JP2000023994A - Ultrasonic treatment device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an ultrasonic treatment device that can contribute to enhancing controllability and reducing operating time, without causing thermal damage to peripheral tissue when solidifying and incising the living tissue specified, by restraining an increase in impedance during ultrasonic treatment, and achieving highly efficient ultrasonic drive to prevent a decrease in treatment capability. SOLUTION: During the ultrasonic treatment of a living tissue, a roller pump 123 is driven when the living tissue sandwiched between a probe 25 and a movable blade 41 is crushed by ultrasonic vibration, so that a liquid to be fed, such as a physiological salt water solution, is ejected to an ultrasonic treatment part via an inner hole in an insertion part sheath 2.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an ultrasonic treatment apparatus for grasping a living tissue and performing a treatment such as coagulation or incision on the grasped living tissue using ultrasonic waves.

[0002]

2. Description of the Related Art Generally, as an ultrasonic treatment apparatus for performing treatment such as coagulation or incision on living tissue using ultrasonic waves, for example, an ultrasonic coagulation apparatus disclosed in US Pat. No. 5,322,055 is disclosed. There is a lancing device. In this method, a rotatable gripping member is provided opposite to a distal end of a probe, which is a vibration transmitting member for transmitting ultrasonic waves, and a living tissue is gripped between the distal end of the probe and the gripping member. Is configured to perform ultrasonic treatment.

[0003] For example, Japanese Patent Application Laid-Open No. Hei 5-23345 discloses a configuration in which an ultrasonic suction device is provided with a water supply / suction function. Here, a cooling passage is provided between the probe and the sheath for flowing cooling water for cooling the probe, and for crushing fragments of living tissue generated by the ultrasonic treatment and for sucking cooling water after use. It is shown. Further, for example, DE 4420608 discloses a forceps having a water feeding / suction function for an electric scalpel.

[0004]

Problems to be Solved by the Invention USP No. 5,3
In the ultrasonic coagulation and incision apparatus disclosed in Japanese Patent No. 22,055, ultrasonic oscillation is performed in a state where a living tissue is gripped between the distal end of the probe and a gripping member, and the ultrasonic vibration is transmitted to the probe. As a result, the living tissue is coagulated and incised. At that time, if a large amount of blood or adipose tissue is present at the surgical site, the blood or adipose tissue is often sucked into the sheath covering the probe.

[0005] Here, a driving mechanism for driving the gripping member is incorporated in the sheath of the ultrasonic coagulation and incision apparatus. As a result, the structure inside the sheath of the ultrasonic coagulation and incision device is very complicated when compared with the structure inside the sheath which is very simple such as an ultrasonic suction device. Etc. adhere to the inside of the probe and become difficult to remove.

In such a case, the impedance of the probe is extremely increased, and a state in which ultrasonic oscillation cannot be performed occurs. In other words, the impedance characteristics of the probe are disturbed, and the resonance point on the resonance circuit cannot be determined.

In this type of ultrasonic coagulation and incision apparatus, a living tissue to be coagulated or to be separated is gripped between the tip of the probe and a gripping member. At this time, as the living tissue is grasped and fixed, the ultrasonic vibration energy is converted into frictional heat, and the living tissue is gradually coagulated and eventually separated.

[0008] At this time, it is sufficient that the frictional heat is transmitted only to the gripped portion. However, since the frictional heat is actually diffused in the direction of the gripped plane, the frictional heat is applied to a living tissue other than the intended portion. May also have a thermal effect.

Therefore, when using this kind of ultrasonic treatment instrument, if the treatment is performed in the vicinity of a part (for example, nervous tissue) where there is a possibility that a problem may occur if thermal influence is transmitted, the treatment is started from that part. It is common sense to use them at a certain distance or more. However, since the site that should not be affected by heat may be buried in adipose tissue or may be present on the back side of the treatment section, such a case may not be confirmed. further,
When the positional relationship between the treatment part and the part that is problematic due to thermal influence is close to each other, ultrasonic treatment cannot be performed, and there is also a problem that the use of the ultrasonic treatment tool is limited. .

Another problem is as follows.
That is, when the probe of the ultrasonic coagulation and incision apparatus is ultrasonically vibrated, it may oscillate at a frequency other than a predetermined frequency (also referred to as lateral vibration). In such a case, an unusual sound such as "Keen" may be generated. Furthermore, in this mode, the energy of the longitudinal oscillation, which is a normal oscillation mode, is converted into the energy of the transverse oscillation, so that the oscillation energy at the tip of the probe is reduced and, consequently, the coagulation / dissection function is reduced. There is a defect.

Further, when using the ultrasonic coagulation and incision apparatus, a mist is generated from a tip portion which grasps a living tissue and coagulates and separates by ultrasonic vibration. This mist hazes the inside of a body cavity particularly in an endoscopic surgical operation, which hinders observation of an operation field. In addition, it is a very troublesome problem because it causes the scope itself to fog.

Furthermore, when using the ultrasonic coagulation and incision apparatus, there is no problem if the blood vessel or organ to be treated is exposed on the surface, but if it is buried in fatty tissue or the like, In the case where the treatment has not been confirmed with a liquid such as blood when the adhesion has been made, the part to be treated must be exfoliated and exposed in advance. For this reason, using various forceps, sometimes, using an ultrasonic suction device, perform treatment such as suction for a sufficient time, peeling and exposing, using an ultrasonic coagulation and incision device, Coagulation and hemostasis are required. However, these operations, particularly in the field of endoscopic surgery, require the insertion and removal of a plurality of tools from the trocar, or require a plurality of operators to work together, which is troublesome. However, there is a problem that the operation cannot be performed continuously and the operation time is long, and the burden on the patient is increased.

