WO2018220736A1 - Instrument de traitement - Google Patents

Instrument de traitement Download PDF

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Publication number
WO2018220736A1
WO2018220736A1 PCT/JP2017/020210 JP2017020210W WO2018220736A1 WO 2018220736 A1 WO2018220736 A1 WO 2018220736A1 JP 2017020210 W JP2017020210 W JP 2017020210W WO 2018220736 A1 WO2018220736 A1 WO 2018220736A1
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WO
WIPO (PCT)
Prior art keywords
region
gripping
gripping surface
width direction
jaw
Prior art date
Application number
PCT/JP2017/020210
Other languages
English (en)
Japanese (ja)
Inventor
尚英 鶴田
Original Assignee
オリンパス株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by オリンパス株式会社 filed Critical オリンパス株式会社
Priority to PCT/JP2017/020210 priority Critical patent/WO2018220736A1/fr
Publication of WO2018220736A1 publication Critical patent/WO2018220736A1/fr

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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
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/295—Forceps for use in minimally invasive surgery combined with cutting implements
    • 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
    • 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
    • A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
    • 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 relates to a treatment instrument.
  • Patent Document 1 a treatment instrument for grasping a living tissue with a pair of jaws and incising the living tissue by applying energy to the living tissue.
  • a pair of jaws is provided with a gripping surface for gripping a living tissue.
  • These gripping surfaces are each formed of a flat surface, and have the same width dimension when a cross section perpendicular to the longitudinal direction of the pair of jaws is viewed with the pair of jaws closed.
  • the pair of jaws is displaced in the width direction (the pair of gripping surfaces are in the width direction). May shift).
  • the pair of gripping surfaces have the same width dimension.
  • the width dimension of the region where the pair of gripping surfaces overlap is also changed.
  • the living tissue is incised in a region where the pair of gripping surfaces overlap. That is, the treatment instrument described in Patent Document 1 has different width dimensions (hereinafter referred to as incision widths) of regions to be incised when biological tissues having different thicknesses and hardnesses are treated. There's a problem.
  • the present invention has been made in view of the above, and an object of the present invention is to provide a treatment instrument that can stably maintain the incision width.
  • a treatment tool includes a first jaw having a first gripping surface and a second gripping gripping a living tissue between the first gripping surface.
  • a grasping portion including a second jaw having a surface; and the living body from at least one of the first grasping surface and the second grasping surface provided on at least one of the first jaw and the second jaw.
  • An energy generating section that generates energy to be applied to the tissue, and the first gripping surface is in a cross section perpendicular to the longitudinal direction of the gripping section with the first jaw and the second jaw closed.
  • the first separation distance along the width direction between the first inflection points is different from the second separation distance along the width direction between the two second inflection points.
  • the treatment tool according to the present invention has an effect that the incision width can be stably maintained.
  • FIG. 1 is a diagram showing a treatment system according to the first embodiment.
  • FIG. 2 is a diagram illustrating the gripping portion.
  • FIG. 3 is an enlarged view of the central portion in the width direction of the grip portion shown in FIG.
  • FIG. 4 is a diagram for explaining the effect of the first embodiment.
  • FIG. 5A is a diagram showing a grip portion according to Modification 1-1 of Embodiment 1.
  • FIG. 5B is a diagram showing a grip portion according to Modification Example 1-2 of Embodiment 1.
  • FIG. 5C is a diagram showing a grip portion according to Modification 1-3 of Embodiment 1.
  • FIG. 5D is a diagram showing a grip portion according to Modification Example 1-4 of Embodiment 1.
  • FIG. 1 is a diagram showing a treatment system according to the first embodiment.
  • FIG. 2 is a diagram illustrating the gripping portion.
  • FIG. 3 is an enlarged view of the central portion in the width direction of the grip portion shown in FIG.
  • FIG. 5E is a diagram showing a gripping part according to Modification 1-5 of Embodiment 1.
  • FIG. 6 is a diagram illustrating a gripping unit according to the second embodiment.
  • FIG. 7 is a diagram illustrating a grip portion according to Modification Example 2-1 of the second embodiment.
  • FIG. 8 is a diagram showing a gripping part according to the modified example 2-2 of the second embodiment.
  • FIG. 9 is a diagram illustrating a gripping unit according to the third embodiment.
  • FIG. 10 is a diagram showing a gripping part according to the modified example 3-1 of the first to third embodiments.
  • FIG. 11 is a diagram showing a grip portion according to Modification 3-2 of Embodiments 1 to 3.
  • FIG. 1 is a diagram showing a treatment system 1 according to the first embodiment.
  • the treatment system 1 treats (joins (or anastomoses), incises, etc.) the living tissue by applying energy (electric energy (high-frequency energy) in the first embodiment) to the living tissue.
