JP3986127B2

JP3986127B2 - Endoscopic surgical instrument

Info

Publication number: JP3986127B2
Application number: JP21198697A
Authority: JP
Inventors: 康彦菊地; 幸治山内; 浩司飯田; 直己関野
Original assignee: Olympus Corp
Current assignee: Olympus Corp
Priority date: 1997-08-06
Filing date: 1997-08-06
Publication date: 2007-10-03
Anticipated expiration: 2017-08-06
Also published as: JPH1147150A

Description

【０００１】
【発明の属する技術分野】
この発明は生体組織を把持する把持部材及び把持した生体組織を切開する切開部を備えた内視鏡下手術器械に関する。
【０００２】
【従来の技術】
一般に、生体組織を把持する一対の把持部材を備え、各把持部材に高周波通電用の電極が配設されたバイポーラ鉗子が知られている。そして、このバイポーラ鉗子の使用時には一対の把持部材間に処置対象の生体組織を把持させた状態で、各把持部材の電極間に高周波電流を通電して把持部材間の生体組織を凝固させるようになっている。
【０００３】
この種のバイポーラ鉗子は、通常、生体組織に含まれる血管の止血、生体組織の表層の病変部、出血点の焼灼、避妊を目的とした卵管の閉塞等の多種の症例に用いられる。そして、バイポーラ鉗子が血管の止血や、卵管の閉塞を目的として用いられ、患者の処置対象の生体組織を凝固できるようになっており、また凝固した生体組織を切開することができるようになっている。
【０００４】
従来、この種の内視鏡下手術器械として、例えば米国特許第４６５５２１６号明細書、米国特許第５４４５６３８号明細書、米国特許第５４３１６７４号明細書、米国特許第５４８４４３６号明細書、米国特許第５５５８６７１号明細書、米国特許第５２６７９９８号明細書等で知られている。
【０００５】
米国特許第４６５５２１６号明細書は、開閉自在な一対の把持部材の間に枢支ピンを支点として回動自在な略Ｌ字状の切開刃が設けられ、生体組織を把持して状態で一対の把持部材間に凝固電流を流して生体組織を凝固させた後、切開刃を回動して生体組織を切開するようになっている。
【０００６】
米国特許第５４４５６３８号明細書及び米国特許第５５５８６７１号明細書は、シースの先端部から突出する一対の把持部材と、この把持部材間に進退自在な切開ナイフとを備え、手元操作部の操作によって一対の把持部材を閉じて処置対象の生体組織を把持した状態で、一対の把持部材間に凝固電流を流して生体組織を凝固させた後、切開ナイフを前進させて生体組織を切開するようになっている。
【０００７】
米国特許第５４３１６７４号明細書は、シースの先端部に固定されたアンビルと進退及び回動自在な切開刃とを備え、切開刃を閉じながら引き込み、生体組織を切開するようになっている。
【０００８】
米国特許第５４８４４３６号明細書は、シースの先端部に一対の切開刃を回動自在に設け、一対の切開刃に凝固電流を流して生体組織を凝固させた後、切開刃によって生体組織を切開するようになっている。
【０００９】
米国特許第５２６７９９８号明細書は、一対の凝固電極と移動可能な切開電極を有し、一対の凝固電極間に凝固電流を流して生体組織を凝固させた後、手元操作部の操作によって切開電極を移動させるとともに、切開電流を流して生体組織を切開するようになっている。
【００１０】
【発明が解決しようとする課題】
しかしながら、前述した米国特許第４６５５２１６号明細書は、一対の把持部材の間に切開刃が突出しているため、正常な生体組織に傷を付ける虞があり、細心の注意を払う必要があることから操作性が悪いという欠点がある。
【００１１】
米国特許第５４４５６３８号明細書及び米国特許第５５５８６７１号明細書は、一対の把持部材間に進退自在な切開ナイフを備えたものであり、切開ナイフの切れ味が劣化すると、切開ナイフを前進させて切開する際に把持した生体組織を押し出してしまうという不都合があり、切開ナイフを頻繁に交換する必要がある。また、把持部材の間に切開ナイフを進退自在に配置する複雑な構造で、洗浄性も悪いという欠点がある。
【００１２】
米国特許第５４３１６７４号明細書、米国特許第５４８４４３６号明細書及び米国特許第５２６７９９８号明細書は、生体組織を把持する機能がないため、処置対象部位を確実に切開することができない。
【００１３】
この発明は、前記事情に着目してなされたもので、その目的とするところは、体腔内に挿入したとき正常な生体組織に傷を付ける虞がなく、また切開性能を維持できる内視鏡下手術器械を提供することにある。
【００１４】
【課題を解決するための手段】
本発明の第１実施態様の内視鏡下手術器械は、互いに開閉され把持面を形成する一対の把持部材と、前記一対の把持部材に設けられている双極電極と、切開部材と、前記把持部材に設けられ前記把持面側に開口し前記把持面に対向する内壁により規定され前記切開部材の全体を収容可能な空間部と、前記切開部材を前記一対の把持部材間で前記把持部材の開閉方向に移動自在に支持し前記内壁へと付勢している弾性部材と、進退操作可能であり、進退操作されて前記弾性部材を押圧して前記開閉方向へと弾性変形させることにより前記切開部材を前記切開部材の少なくとも一部分が前記把持面を通過するように前記把持部材の開閉方向に移動可能な操作部材と、を具備することを特徴とする。
本発明の第２実施態様の内視鏡下手術器械は、互いに開閉され把持面を形成する一対の把持部材と、前記一対の把持部材に設けられている双極電極と、切開部材と、前記把持部材に設けられ前記把持面側に開口し前記把持面に対向する内壁により規定され前記切開部材の全体を収容可能な空間部と、前記切開部材を前記一対の把持部材間で前記把持部材の開閉方向に移動自在に支持し前記内壁へと付勢し、前記切開部材と共に進退操作可能な弾性操作部材と、前記内壁に設けられ、前記切開部材の進退方向に対して前記開閉方向に傾斜している斜面と、を具備し、前記切開部材は、前記弾性操作部材によって前記斜面に沿って進退されることにより前記切開部材の少なくとも一部分が前記把持面を通過可能である、ことを特徴とする。
本発明の第３実施態様の内視鏡下手術器械は、互いに開閉され把持面を形成する一対の把持部材と、前記一対の把持部材に設けられている双極電極と、切開部材と、前記把持部材に設けられ前記把持面側に開口し前記把持面に対向する内壁により規定され前記切開部材の全体を収容可能な空間部と、前記切開部材が一体的に設けられ、進退操作可能であり、先端部が前記一対の把持部材の一方の把持部材に固定され、前記切開部材を前記一方の把持部材の前記内壁へと付勢し、前記一対の把持部材の他方の把持部材に向かって湾曲するように曲がり癖が付けられ、進退操作によって弾性変形されて前記切開部材を前記切開部材の少なくとも一部分が前記把持面を通過するように前記一対の把持部材の開閉方向に移動可能な弾性操作部材と、を具備することを特徴とする。
【００１５】
そして、生体組織の凝固止血等の処置時に把持部材によって生体組織を把持した状態で把持部材間に凝固電流を流して生体組織を凝固させ、次に、切開手段を一対の把持部材で形成される把持面に移動して生体組織を切開することができるようにしたものである。
【００１６】
【発明の実施の形態】
以下、この発明の各実施の形態を図面に基づいて説明する。
【００１７】
図１〜図６は第１の実施形態を示し、図１は内視鏡下手術器械としてのバイポーラ鉗子１を示す。バイポーラ鉗子１には患者の体腔内に挿入される細長い挿入部２と、この挿入部２の先端部に配置され、体腔内で生体組織を把持、凝固するための通電可能な処置部３と、挿入部２の基端部に連結された操作部４とが設けられている。
【００１８】
挿入部２は、図４〜図６に示すように、シース５と、このシース５の内部に軸方向に進退自在に挿入されたロッド６とからなり、シース５の先端部には絶縁材料からなる係合部材７が固定され、シース５の基端部は操作部４を構成するグリップ８に固定されている。ロッド６の基端部は、図１に示すように、操作部４に設けられたロッド駆動部材９に固定されている。
【００１９】
処置部３は、電極を構成する一対の把持部材１１ａ，１１ｂと、これらの把持部材１１ａ，１１ｂを支持し、拡開させる方向に付勢する上下２本ずつの弾性部材１２ａ，１２ｂとからなり、これら弾性部材１２ａ，１２ｂの基端部がロッド６の先端部に固定されている。弾性部材１２ａ，１２ｂはばね鋼等によって形成され、先端部には略くの字状に屈曲された屈曲部１３ａ，１３ｂが形成され、表面は絶縁被膜によって被覆されている。
【００２０】
図５及び図６に示すように、把持部材１１ａ，１１ｂは閉じたときに内部に空間部１４が形成されるように断面が略コ字状の凹溝１４ａ，１４ｂが形成され、互いに対向する端縁は閉じたときに互いに噛合する鋸歯状部が形成され、生体組織Ａを確実に把持できるように形成されている。
【００２１】
さらに、図４〜図６に示すように、ロッド６にはばね鋼等によって形成されたナイフロッド１５が挿通されており、このナイフロッド１５の先端部には切開手段としての切開ナイフ１６が設けられている。さらに、ナイフロッド１５はロッド６の先端部においては下側の弾性部材１２ｂ，１２ｂの間に位置し、ロッド６の軸心より下側に位置しているが、ロッド６の先端部から延出した部分は上側の把持部材１１ａに向かって斜めに曲り癖が付けられ、先端の切開ナイフ１６は上側の把持部材１１ａの凹溝１４ａの内部に収容されている。すなわち、通常時においては、ナイフロッド１５の弾性によって切開ナイフ１６が生体組織Ａと接触しないように退避している。また、切開ナイフ１６は矩形板状体で、その下側に前後方向に延びる切刃１６ａを有する片刃ナイフであり、先端側に向かって上り勾配の斜面が形成されている。
【００２２】
さらに、ロッド６の軸心より上側には軸方向に亘って貫通孔６ａが設けられ、この貫通孔６ａにはナイフ操作ロッド１７が進退自在に挿通されている。このナイフ操作ロッド１７の先端部にはナイフロッド１５と係合する係合溝１８ａを有した操作ヘッド１８が設けられている。そして、ナイフ操作ロッド１７の前進によって操作ヘッド１８によりナイフロッド１５の弾性力に抗して押し下げ、切開ナイフ１６を把持部材１１ａの内部から下側に移動させ、把持部材１１ａ，１１ｂの把持面を通過させることができるようになっている。
【００２３】
このように構成された処置部３の把持部材１１ａ，１１ｂのロッド６、切開ナイフ１６のナイフロッド１５及びナイフ操作ロッド１７は前記挿入部３を構成するシース５に内挿され、シース５の基端部から突出して操作部４まで延長している。
【００２４】
また、図１〜図３に示すように、操作部４のグリップ８には先端部側に延出された先端側延出部８ａが設けられている。この先端側延出部８ａにはシース５の基端部に連結固定される連結リング８ｂが設けられている。さらに、先端側延出部８ａの後方には処置部３の後端部と電気、機械的に接続するための処置部ユニット接続部１９が配設されている。ここで、処置部ユニット接続部１９には処置部３のロッド６の後端部を収納する内腔と、この内腔に収納したロッド６の後端部に接続される接続手段とが設けられている。
【００２５】
また、処置部ユニット接続部１９には処置部３の把持部材１１ａ，１１ｂと電気的に接続されるガイドロッド２０を介して電極ピン２１が設けられ、この電極ピン２１は高周波ケーブル２１ａを介して高周波焼灼電源装置（図示しない）に接続されるようになっている。
【００２６】
また、グリップ８には処置部ユニット接続部１９の操作用のトリガー２２が設けられている。このトリガー２２はグリップ８の上端部に回動ピン２３を中心に回動自在に連結されている。さらに、このトリガー２２には回動支点の上方に長孔２４が形成されている。この長孔２４にはロッド駆動部材９の側面に突設された係合ピン２５が挿入されている。なお、２６は回転ノブであり、シース５内でロッド６を円周方向に回転させることにより、把持部材１１ａ，１１ｂの向きを任意に変更できるようになっている。
【００２７】
