JP3986126B2 - Endoscopic surgical instrument - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an endoscopic surgical instrument provided with a grasping portion for grasping a living tissue and an incision portion for incising the grasped living tissue.
[0002]
[Prior art]
In general, there is known a bipolar forceps that includes a pair of gripping members for gripping a living tissue, and each gripping member is provided with an electrode for high-frequency energization. When using the bipolar forceps, the living tissue to be treated is gripped between the pair of gripping members, and a high-frequency current is passed between the electrodes of each gripping member to coagulate the living tissue between the gripping members. It has become.
[0003]
This type of bipolar forceps is usually used for various cases such as hemostasis of blood vessels contained in living tissue, lesions on the surface layer of living tissue, cauterization of bleeding points, occlusion of fallopian tubes for the purpose of contraception. Bipolar forceps are used for hemostasis of blood vessels and occlusion of the fallopian tube, and can coagulate a living tissue to be treated by a patient, and can incise the coagulated living tissue. ing.
[0004]
Conventionally, as this type of endoscopic surgical instrument, for example, US Pat. No. 5,269,780, US Pat. No. 5,445,638, US Pat. No. 5,267,998 are known.
[0005]
US Pat. No. 5,269,780 includes a pair of coagulation electrodes projecting from the distal end of a sheath and a movable incision electrode, and a coagulation current is passed between the pair of coagulation electrodes to coagulate a living tissue. The living tissue is incised by passing an incision current between the incision electrode and the coagulation electrode.
[0006]
U.S. Pat. No. 5,445,638 includes a pair of gripping members protruding from the distal end of a sheath and an incision knife which can be moved forward and backward between the gripping members. In a state where the target biological tissue is gripped, a biological current is allowed to coagulate by flowing a coagulation current between the pair of gripping members, and then the cutting knife is advanced to cut the biological tissue.
[0007]
U.S. Pat.No. 5,267,998 includes a pair of coagulation electrodes fixed to the distal end of a sheath and a movable incision electrode. After coagulating current flows between the pair of coagulation electrodes to coagulate a living tissue, The incision electrode is moved by the operation of the hand operation unit, and the living tissue is incised by passing an incision current.
[0008]
[Problems to be solved by the invention]
However, although the above-mentioned US Pat. No. 5,269,780 includes a pair of coagulation electrodes and a movable incision electrode, it does not have a function of grasping a living tissue, so that it securely grasps a treatment target site. Can not be incised.
[0009]
U.S. Pat. No. 5,445,638 is provided with an incision knife that can be moved forward and backward between a pair of grasping members. When the sharpness of the incision knife deteriorates, the living tissue grasped when the incision knife is advanced to incise is incised. There is an inconvenience of extruding, and the incision knife needs to be changed frequently.
[0010]
In US Pat. No. 5,267,998, the incision electrode is moved and the incision current is passed to incise the living tissue. However, since there is no function of grasping the in vivo tissue, the incision of the treatment target site is ensured. Can not do it.
[0011]
The present invention has been made paying attention to the above circumstances, and an object of the present invention is to provide an endoscopic surgical instrument capable of reliably grasping and solidifying a treatment target site of a living tissue and incising it. It is in.
[0012]
[Means for Solving the Problems]
In order to achieve the above object, the present invention provides an endoscopic surgical instrument having a pair of grasping portions that open and close relatively and an incision portion that moves through a gap between the grasping portions. Each configured as an electrode, and energizing means for energizing between the gripping portions and between the gripping portion and the incision portion And an electrode switching portion that enables selective energization between the gripping portions and between the gripping portion and the incision portion. It is characterized by that.
[0013]
Then, in a state where the biological tissue is gripped by the gripping part during a treatment such as coagulation hemostasis of the biological tissue, the biological tissue is solidified by flowing a coagulation current between the gripping parts, So that the living tissue can be incised.
[0014]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
1 to 4 show a first embodiment, and FIG. 1 is an overall configuration diagram of an endoscopic surgical instrument. As shown in FIG. 1, it is comprised from the bipolar forceps 1 and the high frequency cauterization power supply device 2 as an endoscopic surgical instrument.
[0015]
The bipolar forceps 1 has an elongated insertion portion 3 to be inserted into a body cavity of a patient, a treatment portion 4 which is disposed at a distal end portion of the insertion portion 3 and can be energized for grasping and coagulating a living tissue in the body cavity, An operation unit 5 connected to the base end of the insertion unit 3 is provided.
