Patent Application
20190247070
The present disclosure relates to an ultrasonic probe that is used to perform a procedure on a target site for procedure in a joint based on ultrasonic vibrations.
Typically, an arthroscopic surgery is known in which portals are opened at about two positions near a joint; a rigid endoscope representing an arthroscope and a therapeutic apparatus are inserted from the portals; the inside of the joint is filled with a circulating water meant to be used in a joint surgery; and a procedure is performed while checking the video displayed on a monitor.
As far as the therapeutic apparatus is concerned, an ultrasonic device is proposed that has an ultrasonic vibrator installed therein, that performs ultrasonic output using an ultrasonic probe, and that performs arbitrary procedures based on ultrasonic vibrations.
In such an ultrasonic probe, a procedure unit is installed at the front end of the probe main body that extends in a linear manner. Usually, when an operator holds the ultrasonic probe, a cutting surface made of a corrugated surface is formed on the underside of the procedure unit.
Examples of an arthroscopic surgery include a surgical procedure performed on the ruptured meniscus of a knee joint. The ultrasonic probe that undergoes ultrasonic vibrations performs the procedure of cutting the ruptured portion and fixing the shape. The meniscus is sandwiched in between the femur and the tibia of the knee joint; and, depending on the site therein, is called an anterior portion, a middle portion, a posterior horn, and a posterior portion, for example. Consider an example of performing a procedure on the targets for procedure such as the posterior portion or the posterior horn and the anterior portion or the anterior horn. In the case of inserting the ultrasonic probe from the same portal, if the positions of the damaged portions are different in the anteroposterior direction, then a situation may occur in which the cutting surface of the procedure portion either cannot make contact with the target site for procedure or does not make contact at an appropriate angle.
In such a case, the ultrasonic probe needs to be replaced with another one or, if replacement is not possible, the position of opening the portal needs to be adjusted; or a new portal needs to be opened.
According to one aspect of the present disclosure, there is provided a method for performing a procedure on a meniscus, via an ultrasonic surgical tool. The ultrasonic surgical tool may include a probe formed in an elongated shaft shape and capable of transmitting ultrasonic vibration from a proximal end to a front end. The probe may include a bent portion that is inclined with respect to a longitudinal axis of a probe main body, and a procedure portion that is disposed at the front end of the probe and that has a plurality of cutting surfaces.
The method may include inserting the probe in a body; moving the probe through a space between a femur and a tibia to position the procedure portion adjacent to a horizontal rupture in the meniscus; positioning a cutting surface of the procedure portion of the probe on posterior portion of the meniscus; and resecting the horizontal rupture along an inclination of the meniscus to form an inclined resection plane.
The above and other features, advantages and technical and industrial significance of this disclosure will be better understood by reading the following detailed description of presently preferred embodiments of the disclosure, when considered in connection with the accompanying drawings.
Exemplary embodiments of an ultrasonic probe of an ultrasonic surgical tool are described below with reference to the accompanying drawings.
An ultrasonic surgical tool system 1 according to the present embodiment mainly includes an ultrasonic surgical tool 2; an electrical power source 3; and a foot switch 4 that is used to instruct turning on or turning off the ultrasonic vibrations. The ultrasonic surgical tool 2 and the electrical power source 3 are connected by a cable 19 that enables supply of driving power and communication of control signals. In the electrical power source 3, a plurality of connectors 20 is disposed on an anterior surface 18 for enabling establishment of connection with the cable 19, various operation switches 21, and a display screen 22 that is used to display the information necessary for procedures. Moreover, depending on the procedure or the details of the surgery, the electrical power source 3 is separately used in combination with an endoscopic system.
The ultrasonic surgical tool 2 includes a device main body 11 and an ultrasonic probe 14. The device main body 11 has a tubular shape with a holdable diameter, and includes a housing 11a through which the ultrasonic probe 14 is disposed and an ultrasonic vibrator unit (an ultrasonic wave generating unit) 11b that is detachably attached to the housing 11a. Inside the ultrasonic vibrator unit 11b, an ultrasonic wave generating unit 12 that is made of ultrasonic vibrators such as piezoelectric bodies is housed along with a horn 13 that is meant for efficiently transmitting the ultrasonic waves. When the ultrasonic vibrator unit 11b is attached to the housing 11a, the proximal end of the ultrasonic probe 14 and the front end of the horn 13 are sonically connected, and the ultrasonic vibrations generated in the ultrasonic wave generating unit 12 are transmitted to a procedure portion 15 (described later) of the ultrasonic probe 14. On the top surface of the housing 11a is disposed an operation switch 17 that is used instruct turning on or turning off the ultrasonic vibrations according to finger operations. Thus, the foot switch 4 has an equivalent function to the operation switch 17.
