JP2016021983A - Subcapsular tissue extraction method and treatment method - Google Patents

Abstract

An object of the present invention is to efficiently perform excision and suction of subcapsular tissue. A liquid having biocompatibility and imparted with a pulsating flow is ejected from an ejection tube configured as an inner tube, and the liquid is ejected from an aspiration tube configured as an outer tube of the ejection tube. The subcapsular tissue is extracted using a liquid ejecting apparatus that performs suction. In the first step, the coated surface of the subcapsular tissue is adsorbed to the open end of the aspirating tube by aspiration by the aspirating tube, and the liquid to which the pulsating flow is applied is ejected from the ejecting tube. Make an incision. In the second step, the subcapsular tissue is excised by ejecting the liquid to which the pulsating flow is applied from the ejection tube to the subcapsular tissue, and the excised subcapsular tissue is aspirated by the suction tube. . [Selection] Figure 6

Description

  The present invention relates to extraction of subcapsular tissue.

  When a living tissue is excised by ejecting a liquid, a technique is known in which the periphery of an excision object is adsorbed and held by a suction force by an adsorption tube (for example, Patent Document 1).

JP 2012-161506 A

  This invention makes it a solution subject to perform excision and suction of a subcapsular tissue efficiently based on the said prior art. In the case of the above prior art, in order to remove the excised living tissue, adsorption by the suction tube must be interrupted. Therefore, every time the excision work and the suction work are switched, the suction must be performed or interrupted. As a result, it has been difficult to efficiently perform excision and suction.

  SUMMARY An advantage of some aspects of the invention is to solve the above-described problems, and the invention can be implemented as the following forms.

(1) According to one aspect of the present invention, a liquid that is biocompatible and imparted with a pulsating flow is ejected from an ejection pipe configured as an inner pipe; and the liquid is used as an outer pipe of the ejection pipe. A method of extracting subcapsular tissue is provided using a liquid ejection device that aspirates from a configured suction tube. In this method, the liquid to which the pulsating flow is applied is ejected from the ejection pipe in a state where the coating surface of the subcapsular tissue is adsorbed to the opening end of the suction pipe by the suction by the suction pipe. A first step of incising the coated surface; resecting the subcapsular tissue by spraying the liquid to which the pulsating flow is applied from the ejection tube to the subcapsular tissue; and the excised subcapsular tissue And a second step of performing suction by the suction tube. According to this embodiment, excision and suction of the subcapsular tissue can be performed efficiently. This is because, in the case of this embodiment, by using a double tube structure having an inner tube and an outer tube, adsorption, excision, and suction can be performed by one device.

(2) In the above embodiment, the excision of the subcapsular tissue in the second step may be performed in a state where the coating surface around the hole formed by the incision is adsorbed to the open end of the suction tube. Good. According to this embodiment, since the coating film is adsorbed around the injection tube, the position of the injection tube can be stabilized, so that the tissue under the coating can be easily excised.

(3) In the above aspect, the injection tube is configured as an innermost tube, the suction tube is configured as an inner tube, and a multiple tube is configured; and the liquid ejection device includes a second suction tube as an outer tube of the multiple tube. The suction by the second suction tube is used for the adsorption of the coating surface in the second step; the suction by the suction tube may be used for the suction of the tissue under the coating. According to this aspect, since the adsorption of the coating surface and the suction of the tissue under the coating can be performed by separate tubes, each can be stably performed.

(4) In the above aspect, the injection pressure in the second step may be equal to or lower than the injection pressure in the first step. According to this aspect, in the second step, it becomes easy to avoid damage to blood vessels and normal tissue.

(5) In the above aspect, the suction force for sucking the subcapsular tissue in the second step may be greater than or equal to the suction force for sucking the coating surface in the first step. According to this embodiment, the excised subcapsular tissue can be efficiently extracted.

(6) The said form WHEREIN: You may further include the step which injects a chemical | medical solution from the said injection pipe after the said 2nd step. According to this form, the medicinal solution can be administered after excision of the subcapsular tissue.

(7) In the above aspect, the liquid ejected in the second step may be a chemical liquid. According to this embodiment, the drug solution can be administered while excising the subcapsular tissue.

