Patent Publication Number: US-2023157717-A1

Title: Ultrasonic treatment tool and method of manufacturing ultrasonic treatment tool

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application is a continuation of International Application No. PCT/JP2020/029857, filed on Aug. 4, 2020, the entire contents of which are incorporated herein by reference. 
    
    
     BACKGROUND 
     1. Technical Field 
     The present disclosure relates to an ultrasonic treatment tool and a method of manufacturing the ultrasonic treatment tool. 
     2. Related Art 
     As a medical treatment tool, an ultrasonic treatment tool that performs treatment on living tissue by using ultrasonic vibration is known. For example, an ultrasonic treatment tool that includes a vibration transmission portion for transmitting ultrasonic vibration and a jaw that is arranged in a rotatable manner on the vibration transmission portion is known (for example, Japanese Translation of PCT International Application Publication No. 2012-531970). With use of the ultrasonic treatment tool, an operator, such as a doctor, grips a region (hereinafter, described as a target) as a target for treatment in living tissue by the vibration transmission portion and the jaw that constitute a pair of gripper pieces, applies ultrasonic vibration to the gripped target, and performs cauterization, coagulation, incision, or the like. 
     SUMMARY 
     In some embodiments, provided is an ultrasonic treatment tool that is connected to a transducer unit and that receives ultrasonic waves generated and applied by the transducer unit. The ultrasonic treatment tool includes: a vibration transmission portion configured to vibrate by receiving the applied ultrasonic waves, and transmit vibration to a treatment target; a sheath that includes a first through hole in which the vibration transmission portion is inserted while a distal end of the vibration transmission portion is exposed, and a second through hole that has a hole shape penetrating in a different direction from a penetration direction of the first through hole; a jaw that includes a first hole portion in which the sheath is inserted and a second hole portion configured to communicate with the second through hole; and a shaft that includes a space in which the vibration transmission portion is inserted, and that allows the jaw to rotate relative to the sheath when the shaft is inserted in the second through hole and the second hole portion. 
     In some embodiments, provided is a method of manufacturing an ultrasonic treatment tool that is connected to a transducer unit and that receives ultrasonic waves generated and applied by the transducer unit. The method includes: arranging a jaw on a sheath, the sheath including a first through hole in which a vibration transmission portion is inserted while a distal end of the vibration transmission portion is exposed and a second through hole that has a hole shape penetrating in a different direction from a penetration direction of the first through hole, the vibration transmission portion being configured to vibrate by receiving the applied ultrasonic waves and transmit the vibration to a treatment target, the jaw including a first hole portion in which the sheath is inserted and a second hole portion configured to communicate with the second through hole, the jaw being arranged on the sheath such that the sheath is inserted in the first hole portion and the second through hole communicates with the second hole portion; inserting a shaft, the shaft including a space in which the vibration transmission portion is inserted, into the second through hole and the second hole portion such that the space is aligned with the penetration direction of the first through hole; and inserting the vibration transmission portion into the first through hole and the space of the shaft. 
     The above and other features, advantages and technical and industrial significance of this disclosure will be better understood by reading the following detailed description of presently preferred embodiments of the disclosure, when considered in connection with the accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG.  1    is a diagram schematically illustrating a treatment system according to one embodiment of the disclosure; 
         FIG.  2    is a diagram illustrating a distal end structure of a treatment tool illustrated in  FIG.  1   ; 
         FIG.  3    is a cross-sectional view of the distal end structure illustrated in  FIG.  2   ; 
         FIG.  4    is a diagram illustrating a configuration of a main part of the distal end structure illustrated in  FIG.  2   ; 
         FIG.  5    is a first diagram for explaining a method of manufacturing the treatment tool illustrated in  FIG.  1   ; 
         FIG.  6    is a second diagram for explaining the method of manufacturing the treatment tool illustrated in  FIG.  1   ; 
         FIG.  7    is a third diagram for explaining the method of manufacturing the treatment tool illustrated in  FIG.  1   ; 
         FIG.  8    is a fourth diagram for explaining the method of manufacturing the treatment tool illustrated in  FIG.  1   ; 
         FIG.  9    is a diagram for explaining a configuration of a main part of a treatment tool according to a first modification; 
         FIG.  10    is a diagram for explaining a configuration of a main part of a treatment tool according to a second modification; 
         FIG.  11    is a first diagram for explaining a configuration of a main part of a treatment tool according to a third modification; 
         FIG.  12    is a second diagram for explaining the configuration of the main part of the treatment tool according to the third modification; 
         FIG.  13    is a diagram for explaining a configuration of a main part of a treatment tool according to a fourth modification; 
         FIG.  14    is an exploded perspective view for explaining a configuration of a main part of a treatment tool according to a fifth modification; 
