JPH0563175B2 - - Google Patents

Description

[Detailed Description of the Invention] [Industrial Application Field] The present invention is a method for removing the internal glands of the enlarged prostate gland (prostatic hyperplasia) by detaching it from the external glands and removing it by transurethral insertion into the bladder. The present invention relates to an improvement of a resectoscope device.

[Prior Art and Problems to be Solved by the Invention] In recent years, endoscopes, which have an insertion section inserted into a body cavity and are capable of observing, diagnosing, and treating diseased areas, have been widely used. This endoscope includes a resectoscope that is inserted into the bladder through the urethra and is configured to perform treatments such as prostate resection using a resection loop electrode device that applies high-frequency current.

In general, a resect scope consists of a hollow resect sheath that is inserted into the urethra, a slider that is detachably attached to the rear end of the resect sheath, and an observation scope (optical) that is detachably attached to the rear end of the slider. A loop electrode device for prostate resection can be inserted into the resect sheath and its rear end can be fixed to a slider, and by operating the slider, the tip of the loop electrode can be fixed to a slider. It is designed so that it can be plunged through the resect sheath.

However, when using a resect scope configured in this way to resect the intraprostatic glands by applying a high-frequency current to the loop electrode of the electrode device protruding from the tip of the resect sheath, it is difficult to completely remove the enlarged intraprostatic glands. The procedure is extremely difficult as it is dangerous to the human body, and has the drawback that some of the internal glands tend to remain, causing the prostate tissue to become enlarged again.

Therefore, as described in Japanese Utility Model Application Publication No. 59-93513, the present applicant installed a resectoscope in place of the above-mentioned electrodes, and under the direct vision of the resectoscope, the extra-prostatic glands and the enlarged prostate glands were detected. We have developed a prostatic dissection device that can be inserted between the prostate gland and the internal gland to separate the internal gland from the external gland and completely remove the internal gland. The prostate ablation device has a retractable coagulation electrode,
It is used to coagulate and stop bleeding by applying pressure to the spot where the bleeding has stopped. Incidentally, it is anatomically more effective to use a loop electrode device to which a high-frequency current is applied, rather than to remove the intraprostatic gland using only the above-mentioned detachment device alone.

However, with conventional resectoscopes and dissection devices, it is necessary to replace the dissection device and loop electrode device as needed during surgery, and these dissection devices and loop electrode devices must be placed on the distal end of the resectoscope. Since the resectoscope is inserted into the bladder from the beginning, it is necessary to remove the resectoscope that has been inserted into the bladder through the urethra each time it is replaced, and then insert it into the bladder through the urethra again after replacing it.

Therefore, in accordance with Japanese Patent Application No. 59-193303, the present applicant provided two sliders at the top and bottom, mounted a stripper on one of them and an electrode on the other, and installed the stripper and the electrode on each slider. We are proposing a resectoscope device that can be slid independently. Although this device has the advantage that it can be used while inserted into the bladder through the urethra without replacing the resection loop electrode device and the ablation device during surgery, it has the following disadvantages. That is, in this resectoscope device,
When operating the slider to which the peeler is fixed and the slider to which the electrode device is fixed, the handle portion must be held with one hand and each slider must be operated with the other hand. Therefore, operating this device requires both hands and requires other actions, such as holding the penis or placing the operator's fingers into the patient's rectum and lifting the prostate from the rectum. become unable.

[Objective of the Invention] The present invention has been made in view of these circumstances, and it is possible to selectively operate the slider equipped with a peeler and the slider equipped with an electrode device with one hand gripping the handle, and the slider equipped with an electrode device can be operated selectively with one hand holding the handle. The object of the present invention is to provide a resectoscope device that allows other operations to be performed with the other hand.

[Means for Solving the Problems and Their Effects] In order to achieve the above object, the resectoscope device according to the present invention has a front fixing part and a rear fixing part connected by a shaft with a sliding gap. ,
a handle portion with a finger hook that can be slid freely in the sliding space; a slender sheath that connects the main body to a connecting portion provided in the anterior fixing portion and extends forward and is inserted into the urethra; and the rear fixing portion. A scope that is connected and fixed to the connecting part of the part and inserted into the sheath through the rear fixing part and the front fixing part, and a stripper that is equipped with a stripper at the tip of an elongated shaft that is inserted into the sheath are attached. a slider disposed so as to be slidable in the slide gap, and an elongated conductive shaft disposed in parallel with the slider in the slide gap and having an ablation electrode at the distal end thereof to be inserted into the sheath. The present invention includes a slider for mounting an electrode device to which current is applied, and a switching mechanism for selectively connecting and disconnecting a finger hook portion of the handle portion to the peeler slider and the electrode device slider.

