JP7613721B2 - Cutting instrument, forceps, end effector, medical tool, medical system, robot, surgical medical robot, grasping and cutting method, and portable surgical instrument - Google Patents

Description

The present invention relates to a cutting instrument that contacts and cuts a target area, and in particular to forceps, end effectors, medical tools, medical systems, robots, surgical medical robots, grasping and cutting methods, and portable surgical instruments that are capable of grasping, incising, dissecting, coagulating (hemostasis), and cutting surgical operations.

The basic operation of the extraction surgery is the repeated operation of dissection, coagulation (hemostasis), and cutting. During this process, the target area must also be grasped. During surgery, it is desirable to perform each operation consecutively, and ideally, the operation can be continued without changing devices.

However, the Ligasure, which is famous for its high-frequency energy, has a two-stage structure in which a wide blade like a waterfowl's beak grasps the biological tissue (target area), high-frequency energy is applied to coagulate it, and the coagulated part with a cutting edge is then cut with a scalpel or scissors-like tool, making it a two-stage operation.

JP 2017-060846 A

No instrument has been developed that can contact and cut tissue without changing or replacing the device, and so a multi-function device is needed to ensure smooth, continuous surgical procedures and reduce time by changing instruments. This is particularly important in laparoscopic and robotic surgery, where the surgeon's hands cannot reach certain areas. There is a demand for a device that can cut and grasp tissue while maintaining coagulation and hemostatic functions.

The present invention aims to provide a cutting instrument that can grasp and cut a target area without changing or replacing the device. It also aims to provide forceps, an end effector, a medical tool, a medical system, a robot, a surgical medical robot, a grasping and cutting method, and a portable surgical instrument that can contact and cut tissue without changing or replacing the device.

The cutting device of the present invention for solving the above problem is characterized in that it is provided with a gripping mechanism having a first gripping part and a second gripping part assembled so as to be openable and closable, a gripping part rotation means for rotating the first gripping part towards the second gripping part, a cutting part provided adjacent to the first gripping part, and a cutting part rotation means for rotating the cutting part in the same direction as the rotation of the first gripping part, and in a state where a target part is gripped by the gripping mechanism, the cutting mechanism rotates the cutting part and joins it with the second gripping part, thereby cutting the target part.

The medical tool of the present invention for solving the above problems includes an end effector having a gripping mechanism and a cutting mechanism, and a drive unit for driving the end effector. The gripping mechanism has a first gripping section and a second gripping section assembled so as to be openable and closable, and a gripping section rotation means for rotating the first gripping section toward the second gripping section. The cutting mechanism has a cutting section attached to the first gripping section and a cutting section rotation means for rotating the cutting section in the same direction as the rotation of the first gripping section. The drive unit selectively provides at least one of a perforation function, a gripping function, a coagulation function, a cutting function, and an opening and exhausting function by driving the first gripping section, the second gripping section, and the cutting section in combination.

The medical system of the present invention for solving the above problem is characterized in that it is provided with a gripping mechanism having a first gripping part and a second gripping part assembled so as to be opened and closed, and a gripping part rotation means for rotating the first gripping part towards the second gripping part, a cutting mechanism having a cutting part attached to the first gripping part and a cutting part rotation means for rotating the cutting part in the same direction as the rotation of the first gripping part, a rotation shaft for rotatably supporting the first gripping part and the cutting part with respect to the second gripping part is provided, a drive unit for independently driving the gripping part rotation means and the cutting part rotation means, and a medical robot configured to coagulate and cut the target part while gripping the target part by applying a drive signal to the drive unit.

The cutting device, robot, or portable surgical instrument of the present invention for solving the above-mentioned problems is provided with a gripping mechanism having a first gripping part and a second gripping part assembled so as to be opened and closed, and a gripping part rotation means for rotating the first gripping part towards the second gripping part, a cutting part provided in the first gripping part, and a cutting part rotation means for rotating the cutting part in the same direction as the rotation of the first gripping part, and a rotation shaft for rotatably supporting the first gripping part and the cutting part with respect to the second gripping part is provided, and the gripping part rotation means moves a portion of the first gripping part supported by the rotation shaft at a predetermined distance from the rotation shaft. The cutting unit moving means is configured with a gripping unit moving means that moves a portion of the cutting unit supported by the rotating shaft at a predetermined distance from the rotating shaft, and the gripping unit moving means and the cutting unit moving means are configured with a long member and are moved along the long longitudinal direction, and the gripping unit moving means moves in the longitudinal direction to rotate the first gripping unit, and in a state in which the target site is gripped by the gripping mechanism, the gripping unit moving means moves in the longitudinal direction to rotate the cutting unit and join it to the second gripping unit, thereby cutting the target site.

According to the above-mentioned configuration, the first gripping unit and the cutting unit are moved by the gripping unit moving means and the cutting unit moving means, respectively, so that the target site can be gripped by the gripping mechanism and the target site can be cut by the cutting mechanism. The long member may be a flexible long member having flexibility.

The gripper moving means, which is made of the flexible long member, may have a first gripper moving means connected to one of two predetermined locations on the first gripper, which are spaced a predetermined distance from the pivot shaft, and a second gripper moving means connected to the other predetermined location and moving in the pulling direction in the longitudinal direction, and the cutting section moving means, which is made of the flexible long member, may have a first gripper moving means connected to one of two predetermined locations on the cutting section, which are spaced a predetermined distance from the pivot shaft, and a second gripper moving means connected to the other predetermined location and moving in the pulling direction in the longitudinal direction.

According to this configuration, the first gripping section moving means and the first gripping section moving means can rotate the first gripping section and the cutting section in the pulling direction relative to the second gripping section by moving a predetermined location in the pulling direction in the longitudinal direction, and the second gripping section moving means and the second gripping section moving means can rotate in the pulling direction by moving a predetermined location in the pulling direction in the longitudinal direction. Therefore, for example, when the first gripping section (cutting section) is rotated in the gripping direction (cutting direction) relative to the second gripping section by moving the first gripping section moving means (the first cutting section moving means) in the pulling direction, the first gripping section (cutting section) can be opened by moving the second gripping section moving means (the second cutting section moving means) in the pulling direction. In other words, the first gripping section (cutting section) can be rotated in the gripping direction (cutting direction) relative to the second gripping section and in the opening direction by moving the moving means.

In addition, the gripping portion moving means and the cutting portion moving means, which are made of the flexible long member, may be provided with a gripping biasing portion that moves a predetermined location in a pulling direction in the longitudinal direction and biases the first gripping portion in a direction in which the predetermined location moves in a pushing direction in the longitudinal direction, and a cutting biasing portion that biases the second cutting portion in a direction in which the predetermined location moves in the pushing direction.
The gripping unit moving means and the cutting unit moving means may move predetermined locations in a pushing direction and a pulling direction in the longitudinal direction.

According to this configuration, by moving the first gripping part with the gripping part moving means, the first gripping part rotates relative to the second gripping part to grip the target part, and by moving the cutting part with the cutting part moving means, the cutting part rotates relative to the second gripping part to cut the target part.

The long member may be a rod-shaped slide plate that slides in the longitudinal direction relative to a reference frame to rotate the first gripping part or the cutting part, and a notification part may be provided that notifies the outside of at least one of the rotation of the first gripping part or the cutting part relative to the second gripping part by sliding the slide plate in the longitudinal direction relative to the reference frame on which the first gripping part or the cutting part rotates, and a notification amount adjustment means may be provided that adjusts the amount of notification by the notification part. Note that the notification part may be, for example, a notification by a sound such as a clicking sound, a notification by a sensation such as a clicking feeling, or a notification as an electrical or electric signal such as ON/OFF of the current supply. Therefore, the notification amount adjustment means is a means for adjusting the loudness of the clicking sound, the loudness of the clicking feeling, the loudness of the current supply, etc.
According to this configuration, at least one of the rotation of the first gripping portion relative to the second gripping portion and the rotation of the cutting portion can be notified to the outside.

Electrodes for irradiating electromagnetic waves may be provided at least one of the gripping portion where the target portion is gripped in the first gripping portion and the vicinity of the cutting blade in the cutting portion, and at the gripping portion where the target portion is gripped in the second gripping portion, and the electrodes are coaxial electrodes having a center electrode and an outer electrode surrounding the center electrode via an insulator, and a coaxial cable connecting the electrode and an irradiation device that irradiates the electromagnetic waves may be branched into multiple parallel cables, and each of the coaxial electrodes may be electrically connected to the center conductor and the outer conductor of the coaxial cable. Furthermore, the coaxial electrodes may be connected in reverse polarity to the coaxial cable.

The medical system of the present invention for solving the above problem may include the above-mentioned cutting device, a drive unit that independently drives the gripper movement means and the cutting unit movement means, and a medical robot connected to apply a drive signal to the drive unit.

The robot of the present invention for solving the above-mentioned problems includes an input/output unit connected to the above-mentioned cutting device by wire and/or wirelessly, an input unit that receives an operation signal in real time, a calculation unit that executes a predetermined operation program based on the operation signal, and an output unit that generates a gripping drive signal for gripping the target part with the first gripping part and the second gripping part by moving the gripping part moving means in the longitudinal direction based on the output from the calculation unit and/or a cutting drive signal for cutting the target part with the cutting part by moving the cutting part moving means in the longitudinal direction based on the output from the calculation unit.Furthermore, in the surgical medical robot of the present invention for solving the above-mentioned problems, in addition to the robot, the output unit may provide a drive signal to an external drive unit that mechanically drives the cutting device.

The end effector of the present invention for solving the above problem may include the above-mentioned cutting tool, a mounting part for mounting at least the second gripping part of the cutting tool to the tip of a robot arm, the gripping part side connection part for connecting to a drive mechanism for driving the gripping part movement means on the robot arm side, and the cutting part side connection part for connecting to a drive mechanism for driving the cutting part movement means on the robot arm side.

The forceps of the present invention for solving the above problem includes the above-mentioned cutter, the target site is biological tissue, and includes a gripping operation unit that drives and operates the cutting unit moving means, and a cutting operation unit that drives and operates the cutting unit moving means, and the gripping operation unit is operated to grip the biological tissue with the first gripping unit and the second gripping unit, and the cutting operation unit is operated to cut the biological tissue with the cutting unit. Alternatively, the forceps of the present invention includes the above-mentioned cutter, the target site is biological tissue, and includes a gripping operation unit that drives and operates the gripping unit moving means, and a cutting operation unit that drives and operates the cutting unit moving means, and the gripping operation unit is operated to grip the biological tissue with the first gripping unit and the second gripping unit, and the electrode is irradiated with electromagnetic waves to coagulate at least a part of the biological tissue, and the cutting operation unit is operated to cut the biological tissue with the cutting unit.

The gripping and cutting method of the present invention for solving the above-mentioned problems comprises the steps of using the above-mentioned cutting device, operating the gripping unit moving means to rotate the first gripping unit towards the second gripping unit, and gripping the target part with the first gripping unit and the second gripping unit, and operating the cutting unit moving means to move the cutting unit attached to the first gripping unit along the first gripping unit, and joining it with the second gripping unit to cut the gripped target part. Alternatively, the above-mentioned cutting device may be used, and the target site may be biological tissue, and the method may include the steps of rotating the first gripping part toward the second gripping part by operating the gripping part moving means to grip the target site with the first gripping part and the second gripping part, coagulating at least a portion of the biological tissue by irradiating electromagnetic waves from the electrode, and operating the cutting part moving means to move the cutting part attached to the first gripping part along the first gripping part and joining it with the second gripping part to cut the gripped and coagulated target site.

This invention provides a cutting instrument, forceps, end effector, medical tool, medical system, robot, surgical medical robot, grasping/cutting method, and portable surgical instrument that can grasp and cut a target area without changing or replacing the device.