         FIG.  15    is a first diagram for explaining the configuration of the main part of the treatment tool according to the fifth modification; 
         FIG.  16    is a second diagram for explaining a configuration of the main part of the treatment tool according to the fifth modification; 
         FIG.  17    is an exploded perspective view for explaining a configuration of a main part of a treatment tool according to a sixth modification; 
         FIG.  18    is a first diagram for explaining a configuration of a main part of a treatment tool according to a seventh modification; 
         FIG.  19    is a second diagram for explaining the configuration of the main part of the treatment tool according to the seventh modification; 
         FIG.  20    is a diagram for explaining a configuration of a main part of a treatment tool according to an eighth modification; 
         FIG.  21    is a diagram for explaining a configuration of a main part of a treatment tool according to a ninth modification; 
         FIG.  22    is a cross-sectional view for explaining a configuration of a main part of a treatment tool according to a tenth modification; 
         FIG.  23    is a perspective view for explaining the configuration of the main part of the treatment tool according to the tenth modification; 
         FIG.  24    is a diagram for explaining a configuration of a main part of a treatment tool according to an eleventh modification; 
         FIG.  25    is a diagram for explaining a configuration of a main part of a treatment tool according to a twelfth modification; 
         FIG.  26    is a cross-sectional view for explaining the configuration of the main part of the treatment tool according to the twelfth modification; 
         FIG.  27    is a first diagram for explaining a configuration of a main part of a treatment tool according to a thirteenth modification; 
         FIG.  28    is a second diagram for explaining the configuration of the main part of the treatment tool according to the thirteenth modification; 
         FIG.  29    is a cross-sectional view for explaining the configuration of the main part of the treatment tool according to the thirteenth modification; and 
         FIG.  30    is an partial enlarged view of the configuration illustrated in  FIG.  29   . 
     
    
    
     DETAILED DESCRIPTION 
     Embodiments of an ultrasonic treatment tool and a method of manufacturing the ultrasonic treatment tool according to the disclosure will be described below with reference to the drawings. The disclosure is not limited by the embodiments below. Further, in description of the drawings, the same or corresponding components are appropriately denoted by the same reference symbols. Furthermore, it is necessary to note that the drawings are schematic, and dimensional relations among the components, ratios among the components, and the like may be different from the actual ones. Moreover, the drawings may include portions that have different dimensional relations or ratios. 
     Embodiments 
       FIG.  1    is a diagram schematically illustrating a treatment system according to one embodiment of the disclosure. A treatment system  1  is a system that grips a region (target) as a target for treatment in living tissue by a pair of gripper pieces and performs cauterization, coagulation, incision, or the like by applying vibration or a high-frequency electric current to the gripped target. The treatment system  1  includes a treatment tool  2 , a transducer unit  3 , a control device  4 , and a connection cable  5 . 
     The treatment tool  2  applies heat to the gripped target and performs cauterization, coagulation, incision, or the like on the target. In this case, the heat applied to the target is frictional heat that is generated by vibration or joule heat that is generated by conduction of a high-frequency electric current. A configuration of the treatment tool  2  will be described later. 
     The transducer unit  3  generates ultrasonic vibration under the control of the control device  4 . The transducer unit  3  includes, for example, an ultrasonic transducer. The ultrasonic transducer includes a piezoelectric element and generates ultrasonic waves by supplying an electric current to the piezoelectric element. The ultrasonic transducer is directly or indirectly connected to the treatment tool  2  (a probe main body  201  to be described later), and transmits the generated ultrasonic waves to the probe main body  201 . Further, the transducer unit  3  is electrically connected to the control device  4  via the connection cable  5 . 
     The control device  4  supplies electric power to the transducer unit  3  and the probe main body  201 , and controls drive of the transducer unit  3  and supply of a high-frequency electric current to the probe main body  201 . The control device  4  is configured with a general-purpose processor, such as a central processing unit (CPU), or a dedicated processor, such as various arithmetic circuits including a field programmable gate array (FPGA) and an application specific integrated circuit (ASIC), for implementing a specific function. 
     The configuration of the treatment tool  2  will be described below.  FIG.  2    is a diagram illustrating a distal end structure of the treatment tool illustrated in  FIG.  1   .  FIG.  3    is a cross-sectional view of the distal end structure illustrated in  FIG.  2   .  FIG.  4    is a diagram illustrating a configuration of a main part of the distal end structure illustrated in  FIG.  2   . 
     The treatment tool  2  includes a probe portion  20 , a first main body portion  21 , a second main body portion  22 , and a shaft  23 . 
     The probe portion  20  includes the probe main body  201  and a sheath  202 . 
     The first main body portion  21  includes a jaw  210  and a gripped portion  211 . 
     The second main body portion  22  includes a connection portion  220  and a gripped portion  221 . 
