JPH0557855B2 - - Google Patents

Description

[Detailed Description of the Invention] [Industrial Application Field] The present invention can be used to remove cartilage (articular meniscus, articular cartilage), chondrocele, tumor, etc. from outside the body cavity to within the body cavity without making an incision, for example, in the joint cavity of the knee etc. This relates to a surgical resection instrument that excises and expels the body from the body cavity.

[Prior Art and Problems to be Solved by the Invention] Conventionally, joint surgery has been mainly performed by an incisional method (open surgery). For example, in general joint surgery, tumors on the patella are removed and damaged cartilage, bone, etc. are removed from the knee joint, but it is relatively difficult to remove tissue within a narrow cavity. A large incision was required. Therefore, the incision causes trauma, which is accompanied by pain and restricted movement, and has the disadvantage that it takes a long time to heal.

Therefore, in recent years, under the observation of an arthroscope (endoscope), a small puncture hole is formed in the adjustment without incising the joint, and a probe inserted into this puncture hole is used to perform surgery (closed surgery). A device to do this has been proposed. For example, in the prior art disclosed in US Pat. No. 4,210,146, the distal end of the outer tube is tapered and an aperture is formed, and the tissue entering the aperture window is moved according to the change in the shape of the inside of the distal end of the outer tube. It cuts efficiently by reciprocating the inner shaft attached to the tip of the flexible blade that can be deformed by moving back and forth.

However, since the area of the aperture window in this prior art example is small, it is not possible to efficiently perform ablation on a resection portion larger than the aperture window.

Therefore, the present applicant has proposed a surgical cutting instrument in Japanese Patent Application Laid-Open No. 183743/1983 in order to solve the above-mentioned problems. This is done by attaching a mantle cover, which has two thin plates with openings that pass through the top and bottom, to the tip of the elongated outer tube. A blade is slidably disposed, and the opening of the two thin plate parts is opened and closed by sliding of the blade, and the tissue piece is taken into the opening and cut by the sliding blade. are doing.

Although this prior art example has relatively good resection efficiency, depending on the shape of the target tissue site and its surrounding areas, it may not be able to penetrate into areas with continuous unevenness, for example. be. Furthermore, since the tissue piece is cut outside the outer tube, it may be difficult to take the cut section into the outer tube depending on its positional relationship.

[Objective of the Invention] The present invention has been made in view of these circumstances, and it not only makes it possible to resect elastic and viscous tissue safely and efficiently, but also to determine the positional relationship in which the cut and cut pieces can be recovered and removed. The purpose of the present invention is to provide a surgical resection instrument that can be used reliably even in the event of a surgical resection.

[Means for Solving the Problems and Their Effects] In order to achieve the above object, the surgical cutting instrument according to the present invention curves the bottomed tip of the elongated outer tube that forms the outer shape of the insertion portion, and On the side of the section, a tissue intake opening is opened that communicates with the inside of the outer tube, which is a section suction path, and a drive shaft is installed inside the outer tube so as to be able to freely slide back and forth in the axial direction, and a thin plate-like plate is attached to the tip of the drive shaft. The knife is attached to a blade and the blade is disposed within the distal end of the outer tube so as to slide back and forth along the tissue-taking opening to open and close the opening.

With this configuration, the tissue-taking edge on the side surface of the tip of the outer tube is curved, so by selecting and using an instrument with the direction and degree of curvature that match the shape of the target tissue site and its surrounding areas, It has good grip on tissues with elasticity and viscosity, and also prevents escape, allowing efficient resection. Furthermore, since the tissue is excised or cut while the tissue is taken into the cutting edge, the section can be reliably recovered regardless of the positional relationship.

[Embodiments of the Invention] Hereinafter, embodiments of the present invention will be specifically described with reference to the drawings.

1 to 5 relate to one embodiment of the present invention, in which FIG. 1 is a sectional view showing the entire cutting instrument, and FIG.
The figure is a sectional view showing the tip of the insertion section with the blade and drive shaft removed, FIG. 3 shows the drive shaft and thin plate-shaped blade, A is a side view thereof, B is a plan view,
The figure is a plan view of the distal end of the insertion section, and FIG. 5 is an explanatory view showing an example of the state of use.

