Abstract:
An ultrasonic treatment instrument includes a piezoelectric element assembly, a probe, a backing plate, an electrode assembly, a cylinder and a cylindrical inner cover. The piezoelectric element assembly includes piezoelectric elements and generates ultrasonic vibration. The probe is connected to the piezoelectric element assembly and transmits the ultrasonic vibration. The backing plate is connected to the piezoelectric element assembly. The electrode assembly includes electrodes respectively clamped between the piezoelectric elements, electrifies the piezoelectric elements and generates the ultrasonic vibration. The cylinder is connected to the probe and locates the piezoelectric element assembly, the backing plate and the electrode assembly therein. The cylindrical inner cover includes an inner diameter larger than the backing plate and an outer diameter smaller than the cylinder. The inner cover is disposed between the backing plate and the electrode assembly, and the electrode assembly is disposed between the cylinder and the inner cover.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    This application is a continuation of U.S. application Ser. No. 12/035,716, filed Feb. 22, 2008, by Norihiro YAMADA entitled ULTRASONIC OPERATING APPARATUS, the entire contents of which are incorporated herein by reference. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    The present invention relates to an ultrasonic treatment instrument which performs a procedure such as incising, removing, or clotting of a body tissue using ultrasonic waves. 
         [0003]    As one example of an ordinary ultrasonic treatment instrument which performs a procedure such as incising, removing, or clotting of a body tissue by using ultrasonic waves, there is an ultrasonic clotting and incising apparatus disclosed in U.S. Pat. No. 5,980,510 (Patent Document 1). In the apparatus, a proximal end portion of an elongated insertion unit is coupled with an operation unit on a near side of an operator. An ultrasonic transducer for producing ultrasonic vibration is disposed in the operation unit. A procedure unit for treating a body tissue is disposed at a distal end portion of the insertion unit. 
         [0004]    The insertion unit includes an elongated circular tube sheath. A rod-like vibration transmission member (probe) is inserted into the sheath. A proximal end portion of the vibration transmission member is detachably connected to an ultrasonic transducer via a connection unit of a screwing type. Ultrasonic vibration produced by the ultrasonic transducer is transmitted to a cylindrical probe distal end portion at a distal end side of the vibration transmission member. 
         [0005]    A clamp arm is disposed in the procedure unit so as to face the probe distal end portion. A pad with uneven is fixed to the clamp arm. Here, an arm holding member for holding the clamp arm is provided at a distal end portion of the sheath of the insertion unit. A proximal end portion of the clamp arm is rotatably supported by the arm holding member via a supporting shaft. An operation member which drives the clamp arm is inserted into the sheath so as to be capable of advancing and retreating in an axial direction. An operation handle is disposed on the operation unit. The operation member is driven so as to advance and retreat in the axial direction according to operation of the operation handle. The clamp arm is operated to be opened or closed to the probe distal end portion in a linking manner with action of the operation member. 
         [0006]    A body tissue is grasped between the cylindrical probe distal end portion and the pad of the clamp arm at a time of closing operation of the clamp arm. In this state, ultrasonic vibration from the ultrasonic transducer is transmitted to the probe distal end portion at the procedure unit side via the vibration transmission member so that a procedure such as incising, removing, or clotting of a body tissue is performed using ultrasonic waves. 
         [0007]    U.S. Pat. No. 6,280,407 (Patent Document 2) discloses an ultrasonic clotting and incising apparatus where a procedure face of a distal end of an ultrasonic transmission member is inclined to an axial direction of a center axis of the ultrasonic transmission member by an angle of 15 to 70°. 
       BRIEF SUMMARY OF THE INVENTION 
       [0008]    According to a first aspect of the present invention, an ultrasonic treatment instrument comprising: an ultrasonic transducer which produces ultrasonic vibration; a probe portion which has a distal end portion and a proximal end portion, the proximal end portion being coupled to the ultrasonic transducer, and ultrasonic wave outputted from the ultrasonic transducer is transmitted; a sheath portion which is formed from a cylinder body having a distal end portion and a proximal end portion and in which the probe portion is inserted detachably, the sheath portion having, at the distal end portion, a grasping member rotatably supported so as to face the probe portion; and a handle portion which is detachably coupled to the proximal end portion of the sheath portion and operates the grasping member such that the grasping member is opened and closed to the probe portion, wherein the distal end portion of the probe portion includes a cavitation production portion where the distal end portion of the probe portion has, on a face thereof facing the grasping member, a flat portion extending so as to intersect a vibration direction of the ultrasonic vibration, and cavitation is produced by the flat face in a state that a body tissue has been grasped between the grasping member and the distal end portion of the probe portion. 
         [0009]    Preferably, the cavitation production portion includes a groove portion with an uneven shape on a face facing the grasping member at the distal end portion of the probe portion. 
         [0010]    Preferably, the grasping member includes a fitting portion fitted to the groove portion at the distal end portion of the probe portion. 
         [0011]    Preferably, the groove portion has a flat face provided so as to extend in a direction intersecting the vibration direction of the ultrasonic vibration at an angle of 70° to 90°. 
         [0012]    Preferably, a plurality of the groove portions is formed on the face facing the grasping member at the distal end portion of the probe portion, and when one wavelength of the ultrasonic vibration is represented as λ, all the groove portions fall within a range from a distal end of the probe portion to λ/8. 
         [0013]    Preferably, a width (w) of the groove portion extending along an axial direction of the probe portion is set so as to fall within a range of λ/200≦w≦λ/16. 
         [0014]    Preferably, the groove portion has a ratio (d/w) of a groove width (w) extending along an axial direction of the probe portion and a depth (d) is set to fall within a range of 0.1≦d/w≦5. 
