WO2016117152A1 - Blood vessel removal device - Google Patents
Blood vessel removal device Download PDFInfo
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- WO2016117152A1 WO2016117152A1 PCT/JP2015/071675 JP2015071675W WO2016117152A1 WO 2016117152 A1 WO2016117152 A1 WO 2016117152A1 JP 2015071675 W JP2015071675 W JP 2015071675W WO 2016117152 A1 WO2016117152 A1 WO 2016117152A1
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- WIPO (PCT)
- Prior art keywords
- blood vessel
- peeling device
- electrode
- peeling
- cutting
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- 0 C*C(CC1CCC1)(CCC(C)(CC1)C[C@@]1(C)CCCCCC(C)C(C)CCCC1)CCC1(CC(C1C2)C12III)I Chemical compound C*C(CC1CCC1)(CCC(C)(CC1)C[C@@]1(C)CCCCCC(C)C(C)CCCC1)CCC1(CC(C1C2)C12III)I 0.000 description 2
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3209—Incision instruments
- A61B17/3211—Surgical scalpels, knives; Accessories therefor
-
- 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
Definitions
- the present invention relates to a blood vessel peeling device.
- Arterial grafts typified by the internal thoracic artery, gastroepiploic artery, and radial artery, and venous grafts typified by the great saphenous vein are used as bypass tubes when performing vascular bypass surgery (coronary artery bypass surgery: CABG) in the heart. It is widely known to use. At present, it has been reported that arterial grafts (particularly internal thoracic arteries) have a higher long-term patency rate than venous grafts.
- vein graft that is said to be inferior in the long-term patency rate
- surrounding tissues for example, fat, connective tissue, tissue between the skin layer and muscle layer, skin If it is collected in a state covered with tissue, bifurcated blood vessels, etc. between the layer and the periosteum, and used as a bypass tube in a state covered with the tissue, the long-term patency rate is improved.
- tissue for example, fat, connective tissue, tissue between the skin layer and muscle layer, skin If it is collected in a state covered with tissue, bifurcated blood vessels, etc. between the layer and the periosteum, and used as a bypass tube in a state covered with the tissue, the long-term patency rate is improved.
- tissue for example, fat, connective tissue, tissue between the skin layer and muscle layer, skin If it is collected in a state covered with tissue, bifurcated blood vessels, etc. between the layer and the periosteum, and used as a bypass tube in a state covered with the tissue, the long-term pat
- a guide wire (support member 50) is inserted into a blood vessel to be collected as a bypass tube, and the tubular member (portion 40) is pushed forward while being guided by the guide wire. It can be collected while covered with tissue.
- the device described in Patent Document 1 has a problem that the inner wall of the blood vessel may be damaged by the guide wire, and the workability of blood vessel collection (blood vessel separation) is poor.
- An object of the present invention is to provide a blood vessel peeling device having excellent blood vessel peeling workability.
- Such an object is achieved by the present inventions (1) to (9) below.
- a pair of insertion devices that are inserted into a living body along a blood vessel and sandwich a branched blood vessel that separates from the blood vessel in the living body;
- One said insertion device has the 1st groove
- the second insertion device opens on a surface facing the one insertion device, and the second insertion device faces the first groove when the branch blood vessel is sandwiched between the insertion device and the one insertion device.
- the other insertion device has a pair of first electrodes arranged to face each other via the second groove,
- the blood vessel peeling device according to any one of (1) to (3), wherein the processing device includes a second electrode and a cutting portion.
- the said processing device has said (1) thru
- the blood vessel peeling device according to any one of
- the processing device includes a first electrode and a second electrode that are arranged to face each other via a gap, and a cutting portion that is located behind the gap in the movement direction and cuts the branch blood vessel.
- the blood vessel peeling device according to any one of (1) to (3) above.
- a pair of the second electrodes are provided so as to face each other via the first electrode,
- the branch blood vessel can be sandwiched by the pair of insertion devices, and the displacement of the branch blood vessel can be suppressed, so that the processing of the branch blood vessel by the processing device is facilitated. Further, since the processing device can be inserted into the insertion device, the processing device can be operated smoothly, and the branch blood vessel can be processed more easily. Therefore, the blood vessel peeling device is excellent in blood vessel peeling workability.
- FIG. 1 is a plan view showing components of the blood vessel peeling device according to the first embodiment of the present invention.
- FIG. 2 is a cross-sectional view showing a skin side peeling device.
- 3 is a cross-sectional view taken along line BB in FIG. 4 is a cross-sectional view taken along line AA in FIG.
- FIG. 5 is a cross-sectional view of a state in which the first peeling device and the second peeling device shown in FIG. 4 are butted together.
- FIG. 6 is a cross-sectional view of a state where the first peeling device and the second peeling device shown in FIG. 4 are butted together.
- FIG. 7 is a cross-sectional view showing the processing device.
- FIG. 8 is a cross-sectional view showing the processing device.
- FIG. 8 is a cross-sectional view showing the processing device.
- FIG. 9 is a cross-sectional view for explaining the cutting position of the branch blood vessel by the processing device.
- FIG. 10 is a cross-sectional view showing the displacement of the cutting portion provided in the processing device.
- FIG. 11 is a side view showing the cutting device.
- 12 is a cross-sectional view taken along the line CC in FIG.
- FIG. 13 is a diagram for explaining a method of peeling a blood vessel.
- FIG. 14 is a diagram for explaining a method of peeling a blood vessel.
- FIG. 15 is a diagram for explaining a method of peeling blood vessels.
- FIG. 16 is a diagram for explaining a method of peeling a blood vessel.
- FIG. 17 is a diagram for explaining a method of peeling a blood vessel.
- FIG. 18 is a diagram for explaining a method of peeling a blood vessel.
- FIG. 19 is a diagram for explaining a method of peeling blood vessels.
- FIG. 20 is a plan view showing a fascia side peeling device included in the blood vessel peeling device according to the second embodiment of the present invention.
- 21 is a cross-sectional view of the fascia side peeling device shown in FIG.
- FIG. 22 is a side view showing a first peeling device included in the blood vessel peeling device according to the third embodiment of the present invention.
- FIG. 23 is a diagram for explaining a branch blood vessel processing method.
- FIG. 24 is a side view showing a first peeling device included in a blood vessel peeling device according to the fourth embodiment of the present invention.
- FIG. 25 is a diagram for explaining a branch blood vessel processing method.
- FIG. 26 is a cross-sectional view illustrating an example of a processing device.
- FIG. 27 is a perspective view showing a treatment device included in the blood vessel peeling device according to the fifth embodiment of the present invention.
- FIG. 28 is a cross-sectional view showing a state where the processing device shown in FIG. 27 is inserted into the cavity.
- FIG. 29 is a perspective view showing a treatment device included in the blood vessel peeling device according to the sixth embodiment of the present invention.
- 30 is a cross-sectional view showing a state in which the processing device shown in FIG. 29 is inserted into the cavity.
- FIG. 31 is a perspective view showing a treatment device included in the blood vessel peeling device according to the seventh embodiment of the present invention.
- FIG. 32 is a cross-sectional view showing a state where the processing device shown in FIG. 31 is inserted into the cavity.
- FIG. 33 is a cross-sectional view illustrating a method for treating a branch blood vessel.
- FIG. 34 is a cross-sectional view illustrating a method for treating a branch blood vessel.
- FIG. 35 is a plan view showing a second peeling device included in the blood vessel peeling device according to the eighth embodiment of the present invention.
- FIG. 36 is a cross-sectional view of the second peeling device shown in FIG.
- FIG. 37 is a diagram for explaining a branch blood vessel processing method.
- FIG. 38 is a diagram for explaining a branch blood vessel processing method.
- FIG. 39 is a side view showing a cutting device included in the blood vessel peeling device according to the ninth embodiment of the present invention.
- 40 is a cross-sectional view of the cutting device shown in FIG.
- FIG. 41 is a diagram for explaining a branch blood vessel processing method.
- FIG. 42 is a diagram for explaining a branch blood vessel processing method.
- FIG. 43 is a side view showing a cutting device included in the blood vessel peeling device according to the tenth embodiment of the present invention.
- FIG. 44 is a diagram for explaining a branch blood vessel processing method.
- FIG. 45 is a diagram for explaining a branch blood vessel processing method.
- FIG. 46 is a side view showing a cutting device included in the blood vessel peeling device according to the eleventh embodiment of the present invention.
- FIG. 47 is a cross-sectional view of the cutting device shown in FIG.
- FIG. 48 is a diagram for explaining a branch blood vessel processing method.
- FIG. 49 is a diagram for explaining a branch blood vessel processing method.
- FIG. 50 is a perspective view showing a cutting device included in a blood vessel peeling device according to a twelfth embodiment of the present invention.
- FIG. 51 is a perspective view showing a fascia side peeling device included in a blood vessel peeling device according to a twelfth embodiment of the present invention.
- FIG. 52 is a cross-sectional view showing a state in which the cutting device and the fascia side peeling device are opposed to each other.
- FIG. 53 is a diagram for explaining a branch blood vessel processing method.
- FIG. 53 is a diagram for explaining a branch blood vessel processing method.
- FIG. 54 is a diagram for explaining a branch blood vessel processing method.
- FIG. 55 is a perspective view showing a skin side peeling device and a fascia side peeling device included in a blood vessel peeling device according to a thirteenth embodiment of the present invention.
- FIG. 56 is a side view showing a cutting device included in a blood vessel peeling device according to a thirteenth embodiment of the present invention.
- FIG. 57 is a top view of the cutting device shown in FIG.
- FIG. 58 is a diagram for explaining a branch blood vessel processing method.
- FIG. 59 is a diagram for explaining a branch blood vessel processing method.
- FIG. 60 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a fourteenth embodiment of the present invention.
- FIG. 60 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a fourteenth embodiment of the present invention.
- FIG. 60 is
- FIG. 61 is a diagram illustrating a method for processing a branch blood vessel.
- FIG. 62 is a side view showing a cutting device included in a blood vessel peeling device according to a fifteenth embodiment of the present invention.
- FIG. 63 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a sixteenth embodiment of the present invention.
- FIG. 64 is a diagram for explaining a branch blood vessel processing method.
- FIG. 65 is a side view showing a cutting device included in a blood vessel peeling device according to a seventeenth embodiment of the present invention.
- FIG. 66 is a diagram for explaining a branch blood vessel processing method.
- FIG. 62 is a side view showing a cutting device included in a blood vessel peeling device according to a fifteenth embodiment of the present invention.
- FIG. 63 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a sixteenth
- FIG. 67 is a side view showing a cutting device included in a blood vessel peeling device according to an eighteenth embodiment of the present invention.
- FIG. 68 is a diagram for explaining a branch blood vessel processing method.
- FIG. 69 is a side view showing a cutting device included in a blood vessel peeling device according to a nineteenth embodiment of the present invention.
- FIG. 70 is a diagram for explaining a branch blood vessel processing method.
- FIG. 71 is a diagram for explaining a method of peeling a blood vessel.
- FIG. 1 is a plan view showing components of the blood vessel peeling device according to the first embodiment of the present invention.
- FIG. 2 is a cross-sectional view showing a skin side peeling device.
- 3 is a cross-sectional view taken along line BB in FIG. 4 is a cross-sectional view taken along line AA in FIG. 5 and 6 are cross-sectional views showing a state in which the first peeling device and the second peeling device shown in FIG. 4 are brought into contact with each other.
- 7 and 8 are cross-sectional views each showing a processing device.
- FIG. 9 is a cross-sectional view for explaining the cutting position of the branch blood vessel by the processing device.
- FIG. 9 is a cross-sectional view for explaining the cutting position of the branch blood vessel by the processing device.
- FIG. 10 is a cross-sectional view showing the displacement of the cutting portion provided in the processing device.
- FIG. 11 is a side view showing the cutting device.
- 12 is a cross-sectional view taken along the line CC in FIG.
- FIG. 13 to FIG. 19 are diagrams for explaining a method of peeling blood vessels.
- the right side in FIG. 1 is also referred to as “tip”, and the left side is also referred to as “base end”.
- a blood vessel peeling device 100 shown in FIG. 1 is a device used to collect a blood vessel used as a bypass tube when performing a blood vessel bypass operation (coronary artery bypass surgery: CABG). It can be collected in a state covered with tissue.
- the blood vessel collected using the blood vessel peeling device 100 is not particularly limited as long as it can be used as a bypass tube.
- the blood vessel to be collected is preferably the great saphenous vein among them.
- the blood vessel peeling device 100 As described above, it becomes easy to collect blood vessels in a state of being covered with surrounding tissues. Therefore, the large saphenous vein is collected using the blood vessel peeling device 100, By using as a bypass tube, the long-term patency after surgery is considered to be high. For this reason, below, the example which extract
- the blood vessel peeling device 100 includes a skin side peeling device 200, a fascia side peeling device 300, a processing device 400, and a cutting device 500.
- the skin side peeling device 200, the fascia side peeling device 300, and the cutting device 500 are devices that are inserted into the living body along the great saphenous vein, and the processing device 400 is inside the fascia side peeling device 300. It is a device to be inserted into.
- each of these devices will be described in detail.
- the skin-side peeling device 200 has a long rod shape that extends substantially linearly, and a peeling portion 220 that peels tissue is provided at the distal end portion. Moreover, as shown in FIG. 3, the skin side peeling device 200 has a flat shape crushed up and down.
- the cross-sectional shape of the skin side peeling device 200 is not particularly limited, but may be, for example, a shape in which a circle such as an ellipse or an ellipse is crushed, a rectangle with rounded corners, or the like.
- the width (length in the major axis direction of the cross section) W1 of the skin side peeling device 200 is larger than the outer diameter of the blood vessel to be collected (large saphenous vein in this embodiment).
- the width W1 is preferably about 4 mm to 4 cm larger than the outer diameter of the blood vessel to be collected.
- concave rails 231 and 232 extending in the axial direction are provided. These rails 231 and 232 are rails used to connect the cutting device 500, respectively.
- the configuration of the rails 231 and 232 is not particularly limited as long as it can be connected to the cutting device 500.
- the skin side peeling device 200 is provided with an insertion hole 210 that opens to the proximal end and extends to the distal end portion (peeling portion 220).
- the imaging device 900 is inserted into the insertion hole 210.
- the imaging device 900 is not particularly limited.
- the imaging device 900 according to the present embodiment includes a long main body 910, and an imaging unit (not shown) that emits illumination light to the distal end of the main body 910 and the front side of the skin-side peeling device 200 are imaged. Part 930 is provided.
- the imaging unit 930 includes, for example, an objective lens system provided at the distal end portion of the main body unit 910 and an imaging device (for example, a solid-state imaging device such as a CMOS image sensor or a CCD sensor) disposed to face the objective lens system. I have.
- an imaging device for example, a solid-state imaging device such as a CMOS image sensor or a CCD sensor
- the peeling part 220 is tapered toward the tip of the skin side peeling device 200. More specifically, the peeling section 220 has a substantially conical shape that is tapered so that both the length in the minor axis direction and the length in the major axis direction of the cross-sectional shape gradually decrease toward the distal end side. Such a peeling portion 220 is blunt in the thickness direction, and does not cut a branch blood vessel branched from the great saphenous vein, and has different properties (for example, fat and skin, fat and fascia) , Fat and blood vessels, fat and bone, etc.) have such a sharpness (dullness) that they can be separated from each other.
- properties for example, fat and skin, fat and fascia
- the shape of the peeling portion 220 is not particularly limited as long as the tissue can be peeled in the thickness direction (short axis direction).
- the length in the short axis direction of the cross-sectional shape of the peeling portion 220 is the tip side. It may be a duckbill shape tapering so as to gradually decrease toward the end and having a tip that is linear along the long axis direction.
- the peeling part 220 is substantially colorless and transparent and has light transmittance. Therefore, by inserting the imaging device 900 into the insertion hole 210 described above, the imaging device 900 can observe the front side of the skin-side peeling device 200 via the peeling portion 220. From this, the peeling part 220 has a function as an observation part which observes the inside of a living body besides the peeling function as mentioned above. Note that the peeling portion 220 is not limited to being colorless and transparent as long as it has light transparency, and may be colored red, blue, green, or the like.
- the fascia side peeling device 300 includes a first peeling device (insertion device) 310 and a second peeling device (insertion device) 320.
- the first peeling device 310 and the second peeling device 320 are used in a living body so as to face each other.
- the first peeling device 310 and the second peeling device 320 have the same configuration except that an electrode is disposed on the first peeling device 310.
- the first peeling device 310 has a long rod shape extending substantially linearly, and a peeling portion 311 for peeling tissue is provided at the tip.
- the second peeling device 320 also has a long rod shape extending substantially linearly, and a peeling portion 321 for peeling tissue is provided at the tip.
- These peeling parts 311 and 321 each taper toward the tip. More specifically, the lengths in the minor axis direction and the length in the major axis direction of the cross-sectional shapes of the peeling portions 311 and 321 are both tapered so as to gradually decrease toward the distal end side.
- Such peeling portions 311 and 321 are blunt in the thickness direction, and do not cut branch blood vessels branching from the great saphenous vein, but have different properties (for example, fat and skin, fat and Such as fascia, fat and blood vessels, fat and bone). Thereby, while being able to fully exhibit a peeling function, the damage and cutting
- the taper angle ⁇ of the peeling portions 311 and 321 in plan view is not particularly limited, but can be about 50 ° to 70 °.
- the shape of the peeling portions 311 and 321 is not particularly limited as long as the tissue can be peeled in the thickness direction, and may be, for example, a duckbill shape.
- first peeling device 310 and the second peeling device 320 each have a flat shape crushed up and down as shown in FIG.
- the cross-sectional shapes of the first peeling device 310 and the second peeling device 320 are rectangles with rounded corners, respectively.
- the cross-sectional shapes of the first peeling device 310 and the second peeling device 320 are not particularly limited, and may be a shape in which a circle such as an ellipse or an ellipse is crushed in addition to a rectangle.
- a concave rail 312 extending in the axial direction is provided on the upper surface (one main surface) of the first peeling device 310.
- a concave rail 322 extending in the axial direction is also provided on the upper surface of the second peeling device 320.
- These rails 312 and 322 are rails used to connect to the cutting device 500.
- the configurations of the rails 312 and 322 are not particularly limited as long as they can be connected to the cutting device 500, respectively.
- the first peeling device 310 and the second peeling device 320 are used so that the side surfaces are abutted with each other.
- the first peeling device 310 is provided with a groove (second groove) 313 that opens to an abutting surface (side surface on the second peeling device 320 side) 310 a.
- the groove 313 extends in the axial direction of the first peeling device 310 and opens at both the distal end and the proximal end.
- the second peeling device 320 is also provided with a groove (first groove) 323 that opens to the abutting surface (side surface on the first peeling device 310 side) 320a.
- the groove 323 extends in the axial direction of the second peeling device 320 and opens at both the distal end and the proximal end. As shown in FIG. 5, the grooves 313 and 323 communicate with each other to form a cavity 330 when the abutting surfaces 310 a and 320 a are abutted with each other.
- the hollow portion 330 functions as an insertion portion into which the processing device 400 is inserted. According to such a configuration, since the processing device 400 can be moved inside the first and second peeling devices 310 and 320, the processing by the processing device 400 can be performed more smoothly and accurately.
- each of the first peeling device 310 and the second peeling device 320 preferably has a width of about 20 mm to 40 mm, for example.
- the 1st peeling device 310 has the notches 314 and 315 opened to the butting surface 310a, as shown in FIG.
- the notches 314 and 315 are spaced apart from the distal end side and the proximal end side of the first peeling device 310.
- the second peeling device 320 has notches 324 and 325 that open to the abutting surface 320a.
- the notches 324 and 325 are spaced apart from the distal end side and the proximal end side of the second peeling device 320. Then, as shown in FIG.
- the great saphenous vein 1000 is not sandwiched between the first peeling device 310 and the second peeling device 320, and the damage, cutting, blood flow reduction, etc. of the great saphenous vein 1000 are prevented. Can do.
- notches are provided in both the first peeling device 310 and the second peeling device 320, but the notches are formed in the first peeling device 310 and the second peeling device 320. It only needs to be provided on one side.
- a pair of electrodes 316 and 317 are provided on the abutting surface 310a side of the first peeling device 310.
- the electrodes 316 and 317 extend in the axial direction between the notches 314 and 315, and are disposed to face each other via the groove 313.
- the electrodes 316 and 317 are connected to the same potential.
- These electrodes 316 and 317 are electrodes used to generate an electric field for cauterizing the branch blood vessel 1100, as will be described later.
- the electrodes 316 and 317 are exposed on the abutting surface 310a, but the electrodes 316 and 317 are not exposed on the abutting surface 310a and are embedded in the first peeling device 310. It may be.
- the insertion for inserting the imaging device 900 is inserted into the first and second peeling devices 310 and 320 in the same manner as the skin-side peeling device 200 described above.
- a hole may be provided.
- the first peeling device 310 and the second peeling device 320 can be more smoothly inserted into the living body.
- the fascia side peeling device 300 has two peeling devices, but the number of peeling devices is not particularly limited as long as it is two or more.
- the processing device 400 includes a rod-like long operation unit 410, an electrode 420 provided at the base end of the operation unit 410, and a cutting unit 430 provided at the base end of the electrode 420. And have.
- the operation unit 410 can be inserted into the cavity 330 of the fascia side peeling device 300. Further, the operation unit 410 can slide in the groove 323 without protruding to the groove 313 side of the first peeling device 310 in the cavity 330. As will be described later, since the branch blood vessel 1100 is sandwiched between the first peeling device 310 and the second peeling device 320, the branch blood vessel 1100 is located between the grooves 313 and 323 as shown in FIG. . Therefore, by making the operation unit 410 slidable in the groove 323, contact between the operation unit 410 and the branch blood vessel 1100 can be suppressed, and the processing device 400 can be operated smoothly. Further, damage and cutting of the branch blood vessel 1100 can be reduced.
- the electrode 420 is disposed to face the electrodes 316 and 317 with the branch blood vessel 1100 interposed therebetween, as shown in FIG.
- the electrode 420 is disposed so as to contact the branch blood vessel 1100. Therefore, when a high-frequency alternating voltage is applied between the electrode 420 and the electrodes 316 and 317, the electric field generated between them acts on the branch blood vessel 1100, cauterizing the branch blood vessel 1100, and heat coagulation (hemostasis). it can.
- the cutting unit 430 In the state where the operation unit 410 is inserted into the groove 323, the cutting unit 430 is disposed so as to straddle the boundary between the groove 313 and the groove 323. For this reason, the electrode 420 and the electrodes 316 and 317 have a bipolar structure, and if the operation unit 410 is slid to the distal end side while applying a high-frequency alternating voltage, it is between the first and second peeling devices 310 and 320.
- the branch blood vessels 1100 sandwiched between the two can be sequentially heat-coagulated, and the heat-coagulated branch blood vessels 1100 can be cut by the cutting unit 430.
- the bottom surface (surface facing the opening) of the groove 323 constitutes a guide surface (sliding surface) 323a for guiding the operation unit 410, and the operation unit 410 is slid on the guide surface 323a.
- the operation unit 410 does not protrude excessively toward the groove 313, and the state where the cutting unit 430 straddles the boundaries of the grooves 313 and 323 can be maintained. Therefore, the above work can be performed more smoothly and accurately.
- the guide surface 323a may be subjected to, for example, a coating process (such as a hydrophilic process) that reduces frictional resistance and increases slidability.
- the branch blood vessel 1100 is sandwiched between the electrode 420 and the electrode 316 (between the abutting surfaces 310a and 320a and crushed into a flat shape.
- Part 1101 and the part between electrode 420 and electrode 317 (the part which is sandwiched between the abutting surfaces 310a and 320a and flattened) 1102 is thermally coagulated, and the part 1101 and 1102 are cut by the cutting part 430. Is done. Therefore, bleeding from the branched blood vessel 1100 after cutting can be prevented.
- the branch blood vessel 1100 sandwiched between the first peeling device 310 and the second peeling device 320 can be easily stopped and cut.
- an electrode may also be disposed on the second peeling device 320 side.
- the electrode By arranging the electrode on the second peeling device 320 side so as to face the electrodes 316 and 317, it is possible to contact the electrode from both sides of the pressing portion of the branch blood vessel 1100, and heat coagulation is efficiently performed when energized. It becomes possible. Further, by providing the cutting unit 430 with an electrode function similar to that of the electrode 420, cutting in an energized state can be performed.
- the cutting part 430 is rotatable as indicated by an arrow B in FIG. 1, for example, and enters the groove 313 across the boundaries of the grooves 313 and 323 in FIG. However, it is preferable to be able to switch to a state in which the groove 313 does not enter and retracts into the groove 323. Accordingly, when the processing device 400 is inserted into the cavity 330, the large saphenous vein 1000 (the portion inserted through the through holes 334 and 335) by the cutting unit 430 is placed in the retracted state. Can be prevented.
- the state illustrated in FIG. 9 is also referred to as an “operating state”
- the state illustrated in FIG. 10 is also referred to as a “retracted state”.
- the cutting device 500 When the cutting device 500 moves along the saphenous vein 1000, the cutting device 500 cuts fat (including connective tissue) around the saphenous vein and cuts a branched blood vessel branched from the saphenous vein. ⁇ Stop bleeding.
- the cutting device 500 has a long plate shape. Moreover, the cutting device 500 has the groove
- the groove 520 has a tapered blood vessel guide groove 521 whose width gradually decreases toward the base end side, and a blood vessel processing groove 522 located on the base end side of the blood vessel guide groove 521 and having a substantially constant width. is doing.
- the blood vessel guide groove 521 is a groove that guides the branch blood vessel 1100 to the blood vessel processing groove 522 when the cutting device 500 is pushed in vivo, and has a tapered shape in order to perform this guidance smoothly.
- the blood vessel processing groove 522 is a groove for cutting and stopping the branch blood vessel guided by the blood vessel guide groove 521.
- the blood vessel processing groove 522 is provided with a processing unit 530 for cutting and stopping the branch blood vessel.
- the processing unit 530 has a bipolar structure including a pair of electrodes 531 and 532 that generate an electric field in the blood vessel processing groove 522.
- the electrode 531 is provided at the proximal end of the vascular treatment groove 522, and the electrode 532 is provided on both sides of the vascular treatment groove 522.
- the branch blood vessel 1100 guided by the blood vessel processing groove 522 can be cauterized, thermally coagulated, hemostatic, and cut.
- tip part 531a of the electrode 531 is sharp so that the branch blood vessel 1100 can be cut
- the width W2 of the blood vessel processing groove 522 is not particularly limited, but is preferably smaller than the outer diameter of the branch blood vessel 1100. As a result, as shown in FIG. 11, the branch blood vessel 1100 can be crushed in the blood vessel processing groove 522, so that the processing (particularly hemostasis) in the processing unit 530 can be performed more reliably.
- the cutting device 500 has a blade portion 550 that cuts fat around the saphenous vein 1000.
- the blade portion 550 is provided at the distal end portion of the cutting device 500, and is provided along the blood vessel guide groove 521 in the present embodiment. It is preferable that the blade part 550 has a sharpness that can cut fat without cutting the branch blood vessel 1100. Thereby, since cutting
- the cutting device 500 has a pair of protection parts 541 and 542 provided on both sides thereof as shown in FIG.
- Each of the protection parts 541 and 542 extends along the axial direction of the cutting device 500, and the peripheral surface (side surface or tip surface) is rounded.
- the protection unit 541 moves along the gap between fat and skin while peeling them. Since the fat and skin having different properties are easily peeled in this way, even if the tip of the protective part 541 is rounded, the peeling function for peeling the fat and the skin can be sufficiently exhibited.
- the cutting device 500 includes connection portions 581 and 582 that can be connected to the rails 231 and 232 of the skin-side peeling device 200, and a connection portion 583 that can be connected to the rails 312 and 322 of the fascia-side peeling device 300. is doing.
- the connection parts 581 and 582 are provided in the protection part 541, and the connection part 583 is provided in the protection part 542.
- These connecting portions 581, 582, 583 are configured by convex portions corresponding to the shapes of the rails 231, 232, 312, 322.
- the first step of peeling the large saphenous vein 1000 while being covered with the surrounding fat 1200 using the blood vessel peeling device 100 and the large saphenous vein 1000 were ligated.
- the skin side peeling device 200 in which the imaging device 900 is inserted is prepared.
- the skin side peeling device 200 is inserted into the living body along the great saphenous vein 1000 while being separated from the great saphenous vein 1000.
- the skin side peeling device 200 is arrange
- the skin side peeling device 200 is arranged so that the thickness direction thereof substantially coincides with the alignment direction of the skin side peeling device 200 and the great saphenous vein 1000.
- the skin side peeling device 200 is inserted from the incision portion 1310, and the distal end portion of the skin side peeling device 200 is protruded from the incision portion 1320. Further, in this work, the skin side peeling device 200 is inserted between the fat 1200 and the skin 1400 (between tissues having different properties), and the skin 1400 and the fat 1200 are inserted in the thickness direction of the skin side peeling device 200 (skin side). The peeling device 200 and the great saphenous vein 1000 are peeled in the direction of alignment). Since such a part is a part where it is particularly easy to peel off, this operation can be performed more smoothly and accurately.
- a fascia side peeling device 300 (first and second peeling devices 310 and 320) is prepared, and the first and second peeling devices 310 and 320 are sequentially separated from the great saphenous vein 1000 while It is inserted into the living body along the venous vein 1000. And the 1st, 2nd peeling device 310,320 is arrange
- the first and second peeling devices 310 and 320 are inserted from the incision portion 1310, and the tip portions thereof are protruded from the incision portion 1320.
- the first peeling device 310 and the second peeling device 320 are arranged side by side and slightly spaced from each other.
- the great saphenous vein 1000 may be located between the 1st peeling device 310 and the 2nd peeling device 320 by planar view.
- a branch blood vessel 1100 divided downward from the great saphenous vein 1000 passes between the first and second peeling devices 310 and 320.
- the first and second peeling devices 310 and 320 are inserted between the fat 1200 and the fascia 1500 (boundary portion of tissue having different properties), and the fat 1200 and the fascia 1500 are inserted into the first.
- the second peeling devices 310 and 320 are peeled in the thickness direction. Since such a part is a part where it is particularly easy to peel off, this operation can be performed more smoothly and accurately.
- the first peeling device 310 and the second peeling device 320 are abutted (approached) and fixed to each other so that the abutted state is maintained.
- the branch blood vessel 1100 that has passed between the first peeling device 310 and the second peeling device 320 is sandwiched between them, and the hollow blood vessel 330 so that the branched blood vessel 1100 that has been sandwiched crosses the hollow portion 330.
- the distal end side of the great saphenous vein 1000 is inserted into the through hole 334 including the notches 314 and 324, and the proximal end side is inserted.
- the through hole 335 is formed by the notches 315 and 325. Thereby, the large saphenous vein 1000 is not sandwiched between the first and second peeling devices 310 and 320, and damage, cutting, blood flow reduction, and the like of the large saphenous vein 1000 can be prevented.
- the fixing method of the first peeling device 310 and the second peeling device 320 is not particularly limited, but both end portions of the first peeling device 310 and the second peeling device 320 are exposed from the living body. Therefore, it is preferable to fix using a fixture etc. in both ends. Thereby, this work becomes easier.
- the processing device 400 is prepared and inserted into the cavity 330 (groove 323) from the tip side.
- the processing device 400 is moved to the distal end side while applying a high-frequency alternating voltage between the electrodes 316 and 317 included in the first peeling device 310 and the electrode 420 included in the processing device 400.
- the branch blood vessel 1100 is stopped and cut in order.
- the branch blood vessel 1100 is sandwiched between the first and second peeling devices 310 and 320, the displacement of the branch blood vessel 1100 is suppressed, and the processing of the branch blood vessel 1100 can be performed more reliably.
- the cutting device 500 is prepared, the connecting portion 581 is connected to the rail 231 of the skin side peeling device 200, and the connecting portion 583 is connected to the rail 322 of the second peeling device 320. Then, the cutting device 500 is inserted into the living body while being guided by the skin side peeling device 200 and the second peeling device 320, and the cutting device 500 is placed on one side of the great saphenous vein 1000 as shown in FIG. Deploy. At this time, the cutting device 500 peels the skin 1400 from the fat 1200 by the protection unit 541.
- the cutting device 500 cuts the fat 1200 on the side of the great saphenous vein 1000 by the blade 550 to the left and right (alignment direction of the cutting device 500 and the great saphenous vein 1000), and the processing unit 530 branches the blood vessel. 1100 is hemostatic and cut.
- the cutting device 500 is laterally separated from the large saphenous vein 1000 as shown in FIG. This can be pushed along the great saphenous vein 1000 while preventing damage to the great saphenous vein 1000 during this operation. Further, since the protective portions 541 and 542 are rounded, damage to the skin 1400 and fascia 1500 due to contact with the cutting device 500 can be reduced.
- the cutting device 500 is removed, and the connecting portion 582 of the extracted cutting device 500 is connected to the rail 232 of the skin side peeling device 200 and the connecting portion 583 is connected to the rail 312 of the first peeling device 310. Then, as in the previous operation, the cutting device 500 is inserted into the living body while being guided by the skin-side peeling device 200 and the first peeling device 310, and as shown in FIG. The cutting device 500 is arranged on the side. Thereby, the fat 1200 is cut right and left, and the branch blood vessel 1100 is stopped and cut by the processing unit 530.
- the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is peeled off while being covered with the surrounding fat 1200.
- the thickness of the fat 1200 that is peeled off together with the great saphenous vein 1000 and is located around the great saphenous vein 1000 is not particularly limited, but is preferably about 0.1 mm to 10 mm, and about 1 mm to 8 mm. More preferably, it is about 3 mm to 5 mm.
- the large saphenous vein 1000 is taken out of the living body through the incision 1310 or the incision 1320 while being covered with the surrounding fat 1200.
- the large saphenous vein 1000 can be collected in a state covered with the surrounding fat 1200.
- the skin-side peeling device 200 and the fascia-side peeling device 300 are used to reduce damage such as bleeding for portions that are easily peeled, and the cutting device 500 is used for fat 1200 that is difficult to peel. Therefore, the large saphenous vein 1000 can be collected with a smooth and low attack.
- the first step can be performed without cutting the saphenous vein 1000, blood can pass through the saphenous vein 1000 as long as possible. Therefore, the great saphenous vein 1000 having a shorter ischemic state and less damage can be collected.
- the upper side (skin 1400 side) of the great saphenous vein 1000 is peeled by the skin side peeling device 200. Since the upper side of the great saphenous vein 1000 tends to have fewer branch blood vessels 1100 than the lower side, the upper side of the great saphenous vein 1000 is only peeled by the skin side peeling device 200 without processing the branch blood vessel 1100. I do. In contrast, since a relatively large number of branch blood vessels 1100 are arranged below the saphenous vein 1000, the fascia side peeling device 300 performs peeling and the processing device 400 processes the branch blood vessels 1100. .
- the use of the peeling devices having different configurations on the upper and lower sides of the great saphenous vein 1000 allows the operation to be performed more smoothly.
- the upper side of the great saphenous vein 1000 may be peeled off using the fascia side peeling device 300 in the same manner as the lower side.
