Abstract:
The present invention addresses the problem of providing a surgical instrument that reduces the variety of surgical instruments used during surgery and that makes it possible to reduce the burden on patients and health care professionals who are involved in surgery. This surgical instrument comprises a pair of working sections that are connected so as to be capable of opening and closing around an axis of rotation. The surgical instrument is characterized in that the working sections comprise a cutting section that cuts a target object by sliding a pair of blades against each other, a pair of gripping surfaces that grip the target object when the pair of working sections is closed, and a pair of detaching sections that are formed so as to be capable of detaching living tissue when the pair of working sections is opened.

Description:
TECHNICAL FIELD 
       [0001]    The present invention relates to a surgical instrument, particularly to a surgical instrument having a plurality of functions. 
       BACKGROUND ART 
       [0002]    In a surgery, a series of surgical operations is performed as follows. After the epidermis is lightly incised, a site where important living tissues such as a blood vessel or a nerve exist is treated such that living tissues are separated from each other using forceps or the like, rarely using a scalpel, to prevent impairing the living tissues. When a surgical site has been reached, the surgical site is incised or resected as required by using a scalpel and scissors. Thereafter, a needle is grasped with forceps to be used for suture and ligation and then the suture is cut off. As described above, basic operations in a surgery include: separation of living tissues; grasping of the living tissues, needles, and suture or the like; and cutting of the living tissues and suture or the like. A surgery is a repetition of a series of these surgical operations, and a dedicated surgical instrument is used corresponding to each surgical operation. Accordingly, surgical instruments are frequently exchanged in a surgery, and a surgical instrument held by a practitioner is frequently exchanged with another by the practitioner. 
         [0003]    Patent Literature 1 describes as one of the surgical instruments used in a surgery as “forceps having a configuration with a detachable soft cover member at a clamping section thereof, the soft cover member being sterilized beforehand, to be provided as disposable forceps that can be manufactured at low cost” (paragraph 0005 in Patent Literature 1) as a technical problem. This Literature also describes “ . . . forceps configured to attach a disposable and detachable cylindrical soft cover member to each clamping section” (claim 1 in Patent Literature 1). 
         [0004]    Also Patent Literature 2 describes, as a technical problem, “to provide a mucosa dissection assistance device which is inserted beside an endoscope to avoid making a perforation or a stab wound on a surface of a skin for performing counter-traction of a mucosa to be resected and which enables smooth release of the mucosa after removal of the mucosa without having the mucosa caught in a section for grasping the mucosa.” (paragraph 0005 in Patent Literature 2). The Literature also describes “ . . . to provide a mucosa dissection assistance device including: a mucosa grasping section, a flexible pipe having the mucosa grasping section on one end; an elastic member passing from an end of the pipe through the inside of the tubular member, passing again from the end of the pipe through the inside of the pipe, which is longitudinally extensible; and an operating line passing inside the pipe, one end being connected to one and the other end of the elastic member, and that operates to make an annular diameter of the mucosa grasping section variable via the elastic member” (claim 1 in Patent Literature 2). 
         [0005]    Although various surgical instruments have been developed other than instruments described in Patent Literatures 1 and 2, it is desirable to further develop a surgical instrument for decreasing a burden on a patient and health-care professionals and ensuring convenience and safety. 
       CITATION LIST 
     Patent Literature 
       [0000]    
       
         Patent Literature 1: JP 08-224251 A 
         Patent Literature 2: JP 2007-307000 A 
       
     
       SUMMARY OF INVENTION 
     Technical Problem 
       [0008]    As described above, a surgery includes a series of repetitive surgical operations of separation, grasping, and cutting, and a surgical instrument is frequently exchanged with a dedicated instrument corresponding to each surgical operation. Such frequent exchanges of surgical instruments become a factor of a prolonged surgery, which increases a burden on a patient and practitioners. Furthermore, using multiple surgical instruments of different types complicates management of the surgical instruments. 
