JP2006087609A - Biological tissue acquisition apparatus - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To prevent pressure in a celom from being raised higher than a prescribed pressure in a biological tissue. <P>SOLUTION: The subject biological tissue acquisition apparatus comprises a grip part 33 and an insertion part 32 to be inserted into the celom. Moreover, the biological tissue acquisition apparatus has: an air sending tube 34 for sending a prescribed gas into the insertion part 32 for releasing the prescribed gas through an opening part 35a formed at the insertion part 32; and a gap 38f for releasing the prescribed gas supplied into the celom. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to a biological tissue collection device for collecting biological tissue such as subcutaneous blood vessels.

In bypass surgery for cardiac blood vessels, subcutaneous blood vessels such as the great saphenous vein may be used as bypass blood vessels. Conventionally, surgery has been performed to cut the skin of the lower limbs and remove the subcutaneous blood vessels so that all the blood vessels can be seen from the groin to the ankle of the lower limbs. An operation for pulling a subcutaneous blood vessel such as a blood vessel is performed. In such an endoscopic operation, for example, there is an instrument disclosed in Patent Document 1 as a surgical instrument used.
US Pat. No. 5,895,353

  When such a surgical instrument is used to collect a subcutaneous blood vessel such as the great saphenous vein endoscopically, gas may be sent into the body cavity to secure space. Similarly, it is not preferable that the gas pressure in the body cavity becomes too high.

  The present invention has been made in view of the above points, and an object of the present invention is to provide a biological tissue collection device that prevents the pressure in a body cavity from rising above a predetermined pressure even in a device for collecting biological tissue. To do.

  The biological tissue collection device of the present invention is a biological tissue collection device having a grip portion and an insertion portion that is connected to the grip portion and inserted into a body cavity, and is provided from an opening provided in the insertion portion. In order to release the gas, there are provided air supply means for supplying the predetermined gas into the insertion portion, and pressure reducing means for releasing the predetermined gas supplied into the body cavity.

  According to the biological tissue collection device of the present invention, the pressure in the body cavity can be prevented from rising more than a predetermined pressure.

(First embodiment)
Hereinafter, embodiments of the present invention will be described with reference to the drawings. First, a system for surgery for pulling and collecting a subcutaneous blood vessel as a living tissue will be described.
FIG. 1 is a configuration diagram showing a configuration of a surgical system including devices, instruments and the like used in the above-described surgery. The surgical system 101 includes a trocar 21, a dissector 31, a harvester 41, and a rigid endoscope 51 that is an endoscope. The dissector 31 and the harvester 41 are biological tissue collection devices. The surgical system 101 further includes a television monitor 102 as a display device, a camera control unit (hereinafter referred to as CCU) 103, a television camera device 104, a light source device 105, a light guide cable 106, and an electric knife device 107. And an air supply device 108.

  One end of a light guide cable 106 is connected to the light guide connector portion 52 of the rigid endoscope 51. The other end of the ride guide cable 106 is connected to the light source device 105. Light from the light source device 105 is supplied to the rigid mirror 51 via a light guide cable 106 through which a light guide of an optical fiber is inserted, and the subject is illuminated from the distal end portion of the rigid mirror 51. A television camera head unit of the television camera device 104 is connected to the eyepiece 53 on the proximal end side of the rigid endoscope 51. The television camera device 104 is connected to the CCU 103, and an image of the subject obtained by the rigid endoscope 51 is displayed on the screen of the connected television monitor 102.

  The distal end insertion portion 54 of the rigid endoscope 51 can be inserted into the rigid endoscope insertion channel 36 of the disector 31 from the proximal end side of the disector 31 as a biological tissue collection device. Similarly, the distal end insertion portion 54 of the rigid endoscope 51 can be inserted into the rigid endoscope insertion channel 46 of the harvester 41 from the proximal end side of the harvester 41 as a biological tissue collection device. The rigid endoscope insertion channels 36 and 46 constitute an endoscope insertion means for inserting the rigid endoscope 51 into the insertion portion of the dissector 31 and the insertion portion of the harvester 41, respectively.

  The air supply tube 34 of the dissector 31 is connected to the air supply device 108, receives supply of a predetermined gas, for example, carbon dioxide gas from the air supply device 108, and receives an opening 35a (FIG. 1) as an air supply outlet of the insertion portion. (Not shown).

  The air supply tube 44 of the harvester 41 is also connected to the air supply device 108, is supplied with a predetermined gas, for example, carbon dioxide gas, from the air supply device 108, and is an opening that is an air supply outlet of the insertion portion (see FIG. 1). (Not shown). The air supply tubes 34 and 44 constitute air supply means for supplying carbon dioxide gas inside the insertion portion of the dissector 31 and the insertion portion of the harvester 41, respectively.

