JP6662690B2 - Endoscopic surgical instruments - Google Patents

Description

  An embodiment of the present invention relates to an endoscopic surgical instrument used to resect and remove a tumor or the like under an endoscope.

In recent years, endoscopic surgery has been widely performed. Endoscopic surgery is a minimally invasive surgery that places less burden on the patient than conventional surgery in which a large incision is made in the patient's body.
Endoscopic surgery is being applied more and more, supported by advances in endoscopes, digital cameras, and image processing technologies. In recent years, endoscopic surgery has been successful in the field of brain surgery, including laparoscopic surgery for gastrointestinal cancer such as gastric cancer.

  In endoscopic surgery, a small hole is made in the body surface of a patient, and a surgical instrument such as an endoscope, long forceps, or an exfoliator is inserted through the hole through a tube such as a trocar. There are many types of surgical instruments, such as forceps, exfoliators, scalpels, and scissors. All the surgical instruments have in common that they have an elongated rod-shaped shaft portion, and while the endoscope image is being viewed, the inserted surgical instrument is used to grasp the affected part, perform a procedure such as peeling or excision.

  As a prior art of surgical instruments used for treatment in endoscopic surgery, there is a surgical instrument as disclosed in Patent Document 1.

JP-A-2013-092948

In recent years, even in the field of neurosurgery, it has become possible to observe precise diseased parts using high-resolution endoscopes, and it has become relatively safe to perform operations for detaching nerves and blood vessels. Various surgical methods such as a keyhole approach have been developed.
Endoscopic neurosurgery requires very fine exfoliation, incision, coagulation, and other operations after the tip of the surgical instrument reaches a lesion in the brain through a narrow corridor (Corridor) .

  However, in surgery in the deep brain deep inside the skull, such as skull base tumor surgery, conventional bipolar devices, forceps, and exfoliators may or may not reach the lesion. There was a scene where operation was not possible.

  The reason that the surgical instrument does not reach the lesion and effective operation becomes difficult is that the conventional instrument has a circular cross-section, so the shaft rotates even if the angle is adjusted freely. This is because there was a problem that the angle adjustment was difficult.

  The present invention has been made in view of the above-mentioned problems of the related art, and has a shaft portion that can be easily and appropriately bent so that an approach to a lesion and effective operation can be performed. It is intended to provide an endoscopic surgical instrument.

In order to achieve the above object, an endoscopic surgical instrument according to the present invention includes a shaft portion, a treatment portion provided at a distal end portion of the shaft portion, and performing a treatment on a lesion, and a shaft portion. and a grip portion for gripping which is connected to the tail end, consist, on the shaft portion, the thickness is relatively thin, flexibility increasing portion is formed, the flexibility increasing portion, before Symbol treatment unit A first recess row having one or more recesses, wherein the first portion is provided at two locations: a tip portion of the shaft portion adjacent to the grip portion; and a tail end portion of the shaft portion close to the grip portion. a second concave portion rows with different recesses of said first concave portion rows and orientation about the axis of the shaft portion, and is characterized in Tona Rukoto.

FIG. 1 is a plan view showing an exfoliator as an endoscopic surgical instrument according to an embodiment of the present invention. It is a front view of the stripper of FIG. It is a perspective view which shows the flexibility increasing part formed in the front-end | tip part of a peeling element. It is a figure explaining bending at the tip part of a stripper. It is a front view which shows the modification of the treatment part of the exfoliator which is an endoscopic surgical instrument by embodiment of this invention. It is a top view which shows the other modification of the treatment part of a stripper. It is a front view which shows another modification of the treatment part of a stripper.

Hereinafter, the best embodiment of the endoscopic surgical instrument according to the present invention will be described with reference to the accompanying drawings.
FIG. 1 is a plan view showing a preferred embodiment in which the present invention is applied to a peeler used in endoscopic surgery, and FIG. 2 is a front view of the peeler according to the embodiment.

The exfoliator 10 is roughly composed of an elongated shaft portion 12 and a grip portion 13 which is held by a surgeon's hand. A treatment section 14 is provided at the tip of the shaft section 12 for performing a treatment such as exfoliation of a lesion or the like of a lesion.
In this embodiment, the treatment section 14 is configured as a ring-shaped curette. This curette is made of mariable (for example, SUS316). In this embodiment, the grip portion 13 is formed in a round bar shape, and its surface is knurled to prevent slippage.

