WO2014073492A1

WO2014073492A1 - Treatment tool

Info

Publication number: WO2014073492A1
Application number: PCT/JP2013/079746
Authority: WO
Inventors: 智之高篠; 秀雄傍島; 武井　祐介
Original assignee: オリンパスメディカルシステムズ株式会社
Priority date: 2012-11-09
Filing date: 2013-11-01
Publication date: 2014-05-15

Abstract

A treatment tool which comprises: a pair of openable/closable holding portions which hold bodily tissue with an opposing pair of holding faces; an energy output portion which is provided on at least one of the pair of holding portions and which comprises, as at least one of the pair of holding faces, an energy applying face which applies high frequency energy to the bodily tissue and then applies resistance heating energy to the bodily tissue; and a gap maintaining portion which protrudes from at least one of the pair of holding faces and maintains the distance between the opposing pair of holding faces at a constant distance of 0.7 mm or less when the pair of holding portions is closed.

Description

Treatment instrument

The present invention relates to a therapeutic treatment instrument for treating a living tissue by applying energy.

Conventionally, various treatment tools and treatment methods for treating a living tissue by applying energy have been proposed.

Here, examples of the energy applied to join the living tissues, for example, include high-frequency energy and resistance heating energy. For example, when high frequency energy is applied from the electrodes, a gap maintaining means for defining a minimum distance between the electrodes is provided in order to prevent a short circuit between the electrodes.

For example, in paragraph [0062], FIG. 9, FIG. 20, FIG. 24B, etc. of US Patent Application Publication No. 2005 / 0154387A1, one or more stop members 175 are disposed on the conductive seal surface 122 and the like. Member 175 preferably defines the distance between the jaws during sealing to a gap distance G, the gap distance G being from about 0.001 inch to about 0.006 inch. In addition, it is described that the stop member 175 is preferably located on either side of the knife channel 115 (however, as can be seen in FIG. The tip of the conductive sealing surface 122 is not only provided at a close position, but is remote from the knife channel 115. It is also provided).

Also, paragraph [0106] of FIG. 23 of US Patent Application Publication No. 2007 / 0078458A1 and FIG. 23 include a description similar to that of US Patent Application Publication No. 2005 / 0154387A1 described above.

Further, in paragraphs [0042], [0059], FIG. 7, etc. of US Patent Application Publication No. 2008 / 0015575A1, at least one stop member 675 where one of the jaw members is located on an inner surface such as the conductive seal surface 632 is shown. In particular, with regard to vascular sealing, it is described that the gap distance is from about 0.001 inch (about 0.03 mm) to about 0.006 inch (about 0.16 mm).

That is, in each of the above publications, it is described in common that the distance between the electrodes should be about 0.03 to 0.16 mm.

However, the distance between the electrodes should be set to determine whether appropriate tissue sealing, bonding, etc. can be performed. It depends on which one of them. On the other hand, a technique for changing the distance between the electrodes for each living tissue to be treated has also been proposed, but this is not necessarily a practical solution.

Therefore, there is a demand for a practical solution that can perform therapeutic treatment on a plurality of types of tissues without changing the distance between the electrodes for each target tissue.

The present invention has been made in view of the above circumstances, and provides a treatment instrument capable of performing treatment on a plurality of types of tissues without changing the distance between electrodes for each target tissue. It is an object.

A therapeutic treatment instrument according to one aspect of the present invention is a therapeutic treatment instrument for treating a living tissue by applying energy, and sandwiches the living tissue with a pair of opposing clamping surfaces, and can be opened and closed. And an energy output provided as at least one of the pair of sandwiching surfaces, which is provided in at least one of the pair of sandwiching portions and applies high-frequency energy to the living tissue and then applies resistance heating energy to the living tissue. And a gap for projecting from at least one of the pair of sandwiching surfaces and maintaining a distance between the pair of sandwiching surfaces facing each other when the pair of sandwiching portions are closed at a constant distance of 0.7 mm or less And a maintenance unit.

The perspective view which shows the structure of the therapeutic treatment system provided with the linear type therapeutic treatment tool in the 1st Embodiment of this invention. The longitudinal cross-sectional view which shows the clamping part of the closed state of the shaft of the treatment tool in the said 1st Embodiment. The longitudinal cross-sectional view which shows the clamping part of the open state of the shaft of the treatment tool in the said 1st Embodiment. The top view which shows the 1st clamping member of the treatment tool in the said 1st Embodiment. FIG. 5 is a cross-sectional view taken along line 5-5 of FIG. 4 of the first clamping member of the treatment instrument in the first embodiment. The perspective view which shows the back surface of the 1st high frequency electrode in which the resistance heater is provided in the said 1st Embodiment. The perspective view which shows the other structural example of the resistance heater provided in the back surface of the 1st high frequency electrode in the said 1st Embodiment. In the said 1st Embodiment, the graph which shows the experimental example of the pressure | voltage resistant performance and target achievement rate of the sealed biological tissue when energy is applied with different gaps with respect to the first tissue sample. In the said 1st Embodiment, the graph which shows the experimental example of the pressure | voltage resistant performance and target achievement rate of the sealed biological tissue when applying a different gap with respect to a 2nd tissue sample. The block diagram which shows mainly the electrical structure of the treatment system in the said 1st Embodiment. The flowchart which shows the process at the time of performing the treatment using a high frequency energy and a thermal energy to a biological tissue using the therapeutic treatment system of the said 1st Embodiment. The top view which shows the 1st clamping member of the treatment tool in the 1st modification of the said 1st Embodiment. FIG. 13 is a cross-sectional view taken along line 13-13 of FIG. 12 of the first holding member of the treatment instrument in the first modification of the first embodiment. The top view which shows the 1st clamping member of the treatment tool in the 2nd modification of the said 1st Embodiment. The top view which shows the 1st clamping member of the treatment tool in the 3rd modification of the said 1st Embodiment. FIG. 16-16 is a cross-sectional view taken along the line 16-16 of FIG. 15 of the first holding member of the treatment instrument in the third modification of the first embodiment. The top view which shows the 1st clamping member of the treatment tool in the 4th modification of the said 1st Embodiment. FIG. 18-18 is a cross-sectional view taken along the line 18-18 in FIG. 17 of the first holding member of the treatment instrument in the fourth modification of the first embodiment. The top view which shows the 1st clamping member of the treatment tool in the 5th modification of the said 1st Embodiment. The side view which shows the structure of the clamping part comprised as a seesaw type of the treatment tool in the 2nd Embodiment of this invention. The perspective view which shows the structure of the therapeutic treatment system provided with the circular type therapeutic treatment tool in the 3rd Embodiment of this invention. In the said 3rd Embodiment, the longitudinal cross-sectional view which shows the treatment instrument in the state which separated the detachment | leave side clamping part with respect to the main body side clamping part. The top view which shows the structure of the clamping surface of the main body side clamping part of a treatment instrument in the said 3rd Embodiment.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.

[First Embodiment]
FIG. 1 to FIG. 19 show a first embodiment of the present invention, and FIG. 1 is a perspective view showing a configuration of a treatment system including a linear type treatment device.

This embodiment is an embodiment in which the therapeutic treatment tool (energy treatment tool) is a linear type therapeutic treatment tool 2 for performing a treatment through, for example, the abdominal wall. However, it may be an open linear type treatment instrument that takes out a living tissue to be treated out of the body through the abdominal wall and performs treatment.

As shown in FIG. 1, the therapeutic treatment system 1 includes a therapeutic treatment instrument 2, an energy source 4, and a foot switch 6.

The treatment instrument 2 includes a handle 11, an elongated shaft 12 extending on the distal end side of the handle 11, and an openable and closable clamping portion 13 disposed on the distal end side of the shaft 12.

The handle 11 is connected to the energy source 4 having the display unit 43 via the cable 16. The energy source 4 is connected to a foot switch 6 having a pedal 6a (but not limited to a foot switch, for example, a hand switch). When the operator operates the pedal 6a of the foot switch 6, ON / OFF of energy supply from the energy source 4 to the treatment instrument 2 can be switched.

The handle 11 is formed in a shape that is easy for an operator to grip, for example, a substantially L-shape. A shaft 12 is disposed at one end of the handle 11. On the other hand, the cable 16 described above extends from the proximal end of the handle 11 that is coaxial with the shaft 12. Further, the other end side of the handle 11 is a grasping portion 11a that is held by a surgeon with a hand.

