WO2017175281A1 - Outil de traitement d'énergie - Google Patents

Outil de traitement d'énergie Download PDF

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Publication number
WO2017175281A1
WO2017175281A1 PCT/JP2016/061044 JP2016061044W WO2017175281A1 WO 2017175281 A1 WO2017175281 A1 WO 2017175281A1 JP 2016061044 W JP2016061044 W JP 2016061044W WO 2017175281 A1 WO2017175281 A1 WO 2017175281A1
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WIPO (PCT)
Prior art keywords
energy
treatment surface
staple
treatment
energy treatment
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Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2016/061044
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English (en)
Japanese (ja)
Inventor
雅人 成澤
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Olympus Corp
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Olympus Corp
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Publication date
Application filed by Olympus Corp filed Critical Olympus Corp
Priority to PCT/JP2016/061044 priority Critical patent/WO2017175281A1/fr
Publication of WO2017175281A1 publication Critical patent/WO2017175281A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • 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
    • A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
    • 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
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor

Definitions

  • the present invention relates to an energy treatment device.
  • an energy treatment tool for treating (joining (or anastomosing), cutting, etc.) biological tissues to be treated by applying energy and stapling is known (see, for example, Patent Document 1).
  • the energy treatment device described in Patent Document 1 has a first clamping surface, and a living body between the staple cartridge assembly portion in which staples are stored and the first clamping surface facing the first clamping surface.
  • an anvil assembly having a second clamping surface for clamping the tissue.
  • the first clamping surface is provided with staple holes for firing the staples housed inside the staple cartridge assembly section toward the outside, and first electrodes for generating energy.
  • the second clamping surface is provided with a staple receiving recess for deforming the staple tip of the staple fired toward the outside of the staple cartridge assembly section, and a second electrode for generating energy. Then, energy is applied to the living tissue by supplying high-frequency power between the first electrode and the second electrode in a state where the living tissue is held between the first and second holding surfaces. In this state, by firing the staple, the staple is driven into the living tissue, and the living tissue is stapled.
  • the first electrode is integrally provided in the staple cartridge assembly portion, and the second electrode is integrally provided in the anvil assembly portion.
  • the energy bonding part located between the first electrode and the second electrode and the stapling part located between the staple hole periphery and the staple receiving recess periphery are respectively appropriate force. There is a problem that it cannot be pinched.
  • the first electrode is structurally configured to be convex with respect to the periphery of the staple hole (or the second electrode is convex with respect to the periphery of the staple receiving recess. It is conceivable that it is configured as follows. However, in the case of such a configuration, when a certain biological tissue is treated among various biological tissues (for example, small intestine, stomach, etc.) having different thicknesses and hardnesses, the energy bonding site in the biological tissue. Can be clamped with an appropriate force, the stapling part of the living tissue may be clamped in an over-compressed state.
  • various biological tissues for example, small intestine, stomach, etc.
  • the present invention has been made in view of the above, and in treating various biological tissues, an energy treatment device capable of reliably treating the biological tissue while suppressing blood flow inhibition of the biological tissue.
  • the purpose is to provide.
  • an energy treatment device includes a first holding member provided with a first staple treatment surface and a first energy treatment surface, and the first staple treatment.
  • the biological tissue between the second staple treatment surface that sandwiches the biological tissue with the first staple treatment surface facing the surface and the first energy treatment surface facing the first energy treatment surface A second holding member provided with a second energy treatment surface for sandwiching the first staple treatment surface, wherein one of the first staple treatment surface and the second staple treatment surface is a staple for suturing the living tissue.
  • At least one of the first energy treatment surface and the second energy treatment surface generates energy for joining the living tissue, and the first staple treatment surface and the second staple treatment surface are generated.
  • a surface, the first energy treatment surface, and the second energy treatment surface are defined as a stapling side separation distance between the first staple treatment surface and the second staple treatment surface. And the second energy treatment surface relative to each other so as to be larger than the energy bonding side separation distance.
  • the biological tissue when various biological tissues are treated, the biological tissue can be reliably treated while suppressing blood flow inhibition of the biological tissue.
  • FIG. 1 is a diagram schematically showing a treatment system according to Embodiment 1 of the present invention.
  • FIG. 2 is a perspective view schematically showing the energy treatment device shown in FIG.
  • FIG. 3 is a cross-sectional view schematically showing a state in which a living tissue is clamped by the clamping unit shown in FIG.
  • FIG. 4 is a diagram schematically illustrating the first treatment surface illustrated in FIGS. 2 and 3.
  • FIG. 5 is a diagram schematically illustrating the second treatment surface illustrated in FIGS. 2 and 3.
  • FIG. 6 is a diagram showing a modification of the first embodiment of the present invention.
  • FIG. 7 is a diagram showing a modification of the first embodiment of the present invention.
  • FIG. 8 is a cross-sectional view schematically showing an energy treatment device constituting the treatment system according to Embodiment 2 of the present invention.
  • FIG. 9 is a flowchart showing the operation of the control device according to the second embodiment of the present invention.
