U.S. patent application number 09/439760 was filed with the patent office on 2001-11-22 for tissue excision and cutting apparatus and its forceps.
This patent application is currently assigned to William L. Androlia. Invention is credited to NIIZEKI, RYUICHIRO, TATSUMI, MASAYA.
Application Number | 20010044635 09/439760 |
Document ID | / |
Family ID | 26419500 |
Filed Date | 2001-11-22 |
United States Patent
Application |
20010044635 |
Kind Code |
A1 |
NIIZEKI, RYUICHIRO ; et
al. |
November 22, 2001 |
TISSUE EXCISION AND CUTTING APPARATUS AND ITS FORCEPS
Abstract
A tissue excision and cutting apparatus used by inserted into a
trocar for cutting off a part of tissue as a sample piece for such
a diagnosis in a laparoscopic surgery or the like. The apparatus
comprises a resection blade having an inner hollow cylinder with a
cutting blade at its tip end, and a forceps having at its tip end a
clamp having a movable jaw capable of opening and closing which is
joined to a fixed jaw with a chopping block piece, open-close
mechanism having an operation part for opening and closing the
movable jaw, and a longitudinal penetrating passage into which the
resection blade is inserted and moves back and forth therein.
Inventors: |
NIIZEKI, RYUICHIRO; (KYOTO,
JP) ; TATSUMI, MASAYA; (KYOTO, JP) |
Correspondence
Address: |
KODA & ANDROLIA
2029 CENTURY PARK EAST, SUITE 3850
LOS ANGELES
CA
90067
US
|
Assignee: |
William L. Androlia
|
Family ID: |
26419500 |
Appl. No.: |
09/439760 |
Filed: |
November 15, 1999 |
Current U.S.
Class: |
606/205 |
Current CPC
Class: |
A61B 17/1611 20130101;
A61B 17/295 20130101; A61B 17/32053 20130101; A61B 2017/320775
20130101; A61B 17/320016 20130101; A61B 10/0096 20130101; A61B
10/06 20130101 |
Class at
Publication: |
606/205 |
International
Class: |
A61B 017/28 |
Foreign Application Data
Date |
Code |
Application Number |
Nov 20, 1998 |
JP |
10-331358 |
Mar 23, 1999 |
JP |
11-78436 |
Claims
1. A tissue excision and cutting apparatus used by inserted into a
trocar for cutting off a part of tissue for sampling in a
laparoscopic surgery or the like comprising: a resection blade
having an inner hollow cylinder body formed with a cutting blade at
its tip end, and a forceps for cutting off a part of tissue as a
sample piece, said forceps having a clamp for grasping a part of
tissue to be cut off, said clamp having a movable jaw capable of
opening and closing which is joined to a fixed jaw with a chopping
block piece, an open-close mechanism with an operation part for
opening and closing said movable jaw, and a longitudinal
penetrating passage into which said resection blade is inserted and
moves back and forth therein.
2. A tissue excision and cutting apparatus used by inserted into a
trocar for cutting off a part of tissue for sampling in a
laparoscopic surgery or the like comprising: a resection blade
having an inner hollow cylinder body formed with a cutting blade at
its tip end, said resection blade being driven by a rotary driving
mechanism, and a forceps for cutting off a part of tissue as a
sample piece, said forceps having a clamp for grasping a part of
tissue to be cut off, said clamp having a movable jaw capable of
opening and closing which is joined to a fixed jaw with a chopping
block piece, an open-close mechanism with an operation part for
opening and closing said movable jaw, and a longitudinal
penetrating passage into which said resection blade is inserted and
moves back and forth therein.
3. The tissue excision and cutting apparatus as set forth in claim
1 or 2, wherein said operation part of said the open-close
mechanism is constructed such that it can be held by one hand and
said movable jaw can be opened and closed by manual operation of
said one hand.
4. The tissue excision and cutting apparatus as set forth in claim
1 or 2, wherein said chopping block piece is formed with a blade
receiving surface so as to contact with the whole circumference of
said blade of resection blade.
5. The tissue excision and cutting apparatus as set forth in claim
1 or 2, wherein said passage is at the rear end provided with an
insertion opening for said resection blade and wherein said
insertion opening is further provided with a sealing valve
mechanism for isolating ventilation into the open air even when
said resection blade is put in and out.
6. The tissue excision and cutting apparatus as set forth in claim
5, wherein said sealing valve mechanism is detachable and
exchangeable for said insertion opening.
7. The tissue excision and cutting apparatus as set forth in claim
1 or 2, wherein said resection blade further comprises a sealing
rod for airtightly sealing the inner of said hollow cylinder body
of said resection blade and a push shaft for outwardly extruding a
part of tissue which is cut off by said blade and held in said
hollow cylinder body as a sample piece, by being airtightly
inserted into said cylinder body from a push hole provided at the
rear end of said sealing rod.
8. The tissue excision and cutting apparatus as set forth in claim
1 or 2, wherein said resection blade further comprises a sealing
push rod which is airtightly inserted into said hollow cylinder
body from an insertion opening provided at the rear end of said
cylinder body, and a simple suction means connected to said sealing
push rod for keeping said inner portion of said hollow cylinder
body airtight condition to hold the cut off tissue as a sample
piece by said resection blade in said cylinder body.
9. The tissue excision and cutting apparatus as set forth in claim
1 or 2, wherein said resection blade further comprises a sealing
suction rod into which a sealing suction mechanism is incorporated,
said sealing suction rod airtightly sealing the inner portion of
said resection blade and keeping airtight condition in the inner
portion of said cylinder body to hold the cut off tissue as a
sample piece by said resection blade, and a push rod for outward
extruding a part of tissue cut off by said resection blade and held
in said hollow cylinder body as a sample piece, by being airtightly
inserted into said hollow cylinder body from a push hole provided
at the rear end of said sealing suction rod.
10. The tissue excision and cutting apparatus as set forth in claim
1 or 2, wherein said resection blade further comprises a suction
sampling collecting means detachably connected to the rear end of
said hollow cylinder for sucking to collect the cut off tissue as a
sample piece by said resection blade.
11. The tissue excision and cutting apparatus as set forth in claim
1 or 2, wherein said resection blade is in an inner surface
adjacent to its tip end provided with a holding craw for preventing
dropping out of the cut off tissue as a sample piece by said
resection blade.
12. A forceps used together with a resection blade which is
inserted into a trocar for cutting off a part of tissue for
sampling in a laparoscopic surgery or the like comprising: a clamp
provided at a tip end having a movable jaw capable of opening and
closing which is jointed to a fixed jaw with a chopping block
piece, an open-close mechanism with an operation part for opening
and closing said movable jaw, and a longitudinal penetrating
passage into which said resection blade is inserted and moves back
and forth therein.
13. The forceps as set forth in claim 12, wherein said operation
part of said open-close mechanism is constructed such that it can
be held by one hand and said movable jaw can be opened and closed
by manual operation of said one hand.
14. The forceps as set forth in claim 12, wherein said chopping
block piece is formed with a blade receiving surface so as to
contact with the whole circumference of said blade of resection
blade.
15. The forceps as set forth in claim 12, wherein said passage is
at rear end provided with an insertion opening for said resection
blade and wherein said insertion opening is further provided with a
sealing valve mechanism for isolating ventilation of the open air
even when said resection blade is put in and out.
16. The forceps as set forth in claim 5, wherein said sealing valve
mechanism is detachable and exchangeable for said opening.
Description
FIELD OF THE INVENTION
[0001] The present invention relates to a newly developed tissue
excision and cutting apparatus and resection forceps for cutting
off a part of human tissue as a sample piece for such a diagnosis
in laparoscopic surgery or the like.
PRIOR ART
[0002] A tissue excision and cutting apparatus for surgical
operation has been -used together with a forceps and a laparoscope
and various kinds of such related apparatuses have been proposed
till up now.
[0003] One example has a cylindrical resection blade rotated by a
motor in a guide cylinder to be inserted into a trocar, and forceps
for grasping an objective tissue inserted into the resection
blade.
[0004] FIGS. 20a to 20c show how to use the tissue excision and
cutting apparatus of prior art and the forceps to be combined
therewith.
[0005] A tissue excision and cutting apparatus 101, as shown in
FIG. 20a, comprises a main body 103 with grip portion, a guide
cylinder 102a to be inserted into a trocar (not shown), and a
resection blade 102b with a blade at its tip end which is driven to
be rotated in the guide cylinder 102a by a motor (not shown).
[0006] On the other hand, a forceps 104 to be combined with the
tissue excision and cutting apparatus 101 in such a manner as shown
in FIG. 20(a) has a main axis 104a with at its tip end a clamp 104b
which can be opened and closed by manual operation of one hand.
[0007] According to such a tissue excision and cutting apparatus
101, while observing around the tip end of the tissue excision and
cutting apparatus 101 inserted into the trocar by a laparoscope
(not shown), a tissue A may be grasped by the clamp 104b of the
forceps 104 by approaching the forceps to the tissue A, after then
the forceps 104 is withdrawn into the guide cylinder 102a in the
state of grasping tissue A to bring it into contact with the blade
of rotating resection blade 102b, by which a part of tissue A can
be cut off as a sample piece (See FIGS. 20a to 20c).
