JPH1147150A - Endoscopic surgery appliance - Google Patents

Abstract

PROBLEM TO BE SOLVED: To enable safely solidifying and incising living tissue and keeping sharpness for incision. SOLUTION: In an endoscopic surgery appliance having a pair of clamping members 11a, 11b clamping tissue, bipolar electrodes provided on the clamping surfaces of the clamping members 11a, 11b, and an incising blade 16 incising the tissue, the incising blade 16 is placed in a first position where it is stored inside the clamping member 11a so as not to make contact with the tissue to be clamped, and is freely movable so that during incision at least a part of the incising blade 16 passes from the first position through the clamping surfaces formed by the pair of claming members 11a, 11b.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an endoscopic surgical instrument having a grasping member for grasping a living tissue and an incision for cutting the grasped living tissue.

[0002]

2. Description of the Related Art In general, there has been known a bipolar forceps having a pair of gripping members for gripping a living tissue, each of which is provided with an electrode for energizing a high frequency. When using the bipolar forceps, a high-frequency current is applied between the electrodes of each gripping member to coagulate the living tissue between the gripping members while the living tissue to be treated is gripped between the pair of gripping members. Has become.

[0003] Bipolar forceps of this kind are usually used in various cases such as hemostasis of blood vessels contained in living tissue, lesions on the surface layer of living tissue, cauterization of bleeding points, occlusion of fallopian tubes for contraception, and the like. Can be Bipolar forceps are used for hemostasis of blood vessels and occlusion of fallopian tubes, so that a living tissue to be treated by a patient can be coagulated, and the coagulated living tissue can be incised. ing.

Conventionally, as this kind of endoscopic surgical instrument,
For example, US Pat. No. 4,655,216, US Pat. No. 5,445,638, US Pat. No. 5,431,674, US Pat. No. 5,484,436, US Pat. No. 5,558,671, US Pat. No. 5,267,998.
It is known in the specification of Japanese Patent Application Publication No.

In US Pat. No. 4,655,216, a substantially L-shaped incision blade rotatable about a pivot pin as a fulcrum is provided between a pair of openable and closable gripping members to grip living tissue. After the coagulation current flows between the pair of gripping members to coagulate the living tissue, the cutting blade is rotated to cut the living tissue.

US Pat. No. 5,445,638 and US Pat. No. 5,558,671 are provided with a pair of gripping members projecting from a distal end portion of a sheath, a cutting knife which can be advanced and retracted between the gripping members, and a hand operating unit. With the pair of gripping members closed and the living tissue to be treated gripped by the operation, a coagulation current is passed between the pair of gripping members to coagulate the living tissue, and then the cutting knife is advanced to cut the living tissue. It is supposed to.

US Pat. No. 5,431,674 has an anvil fixed to the distal end of a sheath and an incising blade that can be advanced and retracted and is rotatable. The incising blade is closed and pulled in to incise living tissue. I have.

In US Pat. No. 5,484,436, a pair of cutting blades are rotatably provided at the distal end of a sheath, and a coagulation current is applied to the pair of cutting blades to coagulate living tissue. The tissue is to be dissected.

US Pat. No. 5,267,998 has a pair of coagulation electrodes and a movable incision electrode. After a coagulation current is passed between the pair of coagulation electrodes to coagulate the living tissue, the operation of the hand operation unit is performed. As a result, the incision electrode is moved, and an incision current is applied to incise the living tissue.

[0010]

However, in the above-mentioned U.S. Pat. No. 4,655,216, since the incision blade projects between the pair of gripping members, there is a fear that normal living tissue may be damaged, and However, there is a disadvantage that operability is poor because it is necessary to pay attention to the above.

US Pat. No. 5,456,638 and US Pat. No. 5,558,671 are provided with a cutting knife which can be advanced and retracted between a pair of gripping members, and when the sharpness of the cutting knife deteriorates, the cutting knife is advanced. There is a disadvantage that the grasped living tissue is pushed out when making the incision, and the incision knife needs to be replaced frequently.
Further, it has a complicated structure in which the incision knife is disposed between the gripping members so as to be able to advance and retreat, and there is a disadvantage that cleaning performance is poor.

No. 5,431,674, US Pat. No. 5,484,436 and US Pat. No. 5,267.
The '998 specification does not have a function of grasping a living tissue, and thus cannot reliably incise a treatment target site.

The present invention has been made in view of the above circumstances, and has as its object to eliminate the possibility of damaging normal living tissue when inserted into a body cavity and to maintain incision performance. An object of the present invention is to provide an endoscopic surgical instrument.

[0014]

To achieve the above object, the present invention provides a pair of gripping members for gripping tissue, a bipolar electrode provided on a gripping surface of the gripping member, and an incision for cutting tissue. Endoscope-operated surgical instrument comprising:
The incision means is disposed at a first position housed inside the grasping member so as not to contact a tissue to be grasped, and at least part of the incision means is formed by a pair of grasping members from the first position at the time of incision. Characterized by being movable so as to pass through a gripping surface.

[0015] When a living tissue is grasped by a grasping member during treatment such as coagulation and hemostasis of a living tissue, a coagulation current is passed between the grasping members to coagulate the living tissue, and then the incision means is operated by a pair of grasping members. The living tissue can be dissected by moving to a gripping surface to be formed.

[0016]

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

1 to 6 show a first embodiment, and FIG.
Shows a bipolar forceps 1 as an endoscopic surgical instrument.
The bipolar forceps 1 has an elongated insertion section 2 inserted into a body cavity of a patient, and a treatment section 3 disposed at the distal end of the insertion section 2 and capable of energizing and coagulating a living tissue in the body cavity.
And an operation unit 4 connected to the base end of the insertion unit 2.

As shown in FIGS. 4 to 6, the insertion portion 2 includes a sheath 5 and a rod 6 inserted into the sheath 5 so as to be able to advance and retreat in the axial direction. An engaging member 7 made of an insulating material is fixed, and a base end of the sheath 5 is fixed to a grip 8 constituting the operation unit 4.
As shown in FIG. 1, the base end of the rod 6 is fixed to a rod driving member 9 provided on the operation unit 4.

