JPH0443214Y2 - - Google Patents

Description

[Detailed description of the invention] [Field of industrial application] This invention is a method for removing the internal glands of the enlarged prostate (prostatic hyperplasia) by detaching it from the external glands and removing it by inserting it into the bladder through the urethra. The present invention relates to an improvement of a resectoscope device.

[Problems to be solved by conventional techniques and ideas] In recent years, endoscopes, which have an insertion section inserted into a body cavity and are capable of observing, diagnosing, and treating diseased areas, have been widely used. This endoscope includes a resectoscope that is inserted into the bladder through the urethra and is configured to perform treatments such as prostate resection using a resection loop electrode device that applies high-frequency current.

In general, a resect scope consists of a hollow resect sheath that is inserted into the urethra, a slider that is detachably attached to the rear end of the resect sheath, and an observation scope (optical) that is detachably attached to the rear end of the slider. A loop electrode device for prostate resection is inserted into the resect sheath and its rear end can be fixed to a slider.By operating the slider, the tip of the loop electrode can be fixed to a slider. It is designed so that it can be plunged through the resect sheath.

However, when using a resect scope configured in this way to resect the intraprostatic glands by applying a high-frequency current to the loop electrode of the electrode device protruding from the tip of the resect sheath, it is difficult to completely remove the enlarged intraprostatic glands. The procedure is extremely difficult as it is dangerous to the human body, and has the drawback that some of the internal glands tend to remain, causing the prostate tissue to become enlarged again.

Therefore, as described in Japanese Utility Model Application Publication No. 59-93513, the present applicant installed a resectoscope in place of the above-mentioned electrodes, and under the direct vision of the resectoscope, the extra-prostatic glands and the enlarged prostate glands were detected. We have developed a prostatic dissection device that can be inserted between the prostate gland and the internal gland to separate the internal gland from the external gland and completely remove the internal gland. The prostate ablation device has a retractable coagulation electrode,
It is pressed against the spot where the bleeding has stopped to coagulate it to stop the bleeding. Incidentally, it is anatomically more effective to use a loop electrode device to which a high-frequency current is applied, rather than to remove the intraprostatic gland using only the above-mentioned ablating device alone.

However, with conventional resectoscopes and dissection devices, it is necessary to replace the dissection device and loop electrode device as needed during surgery, and these dissection devices and loop electrode devices must be placed on the distal end of the resectoscope. Since the resectoscope is made of steel and is inserted from the inside, it is necessary to remove the resectoscope that has been inserted into the bladder through the urethra each time it is replaced, replace it, and reinsert it into the bladder through the urethra. .

Therefore, in accordance with Japanese Patent Application No. 59-193303, the present applicant provided two sliders at the top and bottom, mounted a stripper on one of them and an electrode on the other, and installed the stripper and the electrode on each slider. We are proposing a resectoscope device that can be slid independently. This device has the advantage that it can be used while inserted into the bladder through the urethra without replacing the resection loop electrode device and the ablation device during surgery. In this device, a dissection device slider is slid to project a dissection element from the sheath tip, and when the intraprostatic gland is dissected by the dissection probe, force is applied to the shaft, causing the dissection probe and the shaft to be arranged side by side within the sheath. Touch the tip of the electrode. However, in this device, the stripper is not provided with insulation measures, so if high-frequency current is accidentally applied to the electrode device under the above conditions,
There is a risk that the high frequency current will flow to the ablation device that comes into contact with it and cause burns to the patient and the operator.

[Purpose of the invention] The present invention was developed in view of these circumstances, and it is possible to avoid accidentally applying high-frequency current to the electrode device when the peeler is slid to protrude the peeler from the sheath tip. Another object of the present invention is to provide a resectoscope device in which electrical safety is improved by preventing high-frequency current from flowing through the stripper.

Another object of the present invention is to protrude the separator from the tip of the sheath and move the separator back and forth to ablate the intraprostatic glands. An object of the present invention is to provide a resectoscope device capable of reducing frictional resistance and preventing damage to an electrode device.

