U.S. patent application number 15/673682 was filed with the patent office on 2017-12-28 for ultrasonic treatment instrument and ultrasonic treatment assembly.
This patent application is currently assigned to OLYMPUS CORPORATION. The applicant listed for this patent is OLYMPUS CORPORATION. Invention is credited to Masahiro SAKAI.
Application Number | 20170367727 15/673682 |
Document ID | / |
Family ID | 57834216 |
Filed Date | 2017-12-28 |
United States Patent
Application |
20170367727 |
Kind Code |
A1 |
SAKAI; Masahiro |
December 28, 2017 |
ULTRASONIC TREATMENT INSTRUMENT AND ULTRASONIC TREATMENT
ASSEMBLY
Abstract
An ultrasonic treatment instrument for use in arthroscopic
surgery, includes a probe having a main body that is configured to
transmit ultrasonic vibration, and a treatment portion that is
provided on a distal side of the main body and is configured to cut
a hard tissue and/or a soft tis e by transmission of the ultrasonic
vibration; and a sheath unit that includes an inner sheath covering
an outer peripheral surface of the main body in the probe, and an
outer sheath covering an outer peripheral surface of the inner
sheath and forming a suction path between the outer peripheral
surface of the inner sheath and the outer sheath, wherein a distal
end of the inner sheath extends to a position closer to the
treatment portion of the probe than a distal end of the outer
sheath.
Inventors: |
SAKAI; Masahiro;
(Hachioji-shi, JP) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
OLYMPUS CORPORATION |
Tokyo |
|
JP |
|
|
Assignee: |
OLYMPUS CORPORATION
Tokyo
JP
|
Family ID: |
57834216 |
Appl. No.: |
15/673682 |
Filed: |
August 10, 2017 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
PCT/JP2015/083589 |
Nov 30, 2015 |
|
|
|
15673682 |
|
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62196158 |
Jul 23, 2015 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2017/320084
20130101; A61B 18/00 20130101; A61B 8/12 20130101; A61B 2017/32007
20170801; A61B 2017/320072 20130101; A61B 17/1675 20130101; A61B
2017/320008 20130101; A61B 17/320068 20130101; A61B 2217/005
20130101; A61B 8/4483 20130101; A61B 2017/00738 20130101; A61B
8/0875 20130101; A61N 7/02 20130101; A61B 2017/320073 20170801;
A61B 8/4444 20130101 |
International
Class: |
A61B 17/32 20060101
A61B017/32; A61B 17/00 20060101 A61B017/00 |
Claims
1-12. (canceled)
13. An ultrasonic treatment instrument for use in arthroscopic
surgery, comprising: a probe having a main body that is configured
to transmit ultrasonic vibration, and a treatment portion that is
provided on a distal side of the main body and is configured to cut
a hard tissue and/or a soft tissue by transmission of the
ultrasonic vibration, the main body prescribing a central axis, the
treatment portion including a bent portion continuous with the main
body and bent from a distal end of the main body, and a cutting
region provided on a distal side of the bent portion and formed at
a position shifting from the central axis due to the bent portion;
and a sheath unit that includes an inner sheath covering the main
body present in a region on a proximal side of the bent portion in
the probe and covering a region bent from the distal end of the
main body in a proximal portion of the bent portion, and an outer
sheath covering an outer peripheral surface of the inner sheath and
forming a suction path between the outer peripheral surface of the
inner sheath and the outer sheath, wherein a distal end of the
inner sheath extends to a position closer to the cutting region of
the treatment portion than a distal end of the outer sheath, and
through-holes communicating between an outer peripheral surface of
the outer sheath and an inner peripheral surface of the outer
sheath are formed in a distal portion of the outer sheath.
14. The ultrasonic treatment instrument according to claim 13,
wherein a central axis of the outer sheath shifts from a central
axis of the inner sheath.
15. The ultrasonic treatment instrument according to claim 13,
wherein the inner sheath includes a cutout portion extending from
the distal end toward a proximal side.
16. The ultrasonic treatment instrument according to claim 15,
wherein the cutout portion is provided only in a portion of the
inner sheath which is exposed from the outer sheath.
17. The ultrasonic treatment instrument according to claim 15,
wherein an edge portion of the cutout portion is straightly formed
in parallel with a central axis of the inner sheath.
18. The ultrasonic treatment instrument according to claim 15,
wherein an edge portion of the cutout portion is formed to tilt to
a central axis of the inner sheath.
19. The ultrasonic treatment instrument according to claim 15,
wherein the cutout portion is formed on a side of the inner sheath
on which the cutting region is present.
20. The ultrasonic treatment instrument according to claim 13,
wherein a thickness of the inner sheath is smaller than a thickness
of the outer sheath.
21. The ultrasonic treatment instrument according to claim 13,
wherein a diameter of a distal portion of the inner sheath
decreases from its proximal side toward a distal side.
22. The ultrasonic treatment instrument according to claim 13,
comprising: a connector that is provided on a proximal portion of
the sheath unit and connecting the suction path to a suction
source.
23. The ultrasonic treatment instrument according to claim 13,
wherein the probe has a length to prescribe an antinode position of
the vibration in the treatment portion, when the ultrasonic
vibration is transmitted thereto, and the distal end of the inner
sheath is present on a distal side from a position corresponding to
a first node position of the vibration from the antinode position
of the vibration in the probe.
