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WO2016009704A1 - Outil de traitement médical - Google Patents

Outil de traitement médical Download PDF

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Publication number
WO2016009704A1
WO2016009704A1 PCT/JP2015/063171 JP2015063171W WO2016009704A1 WO 2016009704 A1 WO2016009704 A1 WO 2016009704A1 JP 2015063171 W JP2015063171 W JP 2015063171W WO 2016009704 A1 WO2016009704 A1 WO 2016009704A1
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WO
WIPO (PCT)
Prior art keywords
forceps
pair
portions
medical treatment
insulating
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2015/063171
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English (en)
Japanese (ja)
Inventor
宮城　邦彦
澤井　貴司
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
JIMRO Co Ltd
Original Assignee
JIMRO Co Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by JIMRO Co Ltd filed Critical JIMRO Co Ltd
Priority to JP2016534305A priority Critical patent/JP6267339B2/ja
Publication of WO2016009704A1 publication Critical patent/WO2016009704A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current

Definitions

  • the present invention relates to a medical treatment instrument for performing treatments such as treatment and surgery on a living tissue, and in particular, a treatment section including a pair of forceps members can be opened and closed, and these forceps members are connected to bipolar electrodes.
  • the present invention relates to a medical treatment instrument that generates a high-frequency electric field such as a microwave.
  • the treatment portion is provided at the distal end portion of the insertion portion.
  • the treatment section includes a fixed forceps member and a rotatable forceps member, and can be opened and closed.
  • the proximal ends of the pair of forceps members are separated from each other along the opening / closing direction (direction orthogonal to the rotation axis), and the distal ends of the forceps members are moved closer to and away from each other.
  • the pair of forceps members are made of a bipolar electrode by being made of metal, and a high-frequency electric field is formed between the forceps members.
  • the present invention makes the treatment portion at the distal end of a medical treatment instrument having a pair of forceps members to be a bipolar electrode compact, ensures insulation between the pair of forceps members, and The purpose is to ensure strength.
  • the present invention provides a medical treatment instrument in which a treatment portion including a pair of electrodes capable of forming an electric field between each other is provided at the distal end of an insertion portion.
  • the treatment section includes first and second forceps members constituting the pair of electrodes; Having a holder made of an insulator and a shaft pin made of metal, the base end portions of the first and second forceps members can be rotated relative to each other around a rotation axis along the opposing direction of the base end portions.
  • a connecting part to be connected Comprising the holder, An insulating plate formed in a plate shape orthogonal to the facing direction and interposed between base end portions of the first and second forceps members; An insulating shaft that is formed in a cylindrical shape orthogonal to the insulating plate and penetrates the proximal end portion of the second forceps member, The shaft pin is disposed on the rotation axis, is inserted through the insulating shaft tube, penetrates the insulating plate, and is connected to and supported by the first forceps member.
  • the treatment portion can be made compact by overlapping the proximal end portions of the first and second forceps members along the rotation axis.
  • the base end portions of the first and second forceps members can be insulated from each other by the insulating plate of the holder, and one base end portion of the first and second forceps members can be insulated from the shaft pin by the insulating shaft cylinder. .
  • it can prevent that a 1st forceps member and a 2nd forceps member short-circuit via an axial pin.
  • strength can be ensured by configuring the shaft pin with metal.
  • the holder includes a pair of sandwiching plate portions facing each other in the facing direction and sandwiching a proximal end portion of the second forceps member from both sides, and at least one of the sandwiching plate portions of the first and second forceps members It is preferable that the insulating plate is configured to be interposed between the base end portions, and that the insulating shaft tube is bridged between the pair of sandwiching plate portions. Thereby, the base end portion of the second forceps member can be protected by the holder.
  • the insulating shaft cylinder is composed of a pair of half cylinder parts, one half cylinder part is integrally connected to one clamping plate part, and the other half cylinder part is integrally linked to the other clamping plate part.
  • a holder can be comprised by two members of one holder member which consists of one clamping plate part and a half cylinder part, and the other holder member which consists of the other clamping member and a half cylinder part.
