JP2001170070A - Medical treatment instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical treatment instrument having a highly durable incision edge, firmly holding the tissue so as to surely coagulate it, and surely incising the coagulated tissue without causing hemorrhage. SOLUTION: This medical treatment instrument is provided with a pair of opening/closing holding parts 8, 9 for holding the living body tissue on the tip side and an operation part operating the opening/closing of the holding parts at hand. This instrument is provided with heat generation parts 15, 16 provided in, at least, one of the holding parts 8, 9 and generating heat for coagulating the living tissue held between the holding parts, and an incising means for incising the tissue held between the holding parts. The incising means is positioned approximately on the central axis of the holding parts, provided with pointed ends 28a, 29a formed into incision edges, formed of a pair of cutting elements 28, 29 storedly positioned in the holding parts so as to prevent the pointed ends from projecting from the holding faces 8a, 9a, and it is characterized that the pointed end parts of at least one of the cutting elements are projected from the holding faces so as to abut on the pointed parts of the other cutting element with the operation of the operation means provided in the operation part.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical treatment tool for grasping a living tissue and performing a medical treatment such as coagulation and incision.

[0002]

2. Description of the Related Art Various types of medical treatment tools for coagulating and incising living tissue have been known. For example, a bipolar forceps disclosed in US Pat. No. 5,735,849 includes a long insertion portion and a pair of openable and closable jaws provided at a distal end of the insertion portion. The jaw is provided with an electrode for coagulating living tissue. Further, a rod having a sharp knife protruding and retracting in the gap between the jaws is inserted into the insertion portion so as to be able to advance and retreat.
Therefore, in such a configuration, the tissue held between the jaws is coagulated by the electrode provided on the jaws, and the coagulated tissue between the jaws is incised by the knife that moves between the jaws.

Further, the surgical scissors forceps disclosed in US Pat. No. 5,827,281 is composed of a pair of scissor-shaped jaws which can be opened and closed. Therefore, the contact surface of each jaw applied to the tissue is formed as a cutting blade. Further, each jaw is provided with a distal tip for grasping and coagulating tissue, located at the front side of the cutting blade. In such a configuration, after the tissue is grasped and coagulated between the distal tips, the coagulated tissue is incised by a cutting blade located on the rear side of the distal tip.

The scissors forceps disclosed in US Pat. No. 5,324,289 comprises a pair of openable and closable scissor members having both functions of a cutting blade and a coagulating means. In particular,
The scissor member is formed of a conductive material, and a portion excluding an electrode portion functioning as a cutting blade is covered with an electrically insulating material. Therefore, in such a configuration, the tissue can be incised while being coagulated by the scissor member.

[0005]

By the way, USP 57
In the bipolar forceps disclosed in Japanese Patent No. 35849, since the tissue is incised by one knife, there is a problem that the knife is easily worn and the durability of the knife is low.

Further, in the surgical scissors forceps disclosed in US Pat. No. 5,827,281, the distal tip as a coagulating means and the cutting blade are displaced in the longitudinal direction of the jaw. Can not.
That is, after the tissue is gripped with the distal tip and coagulated, the gripping state of the distal tip is released and the cutting blade is not moved to the site of the coagulated tissue (unless the jaw is moved in the longitudinal direction). Incised tissue cannot be dissected with a dissecting blade. As described above, when the jaw moves between the coagulation and the incision, there is a possibility that the tissue that has not been completely coagulated is erroneously incised, and in that case, bleeding is caused. Further, since a part of the jaw forms a cutting blade, when the cutting blade is worn, the entire jaw must be replaced. That is, it is impossible to replace only the cutting blade.

Further, in the scissors forceps disclosed in US Pat. No. 5,324,289, since the means for coagulating tissue is scissors, coagulation cannot be performed while the tissue is firmly grasped. For this reason, the tissue cannot be sufficiently coagulated, and it is difficult to perform coagulation and incision particularly on a thick blood vessel or the like.

The present invention has been made in view of the above-mentioned circumstances. It is an object of the present invention to provide an incision blade having high durability, capable of firmly grasping tissue, reliably coagulating, and causing bleeding. It is an object of the present invention to provide a medical treatment tool capable of reliably incising only coagulated tissue without causing the coagulation.

[0009]

In order to solve the above-mentioned problems, the present invention has a pair of openable and closable gripping portions for gripping a living tissue at a distal end side, and an operating portion for opening and closing the gripping portions. In a medical treatment tool having a hand side, a heat generating unit that is provided on at least one of the gripping units and generates heat for coagulating a living tissue gripped between the gripping units, and is gripped between the gripping units. Dissecting means for dissecting the cut tissue, wherein the dissecting means is provided substantially on the central axis of each gripping portion, has a sharp end forming an incision blade, and the sharp end is gripped. It consists of a pair of cutting elements housed in the grip so as not to protrude from the gripping surface of the part, and at least one of the cutting elements has a pointed end with the operation of operating means provided in the operating part. Cutting from the other side while protruding from the gripping surface Characterized in that it is operated so as to be in contact with the pointed end of the element.

[0010]

Embodiments of the present invention will be described below with reference to the drawings.

