WO2023157315A1

WO2023157315A1 - Ultrasonic treatment tool and ultrasonic probe

Info

Publication number: WO2023157315A1
Application number: PCT/JP2022/007039
Authority: WO
Inventors: 真倫一方井; 正美押田; 理人松岡; 尚之水戸
Original assignee: オリンパス株式会社
Priority date: 2022-02-21
Filing date: 2022-02-21
Publication date: 2023-08-24

Abstract

This ultrasonic treatment tool is provided with: an ultrasonic probe which has a main body part that transmits ultrasonic vibrations and a processing part that is positioned at the tip of the main body part and cuts a target to be processed, i.e., a bone or a cartilage, by means of the ultrasonic vibrations; a cover member which has a tubular shape, covers the base end side of the main body part, and has a first engaging part and a second engaging part formed at different positions from each other in the length direction; and a sheath which has a tubular shape, covers the base end side of the cover member, and has a first engagement counterpart to be engaged with the first engaging part and a second engagement counterpart to be engaged with the second engaging part. According to this configuration, an ultrasonic treatment tool is provided, in which the two sets of the engaging parts and the engagement counterparts can be prevented from undergoing the simultaneous application of a force in such a direction that the engagement between the engaging parts and the engagement counterparts is released.

Description

Ultrasonic treatment tool and ultrasonic probe

The present invention relates to ultrasonic treatment tools and ultrasonic probes.

Conventionally, an ultrasonic treatment tool that cuts bones by ultrasonic vibration has been known. This ultrasonic treatment instrument includes an ultrasonic probe that transmits ultrasonic vibrations from a proximal end to a distal end, a cover member that covers the proximal side of the ultrasonic probe, and a sheath that covers the proximal side of the cover member. Prepare.

Patent Document 1 discloses that the sheath and the cover member are engaged with each other by so-called snap fit, in which one of the sheath and the cover member has an engaging portion including a claw and the other has an engaged portion including a hole. A suitable configuration is described. In this ultrasonic treatment instrument, two snap fits are provided at the same position in the longitudinal direction of the ultrasonic probe and at symmetrical positions with respect to the central axis of the ultrasonic probe.

WO2019/097689

The ultrasonic treatment instrument is inserted through the cannula or directly into the patient's body. At this time, the ultrasonic treatment instrument may be pressed against the cannula, the living body, or the like, and force may be applied in the direction in which the engagement between the engaging portion and the engaged portion is released.

In the configuration of Patent Document 1, when a force is applied to one snap fit in a direction to disengage the snap fit, the other snap fit located on the opposite side is also engaged with the snap fit. A force is applied in the direction in which the is released.

The present invention has been made in view of the above, and a force is simultaneously applied to the two engaging portions and the engaged portion in a direction in which the engagement between the engaging portion and the engaged portion is released. An object of the present invention is to provide an ultrasonic treatment instrument and an ultrasonic probe that prevent this.

In order to solve the above-described problems and achieve the object, an ultrasonic treatment device according to an aspect of the present invention provides a main body that transmits ultrasonic vibrations, and a distal end of the main body that transmits the ultrasonic vibrations. and an ultrasonic probe having a treatment portion for cutting a bone or cartilage to be treated by means of an ultrasonic probe, and a tubular cover member covering the base end side of the main body portion, which are formed at different positions in the longitudinal direction. a cover member having a first engaging portion and a second engaging portion; and a tubular sheath covering a base end side of the cover member, the first engaged portion being engaged with the first engaging portion. A sheath having a joining portion and a second engaged portion that engages with the second engaging portion.

Further, in the ultrasonic treatment device according to one aspect of the present invention, one of the first engaging portion and the first engaged portion, or one of the second engaging portion and the second engaged portion is , a plurality of holes, and a wall portion located between the adjacent holes, and the other of the first engaging portion or the first engaged portion, or the second engaging portion or the second The other of the two engaged portions has a plurality of claws that are fitted into the holes.

Further, in the ultrasonic treatment device according to one aspect of the present invention, the other of the first engaging portion or the first engaged portion, or the second engaging portion or the second engaged portion The other has a bulging portion that bulges in the direction opposite to the direction in which the claw protrudes, and the distance between the surface of the bulging portion and the surface of the ultrasonic probe is smaller than the height of the claw. .

