WO2016143793A1 - Instrument de traitement médical et dispositif de traitement médical - Google Patents

Instrument de traitement médical et dispositif de traitement médical Download PDF

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Publication number
WO2016143793A1
WO2016143793A1 PCT/JP2016/057201 JP2016057201W WO2016143793A1 WO 2016143793 A1 WO2016143793 A1 WO 2016143793A1 JP 2016057201 W JP2016057201 W JP 2016057201W WO 2016143793 A1 WO2016143793 A1 WO 2016143793A1
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Prior art keywords
electrode
medical treatment
light guide
side electrode
laser
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PCT/JP2016/057201
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English (en)
Japanese (ja)
Inventor
猛 大平
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国立大学法人九州大学
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Application filed by 国立大学法人九州大学 filed Critical 国立大学法人九州大学
Priority to JP2017505354A priority Critical patent/JP6715522B2/ja
Publication of WO2016143793A1 publication Critical patent/WO2016143793A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • 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
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser

Definitions

  • the present invention is, for example, treatment using laser light in abdominal surgery, thoracic surgery, gynecology, urology, otolaryngology (pharynx, larynx, cervical region) such as colostomy.
  • the present invention relates to a medical treatment tool and a medical treatment device for performing treatment with an electric knife.
  • non-contact high-speed incision can be performed with a laser light micro spot, and incision can be performed while hemostasis is performed.
  • the incision site is burned out with the blade electrode for the electric scalpel, so that the cauterization and hemostasis action at the incision site is excellent.
  • a coelomic surgery is employed.
  • a body cavity endoscope is provided with several through holes in the abdomen, and surgical tools such as forceps and a scalpel and a body cavity mirror are inserted into the through hole, and a body cavity image is displayed. It is a method of treatment while confirming.
  • Such a coelomic surgical operation is less burdensome on the patient and quicker to recover than an open operation in which the abdomen is largely opened as in the past.
  • the present invention provides a medical treatment tool and a medical treatment device that can be used by switching between the function of a laser knife and the function of an electric knife with a simple apparatus configuration. Objective.
  • the present invention is a medical treatment instrument to be inserted into a body, and a light guide that guides laser light that can be cut in a non-contact manner on a treatment target portion of a living body that is a treatment target, and a tip of the light guide, A tip-side electrode disposed at least partially on the laser light irradiation path at a predetermined interval from an emission end that emits the laser light in the light guide path, and movable with respect to the tip-side electrode, the tip
  • the treatment target portion is sandwiched and grasped with a side electrode, and provided with a grasping side electrode that functions as a bipolar electrode by energizing the distal end side electrode, and the grasping side electrode is irradiated from the distal end of the light guide path
  • a non-interference structure that does not interfere with laser light is used.
  • the light guide path can be formed of a tubular light guide tube having a light guide space inside, or a light guide member that allows internal light guide, such as a solid fiber.
  • the non-interference structure refers to a structure that does not interfere with laser light irradiation, such as withdrawing from the laser light irradiation path or having a laser light irradiation space.
  • the function of the laser knife and the function of the electric knife can be switched and used during the treatment with a simple device configuration.
  • a light guide path that guides laser light that can be cut in a non-contact manner on a treatment target portion of a living body that is a treatment target, and a predetermined distance from an emission end that emits the laser light in the light guide path at the tip of the light guide path
  • a gripping side electrode that functions as a bipolar electrode by energizing the tip side electrode
  • the tip side electrode and the gripping side electrode function as a bipolar electrode by sandwiching at least the tip side electrode and the gripping side electrode And can be used as an electric knife.
  • the grip-side electrode has a non-interfering structure that does not interfere with the laser light emitted from the tip of the light guide, so that the laser light guided through the light guide does not interfere with the grip-side electrode, Irradiation to a treatment target location can be used as a laser knife.
  • the tip side electrode is disposed on the laser light irradiation path at a predetermined interval from the emission end of the light guide path at which the laser light is irradiated. Since the laser beam is blocked by the distal electrode, for example, there is no risk that the laser beam will reach the deep part of the living tissue and irradiate to an unintended depth or location even in a surgical operation with a narrow surgical field. Can be operated safely. That is, the tip side electrode can function not only as an electric knife electrode but also as a light shielding plate for shielding laser light.
  • the medical treatment instrument of the present invention functions as an electric knife by the distal electrode and the grip electrode and also functions as a laser knife by irradiating laser light. Can be used by switching between the function of the electric knife and the function of the electric knife.
  • the medical treatment tool of the present invention grips a tissue that leads to massive bleeding by incision such as an artery or a vein, a lymph vessel that is concerned about leakage of lymph fluid, etc. with the distal electrode and the grip electrode, and compresses the tissue.
  • the incision operation can be completed as a laser knife while simultaneously performing electrocoagulation with the function of the electric knife while creating a physical blood-feeding state.
  • the distal electrode can function as a monopolar electrode by energizing a counter electrode plate that is in contact with a living body to be treated.