- the great saphenous vein 1000 covered with fat 1200 may become a bypass tube having a long-term patency rate superior to that of the great saphenous vein 1000 not covered with fat 1200.
- This is believed to be due to the following reasons. That is, the great saphenous vein 1000 is used as an arterial bypass tube, but the artery has higher blood pressure (internal pressure received by blood) than the vein. Therefore, if a large saphenous vein that is not covered with tissue is used as a bypass tube, the saphenous vein may expand without being able to withstand blood pressure, and blood flow may be reduced.
- the blood vessel wall may become thickened in the process of remodeling (structural modification) or tissue damage repair.
- Such thickening of the blood vessel wall is considered to affect the progress of arteriosclerosis. For these reasons, if a large saphenous vein that is not covered with tissue and used as a bypass tube is used as a bypass tube, it may lead to blood vessel occlusion in the long term.
- the great saphenous vein 1000 by covering the great saphenous vein 1000 with the fat 1200, it is possible to expect the fat 1200 to suppress the expansion of the large saphenous vein 1000 and to suppress the bending of the great saphenous vein 1000. Therefore, there is a possibility that a decrease in blood flow as described above can be suppressed.
- damage to the great saphenous vein 1000 specifically, damage to endothelial cells, smooth muscle, nutrient blood vessels (small blood vessel network), and the like is reduced. Therefore, there is a possibility that the above-described thickening of the blood vessel wall can be suppressed.
- the configuration of the blood vessel peeling device 100 is not limited to this embodiment.
- the rails 231 and 232 are omitted from the skin side peeling device 200 and the fascia side peeling device 300 is omitted.
- the rails 312 and 322 may be omitted, and the connecting portions 581, 582, and 583 may be omitted from the cutting device 500.
- the cutting device 500 may be inserted into the living body along the skin-side peeling device 200 and the fascia-side peeling device 300 previously inserted into the living body.
- the cutting device 500 is not particularly limited as long as the fat 1200 can be cut.
- the cutting device 500 may be configured to cut the fat 1200 with scissors.
- the blood vessel collection method is not limited to the procedure of this embodiment.
- the insertion order of the skin-side peeling device 200, the fascia-side peeling device 300, and the cutting device 500 is not particularly limited, and any part of the large saphenous vein 1000 may be peeled first. That is, for example, the fascia side peeling device 300, the skin side peeling device 200, and the cutting device 500 may be inserted in this order, or the skin side peeling device 200, the cutting device 500, and the fascia side peeling device 300 are inserted in this order. Alternatively, the cutting device 500, the skin side peeling device 200, and the fascia side peeling device 300 may be inserted in this order. Moreover, you may insert at least 2 of the cutting device 500, the skin side peeling device 200, and the fascia side peeling device 300 simultaneously.
- only one cutting device 500 is used, but two cutting devices 500 may be used.
- the first cutting device 500 is arranged on one of the left and right sides of the great saphenous vein 1000, and then the second cutting device 500 is arranged on the other left and right sides of the great saphenous vein 1000. Should be arranged. According to such a procedure, it is not necessary to remove the cutting device 500 halfway, so that the above procedure can be performed smoothly.
- the skin side peeling device 200 is inserted between the fat 1200 and the skin 1400, but the insertion position of the skin side peeling device 200 is not particularly limited, and for example, the fat 1200 and blood vessels ( However, it may be inserted between tissues having different properties, such as between blood vessels other than the great saphenous vein 1000). Further, the present invention is not limited to insertion between tissues having different properties (borders of tissues having different properties, tissues between tissues having different properties, etc.), for example, by inserting into fat 1200 and peeling fat 1200 Also good.
- the fascia side peeling device 300 is inserted between the fat 1200 and the fascia 1500, but the insertion position of the fascia side peeling device 300 is not particularly limited. It may be inserted between tissues having different properties such as between the fat 1200 and the bone and between the fascia 1500 and the bone. Further, the present invention is not limited to insertion between tissues having different properties (borders of tissues having different properties, tissues between tissues having different properties, etc.), for example, by inserting into fat 1200 and peeling fat 1200 Also good.
- the fat 1200 is cut by the cutting device 500, but the tissue to be cut by the cutting device 500 is not limited to fat.
- the skin-fat boundary and the fat-muscle boundary Tissue between the skin and fat boundary and the fat and osteoskin boundary, connective tissue, tissue between the skin layer and muscle layer, tissue between the skin layer and bone barrier, branch vessel Etc.
- the skin side peeling device 200 and the fascia side peeling device 300 are arranged apart from each other so as not to contact the great saphenous vein 1000.
- the skin side peeling device 200 and the fascia side peeling device are arranged. 300 may be placed in contact with the great saphenous vein 1000. That is, the skin side peeling device 200 and the fascia side peeling device 300 may be inserted between the great saphenous vein 1000 and the fat 1200.
- FIG. 20 is a plan view showing a fascia side peeling device included in the blood vessel peeling device according to the second embodiment of the present invention.
- 21 is a cross-sectional view of the fascia side peeling device shown in FIG.
- This embodiment is the same as the first embodiment described above except that the configuration of the fascia side peeling device is mainly different.
- the first peeling device 310 of the present embodiment is provided with notches 314 and 315 extending to the outside of the groove 313 (on the side surface opposite to the abutting surface 310a) in plan view. It has been.
- the second peeling device 320 the notches 324 and 325 are omitted, and instead, protrusions 324A and 325A that enter the notches 314 and 315 when they are brought into contact with the first peeling device 310. Is provided.
- a protrusion 324A enters the notch 314, and a through hole 334 is formed therebetween.
- the protrusion 325A enters the notch 315, and a through hole 335 is formed therebetween.
- the through holes 334 and 335 are formed at positions shifted from the cavity portion 330, the large saphenous vein 1000 inserted through the through holes 334 and 335 and the cavity portion 330 are inserted.
- the configuration of the processing device 400 is simplified, and the processing by the processing device 400 can be performed more smoothly.
- the branch blood vessel 1100 may be cut and stopped when pushed from the proximal end side to the distal end side.
- the electrode 420 may be disposed on the distal end side of the processing device 400 and the cutting portion 430 may be disposed on the proximal end side.
- the processing device 400 can be inserted in a state where the great saphenous vein 1000 is avoided. Thereby, the rotation function of the cutting part 430 becomes unnecessary, and the processing device 400 can have a simpler configuration.
- FIG. 22 is a side view showing a first peeling device included in the blood vessel peeling device according to the third embodiment of the present invention.
- FIG. 23 is a diagram for explaining a branch blood vessel processing method.
- This embodiment is mainly the same as the first embodiment described above except that the configuration of the first peeling device is different.
- the electrodes 316 and 317 are formed shorter than the first embodiment described above.
- the lengths of the electrodes 316 and 317 are not particularly limited, but can be about 5 mm to 2 cm, for example.
- the electrodes 316 and 317 are integrally movable in the axial direction of the first peeling device 310 (the arrow direction in FIG. 22).
- the processing device 400 is inserted into the cavity 330, and the electrode 420 is disposed opposite to the electrodes 316 and 317. If the processing device 400 is slid to the distal end side while applying a high-frequency alternating voltage between the electrodes 316, 317 and the electrode 420 while maintaining the relative positional relationship between the electrodes 316, 317 and the electrode 420, the branched blood vessel 1100 is obtained. Can be thermally coagulated and cut in order.
- the region where the electric field is generated can be reduced, the electric field can be effectively applied to the branch blood vessel 1100, and the branch blood vessel 1100 can be more reliably hemostatic.
- FIG. 24 is a side view showing a first peeling device included in a blood vessel peeling device according to the fourth embodiment of the present invention.
- FIG. 25 is a diagram for explaining a branch blood vessel processing method.
- FIG. 26 is a cross-sectional view illustrating an example of a processing device.
- This embodiment is mainly the same as the first embodiment described above except that the configuration of the first peeling device is different.
- the electrodes 316 and 317 are divided into a plurality of parts.
- the electrodes 316 and 317 include a plurality of electrode pieces 316 a and 317 a that are arranged apart from each other in the axial direction of the first peeling device 310.
- the electrode pieces 316a and 317a facing each other through the groove 313 are connected to the same potential.
- the length of the electrode pieces 316a and 317a is not particularly limited, but can be, for example, about 5 mm to 2 cm.
- the region where the electric field is generated can be reduced, the electric field can be effectively applied to the branch blood vessel 1100, and the branch blood vessel 1100 can be more reliably thermally coagulated (hemostatic). Can do.
- the mechanism for switching the electrode pieces 316a and 317a to which the high frequency alternating voltage is applied is not particularly limited.
- the switching unit may switch the electrode pieces 316a and 317a to which the voltage is applied according to the detection result of the detection unit.
- the processing device 400 has a conductive lead wire 460 that faces the electrode 420 and moves together with the electrode 420 in the groove 313, and the electrode piece 316a with which the lead wire 460 contacts, A configuration in which a voltage is applied between 317a and the electrode 420 may be employed.
- the processing device 400 is not provided with the electrode 420, the electrode shown in FIG. 22 is arranged on the second peeling device 320 side, and a bipolar structure is formed on the first peeling device 310 side and the second peeling device 320 side. It is also possible to configure. In this case, the pressed portion of the branch blood vessel 1100 can be surely thermally coagulated.
- FIG. 27 is a perspective view showing a treatment device included in the blood vessel peeling device according to the fifth embodiment of the present invention.
- FIG. 28 is a cross-sectional view showing a state where the processing device shown in FIG. 27 is inserted into the cavity.
- This embodiment is mainly the same as the above-described first embodiment except that the configurations of the first peeling device and the processing device are different.
- the first peeling device 310 of the present embodiment has a configuration in which the electrodes 316 and 317 are omitted from the configuration of the first embodiment described above.
- the processing device 400 of the present embodiment includes an operation unit 410 and a processing unit 440 provided at the tip of the operation unit 410, as shown in FIG. Further, the processing unit 440 has a bipolar structure having electrodes 441 and 442.
- a pair of electrodes (first electrodes) 441 are provided facing the width direction of the operation unit 410 (a direction orthogonal to the axial direction).
- a gap S ⁇ b> 1 that guides the branch blood vessel 1100 is formed between one electrode 441 and the other electrode 441.
- the electrode (second electrode) 442 is located between one electrode 441 and the other electrode 441 when viewed from the axial direction of the operation unit 410, and when viewed from the side, the tip thereof is an electrode. It is located on the proximal end side with respect to the distal end of 441. That is, the electrode 442 is disposed on the proximal end side (the rear side in the movement direction) of the gap S1. Further, the distal end portion 442a of the electrode 442 also serves as the cutting portion 430 and is sharp enough to cut the branch blood vessel 1100.
- one electrode 441 is located in the groove 313, the other electrode 441 is located in the groove 323, and the electrode 442 is the groove 313. It arrange
- the treatment device 400 instead of thermally coagulating the flattened portion by pressing the branch blood vessel 1100, the treatment device 400 is slid to the distal end side and tension is applied to the branch blood vessel 1100, so that The blood vessels are flattened, heat-coagulated, and hemostasis / cutting is performed.
- the configuration of the first peeling device 310 becomes simpler.
- FIG. 29 is a perspective view showing a treatment device included in the blood vessel peeling device according to the sixth embodiment of the present invention.
- 30 is a cross-sectional view showing a state in which the processing device shown in FIG. 29 is inserted into the cavity.
- This embodiment is mainly the same as the above-described first embodiment except that the configurations of the first peeling device and the processing device are different.
- the first peeling device 310 of the present embodiment has a configuration in which the electrodes 316 and 317 are omitted from the configuration of the first embodiment described above.
- the processing device 400 includes an operation unit 410 and a processing unit 440 provided at the base end of the operation unit 410 as illustrated in FIG.
- the operation unit 410 includes a pair of rod-shaped portions (operation pieces) 411 and 412 that are arranged to face each other with a gap, and a connection portion 413 that connects the rod-shaped portions 411 and 412 on the proximal end side.
- the processing unit 440 includes a pair of electrodes 441 and 442 and a cutting unit 443.
- the electrode (first electrode) 441 is provided at the base end of the rod-shaped portion 411, and the electrode (second electrode) 442 is provided at the base end of the rod-shaped portion 412.
- a gap S ⁇ b> 2 that guides the branch blood vessel 1100 is formed between the electrodes 441 and 442.
- the cutting part 443 is provided so as to protrude from the connection part 413 to the tip side. Further, the cutting portion 443 is located between the electrodes 441 and 442 when viewed from the axial direction of the operation portion 410, and when viewed from the side, the distal end thereof is located closer to the proximal end than the distal ends of the electrodes 441 and 442. ing. That is, the cutting part 443 is disposed on the base end side (rear side in the movement direction) of the gap S2. Further, the distal end portion 443 a of the cutting portion 443 is sharp enough to cut the branch blood vessel 1100.
- the rod-shaped portion 411 and the electrode 441 are located in the groove 313, the rod-shaped portion 412 and the electrode 442 are located in the groove 323, and the cut portion 443 is arranged so as to straddle the boundaries of the grooves 313 and 323. Therefore, the treatment device 400 is slid to the distal end side while applying a high-frequency alternating voltage between the electrodes 441 and 442, and the branch vessel 1100 is sequentially guided to the gap S2 to be thermally coagulated, and the thermocoagulated branch vessel 1100 is cut.
- the portion 443 can be cut.
- the configuration of the first peeling device 310 becomes simpler.
- FIG. 31 is a perspective view showing a treatment device included in the blood vessel peeling device according to the seventh embodiment of the present invention.
- 32 is a cross-sectional view showing a state where the processing device shown in FIG. 31 is inserted into the cavity.
- FIGS. 33 and 34 are cross-sectional views illustrating a method for treating a branch blood vessel.
- This embodiment is mainly the same as the above-described first embodiment except that the configurations of the first peeling device and the processing device are different.
- the first peeling device 310 of the present embodiment has a configuration in which the electrodes 316 and 317 are omitted from the configuration of the first embodiment described above.
- the processing device 400 of this embodiment has a processing unit 440 as shown in FIG.
- the processing unit 440 includes plate-like electrodes 441 and 442.
- a pair of electrodes (second electrodes) 441 are provided so as to face each other with electrodes (first electrodes) 442 interposed therebetween.
- an insulating plate-like portion 414 is sandwiched between the electrode 442 and one electrode 441, and an insulating plate-like portion 415 is sandwiched between the electrode 442 and the other electrode 441.
- the tip 442 a of the electrode 442 protrudes from the electrode 441 and the plate-like parts 414 and 415.
- the distal end portion 442a also serves as the cutting portion 430 and is sharp enough to cut the branch blood vessel 1100.
- an insulating coating or the like may be applied to the surfaces of the electrodes 441 and 442 instead of the plate-like portions 414 and 415.
- one electrode 441 and one electrode 442 may be stacked.
- the electrodes 441 and 442 are arranged so as to straddle the boundaries of the grooves 313 and 323. Therefore, when the processing device 400 is slid to the distal end side while applying a high-frequency alternating voltage between the electrodes 441 and 442, the branch blood vessel 1100 is expanded and deformed by pressing by the distal end portion 442a of the electrode 442 as shown in FIG. At the same time, it is thermally coagulated by the action of the electric field generated between the electrodes 441 and 442. When the processing device 400 is further moved to the distal end side, the branch blood vessel 1100 is cut by the distal end portion 442a as shown in FIG.
- an electric field is applied to the branch blood vessel 1100 in a state in which the branch blood vessel 1100 is expanded and deformed (a flattened state), so that the branch blood vessel 1100 can be stopped more reliably. it can.
- FIG. 35 is a plan view showing a second peeling device included in the blood vessel peeling device according to the eighth embodiment of the present invention.
- FIG. 36 is a cross-sectional view of the second peeling device shown in FIG.
- FIG. 37 and FIG. 38 are diagrams for explaining a branch blood vessel processing method.
- This embodiment is mainly the same as the first embodiment described above except that the fascia side peeling device also serves as a processing device.
- the second peeling device 320 of this embodiment also serves as the processing device 400.
- the second peeling device 320 has a roller electrode 450 and a cutting portion 430 disposed on the proximal end side with respect to the roller electrode 450.
- the roller electrode 450 is provided so as to protrude from the abutting surface 320a, and is rotatably supported by the shaft.
- the roller electrode 450 includes an electrode 316 included in the first peeling device 310 when the second peeling device 320 is placed along the abutting surface 310a of the first peeling device 310, Opposite to 317.
- the cutting part 430 is provided so as to protrude from the abutting surface 310a, and when the second peeling device 320 is placed along the abutting surface 310a of the first peeling device 310, the groove of the first peeling device 310 is provided. Intrudes into 313.
- a high frequency alternating voltage is applied between the electrodes 316 and 317 and the roller electrode 450 in a state where the first peeling device 310 is disposed below the great saphenous vein 1000, as shown in FIG.
- the second peeling device 320 is inserted into the living body along the abutting surface 310 a of the first peeling device 310.
- the branch blood vessel 1100 is guided between the first peeling device 310 and the second peeling device 320, and is crushed and thermally coagulated by the roller electrode 450 as shown in FIG.
- the thermocoagulated branch blood vessel 1100 is cut by the cutting unit 430. According to this embodiment, in this way, the branch blood vessel 1100 can be thermally coagulated and cut sequentially.
- the second peeling device 320 also serves as the processing device 400, the branch blood vessel 1100 can be processed together with the insertion of the second peeling device 320. Therefore, peeling of the large saphenous vein 1000 (first step) can be performed more smoothly.
- FIG. 39 is a side view showing a cutting device included in the blood vessel peeling device according to the ninth embodiment of the present invention.
- 40 is a cross-sectional view of the cutting device shown in FIG. FIG. 41 and FIG. 42 are diagrams for explaining a branch blood vessel processing method.
- This embodiment is mainly the same as the first embodiment described above except that the configuration of the cutting device is different.
- the cutting device 600 of the present embodiment has a main body 610 and a cutting part 620 that can move in the main body 610, as shown in FIGS.
- the main body 610 has a long plate shape. Moreover, the main-body part 610 has the groove
- a tapered guide portion 613 is provided at the tip of the main body portion 610.
- the guide portion 613 has a guide surface 613a that is inclined and directed downward, and the guide surface 613a is used to move the fat 1200 and the branch blood vessel 1100 downward (grooves 611 and muscles) when the main body portion 610 advances through the living body. It has a function of guiding to the membrane side peeling device 300).
- the main body 610 has connection portions 614 and 615 that can be connected to the rails 231 and 232 of the skin side peeling device 200.
- the main body 610 is provided with electrodes 616 and 617 through grooves 611. That is, an electrode (first electrode) 616 is disposed on one side of the groove 611, and an electrode (second electrode) 617 is disposed on the other side of the groove 611.
- the cutting part 620 can be inserted into the groove 611 and can slide within the groove 611. Further, the tip of the cutting part 620 is a blade part 621 that can protrude from the groove 611.
- the processing of the branch blood vessel 1100 by the cutting device 600 of the present embodiment includes the steps of peeling the fat 1200 along the great saphenous vein 1000, pressing the peeled fat 1200, and the branch blood vessel included in the pressed fat 1200. And cauterizing 1100 and cutting the cauterized branch blood vessel 1100.
- the skin side peeling device 200 and the fascia side peeling device 300 are inserted into the living body, and the fat 1200 above and below the great saphenous vein 1000 is peeled off.
- the connection portion 614 is connected to the rail 231 of the skin side peeling device 200 and the main body portion 610 is inserted into the living body while being guided by the skin side peeling device 200, as shown in FIG.
- the fat 1200 and the branch blood vessel 1100 are guided between the main body 610 and the second peeling device 320 and are sandwiched between them in a crushed state (pressed (compressed) state).
- the skin side peeling device 200 is pressed from the skin 1400 side and inserted while pressing the main body 610 against the second peeling device 320.
- a high-frequency alternating voltage is applied between the electrodes 616 and 617 to cauterize and thermally coagulate the branch blood vessel 1100 sandwiched between the main body 610 and the second peeling device 320.
- the cutting part 620 is inserted into the groove 611, and as shown in FIG. 42, the blade part 621 protrudes from the front end side of the groove 611 and enters the rail 322 of the second peeling device 320.
- the branch blood vessel 1100 and the fat 1200 are cut by the blade portion 621 by sliding the cutting portion 620 to the proximal end side.
- the fat 1200 on the side of the great saphenous vein 1000 is cut right and left, and the branch blood vessel 1100 is heat-coagulated and cut.
- these displacements can be suppressed, and these processes can be performed more reliably.
- the fat 1200 sandwiched between the main body 610 and the first peeling device 310 is cauterized, so that the fat 1200 is cut more smoothly by the blade 621. be able to.
- the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
- a voltage is applied between the electrodes 616 and 617, but the pair of electrodes 616 and 617 are connected to the same potential and one electrode (first electrode) is connected.
- the blade portion 621 of the cutting portion 620 may also serve as the other electrode (second electrode).
- the cutting unit 620 is applied while applying a high-frequency alternating voltage between the electrodes 616, 617 and the blade 621.
- the branch blood vessel 1100 can be thermally coagulated and cut.
- the branch blood vessel 1100 can be more thermally coagulated.
- the fascia side peeling device 300 has the 1st peeling device 310 and the 2nd peeling device 320 similarly to said embodiment,
- a fascia side peeling device The number of peeling devices included in is not limited to this, and may be one or three or more.
- FIG. 43 is a side view showing a cutting device included in the blood vessel peeling device according to the tenth embodiment of the present invention.
- FIG. 44 and FIG. 45 are diagrams for explaining a branch blood vessel processing method.
- This embodiment is mainly the same as the ninth embodiment described above, except that the cutting device has a plurality of main body portions.
- the cutting device 600 includes two main body portions 610A and 610B having different thicknesses T and a cutting portion 620 as shown in FIG.
- the main body portions 610A and 610B each have the same configuration as the main body portion 610 of the ninth embodiment described above.
- two main body portions 610A and 610B are prepared.
- the number of main body portions to be prepared is not limited to two, and may be three or more.
- the fat 1200 and the branch blood vessel 1100 must be guided between the main body 610 and the fascia side peeling device 300 by inserting the main body 610 once.
- the fat 1200 guided between the main body 610 and the fascia-side peeling device 300 becomes too thick, and the fat is properly guided. Even if it is not possible to guide or guide, excessive force may be required to cut the fat 1200 by the cutting part 620.
- the main body portions 610A and 620B having different thicknesses T are prepared, and the fat 1200 and the branch blood vessel 1100 are cut in two steps, so that the work can be performed more smoothly and without excessive force.
- the main body 610A having the smaller thickness T is inserted.
- a high-frequency alternating voltage is applied between the electrodes 616 and 617 to thermally coagulate the branch blood vessel 1100, and then the branch blood vessel 1100 and the fat 1200 are cut using the cutting unit 620. Thereby, fat 1200 will be in the state cut
- the main body 610B is inserted as shown in FIG.
- a high-frequency alternating voltage is applied between the electrodes 616 and 617 to thermally coagulate the branch blood vessel 1100, and then the branch blood vessel 1100 and the fat 1200 are cut using the cutting unit 620.
- the fat 1200 on the side of the great saphenous vein 1000 is cut right and left, and the branch blood vessel 1100 is stopped and cut.
- the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
- FIG. 46 is a side view showing a cutting device included in the blood vessel peeling device according to the eleventh embodiment of the present invention. 47 is a cross-sectional view of the cutting device shown in FIG. FIG. 48 and FIG. 49 are diagrams for explaining a branch blood vessel processing method.
- This embodiment is mainly the same as the ninth embodiment described above except that the configuration of the cutting device is different.
- the cutting device 600 of the present embodiment includes a main body 610 and a cutting unit 620 that moves along the main body 610, as shown in FIGS.
- the main body 610 has a long plate shape.
- An electrode (first electrode) 616 is provided on the lower surface side of the main body 610.
- the cutting part 620 has substantially the same configuration as that of the above-described ninth embodiment, and the blade part 621 also serves as an electrode (second electrode).
- the processing of the branch blood vessel 1100 by the cutting device 600 of the present embodiment includes the steps of peeling the fat 1200 along the great saphenous vein 1000, pressing the peeled fat 1200, and the branch blood vessel included in the pressed fat 1200. Cauterizing and cutting 1100.
- the skin side peeling device 200 and the fascia side peeling device 300 are inserted into the living body, and the fat 1200 above and below the great saphenous vein 1000 is peeled off.
- the connection part 614 is connected to the rail 231 of the skin side peeling device 200, and the main body part 610 is inserted into the living body while being guided by the skin side peeling device 200.
- the fat 1200 and the branch blood vessel 1100 are guided between the main body 610 and the second peeling device 320 by the guide portion 613, and are put in a state of being crushed.
- the cutting part 620 is inserted along the side surface of the main body part 610, and as shown in FIG.
- the blade part 621 protrudes from the lower surface of the main body part 610 to enter the rail 322 of the second peeling device 320. Invade.
- the cutting unit 620 is slid toward the proximal end while applying a high-frequency alternating voltage between the electrode 616 and the blade unit 621, the branch blood vessel 1100 is thermally coagulated and cut by the cutting unit 620.
- the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
- FIG. 50 is a perspective view showing a cutting device included in a blood vessel peeling device according to a twelfth embodiment of the present invention.
- FIG. 51 is a perspective view showing a fascia side peeling device included in a blood vessel peeling device according to a twelfth embodiment of the present invention.
- FIG. 52 is a cross-sectional view showing a state in which the cutting device and the fascia side peeling device are opposed to each other.
- FIG. 53 and FIG. 54 are diagrams for explaining a branch blood vessel processing method.
- This embodiment is mainly the same as the ninth embodiment described above except that the configuration of the cutting device and the fascia side peeling device are different.
- electrodes (first electrodes) 616 and 617 are formed shorter than the ninth embodiment described above.
- the electrodes 616 and 617 can move integrally with the main body 610 in the axial direction.
- the electrodes 616 and 617 are connected to the same potential.
- the lengths of the electrodes 616 and 617 are not particularly limited, and can be about 5 mm to 2 cm, for example.
- the first peeling device 310 has electrodes (second electrodes) 318 and 319 arranged to face each other via the rail 312.
- the electrodes 318 and 319 are provided so as to extend in the axial direction of the first peeling device 310.
- the electrodes 318 and 319 face the electrodes 616 and 617 when the first peeling device 310 and the main body 610 are arranged with the groove 611 and the rail 312 facing each other.
- the second peeling device 320 includes electrodes (second electrodes) 328 and 329 arranged to face each other via the rail 322.
- the electrodes 328 and 329 are provided so as to extend in the axial direction of the second peeling device 320.
- the electrodes 328 and 329 are opposed to the electrodes 616 and 617 when the second peeling device 320 and the main body 610 are disposed with the groove 611 and the rail 322 opposed to each other.
- the main body 610 is inserted into the living body, and the fat 1200 and the branch blood vessel 1100 are sandwiched between the main body 610 and the second peeling device 320.
- the electrodes 616 and 617 are slid with respect to the main body 610 to thermally coagulate the branch blood vessel 1100.
- the thermocoagulated branch blood vessel 1100 is cut by the cutting unit 620.
- the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
- FIG. 55 is a perspective view showing a skin side peeling device and a fascia side peeling device included in a blood vessel peeling device according to a thirteenth embodiment of the present invention.
- FIG. 56 is a side view showing a cutting device included in a blood vessel peeling device according to a thirteenth embodiment of the present invention.
- FIG. 57 is a top view of the cutting device shown in FIG. FIG. 58 and FIG. 59 are diagrams for explaining a branch blood vessel processing method.
- This embodiment is mainly the same as the first embodiment described above except that the configuration of the cutting device is different.
- the skin-side peeling device 200 of the present embodiment has a substantially rectangular cross-sectional shape with rounded corners, as shown in FIG. Rails 231 and 232 are provided on the lower surface of the skin-side peeling device 200.
- first peeling device 310 of the present embodiment is provided with an electrode (first electrode) 340 on the upper surface instead of the rail 312 being omitted from the configuration of the first embodiment described above.
- an electrode (first electrode) 350 is provided on the upper surface instead of the rail 322 being omitted from the configuration of the first embodiment described above.
- the cutting device 700 of this embodiment includes a long main body (guide device) 710 and a roller electrode (second electrode) that is rotatably provided on the main body 710. ) 720 and rollers 731 and 732.
- the main body 710 has a shape in which the roller electrode 720 and the rollers 731 and 732 are sandwiched between the two plate-like pieces 711 and 712 from both sides. Further, a tapered guide portion 713 is provided at the distal end portion of the main body portion 710.
- the guide portion 713 has a guide surface 713a that is inclined and faces downward, and the guide surface 713a is used to move the fat 1200 and the branch blood vessel 1100 downward (when the main body 710 and the main body portion 710 are moved). It has a function of guiding to the fascia side peeling device 300).
- the roller electrode 720 is provided so as to protrude below the main body 710.
- the roller electrode 720 is provided so as to protrude from the guide portion 713 (guide surface 713a).
- Such a roller electrode 720 is an electrode for cauterizing by applying an electric field to the branch blood vessel 1100 and the fat 1200 guided between the main body part 710 and the fascia side peeling device 300 by the guide part 713, It also functions as a cutting part for cutting the cauterized branched blood vessel 1100 and fat 1200.
- the cutting portion may be provided separately from the roller electrode 720, and in this case, the cutting portion may be disposed so as to protrude to the lower side of the main body portion 710 from the base end side of the roller electrode 720.
- Rollers 731 and 732 are provided so as to protrude upward from the main body 710. When the main body 710 is inserted into the living body, the rollers 731 and 732 engage with the rails 231 and 232 of the skin side peeling device 200, so that the cutting device 700 can be smoothly inserted into the living body.
- the processing of the branch blood vessel 1100 by the cutting device 600 of the present embodiment includes the steps of peeling the fat 1200 along the great saphenous vein 1000, pressing the peeled fat 1200, and the branch blood vessel included in the pressed fat 1200. And cauterizing 1100 and cutting the cauterized branch blood vessel 1100.
- the skin side peeling device 200 and the fascia side peeling device 300 are inserted into the living body, and the fat 1200 above and below the great saphenous vein 1000 is peeled off.
- the cutting device 700 is inserted between the skin-side peeling device 200 and the second peeling device 320 as shown in FIG.
- the branched blood vessel 1100 and the fat 1200 are guided in a crushed state (pressed (compressed)) between the main body portion 710 and the second peeling device 320 by the guide portion 713, and as shown in FIG.
- the roller electrode 720 and the second peeling device 320 electrode 350
- it is cauterized and thermally coagulated and cut.
- the branch blood vessel 1100 and the fat 1200 pass between the roller electrode 720 and the electrode 350, so that an electric field can be effectively applied thereto, and these can be sufficiently cauterized.
- the branch blood vessel 1100 since the branch blood vessel 1100 is cauterized in a collapsed state, the branch blood vessel 1100 can be more solidified more reliably.
- the roller electrode 720 since the roller electrode 720 is rotatable, the branch blood vessel 1100 and the fat 1200 can smoothly pass between the roller electrode 720 and the second peeling device 320, so that the above operation can be performed more smoothly. It can be carried out.
- the roller electrode 720 which is one electrode is provided in the main body portion 710, and the electrode 350 (electrode 340) which is the other electrode is provided in the second peeling device 320 (first peeling device 310).
- the branch blood vessel 1100 and the fat 1200 can be passed between the roller electrode 720 and the electrode 350 (electrode 340) with a simple configuration.
- the timing at which the branch blood vessel 1100 is thermally coagulated and the timing at which it is cut are almost the same, but depending on the case, it is thermally coagulated after being cut, or conversely, it is cut after being thermally coagulated.
- the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
- the branch blood vessels 1100 and fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
- the electrode 340 is arranged over almost the entire upper surface of the first peeling device 310.
- the arrangement of the electrode 340 includes the branch blood vessel 1100 by an electric field generated between the roller electrode 720 and the electrode 340. If shochu (thermal coagulation) can come out, it will not be specifically limited.
- the electrodes 340 may be arranged side by side in a plurality of lines, or may be arranged to meander according to the shape (extended state) of the large saphenous vein 1000.
- the rails 231 and 232 of the skin side peeling device 200 are preferably meandered in the same manner.
- FIG. 60 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a fourteenth embodiment of the present invention.
- FIG. 61 is a diagram illustrating a method for processing a branch blood vessel.
- This embodiment is mainly the same as the thirteenth embodiment described above except that the configurations of the skin-side peeling device and the cutting device are different.
- the skin-side peeling device 200 of this embodiment has a rack gear 231A that is linearly cut on the bottom surface of the rail 231. Similarly, the skin-side peeling device 200 is linearly cut on the bottom surface of the rail 232.
- the rack gear 232A is provided.
- the cutting device 700 of the present embodiment is composed of a pinion gear in which rollers 731 and 732 are toothed on the peripheral surface, and can mesh with the rails 231 and 232.
- the roller electrode (rotating body) 720 also includes a pinion gear and meshes with the rollers 731 and 732.
- Such rollers 731 and 732 and the roller electrode 720 constitute a guiding portion 750 for actively guiding the branch blood vessel 1100 and the fat 1200 between the main body portion 710 and the second peeling device 320.
- the roller electrode 720 also serves as a rotating body, the configuration of the cutting device 700 becomes simpler.
- roller electrode 720 is provided so as to protrude from the guide portion 713 (guide surface 713a), the above effect becomes more remarkable. Moreover, since the friction with the fat 1200 is increased by the teeth provided on the peripheral surface of the roller electrode 720, the above effect is further improved.
- the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
- the branch blood vessels 1100 and the fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
- FIG. 62 is a side view showing a cutting device included in a blood vessel peeling device according to a fifteenth embodiment of the present invention.
- This embodiment is mainly the same as the thirteenth embodiment described above except that the configuration of the cutting device is different.
- the cutting device 700 of this embodiment has a drive unit 790 that rotates a roller electrode (rotating body) 720, as shown in FIG.
- the drive unit 790 includes a drive source 791 such as a motor, and an endless belt 792 that transmits power generated from the drive source 791 to the roller electrode 720, and the roller electrode 720 rotates by rotating the drive source 791. It is the composition to do.
- the roller electrode 720 and the drive unit 790 constitute a guide unit 750. Note that the configuration of the drive unit 790 is not particularly limited as long as the roller electrode 720 can be rotated.
- the cutting device 700 is inserted into the living body while the driving unit 790 rotates the roller electrode 720 in a direction in which the branch blood vessel 1100 and the fat 1200 are guided between the main body 710 and the second peeling device 320.
- the branch blood vessel 1100 and the fat 1200 can be more actively guided between the main body 710 and the second peeling device 320.
- the branch blood vessels 1100 and fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
- FIG. 63 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a sixteenth embodiment of the present invention.
- FIG. 64 is a diagram for explaining a branch blood vessel processing method.
- This embodiment is mainly the same as the thirteenth embodiment described above except that the configurations of the skin-side peeling device and the cutting device are different.
- the skin side peeling device 200 of the present embodiment has the same configuration as that of the fourteenth embodiment described above.
- the cutting device 700 of the present embodiment includes a guide portion 750 that actively guides the branch blood vessel 1100 and the fat 1200 between the main body portion 710 and the second peeling device 320.
