Treatment instruments

Abstract

Treatment instrument (12) comprising: a first treatment body (344) having a treatment surface (352) to be used as a high-frequency electrode and configured to receive, together or separately, a high-frequency energy and another energy that differs from the high-frequency energy input into the treatment surface (352); and a second treatment body (402) configured to treat a treatment target in conjunction with the treatment surface (352), wherein the second treatment body (402) comprises: a contact section (462) extending along a longitudinal axis (L2) and possessing an electrically insulating property; and a first surface (452) which is used as the first high-frequency electrode, wherein: the first surface (452) borders the contact section (462) in a first lateral direction (W1) perpendicular to the longitudinal axis (L2), the contact section (462) faces the treatment surface (352) of the first treatment body (344), wherein the contact section (462) is configured to move between an open state in which the contact section (462) is separated from the treatment surface (352) along opening and closing directions, and a closed state in which the contact section (462) is closed relative to the treatment surface (352), and the contact section (462) is configured to be brought into contact with the treatment surface (352) in the closed state, and the first surface (452) is separated from the treatment surface (352) in both the open and closed states and comprises a first near edge (482a) of the first surface (452), wherein the first near edge (482a) is located near the contact section (462); and a first outer edge (482b) which is spaced from the contact section (462) from the longitudinal axis (L2) in the direction of a first side surface (384a) of a treatment section (326) in the first width direction (W1), and Assuming that a virtual plane (VP) is defined such that in the closed state it is perpendicular to the opening and closing directions and passes through the first near edge (482a) of the first surface (452), at a distance between the virtual plane (VP) and the first surface (452) a distance between the first outer edge (482b) and the virtual plane (VP) is greater than a distance between the first near edge (482a) and the virtual plane (VP).

Description

FIELD

[0001] The present invention relates generally to a treatment instrument configured to perform a suitable treatment on a treatment target. BACKGROUND

[0002] For example, JP 2017-225 882 A shows a treatment instrument comprising a treatment unit with a heater and a pair of high-frequency electrodes. The treatment unit includes a pair of handles, one of which, the first handle, is equipped with the heater and a first electrode. The other, the second handle, is equipped with a second electrode. When a treatment target is grasped by the treatment unit, the second handle, in conjunction with the first handle, exerts a gripping pressure on the treatment target from the center to the outer edge of the second electrode in the lateral direction.

[0003] When a high-frequency current flows between the first and second electrodes to the treatment target, the target is coagulated. When the heating element of the first handle is heated and the heat is transferred to the treatment target, the target is incised. In the latter treatment, a high-frequency current can be directed to flow between the first and second electrodes to the treatment target.

[0004] When treatment is performed with the treatment instrument, it is necessary that an efficient treatment is carried out with less energy.

[0005] WO 2015 / 137 139 A1 discloses a clamping device and a bipolar treatment instrument.

[0006] US 2012 / 0277778A1 discloses an ultrasonic surgical instrument comprising an ultrasonic vibrator, a vibration transmission section, a handle part, a pad part arranged at a point on the handle part facing the treatment section, and a flat counter surface seated on the pad part. SUMMARY

[0007] One objective of the present invention is to provide a treatment instrument with which a treatment target can be treated efficiently.

[0008] According to one aspect of the invention, a treatment instrument comprises: a first treatment body with a treatment surface to be used as a high-frequency electrode, configured to receive, together or separately, high-frequency energy and another energy that differs from the high-frequency energy introduced into the treatment surface; and a second treatment body configured to treat a treatment target in conjunction with the treatment surface. The second treatment body comprises: a contact section extending along a longitudinal axis and possessing electrical insulating properties; and a first surface used as the first high-frequency electrode. The first surface borders the contact section in a first lateral direction perpendicular to the longitudinal axis. The contact section faces the treatment surface of the first treatment body.The contact section is configured to move between an open state, in which the contact section is separated from the treatment surface in both the opening and closing directions, and a closed state, in which the contact section is closed relative to the treatment surface. The contact section is configured so that it can be brought into contact with the treatment surface in the closed state. The first surface is separated from the treatment surface in both the open and closed states and comprises a first near edge of the first surface, the first near edge being located close to the contact section; and a first outer edge spaced from the contact section along its longitudinal axis to a first side surface of a treatment section in the first width direction.Assuming that a virtual plane is defined such that, in the closed state, it is perpendicular to the opening and closing directions and passes through the first near edge of the first surface at a distance between the virtual plane and the first surface, a distance between the first outer edge and the virtual plane is greater than a distance between the first near edge and the virtual plane. BRIEF DESCRIPTION OF THE DRAWINGS Fig. Figure 1 is a schematic representation of a treatment system in which a treatment instrument according to a first embodiment is used. Fig. Figure 2 is a cross-sectional view schematically showing a state in which a treatment section of the treatment instrument according to the first embodiment is closed, in a cross-section substantially perpendicular to an extension direction of the treatment section. Fig. Figure 3A is a cross-sectional view schematically showing a state in which a treatment section of the treatment instrument according to the first embodiment is open, in a cross-section substantially perpendicular to the extension direction of the treatment section. Fig. 3B is a schematic enlarged view of a position located in Fig. 3A is marked with the reference number 3B. Fig. Figure 4 is a cross-sectional view that schematically shows a state in which a treatment target is grasped between a first gripping part and a second gripping part of the treatment section of the treatment instrument according to the first embodiment in a cross-section substantially perpendicular to the extension direction of the treatment section. Fig. Figure 5A is a cross-sectional view that schematically shows a state in which a treatment target is grasped between a first gripping part and a second gripping part of a treatment section of a treatment instrument according to a first modification of the first embodiment in a cross-section substantially perpendicular to an extension direction of the treatment section. Fig. 5B is a schematic enlarged view of a position identified by the reference number 5B in Fig. 5A is displayed. Fig. Figure 6A is a cross-sectional view that schematically shows a state in which a treatment target is grasped between a first gripping part and a second gripping part of a treatment section of a treatment instrument according to a second modification of the first embodiment in a cross-section substantially perpendicular to an extension direction of the treatment section. Fig. Figure 6B is a cross-sectional view that schematically shows a state in which a treatment target is grasped between a first gripping part and a second gripping part of a treatment section of a treatment instrument according to a third modification of the first embodiment in a cross-section substantially perpendicular to an extension direction of the treatment section. Fig. Figure 7 is a cross-sectional view that schematically shows a state in which a treatment target is gripped between a first gripping part and a second gripping part of a treatment section of a treatment instrument according to a fourth modification of the first embodiment in a cross-section substantially perpendicular to an extension direction of the treatment section. Fig. Figure 8 is a cross-sectional view that schematically shows a state in which a treatment target is grasped between a first gripping part and a second gripping part of a treatment section of a treatment instrument according to a fifth modification of the first embodiment in a cross-section substantially perpendicular to an extension direction of the treatment section. Fig. Figure 9 is a cross-sectional view that schematically shows a state in which a treatment target is grasped between a first gripping part and a second gripping part of a treatment section of a treatment instrument according to a sixth modification of the first embodiment in a cross-section substantially perpendicular to an extension direction of the treatment section. Fig. Figure 10 is a schematic view showing a treatment system in which a treatment instrument according to a second embodiment is used. Fig. Figure 11 is a schematic representation showing a configuration of a distal end section of a shaft and a treatment section of the treatment instrument according to the second embodiment, viewed from one side in the width direction of the treatment section, and part of it is shown in a cross-section perpendicular or substantially perpendicular to the width direction of the treatment section. Fig. Figure 12 is a schematic representation showing a configuration of the distal end section of the shaft and the treatment section of the treatment instrument according to the second embodiment, viewed from one side in a direction parallel or substantially parallel to an axis of rotation of the treatment section, and also showing an internal configuration of the shaft. Fig. Figure 13 is a cross-sectional view schematically showing a state in which a treatment section of the treatment instrument according to the second embodiment is closed, in a cross-section that is substantially perpendicular to an extension direction of the treatment section (a cross-section extending along line XIII-XIII in Fig. 12 is recorded). Fig. Figure 14 is a cross-sectional view schematically showing a state in which a treatment section of the treatment instrument according to the second embodiment is open, in a cross-section substantially perpendicular to the extension direction of the treatment section. Fig. Figure 15 is a cross-sectional view that schematically shows a state in which a treatment target is gripped between a first gripping part and a second gripping part of the treatment section of the treatment instrument according to the second embodiment in a cross-section substantially perpendicular to the extension direction of the treatment section. Fig. Figure 16 is a cross-sectional view that schematically shows a state in which a treatment target is gripped between a first gripping part and a second gripping part of a treatment section of a treatment instrument according to a first modification of the second embodiment in a cross-section substantially perpendicular to an extension direction of the treatment section. Fig. Figure 17 is a cross-sectional view that schematically shows a state in which a treatment target is grasped between a first gripping part and a second gripping part of a treatment section of a treatment instrument according to a second modification of the second embodiment in a cross-section substantially perpendicular to an extension direction of the treatment section. DETAILED DESCRIPTION

[0009] In the following, embodiments of the present invention are described with reference to the drawings. [First embodiment]

[0010] A first embodiment is described with reference to Fig. 1 to Fig. 4 described. A treatment instrument 12 is described below, which uses ultrasound vibrations and high-frequency current to perform a treatment on living tissue. In the present embodiment, high-frequency energy (high-frequency power) is applied to a blade 44 of a treatment section 26, which will be described later, or ultrasound vibrations are introduced as a different energy (second energy) separate from the high-frequency energy.

[0011] A treatment system 10 comprises the treatment instrument 12, a transducer unit 14 configured to generate ultrasonic vibrations, and a power source 16.

[0012] The treatment instrument 12 comprises a housing 22, a shaft 24, and a treatment section (an end effector) 26. A rod 28, used as part of the treatment section 26, is inserted through the shaft 24. In the present embodiment, a longitudinal axis C is defined as a straight central axis with respect to the shaft 24 and the rod 28.

[0013] The treatment section 26 comprises a first gripping element 26a and a second gripping element 26b, which can approach and separate relative to each other. The first gripping element 26a extends distally from the distal end of the shaft 24 along the longitudinal axis C as its central axis.

[0014] The second gripping element 26b is rotatably mounted relative to a distal end section of the shaft 24. In the treatment section 26, the second gripping element 26b is rotated relative to the first gripping element 26a, thereby defining opening and closing directions that approach and diverge from each other. The opening and closing directions intersect the extension direction of the longitudinal axis C; for example, they are substantially perpendicular to an extension direction of the treatment section 26 relative to the distal end of the shaft 24.

[0015] In the embodiment in which the extension direction of the treatment section 26 is essentially parallel to the longitudinal axis C, the cross-sections of Fig. 2 to Fig. 3B Cross-sections essentially perpendicular to the longitudinal direction along the longitudinal axis C. Fig. Figure 2 shows a closed state in which there is no treatment target between the first gripping part 26a and the second gripping part 26b and the second gripping part 26b is closed with respect to the first gripping part 26a. Fig. Figure 3A shows an open state in which there is no treatment target between the first gripping part 26a and the second gripping part 26b, and the second gripping part 26b is open relative to the first gripping part 26a. Here, a direction that intersects the extension direction of the treatment section 26 (essentially perpendicular to it) and the opening and closing direction of the second gripping part 26b (essentially perpendicular to it) is defined as the width direction of the treatment section 26 (one direction indicated by an arrow W1 and one direction indicated by an arrow W2). The second width direction W2 is opposite to the first width direction W1.

[0016] In the first gripping part 26a, a longitudinal axis L1 is defined. In the second gripping part 26b, a longitudinal axis L2 is defined. The longitudinal axis L1 passes through a central position M in the width direction of the first gripping part 26a. The longitudinal axis L2 passes through a central position M in the width direction of the second gripping part 26b. When the second gripping part 26b is open relative to the first gripping part 26a, the longitudinal axes L1 and L2 diverge from each other. The longitudinal axis L2 moves relative to the longitudinal axis C when the second gripping part 26b rotates about the shaft 24. In the Fig. In the closed state of the second gripping part 26b shown in 2, the longitudinal axes L1 and L2 coincide relative to the first gripping part 26a.

[0017] The longitudinal axis L1 is virtual and can be located either on a medial surface 52b of an opposite surface 52 of the blade 44 or between the opposite surface 52 and a non-opposite surface 54. Alternatively, the longitudinal axis L1 can also be located outside the blade 44.

[0018] The longitudinal axis L2 is virtual and can be located either on a contact section 162 of a cushioning element 114 of a blade 102 (to be described later) or outside the contact section 162 of the cushioning element 114. Alternatively, the longitudinal axis L2 can also be located inside the contact section 162 of the cushioning element 114.

[0019] The opening and closing directions of the first gripping part 26a and the second gripping part 26b lie along a virtual movement surface T defined by the first gripping part 26a and the second gripping part 26b. The movement surface T is preferably planar. The movement surface T is essentially parallel to the extension direction of the treatment section 26 and essentially parallel to the opening and closing directions of the second gripping part 26b.

[0020] In the present embodiment, the first gripping part 26a and the second gripping part 26b of the treatment section 26 are symmetrical about the movement surface T. At this point in time, the longitudinal axes L1 and L2 lie on the movement surface T.

[0021] The lateral direction of the treatment section 26 intersects the movement area T (is essentially perpendicular to it). In the present embodiment, the movement area T extends, for example, through the central position M in the lateral direction of the second gripping part 26b over the entire area from the proximal end to the distal end of the second gripping part 26b. The movement area T is thus a median plane of the second gripping part 26b. Since the movement area T is defined as described above, the movement area T passes through the treatment section 26.

[0022] The shaft 24 is formed from an electrically conductive material. The outer circumferential surface of the shaft 24 is coated with an electrically insulating material, such as PTFE. The rod 28 consists of a material with good vibration transmission and electrical conductivity, such as a titanium alloy. An electrically insulating spacer (not shown) is arranged between the inner circumferential surface of the shaft 24 and the outer circumferential surface of the rod 28. Therefore, the shaft 24 and the rod 28 are electrically isolated from each other, and an unintended current flow between the shaft 24 and the rod 28 is prevented.

[0023] The shaft 24 has a circular outer shape in a cross-section perpendicular to the longitudinal axis C. The shaft 24 comprises a tube 32 and a movable element 34, which is configured to move relative to the tube 32 along the longitudinal axis C.

[0024] The rod 28 comprises a rod body 42 and the blade (first treatment body) 44, which is provided at a distal end section of the rod body 42. The blade 44 serves as the first gripping element 26a. The blade 44 projects distally from the distal end of the shaft 24 along the longitudinal axis L1.

[0025] The longitudinal axis L1 of the blade 44 of the first gripping part 26a is, for example, parallel or substantially parallel to the longitudinal axis C of the shaft 24. In this case, the blade 44 runs substantially straight distal to the shaft 24. The longitudinal axis L1 of the distal end part of the blade 44 may bend with respect to the longitudinal axis C of the shaft 24.

[0026] A cross-section perpendicular to the longitudinal axis L1 of the blade 44 is polygonal or substantially polygonal. In the present embodiment, an example is described in which the cross-section perpendicular to the longitudinal axis L1 of the blade 44 is substantially octagonal.