Further, in the ultrasonic treatment instrument according to one aspect of the present invention, the ultrasonic probe has a blade formed on a first surface facing the first direction, and the diameter becomes smaller toward the tip. The first engaging portion and the first engaged portion are provided in the first direction with respect to the central axis of the ultrasonic probe, and the second engaging portion and the second The engaged portion is provided on the front end side of the first engaging portion and the first engaged portion, and is located on the side opposite to the first direction with respect to the central axis of the ultrasonic probe. 2 direction.

Further, the ultrasonic treatment device according to one aspect of the present invention includes a covering portion that covers the first engaging portion and the first engaged portion or the second engaging portion and the second engaged portion. Prepare.

Further, in the ultrasonic treatment device according to one aspect of the present invention, the sheath has a shape that covers the surface of the cover member.

Further, in the ultrasonic treatment device according to one aspect of the present invention, the cover member is made of resin.

Further, an ultrasonic treatment instrument according to an aspect of the present invention includes a lining member in which a surface of the main body is lined, and the ultrasonic probe is held by the sheath via the lining member. .

Further, an ultrasonic treatment device according to an aspect of the present invention holds an ultrasonic probe that transmits ultrasonic vibrations from a proximal end to a distal end, and a tubular ultrasonic probe that is inserted inside. A sheath, a cylindrical inner tube positioned inside the sheath and covering the ultrasonic probe, and a lining provided on the surface of the ultrasonic probe, between the ultrasonic probe and the inner tube. a lining member for keeping the gap watertight, wherein the lining member includes a protrusion that protrudes from the outer surface of the ultrasonic probe toward the sheath side; and a thick portion that is greater than or equal to a predetermined value.

Further, an ultrasonic probe according to an aspect of the present invention includes a main body that transmits ultrasonic vibrations from a proximal end toward a distal end in a longitudinal direction, and a target that is positioned at a distal end of the main body and is subjected to treatment by the ultrasonic vibrations. A treatment portion for cutting bone or cartilage, comprising a first surface, a second surface facing the opposite side of the first surface, and a direction from the first surface toward the second surface a concave recess, a first blade formed along a direction intersecting with the longitudinal direction at the edge of the tip side of the recess, and a first blade continuing to the first blade and extending in the longitudinal direction at the edge of the recess and a treatment portion having a second blade formed therealong.

According to the present invention, an ultrasonic treatment instrument that prevents a force from being simultaneously applied to two engaging portions and an engaged portion in a direction in which the engagement between the engaging portion and the engaged portion is released, and ultrasonic probes.

FIG. 1 is a schematic diagram showing the configuration of an ultrasonic treatment device according to an embodiment. 2 is a view in the direction of arrow A in FIG. 1. FIG. 3 is a view in the direction of arrow B in FIG. 1. FIG. FIG. 4 is an enlarged view of the tip of the ultrasonic probe. FIG. 5 is an enlarged view of the treatment portion of the ultrasonic probe. FIG. 6 is an enlarged view of the treatment portion of the ultrasonic probe. FIG. 7 is an enlarged view of the distal end portion of the ultrasonic treatment instrument. FIG. 8 is an enlarged view of the distal end portion of the ultrasonic treatment instrument. FIG. 9 is a cross-sectional view of the distal end portion of the ultrasonic treatment instrument. FIG. 10 is an enlarged view of the first engaging portion and the first engaged portion. FIG. 11 is an enlarged view of the second engaging portion and the second engaged portion. FIG. 12 is a diagram showing how the first engaging portion is pressed when the wall portion is not formed. FIG. 13 is a diagram showing how the first engaging portion is pressed when a wall portion is formed. FIG. 14 is an enlarged cross-sectional view of area A1 shown in FIG. FIG. 15 is a cross-sectional view enlarging the area A2 shown in FIG. FIG. 16 is a diagram showing the state of the lining member when no load is applied to the ultrasonic probe. FIG. 17 is a diagram showing how the lining member deforms when a load is applied to the ultrasonic probe. FIG. 18 is a flowchart showing an overview of surgery using the ultrasonic treatment device according to the embodiment. 19 is a cross-sectional view of the distal end portion of the ultrasonic treatment device according to Modification 1. FIG. 20 is a cross-sectional view of the distal end portion of the ultrasonic treatment device according to Modification 2. FIG.

