JP6594800B2 - Cutting device and peeling system having this cutting device - Google Patents

Description

  The present invention relates to a cutting device used for exfoliating tissue such as fat in a living body, and an exfoliation system having the cutting device.

  Arterial grafts typified by the internal thoracic artery, gastroepiploic artery, and radial artery, and venous grafts typified by the great saphenous vein are used as bypass tubes when performing vascular bypass surgery (coronary artery bypass surgery: CABG) in the heart. It is widely known to use. At present, it has been reported that arterial grafts (particularly internal thoracic arteries) have a higher long-term patency rate than venous grafts.

  Thus, vein grafts are said to be inferior in long-term patency. However, in recent years, vein grafts have been covered with surrounding tissue (eg, fat, connective tissue, tissue between the skin layer and muscle layer, tissue between the skin layer and the interosseous membrane, branch vessels, etc.) It has also been reported that the long-term patency rate is improved by collecting the sample in a state and using it as a bypass tube while being covered with tissue.

  By the way, Patent Document 1 discloses a system capable of endoscopically collecting blood vessels in a living body.

US Pat. No. 7,981,127

  By the way, in the system of Patent Document 1, first, the blood vessel and the surrounding tissue (fat) are peeled by the peeling device (disector 3), and then the branch exposed to the living body by the cutting device (treatment sheath 2). Hemostasis and cuts blood vessels. As described above, the system of Patent Document 1 is configured to extract only blood vessels and cannot collect blood vessels together with surrounding tissues.

  The present invention has been made in connection with the above-described technique for exfoliating a living tissue, and is capable of excellently cutting a branched blood vessel connected to the blood vessel being exfoliated while exfoliating the blood vessel and the surrounding tissue together. It is an object to provide a device and a stripping system having this cutting device.

In order to achieve the above object, a cutting device according to the present invention includes a gripping part configured to be gripped by a user, and a direction provided at a tip part of the gripping part and orthogonal to the extending direction of the gripping part. And one or more projecting structure parts that can be inserted into the tissue around the blood vessel, and the projecting structure parts are opposed to the projecting direction of the projecting structure part and the extending direction of the gripping part. And a return portion that forms a holding space capable of holding a branch blood vessel connected to the blood vessel between the protruding direction and the bending direction by bending in a bending direction that forms a right angle or an acute angle with respect to the protruding direction . And a processing section for cauterizing and cutting the branch blood vessel held in the holding space.

  According to the above, the protruding structure portion of the cutting device has the return portion and the processing portion, so that when the blood vessel and the surrounding tissue are peeled, the return portion of the branch blood vessel is inserted into the tissue while the protruding structure portion is inserted. The branched blood vessels can be held by the holding space by guiding to the holding space to be formed. For this reason, when the protruding structure is retracted from the insertion site, the branch blood vessel held in the holding space is lifted, and it is confirmed that the protruding structure has surely captured the branch blood vessel. A branch vessel can be cut. Therefore, the surgeon can cut the branch blood vessel well by avoiding poor cutting of the branch blood vessel leading to the blood vessel being exfoliated, unnecessary cutting or heating of the tissue, and efficiently removing the blood vessel and the surrounding tissue. Can be extracted.

  In this case, the protruding structure portion may be a plate-shaped piece portion that extends along the extending direction of the gripping portion and protrudes in a direction orthogonal to the extending direction.

  Thus, if the protruding structure is a plate-like piece, the plate-like piece can be easily inserted into the tissue. Further, when the branch blood vessel comes into contact with the edge of the plate-like piece portion, the branch blood vessel is deformed along the edge portion, and is smoothly guided to the holding space as the plate-like piece portion moves.

  In addition to the above configuration, it is preferable that the plate-like piece portion is curved toward the tip in the protruding direction when viewed from the extending direction of the gripping portion.

  Thus, when the plate-like piece is curved toward the tip in the protruding direction, the plate-like piece is displaced so as to wrap around the blood vessel to be peeled when the plate-like piece is inserted into the tissue. This makes it possible to better capture and cut branch vessels.

  The return portion may be parallel to the extending direction of the gripping portion or inclined toward the fixed portion side of the protruding structure portion.

  As described above, the return portion is parallel to the extending direction of the gripping portion or inclined toward the fixed portion side of the protruding structure portion, so that the branching blood vessel can be more reliably held in the holding space and can be removed from the holding space. Can be suppressed.

  Here, it is preferable that the protruding structure portion is provided in a pair so that the return portion faces the extending direction of the gripping portion.

  Thus, a cutting device is provided so that the return part of a pair of protrusion structure part may oppose, A pair of protrusion structure part can be made to oppose over the long range of the axial direction of a blood vessel. Therefore, the branch blood vessel can be captured more reliably, and the procedure can be performed efficiently.

  The pair of return portions preferably overlap with each other in the extending direction of the gripping portion.

  As described above, the pair of return portions partially overlap in the extending direction, so that it is possible to more reliably prevent the branching blood vessel led to the holding space from dropping off.

  Furthermore, the pair of return portions may be arranged in a non-contact manner via a space.

  In this way, the pair of return portions are arranged in non-contact with each other through the space, so that the cutting device can easily guide the branch blood vessel to the holding space through the space.

  Still further, the holding spaces formed by the pair of return portions may communicate with each other.

  As described above, since the holding spaces communicate with each other, the branch blood vessel led to the holding space can be freely moved in the holding space, and the blood vessel can be suppressed from being pulled excessively.

  Furthermore, the pair of return portions may constitute a receiving space that is recessed in a valley shape in a direction opposite to the protruding direction.

  As described above, since the pair of return portions constitutes a receiving space that is recessed in a valley shape, the branch blood vessel can be guided into the holding space more smoothly by allowing the branch blood vessel to enter the receiving space.

