Patent Publication Number: US-2015088130-A1

Title: Liquid ejecting apparatus for medical treatment

Description:
This application claims the benefit of Japanese Patent Application No. 2013-194756, filed on Sep. 20, 2013. The content of the aforementioned application is hereby incorporated by reference in its entirety. 
     BACKGROUND 
     1. Technical Field 
     The present invention relates to a technology of a liquid ejecting apparatus for medical treatment. 
     2. Related Art 
     As surgical instruments which are used to carry out incision, excision, hemostasis, and the like of a biological tissue, there are known a liquid ejecting-type liquid ejecting scalpel, an electrical scalpel, an ultrasonic scalpel, and a laser scalpel (for example, JP-A-5-92009 described below). 
     Incidentally, medical doctors use appropriately different surgical instruments in order to carry out incision, excision, and hemostasis of a biological tissue among those surgical instruments, and thus, there has been a disadvantage that the operation has to be interrupted to switch the surgical instrument. 
     For example, in a case of a neurosurgical procedure, a medical doctor performs a surgical operation by using the surgical instruments while magnifying a lesion site by a microscope and the like. The medical doctor needs to perform the surgical operation while checking the surgical instrument and the lesion site through the microscope. In the related art, medical doctors have to refocus their attention on the distal end of the surgical instrument every time they switch the surgical instrument, and thus, there has been a disadvantage that the repeated switching leads to poor concentration and physical exhaustion. 
     In a case of endoscopic/laparoscopic surgery, in order to replace the surgical instrument to be used, a medical doctor needs to draw the endoscope/laparoscope out of the body of a patient and to switch the distal end of the surgical instrument outside the body of the patient, thereby reinserting the endoscope/laparoscope into the patient. A series of the operations causes a disadvantage of deterioration in efficiency of the surgical operation. 
     SUMMARY 
     An advantage of some aspects of the invention is to solve at least a part of the problems described above, and the invention can be implemented as the following forms. 
     (1) An aspect of the invention provides a liquid ejecting apparatus for medical treatment. The liquid ejecting apparatus for medical treatment includes a liquid ejecting scalpel that ejects a liquid, an ultrasonic scalpel that generates an ultrasonic wave, an outer case that accommodates the liquid ejecting scalpel and the ultrasonic scalpel and includes an opening portion allowing a distal end portion of the liquid ejecting scalpel or a distal end portion of the ultrasonic scalpel to protrude therethrough, a guide portion that is arranged in the outer case and guides the distal end portion of the liquid ejecting scalpel or the distal end portion of the ultrasonic scalpel to the opening portion, and a manipulation section that is arranged in the outer case and selectively causes the distal end portion of the liquid ejecting scalpel or the distal end portion of the ultrasonic scalpel to protrude through the opening portion. 
     In the liquid ejecting apparatus for medical treatment of this aspect, since the guide portion is included, when a user manipulates the manipulation section, it is possible to cause the distal end portion of the liquid ejecting scalpel or the distal end portion of the ultrasonic scalpel to protrude from the approximately same position before and after the manipulation. Accordingly, it is possible to suppress the visual point of the user oriented to a distal end of the scalpel from moving before and after the switching of the scalpel. 
     (2) The liquid ejecting apparatus for medical treatment of the aspect described above maybe configured such that the liquid ejecting apparatus for medical treatment further includes a controller that controls the liquid ejecting scalpel and the ultrasonic scalpel, and a switch that is electrically connected to the controller and designates a beginning of use or a cessation of use for each of the scalpels, and the controller controls switching of functions of the switch to be associated with each of the scalpels based on a manipulation of the manipulation section. 
     With the liquid ejecting apparatus for medical treatment of this aspect, a user can manipulate the beginning of use or the cessation of use for each of the scalpels by the same switch before and after the switching of the scalpel to be used. 
     (3) The liquid ejecting apparatus for medical treatment of the aspect described above maybe configured such that the manipulation section includes a plurality of sliders to which the scalpels are connected respectively, the liquid ejecting scalpel includes a communication channel through which a pulsating flow applier applying a pulsation to a liquid and a liquid ejecting portion ejecting the liquid to which a pulsation is applied communicate with each other, the slider connected to the liquid ejecting scalpel is connected to the communication channel, and the communication channel is composed of a tubular-shaped member having flexibility. 
     In the liquid ejecting apparatus for medical treatment of this aspect, since the slider connected to the liquid ejecting scalpel is connected to the communication channel, when a user slides the slider, it is possible to cause the distal end portion of the liquid ejecting scalpel to protrude through the opening portion by sliding the communication channel. 