[0016]
The insertion portion 3 includes an outer sheath 6 and an inner sheath 7 that is inserted into the outer sheath 6 so as to be able to advance and retreat in the axial direction, and a proximal end portion of the outer sheath 6 is connected to a grip 8 that constitutes the operation portion 5. The proximal end portion of the inner sheath 7 is fixed to an inner sheath driving member 9 provided in the operation portion 5.
[0017]
The treatment portion 4 is provided with an elongated rod 10 inserted into the inner sheath 7. The rod 10 is provided with a pair of gripping members 11a and 11b as gripping portions constituting the electrodes, and elastic members 12a and 12b for urging the gripping members 11a and 11b in the direction of expanding. ing. The elastic members 12a and 12b are formed of spring steel or the like, bent portions 13a and 13b bent in a substantially U-shape are formed at the tip, and the surfaces are covered with an insulating coating.
[0018]
As shown in FIG. 2, the gripping members 11a and 11b are formed in a substantially U-shaped cross section so that a space portion 14 is formed inside when the gripping members 11a and 11b are closed. The sawtooth portion is formed so that the living tissue can be securely grasped.
[0019]
Further, as shown in FIG. 2, a knife rod 15 is provided in parallel with the rod 10 of the treatment portion 4, and an incision knife 16 as an incision portion is provided at the distal end portion of the knife rod 15. The incision knife 16 has a cutting edge 16a that extends perpendicularly to the axial direction of the knife rod 15 and extends in the vertical direction, and is sized to enter the space 14 when the gripping members 11a and 11b are closed. .
[0020]
The rod 10 of the gripping members 11a and 11b of the treatment section 4 and the knife rod 15 of the incision knife 16 thus configured are inserted into the inner sheath 7 constituting the insertion section 3, and the rod 10 and the knife rod 15 are inserted. Extends from the proximal end of the inner sheath 7 to the operation portion 5.
[0021]
In addition, the grip 8 of the operation unit 5 is provided with a distal end side extending portion 17 that extends toward the distal end side. The distal end side extension 17 is provided with a connection ring 18 that is connected and fixed to the proximal end of the outer sheath 6. Further, a treatment section unit connection portion 19 for electrically and mechanically connecting to the rear end portion of the treatment section 4 is disposed behind the distal end side extension section 17. Here, the treatment portion unit connection portion 19 is provided with a lumen for accommodating the rear end portion of the rod 10 of the treatment portion 4 and a connecting means connected to the rear end portion of the rod 10 accommodated in the lumen. ing.
[0022]
Further, the treatment section unit connection section 19 is provided with a cable connection section 20 via an electrode switching section 38 described later, and a connection cable 21 is connected to the cable connection section 20. The cable connection portion 21 is connected to the high-frequency ablation power supply device 2.
[0023]
Further, the grip 8 is provided with a trigger 22 for operating the treatment section unit connection section 19. The trigger 22 is connected to the upper end of the grip 8 so as to be rotatable about a rotation pin 23. Further, a long hole 24 is formed in the trigger 22 above the rotation fulcrum. An engaging pin 25 protruding from the side surface of the inner sheath drive member 9 is inserted into the long hole 24.
[0024]
Further, inside the grip 8, there is a biasing member (not shown) for biasing the handle 22a at the lower end of the trigger 22 in a direction away from the grip 8 (clockwise direction around the rotation pin 23 in FIG. 1). It is arranged. The trigger 22 is always held at a fixed position (release position) farthest from the grip 8 by the spring force of the biasing member.
[0025]
Further, a knife operating lever 27 is provided on the side surface of the grip 8 at the upper rear end. The knife operation lever 27 is connected to the grip 8 so as to be rotatable about a rotation pin 28. Further, a long hole 29 is formed above the rotation center of the knife operating lever 27, and an engaging pin 30 protruding from the rear side surface of the knife rod 15 is inserted into the long hole 29.
[0026]
The knife operating lever 27 is provided with upper and lower arm portions 31 and 32 arranged in a substantially V shape. One arm portion 31 has a finger hook portion 33 and the other arm 32 abuts on a stopper pin 34 to restrict the rotation range of the knife operating lever 27. Further, a biasing member (not shown) for biasing the knife operation lever 27 in the clockwise direction is attached to the rotation pin 28.
