JPH1176255A - Surgical tools - Google Patents

Abstract

(57) [Summary] [PROBLEMS] To provide a surgical tool that can be easily changed according to the position and orientation of a surgical target and that is excellent in operational sensation. A pad (4) pivotally attached to a distal end of an outer tube (6) so as to be rotatable in a radial direction, and a distal end portion is connected to the pad (4). A pad operating rod 3 disposed along the shaft 5 and a shaft 5 disposed similarly.
And an ultrasonic brake disposed at a tip of the shaft portion so as to face the pad.
And a handpiece 8 connected to the rear end of the shaft for rotating the ultrasonic blade. The base also has an operation ring 211 and the tip is a pad operation. A surgical instrument comprising: an operation lever-21 connected to a rod; and a lever storage case 7 for pivotally connecting the operation lever and fixing a rear end of the outer tube.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical instrument for performing incision, exfoliation, grasping, and coagulation of a bleeding site when performing a surgical procedure, particularly when using an endoscope.

[0002]

2. Description of the Related Art In surgical procedures, it is necessary to cut tissue with bleeding and to stop the bleeding due to the cutting. When performing laparotomy and thoracotomy, of course,
Especially in endoscopic surgery, hemostasis is important.

Conventionally, a surgical tool 9 using ultrasonic waves has been used as a surgical tool for cutting tissue and stopping blood by coagulating a bleeding site. FIG. 1 shows the surgical instrument 9.
This will be described with reference to FIGS. The surgical tool is shown in FIG.
As shown in the figure, a tissue operation unit 903 for operating a tissue to be subjected to an operation, and a tissue operation unit 90 for operating the tissue.
3 is comprised of a surgical tool operating unit 901 for moving and a connecting unit 902 for connecting the two. Hereinafter, the tissue operation unit 903, the connection unit 902, and the surgical tool operation unit 901 will be described with reference to FIGS.
This will be described in detail with reference to FIG.

[0004] The organization operation unit 903 is shown in FIGS.
As shown in (1), there is provided an ultrasonic blade 951 for incising tissue using ultrasonic energy to coagulate a bleeding site, and a pad 94 which is opposed to the ultrasonic blade 951 and rotates. As shown in FIG. 11, when the ultrasonic blade 951 and the pad 94 are closed, the target tissue is sandwiched and grasped. Also, as shown in FIG. 12, in the opened state, the pad 94 keeps tissue not related to the operation away from the ultrasonic blade 951. Thus, the rotation of the pad 94 causes
Manipulate the organization.

On the other hand, the surgical instrument operating section 901 has an annular grip handle 971 and a lever storage case 97 to which the handle is fixed. In the lever storage case 97, a link lever 92 for operating the pad 94 and an operation lever 91 for rotating the link lever 92 are pivotably connected. The operation lever 91
Has a ring-shaped operating ring 911 at its base, and the operating ring 911 is disposed between the grip handle 971 and a handpiece 98 described later.

The connecting portion 902 has a shaft portion 95 integrally fixed with the ultrasonic blade 951 at a front end portion, a front end portion connected to the pad 94 and a rear end portion connected to the link lever 9.
2 has a pad operating rod 93 engaged therewith. The pad operation rod 93 and the shaft 95 are arranged inside the outer tube 96 along the axis thereof. The rear end of the shaft portion 95 is connected to a handpiece 98 for rotating the ultrasonic blade 951.

Here, an operation method of the conventional surgical instrument 9 will be described with reference to FIGS. The surgeon can grasp the grip handle 971 as shown in FIG.
Put the finger from the index finger to the little finger or the middle finger to the little finger in the ring part of, and hold the grip handle 971 with four or three fingers. On the other hand, the thumb 99 is put into the operation ring 911 of the operation lever 91. That is, a pistol-type grip is made.

In operation, the operation lever 91 is rotated with the thumb 99. As a result, as shown in FIGS. 11 and 12, the operation lever 91 is connected to the shaft pin 972.
Around the center. Accordingly, the operation lever 91
Link lever 92 engaged with recess 913 at the tip of
Is pushed in the rotating direction about the shaft pin 972.

