WO2012056769A1

WO2012056769A1 - Medical microsurgery instrument

Info

Publication number: WO2012056769A1
Application number: PCT/JP2011/065283
Authority: WO
Inventors: 内久松村
Original assignee: Matsumura Nobuhisa
Priority date: 2010-10-26
Filing date: 2011-07-04
Publication date: 2012-05-03
Also published as: JP2012090724A; JP4734469B1

Abstract

A medical microsurgery instrument is a medical instrument having tips which can be opened and closed relative to each other. The medical microsurgery instrument has a pair of elastically deformable arms provided so as to face each other, the pair of arms having tips which can be opened and closed relative to each other, the pair of arms being integrated together at a position behind the tips, the pair of arms having rear portions which are adapted to serve as grip sections to be grasped by finger tips, the gap between the pair of arms at the grip sections being configured so that the grip sections can approach and separate from each other. The medical microsurgery instrument is characterized in that a support member is provided on the front surface side of the grip section of one of the arms, the support member being capable of being gripped between the forefinger and the middle finger, the support member protruding in the direction in which the support member separates from the other arm.

Description

Medical microsurgical instrument

The present invention relates to a medical micro-surgical instrument for performing an operation with emphasis on delicate movement and feeling of a fingertip under a microscope. The term "medical use" here refers not only to pure medical treatment for human beings but also to biological experiments on experimental animals and tissues.

Performing advanced surgery under a surgical microscope is called microscopic surgery or microsurgery. Usually, precise exfoliation, incision, hemostasis, microvascular anastomosis, and the like are performed using a surgical microscope at a magnification of 3 to 20 times. Such surgery spans areas such as neurosurgery, plastic surgery, orthopedic surgery, and transplantation surgery. Specifically, using microvascular anastomosis (a fine blood vessel anastomosis technique with a blood vessel diameter of about 0.3 to 2.0 mm) for cerebrovascular bypass surgery, flap transplantation, reattachment of amputated fingers, and lymphedema Surgery such as lymphatic venule anastomosis and vascular anastomosis for organ transplantation. In addition, cerebral aneurysm clipping is also performed under a surgical microscope.

In addition to micro tweezers (sliders), microscopic scissors (scissors), micro needle holders, clip forceps (opening and closing clips for blood vessels and cerebral aneurysms), bipolar coagulation There is a hemostatic lion etc. These medical instruments include a straight type for surface layer operation and a bayonet type for deep operation. The medical instrument mentioned above is common in the point that the front-end | tip part is provided so that opening and closing is possible. That is, it is a medical tip opening / closing device. The medical tip opening / closing instrument is synonymous with the medical microsurgical instrument adopted as the name of the invention of the present application.

As is well known, as a micro tweezer of such a medical tip end opening / closing device, a pair of elastic arms are provided to face each other, and the tip ends thereof are provided so as to be openable / closable. Also, there is a part that is integrated on the rear side, and a grip part that grips the rear part of the pair of arms with a fingertip, and the grip part is provided so that the distance between the pair of arms can be approached and separated.

This is to be grasped with a fingertip. The pair of arms has elasticity, and a desired operation can be performed by finely adjusting the gripping force against the elasticity.

In this patent application, prior art documents were investigated. As a result, the medical tip opening / closing device described above was found to be provided with a recess having a size that allows the abdomen of the finger to enter the gripping portion of the tweezers (Patent Document 1).

This tweezer has no support member of the present invention (which will be described later). Therefore, Patent Document 1 does not affect the patentability of the present application.

Moreover, as shown in FIG. 5 and FIG. 6, two cases in which the support member protrudes from the arm have been discovered as medical tip opening / closing devices that are different in shape from the application of the present application but are similar in shape. (Non-Patent Document 1).
These are not used under a surgical microscope, nor are they gripped with the fingertips, but are medical tip opening / closing devices that can be grasped firmly with the palm of your hand. I use it. Therefore, Non-Patent Document 1 also does not affect the patentability of the present application in which the delicate movement of the fingertip is a problem.

