JP2000262534A - Bipolar coagulating-dissectioning utensil - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a bipolar coagulating-dissectioning utensil which can coagulate, dissect and separate a tissue, and wherein the operability can be improved. SOLUTION: This bipolar coagulating-dissectioning utensil is equipped with a pair of jaws 10a and 10b comprising first and second jaws, a handle unit 4 which open/close-operates the jaws, a thin and long sheath unit 2 which connects the jaws and the handle unit, and a driving shaft 9 which transmits the operation force of the handle unit to the pair of jaws, and the first jaw is equipped with a first electrode 11a, and the second jaw is equipped with second and third, electrodes 11b and 11c which are insulated from each other, and respective electrodes are insulated from each other, and both of the first jaw and the second jaw rotate, and open/close each other.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a bipolar coagulation / incision treatment device which can be inserted into a body cavity of a living body to coagulate and incise a tissue.

[0002]

2. Description of the Related Art In general, there is known a bipolar forceps having a pair of jaws as gripping members for gripping a living tissue, each of which is provided with an electrode for energizing a high frequency. When using the bipolar forceps, a high-frequency current is applied between the electrodes of each jaw to coagulate the living tissue between the jaws while the living tissue to be treated is held between the pair of jaws. .

[0003] Bipolar forceps of this kind are usually used in 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 contraception, and the like. . Bipolar forceps are used for hemostasis of blood vessels and occlusion of fallopian tubes, so that a living tissue to be treated by a patient can be coagulated, and the coagulated living tissue can be incised. ing.

Conventionally, as a high-frequency treatment instrument, for example, D
E4032471 C2 and DE4138116 A1 are known, which are equipped with one incision electrode and two coagulation electrodes, and are configured to coagulate the tissue with the two coagulation electrodes, and then cut the coagulated tissue with the incision electrode. ing.

Japanese Patent Application Laid-Open No. 9-271476 discloses a monopolar high-frequency incision tool. Also, DE
19608716C1 also discloses a bipolar high frequency treatment device.

[0006]

However, the above-mentioned DE 4032471 C2 is shown in FIG. 2, while DE 4138116 A1 is shown in FIGS.
As shown in (1), only one of the pair of jaws pivots and opens and closes, and has a drawback that operability is poor when performing a tissue peeling operation.

[0007] Further, DE19660816C1 is a bipolar high-frequency treatment device having a double opening, but does not consider continuous coagulation and incision of tissue. JP-A-9-2
Japanese Patent Application Laid-Open No. 71476 discloses a pair of jaws, both of which pivot in a link manner to open and close, as shown in FIG.
It is a monopolar high-frequency treatment device, not a bipolar coagulation / incision treatment device.

The present invention has been made in view of the above circumstances. It is an object of the present invention to enable a pair of jaws to pivot and open and close with each other to coagulate, dissect and exfoliate tissue.
It is an object of the present invention to provide a bipolar coagulation / incision treatment tool that can improve operability.

[0009]

SUMMARY OF THE INVENTION In order to achieve the above object, the present invention provides a pair of first and second jaws,
An operating unit configured to open and close the jaw, an elongated insertion unit connecting the jaw and the operating unit, and a drive shaft transmitting an operating force of the operating unit to the pair of jaws;
The jaw has a first electrode, the second jaw has second and third electrodes insulated from each other, and each electrode is insulated from each other in a bipolar coagulation and incision treatment instrument. It is characterized in that both the first jaw and the second jaw pivot and open and close with each other.

[0010] According to the above configuration, the tissue can be pushed and spread by the pair of jaws when the tissue is peeled off together with the coagulation and incision of the tissue, so that the target portion can be reliably peeled off, and the peeling operation becomes easy.

[0011]

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

1 to 12 show a first embodiment. FIG. 1 shows an entire configuration of a bipolar coagulation / incision treatment device of a three-pole type, (a) is a side view in a state where a jaw is closed, (b) ) Is a side view with the jaws open, (c) is a cross-sectional view along the line AA, and FIG. 2 is partially cut away when the bipolar coagulation and incision treatment tool is disassembled into a forceps unit, a sheath unit and a handle unit. It is a side view.