24. The ultrasonic treatment instrument according to claim 13,
wherein a central axis of the main body of the probe matches a
central axis of the inner sheath, and the central axis of the inner
sheath does not match a central axis of the outer sheath.
25. An ultrasonic treatment assembly comprising: the ultrasonic
treatment instrument according to claim 13; and an ultrasonic
transducer unit detachably attached to the ultrasonic treatment
instrument.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a Continuation Application of PCT
Application No. PCT/JP2015/083589, filed Nov. 30, 2015 and based
upon and claiming the benefit of U.S. Provisional Application No.
62/196,158, filed Jul. 23, 2015, the entire contents of which are
incorporated herein by reference.
BACKGROUND OF THE INVENTION
1. Field of the Invention
[0002] The present invention relates to an ultrasonic treatment
instrument and an ultrasonic treatment assemble which treat a
biological tissue by use of ultrasonic vibration.
2. Description of the Related Art
[0003] For example, in Jpn. Pat. Appln. KOKAI Publication No.
2003-116870, there is disclosed an ultrasonic treatment instrument
to shatter and cut hard tissues such as bones. Furthermore, this
treatment instrument performs suction through a suction path formed
in a probe.
BRIEF SUMMARY OF THE INVENTION
[0004] According to one aspect of the present invention, an
ultrasonic treatment instrument for use in arthroscopic surgery,
includes: a probe having a main body that is configured to transmit
ultrasonic vibration, and a treatment portion that is provided on a
distal side of the main body and is configured to cut a hard tissue
and/or a soft tissue by transmission of the ultrasonic vibration;
and a sheath unit that includes an inner sheath covering an outer
peripheral surface of the main body in the probe, and an outer
sheath covering an outer peripheral surface of the inner sheath and
forming a suction path between the outer peripheral surface of the
inner sheath and the outer sheath, wherein a distal end of the
inner sheath extends to a position closer to the treatment portion
of the probe than a distal end of the outer sheath.
[0005] Advantages of the invention will be set forth in the
description which follows, and in part will be obvious from the
description, or may be learned by practice of the invention.
Advantages of the invention may be realized and obtained by means
of the instrumentalities and combinations particularly pointed out
hereinafter.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
[0006] The accompanying drawings, which are incorporated in and
constitute a part of the specification, illustrate embodiments of
the invention, and together with the general description given
above and the detailed description of the embodiments given below,
serve to explain the principles of the invention.
[0007] FIG. 1 is a schematic view showing a treatment system
according to first to fifth embodiments;
[0008] FIG. 2A is a schematic view showing an ultrasonic treatment
assembly of the treatment system according to the first
embodiment;
[0009] FIG. 2B is a schematic longitudinal cross-sectional view
showing an ultrasonic treatment instrument of the ultrasonic
treatment assembly of the treatment system according to the first
embodiment;
[0010] FIG. 3A is a schematic enlarged view of encircled parts
denoted with reference signs .alpha. and .beta. of FIG. 2B;
[0011] FIG. 3B is a schematic transverse cross--sectional view
taken along the 3B-3B line of FIG. 3A;
[0012] FIG, 3C is a schematic transverse cross-sectional view taken
along the 3C-3C line of FIG. 3A;
[0013] FIG. 4A is a schematic view showing a state where a cutting
region and an area to be resected are observed from a rear side of
a treatment portion with an arthroscope, when the cutting region of
the treatment portion of the ultrasonic treatment instrument of the
treatment system according to the first embodiment is brought into
contact with the area to be resected in a bone;
[0014] FIG. 4B is a schematic view showing a state where the
cutting region and the area to be resected are laterally observed
on the rear side of the treatment portion with the arthroscope,
when the cutting region of the treatment portion of the ultrasonic
treatment instrument of the treatment system according to the first
embodiment is brought into contact with the area to be resected in
the bone;
[0015] FIG. 5 is a schematic enlarged view of the encircled parts
denoted with the reference signs .alpha. and .beta. of FIG. 2B in
an ultrasonic treatment instrument of an ultrasonic treatment
assembly of a treatment system according to the second
embodiment;
[0016] FIG. 6A is a schematic enlarged view of the encircled part
denoted with the reference sign .alpha. of FIG. 2B in an ultrasonic
treatment instrument of an ultrasonic treatment assembly of a
treatment system according to the third embodiment;
[0017] FIG. 6B is a longitudinally cross-sectional view in which
the encircled part denoted with the reference sign .alpha. of FIG.
2B is schematically enlarged in the ultrasonic treatment instrument
of the ultrasonic treatment assembly of the treatment system
according to the third embodiment;
[0018] FIG. 7A is a schematic view showing an ultrasonic treatment
instrument of an ultrasonic treatment assembly of a treatment
system according to the fourth embodiment;
[0019] FIG. 7B is a schematic enlarged view of an encircled part
denoted with reference sign .gamma. of FIG. 7A;
[0020] FIG. 8A is a schematic view of the ultrasonic treatment
instrument of the ultrasonic treatment assembly of the treatment
system according to the fourth embodiment which is seen from a
direction indicated by an arrow 8A in FIG. 7A;
[0021] FIG. 8B is a longitudinal cross-sectional view in which an
encircled Dart denoted with reference sign .delta. of FIG. 8A is
schematically enlarged;
[0022] FIG. 9A is a schematic view which shows a state where a
cutout portion is formed in a distal portion of an inner sheath of
an ultrasonic treatment instrument of an ultrasonic treatment
assembly of a treatment system according to the fifth embodiment,
and in which the encircled part denoted with the reference sign
.gamma. of FIG. 7A is enlarged; and
[0023] FIG. 9B is a schematic view which shows a state where a
cutout portion is formed in a distal portion of an inner sheath of
an ultrasonic treatment instrument of an ultrasonic treatment
assembly of a treatment system according to a modification of the
fifth embodiment, and in which the encircled part denoted with the
reference sign .gamma. of FIG. 7A is enlarged.