  In order to achieve the above object, a peeling system according to the present invention includes the above-described cutting device, and a space forming device that is inserted into a patient's body and separates the blood vessel and the tissue peeled from the blood vessel. The space forming device includes a cavity in which the cutting device is arranged to be movable in the protruding direction of the protruding structure portion, and an opening that exposes the protruding structure portion from the cavity. .

  According to the above, the peeling system can easily insert the cutting device into the living body through the cavity by using the space forming device. Then, the protruding structure portion of the cutting device can be inserted into the tissue from the opening of the space forming device to hold the branch blood vessel, and the branch blood vessel can be reliably cut.

  In this case, the inner peripheral surface constituting the cavity of the space forming device is curvedly formed in a sectional view of the axis of the space forming device, and the protruding structure portion of the cutting device extends the extension of the cutting device. It is preferable that the curved surface of the space forming device is curved so as to substantially coincide with the curved shape as viewed from the present direction.

  In this way, the protruding structure of the cutting device is curved so that it substantially coincides with the inner peripheral surface of the space forming device, so that when the surgeon inserts the cutting device into the tissue, the separation system forms the space. It is possible to accurately guide the protruding structure along the inner peripheral surface of the device. Therefore, the protruding structure can be smoothly inserted into the tissue, and the branch blood vessel can be captured in the vicinity of the blood vessel to be peeled off.

  ADVANTAGE OF THE INVENTION According to this invention, the peeling device and the peeling system which has this cutting device can cut | disconnect the branch blood vessel connected to the blood vessel under peeling favorably while peeling both the blood vessel and the surrounding tissue.

It is a perspective view showing the whole exfoliation system composition concerning one embodiment of the present invention. FIG. 2A is a perspective view showing a state in use of the space forming device and the cutting device of the peeling system of FIG. 1, and FIG. 2B is a cross-sectional view taken along the line IIB-IIB of FIG. 2A. It is a perspective view which expands and shows the front-end | tip part of the cutting device of FIG. 4A is an enlarged side view showing the cutting mechanism of FIG. 3, and FIG. 4B is a front view of the cutting mechanism. It is a figure explaining the insertion method to the biological body of a 1st assembly. It is sectional drawing along the extension direction of the blood vessel explaining the state which pushes a 1st assembly along the blood vessel in the living body. It is a figure explaining insertion of the 2nd assembly in the living body. It is a figure explaining the state which inserts an imaging device, a 2nd holder, and a cutting device in a space formation device. FIG. 9A is a first explanatory diagram illustrating an operation in which the cutting mechanism of the cutting device captures a branched blood vessel, and FIG. 9B is a second explanatory diagram illustrating a capturing operation subsequent to FIG. 9A. It is front sectional drawing which shows the operation | movement in which a cutting | disconnection mechanism captures a branch blood vessel. FIG. 11A is a side view for explaining the operation of the branch blood vessel after the cutting mechanism has captured, and FIG. 11B is a side view for explaining the cutting of the branch blood vessel by the cutting mechanism.

  Hereinafter, preferred embodiments of a cutting device 22 according to the present invention and a peeling system having the cutting device 22 will be described in detail with reference to the accompanying drawings.

  The exfoliation system 10 is used to collect a blood vessel used as a bypass tube when performing a vascular bypass operation (coronary artery bypass operation: CABG), and covers the blood vessel with surrounding tissues (fat, connective tissue, etc.). It can be collected in a broken state. The blood vessel collected using the peeling system 10 is not particularly limited as long as it is a blood vessel that can be used as a bypass tube. For example, the internal thoracic artery, gastroepiploic artery, radial artery, saphenous vein (large saphenous vein) , Small saphenous vein) and the like.

  Among these blood vessels, the saphenous vein is preferable. By using the peeling system 10, as described above, it becomes easy to collect a blood vessel in a state of being covered with surrounding tissue. Therefore, the saphenous vein is collected using the peeling system 10, and it is used as a bypass tube. It is considered that the long-term patency rate after surgery is increased.

  As shown in FIG. 1, the peeling system 10 includes a plurality of devices as a set, and is configured to use each device in combination or independently according to the procedure (treatment status) of the procedure. Specifically, the peeling system 10 includes a spatula device 12, an imaging device 14, a space forming device 16, a first holder 18, a second holder 20, and a cutting device 22.

  In the following, when the direction of each device of the peeling system 10 is shown, the direction indication described in FIG. 1 (the same applies to FIGS. 2A to 11B) will be described as a reference. That is, in each device in FIG. 1, the direction toward the left side of the page is the front direction, the direction toward the right side of the page is the rear direction, the direction toward the upper side of the page is the upper direction, the direction toward the lower side of the page is the lower direction, The direction toward the diagonally front side is referred to as the left direction, and the direction toward the diagonally back side of the paper is referred to as the right direction. The left and right directions of the device are based on the surgeon's viewpoint during the procedure. These directions are for convenience of explanation, and it is a matter of course that each device can be used in an arbitrary direction (for example, upside down).

  The spatula device 12 is a first peeling device that is inserted into the body of a patient when blood vessels are collected, and peels tissues around the blood vessels (fats, fat and skin, etc.). The spatula device 12 includes a plate-like spatula body 24 that is long in the front-rear direction and narrow in the width direction, and a semi-columnar base end operating portion 26 that is connected to the base end side of the spatula body 24.

  The spatula body 24 is a part that is actually inserted into a patient's body to peel tissue. The leading edge 24a and both side edges 24b of the spatula body 24 are formed in a cross-sectional arc shape with a large curvature, and correspond to a portion that touches the tissue and peels directly. The spatula body 24 has a shallow umbrella shape because the side edges 24b are slightly lower than the center in the width direction. This facilitates peeling and reduces the resistance in the body. A housing space (not shown) for housing the imaging device 14 is formed along the axial direction on the lower surface of the center portion in the width direction of the spatula body 24.