  • the tip side electrode not only functions as a bipolar electrode by gripping with the gripping side electrode, but also functions as a monopolar electrode and can constitute an electric knife, so that the treatment status, treatment location, etc. It is possible to perform treatment as a current-carrying type electric scalpel suitable for the above, and more appropriate treatment can be performed.
  • the gripping-side electrode can be provided with a retracting mechanism that retracts from the irradiation path when the laser beam is irradiated.
  • the retraction mechanism can be configured to retreat from the laser path by, for example, a pivot mechanism when irradiating laser light to function as a laser knife. According to the present invention, it is possible to reliably irradiate the affected area with laser light.
  • the light guide path can be configured by a hollow hollow light guide path having a light guide space that allows laser light to be guided therein. According to the present invention, since light can be guided efficiently, it can function as a laser knife having high output energy.
  • the present invention also provides a light guide that guides laser light that can be cut in a non-contact manner on a treatment target portion of a living body that is a treatment target, and an emission end that emits the laser light in the light guide at the tip of the light guide
  • a distal end electrode disposed at least partially on the laser light irradiation path at a predetermined interval from the distal end, and movable relative to the distal end electrode, and sandwiching the treatment target portion with the distal end side electrode
  • a gripping side electrode that functions as a bipolar electrode by energizing the tip side electrode, and the gripping side electrode has a non-interfering structure that does not interfere with the laser light emitted from the tip of the light guide path
  • a medical treatment instrument inserted into the body, a laser oscillator for generating the laser beam, a high-frequency oscillator for generating a high-frequency current, and at least the laser oscillator and the high-frequency oscillator.
  • An apparatus main body having a control unit to be controlled inside, a light guide cable for guiding the laser light generated by the laser oscillator to the light guide, and the high-frequency current oscillated by the high-frequency oscillator, the tip-side electrode and the
  • the medical treatment apparatus includes a conductive cable that is conductively connected to the grasping electrode and includes a connection cable that connects the apparatus main body and the medical treatment tool.
  • the function of the laser knife and the function of the electric knife can be switched and used during the treatment with a simple device configuration.
  • a light guide path that guides laser light that can be cut in a non-contact manner on a treatment target portion of a living body that is a treatment target, and a predetermined distance from an emission end that emits the laser light in the light guide path at the tip of the light guide path
  • a gripping side electrode that functions as a bipolar electrode by energizing the tip side electrode
  • the tip side electrode and the gripping side electrode function as a bipolar electrode by sandwiching at least the tip side electrode and the gripping side electrode And can be used as an electric knife.
  • the grip-side electrode has a non-interfering structure that does not interfere with the laser light emitted from the tip of the light guide, so that the laser light guided through the light guide does not interfere with the grip-side electrode, Irradiation to a treatment target location can be used as a laser knife, and the tip side electrode can also function as a light shielding plate that shields the irradiated laser light.
  • the medical treatment instrument of the present invention functions as an electric knife by the distal electrode and the grip electrode and also functions as a laser knife by irradiating laser light. Can be used by switching between the function of the electric knife and the function of the electric knife.
  • the counter electrode plate can be provided which is brought into contact with a living body to be treated and energizes the tip side electrode to cause the tip side electrode to function as a monopolar electrode.
  • the tip side electrode not only functions as a bipolar electrode by gripping with the gripping side electrode, but also functions as a monopolar electrode and can constitute an electric knife, so that the treatment status, treatment location, etc. It is possible to perform treatment as a current-carrying type electric scalpel suitable for the above, and more appropriate treatment can be performed.
  • control unit is switched between a bipolar circuit for energizing the tip side electrode and the grip electrode and a monopolar circuit for energizing the tip side electrode and the counter electrode plate, and the bipolar circuit and the monopolar
  • An energization switching unit that energizes the high-frequency current may be provided in one of the circuits. Thereby, it can function as an electric knife in an energization form suitable for the treatment situation.
  • control unit may include an operation switching unit that switches between the laser oscillator and the high-frequency oscillator and operates one of the laser oscillator and the high-frequency oscillator. According to the present invention, since the electric knife and the laser knife are selectively switched and operated, it is possible to prevent both from operating and performing an unintended treatment.
  • the gripping-side electrode can be provided with a retracting mechanism that retracts from the irradiation path when the laser beam is irradiated. According to the present invention, it is possible to reliably irradiate the affected area with laser light.
  • the light guide path can be configured by a hollow hollow light guide path having a light guide space that allows laser light to be guided therein. According to the present invention, since light can be guided efficiently, it can function as a laser knife having high output energy.
  • the present invention is a medical treatment instrument to be inserted into the body, in a light guide that guides a laser beam that can be cut in a non-contact manner as a treatment target, and a distal end of the light guide.
  • a gripping side electrode that rotates about a fulcrum provided in the light guide path and can grip the treatment target portion with the tip side electrode, and the grip side electrode is connected to the tip end of the light guide path.
  • a non-interference structure that does not interfere with the laser light emitted from the laser beam is provided.
  • the present invention is a medical treatment instrument that is inserted into the body, and a light guide that guides laser light that can be cut in a non-contact manner as a treatment target, and a distal end of the light guide.
