WO2019092822A1 - Outil de traitement - Google Patents

Outil de traitement Download PDF

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Publication number
WO2019092822A1
WO2019092822A1 PCT/JP2017/040327 JP2017040327W WO2019092822A1 WO 2019092822 A1 WO2019092822 A1 WO 2019092822A1 JP 2017040327 W JP2017040327 W JP 2017040327W WO 2019092822 A1 WO2019092822 A1 WO 2019092822A1
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WO
WIPO (PCT)
Prior art keywords
jaw
region
thickness dimension
gripping
heat
Prior art date
Application number
PCT/JP2017/040327
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English (en)
Japanese (ja)
Inventor
松木　薫
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/JP2017/040327 priority Critical patent/WO2019092822A1/fr
Publication of WO2019092822A1 publication Critical patent/WO2019092822A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/08—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

Definitions

  • the present invention relates to a treatment tool.
  • a treatment tool for treating (joining (or anastomizing) and cutting and the like) a living tissue by applying energy to the living tissue is known (see, for example, Patent Document 1).
  • a living tissue is gripped by a pair of gripping members (jaw portions) that can be opened and closed.
  • one gripping member hereinafter, referred to as a first gripping member
  • a heat transfer plate a metallized portion and a ceramic body
  • a heat generating body (heater assembly) and a heat transfer plate having a laminated structure in which the heat transfer plate and a jaw supporting the heat generating body are laminated. Then, in the treatment tool, the living tissue is grasped by the pair of gripping members, and the heating element is heated to heat the living tissue via the heat transfer plate to treat the living tissue.
  • the present invention has been made in view of the above, and it is an object of the present invention to provide a treatment tool capable of avoiding exerting an unintended action on a living tissue even when miniaturized. Do.
  • the treatment tool includes a first holding member and a second holding member for holding a living tissue
  • the first holding member being A laminated structure in which a heat transfer plate for transferring heat in contact with the living tissue, a heat generating body generating heat, and the heat transfer plate and a jaw supporting the heating member are stacked sequentially from the side of gripping the biological tissue
  • the region including the heating element is an inner region
  • each region located on the outer edge side of the inner region and sandwiching the inner region is a first outer region and a second
  • at least a part of the first outer region and At least a portion of the outer region of the second has a shape projecting respectively in the thickness direction of the jaws than the inner region.
  • the treatment tool according to the present invention it is possible to avoid exerting an unintended action on a living tissue even when miniaturized.
  • FIG. 1 is a view schematically showing a treatment system according to the first embodiment.
  • FIG. 2 is a view showing the grip portion.
  • FIG. 3 is a cross-sectional view of the first gripping member.
  • FIG. 4 is a diagram for explaining the effect of the first embodiment.
  • FIG. 5 is a cross-sectional view of a first gripping member according to the second embodiment.
  • FIG. 6 is a cross-sectional view of a first gripping member according to the third embodiment.
  • FIG. 7 is a cross-sectional view of the first gripping member according to the fourth embodiment.
  • FIG. 8 is a diagram showing a modification of the fourth embodiment.
  • FIG. 9 is a view showing a gripping portion according to the fifth embodiment.
  • FIG. 10 is a cross-sectional view of the first gripping member according to the fifth embodiment.
  • FIG. 11 is a cross-sectional view of the first gripping member according to the sixth embodiment.
  • FIG. 12 is a view showing a gripping portion according to the seventh embodiment.
  • FIG. 13 is a cross-sectional view of the first gripping member according to the seventh embodiment.
  • FIG. 14 is a view showing a gripping portion according to the eighth embodiment.
  • FIG. 15 is a view showing a gripping portion according to the eighth embodiment.
  • FIG. 16 is a cross-sectional view of the first gripping member according to the ninth embodiment.
  • FIG. 1 is a view schematically showing a treatment system 1 according to the first embodiment.
  • the treatment system 1 treats (such as bonding (or anastomosis) and dissection) a living tissue by applying thermal energy to the living tissue to be treated.
  • the treatment system 1 includes a treatment tool 2, a control device 3 and a foot switch 4 as shown in FIG.
  • the treatment tool 2 is, for example, a linear surgical treatment tool for treating a living tissue through the abdominal wall.
  • the treatment tool 2 includes a handle 5, a shaft 6, and a grip 7.
  • the handle 5 is a part held by the operator by hand. Further, as shown in FIG. 1, the handle 5 is provided with an operation knob 51.
  • the shaft 6 has a substantially cylindrical shape, and one end (the right end in FIG. 1) is connected to the handle 5. Further, a grip 7 is attached to the other end (left end in FIG. 1) of the shaft 6.
  • An opening / closing mechanism (shown in the drawing) opens and closes the first and second holding members 8 and 9 (FIG.