Embodiments of an ultrasonic treatment tool and an ultrasonic probe according to the present invention will be described below with reference to the drawings. It should be noted that the present invention is not limited by these embodiments. In the following embodiments, the present invention can be applied to ultrasonic treatment tools and ultrasonic probes in general.

Also, in the description of the drawings, the same or corresponding elements are given the same reference numerals as appropriate. Also, it should be noted that the drawings are schematic, and the relationship of dimensions of each element, the ratio of each element, and the like may differ from reality. Even between the drawings, there are cases where portions with different dimensional relationships and ratios are included.

(Embodiment)
FIG. 1 is a schematic diagram showing the configuration of an ultrasonic treatment device according to an embodiment. 2 is a view in the direction of arrow A in FIG. 1. FIG. 3 is a view in the direction of arrow B in FIG. 1. FIG. As shown in FIGS. 1 to 3, the ultrasonic treatment instrument 1 according to this embodiment includes a treatment instrument main body 2, an ultrasonic probe 3, a cover member 4, and a sheath 5. As shown in FIGS.

The ultrasonic treatment instrument 1 is used, for example, for arthroscopic subacromial decompression (ASD). Arthroscopic subacromial decompression is an operation in which the sharp part of the bone on the back side of the acromion is shaved while observing with an arthroscope. The ultrasonic treatment instrument 1 is inserted into the patient's body through a cannula that has been inserted into the patient's body to undergo surgery, and when cutting a sharp portion of the bone on the back side of the acromion by ultrasonic vibration. Used. Note that the ultrasonic treatment instrument 1 may be directly inserted into the patient's body without using a cannula.

The treatment instrument main body 2 holds the proximal ends of the ultrasonic probe 3 , the cover member 4 , and the sheath 5 . In the treatment section main body 2, an ultrasonic transducer (for example, a bolt-clamped Langevin transducer) that generates ultrasonic vibrations according to the supplied driving power and transmits them to the ultrasonic probe 3 -type transducer)) is connected.

FIG. 4 is an enlarged view of the tip of the ultrasonic probe. As shown in FIG. 4, the ultrasonic probe 3 includes a main body portion 31 that transmits ultrasonic vibrations from the proximal end to the distal end in the longitudinal direction, and a distal end portion of the main body portion 31 that is positioned at the distal end of the main body portion 31 to transmit ultrasonic vibrations to an object to be treated. and a treatment portion 32 for cutting a certain bone or cartilage. The diameter of the main body portion 31 is tapered toward the tip.

　FIGS. 5 and 6 are enlarged views of the treatment portion of the ultrasonic probe. As shown in FIGS. 5 and 6, the treatment portion 32 of the ultrasonic probe 3 has a first surface 321 facing in a first direction (hereinafter also referred to as "front side") and a surface opposite to the first surface 321. A second surface 322 facing a second direction (hereinafter also referred to as “back side”), a recess 323 recessed from the first surface 321 toward the second surface 322, and an edge on the tip side of the recess 323. A first blade 324 formed along a direction intersecting the longitudinal direction, and a second blade 325 continuous with the first blade 324 and formed along the longitudinal direction at the edge of the recess 323. , has Both sides of the treatment portion 32 can be cut by the second blade 325, and the degree of freedom of treatment is high. In addition, since the treatment portion 32 can be made thinner than a double-edged configuration having blades on both sides of the first surface 321 and the second surface 322, treatment can be easily performed even on a treatment target in a narrow position. be able to.

7 and 8 are enlarged views of the tip of the ultrasonic treatment instrument. FIG. 9 is a cross-sectional view of the distal end portion of the ultrasonic treatment instrument. As shown in FIGS. 7 to 9, the cover member 4 has a tubular shape and covers the base end side of the body portion 31. As shown in FIGS. The cover member 4 has a large-diameter portion located on the proximal end side and a small-diameter portion located on the distal end side, the first direction of which the first blade 324 is formed being narrower than the large-diameter portion. have. The small-diameter portion is preferably thinner than the broken line L connecting the tip of the ultrasonic probe 3 and the tip of the large-diameter portion (not in contact with the broken line L). The cover member 4 has a first engaging portion 41 formed on the front side (first direction) with respect to the central axis of the ultrasonic probe 3 and , and a second engaging portion 42 formed on the back side (second direction). Also, the first engaging portion 41 and the second engaging portion 42 are formed at different positions in the longitudinal direction of the ultrasonic probe 3 . Specifically, the position P2 in the longitudinal direction of the second engaging portion 42 is located on the distal side from the position P1 in the longitudinal direction of the first engaging portion 41 . The cover member 4 is made of resin such as PEEK (Poly Ether Ether Ketone). Since the cover member 4 is made of PEEK with high rigidity, external force is applied to the first engaging portion 41 or the second engaging portion 42, and the first engaging portion 41 and the first engaged portion It is possible to prevent the engagement with the portion 51 or the engagement between the second engaging portion 42 and the second engaged portion 52 from being released.