  The proximal end operation unit 26 is a part where an operator (user) grasps the spatula device 12. The proximal end operating portion 26 has an upper side protruding from the spatula main body 24 to form a large arc shape, and a lower side thereof is cut out in a flat shape having a height matching the both side edges 24 b of the spatula main body 24. The proximal end operation portion 26 includes a hole portion 26a that communicates the proximal end surface and the accommodation space, and a groove portion 26b that extends along the front-rear direction on the upper outer peripheral surface. The hole 26a and the groove 26b can pass the imaging device 14.

  The imaging device 14 is configured as a so-called endoscope that is inserted into the patient's body together with other devices of the ablation system 10 during a procedure and images the state of the other devices and tissue. A display device (not shown) is connected to the imaging device 14. During the procedure, the image inside the body is displayed on the display device, and the surgeon can perform the procedure while checking the image. The imaging device 14 includes an imaging shaft portion 28 that is long in the front-rear direction, and a proximal end operation portion 30 that is connected to the proximal end of the imaging shaft portion 28 and is gripped by an operator.

  The imaging shaft portion 28 is formed in an elongated cylindrical shape, and for example, an objective lens 32 and an illumination portion 34 are provided on the front side thereof. In addition, a lead wire (not shown) that is electrically connected to the objective lens 32 and the illumination unit 34 is disposed inside the imaging shaft unit 28. On the other hand, the proximal end operation unit 30 is formed larger in diameter than the imaging shaft unit 28 so that the operator can easily adjust the front-rear position and imaging angle of the objective lens 32 and the illumination unit 34.

  The space forming device 16 is inserted after tissue removal by the spatula device 12. The space forming device 16 is a second peeling device that expands the tissue peeled off by the spatula device 12 and forms a space surrounded by the inner peripheral surface of the space forming device 16 between the blood vessel and the tissue. The space forming device 16 includes a dome portion 36 that is formed long in the front-rear direction and is actually inserted into the patient's body, and a proximal end operation portion 38 that is connected to the proximal end side of the dome portion 36 and is grasped by the operator. Have.

  As shown in FIGS. 1, 2 </ b> A, and 2 </ b> B, the dome portion 36 has a semi-cylindrical shape having a cavity 40 inside, and an opening 42 communicating with the cavity 40 is provided below the dome portion 36. The cavity 40 is constituted by the inner peripheral surface of the dome portion 36, and the cavity 40 forms a space in the body into which the dome portion 36 is inserted. The front side of the dome portion 36 has a tapered shape that gently closes the cavity 40. The cavity 40 and the opening 42 extend along the axial direction of the dome portion 36, and it is possible to construct a space along the blood vessel to be separated.

  The cavity 40 is set to a volume that can accommodate a cutting mechanism 52 of the cutting device 22 described later. The inner peripheral surface of the dome portion 36 constituting the cavity 40 has a smooth arc shape in cross-sectional view. Moreover, the width | variety of the both-sides edge (cavity 40) in the dome part 36 corresponds with the width | variety of the both-sides edge 24b of the spatula device 12 (seller body 24). Further, the lower edge of the front end of the dome portion 36 has a mountain-shaped guide surface 44 along the upper surface of the spatula device 12. Thereby, the dome part 36 can move (slide) smoothly on the upper surface of the spatula device 12.

  The proximal end operation portion 38 of the space forming device 16 has a semi-cylindrical shape that is slightly larger than the dome portion 36. A hollow portion 38 a that communicates with the cavity 40 and can be separately attached to the first holder 18 and the second holder 20 is provided in the proximal end operation portion 38. In addition, a proximal end opening 38b communicating with the hollow portion 38a is provided at the proximal end of the proximal end operation portion 38.

  The first holder 18 and the second holder 20 are block-shaped members that can be replaced according to the procedure of the procedure. The first holder 18 has a semi-cylindrical shape, and an insertion hole 18a through which the imaging shaft portion 28 can be inserted passes through a central portion in the width direction. The second holder 20 has a semi-cylindrical shape, and a holding bulging portion 46 is provided closer to one side of the inner circumferential surface in the width direction. An insertion hole 46 a through which the imaging shaft portion 28 can be inserted is formed through the holding bulge portion 46. A space formed by the lower surface of the second holder 20 and the side surface (outer peripheral surface) of the holding bulge portion 46 is an arrangement space 48 in which the cutting device 22 can be disposed through.

  The cutting device 22 of the peeling system 10 is configured as an instrument that cuts a branch blood vessel that is inserted into the body through the cavity 40 of the space forming device 16 and leads to the blood vessel to be peeled off. The cutting device 22 includes a shaft portion 50 and a cutting mechanism 52 provided on the front side (tip portion) of the shaft portion 50.

  The shaft portion 50 is a grasping portion that is grasped and operated by the operator, and disposes the cutting mechanism 52 at a desired position in the body (the cavity 40 of the space forming device 16). The shaft portion 50 extends linearly in the axial direction, and is longer than the entire length of the space forming device 16 in order to allow the cutting mechanism 52 to reach the back of the cavity 40. On the other hand, the shaft portion 50 is slightly shorter (or similar) than the imaging shaft portion 28 of the imaging device 14. The shaft portion 50 is configured so that the operator can operate the cutting device 22 between the proximal end operation portion 30 of the imaging device 14 and the proximal end operation portion 38 of the space forming device 16. The total length of the shaft portion 50 is preferably set to about 300 to 700 mm, for example. The shaft portion 50 includes a tube body 54 that extends long along the axial direction, and a rod body 56 that protrudes forward from the tube body 54.

  The tubular body 54 extends linearly with an outer diameter capable of arranging and moving the arrangement space 48 of the second holder 20, and a through hole 54 a is provided along the axial direction therein. The rod body 56 is inserted and fixed in the through hole 54 a of the tube body 54. The through hole 54 a has a diameter sufficiently larger than the outer diameter of the rod body 56, and has a sufficient margin (gap) when the rod body 56 is fixed. In addition to the rod body 56, a pair of conducting wires (first conducting wire 58 and second conducting wire 59) that are electrically connected to the cutting mechanism 52 are accommodated in the through hole 54a. The first conducting wire 58 and the second conducting wire 59 extend from the base end side of the shaft portion 50 and are electrically connected to a power source (not shown).

