WO2016117152A1 - Dispositif de retrait de vaisseaux sanguins - Google Patents

Dispositif de retrait de vaisseaux sanguins Download PDF

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Publication number
WO2016117152A1
WO2016117152A1 PCT/JP2015/071675 JP2015071675W WO2016117152A1 WO 2016117152 A1 WO2016117152 A1 WO 2016117152A1 JP 2015071675 W JP2015071675 W JP 2015071675W WO 2016117152 A1 WO2016117152 A1 WO 2016117152A1
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Prior art keywords
blood vessel
peeling device
electrode
peeling
cutting
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Ceased
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PCT/JP2015/071675
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English (en)
Japanese (ja)
Inventor
神野　誠
達徳 藤井
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Terumo Corp
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Terumo Corp
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/3209—Incision instruments
    • A61B17/3211—Surgical scalpels, knives; Accessories therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating

Definitions

  • the present invention relates to a blood vessel peeling device.
  • Arterial grafts typified by the internal thoracic artery, gastroepiploic artery, and radial artery, and venous grafts typified by the great saphenous vein are used as bypass tubes when performing vascular bypass surgery (coronary artery bypass surgery: CABG) in the heart. It is widely known to use. At present, it has been reported that arterial grafts (particularly internal thoracic arteries) have a higher long-term patency rate than venous grafts.
  • vein graft that is said to be inferior in the long-term patency rate
  • surrounding tissues for example, fat, connective tissue, tissue between the skin layer and muscle layer, skin If it is collected in a state covered with tissue, bifurcated blood vessels, etc. between the layer and the periosteum, and used as a bypass tube in a state covered with the tissue, the long-term patency rate is improved.
  • tissue for example, fat, connective tissue, tissue between the skin layer and muscle layer, skin If it is collected in a state covered with tissue, bifurcated blood vessels, etc. between the layer and the periosteum, and used as a bypass tube in a state covered with the tissue, the long-term patency rate is improved.
  • tissue for example, fat, connective tissue, tissue between the skin layer and muscle layer, skin If it is collected in a state covered with tissue, bifurcated blood vessels, etc. between the layer and the periosteum, and used as a bypass tube in a state covered with the tissue, the long-term pat
  • a guide wire (support member 50) is inserted into a blood vessel to be collected as a bypass tube, and the tubular member (portion 40) is pushed forward while being guided by the guide wire. It can be collected while covered with tissue.
  • the device described in Patent Document 1 has a problem that the inner wall of the blood vessel may be damaged by the guide wire, and the workability of blood vessel collection (blood vessel separation) is poor.
  • An object of the present invention is to provide a blood vessel peeling device having excellent blood vessel peeling workability.
  • Such an object is achieved by the present inventions (1) to (9) below.
  • a pair of insertion devices that are inserted into a living body along a blood vessel and sandwich a branched blood vessel that separates from the blood vessel in the living body;
  • One said insertion device has the 1st groove
  • the second insertion device opens on a surface facing the one insertion device, and the second insertion device faces the first groove when the branch blood vessel is sandwiched between the insertion device and the one insertion device.
  • the other insertion device has a pair of first electrodes arranged to face each other via the second groove,
  • the blood vessel peeling device according to any one of (1) to (3), wherein the processing device includes a second electrode and a cutting portion.
  • the said processing device has said (1) thru
  • the blood vessel peeling device according to any one of
  • the processing device includes a first electrode and a second electrode that are arranged to face each other via a gap, and a cutting portion that is located behind the gap in the movement direction and cuts the branch blood vessel.
  • the blood vessel peeling device according to any one of (1) to (3) above.
  • a pair of the second electrodes are provided so as to face each other via the first electrode,
  • the branch blood vessel can be sandwiched by the pair of insertion devices, and the displacement of the branch blood vessel can be suppressed, so that the processing of the branch blood vessel by the processing device is facilitated. Further, since the processing device can be inserted into the insertion device, the processing device can be operated smoothly, and the branch blood vessel can be processed more easily. Therefore, the blood vessel peeling device is excellent in blood vessel peeling workability.
  • FIG. 1 is a plan view showing components of the blood vessel peeling device according to the first embodiment of the present invention.
  • FIG. 2 is a cross-sectional view showing a skin side peeling device.
  • 3 is a cross-sectional view taken along line BB in FIG. 4 is a cross-sectional view taken along line AA in FIG.
  • FIG. 5 is a cross-sectional view of a state in which the first peeling device and the second peeling device shown in FIG. 4 are butted together.
  • FIG. 6 is a cross-sectional view of a state where the first peeling device and the second peeling device shown in FIG. 4 are butted together.
  • FIG. 7 is a cross-sectional view showing the processing device.
  • FIG. 8 is a cross-sectional view showing the processing device.
  • FIG. 8 is a cross-sectional view showing the processing device.
  • FIG. 9 is a cross-sectional view for explaining the cutting position of the branch blood vessel by the processing device.
  • FIG. 10 is a cross-sectional view showing the displacement of the cutting portion provided in the processing device.
  • FIG. 11 is a side view showing the cutting device.
  • 12 is a cross-sectional view taken along the line CC in FIG.
  • FIG. 13 is a diagram for explaining a method of peeling a blood vessel.
  • FIG. 14 is a diagram for explaining a method of peeling a blood vessel.
  • FIG. 15 is a diagram for explaining a method of peeling blood vessels.
  • FIG. 16 is a diagram for explaining a method of peeling a blood vessel.
  • FIG. 17 is a diagram for explaining a method of peeling a blood vessel.
  • FIG. 18 is a diagram for explaining a method of peeling a blood vessel.
  • FIG. 19 is a diagram for explaining a method of peeling blood vessels.
  • FIG. 20 is a plan view showing a fascia side peeling device included in the blood vessel peeling device according to the second embodiment of the present invention.
  • 21 is a cross-sectional view of the fascia side peeling device shown in FIG.
  • FIG. 22 is a side view showing a first peeling device included in the blood vessel peeling device according to the third embodiment of the present invention.
  • FIG. 23 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 24 is a side view showing a first peeling device included in a blood vessel peeling device according to the fourth embodiment of the present invention.
  • FIG. 25 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 26 is a cross-sectional view illustrating an example of a processing device.
  • FIG. 27 is a perspective view showing a treatment device included in the blood vessel peeling device according to the fifth embodiment of the present invention.
  • FIG. 28 is a cross-sectional view showing a state where the processing device shown in FIG. 27 is inserted into the cavity.
  • FIG. 29 is a perspective view showing a treatment device included in the blood vessel peeling device according to the sixth embodiment of the present invention.
  • 30 is a cross-sectional view showing a state in which the processing device shown in FIG. 29 is inserted into the cavity.
  • FIG. 31 is a perspective view showing a treatment device included in the blood vessel peeling device according to the seventh embodiment of the present invention.
  • FIG. 32 is a cross-sectional view showing a state where the processing device shown in FIG. 31 is inserted into the cavity.
  • FIG. 33 is a cross-sectional view illustrating a method for treating a branch blood vessel.
  • FIG. 34 is a cross-sectional view illustrating a method for treating a branch blood vessel.
  • FIG. 35 is a plan view showing a second peeling device included in the blood vessel peeling device according to the eighth embodiment of the present invention.
  • FIG. 36 is a cross-sectional view of the second peeling device shown in FIG.
  • FIG. 37 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 38 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 39 is a side view showing a cutting device included in the blood vessel peeling device according to the ninth embodiment of the present invention.
  • 40 is a cross-sectional view of the cutting device shown in FIG.
  • FIG. 41 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 42 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 43 is a side view showing a cutting device included in the blood vessel peeling device according to the tenth embodiment of the present invention.
  • FIG. 44 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 45 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 46 is a side view showing a cutting device included in the blood vessel peeling device according to the eleventh embodiment of the present invention.
  • FIG. 47 is a cross-sectional view of the cutting device shown in FIG.
  • FIG. 48 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 49 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 50 is a perspective view showing a cutting device included in a blood vessel peeling device according to a twelfth embodiment of the present invention.
  • FIG. 51 is a perspective view showing a fascia side peeling device included in a blood vessel peeling device according to a twelfth embodiment of the present invention.
  • FIG. 52 is a cross-sectional view showing a state in which the cutting device and the fascia side peeling device are opposed to each other.
  • FIG. 53 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 53 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 54 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 55 is a perspective view showing a skin side peeling device and a fascia side peeling device included in a blood vessel peeling device according to a thirteenth embodiment of the present invention.
  • FIG. 56 is a side view showing a cutting device included in a blood vessel peeling device according to a thirteenth embodiment of the present invention.
  • FIG. 57 is a top view of the cutting device shown in FIG.
  • FIG. 58 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 59 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 60 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a fourteenth embodiment of the present invention.
  • FIG. 60 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a fourteenth embodiment of the present invention.
  • FIG. 60 is
  • FIG. 61 is a diagram illustrating a method for processing a branch blood vessel.
  • FIG. 62 is a side view showing a cutting device included in a blood vessel peeling device according to a fifteenth embodiment of the present invention.
  • FIG. 63 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a sixteenth embodiment of the present invention.
  • FIG. 64 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 65 is a side view showing a cutting device included in a blood vessel peeling device according to a seventeenth embodiment of the present invention.
  • FIG. 66 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 62 is a side view showing a cutting device included in a blood vessel peeling device according to a fifteenth embodiment of the present invention.
  • FIG. 63 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a sixteenth
  • FIG. 67 is a side view showing a cutting device included in a blood vessel peeling device according to an eighteenth embodiment of the present invention.
  • FIG. 68 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 69 is a side view showing a cutting device included in a blood vessel peeling device according to a nineteenth embodiment of the present invention.
  • FIG. 70 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 71 is a diagram for explaining a method of peeling a blood vessel.
  • FIG. 1 is a plan view showing components of the blood vessel peeling device according to the first embodiment of the present invention.
  • FIG. 2 is a cross-sectional view showing a skin side peeling device.
  • 3 is a cross-sectional view taken along line BB in FIG. 4 is a cross-sectional view taken along line AA in FIG. 5 and 6 are cross-sectional views showing a state in which the first peeling device and the second peeling device shown in FIG. 4 are brought into contact with each other.
  • 7 and 8 are cross-sectional views each showing a processing device.
