WO2018225258A1 - Instrument de traitement et système de traitement - Google Patents

Instrument de traitement et système de traitement Download PDF

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Publication number
WO2018225258A1
WO2018225258A1 PCT/JP2017/021511 JP2017021511W WO2018225258A1 WO 2018225258 A1 WO2018225258 A1 WO 2018225258A1 JP 2017021511 W JP2017021511 W JP 2017021511W WO 2018225258 A1 WO2018225258 A1 WO 2018225258A1
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WO
WIPO (PCT)
Prior art keywords
longitudinal axis
angular position
groove
rotor assembly
handle
Prior art date
Application number
PCT/JP2017/021511
Other languages
English (en)
Japanese (ja)
Inventor
宮崎　章
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/JP2017/021511 priority Critical patent/WO2018225258A1/fr
Publication of WO2018225258A1 publication Critical patent/WO2018225258A1/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
    • 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

Definitions

  • the present invention relates to a treatment tool capable of grasping a treatment object between a pair of grasping pieces provided on an end effector. Moreover, it is related with the treatment system provided with the treatment tool.
  • US2009 / 0270853A1 discloses a treatment instrument in which a pair of gripping pieces (clamp members) are provided on an end effector.
  • the treatment target can be grasped between the gripping pieces by closing the pair of gripping pieces by an operation with the handle.
  • electrical vibration is supplied to the treatment tool by an operation with an operation button or the like, whereby ultrasonic vibration and / or high-frequency current is applied to the treatment target gripped by the end effector. Is applied as treatment energy.
  • a treatment instrument such as US2009 / 0270853A1
  • it corresponds to the supply state of electric energy to the treatment instrument, that is, the treatment energy application state to the treatment object such as the type and size of the treatment energy applied to the treatment object
  • the appropriate magnitude of the grasping force of the treatment target between the grasping pieces changes. For this reason, it is required that the gripping force be adjusted to a size suitable for the treatment in accordance with the state of energy application to the treatment target.
  • An object of the present invention is to provide a treatment tool capable of adjusting the gripping force of a treatment target between a pair of gripping pieces to an appropriate size in an end effector. Moreover, it is providing the treatment system provided with the treatment tool.
  • a treatment tool includes a sheath extending along a longitudinal axis from a proximal end to a distal end, and a pair of grasping pieces that can be opened and closed relative to each other.
  • An end effector provided at the distal end portion of the sheath, and the distal end is connected to the end effector, and moves between the pair of gripping pieces by moving along the longitudinal axis with respect to the sheath.
  • a movable shaft a slider attached to the movable shaft so as to be movable along the longitudinal axis with respect to the movable shaft, and provided between the movable shaft and the movable shaft in a direction along the longitudinal axis,
  • An elastic member that expands or contracts by movement of the slider with respect to the movable shaft, and the slider is rotatable about the longitudinal axis with respect to the slider.
  • a rotor assembly attached to the lid and having a groove formed about the longitudinal axis about the longitudinal axis at a first angular position about the longitudinal axis.
  • a first width in the direction along the second axis and a second angular position about the axis of the longitudinal axis that is away from the first angular position and smaller than the first width in the direction along the longitudinal axis A rotor assembly having a second width; and a handle engaged with the groove of the rotor assembly, wherein the rotor assembly rotates about the axis of the longitudinal axis with respect to the slider.
  • a handle whose engagement position with the groove changes between the angular position and the second angular position.
  • FIG. 1 is a schematic diagram illustrating a configuration of a treatment system in which the treatment tool according to the first embodiment is used.
  • FIG. 2 is a block diagram schematically showing a configuration for supplying electric energy to the treatment instrument according to the first embodiment.
  • FIG. 3 is a perspective view schematically showing a configuration of a connecting portion of the movable shaft to the handle according to the first embodiment.
  • FIG. 4 is a cross-sectional view schematically showing the configuration of the connecting portion of the movable shaft to the handle according to the first embodiment in a cross section substantially perpendicular to the width direction of the housing.
  • FIG. 5 is a cross-sectional view schematically showing a VV cross section of FIG. FIG.
  • FIG. 6 shows a state where the handle is engaged with the groove of the rotor assembly in the first engagement state in the connecting portion of the movable shaft to the handle according to the first embodiment. It is the schematic seen from.
  • FIG. 7 shows a state where the handle is engaged with the groove of the rotor assembly in the second engagement state in the connecting portion of the movable shaft according to the first embodiment on one side in the width direction of the housing.
  • FIG. 8 is a schematic view showing the configuration of the rotor assembly and the vicinity thereof in a state where the handle according to the first modification is engaged with the groove of the rotor assembly in the first engagement state.
  • FIG. 9 is a schematic view showing the configuration of the rotor assembly and the vicinity thereof in a state where the handle according to the first modification is engaged with the groove of the rotor assembly in the second engagement state.
  • FIG. 10 is a block diagram schematically showing a configuration for supplying electric energy to the treatment instrument according to the first modification.
  • FIG. 11 is a block diagram schematically showing a configuration for supplying electric energy to the treatment instrument according to the second modification.
  • FIG. 12 is a schematic view of the connecting portion of the movable shaft according to the third modification to the handle as viewed from one side in the width direction of the housing.
  • FIG. 1 is a diagram illustrating a configuration of a treatment system 1 in which the treatment tool 2 of the present embodiment is used.
  • the treatment instrument 2 includes a sheath 3.
  • the sheath 3 has a substantially straight longitudinal axis C as a central axis, and extends along the longitudinal axis C.
  • one side in the direction along the longitudinal axis C is defined as the distal end side (arrow C1 side), and the opposite side to the distal end side is defined as the proximal end side (arrow C2 side).
  • the housing 5 is attached to the proximal end side of the sheath 3.
  • the sheath 3 is inserted into the housing 5 from the distal end side.
  • the housing 5 includes a housing body 6 that extends substantially coaxially with the longitudinal axis C along the longitudinal axis C, and a grip 7 that extends from the housing body 6 in a direction intersecting the longitudinal axis C. .
