WO2014102850A1

WO2014102850A1 - Bipolar electrosurgical device

Info

Publication number: WO2014102850A1
Application number: PCT/JP2012/008238
Authority: WO
Inventors: 繁大森
Original assignee: テルモ株式会社
Priority date: 2012-12-25
Filing date: 2012-12-25
Publication date: 2014-07-03

Abstract

The present invention reduces incomplete fusion of living tissue by a bipolar electrosurgical device that applies high-frequency energy to living tissue. The present invention is a bipolar electrosurgical device (100) that comprises a first gripping section (121) and a second gripping section (111) for gripping living tissue and that serves to fuse living tissue that is gripped by the first gripping section (121) and the second gripping section (111). The bipolar electrosurgical device (100) is provided with: a first electrode (113) that is arranged along a gripping surface (112) of the first gripping section (111), said first gripping surface (112) comprising contiguous convex sections and concave sections; a second electrode (123) that is arranged along the gripping surface (122) of the second gripping section (121), said gripping surface (122) meshing with the gripping surface (112) when the first gripping section (111) and the second gripping section (121) are in a closed state; and a suturing unit that sutures living tissue by passing a suture needle having suture thread attached thereto through living tissue that is gripped along the gripping surface (112) by the first gripping section (111) and the second gripping section (121).

Description

Bipolar electrosurgical device

The present invention relates to a bipolar electrosurgical device for applying high-frequency energy to a living tissue such as a digestive tract.

2. Description of the Related Art Conventionally, an automatic suturing device using a stapler is known as a device for suture-separating living tissue. The apparatus is suitable mainly for cutting off a part of the digestive tract such as the stomach or intestine, and has an advantage that a treatment quality is short and a suture quality that does not depend on the skill of the operator can be obtained. However, there are disadvantages in that many staplers remain in the body after the operation and it is difficult to reprocess the sutured portion.

On the other hand, a vessel sealer, which is a bipolar type fusion device, is known as a device for healing and separating living tissues. The device is suitable mainly for fusion and separation of blood vessels and the like, and has an advantage that nothing remains in the body because fusion is performed by applying high-frequency energy.

Against this background, the applicant of the present application is considering the application of a bipolar fusion device as an alternative to an automatic suturing device using a stapler for the digestive tract such as the stomach and intestine.

US Pat. No. 8,147,489

However, gastrointestinal tracts such as the stomach and intestine are larger than those of blood vessels, etc., and the possibility of causing unsatisfactory fusion is higher than that of blood vessels. It is assumed that it will be indispensable to carefully observe.

For this reason, when high-frequency energy is applied to the digestive tract such as the stomach and intestine to perform fusion separation, it is necessary to suppress the occurrence of fusion failure and reduce the burden of the prognostic observation process as much as possible. desirable.

The present invention has been made in view of the above problems, and an object of the present invention is to reduce the failure of fusion of living tissue in a bipolar electrosurgical device that applies high-frequency energy to living tissue.

In order to achieve the above object, a bipolar electrosurgical device according to the present invention comprises the following arrangement. That is,
A bipolar electrosurgical apparatus having a first gripping part and a second gripping part for gripping a living tissue, and healing the living tissue gripped by the first gripping part and the second gripping part There,
In the first gripping portion having a gripping surface in which a convex portion and a concave portion are continuous, a first electrode disposed along the gripping surface;
In the second gripping part having a gripping surface that meshes with the gripping surface of the first gripping part in a state where the first gripping part and the second gripping part are closed, the second gripping part A second electrode disposed along the gripping surface of
The first grasping portion and the second grasping portion allow a suture needle attached with a suture thread to penetrate a biological tissue grasped along a grasping surface in which the convex portion and the concave portion are continuous. And a suture part for suturing the living tissue.

According to the present invention, in a bipolar electrosurgical device that applies high-frequency energy to a living tissue, it is possible to reduce the failure of fusion of the living tissue.

Other features and advantages of the present invention will become apparent from the following description with reference to the accompanying drawings. In the accompanying drawings, the same or similar components are denoted by the same reference numerals.