  • the treatment system 1 includes a treatment tool 2, a control device 3, and a foot switch 4.
  • the treatment tool 2 is, for example, a linear type surgical treatment tool for treating living tissue through the abdominal wall.
  • the treatment tool 2 includes a handle 5, a shaft 6, and a grip portion 7.
  • the handle 5 is a part where the surgeon holds the treatment instrument 2 by hand.
  • the handle 5 is provided with an operation knob 51 as shown in FIG.
  • the shaft 6 has a substantially cylindrical shape, and one end (right end portion in FIG. 1) is connected to the handle 5.
  • a gripping portion 7 is attached to the other end of the shaft 6 (left end portion in FIG. 1).
  • An opening / closing mechanism (not shown) that opens and closes the first and second jaws 8 and 9 (FIG.
  • the “longitudinal direction” described below is a closed state in which a living tissue is gripped (the first and second jaws 8 and 9 are closed (the first and second gripping surfaces 81 and 91 are opposed to each other)).
  • the “width direction” described below means a short direction perpendicular to the longitudinal direction along the first and second grip surfaces 81 and 91 in the grip portion 7.
  • FIG. 2 is a diagram illustrating the gripping unit 7. Specifically, FIG.
  • FIG. 2 is a cross-sectional view of the gripping portion 7 set in a closed state in which a living tissue LT such as a lumen or a blood vessel is gripped, cut along a cross section orthogonal to the longitudinal direction.
  • FIG. 3 is an enlarged view of the central portion in the width direction of the gripping portion 7 shown in FIG.
  • the grip portion 7 is a portion that grips the living tissue LT and treats the living tissue LT.
  • the grip portion 7 includes first and second jaws 8 and 9.
  • the first and second jaws 8 and 9 are pivotally supported on the other end of the shaft 6 so as to be openable and closable in the direction of the arrow Y1 (FIG. 1), and can grasp the living tissue LT according to the operation of the operation knob 51 by the operator.
  • Y1 FIG. 1
  • the first jaw 8 is disposed on the upper side in FIGS. 1 to 3 with respect to the second jaw 9 and has a substantially rectangular parallelepiped shape extending along the longitudinal direction.
  • a material having high heat resistance, low thermal conductivity, and excellent electrical insulation such as PTFE (polytetrafluoroethylene), PFA (tetrafluoroethylene).
  • resins such as ethylene / perfluoroalkyl vinyl ether copolymer), PEEK (polyether ether ketone), and PBI (polybenzimidazole).
  • the 1st jaw 8 As a material of the 1st jaw 8, you may employ
  • the first gripping surface 81 is parallel to the width direction as shown in FIG. 2 or FIG. 3 when viewed in a cross section perpendicular to the longitudinal direction of the gripping portion 7 set in the closed state.
  • These two first inflection points IP1 are respectively located on both sides of a center line Ax1 passing through the center position in the width direction on the first gripping surface 81 and orthogonal to the width direction.
  • the first gripping surface 81 is formed in a convex shape in which the first region Ar1 between the two first inflection points IP1 protrudes toward the second jaw 9 side.
  • the first region Ar1 is configured by a plane orthogonal to the center line Ax1 (a plane parallel to the width direction).
  • the regions on both sides sandwiching the first region Ar1 are, as shown in FIG. 2 or FIG. 3, the second inflection points from the two first inflection points IP1 toward the outside in the width direction. Each of them is composed of a curved surface separated from the jaw 9.
  • the first gripping surface 81 has a shape that is symmetric with respect to the center line Ax1.
  • the first gripping surface 81 has the same cross-sectional shape shown in FIG. 2 or FIG. 3 over the entire length (the entire length in the longitudinal direction, the same applies hereinafter).
  • the first electrode 11 is embedded over the entire length of the first gripping surface 81 in the region excluding both end portions in the width direction as shown in FIG. 2 or FIG. It is.
  • the first electrode 11 is made of a conductive material such as copper, aluminum, stainless steel SUS, or carbon, for example.
  • the first electrode 11 is formed of a plate body extending in the longitudinal direction and having substantially the same thickness dimension, and one plate surface (the lower surface in FIGS. 2 and 3) is the first gripping surface.
  • 81 is embedded in the first gripping surface 81 so as to constitute a part of 81 (with the one plate surface exposed).
  • the second jaw 9 has a substantially rectangular parallelepiped shape extending along the longitudinal direction.
  • the material of the second jaw 9 include resins such as PTFE, PFA, PEEK, and PBI, and ceramics such as alumina and zirconia, as in the first jaw 8.
  • PTFE, DLC, ceramic-based, silica-based, and silicon-based insulating coating materials having non-adhesiveness to a living body may be attached thereto.