また、グリップ８の内部にはトリガー２２の下端部の手掛け部２２ａをグリップ８から離れる方向（図１において回動ピン２３を中心に時計回り方向）に付勢する付勢部材（図示しない）が配設されている。そして、トリガー２２は付勢部材のばね力によって常時グリップ８から最も離れた定位置（解放位置）で保持されている。
【００２８】
さらに、グリップ８の後端上部における側面にはナイフ操作レバー２７が設けられている。このナイフ操作レバー２７はグリップ８に対して回動ピン２８を中心に回動自在に連結されている。さらに、ナイフ操作レバー２７の回動中心より上方には長孔２９が形成され、この長孔２９には前記ナイフ操作ロッド１７の後端側面から突設された係合ピン３０が挿入されている。
【００２９】
ナイフ操作レバー２７には略Ｖ字状に配置された上下のアーム部３１，３２が設けられている。そして、一方のアーム部３１には指掛け部３３が他方のアーム３２はストッパピン３４と当接してナイフ操作レバー２７の回動範囲を規制する役目をしている。さらに、回動ピン２８にはナイフ操作レバー２７を時計回り方向に付勢する付勢部材（図示しない）が装着されている。
【００３０】
ここで、トリガー２２の手掛け部２２ａを付勢部材のばね力に抗してグリップ８側に引き込み操作することにより、ロッド駆動部材９を介してロッド６がシース５の軸方向前方へ移動する。ロッド６の前進に伴って弾性部材１２ａ，１２ｂがシース５から突出し、弾性部材１２ａ，１２ｂの弾性復元力によって拡開して把持部材１１ａ，１１ｂが開く。また、トリガー２２が解放されるとグリップ８内の付勢部材のばね力によって定位置に戻り、弾性部材１２ａ，１２ｂが弾性復元力に抗してシース５内に引き込まれ、把持部材１１ａ，１１ｂが閉じるようになっている。
【００３１】
また、ナイフ操作レバー２７の指掛け部３３に指を掛け、付勢部材の付勢力に抗してナイフ操作レバー２７を反時計回り方向に回動すると、長孔２９に挿入されている係合ピン３０を介してナイフ操作ロッド１７が前進駆動し、ナイフ操作ロッド１７の先端部の操作ヘッド１８によりナイフロッド１５の弾性力に抗して押し下げ、切開ナイフ１６を把持部材１１ａの内部から下側に移動させ、把持部材１１ａ，１１ｂの把持面を通過させることができるようになっている。
【００３２】
また、ナイフ操作レバー２７が解放されると付勢部材のばね力によって定位置に戻り、ナイフ操作ロッド１７は相対的にシース６に引き込まれてナイフロッド１５が解放されて弾性復元力により上方に移動して切開ナイフ１６が上側の把持部材１１ａの内部に収容され、アーム部３２はストッパピン３４に当接すると停止するようになっている。
【００３３】
次に、第１の実施形態の作用について説明する。
【００３４】
バイポーラ鉗子１の電極ピン２１に高周波ケーブル２１ａを接続し、バイポーラ鉗子１と高周波焼灼電源装置とを電気的に接続する。初期状態では操作部４のトリガー２２の手掛け部２２ａは図１（ａ）（ｂ）に示すようにグリップ８から最も離れた定位置で保持され、処置部ユニット接続部１９は挿入部３の軸方向の移動範囲の最後端位置で保持される。この状態では処置部３の一対の弾性部材１２ａ，１２ｂがシース６内に没入して把持部材１１ａ，１１ｂが閉じた状態にある。
【００３５】
この状態で、バイポーラ鉗子１の挿入部２を患者の体内に挿入し、この挿入部２の先端の処置部３を体内の処置対象の生体組織Ａの近傍位置まで誘導する。そこで、トリガー２２の手掛け部２２ａを付勢部材の付勢力に抗してグリップ８側に引き込み操作することにより、ロッド駆動部材９を介してロッド６がシース５の軸方向前方へ移動する。ロッド６の前進に伴って弾性部材１２ａ，１２ｂがシース６から突出し、弾性部材１２ａ，１２ｂの弾性復元力によって把持部材１１ａ，１１ｂが開く（図２参照）。
【００３６】
続いて、拡開した把持部材１１ａ，１１ｂの間に生体組織Ａを挿入した後、トリガー２２を解放するとグリップ８内の付勢部材のばね力によって定位置に戻り、弾性部材１２ａ，１２ｂがシース６内に引き込まれ、把持部材１１ａ，１１ｂが図３に示すように、閉じ、生体組織Ａが図５に示すように、一対の把持部材１１ａ，１１ｂ間に把持される。
【００３７】
このとき、把持部材１１ａ，１１ｂには閉じたときに互いに噛合する鋸歯状部に形成され、生体組織Ａを確実に把持できる。この状態で、高周波焼灼電源装置から高周波ケーブル２１ａを介して電極ピン２１に高周波電流が流れ、さらに弾性部材１２ａ，１２ｂを介して把持部材１１ａと１１ｂとの間に凝固電流が流れ、生体組織Ａの凝固が行われる。
【００３８】
一定時間凝固電流を流して生体組織Ａを凝固（図６（ｂ）の生体組織Ａのクロス線部分は、凝固電流によって凝固された部分を示す。）させた後、ナイフ操作レバー２７の指掛け部３３に指を掛け、付勢部材の付勢力に抗してナイフ操作レバー２７を反時計回り方向に回動すると、長孔２９に挿入されている係合ピン３０を介してナイフ操作ロッド１７が前進駆動する。ナイフ操作ロッド１７の前進によって操作ヘッド１８によりナイフロッド１５を弾性力に抗して押し下げ、切開ナイフ１６を把持部材１１ａの内部から下側に移動させる。
【００３９】
そして、図６（ａ）（ｂ）に示すように、切開ナイフ１６が把持部材１１ａ，１１ｂの把持面を通過すると、把持部材１１ａ，１１ｂ間に把持された生体組織Ａの凝固された部分の内部が切開ナイフ１６の切刃１６ａによって機械的に切開される。
【００４０】
切開が完了した後、ナイフ操作レバー２７を解放すると、付勢部材のばね力によって定位置に戻り、ナイフ操作ロッド１７は相対的にシース６に引き込まれて操作ヘッド１８が後退し、切開ナイフ１６はナイフロッド１５の弾性力によって上昇して上側の把持部材１１ａの内部に収容され、アーム部３２はストッパピン３４に当接すると停止する。
【００４１】
また、トリガー２２を解放するとグリップ８内の付勢部材のばね力によって定位置に戻り、弾性部材１２ａ，１２ｂがシース６から突出して把持部材１１ａ，１１ｂは弾性部材１２ａ，１２ｂの弾性復元力によって開き、把持部材１１ａ，１１ｂは生体組織Ａから解放される。
【００４２】
本実施形態によれば、通常時には、切開ナイフ１６が把持部材１１ａの内部に収容された状態に退避しているため、処置部３を体腔内に目的部位に誘導する際に、切開ナイフ１６によって正常な組織に傷を付ける虞がなく、操作性を向上できる。また、切開ナイフ１６の切れ味が低下しても切開時に生体組織Ａを逃がすことなく、確実に切開できる。
【００４３】
図７〜図１１は第２の実施形態を示し、第１の実施形態と同一構成部分は同一番号を付して説明を省略する。図７〜図１１に示すように、シース５に進退自在に内挿されたロッド６の先端部には弾性部材１２ａ，１２ｂによって一対の把持部材４１ａ，４１ｂが設けられている。把持部材４１ａ，４１ｂは閉じたときに内部に空間部４２が形成されるように互いに対向する面に凹溝４３ａ，４３ｂが形成され、その周縁には閉じたときに互いに噛合する鋸歯状部が形成され、生体組織Ａを確実に把持できるように形成されている。
【００４４】
上側の把持部材４１ａの凹溝４３ａは手前側に向かって漸次浅くなるように斜面に形成され、切開ナイフ４４を案内する案内面４５に形成されている。切開ナイフ４４は矩形板状体で、下部手前側に斜めに切刃４４ａを有しており、この切開ナイフ４４は上側の把持部材４１ａの凹溝４３ａおける最も深い先端側に位置しているときには生体組織Ａと接触しないように退避している。
【００４５】
一方、ロッド６の軸心より下側に偏倚した位置には軸方向に亘って貫通孔４６が設けられている。この貫通孔４６にはばね鋼からなるナイフ操作ロッド４７が進退自在に挿通されている。ナイフ操作ロッド４７のロッド６の先端部から延出した部分は上側の把持部材４１ａに向かって斜めに曲り癖が付けられ、先端部には前記切開ナイフ４４が固定されている。ナイフ操作ロッド４７の基端部は操作部４まで延長しており、操作部４に設けられたナイフ操作レバー２７と連結されている。このナイフ操作レバー２７はグリップ８に対して回動ピン２８を中心に回動自在に連結され、付勢部材（図示しない）によって反時計回り方向に付勢され、ナイフ操作ロッド４７を前進させる方向に付勢している。
【００４６】
次に、第２の実施形態の作用について説明する。把持部材４１ａと４１ｂとを閉じて生体組織Ａを把持し、把持部材４１ａ，４１ｂ間に凝固電流を流して生体組織Ａを凝固するまでは第１の実施形態と同様であり、図１１（ｂ）の生体組織Ａのクロス線部分は、凝固電流によって凝固された部分を示す。生体組織Ａを凝固させた後、ナイフ操作レバー２７の指掛け部３３に指を掛け、付勢部材の付勢力に抗してナイフ操作レバー２７を時計回り方向に回動すると、長孔２９に挿入されている係合ピン３０を介してナイフ操作ロッド４７が後退駆動する。ナイフ操作ロッド４７の後退によってナイフ操作ロッド４７の先端部に設けられた切開ナイフ４４が手前側に引かれ、把持部材４１ａの案内面４５に案内されて凹溝４３ａの深い位置から浅い位置に移動する。
【００４７】
したがって、図１１に示すように、切開ナイフ４４の切刃４４ａが把持部材４１ａ，４１ｂの把持面を通過し、把持部材４１ａ，４１ｂ間に把持された生体組織Ａの凝固された部分の内部が切開ナイフ４４の切刃４４ａによって機械的に切開される。
【００４８】
切開が完了した後、ナイフ操作レバー２７を解放すると、付勢部材のばね力によって定位置に戻り、ナイフ操作ロッド４７は前進し、切開ナイフ４４はナイフ操作ロッド４７の弾性力によって徐々に上昇して上側の把持部材４１ａの凹溝４３ａの内部に収容され、アーム部３２はストッパピン３４に当接すると停止する。
【００４９】
なお、第２の実施形態においては、切開ナイフ４４は矩形板状体で、下部手前側に斜めに切刃４４ａを有した形状であるが、図１２に示すように、下部手前側に略Ｌ字状の切刃４８ａを有した切開ナイフ４８とすることにより、生体組織Ａを一層良好に切開できる。
【００５０】
本実施形態によれば、通常時には、切開ナイフ４４が把持部材４１ａの内部に収容された状態に退避しているため、処置部３を体腔内に目的部位に誘導する際に、切開ナイフ４４によって正常な組織に傷を付ける虞がなく、操作性を向上できる。また、切開ナイフ１６の切れ味が低下しても切開時に生体組織Ａを逃がすことなく、確実に切開できる。
【００５１】
図１３〜図１７は第３の実施形態を示し、第１の実施形態と同一構成部分は同一番号を付して説明を省略する。本実施形態は、第１の実施形態の切開ナイフ１６に代ってナイフワイヤ５０を設けたものである。ロッド６の軸心より下側に偏倚した位置には軸方向に亘って貫通孔５１が設けられ、この貫通孔５１にはばね鋼からなるナイフ操作ロッド５２が進退自在に挿通されている。ナイフ操作ロッド５２のロッド６の先端部から延出した部分は一体にナイフワイヤ５０が設けられている。このナイフワイヤ５０は、断面が角軸状で、上側面を鋭角に形成した切刃５０ａが設けられている。また、ナイフ操作ロッド５２の基端部は操作部４まで延長しており、操作部４に設けられたナイフ操作レバー２７と連結されている。
【００５２】
そして、このナイフワイヤ５０の先端部は下側の把持部材１１ｂの内底部に溶接等によって固定されており、ナイフワイヤ５０の把持部材１１ｂの内部に位置する部分は上側の把持部材１１ａに向かって円弧状に湾曲するように曲り癖が付けられている。
【００５３】
次に、第３の実施形態の作用について説明する。把持部材１１ａと１１ｂとを閉じて生体組織Ａを把持し、把持部材１１ａ，１１ｂ間に凝固電流を流して生体組織Ａを凝固するまでは第１の実施形態と同様であり、図１５（ｂ）の生体組織Ａのクロス線部分は、凝固電流によって凝固された部分を示す。生体組織Ａを凝固させた後、ナイフ操作レバー２７の指掛け部３３に指を掛け、付勢部材の付勢力に抗してナイフ操作レバー２７を半時計回り方向に回動すると、長孔２９に挿入されている係合ピン３０を介してナイフ操作ロッド５２が前進駆動する。ナイフ操作ロッド５２の前進によってナイフ操作ロッド５２の先端部に一体に設けられたナイフワイヤ５０が前方に押され、ナイフワイヤ５０の先端部が把持部材１１ｂに固定されていることと、円弧状に湾曲するように曲り癖が付けられていることから、把持部材１１ａに向かって円弧状に湾曲する。
【００５４】
したがって、図１５に示すように、ナイフワイヤ５０の切刃５０ａが把持部材１１ａ，１１ｂの把持面を通過し、把持部材１１ａ，１１ｂ間に把持された生体組織Ａの凝固された部分の内部がナイフワイヤ５０の切刃５０ａによって機械的に切開される。
【００５５】