The accompanying drawings are included in the specification, constitute a part thereof, show an embodiment of the present invention, and are used to explain the principle of the present invention together with the description.
FIG. 1 is a diagram showing an external configuration of a bipolar electrosurgical apparatus 100 according to the first embodiment of the present invention. FIG. 2 is a side view showing an internal configuration of the shaft portion 110 of the bipolar electrosurgical device 100. FIG. 3 is a perspective view showing a detailed configuration of the distal end portion of the shaft portion 110. FIG. 4 is a plan view showing a detailed configuration of the distal end portion of the shaft portion 110. FIG. 5 is a side view showing an internal configuration of the shaft portion 120 of the bipolar electrosurgical device 100. FIG. 6 is a plan view showing the internal configuration of the distal end portion of the shaft portion 120. FIG. 7 is a view for explaining the cutting operation of the suture needle. FIG. 8 is a view showing a structure of a suture thread. FIG. 9 is an enlarged view of the tip portions of the shaft portion 110 and the shaft portion 120. FIG. 10 is a diagram showing an external configuration of a bipolar electrosurgical apparatus 1000 according to the second embodiment of the present invention. FIG. 11 is a side view showing the internal configuration of the bipolar electrosurgical apparatus 1000.

Hereinafter, embodiments of the present invention will be described in detail with reference to the accompanying drawings. The embodiment described below is a preferred specific example of the present invention, and thus various technically preferable limitations are given. However, the scope of the present invention is particularly limited in the following description. Unless otherwise stated, the present invention is not limited to these embodiments.

[First Embodiment]
<1. External appearance of bipolar electrosurgical device>
FIG. 1 is a diagram showing an external configuration of a bipolar electrosurgical apparatus 100 according to the first embodiment of the present invention. As shown in FIG. 1, the bipolar electrosurgical device 100 has a scissors-like shape in which the grip portion 111 and the grip portion 121 open and close when the shaft portion 110 and the shaft portion 120 rotate around the fulcrum 130. 1a shows a state in which the gripping part 111 and the gripping part 121 are opened, and 1b shows a state in which the gripping part 111 and the gripping part 121 are closed.

As shown to 1a of FIG. 1, the holding part 111 is distribute | arranged to the front end side of the shaft part 110, and has the waveform holding surface 112 where a convex part and a recessed part continue. On the surface of the gripping surface 112, a corrugated electrode 113 is laid along the gripping surface 112. Note that the gripping surface 112 is formed so as to mesh with the corrugated gripping surface 122 of the gripping part 121 in a state where the gripping part 121 is closed (that is, in a state of gripping a living tissue). Accordingly, the corrugated electrode 113 laid along the gripping surface 112 and the corrugated electrode 123 facing the electrode 113 and laid along the gripping surface 122 were gripped at each position. Energization through the living tissue is performed, and the living tissue is fused.

The knob 114 applies a driving force for moving a suture needle and a blade (separation part) not shown in a straight line. Specifically, by rotating the knob 114 clockwise, a suture needle and a blade (not shown) move to the distal end side of the shaft portion 110, and by rotating the knob 114 counterclockwise, The illustrated suture needle and blade are configured to move to the rear end side (details will be described later).

A finger ring portion 115 for inserting the operator's finger is arranged on the rear end side of the shaft portion 110. Further, a cable 116 connected to a generator that supplies a high-frequency voltage to be applied to the electrode 113 is disposed.

Similarly, a grip portion 121 having a corrugated grip surface 122 in which a convex portion and a concave portion are continuous is disposed on the distal end side of the shaft portion 120, and the surface of the grip surface 122 extends along the grip surface 122. A corrugated electrode 123 is laid on the surface. A finger ring portion 124 and a cable 125 are arranged on the rear end side.

As shown in 1b of FIG. 1, in a state where the gripping portion 111 and the gripping portion 121 are closed, the gripping surface 112 of the gripping portion 111 and the gripping surface 122 of the gripping portion 121 mesh with each other. The distance between the electrodes is substantially constant at each position between the grip surface 122 and the grip surface 122. Note that it is desirable that a slight gap be provided between the gripping surface 112 and the gripping surface 122 even when the gripping portion 111 and the gripping portion 121 are completely closed so that the electrode 113 and the electrode 123 do not short-circuit.

<2. Internal Configuration of Shaft Part 110>
Next, the internal configuration of the shaft portion 110 will be described. FIG. 2 is a side view showing an internal configuration of the shaft portion 110.