  The harvester 41 has an electrical cable 47 for the bipolar cutter 43 (not shown in FIG. 1), and is connected to the electrical female device 107 by a connector provided at the proximal end of the electrical cable 47. The

  Using the operation system 101 having such a configuration, the operator can perform an operation of pulling and collecting a subcutaneous blood vessel as a biological tissue to be collected. First, the dissector 31 is used to exfoliate the tissue around the large saphenous vein (hereinafter simply referred to as a blood vessel) from the thigh of the lower limb to the ankle, and then the harvester 41 is used to Cut the side branch. After such a treatment is performed, the end of the blood vessel is treated and the blood vessel is removed. As described above, the biological tissue is collected under the endoscope.

  FIG. 2 is a perspective view of the trocar 21. FIG. 3 is a longitudinal sectional view of the trocar 21. The trocar 21 includes a guide tube portion 22 that is a guide sheath, a seal member 23, and a fixing portion 24 for fixing to the skin. The guide tube portion 22 has a cylindrical hollow portion 25 through which the insertion portions 32 and 42 of the dissector 31 and the harvester 41 are inserted. The distal end side of the guide tube portion 22 has a shape cut at a predetermined angle, for example, an angle of 45 degrees with respect to a direction orthogonal to the axial direction of the guide tube portion 22. The proximal end side of the guide tube portion 22 has a shape cut in a direction orthogonal to the axial direction of the guide tube portion 22, and a seal member 23 is provided on the proximal end side. The seal member 23 is made of an elastic member and has a hole 26 having an inner diameter smaller than the inner diameter of the guide tube portion 22. On the inner peripheral surface of the hole 26, a convex portion 27 is provided on the distal end side so that the inner diameter on the distal end side is smaller than the inner diameter on the proximal end side. With the hole 26 having such a shape, the dissector 31 or the insertion portions 32 and 42 of the harvester 41 inserted into the guide tube portion 22 can be made airtight under the skin.

  A clip member 29 using an elastic force of a torsion spring 28 that is an elastic member is provided on the outer periphery of the guide tube portion 22 of the trocar 21. The clip member 29 has a plate shape that is bent into a letter shape consisting of a distal end portion 29a and a proximal end portion 29b. A torsion spring 28 is provided substantially in the middle of the plate shape bent in a U-shape.

  The tip end portion 29 a of the clip member 29 is always pressed against the outer peripheral surface of the guide tube portion 22 by the torsion spring 28. By pushing down the proximal end portion 29 b of the clip member 29 so as to oppose the pressing force of the torsion spring 28, the distal end portion 29 a can be separated from the outer peripheral surface of the guide tube portion 22. Therefore, as shown in FIG. 4, while pushing down the base end portion 29 b of the clip member 29 toward the outer peripheral surface side of the guide tube portion 22, the clip member 29 is interposed between the distal end portion 29 a and the outer peripheral surface of the guide tube portion 22. The skin of the lower limbs 12 can be pinched. FIG. 4 is a cross-sectional view showing a state where the dissector 31 is inserted through the trocar 21 in the direction of the groin 13 from the skin cut 16 into the lower limb 12.

  On the outer peripheral surface of the guide tube portion 22, a plurality of annular round convex portions 22a are provided. The convex portion 22 a may be provided by being molded integrally with the guide tube portion 22, or may be provided by a separate member from the guide tube portion 22. On the other hand, a locking portion 29 c is formed on the outer peripheral surface side of the guide tube portion 22 of the distal end portion 29 a of the clip member 29. Therefore, as shown in FIG. 4, in a state where the skin of the lower limb 12 is sandwiched between the distal end portion 29 a of the clip member 29 and the outer peripheral surface of the guide tube portion 22 by the pressing force of the torsion spring 28, The skin of the lower limb 12 and the like are firmly clamped by the locking portion 29 c of the clip member 29 and the outer peripheral surface of the guide tube portion 22. Accordingly, the locking portion 29c of the guide tube portion 22 and the locking portion 22a of the guide tube portion 22 constitute a fixing portion 24 having a so-called slip prevention mechanism.

  Next, the configuration of the disector 31 will be described with reference to FIGS. FIG. 5 is a side view of a die sector 31 as a peeling device. The dissector 31 is mainly composed of an insertion part 32 and a grip part 33 connected to the insertion part 32. A peeling member 37 is provided at the tip of the metal insertion portion 32 of the die sector 31. The peeling member 37 is made of a material such as a transparent synthetic resin and has a cylindrical shape on the proximal end side and a conical shape on the distal end side. Since the peeling member 37 is a transparent member, an image of a subject illuminated by illumination light from the distal end portion of the rigid endoscope 51 inserted into the rigid endoscope insertion channel 36 is inserted by the rigid endoscope 51 when inserted under the skin. Can get.