         [0009]    The present invention is intended to solve such a problem. It is an object of the present invention to decrease the types of surgical instruments in a surgery and provide a surgical instrument capable of decreasing a burden on a patient and health-care professionals involving in the surgery. 
       Solution to Problem 
       [0010]    Solutions to the above problem includes: 
         [0011]    (1) a surgical instrument having a pair of working sections openably/closably coupled to each other on a pivot shaft, the pair of working sections including: 
         [0012]    a cutting section configured to cut an object by sliding a pair of cutting edges against each other; 
         [0013]    a pair of grasping surfaces configured to grasp the object by closing the pair of working sections; and 
         [0014]    a pair of separating sections configured to be able to separate living tissues when opening the pair of working sections. 
         [0015]    Preferable aspects of (1) above includes: 
         [0016]    (2) the surgical instrument according to (1), including a step section without a blade between the grasping surface and the cutting edge; 
         [0017]    (3) the surgical instrument according to the above (1) or (2), wherein, on a pair of rod-like members configured to cross each other around the pivot shaft as an intersection, the pair of working sections is provided on a tip side with respect to the pivot shaft, a pair of operating sections is provided on a rear end side with respect to the pivot shaft, and the pair of working sections is configured to open and close corresponding to opening and closing of the pair of operating sections; and 
         [0018]    (3) the surgical instrument according to any one of the above (1) to (3), wherein the grasping section is substantially elliptical, an axial length in a longitudinal direction of the rod-like member and an axial length crossing the axial length in an orthogonal direction each are from 1 to 5 mm, a sum of thicknesses of a pair of tip sections in a closed state of the pair of working sections is from 1 to 5 mm, and a length of the cutting section is from 5 to 50 mm. 
       Advantageous Effects of Invention 
       [0019]    A surgical instrument according to the present invention has three functions enabling: cutting an object such as a living tissue and suture by the cutting section; grasping an object such as a living tissue and suture by the grasping surface; and separating living tissues from each other by the separating section. 
         [0020]    Compared with a conventional surgery in which a dedicated surgical instrument has been used for each surgical operation of separating, grasping, and cutting, the above-described surgical instrument of the present invention alone can achieve the above-described three surgical operations, making it possible to decrease the number of types of surgical instruments used in a surgery. As a result, management of surgical instruments can be streamlined, burden on health-care professionals being decreased, making it possible to reduce a total cost. 
         [0021]    Also, conventionally, a surgical instrument has been exchanged with a dedicated surgical instrument corresponding to each surgical operation, and a surgical instrument held by a practitioner has been frequently exchanged with another by the practitioner. A surgical instrument of the present invention can perform the three surgical operations alone, making it possible to decrease the number of times of exchanging surgical instruments by the practitioner, thereby reducing the time taken for a surgery. Reducing the time taken for a surgery not only decreases the burden on a patient by suppressing the amount of bleeding or the like, but also decreases a burden on all health-care professionals involving in the surgery. 
     
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         [0022]      FIGS. 1(   a ) to  1 ( d ) are schematic diagrams illustrating a surgical instrument according to an embodiment of the present invention.  FIG. 1(   a ) is a top-view schematic diagram illustrating a closed state of a surgical instrument according to an embodiment of the present invention.  FIG. 1(   b ) is a top-view schematic diagram illustrating main portions of the surgical instrument illustrated in  FIG. 1(   a ), including an enlarged view of a working section in an open state.  FIG. 1(   c ) is a side-view schematic diagram, illustrating the surgical instrument illustrated in  FIG. 1(   a ) as seen from the tip side.  FIG. 1(   d ) is a side-view schematic diagram illustrating main portions, including an enlarged view of a tip section, of the surgical instrument illustrated in  FIG. 1(   a ). 
           [0023]      FIG. 2  is a schematic diagram illustrating a surgical instrument according to another embodiment of the present invention. 