[0008] FIG. 21 shows a tissue excision and cutting apparatus
according to the prior art in which a forceps and a resection blade
are integrated wherein FIG. 21a illustrates a front view of its
partial vertical section and FIG. 21b its rear view.
[0009] A tissue excision and cutting apparatus 111, as shown in
these figures, comprises a tissue cutting resection blade 112
composed of a cylindrical blade 112b and a guide cylinder 112a, a
main body 113 with a grip 113a and holing portion 113b for the
forceps 114, a forceps 114 itself, a forceps withdrawing mechanism
115 with a trigger 115a for finger operation, a forceps open-close
mechanism 116 with a finger operation part 116a, and a motor 118
for rotating the blade 112b.
[0010] In this figure, turning operational direction of the
open-close finger operation part 116a is shown as an arrow
corresponding to open and close operations of the clamp 114b
wherein opening direction is shown as an actual line and closing
direction is shown as a dotted line, whereas sequential pulling
operation of the trigger 115a is also shown by an arrow
corresponding to with drawing operation of the forceps.
[0011] According to such a tissue excision and cutting apparatus
111, operating a laparoscope (not shown) by a left hand while
observing objective tissue with the apparatus 111 held by a right
hand, and advancing the forceps 114 to the objective tissue, where
the open-close operation part 116a is turned in a closing direction
by a thumb C of the right B hand as shown in a dotted line in FIG.
21(b), thus enabling to grasp the objective tissue by the clamp
114b of the forceps 114.
[0012] After grasping the tissue A, the motor 118 is driven to
rotate resection blade 112b and the trigger 115a is repeatedly
operated by a forefinger D of the right hand B, thereby cutting off
tissue A by the resection blade 112b in cylindrical shape. And the
apparatus is so constructed that tissue thus grasped is prevented
from dropping out even if the thumb C is departed from the
open-close operation part 116a.
[0013] According to the tissue excision and cutting apparatus 111
described above, comparing to the one shown in FIG. 20, the forceps
can be operated by a thumb C and retraction can be executed by a
forefinger D, with its main body held only by one hand, thus
enabling another hand to operate a laparoscope or the like.
[0014] In any of above-mentioned tissue excision and cutting
apparatus of the prior art, tissue is drawn into a guide cylinder
and cut off therein while rotating a resection blade. Therefore, in
such a method, tissue would not be sharply or finely cut off.
[0015] In other words, in such a method tissue is apt to be torn
off and partly broken when tissue is drawn into the guide cylinder
to be cut off so that it makes difficult to surely and sharply cut
off the tissue, or the part of tissue could not be cut off
well.
[0016] In addition, in such a prior tissue excision and cutting
apparatus, the resection blade is exposed from a guide cylinder
when tissue is cut off. Therefore, there would be a fear that organ
not to be cut off or an end-bag (explained hereinafter referring to
FIG. 6 to FIG. 9) used for laparoscopic surgery happens to be
damaged.
SUMMARY OF THE INVENTION
[0017] The present invention has proposed to solve the
abovementioned problems.
[0018] Accordingly, it is the primary object of the invention to
provide a tissue excision and cutting apparatus which can finely
and sharply cut off an objective tissue and a resection forceps to
be used for the apparatus.
[0019] It is another object to provide a tissue excision and
cutting apparatus which doesn't have such a fear and a forceps used
for the apparatus.
[0020] In the present invention, a tissue excision and cutting
apparatus used by inserted into a trocar for cutting off a part of
tissue for sampling in laparoscopic surgery or the like comprises a
resection blade with an inner hollow cylinder body having a cutting
blade at its tip end, and a forceps for cutting off a part of
tissue to be cut off as a sample piece.
[0021] The forceps has at its tip end a clamp for grasping a part
of tissue which has a movable jaw capable of opening and closing
and is joined to a fixed jaw vertically provided with a chopping
block piece, an open-close mechanism with a hand operation part for
opening and closing by manual operation, and a longitudinal
penetrating passage into which the resection blade is inserted and
moves back and forth therein.
[0022] The tissue excision and cutting apparatus is constructed
such that resection blade and the forceps are combined with when
using it.
[0023] The apparatus is characterized in that the penetrating
passage of the forceps is constructed such that the resection blade
is inserted into and moves back and forth therein and one of the
clamp of the forceps is a fixed jaw provided at its chip end with a
chopping block piece servicing as a stopper plate for the blade of
resection blade. The chopping block piece functions as the so
called chopping block for the blade of the resection blade, thereby
enabling to cut off an objective tissue by pressing it in such
manner as not in the prior pull-in-type tissue excision and cutting
apparatus, thus any of tissues can be finely and surely cut
off.
[0024] In addition, in the apparatus, other organ or an endo-bag
isn't damaged because the resection blade is contained and hidden
in the clamp of the forceps, thereby achieving safety.
[0025] If the shape of a part where the resection blade is
contacted is contrived, tissue can be cut off not only by pressing
on the resection blade a chopping block piece but also by shearing
the resection blade and the chopping block piece. For example, when
the chopping block piece is normally formed as such cylindrical
shape that it has an inner diameter in which the outer diameter of
cylindrical blade of the resection blade is just engaged, tissue
can be sheared to be cut off by cylindrical shape, or the chopping
block piece and the resection blade.
[0026] In other embodiment of the present invention, a tissue
excision and cutting apparatus used by inserted into a trocar for
cutting off a part of tissue for sampling in laparoscopic surgery
or the like comprises a resection blade with an inner hollow
cylinder body having a cutting blade at its tip end, and a forceps
for cutting off a part of tissue as a sample piece wherein the
resection blade is capable of rotating by driving a rotary driving
mechanism and the forceps has at its tip end a clamp for grasping a
part of tissue to be cut off which has a movable jaw capable of
opening and closing and is joined to a fixed jaw vertically
provided with a chopping block piece, an open-close mechanism with
a hand operation part for opening and closing by manual operation,
and a longitudinal penetrating passage into which the resection
blade is inserted and moves back and forth therein.
[0027] According to such a tissue excision and cutting apparatus,
the resection blade is capable of rotating by a rotary driving
mechanism comprised of a motor by operating a switching means such
a foot pedal or the like. Therefore, tissue can be cut off and
sampled more smoothly.
[0028] Further in another tissue excision and cutting apparatus of
the present invention, the hand operation part of the forceps is
constructed such that it can be held by one hand and the movable
jaw can be operated by the one hand. Therefore, the apparatus is
very convenient for handling because forceps can be held and
manually operated by one hand while the resection blade can be
operated by another hand.
[0029] Further in other embodiment of the present invention, a
chopping block piece of the resection blade is formed with a blade
receiving surface on which the whole circumference of the blade
contacts.
[0030] According to such construction, cut end of tissue by the
resection blade can be done sharply and finely by pressing the
blade of the resection blade onto the surface.
[0031] In still another embodiment of the invention, a sealing
mechanism for airtightly sealing the penetrating passage is further
provided for isolating ventilation of the open air even when the
forceps is inserted into the passage or is pulled out from the
passage.
[0032] According to such construction, outer air is prevented from
entering in abdominal cavity or the endo-bag through the
penetrating passage or especially pneumoperitoneum gas is prevented
from leaking out when being filled in the endo-bag.
[0033] In other embodiment of the invention, the sealing valve
mechanism is detachable and exchangeable for the penetrating
passage.
[0034] Therefore, used it is very useful for preventing
contamination or contagion since it can be easily exchanged every
time the forceps is used.
[0035] In still other embodiment of the invention, the resection
blade further comprises a sealing rod for airtightly sealing the
inner of the hollow cylinder body and a push shaft for outward
extruding a part of tissue cut off and held in the hollow cylinder
body as a sample piece which is airtightly inserted into the
cylinder body from a push hole provided at the rear end of the
sealing rod.
[0036] According to such tissue excision and cutting apparatus, the
inner of the hollow cylinder body of the resection blade can be
kept airtight by the sealing rod and the push rod so that the
tissue cut off as a sample piece is prevented from dropping out
from the hollow cylinder body even when the tip of the resection
blade is directed downward for extracting the resection blade from
the forceps. And the cut off tissue held in the hollow cylinder
body can be easily extruded by releasing the sealing and pushing
the push shaft into the inner of the hollow cylinder after when the
resection blade is moved to a predetermined place.
[0037] In other embodiment of the invention, the resection blade
further comprises a sealing push rod airtightly inserted into the
hollow cylinder body from an insertion opening provided at the rear
end of the cylinder body, and a simple suction means which is
connected to the sealing push rod for keeping the inner portion of
the hollow cylinder body airtight to hold a part of tissue cut off
by the resection blade.
[0038] According to such tissue excision and cutting apparatus, the
cut off tissue as a sample piece held in the hollow cylinder body
can be surely prevented from dropping out by effecting sucking
force by means of the simple suction means. Further, the cut off
tissue held in the hollow cylinder body can be easily extruded
outward by releasing the sucking force and pushing a sealing push
rod into the hollow cylinder body after moving to a predetermined
place.
