150° C.
- FIG. 11 shows a sixth embodiment of the present invention.
- a structure of the medical treatment instrument 1 according to the first embodiment is modified as follows:
- a battery housing portion 81 is connected to a cable connection portion 22 of the finger insert ring 11 of one scissor constituent member 5 in the scissor forceps 2 of the first embodiment so that a driving current is supplied from a battery housed in the battery housing portion 81 to the heating element 18 of the scissor forceps 2 .
- a generator 3 used in the medical treatment instrument 1 of the first embodiment is not required, and thus, the connector cable 23 connecting the scissor forceps 2 and the generator 3 is not also required. Therefore, unlike the first embodiment, there is no possibility that movement of the scissor forceps 2 is restricted by the connector cable 23 , and thus, there is an effect that operability of the scissor forceps 2 can be improved more significantly.
- FIG. 12 shows a schematic structure of the entire system of a medical treatment instrument 101 according to the present embodiment.
- the system of the medical treatment instrument 101 according to the present embodiment is provided with a forceps 102 and a power supply unit 103 connected to this forceps 102 .
- a main body 104 of the forceps 102 is provided with two scissor constituent members 105 and 106 . These scissor constituent members 105 and 106 are placed in a state in which the intermediate portions substantially cross with each other. Further, a support shaft 107 is arranged at the cross section of these scissor constituent members 105 and 106 to rotatably link the scissor constituent members 105 and 106 .
- a treatment portion 110 comprising a pair of grasp portions 108 and 109 capable of being opened and closed, which grasps the patient's body tissue, is arranged at the tip of the forceps main body 104 .
- This treatment portion 110 is molded in the substantially same shape as the release forceps.
- substantially elliptical finger insert rings 111 and 112 are formed at the proximal ends of the scissor constituent members 105 and 106 , respectively.
- the frontal operating portion 13 for opening/closing a pair of grasp portions 108 and 109 is formed by the portions of these finger insert rings 111 and 112 .
- the substantially planar, wide rectangular coagulation treatment heat generating portions 114 and 115 are arranged, respectively, on the contact surface side with the patient's body tissue.
- These coagulation treatment heat generating portions 114 and 115 are formed by a heating element current-carried to generate heat such as ceramic heater or PTC heater (heater formed by a positive temperature coefficient material).
- a substantially smooth surface 114 a and 115 a are formed on the contact surface side with the patient's body tissue in the coagulation treatment heat generating portion 114 , 115 of the grasp portions 108 and 109 .
- a recess portion 116 extended along the centerline direction of the grasp portion 109 at the substantially center site of a smooth surface 115 a is formed at the coagulation treatment heat generating portion 115 on the grasp portion 109 side.
- a dissection treatment heat generating portion 117 is arranged in this recess portion 116 .
- This dissection treatment heat generating portion 117 is such as nichrome wire, and is formed by a sectional, substantially circular heating wire current-carried to generate heat.
- the outer end surface of the dissection treatment heat generating portion 117 is located so as to be substantially coincident with a smooth surface 115 a on the outer surface of the coagulation treatment heat generating portion 115 .
- a Teflon-coating layers 118 and 119 for preventing a scorch of the patient's body tissue are formed, respectively, at the smooth outer surfaces 114 a and 115 a (contact surface with the patent's body) of the coagulation treatment heat generating portions 114 and 115 .
- a single lead wire 121 is arranged at one scissor constituent member 105 , and two lead wires 122 and 123 are arranged, respectively, at the other scissor constituent member 106 .
- the lead wire 121 is connected to the coagulation treatment heat generating portion 114 .
- the lead wire 122 is connected to the coagulation treatment heat generating portion 115 .
- the lead wire 123 is connected to the dissection treatment heat generating portion 117 .
- a single cable connection portion 124 is protruded on the peripheral surface of the finger insert ring 111 on the scissor constituent member 106 side. Further, two cable connection portions 125 and 126 are protruded on the peripheral surface of the finger insert ring 12 on the scissor constituent member 106 side. A proximal end of the lead wire 121 is connected to the cable connection portion 124 on the scissor constituent member 105 side, and the lead wires 122 and 123 are connected, respectively, to the cable connection portions 125 and 126 on the scissor constituent member 106 .
- each of the connector cables 127 , 128 , and 129 is detachably connected to each of these cable connection portions 124 , 125 , and 126 at the other end.
- a foot switch 132 is connected to the power supply unit 103 via a cable 133 . This foot switch 132 is provided with a dissection output operating portion 130 and a coagulation output operating portion 131 .
- the treatment portion 110 at the tip of the forceps 102 is inserted into the patient's body tissue including the site targeted for treatment such as blood vessel (not shown) while it is closed. Thereafter, a pair of grasp portions 108 and 109 is opened, whereby the site targeted for treatment such as blood vessel is released from the other patient's body tissue and is exposed.
- the released blood vessel or the like is grasped between the grasp portions 108 and 109 of the forceps 102 while it is compressed with a proper pressure suitable to coagulating treatment.
- the coagulation output operating portion 131 of the foot switch 132 is operated.
- the coagulation treatment heat generating portions 114 and 115 are current-carried and heated.
- a site targeted for treatment such as blood vessel grasped between the grasp portions 108 and 109 is coagulated and treated by heat of the coagulation treatment heat generating portions 114 and 115 , and is sufficiently thermally coagulated.
- the dissection output operating portion 130 of the foot switch 132 is subsequently operated.
- the dissection treatment heat generating portion 117 is current-carried and heated.
- This dissection treatment heat generating portion 117 is heated at a high temperature in comparison with the coagulation treatment heat generating portions 114 and 115 .
- a part of the site targeted for treatment such as coagulated blood vessel is locally heated and cut by heat of the dissection treatment heat generating portion 117 .
- the wide coagulation treatment heat generating portions 114 and 115 are arranged, respectively, at the grasp portions 108 and 109 of the forceps main body 104 .
- a site targeted for treatment such as blood vessel grasped between the grasp portions 108 and 109 of the forceps main body 104 can be thermally coagulated reliably due to heat of these coagulation treatment heat generating portions 114 and 115 while it is compressed with a proper pressure.
- a recess portion 116 is formed on a smooth surface 115 a of the coagulation treatment heat generating portion 115 on the grasp portion 109 side, and the dissection treatment heat generating portion 117 is arranged in this recess portion 115 .
- FIG. 14A shows an eighth embodiment of the present invention.
- a structure of the treatment portion 110 at the tip of the forceps 102 in the medical treatment instrument 101 of the seventh embodiment is modified as follows:
- the recess portion 116 is disposed at the side end of the smooth surface 115 a in the coagulation treatment heat generating portion 115 on the grasp portion 109 side, and the dissection treatment heat generating portion 117 is arranged in this recess portion 116 .
- the structures of the other portions are similar to those in the seventh embodiment.
- the forceps 102 of the present embodiment is used to perform treatment in a way similar to that in the seventh embodiment, the following work are performed.
- the forceps 102 is operated in accordance with the procedure similar to that in the seventh embodiment to release the site targeted for treatment such as blood vessel that is a tissue in the patient's body cavity.
- the released blood vessel or the like is grasped while it is compressed between the grasp portions 108 and 109 with a proper pressure suitable to coagulating treatment.
- the coagulation treatment heat generating portions 114 and 115 are current-carried and heated, and the site targeted for treatment such as blood vessel between the grasp portions 108 and 109 is thermally coagulated.
- the dissection treatment heat generating portion 117 is subsequently set according to the center position of the coagulated site targeted for treatment, and the grasp portions 108 and 109 are closed again.
- the dissection output operating portion 130 of the foot switch 132 is operated.
- the dissection treatment heat generating portion 117 is current-carried and heated, and a part of the site targeted for treatment such as coagulated blood vessel is locally heated and cut due to heat of the dissection treatment heat generating portion 117 .
- the dissection treatment heat generating portion 117 on the grasp portion 109 side is disposed at the side end on the coagulation treatment heat generating portion 115 .
- the treatment portion 110 at the tip of the forceps 102 is visually checked transversely, whereby the dissection treatment heat generating portion 117 on the grasp portion 119 side can be easily checked. Therefore, in the case where the coagulated patient's body tissue is cut, as in the case of operating the scissors, the cutting position can be easily aligned by the patient's intention, and cutting operation can be performed safely.
- FIG. 14B shows a ninth embodiment of the present invention.
- a structure of the treatment portion 110 at the tip of the forceps 102 in the medical treatment instrument 101 of the seventh embodiment is modified as follows:
- the seventh embodiment there is shown a structure in which the dissection treatment heat generating portion 117 is arranged at only the coagulation treatment heat generating portion 115 only.
- the recess portion 116 extended along the centerline direction of the grasp portion 108 is formed at the substantial center site of the smooth surface 114 a similarly, and the dissection treatment heat generating portion 117 is arranged in this recess portion 116 .
- the forceps 102 of the present embodiment is used to perform treatment in a manner similar to that in the seventh embodiment, the following work are performed.
- the forceps 102 is operated in accordance with the procedure similar to that in the seventh embodiment to release a site targeted for treatment such as blood vessel that is a tissue in the patient's body cavity.
- the released blood vessel or the like is grasped between the grasp portions 108 and 109 of the forceps 102 while it is compressed with a proper pressure suitable to coagulating treatment.
- the coagulation treatment heat generating portions 114 and 115 are current-carried and heated, and a site targeted for treatment such as blood vessel between the grasp portions 108 and 109 is thermally coagulated.
- the dissection output operating portion 130 of the foot switch 132 is subsequently operated.
- the dissection treatment heat generating portions 117 of both of the grasp portions 108 and 109 are current-carried and heated simultaneously.
- a part of the site targeted for treatment such as coagulated blood vessel is locally heated and cut by heat of the dissection treatment heat generating portions 117 on both sides.
- the dissection treatment heat generating portions 117 are arranged, respectively, at the coagulation treatment heat generating portion 115 on the grasp portion 109 side and the coagulation treatment heat generating portion 114 on the grasp portion 108 side.
- the heat can be locally concentrated at the thermally coagulated portion of the site targeted for treatment such as blood vessel from the dissection treatment heat generating portion 117 on both sides. Therefore, the thermally coagulated portion of a site targeted for treatment such as coagulated blood vessel can be easily cut by heat of the dissection treatment heat generating portions 117 on both sides.
- the thermally coagulated patient's body tissue can be easily cut, and the treatment time can be reduced.
- FIG. 14C shows a tenth embodiment of the present invention.
- a structure of the treatment portion 110 at the tip of the forceps 102 in the medical treatment instrument 101 of the seventh embodiment is modified as follows:
- the recess portion 116 is formed at the substantial center site of the smooth surface 115 a of the coagulation treatment heat generating portion 115 on the grasp portion 109 side; the dissection treatment heat generating portion 117 is arranged in this recess portion 116 ; and only the smooth surface 114 a is provided on a surface opposite to the coagulation treatment heat generating portion 115 in the coagulation treatment heat generating portion 114 on the grasp portion 108 side.
- a porous heat insulation material 134 such as ceramic, for example, is arranged at a site opposite to the dissection treatment heat generating portion 117 at the grasp portion 109 side on the smooth surface 114 a of the coagulation treatment heat generating portion 114 on the grasp portion 108 side.
- the dissection treatment heat generating portion 117 is current-carried and heated.
- the heat of the dissection treatment heat generating portion 117 can be prevented from escaping to the grasp portion 108 side by means of the heat insulation material 134 of the smooth surface 114 a of the coagulation treatment heat generating portion 114 on the grasp portion 108 side.
- FIG. 14D shows an eleventh embodiment of the present invention.
- a structure of the treatment portion 110 at the tip of the forceps 102 in the medical treatment instrument 101 of the seventh embodiment is modified as follows:
- the coagulation treatment heat generating portion 114 is provided at only one grasp portion 108 of a pair of the grasp portions 108 and 109 ; a recess portion 109 b extended along the centerline direction of the grasp portion 109 is formed at the substantial center site on the contact surface 109 a side with the patient's body tissue at the other grasp portion 109 ; and a dissection treatment heat generating portion 117 is arranged in this recess portion 109 b.
- a Teflon coating layer may be provided on the contact surface 109 a side with the patient's body tissue in the grasp portion 109 . Further, the coagulation treatment heat generating portion is provided on the grasp portion 109 side only, whereby the dissection treatment heat generating portion 117 may be arranged.
- FIGS. 15 to 17 B show a twelfth embodiment of the present invention.
- a structure of the forceps 102 in the medical treatment instrument 101 of the seventh embodiment (refer to FIGS. 12 and 13) is modified as follows:
- the dissection treatment heat generating portion 117 on the grasp portion 109 side can be moved to a standby position shown in FIGS. 16A and 16B and a use position shown in FIGS. 17A and 17B.
- a space 135 for movement of the dissection treatment heat generating portion 117 is formed on the grasp portion 109 side. Further, a gap 135 a communicating with this movement space 135 is provided on a centerline at the coagulation treatment heat generating portion 115 on the grasp portion 109 side.
- two front and rear triangular guide members 136 for guiding movement of the dissection treatment heat generating portion 117 are fixed, respectively, to the inner side of the movement space 135 on the grasp portion 109 side.
- the dissection treatment heat generating portion 117 is supported by means of a support member 137 .
- Columnar smooth members 137 a and 137 b in contact with an inclined surface of the guide member 136 are fixed, respectively, to the front end and rear end of this support member 137 .
- the dissection treatment heat generating portion 117 is movably maintained at the standby position shown in FIGS. 16A and 16B and the use position shown in FIGS. 17A and 17B while slide members 137 a and 137 b of the support member 137 move along the inclined surface of the guide member 136 .
- FIGS. 16A and 16B the standby position shown in FIGS.
- the dissection treatment heat generating portion 117 is maintained while it is apart from the coagulation treatment heat generating portion 114 of the grasp portion 108 .
- the dissection treatment heat generating portion 117 is moved in a direction in which the section 117 abuts against the coagulation treatment heat generating portion 114 of the grasp portion 108 .
- an operating lever 138 retracting in the forward/backward direction is arranged between the support shaft 107 of the scissor constituent member 106 and the finger insert ring 112 .
- This operating lever 138 is supported retractably from the forward position indicated by solid line in FIG. 15 to the backward position indicated by dotted line in the figure.
- an operating wire 139 for moving the dissection treatment heat generating portion 117 is fixed to this operating lever 138 .
- the tip of this operating wire 139 is fixed to the rear end of the support member 137 .
- the forceps 102 of the present embodiment is used to perform treatment in a manner similar to that in the seventh embodiment, the following work are performed.
- the operating lever 138 of the scissor constituent member 106 is generally maintained at the forward position indicated by solid line in FIG. 15, the dissection treatment heat generating portion 117 is maintained at the standby position shown in FIGS. 16A and 16B.
- the forceps 102 is operated in accordance with the procedure similar to that in the seventh embodiment to release the site targeted for treatment such as blood vessel of the patent's body cavity, and is grasped between the grasp portions 108 and 109 to perform thermal coagulation.
- the operating lever 138 is substantially moved from the forward position indicated by solid line in FIG. 15 to the backward position indicated by dotted line.
- an operating wire 139 is pulled backward together with backward operation of the operating lever 138 , and the slide members 137 a and 137 b of the support member 137 is inclined backward along the inclined portion of the guide member 136 .
- the dissection treatment heat generating portion 117 is moved to the use position shown in FIGS. 17A and 17B, and this dissection treatment heat generating portion 117 is abutted against the coagulation treatment heat generating portion 114 .
- the dissection treatment heat generating portion 117 is made movable to the standby position shown in FIGS. 16A and 16B and the use position shown in FIGS. 17A and 17B.
- the dissection treatment heat generating portion 117 is moved to the use position shown in FIGS. 17A and 17B, and is abutted against the coagulation treatment heat generating portion 114 to come into close contact with the section 114 .
- the thermally coagulated patent's body tissue can be thermally cut reliably, and the cut patent's body tissue is not left.
- FIGS. 18 and 19 show a thirteenth embodiment of the present invention.
- a structure of the medical treatment instrument 101 of the twelfth embodiment (refer to FIGS. 15 to 17 B) is modified as follows:
- switch means 140 for turning on/off the dissection treatment heat generating portion 117 is further arranged at the backward position of the operating lever 138 shown in the twelfth embodiment.
- a lead wire 141 is connected to this switch means 140 .
- this lead wire 141 is connected to the inner end of the cable connection portion 142 protruded on the peripheral surface of the finger insert ring 112 of the scissor constituent member 106 .
- the connector cable 143 is detachably connected to the outer end of this cable connection portion 142 .
- this connector cable 143 is connected to the power supply unit 103 .
- a foot switch 145 comprising a coagulation output operating portion 144 is connected to the power supply unit 103 via a cable 146 .
- an output circuit 147 , a control circuit 148 , and a detection circuit 149 are provided, respectively, inside the power supply unit 103 .
- the output circuit 147 , a detection circuit 149 , a panel input/display portion 153 arranged on the operating panel of the power supply unit 103 , and a foot switch 145 are connected, respectively, to the control circuit 148 .
- the control circuit 148 is connected to the panel input/display portion 153 so that data is input and output bidirectionally. At the panel input/display portion 153 , the output or temperature setting input or the temperature setting display or the like is performed.
- the cable connector 150 provided at the power supply unit 103 is connected to the output circuit 147 via three output lines 151 , and is connected to the detection circuit 149 via a detection line 152 .
- the operating lever 138 of the scissor constituent member 106 is held at the forward position indicated by solid line in the FIG. 18, and the dissection treatment heat generating portion 117 is held at the standby position (shown in FIGS. 16A and 16B).
- the forceps 102 is operated in accordance with the procedure similar to that in the thirteenth embodiment, and the site targeted for treatment such as blood vessel that is the tissue in the patient's body cavity is released and grasped between the grasp portions 108 and 109 .
- the coagulation output operating portion 144 of the foot switch 145 is operated, whereby the coagulation treatment heat generating portions 114 and 115 are current-carried and heated, and the site targeted for treatment such as blood vessel is thermally coagulated.
- the operating lever 138 is subsequently operated to be moved from the forward position indicated by solid line in FIG. 18 to the backward position indicated by dotted line.
- the operating wire 139 is pulled back together with backward movement of the operating lever 138 ;
- the dissection treatment heat generating portion 117 is moved to the use position shown in FIGS. 17A and 17B; and this dissection treatment heat generating portion 117 is abutted against the coagulation treatment heat generating portion 114 .
- switch means 140 is actuated, and a signal is output from this switch means 140 .
- the signal output from the switch means 140 is input to a detection circuit 149 of the power supply unit 103 .
- a detection circuit 149 of the power supply unit 103 .
- a control circuit 148 controls an output of the output circuit 147 .
- the dissection treatment heat generating portion 117 is current-carried and heated, and the thermally coagulated patent's body tissue is cut by the heat of the dissection treatment heat generating portion 117 .
- FIGS. 20A and 20B show a fourteenth embodiment of the present invention.
- the present invention is applied to a surgical treatment instrument 154 used for surgical operation under endoscope as a medical treatment instrument.
- FIG. 20A shows a schematic structure of the entire surgical treatment instrument 154 .
- the treatment instrument 154 of the present embodiment is provided with an elongated insert portion 155 to be inserted into the patent's body through a trocar (not shown) and a frontal operating portion 156 linked with the proximal end of this insert portion 155 .
- the insert portion 155 is provided with a tubular insert tube body 157 .
- a driving shaft 158 relatively moved in axial direction of the insert portion 155 is inserted into this insert tube body 157 .
- a treatment portion 159 is arranged at the tip of the insert portion 155 .
- This treatment portion 159 is provided with a pair of grasp members 160 a and 160 b capable to be opened and closed.
- a pair of grasp members 160 a and 160 b is coupled with the tip of the driving shaft 158 via a driving mechanism such as cam mechanism (not shown). An interval between the grasp members 160 a and 160 b is driven to be opened and closed via the driving mechanism together with retracting movement of the driving shaft 158 .
- the grasp members 160 a and 160 b of the present embodiment are structured in a manner substantially similar to that of each of the grasp portions 108 and 109 in the forceps 102 of the present embodiment (refer to FIGS. 15 to 17 B).
- the grasp members 160 a and 160 b of the present embodiment are internally provided with the coagulation treatment heat generating portion 114 , coagulation treatment heat generating portion 115 , dissection treatment heat generating portion 117 , support member 137 , slide members 137 a and 137 b , guide member 136 , and operating wire 139 shown in FIGS. 16A, 16B, 17 A and 17 B.
- the frontal operating portion 156 is provided with an operating portion main body 162 for rotatably holding the proximal end of the insert portion 155 .
- a fixing handle 163 is formed integrally with this operating portion main body 162 .
- a rotating operation knob 164 for rotationally operating the proximal end of the insert portion 155 is arranged at the tip of the operating portion main body 162 .
- a link portion of a movable handle 165 is rotatably linked with the fixing handle 163 via a support shaft 166 .
- the proximal end of the driving shaft 158 is linked with this movable handle 165 .
- a first finger insert ring 167 a into which the operator's finger can be inserted is formed at the end of the fixing handle 163 .
- a second finger insert ring 167 b into which the operator's finger can be inserted is formed similarly at the end of the movable handle 165 .
- the driving shaft 158 is driven retractably along axial direction together with opening/closing (rotating) operation of the movable handle 165 relative to the fixing handle 163 , and an interval between the grasp members 160 a and 160 b of the treatment portion 159 is driven to be opened and closed.
- the operating lever 161 in which the dissection treatment heat generating portion 117 is operated to be moved to be the standby position shown in FIGS. 16A and 16B and to the use position shown in FIGS. 17A and 17B.
- This operating lever 161 is supported retractably from the forward position indicated by solid line in FIG. 20A to the backward position indicated by dotted line in the figure.
- the dissection treatment heat generating portion 117 is moved to a direction in which the section 117 is close to/distant from the coagulation treatment heat generating portion 114 together with operation of this lever 161 .
- the lever 161 is operated by fingers other than those inserted into the rings 167 a and 167 b , whereby the operating wire 139 of the dissection treatment heat generating portion 117 is moved in axial direction relative to the insert portion 155 , and is operated to be moved to a direction in which the wire is close to/distant from the tissue grasp surface of the coagulation treatment heat generating portion 114 in which the grasp portion 160 a is provided with the dissection treatment heat generating portion 117 .
- a site targeted for treatment such as blood vessel in the patent's body tissue when used to treat a site targeted for treatment such as blood vessel in the patent's body tissue, a site targeted for treatment such as blood vessel that is a tissue in the patient's body cavity is released through operation similar to that in the twelfth embodiment, and is grasped between the grasp members 160 a and 160 b to perform thermal coagulation.
- the dissection treatment heat generating portion 117 is protruded and recessed on the centerline of the coagulation treatment heat generating portion 114 .
- the thermally coagulated patient's body tissue can be thermally cut reliably, the cut patient's body tissue is not left, and the treatment time can be reduced.
- FIGS. 21, 22A and 22 B show a fifteenth embodiment of the present invention.
- FIG. 21 shows a structure of a forceps 172 that is a medical treatment instrument 171 of the present embodiment.
- a main body 173 of the forceps 172 is provided with two scissor constituent members 174 and 175 . These scissor constituent members 174 and 175 are placed in a state in which the intermediate portions substantially cross with each other. Further, a support shaft 176 for rotatably linking the scissor constituent members 174 and 175 with each other is arranged at the cross section of the scissor constituent members 174 and 175 .
- a treatment portion 179 comprising a pair of the grasp portions 177 and 178 capable of being opened and closed, which grasps the patient's body tissue, is arranged at the tip of the forceps main body 173 .
- This treatment portion 179 is molded in the substantially same shape as that in the release forceps.
- substantially elliptical finger insert rings 180 and 181 are formed at the proximal end of each of the scissor constituent members 174 and 175 .
- a frontal operating portion 182 for opening/closing a pair of grasp portions 177 and 178 is formed by the portions of these finger insert rings 180 and 181 .
- a substantially arc-shaped, gently curved curve portion 183 is formed at a treatment portion 179 of the forceps main body 173 , as shown in FIG. 22A. Furthermore, at each of the grasp portions 177 and 178 of the forceps main body 173 , as shown in FIG. 22B, coagulation treatment heat generating portions 184 and 185 having substantially planar, wide rectangular cross section are arranged, respectively, on the contact surface side with the patient's body tissue. These coagulation treatment heat generating portions 184 and 175 such as ceramic heater or PTC heater are current-carried to generate heat, and is formed by a heating element.
- Teflon coating layers 186 and 187 for preventing scorch of the patient's body tissue are formed, respectively, on the outer surface of the coagulation treatment heat generating portions 184 and 185 (the contact surface with the patient's body).
- a gap 188 gently curved in the arc shape is provided along the curve shape of the curve portion 183 .
- This gap 188 is formed as a route to the coagulation treatment heat generating portions 184 and 185 in the same width.
- the tip of this gas 188 is structured of having opened at the tip of each of the grasp portions 177 and 178 .
- a lead wire 189 is arranged at one scissor constituent member 174 , and a lead wire 190 is arranged at the other scissor constituent member 175 , respectively.
- the lead wire 189 is connected to the coagulation treatment heat generating portion 184 .
- the lead wire 190 is connected to the coagulation treatment heat generating portion 185 .
- a cable connection portion 191 is protruded on the peripheral surface of the finger insert ring 180 on the scissor constituent member 174 side. Furthermore, a cable connection portion 192 is protruded on the peripheral surface of the finger insert ring 181 on the scissor constituent member 175 side. The proximal end of the lead wire 189 is connected to the cable connection portion 191 on the scissor constituent member 174 side, and the lead wire 190 is connected to the cable connection portion 192 on the scissor constituent member 175 side.
- the treatment portion 179 is inserted into the patient's body tissue including a site targeted for treatment such as blood vessel (not shown) while it is closed at the tip of the forceps 172 . Thereafter, a pair of grasp portions 177 and 178 are opened, whereby the site targeted for treatment such as blood vessel is released from the patent's body tissue, and is exposed.
- a site targeted for treatment such as blood vessel
- the released blood vessel or the like is grasped between the grasp portions 177 and 178 while it is compressed with a proper pressure suitable to coagulating treatment.
- a power supply unit (not shown) is output, the coagulation treatment heat generating portions 184 and 185 of the grasp portions 177 and 178 are current-carried and heated.
- a site targeted for treatment such as blood vessel between the grasp portions 177 and 178 is well thermally coagulated due to the heat of the coagulation treatment heat generating portion 184 and 185 .
- a surgical knife (not shown) or a high-frequency knife is inserted into the gap 188 of each of the grasp portions 177 and 178 of the treatment portion 179 , and the site targeted for treatment such as blood vessel is cut.
- a wide coagulation treatment heat generating portions 184 and 185 are arranged at the grasp portions 177 and 178 of the forceps main body 173 .
- the site targeted for treatment such as blood vessel grasped between the grasp portions 177 and 178 of the forceps main body 173 can be thermally coagulated reliably due to the heat of these coagulation treatment heat generating portions 184 and 185 while it is compressed with a proper pressure.
- the gap 188 is provided at the widthwise center portion of each of the grasp portions 177 and 178 of the treatment portion 179 .
- another cutting means such as surgical knife or high-frequency knife is inserted into the gap 188 between the grasp portions 177 and 178 in the treatment portion 179 , whereby the tissue of the site targeted for treatment such as coagulated blood vessel can be cut. Therefore, in particular, the site can be treated simply and speedily by abdominal cutting surgery.
- the structure is simplified and advantageous in cost efficiency in comparison with the structure in which the coagulating function and cutting function of the tissue of the site targeted for treatment are performed by a single instrument.
- FIGS. 23A and 23B show a sixteenth embodiment of the present invention.
- a structure of the treatment portion 179 at the tip of the forceps 172 in the medical treatment instrument 171 according to the fifteenth embodiment is modified as follows:
- the gap 188 is not provided on the grasp portion 177 side of one scissor constituent member 174 , and the gap 188 is provided on the grasp portion 178 side only of the other scissor constituent member 175 .
- the forceps 172 of the present embodiment is used to perform treatment in a manner similar to the fifteenth embodiment, the following work are performed.
- the forceps 172 is operated in accordance with the procedure similar to that in the fifteenth embodiment, whereby the site targeted for treatment such as blood vessel that is a tissue in the patent's body cavity is released, and grasped between the grasp portions 177 and 178 to perform thermal coagulation.
- the surgical knife (not shown) or the high-frequency knife is inserted into the gap 188 of one grasp portion 178 of the treatment portion 179 , and the site targeted for treatment such as coagulated blood vessel is cut.
- the tip of the knife is pressed to be abutted against the surface of the coagulation treatment heat generating portion 184 of the grasp portion 177 of the treatment portion 179 , and the subsequent inserting operation is stopped. Therefore, the tip of the knife is prevented from penetrating the outside of the gap 188 , and there is no possibility that a portion other than the site targeted for treatment is cut, which is safe.
- FIG. 24 shows a seventeenth embodiment of the present invention.
- a structure of the treatment portion 179 at the tip of the forceps 172 in the medical treatment instrument 171 according to the fifteenth embodiment is modified as follows:
- the gap 188 is not provided at the grasp portion 177 side of one scissor constituent member 174 , and the gap 188 is provided on the grasp portion 178 side only of the other scissor constituent member 175 .
- a receiving member 193 consisting of an ultra hard metal such as tungsten is arranged instead at a site corresponding to the gap 188 of the grasp portion 178 side.
- the forceps 172 of the present embodiment is used to perform treatment in a manner similar to that in the fifteenth embodiment, the following work are performed.
- the forceps 172 is operated in accordance with the procedure similar to that in the fifteenth embodiment, whereby the site targeted for treatment such as blood vessel that is a tissue in the patent's body cavity is released, and is grasped between the grasp portions 177 and 178 to perform thermal coagulation.
- the surgical knife (not shown) or the high-frequency knife is inserted into the gap 188 of one grasp portion 178 of the treatment portion 179 , and the site targeted for treatment such as coagulated blood vessel is cut.
- the tip of the knife is pressed to be abutted against the surface of the receiving member 193 of the grasp portion 177 , and the subsequent inserting operation is stopped. Therefore, the tip of the knife is prevented from penetrating the outside of the gap 188 , and there is no possibility that a portion other than the site targeted for treatment is cut, which is safe.
- the receiving member 193 is made of an ultra hard metal.
- the tip of the knife is pressed to be abutted against the receiving member 193 , the degradation due to damage caused on the surface can be prevented.
- FIG. 25 shows an eighteenth embodiment of the present invention.
- a structure of the treatment portion 179 at the tip of the forceps 172 in the medical treatment instrument 171 according to the fifteenth embodiment is modified as follows:
- a closing portion 194 for closing the tip of the gap 188 of each of the grasp portions 177 and 178 of the treatment portion 179 is provided so that the tip of the gap 188 of each of the grasp portions 177 and 178 is not opened.
- FIG. 26 shows a nineteenth embodiment of the present invention.
- the treatment portion 179 at the tip of the forceps 172 in the medical treatment instrument 171 according to the fifteenth embodiment is changed for high-frequency treatment.
- the forceps main body 173 in the forceps 172 is entirely made of an insulation material. Further, at the grasp portions 177 and 178 of the forceps main body 173 , insulation portions 196 and 197 covered with an insulation material are structured of being formed, respectively, on the inner surface side of the gap 188 .
- a pair of sectional, rectangular electrodes 198 and 199 are arranged, respectively, at their positions opposite to each other on the outside of the insulation portions 196 and 197 on both sides of the gap 188 .
- Each of the electrodes 198 and 199 is connected to a high-frequency power supply unit (not shown) via a lead wire.
- the forceps 172 of the present embodiment is used to perform treatment in a manner similar to that in the fifteenth embodiment, the site targeted for treatment such as vessel blood that is a tissue in the patent's body cavity is released. After the site has been grasped between the grasp portions 177 and 178 , an interval between electrodes 198 and 199 of the grasp portions 177 and 178 is current-carried at a high frequency, and coagulation is performed.
- the surgical knife (not shown) or the high-frequency knife is inserted into the gap 188 of one grasp portion 178 of the treatment portion 179 , and the site targeted for treatment such as coagulated blood vessel is cut.
- a site targeted for treatment is coagulated by supplying the high-frequency bipolar power.
- the high-frequency power supply unit is switched to monopolar, whereby the coagulated site can be cut by the high-frequency knife. Therefore, coagulation and cutting can be performed by a single power supply unit, making it advantageous in cost efficiency.
- FIG. 27 shows a twentieth embodiment of the present invention.
- a structure of the medical treatment instrument 171 according to the fifteenth embodiment is modified as follows:
- the structure is changed such that the treatment portion 179 at the tip of the forceps 172 is provided with the high-frequency treatment electrodes 198 and 199 , and the patient's body tissue is coagulated by supplying high-frequency power.
- the electrode 198 on one grasp portion 177 side is connected to the inner end of the cable connection portion 191 of the finger insert ring 180 on the scissor constituent member 174 side via the lead wire 189 .
- the electrode 199 on the other grasp portion 178 side is connected to the inner end of the cable connection portion 192 of the finger insert ring 181 on the scissor constituent member 175 side via the lead wire 190 .
- a connector cable 200 is detachably connected to the outer end of the cable connection portion 191 .
- the connector cable 201 is detachably connected to the outer end of the cable connection portion 192 .
- these connector cables 200 and 201 are connected to the high-frequency power supply unit 202 .
- a switch unit 203 is intervened intermediately of the connector cable 201 of the high-frequency power supply unit 202 .
- a high-frequency knife 204 is connected via a cable 205 .
- the high-frequency knife 204 is connected to the high-frequency power supply unit 202 via this switch unit 203 .
- a foot switch 207 is connected to the high-frequency power supply unit 202 via a cable 206 . This foot switch 207 is provided with a dissection output operating portion 208 and the coagulation output operating portion 209 .
- the forceps 172 of the present embodiment is used to perform treatment in a manner similar to that in the nineteenth embodiment, the following work are performed.
- the forceps 172 is operated in accordance with the procedure similar to that in the fifteenth embodiment, whereby a site targeted for treatment such as blood vessel that is a tissue in the patient's body cavity is released, and is grasped between the grasp portions 177 and 178 .
- a coagulation output operating portion 209 in the foot switch 207 is operated.
- the site targeted for treatment such as blood vessel between the grasp portions 177 and 178 is coagulated by supplying high-frequency power between the electrodes 198 and 199 .
- the high-frequency knife 204 is inserted into the gap 188 between the grasp portions 177 and 178 of the treatment portion 179 , and a power supply route of the switch unit 203 is changed. Then, a dissection output operating portion 208 in the foot switch 207 is operated, whereby dissection power is supplied from the high-frequency knife 204 to the electrode 199 in the forceps 172 , and the site targeted for treatment is cut.
- the site targeted for treatment can be cut by only bipolar power without changing it to monopolar power, enabling safe treatment.
- FIGS. 28, 29A and 29 B show a twenty-first embodiment of the present invention.
- FIG. 28 shows a structure of a dissection cutting treatment instrument 211 that is a medical treatment instrument of the present embodiment.
- a main body 212 of the coagulation cutting treatment instrument 211 is provided with two scissor constituent members 213 and 214 . These scissor constituent members 213 and 214 are placed so that the intermediate portions substantially cross with each other. Further, a support shaft 215 for rotatably linking these scissor constituent members 213 and 214 with each other is arranged at the cross section of these scissor constituent members 213 and 214 .
- a treatment portion 218 comprising a pair of jaws 216 and 217 capable of being opened and closed, which grasps the patient's body tissue, is arranged at the tip of the treatment instrument main body 212 . Further, the substantially elliptical finger insert rings 219 and 220 are formed at the proximal ends of the scissor constituent members 213 and 214 . A frontal operating portion 221 for opening/closing a pair of jaws 216 and 217 is formed by the portions of these finger insert rings 219 and 220 .
- Heaters 222 and 223 are provided for coagulating the patient's body tissue H at the jaws 216 and 217 .
- Each of the heaters 222 and 223 is provided with a tooth portion 224 for preventing the patient's body tissue from slipping off.
- the heaters 222 and 223 may be any of publicly known heater means such as ceramic heaters, PTC heaters, semiconductor heaters, or electric heat wires.
- Cable connection portions 225 and 226 are protruded, respectively, at the finger insert rings 219 and 220 of the operating portion 221 .
- a heater 222 is connected to the inner end of one cable connection portion 225 via a lead wire.
- a heater 223 is connected to the inner end of the other cable connection portion 226 via the lead wire. Further, connector cables for supplying power to the heaters 222 and 223 are connected to the outer ends of cable connection portions 225 and 226 .
- the jaws 216 and 217 are provided with cutting treatment scissor blades 227 and 228 for cutting the patient's body tissue H, respectively. These scissor blades 227 and 228 are formed in sectional substantial U shape as shown in FIG. 29B. These scissor blades 227 and 228 are mounted on the jaws 216 and 217 while they surround the outer peripheries of the jaws 216 and 217 .
- slide grooves 229 and 230 for movably guiding the scissor blades 227 and 228 in the forward/backward direction are formed on both side surfaces of the jaws 216 and 217 .
- guide protrusions 227 a and 228 a to be inserted into these slide grooves 229 and 230 are protruded at the scissor blades 227 and 228 .
- the scissor blades 227 and 228 are slidably supported forward and backward along the slide grooves 229 and 230 .
- Sharp blade portions 227 b and 228 b are formed on the side portions of the U-shaped sections of the scissor blades 227 and 228 , respectively.
- operating bars 231 and 232 are linked with the scissor blades 227 and 228 .
- the proximal ends of these operating bars 231 and 232 are linked with levers 233 and 234 disposed in the vicinity of the operating portion 221 .
- the scissor blades 227 and 228 are operated to be slid forward and backward along the slide grooves 229 and 230 of the jaws 216 and 217 via the operating bars 231 and 232 together with forward/backward slide operations of the levers 233 and 234 .
- the scissor blades 227 and 228 are held at a standby position at which they are retracted to the frontal side of the treatment instrument main body 212 as shown in FIG. 28 at a usual time other than dissection of the patient's body tissue H.
- the jaws 216 and 217 are closed as shown in FIG. 28, and the patient's body tissue H is grasped between the upper and lower heaters 222 and 223 .
- the scissor blades 227 and 228 are held while they are not in contact with the patient's body tissue H.
- the upper and lower heaters 222 and 223 are current-carried and heated, and the patient's body tissue H between the upper and lower heaters 222 and 223 is coagulated.
- the heaters 222 and 223 for coagulating the patient's body tissue H is provided at the jaws 216 and 217 of the treatment portion 218 of the treatment instrument main body 212 , and the cutting treatment scissor blades 227 and 228 for cutting the patient's body tissue H are provided movably in the forward/backward direction of the jaws 216 and 217 .
- the scissor blades 227 and 228 are held at a standby position at which these blades are retracted to the frontal side of the treatment instrument main body 212 as shown in FIG. 28.
- coagulating treatment of the patient's body tissue H is performed, and the scissor blades 227 and 228 are moved to the tip positions of the jaws 216 and 217 as shown in FIG. 29A.
- cutting treatment of the patient's body tissue H can be performed.
- coagulating treatment and cutting treatment can be performed at the tips of the jaws 216 and 217 of the treatment portion 218 of the treatment instrument main body 212 , and thus, there is an effect that delicate treatment can be performed.
- the patient's body tissue H when the patient's body tissue H is cut to be treated, the patient's body tissue H can be cut to be treated by opening/closing the scissor constituent members 213 and 214 like a pair of scissors, thus improving operability and enabling fine cutting treatment.
- FIG. 30 shows a twenty-second embodiment of the present invention.
- a structure of the treatment portion 218 at the tip of the treatment instrument main body 212 in the coagulating/cutting treatment instrument 211 according to the twenty-first embodiment is modified as follows:
- the heaters 222 and 223 of the twenty-first embodiment are eliminated, and a bipolar electrode 235 is structured by the jaws 216 and 217 themselves.
- insulation layers 236 and 237 are structured to be provided between the jaws 216 and 217 and the knife blades 227 and 228 so that a current is not supplied to the knife blades 227 and 228 during coagulation.
- coagulating treatment is performed at the bipolar electrode 235 at the tip of each of the jaws 216 and 217 of the treatment portion 218 of the treatment instrument main body 212 , and cutting treatment can be performed by the knife blades 227 and 228 of the jaws 216 and 217 on both sides.
- coagulating treatment and cutting treatment can be performed at the tip of each of the jaws 216 and 217 of the treatment portion 218 of the treatment instrument main body 212 , and thus, there is an effect that delicate treatment can be performed.
- FIG. 31 shows a twenty-third embodiment of the present invention.
- a knife blade 228 is provided at only a single-sided jaw 217 of the treatment portion 218 at the tip of the treatment instrument main body 212 in the coagulating/cutting treatment instrument 211 according to the twenty-second embodiment (refer to FIG. 30).