  • FIG. 9 is a cross-sectional view for explaining the cutting position of the branch blood vessel by the processing device.
  • FIG. 9 is a cross-sectional view for explaining the cutting position of the branch blood vessel by the processing device.
  • FIG. 10 is a cross-sectional view showing the displacement of the cutting portion provided in the processing device.
  • FIG. 11 is a side view showing the cutting device.
  • 12 is a cross-sectional view taken along the line CC in FIG.
  • FIG. 13 to FIG. 19 are diagrams for explaining a method of peeling blood vessels.
  • the right side in FIG. 1 is also referred to as “tip”, and the left side is also referred to as “base end”.
  • a blood vessel peeling device 100 shown in FIG. 1 is a device used to collect a blood vessel used as a bypass tube when performing a blood vessel bypass operation (coronary artery bypass surgery: CABG). It can be collected in a state covered with tissue.
  • the blood vessel collected using the blood vessel peeling device 100 is not particularly limited as long as it can be used as a bypass tube.
  • the blood vessel to be collected is preferably the great saphenous vein among them.
  • the blood vessel peeling device 100 As described above, it becomes easy to collect blood vessels in a state of being covered with surrounding tissues. Therefore, the large saphenous vein is collected using the blood vessel peeling device 100, By using as a bypass tube, the long-term patency after surgery is considered to be high. For this reason, below, the example which extract
  • the blood vessel peeling device 100 includes a skin side peeling device 200, a fascia side peeling device 300, a processing device 400, and a cutting device 500.
  • the skin side peeling device 200, the fascia side peeling device 300, and the cutting device 500 are devices that are inserted into the living body along the great saphenous vein, and the processing device 400 is inside the fascia side peeling device 300. It is a device to be inserted into.
  • each of these devices will be described in detail.
  • the skin-side peeling device 200 has a long rod shape that extends substantially linearly, and a peeling portion 220 that peels tissue is provided at the distal end portion. Moreover, as shown in FIG. 3, the skin side peeling device 200 has a flat shape crushed up and down.
  • the cross-sectional shape of the skin side peeling device 200 is not particularly limited, but may be, for example, a shape in which a circle such as an ellipse or an ellipse is crushed, a rectangle with rounded corners, or the like.
  • the width (length in the major axis direction of the cross section) W1 of the skin side peeling device 200 is larger than the outer diameter of the blood vessel to be collected (large saphenous vein in this embodiment).
  • the width W1 is preferably about 4 mm to 4 cm larger than the outer diameter of the blood vessel to be collected.
  • concave rails 231 and 232 extending in the axial direction are provided. These rails 231 and 232 are rails used to connect the cutting device 500, respectively.
  • the configuration of the rails 231 and 232 is not particularly limited as long as it can be connected to the cutting device 500.
  • the skin side peeling device 200 is provided with an insertion hole 210 that opens to the proximal end and extends to the distal end portion (peeling portion 220).
  • the imaging device 900 is inserted into the insertion hole 210.
  • the imaging device 900 is not particularly limited.
  • the imaging device 900 according to the present embodiment includes a long main body 910, and an imaging unit (not shown) that emits illumination light to the distal end of the main body 910 and the front side of the skin-side peeling device 200 are imaged. Part 930 is provided.
  • the imaging unit 930 includes, for example, an objective lens system provided at the distal end portion of the main body unit 910 and an imaging device (for example, a solid-state imaging device such as a CMOS image sensor or a CCD sensor) disposed to face the objective lens system. I have.
  • an imaging device for example, a solid-state imaging device such as a CMOS image sensor or a CCD sensor
  • the peeling part 220 is tapered toward the tip of the skin side peeling device 200. More specifically, the peeling section 220 has a substantially conical shape that is tapered so that both the length in the minor axis direction and the length in the major axis direction of the cross-sectional shape gradually decrease toward the distal end side. Such a peeling portion 220 is blunt in the thickness direction, and does not cut a branch blood vessel branched from the great saphenous vein, and has different properties (for example, fat and skin, fat and fascia) , Fat and blood vessels, fat and bone, etc.) have such a sharpness (dullness) that they can be separated from each other.
  • properties for example, fat and skin, fat and fascia
  • the shape of the peeling portion 220 is not particularly limited as long as the tissue can be peeled in the thickness direction (short axis direction).
  • the length in the short axis direction of the cross-sectional shape of the peeling portion 220 is the tip side. It may be a duckbill shape tapering so as to gradually decrease toward the end and having a tip that is linear along the long axis direction.
  • the peeling part 220 is substantially colorless and transparent and has light transmittance. Therefore, by inserting the imaging device 900 into the insertion hole 210 described above, the imaging device 900 can observe the front side of the skin-side peeling device 200 via the peeling portion 220. From this, the peeling part 220 has a function as an observation part which observes the inside of a living body besides the peeling function as mentioned above. Note that the peeling portion 220 is not limited to being colorless and transparent as long as it has light transparency, and may be colored red, blue, green, or the like.
  • the fascia side peeling device 300 includes a first peeling device (insertion device) 310 and a second peeling device (insertion device) 320.
  • the first peeling device 310 and the second peeling device 320 are used in a living body so as to face each other.
  • the first peeling device 310 and the second peeling device 320 have the same configuration except that an electrode is disposed on the first peeling device 310.
  • the first peeling device 310 has a long rod shape extending substantially linearly, and a peeling portion 311 for peeling tissue is provided at the tip.
  • the second peeling device 320 also has a long rod shape extending substantially linearly, and a peeling portion 321 for peeling tissue is provided at the tip.
  • These peeling parts 311 and 321 each taper toward the tip. More specifically, the lengths in the minor axis direction and the length in the major axis direction of the cross-sectional shapes of the peeling portions 311 and 321 are both tapered so as to gradually decrease toward the distal end side.
  • Such peeling portions 311 and 321 are blunt in the thickness direction, and do not cut branch blood vessels branching from the great saphenous vein, but have different properties (for example, fat and skin, fat and Such as fascia, fat and blood vessels, fat and bone). Thereby, while being able to fully exhibit a peeling function, the damage and cutting
  • the taper angle ⁇ of the peeling portions 311 and 321 in plan view is not particularly limited, but can be about 50 ° to 70 °.
  • the shape of the peeling portions 311 and 321 is not particularly limited as long as the tissue can be peeled in the thickness direction, and may be, for example, a duckbill shape.
  • first peeling device 310 and the second peeling device 320 each have a flat shape crushed up and down as shown in FIG.
  • the cross-sectional shapes of the first peeling device 310 and the second peeling device 320 are rectangles with rounded corners, respectively.
  • the cross-sectional shapes of the first peeling device 310 and the second peeling device 320 are not particularly limited, and may be a shape in which a circle such as an ellipse or an ellipse is crushed in addition to a rectangle.
  • a concave rail 312 extending in the axial direction is provided on the upper surface (one main surface) of the first peeling device 310.
  • a concave rail 322 extending in the axial direction is also provided on the upper surface of the second peeling device 320.
  • These rails 312 and 322 are rails used to connect to the cutting device 500.
  • the configurations of the rails 312 and 322 are not particularly limited as long as they can be connected to the cutting device 500, respectively.
  • the first peeling device 310 and the second peeling device 320 are used so that the side surfaces are abutted with each other.
  • the first peeling device 310 is provided with a groove (second groove) 313 that opens to an abutting surface (side surface on the second peeling device 320 side) 310 a.
  • the groove 313 extends in the axial direction of the first peeling device 310 and opens at both the distal end and the proximal end.
  • the second peeling device 320 is also provided with a groove (first groove) 323 that opens to the abutting surface (side surface on the first peeling device 310 side) 320a.
  • the groove 323 extends in the axial direction of the second peeling device 320 and opens at both the distal end and the proximal end. As shown in FIG. 5, the grooves 313 and 323 communicate with each other to form a cavity 330 when the abutting surfaces 310 a and 320 a are abutted with each other.
  • the hollow portion 330 functions as an insertion portion into which the processing device 400 is inserted. According to such a configuration, since the processing device 400 can be moved inside the first and second peeling devices 310 and 320, the processing by the processing device 400 can be performed more smoothly and accurately.
  • each of the first peeling device 310 and the second peeling device 320 preferably has a width of about 20 mm to 40 mm, for example.
  • the 1st peeling device 310 has the notches 314 and 315 opened to the butting surface 310a, as shown in FIG.
  • the notches 314 and 315 are spaced apart from the distal end side and the proximal end side of the first peeling device 310.
  • the second peeling device 320 has notches 324 and 325 that open to the abutting surface 320a.
  • the notches 324 and 325 are spaced apart from the distal end side and the proximal end side of the second peeling device 320. Then, as shown in FIG.
  • the great saphenous vein 1000 is not sandwiched between the first peeling device 310 and the second peeling device 320, and the damage, cutting, blood flow reduction, etc. of the great saphenous vein 1000 are prevented. Can do.
  • notches are provided in both the first peeling device 310 and the second peeling device 320, but the notches are formed in the first peeling device 310 and the second peeling device 320. It only needs to be provided on one side.
  • a pair of electrodes 316 and 317 are provided on the abutting surface 310a side of the first peeling device 310.
  • the electrodes 316 and 317 extend in the axial direction between the notches 314 and 315, and are disposed to face each other via the groove 313.
  • the electrodes 316 and 317 are connected to the same potential.
  • These electrodes 316 and 317 are electrodes used to generate an electric field for cauterizing the branch blood vessel 1100, as will be described later.
  • the electrodes 316 and 317 are exposed on the abutting surface 310a, but the electrodes 316 and 317 are not exposed on the abutting surface 310a and are embedded in the first peeling device 310. It may be.
  • the insertion for inserting the imaging device 900 is inserted into the first and second peeling devices 310 and 320 in the same manner as the skin-side peeling device 200 described above.
  • a hole may be provided.
  • the first peeling device 310 and the second peeling device 320 can be more smoothly inserted into the living body.
  • the fascia side peeling device 300 has two peeling devices, but the number of peeling devices is not particularly limited as long as it is two or more.
  • the processing device 400 includes a rod-like long operation unit 410, an electrode 420 provided at the base end of the operation unit 410, and a cutting unit 430 provided at the base end of the electrode 420. And have.
