WO2015122350A1 - Dispositif et procédé de traitement par énergie - Google Patents

Dispositif et procédé de traitement par énergie Download PDF

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Publication number
WO2015122350A1
WO2015122350A1 PCT/JP2015/053265 JP2015053265W WO2015122350A1 WO 2015122350 A1 WO2015122350 A1 WO 2015122350A1 JP 2015053265 W JP2015053265 W JP 2015053265W WO 2015122350 A1 WO2015122350 A1 WO 2015122350A1
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Prior art keywords
mucous membrane
treatment device
living tissue
energy
energy treatment
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PCT/JP2015/053265
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English (en)
Japanese (ja)
Inventor
雅人 成澤
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オリンパス株式会社
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Publication of WO2015122350A1 publication Critical patent/WO2015122350A1/fr

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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
    • A61B18/12—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
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • 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
    • A61B18/1482—Probes or electrodes therefor having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
    • 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
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/0016—Energy applicators arranged in a two- or three dimensional array
    • 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
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • 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
    • 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
    • A61B2018/1467—Probes or electrodes therefor using more than two electrodes on a single probe

Definitions

  • the present invention relates to an energy treatment device and an energy treatment method for sealing a biological tissue such as a blood vessel, an organ, or a vascular tissue.
  • Patent Document 1 Japanese Patent Application Laid-Open No. 2012-105987 (hereinafter referred to as Patent Document 1) and Japanese Patent Application Laid-Open No. 2012-239899 (hereinafter referred to as Patent Document 2) disclose sealing of biological tissues such as blood vessels and vascular tissues.
  • An electrosurgical forceps which is a scissors-type treatment tool to be used, is shown.
  • a living tissue is grasped between a pair of openable and closable jaw members, and electric and physical energy are applied to the grasping surface of the jaw member to facilitate the extraction of collagen and elastin which are extracellular substrates of the living tissue.
  • the blood vessel and vascular tissue are sealed.
  • the present invention has been made paying attention to the above circumstances, and an object of the present invention is to provide an energy treatment device and an energy treatment method capable of easily and reliably sealing and anastomosing living tissue.
  • At least a part of the mucous membrane on the surface where two living tissues are in contact with the gripping part sandwiching the living tissue and the two living tissues sandwiched between the gripping parts is removed at the same time.
  • an energy treatment device comprising an energy application unit that applies an anastomosis by applying a target and / or physical energy.
  • an adhesive capable of adhering a living tissue to a surface where the two living tissues are in contact with each other in a state where the two living tissues are overlapped and sandwiched between the holding portions. And an electrical and / or physical connection between the two living tissues in a state where the adhesive supplied from the adhesive supplying section is injected into a surface where the two living tissues are in contact with each other.
  • an energy treatment device comprising: an energy application unit configured to apply a target energy for anastomosing.
  • a step of sandwiching two biological tissues in a state of being overlapped between gripping parts, and a mucous membrane removing function part is moved on the surface where the two biological tissues are in contact to at least partially
  • a step of removing, and in a state in which the mucous membrane removing function unit removes the mucous membrane and extracts the extracellular matrix of the living tissue, the surface from which the mucous membrane has been removed is electrically and / or physically And applying an energy to anastomoses.
  • an energy treatment device and an energy treatment method capable of easily and reliably performing sealing and anastomosis of living tissue.
  • FIG. 1 is a perspective view showing an overall schematic configuration of the energy treatment device according to the first embodiment of the present invention.
  • FIG. 2 is a side view of the main part showing the distal end portion of the energy treatment device according to the first embodiment.
  • FIG. 3 is a perspective view showing a mucous membrane removal function part of the energy treatment device according to the first embodiment.
  • FIG. 4 is a side view showing a state in which the grip portion of the energy treatment device according to the first embodiment is closed.
  • FIG. 5 is a side view showing a state in which the grip portion of the energy treatment device according to the first embodiment is opened.
  • FIG. 6 is a side view showing a state in which two living tissues are sandwiched between a pair of jaws of the grasping portion of the energy treatment device according to the first embodiment.
  • FIG. 1 is a perspective view showing an overall schematic configuration of the energy treatment device according to the first embodiment of the present invention.
