JPH1119086A - Forceps type electric treatment instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To remove and remove a tissue piece in a body cavity easily by opening and closing a pair of cup-shaped forceps pieces without the disadvantages of a monopolar electric treatment instrument. In addition, a bipolar forceps-type electric treatment instrument that does not burn even the living tissue to be collected is provided. SOLUTION: A flexible sheath 4 which can be inserted into a body, and a cup-shaped first sheath attached to a distal end side of the sheath 4.
The first forceps piece 12 in which the recess 24 is formed and the cup-shaped second recess 26 are formed.
A second forceps piece 14 that is openably and closably connected such that the recess 24 and the second recess 26 face each other, and a first electrode formed on a tip side edge of the first recess 24 of the first forceps piece 12. 30 and the second
The proximal end of the sheath 4 is supplied so as to supply a high-frequency voltage between the second electrode 32 formed on the distal end side edge of the second recess 26 of the forceps piece 14 and the first electrode 30 and the second electrode 32. High-frequency power supply 40 connected to the end side, and opening / closing control means 17, 19, 1 for controlling opening / closing of first forceps piece 12 and second forceps piece 14.
8, 22.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a forceps-type electric treatment instrument, and more particularly, to grasping a tissue piece such as a lesion in a body cavity using a cup-shaped forceps and flowing a high-frequency current between the forceps. The present invention relates to a bipolar forceps-type electric treatment instrument capable of burning off the base of a tissue piece by means of the device, thereby enabling treatment of a lesion and collection of the tissue piece.

[0002]

2. Description of the Related Art Biopsy forceps are used to histologically diagnose whether a lesion in a body cavity is benign or malignant. Conventional biopsy forceps are disclosed, for example, in Japanese Patent Application Laid-Open No. 59-9055.
As disclosed in Japanese Unexamined Patent Application Publication No. HEI 3 (1995) -1995 and Japanese Unexamined Patent Application Publication No. Hei 5-42159, a type in which a pair of cup-shaped forceps pieces are opened and closed and cut by an edge of the cup is known.

[0003] However, the biopsy forceps of the type that is cut by the edge of the cup has a problem that the sharp edge portion is likely to damage normal tissue other than the lesion. Also, with this type of biopsy forceps, the sharpness of the edge portion is reduced by several samplings, and the engagement of the edge portion is displaced, resulting in a sharp decrease in sharpness, making it impossible to collect well. It has the problem of becoming.

Therefore, as shown in Japanese Utility Model Laid-Open No. 62-186,708, a monopolar forceps-type electric treatment instrument has been proposed. In this monopolar electric treatment instrument, an electrode is provided on a cup-shaped forceps piece inserted into a body cavity, an electrode plate constituting another electrode is arranged in contact with the outside of a patient, and a high voltage is applied between these electrodes. Is applied. By pinching the tissue piece with the cup-shaped forceps piece, current is concentrated at the base of the picked tissue piece, and the affected tissue at that portion can be coagulated and necrotic and burned off. The burned-out tissue piece remains inside the cup-shaped forceps piece and can be collected.

[0005]

However, in the monopolar forceps-type electric treatment instrument disclosed in the above publication, since the electric current completely penetrates the patient's body because of the monopolar type, the forceps piece is used. There is a possibility that an arc may be generated from a target electrode to an unintended part, or an electric current flowing through the body of a patient may become stray and damage tissue that should not be damaged. In addition, since the unipolar type requires a relatively high output, the arc may cause excessive tissue destruction.

Therefore, a bipolar electric treatment instrument in which a pair of cup-shaped forceps pieces are used as separate electrodes and a high-frequency voltage is applied between these electrodes can be considered, but even the tissue to be collected is burned. As a result, there is a possibility that the examination of the collected tissue cannot be performed accurately.

The present invention has been made in view of such circumstances, and has no inconvenience of a monopolar electric treatment instrument. By opening and closing a pair of cup-shaped forceps pieces, an affected tissue piece in a body cavity can be removed. An object of the present invention is to provide a bipolar forceps-type electric treatment instrument which can be easily coagulated and necrotic and burned out by being picked, and which does not burn even the living tissue to be collected.