[0039] In still further other embodiment of the tissue excision and
cutting apparatus, the resection blade further comprises a sealing
suction rod into which a sealing suction mechanism is incorporated
and a push rod for outward extruding the tissue cut of f and held
in the hollow cylinder body as a sample piece wherein the sealing
suction rod airtightly seals the inner portion of the hollow
cylinder and holds the tissue by keeping airtight, and the push rod
is airtightly inserted in the hollow cylinder body from a push hole
provided at the rear end of the sealing suction rod.
[0040] According to such tissue excision and cutting apparatus, the
cut off tissue as a sample piece held in the hollow cylinder body
can be surely prevented from dropping out by effecting sucking
force by means of the simple suction means. Further, the cut of f
tissue held in the hollow cylinder body can be easily extruded
outward by releasing the sucking force and pushing a sealing push
rod into the hollow cylinder body after moving to a predetermined
place. In addition, it is more convenient to handle it because
sealing suction rod and a sealing suction mechanism are
incorporated into the resection blade together.
[0041] In other embodiment of the tissue excision and cutting
apparatus, the resection blade further comprises a suction sampling
collecting means which is detachably connected to the rear end of
the hollow cylinder body for sucking and collecting a part of
tissue cut off as a sample piece by the resection blade.
[0042] According to such a tissue excision and cutting apparatus,
since the suction sampling collecting means sucks to collect by
effecting active suction force instead of keeping airtight in the
hollow cylinder body, the cut off tissue can be easily and
sequentially suck and collected in the sampling collecting
means.
[0043] In other embodiment of the tissue excision and cutting
apparatus, a holding craw similar to thorn is provided in inner
surface adjacent to the tip end of resection blade for preventing
dropping out the tissue cut off as a sample piece by peripherally
and partially holding it.
[0044] In the present invention, a forceps used together with the
present apparatus has been also proposed, wherein the forceps
comprises a clamp provided at a tip end of the forceps and having a
movable jaw capable of opening and closing which is joined to a
fixed jaw provided with a chopping block piece, an open-close
mechanism with a hand operation part for opening and closing the
movable jaw, and a longitudinal penetrating passage into which the
resection blade is inserted and moves back and forth therein.
[0045] Such a forceps is the one used for the tissue excision and
cutting apparatus of the present invention, and accordingly a part
of tissue can be finely and surely cut off.
[0046] When such a forceps is used, any kinds of resection blade
which are rotatable or not rotatable can be also employed and a
chopping block piece may serve as the so called a cutting
board.
[0047] According to other embodiment of the forceps, the operation
part of the forceps is constructed such that it can be held by one
hand and the movable jaw can be operated for opening and closing by
manual operation of the one hand.
[0048] Further in another tissue excision and cutting apparatus of
the present invention, the operation part of the forceps is
constructed such that it can be held by one hand and the movable
jaw can be operated by the one hand. Therefore, the apparatus is
very convenient for handling because forceps can be held and
manually operated by the same one hand while the resection blade
can be operated by another hand.
[0049] Therefore, it is easy and convenient to handle such a
forceps because it can be opened and closed and held the same one
hand with another hand operating a resection blade.
[0050] Further in other embodiment of the present invention, a
chopping block piece of the resection blade is formed with a blade
receiving surface on which the whole circumference of the blade
contacts.
[0051] According to such construction, a part of tissue grasping by
the clamp can be sharply and finely cut off by pressing the blade
of the resection blade onto the surface, by which a sample piece of
tissue with a sharp cut end can be obtained.
[0052] Still another embodiment of the invention, a sealing
mechanism for airtightly sealing the penetrating passage is further
provided for isolating ventilation of the open air even when the
forceps is inserted into the passage or is pulled out from the
passage.
[0053] According to such construction, outer air is prevented from
entering in abdominal cavity or the endo-bag through the
penetrating passage and especially pneumoperitoneum gas is well
prevented from leaking out when being filled in the endo-bag.
[0054] In other embodiment of the invention, the sealing valve
mechanism is detachable and exchangeable for the penetrating
passage.
[0055] Therefore, according to such construction, it is very useful
for preventing contamination or contagion since it can be easily
exchanged every time the forceps is used.
BRIEF DESCRIPTION OF DRAWINGS
[0056] These and other objects and advantages of the present
invention will become clear from the following description with
reference to the accompanying drawings, wherein:
[0057] FIG. 1 is a partially cutaway front view showing one
embodiment of a tissue excision and cutting apparatus of the
present invention.
[0058] FIG. 2 is a perspective view of a clamp of a tissue excision
and cutting apparatus of the present invention.
[0059] FIG. 3(a) is a partial cutaway front view when the clamp is
opened according to a tissue excision and cutting apparatus of the
present invention.
[0060] FIG. 3(b) is a partial cutaway front view when it is closed
according to a tissue excision and cutting apparatus of the present
invention.
[0061] FIG. 4(a) is a vertical section when tissue is cut and
[0062] FIG. 4(b) is a vertical section after tissue is cut.
[0063] FIG. 5(a) shows a vertical section when tissue is cut
according to a tissue excision and cutting apparatus of the present
invention.
[0064] FIG. 5(b) shows a vertical section after tissue is cut
according to a tissue excision and cutting apparatus of the present
invention.
[0065] FIG. 6 is an explanatory view showing sampling procedure 1
for tissue sample by means of the tissue excision and cutting
apparatus of the present invention.
[0066] FIG. 7 is an explanatory view showing sampling procedure 2
for tissue sample by means of the tissue excision and cutting
apparatus of the present invention.
[0067] FIG. 8 is an explanatory view showing sampling procedure 3
for tissue sample by means of the tissue excision and cutting
apparatus of the present invention.
[0068] FIG. 9 is an explanatory view showing sampling procedure 4
for tissue sample by means of the tissue excision and cutting
apparatus of the present invention.
[0069] FIG. 10 is an explanatory view showing sampling procedure 5
for tissue sample by means of the tissue excision and cutting
apparatus of the present invention.
[0070] FIG. 11 is a partial cutaway front view showing one
embodiment of a tissue excision and cutting apparatus of the
present invention combined with a rotatable resection blade.
[0071] FIG. 12(a) is a front view of a partial vertical section
according to a tissue excision and cutting apparatus of another
embodiment of the present invention.
[0072] FIG. 12(b) is a fragmental view in the direction of the
arrow X according to a tissue excision and cutting apparatus of
another embodiment of the present invention.
[0073] FIG. 13(a) shows when the sealing mechanism is loaded
according to a tissue excision and cutting apparatus of the present
invention.
[0074] FIG. 13(b) shows after it is loaded, and
[0075] FIG. 13(c) shows when the resection blade or the rotatable
resection blade is inserted according to a tissue excision and
cutting apparatus of the present invention.
[0076] FIG. 14(a) is its front view according to a tissue excision
and cutting apparatus of the present invention.
[0077] FIG. 14(b) is a partial vertical section according to a
tissue excision and cutting apparatus of the present invention.
[0078] FIG. 15 is an external front view of one embodiment of a
rotatable resection blade provided with holding craw as shown in
FIG. 14.
[0079] FIG. 16(a) is its front view according to a tissue excision
and cutting apparatus of the present invention.
[0080] FIG. 16(b) is its partial vertical section according to a
tissue excision and cutting apparatus of the present invention.
[0081] FIG. 17 is a partial vertical section explaining operation
of one embodiment of a sealing rod used for a resection blade or a
rotatable resection blade of the present invention.
[0082] FIG. 18(a) is a partial vertical section before tissue is
cut according to a tissue excision and cutting apparatus of the
present invention.
[0083] FIG. 18(b) is a partial vertical section after tissue is cut
according to a tissue excision and cutting apparatus of the present
invention.
[0084] FIG. 18(c) is a partial vertical section when a tissue
sample is suck and held according to a tissue excision and cutting
apparatus of the present invention.
[0085] FIG. 19(a) to FIG. 19(f) explain operation of a suction and
sampling means used for a resection blade or a rotatable resection
blade of the present invention.
[0086] FIGS. 20(a), (b), (c) show one usage of a tissue excision
and cutting apparatus and a forceps of the prior art.
[0087] FIG. 21(a) is a front view of a partial vertical section a
tissue excision and cutting apparatus integrated with a forceps
according to the prior art.
[0088] FIG. 21(b) is its rear view of a tissue excision and cutting
apparatus integrated with a forceps according to the prior art.
DETAILED DESCRIPTION OF THE INVENTION
[0089] Now embodiments of tissue excision and cutting apparatus
will be explained referring to the drawings.
[0090] FIG. 1 is a partially cutaway front view of one embodiment
of a tissue excision and cutting apparatus of the present
invention.
[0091] A tissue excision and cutting apparatus comprises a
resection blade 7 having an inner hollow cylinder body formed with
a cutting blade 7a at its tip end, and a forceps 6 for cutting off
a part of tissue A as a sample piece.
[0092] The forceps 6 has a clamp 3 for grasping a part of tissue A
in which the clamp has a movable jaw 3b capable of opening and
closing joined to a fixed jaw 3a with a chopping block piece 2, an
open-close mechanism 5 with an operation part 5a for opening and
closing the movable jaw 3b, and a longitudinal penetrating passage
4 into which the resection blade 7 is inserted and moves back and
forth therein.