The treatment section 3 includes a pair of gripping members 11a and 11b constituting electrodes, and these gripping members 11a and 11b.
And two upper and lower elastic members 12a and 12b each of which supports and biases in the direction of expanding.
The base ends of a and 12 b are fixed to the front end of the rod 6. The elastic members 12a, 12b are formed of spring steel or the like, and have bent portions 13a, 13a,
13b is formed, and the surface is covered with an insulating film.

As shown in FIG. 5 and FIG.
A and 11b are formed with concave grooves 14a and 14b each having a substantially U-shaped cross section so that a space 14 is formed inside when closed, and the opposing edges are saw-toothed meshing with each other when closed. The part is formed so that the living tissue A can be securely grasped.

Further, as shown in FIGS. 4 to 6, a knife rod 15 made of spring steel or the like is inserted through the rod 6, and a cutting knife as a cutting means is inserted into the tip of the knife rod 15. 16 are provided. Further, the knife rod 15 is located between the lower elastic members 12b and 12b at the distal end of the rod 6 and is located below the axis of the rod 6, but extends from the distal end of the rod 6. The cut portion is inclined and bent toward the upper gripping member 11a, and the cutting knife 16 at the tip is housed in the concave groove 14a of the upper gripping member 11a. That is, at normal times, the cutting knife 16 is retracted so as not to contact the living tissue A by the elasticity of the knife rod 15. The incision knife 16 is a rectangular plate-shaped body, and is a single-edged knife having a cutting blade 16a extending in the front-rear direction below the plate-like body, and has a slope that is inclined upward toward the distal end.

Further, a through hole 6a is provided in the axial direction above the axis of the rod 6, and a knife operating rod 17 is inserted through the through hole 6a so as to be able to move forward and backward. A knife rod 15 is provided at the tip of the knife operation rod 17.
An operation head 18 having an engagement groove 18a that engages with the operation head 18 is provided. When the knife operation rod 17 advances, the operating head 18 pushes down the knife rod 15 against the elastic force of the knife rod 15 to move the incision knife 16 downward from the inside of the gripping member 11a, and the gripping surfaces of the gripping members 11a and 11b are moved downward. It can be passed through.

The thus configured rods 6 of the holding members 11a and 11b of the treatment section 3, the knife rod 15 of the cutting knife 16 and the knife operating rod 17 are inserted into the sheath 5 constituting the insertion section 3, and 5 protrudes from the base end and extends to the operation unit 4.

Further, as shown in FIGS.
The grip 8 has a distal extension 8 extending toward the distal end.
a is provided. The distal extension 8a is provided with a connection ring 8b which is connected and fixed to the base end of the sheath 5. Further, the treatment section 3 is provided behind the distal-side extension section 8a.
A treatment unit connection 19 is provided for electrical and mechanical connection with the rear end of the treatment unit. Here, the treatment section unit connection section 19 is provided with a lumen for accommodating the rear end of the rod 6 of the treatment section 3 and connection means connected to the rear end of the rod 6 accommodated in this lumen. ing.

The treatment section unit connection section 19 is provided with an electrode pin 21 via a guide rod 20 which is electrically connected to the holding members 11a and 11b of the treatment section 3, and the electrode pin 21 is connected to the high-frequency cable 21a. Via a high-frequency ablation power supply device (not shown).

The grip 8 is provided with a trigger 22 for operating the treatment unit connection 19. The trigger 22 is connected to the upper end of the grip 8 so as to be rotatable around a rotation pin 23. Further, a long hole 24 is formed in the trigger 22 above the pivot point.
An engagement pin 25 projecting from the side surface of the rod driving member 9 is inserted into the elongated hole 24. Reference numeral 26 denotes a rotation knob, and the direction of the gripping members 11a and 11b can be arbitrarily changed by rotating the rod 6 in the sheath 5 in the circumferential direction.

The trigger 22 is provided inside the grip 8.
There is provided an urging member (not shown) for urging the handle portion 22a at the lower end of the gripper 8 in the direction away from the grip 8 (clockwise around the pivot pin 23 in FIG. 1). The trigger 22 is always held at a fixed position (release position) farthest from the grip 8 by the spring force of the urging member.

Further, a knife operation lever 27 is provided on a side surface at an upper portion of a rear end of the grip 8. The knife operating lever 27 is pivotally connected to the grip 8 by a rotating pin 28.
Are connected so as to be rotatable around the center. Further, a long hole 29 is formed above the center of rotation of the knife operation lever 27, and an engagement pin 30 projecting from the rear end side surface of the knife operation rod 17 is inserted into the long hole 29. .

The knife operating lever 27 is provided with upper and lower arms 31 and 32 arranged in a substantially V-shape. A finger hook 33 is in contact with one arm 31 and the other arm 32 is in contact with a stopper pin 34 to play a role in restricting the rotation range of the knife operation lever 27. further,
An urging member (not shown) for urging the knife operation lever 27 in a clockwise direction is attached to the rotating pin 28.

Here, by pulling the handle 22a of the trigger 22 toward the grip 8 against the spring force of the biasing member, the rod 6 is moved forward in the axial direction of the sheath 5 via the rod driving member 9. Moving. As the rod 6 advances, the elastic members 12a and 12b protrude from the sheath 5, and expand by the elastic restoring force of the elastic members 12a and 12b to open the grip members 11a and 11b. When the trigger 22 is released, the elastic member 12a, 12b returns to the home position by the spring force of the urging member in the grip 8, and the elastic members 12a, 12b are pulled into the sheath 5 against the elastic restoring force.
Is closed.

Also, the finger hook 3 of the knife operating lever 27
When the knife operation lever 27 is rotated counterclockwise against the urging force of the urging member, the knife operation rod 1 is inserted through the engagement pin 30 inserted into the elongated hole 29.
7 is driven forward and pushed down by the operation head 18 at the tip of the knife operation rod 17 against the elastic force of the knife rod 15 to move the incision knife 16 downward from the inside of the gripping member 11a. 11b can be passed through.