FIG. 2 is a front view of the forceps in an open state according to the first embodiment. 2(a) is a rear view of the forceps in an open state according to the first embodiment, FIG. 2(b) is a plan view of the forceps, and FIG. 2(c) is a bottom view of the forceps in FIG. Fig. 3 is a schematic explanatory diagram of the forceps in Fig. 1. Fig. 3(a) is a side cross-sectional view taken along line A-A in Fig. 1(a), Fig. 3(b) is a partial longitudinal cross-sectional view of the forceps, and Fig. 3(c) is an enlarged view of the electrode portion taken along line B-B in Fig. 3(b). Fig. 4(a) is a front view of the forceps in a gripping state with a gripping mechanism closed, and Fig. 4(b) is a rear view of the forceps in the same state. 5A is a front view of the forceps in a cutting state with a cutting cutter of a cutting mechanism in the forceps closed, and FIG. Fig. 6(a) is a side cross-sectional view taken along the line A-A in Fig. 1 before gripping with the gripping mechanism, Fig. 6(b) is a side cross-sectional view taken along the line C-C in Fig. 4(b) when the target site is gripped with the gripping mechanism, Fig. 6(c) is a side cross-sectional view taken along the line D-D in Fig. 5(b) when the target site is cut with a cutting cutter, and Fig. 6(d) is a right schematic side view of a state gripped by the gripping mechanism of another embodiment of the cutting mechanism. FIG. 13 is a front view of the forceps in the open state according to the second embodiment. FIG. 13 is a bottom view of the forceps in the open state of the second embodiment. 9A is a front view of the forceps in a gripping state with a gripping mechanism closed, and FIG 9B is a rear view of the forceps in the same state. Fig. 10 is an explanatory diagram of the cutting state of the forceps in Fig. 7. Fig. 10(a) is a front view of the cutting state in which the cutting cutter of the cutting mechanism in the forceps is closed, and Fig. 10(b) is a rear view of the forceps in the same state. 11(a) is a front view of the forceps of the third embodiment in an open state, and FIG 11(b) is a plan view of the forceps. FIG. 13 is a rear view of the forceps in the open state of the third embodiment. Fig. 13 is an explanatory view of the forceps in Fig. 11. Fig. 13(a) is a front view of the forceps in a gripping state with a gripping mechanism closed, and Fig. 13(b) is a front view of the forceps in a cutting state with a cutting cutter of a cutting mechanism closed. 14(a) is a rear view of the forceps in an open state having a cutting mechanism according to a fourth embodiment, FIG. 14(b) is a partial longitudinal sectional view of the forceps, and FIG. 14(c) is a side sectional view taken along the line E-E in FIG. 14(a). 15(a) and 15(b) are explanatory views of forceps in an open state having a cutting mechanism according to a fifth embodiment. FIG. 13 is a schematic front view of the end effector of the sixth embodiment. Fig. 17 is a schematic explanatory diagram of the end effector in Fig. 16. Fig. 17(a) is a side cross-sectional view taken along the line F-F in Fig. 16, Fig. 17(b) is a partial vertical cross-sectional view of the end effector, Fig. 17(c) is an enlarged plan view taken along the line G-G in Fig. 16, and Fig. 17(c) is an enlarged view of Fig. 17(b). 18A is a schematic front view of the end effector in a normal state, FIG. 18B is a schematic front view of the end effector in a gripping state, and FIG. 18C is a schematic front view of the end effector in a cutting state according to a sixth embodiment. Fig. 19 is a schematic explanatory diagram of an end effector which is a modified example of the end effector in Fig. 17. Fig. 19(a) is a side cross-sectional view taken along the line F-F in Fig. 16, Fig. 19(b) is a partial vertical cross-sectional view of the end effector, and Fig. 19(c) is an enlarged plan view taken along the line G-G in Fig. 16. FIG. 11 is a schematic diagram of a medical device according to another embodiment. 13 is a schematic diagram of a telesurgery system according to another embodiment. FIG. 1 is a schematic diagram illustrating a surgical device in a remote surgical system. FIG. 1 is an explanatory diagram of a remote surgery system. 13 is a schematic diagram of a forceps according to another embodiment. FIG. 13 is a schematic diagram showing the functional configuration of forceps according to another embodiment.

The following example describes the use of the cutting device of the present invention in a medical device, and the example described below is a pair of forceps, but the present invention provides a cutting device that is not limited to medical devices.

For example, FIG. 1 shows a front view of a first embodiment of forceps 1 in an open position.
Fig. 2 shows an explanatory diagram of the forceps 1 in an open state according to the first embodiment. In detail, Fig. 2(a) shows a rear view of the forceps 1, Fig. 2(b) shows a plan view of the forceps 1, and Fig. 2(c) shows a bottom view of the forceps 1 in Fig. 2(b).

Figure 3 shows a schematic diagram of the forceps 1 in Figure 1. In detail, Figure 3(a) shows a side cross-sectional view taken along the line A-A in Figure 1(a), Figure 3(b) shows a partial vertical cross-sectional view of the forceps 1, and Figure 3(c) shows an enlarged view of the electrode portion taken along the line B-B in Figure 3(b).

Figure 4 shows an explanatory diagram of the gripping state of the forceps 1 in Figure 1. In detail, Figure 4(a) shows a front view of the forceps 1 in the gripping state with the gripping mechanism 17 closed, and Figure 4(b) shows a rear view of the forceps 1 in the same state.

Figure 5 shows an explanatory diagram of the cutting state of the forceps 1 in Figure 1. In detail, Figure 5(a) shows a front view of the forceps 1 in a cutting state with the cutting cutter 15 of the cutting mechanism 10 in the forceps 1 closed, and Figure 5(b) shows a rear view of the forceps 1 in the same state.

Figure 6 shows an explanatory diagram of the gripping state of the gripping mechanism 17 of the forceps 1 and the cutting state of the cutting mechanism 10. In detail, Figure 6(a) shows a side cross-sectional view along the arrows A-A in Figure 1 before gripping by the gripping mechanism 17, and Figure 6(b) shows a side cross-sectional view along the arrows C-C in Figure 4(b) when the target part is gripped by the gripping mechanism 17. Also, Figure 6(c) shows a side cross-sectional view along the arrows D-D in Figure 5(b) when the target part has been cut by the cutting cutter 15, and Figure 6(d) shows a schematic right side view of the cutting mechanism 10 in another embodiment when gripped by the gripping mechanism 17.

1 to 6, the forceps 1 includes a main body frame 11, a pinion gear 12, a trigger handle 13 (13a, 13b), an upper jaw portion 14, a cutting cutter 15, and an opening/closing wire 16.
The direction along the longitudinal direction of the main body frame 11 of the forceps 1 is defined as the longitudinal direction L, the side of the main body frame 11 on which the upper jaw portion 14 and the cutting cutter 15 are arranged is defined as the tip side F, and the side on which the trigger handle 13 is arranged is defined as the base side R.

The main body frame 11 is roughly composed of two sides that intersect at an obtuse angle, one of which is a fixed handle frame 111 that functions together with the trigger handle 13 as an operating section, and the other is a reference frame 112. The main body frame 11 thus configured is made of a metal such as stainless steel.

The end of the fixed handle frame 111 is provided with a finger ring portion 113 into which the finger of the user who operates the forceps 1 is inserted.
Further, a support shaft 114 that axially supports a trigger handle 13 (described later) is provided near the base of the reference frame 112, and a gear support portion 115 that axially supports a pinion gear 12 (described later) is provided above the support shaft 114.

Furthermore, a lower jaw 116 is provided at the end of the tip side F of the reference frame 112. The lower jaw 116 constitutes a gripping mechanism 17 that cooperates with the gripping trigger handle 13a of the trigger handle 13 to grip a target site such as a blood vessel B (see FIG. 6) to be treated. The lower jaw 116 is configured to have a tapered shape toward the tip side F when viewed from the front. The lower jaw 116 is also called a jaw.
Further, a tip support portion 117 that axially supports the upper jaw portion 14 and the cutting cutter 15 is provided on the base end side R of the lower jaw portion 116 of the reference frame 112 .

The pinion gear 12, which functions as a gripping unit rotation (movement) means and a cutting unit rotation (movement) means in cooperation with the opening and closing wire 16 described below, is journaled on the above-mentioned gear support 115 and converts the operation of the trigger handle 13 into the movement of the opening and closing wire 16. Specifically, there is an upper jaw gear 12a that converts the operation of the gripping trigger handle 13a into the movement of the upper jaw wire 16a, and a cutter gear 12b that converts the operation of the cutting trigger handle 13b into the movement of the cutter wire 16b, with the upper jaw gear 12a located on the front side and the cutter gear 12b located on the back side.

The upper jaw gear 12a and the cutter gear 12b have the same configuration, and the outer peripheral surface of the gripping trigger handle 13a has gear teeth 121 that mesh with the rack gear 134 of the trigger handle 13, which will be described later, and a wire attachment portion 122 to which the base end of the opening/closing wire 16, which will be described later, is attached.

Specifically, as shown in FIG. 1, there is a proximal side mounting part 152a that is disposed at the axial center 115a of the gear support part 115 and to which the tip of the proximal side wire 161 is attached, and an open side mounting part 152b that is disposed above the axial center 115a and to which the tip of the open side wire 162 is attached. The wire mounting part 122 is disposed at a predetermined distance in the radial direction from the axial center 115a of the gear support part 115.

As shown in FIG. 2, there is a proximal side mounting part 152a disposed at the axial center 115a of the gear support part 115 to which the tip of the proximal side wire 161 of the cutter wire 16b is attached, and an open side mounting part 152b disposed above the axial center 115a to which the tip of the open side wire 162 of the cutter wire 16b is attached. The wire mounting part 152 is disposed at a predetermined radial distance from the axial center 115a of the gear support part 115.

The trigger handle 13 is an operating part for operating the opening and closing wire 16 described below to rotate the upper jaw 14 and the cutting cutter 15, and includes a gripping trigger handle 13a that rotates the upper jaw 14, and a cutting trigger handle 13b that rotates the cutting cutter 15.

The trigger handle 13 has a finger ring portion 132 into which the user inserts his or her finger at the lower end of a handle body 131 extending downward, and a pivot portion 133 near the upper end of the handle body 131 that is pivotally supported on the support shaft 114 of the main body frame 11.
Furthermore, a rack gear 134 arranged in the shape of an upwardly protruding circular hole is formed at the upper end of the handle body 131. The rack gear 134 is configured to mesh with the gear teeth 121 of the pinion gear 12.

The grasping trigger handle 13a and the cutting trigger handle 13b are configured in the same manner as described above, with the only difference being the length of the handle body 131. Specifically, the handle body 131a of the grasping trigger handle 13a is formed longer than the handle body 131b of the cutting trigger handle 13b so that the finger ring portion 132 of the cutting trigger handle 13b is positioned above the finger ring portion 132 of the grasping trigger handle 13a.

The upper jaw 14 has a base end side R pivotally supported by a tip support portion 117 of the main body frame 11, and constitutes a gripping mechanism 17 together with a lower jaw 116 of the main body frame 11. The upper jaw 14 is also referred to as a jaw.
The upper jaw 14 has a base end (left side in FIG. 1 ) provided with a shaft receiving portion 141 that is axially supported by the tip support portion 117 of the main body frame 11 .

The axially supported portion 141 is provided with a wire attachment portion 142 to which the tip of the opening/closing wire 16, which will be described later, is attached. Specifically, there is a proximal side attachment portion 142a disposed below the axially supported portion 141 to which the tip of the proximal side wire 161 of the upper jaw wire 16a is attached, and an open side attachment portion 142b disposed above the axially supported portion 141 to which the tip of the open side wire 162 of the upper jaw wire 16a is attached. The wire attachment portion 142 is disposed at a predetermined radial distance from the axial center 117a of the tip support portion 117, which is supported by the axially supported portion 141.

As shown in Figures 1 and 2, the cutting cutter 15 is disposed on the rear side of the upper jaw 14 and has a shaft receiving portion 151 that is supported by the tip support portion 117 of the main body frame 11.

The shank 151 is provided with a wire attachment section 152 to which the tip of the opening/closing wire 16, which will be described later, is attached. Specifically, there is a proximal attachment section 152a disposed below the shank 151 to which the tip of the proximal wire 161 of the cutter wire 16b is attached, and an open-side attachment section 152b disposed above the shank 151 to which the tip of the open-side wire 162 of the cutter wire 16b is attached. The wire attachment section 152 is disposed at a predetermined radial distance from the axial center 117a of the tip support section 117, which is supported by the shank 151.

The cutter 15 thus configured has a cutting blade 153 formed along the lower end. The cutter 15 is also plate-shaped and configured to rotate along the side of the upper jaw 14 with the shaft receiving portion 151 as its axis.

The opening/closing wire 16, which functions as a gripping part rotating (moving) means and a cutting part rotating (moving) means in cooperation with the above-mentioned pinion gear 12, is a flexible linear wire having a predetermined strength to which a pulling force can be applied, and includes an upper jaw wire 16a that rotates the upper jaw 14 and a cutter wire 16b that rotates the cutter 15. As shown in Fig. 2(b) , the upper jaw wire 16a that rotates the upper jaw 14 is disposed on the front side, and the cutter wire 16b that rotates the cutter 15 is disposed on the back side.
In addition, the opening/closing wire 16 does not have to be linear, and may be in the form of a plate or a band, so long as it has a predetermined strength that allows a pulling force to act on it and is flexible.

