WO2016075745A1

WO2016075745A1 - Medical treatment apparatus

Info

Publication number: WO2016075745A1
Application number: PCT/JP2014/079766
Authority: WO
Inventors: 光神保
Original assignee: オリンパス株式会社
Priority date: 2014-11-10
Filing date: 2014-11-10
Publication date: 2016-05-19

Abstract

This medical treatment apparatus comprises a vibration unit that includes an ultrasonic vibrator which generates ultrasonic vibrations, a probe 6 which has one end to which the vibration unit is attached and which vibrates longitudinally due to the ultrasonic vibrations generated at the ultrasonic vibrator, and a sheath 8 that supports the probe 6. The probe 6 has a distal end part 63, a base end part 61 that includes the one end, and a bendable bending part 62 that is provided between the distal end part 63 and the base end part 61 and has a diameter that is smaller than the distal end part 63 and the base end part 61. The probe 6 is formed such that at least one node of the longitudinal ultrasonic vibrations is positioned in each of the distal end part 63 and the base end part 61. The sheath 8 supports the probe 6 only at the position of the node of the longitudinal ultrasonic vibrations in the distal end part 63 and at the position of the node of the longitudinal ultrasonic vibrations in the base end part 61.

Description

Medical treatment device

The present invention relates to a medical treatment apparatus.

2. Description of the Related Art Conventionally, medical treatment apparatuses that coagulate and incise (hereinafter, referred to as treatment) a living tissue using ultrasonic vibration are known.
Such a medical treatment apparatus includes a probe that vibrates (extends and contracts in the longitudinal direction) by longitudinal vibration by ultrasonic vibration generated in the ultrasonic vibrator. And in the said medical treatment apparatus, the outer periphery in the front-end | tip part of a probe is made to contact a biological tissue, and the said biological tissue is treated by transmitting a longitudinal vibration to a biological tissue.
By the way, in recent years, considering the degree of invasiveness to a patient, a laparoscopic surgical operation is performed in which a small hole is opened in the abdomen of the patient and a part of a medical treatment device (probe tip, etc.) is inserted to treat a living tissue. Has become mainstream. In such a laparoscopic surgical operation, since the position where the tip of the probe is inserted is determined in advance, the operability (easiness of treatment) can be achieved if the tip of the inserted probe is bent. It is expected to improve significantly.

And the medical treatment apparatus shown below is known as a structure in which the tip of a probe etc. can be bent (for example, refer to patent documents 1).
A medical treatment device described in Patent Document 1 includes a probe (medical ultrasonic blade) in which a first blade portion, a second blade portion, and a third blade portion are sequentially arranged along the longitudinal direction, and an outer periphery of the probe. And a covering sheath.
The probe is formed such that the diameter of the second blade portion is smaller than the diameter of the first and third blade portions, and the probe can be bent at the second blade portion. The probe is formed so that the longitudinal vibration node is located in each of the first to third blade portions.
The sheath contacts and supports (fixes) the probe at each position of the longitudinal vibration node in the first to third blade portions.

Japanese Patent No. 5259420

By the way, when the probe is vibrated by longitudinal vibration while the probe is curved, the vibration vectors in the curved portion (second blade portion in the example described in Patent Document 1) vary widely. It becomes.
And when the 2nd blade part is fixed with a sheath like the medical treatment device of patent documents 1, if the probe is vibrated by a longitudinal vibration in the state where it was bent, the curved part will be fixed. Therefore, a vibration loss occurs in the curved portion, and as a result, the vibration strength of the tip portion of the probe is lowered. That is, there is a problem that the vibration intensity of the longitudinal vibration transmitted to the living tissue is lowered, and the living tissue cannot be sufficiently treated.

The present invention has been made in view of the above, and an object of the present invention is to provide a medical treatment apparatus capable of improving operability and sufficiently treating living tissue.