         [0015]    According to another aspect of the present invention, an ultrasonic treatment instrument comprising: a flexible pipe portion having a distal end portion and a proximal end portion; a procedure tool main body disposed at the distal end portion of the flexible pipe portion; and a procedure tool operation unit disposed at the proximal end portion of the flexible pipe portion, wherein the procedure tool main body comprises: an ultrasonic transducer producing ultrasonic vibration, a cover member having a distal end portion and a proximal end portion and covering a periphery of the ultrasonic transducer, the proximal end portion of the cover member being fixed to the ultrasonic transducer, and a grasping member pivoted to the distal end portion of the cover member, and including a grasping face grasping a body tissue between the one and a distal end portion of the ultrasonic transducer at a position facing the distal end portion of the ultrasonic transducer; and the procedure tool operation unit comprises: a slide mechanism which has a distal end portion and a proximal end portion and whose distal end portion is coupled to the grasping member, and a handle portion which operates the grasping member such that the grasping member is opened and closed to the distal end portion of the ultrasonic transducer according to operation of the slide mechanism in an axial direction thereof, wherein the distal end portion of the ultrasonic transducer includes a cavitation production portion where the distal end portion of the ultrasonic transducer has, on a face thereof facing the grasping member, a flat portion extending so as to intersect a vibration direction of the ultrasonic vibration, and cavitation is produced by the flat face in a state that a body tissue has been grasped between the grasping member and the distal end portion of the ultrasonic transducer. 
         [0016]    Preferably, the slide mechanism includes a distal end cover coupled to the grasping member, and an outer diameter of the distal end cover is smaller than an inner diameter of a channel of an endoscope in which the procedure tool main body is inserted. 
         [0017]    Preferably, the slide mechanism includes a distal end portion and a proximal end portion, the distal end portion of the slide mechanism including an operation wire coupled to the grasping member. 
         [0018]    Preferably, the cavitation production portion includes a groove portion with an uneven shape formed on a face facing the grasping face of the grasping member at the distal end portion of the ultrasonic transducer. 
         [0019]    Preferably, the ultrasonic transducer has an entire length which is half the wavelength of ultrasonic vibration, and the ultrasonic transducer is fixed to the cover member at a node position of ultrasonic vibration of a quarter wavelength from a distal end portion of the ultrasonic transducer. 
         [0020]    Preferably, the ultrasonic transducer comprises: a piezoelectric device stacked body comprising a plurality of piezoelectric devices, a horn expanding vibration amplitude of the piezoelectric device stacked body, plus and minus electrodes supplying power to the piezoelectric devices, a backing plate sandwiching the piezoelectric devices and the electrodes between the one and the horn and positioned at a rear end of the piezoelectric device stacked body, and an inner cover disposed between the plus and minus electrodes and the backing plate, wherein the inner cover has an inner diameter larger than the backing plate and an entire length longer than the backing plate, and has an outer diameter smaller than an inner diameter of the cover member. 
         [0021]    Preferably, the flexible pipe portion includes a coil shaft having a diameter smaller than that of the cover member, and the backing plate has a taper with a smooth inclined face at a connecting portion with the coil shaft. 
         [0022]    Preferably, the ultrasonic transducer produces ultrasonic vibration with a frequency of 100±25 kHz. 
         [0023]    Preferably, the coil shaft is provided with an insulating outer tube covering an outer periphery of the coil shaft, a wire supplying power to the ultrasonic transducer is inserted into the coil shaft, and the coil shaft is electrically grounded. 
         [0024]    Advantages of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. Advantages of the invention may be realized and obtained by means of the instrumentalities and combinations particularly pointed out hereinafter. 
     
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING 
         [0025]    The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate embodiments of the invention, and together with the general description given above and the detailed description of the embodiments given below, serve to explain the principles of the invention. 
           [0026]      FIG. 1  is a side view showing a schematic configuration of a whole ultrasonic clotting and incising apparatus according to a first embodiment of the present invention; 
           [0027]      FIG. 2  is a vertical sectional view of a peripheral portion of a distal end acting unit of the ultrasonic clotting and incising apparatus according to the first embodiment in an enlarged manner; 
           [0028]      FIG. 3  is a perspective view showing a distal end portion of an ultrasonic transmission member of the ultrasonic clotting and incising apparatus according to the first embodiment; 
           [0029]      FIG. 4  is a front view showing a state that a distal end portion of the ultrasonic transmission member and a grasping member have meshed with each other in the ultrasonic clotting and incising apparatus according to the first embodiment; 
           [0030]      FIG. 5  is a sectional view showing a state that the grasping member has been separated from the distal end portion of the ultrasonic transmission member of the ultrasonic clotting and incising apparatus according to the first embodiment, taken along line V-V in  FIG. 2 ; 
           [0031]      FIG. 6  is a side view showing a first modification example of the distal end portion of the ultrasonic transmission member of the ultrasonic clotting and incising apparatus according to the first embodiment; 
           [0032]      FIG. 7  is a side view showing a second modification example of the distal end portion of the ultrasonic transmission member of the ultrasonic clotting and incising apparatus according to the first embodiment; 
           [0033]      FIG. 8  is a side view showing a peripheral portion of a distal end acting unit of an ultrasonic clotting and incising apparatus according to a second embodiment of the present invention in an enlarged manner; 
           [0034]      FIG. 9  is a perspective view showing a distal end portion of an ultrasonic transmission member of the ultrasonic clotting and incising apparatus according to the second embodiment; 
           [0035]      FIG. 10  is a perspective view showing a portion of a grasping face of a grasping member of the ultrasonic clotting and incising apparatus according to the second embodiment; 
           [0036]      FIG. 11  is a side view showing a first modification example of the ultrasonic clotting and incising apparatus according to the second embodiment; 
           [0037]      FIG. 12  is a side view showing a second modification example of the ultrasonic clotting and incising apparatus according to the second embodiment; 
           [0038]      FIG. 13  is a perspective view showing a peripheral portion of a distal end acting unit of an ultrasonic clotting and incising apparatus according to a third embodiment of the present invention in an enlarged manner; 
           [0039]      FIG. 14  is a vertical sectional view of a main portion showing a state that the ultrasonic clotting and incising apparatus according to the third embodiment has been inserted into a channel of an endoscope; 