Referring to FIG. 2, reference numeral 211 denotes a blade support, which holds the blade 212 at the tip. The blade support column 211 extends from the rod 213 and moves linearly on the roller 219 together with the rod 213.

214 is a hollow needle portion made of a hollow member, and a suture thread 215 is arranged inside. A suture needle 216 is attached to the distal end of the suture thread 215. The hollow needle portion 214 is also extended from the rod 213 and operates linearly together with the rod 213. That is, the suture thread 215 disposed inside the hollow needle section 214 and the suture needle 216 attached to the distal end of the suture thread 215 linearly operate integrally with the hollow needle section 214 as a suture section.

A rack gear 220 is provided on the surface of the rod 213 and meshes with a pinion gear 217 that rotates as the knob 114 rotates. As a result, when the knob 114 is rotated clockwise, the pinion gear 217 is rotated clockwise, and the rack gear 220 is moved in the distal direction of the shaft portion 110. When the knob 114 rotates counterclockwise, the pinion gear 217 rotates counterclockwise, and the rack gear 220 moves toward the rear end of the shaft portion 110.

Note that a cable 218 is connected to the electrode 113 and extends outside the shaft portion 110 as a cable 116. As a result, a high frequency voltage can be applied to the electrode 113 via the

cables

116 and 218 from a generator (not shown).

<3. Detailed Configuration of Tip of Shaft 110>
Next, the detailed structure of the front-end | tip part of the shaft part 110 is demonstrated. FIG. 3 is a perspective view showing a detailed configuration of the distal end portion of the shaft portion 110. As shown in FIG. 3, a groove portion 301 and a notch 302 for moving the blade 212 in the distal direction are provided in the central region of the grip portion 111 (note that the grip portion 121 of the opposed shaft portion 120 has Are also provided with similar grooves and notches).

Further, in the central region of each of the grip portions 111 divided into two with the groove portion 301 in between, there are

groove portions

311 and 321 for moving the suture needles 216 and 216 ′ and the

hollow needle portions

214 and 214 ′ in the distal direction. Is provided.

Two hollow needle portions 214 are arranged substantially in parallel with the blade 212 interposed therebetween, and the two

hollow needle portions

214, 214 ′, and two

hollow needle portions

214, 214 ′ are moved by moving the rod 213 toward the distal end of the shaft portion 110. The suture needles 216 and 216 ′ move in the

grooves

311 and 321 respectively. One blade 212 moves in the groove 301 and the notch 302.

FIG. 4 is a plan view showing a detailed configuration of the tip portion of the shaft portion 110. As shown in FIG. 4, the rod 213 can move to the front of the grip portion 111, and the suture needles 216, 216 ′ are moved from the tip of the grip portion 111 when the rod 213 has moved to the front of the grip portion 111. The lengths of the

hollow needle portions

214 and 214 ′ are defined so as to protrude. On the other hand, the length of the blade support column 211 is defined so that the blade 212 reaches the tip of the grip portion 111 in a state where the rod 213 has moved to the front of the grip portion 111.

<4. Internal configuration of shaft portion 120>
Next, the internal configuration of the shaft portion 120 will be described. FIG. 5 is a side view showing the internal configuration of the shaft portion 120. As shown in FIG. 5, the suture needles 216 and 216 ′ attached to the tips of the

hollow needle portions

214 and 214 ′ are separated from the suture thread 215 at the tip region of the gripping surface 122 where the electrode 123 is laid. A cutter unit (cutting unit) 502 and a storage unit 501 for storing the suture needles 216 and 216 ′ separated from the suture thread 215 are provided.

Further, a wire 503 stretched between

rollers

511, 512, and 513 is connected between the cutter unit 502 and the operation end 505, and the operation end 505 is operated in the direction of the arrow 504. Thus, the cutter unit 502 can cut the suture thread 215.

A high-frequency voltage transmitted from a generator (not shown) is applied to the corrugated electrode 123 laid on the gripping surface 122 via the cable 125 and the cable 521.

FIG. 6 is a plan view for explaining the internal configuration of the grip portion 121 at the tip of the shaft portion 120. As illustrated in FIG. 6, two

wires

503 and 503 ′ are stretched between the cutter unit 502 and the operation end 505. The

rollers

511 and 512 and the roller 511 in the grip unit 121 are respectively stretched. Supported by '512'.