- coagulating treatment is performed at the bipolar electrode 235 at the tip of each of the jaws 216 and 217 of the treatment portion 218 of the treatment instrument main body 212 , and cutting treatment can be performed by the knife blade 228 of the single-sided jaw 217 .
- cutting treatment can be performed by the knife blade 228 of the single-sided jaw 217 .
- a cutting current is supplied to the knife blade 228 of the present embodiment, and the knife blade 228 is current-carried and heated, whereby cutting treatment of the patient's body tissue H may be performed.
- FIG. 32 shows a twenty-fourth embodiment of the present invention.
- a structure of the treatment portion 218 at the tip of the treatment instrument main body 212 in the coagulating/cutting treatment instrument 211 according to the twenty-first embodiment is modified as follows:
- a dissection treatment heat generating portion 238 such as nichrome wire is structured to be provided at the tip of each of the knife blades 227 and 228 of the jaws 216 and 217 on both sides of the treatment portion 218 so that cutting treatment is performed by this dissection treatment heat generating portion 238 .
- coagulating treatment is performed at the bipolar electrode 235 at the tip of each of the jaws 216 and 217 of the treatment portion 218 of the treatment instrument main body 212 , and cutting treatment can be performed by the dissection treatment heat generating portion 238 of each of the jaws 216 and 217 on both sides.
- coagulating treatment and cutting treatment can be performed at the tip of each of the jaws 216 and 217 of the treatment portion 218 of the treatment instrument main body 212 , and thus, there is an effect that delicate treatment can be performed.
- FIGS. 33, 34A and 34 B show a twenty-fifth embodiment of the present invention.
- a structure of the treatment portion 218 at the tip of the treatment embodiment main body 212 in the coagulating/cutting treatment instrument 211 according to the twenty-first embodiment is modified as follows:
- a planar heating element 242 is provided partially of a grasp surface 241 meshed with the other jaw 216 .
- a cutting instrument guide groove 243 extended in the centerline direction of the jaw 217 is formed at the substantial center site of the grasp surface 241 of this jaw 217 .
- This cutting instrument guide groove 243 is extended from the tip to the end of this grasp surface 241 beyond the heating element 242 .
- a cutting instrument 244 having structure different from the scissor blades 227 and 228 according to the twenty-first embodiment is slidably arranged along this cutting instrument guide groove 243 .
- a hook portion 246 to be protruded to the outside of the cutting instrument guide groove 243 is connected to the tip of a bar-shaped shank portion 245 .
- a nichrome wire 247 is mounted on this hook portion 246 .
- a finger hoot portion 248 protruded to the outside of the cutting instrument guide groove 243 is formed at the end of the shank portion 245 of the cutting instrument 244 as shown in FIG. 33.
- a planar heating element 250 is provided partially at the grasp portion 249 meshed with the grasp phase 241 of the opposite jaw 217 , as shown in FIG. 34B. Further a hook portion guide groove 251 having the hook portion 246 of the cutting instrument 244 inserted thereinto is formed at the substantial center side of the grasp surface 249 of this jaw 216 . This hook portion guide groove 251 is extended from the tip side of the grasp surface 24 to the end side beyond the longitudinal length of the heating element 250 . When a pair of jaws 216 and 217 is meshed with each other, the depth of this hook portion guide groove 251 is set in dimensions in which the hook portion 246 on the tip side of the cutting instrument 244 is substantially recessed.
- a fine irregularity 252 for preventing slip-off is formed on each of the grasp surfaces 241 and 249 of a pair of jaws 216 and 217 , and on the surface of the heating elements 242 and 250 .
- power supply cables 253 and 254 are connected, respectively to the heating elements 242 and 250 , and are led out, respectively, from the finger insert rings 219 and 220 .
- a power supply cable 255 is also connected to a nichrome wire 247 . This power supply cable 255 is led out from the finger insert ring 220 .
- the led-out power supply cables 253 , 254 , and 255 are connected to a power supply source (not shown).
- a tip side hook portion of the cutting instrument 244 is maintained in advance at a standby position at which the hook portion is moved to be positioned at the terminal end portion of the tip side of the cutting instrument guide groove 243 of the jaw 217 .
- fingers are inserted into the finger insert rings 219 and 220 of the frontal operating portion 221 .
- jaws 216 and 217 of the treatment instrument main boy 212 are operated to be opened, and closed and a target site (for example, blood vessel) is grasped between a pair of jaws 216 and 217 .
- a target site for example, blood vessel
- FIG. 35A shows a schematic structure of the coagulating treatment instrument 301 according to the present embodiment.
- the main body 302 of the coagulating treatment instrument 301 according to the present embodiment is provided with two scissor constituent members 303 and 304 . These scissor constituent members 303 and 304 are placed in a state in which the intermediate portions substantially cross with each other. Further, a fulcrum pin 305 for rotatably connecting these scissor constituent members 303 and 305 with each other is arranged at the cross section of the scissor constituent members 303 and 304 .
- a treatment portion 308 comprising a pair of jaws 306 and 307 capable of being opened and closed, which grasps the patient's body tissue, is arranged at the tip of the treatment instrument main body 302 .
- This treatment portion 308 is molded in the substantially same shape a release forceps.
- substantially elliptical finger insert rings 309 and 310 are formed at the proximal ends of the scissor constituent members 303 and 304 .
- a frontal operating portion 311 for opening/closing a pair of jaws 306 and 307 is formed by portions of these finger insert rings 309 and 310 .
- a curve portion 312 gently curved in substantial arc shape as shown in FIG. 35B is formed at the treatment portion 308 of the treatment instrument main body 302 . Further, ceramic heaters (heater means) 313 and 314 for coagulating the patient's body tissue is provided on a contact surface side with the patient's body tissue as shown in FIG. 35A.
- the ceramic heaters 313 and 314 consist of a heat transmitting portion 315 made of ceramic that is an insulation material as shown in FIG. 36B, and a heating element 316 recessed inside this heat transmitting portion 315 .
- Types of ceramics of the heat transmitting portion 315 include alumina; aluminum nitrate; silicon nitrate or the like.
- a material of the heating element 316 is often selected from among metals such as tungsten.
- the heat transmitting portion 315 and heating element 316 are burned integrally, and the ceramic heaters 313 and 314 are molded.
- this tooth portion 317 is formed by a number of substantially trapezoidal protrusions 318 protruded on the surface of the heating element 316 .
- This tooth portion 317 is molded by cutting the surface of the heating element 316 .
- a Teflon coating layer 319 for covering the surface of the heating body 316 with a Teflon coat is formed on the outer surface (constant surface with the patient's body tissue) of the heating element 316 of each of the ceramic heaters 313 and 314 to prevent scorching (adhering) of the patient's body tissue.
- insulation lead wires 320 and 321 are arranged, respectively, at the scissor constituent members 303 and 304 .
- the insulation lead wire 320 on one scissor constituent member 303 side is connected to the ceramic heater 313 .
- the insulation lead wire 321 on the other scissor constituent member 304 side is connected to the ceramic heater 314 .
- one cable connection portion 322 is protruded on the outer periphery of the finger insert ring 309 on the scissor constituent member 303 side.
- One cable connection portion 323 is protruded similarly on the outer periphery of the finger insert ring 310 on the scissor constituent member 304 side.
- the insulation lead wire 320 is connected to the cable connection portion 322 on the scissor constituent member 303 side.
- the insulation lead wire 321 is connected to the cable connection portion 323 on the scissor constituent member 304 side.
- the connector cables 324 and 325 each connected to a power supply unit (not shown) at one end is detachably connected at the other end. Then, power is supplied to the ceramic heaters 313 and 314 from the power supply unit (not shown).
- the treatment portion 308 at the tip of the coagulating treatment instrument 301 is inserted into the patient's body tissue including a site targeted for treatment such as blood vessel (not shown) while the treatment portion 308 is closed. Thereafter a pair of jaws 306 and 37 is opened, whereby a site targeted for treatment such as blood vessel is released from the other patient's body tissue and is exposed.
- the released blood vessel or the like is grasped while it is compressed between the jaws 306 and 307 of the coagulating treatment instrument 301 with a proper pressure suitable to the coagulating treatment.
- a power supply unit (not shown) is output, power is supplied to the heating element 316 of the ceramic heaters 313 and 314 of each of the jaws 306 and 307 via the connector cables 320 and 321 .
- the heating element 316 is heated by electrical resistance while the power is supplied; the heat transmitting portion 315 is heated; and the patient's body tissue is coagulated at the site targeted for treatment such as blood vessel coming into contact with the surface of this heat transmitting portion 315 .
- the heat transmitting portion 315 is made of a insulating element, and a current supplied to the heating element 316 does not leak the patient's body tissue at the site targeted for treatment.
- the ceramic heaters 313 and 314 are arranged at the jaws 306 and 307 of the treatment instrument main body 302 .
- the ceramic heaters 313 and 314 are arranged at the jaws 306 and 307 of the treatment instrument main body 302 .
- FIG. 37 shows a modified example of the jaws 306 and 307 of the coagulating treatment instrument 301 according to the twenty-sixth embodiment.
- the tooth portion 317 on the surface of each of the ceramic heaters 313 and 314 of the jaws 306 and 307 is formed by providing a plurality of transverse grooves 331 .
- FIG. 38 shows a twenty-seventh embodiment of the present invention.
- the ceramic heaters 313 and 314 of the jaws 306 and 307 of the coagulating treatment instrument 301 according to the twenty-sixth embodiment are covered with a reinforce metal cover 332 . It is desirable that a Teflon for preventing adhesion is coated on the surface of the reinforce metal cover 332 .
- the ceramic heaters 313 and 314 are covered with the reinforce metal cover 332 , and thus, there is an effect that the strength of the jaws 306 and 307 of the coagulating treatment instrument 301 can be improved more significantly.
- the present invention may be a treatment instrument suitable to surgery under endoscope without being limited to the above embodiment.
- FIGS. 39A, 39B, 40 A and 40 B show a twenty-eighth embodiment of the present invention.
- a structure of a fixing portion for fixing the ceramic heaters 313 and 314 to the jaws 306 and 307 of the treatment instrument main body 302 in the coagulating treatment instrument 301 according to the twenty-sixth embodiment is modified as follows:
- connection plate (an intermediate connection member) 341 is brazed and connected to the inner surfaces of the ceramic heaters 313 and 314 (bonding surface with the jaws 306 and 307 ).
- This connection plate 341 may be a thin metal plate to decrease thermal stress during brazing, and is usable to be a stainless steel or a copal (a metal containing iron and cobalt).
- connection pins 342 are protruded at the connection plate 341 .
- a hole 343 having connection pins 342 of the connection plate 341 inserted thereinto is formed at the jaws 306 and 307 .
- Each connection pins 342 of the connection plate 341 has been inserted into the hole 343 of the jaws 306 and 307 , and then, is fixed to the jaws 306 and 307 by bonding or laser-welding the upper surface portion around the hole 343 (X portion indicated by being surrounded by circle in FIG. 39B).
- the connection pin 342 may be used as a screw.
- the pins 342 are directly brazed and connected to the ceramic heaters 313 and 314 .
- connection between the ceramic heaters 313 , 314 and the connection plate 341 may be made by bonding in which strength is slightly reduced.
- connection between the connection plate 341 and the jaws 306 , 307 is directly bonded without using the connection pin 342 .
- each connection pin 342 of the connection plate 341 is inserted into the hole 343 of the jaws 306 and 307 . In this state, such each connection pin 342 is mechanically connected to the jaws 306 and 307 by bonding or laser-welding.
- intervals between the resilient jaws 306 , 307 formed of a metal and the hard, brittle ceramic heaters 313 , 314 are linked with each other via each connection pin 342 of the connection plate 341 .
- a resilience of the jaws 306 and 307 is absorbed by a slight gap between the ceramic heaters 313 , 314 and the jaws 306 , 307 , whereby a load acted on the ceramic heaters 313 and 314 can be reduced.
- ceramic heaters 313 and 314 can be reliably and easily linked with the jaws 306 and 307 with significantly different ceramics and thermal expansion rate.
- connection plate 341 is made of a copal with low thermal expansion rate, and there is an effect that the link strength can be improved more significantly.
- FIG. 41A shows a first modified example of a mount structure of the connection plate 341 for linking between the jaws 306 , 307 of the treatment instrument main body 302 and the ceramic heaters 313 , 314 in the coagulating treatment instrument 301 according to the present modified example.
- a heater fixing claw 341 a is protruded on the link portion side with the ceramic heaters 313 and 314 in the connection plate 341
- a jaw fixing claw 341 b is protruded on the link portion side of the jaws 306 and 307 .
- These heater fixing claw 341 a and jaw fixing claw 341 b are extended partially or over a full length of the connection plate 341 .
- the heater fixing claw 341 a of the connection plate 341 is mechanically engaged with the ceramic heaters 313 and 314 by means of caulking or the like, and the jaw fixing claw 341 b is also engaged with the jaws 306 and 307 by means of caulking or the like.
- the heater fixing claw 341 a may be provided at the jaws 306 and 307 .
- FIG. 41B shows a second modified example of a mount structure of the connection plate 341 for linking between the jaws 306 , 307 of the treatment instrument main body 301 and the ceramic heaters 313 , 314 in the coagulating treatment instrument 301 according to the twenty-eighth embodiment.
- the connection plate 341 is formed in shape covering bottom surfaces of the ceramic heaters 313 and 314 , and a fixing claw 341 c protruded on both sides of this connection plate 341 is mechanically engaged with the jaws 306 and 307 together with the ceramic heaters 313 and 314 by means of caulking or the like.
- FIGS. 42A and 42B show a twenty-ninth embodiment of the present invention.
- a structure of the fixing portion for fixing the ceramic heaters 313 and 314 to the jaws 306 and 307 of the treatment instrument main body 302 in the coagulating treatment instrument 301 according to the twenty-eighth embodiment is modified as follows:
- a split shape portion 342 a is provided at the connection pin 342 of the connection plate 341 according to the twenty-eighth embodiment.
- an engagement portion 342 b having large diameter is provided.
- an engagement portion 342 b at the tip of the split shape portion 342 a is engaged with a peripheral edge site of the hole 343 of the jaws 306 and 307 , whereby the ceramic heaters 313 and 314 are freely and detachably fixed to the jaws 306 and 307 .
- FIG. 43 shows a thirtieth embodiment of the present invention.
- the connection plate 341 for fixing the ceramic heaters 313 and 314 to the jaws 306 and 307 of the treatment instrument main body 302 in the coagulating treatment instrument 301 according to the twenty-eighth embodiment is formed of an elastic member such as rubber.
- the connection plate 341 is bonded with the ceramic heaters 313 , 314 and the jaws 306 , 307 , respectively, and fixed thereto.
- connection plate 341 is made of an elastic member such as rubber. In this manner, there is an effect that resilience of the resilient jaws 306 and 307 formed of a metal material can be positively absorbed by the elastic member of the connection plate 341 , and a load acted to the ceramic heaters 313 and 314 can be reliably reduced.
- FIG. 44 shows a schematic structure of the entire system of the medical treatment embodiment 351 according to the present embodiment.
- a system of the medical treatment instrument 351 according to the present embodiment is provided with a power supply unit 352 and a substantial scissors-shaped, thermal coagulating/cutting forceps 353 .
- An output connector 354 and an initial resistance measurement switch 355 are provided in front of the power supply unit 352 .
- a thermal coagulating/cutting forceps 353 is connected to the output connector 354 of the power supply unit 352 via a cable 356 .
- a treatment portion 360 comprising a pair of jaws 358 and 359 capable of being opened and closed, which grasps the patient's body tissue is arranged at the tip of the main body 357 of the thermal coagulating/cutting forceps 353 .
- heaters 361 and 362 are incorporated into the jaws 358 and 359 , respectively. These heaters 361 and 362 are ceramic heater, for example.
- a foot switch 363 for controlling power supply of the heaters 361 and 362 is connected to the power supply unit 352 .
- a hand switch for controlling power supply of the heaters 361 and 362 may be provided at the thermal coagulating/cutting forceps 353 .
- FIG. 45 is a block diagram showing an electric circuit inside the power supply unit 352 .
- a power supply portion 364 for a heater power source is provided inside the power supply unit 352 .
- This power supply portion 364 is a constant voltage power source, for example.
- two heaters 361 and 362 of the thermal coagulating/cutting forceps 353 are provided with output portions 365 a , 365 b and resistance value measurement portions 366 a , 366 b , respectively.
- An individually independent output control and resistance value measurement are possible for the two heaters 361 and 362 of the thermal coagulating/cutting forceps 353 .
- the resistance value measurement portions 366 a , 366 b and the output portions 365 a , 365 b are connected to a control portion 367 , and individually suitable output correction can be performed.
- An operating portion 368 is connected to this control portion 367 . This operating portion 368 is provided with the initial resistance measurement switch 355 .
- the resistance value measurement portions 366 a and 366 b measure the respective heater resistance values of the heaters 361 and 362 of the thermal coagulating/cutting forceps 353 , and sends data to the control portion 367 . This values are judged as initial resistance values of the heaters 361 and 362 .
- the control portion 367 sends an output correction signal to the output portions 365 a and 365 b according to the respective initial resistance values of the heaters 361 and 362 .
- This correction method is as follows:
- a duty ratio of the voltage is denoted by D, and output is performed at the voltage duty ratio of D so that (V ⁇ D)2/Ri become a predetermined value.
- the output portions 365 a and 365 b perform outputting using any one of the above correction methods.
- FIG. 46 shows a thirty-second embodiment of the present invention.
- an initial resistance measurement switch 355 is omitted from the power supply unit 352 according to the thirty-first embodiment (refer to FIGS. 44 and 45).
- the control portion 367 controls operation in accordance with a flowchart shown in FIG. 46.
- the other portions are same as those in the system of the medical treatment instrument 351 according to the thirty-first embodiment.
- Like elements identical to those in the system of the medical treatment instrument 351 according to the thirty-first embodiment are denoted by like reference numerals, and a description thereof will be omitted here.
- step S 1 measurement of the resistance value is repeated in the resistance value measurement portions 366 a and 366 b with certain time intervals.
- step S 2 it is judged whether or not the resistance value is below 100 ⁇ .
- the resistance value is an open value.
- step S 2 When, in step S 2 , it is judged that the resistance value is not below 100 ⁇ , processing goes to the next step S 3 , and it is judged that it is in an output disable state. In this case, processing returns to step S 1 , measurement of resistance values is repeated.
- step S 2 when it is judged that the resistance value is below 100 ⁇ , processing goes to the next step S 4 .
- step S 4 a resistance value below 100 ⁇ is stored as an initial resistance value. Subsequently, processing goes to the next step S 5 in which switching operation is performed to enter an output enable state, and processing is ended.
- a resistance value threshold is 100 ⁇ , a value suitable to the heater used may be predetermined.
- FIGS. 47A and 47B show a thirty-third embodiment of the present embodiment.
- a temperature display portion 371 is provided in the front surface of the power supply unit 352 according to the thirty-first embodiment (refer to FIGS. 44 and 45). This temperature display portion 371 is connected to the control portion 367 .
- This temperature display portion 371 is structured so that the temperatures of the heaters 361 and 362 of the thermal coagulating/cutting forceps 353 are displayed.
- the other portions are structurally identical to those in the system of the medical treatment instrument 351 according to the thirty-first embodiment. Like elements identical to those in the system of the medical treatment instrument 351 according to the thirty-first embodiment is denoted by like reference numeral, and a description thereof is omitted here.
- the control portion 367 utilizes the fact that the resistance values of the heaters 361 and 362 are changed according to a temperature. Then, the control portion 367 calculates the temperatures of the heaters 361 and 362 of the thermal coagulating/cutting forceps 353 from the resistance measurement values of the resistance value measurement portions 366 a and 366 b . At this time, a temperature error due to dispersion in heater resistance values is corrected in view of the initial resistance value. The thus obtained heater temperatures are displayed on the temperature display portion 371 .
- a temperature displayed on the temperature display portion 371 may be any of the higher temperature, lower temperature, and average temperature of the heaters 361 and 362 .
- a temperature display portion 371 may be employed such that both temperatures can be displayed.
- an output of the power supply unit 352 may be controlled so that the heater temperature becomes a predetermined temperature.
- a PTC heater (a heater formed of a positive temperature coefficient material) is used as heaters 361 and 362 of the thermal coagulating/cutting forceps 353 .
- the PTC heater is used as a heater, and thus, there is an effect that the heater curie temperature is set according to a member with lowest heat resistance temperature, thereby making it possible to easily produce a temperature limiter.
- the curie temperature is set to 200° C. or less in order to protect a Teflon coating of the forceps.
- a desired temperature limiter can be structured without requiring a special circuit or control to be provided at the power supply unit 352 side.
- the curie temperature is set to about 150° C. in order to prevent overheat of the patient's body tissue.
- a temperature limiter can be provided without any special structure.
- the PTC heater is used as heaters 361 and 362 of the thermal coagulating/cutting forceps 353 , thereby making it possible to easily provide a temperature limiter in all of the thirty-first to thirty-third embodiments.
- FIG. 48A shows a schematic structure of the coagulating treatment instrument 401 according to the present embodiment.
- the main body 402 of the coagulating treatment instrument 401 according to the present embodiment is provided with two scissor constituent members 403 and 404 . These scissor constituent members 403 and 404 are placed in a state in which its intermediate portions substantially cross with each other. Further, a fulcrum pin 405 for rotatably linking these scissor constituent members 403 and 404 with each other is arranged at the cross section of these scissor constituent members 403 and 404 .
- a treatment portion 408 comprising a pair of jaws 406 and 407 capable of being opened and closed, which grasps the patient's body tissue, is arranged at the tip of the treatment portion main body 402 . Further, the substantially elliptical finger insert rings 409 and 410 are formed at the proximal ends of the scissor constituent members 403 and 404 , respectively.
- a frontal operating portion 411 for operating a pair of jaws 406 and 407 to be opened and closed is formed by portions of these finger insert rings 409 and 410 .
- a curve portion 412 gently curved in the substantial arc shape is formed at the treatment portion 408 of the treatment instrument main body 402 as shown in FIG. 48B.
- the coagulating treatment unit 413 for coagulating the patient's body tissue is provided on the contact surface side with the patient's body tissue.
- This coagulating treatment unit 413 is provided with a heater 414 fixed to each of the jaws 406 and 407 and a cover 415 for covering the outer surface of this heater 414 , as shown in FIG. 48C.
- the heater 414 to be used includes a ceramic heater, a PTC heater (a heater formed of positive temperature coefficient material), and a semiconductor heater.
- the cover 415 is made of a metal such as stainless or copper, is formed in the substantially same shape as the heater 414 , and is thinly formed so as to improve thermal conductivity. Further, a tissue adhesion preventing treatment portion 416 for preventing adhesion of the patient's body tissue is provided at the outer full surface of this cover 415 as shown in FIG. 48D. Examples of this tissue adhesion preventing treatment portion 416 include a Teflon coating available from Dupon and a ceramic coating (plasma flame spraying) or the like.
- a plurality of inwardly projected protrusion portions 417 are pressed to be provided on the inner surface of the cover 415 .
- recess portions 418 to be detachably engaged with the protrusion portions 417 are projected respectively at the corresponding position of each protrusion portion 417 .
- this cover 415 is designed to be removably mounted on the heater due to the elastic deformation of the cover 415 itself.
- each recess portion 417 of the cover 415 is detachably engaged with each recess portion 418 of the heater 414 .
- the recess portion 418 may be provided at the jaws 406 and 407 so as to fix the cover 415 for covering the heater 414 to each of these jaws 406 and 407 .
- an irregularity 419 or the like for preventing slip-off of the patient's body tissue is provided at the lower surface of the cover 415 so as to prevent the slip-off of the patient's body tissue by the irregularity 419 of the cover 415 when the patient's body tissue is grasped between the jaws 406 and 407 .
- Additional preventive treatment for preventing adhesion of the patient's body tissue may be applied to a site free of being covered with the cover 415 on the outer surface side of the jaws 406 and 407 .
- insulation lead wires 420 and 421 are arranged respectively at the scissor constituent members 403 and 404 .
- an insulation lead wire 420 on one scissor constituent member 403 side is connected to the heater 414 of the coagulating treatment unit 413 on the jaw 406 side.
- an insulation lead wire 421 on the other scissor constituent member 404 side is connected to the heater 414 of the coagulating treatment unit 413 on the jaw 407 side.
- One cable connection portion 422 is protruded at the peripheral surface of the finger insert ring 409 on the scissor constituent member 403 side.
- one cable connection portion 423 is protruded at the peripheral surface of the finger insert ring 410 on the scissor constituent member 404 side.
- the insulation lead wire 420 is connected to the cable connection portion 422 on the scissor constituent member 403 side.
- the insulation lead wire 421 is connected to the cable connection portion 423 on the scissor constituent member 404 side.
- connector cables 424 and 425 connected to the power supply unit are removably connected at the other ends. From the power supply unit (not shown), power is supplied to the heater 414 of each of the jaws 406 and 407 .
- the cover 415 is set to be mounted on the heater 414 in advance.
- a site targeted for treatment such as blood vessel (not shown) is inserted into the patient's body tissue, while the treatment portion 408 at the tip of the coagulating treatment instrument 401 is closed.
- a site targeted for treatment such as blood vessel is released from the other patient's body tissue and is exposed by opening a pair of jaws 406 and 407 .
- the released blood vessel or the like is grasped between the jaws 406 and 407 of the coagulating treatment instrument 401 while it is compressed with a proper pressure.
- the patient's body tissue of the site targeted for blood vessel grasped between the jaws 406 and 407 is prevented from slip-off by the irregularity 419 on the lower surface of the cover 415 , and the slip-off of the patient's body tissue is prevented.
- the tissue adhesion preventing treatment portion 416 of the cover 415 is degraded by use of the coagulating treatment instrument 401 , the cover 415 can be simply replaced with another one.
- the tissue adhesion preventing treatment portion 416 around the heater 414 can be always maintained in a proper state. Therefore, an effect of preventing the adhesion of the tissue around the heater 414 can be maintained over a long period, and there is an effect that maintenance cost due to the degradation of the patient's body tissue adhesion preventing treatment portion 416 can be reduced, making it advantageous in cost efficiency.
- FIGS. 49A and 49B show a thirty-fifth embodiment of the present invention.
- a structure of the coagulating treatment unit 413 of the jaws 406 and 407 of the coagulating treatment instrument 401 according to the thirty fourth embodiment is modified as follows:
- a bar-shaped heater 431 is protruded at the tip of each of the jaws 406 and 407 of the treatment instrument main body 402 ; a cover 433 comprising a heater insert hole 431 for inserting this heater 431 is provided; and the heater 431 is inserted into the heater insert hole 432 of this cover 431 , whereby the entire outer surface of the heater 431 is covered with the cover 433 .
- the cover 433 is formed in a curved shape as in the jaws 406 and 407 according to the thirty-forth embodiment.
- the tissue adhesion preventing treatment portion 416 similar to that in the thirty-fourth embodiment is provided on the peripheral surface of this cover 433 .
- a positioning protrusion portion 434 is protruded at the tip surface of the jaws 406 and 407 as shown in FIG. 49A.
- a recess portion 435 to be detachably engaged with the positioning protrusion portion 434 is provided at the front side end of the cover 433 .
- a plurality of plate spring members 436 to be brought into pressure-contact with the heater 431 are provided inside the heater insert hole 432 of the cover 433 .
- these plate spring members 436 are brought into pressure-contact with the heater 431 so as to ensure thermal conductivity of the heater 431 .
- the bar-shaped heater 431 protruded at the tip side of each of the jaws 406 and 407 is entirely covered with the cover 433 , and thus an effect of preventing adhesion due to the tissue adhesion preventing treatment portion 416 of the cover 433 can be improved more significantly.
- FIG. 50A shows a thirty-sixth embodiment of the present invention.
- a structure of the coagulating treatment unit 413 of each of the jaws 406 and 407 in the coagulating treatment instrument 401 according to the thirty-fourth embodiment is modified as follows:
- a cover member 441 for covering the heater 414 fixed to each of the jaws 406 and 407 together therewith is provided.
- the cover member 441 according to the present embodiment is formed by an elastic tube.
- a tissue adhesion preventing treatment portion 416 similar to that in the thirty-fourth embodiment is provided at the outer full surface of this cover member 441 .
- An example of the cover member 441 formed by such elastic tube includes a Teflon tube.
- the cover member 441 is formed by a Teflon tube with heat shrink properties, and mounting on each of the jaws 406 and 407 may be implemented by utilizing the heating of the heater 414 . In that case, when the cover member 441 is replaced with another one, the tube of the cover member 441 is cut to be removed from each of the jaws 406 and 407 .
- an effect of preventing adhesion of the patient's body tissue can be maintained over a long period of time, and the maintenance cost due to the degradation of the patient's body tissue adhesion preventing treatment portion 416 is reduced, making it advantageous in cost efficiency.
- FIG. 50B shows a modified example of the cover member 441 of the coagulating treatment instrument 401 according to a thirty-sixth embodiment (refer to FIG. 50A).
- a thin film sheet made of Teflon or the like
- This cover 442 is provided with a band-shaped fixing portion 443 to be fixed to each of the jaws 406 and 407 .
- FIGS. 51A to 51 C and 52 A show a thirty-seventh embodiment of the present invention.
- a thermal coagulating treatment instrument 454 comprising a scissor forceps 451 shown in FIG. 51A and a heater unit 453 detachable to a main body 452 of this scissor forceps 451 .
- the forceps main body 452 is provided with two scissor constituent members 455 and 456 . These scissor constituent members 455 and 456 are placed in a state in which their intermediate portions substantially cross with each other.
- a fulcrum pin 457 for rotatably linking these scissor constituent members 455 and 456 with each other is arranged at the cross section of the scissor constituent members 455 and 456 .
- a treatment portion 460 comprising a pair of jaws 458 and 459 capable of being opened and closed, which grasps the patient's body tissue, is arranged at the tip of the forceps main body 452 .
- substantially elliptical finger insert rings 461 and 462 are formed at the proximal ends of the scissor constituent members 455 and 456 .
- a frontal operating portion 463 for operating a pair of the jaws 461 and 462 to be opened and closed is formed by the portion of these finger insert rings 461 and 462 .
- a substantially U-shaped unit main body 464 is provided at the heater unit 453 as shown in FIG. 51C.
- This unit main body 464 is designed to be detachably mounted on one scissor constituent member 456 side. Further, two heaters 465 and 466 are linked with the tip side of this unit main body 464 via elastic members 467 and 468 . Tissue adhesion preventing treatment for preventing adhesion of the patient's body tissue is applied to the peripheral surfaces of the heaters 465 and 466 .
- the elastic members 467 and 468 include synthetic resin, rubber or the like.
- insulation lead wires 469 and 470 are arranged inside the unit main body 464 . At one end, the insulation lead wire 469 is routed into the elastic member 467 , and is connected to the heater 465 . Further, at one end, the other insulation lead wire 470 is routed into the elastic member 468 , and is connected to the heater 466 .
- a connector cable 471 for supplying power to the heaters 465 and 466 is provided in the front surface of the unit main body 464 .
- This connector cable 471 and the heaters 465 and 466 are electrically connected with each other via the insulation lead wires 469 and 470 .
- a plurality of tip-split connector pins 472 are provided at each of the heaters 465 and 466 .
- Heater mounting engagement holes 473 are provided at the jaws 458 and 459 of the forceps main body 452 .
- Each of the heaters 465 and 466 are detachably engaged by the connector pins 472 being inserted into the engagement holes 473 of the jaws 458 and 459 of the forceps main body 452 .
- cover 415 and cover member 441 shown in the thirty-fourth embodiment (refer to FIGS. 48A to 48 D) and the thirty-sixth embodiment (refer to FIG. 50A) are detachably provided at the heaters 465 and 466 .
- one scissor constituent member 456 of the forceps main body 452 is inserted into a U-shaped opening of the unit main body 464 of the heater unit 453 .
- the unit main body 464 of the heater unit 453 is detachably mounted at one scissor constituent member 456 side of the forceps main body 452 .
- the heater unit 453 is removed from the forceps main body 452 . Instead, a new heater unit 453 is designed to be mounted on the forceps main body 452 .
- FIG. 52B shows a modified example of a thirty-seventh embodiment (refer to FIGS. 51A to 51 C and 52 A).
- lead electrodes 474 are provided at the heaters 465 and 466 ; and a heater receiving electrode (not shown) is provided at the forceps main body 452 of the scissor forceps main body 451 so that the lead electrodes 474 of the heaters 465 and 466 are detachably linked with the heater receiving electrode of this forceps main body 452 .
- a heater receiving electrode (not shown) is provided at the forceps main body 452 of the scissor forceps main body 451 so that the lead electrodes 474 of the heaters 465 and 466 are detachably linked with the heater receiving electrode of this forceps main body 452 .
- an effect similar to that in the thirty seventh embodiment will be obtained.
- FIG. 53A shows a schematic structure of a coagulating treatment instrument 481 .
- the main body 482 of the coagulating treatment instrument 481 according to the present embodiment is provided with two scissor constituent members 483 and 484 .
- These scissor constituent members 483 and 484 are placed in a state in which their intermediate portions substantially cross with each other.
- a fulcrum pin 485 for rotatably linking the scissor constituent members 483 and 484 with each other is arranged at the cross section of the scissor constituent members 483 and 484 .
- a treatment portion 488 comprising a pair of jaws 486 and 487 capable of being opened and closed, which grasps the patient's body tissue, is arranged at the tip of the treatment instrument main body 482 . Further, substantially elliptical finger insert rings 489 and 490 are formed at the proximal ends of the scissor constituent members 483 and 484 . A frontal operating portion 491 for operating a pair of jaws 486 and 487 to be opened and closed is formed by the portions of these finger insert rings 489 and 490 .
- heaters 492 and 493 for coagulating the patient's body tissue are provided on the contact surface side with the patient's body tissue.
- These heaters 492 and 493 include a ceramic heater, a PTC heater, a semiconductor heater or the like.
- the PTC heater has a rigid metal case.
- insulation lead wires 494 and 495 are arranged, respectively, at the scissor constituent members 483 and 484 .
- the insulation lead wire 494 on one scissor constituent member 483 side is connected to the heater 492 on the jaw 486 side.
- the insulation lead wire 495 on the other scissor constituent member 484 side is connected to the heater 493 of the jaw 487 side.
- one cable connection portion 496 is protruded at the peripheral surface of the finger insert ring 489 on the scissor constituent member 483 side.
- one cable connection portion 497 is protruded at the peripheral surface of the finger insert ring 490 on the scissor constituent member 484 side.
- the insulation lead wire 494 is connected to the cable connection portion 496 on the scissor constituent member 483 side, and the insulation lead wire 495 is connected to the cable connection portion 497 on the scissor constituent member 484 side.
- connector cables 498 and 499 whose one ends are connected to a power supply unit (not shown) are detachably connected at the other ends. From the power supply unit (not shown), power is supplied to the heaters 492 and 493 of the jaws 486 and 487 , respectively.
- the upper and lower heaters 492 and 493 are provided with contact surfaces 492 a and 493 a coagulating in contact with the patient's body tissue, respectively. Further, on the proximal end side of each of the scissor constituent members 483 and 484 , stoppers 500 and 501 for restricting the closed position of the operating portion 491 are protruded, respectively, at a position close to the finger insert rings 489 and 490 inwardly of the operating portion 491 .
- a closing force is strongly applied to the operating portion 491 from the first closing operation position when the jaws 486 and 487 shown in FIGS. 53A and 53B are operated to be closed with each other, whereby a path between the stoppers 500 and 501 of the scissor constituent member 483 and 484 moves to a position (a final closing operation position) such that the stoppers abut against each other.
- the contact surfaces 492 a and 493 a of the heaters 492 and 493 abut against their rear ends, and are set to be entirely closed.
- a closing force is strongly applied to the operating portion 491 from the first closing operation position when each of the jaws 486 and 487 shown in FIGS. 53A and 53B is operated to be closed, whereby the stoppers 500 and 501 of the scissor constituent members 483 and 484 move to a position (a final closing operation position) such that these members do not abut against each other.
- a root side portion 503 of each of the jaws 486 and 487 is elastically deformed, and the contact surfaces 492 a and 493 a of the heaters 492 and 493 abut against each other at their rear ends, and the entire contact surfaces 492 a and 493 a of the heaters 492 and 493 are closed in their contact state.
- the upper and lower stoppers 500 and 501 are adjusted to be in contact with each other at an interval between the contact surfaces 492 a , 493 a of the heater 492 , 493 abut against each other at their rear ends.
- the abutment position of the upper and lower stoppers 500 and 501 can be adjusted by an adjustment screw or the like (not shown).
- the stoppers 500 and 501 are not provided, when a closing force is further applied from the final closing operation position shown in FIGS. 53A and 53B, the root side portion 503 of each of the jaws 486 and 487 is further elastically deformed. Then, a gap is provided at the tip of each of the contact surfaces 492 a and 493 a of the heaters 492 and 493 of the jaws 486 and 487 .
- the range of elastic deformation of the jaws 486 and 487 depends on the mounting method of the heaters 492 and 493 , and may exceed the range of A shown in FIG. 53A in the case where these heaters are mounted to the jaws 486 and 487 relatively loosely, for example.
- stoppers 500 and 501 for restricting the closed position of the operating portion 491 inwardly of the operating portion 491 is protruded at a position close to the finger insert rings 489 and 490 on the proximal end sides of the scissor constituent members 483 and 484 . Even if an excessive closing force is applied to the operating portion 491 , the stoppers 500 and 501 abut against it, making it possible to prevent a gap from being provided between tips of the contact surfaces 492 a and 493 a in the heaters 492 and 493 of the jaws 486 and 487 .
- FIG. 54C shows a modified example of the coagulating treatment instrument 481 of the thirty-eighth embodiment (refer to FIGS. 53A, 53B, 54 A and 54 B).
- the heaters 492 and 493 are disposed intermediately of the jaws 486 and 487 , and the contact surfaces 492 a and 493 a are partially formed by the tip part of the jaws 486 and 487 .
- an effect similar to the thirty-eighth embodiment can be obtained.
- FIG. 55A shows a schematic structure of a coagulating treatment instrument 511 according to the present embodiment.
- a main body 512 of the coagulating treatment instrument 511 according to the present embodiment is provided with two scissor constituent members 513 and 514 . These scissor constituent members 513 and 514 are placed in a state in which their intermediate portions substantially cross with each other. Further, a fulcrum pin 515 for rotatably linking these scissor constituent members 513 and 514 with each other is arranged at the cross section of the scissor constituent members 513 and 514 .
- a treatment portion 518 comprising a pair of jaws 516 and 517 capable of being opened and closed, which grasps the patient's body tissue, is arranged at the tip of the treatment instrument main body 512 . Further, substantially elliptical finger insert rings 519 and 520 are formed at the proximal ends of the scissor constituent members 513 and 514 . A frontal operating portion 521 for operating a pair of jaws 516 and 517 to be opened and closed is formed by the portions of these finger insert rings 519 and 520 .
- a curve portion 522 gently curved in a substantial arc shape is formed at the treatment portion 518 of the treatment instrument main body 512 .
- heaters 523 and 524 for coagulating the patient's body tissue is provided on the contact surface side with the patient's body tissue.
- the heaters 523 and 524 to be used here include a ceramic heater, a PTC heater (a heater formed of a positive temperature coefficient material), a semiconductor heater or the like.
- insulation lead wires 525 and 526 are arranged, respectively, at the scissor constituent members 513 and 514 .
- the insulation lea wire 525 on one scissor constituent member 513 side is connected to the heater 523 on the jaw 516 side.
- the insulation lead wire 526 on the other scissor constituent member 514 side is connected to the heater 524 on the jaw 517 side.
- two insulation lead wires 525 and 526 requires a total of four lead wires, i.e., two lead wires 526 a and 526 b to be connected to the upper heater 524 as shown in FIG. 55D and two lead wires 525 a and 525 b to be connected to the lower heater 523 .
- These lead wires 526 a , 526 b , 525 a , and 525 b are required to be insulated from each other. In the present embodiment, each of these wires is covered with an insulation cover.
- One cable connection portion 527 is protruded at the peripheral surface of the finger insert ring 519 on the scissor constituent member 513 side.
- one cable connection portion 528 is protruded at the peripheral surface of the finger insert ring 520 on the scissor constituent member 514 side.
- the insulation lead wire 525 is connected to the cable connection portion 527 on the scissor constituent member 513 side
- the insulation lead wire 526 is connected to the cable connection portion 528 on the scissor constituent member 514 side.
- connector cables 529 and 530 whose one ends are connected to the power supply unit (not shown) are detachably connected at the other ends. From the power supply unit (not shown), power is supplied to the heaters 523 and 524 of the jaws 516 and 517 , respectively.
- a lead wire storage groove portion 531 is formed at one scissor constituent member 513 . Two lead wires 525 a and 525 b of the insulation lead wire 525 are stored in this lead wire storage groove portion 531 .
