JPH09538A - High-frequency medical treatment instrument - Google Patents

Abstract

PURPOSE: To perform various types of medical treatment via use of a single treatment instrument by applying a constitution that an electrode oscillating due to travel of a transmission rod inserted in an outer tube is formed to have a plane contact section, a line contact section at both right and left sides thereof, and a point contact section at the front end. CONSTITUTION: When an operation lever 12 is operated by fingers or the like, a transmission rod 21 is displaced along an axial line direction, thereby oscillating and displacing an electrode 3. Also, when a turning operation ring 24 is turned by fingers or the like for axially turning an outer tube 20, the electrode 3 turns. In this case, the side of an electrode body 30 of the electrode 3 is thinned and one side of the body 30 is formed as a plane contact section 30a of large area curved right and left. Also, right and left edges of the body 30 are formed as rounded and thin line contact sections 30b. In addition, the front end of the body 30 is sharpened in a dull state to form a point contact section 30c. According to this construction, not only a surgery, but also medical treatment for coagulation can be undertaken by the use of a single high-frequency medial treatment instrument. Furthermore, an incision can be easily and properly made along the prescribed direction.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a high-frequency treatment instrument for performing incision and cutting of organs and tissues, and coagulation of a bleeding portion in a body cavity.

[0002]

2. Description of the Related Art For example, when performing a surgical operation to remove a gallbladder in an abdominal cavity, a plurality of trocars are inserted into the abdominal cavity, and an endoscope is inserted into one of the trocars. Under observation, forceps or other treatment tool is inserted into the abdominal cavity through another trocar, while holding the gallbladder, a high-frequency treatment tool also called a so-called electric knife is inserted from another trocar, This is done by separating the gallbladder from other organs.

This type of high-frequency treatment instrument is one in which a tip electrode is provided at the tip portion of the insertion portion to be inserted into the trocar, and between this tip electrode and the patient-side electrode plate brought into contact with the patient. By applying a high-frequency current to generate Joule heat in the internal tissue portion where the tip electrode abuts, treatment such as incision or cutting of organs or tissues can be performed.

[0004] Here, in the case where the above-mentioned treatment for separating the gallbladder from the liver is performed, it is necessary to accurately cut along the boundary portion, and this cut portion may be complicated, and the blood vessel It is necessary to finely control the direction and movement of the electrodes in the high-frequency treatment tool, for example, it is necessary to perform cutting while avoiding the passing portion. For this reason, conventionally, such as linear, L-shaped, and J-shaped,
A plurality of treatment tools equipped with electrodes having various shapes are prepared, and a treatment tool having an electrode having an optimum shape is used in accordance with a site, a direction, etc. in which an incision or the like is performed.

[0005]

By the way, as described above, in order to replace and use a high-frequency treatment instrument equipped with electrodes having different shapes depending on the site to be treated and the situation thereof, it is necessary to remove it from the trocar. However, since another treatment tool has to be inserted through the trocar, there is a problem that the operation is extremely troublesome and the treatment time is long. Further, during the treatment, bleeding may occur, and high-frequency coagulation is performed in order to stop the bleeding. However, the above-mentioned treatment tools cannot always surely perform coagulation. It is necessary to also use a tool together, and there is a problem that the operation becomes more troublesome and the treatment takes a long time.

The present invention has been made in view of the above points, and it is an object of the present invention to provide various treatments with a single treatment tool.

[0007]

In order to achieve the above-mentioned object, according to the present invention, the tip of an insertion portion formed by inserting a transmission rod movable in the axial direction into an outer tube is shaken by the movement of the transmission rod. A moving electrode is attached, and the electrode has a curved or flat surface contact portion, line contact portions formed on both left and right sides of the surface contact portion, and a point contact portion formed at the tip. It is characterized by that.

[0008]

The electrode is not fixed to the shaft member to be inserted into the trocar, but is swingably provided at the tip of the insertion portion, and the swing of the electrode can be performed by the operating portion grasped by the operator. This makes it possible to displace the electrode in an appropriate angular state according to the site to be treated, and when performing an operation such as peeling between organs, the electrode is applied in a desired direction. Can be contacted.