The present invention has been made in view of the above circumstances, and an object thereof is to enable a living tissue sucked into a sheath to be smoothly discharged, to suppress a rise in impedance, and to realize a highly efficient ultrasonic wave. By realizing the drive, it is possible to prevent a decrease in treatment ability, and to limit the coagulation range of the living tissue to an area intended by the operator, without causing thermal damage to nerve tissue, etc. To coagulate and dissect the living tissue, exfoliate and expose the living tissue,
Provided is an ultrasonic treatment apparatus that enables a series of operations such as emulsification, crushing, suctioning, and discharging to the outside of a body to be continuously performed, thereby further improving operability and significantly reducing operation time. Is to do.

[0014]

According to a first aspect of the present invention, there is provided an ultrasonic vibrator for generating ultrasonic vibration, and an ultrasonic treatment section which incorporates the ultrasonic vibrator and performs treatment of a living tissue. A handpiece, a probe connected to the ultrasonic vibrator and transmitting an ultrasonic vibration to the ultrasonic treatment section, a sheath as a protective member covering the probe, and a distal end of the sheath. A grip that is disposed on a portion, and grips a living tissue between the ultrasonic treatment unit and the ultrasonic treatment unit when the device is opened and closed with the ultrasonic treatment unit in an openable and closable manner with respect to the ultrasonic treatment unit. A member, operating means for performing an operation for gripping or opening the living tissue between the gripping member and the ultrasonic treatment section, and gripping for driving the gripping member in accordance with the operation of the operating means Member driving means; Is an ultrasonic treatment apparatus characterized by comprising a water supply means for water in the inner hole of the. Then, at the time of ultrasonic treatment of the living tissue, the living tissue sandwiched between the probe and the holding member is crushed by ultrasonic vibration. At this time, by driving the water supply means, a water supply liquid such as a physiological saline solution is ejected to the ultrasonic treatment section or the like through the inner hole of the sheath.

According to a second aspect of the present invention, there is provided a handpiece including an ultrasonic vibrator for generating ultrasonic vibration, an ultrasonic treatment section for incorporating the ultrasonic vibrator and treating a living tissue, A probe as an ultrasonic transmission member that is connected to an ultrasonic transducer and transmits ultrasonic vibration to the ultrasonic treatment unit, a sheath that is a protection member that covers the probe, and is disposed at a distal end portion of the sheath, A gripping member for gripping a living tissue between the ultrasonic treatment unit and the ultrasonic treatment unit when the ultrasonic treatment unit is opened and closed with the ultrasonic treatment unit in an openable and closable manner; Operating means for performing an operation for gripping or releasing a living tissue between the ultrasonic treatment unit and the ultrasonic treatment unit; gripping member driving means for driving the gripping member in accordance with the operation of the operating means; Probe and super A through hole formed substantially on the center axis of the wave vibrator is disposed to the rear end of the handpiece,
An ultrasonic treatment apparatus, comprising: a suction base communicating with the through-hole; and suction means connected to the suction base. Then, at the time of ultrasonic treatment of the living tissue, the living tissue sandwiched between the probe and the holding member is crushed by ultrasonic vibration. At this time, by driving the suction means, the crushed living tissue can be sucked through the through hole of the probe and discharged to the outside.

[0016]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Hereinafter, a first embodiment of the present invention will be described with reference to FIGS. FIG. 1 shows a handpiece 1 of an ultrasonic incision coagulation apparatus which is an example of the ultrasonic treatment apparatus according to the present embodiment. The handpiece 1 of this ultrasonic incision coagulation apparatus is provided with an external unit 4 and an internal unit 5 shown in FIG.

As shown in FIG. 2B, the external unit 4 has an elongated tubular insertion section sheath 2 serving as an insertion section protection member, and a cylindrical section attached to the base end of the insertion section sheath 2. And a gripping sheath 3 are provided. Further, the gripping sheath 3 includes a fixed handle 11 and a movable operation handle 12.
Is provided.

Here, the fixed handle 11 is fixedly provided on the gripping sheath 3, and the movable operation handle 12 is pivotally attached to the same gripping sheath 3 by the pin 10.
Further, the fixed handle 11 and the movable operation handle 12 are formed with finger hanging ring portions 11a and 12a, respectively.

The proximal end of the insertion portion sheath 2 is shown in FIG.
As shown in (A), the rotation operation knob 17 is fixed. At the rear end of the rotary operation knob 17, a cylindrical connecting portion 17a is protruded. Further, the distal end of the gripping sheath 3 is rotatably connected to the connecting portion 17a of the rotary operation knob 17. As a result, the proximal end of the insertion portion sheath 2 is attached to the gripping sheath 3 so as to be rotatable around the axis via the connecting portion 17a of the rotary operation knob 17. An operation means for rotating the insertion sheath 2 around the axis with respect to the grip sheath 3 by the rotation operation knob 17 is configured.

The internal unit 5 is provided with an ultrasonic transducer unit 21 and a gripping member unit 22. Here, the ultrasonic vibrator unit 21 is provided with an ultrasonic vibrator (not shown) which is fixedly incorporated in the cover sheath 23 of the handpiece 1, a horn 24, and a probe 25 which is a vibration transmitting member. I have. Further, an ultrasonic treatment section 26 is formed at the distal end of the probe 25.
Then, the ultrasonic vibration generated by the ultrasonic vibrator is expanded by the horn 24 and the ultrasonic treatment unit 2 at the tip of the probe 25 is expanded.
6.