In order to solve the above-described problems and achieve the object, a medical treatment apparatus according to the present invention includes a vibrating unit having an ultrasonic transducer that generates ultrasonic vibrations, and the vibrating unit is attached to one end. A probe that vibrates by longitudinal vibration by ultrasonic vibration generated in an ultrasonic vibrator, and a support member that supports the probe, the probe including a distal end portion, a proximal end portion including the one end, A bendable bending portion provided between the distal end portion and the proximal end portion and having a small diameter dimension with respect to the distal end portion and the proximal end portion, and the longitudinal vibration node is disposed on the distal end portion and At least one longitudinal vibration node at the distal end portion and at least one longitudinal vibration node at the proximal end portion, and at least one longitudinal vibration node at the distal end portion. Only with the position of Characterized in that for supporting the probe.

According to the medical treatment apparatus of the present invention, it is possible to improve the operability and to sufficiently treat the living tissue.

FIG. 1 is a diagram schematically showing a medical treatment system according to an embodiment of the present invention. FIG. 2 is a diagram schematically illustrating the configuration of the probe and the vibration unit illustrated in FIG. 1. FIG. 3 is a diagram schematically showing the positions of antinodes and nodes of longitudinal vibration in the probe shown in FIG. FIG. 4 is a diagram schematically showing the configuration of the sheath shown in FIG. FIG. 5A is a diagram for explaining the effect of the embodiment of the present invention. FIG. 5B is a diagram for explaining the effect of the embodiment of the present invention. FIG. 6 is a diagram for explaining the effect of the embodiment of the present invention.

DETAILED DESCRIPTION Hereinafter, modes for carrying out the present invention (hereinafter referred to as embodiments) will be described with reference to the drawings. The present invention is not limited to the embodiments described below. Furthermore, the same code | symbol is attached | subjected to the same part in description of drawing.

[Schematic configuration of medical treatment system]
FIG. 1 is a diagram schematically showing a medical treatment system 1 according to an embodiment of the present invention.
The medical treatment system 1 treats (coagulates and incises) a living tissue to be treated using ultrasonic vibration. As shown in FIG. 1, the medical treatment system 1 includes a treatment tool 2, a control device 3, and a foot switch 4.

[Configuration of treatment tool]
The treatment instrument 2 has a function as a medical treatment apparatus according to the present invention, and is, for example, a surgical treatment instrument for performing treatment on a living tissue through the abdominal wall. As shown in FIG. 1, the treatment instrument 2 includes an operation unit 5, a probe 6, a vibration unit 7 (see FIG. 2), a sheath 8, and a jaw 9.
The operation unit 5 is a part where the surgeon operates the treatment tool 2. As shown in FIG. 1, the operation unit 5 includes a cylindrical part 51 having a cylindrical shape, a grip part 52 integrally formed with the cylindrical part 51 and gripped by an operator, an opening / closing operation part 53, A bending operation unit 54.

The opening / closing operation portion 53 causes the jaw portion 9 to perform an opening / closing operation (an operation in which the jaw portion 9 rotates relative to the sheath 8 to open / close the tip of the probe 6 (the left end portion in FIG. 1)). The operator performs an operation (hereinafter referred to as opening / closing operation) and is supported by the cylindrical portion 51 so as to be movable along the axial direction of the cylindrical portion 51. The opening / closing operation unit 53 is connected to an opening / closing mechanism (not shown) provided in the sheath 8, and moves along the axial direction of the cylindrical portion 51 in accordance with the opening / closing operation. The unit 9 is opened and closed.

The bending operation portion 54 is a portion where an operator performs an operation (hereinafter referred to as a bending operation) when the probe 6 performs a bending operation (an operation in which the bending portion 62 of the probe 6 is bent). The bending operation unit 54 is connected to a bending mechanism (not shown) provided inside the sheath 8 and causes the probe 6 to perform a bending operation via the bending mechanism in accordance with the bending operation.
The bending operation unit 54 in the present embodiment has two operation buttons. When one of the buttons is pressed, the probe 6 bends upward, and returns straight if the pressing force is lost. In addition, when the other button is pushed in, it bends in the right direction, and when the pushing force is lost, it returns straight. Furthermore, the probe 6 is configured to be able to rotate 360 ° in the radial direction with respect to the longitudinal direction. For this reason, approaches from various angles are possible with respect to the place to be treated.
Note that various known mechanisms can be adopted as the above-described opening / closing mechanism and bending mechanism (see, for example, Japanese Patent No. 4862105).