The handle 11 is provided with a clamping part opening / closing lever 14 provided so as to be rotatable so as to be arranged in parallel with the gripping part 11a. The sandwiching portion opening / closing lever 14 is connected to a proximal end portion of a later-described sheath 34 (see FIGS. 2 and 3) constituting the outer shell of the shaft 12 at a substantially central portion of the handle 11. When the sandwiching section opening / closing lever 14 is operated so as to approach or separate from the gripping section 11 a of the handle 11, the sheath 34 moves along the axial direction of the shaft 12. When the sheath 34 moves to the distal end side in the axial direction of the shaft 12, the sandwiching portion 13 is closed, and when the sheath 34 moves to the proximal end side in the axial direction, the sandwiching portion 13 is opened.

The handle 11 is further provided with a cutter drive lever 15 provided so as to be rotatable so as to be juxtaposed with the holding portion opening / closing lever 14. When the cutter driving lever 15 is operated so as to approach or separate from the grip portion 11a of the handle 11, a cutter 36 (see FIGS. 2 and 3), which will be described later, moves along the axial direction of the shaft 12. In addition, the biological tissue is cut.

FIG. 2 is a longitudinal sectional view showing the shaft of the treatment instrument and the sandwiched portion in the closed state, and FIG. 3 is a longitudinal sectional view showing the shaft of the treatment instrument and the sandwiched portion in the opened state.

As shown in FIGS. 2 and 3, the shaft 12 includes, for example, a cylindrical body 33 having a substantially cylindrical shape, and a thin-cylindrical sheath 34 that is slidable with respect to the outer periphery of the cylindrical body 33. I have. The cylindrical body 33 is fixed to the handle 11 (see FIG. 1) at its proximal end. The sheath 34 is slidable along the axial direction of the cylindrical body 33.

A groove 33 a along the axial direction of the cylinder 33 is formed on the outer periphery of the cylinder 33. A first high-frequency electrode energization line 21e and a heater energization line 22a are disposed in the groove 33a. The first high-frequency electrode energization line 21e is connected to a first high-frequency electrode 21a described later, and the heater energization line 22a is connected to a resistance heater 22 described later.

The second high-frequency electrode energization line 21 f is inserted into the cylindrical body 33. The second high-frequency electrode conducting line 21f is connected to a second high-frequency electrode 21b described later.

Furthermore, inside the cylindrical body 33, for example, a drive rod 35 having a columnar shape is disposed so as to be movable along its axial direction. A thin plate-like cutter 36, which is a cutting member as a treatment auxiliary tool, is fixed to the distal end portion of the drive rod 35. Further, the base end portion of the drive rod 35 is connected to the cutter drive lever 15. Accordingly, when the cutter drive lever 15 is operated, the cutter 36 moves in the axial direction via the drive rod 35.

The cutter 36 is formed with a blade 36a for cutting the living tissue at the tip thereof. A long hole 36 b serving as an axial guide hole is formed between the distal end and the proximal end of the cutter 36. A movement restricting pin 37 is engaged with the long hole 36b. The movement restricting pin 37 is fixed to the cylindrical body 33 so as to extend in a direction orthogonal to the axial direction of the shaft 12. For this reason, the cutter 36 linearly moves in the axial direction while maintaining the state in which the long hole 36 b is engaged with the movement restriction pin 37. When the cutter 36 moves in the distal direction, it enters into

cutter guide grooves

23a, 24a of a first clamping member 23 and a second clamping member 24 described later.

It should be noted that the movement restricting pins 37 are locked to control the movement of the cutter 36 in at least three places, one end, the other end, and between the one end and the other end, of the long hole 36b of the cutter 36. A locking portion 36c is formed.

As shown in FIGS. 2 and 3, the sandwiching portion 13 has a shape that forms a longitudinal direction from the proximal end portion toward the distal end portion, and includes a first sandwiching member 23 that is also called a first jaw, and a second jaw. A second clamping member 24, also called a second clamping member 24, is connected to the base end side via a rotation shaft, and at least one (second clamping member 24 as shown in FIG. 3 in this embodiment) rotates around the rotation shaft. It is configured to be movable.

It is preferable that the first clamping member 23 and the second clamping member 24 have insulating properties as a whole except for electric circuit portions such as electrodes, heaters, and energization lines. Therefore, the first clamping member main body 25 constituting the first clamping member 23 and the second clamping member main body 26 constituting the second clamping member 24 are formed of an insulating material.

A base portion 25 a that is a base end portion of the first holding member main body 25 is fixed to a distal end portion of the cylindrical body 33 of the shaft 12. On the other hand, a base portion 26 a that is a base end portion of the second holding member main body 26 is attached to the distal end portion of the cylindrical body 33 of the shaft 12 by a support pin 31 disposed in a direction orthogonal to the axial direction of the shaft 12. It is rotatably supported. Therefore, the second clamping member 24 can be opened and closed with respect to the first clamping member 23 by rotating around the axis of the support pin 31. Further, the second clamping member 24 is urged in an opening direction with respect to the first clamping member 23 by an elastic member 32 such as a leaf spring.

When the first sandwiching member body 25 and the second sandwiching member body 26 are closed, the first sandwiching member body has a smooth curved surface such as a substantially circular shape or a substantially elliptical shape when the two are sandwiched. 25 and the outer surface of the 2nd clamping member main body 26 are formed. The outer surfaces of the

base portions

25a and 26a are similarly formed in a smooth circular shape, but are configured to have a slightly smaller diameter than the distal end side, so that

steps

25c and 26c are formed between the distal ends. ing. More specifically, the diameters of the

base portions

25a and 26a when the first holding member main body 25 and the second holding member main body 26 are closed are substantially the same as or slightly smaller than the inner diameter of the sheath 34 (the cylindrical body 33 of the shaft 12). The diameters of the first and second holding

member bodies

25 and 26 are larger than the inner diameter of the sheath 34. Therefore, when the sheath 34 is slid with respect to the cylindrical body 33, the sheath 34 can advance to a position covering the

base portions

25a and 26a, but the progress is stopped at the positions of the

steps

25c and 26c.

With this configuration, when the sheath 34 is slid toward the distal end against the urging force of the elastic member 32, the first clamping member 23 and the second clamping member 24 are closed as shown in FIG. On the other hand, when the sheath 34 is slid to the proximal end side from the state where the distal end portion of the sheath 34 covers the

base portions

25a and 26a, the first clamping member 23 is moved by the urging force of the elastic member 32 as shown in FIG. On the other hand, the 2nd clamping member 24 opens.

A cutter guide groove 23a is formed in the first holding member main body 25, and a cutter guide groove 24a is formed in the second holding member main body 26 so as to face each other when the holding portion 13 is closed. It is formed to be a direction along the direction. These

cutter guide grooves

23a and 24a are structural portions for guiding the cutter 36 described above into the clamping portion 13 along the central axis in the longitudinal direction from the proximal end portion toward the distal end portion. In the closed state, the cutter 36 advances and retreats in a hole formed by combining the two

cutter guide grooves

23a and 24a. Both of these two

cutter guide grooves

23a and 24a are terminated at the leading end side inside the clamping portion 13, that is, are not communicated from the leading end side to the outside. Accordingly, the cutter 36 stops inside the clamping unit 13 even when it is most advanced in the distal direction.

FIG. 4 is a plan view showing a first holding member of the treatment instrument, and FIG. 5 is a cross-sectional view of the first holding member of the treatment tool in FIG.

As shown in FIGS. 2 to 5, a holding surface 25b is formed on the first holding member body 25, and a first output as an energy output unit for applying high-frequency energy to the living tissue is applied to the holding surface 25b. A high frequency electrode 21a is provided. As shown in FIGS. 2 and 3, a holding surface 26b is formed on the second clamping member main body 26, and the holding surface 26b serves as an energy output unit for applying high-frequency energy to the living tissue. Two high-frequency electrodes 21b are provided. The first high-frequency electrode 21a and the second high-frequency electrode 21b are members made of a conductive material.

As shown in FIG. 4, the first high-frequency electrode 21 a is formed in a flat plate shape that fits on the inner peripheral side with respect to the edge of the holding surface 25 b, and extends along the axial direction of the first clamping member 23. Since the cutter guide groove 23a is formed so as to terminate in the clamping portion 13 as described above, it is a substantially U-shaped flat plate, for example.