  • FIG. 1 is a diagram schematically showing a treatment system 1 according to Embodiment 1 of the present invention.
  • the treatment system 1 treats (joins (or anastomoses), detaches, etc.) biological tissues to be treated by applying energy and stapling.
  • the treatment system 1 includes an energy treatment device 2, a control device 3, and a foot switch 4.
  • the energy treatment apparatus 2 is, for example, a linear surgical instrument for performing treatment on a living tissue through the abdominal wall.
  • the energy treatment device 2 includes a handle 5, a first shaft 6, and an energy treatment tool 7.
  • the handle 5 is a portion that the operator holds.
  • the handle 5 is provided with a plurality of operation knobs 51 (in the first embodiment, three of first to third operation knobs 511 to 513).
  • the first shaft 6 has a substantially cylindrical shape, and one end (the right end portion in FIG. 1) is connected to the handle 5.
  • the energy treatment tool 7 is detachably attached to the other end (left end portion in FIG. 1) of the first shaft 6.
  • an electric cable C (FIG. 1) connected to the control device 3 is disposed from one end side to the other end side via the handle 5.
  • FIG. 2 is a perspective view schematically showing the energy treatment device 7.
  • the energy treatment device 7 is a disposable part that is discarded after use, and includes a second shaft 8 and a clamping portion 9 as shown in FIG. 1 or FIG.
  • the second shaft 8 has a substantially cylindrical shape, and one end (the right end portion in FIGS. 1 and 2) is the other end of the first shaft 6 (the left end portion in FIG. 1). ) Is detachable.
  • the clamping part 9 is attached to the other end (the left end part in FIGS. 1 and 2) of the second shaft 8.
  • the first and second shafts 6 and 8 are connected to each other in a state where the second shaft 8 is attached to the first shaft 6, and according to the operation of the first operation knob 511 by the operator, First and second opening / closing mechanisms (not shown) for opening and closing the first and second holding members 10 and 11 (FIGS. 1 and 2) constituting the holding unit 9 are provided.
  • First and second shafts 6 and 8 are connected to each other with the second shaft 8 attached to the first shaft 6, and according to the operation of the second operation knob 512 by the operator, First and second firing mechanisms (not shown) for firing the staple St made of metal or resin (see FIG. 3) and stapling the living tissue LT (FIG. 3) are provided.
  • first and second shafts 6 and 8 are connected to each other with the second shaft 8 attached to the first shaft 6, and according to the operation of the third operation knob 513 by the operator, First and second moving mechanisms (not shown) for moving the cutter 12 (FIG. 2) are provided. Further, in the second shaft 8, the electric cable C routed to the other end (the left end portion in FIG. 1) of the first shaft 6 with the second shaft 8 attached to the first shaft 6. Are connected to the first and second energy treatment sections 13 and 18 (FIG. 2).
  • FIG. 3 is a cross-sectional view schematically showing a state where the living tissue LT is clamped by the clamping unit 9.
  • FIG. 3 is a cross-sectional view in which the state in which the living tissue LT is clamped by the clamping unit 9 is cut by a cut surface orthogonal to the central axis of the second shaft 8.
  • the clamping unit 9 is a part that clamps the living tissue LT and treats the living tissue LT.
  • the clamping unit 9 includes a first holding member 10, a second holding member 11, and a cutter 12 (FIG. 2).
  • the first and second holding members 10 and 11 are pivotally supported on the other end (left end portion in FIGS.
  • the living tissue LT can be clamped according to the operation of the 1 operation knob 511.
  • the detailed configuration of the first and second holding members 10 and 11 will be described later.
  • the cutter 12 is attached to the other end of the second shaft 8 so as to be movable along the direction of the arrow R2 (FIG. 2), and moves according to the operation of the third operation knob 513 by the operator. And the cutter 12 cut
  • the first holding member 10 is disposed on the upper side in FIGS. 1 to 3 with respect to the second holding member 11 and has a substantially rectangular parallelepiped shape extending along the central axis of the second shaft 8.
  • the material of the first holding member 10 include a material having high heat resistance and excellent electrical insulation, for example, PEEK (polyether ether ketone) resin.
  • the shape of the first holding member 10 is not limited to a rectangular parallelepiped shape, and it may be configured to improve the insertability with respect to the trocar by giving the outer peripheral surface a curvature. 2 and 3 of the first holding member 10, a first energy treatment section 13 and two first staple treatment sections 14 are provided on the lower surface 101.
  • first energy treatment unit 13 and the two first staple treatment units 14 function as a first treatment surface 15 (FIGS. 2 and 3) for treating the living tissue LT.
  • the first energy treatment unit 13 and the two first staple treatment units 14 are each in contact with the living tissue LT for treatment, that is, the first energy treatment surface, and the two first treatment units.
  • the treatment surface and the treatment unit may be configured separately. That is, for example, as the energy treatment surface, another member may be bonded to the surface of the first energy treatment unit 13 on the living tissue LT side.
  • FIG. 4 is a diagram schematically showing the first treatment surface 15.
