WO2013042515A1 - Outil de traitement par ultrasons - Google Patents

Outil de traitement par ultrasons Download PDF

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Publication number
WO2013042515A1
WO2013042515A1 PCT/JP2012/071900 JP2012071900W WO2013042515A1 WO 2013042515 A1 WO2013042515 A1 WO 2013042515A1 JP 2012071900 W JP2012071900 W JP 2012071900W WO 2013042515 A1 WO2013042515 A1 WO 2013042515A1
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WO
WIPO (PCT)
Prior art keywords
probe
ultrasonic
axis direction
stress
longitudinal axis
Prior art date
Application number
PCT/JP2012/071900
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English (en)
Japanese (ja)
Inventor
山田　将志
Original Assignee
オリンパスメディカルシステムズ株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by オリンパスメディカルシステムズ株式会社 filed Critical オリンパスメディカルシステムズ株式会社
Publication of WO2013042515A1 publication Critical patent/WO2013042515A1/fr

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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
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • 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
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320095—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw with sealing or cauterizing means

Definitions

  • the present invention relates to an ultrasonic treatment tool for grasping a living tissue between a probe and a jaw and performing treatment such as incision, excision or coagulation of the living tissue using ultrasonic waves.
  • Patent Document 1 discloses an ultrasonic transducer, a probe (vibration transmission member) connected to the ultrasonic transducer, and a jaw (on the base end side that faces the probe and serves as a fulcrum)
  • an ultrasonic treatment instrument that includes a grasping member) and grasps a living tissue between the probe and the jaw by opening and closing the jaw with respect to the probe.
  • This ultrasonic treatment instrument is configured such that an operating rod connected to a jaw advances and retreats in the longitudinal axis direction of the jaw by operation of an operating handle, and the jaw opens and closes with respect to the probe in accordance with the advance and retreat. Then, ultrasonic treatment is performed on the living tissue while the living tissue is held between the probe and the jaw.
  • the probe has a cross-sectional shape in which the cross-sectional area of the probe gradually and continuously increases from the distal end portion toward the proximal end portion. It is formed to make.
  • a bending stress reaction force
  • the bending stress that the tip of the probe receives due to the load from the jaws can be kept small.
  • the amount of bending of the tip of the probe is suppressed, the stability at the time of coagulation, excision and the like is ensured, and the durability of the probe is improved.
  • JP 2002-224133 A Japanese Patent No. 3274826
  • an object of the present invention is to provide an ultrasonic treatment tool that improves the durability and strength of a probe by dispersing stress generated by ultrasonic vibration and stress generated by gripping.
  • One embodiment of the present invention includes an ultrasonic transducer unit that generates ultrasonic vibrations, a distal end portion and a proximal end portion, and extends in a longitudinal axis direction, and the proximal end portion is connected to the ultrasonic transducer unit.
  • a probe that transmits ultrasonic vibrations from the ultrasonic transducer unit and is opposed to the tip of the probe along the longitudinal axis direction of the probe.
  • a gripping unit that grips a living tissue between the probe and the probe, and stress applied by ultrasonic vibration from the ultrasonic transducer unit is concentrated on the tip of the probe.
  • a first stress concentration region, and a second stress concentration region in which stress applied by the gripping unit when the biological tissue is gripped are formed, and the first stress concentration region
  • the way the second and the stress concentration area is located away longitudinally of said probe is an ultrasonic treatment instrument peripheral shape of the probe distal end portion is set.
  • an ultrasonic treatment instrument that improves the durability and strength of a probe by dispersing the stress generated by ultrasonic vibration and the stress generated by gripping.
  • FIG. 1 is a perspective view schematically showing an entire ultrasonic treatment apparatus according to an embodiment of the present invention.
  • FIG. 2 is a perspective view showing an exploded state of the ultrasonic treatment device according to the embodiment of the present invention.
  • FIG. 3A is a cross-sectional view of the YZ plane showing a closed state of the distal end side (gripping unit) of the probe unit and the sheath unit.