  The present invention can be realized in various forms other than the above. It can be realized as a treatment method using the above method.

The block diagram of a liquid ejecting apparatus. The internal structure figure of a handpiece. The figure which looked at the handpiece from the top. The graph which shows the waveform of the drive voltage applied to a piezoelectric element. The figure which shows the correspondence of the waveform of a drive voltage, and the mode of a deformation | transformation of a diaphragm. The flowchart which shows the procedure of the extraction method of a subcapsule structure | tissue roughly. The schematic diagram which shows a mode that a tumor exists under the film which covers a normal tissue. The schematic diagram which shows a mode that the position of a tumor is specified by an ultrasonic diagnosing device. The schematic diagram which shows a mode that an injection port and a suction port are arrange | positioned near the specified tumor. The schematic diagram which shows a mode that a film is made to adsorb | suck to a suction port. The schematic diagram which shows a mode that a film is cut | disconnected by injection of a pulse flow. The schematic diagram which shows a mode that a tumor is excised by injection of a pulse flow. The schematic diagram which shows a mode that a liquid is injected in a wide range. The schematic diagram which shows a mode that it attracts | sucks with a suction tube. The schematic diagram which shows a mode that a chemical | medical solution is inject | poured after extraction of a tumor. FIG. 6 is a configuration diagram of a liquid ejecting apparatus (third embodiment). The schematic diagram which shows a mode that suction and adsorption | suction are performed. FIG. 6 is a configuration diagram of a liquid ejecting apparatus (Embodiment 4).

  Embodiment 1 will be described. FIG. 1 shows a configuration of the liquid ejecting apparatus 10. The liquid ejecting apparatus 10 is a medical device used in a medical institution, and has a function of incising or excising an affected part by ejecting liquid onto the affected part.

  The liquid ejecting apparatus 10 includes a handpiece 20, a liquid supply mechanism 50, a suction device 60, a control unit 70, and a liquid container 80. The liquid supply mechanism 50 and the liquid container 80 are connected by a connection tube 51. The liquid supply mechanism 50 and the handpiece 20 are connected by a liquid supply channel 52. The connection tube 51 and the liquid supply channel 52 are formed of resin.

  The handpiece 20 is an instrument that is operated by the surgeon. The liquid container 80 stores physiological saline. The liquid supply mechanism 50 supplies the liquid sucked from the liquid container 80 via the connection tube 51 to the handpiece 20 via the liquid supply channel 52 by driving a built-in pump.

  The control unit 70 transmits a drive signal via the signal cable 72 to the pulsating flow generation unit 30 built in the handpiece 20. The control unit 70 controls the flow rate of the liquid supplied to the pulsating flow generation unit 30 by controlling the liquid supply mechanism 50 via the control cable 71. A foot switch 75 is connected to the control unit 70. When the surgeon turns on the foot switch 75, the control unit 70 controls the liquid supply mechanism 50 to execute supply of liquid to the pulsating flow generation unit 30 and transmits a drive signal to the pulsating flow generation unit 30. Then, pulsation is generated in the pressure of the liquid supplied to the pulsating flow generation unit 30. The control unit 70 includes an input interface (not shown), and adjusts the strength of pulsation by controlling the drive signal according to the input to the input interface. The input interface according to this embodiment includes a button that receives an instruction to increase pulsation and a button that receives an instruction to weaken pulsation.

  An ejection tube 55 and a suction tube 62 protrude from the distal end side of the handpiece 20. The injection pipe 55 includes an injection nozzle 56 at the tip. The injection nozzle 56 is a nozzle whose inner diameter decreases smoothly toward the tip. The liquid to which the pulsating flow is applied is ejected from the ejection port 58 formed by the ejection nozzle 56 through the ejection pipe 55. Hereinafter, unless otherwise specified, the injection pipe 55 and the injection nozzle 56 are not distinguished, and the injection pipe 55 includes the injection nozzle 56.

  As described above, since the pulsating flow is applied to the liquid to be ejected by the pulsating flow generation unit 30, the liquid is ejected in a pulse form from the ejection port 58. The pulse-like ejection in the present embodiment means that the flow rate or the flow velocity is ejected with fluctuation, and is not limited to repeating the liquid ejection and the stop. That is, it includes various injection forms such as a form in which the injection is completely interrupted between injections and a form in which a low-pressure flow exists between the injections.

