JPH08275948A - Surgical forceps - Google Patents

Abstract

PURPOSE: To provide a surgical forceps which has a simple constitution and by which living body tissue is surely grasped or resected and operability is improved. CONSTITUTION: A head part of a probe 4 is provided with a vibration transmitting part 11 which constitutes a fixed blade for resecting or coagulating tissue, and a movable part 12 which constitutes a movable blade opposed to the vibration transmitting part 11. The vibration transmitting part 11 and the movable part 12 are made open/closed through a wound spring 13. The movable part 12 and the wound spring 13 are fixed freely-rotatablly on a base 15 which is formed out of a sliding member such as fluororesin by means of a pin 14, and the base 15 is provided with a connecting part 16 to the probe 4, and the connecting part 16 is fixed with a small diameter part 17 of the probe 4. An inner sheath 19 by which the movable part 12 is made open/closed is provided on the outer circumference of the probe 4, and a sliding part 20 which is made of the sliding member such as fluororesin is provided on the head part thereof, and a contact part 21 is provided on the sliding part 20 and is made contact with an operation part 22 which is provided on the movable part 12.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical forceps which is inserted into a body cavity to grasp or excise living tissue.

[0002]

2. Description of the Related Art In recent years, by inserting an elongated insertion portion into a body cavity, various organs in the body cavity are observed, and various medical treatments are performed under observation with an endoscope as necessary.

Various surgical forceps for adsorbing or grasping a living tissue have been proposed as one of the methods for performing a medical treatment under the above-mentioned endoscopic observation. For example, ultrasonic vibration is applied to a member adsorbing or grasping. In addition, there are known ones that perform treatment such as excision or coagulation of living tissue.

For example, US Pat. No. 5,322,055 discloses an ultrasonic element mounted in a housing, a surgical blade having an elongated end that vibrates when receiving ultrasonic vibration, and a surgical blade that is placed along one side of the surgical blade and is opposed to the surgical blade. Of an open / close clamp part provided at the distal end of the sheath and an ultrasonic surgical instrument that cuts or coagulates by sandwiching tissue between the clamp part and a surgical blade and applying ultrasonic vibration from an ultrasonic element. Clamp coagulator and cutting system for are shown.

Further, in Japanese Patent Laid-Open No. 6-225886, an outer tube having a generally rigid body and an inner tube inserted through the outer tube are provided, and an inner cavity provided in the inner tube is inserted.
The distal end of the lead wire is opened and closed by the axial movement of the inner tube by this lead wire, and surgical forceps for cauterizing the surgical site by applying a high-frequency current to the surgical site sandwiched between the distal ends of the lead wire. It is shown.

[0006]

However, the above-mentioned U
In the clamp coagulation device and cutting system for ultrasonic surgical instruments shown in SP5322055, an operating rod inserted through the sheath is connected to a clamp part, which is a movable part provided at the distal end of the sheath, to open and close. The structure is complicated, such as making an elongated hole for passing the operating rod that connects to the clamp part in the sheath, making it extremely difficult to wash after use and to prevent infection. The sheath must be disposable.

Further, since the clamp portion, which is a movable portion, and the surgical blade portion are separated from each other, the operator must position the clamp portion and the surgical blade portion before the operation. Further, generally, a treatment tool used for endoscopic surgery requires a length of 300 mm or more, and a relatively large error occurs in the lengthwise direction in manufacturing, so that the length between the sheath and the probe is large. There is a risk of length error, and even if positioning is performed at the rear end, a large deviation may occur at the front end, so new positioning means must be provided on the front end side, and the structure becomes more and more complicated. There was a problem.

On the other hand, in the surgical forceps disclosed in the above-mentioned Japanese Patent Laid-Open No. 6-225886, there is a mechanism for pushing and closing the inclined portion provided in the grip portion by moving the inner tube in the distal direction. Since the inner tube moves forward, the gripping range becomes smaller than before gripping, so there is a possibility of dropping the tissue once gripped.