     Meanwhile, in the treatment tool  2 , a side that is connected to the transducer unit  3  in a longitudinal direction of the sheath  202  will be referred to as a “proximal end” side, and an opposite side will be referred to as a “distal end” side. 
     The probe main body  201  is configured with a rod. The probe main body  201  is caused to perform longitudinal vibration, which is vibration in a direction parallel to a longitudinal direction of the probe main body  201 , by ultrasonic waves transmitted from the transducer unit  3 . With heat or friction generated by the longitudinal vibration, the target is subjected to cauterization, coagulation, incision, or the like. Furthermore, high-frequency power is supplied to the probe main body  201  from the control device  4 . If the high-frequency power is supplied, a high-frequency electric current flows to the target due to a potential difference between the probe main body  201  and the jaw  210 , so that cauterization, coagulation, or the like is performed. The probe main body  201  corresponds to a vibration transmission portion. 
     The sheath  202  has a tubular shape. The probe main body  201  is inserted in the sheath  202 , and the sheath  202  surrounds the probe main body  201 . 
     The jaw  210  is arranged in a rotatable manner on the probe portion  20 . The jaw  210  rotates about an axis (a central axis N 2  to be described later) that penetrates through the sheath  202  and that is perpendicular to a longitudinal axis N 1  of the sheath  202 . Further, the jaw  210  grips, at one end thereof, the target in cooperation with the probe main body  201 . Specifically, a gripper  210   a  is arranged on one end of the jaw  210 . The jaw  210  holds the gripper  210   a  in a swingable manner. The gripper  210   a  rotates about an axis that extends in a direction perpendicular to the longitudinal axis N 1  of the sheath  202 , for example. Furthermore, another end of the jaw  210  is connected to the gripped portion  211 . 
     The gripped portion  211  is a portion that is to be gripped by an operator. In the gripped portion  211 , a through hole  211   a  that is fitted to a part (for example, a thumb) of a hand of the operator is formed. 
     The connection portion  220  holds the sheath  202  and is connected to the transducer unit  3 . 
     The gripped portion  221  is a portion that is to be gripped by the operator. In the gripped portion  221 , a through hole  221   a  that is fitted to another part (for example, a forefinger or a middle finger) of the hand of the operator is formed. 
     Operation buttons  22   a  and  22   b  are arranged in the second main body portion  22 . For example, the operation button  22   a  is a button for causing the probe main body  201  to generate ultrasonic vibration. Further, the operation button  22   b  is a button for supplying high-frequency voltage to the probe main body  201  and causing a high-frequency electric current to flow through the target. Each of the buttons outputs a signal to the control device  4  by being pressed by the operator. The control device  4  drives the transducer unit  3  or supplies high-frequency voltage to the probe main body  201  in accordance with the input signal. 
     The shaft  23  has a columnar shape and is arranged so as to penetrate through the sheath  202  and the jaw  210 . The shaft  23  is held by the sheath  202 . Further, the jaw  210  is mounted on both ends of the shaft  23 . The jaw  210  is able to slide relative to the shaft  23 , and is rotatable relative to the sheath  202 . Specifically, the shaft  23  penetrates through the jaw  210  at both end portions, and allows the jaw  210  to freely rotate about the central axis N 2 . The central axis N 2  is a central axis of the shaft  23 , crosses the probe main body  201 , and is perpendicular to the longitudinal axis N 1  of the sheath  202 . 
     Further, a through hole  231  through which the probe main body  201  penetrates is formed in the shaft  23 . The through hole  231  forms a space in which the probe main body  201  is inserted. 
     Here, in the probe main body  201 , a lining  201   a  that comes in contact with the sheath  202 , that maintains a positional relationship between the probe main body  201  and the sheath  202 , and that reduces friction is arranged (see  FIG.  4   ). In the present embodiment, the lining  201   a  is arranged at a position that comes in contact with a rear end side of the shaft  23 . The lining  201   a  comes in contact with the shaft  23 , and therefore, is able to prevent rotation of the shaft  23  about the central axis N 2 . 
     The treatment tool  2  is able to rotate the jaw  210  about the shaft  23  (the central axis N 2 ) relative to the probe main body  201 , by operation of the gripped portions  211  and  221 . After the jaw  210  is rotated and the probe main body  201  and the gripper  210   a  grip the target, if the operation buttons  22   a  and  22   b  are pressed, energy that is caused by ultrasonic waves or high-frequency power is supplied to the probe main body  201  under the control of the control device  4 . By supplying the energy to the probe main body  201 , the target is subjected to cauterization, coagulation, incision, or the like. 
     A method of manufacturing the treatment tool  2  will be described below with reference to  FIG.  5    to  FIG.  8   .  FIG.  5    to  FIG.  8    are diagrams for explaining the method of manufacturing the treatment tool illustrated in  FIG.  1   . 