[0008]

In order to achieve the above object, a forceps-type electric treatment instrument according to the present invention has a flexible sheath that can be inserted into a body, and is mounted on a distal end side of the sheath. And a first forceps piece having a cup-shaped first recess formed therein, and a cup-shaped second recess formed therein, wherein the first recess and the second recess are formed with respect to the first forceps piece. A second forceps piece that is openably and closably connected to face each other, a first electrode formed on a tip side edge of a first recess of the first forceps piece,
A second electrode formed on the distal end edge of the second recess of the forceps piece, and connected to the proximal end side of the sheath so as to supply a high-frequency voltage between the first electrode and the second electrode. And a switching control means for controlling opening and closing of the first forceps piece and the second forceps piece.

It is preferable that a predetermined gap is formed between the first electrode and the second electrode when the first forceps piece and the second forceps piece are completely closed. In the present invention, the predetermined gap is a distance that keeps the electrodes in an insulated state and does not generate an arc or the like in a state where no living tissue is interposed between the first electrode and the second electrode. Specifically, it is preferably 0.3 to 1.5 mm, more preferably 0.5 to 1.0 mm. If the gap is too far, it becomes difficult to cut the living tissue, and if it is too close, insulation cannot be maintained.

In the present invention, in order to form the first electrode and the second electrode on the distal end side edges of the first and second recesses of the first and second forceps pieces, respectively, the respective forceps pieces are insulated. What is necessary is just to comprise with a member and to form an electroconductive film only in a front-end | tip side edge part. Alternatively, each forceps piece is formed of a conductive member,
An insulating film may be formed except for the end side edge.

The conductive member constituting the forceps piece is preferably a metal having excellent heat resistance and corrosion resistance, such as stainless steel, carbon steel, gold, silver, platinum, nickel, and aluminum. The insulating film formed on the surface of the forceps piece made of such a conductive member is not particularly limited, but may be alumina, titanium nitride, a ceramic coating film such as titanium carbide, a glass coating film,
Synthetic diamond films, polyimide resins, fluororesins and the like are preferred from the viewpoint of heat resistance. Examples of the coating method include an ion plating method, a plasma or flame spray deposition method, an immersion method, and a coating method.

As the insulating member constituting the forceps piece, ceramics such as alumina, titanium nitride and titanium carbide; and resins such as polyimide, polyetherimide, polyethersulfone and fluororesin are preferable from the viewpoint of heat resistance. . The conductive film formed on the surface of the forceps piece made of such an insulating member is not particularly limited,
Silver, copper, gold, platinum and the like are preferred. This is because the conductivity is high. Examples of the coating method include a metal plating method, a sputtering method, an evaporation method, and a coating method.

In the present invention, the connecting portion for opening and closing the pair of forceps pieces is preferably formed of an insulating member.

In the present invention, the open / close control means for controlling the opening / closing of the first forceps piece and the second forceps piece is not particularly limited. A link mechanism for converting the forward and backward movement of the flexible longitudinal member into an opening and closing movement between the forceps pieces, and an operation unit connected to the proximal end of the flexible longitudinal member and operating the forward and backward movement of the longitudinal member in the sheath It is preferable to have

In the present invention, the frequency of the high-frequency voltage supplied from the voltage supply means is not particularly limited.
The power is preferably about 0 kHz to 800 kHz, and the power is preferably about 5 to 35 watts.

[0016]

In order to collect, for example, coagulated necrosis of a diseased tissue and a living tissue using the forceps-type electric treatment device according to the present invention, first, the distal end of the treatment device is removed by using an endoscope or the like. Guide to near the lesion inside. Next, the operation unit connected to the outer-side proximal end of the sheath is operated to rotate the pair of forceps pieces attached to the distal end of the sheath in a closing direction. By closing the pair of forceps pieces, the living tissue piece at the lesion is picked up and positioned in the cup-shaped first and second recesses formed in the forceps pieces. The base of the picked-up living tissue piece at the lesioned portion is connected to the first electrode and the second electrode at the tip side edge of each forceps piece.
The state is sandwiched between the electrodes.

Next, a high frequency voltage is applied between the first electrode and the second electrode from a voltage supply means connected to the proximal end side of the sheath through a conductive wire or the like wired in the sheath. When a high-frequency voltage is applied between these electrodes, current flows only in the base of the piece of tissue sandwiched between the electrodes and heats it, burning off the base. This heating also causes hemostasis and coagulation necrosis of the cut portion. In the recess of the forceps piece,
A cut biopsy piece remains. Therefore, if the treatment instrument is taken out of the body cavity with the forceps pieces closed, the collection of the biopsy tissue piece is completed.