FIGS. 1 to 4 show a first embodiment of the present invention. As shown in FIGS. 1 and 2, the medical treatment tool 2 according to the present embodiment is a coagulated incision forceps for laparotomy surgery, and a pair of forceps that are rotatably connected to each other via a support shaft 7. It is composed of constituent members 5 and 6. Each forceps constituent member 5,
6 are gripping portions 8, 9 for gripping living tissue.
It is formed as. Further, ring-shaped finger hooks 11 and 12 are formed on the base end side of each of the forceps constituting members 5 and 6. Therefore, if the fingers are hooked on the finger hooks 11 and 12 to rotate the forceps constituting members 5 and 6 about the support shaft 7,
The gripping parts 8, 9 are opened and closed. That is, the proximal side of the forceps constituting members 5 and 6 is formed as an operation unit 13 for opening and closing the pair of gripping units 8 and 9.

As shown in detail in FIGS. 3 and 4,
Each of the grip portions 8 and 9 has a flat grip surface 8 for gripping a living tissue.
a, 9a. Each gripping surface 8a, 9a is formed by the surfaces of the conductors 15, 16 joined to the gripping portions 8, 9 respectively. The conductors 15 and 16 generate heat for generating heat for coagulating the living tissue gripped between the grippers 8 and 9 when a current is supplied (energized) through a current supply unit described later. Part is formed.

As shown in FIG. 3, each conductor 15, 1
6, lead wires 17a forming the current supply means,
17b is electrically connected. These lead wires 1
Reference numerals 7a and 17b extend toward the operation unit 13 through the interior of the forceps constituting members 5 and 6, and are electrically connected to connector connection units 22 and 23 (see FIGS. 1 and 2) provided on the finger hooks 11 and 12. It is connected to the.

As shown in FIG. 1, the connector connecting portion 2
The power supply 2 and the power supply 23 are connected to a power supply (generator) 3 via a power supply cable 26. In particular,
The connectors 24 and 25 of the power supply cable 26 are detachably connected to the connector connections 22 and 23, so that the connector connections 22 and 23 are electrically connected to the power supply 3.
Therefore, in such a configuration, when a current is supplied from the power supply 3 to the connector connecting portions 22 and 23 via the energizing cable 26, the current is supplied via the lead wires 17 a and 17 b provided in the forceps constituting members 5 and 6. Electric current flows through the conductors 15 and 16, and the conductors 15 and 16 generate heat. The operation unit 13 is provided with an energization switch 27 for turning ON / OFF the energization of the conductors 15 and 16.

As shown in FIG. 3 and FIG. 4, a cutting member (cutting element) is provided on each of the grips 8 and 9 as a cutting means for cutting the tissue gripped between the grips 8 and 9. 2
8, 29 are provided. Each cutting member 28, 29
It has pointed portions 28a, 29a forming a cutting blade.

The cutting member 29 provided on the grip portion 8 is provided substantially at the center axis of the grip portion 8, and its cutting edge 29 a does not protrude from the grip surface 8 a of the grip portion 8. It is housed and fixed in a housing groove 21 formed in the grip portion 8. The accommodation groove 21 is open at the grip surface 8a.

On the other hand, the cutting member 28 provided on the grip 9
Is provided substantially at the center axis of the gripper 9.
Further, the cutting member 28 is operably accommodated in the accommodating groove 20 formed in the grasping portion 9 and opened at the grasping surface 9a so that the pointed end 28a does not protrude from the grasping surface 9a of the grasping portion 9. Have been. Specifically, a plurality of roller members 31 are fixedly provided on the cutting member 28. Further, a plurality of guide members 30 each having an inclined surface are fixed in the accommodation groove 20. The cutting member 28 is movably supported in the accommodation groove 20 with the roller member 31 constantly pressed against the inclined surface of the guide member 30. Further, the cutting member 28 is connected to an operation wire 32 which is inserted into the forceps constituting member 6 so as to be able to advance and retreat, and is pushed and pulled.

Therefore, in such a configuration, when the operation wire 32 is pulled, the roller member 31 of the cutting member 28 moves along the inclined surface of the guide member 30, and the cutting member 28 faces the cutting member 29. Moved. Thereby, the pointed end 28a of the cutting member 28 protrudes from the grip surface 9a and comes into contact with the pointed end 29a of the cutting member 29 (see FIG. 4).

The operating wire 32 is pushed and pulled by operating means provided on the operating unit 13. The operating means includes an operating lever 33 provided on the finger hook 12, as shown in an enlarged manner in FIG. The operation lever 33 is
It is rotatably mounted on a bracket attached to the finger hook 12 via a support shaft 34. The operation lever 33 includes
The proximal end side of the operation wire 32 led out from the forceps component member 6 is connected. In this case, the base end side of the operation wire 32 is supported while being guided by a guide 35 attached to the finger hook 12. The operation lever 33 is biased by an urging member 36 having one end fixed to the finger hook 12.
The direction in which the operation wire 32 is pushed forward (the cutting member 2
8 is always urged in the direction in which the tip 28a is immersed in the accommodation groove 20).

Next, a case where a living tissue is coagulated and incised using the medical treatment instrument 2 having the above configuration will be described.

First, the distal ends of the forceps constituting members 5, 6 are introduced into the body through an incision formed in the abdomen, for example. Then, the grippers 8, 9 are positioned near the tissue to be treated,
The tissue is positioned between the grips 8 and 9.

After the tissue is positioned between the grasping portions 8 and 9, the operating portion 13 is operated to rotate the forceps constituting members 5 and 6 about the support shaft 7, thereby obtaining the grasping portions 8 and 9. Is closed, and the tissue is firmly gripped between the gripping surfaces 8a and 9a. In this state, not only the pointed end 29a of the cutting member 29 but also the pointed end 28a of the cutting member 28 does not protrude from the gripping surfaces 8a, 9a of the gripping portions 8, 9, so that the grasped tissue is not sharpened. , 29a will not cause bleeding.