  The suction device 60 is for sucking liquid and excision around the ejection port 58. The suction device 60 and the handpiece 20 are connected by a suction pipe 62. The suction device 60 always sucks the inside of the suction tube 62 while the switch for operating the suction device 60 is on. The suction pipe 62 passes through the handpiece 20 and opens near the tip of the injection nozzle 56.

  The suction pipe 62 is made of a transparent resin and covers the injection pipe 55. For this reason, as shown in the arrow A view of FIG. 1, a double tube is formed in which the injection tube 55 is an inner tube and the suction tube 62 is an outer tube. Between the ejection tube 55 and the suction tube 62, a flow path is formed through which the suctioned material sucked from the suction port 64 that is the tip of the suction tube 62 flows. The sucked material is sucked into the suction device 60 through the suction tube 62. The suction force is adjusted by a suction force adjustment mechanism 65 described later.

  FIG. 2 shows the internal structure of the handpiece 20. The handpiece 20 includes a pulsating flow generation unit 30, an inlet channel 40, an outlet channel 41, and a connection tube 54, and includes a suction force adjustment mechanism 65. As shown in FIG. 2, XYZ axes are defined. The X axis is parallel to the penetration direction of the suction force adjusting hole 67, and the upward direction is a positive direction. The Z axis is parallel to the major axis direction of the ejection pipe 55, and the direction in which the liquid is ejected is a negative direction. The Y axis is defined by the right-handed system with reference to the X axis and the Z axis.

  As shown in the enlarged view at the bottom of FIG. 2, the pulsating flow generation unit 30 includes a first case 31, a second case 32, a third case 33, a bolt 34, a piezoelectric element 35, a reinforcing plate 36, a diaphragm 37, and a packing 38. The inlet channel 40 and the outlet channel 41 are provided. The first case 31 is a cylindrical member. The first case 31 is hermetically sealed by joining the second case 32 to one end and fixing the third case 33 to the other end with a bolt 34. A piezoelectric element 35 is disposed in a space formed inside the first case 31.

  The piezoelectric element 35 is a stacked piezoelectric element. One end of the piezoelectric element 35 is fixed to the diaphragm 37 via the reinforcing plate 36. The other end of the piezoelectric element 35 is fixed to the third case 33. The diaphragm 37 is made of a metal thin film. The peripheral edge of the diaphragm 37 is fixed to the first case 31 and is sandwiched between the first case 31 and the second case 32. A liquid chamber 39 is formed between the diaphragm 37 and the second case 32.

  The second case 32 is connected to an inlet channel 40 through which liquid flows. The inlet channel 40 is bent in a U shape and extends toward the rear end 22 of the handpiece 20. A liquid supply channel 52 is connected to the inlet channel 40. The liquid supplied from the liquid supply mechanism 50 is supplied to the liquid chamber 39 via the liquid supply channel 52.

  An ejection pipe 55 is connected to the outlet channel 41 via a metal connection tube 54. The liquid that has flowed into the outlet channel 41 is ejected from the ejection port 58 through the connection tube 54 and the ejection pipe 55.

  A drive signal is input to the piezoelectric element 35 via the signal cable 72 from the control unit 70. The signal cable 72 is inserted from the rear end portion 22 of the handpiece 20. The signal cable 72 accommodates the electrode wire 74. The electrode wire 74 is connected to the piezoelectric element 35 in the pulsating flow generation unit 30. The piezoelectric element 35 expands and contracts based on the drive signal transmitted from the control unit 70. The volume of the liquid chamber 39 is changed by the expansion and contraction of the piezoelectric element 35.

  The suction force adjusting mechanism 65 is for adjusting the force with which the suction pipe 62 sucks liquid or the like from the suction port 64. The suction force adjustment mechanism 65 includes an operation unit 66 and a suction force adjustment hole 67. The suction force adjustment hole 67 is a through hole that connects the suction pipe 62 and the operation unit 66. When the user opens and closes the suction force adjustment hole 67 with the finger of the hand holding the handpiece 20, the amount of air flowing into the suction pipe 62 through the suction force adjustment hole 67 is adjusted according to the degree of opening and closing. Thereby, the suction force by the suction port 64 is adjusted.