     First, the sheath  202  is prepared (see  FIG.  5   ). In the sheath  202 , a first through hole  202   a  in which the probe main body  201  is inserted and a second through hole  202   b  in which the shaft  23  is inserted are formed. 
     The jaw  210  is arranged on the sheath  202  (see  FIG.  6   ). In the jaw  210 , a first hole portion  210   b  in which the sheath  202  is inserted and a second hole portion  210   c  in which the shaft  23  is inserted are formed. A penetration direction of the first hole portion  210   b  and a penetration direction of the second hole portion  210   c  are different from each other, and the holes cross each other. The second hole portion  210   c  has a hole shape that is extended from mutually-different side portions of the first hole portion  210   b.  Here, the side portions of the first hole portion  210   b  correspond to wall portions (thickness portions) that form a hole. The jaw  210  is arranged at a position at which the second hole portion  210   c  communicates with the second through hole  202   b.    
     Meanwhile, in this case, the gripped portion  211  may be mounted on the jaw  210 . 
     Thereafter, the shaft  23  is inserted in the second through hole  202   b  and the second hole portion  210   c  (see  FIG.  7   ). The shaft  23  allows the jaw  210  to freely rotate relative to the sheath  202 . In this case, the shaft  23  is arranged such that a penetration direction of the through hole  231  and a penetration direction of the sheath  202  are aligned. 
     After the shaft  23  is arranged, the probe main body  201  is inserted in the sheath  202  (see  FIG.  8   ). In this case, the probe main body  201  penetrates through the shaft  23  via the through hole  231 . Further, a distal end portion of the probe main body  201  is exposed to outside in a state in which the probe main body  201  is arranged on the sheath  202 . 
     Thereafter, the gripped portion  211  is mounted on the jaw  210 , and the second main body portion  22  is mounted on the sheath  202 , so that the treatment tool  2  is manufactured. 
     According to the embodiment of the disclosure as described above, the shaft  23  that penetrates through the sheath  202  and the jaw  210  allows the jaw  210  to rotate about the central axis N 2 . According to the present embodiment, the probe main body  201 , the sheath  202 , the jaw  210 , and the shaft  23  allow the gripper  210   a  to freely rotate relative to the probe main body  201  that is the vibration transmission portion, so that it is possible to prevent interference between the vibration transmission portion and the jaw and mount the jaw in a rotatable manner with a simple configuration. 
     First Modification 
     A first modification of the embodiment will be described below with reference to  FIG.  9   .  FIG.  9    is a diagram for explaining a configuration of a main part of a treatment tool according to the first modification. Meanwhile, a configuration of a treatment system according to the first modification is the same as the treatment system  1  as described above except that arrangement of the lining  201   a  is changed, and therefore, explanation of the components other than the lining  201   a  will be omitted. A configuration that is different from the embodiment will be described below. 
     The lining  201   a  according to the first modification is arranged at a position that is located on a rear end side relative to the shaft  23  and that does not come in contact with the shaft  23 . 
     In the first modification as described above, the position of the lining  201   a  is changed as compared to the embodiment as described above, but a behavior of the treatment tool itself is not changed, so that it is possible to achieve the same effects as the embodiment. 
     Second Modification 
     A second modification of the embodiment will be described below with reference to  FIG.  10   .  FIG.  10    is a diagram for explaining a configuration of a main part of a treatment tool according to the second modification. Meanwhile, a configuration of a treatment system according to the second modification is the same as the treatment system  1  as described above except that arrangement of the lining  201   a  is changed. A configuration that is different from the embodiment will be described below. 
     The lining  201   a  according to the second modification is arranged inside the shaft  23 . The lining  201   a  comes in contact with an inner peripheral surface of the through hole  231  of the shaft  23 , and determines a position of the probe main body  201  relative to the sheath  202  and the shaft  23 . 
     In the second modification as described above, the position of the lining  201   a  is changed as compared to the embodiment as described above, but a behavior of the treatment tool itself is not changed, so that it is possible to achieve the same effects as the embodiment. 
     Third Modification 
     A third modification of the embodiment will be described below with reference to  FIG.  11    and  FIG.  12   .  FIG.  11    and  FIG.  12    are diagrams for explaining a configuration of a main part of a treatment tool according to the third modification. Meanwhile, a configuration of a treatment system according to the third modification is the same as the treatment system  1  as described above except that the shaft  23  is replaced with a shaft  23 A. A configuration that is different from the embodiment will be described below. 
     The shaft  23 A has a columnar shape. In the shaft  23 A, a notch portion  232  is formed by cutting a central portion. The notch portion  232  forms a space in which the probe main body  201  is inserted. The notch portion  232  is formed by cutting the central portion of the shaft  23 A in a partially connected manner. 
     In the third modification as described above, the configuration of the shaft  23 A is changed as compared to the embodiment as described above, but a behavior of the treatment tool itself is not changed, so that it is possible to achieve the same effects as the embodiment. 