[0093] The chopping block piece 2 is a characteristic of the tissue
excision and cutting apparatus 1, is vertically provided at the
fixed jaw 3a in such manner it intercepts the penetration passage 4
as a stopper of the resection blade 7 to be inserted into the
longitudinal penetrating passage 4 for cutting tissue A, and works
as so called a cutting board.
[0094] The fixed jaw 3a is provided normally at one end of a
forceps cylinder 4a with the longitudinal penetrating passage 4
therein, and the movable jaw 3b is joined to the fixed jaw 3a by a
hinge 3c so as to be pivotally opened and closed. The fixed jaw 3a,
the movable jaw 3b and the hinge 3c construct the clamp 3. These
parts will be detailed hereinafter.
[0095] The longitudinal penetrating passage 4 is constructed with a
cylindrical body as the forceps cylinder 4a and the open-close
mechanism 5, which will be also explained hereinafter, is provided
in the forceps cylinder 4a and on the opposite side of the fixed
jaw 3a in such a manner as to form the longitudinal penetrating
passage 4. The operation part 5a for holding the tissue excision
and cutting apparatus 1 by one hand and for opening and closing the
movable jaw 3b is provided at a back end of the open and close
mechanism 5 in such a manner that it directs approximately normally
to the longitudinal direction of the forceps cylinder 4a.
[0096] The resection blade 7 is comprised of a cylinder body 7b
formed with the cylindrical blade 7a at its one end and a holding
portion 7c for holding the resection blade 7 at its periphery of
the other end, and is so constructed as to contain cut off tissue
as a sample piece Ac at its tip of the hollow cylinder.
[0097] At the back end of the resection blade is provided a sealing
rod 8 for airtightly sealing the inner portion of hollow cylinder
body and a push rod 9 for extruding the cut of f tissue as a sample
piece Ac by being airtightly inserted into the hollow cylinder body
from a push hole (not shown) provided at the back end of the
sealing rod 8.
[0098] The sealing rod 8 and the push rod 9 are detachable on the
resection blade 7 if necessary and they will be explained
hereinafter.
[0099] According to the tissue excision and cutting apparatus 1,
tissue A can be grasped with a clamp 3 only by closing operation of
the operation part 5a (solid line arrow in the figure) while
holding the same part 5a by one hand. Under such a condition,
inserting the resection blade 7 into the longitudinal penetrating
passage 4 of the forceps 6 by another hand and bringing the blade
7a of the resection blade 7 into direct contact with the tissue A
by pressing it or bringing the blade 7a of the resection blade into
contact with the tissue A while twisting it right and left at its
discretion, thereby cutting off the objective tissue A to obtain
only a part of the objective tissue A as a sample piece Ac without
damaging the surrounding tissues and with safety and sureness.
[0100] Namely, according to the tissue excision and cutting
apparatus, since the chopping block piece 2 body provided at the
tip of the fixed jaw 3a serves as a chopping board, only a part of
the objective tissue A held by the clamp 3 can be safely and surely
cut off comparing to the apparatus such a prior type that the
tissue is cut off while being drawn into a cylinder of the
resection blade 7.
[0101] Further, the clamp 3 can be opened and closed by manual
operation of one hand while holding the tissue excision and cutting
apparatus 1 by the one hand and thereby enabling to operate the
resection blade 7 by the other hand. Therefore, the required
operation for cutting off tissue can be done by one person so that
such an apparatus is suitable for laparoscopic surgery or the
like.
[0102] FIG. 2 is a perspective view of the clamp 3 of the tissue
excision and cutting apparatus 1. The repetition explanation will
be omitted by adding same reference numerals to the parts already
explained hereinafter.
[0103] The clamp 3 is constructed such that the fixed jaw 3a is
attached with the movable jaw 3b so as to be opened and closed and
the movable jaw 3b is connected to the open-close mechanism 5
operated by the operation part 5a. The mechanism 5 is provided so
as not to interrupt the blade 7a of the resection blade 7
forwarding to the chopping block piece 2, or the mechanism is
provided in such manner as to assure the longitudinal penetrating
passage 4.
[0104] The fixed jaw 3a is provided with an arch-like support body
3ca constructing a hinge 3c for supporting the movable jaw 3b so as
to be opened and closed. An escape hole of this arch form
constructs the longitudinal penetrating passage 4. A hinge hole
(not shown) is provided at the upper projection of the support body
3ca, a hinge pin 3cb is inserted into the hole, and a hinge hole
(not shown) provided at the open-close end of the movable jaw 3b is
outwardly engaged into the hinge pin 3cb.
[0105] The support body 3ca and the hinge pin 3cb construct the
hinge 3c and the movable jaw 3b can be rotate around the hinge pin
3cb as a rotation rod so as to be opened and closed for the fixed
jaw 3a.
[0106] The attachment method of the movable jaw 3b on the fixed jaw
3a so as to be opened and close isn't limited to the
above-mentioned one which uses a hinge supporting with one rod.
Other method wherein the movable jaw 3b is connected to the fixed
jaw 3a with plural arms so as to form a parallelogram and the
movable jaw 3b is opened or closed always keeping parallel to the
fixed jaw 3a may be used.
[0107] A link arm 3ba is extended from the open-close end of the
movable jaw 3b so as to make a prescribed angle with the movable
jaw 3b, and a link hole (not shown) is provided at its tip and
rotatably connected to a link member 5b by a link pin 5ba. The link
member 5b is further rotatably connected to a connecting rod 5c
connecting the operation part 5a side and the clamp 3 side of the
forceps cylinder 4a and is provided with the escape hole
constructing the longitudinal penetrating passage 4.
[0108] A hook 3bb for preventing moving of the tissue to be held by
biting into the tissue is provided at the tip opposite to the link
arm 3ba side of the movable jaw 3b facing to the fixed jaw 3a,
however such a 3bb hook isn't inevitable.
[0109] According to such a clamp 3 constructed mentioned above, the
movable jaw 3b is closed (a solid line arrow) when the connecting
rod 5c is moved rear (into a solid line arrow), the movable jaw 3b
is opened (a broken line arrow) when the connecting rod 5c is moved
near (into a broken line arrow).
[0110] Any of them are provided so as to assure the longitudinal
penetrating passage 4 for forwarding the resection blade 7 to be
attached with the chopping block piece 2 provided at the tip of the
fixed jaw 3a without being an obstacle. Further, the longitudinal
penetrating passage 4 may assure insertion of the resection blade 7
and may be provided with an open end as mentioned above other than
the forceps cylinder 4a which is closed perpendicular to the
longitudinal direction.
[0111] A connection 3aa is vertically connected with the fixed jaw
3a, connects the forceps cylinder 4a and the fixed jaw 3a, and is
provided with a support hole for inserting the connecting rod 5c
slidably.
[0112] FIG. 3 shows performance of the operation part 5a and the
open-close mechanism 5 of the tissue excision and cutting apparatus
1 of the present invention. FIG. 3(a) is a partial cutaway front
view when the clamp 3 is opened and FIG. 3(b) is a partial cutaway
front view when it is closed.
[0113] The connecting rod 5c passes through the connection 3aa and
the upper part of the forceps cylinder 4a assuring the longitudinal
penetrating passage 4, extends to the operation part 5a side of the
forceps cylinder 4a, and is connected to a slide block 5e.
[0114] The slide block 5e is contained in an operating mechanism
case 5d slidably fixed at the operation part 5a side of the forceps
cylinder 4a and the back and forth movement of the slide block 5e
is transmitted to the clamp 3 side of the forceps cylinder 4a via
the connecting rod 5c so that the link member 5b is moved back and
forth. The slide block 5e is provided with a pair of link pins 5f
at both ends of peripheral and a pair of link plates 5e connecting
the operation part 5a and the slide block 5e are outwardly inserted
into the link pins 5g so as to be slidable. A slide long hole 5da
working as a guide of moving of the link pins 5g accompanying with
back and forth movement of the slide block 5e is provided at a
position corresponding to the link pins 5g of the operation
mechanism case 5d so as to allow back and forth sliding of the
slide block 5e and prevent rotation of the slide block 5e.
[0115] A pair of link support pins 5db are provided forward the
operation mechanism case 5d and a rear cover 5h is provided at back
end of the case 5d.
[0116] The operation part 5a is comprised of a fixed operation part
5aa fixedly provided for the operation mechanism case 5d and a
movable operation part 5ab which can be opened or closed by
rotating the link support pins 5db of the case 5d as a rotating rod
against the fixed operation part 5aa. Such rotation is accomplished
by that a link support hole 5ac provided for the movable operation
part 5ab is outwardly inserted in the pins 5db of the case 5d. A
link support 5ad associating to a link plate 5f outwardly inserted
in the link pins 5g of the slide block 5e and a finger stopper 5ae
for acting operating force of fingers in both open and close
directions are provided for the movable operation part 5ab.
[0117] A link mechanism is constructed by the link pins 5g of the
slide block 5e sliding back and forth in the operation mechanism
case 5d, the link plate 5f, the link support 5ad and the link
support hole 5ac of the removable operation part 5ab, and the link
support pin 5db of the case 5d. When the movable operation part 5ab
of the operation part 5a is opened or closed by such a link
mechanism, the movable jaw 3b of the clamp 3 can be opened or
closed.
