JP3807783B2 - Ophthalmic ultrasound surgery device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an ultrasonic surgical apparatus that crushes or emulsifies a biological tissue by ultrasonic vibration generated by an ultrasonic vibrator.
[0002]
[Prior art]
A probe having an ultrasonic vibrator that generates ultrasonic vibrations is provided, and the ultrasonic vibration from the ultrasonic vibrator is amplified and transmitted to a tubular tip attached to the tip of the probe, and is sent to the tip of the tip. 2. Description of the Related Art An ultrasonic surgical device that crushes and emulsifies a living tissue that comes into contact is known.
In the field of ophthalmology, this type of device is used in cataract surgery for crushing and emulsifying a lens that has become clouded due to cataract. In cataract surgery, a perfusate is supplied from the vicinity of the tip of the tip into the eyeball, and a piece of tissue or the like crushed or emulsified with the perfusate is discharged to the outside through the tip suction hole and the suction passage in the probe.
Such an apparatus usually has a preset ultrasonic oscillation output or a linear control function by a foot pedal (a function to freely adjust an ultrasonic output by depressing or depressing a foot pedal) when oscillating ultrasonic vibration. Surgery is performed in a continuous wave mode using a regulated ultrasonic wave output. Some have a pulse oscillation mode in which ultrasonic oscillation is intermittently performed.
[0003]
[Problems to be solved by the invention]
When the above-described continuous oscillation mode is used, when the nucleus of the crystalline lens is relatively large, the operation can be performed while pressing the tip of the chip, so that the nucleus can be efficiently crushed and emulsified. However, when a small nuclear fragment is crushed and emulsified, the nuclear fragment may be ejected by mechanical hitting of a vibrating chip. In this case, it is difficult to attract the core piece to the tip of the chip and catch it, and there is a disadvantage that unnecessary oscillation or idling occurs without the tip end of the tip contacting the nucleus.
In the case of a device with a linear control function, the surgeon can finely adjust the output of the ultrasonic oscillation according to the condition of the lens nucleus and the state of the operation. Operation is difficult.
[0004]
On the other hand, when the pulse oscillation mode is used, the nuclear fragments can be sucked and captured at the time of non-oscillation, which is particularly advantageous for pulverizing and emulsifying floating nuclei. Further, since the average output of the ultrasonic oscillation is lowered by the intermittent ultrasonic oscillation as compared with the continuous oscillation mode, it is not necessary to give an excessive output to the tissue.
However, in the pulse oscillation mode, a strong oscillation operation is suddenly performed when shifting from the non-oscillation time to the oscillation time, so that the crushing and suction are abruptly performed, and it is difficult to perform a smooth surgical operation. In addition, there is a disadvantage that the operation time becomes longer due to the intermittent oscillation operation.
An object of the present invention is to provide an ultrasonic surgical apparatus in which the average output to be used is reduced while maintaining the crushing force, and even an unskilled operator can easily perform an operation, in view of the conventional techniques as described above.
[0005]
[Means for Solving the Problems]
In order to solve the above problems, the present invention is characterized by having the following configuration.
(1) A tip attached to the tip of a probe having an ultrasonic transducer for generating ultrasonic vibrations, comprising suction means for sucking the pulverized and emulsified lens nucleus together with the perfusate and suction pressure detection means for detecting the suction pressure In an ophthalmic ultrasonic surgical apparatus that amplifies and transmits ultrasonic vibration from the ultrasonic vibrator and crushes and emulsifies the lens nucleus in contact with the chip, the ultrasonic output is a sign when the foot pedal depression amount is constant. Control means for changing to a curve and changing at least one of the upper limit and the lower limit of the ultrasonic output by changing the foot pedal depression amount is provided.
[0011]
【Example】
Hereinafter, an embodiment of the present invention will be described with reference to the drawings. FIG. 1 is a diagram showing a schematic configuration of an ultrasonic cataract surgery device used for cataract surgery.
Reference numeral 1 denotes a probe held by an operator. An ultrasonic transducer 3 made of a piezoelectric element or the like molded with silicon rubber is held in a hollow portion inside the probe 1. The ultrasonic transducer 3 generates ultrasonic vibrations by drive energy supplied from the drive unit 31 via the energization line 4. Reference numeral 5 denotes a horn for amplifying the ultrasonic vibration. The horn 5 and the ultrasonic vibrator 3 are integrally fixed by a bolt and a nut 6 (not shown).
[0012]
A tubular tip 7 having a suction hole in the axial direction is screwed to the tip of the horn 5, and the ultrasonic vibration generated by the ultrasonic transducer 3 is amplified by the horn 5 and transmitted to the tip 7. Is done. The chip 7 crushes and emulsifies the nucleus of the crystalline lens by the ultrasonic vibration that has been amplified and transmitted. Further, a suction passage 8 penetrating in the axial direction is also formed in the horn 5, the nut 6, and the ultrasonic transducer 3, and the front end portion of the suction passage 8 communicates with the suction hole of the chip 7. A rear end portion of the suction passage 8 is connected to a suction tube 10 via a pipe portion 9.