  • a handle 8 is rotatably attached to the housing 5. When the handle 8 is rotated with respect to the housing 5, the handle 8 is opened or closed with respect to the grip 7.
  • a stopper 9 is provided inside the grip 7, and the handle 8 abuts against the stopper 9 when the handle 8 is closed to the grip 7.
  • the handle 8 is located on the side where the grip 7 is located with respect to the longitudinal axis C and on the tip side with respect to the grip 7, and the moving direction in the opening operation or closing operation of the handle 8. Is substantially parallel to the longitudinal axis C, but is not limited thereto. In one embodiment, the handle 8 is located proximal to the grip 7. In another embodiment, the handle 8 is located on the opposite side to the side on which the grip 7 is located with respect to the longitudinal axis C, and the moving direction in the opening or closing operation of the handle 8 is the longitudinal axis C. Is substantially perpendicular to.
  • a rotation knob (rotation operation member) 11 is attached to the housing 5.
  • the rotation knob 11 is provided substantially coaxially with the longitudinal axis C.
  • the sheath 3 is moved along the longitudinal axis C with respect to the housing 5 together with the rotation knob 11. Rotate around the axis.
  • the rotation knob 11 may not be provided, and the sheath 3 may not be able to rotate about the longitudinal axis C with respect to the housing 5.
  • One end of a cable 12 is connected to the housing 5.
  • the other end of the cable 12 is detachably connected to the power supply device (control device) 10.
  • the treatment system 1 is provided with an operation device 13.
  • an operation for supplying electric energy from the power supply device 10 to the treatment tool 2 is input.
  • a foot switch separate from the treatment instrument 2 is provided as the operating device 13, and the foot switch is electrically connected to the operating device 13.
  • an operation button or the like attached to the housing is provided as the operation device 13 instead of or in addition to the foot switch.
  • the end effector 15 includes a pair of gripping pieces (clamp members) 16 and 17. At least one of the gripping pieces 16 and 17 can rotate with respect to the sheath 3, and the gripping pieces 16 and 17 can be opened and closed relative to each other. For this reason, the end effector 15 can grip a treatment target such as a living tissue between the gripping pieces 16 and 17.
  • a treatment target such as a living tissue between the gripping pieces 16 and 17.
  • one of the gripping pieces 16, 17 is fixed to the sheath 3, and the other of the gripping pieces 16, 17 is rotatably attached to the sheath 3.
  • both gripping pieces 16, 17 are pivotally attached to the sheath 3.
  • a rod member (not shown) extends through the inside of the sheath 3, and the rod member protrudes from the distal end of the sheath 3 to the distal end side. Then, one of the gripping pieces 16 and 17 is formed by a protruding portion from the sheath 3 in the rod member. The other of the grip pieces 16 and 17 is attached to the sheath 3 so as to be rotatable.
  • a movable shaft 18 extends along the longitudinal axis C inside the sheath 3.
  • the movable shaft 18 is movable along the longitudinal axis C with respect to the sheath 3.
  • the distal end of the movable shaft 18 is connected to the end effector 15.
  • the movable shaft 18 is inserted into the housing 5 from the distal end side, and the base end portion of the movable shaft 18 is coupled to the handle 8 inside the housing body 6 (inside the housing 5).
  • the rotation knob 11 is provided, by rotating the rotation knob 11, the movable shaft 18 and the end effector 15 rotate about the longitudinal axis C together with the sheath 3.
  • FIG. 2 is a diagram showing a configuration for supplying electric energy to the treatment instrument 2.
  • the power supply device 10 includes a processor 21 and a storage medium 22.
  • the processor 21 is formed of an integrated circuit including a CPU (Central Processing Unit), an ASIC (Application Specific Integrated Circuit), or an FPGA (Field Programmable Gate Array). Only one processor 21 may be provided in the power supply device 10, or a plurality of processors 21 may be provided in the power supply device 10. Processing in the processor 21 is performed according to a program stored in the processor 21 or the storage medium 22.
  • the storage medium 22 stores a processing program used by the processor 21, parameters, functions, tables, and the like used in the calculation by the processor 21.
  • the processor 21 detects an operation input from the operation device 13.
  • the treatment instrument 2 is provided with a first electrical element 23 and a second electrical element 25.
  • the power supply device 10 is provided with a first output source 26 and a second output source 27.
  • the first output source 26 includes a conversion circuit or the like, and converts electric power from a battery power source or an outlet power source into electric energy supplied to the first electrical element 23. Then, the first output source 26 outputs the converted electrical energy to the first electrical element 23.
  • the second output source 27 includes a conversion circuit or the like, and converts electric power from a battery power source or an outlet power source into electric energy supplied to the second electrical element 25. Then, the second output source 27 outputs the converted electric energy to the second electrical element 25.
  • Each of the electrical elements 23, 25 is activated by being supplied with electrical energy.
  • the end effector 15 is provided with a bipolar electrode as the first electrical element 23, and high-frequency power is output as electrical energy from the first output source 26 to the bipolar electrode.
  • high-frequency power is supplied to the bipolar electrode while the treatment target is gripped between the gripping pieces 16 and 17, a high frequency current flows through the treatment target between the bipolar electrodes, and the high frequency current is supplied as treatment energy to the treatment target. Is granted.
  • the object to be treated is denatured and sealed or solidified by heat caused by the high-frequency current.
  • an ultrasonic transducer is provided as the second electrical element 25 inside the housing 5, and the ultrasonic transducer is connected to a rod member (not shown) that forms one of the gripping pieces 16 and 17. Is done. Then, AC power having a predetermined frequency range is output as electric energy from the second output source 27 to the ultrasonic transducer.
  • AC power having a predetermined frequency range is output as electric energy from the second output source 27 to the ultrasonic transducer.
  • AC power is supplied to the ultrasonic transducer, ultrasonic vibration is generated, and the ultrasonic vibration generated by the ultrasonic transducer is transmitted to one of the gripping pieces 16 and 17 through the rod member.
