JP2000060862A - Pallial tube for insertion of thoracoscope with cuff - Google Patents

Abstract

PROBLEM TO BE SOLVED: To prevent the bleeding from the circumference of an insertion part by forming two shrinkable cuffs as internal cuffs and external cuffs, respectively hermetically providing a pallial tube with these cuffs in its circumferential direction and specifying the length of the internal cuff from the end of a thoracoscope inspection port side to an internal side aperture and the expansion capacity of the external cuff. SOLUTION: The pallial tube for thoracoscope insertion with the cuffs for insertion of the thoracoscope into an incised port in thoracoscopic surgery comprises a conduit 1 extending from the external side to the internal side, the external cuff 2 and the internal cuff 3. Ribs are formed along an axial direction in the thoracoscope insertion cavity 6 in the conduit 1. The external cuff 2 and the internal cuff 3 are expandable and shrinkable. The diameter of the largest part of the cuffs 2 and 3 at the time of their dilation attains 8 to 50 mm in diameter and the diameter of the largest part thereof is preferably approximately the same as the outside diameter of the conduit 1 at the time of shrinkage. The length from the end on the thoracoscope insertion port side of the internal cuff 3 to the aperture on the internal side is set at <=30 mm and the dilation capacity of the external cuff 2 at a range of 3 to 10 times the dilation capacity of the internal cuff 3.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a cuffed thoracoscopic insertion mantle tube for insertion into an incision and insertion of a thoracoscope mainly in thoracoscopic surgery.

[0002]

2. Description of the Related Art In recent years, thoracoscopic surgery has been rapidly expanding, and its indication is expanding. Initially, this started with a relatively easy operation such as thoracoscopic pneumothorax surgery, but due to the improvement of the operator's technique and the improvement of instruments, it could only be done by conventional open chest surgery such as surgery for lung tumor and lung cancer. Such surgery is being performed under thoracoscopic procedures.

It is considered that this is because the thoracoscopic surgery does not make an incision, so that the time required for the patient to have a surgical retreat is short and the patient's needs are excellent in cosmetics. On the other hand, attempts have been made to reduce the number of outer tubes to be inserted or to reduce the outer diameter of the outer tube as much as possible due to cosmetic problems. On the other hand, this deteriorates operability,
As a result, it is not progressing so much because it leads to stress and erroneous operation of the operator.

If it is a thoracoscopic pneumothorax operation, the number of mantle tubes to be used is about 1 to 2, and since the time is short, the intercostal nerves are not damaged, but more advanced cases such as lung cancer. When performing surgery, many mantle tubes are used,
In addition, it takes a long time to damage the intercostal nerve, resulting in a long postoperative pain of the patient. For this reason, as a surgical method, it is becoming common to insert an operating forceps from the front chest direction and insert a thoracoscope from the rear chest direction.

According to this operation method, since the number of forceps to be inserted from the precordial direction is small, the intercostal nerve is less likely to be injured, and the postoperative pain of the patient is less likely to occur. On the other hand, since the thoracoscope is inserted from the posterior chest direction, there is a drawback that it passes through two layers of muscle layers and is more likely to bleed than the insertion portion although it is a small amount.

Therefore, in order to prevent such bleeding,
For example, a medical wearing balloon catheter disclosed in Japanese Patent Application No. 3-106410, a trocar with a balloon for treatment after laparoscopic cholecystectomy disclosed in Japanese Patent Application Laid-Open No. 5-161657, and Japanese Patent Application No. 10- The outer tube for inserting a medical laparoscope with a cuff disclosed in No. 032948 was diverted. Since this was originally developed to prevent leakage of pneumoperitoneum, it was not suitable for use in thoracoscopic surgery. The reason for this is that the balloon inserted into the chest cavity becomes an obstacle and the space that can be tightened in the chest cavity is large.

On the other hand, as a trocar exclusively for thoracoscopic surgery, a thoracoscopic insertion assisting tool shown in Utility Model Registration No. 3024069 is also disclosed. This was intended to prevent bleeding around the insert on the chest wall. In the assisting device according to the present invention, the chest wall is sandwiched by the balloon and the stopper to prevent bleeding. In this case, the constituent members had antithrombogenicity and bleeding was well suppressed.
On the other hand, however, since the material is silicone rubber, the pressure resistance is insufficient and it is relatively easy to rupture, and it is unavoidable that the thoracic cavity is damaged when it ruptures. Further, since a material having antithrombogenicity is used, it tends to be relatively expensive.