Next, when the energizing switch 27 is turned on while the tissue is being gripped between the gripping surfaces 8a and 9a, a current is supplied from the power source 3 to the connector connecting portions 22 and 23 via the energizing cable 26. Thereby, the conductor 1 is connected via the lead wires 17a and 17b provided in the forceps constituent members 5 and 6.
Electric current flows through the conductors 5 and 16 to generate heat, so that the tissue grasped between the grasping portions 8 and 9 is coagulated. In this case, since the tissue is firmly grasped by the grasping surfaces 8a, 9a of the grasping portions 8, 9, sufficient coagulation is performed by heat.

When the coagulation treatment of the tissue is completed, the operation wire 33 is pulled by pulling the operation lever 33 by rotating the operation lever 33 while holding the tissue at the coagulation position (without releasing the holding state). I do. Thereby, the roller member 31 of the cutting member 28 moves along the inclined surface of the guide member 30, and the cutting member 28 is moved toward the cutting member 29.
At this time, the tip 28a of the cutting member 28 protrudes from the grip surface 9a at the center of the grip 9 and cuts the cutting member 29 accurately while cutting the center of the solidified tissue gripped between the grips 8, 9.
(See FIG. 4). Therefore,
The tissue is cut into two cutting members 28, 29 without bleeding
Is surely incised.

After the tissue incision is completed, the operation lever 33
When the operation force is released, the operation lever 33 rotates to the original position by the urging force of the urging member 36. This allows
The cutting member 28 is automatically moved so that its pointed end 28a is immersed in the accommodation groove 20 (to be separated from the cutting member 29).

As described above, the medical treatment tool 2 according to the present embodiment has two cutting members 28 and 29, and the two cutting members 28 and 29 cut the tissue, so that the tissue is cut with one knife. The durability of the blade (cutting member) is higher than in the case of incision.

Further, the medical treatment tool 2 of the present embodiment includes a pair of grip portions 8, 9 having grip surfaces 8a, 9a for gripping tissue, and grips the tissue between the grip surfaces 8a, 9a. Since coagulation and incision are performed, coagulation can be sufficiently performed and a reliable incision without bleeding can be performed.

In the medical treatment tool 2 of the present embodiment,
Heat generating parts 15, 16 for generating heat for coagulating tissue
And the incising means 28 and 29 for incising the tissue are both provided in the gripping parts 8 and 9, and one of the incising blades 28 a and 29 a of the incising means 28 and 29 at the center of the gripping part 9 so as to contact each other. Is operated so that the tissue is incised. Accordingly, the center of the grasped coagulated tissue can be accurately cut while holding the tissue at the coagulation position (without releasing the grasping state). That is, only the coagulated tissue can be reliably incised. Therefore, no bleeding occurs during the incision.

Further, in the medical treatment tool 2 of the present embodiment,
The sharp ends 28a, 29a of the cutting members 28, 29 are accommodated in the holding portions 8, 9 so as not to protrude from the holding surfaces 8a, 9a of the holding portions 8, 9, respectively. Therefore, the gripping surface 8
Even if the tissue is gripped between a and 9a, the gripped tissue is not damaged by the tips 28a and 29a (no bleeding occurs).

In the medical treatment tool 2 of the present embodiment,
Since the cutting members 28 and 29 forming the cutting blade are separate from the grippers 8 and 9, it is also possible to remove only the cutting members 28 and 29 from the main body and replace them.

In this embodiment, only the cutting element 28 is operated, but the cutting element 29 may be operated by the same mechanism as the cutting element 28 (both cutting elements). Elements 28 and 29 may be activated).

FIG. 5 shows a second embodiment of the present invention. Note that, in this embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.

As shown in the figure, in the medical treatment instrument 2A of the present embodiment, the operation lever 37 for operating the operation wire 32 is connected to the portion of the operation section 13 distal to the finger hook section 12 (forceps component member). 6) is slidably provided. Further, the operation lever 37 is connected to the forceps constituent member 6.
The operating wire 32 is constantly urged in the distal direction (the direction in which the sharp end 28a of the cutting member 28 sinks into the accommodation groove 20) by the urging member 38 having one end fixed to the front end. The other configuration is the same as that of the first embodiment. Therefore, the same operation and effect as in the first embodiment can be obtained.

FIG. 6 shows a third embodiment of the present invention. Note that, in this embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.

As shown in the figure, in the medical treatment instrument 2B of the present embodiment, each of the grips 8, 9 is provided with an incising means for incising a tissue gripped between the grips 8, 9. Knives (cutting elements) 40A and 40B are provided. Each cutting knife 40A, 40B has a point forming a blade.

An incision knife 40B provided on the grip portion 8
Is provided substantially on the central axis of the grip portion 8,
So that the pointed end does not protrude from the gripping surface of the gripper 8,
It is housed and fixed in a housing groove formed in the grip portion 8. The accommodation groove is open at the grip surface.