As a result, the link lever 92 rotates about the shaft pin 922. Accordingly, the pad operating rod 93 engaged with the link lever 92 slides, so that the pad 94 rotates about the shaft pin 941. Then, as described above, by rotating the pad 94, the tissue is sandwiched between the ultrasonic blade 951 (FIG. 11) and the tissue is opened (FIG. 12).

[0010]

However, in the conventional surgical instrument 9, the grip handle 971 has a shape protruding far in the radial direction of the outer tube 96.
It is a so-called pistol type. Therefore, the surgeon grasps the grip handle 971 with the four fingers and
9, only the operation method of operating the operation lever 91 can be performed.

Approximately 18 people can rotate their wrists.
It is about 0 degrees. Therefore, the range in which the surgeon can easily rotate the tissue operation section 903 of the surgical instrument 9 in accordance with the direction of the target tissue is limited to about 180 degrees around the axis of the shaft section 95. . In the rotation range larger than this, it is necessary to further rotate the arm or the body or to operate the grip handle 971 while holding it upside down.

However, if the surgeon twists his arm or body in an unnatural direction to perform the operation in order to adjust the tissue operation unit 903 to the direction of the tissue to be operated, the surgeon also suffers. In addition, it is an inadequate operation in surgery that requires careful attention.

It is also conceivable to perform the surgery by re-gripping the grip handle 971 upside down with the surgical instrument 9 rotated about 180 degrees about the axis of the shaft 95. However, in this case, the operation ring 911 of the operation lever 91 is connected to the grip handle 971.
Is arranged on the side closer to the lever storage case 97 of the ring portion, so that it is difficult to put the thumb 99 on the operation ring portion 91, and the operation is very difficult. Therefore, the same problem as described above occurs.

The opening / closing mechanism of the pad 94 is such that the operation of the operation lever 91 is performed to the link lever 92, the link lever 92 is operated to the pad operation rod 93, and the pad operation rod 9 is operated.
This is a three-stage link structure transmitted from 3 to the pad 94. The rotation of each of the levers 91 and 92 may cause a slight swing. Therefore, in such a three-stage link structure, the accuracy of transmitting the operation of the operation lever 91 to the pad 94 is low. Conversely, the pad 9
The accuracy with which the gripping force between the blade 4 and the ultrasonic blade 951 is transmitted to the operation ring 911 of the operation lever 91 is also low. Therefore, it may give the surgeon a wrong feeling of operation.

The present invention has been made in view of the above-mentioned conventional problems, and enables a surgeon to easily change a surgical tool operation unit according to the position and orientation of a tissue to be operated on. It is an object of the present invention to provide a surgical tool that can transmit the operation sensation to the tissue operation unit with higher accuracy.

[0016]

According to a first aspect of the present invention, there is provided a pad which is pivotally attached to a distal end of an outer tube so as to be rotatable in a radial direction thereof, and a distal end portion is connected to the pad. A pad operating rod internally provided along the axis thereof; a shaft portion provided along the axis inside the outer tube; An ultrasonic blade, a handpiece connected to the rear end of the shaft for rotating the ultrasonic blade, an annular operating ring at the base, and a pad operating at the distal end. An operating lever connected to the rod,
A surgical operation tool, comprising: a lever storage case for pivotally attaching the operation lever and fixing a rear end of the outer tube.

The most remarkable point in the present invention is that the base has an annular operating ring, and the tip has an operating lever connected to a pad operating rod, and the pad operating rod is directly operated by the operating lever. And a structure in which the operating lever has a range of choices.

Next, the operation of the present invention will be described. In the surgical operating tool of the present invention, the so-called operating tool operating portion that operates the operating lever is not a pistol type as in the conventional example, but a finger is inserted into the operating ring of the operating lever, and the handpiece is covered with the palm. It is a palm grip type that can be held (see FIGS. 4 and 5). The operation lever has an operation ring portion through which a finger can pass in the circumferential direction of the handpiece, and the operation ring portion is close to the handpiece.

