JPH1119087A - Forceps type electric treatment apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To easily excise a texture piece in a body cavity, and also, prevent an organism texture to be collected from being burnt by openably connecting forceps pieces wherein an electrode is formed on the tip end side outer peripheral surfaces without including contact parts with each other at respective recesses which are confronted to each other. SOLUTION: Link pieces 13, 15 of forceps pieces 12, 14 are turnably fitted in a fulcrum shaft 10 which is bridged to a distal side of a supporting piece 8 of a supporting utensil 6, and an insulating spacer is fitted in a space between the link pieces 13, 15. To the link pieces 13, 15 of the forceps pieces 12, 14, other link pieces 17, 19 are connected under a pntograph state, and to the rear ends of the link pieces 17, 19, a distal end of a longitudinal member 18, which can advance or retract in the longitudinal direction X along a lumen in a sheath 4, is connected. Then, on the tip end side edges of cup-shaped recesses 24, 26 which are confronted to each other, sharp edges 31, 33 for cutting are formed, and an electrodes 30, 32 are formed on the tip end side outer peripheral surfaces without including contact parts, of the forceps pieces 12, 14.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a forceps-type electric treatment instrument, and more particularly to a forceps-type electric treatment instrument, and more particularly, to a tissue piece such as a lesion in a body cavity, which can be satisfactorily resected using a cup-shaped forceps, and furthermore, hemostasis. Field of the Invention The present invention relates to a bipolar forceps-type electric treatment instrument having excellent properties.

[0002]

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

However, in a biopsy forceps of a type that is cut by an edge of a cup, a living tissue such as a lesion is removed.
Because of the mechanical resection, hemostasis of the resected portion needs to be performed with another treatment tool. For this reason, many treatment instruments must be inserted into a narrow body cavity, which is unfavorable because it burdens the patient.

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

[0005]

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

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

The present invention has been made in view of such a situation, and has the inconvenience of a monopolar electric treatment instrument. By opening and closing a pair of cup-shaped forceps pieces, a tissue piece in a body cavity can be easily obtained. It is an object of the present invention to provide a bipolar forceps-type electric treatment instrument which can be resected in a short time, has excellent hemostatic properties, and does not burn even the living tissue to be collected.

[0008]

In order to achieve the above object, a forceps-type electric treatment instrument according to the present invention has a flexible sheath that can be inserted into a body, and is mounted on a distal end side of the sheath. And a first forceps piece having a cup-shaped first recess formed therein, and a cup-shaped second recess formed therein, wherein the first recess and the second recess are formed with respect to the first forceps piece. A second forceps piece that is openably and closably connected so as to face each other, and a first electrode formed on a distal end outer peripheral surface of the first forceps piece that does not include a contact portion between the first forceps piece and the second forceps piece. A high-frequency voltage between the first electrode and the second electrode, and a second electrode formed on the distal end side outer peripheral surface of the second forceps piece that does not include a contact portion between the first forceps piece and the second forceps piece; Voltage supply means connected to the proximal end side of the sheath, and opening and closing of the first and second forceps pieces. That has an opening and closing control means.

In the present invention, the distal end edges of the forceps pieces are configured to contact each other in a state where the forceps pieces are closed, and the distal edge portions have sharp cutting edge portions. Is preferably formed.

In the present invention, in order to form the first electrode and the second electrode on the outer peripheral surface of the distal end of the first and second forceps, respectively, each of the forceps is formed of an insulating member, The conductive film may be formed only on the surface. Or
Each forceps piece may be made of a conductive member, and an insulating film may be formed except for the outer peripheral surface on the tip side.

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

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

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

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

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

[0016]

In order to use the forceps-type electric treatment instrument according to the present invention to collect, for example, a living tissue at a lesion, first, the distal end of the treatment instrument is attached to the lesion within the body cavity using an endoscope or the like. Guide to near. Next, the operation unit connected to the outer-side proximal end of the sheath is operated to rotate the pair of forceps pieces attached to the distal end of the sheath in a closing direction. By closing the pair of forceps pieces, the living tissue piece at the lesion is picked up and positioned in the cup-shaped first and second recesses formed in the forceps pieces.
The base of the picked up living tissue piece at the lesion is sandwiched between the distal side edges of the forceps pieces. In this state, when the distal end portion of each forceps piece is pressed against the living tissue side, the first electrode and the second electrode are respectively placed on the surfaces of the living tissue located on both sides of the base of the living tissue piece sandwiched between the forceps pieces. Is pressed against.