           [0024]      FIG. 3  is a schematic diagram illustrating an embodiment of a medical robot system having the surgical instrument of the present invention mounted as a manipulator. 
           [0025]      FIG. 4  is a schematic diagram illustrating an enlarged view of main portions of a manipulator. 
           [0026]      FIG. 5  is a schematic diagram illustrating a surgical instrument according to an embodiment of the present invention when the surgical instrument is used as an endoscopic surgical instrument. 
           [0027]      FIGS. 6(   a ) and  6 ( b ) are schematic diagrams illustrating enlarged views of main portions of the endoscopic surgical instrument illustrated in  FIG. 5 .  FIG. 6(   a ) is a schematic diagram illustrating main portions of the endoscopic surgical instrument illustrated in  FIG. 5 , in an open state.  FIG. 6(   b ) is a schematic diagram illustrating main portions of the endoscopic surgical instrument in  FIG. 5  in a closed state. 
       
    
    
     DESCRIPTION OF EMBODIMENTS 
       [0028]    Hereinafter, a surgical instrument of the present invention will be described with reference to the drawings.  FIG. 1(   a ) is a top-view schematic diagram illustrating a closed state of a surgical instrument according to an embodiment of the present invention.  FIG. 1(   b ) is a top-view schematic diagram illustrating main portions of the surgical instrument illustrated in  FIG. 1(   a ), including an enlarged view of a working section in an open state.  FIG. 1(   c ) is a side-view schematic diagram, illustrating the surgical instrument illustrated in  FIG. 1(   a ) as seen from the tip side. 
         [0029]    As illustrated in  FIG. 1 , a surgical instrument  1  of the present embodiment includes a pair of rod-like members  2  crossing each other with respect to a pivot shaft  5  as an intersection. On the pair of rod-like members  2 , working sections  3 ,  3  are provided at a tip side with respect to the pivot shaft  5 , and operating sections  4 ,  4  operated by inserting a finger are provided at a rear end side with respect to the pivot shaft  5 . The pair of working sections  3 ,  3  is coupled to each other openably/closably on the pivot shaft  5 . The pair of working sections  3 ,  3  includes: cutting sections  9 ,  9  configured to cut an object by sliding a pair of cutting edges  11  against each other; a pair of grasping surfaces  10 ,  10  configured to grasp the object by closing the pair of working sections  3 ,  3 ; and a pair of separating sections  13  configured to be able to separate living tissues when opening the pair of working sections  3 ,  3 . The pair of working sections  3 ,  3  opens and closes according to the opening and closing of the pair of operating sections  4 ,  4 . The surgical instrument  1  has a mechanism that is similar to ordinary scissors in that a rotation shaft  5  works as a fulcrum, the operating sections  4 ,  4  working as points of force, and the working sections  3 ,  3  working as points of action. 
         [0030]    The rod-like member  2  may be formed of a material that is generally used as a material of medial forceps and scissors, the material including, for example, titanium, titanium alloy such as Ti6Al4, stainless steel, and cobalt chromium steel. Furthermore, the surgical instrument  1  preferably has all outer surface corners thereof rounded to avoid impairing a living tissue. 
         [0031]    The operating sections  4 ,  4  are grasped by a health-care professional, and the working sections  3 ,  3  are opened and closed by opening and closing of the pair of operating sections  4 ,  4 . The operating sections  4 ,  4  include ring-shaped ring sections  6 ,  6  for finger insertion and handle sections  7 ,  7  that extend from the ring sections  6 ,  6 . 
         [0032]    The working sections  3 ,  3  have three functions including: separating living tissues from each other in a surgery; grasping a surgical instrument such as a needle and suture, and a living tissue; and cutting a living tissue and suture or the like. The working sections  3 ,  3  include, in the order from the tip side, tip sections  8 ,  8  having the separating sections  13 ,  13  and the grasping surfaces  10 ,  10 , a step section  12 , and the cutting sections  9 ,  9 . 