The opening and closing wires 16 (16a, 16b) each have a proximal side wire 161 that rotates in the proximal direction to grip or cut the upper jaw 14 or the cutting cutter 15, and an opening side wire 162 that rotates in the opening direction. In other words, the opening and closing wires 16 are the proximal side wire 161 and the opening side wire 162 as the upper jaw wire 16a, and the proximal side wire 161 and the opening side wire 162 as the cutter wire 16b, for a total of four opening and closing wires. The opening and closing wires 16 are hung with tension applied between the upper jaw 14 or the cutting cutter 15 and the pinion gear 12.

Specifically, the proximal side wire 161 of the upper jaw wire 16a is arranged between the wire attachment portion 122a of the pinion gear 12 and the proximal side attachment portion 142a of the upper jaw portion 14 so as to be inclined downward toward the tip side F, and the open side wire 162 of the upper jaw wire 16a is arranged between the wire attachment portion 122b of the pinion gear 12 and the open side attachment portion 142b of the upper jaw portion 14 so as to be inclined upward toward the tip side F. Therefore, when viewed from the front side, the proximal side wire 161 and the open side wire 162 of the upper jaw wire 16a intersect near the center of the longitudinal direction L of the reference frame 112.

The proximal side wire 161 of the cutter wire 16b is also wired between the wire attachment portion 122a of the pinion gear 12 and the proximal side attachment portion 152a of the cutting cutter 15 so as to be inclined downward toward the tip side F, and the open side wire 162 of the cutter wire 16b is also wired between the wire attachment portion 122b of the pinion gear 12 and the open side attachment portion 152b of the cutting cutter 15 so as to be inclined upward toward the tip side F. Therefore, when viewed from the front side, the proximal side wire 161 and the open side wire 162 of the cutter wire 16b intersect near the center of the longitudinal direction L of the reference frame 112.

In the forceps 1 configured in this manner, the lower jaw 116 provided at the end of the tip side F of the main frame 11 and the upper jaw 14 whose base is pivotally supported on the main frame 11 by a tip support portion 117 constitute a gripping mechanism 17 for gripping the target area.
In addition, the cutting cutter 15 , which rotates along the side of the upper jaw 14 to cut the target area gripped by the gripping mechanism 17 , constitutes the cutting mechanism 10 together with the lower jaw 116 .

The forceps 1 is provided with irradiation electrodes 24 (24a, 24b, 24c), and is connected to a coaxial cable 40 that connects the irradiation electrodes 24 to a microwave generator 30 that oscillates microwaves.
Specifically, an irradiation electrode 24a is provided on the upper jaw 14, an irradiation electrode 24b is provided on the lower jaw 116, and an irradiation electrode 24c is provided inside the cutter 15, and a coaxial cable 40 is connected to these electrodes. Although not shown, the irradiation electrodes 24 (24a, 24b, 24c) arranged on the upper jaw 14, the cutter 15, and the lower jaw 116 have an insulating layer arranged on the outside, and are insulated from the upper jaw 14, the cutter 15, and the lower jaw 116.

As shown in the enlarged cross-sectional view of Figure 3 (b), the coaxial cable 40 is composed of a central conductor 41, an insulator 42, an outer conductor 43, and an insulating coating 44 sandwiched between the central conductor 41, and is arranged in this order from the center to the radially outer side.
The central conductor 41 is a linear conductor disposed at the center of the coaxial cable 40, and may be a single conductor of an appropriate diameter, or may be composed of multiple core wires.

The insulator 42 is made of resin, surrounds the outside of the central conductor 41, and insulates the central conductors 41 and 43 from each other, and is cylindrical with a predetermined thickness.
The outer conductor 43 is made of a braided wire provided along the outer peripheral surface of the insulator 42 .

The insulating coating 44 is an insulating coating that surrounds the outside of the outer conductor 43 .
In this manner, the coaxial cable 40 in which the central conductor 41, the insulator 42, the outer conductor 43 and the insulating coating 44 are arranged in this order from the center side has appropriate flexibility.

As shown in FIG. 3, the irradiation electrodes 24a and 24c are connected to the central conductor 41 of the coaxial cable 40, and the irradiation electrode 24b is connected to the outer conductor 43, so that electromagnetic waves (microwaves) are irradiated from the irradiation electrodes 24a and 24c to the irradiation electrode 24b. The electrode structure may be a coaxial structure as shown in FIG. 17, and the connection polarity may be a homopolar connection structure or a heteropolar connection structure.

The first electrode portion of the irradiation electrodes 24a, 24c of the upper jaw 14 and the cutter 15, and the second electrode portion of the irradiation electrode 24b provided on the lower jaw 116 are connected to the central conductor 41 of the coaxial cable 40 on one side, and to the outer conductor 43 on the other side. In this way, the forceps 1 provided with the irradiation electrodes 24a, 24c can irradiate microwaves from one side to the other of the first electrode portion of the irradiation electrodes 24a, 24c and the second electrode portion of the irradiation electrode 24b.

This allows the target area grasped by the grasping mechanism 17, which is composed of the lower jaw 116 and the upper jaw 14, to be irradiated with microwaves to coagulate the target area. If necessary, the irradiation electrode 24c may be electrically connected to the irradiation electrode 24b, and microwaves may be irradiated between the upper jaw 14 and the cutting cutter 15 to coagulate the biological tissue.

The operation of the forceps 1 configured as above will be described below.
A user inserts his or her fingers into the finger ring portion 113 of the main frame 11 and the finger ring portion 132 of the gripping trigger handle 13a, and rotates the gripping trigger handle 13a around the pivot portion 133 supported on the support shaft 114 in a direction that brings the gripping trigger handle 13a closer to the fixed handle frame 111 (in the direction in which the lower part of the gripping trigger handle 13a moves to the left in Figure 1).

When the gripping trigger handle 13a rotates around the pivot 133 in a direction approaching the fixed handle frame 111, the upper jaw gear 12a, whose gear teeth 121 mesh with the rack gear 134 protruding upward from the pivot 133, rotates counterclockwise in FIG. 1. When the upper jaw gear 12a rotates counterclockwise, the proximal wire 161 of the upper jaw wire 16a, whose base end is attached to the wire attachment part 122a, is pulled and moves toward the base end side R.

When the proximal side wire 161 of the upper jaw wire 16a moves toward the base end side R, the tip of the proximal side wire 161 is fixed to the proximal side mounting portion 142a, and the upper jaw 14, which is axially supported by the tip support portion 117, pivots with the axis center 117a as the center of rotation in the direction in which the tip side F approaches the lower jaw 116 (see Figure 4).
At this time, the cutter 15 does not rotate and remains in the initial position as shown in FIG.

As a result, in the initial state (open state) as shown in FIG. 6(a), blood vessel B, which is the target site in the biological tissue, is placed between the upper jaw portion 14 and the lower jaw portion 116, and as shown in FIG. 6(b), blood vessel B is sandwiched between the upper surface of the lower jaw portion 116 and the bottom surface of the upper jaw portion 14, whereby blood vessel B can be grasped by the grasping mechanism 17 formed by the lower jaw portion 116 and the upper jaw portion 14.

As described above, the state shown in Figures 4 and 6 (b) in which the grasping trigger handle 13a is operated to bring the upper jaw 14 close to the lower jaw 116 is referred to as the grasping state in which the target area, such as a blood vessel B, is grasped by the grasping mechanism 17.
When the cutting trigger handle 13b is further operated from this gripping state in a direction approaching the fixed handle frame 111, the cutting trigger handle 13b rotates about the pivot part 133 in a direction approaching the fixed handle frame 111, rotating the cutter gear 12b whose gear teeth 121 mesh with the rack gear 134 protruding upward from the pivot part 133 clockwise in Fig. 2. When the cutter gear 12b rotates clockwise, the proximal side wire 161 of the cutter wire 16b, the proximal end of which is attached to the wire attachment part 122a, is pulled and moves toward the proximal side R.

When the proximal side wire 161 of the cutter wire 16b moves toward the base end side R, the tip of the proximal side wire 161 is fixed to the proximal side mounting portion 152a, and the cutting cutter 15 axially supported by the tip support portion 117 pivots with the axis center 117a as the center of rotation, so that the tip side F pivots in a direction approaching the lower jaw portion 116, and the cutting blade 153 pivots over the upper surface of the lower jaw portion 116.
As a result, as shown in FIG. 6( c ), the cutter 15 moves along the side of the upper jaw portion 14 , and the blood vessel B grasped by the grasping mechanism 17 can be cut by the cutting blade 153 of the cutter 15 .

As described above, the cutting state is when the cutting cutter 15 rotates by further operating the cutting trigger handle 13b so that the cutting blade 153 passes over the upper surface of the lower jaw 116, as shown in FIG. 5(b).

As described above, the forceps 1 can grasp a target area such as a blood vessel B with the upper jaw 14 and lower jaw 116 that constitute the grasping mechanism 17, and cut the target area with the cutting cutter 15 by operating the grasping trigger handle 13a and the cutting trigger handle 13b. During the grasping and cutting of the target area by operating the grasping trigger handle 13a and the cutting trigger handle 13b, microwaves can be irradiated from the irradiation electrode 24 to the target area to cause coagulation.

When the cutting trigger handle 13b is operated in a direction away from the fixed handle frame 111 from the above-mentioned cutting state, the cutting trigger handle 13b rotates about the pivot part 133 in a direction away from the fixed handle frame 111, rotating the cutter gear 12b, whose gear teeth 121 mesh with the rack gear 134 protruding upward from the pivot part 133, counterclockwise in FIG. 2. When the cutter gear 12b rotates counterclockwise, the open side wire 162 of the cutter wire 16b, whose base end is attached to the wire attachment part 122b, is pulled and moves toward the base end side R.

When the opening side wire 162 of the cutter wire 16b moves toward the base end side R, the tip of the opening side wire 162 is fixed to the opening side mounting portion 152b, and the cutting cutter 15 axially supported by the tip support portion 117 pivots in the direction in which the tip side F moves away (opens) from the lower jaw portion 116, with the axis center 117a as the rotation center.
This allows the cutting cutter 15 to return to the initial position shown in FIG.

When the gripping trigger handle 13a is operated in a direction away from the fixed handle frame 111 from the gripping state described above, the gripping trigger handle 13a rotates about the pivot 133 in a direction away from the fixed handle frame 111, rotating the upper jaw gear 12a, whose gear teeth 121 mesh with the rack gear 134 protruding upward from the pivot 133, clockwise in FIG. 1. When the upper jaw gear 12a rotates clockwise, the open side wire 162 of the upper jaw wire 16a, whose base end is attached to the wire attachment portion 122b, is pulled and moves toward the base end side R.

When the open side wire 162 of the upper jaw wire 16a moves toward the base end side R, the tip of the open side wire 162 is fixed to the open side mounting portion 142b, and the upper jaw portion 14 supported by the tip support portion 117 pivots in the direction in which the tip side F moves away from the lower jaw portion 116, with the axis center 117a as the rotation center.
This allows the upper jaw 14 to return to the initial position shown in FIG.

As described above, the forceps 1 can grasp the target area with the grasping mechanism 17 and cut the target area with the cutting mechanism 10 by moving the upper jaw portion 14 and the cutting cutter 15 using the upper jaw wire 16a and the cutter wire 16b, respectively.

In addition, the upper jaw wire 16a, which is made of a flexible long member, has a proximal side wire 161 that is connected to the proximal side attachment part 142a that is spaced a predetermined distance from the center of the rotation axis in the upper jaw part 14 and moves in the pulling direction in the longitudinal direction L, and an open side wire 162 that is connected to the open side attachment part 142b and moves in the pulling direction in the longitudinal direction L.

The cutter wire 16b, which is made of a flexible long member, is connected to the proximal side attachment part 152a at a predetermined distance from the center of the rotation axis of the cutting cutter 15, and has a proximal side wire 161 that moves in the pulling direction in the longitudinal direction L, and an open side wire 162 that is connected to the open side attachment part 152b and moves in the pulling direction in the longitudinal direction L.