  • Each clamping plate portion is preferably formed with a hole portion through which the end portion of the half cylinder portion of the other clamping plate portion is fitted and the shaft pin is inserted. Thereby, a pair of clamping board parts can be connected by fitting a pair of half cylinder parts.
  • the half end face of the half cylinder part is a step surface, and the step surfaces of the pair of half cylinder parts are fitted to each other. Thereby, creeping discharge can be suppressed or prevented.
  • the pair of sandwiching plate portions may be integrally connected via a connecting plate portion, and the insulating shaft tube may be separated from the pair of sandwiching plate portions.
  • the first forceps member has a pair of first forceps portions opposed to each other in the facing direction, and a base end portion of the second forceps member is disposed between the base end portions of the first forceps portions.
  • One clamping plate portion is interposed between one first forceps portion and the second forceps member, and the other clamping plate portion is interposed between the other first forceps portion and the second forceps member, It is preferable that both ends of the shaft pin are connected to and supported by a pair of first forceps.
  • the pair of first and second forceps members can be reliably insulated by the pair of sandwiching plate portions. Further, by placing both end portions of the shaft pin in a both-end support state, a load such as a bending moment applied to the shaft pin can be reduced.
  • the first and second forceps members are connected to a microwave power source that outputs a microwave via a coaxial cable housed in the insertion portion. Accordingly, by forming a microwave electric field between the first and second forceps members, it is possible to supply the microwave energy to the treatment target site and perform the treatment.
  • the treatment portion at the distal end of the medical treatment instrument can be made compact, and the pair of forceps members serving as the bipolar electrodes of the treatment portion can be reliably insulated from each other, and the strength of the rotating shaft is ensured can do.
  • FIG. 1 is a schematic configuration diagram of a medical treatment instrument according to the first embodiment of the present invention.
  • FIG. 2A shows the insertion part of the medical treatment instrument, and is a cross-sectional view taken along the line IIa-IIa in FIG.
  • FIG. 2B is a longitudinal sectional view of the insertion portion taken along line IIb-IIb in FIG.
  • FIG. 3 is a longitudinal sectional view of the insertion portion and the treatment portion of the medical treatment instrument.
  • FIG. 4 is a perspective view showing a part of the insertion portion and the treatment portion in cross section.
  • FIG. 5 is an exploded perspective view of the first forceps member of the insertion portion and the treatment portion.
  • FIG. 6 is an exploded perspective view of the second forceps member and the connecting portion of the treatment portion.
  • FIG. 7A is an exploded perspective view of the first and second forceps members of the insertion portion and the treatment portion.
  • FIG. 7B is a perspective view of the insertion portion and the treatment portion.
  • FIG. 8A is a front view of the holder member of the connecting portion along the line VIIIa-VIIIa in FIG.
  • FIG. 8B is a cross-sectional view of the holder member taken along line VIIIb-VIIIb in FIG.
  • FIG.8 (c) is a perspective view of the holder which combined a pair of holder member.
  • FIG. 9 is a cross-sectional view of the processing section taken along line IX-IX in FIG.
  • FIG. 10 (a) is a side view which shows a pair of holder which concerns on 2nd Embodiment of this invention in a group state.
  • FIG. 10B is a sectional view taken along line Xb-Xb in FIG.
  • FIG. 11 is a perspective view showing a section of a connection part and a treatment part according to a third embodiment of the present invention in cross section.
  • FIG. 12 is an exploded perspective view of the connecting portion of the third embodiment.
  • FIG. 13A shows the holder member of the connecting portion of the third embodiment, and is a front view taken along the line XIIIa-XIIIa of FIG.
  • FIG. 13B is a side view taken along line XIIIb-XIIIb in FIG.
  • FIG. 13C is a cross-sectional view taken along line XIIIc-XIIIc in FIG.
  • the medical treatment tool 1 of this embodiment is a forceps that is used by being inserted into a channel of an endoscope (not shown), and includes a hand operation unit 10, an insertion unit 20, The treatment part 30 is provided.
  • the hand operation unit 10 includes an operation main body unit 11 and a slide knob 12.
  • a slide knob 12 is slidably provided on the operation main body 11.
  • the insertion portion 20 includes a lumen tube 21 (insertion main body portion), a coaxial cable 22 (microwave energy supply line), and an operation wire 23 and extends long.
  • a hand operation unit 10 is provided at the proximal end of the insertion unit 20.
  • a treatment portion 30 is provided at the distal end of the insertion portion 20. This insertion part 20 is inserted into the channel of the endoscope.
  • the lumen tube 21 is made of an insulating resin such as polytetrafluoroethylene (PTFE). Inside the lumen tube 21, a large-diameter lumen 21a having a relatively large cross section and a small-diameter lumen 21b having a relatively small cross section are formed in parallel with each other along the axis. As shown in FIG. 3, a lumen communication portion 21 c is formed at a portion between the large and small lumens 21 a and 21 b at the distal end portion of the lumen tube 21. The two lumens 21a and 21b are communicated with each other via the lumen communication portion 21c.