The second high-frequency electrode 21b is also formed in such a manner that the cutter guide groove 24a terminates in the clamping portion 13 in substantially the same manner as the first high-frequency electrode 21a shown in FIG. It is a flat plate.

A gap maintaining portion 27 formed of an insulating material (non-conductive material) at the end of the front end of the cutter guide groove 23a of the first holding member main body 25 is formed into a cutter guide groove of the second holding member main body 26. A gap maintaining portion 28 made of an insulating material is provided at the end on the front end side in 24a. These

gap maintaining portions

27 and 28 are erected in a state of being embedded in the

cutter guide grooves

23a and 24a, respectively, and a pair of clamping surfaces (the energy application surface of the first high-frequency electrode 21a and the second high-frequency electrode 21b). Projecting from the energy application surface). Specific examples of the insulating material constituting the

gap maintaining portions

27 and 28 include a metal subjected to non-conductive treatment, a non-conductive ceramic, or a non-conductive resin. The

gap maintaining portions

27 and 28 are formed of at least one material. Therefore, the

gap maintaining units

27 and 28 do not contribute to the application of high-frequency energy, which is electrical energy, even if they contact the living tissue.

Further, a hole 27h for inserting such a gap maintaining portion 27 is provided in the first high-frequency electrode 21a as shown in FIG. 6 (or FIG. 7 according to a modified example) described later. Similarly, although not shown, the second high-frequency electrode 21b is also provided with a hole through which the gap maintaining portion 28 is inserted.

In the illustrated example, the

gap maintaining portions

27 and 28 are described as having a larger diameter than the groove width of the

cutter guide grooves

23a and 24a, but of course, they may be configured to have the same width as the groove width. Absent. However, the

gap maintaining portions

27 and 28 are provided with a pair of opposing clamping surfaces (the energy application surface of the first high-frequency electrode 21a and the energy of the second high-frequency electrode 21b as shown in FIGS. 2, 3, 5, etc.). When the distance between the application surfaces) is to be maintained at a constant distance at one place, it is preferable that the diameter is large because stability and reliability can be improved.

The

gap maintaining portions

27 and 28 are arranged so that the energy application surface of the first high-frequency electrode 21a and the first application surface of the first high-frequency electrode 21a become a pair of opposing clamping surfaces when the first clamping member 23 and the second clamping member 24 are closed. This is for maintaining the distance between the electrode surfaces of the second high-frequency electrode 21b and the energy application surface at a constant distance δ (see FIG. 2). That is, in the example shown in FIGS. 2 to 5, the

gap maintaining portions

27 and 28 are formed as bosses (however, of course, the shape is not limited to the boss shape). And when the 1st clamping member 23 and the 2nd clamping member 24 close, the head 27a of the gap maintenance part 27 and the head 28a of the gap maintenance part 28 contact | abut, and the above-mentioned fixed distance (delta) is maintained. The That is, the total height of the protruding height of the gap maintaining portion 27 from the energy application surface of the first high-frequency electrode 21a and the protruding height of the gap maintaining portion 28 from the energy application surface of the second high-frequency electrode 21b is The constant distance δ is configured. Here, as will be described later with reference to FIGS. 8 and 9, the constant distance δ is a distance of 0.7 mm or less, and for example, a distance of 0.2 mm or more. And at the time of this close, a pair of opposing clamping surfaces are parallel, for example.

However, the constant distance δ is maintained when nothing is sandwiched between the pair of sandwiching surfaces or when a thickness structure or the like having a distance δ or less is sandwiched. Therefore, when considering the case where a tissue thicker than the distance δ is sandwiched, the

gap maintaining portions

27 and 28 are for maintaining the distance between the pair of clamping surfaces at a certain distance δ or more. I can say that.

As described above, the

gap maintaining portions

27 and 28 are formed of an insulating material and do not contribute to the application of high-frequency energy. Therefore, the

gap maintaining portions

27 and 28 are halfway on the energy application surfaces of the first high-frequency electrode 21a and the second high-frequency electrode 21b. If it is formed at the position (position that is not the periphery), a discontinuous island-like discontinuous portion is generated on the energy application surface to the living tissue. When such discontinuous island-like discontinuous parts are connected to the islands in the structure where the discontinuous parts are connected (inside the edges) or are connected in a line, they become weak parts of the connected structure, resulting in pressure resistance. (See also FIG. 8, FIG. 9, etc.).

On the other hand, according to the configuration of the present embodiment as described above, that is, the configuration in which the

gap maintaining portions

27 and 28 are embedded in the distal ends of the

cutter guide grooves

23a and 24a, the energy application surface has continuity. Maintained. Therefore, when the living tissues are joined, high pressure resistance can be maintained without causing a fragile portion.

Furthermore, as shown in FIGS. 2, 3, and 6, a resistance heater 22 is disposed on the back side of the first high-frequency electrode 21a as an energy output section that generates resistance heating energy. FIG. 6 is a perspective view showing the back surface of the first high-frequency electrode provided with a resistance heater.

In the example shown in FIGS. 2, 3, and 6, the resistance heater 22 has a chip shape, and is discretely formed on the back surface of the first high-frequency electrode 21a along the substantially U-shape of the first high-frequency electrode 21a. It is arranged. However, the first high-frequency electrode 21a and the resistance heater 22 are insulated. When the resistance heater 22 generates heat, the heat is conducted to the first high-frequency electrode 21a, and the heat is transferred to the living tissue via the first high-frequency electrode 21a.

In such a configuration, in order to transmit the heat generated from the resistance heater 22 to the first high-frequency electrode 21a with a small heat loss, the first holding member body 25 has only an insulating property as described above. In addition, it is preferable to cover the outer periphery of the resistance heater 22 with heat insulation.

FIG. 7 is a perspective view showing another configuration example of the resistance heater provided on the back surface of the first high-frequency electrode 21a.

7 is an energy output portion formed in a U shape along the shape of the first high-frequency electrode 21a having a substantially U shape. Here, the U-shaped outer peripheral edge of the resistance heater 22A is an inner side that does not protrude from the U-shaped outer peripheral edge of the first high-frequency electrode 21a. The peripheral edge is the inner side that does not protrude from the U-shaped inner peripheral edge of the first high-frequency electrode 21a.

Such a resistance heater 22A is, for example, a screen-printed thick film heating resistor or a thin film heating resistor formed by physical vapor deposition (PVD) on the back surface of the first high-frequency electrode 21a, It is formed as a disposed nichrome wire or other heating element.

As shown in FIGS. 2 and 3, the first and second high-

frequency electrodes

21a and 21b are connected to the first and

second electrode connectors

21c and 21d provided at the base end portions, respectively. It is connected to the second high-frequency

electrode energization lines

21 e and 21 f and further connected to the energy source 4 via the cable 16. The resistance heater 22 is connected to the heater energization line 22 a and further connected to the energy source 4 via the cable 16.

Thus, the mutually opposing surfaces of the first high-frequency electrode 21a and the second high-frequency electrode 21b are holding surfaces for holding and holding the living tissue, and the high-frequency energy and the resistance heating energy are transferred to the living tissue. It is also an energy application surface to be applied.

Next, with reference to FIG. 8 and FIG. 9, an experimental example when the gap (constant distance δ) between the pair of clamping surfaces described above is varied will be described. FIG. 8 is a graph showing an experimental example of the pressure resistance performance and target achievement rate of the sealed biological tissue when energy is applied with different gaps with respect to the first tissue sample, and FIG. 9 shows the second tissue. It is a graph which shows the experimental example of the pressure | voltage resistant performance and target achievement rate of the sealed biological tissue when energy is applied with different gaps to the sample. Here, the first tissue sample and the second tissue sample are samples obtained from different parts of the living tissue.

8 and 9 show the results when high frequency energy (HF) and resistance heating energy (Heat) are applied to the left half, and the results when only high frequency energy (HF) is applied to the right half, The horizontal axis indicates the gap size in mm.

8 and 9, the average pressure resistance of the sealed tissue is shown in arbitrary units (AU: Arbitrary Unit) as the vertical axis, and the target pressure resistance is achieved with a certain probability. The target achievement rate indicating whether or not it has been done is shown in percent units (%).