           [0040]      FIG. 14  is a vertical sectional view of a main portion showing a state that the ultrasonic clotting and incising apparatus according to the third embodiment has been inserted into a channel of an endo scope; 
           [0041]      FIG. 15  is a side view showing a peripheral portion of the distal end acting unit of the ultrasonic clotting and incising apparatus according to the third embodiment in a partially sectioned manner; 
           [0042]      FIG. 16  is a plan view showing a distal end portion of the distal end acting unit of the ultrasonic clotting and incising apparatus shown in  FIG. 15  in a partially sectioned manner; 
           [0043]      FIG. 17  is a side view showing a state that the distal end acting unit of the ultrasonic clotting and incising apparatus shown in  FIG. 15  has been operated to be opened; 
           [0044]      FIG. 18  is a vertical sectional view showing a portion of an operation unit of the ultrasonic clotting and incising apparatus according to the third embodiment; 
           [0045]      FIG. 19  is a vertical sectional view showing the peripheral portion of the distal end acting unit of the ultrasonic clotting and incising apparatus according to the third embodiment; 
           [0046]      FIG. 20  is a sectional view taken along line  20 - 20  in  FIG. 19 ; 
           [0047]      FIG. 21A  is a perspective view showing a state that a grasping member of the ultrasonic clotting and incising apparatus according to the third embodiment has been operated to be opened; 
           [0048]      FIG. 21B  is a perspective view showing a state that the grasping member of the ultrasonic clotting and incising apparatus according to the third embodiment is put in the course of opening operation thereof; 
           [0049]      FIG. 21C  is a perspective view showing a state that a grasping member of the ultrasonic clotting and incising apparatus according to the third embodiment has been operated to be closed; 
           [0050]      FIG. 22  is a side view showing a state that a grasping member of a first modification example of the distal end acting unit of the ultrasonic clotting and incising apparatus according to the third embodiment has been operated to be closed; 
           [0051]      FIG. 23  is a side view showing a state that the grasping member of the first modification example of the distal end acting unit of the ultrasonic clotting and incising apparatus according to the third embodiment has been operated to be opened; 
           [0052]      FIG. 24  is a side view showing a state that a grasping member of a second modification example of the distal end acting unit of the ultrasonic clotting and incising apparatus according to the third embodiment has been operated to be closed; 
           [0053]      FIG. 23  is a side view showing a state that the grasping member of the second modification example of the distal end acting unit of the ultrasonic clotting and incising apparatus according to the third embodiment has been operated to be opened; 
           [0054]      FIG. 26  is a perspective view showing a peripheral portion of a distal end acting unit of an ultrasonic clotting and incising apparatus according to a fourth embodiment of the present invention in an enlarged manner; and 
           [0055]      FIG. 27  is a side view showing a use state of the ultrasonic clotting and incising apparatus according to the fourth embodiment. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0056]    A first embodiment of the present invention will be explained below with reference from  FIGS. 1 to 5 .  FIG. 1  shows a schematic configuration of a whole ultrasonic clotting and incising apparatus  1  according to the first embodiment. The ultrasonic clotting and incising apparatus  1  mainly comprises a handle unit  2 , a transducer unit  3 , and an ultrasonic transmission member (probe)  4 . 
         [0057]    The transducer unit  3  includes a cylindrical cover  5 . An ultrasonic transducer  6  is provided inside the cover  5 . One end of a cable  7  is connected to a proximal end of the transducer unit  3 . The other end of the cable  7  is connected to an ultrasonic wave power source apparatus (not shown). The ultrasonic transducer  6  is driven by supplying power from the ultrasonic wave power source to the ultrasonic transducer  6  via the cable  7 . 
         [0058]    The ultrasonic transmission member  4  is a rod-like member which transmits/amplitudes ultrasonic vibration produced at the ultrasonic transducer  6 . A proximal end portion of the ultrasonic transmission member  4  includes a horn unit whose outer diameter gradually decreases toward a distal end side of the horn unit. The ultrasonic transmission member  4  is detachably connected to the ultrasonic transducer  6  by such means as a screw. 
         [0059]    As shown in  FIG. 1 , the handle unit  2  is provided with an operation unit  9 , an insertion sheath unit  11  comprising an elongated mantle pipe  10 , and a distal end acting unit  12 . A proximal end portion of the insertion sheath unit  11  is attached to the operation unit  9  rotatably in a spinning direction about an axis. The distal end acting unit  12  is provided at a distal end of the insertion sheath unit  11 . 
         [0060]    The operation unit  9  of the handle unit  2  includes an operation unit main body  13 , a fixed handle  14 , and a movable handle  16 . The operation unit main body  13  is formed integrally with the fixed handle  14 . The movable handle  16  is rotatably attached to the operation unit main body  13  via a handle pivoting shaft  15 . A proximal end of the operation unit main body  13  is detachably connected with the transducer unit  3 . 
         [0061]    The movable handle  16  has an engagement pin  17 . The engagement pin  17  is disposed near the handle pivoting shaft  15 , and it is protruded into the operation unit main body  13 . The engagement pin  17  is engaged with a slider mechanism (not shown) disposed inside the operation unit main body  13 . 
         [0062]      FIG. 2  shows a peripheral portion of the distal end acting unit  12  of the handle unit  2 . The distal end acting unit  12  of the handle unit  2  includes a holding member  18  and a grasping member  20  of one-side opening type. The holding member  18  is attached to a distal end portion of the mantle pipe  10 . The grasping member  20  is rotatably attached to the holding member  18  via a pivoting shaft  19 . 
         [0063]    The distal end acting unit  12  together with the distal end portion  21  of the ultrasonic transmission member  4  configures a procedure unit  22  of the ultrasonic clopping and incising apparatus  1 . The grasping member  20  of a one-side opening type can grasp a body tissue between the one and the distal end portion  21 . 
         [0064]    The holding member  18  is formed with a main channel  23  and a sub-channel  25 . The ultrasonic transmission member  4  is inserted into the main channel  23 . An operation rod  24  for operating the grasping member  20  in a rotating manner is inserted into the sub-channel  25 . 
         [0065]    As shown in  FIG. 2 , a distal end portion of the operation rod  24  is coupled to a proximal end of the grasping member  20  via a pivoting pin  26 . A proximal end side of the operation rod  24  is coupled to a slider mechanism (not shown) disposed inside the operation unit main body  13 . The operation rod  24  is caused to advance or retreat in the axial direction via the slider mechanism by rotating the movable handle  16 . The grasping member  20  of the distal end acting unit  12  is opened or closed in a linking manner with advancing or retreating action of the operation rod  24  in the axial direction. 