  • the first energy treatment unit 13 is fixed to a substantially central position in the width direction on the surface 101 of the first holding member 10. And the 1st energy treatment part 13 generates energy under control by the control apparatus 3, and transmits energy to the 1st energy treatment surface which contact
  • the 1st energy treatment part 13 is comprised with electroconductive materials, such as copper, for example.
  • the first energy treatment unit 13 extends along the longitudinal direction of the first holding member 10 so that the dimension in the longitudinal direction is substantially the same as the dimension in the longitudinal direction of the first holding member 10.
  • the 1st energy treatment part 13 is the state with the 2nd shaft 8 attached to the 1st shaft 6, and the 2nd holding member by the control apparatus 3 via the electric cable C and the connection part (not shown) mentioned above.
  • the high frequency power is supplied to the second energy treatment unit 18 (FIGS. 2 and 3)
  • the treatment surface that contacts the living tissue LT (the first energy treatment surface or the second energy treatment surface). Energy from at least one). That is, the first energy treatment unit 13 is configured as an electrode to which high-frequency power is supplied.
  • one end in the longitudinal direction of the first energy treatment unit 13 (the first energy treatment unit 13) is provided at a substantially central position in the width direction of the first energy treatment unit 13 as shown in FIGS. 2 to 4.
  • a first cutter moving groove that extends along the longitudinal direction from the end on the two shaft 8 side (right end in FIG. 2 (lower end in FIG. 4)) toward the other end and serves as a moving path of the cutter 12 131 is formed.
  • the first staple treatment unit 14 is attached to both sides of the first energy treatment unit 13 on the surface 101 of the first holding member 10 via two dampers 16. Yes.
  • the two first staple treatment units 14 have the same configuration.
  • the first staple treatment unit 14 extends along the longitudinal direction of the first holding member 10, and has a substantially rectangular parallelepiped shape whose longitudinal dimension is set to be substantially the same as the longitudinal dimension of the first holding member 10. It has a shape, and a plurality of staples St (FIG. 3) are accommodated therein. 2 and 3 in the first staple treatment unit 14, a plurality of (four in the first embodiment) are provided on the lower surface (first treatment surface 15), that is, the first staple treatment surface. A hole 141 is formed.
  • the hole 141 penetrates the inside and outside of the first staple treatment unit 14, and the staple St fired in response to the operation of the second operation knob 512 by the operator is outside the first staple treatment unit 14 (the second holding member 11). It is a hole that is inserted toward In the first embodiment, the hole 141 is configured by a long hole extending along the longitudinal direction of the first staple treatment unit 14. As shown in FIG. 2 or FIG. 4, the plurality of hole portions 141 are formed so as to be arranged in a line along the longitudinal direction of the first staple treatment portion 14.
  • the number of holes 141 is not limited to four, and other numbers may be provided.
  • the two dampers 16 are respectively provided between the two first staple treatment units 14 and the first holding member 10, and are fixed to the surface 101 of the first holding member 10, respectively, and the two first staple treatment units 14. Hold each.
  • the two dampers 16 have the same configuration.
  • the damper 16 is composed of a spring or the like, and has a function as an elastic member according to the present invention. 2 and 3 in the first stapling treatment section 14, the damper 16 receives the first holding member 10 when a load is applied to the upper side with respect to the lower side surface (first treatment surface 15). Compressed (elastically deformed) along the normal direction of the surface 101 (vertical direction in FIG. 3), and when the load is no longer applied, it expands along the normal direction and returns to its original shape.
  • the elastic modulus of the damper 16 is set to be smaller than the elastic modulus of the living tissue LT.
  • the damper 16 is in the original shape, and the lower surface of the first staple treatment unit 14 in FIGS. 2 and 3 is the lower surface of the first energy treatment unit 13 in FIGS. 2 and 3.
  • the first treatment surface 15 is set to be a flat surface.
  • the second holding member 11 has a substantially rectangular parallelepiped shape extending along the central axis of the second shaft 8.
  • a material having high heat resistance and excellent electrical insulation for example, PEEK resin can be exemplified.
  • the shape of the second holding member 11 is not limited to a rectangular parallelepiped shape, like the first holding member 10, and is configured to improve the insertability to the trocar by giving the outer peripheral surface a curvature. It doesn't matter.
  • 2 and 3 of the second holding member 11 functions as a second treatment surface 17 (FIGS. 2 and 3) for sandwiching the living tissue LT with the first treatment surface 15. To do.
  • FIG. 5 is a diagram schematically showing the second treatment surface 17.
  • a second energy treatment portion 18 is embedded at a substantially central position in the width direction of the second treatment surface 17 as shown in FIG. 2, FIG. 3, or FIG. 5.
  • the second energy treatment unit 18 is embedded in the second treatment surface 17 with the surface exposed, and generates energy to the second energy treatment surface in contact with the living tissue LT under the control of the control device 3.
  • the 2nd energy treatment part 18 is comprised with electroconductive materials, such as copper, for example.