  • a tip-side electrode disposed at least partially on the laser light irradiation path at a predetermined interval from an emission end that emits the laser light in the light guide path, and movable with respect to the tip-side electrode, the tip
  • the treatment target portion is sandwiched and grasped by a side electrode, and provided with a grasping side electrode that functions as a bipolar electrode by energizing the distal end side electrode, and the grasping side electrode has a pivot shaft. It pivots as an axis and sandwiches the treatment object portion with the tip side electrode, and the grip side electrode has a non-interfering structure that does not interfere with the laser light emitted from the tip of the light guide path.
  • the present invention also provides a light guide that guides a laser beam that can be cut in a non-contact manner as a treatment target, and a predetermined distance from an emission end that emits the laser light in the light guide at the tip of the light guide. At least a portion of the tip side electrode disposed on the laser light irradiation path, and the tip side electrode is energized to function as a bipolar electrode while being spaced from each other.
  • a gripping side electrode that can be gripped by sandwiching the treatment target portion with the tip side electrode, and the gripping side electrode has a non-interference structure that does not interfere with the laser light emitted from the tip of the light guide path.
  • a medical treatment instrument inserted into the body, a laser oscillator that generates the laser light, a high-frequency oscillator that oscillates a high-frequency current, and controls at least the laser oscillator and the high-frequency oscillator
  • An apparatus main body provided with a control unit therein, a light guide cable for guiding the laser light generated by the laser oscillator to the light guide, and the high-frequency current oscillated by the high-frequency oscillator for the tip side electrode and the grip side
  • the medical treatment apparatus includes a light guide cable that is conductively connected to an electrode and includes a connection cable that connects the apparatus main body and the medical treatment tool.
  • the function of the laser knife and the function of the electric knife can be switched and used during the treatment with a simple device configuration, and the affected part can be coagulated or incised while being gripped.
  • the metal cover provided at the tip of the laser probe functions as the blade electrode of the electric knife, but this metal cover is in front of the laser emission port.
  • Japanese Patent Application Laid-Open No. 2015-16035 discloses a medical treatment tool that can be used by switching between the function of a laser knife and the function of an electric knife during a treatment with a simple device configuration, in order to solve the problem that the incision function by the laser is impaired. Has been proposed.
  • a bipolar electrode and a blade electrode are arranged at a predetermined interval from an emission port of a hollow laser probe that guides a carbon dioxide laser that cuts through an affected area.
  • the bipolar electrode is configured to be movable, and the affected part can be sandwiched between the plate electrode and the bipolar electrode to conduct electricity and function as an electric knife.
  • the bipolar electrode in order to energize the bipolar electrode and the plate electrode, the bipolar electrode is moved to the plate electrode side, and the affected part is sandwiched between the bipolar electrode and the plate electrode, that is, the affected part is viewed from both sides by two parallel electrode surfaces. Because of the structure to hold down, it was not possible to coagulate or incise while grasping the affected area.
  • the medical treatment tool and the medical treatment device of the present invention can be used by switching between the function of the laser knife and the function of the electric knife during the operation with a simple device configuration, and grip the affected part. It can coagulate and incision.
  • the grasping side electrode can rotate around the fulcrum and sandwich the treatment object portion with the distal end side electrode and can perform grasping and sealing simultaneously.
  • the grasping side electrode rotates about the fulcrum and can be operated with forceps while sealing the treatment target portion with the distal end side electrode interposed therebetween.
  • the grasping side electrode can be rotated around the fulcrum and can be grasped, sealed, and incised by sandwiching the treatment target portion with the distal end side electrode.
  • the force for sandwiching the treatment target portion between the distal end side electrode and the grasping side electrode can be sealed as a force that is five times or more of the applied force.
  • the distal electrode can function as a monopolar electrode by energizing a counter electrode in contact with a living body that is a treatment target.
  • the tip side electrode not only functions as a bipolar electrode by gripping with the gripping side electrode, but also functions as a monopolar electrode and can constitute an electric knife, so that the treatment status, treatment location, etc. It is possible to perform treatment as a current-carrying type electric scalpel suitable for the above, and more appropriate treatment can be performed.
  • the gripping-side electrode can be provided with a retracting mechanism that retracts from the irradiation path when the laser beam is irradiated.
  • the retraction mechanism can be configured to retreat from the laser path by, for example, a pivot mechanism when irradiating laser light to function as a laser knife. According to the present invention, it is possible to reliably irradiate the affected area with laser light.
  • the light guide path can be configured by a hollow hollow light guide path having a light guide space that allows laser light to be guided therein. According to the present invention, since light can be guided efficiently, it can function as a laser knife having high output energy.
  • control unit is switched between a bipolar circuit for energizing the distal electrode and the grasping electrode and a monopolar circuit for energizing the distal electrode and the counter electrode,
  • An energization switching unit that energizes the high-frequency current may be provided in one of the bipolar circuit and the monopolar circuit. Thereby, it can function as an electric knife in an energization form suitable for the treatment situation.
  • control unit may include an operation switching unit that switches between the laser oscillator and the high-frequency oscillator and operates one of the laser oscillator and the high-frequency oscillator.