  As shown in FIG. 3, the rod body 56 is fixed to the inner surface of the tube body 54 constituting the through hole 54 a by appropriate fixing means (such as fusion or adhesion). The rod body 56 has a solid cylindrical shape and protrudes shorter than the tube body 54. A cutting mechanism 52 is fixed to the outer peripheral surface on the distal end side of the rod body 56. The tube body 54 and the rod body 56 extend in parallel with each other, and the operator grips the proximal end portion of the tube body 54, so that the tube body 54, the rod body 56, and the cutting mechanism 52 operate integrally. Let

  A first conductor 58 and a second conductor 59 exposed from the through hole 54 a of the tube body 54 extend below the rod body 56, and the first conductor 58 and the second conductor 59 serve as a cutting mechanism 52 for the rod 56. To the installation location. The rod body 56 may be fixed to the outer peripheral surface of the tube body 54, and the tube body 54 and the rod body 56 may be integrally formed.

  The cutting mechanism 52 is fixed to the outer peripheral surface of the rod 56 by an appropriate fixing means (such as fusion or adhesion). The cutting mechanism 52 is configured by one or more projecting structure portions 60 that project in a direction orthogonal to the extending direction of the shaft portion 50. In the present embodiment, the protruding structure part 60 is a plate-like piece part, and is provided on the shaft part 50 as a pair (as the first piece part 70 and the second piece part 80).

  The first piece portion 70 and the second piece portion 80 are each formed with a thin thickness so that they can be easily inserted into fat. The first piece 70 and the second piece 80 extend in a straight line from the rod 56 in the tangential direction of the outer peripheral surface to some extent in a cross-sectional view (see FIG. 2B), and then bend with a predetermined curvature from a midway position. is doing. The length in the protruding direction of the first piece 70 and the second piece 80 is set to be shorter than the arcuate circumference from the center in the width direction to the lower end of the dome 36 of the space forming device 16. As a result, the first piece 70 and the second piece 80 do not expose the lower end portions (projecting corner portions 75, 85) from the opening 42 when the cavity 40 of the dome portion 36 is moved in the axial direction. Can move well.

  Specifically, the first piece 70 is fixed to the front side (generally the front end side) of the rod body 56 and extends downward in FIG. 3 and smoothly curves in the front direction in FIG. Yes. The second piece 80 is fixed to the rear side of the first piece 70 on the rod body 56, and, like the first piece 70, extends downward and is smoothly curved. The first piece 70 and the second piece 80 have the same curvature in the curved portions, but are fixed in contact with each other with respect to the outer circumferential surface of the rod body 56 by shifting their circumferential phases. It has become.

  The first piece 70 includes a base portion 72 that is connected and fixed to the rod body 56, and a return portion 74 (barb member) that is connected to the distal end side of the base portion 72. The base 72 of the first piece 70 is generally trapezoidal when viewed from the side facing the plate surface (see FIG. 4A). Specifically, the front edge 72a extends linearly downward, while the rear 72b extends linearly to a middle position downward, and the edge 72b extends downward from the edge 72a. And an edge portion 72c inclined at a predetermined angle (for example, about 30 to 60 °).

  The return portion 74 is connected to the lower end of the base portion 72 that is narrower between the edge portions 72a and 72c, and protrudes downward while being curved in the surface direction. The return portion 74 has a narrower width than the base portion 72 in a side view. The return portion 74 has a V-shape that protrudes obliquely in a downward direction and in the proximal direction, and bends and protrudes upward and in the proximal direction from the protruding corner portion 75. The angle (flexibility) of the return portion 74 with respect to the projecting direction of the first piece 70 is not particularly limited, and is, for example, 90 ° (parallel to the extending direction of the shaft portion 50) to 0 ° (first) with respect to the projecting direction. It is good to set to the range of the angle which inclines toward the fixed side of the shaft part 50 of the piece part 70. The return portion 74 may be narrower than the protruding corner portion 75.

  The outer side of the return portion 74 is connected to the edge portion 72a of the base portion 72 and is bent at a predetermined angle (for example, 45 °) with respect to the edge portion 72a, and is connected to the edge portion 74a with a predetermined angle with respect to the edge portion 74a. The edge 74b is bent at (for example, 90 °), and the edge 74c is connected to the edge 74b and bent at a predetermined angle (for example, 135 °) with respect to the edge 74b. The inner side of the return portion 74 is continuous with the edge portion 72c of the base portion 72 and is bent at a predetermined angle (for example, 90 °) with respect to the edge portion 72c, and is connected to the edge portion 74d with a predetermined angle with respect to the edge portion 74d. The edge portion 74e is bent at (for example, 90 °), and the edge portion 74f is connected to the edge portion 74e and connected to the edge portion 74e at a predetermined angle (for example, 135 °).

  The edge portion 74a and the edge portion 74d, the edge portion 74b and the edge portion 74e extend in parallel with each other, and the width of the return portion 74 is constant. The outer edge portion 74a and the edge portion 74b form a lower end corner portion 74g. The outer edge portion 74c and the inner edge portion 74f constitute an extended end portion 76 of the return portion 74 and intersect at right angles.

  The return part 74 constitutes the insertion part 77 that is inserted into the living tissue when the cutting mechanism 52 is displaced downward by the plate thickness of the return part 74 itself, the edges 74a and 74b, and the lower end corner part 74g. is doing. Further, since the return portion 74 is closed with respect to the lower end direction, a holding space 78 in which the edge portion 72c of the base portion 72 and the edge portions 74d, 74e, and 74f of the return portion 74 can hold a branch blood vessel is located inside. Have. Since the edge portion 72c and the edge portion 74e extend in parallel with each other, the holding space 78 has a certain width from the extended end portion 76 toward the edge portion 74d. The width between the anode terminal 79a and the cathode terminal 79b of the holding space 78 may be narrower than the width of the holding space 78 on the rear side of the cathode terminal 79b. Further, the return portion 74 may be a trough portion that is curved. Further, a projection (not shown) may be provided on the edge 74e in the holding space 78 and on the edge 74f side of the cathode terminal 79b. As a result, the branch blood vessel 102 once held in the holding space 78 can be prevented from coming off from the holding space.

