WO2019106737A1 - Outil de préhension médical - Google Patents

Outil de préhension médical Download PDF

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Publication number
WO2019106737A1
WO2019106737A1 PCT/JP2017/042731 JP2017042731W WO2019106737A1 WO 2019106737 A1 WO2019106737 A1 WO 2019106737A1 JP 2017042731 W JP2017042731 W JP 2017042731W WO 2019106737 A1 WO2019106737 A1 WO 2019106737A1
Authority
WO
WIPO (PCT)
Prior art keywords
piece
gripping
slit
grip
medical
Prior art date
Application number
PCT/JP2017/042731
Other languages
English (en)
Japanese (ja)
Inventor
隆志 中村
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/JP2017/042731 priority Critical patent/WO2019106737A1/fr
Publication of WO2019106737A1 publication Critical patent/WO2019106737A1/fr

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Classifications

    • 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

Definitions

  • the present invention relates to a medical grasper.
  • Patent Literature 1 a medical grasper provided with a plurality of insulating protrusions that strike when closed on opposing surfaces of a pair of grasping pieces that are opened and closed by being mutually pivoted.
  • Patent Literature 1 a medical grasper provided with a plurality of insulating protrusions that strike when closed on opposing surfaces of a pair of grasping pieces that are opened and closed by being mutually pivoted.
  • Patent Literature 1 a medical grasper provided with a plurality of insulating protrusions that strike when closed on opposing surfaces of a pair of grasping pieces that are opened and closed by being mutually pivoted
  • the gap size between gripping pieces may be varied depending on the type of tissue to be gripped and the type of treatment performed while gripping.
  • the swing of the grasping pieces can not be stopped at a predetermined gap size until the projection butts, and only a single dimension gap is realized when the projection butts. There is a disadvantage that you can not do it.
  • the present invention has been made in view of the above-described circumstances, and it is an object of the present invention to provide a medical grasper capable of stopping relative swing between grasping pieces with a plurality of predetermined gap sizes. There is.
  • a pair of gripping pieces that are supported so as to be able to swing relative to a predetermined axis and that can be opened and closed;
  • a power transmission unit for transmitting the driving force supplied by the operation unit to the holding piece, and one or more of the holding units disposed on one side of the holding unit with respect to the operation unit and between the maximum opening state and the closing state And an intermediate locking means for locking at a predetermined locking angle.
  • the driving force supplied by the operation of the operation unit is transmitted to the gripping piece via the power transmission unit, and at least one of the gripping pieces is swung relative to the other, thereby causing the pair of The gripping piece is opened and closed.
  • the object can be gripped between the pair of gripping pieces, or the gripped object can be released.
  • the pair of gripping pieces are locked by the intermediate locking means at one or more locking angles intermediate between the maximum open state and the closed state. Thereby, relative swings of the gripping pieces can be stopped at a plurality of predetermined gap sizes.
  • a bendable portion may be provided between the operation portion and the grip piece, and the intermediate locking means may be provided on one side of the bend from the bend portion.
  • the locking angle of the pair of gripping pieces is fluctuated by the intermediate locking means provided on one gripping side of the curved portion. I do not have to do it. Thereby, a pair of holding pieces can be always locked at the same locking angle.
  • the intermediate locking means may be provided on the grip piece. In this way, regardless of the form of the path from the operation portion to the gripping piece, the pair of gripping pieces can always be locked at the same locking angle.
  • the intermediate locking unit may change the ratio of the amount of gripping force by the gripping piece to the amount of input force to the power transmission unit at the locking angle.
  • the intermediate locking means includes a sliding portion that slides along with the swing of the grip piece
  • the sliding resistance in the sliding portion may be changed at the locking angle. Good.
  • the sliding portion in the longitudinal direction of the slit, is a slit provided in a pair of the holding pieces, and a driving force received in the slit and transmitted by the power transmission portion.
  • a sliding pin may be provided, and a recess or a projection that changes the sliding resistance between the pin and the slit may be provided at an intermediate position in the length direction of at least one of the slits.
  • the pin is a slit in the slit provided in the pair of gripping pieces along with the swinging. Slide along the length of the If the sliding surface of the slit with the pin is smooth, the sliding resistance does not change, but the sliding resistance changes if the pin reaches a recess or a protrusion provided at an intermediate position in the length direction. The change allows the operator to recognize that the locking angle has been reached.