Therefore, the operating ring is operated not only with the thumb but also with the index finger, the middle finger, or the ring finger by rotating the surgical instrument about 180 degrees about the axis of the shaft. It is also possible.

Next, the pad opening / closing mechanism has a two-stage link structure in which the pad operating rod is advanced and retracted by an operation lever, and the pad is opened and closed by the advance and retreat. Therefore, 3
The opening / closing mechanism of the pad is simpler than that of the conventional example having a stage link structure. Therefore, the accuracy of transmitting the operation of the operation lever to the pad is improved, and the accuracy of transmitting the gripping force between the pad and the ultrasonic blade to the operation lever is also improved. Thus, the surgeon is given an accurate operation feeling and the operation performance is improved.

As described above, according to the present invention, the surgeon can easily change the operating tool operation section in accordance with the position and orientation of the tissue to be operated on, and the surgeon's operation feeling can be improved with higher precision. Can be transmitted to the organization operation unit.

Next, as in the second aspect of the present invention, a stop lever for preventing rotation of the ultrasonic blade when the operation lever is closed is rotatably provided in the lever storage case. Preferably.

In this case, when the operation lever is closed, the direction of the ultrasonic blade can be securely fixed in a desired direction, and malfunction can be prevented. In particular, when the pad and the ultrasonic blade are closed to perform cutting or hemostasis, it is possible to prevent the ultrasonic blade from rotating by mistake.

Next, as in the third aspect of the present invention, it is preferable that the operation lever has a stopper for preventing rotation of the ultrasonic blade when the operation lever is closed. .

In this case, when the operation lever is closed, the direction of the ultrasonic blade can be securely fixed in a desired direction, and malfunction can be prevented. Further, since the stopper is provided integrally with the operation lever, the structure is simplified.

[0026]

BEST MODE FOR CARRYING OUT THE INVENTION

First Embodiment A surgical instrument 1 according to a first embodiment of the present invention will be described with reference to FIGS. As shown in FIGS. 1 and 2, the surgical instrument 1 of this embodiment has a pad 4 pivotally attached to a distal end of an outer tube 6 so as to be rotatable in a radial direction, and a distal end portion 32 connected to the pad 4. In addition, a pad operation rod 3 is provided inside the outer tube 6 along the axis thereof.

Also, a shaft portion 5 disposed inside the outer tube 6 along the axis thereof, an ultrasonic blade 51 disposed at the tip of the shaft portion 5 so as to face the pad 4, And a handpiece 8 connected to the rear end of the shaft 5 for rotating the sonic blade 51. The base has an annular operating ring 211, and the distal end has an operating lever 21 connected to the pad operating rod 3, the operating lever 21 pivotally connected to the operating lever 21, and the outer tube 6. And a lever storage case 7 for fixing the rear end.

As shown in FIG. 3, the surgical instrument 1 has
As in the prior art, it is roughly divided into a tissue operation unit 13 for operating a tissue to be operated on, a surgical tool operation unit 11 for moving the tissue operation unit 13, and a connecting unit 12 for connecting the two. . The tissue operation unit 13, the connection unit 12, and the surgical tool operation unit 11 will be described in detail below with reference to FIGS.

The operating tool operation section 11 has a lever storage case 7, a handpiece 8, and a hand cylinder section 80. The lever storage case 7 has a bearing 721 for pivotally pivoting the operation lever 21 and a shaft pin 722 for pivotally pivoting the stop lever 22.

The lever storage case 7 has a bearing 781 for rotatably pivoting a rotation control plate 81 (FIGS. 6 and 7) provided on the hand cylinder portion 80. It has a fixing portion 76 for fixing the rear end of the tube 6.

The operation lever 21 has a ring-shaped operation ring 211 for putting a finger on the base thereof, and a hole 214 for engaging a pad operation rod 3 described later at the end thereof. Further, the operation lever 21 is arranged so that the operation ring portion 211 approaches or moves away from the handpiece 8 about the axis pin 212 as a rotation center.