- the guide portion 750 is rotatably provided on the main body portion 710, and is provided on the main body portion 710 so as to be rotatable, and a first gear portion 751 that meshes with the rails 231 and 232. And a second gear portion 752 that meshes with the first gear portion 751.
- the second gear portion 752 has a small-diameter portion 753 that meshes with the first gear portion 751, and a large-diameter portion 754 that is provided coaxially with the portion 753, and the peripheral surface of the portion 754
- the claw portion 754a is provided side by side. And the nail
- a high-frequency alternating voltage is applied between the roller electrode 720 and the electrode 350, and the first gear portion 751 is engaged with the rail 231 of the skin side peeling device 200 as shown in FIG.
- the second gear part 752 urges the branch blood vessel 1100 and the fat 1200 rearward in the insertion direction, that is, between the main body part 710 and the second peeling device 320. Rotate to guide in between. Therefore, the branch blood vessel 1100 and the fat 1200 can be actively guided between the main body 710 and the second peeling device 320.
- the friction with the fat 1200 is increased by the claw portion 754a provided on the peripheral surface of the second gear portion 752, the above effect is further improved.
- the branched blood vessel 1100 and the fat 1200 guided between the main body 710 and the second peeling device 320 are the roller electrode 720 and the second peeling device 320 (electrodes) positioned behind the second gear portion 752. 350) and is cut and cut.
- the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
- the branch blood vessels 1100 and fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
- FIG. 65 is a side view showing a cutting device included in a blood vessel peeling device according to a seventeenth embodiment of the present invention.
- FIG. 66 is a diagram for explaining a branch blood vessel processing method.
- This embodiment is mainly the same as the thirteenth embodiment described above except that the configurations of the fascia side peeling device and the cutting device are different.
- the first peeling device 310 of this embodiment has a configuration in which the electrode 340 is omitted from the thirteenth embodiment.
- the second peeling device 320 of the present embodiment has a configuration in which the electrode 350 is omitted from the thirteenth embodiment.
- the cutting device 700 of the present embodiment includes a pair of main body portions 710A and 710B that are arranged to face each other, and roller electrodes (first electrodes) provided on the main body portion (first main body portion) 710A. ) 720A and rollers 731A and 732A, and a roller electrode (second electrode) 720B and rollers 731B and 732B provided on the main body (second main body) 710B.
- the main body portions 710A and 710B are disposed to face each other via the gap S3, and are connected by a base end portion.
- the space S3 is a space for guiding the branch blood vessel 1100 and the fat 1200 when inserted into the living body.
- the main body 710A has a long plate shape.
- the main body 710A has a shape in which the roller electrode 720A and the rollers 731A and 732A are sandwiched from both sides by two plate-like pieces 711A and 712A.
- a tapered guide portion 713A is provided at the distal end portion of the main body portion 710A.
- the guide portion 713A has a guide surface 713Aa that is inclined and faces downward.
- the guide surface 713Aa has a function of guiding the fat 1200 and the branch blood vessel 1100 to the gap S3 when the main body portion 710A advances through the living body.
- the main body 710B has a target configuration with the main body 710A via the gap S3.
- roller electrodes 720A and 720B are arranged to face each other, and are both provided so as to protrude into the gap S3.
- Such roller electrodes 720A and 720B are electrodes for cauterizing by causing an electric field to act on the branch blood vessel 1100 and the fat 1200 guided between the main body portions 710A and 720B by the guide portions 713A and 713B. It also functions as a cutting section for cutting the branch blood vessel 1100 and the fat 1200.
- Rollers 731A and 732A are provided to protrude to the upper side of the main body 710A. Similarly, the rollers 731B and 732B are provided so as to protrude downward from the main body 710B.
- the rollers 731A and 732A engage with the rails 231 and 232 of the skin side peeling device 200, and the rollers 731B and 732B rotate along the fascia side peeling device 300.
- the cutting device 700 can be smoothly inserted into the living body.
- the skin-side peeling device 200 and the fascia-side peeling device 300 are placed in the living body, and the cutting device 700 is peeled off the skin while applying a high-frequency alternating voltage between the roller electrodes 720A and 720B. Insert between device 200 and second stripping device 320. Then, the branch blood vessel 1100 and the fat 1200 are guided to the gap S3 (between the main body portions 710A and 710B) by the guide portions 713A and 713B, and cauterized when passing between the roller electrodes 720A and 720B as shown in FIG. And cut off.
- the upper and lower fats 1200 are compressed so as to be collected in the central portion. For example, as in the thirteenth embodiment described above, the compression is performed such that the fats are collected below the upper and lower fats 1200.
- the branched blood vessel 1100 and the fat 1200 can be guided to the gap S3 more smoothly.
- the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
- the branch blood vessels 1100 and the fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
- gap S3 is not necessarily required when the branching blood vessel 1100 and the fat 1200 can be cut reliably.
- FIG. 67 is a side view showing a cutting device included in a blood vessel peeling device according to an eighteenth embodiment of the present invention.
- FIG. 68 is a diagram for explaining a branch blood vessel processing method.
- This embodiment is mainly the same as the thirteenth embodiment described above except that the configuration of the cutting device is different.
- a main body 710 and a roller electrode 720 are provided separately. Further, the roller electrode 720 is rotatably supported by the long operation unit 721. Such a roller electrode 720 can move inside the main body 710 (a gap between the plate-like pieces 711 and 712).
- the main body 710 is first inserted into the living body.
- the roller electrode 720 is pushed against the branch blood vessel 1100 and the fat 1200, and the inside of the main body 710 is advanced. Thereby, the branch blood vessel 1100 and the fat 1200 can be cauterized and cut.
- the branch blood vessels 1100 and fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
- FIG. 69 is a side view showing a cutting device included in a blood vessel peeling device according to a nineteenth embodiment of the present invention.
- FIG. 70 is a diagram for explaining a branch blood vessel processing method.
- This embodiment is mainly the same as the eighteenth embodiment described above except that the configuration of the cutting device is different.
- the cutting device 700 of this embodiment has an electrode 740 having a blade portion 741 instead of the roller electrode 720 of the eighteenth embodiment described above.
- the electrode 740 is fixed to the distal end portion of the long operation portion 742.
- Such an electrode 740 can move inside the main body 710 (a gap between the plate-like pieces 711 and 712).
- the main body 710 is first inserted into the living body.
- the electrode 740 is pressed against the branch blood vessel 1100 and the fat 1200, and the inside of the main body 710 is advanced. Thereby, the branch blood vessel 1100 and the fat 1200 can be cauterized and cut.
- the branch blood vessels 1100 and fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
- roller electrode 720 an insulating coating or the like may be applied to the roller side surface portion, and only the roller end surface portion (circumferential portion) may be used as the electrode. Further, only the vicinity of the blade portion of the electrode 740 having the blade portion 741 may be used as the electrode. In that case, the current-carrying part is limited, and thermal coagulation can be performed more efficiently.
- the blood vessel peeling device of the present invention has been described based on the illustrated embodiment, but the present invention is not limited to this, and the configuration of each part is replaced with an arbitrary configuration having the same function. can do.
- any other component may be added to the present invention.
- the great saphenous vein is peeled in a state where the entire circumference is covered with fat, but is not limited to the case where the entire circumference is covered with fat. That is, the large saphenous vein may be peeled off in a state where a part of its periphery is covered with the set fat, or may be peeled off without being covered with fat.
- the upper and lower fats may be thin (or there is no fat 1200 above and below), and the left and right fats may be thick and covered with flat fat.
- the state of the great saphenous vein for example, presence or absence of damage, shape, twist
- it can be appropriately used for a bypass pipe or the like.
- the great saphenous vein 1000 when the great saphenous vein 1000 is meandering greatly, an incision is made for each region where the great saphenous vein 1000 extends relatively straight, and the above-described operation is performed.
- the saphenous vein 1000 may be peeled by repeating a plurality of times. 71, first, the great saphenous vein 1000 is peeled between the incisions 1310 and 1320, and then the great saphenous vein 1000 is peeled between the incisions 1320 and 1330.
- the large saphenous vein 1000 may be peeled between the portions 1330 and 1340. Then, the large saphenous vein 1000 may be ligated through the incisions 1310 and 1340 and removed from either of the incisions 1310 and 1340.
- a longer (predetermined length) large saphenous vein 1000 can be collected regardless of the state of the large saphenous vein.
- the blood vessel peeling device of the present invention includes a pair of insertion devices that are inserted into a living body along a blood vessel and sandwich the branched blood vessel that separates from the blood vessel in the living body, and a processing device that processes the branched blood vessel.
- One of the insertion devices has a first groove that is open on a surface facing the other insertion device and into which the processing device can be inserted. According to such a configuration, the processing of the branch blood vessel by the processing device is facilitated. Further, since the processing device can be inserted into the insertion device, the processing device can be operated smoothly, and the branch blood vessel can be processed more easily. Therefore, the blood vessel peeling device is excellent in blood vessel peeling workability.
- the blood vessel peeling device of the present invention has industrial applicability.
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Abstract
A blood vessel removal device 100 that has: a first removal device 310 and a second removal device 320 that sandwich and hold branch blood vessels 1100; and a processing device 400 that processes the branch vessels 1100. In addition, the first removal device 310 has a groove 313 that opens at an abutting surface 310a, and the second removal device 320 has a groove 323 that opens at an abutting surface 320a. The grooves 313, 323 form a cavity 330 into which the processing device 400 is inserted.
Description
本発明は、血管剥離デバイスに関するものである。
The present invention relates to a blood vessel peeling device.
心臓における血管バイパス術(冠動脈バイパス術:CABG)を行う際のバイパス管として、内胸動脈、胃大網動脈、橈骨動脈に代表される動脈グラフトや、大伏在静脈に代表される静脈グラフトを用いることが広く知られている。また、現在では、動脈グラフト(特に内胸動脈)の方が静脈グラフトよりも長期的な開存率が高いという報告がなされている。このように、長期的な開存率に劣ると言われる静脈グラフトではあるが、近年、静脈グラフトをその周囲の組織(例えば、脂肪、結合組織、皮膚層と筋肉層との間の組織、皮膚層と骨関膜との間の組織、分岐血管等)に覆われた状態で採取し、組織に覆われたままの状態でバイパス管として使用することで、長期的な開存率が向上するとの報告もされてきている。そして、静脈グラフトを周囲の組織に覆われた状態で採取することのできるデバイスとして、例えば特許文献1に記載されたデバイスがある。
Arterial grafts typified by the internal thoracic artery, gastroepiploic artery, and radial artery, and venous grafts typified by the great saphenous vein are used as bypass tubes when performing vascular bypass surgery (coronary artery bypass surgery: CABG) in the heart. It is widely known to use. At present, it has been reported that arterial grafts (particularly internal thoracic arteries) have a higher long-term patency rate than venous grafts. Thus, although it is a vein graft that is said to be inferior in the long-term patency rate, in recent years the vein graft has been replaced with surrounding tissues (for example, fat, connective tissue, tissue between the skin layer and muscle layer, skin If it is collected in a state covered with tissue, bifurcated blood vessels, etc. between the layer and the periosteum, and used as a bypass tube in a state covered with the tissue, the long-term patency rate is improved. Has also been reported. And as a device which can extract | collect a vein graft in the state covered with the surrounding tissue, there exists a device described in patent document 1, for example.
特許文献1に記載のデバイスでは、バイパス管として採取する血管内にガイドワイヤ(support member50)を挿入し、このガイドワイヤに案内させつつ筒状部材(portion40)を押し進めることで、血管をその周囲の組織に覆われた状態で採取することができるようになっている。しかしながら、特許文献1に記載のデバイスでは、ガイドワイヤによって血管の内壁が損傷するおそれがあり、血管採取(血管剥離)の作業性が悪いという問題がある。
In the device described in Patent Document 1, a guide wire (support member 50) is inserted into a blood vessel to be collected as a bypass tube, and the tubular member (portion 40) is pushed forward while being guided by the guide wire. It can be collected while covered with tissue. However, the device described in Patent Document 1 has a problem that the inner wall of the blood vessel may be damaged by the guide wire, and the workability of blood vessel collection (blood vessel separation) is poor.
本発明の目的は、血管剥離の作業性に優れる血管剥離デバイスを提供することにある。
An object of the present invention is to provide a blood vessel peeling device having excellent blood vessel peeling workability.
このような目的は、下記(1)~(9)の本発明により達成される。
(1) 血管に沿って生体内へ挿入され、前記生体内において前記血管から分かれる分岐血管を挟持する一対の挿入デバイスと、
前記分岐血管を処理する処理デバイスと、を有し、
一方の前記挿入デバイスは、他方の前記挿入デバイスと対向する面に開口し、前記処理デバイスを挿入可能な第1の溝を有することを特徴とする血管剥離デバイス。 Such an object is achieved by the present inventions (1) to (9) below.
(1) a pair of insertion devices that are inserted into a living body along a blood vessel and sandwich a branched blood vessel that separates from the blood vessel in the living body;
A treatment device for treating the branched blood vessel,
One said insertion device has the 1st groove | channel which opens in the surface facing the said other insertion device, and can insert the said processing device, The blood vessel peeling device characterized by the above-mentioned.
(1) 血管に沿って生体内へ挿入され、前記生体内において前記血管から分かれる分岐血管を挟持する一対の挿入デバイスと、
前記分岐血管を処理する処理デバイスと、を有し、
一方の前記挿入デバイスは、他方の前記挿入デバイスと対向する面に開口し、前記処理デバイスを挿入可能な第1の溝を有することを特徴とする血管剥離デバイス。 Such an object is achieved by the present inventions (1) to (9) below.
(1) a pair of insertion devices that are inserted into a living body along a blood vessel and sandwich a branched blood vessel that separates from the blood vessel in the living body;
A treatment device for treating the branched blood vessel,
One said insertion device has the 1st groove | channel which opens in the surface facing the said other insertion device, and can insert the said processing device, The blood vessel peeling device characterized by the above-mentioned.
(2) 前記他方の挿入デバイスは、前記一方の挿入デバイスと対向する面に開口し、前記一方の挿入デバイスとの間に前記分岐血管を挟持したときに前記第1の溝と対向する第2の溝を有する上記(1)に記載の血管剥離デバイス。
(2) The second insertion device opens on a surface facing the one insertion device, and the second insertion device faces the first groove when the branch blood vessel is sandwiched between the insertion device and the one insertion device. The blood vessel peeling device according to (1) above, which has a groove.
(3) 前記第1の溝および前記第2の溝の少なくとも一方は、前記処理デバイスと摺動する摺動面を有する上記(1)または(2)に記載の血管剥離デバイス。
(3) The blood vessel peeling device according to (1) or (2), wherein at least one of the first groove and the second groove has a sliding surface that slides with the processing device.
(4) 前記他方の挿入デバイスは、前記第2の溝を介して対向配置された一対の第1の電極を有し、
前記処理デバイスは、第2の電極と、切断部と、を有する上記(1)ないし(3)のいずれかに記載の血管剥離デバイス。 (4) The other insertion device has a pair of first electrodes arranged to face each other via the second groove,
The blood vessel peeling device according to any one of (1) to (3), wherein the processing device includes a second electrode and a cutting portion.
前記処理デバイスは、第2の電極と、切断部と、を有する上記(1)ないし(3)のいずれかに記載の血管剥離デバイス。 (4) The other insertion device has a pair of first electrodes arranged to face each other via the second groove,
The blood vessel peeling device according to any one of (1) to (3), wherein the processing device includes a second electrode and a cutting portion.
(5) 前記処理デバイスは、空隙を介して対向配置された一対の第1の電極と、前記空隙よりも移動方向の後方に位置する第2の電極と、を有する上記(1)ないし(3)のいずれかに記載の血管剥離デバイス。
(5) The said processing device has said (1) thru | or (3) which has a pair of 1st electrode opposingly arranged through the space | gap, and the 2nd electrode located in the back of a movement direction rather than the said space | gap. ) The blood vessel peeling device according to any one of
(6) 前記処理デバイスは、空隙を介して対向配置された第1の電極および第2の電極と、前記空隙よりも移動方向の後方に位置し、前記分岐血管を切断する切断部と、を有する上記(1)ないし(3)のいずれかに記載の血管剥離デバイス。
(6) The processing device includes a first electrode and a second electrode that are arranged to face each other via a gap, and a cutting portion that is located behind the gap in the movement direction and cuts the branch blood vessel. The blood vessel peeling device according to any one of (1) to (3) above.
(7) 前記処理デバイスは、対向配置された第1の電極および第2の電極と、先端部に配置された切断部と、を有する上記(1)ないし(3)のいずれかに記載の血管剥離デバイス。
(7) The blood vessel according to any one of (1) to (3), wherein the processing device includes a first electrode and a second electrode arranged to face each other, and a cut portion arranged at a distal end portion. Peeling device.
(8) 前記処理デバイスでは、前記第2の電極は、前記第1の電極を介して対向するように一対設けられ、
前記第1の電極の先端部は、前記第2の電極の先端部から突出して前記切断部を構成する上記(7)に記載の血管剥離デバイス。 (8) In the processing device, a pair of the second electrodes are provided so as to face each other via the first electrode,
The blood vessel peeling device according to (7), wherein the distal end portion of the first electrode protrudes from the distal end portion of the second electrode and constitutes the cutting portion.
前記第1の電極の先端部は、前記第2の電極の先端部から突出して前記切断部を構成する上記(7)に記載の血管剥離デバイス。 (8) In the processing device, a pair of the second electrodes are provided so as to face each other via the first electrode,
The blood vessel peeling device according to (7), wherein the distal end portion of the first electrode protrudes from the distal end portion of the second electrode and constitutes the cutting portion.
(9) 前記一対の挿入デバイスのうちの一方は、前記処理デバイスを兼ねている上記(1)に記載の血管剥離デバイス。
(9) The blood vessel peeling device according to (1), wherein one of the pair of insertion devices also serves as the processing device.
本発明によれば、一対の挿入デバイスによって分岐血管を挟持することができ、分岐血管の変位を抑制することができるため、処理デバイスによる分岐血管の処理が容易となる。また、処理デバイスを挿入デバイス内に挿入することができるため、処理デバイスをスムーズに操作することができ、分岐血管の処理がより容易となる。そのため、血管剥離の作業性に優れる血管剥離デバイスとなる。
According to the present invention, the branch blood vessel can be sandwiched by the pair of insertion devices, and the displacement of the branch blood vessel can be suppressed, so that the processing of the branch blood vessel by the processing device is facilitated. Further, since the processing device can be inserted into the insertion device, the processing device can be operated smoothly, and the branch blood vessel can be processed more easily. Therefore, the blood vessel peeling device is excellent in blood vessel peeling workability.
以下、本発明の血管剥離デバイスを添付図面に示す好適な実施形態に基づいて詳細に説明する。
Hereinafter, the blood vessel peeling device of the present invention will be described in detail based on preferred embodiments shown in the accompanying drawings.
<第1実施形態>
図1は、本発明の第1実施形態に係る血管剥離デバイスの構成部材を示す平面図である。図2は、皮膚側剥離デバイスを示す断面図である。図3は、図2中のB-B線断面図である。図4は、図1中のA-A線断面図である。図5および図6は、それぞれ、図4に示す第1の剥離デバイスと第2の剥離デバイスとを突き合わせた状態の断面図である。図7および図8は、それぞれ、処理デバイスを示す断面図である。図9は、処理デバイスによる分岐血管の切断位置を説明する断面図である。図10は、処理デバイスが備える切断部の変位を示す断面図である。図11は、切断デバイスを示す側面図である。図12は、図11中のC-C線断面図である。図13ないし図19は、それぞれ、血管を剥離する方法を説明する図である。なお、以下では、説明の便宜上、図1中の右側を「先端」、左側を「基端」とも言う。 <First Embodiment>
FIG. 1 is a plan view showing components of the blood vessel peeling device according to the first embodiment of the present invention. FIG. 2 is a cross-sectional view showing a skin side peeling device. 3 is a cross-sectional view taken along line BB in FIG. 4 is a cross-sectional view taken along line AA in FIG. 5 and 6 are cross-sectional views showing a state in which the first peeling device and the second peeling device shown in FIG. 4 are brought into contact with each other. 7 and 8 are cross-sectional views each showing a processing device. FIG. 9 is a cross-sectional view for explaining the cutting position of the branch blood vessel by the processing device. FIG. 10 is a cross-sectional view showing the displacement of the cutting portion provided in the processing device. FIG. 11 is a side view showing the cutting device. 12 is a cross-sectional view taken along the line CC in FIG. FIG. 13 to FIG. 19 are diagrams for explaining a method of peeling blood vessels. In the following, for convenience of explanation, the right side in FIG. 1 is also referred to as “tip”, and the left side is also referred to as “base end”.
図1は、本発明の第1実施形態に係る血管剥離デバイスの構成部材を示す平面図である。図2は、皮膚側剥離デバイスを示す断面図である。図3は、図2中のB-B線断面図である。図4は、図1中のA-A線断面図である。図5および図6は、それぞれ、図4に示す第1の剥離デバイスと第2の剥離デバイスとを突き合わせた状態の断面図である。図7および図8は、それぞれ、処理デバイスを示す断面図である。図9は、処理デバイスによる分岐血管の切断位置を説明する断面図である。図10は、処理デバイスが備える切断部の変位を示す断面図である。図11は、切断デバイスを示す側面図である。図12は、図11中のC-C線断面図である。図13ないし図19は、それぞれ、血管を剥離する方法を説明する図である。なお、以下では、説明の便宜上、図1中の右側を「先端」、左側を「基端」とも言う。 <First Embodiment>
FIG. 1 is a plan view showing components of the blood vessel peeling device according to the first embodiment of the present invention. FIG. 2 is a cross-sectional view showing a skin side peeling device. 3 is a cross-sectional view taken along line BB in FIG. 4 is a cross-sectional view taken along line AA in FIG. 5 and 6 are cross-sectional views showing a state in which the first peeling device and the second peeling device shown in FIG. 4 are brought into contact with each other. 7 and 8 are cross-sectional views each showing a processing device. FIG. 9 is a cross-sectional view for explaining the cutting position of the branch blood vessel by the processing device. FIG. 10 is a cross-sectional view showing the displacement of the cutting portion provided in the processing device. FIG. 11 is a side view showing the cutting device. 12 is a cross-sectional view taken along the line CC in FIG. FIG. 13 to FIG. 19 are diagrams for explaining a method of peeling blood vessels. In the following, for convenience of explanation, the right side in FIG. 1 is also referred to as “tip”, and the left side is also referred to as “base end”.
≪血管剥離デバイス≫
図1に示す血管剥離デバイス100は、血管バイパス術(冠動脈バイパス術:CABG)を行う際のバイパス管として用いられる血管を採取するのに用いられるデバイスであり、血管を周囲の組織(脂肪、結合組織等)に覆われた状態で採取することができる。なお、血管剥離デバイス100を用いて採取する血管としては、バイパス管として用いることのできる血管であれば特に限定されず、例えば、内胸動脈、胃大網動脈、橈骨動脈、大伏在静脈等が挙げられる。 ≪Vessel peeling device≫
A bloodvessel peeling device 100 shown in FIG. 1 is a device used to collect a blood vessel used as a bypass tube when performing a blood vessel bypass operation (coronary artery bypass surgery: CABG). It can be collected in a state covered with tissue. The blood vessel collected using the blood vessel peeling device 100 is not particularly limited as long as it can be used as a bypass tube. For example, the internal thoracic artery, gastroepiploic artery, radial artery, great saphenous vein, etc. Is mentioned.
図1に示す血管剥離デバイス100は、血管バイパス術(冠動脈バイパス術:CABG)を行う際のバイパス管として用いられる血管を採取するのに用いられるデバイスであり、血管を周囲の組織(脂肪、結合組織等)に覆われた状態で採取することができる。なお、血管剥離デバイス100を用いて採取する血管としては、バイパス管として用いることのできる血管であれば特に限定されず、例えば、内胸動脈、胃大網動脈、橈骨動脈、大伏在静脈等が挙げられる。 ≪Vessel peeling device≫
A blood
ただし、採取する血管としてはこれらの中でも大伏在静脈であることが好ましい。血管剥離デバイス100を用いることで、前述したように、血管を周囲の組織に覆われた状態で採取することが容易となるため、血管剥離デバイス100を用いて大伏在静脈を採取し、それをバイパス管として用いることで、術後の長期的な開存率が高くなると考えられる。このため、以下では、血管剥離デバイス100を用いて大伏在静脈を採取する例について代表して説明する。
However, the blood vessel to be collected is preferably the great saphenous vein among them. By using the blood vessel peeling device 100, as described above, it becomes easy to collect blood vessels in a state of being covered with surrounding tissues. Therefore, the large saphenous vein is collected using the blood vessel peeling device 100, By using as a bypass tube, the long-term patency after surgery is considered to be high. For this reason, below, the example which extract | collects a great saphenous vein using the blood vessel peeling device 100 is demonstrated as a representative.
血管剥離デバイス100は、図1に示すように、皮膚側剥離デバイス200と、筋膜側剥離デバイス300と、処理デバイス400と、切断デバイス500と、を有している。これらのうち皮膚側剥離デバイス200、筋膜側剥離デバイス300および切断デバイス500は、大伏在静脈に沿って生体内に挿入されるデバイスであり、処理デバイス400は、筋膜側剥離デバイス300内に挿入されるデバイスである。以下、これら各デバイスについて順次詳細に説明する。
As shown in FIG. 1, the blood vessel peeling device 100 includes a skin side peeling device 200, a fascia side peeling device 300, a processing device 400, and a cutting device 500. Among these, the skin side peeling device 200, the fascia side peeling device 300, and the cutting device 500 are devices that are inserted into the living body along the great saphenous vein, and the processing device 400 is inside the fascia side peeling device 300. It is a device to be inserted into. Hereinafter, each of these devices will be described in detail.
[皮膚側剥離デバイス]
皮膚側剥離デバイス200は、図2に示すように、略直線状に延びる長尺な棒状をなし、先端部には組織を剥離する剥離部220が設けられている。また、皮膚側剥離デバイス200は、図3に示すように、上下に潰れた扁平形状となっている。皮膚側剥離デバイス200の断面形状としては、特に限定されないが、例えば、長円、楕円等の円が潰れたような形状や角が丸み付けされた長方形等とすることができる。 [Skin-side peeling device]
As shown in FIG. 2, the skin-side peeling device 200 has a long rod shape that extends substantially linearly, and a peeling portion 220 that peels tissue is provided at the distal end portion. Moreover, as shown in FIG. 3, the skin side peeling device 200 has a flat shape crushed up and down. The cross-sectional shape of the skin side peeling device 200 is not particularly limited, but may be, for example, a shape in which a circle such as an ellipse or an ellipse is crushed, a rectangle with rounded corners, or the like.
皮膚側剥離デバイス200は、図2に示すように、略直線状に延びる長尺な棒状をなし、先端部には組織を剥離する剥離部220が設けられている。また、皮膚側剥離デバイス200は、図3に示すように、上下に潰れた扁平形状となっている。皮膚側剥離デバイス200の断面形状としては、特に限定されないが、例えば、長円、楕円等の円が潰れたような形状や角が丸み付けされた長方形等とすることができる。 [Skin-side peeling device]
As shown in FIG. 2, the skin-
また、皮膚側剥離デバイス200の幅(横断面の長軸方向の長さ)W1は、採取する血管(本実施形態では大伏在静脈)の外径よりも大きくなっている。具体的には、幅W1は、採取する血管の外径よりも4mm~4cm程度大きいことが好ましい。これにより、後述する「血管採取方法」でも説明するように、皮膚側剥離デバイス200に沿わせて切断デバイス500を生体に挿入する際に、切断デバイス500と大伏在静脈との接触を効果的に低減することができる。
Also, the width (length in the major axis direction of the cross section) W1 of the skin side peeling device 200 is larger than the outer diameter of the blood vessel to be collected (large saphenous vein in this embodiment). Specifically, the width W1 is preferably about 4 mm to 4 cm larger than the outer diameter of the blood vessel to be collected. As a result, as will be described later in the “blood vessel collection method”, when the cutting device 500 is inserted into the living body along the skin-side peeling device 200, the contact between the cutting device 500 and the great saphenous vein is effective. Can be reduced.
また、皮膚側剥離デバイス200の長軸方向の両側には、軸方向に延びる凹条のレール231、232が設けられている。これらレール231、232は、それぞれ、切断デバイス500を接続するのに用いるレールである。なお、レール231、232の構成としては、切断デバイス500と接続することができれば、特に限定されない。
Further, on both sides of the skin side peeling device 200 in the major axis direction, concave rails 231 and 232 extending in the axial direction are provided. These rails 231 and 232 are rails used to connect the cutting device 500, respectively. The configuration of the rails 231 and 232 is not particularly limited as long as it can be connected to the cutting device 500.
また、図2に示すように、皮膚側剥離デバイス200には、基端に開放し、先端部(剥離部220)まで延びる挿入孔210が設けられている。この挿入孔210にはイメージングデバイス900が挿入される。イメージングデバイス900としては、特に限定されない。例えば、本実施形態のイメージングデバイス900は、長尺な本体部910を有し、この本体部910の先端部に照明光を出射する図示しない照明部と皮膚側剥離デバイス200の前方を撮像する撮像部930とが設けられている。撮像部930は、例えば、本体部910の先端部に設けられた対物レンズ系と、対物レンズ系に対向設置された撮像素子(例えば、CMOSイメージセンサ、CCDセンサ等の固体撮像素子)と、を備えている。
Further, as shown in FIG. 2, the skin side peeling device 200 is provided with an insertion hole 210 that opens to the proximal end and extends to the distal end portion (peeling portion 220). The imaging device 900 is inserted into the insertion hole 210. The imaging device 900 is not particularly limited. For example, the imaging device 900 according to the present embodiment includes a long main body 910, and an imaging unit (not shown) that emits illumination light to the distal end of the main body 910 and the front side of the skin-side peeling device 200 are imaged. Part 930 is provided. The imaging unit 930 includes, for example, an objective lens system provided at the distal end portion of the main body unit 910 and an imaging device (for example, a solid-state imaging device such as a CMOS image sensor or a CCD sensor) disposed to face the objective lens system. I have.
また、剥離部220は、皮膚側剥離デバイス200の先端に向けて先細りしている。より具体的には、剥離部220の横断面形状の短軸方向の長さおよび長軸方向の長さが共に先端側に向けて漸減するように先細りした略円錐形状をなしている。このような剥離部220は、厚さ方向に鈍となっており、大伏在静脈から分岐している分岐血管を切断することなく、性状の異なる組織(例えば、脂肪と皮膚、脂肪と筋膜、脂肪と血管、脂肪と骨など)同士を剥離することができる程度の鋭さ(鈍さ)を有している。これにより、剥離機能を十分に発揮することができると共に、剥離部220による分岐血管の損傷・切断が抑制される。そのため、出血を少なく抑えることができ、安全かつスムーズに手技を行うことができる。なお、剥離部220の形状としては、組織を厚さ方向(短軸方向)に剥離することができれば特に限定されず、例えば、剥離部220の横断面形状の短軸方向の長さが先端側に向けて漸減するように先細りし、先端が長軸方向に沿った線状となっているダックビル形状であってもよい。
Further, the peeling part 220 is tapered toward the tip of the skin side peeling device 200. More specifically, the peeling section 220 has a substantially conical shape that is tapered so that both the length in the minor axis direction and the length in the major axis direction of the cross-sectional shape gradually decrease toward the distal end side. Such a peeling portion 220 is blunt in the thickness direction, and does not cut a branch blood vessel branched from the great saphenous vein, and has different properties (for example, fat and skin, fat and fascia) , Fat and blood vessels, fat and bone, etc.) have such a sharpness (dullness) that they can be separated from each other. Thereby, while being able to fully exhibit a peeling function, damage and cutting | disconnection of the branch blood vessel by the peeling part 220 are suppressed. Therefore, bleeding can be suppressed to a minimum, and the procedure can be performed safely and smoothly. The shape of the peeling portion 220 is not particularly limited as long as the tissue can be peeled in the thickness direction (short axis direction). For example, the length in the short axis direction of the cross-sectional shape of the peeling portion 220 is the tip side. It may be a duckbill shape tapering so as to gradually decrease toward the end and having a tip that is linear along the long axis direction.
また、剥離部220は、実質的に無色透明で光透過性を有している。そのため、前述した挿入孔210にイメージングデバイス900を挿入することで、イメージングデバイス900によって、剥離部220を介して皮膚側剥離デバイス200の前方を観察することができる。このことから、剥離部220は、前述したような剥離機能の他に、生体内を観察する観察部としての機能を有している。なお、剥離部220は、光透過性を有していれば無色透明に限定されず、赤、青、緑などに着色されていてもよい。
Moreover, the peeling part 220 is substantially colorless and transparent and has light transmittance. Therefore, by inserting the imaging device 900 into the insertion hole 210 described above, the imaging device 900 can observe the front side of the skin-side peeling device 200 via the peeling portion 220. From this, the peeling part 220 has a function as an observation part which observes the inside of a living body besides the peeling function as mentioned above. Note that the peeling portion 220 is not limited to being colorless and transparent as long as it has light transparency, and may be colored red, blue, green, or the like.
[筋膜側剥離デバイス]
筋膜側剥離デバイス300は、図1に示すように、第1の剥離デバイス(挿入デバイス)310と、第2の剥離デバイス(挿入デバイス)320と、を有している。後述するように、これら第1の剥離デバイス310および第2の剥離デバイス320は、生体内において、互いの側面同士を突き合わせるように配置して使用される。なお、本実施形態では、第1の剥離デバイス310および第2の剥離デバイス320は、第1の剥離デバイス310に電極が配置されている以外は、同様の構成となっている。 [Fascia side peeling device]
As shown in FIG. 1, the fasciaside peeling device 300 includes a first peeling device (insertion device) 310 and a second peeling device (insertion device) 320. As will be described later, the first peeling device 310 and the second peeling device 320 are used in a living body so as to face each other. In the present embodiment, the first peeling device 310 and the second peeling device 320 have the same configuration except that an electrode is disposed on the first peeling device 310.