[0027]
Here, by pulling the handle 22 a of the trigger 22 toward the grip 8 against the spring force of the urging member, the inner sheath 7 moves forward in the axial direction of the outer sheath 6 via the inner sheath driving member 9. It moves and protrudes from the front end of the outer sheath 6. As the inner sheath 7 advances, the elastic members 12a and 12b are relatively pulled into the inner sheath 7, and the gripping members 11a and 11b are closed. When the trigger 22 is released, it returns to a fixed position by the spring force of the urging member in the grip 8, and the elastic members 12a and 12b relatively protrude from the inner sheath 7 so that the holding members 11a and 11b are elastic members 12a and 11b. It opens by the elastic restoring force of 12b.
[0028]
Further, when a finger is put on the finger hooking portion 33 of the knife operation lever 27 and the knife operation lever 27 is rotated counterclockwise against the urging force of the urging member, the engagement pin inserted in the elongated hole 29 is inserted. The knife rod 15 is driven forward through 30 and the cutting knife 16 at the tip of the knife rod 15 is advanced to enter the space 14 formed by the gripping members 11a and 11b. When the knife operating lever 27 is released, it returns to a fixed position by the spring force of the urging member, the knife rod 15 is relatively drawn into the inner sheath 7, the incision knife 16 is retracted, and the arm portion 32 is moved to the stopper pin 34. When it comes into contact, it stops.
[0029]
Further, a foot switch 36 is connected to the high-frequency ablation power supply device 2, and the foot switch 36 is provided with a first switch 37 a for flowing a coagulation current and a second switch 37 b for flowing an incision current. It has been.
[0030]
Further, the electrode switching unit 38 of the operation unit 5 will be described. As shown in FIG. 3, the gripper side contacts 39a and 39b that are connected to the gripping members 11a and 11b and the incision side contact 35 that is connected to the incision knife 16 are connected. Cable side connection contacts 40 a and 40 b that are electrically connected to the cable 21 are provided.
[0031]
As shown in FIG. 3A, at the time of solidification, the grip-side contacts 39a and 39b and the cable-side connection contacts 40a and 40b are connected, the incision-side contact 35 is opened, and the solidification current is generated between the grip members 11a and 11b. Shed. As shown in FIG. 3B, at the time of incision, the gripping side contacts 39a and 39b are connected to the cable side connection contact 40a, and the cutting side contact 35 and the cable side connection contact 40b are connected to each other to hold the gripping members 11a and 11b. An incision current is passed between the incision knife 16.
[0032]
As shown in FIG. 4A, the coagulation current is output in a mode having a load characteristic in which the output decreases when the impedance increases with cauterization. The incision current is a constant power output mode in which the output does not decrease even when the impedance increases, as shown in FIG. As shown in FIG. 4 (c), in the impedance control, it is possible to automatically switch from the coagulation mode to the incision mode by determining the completion of coagulation at the time point a when the impedance once lowered with the lapse of time of cauterization rises again. .
[0033]
Next, the operation of the first embodiment will be described.
A connection cable 21 is connected to the cable connection portion 20 of the bipolar forceps 1 to electrically connect the bipolar forceps 1 and the high-frequency ablation power supply device 2. In the initial state, the handle portion 22a of the trigger 22 of the operation portion 5 is held at a fixed position farthest from the grip 8 as shown in FIG. 1, and the treatment portion unit connection portion 19 is the last in the axial movement range of the insertion portion 3. Held in the end position. In this state, the pair of elastic members 12a and 12b of the treatment section 4 protrude from the inner sheath 7 and the gripping members 11a and 11b are opened.
[0034]
Therefore, the inner sheath 7 is moved forward in the axial direction of the outer sheath 6 via the inner sheath driving member 9 by pulling the handle 22 a of the trigger 22 toward the grip 8 against the spring force of the leaf spring member. Then, it protrudes from the front end of the outer sheath 6. As the inner sheath 7 advances, the elastic members 12a and 12b are relatively pulled into the inner sheath 7, and the gripping members 11a and 11b are closed.
[0035]
In this state, the insertion portion 3 of the bipolar forceps 1 is inserted into the patient's body, and the treatment portion 4 at the distal end of the insertion portion 3 is guided to a position near the living tissue to be treated in the body. In this state, when the trigger 22 is released, it returns to a fixed position by the spring force of the biasing member in the grip 8, and the elastic members 12a and 12b relatively protrude from the inner sheath 7 so that the gripping members 11a and 11b are elastic members. It opens by the elastic restoring force of 12a, 12b.
