JPH0557859B2 - - Google Patents

Description

Detailed Description of the Invention [Technical Field of the Invention] The present invention is directed to removing cartilage (articular meniscus, articular cartilage), chondrocele, tumor, etc. in a joint cavity of a knee or the like from outside the body cavity without making an incision. The present invention relates to a surgical resection instrument for cutting and expelling the body cavity.

[Technical background of the invention and its problems] Conventionally, joint surgery has been mainly performed by an incision method (open surgery). For example, common joint surgeries require relatively large incisions, such as removing tumors on the patella and cutting damaged cartilage, bone, etc. from the knee joint. Therefore, the incision causes trauma, which is accompanied by pain and restricted movement, and has the disadvantage that it takes a long time to heal.

Therefore, in recent years, under the observation of an arthroscope (endoscope), a small puncture hole is formed in the adjustment without incising the joint, and a probe inserted into this puncture hole is used to perform surgery (closed surgery). A device to do this has been proposed. For example, these are disclosed in Japanese Patent Application Laid-Open No. 54-77493. In this prior art, the device is
an elongated fixed outer tube having a cutting opening extending in the axial direction formed on its outer periphery; a tube-shaped inner member rotatably housed within the outer tube and forming an internal rotary blade at the cutting opening; , is equipped with a suction device and a drive motor, and while the tissue pieces, etc. are sucked into the cutting opening by vacuuming, the rotary blade is rotated by the drive motor to cut the cut pieces, and the cut pieces are passed through the tube-shaped inner member. It is configured to be sucked and discharged.

However, in the prior art, the suction pipe cap provided on the main body for connection to the suction device side via a tube or the like protrudes at right angles to the axial direction of the main body. It is not possible to increase the diameter of the tube-shaped inner member, and as a result, the cut tissue pieces that have been sucked into the tube-shaped inner member clog the inlet of the suction pipe mouthpiece, making it impossible to discharge them efficiently. There are some problems. In particular, when resecting a damaged joint meniscus, tumor, etc. in the knee joint cavity, the tissue in the joint cavity is elastic and viscous, so the inlet of the suction tube mouthpiece is Sections tend to become clogged.

[Objective of the Invention] The present invention has been made in view of these circumstances, and it makes it difficult for a section of tissue in a body cavity, for example, a joint cavity, to clog the inlet of a suction tube mouthpiece, thereby improving efficiency. The object is to provide a surgical cutting instrument with good evacuation.

[Summary of the Invention] In order to achieve the above object, the surgical resection instrument according to the present invention includes an outer tube having a tissue-taking aperture at the distal end thereof, and an inner tube having a blade aperture that engages with the aperture of the outer tube. A tube is installed inside the inner tube, and the blade opening of the inner tube and the outer tube blade opening can be opened and closed, and the inside of the inner tube is made into a suction path communicating with the double blade opening, and this suction path and the outlet are opened in the main body. In this case, the main body is provided with a suction pipe cap for communicating with the suction device side, and the suction pipe cap is tilted rearward with respect to the axial direction of the inner tube to increase the opening area of the inlet portion. The opening area of the inlet portion is increased.

[Embodiments of the Invention] Examples of the present invention will be specifically described below with reference to the drawings.

1 to 3 relate to a first embodiment of the surgical cutting instrument of the present invention, in which FIG. 1 is a longitudinal cross-sectional view, FIG. 2 is an enlarged cross-sectional view of the main part of the suction tube mouthpiece, and FIG. FIG. 2 is an explanatory diagram showing an example of a usage state.

In these figures, reference numeral 1 denotes a surgical cutting instrument, which includes a main body 2 that also serves as a grip on the proximal side, and an elongated insertion device that extends forward from the main body 2 and is inserted into a body cavity, such as a joint cavity. It consists of Section 3. The insertion section 3 consists of an outer tube 4 whose open base is fixed to the distal end of the main body 2, and an inner tube 5 housed inside the outer tube 4 so as to be rotatable around an axis. A tissue take-in blade opening 6 is opened at the tip, while the inner tube 4 has a blade opening 7 opened at the tip. The outer tube cutting edge 6 is formed by, for example, notching a hemispherical outer tube bottomed tip portion or a portion of the tube side surface, leaving a partially curved bottomed portion 8 at the tip portion, and cutting the tip bottomed portion 8 from the tube side surface. It is formed continuously. Also, the inner tube cutting edge 7
Similarly to the outer tube cutting edge 6, the hemispherical inner tube has a bottomed tip portion or a portion of the tube side surface that is notched, leaving a partially curved bottomed portion 9 at the tip portion, and the bottomed portion 9 that is tipped from the tube side surface.
It is formed continuously to reach . The outer tube cutting edge 6 and the inner tube cutting edge 7 communicate with each other when the inner tube 5 rotates, and are closed when they shift, forming a double cutting edge. It bites into the tissue when the communicating openings 6 and 7 are opened, and when it is closed, it is cut off and the cut piece is taken into the inner tube blade opening 7. The inner tube of the inner tube 5 forms a section suction path 10 that communicates with the outer tube cutting edge 6 and the inner tube cutting edge 7, and also communicates with the proximal main body 2 to which a section suction device is connected.