  Furthermore, an anode terminal 79a and a cathode terminal 79b are provided on one surface of the first piece portion 70 (in the present embodiment, in the bending direction) to form a cutting portion 79 (processing portion) using a bipolar electrode. . The anode terminal 79a and the cathode terminal 79b are electrically insulated at positions separated from each other on the first piece 70. For example, the anode terminal 79 a is disposed at a position in contact with the inner edge 74 d of the return portion 74, and the cathode terminal 79 b is disposed at a position in contact with the inner edge 74 e of the return portion 74.

  Furthermore, an anode wiring 79c electrically connected to the anode terminal 79a and a cathode wiring 79d electrically connected to the cathode terminal 79b are provided on one surface of the first piece 70 in parallel with each other in an insulated state. It has been. The anode wiring 79c is electrically connected to the first conducting wire 58 extending in the axial direction along the rod body 56, and the cathode wiring 79d is electrically connected to the second conducting wire 59 similarly extending in the axial direction along the rod body 56. Connected to.

  On the other hand, the second piece 80 is formed like a plate like the first piece 70, and is provided so that the return portion 84 and the holding space 88 face the return portion 74 and the holding space 78 of the first piece portion 70. It is done. That is, the second piece 80 is formed symmetrically with the first piece 70 with respect to the axial intermediate line L of the cutting mechanism 52 in FIG. 4A. More specifically, the 2nd piece part 80 has the base part 82 comprised by edge part 82a, 82b, 82c, and the return part 84 comprised by edge part 84a-84f.

  In this case, the outer edge portions 84a and 84b and the lower end corner portion 84g of the return portion 84 constitute the insertion portion 87, and the inner edge portions 84d to 84f of the return portion 84 together with the edge portion 82c of the base portion 82 hold space 88. Have

  The cutting mechanism 52 is provided so that the extended end portions 76 and 86 of the return portions 74 and 84 overlap each other and a part of the base portions 72 and 82 overlap each other in a side view (see FIG. 4A). Therefore, the holding space 78 of the first piece portion 70 and the holding space 88 of the second piece portion 80 are in communication with each other to form one angle space 90. In other words, the return portion 74 of the first piece portion 70 and the return portion 84 of the second piece portion 80 overlap each other, thereby having a W shape in a side view. The holding space 78 and the end of the holding space 88 on the edge 74f side may coincide with each other in a side view (see FIG. 4A).

  On the other hand, the 1st piece part 70 and the 2nd piece part 80 are provided so that it may become non-contact each other by front view (refer FIG. 4B). Specifically, the second piece 80 is disposed more inward of the bending direction than the first piece 70. The extended end portion 76 of the first piece 70 and the extended end portion 86 of the second piece 80 are separated from each other in a front view and overlap in a side view. Is forming. The space 92 communicates the outside of the cutting mechanism 52 with the mountain space 90. The size of the space 92 (the interval between the overlapping portions of the first piece 70 and the second piece 80) is preferably set so that the branch blood vessel can pass through, for example, about 0.5 mm to 5.0 mm. There should be.

  Moreover, the edge part 74b of the 1st piece part 70 and the edge part 84b of the 2nd piece part 80 incline in a valley shape toward the width direction center part by side view, and guide a branch vessel to the space 92. A receiving space 94 is provided. The mountain space 90 and the receiving space 94 communicate with each other via a space 92 formed by the extended end portions 76 and 86.

  Further, an anode terminal 89a and a cathode terminal 89b are provided on one surface of the second piece 80 (the same surface as the one surface of the first piece 70) to form a cutting portion 89 (processing portion) using a bipolar electrode. It has been. The anode terminal 89a and the cathode terminal 89b are also arranged at positions symmetrical to the first piece portion 70, and are separated from each other and electrically insulated on the second piece portion 80.

  Also, on one surface of the second piece 80, an anode wiring 89c that is electrically connected to the anode terminal 89a and a cathode wiring 89d that is electrically connected to the cathode terminal 89b are provided. The anode wiring 89c is electrically connected to a terminal 89e at an intermediate position of the first conducting wire 58 extending in the axial direction along the rod body 56, and the cathode wiring 89d is similarly axially along the rod body 56. The second conductive wire 59 extending is electrically connected to a terminal 89f at a midpoint. The first piece 70 and the second piece 80 are not particularly limited with respect to the installation positions of the anode terminals 79a and 89a and the cathode terminals 79b and 89b, the anode wirings 79c and 89c, and the cathode wirings 79d and 89d. For example, the positions of the anode terminal 79a (anode wiring 79c) and the cathode terminal 79b (cathode wiring 79d) may be reversed.

  The material which comprises the 1st piece part 70 and the 2nd piece part 80 will not be specifically limited if it has the hardness which can be penetrated in a structure | tissue, For example, metal materials, such as stainless steel, and a hard resin Examples include materials and glass.

  The peeling system 10 and the cutting device 22 according to the present embodiment are basically configured as described above, and their operational effects will be described below.

  In the blood vessel collection method, a peeling step (first step) for peeling the blood vessel 100 while being covered with surrounding fat (tissue) using the peeling system 10 and a cutting for cutting the branch blood vessel 102 connected to the blood vessel 100 to be peeled off. Step (second step) is repeated as appropriate. When the target blood vessel 100 is separated from the surrounding tissue, an extraction step (third step) is performed in which the blood vessel 100 is extracted from the living body while being covered with surrounding fat. In this example, the case where the saphenous vein in the lower limb is collected will be described.

