JP7201790B2 - Treatment tool - Google Patents

Description

The present invention relates to treatment instruments.

2. Description of the Related Art Conventionally, there is known a treatment instrument that treats a target site (hereinafter referred to as a target site) in a living tissue by applying energy to the target site (see, for example, Patent Literature 1).
The treatment instrument described in Patent Literature 1 includes an end effector having a treatment surface for treating a target site and a back surface having a front and back relationship with the treatment surface. The end effector includes a blade having the treatment surface described above, a heater for heating the blade, and a jaw supporting the blade and the heater and having the back surface described above in order from the side that contacts the target site. It has a laminated structure. Then, in the treatment instrument, the heat of the heater is transmitted to the target site through the blade. The target site is thereby treated.

By the way, when a living tissue is treated by applying energy, the temperature of the back surface of the jaw also rises. Then, when the back surface is in contact with a part other than the target part in the living tissue while the temperature of the back surface is high, it exerts an unintended effect on the living tissue.
Therefore, in the treatment instrument described in Patent Document 1, a heat insulating portion made of a resin having low thermal conductivity is provided between the blade and the heater and the jaw. That is, a structure is adopted in which heat from the blade and the heater to the jaw is insulated by the heat insulating portion.

WO2017/043120

However, even with the treatment instrument described in Patent Literature 1 provided with a heat insulating portion, the heat insulating effect of the heat insulating portion is low when the end effector is downsized. That is, it may not be possible to reduce the temperature of the back surface of the jaw to the desired temperature or less. As a result, there is a risk of exerting an unintended effect on living tissue.

SUMMARY OF THE INVENTION It is an object of the present invention to provide a treatment instrument that can effectively avoid unintended effects on living tissue.

In order to solve the above-described problems and achieve the object, a treatment instrument according to the present invention includes an end effector having a treatment surface for treating a living tissue and a back surface having a front and back relationship with the treatment surface, The end effector includes a treatment section having the treatment surface, a heat insulation section having a thermal conductivity lower than that of the treatment section, and a heat storage member that stores heat. They are sequentially stacked along a first direction from the treatment surface to the back surface.

According to the treatment instrument of the present invention, it is possible to effectively avoid unintended effects on living tissue.

FIG. 1 is a diagram showing a treatment system according to an embodiment. FIG. 2 is a diagram showing a grip portion. FIG. 3 is a diagram showing the first gripping member. FIG. 4 is a diagram showing the first gripping member. FIG. 5 is a diagram for explaining the effects of the embodiment.

EMBODIMENT OF THE INVENTION Below, with reference to drawings, the form (henceforth, embodiment) for implementing this invention is demonstrated. It should be noted that the present invention is not limited by the embodiments described below. Furthermore, in the description of the drawings, the same parts are given the same reference numerals.

[Schematic configuration of treatment system]
FIG. 1 is a diagram showing a treatment system 1 according to this embodiment.
The treatment system 1 treats a target site (hereinafter referred to as a target site) by applying energy to the target site for treatment in a living tissue. Here, the treatment means, for example, coagulation and incision of the target site. This treatment system 1 includes a treatment instrument 2 and a control device 3, as shown in FIG.

[Structure of Treatment Tool]
The treatment tool 2 is, for example, a surgical treatment tool for treating a target site through the abdominal wall. The treatment instrument 2 includes a handle 5, a shaft 6, and a grip portion 7, as shown in FIG.
The handle 5 is a portion held by the operator's hand. The handle 5 is provided with an operation knob 51 and a switch 52 as shown in FIG.
The operation knob 51 receives an opening/closing operation by the operator.
The switch 52 receives an output start operation by the operator. Then, the switch 52 outputs an operation signal corresponding to the output start operation to the control device 3 via the electric cable C (FIG. 1).

The shaft 6 has a substantially cylindrical shape. In addition, below, the central axis of the shaft 6 is described as the central axis Ax (FIG. 1). Further, hereinafter, one side along the central axis Ax is referred to as the distal side Ar1 (FIG. 1), and the other side is referred to as the proximal side Ar2 (FIG. 1). The shaft 6 is connected to the handle 5 at the proximal end Ar2. A gripping portion 7 is attached to the end portion of the shaft 6 on the tip side Ar1. Inside the shaft 6 is an opening/closing mechanism for opening/closing the first and second gripping members 8 and 9 (FIG. 1) constituting the gripping portion 7 according to the opening/closing operation of the operation knob 51 by the operator. (not shown) is provided. Further, an electric cable C is arranged inside the shaft 6 via the handle 5 from the proximal end side Ar2 to the distal end side Ar1.

