JPH06343639A - Surgical treatment tool - Google Patents

Abstract

PURPOSE:To provide a surgical treatment tool which is economical, requires lesser labor for maintenance, and generates less amount of waste. CONSTITUTION:A surgical treatment tool is configured with an operation part 10 and a plurality of insert parts 100 to be fitted therein removably, wherein the operation part 10 includes a frame 12, rotary ring 14. cylindrical part 18 provided in a single piece therewith, and a switch 16. while each insert part 100 consists of four items, i.e., a slip device 100A, stapler 100B, linear cutter 100C, and circular stapler 100D. These 100A-100D of the insert part are equipped with a minor diametric part 102 to be inserted to the cylindrical part 18 and a removable button 112 which is for uncoupling from the operation part 10. All minor diametric parts 102 are structured identically, and each of them is furnished with a key 104 for angle alignment at the time of mounting, a slit 106, detention flange 108, and an O-ring 110.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical treatment tool used for surgery.

[0002]

2. Description of the Related Art Various ligating devices and suturing devices have been developed as surgical instruments used in surgical operations. For example, there are a clip device for hemostasis of blood vessels, a stapler device for suturing an incised tissue, a device for simultaneously cutting and suturing using a plurality of staples, and an anastomosis between intestinal tracts. Also. In response to the recent development of laparoscopic surgery, some have been improved for use under laparoscopic surgery.

Such a device is described in US Pat.
In some cases, the disposable insertion part having a plurality of clips can be attached to and detached from the reusable operation part as disclosed in 100420, but generally, the entire device is made disposable. Is the most.

[0004]

These surgical instruments are used properly according to the contents of the operation, and there are cases where several types are used for one operation. If the entire device is disposable, the cost of the disposable part is higher and the medical cost is higher than that of replacing the insertion part.

Although the reusable operating part is much more economical than the one in which the entire device is disposable, the operating part has to be purchased for each device, so that the expense is still considerable. Is being forced. Also,
In order to maintain many types of operating parts, special care (cleaning, sterilization, maintenance, etc.) is required for each type, which requires considerable labor and maintenance cost.

In recent years, the reduction of medical expenses and the reduction of waste have come to be regarded as social problems, and a medical device having a small portion to be discarded is desired. An object of the present invention is to provide a surgical treatment tool which is economical, requires less maintenance, and has a small amount of waste.

[0007]

A surgical treatment tool according to the present invention comprises an operating portion, a plurality of insertion portions each having a treatment portion of a different type at its distal end, and a plurality of insertion portions. One of the two is selectively attached to the operation section, and the operation section of the insertion section attached to the operation section is operated from the operation section.

[0008]

The surgical instrument of the present invention has a plurality of insertion portions. Each of the plurality of insertion portions has a different treatment portion at the tip portion. An insertion section having an appropriate treatment section is selected according to the content of the surgery and attached to the operation section. The treatment section of the inserted insertion section is operated by the operation section. After use, the insertion part is removed from the operation part and discarded. On the other hand, the operation unit is reused after being subjected to disinfection and the like.

[0009]

Embodiments of the present invention will now be described with reference to the drawings. The overall structure of the surgical treatment tool of this embodiment is shown in FIG. As can be seen from FIG. 1, the surgical treatment tool
The operation unit 10 and a plurality of insertion units 100 attached to and detached from the operation unit 10 are included.

The operation unit 10 has a frame 12, a rotary ring 14 rotatably provided on the frame 12, and a switch 16. Further, it has a cylindrical portion 18 for mounting the insertion portion 100. The cylindrical portion 18 is composed of a part of the rotary ring 14, and rotates together with the rotary ring 14 when it is rotated.

The insertion portion 100 is a clip device 100A,
It consists of four types: stapler 100B, linear cutter 100C, and circular stapler 100D. Each of the insertion portions 100A to 100D is provided with a small diameter portion 102 to be inserted into the cylindrical portion 18 and an attachment / detachment button 112 for releasing the connection with the operation portion 10. The small-diameter portion 102 of each of the insertion portions 100A to 100D has exactly the same structure. The small-diameter portion 102 is provided with a key 104, a slit 106, a locking flange 108, and an O-ring 110 for adjusting the angular direction at the time of mounting. The functions and structures of the clip device 100A, stapler 100B, linear cutter 100C, and circular stapler 100D will be described later.