  • the second energy treatment section 18 extends along the longitudinal direction of the second holding member 11 so that the dimension in the longitudinal direction is substantially the same as the dimension in the longitudinal direction of the second holding member 11.
  • the second energy treatment unit 18 has a surface (upper surface in FIGS. 2 and 3) in a region other than the region where the second energy treatment unit 18 is disposed on the second treatment surface 17 (described later). Embedded in the second treatment surface 17 so as to be substantially flush with the second staple treatment portion 19 (excluding the needle tip receiving portion 191). Further, as shown in FIG. 3, the second energy treatment unit 18 faces the first energy treatment unit 13 in a state where the first and second holding members 10 and 11 are closed. And the 2nd energy treatment part 18 is the state in which the 2nd shaft 8 was attached to the 1st shaft 6, and the 1st energy treatment by the control apparatus 3 via the electric cable C and the connection part (not shown) mentioned above. Energy is generated by supplying high-frequency power to the unit 13. In other words, the second energy treatment unit 18 is configured as an electrode to which high-frequency power is supplied.
  • a substantially central position in the width direction of the second energy treatment section 18 (a position facing the first cutter moving groove 131 in a state where the first and second holding members 10 and 11 are closed). 2, 3, or 5, one end in the longitudinal direction of the second energy treatment unit 18 (the end on the second shaft 8 side (in FIG. 2, the right end (in FIG. 5, A second cutter moving groove 181 that extends along the longitudinal direction from the lower end portion))) to the other end and serves as a moving path of the cutter 12 is formed.
  • both sides sandwiching the second energy treatment unit 18 (sites facing the two first staple treatment units 14 in a state where the first and second holding members 10 and 11 are closed) are Each has a function as the second staple treatment unit 19 (FIGS. 2, 3 and 5) according to the present invention.
  • a total of eight) needle tip receiving portions 191 are formed.
  • the needle tip receiving portion 191 faces the hole portion 141 in a state where the first and second holding members 10 and 11 are closed.
  • the needle tip receiving portion 191 is configured by a recess formed in the second treatment surface 17 (second staple treatment surface).
  • the needle tip receiving portion 191 receives the needle tips (both ends of the U-shaped staple St) of the staple St fired through the hole 141, and deforms the needle tip (the U-shaped staple St is substantially omitted). It has a function of deforming into a B shape.
  • two second staple treatments are performed so that the plurality of needle tip receiving portions 191 are arranged in a line along the longitudinal direction of the second holding member 11.
  • Each of the portions 19 is formed. This is not limited to a single row, and a plurality of rows may be provided.
  • a staggered arrangement may be used.
  • the number of needle tip receiving portions 191 is not limited to eight, and other numbers may be provided. Further, the number of the hole portions 141 and the needle tip receiving portions 191 is one-to-one, but the needle tip receiving portion 191 is configured to receive the staple tips of the staple St (both ends of the U-shaped staple St). Therefore, it may be provided in one-to-two.
  • the foot switch 4 is a part operated by the operator with his / her foot. And according to the said operation to the foot switch 4, supply of high frequency electric power is started from the control apparatus 3 to the energy treatment tool 7 (1st, 2nd energy treatment part 13,18). Note that the means for starting the supply of high-frequency power is not limited to the foot switch 4, and a switch operated by hand or the like may also be employed.
  • the control device 3 includes a CPU (Central Processing Unit) and the like, and comprehensively controls the operation of the energy treatment device 7 according to a predetermined control program. More specifically, the control device 3 includes the first and second energy treatment units 13 and 18 via the electric cable C and the connection unit (not shown) according to the operation of the foot switch 4 by the operator. During this period, high-frequency power having a preset output is supplied.
  • the 1st, 2nd energy treatment parts 13 and 18 are being fixed to the 1st and 2nd holding members 10 and 11, respectively.
  • the second staple treatment unit 19 is provided integrally with the second holding member 11.
  • the first staple treatment unit 14 is attached to the first holding member 10 via a damper 16. Therefore, when the living tissue LT is sandwiched between the first and second holding members 10 and 11, the dampers 16 are elastically deformed by the load from the living tissue LT to the first staple treatment unit 14 as shown in FIG. In response to the elastic deformation, the two first staple treatment units 14 move upward in FIG. 3 with respect to the first holding member 10.
  • the stapling side separation distance D1 (FIG.
  • the stapling part LT1 (FIG. 3) located between the first and second staple treatment units 14 and 19 in the living tissue LT is the first and second staple treatment units 14 and 19 with a force suitable for stapling. It is pinched at.
  • the energy bonding part LT2 (FIG. 3) located between the first and second energy treatment units 13 and 18 in the living tissue LT is the first and second energy treatment units 13 and 18 with a force suitable for energy bonding. It is pinched at.
  • the surgeon operates the foot switch 4.
  • the control device 3 supplies high-frequency power for a preset time between the first and second energy treatment units 13 and 18 via the electric cable C and the connection unit described above. Supply.
  • a high-frequency current flows between the first and second energy treatment units 13 and 18, and Joule heat is generated in the energy bonding portion LT2.