切開が完了した後、ナイフ操作レバー２７を解放すると、付勢部材のばね力によって定位置に戻り、ナイフ操作ロッド５２は後退し、ナイフワイヤ５０は弾性復元力によって略真っ直ぐに復元して下側の把持部材１１ｂの凹溝の内部に収容され、アーム部３２はストッパピン３４に当接すると停止する。
【００５６】
本実施形態によれば、通常時には、ナイフワイヤ５０が把持部材１１ｂの内部に収容された状態に退避しているため、処置部３を体腔内に目的部位に誘導する際に、ナイフワイヤ５０によって正常な組織に傷を付ける虞がなく、操作性を向上できる。また、切開ナイフ１６の切れ味が低下しても切開時に生体組織Ａを逃がすことなく、確実に切開できる。
【００５７】
図１８〜図２３は第４の実施形態を示し、第１の実施形態と同一構成部分は同一番号を付して説明を省略する。図２１〜図２３に示すように、挿入部２は、ロッド５５と、このロッド５５に軸方向に進退自在に外嵌されれたシース５６とからなり、シース５６の先端部には絶縁材料からなる係合部材５７が固定され、ロッド５５の基端部は操作部４を構成するグリップ８に固定されている。シース５６の基端部は操作部４に設けられたシース駆動部材５９に固定されている。
【００５８】
処置部３は、電極を構成する一対の把持部材６１ａ，６１ｂと、これらの把持部材６１ａ，６１ｂを支持し、拡開させる方向に付勢する上下２本ずつの弾性部材６２ａ，６２ｂとからなり、これら弾性部材６２ａ，６２ｂの基端部がロッド５５の先端部に固定されている。弾性部材６２ａ，６２ｂはばね鋼等によって形成され、先端部には略くの字状に屈曲された屈曲部６３ａ，６３ｂが形成され、表面は絶縁被膜によって被覆されている。
【００５９】
図２０に示すように、下側の把持部材６１ｂの把持面における幅方向の中間部には鋭利な切開刃６４が前後方向に亘って設けられ、この切開刃６４の両側は平坦面に形成されている。下側の把持部材６１ｂの把持面にはシリコンゴム等の複数個の弾性体６５が設けられ、この弾性体６５の高さ寸法は、切開刃６４の高さ寸法よりも大きく、通常時においては、切開刃６４が弾性体６５の間の内部にあり、組織に傷を付けないようになっている。
【００６０】
次に、第４の実施形態の作用について説明する。
【００６１】
初期状態では操作部４のトリガー２２の手掛け部２２ａは図２１に示すようにグリップ８から最も離れた定位置で保持され、この状態ではシース５６が後退位置にあることから一対の弾性部材６２ａ，６２ｂが弾性復元力で拡開し、図１８に示すように、一対の把持部材６１ａ，６１ｂが開いた状態にある。
【００６２】
この状態で、挿入部２の先端の処置部３を体内の処置対象の生体組織Ａの近傍位置まで誘導する。続いて、拡開した把持部材６１ａ，６１ｂの間に生体組織Ａを挿入する。そこで、トリガー２２の手掛け部２２ａを付勢部材の付勢力に抗してグリップ８側に引き込み操作することにより、シース駆動部材５９を介してシース５６の軸方向前方へ移動する。
【００６３】
シース５６の前進に伴って弾性部材６２ａ，６２ｂがシース５６内に相対的に引き込まれ、弾性部材６２ａ，６２ｂの弾性復元力に抗して把持部材６１ａ，６１ｂが閉じ、生体組織Ａが図１９に示すように、一対の把持部材６１ａ，６１ｂ間に把持される。この状態で、高周波焼灼電源装置から高周波ケーブル２１ａを介して電極ピン２１に高周波電流が流れ、さらに弾性部材６２ａ，６２ｂを介して把持部材６１ａと６１ｂとの間に凝固電流が流れ、生体組織Ａの凝固が行われる。
【００６４】
一定時間凝固電流を流して生体組織Ａを凝固させた後、図２３に示すように、トリガー２２の手掛け部２２ａを付勢部材の付勢力に抗してさらにグリップ８側に引き込み操作すること、つまりトリガー２２をさらに強く引くと、シース駆動部材５９を介してシース５６がさらに軸方向前方へ移動する。
【００６５】
シース５６の前進に伴って弾性部材６２ａ，６２ｂがシース５６内に相対的にさらに深く引き込まれ、把持部材６１ａ，６１ｂが強く閉じられるため、弾性体６５が圧縮され、相対的に切開刃６４が突出する。したがって、切開刃６４が把持部材６１ａ，６１ｂの把持面を通過して把持部材６１ａ，６１ｂ間に把持された生体組織Ａは切開刃６４によって機械的に切開される。
【００６６】
切開が完了した後、トリガー２２を解放すると、付勢部材のばね力によって定位置に戻り、シース５６は後退し、弾性部材６２ａ，６２ｂの弾性復元力によって開き、把持部材６１ａ，６１ｂは生体組織Ａから解放される。
【００６７】
本実施形態においては、グリップ８を握ってトリガー２２の手掛け部２２ａを引き込む一連の動作によって生体組織Ａを把持して凝固させ、その凝固部分を切開することができ、操作性を向上させることができる。また、切開ナイフ１６の切れ味が低下しても切開時に生体組織Ａを逃がすことなく、確実に切開できる。
なお、本実施形態においては、一対の把持部材６１ａ，６１ｂのうち、下側の把持部材６１ｂのみに切開刃６４及び弾性体６５を設けたが、図２４に示すように、一対の把持部材６１ａ，６１ｂの両方に切開刃６４及び弾性体６５を互いに対向して設けてもよく、図２５に示すように、下側の把持部材６１ｂもしくは一対の把持部材６１ａ，６１ｂの両方にばね６６を介してブロック６７を取り付け、通常時において、ブロック６７の高さが切開刃６４より高くなるようにしてもよい。
【００６８】
本実施形態によれば、通常時には、切開刃６４が弾性体６５の間に没入された状態に退避しているため、処置部３を体腔内に目的部位に誘導する際に、切開刃６４によって正常な組織に傷を付ける虞がなく、操作性を向上できる。
【００６９】
また、前述した第１〜第４の実施形態においては、切開刃及びナイフワイヤにおける切開手段は、機械的な切開について説明したが、切開時に切開刃及びナイフワイヤに切開電流を流して機械的及び電気的に切開するようにしてもよい。
【００７０】
図２６〜図３１は内視鏡下手術器械の第１の開示例を示し、図３１は全体構成図である。手術器械７０は挿入部７１と、この挿入部７１の先端部に設けられた処置部７２と、挿入部７１の基端部に設けられた操作部７３とから構成され、手術器械７０は高周波焼灼電源装置７４に接続されている。
【００７１】
図２６〜図３０に示すように、挿入部７１は内シース７５と、この内シース７５に外嵌され軸方向に進退自在な外シース７６とから二重管構造に構成されている。内シース７５の先端部は外シース７６の先端部より突出しており、この突出部には固定ジョー７７が設けられている。固定ジョー７７の上面には鋸歯状の凹凸面が形成されていると共に、幅方向の中間部には前後方向に亘って案内溝７７ａが設けられている。さらに、固定ジョー７７の両側面には前後方向に長いスライド溝７８が設けられ、このスライド溝７８には外シース７６の先端部に横方向に貫通して設けられた枢支ピン７９が挿入されている。したがって、外シース７６はスライド溝７８の長さの範囲内で進退自在である。
【００７２】
さらに、枢支ピン７９の中間部には可動ジョー８０が回動自在に枢支されている。この可動ジョー８０は固定ジョー７７の案内溝７７ａに対向し、案内溝７７ａの溝幅より狭幅に形成されている。また、可動ジョー８０の基端部で、枢支ピン７９より下側に位置する部分には連結ピン８１が設けられ、この連結ピン８１にはジョー操作ロッド８２の先端部が回動自在に連結されている。ジョー操作ロッド８２は内シース７５の内部を貫通して前記操作部７３まで延長しており、内シース７５及び外シース７６も操作部７３まで延長している。
【００７３】
操作部７３は固定ハンドル８３と、この固定ハンドル８３に枢支軸８４によって回動自在に枢支された可動ハンドル８５及び可動ハンドル８５を反時計回り方向に付勢する付勢部材（図示しない）とから構成されている。固定ハンドル８３には内シース７５の基端部が連結され、外シース７６の基端部は固定ハンドル８３の近傍まで延長しており、この固定ハンドル８３と外シース７６の基端部との間には内シース７５に対して嵌合するコイルばね８６が設けられている。そして、コイルばね８６の復元力によって外シース７６を前進する方向に付勢している。また、可動ハンドル８５にはジョー操作ロッド８２の基端部が連結されている。
【００７４】
さらに、固定ハンドル８３の上部には凝固電流と切開電流とを切換える電流切換えスイッチ８７が取り付けられている。この電流切換えスイッチ８７と対向する外シース７６の基端部にはスイッチ操作レバー８８が取り付けられている。電流切換えスイッチ８７はケーブル８９を介して前記高周波焼灼電源装置７４に接続されている。
【００７５】
次に、前述のように構成された手術器械７０の作用について説明する。
【００７６】
まず、体腔内に挿入部７１を挿入して処置部７２を処置対象部位に誘導する。通常時においては、可動ハンドル８５は付勢部材によって反時計回りに方向に付勢されているため、可動ハンドル８５によってジョー操作ロッド８２は前進状態にあり、可動ジョー８０は枢支ピン７９を支点として時計回り方向に回動して固定ジョー７７に対して可動ジョー８０が開いた状態にある。
【００７７】
そこで、図２７に示すように、固定ジョー７７と可動ジョー８０との間に生体組織Ａに入れ、可動ハンドル８５の指掛け部に指を掛けて固定ハンドル８３に接近する時計回り方向に回動すると、ジョー操作ロッド８２は後退する。ジョー操作ロッド８２が手元側に引かれると、図２８に示すように、連結ピン８１を介して連結されている可動ジョー８０は枢支ピン７９を支点として反時計回り方向に回動し、固定ジョー７７に対して可動ジョー８０が閉じて生体組織Ａを把持する。
【００７８】
そこで、高周波焼灼電源装置７４から凝固電流を流すと、凝固電流はケーブル８９、電流切換えスイッチ８７を介して固定ジョー７７と可動ジョー８０との間に凝固電流が流れ、生体組織Ａの凝固が行われる。
【００７９】
一定時間凝固電流を流して生体組織Ａを凝固させた後、可動ハンドル８５をさらに固定ハンドル８３に接近する方向に回動させると、ジョー操作ロッド８２はさらに後退する。ジョー操作ロッド８２がさらに手元側に引かれると、連結ピン８１を介して連結されている可動ジョー８０は手元側に引かれるため、枢支ピン７９を介して連結されている外シース７６もコイルばね８６の復元力に抗して後退する。このとき、枢支ピン７９はスライド溝７８に支持されているため、枢支ピン７９はスライド溝７８内をスライドして後退し、可動ジョー８０が固定ジョー７７の案内溝７７ａに沿って移動する。すなわち、可動ジョー８０が凝固された生体組織Ａを剪断力によって切開する動作に移り、このとき外シース７６の後退によってスイッチ操作レバー８８が電流切換えスイッチ８７を押圧して電流を切換えるため、高周波焼灼電源装置７４から固定ジョー７７と可動ジョー８０との間に切開電流が流れる。したがって、可動ジョー８０の移動による機械的な切開と切開電流との電気的切開が同時に行える。
【００８０】
切開が完了した後、可動ハンドル８５を解放すると、付勢部材のばね力によって定位置に戻り、外シース７６は前進すると共に、ジョー操作ロッド８２が前進して可動ジョー８０は前進すると共に固定ジョー７７から離れる方向に開き、生体組織Ａから解放される。
【００８１】
本実施形態においては、可動ハンドル８５を固定ハンドル８３側に接近方向に回動する一連の動作によって生体組織Ａを把持して凝固させ、その凝固部分を切開することができ、操作性を向上させることができる。
【００８２】
図３２は手術器械の第２の開示例を示し、第１の開示例と同一構成部分は同一番号を付して説明を省略する。本開示例は、第１の開示例の操作部７３にロック機構を設けたものである。外シース７６の基端部には手元側に延出する延出レバー９０が設けられ、この延出レバー９０の先端部には掛止部９１が設けられている。固定ハンドル８３にはトリガー９２によって回動自在な掛止爪９３が設けられ、掛止爪９３は掛止部９１に掛止されている。したがって、固定ハンドル８３に対して外シース７６が前後方向に移動不能にロックされ、可動ジョー８０が不用意に前後方向に移動しないようになっている。
【００８３】
このように構成することにより、生体組織Ａを把持して凝固する際に、可動ハンドル８５を過剰に操作しても外シース７６が後退することはなく、可動ジョー８０による不用意な切開動作を防止でき、切開時にはトリガー９２を操作して掛止爪９３を掛止部９１から外してロック解除してから操作すればよい。
【００８４】
図３３は手術器械の第３の開示例を示し、第１の開示例と同一構成部分は同一番号を付して説明を省略する。本開示例は、ジョー操作ロッド８２を可動ハンドル８５によって駆動し、外シース７６は固定ハンドル８３に設けたシーススライドアクチュエータ９４によって駆動するようにしたものである。