On the other hand, the tissue operation section 13 is moved by the shaft pin 41 to the tip of the outer tube 6 in the same manner as in the prior art.
It has a pad 4 pivotally attached to the outer tube 6 so as to be rotatable in the radial direction, and has an ultrasonic blade 51 disposed opposite to the pad 4. The ultrasonic blade 51 cuts a tissue using ultrasonic energy and coagulates a bleeding site.

The connecting portion 12 has a shaft portion 5 having the ultrasonic blade 51 at a front end thereof, a front end portion 32 connected to the pad 4, and a rear end portion 31 attached to and detached from the operation lever 21. Pad operating rod 3 engaged as possible
Having. The pad operating rod 3 and the shaft 5
Are arranged inside the outer tube 6 along the axis thereof. Also, the hand cylinder portion 8 is provided at the rear end side of the shaft portion 5.
0 is placed.

Next, the operation and effect of this embodiment will be described. First, as shown in FIG. 4, the operating tool 11 of the surgical operating tool 1 has a palm which can be held by putting a finger into an operating ring 211 of an operating lever 21 and covering the handpiece 8 with a palm. It is a grip type. Therefore, the movement of the finger is not so much restricted by holding the surgical tool 1, and at least one finger can move freely. The operation lever 21 has an annular operation ring portion 211 at the base thereof, through which a finger can be passed in the circumferential direction of the handpiece 8. The operation ring 211 is
The handpiece 8 is arranged so as to be rotatable toward and away from the handpiece 8.

Therefore, as shown in FIG. 4, the operating ring 211 is not only operated by the thumb 111, but also, as shown in FIG. By turning it to the extent possible, operation with the index finger, the middle finger, or the ring finger is also enabled. FIG. 5 shows a case where the operation ring portion 211 is operated with the middle finger 113 as an example.

Next, the opening / closing operation of the pad 4 will be described.
This will be described below with reference to FIGS. The above opening and closing operation
The link operation is performed by a two-stage link structure in which the pad operation rod 3 is advanced and retracted by the operation lever 21 and the pad 4 is opened and closed by the pad operation rod 3. For example, as shown in FIG.
1 and the case where the handpiece 8 is held by covering the handpiece 8 with the palm and other fingers.

First, when closing, as shown in FIG. 1, the operation ring 211 of the operation lever 21 is
At 1, it is drawn to the handpiece 8 side. Then, the operation lever 21 rotates about the shaft pin 212.
A hole 21 provided at the tip of the operation lever 21 is provided.
4 is the convex rear end 31 of the pad operating rod 3
Push forward. Therefore, the pad 4 is
It rotates in the direction of the ultrasonic blade 51 around 1 as a rotation center. This holds the tissue.

Next, when opening, as shown in FIG. 2, the operation ring 211 is separated from the handpiece 8 by the thumb 111. Then, the pad 4 rotates in a direction away from the ultrasonic blade 51 in order to sequentially perform the operation opposite to the case of the closing. This opens the tissue.

As described above, the opening and closing mechanism of the pad 4 is
This is a simple link structure consisting of only two stages, that is, advance and retreat of the pad operation rod 3 by the operation lever 21 and opening and closing of the pad 4 by the pad operation rod 3. Therefore, the accuracy of transmitting the operation of the operation lever 21 to the pad 4 is improved, and the accuracy of transmitting the gripping force between the pad 4 and the ultrasonic blade 51 to the operation ring portion 211 of the operation lever 21 is also improved. . This gives the surgeon a precise sense of operation,
Operation performance is improved.

Therefore, the surgeon can easily operate the operating tool operating unit 11 according to the position and orientation of the tissue to be operated on.
Can be changed, and the operation sensation of the surgeon can be transmitted to the tissue operation unit with higher accuracy.

Next, regarding the ultrasonic blade 51,
This will be described in detail. The cross section of the ultrasonic blade 51 has an elongated home base shape (not shown). It has three types of edges: a blunt edge, a sharp edge, and a flat edge. The blunt edge and the sharp edge are mainly used when performing a tissue incision operation, and the flat edge is mainly used when performing a hemostasis operation.