  • an electric cable C (FIG. 1) connected to the control device 3 passes from the one end side (right end portion side in FIG. 1) to the other end side (in FIG. 1) It is disposed up to the left end side).
  • FIG. 2 is a view showing the gripping portion 7.
  • the gripping portion 7 is a portion that grips a living tissue to treat the living tissue.
  • the gripping portion 7 includes first and second gripping members 8 and 9 as shown in FIG. 1 or 2.
  • the first and second gripping members 8 and 9 are supported by the other end (left end in FIGS. 1 and 2) of the shaft 6 so as to be able to open and close in the direction of arrow R1 (FIG. 2)
  • R1 FIG. 2
  • FIG. 3 is a cross-sectional view of the first gripping member 8.
  • FIG. 3 is a cross-sectional view in which the first gripping member 8 is cut along a plane orthogonal to the longitudinal direction from the distal end of the gripping portion 7 toward the proximal end.
  • the front end side described below is the front end side of the holding part 7, Comprising: The left side is meant in FIG. 1, FIG. Further, “proximal side” described below means the right side in FIGS. 1 and 2 on the side of the shaft 6 of the grip 7.
  • the first holding member 8 is disposed below the second holding member 9 in FIGS. 1 and 2.
  • the first gripping member 8 includes a heat generating structure 10 and a first jaw 11 as shown in FIG. 2 or 3.
  • the heat generating structure 10 generates thermal energy under the control of the controller 3.
  • the heat generating structure 10 includes a heat transfer plate 12, a heat generating body 13 (FIG. 3), and a heat insulating member 14.
  • the heat transfer plate 12 is made of high thermal conductivity copper, silver, aluminum, molybdenum, tungsten, graphite, or a composite material thereof, and the longitudinal direction from the tip end of the grip 7 toward the base end (FIG. 1, FIG. 2 In the left-right direction).
  • the first holding surface 121 is formed by a plane orthogonal to the thickness direction of the heat transfer plate 12 (vertical direction in FIG. 3).
  • the heating element 13 generates energy (thermal energy) to be applied to the living tissue under the control of the control device 3.
  • the heating element 13 partially generates heat, and functions as a sheet heater that heats the heat transfer plate 12 by the heat generation.
  • the heating element 13 includes a substrate 131 and a resistance pattern 132.
  • the substrate 131 is a long plate extending in the longitudinal direction of the grip portion 7 and is made of, for example, a high thermal conductivity ceramic such as aluminum nitride or alumina.
  • the resistance pattern 132 is made of, for example, a conductive material such as platinum and is formed on the substrate 131.
  • the resistance pattern 132 extends in a wavelike manner from the proximal side toward the distal side, and has a generally U-like shape that is folded at the distal side and extends in a wavelike manner toward the proximal side.
  • the resistance pattern 132 is not limited to platinum, and aluminum, SUS, or the like may be used.
  • the heat generating body 13 transfers heat via the bonding metal layer (for example, a multilayer film made of titanium, platinum and gold) provided on the back side of the surface of the substrate 131 on which the resistance pattern 132 is formed.
  • the thermal conductive high joining material which has ceramics, such as AuSn alloy, silver paste, or an alumina, as a main component.
  • the resistance pattern 132 generates heat when a voltage is applied (energized) through the two lead wires under the control of the control device 3.
  • the method of heat generation is not limited to the above-described resistance heating, and a configuration in which heat is generated by another heat generation method may be adopted.
  • the heat insulating member 14 is an elongated plate extending in the longitudinal direction of the grip portion 7 and is fixed to the back surface of the first grip surface 121 of the heat transfer plate 12 so as to cover the heating element 13.
  • the heat insulating member 14 is made of a resin material or the like having a thermal conductivity lower than that of the heat transfer plate 12 and the heating element 13. That is, by arranging the heat insulating member 14 having a low thermal conductivity on the side opposite to the heat transfer plate 12 with respect to the heat generating body 13, the heat generated by the heat generating body 13 is efficiently transmitted to the heat transfer plate 12. Is possible.
  • the first jaw 11 corresponds to the jaw according to the present invention.
  • the first jaw 11 is a portion in which a part of the shaft 6 is extended to the distal end side, and is formed in an elongated shape extending in the longitudinal direction of the grip portion 7.
  • the surface on the upper side in FIG. 2 or 3 is a plane orthogonal to the thickness direction of the first jaw 11 (vertical direction in FIGS. 2 and 3),
  • the heat generating structure 10 is supported in a posture in which the first gripping surface 121 faces upward. That is, the upper side surface corresponds to the support surface 111 according to the present invention.