  • the present invention it is possible to provide a medical treatment tool and a medical treatment device that can be used by switching the functions of a laser knife and an electric knife with a simple device configuration. As a result, the burden on the patient is reduced as compared with the prior art, and safer treatment can be performed.
  • Explanatory drawing about a medical treatment tool The perspective view of a medical treatment apparatus. Explanatory drawing of a hollow light guide. The schematic of the use condition of a medical treatment device. Schematic explaining the use condition of a medical treatment tool.
  • FIG. 1 is an explanatory view of the medical treatment instrument 10. Specifically, FIG. 1 (a) shows a front view of the medical treatment instrument 10, FIG. 1 (b) shows an enlarged view taken along arrow AA in FIG. 1 (a), and FIG. 1 (c) will be described later.
  • FIG. 1D is an enlarged view of a portion near the probe tip 12b in the medical treatment instrument 10 in the gripping state of the gripping electrode 14, and FIG. The enlarged view of a part is shown.
  • FIG. 2 is a perspective view of the medical treatment apparatus 1
  • FIG. 3 is an explanatory view of the hollow light guide 300
  • FIG. 4 is a schematic view of a use state of the medical treatment apparatus 1
  • FIG. The schematic diagram explaining the usage condition of the treatment tool 10 is shown. Note that FIG. 3 illustrates a state in which a part of the hollow light guide 300 in the circumferential direction is transmitted in order to facilitate understanding of the layer configuration of the hollow light guide 300.
  • the medical treatment device 1 is a device having both the function of a laser knife and the function of an electric knife, a laser oscillator 1a that is a laser light source that generates carbon dioxide laser light L, and a high-frequency oscillator that oscillates a high-frequency current for the electric knife. 1b, a gas supply device 1c for supplying carbon dioxide through a connection cable 60, an exhaust gas inhaler 1d for inhaling smoke generated in a body cavity through an exhaust duct (not shown), and an apparatus main body 2 having a control unit 7 therein.
  • a medical treatment instrument 10 that functions as a laser knife and an electric knife, a connection cable 60 that connects the apparatus main body 2 and the medical treatment instrument 10, and a foot pedal that operates the oscillation of the carbon dioxide laser beam L in the laser oscillator 1a. 8 (see FIGS. 2 and 4).
  • the apparatus main body 2 is a rectangular parallelepiped casing that is long in the depth direction and the vertical direction, and includes the laser oscillator 1a, the high-frequency oscillator 1b, the gas supply device 1c, the exhaust gas suction device 1d, and the control unit 7 therein.
  • the operation panel 4 that is inclined is provided on the front side of the upper surface 2a, and the foot pedal 8 that is connected via a cable is provided on the lower part.
  • a foot pedal 8, an operation panel 4, a laser oscillator 1a, a high frequency oscillator 1b, a gas supply device 1c, and an exhaust gas suction device 1d are connected to the control unit 7, and these are controlled by the control unit 7.
  • control unit 7 forms a current-carrying circuit with the counter electrode plate 42 attached to the patient M and the blade electrode 13a so that the blade electrode 13a functions as an electrode of a monopolar electric knife, and the blade tip 13 and the grasping electrode 14 to function as a circuit switching unit for switching an energization circuit in order to switch between the case where the affected part P is sandwiched between and 14 to function as a bipolar electric knife.
  • control unit 7 also functions as an operation switching unit that switches which of the laser oscillator 1a and the high-frequency oscillator 1b is operated.
  • the operation instructions for the control unit 7 to function as a circuit switching unit and an operation switching unit are configured such that each switch (not shown) is provided on the operation panel 4 and can be switched by the switch provided on the operation panel 4. is doing.
  • the gas supply device 1c since the gas supply device 1c has high bioabsorbability, even if it is supplied into the body cavity, it is quickly absorbed after the operation, and carbon dioxide with low patient burden and low invasiveness is introduced into the light guide space.
  • the gas is supplied as gas flowing into 300a, but may be air, nitrogen, inert gas, or gas obtained by containing carbon dioxide in these gases.
  • a caster 3 is provided at the lower part of the apparatus main body 2, and a handle 5 provided on the front side of the operation panel 4 can be gripped to easily move to a desired position and be fixed in position. Further, a holder 6 that holds the medical treatment instrument 10 is provided on the side of the operation panel 4.
  • connection cable 60 whose base end portion projects vertically upward from the rear side of the upper surface 2a of the apparatus main body 2 is constituted by a light guide cable 61, a conductive cable 62, a gas supply cable 63, and an exhaust gas suction cable 64 collectively. (See FIG. 4).
  • the light guide cable 61 is connected to the laser oscillator 1 a inside the apparatus body 2, and can guide the carbon dioxide laser light L oscillated by the laser oscillator 1 a to the medical treatment instrument 10 attached to the tip of the connection cable 60.
  • the conductive cable 62 is connected to the high frequency oscillator 1b inside the apparatus main body 2 and can conduct the high frequency current oscillated by the high frequency oscillator 1b to the blade tip tip 13 and the grasping electrode 14 of the medical treatment instrument 10.