As members such as the horn 24 and the probe 25 for transmitting the vibration generated by the ultrasonic transducer, a titanium material, an aluminum material, or an alloy thereof having a high acoustic effect and good biocompatibility is used. .

FIG. 4 shows the probe 25 at its proximal end.
As shown in (B), a screw portion 27 is formed. The horn 24 is screwed into the tip of the horn 24 using the screw portion 27 and fastened. Further, the probe 25, which is a vibration transmitting member, has a tapered horn portion 28 in a part thereof, but is formed of a substantially straight rod without a step or a groove-shaped small diameter portion.
Due to this structure, the strength of the probe 25 is increased.

A thin ultrasonic treatment section 26 is formed at the tip of the probe 25. This ultrasonic treatment unit 2
Reference numeral 6 denotes a portion serving as the fixed blade 29. The fixed blade 29 may be a blade having a round cross section, but it is preferable to use a blade having a different shape such as an elliptical blade or a triangular blade in addition to a rectangular blade having a reduced blade width. This is desirable in making the treatment working unit compact. Further, in selecting the balance between the incision action and the coagulation action, various irregularly shaped blades are often used, and are generally irregular.

The portion of the fixed blade 29 is not formed integrally with the probe 25, but is formed as a separate member, which is connected to the probe 25 by screws or the like, and can be replaced with another type of fixed blade 29. You may do so.

The gripping member unit 22 has the configuration shown in FIG.
As shown in (A), a movable blade (grip member) 41 made of metal, which is a jaw that opposes the fixed blade 29 and grips and releases living tissue between the fixed blade 29 and the movable blade 4.
An operating rod (grip member driving means) 34 is provided as an operating force transmitting member for driving the opening and closing of the drive lever 1.

Further, FIG.
As shown in (A) to (C), a plurality of spacers 31 are provided at respective nodes n of the ultrasonic vibration in the probe 25. Of these, a gripping member support base 32 also serving as the spacer is disposed at a node n at the most distal position of the ultrasonic vibration in the probe 25.

The operation rod 3 is provided above each spacer 31.
Grooves 35 for fitting and holding 4 are formed. Here, as shown in FIG. 4 (A), an outer stopper 36 made of a small-diameter pipe is fitted and fixed in each groove 35. The operation bar 3 is attached to the outer stopper member 36.
4 is inserted and fixed. In other words, the operating rod 34 is the gripping member support base 32 which also serves as the spacer at the most advanced position.
Are fixed in the axial direction with respect to the other spacers 31 except for.

It is sufficient that the spacer 31 is held by the operation rod 34 so as not to shift from the position of each node n of the ultrasonic vibration in the probe 25. Therefore, as the attaching means, the spacer 31 and the operation rod 34 may be fixed directly or by the outer stopper member 36, but if they are not shifted from the position of each node n of the ultrasonic vibration, both are fixed. You may make it hold | maintain with the locking means which does not do. Since the spacer 31 is positioned and fixed to the operation rod 34 in this manner, it is not necessary to process the probe 25 with a concave and convex portion for positioning the spacer 31, so that the structure can be simplified and the cost can be reduced. And the strength of the probe 25 and the spacer 31 can be increased.

A through hole 37 for inserting and holding the probe 25 and a detachable slit 38 are formed below each spacer 31. The probe 25 is inserted into the through hole 37 so as to be slidable in the axial direction. Each of the spacers 31 is formed of a highly slidable fluororesin material such as so-called Teflon.
5 and a member that slides.

The base of the movable blade 41 is pivotally connected to the gripping member support base 32 formed of a spacer at the most distal end position by a pin 42. Further, the distal end of the operating rod 34 is rotatably connected to the base of the movable blade 41.

FIG. 4A shows the operation rod 34 at the base end thereof.
The slide ring 16 shown in FIG. The slide ring 16 is slidably fitted in the grip sheath 3 in the front-rear direction. Further, an insertion hole 43 through which the probe 25 passes is provided in the axial center portion of the slide ring 16.

An annular groove 44 for connection to the movable operation handle 12 is formed on the outer peripheral surface of the slide ring 16. Here, windows 14 for movable operation handles are formed on both side surfaces of the gripping sheath 3. A locking pin (locking body) 15 provided at the tip of the movable operation handle 12 is inserted into the window 14. Further, the tip of the locking pin 15 is fitted and locked in the annular groove 44 of the slide ring 16. With the operation of rotating the movable operation handle 12 about the pin 10, the slide ring 16 is slid in the front-rear direction via the locking pin 15, and the operation rod 34 is slid in the front-rear direction together with the slide ring 16. Thus, the movable blade 41 facing the fixed blade 29 is opened and closed.

Note that the locking pin 15 is used for the movable operation handle 1.
It is screwed into the tip of 2. And the locking pin 1
5 by turning the head 15a, the tip of the locking pin 15 is protruded and engaged with the annular groove 44 of the slide ring 16, or the tip of the locking pin 15 is retracted to make the slide ring 16 The locking pin 15 can be removed from the annular groove 44.

6 and FIG.
As shown in (A), a curved surface 52 that is in direct contact with the fixed blade 29 is formed on the contact surface side of the probe 25 with the fixed blade 29. It is preferable that the shape of the curved surface 52 be changed according to the shape of the fixed blade 29. Further, the movable blade 41 has corrugated tooth-shaped portions 54 on both sides of the curved surface 52 that is in direct contact with the fixed blade 29. Therefore, the movable blade 41
, And the living tissue can be easily gripped with the fixed blade 29. The curved surface 52 of the movable blade 41 and the material of the tooth-shaped portion 54 are preferably made of Teflon having high slidability.