[Structure of gripping part]
FIG. 2 is a diagram showing the grip portion 7. As shown in FIG.
The grasping part 7 is a part that treats the target part while grasping the target part. The gripping portion 7 includes first and second gripping members 8 and 9, as shown in FIG. 1 or FIG.
The first and second gripping members 8 and 9 correspond to a pair of gripping members according to the present invention. These first and second gripping members 8 and 9 are configured to be openable and closable in the direction of arrow R1 (FIG. 2) according to the opening and closing operation of the operation knob 51 by the operator.

[Structure of first gripping member]
3 and 4 are diagrams showing the first gripping member 8. FIG. Specifically, FIG. 3 is a cross-sectional view of the first gripping member 8 cut along a plane including the central axis Ax. FIG. 4 is a cross-sectional view of the first gripping member 8 cut along a plane orthogonal to the central axis Ax.
The first gripping member 8 corresponds to the end effector according to the invention. The first gripping member 8 is arranged at a position facing the second gripping member 9 . 2 to 4, the first gripping member 8 includes a first jaw 10A, a first heat insulating member 10B, a blade 11, a heater 12 (FIGS. 3 and 4), A second heat insulating member 13 (FIGS. 3 and 4) and a heat storage member 14 (FIGS. 3 and 4) are provided.

The first jaw 10A is a portion of the shaft 6 extending toward the distal end side Ar1, and is formed in an elongated shape extending along the central axis Ax. The first jaw 10A is made of, for example, a metal material such as stainless steel or titanium.
The first heat insulating member 10B has an elongated shape extending along the central axis Ax, and is fixed to the upper surface in FIGS. 3 and 4 of the first jaw 10A.
In this first heat insulating member 10B, in FIGS. 3 and 4, a concave portion 101 extending from the base end of the first heat insulating member 10B toward the tip side Ar1 is formed on the upper surface. . The first heat insulating member 10B supports the members 11 to 14 inside the recess 101. As shown in FIG.

Examples of the material constituting the first heat insulating member 10B described above include a resin material such as PEEK (polyetheretherketone) that has electrical insulation properties and a lower thermal conductivity than the blade 11. be able to. That is, by disposing the first heat insulating member 10B having a low thermal conductivity between the blade 11 and the heater 12 and the first jaw 10A, the heat transfer from the heater 12 toward the first jaw 10A is restricted. As a result, the heat from the heater 12 can be efficiently transmitted to the blade 11 .
The first jaw 10A and the first heat insulating member 10B described above correspond to the supporting member 10 (FIGS. 2 to 4) according to the present invention. In addition, in the first jaw 10A, the lower surface in FIGS. 3 and 4 corresponds to the rear surface 102 according to the present invention.

The blade 11 corresponds to the treatment section according to the invention. The blade 11 has an elongated shape extending along the central axis Ax and is fixed within the recess 101 . The blade 11 is made of a material having electrical conductivity and excellent heat conductivity, such as copper, aluminum, copper alloy, aluminum alloy, or the like.
3 and 4, the upper surface of the blade 11 contacts the target site while the target site is gripped by the first and second gripping members 8 and 9. As shown in FIG. That is, the surface functions as a treatment surface 111 (FIGS. 2 to 4) for treating the target site. 3 and 4, the direction A1 from top to bottom is the direction from the treatment surface 111 to the back surface 102, and corresponds to the first direction according to the present invention. In this embodiment, the treatment surface 111 is configured by a flat surface perpendicular to the first direction A1.
Although the treatment surface 111 is configured as a flat surface, the treatment surface 111 is not limited to this, and may be configured in another shape such as a convex shape or a concave shape. The same applies to a later-described gripping surface 931 of the second gripping member 9 .

Further, in the blade 11, a concave portion 113 (FIGS. 3 and 4) extending from the proximal end to the distal end of the blade 11 is formed on the mounting surface 112, which has a front-back relationship with the treatment surface 111. As shown in FIG. For convenience of explanation, the pair of left and right side walls of FIG.

The heater 12 is a seat heater that generates heat when energized, and is fixed to the bottom surface of the recess 113 . Although not specifically shown, the heater 12 is formed by forming an electric resistance pattern on an electrically insulating sheet-like substrate made of polyimide or the like by vapor deposition or the like. A lead wire (not shown) constituting the electric cable C is joined to the electric resistance pattern. A voltage is applied to the electrical resistance pattern via the lead wire under the control of the control device 3 . This causes the electrical resistance pattern to generate heat.