         [0033]    The separating sections  13 ,  13  are configured to be able to separate living tissues when opening the pair of working sections  3 ,  3 . The separating sections  13 ,  13 , as illustrated in  FIGS. 1(   a ) and  1 ( c ), are outer surfaces on tip sides when the pair of working sections  3 ,  3  is in a closed state. The outlines of the separating sections  13 ,  13  have rounded shapes. The surgical instrument  1  can separate living tissues from each other by changing the state of the pair of working sections  3 ,  3  from closed to open. Since the separating sections  13 ,  13 , which are the outer surfaces of the tip sections  8 ,  8  and come in contact with the living tissues, have rounded shapes, the surgical instrument  1  can separate the living tissues from each other without impairing crucial living tissues. As illustrated in  FIG. 1(   c ), the separating sections  13 ,  13  have substantially elliptical outlines when the pair of working sections  3 ,  3  is closed, viewed from the tip side of the surgical instrument  1 . The outline may be a vertically-long ellipse or a horizontally-long ellipse. A total thickness d of a pair of tip sections  3 ,  3  is preferably from 1 to 5 mm in view of operability in separation. Also, although the outline of the separating sections  13 ,  13  of the present embodiment is substantially elliptical, the shape may be a circle, oval, a rounded square, or a rounded rectangle, or the like. The separating sections  13 ,  13  may have flat outer surfaces at opposite sides of the grasping surfaces  10 ,  10  where the pair of tip sections  8 ,  8  face each other. Furthermore, as illustrated in  FIG. 1(   d ), the separating sections  13 ,  13  have rounded outlines with no corners when viewed from the side of the surgical instrument  1 . The outlines of the separating sections  13 ,  13 , for example, make an arc having a curvature radius ranging from two fifths to three fifths of the total thickness d starting from the tip to the rear end, being connected smoothly to the cutting sections  9 ,  9  having linear outlines. 
         [0034]    The grasping surfaces  10 ,  10  are configured to be able to grasp an object by closing the pair of working sections  3 ,  3 . The grasping surfaces  10 ,  10 , as illustrated in  FIGS. 1(   a ) and ( c ), are configured such that the surfaces facing each other fittingly overlap when the pair of working sections  3 ,  3  is in a closed state. At this time, the grasping surfaces  10 ,  10  are orthogonal to the opening/closing direction of the working sections  3 ,  3 . The surgical instrument  1  can grasp or clamp an object such as a surgical instrument including a needle and suture and such as a living tissue after having the object disposed between the pair of grasping surfaces  10 ,  10 , and then having the pair of working sections  3 ,  3  closed. The grasping surfaces  10 ,  10  are only required to have areas capable of grasping the object. For example, if an outline of the grasping surface  10  viewed from above is substantially elliptical, an axial length in a longitudinal direction of the working section  3  and an axial length in a direction orthogonal to the above-mentioned axial length each are preferably from 1 to 5 mm. Note that the outline of the grasping surface  10  viewed from above is not limited to substantially elliptical; the shape may be a circle, oval, a rounded square, or a rounded rectangle, or the like. Furthermore, the surfaces of the grasping surfaces  10 ,  10  may have suitable degree of irregularities for easily grasping the object. 
         [0035]    The cutting sections  9 ,  9  are configured to be able to cut the object by sliding a pair of cutting edges against each other. The cutting sections  9 ,  9  are provided between the tip sections  8 ,  8  and the rotation shaft  5 , and includes the cutting edges  11 ,  11  on the sides facing each other on the pair of cutting sections  9 ,  9 . The surgical instrument  1  can cut an object such as a living tissue or suture, after having the object disposed between the pair of cutting sections  9 ,  9 , by closing the pair of working sections  3 ,  3  to slide the pair of cutting edges  11 ,  11  against each other. The cutting edges  11 ,  11  preferably have the lengths from 5 to 50 mm according to the site for which the surgical instrument  1  is used. 