With this configuration, the finger hook can be freely connected to the stripper slider or the electrode slider using the switching mechanism, and by sliding this finger hook, the stripper slider or the electrode slider can be slid. The slider can be selectively slid with one hand holding the slider.

[Embodiments of the Invention] Hereinafter, embodiments of the present invention will be specifically described with reference to the drawings.

1 to 13 relate to an embodiment of the device of the present invention, in which FIG. 1 is a plan view showing the whole, FIG. 2 is a side view of FIG. 1, and FIG. 3 is an A-A in FIG. 2. 4 is an enlarged side view showing the handle portion partially cut away; FIG. 5 is a sectional view taken along line B-B in FIG. 3;
The figures are a sectional view showing the click mechanism in Fig. 5, a sectional view showing the switching button in Fig. 7, and a sectional view showing the switching button in Fig. 8.
The figure is a perspective view showing a state where the stripper slider is slid forward to slide the stripper forward, FIG. 9 is a perspective view showing a state where the electrode device slider is slid and the electrode is slid forward, and FIG. Figure 10 is a perspective view showing the structure of the distal end of the peeler and electrode device;
11 is a sectional view taken along the line CC in FIG. 2, FIG. 12 is an enlarged sectional view taken along the line DD in FIG. 2, and FIG. 13 is an enlarged sectional view taken along the line E-E in FIG.

In these figures, reference numeral 1 denotes a resectoscope device, which includes a handle part 2, a main body 3 connected and fixed to the front part of the handle part 2, and an elongated sheath 4 that extends forward and is inserted into the urethra. The scope 5 is connected and fixed to the rear part of the handle part 2 and inserted into the sheath 4 through the handle part 2. As shown in FIG. 2, the handle part 2 forms a sliding gap G between the front fixing part 6 and the rear fixing part 7, and connects them to the upper parallel shafts 8, 9, the middle parallel shafts 10, 11, and the lower center. While connected by a shaft 12, a slider 13 and shafts 9 and 1 slide guided by shafts 8 and 10 at the upper or middle stage within the slide gap G, as shown in FIG.
A slider 14 that slides while being guided by the shaft 12 is arranged in parallel in the lateral direction, and a finger slider 15 that slides while being guided by the shaft 12 is arranged at the lower stage in the slide space G. Further, this handle portion 2 has a scope connecting portion in the rear fixing portion 7, and a scope guide tube 16 is connected to the front from the scope connecting portion of the rear fixing portion 7 through the front fixing portion 6.
is being extended. Further, the front fixing part 6 of the handle part 2 has a connecting part 17 for connecting and fixing the sheath main body 3, while the front fixing part 6 has front finger hooks 18, 1 in the vertical direction.
There are 8. The sheath main body 3 connected and fixed to the connecting portion 17 is provided with a water supply spout 19 for supplying irrigation fluid to the bladder and urethra through the inside of the sheath 4, and a socket 19a for adjusting the water supply. on the other hand,
The scope 5 connected and fixed to the scope connection part is
The insertion section 20 is inserted through the scope guide tube 16 to the distal end inside the sheath 4, and the sheath 4
The front of the tip can be observed. This scope 5 has an eyepiece 21 at the rear, and a light guide base 22 to which a light guide cable is connected to a light source device (not shown).

One of the sliders 13 and 14 arranged in parallel in the horizontal direction within the slide gap G
has a cord connector 23 to which a cord for supplying high-frequency current is connected, and an electrode attachment/detachment button 25 for connecting and fixing the conductive shaft 24a of the excision electrode device 24, and is inserted into a connection hole (not shown) from the front. It is fixed by inserting the elongated conductive shaft 24a and tightening the attachment/detachment button 25. The other slider 14 is a peeler 26
It has a peeler attachment/detachment button 27 for connecting and fixing an elongated shaft 26a, and the shaft 26a inserted from the front into a connection hole (not shown) is fixed by tightening the attachment/detachment button 27.