【００８５】
高周波焼灼電源装置７４にはインピーダンス検知器９５が設けられ、このインピーダンス検知器９５はシーススライドアクチュエータ９４を駆動するアクチュエータ駆動装置９６に接続されている。高周波焼灼電源装置７４から凝固電流を流し、固定ジョー７７と可動ジョー８０との間に凝固電流を流して生体組織Ａの凝固を行った後、生体組織Ａのインピーダンスをインピーダンス検知器９５によって検知して凝固が完全に行われたか否かを判断する。
【００８６】
そして、生体組織Ａのインピーダンスによって凝固が完全におこなわたことを判断したとき、インピーダンス検知器９５はアクチュエータ駆動装置９６に駆動信号を出力し、アクチュエータ駆動装置９６はシーススライドアクチュエータ９４を駆動して外シース７６を後退移動させ、可動ジョー８０を後方にスライドさせて生体組織Ａの切開を行う。このように構成することにより、生体組織Ａを把持して凝固する際に、可動ハンドル８５を過剰に操作しても外シース７６が後退することはなく、可動ジョー８０による不用意な切開動作を防止できる。
【００８７】
図３４及び図３５は第４の開示例を示し、第１の開示例と同一構成部分は同一番号を付して説明を省略する。本開示例は、枢支ピン７９及びこの枢支ピン７９に枢支された可動ジョー８０に絶縁層７９Ａ，８０Ａを設け、固定ジョー７７と可動ジョー８０とを電気的絶縁状態にしてバイポーラ化したものである。
【００８８】
図３６及び図３７は第５の開示例を示す。本開示例は、挿入部としての軸方向に進退自在なスライドパイプ１００の先端部に軸方向に進退自在な第１の可動ジョー１０１とアーム１０２に固定された第２の可動ジョー１０３とから構成されている。アーム１０２は弾性部材によって形成され、拡開方向に曲り癖が付けられており、スライドパイプ１００が後退することにより、第１の可動ジョー１０１に対して第２の可動ジョー１０３が開き、スライドパイプ１００が前進することにより、第１の可動ジョー１０１に対して第２の可動ジョー１０３が閉じて生体組織Ａを把持できるようになっている。
【００８９】
そして、高周波焼灼電源装置から第１の可動ジョー１０１と第２の可動ジョー１０３との間に凝固電流を流して生体組織Ａを凝固させた後、第１の可動ジョー１０１と第２の可動ジョー１０３との間に切開電流を流すとともに、第１の可動ジョー１０１を後退させると、第１の可動ジョー１０１の移動による機械的な切開と切開電流との電気的切開が同時に行える。
【００９０】
切開が完了した後、スライドパイプ１００を後退させると、アーム１０２の弾性力によって拡開して第２の可動ジョー１０３は第１の可動ジョー１０１から離れる方向に開き、生体組織Ａから解放される。
【００９１】
前記実施の形態によれば、次のような構成が得られる。
【００９２】
（付記１）組織を把持する一対の把持部材と、前記把持部材の把持面に設けられた双極電極と、組織を切開する切開手段とを備えた内視鏡下手術器械において、前記切開手段は、把持する組織に接触しないよう前記把持部材の内部に収容される第１の位置に配置され、切開時に切開手段の少なくとも一部が第１の位置から一対の把持部材で形成される把持面を通過するように移動自在であることを特徴とする内視鏡下手術器械。
【００９３】
（付記２）切開手段は、収納される把持部材の開閉動作に応じて移動可能なような弾性部材で支持されていることを特徴とする付記１記載の内視鏡下手術器械。
【００９４】
（付記３）切開手段は、切開操作部材を有し、この切開操作部材は、切開手段を付勢する弾性部材に係合しない第１の位置と弾性部材に係合してその付勢力に抗して切開手段を把持部材から突出させる第２の位置に移動可能であることを特徴とする付記１または２記載の内視鏡下手術器械。
【００９５】
（付記４）切開手段は、鋭利な切刃を有する切開刃であることを特徴とする付記１または２記載の内視鏡手術器械。
【００９６】
（付記５）切開手段は、把持部材の内部に収納される第１の位置と挿入部内まで後退する第２の位置との間を移動可能であることを特徴とする付記１または２記載の内視鏡手術器械。
【００９７】
（付記６）切開手段は、Ｌ字状の切刃を有する切開刃であることを特徴とする付記５記載の内視鏡手術器械。
【００９８】
（付記７）切開手段は、先端が一方の把持部材に固定され、後端が把持部材に対して移動可能な弾性を有するナイフワイヤで、このナイフワイヤは、前進動作に伴って湾曲して把持部材の把持面を通過することを特徴とする付記１記載の内視鏡手術器械。
【００９９】
（付記８）ナイフワイヤは、湾曲方向に鋭利な切刃を有していることを特徴とする付記７記載の内視鏡手術器械。
【０１００】
（付記９）組織の凝固後に凝固部位を切開するための機能を有した高周波処置具において、通常の把持操作では組織に切開を行わないよう、組織把持部に組織の切開を制御する弾性部材を有していることを特徴とする高周波処置具。
【０１０１】
（付記１０）凝固操作と切開操作が一連の動作で行えることを特徴とする付記９記載の高周波処置具。
【０１０２】
（付記１１）操作部の操作により凝固操作と切開操作が一連の動作で行えることを特徴とする付記１０記載の高周波処置具。
【０１０３】
（付記１２）弾性部材は、シリコンゴムであることを特徴とする付記９記載の高周波処置具。
【０１０４】
（付記１３）シリコンゴムはばねによって支持されていることを特徴とする付記１２記載の高周波処置具。
【０１０５】
（付記１４）組織切開部は、組織把持面の一部に設けられ鋭利な切刃を有していることを特徴とする付記９記載の高周波処置具。
【０１０６】
（付記１５）組織切開部は、その両側に組織把持面を持っていることを特徴とする付記１４記載の高周波処置具。
【０１０７】
（付記１６）相対的に開閉する一対のジョーを挿入部の先端に有し、組織を凝固する内視鏡下手術器械において、一方のジョーが他方のジョーに対して開閉するとともに近位側に挿入部と略平行にスライドし、一対のジョーの組織接触面には凝固面が形成され、凝固面に高周波電流を通電して組織の切開を行う内視鏡下手術器械。
【０１０８】
（付記１７）一対のジョーは、第１のジョーと第２のジョーとからなり、第１のジョーは第２のジョーに対して回動自在に支点ピンで支持され、さらに支点ピンは第２のジョーに挿入部と略平行に設けられたスライド溝内をスライド可能であり、さらに支点ピンは第２のジョーに対してスライド可能に設けられたシースに接続され、シースにはスライド防止手段が設けられた付記１６記載の内視鏡下手術器械。
【０１０９】
（付記１８）第１のジョーは弾性変形可能なアームで支持され、アームにシースがスライドして係合することで開閉するとともに、第２のジョーは第１のジョー及びシースに対してスライドし、シースにはスライド防止手段が設けられた付記１６記載の内視鏡下手術器械。
【０１１０】
（付記１９）スライド防止手段は、シースを遠位方向に付勢するコイルばねからなる付記１７または１８記載の内視鏡下手術器械。
【０１１１】
（付記２０）スライド防止手段は、さらにシースに接続された掛止部及びこの掛止部に係脱に係合する掛止爪を有している付記１９記載の内視鏡下手術器械。
【０１１２】
（付記２１）付記１６乃至１８記載の内視鏡下手術器械は、シーススライドアクチュエータからなるスライド防止手段と、生体組織のインピーダンスを検知するインピーダンス検知器と、アクチェエータ駆動装置とを有し、凝固された組織のインピ一ダンスが所定の値を超えたときにアクチェエータ駆動装置がシーススライドアクチュエータを作動させ、ジョーをスライドさせることを特徴とする内視鏡下手術器械。
【０１１３】
（付記２２）付記１６〜２１のいずれかに記載の内視鏡下手術器械は、一方のジョーを他方のジョーから絶縁する手段を含み、各々のジョーには異なる極の高周波電流を通電可能な内視鏡下手術器械。
【０１１４】
（付記２３）付記１６〜２１のいずれかに記載の内視鏡下手術器械は、ジョーが閉じて組織凝固時には凝固電流を、ジョーのスライド時に切開電流を通電することにより連続的に組織の凝固・切開が可能な内視鏡下手術器械。
【０１１５】
（付記２４）付記２３において、ジョーのスライド開始に応じて電流を凝固電流から切開電流に変化させる手段を持つ内視鏡下手術器械。
【０１１６】
【発明の効果】
以上説明したように、この発明によれば、切開手段を、把持する組織に接触しないよう把持部材の内部に収容し、切開時に切開手段の少なくとも一部が一対の把持部材で形成される把持面を通過するように移動自在にしたから、体腔内に挿入したとき、切開手段が正常な組織に接触して傷を付ける虞がなく、操作性の向上を図ることができる。また、切開手段の切れ味が低下しても切開時に生体組織を逃がすことなく、確実に切開できるという効果がある。
【図面の簡単な説明】
【図１】この発明の第１の実施形態を示し、（ａ）は内視鏡下手術器械の全体の平面図、（ｂ）は同側面図、（ｃ）は把持部材が開いた状態の側面図。
【図２】同実施形態の内視鏡下手術器械の動作説明図。
【図３】同実施形態の内視鏡下手術器械の動作説明図。
【図４】同実施形態を示し、把持部材が開いた状態の縦断側面図。
【図５】同実施形態を示し、（ａ）は把持部材が閉じて生体組織を凝固している状態の縦断側面図、（ｂ）はＡ−Ａ線に沿う断面図。
【図６】同実施形態を示し、（ａ）は生体組織の切開状態の縦断側面図、（ｂ）はＢ−Ｂ線に沿う断面図。
【図７】この発明の第２の実施形態を示す内視鏡下手術器械の動作説明図。
【図８】同実施形態の内視鏡下手術器械の動作説明図。
【図９】同実施形態を示し、把持部材が開いた状態の縦断側面図。
【図１０】同実施形態を示し、把持部材が閉じて生体組織を凝固している状態の縦断側面図。
【図１１】同実施形態を示し、（ａ）は生体組織の切開状態の縦断側面図、（ｂ）はＣ−Ｃ線に沿う断面図。
【図１２】同実施形態の切削刃の変形例を示す側面図。
【図１３】この発明の第３の実施形態を示し、把持部材が開いた状態の縦断側面図。
【図１４】同実施形態を示し、把持部材が閉じて生体組織を凝固している状態の縦断側面図。
【図１５】同実施形態を示し、（ａ）は生体組織の切開状態の縦断側面図、（ｂ）はＤ−Ｄ線に沿う断面図。
【図１６】同実施形態の内視鏡下手術器械の動作説明図。
【図１７】同実施形態の内視鏡下手術器械の動作説明図。
【図１８】この発明の第４の実施形態を示し、把持部材が開いた状態の図２０（ｂ）のＨ−Ｈ線に沿う縦断側面図。
【図１９】同実施形態を示し、（ａ）把持部材が閉じて生体組織を凝固している状態の図２０（ｂ）のＨ−Ｈ線に沿う縦断側面図、（ｂ）はＥ−Ｅ線に沿う断面図。
【図２０】同実施形態を示し、（ａ）は生体組織の切開状態の縦断側面図、（ｂ）はＦ−Ｆ線に沿う断面図。
【図２１】同実施形態の内視鏡下手術器械の動作説明図。
【図２２】同実施形態の内視鏡下手術器械の動作説明図。
【図２３】同実施形態の内視鏡下手術器械の動作説明図。
【図２４】同実施形態の変形例を示す把持部材の断面図。
【図２５】同実施形態の変形例を示す把持部材の断面図。
【図２６】内視鏡下手術器械の第１の開示例を示す処置部の平面図。
【図２７】同開示例の処置部の側面図。
【図２８】同開示例の把持部材で生体組織を把持して凝固している状態の側面図。
【図２９】同開示例の把持部材で生体組織を切開している状態の側面図。
【図３０】同開示例の切開時の横断正面図。
【図３１】同開示例の内視鏡下手術器械の全体構成を示す側面図。
【図３２】内視鏡下手術器械の第２の開示例を示す操作部側の側面図。
【図３３】内視鏡下手術器械の第３の開示例を示す操作部側の側面図。
【図３４】内視鏡下手術器械の第４の開示例を示す処置部の縦断平面図。
【図３５】同開示例を示す処置部の横断正面図。
【図３６】内視鏡下手術器械の第５の開示例を示す処置部の側面図。
【図３７】同開示例を示し、生体組織を切開している状態を示す側面図。
【符号の説明】
２…挿入部
３…処置部
４…操作部
１１ａ，１１ｂ…把持部材
１６…切開刃[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an endoscopic surgical instrument having a grasping member for grasping a living tissue and an incision portion for incising the grasped living tissue.