[Means for Solving the Problems and Their Effects] In order to achieve the above object, the resectoscope device according to the present invention has a handle portion and a main body connected and fixed to a connecting portion provided on the entire handle portion so that the front an elongated sheath that extends into the urethra and is inserted into the urethra; a scope that is connected and fixed to a connecting part provided at the rear of the handle and inserted into the sheath through the handle; and a scope that is inserted into the sheath. a slide that is slidably disposed on the handle portion and to which a stripper having a stripper provided at the tip of an elongated shaft can be attached; and a slide that is also disposed on the handle portion and inserted into the sheath. A slider equipped with an electrode device having a cutting electrode at the tip of an elongated conductive shaft and to which a high-frequency current is applied, when the peeling device is slid by the slide of the peeling device slider, at least The part of the ablation device that extends forward from the ablation electrode is insulated.

With this configuration, when the dissection device slider is slid to protrude the dissection element from the sheath tip, and when the intraprostatic gland is dissected by the dissection probe, force is applied to the shaft, causing the dissection probe and the shaft to be juxtaposed within the sheath. The distal end of the electrode device is touched, but in this state, even if a high-frequency current is accidentally applied to the electrode device, the current will not be applied to the stripper side.

[Embodiments of the invention] Hereinafter, embodiments of the invention will be specifically described with reference to the drawings.

1 to 14 relate to the first embodiment of the device of the present invention, in which FIG. 1 is a sectional view of the sheath tip showing a state in which the separator is protruded from the sheath tip, and FIG. 2 is a plan view showing the whole. , FIG. 3 is a side view of FIG. 2, FIG. 4 is a sectional view taken along line A-A in FIG. 7 is a sectional view showing the click mechanism in FIG. 6, FIG. 8 is a sectional view showing the switching button, and FIG. 9 is a sectional view showing the stripper slider. Fig. 10 is a perspective view showing a state in which the electrode slider is slid forward and the electrode is slid forward, Fig. 11 is a perspective view showing the distal end side of the peeler and electrode device. A perspective view showing the configuration, FIG. 12 is an enlarged sectional view taken along line C-C in FIG. 3, and FIG. 13 is an enlarged sectional view taken along line D-D in FIG.
FIG. 14 is an enlarged cross-sectional view taken along the line E--E in FIG. 3.

In these figures, reference numeral 1 denotes a resectoscope device, which includes a handle part 2, a main body 3 connected and fixed to the front part of the handle part 2, and an elongated sheath 4 that extends forward and is inserted into the urethra. The scope 5 is connected and fixed to the rear part of the handle part 2 and inserted into the sheath 4 through the handle part 2. As shown in FIG. 3, the handle part 2 forms a sliding gap G between the front fixing part 6 and the rear fixing part 7, and connects them to the upper parallel shafts 8, 9, the middle parallel shafts 10, 11, and the lower center. While connected by a shaft 12, a slider 13 and shafts 9 and 1 slide guided by shafts 8 and 10 at the upper or middle stage within the slide gap G, as shown in FIG.
A slider 14 that slides while being guided by the shaft 12 is arranged in parallel in the lateral direction, and a finger slider 15 that slides while being guided by the shaft 12 is arranged at the lower stage within the slide gap G. Further, this handle portion 2 has a scope connecting portion in the rear fixing portion 7, and a scope guide tube 16 is connected to the front from the scope connecting portion of the rear fixing portion 7 through the front fixing portion 6.
is being extended. Furthermore, the front fixing part 6 of the handle part 2 has a connecting part 17 for connecting and fixing the sheath main body 3, while the front fixing part 6 has front finger hooks 18, 1 in the vertical direction.
There are 8. The sheath main body 3 connected and fixed to the connecting portion 17 is provided with a water supply spout 19 for supplying irrigation fluid to the bladder and urethra through the inside of the sheath 4, and a socket 19a for adjusting the water supply. on the other hand,
The scope 5 connected and fixed to the scope connection part is
The insertion section 20 is inserted through the scope guide tube 16 to the distal end inside the sheath 4, and the sheath 4
The front of the tip can be observed. This scope 5 has an eyepiece 21 at the rear, and a light guide base 22 to which a light guide cable is connected to a light source device (not shown).