FIG. 2 is a side cross-sectional view of a part of the operating portion and the insertion portion attached thereto, and FIG. 3 is an exploded perspective view of a mechanism for operating the treatment portion provided at the distal end portion of the insertion portion. Shown in. The operation unit 10 includes an identification circuit 20, a control circuit 22, a power supply 24, and a motor 26 inside the frame 12. The rotation of the motor 26 is performed by the first gear 30 and the second gear 3
2, transmitted to the drive shaft 28 via the rack 34 and the pinion 36. A first pulley 38 and a second pulley 40 are fixed to the drive shaft 28. A first pusher link 42 and a second pusher link 44 are connected to the first pulley 38 and the second pulley 40, respectively. First pusher link 4
A first pusher shoe 46 and a second pusher tube 48 are connected to the other ends of the second pusher link 44 and the second pusher link 44, respectively. The second pusher tube 48 is provided movably in the guide 50, and the first pusher tube 46 is provided movably in the second pusher tube 48. A first pusher bar 52 and a second pusher bar 54 are provided at the distal ends of the first pusher tube 46 and the second pusher tube 48, respectively.
Are connected. The first pusher bar 52 and the second pusher bar 54 extend to the inside of the cylindrical portion 18 through the spacer 56 provided on the rotating ring 14. Spacer 5
An elastic seal 58 is provided on the front side of 6. An O-ring is provided on the sliding portion of the rotary ring.

The first pusher bar 52 and the second pusher bar 54 have notches 60 and 62 at their tip ends, respectively. The notches 60 and 62 are provided to engage with the connection flanges 118 and 120 at the rear ends of the first pusher 114 and the second pusher 116, respectively, which are provided in the housing 101 of the insertion portion 100. This engagement can be released by the attach / detach button 112.

A plurality of pins 64 are provided on the inner surface of the rotary ring 14 against which the housing 101 of the insertion portion 100 abuts. The pin 64 is connected to the identification circuit 20 via a signal cable 66 and a slip ring.

As shown in FIG. 12, the pin 64 is composed of four identification pins 64a to 64d and one common pin 64e, and is connected to the identification circuit 20. On the other hand, the insertion part 1
As shown in FIG. 13, a plurality of contacts 103a-1 to 103a respectively contacting the pins 64a-64e are provided at the end of 00.
03e is provided. The contacts are the common contact 103e and the contacts 103a to 103d, depending on the type of the insertion portion 100.
One of them is electrically connected by a conductive wire 105. Insertion part 10
0A has the contact 103a, and the insertion portion 100B has the contact 103b.
However, the contact point 103c of the insertion portion 100C is different from that of the insertion portion 100D.
103d is a conductor 1 to the common contact 103d
It is connected by 05.

In the identification circuit 20, the contacts 103a-1.
It is checked which contact in 03d is in conduction with the common contact 103e. As a result, the insertion part 100 attached to the operation part 10 has four types of insertion parts 100A to 100A.
Which of D is identified.

The pusher 1 of each of the insertion portions 100A to 100D
When the strokes of 14 and 116 are the same, the pusher 114 is rotated by rotating the motor 24 in only one direction.
And 116 can be provided with the required movement. Also,
Pushers 114 and 116 of the respective insertion portions 100A to 100D
If the stroke is different, it is dealt with by rotating the motor 24 in the forward and reverse directions by a predetermined angle. These settings are controlled by the control circuit 22 according to the signal from the identification circuit 20.
Will do. The drive circuit 23 drives the motor 24 according to the signal from the control circuit 22, and the state of the motor 24 is detected by the encoder 25 and fed back to the control circuit 22.

The insertion device 100 includes a clip device 100.
A, stapler 100B, linear cutter 100C,
There are four types of circular stapler 100D, and each of them will be described below.

First, the clip device 100A will be described with reference to FIGS. The clip device 100A has a pair of jaws 130 at its tip. Joe 130
A plurality of U-shaped clips 136 are provided in the rear of the space between
The clips are arranged in a line in the clip track 126 having a character shape. The pressing member 125 in contact with the tail end of the clip row is urged forward by the elastic force of the pressing spring 124. The tip portion of the clip row is fixed by a clip tome 132 at the tip of the clip track and a leaf spring-shaped clip screw 128.