  • FIG. 2 is a side view of the main part showing the distal end portion of the energy treatment
  • FIG. 7 is a longitudinal sectional view showing a state in which the mucous membrane removing function part of the energy treatment device according to the first embodiment is housed in the housing room.
  • FIG. 8 is a diagram illustrating a flowchart for explaining the operation of the energy treatment device according to the first embodiment.
  • FIG. 9 is a flowchart for explaining a modified example of the operation of the energy treatment device according to the first embodiment.
  • FIG. 10 is a perspective view showing a first modification of the mucous membrane removal function part of the energy treatment device according to the first embodiment.
  • FIG. 11 is a perspective view showing a second modification of the mucous membrane removal function part of the energy treatment device according to the first embodiment.
  • FIG. 12 is a side view of the main part showing the distal end portion of the energy treatment device according to the second embodiment of the present invention.
  • FIG. 13 is a side view showing the ultrasonic probe of the energy treatment device according to the second embodiment.
  • FIG. 14 is a side view illustrating a state in which a grip portion of the energy treatment device according to the second embodiment is opened.
  • FIG. 15 is a side view showing a state in which two living tissues are sandwiched between a pair of jaws of a grip portion of the energy treatment device according to the second embodiment.
  • FIG. 16 is a longitudinal sectional view showing a state in which the mucous membrane removal function part of the energy treatment device according to the second embodiment is housed in the housing room.
  • FIG. 17 is a side view showing a state in which the grip portion of the energy treatment device according to the third embodiment of the present invention is opened.
  • FIG. 18 is a perspective view illustrating an adhesive injection portion of the energy treatment device according to the third embodiment.
  • FIG. 19 is a longitudinal sectional view of a main part showing an adhesive injection part of the energy treatment device according to the third embodiment.
  • FIG. 20 is a side view showing a state in which the grip portion of the energy treatment device according to the third embodiment is closed.
  • FIG. 21 is a longitudinal sectional view showing a state where the adhesive injection portion of the energy treatment device according to the third embodiment is housed in the housing chamber.
  • FIG. 1 is a perspective view showing a schematic configuration of the entire system of the therapeutic treatment apparatus 1.
  • the system of the therapeutic treatment apparatus 1 in FIG. 1 includes the energy treatment apparatus 2, the control apparatus 3, and the foot switch 4 according to the present embodiment.
  • the energy treatment device 2 is provided with a handle (operation unit) 5 for an operator to hold by hand, a cylindrical sheath 6 attached to the handle 5, and a distal end of the sheath 6. And a gripping portion 7.
  • the gripping portion 7 is a pair of openable and closable gripping members that hold the living tissue by moving at least one relative to the other, and in this embodiment, an upper jaw 8a and a lower jaw 8b, Have
  • FIG. 2 is a side view showing a peripheral portion of the grip portion 7 of the energy treatment device 2 of the first embodiment.
  • the base end of the upper jaw 8a is rotatably connected to the distal end of the sheath 6 via a rotation pin 9a
  • the base end of the lower jaw 8b is rotatable via a rotation pin 9b. It is connected to.
  • the upper jaw 8a and the lower jaw 8b are formed by an energy application section capable of supplying heat energy, for example, a bipolar high-frequency electrode.
  • the energy application part of the upper jaw 8a and the lower jaw 8b may be a heater that is electrically heated other than the high-frequency electrode, a probe that can transmit ultrasonic vibrations, and the like.
  • the handle 5 includes a plurality of operation levers 10 for opening and closing the grip portion 7.
  • the operation lever 10 When the operation lever 10 is operated, the base end portion of the upper jaw 8a rotates about the rotation pin 9a, and at the same time, the base end portion of the lower jaw 8b rotates about the rotation pin 9b, The lower jaw 8b and the upper jaw 8a are driven to open and close.
  • a cable 11 is connected to the handle 5.
  • the other end of the cable 11 is connected to the control device 3.
  • the cable 11 and the control device 3 are detachably connected by a connector 12.
  • a foot switch 4 is connected to the control device 3.
  • the foot switch 4 operated with a foot may be replaced with a switch operated with a hand or other switches.
  • the sheath 6 is housed in the distal end of the sheath 6 so that the mucous membrane removing function part 13 that can protrude and retract between the upper jaw 8a and the lower jaw 8b and the mucous membrane removing function part 13 can be inserted and removed.