     Fourth Modification 
     A fourth modification of the embodiment will be described below with reference to  FIG.  13   .  FIG.  13    is a diagram for explaining a configuration of a main part of a treatment tool according to the fourth modification. Meanwhile, a configuration of a treatment system according to the fourth modification is the same as the treatment system  1  as described above except that the shaft  23  is replaced with a shaft  23 B and a position of the lining  201   a  is changed. A configuration that is different from the embodiment will be described below. 
     The shaft  23 B has a columnar shape. In the shaft  23 B, the through hole  231  through which the probe main body  201  penetrates is formed. Further, one end portion of the shaft  23 B has a protruding shape. Specifically, the shaft  23 B includes a protruding portion  233  that is arranged on one end portion and has a columnar shape with a smaller diameter than other portions. The protruding portion  233  is inserted in the jaw  210  (the second hole portion  210   c  on one end side in the direction of the central axis N 2 ) at the time of assembly of the treatment tool, and holds the jaw  210  in a rotatable manner. Meanwhile, in the fourth modification, the second hole portion  210   c  has a certain shape that conforms to a connection portion of the shaft  23 B. 
     Further, the lining  201   a  according to the fourth modification is arranged on a distal end side relative to the shaft  23 B. The lining  201   a  comes in contact with the inner peripheral surface of the sheath  202  on the distal end side relative to the shaft  23 B, and determines a position of the probe main body  201  relative to the sheath  202 . 
     In the fourth modification as described above, the configuration of the shaft  23 B and the position of the lining  201   a  are changed as compared to the embodiment as described above, but a behavior of the treatment tool itself is not changed, so that it is possible to achieve the same effects as the embodiment. 
     Meanwhile, the arrangement of the lining  201   a  according to the fourth modification may be adopted to the embodiment and the second modification. 
     Fifth Modification 
     A fifth modification of the embodiment will be described below with reference to  FIG.  14    to  FIG.  16   .  FIG.  14    is an exploded perspective view for explaining a configuration of a main part of a treatment tool according to the fifth modification.  FIG.  15    and  FIG.  16    are diagrams for explaining a configuration of a main part of a treatment tool according to the fifth modification. Meanwhile, a configuration of a treatment system according to the fifth modification is the same as the treatment system  1  as described above except that the shaft  23  is replaced with a shaft  23 C and the sheath  202  is replaced with a sheath  202 A. A configuration that is different from the embodiment will be described below. 
     The shaft  23 C has a pillar shape. The shaft  23 C includes a main body  234  through which the probe main body  201  penetrates, a first end portion  235  that is arranged on one end of the main body  234  and holds the jaw  210 , and a second end portion  236  that is arranged on the other end of the main body  234  and holds the jaw  210 . In the main body  234 , a through hole  234   a  through which the probe main body  201  penetrates is formed. Further, the main body  234  has a prism shape and extends in the direction of the central axis N 2 . Meanwhile, in the fifth modification, the second hole portion  210   c  has a certain shape that conforms to the first end portion  235  and the second end portion  236  of the shaft  23 C. 
     The sheath  202 A has a cylindrical shape. In the sheath  202 A, the first through hole  202   a  in which the probe main body  201  is inserted and a second through hole  202   c  in which the shaft  23 C is inserted are formed. In the second through hole  202   c,  an inner wall surface having a prism shape that conforms to an outer shape of the main body  234  is formed. 
     When the shaft  23 C is inserted in the sheath  202 A, the main body  234  and the second through hole  202   c  are fitted to each other (see  FIG.  15   ). With this fitting, rotation of the shaft  23 C about the central axis N 2  is prevented. 
     After arranging the shaft  23 C, the probe main body  201  is inserted in the sheath  202  (see  FIG.  16   ). In this case, the probe main body  201  penetrates through the shaft  23 C via the through hole  234   a.    
     Thereafter, the gripped portion  211  is mounted on the jaw  210 , and the second main body portion  22  is mounted on the sheath  202 A, so that the treatment tool is manufactured. 
     In the fifth modification as described above, the configurations of the shaft  23 C and the sheath  202 A are changed as compared to the embodiment as described above, but a behavior of the treatment tool itself is not changed, so that it is possible to achieve the same effects as the embodiment. 
     In addition, in the fifth modification, the shaft  23 C and the sheath  202 A are fitted to each other and rotation of the shaft  23 C relative to the sheath  202 A is prevented, so that it is possible to prevent positional deviation of the through hole  234   a  at the time of assembly. 
     Sixth Modification 
     A sixth modification of the embodiment will be described below with reference to  FIG.  17   .  FIG.  17    is an exploded perspective view for explaining a configuration of a main part of a treatment tool according to the fifth modification. Meanwhile, a configuration of a treatment system according to the sixth modification is the same as the treatment system  1  as described above except that the shaft  23  is replaced with a shaft  23 D and the sheath  202  is replaced with a sheath  202 B. A configuration that is different from the embodiment will be described below. 
