JP2000201945A - Resectoscope device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To effectively treat a lesion part positioned at the front face or the like of a scope. SOLUTION: An electrode unit 4 is provided with a treating electrode 41 formed of a hard metal member into a loop shape, and an electrode support part 42 for variably holding the position relation of the treating electrode 41 to a scope insertion shaft. The treating electrode 41 is disposed to freely project and recede from the tip part opening of a sheath. An operator suitably operates a thumb ring provided at a slider while observing a lesion part and the treating electrode 41 of the electrode unit 4 through an eyepiece part. The electrode support part 42 holding the treating electrode 41 in contact with the lesion part is therefore deformed, and the position relation between the treating electrode 41 and the resectoscope insertion shaft changes. The treating electrode 41 can therefore be disposed at a part, desired by the operator, of the lesion part.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a resectoscope apparatus for performing incision, resection, transpiration and the like of body tissue by electroablation under an endoscope.

[0002]

2. Description of the Related Art In general, a resectoscope is used for transurethral resection (TUR) or transcervical resection (TCR), and is an elongated hollow body inserted into a body cavity. In the sheath, an optical viewing tube (also referred to as a scope), which is an endoscope for observation, and an electrode unit for resection of living tissue are mainly provided.

In the above-mentioned resectscope, a high-frequency current is applied to the electrodes of an electrode unit arranged at the opening at the distal end of the sheath while observing the surface of the lesion with a scope.
The operation of the operation unit causes the electrodes to advance and retreat, thereby performing a treatment on the lesion.

[0004] For example, Japanese Utility Model Publication No. 4-45694 discloses a hard heat-resistant member between an end portion of an electric insulating member and the wire so as to be in close contact with the outer periphery of the wire in order to prevent burning of the electric insulating material. There is disclosed an electrode for a treatment instrument of a rigid endoscope in which a medical instrument is interposed.

[0005]

However, in the treatment instrument electrode for a rigid endoscope disclosed in Japanese Utility Model Publication No. 4-45694, when the electrode is moved forward and backward by operating the operation section, the electrode and the electrode support section are not connected to each other. Since it was formed of a hard member, the electrode only moved parallel to the scope insertion axis.

For this reason, when performing a treatment on a lesion facing the front of the scope, the resection of the lesion is performed little by little by repeatedly moving the electrode forward and backward, which requires time for the treatment. Burden on the surgeon and the patient.

[0007] The present invention has been made in view of the above circumstances, and by changing the positional relationship between an electrode to be treated and a scope insertion axis, an effective treatment can be performed on a lesion located in front of the scope or the like. It is an object of the present invention to provide a resectoscope device capable of performing the following.

[0008]

SUMMARY OF THE INVENTION A resectoscope device of the present invention comprises an elongated hollow sheath inserted into a body cavity;
A scope arranged inside the sheath to observe the inside of the body cavity,
An electrode unit that is disposed in the sheath and has at least one electrode for ablating or coagulating tissue in a body cavity using a high-frequency ablation current and an electrode support unit that supports the electrode, and an operation unit that operates the electrode unit; Wherein at least a part of an electrode or an electrode supporting portion constituting the electrode unit has elasticity.

According to this configuration, by changing the positional relationship between the electrode and the scope insertion axis, not only the treatment of the lesion in a positional relationship parallel to the scope insertion axis, but also the lesion facing the front of the scope. The treatment for the part can also be performed.

[0010]

Embodiments of the present invention will be specifically described below with reference to the drawings. 1 to 3 relate to an embodiment of the present invention, FIG. 1 is an explanatory diagram showing a resectoscope device, FIG. 2 is an explanatory diagram showing a configuration of an electrode unit, and FIG. 3 is a diagram illustrating an operation of the electrode unit. It is.

As shown in FIG. 1, a resectoscope device 1
Is a hollow sheath 2 having a through-hole, a scope 3 disposed in the hole of the sheath 2 for observing a lesion or the like, an electrode unit 4 for performing treatment on the lesion, and a handle unit 5 constituting an operation unit. Resect scope 6 with
And a high-frequency power supply 7 which is a means for supplying electricity to the treatment electrode 41 of the electrode unit 4 described later.