         [0066]    A lower face (a face facing the distal end portion  21 ) of the grasping member  20  serves as a grasping face  27  grasping a tissue between the one and the distal end portion  21 . As shown in  FIG. 5 , the grasping face  27  is formed with a recessed portion  27   a  with an arc shape in section. The arc-shaped section of the recessed portion  27   a  of the grasping face  27  is formed to conform with a shape of an outer peripheral face  21   a  of the distal end portion  21 . Thereby, when the grasping member  20  is operated to be closed, as shown in  FIG. 4 , the distal end portion  21  of the ultrasonic transmission member  4  and the grasping member  20  is caused to mesh with each other in a state that the distal end portion  21  of the ultrasonic transmission member  4  is inserted into the recessed portion  27   a  of the grasping face  27 . 
         [0067]    A plurality of groove portions  28  is formed on a face of the distal end portion  21  of the ultrasonic transmission member  4  facing the grasping face  27 . The sizes of the groove portions  28  in the present embodiment are as follows: 
         [0068]    groove width (w)=1.2 mm 
         [0069]    distance between grooves  28  (t)=1.2 mm 
         [0070]    depth (d)=0.5 mm 
         [0071]    length from distal end of the distal end portion  21  to the last groove portion  28 (L)=12 mm 
         [0072]    the number of groove portions  28 : 5 
         [0073]    It is desirable that the length from the distal end of the distal end portion  21  to the last groove portion  28  (L) is within λ/8. In general, vibration amplitude of the ultrasonic transmission member  4  lowers according to advancing thereof from a probe distal end to a node position at a proximal end side. When the vibration amplitude of the ultrasonic transmission member  4  advances from the distal end of the distal end portion  21  toward the proximal end side beyond λ/8, it becomes about 70% or less of amplitude at the distal end position. Therefore, when vibration amplitude advances from the distal end of the distal end portion  21  toward the proximal end side beyond λ/8, it is difficult to obtain sufficient procedure ability. In the present embodiment, a vibration frequency of ultrasonic wave transmitted to the ultrasonic transmission member  4  is 47 kHz, and one wavelength (λ) is 104 mm. Therefore, a length (L) from the distal end of the distal end portion  21  to the last groove portion  28  is 12 mm=λ/8.7. Each groove portion  28  is formed by perpendicular faces  29  which are front and rear wall faces and a horizontal face  31  of a bottom portion. 
         [0074]    It is desirable that a width (w) of the groove portion  28  is in a range of λ/200≦w≦λ/16. The present embodiment is directed to an ultrasonic clotting and incising apparatus  1  using not only frictional heat but also cavitation produced by vibration. Impact pressure due to the cavitation tends to be proportion to an area of the perpendicular face  29  to the vibration direction of ultrasonic wave transmitted to the ultrasonic transmission member  4 . The total area of the perpendicular faces  29  increases according to increase in the number of groove portions  28 . It is necessary to provide at least two groove portions  28  in order to use the cavitation effect. It is necessary to set the width (w) of the groove portion  28  to λ/16 or less in order to provide two groove portions  28  within the length (L)=λ/8 from the distal end of the distal end portion  21  to the last groove portion  28 . In the present embodiment, it is necessary to set the width (w) of the groove portion  28  to less than 6.5 mm. On the other hand, when the number of groove portions  28  on the distal end portion  21  is increased excessively, the cavitation effect is raised but the width (w) of the groove portion  28  is reduced. In the present embodiment, λ/200=0.52 mm. When the groove portion  28  is further thin, there is a possibility that sufficient procedure ability cannot be obtained due to adhesion of a body tissue to an inner face of the groove portion  28 . 
         [0075]    It is desirable that a ratio d/w of the depth (d) and the width (w) of groove portion  28  is in a range of 0.1≦d/w≦5. The area of the perpendicular face  29  increases according to increase of d/w. Thereby, the cavitation effect is elevated, but if the groove portion  28  becomes excessively deep relative to the width (w), a problem similar to the above-mentioned case that the groove portion  28  becomes thin, occurs. In the present embodiment, d/w is 0.42. In case of d/w=5, the width (w) becomes 0.4 mm, for example, in the depth (d)=2 mm. When the groove portion  28  becomes further deep relative to the width, there is a possibility that sufficient procedure ability cannot be obtained due to adhesion of a body tissue to the inner wall of the groove portion  28 . 
         [0076]    Next, an operation of the present embodiment will be explained. The distal end of the insertion sheath unit  11  is first inserted to a position near a targeted body tissue which is a procedure object at a time of using the ultrasonic clotting and incising apparatus  1  according to the present embodiment. Subsequently, the body tissue is positioned between the grasping member  20  and the distal end portion  21  of the ultrasonic transmission member  4 . In this state, the movable handle  16  is operated in a closing direction in a rotating manner to grasp the body tissue between the grasping member  20  and the distal end portion  21 . 
         [0077]    In such a state of grasping the body tissue, power is supplied from the ultrasonic power source to the ultrasonic transducer  6  to vibrate the ultrasonic transducer  6 . The ultrasonic vibration is transmitted to the distal end portion  21  of the ultrasonic transmission member  4 . The body tissue contacting with the groove portions  28  at the distal end portion  21  is crushed by impact pressure of the cavitation produced from the groove portions  28 . Simultaneously therewith, the body tissue is clotted by frictional heat produced by grasping the body tissue between the grasping member  20  and the distal end portion  21  of the ultrasonic transmission member  4 . 
         [0078]    The effect obtained by the present embodiment is as follows. That is, by providing the groove portions  28  at the distal end portion  21  of the ultrasonic transmission member  4 , when a procedure such as incising, removing, or clotting of a body tissue is performed by using ultrasonic waves on the body tissue grasped between the grasping member  20  and the distal end portion  21 , the procedure can be performed by using both cavitation and frictional heat. Therefore, since clotting and incising of a body tissue can be performed at a lower vibration velocity, risk of thermal damage can be reduced, so that an ultrasonic clotting and incising apparatus with high safety can be provided. Further, a stronger still procedure even to a site where risk of thermal damage does not occur can be conducted at a vibration velocity approximately equal to a conventional one. 