筋膜側剥離デバイス300は、図1に示すように、第1の剥離デバイス(挿入デバイス)310と、第2の剥離デバイス(挿入デバイス)320と、を有している。後述するように、これら第1の剥離デバイス310および第2の剥離デバイス320は、生体内において、互いの側面同士を突き合わせるように配置して使用される。なお、本実施形態では、第1の剥離デバイス310および第2の剥離デバイス320は、第1の剥離デバイス310に電極が配置されている以外は、同様の構成となっている。 [Fascia side peeling device]
As shown in FIG. 1, the fascia
第1の剥離デバイス310は、略直線状に延びる長尺な棒状をなし、先端部には組織を剥離する剥離部311が設けられている。同様に、第2の剥離デバイス320も、略直線状に延びる長尺な棒状をなし、先端部には組織を剥離する剥離部321が設けられている。これら剥離部311、321は、それぞれ、先端に向けて先細りしている。より具体的には、剥離部311、321の横断面形状の短軸方向の長さおよび長軸方向の長さが共に先端側に向けて漸減するように先細りしている。このような剥離部311、321は、厚さ方向に鈍となっており、大伏在静脈から分岐している分岐血管を切断することなく、性状の異なる組織(例えば、脂肪と皮膚、脂肪と筋膜、脂肪と血管、脂肪と骨など)同士を剥離することができる程度の鋭さ(鈍さ)を有している。これにより、剥離機能を十分に発揮することができると共に、剥離部311、321による分岐血管の損傷・切断が抑制される。そのため、出血を少なく抑えることができ、安全かつスムーズに手技を行うことができる。なお、平面視での剥離部311、321のテーパー角θとしては、特に限定されないが、50°~70°程度とすることができる。また、剥離部311、321の形状としては、組織を厚さ方向に剥離することができれば特に限定されず、例えば、ダックビル形状であってもよい。
The first peeling device 310 has a long rod shape extending substantially linearly, and a peeling portion 311 for peeling tissue is provided at the tip. Similarly, the second peeling device 320 also has a long rod shape extending substantially linearly, and a peeling portion 321 for peeling tissue is provided at the tip. These peeling parts 311 and 321 each taper toward the tip. More specifically, the lengths in the minor axis direction and the length in the major axis direction of the cross-sectional shapes of the peeling portions 311 and 321 are both tapered so as to gradually decrease toward the distal end side. Such peeling portions 311 and 321 are blunt in the thickness direction, and do not cut branch blood vessels branching from the great saphenous vein, but have different properties (for example, fat and skin, fat and Such as fascia, fat and blood vessels, fat and bone). Thereby, while being able to fully exhibit a peeling function, the damage and cutting | disconnection of the branch blood vessel by the peeling parts 311 and 321 are suppressed. Therefore, bleeding can be suppressed to a minimum, and the procedure can be performed safely and smoothly. The taper angle θ of the peeling portions 311 and 321 in plan view is not particularly limited, but can be about 50 ° to 70 °. In addition, the shape of the peeling portions 311 and 321 is not particularly limited as long as the tissue can be peeled in the thickness direction, and may be, for example, a duckbill shape.
また、第1の剥離デバイス310および第2の剥離デバイス320は、それぞれ、図4に示すように、上下に潰れた扁平形状となっている。なお、本実施形態では、第1の剥離デバイス310および第2の剥離デバイス320の断面形状は、それぞれ、角が丸み付けされた長方形となっている。ただし、第1の剥離デバイス310および第2の剥離デバイス320の断面形状は、特に限定されず、長方形の他、例えば、長円、楕円等の円が潰れたような形状とすることもできる。
Further, the first peeling device 310 and the second peeling device 320 each have a flat shape crushed up and down as shown in FIG. In the present embodiment, the cross-sectional shapes of the first peeling device 310 and the second peeling device 320 are rectangles with rounded corners, respectively. However, the cross-sectional shapes of the first peeling device 310 and the second peeling device 320 are not particularly limited, and may be a shape in which a circle such as an ellipse or an ellipse is crushed in addition to a rectangle.
また、第1の剥離デバイス310の上面(一方の主面)には、軸方向に延びる凹条のレール312が設けられている。同様に、第2の剥離デバイス320の上面にも、軸方向に延びる凹条のレール322が設けられている。これらのレール312、322は、切断デバイス500と接続するのに用いられるレールである。なお、レール312、322の構成としては、それぞれ、切断デバイス500と接続することができれば、特に限定されない。
Further, a concave rail 312 extending in the axial direction is provided on the upper surface (one main surface) of the first peeling device 310. Similarly, a concave rail 322 extending in the axial direction is also provided on the upper surface of the second peeling device 320. These rails 312 and 322 are rails used to connect to the cutting device 500. The configurations of the rails 312 and 322 are not particularly limited as long as they can be connected to the cutting device 500, respectively.
第1の剥離デバイス310および第2の剥離デバイス320は、側面同士を突き合わせるようにして使用される。図4に示すように、第1の剥離デバイス310には、突き当て面(第2の剥離デバイス320側の側面)310aに開口する溝(第2の溝)313が設けられている。溝313は、第1の剥離デバイス310の軸方向に延在しており、先端および基端の両方に開口している。同様に、第2の剥離デバイス320にも、突き当て面(第1の剥離デバイス310側の側面)320aに開口する溝(第1の溝)323が設けられている。溝323は、第2の剥離デバイス320の軸方向に延在しており、先端および基端の両方に開口している。溝313、323は、図5に示すように、突き当て面310a、320a同士を突き合せたときに、互いが連通して空洞部330を形成する。この空洞部330は、処理デバイス400が挿入される挿入部として機能する。このような構成によれば、処理デバイス400を第1、第2の剥離デバイス310、320の内側で移動させることができるため、処理デバイス400による処理をよりスムーズかつ正確に行うことができる。
The first peeling device 310 and the second peeling device 320 are used so that the side surfaces are abutted with each other. As shown in FIG. 4, the first peeling device 310 is provided with a groove (second groove) 313 that opens to an abutting surface (side surface on the second peeling device 320 side) 310 a. The groove 313 extends in the axial direction of the first peeling device 310 and opens at both the distal end and the proximal end. Similarly, the second peeling device 320 is also provided with a groove (first groove) 323 that opens to the abutting surface (side surface on the first peeling device 310 side) 320a. The groove 323 extends in the axial direction of the second peeling device 320 and opens at both the distal end and the proximal end. As shown in FIG. 5, the grooves 313 and 323 communicate with each other to form a cavity 330 when the abutting surfaces 310 a and 320 a are abutted with each other. The hollow portion 330 functions as an insertion portion into which the processing device 400 is inserted. According to such a configuration, since the processing device 400 can be moved inside the first and second peeling devices 310 and 320, the processing by the processing device 400 can be performed more smoothly and accurately.
なお、第1の剥離デバイス310および第2の剥離デバイス320を突き合わせたときの全幅W3は、採取する血管の外径よりも大きくなっている。具体的には、第1の剥離デバイス310および第2の剥離デバイス320は、それぞれ、例えば、20mm~40mm程度の幅を有していることが好ましい。
In addition, the full width W3 when the first peeling device 310 and the second peeling device 320 are brought into contact with each other is larger than the outer diameter of the blood vessel to be collected. Specifically, each of the first peeling device 310 and the second peeling device 320 preferably has a width of about 20 mm to 40 mm, for example.
また、第1の剥離デバイス310は、図1に示すように、突き当て面310aに開放する切り欠き314、315を有している。切り欠き314、315は、第1の剥離デバイス310の先端側と基端側に離間して配置されている。同様に、第2の剥離デバイス320は、突き当て面320aに開放する切り欠き324、325を有している。切り欠き324、325は、第2の剥離デバイス320の先端側と基端側に離間して配置されている。そして、図6に示すように、第1の剥離デバイス310および第2の剥離デバイス320を突き合わせたとき、切り欠き314、324が接続され、これらによって第1、第2の剥離デバイス310、320の上下を貫通する貫通孔334が形成される。同様に、切り欠き315、325が接続され、これらによって第1、第2の剥離デバイス310、320の上下を貫通する貫通孔335が形成される。これら貫通孔334、335は、第1の剥離デバイス310と第2の剥離デバイス320とを突き合わせたときに、大伏在静脈1000を挿通するための挿通部として機能する。これにより、第1の剥離デバイス310と第2の剥離デバイス320の間に大伏在静脈1000が挟まれることが無くなり、大伏在静脈1000の損傷、切断、血流の低下等を防止することができる。なお、本実施形態では、第1の剥離デバイス310と第2の剥離デバイス320の両方に切り欠きが設けられているが、切り欠きは、第1の剥離デバイス310および第2の剥離デバイス320の一方にのみ設けられていればよい。
Moreover, the 1st peeling device 310 has the notches 314 and 315 opened to the butting surface 310a, as shown in FIG. The notches 314 and 315 are spaced apart from the distal end side and the proximal end side of the first peeling device 310. Similarly, the second peeling device 320 has notches 324 and 325 that open to the abutting surface 320a. The notches 324 and 325 are spaced apart from the distal end side and the proximal end side of the second peeling device 320. Then, as shown in FIG. 6, when the first peeling device 310 and the second peeling device 320 are brought into contact with each other, the notches 314 and 324 are connected, and thereby, the first and second peeling devices 310 and 320 are connected to each other. A through hole 334 penetrating vertically is formed. Similarly, notches 315 and 325 are connected to form a through hole 335 penetrating the first and second peeling devices 310 and 320. These through holes 334 and 335 function as insertion portions for inserting the great saphenous vein 1000 when the first peeling device 310 and the second peeling device 320 are brought into contact with each other. As a result, the great saphenous vein 1000 is not sandwiched between the first peeling device 310 and the second peeling device 320, and the damage, cutting, blood flow reduction, etc. of the great saphenous vein 1000 are prevented. Can do. In the present embodiment, notches are provided in both the first peeling device 310 and the second peeling device 320, but the notches are formed in the first peeling device 310 and the second peeling device 320. It only needs to be provided on one side.
また、第1の剥離デバイス310の突き当て面310a側には、一対の電極316、317が設けられている。電極316、317は、切り欠き314、315の間で軸方向に延在し、溝313を介して対向配置されている。また、電極316、317は、同電位に接続されている。これら電極316、317は、後述するように、分岐血管1100を焼灼するための電界を発生させるのに用いる電極である。なお、本実施形態では、電極316、317が突き当て面310aに露出しているが、電極316、317は、突き当て面310aに露出しておらず、第1の剥離デバイス310内に埋設されていてもよい。
In addition, a pair of electrodes 316 and 317 are provided on the abutting surface 310a side of the first peeling device 310. The electrodes 316 and 317 extend in the axial direction between the notches 314 and 315, and are disposed to face each other via the groove 313. The electrodes 316 and 317 are connected to the same potential. These electrodes 316 and 317 are electrodes used to generate an electric field for cauterizing the branch blood vessel 1100, as will be described later. In this embodiment, the electrodes 316 and 317 are exposed on the abutting surface 310a, but the electrodes 316 and 317 are not exposed on the abutting surface 310a and are embedded in the first peeling device 310. It may be.
以上、第1、第2の剥離デバイス310、320について説明したが、第1、第2の剥離デバイス310、320には、前述した皮膚側剥離デバイス200と同様に、イメージングデバイス900を挿入する挿入孔が設けられていてもよい。これにより、第1の剥離デバイス310および第2の剥離デバイス320の生体内への挿入をよりスムーズに行うことができる。
Although the first and second peeling devices 310 and 320 have been described above, the insertion for inserting the imaging device 900 is inserted into the first and second peeling devices 310 and 320 in the same manner as the skin-side peeling device 200 described above. A hole may be provided. As a result, the first peeling device 310 and the second peeling device 320 can be more smoothly inserted into the living body.
また、本実施形態では、筋膜側剥離デバイス300が2本の剥離デバイスを有する構成となっているが、剥離デバイスの数としては、2本以上であれば、特に限定されない。
In the present embodiment, the fascia side peeling device 300 has two peeling devices, but the number of peeling devices is not particularly limited as long as it is two or more.
[処理デバイス]
処理デバイス400は、図1に示すように、棒状で長尺な操作部410と、操作部410の基端部に設けられた電極420と、電極420の基端部に設けられた切断部430と、を有している。 [Processing device]
As illustrated in FIG. 1, theprocessing device 400 includes a rod-like long operation unit 410, an electrode 420 provided at the base end of the operation unit 410, and a cutting unit 430 provided at the base end of the electrode 420. And have.
処理デバイス400は、図1に示すように、棒状で長尺な操作部410と、操作部410の基端部に設けられた電極420と、電極420の基端部に設けられた切断部430と、を有している。 [Processing device]
As illustrated in FIG. 1, the
操作部410は、筋膜側剥離デバイス300の空洞部330内に挿入可能である。また、操作部410は、空洞部330内において、第1の剥離デバイス310の溝313側へはみ出さないで、溝323内をスライドできるようになっている。後述するように、第1の剥離デバイス310と第2の剥離デバイス320とで分岐血管1100を挟持するため、図7に示すように、溝313、323の間に分岐血管1100が位置している。そのため、操作部410を溝323内でスライド可能とすることで、操作部410と分岐血管1100との接触を抑制でき、処理デバイス400をスムーズに操作することができる。また、分岐血管1100の損傷や切断を低減することができる。
The operation unit 410 can be inserted into the cavity 330 of the fascia side peeling device 300. Further, the operation unit 410 can slide in the groove 323 without protruding to the groove 313 side of the first peeling device 310 in the cavity 330. As will be described later, since the branch blood vessel 1100 is sandwiched between the first peeling device 310 and the second peeling device 320, the branch blood vessel 1100 is located between the grooves 313 and 323 as shown in FIG. . Therefore, by making the operation unit 410 slidable in the groove 323, contact between the operation unit 410 and the branch blood vessel 1100 can be suppressed, and the processing device 400 can be operated smoothly. Further, damage and cutting of the branch blood vessel 1100 can be reduced.
また、操作部410を溝323内に挿入した状態では、図8に示すように、電極420は、分岐血管1100を挟んで電極316、317と対向配置される。また、電極420は、分岐血管1100と接触するように配置される。そのため、電極420と電極316、317との間に高周波交番電圧を印加すると、これらの間に発生する電界が分岐血管1100に作用し、分岐血管1100を焼灼し、熱凝固(止血)することができる。
Further, in a state where the operation unit 410 is inserted into the groove 323, the electrode 420 is disposed to face the electrodes 316 and 317 with the branch blood vessel 1100 interposed therebetween, as shown in FIG. In addition, the electrode 420 is disposed so as to contact the branch blood vessel 1100. Therefore, when a high-frequency alternating voltage is applied between the electrode 420 and the electrodes 316 and 317, the electric field generated between them acts on the branch blood vessel 1100, cauterizing the branch blood vessel 1100, and heat coagulation (hemostasis). it can.
また、操作部410を溝323内に挿入した状態では、切断部430は、溝313と溝323の境界を跨ぐように配置される。そのため、電極420と電極316、317との間は、バイポーラ構造となり、高周波交番電圧を印加しながら操作部410を先端側へスライドさせれば、第1、第2の剥離デバイス310、320の間に挟持された分岐血管1100を順に熱凝固することができ、さらに、熱凝固した分岐血管1100を切断部430で切断することができる。ここで、溝323の底面(開口と対向する面)は、操作部410を案内する案内面(摺動面)323aを構成しており、この案内面323aに操作部410を摺動させることにより、操作部410が溝313側へ過度にはみ出てしまうことがなく、かつ、切断部430が溝313、323の境界を跨った状態を維持することができる。そのため、上記の作業をよりスムーズかつ正確に行うことができる。なお、案内面323aには、例えば、摩擦抵抗を低減し摺動性を高めるようなコーティング処理(親水性処理等)が施されていてもよい。
In the state where the operation unit 410 is inserted into the groove 323, the cutting unit 430 is disposed so as to straddle the boundary between the groove 313 and the groove 323. For this reason, the electrode 420 and the electrodes 316 and 317 have a bipolar structure, and if the operation unit 410 is slid to the distal end side while applying a high-frequency alternating voltage, it is between the first and second peeling devices 310 and 320. The branch blood vessels 1100 sandwiched between the two can be sequentially heat-coagulated, and the heat-coagulated branch blood vessels 1100 can be cut by the cutting unit 430. Here, the bottom surface (surface facing the opening) of the groove 323 constitutes a guide surface (sliding surface) 323a for guiding the operation unit 410, and the operation unit 410 is slid on the guide surface 323a. The operation unit 410 does not protrude excessively toward the groove 313, and the state where the cutting unit 430 straddles the boundaries of the grooves 313 and 323 can be maintained. Therefore, the above work can be performed more smoothly and accurately. The guide surface 323a may be subjected to, for example, a coating process (such as a hydrophilic process) that reduces frictional resistance and increases slidability.
切断部430による切断箇所について具体的に説明すると、図9に示すように、分岐血管1100は、電極420および電極316の間の部分(突き当て面310a、320aで挟まれて扁平状に潰れた部分)1101と電極420および電極317の間の部分(突き当て面310a、320aで挟まれて扁平状に潰れた部分)1102で熱凝固され、これら部分1101、1102の間で切断部430によって切断される。したがって、切断後の分岐血管1100からの出血を防止することができる。このような処理デバイス400によれば、第1の剥離デバイス310と第2の剥離デバイス320とで挟持された分岐血管1100を簡単に止血・切断することができる。
When the cutting part by the cutting part 430 is specifically described, as shown in FIG. 9, the branch blood vessel 1100 is sandwiched between the electrode 420 and the electrode 316 (between the abutting surfaces 310a and 320a and crushed into a flat shape. Part) 1101 and the part between electrode 420 and electrode 317 (the part which is sandwiched between the abutting surfaces 310a and 320a and flattened) 1102 is thermally coagulated, and the part 1101 and 1102 are cut by the cutting part 430. Is done. Therefore, bleeding from the branched blood vessel 1100 after cutting can be prevented. According to such a processing device 400, the branch blood vessel 1100 sandwiched between the first peeling device 310 and the second peeling device 320 can be easily stopped and cut.
なお、第2の剥離デバイス320側にも電極を配置してもよい。電極316、317と対向するように第2の剥離デバイス320側にも電極を配置することで、分岐血管1100の押圧部の両側から電極を接触させることが可能となり、通電時に効率よく熱凝固が可能となる。また、切断部430にも電極420と同様の電極機能を持たせることで、通電状態での切断が可能となる。
Note that an electrode may also be disposed on the second peeling device 320 side. By arranging the electrode on the second peeling device 320 side so as to face the electrodes 316 and 317, it is possible to contact the electrode from both sides of the pressing portion of the branch blood vessel 1100, and heat coagulation is efficiently performed when energized. It becomes possible. Further, by providing the cutting unit 430 with an electrode function similar to that of the electrode 420, cutting in an energized state can be performed.
また、切断部430は、例えば、図1中の矢印Bのように回動可能となっており、図9の、溝313、323の境界を跨いで溝313内へ侵入する状態と、図10の、溝313内には侵入せず、溝323内に退避する状態とに切り替え可能になっていることが好ましい。これにより、空洞部330内に処理デバイス400を挿入する際に、切断部430を退避状態としておくことで、切断部430による大伏在静脈1000(貫通孔334、335に挿通されている部分)の切断を防止することができる。なお、以下では、説明の便宜上、図9に示す状態を「作動状態」とも言い、図10に示す状態を「退避状態」とも言う。
Further, the cutting part 430 is rotatable as indicated by an arrow B in FIG. 1, for example, and enters the groove 313 across the boundaries of the grooves 313 and 323 in FIG. However, it is preferable to be able to switch to a state in which the groove 313 does not enter and retracts into the groove 323. Accordingly, when the processing device 400 is inserted into the cavity 330, the large saphenous vein 1000 (the portion inserted through the through holes 334 and 335) by the cutting unit 430 is placed in the retracted state. Can be prevented. In the following, for convenience of explanation, the state illustrated in FIG. 9 is also referred to as an “operating state”, and the state illustrated in FIG. 10 is also referred to as a “retracted state”.
[切断デバイス]
切断デバイス500は、大伏在静脈1000に沿って移動する際に、大伏在静脈の周囲の脂肪(結合組織を含む)を切断すると共に、大伏在静脈から分岐している分岐血管を切断・止血する。 [Cut device]
When thecutting device 500 moves along the saphenous vein 1000, the cutting device 500 cuts fat (including connective tissue) around the saphenous vein and cuts a branched blood vessel branched from the saphenous vein.・ Stop bleeding.
切断デバイス500は、大伏在静脈1000に沿って移動する際に、大伏在静脈の周囲の脂肪(結合組織を含む)を切断すると共に、大伏在静脈から分岐している分岐血管を切断・止血する。 [Cut device]
When the
切断デバイス500は、長尺な板状をなしている。また、切断デバイス500は、図1に示すように、その先端部に開放する溝520を有している。溝520は、その幅が基端側に向けて漸減するテーパー状の血管案内溝521と、血管案内溝521の基端側に位置し、その幅がほぼ一定の血管処理溝522と、を有している。血管案内溝521は、切断デバイス500を生体内で押し進める際に分岐血管1100を血管処理溝522に案内する溝であり、この案内をスムーズに行うためにテーパー状となっている。一方、血管処理溝522は、血管案内溝521によって案内された分岐血管を切断・止血するための溝である。この血管処理溝522には分岐血管を切断・止血するための処理部530が設けられている。
The cutting device 500 has a long plate shape. Moreover, the cutting device 500 has the groove | channel 520 opened to the front-end | tip part, as shown in FIG. The groove 520 has a tapered blood vessel guide groove 521 whose width gradually decreases toward the base end side, and a blood vessel processing groove 522 located on the base end side of the blood vessel guide groove 521 and having a substantially constant width. is doing. The blood vessel guide groove 521 is a groove that guides the branch blood vessel 1100 to the blood vessel processing groove 522 when the cutting device 500 is pushed in vivo, and has a tapered shape in order to perform this guidance smoothly. On the other hand, the blood vessel processing groove 522 is a groove for cutting and stopping the branch blood vessel guided by the blood vessel guide groove 521. The blood vessel processing groove 522 is provided with a processing unit 530 for cutting and stopping the branch blood vessel.
処理部530は、図11に示すように、血管処理溝522内に電界を発生させる一対の電極531、532を備えたバイポーラ構造となっている。電極531は、血管処理溝522の基端部に設けられ、電極532は、血管処理溝522を挟んだ両側に設けられている。このような電極531、532間に高周波交番電圧を印加することで、血管処理溝522に案内された分岐血管1100を焼灼し、熱凝固して止血すると共に切断することができる。なお、電極531の先端部531aは、分岐血管1100を切断することができる程度に鋭利であることが好ましい。これにより、少なくとも前記電界によって分岐血管1100を熱凝固することができれば、電極531の先端部531aによって物理的に分岐血管1100を切断することができる。よって、処理部530による処理の確実性が向上する。
As shown in FIG. 11, the processing unit 530 has a bipolar structure including a pair of electrodes 531 and 532 that generate an electric field in the blood vessel processing groove 522. The electrode 531 is provided at the proximal end of the vascular treatment groove 522, and the electrode 532 is provided on both sides of the vascular treatment groove 522. By applying a high-frequency alternating voltage between the electrodes 531 and 532, the branch blood vessel 1100 guided by the blood vessel processing groove 522 can be cauterized, thermally coagulated, hemostatic, and cut. In addition, it is preferable that the front-end | tip part 531a of the electrode 531 is sharp so that the branch blood vessel 1100 can be cut | disconnected. Accordingly, if at least the branch blood vessel 1100 can be thermally coagulated by the electric field, the branch blood vessel 1100 can be physically cut by the tip portion 531a of the electrode 531. Therefore, the certainty of processing by the processing unit 530 is improved.
なお、血管処理溝522の幅W2としては、特に限定されないが、分岐血管1100の外径よりも細いことが好ましい。これにより、図11に示すように、血管処理溝522内で分岐血管1100を潰すことができるため、処理部530での処理(特に止血)をより確実に行うことができる。
The width W2 of the blood vessel processing groove 522 is not particularly limited, but is preferably smaller than the outer diameter of the branch blood vessel 1100. As a result, as shown in FIG. 11, the branch blood vessel 1100 can be crushed in the blood vessel processing groove 522, so that the processing (particularly hemostasis) in the processing unit 530 can be performed more reliably.
また、切断デバイス500は、大伏在静脈1000の周囲にある脂肪を切断する刃部550を有している。刃部550は、切断デバイス500の先端部に設けられ、本実施形態では血管案内溝521に沿って設けられている。刃部550は、分岐血管1100を切断することなく、脂肪を切断することができる程度の鋭さを有することが好ましい。これにより、刃部550による分岐血管1100の切断が抑制されるため、出血を少なく抑えることができ、安全かつスムーズに手技を行うことができる。
Also, the cutting device 500 has a blade portion 550 that cuts fat around the saphenous vein 1000. The blade portion 550 is provided at the distal end portion of the cutting device 500, and is provided along the blood vessel guide groove 521 in the present embodiment. It is preferable that the blade part 550 has a sharpness that can cut fat without cutting the branch blood vessel 1100. Thereby, since cutting | disconnection of the branch blood vessel 1100 by the blade part 550 is suppressed, bleeding can be suppressed little and a procedure can be performed safely and smoothly.
また、切断デバイス500は、図12に示すように、その両側に設けられた一対の保護部541、542を有している。保護部541、542は、それぞれ、切断デバイス500の軸方向に沿って延在しており、周面(側面や先端面)が丸み付けされている。後述する「血管採取方法」でも説明するように、保護部541は、切断デバイス500を生体内で先端側へ押し進める際に、脂肪と皮膚との間に沿って、これらを剥離しながら移動する。このように性状の異なる脂肪と皮膚とは剥離し易いため、保護部541の先端部を丸み付けしても、脂肪と皮膚とを剥離する剥離機能を十分に発揮することができる。また、丸み付けすることで、保護部541による分岐血管1100の損傷・切断を抑制することができ、さらには保護部541との摺動による皮膚の損傷(焼灼)を抑制することができる。同様に、保護部542は、切断デバイス500を生体内で先端側へ押し進める際に、脂肪と筋膜との間に沿って、これらを剥離しながら移動する。このように性状の異なる脂肪と筋膜とは剥離し易いため、保護部542の先端部を丸み付けしても、脂肪と筋膜とを剥離する剥離機能を十分に発揮することができる。また、丸み付けすることで、保護部542による分岐血管1100の損傷・切断を抑制することができ、さらには、保護部541との摺動による筋膜の損傷を抑制することができる。
Moreover, the cutting device 500 has a pair of protection parts 541 and 542 provided on both sides thereof as shown in FIG. Each of the protection parts 541 and 542 extends along the axial direction of the cutting device 500, and the peripheral surface (side surface or tip surface) is rounded. As will be described later in the “blood vessel collection method”, when the cutting device 500 is pushed forward in the living body, the protection unit 541 moves along the gap between fat and skin while peeling them. Since the fat and skin having different properties are easily peeled in this way, even if the tip of the protective part 541 is rounded, the peeling function for peeling the fat and the skin can be sufficiently exhibited. Further, by rounding, damage / cutting of the branch blood vessel 1100 by the protection part 541 can be suppressed, and further, skin damage (cautery) due to sliding with the protection part 541 can be suppressed. Similarly, when the cutting device 500 is pushed forward in the living body, the protection unit 542 moves along the gap between the fat and the fascia while peeling them off. As described above, fat and fascia with different properties are easily peeled off, so that even if the tip of the protective portion 542 is rounded, the peeling function for peeling fat and fascia can be sufficiently exhibited. Further, by rounding, damage / cutting of the branch blood vessel 1100 by the protection unit 542 can be suppressed, and further, damage to fascia due to sliding with the protection unit 541 can be suppressed.
また、切断デバイス500は、皮膚側剥離デバイス200のレール231、232と接続可能な接続部581、582と、筋膜側剥離デバイス300のレール312、322と接続可能な接続部583と、を有している。接続部581、582は、保護部541に設けられ、接続部583は、保護部542に設けられている。これら接続部581、582、583は、レール231、232、312、322の形状に対応する凸部で構成されている。接続部581、582、583を設けることで、皮膚側剥離デバイス200および筋膜側剥離デバイス300からの切断デバイス500の意図しない離脱が防止され、よりスムーズにかつ正確に手技を行うことができる。
In addition, the cutting device 500 includes connection portions 581 and 582 that can be connected to the rails 231 and 232 of the skin-side peeling device 200, and a connection portion 583 that can be connected to the rails 312 and 322 of the fascia-side peeling device 300. is doing. The connection parts 581 and 582 are provided in the protection part 541, and the connection part 583 is provided in the protection part 542. These connecting portions 581, 582, 583 are configured by convex portions corresponding to the shapes of the rails 231, 232, 312, 322. By providing the connecting portions 581, 582, 583, unintentional detachment of the cutting device 500 from the skin side peeling device 200 and the fascia side peeling device 300 is prevented, and the procedure can be performed more smoothly and accurately.
≪血管採取方法≫
血管剥離デバイス100を用いた血管採取方法は、血管剥離デバイス100を用いて大伏在静脈1000を周囲の脂肪1200に覆われた状態で剥離する第1ステップと、大伏在静脈1000を結紮した後に切断する第2ステップと、大伏在静脈1000を周囲の脂肪1200に覆われた状態で生体から摘出する第3ステップと、を有している。 ≪How to collect blood vessels≫
In the blood vessel collection method using the bloodvessel peeling device 100, the first step of peeling the large saphenous vein 1000 while being covered with the surrounding fat 1200 using the blood vessel peeling device 100 and the large saphenous vein 1000 were ligated. A second step of cutting later, and a third step of extracting the great saphenous vein 1000 from the living body in a state of being covered with the surrounding fat 1200.
血管剥離デバイス100を用いた血管採取方法は、血管剥離デバイス100を用いて大伏在静脈1000を周囲の脂肪1200に覆われた状態で剥離する第1ステップと、大伏在静脈1000を結紮した後に切断する第2ステップと、大伏在静脈1000を周囲の脂肪1200に覆われた状態で生体から摘出する第3ステップと、を有している。 ≪How to collect blood vessels≫
In the blood vessel collection method using the blood
[第1ステップ]
まず、採取する大伏在静脈1000の位置を確認し、その位置に基づいて皮膚を切開する。なお、図13に示すように、本作業では皮膚を2箇所切開し、切開部1310、1320の間の大伏在静脈1000を採集する。 [First step]
First, the position of the greatsaphenous vein 1000 to be collected is confirmed, and the skin is incised based on the position. As shown in FIG. 13, in this work, the skin is incised at two places, and the great saphenous vein 1000 between the incisions 1310 and 1320 is collected.
まず、採取する大伏在静脈1000の位置を確認し、その位置に基づいて皮膚を切開する。なお、図13に示すように、本作業では皮膚を2箇所切開し、切開部1310、1320の間の大伏在静脈1000を採集する。 [First step]
First, the position of the great
次に、イメージングデバイス900が挿入された皮膚側剥離デバイス200を用意する。次に、イメージングデバイス900で生体内を観察しながら、皮膚側剥離デバイス200を大伏在静脈1000と離間させつつ、大伏在静脈1000に沿って生体内へ挿入する。そして、皮膚側剥離デバイス200を、図14に示すように、大伏在静脈1000の上方(皮膚1400側)に配置する。この際、皮膚側剥離デバイス200を、その厚さ方向が、皮膚側剥離デバイス200と大伏在静脈1000との並び方向にほぼ一致するように配置する。なお、本作業では、切開部1310から皮膚側剥離デバイス200を挿入し、切開部1320から皮膚側剥離デバイス200の先端部を突出させる。また、本作業では、皮膚側剥離デバイス200を脂肪1200と皮膚1400の間(性状の異なる組織の間)に挿入し、皮膚1400と脂肪1200とを皮膚側剥離デバイス200の厚さ方向(皮膚側剥離デバイス200と大伏在静脈1000の並び方向)に剥離する。このような箇所は、特に剥離し易い箇所であるため、本作業をよりスムーズかつ的確に行うことができる。
Next, the skin side peeling device 200 in which the imaging device 900 is inserted is prepared. Next, while observing the inside of the living body with the imaging device 900, the skin side peeling device 200 is inserted into the living body along the great saphenous vein 1000 while being separated from the great saphenous vein 1000. And the skin side peeling device 200 is arrange | positioned above the great saphenous vein 1000 (skin 1400 side), as shown in FIG. At this time, the skin side peeling device 200 is arranged so that the thickness direction thereof substantially coincides with the alignment direction of the skin side peeling device 200 and the great saphenous vein 1000. In this operation, the skin side peeling device 200 is inserted from the incision portion 1310, and the distal end portion of the skin side peeling device 200 is protruded from the incision portion 1320. Further, in this work, the skin side peeling device 200 is inserted between the fat 1200 and the skin 1400 (between tissues having different properties), and the skin 1400 and the fat 1200 are inserted in the thickness direction of the skin side peeling device 200 (skin side). The peeling device 200 and the great saphenous vein 1000 are peeled in the direction of alignment). Since such a part is a part where it is particularly easy to peel off, this operation can be performed more smoothly and accurately.
次に、筋膜側剥離デバイス300(第1、第2の剥離デバイス310、320)を用意し、第1、第2の剥離デバイス310、320を順に大伏在静脈1000と離間させつつ大伏在静脈1000に沿って生体内へ挿入する。そして、第1、第2の剥離デバイス310、320を、図15に示すように、大伏在静脈1000の下方(筋膜1500側)に配置する。なお、本作業では、切開部1310から第1、第2の剥離デバイス310、320を挿入し、切開部1320からこれらの先端部を突出させる。この段階では、第1の剥離デバイス310および第2の剥離デバイス320を横に並べ、かつ、互いに若干離間して配置する。また、平面視で、第1の剥離デバイス310と第2の剥離デバイス320の間に大伏在静脈1000が位置するようにこれらを配置する。また、第1、第2の剥離デバイス310、320の間を、大伏在静脈1000から下方へ分かれた分岐血管1100が通過している。なお、本作業では、第1、第2の剥離デバイス310、320を脂肪1200と筋膜1500との間(性状の異なる組織の境界部)に挿入し、脂肪1200と筋膜1500とを第1、第2の剥離デバイス310、320の厚さ方向に剥離する。このような箇所は、特に剥離し易い箇所であるため、本作業をよりスムーズかつ的確に行うことができる。
Next, a fascia side peeling device 300 (first and second peeling devices 310 and 320) is prepared, and the first and second peeling devices 310 and 320 are sequentially separated from the great saphenous vein 1000 while It is inserted into the living body along the venous vein 1000. And the 1st, 2nd peeling device 310,320 is arrange | positioned under the great saphenous vein 1000 (fascia 1500 side), as shown in FIG. In this operation, the first and second peeling devices 310 and 320 are inserted from the incision portion 1310, and the tip portions thereof are protruded from the incision portion 1320. At this stage, the first peeling device 310 and the second peeling device 320 are arranged side by side and slightly spaced from each other. Moreover, these are arrange | positioned so that the great saphenous vein 1000 may be located between the 1st peeling device 310 and the 2nd peeling device 320 by planar view. Further, a branch blood vessel 1100 divided downward from the great saphenous vein 1000 passes between the first and second peeling devices 310 and 320. In this work, the first and second peeling devices 310 and 320 are inserted between the fat 1200 and the fascia 1500 (boundary portion of tissue having different properties), and the fat 1200 and the fascia 1500 are inserted into the first. The second peeling devices 310 and 320 are peeled in the thickness direction. Since such a part is a part where it is particularly easy to peel off, this operation can be performed more smoothly and accurately.