On the other hand, the cutting knife 4 provided on the grip 9
OA is disposed substantially on the central axis of the gripper 9 and is accommodated in the accommodation groove of the gripper 9 that is opened on the gripping surface of the gripper 9 so as to protrude and retract. Also, the incision knife 40
A has an extending portion extending toward the operation portion 13, the extending portion is rotatably supported by the support shaft 7, and the extending end portion is formed as a lever (operation means) 39. I have.
When the incision knife 40A is rotated about the support shaft 7 by the operating force acting on the lever 39, the pointed end of the incision knife 40A does not protrude from the holding surface of the holding portion 9, and the pointed end of the cutting knife 40A moves from the holding surface. It is operated between the protruding tip of the cutting knife 40B and the abutting cutting position. The other configuration is the same as that of the first embodiment. Therefore, the same operation and effect as in the first embodiment can be obtained.

FIG. 7 shows a fourth embodiment of the present invention. Note that, in this embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.

As shown in the figure, a bipolar forceps 51 as a medical treatment tool according to the present embodiment is disposed at an end portion of the insertion portion 52 which can be inserted endoscopically into the body. It comprises a treatment section 56 and an operation section 53 connected to the proximal end of the insertion section 52.

The operation section 53 includes an operation section main body 58, a fixed handle 59 provided integrally with the operation section main body 58, and a movable handle rotatably supported by the operation section main body 58 via a pivot pin 62. 61. The operation unit main body 58
Is provided with a rotatable operation body 60 and a connector connecting portion 70 to which a connector of a power supply cable (not shown) is detachably connected.

The insertion section 52 is provided with the rotary operation body 6 of the operation section 53.
It consists of a sheath 54 supported at zero. This sheath 54
Is rotated with respect to the operation unit main body 58 together with the rotary operation body 60 by rotating the rotary operation body 60. A drive shaft 55 is inserted into the sheath 54 so as to be able to advance and retreat. The base end side of the drive shaft 55 extends inside the operation section main body 58 and is connected to the movable handle 61. Therefore,
When the movable handle 61 is rotated,
The drive shaft 55 advances and retreats in the sheath 54.

The treatment section 56 comprises a pair of openable and closable jaws (grasping portions) 57a, 57b located opposite to each other. The jaws 57a and 57b are connected to the distal end side of the drive shaft 55 via an opening / closing mechanism (not shown) such as a link mechanism driven by the advance / retreat operation of the drive shaft 55. In this case, when the movable handle 61 is rotated in the direction of arrow B and the drive shaft 55 is advanced in the sheath 54, the jaws 57a and 57b are opened via the opening / closing mechanism (FIG. 7). (B)). When the movable handle 61 is rotated in the direction of arrow A and the drive shaft 55 is retracted in the sheath 54, the jaws 57a,
57b is closed (see FIG. 7A).

Each of the jaws 57a and 57b is provided with an electrode. When a high-frequency current is supplied from an unillustrated high-frequency power supply to the connector connecting portion 70 through a current-carrying cable, a conductive member provided in the sheath 54 is provided. Means (not shown)
A high-frequency current flows between the electrodes of the jaws 57a and 57b through the electrodes. That is, each jaw 57
The electrodes a and 57b form a heat generating portion that generates heat for coagulating the living tissue grasped between the grasping portions.

Each jaw 57a, 57b has a first
The cutting members 28 and 29 are provided in a form similar to that of the embodiment. The main body 58 of the operation section 53 is provided with operation means of the operation wire 32 for operating the cutting member 28. This operation means is composed of an operation lever 65 connected to the operation wire 32 and slidable with respect to the operation section main body 58. The operation lever 65 is connected to the operation unit main body 5.
The operating wire 32 is pushed forward by a biasing member 66 having one end fixed to the distal end 8 (the cutting member 28).
Of the jaw 57a in the direction of sinking into the accommodating groove of the jaw 57a). The other configuration is the same as that of the first embodiment. Therefore, the same operation and effect as in the first embodiment can be obtained.

In each of the above embodiments, the operation for grasping (coagulating) the tissue and the operation for incising the grasped tissue are performed by separate operation means. That is, at the time of coagulation, an operation is performed in which fingers are put on the finger hooks 11 and 12 to squeeze the forceps constituting members 5 and 6, and at the time of incision, the operation lever 33 (37, 39, 65) is used.
Must be operated. However, it is troublesome for one operator to perform a series of continuous operations of coagulation and incision by different operations, and it is desired to improve operability. Actually, in the past, Japanese Patent Publication No. 9-510113
In order to dissect tissue after coagulation, another operation of moving the lever provided on the operation unit must be newly performed as described in Japanese Patent Application Publication No. It is.

Therefore, hereinafter, a high-frequency treatment instrument capable of performing a continuous series of operations of coagulation and incision by one continuous operation will be described.

FIG. 8 shows a first embodiment of such a high-frequency treatment instrument. High-frequency treatment tool 102 according to the present embodiment
Is a coagulating incision forceps for laparotomy, and a pair of forceps component members 1 rotatably connected to each other via a support shaft 107.
05,106. Each forceps component 105, 106
Are formed as gripping portions (jaws) 108 and 109 for gripping a living tissue. Further, ring-shaped finger hooks 111 and 112 are formed on the base end side of each forceps component member 105 and 106. Therefore, the fingers are hooked on the finger hooks 111 and 112, and the forceps component 10
When the members 5 and 106 are rotated around the support shaft 107, the grip portions 108 and 109 are opened and closed. That is, the hand side of the forceps component members 105 and 106 is
8, 109 are formed as an operation unit 113 for opening and closing operations.

Each of the grip portions 108 and 109 has flat grip surfaces 108a and 109a for gripping a living tissue.
Further, each of the forceps constituting members 105 and 106 is formed of a conductive material, and all parts except the grip surfaces 108a and 109a are covered with electric insulating materials 125 and 126 (see FIGS. 12 and 13). The conductive parts of the forceps constituent members 105 and 106 are
The connector 112 is electrically connected to the connector connection portions 122 and 123 provided on the connector 112.