  • the intermediate locking means swings the gripping piece in the closing direction or swings the gripping piece in the opening direction, the gripping piece is locked It is also good.
  • the intermediate locking means locks the swinging of the gripping piece, depending on the tissue to be gripped and the type of treatment performed while gripping.
  • the treatment can be performed by locking at a plurality of appropriate locking angles.
  • the intermediate locking means locks the swinging of the gripping piece, so that the gripping piece can be prevented from being opened too much at one time when the gripping piece is opened. .
  • the pin slides and moves on the inner surface of the slit different in the width direction between swinging the gripping piece in the opening direction and swinging the gripping piece in the closing direction. It is also good.
  • the intermediate locking means is provided on one of the inner surfaces in the width direction of the slit, whereby the gripping piece is engaged at a predetermined locking angle in either the opening operation or the closing operation. It can be operated smoothly without locking on the other.
  • FIG. 1 shows the 1st slit of the holding part in the state of FIG. 3, a 2nd slit, and a pin. It is an enlarged view which shows the modification of the 2nd slit of FIG.
  • FIG. 1 It is an enlarged view which shows the other modification of the 2nd slit of FIG.
  • It is a modification of the medical grasper of Drawing 1 and is the elements on larger scale of the medical grasper provided with the middle stop means which holds on the way which makes the 2nd grasping piece move from the closed state to the maximum open state. is there.
  • FIG. It is the elements on larger scale which show the modification provided with the amplification mechanism of the force of the medical grasper of FIG.
  • FIG. 15 is a partially enlarged view showing an intermediate locked state of the medical grasper of FIG. 14; It is the elements on larger scale which show the closed state of the medical grasper of FIG. It is the elements on larger scale which show the maximum open state of the other modification of the medical grasper of FIG.
  • FIG. 18 is a partially enlarged view showing an intermediate locked state of the medical grasper of FIG. 17; It is the elements on larger scale which show the middle locking state of the other modification of the medical grasper of FIG.
  • the medical grasping tool 1 includes a long flexible insertion portion (curved portion) 2, a grasping portion 3 disposed at the tip of the insertion portion 2, and an insertion portion
  • the control unit 4 includes an operation unit 4 disposed at the base end of the drive unit 2, a power transmission unit 5 for transmitting the driving force applied from the operation unit 4 to the grip unit 3, and an intermediate locking unit 6.
  • the insertion portion 2 is a tube having at least one lumen penetrating in the longitudinal direction. When inserted into a body cavity, the insertion portion 2 is curved according to the shape of the body cavity by being inserted through a channel of an endoscope or an overtube, and the grasping portion 3 of the tip is disposed in the vicinity of the affected area It can be done.
  • the gripping portion 3 is an inserting portion with respect to the first gripping piece (gripping piece) 7 fixed to the tip of the insertion portion 2 and the first gripping piece 7.
  • a second grip piece (gripping piece) 8 swingably supported around a rocking axis (axis) A orthogonal to the longitudinal axis of 2 is provided.
  • the pair of gripping pieces 7 and 8 are pivoted about the pivot axis A, so that the tip is separated as shown in FIG. 2 and the tip is brought into close contact as shown in FIG. It is made to be able to be opened and closed mutually between states.
  • the gripping portion 3 is provided with a power conversion mechanism (sliding portion) 9 for converting the tension transmitted by the power transmission portion 5 to be described later into the swinging motion of the second gripping piece 8 to the first gripping piece 7. It is done.
  • the power conversion mechanism 9 is provided in the linear first slit (slit) 10 provided in the first gripping piece 7 along the longitudinal direction of the insertion portion 2 and in the second gripping piece 8, and is provided in the first slit 10.
  • a second slit (slit) 11 extending in a crossing direction, and a cylindrical pin 12 inserted at the intersection position of the first slit 10 and the second slit 11 and disposed parallel to the swing axis A There is.
  • the operation unit 4 has any known structure operated by the operator, and supplies the force applied by the operator as a force along the longitudinal direction of the insertion unit 2 to the power transmission unit 5.
  • the power transmission unit 5 includes a wire 13 which penetrates the inside of the lumen of the insertion unit 2 and connects the operation unit 4 and the grip unit 3. The force supplied from the operation unit 4 is transmitted as tension and transmitted to the gripping unit 3.