  • the first gripping member 8 has a layered structure in which the heat transfer plate 12, the heat generating body 13, and the first jaw 11 are stacked in order from the side of gripping the living tissue. Further, in the first jaw 11, the lower surface (surface that forms the front and back sides with the support surface 111) in FIG. 2 or 3 corresponds to the outer surface 112 according to the present invention.
  • a stacked section orthogonal to the longitudinal direction of the gripping portion 7 is an inner area AI in the width direction (left and right direction in FIG. 3), and the first and second outer areas AO1 and AO2.
  • the inner area AI is an area including the heating element 13 and has the same width as the heating element 13.
  • the first and second outer regions AO1 and AO2 are regions located on both sides (outer edge side) in the width direction across the inner region AI.
  • the outer surface 112 has a concave shape in which both ends in the width direction protrude downward with respect to the other region in FIG. 3 and the other region is a plane orthogonal to the thickness direction of the first jaw 11.
  • the outer surface 112 has a shape that is symmetrical with respect to the center position CP in the width direction of the inner region AI.
  • the protruding portions of both ends in the width direction are described as the convex portion 113, and the portion between the two convex portions 113 is described as the noncontact portion 114. That is, in the outer surface 112 according to the first embodiment, a portion (convex portion 113) of the first outer region AO1 and a portion (convex portion 113) of the second outer region AO2 are more illustrated than the inner region AI. 3 has a shape projecting respectively downward (in the thickness direction of the first jaw 11).
  • the first jaw 11 has a first outer side than the largest thickness dimension of the inner area AI.
  • the largest thickness dimension of the region AO1 (the thickness dimension of the portion where the convex portion 113 is provided) and the largest thickness dimension of the second outer region AO2 (the thickness dimension of the portion where the convex portion 113 is provided) are large.
  • the first jaw 11 has the smallest thickness dimension at the center position CP, and a portion of the first outer region AO1 (a portion provided with the convex portion 113) and a portion of the second outer region AO2 (convex The thickness dimension is the largest at the portion where the portion 113 is provided.
  • the tips of the two convex portions 113 are respectively formed by planes orthogonal to the thickness direction of the first jaw 11. Further, as shown in FIG. 2, the two projections 113 extend over the entire length of the first jaw 11 in the longitudinal direction. Furthermore, in order to avoid contact of the living tissue with the non-contact portion 114, the protrusion dimension from the non-contact portion 114 in the two convex portions 113 is set to about 0.2 to 0.3 mm. The width dimension of the first jaw 11 is about 1 to 2 mm. The dimension in the longitudinal direction of the first jaw 11 is about 3 to 5 mm.
  • the second gripping member 9 comprises a second jaw 15 and a counterplate 16 as shown in FIG.
  • the lower surface of the second jaw 15 is a plane perpendicular to the thickness direction of the second jaw 15 in FIG. 2 and has an elongated shape extending in the longitudinal direction of the grip 7.
  • the second jaw 15 is pivotally supported at its proximal end side relative to the shaft 6 via the fulcrum P1 (FIG. 2), and is opened and closed relative to the first gripping member 8 by pivoting.
  • the first gripping member 8 first jaw 11
  • the second gripping member 9 second jaw 15
  • it has composition, it is not restricted to this.
  • both of the first and second gripping members 8 and 9 are pivotally supported by the shaft 6 and are respectively pivoted to rotate the first and second gripping members 8 , 9 may be adopted.
  • the first gripping member 8 first jaw 11
  • the second gripping member 9 second jaw 15
  • the first gripping member A configuration in which the second holding member 9 is opened and closed by rotating 8 may be adopted.
  • the opposing plate 16 is an elongated plate extending in the longitudinal direction of the grip 7 and is attached to the lower surface of the second jaw 15 in FIG.
  • the lower surface in FIG. 2 functions as a second gripping surface 161 for gripping a living tissue with the first gripping surface 121.
  • the second gripping surface 161 is formed of a plane orthogonal to the thickness direction of the opposing plate 16.
  • the foot switch 4 is a portion operated by the operator with a foot. And according to the operation concerned to foot switch 4, ON and OFF of energization from control device 3 to treatment implement 2 (heating element 13 (resistance pattern 132)) are changed. In addition, as a means to switch the said on and off, you may employ
  • the control device 3 is configured to include a CPU (Central Processing Unit) or the like, and centrally controls the operation of the treatment tool 2 in accordance with a predetermined control program. Specifically, the control device 3 applies a voltage to the heating element 13 (resistance pattern 132) through the electric cable C in response to the operation (operation of power on) of the operator by the operator. The heat plate 12 is heated.
  • a CPU Central Processing Unit
  • 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 outer surface 112 is a part of the first outer area AO1 and the second outer area AO2 in the laminated cross section orthogonal to the longitudinal direction of the first gripping member 8.