  • the ultrasonic vibration is transmitted to one of the gripping pieces 16 and 17 while the treatment target is gripped between the gripping pieces 16 and 17, whereby the ultrasonic vibration is applied to the treatment target as the treatment energy.
  • the object to be treated is incised simultaneously with sealing or coagulation due to frictional heat caused by ultrasonic vibration.
  • a heater is provided as the second electrical element 25 in place of the ultrasonic transducer in the end effector 15, and direct current power or electric energy is supplied from the second output source 27 to the heater. AC power is output.
  • heater heat is generated. Heater heat is generated in a state where the treatment target is gripped between the gripping pieces 16 and 17, whereby the heater heat is applied to the treatment target as treatment energy.
  • the treatment target is incised simultaneously with sealing or coagulation by the heater heat.
  • the processor 21 controls the output of electrical energy from each of the output sources 26 and 27 and controls the supply of electrical energy to each of the electrical elements 23 and 25 based on the operation on the operating device 13. Thereby, application of treatment energy such as high-frequency current, ultrasonic vibration, and heater heat to the treatment target is controlled.
  • the operating device 13 is provided with two operating members 28A and 28B.
  • the processor 21 causes the treatment tool 2 to supply electrical energy in the first supply state.
  • the processor 21 causes the treatment tool 2 to supply electric energy in a second supply state different from the first supply state.
  • the bipolar electrode and the ultrasonic transducer are supplied with electrical energy.
  • both the high-frequency current and the ultrasonic vibration are simultaneously generated by supplying electric energy to the treatment instrument 2 in the first supply state. It is given to the treatment target.
  • electric energy is supplied only to the bipolar electrode in the second supply state.
  • a bipolar electrode is provided as the first electrical element 23 and a heater is provided as the second electrical element 25
  • electrical energy is supplied only to the bipolar electrode in the first supply state. Is done. For this reason, in the state where the treatment object is grasped between the grasping pieces 16 and 17, only high-frequency current is applied to the treatment object by supplying electric energy to the treatment tool 2 in the first supply state. . Thereby, the treatment which seals or solidifies the treatment object is performed. In this embodiment, electric energy is supplied to both the bipolar electrode and the heater in the second supply state.
  • FIGS. 3 to 7 are views showing the configuration of the connecting portion of the movable shaft 18 to the handle 8.
  • FIG. 3 shows a perspective view
  • FIG. 4 shows a cross section substantially perpendicular to the width direction of the housing 5.
  • FIG. 5 shows a VV cross section of FIG. 4, and each of FIGS. 6 and 7 shows a state viewed from one side in the width direction of the housing 5.
  • the handle 8 includes a protruding portion 31 that protrudes from the inside of the housing 5 to the outside of the housing 5, and the protruding portion 31 opens the handle 8 relative to the grip 7. An operating force for closing is applied. Parts other than the protrusion 31 in the handle 8 are inserted into the housing 5.
  • the handle 8 is rotatably attached to the housing 5 via a fulcrum pin 32.
  • the center axis of the fulcrum pin 32 becomes the rotation axis (rotation center) P of the handle 8.
  • the rotation axis P extends along the width direction of the housing 5.
  • the movable shaft 18 is attached to the relay member 35 from the base end side, the rod member 33 extending from the inside of the housing 5 through the inside of the sheath 3, the relay member 35 to which the base end of the rod member 33 is connected, and the relay member 35.
  • the rod member 33, the relay member 35, and the cylindrical member 36 move along the longitudinal axis C together with the sheath 3 and the housing 5.
  • the tip of the rod member 33 is connected to the end effector 15.
  • the relay member 35 and the cylindrical member 36 are disposed inside the housing body 6.
  • the central axis of the cylindrical member 36 is provided coaxially or substantially coaxially with the longitudinal axis C of the sheath 3, and the cylindrical member 36 extends from the relay member 35 toward the proximal end side.
  • the fulcrum pin 32 (rotation axis P) is disposed between the protruding portion 31 of the handle 8 and the cylindrical member 36.
  • a cylindrical slider 37, a cylindrical elastic member 38 such as a coil spring, and a cylindrical rotor assembly 40 are accommodated inside the housing 5, a cylindrical slider 37, a cylindrical elastic member 38 such as a coil spring, and a cylindrical rotor assembly 40 are accommodated.
  • the slider 37 is disposed on the outer peripheral surface of the cylindrical member 36 of the movable shaft 18.
  • the central axis of the slider 37 is coaxial or substantially coaxial with the longitudinal axis C of the sheath 3.
  • the slider 37 is movable along the longitudinal axis C with respect to the movable shaft 18. However, the slider 37 cannot rotate around the longitudinal axis C with respect to the movable shaft 18, and the rotation of the slider 37 about the longitudinal axis C relative to the movable shaft 18 is restricted.
  • a stopper 41 is formed on the outer peripheral portion of the cylindrical member 36.
  • the stopper 41 is disposed on the proximal end side with respect to the slider 37 and is fixed to the movable shaft 18. When the slider 37 abuts on the stopper 41, the movement of the slider 37 to the region closer to the base end than the stopper 41 is restricted.
  • a protrusion 42 that protrudes to the outer peripheral side is formed on the outer peripheral surface of the cylindrical member 36.
  • the protrusion 42 is formed integrally with the cylindrical member 36, for example, and is disposed on the tip side with respect to the slider 37.
  • the elastic member 38 is disposed on the outer peripheral surface of the cylindrical member 36 of the movable shaft 18.
  • the elastic member 38 extends along the longitudinal axis C between the protrusion 42 and the slider 37.
  • One end (tip) of the elastic member 38 is in contact with or connected to the protrusion 42 of the movable shaft 18.
  • the other end (base end) of the elastic member 38 is in contact with or connected to the slider 37.
  • the elastic member 38 is provided between the movable shaft 18 and the slider 37 in the direction along the longitudinal axis C. As the slider 37 moves along the longitudinal axis C with respect to the movable shaft 18, the elastic member 38 expands or contracts.
  • the rotor assembly 40 is attached to the slider 37.