  • a mucous membrane removal function part storage part 14 is provided.
  • the mucous membrane removal function unit 13 has a file-like contact surface 13b having a large number of minute irregularities on both upper and lower surfaces of a flat plate 13a. In FIG. 3, only the file-like contact surface 13b on the upper surface side is shown.
  • the file-like contact surface 13b is like a file having minute irregularities, and for example, a steel file described in JIS B4703 can be used.
  • the mucous membrane removal function unit 13 includes two biological tissues to be treated (first biological tissue H1 and second biological tissue) between the upper jaw 8a and the lower jaw 8b of the gripping unit 7.
  • the tissue H2) is inserted between the first biological tissue H1 and the second biological tissue H2 in a state where the tissue H2) is sandwiched therebetween.
  • the surface where the first living tissue H1 and the second living tissue H2 are in contact with each other is damaged by moving the mucous membrane removal function unit 13 in the axial direction of the sheath 6, thereby causing the first living tissue H1 and the first living tissue H1 to be damaged. It is possible to remove at least a part of the mucous membrane on the surface in contact with the second living tissue H2.
  • the first living tissue H1 and the second living tissue H2 may be two parts of the same living tissue (for example, the stomach wall) or different living tissues (for example, the stomach wall and the intestinal tract).
  • the base end portion of the mucous membrane removal function unit 13 is, for example, an operation lever (drive) of the mucous membrane removal function unit 13 provided on the handle 5 side via an operation force transmission member (movement mechanism) 15 such as an operation rod or a wire. (Means) 16.
  • the operation lever 16 is provided so as to be movable in the axial direction of the sheath 6 along a guide groove 17 formed on the handle 5 side.
  • the mucous membrane removal function unit 13 is caused to enter between the upper jaw 8a and the lower jaw 8b of the gripping unit 7 by manually sliding the operation lever 16 along the guide groove 17 in the axial direction of the sheath 6. It can be moved between a use position (see FIG. 2) and a retracted position (see FIG. 7) housed in the mucous membrane removal function section housing section.
  • a slide mechanism is formed that allows the mucous membrane removal function unit 13 to be slidably operated between the use position and the retracted position.
  • the high-frequency electrodes (energy application units) of the upper jaw 8a and the lower jaw 8b of the present embodiment are connected to a high-frequency power supply line (not shown) disposed inside the sheath 6.
  • the base end portion of the high-frequency power supply line is connected to the control device 3 via, for example, a cable 11 that can supply high-frequency power. Then, by the pedal operation of the foot switch 4, the supply of energy from the control device 3 to the energy treatment device 2 is switched to the ON state, whereby high-frequency power is supplied to the upper jaw 8a and the lower jaw 8b, and the upper jaw 8a High frequency heating by the lower jaw 8b becomes possible.
  • FIG. 8 shows a flowchart of the present embodiment.
  • the grip portion 7 and the sheath 6 of the energy treatment device 2 are closed with the gap between the upper jaw 8a and the lower jaw 8b of the grip portion 7 as shown in FIG. Is inserted into the abdominal cavity through the abdominal wall, for example.
  • the grasping portion 7 is brought close to the two biological tissues to be treated (the first biological tissue H1 and the second biological tissue H2)
  • the operator operates the operation lever 10 as shown in FIG.
  • the gap between the upper jaw 8a and the lower jaw 8b of the gripping part 7 is opened.
  • the mucous membrane removing function unit 13 is held at a use position where it is inserted between the upper jaw 8a and the lower jaw 8b.
  • the first living tissue H1 and the second living tissue H2 are inserted between the upper jaw 8a and the lower jaw 8b of the grip portion 7.
  • the upper jaw 8a and the lower jaw 8b are closed with the mucous membrane removal function part 13 sandwiched between the first living tissue H1 and the second living tissue H2 to be treated.
  • the first biological tissue H1 and the second biological tissue H2 to be treated are gripped by the operation (step of sandwiching the mucous membrane removal function unit 13 at the use position between the two biological tissues (step S1)).
  • the mucous membrane removal function unit 13 is moved in the axial direction by manually sliding the operation lever 16 along the guide groove 17 in the axial direction.