  • a part has a shape which each protruded in the thickness direction of the 1st jaw 11 rather than inner field AI. Therefore, as shown in FIG.
  • the contact area between the outer surface 112 and the living tissue LT can be made only at the tips of the two convex portions 113, and the contact area between the outer surface 112 and the living tissue LT can be reduced.
  • the two convex portions 113 are respectively provided in the first and second outer regions AO1 and AO2 (both ends in the width direction), a structure in which the living tissue LT is difficult to enter between the two convex portions 113 is realized. be able to. That is, in the outer surface 112, the living tissue LT can be prevented from coming into contact with the inner region AI which becomes the highest temperature by the heat transfer from the heating element 13. Therefore, according to the treatment tool 2 according to the first embodiment, it is possible to avoid exerting an unintended effect on the living tissue LT even in the case of downsizing.
  • the first jaw 11 has the largest thickness dimension of the first outer region AO1 (the convex portion 113 is provided than the largest thickness dimension of the inner region AI
  • the thickness dimension of the portion and the largest thickness dimension of the second outer region AO2 (the thickness dimension of the portion where the convex portion 113 is provided) are large. For this reason, the thermal resistance of the part in which the convex part 113 was provided can be increased, and the temperature rise of the front-end
  • the first jaw 11 has the smallest thickness dimension at the central position CP, and a part of the first outer region AO1 (a portion provided with the convex portion 113) And the thickness dimension is the largest in a part of the second outer side area AO2 (the part where the convex portion 113 is provided). Therefore, in the outer surface 112, the biological tissue LT can be effectively prevented from coming into contact with the inner region AI which becomes the highest temperature by the heat transfer from the heating element 13.
  • the outer surface 112 is the first jaw relative to the other region in the widthwise end of the laminated cross section orthogonal to the longitudinal direction of the first holding member 8.
  • Each has a concave shape which protrudes in the thickness direction of 11 and the other area is flat.
  • the processing cost (manufacturing cost) of the first jaw 11 (the treatment tool 2) can be reduced.
  • FIG. 5 is a cross-sectional view of the first gripping member 8A according to the second embodiment. Specifically, FIG. 5 is a cross-sectional view corresponding to FIG. In the first gripping member 8A (the first jaw 11A) according to the second embodiment, as shown in FIG. 5, the first gripping member 8 (FIG. 3) described in the first embodiment described above is used. Thus, the outer surface 112A having a noncontacting portion 114A different in shape from the noncontacting portion 114 is employed. The first jaw 11A corresponds to the jaw according to the present invention.
  • the non-contacting portion 114A is inclined upward toward the center position CP in the width direction of the inner area AI from each edge in the width direction at the tips of the two convex portions 113 in FIG. 1, and has a V-shaped cross section.
  • Outer surface 112A has a shape that is symmetrical with reference to central position CP. That is, as in the case of the outer surface 112 described in the first embodiment, the outer surface 112A according to the second embodiment is a part of the first outer region AO1 (the convex portion 113) and the second outer region A portion (convex portion 113) of AO2 has a shape in which it protrudes to the lower side (the thickness direction of the first jaw 11A) in FIG. 5 with respect to the inner region AI.
  • the first jaw 11A is the first embodiment described above.
  • the largest thickness dimension of the first outer region AO1 thickness dimension of the portion provided with the convex portion 113
  • the largest thickness dimension of the outer region AO2 is large.
  • the first jaw 11A has the smallest thickness dimension at the central position CP, and a part of the first outer region AO1 (the protrusion 113 Are the largest in the portion where the second portion A2 is provided and the portion of the second outer region AO2 (the portion where the convex portion 113 is provided). Further, the thickness dimension of the first jaw 11A decreases in the direction from the portion with the largest thickness dimension provided with the two convex portions 113 to the center position CP.
  • FIG. 6 is a cross-sectional view of the first gripping member 8B according to the third embodiment. Specifically, FIG. 6 is a cross-sectional view corresponding to FIG. In the first gripping member 8B (the first jaw 11B) according to the third embodiment, as shown in FIG. 6, the first gripping member 8 (FIG. 3) described in the first embodiment described above is used. Thus, the outer surface 112B having a noncontacting portion 114B different in shape from the noncontacting portion 114 is employed. The first jaw 11B corresponds to the jaw according to the present invention.
  • the non-contact portion 114B is configured as a concave surface which straddles between the respective edge portions on the inner side in the width direction at the tips of the two convex portions 113, and the center position CP is recessed upward in FIG.
  • Outer surface 112B has a shape that is symmetrical with reference to central position CP. That is, as in the case of the outer surface 112 described in the first embodiment, the outer surface 112B according to the third embodiment is a part of the first outer region AO1 (the convex portion 113) and the second outer region It has a shape in which a part of AO2 (convex part 113) protrudes on the lower side (the thickness direction of the first jaw 11B) than the inner area AI.