When the first tissue sample is treated by applying only high frequency energy (HF) as shown in the right half of FIG. 8, it is sealed regardless of the gap between 0.1 mm and 1 mm. The average pressure resistance of the stopped tissue is about 1.2A. U. To about 1.5 A. U. There is little dependence on the gap.

In addition, the target achievement rate also increases when the gap becomes larger or smaller than 66% when the gap is 0.5 mm, and when the gap is 0.3 mm and 1 mm. Both are 82%. However, it is recognized that a high target achievement rate of 80% or more can be obtained when the gap is 0.3 mm or less.

On the other hand, when the treatment is performed by applying only high frequency energy (HF) to the second tissue sample as shown in the right half of FIG. 9, if the gap is 0.5 mm or less, sealing is performed. The average pressure resistance of the stopped structure is about 1.3A. U or more, but when the gap is 0.7 mm, the average pressure resistance is about 0.8 A.m. U. When the gap is further 1 mm, it is about 0.1 A.m. U. It will drop to the extent and extremely.

Also, the target achievement rate is 99% when the gap is 0.1 mm, the maximum value, and gradually decreases when the gap becomes larger, and extremely decreases to 11% when the gap is 1 mm.

Therefore, when FIG. 8 and FIG. 9 are taken together, if an attempt is made to achieve a target achievement rate of 80% or more when a treatment is performed on a plurality of types of tissues by applying only high frequency energy (HF), a gap will be obtained. It can be seen that it is preferable to set the thickness to 0.3 mm or less.

Next, when the first tissue sample was treated by applying high frequency energy (HF) and resistance heating energy (Heat) as shown in the left half of FIG. 8, the gap was 0.7 mm. In the following cases, the average pressure resistance of the sealed structure is 2A. U. The above is obtained, but when the gap is 1 mm, the average breakdown voltage is about 1.2 A.m. U. Decrease to a degree.

Also, the target achievement rate is less than 90% (89%) or more if the gap is 0.7 mm or less, but when the gap is 1 mm, the target achievement rate is drastically reduced to 59%.

On the other hand, when the treatment is performed by applying high frequency energy (HF) and resistance heating energy (Heat) to the second tissue sample as shown in the left half of FIG. 9, the gap is 0.7 mm or less. If so, the average pressure resistance of the sealed tissue is about 2.5A. U. The above is obtained, but when the gap is 1 mm, the average breakdown voltage is about 0.6 A.m. U. Decrease to a large extent.

Also, the target achievement rate is 99% or more when the gap is 0.7 mm or less, but when the gap is 1 mm, it is extremely reduced to 65%.

Therefore, when FIG. 8 and FIG. 9 are combined, when a treatment is performed on a plurality of types of tissues by applying high frequency energy (HF) and resistance heating energy (Heat), the gap should be 0.7 mm or less. It can be seen that a high target achievement rate of about 90% or more can be obtained.

Thus, when the energy to be treated is only high-frequency energy (HF), the above-mentioned fixed distance δ is preferably set to 0.3 mm or less, and the energy to be treated is high-frequency energy (HF) and resistance heating energy (Heat). In some cases, it can be said that the above-mentioned fixed distance δ is preferably 0.7 mm or less.

FIG. 10 is a block diagram mainly showing an electrical configuration of the treatment system.

As shown in FIG. 10, the energy source 4 includes a control unit 40, a high frequency energy output circuit (HF energy output circuit) 41, a resistance heater driving circuit 42, and a display unit 43. A high-frequency energy output circuit 41, a resistance heater driving circuit 42, and a display unit 43 are connected to the control unit 40. Further, the foot switch 6 is also connected to the control unit 40.

When the foot switch 6 is switched ON, the control unit 40 controls the high frequency energy output circuit (HF energy output circuit) 41 and the resistance heater driving circuit 42 so that the treatment by the treatment instrument 2 is performed. When 6 is switched to OFF, the high-frequency energy output circuit (HF energy output circuit) 41 and the resistance heater driving circuit 42 are controlled so that the treatment is stopped. At the time of this therapeutic treatment, the control unit 40 further controls the display unit 43 to display various displays indicating the progress of the treatment. In addition, the display unit 43 has a display function when setting the control unit 40 and also has an operation input function related to the setting operation. As described above, the control unit 40 controls the therapeutic treatment system 1 in an integrated manner.

The high frequency energy output circuit 41 is electrically connected to the high frequency electrode 21 (first high frequency electrode 21a and second high frequency electrode 21b) of the treatment instrument 2 and outputs high frequency energy to the high frequency electrode 21. is there. The high frequency energy output circuit 41 is further configured to detect the impedance of the circuit based on a signal flowing through the high frequency energy output circuit 41. Since the impedance relating to the treatment system 1 itself is known, the impedance Z of the living tissue sandwiched between the first high-frequency electrode 21a and the second high-frequency electrode 21b based on the detected impedance of the circuit. Can be calculated. Therefore, the high frequency energy output circuit 41 has a sensor function for measuring the impedance Z of the living tissue.

The resistance heater driving circuit 42 is electrically connected to the resistance heater 22 of the treatment instrument 2 and outputs electrical energy for resistance heating to the resistance heater 22. The resistance heater driving circuit 42 further has a sensor function for measuring the heat generation temperature T of the resistance heater 22.

Next, the operation of the treatment system 1 of the present embodiment will be described with reference to FIG. FIG. 11 is a flowchart showing processing when a treatment using high-frequency energy and thermal energy is performed on a living tissue using the treatment system. The action of the therapeutic treatment system 1 also shows a therapeutic treatment method for treating a living tissue by applying energy.

In performing the treatment, the surgeon turns on the power of the treatment system 1 and then operates the display unit 43 of the energy source 4 to output an output condition of the treatment system 1, for example, the set power Pset of the high frequency energy output. [W] (specifically, about 20 [W] to 80 [W]), set temperature Tset [° C.] of thermal energy output (specifically about 100 [° C.] to 300 [° C.]), The threshold values Z1 and Z2 of the impedance Z (here, Z1 <Z2, where Z1 is about 1000 [Ω] and Z2 is about 2000 [Ω]) are set in advance.

When the series of settings is completed, the control unit 40 of the energy source 4 enters a state of waiting for the foot switch 6 to be turned on (step S11).

Then, with the clamping part 13 closed as shown in FIG. 2, for example, the clamping part 13 and the shaft 12 of the treatment instrument 2 are inserted into the abdominal cavity through the abdominal wall. Then, the surgeon confronts the sandwiching portion 13 of the treatment instrument 2 with the biological tissue to be treated.

Next, the surgeon operates the clamping part opening / closing lever 14 of the handle 11 to move the sheath 34 to the proximal end side of the shaft 12 in order to hold the living tissue to be treated by the clamping part 13. When the sheath 34 is moved to a predetermined position, the urging force of the elastic member 32 cannot be locked by the sheath 34, and the second holding member 24 is moved relative to the first holding member 23 as shown in FIG. open.

Then, the surgeon places the biological tissue to be treated between the first high-frequency electrode 21a of the first holding member 23 and the second high-frequency electrode 21b of the second holding member 24. In this state, the surgeon operates the holding portion opening / closing lever 14 of the handle 11 to move the sheath 34 toward the distal end side of the shaft 12. When the sheath 34 moves toward the distal end, the sheath 34 closes between the

base portions

25a and 26a against the urging force of the elastic member 32, that is, as shown in FIG. 23, the second clamping member 24 is closed. In this way, the biological tissue to be treated is gripped between the first clamping member 23 and the second clamping member 24.

That is, the living tissue to be treated is sandwiched between both the energy application surface of the first high-frequency electrode 21a and the energy application surface of the second high-frequency electrode 21b, which are sandwiching surfaces. become.

In this way, the operator operates the foot switch 6 to ON while holding the living tissue. Then, the control unit 40 determines that the foot switch 6 is turned ON in step S11 described above, and controls the high frequency energy output circuit 41 to apply the high frequency energy of the set power Pset [W] described above to the high frequency electrode 21. Is output (step S12). As a result, high frequency energy is applied to the living tissue sandwiched between the first high frequency electrode 21a and the second high frequency electrode 21b. Then, Joule heat is generated in the living tissue, the cell membrane is destroyed, the intracellular components and the extracellular components are made uniform, and cauterization is performed. As a result, the impedance Z of the living tissue increases.