JP-A-9-75361

Hereinafter, description will be made on the premise of the above-described known medical tip opening / closing device. There are two main things that are important when handling medical open / close devices under a microscope. (1) Hold the instrument so as not to drop it. (2) Opening and closing movement of delicate fingertips for opening and closing the instrument tip (gripping, cutting, peeling, clipping). In addition, the opening / closing movement of (2) is performed while feeling the state of a tissue such as a blood vessel with a fingertip that handles the instrument. Therefore, the sense of the fingertip is also important, and in this sense, this is also an element included in (2).

Of the above-mentioned instruments, for example, microtweezers are usually held in a way called a pen holder method. That is, it is a holding method that supports the lower side of the end portions of the pair of arms near the base of the index finger while attaching the tip of the thumb and the tips of the index and middle fingers to the surface of the pair of arms. In such a way of holding, it is in contact with the pair of arms at four points.

The above (1) holding and (2) opening and closing movements are finely adjusted based on the balance between these four points of contact and the delicate force adjustment of the fingertip. At this time, especially the thumb has an important influence. For example, if the thumb is not used, (1) cannot be held and the instrument is dropped. Further, the opening / closing movement of (2) is performed by delicately moving the thumb. In a surgical operation under a microscope in which the surgical field is enlarged, hand tremors (medically referred to as “tremor”) that occur to an operator when such a medical tip opening / closing device is used. A small amount of camera shake is a major problem. Minor tremors, which are not a problem in macroscopic surgery, lack stability and accuracy in performing surgery under a microscope where the surgical field is enlarged, and are a major obstacle to the performance of the surgery. It is thought that it should be overcome by experience. In particular, tremor and the like become a problem in cerebral aneurysm clipping. In cerebral aneurysm clipping, the aneurysm must be picked with a clip while using clip forceps and the picked clip must be left in the brain. The outline of the operation method at this time is as follows. First, the clip is grasped and opened by grasping the clip forceps. Next, the knob is grasped while the clip is closed by loosening the grip. Finally, move the clip forceps to release the clip and leave it in the brain. In this series of procedures, tremor or the like is likely to occur when the clip is closed while the grip is loosened or when the clip forceps are moved.

However, it is presumed that the reason why such a problem occurs is that the holding of (1) and the opening / closing movement of (2) are performed only by holding the fingertip with the thumb and index finger. The holding of (1) is important in order to prevent the risk of damage to biological tissue (such as the brain) due to the fall of the instrument. In addition, the opening / closing movement of (2) is closely related to the surgical result. If the burden on the fingertips, particularly the thumb, can be reduced in the holding of (1), the fingertips, especially the thumb feeling and fingertip movements can be concentrated in the opening / closing movement of (2). As a result, it is presumed that good surgical results can be obtained.

The present invention was created in view of the above circumstances, and its purpose is to reduce the burden of the thumb in holding (1) on the medical tip opening / closing device as much as possible, In particular, it should be possible to concentrate the thumb sensation and fingertip movement.

According to the present invention, a pair of elastically deformable arms are provided opposite to each other, and their front end portions are provided so as to be openable and closable, and are integrated on the rear side of the front end portions, and the rear portions of the pair of arms are gripped by a fingertip. It is assumed that the grasping portion is a medical microsurgical instrument in which the gap between the pair of arms can be approached and separated.

According to the first aspect of the present invention, the grip portion of one arm is provided with a support member on the surface side, and the support member can be sandwiched between the index finger and the middle finger, and is separated from the other arm. It protrudes in the direction.

The invention of the present application is as follows if its application is clarified. That is, as in the invention of claim 2, the surgical instrument is held under a microscope with a tweezer, a needle holder, a scissors blade, a clip forceps, a bipolar coagulation hemostasis lever and other fingertips.