[0027] The blade 44 includes the facing surface (treatment surface) 52, which faces the blade (second treatment body) 102 (described later) of the second gripping part 26b. The blade 44 is used as a high-frequency electrode, and the facing surface 52 is used as the treatment surface of the electrode (electrode surface). The end face 52 can be a flat surface or a curved surface. The end face 52 can be a combination of a plurality of curved surfaces and / or flat surfaces. In the present embodiment, the facing surface 52 comprises three surfaces 52a, 52b, and 52c. The surface (first near surface) 52a is positioned near a first side surface 84a (described later) of the treatment section 26. The surface 52b is configured as a central surface in a central section in the width direction of the facing surface 52.The surface (second near surface) 52c is brought close to a second side surface 84b (described later) of the treatment section 26.

[0028] The blade 44 of the first gripping part 26a comprises the non-facing surface 54, which is not facing the blade 102 of the second gripping part 26b. The non-opposite surface 54 can be a flat or a curved surface. The non-opposite surface 54 can be a combination of several curved surfaces and / or flat surfaces. In this embodiment, the non-opposite surface 54 comprises the five flat surfaces 54a, 54b, 54c, 54d, and 54e. Surface 54a of the non-facing surface 54 is brought close to the first side surface 84a of the treatment section 26 and borders the first near surface 52a of the facing surface 52. Surface 54e of the non-facing surface 54 is brought close to the second side surface 84b of the treatment section 26 and borders the second near surface 52c of the facing surface 52.Surface 54c of the non-facing surface 54 is formed as a central surface in a central section in the width direction of the non-facing surface 54 and is formed on the back side of the central surface 52b of the facing surface 52. Surface 54c of the non-facing surface 54 is formed as a rear surface 86a of the first gripping element 26a.

[0029] The five surfaces 54a, 54b, 54c, 54d and 54e of the non-facing surface 54 are preferably coated with an electrically insulating and heat-resistant resin.

[0030] The blade 44 of the first gripping part 26a has a first outer edge 56a and a second outer edge 56b. In the present embodiment, the first outer edge 56a of the blade 44 is a boundary between the surface 52a of the facing surface 52 and the surface 54a of the non-facing surface 54. The second outer edge 56b of the blade 44 is a boundary between the surface 52c of the facing surface 52 and the surface 54e of the non-facing surface 54.

[0031] The first outer edge 56a is closer to the first side surface 84a of the treatment section 26 than to the second side surface 84b of the treatment section 26. Therefore, the first outer edge 56a of the blade 44 is brought close to the first side surface 84a of the treatment section 26, which is separated from the longitudinal axis L1 of the blade 44 in the first width direction W1 perpendicular to the opening and closing directions along the movement surface T.

[0032] The second outer edge 56b is closer to the second side surface 84b of the treatment section 26 than to the first side surface 84a of the treatment section 26. Therefore, the second outer edge 56b of the blade 44 is brought close to the second side surface 84b of the treatment section 26, which is separated from the longitudinal axis L1 of the blade 44 in the second width direction W2 perpendicular to the opening and closing directions along the movement surface T.

[0033] In the present embodiment, the central surface 52b of the end face 52 between the first outer edge 56a and the second outer edge 56b of the blade 44 is used as a projection which is brought into contact with the (to be described later) contact section 162 of the blade 102 of the second gripping part 26b in conjunction with an area of ​​the surfaces 52a and 52c that adjoin the central surface 52b.

[0034] A normal vector N1a on the first near surface 52a of the end face 52 of the knife 44 is considered. Components of the normal vector N1a of the first near surface 52a are directed at every position on the first near surface 52a parallel to a virtual plane VP (to be described later) from the first near surface 52a to the first side surface 84a of the treatment section 26. A normal vector N1b on the second near surface 52c of the end face 52 of the blade 44 is also considered. Components of the normal vector N1b of the second near surface 52c are directed at every position on the second near surface 52c parallel to the virtual plane VP from the second near surface 52c to the second side surface 84b of the treatment section 26.

[0035] The housing 22 contains a handle 62 that extends in a direction intersecting the central axis C. A movable handle 64 is supported by the housing 22 on a distal side of the handle 62. The movable handle 64 is located on the side of the longitudinal axis C from which the handle 62 extends.

[0036] When the movable handle 64 rotates relative to the housing 22, it moves between an open state and a closed state relative to the handle 62. The direction of movement of the movable handle 64 during both the opening and closing processes is essentially parallel to the longitudinal direction along the longitudinal axis C.

[0037] The movable handle 64 can be positioned on a proximal side of the handle 62. Alternatively, the movable handle 64 can be positioned on the side opposite the longitudinal axis C from the side on which the handle 62 is located. In this case, the direction of movement of the movable handle 64 intersects the longitudinal direction during each opening and closing operation.

[0038] The distal end section of the movable element 34 of the shaft 24 supports the proximal end section of the second gripping part 26b. Although not shown, the proximal end section of the movable element 34 is coupled to the movable handle 64 inside the housing 22.

[0039] The movable element 34 moves along the longitudinal axis C relative to the tube 32 when the movable handle 64 separates from or approaches the handle 62. The second gripping part 26b rotates relative to the first gripping part 26a in accordance with the movement of the movable element 34. When the movable handle 64 separates from the handle 62, the second gripping part 26b opens relative to the first gripping part 26a. When the movable handle 64 approaches the handle 62, the second gripping part 26b closes relative to the first gripping part 26a.

[0040] A rotary knob 66 ​​is attached to the distal side of the housing 22. The rotary knob 66 ​​is rotatable relative to the housing 22 about the longitudinal axis C. The proximal end of the shaft 24 is inserted into the housing 22 from the distal side through the interior of the rotary knob 66.

[0041] The distal end section of the rod 28 extends distally from the distal end of the tube 32 through the interior of the tube 32 and out of the housing 22.

[0042] A transducer unit 14, configured to generate ultrasonic vibrations, is detachably connected to the proximal side of the housing 22 of the treatment instrument 12. The transducer unit 14 comprises a housing 72 and a transducer 74, configured to generate longitudinal ultrasonic vibrations along the longitudinal axis C.

[0043] Inside the housing 22, the transducer 74 is connected to the proximal side of the rod 28. One end of a cable 76 is connected to the housing 72. The other end of the cable 76 is connected to the power source 16.

[0044] In this embodiment, the energy source 16 supplies energy to the transducer 74 to cause the transducer 74 to generate ultrasonic vibrations. At this point, longitudinal ultrasonic vibrations are generated in the transducer 74. The longitudinal ultrasonic vibrations generated in the transducer 74 are input into the proximal end of the rod 28 and transmitted along the longitudinal axis C from the proximal end to the distal end of the rod 28. When the energy source 16 supplies energy to the transducer 74 to generate ultrasonic vibrations, vibrations for cutting the treatment target are transmitted to the blade 44 of the first gripping part 26a. Furthermore, in this embodiment, the energy source 16 is able to supply electrical energy (radio frequency energy) through the shaft 24 and the rod 28 to the treatment target, which is gripped between the first gripping part 26a and the second gripping part 26b of the treatment section 26.

[0045] The energy source 16 supplies electrical energy (high-frequency energy) to the treatment target gripped between the first gripping part 26a and the second gripping part 26b of the treatment section 26 through the shaft 24 and the rod 28, e.g. in response to the pressing of a first switch 16a provided in the housing 22.

[0046] The energy source 16 outputs energy to the transducers 74 to generate ultrasonic vibrations, e.g. in response to the pressing of a second switch 16b, which is provided in the housing 22.

[0047] In one embodiment, the energy source 16 supplies electrical energy (high-frequency energy) to the treatment target gripped between the first gripping part 26a and the second gripping part 26b of the treatment section 26 via the shaft 24 and the rod 28, e.g. in response to pressing a second switch 16b provided in the housing 22, and releases energy to the transducers 74 to generate ultrasonic vibrations.

[0048] In the treatment section 26 of the present embodiment, the longitudinal dimension of the treatment section 26 is larger than any dimension of the treatment section 26 in the opening and closing directions, and larger than the width dimension of the treatment section 26. The treatment section 26, in which the first gripping part 26a and the second gripping part 26b interact, has a distal end section 82a, a proximal end section 82b, a first side surface (side section) 84a, a second side surface (side section) 84b, a first back surface 86a, and a second back surface 86b. In particular, the first back surface 86a is formed on the first gripping part 26a, and the second back surface 86b is formed on the second gripping part 26b.

[0049] The first side surface 84a is separated from the longitudinal axes L1 and L2 in the first lateral direction W1. The second side surface 84b is separated from the longitudinal axes L1 and L2 in the second lateral direction W2, which is opposite to the first lateral direction W1.

[0050] The second gripping part 26b comprises the blade (second treatment body) 102 and a jaw (support body) 104 provided with the blade 102. Here, the second gripping part 26b is described as a rocker or wiper jaw, in which the blade 102 is pivotable relative to the jaw 104. In one embodiment, the blade 102 is fixed relative to the jaw 104.

[0051] The blade 102 faces the flat surface 52 of the blade 44. The blade 102 comprises an electrode element 112 and a cushioning element 114.

[0052] The electrode element 112 is made of an electrically conductive material. For example, the electrode element 112 consists of an aluminum alloy or an aluminum-containing metal. The padding element 114 is made of an electrically insulating material. Since friction can occur between the padding element 114 and the blade 44, onto which the longitudinal ultrasonic vibrations are transmitted, a material with frictional resistance and heat resistance is preferably used to form the padding element 114. The padding element 114 is made, for example, of polytetrafluoroethylene (PTFE) or a similar material.

[0053] The jaw 104 rests, for example, on the tube 32 of the shaft 24 and on the movable element 34. The jaw 104, together with the second gripping part 26b, is movable in an open and a closed state relative to the blade 44 of the first gripping part 26a and is separated from the blade 44 of the first gripping part 26a in both the open and the closed states.

[0054] The jaw 104 is rotatable about a pivot point on the mounting position of the shaft 24 at the distal end of the tube 32. The jaw 104 comprises a support element 122, made of an electrically conductive material such as metal, and a cover 124, which is attached to an outer surface of the support element 122. The cover 124 is made of an electrically insulating material, such as a resin. The distal end of the movable element 34 of the shaft 24 is connected to the support element 122. As described above, the movable element 34 is moved along the longitudinal axis C with respect to the tube 32, rotating the jaw 104 and the blade 102 provided on the jaw 104 about the mounting position on the shaft 24, so that the second gripping part 26b is opened or closed with respect to the first gripping part 26a.A part of the support element 122, which is exposed towards the outside of the second gripping part 26b, is provided with a coating or similar material with electrically insulating properties.

[0055] The cheek 104 comprises a posterior wall 132, lateral walls 134a and 134b, edges 136a and 136b and a distal end wall 137.

[0056] The rear wall 132 forms the second rear surface 86b of the treatment section 26. The side wall 134a forms part of the first side surface 84a of the treatment section 26 on the side of the second gripping part 26b. The side wall 134b forms part of the second side surface 84b of the treatment section 26 on the side of the second gripping part 26b. The distal end wall 137 forms part of the distal end section 82a of the treatment section 26. The distal end wall 137 forms a distal end of the second gripping part 26b and forms a section facing the distal side on the outer surface of the second gripping part 26b.

[0057] Each of the rear wall 132 and the side walls 134a and 134b extends from the distal end wall 137 toward the proximal side. In a cross-section passing through the rear wall 132 and the side walls 134a and 134b, and essentially perpendicular to the direction of extension of the second gripping part 26b, the jaw 104 is essentially U-shaped. For this reason, the side walls 134a and 134b are separated from each other in the width direction. The rear wall 132 forms one end of the second gripping part 26b on a side (arrow side Y1) where the second gripping part 26b opens, i.e., an end on a side opposite the side where the first blade 44 is located. The rear wall 132 forms part of the outer surface of the second gripping part 26b, which faces the side on which the second gripping part 26b opens, i.e. the rear surface 86b of the second gripping part 26b.

[0058] The side wall (first side wall) 134a forms one end of the second gripping part 26b in the width direction. The side wall (second side wall) 134b forms the other end of the second gripping part 26b in the width direction. The side wall 134a forms a section on the outer surface of the second gripping part 26b, i.e., on one side surface of the second gripping part 26b, which faces one side in the width direction. The side wall (first side wall) 134a forms the first side surface 84a of the treatment section 26.

[0059] The side wall 134b forms a section extending in the width direction towards the other side on the outer surface of the second gripping part 26b, i.e., the other side surface of the second gripping part 26b. The side wall (second side wall) 134b forms the second side surface 84b of the treatment section 26.

[0060] Edges 136a and 136b form parts of the outer surfaces of the second gripping part 26b, which face the first gripping part 26a. Edge 136a borders the side wall 134a. Edge 136b borders the side wall 134b.

[0061] In the distal end wall 137, the cover 124 is attached to the support element 122 from the distal side. In the rear wall 132, the cover 124 is attached to the support element 122 from the side where the second gripping part 26b opens. In the side walls 134a and 134b, the cover 124 is attached to the support element 122 from the outside in the width direction.

[0062] In the second gripping part 26b, the electrode element 112 is attached to the jaw 104 via a connecting pin 126. The electrode element 112 and the connecting pin 126 are made of an electrically conductive material, such as metal. The electrode element 112 is located on the side where the second gripping part 26a is positioned relative to the rear wall 132 of the jaw 104, i.e., on the side (arrow Y2-side) where the first gripping part 26b is closed. The electrode element 112 is located on the inside, in the width direction, relative to the side walls 134a and 134b of the jaw 104. The electrode element 112 is positioned between the side walls 134a and 134b in the width direction.

[0063] The electrode element 112 comprises a base 142 and side plates 144a and 144b. The rear wall 132 of the jaw 104 abuts the base 142 of the electrode element 112 on the side where the second gripping part 26b opens. A gap is formed between the base 142 and the rear wall 132 in the opening and closing directions of the second gripping part 26b. Each of the side plates 144a and 144b extends from the base 142 toward the side where the second gripping part 26b is closed. In a cross-section that is substantially perpendicular to the direction of extension of the second gripping part 26b, the electrode element 112 is formed essentially in a U-shape by the base 142 and the side plates 144a and 144b. For this reason, the side plates 144a and 144b are separated from each other in the width direction. The side wall 134a of the jaw 104 borders the side plate 144a of the electrode element 112 on the outside in the width direction.The side wall 134b of the clamping jaw 104 abuts the side plate 144b of the electrode element 112 on the outside in the lateral direction. A gap is formed in the lateral direction between the side plate 144a and the side wall 134a, and a gap is formed in the lateral direction between the side plate 144b and the side wall 134b.

[0064] A hole 146 is formed in the base 142 of the electrode element 112, penetrating the base 142 in the width direction. A hole 138a is formed in the side wall 134a of the jaw 104 in the width direction. A hole 138b is formed in the side wall 134b of the jaw 104 along the width direction. The connecting pin 126, which connects the jaw 104 (support element 122) and the electrode element 112, is inserted through the hole 146 and into each of the holes 138a and 138b. The connecting pin 126 extends in the width direction through the holes 146 and the holes 138a and 138b. The electrode element 112 is pivotable (rotatable) relative to the jaw 104 about the central axis of the connecting pin 126 as the pivot axis X. In other words, the electrode element 112 pivots about the pivot axis X essentially parallel to the width direction.