次に、図16に示すように、第1の剥離デバイス310と第2の剥離デバイス320とを突き合わせて(接近させて)、突き合わせた状態が維持されるようにこれらを互いに固定する。これにより、第1の剥離デバイス310と第2の剥離デバイス320との間を通過していた分岐血管1100がこれらによって挟持され、挟持された分岐血管1100が空洞部330を横切るように空洞部330内に露出する。ここで、第1の剥離デバイス310と第2の剥離デバイス320を固定する際には、大伏在静脈1000の先端側を切り欠き314、324からなる貫通孔334に挿通し、基端側を切り欠き315、325からなる貫通孔335に挿通する。これにより、第1、第2の剥離デバイス310、320の間に大伏在静脈1000が挟まれず、大伏在静脈1000の損傷、切断、血流の低下等を防止することができる。
Next, as shown in FIG. 16, the first peeling device 310 and the second peeling device 320 are abutted (approached) and fixed to each other so that the abutted state is maintained. Thereby, the branch blood vessel 1100 that has passed between the first peeling device 310 and the second peeling device 320 is sandwiched between them, and the hollow blood vessel 330 so that the branched blood vessel 1100 that has been sandwiched crosses the hollow portion 330. Exposed inside. Here, when the first peeling device 310 and the second peeling device 320 are fixed, the distal end side of the great saphenous vein 1000 is inserted into the through hole 334 including the notches 314 and 324, and the proximal end side is inserted. The through hole 335 is formed by the notches 315 and 325. Thereby, the large saphenous vein 1000 is not sandwiched between the first and second peeling devices 310 and 320, and damage, cutting, blood flow reduction, and the like of the large saphenous vein 1000 can be prevented.
なお、第1の剥離デバイス310と第2の剥離デバイス320の固定方法としては、特に限定されないが、第1の剥離デバイス310および第2の剥離デバイス320の両端部がそれぞれ生体から露出しているので、両端部において固定具等を用いて固定することが好ましい。これにより、本作業がより容易となる。
The fixing method of the first peeling device 310 and the second peeling device 320 is not particularly limited, but both end portions of the first peeling device 310 and the second peeling device 320 are exposed from the living body. Therefore, it is preferable to fix using a fixture etc. in both ends. Thereby, this work becomes easier.
次に、処理デバイス400を用意し、先端側から空洞部330(溝323)内へ挿入する。次に、第1の剥離デバイス310が備える電極316、317と処理デバイス400が備える電極420との間に高周波交番電圧を印加しつつ、図17に示すように、処理デバイス400を先端側へ移動させる。これにより、前述したように、分岐血管1100が順に止血、切断される。ここで、第1、第2の剥離デバイス310、320によって分岐血管1100が挟持されているため、分岐血管1100の変位が抑えられ、分岐血管1100の処理をより確実に行うことができる。
Next, the processing device 400 is prepared and inserted into the cavity 330 (groove 323) from the tip side. Next, as shown in FIG. 17, the processing device 400 is moved to the distal end side while applying a high-frequency alternating voltage between the electrodes 316 and 317 included in the first peeling device 310 and the electrode 420 included in the processing device 400. Let Thereby, as described above, the branch blood vessel 1100 is stopped and cut in order. Here, since the branch blood vessel 1100 is sandwiched between the first and second peeling devices 310 and 320, the displacement of the branch blood vessel 1100 is suppressed, and the processing of the branch blood vessel 1100 can be performed more reliably.
次に、切断デバイス500を用意し、接続部581を皮膚側剥離デバイス200のレール231に接続すると共に、接続部583を第2の剥離デバイス320のレール322に接続する。そして、切断デバイス500を皮膚側剥離デバイス200および第2の剥離デバイス320で案内しながら生体内へ挿入し、図18に示すように、大伏在静脈1000の一方の側方に切断デバイス500を配置する。この際、切断デバイス500は、保護部541によって脂肪1200から皮膚1400を剥離する。さらに、切断デバイス500は、刃部550によって大伏在静脈1000の側方にある脂肪1200を左右(切断デバイス500と大伏在静脈1000の並び方向)に切断すると共に、処理部530によって分岐血管1100を止血、切断する。
Next, the cutting device 500 is prepared, the connecting portion 581 is connected to the rail 231 of the skin side peeling device 200, and the connecting portion 583 is connected to the rail 322 of the second peeling device 320. Then, the cutting device 500 is inserted into the living body while being guided by the skin side peeling device 200 and the second peeling device 320, and the cutting device 500 is placed on one side of the great saphenous vein 1000 as shown in FIG. Deploy. At this time, the cutting device 500 peels the skin 1400 from the fat 1200 by the protection unit 541. Further, the cutting device 500 cuts the fat 1200 on the side of the great saphenous vein 1000 by the blade 550 to the left and right (alignment direction of the cutting device 500 and the great saphenous vein 1000), and the processing unit 530 branches the blood vessel. 1100 is hemostatic and cut.
ここで、前述したように、皮膚側剥離デバイス200の幅W1が大伏在静脈1000の外径よりも大きいため、図18に示すように、切断デバイス500を大伏在静脈1000から横に離間させつつ大伏在静脈1000に沿って押し進めることができ、本作業中の大伏在静脈1000の損傷を防止することができる。また、保護部541、542が丸み付けされているため、切断デバイス500との接触による皮膚1400や筋膜1500の損傷を低減することができる。
Here, as described above, since the width W1 of the skin side peeling device 200 is larger than the outer diameter of the large saphenous vein 1000, the cutting device 500 is laterally separated from the large saphenous vein 1000 as shown in FIG. This can be pushed along the great saphenous vein 1000 while preventing damage to the great saphenous vein 1000 during this operation. Further, since the protective portions 541 and 542 are rounded, damage to the skin 1400 and fascia 1500 due to contact with the cutting device 500 can be reduced.
次に、切断デバイス500を抜去し、抜去した切断デバイス500の接続部582を皮膚側剥離デバイス200のレール232に接続すると共に、接続部583を第1の剥離デバイス310のレール312に接続する。そして、先の作業と同様に、切断デバイス500を皮膚側剥離デバイス200および第1の剥離デバイス310で案内しながら生体内へ挿入し、図19に示すように、大伏在静脈1000の他方の側方に切断デバイス500を配置する。これにより、脂肪1200が左右に切断されると共に、処理部530によって分岐血管1100が止血、切断される。
Next, the cutting device 500 is removed, and the connecting portion 582 of the extracted cutting device 500 is connected to the rail 232 of the skin side peeling device 200 and the connecting portion 583 is connected to the rail 312 of the first peeling device 310. Then, as in the previous operation, the cutting device 500 is inserted into the living body while being guided by the skin-side peeling device 200 and the first peeling device 310, and as shown in FIG. The cutting device 500 is arranged on the side. Thereby, the fat 1200 is cut right and left, and the branch blood vessel 1100 is stopped and cut by the processing unit 530.
以上の作業によって、大伏在静脈1000の周囲にある脂肪1200の全周が剥離され、大伏在静脈1000が周囲の脂肪1200で覆われた状態で剥離された状態となる。なお、大伏在静脈1000と共に剥離され、大伏在静脈1000の周囲に位置する脂肪1200の厚みとしては、特に限定されないが、0.1mm~10mm程度であることが好ましく、1mm~8mm程度であることがより好ましく、3mm~5mm程度であることがさらに好ましい。
Through the above operation, the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is peeled off while being covered with the surrounding fat 1200. The thickness of the fat 1200 that is peeled off together with the great saphenous vein 1000 and is located around the great saphenous vein 1000 is not particularly limited, but is preferably about 0.1 mm to 10 mm, and about 1 mm to 8 mm. More preferably, it is about 3 mm to 5 mm.
[第2ステップ]
次に、皮膚側剥離デバイス200、第1の剥離デバイス310、第2の剥離デバイス320および切断デバイス500を生体から抜去した後、大伏在静脈1000の採取部分の両端を結紮し、切断する。 [Second step]
Next, after the skinside peeling device 200, the first peeling device 310, the second peeling device 320, and the cutting device 500 are removed from the living body, both ends of the collection portion of the saphenous vein 1000 are ligated and cut.
次に、皮膚側剥離デバイス200、第1の剥離デバイス310、第2の剥離デバイス320および切断デバイス500を生体から抜去した後、大伏在静脈1000の採取部分の両端を結紮し、切断する。 [Second step]
Next, after the skin
[第3ステップ]
次に、切開部1310または切開部1320を介して、大伏在静脈1000をその周囲の脂肪1200に覆われた状態で生体外へ取り出す。 [Third step]
Next, the largesaphenous vein 1000 is taken out of the living body through the incision 1310 or the incision 1320 while being covered with the surrounding fat 1200.
次に、切開部1310または切開部1320を介して、大伏在静脈1000をその周囲の脂肪1200に覆われた状態で生体外へ取り出す。 [Third step]
Next, the large
以上のような第1ステップ、第2ステップおよび第3ステップによって、大伏在静脈1000をその周囲の脂肪1200に覆われた状態で採取することができる。このような方法では、剥離し易い箇所については出血等のダメージを低減するために皮膚側剥離デバイス200および筋膜側剥離デバイス300を用い、剥離し難い脂肪1200については切断デバイス500を用いているため、スムーズかつ低襲撃で大伏在静脈1000を採取することができる。加えて、大伏在静脈1000を切断せずに第1ステップを行うことができるため、大伏在静脈1000になるべく長く血を通わせることができる。よって、虚血状態がより短く、損傷の少ない大伏在静脈1000を採取することできる。
By the first step, the second step, and the third step as described above, the large saphenous vein 1000 can be collected in a state covered with the surrounding fat 1200. In such a method, the skin-side peeling device 200 and the fascia-side peeling device 300 are used to reduce damage such as bleeding for portions that are easily peeled, and the cutting device 500 is used for fat 1200 that is difficult to peel. Therefore, the large saphenous vein 1000 can be collected with a smooth and low attack. In addition, since the first step can be performed without cutting the saphenous vein 1000, blood can pass through the saphenous vein 1000 as long as possible. Therefore, the great saphenous vein 1000 having a shorter ischemic state and less damage can be collected.
特に、本実施形態では、大伏在静脈1000の上側(皮膚1400側)の剥離を皮膚側剥離デバイス200によって行う。大伏在静脈1000の上側は、下側に比べて分岐血管1100が少ない傾向にあるため、大伏在静脈1000の上側については分岐血管1100の処理を行わずに皮膚側剥離デバイス200で剥離のみを行う。これに対して、大伏在静脈1000の下側については分岐血管1100が比較的多く配置されているため、筋膜側剥離デバイス300で剥離を行うと共に、処理デバイス400で分岐血管1100を処理する。このように、大伏在静脈1000の上下で異なる構成の剥離デバイスを用いることで、よりスムーズに作業を行うことができる。ただし、大伏在静脈1000の上側についても、下側と同様に筋膜側剥離デバイス300を用いて剥離してもよい。
In particular, in this embodiment, the upper side (skin 1400 side) of the great saphenous vein 1000 is peeled by the skin side peeling device 200. Since the upper side of the great saphenous vein 1000 tends to have fewer branch blood vessels 1100 than the lower side, the upper side of the great saphenous vein 1000 is only peeled by the skin side peeling device 200 without processing the branch blood vessel 1100. I do. In contrast, since a relatively large number of branch blood vessels 1100 are arranged below the saphenous vein 1000, the fascia side peeling device 300 performs peeling and the processing device 400 processes the branch blood vessels 1100. . As described above, the use of the peeling devices having different configurations on the upper and lower sides of the great saphenous vein 1000 allows the operation to be performed more smoothly. However, the upper side of the great saphenous vein 1000 may be peeled off using the fascia side peeling device 300 in the same manner as the lower side.
ここで、脂肪1200で覆われた大伏在静脈1000は、脂肪1200で覆われていない大伏在静脈1000よりも優れた長期開存率を有するバイパス管となる可能性がある。これは、次の理由によると考えられている。すなわち、大伏在静脈1000は、動脈のバイパス管として用いられるが、動脈は、静脈に比べて血圧(血液により受ける内圧)が高い。そのため、組織に覆われていない剥き出しの状態の大伏在静脈をバイパス管として用いると、血圧に耐えらずに大伏在静脈が膨張して血流が低下するおそれがある。また、リモデリング(構造的改変)や組織損傷の修復過程において血管壁が肥厚するおそれもある。このような血管壁の肥厚は、動脈硬化の進展に影響すると考えられる。このような原因から、組織に覆われていない剥き出しの状態の大伏在静脈をバイパス管として用いると、長期的には血管閉塞に繋がってしまう可能性がある。
Here, the great saphenous vein 1000 covered with fat 1200 may become a bypass tube having a long-term patency rate superior to that of the great saphenous vein 1000 not covered with fat 1200. This is believed to be due to the following reasons. That is, the great saphenous vein 1000 is used as an arterial bypass tube, but the artery has higher blood pressure (internal pressure received by blood) than the vein. Therefore, if a large saphenous vein that is not covered with tissue is used as a bypass tube, the saphenous vein may expand without being able to withstand blood pressure, and blood flow may be reduced. In addition, the blood vessel wall may become thickened in the process of remodeling (structural modification) or tissue damage repair. Such thickening of the blood vessel wall is considered to affect the progress of arteriosclerosis. For these reasons, if a large saphenous vein that is not covered with tissue and used as a bypass tube is used as a bypass tube, it may lead to blood vessel occlusion in the long term.
これに対して、大伏在静脈1000を脂肪1200で覆うことで、脂肪1200によって大伏在静脈1000の膨張が抑えられると共に、大伏在静脈1000の折れ曲がり等が抑えられるという効果が期待できる。よって、上記のような血流の低下を抑えることができる可能性がある。また、脂肪1200で覆われていることで、大伏在静脈1000の損傷、具体的には、内皮細胞、平滑筋、栄養血管(小血管網)等の損傷が低減される。よって、上記のような血管壁の肥厚を抑えることができる可能性がある。以上のことから、脂肪1200に覆われた大伏在静脈1000をバイパス管として用いることで、優れた長期開存率を発揮することができる可能性がある。特に、本実施形態では、大伏在静脈1000の血管壁や脂肪1200に栄養血管が残存しているため、バイパス後も、バイパス管としての大伏在静脈1000に栄養が供給され、上記効果のさらなる向上が図られると考えられる。
On the other hand, by covering the great saphenous vein 1000 with the fat 1200, it is possible to expect the fat 1200 to suppress the expansion of the large saphenous vein 1000 and to suppress the bending of the great saphenous vein 1000. Therefore, there is a possibility that a decrease in blood flow as described above can be suppressed. In addition, by being covered with fat 1200, damage to the great saphenous vein 1000, specifically, damage to endothelial cells, smooth muscle, nutrient blood vessels (small blood vessel network), and the like is reduced. Therefore, there is a possibility that the above-described thickening of the blood vessel wall can be suppressed. From the above, there is a possibility that an excellent long-term patency rate can be exhibited by using the large saphenous vein 1000 covered with fat 1200 as a bypass tube. In particular, in this embodiment, since the nutrient blood vessels remain in the blood vessel wall and fat 1200 of the great saphenous vein 1000, the nutrient is supplied to the great saphenous vein 1000 as a bypass tube even after the bypass, and the above effect is achieved. Further improvement is expected.
以上、本実施形態について説明したが、血管剥離デバイス100の構成としては、本実施形態に限定されず、例えば、皮膚側剥離デバイス200からレール231、232を省略し、筋膜側剥離デバイス300からレール312、322を省略し、切断デバイス500から接続部581、582、583を省略してもよい。この場合には、例えば、先に生体内へ挿入した皮膚側剥離デバイス200および筋膜側剥離デバイス300に沿わせて切断デバイス500を生体内へ挿入すればよい。
Although the present embodiment has been described above, the configuration of the blood vessel peeling device 100 is not limited to this embodiment. For example, the rails 231 and 232 are omitted from the skin side peeling device 200 and the fascia side peeling device 300 is omitted. The rails 312 and 322 may be omitted, and the connecting portions 581, 582, and 583 may be omitted from the cutting device 500. In this case, for example, the cutting device 500 may be inserted into the living body along the skin-side peeling device 200 and the fascia-side peeling device 300 previously inserted into the living body.
また、切断デバイス500としては、脂肪1200を切断することができれば特に限定されず、例えば、ハサミのようなもので脂肪1200を切断するような構成であってもよい。
The cutting device 500 is not particularly limited as long as the fat 1200 can be cut. For example, the cutting device 500 may be configured to cut the fat 1200 with scissors.
また、血管採取方法は、本実施形態の手順に限定されない。例えば、皮膚側剥離デバイス200と筋膜側剥離デバイス300と切断デバイス500の挿入順は、特に限定されず、大伏在静脈1000の左右上下のいずれの部分を最初に剥離してもよい。すなわち、例えば、筋膜側剥離デバイス300、皮膚側剥離デバイス200、切断デバイス500の順に挿入してもよいし、また、皮膚側剥離デバイス200、切断デバイス500、筋膜側剥離デバイス300の順に挿入してもよいし、また、切断デバイス500、皮膚側剥離デバイス200、筋膜側剥離デバイス300の順に挿入してもよい。また、切断デバイス500、皮膚側剥離デバイス200および筋膜側剥離デバイス300のうちの少なくとも2つを同時に挿入してもよい。
Further, the blood vessel collection method is not limited to the procedure of this embodiment. For example, the insertion order of the skin-side peeling device 200, the fascia-side peeling device 300, and the cutting device 500 is not particularly limited, and any part of the large saphenous vein 1000 may be peeled first. That is, for example, the fascia side peeling device 300, the skin side peeling device 200, and the cutting device 500 may be inserted in this order, or the skin side peeling device 200, the cutting device 500, and the fascia side peeling device 300 are inserted in this order. Alternatively, the cutting device 500, the skin side peeling device 200, and the fascia side peeling device 300 may be inserted in this order. Moreover, you may insert at least 2 of the cutting device 500, the skin side peeling device 200, and the fascia side peeling device 300 simultaneously.
また、本実施形態では、切断デバイス500を1本のみ用いているが、切断デバイス500を2本用いてもよい。この場合には、例えば、まず、一本目の切断デバイス500を大伏在静脈1000の左右の一方側に配置し、次に、2本目の切断デバイス500を大伏在静脈1000の左右の他方側に配置すればよい。このような手順によれば、切断デバイス500を途中で抜去する必要がなくなるため、上記手順をスムーズに行うことができる。
In the present embodiment, only one cutting device 500 is used, but two cutting devices 500 may be used. In this case, for example, first, the first cutting device 500 is arranged on one of the left and right sides of the great saphenous vein 1000, and then the second cutting device 500 is arranged on the other left and right sides of the great saphenous vein 1000. Should be arranged. According to such a procedure, it is not necessary to remove the cutting device 500 halfway, so that the above procedure can be performed smoothly.
また、本実施形態では、皮膚側剥離デバイス200を脂肪1200と皮膚1400の間に挿入しているが、皮膚側剥離デバイス200の挿入位置としては、特に限定されず、例えば、脂肪1200と血管(ただし大伏在静脈1000以外の血管)との間などの性状の異なる組織の間に挿入してもよい。また、性状の異なる組織の間(性状の異なる組織の境界、性状の異なる組織の間の組織等)に挿入する場合に限られず、例えば、脂肪1200の中に挿入し、脂肪1200を剥離してもよい。
Further, in this embodiment, the skin side peeling device 200 is inserted between the fat 1200 and the skin 1400, but the insertion position of the skin side peeling device 200 is not particularly limited, and for example, the fat 1200 and blood vessels ( However, it may be inserted between tissues having different properties, such as between blood vessels other than the great saphenous vein 1000). Further, the present invention is not limited to insertion between tissues having different properties (borders of tissues having different properties, tissues between tissues having different properties, etc.), for example, by inserting into fat 1200 and peeling fat 1200 Also good.
同様に、本実施形態では、筋膜側剥離デバイス300を脂肪1200と筋膜1500との間に挿入しているが、筋膜側剥離デバイス300の挿入位置としては、特に限定されず、例えば、脂肪1200と骨との間、筋膜1500と骨との間などの性状の異なる組織の間に挿入してもよい。また、性状の異なる組織の間(性状の異なる組織の境界、性状の異なる組織の間の組織等)に挿入する場合に限られず、例えば、脂肪1200の中に挿入し、脂肪1200を剥離してもよい。
Similarly, in this embodiment, the fascia side peeling device 300 is inserted between the fat 1200 and the fascia 1500, but the insertion position of the fascia side peeling device 300 is not particularly limited. It may be inserted between tissues having different properties such as between the fat 1200 and the bone and between the fascia 1500 and the bone. Further, the present invention is not limited to insertion between tissues having different properties (borders of tissues having different properties, tissues between tissues having different properties, etc.), for example, by inserting into fat 1200 and peeling fat 1200 Also good.
また、本実施形態では、切断デバイス500で脂肪1200を切断しているが、切断デバイス500で切断する組織としては、脂肪に限定されず、例えば、皮膚と脂肪の境界と脂肪と筋肉の境界の間の組織、皮膚と脂肪の境界と脂肪と骨関膜の境界の間の組織、結合組織、皮膚層と筋肉層との間の組織、皮膚層と骨関膜との間の組織、分岐血管等であってもよい。
In the present embodiment, the fat 1200 is cut by the cutting device 500, but the tissue to be cut by the cutting device 500 is not limited to fat. For example, the skin-fat boundary and the fat-muscle boundary. Tissue between the skin and fat boundary and the fat and osteoskin boundary, connective tissue, tissue between the skin layer and muscle layer, tissue between the skin layer and bone barrier, branch vessel Etc.
また、本実施形態では、皮膚側剥離デバイス200および筋膜側剥離デバイス300を大伏在静脈1000と接触しないように離間させて配置しているが、皮膚側剥離デバイス200および筋膜側剥離デバイス300を大伏在静脈1000に接触させて配置してもよい。すなわち、皮膚側剥離デバイス200および筋膜側剥離デバイス300を大伏在静脈1000と脂肪1200との間に挿入してもよい。
In the present embodiment, the skin side peeling device 200 and the fascia side peeling device 300 are arranged apart from each other so as not to contact the great saphenous vein 1000. However, the skin side peeling device 200 and the fascia side peeling device are arranged. 300 may be placed in contact with the great saphenous vein 1000. That is, the skin side peeling device 200 and the fascia side peeling device 300 may be inserted between the great saphenous vein 1000 and the fat 1200.
<第2実施形態>
図20は、本発明の第2実施形態に係る血管剥離デバイスが有する筋膜側剥離デバイスを示す平面図である。図21は、図20に示す筋膜側剥離デバイスの断面図である。 Second Embodiment
FIG. 20 is a plan view showing a fascia side peeling device included in the blood vessel peeling device according to the second embodiment of the present invention. 21 is a cross-sectional view of the fascia side peeling device shown in FIG.
図20は、本発明の第2実施形態に係る血管剥離デバイスが有する筋膜側剥離デバイスを示す平面図である。図21は、図20に示す筋膜側剥離デバイスの断面図である。 Second Embodiment
FIG. 20 is a plan view showing a fascia side peeling device included in the blood vessel peeling device according to the second embodiment of the present invention. 21 is a cross-sectional view of the fascia side peeling device shown in FIG.
以下、この図を参照して第2実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the second embodiment will be described with reference to this figure, but the description will focus on differences from the above-described embodiment, and description of similar matters will be omitted.
本実施形態は、主に、筋膜側剥離デバイスの構成が異なること以外は、前述した第1実施形態と同様である。
This embodiment is the same as the first embodiment described above except that the configuration of the fascia side peeling device is mainly different.
図20に示すように、本実施形態の第1の剥離デバイス310は、切り欠き314、315が平面視で溝313よりも外側(突き当て面310aと反対の側面側)まで延在して設けられている。一方、第2の剥離デバイス320では、切り欠き324、325が省略されており、その替りに、第1の剥離デバイス310と突き合わせたときに切り欠き314、315内へ侵入する突起部324A、325Aが設けられている。このような第1の剥離デバイス310と第2の剥離デバイス320とを突き合わせると、図21に示すように、切り欠き314内に突起部324Aが侵入し、これらの間に貫通孔334が形成され、同様に、切り欠き315内に突起部325Aが侵入し、これらの間に貫通孔335が形成される。
As shown in FIG. 20, the first peeling device 310 of the present embodiment is provided with notches 314 and 315 extending to the outside of the groove 313 (on the side surface opposite to the abutting surface 310a) in plan view. It has been. On the other hand, in the second peeling device 320, the notches 324 and 325 are omitted, and instead, protrusions 324A and 325A that enter the notches 314 and 315 when they are brought into contact with the first peeling device 310. Is provided. When such a first peeling device 310 and the second peeling device 320 are brought into contact with each other, as shown in FIG. 21, a protrusion 324A enters the notch 314, and a through hole 334 is formed therebetween. Similarly, the protrusion 325A enters the notch 315, and a through hole 335 is formed therebetween.
このような構成によれば、貫通孔334、335が空洞部330からずれた位置に形成されるため、貫通孔334、335に挿通される大伏在静脈1000と、空洞部330内に挿入される処理デバイス400(特に切断部430)との接触が防止される。そのため、切断部430による大伏在静脈1000の損傷、切断等を防止することができる。また、このような構成によれば、前述した第1実施形態のように、切断部430を作動状態と退避状態とに変位可能に構成する必要がなく、作動状態で固定することができるため、処理デバイス400の構成が簡単となると共に、処理デバイス400による処理をよりスムーズに行うことができる。
According to such a configuration, since the through holes 334 and 335 are formed at positions shifted from the cavity portion 330, the large saphenous vein 1000 inserted through the through holes 334 and 335 and the cavity portion 330 are inserted. Contact with the processing device 400 (particularly the cutting portion 430). Therefore, damage, cutting, etc. of the great saphenous vein 1000 by the cutting part 430 can be prevented. Further, according to such a configuration, it is not necessary to configure the cutting portion 430 to be displaceable between the operating state and the retracted state as in the first embodiment described above, and can be fixed in the operating state. The configuration of the processing device 400 is simplified, and the processing by the processing device 400 can be performed more smoothly.
このような第2実施形態によっても、前述した第1実施形態と同様の効果を発揮することができる。
Even in the second embodiment, the same effect as that of the first embodiment described above can be exhibited.
あるいは、基端部側から先端部側へ押し進める際に分岐血管1100を切断・止血する構成としてもよい。その場合、処理デバイス400の先端部側に電極420を配置し、基端部側に切断部430を配置すればよい。さらに、第2の剥離デバイス320の基端部側の溝323の深さを深くすることで、大伏在静脈1000を回避した状態で、処理デバイス400を挿入することが可能となる。これにより、切断部430の回動機能が不要となり、処理デバイス400をよりシンプルな構成とすることができる。
Alternatively, the branch blood vessel 1100 may be cut and stopped when pushed from the proximal end side to the distal end side. In that case, the electrode 420 may be disposed on the distal end side of the processing device 400 and the cutting portion 430 may be disposed on the proximal end side. Furthermore, by increasing the depth of the groove 323 on the proximal end side of the second peeling device 320, the processing device 400 can be inserted in a state where the great saphenous vein 1000 is avoided. Thereby, the rotation function of the cutting part 430 becomes unnecessary, and the processing device 400 can have a simpler configuration.
<第3実施形態>
図22は、本発明の第3実施形態に係る血管剥離デバイスが有する第1の剥離デバイスを示す側面図である。図23は、分岐血管の処理方法を説明する図である。 <Third Embodiment>
FIG. 22 is a side view showing a first peeling device included in the blood vessel peeling device according to the third embodiment of the present invention. FIG. 23 is a diagram for explaining a branch blood vessel processing method.
図22は、本発明の第3実施形態に係る血管剥離デバイスが有する第1の剥離デバイスを示す側面図である。図23は、分岐血管の処理方法を説明する図である。 <Third Embodiment>
FIG. 22 is a side view showing a first peeling device included in the blood vessel peeling device according to the third embodiment of the present invention. FIG. 23 is a diagram for explaining a branch blood vessel processing method.
以下、この図を参照して第3実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the third embodiment will be described with reference to this figure, but the description will focus on differences from the above-described embodiment, and description of similar matters will be omitted.
本実施形態は、主に、第1の剥離デバイスの構成が異なること以外は、前述した第1実施形態と同様である。
This embodiment is mainly the same as the first embodiment described above except that the configuration of the first peeling device is different.
図22に示すように、本実施形態の第1の剥離デバイス310では、前述した第1実施形態と比較して、電極316、317が短く形成されている。電極316、317の長さとしては、特に限定されないが、例えば、5mm~2cm程度とすることができる。また、電極316、317は、第1の剥離デバイス310の軸方向(図22中の矢印方向)に一体的に移動可能となっている。
As shown in FIG. 22, in the first peeling device 310 of the present embodiment, the electrodes 316 and 317 are formed shorter than the first embodiment described above. The lengths of the electrodes 316 and 317 are not particularly limited, but can be about 5 mm to 2 cm, for example. Further, the electrodes 316 and 317 are integrally movable in the axial direction of the first peeling device 310 (the arrow direction in FIG. 22).
このような構成では、図23に示すように、空洞部330に処理デバイス400を挿入し、電極316、317に対して電極420を対向配置させる。そして、電極316、317および電極420の相対的位置関係を維持したまま、電極316、317および電極420間に高周波交番電圧を印加しながら処理デバイス400を先端側へスライドさせれば、分岐血管1100を順に熱凝固、切断することができる。
In such a configuration, as shown in FIG. 23, the processing device 400 is inserted into the cavity 330, and the electrode 420 is disposed opposite to the electrodes 316 and 317. If the processing device 400 is slid to the distal end side while applying a high-frequency alternating voltage between the electrodes 316, 317 and the electrode 420 while maintaining the relative positional relationship between the electrodes 316, 317 and the electrode 420, the branched blood vessel 1100 is obtained. Can be thermally coagulated and cut in order.
このような構成によれば、電界が発生する領域を小さくすることができるため、分岐血管1100により効果的に電界を作用させることができ、分岐血管1100をより確実に止血することができる。
According to such a configuration, since the region where the electric field is generated can be reduced, the electric field can be effectively applied to the branch blood vessel 1100, and the branch blood vessel 1100 can be more reliably hemostatic.
このような第3実施形態によっても、前述した第1実施形態と同様の効果を発揮することができる。
Even in the third embodiment, the same effect as that of the first embodiment described above can be exhibited.
<第4実施形態>
図24は、本発明の第4実施形態に係る血管剥離デバイスが有する第1の剥離デバイスを示す側面図である。図25は、分岐血管の処理方法を説明する図である。図26は、処理デバイスの一例を示す断面図である。 <Fourth embodiment>
FIG. 24 is a side view showing a first peeling device included in a blood vessel peeling device according to the fourth embodiment of the present invention. FIG. 25 is a diagram for explaining a branch blood vessel processing method. FIG. 26 is a cross-sectional view illustrating an example of a processing device.
図24は、本発明の第4実施形態に係る血管剥離デバイスが有する第1の剥離デバイスを示す側面図である。図25は、分岐血管の処理方法を説明する図である。図26は、処理デバイスの一例を示す断面図である。 <Fourth embodiment>
FIG. 24 is a side view showing a first peeling device included in a blood vessel peeling device according to the fourth embodiment of the present invention. FIG. 25 is a diagram for explaining a branch blood vessel processing method. FIG. 26 is a cross-sectional view illustrating an example of a processing device.
以下、この図を参照して第4実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the fourth embodiment will be described with reference to this figure, but the description will focus on differences from the above-described embodiment, and description of similar matters will be omitted.
本実施形態は、主に、第1の剥離デバイスの構成が異なること以外は、前述した第1実施形態と同様である。
This embodiment is mainly the same as the first embodiment described above except that the configuration of the first peeling device is different.
図24に示すように、本実施形態の第1の剥離デバイス310は、電極316、317が複数に分割されている。電極316、317は、第1の剥離デバイス310の軸方向に互いに離間して並ぶ複数の電極片316a、317aを有している。そして、溝313を介して対向する電極片316a、317a同士が同電位に接続されている。なお、電極片316a、317aの長さとしては、特に限定されないが、例えば、5mm~2cm程度とすることができる。
As shown in FIG. 24, in the first peeling device 310 of the present embodiment, the electrodes 316 and 317 are divided into a plurality of parts. The electrodes 316 and 317 include a plurality of electrode pieces 316 a and 317 a that are arranged apart from each other in the axial direction of the first peeling device 310. The electrode pieces 316a and 317a facing each other through the groove 313 are connected to the same potential. The length of the electrode pieces 316a and 317a is not particularly limited, but can be, for example, about 5 mm to 2 cm.
このような構成では、図25に示すように、空洞部330に挿入した処理デバイス400を先端側へスライドさせる際に、移動する電極420とこれに対向する電極片316a、317aとの間に高周波交番電圧が印加されるように、電圧を印加する電極片316a、317aを処理デバイス400の移動に対応させて切り替える。これにより、分岐血管1100を順に熱凝固、切断することができる。
In such a configuration, as shown in FIG. 25, when the processing device 400 inserted into the cavity 330 is slid to the distal end side, a high frequency is generated between the moving electrode 420 and the electrode pieces 316a and 317a facing the electrode 420. The electrode pieces 316 a and 317 a to which the voltage is applied are switched according to the movement of the processing device 400 so that the alternating voltage is applied. Thereby, the branch blood vessel 1100 can be thermally coagulated and cut in order.
このような構成によれば、電界が発生する領域を小さくすることができるため、分岐血管1100により効果的に電界を作用させることができ、分岐血管1100をより確実に熱凝固(止血)することができる。
According to such a configuration, since the region where the electric field is generated can be reduced, the electric field can be effectively applied to the branch blood vessel 1100, and the branch blood vessel 1100 can be more reliably thermally coagulated (hemostatic). Can do.
なお、高周波交番電圧を印加する電極片316a、317aを切り替える機構としては、特に限定されず、例えば、電極420の位置を検出する検出部と、電圧を印加する電極片316a、317aを切り替える切替部と、を有し、検出部の検出結果に応じて切替部が電圧を印加する電極片316a、317aを切り替える構成であってもよい。また、図26に示すように、処理デバイス400が、電極420と対向し、溝313内を電極420と共に移動する導電性のリード線460を有し、このリード線460が接触した電極片316a、317aと電極420との間に電圧が印加される構成であってもよい。
The mechanism for switching the electrode pieces 316a and 317a to which the high frequency alternating voltage is applied is not particularly limited. For example, the detection unit for detecting the position of the electrode 420 and the switching unit for switching the electrode pieces 316a and 317a to which the voltage is applied. The switching unit may switch the electrode pieces 316a and 317a to which the voltage is applied according to the detection result of the detection unit. Further, as shown in FIG. 26, the processing device 400 has a conductive lead wire 460 that faces the electrode 420 and moves together with the electrode 420 in the groove 313, and the electrode piece 316a with which the lead wire 460 contacts, A configuration in which a voltage is applied between 317a and the electrode 420 may be employed.
このような第4実施形態によっても、前述した第1実施形態と同様の効果を発揮することができる。
Even in the fourth embodiment, the same effects as those of the first embodiment described above can be exhibited.
なお、電極の配置は、上述した第1実施形態~第4実施形態に限定されるものではない。例えば、処理デバイス400には、電極420を設けず、第2の剥離デバイス320側に図22で示す電極を配置し、第1の剥離デバイス310側と第2の剥離デバイス320側でバイポーラ構造を構成することも可能である。この場合、分岐血管1100の押圧した部分を確実に、熱凝固することが可能となる。
Note that the arrangement of the electrodes is not limited to the above-described first to fourth embodiments. For example, the processing device 400 is not provided with the electrode 420, the electrode shown in FIG. 22 is arranged on the second peeling device 320 side, and a bipolar structure is formed on the first peeling device 310 side and the second peeling device 320 side. It is also possible to configure. In this case, the pressed portion of the branch blood vessel 1100 can be surely thermally coagulated.
