JP2013172784A - Tissue coagulator - Google Patents

Abstract

PROBLEM TO BE SOLVED: To securely coagulate a dissected surface by sticking or inserting a tissue coagulator into a portion of a dissection line, and to miniaturize the tissue coagulator to such a size as can be used in an endoscopic surgery.SOLUTION: A tissue coagulator has needles 11 with heaters 13 disposed on the whole or in a part within. The needles 11 are stuck or inserted into the periphery of a tumor or along a dissection line, and heated to coagulate the tissue. A plurality of needles 11 are erected at regular intervals on one surface of a base part 15, and the intervals of the needles 11 are retained uniform. The tissue coagulator is stuck or inserted into the periphery of the tumor or an area along the dissection line, so that a dissected surface can be securely coagulated, and bleeding when the tumor is dissected can be controlled.

Description

  The present invention relates to a tissue coagulation instrument that is punctured or inserted into a peripheral part of a tumor or a part of a disconnection line to coagulate a separation section before the tumor of the organ such as hepatectomy is disconnected.

  The liver has a vein such as a portal vein and is an organ with a large blood flow. For this reason, conventionally, a lot of laparotomy has been performed for liver surgery in preparation for bleeding. In laparotomy for liver cancer, ligation is performed to stop blood flow, and then the tumor is disconnected. At present, endoscopic surgery is also performed for hepatectomy as a minimally invasive surgical treatment. In endoscopic surgery, laparoscopic hepatectomy is performed when the tumor is on the surface of the liver, and in consideration of the size and position of the tumor, a needle electrode of microwave or radio wave is used. May be used for liver tumor coagulation necrosis therapy.

  Hemorrhage of the detached surface is controlled using a radiofrequency coagulator, a microwave tissue coagulator, an ultrasonic knife, or the like. For example, the radiofrequency coagulation apparatus (Habib4X) is punctured along the periphery of the tumor or along the separation line before the separation, and the part is solidified. Thereby, the bleeding at the time of disconnection can be controlled.

  However, the radiofrequency coagulation apparatus (Habib4X) and the like described above have limitations on the size and location of the tumor when used for endoscopic surgery. For this reason, a small tissue coagulation apparatus that can be widely used for endoscopic surgery is desired.

WO2011 / 037235

  The present invention provides a tissue coagulation instrument that is punctured or inserted into the periphery of a tumor or a portion along a separation line so that the cross section can be solidified reliably and can be used for endoscopic surgery. The purpose is to do.

  In order to achieve the above-described object, the tissue coagulation instrument according to the present invention has a needle portion in which a heater is disposed, and the needle portion is punctured or inserted along a peripheral portion of a tumor or a separation line. Is heated to solidify the tissue. The needle part has a heater built in the entire length or a part from the needle tip side to the needle base side, and for example, a continuous thread-like heater is used as the heater.

  Such a tissue coagulation instrument can be used for endoscopic surgery, and when used for endoscopic surgery, the tissue coagulation instrument is sized to be inserted into a trocar used for endoscopic surgery.

  For example, such a tissue coagulation instrument is punctured or inserted in the peripheral part of the tumor where the needle part is cut off or the part of the disconnection line, and the needle part is heated by a heater, and thereby the part that is punctured or inserted Is solidified. Thereafter, the tumor part is cut off using an electric knife, an ultrasonic knife or the like. A plurality of needle portions are erected on one surface of the base portion at equal intervals, so that the peripheral portion of the tumor or the part of the separation line can be uniformly solidified in the same state. Of course, the tissue coagulation instrument may be constituted by a needle part and individually punctured or inserted into the peripheral part of the tumor or the part of the disconnection line.

  Note that a temperature detection element may be disposed in the needle portion. Thus, the tissue coagulation instrument control device is supplied with temperature data from the temperature detection element, and the tissue coagulation instrument can control the heater so that the heating temperature is constant.

  In the present invention, the whole including the needle part is miniaturized to such an extent that it can be used for endoscopic surgery, and further, since the needle part is formed long, it can also be used for endoscopic surgery. it can. In addition, the needle portion of the portion where the heater is disposed can be punctured or inserted to the peripheral portion of the tumor or the deep portion of the parting line, and the punctured or inserted portion can be solidified reliably and uniformly. it can. Further, by puncturing or inserting the tissue coagulation device adjacent to each other, the peripheral portion or parting line of the tumor over a wide range can be heated to the deep portion at a time and coagulated. Furthermore, since the needle portion is heated by the heater, the temperature can be accurately controlled. Thereby, it is possible to coagulate the separation surface while minimizing damage to healthy cells, and to control bleeding in the next separation step.

1 is an external perspective view of a tissue coagulation instrument to which the present invention is applied. It is a perspective view of a tissue coagulation instrument. It is a figure which shows endoscopic surgery. It is the figure which showed the state which punctured the affected part with the needle part. It is a figure explaining the space | interval of the needle part when a tissue coagulation instrument is arranged in parallel. It is a figure which shows the example which made the shape of the needle part the shape of a sword. It is a figure which shows the state which punctures an affected part separately to a needle part.