[0065] When the electrode element 112 pivots laterally about the pivot axis X, a portion of the electrode element 112 on the distal side with respect to the pivot axis X approaches the first gripping part 26a and moves away from the rear wall 132 of the jaw 104. At this point, the portion of the electrode element 112 on the proximal side with respect to the pivot axis X moves away from the first gripping part 26a and approaches the rear wall 132 of the jaw 104. When the electrode element 112 then abuts the rear wall 132 at a section on the proximal side with respect to the pivot axis X, the oscillation of the electrode element 112 to one side about the pivot axis X is restricted. On the other hand, when the electrode element 112 swings around the pivot axis X to the other side, a section of the electrode element 112 on the side distal to the pivot axis X moves away from the first gripping part 26a and approaches the rear wall 132 of the jaw 104.At this point, the portion of the electrode element 112 on the proximal side, with respect to the pivot axis X, approaches the first gripping part 26a and moves away from the rear wall 132 of the jaw 104. When the electrode element 112 then abuts the rear wall 132 at a section on the distal side, with respect to the pivot axis X, the pivoting of the electrode element 112 to the other side about the pivot axis X is restricted.

[0066] On the outer surface of the electrode element 112, a pair of separate electrode surfaces (slanted surfaces) 152 and 154 are formed. The electrode surfaces 152 and 154 face the side on which the first gripping part 26a is located, i.e., the side on which the second gripping part 26b is closed. The first electrode surface 152 and the second electrode surface 154 extend, for example, parallel to a longitudinal axis L2 of the contact section 162 described later.

[0067] The first electrode surface 152 borders the inner sides of the side wall 134a and the edge 136a of the jaw 104 at a distance in the width direction. In every state within the area in which the electrode element 112 is pivotable, part or all of the first electrode surface 152 projects from the edge 136a to the side where the first gripping part 26a is located, i.e., to the side where the second gripping part 26b is closed. The first electrode surface 152 faces the first near surface 52a.

[0068] Similarly, the second electrode surface 154 rests against the inner sides of the side wall 134b and the edge 136b of the jaw 104 at a distance in the width direction. In every state within the area in which the electrode element 112 is pivotable, part or all of the second electrode surface 154 projects from the edge 136b toward the side where the first gripping part 26a is located, i.e., toward the side where the second gripping part 26b is closed. The second electrode surface 154 faces the second near surface 52c.

[0069] The first electrode surface 152 is used as the treatment surface of a high-frequency electrode (first high-frequency electrode). The second electrode surface 154 serves as the treatment surface of a high-frequency electrode (second high-frequency electrode). The first electrode surface 152 and the second electrode surface 154 are electrically connected and have the same potential.

[0070] The first electrode surface (first surface) 152 is separated from the opposite surface 52 of the blade 44 in both the open and closed states. The second electrode surface (second surface) 154 is separated from the opposite surface 52 of the blade 44 in both the open and closed states.

[0071] In the second gripping part 26b, the cushioning element 114 is attached to the electrode element 112. Specifically, the cushioning element 114 is attached between the electrode surfaces 152 and 154 to the outer surfaces of the electrode element 112 in the lateral direction. The cushioning element 114, together with the electrode element 112, is pivotable with respect to the jaw 104.

[0072] The cushioning element 114 is provided on one side of the base 142 of the electrode element 112, where the second gripping part 26a is located, i.e., on the side where the first gripping part 26b is closed. Furthermore, the cushioning element 114 is provided on the inside of the side plates 144a and 144b of the electrode element 112 in the lateral direction and is positioned between the side plates 144a and 144b in the lateral direction.

[0073] The cushioning element 114 comprises the contact section 162, which is located between the electrode surfaces 152 and 154 and faces the end face 52 of the blade (first treatment body) 44. Therefore, the blade 102 of the second gripping part 26b contains the contact section 162, the first electrode surface 152, and the second electrode surface 154 as the surfaces facing the opposite surface 52 of the first gripping part 26a.

[0074] The contact section 162 has an electrically insulating property. The contact section 162 faces the surface (treatment surface) 52 of the blade 44. The contact section 162 is movable relative to the surface 52 of the blade 44 along the opening and closing directions between an open state, in which the contact section is separated from the surface, and a closed state, in which the contact section is brought close to the surface 52. In particular, the contact section 162 can be brought into contact with the surface 52 of the blade 44 in the closed state. That is, in the closed state, the central surface (projection) 52b of the end face 52 of the blade 44 of the first gripping part 26a is also located in the width direction between the electrode surfaces 152 and 154.Therefore, the central position M of the second gripping part 26b runs in the width direction through the contact section 162 of the cushioning element 114 and the central surface 52b of the facing surface 52 of the blade 44.

[0075] The contact section 162 comprises a first edge section 172a, which is separated from the central position M in the first width direction W1, a second edge section 172b, which is separated from the central position M in the second width direction W2, and a central section 174 through which the central position M passes. The first edge section 172a is closer to the first side face 84a of the treatment section 26 than to the second side face 84b of the treatment section 26. Therefore, the first edge section 172a of the contact section 162 is brought close to the first side face 84a of the treatment section 26, which is separated from the longitudinal axis L2 of the contact section 162 in the first width direction W1 perpendicular to the opening and closing directions. The second edge section 172b is closer to the second side face 84b of the treatment section 26 than to the first side face 84a of the treatment section 26.Therefore, the second edge section 172b of the contact section 162 is brought close to the second side surface 84b of the treatment section 26, which is separated from the longitudinal axis L2 of the contact section 162 in the second width direction W2 perpendicular to the opening and closing directions.

[0076] The central section 174 is formed between the first edge section 172a and the second edge section 172b. Here, the central section 174 is formed in a concave shape into which the area surrounding the central section of the facing surface 52 of the blade 44 of the first gripping part 26a is fitted. Therefore, in the present embodiment, the three surfaces 52a, 52b, and 52c of the end face 52 are brought into contact with the central section 174 of the contact section 162. Of course, only the central surface 52b can also be in contact with the central section 174 of the contact section 162.

[0077] The first electrode surface 152 comprises a first near edge 182a, which is located near the longitudinal axis L2, and a first outer edge 182b, which is further away from the longitudinal axis L2 than the first near edge 182a and is located near the first side surface 84a of the treatment section 26.

[0078] Preferably, there should be no clearance between the first edge section 172a of the contact section 162 and the nearby edge 182a of the first electrode surface 152; however, a slight clearance between the first edge section 172a and the nearby edge 182a is permissible. Furthermore, it is preferred that there be no step between the first edge section 172a of the contact section 162 and the nearby edge 182a of the first electrode surface 152; however, a slight step between the first edge section 172a and the nearby edge 182a is permissible. Here, the contact section 162 is at the same level as the first electrode surface 152 or projects from the first electrode surface 152 towards the treatment surface 52 when the second gripping part 26b is closed relative to the first gripping part 26a.

[0079] The first electrode surface 152 is provided by the first edge section 172a of the contact section 162 or by the first near edge 182a of the first electrode surface 152 in the direction of the first side surface 84a of the treatment section 26. In the present embodiment, the first electrode surface (first surface) 152 is formed in a flat shape between the first edge section 172a of the contact section 162 or the near edge 182a of the first electrode surface 152 and the outer edge 182b of the first electrode surface 152. Therefore, in cross-section, the section between the near edge 182a of the first electrode surface 152 and the outer edge 182b of the first electrode surface 152 is linear.

[0080] The first electrode surface 152 is inclined in the lateral direction to separate itself from the side on which the first gripping part 26a is located, as the distance to the first side surface 84a of the treatment section 26 decreases. In other words, the electrode surface 152 is directed towards the side on which the second gripping part 26b is open, while separating itself from the central position M in the lateral direction.

[0081] In this process, the contact section 162 of the cushioning element 114 of the blade 102 of the second gripping part 26b can be brought into contact with the end face 52 of the cutting edge 44 of the first gripping part 26a in the closed state. A virtual plane VP is defined on the first electrode surface 152 of the electrode element 112, which is perpendicular to the opening and closing direction and extends through the first near edge 182a of the first electrode surface 152 in the closed state. The virtual plane VP preferably lies on the longitudinal axes L1 and L2 in the closed state. That is, in the present embodiment, the virtual plane VP is defined as a plane that is perpendicular to the movement surface T, extends along the longitudinal axes L1 and L2, and passes through the near edge 182a of the first electrode surface 152.With respect to the second electrode surface 154 of the electrode element 112, a virtual plane that is perpendicular to the opening and closing directions and passes through the second near edge 184a of the second electrode surface 154 in the closed state coincides with the virtual plane VP described above.

[0082] It is assumed that a virtual point exists on the virtual plane VP. The distance between the first electrode surface 152 and the virtual plane VP increases (they separate) as the virtual point moves from the longitudinal axis L2 towards the first side surface 84a of the treatment section 26, in a region between the first edge section 172a of the contact section 162 or the near edge 182a of the first electrode surface 152 and the outer edge 182b of the first electrode surface 152. A distance Ld between the virtual plane VP and the first electrode surface 152 at a position farther from the first near edge 182a is greater than a distance Lp between the virtual plane VP and the first electrode surface 152 at a position closer to the first near edge 182a. Fig. 3B. The distance between the first outer edge 182b and the virtual plane VP is greater than the distance between the first near edge 182a and the virtual plane VP. The distance between the first electrode surface 152 and the virtual plane VP increases continuously from the first near edge 182a towards the first outer edge 182b.

[0083] A normal vector N2a on the first electrode surface (first surface) 152 is considered. At each position of the first electrode surface 152, components of the normal vector N2a of the first electrode surface 152 are parallel to the virtual plane VP and point from the first electrode surface 152 to the first side surface 84a of the treatment section 26. Therefore, the components of the normal vector N2a of the first electrode surface 152 that are parallel to the virtual plane VP are not directed towards the central position M and the second side surface 84b of the treatment section 26.

[0084] In the present embodiment, components of the normal vector N1a on the first near surface 52a of the end face 52 of the knife 44 and of the normal vector N2a on the first electrode surface 152 of the blade 102 are directed parallel to the virtual plane VP in the direction of the first side surface 84a of the treatment section 26.

[0085] The second electrode surface 154 is provided from the second edge section 172b of the contact section 162 in the direction of the second side surface 84b of the treatment section 26.

[0086] The second electrode surface 154 comprises a second near edge 184a, which is located near the longitudinal axis L2, and a second outer edge 184b, which is further away from the longitudinal axis L2 than the second near edge 184a and is located near the second side surface 84b of the treatment section 26.

[0087] Preferably there is no gap between the second edge section 172b of the contact section 162 and the near edge 184a of the second electrode surface 154, but there may be a small gap between the second edge section 172b and the near edge 184a.

[0088] Furthermore, it is preferred that there is no step between the second edge section 172b of the contact section 162 and the near edge 184a of the second electrode surface 154, although a slight step may be present between the second edge section 172b and the near edge 184a. The second electrode surface 154 extends from the second edge section 172b of the contact section 162 or the near edge 184a of the second electrode surface 154 towards the first side surface 84a of the treatment section 26. In the present embodiment, the second electrode surface (second surface) 154 is formed in a flat shape between the second edge section 172b of the contact section 162 or the near edge 184a of the second electrode surface 154 and the outer edge 184b of the second electrode surface 154.Therefore, in a cross-section, the section between the near edge 184a of the second electrode surface 154 and the outer edge 184b of the second electrode surface 154 is linear.

[0089] The second electrode surface 154 is inclined in the lateral direction such that it separates from the side on which the first gripping part 26a is located when the distance to the second side surface 84b of the treatment section 26 is reduced. In other words, the electrode surface 154 is directed towards the side on which the second gripping part 26b is open when it separates in the lateral direction from the central position M.

[0090] The distance between the second electrode surface 154 and the virtual plane VP increases (they separate) when the virtual point moves away from the longitudinal axis L2 in the direction of the second side surface 84b of the treatment section 26 in a region between the second edge section 172b of the contact section 162 or the near edge 184a of the second electrode surface 154 and the outer edge 184b of the second electrode surface 154. The distance between the second outer edge 184b and the virtual plane VP is greater than the distance between the second near edge 184a and the virtual plane VP. The distance between the second electrode surface 154 and the virtual plane VP increases continuously from the second near edge 184a to the second outer edge 184b.

[0091] A normal vector N2b on the second electrode surface (second surface) 154 is considered. At each position of the second electrode surface 154, components of the normal vector N2b of the second electrode surface 154 are parallel to the virtual plane VP and point from the second electrode surface 154 to the second side surface 84b of the treatment section 26. Therefore, the components of the normal vector N2b of the first electrode surface 154 that are parallel to the virtual plane VP are not directed towards the central position M and the first side surface 84a of the treatment section 26.

[0092] In the present embodiment, components of the normal vector N1b on the second near surface 52c of the end face 52 of the blade 44 and of the normal vector N2b on the second electrode surface 154 of the blade 102 are directed parallel to the virtual plane VP in the direction of the second side surface 84b of the treatment section 26.

[0093] In the closed state, the outer edge 182b of the first electrode surface 152 is compared with the first outer edge 56a of the electrode element 112 of the blade 44, which faces the first side surface 84a of the treatment section 26. The outer edge 182b of the first electrode surface 152 is further from the longitudinal axes L1 and L2 than the first outer edge 56a of the electrode element 112 of the blade 44. In other words, the outer edge 182b of the first electrode surface (first surface) 152 is, in the closed state, further from the longitudinal axes L1 and L2 than the first outer edge 56a of the end surface 52.

[0094] Similarly, in the closed state, the outer edge 184b of the second electrode surface 154 is compared with the second outer edge 56b of the electrode element 112 of the blade 44, which is directed towards the second side surface 84b of the treatment section 26. The outer edge 184b of the second electrode surface 154 is located further from the longitudinal axes L1 and L2 than the second outer edge 56b of the electrode element 112 of the blade 44, which is directed towards the second side surface 84b of the treatment section 44. In other words, the outer edge 184b of the second electrode surface (second surface) 154 is located further from the longitudinal axes L1 and L2 than the second outer edge 56b of the opposite surface 52 in the closed state.

[0095] Like the blade 102 of the second gripping part 26b, the electrode surface 152, the contact section 162, and the electrode surface 154 as a whole can be formed at an acute angle, a right angle, or an obtuse angle. Preferably, the width between the first edge section 172a and the second edge section 172b of the contact section 162 is as small as possible. Therefore, the blade 102 of the second gripping part 26b is preferably formed as sharply as possible.

[0096] Even if both the central surface 52b and the contact section 162 have sharp edges, such a shape is acceptable as long as the state in which both the central surface 52b and the contact section 162 are in contact with each other can be maintained in the closed state. (Operation)

[0097] When performing a treatment with the treatment instrument 12, an operator inserts the treatment section 26 into a body cavity, e.g., an abdominal cavity. Then, a treatment target, e.g., living tissue (e.g., a blood vessel), is positioned between the first gripping part 26a and the second gripping part 26b, and the handle 64 is closed relative to the handle 62.

[0098] Accordingly, the second gripping part 26b is closed in relation to the first gripping part 26a, and the treatment target S is gripped between the first gripping part 26a and the second gripping part 26b (see Fig. 4).