         [0036]    The step sections  12 ,  12  are provided between the grasping surfaces  10 ,  10  and the cutting edges  11 ,  11 . The step sections  12 ,  12  are provided as a result of a difference in thickness, that is, the thickness compared in the opening/closing direction on the pair of working sections  3 ,  3  is larger at the cutting sections  9 ,  9  than at the tip sections  8 ,  8 . The step sections  12 ,  12  start from the end portion opposite to the tip side of the grasping surfaces  10 ,  10 , extending toward the cutting sections  9 ,  9  with inclination, to be connected to the cutting edges  11 ,  11 . The step sections  12 ,  12  have rounded shapes, i.e. R shapes, and have no blades. The step sections  12 ,  12  are not always necessary in the surgical instrument of the present invention. Having the step section  12 , however, is beneficial in that the step sections  12 ,  12  become walls when an object is grasped by the grasping surfaces  10 ,  10 , thereby preventing the object to be grasped by the grasping surfaces  10 ,  10  from being erroneously disposed and cut between the cutting edges  11 ,  11 . Also, the step sections  12 ,  12  have no blades, so that the object may not be cut at the step sections  12 ,  12 . Note that the step sections  12 ,  12  are only required to be boundaries that functionally divide the grasping surfaces  10 ,  10  from the cutting edges  11 ,  11 . Heights of the step sections  12 ,  12  in a direction orthogonal to the grasping surfaces  10 ,  10  are preferably 0.1 mm or more, and preferably 10 mm or less considering the relationship between the thickness of the tip sections  8 ,  8  and the thickness of the cutting sections  9 ,  9 . Furthermore, regarding the step sections  12 ,  12 , when defining an angle formed between the grasping surface  10  and the step section  12  as θ as illustrated in  FIG. 1(   d ), the angle θ is preferably from 80° to 150°. 
         [0037]    An exemplary method for using the surgical instrument of the present embodiment will be described in the following. 
         [0038]    As illustrated in  FIG. 1(   a ), the pair of working sections  3 ,  3  of the surgical instrument  1  is in closed states. When a practitioner passes his/her fingers through the ring sections  6 ,  6  and applies a force in a direction of separating the pair of operating sections  4 ,  4  from each other, the rod-like members  2 ,  2  pivot around the rotation shaft  5 . Then, the working sections  3 ,  3  separate from each other to open. 
         [0039]    In separating living tissues, the surgical instrument  1  is moved from a closed state to an open state, and simultaneously, is inserted between the living tissues to be separated, entering further, thereby separating the living tissues from each other. The separating sections  13 ,  13 , namely, the outer surfaces of the tip sections  8 ,  8 , have rounded shapes, making it possible, at this time, to separate the living tissues from each other without impairing crucial living tissues. 
         [0040]    Grasping an object such as a living tissue or a surgical instrument using the grasping surfaces  10 ,  10  can be performed by disposing the object between the grasping surfaces  10 ,  10 , and then applying a force in the direction of causing the operating sections  4 ,  4  to come closer to each other. The step sections  12 ,  12 , which include no blades, exist between the grasping surfaces  10 ,  10  and the cutting edges  11 ,  11 . In addition, a virtual plane containing the grasping surfaces  10 ,  10 , and the cutting edges  11 ,  11 , are not on the same plane. Therefore, it is possible to prevent the object from being erroneously disposed and cut between the cutting edges  11 ,  11 . 
         [0041]    Cutting an object such as a living tissue or suture or the like is possible by disposing the object between the cutting sections  9 ,  9 , and then, by applying a force in the direction of causing the operating sections  4 ,  4  to come closer to each other. This causes the cutting edges  11 ,  11  to slide against each other, making it possible to cut the object using the cutting edges  11 ,  11 . In addition, the surgical instrument  1  can be used for completely cutting the object or cutting part of the object with the cutting edges  11 ,  11 . 