  FIG. 6 is a partial cross-sectional view of the die sector 31. 7 to 9 are cross-sectional views taken along lines AA, BB, and CC in FIG. 6, respectively. A metal tube member 36 a forming the rigid endoscope insertion channel 36 is inserted into the inside of the die sector 31 from the proximal end side of the grip portion 33 to the distal end portion of the insertion portion 32 along the axial direction of the die sector 31. A substantially cylindrical first connecting member 38 is provided on the distal end side of the grip portion 33. Specifically, the grip portion 33 is a hollow cylindrical exterior member, and the outer peripheral surface of the first connecting member 38 is connected to the inner peripheral surface of the exterior member on the distal end side of the grip portion 33 via the sheath 39. Closely fitted.

  An air supply tube 34 is connected to an end face 38 b on the proximal end side of the first connecting member 38. The first connecting member 38 is formed with a hole 38 c that communicates the inner space of the air supply tube 34 and the inner space of the metal sheath 39. The hole 38 c is a communication path between the inner space of the air supply tube 34 and the inner space of the metal sheath 39. An opening 38d of a hole 38c is provided on the tip side surface of the first connecting member 38. In other words, the air supply tube 34 is fitted into the holding portion 33 at one end of the hole 38c, and the other end of the hole 38c is inside the metal sheath 39 and outside the tube member 36a. It is open inside. An air supply connector 34 a is provided at the proximal end of the air supply tube 34, and the air supply connector 34 a is connected to a connector of a tube connected to the air supply device 108. Therefore, the air supply device 108 can send a predetermined gas into the sheath 39 through the air supply tube 34 and the hole 38c of the first connecting member 38.

  Further, the peeling member 37 and the sheath 39 of the insertion portion 32 are connected by a second connecting member 58a. The peeling member 37 is fitted on the distal end side of the second connecting member 58a, and the sheath 39 is fitted on the proximal end side of the second connecting member 58a, so that the inside of the peeling member 37 and the sheath 39 is airtight. It is combined to become.

  On the proximal end side of the second connecting member 58a, three hook-shaped portions 58b projecting toward the proximal end side are formed. The tip of the hook-shaped portion 58 b has a convex portion 58 c that goes in the direction radiating from the central axis in a plane orthogonal to the axial direction of the insertion portion 32. A hole 35 is formed in the sheath 39 at a position corresponding to each of the tip portions of the three hook-shaped portions 58b, and the convex portion 58c is locked to the hole 35 so that the sheath 39 of the insertion portion 32 is engaged. The shape of the hole is formed. Then, by setting the dimensions of each convex portion 58c and each hole 35 so that a gap is formed between the hole 35 and the convex portion 58c in a state where the convex portion 58c is engaged with the hole 35, an opening is formed. Three portions 35a are formed. Here, the outer diameter of the base end side of the second connecting member 58 a is larger than the outer diameter of the sheath 39.

  Therefore, the carbon dioxide gas supplied from the air supply tube 34 passes through the hole 38c of the first connecting member 38, and the sheath 39, the pipe member 36a, the first connecting member 38, and the second connecting member 58a. Are introduced into a sealed space 39a formed by the The introduced gas is discharged from the sealed space 39a to the outside of the insertion portion 32 through the opening 35a.

  FIG. 10 is a partial perspective view seen from the base end side of the dissector 31. As shown in FIG. 10, in order to easily and reliably fix the rigid mirror 51 to the base end portion of the die sector 31, a guide groove 33 b is formed on the inner peripheral surface of the base end portion 33 a of the die sector 31. It is provided along the axial direction. Further, a fixing member 33c is fixed to the guide groove 33b with a screw. The fixing member 33c is formed by bending a metal plate-like member into a U-shape, and both arms of the U-shape are bent so as to have convex portions toward the inside of the U-shape. On the other hand, a convex portion 52 a (see FIG. 5) is provided on the distal end side of the eyepiece 53 of the rigid endoscope 51.

  Further, the base end portion 33a is provided with a notch portion 33d so that the light guide connector portion 52 can move along the notch portion 33d.

  When the rigid mirror 51 is inserted from the base end portion of the die sector 31, the convex portion 52a is along the guide groove 33b provided on the inner peripheral surface of the base end portion 33a, and the light guide connector portion 52 is the notched portion 33d. The rigid endoscope 51 is inserted into the proximal end portion of the dissector 31 so as to enter along the line. When the rigid mirror 51 is inserted from the base end portion of the die sector 31, the convex portion 52a moves along the inside of the guide groove 33b, and the convex portion of the metal fixing member 33c resists the elastic force of the fixing member 33c. Over the shape. At this time, the light guide connector part 52 also moves along the notch part 33d provided in the base end part 33a.

  Accordingly, when the rigid mirror 51 is inserted from the base end portion of the dissector 31, the light guide connector 52 is inserted into the notch 33d, and the convex 52a is inserted into the guide groove 33b. After setting the positional relationship of the mirror 51, the rigid mirror 51 is inserted into the dissector 31. When the rigid mirror 51 is inserted into the die sector 31, the convex portion 52a of the rigid mirror 51 is engaged and fixed so as to be sandwiched by the fixing member 33c in the middle, and easily by the elastic force of the fixing member 33c. It will not fall out.