     The shaft  23 D has a pillar shape. The shaft  23 D includes a main body  237  through which the probe main body  201  penetrates and which holds the jaw  210  at one end side of the main body  237 , an end portion  238  that is arranged on the other end side of the main body  237  and that holds the jaw  210 , and a prism portion  239  that is arranged between the main body  237  and the end portion  238  and that has a prism shape. In the main body  237 , a through hole  237   a  through which the probe main body  201  penetrates is formed. Meanwhile, in the sixth modification, the second hole portion  210   c  has a certain shape that conforms to the main body  237  and the end portion  238  of the shaft  23 C. 
     The sheath  202 B has a cylindrical shape. In the sheath  202 B, the first through hole  202   a  in which the probe main body  201  is inserted and a second through hole  202   d  in which the shaft  23 D is inserted are formed. In the second through hole  202   d,  an inner wall surface having a prism shape that conforms to an outer shape of the prism portion  239  is formed on one end side. 
     At the time of assembly of the treatment tool, when the shaft  23 D is inserted in the sheath  202 B, the prism portion  239  and the second through hole  202   d  are fitted to each other. With this fitting, rotation of the shaft  23 D about the central axis N 2  is prevented. 
     In the sixth modification as described above, the configurations of the shaft  23 D and the sheath  202 B are changed as compared to the embodiment as described above, but a behavior of the treatment tool itself is not changed, so that it is possible to achieve the same effects as the embodiment. 
     In addition, in the sixth embodiment, the shaft  23 D and the sheath  202 B are fitted to each other and rotation of the shaft  23 D relative to the sheath  202 B is prevented, so that it is possible to prevent positional deviation of the through hole  237   a  at the time of assembly. 
     Seventh Modification 
     A seventh modification of the embodiment will be described below with reference to  FIG.  18    and  FIG.  19   .  FIG.  18    and  FIG.  19    are diagrams for explaining a configuration of a main part of a treatment tool according to the third modification. Meanwhile, a configuration of a treatment system according to the seventh modification is the same as the treatment system  1  as described above except that the shaft  23  is replaced with a shaft  23 E. A configuration that is different from the embodiment will be described below. 
     The shaft  23 E has a pillar shape. In the shaft  23 E, a planar portion  240  is formed by cutting a part of a side surface of the cylinder. The planar portion  240  comes in contact with a pin  241  that penetrates through a part of the sheath  202 , in a state in which the shaft  23 E is arranged on the sheath  202 . The planar portion  240  comes in contact with the pin  241  in the sheath  202 , so that rotation of the shaft  23 E about the central axis is prevented. 
     In the seventh modification as described above, the configuration of the shaft  23 E is changed as compared to the embodiment as described above, but a behavior of the treatment tool itself is not changed, so that it is possible to achieve the same effects as the embodiment. 
     In addition, in the seventh modification, the shaft  23 E comes in contact with the pin  241 , and rotation of the shaft  23 E relative to the sheath  202  is prevented, so that it is possible to prevent positional deviation of the through hole  231  at the time of assembly. 
     Meanwhile, in the seventh modification, it may be possible to prevent rotation of the shaft  23 E by forming the second through hole  202   b  into a certain hole shape that conforms to an outer shape of the shaft  23 E, instead of using the pin  241 . 
     Eighth Modification 
     An eighth modification of the embodiment will be described below with reference to  FIG.  20   .  FIG.  20    is a diagram for explaining a configuration of a main part of a treatment tool according to the eighth modification. Meanwhile, in the eighth modification, a shaft  23 F is provided instead of the shaft  23 E of the seventh modification. 
     The shaft  23 F has a pillar shape. A concave portion  240 A that comes in contact with the pin  241  is formed on a side surface of the shaft  23 F. 
     In the eighth modification as described above, the configuration of the shaft  23 F is changed as compared to the embodiment as described above, but a behavior of the treatment tool itself is not changed, so that it is possible to achieve the same effects as the embodiment. 
     Furthermore, in the eighth modification, the concave portion  240 A of the shaft  23 F comes in contact with the pin  241  and rotation of the shaft  23 F relative to the sheath  202  is prevented, so that it is possible to prevent positional deviation of the through hole  231  at the time of assembly. Moreover, in the eighth modification, the planar portion (the concave portion  240 A) is formed in only the contact portion of the pin  241 , so that it is possible to further ensure sliding performance with respect to the jaw  210  and water-tightness with respect to the sheath  202  as compared to the planar portion  240  of the seventh modification. 