  • PTFE polytetrafluoroethylene
  • a coaxial cable 22 is accommodated in the large-diameter lumen 21a.
  • the coaxial cable 22 is accommodated in the insertion part 20.
  • the coaxial cable 22 includes a linear inner conductor 22a, an outer conductor 22b made of a tubular braid, a tubular dielectric layer 22c between the inner and outer conductors 22a and 22b, and an outer conductor 22b. And a tubular protective coating 22d that covers the entire length of the insertion portion 20.
  • the proximal end portion of the coaxial cable 22 is connected to the microwave power source 2.
  • the proximal end portion of the internal conductor 22a is electrically connected to the high-voltage side terminal of the microwave power source 2.
  • the base end portion of the external conductor 22 b is electrically connected to the ground side terminal of the microwave power source 2.
  • the microwave power source 2 outputs a microwave.
  • the microwave means an electromagnetic wave of several hundred MHz to several hundred GHz, preferably an electromagnetic wave of 1 GHz to 10 GHz.
  • the portion on the distal end side (the treatment section 30 side) of the coaxial cable 22 protrudes toward the distal end as the member on the more central side.
  • the distal end portion of the inner conductor 22a is electrically connected to the first forceps member 31 described later on the treatment portion 30, and the distal end portion of the outer conductor 22b is electrically connected to the second forceps member 32 described later on the treatment portion 30. Connected.
  • the operation wire 23 is accommodated in the small diameter lumen 21 b of the lumen tube 21. As shown in FIG. 1, the operation wire 23 extends over substantially the entire length of the insertion portion 20. A proximal end portion of the operation wire 23 is connected to the slide knob 12. The distal end portion of the operation wire 23 is connected to a second forceps member 32 described later.
  • the treatment section 30 includes a pair of forceps members 31 and 32 and can be opened and closed.
  • the forceps members 31 and 32 are made of metal such as stainless steel and have conductivity.
  • the first forceps member 31 integrally includes a base tube portion 31b and a pair of first forceps portions 31a and 31a.
  • the base tube portion 31 b has a cylindrical shape that is coaxial with the insertion portion 20.
  • the base tube portion 31 b is fitted on the outer periphery of the distal end portion of the lumen tube 21. Thereby, the first forceps member 31 is fixed to the distal end portion of the insertion portion 20.
  • the first forceps portion 31a has a plate shape extending in the distal direction from the base tube portion 31b.
  • the pair of first forceps 31a, 31a are parallel to each other and face each other in the facing direction orthogonal to the extending direction.
  • a slit-like gap 39 is formed between the first forceps 31a and 31a.
  • the outer surface of the first forceps portion 31a is a partial cylindrical surface having a slightly smaller diameter than the outer diameter of the base tube portion 31b.
  • the inner surface of the first forceps portion 31a (the surface facing the other first forceps portion 31a) is flat, but may be a concave curved surface or a convex curved surface.
  • a shaft hole 31h is formed in the base end portion 31d (the portion on the base tube portion 31b side) of the first forceps portion 31a.
  • a recessed portion is formed at one edge of the width direction (direction orthogonal to both the extending direction and the opposing direction) of the portion 31 f on the distal end side of the proximal end portion 31 d of the first forceps portion 31 a.
  • 31 g is formed.
  • the inner surface of the recessed portion 31g is a flat receiving surface 31i. Due to the recessed portion 31g, the distal end portion 31f of the first forceps portion 31a is narrower than the proximal end portion 31d.
  • a protrusion 31e is provided at the tip of the tip end portion 31f.
  • the protrusion 31e protrudes from the tip end portion 31f to one side in the width direction. Accordingly, the distal end portion of the first forceps portion 31a has an L shape.
  • the gap 39 between the first forceps 31a and 31a includes a gap portion 39b on the proximal end side and a gap portion 39f on the distal end side than that.
  • the gap portion 39b is formed between the base end portions 31d and 31d of the pair of first forceps portions 31a and 31a.
  • the gap portion 39f is formed between the distal end portions 31f and 31f of the pair of first forceps portions 31a and 31a.
  • the second forceps member 32 has an elongated plate shape.
  • a shaft hole 32 h is formed in the proximal end portion 32 d of the second forceps member 32.
  • a flat receiving surface 32 i is formed at one edge of the portion 32 f on the distal end side of the proximal end portion 32 d of the second forceps member 32.
  • a protrusion 32e is formed at the tip of the second forceps member 32 so as to protrude from the receiving surface 32i.
  • tip part of the 2nd forceps member 32 is L-shaped.