Further, in the hand operation part of the surgical forceps,
The structure that moves the thumb can suppress the blurring of the tip, but when the gripping operation is performed, the actuating rod or the actuating bar moves to move backward because it passes through the fulcrum. Since this is the direction in which the grip portion is opened, it is necessary to devise a structure to move the side opposite to the thumb, or to provide two fulcrums.

Further, in the above-mentioned surgical forceps, since the inner tube pushes the inclined portion, naturally the inner tube cannot be pulled out forward. Therefore, the unit of grip and actuating rod is
It will be inserted from the front of the inner tube. However, in the case of an ultrasonic incision coagulator having a grip portion, a sheath is attached to the tip, so that the inclined portion cannot be pushed from the rear as in the above-described conventional example.

Furthermore, the force for opening the grip portion is said to be due to the leaf spring provided in the grip portion, but if the leaf spring is used, the length direction must be relatively long because of its elastic limit, and , Restoration resistance is low compared to general wound springs. Further, with the double-opening forceps, the opening angle of the grasping portion can be made sufficient, but in the case of single-sided opening, a sufficient opening angle cannot be obtained. In addition, there is a problem that if one tries to obtain a sufficient opening angle by one-sided opening, it is necessary to increase the length of the leaf spring, resulting in an increase in size.

The present invention has been made in view of the above circumstances, and provides a surgical forceps capable of reliably grasping or excising a living tissue with a simple structure and improving operability. Is intended for.

[0013]

The surgical forceps of the present invention is a surgical forceps in which an elongated insertion portion is inserted into a body cavity to grasp or excise a living tissue, and the living body is attached to the tip of the insertion portion. First for grasping or excising tissue
Support member, a second support member facing the first support member for grasping or excising the biological tissue at the tip of the insertion portion, the first support member and the second support member And opening / closing means for opening and closing at least one of the first supporting member and the second supporting member by moving the opening / closing means by moving the opening / closing means in the longitudinal direction of the insertion portion. A direction in which at least one of the first support member and the second support member approaches the other when the opening / closing means is moved to the proximal end side of the insertion section by the operation means. By rotating to, it is possible to reliably grasp or excise the living tissue with a simple structure and improve the operability.

[0014]

Embodiments of the present invention will be described below with reference to the drawings.

1 to 6 relate to an embodiment of the present invention, FIG. 1 is an explanatory view showing a schematic structure of an ultrasonic cutting and coagulating apparatus, and FIG. 2 is an exploded view showing a structure of the ultrasonic cutting and coagulating apparatus of FIG. FIG. 3 is a perspective view, FIG. 3 is a cross-sectional view showing the configuration of the tip of the ultrasonic cutting and coagulating device of FIG. 1, FIG. 4 is an explanatory view for explaining the assembly of the ultrasonic cutting and coagulating device of FIG. 1, and FIG. Explanatory drawing explaining the operation | movement of the front-end | tip part of an incision coagulation apparatus, FIG. 6 is AA of FIG.
It is sectional drawing which shows a line cross section.

As shown in FIG. 1, an ultrasonic incision coagulator 1 as a surgical forceps has a grip portion 2 in which an ultrasonic transducer is arranged, and an operation portion 3 fixed to the grip portion 2. (Operating means), an elongated ultrasonic probe (hereinafter abbreviated as probe) 4 that is connected to the ultrasonic transducer of the grip portion 2 and transmits ultrasonic vibration, and a sheath 5 that covers the probe 4. Has been done. The operation unit 3 is provided with a handpiece 3a that moves a movable unit described later.

2 and FIG. 3 which is a cross section of the tip of the probe 4.
As shown in FIG. 3, a vibration transmission part 11 (first support member) that constitutes a fixed blade for cutting and coagulating tissue is provided at the tip of the probe 4, and a movable blade that opposes the vibration transmission part 11 is formed. The movable part 12 (second support member) is provided. The vibration transmission unit 11 and the movable unit 12 are configured to open and close via the winding spring 13. Movable part 12
The spiral spring 13 is rotatably fixed to a base 15 formed of a sliding member such as fluororesin by a pin 14 formed of metal or resin, and the base 15 has a connecting portion 16 with the probe 4. Is provided, and the connecting portion 16 can be fixed to the small-diameter portion 17 of the probe 4. As a method of fixing the connecting portion 16 and the small-diameter portion 17 of the probe 4, there are a snap fit method, a method of dividing a screw fixing probe and sandwiching it. Further, a flat surface portion 18 is formed on the small-diameter portion 17 of the probe 4, and the movable portion 1
The position of 2 and the vibration transmission part 11 can be fixed.