  • the support surface 111 is formed of the above-described flat surface and the outer surface 112B (the non-contact portion 114B) is formed of the above-described concave curved surface
  • the first jaw 11B is described in the first embodiment described above. Similar to the first jaw 11, the largest thickness dimension of the first outer region AO1 (thickness dimension of the portion provided with the convex portion 113) and the second outer region than the largest thickness dimension of the inner region AI The largest thickness dimension of AO2 (the thickness dimension of the portion where the convex portion 113 is provided) is large.
  • the first jaw 11B has the smallest thickness dimension at the central position CP, and a part of the first outer region AO1 (convex portion 113 Are the largest in the portion where the second portion A2 is provided and the portion of the second outer region AO2 (the portion where the convex portion 113 is provided). Further, as in the case of the first jaw 11A described in the second embodiment described above, the first jaw 11B moves from the portion with the largest thickness dimension provided with the two convex portions 113 toward the central position CP The thickness dimension is smaller.
  • FIG. 7 is a cross-sectional view of a first gripping member 8C according to the fourth embodiment. Specifically, FIG. 7 is a cross-sectional view corresponding to FIG. In the first gripping member 8C (the first jaw 11C) according to the fourth embodiment, as shown in FIG. 7, the first gripping member 8 (FIG. 3) described in the first embodiment described above is used. Thus, the outer surface 112C having a noncontacting portion 114C having a shape different from that of the noncontacting portion 114 is employed. The first jaw 11C corresponds to the jaw according to the present invention.
  • the non-contact portion 114C is formed in a comb shape having a plurality of (four in the fourth embodiment) convex portions 117 whose height dimension is smaller than that of the two convex portions 113.
  • convex part 113, 117 is described as large convex part 113 and small convex part 117, respectively.
  • the respective tips of the plurality of small convex portions 117 are respectively configured by planes that are orthogonal to the thickness direction of the first jaw 11C, similarly to the large convex portions 113.
  • the two large convex portions 113 and the plurality of small convex portions 117 are provided at a predetermined interval from each other.
  • the outer surface 112C has a shape that is symmetrical with respect to the center position CP. That is, as in the case of the outer surface 112 described in the first embodiment described above, the outer surface 112C according to the fourth embodiment is a part (large convex portion 113) of the first outer region AO1 and the second outer A part (large convex part 113) of field AO2 has the shape where each projected to the lower side (thickness direction of the 1st jaw 11C) rather than inside field AI.
  • the support surface 111 is configured by the above-described flat surface and the outer surface 112C is formed as described above, the first jaw 11C is the same as the first jaw 11 described in the first embodiment.
  • the largest thickness dimension of the first outer region AO1 thickness dimension of the portion where the large convex portion 113 is provided
  • the largest thickness dimension of the second outer region AO2 than the largest thickness dimension of the inner region AI is large.
  • the first jaw 11C has the smallest thickness dimension at the central position CP, and a part of the first outer region AO1 (large convex portion The thickness dimension is largest at a portion where the portion 113 is provided and a part of the second outer region AO2 (a portion where the large convex portion 113 is provided).
  • the non-contact portion 114C is formed in a comb shape. Therefore, even if the living tissue LT contacts the non-contact portion 114C, the contact area between the living tissue LT and the non-contact portion 114C is small. That is, it is possible to avoid exerting an unintended action on the living tissue LT.
  • FIG. 8 is a diagram showing a modification of the fourth embodiment. Specifically, FIG. 8 is a cross-sectional view corresponding to FIG. In the fourth embodiment described above, as shown in FIG. 8, each tip of the plurality of small convex portions 117 may be configured by an inclined surface which is inclined upward as it goes to the center position CP.
  • FIG. 9 is a view showing a gripping portion 7D according to the fifth embodiment.
  • FIG. 10 is a cross-sectional view of a first gripping member 8D according to the fifth embodiment. Specifically, FIG. 10 is a cross-sectional view in which the first gripping member 8D is cut along a plane orthogonal to the longitudinal direction from the tip of the gripping portion 7D toward the proximal end.
  • the gripping portion 7D (first gripping member 8D) according to the fifth embodiment as shown in FIG.
  • the gripping portion 7 (FIG. 2, FIG. 3) described in the first embodiment described above is used.
  • the first jaw 11D having a structure different from that of the first jaw 11 is employed.
  • the first jaw 11D corresponds to the jaw according to the present invention.
  • the first jaw 11D includes a jaw body 17, a protection member 18, and an elastic member 19.