[0036]
Subsequently, after inserting the living tissue A between the expanded gripping members 11a and 11b, the handle portion 22a of the trigger 22 is pulled into the grip 8 side against the spring force of the urging member, so The inner sheath 7 moves forward in the axial direction of the outer sheath 6 via the sheath driving member 9 and protrudes from the front end of the outer sheath 6. As the inner sheath 7 advances, the elastic members 12a and 12b are relatively pulled into the inner sheath 7, the gripping members 11a and 11b are closed, and the living tissue A is paired as shown in FIG. It is gripped between the members 11a and 11b.
[0037]
At this time, the grasping members 11a and 11b are formed in serrated portions that mesh with each other when closed, and the living tissue A can be reliably grasped. In this state, when the first switch 37a of the foot switch 36 is turned on, a high-frequency current flows from the high-frequency cautery power supply device 2 to the cord connection portion 20 via the connection cable 21 and further to the gripping member 11a via the electrode switching portion 38. And 11b, a coagulation current flows, and the living tissue A is coagulated.
[0038]
After the coagulation current is allowed to flow for a certain time to coagulate the living tissue A, the first switch 37a is turned off. Then, as shown in FIG. 3B, the electrode switching unit 38 connects the grip-side contacts 39a and 39b to the cable-side connection contact 40a, connects the incision-side contact 35 and the cable-side connection contact 40b, The second switch 37b is turned on to pass an incision current between the gripping members 11a and 11b and the incision knife 16.
[0039]
Further, when a finger is put on the finger hooking portion 33 of the knife operation lever 27 and the knife operation lever 27 is rotated counterclockwise against the urging force of the urging member, the engagement pin inserted in the elongated hole 29 is inserted. The knife rod 15 is driven forward through 30 and the incision knife 16 at the tip of the knife rod 15 is advanced. Therefore, the biological tissue A grasped between the grasping members 11a and 11b is mechanically incised by the cutting blade 16a of the incising knife 16 and electrically incised by an incision current.
[0040]
When the knife operating lever 27 is released after the incision is completed, the knife rod 15 is returned to the home position by the spring force of the urging member, the knife rod 15 is relatively drawn into the inner sheath 7, the incision knife 16 is retracted, and the arm portion 32. Stops when it comes into contact with the stopper pin 34. When the trigger 22 is released, it returns to a fixed position by the spring force of the urging member in the grip 8, and the elastic members 12a and 12b relatively protrude from the inner sheath 7 so that the gripping members 11a and 11b are connected to the elastic members 12a and 12b. The grasping members 11a and 11b are released from the living tissue A by being opened by the elastic restoring force.
[0041]
In the embodiment described above, the coagulation current and the incision current are switched by turning on and off the first switch 37a and the second switch 37b of the foot switch 36. However, as shown in FIG. In the control, it is possible to automatically switch from the coagulation mode to the incision mode by determining the completion of coagulation at the time point a where the impedance once lowered with the time of cauterization rises again.
[0042]
FIG. 5 shows a second embodiment, and the same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. In this embodiment, instead of the foot switch 36 of the first embodiment, the grip 8 of the operation unit 5 has a first switch 41a for flowing a coagulation current and a second switch 41b for flowing an incision current. Is provided.
[0043]
FIG. 6 shows a third embodiment, and the same components as those of the first embodiment are denoted by the same reference numerals and description thereof is omitted. In this embodiment, instead of the foot switch 36 of the first embodiment, the grip 8 of the operation unit 5 has a first switch 41a for flowing a coagulation current and a second switch 41b for flowing an incision current. Is provided. The second switch 41 b is turned on by the arm portion 32 when the knife operating lever 27 is operated to advance the cutting knife 16, and a cutting current flows in synchronization with the knife operating lever 27. .
[0044]
FIG. 7 shows a fourth embodiment, and the same components as those of the first embodiment are denoted by the same reference numerals and description thereof is omitted. In this embodiment, a wire cutter 42 formed of a wire loop is provided between the pair of wire rods 42a and 42b in place of the cutting knife 16 having the cutting edge 16a of the first embodiment.
[0045]
8 and 9 are First reference form The same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. This reference form As shown in FIG. 8, a first electrode 43a in which a wire is stretched between a pair of wire rods 42a and 42b of the fourth embodiment is provided, and a second electrode 43b is provided on the wire rod 42b. ing. FIG. 9 shows an electrode switching portion. As shown in FIG. 9A, the grip side contacts 39a and 39b and the cable side connection contacts 40a and 40b are connected during solidification, and the first and second electrodes 43a and 43b are connected. The contacts 44a and 44b that are electrically connected to each other are opened, and a coagulation current flows between the gripping members 11a and 11b. As shown in FIG. 4B, the contacts 44a and 44b that are electrically connected to the first and second electrodes 43a and 43b are independently connected to the cable-side connection contacts 40a and 40b at the time of incision. An incision current is allowed to flow between the electrodes 43a and 43b.