The shape of the support member, including the thickness and protrusion length, is not limited, but it is desirable that the support member is easily sandwiched between the index finger and the middle finger. That is, as in the third aspect of the invention, the support member has a rod shape, the thickness is smaller than the thickness of the finger, and the protruding length from the arm is equal to or greater than the thickness of the finger.

The support member may be provided so as not to be detachable from the arm. However, if the position of the support member can be changed, the usability is improved. That is, as in the invention of claim 4, the support member is detachably provided on the arm, the attachment / detachment connecting portion is provided on the arm, the connected portion is provided on the support member, and the arm operation portion is provided with its longitudinal The connected parts are provided at intervals along the direction, and the connected parts with respect to the connecting parts are provided so as to be selectable.

To make it possible to selectively hold a medical microsurgical instrument with the right or left hand, it is desirable to do the following. That is, as in the invention of claim 5, the support member is detachably attached to the arm, the attachment / detachment connecting portion is provided on the arm, the connected portion is provided on the support member, and the connected portion is provided on the pair of arms. It is provided in each operation part, and it is provided so that a to-be-connected part to a connection part can be selected.

The connection structure of the connecting part and the connected part does not matter. However, in the case where a plurality of connected parts are provided on the arm, if the connected part that is not attached to the connecting part protrudes from the arm, there is a risk of adversely affecting the grasping of the operator. In order to prevent such adverse effects, it is desirable to do the following. That is, as in the invention of claim 6, the connecting portion is a male screw and the connected portion is a female screw hole.

According to the first and second aspects of the invention, the surgeon can stably hold the medical microsurgical instrument by holding the supporting member protruding from one arm between the index finger and the middle finger. Therefore, the surgeon can concentrate on the opening / closing movement of the tip part with the thumb feeling and fingertip movement pushing the other arm. As a result, it is possible to drastically reduce the tremor of the surgeon, etc., perform precise surgical operations under a microscope, and expect good surgical results. In addition, the ability to hold the medical microsurgical instrument stably and stably enables more accurate fingertip movement, especially when using a hand opposite to the dominant hand or a person who has little experience with surgery. I can expect.

According to the invention of claim 3, since the shape of the support member is specified, the surgeon can easily hold the support member between the index finger and the middle finger.

According to the invention of claim 4, since the support member can be attached to and detached from the arm and the attachment location can be selected, the operator can change the position of the support member and the usability is improved.

According to the fifth aspect of the present invention, since the detachable coupled portions are respectively provided on the pair of arms, the support member is sandwiched between the index finger and the middle finger of the gripped hand, even when gripped by either the right hand or the left hand. be able to.

According to the invention of claim 6, since the connected portion is a female screw hole, the connected portion does not protrude from the surface of the arm. Therefore, the connected portion to which the connecting portion is not attached is not disturbed when the grip portion is gripped by the fingertip, and is easy to use.

It is a perspective view which shows the use condition of 1st embodiment in the medical microsurgical instrument of this invention. It is a disassembled perspective view which shows 1st embodiment in the medical microsurgical instrument of this invention. It is a perspective view which shows 2nd embodiment in the medical microsurgical instrument of this invention. It is a perspective view including a partially enlarged front view showing a third embodiment of the medical microsurgical instrument of the present invention. It is an excerpt of a catalog showing a conventional Hakuba cervical spreader. It is an excerpt of a catalog showing a conventional steele Ruskin round chisel forceps.

1 and 2 show a straight type tweezer 1 for surface layer operation, more specifically, a micro tweezer 1 as a first embodiment of the medical microsurgical instrument of the present invention. The micro tweezers 1 includes a pair of

arms

2 and 3 and a support member 4 detachably attached to one arm 2.

Each

arm

2, 3 is a thin plate (plate spring) that can be elastically deformed, and is curved in the thickness direction. The pair of

arms

2 and 3 are provided to face each other, and are integrated at the end portions of each other, and at portions other than the end portions (portions on the tip side with respect to the end portions), they are outside each other. Curved and thereby spaced apart. The space | interval which is spaced apart approaches by gripping a pair of

arms

2 and 3 with a fingertip against elasticity (force of a leaf | plate spring).