The impedance Z of the grasped living tissue at the time of high frequency energy output is measured by the high frequency energy output circuit 41. The impedance Z when the treatment is started is, for example, about 60 [Ω]. As the high-frequency current flows through the living tissue and the living tissue is cauterized, the cells of the living tissue are dehydrated and the value of the impedance Z increases. In addition, as the biological tissue is dehydrated, the thickness of the biological tissue held between the first clamping member 23 and the second clamping member 24 is reduced. Thus, the distance between the energy application surface of the first high-frequency electrode 21a and the energy application surface of the second high-frequency electrode 21b (the distance between the pair of sandwiching surfaces) is maintained at a certain distance δ or more. Is done.

The control unit 40 monitors the impedance Z detected by the high-frequency energy output circuit 41, and determines whether the impedance Z is equal to or higher than a preset threshold value Z1 (step S13). The threshold value Z1 is set to a value that is known in advance when the rate of increase in the value of the impedance Z slows down (that is, a value that is known in advance that dehydration of the cells of the living tissue has progressed to some extent). When the control unit 40 determines that the impedance Z is smaller than the threshold value Z1, the control unit 40 continuously performs the process of step S12, that is, the process of applying high-frequency energy to the living tissue.

When the control unit 40 determines that the impedance Z is equal to or greater than the threshold value Z1, the control unit 40 controls the resistance heater driving circuit 42 so that the resistance heater 22 has a preset temperature Tset [° C.]. Electric power is supplied to the heater 22 (step S14). At this time, the control unit 40 controls the power supplied to the resistance heater 22 while monitoring the heat generation temperature T of the resistance heater 22 measured by the resistance heater driving circuit 42. Thereby, the grasped living tissue is solidified by heat from the surface side of the living tissue in close contact with the first high-frequency electrode 21a toward the inside.

As is well known, water has a large specific heat, and the temperature rises slowly even if heat is applied in a state before dehydrating the living tissue. On the other hand, in this embodiment, since resistance heating energy is applied after dehydrating the living tissue to a certain level, the temperature of the living tissue can be efficiently increased with respect to the amount of heat applied. .

Further, even after the living tissue is solidified by heat, the

gap maintaining portions

27 and 28 maintain the distance between the pair of sandwiching surfaces at a certain distance δ or more, as described above.

The control unit 40 continues to monitor the impedance Z detected by the high-frequency energy output circuit 41, and determines whether the impedance Z is equal to or higher than a preset threshold value Z2 (step S15). The threshold value Z2 is set to a value that determines that the coagulation of the living tissue has been completed. Then, when the control unit 40 determines that the impedance Z is smaller than the threshold value Z2, the control unit 40 continues the process of step S14.

On the other hand, when determining that the impedance Z is equal to or higher than the threshold value Z2, the control unit 40 generates a buzzer sound, for example, stops the high-frequency energy output circuit 41 from outputting high-frequency energy, and heats the resistance heater driving circuit 42. The output of energy is stopped (step S16).

At this time, the living tissue is joined so as to maintain high pressure resistance performance without causing discontinuous portions due to the

gap maintaining portions

27 and 28 as described above.

Thereafter, the operator operates the cutter drive lever 15 with the pair of clamping surfaces holding the biological tissue to be treated in order to excise the biological tissue to be treated, and moves the cutter 36 in the distal direction. Move.

Thereby, the solidified living tissue sandwiched between the pair of sandwiching surfaces is gradually cut by the blade 36a from the proximal end side toward the distal end side. When the movement restricting pin 37 contacts the proximal end side of the long hole 36b, the movement of the cutter 36 toward the distal end side stops. At this time, the blade 36 a of the cutter 36 reaches the vicinity of the

gap maintaining portions

27 and 28. That is, the living tissue with which the

gap maintaining portions

27 and 28 are in contact is located on the distal end side where the cutter 36 reaches, that is, on the distal end side of the portion to be cut of the living tissue, so that the joint portion of the living tissue is affected. There is no effect.

Thereafter, when the cut biological tissue is detached from the clamping unit 13, the operator operates the clamping unit opening / closing lever 14 to open the clamping unit 13. As a result, the grasped biological tissue is detached from the clamping unit 13.

If there are more living tissues to be treated, the above-described processing is performed in the same manner. Thus, when the treatment for all the biological tissues to be treated is completed, the treatment of the biological tissue using the therapeutic treatment system 1 is completed.

According to such a first embodiment, the following effects can be obtained.

Coagulation treatment is performed by applying resistance heating energy to the living tissue from the resistance heater 54 after applying high frequency energy to the living tissue to break the cell membrane and increasing the thermal conductivity of the living tissue. For this reason, resistance heating energy can be applied in an efficient state.

Also, when the electrodes are short-circuited, high-frequency energy cannot be input through the living tissue. On the other hand, according to the present embodiment, since the

gap maintaining portions

27 and 28 are provided, there is no short circuit between the electrodes, so that it is possible to reliably prevent a reduction in treatment effect.

In addition, the

gap maintaining portions

27 and 28 are set so that the distance δ between the energy application surfaces serving as the pair of sandwiching surfaces is a constant distance of 0.7 mm or less (or 0.2 mm or more) as described above. Since it comprises, a multiple types of biological tissue can be reliably sealed with high pressure | voltage resistance performance and a high target achievement rate.

Furthermore, the state of the living tissue grasped by the holding unit 13 (impedance Z of the living tissue, temperature T of the resistance heater 22 that applies heat to the living tissue, etc.) is monitored, and based on a preset threshold value Z1. Switching time from high-frequency energy input to heat energy input is automatically determined and switched, and the energy input end time is automatically determined based on a preset threshold value Z2. For this purpose, treatment variations due to the operator's senses are prevented, and treatments are performed efficiently and stably according to the state of tissue degeneration (cauterized or coagulated) to make the tissue uniform (stable ).

In this way, it is possible to efficiently perform treatment on living tissue with less energy input loss as much as possible without bothering the surgeon, shortening the treatment time, and greatly reducing the burden on the patient. Can do.

In addition, since the

gap maintaining portions

27 and 28 are embedded in the

cutter guide grooves

23a and 24a so that they are not located in the form of islands in the energy application plane, they are vulnerable to the sealed living tissue. Does not occur, that is, the pressure resistance performance is not deteriorated.

Next, with reference to FIG. 12 to FIG. 19, some modified examples of the gap maintaining part provided in the holding part will be described. In the following, for the sake of simplicity, the gap maintaining portion provided on the first clamping member 23 side will be described. However, the same gap maintaining portion is also provided on the second clamping member 24 side.

First, a first modification will be described with reference to FIGS. FIG. 12 is a plan view showing the first holding member of the treatment instrument in the first modification, and FIG. 13 is a cross-sectional view of the first holding member of the treatment tool in the first modification shown in FIG. FIG. 13 is a sectional view.

In the first modification, in addition to the gap maintaining portion 27 as described above, a gap maintaining portion 29 is further provided.

First, the gap maintaining portion 27 shown in FIG. 12 has substantially the same configuration as the gap maintaining portion 27 shown in FIG. 4 and the like, but is slightly different in that it has the same width as the cutter guide groove 23a. ing.

Further, a plurality of pairs of gap maintaining portions 29 are provided on both inner side surfaces of the cutter guide groove 23a at regular intervals along the axial direction. Here, the pair of gap maintaining portions 29 are provided so as to face each other with the same axial position. As shown in FIG. 13, one gap maintaining portion 29 is erected in a state of being embedded in the cutter guide groove 23a, and protrudes from the energy application surface of the first high-frequency electrode 21a that is the clamping surface. Yes. The gap maintaining portion 29 also has a distance δ between the energy application surfaces as a pair of sandwiching surfaces of 0 as described above in cooperation with the gap maintaining portion similarly provided on the second sandwiching member 24 side. It is for making it a fixed distance of 7 mm or less.

Thus, by providing the gap maintaining portion 27 on the distal end side and the plurality of gap maintaining portions 29 along the cutter guide groove 23a, the distance between the pair of sandwiching surfaces when the sandwiching portion is closed is further stabilized. Can be kept constant, and the holding surface can be kept parallel without being inclined.

In addition, since both

gap maintaining portions

27 and 29 are embedded in the cutter guide groove 23a, the untreated island-like irregularity is not formed on the living tissue to be treated by the first and second high-

frequency electrodes

21a and 21b. A continuous portion is not generated, and a treatment that maintains high pressure resistance can be performed.