  In the peeling step, first, the position of the blood vessel 100 to be collected is confirmed, and the skin 104 of the patient is incised based on the position, for example, as shown in FIG. Once the skin 104 is incised, the surgeon removes the incision 106 and fat until the blood vessel 100 is visible (until the blood vessel 100 or saphenous fascia is exposed).

  Next, the surgeon prepares the spatula device 12 and the imaging device 14, and inserts and holds the imaging shaft portion 28 of the imaging device 14 in the hole 26a on the lower side of the spatula device 12, so that both devices are integrated. The first assembly 95 can be handled. The surgeon inserts the first assembly 95 from the incision 106 and enters the spatula body 24 along the blood vessel 100 while observing the body with the imaging device 14 so that the lower side of the spatula body 24 faces the blood vessel. I will let you. At the time of this entry, the first assembly 95 exfoliates the fat around the blood vessel 100 by the tip edge 24a and both side edges 24b of the spatula body 24, as shown in FIG. The surgeon advances the spatula body 24 while confirming the separation site by the imaging device 14 capturing an image of the vicinity of the blood vessel 100, and pushes the spatula body 24 by a necessary length (length to be collected).

  When the spatula body 24 peels to a desired position, the peeling step is temporarily terminated, and when it is confirmed by the imaging device 14 or the like that the branch blood vessel 102 is connected to the target blood vessel 100, the cutting step is performed. When performing this cutting step, the imaging device 14 is retracted relative to the spatula device 12 and the imaging device 14 is pulled out leaving only the spatula body 24 in the body. When the cutting step is not performed, the first assembly 95 is pulled out, and the first assembly 95 is inserted again with the insertion angle (circumferential direction) of the first assembly 95 changed with respect to the blood vessel 100.

  In the cutting step, the space forming device 16 and the first holder 18 are prepared, and the extracted imaging shaft portion 28 of the imaging device 14 is inserted and held in the insertion hole 18a of the first holder 18 so that the proximal end of the space forming device 16 is obtained. The first holder 18 is inserted and fixed in the hollow portion 38 a of the operation portion 38. That is, as shown in FIG. 7, a second assembly 96 including the space forming device 16, the first holder 18, and the imaging device 14 is constructed. In the second assembly 96, the imaging shaft portion 28 is disposed at the center in the width direction of the cavity 40 of the dome portion 36, and the imaging shaft portion 28 extends in the axial direction of the cavity 40.

  Next, the surgeon puts the dome portion 36 of the space forming device 16 of the second assembly 96 on the proximal end operation portion 26 of the spatula device 12 exposed outside the body. Then, the space forming device 16 is advanced (slided) along the upper surface of the spatula body 24 and inserted into the body through the incision 106. The dome portion 36 has a front guide surface 44 that matches the shape of the upper surface of the spatula body 24, and the side edges on both sides in the width direction accommodate the side edges 24 b of the spatula body 24 inside, thereby comparing the inside of the body. Make it easy to enter. At this time, the imaging device 14 images the spatula main body 24 and the dome portion 36 so that the operator can confirm the positions of both. When the space forming device 16 is inserted, only the space forming device 16 is attached to the spatula device 12 without constructing the second assembly 96 (that is, without using the first holder 18 and the imaging device 14). You may advance along.

  When the space forming device 16 advances, the tapered portion on the front side of the dome portion 36 pushes up the fat. Further, the dome portion 36 of the space forming device 16 is formed in a semicircular shape protruding upward with respect to the spatula body 24, so that a peeled portion (the blood vessel 100 with the spatula body 24 sandwiched therebetween) in the body. And fat) are separated further up and down to promote peeling.

  When the second assembly 96 is inserted to a desired position in the body, the operator removes the first holder 18 inserted into the proximal end operation unit 38 of the space forming device 16, and the first holder 18 and the imaging device are removed. 14 is retracted relative to the space forming device 16. Further, after the first holder 18 and the imaging device 14 are detached, the spatula device 12 is retracted relative to the space forming device 16 and removed from the body. Thereby, only the space forming device 16 remains in the body.

  Next, as shown in FIG. 8, the surgeon prepares the second holder 20 and the cutting device 22, and inserts and holds the imaging shaft portion 28 extracted in the insertion hole 46 a of the second holder 20. Then, by inserting the imaging device 14 and the second holder 20 from the proximal end opening 38b of the proximal end operation unit 38 of the space forming device 16 exposed outside the body, the second holder is inserted into the proximal end operation unit 38. Wear 20 Further, simultaneously with the insertion of the second holder 20 (or after the mounting of the second holder 20), the cutting device 22 is inserted from the proximal end operation portion 38 of the space forming device 16 through the arrangement space 48 of the second holder 20, and the dome is formed. The shaft portion 50 and the cutting mechanism 52 are caused to enter the cavity 40 of the portion 36. That is, the third assembly 97 is constructed by the space forming device 16, the second holder 20, and the cutting device 22.

  Then, the surgeon grasps the shaft portion 50 of the cutting device 22 to advance the cutting mechanism 52 toward the distal direction in the cavity 40 of the dome portion 36, and the branched blood vessel 102 connected to the blood vessel 100 being peeled off. The cutting mechanism 52 is made to face. During operation of the cutting device 22, the inside of the cavity 40 is imaged by the imaging device 14, and the relative position of the cutting mechanism 52 with respect to the blood vessel 100 and fat can be confirmed. Therefore, the surgeon can efficiently oppose the cutting mechanism 52 to the branch blood vessel 102.

  After the cutting mechanism 52 is opposed to the branch blood vessel 102, the operator operates the cutting device 22 as shown in FIG. 9A. That is, by operating the shaft portion 50 downward (toward the branch blood vessel 102), the insertion portions 77 and 87 of the cutting mechanism 52 (the first piece portion 70 and the second piece portion 80) are removed from the opening 42. Make it protrude. As a result, the insertion portions 77 and 87 are inserted and inserted into the fat around the blood vessel 100.