Next, the shaft portion 12 will be described.
The shaft portion 12 is a long and narrow circular cross-section shaft made of stainless steel having good corrosion resistance. The shaft portion 12 gradually becomes thinner toward the tip. At predetermined positions of the shaft portion 12, bendability increasing portions 16 and 17, which facilitate bending, are provided as follows.
In this embodiment, the flexibility increasing portion is located near the treatment portion 14 on the distal end side of the shaft portion 12 and near the grip portion 13 at the tail end of the shaft portion 12. It is provided at two places of the second flexibility increasing portion 17 located at the designated positions. The first flexibility increasing portion 16 is provided on the distal end side of the shaft portion 12 so that the treatment portion 14 can accurately reach the lesioned portion. The reason why it is provided on the end side is to prevent interference between the high-resolution endoscope and the like and the shaft portion 12.

Here, FIG. 3 is a perspective view showing a tip portion of the shaft portion 12. In FIG. 3, the direction is defined as follows. The X direction is an axial direction of the shaft portion 12, and directions perpendicular to the X direction are defined as a Y direction and a Z direction, respectively.
As shown in FIG. 3, in the first flexibility increasing portion 16, concave portions 20 a and 20 b formed with concave surfaces which are crushed from both sides and have a reduced thickness are formed so as to be continuous in the axial direction. In this case, a similar recess 20a is formed on the back side of the recess 20a shown in FIG. The same applies to the recess 20b.

  One of the concave portions 20a, 20a,... Is arranged at a constant interval, and forms a first concave portion row. In FIG. 3, the central portion of the concave portion 20a that looks elliptical when viewed from the Z direction has a concave surface that is concave in the Z direction.

The other recesses 20b, 20b,... Are arranged at the same interval to form a second row of recesses. In FIG. 3, the central portion of the recess 20b, which looks oblong in the Y direction, has a concave surface that is recessed in the Y direction. And
In such a first row of concave portions and a second row of concave portions, the concave portions 20a and the concave portions 20b are in a relationship in which the arrangement is shifted by a half pitch. The direction of each of the oval concave surfaces of the concave portions 20a and 20b is different by 90 degrees with respect to the axis of the shaft portion 12.

  Next, the second increased flexibility portion 17 formed at the tail end of the shaft portion 12 is formed in the same structure as the first increased flexibility portion 16.

  As shown in FIGS. 1 and 2, a series of the recesses 26a, the recesses 26a... Forms a first row of recesses, and a series of the recesses 26b, the recesses 26b. In this case, the direction of the concave surface is alternately different by 90 degrees between the concave portions 26a and the concave portions 26b, and the concave portions 26a and the concave portions 26b are shifted from each other by a half pitch.

The endoscopic surgical instrument according to the present embodiment is configured as described above. Next, the operation and effects thereof will be described.
In the exfoliator according to the present embodiment, since the first flexibility increasing portion 16 and the second flexibility increasing portion 17 are formed on the shaft portion 12, the shaft portion can be easily bent as follows. ing.

Here, FIG. 4 is a diagram illustrating the bending of the first flexibility increasing portion 16 at the tip of the shaft portion 12.
In FIG. 4A, the recess 20a which looks like an oval is a recess having a relatively small thickness in the Z direction that makes the tip of the shaft portion 12 bend easily in the Z direction. As indicated by a dashed line in FIG. 3, the first flexibility increasing portion 16 can be easily bent in the Z direction.

  In addition to this, the concave portion 20b which looks elliptical in FIG. 4 (b) forms a concave portion having a relatively thin wall thickness in the Y direction which makes the tip of the shaft portion 12 easily bendable in the Y direction. As virtually shown by a chain line in FIG. 4A, the first flexibility increase 16 can be easily bent in the Y direction.

As described above, at the distal end portion of the shaft portion 12 according to the present embodiment, the directions of the concave portions 20a and the concave portions 20b are alternately different by 90 degrees, and the concave portions 20a and the concave portions 20b are shifted by a half pitch in the first flexibility. Since the enlarged portion 16 is formed, the distal end portion of the shaft portion 12 can be freely bent not only in one direction but also in various directions.
Since the second flexibility increasing portion 17 shown in FIGS. 1 and 2 has exactly the same structure as the first flexibility increasing portion 16, the base portion of the shaft portion 12 can be freely moved in various directions as necessary. It becomes possible to bend. Moreover, by combining the first flexibility increasing portion 16 and the second flexibility increasing portion 17, the degree of freedom of the bending shape given to the shaft portion 12 is increased. As a result, there is an effect that it is possible to ensure that the treatment section 14 properly reaches the lesion, and to prevent interference with the high-resolution endoscope and the like. In addition, it is easy to return to the original straight state after bending the first flexibility increasing section 16 and the second flexibility increasing section 17.