  • the operation unit 410 can be inserted into the cavity 330 of the fascia side peeling device 300. Further, the operation unit 410 can slide in the groove 323 without protruding to the groove 313 side of the first peeling device 310 in the cavity 330. As will be described later, since the branch blood vessel 1100 is sandwiched between the first peeling device 310 and the second peeling device 320, the branch blood vessel 1100 is located between the grooves 313 and 323 as shown in FIG. . Therefore, by making the operation unit 410 slidable in the groove 323, contact between the operation unit 410 and the branch blood vessel 1100 can be suppressed, and the processing device 400 can be operated smoothly. Further, damage and cutting of the branch blood vessel 1100 can be reduced.
  • the electrode 420 is disposed to face the electrodes 316 and 317 with the branch blood vessel 1100 interposed therebetween, as shown in FIG.
  • the electrode 420 is disposed so as to contact the branch blood vessel 1100. Therefore, when a high-frequency alternating voltage is applied between the electrode 420 and the electrodes 316 and 317, the electric field generated between them acts on the branch blood vessel 1100, cauterizing the branch blood vessel 1100, and heat coagulation (hemostasis). it can.
  • the cutting unit 430 In the state where the operation unit 410 is inserted into the groove 323, the cutting unit 430 is disposed so as to straddle the boundary between the groove 313 and the groove 323. For this reason, the electrode 420 and the electrodes 316 and 317 have a bipolar structure, and if the operation unit 410 is slid to the distal end side while applying a high-frequency alternating voltage, it is between the first and second peeling devices 310 and 320.
  • the branch blood vessels 1100 sandwiched between the two can be sequentially heat-coagulated, and the heat-coagulated branch blood vessels 1100 can be cut by the cutting unit 430.
  • the bottom surface (surface facing the opening) of the groove 323 constitutes a guide surface (sliding surface) 323a for guiding the operation unit 410, and the operation unit 410 is slid on the guide surface 323a.
  • the operation unit 410 does not protrude excessively toward the groove 313, and the state where the cutting unit 430 straddles the boundaries of the grooves 313 and 323 can be maintained. Therefore, the above work can be performed more smoothly and accurately.
  • the guide surface 323a may be subjected to, for example, a coating process (such as a hydrophilic process) that reduces frictional resistance and increases slidability.
  • the branch blood vessel 1100 is sandwiched between the electrode 420 and the electrode 316 (between the abutting surfaces 310a and 320a and crushed into a flat shape.
  • Part 1101 and the part between electrode 420 and electrode 317 (the part which is sandwiched between the abutting surfaces 310a and 320a and flattened) 1102 is thermally coagulated, and the part 1101 and 1102 are cut by the cutting part 430. Is done. Therefore, bleeding from the branched blood vessel 1100 after cutting can be prevented.
  • the branch blood vessel 1100 sandwiched between the first peeling device 310 and the second peeling device 320 can be easily stopped and cut.
  • an electrode may also be disposed on the second peeling device 320 side.
  • the electrode By arranging the electrode on the second peeling device 320 side so as to face the electrodes 316 and 317, it is possible to contact the electrode from both sides of the pressing portion of the branch blood vessel 1100, and heat coagulation is efficiently performed when energized. It becomes possible. Further, by providing the cutting unit 430 with an electrode function similar to that of the electrode 420, cutting in an energized state can be performed.
  • the cutting part 430 is rotatable as indicated by an arrow B in FIG. 1, for example, and enters the groove 313 across the boundaries of the grooves 313 and 323 in FIG. However, it is preferable to be able to switch to a state in which the groove 313 does not enter and retracts into the groove 323. Accordingly, when the processing device 400 is inserted into the cavity 330, the large saphenous vein 1000 (the portion inserted through the through holes 334 and 335) by the cutting unit 430 is placed in the retracted state. Can be prevented.
  • the state illustrated in FIG. 9 is also referred to as an “operating state”
  • the state illustrated in FIG. 10 is also referred to as a “retracted state”.
  • the cutting device 500 When the cutting device 500 moves along the saphenous vein 1000, the cutting device 500 cuts fat (including connective tissue) around the saphenous vein and cuts a branched blood vessel branched from the saphenous vein. ⁇ Stop bleeding.
  • the cutting device 500 has a long plate shape. Moreover, the cutting device 500 has the groove
  • the groove 520 has a tapered blood vessel guide groove 521 whose width gradually decreases toward the base end side, and a blood vessel processing groove 522 located on the base end side of the blood vessel guide groove 521 and having a substantially constant width. is doing.
  • the blood vessel guide groove 521 is a groove that guides the branch blood vessel 1100 to the blood vessel processing groove 522 when the cutting device 500 is pushed in vivo, and has a tapered shape in order to perform this guidance smoothly.
  • the blood vessel processing groove 522 is a groove for cutting and stopping the branch blood vessel guided by the blood vessel guide groove 521.
  • the blood vessel processing groove 522 is provided with a processing unit 530 for cutting and stopping the branch blood vessel.
  • the processing unit 530 has a bipolar structure including a pair of electrodes 531 and 532 that generate an electric field in the blood vessel processing groove 522.
  • the electrode 531 is provided at the proximal end of the vascular treatment groove 522, and the electrode 532 is provided on both sides of the vascular treatment groove 522.
  • the branch blood vessel 1100 guided by the blood vessel processing groove 522 can be cauterized, thermally coagulated, hemostatic, and cut.
  • tip part 531a of the electrode 531 is sharp so that the branch blood vessel 1100 can be cut
  • the width W2 of the blood vessel processing groove 522 is not particularly limited, but is preferably smaller than the outer diameter of the branch blood vessel 1100. As a result, as shown in FIG. 11, the branch blood vessel 1100 can be crushed in the blood vessel processing groove 522, so that the processing (particularly hemostasis) in the processing unit 530 can be performed more reliably.
  • the cutting device 500 has a blade portion 550 that cuts fat around the saphenous vein 1000.
  • the blade portion 550 is provided at the distal end portion of the cutting device 500, and is provided along the blood vessel guide groove 521 in the present embodiment. It is preferable that the blade part 550 has a sharpness that can cut fat without cutting the branch blood vessel 1100. Thereby, since cutting
  • the cutting device 500 has a pair of protection parts 541 and 542 provided on both sides thereof as shown in FIG.
  • Each of the protection parts 541 and 542 extends along the axial direction of the cutting device 500, and the peripheral surface (side surface or tip surface) is rounded.
  • the protection unit 541 moves along the gap between fat and skin while peeling them. Since the fat and skin having different properties are easily peeled in this way, even if the tip of the protective part 541 is rounded, the peeling function for peeling the fat and the skin can be sufficiently exhibited.
  • the cutting device 500 includes connection portions 581 and 582 that can be connected to the rails 231 and 232 of the skin-side peeling device 200, and a connection portion 583 that can be connected to the rails 312 and 322 of the fascia-side peeling device 300. is doing.
  • the connection parts 581 and 582 are provided in the protection part 541, and the connection part 583 is provided in the protection part 542.
  • These connecting portions 581, 582, 583 are configured by convex portions corresponding to the shapes of the rails 231, 232, 312, 322.
  • the first step of peeling the large saphenous vein 1000 while being covered with the surrounding fat 1200 using the blood vessel peeling device 100 and the large saphenous vein 1000 were ligated.
  • the skin side peeling device 200 in which the imaging device 900 is inserted is prepared.
  • the skin side peeling device 200 is inserted into the living body along the great saphenous vein 1000 while being separated from the great saphenous vein 1000.
  • the skin side peeling device 200 is arrange
  • the skin side peeling device 200 is arranged so that the thickness direction thereof substantially coincides with the alignment direction of the skin side peeling device 200 and the great saphenous vein 1000.
  • the skin side peeling device 200 is inserted from the incision portion 1310, and the distal end portion of the skin side peeling device 200 is protruded from the incision portion 1320. Further, in this work, the skin side peeling device 200 is inserted between the fat 1200 and the skin 1400 (between tissues having different properties), and the skin 1400 and the fat 1200 are inserted in the thickness direction of the skin side peeling device 200 (skin side). The peeling device 200 and the great saphenous vein 1000 are peeled in the direction of alignment). Since such a part is a part where it is particularly easy to peel off, this operation can be performed more smoothly and accurately.
  • a fascia side peeling device 300 (first and second peeling devices 310 and 320) is prepared, and the first and second peeling devices 310 and 320 are sequentially separated from the great saphenous vein 1000 while It is inserted into the living body along the venous vein 1000. And the 1st, 2nd peeling device 310,320 is arrange
  • the first and second peeling devices 310 and 320 are inserted from the incision portion 1310, and the tip portions thereof are protruded from the incision portion 1320.
  • the first peeling device 310 and the second peeling device 320 are arranged side by side and slightly spaced from each other.
  • the great saphenous vein 1000 may be located between the 1st peeling device 310 and the 2nd peeling device 320 by planar view.
  • a branch blood vessel 1100 divided downward from the great saphenous vein 1000 passes between the first and second peeling devices 310 and 320.
  • the first and second peeling devices 310 and 320 are inserted between the fat 1200 and the fascia 1500 (boundary portion of tissue having different properties), and the fat 1200 and the fascia 1500 are inserted into the first.
  • the second peeling devices 310 and 320 are peeled in the thickness direction. Since such a part is a part where it is particularly easy to peel off, this operation can be performed more smoothly and accurately.
  • the first peeling device 310 and the second peeling device 320 are abutted (approached) and fixed to each other so that the abutted state is maintained.
  • the branch blood vessel 1100 that has passed between the first peeling device 310 and the second peeling device 320 is sandwiched between them, and the hollow blood vessel 330 so that the branched blood vessel 1100 that has been sandwiched crosses the hollow portion 330.
  • the distal end side of the great saphenous vein 1000 is inserted into the through hole 334 including the notches 314 and 324, and the proximal end side is inserted.
  • the through hole 335 is formed by the notches 315 and 325. Thereby, the large saphenous vein 1000 is not sandwiched between the first and second peeling devices 310 and 320, and damage, cutting, blood flow reduction, and the like of the large saphenous vein 1000 can be prevented.
  • the fixing method of the first peeling device 310 and the second peeling device 320 is not particularly limited, but both end portions of the first peeling device 310 and the second peeling device 320 are exposed from the living body. Therefore, it is preferable to fix using a fixture etc. in both ends. Thereby, this work becomes easier.