[0099] A corresponding gripping pressure is exerted between the end face 52 of the blade 44 of the first gripping part 26a and the contact section 162 of the cushioning element 114 of the blade 102 of the second gripping part 26b. When the first gripping part 26a and the second gripping part 26b are closed, the treatment target S is thinned by the gripping pressure on the movement surface T. Therefore, when using the treatment instrument 12 according to the present embodiment, a suitable gripping pressure is exerted on the treatment target S between the blade 44 of the first gripping part 26a and the contact section 162 of the cushioning element 114 of the second gripping part 26b instead of between electrodes. Furthermore, the treatment target S is brought into contact with the facing surface 52 of the blade 44 of the first gripping part 26a, and the treatment target S is brought into contact with the first electrode surface 152 and the second electrode surface 154 of the electrode element 112 of the second gripping part 26b.

[0100] In this state, when the treatment target is to be coagulated by a high-frequency current passed through it, the operator presses the first switch 16a. System 10 causes the power source 16 to deliver electrical energy to the treatment instrument 12 in response to the pressing of the first switch 16a.

[0101] The blade 44 of the first gripping part 26a and the electrode element 112 of the second gripping part 26b function as electrodes with different potentials relative to each other. A high-frequency current is passed through the treatment target S, which is gripped between the blade 44 of the first gripping part 26a and the electrode element 112 of the second gripping part 26b, and the high-frequency current is supplied to the treatment target S as treatment energy. The heat generated in the treatment target S by the high-frequency current denatures the treatment target S and promotes coagulation of the treatment target S. That is, the blood vessel or the like, which is the treatment target S, is gelatinized, connected, and sealed by the heat generated in the treatment target S by the high-frequency current. Thus, the treatment device 12 can coagulate or seal (treat) the treatment target.

[0102] At this point, the blood vessel, which is the treatment target S, is dried into a thin paper form in an area between the contact section 162 and the facing surface (protrusion) 52. Furthermore, the inner circumferential surfaces of the blood vessels are held in close contact with each other near the area between the first edge section 172a of the contact section 162 and the first adjacent surface 52a of the facing surface 52, and near the area between the second edge section 172b of the contact section 162 and the second adjacent surface 52c of the facing surface 52.

[0103] It was generally accepted that when using a treatment instrument to perform radiofrequency current treatment for the coagulation of living tissue or the sealing of a blood vessel, the opposing electrodes must have parallel or substantially parallel sections. In other words, it was considered that, in a suitable treatment using a radiofrequency current, pressure must be applied between electrodes parallel or substantially parallel to the treatment target.

[0104] Here, an experiment was conducted with regard to the treatment section 26 of the treatment instrument 12 according to the present embodiment and the treatment section of the conventional treatment instrument, involving the flow of a high-frequency current to the treatment target S and the sealing of the living tissue under the same conditions. The first treatment body of the treatment section of the conventional treatment instrument is shaped as a rod configured to allow a high-frequency current to flow and to transmit ultrasonic vibrations, e.g., similar to the blade 44 of the present embodiment described above. For the sake of simplicity, the first treatment body of the treatment section of the conventional treatment instrument has, e.g., the same external shape and the same material as the blade 44 in the present embodiment described above.The second treatment body of the treatment section of the conventional treatment instrument is configured to allow a high-frequency current to flow, e.g. similar to the blade 102 of the embodiment described above.

[0105] In treatment section 26 of the treatment instrument 12 of the present embodiment, the electrode surfaces 152 and 154 of the blade 102 are oriented in the directions described above. Therefore, the area in which the pressure is exerted on the treatment target S by the second gripping part 26b is mainly limited to the contact section 162. In treatment section 26 of the treatment instrument 12 according to the present embodiment, since the tissue of the treatment target S extends in the direction perpendicular to the opening and closing direction, the treatment target S is likely to be thinned by the pressure in the region on which the pressure is exerted.

[0106] In contrast, the treatment section of the conventional treatment instrument includes a section in which the opposing electrodes are parallel or substantially parallel to each other. Therefore, the second treatment body exerts pressure on the treatment target not only at the contact area but also between the electrodes. In the treatment section of the conventional treatment instrument, the treatment target tends to accumulate near the contact section. Therefore, in the treatment section of the conventional treatment instrument, the treatment target is less likely to be thinned by the pressure in the area on which the pressure is applied than in treatment section 26 of the treatment instrument 12 according to the present embodiment.

[0107] The treatment instrument 12 according to the present embodiment and the conventional treatment instrument were subjected to an experiment to close the blood vessel of the treatment target S by flowing only the high-frequency current under the same energy output condition. The temperatures of the rod-shaped blade 44 of the treatment section 26 of the treatment instrument 12 according to the present embodiment and of the rod-shaped first treatment body of the treatment section of the conventional treatment instrument immediately after the experiment and the temperatures of the treated blood vessels were measured.

[0108] The temperature of the blade 44 according to the present embodiment was lower immediately after the end of the treatment than the temperature of the conventional first treatment body. On the other hand, the temperature of the treatment target S when treated with the treatment section 26 of the treatment instrument 12 according to the present embodiment was higher than the temperature of the treatment target when treated with the treatment section of the conventional treatment instrument.

[0109] An experiment was then conducted in which blood was allowed to flow through each of the occluded blood vessels. The sealing performance of the blood vessels was evaluated by measuring the pressure (fluid pressure) at which a fluid such as blood begins to flow through the blood vessel. It was found that the blood vessel occlusion performance was higher when using the treatment instrument 12 according to the present embodiment than the blood vessel occlusion performance when using the conventional treatment instrument. For example, in the experimental results, the blood vessel occlusion performance value when using the treatment instrument 12 according to the present embodiment was 1600 mmHg, and the blood vessel occlusion performance value when using the conventional treatment instrument was 900 mmHg.

[0110] Therefore, by shaping the treatment section 26 of the treatment instrument 12 according to the present embodiment, in particular the blade 102 of the second gripping part 26b, as described above, it is possible to efficiently increase the temperature of the treatment target S and suppress the temperature rise of the blade 44 of the first gripping part 26a. Since it is possible to suppress the temperature rise of the blade 44 of the first gripping part 26a, energy is also efficiently applied to the treatment target S of the blood vessel when using the treatment instrument 12 according to the present embodiment. Therefore, when using the treatment instrument 12 according to the present embodiment, sealing can be performed at a higher speed than when using the conventional treatment instrument.Since the temperature rise of the blade 44 of the first gripping part 26a can be suppressed, the temperature rise of the non-facing surface 54 (the first rear surface 86a of the treatment section 26) of the blade 44 can also be suppressed. Therefore, when using the treatment instrument 12 according to the present embodiment, invasion of the surrounding tissue due to contact of the non-facing surface 54 of the blade 44 with the surrounding tissue during or immediately after treatment is suppressed.

[0111] Next, an example is described in which the operator activates the second switch 16b.

[0112] If the treatment target is to be cut by transmitting ultrasonic vibrations to the blade 44 of the first gripping part 26a, the operator activates the second switch 16b. The system 10 supplies electrical energy from the power source 16 to the ultrasonic transducer 74 to generate ultrasonic vibrations. The generated ultrasonic vibrations are transmitted from the proximal to the distal side in the rod 28 and transferred to the blade 44 of the first gripping part 26a. At this point, the rod 28 vibrates at any frequency within a predefined frequency range.

[0113] The ultrasonic vibrations transmitted to the blade 44 of the first gripping part 26a are transferred as treatment energy to the grasped treatment target S. At this point, frictional heat is generated between the vibrating first gripping part 26a and the treatment target S, and the treatment target S is coagulated by the frictional heat and cut at a position between the facing surface (projection) 52 of the blade 44 and the contact section 162 of the blade 102. That is, the blade 102 of the second gripping part 26b can cut (treat) the treatment target in conjunction with the facing surface (treatment surface) 52 of the blade 44 of the first gripping part 26a.

[0114] As described above, the treatment target S is thinned by the end face 52 of the blade 44 of the first gripping part 26a and the contact section 162 of the blade 102 of the second gripping part 26b. At this point, the treatment section 26 of the treatment instrument 12, according to the present embodiment, reduces the volume of the treatment target in the section to be cut. Accordingly, the cutting speed is increased by the ultrasonic vibrations of the blade 44, and the blade 44 is subjected to minimal stress; thus, the temperature rise of the blade 44 is suppressed.

[0115] If the treatment target is incised by transmitting the ultrasonic vibrations to the blade 44 of the treatment instrument 12 according to the present embodiment, the amplitude of the ultrasonic vibration can therefore be reduced even at the same frequency. Furthermore, during treatment in a liquid, mist formation can be suppressed by reducing the amplitude of the longitudinal ultrasonic vibrations along the longitudinal axis L1 of the blades 44, i.e., by reducing the vibration velocity.

[0116] The treatment section 26 of the treatment instrument 12 according to the present embodiment cuts the treatment target S more easily than the treatment section of the conventional treatment instrument. Therefore, the treatment section 26 of the treatment instrument 12 according to the present embodiment can cut the treatment target S with less energy than the treatment section of the conventional treatment instrument when ultrasonic vibrations are transmitted to the blade 44 of the treatment instrument 12 in a state in which the treatment target S is suitably enclosed by the treatment section 26. Accordingly, the temperature increase of the blade 44 due to friction between the treatment target and the blade 44 is also suppressed compared to the conventional first treatment body.

[0117] When the second switch 16b is pressed, system 10 can also cause a high-frequency current to flow through the treatment target along with the generation of ultrasonic vibrations. During such treatment, the treatment target is in contact with electrode surfaces 152 and 154.

[0118] As described above, the temperature of the treatment object S rises efficiently, while the temperature increase of the blade 44 is suppressed by the high-frequency current. Therefore, the drying of the treatment object S proceeds smoothly, and the cutting speed is further increased by the ultrasonic vibrations of the blade 44. At this point, the sealing performance of the treatment object S is advantageously maintained.

[0119] Therefore, the treatment section 26 of the treatment instrument 12, according to the present embodiment, cuts into the treatment target S more easily than the treatment section of the conventional treatment instrument. Therefore, the treatment section 26 of the treatment instrument 12, according to the present embodiment, cuts into the treatment target S with less energy than the treatment section of the conventional treatment instrument, for example, when ultrasonic vibrations are transmitted in addition to the high-frequency current. Accordingly, the temperature increase of the blade 44 due to friction between the treatment target and the blade 44 is also suppressed compared to the conventional first treatment body.

[0120] According to the present embodiment, if the incision treatment is performed with energy other than high-frequency energy, i.e., with ultrasonic vibrations, it is possible to provide the treatment instrument 12 with which the energy can be efficiently applied to the treatment target S by suppressing the temperature rise of the opposite surface (treatment surface) 52 of the blade 44 of the first gripping part 26a and by shaping the blade 102 of the second gripping part 26b in a suitable form. Therefore, when using the treatment instrument 12 according to the present embodiment, the incision treatment at the treatment target can be performed efficiently with less energy (amount).In the case of coagulation of the treatment target S using high-frequency energy, it is also possible to provide the treatment instrument 12, which can suppress the temperature rise of the electrode (blade 44) when the high-frequency current flows through the treatment target S and the energy can be efficiently applied to the treatment target S. (First modification)

[0121] A first modification is made with reference to Fig. 5A and Fig. 5B described. The first modification is a variation of the first embodiment. The same elements as those of the first embodiment described above are identified by the same reference numerals, and detailed descriptions thereof are omitted. A portion of the treatment instrument 12 of the present modification and a portion of the treatment instrument 12 of the preceding embodiment can be combined appropriately. This also applies to the following modifications.

[0122] In the first embodiment described above, the entire first electrode surface (first surface) 152 is continuously separated from the virtual plane VP from the longitudinal axis L2 in the direction of the first side surface 84a of the treatment section 26. Similarly, an example has been described in which the entire second electrode surface (second surface) 154 is continuously separated from the virtual plane VP from the longitudinal axis L2 in the direction of the second side surface 84b of the treatment section 26.

[0123] In the present modification, the first electrode surface (first area) 152 comprises, along the width direction, a first region 186a, which includes a near edge 182a, a second region 186b, which includes an outer edge 182b, and a third region 186c, which is formed between the first region 186a and the second region 186b.

[0124] The third region 186c is parallel to the virtual plane VP. That is, the region 186c parallel to the virtual plane VP exists in a part of the first electrode surface (first surface) 152. Therefore, in the third region 186c, which is in Fig. As shown in Figure 5B, the distance Lp between the position near the first near edge 182a and the virtual plane VP is equal to the distance Ld between the position furthest from the first near edge 182a and the virtual plane VP. In other words, the first electrode surface (first area) 152 encloses the region 186c in which the distance from the virtual plane VP is constant in at least part of the position between the first edge segment 172a of the contact section 162 and the outer edge 182b of the first electrode surface (first area) 152, since the first electrode surface (first area) 152, in the closed state, separates from the longitudinal axis L2 and approaches the second side surface 84a of the treatment section 26. Therefore, the distance between the first electrode surface 152 and the virtual plane VP intermittently increases from the first near edge 182a to the first outer edge 182b.

[0125] The inclination angles of the first area 186a and the second area 186b with respect to the virtual plane VP can be the same or different.

[0126] When the first electrode surface 152 is viewed microscopically, there is a region where the distance from the virtual plane VP is constant, as the distance from the longitudinal axis L2 to the first side surface 84a of the treatment section 26 decreases. Macroscopically, the first electrode surface 152 is formed in a state where the distance from the virtual plane VP increases when the distance from the longitudinal axis L2 to the first side surface 84a of the treatment section 26 decreases. Of the normal vectors Np, Nm, and Nd of the respective regions 186a, 186b, and 186c of the first electrode surface 152, components parallel to the virtual plane VP do not exist at any position of the first electrode surface 152 (are 0) or are directed towards the first side surface 84a of the treatment section 26.Therefore, of the normal vectors Np, Nm and Nd of the first electrode surface, 152 components parallel to the virtual plane VP are not directed towards the longitudinal axis L2.

[0127] Similarly, the second electrode surface (second surface) 154 comprises a first region 188a, which includes a near edge 184a, a second region 188b, which includes an outer edge 184b, and a third region 188c, which is formed between the first region 188a and the second region 188b. Therefore, the distance between the second electrode surface 154 and the virtual plane VP increases intermittently from the second near edge 184a towards the second outer edge 184b. Macroscopically, the second electrode surface 154 has a region where the distance from the virtual plane VP is constant as the distance from the longitudinal axis L2 to the second side surface 84b of the treatment section 26 decreases.In macroscopic terms, the first electrode surface 154 is configured in such a way that the distance to the virtual plane VP increases as the distance from the longitudinal axis L2 to the second side surface 84b of the treatment section 26 decreases. Of the normal vectors N2b of the respective regions 188a, 188b, and 188c of the second electrode surface 154, no component at any position on the second electrode surface 154 is parallel to the virtual plane VP (which is 0) or directed towards the second side surface 84b of the treatment section 26. Therefore, the components of the normal vector N2b of the second electrode surface 154 that are parallel to the virtual plane VP are not directed towards the longitudinal axis L2.