[0008]

The present invention has been made as a result of various studies in order to improve the performance of a mantle tube used in conventional thoracoscopic surgery, and prevents bleeding around the insertion portion. In addition to providing a sufficient field of view in a narrow thoracic cavity, a sufficient pressure resistance, a low risk of damage to the thoracic cavity, and a relatively inexpensive cuffed thoracic endoscope insertion tube. .

[0009]

[Means for Solving the Problems] That is, the present invention is a tubular outer tube having at least one inner cavity, wherein two cuffs which can be contracted along the length direction include a body inner cuff and a body outer cuff. The cuffs are airtightly provided in the circumferential direction of the outer tube, and the length of the inner cuff of the outer tube from the end on the side of the thoracoscope insertion opening to the opening on the inner side of the body is 30 mm or less, and the outer side of the body. The inflation capacity of the cuff is 3 to the inflation capacity of the inner cuff.
It is 10 times and is a mantle tube for inserting a thoracoscope with a cuff, characterized in that a rib for improving slippage is provided inside the mantle tube.

[0010]

DETAILED DESCRIPTION OF THE INVENTION The present invention will be described in detail below with reference to the drawings. FIG. 1 (a) is a schematic view showing an embodiment of an outer tube for inserting a cuffed thoracoscope according to the present invention, and FIG. 1 (b) is a sectional view thereof. FIG. 2 (a) shows an example of puncturing the chest wall, and FIG. 2 (b) shows an example of using a conventional cuffed medical laparoscopic insertion mantle tube for puncturing the chest wall. FIG. 3 is a schematic view showing an embodiment for performing surgery. FIG. 4 is a schematic view showing an embodiment of a rib standing inside the thoracoscope insertion cavity.

The mantle tube for inserting a thoracoscope with a cuff according to the present invention mainly comprises a conduit (1) extending from the outside of the body to the inside of the body, an outside cuff (2) and an inside cuff (3). The conduit (1) has a symmetric shape such as a circular shape, an elliptical shape, a regular hexagonal shape, a regular octagonal shape, etc., and is preferably circular or elliptical in terms of moldability and insertability.

The rib (5) may be erected along the axial direction of the thoracoscopic cavity (6). (Figure 4) This is a rib (5)
By erecting, the contact area between the thoracoscope (14) and the thoracoscope insertion cavity (6) is reduced, and the sliding of the thoracoscope (14) is improved. As a result, the thoracoscope insertion cavity (6) is crushed, and the lumen is narrowed, so that the thoracoscope (1)
4) Ensures good slipperiness even when it comes into close contact with 4). The ribs (5) have an acute angle in order to reduce the contact area, and the height is 0.5 to 3 mm, which is provided at a plurality of locations, but preferably 3 to 5 locations. Rib (5) height is 0.5m
If it is smaller than m, the thoracoscope (14) and the thoracoscope insertion cavity (6) are likely to come into contact with each other on the entire surface, and there is almost no effect. This is not preferable because the outer diameter of (4) becomes small. When the number of ribs (5) is 2 or less, the thoracoscope (4) cannot be held, and when the number of ribs (5) is 6 or more, the contact area with the thoracoscope (14) becomes large and the usefulness of the ribs is lost.

The conduit (1) is made of natural rubber, silicone rubber,
It is made of a flexible material such as vinyl chloride resin or polyurethane resin or a hard material such as aluminum, stainless steel, titanium, or carbon. Considering the inner diameter of the thoracoscopic insertion cavity (6), the outer diameter of the conduit (1) is 3 to 15
mm is preferred. This is because there is no thoracoscope that can be inserted below 3 mm, and above 15 mm, the patient is greatly invaded and usefulness is lost. The total length is preferably 30 to 150 mm. This is because if the total length is shorter than 30 mm, the obese person may be buried in the chest wall and cannot be used.
Above m, it may be too long and the thoracoscopic field of view may deteriorate. The inner diameter of the thoracoscopic insertion cavity (6) is 2 to 14 mm.
This is because there is substantially no thoracoscope to be inserted when the inner diameter is less than 2 mm, and the thickness of the conduit (1) becomes thin when the inner diameter is more than 14 mm, so that the required strength cannot be maintained.