FIG. 2 is a diagram schematically illustrating the configuration of the probe 6 and the vibration unit 7.
In FIG. 2, for convenience of explanation, the curved portion 62 of the probe 6 is shown in a curved state.
As shown in FIG. 2, the probe 6 has a long cylindrical shape, and a part thereof is configured to be bendable. The probe 6 has a vibrating portion 7 attached to one end (the right end portion in FIG. 1 and the lower end portion in FIG. 2), and the ultrasonic vibration generated in the vibrating portion 7 is transmitted from one end to the other end ( 1 to the left end, and the upper end in FIG. As shown in FIG. 2, the probe 6 includes a proximal end portion 61, a bending portion 62, and a distal end portion 63.

As shown in FIG. 2, the base end portion 61 has a cylindrical shape extending along the longitudinal direction of the probe 6, and is a portion including the one end described above (a portion to which the vibrating portion 7 is attached).
As shown in FIG. 2, the distal end portion 63 has the same shape as the proximal end portion 61 and is a portion including the other end described above. In FIG. 1, only a part of the tip portion 63 of the probe 6 is shown.

As shown in FIG. 2, the curved portion 62 has a columnar shape extending along the longitudinal direction of the probe 6, and is in a state of being coaxial with the proximal end portion 61 and the distal end portion 63, and thus the proximal end portion 61 and the distal end portion 63. This is the part that connects
The curved portion 62 has a diameter smaller than the diameter of the proximal end portion 61 and the distal end portion 63 and is configured to be bendable. That is, the probe 6 is configured to be bendable at the bending portion 62 as shown in FIG.

The vibration unit 7 generates ultrasonic vibrations and causes the probe 6 to generate longitudinal vibrations. As shown in FIG. 2, the vibration unit 7 includes an ultrasonic transducer 71 and a horn 72.
The ultrasonic vibrator 71 is composed of a piezoelectric vibrator using a piezoelectric element that expands and contracts when an AC voltage is applied.
The horn 72 is a member that expands ultrasonic vibration (amplitude) generated in the ultrasonic vibrator 71. The horn 72 has a truncated cone shape, and has a posture in which the central axis of the truncated cone coincides with the central axis Ax of the probe 6 (see FIG. 3). ) Is attached to one end (base end portion 61) of the probe 6.

The ultrasonic transducer 71 described above is attached to the bottom surface of the horn 72 as shown in FIG. And the ultrasonic transducer | vibrator 71 is electrically connected to the control apparatus 3 via the electric cable C (FIG. 1), and an AC voltage is applied under control by the control apparatus 3, thereby the center of the horn 72 Extends and contracts along the axis. That is, the ultrasonic transducer 71 is configured to generate longitudinal vibration (ultrasonic vibration). The longitudinal vibration generated by the ultrasonic transducer 71 is magnified by the horn 72 and causes the probe 6 to generate longitudinal vibration via the horn 72.
The vibration part 7 described above is arranged inside the cylindrical part 51.

FIG. 3 is a diagram schematically showing the positions of the antinodes and nodes of the longitudinal vibration in the probe 6.
In the probe 6 described above, as shown in FIG. 3, the node of longitudinal vibration has the center position of the base end portion 61 (center position in the direction along the center axis Ax) and the center position of the bending portion 62 (on the center axis Ax). The center position in the direction along the center) and the center position of the tip 63 (the center position in the direction along the center axis Ax).
Further, as shown in FIG. 3, the probe 6 has an antinode of longitudinal vibration where one end of the probe 6 (the end of the base end portion 61), the boundary between the base end portion 61 and the curved portion 62, the curved portion 62 and the distal end portion 63. , And the other end of the probe 6 (the end of the tip 63).
That is, the length dimension (length dimension in the direction along the central axis Ax) of the base end portion 61, the curved portion 62, and the distal end portion 63 is set to be a half wavelength of longitudinal vibration.