Since the electrode is provided with the surface contact portion, the line contact portion and the point contact portion, it is possible to cut out a portion having a relatively stable shape without extremely complicated or narrow portions. , Use the line contact part. Then, the electrodes are appropriately tilted according to the direction of the cutting line. This ensures that the line contact portion can be used to make an incision regardless of the direction of the site to be cut. Further, when it is necessary to move the electrode minutely, such as cutting an intricate part or cutting while circling between blood vessels, the point contact portion is contacted. Since the current density is high at this point contact portion, it can be cut to a deeper position. Then, during this operation, bleeding may occur. When bleeding occurs, the surface contact portion is brought into contact with the bleeding point to allow coagulation. As a result, only one high-frequency treatment instrument needs to be used, and there is no need to replace and insert a plurality of high-frequency treatment instruments in the trocar, so that the treatment can be performed smoothly and quickly.

In order to further improve the operability of the electrode, not only the electrode is swung, but the electrode can be rotated by rotating the insertion portion around the axis.
With this, by combining the pivoting operation and the swinging operation of the electrode, the surface contact portion, the line contact portion and the point contact portion of the electrode can be reliably and easily oriented in any direction. , Its controllability is further improved.

[0011]

Embodiments of the present invention will be described below with reference to the drawings. First, FIG. 1 shows the overall configuration of a high-frequency treatment instrument. 2 and 3 are cross-sectional views of the operating portion side and the electrode side, respectively, and FIGS. 4 and 5 are external views of the distal end portion of the treatment instrument. FIG. 6 is a cross-sectional view of the electrode pivot portion. And FIG. 7 shows the appearance of the electrodes.

In the figure, 1 is an operating portion, 2 is an insertion portion,
3 is an electrode. The operation unit 1 includes a grip body 10 and an operation lever 12 pivotally connected to the grip body 10 by a shaft 11. The operator is the grip body 10
The operation lever 12 can be operated by gripping it. Between the grip body 10 and the operating lever 12, a pair of leaf springs 13, 13 is provided,
By the biasing force of the leaf springs 13, 13, the operating lever 1
2 is urged to rotate in a direction away from the grip body 10. A ratchet member 14 is rotatably connected to the grip body 10 in the direction of the arrow in FIG. 1. The ratchet teeth 14 a of the ratchet member 14 are connected to the ratchet member 14.
Is detachable from the end of the operating lever 12. Therefore, when the ratchet member 14 is brought into contact with the end portion of the operating lever 12 with the operating lever 12 in the desired angular position, the operating lever 12 can be fixed at the angular position.

The insertion portion 2 is formed by inserting a transmission rod 21 into the outer tube 20 so as to be movable in the axial direction.
As also shown, the outer tube 20 is inserted into the holding cylinder 15 fixedly provided on the upper surface of the grip body 10 in the operation portion 1. A push piece 22 is connected to the base end of the transmission rod 21, and an operating lever 12 is pivotally supported by a shaft 23 on the push piece 22. Therefore, the operating lever 12 is rotated about the axis 11. Then, the pushing piece 22 moves in the front-rear direction.

A rotating operation ring 24 for rotating the electrode 3 is fitted and fixed to a portion of the outer tube 20 that has passed through the insertion portion into the holding cylinder 15. The rotary operation ring 24 is provided with an operation finger piece 24a, and when the operation finger piece 24a is rotated by a finger or the like, the outer tube 20 of the insertion portion 2 rotates following the rotation. A set screw 16 is screwed into the grip body 10 of the operation unit 1,
The tip of the threaded portion of the set screw 16 penetrates the holding cylinder 15 and can come into contact with and separate from the outer tube 20. Therefore, when the operating finger piece 24a of the rotating operation ring 24 is rotated while the set screw 16 is loosened, the outer tube 20 will follow and rotate, and the set screw 16 will move to the outer surface of the outer tube 20. The outer tube 20 is fixed in the axial direction as well as in the rotating direction by being pressed into contact with.

The insertion portion 2 has a predetermined length, and the electrode 3 is attached to the tip portion of the insertion portion 2. As shown in FIGS. 3 to 6, the tip portion of the outer tube 20 is a half-divided portion 20a by a predetermined length, and the tip portion of the transmission rod 21 extends to the portion of the half-divided portion 20a. Is present. The tip of the transmission rod 21 is inserted into the connecting tubular body 25, and the tip portion thereof is a large diameter portion 21a. As a result, the transmission rod 21 is rotatably connected to the connecting tubular body 25. The connecting tubular body 25 is fixed to the reciprocating member 26 having a substantially semicircular outer shape. The tip end of the reciprocating member 26 extends almost to the same position as the tip end portion of the outer tube 20.
The outer tube 20 is provided with slits 26a and 20b from the tip to a predetermined position.