When the knife operating lever 27 is released, the knife operating rod 17 returns to the home position by the spring force of the urging member, and the knife operating rod 17 is relatively retracted into the sheath 6 to release the knife rod 15 and the elastic restoring force. As a result, the incision knife 16 is accommodated inside the upper gripping member 11a, and the arm 32 stops when it comes into contact with the stopper pin 34.

Next, the operation of the first embodiment will be described.

The high frequency cable 21a is connected to the electrode pin 21 of the bipolar forceps 1, and the bipolar forceps 1 and the high frequency ablation power supply device are electrically connected. In the initial state, the handle 22a of the trigger 22 of the operation unit 4 is shown in FIGS.
As shown in the figure, the treatment section unit connection section 19 is held at the fixed position furthest from the grip 8, and the treatment section unit connection section 19 is held at the rearmost position in the axial movement range of the insertion section 3. In this state, the pair of elastic members 12a and 12b of the treatment section 3 are immersed in the sheath 6 and the grip members 11a and 11b are closed.

In this state, the insertion portion 2 of the bipolar forceps 1
Is inserted into the body of the patient, and the treatment section 3 at the tip of the insertion section 2
Is guided to a position near the living tissue A to be treated in the body. The rod 6 is pulled through the rod driving member 9 by pulling the handle 22a of the trigger 22 toward the grip 8 against the urging force of the urging member.
Move forward in the axial direction of. As the rod 6 advances, the elastic members 12a and 12b protrude from the sheath 6, and the elastic member 1
The gripping members 11a, 1
1b opens (see FIG. 2).

Subsequently, the expanded gripping members 11a, 11b
When the trigger 22 is released after the insertion of the living tissue A, the elastic member 12a, 12b is retracted into the sheath 6 by the spring force of the biasing member in the grip 8, and the grip members 11a, 11b Is closed as shown in FIG. 3, and the living tissue A is closed as shown in FIG.
It is gripped between 1a and 11b.

At this time, the gripping members 11a and 11b are formed as saw-toothed portions that mesh with each other when closed, so that the living tissue A can be reliably gripped. In this state, a high-frequency current flows from the high-frequency cautery power supply to the electrode pin 21 via the high-frequency cable 21a, and a coagulation current flows between the gripping members 11a and 11b via the elastic members 12a and 12b.
Coagulation of the living tissue A is performed.

After a coagulation current is applied for a certain period of time to coagulate the living tissue A (the cross-line portion of the living tissue A in FIG. 6B indicates the portion coagulated by the coagulation current), the knife operating lever 27 is used. When the knife operation lever 27 is rotated counterclockwise against the urging force of the urging member, the engaging pin 30 inserted in the elongated hole 29 is pressed.
, The knife operation rod 17 is driven forward. The knife rod 15 is pushed down against the elastic force by the operation head 18 by the advance of the knife operation rod 17, and the cutting knife 16 is moved downward from the inside of the gripping member 11a.

Then, as shown in FIGS. 6A and 6B,
When the cutting knife 16 passes through the holding surfaces of the holding members 11a and 11b, the inside of the coagulated portion of the living tissue A held between the holding members 11a and 11b is mechanically cut by the cutting blade 16a of the cutting knife 16. You.

After the incision is completed, the knife operating lever 27
Is released, the knife operating rod 17 is returned to the home position by the spring force of the urging member, the knife operating rod 17 is relatively retracted into the sheath 6 and the operating head 18 is retracted, and the cutting knife 16 is raised by the elastic force of the knife rod 15. The arm portion 32 is stored inside the upper gripping member 11a and stops when the arm portion 32 comes into contact with the stopper pin 34.

When the trigger 22 is released, it returns to the home position by the spring force of the biasing member in the grip 8, and the elastic members 12a and 12b protrude from the sheath 6 to hold the grip member 11.
The gripping members 11a and 11b are released from the living tissue A by the elastic restoring force of the elastic members 12a and 12b.

According to the present embodiment, the incision knife 16 is normally retracted in a state of being housed inside the gripping member 11a, so that when the treatment section 3 is guided into the body cavity to the target site, the incision knife 16 is incised. There is no risk of damaging the normal tissue by the knife 16, and the operability can be improved. In addition, incision knife 1
Even if the sharpness of No. 6 is reduced, the incision can be reliably performed without escaping the living tissue A during the incision.

FIGS. 7 to 11 show a second embodiment, in which the same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. As shown in FIG. 7 to FIG. 11, an elastic member 12
A pair of gripping members 41a and 41b are provided by a and 12b. When the gripping members 41a and 41b are closed, concave grooves 43a and 43b are formed on surfaces facing each other so that a space 42 is formed inside, and a sawtooth-shaped portion which meshes with each other when closed is formed on the periphery thereof. Formed and living tissue A
Is formed so as to be surely gripped.

The concave groove 43a of the upper gripping member 41a is formed on a slope so as to gradually become shallower toward the near side, and is formed on a guide surface 45 for guiding the cutting knife 44. The incision knife 44 is a rectangular plate-like body, and has a cutting blade 44a obliquely on the lower front side. When the incision knife 44 is located at the deepest tip side in the concave groove 43a of the upper gripping member 41a. It is retracted so as not to come into contact with the living tissue A.

On the other hand, a through hole 46 is provided at a position deviated below the axis of the rod 6 in the axial direction.
The through-hole 46 has a knife operating rod 4 made of spring steel.
7 is inserted to be able to advance and retreat. Knife operating rod 47
The portion extending from the distal end of the rod 6 is bent obliquely toward the upper gripping member 41a, and the cutting knife 44 is fixed to the distal end. The base end of the knife operation rod 47 extends to the operation unit 4.
Is connected to a knife operation lever 27 provided at the first position.
The knife operation lever 27 is rotatably connected to the grip 8 about a rotation pin 28, is urged counterclockwise by an urging member (not shown), and moves the knife operation rod 47 forward. It is energizing.