  • the pin 12 constituting the power conversion mechanism 9 is fixed to the tip of the wire 13.
  • the pin 12 By pulling the wire 13 proximally, when the pin 12 is pulled proximally by the tension transmitted by the wire 13, the pin 12 can be linearly moved proximally along the first slit 10. ing. Since the pin 12 is also inserted into the second slit 11, as the pin 12 moves, the crossing position of the first slit 10 and the second slit 11 moves, so that the second slit 11 is pushed by the pin 12 and shaken. As it rotates around the movement axis A, the second gripping piece 8 provided with the second slit 11 is made to swing around the swing axis A with respect to the first gripping piece 7.
  • the intermediate locking means 6 is an inner surface on one side in the width direction, ie, a side on which the pin 12 is moved when the pin 12 is moved to the proximal side, at a substantially central position in the longitudinal direction of the second slit 11 It is comprised by providing the recessed part 14 in inner surface.
  • the operator can sense the change in the operation unit 4. That is, the operator can maintain the angle of the second gripping piece 8 at the position where the change in the amount of gripping force is sensed, and realize an intermediate locking state between the maximum open state and the closed state. It can be done.
  • the second grasping piece 8 is closed to the first grasping piece 7 as shown in FIG. It is inserted into the channel of the inserted endoscope or overtube, and is made to project from the tip opening of the channel so as to face the affected part.
  • the operator operates the operation unit 4 to push the wire 13 to the tip end side, thereby applying the force to the first grip piece 7 as shown in FIG.
  • the second gripping piece 8 is swung to the maximum open state.
  • the second slit 11 whose crossing position with the first slit 10 is changed is the swing axis A
  • the second gripping piece 8 is rotated about the swing axis A with respect to the first gripping piece 7 by rotating around.
  • the pin 12 pushes the inner surface of the second slit 11 on the side where the recess 14 is not provided, the pin 12 does not engage with the recess 14 and is substantially constant along the straight inner surface.
  • the second gripping piece 8 can be swung smoothly by the sliding resistance of
  • the second gripping piece 8 is operated by operating the operation unit 4 and applying a force in a direction to pull the wire 13 proximally. 1) It is swung in the closing direction with respect to the gripping piece 7. And, as shown in FIG. 3, when the pin 12 is fitted into the recess 14, as shown in FIG. 6, the tangential direction and the movement of the pin 12 at the contact position between the pin 12 and the inner surface of the second slit 11 The angle ⁇ with the direction (that is, the longitudinal direction of the first slit 10) is sufficiently large as compared with the case where the position is other than the concave portion 14. That is, since the sliding resistance between the pin 12 and the second slit 11 rapidly increases at the position where the pin 12 fits in the recess 14, the swinging motion of the second gripping piece 8 with respect to the first gripping piece 7 Once locked.
  • the treatment performed in a state in which the tissue is sandwiched between the pair of gripping pieces 7 and 8 is, for example, a treatment for coagulating the tissue by electric energy or the like
  • the intermediate open state shown in FIG. It is also possible to set the gap between the two to be the optimal gap for solidification. Then, when the tissue is coagulated and then cut, the wire 13 is pulled by a further strong force, thereby disengaging the pin 12 from the state of being fitted in the concave portion 14 and as shown in FIG.
  • the pieces 7, 8 can be brought close to the closed state to cut the tissue.
  • the intermediate locking means 6 is provided not in the operation unit 4 but in the grip unit 3, the insertion unit between the grip unit 3 and the operation unit 4 Regardless of the shape of 2, there is an advantage that the intermediate locking angle can be maintained constant. That is, although the intermediate locking means 6 can be provided on the operation unit 4 side, in that case, there is a disadvantage that the intermediate locking angle changes due to the change of the path length of the wire 13 due to the shape of the insertion portion 2
  • the medical grasper 1 according to the present embodiment does not have such a disadvantage, and the gap between the first grasping piece 7 and the second grasping piece 8 in the intermediate open state can be maintained constant.
  • the sliding resistance between the pin 12 and the inner surface of the second slit 11 is rapidly changed.
  • a convex portion 15 may be provided on the inner surface of the second slit 11. This likewise allows the sliding resistance to be rapidly changed to easily achieve an intermediate open position.
  • the width of the second slit 11 is gradually expanded from the distal end side toward the proximal end side, The shape may be made to shrink.