  • the energy bonding portion LT2 is treated by the generation of the Joule heat.
  • the stapling to the stapling portion LT1 by operating the second operation knob 512 is performed from the time when the living tissue LT is held between the first and second holding members 10 and 11 until the foot switch 4 is operated. Or at any timing after the foot switch 4 is operated (while supplying the high frequency power to the first and second energy treatment units 13 and 18 or after completing the supply of the high frequency power). It doesn't matter.
  • a notification unit (not shown) provided in the treatment system 1. It is preferable that the surgeon recognizes that the above-described high-frequency power supply has been completed.
  • the notification unit include a display that displays predetermined information, an LED (Light Emitting Diode) that notifies predetermined information by lighting or blinking, and a speaker that notifies predetermined information by sound.
  • the treatment surface of the first staple treatment unit 14 moves so that the stapling side separation distance D1 is larger than the energy bonding side separation distance D2. That is, the energy treatment device 7 clamps the parts LT1 and LT2 in the living tissue LT with appropriate force when treating various living tissues LT (for example, small intestine, stomach, etc.) having different thicknesses and hardnesses. To do. Since the stapling portion LT1 is sandwiched with a relatively low force, the blood flow inhibition of the stapling portion LT1 due to stapling can be suppressed.
  • various living tissues LT for example, small intestine, stomach, etc.
  • the energy bonding portion LT2 is sandwiched with a relatively high force, it can be reliably bonded by applying energy. Therefore, according to the energy treatment tool 7 according to the first embodiment, when treating various living tissues LT, the living tissue LT can be reliably treated while suppressing blood flow inhibition of the living tissue LT. , Has the effect.
  • the first staple treatment unit 14 makes the stapling side separation distance D1 larger than the energy bonding side separation distance D2 in accordance with the elastic deformation of the damper 16. Move to. For this reason, the 1st staple treatment part 14 can be moved with a simple structure (damper 16), and simplification of the structure of the energy treatment tool 7 can be achieved. Moreover, the force which clamps the staple part LT1 can be easily adjusted by setting suitably the elasticity modulus of the damper 16 to be used.
  • the hole portions 141 are arranged in a line along the longitudinal direction of the first staple treatment portion 14. For this reason, for example, compared to a configuration in which the hole portions 141 are arranged in a plurality of rows along the longitudinal direction of the first staple treatment portion 14, the staples St are not densely driven into the stapling portion LT1, and the stapling is performed. Inhibition of blood flow at site LT1 can be further suppressed.
  • FIG. 6 is a diagram showing a modification of the first embodiment of the present invention. Specifically, FIG. 6 corresponds to FIG. In the first embodiment described above, the first and second energy treatment units 13 and 18 are each configured by electrodes to which high-frequency power is supplied.
  • the present invention is not limited to this, for example, the treatment system 1A shown in FIG. You may comprise as follows. Specifically, in the treatment system 1A (energy treatment device 7A) according to this modification, the stapling side separation distance D1 is set to the energy bonding side separation distance D2 with respect to the energy treatment device 7 described in the first embodiment.
  • the structure to be made larger (the structure that sandwiches the portions LT1 and LT2 in the living tissue LT with appropriate force) is the same structure, and the energy applied to the energy joint portion LT2 is different (see the above-described implementation).
  • the high-frequency energy is set as thermal energy) in this modification. That is, in the energy treatment instrument 7A, as shown in FIG. 6, the first energy treatment section is used instead of the first energy treatment section 13 as compared with the energy treatment instrument 7 (FIG. 3) described in the first embodiment. 13A is employed, and the second energy treatment unit 18A is employed instead of the second energy treatment unit 18.
  • the first energy treatment unit 13A has substantially the same outer shape (including the first cutter moving groove 131) as the first energy treatment unit 13 described in the first embodiment. In the first holding member 10, It is fixed at the same position as the first energy treatment section 13.
  • the first energy treatment unit 13 ⁇ / b> A generates energy (thermal energy) under the control of the control device 3.
  • the first energy treatment unit 13A is configured by a heating element such as a ceramic heater that generates heat when energized.
  • the first energy treatment unit 13 ⁇ / b> A is connected to the first shaft 6 via a connection portion (not shown) provided inside the second shaft 8 in a state where the second shaft 8 is attached to the first shaft 6. It is electrically connected to the electric cable C routed to the other end.
  • 13 A of 1st energy treatment parts generate
  • the second energy treatment portion 18A has substantially the same outer shape (including the second cutter moving groove 181) as the second energy treatment portion 18 described in the first embodiment, and in the second holding member 11, It is fixed at the same position as the second energy treatment section 18.
  • the second energy treatment section 18A is made of a heat insulating material (for example, a material having a thermal conductivity of 0.1 W / (m ⁇ K) or less).
  • the second energy treatment portion 18A is formed of a heat insulating material, so that the heat transmitted from the first energy treatment portion 13A to the energy joining portion LT2 is transmitted to the second holding member 11. Transmission can be suppressed. That is, the energy bonding portion LT2 can be heated at a desired temperature, and appropriate treatment can be performed.