  In addition, since a “click” sound is generated between the engaged rigid endoscope 51 and the dissector 31 when being engaged and fixed, the user must confirm that it has been set by sound. Can do.

  Next, the positional relationship between the first connecting member 38 and the metal tube member 36 a forming the rigid endoscope insertion channel 36 in the grip portion 33 will be described in detail. FIG. 11 is a partial cross-sectional view of the distal end portion of the grip portion 33 along the insertion axis. The distal end side of the tube member 36 a is fixed to the second connecting member 58 a, and the proximal end side of the tube member 36 a is fixed to a proximal end portion of the grip portion 33. As shown in FIGS. 6 and 11, the central axis of the pipe member 36 a having both ends fixed is disposed on the same axis AX as the central axis of the insertion section 32, and the pipe member 36 a is the first connecting member 38. Is inserted through the center. As shown in FIG. 11, the tube member 36a is inserted into the hole 38e at the center of the first connecting member 38, and a gap 38f is formed between the inner peripheral surface of the hole 38e and the outer peripheral surface of the tube member 36a. Is provided. The gap 38 f constitutes a communication path that communicates with the inner space of the sheath 39 and the inner space of the grip portion 33.

That is, the tube member 36a is inserted in the hole 38e of the first connecting member 38 in a loosely fitted state.
Since a gap 38f having a distance d3 is provided between the inner circumferential surface of the hole 38e and the outer circumferential surface of the pipe member 36a, the inner space of the sheath 39 is separated from the inner space of the grip portion 33 via the gap 38f. Communicate.

  Further, the exterior member of the grip portion 33 is provided with a gap 33e where the air supply tube 34 is inserted, and other gaps. Other gaps include, for example, holes (not shown) provided in the exterior member of the grip portion 33. Such a gap forms a communication path that connects the inner space and the outer space of the grip portion 33.

  Therefore, the inner space of the sheath 39 communicates with the outer space of the grip portion 33 through the gap 38f and the gap 33e.

  According to the above configuration, the carbon dioxide gas supplied through the air supply tube 34 is introduced into the inner space of the sheath 39 through the hole 38 c of the first connecting member 38. Carbon dioxide is released from the hole 35a into the body cavity. By introducing carbon dioxide into the body cavity, the pressure in the body cavity rises, but through the gap 38f and the gap 33e communicating with the inner space of the sheath 39 and the outer space of the grip portion 33, Carbon dioxide is emitted.

  Accordingly, when carbon dioxide is supplied into the body cavity while controlling the supply amount of carbon dioxide supplied from the air supply tube 34 to a predetermined amount, if the pressure in the body cavity increases, the carbon dioxide in the sheath 39 is increased. The carbon is discharged to the outer space of the grip portion 33 through the gap 38f and the gap 33e. Therefore, the gap 38f and the gap 33e constitute pressure reducing means for reducing, that is, relieving the pressure in the body cavity so as not to exceed a predetermined pressure by allowing carbon dioxide gas to escape. This predetermined pressure is determined from the relationship between the air flow rate and the like and the cross-sectional area of each gap.

Next, the configuration of the harvester 41 will be described with reference to FIGS.
FIG. 12 is a perspective view of the harvester 41. The harvester 41 is mainly composed of an insertion portion 42 and a grip portion 400 connected to the insertion portion 42. A bipolar cutter 43 is provided at the top and a vane keeper 45 is provided inside the lower portion at the distal end of the insertion portion 42 which is a metal cylindrical tube of the harvester 41, and is connected to the proximal end of the insertion portion 42. When the bipolar cutter lever 401 and the vane keeper lever 402 provided in the grip portion 400 are advanced and retracted along the longitudinal axis, the bipolar cutter 43 and the vane keeper 45 can be advanced and retracted forward of the insertion portion 42 in conjunction with the advance and retreat. It can be done.
In addition, since the structure of the base end side of the harvester 41 is the same as the base end side of the dissector 31, description is abbreviate | omitted (refer FIG. 10).

  13 is a partial perspective view showing the configuration of the tip of the harvester 41, FIG. 14 is a diagram for explaining the operation of the lock shaft 414 in FIG. 13, and FIG. 15 is a view as seen from the arrow A in FIG.

  As shown in FIG. 13, the vein keeper 45 of the harvester 41 includes a vein keeper shaft 412 that holds a substantially U-shaped blood vessel holding table 411 so as to be movable back and forth in the longitudinal axis direction, and a substantially U-shape parallel to the vein keeper shaft 412. The blood vessel holding table 411 includes a lock shaft 414 that can advance and retreat in the longitudinal axis direction with respect to the blood vessel holding table 411 that forms a closed space 413 that stores a blood vessel. In the state of FIG. 13, the lock shaft 414 forms a space 413 in a state of being locked to the blood vessel holding base 411 in the same manner as the vane keeper shaft 412, but by releasing the lock state of the lock shaft 414, FIG. As shown, the closed space 413 is released, and the blood vessel 11 can be advanced and retracted in the closed space 413 so as to be retractable.