  • the central axis of the rotor assembly 40 is coaxial or substantially coaxial with the longitudinal axis C of the sheath 3.
  • the rotor assembly 40 is rotatable about the longitudinal axis C with respect to the slider 37 and the movable shaft 18.
  • the rotor assembly 40 includes a first member 45 attached to the slider 37 from the outer peripheral side, and a second member 46 attached to the first member 45 from the proximal end side. In the rotor assembly 40, the members 45 and 46 rotate together about the longitudinal axis C with respect to the slider 37.
  • the first member 45 is movable along the longitudinal axis C with respect to the second member 46, and along the longitudinal axis C with respect to the second member 46 and the movable shaft 18 together with the slider 37.
  • an engagement protrusion (not shown) is provided on the outer peripheral surface of the first member 45, and a long groove-like engagement groove along the longitudinal axis C is provided on the inner peripheral surface of the second member 46. (Not shown) is provided.
  • the engagement protrusion of the first member 45 engages with the engagement groove of the second member 46.
  • the engagement protrusion is movable along the longitudinal axis C, but movement about the longitudinal axis C is restricted. Thereby, the first member 45 can move along the longitudinal axis C with respect to the second member 46, but cannot rotate about the longitudinal axis C with respect to the second member 46. .
  • An opening hole 47 is formed on the outer surface of the housing body 6 of the housing 5 along the longitudinal axis C. Further, a convex portion 48 that protrudes to the outer peripheral side is formed on the outer peripheral surface of the second member 46 of the rotor assembly 40. The convex portion 48 protrudes from the inside of the housing 5 through the opening hole 47 to the outside.
  • the dimension of the opening hole 47 in the direction along the longitudinal axis C is slightly smaller than the dimension of the convex portion 48 in the direction along the longitudinal axis C. Big.
  • the dimension of the opening hole 47 about the axis of the longitudinal axis C is several times the dimension of the convex part 48 about the axis of the longitudinal axis C, for example. It is formed to a size of about. Due to the above-described configuration, the movement of the convex portion 48 in the direction along the longitudinal axis C with respect to the housing body 6 is restricted by the distal end edge and the proximal end edge of the opening hole 47. Thereby, the movement of the second member 46 of the rotor assembly 40 in the direction along the longitudinal axis C with respect to the housing 5 is restricted.
  • the convex portion 48 can move the opening hole 47 around the longitudinal axis C.
  • the movement range of the convex portion 48 about the longitudinal axis C is defined by the side edge of the opening hole 47.
  • an operation for rotating the rotor assembly 40 around the longitudinal axis C is input.
  • the rotor assembly 40 rotates about the longitudinal axis C with respect to the slider 37 and the movable shaft 18.
  • the rotation knob 11 is provided, even when the rotation knob 11 is rotated, the rotor assembly 40 does not rotate together with the movable shaft 18 and the slider 37 and the like.
  • a groove 51 that is recessed toward the inner peripheral side extends along the axis of the longitudinal axis C.
  • the groove 51 is formed over the entire circumference around the longitudinal axis C.
  • the width B of the groove 51 in the direction along the longitudinal axis C differs depending on the angular position about the longitudinal axis C. For example, at each of the angular position (first angular position) ⁇ 1a and the angular position (first angular position) ⁇ 1b that is approximately 180 ° away from the angular position ⁇ 1a about the longitudinal axis C, the groove 51 is long It has a first width B1 in the direction along the axis C.
  • an angular position (second angular position) ⁇ 2a that is approximately 90 ° apart from the angular position ⁇ 1a about the longitudinal axis C
  • an angular position that is approximately 180 ° apart from the angular position ⁇ 2a about the longitudinal axis C In each of the second angular positions) ⁇ 2b, the groove 51 has a second width B2 smaller than the first width B1 in the direction along the longitudinal axis C.
  • the first width B1 is changed to the second width B2.
  • the width B of the groove 51 decreases continuously.
  • the groove 51 extends from the first width B1 to the second width B2.
  • the width B of the battery continuously decreases.
  • the groove 51 has a first groove side surface 52 and a second groove side surface 53.
  • the second groove side surface 53 is located farther from the elastic member 38 than the first groove side surface 52 in the direction along the longitudinal axis C, and in this embodiment, the second groove side surface 53 is the first groove side surface. It is located on the proximal side with respect to 52.
  • the dimension between the groove side surfaces 52 and 53 in the direction along the longitudinal axis C is the width B of the groove 51.
  • the first groove side surface 52 is an end on the side close to the slider 37 of the elastic member 38 in the direction along the longitudinal axis C. (Contact position or connection position of the elastic member 38 to the slider 37) E.
  • the elastic member 38 is positioned away from the base end of the elastic member 38 by the first distance D1.
  • the first groove side surface 52 is closer to the slider 37 of the elastic member 38 in the direction along the longitudinal axis C. And a second distance D2 that is greater than the first distance D1.
  • the second groove side surface 53 has a uniform distance D0 from the end E on the side close to the slider 37 of the elastic member 38 in the direction along the longitudinal axis C at any angular position about the longitudinal axis C. become. Therefore, compared to the first width B1 of the groove 51 at each of the angular positions (first angular positions) ⁇ 1a and ⁇ 1b, the first of the grooves 51 at the angular positions (second angular positions) ⁇ 2a and ⁇ 2b.
  • the width B2 of 2 is small.
  • the handle 8 is provided with a pair of engaging portions 55A and 55B on the side opposite to the side on which the protruding portion 31 is located with respect to the fulcrum pin 32 (rotating shaft P).
  • Each of the engaging portions 55 ⁇ / b> A and 55 ⁇ / b> B is inserted into the groove 51 of the rotor assembly 40 and engages with the groove 51.
  • Each of the engaging portions 55A and 55B engages with the groove 51, whereby the handle 8 is attached to the rotor assembly 40.
  • the rotor assembly 40 is rotatable about the longitudinal axis C with respect to the handle 8.