<第5実施形態>
図27は、本発明の第5実施形態に係る血管剥離デバイスが有する処理デバイスを示す斜視図である。図28は、図27に示す処理デバイスを空洞部に挿入した状態を示す断面図である。 <Fifth Embodiment>
FIG. 27 is a perspective view showing a treatment device included in the blood vessel peeling device according to the fifth embodiment of the present invention. FIG. 28 is a cross-sectional view showing a state where the processing device shown in FIG. 27 is inserted into the cavity.
図27は、本発明の第5実施形態に係る血管剥離デバイスが有する処理デバイスを示す斜視図である。図28は、図27に示す処理デバイスを空洞部に挿入した状態を示す断面図である。 <Fifth Embodiment>
FIG. 27 is a perspective view showing a treatment device included in the blood vessel peeling device according to the fifth embodiment of the present invention. FIG. 28 is a cross-sectional view showing a state where the processing device shown in FIG. 27 is inserted into the cavity.
以下、この図を参照して第5実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the fifth embodiment will be described with reference to this figure, but the description will focus on differences from the above-described embodiment, and the description of the same matters will be omitted.
本実施形態は、主に、第1の剥離デバイスおよび処理デバイスの構成が異なること以外は、前述した第1実施形態と同様である。
This embodiment is mainly the same as the above-described first embodiment except that the configurations of the first peeling device and the processing device are different.
本実施形態の第1の剥離デバイス310は、前述した第1実施形態の構成から電極316、317を省略した構成となっている。
The first peeling device 310 of the present embodiment has a configuration in which the electrodes 316 and 317 are omitted from the configuration of the first embodiment described above.
本実施形態の処理デバイス400は、図27に示すように、操作部410と、操作部410の先端部に設けられた処理部440と、を有している。また、処理部440は、電極441、442を有するバイポーラ構造となっている。
The processing device 400 of the present embodiment includes an operation unit 410 and a processing unit 440 provided at the tip of the operation unit 410, as shown in FIG. Further, the processing unit 440 has a bipolar structure having electrodes 441 and 442.
電極(第1の電極)441は、操作部410の幅方向(軸方向に直交する方向)に対向して一対設けられている。そして、一方の電極441と他方の電極441との間に分岐血管1100を案内する空隙S1が形成されている。また、電極(第2の電極)442は、操作部410の軸方向から見たとき、一方の電極441と他方の電極441との間に位置し、かつ、側面視したとき、その先端が電極441の先端よりも基端側に位置している。すなわち、電極442は、空隙S1の基端側(移動方向後方側)に配置されている。また、電極442の先端部442aは、切断部430を兼ねており、分岐血管1100を切断できる程度に鋭利となっている。
A pair of electrodes (first electrodes) 441 are provided facing the width direction of the operation unit 410 (a direction orthogonal to the axial direction). A gap S <b> 1 that guides the branch blood vessel 1100 is formed between one electrode 441 and the other electrode 441. Further, the electrode (second electrode) 442 is located between one electrode 441 and the other electrode 441 when viewed from the axial direction of the operation unit 410, and when viewed from the side, the tip thereof is an electrode. It is located on the proximal end side with respect to the distal end of 441. That is, the electrode 442 is disposed on the proximal end side (the rear side in the movement direction) of the gap S1. Further, the distal end portion 442a of the electrode 442 also serves as the cutting portion 430 and is sharp enough to cut the branch blood vessel 1100.
図28に示すように、空洞部330に処理デバイス400を挿入した状態では、一方の電極441が溝313内に位置し、他方の電極441が溝323内に位置し、電極442が溝313、323の境界を跨ぐように配置される。そのため、電極441、442間に高周波交番電圧を印加しながら処理デバイス400を先端側へスライドさせることで、分岐血管1100を順に空隙S1に案内して熱凝固し、熱凝固した分岐血管1100を電極442で切断ことができる。
As shown in FIG. 28, in a state where the processing device 400 is inserted into the cavity 330, one electrode 441 is located in the groove 313, the other electrode 441 is located in the groove 323, and the electrode 442 is the groove 313. It arrange | positions so that the boundary of H.323 may be straddled. Therefore, by sliding the processing device 400 toward the distal end side while applying a high-frequency alternating voltage between the electrodes 441 and 442, the branch blood vessel 1100 is sequentially guided to the space S1 to be thermally coagulated, and the thermocoagulated branch blood vessel 1100 is electroded. 442 can be cut.
本実施形態においては、分岐血管1100を押圧して扁平させた部位を熱凝固させるのではなく、処理デバイス400を先端側へスライドさせ、分岐血管1100にテンションをかけることで、熱凝固させる部位の血管を扁平させ、熱凝固させ、止血・切断を行っている。
In the present embodiment, instead of thermally coagulating the flattened portion by pressing the branch blood vessel 1100, the treatment device 400 is slid to the distal end side and tension is applied to the branch blood vessel 1100, so that The blood vessels are flattened, heat-coagulated, and hemostasis / cutting is performed.
このような構成によれば、電界を発生させる電極441、442を処理デバイス400にのみ配置すればよいため、例えば、第1の剥離デバイス310の構成がより簡単なものとなる。
According to such a configuration, since the electrodes 441 and 442 for generating an electric field need only be disposed on the processing device 400, for example, the configuration of the first peeling device 310 becomes simpler.
このような第5実施形態によっても、前述した第1実施形態と同様の効果を発揮することができる。
Also according to the fifth embodiment, the same effect as that of the first embodiment described above can be exhibited.
<第6実施形態>
図29は、本発明の第6実施形態に係る血管剥離デバイスが有する処理デバイスを示す斜視図である。図30は、図29に示す処理デバイスを空洞部に挿入した状態を示す断面図である。 <Sixth Embodiment>
FIG. 29 is a perspective view showing a treatment device included in the blood vessel peeling device according to the sixth embodiment of the present invention. 30 is a cross-sectional view showing a state in which the processing device shown in FIG. 29 is inserted into the cavity.
図29は、本発明の第6実施形態に係る血管剥離デバイスが有する処理デバイスを示す斜視図である。図30は、図29に示す処理デバイスを空洞部に挿入した状態を示す断面図である。 <Sixth Embodiment>
FIG. 29 is a perspective view showing a treatment device included in the blood vessel peeling device according to the sixth embodiment of the present invention. 30 is a cross-sectional view showing a state in which the processing device shown in FIG. 29 is inserted into the cavity.
以下、この図を参照して第6実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the sixth embodiment will be described with reference to this figure, but the description will focus on differences from the above-described embodiment, and the description of the same matters will be omitted.
本実施形態は、主に、第1の剥離デバイスおよび処理デバイスの構成が異なること以外は、前述した第1実施形態と同様である。
This embodiment is mainly the same as the above-described first embodiment except that the configurations of the first peeling device and the processing device are different.
本実施形態の第1の剥離デバイス310は、前述した第1実施形態の構成から電極316、317を省略した構成となっている。
The first peeling device 310 of the present embodiment has a configuration in which the electrodes 316 and 317 are omitted from the configuration of the first embodiment described above.
本実施形態の処理デバイス400は、図29に示すように、操作部410と、操作部410の基端部に設けられた処理部440と、を有している。操作部410は、空隙を隔てて対向配置された一対の棒状部(操作片)411、412と、棒状部411、412を基端側で接続する接続部413と、を有している。
The processing device 400 according to the present embodiment includes an operation unit 410 and a processing unit 440 provided at the base end of the operation unit 410 as illustrated in FIG. The operation unit 410 includes a pair of rod-shaped portions (operation pieces) 411 and 412 that are arranged to face each other with a gap, and a connection portion 413 that connects the rod-shaped portions 411 and 412 on the proximal end side.
また、処理部440は、一対の電極441、442と、切断部443と、を有している。電極(第1の電極)441は、棒状部411の基端部に設けられており、電極(第2の電極)442は、棒状部412の基端部に設けられている。これら電極441、電極442の間には、分岐血管1100を案内する空隙S2が形成されている。
In addition, the processing unit 440 includes a pair of electrodes 441 and 442 and a cutting unit 443. The electrode (first electrode) 441 is provided at the base end of the rod-shaped portion 411, and the electrode (second electrode) 442 is provided at the base end of the rod-shaped portion 412. A gap S <b> 2 that guides the branch blood vessel 1100 is formed between the electrodes 441 and 442.
また、切断部443は、接続部413から先端側へ突出して設けられている。また、切断部443は、操作部410の軸方向から見たとき、電極441、442の間に位置し、側面視したとき、その先端が電極441、442の先端よりも基端側に位置している。すなわち、切断部443は、空隙S2の基端側(移動方向後方側)に配置されている。また、切断部443の先端部443aは、分岐血管1100を切断できる程度に鋭利となっている。
Further, the cutting part 443 is provided so as to protrude from the connection part 413 to the tip side. Further, the cutting portion 443 is located between the electrodes 441 and 442 when viewed from the axial direction of the operation portion 410, and when viewed from the side, the distal end thereof is located closer to the proximal end than the distal ends of the electrodes 441 and 442. ing. That is, the cutting part 443 is disposed on the base end side (rear side in the movement direction) of the gap S2. Further, the distal end portion 443 a of the cutting portion 443 is sharp enough to cut the branch blood vessel 1100.
図30に示すように、空洞部330に処理デバイス400を挿入した状態では、棒状部411および電極441が溝313内に位置し、棒状部412および電極442が溝323内に位置し、切断部443が溝313、323の境界を跨ぐように配置される。そのため、電極441、442間に高周波交番電圧を印加しながら処理デバイス400を先端側へスライドさせことで、分岐血管1100を順に空隙S2に案内して熱凝固し、熱凝固した分岐血管1100を切断部443で切断することができる。
As shown in FIG. 30, in the state where the processing device 400 is inserted into the cavity 330, the rod-shaped portion 411 and the electrode 441 are located in the groove 313, the rod-shaped portion 412 and the electrode 442 are located in the groove 323, and the cut portion 443 is arranged so as to straddle the boundaries of the grooves 313 and 323. Therefore, the treatment device 400 is slid to the distal end side while applying a high-frequency alternating voltage between the electrodes 441 and 442, and the branch vessel 1100 is sequentially guided to the gap S2 to be thermally coagulated, and the thermocoagulated branch vessel 1100 is cut. The portion 443 can be cut.
このような構成によれば、電界を発生させる電極441、442を処理デバイス400にのみ配置すればよいため、例えば、第1の剥離デバイス310の構成がより簡単なものとなる。
According to such a configuration, since the electrodes 441 and 442 for generating an electric field need only be disposed on the processing device 400, for example, the configuration of the first peeling device 310 becomes simpler.
このような第6実施形態によっても、前述した第1実施形態と同様の効果を発揮することができる。
Even in the sixth embodiment, the same effect as that of the first embodiment described above can be exhibited.
<第7実施形態>
図31は、本発明の第7実施形態に係る血管剥離デバイスが有する処理デバイスを示す斜視図である。図32は、図31に示す処理デバイスを空洞部に挿入した状態を示す断面図である。図33および図34は、それぞれ、分岐血管の処理方法を説明する断面図である。 <Seventh embodiment>
FIG. 31 is a perspective view showing a treatment device included in the blood vessel peeling device according to the seventh embodiment of the present invention. 32 is a cross-sectional view showing a state where the processing device shown in FIG. 31 is inserted into the cavity. FIGS. 33 and 34 are cross-sectional views illustrating a method for treating a branch blood vessel.
図31は、本発明の第7実施形態に係る血管剥離デバイスが有する処理デバイスを示す斜視図である。図32は、図31に示す処理デバイスを空洞部に挿入した状態を示す断面図である。図33および図34は、それぞれ、分岐血管の処理方法を説明する断面図である。 <Seventh embodiment>
FIG. 31 is a perspective view showing a treatment device included in the blood vessel peeling device according to the seventh embodiment of the present invention. 32 is a cross-sectional view showing a state where the processing device shown in FIG. 31 is inserted into the cavity. FIGS. 33 and 34 are cross-sectional views illustrating a method for treating a branch blood vessel.
以下、この図を参照して第7実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the seventh embodiment will be described with reference to this drawing, but the description will focus on differences from the above-described embodiment, and the description of the same matters will be omitted.
本実施形態は、主に、第1の剥離デバイスおよび処理デバイスの構成が異なること以外は、前述した第1実施形態と同様である。
This embodiment is mainly the same as the above-described first embodiment except that the configurations of the first peeling device and the processing device are different.
本実施形態の第1の剥離デバイス310は、前述した第1実施形態の構成から電極316、317を省略した構成となっている。
The first peeling device 310 of the present embodiment has a configuration in which the electrodes 316 and 317 are omitted from the configuration of the first embodiment described above.
本実施形態の処理デバイス400は、図31に示すように、処理部440を有している。処理部440は、板状をなす電極441、442を有している。電極(第2の電極)441は、電極(第1の電極)442を介して対向するように一対設けられている。また、電極442と一方の電極441との間には絶縁性の板状部414が挟み込まれており、電極442と他方の電極441との間には絶縁性の板状部415が挟み込まれている。また、電極442の先端部442aは、電極441および板状部414、415から突出している。また、先端部442aは、切断部430を兼ね、分岐血管1100を切断できる程度に鋭利となっている。なお、板状部414、415の代わりに、電極441、442の表面に絶縁コーティングなどを施してもよい。また、1枚の電極441と1枚の電極442を重ね合わせる構成としてもよい。
The processing device 400 of this embodiment has a processing unit 440 as shown in FIG. The processing unit 440 includes plate- like electrodes 441 and 442. A pair of electrodes (second electrodes) 441 are provided so as to face each other with electrodes (first electrodes) 442 interposed therebetween. Further, an insulating plate-like portion 414 is sandwiched between the electrode 442 and one electrode 441, and an insulating plate-like portion 415 is sandwiched between the electrode 442 and the other electrode 441. Yes. Further, the tip 442 a of the electrode 442 protrudes from the electrode 441 and the plate- like parts 414 and 415. Further, the distal end portion 442a also serves as the cutting portion 430 and is sharp enough to cut the branch blood vessel 1100. Note that an insulating coating or the like may be applied to the surfaces of the electrodes 441 and 442 instead of the plate- like portions 414 and 415. Alternatively, one electrode 441 and one electrode 442 may be stacked.
図32に示すように、空洞部330に処理デバイス400を挿入した状態では、電極441、442が溝313、323の境界を跨ぐように配置される。そのため、電極441、442間に高周波交番電圧を印加しながら処理デバイス400を先端側へスライドさせと、分岐血管1100が、図33に示すように、電極442の先端部442aによる押圧によって伸張・変形すると共に、電極441、442間で発生させた電界の作用によって熱凝固する。そして、さらに処理デバイス400を先端側へ移動させると、図34に示すように、先端部442aによって分岐血管1100が切断される。
32, in a state where the processing device 400 is inserted into the cavity 330, the electrodes 441 and 442 are arranged so as to straddle the boundaries of the grooves 313 and 323. Therefore, when the processing device 400 is slid to the distal end side while applying a high-frequency alternating voltage between the electrodes 441 and 442, the branch blood vessel 1100 is expanded and deformed by pressing by the distal end portion 442a of the electrode 442 as shown in FIG. At the same time, it is thermally coagulated by the action of the electric field generated between the electrodes 441 and 442. When the processing device 400 is further moved to the distal end side, the branch blood vessel 1100 is cut by the distal end portion 442a as shown in FIG.
このような構成によれば、分岐血管1100を伸長して変形させた状態(扁平状に潰した状態)で、分岐血管1100に電界を作用させるため、分岐血管1100をより確実に止血することができる。
According to such a configuration, an electric field is applied to the branch blood vessel 1100 in a state in which the branch blood vessel 1100 is expanded and deformed (a flattened state), so that the branch blood vessel 1100 can be stopped more reliably. it can.
このような第7実施形態によっても、前述した第1実施形態と同様の効果を発揮することができる。
Even in the seventh embodiment, the same effects as those of the first embodiment described above can be exhibited.
<第8実施形態>
図35は、本発明の第8実施形態に係る血管剥離デバイスが有する第2の剥離デバイスを示す平面図である。図36は、図35に示す第2の剥離デバイスの断面図である。図37および図38は、それぞれ、分岐血管の処理方法を説明する図である。 <Eighth Embodiment>
FIG. 35 is a plan view showing a second peeling device included in the blood vessel peeling device according to the eighth embodiment of the present invention. FIG. 36 is a cross-sectional view of the second peeling device shown in FIG. FIG. 37 and FIG. 38 are diagrams for explaining a branch blood vessel processing method.
図35は、本発明の第8実施形態に係る血管剥離デバイスが有する第2の剥離デバイスを示す平面図である。図36は、図35に示す第2の剥離デバイスの断面図である。図37および図38は、それぞれ、分岐血管の処理方法を説明する図である。 <Eighth Embodiment>
FIG. 35 is a plan view showing a second peeling device included in the blood vessel peeling device according to the eighth embodiment of the present invention. FIG. 36 is a cross-sectional view of the second peeling device shown in FIG. FIG. 37 and FIG. 38 are diagrams for explaining a branch blood vessel processing method.
以下、この図を参照して第8実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the eighth embodiment will be described with reference to this drawing, but the description will focus on the differences from the above-described embodiment, and the description of the same matters will be omitted.
本実施形態は、主に、筋膜側剥離デバイスが処理デバイスを兼ねていること以外は、前述した第1実施形態と同様である。
This embodiment is mainly the same as the first embodiment described above except that the fascia side peeling device also serves as a processing device.
本実施形態の第2の剥離デバイス320は、処理デバイス400を兼ねている。このような第2の剥離デバイス320は、図35に示すように、ローラー電極450と、ローラー電極450よりも基端側に配置された切断部430と、を有している。ローラー電極450は、突き当て面320aから突出するように設けられ、かつ、回転可能に軸支されている。また、図36に示すように、ローラー電極450は、第2の剥離デバイス320を第1の剥離デバイス310の突き当て面310aに沿わせたときに、第1の剥離デバイス310が備える電極316、317と対向する。また、切断部430は、突き当て面310aから突出して設けられ、第2の剥離デバイス320を第1の剥離デバイス310の突き当て面310aに沿わせたときに、第1の剥離デバイス310の溝313内に侵入する。
The second peeling device 320 of this embodiment also serves as the processing device 400. As shown in FIG. 35, the second peeling device 320 has a roller electrode 450 and a cutting portion 430 disposed on the proximal end side with respect to the roller electrode 450. The roller electrode 450 is provided so as to protrude from the abutting surface 320a, and is rotatably supported by the shaft. In addition, as shown in FIG. 36, the roller electrode 450 includes an electrode 316 included in the first peeling device 310 when the second peeling device 320 is placed along the abutting surface 310a of the first peeling device 310, Opposite to 317. Further, the cutting part 430 is provided so as to protrude from the abutting surface 310a, and when the second peeling device 320 is placed along the abutting surface 310a of the first peeling device 310, the groove of the first peeling device 310 is provided. Intrudes into 313.
このような構成では、第1の剥離デバイス310を大伏在静脈1000の下側へ配置した状態で、電極316、317およびローラー電極450間に高周波交番電圧を印加しながら、図37に示すように、第2の剥離デバイス320を第1の剥離デバイス310の突き当て面310aに沿わせながら生体内へ挿入する。すると、分岐血管1100が第1の剥離デバイス310と第2の剥離デバイス320の間に導かれ、図38に示すように、ローラー電極450によって潰させると共に熱凝固される。第2の剥離デバイス320をさらに挿入していくと、熱凝固された分岐血管1100が切断部430によって切断される。本実施形態によれば、このようにして、分岐血管1100を順に熱凝固、切断することができる。
In such a configuration, a high frequency alternating voltage is applied between the electrodes 316 and 317 and the roller electrode 450 in a state where the first peeling device 310 is disposed below the great saphenous vein 1000, as shown in FIG. In addition, the second peeling device 320 is inserted into the living body along the abutting surface 310 a of the first peeling device 310. Then, the branch blood vessel 1100 is guided between the first peeling device 310 and the second peeling device 320, and is crushed and thermally coagulated by the roller electrode 450 as shown in FIG. When the second peeling device 320 is further inserted, the thermocoagulated branch blood vessel 1100 is cut by the cutting unit 430. According to this embodiment, in this way, the branch blood vessel 1100 can be thermally coagulated and cut sequentially.
このような構成によれば、第2の剥離デバイス320が処理デバイス400を兼ねているため、第2の剥離デバイス320の挿入と共に、分岐血管1100を処理することができる。そのため、大伏在静脈1000の剥離(第1ステップ)をよりスムーズに行うことができる。
According to such a configuration, since the second peeling device 320 also serves as the processing device 400, the branch blood vessel 1100 can be processed together with the insertion of the second peeling device 320. Therefore, peeling of the large saphenous vein 1000 (first step) can be performed more smoothly.
このような第8実施形態によっても、前述した第1実施形態と同様の効果を発揮することができる。
Also in the eighth embodiment, the same effect as that of the first embodiment described above can be exhibited.
<第9実施形態>
図39は、本発明の第9実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。図40は、図39に示す切断デバイスの断面図である。図41および図42は、それぞれ、分岐血管の処理方法を説明する図である。 <Ninth Embodiment>
FIG. 39 is a side view showing a cutting device included in the blood vessel peeling device according to the ninth embodiment of the present invention. 40 is a cross-sectional view of the cutting device shown in FIG. FIG. 41 and FIG. 42 are diagrams for explaining a branch blood vessel processing method.
図39は、本発明の第9実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。図40は、図39に示す切断デバイスの断面図である。図41および図42は、それぞれ、分岐血管の処理方法を説明する図である。 <Ninth Embodiment>
FIG. 39 is a side view showing a cutting device included in the blood vessel peeling device according to the ninth embodiment of the present invention. 40 is a cross-sectional view of the cutting device shown in FIG. FIG. 41 and FIG. 42 are diagrams for explaining a branch blood vessel processing method.
以下、この図を参照して第9実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the ninth embodiment will be described with reference to this figure, but the description will focus on the differences from the above-described embodiment, and the description of the same matters will be omitted.
本実施形態は、主に、切断デバイスの構成が異なること以外は、前述した第1実施形態と同様である。
This embodiment is mainly the same as the first embodiment described above except that the configuration of the cutting device is different.
本実施形態の切断デバイス600は、図39および図40に示すように、本体部610と、本体部610内を移動可能な切断部620とを有している。
The cutting device 600 of the present embodiment has a main body 610 and a cutting part 620 that can move in the main body 610, as shown in FIGS.
本体部610は、長尺な板状をなしている。また、本体部610は、その下面に開口する溝611を有している。溝611は、本体部610の基端にも開口しており、切断部620を挿入する挿入孔を構成している。また、本体部610は、その上側(幅方向の片側)に設けられた保護部612を有している。保護部612は、本体部610の軸方向に沿って延在しており、周面が丸み付けされている。保護部612は、前述した第1実施形態の切断デバイス500が有する保護部541と同様の機能を発揮する。
The main body 610 has a long plate shape. Moreover, the main-body part 610 has the groove | channel 611 opened on the lower surface. The groove 611 is also opened at the base end of the main body portion 610, and constitutes an insertion hole into which the cutting portion 620 is inserted. Moreover, the main-body part 610 has the protection part 612 provided in the upper side (one side of the width direction). The protection part 612 extends along the axial direction of the main body part 610 and has a rounded peripheral surface. The protection unit 612 exhibits the same function as the protection unit 541 included in the cutting device 500 of the first embodiment described above.
また、本体部610の先端部には先細りした案内部613が設けられている。案内部613は、傾斜して下方を向く案内面613aを有し、この案内面613aを用いて、本体部610が生体内を進む際に脂肪1200および分岐血管1100を下方側(溝611と筋膜側剥離デバイス300との間)へ案内する機能を有している。
Further, a tapered guide portion 613 is provided at the tip of the main body portion 610. The guide portion 613 has a guide surface 613a that is inclined and directed downward, and the guide surface 613a is used to move the fat 1200 and the branch blood vessel 1100 downward (grooves 611 and muscles) when the main body portion 610 advances through the living body. It has a function of guiding to the membrane side peeling device 300).
また、本体部610は、皮膚側剥離デバイス200のレール231、232と接続可能な接続部614、615を有している。また、本体部610には溝611を介して電極616、617が設けられている。すなわち、溝611の一方側に電極(第1の電極)616が配置され、溝611の他方側に電極(第2の電極)617が配置されている。
Further, the main body 610 has connection portions 614 and 615 that can be connected to the rails 231 and 232 of the skin side peeling device 200. The main body 610 is provided with electrodes 616 and 617 through grooves 611. That is, an electrode (first electrode) 616 is disposed on one side of the groove 611, and an electrode (second electrode) 617 is disposed on the other side of the groove 611.
一方、切断部620は、溝611内に挿入することができ、溝611内をスライド可能である。また、切断部620の先端部は、溝611から突出可能な刃部621となっている。なお、筋膜側剥離デバイス300が有するレール(凹条)312、322は、本実施形態では刃部621が挿入される溝として機能する。
On the other hand, the cutting part 620 can be inserted into the groove 611 and can slide within the groove 611. Further, the tip of the cutting part 620 is a blade part 621 that can protrude from the groove 611. In addition, the rail (concave) 312 and 322 which the fascia side peeling device 300 has functions as a groove | channel where the blade part 621 is inserted in this embodiment.
本実施形態の切断デバイス600による分岐血管1100の処理は、脂肪1200を大伏在静脈1000に沿って剥離するステップと、剥離した脂肪1200を押圧するステップと、押圧した脂肪1200に含まれる分岐血管1100を焼灼するステップと、焼灼した分岐血管1100を切断するステップと、を有している。
The processing of the branch blood vessel 1100 by the cutting device 600 of the present embodiment includes the steps of peeling the fat 1200 along the great saphenous vein 1000, pressing the peeled fat 1200, and the branch blood vessel included in the pressed fat 1200. And cauterizing 1100 and cutting the cauterized branch blood vessel 1100.
具体的には、まず、皮膚側剥離デバイス200および筋膜側剥離デバイス300を生体内に挿入して、大伏在静脈1000の上下にある脂肪1200を剥離する。次に、接続部614を皮膚側剥離デバイス200のレール231に接続し、本体部610を皮膚側剥離デバイス200で案内しながら生体内へ挿入すると、図41に示すように、案内部613によって、脂肪1200および分岐血管1100が本体部610と第2の剥離デバイス320との間に導かれ、潰れた状態(押圧(圧縮)された状態)でこれらに挟み込まれた状態となる。この際、皮膚1400側から皮膚側剥離デバイス200を押圧し、本体部610を第2の剥離デバイス320に押し付けながら挿入することが好ましい。次に、電極616、617間に高周波交番電圧を印加して、本体部610と第2の剥離デバイス320とに挟み込まれた分岐血管1100を焼灼して熱凝固する。
Specifically, first, the skin side peeling device 200 and the fascia side peeling device 300 are inserted into the living body, and the fat 1200 above and below the great saphenous vein 1000 is peeled off. Next, when the connection portion 614 is connected to the rail 231 of the skin side peeling device 200 and the main body portion 610 is inserted into the living body while being guided by the skin side peeling device 200, as shown in FIG. The fat 1200 and the branch blood vessel 1100 are guided between the main body 610 and the second peeling device 320 and are sandwiched between them in a crushed state (pressed (compressed) state). At this time, it is preferable that the skin side peeling device 200 is pressed from the skin 1400 side and inserted while pressing the main body 610 against the second peeling device 320. Next, a high-frequency alternating voltage is applied between the electrodes 616 and 617 to cauterize and thermally coagulate the branch blood vessel 1100 sandwiched between the main body 610 and the second peeling device 320.
次に、溝611に切断部620を挿入し、図42に示すように、溝611の先端側から刃部621を突出させて、第2の剥離デバイス320のレール322内に侵入させる。次に、切断部620を基端側へスライドさせることで、刃部621によって分岐血管1100および脂肪1200を切断する。以上によって、大伏在静脈1000の側方にある脂肪1200が左右に切断されると共に、分岐血管1100が熱凝固、切断される。なお、本体部610と第2の剥離デバイス320の間に分岐血管1100および脂肪1200を挟み込むことで、これらの変位が抑えられ、これらの処理をより確実に行うことができる。また、先に行った分岐血管1100の熱凝固時に、本体部610と第1の剥離デバイス310とに挟み込まれた脂肪1200が焼灼されるため、刃部621による脂肪1200の切断をよりスムーズに行うことができる。
Next, the cutting part 620 is inserted into the groove 611, and as shown in FIG. 42, the blade part 621 protrudes from the front end side of the groove 611 and enters the rail 322 of the second peeling device 320. Next, the branch blood vessel 1100 and the fat 1200 are cut by the blade portion 621 by sliding the cutting portion 620 to the proximal end side. As described above, the fat 1200 on the side of the great saphenous vein 1000 is cut right and left, and the branch blood vessel 1100 is heat-coagulated and cut. In addition, by sandwiching the branch blood vessel 1100 and the fat 1200 between the main body 610 and the second peeling device 320, these displacements can be suppressed, and these processes can be performed more reliably. In addition, during the thermal coagulation of the branch blood vessel 1100, the fat 1200 sandwiched between the main body 610 and the first peeling device 310 is cauterized, so that the fat 1200 is cut more smoothly by the blade 621. be able to.
反対側(第1の剥離デバイス310側)についても、同様の作業を行うことで、大伏在静脈1000の周囲にある脂肪1200の全周が剥離され、大伏在静脈1000が周囲の脂肪1200で覆われた状態で剥離された状態となる。
By performing the same operation on the opposite side (first peeling device 310 side), the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
このような第9実施形態によっても、前述した第1実施形態と同様の効果を発揮することができる。
Even in the ninth embodiment, the same effect as that of the first embodiment described above can be exhibited.
なお、本実施形態の切断デバイス600では、電極616、617間に電圧を印加する構成となっているが、一対の電極616、617が同電位に接続されて一方の電極(第1の電極)を構成し、切断部620の刃部621が他方の電極(第2の電極)を兼ねた構成となっていてもよい。このような構成では、本体部610を生体内へ挿入し、本体部610に切断部620を挿入した後、電極616、617および刃部621間に高周波交番電圧を印加しつつ、切断部620を基端側へスライドさせることで、分岐血管1100を熱凝固すると共に、切断することができる。このような構成によれば、電界が発生する領域を小さくすることができるため、分岐血管1100により効果的に電界を作用させることができ、分岐血管1100をより確実に熱凝固することができる。
In the cutting device 600 of the present embodiment, a voltage is applied between the electrodes 616 and 617, but the pair of electrodes 616 and 617 are connected to the same potential and one electrode (first electrode) is connected. The blade portion 621 of the cutting portion 620 may also serve as the other electrode (second electrode). In such a configuration, after inserting the main body 610 into the living body and inserting the cutting unit 620 into the main body 610, the cutting unit 620 is applied while applying a high-frequency alternating voltage between the electrodes 616, 617 and the blade 621. By sliding to the proximal end side, the branch blood vessel 1100 can be thermally coagulated and cut. According to such a configuration, since the region where the electric field is generated can be reduced, the electric field can be effectively applied to the branch blood vessel 1100, and the branch blood vessel 1100 can be more thermally coagulated.
また、本実施形態では、上記の実施形態と同様に、筋膜側剥離デバイス300が第1の剥離デバイス310と第2の剥離デバイス320とを有しているが、例えば、筋膜側剥離デバイスが有する剥離デバイスの数としては、これに限定されず、1本であってもよいし、3本以上であってもよい。
Moreover, in this embodiment, the fascia side peeling device 300 has the 1st peeling device 310 and the 2nd peeling device 320 similarly to said embodiment, For example, a fascia side peeling device The number of peeling devices included in is not limited to this, and may be one or three or more.
<第10実施形態>
図43は、本発明の第10実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。図44および図45は、それぞれ、分岐血管の処理方法を説明する図である。 <Tenth Embodiment>
FIG. 43 is a side view showing a cutting device included in the blood vessel peeling device according to the tenth embodiment of the present invention. FIG. 44 and FIG. 45 are diagrams for explaining a branch blood vessel processing method.
図43は、本発明の第10実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。図44および図45は、それぞれ、分岐血管の処理方法を説明する図である。 <Tenth Embodiment>
FIG. 43 is a side view showing a cutting device included in the blood vessel peeling device according to the tenth embodiment of the present invention. FIG. 44 and FIG. 45 are diagrams for explaining a branch blood vessel processing method.
以下、この図を参照して第10実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the tenth embodiment will be described with reference to this figure, but the description will focus on the differences from the above-described embodiment, and the description of the same matters will be omitted.
本実施形態は、主に、切断デバイスが複数の本体部を有すること以外は、前述した第9実施形態と同様である。
This embodiment is mainly the same as the ninth embodiment described above, except that the cutting device has a plurality of main body portions.
本実施形態の切断デバイス600は、図43に示すように、厚さTの異なる2本の本体部610A、610Bと、切断部620と、を有している。本体部610A、610Bは、それぞれ、前述した第9実施形態の本体部610と同様の構成である。なお、本実施形態では2本の本体部610A、610Bを用意しているが、用意する本体部の数としては、2本に限定されず、3本以上であってもよい。
The cutting device 600 according to the present embodiment includes two main body portions 610A and 610B having different thicknesses T and a cutting portion 620 as shown in FIG. The main body portions 610A and 610B each have the same configuration as the main body portion 610 of the ninth embodiment described above. In the present embodiment, two main body portions 610A and 610B are prepared. However, the number of main body portions to be prepared is not limited to two, and may be three or more.
例えば、前述した第9実施形態では、一度の本体部610の挿入によって本体部610と筋膜側剥離デバイス300との間に脂肪1200および分岐血管1100を導かなければならない。しかしながら、皮膚側剥離デバイス200と筋膜側剥離デバイス300との離間距離等によっては、本体部610と筋膜側剥離デバイス300との間に導く脂肪1200が厚くなり過ぎてしまい、適切に導くことができなかったり、導くことができたとしても、切断部620による脂肪1200の切断に過剰な力が必要になってしまったりする場合がある。
For example, in the ninth embodiment described above, the fat 1200 and the branch blood vessel 1100 must be guided between the main body 610 and the fascia side peeling device 300 by inserting the main body 610 once. However, depending on the separation distance between the skin-side peeling device 200 and the fascia-side peeling device 300, the fat 1200 guided between the main body 610 and the fascia-side peeling device 300 becomes too thick, and the fat is properly guided. Even if it is not possible to guide or guide, excessive force may be required to cut the fat 1200 by the cutting part 620.