FIG. 4 is a diagram schematically showing the configuration of the sheath 8. Specifically, FIG. 4 is a cross-sectional view schematically showing a structure for supporting the probe 6 by the sheath 8 by breaking the sheath 8.
In FIG. 4, for the convenience of explanation, illustration of an opening / closing mechanism and a bending mechanism provided inside the sheath 8 is omitted.
The sheath 8 covers the outer periphery of the probe 6 excluding the tip portion of the probe 6 (a part of the tip portion 63) and supports the probe 6. That is, the sheath 8 has a function as a support member according to the present invention. As shown in FIG. 4, the sheath 8 includes a sheath body 81 and a support portion 82.

The sheath body 81 has a cylindrical shape similar to that of the cylindrical portion 51, and one end (the right end portion in FIG. 1) is a cylinder in a state where the central axis of the sheath main body 81 coincides with the central axis of the cylindrical portion 51. It is fixed to the part 51. In the present embodiment, the sheath body 81 has flexibility and bends together with the probe 6 according to the curve of the probe 6 (curved portion 62). The entire sheath body 81 is not limited to a flexible configuration, and only a portion of the sheath body 81 that covers the curved portion 62 may have a flexible configuration (for example, a bellows shape).

As shown in FIG. 4, the support portion 82 has an annular shape fixed to the inner peripheral surface of the sheath body 81, and supports (fixes) the probe 6 by contacting the probe 6. Specifically, the support part 82 has a shape in which the width dimension (the length dimension in the direction along the central axis) decreases as it goes toward the central axis of the support part 82. And the support part 82 is each arrange | positioned in each position of the node of the longitudinal vibration in the base end part 61 and the front-end | tip part 63, and contact | abuts to the base end part 61 and the front-end | tip part 63 in each said position, respectively. That is, the sheath 8 supports the probe 6 only at each position of the longitudinal vibration node at the proximal end portion 61 and the distal end portion 63.

The jaw 9 is formed of an arc-shaped plate that follows the outer peripheral surface of the probe 6. The jaw 9 is pivotally supported by the other end (the left end in FIG. 1) of the sheath body 81 and is supported via an opening / closing mechanism in accordance with an opening / closing operation to the opening / closing operation unit 53 by the operator. Thus, the sheath body 81 is rotated and the other end (tip portion 63) of the probe 6 is opened and closed. That is, the treatment instrument 2 can clamp the living tissue between the other end of the probe 6 and the jaw 9 according to the opening / closing operation.

[Configuration of control device and foot switch]
The foot switch 4 is a part operated by the operator with his / her foot. Then, in response to the operation (ON) to the foot switch 4, the control device 3 starts driving control of the ultrasonic transducer 71.
The means for starting the drive control of the ultrasonic transducer 71 is not limited to the foot switch 4, and other switches that are operated by hand may be employed.
The control device 3 includes a CPU (Central Processing Unit) and the like, and executes drive control of the ultrasonic transducer 71 according to a predetermined control program when the foot switch 4 is turned on.