  • the surface where the first living tissue H1 and the second living tissue H2 are in contact with each other is rubbed and damaged by the file-like contact surface 13b of the mucosal removal function unit 13, and the cell membrane is destroyed.
  • At least a part of the mucous membrane on the surface where the living tissue H1 and the second living tissue H2 are in contact is removed (step of removing at least a part of the mucous membrane by the mucous membrane removing function unit 13 (step S2)).
  • the mucous membrane on the surface where the first living tissue H1 and the second living tissue H2 are in contact with each other is removed by the file-like contact surface 13b of the mucous membrane removing function unit 13, thereby the first living tissue H1 and the second living tissue H2 are removed.
  • Collagen and elastin, which are the extracellular matrix of the living tissue, are directly extracted from the surface in contact with the living tissue H2.
  • the mucous membrane removal function part storage part is moved from the use position between the upper jaw 8 a and the lower jaw 8 b by the operation of sliding in the axial direction along the guide groove 17 by manual operation. 14 is moved to the retracted position housed in 14 (the step of moving the mucous membrane removal function unit 13 to the retracted position (step S3)).
  • step S4 A step of anastomosing the contacting surfaces is performed.
  • the first biological body is moved by moving the mucous membrane removing function unit 13 in a state where the first biological tissue H1 and the second biological tissue H2 are overlapped and sandwiched between the grasping unit 7. At least a part of the mucous membrane on the surface where the tissue H1 and the second living tissue H2 are in contact with each other is removed. At this time, collagen and elastin, which are the extracellular matrix of the living tissue, are directly extracted from the surface where the first living tissue H1 and the second living tissue H2 are in contact with each other.
  • the anastomosis in which the first living tissue H1 and the second living tissue H2 are in contact with each other is performed.
  • the sealing and anastomosis of the surface H3 can be performed easily and reliably.
  • the mucosa removing function unit 13 is moved to the retracted position by operating the operation lever 16. Therefore, when the upper jaw 8a and the lower jaw 8b apply energy to the living tissues H1 and H2, the mucous membrane removal function unit 13 is connected to the anastomosis surface H3 where the first living tissue H1 and the second living tissue H2 contact each other. There is no danger of blocking or anastomosing.
  • the mucous membrane removal function unit 13 protruding in advance to the use position is sandwiched between the first living tissue H1 and the second living tissue H2.
  • the configuration in which the operation of closing the upper jaw 8a and the lower jaw 8b is shown in the state the configuration may be as shown in the flowchart of the modified example of FIG.
  • the following steps S11 to S15 are performed.
  • step S11 a process of superimposing two biological tissues in a state where the mucous membrane removal function unit 13 is in the retracted position is performed.
  • step S12 a step is performed in which the mucous membrane removal function unit 13 is intruded between two superimposed biological tissues and moved to the use position.
  • step S13 a step of removing at least a part of the mucous membrane by the mucosa removing function unit 13 is performed.
  • step S14 a step of moving the mucous membrane removal function unit 13 to the retracted position is performed.
  • step S15 a process of anastomosing the surfaces where the two living tissues are in contact is performed.
  • the tip of the mucous membrane removing function portion 13 sharp, for example, when sealing and anastomosing a living tissue such as the intestinal tract, the upper jaw 8a and the lower jaw 8b are opened in the state of FIG.
  • an operation of closing the upper jaw 8a and the lower jaw 8b between the separated first living tissue H1 and second living tissue H2 is performed. It is also possible to put the first living tissue H1 and the second living tissue H2) in an overlapping manner.
  • the mucous membrane removal function part 13 showed the structure which has the file-like contact surface 13b which has many micro unevenness
  • the configuration in which the mucous membrane removal function unit 13 is moved in the axial direction by the operation of sliding the operation lever 16 in the axial direction along the guide groove 17 manually is shown.
  • the mucous membrane removal function unit 13 may be moved in the axial direction.
  • FIG. 10 is a perspective view showing a first modification of the mucous membrane removal function part 13 of the energy treatment device 2 of the first embodiment (see FIGS. 1 to 8).
  • the mucous membrane removal function part 21 of this modification has a plurality of chevron-shaped protrusions 21b on both upper and lower surfaces of a flat plate 21a.