In the present invention, current flows only through the living tissue sandwiched between the electrodes formed on the distal end side edge of the forceps piece.
Therefore, compared with the monopolar type, the cauterization of the living tissue is less, and the coagulation necrosis of the lesion and the excision of the tissue piece can be reliably performed with a small electric power. Electrodes are formed only in portions necessary for energization, and the inside of the cup-shaped recess of the forceps piece in which the cut living tissue piece is stored is insulated, so that the cut living tissue piece is not damaged. .

In particular, by forming a predetermined gap between the first electrode and the second electrode in a state where the forceps pieces are closed, a short circuit between these electrodes can be effectively prevented.

[0020]

DESCRIPTION OF THE PREFERRED EMBODIMENTS The present invention will be described below based on embodiments shown in the drawings.

FIG. 1 is a schematic view of a forceps-type electric treatment instrument according to an embodiment of the present invention, FIG. 2 is a plan view of a main part on the distal end side of the forceps-type electric treatment instrument shown in FIG. 1, and FIG. Side view of FIG. 4
Is a plan view of a forceps piece alone, and FIG. 5 is a schematic view of a forceps-type electric treatment instrument according to another embodiment of the present invention.

First Embodiment As shown in FIG. 1, a forceps-type electrosurgical treatment instrument 2 according to the present embodiment has a sheath 4 that can be inserted into the body. The sheath 4 has a lumen inside and is made of a flexible material. The material constituting the sheath 4 is not particularly limited as long as it is an electrically insulating material having flexibility. Polyethylene, polypropylene, polyvinyl chloride, polyurethane, polyamide, polyester, polycarbonate,
Plastics such as polyether sulfone and fluororesin can be used, and a material having an appropriate elastic modulus can be selected according to the purpose.

The outer diameter of the sheath 4 is not particularly limited.
Preferably, it is 1.0 to 5.0 mm, more preferably 1.
5 to 3.0 mm. The thickness of the sheath is not particularly limited, but is preferably 0.1 to 1.5 mm, and more preferably 0.2 to 1.0 mm.

As shown in FIGS. 1 and 2, a support member 6 is fixed to the distal end of the sheath 4 (the side to be inserted into the body) by means such as adhesion or fusion. The support 6 is made of an insulating member such as ceramic, polyimide, polyethersulfone, or a fluorine-based resin, and has a pair of support pieces 8 that protrude in the axial direction.

At the distal ends of the support pieces 8, 8, a fulcrum shaft 10 is provided.
And the link pieces 13 and 15 of the first forceps piece 12 and the second forceps piece 14 are
Are rotatably mounted. As shown in FIG. 2, an insulating spacer 16 is mounted between the link pieces 13 and 15, and their insulation is maintained. The fulcrum shaft 10 and the insulating spacer 16 are made of, for example, a heat-resistant plastic such as polyimide, polyether sulfone, or a fluorine-based resin.

As shown in FIG. 1, other link pieces 17 and 19 are connected to the link pieces 13 and 15 of the forceps pieces 12 and 14 in a pantograph shape. The distal end of the longitudinal member 18 is connected. The longitudinal member 18 is attached so as to be able to advance and retreat in the longitudinal direction X along the lumen inside the sheath 4. The longitudinal member 18 has sufficient flexibility so that an operating force can be transmitted along the longitudinal direction X and can be bent together with the sheath 4 in the radial direction of the sheath 4. I have. Further, the longitudinal member 18 is preferably made of an insulating material.
As the longitudinal member 18 that satisfies such a requirement, a rod made of a plastic such as polyamide, polyacetal, or a fluororesin, or stainless steel coated with an insulating material can be used.

The proximal end of the elongate member 18 is connected to a handle 22 movably mounted in the longitudinal direction X with respect to an operation unit 20 arranged outside the body. The operation unit 20
It has an outside diameter that is easy to hold with one hand, and is joined to the proximal end of the sheath 4 by means of adhesion or fusion. In addition, it may be formed integrally with the sheath 4. The material of the operation unit 20 is made of the same insulating material as the sheath 4.

By moving the handle 22 forward and backward in the longitudinal direction X with respect to the operation unit 20, the longitudinal member 18 moves in the lumen of the sheath 4 along the arrow X direction, and the links 17 and 19 are operated. And the forceps pieces 12 and 14
And open / close them can be controlled.