A circular flange 46 is formed on the distal end side of the probe 25 at the position of the earliest node n of the ultrasonic vibration. Here, an engagement groove 47 having a shape corresponding to the flange 46 is formed on the lower surface of the gripping member support base 32 made of the most advanced spacer that supports the movable blade 41. Then, as shown in FIG.
6 is fitted and locked in the engagement groove 47 of the gripping member support base 32. Therefore, the probe 25 is rotatably held by the holding member support base 32.

Accordingly, the holding member support base 32 is incorporated together with the insertion portion sheath 2 in a state where it can be rotated around the axis of the probe 25. For this reason, the orientation of the fixed blade 29 with respect to the movable blade 41 may be any position of 360 °, and the fixed blade 29 can be rotated and used for the convenience of the operator.

The tip of the slide ring 16 is shown in FIG.
As shown in (A), a projection 112 is provided on one side of the center axis of the slide ring 16. Here, as shown in FIG. 5 (B), the probe 2
The shaft hole 17b through which the control rod 5 and the operation rod 34 are inserted is formed. Further, an engagement groove 17c having a shape corresponding to the protrusion 112 of the slide ring 16 is formed on one side of the shaft hole 17b.
Are formed. Then, the protrusion 1 of the slide ring 16
12 is engaged with the engagement groove 17c of the rotary operation knob 17 to prevent relative rotation between the slide ring 16 and the rotary operation knob 17 in the direction around the axis. Therefore, the protrusion 112 of the slide ring 16 is engaged with the engagement groove 17 c of the rotary operation knob 17.
, So that the portion other than the insertion portion sheath 2 and the probe 25 of the internal unit 5 can always be rotated simultaneously.

Further, as shown in FIG. 7B, a substantially flat locking end surface 48 is formed on the lower surface of the holding member support base 32. The locking end surface 48 is locked by a rotation stopping member 49 fixed to the inner surface of the insertion portion sheath 2. Then, the insertion portion sheath 2 and the gripping member support base 32
When and rotates about the axis, they rotate together with the locking member of the rotary operation knob 17, so that the internal unit 5 is not twisted.

The holding member support base 32 is integrally provided with a vibration-stopping member 50 made of a material having good slipperiness such as so-called Teflon for preventing the deflection of the fixed blade 29 of the probe 25. . The anti-vibration member 50 supports the horn portion 28 on the distal end side of the probe 25 and prevents bending.

In this embodiment, the ultrasonic vibrator of the ultrasonic vibrator unit 21, the horn 24, and the probe 2
5 has a through hole 110 formed in the axial center portion. Further, a suction base 102 communicating with the through hole 110 is provided at the rear end of the ultrasonic transducer unit 21 so as to project therefrom.
One end of a suction tube 103 is connected to the suction base 102.

On the outer peripheral surface of the distal end portion of the cover sheath 23, a ring-shaped water channel connecting member 100A for supplying water to the inner hole of the sheath 23 is rotatably mounted. A water supply base 100 is protruded from the waterway connecting member 100A. And the water supply tube 100 is connected to the water supply base 100.
01 is connected to one end.

Further, a hole for water supply penetrating into the cover sheath 23 is formed inside the waterway connecting member 100A. Then, the fluid supplied from the water supply tube 101 flows into the waterway connection member 100A from the water supply mouthpiece 100, and is then supplied into the cover sheath 23 from the water supply hole inside the waterway connection member 100A. Has become.

A water passage is formed between the insertion sheath 2 and the probe 25. Here, a groove 31a for forming a flow path is formed on the side surface of the spacer 31, as shown in FIG. 4A, so that water can be smoothly supplied. Further, as shown in FIG. 3 (C), a key groove 111 is formed in the gripping member support base 32 so as to penetrate therethrough, thereby facilitating the flow of the water supply liquid.

FIG. 8 shows a schematic configuration of the entire system of the ultrasonic incision coagulation apparatus. 8, reference numeral 121 denotes a power supply for ultrasonic treatment, and 114 denotes a power supply for high-frequency treatment.

As shown in FIG. 1, one end of an ultrasonic drive power cord 55 and one end of a high-frequency power cord 56 are connected to the rear end of the handpiece 1, respectively. Here, the other end of the ultrasonic drive power cord 55 is connected to the power supply 121 for ultrasonic treatment, and the other end of the power cord 56 for high frequency treatment is connected to the power cord 1 of the power supply 114 for high frequency treatment.
13 respectively. The power supply 121 for ultrasonic treatment is connected to a foot switch 122 for ultrasonic control, and the power supply 114 for high frequency treatment is connected to a foot switch 118 for high frequency control. Further, a counter electrode plate 120 is connected to the high-frequency power supply 114 via a lead wire 119.

As shown in FIG. 8, the other end of the water supply tube 101 connected to the water supply base 100 of the handpiece 1 is supplied with a water supply liquid such as physiological saline through a roller pump 123. It is connected to the tank 124. As a result, the saline solution or the like in the water supply tank 124 is supplied to the water supply tube 10 by driving the roller pump 123.
Water supply means for supplying water to a water supply passage between the insertion portion sheath 2 and the probe 25 via the first portion 1 is formed.

Further, the other end of the suction tube 103 connected to the suction base 102 is connected to a suction pump 116 via a suction bin 115 and a communication tube 117. Then, the living tissue crushed by the ultrasonic vibration is driven by the suction pump 116 to form the through-hole 11 of the probe 25.
A suction means for sucking through the suction bottle 0 and discharging the suction into the suction bin 115 is formed.