The sheath 5 is made of, for example, a metal or alloy, has a tubular shape, and covers the base end side of the cover member 4 . In addition, the sheath 5 is partially cut away on the distal end side in the first direction in which the first blade 324 is formed. The sheath 5 is formed on the front side and has a first engaged portion 51 that engages with the first engaging portion 41, and is formed on the back side and engages with the second engaging portion 42. and a second engaged portion 52 . In addition, the sheath 5 has a shape on the back side that widely covers the surface of the cover member 4 to the tip side. As a result, the force that pulls the cover member 4 in the distal direction due to the frictional force generated by the contact of the cover member 4 with an external object is prevented, and the second engaging portion 42 and the second cover are prevented from being applied. Disengagement of the engagement with the engaging portion 52 is prevented.

FIG. 10 is an enlarged view of the first engaging portion and the first engaged portion. As shown in FIG. 10 , the first engaged portion 51 includes two

holes

511 and 512 that are separated from each other, and a wall portion 513 positioned between the

holes

511 and 512 that are adjacent to each other. and have The first engaging portion 41 has two

claws

411 and 412 that fit into the

hole portions

511 and 512, respectively. That is, the first engaging portion 41 and the first engaged portion 51 are fitted to each other by a snap fit method. Note that the first engaged portion 51 may have a plurality of claws, and the first engaging portion 41 may have a plurality of holes and walls.

FIG. 11 is an enlarged view of the second engaging portion and the second engaged portion. As shown in FIG. 11, the second engaged portion 52 includes two

hole portions

521 and 522 that are separated from each other, and a wall portion 523 positioned between the

hole portions

521 and 522 that are adjacent to each other. and have The second engaging portion 42 has two

claws

421 and 422 that fit into the

hole portions

521 and 522, respectively. That is, the second engaging portion 42 and the second engaged portion 52 are fitted to each other by a snap fit method. The second engaged portion 52 may have a plurality of claws, and the second engaging portion 42 may have a plurality of holes and walls.

Here, the function of the wall portion 513 (wall portion 523) will be described. FIG. 12 is a diagram showing how the first engaging portion is pressed when the wall portion is not formed. As shown in FIG. 12, when the first engaged portion 51' of the sheath 5' does not have a wall portion, an object C such as a cannula or a patient's living body presses the

claws

411 and 412, A force is applied in a direction to release the engagement between the engaged portion 51 ′ and the first engaging portion 41 .

FIG. 13 is a diagram showing how the first engaging portion is pressed when the wall portion is formed. As shown in FIG. 13, when the first engaged portion 51 has the wall portion 513, the wall portion 513 receives the force from the object C, thereby preventing excessive depression and load on the

claws

411 and 412. , it is possible to prevent the engagement between the first engaged portion 51 and the first engaging portion 41 from being released. Note that the wall portion 523 can also prevent the engagement between the second engaged portion 52 and the second engaging portion 42 from being released, similarly to the wall portion 513 .

FIG. 14 is a cross-sectional view enlarging the area A1 shown in FIG. As shown in FIG. 14, the ultrasonic treatment instrument 1 has a tubular shape, is positioned inside a sheath 5, and has an inner tube 6 that covers the ultrasonic probe 3 and a lining on the surface of the ultrasonic probe 3. and a lining member 7 for keeping the space between the ultrasonic probe 3 and the inner tube 6 watertight.

The lining member 7 has a protrusion 71 that protrudes from the outer surface of the ultrasonic probe 3 toward the sheath 5 side. The ultrasonic probe 3 is held by the sheath 5 via the lining member 7 .

FIG. 15 is a cross-sectional view enlarging the area A2 shown in FIG. As shown in FIG. 15, the ultrasonic treatment instrument 1 has a lining on the surface of the ultrasonic probe 3 and includes a lining member 8 that keeps the space between the ultrasonic probe 3 and the inner tube 6 watertight.