[0046]
FIG. Second reference form The same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. This reference form Are provided with a first wire electrode 45a and a second wire electrode 45b formed of a pair of wire loops instead of the incision knife 16 having the cutting edge 16a of the first embodiment. In the incision, an incision current is caused to flow between the first and second wire electrodes 45a and 45b.
[0047]
11 and 12 are Fifth embodiment The same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. As shown in FIG. 11, this embodiment includes a first grip member 46 a and a second grip member 46 b instead of the pair of grip members 11 a and 11 b constituting the treatment section 4 of the first embodiment. An incision member 48 that protrudes upward through an insulating member 47 is provided in the second gripping member 46b.
[0048]
FIG. 12 shows an electrode switching portion. As shown in FIG. 12 (a), the grip side contacts 39a and 39b and the cable side connection contacts 40a and 40b are connected at the time of solidification, and the contact 49 conducting with the cutting member 48 is opened. Then, a coagulation current is caused to flow between the first and second gripping members 46a and 46b. As shown in FIG. 4B, at the time of incision, the grasping side contact 39a and the incising member 48 are independently connected to the cable side connecting contacts 40a and 40b, and the incision is made between the first grasping member 46a and the incising member 48. A current is allowed to flow.
[0049]
FIG. Third reference form This is a modification of the treatment section 4. That is, the first gripping member 50a and the second gripping member 50b are formed, and the incision 51 protruding upward is integrally provided in the second gripping member 50b with a triangular cross section. The distance between the inner surface of the first gripping member 50a and the top of the incision 51 is g. ₁ The distance between the edges of the first and second gripping members 50a and 50b is g ₂ Then g ₁ <G ₂ It has become. This reference form According to the above, the electrodes are not switched, and the current concentrates on the top of the incision 51 by switching from the coagulation current to the incision current.
[0050]
14 and 15 are Sixth embodiment FIG. 14 shows the high-frequency ablation power supply device 2, and FIG. 15 is a graph showing an example of the time change of impedance. In the first embodiment, in the impedance control, it is described that the coagulation mode is automatically switched to the incision mode by determining the completion of the coagulation at the time point a when the impedance once lowered with the lapse of time of the cauterization rises again. However, in the present embodiment, the second and subsequent controls can be performed by measuring and storing the impedance change amounts ΔZ1 to ΔZ2 due to the change during the cauterization time t1 to t3.
[0051]
That is, the high-frequency ablation power supply device 2 is provided with an output circuit 53 that outputs a high-frequency current in response to a control signal from the control circuit 52 and a detection circuit 54 that detects the cauterization time and impedance at the time of output. Is done. Furthermore, setting means 55 is provided, and by this setting means 55, cauterization time t ₁ ~ T _Three When the desired impedance is reached, an ablation stop signal can be input to the control circuit 52 to stop the output of the high-frequency current.
[0052]
Therefore, shochu time t ₁ ~ T _Three And impedance change ΔZ ₁ ~ ΔZ ₂ Based on these parameters, the second and subsequent controls can be performed accurately, and even if there is a difference in the level of coagulation depending on the operator, the setting means 55 performs the cauterization time t. ₁ ~ T _Three By selecting, the cauterization is stopped when the desired impedance is reached, and the coagulation mode can be automatically switched to the incision mode.
[0053]
16 to 19 are Fourth reference form 16 is an overall configuration diagram of the endoscopic surgical instrument, and FIG. 17 is a longitudinal side view of the distal end side of the endoscopic surgical instrument. The endoscopic surgical instrument 61 includes a pipe-shaped insertion portion 62 and an operation portion 63 provided on the proximal side of the insertion portion 62. The operation portion 63 is provided with an insertion portion rotation knob 64 that rotates the insertion portion 62 about its axis.
[0054]
An operation shaft 65 and a rotation shaft 66 that are movable in the axial direction are inserted into the insertion portion 62. A first jaw 67a constituting a gripping portion is provided at the distal end portion of the insertion portion 62 so as to be rotatable about a pivot pin 68, and the base end portion is connected by an operation shaft 65 and a connection pin 69, The portion protrudes from the front end of the insertion portion 62. A base end portion of the operation shaft 65 is connected to a movable handle 70 provided in the operation portion 63.