The ultrasonic probe 14 is an elongated rod-like shaft member (probe main body) that transmits the ultrasonic vibrations, and is made of a metallic material such as a titanium alloy. Moreover, to the proximal end of the ultrasonic probe 14, the front end of the horn 13 is sonically connected; and, to the front end of the ultrasonic probe 14, the procedure portion 15 is disposed in an integrated manner. Furthermore, the ultrasonic probe 14 has a curvature (a curved portion) that becomes bowed or bends in such a way that, when an operator holds the ultrasonic probe 14 in the normal holding pattern in which the cutting surface is on the underside, the ultrasonic probe 14 bends upward at a position more on the proximal end of the probe main body than the procedure portion 15. Because of the bending, the procedure portion 15 becomes more raised obliquely upward than usual.
The ultrasonic probe 14 is covered by a sheath 16 for an arbitrary length starting from the housing 11a. The sheath 16 is not closely attached to the ultrasonic probe 14 but is disposed with a small clearance gap from the ultrasonic probe 14 so as to prevent attenuation of the ultrasonic vibrations. Moreover, the sheath 16 is fixed to the front end side of the housing 11a at the nodal position of the ultrasonic vibrations. As a result of disposing the sheath 16, in case there is contact with sites other than the target for procedure or contact with other surgical tools or an endoscope, the effect of the contact can be eliminated and the devices and the sites can be protected.
Given below is the explanation of a surgery system that includes an ultrasonic surgical tool and an endoscopic system.
As described earlier, the ultrasonic surgical tool 2 includes the ultrasonic wave generating unit 12, the ultrasonic probe 14, the electrical power source 3, and the operation switch 17.
The endoscopic system 30 is configured with the following: an arthroscope 31 that is made of a rigid endoscope representing a type of endoscope; a visible-light source 32 that functions as the light source of illumination light and that emits visible illumination light; a control unit 33 that controls the entire endoscopic system 30; an input unit 34 such as a keyboard or a touch-sensitive panel; a display unit 35 that displays surgery information containing the photographed surgery status; and a saline delivery-drainage unit 36 that delivers, drains, and perfuses a normal saline solution in the surroundings of a procedure target site 100. In the present embodiment, the saline delivery-drainage unit 36 is configured to perform delivery and drainage of a normal saline solution at the location for procedure via the arthroscope 31. However, alternatively, the configuration can be such that a perfusing medium including a normal saline solution is delivered and drained from the ultrasonic surgical tool 2.
Explained below with reference to
The procedure portion 15 according to the present embodiment is cuboid in shape; has a bone cutting function and a cartilage cutting function based on ultrasonic vibrations as described later; and is capable of performing the desired surgical procedure (mainly the resection procedure) on the procedure target site (or the procedure target location) 100. Meanwhile, as long as the procedure portion is substantially cuboid in shape, it serves the purpose. Moreover, the procedure portion has a flat shape.
Of the procedure portion 15, the top surface and the under surface (the principal surfaces) are rectangular in shape with rounded corners. Moreover, the thickness of the procedure portion 15 is such that it can pass through the space in between narrow joints (in the case of a knee joint, the space in between the femur and the tibia) and can reach the target site for procedure. There is no restriction on the thickness, and it can be appropriately set depending on the intended usage. Regarding the probe main body of the ultrasonic probe 14 too, the length thereof is set according to the position of the target site for procedure.
As illustrated in
Moreover, on both lateral surfaces of the procedure portion 15, lateral cutting surfaces 15c are formed in which a plurality of U-shaped grooves is arranged in a seriate flounder pattern in the vertical direction (the thickness direction). Moreover, on the anterior surface (the apical surface) too, an apical cutting surface 15d is formed in which a plurality of U-shaped grooves is arranged in a flounder pattern.
Meanwhile, as far as the cutting surfaces of the procedure portion 15 according to the present embodiment are concerned, the cutting surfaces can be formed on the abovementioned five surfaces excluding the surface connected to the probe main body. From among the cutting surfaces; three cutting surfaces, namely, the first main cutting surface 15a formed on the underside and the lateral cutting surfaces 15c formed on both lateral surfaces represent reference surfaces for cutting that are fundamentally essential in cutting procedures, and hence are called “reference cutting surfaces”. On the other hand, in the procedure portion 15, the second main cutting surface formed on the top surface and the apical cutting surface formed on the apical surface are formed only if necessary and are required depending on the procedure details, and hence are called “selective cutting surfaces”. This line of thinking is based on the following presumption: regarding an ultrasonic probe having excess cutting surfaces formed thereon that are not used according to the procedure details, the operator needs to ensure that the unused cutting surfaces of such an ultrasonic probe does not come in contact with and cause damage to the surrounding sites. In that regard, in order to be able to deal with the procedure details, the second main cutting surface and the apical cutting surface can be selectively formed depending on the procedure details. For that reason, those cutting surfaces are called selective cutting surfaces.