Next, the operation of the above configuration will be described.
When the ultrasonic incision coagulation apparatus according to the present embodiment is used, the movable blade facing the fixed blade 29 at the foremost part of the probe 25 with the operation of rotating the movable operation handle 12 about the pin 10 with respect to the fixed handle 11. 41 is opened and closed with respect to the fixed blade 29. Then, with the living tissue sandwiched between the fixed blade 29 and the movable blade 41, the living tissue is crushed by ultrasonic vibration. At this time, by driving the suction pump 116, the crushed living tissue can be sucked through the through hole 110 of the probe 25 and discharged into the suction bottle 115.

When the roller pump 123 is driven, a water supply solution such as a physiological saline solution stored in the water supply tank 124 is supplied to the cover sheath 2 via the water supply tube 101, the water supply base 100, and the water path connecting member 100A.
3, and can be further ejected from the distal end opening 2 a of the insertion portion sheath 2 through the lumen of the insertion portion sheath 2, and can be sprayed on a treatment site or the like.

Therefore, the above configuration has the following effects. That is, in the present embodiment, the roller pump 123 is driven during the ultrasonic treatment of the living tissue, and the physiological saline or the like in the water supply tank 124 is transmitted between the insertion portion sheath 2 and the probe 25 via the water supply tube 101. Since the water can be supplied to the water channel, when the living tissue sandwiched between the fixed blade 29 and the movable blade 41 at the foremost part of the probe 25 is crushed by ultrasonic vibration, blood, fat tissue, etc. are inserted into the insertion portion. Inflow between the sheath 2 and the probe 25 can be prevented by the flow of a water supply liquid such as a physiological saline solution supplied to a water supply path between the insertion portion sheath 2 and the probe 25. Therefore, an increase in the impedance of the probe 25 can be suppressed, and the ultrasonic drive can be smoothly performed without disturbing the resonance frequency characteristics. Therefore, a decrease in treatment capability can be prevented.

Further, the probe 2 of the ultrasonic coagulation and incision device
When ultrasonically oscillating 5, it can be prevented from oscillating at a frequency other than a predetermined frequency, so that it is possible to prevent an abnormal sound such as “Keen”, which cannot be heard during ultrasonic treatment, from being emitted, and to be highly efficient. Ultrasonic drive can be realized, and a decrease in treatment capacity can be prevented.

Further, the peripheral portion of the ultrasonic treatment section and the like can be efficiently cooled by a water supply solution such as a physiological saline solution ejected to the outside through the inner hole of the insertion section sheath 2. Therefore, since the coagulation range of the living tissue can be limited to the region intended by the operator, it is possible to contribute to the improvement of the operability and the drastic reduction of the operation time without causing the thermal damage to the nerve tissue or the like. .

Further, at the time of ultrasonic treatment of the living tissue, the suction pump 116 is driven when the living tissue sandwiched between the fixed blade 29 and the movable blade 41 at the foremost part of the probe 25 is crushed by ultrasonic vibration. Thereby, the crushed living tissue can be sucked through the through hole 110 of the probe 25 and discharged to the outside. Therefore, the living tissue sucked into the through-hole 110 of the probe 25 can be smoothly discharged, so that an increase in the impedance of the probe 25 is suppressed, and the treatment efficiency is reduced by realizing highly efficient ultrasonic driving. Can be prevented.

Further, in the handpiece 1 of the present embodiment, by using the water supply function and the suction function together during the ultrasonic coagulation work, in order to coagulate and incise the living tissue at the target site,
A series of operations such as exfoliating, exposing, emulsifying, crushing, aspirating, and discharging a living tissue out of the body can be continuously performed by the single handpiece 1 of the present embodiment without changing the treatment tool. Therefore, it is possible to omit the troublesome operation of exchanging the treatment tools during the operation as in the case where the above-described series of operations for coagulating and incising the living tissue is performed while exchanging a plurality of treatment tools. Can be improved and the operation time can be significantly reduced.

In this embodiment, the ring-shaped water passage connecting member 100A is rotatably mounted on the gripping sheath 3 of the handpiece 1, and the water connection base 100 is protruded from the water passage connecting member 100A. The position of the connecting portion between the tube 101 and the water supply base 100 can be moved to an arbitrary position in the circumferential direction of the gripping sheath 3. Therefore, the water supply tube 101 can be moved to a position where it does not hinder the operation of the user during the ultrasonic treatment, so that the usability of the handpiece 1 can be further enhanced.

FIG. 9 shows a second embodiment of the present invention. In the present embodiment, the configuration of the handpiece 1 of the ultrasonic incision coagulation apparatus of the first embodiment (see FIGS. 1 to 8) is changed as follows.

That is, in this embodiment, the water supply base 1 is attached to the insertion portion sheath 2 of the handpiece 1 of the first embodiment.
00, and a water supply tube 1 is attached to the water supply base 100.
01 is connected to one end. The other parts have the same configuration as the handpiece 1 of the first embodiment, and the same parts as those of the handpiece 1 of the first embodiment are denoted by the same reference numerals, Description is omitted.

Therefore, in the present embodiment, a ring-shaped waterway connection member 100A is rotatably mounted on the gripping sheath 3 of the handpiece 1 as in the first embodiment, and the waterway connection member 100A is attached to the waterway connection member 100A. There is an effect that the configuration of the gripper of the handpiece 1 can be simplified as compared with the case where the base 100 is protruded.