[0128] In the case of performing a coagulation treatment at the treatment target with the treatment instrument 12 of this modification, the coagulation treatment can be performed in the same manner as with the treatment instrument 12 of the first embodiment described above when the first switch 16a is actuated. Furthermore, in the case of performing an incision treatment at the treatment target with the treatment instrument 12 of this modification, the incision treatment can be performed in the same manner as with the treatment instrument 12 of the first embodiment described above when the second switch 16b is actuated.

[0129] The first electrode surface 152 consists of the three surfaces 186a, 186c, and 186b from the first near edge 182a to the first outer edge 182b. Therefore, in a cross-section, the section between the near edge 182a and the outer edge 182b of the first electrode surface 152 is nonlinear. Similarly, in a cross-section, the section between the near edge 184a and the outer edge 184b of the first electrode surface 154 is nonlinear. (Second modification)

[0130] A second modification is made with reference to Fig. 6A described.

[0131] In the first modification described above, for example, the area 186c exists parallel to the virtual plane VP in a part of the first electrode surface (first surface) 152.

[0132] As in Fig. As shown in Figure 6A, the first electrode surface (first area) 152 in the present modification comprises, along the width direction, the first region 186a, which includes the near edge 182a, and the second region 186b, which includes the outer edge 182b. That is, the first electrode surface (first area) 152 comprises a plurality of planar regions 186a and 186b.

[0133] The planar regions 186a and 186b have different angles of inclination with respect to the virtual plane VP. That is, the angles of inclination formed by the first region 186a, including the first near edge 182a, and the second region 186b, including the first outer edge 182b, with respect to the virtual plane VP are different from each other. The angle of a boundary position 182c between the planar regions 186a and 186b is an obtuse angle greater than 90° and less than 180°. The first electrode surface 152 is formed in a state in which the distance from the virtual plane VP increases when the distance from the longitudinal axis L2 to the first side surface 84a of the treatment section 26 decreases. Therefore, the distance between the first electrode surface 152 and the virtual plane VP increases continuously from the first near edge 182a to the first outer edge 182b.

[0134] Similarly, the second electrode surface (second area) 154, along the latitude direction, comprises the first region 188a, which includes the near edge 184a, and the second region 188b, which includes the outer edge 184b. That is, the second electrode surface (second area) 154 comprises a plurality of planar regions 188a and 188b.

[0135] The planar regions 188a and 188b have different angles of inclination with respect to the virtual plane VP. That is, the angles of inclination formed by the first region 188a, including the second near edge 184a, and the second region 188b, including the second outer edge 184b, with respect to the virtual plane VP are different from each other. The angle of a boundary position 184c between the planar regions 188a and 188b is an obtuse angle greater than 90° and less than 180°. The second electrode surface 154 is formed in a state in which the distance from the virtual plane VP increases when the distance from the longitudinal axis L2 to the second side surface 84b of the treatment section 26 decreases. Therefore, the distance between the second electrode surface 154 and the virtual plane VP increases continuously from the second near edge 184a to the second outer edge 184b.

[0136] Even if the first electrode surface 152 and the second electrode surface 154 are shaped in this way, a corresponding treatment can be carried out in the same way as in the treatment device 12 of the first embodiment described above.

[0137] The example described here is one in which the first electrode surface 152 comprises the two regions 186a and 186b. In the case where the first electrode surface 152 comprises three planar regions, a further boundary is formed on the first electrode surface 152 separately from the position indicated by reference numeral 182c. Thus, two boundaries (two angles) are formed on the first electrode surface 152. In each case, the first electrode surface 152 is configured in a state where the distance from the virtual plane VP is increased, while the distance from the longitudinal axis L2 to the first side surface 84a of the treatment section 26 is decreased. The same applies in the case where two boundaries (two angles) are formed on the second electrode surface 154. (Third modification)

[0138] A third modification is made with reference to Fig. 6B is described. This modification is a further modification of the second modification.

[0139] As in Fig. As shown in Figure 6B, the first electrode surface (first area) 152 in the present modification comprises, along the width direction, a first region 186a, which includes a near edge 182a, and a second region 186b, which includes an outer edge 182b. That is, the first electrode surface (first area) 152 comprises a plurality of planar regions 186a and 186b.

[0140] The planar regions 186a and 186b have different inclination angles with respect to the virtual plane VP. The angle of a boundary position 182c between the planar regions 186a and 186b is a reflection angle greater than 180° and less than 270°. That is, the first electrode surface 152 of the present modification differs from the first electrode surface 152 of the second modification in the angle of the boundary position 182c. The first electrode surface 152 is formed in a state in which the distance from the virtual plane VP increases when the distance from the longitudinal axis L2 to the first side surface 84a of the treatment section 26 decreases. Therefore, the distance between the first electrode surface 152 and the virtual plane VP increases continuously from the first near edge 182a to the first outer edge 182b.

[0141] Similarly, the second electrode surface (second area) 154, along the latitude direction, comprises the first region 188a, which includes the near edge 184a, and the second region 188b, which includes the outer edge 184b. That is, the second electrode surface (second area) 154 comprises a plurality of planar regions 188a and 188b.

[0142] The planar areas 188a and 188b have different angles of inclination with respect to the virtual plane VP. The angle of a boundary position 184c between the planar areas 188a and 188b is a reflection angle greater than 180° and less than 270°. That is, the second electrode surface 154 of the present modification differs from the second electrode surface 154 of the second modification in the angle of the boundary position 184c. The second electrode surface 154 is configured in a state in which the distance from the virtual plane VP increases as the distance from the longitudinal axis L2 to the second side surface 84b of the treatment section 26 decreases. Therefore, the distance between the second electrode surface 154 and the virtual plane VP increases continuously from the second near edge 184a towards the second outer edge 184b.

[0143] Even if the first electrode surface 152 and the second electrode surface 154 are shaped in this way, a corresponding treatment can be carried out in the same way as in the treatment device 12 of the first embodiment described above. (Fourth modification)

[0144] A fourth modification is made with reference to Fig. 7 described.

[0145] In the first embodiment described above, the entire first electrode surface (first surface) 152 separates planarly from the virtual plane VP when the distance from the longitudinal axis L2 to the first side surface 84a of the treatment section 26 is reduced. Similarly, the entire second electrode surface (second surface) 154 separates planarly from the virtual plane VP when the distance from the longitudinal axis L2 to the second side surface 84b of the treatment section 26 is reduced.

[0146] In the present modification, the entire first electrode surface (first surface) 152 separates from the virtual plane VP in a curved surface shape (nonlinear in cross-section) when the distance from the longitudinal axis L2 to the first side surface 84a of the treatment section 26 is reduced. Thus, in the present embodiment, the first electrode surface (first surface) 152 is formed in a curved surface shape between the first edge section 172a of the contact section 162 or the near edge 182a of the first electrode surface 152 and the outer edge 182b of the first electrode surface 152. Therefore, in a cross-section, the section between the near edge 182a of the first electrode surface 152 and the outer edge 182b of the first electrode surface 152 is nonlinear.

[0147] A normal vector N2a on the first electrode surface (first surface) 152 is considered (see Fig. 2 and Fig. 3A). From the normal vector N2a of the first electrode surface 152, components parallel to the virtual plane VP are directed at each position of the first electrode surface 152 towards the first side surface 84a of the treatment section 26.

[0148] The second electrode surface (second surface) 154 is symmetrical to the first electrode surface (first surface) 152 with respect to the motion surface T (central position M) in the lateral direction. A normal vector N2b on the second electrode surface (second surface) 154 is considered (see Fig. 2 and Fig. 3A). From the normal vector N2b of the second electrode surface 154, components parallel to the virtual plane VP are directed at each position of the second electrode surface 154 towards the second side surface 84b of the treatment section 26.

[0149] Even in this case, as with the first version and the first modification described above, it is possible to achieve better treatment performance than with the conventional treatment instrument.

[0150] The example in which the first electrode surface 152 and the second electrode surface 154 are concave curved surfaces has been described. Although not shown, the first electrode surface 152 and the second electrode surface 154 can also be convex curved surfaces.

[0151] Although not shown, the first electrode surface 152 can be a combination of a section separating from the virtual plane VP in a planar shape and a section separating from the virtual plane VP in a curved shape, if the distance from the longitudinal axis L2 to the first side surface 84a of the treatment section 26 is reduced. That is, the first electrode surface 152 is preferably formed from one or more planar surfaces and one or more curved surfaces.

[0152] Similarly, the second electrode surface 154 can be a combination of a section that separates from the virtual plane VP in a planar shape and a section that separates from the virtual plane VP in a curved shape when the distance from the longitudinal axis L2 to the second side surface 84b of the treatment section 26 is reduced. That is, the second electrode surface 154 is preferably formed from one or more planar surfaces and one or more curved surfaces. (Fifth modification)

[0153] A fifth modification is made with reference to Fig. 8 described.

[0154] As in Fig. As shown in Figure 8, the contact section 162 of the cushioning element 114 comprises a first edge section 172a, which is separated from the central position M in the first width direction W1, a second edge section 172b, which is separated from the central position M in the second width direction W2, and a central section 174, through which the central position M passes, as in the first embodiment described above.

[0155] The central section 174 is formed between the first edge section 172a and the second edge section 172b. In the present modification, the central section 174 is not recessed, but rather forms a flat surface flush with the first edge section 172a and the second edge section 172b. Therefore, in the present modification, the central surface 52b of the end face 52 can be brought into contact with the central section 174 of the contact section 162.

[0156] Although the first electrode surface 152 and the second electrode surface 154 in Fig. 8 in the same form as the one in Fig. As the seven examples shown illustrate, it goes without saying that they are the ones in Fig. 2 to Fig. 4, Fig. 5A, Fig. 5B, Fig. 6A and Fig. They may have the forms shown in 6B. (Sixth modification)

[0157] A sixth modification will be made with reference to Fig. 9 described.

[0158] In the examples described above, the first edge section 172a of the contact section 162 of the first gripping part 26b is further away from the second back surface 86b of the treatment section 26 along the opening and closing direction than the near edge 182a of the first electrode surface 152 of the electrode element 112.

[0159] As in Fig. As shown in Figure 9, the first edge section 172a of the contact section 162 can be arranged at an equal distance from the second back surface 86b of the treatment section 26 and from the near edge 182a of the second electrode surface 152 of the electrode element 112 along the opening and closing direction, or closer to the second back surface 86b than the near edge 182a. Similarly, the second edge section 172b of the contact section 162 can be arranged at an equal distance from the second back surface 86b of the treatment section 26 and from the near edge 184a of the second electrode surface 154 of the electrode element 112 along the opening and closing direction, or closer to the second back surface 86b than the near edge 184a. Therefore, in the present modification, the virtual plane VP, which passes through the near edge 182a of the electrode surface 152 and the near edge 184a of the electrode surface 154, must not intersect the cushioning element 114 including the contact section 162.

[0160] A recess (concave part) 176 is located in the middle part 174 of the cushioning element 114 of the second gripping part 26b, which is in Fig. Figure 9 is shown. That is, the contact section 162 contains the recess 176, which is recessed in a direction opposite to a direction on the end face 52 of the blade 44 of the first gripping part 26a between the first edge section 172a and the second edge section 172b.

[0161] The blade 102 of the second gripping part 26b contains in the recess 176 an electrode surface (third surface) 156, which is to be used as a high-frequency electrode and has the same potential as the first electrode surface 152 and the second electrode surface 154.

[0162] In a state where the treatment target S is clamped between the first gripping part 26a and the second gripping part 26b, the treatment target S can come into contact with the electrode surface 156 in the recess 176 before or during the application of the high-frequency current. When the treatment target S comes into contact with the electrode surface 156, a current flows not only between the first electrode surface 152 and the opposite surface 52 and between the second electrode surface 154 and the opposite surface 52, but also between the electrode surface 156 and the opposite surface 52.

[0163] Even in this case, it is possible to demonstrate a better treatment performance than the conventional treatment instrument when performing the treatment, as in the first version and the first to fifth modifications described above.

[0164] The positional relationship between the first near edge 182a of the first electrode surface 152 and the second near edge 184a of the second electrode surface 154, as well as the first edge section 172a and the second edge section 172b of the contact section 162, can also be applied to the treatment instrument 12 described in the first to fifth modifications.

[0165] The electrode surface 156 can be used in a similar manner for the blade 102 of the first version and the first to fifth modifications described above. [Second embodiment]

[0166] A second embodiment is described with reference to Fig. 10 to Fig. The second embodiment is a modification of the first embodiment, including its modifications. The same elements as those of the first embodiment described above are identified by the same reference numerals, and detailed descriptions thereof are omitted. A portion of the treatment instrument 312 of the present modification and a portion of the treatment instrument 12 of the preceding embodiment may optionally be combined. This also applies to the following modifications.

[0167] The following describes a treatment instrument 312 that uses heat and a high-frequency current to perform a treatment on living tissue. In the present embodiment, heat is introduced from a heat-generating section (heater) 344c into a blade (first treatment body) 344 of a treatment section 326, to be described later, either together with or separately from the high-frequency energy flow, as a different energy (second energy) than the high-frequency energy.

[0168] A treatment system 10 consists of the treatment device 312 and an energy source 16.

[0169] The treatment instrument 312 is detachably connected to the power source 16 via a cable 376. The treatment instrument 312 comprises a housing 22, a tubular shaft (sheath) 24, and the treatment section (end effector) 326. In the present embodiment, the longitudinal axis C is defined as a straight central axis with respect to a relay section 328 (described later) of the treatment section 326.

[0170] An operating device 318, e.g., a foot switch, is electrically connected to the power source 16. The operating device 318 preferably comprises a plurality of pedals. An operation to supply electrical energy from the power source 16 to the treatment instrument 312 is initiated in the operating device 318. In one embodiment, instead of or in addition to the separate operating device 318, an actuating switch (not shown) or the like, attached to the housing 22 or the like of the treatment instrument 312, is provided as the actuating device. Then, an operation to supply electrical energy from the power source 16 to the treatment instrument 312 is initiated via an operating device attached to the treatment instrument 312.

[0171] In the present embodiment, one end of the cable 376 is connected to the handle 62. The other end of the cable 376 is detachably connected to the power source 16.

[0172] Fig. 11 and Fig. Figure 12 shows an example of the configuration of the distal end section of shaft 24 and the treatment section 326. As in Fig. 11 and Fig. As shown in Figure 12, the treatment section 326 comprises a proximal end and a distal end and extends from the proximal end to the distal end along the longitudinal direction (the direction indicated by arrows E1 and E2). The treatment section 326 is coupled to the distal end section of the shaft 24. The treatment section 326 is rotatable with respect to the shaft 24 about the coupling position with the shaft 24, i.e., rotatable about an axis of rotation R. The rotation of the treatment section 326 about the axis of rotation R relative to the shaft 24 causes the treatment section 326 to bend relative to the shaft 24 and the longitudinal axis C. In a state where the treatment section 326 is not bent with respect to the shaft 24, the longitudinal direction of the treatment section 326 is parallel or substantially parallel to the axial direction of the shaft 24 and is parallel or substantially parallel to the longitudinal axis C.