  A notch 415 is provided on the tip side surface of the insertion portion 42 where the bipolar cutter 43 is provided, and a bipolar shaft (described later) for moving the bipolar cutter 43 forward and backward is inserted into the insertion portion 42 via the notch 415. A guard portion 416 having a circular arc cross section is provided on the inner wall surface of the notch 415, and a wiper 417 for wiping off deposits adhering to the window portion of the distal end portion of the rigid mirror 51 is provided on the inner end surface of the insertion portion 42. Is provided. And the wiper guard part is formed because the other end of the wiper 417 sweeps the inside of the guard part 416 around one end of the wiper 417 as an axis. A part of the cylindrical wiper guard part is provided with a discharge hole 419 for sweeping out the deposit 418 (see FIG. 15) wiped by the wiper 417 to the outside. Examples of the deposit 418 include blood, fat, and smoke generated by an electric knife.

  The wiper 417 is swept by a wiper lever 419 (see FIG. 12) via a wiper shaft (not shown: see FIG. 21).

  As shown in FIG. 15 which is an arrow view seen from the arrow A in FIG. 13, air is supplied to the opening of the rigid endoscope insertion channel 420 through which the rigid endoscope 51 is inserted into a predetermined inner side than the distal end surface of the insertion portion 42. An opening of the air supply channel 421 is provided adjacently.

  16 is a top view of the bipolar cutter 43, and FIG. 17 is a cross-sectional view taken along the line AA of FIG.

  As shown in FIG. 16, the bipolar cutter 43 includes a side branch holding member 422 made of a transparent insulating member, an application electrode 423 that is one bipolar electrode, and a feedback electrode 424 that is the other bipolar electrode. As shown in FIG. 17, the feedback electrode 424 is an upper layer, and the feedback electrode 424, the side branch holding member 422, and the application electrode 423 are three layers.

  The side branch holding member 422 has a V-shaped groove 425 formed on the distal end side, and a slit groove 426 having a width of 0.5 mm, for example, is formed at the base end of the V-shaped groove 425.

  When cutting the side branch 11a, the side branch 11a is guided by the slit groove 426 along the V-shaped groove 425 of the side branch holding member 422. The compressed state is maintained. In this state, a high-frequency current is passed from the application electrode 423 to the return electrode 424, whereby the side branch 11a is cut and stopped.

  Since the return electrode 424 has a larger contact area than the application electrode 423, current is effectively concentrated on the application electrode 423, so that incision hemostasis can be performed.

  18 is a cross-sectional view in the major axis direction showing the operational configuration of the harvester 41, and FIG. 19 is a conceptual diagram of the attachment of the vane keeper lever 402 as seen from the arrow A in FIG.

  As shown in FIG. 18, along the axial direction of the harvester 41, the metal tube member 420 a that forms the rigid endoscope insertion channel 420 is disposed inside the harvester 41 from the proximal end side of the grip portion 400 to the distal end portion of the insertion portion 42. Is inserted. A plurality of holding members 42a are arranged in the middle of the insertion portion 42 of the metal tube. The bipolar cutter 43 is connected to a bipolar cutter lever 401 provided in the grip portion 400 by a bipolar shaft 450 that passes through the insertion portion 42. When the bipolar cutter lever 401 is advanced and retracted along the longitudinal axis, the advancing / retracting force is provided. Is transmitted to the bipolar cutter 43 via the bipolar shaft 450 so that the bipolar cutter 43 can be advanced and retracted forward of the insertion portion 42.

  Similarly, the vane keeper 45 is connected to a vane keeper lever 402 provided in the grip portion 400 by a vane keeper shaft 412 that passes through the insertion portion 42, and when the vane keeper lever 402 is advanced and retracted along the longitudinal axis, The advancing / retreating force is transmitted to the vane keeper 45 via the vane keeper shaft 412 so that the vane keeper 45 can be moved forward and backward with respect to the insertion portion 42.

  The metal tube 420b forming the rigid endoscope insertion channel 420 is fixed to the plurality of holding members 42a, but the two bipolar shafts 450, the vane keeper shaft 412, the lock shaft 414, and the wiper shaft are not fixed. The two bipolar shafts 450, the vane keeper shaft 412, and the lock shaft 414 are configured to be able to advance and retreat in the longitudinal axis direction of the insertion portion 42, and the wiper shaft is configured to be rotatable around the axis of the wiper shaft.

  The vane keeper lever 402 and the vane keeper shaft 412 can be integrally moved on the inner surface of the gripper 400 by a click mechanism 451 that pin-presses the inner surface of the gripper 400, and the click mechanism 451 is provided on the inner surface of the gripper 400. For example, if it is located in any one of the three click grooves 452, the vein keeper lever 402 and the vein keeper shaft 412 can be stably held at that position, and a force can be applied to the longitudinal axis to easily click. The mechanism 451 can be made to escape from the click groove 452.