         [0042]    A conventional surgery has required a dedicated surgical instrument for surgical operations including separating, grasping, and cutting, whereas using a surgical instrument  1  can perform the above-described three surgical operations, making it possible to decrease the types of surgical instruments used in a surgery. As a result, management of surgical instruments can be streamlined, burden on health-care professionals being decreased, making it possible to reduce a total cost. 
         [0043]    Also, conventionally, an instrument has been exchanged with a dedicated surgical instrument corresponding to each surgical operation, and a surgical instrument held by a practitioner has been frequently exchanged with another by the practitioner. A surgical instrument  1  can perform the three surgical operations alone, making it possible to decrease the number of times of exchanging surgical instruments by the practitioner, thereby reducing the time taken for a surgery. Reducing the time taken for a surgery not only decreases the burden on a patient by suppressing the amount of bleeding or the like, but also decreases a burden on all health-care professionals involving in the surgery. 
         [0044]    A surgical instrument of this invention is not limited to the embodiment described above. Various modifications are possible as long as they can achieve the object of the present invention. 
         [0045]    For example, in the surgical instrument  1 , fingers are inserted to the ring sections  6 ,  6  of the pair of operating sections  4 ,  4  to move the pair of operating sections  4 ,  4  to be positioned apart from each other and close to each other, thereby opening and closing the working sections  3 ,  3 . Alternatively, as illustrated in  FIG. 2 , operating sections  41 ,  41  need not always have the ring sections for inserting the fingers. The operating sections  41 ,  41  may be configured to be plates curving outwardly and function as springs, whereby a force applied from the outside to the inside closes the working sections  3 ,  3 . 
         [0046]    In the above-described embodiment, the surgical instrument  1  has been described when operated by inserting fingers of the practitioner in the ring sections  6 ,  6  of the operating sections  4 ,  4 . Alternatively, as illustrated in  FIG. 3 , the surgical instrument of the present invention may also be used as a manipulator  101  that is attached to a medical robot system  120 . 
         [0047]    The configuration of the medical robot system  120  is not particularly limited as long as the system enables surgical operations with the surgical instrument of the present invention attached thereto. The medical robot system  120  includes, for example, as illustrated in  FIG. 3 , a station  114  provided on a floor of a surgery room, a surgical robot  115  provided on the station  114 , a movable bed  116  extending from a side of the station  114 , and a control apparatus  117  that controls these components. The surgical robot  115  has three arms  118  each having a plurality of joints. To a tip of each arm, the manipulator  101 , namely, the surgical instrument of the present invention, is detachably attached. The arms  118  and the manipulators  101 , being controlled by the control apparatus  117 , individually operate using built-in motor drive. 
         [0048]    In the manipulator  101 , a mechanism for opening and closing a pair of working sections  103  is not particularly limited. As illustrated in  FIG. 4 , the manipulator  101  is configured, for example, to have the pair of working sections  103 ,  103  openably/closably coupled to each other on a pulley  105  that is a pivot shaft. To this pulley  105 , a drive wire  119  is fixed, the pair of working sections  103 ,  103  being opened and closed by movements of the drive wire  119  in forward and backward directions. The pair of working sections  103 ,  103  each has a cutting section  109 , a grasping surface  110 , and a separating section  113 , similarly to the above-described surgical instrument  1 . 
         [0049]    In a medical robot system using a plurality of types of surgical instruments as manipulators in a surgery, for example, when the number of types of surgical instruments being used is more than the number of existing arms, a manipulator needs to be exchanged with another type of manipulator during the surgery. The surgical instrument of the present invention, when used as a manipulator, can perform three surgical operations of separation, grasping, and cutting by one manipulator alone. As a result, it is possible to decrease the number of manipulators being used and decrease the number of times of exchanging the manipulators during the surgery. Accordingly, using the surgical instrument of the present invention as a manipulator can reduce the time taken for a surgery performed by the medical robot system and can suppress operation errors or the like in health-care professionals, thereby decreasing a burden on a patient and health-care professionals. 