In these figures, reference numeral 1 denotes a surgical resection instrument, which includes an operating section 2 that is a proximal grip section, and an elongated insertion section that extends forward from the operating section 2 and is inserted into a body cavity, for example, a joint cavity. It consists of Section 3. The insertion section 3 consists of an outer tube 4 whose open base is fixed to the operating section 2 and the fixed handle 2a, and a drive shaft 5 which is installed inside the outer tube 4 so as to be slidable in the axial direction. The bottomed tip part 4 is a curved part 6 which is curved with a predetermined curvature, and a tissue-taking opening 7 in the front-rear direction on the inner side of the curved side surface is formed in a curved state. A pair of guide grooves 8, 8 are formed on the tip end of the outer tube 4 or on the inner wall of the curved portion 6 along the tissue-taking blade opening 7. On the other hand, a flexible thin plate-like blade part 10 is detachably attached to the tip of the drive shaft 5 via a connecting member 9, and this blade part 10 has guide groove engaging parts 10a, 10a on both sides thereof.
is engaged with the guide grooves 8, 8 on the inner wall of the tip of the outer tube 4, and as the drive shaft 5 slides back and forth in the axial direction, the thin plate-shaped blade portion 10 slides back and forth along the guide grooves 8, 8. It is configured to move to open and close a tissue-taking blade opening 7 that curves inward and opens in the front-rear direction. Further, this blade portion 10 has a blade 10b formed at its tip so as to cut the tissue taken into the taking-in blade opening 7. Further, at the abutting portion of the inner wall of the tip end of the curved portion 6, which the blade 10b of the blade portion 10 abuts, a blade that engages with the blade 10b is formed as necessary, although not shown.

The inner path of the outer tube 4 serves as a section suction device 11 for sucking and recovering the cut tissue taken into the blade mouth 7 and cut to the proximal side.

On the other hand, the hand operation unit 2 includes a fixed handle 2a that opens and closes around a fulcrum 2b and a drive handle 2c.
As mentioned above, the base of the outer tube 4 is fixed to the fixed handle 2a side, and the base of the drive shaft 5 is fixed to the drive handle 2c, and the drive handle 2c can be opened and closed around the fulcrum 2b. The drive shaft 5 is configured to slide back and forth in the axial direction within the outer tube 4 due to the movement. The fixed handle 2a has a cylindrical fixing part 2d coaxial with the outer tube 4, and this fixing part 2
The base of the outer tube 4 is fitted and fixed to d, and the base end of the outer tube 4 protrudes rearward from the fixing part 2d, and is connected to the section suction device via, for example, a tube. A suction cap 12 is provided. Drive shaft mounting portion 2 of the drive handle 2c
E is inserted into the outer tube 4 through a slit 4a provided in the axial direction of the base of the outer tube 4, and connects and fixes the base of the drive shaft 5. This slit 4a is connected to the drive handle 2.
The engagement portion of the drive shaft attachment portion 2e of c is formed over the sliding range. Further, the fixed handle 2a covers the slit 4a of the outer tube 4 and the drive shaft mounting portion 2e side of the drive handle 2c, and forms a bag-shaped portion 2f to prevent the suction fluid or a part of the section from wetting out from the slit 4a. ing. Further, a spring body 13 is provided between the fixed handle 2a and the drive handle 2c.
For example, a blade portion 10 at the tip of the drive shaft 5 urges the drive handle 2c so that the drive shaft 5 is driven in the direction in which the tissue-taking blade opening 7 is opened. Note that this biasing may be set in the opposite direction.

The operation of resecting a target tissue within a body cavity, for example, within a joint cavity using one embodiment configured in this manner will be described below with reference to FIG. 5.