One of the sliders 13 and 14 arranged in parallel in the horizontal direction within the slide gap G
has a cord connector 23 to which a cord for supplying high-frequency current is connected, and an electrode attachment/detachment button 25 for connecting and fixing the conductive shaft 24a of the excision electrode device 24, and is inserted into a connection hole (not shown) from the front. It is fixed by inserting the elongated conductive shaft 24a and tightening the attachment/detachment button 25. The other slider 14 is a peeler 26
It has a peeler attachment/detachment button 27 for connecting and fixing an elongated shaft 26a, and the shaft 26a inserted from the front into a connection hole (not shown) is fixed by tightening the attachment/detachment button 27.

The sliders 13 and 14 have screws 2 on their lower surfaces.
At 8 and 28, engaging claw pieces 29 and 30 are fixed and project downward toward the finger hook slider. The engaging claw pieces 29, 30 have engaging portions 29a, 30a, respectively. The respective screws 28, 28 are connected to the shaft 10,
Slits 31 and 32 formed above and below in the axial direction of 11
The slits 31 and 32 of the shafts 10 and 11 follow the slides of the sliders 13 and 14.
It is designed to slide along. Then, within the shafts 10, 11, the screws 28, 28
Compression coil springs 33, 33 are interposed between the front fixing portion 6 and the slider 1.
3 and 14 in the direction of the rear fixed part 7. As a result, the electrode 24b of the electrode device 24 and the peeler 26
The separator 26b is constantly retracted within the distal end of the sheath 4. On the other hand, the finger hook slider 15 has
A finger rest 34 is fixed. The finger slider 15 has a pipe 24 made of a lubricating material, such as Teflon, disposed in the bearing portion of the guide shaft 12 so that it can slide smoothly. The finger hook slider 15 has an insertion hole 35 passing through in the lateral direction at a position partially overlapping with the guide shaft 12, and a switching shaft 36 is slidably mounted in the insertion hole 35. This switching shaft 36 is shown in FIGS.
As shown in the figure, the engaging claw pieces 2 of the sliders 13 and 14
9 or 30 and has recesses 37 and 38 at positions corresponding to the guide shaft 12, and one engaging claw piece 29 or 3
0 and the guide shaft 12 are engaged in these recesses 37 and 38 and retracted, and the other engaging claw piece 30 or 29 is engaged with the outer periphery of the switching shaft 36, and the finger hook slider 15 is moved through the shaft 36. The slider 14 or 13 is configured to slide following the slide. Further, the guide shaft 12 at a position perpendicular to the switching shaft 36 at the position where the finger hook slider 15 is retracted to the rear is provided with a stopper convex portion 39 formed between the recesses 37 and 38 of the switching shaft 36 as shown in FIG. A cutout recess 40 is formed to coincide with the switching shaft 36 and allow the switching shaft 36 to slide. That is, when the finger hook slider 15 is sliding and the electrode slider 13 or the peeler slider 14 is sliding forward, the stopper convex portion 39 comes into contact with the guide shaft 12 and the switching shaft 36 is prevented from switching. The sliders 13 and 14 can be selectively switched by sliding the switching shaft 36 only when the finger slider 15 is retracted to the rear and neither slider 13 or 14 is sliding. Further, the finger slider 15 is provided with a ball 41 and a spring 4 as shown in FIG.
2. A click mechanism 44 consisting of a screw 43 is provided, and engages in a click groove 45 formed in the switching shaft 36 to restrict sliding of the switching shaft 36 at the slidable position. Furthermore, as shown in FIG. 8, the switching shaft 36 has operation button portions 36a and 36b at both ends thereof and protrudes from both sides of the finger slider 15.

Further, in this embodiment of the present invention, the peeler 26b and its shaft 26a are made of an electrically insulating material. This is because when the stripper slider 14 is slid to protrude the stripper 26b from the tip of the sheath 4 and the intraprostatic gland is ablated with the stripper 26b, force is applied to the shaft 26a and the stripper 26b is bent.
The shafts 26a and the shafts 26a touch the distal ends of the electrode devices 24 arranged in parallel inside the sheath 4, but in this state, even if a high-frequency current is accidentally applied to the electrode devices 24, they may come into contact with each other. This improves electrical safety.