[0055]
The distal end portion of the rotating shaft 66 protrudes from the front end of the insertion portion 62, and a second jaw 67b that constitutes a gripping portion is provided integrally with the protruding portion. And the treatment part which grasps and treats living body tissue A by the 1st and 2nd jaws 67a and 67b is constituted.
[0056]
As shown in FIGS. 18 and 19, the second jaw 67b has a trapezoidal or substantially triangular cross section, a solidified portion 71 is formed at the bottom thereof, and an incision 72 is formed at the top. That is, the biological tissue A is coagulated by rotating the rotary shaft 66 about the axis and gripping the biological tissue A with the coagulating portion 71 of the second jaw 67b facing upward and facing the first jaw 67a. By rotating the rotation shaft 66 around the axis and holding the living tissue A with the incision 72 of the second jaw 67b facing upward and facing the first jaw 67a, the living tissue A can be incised.
[0057]
The rotation shaft 66 integral with the second jaw 67b is rotatably supported by a support pipe 73 in the insertion portion 62, and the base end portion thereof is connected to a jaw rotation knob 74 provided in the operation portion 63, so that the jaw By operating the rotary knob 74, the direction of the first jaw 70 can be arbitrarily changed.
[0058]
next, Fourth reference form The operation of will be described.
First, the jaw rotation knob 74 is operated to rotate the rotation shaft 66 so that the solidified portion 71 of the second jaw 67b faces upward and faces the first jaw 67a. In this state, when the operating handle 65 is moved backward by operating the movable handle 70, the first jaw 67a rotates about the pivot pin 68 as a fulcrum, and the solidified portion 71 of the second jaw 67b is illustrated. As shown in FIG. 18, the living tissue A is grasped. Therefore, when a coagulation current is passed between the first and second jaws 67a and 67b, the living tissue A is coagulated.
[0059]
Next, the first and second jaws 67a and 67b are once opened, the jaw rotation knob 74 is operated to rotate the rotation shaft 66 by 180 °, and the incision 72 of the second jaw 70 is directed upward, By grasping the living tissue A so as to face the jaw 67a, the living tissue A is grasped between the incision 72 of the first jaw 67a and the second jaw 67b. Therefore, when a cutting current is passed between the first and second jaws 67a and 67b, the living tissue A is cut.
[0060]
The second jaw 67b has a trapezoidal or substantially triangular cross section, and a solidified portion 71 is formed at the bottom of the second jaw 67b, and an incision 72 is formed at the top thereof. By providing and rotating 90 °, coagulation and incision may be switched.
[0061]
FIG. Fifth reference form Indicate Fourth reference form The same components as those in FIG. This reference form Is provided with a protective cover 75 having a substantially arc-shaped cross section covering the second jaw 67 b at the distal end of the insertion portion 62. By covering the second jaw 67b with the protective cover 75 in this way, it is possible to prevent the living body from being damaged by the second jaw 67b when inserted into the body cavity.
[0062]
FIG. Sixth reference form Indicate Fourth reference form The same components as those in FIG. This reference form Is provided with a distal end pipe 76 made of an insulating member at the distal end of the insertion portion 62, and the operating shaft 65 and the rotating shaft 66 are covered with insulating covers 65a and 66a, and the first and second jaws 67a and 67b are electrically insulated. It is configured in a state.
[0063]
22 and 23 are Seventh reference form Indicate Fourth reference form The same components as those in FIG. This reference form Is provided with a current switching mechanism 77 in the operation unit 63. A switch operation cam 78 is provided at the base end of the rotary shaft 66 integral with the second jaw 67b. The switch operation cam 78 is provided with a large diameter portion 78a corresponding to the solidified portion 71 of the second jaw 67b and a small diameter portion 78b corresponding to the incision portion 72.
[0064]
On the other hand, a through hole 79 is formed in the operation portion 63 so as to face the switch operation cam 78, and a plunger 81 urged by the spring 80 in a direction to contact the cam surface of the switch operation cam 78. Is provided. A current changeover switch 82 is provided in the upper part of the through hole 79 so as to face the plunger 81.
[0065]
When the rotary shaft 66 is rotated by operating the jaw rotation knob 74, the switch operation cam 78 rotates integrally. When the plunger 81 is pushed up by the large diameter portion 78a, the current changeover switch 82 is turned on and the small diameter portion 78b is turned into the plunger. When the spring 81 is pressed down against the current 81, the current changeover switch 82 is turned off. The current changeover switch 82 is connected to a current changeover circuit (not shown) built in the high frequency ablation power supply device 2 via a current changeover cord 83, and is output from the high frequency ablation power supply device 2 when the current changeover switch 82 is turned on / off. Current can be switched from coagulation current to incision current or vice versa.