  • the processing device 400 is prepared and inserted into the cavity 330 (groove 323) from the tip side.
  • the processing device 400 is moved to the distal end side while applying a high-frequency alternating voltage between the electrodes 316 and 317 included in the first peeling device 310 and the electrode 420 included in the processing device 400.
  • the branch blood vessel 1100 is stopped and cut in order.
  • the branch blood vessel 1100 is sandwiched between the first and second peeling devices 310 and 320, the displacement of the branch blood vessel 1100 is suppressed, and the processing of the branch blood vessel 1100 can be performed more reliably.
  • the cutting device 500 is prepared, the connecting portion 581 is connected to the rail 231 of the skin side peeling device 200, and the connecting portion 583 is connected to the rail 322 of the second peeling device 320. Then, the cutting device 500 is inserted into the living body while being guided by the skin side peeling device 200 and the second peeling device 320, and the cutting device 500 is placed on one side of the great saphenous vein 1000 as shown in FIG. Deploy. At this time, the cutting device 500 peels the skin 1400 from the fat 1200 by the protection unit 541.
  • the cutting device 500 cuts the fat 1200 on the side of the great saphenous vein 1000 by the blade 550 to the left and right (alignment direction of the cutting device 500 and the great saphenous vein 1000), and the processing unit 530 branches the blood vessel. 1100 is hemostatic and cut.
  • the cutting device 500 is laterally separated from the large saphenous vein 1000 as shown in FIG. This can be pushed along the great saphenous vein 1000 while preventing damage to the great saphenous vein 1000 during this operation. Further, since the protective portions 541 and 542 are rounded, damage to the skin 1400 and fascia 1500 due to contact with the cutting device 500 can be reduced.
  • the cutting device 500 is removed, and the connecting portion 582 of the extracted cutting device 500 is connected to the rail 232 of the skin side peeling device 200 and the connecting portion 583 is connected to the rail 312 of the first peeling device 310. Then, as in the previous operation, the cutting device 500 is inserted into the living body while being guided by the skin-side peeling device 200 and the first peeling device 310, and as shown in FIG. The cutting device 500 is arranged on the side. Thereby, the fat 1200 is cut right and left, and the branch blood vessel 1100 is stopped and cut by the processing unit 530.
  • the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is peeled off while being covered with the surrounding fat 1200.
  • the thickness of the fat 1200 that is peeled off together with the great saphenous vein 1000 and is located around the great saphenous vein 1000 is not particularly limited, but is preferably about 0.1 mm to 10 mm, and about 1 mm to 8 mm. More preferably, it is about 3 mm to 5 mm.
  • the large saphenous vein 1000 is taken out of the living body through the incision 1310 or the incision 1320 while being covered with the surrounding fat 1200.
  • the large saphenous vein 1000 can be collected in a state covered with the surrounding fat 1200.
  • the skin-side peeling device 200 and the fascia-side peeling device 300 are used to reduce damage such as bleeding for portions that are easily peeled, and the cutting device 500 is used for fat 1200 that is difficult to peel. Therefore, the large saphenous vein 1000 can be collected with a smooth and low attack.
  • the first step can be performed without cutting the saphenous vein 1000, blood can pass through the saphenous vein 1000 as long as possible. Therefore, the great saphenous vein 1000 having a shorter ischemic state and less damage can be collected.
  • the upper side (skin 1400 side) of the great saphenous vein 1000 is peeled by the skin side peeling device 200. Since the upper side of the great saphenous vein 1000 tends to have fewer branch blood vessels 1100 than the lower side, the upper side of the great saphenous vein 1000 is only peeled by the skin side peeling device 200 without processing the branch blood vessel 1100. I do. In contrast, since a relatively large number of branch blood vessels 1100 are arranged below the saphenous vein 1000, the fascia side peeling device 300 performs peeling and the processing device 400 processes the branch blood vessels 1100. .
  • the use of the peeling devices having different configurations on the upper and lower sides of the great saphenous vein 1000 allows the operation to be performed more smoothly.
  • the upper side of the great saphenous vein 1000 may be peeled off using the fascia side peeling device 300 in the same manner as the lower side.
  • the great saphenous vein 1000 covered with fat 1200 may become a bypass tube having a long-term patency rate superior to that of the great saphenous vein 1000 not covered with fat 1200.
  • This is believed to be due to the following reasons. That is, the great saphenous vein 1000 is used as an arterial bypass tube, but the artery has higher blood pressure (internal pressure received by blood) than the vein. Therefore, if a large saphenous vein that is not covered with tissue is used as a bypass tube, the saphenous vein may expand without being able to withstand blood pressure, and blood flow may be reduced.
  • the blood vessel wall may become thickened in the process of remodeling (structural modification) or tissue damage repair.
  • Such thickening of the blood vessel wall is considered to affect the progress of arteriosclerosis. For these reasons, if a large saphenous vein that is not covered with tissue and used as a bypass tube is used as a bypass tube, it may lead to blood vessel occlusion in the long term.
  • the great saphenous vein 1000 by covering the great saphenous vein 1000 with the fat 1200, it is possible to expect the fat 1200 to suppress the expansion of the large saphenous vein 1000 and to suppress the bending of the great saphenous vein 1000. Therefore, there is a possibility that a decrease in blood flow as described above can be suppressed.
  • damage to the great saphenous vein 1000 specifically, damage to endothelial cells, smooth muscle, nutrient blood vessels (small blood vessel network), and the like is reduced. Therefore, there is a possibility that the above-described thickening of the blood vessel wall can be suppressed.
  • the configuration of the blood vessel peeling device 100 is not limited to this embodiment.
  • the rails 231 and 232 are omitted from the skin side peeling device 200 and the fascia side peeling device 300 is omitted.
  • the rails 312 and 322 may be omitted, and the connecting portions 581, 582, and 583 may be omitted from the cutting device 500.
  • the cutting device 500 may be inserted into the living body along the skin-side peeling device 200 and the fascia-side peeling device 300 previously inserted into the living body.
  • the cutting device 500 is not particularly limited as long as the fat 1200 can be cut.
  • the cutting device 500 may be configured to cut the fat 1200 with scissors.
  • the blood vessel collection method is not limited to the procedure of this embodiment.
  • the insertion order of the skin-side peeling device 200, the fascia-side peeling device 300, and the cutting device 500 is not particularly limited, and any part of the large saphenous vein 1000 may be peeled first. That is, for example, the fascia side peeling device 300, the skin side peeling device 200, and the cutting device 500 may be inserted in this order, or the skin side peeling device 200, the cutting device 500, and the fascia side peeling device 300 are inserted in this order. Alternatively, the cutting device 500, the skin side peeling device 200, and the fascia side peeling device 300 may be inserted in this order. Moreover, you may insert at least 2 of the cutting device 500, the skin side peeling device 200, and the fascia side peeling device 300 simultaneously.
  • only one cutting device 500 is used, but two cutting devices 500 may be used.
  • the first cutting device 500 is arranged on one of the left and right sides of the great saphenous vein 1000, and then the second cutting device 500 is arranged on the other left and right sides of the great saphenous vein 1000. Should be arranged. According to such a procedure, it is not necessary to remove the cutting device 500 halfway, so that the above procedure can be performed smoothly.
  • the skin side peeling device 200 is inserted between the fat 1200 and the skin 1400, but the insertion position of the skin side peeling device 200 is not particularly limited, and for example, the fat 1200 and blood vessels ( However, it may be inserted between tissues having different properties, such as between blood vessels other than the great saphenous vein 1000). Further, the present invention is not limited to insertion between tissues having different properties (borders of tissues having different properties, tissues between tissues having different properties, etc.), for example, by inserting into fat 1200 and peeling fat 1200 Also good.
  • the fascia side peeling device 300 is inserted between the fat 1200 and the fascia 1500, but the insertion position of the fascia side peeling device 300 is not particularly limited. It may be inserted between tissues having different properties such as between the fat 1200 and the bone and between the fascia 1500 and the bone. Further, the present invention is not limited to insertion between tissues having different properties (borders of tissues having different properties, tissues between tissues having different properties, etc.), for example, by inserting into fat 1200 and peeling fat 1200 Also good.
  • the fat 1200 is cut by the cutting device 500, but the tissue to be cut by the cutting device 500 is not limited to fat.
  • the skin-fat boundary and the fat-muscle boundary Tissue between the skin and fat boundary and the fat and osteoskin boundary, connective tissue, tissue between the skin layer and muscle layer, tissue between the skin layer and bone barrier, branch vessel Etc.
  • the skin side peeling device 200 and the fascia side peeling device 300 are arranged apart from each other so as not to contact the great saphenous vein 1000.
  • the skin side peeling device 200 and the fascia side peeling device are arranged. 300 may be placed in contact with the great saphenous vein 1000. That is, the skin side peeling device 200 and the fascia side peeling device 300 may be inserted between the great saphenous vein 1000 and the fat 1200.
  • FIG. 20 is a plan view showing a fascia side peeling device included in the blood vessel peeling device according to the second embodiment of the present invention.
  • 21 is a cross-sectional view of the fascia side peeling device shown in FIG.
  • This embodiment is the same as the first embodiment described above except that the configuration of the fascia side peeling device is mainly different.
  • the first peeling device 310 of the present embodiment is provided with notches 314 and 315 extending to the outside of the groove 313 (on the side surface opposite to the abutting surface 310a) in plan view. It has been.
  • the second peeling device 320 the notches 324 and 325 are omitted, and instead, protrusions 324A and 325A that enter the notches 314 and 315 when they are brought into contact with the first peeling device 310. Is provided.
  • a protrusion 324A enters the notch 314, and a through hole 334 is formed therebetween.
  • the protrusion 325A enters the notch 315, and a through hole 335 is formed therebetween.
  • the through holes 334 and 335 are formed at positions shifted from the cavity portion 330, the large saphenous vein 1000 inserted through the through holes 334 and 335 and the cavity portion 330 are inserted.
  • the configuration of the processing device 400 is simplified, and the processing by the processing device 400 can be performed more smoothly.
  • the branch blood vessel 1100 may be cut and stopped when pushed from the proximal end side to the distal end side.
  • the electrode 420 may be disposed on the distal end side of the processing device 400 and the cutting portion 430 may be disposed on the proximal end side.