  • FIG. 10 only the plurality of mountain-shaped protrusions 21b on the upper surface side are shown.
  • These chevron-shaped protrusions 21b do not necessarily need to be regularly arranged side by side, and may be arranged at random.
  • FIG. 11 is a perspective view showing a second modification of the mucous membrane removal function part 13 of the energy treatment device 2 of the first embodiment (see FIGS. 1 to 8).
  • the mucous membrane removal function part 31 of this modification has a large number of minute needle-like parts 31b on both upper and lower surfaces of a flat plate 31a.
  • Each needle-like part 31b has, for example, a round bar-like needle body.
  • FIG. 11 only a large number of needle-like parts 31b on the upper surface side are shown. These needle-like parts 31b do not necessarily have to be regularly arranged side by side, and may be arranged at random.
  • the mucous membrane removal function part 21 of the first modification and the mucous membrane removal function part 31 of the second modification can be used similarly to the mucous membrane removal function part 13 of the first embodiment. Therefore, in the state where two biological tissues to be treated (first biological tissue H1 and second biological tissue H2) are overlapped and sandwiched between the upper jaw 8a and the lower jaw 8b of the grip portion 7, It is inserted between the living tissue H1 and the second living tissue H2. In this state, the first living tissue H1 and the second living tissue H2 are damaged by damaging the surface where the first living tissue H1 and the second living tissue H2 are in contact with each other by moving the mucous membrane removal function unit 21 or 31 in the axial direction. At least a part of the mucous membrane on the surface in contact with the living tissue H2 can be removed.
  • [Second Embodiment] (Constitution) 12 to 16 show a second embodiment of the present invention.
  • the present embodiment is a modification in which the configuration of the energy treatment device 2 of the first embodiment (see FIGS. 1 to 8) is changed as follows.
  • FIG. 12 to FIG. 16 the same parts as those in FIG. 1 to FIG.
  • FIG. 12 is a side view of the main part showing the distal end portion of the energy treatment device 41 of the second embodiment.
  • the energy treatment apparatus 41 according to the present embodiment is configured by configuring the mucous membrane removal function unit 13 according to the first embodiment with an ultrasonic probe 43 of an ultrasonic device 42.
  • the ultrasonic device 42 has a vibrator unit 45 having an ultrasonic vibrator 44.
  • FIG. 13 is a side view illustrating a schematic configuration of the entire vibrator unit 45.
  • the transducer unit 45 is an assembly in which an ultrasonic transducer 44 and a probe 43 that is a rod-shaped vibration transmitting member that transmits ultrasonic vibration generated by the ultrasonic transducer 44 are integrally assembled.
  • the ultrasonic transducer 44 is connected to a horn 46 that amplifies the amplitude.
  • the horn 46 is made of duralumin or a titanium alloy such as 6Al-4V (64Ti).
  • the horn 46 is formed in a conical shape whose outer diameter becomes narrower toward the distal end side, and an outward flange 47 is formed on the base end outer peripheral portion.
  • the probe 43 has a probe main body 48 formed of, for example, a titanium alloy such as 64Ti. On the proximal end side of the probe main body 48, an ultrasonic transducer 44 connected to the horn 46 is disposed. In this way, a transducer unit 45 in which the probe 43 and the ultrasonic transducer 44 are integrated is formed.
  • the probe main body 48 of the probe 43 has a male screw (not shown) formed on the outer peripheral portion of the base end, and is screwed with a female screw (not shown) formed on the inner peripheral portion of the horn 46 to join the horn 46.
  • the ultrasonic vibration generated by the ultrasonic transducer 44 is amplified by the horn 46 and then transmitted to the tip 49 side of the probe 43.
  • a treatment portion for treating living tissue is formed at the distal end portion 49 of the probe 43.
  • two rubber linings 50 are attached to the outer peripheral surface of the probe main body 48 at intervals of vibration nodes located in the middle of the axial direction at intervals formed in a ring shape with an elastic member. These rubber linings 50 prevent contact between the outer peripheral surface of the probe main body 48 and the operation pipe of the insertion sheath 6 made of a mantle tube. That is, when the insertion sheath portion 6 is assembled, the probe 43 as the transducer integrated probe is inserted into the operation pipe. At this time, the rubber lining 50 prevents contact between the outer peripheral surface of the probe main body 48 and the operation pipe.
