JPH0938104A - Incision operation device and incision operating kit by high-frequency current - Google Patents

Abstract

PROBLEM TO BE SOLVED: To easily and safely apply an incision operation for an anterior, e. of the cornea without requiring skill by applying an insulating layer to entire length, forming blades on both sides by narrowing the lateral width of the pointed end of the tip part of a shaft whose center part is curved, bending the pointed end to the side opposite to the curved side of the shaft by micro length and exposing a conductive material by eliminating the insulating layer. SOLUTION: This surgical operating kit 2 is formed by mounting a metallic shaft 30 integrally with a ferrule 31 energized by inserting loadably/unloadably to a hand piece 4. The surface of the shaft 30 is coated with an insulating layer of Teflon (R). The intermediate part of the shaft 30 is bent 32, and a tip end face 33 is formed in the slope of around 75 deg., and also in convergent shape, then, the blades 35 are formed on both sides. Moreover, an insulating chip 37 is pierced through from the tip 33 to the base 31. The length by around 15-20μm of the pointed end 34 of the tip part 33 is bent in the one nearly equal to the coating width of the anterior, e. of the cornea 20, and also, the insulating layer is eliminated, and the metallic material of the shaft 30 is exposed.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an incision operation device and an operation instrument used for incision of the anterior capsule of a lens during cataract surgery and other internal microscopic surgery.

[0002]

2. Description of the Related Art Prior to eye surgery such as cataract surgery and artificial lens insertion, an incision instrument is inserted into the anterior chamber by incising the sclera or part of the cornea, and the anterior capsule of the lens is incised. Is essential. The success of ultrasonic cataract surgery and intraocular lens insertion depends largely on whether or not the anterior capsule incision was performed successfully in a continuous and circular manner as planned. An example of an anterior capsulotomy device is disclosed in Japanese Patent Laid-Open No. 5-76562. As shown in FIG. 5, the shaft body (70) of the surgical instrument (7) having the mouthpiece (71) fitted to the handpiece (4) is inserted into the anterior chamber (14) behind the cornea (12), Apex (75) of the anterior lens capsule (20)
500V while controlling the voltage to 0 to 5V by touching
A high frequency current of kh is intermittently output with a pulse width of 3 to 11 ms and a rest period of 22 to 30 ms to cause local coagulation in the anterior capsule. After generating a large number of freezing points so as to draw a closed curve at short intervals, the inner anterior capsule surrounded by the closed curve is mechanically pulled up and removed.

[0003]

[Problems to be solved] The conventional method is a punctiform incision in which the anterior capsule is intermittently and locally coagulated and the film is pulled up so as to connect the coagulation points, so that a skilled technique is required. Since cells at the freezing point are partially carbonized and become brittle, when the anterior chamber is pushed up to become a shallow anterior chamber due to outflow of aqueous humor to the outside of the eye during cataract surgery and increase in vitreous pressure, The anterior chamber becomes tense and the pulling force that acts toward the periphery acts,
A crack is generated from a discontinuous portion of the point solidification point. If the anterior capsule is inadvertently pulled up, the incision line does not pass through the freezing point and extends to the edge of the capsule and cracks, resulting in posterior capsule damage and making intraocular lens insertion impossible.

As shown in FIG. 5, in the surgical instrument, the central portion of the shaft body (70) is bent at an obtuse angle (72), and the distal end is bent again at the opposite side (73).
Then, a conical needle tip (75) is projectingly provided on the end face of the tip portion (74) from the second bend (73) so that a high frequency current flows from the needle tip (75). During surgery, the doctor places the tip (74) under the microscope approximately perpendicular to the anterior capsule (20) and the tip (75)
Is moved to a line of the anterior capsule (20) to be incised, and a foot switch (not shown) is energized to coagulate the anterior capsule into a point shape. While observing the coagulation of the anterior capsule, the point of the anterior capsule (75) is moved one after another to perform point coagulation of the anterior capsule, but since the freezing point (21) is under the tip (74) under the microscope, , The doctor could not observe the coagulation position of the anterior capsule because the tip (74) got in the way,
An anterior capsule incision will be performed by almost a blind procedure. Moreover, from the freezing point of the anterior capsule, bladder fluid is boiled and gas is generated due to energization of high frequency current, and bubbles are generated at the tip (74)
There was a problem of obstructing the field of vision by blocking the surrounding area of the skin and the back side of the cornea (12).

As described above, in order to safely and correctly perform cataract surgery, although the anterior capsule incision holds the key as described above, the anterior capsulotomy operation has hitherto relied on the experience and skill of a special expert. Was there. The present invention discloses a surgical instrument and a device capable of performing anterior capsule incision easily and safely without requiring special skill.

[0006]

The incision surgical instrument of the present invention is provided with an insulating layer over the entire length thereof, and with respect to a shaft body having a bent central portion, the lateral width of the tip and the tip thereof is narrowed and the thickness thereof is reduced. By sharpening, cutting edges are formed on both sides, the tip is bent by a minute length on the side opposite to the bending of the shaft, and the insulating layer at the tip is removed to expose the conductive material at the tip.