The

grip portions

21 and 31 gripped by the fingertips in this way are the rear portions of the pair of

arms

2 and 3. In the example shown in the figure, three connected portions (female screw holes) 22 are formed in the grip portion 21 of one arm 2 at intervals along the longitudinal direction thereof. The female screw hole 22 penetrates in the thickness direction. A support member 4 is selectively and detachably attached to the female screw holes 22.

The support member 4 has a rod shape and is provided with a connecting portion (male screw 41) at one end thereof. The support member 4 attached to one arm 2 protrudes in a direction away from the other arm 3. The support member 4 has a columnar shape, and the optimum projection length is 2 to 3 cm and 2.5 cm. Further, the thickness is narrower than that of a human finger, more specifically, it is narrower than the plate width of the arm 2, and the specific value is a diameter of 2 to 5 mm or 3 mm.

The micro tweezers 1 described above are used as shown in FIG. While holding the end portions of the

arms

2 and 3 of the micro tweezers 1 on the upper side of the base of the index finger, the support member 4 is sandwiched between the first joint of the index finger and the middle finger, and the fingertip of the middle finger is gripped by the arm 2 on the back side in the figure The micro tweezers 1 can be held by pressing against the surface of the portion 21. If it does so, the adjustment of the force which presses a thumb with respect to the holding part 31 of the arm 3 on the near side in the figure can be assigned only to the delicate opening / closing movement with respect to the tip parts of the pair of

arms

2 and 3. By adjusting the amount of force for gripping both gripping

portions

21 and 31 in such a usage pattern, the distance between the pair of

arms

2 and 3 approaches and separates, and the tip portion can be opened and closed. The surgeon may change the mounting position of the support member 4 with respect to one arm 2 according to his / her preference.

FIG. 3 shows a bionet-type needle holder 11 for deep operation as a second embodiment of the medical microsurgical instrument of the present invention. In the illustrated example, a support member 4 is attached to the arm 2 on the right hand side. Female screw holes 22 and 32 are respectively provided in the

gripping portions

21 and 31 of the pair of

arms

2 and 3 so that the support member 4 can be attached to both the right and left

arms

2 and 3. The needle holder 11 also has a support member 4 detachably attached to one arm 2 in the same manner as the microtweezers 1 of the previous example. In the case of the needle holder 11, the position where the pair of

arms

2 and 3 are integrated is provided not only at the end portions of each other but also slightly behind the tip portion. That is, the pair of

arms

2 and 3 intersect each other slightly behind the tip, and the shaft 5 is attached to the intersecting portion. And the front-end | tip part opens and closes centering on the axis | shaft 5 by strengthening or weakening the force which grips a pair of holding

parts

21 and 31. FIG. Non-slip irregularities are formed on the surfaces of the

grip portions

21 and 31. The

arms

2 and 3 are thinner at the rear portions than the

grip portions

21 and 31, and these portions are elastically deformable portions (plate springs).

FIG. 4 shows a bionet-type clip forceps 12 for deep operation as a third embodiment of the medical microsurgical instrument of the present invention. The clip forceps 12 has the same opening / closing structure as the needle holder 11 of the second embodiment. In addition, arc-shaped

depressions

23 and 33 are provided on the opposing surfaces of the tip portions of the pair of

arms

2 and 3, respectively. In addition,

claw pieces

24 and 34 protrude from opposite surfaces of the rear portions of the pair of

arms

2 and 3, respectively.
The clip 6 gripped by the clip forceps 12 forms a circular loop portion 61 by bending one metal spring, and

leg portions

62 and 63 extend from both ends of the loop portion 61, respectively. The pair of

leg portions

62 and 63 intersect at a position slightly away from the loop portion 61 and usually overlap in parallel from the intersecting portion to the tip due to the spring property.
When the surgeon grasps the pair of