  • the processing device 400 can be inserted in a state where the great saphenous vein 1000 is avoided. Thereby, the rotation function of the cutting part 430 becomes unnecessary, and the processing device 400 can have a simpler configuration.
  • FIG. 22 is a side view showing a first peeling device included in the blood vessel peeling device according to the third embodiment of the present invention.
  • FIG. 23 is a diagram for explaining a branch blood vessel processing method.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the first peeling device is different.
  • the electrodes 316 and 317 are formed shorter than the first embodiment described above.
  • the lengths of the electrodes 316 and 317 are not particularly limited, but can be about 5 mm to 2 cm, for example.
  • the electrodes 316 and 317 are integrally movable in the axial direction of the first peeling device 310 (the arrow direction in FIG. 22).
  • the processing device 400 is inserted into the cavity 330, and the electrode 420 is disposed opposite to the electrodes 316 and 317. If the processing device 400 is slid to the distal end side while applying a high-frequency alternating voltage between the electrodes 316, 317 and the electrode 420 while maintaining the relative positional relationship between the electrodes 316, 317 and the electrode 420, the branched blood vessel 1100 is obtained. Can be thermally coagulated and cut in order.
  • the region where the electric field is generated can be reduced, the electric field can be effectively applied to the branch blood vessel 1100, and the branch blood vessel 1100 can be more reliably hemostatic.
  • FIG. 24 is a side view showing a first peeling device included in a blood vessel peeling device according to the fourth embodiment of the present invention.
  • FIG. 25 is a diagram for explaining a branch blood vessel processing method.
  • FIG. 26 is a cross-sectional view illustrating an example of a processing device.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the first peeling device is different.
  • the electrodes 316 and 317 are divided into a plurality of parts.
  • the electrodes 316 and 317 include a plurality of electrode pieces 316 a and 317 a that are arranged apart from each other in the axial direction of the first peeling device 310.
  • the electrode pieces 316a and 317a facing each other through the groove 313 are connected to the same potential.
  • the length of the electrode pieces 316a and 317a is not particularly limited, but can be, for example, about 5 mm to 2 cm.
  • the region where the electric field is generated can be reduced, the electric field can be effectively applied to the branch blood vessel 1100, and the branch blood vessel 1100 can be more reliably thermally coagulated (hemostatic). Can do.
  • the mechanism for switching the electrode pieces 316a and 317a to which the high frequency alternating voltage is applied is not particularly limited.
  • the switching unit may switch the electrode pieces 316a and 317a to which the voltage is applied according to the detection result of the detection unit.
  • the processing device 400 has a conductive lead wire 460 that faces the electrode 420 and moves together with the electrode 420 in the groove 313, and the electrode piece 316a with which the lead wire 460 contacts, A configuration in which a voltage is applied between 317a and the electrode 420 may be employed.
  • the processing device 400 is not provided with the electrode 420, the electrode shown in FIG. 22 is arranged on the second peeling device 320 side, and a bipolar structure is formed on the first peeling device 310 side and the second peeling device 320 side. It is also possible to configure. In this case, the pressed portion of the branch blood vessel 1100 can be surely thermally coagulated.
  • FIG. 27 is a perspective view showing a treatment device included in the blood vessel peeling device according to the fifth embodiment of the present invention.
  • FIG. 28 is a cross-sectional view showing a state where the processing device shown in FIG. 27 is inserted into the cavity.
  • This embodiment is mainly the same as the above-described first embodiment except that the configurations of the first peeling device and the processing device are different.
  • the first peeling device 310 of the present embodiment has a configuration in which the electrodes 316 and 317 are omitted from the configuration of the first embodiment described above.
  • the processing device 400 of the present embodiment includes an operation unit 410 and a processing unit 440 provided at the tip of the operation unit 410, as shown in FIG. Further, the processing unit 440 has a bipolar structure having electrodes 441 and 442.
  • a pair of electrodes (first electrodes) 441 are provided facing the width direction of the operation unit 410 (a direction orthogonal to the axial direction).
  • a gap S ⁇ b> 1 that guides the branch blood vessel 1100 is formed between one electrode 441 and the other electrode 441.
  • the electrode (second electrode) 442 is located between one electrode 441 and the other electrode 441 when viewed from the axial direction of the operation unit 410, and when viewed from the side, the tip thereof is an electrode. It is located on the proximal end side with respect to the distal end of 441. That is, the electrode 442 is disposed on the proximal end side (the rear side in the movement direction) of the gap S1. Further, the distal end portion 442a of the electrode 442 also serves as the cutting portion 430 and is sharp enough to cut the branch blood vessel 1100.
  • one electrode 441 is located in the groove 313, the other electrode 441 is located in the groove 323, and the electrode 442 is the groove 313. It arrange
  • the treatment device 400 instead of thermally coagulating the flattened portion by pressing the branch blood vessel 1100, the treatment device 400 is slid to the distal end side and tension is applied to the branch blood vessel 1100, so that The blood vessels are flattened, heat-coagulated, and hemostasis / cutting is performed.
  • the configuration of the first peeling device 310 becomes simpler.
  • FIG. 29 is a perspective view showing a treatment device included in the blood vessel peeling device according to the sixth embodiment of the present invention.
  • 30 is a cross-sectional view showing a state in which the processing device shown in FIG. 29 is inserted into the cavity.
  • This embodiment is mainly the same as the above-described first embodiment except that the configurations of the first peeling device and the processing device are different.
  • the first peeling device 310 of the present embodiment has a configuration in which the electrodes 316 and 317 are omitted from the configuration of the first embodiment described above.
  • the processing device 400 includes an operation unit 410 and a processing unit 440 provided at the base end of the operation unit 410 as illustrated in FIG.
  • the operation unit 410 includes a pair of rod-shaped portions (operation pieces) 411 and 412 that are arranged to face each other with a gap, and a connection portion 413 that connects the rod-shaped portions 411 and 412 on the proximal end side.
  • the processing unit 440 includes a pair of electrodes 441 and 442 and a cutting unit 443.
  • the electrode (first electrode) 441 is provided at the base end of the rod-shaped portion 411, and the electrode (second electrode) 442 is provided at the base end of the rod-shaped portion 412.
  • a gap S ⁇ b> 2 that guides the branch blood vessel 1100 is formed between the electrodes 441 and 442.
  • the cutting part 443 is provided so as to protrude from the connection part 413 to the tip side. Further, the cutting portion 443 is located between the electrodes 441 and 442 when viewed from the axial direction of the operation portion 410, and when viewed from the side, the distal end thereof is located closer to the proximal end than the distal ends of the electrodes 441 and 442. ing. That is, the cutting part 443 is disposed on the base end side (rear side in the movement direction) of the gap S2. Further, the distal end portion 443 a of the cutting portion 443 is sharp enough to cut the branch blood vessel 1100.
  • the rod-shaped portion 411 and the electrode 441 are located in the groove 313, the rod-shaped portion 412 and the electrode 442 are located in the groove 323, and the cut portion 443 is arranged so as to straddle the boundaries of the grooves 313 and 323. Therefore, the treatment device 400 is slid to the distal end side while applying a high-frequency alternating voltage between the electrodes 441 and 442, and the branch vessel 1100 is sequentially guided to the gap S2 to be thermally coagulated, and the thermocoagulated branch vessel 1100 is cut.
  • the portion 443 can be cut.
  • the configuration of the first peeling device 310 becomes simpler.
  • FIG. 31 is a perspective view showing a treatment device included in the blood vessel peeling device according to the seventh embodiment of the present invention.
  • 32 is a cross-sectional view showing a state where the processing device shown in FIG. 31 is inserted into the cavity.
  • FIGS. 33 and 34 are cross-sectional views illustrating a method for treating a branch blood vessel.
  • This embodiment is mainly the same as the above-described first embodiment except that the configurations of the first peeling device and the processing device are different.
  • the first peeling device 310 of the present embodiment has a configuration in which the electrodes 316 and 317 are omitted from the configuration of the first embodiment described above.
  • the processing device 400 of this embodiment has a processing unit 440 as shown in FIG.
  • the processing unit 440 includes plate-like electrodes 441 and 442.
  • a pair of electrodes (second electrodes) 441 are provided so as to face each other with electrodes (first electrodes) 442 interposed therebetween.
  • an insulating plate-like portion 414 is sandwiched between the electrode 442 and one electrode 441, and an insulating plate-like portion 415 is sandwiched between the electrode 442 and the other electrode 441.
  • the tip 442 a of the electrode 442 protrudes from the electrode 441 and the plate-like parts 414 and 415.
  • the distal end portion 442a also serves as the cutting portion 430 and is sharp enough to cut the branch blood vessel 1100.
  • an insulating coating or the like may be applied to the surfaces of the electrodes 441 and 442 instead of the plate-like portions 414 and 415.
  • one electrode 441 and one electrode 442 may be stacked.
  • the electrodes 441 and 442 are arranged so as to straddle the boundaries of the grooves 313 and 323. Therefore, when the processing device 400 is slid to the distal end side while applying a high-frequency alternating voltage between the electrodes 441 and 442, the branch blood vessel 1100 is expanded and deformed by pressing by the distal end portion 442a of the electrode 442 as shown in FIG. At the same time, it is thermally coagulated by the action of the electric field generated between the electrodes 441 and 442. When the processing device 400 is further moved to the distal end side, the branch blood vessel 1100 is cut by the distal end portion 442a as shown in FIG.
  • an electric field is applied to the branch blood vessel 1100 in a state in which the branch blood vessel 1100 is expanded and deformed (a flattened state), so that the branch blood vessel 1100 can be stopped more reliably. it can.
  • FIG. 35 is a plan view showing a second peeling device included in the blood vessel peeling device according to the eighth embodiment of the present invention.
  • FIG. 36 is a cross-sectional view of the second peeling device shown in FIG.
  • FIG. 37 and FIG. 38 are diagrams for explaining a branch blood vessel processing method.
  • This embodiment is mainly the same as the first embodiment described above except that the fascia side peeling device also serves as a processing device.
  • the second peeling device 320 of this embodiment also serves as the processing device 400.
  • the second peeling device 320 has a roller electrode 450 and a cutting portion 430 disposed on the proximal end side with respect to the roller electrode 450.
  • the roller electrode 450 is provided so as to protrude from the abutting surface 320a, and is rotatably supported by the shaft.