         [0079]    The vertical wall face of the groove portion  28  is a perpendicular face  29  with an angle of 90° to the vibrating direction at the distal end portion  21  of the ultrasonic transmission member  4  according to the present embodiment, but the vertical wall face is not limited to this face. Cavitation produced by the groove portion  28  at the distal end portion  21  of the ultrasonic transmission member  4  is produced more easily according to the vertical wall face closer to a perpendicular face to the vibration direction. When the angle θ of the vertical wall face of the groove portion  28  is less than 70° to the vibration direction, a drag coefficient becomes about half or less of a drag coefficient obtained when the vertical wall face is a perpendicular face (90°). The drag coefficient shows magnitude of resistance occurring when the ultrasonic transmission member  4  moves in medium (for example, water). Since the resistance from the medium increases according to increase in drag coefficient, the cavitation is produced more easily. Therefore, it is desirable that the angle θ of the vertical wall face of the groove portion  28  is set from 70° to 90° to the vibration direction of ultrasonic wave to be transmitted to the ultrasonic transmission member  4 . That is, the perpendicular face  29  of the groove portion  28  of the first embodiment can be changed to an inclined face put in a range of 70° to 90°, for example. By adopting the inclined face put in this range, a corresponding cavitation effect can be obtained. For example, there are modification examples shown in  FIGS. 6 and 7 . 
         [0080]      FIG. 6  shows a first modification example of the distal end portion  21  of the ultrasonic transmission member  4  of the ultrasonic clotting and incising apparatus  1  according to the first embodiment. In the present modification example, a front side vertical wall face  28   a   1  of front and rear two vertical wall faces  28   a   1  and  28   b   1  of the groove portion  28  at the distal end portion  21  is formed by a perpendicular face  29  with an angle θ of 90°. The angle θ of the rear vertical wall face  28   b   1  is designed to be 75°. 
         [0081]      FIG. 7  shows a second modification example of the distal end portion  21  of the ultrasonic transmission member  4  of the ultrasonic clotting and incising apparatus  1  according to the first embodiment. In the present modification example, angles θ of both of front and rear vertical wall faces  28   a   2 ,  28   b   2  of the groove portion  28  at the distal end portion  21  is defined by inclined faces with an angle θ of 75°. 
         [0082]    In the shapes of the groove portions  28  like modification examples shown in  FIGS. 6 and 7 , impact pressure due to cavitation at the vertical wall face (the vertical wall face  28   b   1 ,  28   a   2 ,  28   b   2  of the inclined face with an angle of 75°) of the groove portion  28  is slightly reduced. However, in the modification examples shown in  FIGS. 6 and 7 , since a horizontal face  31  to the vibration direction as shown by arrow in  FIG. 2  is not present, an even cavitation effect over the whole grasping face  27  can be expected. 
         [0083]      FIGS. 8 to 10  show a second embodiment of the present invention. In the present embodiment, the configuration of the grasping member  20  according to the first embodiment ( FIGS. 1 to 5 ) has been change in the following manner. The remaining configuration of the second embodiment is similar to that of the first embodiment. 
         [0084]    That is, in the second embodiment, as shown in  FIG. 8 , a plurality of protrusions  32  is formed on a grasping face  27  which is a lower face of the grasping member  20 . The protrusions  32  are formed at positions corresponding to the groove portions  28  at the distal end portion  21  so as to have shapes corresponding to the shapes of the groove portions  28 . As shown in  FIG. 10 , vertical wall faces  32   a  and  32   b  are formed at front portion and a rear portion of each protrusion  32 . Further, a horizontal face  32   c  is formed on the bottom portions between adjacent protrusions  32 . 
         [0085]    The front and rear vertical wall faces  32   a  and  32   b  of respective protrusions  32  configure perpendicular faces with an angle θ of 90° to the horizontal face  32   c  of the grasping face  27 . When movement is conducted such that the grasping member  20  and the distal end portion  21  are closed, the grasping member  20  and the distal end portion  21  are caused to mesh with each other without clearance in a state that the respective protrusions  32  of the grasping member  20  are inserted into the respective groove portions  28  at the distal end portion  21  of the ultrasonic transmission member  4 . 
         [0086]    Therefore, when movement is conducted such that the grasping member  20  and the distal end portion  21  are closed to grasp a small thin body tissue, for example, a blood vessel with a diameter Ø of 0.5 mm or less, incising/clotting can be conducted securely. The function/effect other than the above is similar to those in the first embodiment. 
         [0087]      FIG. 11  shows a first modification example of the ultrasonic clotting and incising apparatus  1  according to the second embodiment. In the present modification example, a plurality of protrusions  41  is formed on a grasping face  27  which is a lower face of the grasping member  20  at positions corresponding to the groove portions  28  at the distal end portion  21  of the ultrasonic transmission member  4  shown in  FIG. 6  to have shapes corresponding to shapes of the respective groove portions  28 . Each protrusion  41  is formed with a perpendicular face  41   a  with an angle θ of 90° on a front vertical wall face. A rear vertical wall face is formed with an inclined face  41   b  with an angle θ of 75°. 
         [0088]    In the present modification example, therefore, when movement is performed such that the grasping member  20  and the distal end portion  21  are closed, the grasping member  20  and the distal end portion  21  are caused to mesh with each other without clearance in a state that the respective protrusions  41  of the grasping member  20  are inserted into the respective groove portions  28  at the distal end portion  21  of the ultrasonic transmission member  4 . 
         [0089]      FIG. 12  shows a second modification example of the ultrasonic clopping and incising apparatus  1  according to the second embodiment. In the present modification example, a plurality of protrusions  42  is formed on a grasping face  27  which is a lower face of the grasping member  20  at positions corresponding to the groove portions  28  at the distal end portion  21  of the ultrasonic transmission member  4  shown in  FIG. 7  so as to have shapes corresponding to those of the respective grooves  28 . Each protrusion  42  is formed with an inclined face  42   a  with an angle θ of 75° on a front vertical wall face. A rear vertical wall face is also formed with an inclined face  42   b  with an angle θ of 75°. 
         [0090]    In the present modification example, therefore, when movement is performed such that the grasping member  20  and the distal end portion  21  are closed, the grasping member  20  and the distal end portion  21  are caused to mesh with each other without clearance in a state that the respective protrusions  42  of the grasping member  20  are inserted into the respective groove portions  28  at the distal end portion  21  of the ultrasonic transmission member  4 . 
         [0091]      FIGS. 13 to 21C  show a third embodiment of the present invention. An ultrasonic clotting and incising apparatus  51  shown in  FIG. 14  comprises an elongated endoscope  52  and an ultrasonic procedure tool  53 . 