  • the engaging position of the engaging portion 55A with respect to the groove 51 is an angular position (first angular position) ⁇ 1a and an angular position (second angular position) ⁇ 2a. And change between.
  • the engagement position of the engagement portion 55B with the groove 51 is the angular position (first angular position) ⁇ 1b and the angular position (second angular position). It changes between (angular position) ⁇ 2b.
  • each of the engaging portions 55 ⁇ / b> A and 55 ⁇ / b> B comes into contact with the second groove side surface 53 in the groove 51 from the distal end side and from the first groove side surface 52 to the proximal end side. Located away. Further, the slider 37 contacts the stopper 41 in the state where the handle 8 is most opened with respect to the grip 7.
  • the handle 8 is attached to the grip 7. Close. Thereby, each of the engaging portions 55A and 55B moves toward the distal end side toward the first groove side surface 52 in the groove 51, and each of the engaging portions 55A and 55B is proximal to the first groove side surface 52. Abut.
  • Each of the engaging portions 55A and 55B abuts on the first groove side surface 52, whereby each of the engaging portions 55A and 55B presses the first groove side surface 52 toward the distal end side, and the pressing force is applied to the rotor assembly 40. It is transmitted to the movable shaft 18 via the first member 45, the slider 37 and the elastic member 38. Thereby, the movable shaft 18 moves to the distal end side with respect to the sheath 3 together with the first member 45, the slider 37, and the elastic member 38.
  • the gripping pieces 16 and 17 rotates with respect to the sheath 3 and the space between the gripping pieces 16 and 17 is closed. At this time, the gripping pieces (16 and / or 17) rotate until the treatment target is compressed to some extent, and the gap between the gripping pieces 16 and 17 is closed until the treatment target is compressed to some extent.
  • the engaging portion 55A engages with the groove 51 at the angular position (first angular position) ⁇ 1a
  • the engaging portion 55B engages with the groove 51 at the angular position (first angular position) ⁇ 1b.
  • the state is set to the first engagement state
  • the engagement portion 55A is engaged with the groove 51 at the angular position (second angular position) ⁇ 2a
  • the engagement portion 55B is angular position (second angular position) ⁇ 2b.
  • the state engaged with the groove 51 is defined as a second engagement state. 3 to 6, the engaging portions 55A and 55B are engaged in the first engaging state in the groove 51, and in FIG. 7, the engaging portions 55A and 55B are engaged in the second engaging state in the groove 51.
  • Match the engaging portions 55A and 55B are engaged in the second engaging state in the groove 51.
  • the second width B2 is small. For this reason, the amount of movement of the handle 8 from when the handle 8 is most open to when each of the engaging portions 55A and 55B comes into contact with the first groove side surface 52 is smaller than that in the first engaged state. Small in the engaged state.
  • the movable shaft 18 starts moving toward the tip side at an earlier stage than in the first engagement state. If the other conditions such as the size of the treatment target to be grasped are the same, the slider 37 moves relative to the movable shaft 18 in the second engagement state at an earlier stage than the first engagement state. The movement starts, and the elastic member 38 starts to contract. For this reason, if the other conditions are the same, the amount of contraction of the elastic member 38 when the handle 8 is in contact with the stopper 9 is larger in the second engagement state than in the first engagement state. As a result, if the other conditions are the same, the elastic force from the elastic member 38 to the movable shaft 18 is larger in the second engagement state than in the first engagement state. The gripping force at is large.
  • the width B of the groove 51 continuously decreases in the range from the angular position (first angular position) ⁇ 1a to the angular position (second angular position) ⁇ 2a about the longitudinal axis C.
  • the width B of the groove 51 continuously decreases. For this reason, if the other conditions are the same, the closer the engagement position of the engagement portion 55A to the groove 51 is to the angular position (second angular position) ⁇ 2a, that is, the engagement of the engagement portion 55B to the groove 51.
  • the closer the alignment position is to the angular position (second angular position) ⁇ 2b the greater the elastic force from the elastic member 38 to the movable shaft 18 and the greater the gripping force between the gripping pieces 16,17.
  • the operation and effect of the treatment tool 2 of the present embodiment will be described.
  • the operator grasps the housing 5 and inserts the end effector 15 into a body cavity such as the abdominal cavity. Then, the engagement position of each of the engaging portions 55A and 55B in the groove 51 is adjusted by rotating the rotor assembly 40 about the longitudinal axis C by an operation at the convex portion 48, for example. And after adjusting each engaging position of engaging part 55A, 55B, the handle
  • the surgeon performs an operation input with the operation device 13, and electric energy is supplied from the power supply device 10 to the treatment tool 2.
  • treatment energy is applied to the treatment target as described above, and the grasped treatment target is treated.
  • the engaging portion 55A is moved to the angular position (first angular position).
  • Engage with the groove 51 at ⁇ 1a and engage the engaging portion 55B with the groove 51 at the angular position (first angular position) ⁇ 1b. That is, each of the engaging portions 55A and 55B is engaged with the groove 51 in the first engaged state.
  • the engaging portion 55A is positioned at an angular position (second angular position).
  • the engagement portion 55B is engaged with the groove 51 at an angular position (second angular position) ⁇ 2b. That is, each of the engaging portions 55A and 55B is engaged with the groove 51 in the second engaged state.
  • the elastic force from the elastic member 38 to the movable shaft 18 is larger in the second engagement state than in the first engagement state, and the gripping pieces 16, 17
  • the gripping force between the two is large. Therefore, by adjusting the engaging positions of the engaging portions 55A and 55B in the groove 51 as described above, compared with the case where electrical energy is supplied to the treatment instrument 2 in the first supply state, When electric energy is supplied to the treatment instrument 2 in the supply state 2, the gripping force between the gripping pieces 16 and 17 can be increased.
  • the gripping force between the gripping pieces 16 and 17 is larger in the treatment in which only the high-frequency current is applied to the treatment target than in the treatment in which the ultrasonic vibration and the high-frequency current are simultaneously applied to the treatment target.
  • the gripping force increases, so that the sealing performance and the coagulation performance of the treatment target are improved.