The main body 2 is a portion of the resection instrument 1 that is held and operated by an operator such as a surgeon, and includes a housing 11 that houses a drive portion that rotationally drives the inner tube 5 and the like.
and a cavity 12 communicating with the suction path 10 of the inner tube 5.
The front housing 12 is provided with a suction tube mouthpiece 22 connected to a section suction device. The front housing 12 is removably screwed to the housing 11 by, for example, screwing means. Further, this front housing 12 has an annular fixing part 12b extending in the front and a groove part 12c formed in the axial direction of the inner circumference thereof. On the other hand, outer tube 4
A sleeve 13 having a flange 13a at the front is fitted onto the outer periphery of the base, and a pin 14 is installed on the outer periphery of the sleeve 13. Then, with the pin 14 engaged in the groove 12c, the base portion of the outer tube 4 fitted with the sleeve 13 is inserted into the fixing portion 12b, and the outer tube fixing screw body 15 is inserted into the fixing portion 12.
b It is screwed onto the outer periphery to removably fix the outer tube 4 and the base.

A motor 16 is installed in the rear part of the housing 11, and the motor shaft 17 is connected to a male spline 18.
is fixed. On the other hand, an output shaft 19 is rotatably and slidably supported in the axial direction at the front of the motor 16, and a female spline 20 is formed at the rear thereof, and the female spline 20 meshes with the female spline 18. are doing. The output shaft 19
protrudes into the cavity 12a of the front housing 12, and an inner tube sleeve 21, into which the base of the inner tube 5 is fitted and fixed, is inserted and fixed, and the rotational force of the motor 16 is transmitted to the inner tube 5. The inner tube 5 is rotated. The inner tube sleeve 21 is formed in a cylindrical shape with an open front, and is connected to the suction path 10 of the inner tube 5.
communicates with the inside of the sleeve 21. The sleeve 21 also has an opening 21a on its side and communicates with the cavity 12a of the front housing 12.

The suction tube mouthpiece 22 is attached to the outer periphery of the front housing 12 in communication with the cavity 12a. This suction tube mouthpiece 22 is inclined rearward with respect to the axial direction of the housing 12a so that the opening area of its inlet portion can be increased. Further, the front housing 12 to which the suction tube cap 22 is attached is inclined downwardly toward the front on its outer circumferential wall, and an opening at the inlet portion of the suction tube cap 22 is formed in the same way as when the suction tube cap 22 is mounted at a backward angle. The area is enlarged.

The operation of resecting target tissue within a body cavity, for example, a joint canal, using the first embodiment configured as described above will be described below with reference to FIG. 3.

As shown in FIG. 3, in order to resect the target tissue within the target region, for example, the knee joint, a small hole into which the insertion portion 3 of the surgical resection instrument 1 is inserted is inserted into the knee region 31 using a puncture operation such as a trocar. Therefore, the insertion section 3 is inserted through a trocar or the like or directly. In addition, before inserting the insertion section 3, the insertion section 33 of the arthroscope 32, which is equipped with an illumination and observation optical system, is punctured with a trocar or the like so that the surgical resection of the target tissue can be performed while observing the inside of the joint cavity. The arthroscope 33 is inserted into the joint cavity by operation, and the display device 35 displays an image taken directly from the eyepiece of the arthroscope 33 or by a television camera 34 attached to the eyepiece. The insertion portion 3 of the surgical resection instrument 1 inserted into the cavity is made observable. Furthermore, in order to inflate the inside of the joint cavity and facilitate resection surgery, physiological saline can be supplied into the joint cavity from the water supply source 36 through the water supply pipe 37 punctured into the joint cavity at controlled water pressure. . On the other hand, the tube 38 is connected to the suction tube mouthpiece 22 of the proximal grip main body 2 of the surgical resection instrument 1 and connected to the suction and recovery device 39, and the connector (not shown) of the cable 40 is connected to the motor control section 41. The motor 16 is set to a state where power can be supplied.