         [0092]    The endoscope  52  includes an elongated insertion unit  54 . A proximal end of the insertion unit  54  is coupled with an operation unit (not shown). The insertion unit  54  is provided with an elongated flexible pipe portion (not shown), a flexible bending portion (not shown), and a distal end configuring portion  55 . A plurality of bending pieces is provided on the bending portion in parallel. 
         [0093]    As shown in  FIG. 14 , the distal end configuring portion  55  is provided with an observation window  56  of an observation optical system, an illumination window (not shown) of the illumination optical system, an opening portion  57   a  communicating with a distal end portion of a procedure tool channel  57 , and the like. An objective optical system is disposed on the observation window  56  of the observation optical system behind a cover glass. An imaging device such as an image guide fiber or a CCD is disposed at an imaging position of the objective optical system. One end portion of a signal cable is connected to the imaging device. A distal end portion of a light guide fiber is disposed in the illumination window behind the cover glass. 
         [0094]    The signal cable of the imaging device, the light guide fiber, the procedure tool channel  57 , a bending operation wire, and the like are extended to the operation unit side through inner space of the insertion unit  54 . The signal cable of the imaging device, the light guide fiber, the procedure tool channel  57 , the bending operation wire, and the like are accommodated in the inner space of the insertion unit  54  as inner parts. Observation of an affected area is made possible by picking up an observation image taken in from the observation window  56  by the imaging device in a state that illumination light has been emitted from the illumination window to light up a surrounding area of the observation window  56 , converting the observation image to an electric signal and displaying the observation image on an external monitor or the like. 
         [0095]    An operation knob (not shown) for operating the bending portion in a bending manner is disposed on the operation unit. The operation wire for driving the bending pieces on the bending portion is coupled to a bending operation mechanism (not shown). The distal end portion of the endoscope  52  can be bent by operating the bending portion in a bending manner according to operation of the operation knob. 
         [0096]      FIG. 13  shows a peripheral portion of the distal end portion of the ultrasonic procedure tool  53  in an enlarged manner. The ultrasonic procedure tool  53  of the present embodiment includes a procedure tool main body  59  disposed at the distal end portion of the elongated flexible pipe portion  58 . A procedure tool operation unit  60  shown in  FIG. 18  is disposed at a proximal end portion of the flexible pipe portion  58 . 
         [0097]    As shown in  FIG. 15 , the procedure tool main body  59  includes an ultrasonic transducer  61 . A periphery of the ultrasonic transducer  61  is covered with a cylindrical cylinder  62 . 
         [0098]    As shown in  FIGS. 15 and 16 , the ultrasonic transducer  61  includes an ultrasonic transducer main body  64  comprising a plurality of piezoelectric devices  63 . A horn  65  with a narrowed shape for increasing vibration amplitude of the ultrasonic transducer  61  and a flange  66  are disposed at a distal end portion of the ultrasonic transducer main body  64 . Further, a distal end portion of the horn  65  is extended forward so that a transducer distal end portion  67  is formed. 
         [0099]    As shown in  FIG. 19 , a plus electrode  68  and a minus electrode  69  for supplying power to the piezoelectric devices  63  and a backing plate  70  are disposed at a rear end portion of the ultrasonic transducer main body  64 . The piezoelectric devices  63  and the electrodes  68 ,  69  are sandwiched between the horn  65  and the backing plate  70 . 
         [0100]    A cylindrical inner cover  71  is disposed between the plus electrode  68  and the minus electrode  69 , and the backing plate  70 . The inner cover  71  is disposed between the plus electrode  68  and the minus electrode  69 , and the backing plate  70 . Thereby, the plus electrode  68  and the minus electrode  69  are prevented from being electrically short-circuited via the backing plate  70 . 
         [0101]    As shown in  FIG. 19 , the cylindrical inner cover  71  disposed inside the cylinder  62  has an inner diameter larger than the backing plate  70  of the transducer  61  and an entire length longer than the backing plate  70 , and has an outer diameter smaller than an inner diameter of the cylinder  62 . 
         [0102]    As shown in  FIG. 18 , the procedure tool operation unit  60  comprises an operation unit main body  72 , a movable handle  73 , an ultrasonic wave connector  74 , and a plug  75  for a radio knife. The ultrasonic wave connector  74  includes three terminals of an earth terminal  74   a , a minus terminal  74   b , and a plus terminal  74   c , and it is connected to an external ultrasonic power source via a cable (not shown). 
         [0103]    The flexible pipe portion  58  includes a flexible coil shaft  76  and an insulating outer tube  77 . An outer periphery of the coil shaft  76  is covered with the outer tube  77 . A plus wiring  78  and a minus wiring  79  are inserted into an inner space portion  76   a  of the coil shaft  76 . A proximal end portion of the plus wiring  78  is connected to the plus terminal  74   c  of the ultrasonic wave connector  74  and a proximal end portion of the minus wiring  79  is connected to the minus terminal  74   b  of the ultrasonic wave connector  74 . The earth terminal  74   a  of the ultrasonic wave connector  74  is electrically grounded. Therefore, the plus wiring  78  and the minus wiring  79  inserted into the inner space portion  76   a  of the coil shaft  76  can shield electrical noise from the outside of the coil shaft  76 . 
         [0104]    A proximal end portion of the coil shaft  76  is fixed to the operation unit main body  72 . A distal end portion of the coil shaft  76  is fixed to a proximal end portion of a partition wall  91 . A distal end portion of the partition wall  91  is attached to a rear end portion of the cylinder  62  in a fitting manner. Two wiring holes  92  and  93  are formed in the partition wall  91 . The plus wiring  78  is inserted into one wiring hole  92  while the minus wiring  79  is inserted into the other wiring hole  93 . 
         [0105]    A distal end portion of the plus wiring  78  and a distal end portion of the minus wiring  79  are connected to the plus electrode  68  and the minus electrode  69  of the ultrasonic transducer main body  64 , respectively. Power supplied from the ultrasonic power source is applied to the plus electrode  68  and the minus electrode  69  from the ultrasonic connector  74  of the operation unit  60  via the plus wiring  78  and the minus wiring  79 . Thereby, the ultrasonic transducer  61  produces ultrasonic vibration. The ultrasonic vibration whose amplitude has been expanded by passing through the narrowed type horn  65  is transmitted to the transducer distal end portion  67 . The flange  66  corresponds to a node position of vibration and it is fixed to the cylinder  62  via an O-ring  66   a.    