The electrode 3 is composed of an electrode body 30 and a connecting portion 31, and the connecting portion 31 is a rectangular member having a relatively thin thickness. The connecting portion 31 has two axial holes 32 and 33.
Is provided. On the other hand, the reciprocating member 26 and the outer tube 2
No. 0 slits 26a, 20b are provided with support shafts 27, 28 made of circular protrusions, the connecting portion 31 of the electrode 3 is arranged in the slits 26a, 20b, and shaft holes 32, 3 are provided.
The support shafts 27 and 28 are attached to the shaft 3 so as to be fitted therein. As a result, when the transmission rod 21 moves in the axial direction, the electrode 3 can be pivotally displaced about the support shaft 28 from the solid line position in FIG. 3 in a direction indicated by an imaginary line by a predetermined angle, for example, about 90 °. .

As described above, when the operating lever 12 is operated by a finger or the like, the transmission rod 21 is displaced in the axial direction, and the electrode 3 is oscillated and displaced, and the rotary operation ring 24 is used.
When the outer tube 20 is rotated around the axis by rotating the hand with fingers or the like, the electrode 3 is rotated. The electrode 3 follows the rotation of the outer tube 20, but the connecting cylinder 25 and the reciprocating member 26 also rotate in addition to this. However, the transmission rod 21 is held in a non-rotating state.

Further, as is clear from FIG. 7, the electrode body 30 of the electrode 3 has a substantially triangular shape in a plan view and has a thin side surface. Therefore, one side surface of the electrode main body 30 has a wide area curved to the left and right, and when this portion is pressed against body tissue, it becomes a surface contact portion 30a suitable for coagulation. Further, the left and right edge portions are rounded and have a thin wall thickness, and this portion is brought into contact with a body tissue to cut the tissue or the like.
It becomes 0b and 30b. Furthermore, the tip portion is sharp in a dull state, and when this tip portion is brought into contact with body tissue, a point contact portion 30c suitable for making a fine perforation to a considerable depth or coagulating a narrow portion. Are configured. Although the surface contact portion 30a has a curved curved surface shape, it may have a flat surface shape.

In the high-frequency treatment instrument having the above structure, as is apparent from FIG. 1, a contact portion 40 is provided at the base end of the pushing piece 22 so as to project. The connector 43 of the cable 42 from the power supply device 41 is detachably connected. Further, a flat plate-shaped patient-side electrode 44 is brought into contact with the patient, so that a predetermined potential difference is generated between the electrode body 30 of the electrode 3 and the patient-side electrode 44.

In order to prevent the electric current from leaking to a portion other than the electrode body 30, a member other than the electrode body 30 is exposed to the outside of the conductive member and the connecting portion 31 of the electrode 3. An insulating coating made of a fluororesin or the like having electric insulation is applied up to the portion that has entered the electrode body 30. In order to secure a power supply path from the contact portion 40 to the electrode body 30, at least the pushing piece 2
2, the transmission rod 21, the connecting tubular body 25 and the reciprocating member 26,
Like the electrode 3, it is formed of a metal having conductivity. The contact point portion 40 is inserted in the pushing piece 22, and the transmission rod 21 is inserted in the pushing piece 22. The inserted portion is also on the pushing piece 22 side. The side is not insulation coated either. Further, the tip end of the transmission rod 21 is inserted into the connecting tubular body 25, and the connecting member 26 is in contact with the reciprocating member 26, but these inserting portions and abutting portions are not subjected to insulating coating. However, the pushing piece 22,
The insulating rod having a predetermined thickness is applied to the other parts of the transmission rod 21, the connecting cylinder 25, and the reciprocating member 26. In addition, between the reciprocating member 26 and the electrode 3, as is apparent from FIG. 6, the supporting shaft 27 provided on the reciprocating member 26 is not provided with an insulating coating, and the connecting portion 31 of the electrode 3 is bored. The shaft hole 32 is not coated with insulation. Then, the insulating coating is applied to the portions other than these portions as indicated by a symbol C in the drawing.

With this structure, a power supply path from the contact portion 41 to the electrode 3 is secured. Here, in order to further improve safety, at least a portion of the electrode 3 between the electrode body 30 and the outer tube 20 is covered with an insulating cover. Also, the mantle tube 20
Also, the pushing piece 22 is made of an electrically insulating resin, and the transmission rod 21 inserted therein is made of metal.
1 is made to penetrate the pushing piece 22, and the protruding end portion of the transmission rod 21 from the pushing piece 22 functions as a contact portion,
Between the pushing piece 22 and the outer tube 20, and between the outer tube 20 and the electrode 3.
An insulating cover may be attached to each of the connecting portions 31 of the above.

In order to prevent the electric current from leaking to the parts other than the electrode main body 30, the structure shown in FIG. 8 can be further adopted. That is, when the outer tube 20 is formed of a hard resin pipe or is formed of a metal, the entire portion exposed to the outside, such as the inner and outer surfaces and both ends thereof, is completely electrically insulated, An insulating protective cover 50 is mounted to cover the entire operation portion 1 from a portion of the mantle tube 20 including a portion connected to the rotating operation ring 24, and a portion of the mantle tube 20 and the electrode 3 on the base end side of the electrode body 30. The insulating protection tube 51 may be attached between the two.

Here, as shown in FIG. 9, the insulating protection tube 51 has annular recessed grooves 52, 52 formed in the outer tube 20 and the electrode body 30, respectively. The ring portion 5 that fits into these groove 52
By forming 1a and 51a, the insulating protection tube 51 can be replaced and can be mounted in a state in which it does not deviate from or shift from the treatment tool. Therefore, the insulating protection tube 51 is formed of an elastic member, and the circular portion of the electrode 3 on the base end side of the electrode body 30 is elongated to some extent, and the concave groove 52 is formed in this portion. On the other hand, the insulating protection cover 50 mounted on the operation unit 1 side is
The grip body 10 and the operating lever 12 of the operating portion 1 are gripped from the outside, and the operating lever 12 is operated to swing the electrode 3, and further, the set screw 16 is screwed in and out and the rotary operation ring 24 is operated. In order to perform the turning operation of the outer tube 20 by the method, transparency and flexibility are required. Of course,
It is selected from those having sufficient strength so that there is no fear of damage.

The present embodiment is constructed as described above, and this high-frequency treatment instrument is inserted into the body cavity through a guide member such as a trocar to stop the incision of organs and tissues and the bleeding part. A treatment such as coagulation for treatment can be performed.

First, when making an incision, the line contact portion 30b of the electrode body 30 of the electrode 3 is brought into contact with a body tissue or the like. By the contact of the line contact portion 30b, cutting is performed by the action of Joule heat due to high frequency. Here, the cutting direction does not always coincide with the axial direction of the insertion portion 2. Therefore, the engagement of the ratchet member 14 in the operating portion 1 with the actuating lever 12 is released, and the actuating lever 12 is rotated in the direction against the leaf spring 13. As a result, the pusher piece 22 connected to the actuating lever 12 moves in the axial direction, and the transmission rod 21 connected to the pusher piece 22 moves inside the outer tube 20 and its tip end moves. The connecting tubular body 25 and the reciprocating member 26, which are connected to each other, also move in the same direction. Since the pushing member 26 is connected to the connecting portion 31 of the electrode 3 via the support shaft 27, the electrode 3 swings around the support shaft 28 of the outer tube 20, and the electrode body 3
The direction of the zero line contact portion 30b can be changed. Then, if the ratchet teeth 14a of the ratchet member 14 are engaged with the operating lever 12 with the electrode 3 oriented in a desired direction, the ratchet teeth 14a can be fixed in that state.

When the set screw 16 is loosened, the outer tube 2
The fixing of 0 to the holding cylinder 15 is released, and the outer tube 20 can be rotated by pushing the operating finger piece 24a of the rotating operation ring 24 with a finger. The electrode 3 is connected to the distal end of the outer tube 20, and the connecting portion 31 of the electrode 3 is connected to the reciprocating member 26, and the reciprocating member 26 is connected to the connecting cylinder 25. Since the connecting cylinder 25 is rotatable relative to the transmission rod 21, the rotation of the outer tube 20 causes the electrode 3, the reciprocating member 26, and the connecting cylinder 25 to rotate, so that the transmission rod 21 moves. It is held in a non-rotating state. Then, by rotating the outer tube 20 by a desired angle and then tightening the set screw 16, the outer tube 20 is fixed in the rotating state.