  Hereinafter, a tissue coagulation instrument to which the present invention is applied will be described with reference to the drawings. As shown in FIGS. 1 and 2, the tissue coagulation instrument 1 has a needle part 11 that is punctured or inserted into an affected part in the living body at the affected part in the living body. Since this needle part 11 is punctured or inserted into a cancerous affected part of an organ such as the liver, the needle part 11 is formed of a biocompatible metal such as a stainless steel tube or a titanium tube. The inside of the needle part 11 is formed with a hollow part 12 extending from the needle tip side to the needle base side, and a heater 13 is inserted into the hollow part 12 in the entire length or a part thereof. Since the needle tip of the needle portion 11 is a portion that is punctured or inserted into the peripheral portion of the tumor or the portion of the disconnection line, it has a sharp shape and is blocked.

  The heater 13 inserted into the hollow portion 12 has a continuous thread shape with a thickness of 0.5 mm or less, and has flexibility. The hollow portion 12 of the needle portion 11 is closed, for example, in a state where a thread-like heater is inserted from the needle base side over the entire length, and the heater 13 led out from the needle base is connected to a power line 21 connected to the control device 20. It is connected. In addition to the heater 13, the hollow portion 12 is provided with a temperature detection element 17 such as a thermocouple or a Peltier element so that the temperature of the needle portion 11 can be detected and the temperature of the needle portion 11 can be controlled by the control device 20. It may be. As shown in FIG. 2, when the thermocouple 17 is used, the thermocouple 17 is inserted into the hollow portion 12 while being insulated from the heater 13 by an insulator of a polyimide tube. The example of the heater 13 is not limited to this. For example, one or more heaters 13 may be disposed in the hollow portion 12 of the needle portion 11.

  The needle base of the needle part 11 is further provided with a base part 15 made of biocompatible resin or metal so that it can be held by a surgical instrument such as forceps. The base portion 15 is a member that holds the plurality of needle portions 11 at regular intervals. The base portion 15 has a substantially rectangular parallelepiped shape, and a plurality of needle portions 11 are held at equal intervals on one surface, so that the peripheral portion of the tumor or the part of the separation line can be uniformly cauterized by the needle portion 11. Yes. The needle portion 11 may be integrated with the base portion 15 or may be integrated by fitting the needle portion 11 into a hole formed in the base portion 15. In addition, the number of the needle parts 11 hold | maintained at the base part 15 is not limited. The standing surface 15b on which the needle portion 11 of the base portion 15 is erected serves as a regulating surface for preventing the needle portion 11 from entering too deeply into the peripheral portion of the tumor or the part of the separation line. From the surface opposite to the standing surface 15b, a power line 21 connected to the heater 13 built in the needle portion 11 is led out, and the power line 21 is connected to the control device 20 that controls the tissue coagulation instrument 1. Yes. Further, a groove 18 is formed on the side surface of the base portion 15 to engage forceps and the like.

  Further, the base portion 15 is formed such that the opposite side surface 15a in the direction in which the needle portions 11 are arranged is a flat surface and abuts the side surface 15a of the base portion 15 of the other tissue coagulation instrument 1 adjacent to each other. be able to. Here, the opposing side surface 15a of the base unit 15 is formed as a flat surface, but in order to determine the position of each other, an engagement protrusion is provided on the side surface 15a of one base unit 15 and the other base unit You may make it provide an engagement recessed part in the side surface 15a of the part 15. FIG. In this case, when the needle portion 11 is punctured or inserted into the peripheral portion of the tumor or the part of the disconnection line, the engagement protrusion and the engagement recess can be engaged with each other to position each other.

  As shown in FIG. 3, the tissue coagulation instrument 1 as described above has a diameter of 0.5 to 1 in the abdominal cavity, thoracic cavity, retroperitoneal cavity, etc. It is formed in a size that can be used in endoscopic surgery performed by looking at monitor images using an endoscope and special surgical instruments. For example, a trocar 16 that is a cylindrical instrument for smoothly inserting a surgical instrument used in endoscopic surgery into a body has a diameter of 5 to 10 mm, and the tissue coagulation instrument 1 is The trocar 16 is formed in a size that can be inserted into the abdominal cavity, thoracic cavity, retroperitoneal cavity, and the like. In addition, the tissue coagulation instrument 1 is punctured or inserted along the periphery of the tumor or along the cutting line perpendicularly or parallel to the organ surface 2 such as the liver surface or the kidney surface when the liver is cut off. An instrument that performs pre-coagulation. For this reason, the length of the needle part 11 is formed longer than a device that cauterizes a tumor on the organ surface 2 such as the liver surface or the kidney surface, and is formed to have a length of about 70-100 mm, for example.