Further, the first clip 13 in the clip sequence
A second pusher 116a is in contact with 6 and is pushed between the jaws 130. A first pusher 114a is slidably provided on the lower side of the jaw 130, and has a U-shaped tip cross section so that the jaw 130 can be closed by sliding forward. When slid into, the side of the jaw 130 is pressed inside.

At the rear end of the insertion portion 100A, the first pusher 114a and the second pusher 116a have connecting flanges 118 and 120, respectively, and the first pusher bar 5 is provided.
2 and the second pusher bar 54 are engaged with the notch portions 60 and 62 at the tip end portions thereof. Also, apply silicon grease or the like on the surface of the second pusher 116a and the first pusher 116a.
A seal block 122 having a hole through which the pusher 114a slides is inside the rear end portion of the insertion portion 100A.

The insertion portion housing 101 has a small diameter portion 102 at the rear end portion for fitting with the attachment / detachment portion of the rotary ring 14. The small diameter portion 102 is provided with a key 104, a slit 106, a locking flange 108, and an O-ring 110. In addition, the insert housing 101 is provided with an attachment / detachment button 112. When this button is pressed, the first pusher 1
14a, the first pusher bar 52, and the second pusher 116a.
The second pusher bar 54 can be disconnected.

The motor 24 in the operating portion 10 is driven, and the first pulley 38 and the second pulley 40 are half-turned by the control circuit 20. At this time, the second pusher 116a slides forward and the first pusher 114a slides rearward. This causes the leading clip 136 to be loaded between the jaws 130.

Further, the motor 24 is driven to drive the first pulley 3
When 8 is rotated a half turn, this time, the second pusher 116a slides backward, and the first pusher 114a slides forward. This causes the jaws 130 to close and the clip 136 to deform into a closed condition. At the same time, the clip pusher 116a slides backward and wraps around behind the frontmost clip in the clip row.

Next, the stapler 100B will be described with reference to FIGS. As shown in FIGS. 6 and 7, the stapler 100B includes a plurality of staples 154.
A staple cartridge 140 for accommodating the staples, a first pusher 114b for pushing out the staple 154, a staple passage 146 through which the staple 154 and the first pusher 114b pass, an anvil 150 having a flange 152 for deforming the staple 154, and a deformed A staple ejection spring 148 for ejecting staples. The staple cartridge 140 has a staple pressing spring 144 for pressing the staple 154 against the staple passage.

As shown in FIG. 8 (A), when suturing the incised portion of the tissue 160, the tip of the insertion portion is placed after the tissue pieces are brought together by the grasping forceps. The motor 24 in the operation unit 10 is driven to rotate the first pulley 38, and the first pusher tube 4
6. Slide the first pusher bar 52 and the first pusher 114b toward the tip side. At that time, the first pusher 114b pushes out the staple 154 pushed out into the staple passage 146 to the anvil flange 152 on the leading end side of the insertion portion, as shown in FIG. 8B. Staples 15
4 is further pushed by the first pusher 114b,
As shown in FIG. 8C, the tissue pieces are deformed to the closed state and the tissue pieces are sewn together. After that, the first pusher 114b is retracted rearward, the deformed staple is discharged by the staple discharge spring 148, and the initial state is restored.

Next, the linear cutter 100C will be described with reference to FIG. The linear cutter 100C has an anvil 164 that is openable and closable and a cartridge 172 that is removable. Anvil 164 is spring 1
It is urged in the opening direction by 62. Cartridge 1
Reference numeral 72 has a staple accommodating portion 174 that accommodates a plurality of staple rows so as to project therein, and a groove in which a cutter 178 for tissue excision slides between the staple rows. Behind the cartridge 172, there are provided a pair of staple pushers 176 for sliding the staples out of the staple accommodating portion 174 and a cutter 178 for cutting the tissue therebetween. Further, a slidable anvil opening / closing ring 166 for keeping the anvil 164 closed with respect to the cartridge is provided outside the tip end portion. A second pusher 116c is located behind the staple pusher, and a first pusher 114c is located at the rear end of the anvil opening / closing ring 166.