The connector connecting portions 122 and 123 are connected to the high-frequency oscillator 103 via the power supply cable 126. Specifically, the connectors 124 and 125 of the energizing cable 126 are connected to the connector connecting portions 122 and 12.
3, the connector connecting portions 122 and 123 are electrically connected to the high-frequency oscillator 103. Therefore, in such a configuration, when a high-frequency current is supplied from the high-frequency oscillator 103 to the connector connecting portions 122 and 123 via the energizing cable 126, the grip portions 108 and the conductive portions of the forceps constituting members 105 and 106 are used.
A high-frequency current flows between the gripping surfaces 108a, 109a of the 109. That is, each of the grips 108, 1
09 holding surfaces 108a, 109a
A heat generating portion for generating heat for coagulating the living tissue gripped during the period 09 is formed.

As shown in FIGS. 12 and 13, each of the grip portions 108 and 109 has a groove 120, 1 which is located substantially on the center axis thereof and opens at the grip surfaces 108a, 109a.
21 are formed along the longitudinal direction. In addition, a cutting knife (cutting element) 140 that constitutes cutting means for cutting the tissue held between the holding portions 108 and 109 is housed in the groove 121 of the one holding portion 108 so as to protrude and retract. . The cutting knife 140 has a pointed end forming a blade, and when completely cut into the groove 121,
The pointed end does not protrude from the holding surface 108a of the holding unit 108. Also, this incision knife 140
Constitutes a treatment unit for treating living tissue together with the grips 108 and 109.

The incision knife 140 has an extending portion extending toward the operation portion 113, and this extending portion is attached to the support shaft 107.
And the extending end portion 139 thereof is opposed to the forceps constituting members 105 and 106 so as to be able to abut.

A locking spring 130 for urging the extending end 139 of the cutting knife 140 is fixed to the operation portion 113 side of the forceps component member 106 with a screw 131. By the locking spring 130, the cutting knife 140 is constantly urged in the direction of completely submerging in the groove 121 of the grip portion 108 (see FIGS. 9 and 12A). Also,
When the operating force against the urging force of the locking spring 130 acts on the extending end 139, the incision knife 140
9 is bent so as to protrude from the groove 121 into the groove 120 of the grip portion 109 on the opposite side (see FIG. 10 and FIG. 12B) so as to be able to rotate about the support shaft 107. Is set.

Next, a case where a living tissue is coagulated and incised using the high-frequency treatment instrument 102 having the above-described configuration will be described.

First, the distal ends of the forceps constituting members 105 and 106 are introduced into the body through an incision formed in the abdomen, for example. Then, the grips 108 and 109 are positioned near the tissue to be treated, and the tissue is positioned between the grips 108 and 109.

After the tissue is positioned between the grasping portions 108 and 109, the operating portion 113 is operated (gripped), and the forceps component 105 and the extending end 139 of the cutting knife 140 come into contact with each other. The forceps constituting members 105 and 106 are rotated about the support shaft 107 to a position (a force against the urging force of the locking spring 130 is not applied to the extending end 139) (the operation unit 113 is moved to the first position). To operate). As a result, the grip portions 108 and 109 are closed, and the grip surface 108 is closed.
The tissue is firmly gripped between a and 109a. In this state, the cutting knife 140 is immersed in the groove 121 of the grip portion 108 due to the urging force of the locking spring, and the sharp end thereof does not protrude from the grip surface 108a. Are not damaged by the cutting knife 140 and bleeding occurs.

Next, when a current is supplied from the high-frequency oscillator 103 to the connector connecting parts 122 and 123 via the power supply cable 126 in a state where the tissue is gripped between the gripping surfaces 108a and 109a, the conductive members of the forceps constituting members 105 and 106 are electrically conductive. High-frequency current flows between the grip surfaces 108a and 109a via the site, and the tissue gripped between the grip portions 108 and 109 is coagulated (see FIGS. 9 and 13A). In this case, since the tissue is firmly grasped by the grasping surfaces 108a and 109a of the grasping portions 108 and 109, sufficient coagulation is performed by heat.

When the coagulation treatment of the tissue is completed, this time, while holding the tissue at the coagulation position (without releasing the grasping state), the operation unit 113 is further squeezed, and the operation unit 113 side of the forceps constituting member 105 is grasped. And the locking spring 13
An operating force against the urging force of 0 is applied to the extending end 139 (the operating unit 113 is operated to the second position). As a result, the extension end portion 139 is bent, and the cutting knife 140 is rotated around the support shaft 107 and moved toward the grip portion 109 by a force caused by the bending. At this time, the cutting knife 14
0 protrudes from the grip surface 108a at the center of the grip portion 108, and cuts the center of the coagulated tissue gripped between the grip portions 108 and 109 while accurately cutting the groove 1 of the grip portion 109 on the opposite side.
20 (see FIGS. 10 and 13B). Therefore, the tissue is reliably dissected by the dissection knife 140 without bleeding.

When the operating force on the operating portion 113 is released after the incision of the tissue is completed, the bending state of the forceps constituting member 105 and the extending end portion 139 is released with the help of the urging force of the locking spring 130. Thereby, the cutting knife 140 is
It is automatically moved so as to be completely immersed in the groove 121 of the grip portion 108.