  • the gripping force does not increase in the treatment in which the ultrasonic vibration and the high-frequency current are simultaneously applied to the treatment target, the vibration due to the ultrasonic vibration is not hindered. For this reason, for example, ultrasonic vibration is appropriately transmitted to the gripping piece 16 shown in FIG. 1, and the ultrasonic vibration is appropriately applied to the treatment target.
  • the engaging positions of the engaging portions 55A and 55B are adjusted as described above.
  • the gripping force between the gripping pieces 16 and 17 is larger in the treatment in which the high-frequency current and the heater heat are simultaneously applied to the treatment target.
  • the incision performance of the treatment target is improved by increasing the gripping force in the treatment in which the high-frequency current and the heater heat are simultaneously applied to the treatment target.
  • the gripping force does not increase in the treatment in which only the high-frequency current is applied to the treatment target, it is effectively prevented that the treatment target such as a blood vessel is incised.
  • the rotor assembly 40 is rotated around the longitudinal axis C, and the engagement position of the engagement portions 55A and 55B of the handle 8 in the groove 51 is adjusted.
  • the gripping force between 16 and 17 is adjusted.
  • the grasping force of the treatment object between the grasping pieces is set to a magnitude suitable for the treatment in accordance with the treatment energy application state to the treatment object such as the type and size of the treatment energy given to the treatment object. It is adjustable. That is, the gripping force between the gripping pieces 16 and 17 can be adjusted to an appropriate magnitude in accordance with the supply state of electrical energy to the treatment instrument 2 and the like.
  • the housing 5 is provided with a first engagement portion 61.
  • the second member 46 of the rotor assembly 40 is provided with a second engaging portion 62 and a third engaging portion 63 that can engage with the first engaging portion 61.
  • the second engaging portion 62 and the third engaging portion 63 are located away from each other about the longitudinal axis C.
  • the operator who operates the rotor assembly 40 obtains a click feeling. For this reason, the surgeon can recognize that the engaging portions 55A and 55B are engaged in the first engagement state in the groove 51 based on the click feeling.
  • the engaging portion 55B is engaged with the groove 51 at the angular position (second angular position) ⁇ 2a, and the engaging portion 55B is engaged with the groove 51 at the angular position (second angular position) ⁇ 2b. That is, in the second engagement state, the third engagement portion 63 engages with the first engagement portion 61.
  • the operator who operates the rotor assembly 40 obtains a click feeling. Therefore, the surgeon can recognize that the engaging portions 55A and 55B are engaged in the second engagement state in the groove 51 based on the click feeling.
  • the housing 5 is provided with a first electrical contact 65.
  • a second electrical contact 66 is provided on the second member 46 of the rotor assembly 40.
  • the engaging portion 55A is engaged with the groove 51 at the angular position (second angular position) ⁇ 2a
  • the engaging portion 55B is engaged with the groove 51 at the angular position (second angular position) ⁇ 2b. That is, in the second engagement state, the second electrical contact 66 contacts the first electrical contact 65.
  • the processor 21 determines whether or not the electrical contacts 65 and 66 are in contact with each other based on whether or not a current flows between the electrical contacts 65 and 66. In this modification, the processor 21 controls the output of electrical energy from each of the output sources 26 and 27 based on whether or not the electrical contacts 65 and 66 are in contact with the operation of the operation member 28. , Controlling the supply of electrical energy to each of the electrical elements 23, 25. For example, in a state where the electrical contacts 65 and 66 are located apart from each other, the processor 21 causes the treatment tool 2 to supply electrical energy in the first supply state based on an operation input by the operation member 28. On the other hand, in a state where the electrical contacts 65 and 66 are in contact with each other, the processor 21 supplies electric energy to the treatment instrument 2 in the second supply state based on an operation input from the operation member 28.
  • the processor 21 determines the supply state of the electrical energy to the treatment instrument 2 based on whether or not the electrical contacts 65 and 66 are in contact with each other. The one corresponding to the engagement position of the handle 8 with the groove 51 of the rotor assembly 40 is selected. And if operation input is performed by the operating device 13, electric energy will be supplied to the treatment tool 2 in the selected supply state. For this reason, even if an operation is input with the same operating member 28 in a plurality of supply states, the processor 21 supplies electric energy to the treatment instrument 2 in an appropriate supply state corresponding to the gripping force between the gripping pieces 16 and 17. To supply. Therefore, the treatment energy is supplied to the treatment target in an appropriate application state corresponding to the grasping force between the grasping pieces 16 and 17.
  • At least one of the first engagement portion 61 and the first electrical contact 65 described above is provided on the handle 8.
  • the treatment instrument 2 is provided with an actuator 72 such as an electric motor or a solenoid.
  • the actuator 72 is provided in the housing 5, for example.
  • the power supply 10 is provided with an actuator power supply 71.
  • the actuator power supply 71 includes a conversion circuit and the like, and converts electric power from a battery power supply or an outlet power supply into electric energy supplied to the actuator 72. When the electric energy is supplied to the actuator 72, the actuator 72 is operated, and a driving force for rotating the rotor assembly 40 about the longitudinal axis C is generated.
  • the processor 21 controls the operation of the actuator 72 by controlling the output from the actuator power supply 71 based on the operation input from the operation device 13.
  • the operation of the actuator 72 is controlled by the processor 21, whereby the rotational drive of the rotor assembly 40 is controlled. Therefore, in the present modification, the engagement position of the engagement portions 55 ⁇ / b> A and 55 ⁇ / b> B of the handle 8 in the groove 51 is adjusted by the processor 21 based on the operation input from the operation device 13.
  • the processor 21 controls the rotational drive of the rotor assembly 40, whereby the engaging portion 55A is positioned at an angular position (first angular position).
  • the handle 8 and the rotor assembly are engaged with the groove 51 at ⁇ 1a and the engagement portion 55B is engaged with the groove 51 at the angular position (first angular position) ⁇ 1b, that is, in the first engagement state.
  • the engagement position with 40 is adjusted.