The sheath 2 comprises, for example, an insertion portion 21 inserted into a body cavity via the urethra, and a main body portion 22 provided at the rear end of the insertion portion 21. A water supply mouthpiece 23 with a cock for supplying perfusate to the treatment section is provided on the side periphery.

The scope 3 and the electrode unit 4 are inserted through the insertion portion 21. The distal end of the insertion portion 21 is formed of an insulating member such as a hard resin member. A tip member 24 is provided.

The scope 3 has an elongated hard insertion tube 31 having an observation optical system built therein and inserted through the insertion portion 21 and the distal end member 24, and a hand disposed at a base end of the insertion tube 31. And a section 32. This hand 32
An eyepiece part 33 for performing visual observation by an operator is provided at a base end of the base part, and a light guide (not shown) for supplying illumination light for observation to an observation part is detachably provided on a side of the hand part 32. A light guide connection portion 34 to be connected is provided.

As shown in FIGS. 1 and 2, the electrode unit 4 inserted into the insertion portion 21 has a treatment electrode 41 formed by forming a hard metal member located on the distal end side into a loop shape.
And an electrode support portion 42 comprising a support portion made of a metal member such as a superelastic member having elasticity for variably maintaining a positional relationship of the treatment electrode 41 with respect to the insertion axis of the scope 3 and a base end of the electrode support portion 42 A forked arm member 43 in which one end on the tip side having a hard and through hole that holds
It is mainly constituted by an elongated metal pipe 44 provided with the forked arm member 43 at the distal end.

The outer periphery of the metal pipe 44 is covered with an insulating tube (not shown), and the base end of the metal pipe 44 is exposed at the rear end of the insulating tube as an electrode connecting portion.

The electrode unit 4 is disposed so as to be able to advance and retreat in the insertion portion 21, and the treatment electrode 41 is disposed so as to be able to protrude and retract from the distal end opening 25 of the sheath 2. The treatment electrode 41 and the electrode support 4
2, a metal pipe 4 provided with a forked arm member 43 on the distal end side
The base end of the base member 4 is inserted into the insertion portion 21 and the main body portion 22 to extend from the base end surface of the main body portion 22, and is disposed on a slider 53 described later.

The handle portion 5 has a sheath connecting portion 51 detachably connected to the proximal body portion 22 of the sheath 2, and the handle connecting portion 5 projects rearward from a rear end surface of the sheath connecting portion 51 to form the insertion tube. It is mainly formed by a guide tube 52 through which the base member 31 is inserted and a substantially pipe-shaped slider 53 slidably held by the guide tube 52.

The slider 53 has the electrode unit 4
An electrode fixing portion 54 serving as an electrical connection portion with the electrode connection portion forming a rear end portion; a high-frequency power supply connector 55 to which a power cord 71 extending from the high-frequency power supply device 7 is detachably connected; And a ring-shaped thumb ring 56 for hanging the surgeon's thumb.

The slider 53 and the sheath connection portion 51 are connected via a leaf spring 57. That is, one end of the leaf spring 57 is connected to the sheath connection portion 5.
The other end is fixed to the slider 53, which is fixed to a lever-shaped finger hook 58 fixed integrally to the slider 1. Thus, the slider 53 is constantly urged toward the eyepiece 33 by the leaf spring 57.

Accordingly, by appropriately operating the thumb ring 56 provided on the slider 53, the slider 53 is advanced and retracted so that the treatment electrode 41 of the electrode unit 4 projects from the distal end opening 25 of the sheath 2. It is designed to move forward and backward.

The high-frequency power supply connector 55 and the electrode fixing portion 54 are electrically connected by, for example, a lead wire 61 shown by a broken line. Therefore, the power cord 71 of the high-frequency power supply 7 is connected to the high-frequency power supply connector 5.
5, the treatment electrode 41 of the electrode unit 4 is energized so that a lesion can be treated.

A slider positioning fixing member 62 is provided at the base end of the guide tube 52, and the slider 53 is fixed by the slider positioning fixing member 62.
Is prevented from falling off from the guide tube 52,
The proximal portion 32 of the insertion tube 31 inserted into the guide tube 52 is integrally fixed to a slider positioning fixing member 62.

