JPS61199848A - Surgical incision instrument - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

Detailed Description of the Invention [Technical Field of the Invention] The present invention is for removing cartilage (articular meniscus, articular cartilage), chondrosis, tumors, etc. in a joint cavity of a knee or the like from outside the body cavity without making an incision. The present invention relates to a surgical resection instrument for cutting and expelling the body cavity.

[Technical Background of the Invention and Problems Therewith] Conventionally, joint surgery has been mainly performed by an incisional method (lti radiosurgery). For example, common joint surgeries require relatively large incisions, such as removing tumors on the patella and cutting damaged cartilage, bone, etc. from the knee joint.

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, joint m<endoscopy i+! Based on this observation, an instrument has been proposed in which a small puncture hole is formed in the joint without incising the joint, and a probe is inserted into the puncture hole to perform surgery (closed surgery). For example, JP-A-54-7
These are disclosed in Publication No. 7493 and the like. The device according to this prior art includes an elongated fixed jacket tube in which a cutting opening extending in the axial direction is formed on the outer periphery, and an internal rotating blade is rotatably installed inside the jacket tube and forming an internal rotary blade at the cutting opening. It includes a tubular inner member, a main body, a suction device, and a drive motor, and while the tissue pieces are sucked into the cutting opening by vacuuming, the rotary blade is rotated by the drive motor to cut the cut pieces. It is configured to be sucked and discharged through a tubular inner member.

However, in the prior art, the suction pipe cap provided on the main body to connect to the suction device side via a tube etc.
Since the suction cap protrudes perpendicularly to the axial direction of the main body, the diameter of the inlet portion of the suction cap cannot be increased.
Therefore, there is a point where the cut tissue sections that have been suctioned into the tubular inner member clog the inlet portion of the suction tube mouthpiece, making it impossible to drain them efficiently. In particular, for example, a damaged joint meniscus in the knee joint cavity.

When resecting a tumor or the like, the target tissue within the joint cavity is elastic and viscous, so the section is likely to become clogged at the entrance of the suction tube mouthpiece.

[Objective of the Invention] The present invention has been made in view of the above circumstances, and aims to improve the efficiency and efficiency of the suction tube mouthpiece because the cut tissue from the body cavity, for example, the joint cavity, is clogged at the inlet of the suction tube mouthpiece. The object is to provide a surgical cutting instrument with good evacuation.

[Summary of the invention? J5] In order to achieve the above-mentioned object, the surgical cutting instrument according to the present invention includes an inner tube having a cutting edge that engages with the cutting edge of the outer tube inside an outer tube having a tissue-taking edge opening at the tip thereof. The blade opening of the inner tube and the blade opening of the outer tube can be opened and closed, while the inner path of the inner tube is a suction path communicating with the double blade opening, and the outlet of this suction path is opened in the main body. In addition, in the case where the main body is provided with a suction pipe cap for communicating and connecting to the suction device side, the suction pipe cap is tilted rearward with respect to the axial direction of the inner tube so as to increase the opening area of the inlet portion. It is installed in the main body and has a large opening area at the entrance.

Embodiments of the present invention] Examples of the present invention will be specifically described below with reference to the drawings.

1 to 3 relate to a first embodiment of the surgical cutting instrument of the present invention, in which FIG. 1 is a longitudinal cross-sectional view, FIG. 2 is an enlarged cross-sectional view of the main part of the suction tube mouthpiece, and FIG. FIG. 2 is an explanatory diagram showing an example of a usage state.

In these figures, reference numeral 1 denotes a surgical cutting instrument, which includes a main body 2 that also serves as a grip on the proximal side, and an elongated insertion device that extends forward from the main body 2 and is inserted into a body cavity, such as 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 distal end of the main body 2, and an inner tube 5 which is installed inside the outer tube 4 so as to be rotatable around an axis. has a tissue-taking blade opening 6 at its tip, and the one-way tube 4 has a blade lower opening at its tip. Said outer tube cutting edge 6
For example, by cutting out a portion of the bottomed tip or tube side of the hemispherical outer tube and leaving a partially curved bottomed portion 8 at the tip,
It is formed continuously from the tube side surface to the bottomed portion 8 at the tip. Similarly to the outer tube cutting edge 6, the lower inner tube blade also cuts out a portion of the hemispherical inner tube bottomed tip or tube side, leaving a partially curved bottomed portion 9 at the tip. It is formed continuously so as to reach the bottomed portion 9 at the tip end. Said outer tube cutting edge 6
The lower inner tube blade rotates these blade openings 6,
7 communicates when they match, and closes when they shift, so that when the double-blade opening 6.7 opens for communication, it bites into the tissue, and when it is closed, it is cut and the section is taken into the inner tube blade lower. It has become. The inner path of the inner tube 5 is a section suction path 10 that communicates with the outer tube blade opening 6 and the inner tube blade lower, and also serves as a section suction path 10 that communicates with the section suction device 2.
is connected to.