     (4) The liquid ejecting apparatus for medical treatment of the aspect described above maybe configured such that the manipulation section includes a plurality of sliders to which each of the scalpels is connected respectively, the liquid ejecting scalpel includes a pulsating flow applier which applies a pulsation to a liquid and a liquid ejecting portion which ejects the liquid to which a pulsation is applied, and the slider connected to the liquid ejecting scalpel is connected to a functional portion of the liquid ejecting scalpel including the liquid ejecting portion. 
     With the liquid ejecting apparatus for medical treatment of this aspect, since the slider connected to the liquid ejecting scalpel is connected to the functional portion of the liquid ejecting scalpel, when a user slides the slider, it is possible to cause the distal end portion of the liquid ejecting scalpel to protrude through the opening portion by sliding the functional portion. 
     (5) Another aspect of the invention provides a liquid ejecting apparatus for medical treatment. The liquid ejecting apparatus for medical treatment includes a liquid ejecting scalpel that ejects a liquid, an electrical scalpel that generates a high frequency current, an outer case that accommodates the liquid ejecting scalpel and the electrical scalpel and includes an opening portion allowing a distal end portion of the liquid ejecting scalpel or a distal end portion of the electrical scalpel to protrude therethrough, a guide portion that guides the distal end portion of the liquid ejecting scalpel or the distal end portion of the electrical scalpel to the opening portion, and a manipulation section that is arranged in the outer case and selectively causes the distal end portion of the liquid ejecting scalpel or the distal end portion of the electrical scalpel to protrude through the opening portion. 
     With the liquid ejecting apparatus for medical treatment of this aspect, since the guide portion is included, when a user manipulates the manipulation section, it is possible to cause the distal end portion of the liquid ejecting scalpel or the distal end portion of the electrical scalpel to protrude from the approximately same position before and after the manipulation. Accordingly, it is possible to suppress the visual point of the user oriented to a distal end of the scalpel from moving before and after the switching of the scalpel. 
     (6) The liquid ejecting apparatus for medical treatment of the aspect described above maybe configured such that the liquid ejecting apparatus for medical treatment further includes a controller that controls the liquid ejecting scalpel and the electrical scalpel, and a switch that is electrically connected to the controller and designates a beginning of use or a cessation of use for each of the scalpels, and the controller controls switching of functions of the switch to be associated with each of the scalpels based on a manipulation of the manipulation section. 
     With the liquid ejecting apparatus for medical treatment of this case, a user can manipulate the beginning of use or the cessation of use for each of the scalpels by the same switch before and after the switching of the scalpel to be used. 
     (7) The liquid ejecting apparatus for medical treatment of the aspect described above maybe configured such that the manipulation section includes a plurality of sliders to which the scalpels are connected respectively, the liquid ejecting scalpel includes a communication channel through which a pulsating flow applier applying a pulsation to a liquid and a liquid ejecting portion ejecting the liquid to which a pulsation is applied communicate with each other, the slider connected to the liquid ejecting scalpel is connected to the communication channel, and the communication channel is composed of a tubular-shaped member having flexibility. 
     With the liquid ejecting apparatus for medical treatment of this case, since the slider of the liquid ejecting scalpel is connected to the communication channel, when a user slides the slider, it is possible to cause the distal end portion of the liquid ejecting scalpel to protrude through the opening portion by sliding the communication channel. 
     (8) The liquid ejecting apparatus for medical treatment of the aspect described above maybe configured such that the manipulation section includes a plurality of sliders to which each of the scalpels is connected respectively, the liquid ejecting scalpel includes a pulsating flow applier which applies a pulsation to a liquid and a liquid ejecting portion which ejects the liquid to which a pulsation is applied, and the slider connected to the liquid ejecting scalpel is connected to a functional portion of the liquid ejecting scalpel including the liquid ejecting portion. 
     With the liquid ejecting apparatus for medical treatment of this aspect, since the slider connected to the liquid ejecting scalpel is connected to the functional portion of the liquid ejecting scalpel, when a user slides the slider, it is possible to cause the distal end portion of the liquid ejecting scalpel to protrude through the opening portion by sliding the functional portion. 
     Not all of the multiple configuration elements included in each aspect of the invention described above are essential. In order to partially or entirely solve the above-described disadvantages, or in order to partially or entirely achieve the effects disclosed in this specification, it is possible to appropriately carry out a change, an elimination, replacement for another new configuration element, and a partial elimination of limited contents regarding a portion of the configuration elements among the plurality of configuration elements. In order to partially or entirely solve the above-described disadvantages, or in order to partially or entirely achieve the effects disclosed in this specification, it is possible to combine a portion or the entirety of the above-described technical features included in an aspect of the invention with a portion or the entirety of the above-described technical features included in another aspect of the invention so as to establish an individual aspect of the invention. 