  • the roller electrode 450 includes an electrode 316 included in the first peeling device 310 when the second peeling device 320 is placed along the abutting surface 310a of the first peeling device 310, Opposite to 317.
  • the cutting part 430 is provided so as to protrude from the abutting surface 310a, and when the second peeling device 320 is placed along the abutting surface 310a of the first peeling device 310, the groove of the first peeling device 310 is provided. Intrudes into 313.
  • a high frequency alternating voltage is applied between the electrodes 316 and 317 and the roller electrode 450 in a state where the first peeling device 310 is disposed below the great saphenous vein 1000, as shown in FIG.
  • the second peeling device 320 is inserted into the living body along the abutting surface 310 a of the first peeling device 310.
  • the branch blood vessel 1100 is guided between the first peeling device 310 and the second peeling device 320, and is crushed and thermally coagulated by the roller electrode 450 as shown in FIG.
  • the thermocoagulated branch blood vessel 1100 is cut by the cutting unit 430. According to this embodiment, in this way, the branch blood vessel 1100 can be thermally coagulated and cut sequentially.
  • the second peeling device 320 also serves as the processing device 400, the branch blood vessel 1100 can be processed together with the insertion of the second peeling device 320. Therefore, peeling of the large saphenous vein 1000 (first step) can be performed more smoothly.
  • FIG. 39 is a side view showing a cutting device included in the blood vessel peeling device according to the ninth embodiment of the present invention.
  • 40 is a cross-sectional view of the cutting device shown in FIG. FIG. 41 and FIG. 42 are diagrams for explaining a branch blood vessel processing method.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the cutting device is different.
  • the cutting device 600 of the present embodiment has a main body 610 and a cutting part 620 that can move in the main body 610, as shown in FIGS.
  • the main body 610 has a long plate shape. Moreover, the main-body part 610 has the groove
  • a tapered guide portion 613 is provided at the tip of the main body portion 610.
  • the guide portion 613 has a guide surface 613a that is inclined and directed downward, and the guide surface 613a is used to move the fat 1200 and the branch blood vessel 1100 downward (grooves 611 and muscles) when the main body portion 610 advances through the living body. It has a function of guiding to the membrane side peeling device 300).
  • the main body 610 has connection portions 614 and 615 that can be connected to the rails 231 and 232 of the skin side peeling device 200.
  • the main body 610 is provided with electrodes 616 and 617 through grooves 611. That is, an electrode (first electrode) 616 is disposed on one side of the groove 611, and an electrode (second electrode) 617 is disposed on the other side of the groove 611.
  • the cutting part 620 can be inserted into the groove 611 and can slide within the groove 611. Further, the tip of the cutting part 620 is a blade part 621 that can protrude from the groove 611.
  • the processing of the branch blood vessel 1100 by the cutting device 600 of the present embodiment includes the steps of peeling the fat 1200 along the great saphenous vein 1000, pressing the peeled fat 1200, and the branch blood vessel included in the pressed fat 1200. And cauterizing 1100 and cutting the cauterized branch blood vessel 1100.
  • the skin side peeling device 200 and the fascia side peeling device 300 are inserted into the living body, and the fat 1200 above and below the great saphenous vein 1000 is peeled off.
  • the connection portion 614 is connected to the rail 231 of the skin side peeling device 200 and the main body portion 610 is inserted into the living body while being guided by the skin side peeling device 200, as shown in FIG.
  • the fat 1200 and the branch blood vessel 1100 are guided between the main body 610 and the second peeling device 320 and are sandwiched between them in a crushed state (pressed (compressed) state).
  • the skin side peeling device 200 is pressed from the skin 1400 side and inserted while pressing the main body 610 against the second peeling device 320.
  • a high-frequency alternating voltage is applied between the electrodes 616 and 617 to cauterize and thermally coagulate the branch blood vessel 1100 sandwiched between the main body 610 and the second peeling device 320.
  • the cutting part 620 is inserted into the groove 611, and as shown in FIG. 42, the blade part 621 protrudes from the front end side of the groove 611 and enters the rail 322 of the second peeling device 320.
  • the branch blood vessel 1100 and the fat 1200 are cut by the blade portion 621 by sliding the cutting portion 620 to the proximal end side.
  • the fat 1200 on the side of the great saphenous vein 1000 is cut right and left, and the branch blood vessel 1100 is heat-coagulated and cut.
  • these displacements can be suppressed, and these processes can be performed more reliably.
  • the fat 1200 sandwiched between the main body 610 and the first peeling device 310 is cauterized, so that the fat 1200 is cut more smoothly by the blade 621. be able to.
  • the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
  • a voltage is applied between the electrodes 616 and 617, but the pair of electrodes 616 and 617 are connected to the same potential and one electrode (first electrode) is connected.
  • the blade portion 621 of the cutting portion 620 may also serve as the other electrode (second electrode).
  • the cutting unit 620 is applied while applying a high-frequency alternating voltage between the electrodes 616, 617 and the blade 621.
  • the branch blood vessel 1100 can be thermally coagulated and cut.
  • the branch blood vessel 1100 can be more thermally coagulated.
  • the fascia side peeling device 300 has the 1st peeling device 310 and the 2nd peeling device 320 similarly to said embodiment,
  • a fascia side peeling device The number of peeling devices included in is not limited to this, and may be one or three or more.
  • FIG. 43 is a side view showing a cutting device included in the blood vessel peeling device according to the tenth embodiment of the present invention.
  • FIG. 44 and FIG. 45 are diagrams for explaining a branch blood vessel processing method.
  • This embodiment is mainly the same as the ninth embodiment described above, except that the cutting device has a plurality of main body portions.
  • the cutting device 600 includes two main body portions 610A and 610B having different thicknesses T and a cutting portion 620 as shown in FIG.
  • the main body portions 610A and 610B each have the same configuration as the main body portion 610 of the ninth embodiment described above.
  • two main body portions 610A and 610B are prepared.
  • the number of main body portions to be prepared is not limited to two, and may be three or more.
  • the fat 1200 and the branch blood vessel 1100 must be guided between the main body 610 and the fascia side peeling device 300 by inserting the main body 610 once.
  • the fat 1200 guided between the main body 610 and the fascia-side peeling device 300 becomes too thick, and the fat is properly guided. Even if it is not possible to guide or guide, excessive force may be required to cut the fat 1200 by the cutting part 620.
  • the main body portions 610A and 620B having different thicknesses T are prepared, and the fat 1200 and the branch blood vessel 1100 are cut in two steps, so that the work can be performed more smoothly and without excessive force.
  • the main body 610A having the smaller thickness T is inserted.
  • a high-frequency alternating voltage is applied between the electrodes 616 and 617 to thermally coagulate the branch blood vessel 1100, and then the branch blood vessel 1100 and the fat 1200 are cut using the cutting unit 620. Thereby, fat 1200 will be in the state cut
  • the main body 610B is inserted as shown in FIG.
  • a high-frequency alternating voltage is applied between the electrodes 616 and 617 to thermally coagulate the branch blood vessel 1100, and then the branch blood vessel 1100 and the fat 1200 are cut using the cutting unit 620.
  • the fat 1200 on the side of the great saphenous vein 1000 is cut right and left, and the branch blood vessel 1100 is stopped and cut.
  • the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
  • FIG. 46 is a side view showing a cutting device included in the blood vessel peeling device according to the eleventh embodiment of the present invention. 47 is a cross-sectional view of the cutting device shown in FIG. FIG. 48 and FIG. 49 are diagrams for explaining a branch blood vessel processing method.
  • This embodiment is mainly the same as the ninth embodiment described above except that the configuration of the cutting device is different.
  • the cutting device 600 of the present embodiment includes a main body 610 and a cutting unit 620 that moves along the main body 610, as shown in FIGS.
  • the main body 610 has a long plate shape.
  • An electrode (first electrode) 616 is provided on the lower surface side of the main body 610.
  • the cutting part 620 has substantially the same configuration as that of the above-described ninth embodiment, and the blade part 621 also serves as an electrode (second electrode).
  • the processing of the branch blood vessel 1100 by the cutting device 600 of the present embodiment includes the steps of peeling the fat 1200 along the great saphenous vein 1000, pressing the peeled fat 1200, and the branch blood vessel included in the pressed fat 1200. Cauterizing and cutting 1100.
  • the skin side peeling device 200 and the fascia side peeling device 300 are inserted into the living body, and the fat 1200 above and below the great saphenous vein 1000 is peeled off.
  • the connection part 614 is connected to the rail 231 of the skin side peeling device 200, and the main body part 610 is inserted into the living body while being guided by the skin side peeling device 200.
  • the fat 1200 and the branch blood vessel 1100 are guided between the main body 610 and the second peeling device 320 by the guide portion 613, and are put in a state of being crushed.
  • the cutting part 620 is inserted along the side surface of the main body part 610, and as shown in FIG.
  • the blade part 621 protrudes from the lower surface of the main body part 610 to enter the rail 322 of the second peeling device 320. Invade.
  • the cutting unit 620 is slid toward the proximal end while applying a high-frequency alternating voltage between the electrode 616 and the blade unit 621, the branch blood vessel 1100 is thermally coagulated and cut by the cutting unit 620.
  • the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
  • FIG. 50 is a perspective view showing a cutting device included in a blood vessel peeling device according to a twelfth embodiment of the present invention.
  • FIG. 51 is a perspective view showing a fascia side peeling device included in a blood vessel peeling device according to a twelfth embodiment of the present invention.
  • FIG. 52 is a cross-sectional view showing a state in which the cutting device and the fascia side peeling device are opposed to each other.
  • FIG. 53 and FIG. 54 are diagrams for explaining a branch blood vessel processing method.
  • This embodiment is mainly the same as the ninth embodiment described above except that the configuration of the cutting device and the fascia side peeling device are different.
  • electrodes (first electrodes) 616 and 617 are formed shorter than the ninth embodiment described above.
  • the electrodes 616 and 617 can move integrally with the main body 610 in the axial direction.
  • the electrodes 616 and 617 are connected to the same potential.
  • the lengths of the electrodes 616 and 617 are not particularly limited, and can be about 5 mm to 2 cm, for example.
  • the first peeling device 310 has electrodes (second electrodes) 318 and 319 arranged to face each other via the rail 312.
  • the electrodes 318 and 319 are provided so as to extend in the axial direction of the first peeling device 310.