The main body 2 is a part of the resection instrument 1 that is held and operated by an operator such as a surgeon, and includes a housing 11 that houses a driving part that rotationally drives the inner tube 5 and the like, and a housing 11 that houses a drive section that rotates the inner tube 5 and a suction section of the inner tube 5. a front housing 12 having a cavity 12a communicating with the channel 10 and fitted with a suction tube cap 22 connected to a section suction device;
It is composed of. The front housing 12 is removably screwed to the housing 11 by, for example, screwing means. Further, this front housing 12 has an annular fixing portion 12b extending in the front thereof, and a groove portion 12C is formed in the axial direction of the inner circumference thereof. On the other hand, on the outer periphery of the base of the outer tube 4,
A sleeve 13 having a flange 13a at the front is fitted therein, and a bottle 14 is planted on the outer periphery of the sleeve 13. Then, with the bottle 14 engaged in the groove 12c, the base of the outer tube 4 fitted with the sleeve 13 is attached to the fixing part 12.
b, and insert the outer tube fixing screw 15 into the fixing part 12b.
The base of the outer tube 4 is fixed to the outer circumference in a detachable manner by being screwed onto the outer periphery.

A motor 16 is housed in the rear part of the housing 11, and a male spline 18 is fixed to the motor shaft 17. On the other hand, an output shaft 19 is rotatably and slidably supported in the axial direction at the front of the motor 16, and a female spline 20 is formed at the rear of the output shaft 19.
0 meshes with the male spline 18. The output shaft 19 projects into the cavity 12a of the front housing 12,
An inner tube sleeve 21, into which the base of the inner tube 5 is fitted and fixed, is inserted and fixed into this protrusion, and the rotational force of the motor 16 is transmitted to the inner tube 5 to rotate the inner tube 5. .

The inner tube sleeve 21 is formed into a cylindrical shape with an open front, and communicates the suction path 10 of the inner tube 5 into the sleeve 21 .

The sleeve 21 also has an opening 21a on its side and communicates with the cavity 12a of the front housing 12.

The suction tube mouthpiece 22 is attached to the outer periphery of the front housing 12 in communication with the cavity 12a.

This suction tube mouthpiece 22 is inclined rearward with respect to the axial direction of the housing 12a so that the opening area of its inlet portion can be increased. Further, the front housing 12 to which the suction tube cap 22 is attached has its outer peripheral wall inclined downwardly toward the front, and the opening at the inlet portion of the suction tube cap 22 is made similar to the case where the suction tube cap 22 is mounted at a backward slope. The area is enlarged.

The operation of resecting a target tissue in a body cavity 1, for example, a joint cavity using the first embodiment configured as described above will be described below with reference to FIG.

As shown in FIG. 3, in order to remove a target tissue within a target region, for example, a knee joint, a surgical resection instrument 1 is attached to the knee region 31.
A small hole into which the insertion portion 3 is inserted is provided by a puncturing operation using a trocar or the like, and the insertion portion 3 is inserted directly or through the trocar or the like. Also, before inserting the insertion section 3, the joint is equipped with an illumination and observation optical system so that the target tissue can be removed while observing the inside of the joint cavity! The insertion part 33 of the i32 is inserted into the joint cavity by a puncturing operation such as a trocar, and the display device 35 displays an image taken directly from the eyepiece of the joint 11133 or by a television camera 34 attached to the eyepiece. The joint cavity and the insertion portion 3 of the surgical resection instrument 1 inserted into the cavity are made observable. Furthermore, in order to inflate the inside of the joint cavity and facilitate resection surgery, physiological saline can be supplied into the joint cavity from the water supply source 36 through the water supply pipe 37 punctured into the joint cavity at controlled water pressure. .