[Operation of medical treatment device]
Next, operation | movement of the medical treatment apparatus 1 mentioned above is demonstrated.
The surgeon grasps the treatment instrument 2 and inserts the distal end portion of the treatment instrument 2 (the other end of the probe 6 and the jaw 9) into the abdominal cavity through the abdominal wall, for example. Subsequently, the surgeon positions the living tissue to be treated between the other end of the probe 6 and the jaw 9 by a bending operation while the other end of the probe 6 and the jaw 9 are opened by an opening / closing operation. Then, the surgeon closes the other end of the probe 6 and the jaw 9 by an opening / closing operation, and holds the living tissue to be treated. Thereafter, the surgeon operates (ON) the foot switch 4 to start driving control of the ultrasonic transducer 71 by the control device 3.
And the control apparatus 3 applies an alternating voltage to the ultrasonic transducer | vibrator 71, and vibrates the probe 6 by a longitudinal vibration. And the control apparatus 3 stops the application of the alternating voltage to the ultrasonic transducer | vibrator 71, after predetermined time passes. In this embodiment, the application is stopped after a predetermined time as described above. However, the AC voltage may be applied / stopped directly by turning the foot switch on / off.
Through the above processing, longitudinal vibration (ultrasonic vibration) is transmitted to the living tissue for a predetermined time, and the living tissue is treated (coagulated, incised).

FIG. 5A, FIG. 5B, and FIG. 6 are diagrams for explaining the effects of the present embodiment. Specifically, FIGS. 5A and 5B are diagrams showing simulation results when the probe 6 is vibrated by longitudinal vibration while the probe 6 is bent. Here, FIG. 5A shows a simulation result when the probe 6 is supported (fixed) by the sheath 8 only at each position of the longitudinal vibration node at the base end portion 61 and the tip end portion 63 (this embodiment). Yes. FIG. 5B shows the case where the probe 6 is supported (fixed) by the sheath (conventional configuration) at all positions (three positions) of the longitudinal vibration nodes in the base end portion 61, the curved portion 62, and the distal end portion 63. Simulation results are shown. Note that in FIGS. 5A and 5B, the vibration intensity at each position of the probe 6 is expressed by brightness gradation. That is, in the probe 6, the part indicated by “white” indicates that the vibration intensity is the highest, and indicates that the vibration intensity is low as it approaches “black”. FIG. 6 shows the ratio of the vibration intensity at the distal end portion of the probe 6 to the output (vibration intensity) of the vibration unit 7 in this embodiment (when shown in FIG. 5A) and the conventional configuration (when shown in FIG. 5B). It is the figure compared by.

In the conventional configuration, as a simulation result, as shown in FIG. 5B, the vibration mode of the probe 6 collapses, and the entire probe 6 is wavy. Further, as shown in FIG. 6, the ratio of the vibration intensity at the distal end portion of the probe 6 to the output of the vibration portion 7 was about 0.5. That is, in the conventional configuration, since the bending portion 62 is fixed by the sheath, a vibration loss occurs in the bending portion 62, and as a result, it is considered that the vibration intensity at the tip portion of the probe 6 is reduced.

On the other hand, in the present embodiment, as a simulation result, the vibration mode of the probe 6 is maintained as shown in FIG. 5A. Further, as shown in FIG. 6, the ratio of the vibration intensity at the tip of the probe 6 to the output of the vibration unit 7 was about 1.0. That is, in the present embodiment, since the bending portion 62 is not fixed by the sheath 8, no vibration loss occurs in the bending portion 62, and as a result, the output of the vibration portion 7 is lost to the distal end portion of the probe 6. It is considered that the data is transmitted in a state where the signal is suppressed.
From the above, according to the treatment tool 2 according to the present embodiment, a sufficient treatment can be performed on a living tissue even if the probe 6 is bent. That is, according to the treatment tool 2 according to the present embodiment, the operability can be improved and the living tissue can be sufficiently treated.

Further, in the treatment instrument 2 according to the present embodiment, the probe 6 is formed such that only one longitudinal vibration node is located at each of the bending portion 62 and the distal end portion 63.
That is, the lengths of the curved portion 62 and the distal end portion 63 can be set to be relatively short. For this reason, by curving the probe 6, the distal end portion of the treatment instrument 2 can be moved within a small range, and the distal end portion of the treatment instrument 2 can be accurately positioned on the biological tissue to be treated. Therefore, the operability can be further improved.