  • the electrodes 318 and 319 face the electrodes 616 and 617 when the first peeling device 310 and the main body 610 are arranged with the groove 611 and the rail 312 facing each other.
  • the second peeling device 320 includes electrodes (second electrodes) 328 and 329 arranged to face each other via the rail 322.
  • the electrodes 328 and 329 are provided so as to extend in the axial direction of the second peeling device 320.
  • the electrodes 328 and 329 are opposed to the electrodes 616 and 617 when the second peeling device 320 and the main body 610 are disposed with the groove 611 and the rail 322 opposed to each other.
  • the main body 610 is inserted into the living body, and the fat 1200 and the branch blood vessel 1100 are sandwiched between the main body 610 and the second peeling device 320.
  • the electrodes 616 and 617 are slid with respect to the main body 610 to thermally coagulate the branch blood vessel 1100.
  • the thermocoagulated branch blood vessel 1100 is cut by the cutting unit 620.
  • the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
  • FIG. 55 is a perspective view showing a skin side peeling device and a fascia side peeling device included in a blood vessel peeling device according to a thirteenth embodiment of the present invention.
  • FIG. 56 is a side view showing a cutting device included in a blood vessel peeling device according to a thirteenth embodiment of the present invention.
  • FIG. 57 is a top view of the cutting device shown in FIG. FIG. 58 and FIG. 59 are diagrams for explaining a branch blood vessel processing method.
  • This embodiment is mainly the same as the first embodiment described above except that the configuration of the cutting device is different.
  • the skin-side peeling device 200 of the present embodiment has a substantially rectangular cross-sectional shape with rounded corners, as shown in FIG. Rails 231 and 232 are provided on the lower surface of the skin-side peeling device 200.
  • first peeling device 310 of the present embodiment is provided with an electrode (first electrode) 340 on the upper surface instead of the rail 312 being omitted from the configuration of the first embodiment described above.
  • an electrode (first electrode) 350 is provided on the upper surface instead of the rail 322 being omitted from the configuration of the first embodiment described above.
  • the cutting device 700 of this embodiment includes a long main body (guide device) 710 and a roller electrode (second electrode) that is rotatably provided on the main body 710. ) 720 and rollers 731 and 732.
  • the main body 710 has a shape in which the roller electrode 720 and the rollers 731 and 732 are sandwiched between the two plate-like pieces 711 and 712 from both sides. Further, a tapered guide portion 713 is provided at the distal end portion of the main body portion 710.
  • the guide portion 713 has a guide surface 713a that is inclined and faces downward, and the guide surface 713a is used to move the fat 1200 and the branch blood vessel 1100 downward (when the main body 710 and the main body portion 710 are moved). It has a function of guiding to the fascia side peeling device 300).
  • the roller electrode 720 is provided so as to protrude below the main body 710.
  • the roller electrode 720 is provided so as to protrude from the guide portion 713 (guide surface 713a).
  • Such a roller electrode 720 is an electrode for cauterizing by applying an electric field to the branch blood vessel 1100 and the fat 1200 guided between the main body part 710 and the fascia side peeling device 300 by the guide part 713, It also functions as a cutting part for cutting the cauterized branched blood vessel 1100 and fat 1200.
  • the cutting portion may be provided separately from the roller electrode 720, and in this case, the cutting portion may be disposed so as to protrude to the lower side of the main body portion 710 from the base end side of the roller electrode 720.
  • Rollers 731 and 732 are provided so as to protrude upward from the main body 710. When the main body 710 is inserted into the living body, the rollers 731 and 732 engage with the rails 231 and 232 of the skin side peeling device 200, so that the cutting device 700 can be smoothly inserted into the living body.
  • the processing of the branch blood vessel 1100 by the cutting device 600 of the present embodiment includes the steps of peeling the fat 1200 along the great saphenous vein 1000, pressing the peeled fat 1200, and the branch blood vessel included in the pressed fat 1200. And cauterizing 1100 and cutting the cauterized branch blood vessel 1100.
  • the skin side peeling device 200 and the fascia side peeling device 300 are inserted into the living body, and the fat 1200 above and below the great saphenous vein 1000 is peeled off.
  • the cutting device 700 is inserted between the skin-side peeling device 200 and the second peeling device 320 as shown in FIG.
  • the branched blood vessel 1100 and the fat 1200 are guided in a crushed state (pressed (compressed)) between the main body portion 710 and the second peeling device 320 by the guide portion 713, and as shown in FIG.
  • the roller electrode 720 and the second peeling device 320 electrode 350
  • it is cauterized and thermally coagulated and cut.
  • the branch blood vessel 1100 and the fat 1200 pass between the roller electrode 720 and the electrode 350, so that an electric field can be effectively applied thereto, and these can be sufficiently cauterized.
  • the branch blood vessel 1100 since the branch blood vessel 1100 is cauterized in a collapsed state, the branch blood vessel 1100 can be more solidified more reliably.
  • the roller electrode 720 since the roller electrode 720 is rotatable, the branch blood vessel 1100 and the fat 1200 can smoothly pass between the roller electrode 720 and the second peeling device 320, so that the above operation can be performed more smoothly. It can be carried out.
  • the roller electrode 720 which is one electrode is provided in the main body portion 710, and the electrode 350 (electrode 340) which is the other electrode is provided in the second peeling device 320 (first peeling device 310).
  • the branch blood vessel 1100 and the fat 1200 can be passed between the roller electrode 720 and the electrode 350 (electrode 340) with a simple configuration.
  • the timing at which the branch blood vessel 1100 is thermally coagulated and the timing at which it is cut are almost the same, but depending on the case, it is thermally coagulated after being cut, or conversely, it is cut after being thermally coagulated.
  • the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
  • the branch blood vessels 1100 and fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
  • the electrode 340 is arranged over almost the entire upper surface of the first peeling device 310.
  • the arrangement of the electrode 340 includes the branch blood vessel 1100 by an electric field generated between the roller electrode 720 and the electrode 340. If shochu (thermal coagulation) can come out, it will not be specifically limited.
  • the electrodes 340 may be arranged side by side in a plurality of lines, or may be arranged to meander according to the shape (extended state) of the large saphenous vein 1000.
  • the rails 231 and 232 of the skin side peeling device 200 are preferably meandered in the same manner.
  • FIG. 60 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a fourteenth embodiment of the present invention.
  • FIG. 61 is a diagram illustrating a method for processing a branch blood vessel.
  • This embodiment is mainly the same as the thirteenth embodiment described above except that the configurations of the skin-side peeling device and the cutting device are different.
  • the skin-side peeling device 200 of this embodiment has a rack gear 231A that is linearly cut on the bottom surface of the rail 231. Similarly, the skin-side peeling device 200 is linearly cut on the bottom surface of the rail 232.
  • the rack gear 232A is provided.
  • the cutting device 700 of the present embodiment is composed of a pinion gear in which rollers 731 and 732 are toothed on the peripheral surface, and can mesh with the rails 231 and 232.
  • the roller electrode (rotating body) 720 also includes a pinion gear and meshes with the rollers 731 and 732.
  • Such rollers 731 and 732 and the roller electrode 720 constitute a guiding portion 750 for actively guiding the branch blood vessel 1100 and the fat 1200 between the main body portion 710 and the second peeling device 320.
  • the roller electrode 720 also serves as a rotating body, the configuration of the cutting device 700 becomes simpler.
  • roller electrode 720 is provided so as to protrude from the guide portion 713 (guide surface 713a), the above effect becomes more remarkable. Moreover, since the friction with the fat 1200 is increased by the teeth provided on the peripheral surface of the roller electrode 720, the above effect is further improved.
  • the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
  • the branch blood vessels 1100 and the fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
  • FIG. 62 is a side view showing a cutting device included in a blood vessel peeling device according to a fifteenth embodiment of the present invention.
  • This embodiment is mainly the same as the thirteenth embodiment described above except that the configuration of the cutting device is different.
  • the cutting device 700 of this embodiment has a drive unit 790 that rotates a roller electrode (rotating body) 720, as shown in FIG.
  • the drive unit 790 includes a drive source 791 such as a motor, and an endless belt 792 that transmits power generated from the drive source 791 to the roller electrode 720, and the roller electrode 720 rotates by rotating the drive source 791. It is the composition to do.
  • the roller electrode 720 and the drive unit 790 constitute a guide unit 750. Note that the configuration of the drive unit 790 is not particularly limited as long as the roller electrode 720 can be rotated.
  • the cutting device 700 is inserted into the living body while the driving unit 790 rotates the roller electrode 720 in a direction in which the branch blood vessel 1100 and the fat 1200 are guided between the main body 710 and the second peeling device 320.
  • the branch blood vessel 1100 and the fat 1200 can be more actively guided between the main body 710 and the second peeling device 320.
  • the branch blood vessels 1100 and fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
  • FIG. 63 is a side view showing a skin side peeling device and a cutting device included in a blood vessel peeling device according to a sixteenth embodiment of the present invention.
  • FIG. 64 is a diagram for explaining a branch blood vessel processing method.
  • This embodiment is mainly the same as the thirteenth embodiment described above except that the configurations of the skin-side peeling device and the cutting device are different.
  • the skin side peeling device 200 of the present embodiment has the same configuration as that of the fourteenth embodiment described above.
  • the cutting device 700 of the present embodiment includes a guide portion 750 that actively guides the branch blood vessel 1100 and the fat 1200 between the main body portion 710 and the second peeling device 320.
  • the guide portion 750 is rotatably provided on the main body portion 710, and is provided on the main body portion 710 so as to be rotatable, and a first gear portion 751 that meshes with the rails 231 and 232. And a second gear portion 752 that meshes with the first gear portion 751.
  • the second gear portion 752 has a small-diameter portion 753 that meshes with the first gear portion 751, and a large-diameter portion 754 that is provided coaxially with the portion 753, and the peripheral surface of the portion 754
  • the claw portion 754a is provided side by side. And the nail
  • a high-frequency alternating voltage is applied between the roller electrode 720 and the electrode 350, and the first gear portion 751 is engaged with the rail 231 of the skin side peeling device 200 as shown in FIG.
  • the second gear part 752 urges the branch blood vessel 1100 and the fat 1200 rearward in the insertion direction, that is, between the main body part 710 and the second peeling device 320. Rotate to guide in between. Therefore, the branch blood vessel 1100 and the fat 1200 can be actively guided between the main body 710 and the second peeling device 320.