  • the cable 51 of the ultrasonic transducer 44 is connected to the ultrasonic power source 52.
  • electric power is supplied from the ultrasonic power source 52 to the ultrasonic transducer 44 to vibrate the ultrasonic transducer 44.
  • This ultrasonic vibration is transmitted to the tip 49 of the probe 43.
  • tip part 49 of the probe 43 is used as a mucous membrane removal function part of this Embodiment.
  • the ultrasonic probe 43 of the present embodiment is driven by a slide mechanism having the same configuration as that of the mucous membrane removal function unit 13 of the first embodiment.
  • the tip 49 of the ultrasonic probe 43 is moved by the manual operation of sliding the operation lever 16 provided on the handle 5 side along the guide groove 17 with the upper jaw 8a and the lower jaw 8b of the gripping portion 7. It is possible to move between a use position (see FIG. 15) to enter between and a retracted position (see FIG. 16) housed in the mucous membrane removal function section housing section 14.
  • the grasping portion 7 and the sheath 6 of the energy treatment device 41 are closed with the gap between the upper jaw 8a and the lower jaw 8b of the grasping portion 7 (shown in FIG. 12). Is inserted into the abdominal cavity through the abdominal wall, for example. Thereafter, after the grasping portion 7 is brought close to the two living tissues to be treated (the first living tissue H1 and the second living tissue H2), the operator operates the operation lever 10 as shown in FIG. Then, the gap between the upper jaw 8a and the lower jaw 8b of the gripping part 7 is opened. At this time, the distal end portion 49 of the probe 43 serving as a mucous membrane removing function portion is held at a use position where it is inserted between the upper jaw 8a and the lower jaw 8b.
  • the first living tissue H1 and the second living tissue H2 are inserted between the upper jaw 8a and the lower jaw 8b of the grip portion 7.
  • the upper jaw 8a and the lower jaw 8b are placed with the tip 49 of the probe 43 sandwiched between the first living tissue H1 and the second living tissue H2 to be treated.
  • the first living tissue H1 and the second living tissue H2 to be treated are grasped by the closing operation (step of sandwiching the two living tissues in an overlapped state).
  • the first living tissue H1 and the second living body are removed by removing the mucous membrane on the surface where the first living tissue H1 and the second living tissue H2 are in contact with each other by ultrasonic vibration of the distal end portion 49 of the probe 43.
  • Collagen and elastin which are extracellular matrices of living tissue, are directly extracted from the surface in contact with the tissue H2.
  • the first biological tissue H1 and the second biological tissue H2 are overlapped and sandwiched between the grasping portion 7 and the first vibration is generated by ultrasonic vibration of the distal end portion 49 of the probe 43. At least a part of the mucous membrane on the surface where the first living tissue H1 and the second living tissue H2 are in contact with each other is removed. At this time, collagen and elastin, which are the extracellular matrix of the living tissue, are directly extracted from the surface where the first living tissue H1 and the second living tissue H2 are in contact with each other.
  • the anastomosis in which the first living tissue H1 and the second living tissue H2 are in contact with each other is performed.
  • the sealing and anastomosis of the surface H3 can be performed easily and reliably.
  • the distal end portion 49 of the probe 43 is moved to the retracted position by operating the operation lever 16. Therefore, when the upper jaw 8a and the lower jaw 8b apply energy to the living tissues H1 and H2, the anastomosis surface H3 where the distal end portion 49 of the probe 43 contacts the first living tissue H1 and the second living tissue H2. There is no risk of disturbing the blockage and anastomosis.
  • FIGS. 1 to 8 show a third embodiment of the present invention.
  • the present embodiment is a modification in which the configuration of the energy treatment device 2 of the first embodiment (see FIGS. 1 to 8) is changed as follows.
  • FIG. 17 to FIG. 21 the same parts as those in FIG. 1 to FIG.
  • the energy treatment device 61 of the present embodiment is capable of protruding and retracting the adhesive injection function part 62 between the upper jaw 8a and the lower jaw 8b at the distal end of the sheath 6 and the adhesive injection function part 62.
  • a storage portion 63 is provided for storage.