By operating the operation end 505 in the direction of the arrow 504, the cutter unit 502 moves from the non-cutting position to the cutting position (position indicated by a dotted line) in the storage unit 501, thereby cutting the suture thread 215. The

<5. Cutting operation of suture needle>
Next, the cutting operation of the suture needle 216 will be described. FIG. 7 is a view for explaining the cutting operation of the suture needle 216.

7a in FIG. 7 shows a state in which the rod 213 moves in the distal end direction with the gripping portion 111 and the gripping portion 121 closed. As described above, the length of the hollow needle portion 214 is defined so that the suture needle 216 protrudes from the tip of the grip portion 111 when the rod 213 moves to the front of the grip portion 111. Therefore, as shown in FIG. 7 b, the suture needle 216 disposed at the distal end of the hollow needle portion 214 is disposed at the distal end of the grasping portion 121 in a state where the rod 213 has moved to the front of the grasping portion 111. It is accommodated in the accommodating part 501.

In the housing part 501, flexible

needle holding parts

701 and 702 are attached. The

needle holding portions

701 and 702 are configured to expand outward when the suture needle 216 is inserted, and not to expand when the inserted suture needle 216 is pulled out.

7c in FIG. 7 shows a state in which the suture needle 216 disposed at the tip of the hollow needle portion 214 is housed in the housing portion 501 and held by the

needle holding portions

701 and 702. In this state, when the rod 213 is moved in the rear end direction, the hollow needle portion 214 connected to the rod 213 is also moved in the rear end direction together with the rod 213.

When the operation end 505 is operated after the movement in the rear end direction of the rod 213 is completed, the cutter unit 502 moves to the cutting position. 7d of FIG. 7 has shown the mode that the cutter part 502 moved to the cutting position. As shown in 7d of FIG. 7, when the cutter unit 502 moves to the cutting position, the suture thread 215 is cut.

At this time, since the suture needle 216 is held by the

needle holding portions

701 and 702, the state of being held in the storage portion 501 can be maintained.

As described above, by performing the operations shown in FIGS. 7a to 7d, it is possible to place the suture in the living tissue while accommodating the suture needle 216.

<6. Suture structure>
FIG. 8 is a view showing a structure of a suture thread. As shown in FIG. 8, a plurality of cut portions 811 and cut portions 812 are formed on the peripheral surface of the suture thread 215. The cut portion 811 is a locking portion for the living tissue so that the suture 215 does not come out of the living tissue even when a tensile force in the direction of the arrow 802 is applied to the suture 215. Function as.

Similarly, the notch portion 812 prevents the suture thread 215 from coming out of the living tissue even when a tensile force in the direction of the arrow 801 is applied to the suture thread 215. It functions as a locking part.

In this way, by applying a special process to the peripheral surface, the suture 215 is simply left in the living tissue, and the suture 215 comes out of the living tissue without performing a ball stop or the like. It becomes possible to avoid the situation.

As described with reference to FIG. 7, when the suture 215 is placed in the living tissue, the

cut portions

811 and 812 are inserted in order to penetrate the living tissue while being placed inside the hollow needle portion 214. However, it does not come into contact with the living tissue, and the

cut portions

811 and 812 do not prevent the suture needle 216 from moving in the living tissue.

<7. Examples of fusion separation of living tissue and placement of sutures>
Next, an example of a process in which a part of the digestive tract such as the stomach or intestine is fused and separated and a suture is placed will be described with reference to FIG. FIG. 9 is an enlarged view of the grip portion 111 at the tip of the shaft portion 110 and the grip portion 121 at the tip of the shaft portion 120, and a part of the digestive tract is disposed between the grip portion 111 and the grip portion 121. A state where a part of the digestive tract is gripped by closing the gripping part 111 and the gripping part 121 is shown.

As shown in FIG. 9, a part of the digestive tract 900 is arranged between the gripping part 111 and the gripping part 121 and is held by the gripping part 111 and the gripping part 121, thereby The part is pressed and deformed into a waveform with a predetermined thickness.