The operation of the resectoscope device 1 configured as described above will be described. First, the insertion section 21 constituting the sheath 2 of the resectoscope 6 is inserted from the urethra. Then, while observing the inside of the urethra through the eyepiece 33 of the scope 3 disposed in the sheath 2, for example, the distal end opening 25 of the distal end member 24 faces the lesioned part facing the scope 3. To be placed.

Next, while observing the lesion and the treatment electrode 41 of the electrode unit 4 through the eyepiece 33, the surgeon appropriately operates the thumb hanging ring 56 provided on the slider 53 to thereby obtain the treatment electrode 41. Is moved closer to the lesion.

Then, the treatment electrode 41 comes into contact with the lesion, and the elastic electrode support 42 is deformed, and the positional relationship between the treatment electrode 41 and the scope insertion axis changes as shown in FIG. 41 is arranged at a site desired by the operator at the lesion.

Next, after confirming the positional relationship between the treatment electrode 41 and the lesion, the power supply to the treatment electrode 41 is started, and the thumb ring 56 is appropriately operated. At this time, the operation of the treatment electrode 41 depends on the operation of the thumb ring 56, the elastic force of the electrode support portion 42, and the weight of the treatment electrode 41.
Is moved as shown by the arrow, and a treatment for excision of the lesion facing the scope 3 from the base is performed.

When performing a treatment on a lesion that is in a positional relationship parallel to the scope insertion axis, the surgeon appropriately operates the thumb ring 56 while observing the lesion and the treatment electrode 41 through the eyepiece 33. Then, the treatment electrode 41
Is moved parallel to the scope insertion axis to perform the treatment.

After the treatment is completed, the superficial state of the lesion is observed using the scope 3, and when the treatment is completed, the resectoscope 6 is removed from the urethra to end the procedure.

As described above, by forming the electrode support portion constituting the electrode unit inserted into the sheath of the resectoscope with an elastic member, the treatment electrode constituting the electrode unit can be positioned with respect to the scope insertion axis. Since the positional relationship can be freely changed, by changing the positional relationship of the treatment electrode with respect to the scope insertion axis, it is possible to perform a treatment desired by the operator on the lesion facing the scope inserted through the sheath. it can.

In addition, the treatment electrode can be moved in parallel with the scope insertion axis to perform treatment on the treatment part even for a lesion having a positional relationship parallel to the scope insertion axis.

As a result, the procedure can be performed smoothly regardless of the positional relationship between the lesion and the scope parallel to the scope insertion axis or the position facing the scope, thereby reducing the burden on the operator and the patient. You.

It is to be noted that, instead of forming the entire electrode supporting portion 42 of the electrode unit 4 with an elastic metal member, an elastic metal member is provided on a part or both ends of the electrode supporting portion 42. A configuration in which the positional relationship between the treatment electrode 41 and the scope insertion axis may be changed.

The electrode support 4 of the electrode unit 4
2 is constituted by a coil member 46 as shown in FIG.
A configuration may be adopted in which a coil member 46 is provided in a part of the electrode support portion 42 to change the positional relationship between the treatment electrode 41 and the scope insertion axis.

Further, the electrode supporting portion 42 of the electrode unit 4 may be made of an elastic member, or the electrode supporting portion 42
Instead of providing an elastic member on the treatment electrode, the treatment electrode may be constituted by an elastic member, for example, a coil member 47 as shown in FIG. 5, or the coil member 47 may be provided on a part of the treatment electrode 47. Alternatively, the positional relationship between the treatment electrode 41 and the scope insertion axis may be changed.

As a result, as shown in FIG. 6, the positional relationship of the coil member 47, which is the treatment electrode, with respect to the scope insertion axis can be changed, so that the positional relationship of the coil member 47 with respect to the scope insertion axis changes. The coil member 47 is elastically deformed in accordance with the shape of the above, so that the treatment of the lesion facing the scope inserted and arranged in the sheath can be performed smoothly.

In the configuration in which the positional relationship between the treatment electrode 41 and the scope insertion shaft is changed, instead of providing an elastic member, a shape memory alloy whose shape is changed by a change in current value or temperature is used. You may.

By the way, US Pat. No. 4,060,087 shows a configuration of a resectoscope having a single or double shank cutting loop for cutting a target tissue using a pair of electrodes.