[0118] When the fixed operation part 5aa of the operation part 5a
is held by one hand as shown in FIG. 3(a) and a first finger and a
long finger (they are called "operation fingers") are operated into
closing direction (a solid line arrow in the figure) so as to clip
the finger stopper 5ae, the slide block 5e goes back, such a
movement is transferred to the link member 5b by means of the
connecting rod 5c, the link arm 3ba of the clamp 3 is rotated, and
the movable jaw 3b is moved into closing direction (a solid line
arrow in the figure).
[0119] On the other hand, when the operation fingers are operated
into open direction (a broken line arrow in the figure) as shown in
FIG. 3(b), the movement is transmitted to the link member 5b by the
connecting rod 5c, the link arm 3ba of the clamp 3 is rotated
opposite direction, and the movable jaw 3b is moved into opening
direction (a broken line arrow in the figure).
[0120] Accordingly the clamp 3 can be easily opened and closed by
operating the operation part 5a by one hand.
[0121] Of course an escape for providing the longitudinal
penetrating passage 4 is formed at inside of any of the forceps
cylinder 4a, the slide block 5e, attachment part of the link pins
5g of the slide block 5e, and the rear cover 5h so that the
resection blade 7 or the rotary blade, will be described
hereinafter, can be inserted.
[0122] FIG. 4 shows operation of one embodiment of a sealing rod
and a push rod provided for the resection blade or the rotatable
resection blade of the present invention. FIG. 4(a) is a vertical
section when tissue is cut and FIG. 4(b) is a vertical section
after tissue is cut.
[0123] Now detailed construction of the resection blade 7 provided
corresponding to the sealing function of the seal rod 8.
[0124] The resection blade 7 is constructed such that the rear end
of the hollow and cylindrical main body 7b provided with the blade
7a at its tip is inserted in the hollow and cylindrical holding
portion 7c.
[0125] The inner diameter of the main body 7b isn't uniform. The
main body 7b is comprised of a standard inner diameter part 7ba
having the same inner diameter as the blade 7a portion and an
escape inner diameter part 7bb having the inner diameter larger
than the standard inner diameter part 7ba. The standard inner
diameter part 7ba occupies almost the inside of the main body 7b
from the tip with the blade 7a to the rear end and the escape inner
diameter part 7bb occupies only at a fixed distance from the rear
end. These two inner diameter parts 7ba and 7bb are connected by a
gently tapered part 7bc.
[0126] The inner diameter of the holding portion 7c is tiered and
comprised of an inserting hole 7ca for tightly inserting the rear
end of the main body 7b and a guide hole 7cb of which inner
diameter is smaller than that of the inserting hole 7ca and also is
the same as or a little larger than the standard inner diameter
part 7ba of the main body 7b. The resection blade 7 is constructed
such that the rear end of the main body 7b is inserted in the
inserting hole 7ca of the holding part 7c so as to bump into the
tiered portion of the inserting hole 7ca and the guide hole
7cb.
[0127] According to such a resection blade 7, the resection blade 7
can be held by the holding part 7c and also sealing function of the
sealing rod 8 can be brought out effectively as mentioned
herein.
[0128] The sealing rod 8 is inserted in the guide hole 7cb of the
holding part 7c from the rear end of the resection blade 7 and is
provided with an rod part 8b having a little smaller external
diameter than the inner diameter of the standard inner part 7ba of
the main body 7b and a rib 8a contacting the rear end of the
holding part 7c. And the center of the sealing rod 8 is formed with
a push hole 8c for airtightly inserting the push rod 9 along the
axial direction.
[0129] An O-ring 8d is provided at an appropriate portion of the
external diameter of the rod part 8b and has an sealing effect for
the standard inner diameter part 7ba and doesn't have an sealing
effect for the escape inner diameter part 7bb. Namely the external
diameter of the O-ring 8d is larger than the inner diameter of the
standard inner diameter part 7ba and smaller than the inner
diameter of the escape inner diameter part 7bb.
[0130] Therefore, the O-ring 8d is positioned in the escape inner
diameter part 7bb of the main body 7b and sealing function between
the O-ring 8d and the escape inner diameter port 7bb doesn't
achieved in FIG. 4(a). So, air in a hollow part 7d in the resection
blade 7 is allowed to be communicated outside from the sealing rod
8 side via the space between the standard inner diameter part 7ba
and a head 9c of the push shaft 9, the space between the standard
inner diameter 7ba, the escape inner diameter part 7bb, the guide
hole 7cb of the holding portion 7c and the rod part 8b of the
sealing rod 8. Under such a condition, the resection blade 7 is
pressed on the tissue so that the tissue sample Ac is taken in the
hollow part 7d of the resection blade 7 (see FIG. 4(b)).
[0131] On the other hand when the sealing rod 8 is fully pushed
into the resection blade 7 as shown in FIG. 4(b), the O-ring 8d is
positioned in the standard inner diameter part 7ba of the main body
7b so that air in the hollow part 7d of the resection blade 7 is
sealed not to communicate outside from the sealing rod 8 side. When
the O-ring 8d moves to the standard inner diameter part 7ba from
the escape inner diameter part 7bb, it isn't damaged because it
moves in the gently tapered part 7bc.
[0132] When such a sealing is accomplished, the hollow part 7d of
the resection blade 7 is covered with the tissue sample Ac at its
tip so that the tissue sample Ac doesn't easily dropped off the
resection blade 7 because negative pressure is applied on the
hollow part 7d when the sample Ac is going to be dropped from the
resection blade 7.
[0133] O-rings 8e, 8f are provided for the forward and rear parts
of the push hole 8c penetrating the center of the rod part 8b and
the rib 8a so that the push rod 9 can move back and forth while
keeping airtight between the push hole 8c and the rod portion 9b of
the push rod 9 inserted therein.
[0134] The push rod 9 is comprised of the rod portion 9b and a rib
9a provided at its rear end and the head 9c provided at its forward
end. The external diameter of the head 9c is a little smaller than
the inner diameter of the hollow cylinder of the resection blade 7.
The head 9c is detachable for the rod portion 9b by an appropriate
association means such as a screw and can be disassembled so that
the push rod 9 is removed from the sealing rod 8 in case of
sterilization.
[0135] When cutting tissue, the sealing shaft 8 is inserted into
the position where the O-ring 8d of the sealing rod 8 allows
communication with outside air and the push rod 9 is set at the
position where enough space for containing the tissue to be cut is
remained at the tip of the head 9c.
[0136] In such a case, when the tissue A is grasped by the clamp 3
and is cut by the blade 7a by forwarding the resection blade 7, air
can be leaked from the sealing rod 8 side even if the hollow
cylinder of the resection blade 7 is covered with the cut tissue
sample Ac and sealed airtightly as explained about FIG. 1.
Therefore, cutting operation of tissue can't be hindered. And the
rear end of the resection blade 7 is inserted by the sealing rod 8
so that leakage of waste such as body fluid and blood in abdominal
cavity along the hollow cylinder of the resection blade 7 into
outside is reduced.
[0137] After cutting tissue, the sealing rod 8 is pushed in the
resection blade 7 at the position where the O-ring 8d of the
sealing rod 8 keeps airtight and the push shaft 9 is remained at it
is, as shown in FIG. 4(b).
[0138] Under such a condition, the inside of the resection blade 7
is kept airtight by the tissue sample Ac, the O-ring 8d of the
sealing rod 8, and the O-rings 8e, 8f of the push rod 9 as
mentioned above. When the resection blade 7 is retracted from the
forceps 6 while containing the cut and obtained tissue sample Ac at
its tip and is moved to a prepared sample tray with the contained
side downward, the contained tissue sample Ac doesn't dropped from
the resection blade 7 because of atmospheric pressure.
[0139] After the resection blade 7 reaches the prepared sample
tray, the sealing rod 8 is positioned like FIG. 4(a) and the
contained tissue sample Ac is extruded by pushing the push rod
9.
[0140] Accordingly the tissue A can be surely cut and the cut and
sampled tissue sample Ac can be collected safely and certainly.
[0141] FIG. 5 shows operation of another embodiment of a sealing
rod and a push rod used for a resection blade or a rotating
resection blade of the present invention. FIG. 5(a) shows a
vertical section when tissue is cut and FIG. 5(b) shows a vertical
section after tissue is cut.
[0142] A push shaft 11 has both functions of the sealing rod 8 and
the push rod 9 in FIG. 4 and a sealing rod 10 only has an auxiliary
function to seal or allow communication with outside air.
[0143] The shape of the push rod 11 is almost the same as the push
rod 9 in FIG. 4 and is comprised of a rib 11a, an rod part 11b and
a head 11c. Differently, an O-ring lid for keeping airtight with
the inner diameter of the hollow cylinder of the resection blade 7
is provided for the head lic and an air vent hole 11e penetrating
the center of the push rod 11 is provided.
[0144] The sealing rod 10 is used for sealing the air vent hole lie
of the push rod 11.
[0145] When cutting tissue (FIG. 5(a)), only the push rod 11 is
inserted into the resection blade 7 and the push rod 11 is set at
the position where enough space for containing the cut tissue is
obtained at the tip of the head 11c. The air vent hole 11e isn't
sealed so that tissue can be preferably cut as mentioned above.