[0066]
Said implementation And reference According to the embodiment, the following configuration is obtained.
(Appendix 1) In an endoscopic surgical instrument comprising a pair of gripping parts that open and close relatively and an incision part that moves through a gap between the gripping parts, the gripping part and the incision part are each configured as an electrode, An endoscopic surgical instrument characterized in that energization means for energizing between parts and between a grasping part and the incision part is provided.
[0067]
(Appendix 2) In an endoscopic surgical instrument having a pair of gripping portions that open and close relatively and an incision portion that moves through a gap between the gripping portions, the gripping portion and the incision portion are each configured as an electrode, An endoscopic surgical instrument comprising an electrode switching unit that switches energization between each other and between a grasping unit and an incision unit.
[0068]
(Appendix 3) An endoscopic surgical instrument characterized in that the endoscopic surgical instrument according to appendix 1 or 2 is provided with operation switches for incision output and coagulation output of a high-frequency ablation power supply device. (Supplementary note 4) In the endoscopic surgical instrument according to Supplementary note 1 or 2, there is provided an operation switch for performing coagulation output in synchronization with the gripping operation of the operation unit and performing incision output in synchronization with the incision operation of the operation unit. Features an endoscopic surgical instrument.
(Appendix 5) An endoscopic surgical instrument as set forth in appendix 1 or 2, wherein the electrode of the incision portion is formed in a wire shape.
[0069]
(Appendix 6) In an endoscopic surgical instrument having a pair of gripping portions that open and close relatively and an incision portion that moves through a gap between the gripping portions, the gripping portion and the incision portion are each configured as an electrode, and the gripping portion An endoscopic surgical instrument comprising an electrode switching unit for switching energization between electrodes and between incision electrodes.
[0070]
(Additional remark 7) It has a pair of holding part which opens and closes relatively, and the incision part electrically insulated by one holding part, and the said holding part and incision part are each comprised as an electrode, between grip parts An endoscopic surgical instrument comprising: an electrode switching unit that switches energization between the grasping unit and the incision unit.
[0071]
(Supplementary note 8) The high frequency ablation power supply device includes means for outputting a coagulation current, means for detecting the completion of coagulation, and means for outputting the incision current simultaneously with stopping the coagulation current upon detection of coagulation completion. A high-frequency ablation power supply device.
[0072]
(Appendix 9) An endoscopic surgical instrument used in combination with the high-frequency ablation power supply device described in appendix 8 has a pair of gripping portions that are opened and closed relatively, and further has an incision portion in one gripping portion. An endoscopic surgical instrument characterized in that a contact area between the incision part and the other gripping part is smaller than a contact area between the gripping parts.
[0073]
(Supplementary note 10) A high-frequency ablation power supply apparatus comprising: means for storing a measurement report of living tissue; and means for regenerating tissue ablation according to the stored conditions.
[0074]
(Additional remark 11) In the endoscopic surgical instrument which has a pair of jaws which open and close relatively at the front-end | tip of an insertion part, it has a treatment part which treats an organization in a 1st jaw, The coagulation part and the incision part are formed on different surfaces, and the second jaw is selectively rotated around an axis parallel to the insertion part, so that the first jaw and one of the coagulation part and the incision part are oriented. An endoscopic surgical instrument that can treat tissue by applying high-frequency current to each jaw.
[0075]
(Supplementary note 12) An endoscopic surgical instrument according to supplementary note 11, wherein only the first jaw opens and closes.
(Appendix 13) An endoscopic surgical instrument according to appendix 11 or 12, wherein the coagulation part has a larger area than the incision part.
(Supplementary note 14) The endoscopic surgical instrument according to supplementary note 11, 12 or 13, wherein the second jaw has a trapezoidal cross-sectional shape.
(Additional remark 15) The endoscopic surgical instrument according to Additional remark 11, 12, or 13, wherein the second jaw has a substantially triangular cross-sectional shape.
[0076]
(Appendix 16) The endoscopic surgical instrument according to any one of appendices 11 to 15, including means for insulating the first jaw from the second jaw, and each jaw receives a high-frequency current having a different polarity. An endoscopic surgical instrument characterized by being energized.