Therefore, by moving a predetermined portion of the proximal side wire 161 in the pulling direction in the longitudinal direction L, the upper jaw 14 and the cutting cutter 15 can be rotated in the pulling direction relative to the lower jaw 116, and by moving a predetermined portion of the opening side wire 162 in the pulling direction in the longitudinal direction L, the opening side wire 162 can be rotated in the pulling direction. Therefore, for example, when the upper jaw 14 (cutting cutter 15) is rotated in the gripping direction (cutting direction) relative to the lower jaw 116 by moving the proximal side wire 161 in the pulling direction, the upper jaw 14 (cutting cutter 15) can be opened by moving the opening side wire 162 in the pulling direction. In other words, the upper jaw 14 (cutting cutter 15) can be rotated in the gripping direction (cutting direction) and the opening direction relative to the lower jaw 116 by moving the opening/closing wire 16.

Next, a forceps 1X according to a second embodiment is shown in FIGS.
7 shows a front view of the forceps 1X of the second embodiment in an open state, and FIG. 8 shows a bottom view of the forceps 1X of the second embodiment in an open state.

Figure 9 shows an explanatory diagram of the gripping state of the forceps 1X in Figure 7. Specifically, Figure 9(a) shows a front view of the forceps 1X in a gripping state with the gripping mechanism 17 closed, and Figure 9(b) shows a rear view of the forceps 1X in the same state.

Fig. 10 is an explanatory diagram of the cutting state of the forceps 1X in Fig. 7. Specifically, Fig. 10(a) is a front view of the forceps 1X in a cutting state with the cutting cutter of the cutting mechanism 10 closed, and Fig. 10(b) is a rear view of the forceps 1X in the same state.
In the following description of the forceps 1X, the same components as those of the forceps 1 are given the same reference numerals and detailed description thereof will be omitted.

The forceps 1 of the above-mentioned embodiment 1 are configured such that the proximal side wire 161 and the opening side wire 162 of the opening/closing wire 16 are pulled toward the base end side R by operating the trigger handle 13 (13a, 13b), and the upper jaw 14 and the cutting cutter 15 are rotated so as to approach the lower jaw 116, so as to grasp or cut, or to move away from the lower jaw 116 and open. In contrast, the forceps 1X of embodiment 2 does not have the opening side wire 162, and the opening/closing wire 16 is only the proximal side wire 161, and the trigger handle 13 (13a, 13b) is operated to pull the proximal side wire 161 of the opening/closing wire 16 toward the base end side R, and the upper jaw 14 and the cutting cutter 15 are rotated so as to approach the lower jaw 116. The upper jaw 14 and the cutting cutter 15 are rotated and opened by the biasing force of the spring 19 in the direction of moving away from each other.

Specifically, springs 19 (19a, 19b) are provided on the width direction and outside of the upper jaw 14 and the cutting cutter 15. The spring 19 is composed of a coil portion 191 that fits onto the axis of the tip support portion 117, a first arm 192 that extends from one end of the coil portion 191 and is fixed to the reference frame 112, and a second arm 193 that is fixed to the upper jaw 14 or the cutting cutter 15.

The operation of the forceps 1X configured as described above will now be described.
The action of bringing the upper jaw 14 and the cutting cutter 15 close to the lower jaw 116 for gripping or cutting is the same as that of the forceps 1. However, in order to operate the trigger handle 13 to bring the upper jaw 14 and the cutting cutter 15 close to the lower jaw 116 for gripping or cutting, the trigger handle 13 must be rotated against the biasing force of the spring 19b.

To release the above-mentioned cutting state or gripping state, the gripping trigger handle 13a and the cutting trigger handle 13b can be automatically rotated in the open direction by the biasing force of the spring 19 by releasing the operating force of the gripping trigger handle 13a and the cutting trigger handle 13b, which have been operated in a direction approaching the fixed handle frame 111.

Specifically, by loosening the operating force on the side that brings the grasping trigger handle 13a closer to the fixed handle frame 111 against the biasing force of the spring 19a, the upper jaw 14 in the grasping state rotates by the biasing force of the spring 19 in a direction that moves the tip of the upper jaw 14 away from the lower jaw 116, and is released.

In addition, by loosening the operating force on the side that brings the cutting trigger handle 13b closer to the fixed handle frame 111 against the biasing force of the spring 19a, the cutting cutter 15 in the gripped state rotates in a direction away from the lower jaw 116 due to the biasing force of the spring 19, and is released.

In this way, the forceps 1X of Example 2 has the same effect as the forceps 1 described above, and can rotate the upper jaw portion 14 in the gripping state and the cutting cutter 15 in the cutting state in the opening direction without operating the trigger handle 13 in a direction away from the fixed handle frame 111.

Specifically, the upper jaw wire 16a and the cutter wire 16b, which are made of flexible long members, are provided with a spring 19a that urges the upper jaw 14 in a direction in which a specific location moves in the pushing direction in the longitudinal direction L, and a spring 19b that urges the cutting cutter 15 in a direction in which a specific location moves in the pushing direction. Therefore, by moving a specific location of the upper jaw wire 16a and the cutter wire 16b in the pulling direction in the longitudinal direction L, the upper jaw 14 and the cutting cutter 15 can be rotated in the pulling direction relative to the lower jaw 116, and can be rotated in the pushing direction by the biasing force of the spring 19a and the spring 19b. Therefore, for example, when the upper jaw 14 (cutting cutter 15) is rotated in the gripping direction (cutting direction) relative to the lower jaw 116 by movement in the pulling direction, the upper jaw 14 (cutting cutter 15) can be opened by the biasing force of the spring 19a (spring 19b).

In the above description of the forceps 1X, only the proximal wire 161 is provided, and the upper jaw 14 and the cutting cutter 15 are rotated in a direction approaching the lower jaw 116 by operating the trigger handle 13, and the upper jaw 14 in the gripping state and the cutting cutter 15 in the cutting state are rotated in the opening direction by the biasing force of the spring 19.

In response to this, the spring 19 may be configured to bias the tips of the upper jaw 14 and the cutting cutter 15 in a direction toward the side closer to the lower jaw 116, and the trigger handle 13 may be operated toward the side closer to the fixed handle frame 111 to rotate the upper jaw 14 and the cutting cutter 15 in a direction away from the lower jaw 116, so that the biasing force of the spring 19 biases the tips of the upper jaw 14 and the cutting cutter 15 toward the side closer to the lower jaw 116, thereby gripping or cutting.

Furthermore, only one of the springs 19a and 19b may be provided, and the other may be provided with both the proximal side wire 161 and the releasing side wire 162. In this case, one of the cutting mechanism 10 and the gripping mechanism 17 is automatically returned by the spring 19, but the other is configured to be returned by operating the trigger handle 13.

Next, a forceps 1Y according to a third embodiment is shown in FIGS.
11A and 11B are explanatory diagrams of the forceps 1Y in an open state according to the third embodiment. In detail, Fig. 11A shows a front view of the forceps 1Y according to the third embodiment, and Fig. 11B shows a plan view of the forceps 1Y.

Fig. 12 shows a rear view of the forceps 1Y of the third embodiment in an open state, and Fig. 13 shows an explanatory diagram of the forceps 1Y of Fig. 11. In detail, Fig. 13(a) shows a front view of the forceps 1Y in a gripping state with a gripping mechanism closed, and Fig. 13(b) shows a front view of the forceps 1Y in a cutting state with a cutting cutter of a cutting mechanism closed.
11B and the enlarged views in FIG. 13 show cross-sectional views of the vicinity of the center in the height direction of the regulating frame 124.

In the following description of the forceps 1Y, the same components as those of the forceps 1 and 1X are given the same reference numerals and detailed description thereof will be omitted.
Unlike the forceps 1 in which the operation of the trigger handle 13 is transmitted via an opening/closing wire 16 to rotate the upper jaw 14 and the cutting cutter 15, the forceps 1Y is configured so that the operation of the trigger handle 13Y is transmitted via a rod-shaped slide plate 12Y (12Ya, 12Yb) to rotate the upper jaw 14 and the cutting cutter 15.

Specifically, the forceps 1Y includes a main body frame 11Y, a slide plate 12Y (12Ya, 12Yb), a trigger handle 13Y (13Ya, 13Yb), an upper jaw portion 14Y, and a cutter 15Y.

The forceps 1Y is configured such that the first slide plate 12Ya slides in the longitudinal direction L relative to the reference frame 112Y to rotate the upper jaw 14, and the second slide plate 12Yb slides in the longitudinal direction L relative to the reference frame 112Y to rotate the cutting cutter 15 to perform cutting.

In more detail, the main body frame 11Y is composed of a fixed handle frame 111 and a reference frame 112Y that intersect at an obtuse angle, similar to the main body frame 11, which is composed of a fixed handle frame 111 and a reference frame 112Y.

The first slide plate 12Ya and the second slide plate 12Yb are configured to slide along the upper surface of the reference frame 112Y. The reference frame 112Y is provided with a restriction frame 124 that restricts the first slide plate 12Ya and the second slide plate 12Yb, which slide along the upper surface, so that they can slide.

The first slide plate 12Ya and the second slide plate 12Yb are formed in a plate shape, stacked in the thickness direction, and regulated by a regulating frame 124 so that they can slide independently along the upper surface of the reference frame 112Y.

An upper support shaft 121Ya that supports a drive shaft 181Ya of an arm 18Ya (described later) is provided at the middle portion of the first slide plate 12Ya, the tip of which is connected to the upper jaw portion 14.
An upper support shaft 121Yb that supports a drive shaft 181Yb of an arm 18Yb (to be described later) is provided at the middle portion of the second slide plate 12Yb, the tip of which is connected to the cutting cutter 15.

The trigger handle 13Y includes a gripping trigger handle 13Ya that slides the first slide plate 12Ya to rotate the upper jaw 14, and a cutting trigger handle 13Yb that slides the second slide plate 12Yb to rotate the cutting cutter 15.

The trigger handle 13Y (13Ya, 13Yb) has an upper pivot portion 134Y (134Ya, 134Yb) above the pivot portion 133 that is supported by the reference frame 112Y and protrudes upward from the first slide plate 12Ya and the second slide plate 12Yb.

The upper pivot portion 134Y (134Ya, 134Yb) is connected to an arm 18Y (18Ya, 18Yb) that is inclined downward on the tip side F, and the tip of the arm 18Y (18Ya, 18Yb) is provided with the above-mentioned drive shaft 181Y (181Ya, 181Yb).

The forceps 1Y also includes a click mechanism 50. For example, as shown in the enlarged view of FIG. 11, the click mechanism 50 includes a ratchet hook 51 on the inner surface of the side wall of the regulating frame 124, and a ratchet recess 52 on the side of the slide plate 12Y that is disposed inside the regulating frame 124.

The ratchet hook 51 has an arm 511 extending in the longitudinal direction L and a locking protrusion 512 at the tip thereof, which is pressed against the slide plate 12Y by the biasing force of the arm 511. The ratchet hook 51 also has an adjustment screw 53 for adjusting the amount of pressure applied by the arm 511 to the locking protrusion 512.

When both the cutting mechanism 10 and the gripping mechanism 17 are in an open state, the locking protrusion 512 of the ratchet hook 51 is not locked to the ratchet recess 52, and as the slide plate 12Y moves to the tip side F, the ratchet recess 52 moves to the tip side F, and the clicking sound and clicking sensation produced when the locking protrusion 512 locks with the ratchet recess 52 that has moved to the tip side F notifies the user of the movement of the slide plate 12Y, i.e., the gripping by the gripping mechanism 17 and the cutting by the cutting mechanism 10.

The force of the arm 511 pressing the locking protrusion 512 against the slide plate 12Y can be adjusted by screwing the adjustment screw 53 in and out, and by adjusting the force of the arm 511, it is possible to adjust the increase or decrease in the clicking sound or clicking sensation when the locking protrusion 512 locks into the ratchet recess 52.

In addition, the click mechanism 50 may be provided with a ratchet hook 51 on the side surface of the slide plate 12Y, and a ratchet recess 52 may be provided on the inner surface of the regulating frame 124.
In addition, a ratchet hook 51 and a ratchet recess 52 may be provided on the inner surface of the upper plate of the regulating frame 124 and the upper surface of the slide plate 12Y, or a ratchet hook 51 and a ratchet recess 52 may be provided on the bottom surface of the slide plate 12Y and the upper surface of the reference frame 112.

Furthermore, the click mechanism 50 shown in FIG. 11 has ratchet hooks 51 on both sides of the regulating frame 124, and has ratchet recesses 52 on the sides of both the first slide plate 12Ya and the second slide plate 12Yb, but may be provided only on one of the sides of the regulating frame 124 and the corresponding side of the slide plate 12Y.