The cuffs (2) and (3) can be inflated and deflated by injecting gas or liquid through the pilot balloon (8) for inflation of the cuff outside the body and the pilot balloon (9) for inflation of the cuff inside the body. When the outer cuff (2) and the inner cuff (3) are inflated, the maximum diameter is φ8 to φ50 mm, and when the outer cuff (2) is contracted, the maximum diameter is almost the same as the outer diameter of the conduit (1). Is preferred. This is because when the diameter is less than 8 mm, the expanded diameter is small, so that a sufficient hemostasis effect cannot be obtained, and when the diameter is more than 50 mm, it is too large, which may hinder the use.

As the material for the cuffs (2) and (3), those having flexibility such as soft vinyl chloride resin, polyethylene terephthalate resin, polyurethane resin are preferable. The cuffs (2) and (3) are molded so as to have a desired expansion diameter. As a result, it is possible to expand to a relatively large expansion diameter at low pressure. The wall thickness of the cuffs (2) and (3) is preferably 0.01 mm to 3 mm in terms of expansion characteristics and internal pressure during expansion. This is because if it is less than 0.01 mm, it is too thin and may burst at the time of expansion, and if it is more than 3 mm, it is thick when contracting and becomes an obstacle.

The axial width of the expanded portion of the outer cuff (2) is preferably 5 to 50 mm, and the axial width of the inner cuff (3) is preferably 5 to 15 mm. This is because the inner cuff (3) having the smallest size does not get in the way in the chest cavity. The distance between the inner cuff (3) and the outer cuff (2) is preferably 5 to 50 mm. In addition, from the thoracoscope insertion port side end of the inner cuff (3) to the inner opening (8)
Is less than 30 mm. This is to shorten the length of entry into the chest cavity as much as possible and to obtain a sufficient field of view (13) in the chest cavity. (FIG. 2 (a)) Since the conventional mantle tube had such a long length, a sufficient field of view (13) was not obtained. (Fig. 2 (b))

The preformed expansion diameter of the outer cuff (2) is preferably 1 to 5 times the axial width of the outer cuff (2), and the preformed expansion diameter of the inner cuff (3) is It is preferably 2 to 8 times the axial width of the body cuff (3). This is because if the preformed inflation diameter of the outer cuff (2) is less than 1 time the axial width, it becomes difficult to fix it on the chest wall, and if it is more than 5 times, it may be substantially preformed. This is because it becomes difficult and it becomes an obstacle on the chest wall. If the preformed inflation diameter of the inner cuff (2) is smaller than twice the axial width, it will be difficult to fix it on the chest wall, and if it is larger than 8 times, the size occupied in the chest cavity will be large. This is because it becomes an obstacle. Cuff (2)
The internal pressure of (3) is 2.8 to 75 psi, and a large expansion diameter can be obtained at a relatively low pressure.

Since the inner cuff (3) and the outer cuff (2) have a space, the chest wall (12) is sandwiched between them and both cuffs (2) and (3) are inflated to puncture the site (11). To prevent bleeding from. Before use cuff (2)
(3) is contracted, its outer diameter is almost the same as the outer diameter of the conduit (1), and the puncture site (11) cut slightly larger than the diameter of the conduit (1) on the chest wall is according to the present invention. A mantle tube for inserting a cuffed thoracoscope is introduced into the chest cavity. When only the inside-body cuff (3) is completely introduced into the chest cavity, gas or fluid is first injected from the inside-body cuff inflation pilot balloon (10) to inflate the inside-body cuff (3). This serves as an anchor and prevents the conduit (1) from slipping out of the chest wall (12). Then, a gas or fluid is injected from the pilot balloon (9) for inflation of the external cuff, and the external cuff (2) is also inflated. This gives two cuffs (2)
(3) is in close contact with the chest wall (12) to prevent bleeding into the chest cavity from the puncture site (11).

The gas to be injected into the cuffs (2) and (3) is preferably an inert gas such as air, carbon dioxide or nitrogen.
This is to prevent an accident such as an explosion if gas leaks from the cuffs (2) and (3). The liquid may be sterilized distilled water or physiological saline, but sterilized distilled water is preferable. This is because there is no risk of contamination or infection if it leaks from the cuffs (2) and (3), and there is no dissolved substance even after long-term storage, so there is no risk of sticking. It is easier to inject air, but on the other hand, injecting sterile distilled water is heavier and may be preferable in terms of stability. Which is selected depends on the operator's request.