  • the jaw main body 17 is a portion in which a part of the shaft 6 is extended to the tip end side, and has a shape in which the two convex portions 113 are omitted from the first jaw 11 described in the first embodiment described above. That is, in the jaw body 17, the upper surface in FIG. 9 or FIG. 10 corresponds to the support surface 111D according to the present invention, and supports the heat generating structure 10 with the first gripping surface 121 facing upward. Do. Moreover, in the jaw main body 17, the surface on the lower side in FIG. 9 or 10 is configured by a plane orthogonal to the thickness direction (vertical direction in FIG. 10) of the jaw main body 17.
  • the protection member 18 is formed of a long plate extending in the longitudinal direction of the grip 7D.
  • the upper surface is a plane perpendicular to the thickness direction of the protective member 18 (vertical direction in FIG. 10).
  • the lower surface is the two convex portions similar to the two convex portions 113 and the non-contact portion 114 on the outer surface 112 described in the first embodiment described above. It functions as an outer surface 112D according to the present invention having a portion 113D and a non-contact portion 114D.
  • the elastic member 19 is provided between the jaw body 17 and the protective member 18, and can be elastically deformed in the thickness direction (vertical direction in FIG. 10) of the first jaw 11D.
  • the elastic member 19 is formed of a plurality of coil springs.
  • the present invention is not limited to this. If elastic deformation is possible in the thickness direction of the first jaw 11D, the elastic member 19 is a sheet-like member. You may configure it.
  • an elastic member 19 which is elastically deformable in the thickness direction of the first jaw 11D is provided between the jaw main body 17 and the protective member 18. Therefore, when the living tissue LT contacts the outer surface 112D of the protective member 18, the elastic deformation of the elastic member 19 absorbs the surface pressure on the living tissue LT, and the outer surface 112D and the living tissue LT Contact area can be reduced. Therefore, heat is less likely to be transmitted to the living tissue LT, and it is possible to avoid exerting an unintended effect on the living tissue LT.
  • FIG. 11 is a cross-sectional view of a first gripping member 8E according to the sixth embodiment. Specifically, FIG. 11 is a cross-sectional view corresponding to FIG.
  • the convex portion 113 is The first jaw 11E (outer surface 112E) having two projections 113E different in the shape of the tip is adopted.
  • the first jaw 11E corresponds to the jaw according to the present invention.
  • the tip of the convex portion 113E is formed of a convex curved surface whose center in the width direction protrudes downward in FIG.
  • the low friction material 118 is coated on the tip. That is, the outer surface of the first jaw 11E according to the sixth embodiment is formed such that the tip of the convex portion 113E (low friction material 118) has the smallest coefficient of friction.
  • the outer surface of the first jaw 11E according to the sixth embodiment is formed such that the tip of the convex portion 113E (low friction material 118) has the smallest coefficient of friction. For this reason, even if the living tissue LT contacts the outer surface 112E (two convex portions 113E), sliding occurs when a force is applied, and in the living tissue LT, the site in contact with the outer surface 112E is another site. It becomes. Therefore, heat is not applied to the same site in the living tissue LT for a long time, and it is possible to avoid exerting an unintended effect on the living tissue LT.
  • FIG. 12 is a view showing a gripping portion 7F according to the seventh embodiment.
  • FIG. 13 is a cross-sectional view of a first gripping member 8F according to the seventh embodiment. Specifically, FIG. 13 is a cross-sectional view in which the first gripping member 8F is cut in a plane orthogonal to the width direction of the gripping portion 7F (the direction orthogonal to the longitudinal direction from the tip to the proximal end of the gripping portion 7F). is there.
  • the gripping portion 7F (first gripping member 8F) according to the seventh embodiment, as shown in FIG. 12 or 13, the gripping portion 7 (FIG. 2, FIG. 3) described in the first embodiment described above is used.
  • the first jaw 11F having an outer surface 112F shaped differently from the outer surface 112 is employed.
  • the first jaw 11F corresponds to the jaw according to the present invention.
  • an inner area AI 'and a first and second outer area AO1' in the longitudinal direction are stacked cross sections orthogonal to the width direction of the gripping portion 7F. , AO2 '(Fig. 13).
  • the inner region AI ′ is a region including the heating element 13 and has the same longitudinal dimension as the heating element 13.
  • the first and second outer regions AO1 ′ and AO2 ′ are regions located on both sides (outer edge side) in the longitudinal direction across the inner region AI ′. Specifically, in the outer surface 112F, both ends in the longitudinal direction protrude downward with respect to the other region in FIG.
  • the other region corresponds to the thickness direction of the first jaw 11F (vertical direction in FIG. It has a concave shape that is a plane orthogonal to
  • the outer surface 112F the protruding portions of the both ends in the longitudinal direction are described as the convex portion 113F, and the portion between the two convex portions 113F is described as the non-contact portion 114F. That is, in the outer surface 112F according to the seventh embodiment, a part (convex part 113F) of the first outer area AO1 'and a part (convex part 113F) of the second outer area AO2' are the inner area AI '. Rather than FIG.