  FIG. 3 is a view of the handpiece 20 as viewed from above. As shown in FIG. 3, the suction force adjustment hole 67 is not constant in the Y-axis direction, and the front end side of the handpiece 20 is narrower than the rear end side. Since the suction force adjustment hole 67 has such a shape, it is easy for the operator to finely adjust the opening / closing degree of the suction force adjustment hole 67.

  FIG. 4 shows an example of the waveform of the drive voltage applied to the piezoelectric element 35. In FIG. 4, the horizontal axis indicates time, and the vertical axis indicates drive voltage. One cycle of the waveform of the drive voltage includes a rising period (b) in which the voltage increases, a time (c) at which the voltage becomes maximum, a falling period (d) in which the voltage decreases, and a pause period in which no voltage is applied ( a) and (e).

  The waveform of the rising period of the drive voltage is a waveform corresponding to ½ period of the sin waveform offset in the positive voltage direction and shifted in phase by −90 degrees. The waveform of the falling period of the drive voltage is a waveform corresponding to ½ period of the sin waveform offset in the positive voltage direction and shifted in phase by +90 degrees. The period of the sin waveform in the falling period is larger than the period of the sin waveform in the rising period.

  When the magnitude of the drive voltage is changed, the maximum value of the waveform shown in FIG. 4 is changed. In addition, when the frequency of the drive voltage is changed, the waveforms of the rising period and the falling period are not changed, and the length of the pause period is changed.

  FIG. 5 shows a correspondence relationship between the waveform of the drive voltage and the state of deformation of the diaphragm 37. In the rest period (a), since the drive voltage is not applied, the piezoelectric element 35 is not stretched and the diaphragm 37 is not bent. In the rising period (b), since the drive voltage increases, the piezoelectric element 35 expands, the diaphragm 37 bends toward the liquid chamber 39, and the volume of the liquid chamber 39 decreases.

  At time (c), since the drive voltage is maximized, the length of the piezoelectric element 35 is also maximized, and the volume of the liquid chamber 39 is minimized. In the falling period (d), since the drive voltage is reduced, the piezoelectric element 35 starts to return to the original size, and the volume of the liquid chamber 39 starts to return to the original size. In the rest period (e), since the drive voltage is not applied, the piezoelectric element 35 returns to the original size, and the volume of the liquid chamber 39 returns to the original size. By repeating a series of operations shown in (a) to (e), a pulsating flow is generated in the liquid in the liquid chamber 39. Therefore, if the difference between the maximum value and the minimum value of the drive voltage increases, the pulsating flow becomes strong, and if the difference between the maximum value and the minimum value of the drive voltage becomes small, the pulsating flow becomes weak.

  FIG. 6 is a flowchart schematically showing the procedure of the method for extracting the subcapsular tissue. In this method, the liquid ejecting apparatus 10 described above is used. The extraction of the subcapsular tissue in this embodiment is performed for the purpose of treating a human being.

  First, the surgeon specifies the position of the subcapsular tissue to be extracted (step S210). In step S210 in the present embodiment, the ultrasonic diagnostic apparatus 100 is used as shown in FIG. The ultrasonic diagnostic apparatus 100 is an apparatus for acquiring an image through the skin D. FIG. 7 schematically shows that the tumor S to be extracted is present under the coating C covering the normal tissue. As shown in FIG. 7, a blood vessel V runs inside the tumor S.

  FIG. 8 schematically shows how the position of the tumor Sa is specified by the ultrasonic diagnostic apparatus 100. The tumor Sa is covered with its own coating Ca. The extraction method of the present embodiment can be applied to both the case of FIG. 7 and the case of FIG. Hereinafter, the case of FIG. 7 will be described as an example.

  Subsequently, the surgeon secures an operative field (step S220). Specifically, drape is applied in the vicinity of the position specified in step S210, skin D is incised, and coating C is exposed.

  Next, the surgeon operates the handpiece 20 to place the ejection port 58 and the suction port 64 near the identified tumor S as shown in FIG. 9 (step S230).