The lining member 8 includes a protruding portion 81 protruding from the outer surface of the ultrasonic probe 3 toward the sheath 5, a thick portion 82 located on the distal end side of the protruding portion 81 and having a thickness equal to or greater than a predetermined value, have The ultrasonic probe 3 is held by the sheath 5 via the lining member 8 .

Here, the function of the thick portion 82 will be explained. FIG. 16 is a diagram showing the state of the lining member when no load is applied to the ultrasonic probe. As shown in FIG. 16, when no load is applied to the ultrasonic probe 3, the projecting portion 81 of the lining member 8 is pressed by the inner tube 6 and is compressed by a thickness Δ1.

FIG. 17 is a diagram showing how the lining member is deformed when a load is applied to the ultrasonic probe. As shown in FIG. 17 , when a load is applied to the ultrasonic probe 3 , the lining member 8 is compressed with the position of the sheath 5 facing the load as a fulcrum, and the outer circumference of the thick portion 82 contacts the sheath 5 . At this time, on the side opposite to the position where the lining member 8 is most compressed, the thickness at which the projecting portion 81 of the lining member 8 is crushed is reduced by the displacement of the central axis of the ultrasonic probe 3, and the thickness Δ1 It has a thickness of Δ2. Since the thickness of the thick portion 82 is set to a predetermined value or more so that the thickness ΔT2 is zero or more, the space between the sheath 5 and the lining member 8 can be kept watertight. In addition, since the thick portion 82 is thick, it is possible to prevent the ultrasonic probe 3 from bending and coming into contact with the sheath 5 .

According to the embodiment described above, the first engaging portion 41 and the first engaged portion 51 and the second engaging portion 42 and the second engaged portion 52 are positioned at different longitudinal directions. , the first engaging portion 41 and the first engaged portion 51 and the second engaging portion 42 and the second engaged portion 52 are simultaneously engaged with each other. is prevented from applying a force to release the

Next, surgery using the ultrasonic treatment device 1 will be described. FIG. 18 is a flowchart showing an overview of surgery using the ultrasonic treatment device according to the embodiment. The flowchart shown in FIG. 18 represents arthroscopic subacromial decompression as an example, but the ultrasonic treatment device 1 can also be used for other surgeries.

First, set up for surgery (step S1). Specifically, the patient is anesthetized and positioned appropriately.

Next, create a portal in the patient's surgical site (step S2).

After that, insert the arthroscope into the created portal (step S3). Also, when using a cannula, the cannula is inserted into the created portal.

Subsequently, a shaver and a high-frequency energy device are inserted through the cannula to dissect the soft tissue under the acromion (step S4).

Then, the ultrasonic treatment instrument 1 is inserted through the cannula or directly into the patient's body, and the bone on the lower surface of the acromion is cut while observing with an arthroscope (step S5).

According to the procedure described above, arthroscopic subacromial decompression is performed.

(Modification 1)
19 is a cross-sectional view of the distal end portion of the ultrasonic treatment device according to Modification 1. FIG. As shown in FIG. 19, the first engaging portion 41A has a bulging portion 413A that bulges in the opposite direction to the claw 411A, and the second engaging portion 42A extends in the direction in which the claw 422A protrudes. It has a bulging portion 423A that bulges on the opposite side. The distance between the surfaces of the bulging

portions

413A and 423A and the surface of the ultrasonic probe 3 is smaller than the height of the claws 411A and 422A. As a result, even if the claws 411A and 422A are pressed by an external force, they are prevented from being pushed inward beyond the height of the claws 411A and 422A. As a result, the engagement between the first engaging portion 41A and the first engaged portion 51 and the engagement between the second engaging portion 42A and the second engaged portion 52 are released. is prevented.

(Modification 2)
20 is a cross-sectional view of the distal end portion of the ultrasonic treatment device according to Modification 2. FIG. As shown in FIG. 20, the ultrasonic treatment device of Modification 2 includes a first engaging portion 41 and a first engaged portion 51, and a second engaging portion 42 and a second engaged portion. 52 is provided with a covering portion 9B. As a result, since the covering portion 9B receives a force from the outside, the engagement between the first engaging portion 41 and the first engaged portion 51 and the engagement between the second engaging portion 42 and the second engaged portion 42 are prevented. Disengagement with the joint portion 52 is prevented.