In the treatment instrument 2 according to the present embodiment, the probe 6 is positioned so that the antinodes of longitudinal vibration are located at the boundary between the base end portion 61 and the bending portion 62 and the boundary between the bending portion 62 and the distal end portion 63, respectively. Is formed.
For this reason, it is possible to suppress vibration loss at the boundary between the base end portion 61 and the bending portion 62 and at the boundary between the bending portion 62 and the distal end portion 63. Therefore, the output of the vibration part 7 can be transmitted to the tip part of the probe 6 in a state where the loss is minimized.

(Other embodiments)
So far, the embodiment for carrying out the present invention has been described, but the present invention should not be limited only by the embodiment described above.
In the above-described embodiment, the probe 6 (the base end portion 61, the curved portion 62, and the distal end portion 63) has a circular shape in sectional view, but is not limited thereto, and has other cross-sectional shapes. You may comprise.

In the above-described embodiment, the jaw 9 is opened and closed with respect to the probe 6. However, the present invention is not limited to this, and the probe 6 and the jaw 9 are both opened and closed by moving both the probe 6 and the jaw 9. Or you may employ | adopt the structure which opens and closes the probe 6 with respect to the jaw part 9. FIG.
Moreover, in embodiment mentioned above, although the treatment tool 2 was set as the structure provided with the jaw part 9, it is not restricted to this, You may be set as the structure which abbreviate | omitted the jaw part 9. FIG. That is, when the living tissue is treated, the other end of the probe 6 and the jaw 9 are not sandwiched between the living tissue, and the other end of the probe 6 may be brought into contact with the living tissue.

In the above-described embodiment, the base end portion 61, the curved portion 62, and the distal end portion 63 have the same length, but the present invention is not limited thereto, and the base end portion 61, the curved portion 62, and the distal end portion are not limited thereto. You may comprise so that at least any one of the parts 63 may have a different length dimension. In other words, the base end portion 61, the curved portion 62, and the distal end portion 63 are formed so that only one longitudinal vibration node is located, but the present invention is not limited thereto, and the base end portion 61, the curved portion 62, and You may form so that the position of the node of the longitudinal vibration in at least any one among the front-end | tip parts 63 may become two or more.

In the above-described embodiment, only the ultrasonic vibration (ultrasonic energy) is applied to the living tissue. However, the present invention is not limited thereto, and the high frequency energy and the heat energy are also applied to the living tissue. It doesn't matter.

DESCRIPTION OF SYMBOLS 1 Medical treatment system 2 Treatment tool 3 Control apparatus 4 Foot switch 5 Operation part 6 Probe 7 Vibrating part 8 Sheath 9 Jaw part 51 Cylindrical part 52 Gripping part 53 Opening / closing operation part 54 Bending operation part 61 Base end part 62 Bending part 63 Tip Part 71 Ultrasonic vibrator 72 Horn 81 Sheath body 82 Support part Ax Central axis C Electric cable

Claims

A vibration part having an ultrasonic vibrator for generating ultrasonic vibration;
The vibration unit is attached to one end, and a probe that vibrates by longitudinal vibration by ultrasonic vibration generated in the ultrasonic vibrator;
A support member for supporting the probe,
The probe is
A distal end portion, a proximal end portion including the one end, a bendable bending portion provided between the distal end portion and the proximal end portion and having a small diameter with respect to the distal end portion and the proximal end portion; And at least one node of the longitudinal vibration is located at each of the distal end portion and the proximal end portion,
The support member is
The medical treatment apparatus, wherein the probe is supported only at the position of at least one longitudinal vibration node at the distal end portion and at least one position of the longitudinal vibration node at the proximal end portion.
The probe is
The medical treatment apparatus according to claim 1, wherein the bending portion is formed so that only one longitudinal vibration node is located.
The probe is
The antinode of the longitudinal vibration is formed so as to be positioned at a boundary between the distal end portion and the bending portion and a boundary between the bending portion and the proximal end portion, respectively. Medical treatment equipment.
The probe is
The medical treatment apparatus according to any one of claims 1 to 3, wherein only one longitudinal vibration node is positioned at the distal end portion.