  • the adhesive injection function unit 62 has a plurality of adhesive injection ports 62b on both upper and lower surfaces of a flat plate 62a, for example, as shown in FIG. In FIG. 18, only the plurality of adhesive inlets 62b on the upper surface side are shown.
  • the plurality of adhesive injection ports 62b communicate with an adhesive supply passage 62c formed in the plate 62a as shown in FIG.
  • the proximal end portion of the adhesive supply passage 62c is in communication with an adhesive supply portion (not shown).
  • an adhesive supply means (not shown) is connected to the adhesive supply section.
  • This adhesive supply means is constituted by, for example, a syringe or an electric pump.
  • the adhesive is supplied from the adhesive supply unit to the adhesive supply passage 62c, and the adhesive is injected to the outside from the plurality of adhesive injection ports 62b of the adhesive injection function unit 62.
  • the adhesive to be injected from the adhesive injection function part 62 may be any liquid that is the same component as the collagen or elastin of the extracellular matrix, as long as it is a member that assists the joining of living tissues.
  • a biological adhesive is used. May be.
  • the adhesive injection function unit 62 of the present embodiment is driven by a slide mechanism having the same configuration as that of the mucous membrane removal function unit 13 of the first embodiment. Then, the adhesive injection function part 62 is moved between the upper jaw 8a and the lower jaw 8b of the gripping part 7 by manually sliding the operation lever 16 provided on the handle 5 side along the guide groove 17 in the axial direction. It can be moved between a use position (see FIG. 20) to enter the storage section 63 and a retracted position (see FIG. 21) stored in the storage section 63.
  • the grip portion 7 and the sheath 6 of the energy treatment device 61 are, for example, through the abdominal wall in a state where the upper jaw 8a and the lower jaw 8b are closed. It is inserted into the abdominal cavity. Thereafter, after the grasping portion 7 is brought close to the two living tissues to be treated (the first living tissue H1 and the second living tissue H2), the operator operates the operation lever 10 as shown in FIG. Then, the gap between the upper jaw 8a and the lower jaw 8b of the gripping part 7 is opened. At this time, the adhesive injection function part 62 is held at a use position where it is inserted between the upper jaw 8a and the lower jaw 8b.
  • the first living tissue H1 and the second living tissue H2 are inserted between the upper jaw 8a and the lower jaw 8b of the grip portion 7.
  • the upper jaw 8a and the lower jaw 8b are connected with the adhesive injection function part 62 sandwiched between the first living tissue H1 and the second living tissue H2 to be treated.
  • the first living tissue H1 and the second living tissue H2 to be treated are grasped by the closing operation (step of sandwiching the two living tissues in an overlapped state).
  • the adhesive supply means is driven.
  • the adhesive is supplied from the adhesive supply means to the adhesive supply passage 62c, and the adhesive is injected to the outside from the plurality of adhesive injection ports 62b of the adhesive injection function part 62.
  • an adhesive agent is inject
  • the adhesive injected from the adhesive injection function part 62 may be any member that helps to join biological tissues in addition to a liquid having the same component as the collagen and elastin of the extracellular matrix. May be used. Thereby, the liquid of the same component as collagen and elastin of the extracellular matrix is sufficiently supplied to the surface where the first living tissue H1 and the second living tissue H2 are in contact with each other.
  • anastomosis surface H3 where the first living tissue H1 and the second living tissue H2 contact each other can be easily and reliably sealed and anastomosed.
  • an adhesive injection function part 62 that can protrude and retract between the upper jaw 8a and the lower jaw 8b at the distal end of the sheath 6, and the adhesive injection function part 62 can be taken in and out.
  • a storage portion 63 is provided for storage. Then, the adhesive is injected into the outside from the plurality of adhesive injection ports 62b of the adhesive injection function unit 62 in a state where the first biological tissue H1 and the second biological tissue H2 are overlapped and sandwiched between the gripping portions 7. To be. At this time, the surface where the first living tissue H1 and the second living tissue H2 are in contact with each other is sufficiently supplied with collagen and elastin which are the extracellular matrix of the living tissue.
  • the first living tissue H1 and the second living tissue H2 are in contact with each other by heating the first living tissue H1 and the second living tissue H2 by performing high-frequency heating with the 8a and the lower jaw 8b.