  • the gas supply cable 63 is connected to the gas supply device 1 c inside the apparatus main body 2, and can conduct carbon dioxide supplied by the gas supply device 1 c to the probe tip 12 b through the laser probe 12.
  • the exhaust gas suction cable 64 is connected to the exhaust gas inhaler 1d inside the apparatus main body 2, and can conduct smoke sucked through an exhaust duct (not shown) in the medical treatment instrument 10 to the exhaust gas inhaler 1d. .
  • connection cable 60 is supported by a support pole 2 b provided in the vertical direction on the upper surface 2 a of the apparatus main body 2.
  • the counter electrode coated wire 41 (FIG. 4) having the counter electrode 42 (FIG. 4) connected to the tip is also connected to the high frequency oscillator 1 b of the medical treatment apparatus 1. .
  • the medical treatment instrument 10 connected to the distal end of the connection cable 60 includes a grip 11 held by an operator, a laser probe 12, a blade distal tip 13 disposed on the distal end side of the laser probe 12, and a grasping electrode 14. (See FIG. 1).
  • the grip 11 is made of a resin formed in a grip shape that is easy for the practitioner to hold, and the lower end of the rear end side (the right side in FIG. 1A), that is, the base of the grip 11 on the apparatus main body 2 side.
  • the hollow light guide 300 that constitutes the laser probe 12 and the connection cable 60 are connected by the connection connector 15 disposed at the position.
  • the grip 11 is provided with a trigger 16 that functions as a switch for switching ON / OFF of energization to the blade tip tip 13 in order to use the blade tip tip 13 as an electric knife.
  • 13 may be used as a switch for switching on / off of energization to 13 and pivoting the gripping electrode 14 described later by the trigger 16 with respect to the support arm 13b.
  • the laser probe 12 is configured by a hollow light guide 300, and a part of the length direction is inserted through the grip 11, and the straight pipe portion outer peripheral surface of the hollow light guide 300 not inserted is made of resin. It is configured by covering with an insulating coating 12a. As described above, the laser probe 12 has a part of the length direction penetrating the inside of the grip 11 and the connection cable 60 via the connection connector 15 arranged on the rear end side of the grip 11 as described above. Communicated with.
  • the blade tip 13 includes a blade electrode 13a disposed at a predetermined interval in the irradiation direction of the carbon dioxide laser beam L emitted from the tip of the laser probe 12, and a support arm 13b that supports the blade electrode 13a at the predetermined position. It consists of and.
  • the blade electrode 13a and the support arm 13b are made of a conductive metal material.
  • the blade electrode 13a is a disk-shaped blade inclined forward in the direction of arrows AA, and the center of the blade electrode 13a is substantially coincident with the center of the laser probe 12. It is arranged to do. Further, as shown in FIG. 1B, a reflection unevenness 13c is formed on the surface on the side irradiated with the carbon dioxide laser beam L to reflect and reflect the irradiated carbon dioxide laser beam L. Although not shown in detail, the reflection unevenness 13c is formed in a substantially square frustum shape smaller than the spot of the irradiated carbon dioxide laser beam L, and a plurality of the reflection unevenness 13c are arranged in parallel.
  • the support arm 13b has a base end connected to and fixed to the distal end of the hollow light guide 300, that is, the probe distal end 12b, and extends forward in parallel to the laser light irradiation direction. 13a is supported in a forward inclined state.
  • the blade tip 13 configured in this manner is connected to a high-frequency oscillator 1b described later in a conductive manner, and is brought into contact with a treatment target location to form a current-carrying circuit with a counter electrode plate 42 described later as a monopolar electrode.
  • An energization circuit can be configured by functioning or grasping the affected part P with the grasping electrode 14 described later, and can function as a bipolar electrode.
  • the blade electrode 13a is disposed in front of the probe tip 12b of the laser probe 12, and can function as a shielding member for laser light emitted forward from the laser probe 12.
  • the gripping electrode 14 has a substantially semicircular cross section with a flat bottom surface and is shorter than the support arm 13b.
  • the proximal end of the gripping electrode 14 is a pivot shaft 14a with respect to the probe tip 12b, which is the tip of the laser probe 12. It is mounted so that it can pivot.
  • the gripping electrode 14 is connected to a high-frequency oscillator 1b, which will be described later, via a connection cable 60 so as to be conductive, and forms a current-carrying circuit by gripping the affected part P with the blade tip 13 to form a bipolar electrode. Can function. Further, in the normal state, the gripping electrode 14 can function as a bipolar electrode in a closed state as shown in FIG. 1C, with the retracted position as shown in FIG. 1D as an initial position. .
  • connection cable 60 protruding in the vertical direction from the upper surface 2a of the apparatus main body 2 is a cable having a predetermined length and flexibility, and is a hollow or solid light capable of transmitting the carbon dioxide laser light L. It consists of a fiber and a protective tube that covers it.
  • the hollow light guide 300 constituting the laser probe 12 will be described.
  • the hollow light guide 300 includes a stainless steel tube 310 serving as a base material, a conductive metal layer 320 and a dielectric disposed in order from the radially outer side to the radially inner side on the inner surface of the stainless steel tube 310.