  • the first jaw 11F has a first thickness larger than the largest thickness dimension of the inner area AI '.
  • the largest thickness dimension of the outer region AO1 '(the thickness dimension of the portion where the convex portion 113F is provided) and the largest thickness dimension of the second outer region AO2' (the thickness dimension of the portion where the convex portion 113F is provided) are large .
  • the thickness dimension of the first jaw 11F is smallest at the center position CP 'in the longitudinal direction of the inner area AI', and a part of the first outer area AO1 '(a part provided with the convex portion 113F)
  • the thickness dimension is the largest at a part of the second outer area AO2 '(the portion where the convex portion 113F is provided).
  • the tips of the two convex portions 113F are respectively configured by planes orthogonal to the thickness direction of the first jaw 11F. Further, as shown in FIG. 12, the two convex portions 113F extend over the entire length of the first jaw 11F in the width direction.
  • FIG. 14 and 15 are views showing a gripping portion 7G according to the eighth embodiment.
  • FIG. 14 is a perspective view of the grip 7G as viewed from the support surface 111 side.
  • FIG. 15 is a perspective view of the grip 7G as viewed from the outer surface 112G side.
  • the gripping portion 7G the first gripping member 8G
  • FIG. 14 or 15 the gripping portion 7 (FIG. 2, FIG. 3) described in the first embodiment described above is used.
  • a first jaw 11G having an outer surface 112G shaped differently from the outer surface 112 is employed.
  • the first jaw 11G corresponds to the jaw according to the present invention.
  • both the two convex portions 113 described in the first embodiment and the two convex portions 113F described in the seventh embodiment are provided on the outer surface 112G.
  • the two convex portions 113 and the two convex portions 113F are connected to each other and have a rectangular frame shape.
  • FIG. 16 is a cross-sectional view of the first holding member 8H according to the ninth embodiment. Specifically, FIG. 16 is a cross-sectional view corresponding to FIG.
  • the first jaw 11 is used for the first holding member 8 (FIG. 3) described in the first embodiment described above.
  • the first jaw 11H has a different structure.
  • the first jaw 11H corresponds to the jaw according to the present invention.
  • the first jaw 11H includes a jaw body 20 and a low thermal conductivity member 21.
  • the jaw body 20 is a portion in which a part of the shaft 6 is extended to the distal end side, and has the same shape as the first jaw 11 described in the first embodiment described above. That is, in the jaw body 20, the surface on the upper side in FIG. 16 corresponds to the support surface 111H according to the present invention, and supports the heat generating structure 10 with the first gripping surface 121 facing upward. Further, in the jaw body 20, the lower surface 201 in FIG. 16 is the two convex portions 113H similar to the two convex portions 113 and the non-contact portion 114 on the outer surface 112 described in the first embodiment described above. And a noncontact portion 114H.
  • the low thermal conductivity member 21 is an elongated plate extending in the longitudinal direction of the first jaw 11H, and is attached to the entire surface of the non-contact portion 114H.
  • the low thermal conductivity member 21 is made of a resin material or the like having a thermal conductivity lower than that of the jaw body 20. Further, the thickness dimension of the low heat conducting member 21 is set smaller than the height dimension of the convex portion 113H. And each front end of two convex parts 113H, each side surface of the width direction inner side of the two convex parts 113H, and lower side surface 211 in Drawing 16 in low heat conduction member 21 are outer surface 112H concerning the present invention Equivalent to.
  • the outer surface 112H according to the ninth embodiment is a part of the first outer region AO1 (the convex portion 113H) and the second outer region A portion (convex portion 113) of AO2 has a shape in which it protrudes to the lower side (the thickness direction of the first jaw 11H) in FIG. 16 with respect to the inner area AI.
  • the support surface 111 is configured by the above-described flat surface and the outer surface 112H is configured as described above, the first jaw 11H is the same as the first jaw 11 described in the first embodiment.
  • the largest thickness dimension of the first outer region AO1 and the largest thickness dimension of the second outer region AO2 are larger than the largest thickness dimension of the inner region AI. Furthermore, like the first jaw 11 described in the first embodiment, the first jaw 11H has the smallest thickness dimension at the central position CP, and a part of the first outer region AO1 (the convex portion 113H Is the largest in the portion where the second portion A2 is provided and the portion of the second outer region AO2 (the portion where the convex portion 113H is provided).