As shown in FIG. 1, a bipolar forceps 1 as a bipolar coagulation / incision treatment instrument is connected to a sheath unit 2 as an elongated insertion portion to be inserted into a body cavity of a patient and a distal end of the sheath unit 2. An energizable forceps unit 3 for grasping, coagulating, dissecting and exfoliating a living tissue in a body cavity, and a handle unit 4 as an operation unit connected to a base end of the sheath unit 2 are provided so as to be disassembled from each other. Have been.

As shown in FIG. 2, the sheath unit 2
It is composed of a rotation operation unit 5 and a metal pipe 6, and is rotatable with respect to the handle unit 4 by the rotation operation unit 5. The outer peripheral surface of the metal pipe 6 is covered with an insulating tube 7. A connection pipe 8 for connecting to the handle unit 4 is provided protruding from the hand of the rotation operation unit 5.

The forceps unit 3 is provided with a drive shaft 9 which is inserted into the sheath unit 2 so as to be able to advance and retreat, and the distal end of the drive shaft 9 is provided with a jaw holding portion 9a. The first jaw 10a and the second jaw 1
0b are provided so as to be freely opened and closed by means described later. Then, as shown in FIG.
a is provided with a first electrode 11a, and a second jaw 10b is provided with a second electrode 11b and a third electrode 11c which are insulated from each other by an insulator 12.

As shown in FIG. 2, an annular connection groove 13 is provided at the base end of the drive shaft 9, and a first electrode as an electrode insulated by an insulating member 14 is provided on the proximal side of the connection groove 13. Are electrically separated from each other in the axial direction.

The handle unit 4 is provided with a fixed handle 16 and a movable handle 18 rotatably provided on the fixed handle 16 with a pivot pin 17 as a fulcrum. By rotating the movable handle 18, the drive shaft 9 is moved forward and backward so that the first and second jaws 10a and 10b can be opened and closed.

The fixed handle 16 is provided with a sheath support 19 for connecting to the connection pipe 8 of the sheath unit 2 and a connection support 24 having a stopper 23.
A connection plug 20 is projected from the sheath support portion 19, and a stopper 23 of the connection support portion 24 engages with the connection groove 13 of the drive shaft 9.

The first active cord 21 is connected to the connection plug 20. Further, a second active cord 22 is connected to the first electric connection portion 15a and the second electric connection portion 15b of the drive shaft 9.

The first active cord 21 is electrically connected to the first electrode 11a via the connection plug 20, the sheath support 19, the metal pipe 6, and the jaw holder 9a. The second active cord 22 is electrically connected to the second electrode 11b and the third electrode 11c via a first electric connection portion 15a, a second electric connection portion 15b, and a later-described lead wire provided inside the drive shaft 9. It is connected.

Next, the forceps unit 3 will be described with reference to FIGS. 3 to 8. Drive shaft 9
Inside the first conductor 25a and the second conductor 2 connected to the first electrical connection 15a and the second electrical connection 15b.
5b are interpolated, and the first and second conductors 25a, 25
5b is insulated and extends to the inside of the jaw holding portion 9a.

A vertical groove 26 penetrating vertically is formed at the tip of the jaw holding portion 9a, and a pair of support pieces 27 are provided with the vertical groove 26 interposed therebetween. A first insulating plate 28a and a second insulating plate 28b having substantially the same width as the support piece 27 are joined inside the support piece 27. Further, one end of the pair of support pieces 27 is provided with a second insulating plate 28.
b, there is a first insulating plate 28 on the other side.
The screw holes 30 penetrating a are formed so as to face each other.

The first insulating plate 2 of the jaw holding portion 9a
8a and the second jaw 1 between the second insulating plate 28b.
0a and the second jaw 10b are rotatably held with each other. That is, the third insulating plate 31a and the fourth insulating plate 31b are joined to the base end of the first jaw 10a from both sides, and the third and fourth insulating plates 31a and 31b are connected to the base end. A first through hole 32a and a second through hole 32b penetrating therethrough are provided. A screw pin 33 screwed into the screw hole 30 from the through hole 29 of the jaw holding portion 9a penetrates the first through hole 32a, and the first jaw 10a is pivotally supported rotatably. .
Here, the screw pin 33 also serves as a member for electrically conducting from the jaw holding portion 9a to the first electrode 11a of the first jaw 10a. The screw pin 33 is fastened to the support piece 2
7 to prevent rattling of the jaws 10a, 10b in the left-right direction.

At the base end of the second jaw 10b, the jaw connecting piece 3 is integrally formed with the second electrode 11b and the third electrode 11c.
4 and 35 are provided, and the jaw connecting pieces 34 and 35 are provided with the first
And a second through hole 36b. Then, the base end of the first jaw 10a is inserted between the jaw connection pieces 34 and 35, and the first jaw 10a
Of the second through hole 32b and the first of the jaw connecting pieces 34, 35
And the second through hole 32 concentrically opposes the through hole 36a of the second through hole 32a.
A first hollow pin 37 serving as a connecting pin is provided to pass through the first through hole 36b and the first through hole 36a. The first hollow pin 37 is an insulator such as ceramic or synthetic resin, and has a first metal pin 38 inserted therein.

A center member 40 made of metal is provided at the end portion 39 of the drive shaft 9. A fifth insulating member 41a and a sixth insulating member 41b are provided on both sides of the center member 40.
And a first energizing member 42a is provided on a part of the fifth insulating member 41a.
Is provided with a second energizing member 42b. The first conducting member 42a is connected to the first conducting wire 25a.
Are electrically connected to each other, and the second conducting wire 25b is electrically connected to the second conducting member 42b. The first and second current-carrying members 42a and 42b also serve as members that are electrically connected to the second electrode 11b and the third electrode 11c of the second jaw 10b.

Further, the center member 40, the fifth and sixth insulating members 41a, 41b, and the first
And a through-hole 4 penetrating the second conducting members 42a and 42b
3, and a second pin as a connecting pin made of an insulator such as a ceramic or a synthetic resin is formed in the through hole 43.
Is provided through the second hollow pin 44, and a second metal pin 45 is inserted into the second hollow pin 44.

The second through-holes 36b of the jaw connecting pieces 34 and 35 are rotatably fitted to both ends of the second hollow pin 44, respectively. First and second conducting members 42
The inner diameter of the through hole 43 formed in each of the a and b is slightly larger than the outer diameter of the second hollow pin 44, and a force is applied from the drive shaft 9 to the center member 40, so that the first and second insulating pins are formed. The members 42a and 42b are formed so as not to directly apply a force. On the other hand, the hollow pin 44 and the metal pin 45 transmit the force applied to the current-carrying members 41a and 41b to the central member, thereby preventing the force from being transmitted to the current-carrying members 41a and 41b and the conductive wires 25a and 25b to prevent breakage.

On the other hand, FIG. 9 shows a connection structure between the connection groove 13 of the drive shaft 9 and the stopper 23 of the connection support 24, and a slide pin 46 slidable with respect to the movable handle 18.
Is provided, and the connection support portion 2
4 is provided with a stopper 23 urged upward by a rubber spring 47. The stopper 23 is provided with an engagement portion 23 a that engages with the engagement groove 13 of the drive shaft 9. When the rubber spring 47 provided on the stopper 23 is pressed down against the urging force, the engagement between the engagement portion 23a and the engagement groove 13 is released, and the forceps unit 3 and the handle unit 4 can be disassembled. ing.

FIG. 10A shows a first modification of the second connecting pin in the first embodiment, in which the distal end 3 of the drive shaft 9 is provided.
9, a central member 40 and fifth and sixth insulating members 41a,
A through-hole 43 penetrating the 41b and the first and second conducting members 42a and 42b is formed, and a solid insulating pin 60 is provided through the through-hole 43. The use of solid pins simplifies the structure.

FIG. 10B shows a second modification of the second connecting pin in the first embodiment, in which the distal end 3 of the drive shaft 9 is provided.
9, a central member 40 and fifth and sixth insulating members 41a,
A through-hole 43 penetrating the first and second current-carrying members 42a and 42b is formed, and insulating bushes 61a and 61b are inserted from both ends of the through-hole 43, and are inserted into the insulating bushes 61a and 61b. Is provided with a caulking pin 62. Then, by crimping both ends of the caulking pin 62, both ends of the insulating bushes 61a and 61b are expanded and fixed. By caulking the pins, the jaw connecting pieces 34, 35 are connected to the energizing members 42a, 42b.
, And conduction is improved.

Bipolar forceps 1 constructed as described above
Is connected to the high-frequency ablation power supply device 50 shown in FIG. In the drawing, reference numeral 51 denotes an output circuit for supplying a high-frequency current, and 52 denotes an output circuit 5 according to a control signal from a foot switch 53.
1 is a control circuit for controlling the high-frequency output from the device 1; 54 is a setting means for inputting predetermined output conditions as an electric signal to the control circuit 52; 55 is first and second active cords 21 and 22 extending from the bipolar forceps 1 Are connected to the output circuit 51 and the connector 55.
And a line connecting each of the electrode portions 11a,
11b and 11c. A detection circuit 59 detects a high-frequency current flowing through the first and second active codes 21 and 22 and sends a detection signal to the control circuit 52.

Next, the operation of the first embodiment will be described.

The bipolar forceps 1 constructed as described above
According to this, the movable handle 18 is
Is opened, the drive shaft 9 is connected to the metal pipe 6 of the sheath unit 2.
Move forward inside. The forward force of the drive shaft 9 is the second jaw 1
0b, and then to the proximal end of the first jaw 10a. First jaw 10
a is pivotally supported by the jaw holding portion 9a via the screw pin 33, so that the first jaw 10a and the second jaw 10b
When the movable handle 18 is rotated in the closing direction at the same time, the drive shaft 9 is retracted, and the first jaw 10a and the second jaw 10b are simultaneously rotated and closed.

Therefore, as shown in FIG. 12, the tissue P is held between the first jaw 10a and the second jaw 10b, and the second jaw 10b is placed between the second electrode 11b and the third electrode 11c. A coagulation current is applied to the tissue P to coagulate it. When the coagulation is completed, the first electrode 11a
The tissue P can be incised by passing an incision current between the first and second and third electrodes 11b and 11c. When exfoliating the tissue P, when the first jaw 10a and the second jaw 10b are closed and their distal ends are pressed against the tissue P and the movable handle 18 is opened, the first and second jaws 10a and 10b are opened. Since the jaws 10a and 10b are simultaneously pivoted outward and open, the tissue P can be spread and peeled, and the peeling operation can be easily performed, and the operability can be improved.

FIG. 13 shows a second embodiment, in which the same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. In the present embodiment, in addition to providing the first and second electrical connection portions 15a and 15b at the base end of the drive shaft 9, the third
Is provided with the electrical connection part 15c.

At the end of one active cord 65, there is provided a connector 66 which is fitted and connected to the base end of the drive shaft 9, and this connector 66 has first, second and third electrical connections. There are provided contact plates 67a, 67b, 67c formed of leaf springs connected to the portions 15a, 15b, 15c.
Further, a concave portion 68 is provided inside the jaw holding portion 9a, and a contact plate 69 made of a leaf spring connected to the drive shaft 9 is provided inside the concave portion 68. Then, the third electric connection portion 67c is electrically connected to the jaw holding portion 9a via the drive shaft 9, and is electrically connected from the jaw holding portion 9a to the first electrode 11a of the first jaw 10a. It has become so.

FIG. 14 shows a third embodiment, in which the same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. First, second, and third electrical connection portions 15 a, 15 b, and 15 c are provided at an intermediate portion of the drive shaft 9 via an insulating member 14.

On the other hand, the sheath support 1 of the fixed handle 16
9 is provided with a concave portion 70, and the concave portion 70 has first, second and third electrical connection portions 15a, 15b, 15
c, contact plates 71a, 71b,
71c is provided. These contact plates 71a, 71
b and 71c are connected to the connection plug 20, and one active cord 72 is connected to the connection plug 20. Others are the same as in the second embodiment. Therefore, handling is simplified by using only one active code.

FIG. 15 shows the fourth embodiment. The same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. In the present embodiment, a cam-type jaw opening / closing mechanism is provided at the distal end of the forceps unit 3. At the distal end of the drive shaft 9, a first energizing member 81, a second energizing member 82, and an insulating drive shaft 83 that insulates between the energizing members 81 and 82 are provided. The first and second energizing members 81 and 82 are provided at their tip ends with cam grooves 84 which are arc-shaped and are curved in opposite directions.

The first jaw 10a and the second jaw 10b
Is rotatably supported by a pivot shaft 87 provided on the jaw holding portion 9a. The base 85 of the first jaw 10 a is provided with an engaging projection 85 a that engages with the cam groove 84 of the second energizing member 82. The cam groove 8 of the first energizing member 81 is provided at the base end portion 86 of the second jaw 10b.
4 are provided with engaging projections 86a.

Accordingly, the first movement of the drive shaft 9 causes the first movement.
And the second energizing members 81 and 82 advance and retreat, the engaging projections 85a and 86a engaging with the cam groove 84 move along the cam groove 84, and the first jaw 10a and the second jaw 10b move together. It is opened and closed with the pivot 87 as a fulcrum. Here, the conducting member 81 is electrically connected to the electrode 11b, the conducting member 82 is electrically connected to the electrode 11a, and the jaw holding portion 9a is electrically connected to the electrode 11c via the pivot 87.

FIG. 16 shows a fifth embodiment. The same components as those in the first embodiment are designated by the same reference numerals and the description thereof will be omitted. In this embodiment, a link-type jaw opening / closing mechanism is provided at the tip of the forceps unit 3. At the distal end of the drive shaft 9, a first energizing member 81, a second energizing member 82, and an insulating drive shaft 83 that insulates between the energizing members 81 and 82 are provided. One end of a first link 92 is connected to the first energizing member 81 via a pin 91, and the other end of the first link 92 is connected to the opposite second jaw 10b via a pin 93. It is connected to the proximal end 86. One end of a first link 95 is connected to the second energizing member 82 via a pin 94, and the other end of the first link 95 is connected to a pin 96.
Is connected to the base end 85 of the opposite first jaw 10a.

Accordingly, the first movement of the drive shaft 9 causes the first movement.
And the second conducting members 81 and 82 move forward and backward, and the first and second conducting members 81 and 82 move forward and backward.
The links 92 and 95 rotate about the pins 91 and 93, and the first jaw 10a and the second jaw 10b are opened and closed using the pivot 87 as a fulcrum. Here, the conducting member 81
Is electrically connected to the electrode 11b, the conducting member 82 is electrically connected to the electrode 11a, and the jaw holding portion 9a is electrically connected to the electrode 11c via the pivot 87.

According to the first to fifth embodiments described above,
The following configuration is obtained.

(Supplementary Note 1) A pair of first and second jaws, an operation portion for opening and closing the jaws, an elongated insertion portion for connecting the jaws and the operation portion, and the operation of the pair of jaws A drive shaft for transmitting the operating force of the section, the first jaw having a first electrode, and the second jaw having second and third electrodes insulated from each other. A bipolar coagulation / incision treatment device in which each electrode is insulated from each other, wherein both the first jaw and the second jaw pivot to open and close with each other.

(Supplementary Note 2) In Supplementary Note 1, further, the insertion portion may have a jaw holding portion at a distal end, and a first shaft supporting means for supporting the pair of jaws with each other, a first jaw and a jaw holding portion. A bipolar coagulation and incision treatment tool comprising: a second shaft supporting means for supporting the parts mutually; and a third shaft supporting means for supporting the second jaw and the tip of the drive shaft to each other.

(Supplementary note 3) In Supplementary note 2, the second jaw is provided with two connecting portions on the hand side, and the driving shaft is connected to a driving shaft tip portion connected to the connecting portion of the second jaw and to each other. A pair of insulated electric transmission means having a pair of drive shaft distal ends electrically connected to the second and third electrodes by being connected correspondingly to each of the connection portions of the second jaw. A bipolar coagulation / incision treatment tool, comprising:

(Supplementary Note 4) The bipolar coagulation / incision treatment instrument according to supplementary note 3, wherein the pair of electric transmission means is a conductive wire coated with insulation.

(Supplementary Note 5) In Supplementary note 2, the first shaft support means may include a first pin member having an insulator at least in a part capable of insulating the first jaw and the second jaw from each other. A bipolar coagulation / incision treatment tool, wherein the second shaft support means comprises a second pin member for electrically connecting the first jaw and the jaw holding portion.

(Supplementary Note 6) In the supplementary note 5, the insertion portion may include a metal pipe slidably covering a drive shaft electrically connected to the jaw holding portion, and an insulating tube covering the metal pipe. Bipolar coagulation and incision treatment tool.

(Supplementary Note 7) In the supplementary note 5, the first pin member is a combination of an outer hollow pin made of an insulating material and an inner pin made of a metal.