  • the protruding direction of the protruding portion 32 e is directed to the opposite side to the protruding portion 31 e of the first forceps member 31.
  • the proximal end portion 32d of the second forceps member 32 is disposed inside the gap portion 39b at the proximal end of the gap 39 between the pair of first forceps portions 31a and 31a. , via a connecting portion 5 which will be described later, it is rotatably connected around a rotation axis L 5 relative to the first forceps member 31.
  • the distal end side portion 32f of the second forceps member 32 can enter and exit the distal end side gap portion 39f. That is, the second forceps member 32 is rotatable relative to the first forceps member 31 within an angular range in which the gap portion 39f and thus the gap 39 can enter and exit.
  • the treatment section 30 can be opened and closed between an open position (open state) and a closed position (closed state).
  • the tip end portion 32f of the second forceps member 32 is protruded obliquely outward from the first forceps member 31, the direction along the rotational axis L 5
  • the receiving surfaces 31i and 32i and the protrusions 31e and 32e face each other.
  • the entire second forceps member 32 is sandwiched between the pair of first forceps portions 31a and 31a of the first forceps member 31.
  • it is accommodated in the gap 39.
  • Rotation axis L 5 represents, together with the orthogonal to the extending direction and the width direction of the forceps members 31 and 32, the first gripper 31a, along the opposing direction of and what 31a, and the opposing direction of the base end portion to each other of the forceps members 31, 32 It is along. Proximal end to each other of the forceps members 31 and 32, are stacked along the rotation axis L 5.
  • a connecting protrusion 32 b is formed integrally with the base end portion 32 d of the second forceps member 32.
  • the connecting protrusion 32 b protrudes obliquely and rearward with respect to the extending direction of the second forceps member 32.
  • a metal connection press 35 having the same shape as the connection protrusion 32b is joined to the proximal end portion 32d of the second forceps member 32 by welding or the like.
  • the interlocking protrusion 32b and interlocking retainer 35 has opposed in a direction parallel to the rotational axis L 5.
  • the 2nd forceps member 32 may have a pair of connection protrusion 32b, 32b integrally.
  • the pair of connection pressers 35, 35 may be joined to the second forceps member 32 by welding or the like.
  • a metal connecting piece 33 is joined to the distal end portion of the operation wire 23 by welding or the like.
  • the connecting piece 33 is inserted between the connecting protrusion 32 b and the connecting presser 35 and is rotatably connected to the connecting protrusion 32 b and the connecting presser 35 through a metal connecting pin 34. Axis and thus the axis of rotation of the interlocking piece 33 of the connection pin 34 is parallel to the rotation axis L 5.
  • the treatment part 30 can be opened and closed. Since the first forceps member 31 is fixed and the second forceps member 32 is movable, the treatment section 30 is a single-opening type forceps.
  • the first and second forceps members 31, 32 of the treatment unit 30 constitute a pair of electrodes of the treatment unit 30 by being connected to the microwave power source 2 via the coaxial cable 22.
  • the first forceps member 31 is connected to the high-voltage side terminal of the microwave power source 2 via the inner conductor 22 a of the coaxial cable 22.
  • the second forceps member 32 is connected to the ground-side terminal of the microwave power source 2 via the outer conductor 22 b of the coaxial cable 22. Therefore, the first forceps member 31 is a high-voltage electrode, and the second forceps member 32 is a ground electrode.
  • a microwave electric field high frequency electric field
  • the first forceps member 31 is connected to the internal conductor 22a as follows.
  • a metal inner connection pipe 41 is fitted on the outer periphery of the exposed portion of the tip of the inner conductor 22a.
  • the outer peripheral surface of the inner connection pipe 41 and the outer peripheral surface of the dielectric layer 22c are flush with each other.
  • a slit 41 a is formed in the peripheral side portion of the inner connection pipe 41.
  • the inner connection pipe 41 and the inner conductor 22a are integrated by soldering through the slit 41a.
  • a metal outer connecting pipe 42 is fitted into the base tube portion 31b.
  • the base cylinder part 31b and the outer connection pipe 42 are integrated by welding or the like.
  • the outer connection pipe 42 protrudes to the proximal end side (left side in FIG. 3) from the first forceps member 31.
  • the outer connection pipe 42 is inserted into the large-diameter lumen 21a, is fitted into the outer periphery of the inner connection pipe 41, and is further fitted into the outer periphery of the exposed portion at the tip of the dielectric layer 22c. Yes.
  • the inner connection pipe 41 and the outer connection pipe 42 are integrated by laser welding or the like.
  • the inner conductor 22a is electrically connected to the first forceps member 31 through the inner connection pipe 41 and the outer connection pipe 42 in order.