  • FIG. 3B is a cross-sectional view of the YZ plane showing a state in which the distal ends (gripping units) of the probe unit and the sheath unit are opened.
  • FIG. 4 is an XY plan view showing a meshing state between the probe tip of the probe unit and the gripping unit.
  • FIG. 5A is an XY plan view of the probe unit of the ultrasonic treatment apparatus according to the embodiment of the present invention.
  • FIG. 5B is a YZ plan view of the probe unit of the ultrasonic treatment apparatus according to the embodiment of the present invention.
  • FIG. 6A is a perspective view of the probe distal end portion of the probe unit of the ultrasonic treatment apparatus according to the embodiment of the present invention.
  • FIG. 6B is a perspective view of the probe distal end portion of the probe unit of the ultrasonic treatment apparatus according to the embodiment of the present invention.
  • FIG. 7A is a diagram illustrating a cross-sectional shape (peripheral shape) in an XY plane passing through the central axis in the longitudinal axis direction of the probe tip of the probe unit.
  • FIG. 7B is a diagram showing a cross-sectional shape (peripheral shape) in the YZ plane passing through the central axis in the longitudinal axis direction of the probe tip of the probe unit.
  • FIG. 1 is a perspective view schematically showing an entire ultrasonic treatment instrument 1 according to an embodiment of the present invention.
  • FIG. 2 is a perspective view showing an exploded state of the ultrasonic treatment instrument 1.
  • the ultrasonic treatment tool 1 is a so-called scissors-type treatment tool that is used by being grasped by an operator, and performs treatment such as incision, excision, or coagulation of a living tissue using ultrasonic energy.
  • the ultrasonic treatment instrument 1 has an ultrasonic transducer unit 2, a probe unit 3, a sheath unit 4, and a handle unit 5. In the present embodiment, these four units 2 to 5 are detachably fitted to each other.
  • an ultrasonic transducer is incorporated inside a cylindrical transducer cover 6.
  • a proximal end portion of a horn that expands the amplitude of the ultrasonic vibration is connected to the distal end portion of the ultrasonic transducer.
  • the cable 7 extends to the proximal end of the ultrasonic transducer unit 2.
  • a power supply device main body 9 is connected to the cable 7 via an electric cord 8, and an ultrasonic vibrator generates ultrasonic vibrations due to a current supplied therefrom.
  • the probe unit 3 includes a probe 10 as a long and substantially rod-shaped vibration transmission member having a distal end portion and a proximal end portion and extending in the longitudinal axis direction.
  • a screw portion 11 (shown in FIGS. 5A and 5B) is formed at the proximal end portion of the probe 10.
  • the screw 11 is screwed into a screw hole formed in the horn of the ultrasonic transducer unit 2 so that the ultrasonic transducer unit 2 and the probe unit 3 are connected.
  • the probe 10 is made of a material having excellent sound wave propagation and good biocompatibility, for example, a titanium material or an aluminum material.
  • the total length of the probe 10 is designed to be an integral multiple of a half wavelength of the ultrasonic vibration transmitted from the ultrasonic transducer unit 2.
  • the tip of the probe 10 is set to be an abdomen of ultrasonic vibration in order to obtain a desired amplitude necessary for the treatment.
  • a flange portion 12 is provided at the position of the most proximal vibration node in the longitudinal axis direction of the probe 10.
  • the probe distal end portion 3a which is an ultrasonic treatment portion on the distal end side of the probe 10, has a tapered curved shape from the viewpoint of the operator's visibility at the time of use and ease of dive into the treatment target. ing. Details of the shape of the probe tip 3a will be described later.
  • the sheath unit 4 has a sheath body 13 formed in a cylindrical shape, and a jaw 14 as a gripping unit disposed at the distal end portion of the sheath body 13.
  • the sheath main body 13 includes a metal sheath 15 that is an outer cylinder and a metal operation rod 16 that is an inner cylinder.
  • the probe unit 3 (probe 10) is inserted inside the sheath 15.
  • the operation rod 16 is inserted into the sheath 15 so as to be movable in the longitudinal axis direction within the sheath 15.
  • a connecting tube body 17, a guide tube body 18, a knob member 19, and the like that are connected to a rotation operation knob 23 of the handle unit 5 described later are provided.
  • the handle unit 5 includes a fixed handle 20, a holding cylinder 21, a movable handle 22, and a rotation operation knob 23.