  • this modification can reduce the number of energy generation parts, and accordingly, the number of wirings can be reduced, so that simplification of the structure can be expected.
  • the first energy treatment unit 13A may be formed of a heat insulating material
  • the second energy treatment unit 18A may be formed of a heating element.
  • you may comprise both the 1st energy treatment part 13A and the 2nd energy treatment part 18A with a heat generating body.
  • FIG. 7 is a diagram showing a modification of the first embodiment of the present invention. Specifically, FIG. 7 corresponds to FIG. In the first embodiment described above, the first staple treatment unit 14 is movably attached to the first holding member 10 via the damper 16, and the second staple treatment unit 19 is provided integrally with the second holding member 11.
  • the treatment system 1B illustrated in FIG. 7 may be configured. Specifically, in the treatment system 1B (energy treatment device 7B) according to the present modification, as shown in FIG. 7, the first is different from the energy treatment device 7 (FIG. 3) described in the first embodiment.
  • a first staple treatment unit 14B is employed instead of the staple treatment unit 14, and a second staple treatment unit 19B is employed instead of the second staple treatment unit 19.
  • the two first staple treatment units 14B are fixed to the first holding member 10 with respect to the first staple treatment unit 14 described in the first embodiment.
  • the two first staple treatment units 14B are configured by a lower surface of the first staple treatment unit 14B in FIG. 7 and a lower surface of the first energy treatment unit 13 in FIG.
  • the first treatment surface 15B (FIG. 7) is fixed to the first holding member 10 so as to be a flat surface.
  • the two second staple treatment sections 19B (including the needle tip receiving section 191) are configured separately from the second holding member 11, and the first staple treatment section 14 described in the first embodiment is the same as the first staple treatment section 14 described in the first embodiment. Similarly, it attaches to the 2nd holding member 11 via the damper 16, respectively.
  • the second staple treatment unit 19B moves downward in FIG. 7 with respect to the second holding member 11 according to the elastic deformation of the damper 16 (second staple treatment).
  • the second treatment surface 17B (FIG. 7) composed of the upper surface in FIG. 7 in the portion 19B and the upper surface in FIG. 7 in the second energy treatment portion 18 is deformed from a flat surface to a convex surface). Therefore, a structure (a structure in which the portions LT1 and LT2 in the living tissue LT are respectively clamped with an appropriate force) in which the stapling side separation distance D1 is larger than the energy bonding side separation distance D2 is employed.
  • FIG. 8 is a cross-sectional view schematically showing an energy treatment device 7C constituting the treatment system 1C according to Embodiment 2 of the present invention. Specifically, FIG. 8 corresponds to FIG.
  • the first staple treatment surface 14 is moved by the movement of the first staple treatment unit 14 in accordance with the elastic deformation of the damper 16, and the stapling side separation distance D1 is set as the energy.
  • a structure that is larger than the bonding-side separation distance D2 is employed.
  • the first energy treatment unit 13 moves relative to the first holding member 10 as shown in FIG. 1
  • the energy treatment surface is moved, and a structure is adopted in which the stapling side separation distance D1 is larger than the energy bonding side separation distance D2.
  • the piezoelectric element 16C is used as a drive mechanism instead of the damper 16 as compared with the energy treatment instrument 7 (FIG. 3) described in the first embodiment.
  • the first staple treatment unit 14B (the modified example of the first embodiment described above (FIG. 7)) is employed instead of the first staple treatment unit 14, and a load sensor 20 is added.
  • the piezoelectric element 16C is used.
  • the present invention is not limited to this, and any mechanism that can control the displacement of the energy bonding side separation distance D2, such as a balloon, is applicable.
  • the piezoelectric element 16 ⁇ / b> C as a drive mechanism is provided between the first energy treatment unit 13 and the first holding member 10, and is fixed to the surface 101 of the first holding member 10, while The energy treatment unit 13 is held.
  • the piezoelectric element 16 ⁇ / b> C is connected to the first shaft 6 via a connection portion (not shown) provided inside the second shaft 8 in a state where the second shaft 8 is attached to the first shaft 6. It is electrically connected to the electric cable C routed to the other end.
  • the piezoelectric element 16C is applied with a voltage by the control device 3 via the electric cable C and the above-described connection portion (not shown), whereby the normal direction of the surface 101 of the first holding member 10 (in FIG.
  • the piezoelectric element 16C is in the original shape, and the lower surface of the first energy treatment unit 13 in FIG. 8 is substantially the same as the lower surface of the first staple treatment unit 14B in FIG.
  • the first treatment surface 15C is composed of a lower surface in FIG. 8 in the first energy treatment unit 13 and a lower surface in FIG. 8 in the two first staple treatment units 14B. Is set to be a flat surface).
  • the load sensor 20 is provided between the second energy treatment section 18 and the second holding member 11, and an upper surface (second treatment section) of the second energy treatment section 18 in FIG. 8.
  • the load applied to the lower side with respect to the surface 17) is detected.