  • the body thin film 330 is used.
  • the light guide space 300a is comprised in the hollow inside.
  • the conductive metal layer 320 formed on the inner surface of the stainless steel tube 310 is preferably gold, silver or copper. These metal materials are materials having higher conductivity than stainless steel and high reflectivity with respect to the carbon dioxide laser beam L. Such a conductive metal layer 320 can be formed on the inner surface of the stainless steel tube 310 by plating or rolling.
  • the dielectric thin film 330 formed on the inner surface of the conductive metal layer 320 is a dielectric material having an appropriate film thickness for efficiently reflecting and transmitting the carbon dioxide laser beam L in the hollow light guide tube 300.
  • the dielectric thin film 330 is made of a cyclic olefin polymer. It is a thin film.
  • the hollow light guide 300 configured as described above has high electrical conductivity due to the stainless steel tube 310 and the conductive metal layer 320, and can improve the transmission efficiency of the carbon dioxide laser light L that guides the light guide space 300a. .
  • the medical treatment apparatus 1 configured in this way is first provided with a counter electrode plate attached to the distal end of the counter electrode covered electric wire 41 connected to the high frequency oscillator 1 b to the patient M to be treated. 42 is attached. Further, the connection cable 60 connected to the high-frequency oscillator 1 b is connected to the connection connector 15 of the medical treatment instrument 10.
  • a high-frequency current is applied by the high-frequency oscillator 1b and the blade electrode 13a of the medical treatment instrument 10 is brought into contact with the treatment site of the patient M, thereby supporting the high-frequency oscillator 1b, the connection cable 60, the connection connector 15, and the support.
  • the arm 13b, the blade electrode 13a, the patient M, the counter electrode plate 42, and the counter electrode plate-covered electric wire 41 constitute an energization circuit.
  • the blade electrode 13a that contacts the patient M is incised or cauterized.
  • a monopolar electric knife can be configured.
  • the affected part P of the patient M is sandwiched and held by the blade tip 13 and the grasping electrode 14, and a high-frequency current is applied by the high-frequency oscillator 1b, the high-frequency oscillator 1b, the connection cable 60, the connection connector 15, the blade tip 13 and the patient M, and the grasping electrode 14 constitute an energization circuit, and the circuit is energized by a high-frequency current and is sandwiched between the blade tip 13 and the grasping electrode 14
  • a bipolar electric scalpel that incises or cauterizes hemostasis can be constructed.
  • the carbon dioxide laser light L output from the laser oscillator 1 a is hollow to form the laser probe 12 via the connection cable 60.
  • the light guide space 300a of the light guide path 300 is guided, and the carbon dioxide laser light L (see the enlarged view (a) in FIG. 5c) is irradiated forward from the probe tip 12b of the laser probe 12 to function as a laser knife. .
  • the blade electrode 13a of the blade tip 13 is disposed in front of the laser probe 12 in the irradiation direction and on the optical axis of the laser beam, the irradiated carbon dioxide laser beam L is blocked by the blade electrode 13a. In this case, no irradiation is performed ahead of the blade electrode 13a.
  • the gripping electrode 14 since the gripping electrode 14 has a retracted position as shown in FIG. 1D in the normal state as an initial position, the irradiation path of the carbon dioxide laser beam L irradiated from the probe tip 12b of the laser probe 12 is hindered. Without doing so, the carbon dioxide laser beam L can be irradiated forward.
  • FIG. 5 is a schematic view of a coelomic surgery using the medical treatment apparatus 1.
  • the counter electrode plate 42 is attached to the back of the patient M to establish conduction with the living body, and the connection cable 60 is connected to the connection connector 15 of the medical treatment instrument 10 so that the treatment can be performed by the medical treatment apparatus 1.
  • a hole for inserting the medical treatment tool 10 and the body cavity endoscope 100 is opened in the body cavity endoscope, and the cylindrical trocar 110 is inserted.
  • the body cavity mirror 100 is inserted into one trocar 110, and the medical treatment instrument 10 is inserted into the other trocar 110. Then, while confirming the image displayed on the monitor 101 connected to the body cavity mirror 100, a high-frequency current is applied to the periphery of the affected part P to be incised by the high-frequency oscillator 1b, so that the blade electrode 13a is connected to the monopolar electric knife. The blade electrode 13a is inserted into the lower part of the living tissue of the affected part P.
  • the counter electrode plate 42 is not attached to the patient M, or the energization circuit is switched, and a high frequency current is energized by the high frequency oscillator 1b, and the blade tip 13 and the grasping electrode 14 function as a bipolar electric scalpel, and the incision is performed. Then, the blade electrode 13a is inserted into the lower part of the living tissue of the affected part P.
  • the laser oscillator 1a oscillates the carbon dioxide laser light L and propagates the carbon dioxide laser light L into the light guiding space 300a, so that the laser probe 12 is shown in FIG.
  • the carbon dioxide laser beam L is irradiated from the tip of the laser beam to incise the periphery of the affected part P interposed between the laser probe 12 and the blade electrode 13a, and the affected part P is excised.