[0002]
[Prior art]
In general, there is known a bipolar forceps that includes a pair of gripping members for gripping a living tissue, and each gripping member is provided with an electrode for high-frequency energization. When using the bipolar forceps, the living tissue to be treated is gripped between the pair of gripping members, and a high-frequency current is passed between the electrodes of each gripping member to coagulate the living tissue between the gripping members. It has become.
[0003]
This type of bipolar forceps is usually used for various cases such as hemostasis of blood vessels contained in living tissue, lesions on the surface layer of living tissue, cauterization of bleeding points, occlusion of fallopian tubes for the purpose of contraception. Bipolar forceps are used for hemostasis of blood vessels and occlusion of the fallopian tube, and can coagulate a living tissue to be treated by a patient, and can incise the coagulated living tissue. ing.
[0004]
Conventionally, as this type of endoscopic surgical instrument, for example, US Pat. No. 4,655,216, US Pat. No. 5,445,638, US Pat. No. 5,431,674, US Pat. No. 5,484,436, US Pat. No. 5,558,671. No. 5, U.S. Pat. No. 5,267,998 and the like.
[0005]
In U.S. Pat. No. 4,655,216, an approximately L-shaped incision blade that is rotatable about a pivot pin is provided between a pair of openable and closable gripping members, and a pair of gripping members in a state of gripping a living tissue. After the coagulation current is passed between the gripping members to coagulate the living tissue, the incision blade is rotated to incise the living tissue.
[0006]
U.S. Pat. No. 5,445,638 and U.S. Pat. No. 5,558,671 are provided with a pair of gripping members protruding from the distal end of a sheath, and an incision knife that can be moved forward and backward between the gripping members. In a state where a pair of grasping members are closed and a living tissue to be treated is grasped, a coagulation current is passed between the pair of grasping members to solidify the living tissue, and then the incision knife is advanced to incise the living tissue. It has become.
[0007]
U.S. Pat. No. 5,431,674 includes an anvil fixed to a distal end portion of a sheath and a cutting blade that can be moved forward and backward, and is rotatable, and is retracted while closing the cutting blade to cut a living tissue.
[0008]
In US Pat. No. 5,484,436, a pair of cutting blades are rotatably provided at the distal end of a sheath, and a living tissue is coagulated by flowing a coagulation current through the pair of cutting blades, and then the living tissue is cut by the cutting blade. It is supposed to be.
[0009]
US Pat. No. 5,267,998 has a pair of coagulation electrodes and a movable incision electrode, and a coagulation current is allowed to flow between the pair of coagulation electrodes to coagulate the living tissue, and then the incision electrode is operated by operating the hand operation unit. The living tissue is incised by passing an incision current.
[0010]
[Problems to be solved by the invention]
However, in the above-mentioned US Pat. No. 4,655,216, since the incision blade protrudes between the pair of gripping members, there is a risk of damaging normal living tissue, and it is necessary to pay close attention. There is a drawback of poor operability.
[0011]
U.S. Pat. No. 5,445,638 and U.S. Pat. No. 5,558,671 are provided with an incision knife which can be moved forward and backward between a pair of gripping members, and when the sharpness of the incision knife is deteriorated, the incision knife is advanced to perform incision. There is a disadvantage in that the grasped living tissue is pushed out, and it is necessary to frequently replace the incision knife. In addition, there is a drawback in that the incision knife is arranged between the gripping members so as to be movable back and forth, and the cleaning property is poor.
[0012]
In US Pat. No. 5,431,674, US Pat. No. 5,484,436 and US Pat. No. 5,267,998, there is no function of grasping a living tissue, so that the treatment target site cannot be reliably incised.
[0013]
The present invention has been made paying attention to the above-mentioned circumstances, and an object of the present invention is to provide an endoscope under which there is no risk of damaging normal living tissue when inserted into a body cavity, and the incision performance can be maintained. To provide a surgical instrument.
[0014]
[Means for Solving the Problems]
An endoscopic surgical instrument according to a first embodiment of the present invention includes a pair of gripping members that are opened and closed to form a gripping surface, a bipolar electrode provided on the pair of gripping members, an incision member, and the gripping A space provided in a member and defined by an inner wall facing the gripping surface that opens toward the gripping surface and accommodates the entire incision member; and opening / closing the gripping member between the pair of gripping members An elastic member that is movably supported in a direction and is urged toward the inner wall, and can be advanced and retracted, and the incision member is elastically deformed in the opening and closing direction by pressing the elastic member by being advanced and retracted. And an operating member movable in the opening and closing direction of the gripping member so that at least a part of the incision member passes through the gripping surface.
An endoscopic surgical instrument according to a second embodiment of the present invention includes a pair of gripping members that are opened and closed to form a gripping surface, a bipolar electrode provided on the pair of gripping members, an incision member, and the gripping A space provided in a member and defined by an inner wall facing the gripping surface that opens toward the gripping surface and accommodates the entire incision member; and opening / closing the gripping member between the pair of gripping members An elastic operation member that is movably supported in a direction and urged toward the inner wall, and that can be moved forward and backward together with the incision member, and provided on the inner wall, is inclined in the opening and closing direction with respect to the advance and retreat direction of the incision member And the cutting member is advanced and retracted along the slope by the elastic operation member, so that at least a part of the cutting member can pass through the gripping surface.
An endoscopic surgical instrument according to a third embodiment of the present invention includes a pair of grasping members that are opened and closed to form a grasping surface, a bipolar electrode provided on the pair of grasping members, an incision member, and the grasping member A space portion that is provided in a member and is defined by an inner wall that opens to the gripping surface side and faces the gripping surface and can accommodate the entire cutting member; and the cutting member is provided integrally; The tip portion is fixed to one gripping member of the pair of gripping members, the cutting member is urged toward the inner wall of the one gripping member, and the other gripping of the pair of gripping members is possible Bends to bend toward the member, An elastic operation member that is elastically deformed by an advancing / retreating operation and is movable in the opening / closing direction of the pair of gripping members so that at least a part of the cutting member passes through the gripping surface. To do.
[0015]
Then, in a state where the biological tissue is gripped by the gripping member during treatment such as coagulation hemostasis of the biological tissue, the biological tissue is solidified by flowing a coagulation current between the gripping members, and then the incision means is formed by a pair of gripping members. The living body tissue can be incised by moving to the gripping surface.
[0016]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
[0017]
1 to 6 show a first embodiment, and FIG. 1 shows a bipolar forceps 1 as an endoscopic surgical instrument. The bipolar forceps 1 has an elongated insertion portion 2 to be inserted into a body cavity of a patient, a treatment portion 3 which is disposed at a distal end portion of the insertion portion 2 and can energize and grasp a living tissue in the body cavity, An operation unit 4 connected to the base end of the insertion unit 2 is provided.
[0018]
As shown in FIGS. 4 to 6, the insertion portion 2 includes a sheath 5 and a rod 6 that is inserted into the sheath 5 so as to be capable of moving forward and backward in the axial direction. The engaging member 7 is fixed, and the proximal end portion of the sheath 5 is fixed to the grip 8 constituting the operation portion 4. As shown in FIG. 1, the base end portion of the rod 6 is fixed to a rod driving member 9 provided in the operation unit 4.
[0019]
The treatment section 3 includes a pair of gripping members 11a and 11b that constitute electrodes, and two upper and lower elastic members 12a and 12b that support the gripping members 11a and 11b and bias them in the direction of expansion. The base end portions of the elastic members 12 a and 12 b are fixed to the tip end portion of the rod 6. The elastic members 12a and 12b are formed of spring steel or the like, bent portions 13a and 13b bent in a substantially U-shape are formed at the tip, and the surfaces are covered with an insulating coating.
[0020]
As shown in FIGS. 5 and 6, the gripping members 11 a and 11 b are formed with concave grooves 14 a and 14 b having a substantially U-shaped cross section so that a space 14 is formed inside when the gripping members 11 a and 11 b are closed, and face each other. A serrated portion that meshes with each other when the end edge is closed is formed so that the living tissue A can be securely grasped.
[0021]
Further, as shown in FIGS. 4 to 6, a knife rod 15 formed of spring steel or the like is inserted into the rod 6, and an incision knife 16 as an incision means is provided at the tip of the knife rod 15. It has been. Furthermore, the knife rod 15 is located between the lower elastic members 12b and 12b at the tip of the rod 6 and is located below the axis of the rod 6, but extends from the tip of the rod 6. The bent portion is obliquely bent toward the upper gripping member 11a, and the cutting knife 16 at the tip is housed in the concave groove 14a of the upper gripping member 11a. That is, during normal times, the cutting knife 16 is retracted so as not to come into contact with the living tissue A due to the elasticity of the knife rod 15. Further, the incision knife 16 is a rectangular plate-like body, and is a single-edged knife having a cutting edge 16a extending in the front-rear direction on the lower side thereof, and is formed with an upward slope on the tip side.
[0022]
Further, a through hole 6a is provided in the axial direction above the axis of the rod 6, and a knife operation rod 17 is inserted into the through hole 6a so as to be able to advance and retreat. An operation head 18 having an engagement groove 18 a that engages with the knife rod 15 is provided at the tip of the knife operation rod 17. Then, the knife operating rod 17 moves forward to push down the operation head 18 against the elastic force of the knife rod 15 to move the incision knife 16 downward from the inside of the gripping member 11a, and the gripping surfaces of the gripping members 11a and 11b are moved. It can be passed.
[0023]
The rod 6 of the grasping members 11a and 11b of the treatment section 3 thus configured, the knife rod 15 of the incision knife 16 and the knife operation rod 17 are inserted into the sheath 5 constituting the insertion section 3, and the base of the sheath 5 is inserted. It protrudes from the end portion and extends to the operation portion 4.
[0024]
Moreover, as shown in FIGS. 1-3, the grip 8 of the operation part 4 is provided with the front end side extension part 8a extended to the front end part side. The distal end side extension 8 a is provided with a connection ring 8 b that is connected and fixed to the proximal end of the sheath 5. Further, a treatment section unit connection section 19 for electrically and mechanically connecting to the rear end section of the treatment section 3 is disposed behind the distal end side extension section 8a. Here, the treatment section unit connection section 19 is provided with a lumen for accommodating the rear end portion of the rod 6 of the treatment section 3 and a connection means connected to the rear end portion of the rod 6 accommodated in the lumen. ing.
[0025]
Moreover, the treatment part unit connection part 19 is provided with an electrode pin 21 via a guide rod 20 electrically connected to the gripping members 11a and 11b of the treatment part 3, and this electrode pin 21 is provided via a high frequency cable 21a. It is connected to a high-frequency cautery power supply device (not shown).
[0026]
Further, the grip 8 is provided with a trigger 22 for operating the treatment section unit connection section 19. The trigger 22 is connected to the upper end of the grip 8 so as to be rotatable about a rotation pin 23. Further, a long hole 24 is formed in the trigger 22 above the rotation fulcrum. An engaging pin 25 protruding from the side surface of the rod driving member 9 is inserted into the long hole 24. Reference numeral 26 denotes a rotation knob, and the direction of the gripping members 11a and 11b can be arbitrarily changed by rotating the rod 6 in the circumferential direction within the sheath 5.
[0027]
Further, inside the grip 8, there is a biasing member (not shown) for biasing the handle 22a at the lower end of the trigger 22 in a direction away from the grip 8 (clockwise direction around the rotation pin 23 in FIG. 1). It is arranged. The trigger 22 is always held at a fixed position (release position) farthest from the grip 8 by the spring force of the biasing member.
[0028]
Further, a knife operating lever 27 is provided on the side surface of the grip 8 at the upper rear end. The knife operation lever 27 is connected to the grip 8 so as to be rotatable about a rotation pin 28. Further, a long hole 29 is formed above the rotation center of the knife operation lever 27, and an engagement pin 30 protruding from the rear end side surface of the knife operation rod 17 is inserted into the long hole 29. .
[0029]
The knife operating lever 27 is provided with upper and lower arm portions 31 and 32 arranged in a substantially V shape. One arm portion 31 has a finger hook portion 33 and the other arm 32 abuts on a stopper pin 34 to restrict the rotation range of the knife operating lever 27. Further, a biasing member (not shown) for biasing the knife operation lever 27 in the clockwise direction is attached to the rotation pin 28.
[0030]
Here, by pulling the handle portion 22 a of the trigger 22 toward the grip 8 against the spring force of the urging member, the rod 6 moves forward in the axial direction of the sheath 5 via the rod drive member 9. As the rod 6 advances, the elastic members 12a and 12b protrude from the sheath 5, and are expanded by the elastic restoring force of the elastic members 12a and 12b to open the gripping members 11a and 11b. When the trigger 22 is released, it returns to a fixed position by the spring force of the urging member in the grip 8, and the elastic members 12a and 12b are drawn into the sheath 5 against the elastic restoring force, and the holding members 11a and 11b. Is supposed to close.