  • the load sensor 20 has a function as a load detection part which concerns on this invention.
  • the load sensor 20 is connected to the first shaft 6 via a connection portion (not shown) provided inside the second shaft 8 in a state where the second shaft 8 is attached to the first shaft 6. It is electrically connected to the electric cable C routed to the other end.
  • the load sensor 20 outputs a signal corresponding to the detected load to the control device 3 via the electric cable C and the connection portion (not shown).
  • the control device 3 controls the operation of the piezoelectric element 16C based on the load detected by the load sensor 20.
  • FIG. 9 is a flowchart showing the operation of the control device 3 according to Embodiment 2 of the present invention.
  • the control device 3 inputs a signal from the load sensor 20 via the electric cable C and the connection portion (not shown) and detects the load sensor 20. Monitoring of the applied load is started (step S1).
  • the surgeon grasps the energy treatment device 2 and uses the trocar or the like for the tip portion of the energy treatment device 2 (part of the energy treatment tool 7C and the first shaft 6). Through and into the abdominal cavity. Then, the operator operates the first operation knob 511 and clamps the living tissue LT between the first and second holding members 10 and 11.
  • the control device 3 constantly monitors whether or not the load detected by the load sensor 20 is equal to or higher than the load PA suitable for stapling (step S2).
  • the control device 3 is in a state in which no voltage is applied to the piezoelectric element 16C via the electric cable C and the connecting portion (not shown). Therefore, the lower surface of the first energy treatment unit 13 in FIG. 8 is flush with the lower surface of the two first staple treatment units 14B in FIG. 8 (first treatment surface 15C). Is flat). That is, in this state, the load acting between the first and second energy treatment units 13 and 18 by sandwiching the living tissue LT between the first and second holding members 10 and 11 and the first and second staple treatments. The load acting between the portions 14B and 19 is substantially equivalent. Therefore, the control device 3 monitors the load detected by the load sensor 20 in step S2, so that the stapling side separation distance D1 has become a distance for holding the stapling portion LT1 with an appropriate force. Judgment.
  • step S2 If it is determined that the load PA is suitable for stapling (step S2: Yes), the control device 3 is connected to the first and second opening / closing mechanisms (not shown) described above. Is set to a locked state in which the operation of the first and second opening / closing mechanisms (not shown) is restricted (the positional relationship between the first and second holding members 10 and 11 is fixed) (step S3). Next, the control device 3 notifies that the lock state is set (lock completion) from a notification unit (not shown) such as a display, LED, or speaker provided in the treatment system 1C (step S4).
  • a notification unit not shown
  • the control device 3 constantly monitors whether or not the foot switch 4 has been operated (foot switch ON) by the operator (step S5).
  • the control device 3 applies a predetermined voltage to the piezoelectric element 16C via the electric cable C and the connection portion (not shown) (not shown) ( The piezoelectric element 16C is driven) (step S6).
  • the piezoelectric element 16 ⁇ / b> C extends by a predetermined amount, and the first energy treatment unit 13 moves downward in FIG. 8 with respect to the first holding member 10.
  • the energy bonding side separation distance D2 (FIG. 8) is smaller than the stapling side separation distance D1 (FIG. 8) (the first treatment surface 15C is deformed from a flat surface to a convex surface).
  • the control device 3 constantly monitors whether or not the load detected by the load sensor 20 is equal to or higher than the load PB suitable for energy bonding (step S7).
  • the first treatment surface 15C is deformed into a convex surface. That is, in this state, the load acting between the first and second energy treatment units 12 and 18 by sandwiching the living tissue LT between the first and second holding members 10 and 11 and the first and second staple treatments.
  • the load acting between the portions 14B and 19 is different.
  • the load detected by the load sensor 20 corresponds to a load acting between the first and second energy treatment units 12 and 18.
  • the control device 3 monitors the load detected by the load sensor 20 in step S7, so that the energy bonding side separation distance D2 has become a distance for holding the energy bonding part LT2 with an appropriate force. Judgment. As the piezoelectric element 16C is driven, a part of the energy bonding portion LT2 moves to the outside (on the first and second stapling treatment portions 14B and 19 sides). Then, the force that has pinched the stapling portion LT1 at the time when the locked state described above is set may change with the movement of a part of the energy bonding portion LT2. For this reason, the load PA described above is set in consideration of the change.
  • step S7: No When determining that the load PB is not equal to or higher than the load PB suitable for energy bonding (step S7: No), the control device 3 returns to step S6, changes the voltage value applied to the piezoelectric element 16C, and changes the piezoelectric element 16C. Further increase the amount of elongation. On the other hand, if it is determined that the load PB suitable for energy bonding has been reached (step S7: Yes), the control device 3 causes the first and second energy treatment units to pass through the electric cable C and the connection unit described above. High frequency power is supplied for a preset time between 13 and 18 (step S8).
  • a high-frequency current flows between the first and second energy treatment units 13 and 18, and Joule heat is generated in the energy bonding portion LT2.
  • the energy bonding portion LT2 is treated by the generation of the Joule heat.