In this setting state, the operator uses the arthroscope 33 or the display device 35 to observe the inside of the joint cavity and the distal end of the insertion section 3 of the resection instrument 1.
The tissue-taking blade openings 6 and 7 at the tip are brought into contact with the tissue to be resected, and in this state, the switch is turned on and the motor 16 is turned on.
is driven to rotate the inner tube 5 around the axis via a drive transmission system such as the output shaft 19 to engage the outer tube cutting edge 6 and the inner tube cutting edge 7 and opening and closing the cutting edges 6 and 7. The tissue taken into the blade openings 6 and 7 is cut or cut, and the suction and collection device 39 is activated when necessary or constantly to remove the sections from the suction path 10 of the inner tube 5 and the inner tube sleeve 2.
1. Suction and recovery device 39 via the cavity 12a of the front housing 12, the suction tube mouthpiece 22, and the tube 38
can be collected and discharged.

In FIG. 3, reference numeral 42 indicates a light source device, 43 indicates a light guide cable, and 44 indicates a television camera cable.

As described above, in the present invention, the target tissue in a body cavity, for example, a joint cavity, is excised and cut with the blade ports 6 and 7 at the tip of the insertion part 3 of the surgical resection instrument 1 inserted from outside the body cavity, and the cut tissue is transferred to the insertion part. 3 is discharged into the cavity 12 of the main body 2 through the inner path of the inner tube 5, and collected from within this cavity 12 through the suction pipe mouthpiece 22 and the tube 38 to the suction recovery device 39. Since the area of the inlet portion of the suction tube mouthpiece 22 connected to the cavity 12 is formed to be large, there is no risk of the section becoming clogged in this portion.

FIGS. 4 to 6 show second, third, and fourth embodiments of the shapes of the suction pipe mouthpiece 22 and its connecting housing 12. FIG.

In the second embodiment shown in FIG. 4, the base of the suction tube mouthpiece 22 is expanded into a linear shape, and in the third embodiment shown in FIG. 5, it is expanded into a curved shape.
Further, the fourth embodiment shown in FIG.
The outer circumferential wall is flat rather than forward-sloping.

Incidentally, in the above-described embodiments of the present invention, a cutting instrument in which the inner tube is rotated has been described, but the inner tube may be slidable, or the inner tube may be fixed and the outer tube may be rotated or slid. Various methods of cutting are used, such as a method in which members inserted into the outer tube and the inner tube are rotated or slid. Further, the shape of the cutting edge can be used as appropriate.

Furthermore, it is clear that the present invention is applicable not only to joint cavities but also to other intrabody cavities.

[Effects of the Invention] As explained above, according to the present invention, in the body cavity,
For example, a section obtained by removing tissue within a joint cavity is less likely to clog the entrance of a suction tube mouthpiece, and can be efficiently discharged.

[Brief explanation of the drawing]

1 to 3 relate to a first embodiment of the surgical cutting instrument of the present invention, in which FIG. 1 is a longitudinal sectional view, FIG. 2 is an enlarged sectional view of the main part of the suction tube mouthpiece, and FIG. FIG. 4 is an explanatory diagram showing an example of a usage state, and FIGS. 4 to 6 are sectional views of essential parts showing second, third, and fourth embodiments of the present invention. 2... Main body, 3... Insertion section, 4... Outer tube, 5...
...inner tube, 6...blade mouth, 7...blade mouth, 10...section suction path, 22...suction tube mouthpiece.

Claims (1)

[Claims] 1 Inside the outer tube with a tissue inlet opening at the tip,
An inner tube having a cutting edge that engages with the cutting edge of the outer tube is installed, and the cutting edge of the inner tube and the outer tube edge can be opened and closed, while the contents of the inner tube are communicated with the double edge edge. In the case where the suction passage has a suction passage with an outlet opening inside the main body and a suction pipe cap for communicating and connecting to the suction device side, the suction passage has a large opening area at the inlet. A surgical resection instrument characterized in that a tube cap is provided on the main body so as to be inclined rearward with respect to the axial direction of the inner tube, and an inlet portion of the suction tube cap is opened at an angle.