Next, the operation of the second embodiment will be described. FIG. 11 (b) is the same as in the first embodiment until the living tissue A is gripped by closing the gripping members 41a and 41b, and a coagulation current flows between the gripping members 41a and 41b to solidify the living tissue A. The cross line portion of the living tissue A in ()) indicates a portion coagulated by the coagulation current. After coagulating the living tissue A, a finger is put on the finger hook 33 of the knife operating lever 27, and the knife operating lever 27 is pressed against the urging force of the urging member.
Is rotated clockwise, the knife operation rod 47 is driven to retreat through the engagement pin 30 inserted into the elongated hole 29. By retreating the knife operating rod 47, the incision knife 44 provided at the distal end of the knife operating rod 47 is pulled toward the near side, guided by the guide surface 45 of the gripping member 41a, and moved from the deep position to the shallow position of the concave groove 43a. I do.

Therefore, as shown in FIG. 11, the cutting blade 44a of the cutting knife 44 passes through the gripping surfaces of the gripping members 41a and 41b, and the coagulated portion of the living tissue A gripped between the gripping members 41a and 41b. Is mechanically cut by the cutting blade 44a of the cutting knife 44.

After the incision is completed, the knife operating lever 27
Is released, the knife operating rod 47 is returned to the home position by the spring force of the urging member, the knife operating rod 47 advances, and the incision knife 44 is gradually raised by the elastic force of the knife operating rod 47, and the concave groove 43a of the upper gripping member 41a. Housed inside
The arm 32 stops when it comes into contact with the stopper pin 34.

In the second embodiment, the cutting knife 44 is a rectangular plate, and the cutting knife 44 is inclined diagonally toward the lower front side.
Although the shape has a, as shown in FIG. 12, the incision knife 48 having a substantially L-shaped cutting blade 48a on the lower front side allows the living tissue A to be more incised.

According to the present embodiment, the incision knife 44 is normally retracted in a state of being housed inside the gripping member 41a, so that when the treatment section 3 is guided to the target site in the body cavity, the incision knife 44 is incised. There is no risk of damaging the normal tissue by the knife 44, and the operability can be improved. In addition, incision knife 1
Even if the sharpness of No. 6 is reduced, the incision can be reliably performed without escaping the living tissue A during the incision.

FIGS. 13 to 17 show a third embodiment.
The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted. In the present embodiment, a knife wire 50 is provided in place of the cutting knife 16 of the first embodiment.
A through hole 51 is provided in a position deviated below the axis of the rod 6 in the axial direction, and a knife operation rod 52 made of spring steel is inserted through the through hole 51 so as to be able to advance and retreat. A portion of the knife operation rod 52 extending from the distal end of the rod 6 is integrally provided with a knife wire 50. The knife wire 50 is provided with a cutting blade 50a having a square axis in cross section and an upper surface formed at an acute angle. Also,
The base end of the knife operation rod 52 extends to the operation section 4 and is connected to the knife operation lever 27 provided on the operation section 4.

The tip of the knife wire 50 is fixed to the inner bottom of the lower gripping member 11b by welding or the like, and the portion of the knife wire 50 located inside the gripping member 11b is the upper gripping member 11a. It is bent so as to be curved in an arc toward.

Next, the operation of the third embodiment will be described. FIG. 15 (b) is the same as that of the first embodiment until the living tissue A is gripped by closing the gripping members 11a and 11b and coagulating the living tissue A by flowing a coagulation current between the gripping members 11a and 11b. The cross line portion of the living tissue A in ()) indicates a portion coagulated by the coagulation current. After coagulating the living tissue A, a finger is put on the finger hook 33 of the knife operating lever 27, and the knife operating lever 27 is pressed against the urging force of the urging member.
Is rotated in the counterclockwise direction, the knife operation rod 52 is driven forward through the engagement pin 30 inserted in the elongated hole 29. The knife wire 50 provided integrally with the distal end of the knife operating rod 52 is pushed forward by the advance of the knife operating rod 52, and the distal end of the knife wire 50 is fixed to the gripping member 11b. The holding member 1 has a bending habit so as to be curved.
It curves in an arc toward 1a.

Therefore, as shown in FIG. 15, the cutting edge 50a of the knife wire 50 passes through the holding surfaces of the holding members 11a and 11b, and the coagulated portion of the living tissue A held between the holding members 11a and 11b. Inside is a knife wire 50
Is mechanically cut by the cutting blade 50a.

After the incision is completed, the knife operating lever 27
Is released, the knife operating rod 52 returns to the home position by the spring force of the urging member, and the knife wire 50 is retracted.
Is restored substantially straight by the elastic restoring force, is accommodated in the concave groove of the lower gripping member 11b, and stops when the arm portion 32 comes into contact with the stopper pin.

According to the present embodiment, the knife wire 50 is normally retracted in a state of being housed inside the gripping member 11b. Therefore, when the treatment section 3 is guided to the target site in the body cavity, the knife wire 50 is retracted. There is no risk of damaging normal tissue by the wire 50, and operability can be improved. In addition, even if the sharpness of the cutting knife 16 is reduced, the incision can be reliably performed without escaping the living tissue A during the incision.

FIGS. 18 to 23 show a fourth embodiment.
The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted. As shown in FIG. 21 to FIG.
Is composed of a rod 55 and a sheath 56 which is fitted to the rod 55 so as to be able to advance and retreat in the axial direction. An engaging member 57 made of an insulating material is fixed to the distal end of the sheath 56. The end is fixed to a grip 8 constituting the operation unit 4. The proximal end of the sheath 56 is fixed to a sheath driving member 59 provided in the operation unit 4.

The treatment section 3 includes a pair of gripping members 61a, 61b constituting electrodes, and these gripping members 61a, 61b.
And upper and lower two elastic members 62a and 62b which urge in the direction of expanding.
The base ends of a and 62b are fixed to the front end of the rod 55. The elastic members 62a and 62b are formed of spring steel or the like, and have bent portions 63 bent in a substantially U-shape at the distal ends.
a, 63b are formed, and the surface is covered with an insulating film.

As shown in FIG. 20, the lower gripping member 61
A sharp incision blade 6 is provided at the middle part in the width direction on the gripping surface of b.
4 are provided in the front-rear direction, and both sides of the cutting blade 64 are formed as flat surfaces. A plurality of elastic bodies 65 such as silicone rubber are provided on the gripping surface of the lower gripping member 61b, and the height of the elastic body 65 is larger than the height of the cutting blade 64. The cutting blade 64 is located between the elastic members 65 so as not to damage the tissue.