Moreover, when an operator holds the ultrasonic probe 14 in the normal holding pattern in which the cutting surface 15a (described later) is on the underside, the front end side of the ultrasonic probe 14 is bent upward in such a way that the probe main body bends backward at a position away by about 10 mm from the front end of the procedure portion 15. Meanwhile, the corrugated pattern formed on each cutting surface of the ultrasonic probe 14 is not limited to the arrangement described above, and can be appropriately modified according to the intention of the procedure.
The procedure portion 15 of the ultrasonic probe 14 performs mechanical cutting according to minor sliding to which ultrasonic vibrations are applied. Herein, the amount of scraping can be adjusted according to the strength of the press against the procedure target site 100 (i.e., depending on the pressing pressure). That is, the scraping amount is controlled according to the adjustments made by the operator, thereby enabling efficient cutting and resection. In the following explanation, in the case of performing cutting or performing a procedure using the procedure portion 15, it is assumed that the procedure portion 15 undergoes ultrasonic vibrations even if it is not explicitly mentioned. Moreover, although the ultrasonic surgical tool 2 according to the present embodiment is configured without a mechanism for delivering and draining a perfusing medium, it is alternatively possible to dispose a mechanism for delivering and draining a perfusing medium depending on the intended usage.
Given below is the explanation of an example of a procedure performed on a meniscus that represents an example of the target for procedure of the ultrasonic surgical tool 2 according to the present embodiment.
As illustrated in
For example, as illustrated in
On the other hand, in case a horizontal rupture is developed only within the range of the no-blood-flow area C, the ruptured location is resected to form an inclined resection plane 102. In order to form the inclined resection plane, it becomes necessary to adjust the manner of abutment (i.e., the angle of surface contact) of the ultrasonic probe 14 (described later).
Meanwhile, the inclination of the resection plane, which is formed using the ultrasonic probe 14, is used to avoid concentration of and enable dispersion of the stress attributed to a femur 43. More particularly, in a normal meniscus, the top surface making contact with the femur as illustrated in
Moreover, as illustrated in
Explained below with reference to
An exemplary embodiment is discussed below under the assumption that a horizontal rupture is developed in each portion of the meniscus 100 representing the target for procedure. In
Firstly, the ultrasonic probe 14 is inserted from a portal 51, and the arthroscope 31 is inserted from a portal 52. The positions of the portals should be appropriately set according to the individual differences of the patient, the targets for procedure, and the procedure details.
As illustrated in
With reference to
Then, as illustrated in
Subsequently, as illustrated in
With reference to
Meanwhile, the target sites for procedure are not limited to the meniscus. As illustrated in
According to the present embodiment, a cutting procedure on the target sites for procedure can be performed using the principal surfaces formed on the upper side and the lower side of the ultrasonic probe, using both lateral surfaces, and using the apical surface. Hence, even if the approach is from the same portal, by changing the posture of the ultrasonic probe, the reachable range of the procedure portion 15 becomes wider thereby widening the procedure range. As a result, the desired cutting procedure can be performed without having to open new portals.
Given below is the explanation of another exemplary embodiment.
In a procedure portion 25 of the ultrasonic probe 14 according to the present embodiment, a cutting surface 25a that is meant for rough cutting and that is made of a corrugated surface having a crosshatch pattern or a twill line pattern due to a plurality of U-shaped grooves is formed on the lower principal surface. In an identical manner, a cutting surface 25b that is made of a corrugated surface having a crosshatch pattern or a twill line pattern is formed on the upper principal surface.
Moreover, on one lateral surface of the procedure portion 25, for example, a raspatory surface 25d can be formed by cohesively using granular diamond or borazon abrasive grain. Furthermore, on the lateral surface is formed a lateral cutting surface 25c in which a plurality of U-shaped grooves is arranged in a flounder pattern. Moreover, on the anterior surface (the apical surface) is formed an apical cutting surface 25e in which a plurality of U-shaped grooves is arranged in a flounder pattern. Furthermore, when an operator holds the ultrasonic probe 14 in the normal holding pattern in which the cutting surface 25a (described later) is on the underside, the front end side of the ultrasonic probe 14 is bent upward in such a way that the probe main body 14 bends backward at a position away by about 10 mm from the front end of the procedure portion 25. Meanwhile, the raspatory surface 25d formed by cohesively using granular diamond or borazon abrasive grain can be adapted in other exemplary embodiments too.