  • the anastomosis surface H3 can be easily and reliably sealed and anastomosed.
  • the adhesive injection function part 62 is moved to the retracted position by operating the operation lever 16. Therefore, when the upper jaw 8a and the lower jaw 8b apply energy to the living tissues H1 and H2, the adhesive injection function unit 62 causes the anastomosis surface H3 where the first living tissue H1 and the second living tissue H2 contact each other. There is no risk of disturbing the blockage and anastomosis.
  • the present invention is not limited to the above embodiment.
  • the energy treatment device 2 of the first embodiment see FIGS. 1 to 8 or the energy treatment device 41 of the second embodiment (see FIGS. 12 to 16) and the third embodiment ( You may combine with the energy treatment apparatus 61 of FIG. 17 thru
  • various modifications can be made without departing from the scope of the present invention.
  • Appendix [1] A gripping part that sandwiches two biological tissues in an overlapped state, an adhesive output part that injects an adhesive capable of adhering the biological tissue to a surface that contacts the two biological tissues, and the adhesive output part
  • An energy treatment device comprising: an energy application unit configured to apply an electrical and / or physical energy to the surface into which the adhesive has been injected and anastomoses.
  • the main body of the energy treatment device moves to move the adhesive output part between a use position where the adhesive output part enters between the gripping parts and a retracted position deviated from the use position.
  • Treatment device [3] The energy treatment device according to [1], wherein the gripping part sandwiches two living tissues with the adhesive output part sandwiched therebetween. [4] The energy treatment device according to [2], wherein the driving unit extends the adhesive output unit so as to enter between two living tissues sandwiched by the grasping unit.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Otolaryngology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Plasma & Fusion (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (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

L'invention concerne un dispositif de traitement par énergie (2), ledit dispositif comprenant : une partie de maintien (7) qui maintient des tissus biologiques (H1, H2) ; une partie servant à supprimer les muqueuses (13) qui élimine au moins une partie de la muqueuse au niveau des surfaces où les deux tissus biologiques (H1, H2) se rejoignent quand la partie de maintien (7) fait chevaucher les tissus biologiques (H1, H2) ; une mâchoire supérieure (8a) et une mâchoire inférieure (8b) qui, en tant que parties d'application d'énergie, appliquent une énergie électrique ou physique qui anastomose les surfaces où la muqueuse a été supprimée quand la matrice extracellulaire des tissus biologiques est extraite après élimination de la muqueuse par la partie servant à supprimer les muqueuses (13).
PCT/JP2015/053265 2014-02-17 2015-02-05 Dispositif et procédé de traitement par énergie WO2015122350A1 (fr)

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JP2014-027747 2014-02-17
JP2014027747A JP2015150282A (ja) 2014-02-17 2014-02-17 エネルギー処置装置とエネルギー処置方法

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2009125442A (ja) * 2007-11-27 2009-06-11 Olympus Corp 生体組織接合装置
JP2010029687A (ja) * 2001-04-20 2010-02-12 Power Medical Interventions Llc 双極性の又は超音波の外科用装置
JP2012105987A (ja) * 2010-11-17 2012-06-07 Tyco Healthcare Group Lp 減少したエネルギー消費の脈管組織の密閉の方法および装置
JP5231659B2 (ja) * 2010-01-22 2013-07-10 オリンパスメディカルシステムズ株式会社 治療用処置装置
JP2013537086A (ja) * 2010-09-17 2013-09-30 アエスキュラップ アーゲー シール強化組成物で増強された電気外科的組織シーリング

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2010029687A (ja) * 2001-04-20 2010-02-12 Power Medical Interventions Llc 双極性の又は超音波の外科用装置
JP2009125442A (ja) * 2007-11-27 2009-06-11 Olympus Corp 生体組織接合装置
JP5231659B2 (ja) * 2010-01-22 2013-07-10 オリンパスメディカルシステムズ株式会社 治療用処置装置
JP2013537086A (ja) * 2010-09-17 2013-09-30 アエスキュラップ アーゲー シール強化組成物で増強された電気外科的組織シーリング
JP2012105987A (ja) * 2010-11-17 2012-06-07 Tyco Healthcare Group Lp 減少したエネルギー消費の脈管組織の密閉の方法および装置

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