In the resectoscope provided with the pair of electrodes, the electrodes and the electrode support are formed of a hard member. The desired treatment cannot be performed due to loss, or the electrodes bite into the treatment section by operating the pair of electrodes so that they contact the treatment section evenly, and the electrodes are parallel to the scope insertion axis. The problem that it becomes difficult to move to a different location has arisen. Therefore, there has been a demand for a resectscope having a pair of electrodes capable of eliminating electric loss and performing a smooth treatment.

FIGS. 7 and 8 relate to an embodiment of a resectoscope provided with a pair of electrodes capable of performing a treatment smoothly without electrical loss. FIG. 7 shows a resectoscope having a plurality of electrode portions. FIG. 8 is a view for explaining the configuration, and FIG. 8 is a view for explaining the operation of the resectscope shown in FIG.

As shown in FIGS. 7 and 8, the resectoscope 6A of the present embodiment has a first electrode 80 located on the distal end side.
A pair of electrodes 80 and 83 having a first electrode unit 81 having a first electrode unit 81 and a second electrode unit 82 having a second electrode 83 located on the base end side of the first electrode 80. This is a bipolar type resectscope that can be moved forward and backward. The first electrode unit 81 and the second electrode unit 82 are electrically insulated from each other by an insulating tube (not shown).

The first electrode unit 81 has a first electrode 80 which is a treatment electrode in which a hard metal member located at the tip is formed in a loop shape, and a positional relationship of the first electrode 80 with respect to the insertion axis of the scope 3. A first electrode supporting portion 84 formed of a metal member such as a superelastic member having elasticity which constitutes a supporting portion for variably holding, and a bifurcated fork holding a base end of the first electrode supporting portion 84 and having a through hole. An arm member 85;
It is mainly constituted by an elongated metal pipe 86 provided with the forked arm member 85 at the distal end.

On the other hand, the second electrode unit 82
Is a second electrode 83 which is a return electrode formed by forming a hard metal member at the tip end into a loop, and a second electrode 8
The second electrode support portion 87 made of a hard metal member constituting a support portion for holding the positional relationship of the scope 3 with respect to the insertion axis of the scope 3 and a hard electrode for holding the base end of the second electrode support portion 87 Arm member 88 with through hole
And a slender metal pipe 89 in which the forked arm member 88 is disposed at the distal end.

The structure of the first electrode unit 81 is the same as the electrode unit of the above-described embodiment.
Instead of providing the elastic portion on the first electrode, the first electrode 80 may be formed of an elastic member, or the first electrode 80 may be provided with an elastic portion.

The operation of the resectoscope 6A configured as described above will be described. The insertion section 21 constituting the sheath 2 of the resectoscope 6A of the present embodiment is inserted from the urethra. Then, while observing the inside of the urethra through the eyepiece 33 of the scope 3 disposed in the sheath 2, the distal end opening 25 of the distal end member 24 is disposed near the lesion, and the electrode The units 81 and 82 are protruded to bring the electrodes 80 and 83 into contact with the lesion. At this time, even if the body tissue has an uneven portion or a step, the first electrode support portion 84 of the first electrode unit 81 has elasticity. The position of the first electrode 80 with respect to the scope insertion axis changes, and the electrodes 80 and 83 come into uniform contact with the step of the lesion.

Next, after confirming the positional relationship between the electrodes 80 and 83 and the affected part through the eyepiece 33, energization is started. As a result, the first electrode 80 to the second electrode 8
The current flows through 3.

In this state, the thumb ring 56
Is appropriately operated to move the electrodes 80 and 83 in parallel with the scope insertion axis. Then, while performing the resection of the lesion in accordance with the elastic force of the electrode support portion 42, the weight of the electrodes 80 and 83, and the operation of the thumb ring 56, the electrode 8
0, 83 moves from the position shown by the broken line to the position shown by the solid line to perform the treatment.

After the treatment, the surface state of the lesion is observed by the scope 3, and when the treatment is completed, the resectoscope 6 is removed from the urethra to end the procedure.

As described above, in the bipolar type resectoscope having two electrodes, the first position located on the distal end side.
At least a part of the first electrode or the first electrode support part constituting the first electrode unit having an electrode is formed of an elastic member, or at least a part of the first electrode or the first electrode support part has elasticity. By providing the member having the first electrode, the positional relationship of the first electrode with respect to the scope insertion axis can be freely changed, and the treatment can be performed by reliably bringing the pair of electrodes into contact with the treatment site.