     For example, an aspect of the invention can be implemented as an apparatus including one or more elements among the five elements such as the liquid ejecting scalpel, the ultrasonic scalpel, the outer case, the guide portion, and the manipulation section. In other words, the apparatus may have the liquid ejecting scalpel or need not have the same. The apparatus may have the ultrasonic scalpel or need not have the same. The apparatus may have the outer case or need not have the same. The apparatus may have the guide portion or need not have the same. The apparatus may have the manipulation section or need not have the same. 
     The liquid ejecting scalpel may be configured to be as a liquid ejecting scalpel that ejects a liquid. The ultrasonic scalpel may be configured to be as an ultrasonic scalpel that generates an ultrasonic wave. The outer case may be configured to be as an outer case that accommodates the liquid ejecting scalpel and the ultrasonic scalpel and includes an opening portion allowing a distal end portion of the liquid ejecting scalpel or a distal end portion of the ultrasonic scalpel to protrude therethrough. The guide portion may be configured to be as a guide portion that is arranged in the outer case and guides the distal end portion of the liquid ejecting scalpel or the distal end portion of the ultrasonic scalpel to the opening portion. The manipulation section may be configured to be as a manipulation section that is arranged in the outer case and selectively causes the distal end portion of the liquid ejecting apparatus or the distal end portion of the ultrasonic scalpel to protrude through the opening portion. 
     Such an apparatus can be implemented as a liquid ejecting apparatus for medical treatment as well as it can be used as another apparatus other than the liquid ejecting apparatus for medical treatment. According to the aspects described above, it is possible to solve at least one of various problems such as miniaturization of the apparatus, reduction in cost, saving of resources, facilitation in manufacturing, and enhancement of usability. A portion or the entirety of the above-described technical features according to each aspect of the liquid ejecting apparatus can be applied to the apparatus. 
     The invention can be implemented in various forms other than the apparatus described above. For example, it is possible to be implemented in forms of a scalpel for medical treatment, a scalpel switching apparatus for medical treatment, a scalpel switching method for medical treatment, a liquid ejecting method, and a medical instrument. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention will be described with reference to the accompanying drawings, wherein like numbers reference like elements. 
         FIG. 1  is a diagram illustrating a configuration of a scalpel apparatus for medical treatment. 
         FIG. 2  is a schematic view schematically illustrating a structure of a handpiece. 
         FIG. 3  is a schematic view illustrating a state where a probe moves. 
         FIG. 4  is a diagram illustrating the handpiece in a second embodiment. 
         FIG. 5  is a schematic view schematically illustrating a configuration of a functional portion accommodation case. 
         FIG. 6  is a diagram schematically illustrating a configuration of the functional portion accommodation case. 
         FIG. 7  is a schematic view illustrating another state where the probe moves. 
         FIG. 8  is a diagram illustrating a guide member. 
     
    
    
     DESCRIPTION OF EXEMPLARY EMBODIMENTS 
     A. First Embodiment 
     A1. Scalpel Apparatus for Medical Treatment 
       FIG. 1  is a diagram illustrating a configuration of a scalpel apparatus  10  for medical treatment as a first embodiment of the invention. The scalpel apparatus  10  for medical treatment is a medical instrument including multiple types of scalpels for medical treatment. 
     The scalpel apparatus  10  for medical treatment includes a handpiece  20  and a controller  30 . The handpiece  20  accommodates a liquid ejecting scalpel  200 , an ultrasonic scalpel  300 , and an electrical scalpel  400  inside thereof. 
     The liquid ejecting scalpel  200  is a surgical instrument which ejects a liquid to perform incision or excision of a lesion site by a stream flow. The ultrasonic scalpel  300  is a surgical instrument which vibrates a vibrator using an ultrasonic frequency and emulsifies or destroys a biological tissue by the vibration to perform incision or excision of a lesion site. The electrical scalpel  400  is a surgical instrument which performs incision or coagulation (hemostasis) of a lesion site by a thermic effect of a high frequency current. 
     The handpiece  20  includes a manipulation section  22 . The manipulation section  22  includes sliders  202 ,  302 , and  402 . A user of the scalpel apparatus  10  for medical treatment selects one slider among the three sliders included in the manipulation section  22  and operates the same so that a scalpel to be used can be selected from the three scalpels accommodated in the handpiece  20 . The slider  202  is a slider to select the liquid ejecting scalpel  200 . The slider  302  is a slider to select the ultrasonic scalpel  300 . The slider  402  is a slider to select the electrical scalpel  400 . When using each of the scalpels, the user causes the slider corresponding to the scalpel to be used to be turned ON. While one slider is turned ON, the remaining sliders are turned OFF. 
     When a user selects and operates the slider, a distal end portion of the scalpel corresponding to the selected slider protrudes through an opening portion  24  formed in the handpiece  20 . The user performs incision, excision, hemostasis, and the like of a lesion site by bringing the distal end portion of the scalpel protruding through the opening portion  24  to be in contact or causing the distal end portion thereof to approach the lesion site. 