Subsequently, a second modification will be described with reference to FIG. FIG. 14 is a plan view showing the first holding member of the treatment instrument in the second modification.

This second modification is such that, in the first modification described above, the gap maintaining portions 29 provided at regular intervals are alternately arranged with different axial positions.

That is, the gap maintaining portions 29 arranged on one inner side surface of the cutter guide groove 23a and the gap maintaining portions 29 arranged on the other inner side surface are alternately arranged with the axial position shifted.

Even with such a second modification, it is possible to achieve substantially the same effect as the first modification described above.

Furthermore, a third modification will be described with reference to FIG. 15 and FIG. FIG. 15 is a plan view showing the first holding member of the treatment instrument in the third modification, and FIG. 16 is a plan view of the first holding member of the treatment tool in the third modification shown in FIG. It is 16 sectional drawing.

This third modification is provided with a single gap maintaining portion 27A, but the configuration is different from that of the first modification.

That is, as shown in FIG. 16, the gap maintaining portion 27A is formed on the energy application surface of the first high-frequency electrode 21a, which is the clamping surface, so as to protrude from the energy application surface. This gap maintaining portion 27A also has a distance δ between the energy application surfaces as a pair of sandwiching surfaces of 0 as described above in cooperation with the gap maintaining portion similarly provided on the second sandwiching member 24 side. It is for making it a fixed distance of 7 mm or less.

And this gap maintenance part 27A is provided adjacent to the front end side end of the cutter guide groove 23a so as to be flush with each other. That is, the base end side end surface of the gap maintaining portion 27A and the end surface of the cutter guide groove 23a are configured to be the same end surface.

Even with such a configuration, an untreated island-like discontinuous portion is not generated in the living tissue treated by the first and second high-

frequency electrodes

21a and 21b, and a treatment that maintains high pressure resistance is performed. Is possible.

Next, a fourth modification will be described with reference to FIGS. 17 and 18. FIG. 17 is a plan view showing the first holding member of the treatment instrument in the fourth modification, and FIG. 18 is a cross-sectional view of the first holding member of the treatment tool in the fourth modification shown in FIG. FIG. 18 is a sectional view.

In the fourth modification example, a gap maintaining portion 29A is further provided in addition to the gap maintaining portion 27A as described above.

A plurality of gap maintaining portions 29A are provided at regular intervals along the axial direction so as to protrude from the energy application surface on the energy application surface of the first high-frequency electrode 21a, which is the clamping surface, on both sides of the cutter guide groove 23a. Pairs are provided. This gap maintaining portion 29A also has a distance δ between the energy application surfaces as a pair of clamping surfaces of 0 as described above in cooperation with the gap maintaining portion similarly provided on the second clamping member 24 side. It is for making it a fixed distance of 7 mm or less.

Here, the pair of gap maintaining portions 29A are provided so as to face each other with the same axial position. As shown in FIG. 18, one gap maintaining portion 29A is provided adjacent to the inner side surface of the cutter guide groove 23a so as to be flush with each other. That is, the end surface on the cutter guide groove 23a side of the gap maintaining portion 29A and the end surface on the first high-frequency electrode 21a side of the cutter guide groove 23a are configured to be the same surface.

Thus, by providing the gap maintaining portion 27A on the distal end side and the plurality of gap maintaining portions 29A along the cutter guide groove 23a, the distance between the pair of sandwiching surfaces when the sandwiching portion is closed is further stabilized. Can be kept constant, and the holding surface can be kept parallel without being inclined.

In addition, since any

gap maintaining portions

27A and 29A are provided adjacent to each other so as to face the cutter guide groove 23a, the living body tissue to be treated by the first and second high-

frequency electrodes

21a and 21b is provided. In this way, a treatment that maintains a high pressure resistance performance can be performed without causing an untreated island-like discontinuous portion.

And a 5th modification is demonstrated with reference to FIG. FIG. 14 is a plan view showing the first clamping member of the treatment instrument in the fifth modification.

In the fifth modification example, in the fourth modification example described above, the gap maintaining portions 29A provided at regular intervals are alternately arranged with different positions in the axial direction.

That is, the gap maintaining portions 29A arranged on one side surface of the cutter guide groove 23a and the gap maintaining portions 29A arranged on the other side surface are alternately arranged with the axial position shifted.

The fifth modification example as described above can achieve substantially the same effect as the fourth modification example described above.

In addition, in the example in which the plurality of gap maintaining portions are provided, in the above description, there are only a plurality of gap maintaining portions embedded in the cutter guide groove, or the cutter guide groove so as to be flush with the cutter guide groove. Although there are only a plurality of gap maintaining portions adjacent to each other, it is needless to say that these may be combined.

Further, in the first embodiment and each modification described above, the gap maintaining portion is provided in both of the pair of sandwiching portions, but of course the present invention is not limited to this, and a configuration in which only one of them is provided may be employed. Absent.

And in the modification mentioned above, although the example which added the gap maintenance part 29 to the gap maintenance part 27, the example which added the gap maintenance part 29A to the gap maintenance part 27A, etc. were shown, the gap maintenance part was shown. When 29 or the gap maintaining part 29A is provided, the gap maintaining part 27 or the gap maintaining part 27A is not necessarily provided, but may not be provided.

[Second Embodiment]
FIG. 20 shows a second embodiment of the present invention, and is a side view showing a configuration of a clamping portion configured as a seesaw type of a treatment instrument. In the second embodiment, the same parts as those in the first embodiment described above are denoted by the same reference numerals, description thereof is omitted, and only different points will be mainly described.

The present embodiment is an embodiment in which the treatment instrument (energy treatment instrument) is a linear treatment instrument 2 and a seesaw type jaw is further employed.

The clamping part 13 arrange | positioned at the front-end | tip side of the shaft 12 is provided with the 1st clamping member 23 and the 2nd clamping member 24. As shown in FIG.

The first clamping member 23 includes a first clamping member main body 25, and the first clamping member main body 25 is provided integrally with the shaft 12 so as to extend in the axial direction of the shaft 12. .

The second clamping member 24 includes a proximal-side clamping unit pivot body 26A and a distal-side second clamping member main body 26B, and is based on the clamping unit pivot body 26A. The end side is pivotally supported with respect to the shaft 12 and the first holding member 23 via the rotation shaft 52. The second sandwiching member main body 26B is pivotally supported via the swing shaft 51 with respect to the sandwiching portion pivot support body 26A. That is, the second clamping member 24 is a second clamping member main body 26B pivotally supported by the swing shaft 51 as a seesaw mechanism that brings the clamping surface closer to the clamping surface of the first clamping member 23 in parallel. It has the structure which has.

A cam hole 53 is formed on the proximal end side of the sandwiching portion pivot 26A with respect to the rotation shaft 52. On the other hand, an axial cam hole 54 is formed in the shaft body 12 a of the shaft 12. And the cam hole 53 and the cam hole 54 are comprised so that it may mutually cross | intersect, and the cam pin 55 is engaged so that it may penetrate in an intersection position. The cam pin 55 is fixed to the distal end side of the opening / closing drive shaft 56. On the other hand, the proximal end side of the opening / closing drive shaft 56 is mechanically connected to the clamping portion opening / closing lever 14 (see FIG. 1 and the like).

By adopting such a cam mechanism, when the holding portion opening / closing lever 14 (see FIG. 1 or the like) is operated and the opening / closing drive shaft 56 is moved to the distal end side, the second holding member with respect to the first holding member 23. 24 opens. On the other hand, when the opening / closing drive shaft 56 is moved to the proximal end side by operating the holding portion opening / closing lever 14 (see FIG. 1 and the like), the second holding member 24 is closed with respect to the first holding member 23.

The first high-frequency electrode 21a is provided on the holding surface 25b of the first holding member main body 25, and the second high-frequency electrode 21b is provided on the holding surface 26Bb of the second holding member main body 26B. The energy application surfaces of the first high-frequency electrode 21a and the second high-frequency electrode 21b facing each other are sandwiching surfaces.