Next, the operation of the fourth embodiment will be described.

In the initial state, the handle portion 22a of the trigger 22 of the operation section 4 is held at a fixed position farthest from the grip 8 as shown in FIG. 21. In this state, since the sheath 56 is at the retracted position, a pair of elastic members is provided. The members 62a and 62b are expanded by the elastic restoring force, and as shown in FIG. 18, the pair of gripping members 61a and 61b are in an open state.

In this state, the treatment section 3 at the distal end of the insertion section 2 is guided to a position near the living tissue A to be treated in the body.
Subsequently, the living tissue A is inserted between the expanded holding members 61a and 61b. Therefore, the handle 22 of the trigger 22
By pulling a toward the grip 8 against the urging force of the urging member, the a moves forward in the axial direction of the sheath 56 via the sheath driving member 59.

As the sheath 56 advances, the elastic member 62
a and 62b are relatively drawn into the sheath 56, and the grip members 61 are opposed to the elastic restoring force of the elastic members 62a and 62b.
a, 61b are closed, and the living tissue A is as shown in FIG.
It is gripped between the pair of gripping members 61a, 61b. In this state, a high-frequency current flows from the high-frequency ablation power supply device to the electrode pin 21 via the high-frequency cable 21a, and a coagulation current flows between the gripping members 61a and 61b via the elastic members 62a and 62b. Coagulation is performed.

After the coagulation current is passed for a certain period of time to coagulate the living tissue A, as shown in FIG. 23, the handle 22a of the trigger 22 is further pulled toward the grip 8 against the urging force of the urging member. In other words, when the trigger 22 is pulled more strongly, the sheath 5
6 moves further axially forward.

As the sheath 56 advances, the elastic member 62
a and 62b are drawn relatively deeper into the sheath 56, and the gripping members 61a and 61b are strongly closed.
The elastic body 65 is compressed, and the cutting blade 64 protrudes relatively. Therefore, the incision blade 64 is used for the holding members 61a, 61b.
The living tissue A grasped between the grasping members 61a and 61b after passing through the grasping surface is mechanically dissected by the dissecting blade 64.

After the incision is completed, when the trigger 22 is released, the sheath returns to the home position by the spring force of the urging member, and the sheath 56 retreats and opens by the elastic restoring force of the elastic members 62a and 62b, and the grip members 61a and 61b. Is released from the living tissue A.

In the present embodiment, the living tissue A is grasped and coagulated by a series of operations of grasping the grip 8 and pulling the handle 22a of the trigger 22, and the coagulated portion can be cut, thereby improving operability. Can be done. In addition, even if the sharpness of the cutting knife 16 is reduced, the incision can be reliably performed without escaping the living tissue A during the incision. In the present embodiment, a pair of gripping members 61a, 6
1b, the cutting blade 64 and the elastic body 65 are provided only on the lower gripping member 61b, but as shown in FIG. 24, the cutting blade 64 and the elastic body 65 are attached to both the pair of gripping members 61a, 61b. The lower gripping member 61b or a pair of gripping members 61 may be provided as shown in FIG.
A block 67 may be attached to both a and 61b via a spring 66 so that the height of the block 67 is higher than the cutting blade 64 in a normal state.

According to the present embodiment, the incision blade 64 is normally retracted in a state of being immersed between the elastic bodies 65, so that when the treatment section 3 is guided to a target site in the body cavity, the incision blade 64 is incised. There is no risk of damaging normal tissue by the blade 64, and operability can be improved.

In the first to fourth embodiments described above, the incision means in the incision blade and the knife wire is
Although the mechanical incision has been described, the incision may be made mechanically and electrically by applying an incision current to the incision blade and the knife wire at the time of incision.

FIGS. 26 to 31 show a first example of the endoscopic surgical instrument.
FIG. 31 is an overall configuration diagram. The surgical instrument 70 includes an insertion section 71, a treatment section 72 provided at the distal end of the insertion section 71, and an operation section 73 provided at the base end of the insertion section 71. It is connected to a power supply 74.

As shown in FIGS. 26 to 30, the insertion portion 71
Is formed in a double-pipe structure by an inner sheath 75 and an outer sheath 76 which is fitted on the inner sheath 75 and which can move forward and backward in the axial direction. The distal end portion of the inner sheath 75 protrudes from the distal end portion of the outer sheath 76, and a fixing jaw 77 is provided at this protruding portion. The upper surface of the fixed jaw 77 is formed with a saw-toothed uneven surface, and a guide groove 77a is provided in the middle part in the width direction in the front-rear direction. Further, slide grooves 7 which are long in the front-rear direction
A pivot pin 79 is inserted into the slide groove 78 so as to penetrate the distal end of the outer sheath 76 in the lateral direction. Therefore, the outer sheath 76 can move forward and backward within the length of the slide groove 78.

Further, a movable jaw 80 is rotatably supported at an intermediate portion of the pivot pin 79. The movable jaw 80 faces the guide groove 77a of the fixed jaw 77 and is formed to have a width smaller than the width of the guide groove 77a. A connecting pin 81 is provided at a portion of the base end of the movable jaw 80 below the pivot pin 79, and a distal end of a jaw operating rod 82 is rotatably connected to the connecting pin 81. Have been. The jaw operation rod 82 extends through the inside of the inner sheath 75 and extends to the operation section 73.
5 and the outer sheath 76 also extend to the operation section 73.

The operating portion 73 includes a fixed handle 83, a movable handle 85 pivotally supported by the fixed handle 83 by a pivot 84, and an urging member (urging member) for urging the movable handle 85 counterclockwise. (Not shown). The proximal end of the inner sheath 75 is connected to the fixed handle 83, and the proximal end of the outer sheath 76 is connected to the fixed handle 83.
Is provided between the fixed handle 83 and the proximal end of the outer sheath 76, and a coil spring 86 fitted to the inner sheath 75 is provided. The outer sheath 76 is urged in the forward direction by the restoring force of the coil spring 86. The movable handle 85 is connected to the base end of the jaw operation rod 82.