  When operating the cutting device 22, as shown in FIG. 10, the shaft portion 50 is moved along the inner peripheral surface of the dome portion 36 of the space forming device 16 and the inner peripheral surface of the arrangement space 48 of the second holder 20. be able to. Thereby, the cutting mechanism 52 (the first piece 70 and the second piece 80) moves so as to draw an arc around the blood vessel, and is smoothly inserted into the fat around the blood vessel 100. In addition, the cutting mechanism 52 is prevented from shifting to the left in FIG. 10 and the first piece 70 and the second piece 80 cannot secure the branch blood vessel 102.

  When the first piece 70 and the second piece 80 are inserted, the opposing branch blood vessel 102 enters the receiving space 94, and the branch blood vessel is formed at the top of the receiving space 94 by the edges 74 b and 84 b of the return portions 74 and 84. 102 is guided. When the insertion operation of the insertion portions 77 and 87 (movement to the branch blood vessel 102) is continued, the branch blood vessel 102 passes through the space 92 between the first piece portion 70 and the second piece portion 80. That is, as shown in FIG. 9B, the branch blood vessel 102 contacts the return portions 74 and 84, and is deformed as a whole into an S shape in accordance with the shape of the return portions 74 and 84. By thus deforming into an S-shape, the branch blood vessel 102 avoids the extended end portion 76 of the first piece 70 on the rear side and avoids the extended end portion 86 of the second piece portion 80 on the front side. Thus, it can pass through the space 92 and moves from the receiving space 94 to the mountain space 90.

  The branch blood vessel 102 that has moved to the chevron space 90 is prevented from coming off from the chevron space 90 by the return portions 74 and 84 of the first piece 70 and the second piece 80, that is, captured by the cutting mechanism 52. The insertion of the cutting device 22 into the tissue is stopped at a position where the shaft portion 50 is not exposed from the opening 42.

  After capturing the branch blood vessel 102 by the return portions 74 and 84, the operator moves the shaft portion 50 along the inner peripheral surface of the dome portion 36 in the direction opposite to the insertion direction (upward direction) in order to return the cutting device 22 to its original position. ). At this time, the branching blood vessel 102 arranged in the mountain space 90 is pulled out together with the first piece 70 and the second piece 80 because the return portions 74 and 84 prevent the branch vessel 102 from coming off.

  As a result, as shown in FIG. 11A, the branch blood vessel 102 moves in the angle space 90 toward the edge 74d on the first piece 70 side, for example, when the cutting mechanism 52 returns. Here, since the mountain space 90 is configured by the pair of holding spaces 78 and 88, the branch blood vessel 102 can move to either the back side of the holding space 78 or the back side of the holding space 88. . That is, depending on the position of the branch blood vessel 102, if the branch blood vessel 102 is moved to the back of the first piece 70 side, the branch blood vessel 102 may be forcibly pulled, but also on the second piece 80 side. Since the branch blood vessel 102 is movable, the burden on the branch blood vessel 102 can be reduced.

  When the cutting mechanism 52 returns to the cavity 40 in general, the narrowed branch blood vessel 102 is imaged by the imaging device 14, and the branch blood vessel 102 is displayed on a display device (not shown). Thus, the surgeon cuts the branch blood vessel 102 by operating the power supply and energizing the cutting portions 79 and 89 while viewing the branch blood vessel 102.

  The cutting mechanism 52 contacts the branch blood vessel 102 with the edge portion 74d (or the edge portion 84d) when returning from the insertion site to the cavity 40, and the anode terminal 79a (or anode terminal 89a) and the cathode terminal 79b ( Alternatively, the branch blood vessel 102 is sandwiched between the cathode terminals 89b). Therefore, as shown in FIG. 11B, by energizing the anode terminal 79a and the cathode terminal 79b, the branch blood vessel 102 can be cauterized (thermally coagulated) to stop bleeding. After cauterization of the branched blood vessel 102, the cauterized portion becomes brittle and the first or second piece 70, 80 is a thin plate, so that the branched blood vessel 102 is easily cut by the edge 74d.

  As described above, in the cutting step, the cutting device 22 can cut the branch blood vessel 102 well. When a plurality of branch blood vessels 102 are connected in the axial direction of the blood vessel 100, the above cutting step is repeated a plurality of times. Further, in the peeling step and the cutting step, in order to cut out the blood vessel 100 and fat to be extracted in the circumferential direction, the phase in the circumferential direction is changed, and the peeling step and the cutting step are repeated a plurality of times (for example, in order to cut the four directions of the blood vessel 100). Thus, the blood vessel 100 can be pulled out.

  Then, after separating the tissue in the circumferential direction of the blood vessel 100 to be peeled off, the operator takes out the fat blood vessel 100 from the body through the incision portion 106 in the extraction step.

  As described above, in the peeling system 10 and the cutting device 22 according to this embodiment, the first piece 70 and the second piece 80 have the return portions 74 and 84, the insertion portions 77 and 87, and the cutting portions 79 and 89, respectively. Have. As a result, when the blood vessel 100 and the surrounding tissue are peeled, the branching blood vessel 102 is guided to the holding spaces 78 and 88 formed by the return portions 74 and 84 while being inserted into the tissue, and held. The branched blood vessels 102 can be held by the spaces 78 and 88. Therefore, when the first piece 70 and the second piece 80 are retracted from the insertion site, the branch blood vessel 102 held in the holding spaces 78 and 88 is lifted, and the cutting mechanism 52 reliably captures the branch blood vessel 102. After confirming that the branch blood vessel 102 is cut, the cutting sections 79 and 89 can cut the branch blood vessel 102. Therefore, the surgeon can avoid the cutting failure of the branching blood vessel 102 connected to the blood vessel 100 being exfoliated and the unnecessary cutting of the tissue, and can satisfactorily cut the branching blood vessel 102. Can be efficiently extracted.