     A cable-shaped member group  25  extends from the rear end of the handpiece  20 . The cable-shaped member group  25  is a bundle of pipes and electrical wires necessary to operate the three scalpels. 
     The controller  30  is connected to the liquid ejecting scalpel  200 , the ultrasonic scalpel  300 , and the electrical scalpel  400 . The controller  30  controls the operations of the three scalpels. A foot switch  40  is connected to the controller  30 . When a user turns ON/OFF the foot switch  40 , the scalpel selected by the user through the manipulation section  22  is driven. 
       FIG. 2  is a schematic view schematically illustrating a structure of the handpiece  20 . As described above, the liquid ejecting scalpel  200 , the ultrasonic scalpel  300 , and the electrical scalpel  400  are accommodated in the handpiece  20 . 
     The liquid ejecting scalpel  200  includes an actuator  220 , a liquid supply channel  240 , a liquid ejection channel  250 , and a suctioning channel  260 . The liquid supply channel  240  is a flow channel to supply a liquid pumped from a pump (not illustrated) which is prepared outside the handpiece  20 , to the actuator  220 . The liquid supply channel  240  is composed of a member having flexibility. In the embodiment, the liquid supply channel  240  is formed with a PEEK member. The liquid supply channel  240  may be formed with various flexible members such as polyvinyl chloride, silicon, and thermoplastic elastomers. As the liquid to be supplied to the actuator  220 , it is possible to employ various liquids such as sterile water for medical use or pure water. 
     The actuator  220  applies a pulsation to a liquid which is supplied from the liquid supply channel  240 . The liquid applied with a pulsating flow is supplied to the liquid ejection channel  250 , thereby being ejected from a distal end of the liquid ejection channel  250  as a pulsatile liquid. The pulsatile liquid denotes a liquid in a state where a flow rate or a flow velocity is accompanied by fluctuation. As a form of ejecting a liquid in a pulsatile manner, intermittent ejection in which liquid is ejected while repeating the ejection and a pause is included. However, it is acceptable as long as the flow rate or the flow velocity of a liquid fluctuates, and thus, it does not necessarily have to be the intermittent ejection. 
     As illustrated in the drawing, the actuator  220  includes a first case  231 , a second case  232 , a third case  233 , a piezoelectric element  235 , a reinforcement plate  236 , and a diaphragm  237 . The first case  231  is a tubular member. An end of the first case  231  is connected to the second case  232 . Another end of the first case  231  is sealed by the third case  233 . The piezoelectric element  235  is arranged in a space formed inside the first case  231 . 
     The piezoelectric element  235  is a laminated piezoelectric element. One end of the piezoelectric element  235  is fixed to the diaphragm  237  via the reinforcement plate  236 . Another end of the piezoelectric element  235  is fixed to the third case  233 . The diaphragm  237  is formed with a thin metal film and a peripheral edge thereof is fixed to the first case  231 . An accommodation chamber  238  is formed between the diaphragm  237  and the second case  232 . The volume of the accommodation chamber  238  changes in response to driving of the piezoelectric element  235 . 
     A first flow channel  239  which allows a liquid to flow into the accommodation chamber  238  is formed in the second case  232 . The first flow channel  239  is connected to the liquid supply channel  240 . A second flow channel  234  which allows a liquid accommodated in the accommodation chamber  238  to flow out is formed in the second case  232 . The second flow channel  234  is connected to the liquid ejection channel  250 . 
     A drive signal at a predetermined frequency is applied from the controller  30  to the piezoelectric element  235 . The piezoelectric element  235  vibrates at a predetermined frequency upon reception of the drive signal from the controller  30 . When the piezoelectric element  235  vibrates, the volume of the accommodation chamber  238  changes via the diaphragm  237 , and then, the liquid accommodated in the accommodation chamber  238  is pressurized. A pulsation is applied to the liquid which is compressed or decompressed at a predetermined frequency. The liquid passes through the second flow channel  234  and the liquid ejection channel  250  and is ejected to the outside as the pulsatile liquid. The actuator  220  has such a configuration. 
     The suctioning channel  260  is connected to a suctioning pump (not illustrated) outside the handpiece  20 . Excision which is excised by a liquid ejected from the liquid ejection channel  250 , a waste liquid, or the like are subjected to suctioning through the suctioning channel  260 . In the embodiment, the liquid ejection channel  250  is inserted into the suctioning channel  260  at a distal end portion of the handpiece  20 . The suctioning channel  260  may be configured to be arranged so as to abut on the outside of the liquid ejection channel  250  in parallel thereto. 