  • the friction with the fat 1200 is increased by the claw portion 754a provided on the peripheral surface of the second gear portion 752, the above effect is further improved.
  • the branched blood vessel 1100 and the fat 1200 guided between the main body 710 and the second peeling device 320 are the roller electrode 720 and the second peeling device 320 (electrodes) positioned behind the second gear portion 752. 350) and is cut and cut.
  • the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
  • the branch blood vessels 1100 and fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
  • FIG. 65 is a side view showing a cutting device included in a blood vessel peeling device according to a seventeenth embodiment of the present invention.
  • FIG. 66 is a diagram for explaining a branch blood vessel processing method.
  • This embodiment is mainly the same as the thirteenth embodiment described above except that the configurations of the fascia side peeling device and the cutting device are different.
  • the first peeling device 310 of this embodiment has a configuration in which the electrode 340 is omitted from the thirteenth embodiment.
  • the second peeling device 320 of the present embodiment has a configuration in which the electrode 350 is omitted from the thirteenth embodiment.
  • the cutting device 700 of the present embodiment includes a pair of main body portions 710A and 710B that are arranged to face each other, and roller electrodes (first electrodes) provided on the main body portion (first main body portion) 710A. ) 720A and rollers 731A and 732A, and a roller electrode (second electrode) 720B and rollers 731B and 732B provided on the main body (second main body) 710B.
  • the main body portions 710A and 710B are disposed to face each other via the gap S3, and are connected by a base end portion.
  • the space S3 is a space for guiding the branch blood vessel 1100 and the fat 1200 when inserted into the living body.
  • the main body 710A has a long plate shape.
  • the main body 710A has a shape in which the roller electrode 720A and the rollers 731A and 732A are sandwiched from both sides by two plate-like pieces 711A and 712A.
  • a tapered guide portion 713A is provided at the distal end portion of the main body portion 710A.
  • the guide portion 713A has a guide surface 713Aa that is inclined and faces downward.
  • the guide surface 713Aa has a function of guiding the fat 1200 and the branch blood vessel 1100 to the gap S3 when the main body portion 710A advances through the living body.
  • the main body 710B has a target configuration with the main body 710A via the gap S3.
  • roller electrodes 720A and 720B are arranged to face each other, and are both provided so as to protrude into the gap S3.
  • Such roller electrodes 720A and 720B are electrodes for cauterizing by causing an electric field to act on the branch blood vessel 1100 and the fat 1200 guided between the main body portions 710A and 720B by the guide portions 713A and 713B. It also functions as a cutting section for cutting the branch blood vessel 1100 and the fat 1200.
  • Rollers 731A and 732A are provided to protrude to the upper side of the main body 710A. Similarly, the rollers 731B and 732B are provided so as to protrude downward from the main body 710B.
  • the rollers 731A and 732A engage with the rails 231 and 232 of the skin side peeling device 200, and the rollers 731B and 732B rotate along the fascia side peeling device 300.
  • the cutting device 700 can be smoothly inserted into the living body.
  • the skin-side peeling device 200 and the fascia-side peeling device 300 are placed in the living body, and the cutting device 700 is peeled off the skin while applying a high-frequency alternating voltage between the roller electrodes 720A and 720B. Insert between device 200 and second stripping device 320. Then, the branch blood vessel 1100 and the fat 1200 are guided to the gap S3 (between the main body portions 710A and 710B) by the guide portions 713A and 713B, and cauterized when passing between the roller electrodes 720A and 720B as shown in FIG. And cut off.
  • the upper and lower fats 1200 are compressed so as to be collected in the central portion. For example, as in the thirteenth embodiment described above, the compression is performed such that the fats are collected below the upper and lower fats 1200.
  • the branched blood vessel 1100 and the fat 1200 can be guided to the gap S3 more smoothly.
  • the entire circumference of the fat 1200 around the large saphenous vein 1000 is peeled off, and the large saphenous vein 1000 is surrounded by the surrounding fat 1200. It will be in the state peeled in the state covered with.
  • the branch blood vessels 1100 and the fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
  • gap S3 is not necessarily required when the branching blood vessel 1100 and the fat 1200 can be cut reliably.
  • FIG. 67 is a side view showing a cutting device included in a blood vessel peeling device according to an eighteenth embodiment of the present invention.
  • FIG. 68 is a diagram for explaining a branch blood vessel processing method.
  • This embodiment is mainly the same as the thirteenth embodiment described above except that the configuration of the cutting device is different.
  • a main body 710 and a roller electrode 720 are provided separately. Further, the roller electrode 720 is rotatably supported by the long operation unit 721. Such a roller electrode 720 can move inside the main body 710 (a gap between the plate-like pieces 711 and 712).
  • the main body 710 is first inserted into the living body.
  • the roller electrode 720 is pushed against the branch blood vessel 1100 and the fat 1200, and the inside of the main body 710 is advanced. Thereby, the branch blood vessel 1100 and the fat 1200 can be cauterized and cut.
  • the branch blood vessels 1100 and fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
  • FIG. 69 is a side view showing a cutting device included in a blood vessel peeling device according to a nineteenth embodiment of the present invention.
  • FIG. 70 is a diagram for explaining a branch blood vessel processing method.
  • This embodiment is mainly the same as the eighteenth embodiment described above except that the configuration of the cutting device is different.
  • the cutting device 700 of this embodiment has an electrode 740 having a blade portion 741 instead of the roller electrode 720 of the eighteenth embodiment described above.
  • the electrode 740 is fixed to the distal end portion of the long operation portion 742.
  • Such an electrode 740 can move inside the main body 710 (a gap between the plate-like pieces 711 and 712).
  • the main body 710 is first inserted into the living body.
  • the electrode 740 is pressed against the branch blood vessel 1100 and the fat 1200, and the inside of the main body 710 is advanced. Thereby, the branch blood vessel 1100 and the fat 1200 can be cauterized and cut.
  • the branch blood vessels 1100 and fat 1200 on the left and right of the great saphenous vein 1000 can be easily processed.
  • roller electrode 720 an insulating coating or the like may be applied to the roller side surface portion, and only the roller end surface portion (circumferential portion) may be used as the electrode. Further, only the vicinity of the blade portion of the electrode 740 having the blade portion 741 may be used as the electrode. In that case, the current-carrying part is limited, and thermal coagulation can be performed more efficiently.
  • the blood vessel peeling device of the present invention has been described based on the illustrated embodiment, but the present invention is not limited to this, and the configuration of each part is replaced with an arbitrary configuration having the same function. can do.
  • any other component may be added to the present invention.
  • the great saphenous vein is peeled in a state where the entire circumference is covered with fat, but is not limited to the case where the entire circumference is covered with fat. That is, the large saphenous vein may be peeled off in a state where a part of its periphery is covered with the set fat, or may be peeled off without being covered with fat.
  • the upper and lower fats may be thin (or there is no fat 1200 above and below), and the left and right fats may be thick and covered with flat fat.
  • the state of the great saphenous vein for example, presence or absence of damage, shape, twist
  • it can be appropriately used for a bypass pipe or the like.
  • the great saphenous vein 1000 when the great saphenous vein 1000 is meandering greatly, an incision is made for each region where the great saphenous vein 1000 extends relatively straight, and the above-described operation is performed.
  • the saphenous vein 1000 may be peeled by repeating a plurality of times. 71, first, the great saphenous vein 1000 is peeled between the incisions 1310 and 1320, and then the great saphenous vein 1000 is peeled between the incisions 1320 and 1330.
  • the large saphenous vein 1000 may be peeled between the portions 1330 and 1340. Then, the large saphenous vein 1000 may be ligated through the incisions 1310 and 1340 and removed from either of the incisions 1310 and 1340.
  • a longer (predetermined length) large saphenous vein 1000 can be collected regardless of the state of the large saphenous vein.
  • the blood vessel peeling device of the present invention includes a pair of insertion devices that are inserted into a living body along a blood vessel and sandwich the branched blood vessel that separates from the blood vessel in the living body, and a processing device that processes the branched blood vessel.
  • One of the insertion devices has a first groove that is open on a surface facing the other insertion device and into which the processing device can be inserted. According to such a configuration, the processing of the branch blood vessel by the processing device is facilitated. Further, since the processing device can be inserted into the insertion device, the processing device can be operated smoothly, and the branch blood vessel can be processed more easily. Therefore, the blood vessel peeling device is excellent in blood vessel peeling workability.
  • the blood vessel peeling device of the present invention has industrial applicability.

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Abstract

L'invention concerne un dispositif (100) de retrait de vaisseaux sanguins qui comporte : un premier dispositif (310) de retrait et un second dispositif (320) de retrait qui prennent en sandwich et retiennent des vaisseaux sanguins ramifiés (1100) ; et un dispositif de traitement (400) qui traite les vaisseaux ramifiés (1100). Le premier dispositif de retrait (310) comporte en outre une rainure (313) qui s'ouvre au niveau d'une surface de butée (310a), et le second dispositif (320) de retrait comporte une rainure (323) qui s'ouvre au niveau d'une surface de butée (320a). Les rainures (313, 323) forment une cavité (330) dans laquelle le dispositif de traitement (400) est inséré.
PCT/JP2015/071675 2015-01-19 2015-07-30 Dispositif de retrait de vaisseaux sanguins Ceased WO2016117152A1 (fr)

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6468275B1 (en) * 1998-02-06 2002-10-22 Ethicon Endo-Surgery, Inc. RF bipolar mesentery takedown device including improved bipolar end effector
WO2007021010A1 (fr) * 2005-08-18 2007-02-22 Olympus Medical Systems Corp. Coupeuse bipolaire
JP2008119470A (ja) * 2006-11-08 2008-05-29 Covidien Ag 電気外科用鉗子のための絶縁ブーツ

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6468275B1 (en) * 1998-02-06 2002-10-22 Ethicon Endo-Surgery, Inc. RF bipolar mesentery takedown device including improved bipolar end effector
WO2007021010A1 (fr) * 2005-08-18 2007-02-22 Olympus Medical Systems Corp. Coupeuse bipolaire
JP2008119470A (ja) * 2006-11-08 2008-05-29 Covidien Ag 電気外科用鉗子のための絶縁ブーツ

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