DETAILED DESCRIPTION OF THE INVENTION
[0024] Hereinafter, embodiments of this invention will be described
with reference to the drawings.
First Embodiment
[0025] A first embodiment will be described with reference to FIG.
1 to FIG. 4B.
[0026] In case of treating a joint 100, for example, a treatment
system 10 shown in FIG. 1 is used. The treatment system 10 includes
an arthroscope apparatus 12, a treatment apparatus 14, and a
perfusion apparatus 16.
[0027] The arthroscope apparatus 12 includes an arthroscope 22 with
which an inside of the joint 100 of a patient, i.e., the inside of
a joint cavity 136 is observed, an arthroscope controller 24 that
performs image processing on the basis of a subject image taken by
the arthroscope 22, and a monitor 26 that projects a projected
image generated by the image processing in the arthroscope
controller 24. The arthroscope 22 is inserted into the joint cavity
136 of the joint 100 by a first cannula 18a forming an outer portal
102 that communicates between an inside of the patient's joint 100
and an outside of skin of the patient. It is to be noted that a
position of the portal 102 is not uniform, but is suitably
determined in accordance with patient's condition.
[0028] The treatment apparatus 14 includes an ultrasonic treatment
assembly 32, a treatment instrument controller 34, and a switch 36.
The ultrasonic treatment assembly 32 includes an ultrasonic
treatment instrument 42, and an ultrasonic transducer unit 44
including an ultrasonic transducer 44a. As the ultrasonic
transducer 44a of the ultrasonic transducer unit 44, there is used,
for example, a known BLT type of transducer or the like that
generates ultrasonic vibration when energy is input thereto. The
ultrasonic transducer 44a of the ultrasonic transducer unit 44 can
vibrate at a suitable resonance frequency, and an amplitude is
changeable in a suitable range by adjustment of an amount of the
energy to be input. In response to an operation of the switch 36,
the treatment instrument controller 34 supplies the energy to the
ultrasonic transducer unit 44, to transmit the ultrasonic vibration
to a treatment portion 64 of an after-mentioned probe 52 of the
ultrasonic treatment instrument 42.
[0029] The ultrasonic treatment assembly 32 is inserted into the
joint cavity 136 of the joint 100 by a second cannula 18b forming
an inner portal 104 that communicates between the inside of the
patient's joint 100 and the outside of the skin of the patient. It
is to be noted that a position of the portal 104 is not uniform but
is suitably determined in accordance with the patient's condition.
The switch 36, for example, in a pressed and operated state
maintains a state where the ultrasonic transducer 44a of the
ultrasonic transducer unit 44 is driven, and when the pressed
switch is released, the driven state of the ultrasonic transducer
44a is cancelled.
[0030] As shown in FIG. 2A to FIG. 3A, the ultrasonic treats
instrument (an ultrasonic device) 42 for use together with the
arthroscope 22, i.e., for use in arthroscopic surgery includes the
probe 52, a sheath unit 54, and a handle 56 in which at least an
outer peripheral surface of the handle 56 has electric insulation
properties. The handle 56 is provided in a proximal portion of the
sheath unit 54, and includes a connector 58 connecting an
after-mentioned suction path 76 to a suction pump unit (a suction
source) 94 disposed on a wall or the like in an operating room. A
proximal end of the handle 56 is attachably/detachably connected to
the ultrasonic transducer unit 44. Thus, the ultrasonic treatment
instrument 42 is for use in a treatment in a state where the
ultrasonic transducer unit 44 is attached to the instrument to form
the ultrasonic treatment assembly 32.
[0031] It is to be noted that here, as shown in FIG. 1, there is
described an example of use of the foot switch 36 connected to the
treatment instrument controller 34 to give an instruction of
inputting the energy into the ultrasonic transducer unit 44, but
needless to say, it is preferable that an unshown switch (hand
switch) is disposed in the handle 56. The switch 36 includes
pressing portions 36a and 36b. In a case that a large vibration
amplitude is generated in the transducer 44a, the pressing portion
36a is pressed, and in a case that a small vibration amplitude is
generated in the transducer 44a, the pressing portion 36b is
pressed. For example, the amplitude may be changed in cutting a
hard tissue such as a bone and in cutting a soft tissue such as a
cartilage. In other words, the amplitude may suitably be changed in
accordance with a condition of a treatment target Alternatively,
the amplitude may suitably be changed in accordance with a
condition of an amount of the treatment target to be cut.
