WO2016075745A1 - Appareil de traitement médical - Google Patents

Appareil de traitement médical Download PDF

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Publication number
WO2016075745A1
WO2016075745A1 PCT/JP2014/079766 JP2014079766W WO2016075745A1 WO 2016075745 A1 WO2016075745 A1 WO 2016075745A1 JP 2014079766 W JP2014079766 W JP 2014079766W WO 2016075745 A1 WO2016075745 A1 WO 2016075745A1
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WO
WIPO (PCT)
Prior art keywords
probe
end portion
distal end
vibration
medical treatment
Prior art date
Application number
PCT/JP2014/079766
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English (en)
Japanese (ja)
Inventor
光 神保
Original Assignee
オリンパス株式会社
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 オリンパス株式会社 filed Critical オリンパス株式会社
Priority to PCT/JP2014/079766 priority Critical patent/WO2016075745A1/fr
Publication of WO2016075745A1 publication Critical patent/WO2016075745A1/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

Definitions

  • the present invention relates to a medical treatment apparatus.
  • 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
  • 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.
  • 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.
  • 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.
  • 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.
  • a medical treatment apparatus 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.
  • 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.
  • 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.
  • the medical treatment system 1 includes a treatment tool 2, a control device 3, and a foot switch 4.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • the curved portion 62 of the probe 6 is shown in a curved state.
  • 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.
  • the probe 6 includes a proximal end portion 61, a bending portion 62, and a distal end portion 63.
  • 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).
  • 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.
  • 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.
  • 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.
  • 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.
  • 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).
  • 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.
  • 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.
  • 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.
  • 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).
  • 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.
  • 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.
  • the support part 82 is each arrange
  • 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.
  • 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.
  • 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.
  • the surgeon operates (ON) the foot switch 4 to start driving control of the ultrasonic transducer 71 by the control device 3.
  • the control apparatus 3 applies an alternating voltage to the ultrasonic transducer
  • the control apparatus 3 stops the application of the alternating voltage to the ultrasonic transducer
  • the application is stopped after a predetermined time as described above.
  • the AC voltage may be applied / stopped directly by turning the foot switch on / off.
  • FIG. 5A, FIG. 5B, and FIG. 6 are diagrams for explaining the effects of the present embodiment.
  • FIGS. 5A and 5B are diagrams showing simulation results when the probe 6 is vibrated by longitudinal vibration while the probe 6 is bent.
  • 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).
  • 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.
  • 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.
  • the vibration mode of the probe 6 collapses, and the entire probe 6 is wavy.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • the jaw 9 is opened and closed with respect to the probe 6.
  • the probe 6 and the jaw 9 are both opened and closed by moving both the probe 6 and the jaw 9.
  • 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
  • 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.
  • 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.
  • the ultrasonic vibration (ultrasonic energy) is applied to the living tissue.
  • 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.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Otolaryngology (AREA)
  • Engineering & Computer Science (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (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

La présente invention concerne un appareil de traitement médical qui comprend une unité de vibration comprenant un vibrateur ultrasonore générant des vibrations ultrasonores, une sonde (6) dont une extrémité est fixée à l'unité de vibration et qui vibre longitudinalement grâce aux vibrations ultrasonores générées par le vibrateur ultrasonore, et une gaine (8) qui supporte la sonde (6). La sonde (6) comporte une partie d'extrémité (63) distale, une partie d'extrémité (61) de base qui comprend cette extrémité, et une partie de flexion (62) flexible qui est prévue entre la partie d'extrémité (63) distale et la partie d'extrémité (61) de base, et dont le diamètre est inférieur à la partie d'extrémité (63) distale et la partie d'extrémité (61) de base. La sonde (6) est formée de sorte qu'au moins un noeud des vibrations ultrasonores longitudinales est positionné dans chacune des parties d'extrémité distale (63) et d'extrémité de base (61). La gaine (8) supporte la sonde (6) uniquement au point du noeud des vibrations ultrasonores longitudinales se situant dans la partie d'extrémité (63) distale et au point du noeud des vibrations ultrasonores longitudinales se situant dans la partie d'extrémité (61) de base.
PCT/JP2014/079766 2014-11-10 2014-11-10 Appareil de traitement médical WO2016075745A1 (fr)

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PCT/JP2014/079766 WO2016075745A1 (fr) 2014-11-10 2014-11-10 Appareil de traitement médical

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Application Number Priority Date Filing Date Title
PCT/JP2014/079766 WO2016075745A1 (fr) 2014-11-10 2014-11-10 Appareil de traitement médical

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WO2016075745A1 true WO2016075745A1 (fr) 2016-05-19

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH02135006U (fr) * 1989-04-12 1990-11-09
JPH11113922A (ja) * 1997-10-15 1999-04-27 Olympus Optical Co Ltd 超音波処置具
JP2009523559A (ja) * 2006-01-20 2009-06-25 エシコン・エンド−サージェリィ・インコーポレイテッド 医療用超音波ブレードを有する超音波医療用器具
US20140005705A1 (en) * 2012-06-29 2014-01-02 Ethicon Endo-Surgery, Inc. Surgical instruments with articulating shafts

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH02135006U (fr) * 1989-04-12 1990-11-09
JPH11113922A (ja) * 1997-10-15 1999-04-27 Olympus Optical Co Ltd 超音波処置具
JP2009523559A (ja) * 2006-01-20 2009-06-25 エシコン・エンド−サージェリィ・インコーポレイテッド 医療用超音波ブレードを有する超音波医療用器具
US20140005705A1 (en) * 2012-06-29 2014-01-02 Ethicon Endo-Surgery, Inc. Surgical instruments with articulating shafts

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