     Ninth Modification 
     A ninth modification of the embodiment will be described below with reference to  FIG.  21   .  FIG.  21    is a diagram for explaining a configuration of a main part of a treatment tool according to the ninth modification. Meanwhile, a configuration of a treatment system according to the ninth modification is the same as the treatment system  1  as described above except that the shaft  23  is replaced with a shaft  23 G, and therefore, explanation thereof will be omitted. A configuration that is different from the embodiment will be described below. 
     The shaft  23 G has a pillar shape. Bearings  242  are arranged on both end portions of the shaft  23 G. When the shaft  23 G is assembled onto the treatment tool, the bearings  242  are held by the jaw  210 . Therefore, the jaw  210  is able to smoothly rotate with the aid of the bearings  242 . Meanwhile, as long as rotation centers of the bearings match each other and it is possible to mount the jaw in a rotatable manner, the bearings arranged at both ends may have different sizes. 
     In the ninth modification as described above, the configuration of the shaft  23 G is changed as compared to the embodiment as described above, but a behavior of the treatment tool itself is not changed, so that it is possible to achieve the same effects as the embodiment. 
     In the ninth modification, the bearings  242  restrict rotation of a portion other than the bearings  242  of the shaft  23 G caused by rotation of the jaw  210 . With this configuration, it is possible to prevent friction between the shaft  23 G and the sheath  202 , so that it is possible to improve durability of the treatment tool. 
     Tenth Modification 
     A tenth modification of the embodiment will be described below with reference to  FIG.  22    and  FIG.  23   .  FIG.  22    is a cross-sectional view for explaining a configuration of a main part of a treatment tool according to the tenth modification.  FIG.  23    is a perspective view for explaining the configuration of the main part of the treatment tool according to the tenth modification. Meanwhile, a configuration of a treatment system according to the tenth modification is the same as the treatment system  1  as described above except that the shaft  23  is replaced with a shaft  23 H. A configuration that is different from the embodiment will be described below. 
     The shaft  23 H has a pillar shape. A through hole  231 A through which the probe main body  201  penetrates is formed. The through hole  231 A forms a space in which the probe main body  201  is inserted. An insulating film is formed on an inner wall surface that is formed by the through hole  231 A. Therefore, the probe main body  201  is insulated from the sheath  202  and the jaw  210 . Meanwhile, as long as a surface of the inner wall surface of the through hole  231 A has insulation property, it is not always needed to provide the insulating film. For example, it may be possible to mount an insulating tubular member on the shaft  23 H, and a hole of the tubular member may be adopted as the through hole  231 A. 
     In the tenth modification as described above, the configuration of the shaft  23 H is changed as compared to the embodiment as described above, but a behavior of the treatment tool itself is not changed, so that it is possible to achieve the same effects as the embodiment. 
     In the tenth modification, the probe main body  201  is insulated from the sheath  202  and the jaw  210 , and therefore, it is possible to perform treatment while reliably insulating the probe main body  201 , which serves as one of poles, and the jaw  210  (and the sheath  202 ), which serves as the other one of the poles, when a high-frequency electric current flows. 
     Eleventh Modification 
     An eleventh modification of the embodiment will be described below with reference to  FIG.  24   .  FIG.  24    is a diagram for explaining a configuration of a main part of a treatment tool according to the eleventh modification. Meanwhile, a configuration of a treatment system according to the eleventh modification is the same as the treatment system  1  as described above except that the shaft  23  is replaced with a shaft  231 . A configuration that is different from the embodiment will be described below. 
     The shaft  231  has a pillar shape. A through hole  231 B through which the probe main body  201  penetrates is formed. The through hole  231 B forms a space in which the probe main body  201  is inserted. In the through hole  231 B, openings at both ends have different diameters. Specifically, a diameter di of the opening located on the distal end side of the probe main body  201  is larger than a diameter d 2  of the opening located on the proximal end side of the probe main body  201 . Meanwhile, an inner peripheral surface communicating with the both ends may have a shape in which a diameter is changed in a stepped manner or may have a conical shape. 
     Here, when the probe main body  201  bends while gripping the target, the distal end side bends largely as compared to the proximal end side in the probe main body  201 . In the through hole  231 B, by increasing the diameter di of the opening on the distal end side of the probe main body  201  as compared to the diameter d 2  of the opening on the proximal end side, it is possible to cope with a deflection difference of the probe main body  201 . 
     In the eleventh modification as described above, the configuration of the shaft  231  is changed as compared to the embodiment as described above, but a behavior of the treatment tool itself is not changed, so that it is possible to achieve the same effects as the embodiment. 
     In addition, in the eleventh embodiment, in the through hole  231 B, the diameter di of the opening on the distal end side of the probe main body  201  is larger than the diameter d 2  of the opening on the proximal end side, so that it is possible to prevent interference between the shaft  231  and the probe main body  201  caused by a deflection difference. 