[0173] Here, the axis of rotation R extends along a direction that intersects (at right angles or substantially perpendicular to) the longitudinal direction of the treatment section 326. The bending direction of the treatment section 326 (the same direction as the lateral direction indicated by arrows W1 and W2) intersects (is perpendicular or substantially perpendicular to) the longitudinal direction of the treatment section 326 and intersects (is perpendicular or substantially perpendicular to) the axis of rotation R. In the present embodiment, the bending direction of the treatment section 326 is parallel or substantially parallel to the lateral direction of the treatment section 326. Fig. Figure 11 shows a state seen from one side in the width direction of the treatment section 326, and part of it is shown in a cross-section perpendicular or substantially perpendicular to the width direction of the treatment section 326. Fig. Figure 12 shows a state viewed from one side in a direction parallel or substantially parallel to the axis of rotation R of the treatment section 326, and also shows an internal structure of the shaft 24.

[0174] In the present embodiment, an actuating wheel 368 is mounted on the housing 22 as an actuating element. A pair of elongated elements 332a and 332b extend along the longitudinal axis C, i.e., along the axial direction of the shaft 24. The distal end of each of the elongated elements 332a and 332b is connected to the treatment section 326. When actuation is applied to the actuating wheel 368, a driving force is transmitted to the elongated elements 332a and 332b via a driving force transmission mechanism (not shown) or the like within the housing 22, and each of the elongated elements 332a and 332b moves along the longitudinal axis C with respect to the shaft 24. Accordingly, the treatment section 326 rotates about the axis of rotation R, and the treatment section 326 performs a bending operation with respect to the shaft 24.

[0175] The treatment section 326 comprises a tubular relay section 328 and a pair of gripping elements 26a and 26b. The relay section 328 is attached to the distal end section of the shaft 24 such that it is rotatable about the axis of rotation R. The pair of gripping elements 26a and 26b can be opened and closed relative to each other. One of the gripping elements 26a and 26b is rotatably connected to the relay section 328. In one embodiment, the other gripping element 26a and 26b is formed integrally with or attached to the relay section 328. In another embodiment, the other gripping element 26a and 26b is also rotatably attached to the relay section 328. In yet another embodiment, a rod element (not shown) is provided that projects distally from the distal end of the relay section 328. One section of the rod element protruding from the relay section 328 forms the other of the gripping parts 26a and 26b.

[0176] In the present embodiment, the opening and closing directions of the gripping parts 26a and 26b (the directions indicated by arrow Y1 and arrow Y2), i.e., the directions of movement of the gripping parts 26a and 26b during the opening and closing processes of the treatment section 326, intersect the longitudinal direction and the bending direction of the treatment section 326 (are perpendicular or substantially perpendicular thereto). The opening and closing directions of the gripping parts 26a and 26b (the opening and closing directions of the treatment section 326) are parallel or substantially parallel to the axis of rotation R.

[0177] A movable element 334a extends along the axial direction of the shaft 24, either inside or outside the shaft 24. The proximal end section of the movable element 334a is coupled to the handle 64 inside the housing 22. The distal end of the movable element 334a is connected to the treatment section 326 via a connecting mechanism 334b. Thus, the joint mechanism 334b ​​connects the treatment section 326 and the movable element 334a. Because of the joint mechanism 334b, when the treatment section 326 is bent relative to the shaft 24, the treatment section 326 is also bent relative to the movable element 334a.

[0178] When the handle 64 is opened or closed relative to the handle 62, the movable element 334a moves along the axial direction of the shaft 24. As a result, the driving force is transmitted from the movable element 334a via the connecting mechanism 334b ​​to the treatment section 326, and the gripping parts 26a and 26b are opened or closed in pairs relative to each other. The closing of the gripping parts 26a and 26b relative to each other allows the gripping parts 26a and 26b to clamp tissue or the like between them.

[0179] Regardless of the axial position of the movable element 334a along the shaft 24, the shaft 24 is coupled to the treatment section 326 in a region where the connection mechanism 334b ​​extends. In other words, regardless of the axial position of the movable element 334a along the shaft 24, the coupling position of the treatment section 326 with the shaft 24 is in a region where the connection mechanism 334b ​​extends.

[0180] In one embodiment, the treatment section 326 is not bendable relative to the shaft 24. In this case, the connection mechanism 334b ​​is not provided, and the distal end of the shaft 24 is directly connected to the treatment section 326. At this point, the longitudinal axis C of the relay section 328 coincides with the longitudinal axis of the shaft 24.

[0181] In this case, the actuating wheel 368 and the elongated links 332a and 332b are not provided, and the longitudinal direction of the treatment section 326 always runs parallel or substantially parallel to the axial direction of the shaft 24. In this embodiment, one of the gripping elements 26a and 26b is rotatably attached to the distal end section of the shaft 24. The other gripping element 26a and 26b can be formed integrally with the shaft 24 or attached to the shaft 24. The other gripping element 26a and 26b can also be rotatably attached to the shaft 24.

[0182] In the treatment section 326 of the present embodiment, the longitudinal dimension of the treatment section 326 is larger than any dimension of the treatment section 326 in the opening and closing directions and the dimension of the treatment section 326 in the width direction. In the longitudinal direction of the treatment section 326, the respective dimensions of the first gripping part 26a and the second gripping part 26b are equal or substantially equal. In the width direction of the treatment section 326, the respective dimensions of the first gripping part 26a and the second gripping part 26b are equal or substantially equal, in contrast to the treatment section 26 of the first embodiment.

[0183] The treatment section 326, in which the first gripping part 26a and the second gripping part 26b interact, comprises a distal end section 382a, a proximal end section 382b, a first side surface (side section) 384a, a second side surface (side section) 384b, a first back surface 386a and a second back surface 386b. In particular, the first back surface 386a is formed on the first gripping part 26a and the second back surface 386b on the second gripping part 26b.

[0184] In the present embodiment, the widths of the first gripping part 26a and the second gripping part 26b are essentially the same. Therefore, the first side surface 384a is defined by a virtual line connecting a position of a clamping jaw 346 of the first gripping part 26a and / or a base 344d of the blade 344, which is furthest from a movement surface T in the first width direction W1, and a position of a clamping jaw 404 of the second gripping part 26b and / or a base 414 of a blade 402, which is furthest from the movement surface T in the first width direction W1.Similarly, the second side surface 384b is defined by a virtual line connecting a position of the jaw 346 of the first gripping part 26a and / or the base 344d of the blade 344, which is furthest from the movement surface T in the second width direction W1, and a position of the jaw 404 of the second gripping part 26b and / or the base 414 of the blade 402, which is furthest from the movement surface T in the second width direction W2.

[0185] Fig. 13 and Fig. Figure 14 shows cross-sections perpendicular or substantially perpendicular to the longitudinal direction of the treatment section 326. The first gripping part 26a and the second gripping part 26b of the treatment section 326 can be opened and closed relative to each other.

[0186] The first gripping part 26a comprises the blade (first treatment body) 344 and the jaw (support body) 346 equipped with the blade 344. The blade 344 is attached to the jaw 346 from the side on which the second gripping part 26b is located. In the first gripping part 26a, the blade 344 together with the jaw 346 can be opened and closed relative to the second gripping part 26b.

[0187] The second gripping part 26b comprises the blade (second treatment body) 402 and the jaw (support body) 404 equipped with the blade 402. The blade 402 is attached to the jaw 404 on the side where the first gripping part 26a is located. In the second gripping part 26b, the blade 402 together with the jaw 404 can be opened and closed relative to the first gripping part 26a.

[0188] The opening and closing directions of the treatment section 326, which approach and move away from each other, are defined by rotating the second gripping part 26b relative to the first gripping part 26a. The opening and closing directions intersect the extension direction of the treatment section 326 with respect to the distal end of the relay section 328 along the longitudinal axis C, e.g., substantially perpendicularly.

[0189] As described above in the first version, in the state in which the second gripping part 26b is open relative to the first gripping part 26a (see Fig. 14), the longitudinal axes L1 and L2 are separated from each other. The longitudinal axis L2 moves with respect to the longitudinal axis C, while the second gripping part 26b rotates with respect to the relay section 328. In the Fig. In the state shown in Figure 13, in which the second gripping part 26b is closed relative to the first gripping part 26a, the longitudinal axes L1 and L2 coincide.

[0190] The blade (first treatment body) 344 comprises an electrode element 344a, an adhesive layer 344b provided on the back of the electrode element 344a and having an electrically insulating property, a heat-generating section 344c provided on the back of the adhesive layer 344b, a base 344d provided between the electrode element 344a and the heat-generating section 344c on the one hand and the jaw (first jaw) 346 on the other hand, and a heat sink 344e provided between the base 344d and the jaw 346.

[0191] The electrode element 344a extends continuously from the proximal end section to the distal end section of the first gripping part 26a along the longitudinal direction of the treatment section 326. The electrode element 344a has electrical conductivity and high thermal conductivity. The electrode element 344a is made, for example, of an aluminum alloy or a metal containing aluminum.

[0192] The base 344d, the heat sink 344e, and the jaw 346 each extend continuously over a region from the proximal end section to the distal end section of the first gripping part 26a in the longitudinal direction of the treatment section 326. In the case of the blade 344, the heat sink 344e is attached to the base 344d on the side where the jaw 346 opens (from the rear of the jaw 346). The jaw 346 is attached to the base 344d and the heat sink 344e on the side where the jaw 346 opens. The jaw 346 forms the back side 386a facing the opening side of the jaw 346 on the outer surface of the jaw 346. The electrode element 344a is attached to the base 344d from the side where the jaw 346 is closed, i.e., from the side where the blade 402 is located.

[0193] The base 344d is electrically insulating and has a lower thermal conductivity than the electrode element 344a. The base 344d consists of a resin such as liquid crystal polymer (LCP) and polyetheretherketone (PEEK). The heat sink 344e has a higher thermal conductivity than the base 344d and transfers the heat transferred by the base 344d to the proximal side of the jaw 346. The heat sink 344e is made of a material with high thermal conductivity, such as aluminum or copper. The clamping jaw 346 is made of metal. The exposed part of the jaw 346, including the first back surface 386a of the first gripping part 26a, is preferably provided with an electrically insulating coating or overmolded with an electrically insulating material.

[0194] The electrode element 344a comprises a projection (end face) 352 that extends toward the blade 402 of the second gripping part 26b. The projection 352 extends toward side Y2, where the jaw (first jaw) 346 is closed. Furthermore, the projection 352 extends continuously from the proximal end section to the distal end section of the jaw 346 along the longitudinal direction of the treatment section 326. The electrode element 344a has a rear electrode surface 354 that faces side Y1 opposite side Y2, from which the projection 352 extends. The rear electrode surface 354 faces the side where the jaw 346 opens and is not directed outward. The base 344d is attached to the electrode back surface 354 of the electrode element 344a, and a cavity 355 is defined between the base 344d and the electrode back surface 354 of the electrode element 344a.Both the electrode back surface 354 and the cavity 355 extend continuously over the area from the proximal end section to the distal end section of the cheek 346 in the longitudinal direction of the treatment section 326.

[0195] The heat-generating section 344c, e.g., a heating element, is arranged in the cavity 355. The heat-generating section 344c comprises a heating wire (not shown), and the heating wire is made of an electrically conductive material such as stainless steel, platinum, or tungsten. The heat-generating section 344c is attached to the electrode back surface 354 of the electrode element 344a via the adhesive layer 344b. The heat-generating section 344c is electrically insulated from the electrode element 344a by the adhesive layer 344b. Both the heat-generating section 344c and the adhesive layer 344b extend continuously over the area from the proximal end section to the distal end section of the jaw 346 in the longitudinal direction of the treatment section 326.

[0196] The first gripping element 26a is symmetrical or substantially symmetrical in the width direction about the movement area T (central position M). In the present embodiment, the movement area T extends through the projection 352 and the heat-generating part 344c. The electrode element 344a is also symmetrical or substantially symmetrical about the central position M.

[0197] The projection 352 can be a flat surface or a curved surface. The projection 352 can be a combination of a plurality of curved surfaces and / or flat surfaces. In the present embodiment, the projection 352 comprises three surfaces 352a, 352b, and 352c. The surface (first near surface) 352a is located near a first side surface 384a (described later) of the treatment section 326. The surface 352b is configured as a central surface in a central section in the width direction of the projection 352. The surface (second near surface) 352c is proximal to a second side surface 384b (described later) of the treatment section 326.

[0198] The base 344d comprises a pair of mutually facing surfaces (insulating surfaces) 348a and 348b, which are spaced apart from each other. In Fig. 13 to Fig. 15 the end face 348a and the first near surface 352a are flush with each other, and the end face 348b and the second near surface 352c are flush with each other.

[0199] The electrode element 344a of the blade 344 of the first gripping part 26a comprises a first outer edge 356a and a second outer edge 356b. In the present embodiment, the first outer edge 356a is a boundary between the first near surface 352a of the projection 352 and the opposite surface 348a of the base 344d. The second outer edge 356b of the electrode element 344a of the blade 344 of the first gripping part 26a is a boundary between the surface 352c of the projection 352 and the facing surface 348b of the base 344d.

[0200] The first outer edge 356a is closer to the first side surface 384a of the treatment section 326 than to the second side surface 384b of the treatment section 326. Therefore, the first outer edge 356a of the blade 344 is brought close to the first side surface 384a of the treatment section 326, which is separated from the longitudinal axis L1 of the blade 344 in the first width direction W1 perpendicular to the opening and closing directions along the movement surface T.

[0201] The second outer edge 356b is closer to the second side surface 384b of the treatment section 326 than to the first side surface 384a of the treatment section 326.

[0202] Therefore, the second outer edge 356b of the blade 344 is brought close to the second side surface 384b of the treatment section 326, which is separated from the longitudinal axis L1 of the blade 344 in the second width direction W2 perpendicular to the opening and closing directions along the movement surface T.

[0203] In the present embodiment, the central surface 352b of the projection 352 between the first outer edge 356a and the second outer edge 356b of the blade 344 is used as a projection which, in conjunction with an area of ​​the surfaces 352a and 352c adjacent to the central surface 352b, is brought into contact with a contact section (contact surface) 462 (described later) of the blade 402 of the second gripping part 26b.

[0204] The blade 402 comprises an electrode element 412 and the base 414.

[0205] Both the base 414 and the jaw (second jaw) 404 extend continuously along the length of the treatment section 326, from the proximal end to the distal end of the jaw 404. The jaw 404 is attached to the base 414 on the side where it opens. The clamping jaw 404 forms the second back surface 386b on the outer surface of the clamping jaw 404, facing the side where the clamping jaw 404 opens. Furthermore, the electrode element 412, for example, is attached to the base 414 on the side where the jaw 404 is closed, i.e., on the side where the blade 344 is located. The electrode element 412 extends continuously over the area from the proximal end section to the distal end section of the second gripping part 26b in the longitudinal direction of the treatment section 326. The electrode element 412 is made of an electrically conductive material.

[0206] The base 414 is electrically insulating and has a lower thermal conductivity than the electrode element 412. The base 414 is made, for example, of synthetic resin. The clamping jaw 404 is made of metal. The exposed part of the jaw 404, including the second back surface 386b, is preferably provided with an electrically insulating coating or overmolded with an electrically insulating material.

[0207] The base (second base) 414 comprises the contact section 462, with which the projection 352 of the electrode element (first electrode) 344a can be brought into contact. The contact section 462 faces the projection 352. In the present embodiment, the contact section 462 intersects the opening and closing direction of the jaw 404 (is perpendicular or substantially perpendicular to it).