  Subsequently, the operator operates the handpiece 20 to bring the suction port 64 into contact with the coating C, and closes a part (for example, half) of the suction force adjustment hole 67 with a finger, as shown in FIG. Next, the coating C is adsorbed to the suction port 64 (step S240). The operator determines the degree of opening and closing of the suction force adjustment hole 67 with his / her own sense. This adsorption is realized by a suction force by the suction pipe 62. At the time of this adsorption, the surgeon applies tension to the film C by pulling up the film C using the adsorption force.

  Next, the surgeon steps on the foot switch 75 to cause a pulse flow to be ejected. As shown in FIG. Also in step S250, the surgeon continues the above-described tension load. Due to the load of the tension, the coating C is easily cut.

  If the coating C can be incised, the surgeon operates the input interface described above to reduce the injection pressure (step S260). The injection pressure is the maximum pressure measured at the opening of the injection pipe 55. This operation is executed as preparation for excision of the tumor S in the next step S270. The purpose of reducing the injection pressure is to prevent damage to the blood vessel V and normal tissue. The injection pressure changes according to the strength of the pulsating flow of the liquid in the liquid chamber 39.

  Next, the excised tumor S is excised while being excised while excising the tumor S, which is the subcapsular tissue (step S270). The excision of the tumor S is realized by a pulse flow ejected by the operator stepping on the foot switch 75. The suction of the tumor S is realized by the operator closing the suction force adjusting hole 67. FIG. 12 schematically shows a state in which the tumor S is excised by jetting a pulse flow while the coating C is adsorbed. By adsorbing the coating C to the suction tube 62, the position of the ejection tube 55 can be stabilized, and by applying tension to the tumor S via the coating C, the tumor S can be easily excised. However, when the tumor S is excised, the coating C may not be adsorbed.

  FIG. 13 schematically shows a state where a surgeon operates the handpiece 20 and moves the ejection tube 55 relative to the suction tube 62 to eject liquid over a wide range. FIG. 14 schematically shows a state in which the sucked material is sucked by the suction pipe 62. The aspirated material is a resected tumor S, a jetted liquid, or the like.

  The excision and aspiration of the tumor S in step S270 can be operated independently. That is, excision can be performed if the surgeon steps on the foot switch 75, and suction can be performed if the surgeon closes the suction force adjusting hole 67. Therefore, in step S270, the surgeon may perform suction after the excision is completed, may alternately perform excision and suction, or may perform excision and suction at the same time.

  The suction force in step S270 is preferably larger than the suction force in step S240. This is because, generally, suction of a sucked material requires a larger suction force than adsorption of the coating C. Therefore, the surgeon increases the area for closing the suction force adjusting hole 67 in the case of step S270 as compared with the case of step S240.

  When suction of the aspirated material is completed, extraction of the subcapsular tissue is completed, so the operator removes the foot from the foot switch 75 and separates the tip of the ejection tube 55 and the suction tube 62 from the coating C.

According to the embodiment described above, at least the following effects can be obtained.
(1) Adsorption of the tumor S enables efficient excision, and switching between excision and aspiration can be performed simultaneously without requiring complicated operations. As a result, the tumor S can be extracted more smoothly than before.

(2) According to the jet of pulsating flow, the tumor is excised while the blood vessel is difficult to be incised. Therefore, as shown in FIG. 14, the blood vessel V traveling in the vicinity of the tumor S is easily preserved even after the tumor S is removed.

(3) By using the suction force of the suction pipe 62 to adsorb the coating C before the incision, the incision of the coating C is facilitated.
(4) By using the suction force by the suction tube 62 to adsorb the coating C after the incision, the tumor S can be easily excised.

(5) Since the suction tube 62 is transparent, the operator can visually recognize the ejection tube 55. Therefore, it becomes easy to adjust the position at which the liquid is ejected for the incision of the coating C (step S250) and the excision of the tumor S (step S260).

  A second embodiment will be described. The second embodiment adds the following procedure to the first embodiment. FIG. 15 schematically shows a state in which a drug solution is injected after the tumor is removed. A chemical | medical solution is a liquid containing the chemical | medical agent for hemostasis, for example. The liquid containing the hemostatic agent is, for example, a liquid obtained by diluting a vasoconstrictor (adrenaline) 100 to 1000 times.