  • a recess 14 may be provided on the inner surface of the second slit 11 on the side to be pressed when the pin 12 is moved toward the tip end side.
  • the pair of gripping pieces 7 and 8 can be prevented from being opened unintentionally and it is possible to prevent an open state when pulling out from the channel of the endoscope or the overtube. Can.
  • the concave portion 14 or the convex portion 15 is provided in the second slit 11, but instead, the concave portion 14 or the convex portion 15 may be provided in the first slit 10.
  • the case where the tip of the wire 13 is directly fixed to the pin 12 has been described, but instead, as shown in FIG. 16, 17 may be provided, and the wires 13a, 13b may be wound around these pulleys 16, 17.
  • the wire 13 a whose tip is fixed to the insertion portion 2 or the first gripping piece 7 is wound around the pulley 16 provided on the pin 12 to swing the second gripping piece 8 in the closing direction.
  • the pulling force of the pin 12 can be amplified to twice the tension to perform the closing operation with a smaller tension.
  • the direction in which the second gripping piece 8 is opened by fixing the tip to the second gripping piece 8 and winding the wire 13 b wound around the pulley 16 of the pin 12 on the pulley 17 provided on the swinging axis A the pulling force of the pin 12 can be amplified to four times the tension to perform the opening operation with a smaller tension.
  • the sliding resistance is changed by providing the concave portion 14 or the convex portion 15 in the second slit 11, as shown in FIGS. 12 and 13, the first gripping piece 7 and the second gripping piece 8 And a sliding portion 18 that starts contact near the intermediate locking angle to increase sliding resistance.
  • the drive system in this case is not limited to the wire 13.
  • the sliding portion 18 provided on the second grip piece 8 does not contact the first grip piece 7 at an angle between the maximum open state shown in FIG. 12 and the locked state shown in FIG.
  • the dynamic resistance is maintained low, but from the locked state shown in FIG. 13 to the closed state, the sliding portion 18 contacts the first gripping piece 7 to make the first gripping piece 7 and the second gripping piece 8 Since the sliding resistance between them increases, the operator can sense the change and temporarily stop the operation in the locked state of FIG.
  • a spring 20 is provided between the first gripping piece 7 and the second gripping piece 8 to start an elastic deformation by contacting in the vicinity of an intermediate locking angle. May be Also by this, the elastic deformation of the spring 20 is started in the intermediate locking state on the way from the maximum open state to the closed state, and the amount of operation force increases, so that the operator can recognize this state. .
  • the shapes of the first gripping piece 7 and the second gripping piece 8 may be configured to form a certain gap in the intermediate locked state.
  • the tissue can be sandwiched to a uniform thickness in the intermediate locked state, and uniform treatment can be performed in the case of coagulation or the like.
  • the tissue can be easily cut by shearing at the time of transition to the closed state.
  • magnets 21 and 22 are employed instead of the sliding portion 18 of FIGS. 12 and 13, and different magnetic poles are opposed to each other in an intermediate locked state.
  • the magnets 21 and 22 may be fixed to the first grip piece 7 and the second grip piece 8.
  • the magnetic attraction force generated by the magnets 21 and 22 is maximized in the intermediate locked state shown in FIG. 22. Therefore, the second gripping piece 8 can be arranged more reliably in the intermediate locked state. .
  • the second grip piece 8 may be provided on the wire 13 for driving.
  • the wire 13 is penetrated into the sleeve 23, and the friction coefficient of the inner surface of the sleeve 23 is larger on the proximal side (hatched portion in the figure) than on the distal side. You should do it.
  • the sliding portion 18 fixed to the wire 13 reaches a region with a large coefficient of friction near the position where the second gripping piece 8 is in the intermediate locked state, After that, the amount of operation power to the closed state can be increased.
  • a stopper 25 is provided on the first gripping piece 7 to abut the projection 24 provided on the second gripping piece 8.
  • the stopper 25 may be made movable between a position where the projection 24 abuts and a position not in contact with the projection 24.
  • the first gripping piece 7 is fixed to the tip end of the insertion portion 2 and the second gripping piece 8 is movably supported relative to the first gripping piece 7 by way of example.
  • the present invention is not limited to this, and the present invention may be applied to the gripping portion 3 in which both the first gripping piece 7 and the second gripping piece 8 are swingably supported around the swing axis A.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Ophthalmology & Optometry (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