  • An insulating coating layer 44 made of a heat shrinkable tube is provided on the outer periphery of the outer connection pipe 42.
  • the front end surface of the outer connection pipe 42 is cut obliquely to avoid interference with the connection protrusion 32b and the connection presser 35.
  • an insulating tube 43 is provided on the outer periphery of the dielectric layer 22c between the proximal end portion (the left end portion in FIG. 5) of the outer connection pipe 42 and the distal end portion (the right end portion in FIG. 5) of the external conductor 22b. ing.
  • the second forceps member 32 is connected to the outer conductor 22b as follows.
  • a connection ring 24 is provided at the tip of the coaxial cable 22.
  • the connection ring 24 includes a large-diameter ring portion 24a, a small-diameter ring portion 24b, and a ring connection portion 24c.
  • the axes of the large and small ring portions 24a and 24b are parallel to each other.
  • These ring portions 24a and 24b are integrally connected via a ring connection portion 24c. As shown in FIG.
  • the large-diameter ring portion 24a is fitted and fixed to the outer periphery of the exposed portion of the tip of the outer conductor 22b, and is accommodated in the large-diameter lumen 21a.
  • the ring connection portion 24c is passed through the lumen communication portion 21c.
  • the small diameter ring 24b is accommodated in the small diameter lumen 21b.
  • An operation wire 23 is slidably passed through the small diameter ring portion 24b.
  • the outer conductor 22 b and the operation wire 23 are electrically connected via the connection ring 24.
  • the outer conductor 22 b is electrically connected to the second forceps member 32 through the connection ring 24, the operation wire 23, and the connecting piece 33 in order.
  • the insulation coating layer 25 which consists of a heat-shrinkable tube is coat
  • the insulation coating layer 25 and the insulation coating layer 44 of the outer connection pipe 42 prevent the operation wire 23 and the outer connection pipe 42 from being short-circuited via the lumen communication portion 21c.
  • the connecting portion 5 includes a holder 50 and a shaft pin 53.
  • the holder 50 includes a pair of holder members 51 and 51. These holder members 51 and 51 are comprised with insulators, such as polyetheretherketone (PEEK), and are mutually the same shape.
  • PEEK polyetheretherketone
  • each holder member 51 integrally includes a clamping plate portion 51a and a half cylinder portion 51b. Holding plate portion 51a is adapted to a circular plate shape perpendicular to the rotational axis L 5.
  • a hole 51h is formed at the center of the sandwiching plate 51a.
  • the hole 51h integrally includes a large-diameter semicircular portion 51d and a small-diameter semicircular portion 51e.
  • a protrusion 51f is formed on the inner periphery of the large-diameter semicircular portion 51d.
  • the half cylinder portion 51 b has a half-cylindrical shape, and the rotation axis L 5 (from the inner side surface of the sandwich plate portion 51 a (the surface facing the other sandwich plate portion 51 a)). It protrudes along the above-mentioned facing direction.
  • the inner peripheral surface of the half cylinder portion 51b is continuous with the inner peripheral surface of the small-diameter semicircular portion 51e.
  • a half end surface 51c of the half cylinder portion 51b (a surface facing the other half cylinder portion 51b) is flat.
  • a concave portion 51g is formed on the distal end surface of the half cylinder portion 51b.
  • the clamping plate portion 51 a is interposed between the base end portions of the forceps members 31 and 32. That is, the holding plate portion 51 a of one holder member 51 is interposed between the proximal end portion 31 d of one first forceps portion 31 a and the proximal end portion 32 d of the second forceps member 32. The holding plate portion 51 a of the other holder member 51 is interposed between the proximal end portion 31 d of the other first forceps portion 31 a and the proximal end portion 32 d of the second forceps member 32. Therefore, the pair of sandwiching plate portions 51a and 51a sandwich the proximal end portion 32d of the second forceps member 32 from both sides. Each clamping plate portion 51a constitutes an insulating plate that insulates the forceps members 31 and 32 from each other.
  • each holder member 51 is inserted into the shaft hole 32h from both sides with the second forceps member 32 interposed therebetween.
  • the two half cylinder portions 51 b and 51 b are combined inside the shaft hole 32 h to constitute an insulating shaft cylinder 52.
  • the holder 50 includes a pair of sandwiching plate portions 51 a and 51 a (insulating plate) and an insulating shaft cylinder 52.
  • the insulating shaft cylinder 52 has a cylindrical shape orthogonal to the sandwiching plate portions 51a and 51a, and is spanned between the sandwiching plate portions 51a and 51a.
  • the insulating shaft cylinder 52 is inserted through the shaft hole 32h, thereby penetrating the proximal end portion 32d of the second forceps member 32. Insulation barrel 52 and thus the holder 50 is adapted to rotate relative about the axis of rotation L 5 with respect to the forceps members 31, 32.
  • each half cylinder 51 b is fitted into the large-diameter semicircle 51 d of the other holder member 51. Furthermore, the other protrusion 51f is fitted in the recess 51g of the one half cylinder portion 51b.