- a lead wire storage groove portion 532 is formed at the other scissor constituent member 514 . Two lead wires 526 a and 526 b of the insulation lead wire 526 are stored in this lead wire storage portion 532 .
- a combination of these two lead wires to be stored in the lead wire storage groove portions 531 and 532 is not limited to that of the present embodiment, and these four lead wires may be stored in a single lead wire storage groove portion.
- each connection portion 533 may be covered with a rubber seal material or the like.
- a rubber seal material 534 for fixing the insulation lead wires 525 and 526 may be charged in the lead wire storage groove portions 531 and 532 of the scissor constituent members 513 and 514 .
- Any shape or configuration of the insulation lead wires 525 and 526 may be employed as long as power can be supplied.
- An elongated thin plate covered to be insulated may be employed without being limited to these lead wires.
- the lead wire storage groove portion 531 is formed at one scissor constituent member 513 , and two lead wires 525 a and 525 b of the insulation lead wire 525 are stored at this lead wire storage groove portion 531 . Further, a lead wire storage groove portion 532 is formed at the other scissor constituent member 532 , And two lead wires 526 a and 526 b of the insulation lead wire 526 are stored in this lead wire storage groove portion 532 .
- the insulation lead wires 525 and 526 are exposed to the scissor constituent members 513 and 514 of the treatment instrument main body 512 . Therefore, the insulation lead wires 525 and 526 do not interfere with operation, and operability of the coagulating treatment instrument 511 can be improved.
- FIG. 55G shows a modified example of the coagulating treatment instrument 511 according to the thirty-ninth embodiment (refer to FIGS. 55A to 55 F).
- a cover 541 made of an insulation material is provided outside the scissor constituent members 513 and 514 of the treatment instrument main body 512 .
- insulation lead wires 525 and 526 are stored.
- an effect similar to that in the thirty-ninth embodiment will be obtained.
- FIGS. 56A to 56 F show a fortieth embodiment of the present invention.
- a structure of the coagulating treatment instrument 511 according to the thirty ninth embodiment is modified as follows:
- connection portion 551 wherein the same electrodes of the insulation lead wires 525 and 526 of the heaters 523 and 524 mounted on the jaws 516 and 517 , for example, lead wires 525 a and 526 a that are cathodes (lead wires 525 b and 526 b that are anodes) are connected to the jaws 516 and 517 , respectively.
- This connection portion 551 is electrically insulated from the outside with a rubber seal material.
- the jaws 516 and 517 , the scissor constituent members 513 and 514 of the treatment instrument main body 512 and the jaws 516 and 517 are made of a metal such as stainless.
- a cable connection portion 552 electrically connected to this scissor constituent member 513 is added to the peripheral surface of the finger insert ring 519 of one constituent element 513 .
- An external connector cable 553 is detachably connected to this cable connection portion 552 .
- the scissor constituent members 513 and 514 of the treatment instrument main body 512 and at least a part of the peripheral surface of the operating portion 521 are covered with an insulation cover.
- one insulation lead wire 525 b that is an anode is stored in the lead wire storage groove portion 531 of the scissor constituent member 513 .
- one insulation lead wire 526 b that is an anode is stored in the lead wire storage groove portion 532 of the scissor constituent member 514 .
- connection portion 551 wherein the lead wire 525 b that is an anode and the lead wire 526 b are connected to the jaws 516 and 517 , respectively.
- one insulation lead wire 525 a that is a cathode may be stored in the lead wire storage groove portion 531 of the scissor constituent member 513
- one insulation lead wire 526 a that is an anode may be stored in the lead wire storage groove portion 532 of the scissor constituent member 514 .
- one scissor constituent member 513 and the jaw 516 are utilized as a electrically conducting member of an anode or a cathode for supplying power to each of the heaters 523 and 524 .
- the number of insulation lead wires to be stored in the lead wire storage groove portions 531 and 532 of the scissor constituent members 513 and 514 of the treatment instrument main body 512 can be reduced. Therefore, there is an affect that the scissor constituent members 513 and 514 of the treatment instrument main body 512 can be thinned.
- the insulation lead wires themselves can be thickened, and a loss due to an electric resistance can be decreased.
- FIGS. 57A to 57 F show a forty-first embodiment of the present invention.
- a structure of the coagulating treatment instrument 511 according to the fortieth embodiment (refer to FIGS. 56A to 56 F) is modified as follows:
- insulation lead wire 561 there is provided one insulation lead wire 561 , wherein insulation lead wires 525 b and 526 b to be arranged respectively at the scissor constituent members 513 and 514 of the treatment instrument main body 512 according to the present embodiment are provided in common.
- This insulation lead wire 561 is diverged into two ways near the jaws 516 and 517 , and is connected to the same electrodes of the upper and lower heaters 523 and 524 , i.e., an anode in the present embodiment.
- a lead wire storage groove portion 562 is provided at only one scissor constituent member 514 of the two scissor constituent members 513 and 514 of the treatment instrument main body 512 .
- One insulation lead wire 561 is stored in this lead wire storage groove portion 562 .
- one insulation lead wire 561 wherein insulation lead wires 525 b and 526 b to be arranged respectively at the scissor constituent members 513 and 514 of the treatment instrument main body 512 according to the fortieth embodiment are provided in common.
- This insulation lead wire 561 is connected to the same electrodes of the upper and lower heaters 523 and 524 , i.e., an anode in the present embodiment.
- a lead wire storage groove portion 562 is provided only at one scissor constituent member 514 , and one insulation lead wire 561 is stored in this lead wire storage groove portion 562 .
- the present invention is not limited to the above mentioned embodiment, and can be deformed and implemented without departing from the gist of the present invention.
- FIGS. 58 to 62 show a forty-second embodiment of the present invention.
- FIG. 58 is a general view of a coagulating/cutting system according to the present embodiment
- FIG. 59 is a perspective view of holding portions of a thermocoagulation cutting forceps
- FIG. 60 is a sectional view taken along line 60 - 60 of FIG. 59
- FIGS. 61A and 61B are views for illustrating processes of operation for coagulating and incising a tissue
- FIG. 62 is an electric circuit diagram of a power source unit.
- thermocoagulation cutting forceps 601 for uses as a surgical instrument is connected to a power source unit 603 as power supply means by means of a cable 602 , and a footswitch 604 for output control is also connected to the unit 603 .
- the forceps 601 is composed of a hand operating portion 605 for use as holding portion drive means, insert portion 606 , and a pair of holding portions 607 and 608 as first and second engaging surfaces on the distal end of the insert portion 606 .
- the hand operating portion 605 is formed of an operating portion body 612 , fixed handle 609 integral with the body 612 , and a movable handle 611 rockable around a pivot 610 .
- the insert portion 606 is mounted on the operating portion body 612 for rotation around it axis by means of a rotation control portion 613 .
- the insert portion 606 is formed of a slender pipe, in which a drive shaft 614 is inserted for axial movement.
- the proximal end portion of the shaft 614 is coupled to the movable handle 611 .
- the first and second holding portions 607 and 608 are provided on the distal end portion of the shaft 614 .
- the holding portions 607 and 608 are swingable around a pivot pin 615 . If the movable handle 611 is rocked in the direction of arrow a, the drive shaft 614 retreats to close the holding portions 607 and 608 . If the handle 611 is rocked in the direction of arrow b, the shaft 614 advances to open the holding portions 607 and 608 .
- the operating portion body 612 is provided with a connector junction 616 a , which is removably connected with a connector 616 of the cable 602 .
- the junction 616 a is connected electrically to a heating unit 618 (mentioned later), which is provided on the first holding portion 607 so as to extend along the drive shaft 614 .
- the first holding portion 607 is provided with a groove 617 that opens toward the second holding portion 608 .
- the groove 617 extends in the longitudinal direction of the first holding portion 607 .
- a heating unit 618 is stored in the groove 617 .
- a heating plate 619 is bonded to the heating unit 618 .
- the heating unit 618 is formed of, for example, a molybdenum-film resistance-heating element that is small-sized and enjoys high heating efficiency.
- the heating plate 619 is profiled having a substantially chevron-shaped projection 619 a .
- a flat portion 619 b with a width d is formed on the distal end of the projection 619 a , and two flat surfaces 619 c and 619 d are formed individually on the opposite sides of the flat portion 619 b in a manner such that an angle ⁇ is formed between them.
- the width d is a dimension that covers a Teflon coating on the surface of the heating plate 619 (the Teflon coating is not shown).
- the heating plate 619 should be formed of a material with high thermal conductivity, such as copper, silver, tungsten, etc., and the heating unit 618 may alternatively be a ceramic heater, cartridge heater, PTC heater, etc.
- the second holding portion 608 has a wide recess 620 that opens toward the first holding portion 607 , and its cross section is U-shaped.
- a receiving member 621 of a soft material is provided in the recess 620 .
- Available materials for the receiving member 621 include, for example, rubber (silicone rubber, fluororubber, ethylene-propylene rubber, butyl rubber, etc.), gel (silicone-based a gel or the like), and fluoroplastics (e.g., Teflon).
- Serrated antiskid portions 622 are provided individually on the opposite side edges of the recess 620 .
- the power source unit 603 is provided with a setting portion 623 capable of setting the heating temperature of the heating unit 618 and a display portion 624 .
- the setting portion 623 is provided with an upper button 623 a for raising the set temperature and a lower button 623 b for lowering the set temperature.
- the display portion 624 displays the set heating temperature (e.g., 150° C.) of the heating unit 618 .
- the heating temperature can be set by means of the setting portion 623 .
- the set temperature can be raised and lowered by depressing the upper and lower buttons 623 a and 623 b , respectively.
- the footswitch 604 is provided with first and second pedals 625 and 626 .
- the first pedal 625 is an incision pedal for an output set at a possible incision temperature, for example.
- the second pedal 626 is a coagulation pedal for an output set at a possible coagulation temperature, for example.
- FIG. 62 shows an electric circuit of the power source unit 603 .
- a power source element 627 that is connected to the commercial power supply is connected to the cable 602 through an output element 628 .
- the output element 628 is connected to a control element 629 .
- the control element 629 is connected with setting means 630 for setting the heating temperature and the footswitch 604 .
- thermocoagulation cutting forceps 601 of the present embodiment an operator holds the hand operating portion 605 and rocks the movable handle 611 in the direction of arrow b of FIG. 58 with respect to the fixed handle 609 . Thereupon, the drive shaft 614 advances to open the first and second holding portions 607 and 608 . In this state, the forceps 601 is advanced, and the movable handle 611 is rocked in the direction of arrow a of FIG. 58 in a manner such that a region X of the organism tissue to be coagulated and incised is interposed between the first and second holding portions 607 and 608 . Thereupon, the drive shaft 614 retreats to close the holding portions 607 and 608 .
- the region X of the organism tissue to be coagulated and incised is held stressed under a force of pressure that suits a coagulative treatment, as shown in FIG. 61A.
- the organism tissue is compressed between the flat portions 619 b , 619 c and 619 d of the heating plate 619 and the receiving member 621 .
- the distal end of the 619 is not sharp enough to be able to cut the organism tissue.
- the organism tissue cannot be incised.
- the heating unit 618 is then supplied with current from the power source unit 603 and heated, the heating plate 619 is heated by transferred heat. Thereupon, a region of the organism tissue in contact with the thin flat portion 619 b is coagulated at high pressure, so that evaporation of water from the organism tissue advances. Then, the weakened organism tissue is cut and incised. As this is done, those portions of the receiving member 621 which engage the flat portions 619 b , 619 c and 619 d are delicately deformed, so that a coagulative force for compressing the periphery of the organism tissue to be incised is enhanced.
- the heating temperature is then adjusted to 180° C., water evaporates more slowly than in the case where the heating temperature is set at 200° C. Since the heating time is a little longer in this case, the organism tissue is fully coagulated, the coagulative force can be enhanced, and incision can be carried out. Thus, tissues including blood vessels can be incised without bleeding.
- the heating time is set at 160° C., moreover, evaporation of water from the organism tissue is insufficient for incision. In this state, therefore, the organism tissue can be only coagulated without being incised.
- the thin heating plate compresses the organism tissue according to the forty-second embodiment, it produces a great coagulative force.
- the organism tissue can be incised the moment it is coagulated. Further, the organism tissue is never cut in an unheated state.
- the holding portions are closed, moreover, the receiving member is deformed to compress the tissue uniformly throughout the length, so that the tissue can be coagulated and incised securely.
- the coagulative force increases as the receiving member is delicately deformed.
- thin-film resistance-heating elements or other heating units that are susceptible to external environment enjoy higher durability, since they are embedded in holding portions.
- the following is a description of another example of the coagulating/cutting operation.
- the operator steps on the first or second pedal 625 or 626 in a manner such that the region X of the organism tissue to be coagulated and incised is held stressed under a force of pressure that suits the coagulative treatment, as shown in FIG. 61A.
- the case where the first pedal 625 is worked will be described first.
- the thermocoagulation cutting forceps 601 is supplied with current from the power source unit 603 through the cable 602 . If the first pedal 625 is worked without regard to the setup of the setting means 630 , the control element 629 controls the heating unit 618 of the first holding portion 607 so that it is heated at its maximum temperature, whereupon current is supplied.
- the heating unit 618 Since the heating unit 618 is heated at the maximum temperature, water quickly evaporates from the organism tissue, so that incision can be carried out rapidly. In consequence, the incisive force becomes greater. Since the heating time is short, however, the organism tissue cannot be coagulated much and looks as if it were cut by means of a sharp edge tool. Thus, the arrangement of the present embodiment is suited for the incision of tissues that include very fine blood vessels or rarely include ones.
- the control element 629 controls the heating unit 618 so that it is heated at a temperature set by means of the setting means 630 , whereupon current is supplied.
- the operator sets a temperature a little lower than the maximum temperature of the heating unit 618 as a set temperature. Since the heating unit 618 is heated at a temperature a little lower than the maximum temperature, incision is slower than in the case where the first pedal 625 is worked. Thus, the heating time lengthens, so that the coagulative force can be enhanced.
- the organism tissue can be incised the moment it is coagulated, so that tissues including blood vessels can be incised without bleeding.
- thermocoagulation cutting forceps 601 can be freely alternatively used for any of three operation modes, including incision-only, continuous coagulation/incision, and coagulation-only.
- it can provide expediency of a level that can be attained with use of a plurality of medical instruments.
- This arrangement can produce a great effect in an endoscopic surgical operation that requires troublesome intra-operative replacement of forceps, in particular.
- the operator can previously omit the setup of the set temperature for an incisive treatment that is frequently used in surgical operations for digestive organs or the like.
- footswitch 604 The operation of the footswitch 604 is not limited to the embodiment described above, and may be carried out in the following manner.
- the first pedal 625 is heated at a set temperature.
- the second pedal 626 is always heated at its minimum temperature (lower limit of the set temperature).
- the first or second pedal is used for the output at the set temperature set by means of the setting means 630 .
- the setting means 630 may be given an additional function to set the maximum or minimum temperature or provided with two setting means for setting the set temperature and setting the maximum or minimum temperature.
- the setting means 630 may be formed of various means including input means, such as various switches, keyboard, mouse, etc., memories stored with set values, and circuits with the set values.
- FIG. 63 shows a forty-third embodiment.
- Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS. 58 to 62 ), and a description of those components is omitted.
- a flat portion 619 b with a width dl is formed on the distal end portion of a heating plate 619 .
- Each corner portion of the flat portion 619 b is cut into a smooth arcuate shape, thus forming a chamfer portion 619 b 1 .
- Recommended values for the width dl range from about 0.1 to 0.15 mm (dimensions covering a resin coating of fluoroplastics, such as Teflon).
- the presence of the chamfer portion 619 b 1 results in an increased area of contact with the organism tissue and enhanced coagulative force (and correspondingly reduced incisive force).
- FIG. 64 shows a forty-fourth embodiment.
- Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS. 58 to 62 ), and a description of those components is omitted.
- a distal end portion 619 e of a heating plate 619 is in the form of a circular arc with a radius R, and flat portions 619 f and 619 g are formed individually on the opposite sides of the heating plate 619 .
- Recommended values for the radius R range from about 0.05 to 0.15 mm (dimensions covering a Teflon coating).
- the distal end portion 619 e of the heating plate 619 is smoother as a whole and has no shape angle portions, so that it can be reliably coated with Teflon.
- FIG. 65 shows a forty-fifth embodiment.
- Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS. 58 to 62 ), and a description of those components is omitted.
- an arcuate protrusion 619 h is formed on the distal end portion of a heating plate 619 .
- the protrusion 619 h is not limited to the arcuate shape, and may alternatively be rectangular or triangular.
- the protrusion 619 h on the distal end portion of the heating plate 619 is used for incision, so that the incisive force is greater than in the case of the forty-fourth embodiment.
- FIG. 66 shows a forty-sixth embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS. 58 to 62 ), and a description of those components is omitted.
- a ceramic heater 631 is provided directly in place the heating plate 619 .
- the ceramic heater 631 is fixed directly to the lower part of a first holding portion 607 .
- the heater 631 has the same cross profile as that of the heating plate 619 of the forty-second embodiment, it may have the same cross profile as those of the heating plates 619 of the forty-third to forty-fifth embodiments.
- a Teflon coating 632 covers the respective outer surfaces of the ceramic heater 631 and the first holding portion 607 . Since the heater 631 is a relatively strong simple, it can be used in this manner and its construction can be simplified.
- FIG. 67 shows a forty-seventh embodiment.
- Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS. 58 to 62 ), and a description of those components is omitted.
- a Teflon coating 633 covers the outer surface of a heating plate 619 that has a sharp projection 619 a.
- the Teflon coating 633 can form a thin straight portion and a smooth arcuate portion 634 at the distal end of the plate 619 , thus producing the same effect of the forty-second embodiment.
- the shape of the heating plate 619 (including the ceramic heater 631 ) is not limited to the embodiments described above, and may be changed as required.
- the respective cross profiles of the heating plate and the ceramic heater need not be uniform throughout the length, and may be varied partially.
- the remote-side portion of the heating plate 619 may be sharpened so that it can serve as a portion for incision only.
- the hand-side portion of the plate 619 is given the shape according to the foregoing embodiment so that it can serve for coagulation and incision.
- FIG. 68A shows a forty-eighth embodiment.
- Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS. 58 to 62 ), and a description of those components is omitted.
- the present embodiment is based on a modification of the second holding portion 608 .
- a groove portion 621 a having an arcuate cross section is formed on the upper surface of a receiving member 621 , substantially covering the overall length of the member 621 .
- the receiving member 621 is formed of the material described in connection with the forty-second embodiment.
- the groove portion 621 a may be replaced with a rectangular groove portion 621 b according to a modification shown in FIG. 68B or a triangular groove portion 621 c according to a modification shown in FIG. 68C.
- the coagulative and incisive forces can be improved as the organism tissue is caught between the heating portion (heating plate, ceramic heater, etc.) of the first holding portion 607 and the groove portion 621 a.
- FIG. 69 shows a forty-ninth embodiment.
- Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS. 58 to 62 ), and a description of those components is omitted.
- a Teflon coating 633 covers a recess 620 of a second holding portion 608 . According to the present embodiment, the system can be easily manufactured at low cost.
- FIGS. 70A and 70B show a fiftieth embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS. 58 to 62 ), and a description of those components is omitted.
- a receiving member 635 of a synthetic resin is pivotally supported in a recess 620 of a second holding portion 608 by means of a pivot pin 636 so that it can slightly rock around the pin 636 .
- Available synthetic resin materials for the receiving member 635 include, for example, fluoroplastics (e.g., Teflon), PEEK, polyimide, PPS, etc.
- the receiving member 635 rocks around the pivot pin 636 following the action of the second holding portion 608 as a first holding portion 607 and the second holding portion 608 are closed. Accordingly, a heating plate 619 and the receiving member 635 come intimately into contact with each other without a gap, so that the organism tissue can be uniformly compressed and securely coagulated and incised.
- FIGS. 71A, 71B and 72 show a fifty-first embodiment, which is based on modifications of the display portion 624 of the power source unit 603 according to the forty-second embodiment (see FIGS. 58 to 62 ).
- a display portion 641 for displaying the temperature level is provided in place of the display portion 624 of the forty-second embodiment that displays the heating temperature.
- FIG. 71A shows a plurality of bars 641 a of different heights that indicate the temperature level (level 3 is illustrated as an example).
- FIG. 71B shows a display portion 642 that indicates the temperature level by a figure (for level 3 as an example).
- FIG. 72 shows the relation between the set level and the heating temperature.
- levels 5 and 1 correspond to T 5 (maximum temperature) and T 1 (minimum temperature), respectively.
- the relation between the set level and the heating temperature T is nonlinear.
- the change of the temperature T relative to the change of the set level is slower. This is based on the fact that even a small temperature difference near the maximum temperature T 5 causes a difference in the way the region of the organism tissue to be coagulated and incised is cut, and that the region of the tissue to be coagulated and incised can be cut without any substantial difference at somewhat lower temperatures.
- the nonlinear relation is established in a manner such that the current supply and heating are effected in a desired coagulating/cutting state that is selected by changing the level by means of the setting portion 623 of the power source unit 603 . If the level is changed, therefore, the incisive force changes only slowly, ensuring user-friendliness.
- FIG. 73 shows a fifty-second embodiment.
- a fixed handle 609 of a thermocoagulation cutting forceps 601 is provided with a hand switch unit 643 for output control in place of the footswitch 604 of the forty-second embodiment (see FIGS. 58 to 62 ).
- the hand switch unit 643 is provided with first and second switches 643 a and 643 b that correspond to the first and second pedals 625 and 626 of the footswitch 604 , respectively.
- the first switch 643 a is used for the output at a set temperature for incision, and the second switch 643 b for the output at a set temperature for coagulation, for example.
- the output of the thermocoagulation cutting forceps 601 can be controlled by only manipulating the hand switch 643 of the fixed handle 609 of the forceps 601 with fingers, so that the user-friendliness is higher than in the case where the footswitch 604 is used.
- FIG. 74 is a perspective view of a scissors-type thermocoagulation cutting forceps 645 according to a fifty-third embodiment.
- a body 646 of the forceps 645 of the present embodiment is provided with two scissors members 647 and 648 .
- the members 647 and 648 are lapped crossing each other substantially in the middle. Further, a pivot pin 649 for rockably connecting the scissors members 647 and 648 is provided on the intersection of the members 647 and 648 .
- a treatment portion 652 is formed on the distal end portion of the body 646 . It is provided with a pair of jaws 650 and 651 that constitute swingable holding portions for holding the organism tissue. Further, substantially elliptic finger rings 653 and 654 , having ratchets 653 a and 654 a , respectively, are formed on the proximal end portions of the scissors members 647 and 648 , respectively. These finger rings 653 and 654 form a hand operating portion 655 for opening and closing the jaws 650 and 651 .
- the treatment portion 652 of the body 646 is formed having a curved portion 656 that is curved gently in the shape of a substantially circular arc. Further, a serrated antiskid portion 650 a is provided on the inner surface of the one jaw 650 , while a thin heating plate 651 a , having a heating unit for coagulating the organism tissue embedded therein, is formed on the inner surface of the other jaw 650 , that is, on the side in contact with the organism tissue.
- the heating plate 651 a is connected to a connector 657 by means of the scissors member 647 .
- the connector 657 is connected with a cable 658 that connects with a power source unit (not shown).
- thermocoagulation cutting forceps 645 constructed in this manner.
- the treatment portion 652 at the distal end portion of the body 646 is inserted in a closed state into the organism tissue that includes a to-be-treated region such as a blood vessel (not shown).
- a to-be-treated region such as a blood vessel (not shown).
- the jaws 650 and 651 are opened so that the blood vessel or the like is separated from other organism tissues and exposed.
- the separated blood vessel or the like is held stressed between the jaws 650 and 651 under a relatively small appropriate force of pressure that suits the coagulative treatment.
- the power source unit (not shown) is worked in this state, current is supplied to the heating unit of the heating plate 651 a of the jaw 651 through the cable 658 .
- the heating unit is heated by electrical resistance during the power supply, whereupon the blood vessel or other organism tissue to be treated, in contact with the surface of the heating plate 651 a , is coagulated and incised.
- the organism tissue can be satisfactorily incised with a small grip force of the jaws 650 and 651 that are substantially in linear contact with the tissue.
- a thermocoagulation cutting forceps that can efficiently coagulate and incise the organism tissue in a series of operations.
- the heating unit may alternatively be a thin-film resistance-heating element, PTC heater, cartridge heater, or ceramic heater.
- FIG. 75 is a perspective view of a scissors-type forceps 661 for use as a medical instrument.
- a body 662 of the forceps 661 is provided with two scissors members 663 a and 663 b .
- the members 663 a and 663 b are lapped crossing each other substantially in the middle.
- a pivot 665 for rockably connecting the scissors members 663 a and 663 b is provided on the intersection of the members 663 a and 663 b.
- a pair of swing elements 666 and 667 are provided on the distal end side of the forceps body 662 with respect to the pivot 665 .
- the swing elements 666 and 667 are formed having holding portions 668 a and 668 b , respectively, which are curved gently in the shape of a substantially circular arc each.
- a heating unit 618 is located in each of respective holding portions 668 a and 668 b of the swing elements 666 and 667 .
- the heating units 618 are energized and heated, their heat is transferred to the surface side of the holding portions 668 a and 668 b through heating plates 619 , so that the organism tissue held between the holding portions 668 a and 668 b of the swing elements 666 and 667 can be coagulated.
- a cutting edge portion 669 for incising the organism tissue protrudes from the one holding portion 668 b of the scissors-type forceps 661 toward the other holding portion 668 a .
- the edge portion 669 is located substantially in the center of the holding portion 668 b and extends in the longitudinal direction of the holding portion 668 b.
- the blood vessel is held between the holding portions 668 a and 668 b after it is separated from the organism tissue. As this is done, the blood vessel is stressed between the holding portions 668 a and 668 b under a relatively small force of pressure such that the edge portion 669 on the holding portion 668 b cannot cut off the blood vessel.
- the heating units 618 are energized and heated in this state, their heat is transferred through the heating plates 619 to the blood vessel that is held between the holding portions 668 a and 668 b , whereupon the lumen of the blood vessel is coagulated. If a hand operating portion 664 is held tight to move the holding portions 668 a and 668 b further toward each other, the top of the edge portion 669 of the holding portion 668 b is pressed hard against the holding portion 668 a . In this manner, the coagulated portion of the blood vessel can be incised by means of the edge portion 669 of the holding portion 668 b.
- the lumen of the blood vessel is coagulated as the heating units 618 are energized and heated with the blood vessel stressed under a relatively small force of pressure such that the edge portion 669 of the holding portion 668 b cannot cut it off when it is held between the holding portions 668 a and 668 b of the scissors-type forceps 661 .
- the coagulated portion of the blood vessel can be easily incised by means of the edge portion 669 of the holding portion 668 b in a manner such that the hand operating portion 664 is held tight to press the top of the edge portion 669 hard against the holding portion 668 a.
- the organism tissue can be coagulated and incised with use of the one scissors-type forceps 661 . It is unnecessary, therefore, to replace separate medical instruments for individual treatments, so that the user-friendliness is improved and costs are lowered.
- FIGS. 77A and 77B show a fifty-fifth embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS. 58 to 62 ), and a description of those components is omitted.
- a receiving member 671 of a soft material is located in a recess 620 of a second holding portion 608 .
- a corrugated antiskid portion 672 for organism tissue is formed on a holding surface of the receiving member 671 .
- the corrugated portion 672 of the receiving member 671 can be elastically deformed into a substantially flat shape, thereby preventing the organism tissue from slipping off.
- FIGS. 78A and 78B show a fifty-sixth embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS. 58 to 62 ), and a description of those components is omitted.
- a receiving member 681 of a soft material is located in a recess 620 of a second holding portion 608 .
- An arcuate portion 682 with a wide radius of curvature is formed on a holding surface of the receiving member 681 .
- FIG. 78A shows a state in which a first holding portion 607 and the second holding portion 608 are closed softly. In coagulating and incising the organism tissue, the first and second holding portions 607 and 608 in this state are closed tight.
- the arcuate portion 682 of the receiving member 681 can be elastically deformed into a substantially flat shape by means of the first holding portion 607 , so that the organism tissue can be held securely.
- FIGS. 79A and 79B show a fifty-seventh embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS. 58 to 62 ), and a description of those components is omitted.
- a receiving member 691 of a soft material is located in a recess 620 of a second holding portion 608 .
- a protrusion 692 is formed on that region of a holding surface of the receiving member 691 which engages a heating plate 619 of a first holding portion 607 . As shown in FIG. 79B, moreover, the protrusion 692 may be chevron-shaped.
- the protrusion 692 thus formed on the receiving member 691 serves to facilitate incision of the organism tissue. Further, the protrusion 692 may be designed so that it can be elastically deformed into a substantially flat shape when the first and second holding portions 607 and 608 are closed tight to coagulate and incise the organism tissue.
- FIGS. 80A and 80B show a fifty-eighth embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS. 58 to 62 ), and a description of those components is omitted.
- a receiving member 701 of a soft material is located in a recess 620 of a second holding portion 608 .
- a concave surface 702 is formed in that region of a holding surface of the receiving member 701 which engages a heating plate 619 of a first holding portion 607 .
- the concave surface 702 may be formed only in a part of the holding surface of the receiving member 701 .
- the concave surface 702 thus formed in the holding surface of the receiving member 701 is an effective measure for the case where the organism tissue to be held is slippery cannot be seized with ease, owing to its shape or properties.
- the concave surface 702 may be designed so that it can be elastically deformed into a substantially flat shape when the first and second holding portions 607 and 608 are closed tight to coagulate and incise the organism tissue.
- FIGS. 81 to 86 collectively show a fifty-ninth embodiment of the present invention, wherein FIG. 81 is an entire structural view of a surgical instrument, FIG. 82 is a side view of the surgical instrument, FIG. 83 is a perspective view of the holding portion, FIG. 84 is a cross sectional along the line A-A shown in FIG. 83, FIG. 85 is an electrical circuit diagram of the power source apparatus, and FIG. 86 is a graph.
- thermocoagulation cutting forceps 801 constituting a surgical instrument is connected to a power source apparatus 803 via a cable 802 .
- a foot switch 804 is connected to the power source apparatus 803 .
- the thermocoagulation cutting forceps 801 comprises a slender inserting portion 806 , a manual operating portion 805 arranged at a proximal end portion of the inserting portion 806 , and a treating portion 807 mounted at the distal end portion of the inserting portion 806 .
- a pair of first and second holding portions 808 A and 808 B are arranged in the treating portion 807 .
- An operating body 812 and a stationary handle 809 are integrally mounted to the manual operating portion 805 . Further, a movable handle 811 is swingably mounted to the operating body 812 such that the handle 811 is swingable about a pivotal shaft 810 providing the fulcrum.
- the inserting portion 806 is joined to the operating body 812 such that the inserting portion 806 is rotatable about its own axis.
- a rotary operating portion 813 is arranged in the operating body 812 .
- the proximal end portion of the inserting portion 806 is joined to the rotary operating portion 813 . It should be noted that the rotary operating portion 813 permits the inserting portion 806 to be rotated relative to the operating body 812 .
- the inserting portion 806 is formed of a pipe having a small diameter, and a driving shaft 814 is movably inserted into the inserting portion 806 .
- the proximal end portion of the driving shaft 814 is joined to the movable handle 811 , and the first and second holding portions 808 A, 808 B are arranged in the distal end portion of the driving shaft 814 . It is possible to open the first and second holding portions 808 A, 808 B about a pivotal pin 815 providing a fulcrum. If the movable handle 811 is rotated in a direction denoted by an arrow a in FIG. 82, the driving shaft 814 is moved backward so as to close the first and second holding portions 808 A, 808 B. Further, if the movable handle 811 is moved in a direction denoted an arrow b shown in FIG. 82, the driving shaft 814 is moved forward so as to open the first and second holding portions 808 A and 808 B.
- a connector connecting portion 816 a is mounted to project upward from the operating body 812 , as shown in FIG. 82.
- An electrical contact 816 b is mounted to the connector connecting portion 816 a .
- the electrical contact 816 b is electrically connected to a heating element 823 of a ceramic heater 822 , which will be described hereinlater, arranged in the second holding portion 808 B along the driving shaft 814 .
- a connector 816 of a cable 802 is detachably connected to the connector connecting portion 816 a.
- the first holding portion 808 A is wide and is formed in the shape of a letter “U” in its cross section.
- a concave portion 817 open in its lower portion is formed in the first holding portion 808 A.
- saw tooth-like slip-preventing portions 818 are formed in the edge portions on the lower side of the first holding portion 808 A in a manner to have the concave portion 817 sandwiched therebetween.
- a heat insulating member 819 formed of a flexible material such as Teflon is buried in the concave portion 817 .
- a heater holding portion 820 having a width smaller than that of the concave portion 817 and having a rectangular cross section is arranged in the second holding portion 808 B.
- An arcuate groove 821 is formed on the upper surface of the heater holding portion 820 .
- the columnar ceramic heater 822 acting as a heat generating portion is fixed to the arcuate groove 821 .
- the ceramic heater 822 is formed by burying a heating element 823 , which is a heat generating resistor, within the ceramic material, which is an insulating material.
- a Teflon coating is applied to the outer surfaces of the first and second holding portions 808 A and 808 B so as to prevent the scorch of the living tissues.
- FIG. 85 shows the electric circuit of the power source apparatus 803 .
- a power source circuit 824 connected to a commercial power source is connected to the cable 802 via an output circuit 825 .
- the output circuit 825 is connected to a control circuit 826 , which is connected to the foot switch 804 .
- the control circuit 826 is connected to a setting means 827 for setting the temperature, time, etc.
- FIG. 86 is a graph showing the change with time in temperature during the cutting time, the coagulation time and the coagulating cutting time.
- the time t (seconds) is plotted on the abscissa, with the temperature T (° C.) being plotted on the ordinate.
- the setting means 827 can set selectively the temperature elevation in the cutting step in which the temperature is rapidly elevated to temperature T 1 as denoted by curve fl, the temperature elevation in the coagulation step in which the temperature is slowly elevated to temperature T 2 and temperature T 2 is maintained for several seconds as denoted by curve f 2 , and the temperature elevation in the coagulation cutting step in which the temperature is slowly elevated to temperature T 2 and, then, rapidly elevated to temperature T 1 as denoted by curve f 3 .
- thermocoagulation cutting forceps of the construction described above The operation for coagulating-cutting the coagulation cutting portion of the living tissue by the thermocoagulation cutting forceps of the construction described above will now be described.
- the driving shaft 814 is moved forward so as to open the first and second holding portions 808 A and 808 B. If the thermocoagulation cutting forceps 801 is moved forward under this condition, the coagulation cutting portion of the living tissue is held between the first and second holding portions 808 A and 808 B. If the movable handle 811 is rotated under this condition in the direction denoted by the arrow “a” in FIG. 82, the driving shaft 814 is moved backward so as to close the first and second holding portions 808 A and 808 B.
- the coagulation cutting portion of the living tissue is held under a compressed state with a relatively small appropriate compressing force adapted for the coagulation treatment. If the foot switch 804 is turned on under this state, an electric current is supplied from the power source apparatus 803 to the thermocoagulation cutting forceps 801 through the cable 802 . As a result, the current set by the setting means 827 is supplied to the heating element 823 arranged within the ceramic heater 822 of the second holding portion 808 B, with the result that heat is generated from the heating element 823 .
- the electric current set by the setting means 827 is supplied to the heating element 823 at time t 4 .
- the temperature is rapidly elevated to temperature T 1 as denoted by curve f 3 in FIG. 86.
- the driving shaft 814 is moved backward so as to further close the first and second holding portions 808 A and 808 B, thereby making it possible to cut the coagulation cutting portion of the living tissue.
- the contact surface of the second holding portion 808 B with the living tissue is formed of the columnar ceramic heater 822 , making it possible for the second holding portion 808 B to be brought into a linear contact with the living tissue, leading to an excellent cutting performance.
- the living tissue can be cut with a small holding force between the first and second holding portions 808 A and 808 B.
- the present invention provides a thermocoagulation cutting forceps, which permits the operations ranging between the coagulation and the cutting to be performed by a series of continuous operations and which is excellent in the cutting performance of the living tissue.
- FIG. 87A shows a sixtieth embodiment of the present invention.
- This embodiment is substantially equal to the fifty-ninth embodiment shown in FIGS. 81 to 86 , except that, in the sixtieth embodiment, the treatment portion 807 of the thermocoagulation cutting forceps 801 is constructed as described in the following.
- the constructions of the embodiment shown in FIG. 87A which are the same as those of the fifty-ninth embodiment, are denoted by the same reference numerals.
- a columnar ceramic heater 831 is arranged in the concave portion 817 of the first holding portion 808 A.
- a heating element 832 formed of a heat generating resistor is buried in the ceramic heater 831 .
- heat is generated from both the heater 832 within the first holding portion 808 A and the heater 823 within the second holding portion 808 B.
- FIG. 87B shows a first modification of the treatment portion 807 in the surgical instrument according to the sixtieth embodiment of the present invention, which is shown in FIG. 87A.
- a rectangular ceramic heater 833 is arranged within the concave portion 817 of the first holding portion 808 A.
- a heating element 834 formed of a heat generating resistor is buried in the ceramic heater 833 . It follows that the heat energy is generated from both the heating element 834 within the first holding portion 808 A and the heating element 823 within the second holding portion 808 B.
- FIG. 87C shows a second modification of the treatment portion 807 in the surgical instrument according to the sixtieth embodiment of the present invention, which is shown in FIG. 87A.
- a rectangular heater holding portion 835 having a small width is mounted to the first holding portion 808 A.
- An arcuate groove 836 is formed in the heater holding portion 835 .
- a ceramic heater 837 is arranged in the arcuate groove 836 .
- a heating element 838 formed of a heat generating resistor is buried in the ceramic heater 837 . It follows that the heat energy is generated from both the heating element 838 within the first holding portion 808 a and the heating element 823 within the second holding portion 808 B.
- FIG. 87D shows a third modification of the treatment portion 807 in the surgical instrument according to the sixtieth embodiment of the present invention, which is shown in FIG. 87A.
- a rectangular ceramic heater 839 having a small width is mounted to the heater holding portion 820 of the second holding portion 808 B.
- a heating element 840 formed of a heat generating resistor is buried in the ceramic heater 839 , thereby improving the cutting performance.
- FIG. 87E exemplifies another construction of the second holding portion 808 B in the third modification (FIG. 87D) of the surgical instrument according to the sixtieth embodiment of the present invention shown in FIG. 87A.
- a chamfered portion 839 a which is prepared by a C-chamfering process, is formed in the corner portion of the ceramic heater 839 of the second holding portion 808 B, as shown in FIG. 87E.
- FIG. 87F exemplifies still another construction of the second holding portion 808 B in the third modification (FIG. 87D) of the surgical instrument according to the sixtieth embodiment of the present invention shown in FIG. 87A.
- a chamfered portion 839 b which is prepared by an R-chamfering process for cutting the edge portion so as to provide an edge portion having an obtuse angle, is formed in the corner portion of the ceramic heater 839 of the second holding portion 808 B.
- thermocoagulation cutting forceps which permits the operations ranging between the coagulation and the cutting to be performed by a series of continuous operations and which is excellent in the cutting performance of the living tissue.
- FIG. 88 shows a sixty-first embodiment of the present invention.
- a scissors-type thermocoagulation cutting forces 841 is used in this embodiment.
- Two scissors components 843 , 844 are mounted to a main body 842 of the thermocoagulation cutting forceps 841 .
- These scissors components 843 , 844 are overlapped one upon the other such that these scissors components are allowed to substantially cross each other in the intermediate portions.
- a pivotal pin 845 for rotatably joining these scissors components 843 , 844 is arranged in the crossing portion of these scissors components 843 and 844 .
- a bent portion 852 which is moderately bent to form a substantially arcuate configuration, is formed in the treatment portion 848 of the main body 842 . Further, a saw tooth-shaped slip preventing portion 847 a is formed on the inner surface one jaw 847 . Also, a columnar ceramic heater 846 a having a heating element buried therein is formed on the inner surface of the other jaw 846 , i.e., on the surface that is brought into contact with the living tissue. The heating element buried in the ceramic heater 846 serves to coagulate the living tissue.
- the ceramic heater 846 a is connected to the connector 853 through the scissors component 843 , and the cable 854 connected to the power source apparatus (not shown) is connected to the connector 853 .
- thermocoagulation cutting forceps 841 of the construction described above will now be described.
- the forceps 841 is inserted into the portion to be treated including, for example, a blood vessel, with the treatment portion 848 at the distal end portion of the main body 842 closed.
- the pair of jaws 846 , 847 are opened so as to peel the treated portion such as a blood vessel from the living tissue and expose the peeled treated portion.
- the peeled blood vessel or the like is compressed and held between the jaws 846 and 847 with a relatively small appropriate compressing force adapted for the coagulation treatment.
- the power source apparatus (not shown) is turned on under this condition, an electric current denoted by f 2 in FIG. 86 is supplied from the power source apparatus to the heating element of the ceramic heater 846 a of the jaw 847 through the cable 854 .
- the ceramic heater 846 a generates heat because of the electrical resistance during the current supply so as to coagulate the living tissue of the treated portion such as the blood vessel, which is in contact with the surface of the ceramic heater 846 a.
- the columnar ceramic heater 846 a is mounted to the inner surface of the jaw 846 of one scissors component 843 , i.e., to the contact surface with the living tissue. Also, since the contact surface of the jaw 846 with the living tissue is formed of the columnar ceramic heater 846 a , the columnar ceramic heater 846 a is brought into a substantially linear contact with the living tissue, leading to an excellent cutting performance. It follows that the living tissue can be cut open with a small holding force of the jaws 846 and 847 , as in the fifty-ninth embodiment.
- FIGS. 89A to 89 C collectively show a sixty-second embodiment of the present invention, wherein FIG. 89A is a side view showing the entire construction of a scissors type coagulation treatment apparatus, FIG. 89B is a plan view showing the treatment portion, and FIG. 89C is a perspective view of the jaw.
- Two scissors components 863 , 864 are mounted to a main body 862 of a coagulation treatment apparatus 861 according to the sixty-second embodiment of the present invention. These scissors components 863 , 864 are overlapped one upon the other such that these scissors components are allowed to substantially cross each other in the intermediate portions. Further, a pivotal pin 865 for rotatably joining these scissors components 863 , 864 is arranged in the crossing portion of these scissors components 863 and 864 .
- a bent portion 872 which is moderately bent to form a substantially arcuate configuration, is formed in the treatment portion 868 of the main body 862 . Further, rectangular ceramic heaters 873 , 874 each having a large contact area with the living tissue and serving to coagulate the living tissue are arranged on the contact surfaces of the jaws 866 , 867 with the living tissue on the rear sides of the jaws 866 , 867 .
- Each of these ceramic heaters 873 and 874 is formed by burying a heating element in a ceramic material, which is an insulating material. Teflon coating is applied to the outer surface, which is brought into contact with the living tissue, of each of the ceramic heaters 873 and 874 so as to prevent the baking (or attachment) of the living body to the outer surface of each of the ceramic heaters 873 and 874 .
- holding portions 875 , 876 for holding the living tissue are mounted on the side of the distal end of the jaws 866 and 867 , respectively. As shown in FIG. 89C, saw tooth-shaped slip preventing portions 875 a , 876 a are mounted to these holding portions 875 a , 876 a.
- Insulated lead wires 877 , 878 are arranged in the scissors component members 863 , 864 , respectively, as shown in FIG. 89A. It should be noted that the distal end of the insulated lead wire 877 on the side of the scissors component member 863 is connected to the ceramic heater 873 . Likewise, the distal end of the insulated lead wire 878 on the side of the other scissors component 864 is connected to the ceramic heater 674 .
- a cord connecting portion 879 is mounted on the outer circumferential surface of the finger-inserting ring 869 on the side of the scissors component 863 .
- another code connection portion 880 is mounted on the outer circumferential surface of the finger-inserting ring 870 on the side of the scissors component 864 .
- the proximal end portion of the insulated lead wire 877 is connected to the cord connecting portion 879 on the side of the scissors component 863 .
- the insulated lead wire 878 is connected to the cord connecting portion 880 on the side of the scissors component 864 .
- connecting cords 881 , 882 having one end portions connected to a power source apparatus are detachably connected to these cord connecting portions 879 , 880 . It should be noted that an electric current is supplied from the power source apparatus (not shown) to the ceramic heaters 873 , 874 through the current paths noted above.
- the forceps is inserted into the portion to be treated including, for example, a blood vessel, with the treatment portion 868 at the distal end portion of coagulation treatment apparatus 861 closed. Then, the pair of jaws 866 , 867 are opened so as to peel the treated portion such as a blood vessel from the living tissue and expose the peeled treated portion.
- the peeled blood vessel or the like is held by the holding portions 875 , 876 positioned forward of the treating portion 868 so as to withdraw the held blood vessel or the like toward the proximal end. Then, the blood vessel or the like is held between and compressed by the jaws 866 , 867 of the coagulation treatment apparatus with an appropriate pressurizing force adapted for the coagulation treatment. If the power source apparatus (not shown) is turned on under this condition, an electric current is supplied to the heating elements of the ceramic heaters 873 , 874 of the jaws 866 , 867 through the current path formed of the connection cords 881 , 882 , etc.
- the heating element is caused to generate heat by the electric resistance of the heating element during flow of the current, with the result that the living tissue of the portion to be treated such as the blood vessel, which is in contact with the surface of each of the ceramic heaters 873 , 874 , is coagulated. It should be noted that, since the ceramic heaters 873 , 874 are insulators, the current flowing through the heating element does not leak into the living tissue of the portion to be treated.
- the ceramic heaters 873 , 874 are arranged in the jaws 866 , 867 of the main body 862 . It should be noted that the ceramic heaters 873 , 874 themselves, which are brought into direct contact with the living tissue of the portion to be treated such as the blood vessel, are insulators, making it unnecessary to cover the ceramic heaters 873 , 874 of the jaws 866 , 867 with an additional insulating material. It follows that it is possible to improve the durability and the reliability of the coagulation treatment apparatus 861 .
- FIGS. 90 and 91 collectively show a sixty-third embodiment of the present invention.
- the sixty-third embodiment is substantially equal to the fifty-ninth embodiment shown in FIGS. 81 to 86 , except that, in the sixty-third embodiment, a distal end treatment portion 807 of a coagulation treatment apparatus 801 capable of insertion into a body cavity like an endoscope is modified to be constructed like the treatment portion 868 included in the sixty-second embodiment shown in FIGS. 89A to 89 C.
- the treatment portion 868 of the coagulation treatment apparatus 801 constructed to be capable of insertion into a body cavity like an endoscope permits producing an effect similar to that produced by the sixty-second embodiment.
- FIGS. 92 and 93 collectively show a sixty-fourth embodiment of the present invention.
- a housing case 890 for housing the coagulation treatment apparatus 861 of the sixty-second embodiment shown in FIGS. 89A to 89 C is arranged as shown in FIG. 92.
- the housing case 890 is formed of a material having a high thermal conductivity such as a aluminum material having an anodizing treatment applied thereto.
- a substantially V-shaped housing groove 891 for housing the distal end portion of the main body 862 including the treatment portion 868 of the coagulation treatment apparatus 861 is formed in the housing case 890 .
- a lever-like holding member 892 for holding the treatment portion 868 of the coagulation treatment portion 861 in a manner to prevent the treatment portion 868 from being withdrawn is arranged on the side of the distal end of the housing groove 891 . Further, a fixing band 893 is mounted to the housing case 890 .
- the housing case 890 When a surgery is performed, the housing case 890 is disposed on a sterilized cloth 894 covering the body of a patient, as shown in FIG. 93. Under this condition, the fixing band 893 is fixed to the sterilized cloth 894 by using a forceps 895 so as to fix the housing case 890 without fail.
- the treatment portion 868 of the coagulation treatment apparatus 861 used for the surgery is heated to a high temperature.
- the main body 862 including the treatment portion 868 of the coagulation treatment apparatus 861 is disposed in the groove 891 of the housing case 890 , the heat of the treatment portion 868 is conducted to the housing case 890 , with the result that the treatment portion 868 is cooled in a short time. It follows that a high safety can be ensured.
- the temperature can be controlled accurately when the coagulation treatment apparatus 861 is used again.
- FIGS. 94 to 96 collectively show a sixty-fifth embodiment of the present invention, wherein FIG. 94 is a side view showing the entire structure of an ultrasonic coagulation cutting instrument, FIG. 95 is a perspective view of the treatment portion, and FIG. 96 is a cross sectional view showing the state that the treatment portion is closed.
- a slender inserting portion 902 is formed in a main body 901 of an ultrasonic coagulating cutting instrument 900 .
- a rotatable jaw 903 is mounted to the distal end portion of the inserting portion 902 .
- a saw tooth-like slip preventing portion 905 is formed on the lower surface of the jaw 903 .
- a manual operating portion 904 is joined to the proximal end portion of the inserting portion 902 .
- the jaw 903 can be rotated by the manual operation portion 904 .
- a probe 906 is inserted movable in the axial direction into the inserting portion 902 .
- the proximal end portion of the probe 906 is joined to an ultrasonic oscillator 907 mounted to the main body 901 .
- the probe 906 is vibrated in the axial direction by the ultrasonic oscillator 907 .
- a plurality of projecting stripes 908 are arranged a predetermined distance apart from each other in the circumferential direction in the distal end portion of the probe 906 . These projecting stripes 908 extend in parallel to the vibrating direction. Further, recessed stripes 909 are formed between adjacent projecting stripes 908 . When the jaws 903 are closed so as to hold a living tissue, the projecting stripes 908 of the probe 906 are brought into contact with the living tissue, and the recessed stripes 909 are not brought into contact with the living tissue.
- the jaw 903 is closed so as to hold the living tissue between the jaw 903 and the probe 906 . If the probe 906 is subjected to an ultrasonic vibration under this state, the living tissue is coagulated by the heat generated by the ultrasonic vibration. Then, when the jaw 903 is further closed, the coagulated portion is brought into a linear contact with the projecting stripes 908 of the probe 906 so as to cut the living tissue open.
- the temperature of the probe 906 is rapidly lowered because the projecting stripes 908 and the recessed stripes 909 have a large heat dissipating area. It follows that a high safety can be ensured. In addition, the temperature can be controlled accurately when the coagulation treatment apparatus 861 is used again.
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Abstract
According to the present invention, a heat generating element to be current-carried is provided at a grasp portion on the tip side of a treatment portion, the patient's body tissue grasped between a pair of grasp portions is coagulated by heat of the heat generating element, and a metal scissors blade for cutting the patient's body tissue is provided on the rear side of the grasp portion in the treatment portion.
Description
- This is a Continuation-in-Part application of U.S. patent application Ser. No. 09/488,732, filed Jan. 20, 2000, the entire contents of which are incorporated herein by reference.
- This application is based upon and claims the benefit of priority from the prior Japanese Patent Applications No. 11-015661, filed Jan. 25, 1999; No. 2000-327148, filed Oct. 26, 2000; and No. 2000-164905, filed Jun. 1, 2000, the entire contents of all of which are incorporated herein by reference.
- The present invention relates to a medical treatment instrument such as scissor forceps used for coagulating and cutting blood vessels or the like by inserting it into the patient's body cavity.
- As a medical treatment instrument inserted into the patient's body, for example, a pair of electric heating type scissors is disclosed in German Patent DE 297 02 608 U1. This pair of electric heating type scissors is provided with two scissor constituent members rotatably coupled with each other around a rotating movement pin. A layer capable of electric heating is provided at a part of a dissection region disposed at the tip of these scissor constituent members.
- In the electric heating type scissors disclosed in German Patent DE 297 02 608 U1, the two scissor constituent members are formed by relatively sharp cutting blades with thin plate thickness, respectively. Thus, when a patient's body tissue such as blood vessel is grasped between the two scissor constituent members, a contact area between these two scissor constituent members and the patient's body tissue is reduced. As a result, there is a problem that the patient's body tissue such as blood vessel cannot be sufficiently compressed between the two scissor constituent members, and the patient's body tissue such as blood vessel cannot be thermally coagulated.
- In addition, in U.S. Pat. No. 5,342,381, there is disclosed a treatment instrument in which a treatment portion comprising a pair of treatment members capable of being opened and closed is arranged at the tip of the main body of the treatment instrument, and a frontal operating portion for opening/closing a pair of treatment members is arranged at the proximal end of the main body of the treatment instrument. In this treatment instrument, a grasp portion for grasping patient's body tissues is arranged at the tip side of the treatment section, and a dissection scissors section is arranged at the rear end of this grasp portion. In this treatment instrument, a bipolar high-frequency current is supplied to the grasp portion during in use; the patient's body tissue grasped by the grasp portion is coagulated by this high-frequency current, and then, a coagulation section of this patient's body tissue is cut at the scissors section.
- In addition, the treatment instrument disclosed in U.S. Pat. No. 5,342,381 is configured to supply a bipolar high-frequency current to the grasp portion at the tip side of the treatment section, so that a portion of the scissors section at the rear end of the grasp portion cannot be made of metal. Therefore, in the treatment instrument disclosed in U.S. Pat. No. 5,342,381, the scissors portion of the treatment section is composed of an insulator consisting of ceramics. However, thus, there is a problem that, when a ceramic based scissors portion is used, the dissection capability is gradually degraded due to a friction between slide portions of the scissors portion during in use.
- The present invention has been achieved in view of the foregoing circumference. It is an object of the present invention to provide a medical treatment instrument capable of reliably thermally coagulating a patient's body tissue such as blood vessel grasped between a pair of treatment members and capable of reducing degradation of the dissection capability of a dissection portion due to a scissors during in use and maintaining sharpness of the dissection portion for a long period of time.
- In order to achieve the foregoing object, according to the present invention, there is provided a medical treatment instrument used for coagulating and cutting the patient's body tissue, the medical treatment instrument comprising:
- a treatment portion arranged at the tip of the treatment instrument, the treatment portion being supported to be capable of being opened and closed, comprising a pair of grasp portions for grasping the patient's body tissue;
- a frontal operating portion arranged at the proximal end of the treatment instrument, the operating portion opening and closing a pair of the grasp portions;
- a heat generating portion provided on at least one of the grasp portions, the heat generating portion current-carried and heated to coagulate the patient's body tissue grasped between the grasp portions; and
- a cutting portion disposed at each of the grasp portions, the cutting portion cutting the patient's body tissue.
- In the present invention, during in use, the heat generating portion at the tip side in the treatment portion is current-carried and heated, and the patient's body tissue such as blood vessel wall grasped between a pair of grasp portions is coagulated by heat of the heat generating portion and is welded. Then, the coagulated site of the patient's body tissue is cut by the cutting portion with a pair of scissors on the rear side of the grasp portions in the treatment portion.
- Therefore, according to the present invention, the heat generating portion to be current-carried and heated is provided at least at one grasp portion on the tip side of the treatment portion; the patient's body tissue grasped between a pair of the grasp portions is coagulated by heat of the heat generating portion, and the cutting portion with the scissors and cutting the patient's body tissue on the rear side of the grasp portions is provided. Thus, the patient's body tissue such as blood vessel grasped between a pair of the grasp portions can be reliably thermally coagulated by heat of the heat generating portion. Further, degradation of the cutting capability of the cutting portion due to the scissors during in use is reduced, and the sharpness of the cutting portion can be maintained for a long period of time.
- Additional objects and advantages of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objects and advantages of the invention may be realized and obtained by means of the instrumentalities and combinations particularly pointed out hereinafter.
- The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate presently preferred embodiments of the invention, and together with the general description given above and the detailed description of the preferred embodiments given below, serve to explain the principles of the invention.
- FIG. 1 is a schematic structural view illustrating an entire system of a medical treatment instrument according to a first embodiment of the present invention;
- FIG. 2 is a perspective view of a scissor forceps in the medical treatment instrument according to the first embodiment;
- FIG. 3 is a perspective view showing a tip grasp portion and a blade portion of the scissor forceps according to the first embodiment;
- FIG. 4 is a longitudinal sectional view illustrating an internal structure of the tip grasp portion of the scissor forceps according to the first embodiment;
- FIG. 5A is a view for illustrating a release process of a blood vessel using the scissor forceps according to the first embodiment;
- FIG. 5B is a view for illustrating a coagulation process of a blood vessel;
- FIG. 5C is a view for illustrating a dissection process of a blood vessel;
- FIG. 6 is a perspective view showing a structure of essential portions of the scissor forceps according to a second embodiment of the present invention;
- FIG. 7 is a perspective view showing a scissor forceps according to a third embodiment of the present invention;
- FIG. 8A is a sectional perspective view showing a tip grasp portion of the scissor forceps according to the third embodiment;
- FIG. 8B is a cross sectional view taken along the line VIIIB-VIIIB;
- FIG. 8C is a cross sectional view of essential portions showing a modified example of the scissor forceps according to the third embodiment;
- FIG. 9A is a side view showing the entire surgical treatment instrument in a fourth embodiment of the present invention;
- FIG. 9B is a side view of essential portions showing an opened state of a tip grasp portion of the surgical treatment instrument according to the fourth embodiment;
- FIG. 10 is a schematic structural view of essential portions showing a fifth embodiment of the present invention;
- FIG. 11 is a perspective view of the entire medical treatment instrument showing a sixth embodiment of the present invention;
- FIG. 12 is a schematic structural view showing the entire system of the medical treatment instrument according to a seventh embodiment of the present invention;
- FIG. 13 is a cross sectional view taken along the line XIII-XIII of FIG. 12;
- FIG. 14A is a longitudinal sectional view of essential portions showing an eighth embodiment of the present invention;
- FIG. 14B is a longitudinal sectional view of essential portions showing a ninth embodiment of the present invention;
- FIG. 14C is a longitudinal sectional view of essential portions showing a tenth embodiment of the present invention;
- FIG. 14D is a longitudinal sectional view of essential portions showing an eleventh embodiment of the present invention;
- FIG. 15 is a plan view of the entire forceps showing a twelfth embodiment of the present invention;
- FIG. 16A is a cross sectional view taken along the
line 16A-16A of FIG. 15 showing a state in which a heat generating section for dissection treatment in the forceps of the twelfth embodiment is maintained at a standby position departed from a heat generating section for coagulating treatment; - FIG. 16B is a cross sectional view taken along the
line 16B-16B of FIG. 16A; - FIG. 17A is a longitudinal sectional view of essential portions of scissor constituent members showing a state in which the heat generating section for dissection treatment in the forceps according to the twelfth embodiment is brought into contact with the heat generating section for coagulating treatment;
- FIG. 17B is a cross sectional view taken along the
line 17B-17B of FIG. 17A; - FIG. 18 is a schematic structural view showing the entire system of a medical treatment instrument according to a thirteenth embodiment of the present invention;
- FIG. 19 is a schematic structural view showing an electric circuit of a power supply unit in the medical treatment instrument system according to the thirteenth embodiment;
- FIG. 20A is a side view showing the entire medical treatment instrument according to a fourteenth embodiment of the present invention;
- FIG. 20B is a side view of essential portions showing an opened state of a grasp element of the treatment section in the medical treatment instrument according to the fourteenth embodiment;
- FIG. 21 is an entire side view showing a medical treatment instrument according to a fifteenth embodiment of the present invention;
- FIG. 22A is a plan view of essential portions showing a curve portion of an opening/closing element of the medical treatment instrument according to the fifteenth embodiment of the present invention;
- FIG. 22B is a cross sectional view showing a treatment section of the medical treatment instrument according to the fifteenth embodiment;
- FIG. 23A is a plan view of essential portions showing a curve portion of a grasp portion in a medical treatment instrument according to a sixteenth embodiment of the present invention;
- FIG. 23B is a cross sectional view of the curve portion in the medical treatment instrument according to the sixteenth embodiment;
- FIG. 24 is a cross sectional view of essential portions showing a medical treatment instrument according to a seventh embodiment of the present invention;
- FIG. 25 is a plan view of essential portions showing the curve portion of a grasp portion of a medical treatment instrument according to an eighteenth embodiment of the present invention;
- FIG. 26 is a cross sectional view of essential portions showing the medical treatment instrument according to a nineteenth embodiment of the present invention;
- FIG. 27 is a schematic structural view showing the entire system of a medical treatment instrument according to a twentieth embodiment of the present invention;
- FIG. 28 is an entire plan view showing the medical treatment instrument according to a twenty-first embodiment of the present invention;
- FIG. 29A is a plan view showing a state in which a scissor blade of the medical treatment instrument according to the twenty-first embodiment is slid to the tip side;
- FIG. 29B is a cross sectional view taken along the
line 29B-29B of FIG. 29A; - FIG. 30 is a cross sectional view of essential portions showing a medical treatment instrument according to a twenty-second embodiment of the present invention;
- FIG. 31 is a cross sectional view of essential portions showing a medical treatment instrument according to a twenty-third embodiment of the present invention;
- FIG. 32 is a structural side view of essential portions showing a coagulating/dissection treatment instrument according to a twenty-fourth embodiment of the present invention;
- FIG. 33 is an entire plan view showing a coagulating/dissection treatment instrument according to a twenty-fifth embodiment of the present invention;
- FIG. 34A is a perspective view showing a mount state of heating elements on a grasp surface of one jaw in the coagulating/dissection treatment instrument according to the twenty-fifth embodiment;
- FIG. 34B is a perspective view showing a guide groove of a grasp surface of the other jaw in the coagulating/dissection treatment instrument according to the twenty-fifth embodiment;
- FIG. 35A is a side view of the entire coagulating treatment instrument according to a twenty-sixth embodiment of the present invention;
- FIG. 35B is a plan view showing the curve shape of the jaw of the coagulating treatment instrument according to the twenty-sixth embodiment;
- FIG. 35C is a perspective view showing a non-slip teeth section of the patient's body tissues of a heating element in the coagulating treatment instrument according to the twenty-sixth embodiment;
- FIG. 36A is an enlarged side view showing the jaw section of the coagulating treatment instrument according to the twenty-sixth embodiment;
- FIG. 36B is a cross sectional view taken along the
line 36B-36B of FIG. 36A; - FIG. 37 is a perspective view of essential portions showing a modified example of the jaw of the coagulating treatment instrument according to the twenty-sixth embodiment;
- FIG. 38 is a cross sectional view of essential portions of a coagulating treatment instrument showing a twenty-seventh embodiment of the present invention;
- FIG. 39A is a side view of the entire coagulating treatment instrument showing a twenty-eighth embodiment of the present invention;
- FIG. 39B is a sectional side view of essential portions showing a part of jaw of the coagulating treatment instrument according to the twenty-eighth embodiment;
- FIG. 40A is a sectional side view partially showing a state before mounting an intermediate connecting member of the jaw in the coagulating treatment instrument according to the twenty-eighth embodiment;
- FIG. 40B is a cross sectional view taken along the
line 40B-40B of FIG. 40A; - FIG. 40C is a longitudinal section view showing a modified example of a structure for mounting the connection pin of the connection plate according to the twenty-eighth embodiment;
- FIG. 41A is a longitudinal sectional view showing a first modified example of a structure for mounting the intermediate connecting member in the coagulating treatment instrument according to the twenty-eighth embodiment;
- FIG. 41B is a longitudinal sectional view showing a second modified example of a structure for mounting the intermediate connecting member in the coagulating treatment instrument according to the twenty-eighth embodiment;
- FIG. 42A is a sectional side view partially showing a state before mounting the intermediate connecting member of the jaw in the coagulating treatment instrument according to a twenty-ninth embodiment of the present invention;
- FIG. 42B is a cross sectional view taken along the
line 42B-42B of FIG. 42A; - FIG. 43 is a sectional side view partially showing a state before mounting the intermediate connecting member of the jaw in the coagulating treatment instrument according to a thirtieth embodiment of the present invention;
- FIG. 44 is a perspective view showing a schematic configuration of the entire system of a coagulating treatment instrument according to a thirty-first embodiment of the present invention;
- FIG. 45 is a schematic structural view showing an electric circuit of the coagulating treatment instrument system according to the thirty-first embodiment;
- FIG. 46 is a flowchart showing an operation of the coagulation treatment instrument according to a thirty-second embodiment of the present invention;
- FIG. 47A is a perspective view showing a schematic configuration of the entire system of a coagulating treatment instrument in a thirty-third embodiment of the present invention;
- FIG. 47B is a schematic structural view showing an electric circuit of the coagulating treatment instrument system according to the thirty-third embodiment;
- FIG. 48A is a front view of the entire coagulating treatment instrument showing a thirty-fourth embodiment of the present invention;
- FIG. 48B is a plan view showing a curve shape of the jaw of the coagulating treatment instrument according to the thirty-fourth embodiment;
- FIG. 48C is a perspective view of a heater cover of an upper jaw according to the thirty-fourth embodiment;
- FIG. 48D is a longitudinal sectional view of essential portions showing the tissue adhesion preventing treatment portion of the cover according to the thirty-fourth embodiment;
- FIG. 49A is a perspective view of a heater cover of an upper jaw of a coagulating treatment instrument according to a thirty-fifth embodiment of the present invention;
- FIG. 49B is a longitudinal sectional view of the heater cover in the coagulating treatment instrument according to the thirty-fifth embodiment;
- FIG. 50A is an enlarged perspective view showing a heater cover of a jaw of a coagulating treatment instrument according to a thirty-sixth embodiment of the present invention;
- FIG. 50B is a perspective view showing a modified example of the heater cover of the jaw of the coagulating treatment instrument according to the thirty-sixth embodiment;
- FIG. 51A is a front view of the entire coagulating treatment instrument showing a thirty-seventh embodiment of the present invention;
- FIG. 51B is a front view of a heater unit according to the thirty-seventh embodiment;
- FIG. 51C is a cross sectional view taken along the
line 51C-51C of FIG. 51B; - FIG. 52A is a front view showing a state in which a heater unit is mounted on the coagulating treatment instrument according to the thirty-seventh embodiment;
- FIG. 52B is a perspective view of essential portions showing a modified example of the coagulating treatment instrument according to the thirty-seventh embodiment;
- FIG. 53A is a front view of the entire coagulating treatment instrument showing a thirty-eighth embodiment of the present invention;
- FIG. 53B is an enlarged front view showing the jaw at the tip of the coagulating treatment instrument according to the thirty-eighth embodiment;
- FIG. 54A is a front view showing a state in which the coagulating treatment instrument according to the thirty-eighth embodiment is closed to a position at which the treatment instrument abuts against a stopper, and a closing force is applied to the jaw;
- FIG. 54B is an enlarged front view showing the jaw at the tip of the coagulating treatment instrument according to the thirty-eighth embodiment;
- FIG. 54C is a front view of essential portions showing a modified example of the coagulating treatment instrument according to the thirty-eighth embodiment;
- FIG. 55A is a front view of the entire coagulating treatment instrument showing a thirty-ninth embodiment of the present invention;
- FIG. 55B is an enlarged front view showing the jaw at the tip of the coagulating treatment instrument according to the thirty-ninth embodiment;
- FIG. 55C is a cross sectional view taken along the
line 55C-55C of FIG. 55B; - FIG. 55D is a cross sectional view taken along the
line 55D-55D of FIG. 55B; - FIG. 55E is a cross sectional view taken along the
line 55E-55E of FIG. 55A; - FIG. 55F is a cross sectional view taken along the
line 55F-55F of FIG. 55A; - FIG. 55G is a cross sectional view of essential portions showing a modified example of the coagulating treatment instrument according to the thirty-ninth embodiment;
- FIG. 56A is a front view of the entire coagulating treatment instrument showing a fortieth embodiment of the present invention;
- FIG. 56B is an enlarged front view showing the jaw at the tip of the coagulating treatment instrument according to the fortieth embodiment;
- FIG. 56C is a cross sectional view taken along the
line 56C-56C of FIG. 56B; - FIG. 56D is a cross sectional view taken along the
line 56D-56D of FIG. 56B; - FIG. 56E is a cross sectional view taken along the
line 56E-56E of FIG. 56A; - FIG. 56F is a cross sectional view taken along the
line 56F-56F of FIG. 56A; - FIG. 57A is a front view of the entire coagulating treatment instrument showing a forty-first embodiment of the present invention;
- FIG. 57B is a plan view showing the coagulating treatment instrument according to the forty-first embodiment;
- FIG. 57C is an enlarged front view showing the jaw at the tip of the coagulating treatment instrument according to the forty-first embodiment;
- FIG. 57D is a cross sectional view taken along the
line 57D-57D of FIG. 57C; - FIG. 57E is a cross sectional view taken along the
line 57E-57E of FIG. 57C; - FIG. 57F is a cross sectional view taken along the
line 57F-57F of FIG. 57A; - FIG. 58 is a general view of a coagulating/cutting system according to a forty-second embodiment of the invention;
- FIG. 59 is a perspective view of a treatment portion according to the forty-second embodiment;
- FIG. 60 is a sectional view taken along line60-60 of FIG. 59;
- FIG. 61A is a longitudinal sectional view of a principal part of the system, showing a state in which an organism tissue is held stressed under a force of pressure that suits a coagulative treatment, by means of the treatment portion of the forty-second embodiment;
- FIG. 61B is a longitudinal sectional view of the principal part, showing a state in which a weakened organism tissue is cut and incised;
- FIG. 62 is a diagram showing an electric circuit of a power source unit according to the forty-second embodiment;
- FIG. 63 is a sectional view of holding portions of a thermocoagulation cutting forceps according to a forty-third embodiment of the invention;
- FIG. 64 is a sectional view of holding portions of a thermocoagulation cutting forceps according to a forty-fourth embodiment of the invention; FIG. 65 is a sectional view of holding portions of a thermocoagulation cutting forceps according to a forty-fifth embodiment of the invention;
- FIG. 66 is a sectional view of holding portions of a thermocoagulation cutting forceps according to a forty-sixth embodiment of the invention;
- FIG. 67 is a sectional view of a holding portion of a thermocoagulation cutting forceps according to a forty-seventh embodiment of the invention;
- FIG. 68A is a sectional view of a holding portion of a thermocoagulation cutting forceps according to a forty-eighth embodiment of the invention;
- FIG. 68B is a sectional view showing a modification of the heating portion of FIG. 68A;
- FIG. 68C is a sectional view showing another modification of the heating portion of FIG. 68A;
- FIG. 69 is a sectional view of a holding portion of a thermocoagulation cutting forceps according to a forty-ninth embodiment of the invention;
- FIG. 70A is a sectional view of a holding portion of a thermocoagulation cutting forceps according to a fiftieth embodiment of the invention;
- FIG. 70B is a perspective view showing holding portions of the forceps of the fiftieth embodiment;
- FIG. 71A is a diagram showing bars indicative of the temperature level, on a display portion of a power source unit according to a fifty-first embodiment of the invention;
- FIG. 71B is a diagram showing a figure indicative of the temperature level, on the display portion of the power source unit of the fifty-first embodiment;
- FIG. 72 is a graph showing the relation between the set level and the heating temperature displayed on the display portion of the power source unit of the fifty-first embodiment;
- FIG. 73 is a perspective view of an operating portion of a thermocoagulation cutting forceps according to a fifty-second embodiment of the invention;
- FIG. 74 is a perspective view of a thermocoagulation cutting forceps according to a fifty-third embodiment of the invention;
- FIG. 75 is a perspective view of a thermocoagulation cutting forceps according to a fifty-fourth embodiment of the invention;
- FIG. 76 is a sectional view taken along line76-76 of FIG. 75;
- FIG. 77A is a side view, partially in section, showing an open state of holding portions of a thermocoagulation cutting forceps according to a fifty-fifth embodiment of the invention;
- FIG. 77B is a side view, partially in section, showing a closed state of the holding portions of the forceps of the fifty-fifth embodiment;
- FIG. 78A is a side view, partially in section, showing an open state of holding portions of a thermocoagulation cutting forceps according to a fifty-sixth embodiment of the invention;
- FIG. 78B is a side view, partially in section, showing a closed state of the holding portions of the forceps of the fifty-sixth embodiment;
- FIG. 79A is a side view, partially in section, showing an open state of holding portions of a thermocoagulation cutting forceps according to a fifty-seventh embodiment of the invention;
- FIG. 79B is a side view, partially in section, showing a closed state of the holding portions of the forceps of the fifty-seventh embodiment;
- FIG. 80A is a side view, partially in section, showing an open state of holding portions of a thermocoagulation cutting forceps according to a fifty-eighth embodiment of the invention;
- FIG. 80B is a side view, partially in section, showing a closed state of the holding portions of the forceps of the fifty-eighth embodiment;
- FIG. 81 is a schematic structural view illustrating an entire system of a surgical instrument denoting a thermocoagulation cutting forceps according to a fifty-ninth embodiment of the present invention;
- FIG. 82 is a side view showing the thermocoagulation cutting forceps according to the fifty-ninth embodiment of the present invention;
- FIG. 83 is a perspective view of the holding portion of the thermocoagulation cutting forceps according to the fifty-ninth embodiment of the present invention;
- FIG. 84 is a cross sectional view along the line84-84 shown in FIG. 83;
- FIG. 85 is an electrical circuit diagram of the fifty-ninth embodiment of the present invention;
- FIG. 86 of a graph relating to the fifty-ninth embodiment of the present invention;
- FIG. 87A is a cross sectional view showing the state that a ceramic heater is arranged in a treatment portion included in the thermocoagulation cutting forceps according to a sixtieth embodiment of the present invention;
- FIG. 87B is a cross sectional view showing a first modification of the treatment portion included in the thermocoagulation cutting forceps according to the sixtieth embodiment of the present invention;
- FIG. 87C is a cross sectional view showing a second modification of the treatment portion included in the thermocoagulation cutting forceps according to the sixtieth embodiment of the present invention;
- FIG. 87D is a cross sectional view showing a third modification of the treatment portion included in the thermocoagulation cutting forceps according to the sixtieth embodiment of the present invention;
- FIG. 87E is a cross sectional view of a gist portion exemplifying another construction of a third modification of the second holding portion included in the thermocoagulation cutting forceps according to the sixtieth embodiment of the present invention;
- FIG. 87F is a cross sectional view of a gist portion exemplifying still another construction of a third modification of the second holding portion included in the thermocoagulation cutting forceps according to the sixtieth embodiment of the present invention;
- FIG. 88 is a perspective view showing a thermocoagulation cutting forceps according to a sixty-first embodiment of the present invention;
- FIG. 89A is a side view showing the entire scissors type coagulation treating instrument according to a sixty-second embodiment of the present invention;
- FIG. 89B is a plan view showing the treatment portion of the scissors type coagulation treating instrument according to the sixty-second embodiment of the present invention;
- FIG. 89C is a perspective view showing the jaw of the scissors type coagulation treating instrument according to the sixty-second embodiment of the present invention;
- FIG. 90 is a side view showing the entire thermocoagulation cutting forceps according to a sixty-third embodiment of the present invention;
- FIG. 91 is a cross sectional view, partly broken away, showing the treatment portion included in the thermocoagulation cutting forceps according to the sixty-third embodiment of the present invention;
- FIG. 92 is a perspective view showing a housing case for housing the coagulation treating instrument according to a sixty-fourth embodiment of the present invention;
- FIG. 93 is a perspective view showing how to use the housing case according to the sixty-fourth embodiment of the present invention;
- FIG. 94 is a side view showing the entire ultrasonic wave coagulation cutting instrument according to a sixty-fifth embodiment of the present invention;
- FIG. 95 is a perspective view showing the treatment portion according to the sixty-fifth embodiment of the present invention; and
- FIG. 96 is a cross sectional view at the time when the treatment portion according to the sixty-fifth embodiment of the present invention is closed.
- Hereinafter, a first embodiment of the present invention will be described with reference to FIGS.1 to 5C. FIG. 1 shows a schematic configuration of the entire system of a
medical treatment instrument 1 according to the present embodiment. Themedical treatment instrument 1 of the present embodiment is provided with a pair ofscissor forceps 2 and agenerator 3 connected to thisscissor forceps 2. - Here, a forceps main body (treatment instrument main body)4 of the
scissor forceps 2 is provided with two scissorconstituent members constituent members support shaft 7 rotatably linking the scissorconstituent members constituent members - In addition, a
treatment portion 10 comprising a pair of opening/closing elements main body 4. Thistreatment portion 10 is molded in the substantially same shape as that in a release forceps. - Further, substantially
elliptical rings constituent members frontal operating portion 13 for opening/closing a pair of opening/closing elements rings - At each of the opening/
closing elements main body 4, agrasp portion 14 for grasping patient's body tissues is disposed at the tip side, for example, with a length of about 2 cm from the tips of the opening/closing elements wide contact plate 15 is arranged at the inner surface side of this grasp portion 14 (an opposite surface to the other grasp portion 14), as shown in FIG. 3. Thiscontact plate 15 is formed by a metal material with its high thermal conductivity, for example, brass. Further, a substantiallyserrate grasp surface 16 having a plurality of protrusions and recesses arranged thereon is formed on the outer surface of thiscontact plate 15. A Teflon-coating layer 17 preventing a scorch of patient's body tissues is formed on the outer surface of the contact plate 15 (contact surface with the patient's body tissues). - A heating element (heat generating section)18 is arranged inside the
grasp portion 14 of each of the opening/closing elements heating element 18 is formed, for example, by a ceramic heater or a heating element current-carried and heated to generate heat such as metal resistor. Thisheating element 18 is fixed to the inner surface of eachcontact plate 15. In this manner, when theheating element 18 is current-carried, heat of theheating element 18 is transmitted via thecontact plate 15 so that the patient's body tissue grasped between thegrasp portions 14 is coagulated. - Further, a stainless
back plate member 19, for example, is arranged at an opposite side to that of thecontact plate 15 in eachgrasp portion 14. Acoat layer 20 to which a heat resistance coating is applied is formed on the outer surface of this stainlessback plate member 19. - At one end, a
lead wire 21 is connected to theheating element 18. At the other end, thislead wire 21 is extended to thefrontal operating portion 13 side. Acable connection portion 22 is protruded on the peripheral surface of onering 11 at the operatingportion 13. At the other end, thelead wire 21 is connected to the inner end of thecable connection portion 22. - Further, a
connector 24 arranged at the other end of theconnector cable 23 connected to thegenerator 3 at one end is detachably connected to thiscable connection portion 22. When thescissor forceps 2 is used, theheating element 18 is current-carried from thegenerator 3 via theconnector cable 23 and thelead wire 21, and theheating element 18 is current-carried so as to generate heat. At onescissor constituent member 5, an ON/OFF operation switch 25 for heat generation due to theheating element 18 is arranged in the vicinity of thering 11. - A single-blade scissor blade (dissection portion)26 is formed on the rear side of the
grasp portion 14 in each of the opening/closing elements scissor blade 26 is molded integrally with theback plate member 19 in eachgrasp portion 14 by a stainless material, for example. Acoat layer 20 is not formed at a portion of thisscissor blade 26, and a stainless metal surface is exposed. A metalscissors dissection portion 27 for cutting a patient's body tissue by thescissor blades 26 of both of the opening/closing elements main body 4 of thescissor forceps 2, a portion other than eachgrasp portion 14 andscissor blade 26 is formed by heat resistance plastic, for example. - Now, an operation of the
medical treatment instrument 1 with the above structure according to the present embodiment will be described. Here, an example of work of treating a lesion in blood vessels or the like brought into close contact with patient's body tissues such as internal organs by using thescissor forceps 2 according to the present embodiment will be described with reference to FIGS. 5A to 5C. - First, as shown in FIG. 5A, a
treatment portion 10 at the tip of thescissor forceps 2 is inserted between a blood vessel Hi brought in close contact with a patient's body tissue H such as internal organs and the patient's body tissue H. At this time, while a pair of opening/closing elements treatment portion 10 is closed in advance, these elements are both inserted between the blood vessel Hi and the patient's body tissue H. Then, an interval between the blood vessel H1 and the patient's body tissue H is released by opening a pair of the opening/closing elements - Thereafter, the blood vessel H1 released as shown in FIG. 5B is grasped between the
grasp portions 14 of the opening/closing elements grasp portions 14 at a proper pressure. - In this state, a
switch 25 is turned ON, and theheating element 18 is current-carried and heated. At this time, heat of theheating element 18 is transmitted to the blood vessel H1 between thegrasp portions 14 via thecontact plate 15. In this manner, a wall of the blood vessel H1 grasped between thegrasp portions 14 is coagulated and welded, and a coagulated-welded portion H2 is formed. - In addition, after the wall of the blood vessel H1 has been coagulated and welded, the coagulated-welded portion H2 of this blood vessel H1 is separated by the
scissor blade 26 of thedissection portion 27 on the rear side of thegrasp portion 14 in each of the opening/closing elements - With the above structure, the following effect is obtained. That is, in the
medical treatment instrument 1 according to the present embodiment, a substantially planarwide contact plate 15 is arranged at thegrasp portion 14 of each of the opening/closing elements main body 4, so that the blood vessel H1 is grasped between the twocontact plates 15. Thus, theheating element 18 on the tip of thetreatment portion 10 is current-carried and heated, whereby the patient's body tissue such as blood vessel Hi grasped between a pair of thegrasp portions 14 can be thermally coagulated reliably by heat of theheating element 18. - Further, the patient's body tissue such as blood vessel H1 has been thermally coagulated, the coagulated-welded portion H2 is cut by the
dissection portion 27 using themetal scissor blade 26 on the rear side of thegrasp portion 14 in thetreatment portion 10. Unlike a case in which a ceramic based scissors portion is used, there is less possibility that the dissection capability is gradually degraded due to a friction between the slide portions of the scissors portion during in use. Thus, the degradation of the dissection capability of thedissection portion 27 due to thescissor blade 26 while thescissor forceps 2 is used is minimized, and the sharpness of thedissection portion 27 can be maintained for a long period of time. - In the present embodiment, work of releasing the blood vessel H1 brought into close contact with the patient's body tissue H such as internal organ from the patient's body tissue H; work of coagulating and welding the wall of the blood vessel H1; or work of separating the suspected coagulated-welded portion H2 of the blood vessel H1 can be performed by a
single scissor forceps 2. Thus, unlike a case in which these work are performed by using respective individual treatment instruments, work of replacing one treatment instrument with another can be eliminated, thus improving usability. Further, the number of treatment instruments used in the above treatments can be reduced, making it advantageous in cost efficiency. - In the present embodiment, at the forceps
main body 4 of thescissor forceps 2, a portion other than eachgrasp portion 14 andscissor blade 26 is formed by heat resistance plastic, for example. Thus, there is achieved an effect that the patient's body tissues adjacent to a treatment portion treated by eachgrasp portion 14 and thescissor blade 26 can be protected, and the surgeon's hands can also be protected. - FIG. 6 shows a second embodiment of the present invention. In the present embodiment, a configuration of the
scissor forceps 2 in themedical treatment instrument 1 according to the first embodiment (refer to FIGS. 1 to 5C) is modified as follows: - That is, in the
scissor forceps 2 according to the present embodiment, acurve portion 31 gently curved in the substantial arc shape is formed at thegrasp portion 14 disposed at the tip of the forcepsmain body 4. A configuration of the other portion is similar to that of the first embodiment. Like elements identical to those in the first embodiment is represented by like reference numerals, and a description thereof will be omitted here. - According to the present embodiment, an effect substantially similar to that of the first embodiment is obtained. Further, in the present embodiment, in particular, a
curve portion 31 gently curved in the substantial arc shape is formed at thegrasp portion 14 disposed at the tip of the forcepsmain body 4 of thescissor forceps 2. Thus, as shown in FIG. 5A, work of inserting thetreatment portion 10 at the tip of thescissor forceps 2 between the blood vessel H1 brought into close contact with the patient's body tissue H such as internal organ and the patient's body tissue H can be performed more easily. - FIGS. 7, 8A and8B show a third embodiment of the present invention. In the present embodiment, a configuration of the
scissor forceps 2 in themedical treatment instrument 1 according to the first embodiment (refer to FIGS. 1 to 5C) is modified as follows: - That is, in the
scissor forceps 2 of the present embodiment,grasp portions 41 a and 41 b gently curved in the substantial arc shape are formed, respectively, at the portions of a pair of opening/closing elements support shaft 7. - Further, as in the first embodiment, the
heating element 18 shown in FIG. 4 is arranged inside each of thegrasp portions 41 a and 41 b of each of the opening/closing elements heating element 18 is current-carried, heat of thisheating element 18 is transmitted to the surface side of thegrasp portions 41 a and 41 b via thecontact plate 15 so that the patient's body tissue grasped between thegrasp portions 41 a and 41 b of each of the opening/closing element - In addition, in the
scissor forceps 2 of the present embodiment, as shown in FIGS. 8A and 8B, adissection blade portion 42 for cutting the patient's body tissue toward one grasp portion 41 a side is protruded toward theother grasp portion 41 b side. At onegrasp portion 41 b, thisblade portion 42 is disposed at the substantial center site of theopposite surface 41b 1 to the other grasp portion 41 a, and is extended in longitudinal direction of thisgrasp portion 41 b. - Further, a recess-shaped long groove portion (recess portion)43 meshed with the
blade portion 42 of thegrasp portion 41 b is formed on the other grasp portion 41 a side. Here, as shown in FIG. 8B, a depth L1 of thelong groove portion 43 is set to be lower than a height L2 of theblade portion 42 of thegrasp portion 41 b (L1<L2). When thefrontal operating portion 13 is firmly gripped and moved in a direction in which an interval between thegrasp portions 41 a and 41 b is closed, a top part of theblade portion 42 of thegrasp portion 41 b abuts against the inner bottom of thelong groove portion 43 so as to maximize the pressure of this abutment portion. - Next, an operation in the above structure will be described. When a lesion in a blood vessel or the like brought into close contact with the patient's body tissue such as internal organ is treated by using the
scissor forceps 2 of the present embodiment, a process for releasing the blood vessel H1 and the patient's body tissue H from each other shown in FIG. 5A is performed through operation similar to that in the first embodiment. - Thereafter, the blood vessel H1 released as shown in FIG. 5B is grasped between the
grasp portions 41 a and 41 b of the opening/closing elements scissor forceps 2. At this time, the blood vessel H1 is compressed between thegrasp portions 41 a and 41 b with a relatively gentle pressure to an extent such that the blood vessel H1 is not cut by theblade portion 42 of thegrasp portion 41 b. - In this state, the
heating element 18 is current-carried and heated, whereby heat of theheating element 18 is transmitted to the blood vessel H1 between thegrasp portions 41 a and 41 b via thecontact plate 15. In this manner, the wall of the blood vessel H1 grasped between thegrasp portions 41 a and 41 b is coagulated and welded, and the coagulated-welded portion H2 is formed. - Further, after the wall of the blood vessel H1 has been coagulated and welded, the
frontal operating portion 13 is firmly gripped, and is moved in a direction in which an interval between thegrasp portions 41 a and 41 b is closed. At this time, a top part of theblade portion 42 of thegrasp portion 41 b is strongly pressed in a direction in which the top part abuts against the inner bottom of thelong groove portion 43, whereby the coagulated-welded portion H2 is separated by theblade portion 42 of thegrasp portion 41 b as shown in FIG. 5C. - With the above structure, the following effect is obtained. That is, in the
scissor forceps 2 of the present embodiment, when the released blood vessel H1 is grasped between thegrasp portions 41 a and 41 b of the opening/closing elements grasp portions 41 a and 41 b with a relatively gentle pressure to an extent such that the blood vessel H1 is not cut by theblade portion 42 of thegrasp portion 41 b. In this state, theheating element 18 is current-carried and heated, whereby the wall of the blood vessel H1 grasped between thegrasp portions 41 a and 41 b can be coagulated and welded. Further, after the wall of the blood vessel H1 has been coagulated and welded, thefrontal operating portion 13 is firmly gripped, and is further moved in a direction in which an interval between thegrasp portions 41 a and 41 b is closed. Then, the top part of theblade portion 42 of thegrasp portion 41 b is strongly pressed in a direction in which the top part abuts against the inner bottom of thelong groove portion 43 of the grasp portion 41 a, whereby the coagulated-welded portion H2 of the blood vessel H1 can be separated by theblade portion 42 of thegrasp portion 41 b. - Therefore, in the
scissor forceps 2 of the present embodiment, as is substantially similar to the first embodiment, work of releasing the blood vessel H1 brought into close contact with the patient's body tissue H such as internal organ from the patient's body tissue H1; work of coagulating and welding the wall of the blood vessel H1; or work of separating the coagulated-welded portion H2 of the blood vessel H1 can be performed by asingle scissor forceps 2. Thus, unlike a case in which each of these work is performed by using the respective individual treatment instruments, work of replacing one treatment instrument with another can be eliminated, making it advantageous in usability and cost efficiency. - Further, also in the
scissor forceps 2 of the present embodiment, the coagulated-welded portion H2 of the blood vessel H1 is cut by themetal blade portion 42. Thus, there is less possibility that the dissection capability is gradually degraded due to a friction between the slide portions of the scissors portion while in use when a ceramic scissors portion is used. Therefore, in thescissor forceps 2 of the present embodiment also, as is substantially similar to the first embodiment, the degradation of the dissection capability of theblade portion 42 while thescissor forceps 2 is used can be reduced, and the sharpness of theblade portion 42 can be maintained for a long period of time. - FIG. 8C shows a modified example of the
scissor forceps 2 according to the third embodiment (refer to FIGS. 7, 8A and 8B). In thescissor forceps 2 of the present embodiment, at onegrasp portion 41 b side, thedissection blade portion 42 for cutting the patient's body tissue is protruded toward the other grasp portion 41 a side. At onegrasp portion 41 b side, thisblade portion 42 is disposed at the substantial center of an opposite surface to the other grasp portion 41 a, and is extended in longitudinal direction of thisgrasp portion 41 b. - Further, a smooth contact surface41 a 1 is formed on the other grasp portion 41 a side. When the
frontal operating portion 13 is firmly gripped, and is moved in a direction in which an interval between thegrasp portions 41 a and 41 b is closed, the top part of theblade portion 42 of thegrasp portion 41 b abuts against the contact surface 41 a 1 so as to maximize the pressure of this abutment portion. - FIGS. 9A and 9B show a fourth embodiment of the present invention. FIG. 9A shows a schematic structure of the entire
surgical treatment instrument 51 used for surgical operation under endoscope that is a medical treatment instrument of the present embodiment. Atreatment instrument 51 of the present embodiment is provided with anelongated insert portion 52 to be inserted into the patient body through trocar (not shown); and afrontal operating portion 53 coupled with the proximal end of thisinsert portion 52. - In addition, the
insert portion 52 is provided with a tubularinsert tube body 54. A drivingshaft 55 relatively driven in axial direction of theinsert portion 52 is inserted into thisinsert tube body 54. Further, atreatment portion 56 is arranged at the tip of theinsert portion 52. Thistreatment portion 56 is provided with a pair of grasp members (opening/closing elements) 57 a and 57 b capable of being opened and closed. Here, a pair of thegrasp members shaft 55 via a driving mechanism (not shown) such as cam mechanism. An interval between thegrasp members treatment portion 56 is driven to be opened and closed via the driving mechanism together with retracting movement of the drivingshaft 55. - In addition, the grasp member57 of the present embodiment is structured in a manner substantially similar to that in the
grasp portion 14 of each of the opening/closing elements scissor forceps 2 in the first embodiment (refer to FIGS. 1 to 4). - That is, as in the first embodiment, the
heating element 18 shown in FIG. 4 is arranged inside thegrasp members heating element 18 is current-carried and heated, heat of thisheating element 18 is transmitted to the surface side of thegrasp members contact plate 15 so that the patient's body tissue grasped between thegrasp members - In the
treatment instrument 51 of the present embodiment, each single-blade scissor blade (dissection portion) 26′ is formed on the rear side of thegrasp members - In addition, the
frontal operating portion 53 is provided with an operating portionmain body 58 for rotatably holding the proximal end of theinsert portion 52. A fixinghandle 59 is formed integrally with this operating portionmain body 58. Arotation operation knob 60 for rotating the proximal end of theinsert portion 52 is arranged at the tip of the operating portionmain body 58. - Further, a link portion of a
movable handle 61 is rotatably linked with the fixinghandle 59 via-thesupport shaft 62. The proximal end of the drivingshaft 55 is coupled with thismovable handle 61. - Furthermore, a first finger receiving ring59 a capable of inserting the operator's finger thereinto is formed at the end of the fixing
handle 59. Still furthermore, a second finger receiving ring 61 a capable of inserting the operator's finger thereinto is formed similarly at the end of themovable handle 61. The drivingshaft 55 is driven to be retracted along axial direction together with opening/closing (rotating movement) operation of themovable handle 61 for the fixinghandle 59 so that an interval between thegrasp members treatment portion 56 is driven to be opened and closed. - Now, an operation in the above structure will be described. When the
surgical treatment instrument 51 of the present embodiment is used, the operator's fingers are inserted into the ring 59 a of the fixinghandle 59 and into the ring 61 a of themovable handle 61, respectively. In this state, themovable handle 61 is rotated with respect to the fixinghandle 59. At this time, together with the rotating movement of themovable handle 61, the drivingshaft 55 is moved in axial direction relative to theinsert tube body 54 of theinsert portion 52, and an interval between thegrasp members treatment portion 56 at the tip of theinsert portion 52 is driven to be opened and closed via a driving mechanism. - As in the first embodiment, in the case where a lesion in a blood vessel or the like brought into close contact with the patient's body tissue such as internal organ is treated by using the
treatment instrument 51 of the present embodiment, a process for releasing the blood vessel H1 and the patient's body tissue H shown in FIG. 5A is performed through operation similar to that in the first embodiment. - Thereafter, the blood vessel H1 released as shown in FIG. 5B is grasped between the
grasp members treatment instrument 51. At this time, the blood vessel H1 is maintained while it is compressed between the grasp members 57 with a proper pressure. - In this state, the
heating element 18 is current-carried and heated, whereby heat of theheating element 18 is transmitted to the blood vessel H1 between the grasp members 57 via thecontact plate 15. In this manner, the wall of the blood vessel H1 grasped between the grasp members 57 is coagulated and welded, and the coagulated-welded portion H2 is formed. - Further, after the wall of the blood vessel H1 has been coagulated and welded, the coagulated-welded portion H2 is separated by the
scissor blade 26′ on the rear side of thegrasp members - When the blood vessel H1 released by the
treatment instrument 51 having the above structure of the present embodiment is grasped between thegrasp members treatment instrument 51, the blood vessel H1 is grasped between twocontact plates 15 of thegrasp members heating element 18 is current-carried and heated, thereby the wall of the blood vessel H1 grasped between thegrasp members - Furthermore, after the wall of the blood vessel H1 has been coagulated and welded, the coagulated-welded portion H2 of the blood vessel H1 is cut by the
metal scissor blade 26′ on the rear side of thegrasp members treatment instrument 51 of the present instrument, as is substantially similar to the first and third embodiments, work of releasing the blood vessel H1 brought into close contact with the patient's body tissue H such as internal organ from the patient's body tissue H; work of coagulating and welding the wall of the blood vessel H1; or work of separating the coagulated-welded portion H2 of the blood vessel H1, or the like can be performed by asingle treatment instrument 51. Thus, unlike the case in which each of these work is treated by using respective individual treatment instruments, work of replacing the treatment instrument can be eliminated, making it advantageous in usability and cost efficiency. - FIG. 10 shows a fifth embodiment of the present45 invention. In the present embodiment, control means 71 of the
heating element 18 of thescissor forceps 2 in themedical treatment instrument 1 is provided according to the first embodiment. The control means 71 of the present embodiment is provided with atemperature control portion 72 connected to theheating element 18 of thescissor forceps 2. ACPU 74 is connected to thistemperature control portion 72 via anamplifier 73. Further, an operatingpanel 75 for temperature setting is connected to theCPU 74. - The
heating element 18 mounted on thescissor forceps 2 of the present embodiment is formed by a metal resistor such as molybdenum in which a resistance value is changed due to a temperature, and the temperature and resistance value change linearly. - In the
temperature control portion 72 of the present embodiment, a current amplified by theamplifier 73 is controlled, whereby the resistance value of theheating element 18 of thescissor forceps 2, i.e., the temperature of theheating element 18 can be adjusted within an arbitrary temperature range, for example, within the range from 60° C. to 150° C. - FIG. 11 shows a sixth embodiment of the present invention. In the present embodiment, a structure of the
medical treatment instrument 1 according to the first embodiment (refer to FIGS. 1 to 5C) is modified as follows: - That is, in the present embodiment, a
battery housing portion 81 is connected to acable connection portion 22 of thefinger insert ring 11 of onescissor constituent member 5 in thescissor forceps 2 of the first embodiment so that a driving current is supplied from a battery housed in thebattery housing portion 81 to theheating element 18 of thescissor forceps 2. With the above structure, agenerator 3 used in themedical treatment instrument 1 of the first embodiment is not required, and thus, theconnector cable 23 connecting thescissor forceps 2 and thegenerator 3 is not also required. Therefore, unlike the first embodiment, there is no possibility that movement of thescissor forceps 2 is restricted by theconnector cable 23, and thus, there is an effect that operability of thescissor forceps 2 can be improved more significantly. - FIGS. 12 and 13 show a seventh embodiment of the present invention. FIG. 12 shows a schematic structure of the entire system of a
medical treatment instrument 101 according to the present embodiment. The system of themedical treatment instrument 101 according to the present embodiment is provided with aforceps 102 and apower supply unit 103 connected to thisforceps 102. - A
main body 104 of theforceps 102 is provided with two scissorconstituent members constituent members support shaft 107 is arranged at the cross section of these scissorconstituent members constituent members - In addition, a
treatment portion 110 comprising a pair ofgrasp portions main body 104. Thistreatment portion 110 is molded in the substantially same shape as the release forceps. - Further, the substantially elliptical finger insert rings111 and 112 are formed at the proximal ends of the scissor
constituent members frontal operating portion 13 for opening/closing a pair ofgrasp portions - In addition, at the
grasp portions main body 104, as shown in FIG. 13, the substantially planar, wide rectangular coagulation treatmentheat generating portions heat generating portions - A substantially smooth surface114 a and 115 a are formed on the contact surface side with the patient's body tissue in the coagulation treatment
heat generating portion grasp portions - A
recess portion 116 extended along the centerline direction of thegrasp portion 109 at the substantially center site of a smooth surface 115 a is formed at the coagulation treatmentheat generating portion 115 on thegrasp portion 109 side. A dissection treatmentheat generating portion 117 is arranged in thisrecess portion 116. This dissection treatmentheat generating portion 117 is such as nichrome wire, and is formed by a sectional, substantially circular heating wire current-carried to generate heat. The outer end surface of the dissection treatmentheat generating portion 117 is located so as to be substantially coincident with a smooth surface 115 a on the outer surface of the coagulation treatmentheat generating portion 115. - Further, a Teflon-coating
layers heat generating portions - As shown in FIG. 1, a
single lead wire 121 is arranged at onescissor constituent member 105, and twolead wires constituent member 106. At the tip, thelead wire 121 is connected to the coagulation treatmentheat generating portion 114. Further, at the tip, thelead wire 122 is connected to the coagulation treatmentheat generating portion 115. Furthermore, at the tip, thelead wire 123 is connected to the dissection treatmentheat generating portion 117. - A single
cable connection portion 124 is protruded on the peripheral surface of thefinger insert ring 111 on the scissorconstituent member 106 side. Further, twocable connection portions finger insert ring 12 on the scissorconstituent member 106 side. A proximal end of thelead wire 121 is connected to thecable connection portion 124 on the scissorconstituent member 105 side, and thelead wires cable connection portions constituent member 106. - Further, each of the
connector cables power supply unit 103, is detachably connected to each of thesecable connection portions foot switch 132 is connected to thepower supply unit 103 via acable 133. Thisfoot switch 132 is provided with a dissectionoutput operating portion 130 and a coagulationoutput operating portion 131. - Now, an operation of the
medical treatment instrument 101 with the above structure according to the present embodiment will be described. First, thetreatment portion 110 at the tip of theforceps 102 is inserted into the patient's body tissue including the site targeted for treatment such as blood vessel (not shown) while it is closed. Thereafter, a pair ofgrasp portions - Subsequently, the released blood vessel or the like is grasped between the
grasp portions forceps 102 while it is compressed with a proper pressure suitable to coagulating treatment. In this state, the coagulationoutput operating portion 131 of thefoot switch 132 is operated. In this manner, the coagulation treatmentheat generating portions grasp portions heat generating portions - Thereafter, the dissection
output operating portion 130 of thefoot switch 132 is subsequently operated. In this manner, the dissection treatmentheat generating portion 117 is current-carried and heated. This dissection treatmentheat generating portion 117 is heated at a high temperature in comparison with the coagulation treatmentheat generating portions heat generating portion 117. - With the above structure, the following effect is obtained. That is, in the
medical treatment instrument 101 of the present embodiment, the wide coagulation treatmentheat generating portions grasp portions main body 104. Thus, a site targeted for treatment such as blood vessel grasped between thegrasp portions main body 104 can be thermally coagulated reliably due to heat of these coagulation treatmentheat generating portions - Further, a
recess portion 116 is formed on a smooth surface 115 a of the coagulation treatmentheat generating portion 115 on thegrasp portion 109 side, and the dissection treatmentheat generating portion 117 is arranged in thisrecess portion 115. After a site targeted for treatment such as blood vessel has been thermally coagulated due to heat of the coagulation treatmentheat generating portions heat generating portion 117. Therefore, unlike a case in which the patient's body tissue is cut by a blade, there is less possibility that the cutting capability is gradually degraded by repeatedly using the blade, making it impossible to reuse the blade, thereby making it advantageous in cost efficiency. - FIG. 14A shows an eighth embodiment of the present invention. In the present embodiment, a structure of the
treatment portion 110 at the tip of theforceps 102 in themedical treatment instrument 101 of the seventh embodiment (refer to FIGS. 12 and 13) is modified as follows: - That is, in the present embodiment, the
recess portion 116 is disposed at the side end of the smooth surface 115 a in the coagulation treatmentheat generating portion 115 on thegrasp portion 109 side, and the dissection treatmentheat generating portion 117 is arranged in thisrecess portion 116. The structures of the other portions are similar to those in the seventh embodiment. - Now, an operation in the above structure will be described. When the
forceps 102 of the present embodiment is used to perform treatment in a way similar to that in the seventh embodiment, the following work are performed. First, theforceps 102 is operated in accordance with the procedure similar to that in the seventh embodiment to release the site targeted for treatment such as blood vessel that is a tissue in the patient's body cavity. The released blood vessel or the like is grasped while it is compressed between thegrasp portions heat generating portions grasp portions - Thereafter, after the coagulation state has been confirmed by opening the
grasp portions heat generating portion 117 is subsequently set according to the center position of the coagulated site targeted for treatment, and thegrasp portions output operating portion 130 of thefoot switch 132 is operated. In this manner, the dissection treatmentheat generating portion 117 is current-carried and heated, and a part of the site targeted for treatment such as coagulated blood vessel is locally heated and cut due to heat of the dissection treatmentheat generating portion 117. - With the above structure, the following effect is obtained. That is, in the
forceps 102 of the present embodiment, the dissection treatmentheat generating portion 117 on thegrasp portion 109 side is disposed at the side end on the coagulation treatmentheat generating portion 115. Thus, thetreatment portion 110 at the tip of theforceps 102 is visually checked transversely, whereby the dissection treatmentheat generating portion 117 on thegrasp portion 119 side can be easily checked. Therefore, in the case where the coagulated patient's body tissue is cut, as in the case of operating the scissors, the cutting position can be easily aligned by the patient's intention, and cutting operation can be performed safely. - FIG. 14B shows a ninth embodiment of the present invention. In the present embodiment, a structure of the
treatment portion 110 at the tip of theforceps 102 in themedical treatment instrument 101 of the seventh embodiment (refer to FIGS. 12 and 13) is modified as follows: - That is, in the seventh embodiment, there is shown a structure in which the dissection treatment
heat generating portion 117 is arranged at only the coagulation treatmentheat generating portion 115 only. In contrast, in the present embodiment, in addition to this structure, therecess portion 116 extended along the centerline direction of thegrasp portion 108 is formed at the substantial center site of the smooth surface 114 a similarly, and the dissection treatmentheat generating portion 117 is arranged in thisrecess portion 116. - Now, an operation in the above structure will be described. When the
forceps 102 of the present embodiment is used to perform treatment in a manner similar to that in the seventh embodiment, the following work are performed. First, theforceps 102 is operated in accordance with the procedure similar to that in the seventh embodiment to release a site targeted for treatment such as blood vessel that is a tissue in the patient's body cavity. Then, the released blood vessel or the like is grasped between thegrasp portions forceps 102 while it is compressed with a proper pressure suitable to coagulating treatment. In this state, the coagulation treatmentheat generating portions grasp portions - Thereafter, the dissection
output operating portion 130 of thefoot switch 132 is subsequently operated. In this manner, the dissection treatmentheat generating portions 117 of both of thegrasp portions heat generating portions 117 on both sides. - With the above structure, the following effect is obtained. That is, in the
forceps 102 of the present embodiment, the dissection treatmentheat generating portions 117 are arranged, respectively, at the coagulation treatmentheat generating portion 115 on thegrasp portion 109 side and the coagulation treatmentheat generating portion 114 on thegrasp portion 108 side. Thus, the heat can be locally concentrated at the thermally coagulated portion of the site targeted for treatment such as blood vessel from the dissection treatmentheat generating portion 117 on both sides. Therefore, the thermally coagulated portion of a site targeted for treatment such as coagulated blood vessel can be easily cut by heat of the dissection treatmentheat generating portions 117 on both sides. The thermally coagulated patient's body tissue can be easily cut, and the treatment time can be reduced. - FIG. 14C shows a tenth embodiment of the present invention. In the present embodiment, a structure of the
treatment portion 110 at the tip of theforceps 102 in themedical treatment instrument 101 of the seventh embodiment (refer to FIGS. 12 and 13) is modified as follows: - That is, in the seventh embodiment, there is shown a structure in which the
recess portion 116 is formed at the substantial center site of the smooth surface 115 a of the coagulation treatmentheat generating portion 115 on thegrasp portion 109 side; the dissection treatmentheat generating portion 117 is arranged in thisrecess portion 116; and only the smooth surface 114 a is provided on a surface opposite to the coagulation treatmentheat generating portion 115 in the coagulation treatmentheat generating portion 114 on thegrasp portion 108 side. In the present embodiment, a porousheat insulation material 134 such as ceramic, for example, is arranged at a site opposite to the dissection treatmentheat generating portion 117 at thegrasp portion 109 side on the smooth surface 114 a of the coagulation treatmentheat generating portion 114 on thegrasp portion 108 side. - In the
forceps 102 of the present embodiment, the dissection treatmentheat generating portion 117 is current-carried and heated. When the dissection treatmentheat generating portion 117 is heated, the heat of the dissection treatmentheat generating portion 117 can be prevented from escaping to thegrasp portion 108 side by means of theheat insulation material 134 of the smooth surface 114 a of the coagulation treatmentheat generating portion 114 on thegrasp portion 108 side. There is achieved an effect that the heat of the dissection treatmentheat generating portion 117 can be intensively acted on a thermally coagulated portion of a site targeted for treatment such as blood vessel between thegrasp portions forceps 102, and thus, the thermally coagulated patient's body tissue can be easily cut. - FIG. 14D shows an eleventh embodiment of the present invention. In the present embodiment, a structure of the
treatment portion 110 at the tip of theforceps 102 in themedical treatment instrument 101 of the seventh embodiment (refer to FIGS. 12 and 13) is modified as follows: - That is, in the present embodiment, the coagulation treatment
heat generating portion 114 is provided at only onegrasp portion 108 of a pair of thegrasp portions grasp portion 109 is formed at the substantial center site on thecontact surface 109 a side with the patient's body tissue at theother grasp portion 109; and a dissection treatmentheat generating portion 117 is arranged in this recess portion 109 b. - In the present embodiment, an effect substantially similar to that in the seventh embodiment can be achieved. A Teflon coating layer may be provided on the
contact surface 109 a side with the patient's body tissue in thegrasp portion 109. Further, the coagulation treatment heat generating portion is provided on thegrasp portion 109 side only, whereby the dissection treatmentheat generating portion 117 may be arranged. - FIGS.15 to 17B show a twelfth embodiment of the present invention. In the present embodiment, a structure of the
forceps 102 in themedical treatment instrument 101 of the seventh embodiment (refer to FIGS. 12 and 13) is modified as follows: - That is, in the
forceps 102 of the present embodiment, the dissection treatmentheat generating portion 117 on thegrasp portion 109 side can be moved to a standby position shown in FIGS. 16A and 16B and a use position shown in FIGS. 17A and 17B. - Here, in the
forceps 102 of the present embodiment, as shown in FIGS. 16A and 16B, aspace 135 for movement of the dissection treatmentheat generating portion 117 is formed on thegrasp portion 109 side. Further, a gap 135 a communicating with thismovement space 135 is provided on a centerline at the coagulation treatmentheat generating portion 115 on thegrasp portion 109 side. - In addition, two front and rear
triangular guide members 136 for guiding movement of the dissection treatmentheat generating portion 117 are fixed, respectively, to the inner side of themovement space 135 on thegrasp portion 109 side. - Further, the dissection treatment
heat generating portion 117 is supported by means of asupport member 137. Columnarsmooth members 137 a and 137 b in contact with an inclined surface of theguide member 136 are fixed, respectively, to the front end and rear end of thissupport member 137. The dissection treatmentheat generating portion 117 is movably maintained at the standby position shown in FIGS. 16A and 16B and the use position shown in FIGS. 17A and 17B whileslide members 137 a and 137 b of thesupport member 137 move along the inclined surface of theguide member 136. At the standby position shown in FIGS. 16A and 16B, the dissection treatmentheat generating portion 117 is maintained while it is apart from the coagulation treatmentheat generating portion 114 of thegrasp portion 108. At the use position shown in FIGS. 17A and 17B, the dissection treatmentheat generating portion 117 is moved in a direction in which thesection 117 abuts against the coagulation treatmentheat generating portion 114 of thegrasp portion 108. - In addition, an operating
lever 138 retracting in the forward/backward direction is arranged between thesupport shaft 107 of the scissorconstituent member 106 and thefinger insert ring 112. This operatinglever 138 is supported retractably from the forward position indicated by solid line in FIG. 15 to the backward position indicated by dotted line in the figure. - Further, the proximal end of an
operating wire 139 for moving the dissection treatmentheat generating portion 117 is fixed to thisoperating lever 138. The tip of thisoperating wire 139 is fixed to the rear end of thesupport member 137. When the operatinglever 138 is maintained at the forward position indicated by solid line in FIG. 15, the dissection treatmentheat generating portion 117 is maintained at the standby position shown in FIGS. 16A and 16B. When the operatinglever 138 is operated to be moved to the backward position indicated by dotted line in FIG. 15, the dissection treatmentheat generating portion 117 is moved to the use position shown in FIGS. 17A and 17B. - Now, an operation in the above structure will be described. When the
forceps 102 of the present embodiment is used to perform treatment in a manner similar to that in the seventh embodiment, the following work are performed. First, the operatinglever 138 of the scissorconstituent member 106 is generally maintained at the forward position indicated by solid line in FIG. 15, the dissection treatmentheat generating portion 117 is maintained at the standby position shown in FIGS. 16A and 16B. In this state, theforceps 102 is operated in accordance with the procedure similar to that in the seventh embodiment to release the site targeted for treatment such as blood vessel of the patent's body cavity, and is grasped between thegrasp portions - Thereafter, the operating
lever 138 is substantially moved from the forward position indicated by solid line in FIG. 15 to the backward position indicated by dotted line. At this time, anoperating wire 139 is pulled backward together with backward operation of the operatinglever 138, and theslide members 137 a and 137 b of thesupport member 137 is inclined backward along the inclined portion of theguide member 136. As a result, the dissection treatmentheat generating portion 117 is moved to the use position shown in FIGS. 17A and 17B, and this dissection treatmentheat generating portion 117 is abutted against the coagulation treatmentheat generating portion 114. - In this state, when the dissection
output operating portion 130 of thefoot switch 132 is operated, the dissection treatmentheat generating portion 117 is current-carried and heated. The thermally coagulated patient's body tissue is cut by the heat of the dissection treatmentheat generating portion 117. - With the above structure, the following effect will be achieved. That is, in the
forceps 102 of the present embodiment, the dissection treatmentheat generating portion 117 is made movable to the standby position shown in FIGS. 16A and 16B and the use position shown in FIGS. 17A and 17B. In the case where the thermally coagulated patent's body tissue is cut, the dissection treatmentheat generating portion 117 is moved to the use position shown in FIGS. 17A and 17B, and is abutted against the coagulation treatmentheat generating portion 114 to come into close contact with thesection 114. Thus, there is an effect that the thermally coagulated patent's body tissue can be thermally cut reliably, and the cut patent's body tissue is not left. - FIGS. 18 and 19 show a thirteenth embodiment of the present invention. In the present embodiment, a structure of the
medical treatment instrument 101 of the twelfth embodiment (refer to FIGS. 15 to 17B) is modified as follows: - That is, in the
forceps 102 of the present embodiment, switch means 140 for turning on/off the dissection treatmentheat generating portion 117 is further arranged at the backward position of the operatinglever 138 shown in the twelfth embodiment. At one end, alead wire 141 is connected to this switch means 140. At the other end, thislead wire 141 is connected to the inner end of thecable connection portion 142 protruded on the peripheral surface of thefinger insert ring 112 of the scissorconstituent member 106. At one end, theconnector cable 143 is detachably connected to the outer end of thiscable connection portion 142. At the other end, thisconnector cable 143 is connected to thepower supply unit 103. - In addition, a
foot switch 145 comprising a coagulationoutput operating portion 144 is connected to thepower supply unit 103 via acable 146. Further, as shown in FIG. 19, anoutput circuit 147, acontrol circuit 148, and adetection circuit 149 are provided, respectively, inside thepower supply unit 103. Theoutput circuit 147, adetection circuit 149, a panel input/display portion 153 arranged on the operating panel of thepower supply unit 103, and afoot switch 145 are connected, respectively, to thecontrol circuit 148. Thecontrol circuit 148 is connected to the panel input/display portion 153 so that data is input and output bidirectionally. At the panel input/display portion 153, the output or temperature setting input or the temperature setting display or the like is performed. - Further, at an inner end side, the
cable connector 150 provided at thepower supply unit 103 is connected to theoutput circuit 147 via threeoutput lines 151, and is connected to thedetection circuit 149 via adetection line 152. - Now, an operation in the above structure will be described. When the
forceps 102 of the present embodiment is used to perform treatment in a manner similar to that in the twelfth embodiment, the following work are performed. - First, as in the twelfth embodiment, the operating
lever 138 of the scissorconstituent member 106 is held at the forward position indicated by solid line in the FIG. 18, and the dissection treatmentheat generating portion 117 is held at the standby position (shown in FIGS. 16A and 16B). In this state, theforceps 102 is operated in accordance with the procedure similar to that in the thirteenth embodiment, and the site targeted for treatment such as blood vessel that is the tissue in the patient's body cavity is released and grasped between thegrasp portions output operating portion 144 of thefoot switch 145 is operated, whereby the coagulation treatmentheat generating portions - Thereafter, the operating
lever 138 is subsequently operated to be moved from the forward position indicated by solid line in FIG. 18 to the backward position indicated by dotted line. At this time, theoperating wire 139 is pulled back together with backward movement of the operatinglever 138; the dissection treatmentheat generating portion 117 is moved to the use position shown in FIGS. 17A and 17B; and this dissection treatmentheat generating portion 117 is abutted against the coagulation treatmentheat generating portion 114. Further, when the operatinglever 138 is operated to be moved to the backward position, switch means 140 is actuated, and a signal is output from this switch means 140. At this time, the signal output from the switch means 140 is input to adetection circuit 149 of thepower supply unit 103. Thus, the state in whichoperating lever 138 is moved to the backward position is detected by means of thisdetection circuit 149. When the state in which thisoperating lever 138 is moved to the backward position is detected, acontrol circuit 148 controls an output of theoutput circuit 147. Then, the dissection treatmentheat generating portion 117 is current-carried and heated, and the thermally coagulated patent's body tissue is cut by the heat of the dissection treatmentheat generating portion 117. - With the above structure, the following effect is obtained. That is, in the
medical treatment instrument 101, when the operatinglever 138 is operated to be moved to the backward position, the switch means 140 is actuated at the same time so as to switch an output of thepower supply unit 103. Thus, there is no possibility that the coagulation treatmentheat generating portions heat generating portion 117 are mistakenly actuated due to mistaken stepping of thefoot switch 145, and there is an effect that coagulating and cutting operations can be performed safely. - FIGS. 20A and 20B show a fourteenth embodiment of the present invention. In the present embodiment, the present invention is applied to a
surgical treatment instrument 154 used for surgical operation under endoscope as a medical treatment instrument. FIG. 20A shows a schematic structure of the entiresurgical treatment instrument 154. - The
treatment instrument 154 of the present embodiment is provided with anelongated insert portion 155 to be inserted into the patent's body through a trocar (not shown) and afrontal operating portion 156 linked with the proximal end of thisinsert portion 155. - The
insert portion 155 is provided with a tubularinsert tube body 157. A drivingshaft 158 relatively moved in axial direction of theinsert portion 155 is inserted into thisinsert tube body 157. Further, atreatment portion 159 is arranged at the tip of theinsert portion 155. Thistreatment portion 159 is provided with a pair ofgrasp members 160 a and 160 b capable to be opened and closed. A pair ofgrasp members 160 a and 160 b is coupled with the tip of the drivingshaft 158 via a driving mechanism such as cam mechanism (not shown). An interval between thegrasp members 160 a and 160 b is driven to be opened and closed via the driving mechanism together with retracting movement of the drivingshaft 158. - The
grasp members 160 a and 160 b of the present embodiment are structured in a manner substantially similar to that of each of thegrasp portions forceps 102 of the present embodiment (refer to FIGS. 15 to 17B). - That is, as in each of the
grasp portions grasp members 160 a and 160 b of the present embodiment are internally provided with the coagulation treatmentheat generating portion 114, coagulation treatmentheat generating portion 115, dissection treatmentheat generating portion 117,support member 137,slide members 137 a and 137 b,guide member 136, andoperating wire 139 shown in FIGS. 16A, 16B, 17A and 17B. - In addition, the
frontal operating portion 156 is provided with an operating portionmain body 162 for rotatably holding the proximal end of theinsert portion 155. A fixinghandle 163 is formed integrally with this operating portionmain body 162. Arotating operation knob 164 for rotationally operating the proximal end of theinsert portion 155 is arranged at the tip of the operating portionmain body 162. - Further, a link portion of a
movable handle 165 is rotatably linked with the fixinghandle 163 via asupport shaft 166. The proximal end of the drivingshaft 158 is linked with thismovable handle 165. - Further, a first finger insert ring167 a into which the operator's finger can be inserted is formed at the end of the fixing
handle 163. Still further, a secondfinger insert ring 167 b into which the operator's finger can be inserted is formed similarly at the end of themovable handle 165. The drivingshaft 158 is driven retractably along axial direction together with opening/closing (rotating) operation of themovable handle 165 relative to the fixinghandle 163, and an interval between thegrasp members 160 a and 160 b of thetreatment portion 159 is driven to be opened and closed. - Further, in the fixing handle163 of the present embodiment, there is arranged the operating
lever 161 in which the dissection treatmentheat generating portion 117 is operated to be moved to be the standby position shown in FIGS. 16A and 16B and to the use position shown in FIGS. 17A and 17B. This operatinglever 161 is supported retractably from the forward position indicated by solid line in FIG. 20A to the backward position indicated by dotted line in the figure. The dissection treatmentheat generating portion 117 is moved to a direction in which thesection 117 is close to/distant from the coagulation treatmentheat generating portion 114 together with operation of thislever 161. - Now, an operation in the above structure will be described. When the
surgical treatment instrument 154 of the present embodiment is used, the operator's fingers are inserted into a ring 167 a of the fixinghandle 163 and into aring 167 b of themovable handle 165. In this state, themovable handle 165 is rotated relative to the fixinghandle 163. At this time, the drivingshaft 158 is moved in axial direction relative to theinsert portion 155 together with rotating operation of themovable handle 163, and an interval between thegrasp members 160 a and 160 b of thetreatment portion 159 is driven to be opened and closed at the tip of theinsert portion 155 via the driving mechanism. - Further, the
lever 161 is operated by fingers other than those inserted into therings 167 a and 167 b, whereby theoperating wire 139 of the dissection treatmentheat generating portion 117 is moved in axial direction relative to theinsert portion 155, and is operated to be moved to a direction in which the wire is close to/distant from the tissue grasp surface of the coagulation treatmentheat generating portion 114 in which the grasp portion 160 a is provided with the dissection treatmentheat generating portion 117. - As in the twelfth embodiment, when the
treatment instrument 154 of the present embodiment is used to treat a site targeted for treatment such as blood vessel in the patent's body tissue, a site targeted for treatment such as blood vessel that is a tissue in the patient's body cavity is released through operation similar to that in the twelfth embodiment, and is grasped between thegrasp members 160 a and 160 b to perform thermal coagulation. - When the
lever 161 is subsequently operated to be moved from the solid line position to the dotted line position in FIG. 20A, thewire 139 is pulled backward, andslide members 137 a and 137 b fixed to thesupport member 137 are moved to be inclined backward along the inclined portion of theguide member 136. As a result, as shown in FIGS. 17A and 17B, the dissection treatmentheat generating portion 117 is abutted against the coagulation treatmentheat generating portion 114. In this state, the dissectionoutput operating portion 130 of thefoot switch 132 is operated, whereby the dissection treatmentheat generating portion 117 is current-carried and heated, and the thermally coagulated tissue is cut. - With the above structure, the following effect is obtained. That is, in the
treatment instrument 154 of the present embodiment, the dissection treatmentheat generating portion 117 is protruded and recessed on the centerline of the coagulation treatmentheat generating portion 114. Thus, the thermally coagulated patient's body tissue can be thermally cut reliably, the cut patient's body tissue is not left, and the treatment time can be reduced. - In addition, FIGS. 21, 22A and22B show a fifteenth embodiment of the present invention. FIG. 21 shows a structure of a
forceps 172 that is amedical treatment instrument 171 of the present embodiment. - A
main body 173 of theforceps 172 is provided with two scissorconstituent members constituent members support shaft 176 for rotatably linking the scissorconstituent members constituent members - In addition, a
treatment portion 179 comprising a pair of thegrasp portions main body 173. Thistreatment portion 179 is molded in the substantially same shape as that in the release forceps. - Further, substantially elliptical finger insert rings180 and 181 are formed at the proximal end of each of the scissor
constituent members frontal operating portion 182 for opening/closing a pair ofgrasp portions - A substantially arc-shaped, gently
curved curve portion 183 is formed at atreatment portion 179 of the forcepsmain body 173, as shown in FIG. 22A. Furthermore, at each of thegrasp portions main body 173, as shown in FIG. 22B, coagulation treatmentheat generating portions heat generating portions - Teflon coating layers186 and 187 for preventing scorch of the patient's body tissue are formed, respectively, on the outer surface of the coagulation treatment
heat generating portions 184 and 185 (the contact surface with the patient's body). - Further, at the widthwise center portion of each of the
grasp portions treatment portion 179, as shown in FIG. 22A, agap 188 gently curved in the arc shape is provided along the curve shape of thecurve portion 183. Thisgap 188 is formed as a route to the coagulation treatmentheat generating portions gas 188 is structured of having opened at the tip of each of thegrasp portions - As shown in FIG. 21, a
lead wire 189 is arranged at onescissor constituent member 174, and alead wire 190 is arranged at the other scissorconstituent member 175, respectively. At the tip, thelead wire 189 is connected to the coagulation treatmentheat generating portion 184. At the tip, thelead wire 190 is connected to the coagulation treatmentheat generating portion 185. - Further, a
cable connection portion 191 is protruded on the peripheral surface of thefinger insert ring 180 on the scissorconstituent member 174 side. Furthermore, acable connection portion 192 is protruded on the peripheral surface of thefinger insert ring 181 on the scissorconstituent member 175 side. The proximal end of thelead wire 189 is connected to thecable connection portion 191 on the scissorconstituent member 174 side, and thelead wire 190 is connected to thecable connection portion 192 on the scissorconstituent member 175 side. - Now, an operation of the
medical treatment instrument 171 with the above structure according to the present embodiment will be described. First, thetreatment portion 179 is inserted into the patient's body tissue including a site targeted for treatment such as blood vessel (not shown) while it is closed at the tip of theforceps 172. Thereafter, a pair ofgrasp portions - Subsequently, the released blood vessel or the like is grasped between the
grasp portions heat generating portions grasp portions grasp portions heat generating portion - Thereafter, in this state, a surgical knife (not shown) or a high-frequency knife is inserted into the
gap 188 of each of thegrasp portions treatment portion 179, and the site targeted for treatment such as blood vessel is cut. - With the above structure, the following effect is obtained. In the
medical treatment instrument 101 of the present embodiment, a wide coagulation treatmentheat generating portions grasp portions main body 173. Thus, the site targeted for treatment such as blood vessel grasped between thegrasp portions main body 173 can be thermally coagulated reliably due to the heat of these coagulation treatmentheat generating portions - Further, in the present embodiment, the
gap 188 is provided at the widthwise center portion of each of thegrasp portions treatment portion 179. After the site targeted for treatment such as blood vessel has been thermally coagulated, another cutting means such as surgical knife or high-frequency knife is inserted into thegap 188 between thegrasp portions treatment portion 179, whereby the tissue of the site targeted for treatment such as coagulated blood vessel can be cut. Therefore, in particular, the site can be treated simply and speedily by abdominal cutting surgery. In addition, the structure is simplified and advantageous in cost efficiency in comparison with the structure in which the coagulating function and cutting function of the tissue of the site targeted for treatment are performed by a single instrument. - FIGS. 23A and 23B show a sixteenth embodiment of the present invention. In the present embodiment, a structure of the
treatment portion 179 at the tip of theforceps 172 in themedical treatment instrument 171 according to the fifteenth embodiment (refer to FIGS. 21, 22A and 22B) is modified as follows: - That is, in the present embodiment, the
gap 188 is not provided on thegrasp portion 177 side of onescissor constituent member 174, and thegap 188 is provided on thegrasp portion 178 side only of the other scissorconstituent member 175. - Now, an operation in the above embodiment will be described. When the
forceps 172 of the present embodiment is used to perform treatment in a manner similar to the fifteenth embodiment, the following work are performed. First, theforceps 172 is operated in accordance with the procedure similar to that in the fifteenth embodiment, whereby the site targeted for treatment such as blood vessel that is a tissue in the patent's body cavity is released, and grasped between thegrasp portions - Then, in this state, the surgical knife (not shown) or the high-frequency knife is inserted into the
gap 188 of onegrasp portion 178 of thetreatment portion 179, and the site targeted for treatment such as coagulated blood vessel is cut. - With the above structure, the following effect is obtained. That is, in the present embodiment, when a surgical knife or a high-frequency knife is inserted into the
gap 188, the tip of the knife is pressed to be abutted against the surface of the coagulation treatmentheat generating portion 184 of thegrasp portion 177 of thetreatment portion 179, and the subsequent inserting operation is stopped. Therefore, the tip of the knife is prevented from penetrating the outside of thegap 188, and there is no possibility that a portion other than the site targeted for treatment is cut, which is safe. - FIG. 24 shows a seventeenth embodiment of the present invention. In the present embodiment, a structure of the
treatment portion 179 at the tip of theforceps 172 in themedical treatment instrument 171 according to the fifteenth embodiment is modified as follows: - That is, in the present embodiment, as in the sixteenth embodiment (refer to FIGS. 23A and 23B), the
gap 188 is not provided at thegrasp portion 177 side of onescissor constituent member 174, and thegap 188 is provided on thegrasp portion 178 side only of the other scissorconstituent member 175. Further, in the present embodiment, in addition to these scissor constituent members, on thegrasp portion 177 side of the scissorconstituent member 174, a receivingmember 193 consisting of an ultra hard metal such as tungsten is arranged instead at a site corresponding to thegap 188 of thegrasp portion 178 side. - Now, an operation in the above structure will be described. When the
forceps 172 of the present embodiment is used to perform treatment in a manner similar to that in the fifteenth embodiment, the following work are performed. First, theforceps 172 is operated in accordance with the procedure similar to that in the fifteenth embodiment, whereby the site targeted for treatment such as blood vessel that is a tissue in the patent's body cavity is released, and is grasped between thegrasp portions - Then, in this state, the surgical knife (not shown) or the high-frequency knife is inserted into the
gap 188 of onegrasp portion 178 of thetreatment portion 179, and the site targeted for treatment such as coagulated blood vessel is cut. - With the above structure, the following effect is obtained. That is, in the present embodiment, when the surgical knife or the high-frequency knife is inserted into the
gap 188, the tip of the knife is pressed to be abutted against the surface of the receivingmember 193 of thegrasp portion 177, and the subsequent inserting operation is stopped. Therefore, the tip of the knife is prevented from penetrating the outside of thegap 188, and there is no possibility that a portion other than the site targeted for treatment is cut, which is safe. - Further, in the present embodiment, the receiving
member 193 is made of an ultra hard metal. When the tip of the knife is pressed to be abutted against the receivingmember 193, the degradation due to damage caused on the surface can be prevented. - FIG. 25 shows an eighteenth embodiment of the present invention. In the present embodiment, a structure of the
treatment portion 179 at the tip of theforceps 172 in themedical treatment instrument 171 according to the fifteenth embodiment (refer to FIGS. 21, 22A and 22B) is modified as follows: - That is, in the present embodiment, a closing
portion 194 for closing the tip of thegap 188 of each of thegrasp portions treatment portion 179 is provided so that the tip of thegap 188 of each of thegrasp portions - With the above structure, when the surgical knife or the high-frequency knife is inserted into the
gap 188 to cut the site targeted for treatment, the knife movement range is restricted between the closingportion 194 at the tip of thegap 188 and aterminal end 195 of thisgap 188. Therefore, in particular, when a parenchymal organ such as liver is coagulated and cut, there is no possibility that a site not coagulated other than a site targeted for dissection is cut and blooded, and there is an effect that the site can be treated safely. - FIG. 26 shows a nineteenth embodiment of the present invention. In the present embodiment, the
treatment portion 179 at the tip of theforceps 172 in themedical treatment instrument 171 according to the fifteenth embodiment (refer to FIGS. 21, 22A and 22B) is changed for high-frequency treatment. - That is, in the present embodiment, the forceps
main body 173 in theforceps 172 is entirely made of an insulation material. Further, at thegrasp portions main body 173,insulation portions gap 188. - In addition, at the
grasp portions rectangular electrodes insulation portions gap 188. Each of theelectrodes - Now, an operation in the above structure will be described. When the
forceps 172 of the present embodiment is used to perform treatment in a manner similar to that in the fifteenth embodiment, the site targeted for treatment such as vessel blood that is a tissue in the patent's body cavity is released. After the site has been grasped between thegrasp portions electrodes grasp portions - Then, in this state, the surgical knife (not shown) or the high-frequency knife is inserted into the
gap 188 of onegrasp portion 178 of thetreatment portion 179, and the site targeted for treatment such as coagulated blood vessel is cut. - With the above structure, the following effect is obtained. That is, in the
forceps 172 of the present embodiment, a site targeted for treatment is coagulated by supplying the high-frequency bipolar power. At the same time, the high-frequency power supply unit is switched to monopolar, whereby the coagulated site can be cut by the high-frequency knife. Therefore, coagulation and cutting can be performed by a single power supply unit, making it advantageous in cost efficiency. - FIG. 27 shows a twentieth embodiment of the present invention. In the present embodiment, a structure of the
medical treatment instrument 171 according to the fifteenth embodiment (refer to FIGS. 21, 22A and 22B) is modified as follows: - That is, in the present embodiment, as in the nineteenth embodiment (refer to FIG. 26), the structure is changed such that the
treatment portion 179 at the tip of theforceps 172 is provided with the high-frequency treatment electrodes electrode 198 on onegrasp portion 177 side is connected to the inner end of thecable connection portion 191 of thefinger insert ring 180 on the scissorconstituent member 174 side via thelead wire 189. Further, theelectrode 199 on theother grasp portion 178 side is connected to the inner end of thecable connection portion 192 of thefinger insert ring 181 on the scissorconstituent member 175 side via thelead wire 190. - At one end, a
connector cable 200 is detachably connected to the outer end of thecable connection portion 191. At one end, theconnector cable 201 is detachably connected to the outer end of thecable connection portion 192. At the other ends, theseconnector cables power supply unit 202. - A
switch unit 203 is intervened intermediately of theconnector cable 201 of the high-frequencypower supply unit 202. To thisswitch unit 203, a high-frequency knife 204 is connected via acable 205. The high-frequency knife 204 is connected to the high-frequencypower supply unit 202 via thisswitch unit 203. Afoot switch 207 is connected to the high-frequencypower supply unit 202 via acable 206. Thisfoot switch 207 is provided with a dissectionoutput operating portion 208 and the coagulationoutput operating portion 209. - Now, an operation in the above structure will be described. When the
forceps 172 of the present embodiment is used to perform treatment in a manner similar to that in the nineteenth embodiment, the following work are performed. First, theforceps 172 is operated in accordance with the procedure similar to that in the fifteenth embodiment, whereby a site targeted for treatment such as blood vessel that is a tissue in the patient's body cavity is released, and is grasped between thegrasp portions output operating portion 209 in thefoot switch 207 is operated. In this manner, the site targeted for treatment such as blood vessel between thegrasp portions electrodes - Then, in this state, the high-
frequency knife 204 is inserted into thegap 188 between thegrasp portions treatment portion 179, and a power supply route of theswitch unit 203 is changed. Then, a dissectionoutput operating portion 208 in thefoot switch 207 is operated, whereby dissection power is supplied from the high-frequency knife 204 to theelectrode 199 in theforceps 172, and the site targeted for treatment is cut. - With the above structure, the following effect is obtained. That is, when a site targeted for treatment such as blood vessel is cut in the
forceps 172 of the present embodiment, the site targeted for treatment can be cut by only bipolar power without changing it to monopolar power, enabling safe treatment. - FIGS. 28, 29A and29B show a twenty-first embodiment of the present invention. FIG. 28 shows a structure of a dissection cutting
treatment instrument 211 that is a medical treatment instrument of the present embodiment. - Here, a
main body 212 of the coagulation cuttingtreatment instrument 211 is provided with two scissorconstituent members constituent members support shaft 215 for rotatably linking these scissorconstituent members constituent members - A
treatment portion 218 comprising a pair ofjaws main body 212. Further, the substantially elliptical finger insert rings 219 and 220 are formed at the proximal ends of the scissorconstituent members frontal operating portion 221 for opening/closing a pair ofjaws -
Heaters jaws heaters tooth portion 224 for preventing the patient's body tissue from slipping off. Theheaters -
Cable connection portions portion 221. Aheater 222 is connected to the inner end of onecable connection portion 225 via a lead wire. Aheater 223 is connected to the inner end of the othercable connection portion 226 via the lead wire. Further, connector cables for supplying power to theheaters cable connection portions - The
jaws treatment scissor blades scissor blades scissor blades jaws jaws - In addition,
slide grooves scissor blades jaws slide grooves scissor blades scissor blades slide grooves Sharp blade portions scissor blades - At tips, operating
bars scissor blades bars levers portion 221. Thescissor blades slide grooves jaws levers - Now, an operation in the above structure will be described. When the coagulating/
cutting treatment instrument 211 of the present embodiment is used, thescissor blades main body 212 as shown in FIG. 28 at a usual time other than dissection of the patient's body tissue H. In this state, after thejaws portion 221, thejaws lower heaters scissor blades lower heaters lower heaters - Next, after the
jaws levers scissor blades scissor blades jaws - In that state, the
jaws lower scissor blades - With the above structure, the following effect is obtained. That is, in the present embodiment, the
heaters jaws treatment portion 218 of the treatment instrumentmain body 212, and the cuttingtreatment scissor blades jaws scissor blades main body 212 as shown in FIG. 28. In this state, coagulating treatment of the patient's body tissue H is performed, and thescissor blades jaws jaws treatment portion 218 of the treatment instrumentmain body 212, and thus, there is an effect that delicate treatment can be performed. - Further, when the patient's body tissue H is cut to be treated, the patient's body tissue H can be cut to be treated by opening/closing the scissor
constituent members - FIG. 30 shows a twenty-second embodiment of the present invention. In the present embodiment, a structure of the
treatment portion 218 at the tip of the treatment instrumentmain body 212 in the coagulating/cutting treatment instrument 211 according to the twenty-first embodiment (refer to FIGS. 28, 29A, and 29B) is modified as follows: - That is, in the present embodiment, the
heaters bipolar electrode 235 is structured by thejaws jaws knife blades knife blades - In the present embodiment, coagulating treatment is performed at the
bipolar electrode 235 at the tip of each of thejaws treatment portion 218 of the treatment instrumentmain body 212, and cutting treatment can be performed by theknife blades jaws jaws treatment portion 218 of the treatment instrumentmain body 212, and thus, there is an effect that delicate treatment can be performed. - FIG. 31 shows a twenty-third embodiment of the present invention. In the present embodiment, a
knife blade 228 is provided at only a single-sided jaw 217 of thetreatment portion 218 at the tip of the treatment instrumentmain body 212 in the coagulating/cutting treatment instrument 211 according to the twenty-second embodiment (refer to FIG. 30). - In the present embodiment, coagulating treatment is performed at the
bipolar electrode 235 at the tip of each of thejaws treatment portion 218 of the treatment instrumentmain body 212, and cutting treatment can be performed by theknife blade 228 of the single-sided jaw 217. In the present embodiment, as in the coagulating/cutting treatment instrument 211 according to the twenty-second embodiment, there is an effect that delicate treatment can be performed. - A cutting current is supplied to the
knife blade 228 of the present embodiment, and theknife blade 228 is current-carried and heated, whereby cutting treatment of the patient's body tissue H may be performed. - FIG. 32 shows a twenty-fourth embodiment of the present invention. In the present embodiment, a structure of the
treatment portion 218 at the tip of the treatment instrumentmain body 212 in the coagulating/cutting treatment instrument 211 according to the twenty-first embodiment (refer to FIGS. 28, 29A and 29B) is modified as follows: - That is, in the present embodiment, a dissection treatment
heat generating portion 238 such as nichrome wire is structured to be provided at the tip of each of theknife blades jaws treatment portion 218 so that cutting treatment is performed by this dissection treatmentheat generating portion 238. - In the present embodiment, coagulating treatment is performed at the
bipolar electrode 235 at the tip of each of thejaws treatment portion 218 of the treatment instrumentmain body 212, and cutting treatment can be performed by the dissection treatmentheat generating portion 238 of each of thejaws cutting treatment instrument 211 according to the twenty-first embodiment, coagulating treatment and cutting treatment can be performed at the tip of each of thejaws treatment portion 218 of the treatment instrumentmain body 212, and thus, there is an effect that delicate treatment can be performed. - FIGS. 33, 34A and34B show a twenty-fifth embodiment of the present invention. In the present embodiment, a structure of the
treatment portion 218 at the tip of the treatment embodimentmain body 212 in the coagulating/cutting treatment instrument 211 according to the twenty-first embodiment (refer to FIGS. 28, 29A and 29B) is modified as follows: - That is, at one
jaw 217 of thetreatment portion 218 according to the present embodiment, as shown in FIG. 34A, aplanar heating element 242 is provided partially of agrasp surface 241 meshed with theother jaw 216. - Further, a cutting
instrument guide groove 243 extended in the centerline direction of thejaw 217 is formed at the substantial center site of thegrasp surface 241 of thisjaw 217. This cuttinginstrument guide groove 243 is extended from the tip to the end of thisgrasp surface 241 beyond theheating element 242. In this cuttinginstrument guide groove 243, a cuttinginstrument 244 having structure different from thescissor blades instrument guide groove 243. - At this
cutting instrument 244, ahook portion 246 to be protruded to the outside of the cuttinginstrument guide groove 243 is connected to the tip of a bar-shapedshank portion 245. Anichrome wire 247 is mounted on thishook portion 246. Further, afinger hoot portion 248 protruded to the outside of the cuttinginstrument guide groove 243 is formed at the end of theshank portion 245 of the cuttinginstrument 244 as shown in FIG. 33. - In addition, at the
jaw 216 side, aplanar heating element 250 is provided partially at thegrasp portion 249 meshed with thegrasp phase 241 of theopposite jaw 217, as shown in FIG. 34B. Further a hookportion guide groove 251 having thehook portion 246 of the cuttinginstrument 244 inserted thereinto is formed at the substantial center side of thegrasp surface 249 of thisjaw 216. This hookportion guide groove 251 is extended from the tip side of thegrasp surface 24 to the end side beyond the longitudinal length of theheating element 250. When a pair ofjaws portion guide groove 251 is set in dimensions in which thehook portion 246 on the tip side of the cuttinginstrument 244 is substantially recessed. - A
fine irregularity 252 for preventing slip-off is formed on each of the grasp surfaces 241 and 249 of a pair ofjaws heating elements - Further,
power supply cables heating elements power supply cable 255 is also connected to anichrome wire 247. Thispower supply cable 255 is led out from thefinger insert ring 220. The led-outpower supply cables - Now, an operation in the above structure will be described. In the present embodiment, when the coagulating/
cutting treatment instrument 211 is used, a tip side hook portion of the cuttinginstrument 244 is maintained in advance at a standby position at which the hook portion is moved to be positioned at the terminal end portion of the tip side of the cuttinginstrument guide groove 243 of thejaw 217. In this state, fingers are inserted into the finger insert rings 219 and 220 of thefrontal operating portion 221. Then,jaws main boy 212 are operated to be opened, and closed and a target site (for example, blood vessel) is grasped between a pair ofjaws heating elements heating elements - Subsequently, while this grasped state is maintained, power is supplied to the
nichrome wire 247. While thenichrome wire 247 is heated, afinger hook portion 248 is pulled to the end side. Then, thenichrome wire 247 is moved from the tip side to the end side of thejaw 217. In this manner, a blood-coagulated site is cut by thenichrome wire 247. - With the above structure, the following effect is obtained. That is, in the present embodiment, since coagulation and dissection can be performed continuously while the target site is grasped, positioning operation during cutting is not required, and there is no worrying about mistaking a cutting site. Therefore, the operator's burden is reduced, and precision in coagulating/cutting treatment is improved.
- FIGS. 35A to35C, 36A and 36B show a twenty-sixth embodiment of the present invention. FIG. 35A shows a schematic structure of the coagulating
treatment instrument 301 according to the present embodiment. Themain body 302 of the coagulatingtreatment instrument 301 according to the present embodiment is provided with two scissorconstituent members constituent members fulcrum pin 305 for rotatably connecting these scissorconstituent members constituent members - A
treatment portion 308 comprising a pair ofjaws main body 302. Thistreatment portion 308 is molded in the substantially same shape a release forceps. - Further, substantially elliptical finger insert rings309 and 310 are formed at the proximal ends of the scissor
constituent members frontal operating portion 311 for opening/closing a pair ofjaws - A
curve portion 312 gently curved in substantial arc shape as shown in FIG. 35B is formed at thetreatment portion 308 of the treatment instrumentmain body 302. Further, ceramic heaters (heater means) 313 and 314 for coagulating the patient's body tissue is provided on a contact surface side with the patient's body tissue as shown in FIG. 35A. - The
ceramic heaters heat transmitting portion 315 made of ceramic that is an insulation material as shown in FIG. 36B, and aheating element 316 recessed inside thisheat transmitting portion 315. Types of ceramics of theheat transmitting portion 315 include alumina; aluminum nitrate; silicon nitrate or the like. Further, a material of theheating element 316 is often selected from among metals such as tungsten. In general, theheat transmitting portion 315 andheating element 316 are burned integrally, and theceramic heaters tooth portion 317 for preventing the patient's body tissue from slip-off as shown in FIG. 35C is provided on the surface of theheating element 316 of each of theceramic heaters tooth portion 317 is formed by a number of substantiallytrapezoidal protrusions 318 protruded on the surface of theheating element 316. Thistooth portion 317 is molded by cutting the surface of theheating element 316. - Further, a
Teflon coating layer 319 for covering the surface of theheating body 316 with a Teflon coat is formed on the outer surface (constant surface with the patient's body tissue) of theheating element 316 of each of theceramic heaters - As shown in FIG. 35A,
insulation lead wires constituent members insulation lead wire 320 on onescissor constituent member 303 side is connected to theceramic heater 313. At the tip, theinsulation lead wire 321 on the other scissorconstituent member 304 side is connected to theceramic heater 314. - In addition, one
cable connection portion 322 is protruded on the outer periphery of thefinger insert ring 309 on the scissorconstituent member 303 side. Onecable connection portion 323 is protruded similarly on the outer periphery of thefinger insert ring 310 on the scissorconstituent member 304 side. At the proximal end, theinsulation lead wire 320 is connected to thecable connection portion 322 on the scissorconstituent member 303 side. Theinsulation lead wire 321 is connected to thecable connection portion 323 on the scissorconstituent member 304 side. Further, to thesecable connection portions connector cables ceramic heaters - Now, an operation of the coagulating
treatment instrument 301 with the above structure according to the present embodiment will be described. First, thetreatment portion 308 at the tip of the coagulatingtreatment instrument 301 is inserted into the patient's body tissue including a site targeted for treatment such as blood vessel (not shown) while thetreatment portion 308 is closed. Thereafter a pair ofjaws 306 and 37 is opened, whereby a site targeted for treatment such as blood vessel is released from the other patient's body tissue and is exposed. - Subsequently, the released blood vessel or the like is grasped while it is compressed between the
jaws treatment instrument 301 with a proper pressure suitable to the coagulating treatment. In this state, when a power supply unit (not shown) is output, power is supplied to theheating element 316 of theceramic heaters jaws connector cables heating element 316 is heated by electrical resistance while the power is supplied; theheat transmitting portion 315 is heated; and the patient's body tissue is coagulated at the site targeted for treatment such as blood vessel coming into contact with the surface of thisheat transmitting portion 315. Theheat transmitting portion 315 is made of a insulating element, and a current supplied to theheating element 316 does not leak the patient's body tissue at the site targeted for treatment. - With the above structure, the following effect is obtained. That is, in the present embodiment, the
ceramic heaters jaws main body 302. Thus, there is no need for applying another insulation coating to theceramic heaters jaws treatment instrument 301 can be improved. - FIG. 37 shows a modified example of the
jaws treatment instrument 301 according to the twenty-sixth embodiment. In the present modified example, thetooth portion 317 on the surface of each of theceramic heaters jaws transverse grooves 331. - FIG. 38 shows a twenty-seventh embodiment of the present invention. In the present embodiment, the
ceramic heaters jaws treatment instrument 301 according to the twenty-sixth embodiment (refer to FIGS. 35A to 35C, 36A and 36B) are covered with a reinforcemetal cover 332. It is desirable that a Teflon for preventing adhesion is coated on the surface of the reinforcemetal cover 332. - In the present embodiment, the
ceramic heaters metal cover 332, and thus, there is an effect that the strength of thejaws treatment instrument 301 can be improved more significantly. The present invention may be a treatment instrument suitable to surgery under endoscope without being limited to the above embodiment. - FIGS. 39A, 39B,40A and 40B show a twenty-eighth embodiment of the present invention. In the present embodiment, a structure of a fixing portion for fixing the
ceramic heaters jaws main body 302 in the coagulatingtreatment instrument 301 according to the twenty-sixth embodiment (refer to FIGS. 35A to 35C, 36A and 36B) is modified as follows: - That is, in the present embodiment, as shown in FIGS. 40A and 40B, a connection plate (an intermediate connection member)341 is brazed and connected to the inner surfaces of the
ceramic heaters 313 and 314 (bonding surface with thejaws 306 and 307). Thisconnection plate 341 may be a thin metal plate to decrease thermal stress during brazing, and is usable to be a stainless steel or a copal (a metal containing iron and cobalt). - Further, a plurality of connection pins342 are protruded at the
connection plate 341. Here, ahole 343 having connection pins 342 of theconnection plate 341 inserted thereinto is formed at thejaws connection plate 341 has been inserted into thehole 343 of thejaws jaws connection pin 342 may be used as a screw. Furthermore, as shown in FIG. 40C, thepins 342 are directly brazed and connected to theceramic heaters - Instead of blazing, connection between the
ceramic heaters connection plate 341 may be made by bonding in which strength is slightly reduced. In addition, connection between theconnection plate 341 and thejaws connection pin 342. - With the above structure, the following effect is obtained. That is, in the present embodiment, when the
ceramic heaters jaws main body 302 in the coagulatingtreatment instrument 301, after athin connection plate 341 has been blazed to be connected to theceramic heaters connection pin 342 of theconnection plate 341 is inserted into thehole 343 of thejaws connection pin 342 is mechanically connected to thejaws resilient jaws ceramic heaters connection pin 342 of theconnection plate 341. A resilience of thejaws ceramic heaters jaws ceramic heaters - As a result,
ceramic heaters jaws - Further, as in the case in which the hard, brittle
ceramic heaters jaws ceramic heaters ceramic heaters jaws connection plate 341 is made of a copal with low thermal expansion rate, and there is an effect that the link strength can be improved more significantly. - FIG. 41A shows a first modified example of a mount structure of the
connection plate 341 for linking between thejaws main body 302 and theceramic heaters treatment instrument 301 according to the present modified example. In the present embodiment, a heater fixing claw 341 a is protruded on the link portion side with theceramic heaters connection plate 341, and ajaw fixing claw 341 b is protruded on the link portion side of thejaws jaw fixing claw 341 b are extended partially or over a full length of theconnection plate 341. - Structurally, the heater fixing claw341 a of the
connection plate 341 is mechanically engaged with theceramic heaters jaw fixing claw 341 b is also engaged with thejaws jaws - FIG. 41B shows a second modified example of a mount structure of the
connection plate 341 for linking between thejaws main body 301 and theceramic heaters treatment instrument 301 according to the twenty-eighth embodiment. In the present modified example, theconnection plate 341 is formed in shape covering bottom surfaces of theceramic heaters connection plate 341 is mechanically engaged with thejaws ceramic heaters - In the above first and second modified examples, as in the coagulating
treatment instrument 301 according to the twenty-eighth embodiment, there is an effect that theceramic heaters jaws - FIGS. 42A and 42B show a twenty-ninth embodiment of the present invention. In the present embodiment, a structure of the fixing portion for fixing the
ceramic heaters jaws main body 302 in the coagulatingtreatment instrument 301 according to the twenty-eighth embodiment (refer to FIGS. 39A, 39B, 40A and 40B) is modified as follows: - That is, in the present embodiment, a split shape portion342 a is provided at the
connection pin 342 of theconnection plate 341 according to the twenty-eighth embodiment. At the tip of this split shape portion 342 a, anengagement portion 342 b having large diameter is provided. When thisconnection pin 342 has inserted into thehole 343 of thejaws engagement portion 342 b at the tip of the split shape portion 342 a is engaged with a peripheral edge site of thehole 343 of thejaws ceramic heaters jaws - In the present embodiment, as in the coagulating
treatment instrument 301 according to the twenty-eighth embodiment, there is an effect that theceramic heaters jaws 306 and 30 with significantly different thermal expansion rate from ceramics. - FIG. 43 shows a thirtieth embodiment of the present invention. In the present embodiment, the
connection plate 341 for fixing theceramic heaters jaws main body 302 in the coagulatingtreatment instrument 301 according to the twenty-eighth embodiment (refer to FIGS. 39A, 39B, 40A and 40B) is formed of an elastic member such as rubber. In the present embodiment, theconnection plate 341 is bonded with theceramic heaters jaws - With the above structure, the
connection plate 341 is made of an elastic member such as rubber. In this manner, there is an effect that resilience of theresilient jaws connection plate 341, and a load acted to theceramic heaters - FIGS. 44 and 45 show a thirty-first embodiment of the present invention. FIG. 44 shows a schematic structure of the entire system of the
medical treatment embodiment 351 according to the present embodiment. A system of themedical treatment instrument 351 according to the present embodiment is provided with apower supply unit 352 and a substantial scissors-shaped, thermal coagulating/cuttingforceps 353. - An
output connector 354 and an initialresistance measurement switch 355 are provided in front of thepower supply unit 352. A thermal coagulating/cuttingforceps 353 is connected to theoutput connector 354 of thepower supply unit 352 via acable 356. - A
treatment portion 360 comprising a pair ofjaws main body 357 of the thermal coagulating/cuttingforceps 353. Further,heaters jaws heaters - A
foot switch 363 for controlling power supply of theheaters power supply unit 352. Although there is shown an example when thefoot switch 363 is connected to thepower supply unit 352, a hand switch for controlling power supply of theheaters forceps 353. - FIG. 45 is a block diagram showing an electric circuit inside the
power supply unit 352. Apower supply portion 364 for a heater power source is provided inside thepower supply unit 352. Thispower supply portion 364 is a constant voltage power source, for example. - Further, two
heaters forceps 353 are provided withoutput portions 365 a, 365 b and resistancevalue measurement portions 366 a, 366 b, respectively. An individually independent output control and resistance value measurement are possible for the twoheaters forceps 353. - The resistance
value measurement portions 366 a, 366 b and theoutput portions 365 a, 365 b are connected to acontrol portion 367, and individually suitable output correction can be performed. An operatingportion 368 is connected to thiscontrol portion 367. This operatingportion 368 is provided with the initialresistance measurement switch 355. - Now, an operation in the above structure will be described. When a system of the
medical treatment instrument 351 according to the present embodiment is used, the operation is controlled as follows: - While the
medical treatment instrument 351 according to the present embodiment is connected as shown in FIG. 44, the initialresistance measurement switch 355 is first pressed. - Then, the resistance
value measurement portions 366 a and 366 b measure the respective heater resistance values of theheaters forceps 353, and sends data to thecontrol portion 367. This values are judged as initial resistance values of theheaters - When measurement of this initial resistance values has been completed, an output of the
foot switch 363 is made possible. Even if thefoot switch 363 is pressed before measuring the initial resistance values of theheaters forceps 353, a buzzer or the like indicates a warning, and the output of thefoot switch 363 is made impossible. - When the
foot switch 363 is pressed, thecontrol portion 367 sends an output correction signal to theoutput portions 365 a and 365 b according to the respective initial resistance values of theheaters - Assuming that a power voltage is denoted by V, and a heater initial resistance value is denoted by Ri,
- (1) The voltage v is adjusted so that V2/Ri becomes a predetermined value, and a constant voltage is output by the voltage V;
- (2) A duty ratio of the voltage is denoted by D, and output is performed at the voltage duty ratio of D so that (V×D)2/Ri become a predetermined value.
- The
output portions 365 a and 365 b perform outputting using any one of the above correction methods. - With the above structure, the following effect is obtained. That is, in the present embodiment, even if heater resistance values are dispersed, heating characteristics of the
heaters - Further, FIG. 46 shows a thirty-second embodiment of the present invention. In the present embodiment, an initial
resistance measurement switch 355 is omitted from thepower supply unit 352 according to the thirty-first embodiment (refer to FIGS. 44 and 45). Further, while the thermal coagulating/cuttingforceps 353 is connected after thepower supply unit 352 has been current-carried, thecontrol portion 367 controls operation in accordance with a flowchart shown in FIG. 46. The other portions are same as those in the system of themedical treatment instrument 351 according to the thirty-first embodiment. Like elements identical to those in the system of themedical treatment instrument 351 according to the thirty-first embodiment are denoted by like reference numerals, and a description thereof will be omitted here. - Now, an operation in the above embodiment will be described. In the present embodiment, while the thermal coagulating/cutting
forceps 353 is connected after thepower supply unit 352 has been current-carried, thecontrol portion 367 controls operation in accordance with a flowchart shown in FIG. 46. First, in step S1, measurement of the resistance value is repeated in the resistancevalue measurement portions 366 a and 366 b with certain time intervals. In the next step S2, it is judged whether or not the resistance value is below 100 Ω. Here if the thermal coagulating/cuttingforceps 353 is not connected, the resistance value is an open value. When, in step S2, it is judged that the resistance value is not below 100 Ω, processing goes to the next step S3, and it is judged that it is in an output disable state. In this case, processing returns to step S1, measurement of resistance values is repeated. - Further, in step S2, when it is judged that the resistance value is below 100 Ω, processing goes to the next step S4. In step S4, a resistance value below 100 Ω is stored as an initial resistance value. Subsequently, processing goes to the next step S5 in which switching operation is performed to enter an output enable state, and processing is ended. In the present embodiment, although a resistance value threshold is 100 Ω, a value suitable to the heater used may be predetermined.
- Thereafter, as in the thirty-first embodiment, when the
foot switch 363 is pressed, an output corrected by the initial resistance value is performed. - With the above structure, an effect identical to that in the thirty-first embodiment is achieved. In the present embodiment, in particular, an initial resistance is measured automatically, and thus, there is an effect that operation of the thermal coagulating/cutting
forceps 353 is further simplified. - FIGS. 47A and 47B show a thirty-third embodiment of the present embodiment. In the present embodiment, a
temperature display portion 371 is provided in the front surface of thepower supply unit 352 according to the thirty-first embodiment (refer to FIGS. 44 and 45). Thistemperature display portion 371 is connected to thecontrol portion 367. - This
temperature display portion 371 is structured so that the temperatures of theheaters forceps 353 are displayed. The other portions are structurally identical to those in the system of themedical treatment instrument 351 according to the thirty-first embodiment. Like elements identical to those in the system of themedical treatment instrument 351 according to the thirty-first embodiment is denoted by like reference numeral, and a description thereof is omitted here. - Now an operation in the above structure will be described. In the present embodiment, as in the thirty-second embodiment (refer to FIG. 46), the
power supply unit 352 is turned on, the thermal coagulating/cuttingforceps 353 is connected, and then, an initial resistance value is measured. - Subsequently, the
control portion 367 utilizes the fact that the resistance values of theheaters control portion 367 calculates the temperatures of theheaters forceps 353 from the resistance measurement values of the resistancevalue measurement portions 366 a and 366 b. At this time, a temperature error due to dispersion in heater resistance values is corrected in view of the initial resistance value. The thus obtained heater temperatures are displayed on thetemperature display portion 371. - A temperature displayed on the
temperature display portion 371 may be any of the higher temperature, lower temperature, and average temperature of theheaters temperature display portion 371 may be employed such that both temperatures can be displayed. Further, it is obvious that an output of thepower supply unit 352 may be controlled so that the heater temperature becomes a predetermined temperature. - With the above structure, the following effect is obtained. That is, in the present embodiment, there is an effect that the temperatures of the
heaters forceps 353 can be measured without a temperature sensor. Even if there is dispersion in heater resistance values, there is an effect that temperature precision can be improved. - In the thirty-first embodiment (refer to FIGS. 44 and 45) to the thirty-third embodiment (refer to FIGS. 47A and 47B), a PTC heater (a heater formed of a positive temperature coefficient material) is used as
heaters forceps 353. - With the above structure, in the case where a constant voltage is applied to the PTC heater, when the heater temperature reaches a Curie temperature, the resistance value rapidly increases, and then, heating is restricted. As a result, the temperature is controlled close to the Curie temperature.
- With the above structure, the PTC heater is used as a heater, and thus, there is an effect that the heater curie temperature is set according to a member with lowest heat resistance temperature, thereby making it possible to easily produce a temperature limiter.