In the present embodiment, the gap maintaining part is provided only on one of the pair of sandwiching parts. That is, a gap maintaining portion 27B formed in a boss shape with an insulating material is provided so as to protrude from the surface of the first high-frequency electrode 21a facing the second high-frequency electrode 21b. The gap maintaining portion 27B is in contact with the surface of the second high-frequency electrode 21b facing the first high-frequency electrode 21a, and the distance between the electrode surfaces of the first high-frequency electrode 21a and the second high-frequency electrode 21b is constant. This is for maintaining the distance δ (see FIG. 2). Therefore, the protrusion height of the gap maintaining portion 27B from the energy application surface of the first high-frequency electrode 21a is a constant distance δ. As described above, the constant distance δ is configured to be a distance of 0.7 mm or less, for example.

Also in this embodiment, the cutter 36 is provided so as to be movable along the axial direction of the shaft 12 as in the first embodiment described above, and the first clamping member main body 25 and the second clamping member are provided. The member main body 26B is provided with

cutter guide grooves

23a and 24a similar to those described above. The gap maintaining portion 27B is erected in a state of being embedded at the distal end side end in the cutter guide groove 23a, for example, as shown in FIGS.

However, also in this embodiment, various modifications similar to those in the first embodiment described above can be applied. The seesaw-type jaw as employed in the present embodiment can realize parallelism between a pair of clamping surfaces in a wider opening range of the clamping part (that is, not only in a state where the clamping part is closed but also in a closed state). Even if the state is somewhat opened, it is possible to maintain the parallelism of the pair of clamping surfaces). Therefore, in the configuration of the present embodiment, it is preferable to employ a configuration in which gap maintaining portions are provided at a plurality of locations as shown in FIGS. 12, 14, 17, and 19, for example.

According to the second embodiment as described above, substantially the same effect as that of the first embodiment described above can be obtained, and the treatment instrument includes the seesaw type jaw, so that the living body to be treated can be obtained. The pair of clamping surfaces can be easily made parallel without depending on the thickness of the tissue. In such a highly parallel treatment instrument, the distance between the pair of clamping surfaces can be more reliably maintained at the constant distance δ.

In the first and second embodiments described above, as a linear type treatment instrument, one of the pair of clamping members is fixed to the shaft, and the other clamping member is configured to be rotatable with respect to the shaft. Although the example which was made was demonstrated, of course, it does not matter even if both clamping members are comprised so that rotation with respect to the shaft is possible.

[Third Embodiment]
FIG. 21 to FIG. 23 show a third embodiment of the present invention, FIG. 21 is a perspective view showing the configuration of a therapeutic treatment system including a circular type therapeutic treatment instrument, and FIG. FIG. 23 is a longitudinal sectional view showing the treatment instrument in a state in which the detachable side clamping part is spaced apart from FIG. 23, and FIG.

In the third embodiment, the same parts as those in the first and second embodiments described above are denoted by the same reference numerals, description thereof will be omitted, and only different points will be mainly described.

This embodiment is an embodiment in which the therapeutic treatment tool (energy treatment tool) is a circular type bipolar therapeutic treatment tool 102 for performing treatment through, for example, the abdominal wall or outside the abdominal wall.

As shown in FIG. 21, the treatment system 101 includes a treatment instrument 102, an energy source 4 having a display unit 43, and a foot switch 6 having a pedal 6a.

The treatment instrument 102 includes a handle 111, a shaft 112, and an openable / closable clamping portion 113. The handle 111 is connected to the energy source 4 via the cable 16. The holding part 113 includes a main body side holding part 123 and a detachable side holding part 124 configured to be able to perform separation / proximity with respect to the main body side holding part 123.

The handle 111 is provided with a clamping portion opening / closing knob 114 which is a rotatable operation member and a cutter driving lever 115 which is a swingable operation member. For example, when the clamping part opening / closing knob 114 is rotated clockwise with respect to the handle 111, the detaching side clamping part 124 of the clamping part 113 is separated from the main body side clamping part 123 while maintaining the parallelism of the pair of clamping surfaces. When rotated counterclockwise, the detachable side clamping portion 124 comes close to the main body side clamping portion 123 while maintaining the parallelism of the pair of clamping surfaces.

The shaft 112 is formed in an elongated cylindrical shape. In the example shown in FIG. 21, the shaft 112 is appropriately curved in consideration of the insertion property into the living tissue. Of course, the shaft 112 may be formed in a straight line.

The clamping part 113 is arrange | positioned at the front-end | tip of the shaft 112. As shown in FIG. The sandwiching portion 113 is a first sandwiching member formed at the tip of the shaft 112 and is also referred to as a first jaw, and a second sandwiching member that can be attached to and detached from the body sandwiching portion 123. A detachable side holding portion 124 also called a second jaw is provided.

As shown in FIGS. 22 and 23, the main body side holding portion 123 includes a cylindrical body 126, a frame 133, and a current-carrying pipe 131. The cylindrical body 126 and the frame 133 have insulating properties. The cylindrical body 126 is connected to the tip of the shaft 112. The frame 133 is disposed on the inner peripheral side of the cylindrical body 126 while being fixed to the cylindrical body 126.

The frame 133 has a cylindrical shape with a central axis portion serving as a communication hole. An energization pipe 131 is disposed in the communication hole in the central axis portion of the frame 133 so as to be movable within a predetermined range along the central axis of the frame 133. The energization pipe 131 is formed in a cylindrical shape from a conductive material, and is connected to the energy source 4 via the shaft 112, the handle 111, and the cable 16. The movement of the energizing pipe 131 along the central axis of the frame 133 is performed by the rotation of the holding portion opening / closing knob 114.

A cutter guide groove (space) 123 a is formed between the cylindrical body 126 and the frame 133. A cylindrical cutter 136 is disposed in the cutter guide groove 123a. The base end portion of the cutter 136 is fixed to the outer peripheral surface of the distal end portion of the cutter pusher 135 disposed inside the shaft 112. The base end portion of the cutter pusher 135 is connected to the cutter driving lever 115 of the handle 111 via a mechanism (not shown). For this reason, when the cutter driving lever 115 of the handle 111 is operated, the cutter 136 moves in the direction along the central axis of the frame 133 via the cutter pusher 135 and moves forward and backward.

A first high-frequency electrode 121a and a resistance heater 122 are disposed on the outer peripheral side of the cutter guide groove 123a at the tip of the cylindrical body 126 as an energy output unit.

The first high-frequency electrode 121a is for outputting high-frequency energy, and is a member formed in an annular shape with a conductive material. The energy application surface of the first high-frequency electrode 121a is a sandwiching surface and is, for example, flush with the holding surface 126b of the cylindrical body 126. The tip of the first high-frequency electrode conducting line 121e is fixed to the first high-frequency electrode 121a. The first high-frequency electrode energization line 121 e is connected to the energy source 4 via the main body side clamping portion 123, the shaft 112, the handle 111, and the cable 16.

Also, a plurality of resistance heaters 122 are provided, and are discretely arranged on the circumference of the back surface of the first high-frequency electrode 121a at appropriate regular intervals. The tip of the heater energization line 122a is fixed to the resistance heater 122. The heater energization line 122 a is connected to the energy source 4 via the main body side clamping portion 123, the shaft 112, the handle 111, and the cable 16.

An annular gap maintaining portion 129 is formed on the inner peripheral side of the first high-frequency electrode 121a facing the cutter guide groove 123a from the energy application surface of the first high-frequency electrode 121a toward the separation-side clamping portion 124. It protrudes toward you. The inner peripheral surface of the gap maintaining portion 129 is flush with the outer peripheral surface of the cutter guide groove 123a. The gap maintaining unit 129 contacts an energy application surface of a second high-frequency electrode 121b, which will be described later, and sets the distance between the electrode surfaces of the first high-frequency electrode 121a and the second high-frequency electrode 121b to a certain distance δ (FIG. 22). For reference). Accordingly, the protrusion height of the gap maintaining portion 27B from the energy application surface of the first high-frequency electrode 121a is a constant distance δ. As described above, the constant distance δ is configured to be a distance of 0.7 mm or less (or 0.2 mm or more), for example.

On the other hand, the detachable side clamping portion 124 includes an energizing shaft 132 having an axial shape, and a head portion 125 provided on the distal end side of the energizing shaft 132.

The energizing shaft 132 is formed in a cylindrical shape from a conductive material, the distal end portion is fixed to the head portion 125, the proximal end portion is formed in a tapered shape, and is attached to and detached from the energizing pipe 131 through irregularities. Engaged as possible. The energizing shaft 132 is insulated by coating or the like on the outer surface except for the portion that comes into contact with the energizing pipe 131.