As shown in FIG. 5, in order to resect the target tissue within the target region, for example, the knee joint, a small hole into which the insertion section 3 of the surgical resection instrument 1 is inserted is inserted into the knee region 21 using a puncturing operation such as a trocar. The insertion portion 3 is inserted directly or via a trocar or the like. In addition, before inserting the insertion section 3, the insertion section 23 of the arthroscope 22, which is equipped with an illumination and observation optical system, is punctured with a trocar or the like so that the surgical resection of the target tissue can be performed while observing the inside of the joint cavity. Insert into the joint cavity by manipulation,
The surgical resection instrument inserted into the joint cavity and into the display device 25 that displays images taken directly from the eyepiece of the arthroscope 23 or by a television camera 24 attached to the eyepiece. The insertion section 3 of No. 1 is brought into a state where it can be observed. Further, in order to inflate the joint cavity and facilitate resection surgery, physiological saline can be supplied into the joint cavity from the water supply source 26 at controlled water pressure through the water supply pipe 27 punctured into the joint cavity. . On the other hand, a tube 28 is connected to the suction tube mouthpiece 12 on the proximal operation section 2 side of the surgical resection instrument 1, and connected to a suction and recovery device 29.

In this setting state, the operator uses the arthroscope 23 or the display device 25 to observe the inside of the joint cavity, the resection instrument 1, and the distal end of the insertion section 3, and insert the insertion section 3.
A tissue taking-in blade opening 7 provided on the curved portion 6 of the tip is brought into contact with the tissue to be excised, and the tissue to be excised is taken into the cutting opening 7. In this state, the drive handle 2c of the operating part 2 is operated to open in the closing direction around the fulcrum, and the thin plate-like blade part 10 is slid through the drive shaft 5 in the direction in which the blade opening 7 is closed. This is for cutting the tissue taken into the mouth 7. This cut section is removed from the outer tube 4 by operating the suction and collection device 29 whenever necessary or at all times.
It can be collected and discharged to a collection device 29 through suction path 11, suction tube mouthpiece 12, and tube 28.

In FIG. 5, reference numeral 30 indicates a light source device, 31 indicates a light guide cable, and 32 indicates a television camera cable.

In this way, in the present invention, since the tissue is cut while being taken into the blade mouth 7, the blade mouth 7 at the tip of the insertion section is cut.
Regardless of the positional relationship, i.e., upper, side, or lower, the cut sections can be recovered without missing any. In addition, the degree of curvature of the curved portion 6 having the tissue-taking blade opening 7 provided at the tip of the outer tube 4;
Alternatively, it is possible to prepare multiple pieces with various lengths, curved directions, etc., and select and use the one that matches the shape of the tissue to be resected and its surrounding area, so that the target tissue with elasticity and viscosity can be used. It has good bite and prevents escape, allowing for efficient resection.

The shape of the tip of the insertion tube shown in the figure is an example.
Various degrees of curvature, lengths, and directions of curvature are formed, or the tissue-taking blade opening is also formed on the outer curved side. Further, the sliding movement of the blade portion or the drive shaft can be performed not only manually as in the illustrated example, but also by using an electric motor.

[Effects of the Invention] As explained above, according to the present invention, tissue having elasticity and viscosity can be resected safely, reliably, and efficiently, and even in positional relationships such as cutting, collecting and removing cut pieces, etc. There are effects that can be achieved.

[Brief explanation of the drawing]

1 to 5 relate to one embodiment of the present invention, in which FIG. 1 is a sectional view showing the entire cutting instrument, and FIG.
The figure is a sectional view showing the tip of the insertion section with the blade and drive shaft removed, FIG. 3 shows the drive shaft and thin plate-shaped blade, A is a side view thereof, B is a plan view,
The figure is a plan view of the distal end of the insertion section, and FIG. 5 is an explanatory view showing an example of the state of use. 1...Surgical resection instrument, 2...Operation unit, 3...
Insertion part, 4... Outer tube, 5... Drive shaft, 6... Curved part, 7... Tissue take-in blade opening, 10... Blade portion.

Claims (1)

[Claims] 1 The bottomed tip of the elongated outer tube that forms the outer shape of the insertion portion is curved, and a tissue intake opening communicating with the inside of the outer tube, which is a section suction path, is opened on the side of this curved portion, while the inside of the outer tube is A drive shaft is installed inside the drive shaft so as to be slidable back and forth in the axial direction, and a thin plate-like blade is attached to the tip of the drive shaft, and this blade is slid back and forth along the tissue-taking blade opening. A surgical resection instrument, characterized in that the surgical cutting instrument is disposed within the distal end of the outer tube so as to open and close.