As a result, the outer tube 20 is rotated to bring the electrode 3 into a desired rotating state, and the electrode 3 is swung by operating the actuating lever 12, so that the wire in the electrode body 30 is moved. The contact portion 30b can be oriented in any direction. Therefore, regardless of the direction of the cut portion in the organ or tissue, the line contact portion 30b can be reliably oriented in the corresponding direction.

In addition, bleeding may occur during treatment such as incision. In this case, the bleeding portion can be coagulated by bringing the surface contact 30a of the electrode body 30 into contact with the bleeding portion. Of course, also in this case, the surface contact portion 30a can be surely brought into surface contact with the bleeding portion by rotating or swinging the electrode 3. Here, since the surface contact portion 30a is in contact with a wide surface, the current density is lower than that of the line contact portion 30b, and the generated Joule heat is also low, which is convenient for solidification.

Further, in the case of cutting a convoluted portion, making a detour between blood vessels, or cutting a narrow portion, the point contact portion 30c of the electrode body 30 is used. Here, since the current density concentrates on a minute portion of the point contact portion 30c, it is possible to cut to a certain depth even in a narrow portion. Further, when the bleeding spot is small, the point contact portion 30c is slightly brought into contact with the bleeding spot, so that the hemostasis can be performed by minimizing the coagulation spot. Of course, in order to ensure that the point contact portion 30c is directed to the contact portion, the electrode 3
Rotate or rock.

[0030]

As described above, according to the present invention, the electrode of the high-frequency treatment instrument is provided with the surface contact portion, the line contact portion, and the point contact portion, and the electrode is swingably connected to the insertion portion. With this configuration, it is possible to perform not only incision but also coagulation using a single high-frequency treatment instrument, and regardless of the site to be incised and in any direction. Therefore, it is possible to easily and surely make an incision in a predetermined direction.

[Brief description of drawings]

FIG. 1 is an overall configuration diagram of a high-frequency treatment tool showing an embodiment of the present invention.

FIG. 2 is a cross-sectional view of a main part of the high-frequency treatment instrument on the operating portion side.

FIG. 3 is a cross-sectional view of a portion of the high-frequency treatment instrument on the electrode side.

FIG. 4 is a bottom view of the distal end portion of the high-frequency treatment instrument.

FIG. 5 is a plan view of the distal end portion of the high-frequency treatment instrument.

FIG. 6 is a sectional view taken along line XX of FIG. 3;

FIG. 7 is an external view of an electrode.

FIG. 8 is a structural explanatory view showing a structure for preventing a current from leaking to portions other than the electrodes in the high-frequency treatment instrument.

9 is an enlarged view of a main part of FIG.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Operation part 2 Insertion part 3 Electrode 10 Grip main body 12 Operating lever 14 Ratchet member 15 Holding cylinder 16 Set screw 20 Outer tube 21 Transmission rod 22 Pushing piece 24 Rotating operation ring 25 Connecting cylinder 26 Reciprocating member 27, 28 Support Shaft 30 Electrode body 30a Surface contact part 30b Line contact part 30c Point contact part 31 Connection part 40 Contact part 41 High frequency power supply device 50 Insulation protection cover 51 Insulation protection tube

Claims (4)

[Claims] 1. An electrode oscillated by the movement of a transmission rod is attached to the tip of an insertion portion formed by inserting a transmission rod movable in the axial direction into an outer tube, and the electrode has a curved or plane shape. A high-frequency treatment tool comprising: a surface contact portion, line contact portions formed on both left and right sides of the surface contact portion, and a point contact portion formed at a tip. 2. The outer tube of the insertion portion is configured to be rotatable in a direction around an axis, and the electrodes are configured to rotate in accordance with the rotation of the outer tube. High frequency treatment tool. 3. A contact portion for connecting a connector of a high-frequency power supply device to the transmitting rod, wherein the transmitting rod of the insertion portion serves as a power supply path to the electrode, and a pushing piece is connected to the transmitting rod. The high-frequency treatment instrument according to claim 1 or 2, characterized in that an insulating coating having electrical insulation is provided on the outer periphery of the power supply path and the outer surface of the other conductive member. 4. An operating portion is connected to a base end portion of the insertion portion,
The operation protection portion is covered with an electrically insulating insulation cover, and an electrically insulating insulation tube having electrical insulation is mounted between the outer tube and the electrode. Alternatively, the high-frequency treatment tool according to 2.