  • 2 and 3 of the second jaw 9 functions as a second gripping surface 91 that grips the living tissue LT with the first gripping surface 81.
  • the second gripping surface 91 has two parallel lines in the width direction as shown in FIG. 3 when viewed in a cross section orthogonal to the longitudinal direction of the gripping portion 7 set in the closed state. It has a second inflection point IP2. These two second inflection points IP2 are located on both sides of a center line Ax2 that passes through the center position in the width direction on the second gripping surface 91 and is orthogonal to the width direction.
  • the second gripping surface 91 is formed in a convex shape such that the second region Ar2 between the two second inflection points IP2 faces the first region Ar1 and protrudes toward the first gripping surface 81.
  • the second region Ar2 is configured by a plane (a plane parallel to the width direction) orthogonal to the center line Ax2.
  • the second separation distance D2 along the width direction between the two second inflection points IP2 is set to be smaller than the first separation distance D1 along the width direction between the two first inflection points IP1.
  • the regions on both sides sandwiching the second region Ar2 are, as shown in FIG. 2 or FIG. Each of them is composed of a plane (inclined surface) that is separated from the gripping surface 81.
  • the second gripping surface 91 has a shape that is symmetric with respect to the center line Ax2. In the first embodiment, the second gripping surface 91 has the same cross-sectional shape shown in FIG.
  • the region facing the first electrode 11 extends over the entire length of the second gripping surface 91 as shown in FIG. 2 or FIG.
  • the second electrode 12 is embedded. Similar to the first electrode 11, the second electrode 12 is made of a conductive material such as copper, aluminum, stainless steel SUS, or carbon, for example.
  • the second electrode 12 is formed of a plate body extending in the longitudinal direction and having substantially the same thickness dimension, and one plate surface (the upper surface in FIGS. 2 and 3) is the second gripping surface. It is embedded in the second gripping surface 91 so as to constitute a part of 91 (with the one plate surface exposed).
  • a pair of high-frequency lead wires constituting the electric cable C disposed from one end side to the other end side of the shaft 6 are joined to the first and second electrodes 11 and 12, respectively.
  • the first and second electrodes 11 and 12 can generate electric energy (high-frequency energy) by being supplied with high-frequency power by the control device 3 via a pair of high-frequency lead wires.
  • high-frequency power is supplied in a state where the living tissue LT is gripped by the first and second jaws 8 and 9 (first and second gripping surfaces 81 and 91), the first and second electrodes 11 and 12 are connected.
  • the first and second electrodes 11 and 12 are a pair of electrodes, one of which is a positive electrode and the other is a negative electrode, and corresponds to an energy generating unit according to the present invention.
  • the first and second electrodes 11 and 12 are not limited to plates having substantially the same thickness as long as the surfaces have the same shape as the first and second gripping surfaces 81 and 91. You may comprise with a block-shaped member, respectively.
  • the first and second electrodes 11 and 12 do not need to be bulk materials, and may be composed of conductive thin films such as copper, gold, and platinum formed by vapor deposition, sputtering, plating, or the like. Absent. Further, the surfaces of the first and second electrodes 11 and 12 are not limited to the physical exposure as described above, but may be electrically exposed.
  • the surface of the electrode does not deviate from the intention of the invention even if it provides a potential as an electrode. It is not a thing.
  • the foot switch 4 is a part operated by the operator with his / her foot. And according to the said operation to the foot switch 4, ON / OFF of the electricity supply from the control apparatus 3 to the treatment tool 2 (1st, 2nd electrode 11, 12) is switched. Note that the means for switching on and off is not limited to a foot switch, and other switches that are operated by hand may be employed.
  • the control device 3 includes a CPU (Central Processing Unit) and the like, and comprehensively controls the operation of the treatment instrument 2 according to a predetermined control program. More specifically, the control device 3 is arranged between the first and second electrodes 11 and 12 via a pair of high-frequency lead wires in response to an operation to the foot switch 4 by the operator (operation to turn on the power). A high-frequency power having a preset output is supplied to appropriately control energy.
  • the surgeon holds the treatment instrument 2 by hand, and inserts the distal end portion of the treatment instrument 2 (a part of the gripping portion 7 and the shaft 6) into the abdominal cavity through the abdominal wall using, for example, a trocar.
  • the surgeon operates the operation knob 51 to hold the living tissue LT with the first and second jaws 8 and 9.
  • the first and second gripping surfaces 81 and 91 have convex shapes in which the first and second regions Ar1 and Ar2 protrude to the other side, respectively. That is, in the second gripping surface 91, the second region Ar2 has the smallest separation distance from the first gripping surface 81.
  • the tissue LT1 (FIGS. 2 and 3) pressed in the second region Ar2 at the portion gripped by the first and second gripping surfaces 81 and 91 of the living tissue LT is the other tissue LT2. It is pressed with a higher pressure than (FIGS. 2 and 3).