According to the present embodiment, because of the procedure portion 25 of the ultrasonic probe 14, in the cutting procedure, operations from rough cutting to finishing of the target site for procedure can be performed using only a single ultrasonic probe without having to replace it. As a result, the surgery can be continued without any interruption for probe replacement, thereby enabling achieving reduction in the time and efforts of the operator and shortening of the period of time taken for surgery. Particularly, in the ultrasonic probe 14 according to the present embodiment, since the probe main body on the near side is configured to have a bent shape, when the insertion path inside a joint is curved, the procedure portion 25 can be inserted using the bend thereby enabling achieving enhancement in the accessibility.
In the exemplary embodiments described above, the ultrasonic probe 14 is configured to have a bent shape. However, the ultrasonic probe 14 need not always be bent. For example, at the time of resecting a bony spur, it is expected to use a probe not having any bends. Moreover, because of not having any bends, when there are different cutting blades for all cutting surfaces, it becomes possible to deal with various procedures.
Given below is the explanation of another exemplary embodiment.
As illustrated in
Moreover, in the procedure portion 26, a plurality of vertical U-shaped grooves 27 are formed in a flounder pattern on both lateral surfaces and the anterior surface (the apical surface), thereby resulting in the formation of cutting surfaces 26c and 26e. The arrangement of the U-shaped grooves 27 and the U-shaped grooves 28 is such that a flounder pattern, a crosshatch pattern, or a twill line pattern is formed. Moreover, the U-shaped grooves 27 as well as the U-shaped grooves 28 either can be arranged at regular intervals or can be arranged with different intervals set therebetween.
When an operator holds the ultrasonic probe 14 in the normal holding pattern in which the cutting surface 26a (described later) is on the underside, the front end side of the ultrasonic probe 14 is bent upward in such a way that the probe main body 14 bends backward at a position away by about 10 mm from the front end of the procedure portion 26.
According to the present embodiment, apart from the fact that resection is performed using only one principal surface, it becomes possible to achieve the identical actions and effect to the embodiment described above.
Given below is the explanation of another exemplary embodiment.
In a procedure portion 29 of the ultrasonic probe 14, cutting surfaces 29a and 29b that are made of corrugated surfaces having a crosshatch pattern due to the plurality of U-shaped grooves 28 are formed on the lower principal surface and the upper principal surface, respectively. The arrangement of the U-shaped grooves 28 is such that a flounder pattern, a crosshatch pattern, or a twill line pattern is formed. Moreover, the U-shaped grooves 28 either can be arranged at regular intervals or can be arranged with different intervals set therebetween.
Moreover, on both lateral faces of the procedure portion 29, lateral cutting surfaces 29c are formed in which the plurality of U-shaped grooves 27 is arranged in a seriate flounder pattern in the vertical direction (the thickness direction). However, there is no cutting surface formed on the anterior surface (the apical surface).
When an operator holds the ultrasonic probe 14 in the normal holding pattern in which the cutting surface 29a (described later) is on the underside, the front end side of the ultrasonic probe 14 is bent upward in such a way that the probe main body 14 bends backward at a position away by about 10 mm from the front end of the procedure portion 29.
According to the present embodiment, apart from eliminating the cutting using the front end, it becomes possible to achieve the identical actions and effect to the embodiment described above. Moreover, this ultrasonic probe 14 is suitable for such target sites for procedure in which even though the front end of the procedure portion makes contact, the location of contact is not to be cut.
Meanwhile, in the above exemplary embodiments, the explanation is given for an example in which the procedure portion is cuboid in shape with rounded corners (having only rectangular surfaces, or a box shape enclosed by rectangular surfaces or square surfaces). However, that is not the only possible case. Herein, the surface at which the procedure portion and the target site for procedure come in contact is treated as the bottom surface.
Thus, the procedure portion having a cuboid shape is formed using the surfaces formed by the sides present in the direction orthogonal to the longitudinal axis of the probe main body. Alternatively, using the surfaces such as trapezoids formed by the sides present in the directions intersecting with the longitudinal axis of the probe main body, the procedure portion having the shape of a quadratic prism can be formed. For example, the surface on which the procedure portion is to be formed can be of a box shape formed by combining trapezoids. For example, when the two principal surfaces (15a and 15b) have a trapezoidal shape, a quadratic prism is obtained whose front end side in the width direction has a narrowing shape or an expanding shape in the width direction. When both lateral surfaces have a trapezoidal shape, a quadratic prism is obtained that becomes smaller or bigger in the thickness direction of the front end side. Of course, it is possible to have a quadratic prism in which the two principal surfaces and both lateral surfaces have a trapezoidal surface shape.
Additional advantages and modifications will readily occur to those skilled in the art. Therefore, the disclosure 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.
This application is a continuation of International Application No. PCT/JP2016/082190, filed on Oct. 28, 2016, the entire contents of which are incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/JP2016/082190 | Oct 2016 | US |
| Child | 16395476 | US |