[0032] In the probe 52, there is used a material such as a titanium
alloy material excellent in transmission properties of the
ultrasonic vibration. When the handle 56 is connected to the
ultrasonic transducer unit 44, a proximal end of the probe 52 is
connected to the ultrasonic transducer 44a of the ultrasonic
transducer unit 44 which generates the ultrasonic vibration when
the energy is input. The probe 52 includes a straight rod-like main
body 62 that is configured to transmit the ultrasonic vibration,
and the treatment portion 64 that is provided on a distal side of
the main body 62 and is configured to cut the bone by the
transmission of the ultrasonic vibration. The treatment portion 64
includes a cutting region (a cutting blade) 66 projecting in a
direction different from a direction along a central axis C0 of the
main body 62 of the probe 52. Furthermore, the treatment portion 64
includes a bent portion 64a bent from a distal end of the main body
62. Consequently, a position of the cutting region 66 can shift
from the central axis C0 of the probe 52 in a state where the
treatment portion 64 is maintained to be small.
[0033] It is to be noted that the treatment portion 64 in FIG. 3A
shows an example where the portion is drawn as the hook-shaped
cutting region 66, but there is usable the probe 52 including the
treatment portion 64 having the cutting region 66 of any type of
shape such as an unshown blade or curette type.
[0034] A wavelength of the ultrasonic vibration input into the
probe 52 determined in accordance with the resonance frequency of
the transducer 44a of the ultrasonic transducer unit 44. In other
words, a length of the probe 52 is determined in accordance with
the transducer 44a for use. Therefore, the probe 52 has the length
to prescribe an antinode position of the vibration in the treatment
portion 64, when the ultrasonic vibration is input from the
ultrasonic: transducer 44a of the ultrasonic transducer unit 44
into the proximal end of the probe 52 to transmit the ultrasonic
vibration to the probe 52. It is preferable that the antinode
position of the vibration matches the position of the cutting
region 66. In other words, the position of the cutting region 66 is
adjusted to be a position corresponding to the antinode position of
the vibration. When the ultrasonic vibration is transmitted, a
first node position of the vibration which is present on a proximal
side of the antinode position of the vibration is prescribed
between the distal end of the main body 62 of the probe 52 and a
proximal end thereof.
[0035] The sheath unit 54 includes an inner sheath (a first sheath)
72 and an outer sheath (a second sheath) 74. The inner sheath 72
and the outer sheath 74 are made of a material such as a stainless
alloy material having rigidity. It is preferable that a thickness
of the inner sheath 72 is smaller than a thickness of the cuter
sheath 74. Thus, the inner sheath 72 is formed to be thin, whereby
an outer diameter of the whole sheath unit 54, i.e., an outer
diameter of the outer sheath 74 can be smaller.
[0036] The inner sheath 72 covers an outer peripheral surface of
the main body 62 in the probe 52. A central axis C1 of the inner
sheath 72 matches the central axis C0 of the main body 62 of the
probe 52. A distal end 72a of the inner sheath 72 to which the
ultrasonic vibration is transmitted is present on a distal side
from a position denoted with reference sign N1, that is, the first
node position of the vibration from the position corresponding to
the antinode position of the vibration of the treatment portion 64
of the probe 52. In the main body 62 of the probe 52, an O-ring 78
is interposed between an outer peripheral surface of the position
N1 that is the node position of the vibration and an inner
peripheral surface of the inner sheath 72. Consequently, it is
possible to prevent a liquid from entering a space between the main
body 62 of the probe 52 and the inner sheath 72 on a proximal side
from the O-ring 78 along the central axes C0 and C1.
[0037] The outer sheath 74 covers an outer peripheral surface of
the inner sheath 72. A proximal end 72b of the inner sheath 72 and
a proximal end 74b of the outer sheath 74 are fixed to the handle
56, respectively.
[0038] Furthermore, the suction path 76 is formed between the outer
peripheral surface of the inner sheath 72 and an inner peripheral
surface of the outer sheath 74. The proximal end 74b of the outer
sheath 74 is present on the distal side from the proximal end 72b
of the inner sheath 72 along the central axis C1 of the inner
sheath 72, and hence the suction path 76 communicates with a
communication path 58a of the connector 58. It is to be noted that
as shown in FIG. 3B, the handle 56 is fixed in a state where the
central axis C1 of the inner sheath 72 shifts from a central axis
C2 of the outer sheath 74. Consequently, in the suction path 76,
there can be formed a portion in which a distance between the outer
peripheral surface of the inner sheath 72 and the inner peripheral
surface of the outer sheath 74 can be taken longer as compared with
circumstances where the central axes of the inner sheath 72 and the
outer sheath 74 are matched. Consequently, it is possible to suck
cut pieces larger than those in the circumstances where the central
axes of the inner sheath 72 and the outer sheath 74 are matched.
Needless to say, it is also preferable that the central axes C1 and
C2 of the inner sheath 72 and the outer sheath 74 are matched.
[0039] The distal end 72a of the inner sheath 72 extends to a
position closer to the treatment portion 64 of the probe 52 than a
distal end 74a of the outer sheath 74. Consequently, a region
between the distal end 72a of the inner sheath 72 and the distal
end 74a of the outer sheath 74, i.e., the inner sheath 72 extends
to the distal side as much as a distal portion 73 from the distal
end 74a of the outer sheath 74. Therefore, a suction opening 76a of
the suction path 76 is present at a position on the proximal side
from the distal end 72a of the inner sheath 72 along the central
axis C1.