(Supplementary Note 8) The bipolar coagulation / incision treatment instrument according to supplementary note 5, wherein the first pin member is a solid pin made of an insulating material.

(Supplementary note 9) The bipolar coagulation / incision treatment instrument according to supplementary note 3, wherein the second jaw is insulated from the jaw holding portion by a thin insulating material.

(Supplementary note 10) In Supplementary note 3, the tip of the drive shaft is composed of a central member and energizing members provided on both sides of the central member, and the central member is composed of the second jaw and the third jaw.
A bipolar coagulation / incision treatment device, wherein the treatment device is connected by a shaft supporting means.

(Supplementary Note 11) In Supplementary Note 1, the insertion portion has a jaw holding portion at a distal end, and a pair of first and second jaws are supported by the jaw holding portion by a pin member and a drive shaft. The cam mechanism includes an engaging protrusion that engages with the cam groove provided on the drive shaft and moves along the cam groove. A bipolar coagulation / incision treatment instrument wherein the jaws open and close with each other.

(Supplementary Note 12) In Supplementary Note 11, the drive shaft has a pair of conducting members electrically connected to the first and second electrodes at a distal end, and the third electrode is jaw-connected by the pin member. A bipolar coagulation / incision treatment device, which is electrically connected to a holding portion.

(Supplementary Note 13) In Supplementary Note 1, the insertion portion has a jaw holding portion at a distal end, and a pair of first and second jaws are pivotally supported by the jaw holding portion by a pin member. Linked to the drive shaft by a link member,
A bipolar coagulation / incision treatment tool, wherein a pair of jaws open and close with each other in accordance with advance and retreat of a drive shaft.

(Supplementary note 14) In Supplementary note 13, the drive shaft has a pair of conducting members electrically connected to the first and second electrodes via a link member at its tip, and the third electrode has A bipolar coagulation / incision treatment tool, which is electrically connected to the jaw holding portion by the pin member.

(Supplementary Note 15) A pair of first and second jaws, an operation portion for opening and closing the jaws, an elongated insertion portion for connecting the jaws and the operation portion, and the operation of the pair of jaws A drive shaft for transmitting the operation force of the unit,
The first jaw has a first electrode, the second jaw has second and third electrodes insulated from each other, and each electrode is insulated from each other. The operation unit includes a fixed handle to which the insertion unit is connected, and a movable handle pivotally connected to the fixed handle, and the fixed handle is electrically connected to one of the three electrodes; A bipolar coagulation incision, wherein a first electrical plug is provided for connection to a high frequency power supply, and a movable electrical handle is provided with a second electrical plug electrically connected to the remaining two electrodes. Treatment tools.

(Supplementary note 16) The bipolar coagulation / incision instrument according to supplementary note 15, wherein the second electric plug is constituted by a drive shaft protruding from the movable handle.

(Supplementary note 17) The bipolar coagulation / incision treatment instrument according to supplementary note 15, wherein the drive shaft is provided with two electrodes provided in series in the vertical direction.

(Supplementary Note 18) A pair of first and second jaws, an operation portion for opening and closing the jaws, an elongated insertion portion for connecting the jaws and the operation portion, and the operation of the pair of jaws A drive shaft for transmitting the operation force of the unit,
The first jaw has a first electrode, the second jaw has second and third electrodes insulated from each other, and each electrode is insulated from each other. A bipolar coagulation / incision treatment tool, wherein the drive shaft has three electrically conducting means electrically connected to each of the electrodes.

(Supplementary note 19) The bipolar coagulation / incision treatment instrument according to supplementary note 18, wherein one of the three energizing means is electrically connected to the insertion portion by contact means including a leaf spring.

(Supplementary note 20) In Supplementary note 19, the three energizing means include a metal pipe included in the drive shaft and two insulated conductors in the metal pipe, and the contact means includes a metal pipe and an insertion portion. A bipolar coagulation / incision treatment device, which is connected.

(Supplementary note 21) The bipolar coagulation and incision treatment instrument according to supplementary note 19, wherein an electric plug including three electrodes connectable to a high-frequency power source is provided at a proximal end of the drive shaft.

(Supplementary note 22) The bipolar coagulation / incision treatment instrument according to supplementary note 20, wherein the insertion portion includes a jaw holding portion for holding the jaw, and the contact means is provided on the jaw holding portion.