     The slider  202  is connected to the suctioning channel  260 . When the slider  202  is slid to be turned ON, the liquid ejection channel  250  and the suctioning channel  260  move in a sliding direction. Then, distal end portions of the liquid ejection channel  250  and the suctioning channel  260  protrude through the opening portion  24 . The actuator  220  is fixed to the handpiece  20 . Accordingly, even though the slider  202  moves, the actuator  220  does not move. The state where the slider  202  and the liquid ejection channel  250  are connected to each other includes a case where the suctioning channel  260  moves by the movement of the slider  202  and the liquid ejection channel  250  moves in accordance with the movement of the suctioning channel  260 , as in the embodiment. A piping configuration configured to have the liquid ejection channel  250  and the suctioning channel  260  at a distal end from the actuator  220  is also referred to as a probe  270 . 
     The probe  270  has a sufficient length to be movable by the sliding of the slider  202 . When the slider  202  is turned OFF, the probe  270  is accommodated in the handpiece  20  in a flexed state. The liquid ejection channel  250  and the suctioning channel  260  are configured of members having flexibility. In the embodiment, the liquid ejection channel  250  and the suctioning channel  260  are formed with PEEK members . The liquid ejection channel  250  and the suctioning channel  260  may be formed with various flexible members such as polyvinyl chloride, silicon, and thermoplastic elastomers. The liquid ejection channel  250  and the suctioning channel  260  may be configured of members having elasticity. The liquid ejecting scalpel  200  has such a configuration. 
     The ultrasonic scalpel  300  includes an actuator  320 , an ultrasonic wave transmission body  330 , a liquid supply channel  340 , a liquid ejection channel  350 , and a suctioning channel  360 . A configuration including the ultrasonic wave transmission body  330 , the liquid ejection channel  350 , and the suctioning channel  260  at a distal end from the actuator  320  is also referred to as a probe  370 . 
     The actuator  320  includes a vibrator  322  that generates an ultrasonic wave. The vibrator  322  is connected to the controller  30 . A drive signal having a predetermined voltage is applied to the vibrator  322  from the controller  30 . The vibrator  322  generates a vibrating ultrasonic wave upon reception of the drive signal. The ultrasonic wave generated by the vibrator  322  transmits the ultrasonic wave transmission body  330 , and destroys or emulsifies a biological tissue existing at a distal end of the ultrasonic wave transmission body  330 . 
     The liquid supply channel  340  is a flow channel to supply a liquid pumped from the pump which is prepared outside the handpiece  20 , to the distal end of the probe  270 . The liquid supplied from the liquid supply channel  340  transmits an ultrasonic wave which is transmitted to the ultrasonic wave transmission body  330 , to a lesion site. The liquid supplied from the liquid supply channel  340  performs washing of the lesion site. As the liquid, it is possible to employ various liquids such as sterile water for medical use or pure water. In the embodiment, the liquid supply channel  240  is formed with the PEEK member. The liquid supply channel  240  may be formed with various resins such as polyvinyl chloride, silicon, and thermoplastic elastomers. 
     The suctioning channel  360  is connected to the suctioning pump (not illustrated) outside the handpiece  20 . Excision which is destroyed and emulsified by an ultrasonic wave, a waste liquid, or the like is subjected to suctioning through the suctioning channel  360 . 
     In the embodiment, the probe  370  may have a configuration in which the ultrasonic wave transmission body  330 , the liquid ejection channel  350 , and the suctioning channel  360  come into contact with each other outside to be arranged in parallel. The slider  302  is connected to the probe  370 . When the slider  302  is slid to be turned ON, the probe  370  and the actuator  320  move in the sliding direction. Then, a distal end portion of the probe  370  protrudes through the opening portion  24 . 
     The liquid supply channel  340  and the suctioning channel  360  have a sufficient length to be movable by the sliding of the slider  302  at the rear from the actuator  320 . When the slider  302  is turned OFF, the liquid supply channel  340  and the suctioning channel  360  are accommodated in the handpiece  20  in a flexed state at the rear of the actuator  320 . The ultrasonic scalpel  300  has such a configuration. 
     The electrical scalpel  400  includes an actuator  420 , an electrical cable  440 , and a high frequency treatment electrode  450 . The high frequency treatment electrode  450  is also referred to as a probe  470 , for convenience of the description. 
     The electrical cable  440  is a cable that supplies electrical power to the actuator  420 . The electrical cable  440  is connected to a high frequency current generator (not illustrated) outside the handpiece  20 . The actuator  420  supplies a high frequency current which is supplied from the electrical cable  440 , to the high frequency treatment electrode  450 . 
     The high frequency current supplied to the high frequency treatment electrode  450  flows to a lesion site. In this case, Joule heat is generated due to a load or contact resistance resulting in coagulation of protein in the lesion site, thereby making hemostasis and the like possible. 