As described above, the ultrasonic blade 51
In the state where the target tissue is sandwiched and grasped with the pad 4 closed, and the case where the pad 4 is opened, the tissue unrelated to the operation is moved away from the ultrasonic blade 51 by the pad 4. May cut tissue or stop bleeding. In the former, the desired edge of the ultrasonic blade 51 is directed toward the pad, and in the latter, the desired edge of the ultrasonic blade 51 is directed toward the opposite side of the pad. Therefore, it is necessary to rotate the ultrasonic blade 51 around the axis of the shaft 5.

To operate the rotation, a handpiece 8 for rotating the ultrasonic blade 51 is screw-fixed to the rear end of the shaft 5. By operating the handpiece 8, the edge of the ultrasonic blade 51 to be used can be easily rotated and fixed in the desired direction. In order to rotate the handpiece 8, the rotation control lever 801 provided on the hand cylinder 80 is moved away from the handpiece 8. As a result, the friction portion 802 pressed against the handpiece 8 is released, the two pieces 80 and 8 do not adhere to each other, and the handpiece 8 can be rotated.

On the other hand, a stop lever 22 for preventing the rotation of the ultrasonic blade 51 when the operation lever 21 is closed is pivotally connected to the lever storage case 7 so as to be rotatable. When closing the operation lever 21,
As shown in FIG. 1, the operating ring 21 of the operating lever 21 is provided.
1 is drawn toward the handpiece 8 with the thumb 111, for example. Then, the operation lever 21 rotates about the shaft pin 212. And the stop lever 22
The convex portion 213 of the operation lever 21 engaged with the concave portion 223 at the tip end of the lever rotates around the shaft pin 722 toward the handpiece 8 side. Therefore, the stop lever 2
2 rotates around the shaft pin 722 toward the handpiece 8 side.

Then, the hook-shaped stopper 228 provided at the tip of the stop lever 22 is moved from the state shown in FIGS. 6A and 7A to the recess 811 provided in the rotation control plate 81 as shown in FIGS. 6B and 7B. The rotation control plate 8 is inserted
1 prevents it from rotating. Therefore, the shaft 5 cannot rotate, and the ultrasonic blade 51 is also prevented from rotating.

On the other hand, when the rotation control plate 81 is rotated 45 degrees from the above state with the operation lever 21 opened, the concave portion 811 is displaced from the position where the hook type stopper 228 faces. Therefore, the hook type stopper 2
28 cannot be inserted into the recess 811. Therefore, the rotation of the rotation control plate 81 is free. 6 and 7, reference numeral 224 indicates a shaft hole for receiving the shaft pin 722, and reference numeral 84 indicates a hole through which the shaft portion 5 passes.

As described above, when the pad 4 and the ultrasonic blade 51 are closed, the stop lever 2 is closed.
2 prevents the rotation control plate 81 from rotating. That is,
The rotation control lever 801 provided on the hand cylinder 80 is
This is a state in which the handpiece 8 is approached. That is, the friction part 802 of the hand cylinder part 80 is pressed against the handpiece 8, and the handpiece 8 and the hand cylinder part 80
It is fixed in close contact. Therefore, when the rotation of the rotation control plate 81 provided on the hand cylinder portion 80 is prevented,
The shaft portion 5 screwed to the handpiece 8 cannot rotate, and the rotation of the ultrasonic blade 51 is prevented.

Therefore, while performing the operations such as incision and coagulation while holding and grasping the tissue to be subjected to the operation,
The ultrasonic blade 51 does not rotate. Therefore, the edge to be used can be reliably selected in the direction to be used, and malfunction of the edge can be prevented. In particular, when performing hemostasis, the ultrasonic blade 5
1 can be prevented from rotating and incising the tissue to be stopped.

Second Embodiment FIG. 8 shows a surgical instrument according to a second embodiment of the present invention.
This will be described with reference to FIG. The surgical instrument 10 of this example is
As shown in FIG. 8, the operation lever 21 is
1 directly has a stopper 28 for preventing rotation of the ultrasonic blade 51 when the blade 1 is closed.