When the forceps 1Y configured in this manner is operated by operating the grasping trigger handle 13Ya in a direction approaching the fixed handle frame 111, the upper pivot portion 134Ya moves toward the tip side F, with the pivot portion 133 as the rotation axis.

When the upper pivot portion 134Ya moves toward the tip side F, the arm 18Ya connected to the upper pivot portion 134Ya also moves toward the tip side F while changing its inclination angle. When the arm 18Ya moves toward the tip side F while changing its inclination angle, the first slide plate 12Ya, which supports the drive shaft 181Ya of the arm 18Ya by the upper support shaft 121Yab, slides toward the tip side F relative to the reference frame 112Y.

When the first slide plate 12Ya moves to the tip side F, the lower shaft receiving portion 141 is supported by the tip support portion 117 of the main frame 11Y, and the upper rotary bearing portion 143 of the upper jaw portion 14 is supported by the tip upper support shaft 122Ya, which moves the tip upper support shaft 122Ya to the tip side F. As a result, the tip side F pivots around the tip support portion 117 in a direction approaching the lower jaw portion 116, and the gripping mechanism 17 consisting of the lower jaw portion 116 and the upper jaw portion 14 enters a gripping state in which it can grip a target site such as a blood vessel B (see FIG. 17).

At this time, as shown in the enlarged view of FIG. 13(a), the locking protrusion 512 of the ratchet hook 51 provided on the side wall of the regulating frame 124 locks into the ratchet recess 52 formed on the side of the moved first slide plate 12Ya. The clicking sound and clicking sensation produced when the locking protrusion 512 of the ratchet hook 51 locks into the ratchet recess 52 formed on the side of the first slide plate 12Ya notifies the user that the gripping state has been achieved.

When the cutting trigger handle 13Yb of the forceps 1Y is operated in a direction approaching the fixed handle frame 111, the upper pivot portion 134Yb moves toward the tip side F, with the pivot portion 133 as the rotation axis.

When the upper pivot portion 134Yb moves toward the tip side F, the arm 18Yb connected to the upper pivot portion 134Yb also moves toward the tip side F while changing its inclination angle. When the arm 18Yb moves toward the tip side F while changing its inclination angle, the second slide plate 12Yb, which supports the drive shaft 181Yb of the arm 18Yb by the upper support shaft 121Yb, slides toward the tip side F relative to the reference frame 112Y.

When the second slide plate 12Yb moves to the tip side F, the lower shaft receiving portion 151 is supported by the tip support portion 117 of the main frame 11Y, and the upper rotating bearing portion 154 of the cutting cutter 15 is supported by the tip upper support shaft 122Yb, and the tip upper support shaft 122Yb moves to the tip side F. As a result, the tip side F pivots around the tip support portion 117 in a direction approaching the lower jaw 116, and the cutting mechanism 10 consisting of the lower jaw 116 and the cutting cutter 15 enters a cutting state in which it can cut the target site, such as a blood vessel B (see FIG. 17).

At this time, as shown in the enlarged view of FIG. 13(b), the locking protrusion 512 of the ratchet hook 51 provided on the side wall of the regulating frame 124 locks into the ratchet recess 52 formed on the side of the moved second slide plate 12Yb. The clicking sound or clicking sensation produced when the locking protrusion 512 of the ratchet hook 51 locks into the ratchet recess 52 formed on the side of the second slide plate 12Yb notifies the user that the disconnection state has been achieved.

When the cutting trigger handle 13Yb is operated in a direction away from the fixed handle frame 111 in the cutting state, the upper pivot portion 134Yb moves toward the base end side R with the pivot portion 133 as a rotation axis.
When the upper pivot portion 134Yb moves toward the base end side R, the arm 18Yb connected to the upper pivot portion 134Yb also moves toward the base end side R while changing its inclination angle. When the arm 18Yb moves toward the base end side R while changing its inclination angle, the second slide plate 12Yb, which supports the drive shaft 181Yb of the arm 18Yb by the upper support shaft 121Yb, slides toward the base end side R relative to the reference frame 112Y.

When the second slide plate 12Yb moves to the base end side R, the cutting cutter 15, whose lower shaft receiving portion 151 is journaled on the tip support portion 117 of the main frame 11Y and whose upper rotating bearing portion 154 is journaled on the tip upper support shaft 122Yb, moves the tip upper support shaft 122Yb to the base end side R. As a result, the base end side R pivots around the tip support portion 117 in a direction away from the lower jaw portion 116, opening the cutting mechanism 10 consisting of the lower jaw portion 116 and the cutting cutter 15.

Furthermore, when the gripping trigger handle 13Ya is operated in a direction away from the fixed handle frame 111 in a gripped state, the upper pivot portion 134Ya moves toward the base end side R with the pivot portion 133 as a rotation axis.
When the upper pivot portion 134Ya moves toward the base end side R, the arm 18Ya connected to the upper pivot portion 134Ya also moves toward the base end side R while changing its inclination angle. When the arm 18Ya moves toward the base end side R while changing its inclination angle, the first slide plate 12Ya, which supports the drive shaft 181Ya of the arm 18Ya by the upper support shaft 121Ya, slides toward the base end side R relative to the reference frame 112Y.

When the first slide plate 12Ya moves to the base end side R, the upper jaw 14, whose lower shaft receiving portion 141 is journaled to the tip support portion 117 of the main frame 11Y and whose upper rotating bearing portion 143 is journaled to the tip upper support shaft 122Ya, moves the tip upper support shaft 122Ya to the base end side R. As a result, the base end side R pivots around the tip support portion 117 in a direction away from the lower jaw 116, and the gripping mechanism 17 consisting of the lower jaw 116 and the upper jaw 14 can be opened.

As described above, like the forceps 1 and 1X, the forceps 1Y can grasp a target area such as a blood vessel B with the upper jaw 14 and lower jaw 116 that constitute the grasping mechanism 17, and cut the grasped target area with the cutting cutter 15 by operating the trigger handle 13 (13a, 13b). While the target area is being grasped and cut by operating the trigger handle 13 (13a, 13b), microwaves can be irradiated from the irradiation electrode 24 to the target area to cause coagulation.

Next, a forceps 1A having a cutting mechanism 10 will be described as a fourth embodiment with reference to FIG.
Fig. 14 shows an explanatory diagram of the forceps 1A in an open state equipped with the cutting mechanism 10 of the fourth embodiment. In detail, Fig. 14(a) shows a rear view of the forceps 1A, Fig. 14(b) shows a partial vertical cross-sectional view of the forceps 1A, and Fig. 14(c) shows a side cross-sectional view taken along the line E-E in Fig. 14(a).

In the following description of the forceps 1A, the same components as those of the forceps 1, 1X, and 1Y are given the same reference numerals and detailed description thereof will be omitted.
In the above-mentioned forceps 1, 1X, a lower jaw 116 is formed at the tip of the tip side F of the reference frame 112 in the main body frame 11, and a trigger handle 13 (13a, 13b) is provided which cooperates with the fixed handle frame 111 to rotate the upper jaw 14 and the cutting cutter 15. However, while the forceps 1A is equipped with a cutting mechanism 10 and a gripping mechanism 17, the base of the main body frame 11A on which the lower jaw 116 is provided is configured to be attached to an attachment 60 provided at the tip of the tube T.

Specifically, the lower half of the main body frame 11A has a downwardly convex semicircular cross-sectional shape, and the base end side R is provided with an upwardly convex inverse arc-shaped roof 119. Therefore, the base end side R of the main body frame 11A is formed into a circular cross-sectional shape by the lower half portion having a downwardly convex semicircular cross-sectional shape and the upwardly convex inverse arc-shaped roof 119, and a fastening portion that is fastened to the mounting fixture 60 is formed at the end of the base end side R.
The tube T to which the forceps 1A is connected via the attachment 60 is a flexible hollow tube.

In addition, the four opening and closing wires 16, the tips of which are attached to the upper jaw portion 14 and the cutting cutter 15 in the forceps 1A, pass through the inside of the roof 119 and are inserted into the inside of the tube T to the opposite end, and are connected to an operating unit (not shown) provided on the opposite side of the tube T.

The upper jaw wire 16a and the cutter wire 16b can move a specific location to the tip side F or base side R in the longitudinal direction L, so that the upper jaw 14 and the cutting cutter 15 can be rotated in the approaching direction or the opening direction relative to the lower jaw 116.

Therefore, for example, when the upper jaw 14 (cutting cutter 15) is rotated from a gripping state (cutting state) to an opening direction relative to the lower jaw 116 by moving the opening side wire 162 in the pulling direction, the upper jaw 14 (cutting cutter 15) can be rotated in the gripping direction (cutting direction) by moving the proximal side wire 161 in the pulling direction.

In addition, a coaxial cable 24x that supplies electricity to the irradiation electrode 24 provided on the forceps 1A is also inserted inside the tube T and connected to a microwave transmitter 30 provided on the opposite side of the tube T.

The forceps 1A configured in this manner is used, for example, in endoscopic surgery while inserted into the channel of an endoscope, and by operating an operating unit (not shown) provided on the opposite side of the tube T (the base side of the endoscope), the proximal side wire 161 and the opening side wire 162 of the opening/closing wire 16 can be pulled to rotate the upper jaw portion 14 of the grasping mechanism 17 and the cutting cutter 15 of the cutting mechanism 10, respectively, to grasp, cut, or open the target site, which is biological tissue.
In this way, the forceps 1A described above can achieve the same effects as the forceps 1, 1X, and 1Y equipped with the gripping mechanism 17 and the cutting mechanism 10.

Next, a forceps 1B having a cutting mechanism 10 will be described as a fifth embodiment with reference to FIG.
Fig. 15 shows an explanatory diagram of a forceps 1B in an open state having a cutting mechanism 10 of the fifth embodiment. In detail, Fig. 15(a) shows a rear view of the forceps 1B, and Fig. 15(b) shows a partial vertical cross-sectional view of the forceps 1B.

In the following description of the forceps 1B, the same components as those of the forceps 1, 1X, 1Y and the forceps 1A will be given the same reference numerals and detailed description thereof will be omitted.
In the above-described forceps 1A, the base of the main body frame 11 is attached to the attachment tool 60 provided at the tip of the tube T. However, the forceps 1B does not use the tube T and attachment tool 60, and the main body frame 11B and roof 119, which form a circular cross section, are formed to the same length as the tube T in the forceps 1A.

Although the main body frame 11B and the roof 119, which form a circular cross section, have a certain degree of flexibility, the portion that forms the lower jaw portion 116 has a rigid structure.
In the forceps 1B, the four opening and closing wires 16, whose tips are attached to the upper jaw portion 14 and the cutting cutter 15, pass through the inside of the roof 119, pass through the inside of the tube T to the opposite end, and are connected to an operating part (not shown) provided on the opposite side of the tube T.

In addition, a coaxial cable (not shown) that supplies electricity to the irradiation electrode 24 provided on the forceps 1B is inserted inside the tube T and connected to a microwave transmitter 30 provided on the opposite side of the tube T.

Like the forceps 1A, the forceps 1B configured in this manner is used, for example, in a state where it is inserted into a channel of an endoscope in a endoscopic surgery, and by operating an operation unit (not shown) provided on the opposite side of the tube T (the base side of the endoscope), the proximal side wire 161 and the opening side wire 162 of the opening/closing wire 16 can be pulled to rotate the upper jaw portion 14 of the grasping mechanism 17 and the cutting cutter 15 of the cutting mechanism 10, respectively, to grasp, cut, or open a target site which is biological tissue. Furthermore, the irradiation electrode 24 can coagulate the target site which is biological tissue.
In this manner, the forceps 1B described above can achieve the same effects as the forceps 1, 1X, and 1Y that include the gripping mechanism 17 and the cutting mechanism 10, similar to the forceps 1A.

In addition, an opening/closing wire 16 thick enough to slide in the internal space may be inserted between the main frame 11A and the roof 119. In this case, the opening/closing wire 16 thick enough to slide in the internal space can move not only in the pulling direction toward the base end side R, but also in the pushing direction toward the tip end side F, allowing the upper jaw 14 and the cutting cutter 15 to rotate in either direction.

Next, an end effector 10c for irradiating a living tissue with microwaves will be described as a sixth embodiment with reference to FIGS.
FIG. 16 shows a schematic front view of an end effector 10c according to the sixth embodiment.

Figure 17 shows a schematic diagram of the end effector 10c in Figure 16. In more detail, Figure 17(a) shows a side cross-sectional view taken along the line F-F in Figure 16, Figure 17(b) shows a partial vertical cross-sectional view of the end effector 10c, Figure 17(c) shows an enlarged plan view taken along the line G-G in Figure 16, and Figure 17(c) shows an enlarged view of Figure 17(b).