Further effects and modifications can be easily derived by those skilled in the art. Therefore, the broader aspects of the invention are not limited to the specific details and representative embodiments shown and described above. Accordingly, various changes may be made without departing from the spirit or scope of the general inventive concept defined by the appended claims and equivalents thereof.

1 ultrasonic treatment device 2 treatment device main body 3 ultrasonic probe 4 cover member 5 sheath 6

inner tube

7, 8 lining member 9B covering portion 31 main body portion 32 treatment portion 321 first surface 322 second surface 323 recess 324 second First blade 325

Second blade

41, 41A

First engaging portion

42, 42A Second engaging portion 51 First engaged portion 52 Second engaged

portion

71, 81 Protruding portion 82

Thickness Parts

411, 411A, 412, 421, 422, 422A

Claws

413A,

423A Swelling parts

511, 512, 521, 522

Hole parts

513, 523 Wall parts

Claims

an ultrasonic probe having a main body that transmits ultrasonic vibrations, and a treatment part that is positioned at the tip of the main body and that cuts a bone or cartilage to be treated by the ultrasonic vibrations;
a cover member having a tubular shape and covering the base end side of the main body, the cover member having a first engaging portion and a second engaging portion formed at different positions in the longitudinal direction;
A sheath that has a tubular shape and covers the base end side of the cover member, and includes a first engaged portion that engages with the first engaging portion and a second engaging portion that engages with the second engaging portion. a sheath having an engaging portion;
An ultrasonic treatment instrument.
One of the first engaging portion or the first engaged portion, or one of the second engaging portion or the second engaged portion is provided between a plurality of holes and between the adjacent holes. having a wall located at
The other of the first engaging portion or the first engaged portion, or the other of the second engaging portion or the second engaged portion has a plurality of claws that fit into the holes. Item 1. The ultrasonic treatment device according to item 1.
The other of the first engaging portion or the first engaged portion, or the other of the second engaging portion or the second engaged portion bulges in a direction opposite to the direction in which the claw protrudes. having a bulging portion that
3. The ultrasonic treatment instrument according to claim 2, wherein the distance between the surface of said bulging portion and the surface of said ultrasonic probe is smaller than the height of said nail.
The ultrasonic probe is
having a blade formed on a first face facing a first direction;
The diameter becomes thinner toward the tip,
The first engaging portion and the first engaged portion are provided in the first direction with respect to the central axis of the ultrasonic probe,
The second engaging portion and the second engaged portion are provided on the distal side from the first engaging portion and the first engaged portion, and with respect to the central axis of the ultrasonic probe, The ultrasonic treatment instrument according to claim 1, which is provided in a second direction opposite to the first direction.
The ultrasonic treatment instrument according to claim 1, further comprising a covering portion that covers the first engaging portion and the first engaged portion or the second engaging portion and the second engaged portion.
The ultrasonic treatment instrument according to claim 1, wherein the sheath has a shape that covers the surface of the cover member.
The ultrasonic treatment instrument according to claim 1, wherein the cover member is made of resin.
A lining member having a lining applied to the surface of the main body,
The ultrasonic treatment instrument according to claim 1, wherein the ultrasonic probe is held by the sheath via the lining member.
an ultrasonic probe that transmits ultrasonic vibrations from the proximal end toward the distal end;
a tubular sheath that holds the ultrasonic probe inserted inside;
an inner tube having a cylindrical shape, positioned inside the sheath, and covering the ultrasonic probe;
a lining member provided on the surface of the ultrasonic probe by lining and keeping a space between the ultrasonic probe and the inner tube watertight;
with
The lining member is
a protruding portion protruding from the outer surface of the ultrasonic probe toward the sheath;
a thick portion located on the tip side of the projecting portion and having a thickness equal to or greater than a predetermined value;
An ultrasonic treatment instrument having
a main body that transmits ultrasonic vibrations from the proximal end toward the distal end in the longitudinal direction;
A treatment section located at the tip of the main body section for cutting a bone or cartilage to be treated by the ultrasonic vibration,
a first surface;
a second surface facing away from the first surface;
a concave portion recessed from the first surface toward the second surface;
a first blade formed along a direction intersecting with the longitudinal direction on the tip side edge of the recess;
a second blade continuous with the first blade and formed along the longitudinal direction at the edge of the recess;
a treatment section having
an ultrasound probe.