[0031]
Further, when a finger is put on the finger hooking portion 33 of the knife operation lever 27 and the knife operation lever 27 is rotated counterclockwise against the urging force of the urging member, the engagement pin inserted in the elongated hole 29 is inserted. The knife operating rod 17 is driven forward through 30 and is pushed down against the elastic force of the knife rod 15 by the operating head 18 at the tip of the knife operating rod 17, so that the incision knife 16 is moved downward from the inside of the gripping member 11a. It can be moved to pass the gripping surfaces of the gripping members 11a and 11b.
[0032]
When the knife operation lever 27 is released, it returns to a fixed position by the spring force of the urging member, the knife operation rod 17 is relatively drawn into the sheath 6 and the knife rod 15 is released, and is moved upward by the elastic restoring force. The incision knife 16 is moved and accommodated in the upper gripping member 11a, and the arm portion 32 stops when it comes into contact with the stopper pin 34.
[0033]
Next, the operation of the first embodiment will be described.
[0034]
A high frequency cable 21a is connected to the electrode pin 21 of the bipolar forceps 1 to electrically connect the bipolar forceps 1 and the high frequency cautery power supply device. In the initial state, the handle 22 a of the trigger 22 of the operation unit 4 is held at a fixed position farthest from the grip 8 as shown in FIGS. 1 (a) and 1 (b), and the treatment unit connection 19 is the axis of the insertion unit 3. It is held at the end position of the direction movement range. In this state, the pair of elastic members 12a and 12b of the treatment section 3 are immersed in the sheath 6 and the gripping members 11a and 11b are closed.
[0035]
In this state, the insertion part 2 of the bipolar forceps 1 is inserted into the body of the patient, and the treatment part 3 at the tip of the insertion part 2 is guided to a position near the living tissue A to be treated in the body. Therefore, the rod 6 is moved forward in the axial direction of the sheath 5 via the rod driving member 9 by pulling the handle portion 22a of the trigger 22 toward the grip 8 against the urging force of the urging member. As the rod 6 advances, the elastic members 12a and 12b protrude from the sheath 6, and the gripping members 11a and 11b are opened by the elastic restoring force of the elastic members 12a and 12b (see FIG. 2).
[0036]
Subsequently, after inserting the living tissue A between the expanded grasping members 11a and 11b and then releasing the trigger 22, the elastic members 12a and 12b are returned to their home positions by the spring force of the biasing member in the grip 8. 6, the grasping members 11a and 11b are closed as shown in FIG. 3, and the living tissue A is grasped between the pair of grasping members 11a and 11b as shown in FIG.
[0037]
At this time, the grasping members 11a and 11b are formed in serrated portions that mesh with each other when closed, and the living tissue A can be reliably grasped. In this state, a high-frequency current flows from the high-frequency ablation power supply device to the electrode pin 21 via the high-frequency cable 21a, and further, a coagulation current flows between the gripping members 11a and 11b via the elastic members 12a and 12b. Coagulation is performed.
[0038]
A solidification current is allowed to flow for a certain period of time to coagulate the biological tissue A (the cross line portion of the biological tissue A in FIG. 6B indicates the portion coagulated by the coagulation current), and then the finger-hanging portion of the knife operation lever 27. When the knife operating lever 27 is rotated counterclockwise against the urging force of the urging member, the knife operating rod 17 is moved via the engaging pin 30 inserted in the long hole 29. Drive forward. As the knife operating rod 17 advances, the operating head 18 pushes down the knife rod 15 against the elastic force, and moves the incision knife 16 downward from the inside of the gripping member 11a.
[0039]
6 (a) and 6 (b), when the incision knife 16 passes through the gripping surfaces of the gripping members 11a and 11b, the solidified portion of the living tissue A gripped between the gripping members 11a and 11b is obtained. The inside is mechanically incised by the cutting edge 16a of the incision knife 16.
[0040]
When the knife operating lever 27 is released after the incision is completed, the knife operating lever 27 is returned to the home position by the spring force of the urging member, the knife operating rod 17 is relatively drawn into the sheath 6 and the operating head 18 is retracted. Is raised by the elastic force of the knife rod 15 and accommodated in the upper gripping member 11a, and the arm portion 32 stops when it comes into contact with the stopper pin 34.
[0041]
When the trigger 22 is released, it returns to a fixed position by the spring force of the biasing member in the grip 8, the elastic members 12a and 12b protrude from the sheath 6, and the gripping members 11a and 11b are moved by the elastic restoring force of the elastic members 12a and 12b. The grasping members 11a and 11b are released from the living tissue A.
[0042]
According to the present embodiment, since the incision knife 16 is normally retracted in the state of being accommodated inside the gripping member 11a, the incision knife 16 causes the treatment section 3 to be guided to the target site in the body cavity. There is no risk of damaging normal tissue, and operability can be improved. Further, even when the sharpness of the cutting knife 16 is lowered, the living tissue A can be reliably cut without escaping.
[0043]
7 to 11 show a second embodiment, and the same components as those of the first embodiment are denoted by the same reference numerals and description thereof is omitted. As shown in FIGS. 7 to 11, a pair of gripping members 41 a and 41 b are provided by elastic members 12 a and 12 b at the tip of the rod 6 inserted in the sheath 5 so as to be able to advance and retreat. The gripping members 41a and 41b are formed with concave grooves 43a and 43b on the surfaces facing each other so that the space portion 42 is formed inside when the gripping members 41a and 41b are closed. It is formed so that the living tissue A can be reliably grasped.
[0044]
The concave groove 43a of the upper gripping member 41a is formed on the inclined surface so as to gradually become shallower toward the near side, and is formed on the guide surface 45 that guides the incision knife 44. The incision knife 44 is a rectangular plate-like body, and has a cutting blade 44a obliquely on the lower front side. When the incision knife 44 is positioned at the deepest tip side in the groove 43a of the upper gripping member 41a, It is retracted so as not to come into contact with the living tissue A.
[0045]
On the other hand, a through hole 46 is provided in the axial direction at a position biased downward from the axis of the rod 6. A knife operating rod 47 made of spring steel is inserted into the through-hole 46 so as to freely advance and retract. The portion of the knife operating rod 47 extending from the tip of the rod 6 is bent obliquely toward the upper gripping member 41a, and the cutting knife 44 is fixed to the tip. The proximal end portion of the knife operation rod 47 extends to the operation unit 4 and is connected to a knife operation lever 27 provided in the operation unit 4. The knife operation lever 27 is connected to the grip 8 so as to be rotatable about a rotation pin 28, and is urged counterclockwise by an urging member (not shown) to advance the knife operation rod 47. Is energized.
[0046]
Next, the operation of the second embodiment will be described. The procedure is the same as in the first embodiment until the grasping members 41a and 41b are closed and the living tissue A is grasped, and the living tissue A is coagulated by causing a coagulation current to flow between the grasping members 41a and 41b. The cross line portion of the biological tissue A in FIG. After the living tissue A is solidified, when a finger is put on the finger hooking portion 33 of the knife operation lever 27 and the knife operation lever 27 is rotated in the clockwise direction against the urging force of the urging member, it is inserted into the long hole 29. The knife operating rod 47 is driven to move backward through the engaging pin 30. With the retraction of the knife operation rod 47, the incision knife 44 provided at the tip of the knife operation rod 47 is pulled to the near side and is guided by the guide surface 45 of the gripping member 41a to move from the deep position of the concave groove 43a to the shallow position. To do.
[0047]
Therefore, as shown in FIG. 11, the cutting blade 44a of the incision knife 44 passes through the gripping surfaces of the gripping members 41a and 41b, and the inside of the solidified portion of the living tissue A gripped between the gripping members 41a and 41b is inside. The incision knife 44 is mechanically incised by the cutting blade 44a.
[0048]
When the knife operation lever 27 is released after the incision is completed, the knife operation lever 27 returns to a fixed position by the spring force of the biasing member, the knife operation rod 47 moves forward, and the incision knife 44 gradually rises by the elastic force of the knife operation rod 47. The arm portion 32 stops when it comes into contact with the stopper pin 34.
[0049]
In the second embodiment, the incision knife 44 is a rectangular plate and has a shape having a cutting blade 44a obliquely on the lower front side. However, as shown in FIG. By using the cutting knife 48 having the letter-shaped cutting edge 48a, the living tissue A can be cut more satisfactorily.
[0050]
According to the present embodiment, since the incision knife 44 is normally retracted in the state of being accommodated in the gripping member 41a, when the treatment unit 3 is guided to the target site in the body cavity, the incision knife 44 is used. There is no risk of damaging normal tissue, and operability can be improved. Further, even when the sharpness of the cutting knife 16 is lowered, the living tissue A can be reliably cut without escaping.
[0051]
13 to 17 show a third embodiment, and the same components as those of the first embodiment are denoted by the same reference numerals and description thereof is omitted. In the present embodiment, a knife wire 50 is provided in place of the incision knife 16 of the first embodiment. A through hole 51 is provided in the axial direction at a position biased downward from the axis of the rod 6, and a knife operating rod 52 made of spring steel is inserted into the through hole 51 so as to be able to advance and retract. A portion of the knife operation rod 52 extending from the tip of the rod 6 is integrally provided with a knife wire 50. The knife wire 50 is provided with a cutting edge 50a having a cross section of an angular axis and an acute upper surface. The proximal end of the knife operation rod 52 extends to the operation unit 4 and is connected to a knife operation lever 27 provided in the operation unit 4.
[0052]
And the front-end | tip part of this knife wire 50 is being fixed to the inner bottom part of the lower holding member 11b by welding etc., and the part located inside the holding member 11b of the knife wire 50 is toward the upper holding member 11a. A curl is attached so as to be curved in an arc shape.
[0053]
Next, the operation of the third embodiment will be described. It is the same as in the first embodiment until the grasping members 11a and 11b are closed and the living tissue A is grasped, and the living tissue A is coagulated by supplying a coagulation current between the grasping members 11a and 11b. The cross line portion of the biological tissue A in FIG. After the living tissue A is solidified, when a finger is put on the finger hooking portion 33 of the knife operation lever 27 and the knife operation lever 27 is rotated counterclockwise against the urging force of the urging member, the elongated hole 29 is formed. The knife operating rod 52 is driven forward via the inserted engagement pin 30. The forward movement of the knife operation rod 52 pushes the knife wire 50 integrally provided at the distal end portion of the knife operation rod 52 forward, and the distal end portion of the knife wire 50 is fixed to the gripping member 11b. Since the curving ridge is attached so as to be curved, it is curved in an arc shape toward the gripping member 11a.
[0054]
Therefore, as shown in FIG. 15, the cutting blade 50a of the knife wire 50 passes through the gripping surfaces of the gripping members 11a and 11b, and the inside of the solidified portion of the living tissue A gripped between the gripping members 11a and 11b is inside. It is mechanically incised by the cutting edge 50a of the knife wire 50.
[0055]
When the knife operation lever 27 is released after the incision is completed, the knife operation lever 27 is returned to a fixed position by the spring force of the urging member, the knife operation rod 52 is retracted, and the knife wire 50 is restored substantially straight by the elastic restoring force to be lowered. The arm portion 32 is accommodated in the concave groove of the holding member 11b and stops when it comes into contact with the stopper pin 34.
[0056]
According to the present embodiment, since the knife wire 50 is retracted in a state of being accommodated inside the gripping member 11b at normal times, the knife wire 50 is used to guide the treatment section 3 to the target site in the body cavity. There is no risk of damaging normal tissue, and operability can be improved. Further, even when the sharpness of the cutting knife 16 is lowered, the living tissue A can be reliably cut without escaping.
[0057]
18 to 23 show a fourth embodiment, and the same components as those of the first embodiment are denoted by the same reference numerals and description thereof is omitted. As shown in FIGS. 21 to 23, the insertion portion 2 includes a rod 55 and a sheath 56 that is externally fitted to the rod 55 so as to advance and retreat in the axial direction. The engagement member 57 is fixed, and the proximal end portion of the rod 55 is fixed to the grip 8 constituting the operation portion 4. A base end portion of the sheath 56 is fixed to a sheath driving member 59 provided in the operation unit 4.
[0058]
The treatment section 3 includes a pair of gripping members 61a and 61b constituting electrodes, and two upper and lower elastic members 62a and 62b that support the gripping members 61a and 61b and urge them in the expanding direction. The base ends of the elastic members 62a and 62b are fixed to the tip of the rod 55. The elastic members 62a and 62b are formed of spring steel or the like, and bent portions 63a and 63b that are bent in a substantially U-shape are formed at the tip, and the surfaces are covered with an insulating coating.
[0059]
As shown in FIG. 20, a sharp incision blade 64 is provided across the front-rear direction at the intermediate portion in the width direction of the grasping surface of the lower grasping member 61b, and both sides of the incision blade 64 are formed as flat surfaces. ing. A plurality of elastic bodies 65 such as silicon rubber are provided on the holding surface of the lower holding member 61b. The height of the elastic body 65 is larger than the height of the incising blade 64. The incision blade 64 is located inside the elastic body 65 so as not to damage the tissue.
[0060]
Next, the operation of the fourth embodiment will be described.