- For example, the curie temperature is set to 200° C. or less in order to protect a Teflon coating of the forceps. Thus, in the case where an attempt is made to set the upper limit of the heater temperature to about 200° C. in order to protect the Teflon coating, when the PTC heater with curie temperature of 190° C. is employed, a desired temperature limiter can be structured without requiring a special circuit or control to be provided at the
power supply unit 352 side. - In addition, the curie temperature is set to about 150° C. in order to prevent overheat of the patient's body tissue. In this manner, a temperature limiter can be provided without any special structure. Thus, the PTC heater is used as
heaters forceps 353, thereby making it possible to easily provide a temperature limiter in all of the thirty-first to thirty-third embodiments. - FIGS. 48A to48D show a thirty-fourth embodiment of the present invention. FIG. 48A shows a schematic structure of the coagulating
treatment instrument 401 according to the present embodiment. Themain body 402 of the coagulatingtreatment instrument 401 according to the present embodiment is provided with two scissorconstituent members constituent members fulcrum pin 405 for rotatably linking these scissorconstituent members constituent members - A
treatment portion 408 comprising a pair ofjaws main body 402. Further, the substantially elliptical finger insert rings 409 and 410 are formed at the proximal ends of the scissorconstituent members frontal operating portion 411 for operating a pair ofjaws - In addition, a
curve portion 412 gently curved in the substantial arc shape is formed at thetreatment portion 408 of the treatment instrumentmain body 402 as shown in FIG. 48B. Further, at thejaws main body 402, as shown in FIG. 48A, the coagulatingtreatment unit 413 for coagulating the patient's body tissue is provided on the contact surface side with the patient's body tissue. - This coagulating
treatment unit 413 is provided with aheater 414 fixed to each of thejaws cover 415 for covering the outer surface of thisheater 414, as shown in FIG. 48C. Theheater 414 to be used includes a ceramic heater, a PTC heater (a heater formed of positive temperature coefficient material), and a semiconductor heater. - The
cover 415 is made of a metal such as stainless or copper, is formed in the substantially same shape as theheater 414, and is thinly formed so as to improve thermal conductivity. Further, a tissue adhesion preventingtreatment portion 416 for preventing adhesion of the patient's body tissue is provided at the outer full surface of thiscover 415 as shown in FIG. 48D. Examples of this tissue adhesion preventingtreatment portion 416 include a Teflon coating available from Dupon and a ceramic coating (plasma flame spraying) or the like. - A plurality of inwardly projected
protrusion portions 417 are pressed to be provided on the inner surface of thecover 415. In theheater 414,recess portions 418 to be detachably engaged with theprotrusion portions 417 are projected respectively at the corresponding position of eachprotrusion portion 417. When thecover 415 is mounted on theheater 414, thiscover 415 is designed to be removably mounted on the heater due to the elastic deformation of thecover 415 itself. At this time, eachrecess portion 417 of thecover 415 is detachably engaged with eachrecess portion 418 of theheater 414. - The
recess portion 418 may be provided at thejaws cover 415 for covering theheater 414 to each of thesejaws irregularity 419 or the like for preventing slip-off of the patient's body tissue is provided at the lower surface of thecover 415 so as to prevent the slip-off of the patient's body tissue by theirregularity 419 of thecover 415 when the patient's body tissue is grasped between thejaws cover 415 on the outer surface side of thejaws - As shown in FIG. 48A,
insulation lead wires constituent members insulation lead wire 420 on onescissor constituent member 403 side is connected to theheater 414 of the coagulatingtreatment unit 413 on thejaw 406 side. At the tip, aninsulation lead wire 421 on the other scissorconstituent member 404 side is connected to theheater 414 of the coagulatingtreatment unit 413 on thejaw 407 side. - One
cable connection portion 422 is protruded at the peripheral surface of thefinger insert ring 409 on the scissorconstituent member 403 side. Similarly, onecable connection portion 423 is protruded at the peripheral surface of thefinger insert ring 410 on the scissorconstituent member 404 side. At a proximal end, theinsulation lead wire 420 is connected to thecable connection portion 422 on the scissorconstituent member 403 side. Theinsulation lead wire 421 is connected to thecable connection portion 423 on the scissorconstituent member 404 side. Further, to one ends of thesecable connection portions connector cables heater 414 of each of thejaws - Now, an operation of the coagulating
treatment instrument 401 with the above structure according to the present invention will be described here. When the coagulatingtreatment instrument 401 according to the present embodiment is used, thecover 415 is set to be mounted on theheater 414 in advance. In this state, a site targeted for treatment such as blood vessel (not shown) is inserted into the patient's body tissue, while thetreatment portion 408 at the tip of the coagulatingtreatment instrument 401 is closed. Then, a site targeted for treatment such as blood vessel is released from the other patient's body tissue and is exposed by opening a pair ofjaws - Subsequently, the released blood vessel or the like is grasped between the
jaws treatment instrument 401 while it is compressed with a proper pressure. At this time, the patient's body tissue of the site targeted for blood vessel grasped between thejaws irregularity 419 on the lower surface of thecover 415, and the slip-off of the patient's body tissue is prevented. - In this state, when power is output from a power supply unit (not shown), the power is supplied to the
heater 414 of each of thejaws jaws - In the case where the tissue adhesion preventing
treatment portion 416 of thecover 415 is degraded by use of the coagulatingtreatment instrument 401, thecover 415 is removed from theheater 414. In this state, anew cover 415 is mounted on theheater 414. - With the above structure, the following effect is obtained. That is, in the case where the tissue adhesion preventing
treatment portion 416 of thecover 415 is degraded by use of the coagulatingtreatment instrument 401, thecover 415 can be simply replaced with another one. Thus, the tissue adhesion preventingtreatment portion 416 around theheater 414 can be always maintained in a proper state. Therefore, an effect of preventing the adhesion of the tissue around theheater 414 can be maintained over a long period, and there is an effect that maintenance cost due to the degradation of the patient's body tissue adhesion preventingtreatment portion 416 can be reduced, making it advantageous in cost efficiency. - FIGS. 49A and 49B show a thirty-fifth embodiment of the present invention. In the present embodiment, a structure of the coagulating
treatment unit 413 of thejaws treatment instrument 401 according to the thirty fourth embodiment (refer to FIGS. 48A to 48D) is modified as follows: - That is, in the present embodiment, a bar-shaped
heater 431 is protruded at the tip of each of thejaws main body 402; acover 433 comprising aheater insert hole 431 for inserting thisheater 431 is provided; and theheater 431 is inserted into theheater insert hole 432 of thiscover 431, whereby the entire outer surface of theheater 431 is covered with thecover 433. Thecover 433 is formed in a curved shape as in thejaws treatment portion 416 similar to that in the thirty-fourth embodiment is provided on the peripheral surface of thiscover 433. - Further, a
positioning protrusion portion 434 is protruded at the tip surface of thejaws recess portion 435 to be detachably engaged with thepositioning protrusion portion 434 is provided at the front side end of thecover 433. When thecover 433 is mounted on theheater 431, therecess portion 435 of thecover 433 is detachably engaged with thepositioning protrusion portion 434 of theheater 431 so that thecover 433 is prevented from rotating with respect to the axial direction of theheater 431. - A plurality of
plate spring members 436 to be brought into pressure-contact with theheater 431 are provided inside theheater insert hole 432 of thecover 433. When theheater 431 is inserted into theheater insert hole 432 of thecover 433, theseplate spring members 436 are brought into pressure-contact with theheater 431 so as to ensure thermal conductivity of theheater 431. - In the present embodiment, the bar-shaped
heater 431 protruded at the tip side of each of thejaws cover 433, and thus an effect of preventing adhesion due to the tissue adhesion preventingtreatment portion 416 of thecover 433 can be improved more significantly. - FIG. 50A shows a thirty-sixth embodiment of the present invention. In the present embodiment, a structure of the coagulating
treatment unit 413 of each of thejaws treatment instrument 401 according to the thirty-fourth embodiment (refer to FIGS. 48A to 48D) is modified as follows: - That is, in the present embodiment, a
cover member 441 for covering theheater 414 fixed to each of thejaws cover member 441 according to the present embodiment is formed by an elastic tube. A tissue adhesion preventingtreatment portion 416 similar to that in the thirty-fourth embodiment is provided at the outer full surface of thiscover member 441. - An example of the
cover member 441 formed by such elastic tube includes a Teflon tube. In addition, thecover member 441 is formed by a Teflon tube with heat shrink properties, and mounting on each of thejaws heater 414. In that case, when thecover member 441 is replaced with another one, the tube of thecover member 441 is cut to be removed from each of thejaws - In the present embodiment, as in the thirty-fourth embodiment, an effect of preventing adhesion of the patient's body tissue can be maintained over a long period of time, and the maintenance cost due to the degradation of the patient's body tissue adhesion preventing
treatment portion 416 is reduced, making it advantageous in cost efficiency. - In addition, FIG. 50B shows a modified example of the
cover member 441 of the coagulatingtreatment instrument 401 according to a thirty-sixth embodiment (refer to FIG. 50A). In this modified example, a thin film sheet (made of Teflon or the like) on which the adhesion preventingtreatment portion 416 is formed by applying tissue adhesion preventing treatment is used, thereby to form acover 442 as shown in FIG. 50B. Thiscover 442 is provided with a band-shapedfixing portion 443 to be fixed to each of thejaws cover 442 is reduced. - FIGS. 51A to51C and 52A show a thirty-seventh embodiment of the present invention. In the present embodiment, there is provided a thermal
coagulating treatment instrument 454 comprising ascissor forceps 451 shown in FIG. 51A and aheater unit 453 detachable to amain body 452 of thisscissor forceps 451. The forcepsmain body 452 is provided with two scissorconstituent members constituent members fulcrum pin 457 for rotatably linking these scissorconstituent members constituent members - In addition, a
treatment portion 460 comprising a pair ofjaws main body 452. Further, substantially elliptical finger insert rings 461 and 462 are formed at the proximal ends of the scissorconstituent members frontal operating portion 463 for operating a pair of thejaws - A substantially U-shaped unit
main body 464 is provided at theheater unit 453 as shown in FIG. 51C. This unitmain body 464 is designed to be detachably mounted on onescissor constituent member 456 side. Further, twoheaters main body 464 viaelastic members heaters elastic members - As shown in FIG. 51C,
insulation lead wires main body 464. At one end, theinsulation lead wire 469 is routed into theelastic member 467, and is connected to theheater 465. Further, at one end, the otherinsulation lead wire 470 is routed into theelastic member 468, and is connected to theheater 466. - In addition, a
connector cable 471 for supplying power to theheaters main body 464. Thisconnector cable 471 and theheaters insulation lead wires - Further, a plurality of tip-split connector pins472 are provided at each of the
heaters engagement holes 473 are provided at thejaws main body 452. Each of theheaters jaws main body 452. - Still further, the
cover 415 andcover member 441 shown in the thirty-fourth embodiment (refer to FIGS. 48A to 48D) and the thirty-sixth embodiment (refer to FIG. 50A) are detachably provided at theheaters - Now, an operation in the above embodiment will be described here. When the thermal
coagulating treatment instrument 454 according to the present embodiment is used, onescissor constituent member 456 of the forcepsmain body 452 is inserted into a U-shaped opening of the unitmain body 464 of theheater unit 453. In this manner, the unitmain body 464 of theheater unit 453 is detachably mounted at onescissor constituent member 456 side of the forcepsmain body 452. - Subsequently, the
connector pin 472 of each of theheaters engagement hole 473 of each of thejaws main body 452, and theheaters jaws heaters jaws main body 452. - In the case where tissue adhesion preventing treatment of the
heaters coagulating treatment instrument 454 according to the present embodiment, theheater unit 453 is removed from the forcepsmain body 452. Instead, anew heater unit 453 is designed to be mounted on the forcepsmain body 452. - With the above structure, in the case where tissue adhesion preventing treatment of the
heaters coagulating treatment instrument 454 according to the present embodiment, only theheater unit 453 is replaced with another one without replacing the entire forcepsmain unit 452. Thus, there is an effect that tissue adhesion preventing treatment can always be maintained in a proper state, and the maintenance cost can be reduced. - FIG. 52B shows a modified example of a thirty-seventh embodiment (refer to FIGS. 51A to51C and 52A). In the present embodiment,
lead electrodes 474 are provided at theheaters main body 452 of the scissor forcepsmain body 451 so that thelead electrodes 474 of theheaters main body 452. In the present embodiment, an effect similar to that in the thirty seventh embodiment will be obtained. - FIGS. 53A, 53B,54A and 54B show a thirty-eighth embodiment of the present invention. FIG. 53A shows a schematic structure of a coagulating
treatment instrument 481. Themain body 482 of the coagulatingtreatment instrument 481 according to the present embodiment is provided with two scissorconstituent members constituent members fulcrum pin 485 for rotatably linking the scissorconstituent members constituent members - A
treatment portion 488 comprising a pair ofjaws main body 482. Further, substantially elliptical finger insert rings 489 and 490 are formed at the proximal ends of the scissorconstituent members frontal operating portion 491 for operating a pair ofjaws - At the
jaws main body 482, as shown in FIG. 48A,heaters heaters - As shown in FIG. 53A,
insulation lead wires constituent members insulation lead wire 494 on onescissor constituent member 483 side is connected to theheater 492 on thejaw 486 side. At the tip, theinsulation lead wire 495 on the other scissorconstituent member 484 side is connected to theheater 493 of thejaw 487 side. - In addition, one
cable connection portion 496 is protruded at the peripheral surface of thefinger insert ring 489 on the scissorconstituent member 483 side. Similarly, onecable connection portion 497 is protruded at the peripheral surface of thefinger insert ring 490 on the scissorconstituent member 484 side. At a proximal end, theinsulation lead wire 494 is connected to thecable connection portion 496 on the scissorconstituent member 483 side, and theinsulation lead wire 495 is connected to thecable connection portion 497 on the scissorconstituent member 484 side. Further, to thesecable connection portions connector cables heaters jaws - In addition, the upper and
lower heaters constituent members stoppers portion 491 are protruded, respectively, at a position close to the finger insert rings 489 and 490 inwardly of the operatingportion 491. - In the present embodiment, when the
jaws main body 482 is operated to be closed by the operatingportion 491 of each of the scissorconstituent members gap 502 is formed between the rear ends of the contact surfaces 492 a and 493 a of theheaters heaters jaws stoppers constituent members jaws - Further, a closing force is strongly applied to the operating
portion 491 from the first closing operation position when thejaws stoppers constituent member heaters - Now, an operation in the above structure will be described here. In the present embodiment, when each of the
jaws portion 491 of each of the scissorconstituent members heaters jaws gap 502 is formed between the rear ends of the contact surfaces 492 a and 493 a of theheaters stoppers constituent members - Further, a closing force is strongly applied to the operating
portion 491 from the first closing operation position when each of thejaws stoppers constituent members root side portion 503 of each of thejaws heaters heaters - When the contact surfaces492 a and 493 a of the
heaters jaws - In addition, the upper and
lower stoppers heater lower stoppers - If the
stoppers root side portion 503 of each of thejaws heaters jaws jaws heaters jaws - With the above structure, the following effect will be obtained. That is, in the present embodiment,
stoppers portion 491 inwardly of the operatingportion 491 is protruded at a position close to the finger insert rings 489 and 490 on the proximal end sides of the scissorconstituent members portion 491, thestoppers heaters jaws - Further, while the
stoppers heaters jaws jaws - The user may only grip the operating
portion 491 until thestoppers treatment instrument 481 becomes simpler. - FIG. 54C shows a modified example of the coagulating
treatment instrument 481 of the thirty-eighth embodiment (refer to FIGS. 53A, 53B, 54A and 54B). In this modified example, theheaters jaws jaws - FIGS. 55A to55F show a thirty-ninth embodiment of the present invention. FIG. 55A shows a schematic structure of a coagulating
treatment instrument 511 according to the present embodiment. Amain body 512 of the coagulatingtreatment instrument 511 according to the present embodiment is provided with two scissorconstituent members constituent members fulcrum pin 515 for rotatably linking these scissorconstituent members constituent members - A
treatment portion 518 comprising a pair ofjaws main body 512. Further, substantially elliptical finger insert rings 519 and 520 are formed at the proximal ends of the scissorconstituent members frontal operating portion 521 for operating a pair ofjaws - In addition, as shown in FIGS. 55C and 55D, a
curve portion 522 gently curved in a substantial arc shape is formed at thetreatment portion 518 of the treatment instrumentmain body 512. Further, at thejaws main body 512, as shown in FIG. 55A,heaters heaters - As shown in FIG. 55A,
insulation lead wires constituent members insulation lea wire 525 on onescissor constituent member 513 side is connected to theheater 523 on thejaw 516 side. At the tip, theinsulation lead wire 526 on the other scissorconstituent member 514 side is connected to theheater 524 on thejaw 517 side. - When power is supplied to each of the
heaters insulation lead wires lead wires 526 a and 526 b to be connected to theupper heater 524 as shown in FIG. 55D and twolead wires 525 a and 525 b to be connected to thelower heater 523. Theselead wires - One
cable connection portion 527 is protruded at the peripheral surface of thefinger insert ring 519 on the scissorconstituent member 513 side. Similarly, onecable connection portion 528 is protruded at the peripheral surface of thefinger insert ring 520 on the scissorconstituent member 514 side. At a proximal end, theinsulation lead wire 525 is connected to thecable connection portion 527 on the scissorconstituent member 513 side, and theinsulation lead wire 526 is connected to thecable connection portion 528 on the scissorconstituent member 514 side. Further, to thesecable connection portions connector cables heaters jaws - As shown in FIG. 55E, a lead wire
storage groove portion 531 is formed at onescissor constituent member 513. Twolead wires 525 a and 525 b of theinsulation lead wire 525 are stored in this lead wirestorage groove portion 531. Similarly, as shown in FIG. 55F, a lead wirestorage groove portion 532 is formed at the other scissorconstituent member 514. Twolead wires 526 a and 526 b of theinsulation lead wire 526 are stored in this leadwire storage portion 532. - A combination of these two lead wires to be stored in the lead wire
storage groove portions - In addition, in order to ensure electrical insulation of each
connection portion 533 between theheaters insulation lead wires connection portion 533 may be covered with a rubber seal material or the like. Further, arubber seal material 534 for fixing theinsulation lead wires storage groove portions constituent members insulation lead wires - With the above structure, the following effect will be obtained. That is, in the present embodiment, the lead wire
storage groove portion 531 is formed at onescissor constituent member 513, and twolead wires 525 a and 525 b of theinsulation lead wire 525 are stored at this lead wirestorage groove portion 531. Further, a lead wirestorage groove portion 532 is formed at the other scissorconstituent member 532, And twolead wires 526 a and 526 b of theinsulation lead wire 526 are stored in this lead wirestorage groove portion 532. Thus, there is no possibility that theinsulation lead wires constituent members main body 512. Therefore, theinsulation lead wires treatment instrument 511 can be improved. - FIG. 55G shows a modified example of the coagulating
treatment instrument 511 according to the thirty-ninth embodiment (refer to FIGS. 55A to 55F). In the modified example, acover 541 made of an insulation material is provided outside the scissorconstituent members main body 512. In thiscover 541,insulation lead wires insulation lead wires - FIGS. 56A to56F show a fortieth embodiment of the present invention. In the present embodiment, a structure of the coagulating
treatment instrument 511 according to the thirty ninth embodiment (refer to FIGS. 55A to 55F) is modified as follows: - That is, in the present embodiment, as shown in FIGS. 56C and 56D, there is provided a
connection portion 551, wherein the same electrodes of theinsulation lead wires heaters jaws wires jaws connection portion 551 is electrically insulated from the outside with a rubber seal material. In the meantime, thejaws constituent members main body 512 and thejaws - A
cable connection portion 552 electrically connected to this scissorconstituent member 513 is added to the peripheral surface of thefinger insert ring 519 of oneconstituent element 513. Anexternal connector cable 553 is detachably connected to thiscable connection portion 552. In the meantime, the scissorconstituent members main body 512 and at least a part of the peripheral surface of the operatingportion 521 are covered with an insulation cover. - As shown in FIG. 56E, one
insulation lead wire 525 b that is an anode is stored in the lead wirestorage groove portion 531 of the scissorconstituent member 513. Similarly, as shown in FIG. 56F, oneinsulation lead wire 526 b that is an anode is stored in the lead wirestorage groove portion 532 of the scissorconstituent member 514. - In the meantime, there may be provided a
connection portion 551, wherein thelead wire 525 b that is an anode and thelead wire 526 b are connected to thejaws storage groove portion 531 of the scissorconstituent member 513, and one insulation lead wire 526 a that is an anode may be stored in the lead wirestorage groove portion 532 of the scissorconstituent member 514. - With the above structure, the following effect will be obtained. That is, one
scissor constituent member 513 and thejaw 516 are utilized as a electrically conducting member of an anode or a cathode for supplying power to each of theheaters storage groove portions constituent members main body 512 can be reduced. Therefore, there is an affect that the scissorconstituent members main body 512 can be thinned. In addition, the insulation lead wires themselves can be thickened, and a loss due to an electric resistance can be decreased. - FIGS. 57A to57F show a forty-first embodiment of the present invention. In the present embodiment, a structure of the coagulating
treatment instrument 511 according to the fortieth embodiment (refer to FIGS. 56A to 56F) is modified as follows: - That is, in the present embodiment, there is provided one
insulation lead wire 561, whereininsulation lead wires constituent members main body 512 according to the present embodiment are provided in common. Thisinsulation lead wire 561 is diverged into two ways near thejaws lower heaters - Further, in the present embodiment, a lead wire
storage groove portion 562 is provided at only onescissor constituent member 514 of the two scissorconstituent members main body 512. Oneinsulation lead wire 561 is stored in this lead wirestorage groove portion 562. - With the above structure, the following effect will be obtained. That is, in the present embodiment, there is provided one
insulation lead wire 561, whereininsulation lead wires constituent members main body 512 according to the fortieth embodiment are provided in common. Thisinsulation lead wire 561 is connected to the same electrodes of the upper andlower heaters storage groove portion 562 is provided only at onescissor constituent member 514, and oneinsulation lead wire 561 is stored in this lead wirestorage groove portion 562. Thus, power is supplied from a power source to theheaters insulation lead wire 561 and the treatment instrumentmain body 512. Therefore, there is an effect that the number of insulation lead wires to be arranged at the treatment instrumentmain body 512 can further be reduced, and a structure can be simplified more significantly. - Further, of course, the present invention is not limited to the above mentioned embodiment, and can be deformed and implemented without departing from the gist of the present invention.
- FIGS.58 to 62 show a forty-second embodiment of the present invention. FIG. 58 is a general view of a coagulating/cutting system according to the present embodiment, FIG. 59 is a perspective view of holding portions of a thermocoagulation cutting forceps, FIG. 60 is a sectional view taken along line 60-60 of FIG. 59, FIGS. 61A and 61B are views for illustrating processes of operation for coagulating and incising a tissue, and FIG. 62 is an electric circuit diagram of a power source unit.
- As shown in FIG. 58, a
thermocoagulation cutting forceps 601 for uses as a surgical instrument is connected to apower source unit 603 as power supply means by means of acable 602, and afootswitch 604 for output control is also connected to theunit 603. Theforceps 601 is composed of ahand operating portion 605 for use as holding portion drive means, insertportion 606, and a pair of holdingportions insert portion 606. - The
hand operating portion 605 is formed of an operatingportion body 612, fixedhandle 609 integral with thebody 612, and amovable handle 611 rockable around apivot 610. Theinsert portion 606 is mounted on the operatingportion body 612 for rotation around it axis by means of arotation control portion 613. - The
insert portion 606 is formed of a slender pipe, in which adrive shaft 614 is inserted for axial movement. The proximal end portion of theshaft 614 is coupled to themovable handle 611. The first and second holdingportions shaft 614. The holdingportions pivot pin 615. If themovable handle 611 is rocked in the direction of arrow a, thedrive shaft 614 retreats to close the holdingportions handle 611 is rocked in the direction of arrow b, theshaft 614 advances to open the holdingportions - The operating
portion body 612 is provided with a connector junction 616 a, which is removably connected with aconnector 616 of thecable 602. The junction 616 a is connected electrically to a heating unit 618 (mentioned later), which is provided on thefirst holding portion 607 so as to extend along thedrive shaft 614. - As shown in FIGS. 59 and 60, the
first holding portion 607 is provided with agroove 617 that opens toward thesecond holding portion 608. Thegroove 617 extends in the longitudinal direction of thefirst holding portion 607. Aheating unit 618 is stored in thegroove 617. Aheating plate 619 is bonded to theheating unit 618. - The
heating unit 618 is formed of, for example, a molybdenum-film resistance-heating element that is small-sized and enjoys high heating efficiency. As shown in FIG. 60, theheating plate 619 is profiled having a substantially chevron-shapedprojection 619 a. Aflat portion 619 b with a width d is formed on the distal end of theprojection 619 a, and twoflat surfaces flat portion 619 b in a manner such that an angle α is formed between them. - In order to prevent an organism tissue from sticking to the outer surface of the
heating plate 619 and the respective outer surfaces of the first and second holdingportions - The width d is a dimension that covers a Teflon coating on the surface of the heating plate619 (the Teflon coating is not shown). Preferably, the
heating plate 619 should be formed of a material with high thermal conductivity, such as copper, silver, tungsten, etc., and theheating unit 618 may alternatively be a ceramic heater, cartridge heater, PTC heater, etc. - The
second holding portion 608 has awide recess 620 that opens toward thefirst holding portion 607, and its cross section is U-shaped. A receivingmember 621 of a soft material is provided in therecess 620. Available materials for the receivingmember 621 include, for example, rubber (silicone rubber, fluororubber, ethylene-propylene rubber, butyl rubber, etc.), gel (silicone-based a gel or the like), and fluoroplastics (e.g., Teflon). Serratedantiskid portions 622 are provided individually on the opposite side edges of therecess 620. - As shown in FIG. 58, moreover, the
power source unit 603 is provided with a settingportion 623 capable of setting the heating temperature of theheating unit 618 and adisplay portion 624. The settingportion 623 is provided with anupper button 623 a for raising the set temperature and alower button 623 b for lowering the set temperature. Further, thedisplay portion 624 displays the set heating temperature (e.g., 150° C.) of theheating unit 618. The heating temperature can be set by means of the settingportion 623. The set temperature can be raised and lowered by depressing the upper andlower buttons - The
footswitch 604 is provided with first andsecond pedals first pedal 625 is an incision pedal for an output set at a possible incision temperature, for example. Thesecond pedal 626 is a coagulation pedal for an output set at a possible coagulation temperature, for example. - FIG. 62 shows an electric circuit of the
power source unit 603. Apower source element 627 that is connected to the commercial power supply is connected to thecable 602 through anoutput element 628. Theoutput element 628 is connected to acontrol element 629. Thecontrol element 629 is connected with setting means 630 for setting the heating temperature and thefootswitch 604. - The following is a description of the operation of the forty-second embodiment. In operating the
thermocoagulation cutting forceps 601 of the present embodiment, an operator holds thehand operating portion 605 and rocks themovable handle 611 in the direction of arrow b of FIG. 58 with respect to the fixedhandle 609. Thereupon, thedrive shaft 614 advances to open the first and second holdingportions forceps 601 is advanced, and themovable handle 611 is rocked in the direction of arrow a of FIG. 58 in a manner such that a region X of the organism tissue to be coagulated and incised is interposed between the first and second holdingportions drive shaft 614 retreats to close the holdingportions - Then, the region X of the organism tissue to be coagulated and incised is held stressed under a force of pressure that suits a coagulative treatment, as shown in FIG. 61A. Thus, the organism tissue is compressed between the
flat portions heating plate 619 and the receivingmember 621. Owing to the presence of theflat portion 619 b, in this state, the distal end of the 619 is not sharp enough to be able to cut the organism tissue. Thus, the organism tissue cannot be incised. - If the
heating unit 618 is then supplied with current from thepower source unit 603 and heated, theheating plate 619 is heated by transferred heat. Thereupon, a region of the organism tissue in contact with the thinflat portion 619 b is coagulated at high pressure, so that evaporation of water from the organism tissue advances. Then, the weakened organism tissue is cut and incised. As this is done, those portions of the receivingmember 621 which engage theflat portions - The organism tissue incised by this deformation is compressed throughout the length between the
flat portion 619 b and the receivingmember 621, so that theheating plate 619 can securely coagulate and incise the tissue throughout its length. - The following is a description of the heating temperature of the
heating unit 618. It is known that if the heating temperature is set at 200° C., water evaporates from the organism tissue relatively drastically, so that incision can be carried out rapidly. Since the heating time need not be long, the organism tissue cannot be coagulated much and looks as if it were cut by means of a sharp edge tool. Thus, the arrangement of the present embodiment is suited for the incision of tissues that include very fine blood vessels or rarely include ones. - If the heating temperature is then adjusted to 180° C., water evaporates more slowly than in the case where the heating temperature is set at 200° C. Since the heating time is a little longer in this case, the organism tissue is fully coagulated, the coagulative force can be enhanced, and incision can be carried out. Thus, tissues including blood vessels can be incised without bleeding.
- If the heating time is set at 160° C., moreover, evaporation of water from the organism tissue is insufficient for incision. In this state, therefore, the organism tissue can be only coagulated without being incised.
- Since the thin heating plate compresses the organism tissue according to the forty-second embodiment, it produces a great coagulative force. The organism tissue can be incised the moment it is coagulated. Further, the organism tissue is never cut in an unheated state. When the holding portions are closed, moreover, the receiving member is deformed to compress the tissue uniformly throughout the length, so that the tissue can be coagulated and incised securely. The coagulative force increases as the receiving member is delicately deformed. Furthermore, thin-film resistance-heating elements or other heating units that are susceptible to external environment enjoy higher durability, since they are embedded in holding portions.
- The following is a description of another example of the coagulating/cutting operation. The operator steps on the first or
second pedal first pedal 625 is worked will be described first. Thethermocoagulation cutting forceps 601 is supplied with current from thepower source unit 603 through thecable 602. If thefirst pedal 625 is worked without regard to the setup of the setting means 630, thecontrol element 629 controls theheating unit 618 of thefirst holding portion 607 so that it is heated at its maximum temperature, whereupon current is supplied. - Since the
heating unit 618 is heated at the maximum temperature, water quickly evaporates from the organism tissue, so that incision can be carried out rapidly. In consequence, the incisive force becomes greater. Since the heating time is short, however, the organism tissue cannot be coagulated much and looks as if it were cut by means of a sharp edge tool. Thus, the arrangement of the present embodiment is suited for the incision of tissues that include very fine blood vessels or rarely include ones. - The following is a description of the case where the
second pedal 626 is worked. If thesecond pedal 626 is worked, thecontrol element 629 controls theheating unit 618 so that it is heated at a temperature set by means of the setting means 630, whereupon current is supplied. Let it be supposed that the operator sets a temperature a little lower than the maximum temperature of theheating unit 618 as a set temperature. Since theheating unit 618 is heated at a temperature a little lower than the maximum temperature, incision is slower than in the case where thefirst pedal 625 is worked. Thus, the heating time lengthens, so that the coagulative force can be enhanced. In this case also, the organism tissue can be incised the moment it is coagulated, so that tissues including blood vessels can be incised without bleeding. - If the set temperature is then further lowered, evaporation of water from the organism tissue is insufficient for incision. In this state, therefore, the organism tissue can be only coagulated without being incised.
- In this manner, the one
thermocoagulation cutting forceps 601 can be freely alternatively used for any of three operation modes, including incision-only, continuous coagulation/incision, and coagulation-only. Thus, it can provide expediency of a level that can be attained with use of a plurality of medical instruments. This arrangement can produce a great effect in an endoscopic surgical operation that requires troublesome intra-operative replacement of forceps, in particular. - In the operation of the
footswitch 604 according to the embodiment described above, the operator can previously omit the setup of the set temperature for an incisive treatment that is frequently used in surgical operations for digestive organs or the like. - The operation of the
footswitch 604 is not limited to the embodiment described above, and may be carried out in the following manner. - The
first pedal 625 is heated at a set temperature. - The
second pedal 626 is always heated at its minimum temperature (lower limit of the set temperature). - Thus, if the
second pedal 626 is worked, only coagulation can be carried out without incision, so that the setup can be omitted for surgical operations that involve much bleeding or the like. It is to be understood that the operator may be enabled to select one of the above-described operation patterns. - According to the forty-second embodiment, moreover, the first or second pedal is used for the output at the set temperature set by means of the setting means630. Alternatively, however, the setting means 630 may be given an additional function to set the maximum or minimum temperature or provided with two setting means for setting the set temperature and setting the maximum or minimum temperature.
- Further, the setting means630 may be formed of various means including input means, such as various switches, keyboard, mouse, etc., memories stored with set values, and circuits with the set values.
- FIG. 63 shows a forty-third embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS.58 to 62), and a description of those components is omitted. In the present embodiment, a
flat portion 619 b with a width dl is formed on the distal end portion of aheating plate 619. Each corner portion of theflat portion 619 b is cut into a smooth arcuate shape, thus forming achamfer portion 619b 1. Recommended values for the width dl range from about 0.1 to 0.15 mm (dimensions covering a resin coating of fluoroplastics, such as Teflon). - In the
heating plate 619 of the present embodiment, compared with that of the forty-second embodiment, the presence of thechamfer portion 619 b 1 results in an increased area of contact with the organism tissue and enhanced coagulative force (and correspondingly reduced incisive force). - FIG. 64 shows a forty-fourth embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS.58 to 62), and a description of those components is omitted. In the present embodiment, a
distal end portion 619 e of aheating plate 619 is in the form of a circular arc with a radius R, andflat portions 619 f and 619 g are formed individually on the opposite sides of theheating plate 619. Recommended values for the radius R range from about 0.05 to 0.15 mm (dimensions covering a Teflon coating). - According to the present embodiment, compared with the forty-second embodiment, the
distal end portion 619 e of theheating plate 619 is smoother as a whole and has no shape angle portions, so that it can be reliably coated with Teflon. - FIG. 65 shows a forty-fifth embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS.58 to 62), and a description of those components is omitted. In the present embodiment, an
arcuate protrusion 619 h is formed on the distal end portion of aheating plate 619. Theprotrusion 619 h is not limited to the arcuate shape, and may alternatively be rectangular or triangular. - According to the present embodiment, the
protrusion 619 h on the distal end portion of theheating plate 619 is used for incision, so that the incisive force is greater than in the case of the forty-fourth embodiment. - FIG. 66 shows a forty-sixth embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS.58 to 62), and a description of those components is omitted. In the present embodiment, a
ceramic heater 631 is provided directly in place theheating plate 619. - More specifically, the
ceramic heater 631 is fixed directly to the lower part of afirst holding portion 607. Although theheater 631 has the same cross profile as that of theheating plate 619 of the forty-second embodiment, it may have the same cross profile as those of theheating plates 619 of the forty-third to forty-fifth embodiments. ATeflon coating 632 covers the respective outer surfaces of theceramic heater 631 and thefirst holding portion 607. Since theheater 631 is a relatively strong simple, it can be used in this manner and its construction can be simplified. - FIG. 67 shows a forty-seventh embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS.58 to 62), and a description of those components is omitted. In the present embodiment, a
Teflon coating 633 covers the outer surface of aheating plate 619 that has asharp projection 619 a. - Although the
projection 619 a on the distal end of theheating plate 619 according to the present embodiment is very sharp, the Teflon coating 633 can form a thin straight portion and a smootharcuate portion 634 at the distal end of theplate 619, thus producing the same effect of the forty-second embodiment. - The shape of the heating plate619 (including the ceramic heater 631) is not limited to the embodiments described above, and may be changed as required. The respective cross profiles of the heating plate and the ceramic heater need not be uniform throughout the length, and may be varied partially. For example, the remote-side portion of the
heating plate 619 may be sharpened so that it can serve as a portion for incision only. In this case, the hand-side portion of theplate 619 is given the shape according to the foregoing embodiment so that it can serve for coagulation and incision. - FIG. 68A shows a forty-eighth embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS.58 to 62), and a description of those components is omitted. The present embodiment is based on a modification of the
second holding portion 608. Agroove portion 621 a having an arcuate cross section is formed on the upper surface of a receivingmember 621, substantially covering the overall length of themember 621. The receivingmember 621 is formed of the material described in connection with the forty-second embodiment. - The
groove portion 621 a may be replaced with arectangular groove portion 621 b according to a modification shown in FIG. 68B or atriangular groove portion 621 c according to a modification shown in FIG. 68C. - The coagulative and incisive forces can be improved as the organism tissue is caught between the heating portion (heating plate, ceramic heater, etc.) of the
first holding portion 607 and thegroove portion 621 a. - FIG. 69 shows a forty-ninth embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS.58 to 62), and a description of those components is omitted. In the present embodiment, a
Teflon coating 633 covers arecess 620 of asecond holding portion 608. According to the present embodiment, the system can be easily manufactured at low cost. - FIGS. 70A and 70B show a fiftieth embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS.58 to 62), and a description of those components is omitted. In the present embodiment, a receiving
member 635 of a synthetic resin is pivotally supported in arecess 620 of asecond holding portion 608 by means of apivot pin 636 so that it can slightly rock around thepin 636. Available synthetic resin materials for the receivingmember 635 include, for example, fluoroplastics (e.g., Teflon), PEEK, polyimide, PPS, etc. - According to the present embodiment, the receiving
member 635 rocks around thepivot pin 636 following the action of thesecond holding portion 608 as afirst holding portion 607 and thesecond holding portion 608 are closed. Accordingly, aheating plate 619 and the receivingmember 635 come intimately into contact with each other without a gap, so that the organism tissue can be uniformly compressed and securely coagulated and incised. - FIGS. 71A, 71B and72 show a fifty-first embodiment, which is based on modifications of the
display portion 624 of thepower source unit 603 according to the forty-second embodiment (see FIGS. 58 to 62). In the present embodiment, adisplay portion 641 for displaying the temperature level is provided in place of thedisplay portion 624 of the forty-second embodiment that displays the heating temperature. FIG. 71A shows a plurality ofbars 641 a of different heights that indicate the temperature level (level 3 is illustrated as an example). - FIG. 71B shows a
display portion 642 that indicates the temperature level by a figure (forlevel 3 as an example). FIG. 72 shows the relation between the set level and the heating temperature. In this case,levels - As shown in FIG. 72, the relation between the set level and the heating temperature T is nonlinear. In the range near the maximum temperature T5, in particular, the change of the temperature T relative to the change of the set level is slower. This is based on the fact that even a small temperature difference near the maximum temperature T5 causes a difference in the way the region of the organism tissue to be coagulated and incised is cut, and that the region of the tissue to be coagulated and incised can be cut without any substantial difference at somewhat lower temperatures.
- Thus, the nonlinear relation is established in a manner such that the current supply and heating are effected in a desired coagulating/cutting state that is selected by changing the level by means of the setting
portion 623 of thepower source unit 603. If the level is changed, therefore, the incisive force changes only slowly, ensuring user-friendliness. - FIG. 73 shows a fifty-second embodiment. In the present embodiment, a fixed
handle 609 of athermocoagulation cutting forceps 601 is provided with ahand switch unit 643 for output control in place of thefootswitch 604 of the forty-second embodiment (see FIGS. 58 to 62). Thehand switch unit 643 is provided with first andsecond switches 643 a and 643 b that correspond to the first andsecond pedals footswitch 604, respectively. The first switch 643 a is used for the output at a set temperature for incision, and thesecond switch 643 b for the output at a set temperature for coagulation, for example. - According to the present embodiment, the output of the
thermocoagulation cutting forceps 601 can be controlled by only manipulating thehand switch 643 of the fixedhandle 609 of theforceps 601 with fingers, so that the user-friendliness is higher than in the case where thefootswitch 604 is used. - FIG. 74 is a perspective view of a scissors-type
thermocoagulation cutting forceps 645 according to a fifty-third embodiment. Abody 646 of theforceps 645 of the present embodiment is provided with twoscissors members members pivot pin 649 for rockably connecting thescissors members members - A
treatment portion 652 is formed on the distal end portion of thebody 646. It is provided with a pair ofjaws ratchets scissors members hand operating portion 655 for opening and closing thejaws - The
treatment portion 652 of thebody 646 is formed having acurved portion 656 that is curved gently in the shape of a substantially circular arc. Further, a serratedantiskid portion 650 a is provided on the inner surface of the onejaw 650, while athin heating plate 651 a, having a heating unit for coagulating the organism tissue embedded therein, is formed on the inner surface of theother jaw 650, that is, on the side in contact with the organism tissue. Theheating plate 651 a is connected to aconnector 657 by means of thescissors member 647. Theconnector 657 is connected with acable 658 that connects with a power source unit (not shown). - The following is a description of the operation of the
thermocoagulation cutting forceps 645 constructed in this manner. First, thetreatment portion 652 at the distal end portion of thebody 646 is inserted in a closed state into the organism tissue that includes a to-be-treated region such as a blood vessel (not shown). Thereafter, thejaws - Subsequently, the separated blood vessel or the like is held stressed between the
jaws heating plate 651 a of thejaw 651 through thecable 658. The heating unit is heated by electrical resistance during the power supply, whereupon the blood vessel or other organism tissue to be treated, in contact with the surface of theheating plate 651 a, is coagulated and incised. - According to the present embodiment, as in the case of the forty-second embodiment, the organism tissue can be satisfactorily incised with a small grip force of the
jaws - It is to be understood that the heating unit may alternatively be a thin-film resistance-heating element, PTC heater, cartridge heater, or ceramic heater.
- FIGS. 75 and 76 show a fifty-fourth embodiment. FIG. 75 is a perspective view of a scissors-
type forceps 661 for use as a medical instrument. In the present embodiment, abody 662 of theforceps 661 is provided with twoscissors members members pivot 665 for rockably connecting thescissors members members - A pair of
swing elements forceps body 662 with respect to thepivot 665. Theswing elements portions - As in the forty-second embodiment (see FIGS.58 to 62), a
heating unit 618 is located in each of respective holdingportions swing elements heating units 618 are energized and heated, their heat is transferred to the surface side of the holdingportions heating plates 619, so that the organism tissue held between the holdingportions swing elements - As shown in FIG. 76, a
cutting edge portion 669 for incising the organism tissue protrudes from the one holdingportion 668 b of the scissors-type forceps 661 toward the other holdingportion 668 a. Theedge portion 669 is located substantially in the center of the holdingportion 668 b and extends in the longitudinal direction of the holdingportion 668 b. - The following is a description of the operation of the present embodiment. In using the
forceps 661 to treat a blood vessel or other affected region that are intimately in contact with an organism tissue such as an internal organ, as in the case of the forty-second embodiment, the blood vessel is held between the holdingportions portions edge portion 669 on the holdingportion 668 b cannot cut off the blood vessel. - If the
heating units 618 are energized and heated in this state, their heat is transferred through theheating plates 619 to the blood vessel that is held between the holdingportions hand operating portion 664 is held tight to move the holdingportions edge portion 669 of the holdingportion 668 b is pressed hard against the holdingportion 668 a. In this manner, the coagulated portion of the blood vessel can be incised by means of theedge portion 669 of the holdingportion 668 b. - According to the present embodiment, the lumen of the blood vessel is coagulated as the
heating units 618 are energized and heated with the blood vessel stressed under a relatively small force of pressure such that theedge portion 669 of the holdingportion 668 b cannot cut it off when it is held between the holdingportions type forceps 661. Further, the coagulated portion of the blood vessel can be easily incised by means of theedge portion 669 of the holdingportion 668 b in a manner such that thehand operating portion 664 is held tight to press the top of theedge portion 669 hard against the holdingportion 668 a. - Thus, according to the present embodiment, as in the case of the forty-second embodiment, the organism tissue can be coagulated and incised with use of the one scissors-
type forceps 661. It is unnecessary, therefore, to replace separate medical instruments for individual treatments, so that the user-friendliness is improved and costs are lowered. - FIGS. 77A and 77B show a fifty-fifth embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS.58 to 62), and a description of those components is omitted. In the present embodiment, as shown in FIG. 77A, a receiving
member 671 of a soft material is located in arecess 620 of asecond holding portion 608. A corrugatedantiskid portion 672 for organism tissue is formed on a holding surface of the receivingmember 671. - When a
first holding portion 607 and thesecond holding portion 608 are closed tight to coagulate and incise the organism tissue, as shown in FIG. 77B, thecorrugated portion 672 of the receivingmember 671 can be elastically deformed into a substantially flat shape, thereby preventing the organism tissue from slipping off. - FIGS. 78A and 78B show a fifty-sixth embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS.58 to 62), and a description of those components is omitted. In the present embodiment, as shown in FIG. 78A, a receiving
member 681 of a soft material is located in arecess 620 of asecond holding portion 608. Anarcuate portion 682 with a wide radius of curvature is formed on a holding surface of the receivingmember 681. - FIG. 78A shows a state in which a
first holding portion 607 and thesecond holding portion 608 are closed softly. In coagulating and incising the organism tissue, the first and second holdingportions arcuate portion 682 of the receivingmember 681 can be elastically deformed into a substantially flat shape by means of thefirst holding portion 607, so that the organism tissue can be held securely. - FIGS. 79A and 79B show a fifty-seventh embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS.58 to 62), and a description of those components is omitted. In the present embodiment, as shown in FIG. 79A, a receiving
member 691 of a soft material is located in arecess 620 of asecond holding portion 608. Aprotrusion 692 is formed on that region of a holding surface of the receivingmember 691 which engages aheating plate 619 of afirst holding portion 607. As shown in FIG. 79B, moreover, theprotrusion 692 may be chevron-shaped. - The
protrusion 692 thus formed on the receivingmember 691 serves to facilitate incision of the organism tissue. Further, theprotrusion 692 may be designed so that it can be elastically deformed into a substantially flat shape when the first and second holdingportions - FIGS. 80A and 80B show a fifty-eighth embodiment. Like reference numerals refer to like components of the present embodiment and the forty-second embodiment (see FIGS.58 to 62), and a description of those components is omitted. In the present embodiment, as shown in FIG. 80A, a receiving
member 701 of a soft material is located in arecess 620 of asecond holding portion 608. A concave surface 702 is formed in that region of a holding surface of the receivingmember 701 which engages aheating plate 619 of afirst holding portion 607. As shown in FIG. 80B, moreover, the concave surface 702 may be formed only in a part of the holding surface of the receivingmember 701. - The concave surface702 thus formed in the holding surface of the receiving
member 701 is an effective measure for the case where the organism tissue to be held is slippery cannot be seized with ease, owing to its shape or properties. The concave surface 702 may be designed so that it can be elastically deformed into a substantially flat shape when the first and second holdingportions - FIGS.81 to 86 collectively show a fifty-ninth embodiment of the present invention, wherein FIG. 81 is an entire structural view of a surgical instrument, FIG. 82 is a side view of the surgical instrument, FIG. 83 is a perspective view of the holding portion, FIG. 84 is a cross sectional along the line A-A shown in FIG. 83, FIG. 85 is an electrical circuit diagram of the power source apparatus, and FIG. 86 is a graph.