[0208] The base 414 comprises a pair of inclined surfaces (insulating surfaces) 464a and 464b, which are separated from each other. The inclined surface 464a is located closer to the first side surface 384a of the treatment section 326 along the first lateral direction W1 than an electrode surface 452, which will be described later. The inclined surface 464a and the electrode surface 452 can be parallel to each other or inclined relative to each other. The inclined surface 464b is located closer to the second side surface 384b of the treatment section 326 along the second lateral direction W2 than an electrode surface 454, which will be described later. The inclined surface 464b and the electrode surface 454 can be parallel to each other or inclined relative to each other.

[0209] The electrode element (second electrode) 412 comprises a pair of electrode surfaces (inclined surfaces) 452 and 454, which are spaced apart from each other. The electrode surfaces 452 and 454 face the side on which the first gripping part 26a is located, i.e., the side on which the second gripping part 26b is closed. The electrode surfaces 452 and 454 are electrically connected and have the same potential.

[0210] A virtual plane VP is defined on the first electrode surface 452 of the electrode element 412. This plane is perpendicular to the opening and closing directions and passes through a first near edge 482a of the first electrode surface 452 in the closed state. In the closed state, the virtual plane VP preferably lies on the longitudinal axes L1 and L2. That is, in the present embodiment, the virtual plane VP is defined as a plane that is perpendicular to the movement surface T, extends along the longitudinal axes L1 and L2, and passes through the near edge 482a of the first electrode surface 452. With respect to the second electrode surface 454 of the electrode element 412, a virtual plane that is perpendicular to the opening and closing directions and passes through the second near edge 484a of the second electrode surface 454 in the closed state coincides with the virtual plane VP described above.

[0211] The base 414 is attached to the rear surfaces of the electrode surfaces 452 and 454, i.e., to the end faces of the electrode surfaces 452 and 454 on the side opposite the side on which the blade 344 is located. The electrode surfaces 452 and 454 are arranged with the contact section 462 between them and are spaced apart from each other in the width direction of the jaw 404. Therefore, the electrode surface 452 rests against one side of the contact section 462 in the width direction of the jaw 404. The electrode surface 454 borders the other side of the contact section 462 in the width direction of the jaw 404. Each of the contact sections 462 and the electrode surfaces 452 and 454 extend continuously over the area from the proximal end section to the distal end section of the jaw 404 in the longitudinal direction of the treatment section 326.When the first gripping part 26a and the second gripping part 26b are closed to each other in a state in which no tissue is present between the first gripping part 26a and the second gripping part 26b, the projection 352 is in contact with the contact section 462 over the area from the proximal end section to the distal end section of the treatment section 326.

[0212] The first electrode surface 452 is located on the inside of the first side surface 384a of the treatment section 326 in the width direction. The first electrode surface 452 projects forward on the side where the first gripping part 26a is located, i.e., on the side where the second gripping part 26b is closed. Similarly, the second electrode surface 454 is located on the inside of the second side surface 384b of the treatment section 326 in the width direction. The second electrode surface 454 projects forward on the side where the first gripping part 26a is located, i.e., on the side where the second gripping part 26b is closed.

[0213] The first electrode surface (first surface) 452 is separated from the projection (opposite surface) 352 of the blade 344 in both the open and closed states. The second electrode surface (second surface) 454 is separated from the opposite surface 352 of the blade 344 in both the open and closed states.

[0214] The distance between the first outer edge 482b and the virtual plane VP is greater than the distance between the first near edge 482a of the first electrode surface (first surface) 452 and the virtual plane VP. In the Fig. 13 to Fig. In the example shown in Figure 15, the distance between the first electrode surface 452 and the virtual plane VP increases continuously from the first near edge 482a to the first outer edge 482b.

[0215] Likewise, the distance between the second outer edge 484b and the virtual plane VP is greater than the distance between the first near edge 484a of the second electrode surface (second surface) 454 and the virtual plane VP. In the Fig. 13 to Fig. In the example shown in Figure 15, the distance between the second electrode surface 452 and the virtual plane VP increases continuously from the second near edge 484a to the second outer edge 484b.

[0216] The base 414 of the second gripping part 26b comprises, between the electrode surfaces 452 and 454, the contact section 462, which faces the projection 352 of the blade 344. Therefore, the blade 402 of the second gripping part 26b includes the contact section 462, the first electrode surface (first surface) 452, the second electrode surface (second surface) 454, and a pair of inclined surfaces 464a and 464b facing the projection 352, as well as a pair of mutually facing surfaces 348a and 348b of the first gripping part 26a.

[0217] The contact section 462 has an electrically insulating property. The contact section 462 faces the projection (treatment surface) 352 of the blade 344. The contact section 462 is movable relative to the projection 352 of the blade 344 along the opening and closing directions between an open state, in which the contact section is separated from the projection, and a closed state, in which the contact section is close to the projection. In particular, the contact section 462 can come into contact with the projection 352 of the blade 344 in the closed state. That is, in the closed state, the central surface (projection) 352b of the projection 352 of the blade 344 of the first gripping part 26a is also located in the width direction between the electrode surfaces 452 and 454.Therefore, a movement surface T (central position M) runs in the width direction of the second gripping part 26b through the contact section 462 and the central surface 352b of the projection 352 of the blade 344.

[0218] The contact section 462 comprises a first edge section 472a, which is separated from the central position M in the first width direction W1, a second edge section 472b, which is separated from the central position M in the second width direction W2, and a central section 474 through which the movement surface T passes. The first edge section 472a is closer to the first side surface 384a of the treatment section 326 than to the second side surface 384b of the treatment section 326. Therefore, the first edge section 472a of the contact section 462 is brought close to the first side surface 384a of the treatment section 326, which is separated from the longitudinal axis L2 of the contact section 462 in the first width direction W1 perpendicular to the opening and closing directions. The second edge segment 472b is closer to the second side surface 384b of the treatment section 326 than to the first side surface 384a of the treatment section 326.Therefore, the second edge section 472b of the contact section 462 is close to the second side surface 384b of the treatment section 326, which is separated from the longitudinal axis L2 of the contact section 462 in the second width direction W2 perpendicular to the opening and closing directions.

[0219] The central section 474 is formed between the first edge section 472a and the second edge section 472b. The central section 474 is flat, bringing into contact with the area surrounding the central section of the projection 352 of the blade 344 of the first gripping part 26a. Therefore, in the present embodiment, the three surfaces 352a, 352b, and 352c of the projection 352 are brought into contact with the central section 474 of the contact section 462. Of course, it is also possible for only the central surface 352b to be in contact with the central section 474 of the contact section 462.

[0220] The first electrode surface 452 comprises a first near edge 482a, which is located near the longitudinal axis L2, and a first outer edge 482b, which is further away from the longitudinal axis L2 than the first near edge 482a and is located near the first side surface 384a of the treatment section 326.

[0221] Preferably, there should be no clearance between the first edge section 472a of the contact section 462 and the near edge 482a of the first electrode surface 452; however, a slight clearance between the first edge section 472a and the near edge 482a is permissible. Furthermore, it is preferred that there be no step between the first edge section 472a of the contact section 462 and the near edge 482a of the first electrode surface 452; however, a slight step between the first edge section 472a and the near edge 482a is permissible. The first electrode surface 452 extends from the first edge section 472a of the contact section 462 or the first near edge 482a of the first electrode surface 452 toward the first side surface 384a of the treatment section 26.In the present embodiment, the first electrode surface (first surface) 452 is formed in a flat shape between the first edge section 472a of the contact section 462 or the near edge 482a of the first electrode surface 452 and the outer edge 482b of the first electrode surface 452.

[0222] In one embodiment, the area between the near edge 482a of the first electrode surface 452 and the outer edge 482b of the first electrode surface 452 can be a non-planar, combined curved / planar surface, similar to that in Fig. 5A to Fig. The first electrode surface 452 is described in the example of electrode surface 152 in Figure 7. That is, the first electrode surface 452 can be a flat surface or a curved surface. Furthermore, the first electrode surface 452 can be formed from one or more flat surfaces and one or more curved surfaces. Additionally, the distance between the first electrode surface 152 and the virtual plane VP can increase continuously or intermittently from the first near edge 182a towards the first outer edge 182b.

[0223] The inclined surface 464a is formed between the first outer edge 482b of the electrode surface 452 and the first side surface 384a of the treatment section 326. The inclined surface 464b is formed between the second outer edge 484b of the electrode surface 454 and the second side surface 384b of the treatment section 326. Fig. 13 to Fig. In section 15, the first outer edge 482b of the electrode surface 452 is located at a position projecting from the inclined surface 464a towards the first gripping element 26a. However, the first outer edge 482b of the electrode surface 452 and the end section 465a of the inclined surface 464a near the longitudinal axis L2 may be flush with each other. Similarly, the second outer edge 484b of the electrode surface 454 is located at a position projecting from the inclined surface 464b towards the first gripping element 26a. However, the second outer edge 484b of the electrode surface 454 and the end section 465b of the inclined surface 464b near the longitudinal axis L2 may be flush with each other.

[0224] The first electrode surface 452 is inclined in the lateral direction such that it separates from the side on which the first gripping part 26a is located when the distance to the first side surface 384a of the treatment section 326 decreases. In other words, the electrode surface 452 is oriented towards the side on which the distance to the first gripping part 26a increases when the electrode surface separates from the central position M in the first lateral direction W1.

[0225] Here, the contact section 462 of the base 414 of the blade 402 of the second gripping part 26b can be brought into contact with the projection 352 of the blade 344 of the first gripping part 26a in the closed state. On the first electrode surface 452 of the electrode part 412, a virtual plane VP perpendicular to the opening and closing direction is defined, which, in the closed state, extends through the first near edge 482a of the first electrode surface 452. In the closed state, the virtual plane VP preferably lies on the longitudinal axes L1 and L2. That is, in the present embodiment, the virtual plane VP is defined as a plane that is perpendicular to the movement surface T, extends along the longitudinal axes L1 and L2, and passes through the near edge 482a of the first electrode surface 452.A virtual plane, which passes through the second near edge 484a of the second electrode surface 454 and is defined between the projection 352 and the second near edge 484a of the second electrode surface 454 on the side of the second side surface 384b of the treatment section 326, which is separated from the longitudinal axes L1 and L2 in a second lateral direction W2 perpendicular to the opening and closing directions, coincides with the virtual plane VP described above.

[0226] The distance between the first electrode surface 452 and the virtual plane VP increases (becomes larger) as the virtual point moves away from the longitudinal axis L2 towards the first side surface 384a of the treatment section 326, specifically in a region between the first edge section 472a of the contact section 462 or the near edge 482a of the first electrode surface 452 and the outer edge 482b of the first electrode surface 452. A distance Ld at a position farther from the first near edge 482a is greater than a distance Lp between the virtual plane VP and the first electrode surface 452 at a position near the first near edge 482a. Fig. 13.

[0227] A normal vector N2a on the first electrode surface (first surface) 452 is taken into account. Components of the normal vector N2a of the first electrode surface 452, parallel to the virtual plane VP at an arbitrary position of the first electrode surface 452, are directed onto the first side surface 384a of the treatment section 326.

[0228] The second electrode surface 454 is provided from the second edge section 472b of the contact section 462 in the direction of the second side surface 384b of the treatment section 326.

[0229] The second electrode surface 454 includes the second near edge 484a, which is located near the longitudinal axis L2, and the second outer edge 484b, which is further away from the longitudinal axis L2 than the second near edge 484a and is located near the second side surface 384b of the treatment section 326.

[0230] In the present embodiment, the first electrode surface 452 and the second electrode surface 454 are symmetrical with respect to the movement surface T (central position M).

[0231] A normal vector N2b on the second electrode surface (second surface) 454 is considered. Components of the normal vector N2b of the second electrode surface 454 are directed parallel to the virtual plane VP at each position of the second electrode surface 454 towards the second side surface 384b of the treatment section 326.

[0232] A normal vector N1a on the first near surface 352a of the opposite surface 352 of the blade 344 is considered. Components of the normal vector N1a of the first electrode surface 352a, parallel to the virtual plane VP, are directed at each position of the first near surface 352a onto the first side surface 384a of the treatment section 326. A normal vector N1b on the second near surface 352c of the opposite surface 352 of the blade 344 is considered. Components of the normal vector N1b of the second near surface 352c, parallel to the virtual plane VP, are directed at each position of the second side surface 384b of the treatment section 226.

[0233] Like the blade 402 of the second gripping part 26b, the electrode surface 452, the contact section 462, and the electrode surface 454 as a whole can be formed at an acute angle, a right angle, or an obtuse angle. The width between the first edge section 472a and the second edge section 472b of the contact section 462 is preferably as small as possible. Therefore, it is preferred that the blade 402 of the second gripping part 26b be as sharp as possible. (Operation)

[0234] Next, the operation of the treatment instrument 312 according to the present embodiment is described. Descriptions of parts identical to those of the first embodiment are expediently omitted.

[0235] When performing a treatment with the treatment instrument 312, an operator inserts the treatment section 326 into a body cavity, e.g., an abdominal cavity. Then, a treatment target S, such as living tissue (e.g., a blood vessel), is placed between the first gripping part 26a and the second gripping part 26b, and the treatment target S is grasped between the first gripping part 26a and the second gripping part 26b (see Fig. 15).

[0236] A corresponding gripping pressure is exerted between the projection 352 of the electrode element 344a of the blade 344 of the first gripping part 26a and the contact section 462 of the blade 402 of the second gripping part 26b. When the first gripping part 26a and the second gripping part 26b are closed, the treatment target is thinned by the gripping pressure on the movement surface T. Therefore, when using the treatment instrument 312 according to the present embodiment, a suitable gripping pressure is exerted on the treatment target between the blade 344 of the first gripping part 26a and the contact section 462 of the second gripping part 26b instead of between electrodes. Furthermore, the treatment target is brought into contact with the projection 352 of the electrode element 344a of the blade 344 of the first gripping part 26a, and the treatment target is brought into contact with the first electrode surface 452 and the second electrode surface 454 of the electrode element 412 of the second gripping part 26b.

[0237] In this state, the operator, for example, activates a first pedal of the control device 318, which functions similarly to the first switch 16a of the first embodiment described above. The energy source 16 outputs electrical energy as a result of an activation input at the first pedal of the control device 318.

[0238] The electrode element 344a of the blade 344 of the first gripping part 26a and the electrode element 412 of the second gripping part 26b function as electrodes with different potentials relative to each other. A high-frequency current is passed through the treatment target gripped between the electrode element 344a of the blade 344 of the first gripping part 26a and the electrode element 412 of the second gripping part 26b, and the high-frequency current is applied to the treatment target S as treatment energy. The heat generated by the high-frequency current denatures the treatment target and promotes its coagulation. That is, the blood vessel or similar structure that is the treatment target is gelatinized, connected, and sealed by the heat generated by the high-frequency current. Thus, the treatment device 312 can seal (treat) the treatment target.

[0239] In the treatment section 326 of the treatment instrument 312 according to the present embodiment, in particular by the shaping of the blade 402 of the second gripping part 26b as described above, it is possible to efficiently increase the temperature of the treatment target and to suppress the temperature rise of the blade 344 of the first gripping part 26a in the same way as in the first embodiment described above. Furthermore, when using the treatment instrument 312 according to the present embodiment, energy is efficiently applied to the blood vessel as the treatment target S in the same way as in the first embodiment described above, since it is possible to suppress the temperature rise of the blade 344 of the first gripping part 26a.