An inner sheath 19 (opening / closing means) for opening and closing the movable portion 12 is provided on the outer periphery of the probe 4, and a sliding portion 20 made of a sliding member such as fluororesin is provided at the tip thereof. Is provided. Further, the sliding portion 20 is provided with an abutting portion 21 so as to abut against an action portion 22 provided on the movable portion 12. In addition, instead of the sliding portion 20 made of a sliding member such as fluororesin, the probe 4 is used.
It may be configured by applying a fluororesin coating to the portion in contact with.

As shown in FIG. 4, the assembly is performed by the grip portion 2
After embedding the probe 4 in the horn 31 protruding from the sheath 4, the sheath 5 is inserted into the outer periphery of the probe 4. After the insertion, the support rod 36 provided on the U-shaped portion 35 connected to the handpiece 3a of the operation portion 3 is movable in the groove 33 provided on the flange portion 32 provided on the rear end portion of the sheath 5. Combined with.

Next, the operation of this embodiment thus constructed will be described.

As shown in FIGS. 5 and 6 which is an AA cross section of FIG. 5, the inner sheath 19 is operated by operating the operating portion 3.
Goes back and forth in the axial direction. When the inner sheath 19 moves rearward, the contact portion 21 contacts the acting portion 22, and the movable portion 12 is rotated about the pin 14 to close it. When the inner sheath 19 moves forward, the movable portion 12 is reopened by the force of the coil spring 13. Ultrasonic vibration generated from the ultrasonic transducer inside the grip portion 2 is transmitted to the probe 4 and transmitted to the vibration transmission portion 11. When the movable part 12 is closed, the tissue sandwiched between the movable part 12 and the vibration transmitting part 11 is cauterized by the frictional heat generated by the ultrasonic vibration of the vibration transmitting part 11.

Since the ultrasonic wave transmitted to the probe 4 is transmitted to the vibration transmitting portion 11, frictional heat due to ultrasonic vibration is generated between the ultrasonic wave and the object in contact with the probe 4. In the above, the portion in contact with the probe 4 is only the base 15 formed of the sliding member, and frictional heat due to perturbation is unlikely to be generated. Therefore, heat does not affect the normal tissue. Further, the problem that the probe 4 is scraped off is eliminated, and the resistance is improved. Further, it also has an effect of preventing generation of abnormal noise due to contact between metals due to vibration. Further, if a fluororesin coating or the like is used, it is possible to further reduce the size and simplify. Since the inner sheath 19 and the probe are positioned by the base 15, contact between the probe and the inner sheath 19 can be prevented, heat generation can be prevented, and durability can be improved.

Thus, according to this embodiment, during cauterization,
Since the tissue is sandwiched by the movable portion 12, it does not slip off and is reliably cauterized. Further, by using the winding spring 13, the opening angle of the movable portion 12 can be increased, the opening / closing portion at the tip portion can be downsized, and the durability of the opening / closing operation can be improved.

The inner sheath 19 is moved backward to move the movable portion 12
Since it is a mechanism for closing, the sheath 4 can be attached after the probe 4 is fixed to the handpiece 3a of the operation unit 3, so that the assembly / disassembly becomes easy. Further, since the structure is simple, the washability is improved, the mechanism of the operation portion is simplified, and the grip range when the movable portion 12 is closed is not reduced.

In the above embodiment, the ultrasonic incision coagulator was used as an example of the surgical forceps, but the present invention is not limited to this.
Needless to say, the present invention can be applied to surgical forceps such as an ablation device using high-frequency current and grasping forceps that grasp the affected tissue.