Figure 18 shows a schematic diagram of the end effector 10c of the sixth embodiment. In detail, Figure 18(a) shows a schematic front view of the end effector 10c in a normal state, Figure 18(b) shows a schematic front view of the end effector 10c in a gripping state, and Figure 18(c) shows a schematic front view of the end effector 10c in a cutting state.

The end effector 10c is used in a multi-function surgical instrument and corresponds to the cutting mechanism 10 in the forceps 1 described above. Therefore, the same components as those in the forceps 1 described above are given the same reference numerals. Furthermore, the end effector in this embodiment can constitute the cutter, cutting mechanism, and forceps described above, and includes other similar components.

16 and 17, a part of the tip side F of the end effector 10c is illustrated.
The end effector 10c includes a reference axis 11a (corresponding to the reference frame 112 in the cutting mechanism 10) that passes through a bellows-shaped flexible portion 101 provided at the tip of a tubular support tool 100 that is attached to a multi-function surgical instrument, an upper jaw portion 14, a cutting cutter 15, and an opening/closing wire 16.

In addition, the portion of the reference axis 11a that corresponds to the inside of the flexible part 101 is configured to have flexibility that allows it to deform in accordance with the movable flexible part 101, but a wire may also be used for drive.

The operation of the upper jaw 14 and the cutting cutter 15 in the end effector 10c configured in this manner is similar to that of the upper jaw 14 and the cutting cutter 15 of the cutting mechanism 10 in the forceps 1 described above, and by moving the opening and closing wire 16 in the longitudinal direction L, the target area can be grasped by the grasping mechanism 17 consisting of the upper jaw 14 and the lower jaw 116 provided at the end of the tip side F of the reference shaft 11a, and can be cut by the cutting cutter 15.

In the end effector 10c configured in this manner, a coaxial electrode 20 is provided along the longitudinal direction L on the upper surface of the lower jaw 116 and the bottom surface of the upper jaw 14.
Further, the end effector 10c is connected to a coaxial cable 40 that connects a microwave transmitter 30 that irradiates microwaves with the coaxial electrode 20. The microwave transmitter 30 may be provided inside the end effector 10c.

As shown in the enlarged cross-sectional view of FIG. 17, the coaxial cable 40 is composed of a central conductor 41, an insulator 42, an outer conductor 43, and an insulating coating 44, which are arranged in this order from the center to the radially outward, and has appropriate flexibility.

The coaxial electrode 20 provided on the bottom surface of the upper jaw 14 and the top surface of the lower jaw 116 is composed of a central conductor 21, a semicircular insulator 22 with a semicircular cross section, and a semicircular tube conductor 23 arranged on the outside of the semicircular insulator 22, as shown in the enlarged view in Figure 17 (c).

As shown in FIG. 17(c), the coaxial electrode 20 thus configured is semi-cylindrical and of a predetermined length, and is arranged along the longitudinal direction so that the flat surfaces face each other on the bottom surface of the upper jaw 14 and the top surface of the lower jaw 116. Although not shown, the coaxial electrodes 20 arranged on the upper jaw 14 and the lower jaw 116 have an insulating layer arranged on the outside, and are insulated from the upper jaw 14 and the lower jaw 116.

As shown in FIG. 17(b), the central conductor 21 of each coaxial electrode 20 provided on the upper jaw 14 and the lower jaw 116 is connected to the central conductor 41 of the coaxial cable 40, and the semicircular tube conductor 23 of the coaxial electrode 20 is connected to the outer conductor 43 of the coaxial cable 40, resulting in a homopolar connection. If necessary, one side may be connected to the opposite polarity.

In this way, the coaxial electrode 20 connected to the microwave transmitter 30 via the coaxial cable 40 can irradiate microwaves between the central conductor 21 and the semicircular tube conductor 23 of the coaxial electrode 20 via the coaxial cable 40 when the microwave transmitter 30 is operating.

When microwaves are applied from the coaxial electrode 20 while the target area, blood vessel B, is grasped by the grasping mechanism 17, the blood vessel B grasped by the grasping mechanism 17 coagulates due to the microwaves. The portion of blood vessel B that has coagulated due to the microwaves applied from the coaxial electrode 20 can then be cut by the cutting cutter 15. As a modification of this embodiment, FIG. 16 shows an embodiment in which an electronic module 31 is built into the end effector 10c.

In this example, the microwave transmitter 30 is built into the end effector 10c, but it may be an electronic module that incorporates the microwave irradiation module 222 in FIG. 20 or the electronic circuit of the surgical device 221 shown in FIG. 22(b) as appropriate. Providing the electronic module 31 in the end effector 10c allows the medical device to be miniaturized, improving the convenience of surgery.

In addition, the end effector 10c may be configured such that the coaxial electrodes 20 provided on the opposing surfaces of the lower jaw 116a and the upper jaw 14 are connected to have opposite polarities.
Furthermore, although not shown, in the end effector 10c, the coaxial electrode 20 may be provided on the side surface of the cutter 15 in addition to the opposing surfaces of the lower jaw 116a and the upper jaw 14, or the coaxial electrode 20 may not be provided on the upper jaw 14 but may be provided on the upper surface of the lower jaw 116a and the side surface of the cutter 15. Furthermore, the coaxial electrode 20 may be provided only on one of the opposing surfaces of the upper jaw 14 and the lower jaw 116a.

Also, as shown in FIG. 19, the above-mentioned irradiation electrodes 24a and 24b may be provided instead of the coaxial electrodes 20 provided on the upper jaw 14 and lower jaw 116a of the end effector 10c. Furthermore, the irradiation electrode 24c may be provided on the side of the cutting cutter 15. Note that FIG. 19(a) shows a vertical cross-sectional view of the end effector 10c equipped with the irradiation electrodes 24 (24a, 24b, 24c), and FIG. 19(b) shows a partially enlarged vertical cross-sectional view of the end effector 10c equipped with the irradiation electrode 24.

Furthermore, at least one of the upper jaw portion 14, the cutting cutter 15, and the lower jaw portion 116 of the forceps 1, 1X, and 1Y described above may be provided with a coaxial electrode 20 connected to the microwave transmitter 30 by a coaxial cable 40.

In addition, when a coaxial electrode 20 is provided on both the lower jaw 116a and the upper jaw 14 of the end effector 10c, or when a coaxial electrode 20 is provided on the lower jaw 116a and the cutting cutter 15, or even when a coaxial electrode 20 is provided on all of the lower jaw 116a, the upper jaw 14, and the cutting cutter 15, the cutting mechanism of the end effector 10c can cut, for example, the coagulated portion of blood vessel B.

Surgical equipment such as the end effector 10c that emits microwaves produces little smoke or mist and has a strong hemostatic function, making it ideal for supporting surgery in closed spaces such as laparoscopic surgery and robotic surgery. However, like other energy devices, the ability to stop bleeding in a blood pool in cases of heavy bleeding and to stop bleeding in liquids is weakened.

Figure 20 shows a medical instrument 220 in another embodiment of the present invention. In Figure 20 (a), the medical instrument 220 includes a surgical device 221 that drives the end effector 10c of a multi-function surgical instrument (medical processing tool) as described in conjunction with Figures 16 to 19.

The surgical device 221 includes a microwave irradiation module 222 including a microwave control circuit such as an irradiator and an amplifier, and a drive unit 224 of a mechanical mechanism that drives the end effector 10c by manually operating a lever 223. Specifically, the trigger handle 13 of the forceps shown in Figures 1 to 13 may be the lever 223, and the mechanical mechanism extending from the trigger handle 13 to the end effector 10c may be incorporated into the surgical device 221.

The microwave irradiation module 222 having an irradiator is provided inside the surgical device 221, but if necessary, it can be provided inside the shaft portion 225, or in the bending portion 226 having a wrist function (such as the flexible portion 101 in FIG. 16), or in the end effector 10c (FIGS. 1 and 2, or electronic module 31 in FIG. 16(a)), making it possible to make the medical device 220 ultra-compact.

When the operator manually grips the lever 223 of the grip portion of the surgical device 221, the drive unit 224 operates the end effector 10c shown in FIG. 16 via the shaft portion 225.

The surgical device 221 receives power from an adapter 227. The microwave irradiation module 222 included in the surgical device 221 may be configured to be directly or indirectly connected to an irradiator installed on the robot body, in addition to the conventional stationary, shoulder-hanging, or built-in type.

In the above embodiment, microwave irradiation does not cause coagulation when the tissue is grasped by the lower jaw 116 and upper jaw 14 of the end effector 10c, but rather coagulates the target tissue when the upper jaw 14 rotates relative to the lower jaw 116, making it possible to coagulate the tissue, stop bleeding, and cut it. Furthermore, microwaves may be irradiated when the tissue is grasped by the grasping mechanism 17a of the end effector 10c and cut by the cutting cutter 15.

With such forceps, the grasping function can be used to open and remove tissue, grasp and remove obstacles, and prepare the surgical field, and it is also possible to grasp the part to be coagulated and cut with the forceps and then perform the coagulation and cutting. The coagulation and cutting operations do not require multiple re-grasping of tissue or re-clamping, but the operation is completed by grasping what has already been clamped. Therefore, surgical operations such as grasping, coagulation, and cutting can be performed with a single device.
All of the procedures involved in general resection surgery can be completed using a single instrument, eliminating the need to switch to other instruments.

As a modified example of this embodiment, the microwave irradiation module 222 may be provided with an execution program memory, and the drive unit 224 may be configured as an electric mechanical mechanism controlled by the execution program. In operation, when the lever 223 is gripped, the execution program moves the drive unit 224 based on the position data of the lever 223, and by configuring the end effector 10c in FIG. 16, the upper jaw wire 16a and the cutter wire 16b are moved, thereby rotating the upper jaw portion 14 in the direction of the lower jaw portion 116, and the program sends a microwave signal to the irradiation electrode 24, and the biological tissue can be coagulated by irradiating microwaves.

In addition, when the lever 223 is grasped, the proximal wire 161 of the upper jaw wire 16a moves in the pulling direction according to the position data as described above by the program, and the biological tissue can be grasped by the upper jaw portion 14a and the lower jaw portion 116a.

Furthermore, when the lever 223 is gripped, the proximal wire 161 of the cutter wire 16b moves in the pulling direction according to the lever position data, and the cutting cutter 15 is rotated alone to cut the coagulated biological tissue. After cutting, the lever 223 is released, and the medical device 220 returns to the initial state (open state) according to the lever position data.

The rotational position of the upper jaw 14 and the cutting cutter 15 relative to the lower jaw 116, the rotation of the pinion gear 12, and the position of the trigger handle 13 (13a, 13b) relative to the fixed handle frame 111 may be detected, and a detection signal based on the detection results may be received to detect the state of the cutting mechanism 10 and the gripping mechanism 17.

Figure 20(b) is a schematic diagram of a surgical system equipped with multiple medical devices 220 as shown in Figure 20(a). The internal configuration of each is similar to that of Figure 20(a), but each microwave irradiation module 222 of the medical device 220 further includes a unit that synchronizes the microwave wavelengths of each other, and the synchronization is performed via an adapter 227 or wirelessly.

Therefore, when two medical devices 220 are operated inside a patient by one or two operators, the wavelengths of the microwaves of both devices are synchronized, which prevents sparks and other accidents from occurring between the two medical devices 220, thereby increasing safety.

Figure 21 shows a telesurgery system 200 in one embodiment of the present invention. The telesurgery system 200 has a surgeon console 201 which serves as a station for each of two operators D (D1, D2), a master control unit 202 operated by the operator D, a vision/core cart 240, and a patient side cart 210 robot which is a patient side cart.

The surgeon console 201 includes a viewer 201a on which an image of the surgical site is displayed to the operator D. When using the surgeon console 201, the operators D1 and/or D2 typically sit in a chair at the surgeon console, position both of their eyes in front of the viewer 201a, and hold the master control unit 202 in one hand.

The remote surgery system 200 can be operated by two operators simultaneously, but can also be operated by a single operator. When two operators operate simultaneously, they can work together, which has the advantage of shortening the overall surgery time for the patient. The system may be provided with three or more surgeon consoles 201 and master control units 202, if necessary.

The robot on the Patient Side Cart 210 is placed adjacent to the patient. In use, the Patient Side Cart 210 is placed near the patient requiring surgery. The robot on the Patient Side Cart 210 is fixed during the surgical procedure but has casters on the base 211 to allow for mobility. The Surgeon Console 201 is used in the same operating room as the Patient Side Cart, but may be placed remotely from the Patient Side Cart 210.