  The vane keeper lever 402 is detachably connected to the lock lever 453, and the vane keeper lever 402 can be separated from the lock lever 453 by pressing a lock button 454. The lock lever 453 is connected to the lock shaft 414. By moving the lock lever 453 forward and backward while being separated from the vane keeper lever 402, the blood vessel 11 can be advanced and retracted in the closed space 413 so as to be retractable. (See FIGS. 13 and 14).

  As shown in FIG. 19, the vane keeper lever 402 is firmly fixed to the vane keeper shaft 412 by screws 460 and adhesion.

  20 is a cross-sectional view in the major axis direction showing the air supply configuration of the harvester 41, and FIG. 21 is a cross-sectional view showing the cross section along the line AA in FIG.

  As shown in FIG. 20, along the axial direction of the harvester 41, a metal air supply pipe 461 that forms an air supply channel 421 extends from the proximal end side of the grip portion 400 to the distal end portion of the insertion portion 42. Is inserted. An air supply tube 44 is fitted into one end of the air supply pipe 461 on the proximal end side of the grip portion 400 in the grip portion 400, and an air supply connector 44a is provided at the base end of the air supply tube 44. The air connector 44 a is connected to a connector of a tube connected to the air supply device 108.

  FIG. 22 is a first diagram for explaining the operation of the harvester vane keeper, FIG. 23 is a second diagram for explaining the operation of the harvester vane keeper, and FIG. 24 is a third diagram for explaining the operation of the harvester vane keeper.

  As described above, in this embodiment, as shown in FIG. 22, the vane keeper 45 can be advanced and retracted by moving the vane keeper lever 402 forward and backward. Therefore, for example, when the endoscopic image at the time of cutting the side branch 11a is difficult to confirm the state of the side branch 11a in the image as shown in FIG. 23, the vane keeper lever 402 is advanced in the longitudinal direction as shown in FIG. By doing so, the vane keeper 45 is also advanced from the tip, and an endoscopic image suitable for confirming the state of the side branch 11a can be viewed as shown in FIG.

  In this embodiment, as shown in FIGS. 25 and 26, the dissector 31 is integrated with the air supply tube 34 and the air supply connector 34a, and the harvester 41 is based on the electric cable 47 and the electric cable 47. The disector 31 and the harvester 41 can be configured in a disposable manner by configuring them integrally with the connector 470, the air supply tube 44, and the air supply connector 44a provided at the ends. FIG. 25 is a diagram showing the appearance of a disposable dissector, and FIG. 26 is a diagram showing the appearance of a disposable harvester.

  Next, when the carbon dioxide gas supplied from the air supply tube 44 is supplied into the body cavity from the air supply channel 421, the carbon dioxide gas is externally supplied so that the inside of the body cavity does not exceed a predetermined pressure. The structure of the harvester 41 for escaping will be described in detail. As shown in FIG. 21, a plurality of holding members 42a are arranged inside the insertion portion 42, which is a tube member. As described above, the metal tube 420b is fixed to the holding member 42a in the insertion portion 42a, but the two bipolar shafts 450, the vane keeper shaft 412 and the lock shaft 414 which are other built-in components. The wiper shaft is not fixed. That is, the two bipolar shafts 450, the vane keeper shaft 412, the lock shaft 414, and the wiper shaft are inserted into a plurality of holes provided in the holding member 42a in a loosely fitted state. Accordingly, a gap 42b is formed between each hole and the built-in object.

  The supplied carbon dioxide gas is supplied into the body cavity from the air supply channel 421, and the body cavity communicates with the inner space of the grasping part 400 through the gap 42 b in the insertion part 42. Yes. That is, the gap 42 b constitutes a communication path that communicates the outer space of the insertion portion 42 and the inner space of the grip portion 400.

  Further, the exterior member of the grip portion 400 is provided with a gap 400a for inserting the air supply tube 44 therein, and other gaps. Other gaps include holes (not shown) provided in the exterior member of the grip portion 400. Such a gap forms a communication path that connects the inner space and the outer space of the grip portion 400.

  Therefore, the inner space of the insertion portion 42 communicates with the outer space of the grip portion 400 through the gap 42b and the gap 400a.

  According to the above configuration, the carbon dioxide gas supplied through the air supply tube 44 is introduced into the body cavity from the distal end portion of the insertion portion 42 via the air supply channel 421. By introducing carbon dioxide into the body cavity, the pressure in the body cavity increases, but carbon dioxide in the body cavity is discharged from the distal end portion of the insertion portion 42 through the gap 42b and the gap 400a described above.

  Therefore, when carbon dioxide is supplied into the body cavity while controlling the supply amount of carbon dioxide supplied from the air supply tube 44 to be a predetermined amount, when the inside of the body cavity exceeds a predetermined pressure, the insertion portion 42 The carbon dioxide gas is discharged from the front end portion to the external space of the grip portion 400 through the gap 42b and the gap 400a. Therefore, the gap 42b and the gap 400a constitute a pressure reducing means for reducing, that is, relieving the pressure in the body cavity so as not to exceed a predetermined pressure by allowing carbon dioxide gas to escape. This predetermined pressure is determined from the relationship between the air flow rate and the like and the cross-sectional area of each gap.