Further, in the open surgery apparatus, the open surgical instrument is connected to a high frequency current oscillator having an ON-OFF switch in the circuit.

[0008]

[Operation] The shaft of the surgical instrument (3) attached to the handpiece (4)
(30) is inserted into the anterior chamber (14) through the incision in the sclera (11),
The tip (34) of the tip (33) is applied to the anterior lens capsule (20). The switch (6) causes the oscillator (5) to generate a high-frequency current having the optimum frequency, waveform, and amplitude for the anterior capsulotomy electric knife. Since the shaft body (30) of the surgical instrument (3) is covered with the insulating layer (36) and the insulating tube (37), the anterior capsule is formed only at the tip (34).
A high-frequency current is applied to (20) to cause a cell incision action.
Since the tip (34) has a minute length which is almost equal to the thickness of the anterior capsule (20), neither excessive insertion of the surgical instrument tip (33) nor excessively large lens coagulation occurs.

In the shaft body of the surgical instrument (3), the tip portion (33) is a bent portion.
Since it extends straight from (32), the thickness and both sides are thin and the width is reduced, it does not hinder direct view of the tip (34) that conducts electricity, and the doctor can see the position of the tip (34) under the microscope. The surgery can be continued while observing clearly. Moreover, since energization is performed only at the extremely minute tip (34), especially at the cutting edge in the advancing direction of the surgical instrument, the evaporation of tissue and the generation of bubbles at the freezing point are small and the visual field is not blocked as in the conventional case. . The cells hardly coagulate, and the surgical instrument (3) exerts only an incision action. The doctor operates the foot switch (6) and carries the tip (34) so as to draw a closed curve on the surface of the anterior capsule (20). For example, surgical instrument (3
When carrying the tip (34) to the right of the clock by utilizing the knife-shaped edge on the tip of (6), the right edge of the tip is involved in the discharge for half the circumference, and the wrist for the next half circumference. In return, the left edge is discharged. In addition, since the tip (34) is bent in a hook shape from the tip (33) by a length approximately equal to the thickness of the anterior capsule film, the anterior capsule that has been incised by using the tip (34) is cut into the lens (2). ) Can be removed from

[0010]

[Effect] In the surgical instrument (3), the axial body extends straight from the bent portion (32), and the thickness and width of the tip portion (33) are narrowed and reduced. Do not disturb
In the case of a conventional surgical instrument (Fig. 5), the tip (75) that becomes the electrode
Since the needle is needle-shaped, the shaft is designed to be bent 90 ° again (73) so that it is vertically applied to the anterior capsule, and the tip (74) is designed to be visible to the operator. In contrast, in the present invention, the tip (34)
Since it is a knife-shaped cutting blade, it is not necessary to bend the shaft body a second time, and the tip portion (33) can be extended or set at an arbitrary angle. In addition, when coagulating tissue by electric discharge, in the conventional surgical instrument (FIG. 5), since the electrode tip has a conical needle shape, the discharge area is wide and a large amount of bubbles are generated. Since the tip (34) that becomes is a thin knife shape, the surface area of the exposed metal part of the electrode is small,
Generation of air bubbles is small. Therefore, the operation can be continued while always observing the operation position on the anterior capsule. Furthermore, a female-shaped cutting edge is formed on both sides of the tip and the tip, and since the anterior capsule can be continuously incised, the anterior capsule can be pulled up by the tip (34), or by other intraoperative procedures. There is no risk of cracking the anterior capsule or leaving the freezing point as in the past and extending the incision line to the posterior capsule and the ciliary band. Since the anterior capsule incision can be safely performed without requiring any skill, the success rate of the subsequent lens surgery and eye surgery can be dramatically improved. For example, in the present invention, at the time of incision, a pulling force toward the peripheral portion such as a tear-off operation or a push-off operation is not generated, so a small circular incision can be performed first, and then a secondary enlarged circular incision can be performed. . Therefore, it becomes easy to protect the corneal endothelium against the lens nucleus fragments by ultrasonic cataract surgery. Further, it is easy to prevent the anterior capsule incision window from contracting, which is also effective for the postoperative glare phenomenon.

[0011]

The drawings and the following description are for facilitating the understanding of the invention, and should not be construed as limiting the description of the claims.

The surgical apparatus includes a handpiece (4) and an oscillator (5).
To generate a high-frequency current having a frequency, waveform, and amplitude suitable for cutting the anterior capsule. The patient is brought into contact with the ground electrode, the oscillator (5) is grounded, the surgical instrument (3) is detachably attached to the handpiece (4), and the operation switch (6) of the oscillator (5) is operated to operate the surgical instrument. A high frequency current is applied to (3).