The sliders 13 and 14 have screws 2 on their lower surfaces.
At 8 and 28, engaging claw pieces 29 and 30 are fixed and project downward toward the finger hook slider. The engaging claw pieces 29, 30 have engaging portions 29a, 30a, respectively. The respective screws 28, 28 are connected to the shaft 10,
Slits 31 and 32 formed above and below in the axial direction of 11
The slits 31 and 32 of the shafts 10 and 11 follow the slides of the sliders 13 and 14.
It is designed to slide along. Then, within the shafts 10, 11, the screws 28, 28
Compression coil springs 33, 33 are interposed between the front fixing portion 6 and the slider 1.
3 and 14 in the direction of the rear fixed part 7. As a result, the electrode 24b of the electrode device 24 and the peeler 26
The separator 26b is constantly retracted within the distal end of the sheath 4. On the other hand, the finger hook slider 15 has
A finger rest 34 is fixed. The finger slider 15 has a pipe 24 made of a lubricating material, such as Teflon, disposed in the bearing portion of the guide shaft 12 so that it can slide smoothly. The finger hook slider 15 has a mounting hole 35 passing through in the lateral direction at a position partially overlapping the guide shaft 12, and a switching shaft 36 is slidably mounted in the mounting hole 35. This switching shaft 36 is shown in FIGS.
As shown in the figure, the engaging claw pieces 2 of the sliders 13 and 14
9 or 30 and has recesses 37 and 38 at positions corresponding to the guide shaft 12, and one engaging claw piece 29 or 3
0 and the guide shaft 12 are engaged in these recesses 37 and 38 and retracted, and the other engaging claw piece 30 or 29 is engaged with the outer periphery of the switching shaft 36, and the finger hook slider 15 is moved through the shaft 36. The slider 14 or 13 is configured to slide following the slide. Further, the guide shaft 12 at a position perpendicular to the switching shaft 36 at the position where the finger hook slider 15 is retracted to the rear is provided with a stopper convex portion 39 formed between the recesses 37 and 38 of the switching shaft 36 as shown in FIG. A cutout recess 40 is formed to coincide with the switching shaft 36 and allow the switching shaft 36 to slide. That is, when the finger hook slider 15 is sliding and the electrode slider 13 or the peeler slider 14 is sliding forward, the stopper convex portion 39 comes into contact with the guide shaft 12 and the switching shaft 36 is prevented from switching. The sliders 13 and 14 to be slid can be selectively switched by sliding the switching shaft 36 only when the finger slider 15 is retracted to the rear and neither slider 13 or 14 is sliding. Furthermore, a ball 4 is attached to the finger slider 15 as shown in FIG.
1, a spring 42, and a screw 43 are provided with a click mechanism 44 which engages in a click groove 45 formed in the switching shaft 36 and closes the switching shaft 3.
The slide at the slidable position of No. 6 is restricted. Furthermore, as shown in FIG. 7, the switching shaft 36 has operation button portions 36a and 36b at both ends.
, and protrudes from both sides of the finger hook slider 15.

As shown in FIGS. 10 and 11, an electrode device guide tube 46 and a stripper guide tube 47 are attached in parallel in the axial direction at the lower part of the scope guide tube 16 extending in front of the handle portion 2. has been done. By arranging both the guide tubes 46 and 47 in this manner, the cross section within the sheath 4 can be used effectively. That is, the two tubes 46 and 47 can be placed inside the sheath 4 without increasing the diameter of the sheath 4 and without narrowing the irrigation channel. The conductive shaft 24a of the electrode device 24 inserted through the electrode device guide tube 46 protrudes from the guide tube 46 and extends so as to be located on the side of the scope insertion portion 20 as it goes forward. 1st
As shown in FIG. 0, an electrode support pipe 48 that inserts the scope insertion part 20 and slides along the scope insertion part 20 is fixedly installed in the middle of the conductive shaft tip arm 24.
c, 24c are designed so that they do not swing relative to the scope insertion section 20. This is the conductive shaft tip arm 2
When 4c and 24c swing, the loop electrode 24b at the tip
This is because the ablation range is not stable and the ablation range is not determined. Therefore, the loop electrode 24b is
This is to stabilize the Further, in front of the electrode fixing pipe 48 is a conductive shaft tip arm 24.
c, 24c are 2 with respect to the scope insertion part 20.
This has been extended. This is because when the intraprostatic gland is excised with the loop electrode 24b, an upward force is applied and the tip of the conductive shaft 24a warps, so a certain degree of strength against bending is provided to prevent this. It is something. Further, there is only one conductive shaft 24a rearward of the pipe 48, and a peeler shaft 26, which will be described later, is disposed in the space created by not extending rearward, so that the space inside the sheath 4 is used effectively.

On the other hand, the stripper shaft 26a inserted into the stripper guide tube 47 protrudes from the guide tube 47 and extends directly below the scope insertion section 20, and a first
As shown in FIG. 0, a pipe 49 for supporting a peeler that is inserted through the scope insertion part 20 and slides along the scope insertion part is fixedly installed so that the peeler 26b at the tip does not swing relative to the scope insertion part 20. It's summery.
Further, a guide member 50 for positioning or guiding is fixedly provided on the outer periphery of the peeler shaft 26a near the peeler 26b.