As a result, the electric loss of the current flowing from the first electrode to the second electrode is prevented, and the treatment by the pair of electrodes can be performed reliably and smoothly.

It should be noted that the present invention is not limited to only the above-described embodiments, and various modifications can be made without departing from the spirit of the invention.

[Appendix] According to the embodiment of the present invention described in detail above, the following configuration can be obtained.

(1) An elongated hollow sheath to be inserted into a body cavity, a scope arranged in the sheath for observing the inside of the body cavity, and a tissue arranged in the sheath and using a high-frequency ablation current to generate a tissue in the body cavity An electrode unit having at least one electrode for ablating or coagulating the electrode and an electrode supporting portion for supporting the electrode, and a resectoscope device including an operating portion for operating the electrode unit; A resectoscope device in which at least a part of the electrode support has elasticity.

(2) The resectoscope device according to appendix 1, wherein the electrode support portion of the electrode unit has elasticity.

(3) The resectoscope device according to appendix 2, wherein at least a part of the electrode support portion is made of an elastic metal member.

(4) The resectoscope device according to appendix 2, wherein at least a part of the electrode support portion is formed of a coil member having elasticity.

(5) The resectoscope device according to appendix 1, wherein at least a part of the electrodes of the electrode unit has elasticity.

(6) The resectoscope device according to appendix 5, wherein the electrodes of the electrode unit are coil members having elasticity formed in a loop shape.

(7) The resectoscope device according to appendix 1, wherein the electrode unit has a pair of electrode units that are electrically insulated from each other.

(8) The pair of electrode units includes a first electrode unit having a first electrode located on the distal end side and a second electrode unit having a second electrode located on the proximal end side of the first electrode. 8. The resectoscope device according to claim 7, wherein at least a part of the first electrode or the first electrode supporting portion constituting the first electrode unit has elasticity.

(9) The resectoscope device according to appendix 8, wherein the first electrode support portion of the first electrode unit has elasticity.

(10) The resectoscope device according to appendix 9, wherein at least a part of the first electrode support portion is made of a metal member having elasticity.

(11) The resectoscope device according to appendix 9, wherein at least a part of the first electrode support portion is formed of a coil member having elasticity.

(12) The resectoscope device according to appendix 8, wherein at least a part of the first electrode of the first electrode unit has elasticity.

(13) The resectoscope apparatus according to appendix 12, wherein the first electrode is a coil member having elasticity formed in a loop shape.

[0066]

As described above, according to the present invention, an effective treatment can be performed on a lesion located in front of the scope or the like by changing the positional relationship between the electrode to be treated and the scope insertion axis. A resectoscope device that can be provided can be provided.

[Brief description of the drawings]

FIG. 1 to FIG. 3 relate to an embodiment of the present invention,
FIG. 1 is an explanatory diagram showing a resectoscope device.

FIG. 2 is an explanatory diagram showing a configuration of an electrode unit.

FIG. 3 is a diagram illustrating the operation of an electrode unit.

FIG. 4 is an explanatory view showing another configuration of the electrode unit.

FIG. 5 is an explanatory view showing another configuration of the electrode unit.

FIG. 6 is a view for explaining the operation of the electrode unit shown in FIG. 5;

7 and 8 relate to an embodiment of a resectoscope having a pair of electrodes capable of performing a treatment smoothly without electrical loss, and FIG. 7 is a resectscope having a plurality of electrode units. Explaining the configuration of

FIG. 8 is a view for explaining the operation of the resectoscope shown in FIG. 7;

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Resect scope device 3 ... Scope 4 ... Electrode unit 6 ... Resect scope 7 ... High frequency power supply device 41 ... Treatment electrode 42 ... Electrode support

Claims (1)

[Claims] 1. An elongated hollow sheath inserted into a body cavity, a scope disposed in the sheath to observe the inside of the body cavity, and a tissue disposed in the sheath and using a high-frequency ablation current to remove tissue in the body cavity. An electrode unit having at least one electrode to be excised or coagulated and an electrode unit having an electrode supporter for supporting the electrode, and an operation unit for operating the electrode unit, wherein an electrode or an electrode constituting the electrode unit A resectoscope device, wherein at least a part of the support portion has elasticity.