A pump 20 that generates suction pressure is disposed behind the suction tube 10, and the pump 20 is driven and controlled by the control unit 30. The sucked waste is discharged into the waste liquid bag 21. Further, the suction tube 10 is connected to the suction pressure sensor 22 and the electromagnetic valve 23 through a connecting portion. The suction pressure sensor 22 always detects the suction pressure. Based on the detection signal of the suction pressure sensor 22, the control unit 30 allows air to flow in so that the suction pressure decreases by driving control of the electromagnetic valve 23, or controls the suction flow rate by driving control of the pump 20.
[0013]
Reference numeral 11 denotes a cylindrical and tapered sleeve covered with a chip 7, and an outlet (not shown) for supplying the perfusate into the eye is provided at the tip of the sleeve 11. The rear end of the sleeve 11 is attached to the front end of the probe 1. Reference numeral 12 denotes a perfusion passage for guiding perfusion fluid such as physiological saline to the sleeve 11, and the perfusion fluid is supplied from the perfusion bottle 24 through the perfusion tube 13. The height position of the perfusion bottle 24 is adjusted so that the perfusate is suspended at a pole or the like and the perfusate is supplied at an appropriate speed. A perfusion control valve 25 is disposed in the middle of the perfusion tube 13, and the perfusion fluid outflow is controlled by opening and closing the perfusion control valve 25.
Reference numeral 14 denotes an O-ring mounted on the outer periphery of the horn 5 in order to maintain the watertightness of the perfusate.
[0014]
A control panel unit 34 and a foot pedal 35 for setting various conditions are connected to the control unit 30. The foot pedal 35 generates a signal for driving the perfusion control valve 25, the pump 20, and the drive unit 31 according to the position of the depression / depression. Further, the foot pedal 35 is provided with a linear control function for freely adjusting the ultrasonic output by adjusting the depression.
[0015]
FIG. 2 is a view for explaining the control panel 34.
Reference numeral 40 denotes a LINEAR / PANEL selector switch, which switches between selecting whether to control ultrasonic oscillation by linear control by depressing the foot pedal 35 or based on a set value set in advance on the control panel. 41 is a selection switch for selecting the ultrasonic oscillation mode. The continuous oscillation mode, the pulse oscillation mode, and the ultrasonic vibration output are gradually increased and then gradually decreased. Three types of oscillation modes can be selected: output change oscillation mode (described later) that repeats continuously or intermittently. When the linear control of the foot pedal 35 is selected in addition to the selection of the output change oscillation mode, the ultrasonic change pattern to be changed linearly can be further selected by the linear change selection switch 49.
[0016]
42 is a switch for setting the upper limit of the ultrasonic output, and 43 is a display unit thereof. 44 is a switch for setting a lower limit of the ultrasonic output when the output change oscillation mode is selected, and 45 is a display unit thereof. Reference numeral 46 denotes a switch for setting a pulse rate or a repetitive rate per unit time when the pulse oscillation mode or the output change oscillation mode is selected, and 47 is a display unit thereof. Reference numeral 48 denotes a display unit for displaying the ultrasonic oscillation time and a reset switch.
50 is a suction switch unit for setting a suction pressure and a suction flow rate at the time of suction operation, 51 is a perfusion switch unit for adjusting the perfusion rate to be supplied by changing the height of the perfusion bottle, and 52 is various operations of the apparatus This is an operation mode selection switch section for selecting a mode.
Reference numeral 53 denotes a display for displaying various information, and reference numeral 54 denotes a PRESET switch group in which condition settings are stored and set in advance.
[0017]
Next, the operation of the apparatus configured as described above will be described. Here, the operation when the output change oscillation mode which is a characteristic part of the present invention is selected will be mainly described.
During the operation, the height setting of the perfusion bottle 24, the setting of the suction conditions of the suction pressure and the suction flow rate, the condition setting of the ultrasonic oscillation, and the like are performed in advance by the switch of the control panel unit 34. When the apparatus side is ready, the operator grasps the probe 1 and inserts the tip 7 into the eyeball to perform a crushing and removing operation of the lens.
When the foot pedal 35 is depressed, the position position signal is input to the control unit 30. The control unit 30 operates the perfusion control valve 25 and the pump 20 based on the input signal to supply and suck the perfusate. When a signal for oscillating ultrasonic vibrations is input by depressing the foot pedal 35, the control unit 30 operates the drive unit 31, and the drive unit 31 supplies drive energy to the ultrasonic transducer 3. To generate ultrasonic vibration.
[0018]
FIG. 3 is a diagram showing a temporal change of the ultrasonic oscillation output by the ultrasonic transducer 3 when the control of the ultrasonic output is set to the panel setting. While the signal for oscillating the ultrasonic vibration is input from the foot pedal 35, the control unit 30 drives and controls the ultrasonic vibrator 3 so as to change the output of the ultrasonic oscillation in a sine curve. That is, the output of the ultrasonic oscillation is gradually increased to the set upper limit and then gradually decreased to the set lower limit output. The ultrasonic transducer 3 is operated so as to repeat this at a set rate.