Further, a current switch 87 for switching between coagulation current and incision current is mounted on the upper portion of the fixed handle 83. A switch operating lever 8 is provided at the base end of the outer sheath 76 facing the current switch 87.
8 is attached. The current switch 87 is connected to the high-frequency ablation power supply 74 via a cable 89.

Next, the surgical instrument 7 configured as described above is used.
The operation of 0 will be described.

First, the insertion section 71 is inserted into the body cavity to guide the treatment section 72 to the treatment target site. At normal times,
Since the movable handle 85 is urged in the counterclockwise direction by the urging member, the movable handle 85 moves the jaw operation rod 82 forward, and the movable jaw 80 moves clockwise about the pivot pin 79 as a fulcrum. The movable jaw 80 is opened with respect to the fixed jaw 77 by rotating.

Therefore, as shown in FIG. 27, the living tissue A is inserted between the fixed jaw 77 and the movable jaw 80,
, The jaw operation rod 82 is retracted. When the jaw operation rod 82 is pulled toward the hand, as shown in FIG. 28, the movable jaw 80 connected via the connection pin 81 rotates counterclockwise around the pivot pin 79 as a fulcrum and is fixed. The movable jaw 80 closes with respect to the jaw 77 to grip the living tissue A.

Then, when a coagulation current flows from the high-frequency ablation power supply 74, the coagulation current flows between the fixed jaw 77 and the movable jaw 80 via the cable 89 and the current changeover switch 87, and Coagulation takes place.

After the living tissue A is coagulated by flowing a coagulation current for a predetermined time, the movable handle 85 is further fixed to the fixed handle 8.
3, the jaw operation rod 8
2 retreats further. When the jaw operation rod 82 is further pulled to the proximal side, the movable jaw 80 connected via the connecting pin 81 is pulled to the proximal side.
The outer sheath 76 connected via the coil spring 8
6 retreats against the restoring force. At this time, the pivot pin 79
Is supported by the slide groove 78, so that the pivot pin 79
Slides back in the slide groove 78, and the movable jaw 80 moves along the guide groove 77a of the fixed jaw 77. That is, the living tissue A in which the movable jaw 80 is coagulated
Is moved by the shearing force. At this time, the switch operation lever 88 presses the current changeover switch 87 to switch the current by the retreat of the outer sheath 76, so that the fixed jaw 77 and the movable jaw 8 are supplied from the high frequency ablation power supply 74.
An incision current flows between zero. Therefore, the mechanical incision by the movement of the movable jaw 80 and the electrical incision of the incision current can be performed simultaneously.

When the movable handle 85 is released after the incision is completed, the movable sheath 85 returns to the home position by the spring force of the urging member, the outer sheath 76 advances, the jaw operation rod 82 advances, and the movable jaw 80 advances. With fixed jaw 7
7 and is released from the living tissue A.

In this embodiment, the movable handle 85
The living tissue A can be grasped and coagulated by a series of operations of rotating in the approaching direction toward the fixed handle 83 side, and the coagulated portion can be incised to improve operability.

FIG. 32 shows a second disclosed example of the surgical instrument,
The same components as those of the first disclosure are denoted by the same reference numerals, and description thereof will be omitted. In the present disclosure, a lock mechanism is provided in the operation unit 73 of the first disclosure. An extension lever 90 is provided at the base end of the outer sheath 76 and extends toward the hand. A hook 91 is provided at the tip of the extension lever 90. The fixed handle 83 is provided with a locking claw 93 that is rotatable by a trigger 92, and the locking claw 93 is locked by a locking portion 91. Therefore, the outer sheath 76 is locked immovably in the front-rear direction with respect to the fixed handle 83, so that the movable jaw 80 is not accidentally moved in the front-rear direction.

With this configuration, when the living tissue A is grasped and coagulated, the outer sheath 76 does not retreat even if the movable handle 85 is excessively operated, and the movable jaw 80 is inadvertent. The incision operation can be prevented, and at the time of incision, the trigger 92 should be operated to release the locking claw 93 from the locking portion 91 and release the lock before operation.

FIG. 33 shows a third disclosed example of the surgical instrument.
The same components as those of the first disclosure are denoted by the same reference numerals, and description thereof will be omitted. In the present disclosure, the jaw operation rod 82 is driven by the movable handle 85, and the outer sheath 76 is driven by the sheath slide actuator 94 provided on the fixed handle 83.

The high-frequency ablation power supply 74 is provided with an impedance detector 95.
5 is connected to an actuator driving device 96 for driving a sheath slide actuator 94. After a coagulation current is supplied from the high frequency ablation power supply 74 and a coagulation current is supplied between the fixed jaw 77 and the movable jaw 80 to coagulate the living tissue A, the impedance of the living tissue A is detected by the impedance detector 95. To determine if coagulation has been completed.

When it is determined from the impedance of the living tissue A that coagulation has been completed, the impedance detector 95 outputs a driving signal to the actuator driving device 96, and the actuator driving device 96 drives the sheath slide actuator 94. Outer sheath 76
Is moved backward, and the movable jaw 80 is slid backward to make an incision in the living tissue A. With this configuration, when the living tissue A is grasped and coagulated, the outer sheath 76 does not retreat even if the movable handle 85 is excessively operated, and the careless incision operation by the movable jaw 80 can be performed. Can be prevented.

FIGS. 34 and 35 show a fourth disclosure example.
The same components as those of the first disclosure are denoted by the same reference numerals, and description thereof will be omitted. In the present disclosure, the insulating layers 79A and 80A are attached to the pivot pin 79 and the movable jaw 80 pivotally supported by the pivot pin 79.
A is provided, and the fixed jaw 77 and the movable jaw 80 are electrically insulated to be bipolar.

FIGS. 36 and 37 show a fifth disclosure example.
The present disclosure example includes a first movable jaw 101 axially movable back and forth at a distal end portion of a slide pipe 100 axially movable as an insertion portion, and a second movable jaw 103 fixed to an arm 102. Have been. The arm 102 is formed of an elastic member, has a bending tendency in the expanding direction, and the slide pipe 100 retreats,
The first movable jaw 101 and the second movable jaw 10
When the slide 3 is opened and the slide pipe 100 moves forward, the second movable jaw 103 closes with respect to the first movable jaw 101 so that the living tissue A can be grasped.