そこで、本実施形態では、厚さTの異なる本体部610A、620Bを用意し、2回に分けて脂肪1200および分岐血管1100を切断することで、よりスムーズに過剰な力も必要なく作業を行うことができるようにしている。具体的には、まず、図44に示すように、厚さTが小さい方の本体部610Aを挿入する。そして、電極616、617間に高周波交番電圧を印加して分岐血管1100を熱凝固させた後に、切断部620を用いて分岐血管1100および脂肪1200を切断する。これにより、脂肪1200が途中まで切断された状態となる。次に、本体部610Aを抜去した後、図45に示すように、本体部610Bを挿入する。そして、電極616、617間に高周波交番電圧を印加して分岐血管1100を熱凝固させた後に、切断部620を用いて分岐血管1100および脂肪1200を切断する。以上により、大伏在静脈1000の側方にある脂肪1200が左右に切断されると共に、分岐血管1100が止血、切断される。
Therefore, in this embodiment, the main body portions 610A and 620B having different thicknesses T are prepared, and the fat 1200 and the branch blood vessel 1100 are cut in two steps, so that the work can be performed more smoothly and without excessive force. To be able to. Specifically, first, as shown in FIG. 44, the main body 610A having the smaller thickness T is inserted. Then, a high-frequency alternating voltage is applied between the electrodes 616 and 617 to thermally coagulate the branch blood vessel 1100, and then the branch blood vessel 1100 and the fat 1200 are cut using the cutting unit 620. Thereby, fat 1200 will be in the state cut | disconnected to the middle. Next, after removing the main body 610A, the main body 610B is inserted as shown in FIG. Then, a high-frequency alternating voltage is applied between the electrodes 616 and 617 to thermally coagulate the branch blood vessel 1100, and then the branch blood vessel 1100 and the fat 1200 are cut using the cutting unit 620. As described above, the fat 1200 on the side of the great saphenous vein 1000 is cut right and left, and the branch blood vessel 1100 is stopped and cut.
反対側(第1の剥離デバイス310側)についても、同様の作業を行うことで、大伏在静脈1000の周囲にある脂肪1200の全周が剥離され、大伏在静脈1000が周囲の脂肪1200で覆われた状態で剥離された状態となる。
By performing the same operation on the opposite side (first peeling device 310 side), the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
このような第10実施形態によっても、前述した第1実施形態と同様の効果を発揮することができる。
Also according to the tenth embodiment, the same effects as those of the first embodiment described above can be exhibited.
<第11実施形態>
図46は、本発明の第11実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。図47は、図46に示す切断デバイスの断面図である。図48および図49は、それぞれ、分岐血管の処理方法を説明する図である。 <Eleventh embodiment>
FIG. 46 is a side view showing a cutting device included in the blood vessel peeling device according to the eleventh embodiment of the present invention. 47 is a cross-sectional view of the cutting device shown in FIG. FIG. 48 and FIG. 49 are diagrams for explaining a branch blood vessel processing method.
図46は、本発明の第11実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。図47は、図46に示す切断デバイスの断面図である。図48および図49は、それぞれ、分岐血管の処理方法を説明する図である。 <Eleventh embodiment>
FIG. 46 is a side view showing a cutting device included in the blood vessel peeling device according to the eleventh embodiment of the present invention. 47 is a cross-sectional view of the cutting device shown in FIG. FIG. 48 and FIG. 49 are diagrams for explaining a branch blood vessel processing method.
以下、この図を参照して第11実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the eleventh embodiment will be described with reference to this drawing, but the description will focus on the differences from the above-described embodiment, and the description of the same matters will be omitted.
本実施形態は、主に、切断デバイスの構成が異なること以外は、前述した第9実施形態と同様である。
This embodiment is mainly the same as the ninth embodiment described above except that the configuration of the cutting device is different.
本実施形態の切断デバイス600は、図46および図47に示すように、本体部610と、本体部610に沿って移動させる切断部620とを有している。本体部610は、長尺な板状をなしている。また、本体部610の下面側には電極(第1の電極)616が設けられている。一方、切断部620は、前述した第9実施形態とほぼ同様の構成であり、刃部621が電極(第2の電極)を兼ねている。
The cutting device 600 of the present embodiment includes a main body 610 and a cutting unit 620 that moves along the main body 610, as shown in FIGS. The main body 610 has a long plate shape. An electrode (first electrode) 616 is provided on the lower surface side of the main body 610. On the other hand, the cutting part 620 has substantially the same configuration as that of the above-described ninth embodiment, and the blade part 621 also serves as an electrode (second electrode).
本実施形態の切断デバイス600による分岐血管1100の処理は、脂肪1200を大伏在静脈1000に沿って剥離するステップと、剥離した脂肪1200を押圧するステップと、押圧した脂肪1200に含まれる分岐血管1100を焼灼すると共に切断するステップと、を有している。
The processing of the branch blood vessel 1100 by the cutting device 600 of the present embodiment includes the steps of peeling the fat 1200 along the great saphenous vein 1000, pressing the peeled fat 1200, and the branch blood vessel included in the pressed fat 1200. Cauterizing and cutting 1100.
具体的には、まず、皮膚側剥離デバイス200および筋膜側剥離デバイス300を生体内に挿入して、大伏在静脈1000の上下にある脂肪1200を剥離する。次に、接続部614を皮膚側剥離デバイス200のレール231に接続し、本体部610を皮膚側剥離デバイス200で案内しながら生体内へ挿入する。すると、図48に示すように、案内部613によって、脂肪1200および分岐血管1100が本体部610と第2の剥離デバイス320との間に導かれ、潰れた状態でこれらに挟み込まれた状態となる。次に、本体部610の側面に沿って切断部620を挿入し、図49に示すように、本体部610の下面から刃部621を突出させて、第2の剥離デバイス320のレール322内に侵入させる。そして、電極616および刃部621の間に高周波交番電圧を印加しながら、切断部620を基端側へスライドさせると、分岐血管1100が熱凝固すると共に、切断部620によって切断される。
Specifically, first, the skin side peeling device 200 and the fascia side peeling device 300 are inserted into the living body, and the fat 1200 above and below the great saphenous vein 1000 is peeled off. Next, the connection part 614 is connected to the rail 231 of the skin side peeling device 200, and the main body part 610 is inserted into the living body while being guided by the skin side peeling device 200. Then, as shown in FIG. 48, the fat 1200 and the branch blood vessel 1100 are guided between the main body 610 and the second peeling device 320 by the guide portion 613, and are put in a state of being crushed. . Next, the cutting part 620 is inserted along the side surface of the main body part 610, and as shown in FIG. 49, the blade part 621 protrudes from the lower surface of the main body part 610 to enter the rail 322 of the second peeling device 320. Invade. When the cutting unit 620 is slid toward the proximal end while applying a high-frequency alternating voltage between the electrode 616 and the blade unit 621, the branch blood vessel 1100 is thermally coagulated and cut by the cutting unit 620.
反対側(第1の剥離デバイス310側)についても、同様の作業を行うことで、大伏在静脈1000の周囲にある脂肪1200の全周が剥離され、大伏在静脈1000が周囲の脂肪1200で覆われた状態で剥離された状態となる。
By performing the same operation on the opposite side (first peeling device 310 side), the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
このような第11実施形態によっても、前述した第1実施形態と同様の効果を発揮することができる。
Also according to the eleventh embodiment, the same effects as those of the first embodiment described above can be exhibited.
<第12実施形態>
図50は、本発明の第12実施形態に係る血管剥離デバイスが有する切断デバイスを示す斜視図である。図51は、本発明の第12実施形態に係る血管剥離デバイスが有する筋膜側剥離デバイスを示す斜視図である。図52は、切断デバイスと筋膜側剥離デバイスとを対向させた状態を示す断面図である。図53および図54は、それぞれ、分岐血管の処理方法を説明する図である。 <Twelfth embodiment>
FIG. 50 is a perspective view showing a cutting device included in a blood vessel peeling device according to a twelfth embodiment of the present invention. FIG. 51 is a perspective view showing a fascia side peeling device included in a blood vessel peeling device according to a twelfth embodiment of the present invention. FIG. 52 is a cross-sectional view showing a state in which the cutting device and the fascia side peeling device are opposed to each other. FIG. 53 and FIG. 54 are diagrams for explaining a branch blood vessel processing method.
図50は、本発明の第12実施形態に係る血管剥離デバイスが有する切断デバイスを示す斜視図である。図51は、本発明の第12実施形態に係る血管剥離デバイスが有する筋膜側剥離デバイスを示す斜視図である。図52は、切断デバイスと筋膜側剥離デバイスとを対向させた状態を示す断面図である。図53および図54は、それぞれ、分岐血管の処理方法を説明する図である。 <Twelfth embodiment>
FIG. 50 is a perspective view showing a cutting device included in a blood vessel peeling device according to a twelfth embodiment of the present invention. FIG. 51 is a perspective view showing a fascia side peeling device included in a blood vessel peeling device according to a twelfth embodiment of the present invention. FIG. 52 is a cross-sectional view showing a state in which the cutting device and the fascia side peeling device are opposed to each other. FIG. 53 and FIG. 54 are diagrams for explaining a branch blood vessel processing method.
以下、この図を参照して第12実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the twelfth embodiment will be described with reference to this figure, but the description will focus on the differences from the above-described embodiment, and the description of the same matters will be omitted.
本実施形態は、主に、切断デバイスおよび筋膜側剥離デバイスの構成が異なること以外は、前述した第9実施形態と同様である。
This embodiment is mainly the same as the ninth embodiment described above except that the configuration of the cutting device and the fascia side peeling device are different.
本実施形態の切断デバイス600の本体部610では、図50に示すように、電極(第1の電極)616、617が前述した第9実施形態と比較して短く形成されている。そして、電極616、617は、本体部610に対して軸方向に一体的に移動可能となっている。また、電極616、617は、同電位に接続されている。なお、電極616、617の長さとしては、特に限定されず、例えば、5mm~2cm程度とすることができる。
In the main body 610 of the cutting device 600 of the present embodiment, as shown in FIG. 50, electrodes (first electrodes) 616 and 617 are formed shorter than the ninth embodiment described above. The electrodes 616 and 617 can move integrally with the main body 610 in the axial direction. The electrodes 616 and 617 are connected to the same potential. The lengths of the electrodes 616 and 617 are not particularly limited, and can be about 5 mm to 2 cm, for example.
一方、図51に示すように、第1の剥離デバイス310は、レール312を介して対向配置された電極(第2の電極)318、319を有している。また、電極318、319は、第1の剥離デバイス310の軸方向に延在して設けられている。また、電極318、319は、図52に示すように、溝611とレール312とを対向させて第1の剥離デバイス310および本体部610を配置したとき、電極616、617と対向する。同様に、第2の剥離デバイス320は、レール322を介して対向配置された電極(第2の電極)328、329を有している。また、電極328、329は、第2の剥離デバイス320の軸方向に延在して設けられている。また、電極328、329は、溝611とレール322とを対向させて第2の剥離デバイス320および本体部610を配置したとき、電極616、617と対向する。
On the other hand, as shown in FIG. 51, the first peeling device 310 has electrodes (second electrodes) 318 and 319 arranged to face each other via the rail 312. The electrodes 318 and 319 are provided so as to extend in the axial direction of the first peeling device 310. As shown in FIG. 52, the electrodes 318 and 319 face the electrodes 616 and 617 when the first peeling device 310 and the main body 610 are arranged with the groove 611 and the rail 312 facing each other. Similarly, the second peeling device 320 includes electrodes (second electrodes) 328 and 329 arranged to face each other via the rail 322. The electrodes 328 and 329 are provided so as to extend in the axial direction of the second peeling device 320. The electrodes 328 and 329 are opposed to the electrodes 616 and 617 when the second peeling device 320 and the main body 610 are disposed with the groove 611 and the rail 322 opposed to each other.
このような構成では、まず、本体部610を生体内へ挿入し、本体部610と第2の剥離デバイス320との間に脂肪1200および分岐血管1100を挟み込んだ状態とする。次に、図53に示すように、電極616、617および電極328、329間に高周波交番電圧を印加しつつ、電極616、617を本体部610に対してスライドさせ、分岐血管1100を熱凝固する。次に、図54に示すように、熱凝固された分岐血管1100を切断部620で切断する。
In such a configuration, first, the main body 610 is inserted into the living body, and the fat 1200 and the branch blood vessel 1100 are sandwiched between the main body 610 and the second peeling device 320. Next, as shown in FIG. 53, while applying a high-frequency alternating voltage between the electrodes 616 and 617 and the electrodes 328 and 329, the electrodes 616 and 617 are slid with respect to the main body 610 to thermally coagulate the branch blood vessel 1100. . Next, as shown in FIG. 54, the thermocoagulated branch blood vessel 1100 is cut by the cutting unit 620.
反対側(第1の剥離デバイス310側)についても、同様の作業を行うことで、大伏在静脈1000の周囲にある脂肪1200の全周が剥離され、大伏在静脈1000が周囲の脂肪1200で覆われた状態で剥離された状態となる。
By performing the same operation on the opposite side (first peeling device 310 side), the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
このような第12実施形態によっても、前述した第1実施形態と同様の効果を発揮することができる。
Also according to the twelfth embodiment, the same effects as those of the first embodiment described above can be exhibited.
<第13実施形態>
図55は、本発明の第13実施形態に係る血管剥離デバイスが有する皮膚側剥離デバイスおよび筋膜側剥離デバイスを示す斜視図である。図56は、本発明の第13実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。図57は、図56に示す切断デバイスの上面図である。図58および図59は、それぞれ、分岐血管の処理方法を説明する図である。 <13th Embodiment>
FIG. 55 is a perspective view showing a skin side peeling device and a fascia side peeling device included in a blood vessel peeling device according to a thirteenth embodiment of the present invention. FIG. 56 is a side view showing a cutting device included in a blood vessel peeling device according to a thirteenth embodiment of the present invention. FIG. 57 is a top view of the cutting device shown in FIG. FIG. 58 and FIG. 59 are diagrams for explaining a branch blood vessel processing method.
図55は、本発明の第13実施形態に係る血管剥離デバイスが有する皮膚側剥離デバイスおよび筋膜側剥離デバイスを示す斜視図である。図56は、本発明の第13実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。図57は、図56に示す切断デバイスの上面図である。図58および図59は、それぞれ、分岐血管の処理方法を説明する図である。 <13th Embodiment>
FIG. 55 is a perspective view showing a skin side peeling device and a fascia side peeling device included in a blood vessel peeling device according to a thirteenth embodiment of the present invention. FIG. 56 is a side view showing a cutting device included in a blood vessel peeling device according to a thirteenth embodiment of the present invention. FIG. 57 is a top view of the cutting device shown in FIG. FIG. 58 and FIG. 59 are diagrams for explaining a branch blood vessel processing method.
以下、この図を参照して第13実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the thirteenth embodiment will be described with reference to this figure, but the description will focus on the differences from the above-described embodiment, and the description of the same matters will be omitted.
本実施形態は、主に、切断デバイスの構成が異なること以外は、前述した第1実施形態と同様である。
This embodiment is mainly the same as the first embodiment described above except that the configuration of the cutting device is different.
本実施形態の皮膚側剥離デバイス200は、図55に示すように、角部が丸み付けされた略長方形状の横断面形状を有している。また、レール231、232が皮膚側剥離デバイス200の下面に設けられている。
The skin-side peeling device 200 of the present embodiment has a substantially rectangular cross-sectional shape with rounded corners, as shown in FIG. Rails 231 and 232 are provided on the lower surface of the skin-side peeling device 200.
また、本実施形態の第1の剥離デバイス310は、前述した第1実施形態の構成からレール312が省略されている替りに、上面に電極(第1の電極)340が設けられている。同様に、本実施形態の第2の剥離デバイス320は、前述した第1実施形態の構成からレール322が省略されている替りに、上面に電極(第1の電極)350が設けられている。
Further, the first peeling device 310 of the present embodiment is provided with an electrode (first electrode) 340 on the upper surface instead of the rail 312 being omitted from the configuration of the first embodiment described above. Similarly, in the second peeling device 320 of this embodiment, an electrode (first electrode) 350 is provided on the upper surface instead of the rail 322 being omitted from the configuration of the first embodiment described above.
また、本実施形態の切断デバイス700は、図56および図57に示すように、長尺な本体部(案内デバイス)710と、本体部710に回転可能に設けられたローラー電極(第2の電極)720およびローラー731、732と、を有している。
In addition, as shown in FIGS. 56 and 57, the cutting device 700 of this embodiment includes a long main body (guide device) 710 and a roller electrode (second electrode) that is rotatably provided on the main body 710. ) 720 and rollers 731 and 732.
本体部710は、2枚の板状片711、712でローラー電極720およびローラー731、732を両側から挟み込むような形状となっている。また、本体部710の先端部には先細りした案内部713が設けられている。案内部713は、傾斜して下方を向く案内面713aを有し、この案内面713aを用いて、本体部710が生体内を進む際に脂肪1200および分岐血管1100を下方側(本体部710と筋膜側剥離デバイス300との間)へ案内する機能を有している。
The main body 710 has a shape in which the roller electrode 720 and the rollers 731 and 732 are sandwiched between the two plate- like pieces 711 and 712 from both sides. Further, a tapered guide portion 713 is provided at the distal end portion of the main body portion 710. The guide portion 713 has a guide surface 713a that is inclined and faces downward, and the guide surface 713a is used to move the fat 1200 and the branch blood vessel 1100 downward (when the main body 710 and the main body portion 710 are moved). It has a function of guiding to the fascia side peeling device 300).
ローラー電極720は、本体部710の下側へ突出して設けられている。また、ローラー電極720は、案内部713(案内面713a)から突出して設けられている。このようなローラー電極720は、案内部713によって本体部710と筋膜側剥離デバイス300との間に導かれた分岐血管1100および脂肪1200に電界を作用させて焼灼するための電極であると共に、焼灼した分岐血管1100および脂肪1200を切断する切断部としても機能する。なお、切断部は、ローラー電極720と別途設けてもよく、この場合には、ローラー電極720よりも基端側に本体部710の下側へ突出させて配置すればよい。
The roller electrode 720 is provided so as to protrude below the main body 710. The roller electrode 720 is provided so as to protrude from the guide portion 713 (guide surface 713a). Such a roller electrode 720 is an electrode for cauterizing by applying an electric field to the branch blood vessel 1100 and the fat 1200 guided between the main body part 710 and the fascia side peeling device 300 by the guide part 713, It also functions as a cutting part for cutting the cauterized branched blood vessel 1100 and fat 1200. Note that the cutting portion may be provided separately from the roller electrode 720, and in this case, the cutting portion may be disposed so as to protrude to the lower side of the main body portion 710 from the base end side of the roller electrode 720.
ローラー731、732は、本体部710の上側へ突出して設けられている。本体部710を生体内に挿入する際に、このローラー731、732が皮膚側剥離デバイス200のレール231、232に係合することで、切断デバイス700をスムーズに生体内へ挿入することができる。
Rollers 731 and 732 are provided so as to protrude upward from the main body 710. When the main body 710 is inserted into the living body, the rollers 731 and 732 engage with the rails 231 and 232 of the skin side peeling device 200, so that the cutting device 700 can be smoothly inserted into the living body.
本実施形態の切断デバイス600による分岐血管1100の処理は、脂肪1200を大伏在静脈1000に沿って剥離するステップと、剥離した脂肪1200を押圧するステップと、押圧した脂肪1200に含まれる分岐血管1100を焼灼するステップと、焼灼した分岐血管1100を切断するステップと、を有している。
The processing of the branch blood vessel 1100 by the cutting device 600 of the present embodiment includes the steps of peeling the fat 1200 along the great saphenous vein 1000, pressing the peeled fat 1200, and the branch blood vessel included in the pressed fat 1200. And cauterizing 1100 and cutting the cauterized branch blood vessel 1100.
具体的には、まず、皮膚側剥離デバイス200および筋膜側剥離デバイス300を生体内に挿入して、大伏在静脈1000の上下にある脂肪1200を剥離する。次に、電極350およびローラー電極720間に高周波交番電圧を印加しながら、図58に示すように、切断デバイス700を皮膚側剥離デバイス200と第2の剥離デバイス320との間に挿入する。この際、皮膚1400側から皮膚側剥離デバイス200を押圧し、切断デバイス700を第2の剥離デバイス320に押し付けながら挿入することが好ましい。すると、分岐血管1100および脂肪1200が案内部713によって本体部710と第2の剥離デバイス320との間に潰れた状態(押圧(圧縮)された状態)で導かれ、図59に示すように、ローラー電極720と第2の剥離デバイス320(電極350)との間を通過する際に焼灼されて熱凝固すると共に切断される。このように、分岐血管1100および脂肪1200がローラー電極720および電極350の間を通過することで、これらにより効果的に電界を作用させることができ、これらを十分に焼灼することができる。
Specifically, first, the skin side peeling device 200 and the fascia side peeling device 300 are inserted into the living body, and the fat 1200 above and below the great saphenous vein 1000 is peeled off. Next, while applying a high-frequency alternating voltage between the electrode 350 and the roller electrode 720, the cutting device 700 is inserted between the skin-side peeling device 200 and the second peeling device 320 as shown in FIG. At this time, it is preferable to press the skin side peeling device 200 from the skin 1400 side and insert the cutting device 700 while pressing the cutting device 700 against the second peeling device 320. Then, the branched blood vessel 1100 and the fat 1200 are guided in a crushed state (pressed (compressed)) between the main body portion 710 and the second peeling device 320 by the guide portion 713, and as shown in FIG. When passing between the roller electrode 720 and the second peeling device 320 (electrode 350), it is cauterized and thermally coagulated and cut. As described above, the branch blood vessel 1100 and the fat 1200 pass between the roller electrode 720 and the electrode 350, so that an electric field can be effectively applied thereto, and these can be sufficiently cauterized.
特に、前述したように、分岐血管1100が潰れた状態で焼灼されるため、より確実に、分岐血管1100を熱凝固することができる。また、ローラー電極720が回転可能となっているため、ローラー電極720と第2の剥離デバイス320との間を分岐血管1100および脂肪1200がスムーズに通過することができ、上記の作業をよりスムーズに行うことができる。さらには、本体部710に一方の電極であるローラー電極720を設け、第2の剥離デバイス320(第1の剥離デバイス310)に他方の電極である電極350(電極340)を設けることで、比較的簡単な構成で、ローラー電極720と電極350(電極340)の間に分岐血管1100および脂肪1200を通過させることができる。
Particularly, as described above, since the branch blood vessel 1100 is cauterized in a collapsed state, the branch blood vessel 1100 can be more solidified more reliably. In addition, since the roller electrode 720 is rotatable, the branch blood vessel 1100 and the fat 1200 can smoothly pass between the roller electrode 720 and the second peeling device 320, so that the above operation can be performed more smoothly. It can be carried out. Furthermore, the roller electrode 720 which is one electrode is provided in the main body portion 710, and the electrode 350 (electrode 340) which is the other electrode is provided in the second peeling device 320 (first peeling device 310). The branch blood vessel 1100 and the fat 1200 can be passed between the roller electrode 720 and the electrode 350 (electrode 340) with a simple configuration.
なお、本実施形態では、分岐血管1100が熱凝固されるタイミングと切断されるタイミングは、ほぼ同時であるが、場合によっては切断された後に熱凝固したり、反対に、熱凝固した後に切断されたりする。
In this embodiment, the timing at which the branch blood vessel 1100 is thermally coagulated and the timing at which it is cut are almost the same, but depending on the case, it is thermally coagulated after being cut, or conversely, it is cut after being thermally coagulated. Or
反対側(第1の剥離デバイス310側)についても、同様の作業を行うことで、大伏在静脈1000の周囲にある脂肪1200の全周が剥離され、大伏在静脈1000が周囲の脂肪1200で覆われた状態で剥離された状態となる。
By performing the same operation on the opposite side (first peeling device 310 side), the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
このような第13実施形態によっても、大伏在静脈1000の左右にある分岐血管1100および脂肪1200を簡単に処理することができる。
Also according to the thirteenth embodiment, the branch blood vessels 1100 and fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
なお、本実施形態では、電極340が第1の剥離デバイス310の上面のほぼ全域にわたって配置されているが、電極340の配置としては、ローラー電極720との間に発生する電界によって分岐血管1100を焼灼(熱凝固)することが出きれば、特に限定されなない。例えば、電極340を複数のライン状に並べて配置してもよいし、大伏在静脈1000の形状(延在状態)に合わせて蛇行させて配置してもよい。この場合には、皮膚側剥離デバイス200のレール231、232についても、同様に蛇行させることが好ましい。
In the present embodiment, the electrode 340 is arranged over almost the entire upper surface of the first peeling device 310. However, the arrangement of the electrode 340 includes the branch blood vessel 1100 by an electric field generated between the roller electrode 720 and the electrode 340. If shochu (thermal coagulation) can come out, it will not be specifically limited. For example, the electrodes 340 may be arranged side by side in a plurality of lines, or may be arranged to meander according to the shape (extended state) of the large saphenous vein 1000. In this case, the rails 231 and 232 of the skin side peeling device 200 are preferably meandered in the same manner.
<第14実施形態>
図60は、本発明の第14実施形態に係る血管剥離デバイスが有する皮膚側剥離デバイスおよび切断デバイスを示す側面図である。図61は、分岐血管の処理方法を説明する図である。 <Fourteenth embodiment>
FIG. 60 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a fourteenth embodiment of the present invention. FIG. 61 is a diagram illustrating a method for processing a branch blood vessel.
図60は、本発明の第14実施形態に係る血管剥離デバイスが有する皮膚側剥離デバイスおよび切断デバイスを示す側面図である。図61は、分岐血管の処理方法を説明する図である。 <Fourteenth embodiment>
FIG. 60 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a fourteenth embodiment of the present invention. FIG. 61 is a diagram illustrating a method for processing a branch blood vessel.
以下、この図を参照して第14実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the fourteenth embodiment will be described with reference to this figure, but the description will focus on the differences from the above-described embodiments, and description of similar matters will be omitted.
本実施形態は、主に、皮膚側剥離デバイスおよび切断デバイスの構成が異なること以外は、前述した第13実施形態と同様である。
This embodiment is mainly the same as the thirteenth embodiment described above except that the configurations of the skin-side peeling device and the cutting device are different.
図60に示すように、本実施形態の皮膚側剥離デバイス200は、レール231の底面に直線状に歯切りをしたラックギア231Aを有し、同様に、レール232の底面に直線状に歯切りをしたラックギア232Aを有している。
As shown in FIG. 60, the skin-side peeling device 200 of this embodiment has a rack gear 231A that is linearly cut on the bottom surface of the rail 231. Similarly, the skin-side peeling device 200 is linearly cut on the bottom surface of the rail 232. The rack gear 232A is provided.
また、本実施形態の切断デバイス700は、ローラー731、732が周面に歯切りされたピニオンギアからなり、レール231、232に噛合可能となっている。同様に、ローラー電極(回転体)720もピニオンギアからなり、ローラー731、732と噛合している。このようなローラー731、732およびローラー電極720は、分岐血管1100および脂肪1200を本体部710と第2の剥離デバイス320との間に積極的に導くための誘導部750を構成している。このように、ローラー電極720が回転体を兼ねることにより、切断デバイス700の構成がより簡単なものとなる。
Further, the cutting device 700 of the present embodiment is composed of a pinion gear in which rollers 731 and 732 are toothed on the peripheral surface, and can mesh with the rails 231 and 232. Similarly, the roller electrode (rotating body) 720 also includes a pinion gear and meshes with the rollers 731 and 732. Such rollers 731 and 732 and the roller electrode 720 constitute a guiding portion 750 for actively guiding the branch blood vessel 1100 and the fat 1200 between the main body portion 710 and the second peeling device 320. Thus, when the roller electrode 720 also serves as a rotating body, the configuration of the cutting device 700 becomes simpler.
このような構成では、図61に示すように、皮膚側剥離デバイス200のレール231にローラー731、732を噛合させた状態で切断デバイス700を生体内へ挿入すると、ローラー731、732が回転し、さらに、この回転に伴ってローラー電極720が回転する。ローラー電極720は、分岐血管1100および脂肪1200を挿入方向後方側へ付勢するように、すなわち、本体部710と第2の剥離デバイス320との間に導くように回転する。そのため、分岐血管1100および脂肪1200を本体部710と第2の剥離デバイス320との間により積極的に導くことができる。特に、ローラー電極720が案内部713(案内面713a)から突出して設けられているため、上記の効果がより顕著となる。また、ローラー電極720の周面に設けられた歯によって、脂肪1200との摩擦が高まるため、上記効果がより向上する。
In such a configuration, as shown in FIG. 61, when the cutting device 700 is inserted into the living body with the rollers 731 and 732 engaged with the rail 231 of the skin-side peeling device 200, the rollers 731 and 732 rotate, Furthermore, the roller electrode 720 rotates with this rotation. The roller electrode 720 rotates so as to urge the branch blood vessel 1100 and the fat 1200 rearward in the insertion direction, that is, to guide between the main body 710 and the second peeling device 320. Therefore, the branch blood vessel 1100 and the fat 1200 can be more actively guided between the main body 710 and the second peeling device 320. In particular, since the roller electrode 720 is provided so as to protrude from the guide portion 713 (guide surface 713a), the above effect becomes more remarkable. Moreover, since the friction with the fat 1200 is increased by the teeth provided on the peripheral surface of the roller electrode 720, the above effect is further improved.
反対側(第1の剥離デバイス310側)についても、同様の作業を行うことで、大伏在静脈1000の周囲にある脂肪1200の全周が剥離され、大伏在静脈1000が周囲の脂肪1200で覆われた状態で剥離された状態となる。
By performing the same operation on the opposite side (first peeling device 310 side), the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
このような第14実施形態によっても、大伏在静脈1000の左右にある分岐血管1100および脂肪1200を簡単に処理することができる。
Also according to the fourteenth embodiment, the branch blood vessels 1100 and the fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
<第15実施形態>
図62は、本発明の第15実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。 <Fifteenth embodiment>
FIG. 62 is a side view showing a cutting device included in a blood vessel peeling device according to a fifteenth embodiment of the present invention.
図62は、本発明の第15実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。 <Fifteenth embodiment>
FIG. 62 is a side view showing a cutting device included in a blood vessel peeling device according to a fifteenth embodiment of the present invention.
以下、この図を参照して第15実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the fifteenth embodiment will be described with reference to this drawing, but the description will focus on the differences from the above-described embodiment, and the description of the same matters will be omitted.
本実施形態は、主に、切断デバイスの構成が異なること以外は、前述した第13実施形態と同様である。
This embodiment is mainly the same as the thirteenth embodiment described above except that the configuration of the cutting device is different.
本実施形態の切断デバイス700は、図62に示すように、ローラー電極(回転体)720を回転させる駆動部790を有している。駆動部790は、モーター等の駆動源791と、駆動源791から発生する動力をローラー電極720に伝達する無端ベルト792と、を有し、駆動源791を回転させることで、ローラー電極720が回転する構成となっている。そして、ローラー電極720と駆動部790とで誘導部750を構成している。なお、駆動部790の構成としては、ローラー電極720を回転させることができれば特に限定されない。
The cutting device 700 of this embodiment has a drive unit 790 that rotates a roller electrode (rotating body) 720, as shown in FIG. The drive unit 790 includes a drive source 791 such as a motor, and an endless belt 792 that transmits power generated from the drive source 791 to the roller electrode 720, and the roller electrode 720 rotates by rotating the drive source 791. It is the composition to do. The roller electrode 720 and the drive unit 790 constitute a guide unit 750. Note that the configuration of the drive unit 790 is not particularly limited as long as the roller electrode 720 can be rotated.
このような構成では、駆動部790によってローラー電極720を分岐血管1100および脂肪1200を本体部710と第2の剥離デバイス320との間に導く方向に回転させつつ、切断デバイス700を生体内へ挿入することで、分岐血管1100および脂肪1200を本体部710と第2の剥離デバイス320との間により積極的に導くことができる。
In such a configuration, the cutting device 700 is inserted into the living body while the driving unit 790 rotates the roller electrode 720 in a direction in which the branch blood vessel 1100 and the fat 1200 are guided between the main body 710 and the second peeling device 320. By doing so, the branch blood vessel 1100 and the fat 1200 can be more actively guided between the main body 710 and the second peeling device 320.
このような第15実施形態によっても、大伏在静脈1000の左右にある分岐血管1100および脂肪1200を簡単に処理することができる。
Also according to the fifteenth embodiment, the branch blood vessels 1100 and fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
<第16実施形態>
図63は、本発明の第16実施形態に係る血管剥離デバイスが有する皮膚側剥離デバイスおよび切断デバイスを示す側面図である。図64は、分岐血管の処理方法を説明する図である。 <Sixteenth Embodiment>
FIG. 63 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a sixteenth embodiment of the present invention. FIG. 64 is a diagram for explaining a branch blood vessel processing method.
図63は、本発明の第16実施形態に係る血管剥離デバイスが有する皮膚側剥離デバイスおよび切断デバイスを示す側面図である。図64は、分岐血管の処理方法を説明する図である。 <Sixteenth Embodiment>
FIG. 63 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a sixteenth embodiment of the present invention. FIG. 64 is a diagram for explaining a branch blood vessel processing method.
以下、この図を参照して第16実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the sixteenth embodiment will be described with reference to this figure, but the description will focus on the differences from the above-described embodiment, and description of similar matters will be omitted.
本実施形態は、主に、皮膚側剥離デバイスおよび切断デバイスの構成が異なること以外は、前述した第13実施形態と同様である。
This embodiment is mainly the same as the thirteenth embodiment described above except that the configurations of the skin-side peeling device and the cutting device are different.
本実施形態の皮膚側剥離デバイス200は、前述した第14実施形態と同様の構成である。
The skin side peeling device 200 of the present embodiment has the same configuration as that of the fourteenth embodiment described above.
本実施形態の切断デバイス700は、分岐血管1100および脂肪1200を本体部710と第2の剥離デバイス320との間に積極的に導く誘導部750を有している。誘導部750は、図63に示すように、本体部710に回転可能に設けられており、レール231、232と噛合する第1のギア部751と、本体部710に回転可能に設けられており、第1のギア部751と噛合する第2のギア部752と、を有している。また、第2のギア部752は、第1のギア部751と噛合する小径の部分753と、部分753と同軸的に設けられた大径の部分754と、を有し、部分754の周面には爪部754aが並んで設けられている。そして、爪部754aが案内部713の案内面713aから突出している。
The cutting device 700 of the present embodiment includes a guide portion 750 that actively guides the branch blood vessel 1100 and the fat 1200 between the main body portion 710 and the second peeling device 320. As shown in FIG. 63, the guide portion 750 is rotatably provided on the main body portion 710, and is provided on the main body portion 710 so as to be rotatable, and a first gear portion 751 that meshes with the rails 231 and 232. And a second gear portion 752 that meshes with the first gear portion 751. The second gear portion 752 has a small-diameter portion 753 that meshes with the first gear portion 751, and a large-diameter portion 754 that is provided coaxially with the portion 753, and the peripheral surface of the portion 754 The claw portion 754a is provided side by side. And the nail | claw part 754a protrudes from the guide surface 713a of the guide part 713. FIG.