     The actuator  420  includes a switching element which performs turning ON/OFF of a high frequency current to the high frequency treatment electrode  450  upon reception of the control signal from the controller  30 . The actuator  420  further performs various types of controlling necessary to operate the electrical scalpel  400 . The switching element may be included in the high frequency current generator. The high frequency generator may be accommodated in the actuator  420 . 
     The slider  402  is connected to the high frequency treatment electrode  450 . When the slider  402  is slid to be turned ON, the high frequency treatment electrode  450  moves in the sliding direction. Then, a distal end of the high frequency treatment electrode  450  protrudes through the opening portion  24 . The actuator  420  is fixed to the handpiece  20 . Accordingly, even though the slider  402  moves, the actuator  420  does not move. 
     The high frequency treatment electrode  450  is covered by an insulating resin excluding the distal end portion. The high frequency treatment electrode  450  configuring the probe  470 , and the insulating resin have flexibility. The probe  470  has a sufficient length to be movable by the sliding of the slider  402 . When the slider  402  is turned OFF, the probe  470  is accommodated in the handpiece  20  in a flexed state. The electrical scalpel  400  has such a configuration. 
       FIG. 3  is a schematic view illustrating a state where the probe moves. The distal end portion of the handpiece  20  forms a curved shape. The curved portion of the handpiece  20  is also referred to as the guide portion  26 . 
     The guide portion  26  respectively guides the distal end portions of the probes of the scalpels to the opening portion  24  when the sliders of each of the scalpels are moved forward. The probes of the scalpels respectively move along the guide portion  26 , and every probe protrudes from the approximately same position of the opening portion  24 . 
     As illustrated in the drawing, the manipulation section  22  includes a sensor  28  that detects an ON/OFF state of each slider. The sensor  28  transmits a signal indicating the ON/OFF state of each slider to the controller  30 . The controller  30  receives a signal from the sensor  28 . The controller  30  controls the foot switch  40  to function as a switch to start/pause the operation of the scalpel of which the slider is turned ON, based on the ON/OFF state of each slider. A user performs the manipulation to start/pause the operation of the scalpel by using the foot switch  40  while any scalpel is used. 
     The manipulation section  22  includes a locking function to respectively regulate only one slider among a plurality thereof to be in the ON state. The locking function allows a user to selectively use only one scalpel among the respective scalpels. 
     As described above, the liquid ejecting scalpel  200 , the ultrasonic scalpel  300 , and the electrical scalpel  400  are accommodated in the handpiece  20 . The liquid ejecting scalpel  200  is suitable for excising or incising a site having relatively little fibers or a site in which a minimized invasive operation is a major concern (for example, brain). The liquid ejecting scalpel  200  allows fine blood vessels or nerves to be soundly retained. The ultrasonic scalpel  300  is highly capable of destroying and emulsifying a biological tissue, thereby being suitable for excising or incising a site having relatively many fibers. The electrical scalpel is effective when performing hemostasis. Accordingly, the scalpel apparatus  10  for medical treatment allows a user to switch and use each of the scalpels in accordance with the type of treatment. 
     A user can switch the scalpel to be used by the manipulation section  22 . Accordingly, the visual point of the user can be suppressed from moving when switching the scalpel to be used. 
     Since the handpiece  20  includes the guide portion  26 , when each of the sliders is slid, the distal end of the probe of each of the scalpels protrudes from the approximately same position of the opening portion  24 . Accordingly, the visual point of the user can be minimized from moving when switching the scalpel to be used. Therefore, poor concentration and physical exhaustion of a user during the surgical operation can be suppressed. 
     The controller  30  controls the foot switch  40  to function as a switch to start/pause the operation of the scalpel of which the slider is turned ON, in accordance with the ON/OFF state of each slider. Accordingly, a user can manipulate the beginning of use or the cessation of use for each of the scalpels by the same foot switch before and after the switching of the scalpel to be used. 
     The slider  202  included in the liquid ejecting scalpel  200  is connected to the probe  270 . When the slider  202  is slid, only the probe  270  moves, and the actuator  220  maintains a state of being fixed to the handpiece  20 . Accordingly, when manipulating the slider, a user can slide the slider  202  by a relatively small force. Since the actuator  220  is fixed to the handpiece  20 , when the slider  202  slides, movements of a centroid of the handpiece  20  itself can be suppressed. 
     B. Second Embodiment 
     A second embodiment of the invention will be described.  FIG. 4  is a diagram illustrating a handpiece  20   a  in the second embodiment. The difference between the second embodiment and the first embodiment is that a laser scalpel  500  is accommodated in the handpiece  20   a,  and the scalpels are respectively accommodated in cases inside the handpiece  20   a . The laser scalpel  500  is a medical scalpel performing incision and excision of a biological tissue by using heat energy of a laser beam. As illustrated in the drawing, the liquid ejecting scalpel  200 , the ultrasonic scalpel  300 , the electrical scalpel  400 , and the laser scalpel  500  are accommodated in the handpiece  20   a.    