That is, in this embodiment, the stopper 28 shown in the first embodiment is provided integrally with the operation lever 21. As shown in FIG. 8, the operation lever 21 is pivotally mounted on a bearing 721 of the lever storage case 7 around a shaft pin 212 as a rotation center. 8 and 10, the stopper 28 is provided so as to protrude from the operation lever 21 closer to the operation ring portion 211 than the shaft pin 212. The stopper 28 has a rectangular cross section.

On the other hand, as shown in FIG. 9, the rotation control plate 81 has cutout recesses 812 for inserting the stopper 28 at four locations on its outer periphery. In FIG. 8, reference numeral 77 denotes a spring for positioning the rotation control plate 81 in units of 90 °, and reference numeral 79 denotes a ball for sliding. Others are the same as the embodiment.

In this embodiment, when the operation lever 21 is closed, the stopper 28 is directly inserted into the notch recess 812 provided in the rotation control plate 81, and the rotation control plate 8 is closed.
1 prevents rotation. Therefore, when the operation lever 21 is closed, the direction of the ultrasonic blade 51 can be securely fixed in a desired direction, and malfunction can be prevented. Further, the stopper 28 is connected to the operation lever 21.
Since it is provided integrally, the structure is simplified. In addition, in this embodiment, the same effects as those of the first embodiment can be obtained.

[0053]

As described above, according to the present invention, the surgeon can easily change the operating tool operation section according to the position and orientation of the tissue to be operated on, and further improve the operation feeling of the surgeon. A surgical tool that can be transmitted to a tissue operation unit with high accuracy can be provided.

[Brief description of the drawings]

FIG. 1 is an explanatory side view of a first embodiment in a state where a pad of a surgical instrument is closed.

FIG. 2 is an explanatory side view of the first embodiment with the pad of the surgical operating tool opened;

FIG. 3 is an external view of the first embodiment in a state where a pad of the surgical instrument is opened.

FIG. 4 is a diagram illustrating an example of how to grasp the surgical operating tool according to the first embodiment.

FIG. 5 is a view for explaining another example of how to grasp the surgical instrument according to the first embodiment.

FIG. 6 is an explanatory view of a cross section taken along line AA of FIG. 7B in the first embodiment.

7A is a front view of a rotation control plate, and FIG. 7B is a front view of a rotation control plate and a stop lever in the first embodiment.

FIG. 8 is an explanatory side view of a surgical instrument according to the second embodiment.

FIG. 9 is a perspective view of a rotation control plate according to the second embodiment.

FIG. 10 is a perspective view of a stopper according to the second embodiment.

FIG. 11 is an explanatory side view of a state in which a pad of a conventional surgical instrument is closed.

FIG. 12 is an explanatory side view of a conventional surgical instrument with a pad open.

FIG. 13 is an external view of a conventional surgical instrument with a pad open.

[Explanation of symbols]

 1. . . Surgical tools, 21. . . Operating lever, 211. . . Operation ring part, 22. . . Stop lever, 228. . . Hook-type stopper, 28. . . Stopper, 3. . . Pad operating rod, 4. . . Pad, 5. . . Shaft, 51. . . Ultrasonic blade, 6. . . 6. outer tube, . . 7. Lever storage case, . . Handpiece, 80. . . Hand cylinder section, 81. . . Rotation control board,

Claims (3)

[Claims] 1. A pad pivotally connected to a distal end of an outer cylinder tube so as to be rotatable in a radial direction thereof, and a distal end portion is connected to the pad and disposed inside the outer cylinder tube along an axis thereof. A pad operating rod, a shaft disposed inside the outer tube along the axis thereof, an ultrasonic blade disposed opposite to the pad at a tip of the shaft, and a rotating ultrasonic blade. A handpiece connected to the rear end of the shaft for movement, an annular operating ring at the base, and an operating lever connected to the pad operating rod at the distal end; A surgical operation tool comprising: a lever storage case for pivotally attaching a lever and fixing a rear end of the outer tube. 2. The lever storage case according to claim 1, wherein a stop lever for preventing rotation of the ultrasonic blade when the operation lever is closed is rotatably provided in the lever storage case. Surgical tools. 3. The surgical operating tool according to claim 1, wherein the operating lever has a stopper for preventing rotation of the ultrasonic blade when the operating lever is closed.