[0061]
In the initial state, the handle 22a of the trigger 22 of the operation unit 4 is held at a fixed position farthest from the grip 8 as shown in FIG. 21, and in this state the sheath 56 is in the retracted position, so that the pair of elastic members 62a, 62b is expanded by an elastic restoring force, and as shown in FIG. 18, the pair of gripping members 61a and 61b are in an open state.
[0062]
In this state, the treatment section 3 at the distal end of the insertion section 2 is guided to a position near the living tissue A to be treated in the body. Subsequently, the living tissue A is inserted between the expanded grasping members 61a and 61b. Accordingly, the handle 22 a of the trigger 22 is pulled toward the grip 8 against the urging force of the urging member, thereby moving forward in the axial direction of the sheath 56 via the sheath driving member 59.
[0063]
As the sheath 56 advances, the elastic members 62a and 62b are relatively drawn into the sheath 56, the gripping members 61a and 61b are closed against the elastic restoring force of the elastic members 62a and 62b, and the living tissue A is shown in FIG. As shown in FIG. 2, the gripping member 61a is gripped between the pair of gripping members 61a and 61b. In this state, a high-frequency current flows from the high-frequency ablation power supply device to the electrode pin 21 via the high-frequency cable 21a, and further a coagulation current flows between the gripping members 61a and 61b via the elastic members 62a and 62b. Coagulation is performed.
[0064]
After solidifying the living tissue A by flowing a coagulation current for a certain period of time, as shown in FIG. 23, the handle 22a of the trigger 22 is further pulled toward the grip 8 against the biasing force of the biasing member. That is, when the trigger 22 is pulled more strongly, the sheath 56 moves further forward in the axial direction via the sheath driving member 59.
[0065]
As the sheath 56 advances, the elastic members 62a and 62b are drawn relatively deeply into the sheath 56, and the gripping members 61a and 61b are strongly closed, so that the elastic body 65 is compressed and the cutting blade 64 is relatively moved. Protruding. Accordingly, the living tissue A that is held between the gripping members 61 a and 61 b through the cutting surface of the gripping members 61 a and 61 b is mechanically cut by the cutting blade 64.
[0066]
When the trigger 22 is released after the incision is completed, the trigger 22 is returned to a fixed position by the spring force of the urging member, the sheath 56 is retracted and opened by the elastic restoring force of the elastic members 62a and 62b, and the grasping members 61a and 61b are living tissue. Freed from A.
[0067]
In this embodiment, the living tissue A can be grasped and solidified by a series of operations of grasping the grip 8 and pulling the handle portion 22a of the trigger 22, and the solidified portion can be incised to improve operability. it can. Further, even when the sharpness of the cutting knife 16 is lowered, the living tissue A can be reliably cut without escaping.
In the present embodiment, the cutting blade 64 and the elastic body 65 are provided only on the lower gripping member 61b of the pair of gripping members 61a and 61b. However, as shown in FIG. 24, the pair of gripping members 61a 61b, the cutting blade 64 and the elastic body 65 may be provided opposite to each other. As shown in FIG. 25, both the lower gripping member 61b or the pair of gripping members 61a, 61b are provided with springs 66. The block 67 may be attached, and the height of the block 67 may be higher than the cutting blade 64 in a normal state.
[0068]
According to the present embodiment, since the cutting blade 64 is normally retracted in a state of being immersed between the elastic bodies 65, the cutting blade 64 is used to guide the treatment section 3 to the target site in the body cavity. There is no risk of damaging normal tissue, and operability can be improved.
[0069]
In the first to fourth embodiments described above, the incision means in the incision blade and the knife wire has been described with respect to the mechanical incision. However, the incision current is supplied to the incision blade and the knife wire at the time of incision. An electrical incision may be made.
[0070]
26 to 31 show a first disclosed example of an endoscopic surgical instrument, and FIG. 31 is an overall configuration diagram. The surgical instrument 70 includes an insertion portion 71, a treatment portion 72 provided at the distal end portion of the insertion portion 71, and an operation portion 73 provided at the proximal end portion of the insertion portion 71. The surgical instrument 70 is a high-frequency ablation. It is connected to the power supply device 74.
[0071]
As shown in FIGS. 26-30, the insertion part 71 is comprised by the double tube | pipe structure from the inner sheath 75 and the outer sheath 76 which is externally fitted by this inner sheath 75, and can move forward / backward in an axial direction. The distal end portion of the inner sheath 75 protrudes from the distal end portion of the outer sheath 76, and a fixed jaw 77 is provided on this protruding portion. A serrated irregular surface is formed on the upper surface of the fixed jaw 77, and a guide groove 77a is provided in the middle in the width direction in the front-rear direction. Further, slide grooves 78 that are long in the front-rear direction are provided on both side surfaces of the fixed jaw 77, and pivot pins 79 that are provided so as to penetrate the distal end portion of the outer sheath 76 in the lateral direction are inserted into the slide grooves 78. ing. Accordingly, the outer sheath 76 can advance and retract within the range of the length of the slide groove 78.
[0072]
Further, a movable jaw 80 is pivotally supported at an intermediate portion of the pivot pin 79 so as to be rotatable. The movable jaw 80 faces the guide groove 77a of the fixed jaw 77 and is formed narrower than the groove width of the guide groove 77a. Further, a connecting pin 81 is provided at the base end portion of the movable jaw 80 and below the pivot pin 79, and the tip end portion of the jaw operating rod 82 is rotatably connected to the connecting pin 81. Has been. The jaw operation rod 82 extends through the inner sheath 75 to the operation portion 73, and the inner sheath 75 and the outer sheath 76 also extend to the operation portion 73.
[0073]
The operation unit 73 includes a fixed handle 83, a movable handle 85 pivotally supported on the fixed handle 83 by a pivot shaft 84, and a biasing member (not shown) for biasing the movable handle 85 in the counterclockwise direction. It consists of and. A proximal end portion of the inner sheath 75 is connected to the fixed handle 83, and a proximal end portion of the outer sheath 76 extends to the vicinity of the fixed handle 83, and between the fixed handle 83 and the proximal end portion of the outer sheath 76. Is provided with a coil spring 86 to be fitted to the inner sheath 75. The outer sheath 76 is urged in the forward direction by the restoring force of the coil spring 86. The movable handle 85 is connected to the proximal end portion of the jaw operation rod 82.
[0074]
Further, a current switching switch 87 for switching between a coagulation current and an incision current is attached to the upper portion of the fixed handle 83. A switch operating lever 88 is attached to the proximal end portion of the outer sheath 76 facing the current changeover switch 87. The current changeover switch 87 is connected to the high-frequency ablation power supply device 74 via a cable 89.
[0075]
Next, the operation of the surgical instrument 70 configured as described above will be described.
[0076]
First, the insertion portion 71 is inserted into the body cavity to guide the treatment portion 72 to the treatment target site. In a normal state, the movable handle 85 is urged counterclockwise by the urging member, so that the jaw operating rod 82 is in the advanced state by the movable handle 85, and the movable jaw 80 supports the pivot pin 79 as a fulcrum. The movable jaw 80 is opened with respect to the fixed jaw 77 by rotating clockwise.
[0077]
Therefore, as shown in FIG. 27, when the living tissue A is inserted between the fixed jaw 77 and the movable jaw 80 and the finger is hooked on the finger-hanging portion of the movable handle 85 and rotated in the clockwise direction approaching the fixed handle 83. The jaw operating rod 82 moves backward. When the jaw operating rod 82 is pulled toward the hand side, as shown in FIG. 28, the movable jaw 80 connected via the connecting pin 81 rotates counterclockwise with the pivot pin 79 as a fulcrum, and is fixed. The movable jaw 80 is closed with respect to the jaw 77 to grip the living tissue A.
[0078]
Therefore, when a coagulation current is supplied from the high-frequency ablation power supply 74, the coagulation current flows between the fixed jaw 77 and the movable jaw 80 via the cable 89 and the current changeover switch 87, and the living tissue A is coagulated. Is called.
[0079]
After the coagulation current is allowed to flow for a certain time to coagulate the living tissue A, when the movable handle 85 is further rotated in the direction approaching the fixed handle 83, the jaw operation rod 82 is further retracted. When the jaw operating rod 82 is further pulled to the proximal side, the movable jaw 80 coupled via the coupling pin 81 is pulled toward the proximal side, so that the outer sheath 76 coupled via the pivot pin 79 is also coiled. The spring 86 moves backward against the restoring force of the spring 86. At this time, since the pivot pin 79 is supported by the slide groove 78, the pivot pin 79 slides back in the slide groove 78, and the movable jaw 80 moves along the guide groove 77 a of the fixed jaw 77. . That is, the operation shifts to an operation of incising the living tissue A solidified by the movable jaw 80 by a shearing force. At this time, the switch operating lever 88 presses the current switching switch 87 and switches the current by the retraction of the outer sheath 76. An incision current flows from the power supply device 74 between the fixed jaw 77 and the movable jaw 80. Therefore, mechanical incision by moving the movable jaw 80 and electrical incision with an incision current can be performed simultaneously.
[0080]
After the incision is completed, when the movable handle 85 is released, it returns to a fixed position by the spring force of the biasing member, the outer sheath 76 moves forward, the jaw operating rod 82 moves forward, the movable jaw 80 moves forward, and the fixed jaw It opens in a direction away from 77 and is released from the living tissue A.
[0081]
In the present embodiment, the living tissue A can be grasped and solidified by a series of operations in which the movable handle 85 is rotated in the approaching direction toward the fixed handle 83, and the solidified portion can be incised to improve operability. be able to.
[0082]
FIG. 32 shows a second disclosed example of the surgical instrument, and the same components as in the first disclosed example are assigned the same reference numerals and explanations thereof are omitted. In the present disclosure example, the operation unit 73 of the first disclosure example is provided with a lock mechanism. An extension lever 90 extending toward the proximal side is provided at the proximal end portion of the outer sheath 76, and a latching portion 91 is provided at the distal end portion of the extension lever 90. The fixed handle 83 is provided with a latching claw 93 that can be rotated by a trigger 92, and the latching claw 93 is latched by a latching portion 91. Therefore, the outer sheath 76 is locked so as not to move in the front-rear direction with respect to the fixed handle 83, so that the movable jaw 80 does not move in the front-rear direction carelessly.
[0083]
With this configuration, when the living tissue A is grasped and solidified, the outer sheath 76 does not retract even if the movable handle 85 is excessively operated, and an inadvertent incising operation by the movable jaw 80 is performed. In the incision, the trigger 92 is operated to remove the latching claw 93 from the latching portion 91 and release the lock.
[0084]
FIG. 33 shows a third disclosed example of the surgical instrument, and the same components as those in the first disclosed example are assigned the same reference numerals and explanation thereof is omitted. In the present disclosure, the jaw operating rod 82 is driven by a movable handle 85, and the outer sheath 76 is driven by a sheath slide actuator 94 provided on the fixed handle 83.
[0085]
The high-frequency ablation power supply 74 is provided with an impedance detector 95, and this impedance detector 95 is connected to an actuator driving device 96 that drives a sheath slide actuator 94. After a coagulation current is supplied from the high-frequency ablation power supply 74 and the coagulation current is supplied between the fixed jaw 77 and the movable jaw 80 to coagulate the living tissue A, the impedance of the living tissue A is detected by the impedance detector 95. To determine whether coagulation is complete.
[0086]
When it is determined that the coagulation is completely performed by the impedance of the living tissue A, the impedance detector 95 outputs a drive signal to the actuator driving device 96, and the actuator driving device 96 drives the sheath slide actuator 94 to remove the external signal. The sheath 76 is moved backward, and the movable jaw 80 is slid rearward to cut the living tissue A. With this configuration, when the living tissue A is grasped and solidified, the outer sheath 76 does not retract even if the movable handle 85 is excessively operated, and an inadvertent incising operation by the movable jaw 80 is performed. Can be prevented.
[0087]
34 and 35 show a fourth disclosed example, and the same components as those in the first disclosed example are denoted by the same reference numerals and description thereof is omitted. In the present disclosure example, insulating layers 79A and 80A are provided on the pivot pin 79 and the movable jaw 80 pivotally supported by the pivot pin 79, and the fixed jaw 77 and the movable jaw 80 are electrically insulated to be bipolarized. Is.
[0088]
36 and 37 show a fifth disclosed example. The present disclosure includes a first movable jaw 101 that is movable in the axial direction and a second movable jaw 103 that is fixed to the arm 102 at the distal end portion of the slide pipe 100 that is movable in the axial direction as an insertion portion. Has been. The arm 102 is formed of an elastic member and is bent in the expanding direction. When the slide pipe 100 is retracted, the second movable jaw 103 is opened with respect to the first movable jaw 101, and the slide pipe. As the 100 moves forward, the second movable jaw 103 is closed with respect to the first movable jaw 101 so that the living tissue A can be grasped.
[0089]
Then, after the coagulation current is passed between the first movable jaw 101 and the second movable jaw 103 from the high-frequency ablation power supply device to coagulate the living tissue A, the first movable jaw 101 and the second movable jaw are coagulated. When an incision current is passed between the first movable jaw 101 and the first movable jaw 101 is retracted, a mechanical incision by the movement of the first movable jaw 101 and an electrical incision with the incision current can be performed simultaneously.