Then, after a coagulation current is passed between the first movable jaw 101 and the second movable jaw 103 from the high-frequency cautery power supply to coagulate the living tissue A, the first movable jaw 101 and the second movable jaw 101 are coagulated. When a cutting current is caused to flow between the movable jaw 103 and the first movable jaw 101, and the first movable jaw 101 is retracted, mechanical dissection by the movement of the first movable jaw 101 and electric dissection of the dissection current can be performed simultaneously.

After the incision is completed, slide pipe 100
Is retracted, the second movable jaw 103 expands due to the elastic force of the arm 102, opens in a direction away from the first movable jaw 101, and is released from the living tissue A.

According to the above embodiment, the following configuration is obtained.

(Supplementary Note 1) An endoscopic surgical instrument comprising a pair of gripping members for gripping tissue, a bipolar electrode provided on a gripping surface of the gripping member, and a cutting means for cutting tissue. The incision means is disposed at a first position accommodated inside the gripping member so as not to contact the tissue to be gripped, and at the time of incision, at least a part of the incision means is formed by a pair of gripping members from the first position. An endoscopic surgical instrument which is movable so as to pass through a gripping surface.

(Supplementary Note 2) The endoscopic surgical instrument according to Supplementary Note 1, wherein the incision means is supported by an elastic member that is movable in accordance with the opening and closing operation of the stored gripping member.

(Supplementary Note 3) The incision means has an incision operating member, and the incision operation member engages with the first position not engaged with the elastic member biasing the incision means and the elastic member. 3. The endoscopic surgical instrument according to claim 1, wherein the incision means is movable to a second position where the incision means projects from the gripping member against the force.

(Supplementary Note 4) The endoscopic surgical instrument according to Supplementary note 1 or 2, wherein the cutting means is a cutting blade having a sharp cutting blade.

(Supplementary note 5) Supplementary note 1 or 2, characterized in that the cutting means is movable between a first position housed inside the gripping member and a second position retracted into the insertion portion. An endoscopic surgical instrument as described.

(Supplementary note 6) The endoscopic surgical instrument according to supplementary note 5, wherein the cutting means is a cutting blade having an L-shaped cutting blade.

(Supplementary Note 7) The cutting means is a knife wire having a distal end fixed to one of the gripping members and a rear end having elasticity movable with respect to the gripping member. 2. The endoscopic surgical instrument according to claim 1, wherein the instrument passes through a gripping surface of the gripping member.

(Supplementary note 8) The endoscopic surgical instrument according to supplementary note 7, wherein the knife wire has a sharp cutting edge in a bending direction.

(Supplementary Note 9) In a high-frequency treatment instrument having a function of incising a coagulation site after coagulation of tissue, incision of the tissue is controlled by a tissue grasping portion so that the tissue is not incised by a normal grasping operation. A high-frequency treatment instrument having an elastic member.

(Supplementary note 10) The high-frequency treatment instrument according to supplementary note 9, wherein the coagulation operation and the incision operation can be performed by a series of operations.

(Supplementary note 11) The high-frequency treatment instrument according to supplementary note 10, wherein the coagulation operation and the incision operation can be performed by a series of operations by operating the operation unit.

(Supplementary note 12) The high-frequency treatment instrument according to supplementary note 9, wherein the elastic member is silicon rubber.

(Supplementary note 13) The high-frequency treatment instrument according to supplementary note 12, wherein the silicone rubber is supported by a spring.

(Supplementary note 14) The high-frequency treatment instrument according to supplementary note 9, wherein the tissue incision portion is provided on a part of the tissue gripping surface and has a sharp cutting blade.

(Supplementary note 15) The high-frequency treatment instrument according to supplementary note 14, wherein the tissue incision portion has tissue grasping surfaces on both sides thereof.

(Supplementary Note 16) In an endoscopic surgical instrument that has a pair of jaws that relatively open and close at the distal end of an insertion portion and coagulates tissue, one jaw opens and closes with respect to the other jaw and closes. Slide in parallel with the insertion section
An endoscopic surgical instrument in which a coagulated surface is formed on a tissue contacting surface of a pair of jaws, and a high-frequency current is applied to the coagulated surface to cut the tissue.

(Supplementary Note 17) The pair of jaws includes a first jaw and a second jaw, and the first jaw is rotatably supported by a fulcrum pin with respect to the second jaw. Is slidable in a slide groove provided substantially parallel to the insertion portion in the second jaw, and the fulcrum pin is connected to a sheath provided slidably with respect to the second jaw. 17. The endoscopic surgical instrument according to claim 16, further comprising a prevention means.

(Supplementary Note 18) The first jaw is supported by an elastically deformable arm, and the sheath is slid and engaged with the arm to open and close, and the second jaw is moved relative to the first jaw and the sheath. 17. The endoscopic surgical instrument according to claim 16, wherein the surgical instrument is slid and the sheath is provided with a slide preventing means.

(Supplementary note 19) The endoscopic surgical instrument according to supplementary note 17 or 18, wherein the slide preventing means comprises a coil spring for biasing the sheath in a distal direction.

(Supplementary note 20) The endoscopic surgery according to supplementary note 19, wherein the slide prevention means further has a hook connected to the sheath and a hook claw that engages with and disengages from the hook. instrument.

(Supplementary Note 21) The endoscopic surgical instrument according to Supplementary Notes 16 to 18 has a slide prevention means including a sheath slide actuator, an impedance detector for detecting impedance of a living tissue, and an actuator driving device. An endoscopic surgical instrument characterized in that an actuator driving device activates a sheath slide actuator to slide a jaw when the impedance of coagulated tissue exceeds a predetermined value.

(Supplementary Note 22) The endoscopic surgical instrument according to any one of Supplementary Notes 16 to 21 includes means for insulating one jaw from the other jaw, and each jaw receives a high-frequency current of a different pole. Endoscopic surgical instruments that can be energized.