  As described above, according to the exfoliator according to the present embodiment, the shaft portion 12 is formed by the first flexibility increasing portion 16 and the second flexibility increasing portion 17 in accordance with the bending of the approach path to the lesion. Can be easily bent, so that the treatment section 14 at the distal end can reach the lesion, and operations such as exfoliation and resection can be effectively performed. For example, in nasal endoscopic surgery, when the tumor is deep in the brain, the shape of the shaft portion 12 can be bent so that it can easily reach along the corridor. When the treatment section 14 is reached, effective peeling, excision, and extraction operations can be performed.

  As described above, the endoscopic surgical instrument according to the present invention has been described with reference to the best embodiment. However, various variations are possible for the flexibility increasing portion provided on the shaft portion.

  In the above-described embodiment, in the first increased flexibility portion 16, the concave portions 20 a and 20 b have a structure in which each of the concave portions 20 b is crushed from both sides of the shaft 12 to form a concave surface, but the concave surface is formed by crushing only one side. You may make it. The processing of the concave surface may be not only plastic processing but also cutting processing. This is the same for the second flexibility increasing portion 17.

  Further, the first flexibility increasing portion 16 and the second flexibility increasing portion 17 may have a substantially rectangular cross section. Further, the first flexibility increasing portion 16 and the second flexibility increasing portion 17 may have a bellows-like structure processed by bending or the like.

  Further, in the above-described embodiment, the first flexibility increasing portion 16 has the concave portions 20a and 20b in which the directions of the concave surfaces are different by 90 degrees, but only one of them may be used. This is the same for the second flexibility increasing portion 17.

  Further, in the above-described embodiment, the first flexibility increasing portion 16 has a structure in which the plurality of recesses 20a and 20b are respectively arranged in the axial direction. However, the present invention is not limited to this, and the number of recesses is minimum. You only need one. The same applies to the second flexibility increasing portion 17.

(Modification)
Next, a modified example of the peeler according to the present embodiment will be described with reference to FIGS.
5 to 7 show modified examples of the treatment section 14 of the peeler 10. In this case, the configuration of the shaft portion 12 is the same as that of the embodiment shown in FIGS.

  FIG. 5 shows the treatment section 14 including a hook 30 for peeling a nerve or the like. FIG. 6 shows the treatment section 14 composed of a small disk-shaped round plate 31. FIG. 7 shows the treatment section 14 including the curved spatula 32. Thus, various shapes can be adopted for the treatment section 14.

  The above is an embodiment in which the present invention is applied to an exfoliator in an endoscopic surgical instrument, but the present invention is also applicable to scalpels such as bipolar and forceps. In this case, the exfoliator is common to the exfoliator in that the exfoliator has an elongate shaft portion, and therefore, a portion having increased flexibility may be formed in the shaft portion.

  The above embodiment is an example in which the first flexibility increasing portion 16 and the second flexibility increasing portion 17 are provided at two places, but the present invention is not limited to this. Only one of the first flexibility increasing portion 16 and the second flexibility increasing portion 17 may be provided, or three or more locations may be provided. Further, the entire shaft portion 12 may be a flexure increasing portion.

DESCRIPTION OF SYMBOLS 10 ... Peeling element, 12 ... Shaft part, 13 ... Grip part, 14 ... Treatment part, 15 ... Joint, 16 ... 1st flexibility increase part, 17 ... 2nd flexibility increase part, 20a, 20b ... Depression, 26a, 26b: recess, 30: hook, 31: round plate, 32: spatula

Claims (3)

Shaft part,
A treatment unit provided at the distal end of the shaft unit for performing treatment on a lesion,
A grip portion for gripping connected to the tail end of the shaft portion,
The shaft portion is formed with a relatively increased flexibility portion having a relatively small thickness ,
The bent-increasing portion, and the distal end portion of the shaft portion proximate the front Symbol treatment portion, and the tail end of the shaft portion proximate the grip portion, provided at two positions,
The bent-increasing portion, characterized the first concave portion rows having one or more recesses, and a second concave portion rows having the first concave portion rows and orientation different recess about the axis of the shaft portion, the Tona Rukoto Endoscopic surgical instruments. The bending-enhancement portion includes a first row of recesses in which the plurality of recesses are arranged on the surface of the shaft portion at a constant pitch in the axial direction, and a plurality of recesses different in direction by 90 degrees around the axis of the shaft portion. 2. A row of second concave portions arranged in the axial direction at the same pitch on the surface of the portion, wherein the first concave line and the second concave line are displaced in the axial direction by a half pitch. An endoscopic surgical instrument according to claim 1. 3. The endoscopic surgical instrument according to claim 1, wherein the concave portion of the flexibility increasing portion has a concave surface having an elliptical shape. 4.

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