Le but de la présente invention est d'arrêter le pivotement relatif entre des pièces de préhension à une pluralité prédéterminée de dimensions d'espace. Cet outil de préhension médical (1) est pourvu : d'une paire de pièces de préhension (7, 8) qui peuvent s'ouvrir et se fermer et qui sont supportées pour être relativement pivotantes autour d'un axe prédéterminé ; d'une partie d'actionnement (4) qui fournit une force d'entraînement pour amener au moins l'une des pièces de préhension (7, 8) à pivoter ; d'une partie de transmission de force (5) qui transmet la force d'entraînement fournie par la partie d'actionnement (4) à la pièce de préhension (8) ; et d'un moyen de verrouillage intermédiaire (6) qui est disposé plus près des pièces de préhension (7, 8) que la partie d'actionnement (4), et amène la pièce de préhension (8) à être verrouillée à un ou plusieurs angles de verrouillage prédéterminés entre un état d'ouverture maximale et un état fermé.
PCT/JP2017/042731 2017-11-29 2017-11-29 Outil de préhension médical WO2019106737A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/JP2017/042731 WO2019106737A1 (fr) 2017-11-29 2017-11-29 Outil de préhension médical

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/JP2017/042731 WO2019106737A1 (fr) 2017-11-29 2017-11-29 Outil de préhension médical

Publications (1)

Publication Number Publication Date
WO2019106737A1 true WO2019106737A1 (fr) 2019-06-06

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PCT/JP2017/042731 WO2019106737A1 (fr) 2017-11-29 2017-11-29 Outil de préhension médical

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WO (1) WO2019106737A1 (fr)

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2011251122A (ja) * 2010-06-02 2011-12-15 Tyco Healthcare Group Lp 電気外科処置を行うための装置
US20120022584A1 (en) * 2010-07-23 2012-01-26 Stephen Donnigan Jaw Movement Mechanism and Method for a Surgical Tool
US20120289999A1 (en) * 2011-05-11 2012-11-15 Timothy Graham Frank Medical Instrument For Grasping An Object, In Particular A Needle Holder
WO2013140648A1 (fr) * 2012-03-21 2013-09-26 オリンパスメディカルシステムズ株式会社 Instrument de traitement endoscopique
WO2014185515A1 (fr) * 2013-05-17 2014-11-20 オリンパスメディカルシステムズ株式会社 Outil de traitement endoscopique

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2011251122A (ja) * 2010-06-02 2011-12-15 Tyco Healthcare Group Lp 電気外科処置を行うための装置
US20120022584A1 (en) * 2010-07-23 2012-01-26 Stephen Donnigan Jaw Movement Mechanism and Method for a Surgical Tool
US20120289999A1 (en) * 2011-05-11 2012-11-15 Timothy Graham Frank Medical Instrument For Grasping An Object, In Particular A Needle Holder
WO2013140648A1 (fr) * 2012-03-21 2013-09-26 オリンパスメディカルシステムズ株式会社 Instrument de traitement endoscopique
WO2014185515A1 (fr) * 2013-05-17 2014-11-20 オリンパスメディカルシステムズ株式会社 Outil de traitement endoscopique

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