The patient side cart 210 includes four robot arm assemblies 212, but the number of robot arm assemblies 212 is arbitrary. Each robot arm assembly 212 is connected to and driven and controlled by a drive unit 213 that enables three-dimensional movement.

The display 214 displays image data related to the surgery. The drive 213 is controlled by the master control unit 202 of the surgeon console 201. The movement of the manipulator portion of the robot arm assembly 212 is controlled by operation of the master control unit 202.

An image capture device 215, such as an endoscope, is disposed on one of the four robotic arm assemblies 212, robotic arm assembly 212a. The image capture device 215 includes a viewing camera 216 at its distal end. The elongated shaft of the image capture device 215 allows the viewing camera 216 to be inserted through a surgical entry port in a patient (not shown).
The image capture device 215 is operatively connected to the viewer 201 a of the surgeon console 201 for displaying images captured by its viewing camera 216 .

Each of the other robotic arm assemblies 212 is a linkage that supports and includes a tool 217, which is a removable surgical instrument. The tool 217 of each robotic arm assembly 212 includes an end effector 10c.

The tool 217 has an elongated shaft to allow the end effector 10c to be inserted through the patient's surgical entry port. Movement of the end effector 10c is controlled by the master control unit 202 of the surgeon console 201.

When the end effector 10c is used as the tool 217 with an electrode (20, 24) for irradiating microwaves and a microwave irradiation unit, the wavelengths of the microwaves irradiated from the end effector 10c are synchronized.

For example, when one or two operators D operate multiple tools 217 inside a patient, the wavelengths of the irradiated microwaves are synchronized, which can prevent sparks and other accidents between the multiple tools 217 or multiple end effectors 10c, thereby improving safety. Simultaneous operation of multiple end effectors 10c can shorten surgery time as well as enable advanced surgery.

Figure 22 shows the configuration of a tool 217 that can be loaded onto the robot arm assembly 212 of the remote surgery system 200 in Figure 21 as a representative example of a surgical device. The tools 217 attached to other robot arm assemblies 212 may have a similar configuration, or may be surgical devices of other configurations.

Figure 22(a) shows a plan view of the tool 217. The tool 217 has an end effector 10c of a multi-function surgical instrument, a bending portion 226, a shaft portion 225, a surgical device 221 that drives, controls, and monitors the tool 217, and a connector 228 that connects to the robot. The bending portion 226 increases the degree of freedom of the operation angle of the effector, improving the accuracy of robot control.

Figure 22(b) shows the internal configuration of the tool 217 in Figure 22(a). It shows a medical system consisting of a surgical device 221 that drives the end effector 10c directly connected to the slide shaft in Figure 16 via a shaft portion 225, and a patient side cart 210 robot that controls the surgical device 221.

The end effector 10c is equipped with a cutter having a rotatable upper jaw 14 and lower jaw 116 that are held openable and closable, and a movable cutting cutter 15 attached to the upper jaw 14 and lower jaw 116. The surgical device 221 connected to the end effector 10c has an alignment unit 231 with the tool 217, a reflected wave monitor 232, a control circuit 233 that controls signals within the surgical device, an irradiation/drive unit 234 that has an amplifier and a microwave-generating irradiator that mechanically drives the cutter of the tool 217 via the shaft 225 of the tool 217, and a signal interface 235 with the robot of the patient side cart 210.

23, the robot of the patient side cart 210 is connected to the surgical device 221 by wire and/or wirelessly via a signal interface 235 and a connector 228, and the robot of the patient side cart 210 is provided with an input unit 210a that receives operation signals from the master control unit 202, a calculation unit CPU that executes a predetermined operation program based on the operation signals, and an output unit 210a that generates a drive signal for driving the upper jaw 14 and the cutting cutter 15 of the end effector 10c via the surgical device 221 based on the output from the calculation unit. The input unit and the output unit are composed of an input/output unit 210a (I/O).
23A and 23B are explanatory diagrams of a remote surgery system 200, in which FIG. 23A is a block diagram showing the connection relationships between each unit, and FIG. 23B is an operation flow diagram of the remote surgery system 200.

The vision and core cart 240 has a function related to the image capture device. When the remote surgery system 200 is started for surgery, the surgeon operates the master control unit 202 of the surgeon console 201, and in the case of two surgeons, the surgeon also operates the master control unit 202 of the surgeon console 201 (step S1), and the command generated by the operation is sent to the vision and core cart 240 (step S2).
The vision and core cart 240 then interprets the signals and moves the desired robotic arm assembly 212 to the patient's surgical area (step S3).

Next, the tool 217 attached to the selected robot arm assembly 212 is inserted into the patient through the long, thin pipe (step S4), and the end effector 10c of the above embodiment is caused to grasp, coagulate, and cut the tissue (step S5), completing the surgery on the living tissue.

The action of grasping, coagulating, and cutting the biological tissue in step S5 is the action of the end effector 10c, and there are three action patterns: a first action pattern in which the biological tissue is coagulated, grasped, and cut while irradiating microwaves from the electrode; a second action pattern in which the biological tissue is grasped, coagulated by irradiating microwaves from the electrode, and cut while irradiating microwaves from the electrode; and a third action pattern in which the biological tissue is grasped and coagulated while irradiating microwaves from the electrode, but the irradiation of microwaves from the electrode is stopped and the tissue is cut. These three action patterns are configured to be selectively adopted depending on the contents of the surgery. In addition, a pattern in which the multiple tools in FIG. 21 share the same operation, such as grasping or coagulating with tool 217 and cutting with another tool 217, may be used.

In this embodiment, the tissue coagulation, grasping, and cutting operations are performed by the end effector 10c based on a control signal from the robot 210, instead of the control operation of the end effector 10c based on the position data of the lever 223 described as a modified example of the embodiment in Figure 20, so that a similar control operation flow can be obtained.

That is, a medical system can be provided that includes a gripping mechanism having a first gripping section and a second gripping section assembled so as to be openable and closable, and a gripping section rotation means for rotating the first gripping section towards the second gripping section, a cutting mechanism having a cutting section attached to the first gripping section and a cutting section rotation means for rotating the cutting section in the same direction as the rotation of the first gripping section, a rotation shaft for rotatably supporting the first gripping section and the cutting section with respect to the second gripping section, a drive unit for independently driving the gripping section rotation means and the cutting section rotation means, and a medical robot configured to coagulate and cut the target area while gripping the target area by applying a drive signal to the drive unit.

As another embodiment, Fig. 24 shows a structural diagram of forceps 1D. Fig. 24(a) shows a rear view of forceps 1D, Fig. 24(b) shows a front view of end effector section 10D at the tip of forceps 1D, Fig. 24(c) shows a plan view of end effector section 10D shown in Fig. 24(a), Fig. 24(d) shows a partial cross-sectional external view of forceps 1D, and Fig. 24(e) shows a cross-sectional view of tube T connecting forceps 1D and drive unit 32.

The device is equipped with a drive unit 32 that drives and controls the forceps 1D. The forceps 1D and the drive unit 32 are connected by a drive wire 16Da that rotates the upper jaw 14, a drive wire 16Db that rotates the cutting cutter 15, and a coaxial cable 24D that is connected to the electrode 24a of the upper jaw 14 and the electrode 24b of the lower jaw 116, which are inserted into a flexible tube T.

The end effector section 10D is composed of a fixed lower jaw section 116, an upper jaw section 14, and a cutting cutter 15, and the base section 11A of the main body frame 11 on which the lower jaw section 116 is provided is configured to be attached to a mounting fixture 60 provided at the tip of the tube T.

The tip of the drive wire 16Da is rotatably engaged with the base of the upper jaw 14 on the engagement shaft 143, which is supported by the rotating shaft 141 and spaced above the rotating shaft 141. When the drive wire 16Da moves to the tip side F, the engagement shaft 143 moves to the tip side F, and the upper jaw 14, which is supported by the rotating shaft 141, rotates in a direction approaching the lower jaw 116. The upper jaw 14 and the lower jaw 116 then grasp an object such as biological tissue. Conversely, when the drive wire 16Da is moved to the base side R, the upper jaw 14 moves away from the lower jaw 116 and releases the grasp.

In Figures 24(a) and 24(c), the cutting cutter 15 is juxtaposed to the upper jaw 14 so as to be independently rotatable, the base of the cutting cutter 15 is supported by a rotating shaft 151 provided on the lower jaw 116, and the tip of the drive wire 16Db rotatably engages the base of the cutting cutter 15 with an engagement shaft 154 spaced above the rotating shaft 151.

When the drive wire 16Db moves to the tip side F, the engagement shaft 154 moves to the tip side F, and the cutting cutter 15 supported by the rotating shaft 151 rotates in a direction approaching the lower jaw 116 and joins with it, thereby cutting the target object such as biological tissue. Conversely, when the drive wire 16Db is moved to the base side R, the cutting cutter 15 moves away from the lower jaw 116 and the cutting state is canceled.

The central conductor of the coaxial cable 24D is connected to the electrode 24a, and the outer conductor is connected to the electrode 24b, but the connection structure with both electrodes is not limited to this embodiment and may be the electrode connection structure of the previous embodiment. As shown in FIG. 24(d), the coaxial cable 24D is inserted into the hollow part of the tube T, and is led out of the forceps 1D together with the drive wires 16Da and Db, and is connected to the drive unit 32.

The drive unit 32 includes a circuit that supplies electromagnetic waves, microwaves, high frequency waves, and electric current to the electrodes 24a and 24b, and includes a control unit that can individually control the rotation of the upper jaw 14 and the cutting cutter 15 by selectively or simultaneously pushing the drive wires 16Da and Db toward the forceps 1D or pulling them away from the forceps 1D based on an internal or external signal. The drive unit 32 includes a built-in micromotor M, which enables the upper jaw 14 and the cutting cutter 15 to be individually driven and rotated by an electric signal.

In this embodiment, the end effector section 10D has a simple structure that does not require differential mechanisms such as springs and gears, so malfunctions caused by biological tissue entering the end effector section 10D can be prevented, and the end effector section 10D is particularly suitable for ultra-thin forceps with a diameter of a few millimeters. As shown in FIG. 24(e), the drive wires 16Da and Db are forced to move in the direction of travel by running along the inner wall of the tube T, making the end effector section 10D suitable for endoscopic forceps. Both the tube T and the drive wire 16D are made of flexible material, but the wires may be thin, elongated members or may be made of rigid materials if necessary.

By incorporating the functions of the drive unit 32 into the drive unit 224 of the medical device in FIG. 20, or into the irradiation and drive unit 2 of the surgical device in FIG. 22, it is possible to easily provide multiple functions such as a portable medical device and a robotic drilling function, grasping function, coagulation function, cutting function, and opening and removal function.

For example, in step S5 in the flow chart of FIG. 23, if the end effector unit 10D of this embodiment is applied to the end effector 10c of the tool 217 of FIG. 22, the upper jaw unit 14 and the cutting cutter 15 can be easily driven independently, so that, as shown in FIG. 25,
(1) The upper jaw, lower jaw, and cutting cutter are all closed to provide a drilling function;
(2) Providing a grasping function by manipulating the upper and lower jaws together;
(3) In the second gripping function state, a coagulation button is operated to provide a coagulation function;
(4) Providing a cutting function by operating a cutting cutter;
(5) Opening and closing the upper and lower jaws provides an opening and closing function.
This allows a multi-function forceps function to be provided at the surgical site with a single forceps tool 217 without the need for replacement.

That is, the medical tool includes an end effector having a gripping mechanism and a cutting mechanism, and a drive unit for driving the end effector. The gripping mechanism includes a first gripping section and a second gripping section that are assembled so as to be openable and closable, and a gripping section rotation means for rotating the first gripping section toward the second gripping section. The cutting mechanism includes a cutting section provided in the first gripping section and a cutting section rotation means for rotating the cutting section in the same direction as the rotation of the first gripping section. The drive unit drives the first gripping section, the second gripping section, and the cutting section in combination, thereby providing a medical tool that selectively provides at least one of a perforation function, a gripping function, a coagulation function, a cutting function, and an opening and closing function. The medical tool may be used alone, or may be used with a medical robot that is driven by a control signal from a robot. In addition, when the gripping and cutting parts are all closed and integrated, they can be used for opening a window, and when either the cutting or gripping parts are opened from this state, they can be used for opening and removing the window. All surgical operations can be recorded and saved in the robot, making it possible to perform surgery using artificial intelligence (AI) functions.