The second heat insulating member 13 is an elongated flat plate extending along the central axis Ax, and as shown in FIG. 3 or FIG. fixed against.
Examples of the material forming the second heat insulating member 13 include a resin material such as PEEK that has electrical insulation properties and a thermal conductivity lower than that of the blade 11 . That is, by disposing a second heat insulating member 13 having a low thermal conductivity between the blade 11 and the heater 12 and the first jaw 10A, the heat transfer from the heater 12 toward the first jaw 10A is restricted. As a result, the heat from the heater 12 can be efficiently transmitted to the blade 11 .
The second heat insulating member 13 described above corresponds to the heat insulating portion according to the present invention. Note that the heat insulating portion according to the present invention is not limited to the second heat insulating member 13 described above, and an air layer (heat insulating layer) may be employed.

The heat storage member 14 is composed of an elongated sheet extending along the central axis Ax, and fixed to the bottom surface of the recess 101 as shown in FIG. 3 or 4 . In this state, heat storage member 14 is positioned between second heat insulating member 13 and the bottom surface of recess 101 . The heat storage member 14 includes a latent heat storage material 141 and a sealing member 142 .
Although the latent heat storage material 141 exhibits the same thermal behavior as other substances up to a certain temperature, it undergoes a phase change at the certain temperature specific to the substance, and by utilizing the accompanying endothermic action of the latent heat, It is a substance that can hold a large amount of heat per unit volume compared to . Examples of the latent heat storage material 141 include, for example, paraffin, which undergoes a phase change (a phase change from solid to liquid) within a temperature range of 50° C. or higher and 100° C. or lower, more preferably 60° C. or higher and 80° C. or lower. can be done.
The sealing member 142 is configured by, for example, a resin container or an aluminum laminate pack in which the latent heat storage material 141 is enclosed.

As described above, as shown in FIG. 3 or 4, the first gripping member 8 includes the blade 11, the second heat insulating member 13, the heat storage member 14, and the support member 10 in this order along the first direction A1. are laminated together.

[Structure of Second Holding Member]
The second gripping member 9 includes a second jaw 91, a third heat insulating member 92, and an opposing plate 93, as shown in FIG.
The second jaw 91 has an elongated shape extending along the central axis Ax. The end of the proximal side Ar2 of the second jaw 91 is rotatably supported with respect to the shaft 6 about the fulcrum P0 (FIG. 2). to open and close.
In addition, although the 1st holding member 8 is fixed to the shaft 6 and the 2nd holding member 9 is pivotally supported by the shaft 6 in this Embodiment, it is not restricted to this. For example, both the first and second gripping members 8 and 9 may be pivotally supported by the shaft 6, and the first and second gripping members 8 and 9 may be opened and closed by rotating. Absent. Further, for example, the first gripping member 8 is pivotally supported by the shaft 6, the second gripping member 9 is fixed to the shaft 6, and the first gripping member 8 rotates to move the second gripping member 9. You may adopt the structure which opens and closes with respect to it.

The third heat insulating member 92 is made of a resin material, such as PEEK, which has electrical insulation and low thermal conductivity, and is disposed between the second jaw 91 and the opposing plate 93 . ing.
The facing plate 93 is made of a conductive material such as copper, and is fixed on the surface of the third heat insulating member 92 facing the first gripping member 8 .
In the facing plate 93 , the surface on the side of the first gripping member 8 functions as a gripping surface 931 ( FIG. 2 ) for gripping the target site with the treatment surface 111 .

[Configuration of control device]
The treatment instrument 2 is detachably connected to the control device 3 by an electric cable C. As shown in FIG. Then, the control device 3 is electrically connected to the switch 52 via the electric cable C. As shown in FIG. Also, the control device 3 is electrically connected to the heater 12 (electrical resistance pattern) through the electric cable C. As shown in FIG. Further, the control device 3 electrically connects the blade 11 and the opposing plate 93 via the electric cable C, respectively. Then, the control device 3 executes treatment control described below according to the operation signal from the switch 52 .