[0040] As shown in FIG. 1, the perfusion apparatus 16 includes a
bag-shaped liquid source 82 that holds perfusate such as
physiological saline, a perfusion pump unit 84, a liquid feed tube
86 having one end connected to the liquid source 82, a liquid
discharge tube 88, and a suction bottle 90 connected to one end of
the liquid discharge tube 88. The suction bottle 90 is connected to
the suction pump unit 94 attached to a wall 92 of the operating
room. The perfusion pump unit 84 is capable of feeding out the
perfusate from the liquid source 82 by a liquid feed pump 84a.
Furthermore, the perfusion pump unit 84 is capable of opening and
closing a pinch valve 84b as a liquid discharge valve, whereby it
is possible to switch suction and suction stop of the perfusate in
the joint cavity 136 to the suction bottle 90.
[0041] An operation of the treatment system 10 according to this
embodiment will be described.
[0042] In case of performing an operation by use of the arthroscope
22, as shown in FIG. 2A, the ultrasonic transducer unit 44 is
attached to the ultrasonic treatment instrument 42, to form the
ultrasonic treatment assembly 32. Then, the connector 58 shown in
FIG. 2A is connected to the liquid discharge tube 88 shown in FIG.
1, to prepare the treatment system 10 shown in FIG. 1.
[0043] As shown in FIG. 1, an operator forms the first portal 102,
and disposes the first cannula 18a in the first portal 102 as
required. The operator disposes a distal end of the arthroscope 22
in the joint cavity 136 of the joint 100 through the first cannula
18a. Here, when the perfusion apparatus 16 is connectable to the
arthroscope 22, the first cannula 18a is not necessarily required.
The operator forms the second portal 104 and disposes the second
cannula 18b in the second portal 104. It is to be noted that here,
an example of use of the second cannula 18b is described, but the
second cannula lab is not necessarily required.
[0044] As to the ultrasonic treatment assembly 32 that performs the
cutting of the bone, the treatment portion 64 of the probe 52 and
the sheath unit 54 are inserted together with the arthroscope 22
into a narrow joint capsule 130. Then, the operator brings the
cutting region 66 of the treatment portion 64 into contact with an
area (a treatment target) S to be resected in the bone (see FIG. 4A
and FIG. 4B) on the basis of the projected image observed with the
arthroscope 22. In a state where the cutting region 66 is inserted
in a viewing field of the arthroscope 22, the operator operates the
switch 36 to supply the energy to the ultrasonic transducer unit 44
while operating the suction pump unit 94. Ultrasonic vibration is
generated in the ultrasonic transducer 44a of the ultrasonic
transducer unit 44, and the ultrasonic vibration is input into the
probe 52. Thus, the ultrasonic vibration is transmitted to the
cutting region 66 of the treatment portion 64, whereby a treatment
of resecting the area S to be resected in the bone can be performed
with the cutting region 66. By this treatment, a hard tissue such
as a bone spur can be removed. The operator removes, by suction,
bubbles or cut pieces generated during the treatment by use of the
ultrasonic treatment instrument 42, and acquires the viewing field
of the arthroscope 22. Parts of the cut pieces of the bone are fine
particles. Consequently, the resected and cut pieces are sucked
from the suction opening 76a between the outer peripheral surface
of the inner sheath 72 and the inner peripheral surface of the
outer sheath 74.
[0045] It is to be noted that the cut pieces that cannot enter the
suction opening 76a are floated in the joint cavity and collected
by using forceps or the like as required.
[0046] When the treatment portion 64 of the probe 52 is disposed to
face a distal end 22a of the arthroscope 22 as shown in FIG. 1, it
is possible to easily observe the cutting region 66 of the
treatment portion 64 and the area S to be resected in the bone with
the arthroscope 22. On the other hand, as shown in FIG. 4A and FIG.
4B, the treatment is occasionally performed while observing the
treatment portion 64 of the probe 52 from a rear side with the
arthroscope 22. At this time, when it is supposed that the distal
end 74a of the outer sheath 74 extends to the same position as the
distal end 72a of the inner sheath 72, it can easily be considered
that the distal end 74a of the outer sheath 74 which has the outer
diameter larger than an outer diameter of the inner sheath 72 would
obstruct the observation with the arthroscope 22. As shown in FIG.
3A, in this embodiment, the distal end 72a of the inner sheath 72
extends from the distal end 74a of the outer sheath 74 on the
distal side along the central axis C1, to project the cutting
region 66 of the treatment portion 64 of the probe 52 from the
distal end 72a of the inner sheath 72. In other words, the distal
end 72a of the inner sheath 72 extends farther than the distal end
74a of the outer sheath 74, that is, the suction opening 76a, to
cover the bent portion 64a of the treatment portion 64 of the probe
52. Again in other words, the suction opening 76a is formed at the
position on the proximal side along the central axes C1 and C2 to
the distal end 72a of the inner sheath 72. The outer diameter of
the inner sheath 72 is smaller than that of the outer sheath 74,
and hence when the distal end 72a of the inner sheath 72 extends to
the distal side from the distal end 74a of the outer sheath 74, it
is easy to confirm the cutting region 66 of the treatment portion
64 and the area S to be resected in the bone from the rear side
with the arthroscope 22. In other words, according to this
embodiment, as compared with circumstances where the distal end 74a
of the outer sheath 74 extends to the same position as the distal
end 72a of the inner sheath 72, it is easier to observe the cutting
region 66 of the treatment portion 64 of the probe 52 with the
arthroscope 22, because the presence of the outer sheath 74 having
the outer diameter larger than that of the inner sheath 72 is
eliminated in the distal portion 73 of the inner sheath 72 (a
region of the inner sheath 72 between the distal end 72a of the
inner sheath 72 and the distal end 74a of the outer sheath 74).