FIG. 10 shows a third embodiment of the present invention. In the present embodiment, the configuration of the handpiece 1 of the ultrasonic incision coagulation apparatus of the first embodiment (see FIGS. 1 to 8) is changed as follows.

That is, in the present embodiment, the tip of the fixed blade 29 which becomes the ultrasonic treatment section 26 at the tip of the probe 25 in the handpiece 1 of the first embodiment is inclined with respect to the center line direction. The movable blade 41 is provided with a bent portion 41a bent in the same direction as the bent portion 29a of the fixed blade 29. The other parts have the same configuration as the handpiece 1 of the first embodiment, and the same parts as those of the handpiece 1 of the first embodiment are denoted by the same reference numerals, Description is omitted.

Therefore, in the above configuration, the fixed blade 29 and the movable blade 41 of the handpiece 1 are provided with the bent portions 29a and 41a bent in the same direction at the distal ends thereof. Fixed blade 29 and movable blade 4
There is an effect that the work of sandwiching or exfoliating the living tissue between the first and the second is easy to perform.

FIG. 11 shows a fourth embodiment of the present invention. In the present embodiment, the configuration of the handpiece 1 of the ultrasonic incision coagulation apparatus of the first embodiment (see FIGS. 1 to 8) is changed as follows.

That is, in the present embodiment, a part of the outer peripheral surface of the probe 25 is attached to the tip of the fixed blade 29 which becomes the ultrasonic treatment section 26 at the foremost part of the probe 25 in the handpiece 1 of the first embodiment. Is formed to form a notch 131. The other parts have the same configuration as the handpiece 1 of the first embodiment, and the same parts as those of the handpiece 1 of the first embodiment are denoted by the same reference numerals, Description is omitted.

Therefore, in the above-described configuration, the work of, for example, hooking and cutting a living tissue can be performed by the notch 131 in the fixed blade 29 of the probe 25 in the handpiece 1. Therefore, the number of types of treatment that can be performed when using the handpiece 1 of the present embodiment can be further increased, so that the replacement work of the treatment tool during the operation can be further reduced, so that further operability can be achieved. This can contribute to improvement and a significant reduction in operation time.

Further, the present invention is not limited to the above-described embodiment, and it goes without saying that various modifications can be made without departing from the spirit of the present invention. Next, other characteristic technical matters of the present application will be additionally described as follows. (Supplementary note 1) The ultrasonic treatment apparatus is connected to the ultrasonic vibrator that generates ultrasonic vibration, a handpiece that incorporates the ultrasonic vibrator, and the ultrasonic vibrator, and performs treatment of a living tissue. A probe as an ultrasonic transmission member for transmitting ultrasonic vibration, a sheath as a protective member covering the probe, and a living tissue between the distal end member facing the distal end member at the distal end of the sheath. A gripping member for gripping, an operating means for performing an operation for gripping or releasing the living tissue with the gripping member and the distal end member, and an operating member for driving the gripping member in accordance with the operation of the operating means And a water supply means having a water supply base communicating with the sheath inner hole.

(Supplementary Item 2) The ultrasonic treatment apparatus is connected to an ultrasonic vibrator that generates ultrasonic vibration, a handpiece containing the ultrasonic vibrator, and the ultrasonic vibrator.
A probe as an ultrasonic transmission member for transmitting ultrasonic vibration by performing treatment on a living tissue, a sheath that is a protective member that covers the probe, and the distal end member facing the distal end member at the distal end of the sheath. A gripping member that grips the living tissue between, operating means for performing an operation for gripping or opening the living tissue by the gripping member and the distal end member,
An operating member for driving the gripping member in accordance with the operation of the operating means, provided at a rear end of the handpiece,
And a suction means having a suction base communicating with a through hole provided substantially on the central axis of the probe and the ultrasonic transducer.

(Appendix 3) The ultrasonic treatment apparatus is connected to the ultrasonic vibrator for generating ultrasonic vibration, a handpiece containing the ultrasonic vibrator, and the ultrasonic vibrator.
A probe as an ultrasonic transmission member for transmitting ultrasonic vibration by performing treatment on a living tissue, a sheath that is a protective member that covers the probe, and the distal end member facing the distal end member at the distal end of the sheath. A gripping member that grips the living tissue between, operating means for performing an operation for gripping or opening the living tissue by the gripping member and the distal end member,
An operation member for driving the gripping member in accordance with an operation of the operation means, and a water supply unit having a water supply base communicating with the sheath inner hole, and provided at a rear end of the handpiece. And a suction means having a suction base communicating with a through hole provided substantially on the central axis of the probe and the ultrasonic transducer.

(Additional Item 4) The ultrasonic treatment apparatus according to Additional Item 3, wherein the gripping member rotates about the axis of the probe. (Additional Item 5) The ultrasonic treatment apparatus according to Additional Item 3, wherein the handpiece includes a suction base.

(Additional Item 6) The ultrasonic treatment apparatus according to additional item 3, further comprising high-frequency power supply means. (Additional Item 7) The ultrasonic treatment apparatus according to Additional Item 3, further comprising a unit for supplying water only during ultrasonic oscillation.

(Prior Art of Additional Items 1 to 7)
Grasps living tissue, coagulates living tissue using ultrasound,
Alternatively, the present invention relates to an ultrasonic therapy apparatus for performing a procedure such as incision.
Conventionally, in US Pat. No. 5,322,055, a rotatable gripping member is provided opposite to a distal end of a probe that is a vibration transmitting member, and a living tissue is placed between the distal end of the probe and the gripping member. An ultrasonic coagulation / incision device which is grasped and adapted to perform an ultrasonic device on a living tissue is presented. on the other hand,
For example, Japanese Unexamined Patent Publication No. Hei 5-23345 describes a water supply / suction function of an ultrasonic suction apparatus, in which cooling water for cooling a probe is flowed between a probe and a sheath. It is proposed that there is a suction passage for sucking tissue, crushed pieces, and the like generated by sonication. Furthermore, for example, DE 4420608 discloses a forceps having a water supply / suction function for an electric scalpel.