Next, a high frequency voltage is applied between the first electrode and the second electrode from a voltage supply means connected to the proximal end side of the sheath through a conductive wire or the like wired in the sheath. When a high-frequency voltage is applied between these electrodes, a current flows only in the base of the tissue piece located between the first electrode and the second electrode, and the tissue is heated to burn off the base. By this heating, the cut part is also stopped. The cut biopsy piece remains in the recess of the forceps piece. Therefore, if the treatment instrument is taken out of the body cavity with the forceps pieces closed, the collection of the biopsy tissue piece is completed.

In the present invention, the current flows only through the living tissue located between the electrodes formed on the outer peripheral surface on the distal end side of the forceps piece. Therefore, compared with the monopolar system, the cauterization of the living tissue is reduced, and the tissue piece can be reliably removed with a small electric power. Electrodes are formed only in portions necessary for energization, and the inside of the cup-shaped recess of the forceps piece in which the cut living tissue piece is stored is insulated, so that the cut living tissue piece is not damaged. .

In the present invention, when a sharp cutting edge is formed at the tip side edge of each forceps piece, a high-frequency voltage is applied between the first electrode and the second electrode. It is also possible to use the cutting edge by engaging the cutting edge portion without cutting the tissue piece. In such a method of use, after excision of the tissue piece, the distal end of the closed forceps piece is pressed against the cut surface of the living tissue, and in this state, a high-frequency wave is applied between the first and second electrodes. Apply voltage. As a result, the portion against which the forceps piece is pressed is heated and cauterized, and good hemostasis can be performed.

In the present invention, since the first electrode and the second electrode are formed on the outer peripheral surface of each forceps piece, bleeding occurs outside the tissue piece collection site during the tissue piece collection procedure. Even in such a case, it is convenient because the hemostasis can be performed only by pressing the tip of the forceps piece against the bleeding part and supplying a high-frequency current.

[0021]

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

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

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

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

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

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

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

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

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

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

In this embodiment, as shown in FIG. 4, sharp cutting edges 31, 33 are formed at the distal end side edges of the recesses 24, 26 of the forceps pieces 12, 14. The forceps pieces 12 and 14 are closed, and the edges 31 and 33 mesh with each other, so that the tissue piece can be cut.

Also, in the present embodiment, as shown in FIGS. 1 to 4, the first electrode 30 and the second electrode 30 are provided on the distal end side outer peripheral surface of each forceps piece, not including the contact portion of each forceps piece 12, 14. An electrode 32 is formed. The electrode area of each of the electrodes 30 and 32 is not particularly limited, but is 2.0 to 40.0, respectively.
mm ² is preferred. The first electrode 30 and the second electrode 32 are insulated because no electrodes are formed at these contact portions so as to prevent a short circuit even when the forceps pieces 12 and 14 are closed. Also, the electrodes are not formed on the inner surfaces of the recesses 24 and 26 of the forceps pieces 12 and 14, and are in an insulated state.

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

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

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

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

In order to collect, for example, a living tissue at a lesion using the forceps-type electric treatment instrument 2 according to the present embodiment, first, the distal end of the treatment instrument 2 is moved by using an endoscope or the like as shown in FIG. Is guided to the vicinity of the lesion 52 in the body cavity 50 shown in FIG. Next, FIG.
Operating unit 20 connected to the outer end of the sheath 4 shown in FIG.
To pull the handle 22 from the sheath 4
The pair of forceps pieces 12, 14 attached to the proximal end of the pair are rotated in the closing direction. By closing the pair of forceps pieces 12 and 14, the biological tissue piece in the lesioned part 52 is picked up, and the first and second cup-shaped recesses 2 formed in the forceps pieces 12 and 14 are formed.
4, 26. As shown in FIG. 4, the base of the biological tissue piece of the picked up lesioned part 52 is
Due to the engagement of the cutting edges 31 and 33 of the cutting members 2 and 14, they are completely cut. Or even if it is not completely cut,
It can be completely cut as shown below.