As shown in FIGS. 1 and 4, each forceps piece 12, 1
4, a cup-shaped first recess 24 and a second recess 26 are respectively formed. The volume of each of the recesses 12 and 14 is not particularly limited, but is determined according to the volume of a living tissue piece to be collected and the like, and is preferably 0.5 to 33.0 mm ³ , respectively.
More preferably, it is about 1.0 to 18.0 mm ³ .
The forceps pieces 12, 14 are arranged such that the recesses 24, 26 face each other.
The link pieces 13 and 15 are rotatably mounted on the fulcrum shaft 10.

The first electrode 30 and the second electrode 3 are provided at the distal end side edges of the recesses 24, 26 of the forceps pieces 12, 14, respectively.
2 are formed. The electrode area of each of the electrodes 31 and 32 is not particularly limited, but is preferably 0.3 to 5.0 mm ² .

The distal ends of conductive wires (not shown) extending insulated from each other through the sheath 4 are electrically connected to the electrodes 30 and 32, respectively. The proximal end of each conductive wire is connected to a high-frequency power supply 40 as a voltage supply means via an electric cord 42 branched from the operation unit 20, and a high-frequency voltage is applied between the electrodes 30 and 32 from the high-frequency power supply 40. Is applied.

The frequency of the high-frequency voltage supplied from the high-frequency power supply 40 is not particularly limited.
0 kHz is preferable, and the electric power is preferably 5-35.
About watts.

In the present embodiment, each forceps piece 12, 14
It is made of stainless steel, and all parts other than those corresponding to the first electrode 30 and the second electrode 32 are covered with an insulating film. In the present embodiment, the insulating film employs a ceramic coating film such as alumina. This ceramic coating film can be formed by an ion plating method or the like. The thickness of the insulating film is such that the insulation of both forceps pieces 12 and 14 is maintained, and is preferably 0.01 to 0.06 mm.

Although not shown, each forceps piece 1
The link pieces 13 and 15 are also coated with an insulating film, and only a part of each of the link pieces 13 and 15 is formed with a portion that is not coated with the insulating film, and the distal end of each conductive wire is connected thereto. A high frequency power supply 40 is connected through the sheath 4. As a result, a high-frequency voltage is applied between the two electrodes 30 and 32 from the high-frequency power supply 40.

In this embodiment, as shown in FIG. 3, when the pair of forceps pieces 12, 14 are completely closed, the electrodes 30, 32 of the forceps pieces 12, 14 have a predetermined gap t. The links 17, 19 shown in FIG.
Has been adjusted. The predetermined gap t shown in FIG. 3 is such that no living tissue is interposed between the first electrode 30 and the second electrode 32, the electrodes 30 and 32 are kept in an insulated state, and an arc or the like is not generated. , Specifically, 0.4 to 1.5 mm.

In order to use the forceps-type electrosurgical treatment instrument 2 according to the present embodiment to collect, for example, a living tissue at a lesion, the distal end of the treatment instrument 2 is firstly treated with an endoscope or the like.
It is guided to the vicinity of the lesion 52 in the body cavity 50 shown in FIG. Next, the handle 22 is operated to be pulled from the operating section 20 connected to the outer-side proximal end of the sheath 4 shown in FIG.
A pair of forceps pieces 12 and 14 attached to the proximal end of the sheath 4
Is rotated in the closing direction. By closing the pair of forceps pieces 12 and 14, the biological tissue piece at the lesion 52 is picked up and positioned in the cup-shaped first and second recesses 24 and 26 formed on the forceps pieces 12 and 14. The base of the picked up living tissue piece of the lesion 52 is sandwiched between the first electrode 30 and the second electrode 32 at the distal end edges of the forceps pieces 12 and 14. FIG. 3 shows this state.

Next, a high-frequency voltage is applied between the first electrode 30 and the second electrode 32 from a high-frequency power supply 40 connected to the proximal end side of the sheath 4 through a conductive wire or the like wired in the sheath 4. When a high-frequency voltage is applied between the electrodes 30 and 32, current flows only in the base of the piece of tissue sandwiched between the electrodes 30 and 32, and the tissue is heated and burned. This heating also causes coagulation necrosis and hemostasis around the cut. The cut biopsy pieces remain in the recesses 24 and 26 of the forceps pieces. Therefore, if the treatment instrument is taken out of the body cavity with the forceps pieces closed, the collection of the biopsy tissue piece is completed.