  • a U-shaped arm portion 24 is provided on the upper portion of the movable handle 22, and the holding cylinder 21 is attached to the fixed handle 20 in a state where the holding cylinder 21 is inserted into the U-shaped portion of the arm portion 24. It is attached.
  • the upper end of the movable handle 22 is pivotally supported with respect to the holding cylinder 21 via a fulcrum pin 25.
  • Ring-shaped finger hooks 26 and 27 are provided at the lower portions of the fixed handle 20 and the movable handle 22, respectively. By applying a force by applying a finger to these finger hooks 26, 27, the movable handle 22 rotates around the fulcrum pin 25, and the movable handle 22 opens and closes with respect to the fixed handle 20.
  • the arm portion 24 is provided with an action pin 28, and the action pin 28 extends into the holding cylinder 21.
  • An operation force transmission mechanism (not shown) that transmits the operation force of the movable handle 22 to the operation rod 16 of the sheath unit 4 is provided inside the holding cylinder 21.
  • the operating force transmission mechanism includes, for example, a coil spring, a spring receiving member, a slider member, and a stopper, and gives the operating rod 16 an advance / retreat operation along the longitudinal axis direction.
  • a rotation transmission mechanism (not shown) operated by the rotation operation knob 23 is provided inside the holding cylinder 21.
  • This rotation transmission mechanism has a rotation transmission member, for example.
  • the rotation transmission member rotates together with the rotation operation knob 23. , Rotate integrally with the spring receiving member.
  • the ultrasonic transducer unit 2 and the probe unit 3 also rotate together. This prevents the operating rod 16 from being twisted.
  • First and second switches 29 and 30 are provided on the side surface of the fixed handle 20. These switches 29 and 30 are switches for selecting a treatment function of the ultrasonic treatment instrument 1. For example, the first switch 29 selects a function for outputting an ultrasonic wave at the maximum output, and the second switch 30 is selected. The function of outputting an ultrasonic wave lower than the maximum output can be selected. Of course, various settings are possible without being limited to this setting.
  • FIG. 3A and 3B are longitudinal sectional views (YZ plan views) showing the closed state and the opened state of the probe unit 3 and the sheath unit 4, respectively.
  • FIG. 4 is an XY plan view showing a meshing state between the probe tip 3 a of the probe unit 3 and the jaw 14 of the sheath unit 4.
  • a pair of projecting pieces 31 project from the distal end portion of the sheath 15 toward the distal end side of the sheath 15.
  • a base end portion of the jaw 14 is rotatably attached to the projecting pieces 31 via a fulcrum pin 32.
  • the jaw 14 In the assembled state, the jaw 14 is disposed at a position facing the probe tip 3 a along the longitudinal axis direction (Y-axis direction) of the probe 10.
  • the jaw 14 has a jaw main body 33 and a gripping member 34 attached to the jaw main body 33.
  • the grasping surface for grasping the living tissue in the grasping member 34 is formed of a resin material such as polytetrafluoroethylene.
  • the holding member 34 is connected with the jaw main body 33 via the screw part 35b. Further, the jaw body 33 and the operating rod 16 in the sheath 15 are connected via a connecting pin 35.
  • a plurality of teeth 34 b for preventing slipping are formed on the wall 34 a of the gripping member 34. These tooth portions 34b prevent the living tissue sandwiched between the probe tip portion 3a and the jaw 14 from slipping when they are engaged.
  • a tip chip 36 made of an insulating material such as a resin material is provided at the tip of the gripping member 34.
  • the tip 36 allows a relative shift in the meshing position when the probe tip 3a and the jaw 14 mesh.
  • the upper surface of the probe tip 3a that grips the living tissue between the gripping member 34 is a substantially flat surface as shown in FIG. 3B so that the living tissue to be treated can be easily sandwiched.
  • the movable handle 22 When the living tissue is treated, the movable handle 22 is grasped and the movable handle 22 is rotated with respect to the fixed handle 20 (closing operation). As the movable handle 22 rotates at this time, the operating force is transmitted by the operating force transmission mechanism, and the operating rod 16 retracts in the longitudinal axis direction. Then, the force from the operating rod 16 is transmitted to the jaw 14 via the connecting pin 35, and the jaw 14 is rotated about the fulcrum pin 32.