  • the affected part P may be sandwiched between the blade tip 13 and the grasping electrode 14 and excised.
  • the affected part P can be incised with cauterization and hemostasis.
  • the medical treatment instrument 10 inserted into the body is supplied with the laser probe 12 that guides the carbon dioxide laser beam L that can cut the affected part P of the patient M to be treated without contact, and the carbon dioxide laser beam L.
  • a blade tip 13 disposed on the irradiation path of the carbon dioxide laser light L at a predetermined interval from the probe tip 12b to be irradiated, and movable with respect to the blade tip 13 to sandwich the affected part P with the blade tip 13.
  • the blade tip chip 13 is provided with a gripping electrode 14 that is energized to function as a bipolar electrode, so that the gripping electrode 14 does not interfere with the carbon dioxide laser light L emitted from the probe tip 12b.
  • the initial position is the retracted position shown in Fig. 2). Switching and can be used.
  • the laser probe 12 that guides the carbon dioxide laser beam L that can cut the affected part P of the patient M in a non-contact manner, and the probe tip 12b at a predetermined interval from the probe tip 12b that irradiates the carbon dioxide laser beam L in the laser probe 12.
  • the blade tip tip 13 disposed on the irradiation path of the carbon dioxide laser light L and the blade tip tip 13 are movable, and the affected part P is sandwiched and held between the blade tip tip 13 and the blade tip tip 13.
  • the gripping electrode 14 that functions as a bipolar electrode is provided, so that at least the blade tip tip 13 and the gripping electrode 14 sandwich the blade tip tip 13 and the gripping electrode 14 to function as bipolar electrodes. Can be used as a knife.
  • the gripping electrode 14 has a non-interfering structure that does not interfere with the carbon dioxide laser light L emitted from the probe tip 12b, the carbon dioxide laser light L that guides the laser probe 12 does not interfere with the gripping electrode 14. By irradiating the affected part P of the patient M, it can be used as a laser knife.
  • the medical treatment instrument 10 functions as an electric knife by the blade tip 13 and the gripping electrode 14 and also functions as a laser knife by irradiating the carbon dioxide laser light L.
  • the function of the laser knife and the function of the electric knife can be switched and used.
  • the blade tip 13 functions as an electric knife and also functions as a laser light shielding plate that shields the irradiated carbon dioxide laser beam L. Therefore, a part of the serosa covering the surface of the body cavity in the living body is electrically opened as an electric knife, and the medical treatment instrument 10 is shielded from laser light by intruding into the lower part thereof.
  • the blade tip 13 functioning as a plate can be used as a backing guide plate directly under the serosa to make a high-speed continuous incision with the carbon dioxide laser beam L while maintaining only the film thickness. This means that it has a function of incising and opening the serosa on the surface of all the organs existing in the body cavity in a short time, and enables rapid exposure and extraction of the organ that has been subjected to extracorporeal extraction.
  • the blade tip 13 is energized with the counter electrode 42 that is in contact with the patient M to be treated and functions as a monopolar electrode, the blade tip 13 and the grasping electrode 14 grasp the affected part P and the bipolar electrode
  • an electric scalpel that functions as a monopolar electrode can be configured, it can be operated as a current-carrying type electric scalpel suitable for the treatment status, treatment location, etc., and more appropriate treatment It can be performed.
  • the grasping electrode 14 pivots about the pivot shaft 14a so as to retract from the irradiation path when the carbon dioxide laser beam L is irradiated, the carbon dioxide laser beam L is surely irradiated to the affected part. Can do.
  • the laser probe 12 is configured by the hollow hollow light guide 300 having a light guide space that allows the light guide of the carbon dioxide laser light L inside, the laser probe 12 can efficiently guide light and function as a laser knife having high output energy. Can do.
  • it can be used in a method suitable for the operation content, such as making an incision efficiently with the function of the laser knife and suppressing the incision width to a minute and stopping the bleeding site over a wide area with the function of the electric knife.
  • the blade electrode 13a is arranged on the irradiation path of the carbon dioxide laser beam L, the carbon dioxide laser beam L is blocked by the blade electrode 13a. There is no possibility that the gas laser beam L reaches the deep part of the living tissue and is irradiated to an unintended depth or location, and the treatment can be performed safely.
  • the blade electrode 13a can function not only as an electric knife electrode but also as a light shielding plate for shielding laser light.
  • the hollow light guide 300 is constituted by a stainless steel tube 310 and a conductive metal layer 320 having higher conductivity than stainless steel covering its inner peripheral surface.
  • the conductive metal layer 320 is reflected from the inner wall of the hollow light guide 300. Since it also acts to increase the rate, it is possible to improve the light guide performance of the hollow light guide 300 that guides the carbon dioxide laser light L inside.
  • carbon dioxide laser light L is used as the laser light for guiding the inside of the hollow light guide 300, and the carbon dioxide laser light L has a small divergence angle and high energy density, so it is more efficient and has a narrow incision width. It can be performed. Further, since the laser beam absorbability by water is high and does not penetrate deeply into the living tissue, there is little influence on the normal tissue and the post-operative patient burden can be further reduced.