The above-mentioned examples and embodiments have been described using medical examples such as forceps and medical instruments, but the present invention is not limited to the above description, and the target site may be not only a part of an object but also a member, and includes a general-purpose cutting device that can grasp/contact and cut the target member. In addition, the energy waves irradiated from the electrodes of the forceps are not limited to microwaves, and may include other electromagnetic waves and currents.

For example, as described above, in the cutting mechanism 10 and end effector 10c of the forceps 1, 1X, 1Y, etc., the gripping mechanism 17 is configured to be made up of the lower jaw 116 and the upper jaw 14, and the target portion such as the blood vessel B gripped by the gripping mechanism 17 is cut by the cutting cutter 15. However, as shown in FIG. 6(d), the gripping mechanism 17 made up of the lower jaw 116 and the upper jaw 14 may be provided on both sides of the cutting cutter 15, and the target portion gripped by the two gripping mechanisms 17 may be cut by the cutting cutter 15.

In addition, the horizontal movement of the forceps or end effector of the present invention is not limited to axial movement, and may be structured to be connected by a wire in order to increase the degree of freedom of the position and angle of the end effector. The spring mechanism for moving the upper jaw and the cutting cutter for grasping, coagulating, and cutting biological tissue may be provided at any position, not limited to the embodiment.

In addition, parts other than the electrodes and cutting edges may be appropriately insulated to prevent corrosion and sparks. In the above embodiment, the tissue between the upper jaw 14 or the cutting cutter 15 and the lower jaw 116 can be coagulated from both sides. The split part of the coaxial cable that supplies microwaves to the end effector allows for a structure that sends energy across multiple robot joints using a flexible cable without restricting the movement of the multiple joints.

In addition, by using a metal blade, the rigidity and shape can be freely designed. The forceps and medical devices with end effectors of the present invention can be used under MR image guidance, and microwave energy can be introduced not only under endoscopy and with robotic hands, but also in endovascular surgery and fetal surgery.

In the above embodiment, the tissue between the upper jaw 14 or the cutting cutter 15 and the lower jaw 116 can be coagulated from both sides. The split part of the coaxial cable that supplies microwaves to the end effector makes it possible to send energy across multiple robot joints using a flexible cable without restricting the movement of the multiple joints.

In addition, by using a metal blade, the rigidity and shape can be freely designed. The forceps and medical devices having the end effector of the present invention can be used under MR image guidance, making it possible to introduce microwave energy not only under endoscopy or with robotic hands, but also in endovascular surgery and fetal surgery.

The embodiments of the present invention are illustrative in all respects, and the scope of the present invention includes all modifications within the meaning and scope of the claims.

1, 1A, 1B, 1X, 1Y... Forceps 10, 10X... Cutting mechanism 10c... End effector 11, 11X, 11Y... Main body frame 11a... Reference axis 13a... Gripping trigger handle 13b... Cutting trigger handle 14... Upper jaw portion 15... Cutting cutter 19... Spring 17... Gripping mechanism 18Y... Arm 20... Coaxial electrode 21... Central conductor 22... Semicircular insulator 23... Semicircular tube conductors 24a, 24b, 24c... (Irradiation) electrode 30... Microwave oscillator 40... Coaxial Cable 41...Central conductor 42...Insulator 43...Outer conductor 44...Insulating coating 51...Ratchet hook 111...Fixed handle frame 112...Reference frame 113...Finger ring portion 115...Support shaft 116...Mandible portion 117...Tip support portion 121, 121Ya, 121Yb...Upper support shaft 122, 122Xa, 122Yb...Tip upper support shaft 200...Remote surgery system 212, 212a...Robot arm assembly 220...Medical device 221...Surgical device B...Blood vessel

Claims (19)

a gripping mechanism including a first gripping portion and a second gripping portion assembled so as to be openable and closable, and a gripping portion rotating means for rotating the first gripping portion toward the second gripping portion;
a cutting mechanism including a cutting unit provided next to the first gripping unit and a cutting unit rotating means for rotating the cutting unit in the same direction as the rotation of the first gripping unit;
A cutter that, while a target portion is gripped by the gripping mechanism, rotates the cutting portion by the cutting mechanism and joins it with the second gripping portion, thereby cutting the target portion. a gripping mechanism including a first gripping portion and a second gripping portion assembled so as to be openable and closable, and a gripping portion rotating means for rotating the first gripping portion toward the second gripping portion;
a cutting mechanism including a cutting unit provided next to the first gripping unit and a cutting unit rotating means for rotating the cutting unit in the same direction as the rotation of the first gripping unit;
A rotation shaft that rotatably supports the first gripping portion and the cutting portion is provided for the second gripping portion,
the gripping part rotating means is constituted by a gripping part moving means for moving a portion of the first gripping part pivotally supported by the pivot shaft at a predetermined distance from the pivot shaft,
the cutting unit rotating means is composed of a cutting unit moving means for moving a portion of the cutting unit journaled by the rotating shaft at a predetermined distance from the rotating shaft,
The gripping unit moving means and the cutting unit moving means are made of elongated members and are moved along the longitudinal direction of the elongated members;
A cutting device in which the first gripping part is rotated by moving the gripping part moving means in the longitudinal direction to grip a target area with the gripping mechanism, and the cutting part is rotated by moving the cutting part moving means in the longitudinal direction to join with the second gripping part, thereby cutting the target area. 3. The cutter according to claim 2, wherein the elongated member is a flexible elongated member. The gripper moving means, which is made of the flexible long member, includes a first gripper moving means that is connected to one of two predetermined locations on the first gripper that are spaced a predetermined distance from the rotation shaft and moves the first gripper in a pulling direction in the longitudinal direction, and a second gripper moving means that is connected to the other predetermined location and moves the first gripper in the pulling direction in the longitudinal direction,
The cutting device according to claim 3, wherein the cutting section moving means, which is made of the flexible elongated member, has a first gripping section moving means connected to one of two specified locations at the cutting section spaced a specified distance from the pivot shaft and moving the first gripping section in the pulling direction in the longitudinal direction, and a second gripping section moving means connected to the other specified location and moving the first gripping section in the pulling direction in the longitudinal direction. The gripping unit moving means and the cutting unit moving means, which are made of the flexible elongated member, move a predetermined portion in a pulling direction in the longitudinal direction,
4. The cutting tool according to claim 3, further comprising: a gripping biasing portion that biases the first gripping portion in a direction in which the specified location moves in the pushing direction in the longitudinal direction; and a cutting biasing portion that biases the cutting portion in a direction in which the specified location moves in the pushing direction. 4. The cutter according to claim 3, wherein the gripper moving means and the cutting portion moving means move predetermined locations in the pushing direction and the pulling direction in the longitudinal direction. the long member is a rod-shaped slide plate that slides in the longitudinal direction relative to a reference frame to rotate the first gripping portion or the cutting portion,
A cutting tool as described in any one of claims 2 to 6, further comprising a notification unit that notifies an outside party of at least one of the rotation of the first gripping part or the cutting part relative to the second gripping part by sliding the slide plate in the longitudinal direction relative to the reference frame about which the first gripping part or the cutting part rotates. 8. The cutter according to claim 7, further comprising notification amount adjustment means for adjusting the amount of notification by the notification section. 9. A cutting tool as described in any one of claims 2 to 8, wherein electrodes for irradiating electromagnetic waves are provided at at least one of a gripping portion of the first gripping part that grips the target portion and a vicinity of a cutting blade of the cutting part, and at a gripping portion of the second gripping part that grips the target portion. The electrode is
A coaxial electrode includes a center electrode and an outer electrode surrounding the center electrode via an insulator,
10. The cutter according to claim 9, wherein a coaxial cable connecting an irradiation device for irradiating the electromagnetic waves and the electrode is branched into a plurality of parallel cables, and each of the coaxial electrodes is electrically connected to a central conductor and an outer conductor of the coaxial cable. 11. The cutter of claim 10, wherein the coaxial electrodes are connected in reverse polarity to the coaxial cable. A cutter according to any one of claims 2 to 11,
a drive unit that drives the gripping unit moving means and the cutting unit moving means independently of each other;
and a medical robot connected to apply a drive signal to the drive unit. an input/output unit connected by wire and/or wirelessly to the cutting device according to any one of claims 2 to 11;
an input unit for receiving an operation signal in real time;
a computing unit that executes a predetermined operation program based on the operation signal;
and an output unit which generates, based on the output from the arithmetic unit, a gripping drive signal for gripping the target portion with the first gripping portion and the second gripping portion by moving the gripping portion moving means in the longitudinal direction, and/or a cutting drive signal for cutting the target portion with the cutting portion by moving the cutting portion moving means in the longitudinal direction. The robot according to claim 13,
The output unit provides a drive signal to an external drive unit that mechanically drives the cutter. A cutter according to any one of claims 2 to 11,
a mounting portion for mounting at least the second gripping portion of the cutting device to a tip end of a robot arm;
a gripper side connection part that is connected to a drive mechanism that drives the gripper moving means on the robot arm side;
An end effector provided with a cutting unit side connection part that connects to a drive mechanism that drives the cutting unit moving means on the robot arm side. A cutting device according to any one of claims 2 to 8,
The target site is a biological tissue,
A gripping operation unit that drives and operates the gripping unit moving means;
a cutting operation unit that drives and operates the cutting unit moving means,
Forceps for operating the gripping operation portion to grip the biological tissue with a first gripping portion and a second gripping portion, and for operating the cutting operation portion to cut the biological tissue with a cutting portion. A cutting device according to any one of claims 9 to 11,
The target site is a biological tissue,
A gripping operation unit that drives and operates the gripping unit moving means;
a cutting operation unit that drives and operates the cutting unit moving means,
The gripping operation unit is operated to grip the biological tissue with a first gripping unit and a second gripping unit,
irradiating electromagnetic waves from the electrodes to coagulate at least a portion of the biological tissue;
Forceps for cutting the biological tissue with a cutting portion by operating the cutting operation portion. a gripping mechanism including a first gripping portion and a second gripping portion assembled so as to be openable and closable, and a gripping portion rotating means for rotating the first gripping portion toward the second gripping portion;
a cutting mechanism including a cutting unit provided next to the first gripping unit and a cutting unit rotating means for rotating the cutting unit in the same direction as the rotation of the first gripping unit;
A rotation shaft that rotatably supports the first gripping portion and the cutting portion is provided for the second gripping portion,
the gripping part rotating means is constituted by a gripping part moving means for moving a portion of the first gripping part pivotally supported by the pivot shaft at a predetermined distance from the pivot shaft,
the cutting unit rotating means is composed of a cutting unit moving means for moving a portion of the cutting unit journaled by the rotating shaft at a predetermined distance from the rotating shaft,
The gripping unit moving means and the cutting unit moving means are made of elongated members and are moved along the longitudinal direction of the elongated members;
A gripping side drive unit that drives the gripping unit moving means and a cutting side drive unit that drives the cutting unit moving means are provided,
In a state in which the first gripping part is rotated by the gripping part moving means driven by the gripping side drive part and the target site is gripped by the gripping mechanism,
The robot rotates the cutting unit using the cutting unit moving means driven by the cutting side drive unit, and joins the cutting unit with the second gripping unit, thereby cutting the target portion. a gripping mechanism including a first gripping portion and a second gripping portion assembled so as to be openable and closable, and a gripping portion rotating means for rotating the first gripping portion toward the second gripping portion;
a cutting mechanism including a cutting unit provided next to the first gripping unit and a cutting unit rotating means for rotating the cutting unit in the same direction as the rotation of the first gripping unit;
A rotation shaft that rotatably supports the first gripping portion and the cutting portion is provided for the second gripping portion,
the gripping part rotating means is constituted by a gripping part moving means for moving a portion of the first gripping part pivotally supported by the pivot shaft at a predetermined distance from the pivot shaft,
the cutting unit rotating means is composed of a cutting unit moving means for moving a portion of the cutting unit journaled by the rotating shaft at a predetermined distance from the rotating shaft,
The gripping unit moving means and the cutting unit moving means are made of elongated members and are moved along the longitudinal direction of the elongated members;
A gripping side drive unit that drives the gripping unit moving means and a cutting side drive unit that drives the cutting unit moving means are provided,
In a state in which the first gripping part is rotated by the gripping part moving means driven by the gripping side drive part and the living tissue to be cut is gripped by the gripping mechanism,
A portable surgical instrument that rotates the cutting section using the cutting section moving means driven by the cutting side drive section, and cuts the biological tissue by joining the cutting section to the second gripping section.

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