(Supplementary note 23) In Supplementary note 18, the operating unit has three electric connection units that can be connected to a high-frequency power supply that is insulated from each other, and each electric connection unit is electrically connected to the energizing unit. A bipolar coagulation / incision treatment device characterized by being performed.

(Supplementary note 24) The bipolar coagulation / incision instrument according to supplementary note 23, wherein the three electric connection means are integrated electric plugs.

(Supplementary note 25) The bipolar coagulation / incision treatment instrument according to supplementary note 23, wherein the electric connection means and the current supply means are connected by a connection means comprising a leaf spring.

On the other hand, in the bipolar coagulation incision treatment device, as shown in DE4138116A1 mentioned in the section of the prior art, in order to increase the current density during the incision operation and to improve the incision ability, the incision jaw is set to about φ0.5 mm. What is constituted by a wire is known. However, at the time of coagulation and incision, the mounting rod for attaching the wire may also come into contact with the tissue, so that only the wire is energized and the tissue at the target position cannot be coagulated and incised. In addition, when a large amount of tissue comes into contact with the mounting rod of the wire, the cutting operation may not be performed in some cases.

Therefore, in order to prevent the tissue from sticking, in Japanese Patent Application Laid-Open No. 9-16847, the distal end of the catheter is composed of a conductive portion and an insulating portion. In JP-A-9-108234, the entire outer surface of the jaw except for the vicinity of the electrodes is covered with an insulating material.

However, Japanese Patent Application Laid-Open No. Hei 9-16847 discloses a catheter which does not coagulate and incise tissue, and Japanese Patent Application Laid-Open No. Hei 9-108234 discloses a method for coagulating tissue and does not dissect tissue. Absent.

FIG. 17 shows a first embodiment of a bipolar coagulation / incision treatment tool which solves the above-described problem and performs a coagulation / incision operation on a tissue. An incision jaw 101 and a solidification jaw 102 are provided at the distal end of the insertion section 100 so as to be freely opened and closed. The incision jaw 101 has a first electrode 103a
The solidified jaw 102 is provided with a second electrode 103b and a third electrode 103c with an insulating material 104 interposed therebetween.

The cutting jaw 101 is provided with an insulating coating 105 such as ceramic or Teflon, except for a current-carrying portion 101a for the cutting current at the pointed end. According to the experiment of the inventor, the width a of the conducting portion 101a is 0.2 to 0.7 mm,
A height b of 0.2 to 1.0 mm is a size suitable for coagulation and incision.

With this configuration, when the incision current is applied, only the energized portion 101a of the incision jaw 101 can be energized, so that a sufficient incision operation can be performed without reducing the current density. Further, by applying the insulating coating 105 to the side surface of the cutting jaw 101, there is an effect that heat invasion is not applied to tissues other than the target site.

FIG. 18 shows a second embodiment of the bipolar coagulation / incision treatment tool for the same purpose as the first embodiment. The same components as in the first embodiment are assigned the same reference numerals and description thereof is omitted. In the cutting jaw 106, a cutting wire 108 is fixed to a wire support member 107. The wire support member 107 is entirely coated with an insulating coating 105 such as ceramic or Teflon. Therefore, there is an effect similar to that of the disclosure example 1.

FIG. 19 shows a third embodiment of the bipolar coagulation / incision treatment tool for the same purpose as the first and second embodiments. The same components as in the first embodiment are assigned the same reference numerals and description thereof will be omitted. The incision 110 of the incision jaw 109 is formed like the wire 108 in FIG. 18, and a space 111 is provided in the center. The lower side of the cutout 110 is formed in the conducting part 110a, and the entire upper side is coated with an insulating coating 105 such as ceramic or Teflon. Therefore, the same effects as those of the first and second disclosure examples are obtained.

According to the disclosed example, the following configuration is obtained.

(Supplementary Note 26) In a bipolar coagulation / incision treatment instrument having an operation portion on the proximal side and a jaw at the tip portion for performing coagulation / incision of tissue, the incision jaw is a portion other than the high-frequency current-carrying portion that comes into contact with the tissue. A bipolar coagulation / incision treatment device, comprising an insulating material.

(Supplementary note 27) The bipolar coagulation / incision treatment instrument according to supplementary note 26, wherein a coating is used as an insulating material.