[0240] Next, an example is described in which a second pedal of the operating device 318, which functions in the same way as the second switch 16b of the first embodiment described above, is pressed. Based on the operating input at the second pedal of the operating device 318, the power source 16 supplies electrical energy to the treatment instrument 312.

[0241] When electrical energy is supplied to the heat-generating section 344c from the energy source 16, the heat-generating section 344c generates heat. The heat generated in the heat-generating section 344c is transferred from the back side via the adhesive layer 344b to the projection 352 in the electrode element 344a. The temperature of the heat transferred to the projection 352 is set higher than the temperature of the treatment target, which can be increased by the high-frequency current. The heat (thermal energy) transferred to the projection 352 of the blade 44 of the first gripping part 26a is transferred to the treatment target. At this point, the treatment target is coagulated and cut between the projection (end face) 352 of the blade 344 and the contact section 462 of the blade 402.

[0242] As described above, the treatment target is thinned by the projection 352 of the blade 344 of the first gripping part 26a and the contact section 462 of the blade 402 of the second gripping part 26b. Therefore, the temperature of the treatment object S rises efficiently. Consequently, the drying of the treatment object S proceeds smoothly, and the incision rate of the treatment object S is improved. When the treatment target is incised, coagulation occurs in a section closer to the first side surface 384a and a section closer to the second side surface 384b of the treatment section 326 than the incision position of the treatment target.

[0243] Therefore, according to the present embodiment, the treatment section 326 of the treatment instrument 312 cuts into the treatment target more easily than the treatment section of the conventional treatment instrument. Thus, when heat is transferred to the treatment target, the treatment section 326 of the treatment instrument 312, according to the present embodiment, is likely to cut into the treatment target with less energy than the treatment section of the conventional treatment instrument requires.

[0244] When the second pedal of the actuating device 318 is pressed, the system 10 can cause a high-frequency current to flow through the treatment target to coagulate and incise the treatment target S simultaneously when the temperature of the heat-generating section 344c is increased, in the same way as when the first pedal of the actuating device 318 is pressed.

[0245] According to the present embodiment, in cases where the incision treatment is performed by energy other than high-frequency energy generated by the heat-generating section 344c of the first gripping part 26a, the treatment instrument 312, capable of efficiently applying the energy to the treatment target S, can be provided by shaping the blade 402 of the second gripping part 26b into a suitable form. Therefore, by using the treatment instrument 312 according to the present embodiment, the incision treatment on the treatment target can be performed efficiently with less energy (amount). That is, the blade 402 of the second gripping part 26b can incise (treat) the treatment target in conjunction with the projection (treatment surface) 352 of the blade 344 of the first gripping part 26a.

[0246] Furthermore, in a case where the treatment target S is to be coagulated using high-frequency energy, it is possible to provide the treatment instrument 312, which is able to suppress the temperature rise of the electrode (of the electrode element 344a of the blade 344) when the high-frequency current flows and to apply the energy efficiently to the treatment target S.

[0247] In the embodiment described above, the second gripping part 26b is movable, for example, with respect to the first gripping part 26a, which is attached to the distal end of the relay section 328. It is also preferred that both the first gripping part 26a and the second gripping part 26b are movable with respect to the distal end of the relay section 328. (First modification)

[0248] Next, a first modification of the second embodiment will be described with reference to Fig. 16 described. This modification is a modification of the first embodiment, including its modifications, and / or the second embodiment. The same elements, or elements having the same functions as those described above, are designated with the same reference numerals as far as possible, and detailed descriptions of them are omitted.

[0249] The in Fig. 13 to Fig. The contact section 462 of the second gripping part 26b shown in Figure 15 is, for example, planar. The one in Fig. The contact section 462 shown in Figure 16 comprises a curved surface that projects towards the projection 352 of the first gripping part 26a. Therefore, in the closed state, the contact section 462 is either at the same level as the first electrode surface 452 or projects away from the first electrode surface 452 in the direction of the treatment surface 352. Even though the projection 352 has a curved surface, the treatment is carried out in the same way as in the second embodiment described above.

[0250] The contact section 462 of the second gripping part 26b can be flat, as shown in the second embodiment, or concave, as shown in the first embodiment.

[0251] The end faces 348a and 348b of the first gripping element 26a have a combination of a region parallel to the virtual plane VP and a region inclined with respect to the virtual plane VP. The facing surfaces 348a and 348b can only be formed by surfaces parallel to the virtual plane VP.

[0252] A normal vector N1 on the end face 352 of the blade 344 is considered. The components of the normal vector N1 that run parallel to the virtual plane VP contain no components in the direction of the first side face 384a and no components in the direction of the second side face 384b at any position on the end face 352. In the Fig. In the example shown, the mutually facing surfaces 348a and 348b of the basis 344d are continuous with the facing surface 352 of the blade 344. The positions of the end faces 348a and 348b closest to the end face 352 of the blade 344 are parallel to the virtual plane VP. Positions of the end faces 348a and 348b farther from the end face 352 of the blade 344 are inclined to the virtual plane VP. At each position of the end face 348a of the basis 344d, there can be components of the normal vectors N1 directed towards the first face 348a, but there are no components directed towards the second face 348b. At each position of the facing surface 348b of the basis 344d, there may be components of the normal vectors N1 directed in the direction of the second side surface 384b, but there are no components directed in the direction of the second side surface 384b.

[0253] The first electrode surface 452 is inclined in the lateral direction to separate from the side on which the first gripping part 26a is located, as the distance to the first side surface 384a of the treatment section 326 decreases. In other words, the electrode surface 452 is oriented towards the side on which the distance from the first gripping part 26a increases as the electrode surface separates from the central position M in the first lateral direction W1. Here, the first electrode surface (first surface) 452 comprises a first region 452a including the near edge 482a and a second region 452b including the outer edge 482b along the lateral direction. The first region 452a and the second region 452b are each formed as a planar surface. Thus, the first electrode surface 452 is formed by a plurality of planar surfaces. These regions 452a and 452b are inclined similarly to regions 186a and 186b, which are the second modification (see Fig. 6A) or third modification (see Fig. 6B) of the first embodiment. That is, the inclination angles formed by the first region 452a including the first near edge 482a and the second region 452b including the first outer edge 482b with respect to the virtual plane VP are different from each other.

[0254] The second electrode surface 454 is inclined in the lateral direction such that it separates from the side on which the first gripping part 26a is located as the distance to the second side surface 384b of the treatment section 326 decreases. In other words, the electrode surface 454 is oriented towards the side on which the distance to the first gripping part 26a increases as the electrode surface separates from the central position M in the second lateral direction W2. The second electrode surface (second surface) 454 comprises, along the lateral direction, a first region 454a, which includes the near edge 484a, and a second region 454b, which includes the outer edge 482b. The first region 454a and the second region 454b are each formed as a planar surface. Thus, the second electrode surface 454 is formed by a plurality of planar surfaces. These areas 454a and 454b are inclined similarly to those of the second modification (see Fig. 6A) or third modification (see Fig. 6B) of the first embodiment described areas 188a and 188b. That is, the inclination angles formed by the second area 454a including the first near edge 484a and the second area 454b including the second outer edge 484b with respect to the virtual plane VP are different from each other.

[0255] The first electrode surface 452 and the second electrode surface 454 can each be a flat surface or a curved surface. The first electrode surface 452 and the second electrode surface 454 can each be formed from one or more flat surfaces and one or more curved surfaces.

[0256] In Fig. 16 The first outer edge 356a of the end face 352 of the blade 344 is located closer to the movement surface T than the first near edge 482a of the first electrode surface 452 of the blade 402. As long as the facing surface 352 of the blade 344 and the first electrode surface 452 of the blade 402 are not in contact with each other, the first outer edge 356a of the facing surface 352 of the blade 344 can be further away from the movement surface T than the first near edge 482a of the first electrode surface 452 of the blade 402. (Second modification)

[0257] Next, a second modification of the second embodiment will be described with reference to Fig. 17 described. This modification is a further modification of the first embodiment including its modifications and / or of the second embodiment including the first modification, and the same elements or elements having the same functions as those described above are designated by the same reference numerals as far as possible, and detailed descriptions thereof are omitted.

[0258] As in Fig. As shown in Figure 17, the first edge section 472a of the contact section 462 can be arranged at an equal distance to the second back surface 386b of the treatment section 326 from the near edge 482a of the second electrode surface 452 of the electrode element 412 along the opening and closing direction, or can be located closer to the second back surface 386b than the near edge 482a.

[0259] A recess (concave part) 476 is located in the middle part 474 of the base 414 of the second gripping part 26b, which is in Fig.Figure 17 shows the form. That is, the contact section 462 contains the recess 476, which is recessed in a direction opposite to a direction to the projection 352 of the electrode element 344a of the first gripping part 26a between the first edge section 472a and the second edge section 472b.

[0260] The blade 402 of the second gripping part 26b contains in the recess 476 an electrode surface (third surface) 456, which is used as a high-frequency electrode and has the same potential as the first electrode surface 452 and the second electrode surface 454.

[0261] In a state where the treatment target is gripped between the first gripping part 26a and the second gripping part 26b, the treatment target can come into contact with the electrode surface 456 in the recess 476 before or during the application of the high-frequency current. When the treatment target S comes into contact with the electrode surface 456, a current flows not only between the first electrode surface 452 and the projection 352 and between the second electrode surface 454 and the projection 352, but also between the electrode surface 456 and the projection 352.

[0262] Some embodiments have been specifically described with reference to the drawings; however, the present invention is not limited to the embodiments described above and includes all embodiments that have been carried out without departing from the scope of the present invention.

Claims

[1] Treatment instrument (12) comprising: a first treatment body (344) having a treatment surface (352) to be used as a high-frequency electrode and configured to receive, together or separately, a high-frequency energy and another energy that differs from the high-frequency energy input into the treatment surface (352); and a second treatment body (402) configured to treat a treatment target in conjunction with the treatment surface (352), wherein the second treatment body (402) comprises: a contact section (462) extending along a longitudinal axis (L2) and possessing an electrically insulating property; and a first surface (452) which is used as the first high-frequency electrode, wherein: the first surface (452) borders the contact section (462) in a first lateral direction (W1) perpendicular to the longitudinal axis (L2), the contact section (462) faces the treatment surface (352) of the first treatment body (344), wherein the contact section (462) is configured to move between an open state in which the contact section (462) is separated from the treatment surface (352) along opening and closing directions, and a closed state in which the contact section (462) is closed relative to the treatment surface (352), and the contact section (462) is configured to be brought into contact with the treatment surface (352) in the closed state, and the first surface (452) is separated from the treatment surface (352) in both the open and closed states and comprises a first near edge (482a) of the first surface (452), wherein the first near edge (482a) is located near the contact section (462); and a first outer edge (482b) which is spaced from the contact section (462) from the longitudinal axis (L2) in the direction of a first side surface (384a) of a treatment section (326) in the first width direction (W1), and Assuming that a virtual plane (VP) is defined such that in the closed state it is perpendicular to the opening and closing directions and passes through the first near edge (482a) of the first surface (452), at a distance between the virtual plane (VP) and the first surface (452) a distance between the first outer edge (482b) and the virtual plane (VP) is greater than a distance between the first near edge (482a) and the virtual plane (VP). [2] Treatment instrument according to claim 1, wherein the distance between the virtual plane (VP) and the first surface (452) increases continuously or intermittently from the first near edge (482a) to the first outer edge (482b). [3] Treatment instrument according to claim 1, wherein the first surface (452) is formed by a flat surface or a curved surface. [4] Treatment instrument according to claim 1, wherein the first surface (452) is formed by a plurality of surfaces. [5] Treatment instrument according to claim 1, wherein the first surface (452) is formed by one or more flat surfaces and one or more curved surfaces. [6] Treatment instrument according to claim 1, wherein the angles of inclination formed between the virtual plane (VP) and a first region including the first near edge (482a) and between the virtual plane (VP) and a second region including the first outer edge (482b) are different from each other. [7] Treatment instrument according to claim 1, wherein the first surface (452) between the first near edge (482a) and the first outer edge (482b) has a region in which the distance between the virtual plane (VP) and the first surface (452) is constant. [8] Treatment instrument according to claim 1, wherein the contact section (462) is at the same level as the first surface (452) in the closed state or projects from the first surface (452) in the direction of the treatment surface (352). [9] Treatment instrument according to claim 1, wherein in the closed state the first outer edge (482b) of the first surface (452) is further away from the longitudinal axis (L2) than an outer edge (356a) in the treatment surface (352) of the first treatment body (344), wherein the outer edge (356a) is located near the first side surface (384a) of the treatment section (326) away from the longitudinal axis (L2). [10] Treatment instrument according to claim 1, wherein a cross-section of at least a part of the first surface (452) between the first near edge (482a) and the first outer edge (482b) is formed in a linear state. [11] Treatment instrument according to claim 1, wherein a cross-section of at least a part of the first surface (452) between the first near edge (482a) and the first outer edge (482b) is formed in a non-linear state. [12] Treatment instrument according to claim 1, wherein: the second treatment body (402) has a second surface (454) which is used as a second high-frequency electrode with the same potential as the first high-frequency electrode (452); the second surface (454) adjoins the contact section (462) in a second latitude direction (W2) that is opposite to the first latitude direction (W1); and the second surface (454) is separated from the treatment surface (352) in both the open and closed states and comprises a second near edge (484a) of the second surface (454), wherein the second near edge (484a) is located near the contact section (462); and a second outer edge (484b) which is spaced from the contact section (462) from the longitudinal axis (L2) in the direction of a second side surface (384b) of the treatment section (326) in the second width direction (W2), and wherein: the virtual plane (VP) passes through the second near edge (484a) of the second surface (454), and at a distance between the virtual plane (VP) and the second surface (454) the distance between the second outer edge (484b) and the virtual plane (VP) is greater than the distance between the second near edge (484a) and the virtual plane (VP). [13] Treatment instrument according to claim 12, wherein the second surface (454) comprises a region in which the distance between the virtual plane (VP) and the second surface (454) between the second near edge (484a) and the second outer edge (484b) is constant. [14] Treatment instrument according to claim 1, wherein: the contact section (462) has a first edge section (472a) adjacent to the first near edge (482a) of the first surface (452), a second edge section (472b) spaced apart from the first near edge (482a), and a recess (recess) (476) provided between the first edge section (472a) and the second edge section (472b), recessed in a direction opposite to the direction towards the treatment surface (352); and the second treatment body (402) in the recess (476) contains a third surface (456) which is to be used as a high-frequency electrode and has the same potential as the first surface (452). [15] Treatment instrument according to claim 1, wherein: the treatment surface (352) of the first treatment body (344) is part of a rod (28), If ultrasonic vibrations are supplied to the rod (28) as a different energy than the radio frequency energy, the ultrasonic vibrations can be transmitted to the treatment surface (352) of the first treatment body (344), and the treatment instrument comprises a shaft (24) through which the rod (28) is inserted, wherein the first treatment body (344) is fixed relative to the shaft (24) and the second treatment body (402) is movable relative to the shaft (24).

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