On the other hand, the tube 38 is connected to the suction tube mouthpiece 22 of the proximal grip main body 2 of the surgical resection instrument 1, and suction is performed.

The cable 40 is connected to the collection device 39, and a connector (not shown) of the cable 40 is connected to the motor control unit 41, so that the motor 16 can be supplied with electric power.

In this setting state, the operator observes the inside of the joint cavity and the distal end of the insertion section 3 of the resection instrument 1 using the arthroscope 33 or the display device 35 while observing the tissue-taking blade opening 6 at the distal end of the insertion section 3.
7 is brought into contact with the tissue to be resected, and in this state, the switch is turned on to drive the motor 16 to rotate the inner tube 5 around the axis via the drive transmission system such as the output shaft 19, thereby cutting the outer tube blade tip 6. At the same time, the blade 6.7 is engaged with the inner tube blade lower, and the tissue taken into the blade 6.7 is cut or cut by opening and closing the blade 6.7, and the suction 9 collection device 39 is activated when necessary or constantly to cut the tissue into sections. the suction path 10 of the inner tube 5. Inner tube sleeve 21. Cavity 128 in front housing 12. Suction pipe cap 22. It can be collected and discharged through the tube 38 into the suction 1 collection device 2I39.

In FIG. 3, reference numeral 42 indicates a light source device, 43 indicates a light guide cable, and 44 indicates a television camera cable.

As described above, in the present invention, the insertion portion 3 of the surgical resection instrument 1 into which the target tissue in a body cavity, for example, a joint cavity, is inserted from outside the body cavity.
Excise and cut with the cutting edge 6.7 at the tip, and insert the cut into the insertion section 3.
The suction pipe mouthpiece 22. It is collected through the tube 38 into the suction collection device @ 39, and since the area of the entrance part of the suction tube mouthpiece 22 connected to the cavity 12□ of the main body 2 is large, the section is taken from this part. There is no risk of it getting clogged.

FIGS. 4 to 6 show a second example of the shape of the suction pipe mouthpiece 22 and its connection housing 12. Third. A fourth example is shown.

In the second embodiment shown in FIG. 4, the base of the suction tube mouthpiece 22 is expanded into a linear shape, and in the third embodiment shown in FIG. 5, it is expanded into a curved shape.

Further, in the fourth embodiment shown in FIG. 6, the outer circumferential wall of the housing 12 is not tilted forward but flat.

Incidentally, in the above embodiments of the present invention, a cutting instrument in which the inner tube is rotated has been described, but the inner tube may be slidable, or the inner tube may be fixed and the outer tube may be rotated or slid. too,
Alternatively, various methods of cutting may be used, such as one in which members inserted into the outer tube and the inner tube are rotated or slid. Further, the shape of the cutting edge can be used as appropriate.

Furthermore, it is clear that the present invention is applicable not only to joint cavities but also to intracorporeal sites.

[Effects of the Invention] As explained above, according to the present invention, a section obtained by removing tissue from a body cavity, for example, a joint cavity, is less likely to clog the inlet of the suction tube mouthpiece and can be efficiently discharged. be.

[Brief explanation of the drawing]

1 to 3 relate to a first embodiment of the surgical cutting instrument of the present invention, in which FIG. 1 is a longitudinal cross-sectional view, FIG. 2 is an enlarged cross-sectional view of the main part of the suction tube mouthpiece, and FIG. 1 is an explanatory diagram showing an example of a usage state, and FIGS. 4 to 6 are illustrations of the second embodiment of the present invention. Third.
FIG. 7 is a sectional view of a main part showing a fourth embodiment.

Claims (1)

[Claims] An inner tube having a cutting edge that engages with the cutting edge of the outer tube is placed inside the outer tube that has a tissue-taking edge opening at the tip, and the cutting edge of the inner tube and the outer tube can be opened and closed. On the other hand, the inner path of the inner tube is a suction path communicating with the double-edged opening, the outlet of this suction path is opened in the main body, and a suction pipe base is provided in the main body for communicating and connecting to the suction device side. The suction pipe cap is provided on the main body so as to be tilted rearward with respect to the axial direction of the inner tube so as to increase the opening area of the inlet portion, and the inlet portion of the suction pipe cap is opened at an angle. surgical cutting instruments.