  • the processor 21 supplies electric energy to the electrical elements 23 and 25 in the first supply state, and applies treatment energy to the treatment target.
  • the processor 21 controls the rotational drive of the rotor assembly 40, so that the engaging portion 55B is in an angular position (second angular position).
  • the handle 8 and the rotor assembly are engaged with the groove 51 at ⁇ 2a and the engagement portion 55B is engaged with the groove 51 at the angular position (second angular position) ⁇ 2b, that is, in the second engagement state.
  • the engagement position with 40 is adjusted.
  • the processor 21 supplies electric energy to the electrical elements 23 and 25 in the second supply state, and applies treatment energy to the treatment target.
  • the engagement position of the handle 8 with the groove 51 of the rotor assembly 40 is changed to the operation input. Is automatically adjusted by the processor 21 to the appropriate engagement position corresponding to the treatment based on. That is, the processor 21 automatically adjusts the gripping force between the gripping pieces 16 and 17 to an appropriate size corresponding to the treatment based on the operation input. Then, after the processor 21 automatically adjusts the engagement position of the handle 8 with the groove 51 and the gripping force between the gripping pieces 16 and 17, the electrical elements 23 and 25 are supplied in a supply state based on an operation input. The electric energy is supplied to the treatment object, and the treatment energy is given to the treatment object.
  • the operation members 28A and 28B are attached to the housing 5 of the treatment instrument 2.
  • a rotational driving force is transmitted to the rotor assembly 40 by a mechanical mechanism, and the engagement position between the handle 8 and the rotor assembly 40 is adjusted to the first engagement state.
  • a rotational driving force is transmitted to the rotor assembly 40 by a mechanical mechanism, and the engagement position between the handle 8 and the rotor assembly 40 is adjusted to the second engagement state.
  • the movable shaft 18 moves to the tip side, so that the space between the gripping pieces 16 and 17 is closed, but the present invention is not limited to this.
  • the movable shaft 18 moves toward the proximal end, whereby the gap between the gripping pieces 16 and 17 is closed.
  • the cylindrical member 36 of the movable shaft 18 is disposed between the protruding portion 31 of the handle 8 and the fulcrum pin 32 (rotation axis P).
  • engaging portions 55 ⁇ / b> A and 55 ⁇ / b> B are provided between the protruding portion 31 and the fulcrum pin 32.
  • the slider 37 is provided on the tip side with respect to the protrusion 42 of the movable shaft 18.
  • a stopper 41 (not shown in FIG. 12) is provided on the tip side with respect to the slider 37, and the movement of the slider 37 to a region on the tip side from the stopper 41 is restricted.
  • one end (base end) of the elastic member 38 is in contact with or connected to the protrusion 42 of the movable shaft 18. Further, the other end (tip) of the elastic member 38 is in contact with or connected to the slider 37. Therefore, also in this modification, the elastic member 38 is provided between the movable shaft 18 and the slider 37 in the direction along the longitudinal axis C. Also in this modification, the rotor assembly 40 is attached to the slider 37, and the rotor assembly 40 can rotate around the longitudinal axis C with respect to the slider 37 and the handle 8. Also in this modification, the groove 51 is formed in the rotor assembly 40.
  • the groove 51 in each of the angular positions (first angular positions) ⁇ 1a and ⁇ 1b, the groove 51 has the first width B1 in the direction along the longitudinal axis C, and the angular position (second angle). In each of the positions ⁇ 2a and ⁇ 2b, the groove 51 has a second width B2 smaller than the first width B1 in the direction along the longitudinal axis C.
  • the groove 51 has groove side surfaces 52 and 53, and the second groove side surface 53 is located farther from the elastic member 38 than the first groove side surface 52 in the direction along the longitudinal axis C. To do.
  • the second groove side surface 53 is located on the tip side with respect to the first groove side surface 52.
  • the first groove side surface 52 is the end closer to the slider 37 of the elastic member 38 in the direction along the longitudinal axis C. It is located at a first distance D1 from E.
  • the first groove side surface 52 extends from the end E on the side close to the slider 37 of the elastic member 38 in the direction along the longitudinal axis C. It is located at a second distance D2 that is greater than the distance D1.
  • the handle 37 is closed with respect to the grip 7 until it comes into contact with the stopper 9, so that the slider 37 moves to the proximal end side with respect to the movable shaft 18.
  • the elastic member 38 contracts, and the elastic force from the elastic member 38 to the proximal end acting on the movable shaft 18 increases.
  • the gripping force of the treatment target between the gripping pieces 16 and 17 increases.
  • the amount of movement of the handle 8 from the state in which the handle 8 is most open until each of the engaging portions 55A and 55B abuts on the first groove side surface 52 is larger than that in the first engaged state. Small in the second engaged state. Therefore, when the handle 8 is closed, the movable shaft 18 starts to move toward the proximal end in the second engagement state at an earlier stage than the first engagement state. If the other conditions such as the size of the treatment target to be grasped are the same, the slider 37 moves relative to the movable shaft 18 in the second engagement state at an earlier stage than the first engagement state. The movement toward the proximal end is started, and the elastic member 38 starts to contract.
  • the angular position ⁇ 1a and the angular position ⁇ 2a are approximately 90 ° apart about the longitudinal axis C, and the angular position ⁇ 1b and the angular position ⁇ 2b are about the longitudinal axis C. Although it is approximately 90 ° apart, it is not limited to this. In a variation, the angular position (first angular position) ⁇ 1a is separated from the angular position (second angular position) ⁇ 2a by an angle smaller than 90 °, such as 30 ° or 45 °, about the axis of the longitudinal axis C. .
  • the angular position (first angular position) ⁇ 1b is separated from the angular position (second angular position) ⁇ 2b by approximately the same angle between the angular position ⁇ 1a and the angular position ⁇ 2a about the axis of the longitudinal axis C. .
  • the angular position (first angular position) ⁇ 1a is greater than 90 °, such as 120 ° or 135 ° about the axis of the longitudinal axis C, from the angular position (second angular position) ⁇ 2a, And the angle is less than 180 °.