The first pusher 114c is connected to the first pusher bar 52 in the operating section 10, and the second pusher 116c is connected to the second pusher bar 54. Anvil opening / closing ring 166
Is urged rearward by a spring 168 and has an elastic locking portion 182 at the rear end. The insertion part housing on the side facing the locking part 182 has a locking hole 180 for holding the locking part 182, and the engagement between the locking part 182 and the locking hole 180 is released behind the pusher bar. A release portion 184 having a cam surface for operating is provided.

By driving the motor 24 of the operating portion 10, the first pusher 114c and the anvil opening / closing ring 166 are moved through the first pulley 38, the first pusher link 42, the first pusher tube 46, and the first pusher bar 52. The anvil 164 is closed by sliding it to the tip side. At that time, the locking portion 168 is held in the locking hole 180 and the anvil 164 is maintained in the closed state.

When the motor 24 of the operating portion 10 is further driven, the second pulley 40, the second pusher link 44, and the second pulley 40
The second pusher 116c is slid toward the front end side through the pusher tube 48 and the first pusher bar 54, whereby the staple pusher 176 and the cutter 17 are inserted.
8 is slid into the cartridge, the staple is projected from the staple accommodating portion to puncture the tissue, and then the anvil is deformed and sutured. At the same time, a cutter 178 cuts between the suture lines.

When the cutter 178 arrives at the tip of the cartridge, the releasing portion 184 of the second pusher 116c disengages the engaging portion 182 and the engaging hole 180, and the anvil opening / closing ring slides backward to open the anvil and suture. The resection is complete.

Finally, the circular stapler 100D will be described with reference to FIGS. As shown in FIG. 10, the circular stapler 100D has an anvil shaft 19
It has an anvil 186 removably attached to zero. The anvil 186 has a forming surface 188 on the rear side for forming the staple in a closed shape in a circumferential shape. A staple accommodating portion 192 is provided behind the anvil 186. The staple accommodating portion 192 includes a plurality of staples 1.
The cylindrical cutter 1 accommodates 94 in a circumferential shape.
Has 96. A staple pusher 200 for pushing out the staples 194 is provided behind it. The staple pusher 200 has a first pusher 114.
It is connected to the first pusher bar 52 of the operation unit 10 via d.

The anvil 186 is connected to the anvil pusher 202 via the anvil shaft 190, and the rear end of the anvil pusher 202 is screwed with the screw portion 204 inside the anvil adjusting ring 206 at the rear end of the insertion portion. .

In use, the anvil 186 and the staple accommodating portion 192 are separated and placed inside the tubular tissue 208 (FIG. 11A). The end face of the tubular tissue 298 is sandwiched between the anvil 186 and the staple accommodating portion 192, and the anvil adjusting ring 206 is rotated to adjust the distance between the anvil 186 and the staple accommodating portion 192 (FIG. 11).
(B)).

Then, by driving the motor 24 of the operating section 10, the staple 194 of the staple accommodating section 192 is pierced toward the body tissue through the first pusher bar 52 and the staple pusher 200, and the anvil forming surface is formed. The staple 194 is deformed to the closed state. At the same time, the cylindrical cutter 196 cuts out the tissue inside the staple row (FIG. 11C).

After that, the anvil opening / closing ring is operated to open the space between the anvil and the staple accommodating portion to complete the end-to-end anastomosis of the tubular tissue (FIG. 11 (D)). As described above, since the operation portion of this embodiment has a structure in which the blood of the patient is hard to enter due to the O-ring, the seal block of the attachment / detachment portion, and the elastic seal, it can be washed and sterilized after use. High-pressure steam sterilization by using heat-resistant plastic for the frame of the part and covering the electric circuit with a heat-resistant material. O. It becomes possible to sterilize with G or the like. Therefore, the operating portion can be reused and can be used in combination with a plurality of insertion portions performing various suturing operations, which leads to improvement in operability and reduction in medical costs.

In addition, obtaining the force necessary for the suturing operation according to the type of the insertion portion also improves the operability. The insertion section is not limited to the above-mentioned four types, and the identification means is not limited to the above-described method.