- As shown in FIG. 81, a
thermocoagulation cutting forceps 801 constituting a surgical instrument is connected to apower source apparatus 803 via acable 802. Afoot switch 804 is connected to thepower source apparatus 803. - As shown in FIGS.82 to 84, the
thermocoagulation cutting forceps 801 comprises a slender insertingportion 806, amanual operating portion 805 arranged at a proximal end portion of the insertingportion 806, and a treatingportion 807 mounted at the distal end portion of the insertingportion 806. A pair of first andsecond holding portions portion 807. - An
operating body 812 and astationary handle 809 are integrally mounted to themanual operating portion 805. Further, amovable handle 811 is swingably mounted to theoperating body 812 such that thehandle 811 is swingable about apivotal shaft 810 providing the fulcrum. - The inserting
portion 806 is joined to theoperating body 812 such that the insertingportion 806 is rotatable about its own axis. Arotary operating portion 813 is arranged in theoperating body 812. The proximal end portion of the insertingportion 806 is joined to therotary operating portion 813. It should be noted that therotary operating portion 813 permits the insertingportion 806 to be rotated relative to theoperating body 812. - The inserting
portion 806 is formed of a pipe having a small diameter, and a drivingshaft 814 is movably inserted into the insertingportion 806. The proximal end portion of the drivingshaft 814 is joined to themovable handle 811, and the first andsecond holding portions shaft 814. It is possible to open the first andsecond holding portions pivotal pin 815 providing a fulcrum. If themovable handle 811 is rotated in a direction denoted by an arrow a in FIG. 82, the drivingshaft 814 is moved backward so as to close the first andsecond holding portions movable handle 811 is moved in a direction denoted an arrow b shown in FIG. 82, the drivingshaft 814 is moved forward so as to open the first andsecond holding portions - A connector connecting portion816 a is mounted to project upward from the operating
body 812, as shown in FIG. 82. Anelectrical contact 816 b is mounted to the connector connecting portion 816 a. Theelectrical contact 816 b is electrically connected to aheating element 823 of aceramic heater 822, which will be described hereinlater, arranged in thesecond holding portion 808B along the drivingshaft 814. Further, aconnector 816 of acable 802 is detachably connected to the connector connecting portion 816 a. - The first and
second holding portions first holding portion 808A is wide and is formed in the shape of a letter “U” in its cross section. Aconcave portion 817 open in its lower portion is formed in thefirst holding portion 808A. Further, saw tooth-like slip-preventingportions 818 are formed in the edge portions on the lower side of thefirst holding portion 808A in a manner to have theconcave portion 817 sandwiched therebetween. Incidentally, aheat insulating member 819 formed of a flexible material such as Teflon is buried in theconcave portion 817. - A
heater holding portion 820 having a width smaller than that of theconcave portion 817 and having a rectangular cross section is arranged in thesecond holding portion 808B. Anarcuate groove 821 is formed on the upper surface of theheater holding portion 820. Further, the columnarceramic heater 822 acting as a heat generating portion is fixed to thearcuate groove 821. Theceramic heater 822 is formed by burying aheating element 823, which is a heat generating resistor, within the ceramic material, which is an insulating material. Further, a Teflon coating is applied to the outer surfaces of the first andsecond holding portions - FIG. 85 shows the electric circuit of the
power source apparatus 803. As shown in the drawing, apower source circuit 824 connected to a commercial power source is connected to thecable 802 via anoutput circuit 825. Theoutput circuit 825 is connected to acontrol circuit 826, which is connected to thefoot switch 804. Further, thecontrol circuit 826 is connected to a setting means 827 for setting the temperature, time, etc. - FIG. 86 is a graph showing the change with time in temperature during the cutting time, the coagulation time and the coagulating cutting time. In the graph of FIG. 86, the time t (seconds) is plotted on the abscissa, with the temperature T (° C.) being plotted on the ordinate. It is possible for the setting means827 to set selectively the temperature elevation in the cutting step in which the temperature is rapidly elevated to temperature T1 as denoted by curve fl, the temperature elevation in the coagulation step in which the temperature is slowly elevated to temperature T2 and temperature T2 is maintained for several seconds as denoted by curve f2, and the temperature elevation in the coagulation cutting step in which the temperature is slowly elevated to temperature T2 and, then, rapidly elevated to temperature T1 as denoted by curve f3.
- The operation for coagulating-cutting the coagulation cutting portion of the living tissue by the thermocoagulation cutting forceps of the construction described above will now be described.
- If the operator holds the
manual operating portion 805 and rotates themovable handle 811 relative to thestationary handle 809 in a direction denoted by an arrow b in FIG. 82, the drivingshaft 814 is moved forward so as to open the first andsecond holding portions thermocoagulation cutting forceps 801 is moved forward under this condition, the coagulation cutting portion of the living tissue is held between the first andsecond holding portions movable handle 811 is rotated under this condition in the direction denoted by the arrow “a” in FIG. 82, the drivingshaft 814 is moved backward so as to close the first andsecond holding portions - Then, the coagulation cutting portion of the living tissue is held under a compressed state with a relatively small appropriate compressing force adapted for the coagulation treatment. If the
foot switch 804 is turned on under this state, an electric current is supplied from thepower source apparatus 803 to thethermocoagulation cutting forceps 801 through thecable 802. As a result, the current set by the setting means 827 is supplied to theheating element 823 arranged within theceramic heater 822 of thesecond holding portion 808B, with the result that heat is generated from theheating element 823. - Since the temperature is gradually elevated to temperature T2 by the heat generation from the
heating element 823 and temperature T2 maintained for several seconds as denoted by curve f2 in FIG. 86, the coagulation cutting portion of the living tissue is coagulated. In this case, the heat of theceramic heater 822 is not released to thefirst holding portion 808A because that region of thefirst holding portion 808A which is in contact with the living tissue is formed of theheat insulating material 819. - Then, the electric current set by the setting means827 is supplied to the
heating element 823 at time t4. As a result, the temperature is rapidly elevated to temperature T1 as denoted by curve f3 in FIG. 86. At the same time, if themovable handle 811 is rotated in the direction denoted by the arrow “a”, the drivingshaft 814 is moved backward so as to further close the first andsecond holding portions - It should be noted that the contact surface of the
second holding portion 808B with the living tissue is formed of the columnarceramic heater 822, making it possible for thesecond holding portion 808B to be brought into a linear contact with the living tissue, leading to an excellent cutting performance. As a result, the living tissue can be cut with a small holding force between the first andsecond holding portions - FIG. 87A shows a sixtieth embodiment of the present invention. This embodiment is substantially equal to the fifty-ninth embodiment shown in FIGS.81 to 86, except that, in the sixtieth embodiment, the
treatment portion 807 of thethermocoagulation cutting forceps 801 is constructed as described in the following. Incidentally, the constructions of the embodiment shown in FIG. 87A, which are the same as those of the fifty-ninth embodiment, are denoted by the same reference numerals. - In the embodiment shown in FIG. 87A, a columnar
ceramic heater 831 is arranged in theconcave portion 817 of thefirst holding portion 808A. Aheating element 832 formed of a heat generating resistor is buried in theceramic heater 831. In this embodiment, heat is generated from both theheater 832 within thefirst holding portion 808A and theheater 823 within thesecond holding portion 808B. - FIG. 87B shows a first modification of the
treatment portion 807 in the surgical instrument according to the sixtieth embodiment of the present invention, which is shown in FIG. 87A. In this modification, a rectangularceramic heater 833 is arranged within theconcave portion 817 of thefirst holding portion 808A. Aheating element 834 formed of a heat generating resistor is buried in theceramic heater 833. It follows that the heat energy is generated from both theheating element 834 within thefirst holding portion 808A and theheating element 823 within thesecond holding portion 808B. - FIG. 87C shows a second modification of the
treatment portion 807 in the surgical instrument according to the sixtieth embodiment of the present invention, which is shown in FIG. 87A. In this modification, a rectangularheater holding portion 835 having a small width is mounted to thefirst holding portion 808A. Anarcuate groove 836 is formed in theheater holding portion 835. Also, aceramic heater 837 is arranged in thearcuate groove 836. Aheating element 838 formed of a heat generating resistor is buried in theceramic heater 837. It follows that the heat energy is generated from both theheating element 838 within the first holding portion 808 a and theheating element 823 within thesecond holding portion 808B. - FIG. 87D shows a third modification of the
treatment portion 807 in the surgical instrument according to the sixtieth embodiment of the present invention, which is shown in FIG. 87A. In this modification, a rectangularceramic heater 839 having a small width is mounted to theheater holding portion 820 of thesecond holding portion 808B. Aheating element 840 formed of a heat generating resistor is buried in theceramic heater 839, thereby improving the cutting performance. - FIG. 87E exemplifies another construction of the
second holding portion 808B in the third modification (FIG. 87D) of the surgical instrument according to the sixtieth embodiment of the present invention shown in FIG. 87A. In this modification, a chamfered portion 839 a, which is prepared by a C-chamfering process, is formed in the corner portion of theceramic heater 839 of thesecond holding portion 808B, as shown in FIG. 87E. - FIG. 87F exemplifies still another construction of the
second holding portion 808B in the third modification (FIG. 87D) of the surgical instrument according to the sixtieth embodiment of the present invention shown in FIG. 87A. In this modification, a chamferedportion 839 b, which is prepared by an R-chamfering process for cutting the edge portion so as to provide an edge portion having an obtuse angle, is formed in the corner portion of theceramic heater 839 of thesecond holding portion 808B. - According to the sixtieth embodiment of the present invention shown in FIG. 87A and the modifications shown in FIGS. 87B to87F, a substantially linear contact with the living tissue can be achieved as in the fifty-ninth embodiment, leading to an excellent cutting performance. As a result, the living tissue can be cut with a small holding force between the first and
second holding portions - FIG. 88 shows a sixty-first embodiment of the present invention. A scissors-type
thermocoagulation cutting forces 841 is used in this embodiment. Twoscissors components main body 842 of thethermocoagulation cutting forceps 841. Thesescissors components pivotal pin 845 for rotatably joining thesescissors components scissors components - A
treatment portion 848 provided with a pair ofjaws main body 842. Further, substantially elliptical finger-insertingrings scissors components rings manual operation portion 851 for opening or closing the pair ofjaws - A
bent portion 852, which is moderately bent to form a substantially arcuate configuration, is formed in thetreatment portion 848 of themain body 842. Further, a saw tooth-shaped slip preventing portion 847 a is formed on the inner surface onejaw 847. Also, a columnar ceramic heater 846 a having a heating element buried therein is formed on the inner surface of theother jaw 846, i.e., on the surface that is brought into contact with the living tissue. The heating element buried in theceramic heater 846 serves to coagulate the living tissue. The ceramic heater 846 a is connected to theconnector 853 through thescissors component 843, and thecable 854 connected to the power source apparatus (not shown) is connected to theconnector 853. - The operation of the
thermocoagulation cutting forceps 841 of the construction described above will now be described. In the first step, theforceps 841 is inserted into the portion to be treated including, for example, a blood vessel, with thetreatment portion 848 at the distal end portion of themain body 842 closed. Then, the pair ofjaws - In the next step, the peeled blood vessel or the like is compressed and held between the
jaws jaw 847 through thecable 854. The ceramic heater 846 a generates heat because of the electrical resistance during the current supply so as to coagulate the living tissue of the treated portion such as the blood vessel, which is in contact with the surface of the ceramic heater 846 a. - When the coagulated portion is cut open in the subsequent step, the current denoted by f3 in FIG. 86 is supplied through the
cable 854 to the heating element of the ceramic heater 846 a arranged in thejaw 846. If thejaws - According to the embodiment described above, the columnar ceramic heater846 a is mounted to the inner surface of the
jaw 846 of onescissors component 843, i.e., to the contact surface with the living tissue. Also, since the contact surface of thejaw 846 with the living tissue is formed of the columnar ceramic heater 846 a, the columnar ceramic heater 846 a is brought into a substantially linear contact with the living tissue, leading to an excellent cutting performance. It follows that the living tissue can be cut open with a small holding force of thejaws - FIGS. 89A to89C collectively show a sixty-second embodiment of the present invention, wherein FIG. 89A is a side view showing the entire construction of a scissors type coagulation treatment apparatus, FIG. 89B is a plan view showing the treatment portion, and FIG. 89C is a perspective view of the jaw. Two
scissors components main body 862 of acoagulation treatment apparatus 861 according to the sixty-second embodiment of the present invention. Thesescissors components pivotal pin 865 for rotatably joining thesescissors components scissors components - A
treatment portion 868 provided with a pair ofjaws main body 862. Further, substantially elliptical finger-insertingrings scissors components rings manual operation portion 871 for opening or closing the pair ofjaws - A
bent portion 872, which is moderately bent to form a substantially arcuate configuration, is formed in thetreatment portion 868 of themain body 862. Further, rectangularceramic heaters jaws jaws - Each of these
ceramic heaters ceramic heaters ceramic heaters - Further, holding
portions jaws -
Insulated lead wires scissors component members insulated lead wire 877 on the side of thescissors component member 863 is connected to theceramic heater 873. Likewise, the distal end of theinsulated lead wire 878 on the side of theother scissors component 864 is connected to the ceramic heater 674. - A
cord connecting portion 879 is mounted on the outer circumferential surface of the finger-insertingring 869 on the side of thescissors component 863. Likewise, anothercode connection portion 880 is mounted on the outer circumferential surface of the finger-insertingring 870 on the side of thescissors component 864. The proximal end portion of theinsulated lead wire 877 is connected to thecord connecting portion 879 on the side of thescissors component 863. Also, theinsulated lead wire 878 is connected to thecord connecting portion 880 on the side of thescissors component 864. Further, connectingcords cord connecting portions ceramic heaters - The operation of the coagulation treatment apparatus of the construction described above will now be described. In the first step, the forceps is inserted into the portion to be treated including, for example, a blood vessel, with the
treatment portion 868 at the distal end portion ofcoagulation treatment apparatus 861 closed. Then, the pair ofjaws - In the next step, the peeled blood vessel or the like is held by the holding
portions portion 868 so as to withdraw the held blood vessel or the like toward the proximal end. Then, the blood vessel or the like is held between and compressed by thejaws ceramic heaters jaws connection cords ceramic heaters ceramic heaters - In this embodiment, the
ceramic heaters jaws main body 862. It should be noted that theceramic heaters ceramic heaters jaws coagulation treatment apparatus 861. - FIGS. 90 and 91 collectively show a sixty-third embodiment of the present invention. The sixty-third embodiment is substantially equal to the fifty-ninth embodiment shown in FIGS.81 to 86, except that, in the sixty-third embodiment, a distal
end treatment portion 807 of acoagulation treatment apparatus 801 capable of insertion into a body cavity like an endoscope is modified to be constructed like thetreatment portion 868 included in the sixty-second embodiment shown in FIGS. 89A to 89C. - It follows that, in the sixty-third embodiment, the
treatment portion 868 of thecoagulation treatment apparatus 801 constructed to be capable of insertion into a body cavity like an endoscope permits producing an effect similar to that produced by the sixty-second embodiment. - FIGS. 92 and 93 collectively show a sixty-fourth embodiment of the present invention. In the sixty-fourth embodiment, a
housing case 890 for housing thecoagulation treatment apparatus 861 of the sixty-second embodiment shown in FIGS. 89A to 89C is arranged as shown in FIG. 92. Thehousing case 890 is formed of a material having a high thermal conductivity such as a aluminum material having an anodizing treatment applied thereto. A substantially V-shapedhousing groove 891 for housing the distal end portion of themain body 862 including thetreatment portion 868 of thecoagulation treatment apparatus 861 is formed in thehousing case 890. A lever-like holding member 892 for holding thetreatment portion 868 of thecoagulation treatment portion 861 in a manner to prevent thetreatment portion 868 from being withdrawn is arranged on the side of the distal end of thehousing groove 891. Further, a fixingband 893 is mounted to thehousing case 890. - When a surgery is performed, the
housing case 890 is disposed on a sterilizedcloth 894 covering the body of a patient, as shown in FIG. 93. Under this condition, the fixingband 893 is fixed to the sterilizedcloth 894 by using aforceps 895 so as to fix thehousing case 890 without fail. - The
treatment portion 868 of thecoagulation treatment apparatus 861 used for the surgery is heated to a high temperature. However, since themain body 862 including thetreatment portion 868 of thecoagulation treatment apparatus 861 is disposed in thegroove 891 of thehousing case 890, the heat of thetreatment portion 868 is conducted to thehousing case 890, with the result that thetreatment portion 868 is cooled in a short time. It follows that a high safety can be ensured. In addition, the temperature can be controlled accurately when thecoagulation treatment apparatus 861 is used again. - FIGS.94 to 96 collectively show a sixty-fifth embodiment of the present invention, wherein FIG. 94 is a side view showing the entire structure of an ultrasonic coagulation cutting instrument, FIG. 95 is a perspective view of the treatment portion, and FIG. 96 is a cross sectional view showing the state that the treatment portion is closed.
- As shown in FIG. 94, a slender inserting
portion 902 is formed in amain body 901 of an ultrasoniccoagulating cutting instrument 900. Arotatable jaw 903 is mounted to the distal end portion of the insertingportion 902. As shown in FIG. 95, a saw tooth-likeslip preventing portion 905 is formed on the lower surface of thejaw 903. - Also, a
manual operating portion 904 is joined to the proximal end portion of the insertingportion 902. Thejaw 903 can be rotated by themanual operation portion 904. - Further, a
probe 906 is inserted movable in the axial direction into the insertingportion 902. The proximal end portion of theprobe 906 is joined to anultrasonic oscillator 907 mounted to themain body 901. Theprobe 906 is vibrated in the axial direction by theultrasonic oscillator 907. - As shown in FIG. 96, a plurality of projecting
stripes 908 are arranged a predetermined distance apart from each other in the circumferential direction in the distal end portion of theprobe 906. These projectingstripes 908 extend in parallel to the vibrating direction. Further, recessedstripes 909 are formed between adjacent projectingstripes 908. When thejaws 903 are closed so as to hold a living tissue, the projectingstripes 908 of theprobe 906 are brought into contact with the living tissue, and the recessedstripes 909 are not brought into contact with the living tissue. - It follows that, when the ultrasonic
coagulation cutting instrument 900 is used, thejaw 903 is closed so as to hold the living tissue between thejaw 903 and theprobe 906. If theprobe 906 is subjected to an ultrasonic vibration under this state, the living tissue is coagulated by the heat generated by the ultrasonic vibration. Then, when thejaw 903 is further closed, the coagulated portion is brought into a linear contact with the projectingstripes 908 of theprobe 906 so as to cut the living tissue open. - If the ultrasonic vibration of the
ultrasonic oscillator 907 is stopped in the subsequent step, the temperature of theprobe 906 is rapidly lowered because the projectingstripes 908 and the recessedstripes 909 have a large heat dissipating area. It follows that a high safety can be ensured. In addition, the temperature can be controlled accurately when thecoagulation treatment apparatus 861 is used again. - Additional advantages and modifications will readily occur to those skilled in the art. Therefore, the invention in its broader aspects is not limited to the specific details and representative embodiments shown and described herein. Accordingly, various modifications may be made without departing from the spirit or scope of the general inventive concept as defined by the appended claims and their equivalents.
Claims (69)
1. A medical treatment instrument used for coagulating and cutting the patient's body tissue, the medical treatment instrument comprising:
a treatment portion arranged at the tip of the treatment instrument, the treatment portion being supported capable of being opened and closed and comprising a pair of grasp portions for grasping the patient's body tissue;
a frontal operating portion arranged at the proximal end of the treatment instrument, the operating portion operating the pair of grasp portions to be opened and closed;
a heat generating portion provided at least at one of the grasp portions, the heat generating portion being current-carried to coagulate the patient's body tissue grasped between the grasp portions; and
a cutting portion disposed at the grasp portions to cut the patient's body tissue.
2. The treatment instrument according to claim 1 , wherein the cutting portion is disposed at the rear side of the heat generating portion in the each grasp portion, and constitutes a pair of metal scissors for cutting the patient's body tissue.
3. The treatment instrument according to claim 1 ,
wherein the grasp portions have a contact portion coming into contact with the patient's body tissue, the contact portion being formed of a material with high thermal conductivity;
the heat generating portion is a heating element arranged inside the grasp portion, the heating element being fixed to the contact portion; and
a slip-off preventing portion for preventing slip-off of the patient's body tissue is formed at the contact portion.
4. The treatment instrument according to claim 3 , wherein the slip-off preventing treatment portion is formed by ridges on the surface of the contact portion.
5. The treatment instrument according to claim 3 , wherein the contact portion is formed by the heat generating portion.
6. The treatment instrument according to claim 3 , wherein the contact portion has a cover portion for preventing adhesion of the patient's body tissue on its surface.
7. The treatment instrument according to claim 1 , wherein the treatment instrument is formed by surgical operation instrument used for endoscopy operation; the surgical operation instrument has an insert portion to be inserted into the patient's body; the treatment portion is disposed at the distal end of the insert portion; and the operating portion is disposed at the proximal end of the insert portion.
8. The treatment instrument according to claim 1 , wherein the grasp portions have a curve portion curved in a substantial arc shape.
9. The treatment instrument according to claim 1 , wherein the heat generating portion is connected to temperature control means for controlling a heating temperature.
10. The treatment instrument according to claim 1 , wherein the treatment portion has the heat generating portion provided at one of the pair of grasp portions.
11. The treatment instrument according to claim 1 , wherein the treatment portion has the heat generating portions at both of the pair of grasp portions.
12. The treatment instrument according to claim 1 , wherein the cutting portion is disposed at the each grasp portion, and is comprised of a dissection treatment heat generating portion for heating and cutting the patient's body tissue.
13. The treatment instrument according to claim 12 , wherein the grasp portions have a coagulation treatment heat generating portion with its large area for contact with the patient's body tissue and a dissection treatment heat generating portion with small area for contact with the patient's body tissue.
14. The treatment instrument according to claim 13 , wherein the coagulation treatment heat generating portion and the dissection treatment heat generating portion are connected to a power supply unit comprising an output circuit for supplying power independently.
15. The treatment instrument according to claim 12 , wherein the cutting portion comprises dissection treatment heat generating portion moving means for moving the dissection treatment heat generating portion in a direction identical to the opening/closing direction of the grasp portions; and the frontal operating portion has operating means for operating the dissection treatment heat generating portion moving means.
16. The treatment instrument according to claim 1 , wherein the cutting portion is slidably supported along the grasp portions, and the treatment instrument has operating means for sliding the cutting portion to the vicinity of a coagulated portion by the heat generating portion.
17. The treatment instrument according to claim 16 , wherein the cutting portion is a shear blade.
18. The treatment instrument according to claim 17 , wherein the shear blade is a scissors-shaped shear blade consisting of upper and lower sections in set.
19. The treatment instrument according to claim 16 , wherein the cutting portion is formed by a heating element wire for dissection.
20. The treatment instrument according to claim 1 , wherein the treatment portion has an interfacing surface at the each grasp portion; the interfacing surface has the heat generating portion and the cutting portion disposed thereon; and the cutting portion is slidably supported along the grasp portions.
21. A medical treatment instrument used for coagulating and cutting the patient's body tissue, the medical treatment instrument comprising:
a treatment portion disposed at the distal end of the treatment instrument, the treatment portion being supported capable of being opened and closed, comprising a pair of grasp portions for grasping the patient' body tissue;
a frontal operating portion disposed at the proximal end of the treatment instrument, the operating portion operating the pair of grasp portion to be opened and closed;
a heat generating portion provided at least one of the grasp portions, the heat generating portion being current-carried to coagulate a patient's body tissue grasped between the grasp portions; and
a cutting portion disposed at the each grasp portion to cut the patient's body tissue,
wherein the cutting portion is protruded on one side of the grasp portions in the treatment portion toward the other side of the grasp portions, and comprises a heat treatment protrusion portion for thermally treating the patient's body tissue and a receiving portion formed at the other side of the grasp portions and receiving the protrusion portion.
22. A medical treatment instrument used for coagulating and cutting the patient's body tissue, the medical treatment instrument comprising:
a treatment portion disposed at the distal end of the treatment instrument, the treatment portion being supported capable of being opened and closed and comprising a pair of grasp portions for grasping the patient's body tissue;
a frontal operating portion arranged at the proximal end of the treatment instrument, the operating portion operating the pair of grasp portions to be opened and closed; and
a heat generating portion provided at least at one of the grasp portions, the heat generating portion being current-carried to coagulate the patient's body tissue grasped between the grasp portions,
wherein the grasp portions each have an insert portion for inserting cutting means for cutting the patient's body tissue.
23. A medical treatment instrument used for coagulating and cutting the patient's body tissue, the medical treatment instrument comprising:
a treatment portion arranged at the distal end of the treatment instrument, the treatment portion being supported capable of being opened and closed and comprising a pair of grasp portions for grasping the patient's body tissue;
a frontal operating portion disposed at the proximal end of the treatment instrument, the operating portion operating the pair of grasp portions to be opened and closed; and
a heat generating portion provided at least at one of the grasp portions, the heat generating portion being current-carried to coagulate the patient's body tissue grasped between the grasp portions,
wherein the heat generating portion is heater means consisting of an insulation material.
24. The treatment instrument according to claim 23 , wherein the heater means is a ceramic heater having a heat transmitting portion made of ceramic and a heating element provided in this heat transmitting portion.
25. The treatment instrument according to claim 23 , wherein the heater means is reinforced by a reinforce member consisting of a metal.
26. The treatment instrument according to claim 23 , wherein the heater means has a cover portion for preventing adhesion of the patient's body tissue provided on its surface.
27. The treatment instrument according to claim 24 , wherein the each grasp portion is formed by jaws consisting of stainless steel; the jaws have an intermediate connection member provided between the ceramic heaters and jaws; and the intermediate connection member has first connecting means to be connected to the ceramic heater and second connecting means to be connected to the jaws.
28. A power supply unit connected to a medical treatment instrument used for coagulating and cutting the patient's body tissue,
wherein the treatment instrument comprises a treatment portion arranged at the distal end thereof, the treatment portion being supported capable of being opened and closed and comprising a pair of grasp portions for grasping the patient's body tissue; a frontal operating portion arranged at the proximal end of the treatment instrument, the operating portion operating the pair of grasp portions to be opened and closed; and a heat generating heater portion provided at least at one of the grasp portions, the heater portion being current-carried to coagulate and cut the patient's body tissue grasped between the grasp portions, the power supply unit comprising:
resistance value measuring means for measuring a resistance value of the heater portion; and
control means for controlling power supply to the heater portion according to an initial resistance value of the heater portion.
29. The power supply unit according to claim 28 , wherein the power supply unit has a measurement switch for measuring the initial resistance value; and means for, when the measurement switch is pressed, setting the resistance value of the heater portion measured by the resistance value measuring means as an initial resistance value.
30. The power supply unit according to claim 28 , wherein the power supply unit has means for automatically measuring the initial resistance value when a treatment instrument incorporating the heater portion is connected.
31. The power supply unit according to claim 28 , wherein the power supply unit comprises resistance value measuring means for measuring a resistance value of the heater portion; temperature measuring means for measuring a temperature of the heater portion from the resistance value of the heater portion; and means for correcting the temperature by using the initial resistance value of the heater portion.
32. The power supply unit according to claim 28 , wherein the power supply unit comprises control means for, if the initial resistance value of the heater portion is not measured, controlling operation so as not to output.
33. A coagulating treatment instrument used for coagulating the patient's body tissue, the coagulating treatment instrument comprising:
a treatment portion arranged at the distal end of the treatment instrument, the treatment portion being supported capable of being opened and closed and comprising a pair of grasp portions for grasping the patient's body tissue;
a frontal operating portion arranged at the proximal end of the treatment instrument, the operating portion operating the pair of grasp portions to be opened and closed;
a heater portion provided at least at one of the grasp portions, the heater portion being current-carried and heated to coagulate the patient's body tissue grasped between the grasp portions; and
an adhesion preventing treatment portion for covering the periphery of the heater portion, thereby to prevent adhesion of the patient's body tissue, the adhesion preventing treatment portion being detachably mounted to the grasp portions.
34. The treatment instrument according to claim 33 , wherein the adhesion preventing treatment portion is provided on the outer surface of a cover detachable from the heater portion.
35. The treatment instrument according to claim 33 , wherein the heater portion is detachably mounted on the grasp portions; and the adhesion preventing treatment portion is provided on the outer surface of the heater portion.
36. The treatment instrument according to claim 35 , wherein the treatment instrument has a heater unit detachably connected thereto, the heater portion is contained in the heater unit, and the heater unit has a electrically conducting member for supplying power to the heater portion.
37. The treatment instrument according to claim 33 , wherein the adhesion preventing treatment portion is a cover detachable from the heater portion.
38. A coagulating treatment instrument used for coagulating the patient's body tissue, the coagulating treatment instrument comprising:
a treatment portion arranged at the distal end of the treatment instrument, the treatment portion being supported capable of being opened and closed and comprising a pair of grasp portions for grasping the patient's body tissue;
a frontal operating portion arranged at the proximal end of the treatment instrument, the operating portion operating the pair of grasp portions to be opened and closed; and
a heater portion provided at least at one of the grasp portions, the heater portion being current-carried to coagulate the patient's body tissue grasped between the grasp portions,
wherein the treatment instrument has a coagulation surface for coagulating the patient's body tissue provided at least at the heater portion or either one of the grasp portions; and the coagulation surface comprises a distal end abutting against the counterpart member of the grasp portions each other immediately after closing of the grasp portions; and a proximal end having a gap provided between the proximal end and the counterpart member of the grasp portion.
39. The treatment instrument according to claim 38 , wherein the grasp portions can be elastically deformed by a closing force applied to the operating portion, and the heater portion consists of a rigid element.
40. The treatment instrument according to claim 38 , wherein the operating portion comprises a stopper member actuated to stop closing operation of the grasp portions at a predetermined closed position during close movement of the grasp portions.
41. The treatment instrument according to claim 40 , wherein the closed position is determined at a position where the grasp portions are elastically deformed, and the proximal end of the coagulation surface substantially abuts.
42. A coagulating treatment instrument used for coagulating the patient's body tissue, the coagulating treatment instrument comprising:
a treatment portion arranged at the distal end of the treatment instrument, the treatment portion being supported capable of being opened and closed and comprising a pair of grasp portions for grasping the patient's body tissue;
a frontal operating portion arranged at the proximal end of the treatment instrument, the operating portion operating the pair of grasp portions to be opened and closed;
a heater portion provided at least one of the grasp portions, the heater portion being current-carried;
bipolar electrically conducting members connected to the heater portion, these bipolar electrically conducting members being insulated from each other and arranged at a main body of the treatment instrument; and
exposure preventing means for preventing the electrically conducting member from being exposed to the outside of the main body of the treatment instrument.
43. The treatment instrument according to claim 42 , wherein the electrically conducting member is a lead wire.
44. The treatment instrument according to claim 42 , wherein the treatment instrument main body comprises a housing groove of the electrically conducting member, and the exposure preventing means houses the electrically conducting member in the housing groove.
45. The treatment instrument according to claim 42 , wherein the treatment instrument main body comprises a housing groove of the electrically conducting member, and the exposure preventing means is a cover member for covering the housing groove while the electrically conducting member is housed in the housing groove.
46. The treatment instrument according to claim 42 , wherein the treatment instrument main body is comprised of a metal, and the electrically conducting member is composed of the treatment instrument main body at least at one electrode.
47. The treatment instrument according to claim 46 , wherein at least a part of the treatment instrument main body is covered for insulation.
48. In a coagulating/cutting system comprising a medical instrument used to coagulate and incise a living tissue and a control element for controlling the operation of the instrument,
the instrument including
a first engaging portion having a first engaging surface constituting an engaging surface for holding the living tissue,
a second engaging portion having a second engaging surface constituting an engaging surface capable of holding the living tissue in conjunction with the first engaging surface,
a holding drive element capable of moving the first and second engaging portions toward and away from each other to hold the living tissue, and
a heating unit adapted to heat the first engaging portion when energized,
the control element including
a current supply element for supplying current to the heating unit, and
a setting element capable of adjusting the current supply element to a temperature at which the living tissue can be incised as the heating unit is heated when the living tissue is held between the first and second engaging surfaces by means of the holding drive element.
49. In a coagulating/cutting system comprising a medical instrument used to coagulate and incise a living tissue and a control element for controlling the operation of the instrument,
the instrument including
a first engaging portion having a first engaging surface constituting an engaging surface for holding the living tissue,
a second engaging portion having a second engaging surface constituting an engaging surface capable of holding the living tissue in conjunction with the first engaging surface,
a holding drive element capable of moving the first and second engaging portions toward and away from each other to hold the living tissue, and
a heating unit adapted to heat the first engaging portion when energized,
the control element including
a current supply element for supplying current to the heating unit,
a first setting element capable of adjusting the current supply element to a temperature at which the living tissue can be coagulated as the heating unit is heated when the living tissue is held between the first and second engaging surfaces by means of the holding drive element, and
a second setting element capable of adjusting the current supply element to a temperature at which the living tissue can be incised as the heating unit is heated when the living tissue is held between the first and second engaging surfaces by means of the holding drive element.
50. A coagulating/cutting system according to claim 49 , wherein said control element further includes a set state changing element capable of changing at least one of set states of the current supply element set by means of the first and second setting portions.
51. A coagulating/cutting system according to claim 49 , wherein said control element includes a first switch for driving the current supply element set by means of the first setting element and a second switch for driving the current supply element set by means of the second setting element.
52. A coagulating/cutting instrument used to coagulate and incise a living tissue, comprising:
a first engaging portion having a first engaging surface constituting a protrusion holding the living tissue;
a second engaging portion having a second engaging surface constituting an engaging surface capable of holding the living tissue in conjunction with the first engaging surface;
a holding drive element capable of moving the first and second engaging portions to hold the living tissue, and
a heating unit adapted to heat the first engaging portion when energized.
53. A coagulating/cutting instrument according to claim 52 , wherein said first engaging surface is an elongate flat surface.
54. A coagulating/cutting instrument according to claim 52 , wherein said first engaging surface is an elongate curved surface profiled in the shape of a substantially circular arc.
55. A coagulating/cutting instrument according to claim 52 , wherein said second engaging portion includes a receiving member formed of a resin.
56. A coagulating/cutting instrument according to claim 55 , wherein said resin is a flexible material.
57. A coagulating/cutting instrument according to claim 55 , wherein the material of said receiving member is rubber.
58. A coagulating/cutting instrument according to claim 55 , wherein the material of said receiving member is gel.
59. A coagulating/cutting instrument according to claim 55 , wherein the material of said receiving member is fluoroplastic.
60. A coagulating/cutting instrument according to claim 55 , wherein said receiving member has a groove on a portion thereof in contact with the first engaging surface.
61. A surgical instrument, comprising:
a distal end portion including a pair of holding portions for holding a living tissue, said holding portion having a contact surface that is brought into contact with said living tissue; and
a manual operating portion for opening or closing said holding portions;
wherein at least one of said holding portions has a heat generating portion formed in said contact portion with the living tissue, and
the contact surface of the heat generating portion with the living tissue is smaller in the contact area with the living tissue than the contact surface of the other holding portion with the living tissue.
62. The surgical instrument according to claim 61 , wherein the contact surface of said heat generating portion with the living tissue is formed arcuate in its cross section.
63. The surgical instrument according to claim 61 , wherein the contact surface of the other holding portion, which is arranged to face said heat generating portion, with the living tissue is formed of a heat insulating material.
64. The surgical instrument according to claim 61 , wherein said holding portion is curved from the distal end toward the proximal end.
65. The surgical instrument according to claim 61 , wherein a slip preventing portion is formed in the contact surface of the other holding portion, which is arranged to face said heat generating portion, with the living tissue.
66. The surgical instrument according to claim 61 , wherein a coating for preventing the sticking of the heated living tissue is applied to the outer surface of said holding portion.
67. The surgical instrument according to claim 61 , wherein the contact surface of the other holding portion, which is arranged to face said heat generating portion, with the living tissue is formed of a second heat generating portion that is rectangular in its cross section.
68. The surgical instrument according to claim 61 , wherein the other holding portion, which is arranged to face said heat generating portion, has a chamfered portion in which the both edge portions of the contact surface with the living tissue are cut to have an obtuse angle.
69. The surgical instrument according to claim 61 , wherein the contact surface of other holding portion, which is arranged to face said heat generating portion, with the living tissue is formed of a flexible heat insulating material.
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/793,431 US20030171747A1 (en) | 1999-01-25 | 2001-02-26 | Medical treatment instrument |
US10/654,178 US7329257B2 (en) | 1999-01-25 | 2003-09-03 | Medical treatment instrument |
Applications Claiming Priority (8)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP01566199A JP3255885B2 (en) | 1999-01-25 | 1999-01-25 | Medical treatment tools |
JP11-015661 | 1999-01-25 | ||
US48873200A | 2000-01-20 | 2000-01-20 | |
JP2000164905A JP2001340349A (en) | 2000-06-01 | 2000-06-01 | Surgical instrument |
JP2000-164905 | 2000-06-01 | ||
JP2000327148A JP3349139B2 (en) | 2000-01-20 | 2000-10-26 | Coagulation incision system |
JP2000-327148 | 2000-10-26 | ||
US09/793,431 US20030171747A1 (en) | 1999-01-25 | 2001-02-26 | Medical treatment instrument |
Related Parent Applications (1)
Application Number | Title | Priority Date | Filing Date |
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US48873200A Continuation-In-Part | 1999-01-25 | 2000-01-20 |
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US10/654,178 Continuation US7329257B2 (en) | 1999-01-25 | 2003-09-03 | Medical treatment instrument |
US10/654,178 Continuation-In-Part US7329257B2 (en) | 1999-01-25 | 2003-09-03 | Medical treatment instrument |
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Publication Number | Publication Date |
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US20030171747A1 true US20030171747A1 (en) | 2003-09-11 |
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US09/793,431 Abandoned US20030171747A1 (en) | 1999-01-25 | 2001-02-26 | Medical treatment instrument |
US10/654,178 Expired - Lifetime US7329257B2 (en) | 1999-01-25 | 2003-09-03 | Medical treatment instrument |
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Application Number | Title | Priority Date | Filing Date |
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US10/654,178 Expired - Lifetime US7329257B2 (en) | 1999-01-25 | 2003-09-03 | Medical treatment instrument |
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