  • the angular position (first angular position) ⁇ 1b is separated from the angular position (second angular position) ⁇ 2b by approximately the same angle between the angular position ⁇ 1a and the angular position ⁇ 2a about the axis of the longitudinal axis C. .
  • the width B of the groove 51 is continuous in the range from the angular position (first angular position) ⁇ 1a to the angular position (second angular position) ⁇ 2a about the longitudinal axis C.
  • a step is formed between the angular position ⁇ 1a and the angular position ⁇ 2a about the longitudinal axis C in the first groove side surface 52.
  • the width B of the groove 51 becomes substantially uniform at the first width B1, and from the step to the angular position (second angular position) ⁇ 2a.
  • the width B of the groove 51 is substantially uniform with a second width B2 smaller than the first width B1.
  • the same deformation is possible in the range from the angular position (first angular position) ⁇ 1b to the angular position (second angular position) ⁇ 2b about the longitudinal axis C.
  • the rotor assembly 40 described above may be applied to a configuration in which the end effector 15 can be bent or bent with respect to the sheath 3 (longitudinal axis C). If other conditions such as the elastic force from the elastic member 38 to the movable shaft 18 are the same, the end effector 15 is not bent or bent with respect to the sheath 3 in a state where the end effector 15 is bent or bent with respect to the sheath 3. Compared with the straight state, the gripping force between the gripping pieces 16 and 17 is small. If the other conditions are the same, the gripping force between the gripping pieces 16 and 17 is smaller as the bending angle or the bending angle of the end effector 15 with respect to the sheath 3 is larger.
  • the same rotor assembly 40 as that of the first embodiment is applied to a treatment instrument that can bend the end effector 15.
  • the engaging portion 55A in a straight state where the end effector 15 is not bent, the engaging portion 55A is engaged with the groove 51 at the angular position (first angular position) ⁇ 1a by the operation of the convex portion 48, etc.
  • the portion 55B is engaged with the groove 51 at the angular position (first angular position) ⁇ 1b.
  • the engaging position of the engaging portion 55A is brought closer to the angular position (second angular position) ⁇ 2a, and the engaging portion 55B is engaged.
  • the position is brought close to the angular position (second angular position) ⁇ 2b.
  • the elastic member is increased as the bending angle of the end effector 15 is increased.
  • the amount of contraction of 38 is large and the elastic force from the elastic member 38 to the movable shaft 18 is large. For this reason, the influence of the bending angle on the gripping force between the gripping pieces 16 and 17 is canceled by the influence of the elastic force from the elastic member 38 on the gripping force.
  • the gripping force between the gripping pieces 16 and 17 can be made uniform or substantially uniform.
  • the movable shaft (18) moves along the longitudinal axis (C) with respect to the sheath (3), so that the end effector (15) has a pair of gripping pieces (16, 17). Opens or closes, and movement of the slider (37) relative to the movable shaft (18) causes the elastic member (38) to expand or contract.
  • a rotor assembly (40) is attached to the slider (37) so as to be rotatable about the longitudinal axis (C), and the groove (51) of the rotor assembly (40) has first angular positions ( ⁇ 1a, ⁇ 1b).
  • B1 At the second angular position ( ⁇ 2a, ⁇ 2b) away from the first angular position ( ⁇ 1a, ⁇ 1b) about the longitudinal axis (C).
  • B1 has a smaller second width (B2).
  • the rotor assembly (40) rotates about the longitudinal axis (C) with respect to the slider (37), so that the first angular position ( ⁇ 1a, ⁇ 1b) and the second angular position ( ⁇ 2a, ⁇ 2b) In the meantime, the engagement position of the handle (8) and the groove (51) changes.
  • the present invention is not limited to the above-described embodiment, and various modifications can be made without departing from the scope of the invention in the implementation stage.
  • the embodiments may be appropriately combined as much as possible, and in that case, the combined effect can be obtained.
  • the above embodiments include inventions at various stages, and various inventions can be extracted by appropriately combining a plurality of disclosed constituent elements.

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  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Public Health (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Veterinary Medicine (AREA)
  • General Health & Medical Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Physics & Mathematics (AREA)
  • Otolaryngology (AREA)
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  • Ophthalmology & Optometry (AREA)
  • Surgical Instruments (AREA)

Abstract

Le présent instrument de traitement est configuré de sorte qu'une paire de pièces de préhension soit ouverte ou fermée lorsqu'un arbre mobile se déplace par rapport à une gaine, et qu'un élément élastique s'étende ou se contracte lorsqu'un curseur se déplace par rapport à l'arbre mobile. Une rainure dans un ensemble de rotor présente une première largeur à une première position angulaire et présente une seconde largeur à une seconde position angulaire séparée de la première position angulaire dans une direction autour d'un axe longitudinal, la seconde largeur étant inférieure à la première largeur. La position dans laquelle une poignée et la rainure sont en prise l'une avec l'autre change entre la première position angulaire et la seconde position angulaire lorsque l'ensemble de rotor tourne autour de l'axe longitudinal par rapport au curseur.
PCT/JP2017/021511 2017-06-09 2017-06-09 Instrument de traitement et système de traitement WO2018225258A1 (fr)

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PCT/JP2017/021511 WO2018225258A1 (fr) 2017-06-09 2017-06-09 Instrument de traitement et système de traitement

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2000254135A (ja) * 1999-03-09 2000-09-19 Olympus Optical Co Ltd 超音波凝固切開装置
JP2001017442A (ja) * 1999-07-09 2001-01-23 Olympus Optical Co Ltd 超音波処置装置
WO2003026519A1 (fr) * 2001-09-26 2003-04-03 Sentitic Forceps

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2000254135A (ja) * 1999-03-09 2000-09-19 Olympus Optical Co Ltd 超音波凝固切開装置
JP2001017442A (ja) * 1999-07-09 2001-01-23 Olympus Optical Co Ltd 超音波処置装置
WO2003026519A1 (fr) * 2001-09-26 2003-04-03 Sentitic Forceps

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