  After step S270, the surgeon realizes the above procedure by transferring the open end of the connection tube 51 from the liquid container 80 to the container in which the chemical solution is stored. Thus, applying hemostasis after tumor removal (step S270) is effective to prevent a small amount of venous bleeding over a wide area.

  A third embodiment will be described. FIG. 16 shows the liquid ejecting apparatus 13. The liquid ejecting apparatus 13 has a configuration in which a second suction device 61, a suction flow path 610, and a second suction pipe 620 are added to the liquid ejecting apparatus 10.

  The second suction pipe 620 is connected to the handpiece 20 as shown in FIG. As shown in FIG. 16, the second suction pipe 620 is configured as an outer pipe in a triple pipe having the injection pipe 55 as the innermost pipe and the suction pipe 62 as the inner pipe. A second suction port 640 is formed between the suction tube 62 and the second suction tube 620. The suction flow path 610 has flexibility and connects the second suction device 61 and the second suction pipe 620. The second suction device 61 sucks the second suction pipe 620 through the suction flow path 610 according to the control of the control unit 70.

  FIG. 17 schematically illustrates how step S270 is executed by the liquid ejecting apparatus 13. As shown in FIG. 17, the suction object is sucked by the suction pipe 62, while the coating C is adsorbed by the second suction pipe 620. Thus, by performing suction and suction using separate tubes, suction and suction can be performed simultaneously. As a result, since the coating film C can be stably adsorbed in step S270, the position of the injection pipe 55 is not easily displaced. In addition, since the sucked material can be sucked stably, it is easy to avoid damage to the surrounding normal tissue.

  A fourth embodiment will be described. FIG. 18 shows the liquid ejecting apparatus 14. The liquid ejecting apparatus 14 is a modification of the liquid ejecting apparatus 13. The liquid ejecting apparatus 14 includes a suction tube 700 instead of the suction tube 62. As shown in the arrow A view, the suction pipe 700 is divided into two flow paths by a partition 710. One of the partitioned flow paths forms a suction port 64 a as shown in FIG. 18 and is sucked by the suction device 60. An injection pipe 55 is disposed inside the flow path. The other channel forms a second suction port 640 a and is sucked by the second suction device 61.

  The flow path sucked by the second suction device 61 is sealed in the handpiece 20. This separates the two suctions. Also with the liquid ejecting apparatus 14, the same effect as that of the liquid ejecting apparatus 13 according to the third embodiment can be obtained.

  The present invention is not limited to the embodiments, examples, and modifications of the present specification, and can be implemented with various configurations without departing from the spirit of the present invention. For example, the technical features in the embodiments, examples, and modifications corresponding to the technical features in the embodiments described in the summary section of the invention are to solve some or all of the above-described problems, or In order to achieve part or all of the effects described above, replacement or combination can be performed as appropriate. If the technical feature is not described as essential in this specification, it can be deleted as appropriate. For example, the following are exemplified.

The location of the tumor may be determined using an X-ray, an MRI (Magnetic Resonance Imaging) apparatus, a CT (Computed Tomography) apparatus, etc., instead of using an ultrasonic diagnostic apparatus. However, a visual method by the operator may be used.
The position of the tissue to be extracted may be specified after incising the skin.

  The object to be removed may not be a tumor. For example, other diseased tissues may be removed, or normal tissues may be removed for disease prevention.

The suction force for the coating and the suction force for the suction object may be adjusted by the output of the suction device. In this case, specific numerical values such as an adsorption force of −30 kPaG and an attractive force of −50 kPaG may be controlled as target values.
The suction force for sucking the sucked material may be the same as or stronger than the suction force for sucking the film.

The injection pressure may be switched with a foot switch. For example, it may be possible to adjust the amount of depression, or a switch for switching the strength of the injection pressure may be provided separately.
The spray pressure for excising the tumor may be the same as or greater than the spray pressure for incising the capsule.
The definition of the injection pressure may not be the maximum pressure. For example, the average pressure may be used.

The connection tube and the liquid supply channel may be formed of metal.
The injection pipe may be formed of other metal such as brass, reinforced plastic, or the like.