     The liquid ejecting scalpel  200  includes a functional portion accommodation case  210 . The probe  270  is stretched from the front of the functional portion accommodation case  210 . A cable-shaped member group  212  is stretched from the rear of the functional portion accommodation case  210 . The cable-shaped member group  212  includes the liquid supply channel  240 , the suctioning channel  260 , and a control wire through which a drive signal to drive the piezoelectric element  235  is transmitted (refer to  FIG. 2 ). The slider  202  is connected to the functional portion accommodation case  210 . 
     The ultrasonic scalpel  300  includes a functional portion accommodation case  310 . The probe  370  is stretched from the front of the functional portion accommodation case  310 . A cable-shaped member group  312  is stretched from the rear of the functional portion accommodation case  310 . The cable-shaped member group  312  includes the liquid supply channel  340  and the suctioning channel  360  (refer to  FIG. 2 ). The slider  302  is connected to the functional portion accommodation case  310 . 
     The electrical scalpel  400  includes a functional portion accommodation case  410 . The probe  470  is stretched from the front of the functional portion accommodation case  410 . A cable-shaped member group  412  is stretched from the rear of the functional portion accommodation case  410 . The cable-shaped member group  412  includes the electrical cable  440  (refer to  FIG. 2 ). The slider  402  is connected to the functional portion accommodation case  410 . 
     The laser scalpel  500  includes a functional portion accommodation case  510 . A probe  570  is stretched from the front of the functional portion accommodation case  510 . A cable-shaped member group  512  is stretched from the rear of the functional portion accommodation case  510 . The cable-shaped member group  512  includes an optical fiber to transmit laser light. A slider  502  is connected to the functional portion accommodation case  510 . 
     In the embodiment, when each of the sliders is slid, each of the probes and the cases moves. When the slider of each scalpel is turned OFF, the cable-shaped member groups  212 ,  312 ,  412 , and  512  are accommodated in the handpiece  20   a  at the rear of each case in a flexed state. When the slider of each scalpel is turned ON, the each of the flexed cable-shaped member groups is in an extended state. Similar to the first embodiment, when the slider of each scalpel is turned ON, each probe is guided to the opening portion  24  by a guide portion  26   a  included in the handpiece  20   a,  thereby protruding through the opening portion  24 . 
     The cable-shaped member group of each of the scalpels may include another pipe and wire in accordance with the function included in each of the scalpels, in addition to the configuration described above. The cable-shaped member group  212 , the cable-shaped member group  312 , the cable-shaped member group  412 , and the cable-shaped member group  512  configure a cable-shaped member group  25   a  as a bundle. The cable-shaped member group  25   a  is stretched from the rear of the handpiece  20   a.    
       FIG. 5  is a schematic view schematically illustrating a configuration of the functional portion accommodation case  210 . The actuator  220 , the liquid supply channel  240 , the liquid ejection channel  250 , and the suctioning channel  260  are accommodated in the functional portion accommodation case  210 . In the embodiment, the liquid supply channel  240  is connected to the entire surface of the actuator  220 . Regarding the function of each configuration, the description has been given in the first embodiment, thereby omitting the description. 
     The description for the functional portion accommodation case  310  with reference to the drawing will be omitted. The actuator  320  ( FIG. 2 ) is accommodated in the functional portion accommodation case  310 . 
     The description for the functional portion accommodation case  410  with reference to the drawing will be omitted. The actuator  420  ( FIG. 2 ) is accommodated in the functional portion accommodation case  410 . 
       FIG. 6  is a diagram schematically illustrating a configuration of the functional portion accommodation case  510 . In the functional portion accommodation case  510 , an optical fiber  550  through which a laser beam passes through, a liquid supply channel  540  to which a liquid is supplied, and a suctioning channel  560  communicate with one another. The liquid supply channel  540  is inserted into the optical fiber  550 . The liquid supply channel  540  is inserted into the suctioning channel  560 . 
       FIG. 7  is a schematic view illustrating the state where the probe moves. The handpiece  20   a  includes the curved-shaped guide portion  26   a.  In the embodiment, when each of the sliders is slid, each of the cases of the scalpels moves. The guide portion  26   a  respectively guides the distal end portions of the probes of the scalpels to the opening portion  24  when the sliders of each of the scalpels are moved forward. The probes of the scalpels respectively move along the guide portion  26 , and every probe protrudes from the approximately same position of the opening portion  24 . 