The control device 3 applies voltage to the heater 12 (electric resistance pattern) via the electric cable C. FIG. Here, the control device 3 measures the resistance value (hereinafter referred to as heater resistance) of the heater 12 (electrical resistance pattern) using, for example, the voltage drop method from the voltage value and current value supplied to the heater 12. do. Also, the control device 3 refers to the resistance-temperature characteristics measured in advance. The resistance-temperature characteristic is a characteristic indicating the relationship between the heater resistance and the temperature of the heater 12 (electrical resistance pattern) (hereinafter referred to as heater temperature). Then, the control device 3 controls the heater resistance to a target resistance value corresponding to the target temperature in the resistance temperature characteristic while changing the power supplied to the heater 12 (electric resistance pattern). Thereby, the heater temperature is controlled to the target temperature. The heat from the heater 12 controlled to the target temperature is transferred to the target portion gripped between the first and second gripping members 8 and 9 via the blade 11 . In other words, thermal energy is applied to the target site.

Further, the control device 3 supplies high-frequency power to the blade 11 and the opposing plate 93 via the electric cable C substantially at the same time as applying the thermal energy to the target portion described above. As a result, a high-frequency current flows through the target portion held between the blade 11 and the opposing plate 93 . In other words, high-frequency energy is applied to the target site. In other words, the blade 11 and the opposing plate 93 are supplied with high-frequency power and also function as electrodes that pass high-frequency current to the target site.
Then, the target site is heated by applying the thermal energy described above. In addition, Joule heat is generated in the target portion due to the high-frequency current flowing therethrough. Thus, the target site is treated.

According to this embodiment described above, the following effects are obtained.
FIG. 5 is a diagram for explaining the effects of this embodiment. Specifically, the solid line shown in FIG. 5 indicates the behavior of the temperature of the back surface 102 of the first jaw 10A when the heater 12 is controlled at a constant temperature. 5 is a configuration in which the second heat insulating member 13 is omitted from the first gripping member 8, and the heat storage member 14 is directly in contact with the heater 12 and the blade 11 (hereinafter referred to as 5 shows the behavior of the temperature of the back surface 102 of the first jaw 10A when the heater 12 is controlled to a constant temperature as in the case of the solid line shown in FIG.

When the first gripping member 8 has the non-insulating structure described above and the heater 12 is controlled to a constant temperature, the heat from the heater 12 is stored directly without passing through the second heat insulating member 13. It is transmitted to member 14 . That is, the heat storage member 14 reaches the temperature T1 (FIG. 5) at which the phase change occurs in a relatively short period of time. Therefore, in this case, the temperature of the rear surface 102 becomes high in a relatively short period of time, as indicated by the dashed line in FIG. In addition, in a configuration in which not only the second heat insulating member 13 but also the heat storage member 14 are omitted, the temperature rises in a shorter time than in the non-insulating structure described above, although the specific illustration is omitted.

On the other hand, in the treatment instrument 2 according to the present embodiment, the first gripping member 8 includes the blade 11, the second heat insulating member 13, the heat storage member 14, and the support member 10, which are stacked in this order along the first direction A1. It is Also, the second heat insulating member 13 is positioned between the heater 12 and the heat storage member 14 . Therefore, the heat transfer from the heater 12 to the heat storage member 14 is restricted by the second heat insulating member 13 . That is, the heat storage member 14 reaches the temperature T1 at which the phase change occurs after a relatively long period of time. After reaching the temperature T1, the heat storage member 14 absorbs heat due to the latent heat associated with the phase change. Therefore, in the treatment instrument 2 according to the present embodiment, the temperature of the back surface 102 does not reach a high temperature in a short period of time, as indicated by the solid line in FIG. 5, unlike the non-insulated structure described above.
As described above, according to the treatment instrument 2 according to the present embodiment, it is possible to lower the temperature of the back surface 102 to a desired temperature or lower, and as a result, it is possible to prevent unintended effects on living tissue. can be effectively avoided.

Moreover, in the treatment instrument 2 according to the present embodiment, the heat storage member 14 includes the latent heat storage material 141 that stores heat by latent heat associated with phase change.
Therefore, until the latent heat storage material 141 reaches the temperature T1, the latent heat absorption effect of the latent heat storage material 141 does not work. The target site can be treated appropriately.

Moreover, in the treatment instrument 2 according to the present embodiment, the heat storage member 14 includes the sealing member 142 that seals the latent heat storage material 141 .
Therefore, when the latent heat storage material 141 gels due to phase change, the sealing member 142 can prevent the latent heat storage material 141 from flowing out to the outside.