  • the surgeon operates the foot switch 4 to turn on the power supply from the control device 3 to the treatment instrument 2.
  • the control device 3 supplies high-frequency power between the first and second electrodes 11 and 12 via a pair of high-frequency lead wires.
  • high-frequency power is supplied between the first and second electrodes 11 and 12
  • a high-frequency current flows between the first and second electrodes 11 and 12 via the living tissue LT. That is, Joule heat is generated in the living tissue LT.
  • the first and second electrodes 11 and 12 are considered to be equipotential, the first and second electrodes are grasped by the first and second grasping surfaces 81 and 91 of the living tissue LT.
  • the heat generation density of the tissue LT1 having the shortest distance between the two electrodes 11 and 12 is the highest as compared with the other tissue LT2. That is, the tissue LT1 is rapidly heated. On the other hand, the other tissue LT2 gradually rises in temperature due to the high-frequency current and also rises due to heat conduction from the tissue LT1. Then, due to the pressure difference and the temperature difference described above, the tissue LT2 becomes a tissue to be sealed (hereinafter referred to as a sealed tissue LT2), and the tissue LT1 is a tissue to be cut (hereinafter referred to as a tissue to be cut LT1). It becomes.
  • FIG. 4 is a diagram for explaining the effect of the first embodiment. Specifically, FIG. 4 is a cross-sectional view corresponding to FIG.
  • the first gripping surface 81 has two first inflection points IP1 arranged in parallel in the width direction, and a first region between the two first inflection points IP1.
  • Ar1 is formed in a convex shape protruding to the second gripping surface 91 side.
  • the second gripping surface 91 has two second inflection points IP2 arranged in parallel in the width direction, and the second region Ar2 between the two second inflection points IP2 faces the first region Ar1.
  • the second separation distance D2 along the width direction between the two second inflection points IP2 is set to be smaller than the first separation distance D1 along the width direction between the two first inflection points IP1. For this reason, as shown in FIG. 3, the center lines Ax1 and Ax2 are aligned with each other, and the first and second jaws 8 and 9 are shifted in the width direction, so that the center lines Ax1 and Ax2 are aligned with each other as shown in FIG.
  • the width dimension (incision width) of the incised tissue LT1 can be made the same in a state in which a deviation ⁇ is generated in the width direction.
  • the incision width can be made the same. Therefore, according to the treatment tool 2 according to the first embodiment, there is an effect that the incision width can be stably maintained.
  • the width of the incised tissue LT1 can be narrowed by the shapes of the first and second gripping surfaces 81 and 91.
  • the width of the sealed tissue LT2 can be increased. For this reason, the living tissue LT can be stably sealed.
  • FIG. 5A is a diagram showing a gripping portion 7A according to Modification 1-1 of Embodiment 1.
  • FIG. 5A is a cross-sectional view corresponding to FIG.
  • the first electrode 11 is provided on the first gripping surface 81 and the second electrode 12 is provided on the second gripping surface 91, but this is not restrictive.
  • the first and second electrodes 11 and 12 may be provided only on the first gripping surface 81 as in the gripping portion 7A according to Modification 1-1 shown in FIG. 5A.
  • FIG. 1 is a diagram showing a gripping portion 7A according to Modification 1-1 of Embodiment 1.
  • FIG. 5A is a cross-sectional view corresponding to FIG.
  • the first electrode 11 is provided on the first gripping surface 81 and the second electrode 12 is provided on the second gripping surface 91, but this is not restrictive.
  • the first and second electrodes 11 and 12 may be provided only on the first gripping surface 81 as in the gripping portion 7A according to Modification 1-1 shown in
  • the first and second electrodes 11 and 12 constitute a part of the first gripping surface 81 over the entire length of the first gripping surface 81 on both sides of the center line Ax1. Each embedded. More specifically, the first and second electrodes 11 and 12 are arranged at positions symmetrical with respect to the center line Ax1 outside the two first inflection points IP1 in the width direction.
  • the heat capacity of the said 1st, 2nd electrodes 11 and 12 can be made low. That is, the amount of heat generated in the living tissue LT due to Joule heating significantly reduces that the first and second electrodes 11 and 12 serve as heat sinks and contribute unintentionally to the cooling of the living tissue LT. Therefore, even with a small amount of power, the tissue heating rate can be increased, the treatment time can be shortened, the thermal invasion to the side tissue can be further reduced, and the residual heat of the first and second jaws 8 and 9 can be reduced.
  • the residual heat means heat that is originally necessary for the treatment after the treatment and is unnecessary for the jaw. Furthermore, even when the gripping portion 7A is set to the closed state, the first and second electrodes 11 and 12 do not come into contact with each other and are short-circuited.