  • stapling to the stapling portion LT1 by operating the second operation knob 512 is performed after the foot switch 4 is operated after recognizing that it is set to the locked state (between steps S4 and S5). ) Or after operating the foot switch 4 (while supplying high-frequency power to the first and second energy treatment units 13 and 18 or after completing the supply of high-frequency power). It doesn't matter.
  • a notification unit such as a display, LED, or speaker provided in the treatment system 1C. It is preferable to notify the operator that predetermined information has been notified and that the supply of the high-frequency power described above has been completed.
  • the following effects can be obtained in addition to the effects similar to those of the first embodiment described above.
  • the load detected by the load sensor 20 is monitored, and the extension amount of the piezoelectric element 16C is changed according to the load. For this reason, it is possible to accurately set the force for sandwiching the portions LT1 and LT2 in the living tissue LT to a desired force, and “inhibiting blood flow inhibition of the living tissue LT when treating various living tissues LT.
  • the effect that the living tissue LT can be reliably treated can be suitably realized.
  • Embodiment 2 (Modification of Embodiment 2)
  • a configuration in which the load sensor 20 is omitted may be employed. That is, regardless of the load detected by the load sensor 20, a preset extension amount (for example, an extension amount set for each type of biological tissue LT to be treated (eg, small intestine, stomach, etc.))
  • a preset extension amount for example, an extension amount set for each type of biological tissue LT to be treated (eg, small intestine, stomach, etc.)
  • a configuration in which the piezoelectric element 16C is driven may be adopted.
  • control flow is not limited to the flow shown in FIG. 9 and may be changed within a consistent range.
  • the present invention should not be limited only by the above-described first and second embodiments and their modifications.
  • the first energy treatment unit 13 (13A), the first staple treatment unit 14 (14B), the second energy treatment unit 18 (18A), and the second staple treatment If the part 19 (19B) moves relative to each other and can hold the parts LT1 and LT2 of the living tissue LT with appropriate force, the first energy treatment part 13 (13A) and the first staple treatment part 14 (14B) Any of the second energy treatment section 18 (18A) and the second staple treatment section 19 (19B) may move (all may move).
  • the piezoelectric element 16C is disposed between the first staple treatment unit 14B and the first holding member 10, and the first staple treatment unit 14B is moved with respect to the first holding member 10. It does not matter.
  • high-frequency energy and thermal energy are employed as the energy to be applied to the energy joining portion LT2, but the configuration is not limited thereto, and ultrasonic energy is applied. You may adopt.
  • the stapling is performed manually (operation of the second operation knob 512).
  • the configuration is not limited to this, and the configuration is automatically performed by a driving unit such as a motor. May be adopted.

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Abstract

La présente invention concerne un outil de traitement d'énergie (7) qui est pourvu de : un premier élément de maintien (10) qui est pourvu d'une première unité de traitement d'agrafage (14) et une première unité de traitement d'énergie (13) ; et un deuxième élément de maintien (11) qui est pourvu d'une deuxième unité de traitement d'agrafage (19) qui prend en sandwich un tissu vivant (LT) avec la première unité de traitement d'agrafage (14) et une deuxième unité de traitement d'énergie (18) qui prend en sandwich le tissu vivant (LT) avec la première unité de traitement d'énergie (13), la première unité de traitement d'agrafage (14) éjectant des agrafes (St) pour suturer le tissu vivant (LT) vers la deuxième unité de traitement d'agrafage (19). Les première et deuxième unités de traitement d'énergie (13, 18) génèrent de l'énergie pour assembler le tissu vivant (LT), et la première unité de traitement d'agrafage (14) est déplacée de façon à former une distance de séparation latérale d'agrafage (D1) entre les première et deuxième unités de traitement d'agrafage (14, 19) qui est supérieure à une distance de séparation côté assemblage d'énergie (D2) entre les première et deuxième unités de traitement d'énergie (13, 18).
PCT/JP2016/061044 2016-04-04 2016-04-04 Outil de traitement d'énergie Ceased WO2017175281A1 (fr)

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5624452A (en) * 1995-04-07 1997-04-29 Ethicon Endo-Surgery, Inc. Hemostatic surgical cutting or stapling instrument
JP2005514102A (ja) * 2002-01-03 2005-05-19 スタリオン・インストゥルメンツ・コーポレイション 切開、焼灼およびステープル留めする装置を併設した装置
JP2007229448A (ja) * 2006-01-31 2007-09-13 Ethicon Endo Surgery Inc 記録機能を備えた手術器具

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5624452A (en) * 1995-04-07 1997-04-29 Ethicon Endo-Surgery, Inc. Hemostatic surgical cutting or stapling instrument
JP2005514102A (ja) * 2002-01-03 2005-05-19 スタリオン・インストゥルメンツ・コーポレイション 切開、焼灼およびステープル留めする装置を併設した装置
JP2007229448A (ja) * 2006-01-31 2007-09-13 Ethicon Endo Surgery Inc 記録機能を備えた手術器具

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