[0146] When the sealing rod 10 is inserted in the air vent hole lie
of the push rod 11 after cutting tissue (FIG. 5(b)), the air vent
hole 11e is sealed so that the cut and sampled tissue sample Ac
doesn't drop from the contained portion even if the resection blade
7 is extracted and moved as explained for FIG. 4(b). When the push
shaft 11 is further pushed after being moved at a predetermined
position, the tissue sample Ac is extruded from the tip of the
resection blade 7 by air pressure between the tissue sample Ac and
the head 11c of the push rod 11 which are kept airtight.
[0147] In such a case the tissue A can be surely cut and the cut
and sampled tissue sample Ac can be collected safely and
certainly.
[0148] If the construction members of the above-mentioned clamp 3
comprised of the chopping block piece 2, the fixed jaw 3a, and the
movable jaw 3b, the forceps cylinder 4a having the penetrating
passage 4, the open-close mechanism 5, the operation part 5a and
the resection blade 7 are made of material excellent for
sterilization and chemical proof, they are appropriate for surgical
instruments because they can be easily sterilized such as autoclave
sterilization after used. For example, the clamp 3, the forceps
cylinder 4a, members of the open-close mechanism 5, and the
resection blade 7 are preferably made of stainless steel and the
O-ring for sealing is made of silicon rubber.
[0149] Next, one embodiment of actual procedures for sampling
tissue sample using a tissue excision and cutting apparatus of the
present invention in case of laparoscopic surgery will be
explained.
[0150] FIG. 6 to FIG. 10 explain the procedure at five stages.
[0151] At the step 1 (FIG. 6), an inserting instrument F for
inserting an endo-bag E in abdominal cavity H and a trocar T are
set at a trocar site J of patient's abdomen I. In the figure, the
endo-bag E is already inserted in the abdominal cavity H by the
inserting instrument F, is expanded and contains the extracted
organ A, an opening of the endo bag E is taken out of the trocar
site F, the trocar T is inserted into the trocar site J, sterilized
distilled water is injected into a trocar cuff TA provided for the
trocar T so as to be expanded, and sealing between the trocar site
J and the trocar T is kept.
[0152] On the other hand, the auxiliary opening for the endo-bag E
is set at the inserting instrument F and a laparoscope G is
inserted in the auxiliary opening so as to observe inside of the
endo-bag E.
[0153] At first the forceps 6 is inserted into the trocar T and the
organ A is grasped by operating the operation part 5a of the
forceps 6 while confirming the position of the organ A by the
laparoscope G.
[0154] At the step 2 (FIG. 7), the resection blade 7 is inserted
into the longitudinal penetrating passage 4 of the forceps 6. In
this time, the forceps 6 is held by one hand while grasping the
organ A and the resection blade 7 can be easily inserted by holding
the holding portion 7c by another hand. The sealing rod 8 with the
push rod 9 is prepared for the resection blade 7 in such a manner
that the resection blade 7 is allowed to be communicated with the
air from the sealing rod 8 as shown in FIG. 4(a).
[0155] At the step 3 (FIG. 8), the tissue which is grasped by the
clamp 3 and received by the chopping block piece 2 is finely and
surely cut while the resection blade 7 is rotated right or left by
a hand if necessary. The cut end is pressed and cut by the blade 7a
of the resection blade 7 and the chopping block piece 2 or is
sheared and cut by the blade 7a and a receiving blade (not shown)
provided at the chopping block piece 2 depending on the shape of
the blade 7a. The resection blade 7 is guarded with the clamp 3 so
that tissue can be safely cut without damaging the endo-bag E by
the blade 7a of the resection blade 7 is extruded.
[0156] At the step 4 (FIG. 9), the sealing rod 8 is fully inserted
in the resection blade 7 and the resection blade 7 is extracted
from the forceps 6 while sealing the hollow cylinder containing the
cut tissue sample Ac.
[0157] At the step 5 (FIG. 10), the extracted resection blade 7 is
moved to a sample tray K, the position of the sealing rod 8 is
returned to where communication with outside air is allowed, then
the tissue sample Ac contained at the tip in the hollow cylinder of
the resection blade 7.
[0158] Accordingly, the tissue can be surely cut and the sampled
tissue sample can be certainly moved to a prepared position.
[0159] Such an organ for cutting and sampling tissue thereof is
generally attacked by malignant in many cases so that it is highly
required to prevent that a part of the organ is leaked out of the
endo-bag E, the endo-bag E itself is damaged, or the other normal
organ is damaged or broken. According to the present invention, the
blade 7a is constructed so as not to go forward the chopping block
piece 2 so that such a danger isn't caused.
[0160] When the forceps of the present invention is used together
with a rotatable resection blade which rotates automatically, its
effect is further brought out.
[0161] FIG. 11 is a partial cutaway front view showing one
embodiment of the forceps of the present invention combined with
the rotatable resection blade.
[0162] A tissue excision and cutting apparatus 1A is different from
the apparatus 1 in that a resection blade is a rotatable resection
blade 12. The rotatable resection blade 12 includes a guide
cylinder 13a containing the rotatable resection blade 12 rotatably,
a warm mechanism 13b with a warm and a warm wheel for driving and
rotating the resection blade 12, and a driving and rotating
mechanism 13 containing a mechanism for transmitting rotating power
to the warm mechanism 13b and comprised of a transmission part 13c
which can be a holding part of the resection blade 12 and a motor
13d as a drive source.
[0163] The driving and rotating mechanism 13 is provided with a
controller such as a foot controller (not shown) for controlling on
or off of driving and its rotation number so that rotation of the
rotatable resection blade 12 can be controlled freely while
operating the forceps 6 by one hand and grasping a transmission
part 13c of the blade 12 by another hand.
[0164] Therefore, according to the tissue excision and cutting
apparatus 1A, the tissue A which is grasped by the clamp 3 and
received by the chopping block piece 2 like a cutting board can be
finely cut.
[0165] The warm mechanism 13b is shown as one sample of the
transmission mechanism for transmitting the rotational movement
into perpendicular direction and the present invention isn't
limited by such a warm mechanism 13b. For example, a mechanism
combined with a bevel wheel may be used if the rotational movement
is transmitted perpendicular. The driving and rotating mechanism 13
isn't limited to the above-mentioned one if the hollow cylindrical
part is assured in the resection blade. For example, a direct drive
electric motor comprising the rotary blade itself as a rotor
thereof may be used and in such a case the above-mentioned warm
mechanism isn't required.
[0166] The resection blade which is used together with the forceps
comprising the tissue excision and cutting apparatus of the present
invention may be rotated or not rotated. Further any resection
blade can be combined if the cutting board function of the chopping
block piece of the resection blade can be effectively utilized.
Therefore, the forceps alone is available for a resection forceps
6A (FIG. 1) and in such a case it can execute cutting operation
more finely and surely cooperating with the combined resection
blade.
[0167] The chopping block piece and the sealing mechanism of the
forceps, a drop-out prevention means and a suction means provided
for the resection blade as an active means for preventing drop out
of the tissue sample after sampled, which are other characteristics
of the tissue excision and cutting apparatus of the present
invention, will be explained hereinafter.
[0168] FIG. 12 shows another embodiment of the forceps of the
tissue excision and cutting apparatus of the present invention.
FIG. 12(a) is a front view of a partial vertical section and FIG.
12(b) is a fragmental view in the direction of the arrow X.
[0169] At first FIG. 12(b) is explained. In this figure, the
resection blade which is contacted with the chopping block piece 2
or the blade 7a of the rotatable resection blade is virtually shown
by dotted lines.
[0170] The forceps 6 is constructed such that the size of the
chopping block piece 2 provided at the tip of the fixed jaw 3 is
designed to be contacted with the whole circumference of the blade
7a of the resection blade or the rotatable resection blade which is
inserted in the longitudinal penetrating passage 4 of the forceps
6, as shown in the figure. Therefore, the chopping block piece 2
can be effected as a cutting board for any parts of the blade 7a
and cutting end of tissue can be completely done so that the tissue
sample can be completely cut and separated.
[0171] It isn't required to rip down the cut end by pulling the cut
tissue sample with the forceps which has been done in the prior
art. Therefore, tissue sample can be cut and sampled finely.
[0172] The virtual lines of the blade 7a almost correspond to the
shape of the longitudinal penetrating passage 4 and the
above-mentioned effect can be expected for the resection blade or
the rotatable resection blade which can be inserted in the
penetration passage 4.
[0173] Then the front view of the FIG. 12(a) will be explained. As
shown in the figure, the forceps 6 is detachably provided with a
sealing mechanism 5i at the end of the open-close mechanism 5.
[0174] FIG. 13 is a partial vertical section explaining its sealing
mechanism and FIG. 13(a) shows when the sealing mechanism is
loaded, FIG. 13(b) shows after it is loaded, and FIG. 13(c) shows
when the resection blade or the rotatable resection blade is
inserted.
[0175] The sealing mechanism 5i is comprised of a sealing body 5ia,
a sealing ring 5ib, a presser board 5ic, a sealing plate 5id, a
spring 5ie, a setscrew 5if, an auxiliary ring 5ig, and an O-ring
5ih.