  In endoscopic surgery, as shown in FIG. 3, a small hole having a diameter of about 1 cm is incised at several places on the body surface, and serves as a passage (tube) for inserting forceps or the like into the incision. By inserting the trocar 16 and injecting carbon dioxide gas, the inside is inflated to form a space in the abdominal cavity. Then, an endoscope is inserted from the trocar 16 and, after internal observation, forceps are inserted from the trocar 16 into the body, and an operation is performed while checking the internal state projected by the endoscope on the monitor. During this operation, the tissue coagulation instrument 1 to which the present invention is applied is inserted into the trocar 16 from the side of the needle portion 11, for example, and the forceps and the like are engaged with the groove portion 18 of the base portion 15 as shown in FIG. In combination, it is punctured or inserted along the periphery of the tumor of the organ such as the liver or along the cutting line. At this time, the tissue coagulation device 1 is punctured or inserted along the periphery of the tumor or along the cutting line in a line according to the length to be cut off. The power line 21 connected to the heater 13 and led out from the needle base is led out from the trocar 16 and connected to the control device 20. Note that the number of tissue coagulation instruments 1 may be one depending on the length to be cut off.

  The control device 20 that supplies power to the heater 13 of the tissue coagulation instrument 1 supplies power to the heater 13 in accordance with the operation of a user such as a doctor, and heats the needle portion 11 to disconnect it. Solidify the part. When the temperature detection element is provided in the needle portion 11, temperature data is supplied from the temperature detection element to the control device 20, and the control device 20 controls the heater 13 so that the heating temperature is constant, Even when the tissue coagulation instrument 1 is punctured in a row, the peripheral part of the tumor or the part of the disconnection line can be precoagulated uniformly. Thereafter, the tumor part is cut off using an electric knife or an ultrasonic knife. Note that the portal vein, hepatic artery, or the like may be ligated at the time of disconnection.

  As shown in FIGS. 4 and 5, the tissue coagulation instrument 1 may be used as a single tumor depending on the tumor, but a plurality of the tissue coagulation instruments 1 are adjacent to each other along the tumor periphery or the separation line. It is an instrument that often punctures the part. Therefore, as shown in FIG. 5, the base portion 15 of the tissue coagulation instrument 1 has a distance P between the center lines O and O of the plurality of needle portions 11 arranged side by side of the needle portions 11 a at both ends. The distance from the central axis O to the side surface 15a of the base portion 15 on the needle portion 11a side is formed. Thereby, even when the tissue coagulation instrument 1 is arranged side by side, the interval between the needle portions 11 at the boundary portion becomes the same as the interval between the other needle portions 11, and thereby the peripheral portion of the tumor or the part of the disconnection line It can be uniformly solidified.

  Further, when a plurality of rows of the needle portions 11 are provided on the base portion 15, the needle portions 11 may be provided in a plurality of rows. For example, the upper and lower three needle portions 11 (for example, the upper two rows, the lower tiers). They may be formed so as to be spaced apart so that the center of one) is an equilateral triangle. Thereby, the peripheral part of a tumor or the part of a parting line can be coagulated more uniformly than in a single row. Further, the shape of each needle portion 11 is not limited to a needle shape, but as shown in FIG. 6, for example, the shape of the base portion 15 is a sword shape with the longitudinal direction being the width direction so as to increase the contact area with the tissue. Also good.

  The tissue coagulation instrument 1 as described above is miniaturized to such an extent that it can be used for endoscopic surgery, and the needle portion 11 is formed long. The peripheral part of the tumor on the surface 2 or the part of the separation line can be solidified uniformly and surely up to the deep part. Furthermore, since the needle portion is directly heated by the heater, the temperature can be accurately controlled. This makes it possible to coagulate the detached surface while minimizing damage to healthy cells, and to minimize bleeding at the time of tumor detachment. In addition, bleeding in the next cutting step can be controlled, and in some cases, the ligation step can be omitted.

  The tissue coagulation instrument 1 can also be used for heating tumors such as oral cancer and colon cancer. The present invention can also be used for heat coagulation at the time of disconnection of organs other than humans. Furthermore, the tissue coagulation instrument 1 may be used not only for endoscopic surgery but also for laparotomy.

  In the above example, the case where a plurality of needle portions 11 are erected on the base portion 15 has been described. However, as shown in FIG. 7, the present invention individually applies a plurality of tissue coagulation needles 30 to the affected area. You may make it puncture or insert. In this case, the gap formation convex part 31 is formed in the needle base, and the gap formation convex part 31 of the adjacent needle is abutted to make the gap between the needles constant.

  DESCRIPTION OF SYMBOLS 1 Tissue coagulation instrument, 2 affected part, 11 needle part, 12 hollow part, 13 heater, 15 base part, 16 trocar, 17 thermocouple, 18, groove part, 20 control device, 21 power line, 30 tissue coagulation needle, 31 gap formation Convex

Claims (5)

It has a needle part in which a heater is arranged,
The heater is provided on the entire length or a part of the needle part,
A tissue coagulation instrument in which the needle portion is punctured or inserted along a peripheral portion of a tumor or a separation line and heated by the heater to coagulate tissue. The tissue coagulation instrument according to claim 1, wherein the heater is a continuous filamentous heater. The tissue coagulation instrument according to claim 1 or 2, wherein a temperature detection element is disposed in the needle portion. The tissue coagulation instrument according to any one of claims 1 to 3, wherein a plurality of the needle parts are erected at an equal interval on one surface of the base part. The tissue coagulation instrument according to any one of claims 1 to 4, which is a size that can be inserted into a trocar used in endoscopic surgery.

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