Next, a method of actually performing an operation using the cuffed thoracoscopic insertion mantle tube according to the present invention will be described with reference to FIGS. 2 and 3.
To clarify the effect of the present invention. First, insert a scalpel between the patient's ribs and make a small incision. A small incision is made and the mantle tube for inserting a thoracoscope with a cuff according to the present invention is inserted from the puncture site (11) to inflate the cuff (3) inside the body. Subsequently, the outer cuff (2) is inflated while pulling the conduit (1) toward you. This fixes the conduit (1).

Subsequently, the thoracoscope (14) is inserted into the thoracoscope insertion cavity (6) through the thoracoscope insertion opening (7) of the conduit (1).
Then, make small incisions at appropriate 1 to 3 positions between the ribs,
From these small openings, forceps (15), suction beak tube, electric knife, ultrasonic knife, laser knife, etc. are introduced into the chest cavity,
Take necessary action. (Fig. 3) At this time, puncture site (11)
Are often intercostal, and the lumen is often narrowed due to the pressure of the conduit (1) by muscles and ribs. However, even in such a case, the ribs (5) are upright, so that the movement of the thoracoscope (14) is smooth.

Here, as shown in FIGS. 2 (a) and 2 (b), the maximum height in the chest cavity is about 100 mm,
When the length from the thoracoscope insertion port side end of the body inner cuff (3) to the body inner opening (8) is 50 mm, for example, when the thoracoscopic viewing angle is 60 degrees, the field of view ( 13)
Becomes a circle with a diameter of 58 mm, a sufficient visual field cannot be obtained, and the tumor may be overlooked. (FIG. 2 (b)) On the other hand, in the case of the mantle tube for inserting a thoracoscope with a cuff according to the present invention shown in FIG. 2 (a), since 1 is 30 mm, the field of view (13) becomes a circle with a diameter of 80 mm, and a sufficient field of view Is obtained. Further, since bleeding from the puncture site (11) is also prevented, the distal end of the thoracoscope (14) is less likely to get dirty and stress on the operator is reduced. At the time of removal, it can be easily removed by deflating the cuff (3) inside the body.

[0024]

EFFECTS OF THE INVENTION According to the present invention, not only bleeding around the insertion portion of the mantle tube used in thoracoscopic surgery is prevented, but also a sufficient field of view is obtained in a narrow thoracic cavity and pressure resistance is sufficient. Therefore, it is possible to provide a relatively low-cost mantle tube for insertion of a thoracoscope with a cuff, with a low risk of damaging the inside of the chest cavity.

[Brief description of drawings]

FIG. 1 is a schematic view showing an embodiment of an outer tube for inserting a cuffed thoracoscope according to the present invention.

FIG. 2 is a schematic view showing an example of mounting the outer tube for inserting a cuffed thoracoscope according to the present invention to a chest wall.

FIG. 3 is a schematic view showing an embodiment in which an operation is performed by using the mantle tube for inserting a cuffed thoracoscope according to the present invention.

FIG. 4 is a schematic view showing an embodiment of a rib standing inside a thoracoscope insertion cavity.

[Explanation of symbols]

1. conduit 2. External cuff 3. Inner cuff 5. rib 6. Thoracoscopic insertion cavity 7. Thoracoscope insertion port 8. Internal opening 9. Pilot balloon for inflation of external cuff 10. Pilot balloon for inflating cuff 11. Puncture site 12. Battlements 13. Field of view 14. Thoracoscope 15. forceps

Claims (2)

[Claims] 1. A tubular mantle tube having at least one lumen, wherein two cuffs that can be contracted along the length direction are the inner and outer body cuffs, respectively, in the circumferential direction of the mantle tube. The length of the inner tube of the outer tube from the end on the side of the thoracoscope insertion opening to the inner opening of the outer tube is 30 mm or less, and the expansion capacity of the outer cuff is larger than that of the inner cuff. A sheath tube for insertion of a thoracoscope with a cuff, which has an expansion capacity of 3 to 10 times. 2. The mantle tube for inserting a thoracoscope with a cuff according to claim 1, wherein a rib for improving slippage is provided inside the mantle tube.