     As illustrated above, each of the scalpels in the embodiment is individually accommodated in the cases inside the handpiece  20   a.  Each of the sliders is connected to each of the cases. When each of the sliders is slid, each of the cases and the probes moves. Accordingly, when each of the slider is OFF, the cable-shaped member group of each of the scalpels is accommodated in the handpiece  20   a  in a flexed state. Accordingly, when each of the sliders is turned OFF, it is possible to avoid the probe portion to be accommodated in a flexed state. Therefore, the distal end portion of the handpiece  20   a  can be thinned. Since each of the scalpels is individually accommodated in the case inside the handpiece  20   a , it is possible to improve the durability thereof. 
     C. Modification Example 
     The invention is not limited to the embodiments described above and can be embodied in various aspects without departing from the scope of the invention. For example, following modifications can also be made. 
     C1. Modification Example 1 
     In the scalpel apparatus  10  for medical treatment, the guide portion  26  is the curved portion formed in the handpiece  20 . However, a guide member  27  may be separately included therein.  FIG. 8  is a diagram illustrating the guide member  27 . As illustrated in the drawing, the guide member  27  has a structure in which a cylindrical member  27   b  is connected to the center of a conical-shaped member  27   a.  The guide member  27  is fixed to the distal end inside the handpiece  20 . When the slider of each of the scalpels is slid to be in the ON state, the probe is guided from the conical-shaped member  27   a  to the cylindrical member  27   b,  thereafter, the probe is guided to the opening portion  24 . The handpiece  20  in a Modification Example 1 separately includes the guide member  27 , and thus, there is no need to form the guide portion  26  at the distal end portion of the handpiece  20 . Therefore, the shape of the distal end portion of the handpiece  20  is not limited. For example, a user can form the distal end of the handpiece  20  to have a shape so as to be easily grasped. 
     C2. Modification Example 2  
     In the embodiment, each of the scalpels includes the suctioning channel in accordance with necessity. However, the suctioning channel may be configured not to be included. In this manner, the structure of the inside of the handpiece  20  can be facilitated. Therefore, it is possible to miniaturize the handpiece  20 . 
     C3. Modification Example 3 
     The ultrasonic scalpel  300  may be configured not to include the liquid ejection channel  350 . Thus, it is possible to attain the miniaturization of the handpiece  20 . 
     C4. Modification Example 4  
     In the scalpel for medical treatment as a liquid ejecting apparatus for medical treatment of the embodiments, a user can switch and use each of the scalpels by the manipulation section as described above. In other words, the scalpel apparatus  10  for medical treatment can be used by the following usage method. 
     There is provided a method of using a liquid ejecting apparatus for medical treatment including a liquid ejecting scalpel that includes a liquid ejecting portion ejecting a liquid and a pulsating flow applier applying a pulsating flow to the liquid, an ultrasonic scalpel that has an ultrasonic wave generation portion generating a ultrasonic wave, an electrical scalpel provided with a high frequency treatment electrode, an outer case that accommodates the liquid ejecting scalpel, the ultrasonic scalpel, and the electrical scalpel and has an opening portion through which a distal end portion of the liquid ejecting scalpel, a distal end portion of the ultrasonic scalpel, or a distal end portion of the electrical scalpel can protrude, a manipulation section that selectively causes the distal end portion of each scalpel to protrude through the opening portion, and a guide portion that guides the distal end portion of each scalpel to the opening portion. 
     The method of using a liquid ejecting apparatus for medical treatment includes at least using one scalpel, switching from one scalpel to another scalpel by manipulating the manipulation section, and using another scalpel. According to the method of using a liquid ejecting apparatus for medical treatment, a user using the liquid ejecting apparatus for medical treatment can be suppressed in the visual point oriented to the distal end of the scalpel from being moving when switching the scalpel to be used. 
     C5. Modification Example 5 
     In addition to Modification Example 4, the liquid ejecting apparatus for medical treatment can be used as follows. 
     There is provided the method of using a liquid ejecting apparatus for medical treatment disclosed in Modification Example 4. The liquid ejecting apparatus for medical treatment further includes a controller that is electrically connected to each of the liquid ejecting scalpel, the ultrasonic scalpel, and the electrical scalpel to perform controlling of each of the scalpels, and a switch that is electrically connected to the controller and designates a beginning of use and a cessation of use for each of the scalpels. The liquid ejecting apparatus for medical treatment includes selecting one scalpel by manipulating the manipulation section, beginning use of one scalpel by manipulating the switch, ceasing use of one scalpel by manipulating the switch, selecting another scalpel by manipulating the manipulation section, beginning use of another scalpel by manipulating the switch, ceasing use of another scalpel by manipulating the switch. 
     According to the method of using the liquid ejecting apparatus for medical treatment, a user can designate the beginning of use or the cessation of use for each of the scalpels by using the same switch before and after the switching of the scalpel to be used.