  • the pair of holder members 51 and 51 are fitted so as not to be relatively rotatable. Further, the flat halved end surfaces 51c and 51c of the pair of halved cylinder portions 51b and 51b are in close contact with each other.
  • the shaft pin 53 is made of a rigid metal and has a thin cylindrical shape. As shown in FIG. 9, the shaft pin 53, disposed on the rotational axis L 5, it extends through a hole 51h of the clamping plate portion 51a while being inserted into the insulating barrel 52. The intermediate portion of the shaft pin 53 is insulated from the second forceps member 32 by being covered with the holder 50. Furthermore, both end portions of the shaft pin 53 are inserted into shaft holes 31h and 31h of the first forceps portions 31a and 31a, respectively, and are connected to the base end portions of the first forceps portions 31a and 31a by caulking, welding, or the like. Accordingly, the shaft pin 53 is supported by the first forceps member 31 in a both-end supported state.
  • the medical treatment tool 1 is used as follows.
  • the insertion part 20 is inserted into the channel of the endoscope, and the treatment part 30 is projected into the living body from the tip of this channel.
  • the treatment unit 30 is opened and closed via the operation wire 23, and the treatment member 30 is addressed, and the microwave power source 2 outputs a microwave, whereby the forceps member 31. , 32 form a microwave (high frequency) electric field.
  • the microwave power source 2 outputs a microwave, whereby the forceps member 31. , 32 form a microwave (high frequency) electric field.
  • it is possible to perform treatment such as burning the treatment target site and stopping hemostasis.
  • Providing the protrusions 31e and 32e at the distal ends of the forceps members 31 and 32 not only facilitates locking of the treatment part 30 to the treatment target site, but also concentrates the microwave electric field between the protrusions 31e and 32e. be able to.
  • the electric power from the microwave power source is transmitted by the coaxial cable 22 up to the vicinity of the distal end portion of the insertion portion 20.
  • Only the tip portion of the operation wire 23 serves as a conductive wire.
  • transmission loss can be sufficiently suppressed. Therefore, the microwave energy formed between the forceps members 31 and 32 can be sufficiently increased. As a result, the treatment time can be shortened.
  • the operation wire 23 can be made of a steel material (for example, stainless steel) that is suitable only for opening and closing the treatment section 30, the treatment section 30 can be reliably opened and closed.
  • the living tissue is sandwiched between the first and second forceps members 31 and 32, and is coagulated and stopped by the microwave, and then cut (removed). Specifically, first, as shown by the solid line in FIG. 7B, the living tissue is sandwiched between the first and second forceps members 31 and 32 by opening the treatment portion 30. In the open position, the distal end side portion 32f of the second forceps member 32 projects obliquely outward with respect to the first forceps member 31, and the space between the protrusions 31e and 32e at the distal end opens, so that the living tissue is securely sandwiched. Can do.
  • the treatment unit 30 is closed. Then, as indicated by a two-dot chain line in FIG. 7B, the distal end side portion 32f of the second forceps member 32 enters the gap portion 39f between the first forceps portions 31b and 31b. Thereby, the region between the two most burned and solidified sites is cut (including incision and excision). Accordingly, the most burned and solidified portions face the cut surfaces on both sides of the cut portion. Therefore, bleeding from the cut surface can be prevented, or the amount of bleeding can be suppressed to a small extent. As a result, treatments including coagulation and hemostasis, treatments such as surgery can be performed satisfactorily.
  • the medical treatment tool by disposing the base end portion to each other of the first forceps member 31 and the second forceps member 32 to overlap along the rotational axis L 5, and a compact treatment unit 30 The diameter can be reduced.
  • the first forceps member 31 and the second forceps member 32 can be reliably insulated.
  • the creepage distance can be increased, and a short circuit between the first forceps member 31 and the second forceps member 32 can be reliably prevented. Thereby, energy loss can be further suppressed.
  • the twist of the second forceps member 32 can be suppressed, and as a result, a short circuit between the forceps members 31 and 32 can be reliably prevented. can do.
  • the base end portion 32 d of the second forceps member 32 can be protected by the holder 50.
  • On the rotation axis L 5 represents by providing a metal shaft pin 53 can be sufficiently ensured strength of the rotary shaft. Also, by placing both ends of the shaft pin 53 in a state of being supported by the pair of forceps portions 31a, 31a, a load such as a bending moment applied to the shaft pin 53 can be reduced. By surrounding the shaft pin 53 with the insulating shaft cylinder 52, the inner peripheral surface of the shaft hole 32h of the second forceps member 32 and the shaft pin 53 can be reliably insulated.