  • FIG. 5B is a diagram showing a gripping portion 7B according to Modification 1-2 of Embodiment 1. Specifically, FIG. 5B is a cross-sectional view corresponding to FIG. Like the gripping part 7B according to Modification 1-2 shown in FIG. 5B, the first and second electrodes 11 and 12 are further added to the gripping part 7A according to Modification 1-1 described above. It doesn't matter. That is, two sets of the first and second electrodes 11 and 12 may be provided. Specifically, of the two sets of first and second electrodes 11 and 12, the arrangement position of one set of the first and second electrodes 11 and 12 is arranged at the same position as in the first modification described above. ing. Further, as shown in FIG.
  • the other set of the first and second electrodes 11 and 12 is located on the second gripping surface 91 at a position facing the first and second electrodes 11 and 12 of the one set.
  • the second gripping surface 91 is embedded so as to constitute a part of the second gripping surface 91 over the entire length of the second gripping surface 91.
  • the number of electrodes can be freely selected from 2 to 4, between the first and second electrodes 11 and 12 arranged in the width direction, or in different jaws.
  • a high-frequency current can flow between the first and second electrodes 11 and 12 located at the provided diagonal positions. That is, diversification of the possibility of treatment by increasing variations in the application sequence of high-frequency power, suppression of electrode heat generation by reducing the amount of current per electrode, and low thermal invasion by not using heated electrodes for treatment It becomes.
  • FIG. 5C is a diagram showing a gripping portion 7C according to Modification 1-3 of Embodiment 1.
  • FIG. 5C is a cross-sectional view corresponding to FIG.
  • a floating electrode 13 may be added to the gripping portion 7A according to Modification 1-1 described above, like the gripping portion 7C according to Modification 1-3 shown in FIG. 5C.
  • the floating electrode 13 constitutes a part of the second gripping surface 91 over the entire length of the second gripping surface 91 at a position facing the first region Ar1 on the second gripping surface 91.
  • the floating electrode 13 is a good conductor such as copper, aluminum, gold, or carbon.
  • the floating electrode 13 is not connected to the control device 3 via a lead wire, and is not grounded, and is electrically floating. is there.
  • the floating electrode 13 when high-frequency power is supplied between the first and second electrodes 11 and 12, the floating electrode 13 is relayed between the first and second electrodes 11 and 12. A high-frequency current can be passed through.
  • the holding part 7C when the holding part 7C is set in the closed state, not only can the contact between the first and second electrodes 11 and 12 be avoided, but also the aim of setting the heat generating region as central as possible in the width direction can be achieved.
  • the resistance can be reduced as compared with the configuration of Modification 1-1 described above.
  • the size of the floating electrode 13 in the width direction is not limited to the position facing the first region Ar1. For example, it is conceivable to reduce the size to the same size as the second region Ar2. By changing the width between the first region Ar1 and the second region Ar2, it is possible to more precisely control the heat generation region and the ultimate temperature at the center.
  • FIG. 5D is a diagram showing a gripping part 7D according to Modification 1-4 of Embodiment 1. Specifically, FIG. 5D is a cross-sectional view corresponding to FIG. Like the gripping part 7D according to Modification 1-4 shown in FIG. 5D, the thermal energy application part 14 may be added to the gripping part 7A according to Modification 1-1 described above. As shown in FIG. 5D, the thermal energy application unit 14 includes a heating element 141 and a heat transfer member 142. The heating element 141 extends, for example, from the proximal end side (right side in FIG. 1) of the first jaw 8 to the distal end side (left side in FIG.
  • a pair of heating lead wires constituting the electric cable C disposed from one end side to the other end side of the shaft 6 are joined to both ends of the heating element 141.
  • the heating element 141 generates heat when a voltage is applied (energized) by the control device 3 through the heating lead wire.
  • the heating element 141 described above is obtained by processing stainless steel (SUS304), which is a conductive material, and is bonded to the center portion in the width direction on the upper surface in FIG. 5D of the heat transfer member 142 by thermocompression bonding. ing.
  • the material of the heating element 141 is not limited to stainless steel (SUS304), but may be other stainless steel materials (for example, No. 400 series), or may be a conductive material such as platinum or tungsten.
  • the heating element 141 is not limited to the configuration in which the heat transfer member 142 is bonded to the upper surface by thermocompression bonding in FIG. 5D, but the configuration formed on the upper surface by vapor deposition or sputtering is adopted. It doesn't matter.
  • the heat transfer member 142 has high heat resistance, high thermal conductivity, and excellent electrical insulation, for example, ceramic such as PTFE, PFA, PEEK, PBI, etc. It is composed of a composite material contained as a filler, a material such as a ceramic such as aluminum nitride, or a material obtained by coating a conductive substance such as copper, aluminum, or carbon with an insulating coating such as PTFE. Further, the heat transfer member 142 has a width dimension identical to that of the first region Ar ⁇ b> 1 in the first gripping surface 81, and is configured by a substantially rectangular parallelepiped plate extending over the entire length of the first gripping surface 81. .