As described above, the high-frequency treatment device 102 of this embodiment can perform a series of continuous operations such as coagulation and incision by one continuous operation, so that the operability is improved as compared with the related art. . Further, substantially the same operation and effect as those of the first embodiment can be obtained.

In this embodiment, if the stopper for restricting the operation of the operation unit 113 at the first position (regulating the amount of rotation of the forceps component) is provided so as to be removable, the incision can be performed by jumping over the coagulation treatment. Transition to treatment (incision knife 140 protrudes from gripping surface 108a during coagulation)
Can be prevented. In addition, if a fixed knife in contact with the incision knife 140 is provided in the groove 120 of the grip portion 109, the durability of the knife is improved, and the same operation and effect as in the first embodiment can be obtained.

FIG. 14 shows a second embodiment of the high-frequency treatment device. Note that, in this embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof will be omitted.

As shown in the figure, the high-frequency treatment instrument 1 of this embodiment
In 02A, a high-frequency current is supplied to the incision knife 140 from the high-frequency oscillator 103 via the power supply cable 127. In addition, the cutting knife 140 is formed of a conductive material, and a portion excluding a sharp end thereof is covered with an electrically insulating material 141. The other configuration is the same as that of the first embodiment.

Therefore, the same operation and effect as those of the first embodiment can be obtained, and the incision can be made electrically by the high-frequency current. As a result, the durability of the cutting knife 140 is improved.

FIG. 15 shows a third embodiment of the high-frequency treatment device. Note that, in this embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof will be omitted.

As shown in the figure, the high-frequency treatment device 1 of this embodiment
02B, the grip surface 108 of each grip portion 108, 109
Ceramic heaters 158 and 159 are provided for the heaters a and 108b, and current is supplied to the ceramic heaters 158 and 159 from the ceramic heater energizing power supply 103A. That is, in the present embodiment, the ceramic heaters 158 and 159 form a heat generating portion that generates heat for coagulating the living tissue held between the holding portions 108 and 109. The other configuration is the same as that of the first embodiment, and therefore, the same operation and effect as those of the first embodiment can be obtained.

According to the first to third embodiments described above, the following various configurations can be obtained.

1. A high-frequency treatment instrument that has a treatment section for performing a predetermined treatment on the living tissue on the distal end side, has an operation section for operating the treatment section on the near side, and is capable of treating the living tissue with high-frequency current, wherein the operation section is Operable continuously from a first position at which a first treatment is performed on the living tissue by the treatment section to a second position at which the second treatment is performed on the living tissue by the treatment section A high-frequency treatment tool characterized by the above-mentioned.

2. The treatment section is provided on at least one of the openable and closable gripping sections for gripping the living tissue, and generates heat for coagulating the living tissue gripped between the holding sections by being energized. Heat generating part,
2. The high-frequency treatment instrument according to claim 1, further comprising an incision means for incising a tissue grasped between the grasping portions.

3. 2. The operation unit according to claim 1, wherein the operation unit reaches a first position when operated by a predetermined amount from an initial position, and reaches a second position when further operated by a predetermined amount from the first position. High frequency treatment tool.

4. The high-frequency treatment instrument according to claim 2, wherein the tissue is gripped by the gripper at the first position, and the tissue gripped by the gripper at the second position is cut by the cutting means.

5. The high-frequency treatment device according to claim 2 or 4, wherein the incision means electrically incises the tissue with a high-frequency current.

6. The second or fourth aspect, wherein the cutting means mechanically cuts the tissue with a knife.
A high-frequency treatment device according to the item.

FIG. 16 shows another example of the electric scalpel system including the high-frequency treatment instrument and the high-frequency power source described above.
0 is a bipolar settler 201, a monopolar handpiece 202, a changeover switch 203, a foot switch 204 having two pedals 204a and 204b,
A high-frequency power supply unit (electric knife unit main body) 205 to which these constituent members 201, 202, 203, and 204 are electrically connected is provided.

The changeover switch 203 has a switch section for setting a bipolar output state and a switch section for switching between incision and coagulation. In addition, the high-frequency power supply device 205 includes the constituent members 201, 202, and 20.
Receiving electric signals from 3,204
01 and the high-frequency output state to the monopolar handpiece 202 are controlled. The power supply device 205 is provided with an operation panel 205a. The operation panel 205a includes a changeover switch 210 for switching between monopolar and bipolar, a changeover switch 212 for switching between incision and coagulation, a display section 214 for displaying incision output values, and a display for displaying coagulation output values. A part 216 is provided. In addition, the monopolar handpiece 202
Is provided with a hand switch 202a for switching the output ON / OFF.

Conventionally, in such a system, the output operation of the monopolar handpiece 202 is performed by operating either the hand switch 202a or the foot switch 204. In contrast, the bipolar settler 20
In most cases, output operation 1 is performed only by operating the foot switch 204. That is, foot switch 2
04 was shared by both bipolar and monopolar (when a bipolar connector was connected, some switches to bipolar with priority). Further, when both the monopolar handpiece 202 and the bipolar armature 201 are used in one operation, the surgeon switches between the bipolar armature 201 and the monopolar handpiece 202 each time the use is switched, and the high-frequency power supply is used. An operation such as a nurse switching a changeover switch of the device 205 was required.

In such a conventional embodiment, the power supply 20
Switching of the switch No. 5 is troublesome, and there is a problem that even when the foot switch is not used, an error is output if the foot switch is depressed by mistake. In addition, handpiece 20
It was troublesome to switch between 2 and Setsuko 201. Therefore, an embodiment of a system capable of solving such a problem will be described below.