Moreover, in the treatment instrument 2 according to the present embodiment, the latent heat storage material 141 contains paraffin that undergoes a phase change in the temperature range of 60°C or higher and 80°C or lower.
Therefore, it is possible to set the temperature of the back surface 102 to 90° C. or lower, for example.

Moreover, in the treatment instrument 2 according to the present embodiment, the heater 12 and the second heat insulating member 13 are attached to the blade 11 . Also, the blade 11 and the heat storage member 14 are attached to the support member 10 respectively.
Therefore, the heat storage member 14 can be replaced by removing the blade 11 from the support member 10 . Therefore, the work at the time of remanufacturing the treatment instrument 2 is facilitated.

(Other embodiments)
Although the embodiments for carrying out the present invention have been described so far, the present invention should not be limited only to the above-described embodiments.
In the treatment instrument 2 according to the above-described embodiment, both thermal energy and high-frequency energy are applied to the target site, but the present invention is not limited to this. For example, the treatment instrument according to the present invention may be configured to apply only thermal energy (configured to treat the target site only with heat from the heater 12), or configured to apply only high-frequency energy (from the blade 11 and the opposing plate 93). A configuration in which the target site is treated only with a high-frequency current) may be used. Furthermore, the energy applied to the target site is not limited to thermal energy and high-frequency energy, and ultrasonic energy may be employed. Note that "applying ultrasonic energy to a target site" means applying ultrasonic vibrations to the target site.

In the treatment instrument 2 according to the above-described embodiment, only the first gripping member 8 of the first and second gripping members 8 and 9 is provided with the heat insulating portion and the heat storage member according to the present invention. It is not limited, and may be provided on both the first and second gripping members 8 and 9 . When the second gripping member 9 is provided with the heat insulating portion and the heat storage member according to the present invention, the third heat insulating member 92 is used as the heat insulating portion according to the present invention, and the third heat insulating member 92 and the second jaw 91 The heat storage member according to the present invention is arranged between and.
Although the treatment instrument 2 according to the above-described embodiment employs the heat storage member 14 including the latent heat storage material 141 as the heat storage member according to the present invention, the heat storage member 14 is not limited to this, and can store the transferred heat. Other heat storage members may be employed as long as they are suitable members.
Although the treatment instrument 2 according to the above-described embodiment employs a configuration in which the target site is gripped by the first and second gripping members 8 and 9, the present invention is not limited to this. For example, a configuration in which the second gripping member 9 is omitted may be employed.

1 treatment system 2 treatment instrument 3 control device 5 handle 6 shaft 7 gripping part 8 first gripping member 9 second gripping member 10 support member 10A first jaw 10B first heat insulating member 11 blade 12 heater 13 second Heat-insulating member 14 Heat storage member 51 Operation knob 52 Switch 91 Second jaw 92 Third heat-insulating member 93 Opposing plate 101 Recess 102 Rear surface 111 Treatment surface 112 Mounting surface 113 Recess 114 Protruding portion 141 Latent heat storage material 142 Sealing member 931 Gripping surface A1 First direction Ar1 Distal side Ar2 Base side Ax Center axis C Electric cable P0 Fulcrum R1 Arrow T1 Temperature

Claims (8)

An end effector having a treatment surface for treating living tissue and a back surface having a front-back relationship with the treatment surface,
The end effector is
A treatment section having the treatment surface, a heat insulation section having a thermal conductivity lower than that of the treatment section, and a heat storage member that stores heat, wherein the treatment section, the heat insulation section, and the heat storage member are arranged in this order. to said back surface along a first direction. The heat storage member is
2. The treatment instrument according to claim 1, comprising a latent heat storage material that stores heat by latent heat associated with a phase change. The heat storage member is
The treatment instrument according to claim 2, further comprising a sealing member that seals the latent heat storage material. The latent heat storage material is
The treatment instrument according to claim 2, which contains paraffin. further comprising a heater for heating the treatment section,
The heat insulating part is
The treatment instrument according to claim 1, located between the heater and the heat storage member. The end effector is
further comprising a support member having the back surface;
The heater is
attached to the treatment section,
The treatment section and the heat storage member are
The treatment instrument according to claim 5, which is attached to each of the support members. The treatment section is
2. The treatment instrument according to claim 1, which is an electrode made of a conductive material and configured to apply a high-frequency current to the living tissue. A pair of gripping members for gripping a living tissue,
At least one of the pair of gripping members,
The treatment instrument according to claim 1, which is the end effector.

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