In this state, by applying a high-frequency voltage between the electrode 113 and the electrode 123, high-frequency energy is generated between the electrode 113 and the electrode 123, and the living tissue between both electrodes is fused.

Thereafter, by moving the rod 213 to the distal end side, the hollow needle portion 214 penetrates the living tissue deformed into a waveform, and the suture needle 216 is accommodated in the accommodating portion 501. At this time, since the blade 212 also moves to the tip side with the movement of the rod 213, the living tissue fused between the electrode 113 and the electrode 123 is sequentially separated by the blade 212. As a result, in a state where the blade 212 has reached the tip of the grip portion 111, the living tissue is separated into a portion on the back side of the paper surface and a portion on the near side of the paper surface.

Thereafter, when the hollow needle portion 214 moves to the rear end side of the shaft portion 110, the suture thread 215 is exposed and comes into contact with the living tissue. Further, the suture thread 215 is cut at the base of the suture needle 216 by the cutter unit 502, the suture needle 216 is accommodated in the accommodation part 501, and the suture thread 215 is left in the living tissue.

As described above, since the

cut portions

811 and 812 are formed in the suture thread 215, the suture thread 215 is not pulled out by being locked by the living tissue. At this time, since the living tissue through which the suture thread 215 passes is deformed into a waveform, the living tissue is wave-stitched by the suture thread 215. As a result, the living tissue that has been cut off by fusion is reinforced by the suture thread 215, and it becomes possible to reduce the failure of fusion of the living tissue.

As is clear from the above description, in the bipolar electrosurgical device 100 according to the present embodiment, a wave is sutured by the suture thread 215 in order to reduce fusion failure when part of the digestive tract such as the stomach and intestine is fused and separated. It was configured to sew and reinforce.

In particular,
-It was set as the structure which lays an electrode along the shape of the waveform of the holding surface of the holding part which hold | maintains a biological tissue.
-It was set as the structure which accommodates the suturing needle used at the time of wave sewing in an accommodating part.
A cut was formed in the peripheral surface of the suture so that the wave-sewn suture was locked to the living tissue.
In order to allow the suture with the cuts to penetrate the living tissue, the suture is arranged in the hollow needle portion and moved together with the hollow needle.
-It was set as the structure which implements wave sewing and separation in parallel by moving a braid | blade with the movement of a hollow needle.

This makes it possible to house the suture needle and reinforce and separate the fused living tissue with a suture by simply reciprocating the rod once. As a result, it has become possible to reduce the failure of fusion of living tissues.

[Second Embodiment]
In the first embodiment, the bipolar electrosurgical apparatus having the scissor shape has been described, but the present invention is not limited to this. For example, you may comprise so that opening / closing operation | movement of a holding part may be implement | achieved by operation of the handle | steering-wheel part distribute | arranged to the rear end of the shaft part. Details of this embodiment will be described below.

<1. External appearance of bipolar electrosurgical device>
FIG. 10 is a diagram showing an external configuration of a bipolar electrosurgical apparatus 1000 according to the second embodiment of the present invention. As shown in FIG. 10, in the bipolar electrosurgical apparatus 1000, the handle portion 1030 disposed at the rear end of the shaft portion 1010 rotates around the fulcrum 1031 and opens and closes, so that the grip portion 111 and the grip portion 121 are opened. Are configured to open and close. Among these, 10a shows a state where the gripping part 111 and the gripping part 121 are opened, and 10b shows a state where the gripping part 111 and the gripping part 121 are closed. In the first embodiment, the same reference numerals are assigned to the same external configurations as those of the bipolar electrosurgical apparatus 100 described with reference to FIG. 1, and the description thereof is omitted here.

As shown in 10a of FIG. 10, the grip part 121 is attached to the shaft part 1010 via a fulcrum 130 so as to be rotatable. In addition, at the connection unit 1011, one end of the transmission unit 1012 is connected.

The other end of the transmission unit 1012 is connected to the handle unit 1030 at the connection unit 1032, and moves to the rear end side with the closing operation of the handle unit 1030. Thereby, the holding part 121 rotates counterclockwise and is in a closed state (see 10b). An elastic member 1021 such as a spring is provided between the handle portion 1030 and the handle portion 1030 so that the handle portion 1030 rotates counterclockwise (that is, moves in the opening direction). It is fast.