In the head portion 125, a second high-frequency electrode 121b formed in an annular shape with a conductive material is disposed so as to face the first high-frequency electrode 121a of the body-side clamping portion 123. The energy application surface of the second high-frequency electrode 121b is a clamping surface and is, for example, flush with the holding surface 125b of the separation-side clamping unit 124.

One end of the second energization line 121f is fixed to the second high-frequency electrode 121b. The other end of the second energization line 121f is electrically connected to the energization shaft 132. For this reason, when the energization shaft 132 is inserted into the energization pipe 131, the second high-frequency electrode 121b and the energization pipe 131 are electrically connected. Accordingly, the second high-frequency electrode 121b is connected to the energy source 4 via the second energization line 121f, the energization shaft 132, the energization pipe 131, the shaft 112, the handle 111, and the cable 16.

An annular cutter receiving portion 127 for receiving the blade of the cutter 136 is formed on the inner peripheral side of the second high-frequency electrode 121b disposed in the head portion 125. The receiving surface of the cutter receiving portion 127 is on the inner side of the head portion 125 (the side away from the main body side holding portion 123) than the holding surface 125b of the detachable side holding portion 124.

Next, the operation of the treatment system 101 according to this embodiment will be described.

With the main body side clamping portion 123 closed with respect to the detachable side clamping portion 124, the clamping portion 113 and the shaft 112 of the treatment instrument 102 are inserted into the abdominal cavity through the abdominal wall, for example. And the clamping part 113 is made to oppose the biological tissue which wants to treat.

Next, the operator operates the holding portion opening / closing knob 114 of the handle 111 to rotate it clockwise, for example. Then, the detachable side clamping part 124 moves in the distal direction while maintaining the parallelism of the pair of clamping surfaces, and the detachable side clamping part 124 is detached from the main body side clamping part 123.

Then, the living tissue to be treated is disposed between the main body side holding portion 123 and the detachable side holding portion 124 in the opened state. In this state, the surgeon operates the holding portion opening / closing knob 114 of the handle 111 and rotates it counterclockwise, for example. As a result, the detachable side clamping part 124 approaches the main body side clamping part 123 side while maintaining the parallelism of the pair of clamping surfaces, and the living tissue to be treated is separated from the first high-frequency electrode 121a of the main body side clamping part 123 and the detachable side. It is held between the second high-frequency electrode 121b of the holding part 124.

At this time, since the gap maintaining portion 129 is provided, the distance between the electrode surfaces of the first high-frequency electrode 121a and the second high-frequency electrode 121b is maintained at a certain distance δ or more.

Thereafter, the biological tissue is heated and dehydrated by Joule heat by the application of high-frequency energy, and the biological tissue is coagulated by the application of resistance heating energy, as in the first embodiment described above.

When the application of energy to the living tissue is completed, the living tissue is denatured continuously (substantially annular or arcuate).

Even at this time, the distance between the electrode surfaces of the first high-frequency electrode 121a and the second high-frequency electrode 121b is maintained at a certain distance δ or more by the action of the gap maintaining portion 129.

Subsequently, the operator operates the cutter driving lever 115 to move the cutter 136 in the distal direction. Thereby, the solidified living tissue is cut into a circular shape or an arc shape. When detaching the cut biological tissue from the clamping unit 113, the operator operates the clamping unit opening / closing knob 114 to open the clamping unit 113. As a result, the grasped living tissue is detached from the clamping unit 113.

In the above description, only one gap maintaining portion 129 having an annular shape is provided. However, for example, a plurality of gap maintaining portions having a boss shape may be discretely arranged along the cutter guide groove 123a at regular intervals. .

Further, in the above description, the gap maintaining portion 129 is provided adjacent to the cutter guide groove 123a so as to be flush with the cutter guide groove 123a. However, the gap maintaining portion 129 may be provided so as to be embedded in the cutter guide groove 123a instead. .

In addition, although the gap maintaining portion is provided only in the main body side holding portion, it may be provided only in the detachable side holding portion, or may be provided in both the main body side holding portion and the detaching side holding portion. This is the same as the embodiment.

According to the third embodiment as described above, even in the circular type treatment instrument, it is possible to achieve substantially the same effect as in the first and second embodiments described above, and the fragile portion in the sealed biological tissue. Without causing any problems, it is possible to reliably seal a plurality of types of living tissues with high pressure resistance and high target achievement rate.

Furthermore, if a circular type treatment instrument is used, it becomes possible to seal living tissues in a substantially annular shape.

In each of the above-described embodiments, the configuration example in which the energy output unit is provided on both of the pair of sandwiching surfaces (that is, the bipolar treatment instrument) is described as the treatment instrument. It is also possible to have a configuration (that is, a monopolar type treatment instrument) including only an energy output unit.

It should be noted that the present invention is not limited to the above-described embodiment as it is, and can be embodied by modifying the constituent elements without departing from the scope of the invention in the implementation stage. In addition, various aspects of the invention can be formed by appropriately combining a plurality of components disclosed in the embodiment. For example, you may delete some components from all the components shown by embodiment. Furthermore, the constituent elements over different embodiments may be appropriately combined. Thus, it goes without saying that various modifications and applications are possible without departing from the spirit of the invention.

This application is filed on the basis of USSN 61 / 724,706, filed in the United States on November 9, 2012, as a basis for claiming priority. Shall be cited in

Claims

In a therapeutic treatment device for treating a living tissue by applying energy,
The biological tissue is clamped by a pair of opposing clamping surfaces, and a pair of clamping parts that can be opened and closed,
Energy provided on at least one of the pair of sandwiching portions and having an energy application surface for applying high-frequency energy to the living tissue and then applying resistance heating energy to the living tissue as at least one of the pair of sandwiching surfaces An output section;
Gap maintenance for projecting from at least one of the pair of clamping surfaces and maintaining a distance between the pair of opposing clamping surfaces at a constant distance of 0.7 mm or less when the pair of clamping parts are closed. And
A therapeutic treatment instrument comprising:
The gap maintaining portion is configured to maintain a distance between the pair of sandwiching surfaces facing each other at one or both of the pair of sandwiching surfaces in order to maintain a constant distance of 0.7 mm or less at one or more locations including a predetermined location. The treatment instrument according to claim 1, wherein the treatment instrument is provided at a position corresponding to more than one place.
A cutting member capable of advancing and retreating in the clamping part, and for cutting the living tissue clamped in the clamping part;
A guide groove provided along an end surface of the energy application surface, guiding the cutting member so as to advance and retreat in the sandwiching portion, and a leading end terminating in the sandwiching portion;
Further comprising
The gap maintaining portion is adjacent to the guide groove so as to be flush with the tip end in the guide groove with the position corresponding to the tip end of the guide groove as the predetermined location, or the guide The treatment instrument according to claim 2, wherein the treatment instrument is embedded at a distal end side end in the groove.
The gap maintaining portion is further provided at one or both of the plurality of locations of the pair of clamping surfaces in order to maintain the distance between the pair of clamping surfaces facing each other at a constant distance of 0.7 mm or less at the plurality of locations. The treatment instrument according to claim 3, wherein the treatment instrument is provided at a corresponding position.
The treatment instrument according to claim 4, wherein the plurality of gap maintaining portions are provided at regular intervals along the guide groove.
The therapeutic treatment device according to claim 1, wherein the energy output unit includes a high-frequency electrode that generates the high-frequency energy and a resistance heater that generates the resistance heating energy.
The therapeutic treatment according to claim 1, wherein the gap maintaining portion is formed of at least one material of a metal subjected to non-conductive treatment, non-conductive ceramics, or non-conductive resin. Ingredients.
The pair of sandwiching portions has a shape that forms a longitudinal direction from a base end portion that opens and closes around a rotation axis to a distal end portion, and when the pair of sandwiching portions is closed, the pair of sandwiching surfaces are parallel to each other. In order to form the energy output unit, the energy output unit is rotatably held in the longitudinal axis direction with respect to at least one of the pair of sandwiching units,
The treatment instrument according to claim 1, further comprising a seesaw mechanism for maintaining the pair of clamping surfaces in parallel even when the pair of clamping parts is opened.
The treatment instrument according to claim 1, wherein the pair of sandwiching portions are configured to be opened and closed by separating or approaching the pair of sandwiching surfaces while maintaining parallelism. .