FIGS. 17 to 21 show such a system. 17 to 20 show different embodiments, and FIG. 21 shows an electrical connection state of a system which can cover all of the embodiments.

In the embodiment shown in FIG. 17, for example, a pressure sensitive switch 230 is attached to the bipolar armature 201. When the surgeon grasps the centrifuge 201, it is detected by the detection circuit 240 (see FIG. 21) via the pressure-sensitive switch 230, and the output mode is switched to bipolar on the power supply device 205 side. In this case, ON / OFF of the bipolar output is performed by the foot switch 204. When the hand switch 202a of the monopolar handpiece 202 is pressed, the output is automatically switched to monopolar output. Further, when neither the pressure-sensitive switch 230 of the setteller 201 nor the hand switch 202a of the handpiece 202 is pressed, no output is produced even if the foot switch 204 is depressed. In this embodiment, the pressure-sensitive switch 230 may function as a bipolar output ON / OFF switch.

In the embodiment shown in FIG. 18, a changeover switch 232 is provided at the site of the setter 201 which is held by the operator. The changeover switch 232 is provided with an incision switch section 232a and a coagulation switch section 232b. When the foot switch 204 is depressed while pressing one of the switch sections 232a and 232b, the power supply device 2
On the 05 side, the output mode is set to monopolar. Therefore, the foot switch 204 requires only one pedal, and the foot is neat. In neurosurgery, foot switches for ultrasonic aspirators, microscope foot switches, and electric scalpel foot switches are mixed under the feet, and it is beneficial in terms of operability that this configuration makes the feet clear. is there. Further, the point that it is not necessary to switch between the armature 201 and the handpiece 202 is also advantageous in terms of operability.

In the embodiment shown in FIG. 19, a third switch section 232c is added to the changeover switch 232. The third switch section 232c is for setting a bipolar output state. In such a configuration, the foot switch 204 becomes unnecessary.

In the embodiment shown in FIG. 20, the third switch section 232c is separate from the changeover switch 232. In this case, when the third switch section 232c is pressed, the output mode is set to bipolar, and when the incision switch section 232a and the coagulation switch section 232b are pressed, the output mode is set to monopolar, and all switches are set. When the sections 232a, 232b, and 232c are pressed, the output mode is set to bipolar for safety.

The switching between bipolar and monopolar may be performed by the voice of the surgeon (which responds only to the voice of the registered person). In particular,
As shown in FIG. 21, the voice of the operator captured by the microphone 250 is recognized by the detection circuit 240, and switching between bipolar and monopolar is performed. Further, a notifying means for notifying the surgeon or the like of switching between bipolar and monopolar may be provided. Specifically, as shown in FIG. 21, the switching of the output mode is notified to the operator using a notification device such as a speaker 252. As the notification means, other than the above, the operation panel 205 of the power supply device 205
It is also conceivable to display such a sound on a, or to output a synthesized voice, a different output sound, a characteristic switching sound, or the like.

According to the technical contents shown in FIGS. 16 to 21, it is possible to obtain a handshake configuration as shown below.

1. In an electrocautery device having both a monopolar output and a bipolar output, a detecting means for detecting that an operator is holding a bipolar settler to be connected and used is provided, and it is detected that the operator is holding Automatically switches the circuit to bipolar output mode,
An electrosurgical apparatus characterized in that an output switch (foot switch) provided separately can be operated in bipolar mode to output in bipolar mode.

2. The electric scalpel according to claim 1, wherein a circuit is automatically switched to a monopolar output mode by operating a monopolar output switch provided in a monopolar handpiece used at the same time, and output can be performed in a monopolar mode from the monopolar handpiece. apparatus.

3. In the case where neither the detection means nor the monopolar output switch is turned on, no output is produced even if an output switch (foot switch) provided separately is operated. An electrosurgical device as described.

4. In an electrocautery device having a monopolar output and a bipolar output, it is possible to flow a monopolar output to a bipolar set that is used by connection, and the bipolar set has an incision / coagulation changeover switch. An electrosurgical apparatus characterized in that a monopolar output in a selected output mode can be performed by simultaneously operating a separately provided output switch (foot switch) while operating the.

5. The electrosurgical device according to claim 4, wherein the output can be performed in the bipolar mode by operating the output switch without operating the changeover switch.

6. 5. The electrosurgical unit according to claim 4, wherein the mixing output is performed by operating the output switch while simultaneously operating the incision switch and the coagulation switch.

7. In an electrosurgical device having a monopolar output and a bipolar output, it is possible to flow a monopolar output to a bipolar set that is connected and used, and the bipolar set is provided with a bipolar output, a monopolar incision, and a monopolar coagulation switch, An electrosurgical device characterized in that a desired output is produced by operating these switches.

8. 8. The electrocautery device according to claim 7, wherein the mixing output is performed by simultaneously operating the monopolar incision / monopolar coagulation switch.

9. 8. The electrosurgical apparatus according to claim 7, wherein the bipolar switch is provided on one arm outside the armature, and the monopolar incision / monopolar coagulation switch is provided on the other arm outside.

10. 10. The electrocautery device according to any one of items 7 to 9, wherein a bipolar output is performed when all switches are operated simultaneously.

11. In an electrocautery device having a monopolar output and a bipolar output, it is possible to flow a monopolar output to a bipolar set that is connected and used, and an output switch is provided for the bipolar settler, so that monopolar incision, monopolar coagulation, and bipolar The electrosurgical device is characterized in that the switching of the operation is performed by the voice of the operator.