(Problems to be Solved by Additional Items 1 to 7)
Conventional ultrasonic coagulation and incision equipment grasps tissue,
When making an incision, ultrasonic oscillation is performed and the ultrasonic vibration is transmitted to the probe. At that time, if a large amount of blood, adipose tissue, or the like is present at the operation site, the blood is often sucked into the sheath covering the probe. The structure inside the sheath of the ultrasonic coagulation and incision device is very complicated because it has a shape for driving the gripping member, compared to a very simple structure inside the sheath such as an ultrasonic suction device. Blood, adipose tissue, and the like adhere to the probe and cannot be removed. In that case, the impedance of the probe rises extremely, and a state where ultrasonic oscillation cannot be performed occurs. In other words, the impedance characteristic is disturbed, so that the resonance point on the resonance circuit cannot be determined, and there is a problem that ultrasonic oscillation cannot be performed.

There is still another problem. In this type of ultrasonic coagulation and incision apparatus, a living tissue to be coagulated or cut is gripped by the tip of the probe and a gripping member. At this time, the ultrasonic vibration energy is converted into frictional heat in the living tissue by being grasped and fixed, and the tissue gradually coagulates and is eventually separated. At that time, the frictional heat only needs to be transferred to the gripped portion, but the frictional heat diffuses in the plane direction of the gripped portion, so that there is a possibility that the thermal effect may be exerted on a portion other than the intended portion. . Therefore, when using this type of ultrasonic treatment instrument, when performing treatment near a site (for example, nerve tissue) where transmission of thermal influence becomes a serious problem, the ultrasonic treatment device should be used at a certain distance from the site. It is considered common sense. However, a portion that should not be affected by heat may not be able to be confirmed when it is buried in adipose tissue or when it is present on the back side of the treatment section. Further, there is also a problem in that when the positional relationship between the treatment section and a portion that is problematic due to thermal influence is close to each other, the use of ultrasonic treatment cannot be performed, which limits the usage.

There is still another problem. When ultrasonically oscillating the probe of the ultrasonic coagulation and incision device, it may oscillate at a frequency other than the specified frequency (also called lateral vibration), and emits an unusual sound called "Keen" that is unbearable to hear is there. In this mode, the energy of the normal oscillation form (longitudinal vibration) is converted into the energy of transverse vibration, so the vibration energy at the tip of the probe is reduced, and consequently the coagulation / incision function is deteriorated. there were.

There is another problem. When using an ultrasonic coagulation incision device, grasp the tissue and coagulate
Mist is generated from the tip part to be separated. This mist hinders the surgical field, particularly in endoscopic surgery, because it obscures the body cavity. In addition, it is a very troublesome problem because it causes the scope itself to fog.

There is still another problem. When using an ultrasonic coagulation incision device, there is no problem if the blood vessel or organ to be treated is exposed on the surface, but if it is buried in adipose tissue, etc., or it has adhered to other parts If the treatment section cannot be confirmed with a liquid such as blood,
The site to be treated must be peeled and exposed. Therefore, use a variety of forceps, and sometimes use an ultrasonic suction device, take sufficient time to exfoliate, aspirate, and expose, and then use an ultrasonic coagulation and incision device to coagulate and stop bleeding. There is. However, in these operations, particularly in the field of endoscopic surgery, it is necessary to put multiple tools in and out of the trocar, or multiple operators must work together, and the operation is continuous. The operation was troublesome, and the operation time was long, which was not a favorable condition for the patient.

(Objects of Supplementary Items 1 to 7) The present invention has been made in view of the above circumstances, and an object of the present invention is to use an ultrasonic coagulation and incision function together with a water supply function and a suction function. Suppressing the rise of impedance by smoothly discharging the tissue sucked up into the sheath, limiting the coagulation range of the living tissue to the area intended by the operator, without causing thermal damage to nerve tissue, etc., To realize a highly efficient ultrasonic drive, prevent the decrease of treatment ability, and to coagulate and dissect the tissue at the target site, exfoliate, expose, emulsify, crush, aspirate, and discharge the tissue outside the body It is an object of the present invention to provide an ultrasonic treatment apparatus that enables a series of operations to be continuously performed, and further contributes to improvement of operability and significant reduction of operation time.

(Means for Solving the Problem of Additional Item 1)
The present invention is directed to an ultrasonic transducer that generates ultrasonic vibration, a handpiece that incorporates the ultrasonic transducer, and an ultrasonic transducer that is connected to the ultrasonic transducer and that performs a treatment on a living tissue and transmits the ultrasonic vibration. A probe as a sound wave transmitting member, a sheath that is a protective member that covers the probe, a gripping member that faces the distal end member at the distal end of the sheath, and grips a living tissue between the distal end member, An operating means for performing an operation for gripping or releasing the living tissue by the gripping member and the distal end member, an operating member for driving the gripping member corresponding to the operation of the operating means, and communicating with the sheath inner hole And a suction port provided at the rear end of the handpiece and communicating with a through hole provided substantially on the center axis of the probe and the ultrasonic vibrator. And suction means having the ultrasonic treatment apparatus constituted by.