As shown in FIGS. 11 and 12, an electrode device guide tube 46 and a stripper guide tube 47 are attached in parallel in the axial direction at the lower part of the scope guide tube 16 extending in front of the handle portion 2. has been done. By arranging both the guide tubes 46 and 47 in this manner, the cross section within the sheath 4 can be used effectively. That is, the two tubes 46 and 47 can be disposed within the sheath 4 without increasing the diameter of the sheath 4 and without sandwiching the irrigation waterway. The conductive shaft 24a of the electrode device 24 inserted through the electrode device guide tube 46 protrudes from the guide tube 46 and extends so as to be located on the side of the scope insertion portion 20 as it goes forward. 1st
As shown in FIG. 1, an electrode support pipe 48 is fixedly inserted through the scope insertion portion 20 midway and slides along the scope insertion portion 20, and the tip arms 24c, 24c of the conductive shaft 24a are inserted into the scope insertion portion 20. I've learned not to touch it. This is because if the conductive shaft distal end arms 24c, 24c swing, the loop electrode 24b at the distal end becomes unstable and the resection range cannot be determined, so the loop electrode 24b is stabilized so that the resection range can be determined. Further, a conductive shaft 24a is located in front of the electrode fixing pipe 48.
Two distal arms 24c, 24c are provided as distal ends thereof, extending symmetrically with respect to the scope insertion section 20. This is because when the intraprostatic gland is excised using the loop electrode 24b, an upward force is applied to the conductive shaft 24.
(a) Since the tip part will warp, a certain degree of strength against bending is provided to prevent this. Further, there is only one conductive shaft 24a rearward of the pipe 48, and a peeler shaft 26a, which will be described later, is disposed in the space created without extending rearward, so that the space inside the sheath 4 is used effectively.

On the other hand, the stripper shaft 26a inserted into the stripper guide tube 47 protrudes from the guide tube 47 and extends directly below the scope insertion section 20, and a first
As shown in FIG. 1, a pipe 49 for supporting a peeler that is inserted through the scope insertion part 20 and slides along the scope insertion part is fixedly installed so that the peeler 26b at the tip does not swing relative to the scope insertion part 20. It's summery.
Further, a guide member 50 for positioning or guiding is fixedly provided on the outer periphery of the peeler shaft 26a near the peeler 26b.

With this configuration, in order to operate the loop electrode 24b to protrude from the tip of the sheath 4, slide the switching shaft 36 with the finger slider 15 retracted backward as shown in FIG. The engaging claw piece 30 of the peeler slider 14 is engaged into and retracted from the recess 38 of the switching shaft 36, while the engaging claw piece 29 of the electrode device slider 13 is engaged with the outer periphery of the switching shaft 36. In this setting state, the click mechanism 4
4 ball 41 is in the click groove 4 of the switching shaft 36
5 and restricts the switching shaft 36 from sliding freely. By sliding the finger slider 15 forward against the biasing force of the spring 33 in the shaft 10 in the above setting state, the loop electrode 24b can be made to protrude from the tip of the sheath 4, and a high frequency current can be applied to the electrode 24b. By applying electricity, the intraprostatic gland can be removed or hemostasis can be performed.

Next, in order to protrude the stripper 26b from the tip of the sheath 5, slide the switching shaft 36 with the finger slider 15 retracted backward as shown in FIG. is engaged and retracted into the recess 37 of the switching shaft 36, while the engaging claw piece 30 of the peeler slider 14 is engaged with the outer periphery of the switching shaft 36. Even in this setting state, the ball 41 of the click mechanism 44 is engaged with the click groove of the switching shaft 36, and the sliding of the switching shaft 36 is regulated. In this state, the finger hook sliver 15
By sliding the separator 26b back and forth against the urging force of the spring 33 within the shaft 11, the separator 26b protruding from the distal end of the sheath 4 moves back and forth, and the prostate tissue can be separated from the surrounding tissue.

At this time, the shaft 26a of the peeler 26 is bent due to the external force, and the shaft 26a and the peeler 26b come into contact with the distal end side of the electrode device 24 arranged side by side inside the sheath 4, but in this state, the electrode device Even if a high frequency current is applied to the electrode device 24, the contacting shaft 26a and the peeler 26b are insulated, so the high frequency current will not flow through these electrode devices 26 and it is safe. Moreover, in this way, the peeler 26 is connected to the electrode device 24.
However, since the peeler 26 is made of an insulating material and has improved lubricity, damage to the electrode device 24 can be prevented. Similarly, the lubricity of the peeler 26 also prevents damage to biological tissues.