  As described above, when the dissector 31 and the harvester 41 according to the present embodiment are used, the gas pressure in the body cavity is a predetermined pressure even when a subcutaneous blood vessel such as the great saphenous vein is collected endoscopically. It can be prevented from rising further.

(Second Embodiment)
Next, a second embodiment of the present invention will be described. In the configuration according to the first embodiment described above, carbon dioxide in the body cavity is discharged through the gap 38f and the gap 33e communicating with the inner space of the sheath 39 of the dissector 31 and the outer space of the grip portion 33. However, as shown in FIGS. 27 to 29, the biological tissue collection apparatus according to the second embodiment actively discharges carbon dioxide gas to the insertion portion of the disector 31. The exhaust channel is provided.

  FIG. 27 to FIG. 29 are diagrams for explaining the configuration according to the second embodiment. FIG. 27 is a partial cross-sectional view of the distal end portion of the insertion portion 32 along the insertion axis. FIG. 28 is a partial cross-sectional view of the distal end portion of the grip portion 33 along the insertion axis. FIG. 29 is a diagram for explaining the position of the opening of each hole in the insertion portion 32. In FIG. 27 to FIG. 29, the same components as those in the first embodiment described above are denoted by the same reference numerals and description thereof is omitted.

  As shown in FIG. 27, the second connecting member 58a is provided with one or more, here three holes 35c, having an opening 35b on the outer peripheral surface thereof. Specifically, each hole 35c is formed from the outer peripheral direction of the second connecting member 58a toward the inner peripheral direction and toward the proximal end side of the insertion portion 32 in the middle of the second connecting member 58a. . Therefore, the hole 35c has a substantially L-shaped shape. An exhaust tube 34b constituting an exhaust channel communicating with the inner space of the hole 35c is connected to the proximal end side of the second connecting member 58a.

  On the other hand, the proximal end side of the exhaust tube 34b is connected to the distal end surface of the first connecting member 38 as shown in FIG. The first connecting member 38 is formed with a hole 38g from the distal end surface toward the proximal end surface. One end of the exhaust tube 34 b is connected to the opening of the hole 38 g on the distal end side of the first connecting member 38. The hole 35 c, the exhaust tube 34 b, and the hole 38 g constitute a communication path that connects the outer space of the insertion portion 32 and the inner space of the grip portion 33.

  FIG. 29 is a partial perspective view for illustrating the positions of the openings 35 a and 35 b formed at the distal end of the insertion portion 32. Three openings 35 a are provided in the sheath 39 along the circumferential direction with an interval of 120 degrees around the central axis of the insertion portion 32. Similarly, three openings 35b are provided in the second connecting member 58a along the circumferential direction with an interval of 120 degrees around the central axis of the insertion portion 32. Each opening 35b is separated from each opening 35a by a predetermined distance in the axial direction of the insertion portion 32, and when viewed from the axial direction of the insertion portion 32, each opening 35b and each opening 35a. The three openings 35b are provided at positions where the three openings 35a are rotated around the central axis of the insertion portion 32 by a predetermined angle, for example, 60 degrees.

  According to the above configuration, carbon dioxide supplied from one air supply tube 34 is supplied into the body cavity from the three openings 35a, and from the three openings 35b through the three tubes 34b and the gap 33e. It is discharged to the external space of the grip part 33. Therefore, the communication path formed by the hole 35c, the exhaust tube 34b, and the hole 38g reduces the pressure in the body cavity by releasing the carbon dioxide gas so that the pressure in the body cavity does not exceed a predetermined pressure, that is, relief. Constituting a pressure reducing means. The predetermined pressure is determined from the relationship between the air flow rate and the like and the cross-sectional areas of the inner channels of the three tubes 34b.

  In the above description, in the configuration of the dissector 31, an example in which a channel for discharging carbon dioxide is positively provided in the insertion portion has been described. In addition, a channel for the discharge of carbon dioxide can be provided.

(Third embodiment)
Next, a third embodiment of the present invention will be described. In the configuration according to the first and second embodiments described above, the gap 38f and the gap 33e communicating with the inner space of the sheath 39 of the dissector 31 and the outer space of the grip portion 33, or the channel provided in the insertion portion The carbon dioxide in the body cavity is discharged through the living body tissue collecting device according to the third embodiment, but the relief valve 200 is provided in the middle of the air supply tube 34 as shown in FIG. have.

  FIG. 30 is a diagram for explaining a configuration according to the third embodiment. FIG. 30 is a partial cross-sectional view of a disector 31 according to the third embodiment. In FIG. 30, the same components as those in the first embodiment described above are denoted by the same reference numerals, and description thereof is omitted.