[Additional remarks] (Additional remark 1) In a surgical forceps for inserting or inserting a slender insertion portion into a body cavity and grasping or excising a living tissue, a tip for grasping or excising the living tissue at the tip of the insertion portion. A first support member, a second support member facing the first support member for gripping or excising the biological tissue at the tip of the insertion portion, the first support member and the second support member An opening / closing means for opening and closing at least one of the first supporting member and the second supporting member by covering the supporting member and moving in the longitudinal direction of the insertion portion, and the opening / closing means for the longitudinal direction of the insertion portion. When the opening / closing means is moved to the proximal end side of the insertion portion by the operating means, at least one of the first support member and the second support member is close to the other. You Forceps were characterized by pivoting in the direction.

(Additional Item 2) The surgical forceps according to Additional Item 1, wherein the opening / closing means has opening / closing assisting means (winding spring 13) for assisting opening / closing.

(Additional Item 3) A rotation supporting means (pin 1) for rotatably supporting the first supporting member and the second supporting member.
4) The surgical forceps according to appendix 1, further comprising:

(Additional Item 4) Rotational supporting means (pin 1) for rotationally supporting the first supporting member and the second supporting member.
4), and the opening / closing assisting means is fixed by the rotation supporting means.

(Additional Item 5) A convex portion is provided at a tip end portion of the opening / closing means, and the convex portion pushes an action portion provided on the first supporting member, thereby the first supporting member. The surgical forceps according to appendix 1, wherein the surgical forceps is closed.

(Additional Item 6) The additional item 1 is characterized in that the opening / closing means and the contact portions of the first supporting member and the second supporting member are formed of sliding members. Surgical forceps.

(Additional Item 7) The first supporting member is formed of a member which is connected to the ultrasonic oscillating source at the base end and can transmit the ultrasonic wave from the ultrasonic oscillating source. The surgical forceps according to the additional item 1, wherein the forceps is a surgical forceps.

[0033]

As described above, according to the surgical forceps of the present invention, at least the first support member and the second support member when the opening / closing means is moved to the proximal end side of the insertion portion by the operating means. Since one of them rotates in the direction of approaching the other,
With a simple structure, you can securely grasp or excise living tissue,
There is an effect that operability can be improved.

[Brief description of drawings]

FIG. 1 is an explanatory diagram showing a schematic configuration of an ultrasonic incision coagulation apparatus according to an embodiment of the present invention.

FIG. 2 is an exploded perspective view showing the configuration of the ultrasonic incision coagulation apparatus in FIG.

FIG. 3 is a cross-sectional view showing the configuration of the tip of the ultrasonic incision coagulator of FIG.

FIG. 4 is an explanatory view for explaining assembly of the ultrasonic incision coagulation apparatus in FIG.

FIG. 5 is an explanatory view for explaining the operation of the tip portion of the ultrasonic dissection and coagulation apparatus in FIG.

6 is a cross-sectional view showing a cross section taken along the line AA of FIG.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Ultrasonic incision coagulator 2 ... Grip part 3 ... Operation part 3a ... Handpiece 4 ... Ultrasonic probe 5 ... Sheath 11 ... Vibration transmission part 12 ... Movable part 13 ... Wound spring 14 ... Pin 15 ... Base 16 ... Connection part 17 ... Small-diameter part 18 ... Planar part 19 ... Inner sheath 20 ... Sliding part 21 ... Abutting part 22 ... Working part

Claims (1)

[Claims] 1. A surgical forceps that inserts an elongated insertion portion into a body cavity to grasp or excise living tissue, and a first support member for grasping or excising the living tissue at the tip of the insertion portion. A second support member facing the first support member for gripping or excising the biological tissue at the tip of the insertion portion, covering the first support member and the second support member, Opening and closing means for opening and closing at least one of the first supporting member and the second supporting member by moving in the longitudinal direction of the insertion section, and operating means for moving the opening and closing means in the longitudinal direction of the insertion section. When the opening / closing means is moved to the proximal end side of the insertion portion by the operating means, at least one of the first supporting member and the second supporting member rotates in a direction in which the opening and closing means approaches the other. This Surgical forceps, which was characterized by.