         [0106]    In the present embodiment, a distance from a distal end of the transducer distal end portion  67  to flange  66  is a quarter wavelength. A portion corresponding to the quarter wavelength is covered with a horn cover  80  fixed to the cylinder  62  except for the transducer distal end portion  67 . 
         [0107]    The entire length of the ultrasonic transducer  61  is half a wavelength. In the present embodiment, the ultrasonic transducer  61  produces ultrasonic vibration with 100 kHz. When ultrasonic vibration is produced by using resonance, one wavelength in high frequency is short, so that the entire length of the ultrasonic transducer  61  becomes short. When the endoscope  52  is used, if the entire length of the ultrasonic transducer  61  is long, the hard portion becomes long, so that it becomes difficult to bend the endoscope  52 , which results in deterioration of operability of the endoscope  52 . Therefore, it is required to set the entire length of the ultrasonic transducer  61  to 50 mm or less. In order to satisfy this requirement, the frequency of the ultrasonic vibration must be 75 kHz or more. 
         [0108]    On the other hand, when the frequency of the ultrasonic vibration is 150 kHz, vibration velocity required for producing cavitation is about 2.5 times the vibration velocity at 100 kHz or it is about 5 times the vibration velocity at 20 kHz. It is difficult to obtain sufficient cavitation at a frequency exceeding 150 kHz. 
         [0109]    Therefore, in order to achieve both high operability and procedure ability, it is ideal that the frequency of the ultrasonic vibration is set in a range of 75 to 150 kHz. 
         [0110]    A grasping member  81  grasping a body tissue between the one and the transducer distal end portion  61  is provided at a distal end portion of the procedure tool main body  59 . As shown in  FIG. 16 , the grasping member  81  comprises two supporting arms  81   a ,  81   b  and a grasping portion  82 . Two supporting arm  81   a ,  81   b  are disposed on both sides of a distal end portion of the horn cover  80 . Each of supporting arms  81   a ,  81   b  is provided with one rotating shaft  83  and two supporting pins  84 . The supporting arms  81   a ,  81   b  of the grasping member  81  are rotatably pivoted to the horn cover  80  via the rotating shaft  83 . 
         [0111]    One of two supporting pins  84  is provided such that an inner end portion thereof is fixed to the supporting arm  81   a  while an outer end portion thereof projects outside the supporting arm  81   a . Similarly, the other supporting pin  84  is provided such that an inner end portion thereof is fixed to the supporting arm  81   b  while an outer end portion thereof projects outside the supporting arm  81   b.    
         [0112]    A cylindrical distal end cover  85  is provided outside the cylinder  62  so as to cover the cylinder  62 . The distal end cover  85  is supported so as to be movable relative to the cylinder  62  in an axial direction. As shown in  FIG. 15 , engagement holes  86  which are elongated long hole are provided on both side of the distal end portion of the distal end cover  85 , respectively. Each engagement hole  86  is larger than the supporting pin  84  of the grasping member  81 . Outer end portions of the supporting pins  84  are inserted into two engagement holes  86  of the distal end cover  85  in an engaging manner. 
         [0113]    A proximal end portion of the distal end cover  85  is fixed to the distal end portion of the outer tube  77 . A proximal end portion of the outer tube  77  is fixed to the movable handle  73 . Thereby, the distal end cover  85  is moved in the axial direction via the outer tube  77  according to moving operation of the movable handle  73  in the axial direction to the operation unit main body  72 . At this time, when the distal end cover  85  is moved backward and forward, the grasping member  81  is operated in an opening or closing manner about the rotating shaft  83  rotatably supported by the horn cover  80  (shown in  FIGS. 21A ,  21 B, and  21 C). 
         [0114]    An outer diameter of the distal end cover  85  is smaller than an inner diameter of the channel  57  of the endoscope  52 . Thereby, the ultrasonic procedure tool  53  is capable of advancing/retreating in the channel  57  and can be inserted into/removed from the channel  57 . 
         [0115]    A plurality of groove portions  87  is provided on a face of the transducer distal end portion  67  of the embodiment facing the grasping portion  82  of the grasping member  81 . A desirable shape of the groove portion  87  is similar to that in the first embodiment. A plurality of protrusions  88  is formed on a grasping face  82   a  which is a lower face of the grasping portion  82  of the grasping member  81 . The protrusions  88  of the grasping member  81  conform with the groove portions  87  of the transducer distal end portion  67  of the ultrasonic transducer  61 . Incidentally, such a configuration can be adopted that the protrusions  88  are not provided on the grasping portion  82  when a targeted body tissue is material except for narrowed and thin material like the first embodiment. 
         [0116]    In the present embodiment, excellent procedure ability can be obtained in the following two kinds of groove shapes (Example 1 and Example 2). 
       Example 1 
       [0117]    groove width (w)=1 mm 
         [0118]    distance between groove portions  87  (t)=0.2 mm 
         [0119]    depth (d)=0.5 mm 
         [0120]    length from a distal end of the transducer distal end portion  67  to the last groove portion  87  (L)=3.9 mm 
         [0121]    the number of groove portions  87 : 3 
         [0122]    λ (one wavelength) of ultrasonic vibration of the ultrasonic transducer  61  is 49 mm. Therefore, the length (L) from the distal end of the transducer distal end portion  67  to the last groove portion  87 (L)=3.9 mm is λ/12.6, which falls within λ/8. 
         [0123]    The width of the groove portion  87  (w)=1 mm is λ/49, which falls within a range of λ/200≦w≦λ/16. 
         [0124]    Ratio d/w of the depth (d) and the width (w) of the groove portion  87  is 0.5. This value falls within 0.1≦d/w≦5. 
       Example 2 
       [0125]    groove width (w)=0.4 mm 
         [0126]    distance between groove portions  87  (t)=0.2 mm 
         [0127]    depth (d)=0.5 mm 
         [0128]    length from a distal end of the distal end portion  67  to the last groove portion  87  (L)=3.55 mm 
         [0129]    the number of groove portions  87 : 3 
         [0130]    λ (one wavelength) of ultrasonic vibration of the ultrasonic transducer  61  is 49 mm. 
         [0131]    Therefore, the length from the distal end of the transducer distal end portion  67  to the last groove portion  87 =3.55 mm is λ/13.8, which falls within λ/8. 