FIG. 15 is a sectional view showing a second embodiment of the peeler used in the present invention.

In this embodiment, the peeler 26b is made of an insulating material, while the core material 61 of the shaft 26a is made of strong metal, and the outer periphery is insulated with a resin tube, resin coating, or ceramic pipe 62. It is something. The insulating coating 62 of the core material 61 may be applied to the entire body, or it may be applied only to the portion that protrudes from the excision electrode toward the distal end when the separator 26b is protruded from the sheath distal end and moved back and forth as shown in the figure.

FIG. 16 is a sectional view showing a third embodiment of the peeler. This embodiment has a peeler 26b and a shaft 26a.
are made of strong metal materials 63 and 64, and their outer surfaces are coated with an insulating coating 65 using a resin tube, resin coating, and ceramic coating.

FIG. 17 is a plan view showing a fourth embodiment of the peeler. In this embodiment, the entire rear end of the separator 26b is rounded. This is the peeler 26b
This is to prevent the rear end of the peeling element 26b from engaging with the looped electrode 24b and being unable to be pulled in when the peeling element 26b is pulled back into the sheath 4 after being protruded from the tip of the sheath 4, or to prevent damage to the looped electrode 24b. be.

It should be noted that the above embodiment is merely an example, and it goes without saying that each member can be replaced with another member having the same function.

[Effect of the invention] As explained above, according to the invention, even if a high-frequency current is accidentally applied to the electrode device when the peeler is slid to protrude from the sheath tip, the peeler does not This has the effect of improving electrical safety because high-frequency current does not flow.

[Brief explanation of the drawing]

1 to 14 relate to the first embodiment of the device of the present invention, in which FIG. 1 is a sectional view of the sheath tip showing a state in which the separator is protruded from the sheath tip, and FIG. 2 is a plan view showing the whole. , FIG. 3 is a side view of FIG. 2, FIG. 4 is a sectional view taken along line A-A in FIG. 7 is a sectional view showing the click mechanism in FIG. 6, FIG. 8 is a sectional view showing the switching button, and FIG. 9 is a sectional view showing the stripper slider. Fig. 10 is a perspective view showing a state in which the electrode slider is slid forward and the electrode is slid forward, Fig. 11 is a perspective view showing the distal end side of the peeler and electrode device. A perspective view showing the configuration, FIG. 12 is an enlarged sectional view taken along line C-C in FIG. 3, and FIG. 13 is an enlarged sectional view taken along line D-D in FIG.
FIG. 14 is an enlarged cross-sectional view taken along the line E--E in FIG. 3. 15 to 17 show other embodiments of the peeler, FIG. 15 is a sectional view of the second embodiment, FIG. 16 is a sectional view of the third embodiment, and FIG. 17 is a sectional view of the third embodiment.
The figure is a plan view showing the fourth embodiment. 2...Handle part, 3...Sheath body, 4...
Sheath, 5...Scope, 13, 14...Slider, 24...Electrode device, 26...Peeler, 26a...
...Spindle, 26b...Peeler.

Claims (1)

[Claims for Utility Model Registration] The front fixing part and the rear fixing part are connected to each other by a shaft with a sliding gap. A slender sheath that connects the main body to a connecting part provided on the fixing part and extends forward and is inserted into the urethra; and a slender sheath that is connected and fixed to the connecting part of the rear fixing part and passes through the rear fixing part and the front fixing part. A scope inserted into the sheath, a slider inserted into the sheath and capable of attaching a stripper having a stripper at the tip of an elongated shaft and slidably arranged in the slide gap; a slider equipped with an electrode device having an ablation electrode at the tip of an elongated conductive shaft that is arranged in parallel in the slide gap and inserted into the sheath and to which a high frequency current is applied; and a finger hook part of the handle part. a switching mechanism that selectively connects and disconnects the stripper to the stripper slider and the electrode device slider, and when the stripper is slid by the slide of the stripper slider, at least the part of the stripper that comes out to the front side of the cutting electrode is provided. A resectoscope device characterized by having insulated parts.