[0047] Furthermore, the bent portion 64a of the treatment portion
64 of the probe 52 is covered with the distal portion 73 of the
inner sheath 72. In particular, a proximal portion of the bent
portion 64a of the treatment portion 64 of the probe 52 is covered
with the distal portion 73 of the inner sheath 72. Consequently,
when the distal end of the arthroscope 22 is brought close to the
cutting region 66 from the rear side of the treatment portion 64 to
insert the cutting region into the viewing field, the bent portion
64a of the treatment portion 64 is prevented from being brought
into contact with the arthroscope 22, by the distal portion 73 of
the inner sheath 72. It is to be noted that when the distal end of
the arthroscope 22 is brought close to the cutting region 66 from
the rear side of the treatment portion 64 to insert the region into
the viewing field, needless to say, the bent portion 64a of the
treatment portion 64 is occasionally prevented from being brought
into contact with the arthroscope 22, by the outer peripheral
surface of the outer sheath 74 depending on a relative position
between the sheath unit 54 and the arthroscope 22.
[0048] It is to be noted that here, the example of the treatment of
cutting a hard tissue such as the bone is described, but also in
case of performing a treatment of removing a part of a
comparatively soft tissue such as the cartilage, the same treatment
assembly 32 is usable. Furthermore, also in a case of treating the
hard tissue or a case of treating the soft tissue, it is preferable
that the amplitude of the transducer 44a is suitably selected to
proceed with the treatment.
[0049] As described above, the ultrasonic treatment assembly 32 and
the ultrasonic treatment instrument 42 according to this embodiment
can be considered as follows.
[0050] In this structure, the distal end 72a of the inner sheath 72
extends farther than the distal end 74a of the outer sheath 74 (the
suction opening 76a), to cover the bent portion 64a of the
treatment portion 64 of the probe 52, whereby the distal portion 73
is formed. Moreover, the bent portion 64a of the probe 52 is
covered with the distal portion 73 of the inner sheath 72.
Therefore, the bent portion 64a of the probe 52 can be protected
from the contact with the arthroscope 22, by the distal portion 73
of the inner sheath 72. Consequently, a distal portion 63 of the
main body 62 of the probe 52 (a region of the bent portion 64a on
the proximal side) which is shown in FIG. 3A is protectable by the
inner sheath 72.
[0051] In addition, the distal end 72a of the inner sheath 72
extends farther than the distal end 74a of the outer sheath 74 (the
suction opening 76a). Thus, due to the structure where the inner
sheath 72 having the small outer diameter extends farther than the
outer sheath 74, it is possible to improve visibility of the
cutting region 66 with the arthroscope 22. Additionally, due to the
structure where the inner sheath 72 having the small outer diameter
extends farther than the outer sheath 74, it is possible to improve
visibility of the area S to be resected in the bone.
[0052] Therefore, due to the structure where the inner sheath 72
having the small diameter extends to cover the bent portion 64a of
the treatment portion 64 of the probe 52 on the distal side from
the suction opening 76a, it is possible to acquire easiness of the
treatment in the cutting region 66 of the treatment portion 64
while preventing the arthroscope 22 from coming in contact with the
bent portion 64a of the treatment portion 64 of the probe 52.
[0053] Here, it is not necessary to form a suction path in the
probe 52 itself. Therefore, the size and strength of the probe 52
can be maintained in a suitable state. At this time, the suction
path 76 is formed between the outer peripheral surface of the inner
sheath 72 and the inner peripheral surface of the outer sheath 74.
Consequently, the suitable suction path 76 can be acquired In this
embodiment, the central axis C1 of the inner sheath 72 shifts
slightly from the central axis C2 of the outer sheath 74, whereby a
broad portion and a narrow portion can be formed in the suction
path 76, and it is possible to inhibit the suction path from being
clogged with the comparatively large cut pieces and the like.
Second Embodiment
[0054] Next, a second embodiment will be described with reference
to FIG. 5. This embodiment is a modification of the first
embodiment, the same members or members having the same functions
as in the members described in the first embodiment are denoted
with the same reference signs, and detailed description is
omitted.
[0055] In the first embodiment, as shown in FIG. 2A to FIG. 3A, the
example where the inner sheath 72 has the straight state has been
described. In this embodiment, as shown in FIG. 5, a distal portion
73 of an inner sheath 72 is formed so that its outer diameter
decreases toward a distal side. In this case, it is preferable that
not only an inner diameter but also the outer diameter of the
distal portion 73 of the inner sheath 72 decrease toward the distal
side. It is preferable that the diameter of the distal portion 73
of the inner sheath 72 decreases from its proximal side toward the
distal side. It is preferable that the distal portion 73 of the
inner sheath 72 is formed into, for example, a tapered shape so
that its diameter decreases toward the distal side.