With this configuration, in order to operate the loop electrode 24b to protrude from the tip of the sheath 4, slide the switching shaft 36 with the finger slider 15 retracted backward as shown in FIG. Then, the engaging claw piece 30 of the peeler slider 14 is engaged with and retracted from the recess 38 of the switching shaft 36, while the engaging claw piece 29 of the electrode device slider 13 is engaged with the outer periphery of the switching shaft 36. In this setting state, click groove 4
4 ball 41 is in the click groove 4 of the switching shaft 36
5 and restricts the switching shaft 36 from sliding freely. By sliding the finger slider 15 forward against the biasing force of the spring 33 in the shaft 10 in the above setting state, the loop electrode 24b can be made to protrude from the tip of the sheath 4, and a high frequency current can be applied to the electrode 24b. By applying electricity, the intraprostatic gland can be removed or hemostasis can be performed.

Next, in order to operate the peeling element 26b to protrude from the tip of the sheath 5, the finger hook slider 15 is retracted backward as shown in FIG. 29
is engaged and retracted into the recess 37 of the switching shaft 36, while the engaging claw piece 30 of the peeler slider 14 is engaged with the outer periphery of the switching shaft 36. Even in this setting state, the ball 41 of the click mechanism 44 is engaged with the click groove of the switching shaft 36, and the sliding of the switching shaft 36 is regulated. In this state, finger hook slider 15
By sliding the separator 26b back and forth against the urging force of the spring 33 within the shaft 11, the separator 26b protruding from the distal end of the sheath 4 moves back and forth, and the prostate tissue can be separated from the surrounding tissue.

It should be noted that the above embodiment is merely an example, and it goes without saying that each member can be replaced with another member having the same function. For example, the switching mechanism is configured to switch the sliding slider by selectively engaging and connecting an engaging claw protruding from each slider with a switching shaft.
Other switching configurations may also be used.

[Effects of the Invention] As explained above, according to the present invention, the slider equipped with a peeler and the slider equipped with an electrode device can be selectively operated with one hand gripping the handle, and the slider equipped with an electrode device can be used with the other hand. This has the effect of allowing you to perform other movements with your hands.

[Brief explanation of the drawing]

1 to 13 relate to an embodiment of the device of the present invention, in which FIG. 1 is a plan view showing the whole, FIG. 2 is a side view of FIG. 1, and FIG. 3 is an A-A in FIG. 2. 4 is an enlarged side view showing the handle portion partially cut away; FIG. 5 is a sectional view taken along line B-B in FIG. 3;
The figures are a sectional view showing the click mechanism in Fig. 5, a sectional view showing the switching button in Fig. 7, and a sectional view showing the switching button in Fig. 8.
The figure is a perspective view showing a state where the stripper slider is slid forward to slide the stripper forward, FIG. 9 is a perspective view showing a state where the electrode device slider is slid and the electrode is slid forward, and FIG. Figure 10 is a perspective view showing the structure of the distal end of the peeler and electrode device;
Figure 11 is an enlarged sectional view taken along line CC in Figure 2;
The figure is an enlarged cross-sectional view taken along the line DD in FIG. 2, and FIG. 13 is an enlarged cross-sectional view taken along the line E-E in FIG. 2...Handle part, 3...Sheath body, 4...
Sheath, 5...Scope, 6...Front fixation part, 7
... Rear fixed part, G ... Slide gap, 8, 9,
12...Axis, 13,14...Slider, 15...
Finger slider, 24... Cutting electrode device, 26...
Peeling device, 29, 30... engaging claw piece, 36... switching shaft.

Claims (1)

[Claims] 1. A separator with a separator attached to the tip of an elongated shaft to separate the prostate from surrounding tissue, an electrode device with an electrode attached to the tip of the elongated conductive shaft to which high-frequency electricity is applied to ablate the prostate, and A scope to observe,
The sheath, which is introduced into the body cavity by inserting the ablation device, the electrode device, and the scope, faces the front connection portion and the rear connection portion with a predetermined sliding gap, and connects the sheath to the front connection portion; A handle with a scope connected to the rear connection part, two sliders arranged so as to be movable back and forth between the front and rear connection parts and fixing the stripper and the electrode device respectively, and connected to these two sliders, A resectoscope device comprising: a finger hook for operating these back and forth; and a switching mechanism that selectively connects and switches the finger hook to the stripper slider and the electrode slider.