  • the heat transfer member 142 is embedded in the first gripping surface 81 so that the lower surface constitutes the first region Ar1 (with the lower surface exposed).
  • the heat transfer member 142 described above transfers the heat from the heating element 141 to the living tissue LT (gives heat energy to the living tissue LT). That is, in the gripping part 7D, the first and second electrodes 11, 12 and the thermal energy applying part 14 correspond to the energy generating part according to the present invention.
  • the center of the width direction can be selectively heated by the combination of the first and second electrodes 11 and 12 and the thermal energy application unit 14. Further, the treatment can be advanced at a higher speed than in the case where the living tissue LT is treated only with the high-frequency current. Further, since nothing is arranged on the second jaw 9, it is possible to reduce the size.
  • FIG. 5E is a diagram showing a gripping portion 7E according to Modification 1-5 of Embodiment 1. Specifically, FIG. 5E is a cross-sectional view corresponding to FIG. Like the gripping part 7E according to Modification Example 1-5 shown in FIG. 5E, the first and second electrodes 11 and 12 are omitted from the gripping part 7D according to Modification Example 1-4 described above. An ultrasonic energy application unit 15 may be employed instead of the thermal energy application unit 14. As shown in FIG.
  • the ultrasonic energy application unit 15 has the same width dimension as the first region Ar ⁇ b> 1 in the first gripping surface 81, and has an overall substantially rectangular parallelepiped shape that extends over the entire length of the first gripping surface 81. Is formed. And the ultrasonic energy provision part 15 is embedded in the said 1st holding surface 81 so that the surface of the lower side may comprise 1st area
  • the ultrasonic energy applying unit 15 has a configuration in which insulating plates 152A and 152B are bonded to the front and back surfaces of a flat piezoelectric member 151, respectively.
  • a pair of ultrasonic lead wires constituting the electric cable C disposed from one end side to the other end side of the shaft 6 are joined to the piezoelectric body 151.
  • the piezoelectric body 151 generates ultrasonic vibration whose vibration direction is the thickness direction (vertical direction in FIG. 5E) when a voltage is applied by the control device 3 via the heating lead wire (biological tissue). Apply ultrasonic energy to LT). That is, in the grip part 5E, the ultrasonic energy application part 15 corresponds to an energy generation part according to the present invention.
  • FIG. 6 is a diagram showing a gripping portion 7F according to the second embodiment. Specifically, FIG. 6 is a cross-sectional view corresponding to FIG. In the gripping portion 7F (first jaw 8F) according to the second embodiment, as shown in FIG. 6, the first gripping is performed with respect to the gripping portion 7 (first jaw 8) described in the first embodiment.
  • a first gripping surface 81F is used in which the first region Ar1 is formed of a curved surface that protrudes toward the second gripping surface 91 and has a predetermined radius of curvature.
  • the curved surface of the first region Ar1 for example, a curved surface having a radius of curvature that is half of the first separation distance D1 is preferable.
  • the first region Ar1 of the first grip surface 81F is configured by a curved surface having a predetermined radius of curvature. For this reason, compared with the case where 1st area
  • FIG. 7 is a diagram showing a gripping portion 7G according to Modification 2-1 of the second embodiment.
  • FIG. 7 is a cross-sectional view corresponding to FIG.
  • the second region Ar2 is not the first region Ar1 but the first gripping surface 81 side instead of the second embodiment described above.
  • the curved surface of the second region Ar2 is preferably a curved surface having a radius of curvature that is half the second separation distance D2.
  • FIG. 8 is a diagram showing a gripping portion 7H according to Modification 2-2 of Embodiment 2. Specifically, FIG. 8 is a cross-sectional view corresponding to FIG.
  • the first gripping surface 81H first region Ar1 is formed of a curved surface having a predetermined radius of curvature that is convex toward the second gripping surface 91H side.
  • the first jaw 8H and the second gripping surface 91H second jaw 9H configured with a curved surface having a predetermined curvature radius and projecting the second region Ar2 toward the first gripping surface 81H may be employed. I do not care.
  • a distance along the center line Ax1 between the first inflection point IP1 and the apex of the first region Ar1 is defined as a distance g1 (FIG. 8).
  • a distance along the center line Ax2 between a position separated from the apex of the second region Ar2 by a half of the first separation distance D1 in the width direction and the apex is defined as a distance g2 (FIG. 8).