[0176] The sealing body 5ia is approximately cylindrical as shown
in the figure and one end of the external diameter is detachably
inserted into an insertion hole provided at the rear end of the
open-close mechanism 5. A penetrating hole is provided in the inner
diameter for securing the longitudinal penetrating passage 4 in
sequence of the open-close mechanism 5.
[0177] The sealing ring 5ib is provided opposite to the inserted
side of the open-close mechanism 5 with the sealing body 5ia and is
fixed with the presser board 5ic. The sealing body 5ia is like a
circular disc with a hole made of rubber and the diameter of the
hole is a little smaller than that of the longitudinal penetrating
passage 4. When the resection blade is inserted in the hole, the
hole is designed to seal its external diameter.
[0178] The seal plate 5id is enforced by the spring 5ie so as to
open and close the hole provided at the intermediate part of the
seal body 5ia in axial direction. The setscrew 5if is provided at
the rear end of the open-close mechanism 5 for fixing and holding
the detachably inserted seal body 5ia.
[0179] The auxiliary ring 5ig is provided at the position which is
the rear end of the forceps inner cylinder 4b comprising a double
cylinder in the forceps cylinder 4a and also the seal body 5ia is
contacted and it is formed with a groove for containing the O-ring
5ih. The O-ring 5ih is designed to keep sealing between the seal
body 5ia and the forceps inner cylinder 4b when the seal body 5ia
is inserted in the rear end of the open-close mechanism 5. The
inner diameter part of the forceps inner cylinder 4b is formed the
longitudinal penetrating passage 4.
[0180] The sealing mechanism 5i is constructed such that the seal
body 5ia having the seal ring 5ib and the sealing plate 5id is
detachably inserted into the rear end of the open-close mechanism 5
as shown in FIG. 13(a) and the mechanism 5i is fixed by the
setscrew 5if as shown in FIG. 13(b), thereby exerting its
function.
[0181] As shown in FIG. 13(b), when the resection blade or the
rotatable resection blade isn't inserted in the longitudinal
penetrating passage 4, the seal plate 5id of the sealing mechanism
5i is enforce by the spring 5ie so that the hole of the seal body
5ia is closed and the longitudinal penetrating passage 4 and outer
air are sealed. Although the seal plate 5id is enforced by the
spring 5ie, its enforcing power is set so as to fell down the seal
plate 5id when pushed by the inserted resection blade.
[0182] As shown in FIG. 13(c), when the resection blade or the
rotatable resection blade is inserted in the longitudinal
penetrating passage 4, the seal plate 5id is pushed and fell down
by the resection blade so as not to prevent the resection blade
from inserting. The periphery of the blade 7b of the inserted
resection blade or the guide cylinder 13a of the rotatable
resection blade is sealed from outside by affected by the inner
diameter of the sealing ring 5ib.
[0183] Accordingly, the longitudinal penetrating passage 4 is kept
sealed whenever the resection blade is inserted or not so that
outer air is prevented from entering in abdominal cavity and the
endo-bag through the longitudinal penetrating passage 4 or
especially pneumoperitoneum gas is prevented from leaking out while
being filled in the endo-bag.
[0184] Because the seal body 5ia is exchangeable, it can be
exchanged when polluted, thereby keeping safety without executing
troublesome sterilization.
[0185] The above-mentioned forceps is explained as a member of the
tissue excision and cutting apparatus, however it doesn't matter
the kind of the resection blade or the rotatable resection blade
which is used together with the forceps. The forceps, as mentioned
above, has independent utility value and technical value.
Therefore, it can be used as a resection forceps 6A (FIG. 12, FIG.
13) alone and has similar effect cooperating with the combined
resection blade.
[0186] Next the drop-out prevention means and the suction means
provided for the resection blade as an active means for preventing
the sampled tissue sample will be explained.
[0187] FIG. 14 shows one embodiment of a holding craw provided at
the internal tip of the resection blade or the rotatable resection
blade. FIG. 14(a) is its front view and Fib. 14(b) is a partial
vertical section.
[0188] A holding craw 7e provided at an inner circumference of the
blade 7a of the resection blade 7 is the same one which is used for
preventing dropping out of fish after hooked by a fishhook and is
one of drop-out prevention methods of the sampled tissue
sample.
[0189] In this embodiment, the blade 7a is made of stainless steel
capable of hardening, for example SUS440C, for keeping sharpness of
the blade. It is different from the material used for the resection
blade body 7b such as titanium or stainless steel of SUS304.
Therefore, the blade 7a is integrated with the body 7b by a tight
insertion of an insertion integration part 7g after appropriate
procedures such as sharpening and hardening of the blade 7a are
executed.
[0190] The holding craw 7e is formed such that a radius shape is
formed by turnery and substantial part is ground from the entire
circumference of the radius shape formed around the circumference
so as to leave three holding craws 7e as shown in the figures.
[0191] If the holding craw is formed circumferential, it is
excellent for drop-out prevention, however, contrarily the cut
tissue sample which has been cut into cylindrical by the tip blade
and fed in the inmost recesses of the resection blade 7 in turn is
prevented from being fed into further inmost recess.
[0192] Therefore, the holding craw 7e is partially left and three
holding craws are appropriate as shown in the figure, however from
two to five holding craws may be provided.
[0193] According to such about three holding craws 7e doesn't
hinder the tissue sample from being fed and can prevent the tissue
sample from dropping out.
[0194] The holding craws are appropriately positioned not far from
the tip of the blade 7a in the blade axis direction, more
concretely, where the shortest one of the usually formed
cylindrical tissue samples can be hooked. Further, the holding
craws may be provided in a line as shown in the figure, however
they may be provided in plural lines at different positions from
the tip in the direction of the blade axis by differing
circumferential position or at the same circumferential
position.
[0195] Such a holding craw may be similarly provided for the
rotatable resection blade 12 (FIG. 11) and such a case is shown as
the parenthetic numerals in the figures such as a rotatable
resection blade 12, a blade 12a, a body 12b, a holding craw
12e.
[0196] FIG. 15 is an external front view of one embodiment of a
rotatable resection blade provided with holding craw 12e as shown
in FIG. 14.
[0197] The holding craw 12e can be similarly provided for a
rotatable resection blade and have the same effect.
[0198] FIG. 16 shows another embodiment of a holding craw provided
inside tip of a resection blade or a rotatable resection blade of
the present invention. FIG. 16(a) is its front view and FIG. 16(b)
is its partial vertical section.
[0199] The holding craw 7f is provided for the body 7b of the
resection blade 7 comparing to the holding craw 7e of FIG. 14 and
is formed by plastic forming of the blade body 7b made of
lightweight titanium, and excellent for anti-corrosion, and
plasticity or SUS304 stainless steel which is excellent for
anti-corrosion and easy to be manufactured.
[0200] The holding craw 7f is designed t prevent the cut tissue
sample from dropping out like the holding craw 7e of FIG. 14.
However, the holding craw 7f is shaped by plastic forming with
shearing and pressing against the relatively thin cylindrical part
of the blade body 7b.
[0201] Its drop-out prevention effect isn't different from the
holding craw 7e, however, it must be provided for the body 7b
because of the manufacturing performance so that it must be
provided at substantial distance from the tip of the blade 7a. In
this point the holding craw 7f isn't suitable for preventing
dropping out of a short tissue sample.
[0202] Both of the holding craw 7e and 7f may be provided.
[0203] The holding craw 7f can be provided for the rotatable
resection blade 12 like the holding craw 7e and such a case is
shown as parenthetic numbers in the figure.
[0204] FIG. 17 is a partial vertical section explaining operation
of one embodiment of a sealing rod used for a resection blade or a
rotatable resection blade of the present invention.
[0205] The sealing push rod 8A is constructed like the push rod 11
in FIG. 5 and they are different in that the sealing push rod 8A is
provided with a simple suction means 8g actively generating suction
force in place of the sealing rod 10, the simple suction means 8g
is one embodiment of a suction means of the cut and sampled tissue
sample.
[0206] The sealing push rod 8A itself is constructed with a rib
8Aa, an rod part 8Ab, a head 8Ac, an O-ring 8Ad, and an air vent
hole 8Ae like the push rod 11 in FIG. 5 and they work like those
for the push rod 11.
[0207] The simple suction means 8g detachably provided for the air
vent hole 8Ae instead of the sealing rod 10 is comprised of a
syringe 8ga, a switch valve 8gb, and a tube 8gc.
[0208] The simple suction means 8g isn't loaded before the sealing
rod 8A is inserted in the resection blade 7 and it cuts and samples
tissue so as not to disturb cutting and sampling of tissue by
allowing communication of air from the air vent hole 8Ae.
[0209] However, as shown in FIG. 17, the simple suction means 8g is
loaded after the tissue sample Ac is sampled, the switch valve 8gb
is opened, and suction force is generated by operating the syringe
8ga so as to actively suck the sampled tissue sample Ac not to be
dropped out.
[0210] After the resection blade 7 is moved at a predetermined
position while keeping suction, the contained tissue sample Ac may
be extruded by generating pressure force by operating the syringe
8ga of the simple such means 8g, or it may be extruded only by the
operation of the sealing push rod 8A after removing the simple
suction means 8g.