  In preparation for the step of administering the drug solution in the second embodiment, opening and closing of a valve may be used to switch the liquid to be ejected. Specifically, it may be realized as follows. The connecting tube is branched into two, one branch destination is immersed in physiological saline, and the other branch destination is immersed in the chemical solution. A valve is provided at each of the two branch destinations. Until the tumor is excised, the valve on the branch of the drug solution is closed. Then, in the step of administering the chemical solution, a valve provided at the branch of the chemical solution is opened. At this time, the valve provided at the branch of the physiological saline may be opened or closed.

  As in the fourth embodiment, when the second suction pipe is realized by dividing the suction channel, the shape of the division may be any.

The subject of treatment may be an animal other than a human.
The purpose of the extraction method described above may be other than treatment. For example, a tumor or the like may be removed for research or educational purposes.
The liquid to be ejected for incision and excision need not be physiological saline, but may be biocompatible. For example, pure water, the above-described chemical solution, or another chemical solution may be used.

DESCRIPTION OF SYMBOLS 10 ... Liquid ejector 13 ... Liquid ejector 14 ... Liquid ejector 20 ... Handpiece 22 ... Rear end part 30 ... Pulsating flow generation part 31 ... 1st case 32 ... 2nd case 33 ... 3rd case 34 ... Bolt 35 ... Piezoelectric element 36 ... Reinforcing plate 37 ... Diaphragm 38 ... Packing 39 ... Liquid chamber 40 ... Inlet channel 41 ... Outlet channel 50 ... Liquid supply mechanism 51 ... Connection tube 52 ... Liquid supply channel 54 ... Connection tube 55 ... Injection tube 58 ... Suction port 61 ... Suction device 61 ... Second suction device 62 ... Suction tube 64 ... Suction port 65 ... Suction force adjustment mechanism 66 ... Operation unit 67 ... Suction force adjustment hole 70 ... Control unit 71 ... Control cable 72 ... Signal cable 74 ... Electrode wire 75 ... Foot switch 80 ... Liquid container 100 ... Ultrasonic diagnostic apparatus 610 ... Suction flow path 620 ... Second suction pipe 640 ... Second suction port 640a ... First 2 suction port 700 ... suction tube C ... coating Ca ... coating D ... skin S ... tumor Sa ... tumor V ... blood vessel

Claims (8)

A liquid that is biocompatible and imparted with a pulsating flow is jetted from a jet pipe configured as an inner pipe,
Using a liquid ejecting apparatus that sucks the liquid from a suction tube configured as an outer tube of the ejection tube,
A method of removing subcapsular tissue,
By spraying the liquid to which the pulsating flow has been imparted from the ejection tube in a state where the coating surface of the subcapsular tissue is adsorbed to the opening end of the suction tube by suction by the suction tube, the coating surface is A first step of incision;
Executing excision of the subcapsular tissue by ejecting the liquid provided with the pulsating flow from the ejection tube to the subcapsular tissue, and aspiration of the excised subcapsular tissue by the suction tube A subcapsular tissue extraction method comprising: a second step. 2. The subcapsular tissue according to claim 1, wherein the excision of the subcapsular tissue in the second step is performed in a state where the coating surface around the hole formed by the incision is adsorbed to the open end of the suction tube. Extraction method. The injection tube is an innermost tube, the suction tube is an inner tube, and constitutes a multiple tube,
The liquid ejecting apparatus includes a second suction tube as an outer tube of the multiple tube,
For suction of the coating surface in the second step, suction by the second suction pipe is used,
The method according to claim 2, wherein suction with the suction tube is used for suction of the subcapsular tissue. The subcapsular tissue extraction method according to any one of claims 1 to 3, wherein an injection pressure in the second step is equal to or less than an injection pressure in the first step. 5. The suction force for sucking the subcapsular tissue in the second step is equal to or greater than the suction force for sucking the coating surface in the first step. 5. The subcapsular tissue extraction method described. The subcapsular tissue extraction method according to any one of claims 1 to 5, further comprising a step of injecting a chemical solution from the injection tube after the second step. The subcapsular tissue extraction method according to any one of claims 1 to 6, wherein the liquid ejected in the second step is a chemical liquid.   The treatment method using the subcapsular tissue extraction method as described in any one of Claim 1- Claim 7.

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