arms

2 and 3 and closes the tip portions, the tip portions of the pair of

nail pieces

24 and 34 are locked (hooked), so that both

arms

2 and 3 The closed state of the tip portion is maintained, the opposing

depressions

23 and 33 are narrowed, and the loop portion 61 of the clip 6 is sandwiched therebetween. By a series of these operations, the pair of

legs

62 and 63 of the clip 6 are opened.
Then, when the surgeon holds the pair of

arms

2 and 3 deeply, the engagement between the tip portions of the pair of

nail pieces

24 and 34 is released. Then, when the surgeon loosens the grip, the tip portions of the pair of

arms

2 and 3 are in an open state, the interval between the opposing

depressions

23 and 33 is widened, and the loop portion 61 is released between the two. By a series of these operations, the pair of

legs

62 and 63 are closed, for example, a cerebral aneurysm is sandwiched, and hemostasis / treatment is completed. Thereafter, the operator moves the clip forceps 12 and leaves the clip 6 in the brain.

1 to FIG. 4 are not limited to the tweezers 1, the needle holder 11, and the clip forceps 12, and the usage method of the medical micro surgical instrument is the same. That is, the method of use projects from one arm 2 between two of the four fingers other than the thumb in one hand (more preferably, between the index and middle fingers of one hand (between the first joints depending on the surgeon)). By holding the supporting member 4 to be held, the medical micro surgical instrument is held, and the force applied to press the thumb of the same hand against the grip portion 31 of the other arm 3 is delicately applied to the distal ends of the pair of

arms

2 and 3. It can be assigned only to opening and closing movements.

The present invention is not limited to the above embodiment. For example, the medical microsurgical instrument is not limited to the tweezers 1, the needle holder 11, and the clip forceps 12, but may be a surgical instrument under a microscope that is gripped by a cutting blade, a bipolar coagulation hemostatic hemostasis, or other fingertips (not shown). . Further, as described in the section of means for solving the problem, it is possible to appropriately change the shape and the like within a range not changing the gist of the present invention.

1 tweezers 2 arm 11 needle holder 12 clip forceps 21 gripping part 22 female screw hole (connected part)
23 depression 24 claw piece 3 arm 31 gripping part 32 female screw hole 33 depression 34 claw piece 4 support member 41 male screw (connection part)
5 axis 6 clip 61 loop part 62 leg part 63 leg part

Claims

A pair of elastically deformable arms are provided facing each other, and their tip portions are provided so as to be openable and closable, and are integrated on the rear side of the tip portions, and are configured as gripping portions that grip the rear portions of the pair of arms with a fingertip. In the medical microsurgical instrument in which the gap between the pair of arms can be approached and separated in the gripping part,
The grip portion of one arm is provided with a support member on the surface side,
The medical microsurgical instrument, wherein the support member can be sandwiched between the index finger and the middle finger and protrudes in a direction away from the other arm.
The medical microsurgical instrument according to claim 1, wherein the instrument is a microsurgical instrument held by a fingertip, a tweezer, a needle holder, a cutting blade, a clip forceps, a bipolar coagulation hemostasis insulator or the like.
3. The medical microsurgical instrument according to claim 1 or 2, wherein the medical microsurgical instrument is rod-shaped and has a thickness smaller than the thickness of the finger and a protruding length from the arm equal to or greater than the thickness of the finger.
A support member is detachably attached to the arm,
A connecting part for attachment and detachment is provided on the arm, and a connected part is provided on the support member,
The connected part with respect to a connection part is provided in the operation part of an arm at intervals along the longitudinal direction, and the connection part with respect to a connection part is provided so that selection is possible. Medical microsurgical instrument.
A support member is detachably attached to the arm,
A connecting part for attachment and detachment is provided on the arm, and a connected part is provided on the support member,
The connected parts are provided in the operation parts of the pair of arms,
The medical microsurgical instrument according to claim 1, 2, or 3, wherein a connected portion with respect to the connecting portion is selectable.
6. The medical microsurgical instrument according to claim 4 or 5, wherein the connecting portion is a male screw and the connected portion is a female screw hole.