  • the jaw 14 When the operating rod 16 is pulled out to the proximal end side, the jaw 14 is driven in a direction (open position) away from the probe distal end portion 3a around the fulcrum pin 32. On the other hand, when the operation rod 16 is pushed out to the tip side, the jaw 14 is driven toward the probe tip portion 3a (closed position) with the fulcrum pin 32 as the center. By rotating the jaw 14 to the closed position, the living tissue is sandwiched between the probe tip 3 a and the jaw 14.
  • the gripping member 34 follows the probe tip 3a flexing and the screw 35b serves as a fulcrum. Only a force is applied to the gripping member 34 over the entire length. Then, by applying ultrasonic vibration to the grasped biological tissue from the ultrasonic transducer unit 2 to the probe distal end portion 3a, for example, the biological tissue such as a blood vessel is incised while being coagulated (hemostatic).
  • FIG. 5A and 5B are an XY plan view and a YZ plan view of the probe unit 3, respectively.
  • 6A and 6B are perspective views of the probe tip 3a of the probe unit 3.
  • FIG. The probe unit 3 (probe 10) has a cross-sectional area in the longitudinal axis direction at several node portions of vibration in the middle of the longitudinal axis direction (Y-axis direction) so that the amplitude necessary for the treatment can be obtained at the probe tip 3a. Has been reduced.
  • the probe tip 3a is curved toward the asymmetric shape with respect to the longitudinal axis direction, that is, in the X-axis direction, as shown in FIG. 5A.
  • the probe tip 3a has a tapered shape whose diameter decreases in the Y-axis direction, as shown in FIGS. 5A and 5B.
  • the probe tip 3a is thinner in the thickness direction perpendicular to the X-axis direction and the Y-axis direction, that is, in the Z-axis direction, in the Y-axis direction.
  • the jaw 14 facing the probe tip 3a is also formed in a curved shape that substantially matches the curved shape of the probe tip 3a, as shown in FIG.
  • the probe tip 3a receives stress from the ultrasonic transducer unit 2 (hereinafter referred to as stress due to ultrasonic vibration) as described above, and from the grasping unit (jaw 14) when grasping the living tissue.
  • stress due to ultrasonic vibration A stress obtained by adding two of stress (hereinafter referred to as stress due to gripping) is added. If these two stress concentration areas (concentration points) are coincident or close to each other on the probe tip portion 3a, the area becomes a weak point in strength, which is not preferable.
  • the probe diameter is increased, the visibility and usability are reduced. Therefore, it is preferable that the probe diameter, particularly the probe tip diameter, is thinner. That is, in view of visibility and ease of dive, it is necessary to maintain the thinness of the probe diameter and increase the probe strength.
  • the ultrasonic vibration has the property of basically going straight. Accordingly, the ultrasonic waves generated from the ultrasonic transducer unit 2 travel straight through the probe 10 in the longitudinal direction.
  • the probe tip portion 3a has a curved portion from the viewpoint of visibility and ease of dive, and therefore a moment is generated by the vibration of the curved portion. Then, it was found that the stress due to the ultrasonic vibration tends to concentrate at the shape change point related to the curvature together with the amplitude change point of the ultrasonic vibration. In other words, in the probe 10 having the bending portion at the probe tip portion 3a, it has been found that the stress due to the ultrasonic vibration tends to concentrate on the portion of the probe tip portion 3a that starts to bend.
  • the stress due to ultrasonic vibration is generally maximum at the node and minimum (zero) at the abdomen. This is true when the ultrasonic vibration can be regarded as pure longitudinal vibration, but cannot simply be regarded as such when the probe tip 3a is curved.
  • the outer peripheral shape of the probe tip 3a is formed in the probe tip 3a with a first stress concentration region where stress due to ultrasonic vibration is concentrated and a second stress concentration region where stress due to gripping is concentrated.
  • these two stress concentration regions are designed to be located apart in the longitudinal axis direction (Y-axis direction) of the probe unit 3 (probe 10). That is, the outer peripheral shape of the probe tip 3a is shifted from the point where the cross-sectional shape of the probe tip 3a starts to change in two planes (XY plane and YZ plane) penetrating the central axis in the longitudinal axis direction of the probe 10. It is formed to be.
  • FIGS. 7A and 7B are diagrams showing cross-sectional shapes in the XY plane and the YZ plane passing through the central axis in the longitudinal axis direction of the probe tip 3a of the probe unit 3, respectively.