     Twelfth Modification 
     A twelfth modification of the embodiment will be described below with reference to  FIG.  25    and  FIG.  26   .  FIG.  25    is a diagram for explaining a configuration of a main part of a treatment tool according to the twelfth modification.  FIG.  26    is a cross-sectional view for explaining the configuration of the main part of the treatment tool according to the twelfth modification. Meanwhile, a configuration of a treatment system according to the twelfth modification is the same as the treatment system  1  as described above except that a cover  250  that covers a part of the jaw  210  is further provided, and therefore, explanation of the configuration other than the cover  250  will be omitted. A configuration that is different from the embodiment will be described below. 
     The cover  250  extends from an end portion at the side of the gripped portion  211  to a position at which the second hole portion  210   c  is covered, and covers a part of the jaw  210 . Further, the cover  250  covers the both ends of the shaft  23  (see  FIG.  26   ). 
     In the twelfth modification as described above, the configuration is changed so as to further include the cover  250  in the embodiment as described above, but a behavior of the treatment tool itself is not changed, so that it is possible to achieve the same effects as the embodiment. 
     Further, in the twelfth modification, the cover  250  that is mounted on the jaw  210  and that covers a part of the jaw  210  covers the both ends of the shaft  23 , so that it is possible to prevent coming off of the shaft  23 . 
     Thirteenth Modification 
     A thirteenth modification of the embodiment will be described below with reference to  FIG.  27    to  FIG.  30   .  FIG.  27    and  FIG.  28    are diagrams for explaining a configuration of a main part of a treatment tool according to the thirteenth modification.  FIG.  29    is a cross-sectional view for explaining the configuration of the main part of the treatment tool according to the thirteenth modification.  FIG.  30    is a partial enlarged view of the configuration illustrated in  FIG.  29   . Meanwhile, a configuration of a treatment system according to the thirteenth modification is the same as the treatment system  1  as described above except that watertight materials  251  are further provided, and therefore, explanation of the configuration other than the watertight materials  251  will be omitted. A configuration that is different from the embodiment will be described below. 
     The watertight material  251  is arranged on each of end portions of the second through hole  202   b  of the sheath  202  (see  FIG.  29   ). The watertight materials  251  have annular shapes (see  FIG.  28   ). The watertight materials  251  come in press-contact with the shaft  23  and the sheath  202 , and ensures water-tightness between the shaft  23  and the sheath  202 . Specifically, outer peripheral surfaces of the watertight materials  251  and an inner peripheral surface of the sheath  202  come in close contact with each other at positions P 11  and P 21 . Further, inner peripheral surfaces of the watertight materials  251  and an outer peripheral surface of the shaft  23  come in close contact with each other at positions P 12  and P 22 . The watertight materials  251  come in close contact with each of the members in a line contact manner or in a plane contact manner. 
     When manufacturing the treatment tool according to the thirteenth modification, the watertight materials  251  are first arranged on the sheath  202 . Thereafter, the same method as the embodiment is performed (see  FIG.  6    to  FIG.  8   ). 
     In the thirteenth modification as described above, the configuration is changed to further include the watertight materials  251  as compared to the embodiment as described above, but a behavior of the treatment tool itself is not changed, so that it is possible to achieve the same effects as the embodiment. 
     Furthermore, in the thirteenth modification, the watertight materials  251  ensure water-tightness between the shaft  23  and the sheath  202 , so that it is possible to prevent intrusion of liquid (for example, body fluid or blood) into the sheath  202 . 
     While the embodiment of the disclosure has been described above, the disclosure is not limited to only the embodiment as described above. The disclosure may include various embodiments and the like that are not described herein. The embodiment and the modifications may be combined appropriately. 
     Meanwhile, in the embodiment as described above, the examples have been described in which ultrasonic waves or high-frequency power are/is supplied to the probe main body, but it may be possible to adopt a configuration in which only ultrasonic waves are applied without supplying high-frequency power. 
     Furthermore, in the embodiments as described above, the examples have been described in which the shaft penetrates through the second hole portion of the jaw, but it may be possible to adopt a configuration in which one end of the second hole portion is closed. In this case, the shaft is arranged so as to come into contact with the closed portion of the second hole portion of the jaw. 
     The ultrasonic treatment tool and the method of manufacturing the ultrasonic treatment tool according to the disclosure as described above are useful to mount a jaw in a rotatable manner while preventing interference between the vibration transmission portion and the jaw with a simple configuration. 
     According to the disclosure, it is possible to mount a jaw in a rotatable manner while preventing interference between the vibration transmission portion and the jaw with a simple configuration. 
     Additional advantages and modifications will readily occur to those skilled in the art. Therefore, the disclosure in its broader aspects is not limited to the specific details and representative embodiments shown and described herein. Accordingly, various modifications may be made without departing from the spirit or scope of the general inventive concept as defined by the appended claims and their equivalents.