[0019]
The chip 7 connected to the ultrasonic transducer 3 vibrates in response to such an output change of ultrasonic oscillation. When the output of the ultrasonic oscillation is reduced, the vibration speed and amplitude of the chip 7 are reduced, and the core piece of the lens that has floated due to the applied suction pressure is attracted to the chip 7 and easily caught. Thereafter, as the ultrasonic output gradually increases, the vibration speed and amplitude of the chip 7 gradually increase correspondingly. The tip of the chip 7 impacts the lens nucleus by the amplified and transmitted vibration, and the nucleus is crushed and emulsified.
[0020]
Since the ultrasonic output gradually changes as described above, the chip 7 does not suddenly perform a strong vibration operation. For this reason, since the crushing and suctioning of the lens nucleus is performed gradually rather than suddenly, the operator can easily perform a smooth surgical operation. In addition, since the increase / decrease change of the ultrasonic output is automatically repeated, the surgeon can attract and crush the fragment to the tip 7 by suction without adjusting the output by fine operation of the foot pedal 35. Can do. Also, the average output can be kept as low as in the pulse oscillation mode while maintaining the crushing force to some extent as compared with that in the pulse oscillation mode due to the repeated increase / decrease in the ultrasonic output. Therefore, it is not necessary to give an excessive output to the patient's eyes.
[0021]
When the control of the ultrasonic output is set to linear, the following control pattern can be further selected by the linear change selection switch 49. FIG. 4 is a diagram showing temporal changes in the ultrasonic oscillation output and the signal output from the foot pedal 35. In FIG. 4, I indicates the ultrasonic output change, and P indicates the signal output change from the foot pedal. (A) of FIG. 4 is a pattern in which the upper limit output of the ultrasonic output is adjusted by a position signal by depressing or depressing the foot pedal. The decrease in output decreases to a preset lower limit output. (B) is a pattern in which the increase in output rises to the set upper limit, and the lower limit output at the time of decrease is adjusted. (C) is a pattern in which the upper limit output and the lower limit output are adjusted together with a preset width. Due to such an output change, when a linear control by the foot pedal 35 is selected, it is possible to perform a surgical operation more in accordance with the operator's intention.
[0022]
As mentioned above, although this invention was demonstrated based on the Example, this invention is not limited to an Example, A various change is possible. For example, the output of the ultrasonic oscillation may be changed based on the suction pressure detected by the suction pressure sensor 22 (see FIG. 5). When the suction pressure is low, the suction holding force to the chip 7 of the nucleus to be crushed is weak, so the control unit 30 controls the drive so as to increase the upper limit output of the gradually increasing ultrasonic oscillation. Conversely, when the suction pressure increases, the suction holding force of the nuclei increases, so that the control unit 30 controls the drive so as to lower the upper limit output of the gradually increasing ultrasonic oscillation. Thereby, the crushing force can be maintained without giving excessive output to the patient's eye.
[0023]
【The invention's effect】
As described above, according to the present invention, since the output of the ultrasonic oscillation is gradually increased and decreased automatically even if the operator does not perform fine operations, it is smooth without a sudden oscillation operation. Surgery is possible. Moreover, the average output to be used can be lowered while maintaining the crushing force, thereby reducing the influence of ultrasonic waves on the ecological tissue.
[Brief description of the drawings]
FIG. 1 is a diagram illustrating a schematic configuration of an apparatus according to an embodiment.
FIG. 2 is a diagram illustrating a control panel unit.
FIG. 3 is a diagram showing temporal changes in ultrasonic oscillation output when ultrasonic output control is set to panel setting.
FIG. 4 is a diagram showing temporal changes in ultrasonic oscillation output and signal output from a foot pedal in each control pattern when the control of ultrasonic output is set linearly.
FIG. 5 is a diagram showing temporal changes in ultrasonic oscillation output when the output of ultrasonic oscillation is changed based on the suction pressure detected by the suction pressure sensor.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Probe 3 Ultrasonic vibrator 7 Chip 30 Control part 31 Drive part 34 Control panel part 35 Foot pedal

Claims (1)

  A suction means for sucking the pulverized and emulsified lens nucleus together with the perfusate and a suction pressure detection means for detecting the suction pressure, and the ultrasonic probe is attached to a tip attached to the tip of a probe having an ultrasonic vibrator for generating ultrasonic vibration. In an ophthalmic ultrasonic surgical device that amplifies and transmits ultrasonic vibration from a sound wave oscillator and crushes and emulsifies the lens nucleus in contact with the chip, the ultrasonic output changes to a sine curve when the amount of foot pedal depression is constant And a control means for changing at least one of an upper limit and a lower limit of the ultrasonic output according to a change in the amount of depression of the foot pedal.

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