The surgical instrument (3) is detachably attached to the handpiece (4) to energize the mouthpiece (31) and has a metal shaft body (30).
It is one that is attached. The shaft (30) has a diameter of 0.3 m
It is a thin metal wire with a length of 30 mm and a length of 30 mm.
2) Then, the tip part (33) is formed by tapering the end face to a slope of about 75 °, making the thickness thin toward the tip and narrowing the width, and forming the cutting edges (35) (35) on both sides. . The surgical instrument (3) can be made by bending the shaft and the tip by using an injection needle of similar shape. On the surface of the shaft (30), a thickness of 0 is obtained by vapor deposition, adhesion or application of an insulating material such as Teflon or polysulfone.
An insulating layer (36) of 04 mm is formed to electrically insulate the surface of the shaft body (30). Further, an insulating tube (37) is passed from the tip (33) to the base (31) or latex is applied. Make the tip (34) of the tip (33) approximately equal to the film thickness of the anterior capsule (20).
Bend to a length of 5 to 20 μm. Simultaneously with the bending of the tip (34), the insulating layer (36) is removed, and the metal material of the shaft body is exposed.

In the anterior capsule incision, the doctor first stands on the head side of the patient and incises the cornea (11) or the cornea from the 12 o'clock side or side of the eyeball, and the distal end (33) of the surgical instrument (3). Is inserted into the anterior chamber (14). The surgical site may be performed from any part of the anterior capsule 360 °. While observing the tip (34) of the surgical instrument (3) against the anterior capsule while observing it with a microscope, operating the foot switch (6) causes the tip (3) to move.
A high-frequency current is passed between the anterior capsule (4) and the anterior capsule (20). While continuing to energize, the tip is continuously carried on the anterior capsule (20) according to the contour to be incised. Cutting edge (3) on the side of the tip (33) and the tip (34)
5) exerts an incision action with almost no coagulation of cells. In the surgical instrument of the present invention, even if the above-mentioned controlled high-frequency current is applied, the cells of the anterior capsule are hardly coagulated, and the reason why they can be incised is not clear, but the following principle Is estimated. That is, the surgical instrument (3) of the present invention has a flat tip (34) and is formed with cutting edges on both sides. When performing a surgical operation, one of the cutting blades is energized in the direction of transition of the surgical instrument. Discharge from the cutting edge of the transition side,
The discharge is local compared to (Fig.). This is because the cells do not reach the coagulation temperature, a steam explosion is continuously generated between the cells, and the cell boundaries are easily separated. Since the apex (34) has an extremely slight exposure of about the thickness of the anterior capsule (20), when the tip (33) is applied to the anterior capsule (20), the apex (34) incises the anterior capsule. Only by doing so, it is almost possible to avoid penetrating the anterior capsule and accidentally coagulating the inner lens (2) tissue.

Further, since the tip (34) is the apex of a triangular shape with the tip (33) being tapered, and since electricity is only applied to this tip, there is almost no bubble generation due to the electric scalpel incision, and the microscope is used. Energization and incision are made at the tip (34) while continuing observation without obstructing the lower visual field. Power the anterior capsule and make an incision
(34), the inner anterior capsule surrounded by the incised contour is hooked to the apex (34) and pulled up, or removed with tweezers to expose the lens nucleus (2). It is possible to easily perform ultrasonic cataract surgery, delivery of the lens nucleus by the extrusion method, artificial lens insertion, and the like.

The above description of the embodiments is for explaining the present invention, and should not be construed as limiting the invention described in the claims or limiting the scope. The configuration of each part of the present invention is not limited to the above embodiment, and it goes without saying that various modifications can be made within the technical scope described in the claims.

[Brief description of drawings]

FIG. 1 is a vertical cross-sectional view of a surgical operation state of a crystalline lens.

FIG. 2 is an enlarged cross-sectional view of a surgical instrument distal end portion.

FIG. 3 is a plan view of an eyeball and a surgical instrument in the operation state of FIG.

FIG. 4 is an enlarged plan view of a surgical instrument distal end portion.

FIG. 5 is a vertical sectional view of a conventional example.

[Explanation of symbols]

 (12) Corneal (14) Anterior chamber (2) Lens (20) Anterior capsule (3) Surgery instrument (30) Shaft (31) Base (32) Bend (33) Tip (34) Tip (35) Cut Blade (36) Insulating layer (4) Handpiece (5) Oscillator (6) Foot switch

Claims (2)

[Claims] 1. In an incision surgical instrument using a high frequency current in which the shaft is bent at an obtuse angle, the width of the tip of the shaft is changed while covering the entire length of the shaft formed of a conductive material with an insulating layer. Shrink and thin to sharpen the tip, and bend the tip on the side opposite to the flexion of the shaft, a minute length to the thickness of the anterior lens capsule and form cutting edges on both the tip and the tip. Then, an incision surgical instrument in which the insulating layer on the tip is removed to expose the conductive material on the tip. 2. A high-frequency oscillator is connected to an incision surgical instrument by a high-frequency current in which the whole length of a shaft formed of a conductive material is covered with an insulating layer and the shaft is bent at an obtuse angle, and a high-frequency oscillator is connected to the circuit of the high-frequency oscillator. A surgical incision device for controlling the output of a surgical instrument by inserting a switch into the surgical instrument, wherein the incisional surgical instrument reduces the width of the tip of the bent shaft body to make the thickness thinner and sharpen the tip. On the side opposite to the flexion of the shank, bend a minute length to the thickness of the anterior capsule of the lens and form cutting edges on both sides of the tip and tip, remove the insulating layer at the tip and make the tip electrically conductive. Incision surgery device with high-frequency current exposing materials.