For this reason, when the surgeon stops the closing operation with respect to the handle portion 1030, the handle portion 1030 moves in the opening direction, and accordingly, the transmission portion 1012 moves in the distal direction of the shaft portion 1010. Rotate around 130 to the right. As a result, the grip portion 121 is opened (see 10a).

Note that an electrode pole 1013 to which a cable (not shown) connected to the generator is connected is provided on the rear end side of the shaft portion 1010.

<2. Internal configuration of shaft portion 1010>
Next, the internal configuration of the shaft portion 1010 will be described. In addition, also about the internal structure of the shaft part 1010, the same reference number is attached | subjected about the internal structure similar to the internal structure of the

shaft parts

110 and 120 demonstrated using FIG.2 and FIG.5 in the said 1st Embodiment. Therefore, the description is omitted here.

11a of FIG. 11 has shown the structure of each part attached to the housing of the paper surface back | inner side among the shaft parts 1010. FIG. Except that a cable 218 for applying a high-frequency voltage to the electrode 113 is connected to the electrode pole 1013, it is the same as FIG. 2 described in the first embodiment.

11b of FIG. 11 shows the configuration of each part of the shaft part 1010 attached to the housing on the front side of the page. 11b, the corrugated electrode 123 laid on the corrugated gripping surface 122 of the gripper 121 is connected to the electrode pole 1013 via the cable 1101.

As is clear from the above description, the bipolar electrosurgical apparatus 1000 according to the present embodiment is configured to realize the opening / closing operation of the gripping portion by the operation of the handle portion arranged at the rear end of the shaft portion. As a result, it is possible to receive the same effects as those of the first embodiment.

In addition, according to such a shape, the shaft portion 1010 can be lengthened as compared with the bipolar electrosurgical device 100 having a scissor-like shape as in the first embodiment. There is an incidental effect that the operator can operate at a position away from the site.

The present invention is not limited to the above embodiment, and various changes and modifications can be made without departing from the spirit and scope of the present invention. Therefore, in order to make the scope of the present invention public, the following claims are attached.

Claims

A bipolar electrosurgical apparatus having a first gripping part and a second gripping part for gripping a living tissue, and healing the living tissue gripped by the first gripping part and the second gripping part There,
In the first gripping portion having a gripping surface in which a convex portion and a concave portion are continuous, a first electrode disposed along the gripping surface;
In the second gripping part having a gripping surface that meshes with the gripping surface of the first gripping part in a state where the first gripping part and the second gripping part are closed, the second gripping part A second electrode disposed along the gripping surface of
The first grasping portion and the second grasping portion allow a suture needle attached with a suture thread to penetrate a biological tissue grasped along a grasping surface in which the convex portion and the concave portion are continuous. Thus, a bipolar electrosurgical device comprising: a suturing portion for suturing the living tissue.
A separation part that moves with the movement of the suture part for penetrating the suture needle;
2. The separation unit according to claim 1, wherein the separation unit separates the biological tissue grasped by the first grasping unit and the second grasping unit as the suturing unit moves. Bipolar electrosurgical device.
The first grip portion is provided with a plurality of grooves.
The bipolar electrosurgical device according to claim 2, wherein the separation portion is configured to move in a groove portion provided in a central region of the first gripping portion.
The stitching portion that moves in a groove portion different from the groove portion provided in the central region of the first gripping portion is composed of two stitching portions arranged substantially in parallel.
The bipolar electrosurgical device according to claim 3, wherein the separation portion is disposed between the two suture portions.
The second gripping part further includes a housing part that houses the suture needle penetrating the living tissue,
The bipolar electrosurgical device according to claim 1, wherein the accommodating portion further includes a cutting portion that cuts the suture in order to separate the suture needle from the suture.
The bipolar electrosurgical device according to claim 1, wherein a plurality of cut portions having different cut directions are provided on a peripheral surface of the suture thread.
The suturing portion further includes a hollow member in which the suture thread is arranged and the suture needle is exposed at a tip.
As the suture part moves in the distal direction, the suture needle, the suture thread, and the hollow member penetrate the biological tissue,
The bipolar electrosurgical device according to claim 6, wherein the hollow member is pulled out from the living tissue in accordance with the movement toward the rear end of the suture portion.