  • the difference between the distance g1 and the distance g2 is preferably suppressed to about twice, and the first and second separation distances D1, D2 and the first region Ar1 where the distance g1 and the distance g2 are the same. It is most preferable to select the curvature radius R1 (FIG. 8) and the curvature radius R2 (FIG. 8) of the second region Ar2.
  • ⁇ 1 means an angle formed by a line segment connecting the center of curvature of the first region Ar1 and the first inflection point IP1 and a line segment connecting the center of curvature and the vertex of the first region Ar1.
  • ⁇ 3 means an angle formed by a line segment connecting the center of curvature of the second region Ar2 and the second inflection point IP2 and a line segment connecting the center of curvature and the vertex of the second region Ar2.
  • ⁇ 2 means an angle formed by line segments obtained by extending regions outside the width direction of the two second inflection points IP2.
  • FIG. 9 is a diagram showing a gripping portion 7I according to the third embodiment. Specifically, FIG. 9 is a cross-sectional view corresponding to FIG. In the gripping portion 7I (first jaw 8I) according to the third embodiment, as shown in FIG. 9, the gripping portion 7 described in the first embodiment described above is the first gripping surface 81 instead of the first gripping surface 81. One gripping surface 81I is employed. As shown in FIG.
  • the first gripping surface 81I is located on both sides of the first region Ar1, and is closer to the second gripping surface 91 side toward the outer side in the width direction. Sealing regions Ar ⁇ b> 3 that maintain a third separation distance D ⁇ b> 3 from 91 are provided.
  • the region other than the pair of sealing regions Ar3 has the same shape as the first gripping surface 81 described in the first embodiment.
  • the first gripping surface 81I has a shape that is symmetric with respect to the center line Ax1.
  • the first gripping surface 81I is located on both sides of the first region Ar1, and is separated from the second gripping surface 91 toward the outer side in the width direction. Sealing regions Ar3 that maintain the distance D3 are provided. For this reason, a sufficient pressure can be applied to the sealed tissue LT2, and the living tissue LT can be sealed more stably.
  • FIG. 10 is a diagram showing a gripping portion 7J according to Modification 3-1 of Embodiments 1 to 3. Specifically, FIG. 10 is a cross-sectional view corresponding to FIG. Instead of the grip portion 7 (7A to 7I) described in the first to third embodiments, the grip portion 7J according to the modification 3-1 shown in FIG. 10 may be employed. In FIG.
  • a bulging portion 82 that bulges downward in the center portion in the width direction is formed on the entire length of the first jaw 8J. It is provided over. That is, the first gripping surface 81J according to Modification 3-1 has a stepped shape. And the both ends edge of the width direction in the bulging part 82 becomes 1st inflection point IP1, respectively. Further, in the first gripping surface 81J, the first region Ar1 between the two first inflection points IP1 (the tip surface of the bulging portion 82 (the lower surface in FIG. 10)) constitutes the gripping portion 7J.
  • the first gripping surface 81J It is formed of a curved surface that is convex toward the second jaw 9J and has a predetermined radius of curvature. Furthermore, in the first gripping surface 81J, the regions on both sides sandwiching the first region Ar1 are respectively configured by planes orthogonal to the center line Ax1.
  • the first region Ar1 is embedded with the first and second electrodes 11 and 12 so as to constitute a part of the first gripping surface 81J.
  • the first and second electrodes 11 and 12 are arranged at symmetrical positions on both sides of the center line Ax1 with respect to the center line Ax1.
  • the second gripping surface 91J has the same shape as the second gripping surface 91 described in the first embodiment described above in the portion facing the first region Ar1. Moreover, the area
  • the thermal energy application unit 14 described in Modification 1-4 described above constitutes a part of the second gripping surface 91J. Embedded in.
  • FIG. 11 is a diagram showing a gripping portion 7K according to the modified example 3-2 of the first to third embodiments. Specifically, FIG. 11 is a cross-sectional view corresponding to FIG. Instead of the gripping portion 7 (7A to 7I) described in the first to third embodiments, the gripping portion 7K according to the modification 3-2 shown in FIG. 11 may be employed.
  • a bulging portion 82 that bulges downward in the central portion in the width direction is formed on the entire length of the first jaw 8K. It is provided over. That is, the first gripping surface 81K according to the modification 3-2 has a stepped shape.
  • the distal end surface (the lower surface in FIG. 11) of the bulging portion 82 has substantially the same shape as the first gripping surface 81I described in the third embodiment. Furthermore, in the first gripping surface 81K, the regions on both sides sandwiching the bulging portion 82 are respectively configured by planes orthogonal to the center line Ax1.
  • the first and second electrodes 11 and 12 are embedded in the distal end surface of the bulging portion 82 so as to constitute a part of the first gripping surface 81K.