[0056] In case of FIG. 5, the distal portion 73 of the inner sheath
72 is formed into a state where its diameter decreases toward the
distal side, whereby when a cutting region 66 is observed with an
arthroscope 22, the observation of the cutting region 66 can be
prevented from being obstructed by the distal portion 73 of the
inner sheath 72 as compared with the first embodiment mentioned
above. Furthermore, a distal portion 63 of a main body 62 of a
probe 52 (a region of a bent portion 64a on the proximal side) can
be protected by the presence of the distal portion 73 of the inner
sheath 72.
Third Embodiment
[0057] Next, a third embodiment will be described with reference to
FIG. 6A and FIG. 6B. This embodiment is a modification of the first
and second embodiments, the same members or members having the same
functions as in the members described in the first and second
embodiments are denoted with the same reference signs, and detailed
description is omitted.
[0058] A distal portion (a region having a suitable length (e.g.,
from several millimeters to several tens of millimeters) from a
distal end 74a of the outer sheath 74 along a central axis C2
toward a proximal side) 75 of the outer sheath 74 has through-holes
75a which communicate between an outer peripheral surface of the
outer sheath 74 and an inner peripheral surface thereof. In other
words, the through-holes 75a communicate between the outer
peripheral surface of the outer sheath 74 and a suction path 76. A
hole diameter of the through-holes 75a is suitably settable. For
example, the hole diameter may be larger or smaller than a width of
a suction opening 76a in a radial direction which is prescribed by
an outer peripheral surface of an inner sheath 72 and an inner
peripheral surface of the distal end 74a of the outer sheath 74.
Needless to say, the hole diameter of the through-holes 75a is set
to a size so that when an arthroscope 22 comes in contact with the
outer peripheral surface of the outer sheath 74, the arthroscope
does not contact the outer peripheral surface of the inner sheath
72. As one example, the hole diameter of the through-holes 75a may
be of the same degree as or smaller than a size of presumed cut
pieces of a bone.
[0059] An operation of a treatment system 10 according to this
embodiment will be described.
[0060] For example, when a membranous biological tissue such as a
synovial membrane (not shown) in a joint cavity 136 covers the
suction opening 76a, the suction opening 76a is clogged. In this
case, according to the examples described in the first and second
embodiments, the suction path 76 is cut off. In this embodiment,
the through-holes 75a have a suitable diameter, and hence the
through-holes 75a are used as suction openings together with the
suction opening 76a. Consequently, even when the suction opening
76a is clogged, particles of cut pieces can continue to be sucked
through the through-holes 75a and the suction path 76. In
consequence, due to the through-holes 75a, the suction opening can
be prevented from being clogged with the cut pieces, and it is easy
to always acquire a viewing field by the arthroscope 22.
[0061] As described above, an ultrasonic treatment assembly 32 and
an ultrasonic treatment instrument 42 according to this embodiment
can be considered as follows.
[0062] The cut pieces generated by a cutting treatment with a
cutting region 66 of a treatment portion 64 are occasionally stuck
on the suction opening 76a. In the distal portion 75 of the outer
sheath 74, the optional number of the through-holes 75a each having
an optional diameter are formed in an optional direction, whereby
even when the suction opening 76a is closed, it is possible to
prevent the suction through the suction path 76 from being stopped
because the suction is performed from the through-holes 75a. In
consequence, it is possible to always acquire the observation
viewing field of the arthroscope 22.
Fourth Embodiment
[0063] Next, a fourth embodiment will be described with reference
to FIG. 7A to FIG. 8B. This embodiment is a modification of the
first to third embodiments, the same members or members having the
same functions as in the members described in the first to third
embodiments are denoted with the same reference signs, and detailed
description is omitted.
[0064] An inner sheath 72 includes a cutout portion 77 extending
from a distal end 72a toward a predetermined position on a proximal
side. The cutout portion 77 is formed especially in a distal
portion 73 of the inner sheath 72. The cutout portion 77 is
straightly formed in parallel along a central axis C1. A length of
the cutout portion 77 in a direction along the central axis C1 of
the inner sheath 72 is substantially equal to a length of the
distal portion 73 in the central axis C1. The cutout portion 77
includes a pair of edge portions 77a straightly formed in parallel
along the central axis C1 and facing each other, and a semicircular
bottom portion 77b provided at proximal ends of the edge portions
77a. The proximal ends of the pair of edge portions 77a are
smoothly continuous with the bottom portion 77b. The cutout portion
77 is formed on a projecting side of the distal portion 73 of the
inner sheath 72 on which a cutting region 66 of a treatment portion
64 of a probe 52 is present.
[0065] A width W of the cutout portion 77 between the pair of edge
portions 77a which is perpendicular to the central axis C1 of the
inner sheath 72 is smaller than a diameter D (see FIG. 4A and FIG.
4B) of a minimum region of a distal portion of an arthroscope 22.
Furthermore, a suitable clearance is formed between an inner
peripheral surface of the distal portion 73 of the inner sheath 72
and the bent portion 64a of the treatment portion 64 of the probe
52.
[0066] An operation of a treatment system 10 according to this
embodiment be described.
[0067] The cutout portion (a groove) 77 having the width W smaller
than the diameter D of the arthroscope 22 is formed in the distal
portion 73 of the inner sheath 72. Consequently, as shown in FIG.