In the present embodiment, current flows only through the living tissue sandwiched between the electrodes 30 and 32 formed on the distal side edges of the forceps pieces 12 and 14. Therefore, compared with the monopolar system, the cauterization of the living tissue is reduced, and the tissue piece can be reliably removed with a small electric power. Electrodes 30 and 32 are formed only in portions necessary for energization, and the insides of the cup-shaped recesses 24 and 26 of the forceps pieces for accommodating the cut biological tissue pieces are insulated. No damage to living tissue pieces.

In addition, since a predetermined gap is formed between the first electrode 30 and the second electrode 32 in a state where the forceps pieces 12 and 14 are closed, a short circuit between the electrodes 30 and 32 may occur. It can be effectively prevented. Forceps pieces 12, 14
The insulation between the link pieces 13 and 15 integrally formed on
It is secured by the fulcrum shaft 10 and the insulating spacer 16 made of an insulating member shown in FIG.

Second Embodiment In this embodiment, as shown in FIG.
Opening and closing control means for controlling opening and closing of the forceps piece 1
It has two flexible filaments 18a which are directly connected to the link pieces 13 and 15 of the two and fourteen. The proximal end of the flexible filament 18a is connected to the handle 22. The two filaments 18a are insulated from each other, and each of the filaments 18a has a built-in conductive wire. The proximal end of each conductive wire is code 4
2, the electrodes 30, 32 shown in FIG.
And a high-frequency power supply 40 so that a high-frequency voltage can be applied between the electrodes. Other configurations and operations are the same as those of the first embodiment.

It should be noted that the present invention is not limited to the above-described embodiment, but can be variously modified within the scope of the present invention.

For example, in the above embodiment, the forceps piece 1
2 and 14 are made of a conductive member, and portions other than the portions corresponding to the electrodes 30 and 32 are covered with an insulating film.
Each of the forceps pieces 12 and 14 may be formed of an insulating member, and a conductive film may be formed only on the tip side edges corresponding to the electrodes 30 and 32 of the forceps pieces 12 and 14.

[0043]

As described above, according to the present invention, an electric current flows only through the living tissue sandwiched between the electrodes formed on the tip side edge of the forceps piece. Therefore, compared with the monopolar system, the cauterization of the living tissue is reduced, and the coagulation necrosis of the affected tissue and the excision of the tissue piece can be reliably performed with a small electric power. Electrodes are formed only in portions necessary for energization, and the inside of the cup-shaped recess of the forceps piece in which the cut living tissue piece is stored is insulated, so that the cut living tissue piece is not damaged. .

In particular, by forming a predetermined gap between the first electrode and the second electrode in a state where the forceps pieces are closed, a short circuit between these electrodes can be effectively prevented.

[Brief description of the drawings]

FIG. 1 is a schematic view of a forceps-type electric treatment instrument according to an embodiment of the present invention.

FIG. 2 is a plan view of a main part on a distal end side of the forceps-type electric treatment instrument shown in FIG.

FIG. 3 is a side view of FIG. 2;

FIG. 4 is a plan view of a forceps piece alone.

FIG. 5 is a schematic view of a forceps-type electric treatment instrument according to another embodiment of the present invention.

[Explanation of symbols]

 2 ... forceps type electric treatment instrument 4 ... sheath 10 ... fulcrum shaft 12 ... 1st forceps piece 14 ... 2nd forceps piece 18 ... elongate member 20 ... operation part 22 ... handle 24 ... 1st recess 26 ... 2nd recess 30 ... 1st electrode 32 ... 2nd electrode

Claims (2)

[Claims] 1. A flexible sheath that can be inserted into a body, a first forceps piece attached to a distal end side of the sheath and having a cup-shaped first recess formed therein, and a cup-shaped first forceps piece. A second recess formed with two recesses, the first recess being openably and closably connected to the first recess so that the first recess and the second recess face each other; A first electrode formed at a tip side edge of one recess, a second electrode formed at a tip side edge of a second recess of the second forceps piece, the first electrode and the second electrode, A force supply means connected to the proximal end side of the sheath so as to supply a high-frequency voltage between the forceps; and an opening / closing control means for controlling opening / closing of the first forceps piece and the second forceps piece. Type electric treatment instrument. 2. A predetermined gap is formed between the first electrode and the second electrode when the first forceps piece and the second forceps piece are completely closed. 2. The forceps-type electric treatment instrument according to 1.