  • the probe tip portion 3a passes through the central axis in the longitudinal axis direction of the probe and has a cross-sectional shape in the longitudinal axis direction of the probe and a direction (X-axis direction) orthogonal to the longitudinal axis direction and the thickness direction (X-axis direction).
  • the outer peripheral shape) starts to change, that is, has a first shape change point that starts to curve toward the tip of the probe.
  • the probe tip 3a passes through the central axis in the longitudinal axis direction of the probe and passes in the probe thickness direction (Z-axis) perpendicular to the longitudinal axis direction (Y-axis direction) of the probe.
  • the cross-sectional shape (peripheral shape, that is, the shape of the cross-sectional contour) in the direction of the first direction starts to change, that is, has a second shape change point that starts to become thinner toward the tip of the probe. These two shape change points are located apart in the longitudinal direction of the probe as shown in FIGS. 7A and 7B.
  • the stress concentration point due to the ultrasonic wave received from the ultrasonic transducer unit 2 substantially coincides with the position of the first shape change point.
  • the stress concentration point due to gripping received from the gripping unit substantially coincides with the position of the second shape change point. That is, the first stress concentration region is a region including the first shape change point, and the second stress concentration region is a region including the second shape change point. Similar to the two shape change points, these two stress concentration regions are located apart in the longitudinal direction of the probe.
  • the first shape change point of the probe tip 3a shown in FIG. 7A includes the second shape change point. It is formed so that the shape is smoothly continuous before and after. Thereby, it is possible to avoid that the stress concentration point due to ultrasonic vibration approaches the stress concentration point due to gripping.
  • the ultrasonic treatment instrument 1 of the present embodiment when driven at a frequency of 47 kHz, a desired amplitude necessary for the treatment is obtained by the probe tip 3a, and a stress concentration region by ultrasonic waves and a stress concentration region by gripping are obtained.
  • the first and second shape change points are separated by about 2 mm to 6 mm, preferably about 2.51 mm to 5.68 mm, in the longitudinal axis direction of the probe 10. It is derived by simulation. These numerical values are not limited and are values that can be appropriately changed depending on the shape and size of the probe.
  • this ultrasonic treatment instrument can be applied to treatment of a harder biological tissue.
  • this ultrasonic treatment tool is less susceptible to bending due to bending stress by dispersing the stress concentration region, it can be used in a state where tension is applied to the probe tip. Thus, the cutting ability of the ultrasonic treatment instrument can be improved.
  • the shape changing point of the probe tip 3a is designed to be smoothly continuous before and after that.
  • focusing on the stress concentration region due to gripping it is effective to form a local stepped portion or tapered portion whose shape changes sharply in the probe tip portion 3a.
  • a step portion that rapidly changes the cross-sectional shape of the probe tip 3a is formed as the second shape change point. Then, the stress due to gripping is concentrated on this stepped portion.
  • the stress concentration area due to gripping is reliably separated from the stress concentration area due to ultrasonic waves, and the two stress concentration areas are dispersed. Is possible.
  • the outer peripheral shape of the probe tip portion in the ultrasonic treatment instrument includes the first stress concentration region applied to the probe tip portion by the ultrasonic transducer unit and the first stress concentration region applied to the probe tip portion by the gripping unit. 2 stress concentration regions are set to be dispersed. Thereby, the tolerance with respect to the stress of the probe front-end
  • DESCRIPTION OF SYMBOLS 1 ... Ultrasonic treatment tool, 2 ... Ultrasonic transducer unit, 3 ... Probe unit, 3a ... Probe tip part, 4 ... Sheath unit, 5 ... Handle unit, 6 ... Vibrator cover, 7 ... Cable, 8 ... Electric cord , 9... Power supply device main body, 10... Probe, 11... Threaded portion, 12 .. Flange portion, 13 .. Sheath body, 14 .. Jaw (gripping unit), 15. DESCRIPTION OF SYMBOLS ... Guide cylinder, 19 ... Knob member, 20 ... Fixed handle, 21 ... Holding cylinder, 22 ... Movable handle, 23 ... Rotation knob, 24 ... Arm part, 25 ...