  At this time, since the cutting mechanism 52 includes the plate-like first piece 70 and the second piece 80, the insertion portions 77 and 87 can be easily inserted into the tissue. Further, the branch blood vessel 102 is appropriately deformed by coming into contact with the first piece 70 and the second piece 80 and smoothly moves into the holding spaces 78 and 88 as the first piece 70 and the second piece 80 move. Will be led to. In addition, since the first piece 70 and the second piece 80 are curved toward the tip in the protruding direction, the first piece 70 and the second piece so as to wrap around the blood vessel 100 at the time of insertion. The part 80 is displaced. Therefore, the branch blood vessel 102 can be captured and cut better. Further, the return portions 74 and 84 of the first piece portion 70 and the second piece portion 80 extend in a direction that forms a right angle or an acute angle with respect to the protruding direction in a side view, so that the holding spaces 78 and 88 are formed. The branch blood vessel 102 can be held more reliably and can be prevented from coming out of the holding spaces 78 and 88.

  The cutting device 22 is provided so that the return portions 74 and 84 of the first piece 70 and the second piece 80 face each other along the shaft portion 50, thereby cutting over the long range in the axial direction of the blood vessel 100. The mechanism 52 can be opposed. Therefore, the branch blood vessel 102 can be captured more reliably, and the procedure can be performed efficiently.

  Further, since the return portions 74 and 84 of the first piece 70 and the second piece 80 are arranged in a non-contact manner via the space 92, the cutting device 22 holds the branch blood vessel 102 through the space 92. , 88. The branch blood vessel 102 is more reliably prevented from falling off because the return portions 74 and 84 overlap in a side view. Further, since the return portions 74 and 84 constitute a receiving space 94 that is recessed in a valley shape, the branch blood vessel 102 can be introduced into the receiving space 94 and the branch blood vessel 102 can be guided more smoothly.

  Furthermore, the peeling system 10 can easily insert the cutting device 22 into the body through the cavity 40 of the dome portion 36 by using the space forming device 16. Then, the cutting mechanism 52 of the cutting device 22 can be inserted into the tissue from the opening 42 of the space forming device 16 to hold the branch blood vessel 102, and the branch blood vessel 102 can be reliably cut. . In addition, since the first piece 70 and the second piece 80 of the cutting device 22 are curved so as to substantially coincide with the inner peripheral surface of the cavity 40 of the space forming device 16, the operator turns the cutting device 22 into tissue. When inserting, the protruding structure 60 can be accurately guided along the inner peripheral surface of the dome 36. Therefore, the first piece 70 and the second piece 80 can be smoothly inserted into the tissue, and the branch blood vessel 102 can be captured in the vicinity of the blood vessel 100 to be separated.

  The present invention is not limited to the above-described embodiment, and it goes without saying that various modifications can be made without departing from the gist of the present invention. For example, although the cutting mechanism 52 is configured by the first piece portion 70 and the second piece portion 80 in the present embodiment, the cutting mechanism 52 can take various configurations. As an example, the cutting mechanism 52 may be composed of only one piece, or may be composed of three or more pieces. The return portion 74 of the first piece portion 70 and the return portion 84 of the second piece portion 80 may not overlap with each other, and may be disposed so as to have a space in the axial direction of the shaft portion 50.

DESCRIPTION OF SYMBOLS 10 ... Stripping system 16 ... Space forming device 22 ... Cutting device 36 ... Dome part 40 ... Cavity 42 ... Opening 50 ... Shaft part 52 ... Cutting mechanism 60 ... Protruding structure part 70 ... 1st piece part 74, 84 ... Return part 76, 86 ... Extension end portions 77, 87 ... Insertion portion 78, 88 ... Holding space 79, 89 ... Cutting portion 80 ... Second piece 90 ... Yamagata space 92 ... Space 94 ... Receiving space 100 ... Blood vessel 102 ... Branch blood vessel

Claims (9)

A gripper configured to be grippable by a user;
One or more projecting structures provided at the distal end of the gripping part, projecting in a direction perpendicular to the extending direction of the gripping part, and capable of being inserted into a tissue around a blood vessel,
The protruding structure is
It is possible to hold a branched blood vessel connected to the blood vessel by bending in a bending direction that forms a right angle or an acute angle with respect to the protruding direction in a side view facing the protruding direction of the protruding structure portion and the extending direction of the gripping portion. A return portion that forms a holding space between the protruding direction and the bending direction ;
A cutting device, comprising: a treatment unit that cauterizes and branches the branched blood vessel held in the holding space. The cutting device according to claim 1.
The cutting device characterized in that the return portion is parallel to the extending direction of the gripping portion or inclined toward the fixed portion side of the protruding structure portion. The cutting device according to claim 1 or 2,
The projecting structure part is provided in a pair so that the return part is opposed to the extending direction of the grip part. The cutting device according to claim 3, wherein
The pair of return portions partially overlap with each other in the extending direction of the grip portion. The cutting device according to claim 4.
The pair of return portions are arranged in non-contact with each other through a space. The cutting device according to any one of claims 3 to 5,
The cutting device, wherein the holding spaces formed by the pair of return portions communicate with each other. The cutting device according to any one of claims 3 to 6,
The pair of return portions constitutes a receiving space that is recessed in a valley shape in a direction opposite to the protruding direction. The cutting device according to any one of claims 1 to 7,
A space forming device that is inserted into a patient's body and separates the blood vessel and the tissue exfoliated from the blood vessel,
The said space formation device is provided with the cavity which arrange | positions the said cutting device movably in the said protrusion direction of the said protrusion structure part, and the opening which exposes the said protrusion structure part from the said cavity. The peeling system characterized by the above-mentioned. The stripping system of claim 8,
The inner peripheral surface constituting the cavity of the space forming device is formed in a curved shape in a sectional view of the axis of the space forming device,
The peeling system characterized in that the protruding structure portion of the cutting device is curved substantially in accordance with the curved shape of the inner peripheral surface of the space forming device as viewed from the extending direction of the cutting device.

Images