12. The electrosurgical apparatus according to claim 11, wherein characteristics of voices of a plurality of surgeons are stored in advance, and only the voices of the selected surgeons are reacted.

13. 13. When any output operation is performed, a prescribed time lag is provided until the operation is output, and the output mode is notified by voice during the time lag. An electrosurgical device according to item 1.

14. Item 14. The electrosurgical device according to item 13, wherein the output value (W) is also notified.

15. 15. The electric scalpel device according to any one of items 1 to 14, wherein the output mode is notified by an output sound unique to the output mode at the time of output.

16. 15. The electrosurgical device according to any one of items 1 to 14, wherein the mode selected is notified by voice when switching from the mode used immediately before to another mode.

[0100]

As described above, according to the medical treatment tool of the present invention, the cutting blade has high durability, can firmly coagulate the tissue by firmly grasping it, and does not cause bleeding. Only the coagulated tissue can be reliably dissected.

[Brief description of the drawings]

FIG. 1 is a perspective view showing a state in which a medical treatment tool according to a first embodiment of the present invention is connected to a power supply.

FIG. 2 is an enlarged perspective view of the medical treatment tool in FIG.

3A is a longitudinal sectional view of the medical treatment tool of FIG. 1 in a solidified state, and FIG. 3B is a transverse sectional view of the solidified state of FIG. 1 and FIG. 2 along line AA.

4A is a longitudinal sectional view of the medical treatment tool of FIG. 1 in an incision state, and FIG. 4B is a transverse sectional view of the medical treatment instrument in an incision state along line AA in FIGS. 1 and 2;

FIG. 5 is a perspective view of a medical treatment tool according to a second embodiment of the present invention.

FIG. 6A is a perspective view of a medical treatment tool according to a third embodiment of the present invention in a solidified state, and FIG. 6B is a perspective view of the medical treatment tool in FIG.

FIG. 7 (a) is a side view of the medical treatment tool according to the fourth embodiment of the present invention in a closed state, and FIG. 7 (b) is a dissection means in the medical treatment tool of FIG. FIG. 6 is a side view of the jaw when is operated.

FIG. 8 is a side view of the high-frequency treatment device according to the first embodiment (with the grip portion opened).

FIG. 9 is a side view of the high-frequency treatment device according to the first embodiment (in a solidified state with a gripper closed).

FIG. 10 is a side view of the high-frequency treatment device according to the first embodiment (an incision state in which a grip portion is closed).

11 is a view in the direction of arrow D in FIG. 10;

FIG. 12A shows a state in which the tissue is not grasped.
FIG. 11B is a cross-sectional view taken along line BB of FIG. 10, and FIG. 11B is a cross-sectional view taken along line CC of FIG. 10 in a state where the tissue is not gripped.

FIG. 13 (a) is a diagram illustrating a state where a tissue is grasped;
FIG. 11B is a cross-sectional view taken along the line B, and FIG. 11B is a cross-sectional view taken along the line CC in FIG. 10 in a state where the tissue is grasped.

14A is a side view of a high-frequency treatment device according to a second embodiment, FIG. 14B is a cross-sectional view of the treatment device of FIG. It is a cross-sectional view in the incision state which closed the grip part in the treatment tool of a).

15A is a side view of a high-frequency treatment device according to a third embodiment, FIG. 15B is a cross-sectional view of the treatment device of FIG. It is a cross-sectional view of an incision state in which a tissue is grasped in the treatment tool of ()).

FIG. 16 is a perspective view of the electric scalpel system.

FIG. 17 is a perspective view showing a first embodiment of the improved electric scalpel system.

FIG. 18 is a perspective view showing a second embodiment of the improved electric scalpel system.

FIG. 19 is a perspective view showing a third embodiment of the improved electric scalpel system.

FIG. 20 is a perspective view showing a fourth embodiment of the improved electric scalpel system.

FIG. 21 is a diagram showing an electrical connection form of the improved electric scalpel system.

[Explanation of symbols]

 2 Medical treatment tool 8, 9 Holding part 8a, 9a Holding surface 13 Operating part 15, 16 Conductor (heat generating part) 28, 29 Cutting member (cutting element) 28a, 29a Pointed end

 ──────────────────────────────────────────────────続 き Continuing on the front page (72) Inventor Toshiya Suga 2-43-2 Hatagaya, Shibuya-ku, Tokyo F-term in Olympus Optical Industrial Co., Ltd. 4C060 AA04 KK04 MM24

Claims (2)

[Claims] 1. A medical treatment tool having a pair of openable and closable gripping parts for gripping a living tissue on a distal end side and an operation part for opening and closing the gripping parts on a hand side, at least one of the gripping parts. A heat generating unit that generates heat for coagulating the living tissue grasped between the grasping units, and a dissecting unit for dissecting the tissue grasped between the grasping units, The incision means is provided substantially at the center axis of each gripping portion, has a pointed end forming a cutting blade, and is housed in the gripping portion so that the pointed end does not protrude from the gripping surface of the gripping portion. At least one of the cutting elements has an apex protruding from a gripping surface and comes into contact with the apex of the other cutting element in accordance with an operation of an operation unit provided in the operation unit. Specially to be operated as Medical treatment instrument to be. 2. The medical treatment tool according to claim 1, wherein the heat generating portion is formed of an electrode to which a high-frequency current is applied.