  • the first jaw 11H according to the ninth embodiment is provided in the jaw body 20 forming the support surface 111H and in the inner area AI, has a lower thermal conductivity than the jaw body 20, and
  • the low thermal conductive member 21 which comprises the outer surface 112H is provided. Therefore, even if the living tissue LT intrudes between the two convex portions 113, the living tissue LT comes into contact with the low thermal conductive member 21 in which the heat transfer from the jaw main body 20 is suppressed. That is, it is possible to avoid exerting an unintended action on the living tissue LT.
  • the present invention should not be limited only by the above-described first to ninth embodiments.
  • the two convex portions 113, 113D to 113F, 113H are respectively provided at both ends in the longitudinal direction or the width direction of the first holding members 8, 8A to 8H. Not limited to. As long as they are respectively provided in the first outer area AO1 and AO1 ′ and the second outer area AO2 and AO2 ′, two convex portions 113 and 113D to 113F and 113H may be provided at other positions.
  • two convex portions 113, 113D to 113F, 113H may be provided on the entire first outside area AO1, AO1 'and the second outside area AO2, AO2'. Furthermore, if provided in each of the first outer area AO1 and AO1 ′ and the second outer area AO2 and AO2 ′, two convex portions 113 and 113D to 113F and 113H are opposed in the width direction and the longitudinal direction. You don't have to.
  • the convex portions 113, 113D to 113F, 113H, and 117 are integrally formed on the first jaws 11, 11A to 11H, but the present invention is not limited to this. It does not matter.
  • the first and second gripping surfaces 121 and 161 are formed in a plane, but the present invention is not limited to this, and may be formed in a convex shape, a concave shape, a mountain shape or the like. I do not care.
  • the low friction material 118 may be coated on the entire outer surface 112E. In addition, the coefficient of friction may be reduced by adjusting the surface roughness by surface treatment or the like without coating the low friction material 118.
  • the configuration for generating thermal energy is employed, but not limited to this, a configuration for generating high frequency energy or ultrasonic energy in addition to thermal energy may be employed.
  • the heating element 13 and the outer surfaces 112 and 112A to 112H according to the present invention may be provided on both of the first holding members 8 and 8A to 8H and the second holding member 9.

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

Abstract

Cet outil de traitement (2) est pourvu d'un premier élément de maintien (8) et d'un second élément de maintien (9) pour maintenir un tissu biologique. Le premier élément de maintien (8) a une structure en couches dans laquelle, à partir du côté où le tissu biologique est maintenu, une plaque de transfert de chaleur (12) qui est mise en contact avec le tissu biologique et transmet à celui-ci la chaleur, un générateur de chaleur (13) pour générer de la chaleur, et une mâchoire (11) pour supporter la plaque de transfert de chaleur (12) et le générateur de chaleur (13) sont empilés dans l'ordre indiqué. La mâchoire (11) comporte : une surface de support (111) qui fait face à la plaque de transfert de chaleur (12) et supporte la plaque de transfert de chaleur (12) et le générateur de chaleur (13); et une surface externe (112) qui, conjointement avec la surface de support (111), constituent les deux faces opposées du même corps. Dans une section transversale en couches du premier élément de maintien (8), une région de la surface externe (112) qui comprend le générateur de chaleur (13) est appelée région interne (AI) et des régions qui sont situées plus près du bord externe que la région interne (AI) et des deux côtés de la région interne (AI) sont appelées première et seconde régions externes (AO1, AO2). La surface externe (112) est formée de telle sorte qu'une partie de la première région externe (AO1) et une partie de la seconde région externe (AO2) font saillie au-delà de la région interne (AI) dans la direction de l'épaisseur de la mâchoire (11).
PCT/JP2017/040327 2017-11-08 2017-11-08 Outil de traitement WO2019092822A1 (fr)

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2006187323A (ja) * 2004-12-28 2006-07-20 Olympus Corp 処置具及び医療用処置装置
JP2013541988A (ja) * 2010-10-01 2013-11-21 エシコン・エンド−サージェリィ・インコーポレイテッド 顎部材を有する外科用器具
US20140276735A1 (en) * 2013-03-15 2014-09-18 Ethicon Endo-Surgery, Inc. Tissue Clamping Features of Surgical Instrument End Effector
WO2017043120A1 (fr) * 2015-09-09 2017-03-16 オリンパス株式会社 Dispositif médical

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2006187323A (ja) * 2004-12-28 2006-07-20 Olympus Corp 処置具及び医療用処置装置
JP2013541988A (ja) * 2010-10-01 2013-11-21 エシコン・エンド−サージェリィ・インコーポレイテッド 顎部材を有する外科用器具
US20140276735A1 (en) * 2013-03-15 2014-09-18 Ethicon Endo-Surgery, Inc. Tissue Clamping Features of Surgical Instrument End Effector
WO2017043120A1 (fr) * 2015-09-09 2017-03-16 オリンパス株式会社 Dispositif médical

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