  • the pair of holder members 51 and 51 can be easily connected. Further, for example, compared to the case where one holder member 51 is provided with a large-diameter cylinder and the other holder member 51 is provided with a small-diameter cylinder, and the large-diameter cylinder and the small-diameter cylinder are fitted together, these large-diameter cylinders and The thickness of each half cylinder part 51b can be made larger than the thickness of a small diameter cylinder. Accordingly, the rigidity of the insulating shaft cylinder 52 can be ensured. Further, by making the pair of holder members 51 have the same shape, the manufacturing cost can be reduced and the parts management can be facilitated.
  • FIG. 10 shows a second embodiment of the present invention.
  • the second embodiment is a modification of the holder member 51, and a half end surface (a circumferential end surface) of the half cylinder portion 51 b is a step surface 54.
  • the step surface 54 includes a concave section 54a having a triangular cross section and a convex section 54b having a triangular cross section.
  • Each of the concave portions 54a and the convex portions 54b has a triangular cross section and extends along the axis L 5 (a direction orthogonal to the paper surface in FIG. 10B).
  • These concave portions 54a and convex portions 54b are alternately continued in the radial direction of the half cylinder portion 51b.
  • the stepped surfaces 54 and 54 of the half cylinder portions 51b and 51b of the pair of holder members 51 and 51 are engaged with each other. That is, the convex part 54b of the other half cylinder part 51b fits into contact with the concave part 54a of one half cylinder part 51b. As a result, the creepage distance can be increased and creeping discharge can be prevented.
  • the connecting portion 5 ⁇ / b> A of the third embodiment includes a holder 50 ⁇ / b> A and a metal shaft pin 53.
  • the holder 50 ⁇ / b> A includes a holder member 60 and an insulating shaft cylinder 62.
  • the holder member 60 is made of an insulator such as PEEK, and integrally includes a pair of sandwiching plate portions 61 and 61 and a connecting plate portion 65.
  • Holding plates 61, 61 has a flat plate shape opposed to each other along the rotation axis L 5. Each clamping plate 61 has a hole 61h.
  • the base end portions of the sandwiching plate portions 61 and 61 are connected and integrated by a connecting plate portion 65.
  • each clamping plate portion 61 is interposed between the first forceps portion 31 a and the proximal end portions of the second forceps member 32.
  • the other clamping plate portion 61 is interposed between the proximal ends of the other first forceps portion 31 a and the second forceps member 32.
  • each clamping plate portion 61 constitutes an insulating plate that insulates the first forceps member 31 from the second forceps member 32.
  • the insulating shaft cylinder 62 is formed of an insulator such as PEEK that is separate from the holder member 60 and thus the pair of sandwiching plate portions 61 and 61, and has a cylindrical shape. .
  • the insulation barrel 62 so along the tube axis to the rotation axis L 5, the hole 61h of the holding plates 61, 61 are inserted through the 61h and the shaft hole 32h. Accordingly, the insulating shaft cylinder 62 penetrates the pair of clamping plate portions 61 and 61 and the second forceps member 32.
  • a shaft pin 53 is inserted into the insulating shaft cylinder 62. Both end portions of the shaft pin 53 are inserted into shaft holes 31h and 31h of the pair of first forceps portions 31a and 31a, and are connected to the first forceps portions 31a and 31a by caulking or the like.
  • the second forceps member 32 and the shaft pin 53 are insulated. Note that the end surface of the insulating shaft cylinder 62 may be flush with the side surface of the second forceps member 32, and the inner peripheral surface of the hole 61 h of the clamping plate portion 61 may be in direct contact with the shaft pin 53.
  • the pair of sandwiching plate portions 61, 61 that is, the pair of insulating plates can be configured by one member 60.
  • the first forceps member 31 may be a movable side, and the second forceps member 32 may be a fixed side.
  • a double-open type in which both forceps members 31 and 32 rotate and open and close may be used.
  • the first forceps member 31 may be a ground electrode, and the second forceps member 32 may be a high-voltage electrode.
  • the 1st forceps member 31 may be comprised only with the single forceps part 31a instead of a pair of forceps parts 31a and 31a.
  • the holder may have a single insulating plate instead of a pair of sandwiching plate portions, that is, a pair of insulating plates.
  • only one of the pair of sandwiching plate portions may constitute an insulating plate interposed between the first and second forceps members 31 and 32.
  • the second forceps member 32 may have a pair of forceps portions.
  • the insulating shaft cylinders 52 and 62 may be provided so as to penetrate the proximal end portion of the first forceps member 31, and the end portion of the shaft pin 53 may be connected to the second forceps member 32.
  • the power supply 2 is not limited to the microwave, and may be one that outputs millimeter waves, radio waves, or other high frequencies.
  • the present invention is applicable to, for example, medical forceps.