As shown in FIG. 30, since the relief valve 200 is provided in the middle of the air supply tube 34, when the pressure in the air supply tube 34 becomes equal to or higher than the pressure set in the relief valve 200, the air supply tube 34. The carbon dioxide gas inside is discharged. Therefore, the pressure in the body cavity does not exceed a predetermined pressure. The relief valve 200 allows the carbon dioxide gas to escape, thereby constituting pressure reducing means for reducing, or relief, so that the pressure in the body cavity does not exceed a predetermined pressure.
Note that the relief valve 200 may be provided on the proximal end side of the sheath 39 of the insertion portion 32. By providing the relief valve 200 on the proximal end side of the sheath 39, the carbon dioxide gas in the sealed space 39a is discharged when the pressure in the sealed space 39a becomes equal to or higher than a predetermined pressure.

  Furthermore, in the above description, the example in which the relief valve 200 is provided in the air supply tube 34 or the sheath 39 of the insertion portion 32 in the configuration of the dissector 31 has been described, but the air supply tube 44 is similarly applied to the harvester 41. Alternatively, the relief valve 200 can be provided in the insertion portion 42.

It is a block diagram which shows the structure of the surgery system concerning the 1st Embodiment of this invention. 1 is a perspective view of a trocar according to a first embodiment of the present invention. It is a longitudinal cross-sectional view of the trocar concerning the 1st Embodiment of this invention. It is sectional drawing which shows the state by which the dissector was inserted under the leg of the lower leg via the trocar concerning the 1st Embodiment of this invention. It is a side view of the dissector concerning the 1st Embodiment of this invention. It is a fragmentary sectional view of the dissector concerning the 1st embodiment of the present invention. It is sectional drawing along the AA in FIG. It is sectional drawing along the BB line in FIG. It is sectional drawing along CC line in FIG. It is the fragmentary perspective view seen from the base end side of the disector concerning the 1st Embodiment of this invention. It is a fragmentary sectional view of the front-end | tip part of the holding part concerning the 1st Embodiment of this invention. 1 is a perspective view of a harvester according to a first embodiment of the present invention. It is a fragmentary perspective view which shows the structure of the front-end | tip of the harvester concerning the 1st Embodiment of this invention. It is a figure explaining the effect | action of the lock shaft of FIG. It is the arrow view seen from the arrow A of FIG. It is the figure which looked at the bipolar cutter concerning the 1st Embodiment of this invention from the upper surface. It is sectional drawing which shows the AA line cross section of FIG. It is sectional drawing of the major axis direction which shows the operation structure of the harvester concerning the 1st Embodiment of this invention. It is the attachment conceptual diagram of the vane keeper lever seen from the arrow A of FIG. It is sectional drawing of the major axis direction which shows the air_supply structure of the harvester concerning the 1st Embodiment of this invention. It is sectional drawing which shows the AA line cross section of FIG. It is a 1st figure explaining the effect | action of the vein keeper of the harvester concerning the 1st Embodiment of this invention. It is a 2nd figure explaining the effect | action of the vein keeper of the harvester concerning the 1st Embodiment of this invention. It is a 3rd figure explaining the effect | action of the vein keeper of the harvester concerning the 1st Embodiment of this invention. It is a figure which shows the external appearance of the dissector concerning the 1st Embodiment of this invention. It is a figure which shows the external appearance of the disposable harvester concerning the 1st Embodiment of this invention. It is a fragmentary sectional view of the front-end | tip part of the insertion part concerning the 2nd Embodiment of this invention. It is a fragmentary sectional view of the front-end | tip part of the holding part concerning the 2nd Embodiment of this invention. It is a figure for demonstrating the position of the opening part of each hole in the insertion part concerning the 2nd Embodiment of this invention. It is a fragmentary sectional view of the die sector concerning a 3rd embodiment of the present invention.

Explanation of symbols

21 trocar, 31 dissector, 32 insertion part, 33 gripping part, 34 air supply tube, 36a tube member, 38 first connecting member, 38b end face, 38e hole, 38f gap, 39 sheath, 41 harvester, 51 rigid mirror,
Agent Patent Attorney Susumu Ito

Claims (5)

A biological tissue collection device having a gripping part and an insertion part connected to the gripping part and inserted into a body cavity,
An air supply means for supplying the predetermined gas into the insertion portion in order to release the predetermined gas from the opening provided in the insertion portion;
A biological tissue collection device comprising pressure reducing means for escaping the predetermined gas supplied into the body cavity.   The living tissue sampling apparatus according to claim 1, further comprising an endoscope insertion unit that inserts an endoscope into the insertion portion.   The biological tissue collection device according to claim 1 or 2, wherein the pressure reducing means is a communication path that connects the inner space of the insertion portion and the inner space of the grip portion.   The biological tissue collection device according to claim 1 or 2, wherein the pressure reducing means is a communication path that communicates the outer space of the insertion portion and the inner space of the gripping portion. The biological tissue collection device according to claim 1 or 2, wherein the pressure reducing means is a relief valve provided in the air supply means.

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