このような構成では、ローラー電極720および電極350の間に高周波交番電圧を印加しつつ、図64に示すように、皮膚側剥離デバイス200のレール231に第1のギア部751を噛合させた状態で切断デバイス700を生体内へ挿入すると、第2のギア部752が分岐血管1100および脂肪1200を挿入方向後方側へ付勢するように、すなわち、本体部710と第2の剥離デバイス320との間に導くように回転する。そのため、分岐血管1100および脂肪1200を本体部710と第2の剥離デバイス320との間に積極的に導くことができる。加えて、第2のギア部752の周面に設けられた爪部754aによって、脂肪1200との摩擦が高まるため、上記効果がより向上する。そして、本体部710と第2の剥離デバイス320との間に導かれた分岐血管1100および脂肪1200は、第2のギア部752の後方に位置するローラー電極720と第2の剥離デバイス320(電極350)との間を通過する際に焼灼されると共に切断される。
In such a configuration, a high-frequency alternating voltage is applied between the roller electrode 720 and the electrode 350, and the first gear portion 751 is engaged with the rail 231 of the skin side peeling device 200 as shown in FIG. When the cutting device 700 is inserted into the living body, the second gear part 752 urges the branch blood vessel 1100 and the fat 1200 rearward in the insertion direction, that is, between the main body part 710 and the second peeling device 320. Rotate to guide in between. Therefore, the branch blood vessel 1100 and the fat 1200 can be actively guided between the main body 710 and the second peeling device 320. In addition, since the friction with the fat 1200 is increased by the claw portion 754a provided on the peripheral surface of the second gear portion 752, the above effect is further improved. The branched blood vessel 1100 and the fat 1200 guided between the main body 710 and the second peeling device 320 are the roller electrode 720 and the second peeling device 320 (electrodes) positioned behind the second gear portion 752. 350) and is cut and cut.
反対側(第1の剥離デバイス310側)についても、同様の作業を行うことで、大伏在静脈1000の周囲にある脂肪1200の全周が剥離され、大伏在静脈1000が周囲の脂肪1200で覆われた状態で剥離された状態となる。
By performing the same operation on the opposite side (first peeling device 310 side), the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
このような第16実施形態によっても、大伏在静脈1000の左右にある分岐血管1100および脂肪1200を簡単に処理することができる。
Also according to the sixteenth embodiment, the branch blood vessels 1100 and fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
<第17実施形態>
図65は、本発明の第17実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。図66は、分岐血管の処理方法を説明する図である。 <Seventeenth Embodiment>
FIG. 65 is a side view showing a cutting device included in a blood vessel peeling device according to a seventeenth embodiment of the present invention. FIG. 66 is a diagram for explaining a branch blood vessel processing method.
図65は、本発明の第17実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。図66は、分岐血管の処理方法を説明する図である。 <Seventeenth Embodiment>
FIG. 65 is a side view showing a cutting device included in a blood vessel peeling device according to a seventeenth embodiment of the present invention. FIG. 66 is a diagram for explaining a branch blood vessel processing method.
以下、この図を参照して第17実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the seventeenth embodiment will be described with reference to this drawing, but the description will focus on the differences from the above-described embodiment, and the description of the same matters will be omitted.
本実施形態は、主に、筋膜側剥離デバイスおよび切断デバイスの構成が異なること以外は、前述した第13実施形態と同様である。
This embodiment is mainly the same as the thirteenth embodiment described above except that the configurations of the fascia side peeling device and the cutting device are different.
本実施形態の第1の剥離デバイス310は、前述した第13実施形態から電極340を省略した構成となっている。同様に、本実施形態の第2の剥離デバイス320は、前述した第13実施形態から電極350を省略した構成となっている。
The first peeling device 310 of this embodiment has a configuration in which the electrode 340 is omitted from the thirteenth embodiment. Similarly, the second peeling device 320 of the present embodiment has a configuration in which the electrode 350 is omitted from the thirteenth embodiment.
本実施形態の切断デバイス700は、図65に示すように、対向配置された一対の本体部710A、710Bと、本体部(第1の本体部)710Aに設けられたローラー電極(第1の電極)720Aおよびローラー731A、732Aと、本体部(第2の本体部)710Bに設けられたローラー電極(第2の電極)720Bおよびローラー731B、732Bと、を有している。本体部710A、710Bは、空隙S3を介して対向配置されており、基端部によって連結されている。空隙S3は、生体内に挿入したときに、分岐血管1100および脂肪1200を導くための空間である。
As shown in FIG. 65, the cutting device 700 of the present embodiment includes a pair of main body portions 710A and 710B that are arranged to face each other, and roller electrodes (first electrodes) provided on the main body portion (first main body portion) 710A. ) 720A and rollers 731A and 732A, and a roller electrode (second electrode) 720B and rollers 731B and 732B provided on the main body (second main body) 710B. The main body portions 710A and 710B are disposed to face each other via the gap S3, and are connected by a base end portion. The space S3 is a space for guiding the branch blood vessel 1100 and the fat 1200 when inserted into the living body.
本体部710Aは、長尺な板状をなしている。また、本体部710Aは、2枚の板状片711A、712Aでローラー電極720Aおよびローラー731A、732Aを両側から挟み込む形状となっている。また、本体部710Aの先端部には先細りした案内部713Aが設けられている。案内部713Aは、傾斜して下方を向く案内面713Aaを有し、この案内面713Aaを用いて、本体部710Aが生体内を進む際に脂肪1200および分岐血管1100を空隙S3へ案内する機能を有している。なお、本体部710Bは、空隙S3を介して本体部710Aと対象的な構成となっている。
The main body 710A has a long plate shape. The main body 710A has a shape in which the roller electrode 720A and the rollers 731A and 732A are sandwiched from both sides by two plate- like pieces 711A and 712A. Further, a tapered guide portion 713A is provided at the distal end portion of the main body portion 710A. The guide portion 713A has a guide surface 713Aa that is inclined and faces downward. The guide surface 713Aa has a function of guiding the fat 1200 and the branch blood vessel 1100 to the gap S3 when the main body portion 710A advances through the living body. Have. The main body 710B has a target configuration with the main body 710A via the gap S3.
ローラー電極720A、720Bは、対向配置されており、共に空隙S3へ突出して設けられている。このようなローラー電極720A、720Bは、案内部713A、713Bによって本体部710A、720Bの間に導かれた分岐血管1100および脂肪1200に電界を作用させて焼灼するための電極であると共に、焼灼した分岐血管1100および脂肪1200を切断する切断部としても機能する。
The roller electrodes 720A and 720B are arranged to face each other, and are both provided so as to protrude into the gap S3. Such roller electrodes 720A and 720B are electrodes for cauterizing by causing an electric field to act on the branch blood vessel 1100 and the fat 1200 guided between the main body portions 710A and 720B by the guide portions 713A and 713B. It also functions as a cutting section for cutting the branch blood vessel 1100 and the fat 1200.
ローラー731A、732Aは、本体部710Aの上側へ突出して設けられている。同様に、ローラー731B、732Bは、本体部710Bの下側へ突出して設けられている。本体部710を生体内に挿入する際に、ローラー731A、732Aが皮膚側剥離デバイス200のレール231、232に係合し、ローラー731B、732Bが筋膜側剥離デバイス300に沿って回転することで、切断デバイス700をスムーズに生体内へ挿入することができる。
Rollers 731A and 732A are provided to protrude to the upper side of the main body 710A. Similarly, the rollers 731B and 732B are provided so as to protrude downward from the main body 710B. When the main body 710 is inserted into the living body, the rollers 731A and 732A engage with the rails 231 and 232 of the skin side peeling device 200, and the rollers 731B and 732B rotate along the fascia side peeling device 300. The cutting device 700 can be smoothly inserted into the living body.
このような構成では、皮膚側剥離デバイス200および筋膜側剥離デバイス300を生体内に配置した状態で、ローラー電極720A、720Bの間に高周波交番電圧を印加しながら、切断デバイス700を皮膚側剥離デバイス200と第2の剥離デバイス320との間に挿入する。すると、分岐血管1100および脂肪1200が案内部713A、713Bによって空隙S3(本体部710A、710Bの間)に導かれ、図66に示すように、ローラー電極720A、720Bの間を通過する際に焼灼されると共に切断される。このような構成よれば、上下の脂肪1200を中央部に集めるようにして圧縮するため、例えば、前述した第13実施形態のように上下の脂肪1200の下側に集めるようにして圧縮する場合と比較して、よりスムーズに、分岐血管1100および脂肪1200を空隙S3に導くことができる。
In such a configuration, the skin-side peeling device 200 and the fascia-side peeling device 300 are placed in the living body, and the cutting device 700 is peeled off the skin while applying a high-frequency alternating voltage between the roller electrodes 720A and 720B. Insert between device 200 and second stripping device 320. Then, the branch blood vessel 1100 and the fat 1200 are guided to the gap S3 (between the main body portions 710A and 710B) by the guide portions 713A and 713B, and cauterized when passing between the roller electrodes 720A and 720B as shown in FIG. And cut off. According to such a configuration, the upper and lower fats 1200 are compressed so as to be collected in the central portion. For example, as in the thirteenth embodiment described above, the compression is performed such that the fats are collected below the upper and lower fats 1200. In comparison, the branched blood vessel 1100 and the fat 1200 can be guided to the gap S3 more smoothly.
反対側(第1の剥離デバイス310側)についても、同様の作業を行うことで、大伏在静脈1000の周囲にある脂肪1200の全周が剥離され、大伏在静脈1000が周囲の脂肪1200で覆われた状態で剥離された状態となる。
By performing the same operation on the opposite side (first peeling device 310 side), the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
このような第17実施形態によっても、大伏在静脈1000の左右にある分岐血管1100および脂肪1200を簡単に処理することができる。
Also according to the seventeenth embodiment, the branch blood vessels 1100 and the fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
なお、確実に分岐血管1100および脂肪1200を切断できる場合は、空隙S3は必ずしも必要ない。
Note that the gap S3 is not necessarily required when the branching blood vessel 1100 and the fat 1200 can be cut reliably.
<第18実施形態>
図67は、本発明の第18実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。図68は、分岐血管の処理方法を説明する図である。 <Eighteenth embodiment>
FIG. 67 is a side view showing a cutting device included in a blood vessel peeling device according to an eighteenth embodiment of the present invention. FIG. 68 is a diagram for explaining a branch blood vessel processing method.
図67は、本発明の第18実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。図68は、分岐血管の処理方法を説明する図である。 <Eighteenth embodiment>
FIG. 67 is a side view showing a cutting device included in a blood vessel peeling device according to an eighteenth embodiment of the present invention. FIG. 68 is a diagram for explaining a branch blood vessel processing method.
以下、この図を参照して第18実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the eighteenth embodiment will be described with reference to this figure, but the description will focus on the differences from the above-described embodiment, and description of similar matters will be omitted.
本実施形態は、主に、切断デバイスの構成が異なること以外は、前述した第13実施形態と同様である。
This embodiment is mainly the same as the thirteenth embodiment described above except that the configuration of the cutting device is different.
本実施形態の切断デバイス700では、図67に示すように、本体部710と、ローラー電極720とが別体に設けられている。また、ローラー電極720は、長尺な操作部721に回転可能に支持されている。そして、このようなローラー電極720は、本体部710の内側(板状片711、712の間の隙間)を移動可能となっている。
In the cutting device 700 of this embodiment, as shown in FIG. 67, a main body 710 and a roller electrode 720 are provided separately. Further, the roller electrode 720 is rotatably supported by the long operation unit 721. Such a roller electrode 720 can move inside the main body 710 (a gap between the plate-like pieces 711 and 712).
このような構成では、まず、本体部710を生体内に挿入した状態とする。次に、図68に示すように、ローラー電極720と電極350との間に高周波交番電圧を印加しながら、ローラー電極720を分岐血管1100および脂肪1200に押し付けつつ本体部710の内側を前進させる。これにより、分岐血管1100および脂肪1200を焼灼すると共に切断することができる。
In such a configuration, the main body 710 is first inserted into the living body. Next, as shown in FIG. 68, while applying a high-frequency alternating voltage between the roller electrode 720 and the electrode 350, the roller electrode 720 is pushed against the branch blood vessel 1100 and the fat 1200, and the inside of the main body 710 is advanced. Thereby, the branch blood vessel 1100 and the fat 1200 can be cauterized and cut.
このような第18実施形態によっても、大伏在静脈1000の左右にある分岐血管1100および脂肪1200を簡単に処理することができる。
Also according to the eighteenth embodiment, the branch blood vessels 1100 and fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
<第19実施形態>
図69は、本発明の第19実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。図70は、分岐血管の処理方法を説明する図である。 <Nineteenth embodiment>
FIG. 69 is a side view showing a cutting device included in a blood vessel peeling device according to a nineteenth embodiment of the present invention. FIG. 70 is a diagram for explaining a branch blood vessel processing method.
図69は、本発明の第19実施形態に係る血管剥離デバイスが有する切断デバイスを示す側面図である。図70は、分岐血管の処理方法を説明する図である。 <Nineteenth embodiment>
FIG. 69 is a side view showing a cutting device included in a blood vessel peeling device according to a nineteenth embodiment of the present invention. FIG. 70 is a diagram for explaining a branch blood vessel processing method.
以下、この図を参照して第19実施形態について説明するが、前述した実施形態との相違点を中心に説明し、同様の事項については、その説明を省略する。
Hereinafter, the nineteenth embodiment will be described with reference to this drawing, but the description will focus on the differences from the above-described embodiment, and description of similar matters will be omitted.
本実施形態は、主に、切断デバイスの構成が異なること以外は、前述した第18実施形態と同様である。
This embodiment is mainly the same as the eighteenth embodiment described above except that the configuration of the cutting device is different.
本実施形態の切断デバイス700では、前述した第18実施形態のローラー電極720に替えて刃部741を有する電極740を有している。この電極740は、長尺な操作部742の先端部に固定されている。そして、このような電極740は、本体部710の内側(板状片711、712の間の隙間)を移動可能となっている。
The cutting device 700 of this embodiment has an electrode 740 having a blade portion 741 instead of the roller electrode 720 of the eighteenth embodiment described above. The electrode 740 is fixed to the distal end portion of the long operation portion 742. Such an electrode 740 can move inside the main body 710 (a gap between the plate-like pieces 711 and 712).
このような構成では、まず、本体部710を生体内に挿入した状態とする。次に、図70に示すように、電極740と電極350との間に高周波交番電圧を印加しながら、電極740を分岐血管1100および脂肪1200に押し付けつつ本体部710の内側を前進させる。これにより、分岐血管1100および脂肪1200を焼灼すると共に切断することができる。
In such a configuration, the main body 710 is first inserted into the living body. Next, as shown in FIG. 70, while applying a high-frequency alternating voltage between the electrode 740 and the electrode 350, the electrode 740 is pressed against the branch blood vessel 1100 and the fat 1200, and the inside of the main body 710 is advanced. Thereby, the branch blood vessel 1100 and the fat 1200 can be cauterized and cut.
このような第19実施形態によっても、大伏在静脈1000の左右にある分岐血管1100および脂肪1200を簡単に処理することができる。
Also according to the nineteenth embodiment, the branch blood vessels 1100 and fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
なお、ローラー電極720において、ローラー側面部に絶縁コーティング等を施し、ローラー端面部(円周部)のみを電極としてもよい。また、刃部741を有する電極740の刃部近傍のみを電極としてもよい。その場合は、通電部位が限定され、より効率よく熱凝固することが可能となる。
In the roller electrode 720, an insulating coating or the like may be applied to the roller side surface portion, and only the roller end surface portion (circumferential portion) may be used as the electrode. Further, only the vicinity of the blade portion of the electrode 740 having the blade portion 741 may be used as the electrode. In that case, the current-carrying part is limited, and thermal coagulation can be performed more efficiently.
以上、本発明の血管剥離デバイスを、図示の実施形態に基づいて説明したが、本発明はこれに限定されるものではなく、各部の構成は、同様の機能を有する任意の構成のものに置換することができる。また、本発明に、他の任意の構成物が付加されていてもよい。また、各実施形態を適宜組み合わせてもよい。
As described above, the blood vessel peeling device of the present invention has been described based on the illustrated embodiment, but the present invention is not limited to this, and the configuration of each part is replaced with an arbitrary configuration having the same function. can do. In addition, any other component may be added to the present invention. Moreover, you may combine each embodiment suitably.
また、前述した実施形態では、大伏在静脈をその全周が脂肪に覆われた状態で剥離しているが、全周が脂肪で覆われているものに限定されない。すなわち、大伏在静脈をその周囲の一部が組脂肪に覆われた状態で剥離してもよいし、脂肪に覆われていない状態で剥離してもよい。例えば、上下の脂肪が薄く(または上下に脂肪1200がなく)、左右の脂肪が厚い、扁平状の脂肪で覆われていてもよい。このような状態では、上下から大伏在静脈の状態(例えば、損傷の有無、形状、捩じれ等)を容易に確認することができる。そのため、大伏在静脈の状態を把握したうえで、適切に、バイパス管等に使用することができる。
Further, in the embodiment described above, the great saphenous vein is peeled in a state where the entire circumference is covered with fat, but is not limited to the case where the entire circumference is covered with fat. That is, the large saphenous vein may be peeled off in a state where a part of its periphery is covered with the set fat, or may be peeled off without being covered with fat. For example, the upper and lower fats may be thin (or there is no fat 1200 above and below), and the left and right fats may be thick and covered with flat fat. In such a state, the state of the great saphenous vein (for example, presence or absence of damage, shape, twist) can be easily confirmed from above and below. Therefore, after grasping the state of the great saphenous vein, it can be appropriately used for a bypass pipe or the like.
また、例えば、図71に示すように、大伏在静脈1000が大きく蛇行している場合などには、大伏在静脈1000が比較的真っ直ぐに延びている領域毎に切開して、上述した作業を複数回繰り返すことで、大伏在静脈1000を剥離してもよい。図71で説明すれば、まず、切開部1310、1320の間で大伏在静脈1000を剥離し、次に、切開部1320、1330の間で大伏在静脈1000を剥離し、次に、切開部1330、1340の間で大伏在静脈1000を剥離してもよい。そして、切開部1310、1340を介して大伏在静脈1000を結紮し、切開部1310、1340のいずれかから摘出すればよい。これにより、大伏在静脈の状態によらずに、より長い(所定長さの)大伏在静脈1000を採取することができる。
Further, for example, as shown in FIG. 71, when the great saphenous vein 1000 is meandering greatly, an incision is made for each region where the great saphenous vein 1000 extends relatively straight, and the above-described operation is performed. The saphenous vein 1000 may be peeled by repeating a plurality of times. 71, first, the great saphenous vein 1000 is peeled between the incisions 1310 and 1320, and then the great saphenous vein 1000 is peeled between the incisions 1320 and 1330. The large saphenous vein 1000 may be peeled between the portions 1330 and 1340. Then, the large saphenous vein 1000 may be ligated through the incisions 1310 and 1340 and removed from either of the incisions 1310 and 1340. Thus, a longer (predetermined length) large saphenous vein 1000 can be collected regardless of the state of the large saphenous vein.
また、前述した実施形態では、血管バイパス術を行う際のバイパス管を採取する場合について説明したが、採取した血管の用途は、バイパス管に限定されない。
In the above-described embodiment, the case of collecting the bypass tube when performing the blood vessel bypass operation has been described. However, the use of the collected blood vessel is not limited to the bypass tube.
本発明の血管剥離デバイスは、血管に沿って生体内へ挿入され、前記生体内において前記血管から分かれる分岐血管を挟持する一対の挿入デバイスと、前記分岐血管を処理する処理デバイスと、を有し、一方の前記挿入デバイスは、他方の前記挿入デバイスと対向する面に開口し、前記処理デバイスを挿入可能な第1の溝を有することを特徴とする。このような構成によれば、処理デバイスによる分岐血管の処理が容易となる。また、処理デバイスを挿入デバイス内に挿入することができるため、処理デバイスをスムーズに操作することができ、分岐血管の処理がより容易となる。そのため、血管剥離の作業性に優れる血管剥離デバイスとなる。
The blood vessel peeling device of the present invention includes a pair of insertion devices that are inserted into a living body along a blood vessel and sandwich the branched blood vessel that separates from the blood vessel in the living body, and a processing device that processes the branched blood vessel. One of the insertion devices has a first groove that is open on a surface facing the other insertion device and into which the processing device can be inserted. According to such a configuration, the processing of the branch blood vessel by the processing device is facilitated. Further, since the processing device can be inserted into the insertion device, the processing device can be operated smoothly, and the branch blood vessel can be processed more easily. Therefore, the blood vessel peeling device is excellent in blood vessel peeling workability.
したがって、本発明の血管剥離デバイスは、産業上の利用可能性を有している。
Therefore, the blood vessel peeling device of the present invention has industrial applicability.
100 血管剥離デバイス
200 皮膚側剥離デバイス
210 挿入孔
220 剥離部
231 レール
231A ラックギア
232 レール
232A ラックギア
300 筋膜側剥離デバイス
310 第1の剥離デバイス
310a 突き当て面
311 剥離部
312 レール
313 溝
314 切り欠き
315 切り欠き
316 電極
317 電極
318 電極
319 電極
316a 電極片
317a 電極片
320 第2の剥離デバイス
320a 突き当て面
321 剥離部
322 レール
323 溝
323a 案内面
324 切り欠き
325 切り欠き
324A 突起部
325A 突起部
328 電極
329 電極
330 空洞部
334 貫通孔
335 貫通孔
340 電極
350 電極
400 処理デバイス
410 操作部
411 棒状部
412 棒状部
413 接続部
414 板状部
415 板状部
420 電極
430 切断部
440 処理部
441 電極
442 電極
442a 先端部
443 切断部
443a 先端部
450 ローラー電極
460 リード線
500 切断デバイス
520 溝
521 血管案内溝
522 血管処理溝
530 処理部
531 電極
532 電極
531a 先端部
541 保護部
542 保護部
550 刃部
581 接続部
582 接続部
583 接続部
600 切断デバイス
610 本体部
610A 本体部
610B 本体部
611 溝
612 保護部
613 案内部
613a 案内面
614 接続部
615 接続部
616 電極
617 電極
620 切断部
621 刃部
700 切断デバイス
710 本体部
710A 本体部
710B 本体部
711 板状片
711A 板状片
712 板状片
712A 板状片
713 案内部
713A 案内部
713B 案内部
713a 案内面
713Aa 案内面
713Ba 案内面
720 ローラー電極
720A ローラー電極
720B ローラー電極
721 操作部
731 ローラー
731A ローラー
731B ローラー
732 ローラー
732A ローラー
732B ローラー
740 電極
741 刃部
742 操作部
750 誘導部
751 第1のギア部
752 第2のギア部
753 部分
754 部分
754a 爪部
790 駆動部
791 駆動源
792 無端ベルト
900 イメージングデバイス
910 本体部
930 撮像部
1000 大伏在静脈
1100 分岐血管
1101 部分
1102 部分
1200 脂肪
1310 切開部
1320 切開部
1330 切開部
1340 切開部
1400 皮膚
1500 筋膜
S1 空隙
S2 空隙
S3 空隙
W1 幅
W2 幅
W3 全幅
T 厚さ
θ テーパー角 DESCRIPTION OF SYMBOLS 100 Blood vessel peeling device 200 Skin side peeling device 210 Insertion hole 220 Peeling part 231 Rail 231A Rack gear 232 Rail 232A Rack gear 300 Fascia side peeling device 310 First peeling device 310a Butting surface 311 Peeling part 312 Rail 313 Groove 314 Notch 315 Notch 316 Electrode 317 Electrode 318 Electrode 319 Electrode 316a Electrode piece 317a Electrode piece 320 Second peeling device 320a Abutting surface 321 Separating part 322 Rail 323 Groove 323a Guide surface 324 Notch 325A Protruding part 325A Protruding part 325A Protruding part 325A Protruding part 329 Electrode 330 Cavity 334 Through hole 335 Through hole 40 electrode 350 electrode 400 treatment device 410 operation unit 411 rod-like portion 412 rod-like portion 413 connection portion 414 plate-like portion 415 plate-like portion 420 electrode 430 cutting portion 440 treatment portion 441 electrode 442 electrode 442a tip portion 443 cutting portion 443a roller tip portion 443a Electrode 460 Lead wire 500 Cutting device 520 Groove 521 Blood vessel guide groove 522 Blood vessel treatment groove 530 Treatment portion 531 Electrode 532 Electrode 531a Tip portion 541 Protection portion 542 Protection portion 550 Blade portion 581 Connection portion 582 Connection portion 583 Connection portion 600 Cutting device 610 610A body 610B body 611 groove 612 protection 613 guide 613a Guide surface 614 Connection portion 615 Connection portion 616 Electrode 617 Electrode 620 Cutting portion 621 Blade portion 700 Cutting device 710 Body portion 710A Body portion 710B Body portion 711 Plate piece 711A Plate piece 712 Plate piece 712A Plate piece 713 A Guide portion 713 Guide unit 713B Guide unit 713a Guide surface 713Aa Guide surface 713Ba Guide surface 720 Roller electrode 720A Roller electrode 720B Roller electrode 721 Operation unit 731 Roller 731A Roller 731B Roller 732 Roller 732A Roller 732B Roller 732B Roller 732B Roller 732B First gear portion 752 Second gear portion 753 Portion 754 Part 754a Claw part 790 Drive part 791 Drive source 792 Endless belt 900 Imaging device 910 Main body part 930 Imaging part 1000 Great saphenous vein 1100 Branched blood vessel 1101 Part 1102 Part 1200 Fat 1310 Incision part 1320 Incision part 1330 Incision part 1340 Incision part 1340 Incision part 1340 1500 Fascia S1 gap S2 gap S3 gap W1 width W2 width W3 full width T thickness θ taper angle
200 皮膚側剥離デバイス
210 挿入孔
220 剥離部
231 レール
231A ラックギア
232 レール
232A ラックギア
300 筋膜側剥離デバイス
310 第1の剥離デバイス
310a 突き当て面
311 剥離部
312 レール
313 溝
314 切り欠き
315 切り欠き
316 電極
317 電極
318 電極
319 電極
316a 電極片
317a 電極片
320 第2の剥離デバイス
320a 突き当て面
321 剥離部
322 レール
323 溝
323a 案内面
324 切り欠き
325 切り欠き
324A 突起部
325A 突起部
328 電極
329 電極
330 空洞部
334 貫通孔
335 貫通孔
340 電極
350 電極
400 処理デバイス
410 操作部
411 棒状部
412 棒状部
413 接続部
414 板状部
415 板状部
420 電極
430 切断部
440 処理部
441 電極
442 電極
442a 先端部
443 切断部
443a 先端部
450 ローラー電極
460 リード線
500 切断デバイス
520 溝
521 血管案内溝
522 血管処理溝
530 処理部
531 電極
532 電極
531a 先端部
541 保護部
542 保護部
550 刃部
581 接続部
582 接続部
583 接続部
600 切断デバイス
610 本体部
610A 本体部
610B 本体部
611 溝
612 保護部
613 案内部
613a 案内面
614 接続部
615 接続部
616 電極
617 電極
620 切断部
621 刃部
700 切断デバイス
710 本体部
710A 本体部
710B 本体部
711 板状片
711A 板状片
712 板状片
712A 板状片
713 案内部
713A 案内部
713B 案内部
713a 案内面
713Aa 案内面
713Ba 案内面
720 ローラー電極
720A ローラー電極
720B ローラー電極
721 操作部
731 ローラー
731A ローラー
731B ローラー
732 ローラー
732A ローラー
732B ローラー
740 電極
741 刃部
742 操作部
750 誘導部
751 第1のギア部
752 第2のギア部
753 部分
754 部分
754a 爪部
790 駆動部
791 駆動源
792 無端ベルト
900 イメージングデバイス
910 本体部
930 撮像部
1000 大伏在静脈
1100 分岐血管
1101 部分
1102 部分
1200 脂肪
1310 切開部
1320 切開部
1330 切開部
1340 切開部
1400 皮膚
1500 筋膜
S1 空隙
S2 空隙
S3 空隙
W1 幅
W2 幅
W3 全幅
T 厚さ
θ テーパー角 DESCRIPTION OF SYMBOLS 100 Blood vessel peeling device 200 Skin side peeling device 210 Insertion hole 220 Peeling part 231 Rail 231A Rack gear 232 Rail 232A Rack gear 300 Fascia side peeling device 310 First peeling device 310a Butting surface 311 Peeling part 312 Rail 313 Groove 314 Notch 315 Notch 316 Electrode 317 Electrode 318 Electrode 319 Electrode 316a Electrode piece 317a Electrode piece 320 Second peeling device 320a Abutting surface 321 Separating part 322 Rail 323 Groove 323a Guide surface 324 Notch 325A Protruding part 325A Protruding part 325A Protruding part 325A Protruding part 329 Electrode 330 Cavity 334 Through hole 335 Through hole 40 electrode 350 electrode 400 treatment device 410 operation unit 411 rod-like portion 412 rod-like portion 413 connection portion 414 plate-like portion 415 plate-like portion 420 electrode 430 cutting portion 440 treatment portion 441 electrode 442 electrode 442a tip portion 443 cutting portion 443a roller tip portion 443a Electrode 460 Lead wire 500 Cutting device 520 Groove 521 Blood vessel guide groove 522 Blood vessel treatment groove 530 Treatment portion 531 Electrode 532 Electrode 531a Tip portion 541 Protection portion 542 Protection portion 550 Blade portion 581 Connection portion 582 Connection portion 583 Connection portion 600 Cutting device 610 610A body 610B body 611 groove 612 protection 613 guide 613a Guide surface 614 Connection portion 615 Connection portion 616 Electrode 617 Electrode 620 Cutting portion 621 Blade portion 700 Cutting device 710 Body portion 710A Body portion 710B Body portion 711 Plate piece 711A Plate piece 712 Plate piece 712A Plate piece 713 A Guide portion 713 Guide unit 713B Guide unit 713a Guide surface 713Aa Guide surface 713Ba Guide surface 720 Roller electrode 720A Roller electrode 720B Roller electrode 721 Operation unit 731 Roller 731A Roller 731B Roller 732 Roller 732A Roller 732B Roller 732B Roller 732B Roller 732B First gear portion 752 Second gear portion 753 Portion 754 Part 754a Claw part 790 Drive part 791 Drive source 792 Endless belt 900 Imaging device 910 Main body part 930 Imaging part 1000 Great saphenous vein 1100 Branched blood vessel 1101 Part 1102 Part 1200 Fat 1310 Incision part 1320 Incision part 1330 Incision part 1340 Incision part 1340 Incision part 1340 1500 Fascia S1 gap S2 gap S3 gap W1 width W2 width W3 full width T thickness θ taper angle
Claims (9)
- 血管に沿って生体内へ挿入され、前記生体内において前記血管から分かれる分岐血管を挟持する一対の挿入デバイスと、
前記分岐血管を処理する処理デバイスと、を有し、
一方の前記挿入デバイスは、他方の前記挿入デバイスと対向する面に開口し、前記処理デバイスを挿入可能な第1の溝を有することを特徴とする血管剥離デバイス。 A pair of insertion devices inserted into a living body along a blood vessel and sandwiching a branched blood vessel that separates from the blood vessel in the living body;
A treatment device for treating the branched blood vessel,
One said insertion device has the 1st groove | channel which opens in the surface facing the said other insertion device, and can insert the said processing device, The blood vessel peeling device characterized by the above-mentioned. - 前記他方の挿入デバイスは、前記一方の挿入デバイスと対向する面に開口し、前記一方の挿入デバイスとの間に前記分岐血管を挟持したときに前記第1の溝と対向する第2の溝を有する請求項1に記載の血管剥離デバイス。 The other insertion device has an opening in a surface facing the one insertion device, and a second groove facing the first groove when the branch blood vessel is sandwiched between the one insertion device. The blood vessel peeling device according to claim 1.
- 前記第1の溝および前記第2の溝の少なくとも一方は、前記処理デバイスと摺動する摺動面を有する請求項1または2に記載の血管剥離デバイス。 The blood vessel peeling device according to claim 1 or 2, wherein at least one of the first groove and the second groove has a sliding surface that slides with the processing device.
- 前記他方の挿入デバイスは、前記第2の溝を介して対向配置された一対の第1の電極を有し、
前記処理デバイスは、第2の電極と、切断部と、を有する請求項1ないし3のいずれか1項に記載の血管剥離デバイス。 The other insertion device has a pair of first electrodes disposed to face each other via the second groove,
The blood vessel peeling device according to any one of claims 1 to 3, wherein the processing device includes a second electrode and a cutting portion. - 前記処理デバイスは、空隙を介して対向配置された一対の第1の電極と、前記空隙よりも移動方向の後方に位置する第2の電極と、を有する請求項1ないし3のいずれか1項に記載の血管剥離デバイス。 The said processing device has a pair of 1st electrode opposingly arranged through the space | gap, and the 2nd electrode located in the back of a movement direction rather than the said space | gap. The blood vessel peeling device according to 1.
- 前記処理デバイスは、空隙を介して対向配置された第1の電極および第2の電極と、前記空隙よりも移動方向の後方に位置し、前記分岐血管を切断する切断部と、を有する請求項1ないし3のいずれか1項に記載の血管剥離デバイス。 The said processing device has the 1st electrode and 2nd electrode which were opposingly arranged through the space | gap, and the cutting part which is located in the back of the movement direction rather than the said space | gap, and cut | disconnects the said branch blood vessel. The blood vessel peeling device according to any one of 1 to 3.
- 前記処理デバイスは、対向配置された第1の電極および第2の電極と、先端部に配置された切断部と、を有する請求項1ないし3のいずれか1項に記載の血管剥離デバイス。 The blood vessel peeling device according to any one of claims 1 to 3, wherein the processing device includes a first electrode and a second electrode arranged to face each other, and a cutting portion arranged at a distal end portion.
- 前記処理デバイスでは、前記第2の電極は、前記第1の電極を介して対向するように一対設けられ、
前記第1の電極の先端部は、前記第2の電極の先端部から突出して前記切断部を構成する請求項7に記載の血管剥離デバイス。 In the processing device, a pair of the second electrodes are provided so as to face each other via the first electrode,
The blood vessel peeling device according to claim 7, wherein a distal end portion of the first electrode protrudes from a distal end portion of the second electrode to constitute the cutting portion. - 前記一対の挿入デバイスのうちの一方は、前記処理デバイスを兼ねている請求項1に記載の血管剥離デバイス。 The blood vessel peeling device according to claim 1, wherein one of the pair of insertion devices also serves as the processing device.
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US6468275B1 (en) * | 1998-02-06 | 2002-10-22 | Ethicon Endo-Surgery, Inc. | RF bipolar mesentery takedown device including improved bipolar end effector |
WO2007021010A1 (en) * | 2005-08-18 | 2007-02-22 | Olympus Medical Systems Corp. | Bipolar cutter |
JP2008119470A (en) * | 2006-11-08 | 2008-05-29 | Covidien Ag | Insulating boot for electrosurgical forceps |
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US6468275B1 (en) * | 1998-02-06 | 2002-10-22 | Ethicon Endo-Surgery, Inc. | RF bipolar mesentery takedown device including improved bipolar end effector |
WO2007021010A1 (en) * | 2005-08-18 | 2007-02-22 | Olympus Medical Systems Corp. | Bipolar cutter |
JP2008119470A (en) * | 2006-11-08 | 2008-05-29 | Covidien Ag | Insulating boot for electrosurgical forceps |
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