Landscapes

  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Otolaryngology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Plasma & Fusion (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Dans l'outil de traitement médical, l'unité de traitement à l'extrémité avant est rendue compact, les deux éléments de forceps sont isolés l'un de l'autre de façon fiable, et la résistance de l'arbre de rotation est garantie. Les parties de base de premier et second éléments de forceps (31, 32) de l'outil de traitement médical (1) sont liées par une unité de liaison (5) de façon à permettre une rotation relative autour d'un axe de rotation (L5). L'axe de rotation (L5) s'étend dans la direction opposée, dans laquelle les parties de base des premier et second éléments de forceps (31, 32) sont opposées. L'unité de liaison (5) comprend un support (50) fabriqué à partir d'un isolant et un arbre pivot (53) fabriqué à partir d'un métal. Une plaque isolante (51a) du support (50) est interposée entre les parties de base des premier et second éléments de forceps (31, 32), et un tube d'arbre isolant (52) est passé à travers un trou d'arbre (32h) dans la partie de base du second élément de forceps (32). L'arbre pivot (53) est inséré dans le tube d'arbre isolé (52), est relié au premier élément de forceps (31), et supporte le premier élément de forceps (31).
PCT/JP2015/063171 2014-07-15 2015-05-07 Outil de traitement médical Ceased WO2016009704A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
JP2016534305A JP6267339B2 (ja) 2014-07-15 2015-05-07 医療用処置具

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
JP2014-144892 2014-07-15
JP2014144892 2014-07-15
JP2014221422 2014-10-30
JP2014-221422 2014-10-30

Publications (1)

Publication Number Publication Date
WO2016009704A1 true WO2016009704A1 (fr) 2016-01-21

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JP (1) JP6267339B2 (fr)
WO (1) WO2016009704A1 (fr)

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CN109009414A (zh) * 2018-08-23 2018-12-18 微创（上海）医疗机器人有限公司 手术器械及其末端执行器
JP2023058576A (ja) * 2017-10-13 2023-04-25 クレオ・メディカル・リミテッド 電気手術切除器具
WO2025214791A1 (fr) * 2024-04-09 2025-10-16 Creo Medical Limited Instrument électro-chirurgical

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JP2000262534A (ja) * 1999-03-17 2000-09-26 Olympus Optical Co Ltd バイポーラ凝固切開処置具
JP2003175053A (ja) * 2001-12-11 2003-06-24 Olympus Optical Co Ltd 高周波処置具
US20050203499A1 (en) * 2004-03-09 2005-09-15 Ethicon, Inc. High intensity ablation device
JP2009028541A (ja) * 2007-07-30 2009-02-12 Tyco Healthcare Group Lp ポリープ除去顎および使用方法
US20130144284A1 (en) * 2011-12-06 2013-06-06 Tyco Healthcare Group Lp Vessel Sealing Using Microwave Energy

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WO2008149882A1 (fr) * 2007-06-05 2008-12-11 Ajinomoto Co., Inc. Conteneur à multiples chambres

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JP2000262534A (ja) * 1999-03-17 2000-09-26 Olympus Optical Co Ltd バイポーラ凝固切開処置具
JP2003175053A (ja) * 2001-12-11 2003-06-24 Olympus Optical Co Ltd 高周波処置具
US20050203499A1 (en) * 2004-03-09 2005-09-15 Ethicon, Inc. High intensity ablation device
JP2009028541A (ja) * 2007-07-30 2009-02-12 Tyco Healthcare Group Lp ポリープ除去顎および使用方法
US20130144284A1 (en) * 2011-12-06 2013-06-06 Tyco Healthcare Group Lp Vessel Sealing Using Microwave Energy

Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2023058576A (ja) * 2017-10-13 2023-04-25 クレオ・メディカル・リミテッド 電気手術切除器具
JP2023058578A (ja) * 2017-10-13 2023-04-25 クレオ・メディカル・リミテッド 電気手術切除器具
JP2023058577A (ja) * 2017-10-13 2023-04-25 クレオ・メディカル・リミテッド 電気手術切除器具
JP7496159B2 (ja) 2017-10-13 2024-06-06 クレオ・メディカル・リミテッド 電気手術切除器具
JP7496158B2 (ja) 2017-10-13 2024-06-06 クレオ・メディカル・リミテッド 電気手術切除器具
JP7496157B2 (ja) 2017-10-13 2024-06-06 クレオ・メディカル・リミテッド 電気手術切除器具
CN109009414A (zh) * 2018-08-23 2018-12-18 微创（上海）医疗机器人有限公司 手术器械及其末端执行器
WO2025214791A1 (fr) * 2024-04-09 2025-10-16 Creo Medical Limited Instrument électro-chirurgical

Also Published As

Publication number Publication date
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JP6267339B2 (ja) 2018-01-24

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