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Mechanical Engineering (AREA)
  • Biomedical Technology (AREA)
  • Dentistry (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne un outil de traitement par ultrasons équipé comme suit : un transducteur ultrasonore pour créer des vibrations ultrasonores ; une sonde, dont l'extrémité de base est reliée au transducteur ultrasonore et qui vibre de façon ultrasonore ; et une unité de préhension qui est prévue en face de la sonde le long de la direction longitudinale de la sonde et qui attrape du tissu somatique entre l'unité de préhension et la sonde par rotation par rapport à la pointe de la sonde. Sur la pointe de la sonde dans l'outil de traitement par ultrasons, une première région de concentration des contraintes, où la contrainte appliquée à partir du transducteur ultrasonore en conséquence des vibrations ultrasonores est concentrée, est formée et une seconde région de concentration des contraintes, où la contrainte appliquée par l'unité de préhension au moment de la prise du tissu somatique est concentrée, est formée. En outre, la forme circonférentielle externe de la pointe de la sonde est telle que la première et la seconde région de concentration des contraintes sont séparées dans la direction longitudinale de la sonde.
PCT/JP2012/071900 2011-09-21 2012-08-29 Outil de traitement par ultrasons WO2013042515A1 (fr)

Applications Claiming Priority (2)

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US201161537321P 2011-09-21 2011-09-21
US61/537,321 2011-09-21

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WO2013042515A1 true WO2013042515A1 (fr) 2013-03-28

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2001161706A (ja) * 1999-12-09 2001-06-19 Olympus Optical Co Ltd 超音波手術装置
JP2005253874A (ja) * 2004-03-15 2005-09-22 Olympus Corp 超音波処置具
JP2009082711A (ja) * 2007-09-28 2009-04-23 Olympus Medical Systems Corp 外科手術装置

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2001161706A (ja) * 1999-12-09 2001-06-19 Olympus Optical Co Ltd 超音波手術装置
JP2005253874A (ja) * 2004-03-15 2005-09-22 Olympus Corp 超音波処置具
JP2009082711A (ja) * 2007-09-28 2009-04-23 Olympus Medical Systems Corp 外科手術装置

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