(Supplementary note 17) In the endoscopic surgical instrument according to any one of Supplementary notes 11 to 16, when the coagulation part of the second jaw faces the gripping surface of the first jaw, the coagulation current is An endoscopic surgical instrument characterized in that coagulation / incision of tissue can be continuously performed by supplying an incision current when the incision portion of the tissue faces the gripping surface of the first jaw.
[0077]
(Appendix 18) The endoscopic surgical instrument according to any one of appendices 11 to 16, further comprising means for changing a current from a coagulation current to an incision current according to the rotation of the second jaw. Endoscopic surgical instrument.
[0078]
【The invention's effect】
As described above, according to the present invention, the gripping portion includes a pair of gripping portions that open and close relatively and an incision portion that moves through the gap between the gripping portions. By providing energization means to energize between the grasping part and the incision part, it is possible to reliably grasp and solidify the treatment target part of the living tissue, and to incision, and to maintain the incision performance for a long time. There is an effect that the cost can be reduced.
[Brief description of the drawings]
1A and 1B show a first embodiment of the present invention, wherein FIG. 1A is a side view of an entire endoscopic surgical instrument, and FIG. 1B is a side view of a state in which a gripping member is closed;
FIG. 2 is a longitudinal side view of a state in which a living tissue is grasped by a grasping member according to the embodiment.
FIG. 3 is an explanatory diagram of an electrode switching unit according to the embodiment.
4A and 4B show the embodiment, where FIG. 4A is an explanatory diagram of load characteristics during coagulation, FIG. 4B is an explanatory diagram of load characteristics at the time of incision, and FIG. 4C is an explanatory diagram of impedance control.
5A and 5B show a second embodiment of the present invention, in which FIG. 5A is a side view of the entire endoscopic surgical instrument, and FIG. 5B is a side view of a state in which a gripping member is closed.
6A and 6B show a third embodiment of the present invention, in which FIG. 6A is a side view of an entire endoscopic surgical instrument, and FIG. 6B is a side view of a state in which a gripping member is closed.
FIG. 7 is a longitudinal side view of a state in which a living tissue is grasped by a grasping member according to a fourth embodiment of the present invention.
FIG. 8 of the present invention First reference form FIG.
FIG. 9 Reference form Explanatory drawing of the electrode switching part.
FIG. 10 shows the present invention. Second reference form FIG.
FIG. 11 shows the present invention. Fifth embodiment FIG.
FIG. 12 is an explanatory diagram of an electrode switching unit according to the embodiment.
FIG. 13 shows the present invention. Third reference form The longitudinal cross-sectional front view of the state which hold | gripped the biological tissue with the holding member which shows this.
FIG. 14 shows the present invention. Sixth embodiment FIG.
FIG. 15 is an explanatory diagram of impedance control.
FIG. 16 shows the present invention. Fourth reference form The whole side view of the endoscopic operation instrument which shows this.
FIG. 17 Reference form The longitudinal section side view which shows the treatment part of the front end side.
FIG. 18 Reference form FIG.
FIG. 19 Reference form FIG.
FIG. 20 shows the present invention. Fifth reference form (A) is a longitudinal front view during solidification, and (b) is a longitudinal front view during incision.
FIG. 21 shows the present invention. Sixth reference form The longitudinal section side view of the front-end | tip part of the endoscopic surgery instrument which shows this.
FIG. 22 shows the present invention. Seventh reference form The side view of the operation part of the endoscopic surgical instrument which shows this.
23 is a cross-sectional view taken along line XX in FIG.
[Explanation of symbols]
1 ... Endoscopic surgical instrument
2 ... Induction cautery power supply
3 ... Insertion section
4. Treatment unit
5. Operation unit
11: Holding member
16 ... Incision knife

Claims (2)

In an endoscopic surgical instrument comprising a pair of gripping parts that open and close relatively and an incision part that moves through the gap between the gripping parts,
The gripping part and the incision part are each configured as an electrode, energization means for energizing between the gripping parts and between the gripping part and the incision part, between the gripping parts and between the gripping part and the incision part An endoscopic surgical instrument, comprising: an electrode switching unit that can selectively energize between the two.   The endoscopic surgical instrument according to claim 1,
  Based on the detection results of the means for outputting current to the endoscopic surgical instrument, the means for detecting coagulation completion, and the current output to the endoscopic surgical instrument for detecting coagulation completion A high-frequency ablation power supply device comprising means for switching from a coagulation current to an incision current;
  An endoscopic surgery system comprising:

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