That is, by operating the operation unit 20 shown in FIG. 1, the distal ends of the closed forceps pieces 12 and 14 are pressed against the body tissue surface of the body cavity 50 as shown in FIG. As a result, the first electrode 30 and the second electrode 32 are respectively pressed against the surfaces of the living tissue located on both sides of the base of the living tissue piece sandwiched between the forceps pieces 12 and 14. In this state, the high-frequency power supply 40 connected to the proximal end side of the sheath 4
A high-frequency voltage is applied between the first electrode 30 and the second electrode 32 through a conductive wire wired inside. When a high frequency voltage is applied between these electrodes 30, 32,
Current flows only through the base of the tissue piece located between the 32 and heats it, burning off the base. By this heating, the cut part is also stopped. The cut biopsy pieces remain in the recesses 24 and 26 of the forceps pieces. Therefore, if the treatment instrument is taken out of the body cavity with the forceps pieces closed, the collection of the biopsy tissue piece is completed.

When the base of the tissue piece is completely cut by the cutting edges 31 and 33 of the forceps pieces 12 and 14, the application of the high-frequency voltage does not stop the hemostasis on the surface of the living tissue after cutting. Only done for. Such hemostasis may be performed by applying a high-frequency voltage by pressing the tips of the closed forceps pieces 12 and 14 against a part that has bleeding for some reason other than the part where the tissue piece is collected. it can.

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

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

Note that the present invention is not limited to the above-described embodiment, and can be variously modified within the scope of the present invention.

For example, in the above embodiment, the forceps piece 1
2 and 14 are made of a conductive member, and portions other than the portions corresponding to the electrodes 30 and 32 are covered with an insulating film.
Each of the forceps pieces 12, 14 is made of an insulating member, and a conductive film is formed only on the tip side edges corresponding to the electrodes 30, 32 of the forceps pieces 12, 14 by means of metal plating or the like. Is also good.

[0044]

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

In the present invention, when a sharp cutting edge is formed at the tip side edge of each forceps piece, a high-frequency voltage is applied between the first electrode and the second electrode. It is also possible to use the cutting edge by engaging the cutting edge portion without cutting the tissue piece. In such a method of use, after excision of the tissue piece, the distal end of the closed forceps piece is pressed against the cut surface of the living tissue, and in this state, a high-frequency wave is applied between the first electrode and the second electrode. Apply voltage. As a result, the portion against which the forceps piece is pressed is heated and cauterized, and good hemostasis can be performed.

In the present invention, since the first electrode and the second electrode are formed on the outer peripheral surface of each forceps piece, bleeding occurs outside the tissue piece collection site during the tissue piece collection procedure. Even in such a case, it is convenient because the hemostasis can be performed only by pressing the tip of the forceps piece against the bleeding part and supplying a high-frequency current.

[Brief description of the drawings]

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

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

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

FIG. 4 is a cross-sectional view of a main part of a tip of a forceps piece in a used state.

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

[Explanation of symbols]

 2 ... forceps type electric treatment instrument 4 ... sheath 10 ... fulcrum shaft 12 ... 1st forceps piece 14 ... 2nd forceps piece 18 ... elongate member 20 ... operation part 22 ... handle 24 ... 1st recess 26 ... 2nd recess 30 ... First electrode 31 ... Cutting edge 32 ... Second electrode 33 ... Cutting edge

Claims (2)

[Claims] 1. A flexible sheath that can be inserted into a body, a first forceps piece attached to a distal end side of the sheath and having a cup-shaped first recess formed therein, and a cup-shaped first forceps piece. Two recesses are formed, and a second forceps piece is connected to the first forceps piece so as to be openable and closable such that the first recess and the second recess face each other; 2 First not including the contact portion with the forceps piece
A first electrode formed on the outer peripheral surface on the distal end side of the forceps piece; and a second electrode not including a contact portion between the first forceps piece and the second forceps piece.
A second electrode formed on the outer peripheral surface on the distal end side of the forceps piece; and a voltage supply means connected to the proximal end side of the sheath so as to supply a high-frequency voltage between the first electrode and the second electrode. And a forceps-type electric treatment instrument having opening / closing control means for controlling opening / closing of the first forceps piece and the second forceps piece. 2. The distal end side edges of each forceps piece are configured to contact each other in a state where the forceps pieces are closed, and a sharp cutting edge is formed on the distal end side edge. The forceps-type electric treatment instrument according to claim 1, which is formed.