         [0050]    Furthermore, as illustrated in  FIG. 5 , the surgical instrument of the present invention can be used as an endoscopic surgical instrument  201 . As long as the endoscopic surgical instrument  201  includes, at a tip thereof, similarly to the surgical instrument  1  of the above-described embodiment, a pair of working sections  203 ,  203  including: a cutting section  209 ; a grasping surface  210 ; and a separating section  213 , the configuration of other than the above is not particularly limited. As illustrated in  FIG. 5 , for example, the endoscopic surgical instrument  201  includes, in the order from a tip side, the working section  203 , a guide pipe section  214 , and an operating section  204 . To the guide pipe section  214 , a drive shaft  215  is inserted, and a proximal end of the guide pipe section  214  is coupled to an opening/closing handle  206  of the operating section  204 . The pair of working sections  203 ,  203  that is coupled to the drive shaft  215  is provided at the tip side of the guide pipe section  214 . The pair of working sections  203  is opened and closed by pivoting the opening/closing handle  206 . 
         [0051]    A mechanism for opening and closing the pair of working sections  203  in the endoscopic surgical instrument  201  is not particularly limited. As illustrated in  FIGS. 6(   a ) and  6 ( b ), for example, the pair of working sections  203 ,  203  is openably/closably and pivotally supported by a hinge pin  205  that is the pivot shaft, and by pins  216  and  217 . Between the hinge pin  205  and the drive shaft  215 , a pair of opening/closing links  218  and  219  is disposed, each link being pivotally supported by the pins  216  and  217  at the tip of the drive shaft  215 . The other end of the pair of opening/closing links is pivotally supported by pins  220  and  221  at the proximal end of the pair of working sections  203 ,  203 . Pivoting the opening/closing handle  206  that is coupled to the proximal end of the drive shaft  215  can move the drive shaft  215  in a shaft direction, thereby opening and closing the pair of working sections  203 ,  203 . 
         [0052]    An endoscopic surgery is performed by incising an abdominal wall or the like to make a plurality of holes, and a trocar is inserted to the hole. A surgery is performed by inserting a surgical instrument such as an endoscope and forceps through the trocar. Since the number of holes made at incision is minimized to decrease a burden on a patient, a plurality of types of surgical instruments for use is inserted to one hole. The surgical instrument of the present invention, when used as an endoscopic surgical instrument, can perform three surgical operations of separation, grasping, and cutting by one endoscopic surgical instrument. As a result, it is possible to decrease the number of surgical instruments being used and decrease the number of times of exchanging the surgical instruments during the surgery. As a result, using the surgical instrument of the present invention as an endoscopic surgical instrument can reduce the time needed for an exchange of the surgical instruments, thereby reducing the time taken for a surgery. Furthermore, decreasing complicated exchange operations can suppress errors in health-care professionals, thereby decreasing a burden on a patent and the health-care professionals. 
         [0053]    The surgical instrument of the present invention is used in a surgery, for example, for separating living tissues from each other, grasping and pulling the living tissue, grasping surgical instruments such as a needle and suture, and cutting the living tissue and suture or the like. The surgical instrument of the present invention alone can perform surgical operations including separation, grasping, and cutting. Therefore, the surgical instrument can be used in place of a plurality of dedicated medical devices for individual surgical operations. Therefore, the surgical instrument of the present invention is used in a surgery that includes at least one of the surgical operations of separation, grasping, and cutting. 
       REFERENCE SIGNS LIST 
       [0000]    
       
           1  surgical instrument 
           2  rod-like member 
           3  working section 
           4  operating section 
           5  pivot shaft 
           6  ring section 
           7  handle section 
           8  tip section 
           9  cutting section 
           10  grasping surface 
           11  cutting edge 
           12  step section 
           13  separating section 
           101  manipulator 
           120  medical robot system 
           201  endoscopic surgical instrument