  • the carbon dioxide laser light L is guided to the light guide space 300a of the hollow light guide 300 constituting the laser probe 12.
  • a predetermined gas flows at a predetermined flow rate. You may let them.
  • a tube for introducing a gas is separately inserted into the connection cable 60 to connect the flexible optical fiber in the connection cable 60 and the laser probe 12.
  • a gap for introducing gas is provided in 15, and gas flows into the light guide space 300 a of the hollow light guide 300.
  • gas flowing into the light guide space 300a carbon dioxide, air, nitrogen, an inert gas, or a gas containing carbon dioxide in these gases is preferable. Since carbon dioxide is highly bioabsorbable, carbon dioxide supplied into the body cavity is absorbed quickly after the operation, so the burden on the patient is low and the degree of invasiveness is low.
  • the treatment target part of this invention corresponds to the affected part P
  • the laser beam corresponds to the carbon dioxide laser beam L
  • the light guide corresponds to the laser probe 12
  • the emission end corresponds to the probe tip 12b
  • the tip side electrode corresponds to the blade tip 13
  • the gripping side electrode corresponds to the gripping electrode 14
  • the living body corresponds to the patient M
  • the retraction mechanism corresponds to the pivot mechanism
  • the energization switching unit corresponds to the control unit 7 functioning as an energization switching unit
  • the operation switching unit corresponds to the control unit 7 functioning as the operation switching unit
  • the conductive line corresponds to the connection cable 60 and the coated electrode 41 for the counter electrode
  • the gripping electrode 14 is configured by an electrode having a substantially semicircular cross section with a flat bottom surface and shorter than the support arm 13b, and the probe tip 12b, which is the tip of the laser probe 12, has a base.
  • the end portion is configured to be pivotable by the pivot shaft 14a, and in the normal state, the retracted position as shown in FIG.
  • a groove allowing the passage of the irradiated carbon dioxide laser beam L is formed on the bottom surface in a substantially semicircular cross section having a flat bottom surface, which is in a closed state as shown in FIG.
  • it may be configured not to interfere with the irradiation of the carbon dioxide laser beam L.
  • the laser probe 12 is inserted into a conductive tubular member, the laser probe 12 and the tubular member are insulated from each other, and the blade tip 13 and the gripping electrode 14 are connected to the distal end of the tubular member.
  • the configuration of the laser knife and the configuration of the electric knife may be separated. In this case, among the constituent elements of the connection cable 60, the light guide cable 61 and the conductive cable are separated, the light guide cable 61 is connected to the laser probe 12, and the conductive cable 62 is connected to the tubular member. .

Abstract

L'invention concerne un instrument de traitement médical et un dispositif de traitement médical présentant une configuration de dispositif simple et qui peut être utilisé par la commutation des fonctions entre un scalpel au laser et un scalpel électrochirurgical. La présente invention est pourvue : d'une sonde laser (12) pour guider un faisceau laser (L) de dioxyde de carbone gazeux à travers un instrument de traitement médical à introduire dans un corps, le faisceau laser (L) de dioxyde de carbone gazeux pouvant inciser d'une manière sans contact une partie affectée (P) d'un patient (M) à traiter ; d'une puce (13) de pointe de lame disposée sur le trajet d'irradiation du faisceau laser (L) de dioxyde de carbone gazeux à un intervalle prédéterminé à partir d'une pointe de sonde (12b) pour irradier le faisceau laser (L) de dioxyde de carbone gazeux ; et d'une électrode de préhension (14) pour prendre en sandwich et saisir la partie affectée (P) contre la puce (13) de pointe de lame et qui est excitée par la puce (13) de pointe de lame pour fonctionner comme une électrode bipolaire, l'électrode de préhension (14) pouvant se déplacer par rapport à la puce (13) de pointe de lame, la position rétractée étant la position initiale de sorte que l'électrode de préhension (14) n'interfère pas avec la lumière laser (L) de dioxyde de carbone gazeux irradiée à partir de la pointe de sonde (12b), comme montré dans la figure 1(d).
PCT/JP2016/057201 2015-03-09 2016-03-08 Instrument de traitement médical et dispositif de traitement médical WO2016143793A1 (fr)

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2021033322A1 (fr) * 2019-08-22 2021-02-25 オリンパス株式会社 Outil de traitement et système de traitement

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5441498A (en) * 1994-02-16 1995-08-15 Envision Surgical Systems, Inc. Method of using a multimodality probe with extendable bipolar electrodes
JP2015016035A (ja) * 2013-07-09 2015-01-29 株式会社モリタ製作所 医療用処置具及び医療用処置装置

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5441498A (en) * 1994-02-16 1995-08-15 Envision Surgical Systems, Inc. Method of using a multimodality probe with extendable bipolar electrodes
JP2015016035A (ja) * 2013-07-09 2015-01-29 株式会社モリタ製作所 医療用処置具及び医療用処置装置

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2021033322A1 (fr) * 2019-08-22 2021-02-25 オリンパス株式会社 Outil de traitement et système de traitement

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