[0078]

According to the first aspect of the present invention, when the living tissue sandwiched between the probe and the gripping member is crushed by ultrasonic vibration during the ultrasonic treatment of the living tissue, the water supply means is driven, A water supply solution such as a physiological saline solution is ejected to the ultrasonic treatment section through the inner hole of the sheath, so that the water treatment liquid efficiently cools the ultrasonic treatment section, etc. By realizing efficient ultrasonic drive, it is possible to prevent a decrease in treatment capacity, and to limit the coagulation range of living tissue to the area intended by the operator, without causing thermal damage to nerve tissue etc. This can contribute to improvement of operability and drastic reduction of operation time.

According to the second aspect of the present invention, at the time of ultrasonic treatment of the living tissue, when the living tissue sandwiched between the probe and the holding member is crushed by ultrasonic vibration, the crushing is performed by driving the suction means. The living tissue that has been sucked through the through-hole of the probe can be discharged to the outside, so that the living tissue sucked into the sheath can be smoothly discharged, suppressing a rise in impedance, By realizing efficient ultrasonic drive, it is possible to prevent a decrease in treatment capacity, and to limit the coagulation range of living tissue to the area intended by the operator, without causing thermal damage to nerve tissue etc. In addition, in order to coagulate and dissect the living tissue at the target site, a series of operations such as peeling, exposing, emulsifying, crushing, aspirating, and discharging the living tissue out of the body can be performed continuously. To, can contribute to significant reduction in a further improvement in operability and operation time.

[Brief description of the drawings]

FIG. 1 is a perspective view showing a handpiece of an ultrasonic incision coagulation apparatus according to a first embodiment of the present invention.

FIG. 2A is a perspective view showing an internal unit in a handpiece of the ultrasonic incision coagulation apparatus according to the first embodiment, and FIG. 2B is a perspective view showing an external unit.

FIG. 3A is a longitudinal sectional view showing a distal end portion of an internal unit in the handpiece of the ultrasonic incision coagulation apparatus according to the first embodiment, FIG. 3B is a sectional view taken along line BB of FIG. (C)
FIG. 4 is a cross-sectional view taken along line CC of FIG.

FIG. 4 is a diagram illustrating a probe and a gripping member driving mechanism of an internal unit in a handpiece of the ultrasonic incision coagulation apparatus according to the first embodiment.

FIG. 5 shows an external unit in the handpiece of the ultrasonic incision coagulation apparatus according to the first embodiment, and (A).
Is a vertical cross-sectional view showing a main part configuration of a peripheral portion of the fixed handle,
(B) is a sectional view taken along line BB of (A).

FIG. 6 is a perspective view of a treatment unit in the handpiece of the ultrasonic incision coagulation apparatus according to the first embodiment.

FIG. 7A is a front view illustrating a closed state of a grasping member of a treatment unit in the handpiece of the ultrasonic incision coagulation apparatus according to the first embodiment, and FIG. 7B is a diagram illustrating an open state of the grasping member of the treatment unit. FIG.

FIG. 8 is a schematic configuration diagram of the entire system of the ultrasonic incision coagulation apparatus according to the first embodiment.

FIG. 9 is a perspective view of a handpiece of an ultrasonic incision coagulation apparatus showing a second embodiment of the present invention.

FIG. 10 is a perspective view of a treatment unit in a handpiece of an ultrasonic incision coagulation apparatus showing a third embodiment of the present invention.

FIG. 11 is a perspective view of a treatment unit in a handpiece of an ultrasonic incision coagulation apparatus showing a fourth embodiment of the present invention.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Handpiece 2 Insertion part sheath 3 Grasping part sheath 13 Grasping member operation means 25 Probe 26 Ultrasonic treatment part 29 Fixed blade 34 Operation rod (Grip member drive means) 41 Movable blade (Grip member) 100 Water supply mouthpiece (Water supply means) 101 water supply tube (water supply means) 123 roller pump (water supply means) 124 water supply tank (water supply means)

Claims (2)

[Claims] 1. An ultrasonic vibrator for generating ultrasonic vibration, a handpiece including the ultrasonic vibrator and having an ultrasonic treatment unit for treating a living tissue, A probe as an ultrasonic transmission member that is connected and transmits ultrasonic vibrations to the ultrasonic treatment unit; a sheath that is a protective member that covers the probe; and A gripping member for gripping a living tissue between the ultrasonic treatment section when the ultrasonic treatment section is opened and closed with the ultrasonic treatment section in an openable and closable manner; Operating means for performing an operation for gripping or opening the living tissue between the part, gripping member driving means for driving the gripping member in accordance with the operation of the operating means, and an inner hole of the sheath. Water supply means for water supply Ultrasonic treatment apparatus characterized by comprising. 2. A handpiece having an ultrasonic transducer for generating ultrasonic vibration, an ultrasonic treatment unit for incorporating the ultrasonic transducer and treating a living tissue, and A probe as an ultrasonic transmission member that is connected and transmits ultrasonic vibrations to the ultrasonic treatment unit; a sheath that is a protective member that covers the probe; and A gripping member for gripping a living tissue between the ultrasonic treatment section when the ultrasonic treatment section is opened and closed with the ultrasonic treatment section in an openable and closable manner; Operating means for performing an operation for gripping or releasing the living tissue between the unit and the gripping member driving means for driving the gripping member in accordance with the operation of the operating means; the probe and the ultrasonic wave Vibrator A through-hole formed on a central axis, a suction base provided at a rear end of the handpiece and communicating with the through-hole, and suction means connected to the suction base. Ultrasonic treatment equipment.