A second embodiment will be described with reference to FIGS. 14 and 15. This embodiment is a modification of the clip device of the first embodiment. As shown in FIG. 14, a dummy clip 210 having a resinous base shape is arranged at the end of the clip row 136. The dummy clip 210 has elastic locking portions 212 on both sides. Further, as shown in FIG. 15, a concave portion 130 is formed on the inner surface of the jaw 130.
a is provided.

After the last clip 136 is used, as shown in FIG. 15A, the dummy clip 212 is used.
Is fed between the jaws 130 by the first pusher 114a, the locking portion 212 is locked in the recess 130a on the inner surface of the jaw 130, and the dummy clip 210 is moved between the jaws 130 as shown in FIG. It is held and fixed.

Since the dummy clip 210 does not deform even if force is applied when the jaw 130 is closed, the device does not operate when the clip 136 disappears, and the jaw is accidentally closed without the clip, so that the tissue It is possible to prevent the damage to the. Also, the user can know that the clip is gone.

[0041]

According to the present invention, there is provided a surgical treatment tool which is economical, requires little maintenance, and has a small amount of waste.

[Brief description of drawings]

FIG. 1 is a diagram showing an overall configuration of a surgical treatment tool according to an embodiment of the present invention.

FIG. 2 is a side cross-sectional view of a part of the operation section shown in FIG. 1 and an insertion section attached to the operation section.

FIG. 3 is an exploded perspective view of a mechanism for operating a treatment section provided on the distal end portion of the insertion section.

FIG. 4 is a side sectional view of the clip device shown in FIG.

5 is an exploded perspective view for explaining the internal structure of the clip shown in FIG.

FIG. 6 is a side sectional view of the stapler shown in FIG.

7 is an exploded perspective view for explaining the internal structure of the cutler shown in FIG.

FIG. 8 is a diagram for explaining the operation of the stapler in FIG.

FIG. 9 is a side sectional view of the linear cutter shown in FIG.

FIG. 10 is a side sectional view of the circular stapler shown in FIG.

11 is a view for explaining the operation of the circular stapler of FIG.

12 is a block diagram for driving the operation unit shown in FIG.

FIG. 13 is a view showing a contact provided at an end portion of the insertion portion forming a part of a mechanism for identifying the insertion portion.

FIG. 14 is a perspective view showing a clip device according to a second embodiment.

FIG. 15 is a diagram for explaining the operation of the clip device in FIG.

[Explanation of symbols]

10 ... Operation part, 100A ... Clip device, 100B ... Stapler, 100C ... Linear cutter, 100D ... Circular stapler.

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[Procedure amendment]

[Submission date] September 13, 1993

[Procedure Amendment 1]

[Document name to be amended] Statement

[Name of item to be corrected] 0032

[Correction method] Change

[Correction content]

Finally, the circular stapler 100D will be described with reference to FIGS. As shown in FIG. 10, the circular stapler 100D has an anvil shaft 19
It has an anvil 186 removably attached to zero. The anvil 186 has a forming surface 188 on the rear side for forming the staple in a closed shape in a circumferential shape. A staple accommodating portion 192 is provided behind the anvil 186. The staple accommodating portion 192 includes a plurality of staples 1.
The cylindrical cutter 1 accommodates 94 in a circumferential shape.
Has 96. Its rear is provided staple pusher 200 b to push the staples 194. This is behind the staple pusher 200b.
The connecting pipe 200a for pushing out the coil spring
198 is interposed. Connection pipe 200
a is the first pusher 114d of the operation unit 10 via the first pusher 114d.
It is connected to the pusher bar 52.

[Procedure Amendment 2]

[Document name to be amended] Statement

[Correction target item name] 0033

[Correction method] Change

[Correction content]

The anvil 186, via the anvil shaft 190 is connected to the anvil pusher 202, the rear end insertion portion anvil adjustment ring 20 4 of the inner threaded portion 20 6 and screwed on the rear end of the anvil pusher 202 ing.

[Procedure 3]

[Document name to be corrected] Drawing

[Name of item to be corrected] Fig. 10

[Correction method] Change

[Correction content]

[Figure 10]

Claims (1)

[Claims] 1. An operating section, a plurality of insertion sections each having a treatment section of a different type at its distal end, and means for selectively mounting one of the plurality of insertion sections on the operation section. And a means for operating the treatment section of the insertion section attached to the operation section from the operation section.