  • the first and second electrodes 11 and 12 are symmetric with respect to the center line Ax1 on both sides of the center line Ax1 (outside in the width direction of the two first inflection points IP1). Has been placed.
  • the region on the outer side in the width direction of the two first inflection points IP1 where the first and second electrodes 11 and 12 are disposed is the second grip toward the outer side in the width direction as in the third embodiment. This is a region for maintaining a separation distance from the surface 91. Further, at the position facing the bulging portion 82 on the second gripping surface 91, the thermal energy application unit 14 described in Modification 1-4 described above constitutes a part of the second gripping surface 91. Embedded.
  • the first jaw 8 (8F, 8H, 8I) is disposed above the second jaw 9 (9G, 9H).
  • the present invention is not limited to this.
  • the first jaw 8 (8F, 8H, 8I) may be arranged on the lower side with respect to the second jaw 9 (9G, 9H).
  • the shaft 6 (the gripping portions 7 (7A to 7I)) may be configured to be rotatable with respect to the handle 5 around the central axis of the shaft 6.
  • the gripping portion 7 (7A to 7I) is configured to apply at least one of high-frequency energy, thermal energy, and ultrasonic energy to the living tissue LT. Not exclusively.
  • first and second electrodes 11 and 12 are not limited to the first to third embodiments described above, and can be changed as appropriate.
  • the first electrode 11 is disposed on both sides of the first jaw 8 across the first region Ar1
  • the second electrode 12 is disposed on the second jaw 9 at a position facing the first region Ar1.
  • the number of the second electrodes 12 may be different.

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Abstract

La présente invention concerne un instrument de traitement pourvu : d'une partie de préhension (7) ; et de parties de génération d'énergie (11, 12) disposées sur des première et seconde mâchoires (8, 9) et générant de l'énergie à imprimer à un tissu vivant (LT). Une surface de préhension (81) d'une première mâchoire (8) comporte deux premiers points d'inflexion (IP1) disposés en parallèle dans le sens de la largeur de la partie de préhension (7), et une première région (Ar1) entre les deux premiers points d'inflexion (IP1) est formée selon une forme en saillie faisant saillie vers la seconde mâchoire (9). Une seconde surface de préhension (91) de la seconde mâchoire présente deux seconds points d'inflexion (IP2) disposés en parallèle dans le sens de la largeur, et une seconde région (Ar2) entre les deux seconds points d'inflexion (IP2) faisant face à la première région (Ar1) et est formée selon une forme en saillie faisant saillie vers la première surface de préhension (81). Une première distance de séparation (D1) entre les deux premiers points d'inflexion (IP1) dans le sens de la largeur est différente d'une seconde distance de séparation entre les deux seconds points d'inflexion (IP2) dans le sens de la largeur.
PCT/JP2017/020210 2017-05-31 2017-05-31 Instrument de traitement WO2018220736A1 (fr)

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2005512619A (ja) * 2001-11-08 2005-05-12 エシコン・エンド−サージェリィ・インコーポレイテッド 改良されたクランピング・エンドエフェクタを備えた超音波クランプ凝固装置
WO2007097330A1 (fr) * 2006-02-22 2007-08-30 Olympus Medical Systems Corp. Appareil d'incision a coagulation
JP2008534069A (ja) * 2005-03-25 2008-08-28 オリジン・メッドシステムズ・インコーポレイテッド 組織溶接器の顎部を調整するための装置
JP2008212663A (ja) * 2007-02-14 2008-09-18 Tyco Healthcare Group Lp 電気的切除メカニズムを有する血管密封器具
WO2015022919A1 (fr) * 2013-08-16 2015-02-19 オリンパスメディカルシステムズ株式会社 Instrument de traitement, et système de traitement
WO2016080147A1 (fr) * 2014-11-18 2016-05-26 オリンパス株式会社 Outil de traitement et système de traitement

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2005512619A (ja) * 2001-11-08 2005-05-12 エシコン・エンド−サージェリィ・インコーポレイテッド 改良されたクランピング・エンドエフェクタを備えた超音波クランプ凝固装置
JP2008534069A (ja) * 2005-03-25 2008-08-28 オリジン・メッドシステムズ・インコーポレイテッド 組織溶接器の顎部を調整するための装置
WO2007097330A1 (fr) * 2006-02-22 2007-08-30 Olympus Medical Systems Corp. Appareil d'incision a coagulation
JP2008212663A (ja) * 2007-02-14 2008-09-18 Tyco Healthcare Group Lp 電気的切除メカニズムを有する血管密封器具
WO2015022919A1 (fr) * 2013-08-16 2015-02-19 オリンパスメディカルシステムズ株式会社 Instrument de traitement, et système de traitement
WO2016080147A1 (fr) * 2014-11-18 2016-05-26 オリンパス株式会社 Outil de traitement et système de traitement

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