4B, when an area S to be resected in a bone is observed with the
arthroscope 22 and the cutting region 66 of the treatment portion
64 is observed therewith, the area S and the cutting region 66 are
both observed through the cutout portion 77 of the inner sheath
72.
[0068] Furthermore, even when the arthroscope 22 contacts the
cutout portion 77, the arthroscope 22 is prevented from coming in
contact with the bent portion 64a of the treatment portion 64 of
the probe 52. In particular, when the cutting region 66 of the
treatment portion 64 is brought into contact with the area S to be
resected in the bone, the bent portion 64a is elastically deformed
in a direction away from the cutout portion 77. Consequently, a
distance between the bent portion 64a of the treatment portion 64
of the probe 52 and the cutout portion 77 of the distal portion 73
of the inner sheath 72 increases Therefore, the arthroscope 22 is
prevented from coming in contact with the probe 52 to which
ultrasonic vibration is being transmitted.
[0069] As described above, an ultrasonic treatment assembly 32 and
an ultrasonic treatment instrument 42 according to this embodiment
can be considered as follows.
[0070] The inner sheath 72 extends as much as the distal portion 73
from a distal end 74a of an outer sheath 74 on a distal side. In
this embodiment, the cutout portion 77 is formed in the distal
portion 73 of the inner sheath 72, whereby it is easier to insert
the cutting region 66 of the treatment portion 64 into a viewing
field of the arthroscope 22 through the cutout portion 77 of the
inner sheath 72, as compared with circumstances where the cutout
portion 77 is not present. Furthermore, it is possible to observe
the area S to be resected in the bone while observing the cutting
region 66 of the treatment portion 64 through the cutout portion 77
of the inner sheath 72 with the arthroscope 22. In consequence, it
is possible to acquire the observation viewing field of the
arthroscope 22.
[0071] Furthermore, the width W of the cutout portion 77 of the
inner sheath 72 is smaller than the diameter D of the arthroscope
22. In consequence, the arthroscope 22 can be prevented from coming
in contact with the treatment portion 64 of the probe 52.
[0072] Thus, the width W of the cutout portion 77 formed in the
inner sheath 72 is smaller than the diameter D of the arthroscope
22, whereby it can be easier to insert the cutting region 66 of the
treatment portion 64 into the viewing field of the arthroscope 22
while preventing the arthroscope 22 from coming in contact with the
treatment portion 64 of the probe 52.
Fifth Embodiment
[0073] Next, a fifth embodiment will be described with reference to
FIG. 9A and FIG. 9B. This embodiment is a modification of the first
to fourth embodiments, but is especially a modification of the
fourth embodiment among these embodiment the same members or
members having the same functions as in the members described in
the first to fourth embodiments are denoted with the same reference
signs, and detailed description is omitted.
[0074] As shown in FIG. 9A, a cutout portion 177 is formed in a
distal portion 73 of an inner sheath 72. The cutout portion 177
includes a pair of edge portions 177a and a bottom portion 177b The
pair of edge portions 177a are not formed in parallel with a
central axis C1 of the inner sheath 72, but are obliquely formed.
In other words, the cutout portion 177 is formed to tilt to the
central axis C1 of the inner sheath 72. It is preferable that the
pair of edge portions 177a are parallel to each other.
[0075] When a treatment of cutting a bone of a treatment target is
performed, a cutting region 66 of a treatment portion 64 is
observed obliquely from a rear side with an arthroscope 22 in most
cases. Consequently, in a state where a positional relation between
the arthroscope 22 and the treatment portion 64 is determined, the
edge portions 177a of the cutout portion 177 may have a straight
state, but when the edge portions obliquely extend, it can be easy
to observe the cutting region 66 of the treatment portion 64 with
the arthroscope 22. In particular, when the arthroscope 22 and a
treatment instrument 42 have such a state as shown in FIG. 4A, that
is, when the arthroscope 22 is disposed on a right rear side of the
treatment instrument 42, and when the cutout portion 177 having
such a shape as shown in FIG. 9A is formed, it can be easy to
observe the treating region 66.
[0076] An extending direction of the cutout portion 177 shown in
FIG. 9A may be a direction shown in FIG. 9B. This can further
contribute to easiness of the observation of the treatment portion
64, when a positional relation between portals 102 and 104 (see
FIG. 1) is determined. In particular, when the arthroscope 22 is
disposed on a left rear side of the treatment instrument 42
conversely to the state of the arthroscope 22 and the treatment
instrument 42 shown in FIG. 4A and when the cutout portion 177
having such a shape as shown in FIG. 9B is formed, it can be easy
to observe the cutting region 66.
[0077] Here, there is described the example where the pair of edge
portions 177a of the cutout portion 177 are parallel to each other
as shown in FIG. 9A and FIG. 9B. Alternatively, it is also
preferable that a cutout width between the pair of edge portions
177a decreases toward a distal end 72a of the inner sheath 72.
[0078] Additional advantages and modifications will readily occur
to those skilled in the art. Therefore, the invention in its
broader aspects is not limited to the specific details and
representative embodiments shown and described herein. Accordingly,
various modifications may be made without departing from the spirit
or scope of the general inventive concept as defined by the
appended claims and their equivalents.
* * * * *