[0211] The switch valve 8gb may be closed after sucking with the
syringe 8ga to keep suction force. When it can be replaced by the
operation of the syringe 8ga, the switch valve 8gb isn't always
required.
[0212] In this case a syringe is used as a sample of the simple
suction means 8g because it is easily obtained at medical sites,
however it isn't limited.
[0213] FIG. 18 explains operation of another embodiment of a
sealing rod and a push rod used for a resection blade or a
rotatable resection blade of the present invention. FIG. 18(a) is a
partial vertical section before tissue is cut, FIG. 18(b) is a
partial vertical section after tissue is cut, and FIG. 18(c) is a
partial vertical section when a tissue sample is suck and held.
[0214] A sealing suction rod 8B and a push rod 9A are the same as
the sealing rod 8 and the push rod 9 in FIG. 4. However, a sealing
suction mechanism 8h is provided for the sealing suction rod 8B.
The push rod 9A and a resection blade 7A are a little different
from those in FIG. 4. The sealing suction rod 8B and the push rod
9A are another embodiment of the suction means of cut and sampled
tissue sample.
[0215] The resection blade 7A is different from the resection blade
7 in FIG. 4 in that a container 7Ae containing the sealing suction
mechanism 8h is included in a holding portion 7Ac corresponding to
the sealing suction rod 8B provided with the sealing suction
mechanism 8h. It also different in that a part connected from the
container 7Ae to the hollow 7Ad in the resection blade 7A is a
sealing tapered part 7Af. A blade 7Aa, a body 7Ab, the holding
portion 7Ac and the hollow 7Ad are the same as those of the
resection blade 7.
[0216] A rib 8Ba, an rod part 8Bb, and a push hole 8Bc of the
sealing suction rod 8B are almost the same as those of the sealing
rod 8. It is different in that a piston flange 8he to be contained
in the sealing suction mechanism 8h is provided at the tip of the
rod part 8Bb.
[0217] The sealing suction mechanism 8h is comprised of a sealing
cylinder 8ha slidably contained in the container 7Ae of the
resection blade 7A, an inner chamber 8hb provided therein, a
communication passage 8hc for communicating air between the inner
chamber 8hb and the hollow 7Ad of the resection blade 7A, an O-ring
8hd which is provided at the tip of the hollow 7Ad side of the
sealing cylinder 8ha and exerts sealing function when it contacts
with the sealing tapered part 7Af of the resection blade 7A, the
above-mentioned piston flange 8he sliding airtightly in the inner
chamber 8hb, a spring 8hf enforcing the piston flange 8he in the
left direction in FIG. 18, and a spring 8hg provided at the tip of
the hollow 7Ad of the sealing cylinder 8ha and enforcing the
sealing cylinder 8ha in the left direction of FIG. 18 by generating
enforce power between an inner wall of the container 7Ad of the
resection blade 7A.
[0218] The spring 8hf is designed to require larger force than the
spring 8hg to be compressed the same length so that the spring
constant (load/distortion) of the spring 8hf becomes larger than
the spring 8hg.
[0219] The push rod 9A is comprised of a rib 9Aa, an rod part 9Ab,
and a head 9Ac like those of the push rod 9 in FIG. 4. The push
hole 8Bc of the sealing suction rod 8B, the spring 8hf and the
sealing cylinder 8ha of the sealing suction mechanism 8h are
penetrated by the rod part 9Ab and the push hole 8Bc and the
sealing cylinder 8ha are sealed by an appropriate sealing means
such as an O-ring so as to be slidable keeping airtight.
[0220] The holding portion 7Ac of the resection blade 7A is
constructed such that the container 7Ae can be opened, the sealing
cylinder 8ha of the sealing suction mechanism 8h is constructed so
as to be able to open the inner chamber 8hb, and the head 9Ac of
the push rod 9A is constructed detachable. As shown in the figure
they can be disassembled after assembled and used.
[0221] When tissue sample is cut and sampled by means of the
sealing suction rod 8B and the push shaft 9A, the sealing suction
rod 8B is positioned freely as shown in FIG. 18(a). The distance
between the rib 8Ba of the sealing suction rod 8B and the holding
portion 7Ac of the resection blade 7A is defined as L1. The push
rod 9A is positioned so as to keep enough space for containing the
cut tissue sample in the hollow 7Ad forward of the head 9Ac. The
hollow 7Ad in the resection blade 7A is communicated with air
because of the space between the sealing suction rod 8B, and
sealing cylinder 8ha and the container 7Ae of the holding portion
7Ac.
[0222] After tissue sample is cut by the tissue excision and
cutting apparatus 1 having the resection blade 7A, only the sealing
suction rod 8B is pushed as shown in FIG. 8(b). Because the spring
8hg is stronger than the spring 8hf, the sealing cylinder 8ha
slides forward in the container 7Ae of the holding portion 7Ac by
the just distance that the sealing suction rod 8B is pushed. The
O-ring 8hd provided at the tip of the sealing cylinder 8ha contacts
with the sealing tapered part 7Af of the holding portion 7Ac and
the hollow 7Ad in the resection blade 7A is kept airtight by the
sealing cylinder 8ha. The distance between the rib 8Ba of the
sealing suction rod 8B and the holding portion 7Ac of the resection
blade 7A is defined as L2.
[0223] When only the sealing suction rod 8B is further pushed, the
sealing cylinder 8ha doesn't further slide and only the sealing
suction rod 8B slides forward against the sealing cylinder 8ha
while compressing the spring 8hf as shown in FIG. 18(c). The piston
flange 8he of the sealing suction rod 8B slides forward while
keeping airtight in the inner chamber 8hb of the sealing cylinder
8ha so that suction force is generated in the space in the rear of
the piston flange 8he and is transmitted to the hollow 7Ad of the
resection blade 7A via the communication passage 8hc. Accordingly
suction force is generated in the hollow 7Ad. The distance between
the rib 8Ba of the sealing suction rod 8B and the holding portion
7Ac of the resection blade 7A is defined as L3.
[0224] Sealing and suction can be achieved and the cut and sampled
tissue sample Ac can be easily suck and grasped simply by pushing
the sealing suction rod 8B from a free condition L1 to the
distances L2 and L3. After the resection blade 7A holding the
tissue sample Ac is moved at a predetermined place, the sealing
suction rod 8B can be returned to its original free position L1 by
the force of repulsion of the springs 8hf, 8hg only by releasing
pushing of the sealing suction rod 8B. Then the tissue sample Ac
can be easily extruded by operating the push rod 9A.
[0225] It is more convenient that a lock means which can keep the
sealing suction rod 8B at the distance L3 and can be easily
released is provided if required.
[0226] FIG. 19(a)-FIG. 19(f) explain operation of a suction and
sampling means used for a resection blade or a rotatable resection
blade of the present invention.
[0227] This suction and sampling means 14 is provided for actively
collecting the tissue sample cut and sampled by the resection blade
in a sample container not only by sucking and grasping but also by
utilizing air suction force. It is another embodiment of a suction
means of tissue sample.
[0228] The suction and sampling means 14 is comprised of a sample
container 14a which is a bag made of mesh material for passing
suction force and provided with an attachment opening, a connecting
means 14b for connecting the sample container 14a and a connecting
part 7Ba at the rear of a resection blade 7B, and a cover 14c
provided for the connecting means 14b and covering the sample
container 14a fully for keeping airtight.
[0229] The resection blade 7B connected with the suction and
sampling means 14 is different from the above-mentioned resection
blade 7, 7B in that it is provided with the connecting part 7Ba at
its rear end. A connecting groove 7Bb is provided for the
connecting part 7Ba for fixing the connecting means 14b of the
suction and sampling means 14 and a connecting pin 14ba is
vertically provided for the connecting means 14b to be inserted in
the groove 7Bb.
[0230] When the suction and sampling means 14 is used, at first the
connecting means 14b is set for the sample holder 14a (FIGS. 19(a),
(b)), then the cover 14c is covered (FIG. 19(c)), and the assembled
suction and sampling means 14 is connected and fixed to the
connecting part 7Ba of the resection blade 7B by utilizing
association of the connecting pin 14ba and the connecting groove
7Bb (FIG. 19(d)).
[0231] Then suction force is supplied to the suction and sampling
means 14 from an suction air source (not shown) and the tissue
sample cut and sampled by the resection blade 7B is suck and
collected (FIG. 19(e)). This suction and collection may be repeated
until a purpose is accomplished more than one time.
[0232] After suck and collection are finished, the suction and
sampling means 14 is removed from the resection blade 7B and
disassembled. The tissue sample collected in the sample container
14a is taken out at a predetermined place (FIG. 19(f)).
[0233] Accordingly tissue samples taken out several times can be
easily collected and taken out in bulk.
[0234] This suction and sampling means can be used for a rotatable
resection blade. Both of the above-mentioned holding craw and
several suction means for preventing dropping out of tissue sample
can be applied for a resection blade or a rotatable resection
blade. In such a case both effects can be synergistically brought
out.
[0235] While the present invention has been particularly shown and
described with reference to preferred embodiments thereof, it will
be understood by those skilled in the art that the foregoing and
other changes in form and details can be made therein without
departing from the spirit and scope of the invention.
* * * * *