         [0132]    The width of the groove portion  87  (w)=1 mm is λ/122.5, which falls within a range of λ/200≦w≦λ/16. Ratio d/w of the depth (d) and the width (s) of the groove portion  87  is 1.25. This value falls within 0.1≦d/w≦5. 
         [0133]    Next, an operation of the present embodiment will be explained. The endoscope  52  shown in  FIG. 14  is first inserted into a body cavity at a time of using the ultrasonic clotting and incising apparatus  51  of the present embodiment. At this time, an affected area is confirmed through the observation window  56  of the observation optical system. 
         [0134]    Thereafter, the ultrasonic procedure tool  53  is inserted into the channel  57  of the endoscope  52 . The distal end portion of the ultrasonic procedure tool  53  is caused to project outside the channel  57 . Further, a body tissue is positioned between the grasping portion  82  of the grasping member  81  and the transducer distal end portion  67  of the transducer  61  while observation is being continued. In this state, the movable handle  73  is pulled so that the body tissue is grasped between the grasping portion  82  of the grasping member  81  and the transducer distal end portion  67 . 
         [0135]    In the state that the body tissue has been grasped in this manner, power is supplied to the ultrasonic transducer  61  from the ultrasonic power source so that ultrasonic transducer  61  is vibrated. The body tissue contacting with the groove portions  87  of the transducer distal end portion  67  is crushed by impact pressure of cavitation produced from the groove portions  87 . Simultaneously therewith, the body tissue is clotted by frictional heat produced by grasping the body tissue. The operation other than the above is the same as that of the first embodiment. 
         [0136]    In the present embodiment, sufficient incising/clotting of a body tissue such as a body organ and a digestive organ can be achieved even when the vibration velocity of the transducer distal end portion  67  is a low output such as 10 to 20 m/s. 
         [0137]    The effect of the present embodiment is as follows. That is, by providing the groove portions  87  on the transducer distal end portion  67  of the ultrasonic transducer  61 , an ultrasonic clotting and incising apparatus which can clot and incise tissue at a lower vibration velocity by using both cavitation and frictional heat can be provided. 
         [0138]      FIGS. 22 and 23  show a first modification example of the ultrasonic clotting and incising apparatus according to the third embodiment.  FIG. 22  shows a state that the grasping member  81  has been closed.  FIG. 23  shows a state that the grasping member  81  has been opened. 
         [0139]    As shown in  FIG. 22 , even if one wall faces of the protrusions  88  of the grasping member  81  are faces inclined at an angle of less than 70°, when the other wall faces thereof have an inclined angle of 70° or more, some cavitation effect can be obtained. 
         [0140]      FIGS. 24 and 25  show a second modification example of the ultrasonic clotting and incising apparatus according to the third embodiment. A shape of the groove portions  87  at the transducer distal end portion  67  shown in  FIG. 25  is as follows: 
         [0141]    groove width (w)=1 mm 
         [0142]    distance between groove portions  87  (t)=nothing 
         [0143]    depth (d)=0.5 mm 
         [0144]    length from a distal end of the transducer distal end portion  67  to the last groove portion  87  (L)=3.75 mm 
         [0145]    the number of groove portions  87 : 3 
         [0146]    λ (one wavelength) of ultrasonic vibration of the ultrasonic transducer  61  is 49 mm. Therefore, the length (L) from the distal end of the transducer distal end portion  67  to the last groove portion  87 =3.75 mm is λ/13.1. This value falls within λ/8. 
         [0147]    The width of the groove portion  87  (w)=1 mm is λ/49, which falls within a range of λ/200≦w≦λ/16. 
         [0148]    Ratio d/w of the depth (d) and the width (w) of the groove portion  87  is 0.5. This value falls within 0.1≦d/w≦5. 
         [0149]    Incidentally, such a configuration that only one supporting arm  81   a ,  81   b  of the grasping member  81  and only one engagement hole  86  of the distal end cover  85  are provided may be adopted. A groove portion  87  having a non-perpendicular face may be provided like the modification examples of the first embodiment shown in  FIGS. 6 and 7 . 
         [0150]      FIGS. 26 and 27  show a fourth embodiment of the present invention. In the present embodiment, an operation wire  101  is provided instead of the distal end cover  85  in the third embodiment ( FIGS. 13 to 21C ). As shown in  FIG. 26 , a distal end portion of the operation wire  101  is connected to a supporting pin  84  of a grasping member  81 . A proximal end portion of the operation wire  101  is connected to the movable handle  73  of the operation unit  60  shown in  FIG. 18 . 
         [0151]    A coil shaft  76  has a diameter smaller than that of the cylinder  62 . A partition wall  91  is disposed between a proximal end portion of the cylinder  62  and a distal end portion of the coil shaft  76 . A taper  102  is provided on the partition wall  91  between the coil shaft  76  and the cylinder  62 . The configuration other than the above is the same as that in the third embodiment. 
         [0152]    An operation/an effect of the present embodiment are as follows. That is, the endoscope shown in  FIG. 27  is connected with a suction pump (not shown). A portion of the ultrasonic procedure tool  53  which is from the distal end thereof to the partition wall  91  is caused to project outside the channel  57  so that a clearance of the channel  57  is secured. Thereby, foreign material X can be sucked/drained from the channel  57  of the endoscope  52 . 
         [0153]    Here, when the foreign material X is clot of clotted blood, feces or the like, it can be sucked more easily by using the coil shaft  76  having a smaller diameter. When sucking/draining of the foreign material X are completed and the procedure tool  53  is pulled into the channel  57 , a rear end portion of the partition wall  91  gets lodged on the distal end portion of the endoscope  52  unless the taper  102  is provided on the partition wall  91 . Smooth taking-in and putting-out of the procedure tool  53  is made possible by providing the taper  102  on the partition wall  91 . 
         [0154]    Incidentally, the present invention is not limited to the embodiments and it can be implemented in variously modified manner without departing from the gist of the invention. 
         [0155]    Additional advantages and modifications will readily occur to those skilled in the art. Therefore, the invention in its broader aspects is not limited to the specific details and representative embodiments shown and described herein. Accordingly, various modifications may be made without departing from the spirit or scope of the general inventive concept as defined by the appended claims and their equivalents.