(Supplementary Note 23) In the endoscopic surgical instrument according to any one of Supplementary Notes 16 to 21, the coagulation current is continuously supplied when the jaws are closed and the tissue is coagulated, and the incision current is supplied when the jaws are slid. Endoscopic surgical instruments that can coagulate and dissect tissues.

(Supplementary note 24) The endoscopic surgical instrument according to supplementary note 23, further comprising means for changing a current from a coagulation current to an incision current in response to the start of sliding of the jaw.

[0116]

As described above, according to the present invention, the incision means is housed inside the grasping member so as not to contact the tissue to be grasped, and at least a part of the incision means is formed by a pair of grasping members at the time of incision. Since it is free to move so as to pass through the formed gripping surface, there is no possibility that the incision means will contact and damage normal tissue when inserted into a body cavity, and operability can be improved. Moreover, even if the sharpness of the incision means is reduced, there is an effect that the incision can be reliably performed without escaping the living tissue at the time of incision.

[Brief description of the drawings]

1A and 1B show a first embodiment of the present invention, wherein FIG. 1A is a plan view of an entire endoscopic surgical instrument, FIG.
(C) is a side view in the state where the holding member was opened.

FIG. 2 is an explanatory view of the operation of the endoscopic surgical instrument of the embodiment.

FIG. 3 is an explanatory view of the operation of the endoscopic surgical instrument of the embodiment.

FIG. 4 is a longitudinal sectional side view showing the same embodiment, with a gripping member opened.

5A and 5B show the same embodiment, wherein FIG. 5A is a longitudinal side view showing a state in which a grasping member is closed to coagulate a living tissue, and FIG.
Sectional drawing which follows the -A line.

6A and 6B show the same embodiment, in which FIG. 6A is a longitudinal sectional side view of an incised state of a living tissue, and FIG. 6B is a cross-sectional view along line BB.

FIG. 7 is an explanatory view of the operation of the endoscopic surgical instrument according to the second embodiment of the present invention.

FIG. 8 is an operation explanatory view of the endoscopic surgical instrument of the embodiment.

FIG. 9 shows the same embodiment, and is a longitudinal side view in a state where a gripping member is opened.

FIG. 10 is a longitudinal sectional side view showing the same embodiment, in a state where the grasping member is closed and the living tissue is coagulated.

11A and 11B show the same embodiment, in which FIG. 11A is a longitudinal side view of an incised state of a living tissue, and FIG. 11B is a cross-sectional view taken along line CC.

FIG. 12 is a side view showing a modification of the cutting blade of the embodiment.

FIG. 13 shows a third embodiment of the present invention, and is a longitudinal sectional side view in a state where a gripping member is opened.

FIG. 14 is a longitudinal sectional side view showing the same embodiment, in a state where the grasping member is closed and the living tissue is coagulated.

15A and 15B show the same embodiment, wherein FIG. 15A is a longitudinal side view of an incised state of a living tissue, and FIG. 15B is a cross-sectional view taken along line DD.

FIG. 16 is an explanatory view of the operation of the endoscopic surgical instrument of the embodiment.

FIG. 17 is an explanatory view of the operation of the endoscopic surgical instrument of the embodiment.

FIG. 18 shows the fourth embodiment of the present invention and is a longitudinal sectional side view along the line HH in FIG. 20 (b) with the gripping member opened.

FIGS. 19A and 19B show the same embodiment, and FIG. 20A is a longitudinal sectional view taken along line HH of FIG. 20B in a state where the grasping member is closed and the living tissue is coagulated, and FIG. Sectional view along the line.

FIG. 20 shows the same embodiment, (a) is a longitudinal sectional side view of an incised state of a living tissue, and (b) is a cross-sectional view taken along line FF.

FIG. 21 is an explanatory view of the operation of the endoscopic surgical instrument of the embodiment.

FIG. 22 is an explanatory view of the operation of the endoscopic surgical instrument of the embodiment.

FIG. 23 is an explanatory view of the operation of the endoscopic surgical instrument of the embodiment.

FIG. 24 is a sectional view of a gripping member showing a modification of the embodiment.

FIG. 25 is a sectional view of a gripping member showing a modification of the embodiment.

FIG. 26 is a plan view of a treatment section showing a first disclosed example of the endoscopic surgical instrument.

FIG. 27 is a side view of the treatment section of the disclosure example.

FIG. 28 is a side view of a state where the living tissue is grasped and coagulated by the grasping member of the example of the disclosure.

FIG. 29 is a side view of a state where the living tissue is incised by the gripping member according to the embodiment of the disclosure;

FIG. 30 is a cross-sectional front view of the disclosed example at the time of incision.

FIG. 31 is a side view showing the overall configuration of the endoscopic surgical instrument according to the embodiment of the present disclosure;

FIG. 32 is a side view of the operation unit side showing a second disclosed example of the endoscopic surgical instrument.

FIG. 33 is a side view of the operation unit side showing a third disclosed example of the endoscopic surgical instrument.

FIG. 34 is a longitudinal plan view of a treatment unit showing a fourth disclosed example of the endoscopic surgical instrument.

FIG. 35 is a cross-sectional front view of a treatment section showing the example of the disclosure.

FIG. 36 is a side view of a treatment section showing a fifth disclosed example of the endoscopic surgical instrument.

FIG. 37 is a side view showing the example of the disclosure and showing a state in which a living tissue is incised.

[Explanation of symbols]

 2. Insertion part 3. Treatment part 4. Operation part 11a, 11b. Gripping member 16. Cutting blade.

 ────────────────────────────────────────────────── ─── Continuing on the front page (72) Inventor Naoki Sekino 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd.

Claims (1)

[Claims] 1. An endoscopic surgical instrument comprising: a pair of gripping members for gripping tissue; a bipolar electrode provided on a gripping surface of the gripping member; and a cutting means for cutting tissue. Is disposed at a first position accommodated inside the gripping member so as not to contact a tissue to be gripped, and a gripping surface formed by a pair of gripping members at least a part of the incision means from the first position at the time of incision An endoscopic surgical instrument, which is movable so as to pass through.