(Supplementary Note 28) The bipolar solid incision treatment instrument according to supplementary note 27, wherein the material of the insulating material is ceramic or Teflon.

(Supplementary note 29) The bipolar coagulation and incision treatment instrument according to supplementary note 26, wherein an insulating coating is applied to portions other than the high-frequency current-carrying portion of the cutting jaw.

(Supplementary Note 30) In Supplementary Note 26, the width of the current-carrying portion of the cutting jaw is 0.2 to 0.7 mm, and the height is 0.2 to 0.7 mm.
A bipolar coagulation / incision treatment instrument having a length of 1.0 mm and insulated except for a current-carrying part.

[0084]

As described above, according to the present invention, in a bipolar coagulation / incision treatment instrument, a pair of jaws pivot and open and close with each other, so that tissue can be coagulated, incised, and separated, and operability is improved. There is an effect that can be achieved.

[Brief description of the drawings]

FIG. 1 shows the overall configuration of a bipolar coagulation and incision treatment instrument of a first embodiment of the present invention, in which (a) is a side view with a jaw closed, and (b) is a state with the jaw open. (C) is a sectional view taken along line AA.

FIG. 2 is a partially cutaway side view of the bipolar coagulation / incision treatment tool of the embodiment when disassembled into a forceps unit, a sheath unit, and a handle unit.

FIG. 3 is an exploded perspective view of the forceps unit of the embodiment.

FIG. 4 shows the forceps unit of the embodiment,
Sectional drawing which follows the D line.

FIG. 5 is a sectional view of the embodiment, taken along line CC in FIG. 4;

FIG. 6 shows the same embodiment, and FIG. 4 in a state where a jaw is opened;
Sectional drawing which follows the CC line of FIG.

7A and 7B show the same embodiment, FIG. 7A is a cross-sectional view taken along the line EE of FIG. 5, FIG. 7B is a cross-sectional view taken along the line FF of FIG.
(C) is a sectional view taken along the line GG of FIG. 5, (d) is a sectional view taken along the line HH of FIG. 5, and (e) is a sectional view taken along the line II of FIG.

FIG. 8 is a vertical side view showing the coupling structure of the connecting pin of the embodiment.

FIG. 9 is a sectional view of the same embodiment, taken along line BB of FIG. 2;

FIG. 10 is a vertical cross-sectional side view showing a modified example of the coupling pin coupling structure of the embodiment.

FIG. 11 is an electric circuit diagram of the embodiment for supplying a high-frequency current.

FIG. 12 is a sectional view of the treatment state of the embodiment.

13A and 13B show a second embodiment of the present invention, wherein FIG. 13A is a longitudinal side view of a forceps unit, and FIG. 13B is a partially cutaway side view of a bipolar coagulation / incision treatment instrument.

FIG. 14 is a partially cutaway side view of the handle unit according to the third embodiment of the present invention.

15A and 15B show a fourth embodiment of the present invention, in which FIG. 15A is a cross-sectional view along the line KK, and FIG. 15B is a cross-sectional view along the line JJ.

16A and 16B show a fifth embodiment of the present invention, in which FIG. 16A is a cross-sectional view taken along line NN, and FIG. 16B is a cross-sectional view taken along line MM.

17A and 17B show Disclosure Example 1 of a forceps unit, wherein FIG. 17A is a perspective view, and FIG. 17B is a cross-sectional view taken along line OO.

FIG. 18 is a perspective view showing a second disclosure example of the forceps unit.

FIG. 19 is a perspective view showing a third disclosure example of the forceps unit.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Bipolar coagulation incision treatment tool 2 ... Sheath unit (insertion part) 3 ... Forceps unit 4 ... Handle unit (operation part) 9 ... Drive shaft 10a ... 1st jaw 10b ... 2nd jaw 11a ... 1st electrode 11b ... second electrode 11c ... third electrode 15a, 15b ... coagulation electrode

Claims (1)

[Claims] A pair of jaws comprising a first and a second jaw, an operating portion for opening and closing the jaws, an elongated insertion portion connecting the jaws to the operating portion, A drive shaft for transmitting an operating force, wherein the first jaw has a first electrode, and the second jaw has second and third electrodes insulated from each other. A bipolar coagulation and incision device in which electrodes are insulated from each other, wherein both the first jaw and the second jaw pivot to open and close with each other.