[0090]
When the slide pipe 100 is retracted after the incision is completed, the second movable jaw 103 is opened away from the first movable jaw 101 by the elastic force of the arm 102 and released from the living tissue A. .
[0091]
According to the embodiment, the following configuration is obtained.
[0092]
(Appendix 1) In an endoscopic surgical instrument comprising a pair of grasping members for grasping a tissue, a bipolar electrode provided on a grasping surface of the grasping member, and an incision means for incising the tissue, the incision means includes: A gripping surface that is disposed in a first position accommodated in the gripping member so as not to contact the tissue to be gripped, and at the time of incision, at least a part of the incision means is formed by a pair of gripping members from the first position. An endoscopic surgical instrument characterized by being movable so as to pass therethrough.
[0093]
(Supplementary note 2) The endoscopic surgical instrument according to supplementary note 1, wherein the incision means is supported by an elastic member that is movable in accordance with an opening / closing operation of a grasping member to be accommodated.
[0094]
(Supplementary Note 3) The incision means has an incision operation member, and this incision operation member engages with the first position that does not engage with the elastic member that urges the incision means and the elastic member and resists the urging force. The endoscopic surgical instrument according to appendix 1 or 2, wherein the incision means can be moved to a second position where the incision means protrudes from the grasping member.
[0095]
(Appendix 4) The endoscopic surgical instrument according to appendix 1 or 2, wherein the incision means is an incision blade having a sharp cutting edge.
[0096]
(Additional remark 5) The incision means can move between the first position housed in the gripping member and the second position retracted into the insertion portion. Endoscopic surgical instrument.
[0097]
(Appendix 6) The endoscopic surgical instrument according to appendix 5, wherein the incision means is an incision blade having an L-shaped cutting blade.
[0098]
(Supplementary Note 7) The incision means is a knife wire having a tip fixed to one gripping member and a rear end movable with respect to the gripping member, and the knife wire is curved and gripped with a forward movement. The endoscopic surgical instrument according to appendix 1, wherein the endoscopic surgical instrument passes through a gripping surface of a member.
[0099]
(Appendix 8) The endoscopic surgical instrument according to appendix 7, wherein the knife wire has a sharp cutting edge in the bending direction.
[0100]
(Supplementary note 9) In a high-frequency treatment instrument having a function for incising a coagulation site after coagulation of a tissue, an elastic member for controlling the incision of the tissue is provided in the tissue grasping portion so that the tissue is not incised by a normal grasping operation. A high-frequency treatment tool characterized by comprising:
[0101]
(Additional remark 10) The high frequency treatment tool of Additional remark 9 characterized by performing coagulation | solidification operation and incision operation by a series of operation | movement.
[0102]
(Additional remark 11) The high frequency treatment tool of Additional remark 10 characterized by performing coagulation operation and incision operation by a series of operation | movement by operation of an operation part.
[0103]
(Supplementary note 12) The high-frequency treatment instrument according to supplementary note 9, wherein the elastic member is silicon rubber.
[0104]
(Additional remark 13) Silicone rubber is supported by the spring, The high frequency treatment tool of Additional remark 12 characterized by the above-mentioned.
[0105]
(Supplementary note 14) The high-frequency treatment instrument according to supplementary note 9, wherein the tissue incision part is provided on a part of the tissue gripping surface and has a sharp cutting edge.
[0106]
(Supplementary note 15) The high frequency treatment instrument according to supplementary note 14, wherein the tissue incision portion has a tissue gripping surface on both sides thereof.
[0107]
(Supplementary Note 16) In an endoscopic surgical instrument having a pair of jaws that open and close relatively at the distal end of the insertion portion and coagulate tissue, one jaw opens and closes to the other jaw and An endoscopic surgical instrument that slides substantially parallel to an insertion portion, has a coagulation surface formed on the tissue contact surface of a pair of jaws, and conducts tissue incision by applying a high-frequency current to the coagulation surface.
[0108]
(Supplementary Note 17) The pair of jaws includes a first jaw and a second jaw. The first jaw is supported by a fulcrum pin so as to be rotatable with respect to the second jaw, and the fulcrum pin is a second jaw. The jaw is slidable in a slide groove provided substantially parallel to the insertion portion, and the fulcrum pin is connected to a sheath provided to be slidable with respect to the second jaw. The endoscopic surgical instrument according to Supplementary Note 16, which is provided.
[0109]
(Supplementary Note 18) The first jaw is supported by an elastically deformable arm, and the sheath is opened and closed by sliding and engaging the arm, and the second jaw slides relative to the first jaw and the sheath. The endoscopic surgical instrument according to appendix 16, wherein the sheath is provided with a slide preventing means.
[0110]
(Supplementary note 19) The endoscopic surgical instrument according to supplementary note 17 or 18, wherein the slide preventing means includes a coil spring that biases the sheath in the distal direction.
[0111]
(Supplementary note 20) The endoscopic surgical instrument according to supplementary note 19, wherein the slide preventing means further includes a latching portion connected to the sheath and a latching claw that engages and disengages with the latching portion.
[0112]
(Supplementary note 21) The endoscopic surgical instruments according to supplementary notes 16 to 18 have a slide preventing means including a sheath slide actuator, an impedance detector for detecting impedance of a living tissue, and an actuator driving device, and are coagulated. An endoscopic surgical instrument characterized in that an actuator driving device operates a sheath slide actuator to slide a jaw when an impedance of a tissue exceeds a predetermined value.
[0113]
(Appendix 22) The endoscopic surgical instrument according to any one of Appendixes 16 to 21 includes means for insulating one jaw from the other jaw, and each jaw can be supplied with a high-frequency current of a different polarity. Endoscopic surgical instrument.
[0114]
(Supplementary note 23) The endoscopic surgical instrument according to any one of supplementary notes 16 to 21, wherein the jaw is closed and a coagulation current is applied when the tissue is coagulated, and an incision current is applied when the jaw is slid. -Endoscopic surgical instruments that can be incised.
[0115]
(Supplementary note 24) The endoscopic surgical instrument according to supplementary note 23, comprising means for changing a current from a coagulation current to an incision current in response to the start of jaw sliding.
[0116]
【The invention's effect】
As described above, according to the present invention, the incision means is accommodated inside the gripping member so as not to contact the tissue to be grasped, and at least a part of the incision means is formed by the pair of gripping members at the time of incision. Therefore, when inserted into a body cavity, there is no risk that the incision means will come into contact with normal tissue and cause damage, and operability can be improved. Moreover, even if the sharpness of the incision means is lowered, there is an effect that the incision can be surely incised without losing the living tissue at the time of incision.
[Brief description of the drawings]
1A and 1B show a first embodiment of the present invention, in which FIG. 1A is a plan view of an entire endoscopic surgical instrument, FIG. 1B is a side view thereof, and FIG. 1C is a state in which a gripping member is opened; Side view.
FIG. 2 is an operation explanatory diagram of the endoscopic surgical instrument according to the embodiment.
FIG. 3 is an operation explanatory diagram of the endoscopic surgical instrument according to the embodiment.
FIG. 4 is a longitudinal side view showing the embodiment, with a gripping member being opened.
5A is a longitudinal sectional side view showing a state where the grasping member is closed and the living tissue is coagulated, and FIG. 5B is a cross-sectional view taken along the line AA.
6A and 6B show the same embodiment, in which FIG. 6A is a longitudinal side view of a living tissue incised state, and FIG. 6B is a cross-sectional view taken along line BB.
FIG. 7 is an operation explanatory view of an endoscopic surgical instrument showing a second embodiment of the present invention.
FIG. 8 is an operation explanatory diagram of the endoscopic surgical instrument according to the embodiment.
FIG. 9 is a longitudinal side view showing the embodiment, with a gripping member being opened.
FIG. 10 is a longitudinal side view showing the same embodiment and showing a state where the grasping member is closed and the living tissue is coagulated.
11A and 11B show the embodiment, in which FIG. 11A is a longitudinal side view of a living tissue incised state, and FIG. 11B is a cross-sectional view taken along the line CC.
FIG. 12 is a side view showing a modification of the cutting blade of the embodiment.
FIG. 13 is a longitudinal side view of the third embodiment of the present invention with the gripping member open.
FIG. 14 is a longitudinal side view showing the embodiment, in a state where the grasping member is closed and the living tissue is coagulated.
15A is a longitudinal sectional side view of an incised state of a living tissue, and FIG. 15B is a cross-sectional view taken along the line DD.
FIG. 16 is an operation explanatory view of the endoscopic surgical instrument according to the embodiment.
FIG. 17 is an operation explanatory diagram of the endoscopic surgical instrument according to the embodiment.
18 shows a fourth embodiment of the present invention, and is a longitudinal side view taken along the line HH of FIG. 20B in a state where a gripping member is opened. FIG.
19 shows the same embodiment, (a) a longitudinal side view taken along the line HH in FIG. 20 (b) in a state where the grasping member is closed and the living tissue is coagulated, and FIG. 19 (b) is an EE view. Sectional drawing which follows a line.
FIG. 20 shows the same embodiment, (a) is a longitudinal side view of an incision state of a living tissue, and (b) is a cross-sectional view taken along line FF.
FIG. 21 is an operation explanatory diagram of the endoscopic surgical instrument according to the embodiment.
FIG. 22 is an operation explanatory diagram of the endoscopic surgical instrument according to the embodiment.
FIG. 23 is an operation explanatory view of the endoscopic surgical instrument according to the embodiment.
FIG. 24 is a cross-sectional view of a gripping member showing a modification of the embodiment.
FIG. 25 is a cross-sectional view of a gripping member showing a modification of the embodiment.
FIG. 26 is a plan view of a treatment portion showing a first disclosed example of an endoscopic surgical instrument.
FIG. 27 is a side view of the treatment portion of the disclosed example.
FIG. 28 is a side view showing a state in which a living tissue is grasped and solidified by the grasping member of the disclosed example.
FIG. 29 is a side view showing a state in which a living tissue is incised by the grasping member according to the disclosed example.
FIG. 30 is a cross-sectional front view at the time of incision according to the disclosed example.
FIG. 31 is a side view showing the overall configuration of the endoscopic surgical instrument of the disclosed example.
FIG. 32 is a side view of the operation unit side showing a second disclosed example of an endoscopic surgical instrument.
FIG. 33 is a side view of the operation unit side showing a third disclosed example of an endoscopic surgical instrument.
FIG. 34 is a longitudinal plan view of a treatment section showing a fourth disclosed example of an endoscopic surgical instrument.
FIG. 35 is a cross-sectional front view of the treatment section showing the disclosed example.
FIG. 36 is a side view of a treatment portion showing a fifth disclosed example of an endoscopic surgical instrument.
FIG. 37 is a side view showing a state in which a living tissue is incised, showing the disclosed example.
[Explanation of symbols]
2 ... Insertion section
3 ... treatment section
4 ... Operation part
11a, 11b ... gripping member
16 ... Incision blade

Claims

A pair of gripping members that are opened and closed to form a gripping surface;
A bipolar electrode provided on the pair of gripping members;
An incision member;
A space that is provided in the gripping member and that is defined by an inner wall that opens to the gripping surface and faces the gripping surface and can accommodate the entire incision member;
An elastic member that supports the incision member movably in the opening and closing direction of the gripping member between the pair of gripping members and biases it toward the inner wall;
The cutting member can be moved forward and backward, and the elastic member is pressed and elastically deformed in the opening and closing direction by pressing the elastic member, so that the cutting member is passed through the holding surface so that at least a part of the cutting member passes through the holding surface. An operation member movable in the opening and closing direction;
An endoscopic surgical instrument comprising:

A pair of gripping members that are opened and closed to form a gripping surface;
A bipolar electrode provided on the pair of gripping members;
An incision member;
A space that is provided in the gripping member and that is defined by an inner wall that opens to the gripping surface and faces the gripping surface and can accommodate the entire incision member;
An elastic operation member that supports the cutting member movably in the opening and closing direction of the gripping member between the pair of gripping members and urges the cutting member together with the cutting member;
An inclined surface provided on the inner wall and inclined in the opening / closing direction with respect to the advancing / retreating direction of the cutting member;
The cutting member is advanced and retracted along the slope by the elastic operation member, so that at least a part of the cutting member can pass through the gripping surface.
Endoscopic surgical instrument characterized by that.

A pair of gripping members that are opened and closed to form a gripping surface;
A bipolar electrode provided on the pair of gripping members;
An incision member;
A space that is provided in the gripping member and that is defined by an inner wall that opens to the gripping surface and faces the gripping surface and can accommodate the entire incision member;
The incision member is integrally provided and can be moved forward and backward, and a distal end portion is fixed to one gripping member of the pair of gripping members, and the incision member is urged toward the inner wall of the one gripping member. The bending member is attached to bend toward the other holding member of the pair of holding members, and is elastically deformed by an advancing and retreating operation so that at least a part of the cutting member passes through the holding surface. An elastic operation member movable in the opening and closing direction of the pair of gripping members;
An endoscopic surgical instrument comprising: