JP6522421B2 - Insufflation system - Google Patents

Description

  The present invention relates to an insufflation system that insufflates gas.

In recent years, surgery under laparoscopic observation has become widely adopted. As described above, in the laparoscopic surgery, a pneumoperitoneum device or a pneumoperitoneum is provided to supply a predetermined gas such as carbon dioxide gas into the abdominal cavity to secure the observation field of view by the laparoscope and the region for the operation. A system is used.
For example, Japanese Patent Laid-Open No. 6-209901 as a first conventional example relates to the inside of a gas supply line when gas for insufflation flows in or out in the gas supply line to which an insufflation tube is connected. The contents of detecting the magnitude of the pressure change of and the clogging state of the insufflation tube based on the detection data of the pressure change are disclosed.
Further, Japanese Patent Laid-Open No. 9-38029 as a second conventional example is directed to a fifth valve which is introduced into a patient's abdominal wall through a trocar connected to an insufflation tube, and the downstream conduit leads to the atmosphere. The pressure at the time of pressure rise in the internal channel immediately after closing is detected by a pressure sensor, and the control unit is in a state where the abdominal pressure is normal or the tube is It discloses the contents to judge whether it is clogged or abdominal overpressure.
Further, according to Japanese Patent Application Laid-Open No. 2014-113256 as a third conventional example, the air supply device supplies carbon dioxide gas into the abdominal cavity through the air supply tube, and the suction device through the suction tube. The control unit controls the air supply device and the suction device according to the measurement results of the pressure sensor provided in the air supply device and the pressure sensor provided in the suction device. In addition, the contents of control to operate the roller pump when the abdominal pressure reaches a predetermined set value are disclosed.

JP-A-6-209901 JP-A-9-38029 JP, 2014-113256, A

The first and second conventional examples detect the presence or absence of clogging but do not disclose determining the degree of clogging in more detail. In actuality, the blockage (or blockage) may be a slight blockage state or a severe blockage state, and different air supply control is required for the former determination result and the latter determination result. In the first and second conventional examples, the function of determining is insufficient to determine such a blocked state. Therefore, a more reliable insufflation system is desired which can determine the occlusion state more accurately.
The third prior art also does not disclose determining the degree of clogging in more detail.
The present invention has been made in view of the above-described point, and an object thereof is to provide an insufflation system capable of accurately determining an occlusion state.

The insufflation system according to one aspect of the present invention is connected to an insufflation apparatus having a control unit that controls an insufflation operation at the time of insufflation of a predetermined gas, and a first trocar having one end pierced in the abdominal wall. The other end is connected to the insufflation apparatus, the air supply conduit for supplying the predetermined gas, and one end is connected to the second trocar inserted in the abdominal wall, and the other end is connected to the insufflation apparatus. A second measuring line connected to one end of the first measuring line of the abdominal device and for measuring the pressure in the abdominal cavity, and provided on the first measuring line, in the first measuring line A pressure measurement unit for measuring pressure, an openable / closable gas outlet at the other end of the first measurement pipeline for discharging the predetermined gas, and a first measurement pipeline. A throttling member that generates a pressure difference between the pressure measurement unit and the gas discharge port; Closed state determination unit that determines the closed state of the measurement pipeline consisting of the first measurement pipeline and the second measurement pipeline from the pressure measurement result of the pressure measurement unit generated by the throttling member when opening the And a setting unit that sets a threshold that determines a condition under which the closed state determination unit performs the closed state determination during the insufflation operation, the closed state determination unit closing the measurement pipeline A non-occlusion state which is not normal, a slight semi-occlusion state in which the measurement conduit is in a slight occlusion state and it is possible to measure an intra-abdominal pressure, and the measurement conduit is in a severe occlusion state; The control unit makes it possible to determine either a severe semi-occlusion state in which the abdominal pressure may be erroneously measured or a total occlusion state in which the measurement conduit is completely occluded and the intra-abdominal pressure can not be measured. According to the determination result of the closed state determination unit When the non-occlusive state or the slight occlusion state, the predetermined gas is continuously supplied to the abdominal cavity, and when the severe semi-occlusive state or the total occlusion state, the predetermined intermittent state is intermittently applied to the abdominal cavity The gas is controlled to be insufflated, and the threshold value set by the setting unit when it is determined to be the slight semi-occlusion state according to the occlusion state determination by the occlusion state determination unit, The predetermined threshold is switched to perform the determination of the closed state more frequently by the closed state determination unit during the insufflation operation than the threshold when the closed state is determined to be the non-closed state. Control to perform the gas supply operation of

  According to the present invention, the closed state can be determined with high accuracy.

FIG. 1 is a diagram showing an entire configuration of an insufflation system according to a first embodiment of the present invention. FIG. 2 is a view showing a configuration of a measurement pipeline system portion provided with the throttle in FIG. FIG. 3 is a diagram showing in tabular form an occlusion state to be determined. FIG. 4 is a view showing a change in measurement pressure of the measurement line measured by the pressure sensor when the solenoid valve is opened and closed in the measurement line system of FIG. 2; FIG. 5A is a view showing a change in measurement pressure of FIG. 3 in a non-occlusion state in which the occlusion part in FIG. 2 is not generated. 5: B is a figure which shows the mode of a change of the measurement pressure of FIG. 3 in the slight semi-occlusion state from which the obstruction part in FIG. 2 becomes the slight occlusion state. FIG. 5C is a view showing a change in measurement pressure of FIG. 3 in a severe semi-occlusion state in which the occlusion part in FIG. 2 is in a severe occlusion state. 6 is a view showing the configuration of a measurement line system portion in a completely closed state in which the closed portion in FIG. 2 is completely closed. FIG. 7 is a view showing a change in measurement pressure of the measurement line measured by the pressure sensor when the solenoid valve is opened and closed in the measurement line system in the completely closed state of FIG. 6; FIG. 8A is an explanatory view showing a measurement pressure when the flow resistance of the trocar is sufficiently larger than the flow resistance of the throttle. FIG. 8B is an explanatory view showing a measurement pressure when the flow passage resistance of the throttle is made larger than the flow passage resistance of the trocar. FIG. 9A is a table showing the relationship between a threshold pressure for determining an occlusion state and a measured pressure measured by a pressure sensor. FIG. 9B shows a plurality of threshold values in FIG. 9A. FIG. 10 is a flow chart showing a representative processing procedure of the first embodiment of the present invention. FIG. 11 is a flowchart showing a detailed processing procedure of the blocking state determination processing in FIG. FIG. 12 is an explanatory diagram of processing of waiting for time in FIG. FIG. 13 is a flow chart showing contents in which the controller performs continuous air supply control and intermittent air supply control according to the determination result of the closed state in FIG. FIG. 14 is a flowchart showing a process of intermittent air supply control. FIG. 15 is a flowchart showing the processing procedure of the modification of the first embodiment of the present invention.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.
First Embodiment
As shown in FIG. 1, the insufflation system 1 according to the first embodiment of the present invention supplies carbon dioxide gas as a predetermined gas into the abdominal cavity of the patient 2 placed on the operating table B, and A treatment for treatment under the observation of the insufflation apparatus 3 for insufflation, the endoscope apparatus 4 for observing the inside of the abdominal cavity of the patient 2, and the endoscope 5 constituting the endoscope apparatus 4 And 6.
The endoscope apparatus 4 includes an endoscope 5 which is inserted into the abdominal cavity through a first trocar 13, and a light source apparatus 7 which supplies illumination light for optical observation to the endoscope 5. , A video processor 8 as a signal processing device for driving an imaging element provided in the endoscope 5 and performing signal processing on an imaging signal imaged by the imaging element, and an image signal generated by the video processor 8 are input Thus, it has a monitor 9 as a display device that displays an image within the observation field of view in the abdominal cavity imaged by the imaging device as an endoscopic image.
The insufflation system 1 is connected to a housing 3 a of the insufflation apparatus 3 and has a carbon dioxide gas cylinder (hereinafter simply referred to as a gas cylinder) 10 serving as a gas supply source for supplying carbon dioxide gas to the insufflation apparatus 3.

The insufflation apparatus 3 is connected to one end to be a gas cylinder 10 and an air supply source cap 11 a, and has an air supply passage 11 as a conduit for supplying carbon dioxide gas supplied from the gas cylinder 10. One end of an air supply tube 12 forming a flexible air supply conduit is connected to the air supply cap 11 b at the other end of the passage 11.
The other end of the air supply tube 12 is connected to a first trocar 13 which forms an air supply trocar (or an insufflational trocar) which is inserted into the abdominal wall of the patient 2.
In the first trocar 13, the insertion portion 5a of the endoscope 5 is inserted into the hollow guide tube, and the carbon dioxide gas supplied via the route of the air supply tube 12 is connected to the air supply tube 12. The gap between the insertion portion 5a and the guide tube in the first trocar 13 is supplied into the abdominal cavity as a passage from the connection portion to be connected. Note that the air supply conduit 11 connected to the gas cylinder 10, the air supply tube 12 connected to the air supply conduit 11, the carbon dioxide gas communicated with the abdominal cavity 2a via the air supply tube 12 and the first trocar 13. The air supply passage is referred to as an air supply passage system 14.

Further, in the present embodiment, as a pipeline system for measuring the intra-abdominal pressure (also referred to simply as intra-abdominal pressure or abdominal pressure, also referred to as pressure) as intra-abdominal pressure as described below And a measurement line system 19 separate from the air supply line system 14.
A second trocar 15 forming a measuring trocar is inserted into the abdominal wall of the patient 2 and a flexible measurement forming a second measuring conduit whose one end is connected to the connection of this second trocar 15 The other end of the tube 17 is connected to a measurement base 16 a which is one end of a first measurement pipeline 16 provided in the insufflation apparatus 3. The measurement tube 17 is, for example, a flexible tube having an inner diameter of 2 mm and a length of about 3 m. Also, in the specification, the first measurement line 16 is simplified and simply referred to as the measurement line 16.
A filter 18 for preventing the inside of the insufflation apparatus 3 from being contaminated is interposed in the measuring mouthpiece 16a (see FIG. 2). The filter 18 is replaced with a new clean one every time the operation is performed.

As shown in FIG. 2, the outer tube of the treatment tool 6 is inserted into the guide tube of the second trocar 15. In this second trocar 15, the tip opening of the second trocar 15 inserted into the abdominal cavity is connected to the connecting portion with the gap between the outside of the armored tube of the treatment tool 6 and the inside of the guide tube as a passage The open end serving as one end of the measurement tube 17 is communicated.
As shown in FIG. 2, when the outer tube of the treatment tool 6 is inserted into the second trocar 15, the passage inside the second trocar 15 is made by the rubber lid 15a provided with a cross cut for insertion. Is cut off from the outside.
A second trocar 15 having a passage communicating with the abdominal cavity 2a, a measuring tube 17 connected via the second trocar 15, and a measuring means connected to one end of the measuring tube 17 for measuring the abdominal pressure A measurement pipeline system including the measurement pipeline 16 and the measurement pipeline 16 is provided as a measurement pipeline system 19.
As shown in FIG. 1, a pressure reducing device 21 for reducing pressure, an electro-pneumatic proportional valve 22 for adjusting and outputting the pressure of carbon dioxide gas by an electric signal, and an opening and closing by a control signal The electromagnetic valve 23 of 1, the flow rate sensor 24 forming a flow rate measuring unit for measuring the amount of air flow, and the first pressure sensor 25 for measuring the pressure in the air supply passage 11 (from the air supply source cap 11a It is arrange | positioned one by one between the air supply nozzle | capacitances 11b of the downstream side. The first solenoid valve 23 is also simply referred to as the solenoid valve 23. Further, the second solenoid valve 31 described later is also simply referred to as the solenoid valve 31.

Further, the insufflation device 3 includes a controller 26 that forms a control unit that controls the insufflation operation and the like of the insufflation device 3, and an insufflation (insufflation) from the insufflation device 3 to achieve a target target abdominal pressure (or A panel 27 for setting (or inputting) the set pressure) and the like, and a display 28 for displaying the measured abdominal pressure, air flow rate and the like are provided. The controller 26 is formed of, for example, a central processing unit (CPU), but may be formed using an electronic circuit including a comparison circuit, an arithmetic circuit for performing addition and integration, a memory for storing data, and the like.
Further, the panel 27 is provided with a switch for instructing the start and end of the insufflation operation.
The gas cylinder 10 supplies high-pressure carbon dioxide gas of, for example, about 6 MPa from the air supply source cap 11 a to the pressure reducer 21 through the air supply passage 11. The decompressor 21 decompresses, for example, to a low pressure of about 0.4 Mpa, and supplies the air to the electro-pneumatic proportional valve 22.

The electropneumatic proportional valve 22 is a valve that variably controls the air supply pressure to be supplied to the solenoid valve 23 by adjusting the pressure according to the control signal when the control signal from the controller 26 is applied. The controller 26 applies to the electropneumatic proportional valve 22 a control signal corresponding to the difference between the target abdominal pressure (or the set pressure) set by the panel 27 and the abdominal pressure actually measured. The air proportional valve 22 supplies carbon dioxide gas at a pressure of about 0 to 80 mmHg corresponding to the difference to the solenoid valve 23 side.
Specifically, when the difference in abdominal pressure actually measured is larger than the set pressure, as when air supply is started, the electropneumatic proportional valve 22 performs air supply with a large pressure, and the abdominal cavity Since the difference becomes smaller as the pressure approaches the set pressure, the electro-pneumatic proportional valve 22 is in a state of delivering air at a pressure close to zero.
The solenoid valve 23 electrically opens / closes in response to an ON / OFF control signal from the controller 26. In the present embodiment, since the air supply conduit system 14 for supplying air and the measurement conduit system 19 for measuring the abdominal pressure are provided separately, the air supply conduit system 14 has a flow rate of air supply almost zero. Send air almost continuously including values close to. As described later (refer to FIG. 10), when it is determined that the semi-occlusion is close to the non-occlusion state or the non-occlusion state in the occlusion state determination processing, the controller 26 continuously outputs the electromagnetic valve 23 in the open state. Control to supply air.

The solenoid valve 23 is set to open by a control signal from the controller 26 from the start of the insufflation (air supply) to the end of the insufflation (air supply), and the solenoid valve 23 is closed by the instruction of the end of the insufflation. It becomes. As described later, when it is determined that the measurement conduit system 19 may erroneously measure abdominal pressure, the controller 26 stops the operation of the measurement conduit system 19 and turns on the solenoid valve 23 / The air supply is controlled to be intermittently performed by the air supply conduit system 14 by turning it off.
The flow rate sensor 24 constantly sends the measured air flow rate to the controller 26, and the controller 26 samples and integrates the measured air flow rate in an appropriate cycle (for example, about 10 ms) to calculate an integrated flow rate Q. The controller 26 determines whether the integrated flow rate Q is equal to or higher than the integrated flow rate threshold Qth. If the integrated flow rate Q is determined to be equal to or higher than the integrated flow rate threshold Qth, the controller 26 is provided in the measurement pipeline system 19. The second solenoid valve 31 is closed and opened, and a determination operation of the degree of blockage or the blockage state as the degree of clogging of the measurement conduit system 19 is performed.
The carbon dioxide gas having passed through the flow rate sensor 24 is insufflated into the abdominal cavity through the air supply tube 12 and the first trocar 13. The first pressure sensor 25 measures the pressure in the air feeding conduit 11 and outputs the pressure to the controller 26. FIG. 2 shows the measuring line system 19 in FIG.

A second solenoid valve 31 is provided at the other end of the measurement line 16 at one end of which the measurement nozzle 16a is connected to the measurement tube 17. The other end of the measurement line 16 is open to the atmosphere and electromagnetic When the valve 31 is open, the gas outlet 16 b is formed to discharge the carbon dioxide gas in the measurement pipeline 16 to the atmosphere.
Further, a second pressure measurement unit is formed on the measurement pipeline 16 between one end and the other end of the measurement pipeline 16 to measure the abdominal pressure by measuring the pressure in the measurement pipeline 16. A pressure sensor 32 and a throttle 33 forming a throttle member which generates a pressure difference (to the pressure measured by the second pressure sensor 32 with respect to the case where it is not provided) are arranged in the measurement pipeline 16. The throttle 33 is provided on the measurement pipeline 16 between the pressure sensor 32 and the solenoid valve 31.
The measurement conduit 16 communicates with the abdominal cavity 2a at one end via the measurement tube 17 and the trocar 15 at one end, so the measurement pressure as the pressure measured in the measurement conduit 16 is the abdominal cavity when the other end is closed. It becomes pressure.
However, if the carbon dioxide gas passage or flow path is blocked in the measurement pipeline system 19 between the abdominal cavity 2a and the position where the pressure sensor 32 is provided in the measurement pipeline 16, the other end of the measurement pipeline 16 is turned off. The measured pressure measured in the occluded state is a measured value that does not reflect the abdominal pressure, and the abdominal pressure can not be measured.

Further, even in the case of a state of severe occlusion (or semi-occlusion) in which the degree of occlusion is large even in the state of not being completely blocked, the measured pressure measured becomes a large error.
On the other hand, in the case of a slight occlusion or semi-occlusion to the extent that there is no hindrance to measurement of abdominal pressure, it becomes possible to perform air supply control in a state close to a normal state (non-occlusion state). For this reason, it is desirable to determine these closed states and control the insufflation operation according to the determination result. In the present embodiment, the closed state is determined as described below, and the air feeding operation is controlled according to the determination result.
FIG. 3 shows, in the form of a table, an occlusion state that requires determination and that can be determined in the present embodiment.
Non-occlusion is a normal condition that is not occluded, and a slight semi-occlusion is a slight occlusion, and in this slight occlusion, there is no problem in measuring the abdominal pressure.
On the other hand, severe semi-occlusion is not completely occluded, but it is a state of severe occlusion, which may cause incorrect measurement of abdominal pressure, and total occlusion is measured by the measurement line (peritoneal cavity 2a The measurement tube 17 or the measurement line 16) on the way to the end is completely occluded, and the abdominal pressure can not be measured.

In the present embodiment, the solenoid valve 31 serving as the outlet opening and closing device for opening and closing the gas outlet 16 b serving as the other end and the solenoid valve 31 are opened near the other end or the other end in the measurement pipeline 16. In this case, there is provided a throttle 33 which generates a pressure difference in the measurement pipeline 16 (which becomes a flow path resistance), and a pressure sensor 32 which forms a pressure measuring unit which measures the pressure in the measurement pipeline 16 where the pressure difference is generated. Thus, the controller 26 forms an occlusion state determination unit that determines the occlusion state of the measurement pipeline system 19 or the measurement pipeline (composed of the measurement pipeline 16 and the measurement tube 17) based on the measurement pressure of the pressure sensor 32. It has the function of the closed state determination circuit 26a.
As shown in FIG. 1, the measured pressure measured by the pressure sensor 32 is input to the controller 26. Further, the controller 26 performs the determination operation of the degree of blockage or the blockage state as the degree of clogging of the measurement conduit system 19 at the timing when it is determined that the integrated flow rate Q is the threshold Qth or more as described above.
Moreover, the principle in the case of determining the obstruction | occlusion state by this embodiment is demonstrated using FIG.

When measuring the abdominal pressure by the pressure sensor 32, the electromagnetic valve 31 is kept closed. Then, the measurement line 16 forms a closed space communicating with the abdominal cavity 2a, so that the pressure measured by the pressure sensor 32 provided on the measurement line 16 coincides with the abdominal pressure.
When the determination (detection) of the closed state is performed, the solenoid valve 31 is opened. Then, carbon dioxide gas in the abdominal cavity flows through the trocar 15, the measurement tube 17 and the measurement line 16 to the gas outlet 16b. When carbon dioxide gas flows in the measurement pipeline system 19, energy loss (that is, pressure loss) corresponding to the flow path resistance occurs.
In general, a portion where the flow path resistance is large in the measurement pipeline system 19 is a trocar 15. In the present embodiment, a throttle 33 is provided on the measurement line 16, and pressure loss also occurs in the portion of the throttle 33. In addition, even if there is a closed portion (a closed portion on the measurement tube 17 in the illustrated example in FIG. 2) 35 on the measurement pipeline system 19 in FIG. 2, a pressure loss occurs in that portion.
In the measurement conduit system 19, when the measurement tube 17 formed of a long flexible tube in FIG. 2 is bent or the like, the inner diameter is deformed into a flat shape, and the substantial inner diameter is reduced. There may be a state such as the closed portion 35 where the function of passing carbon dioxide gas is reduced.

In addition, the filter 18 disposed in the middle of the measurement conduit system 19 is clogged with fine particles or the like to be in a closed state, or the narrow passage portion in the second trocar 15 is clogged due to the entry of foreign matter. And there is a risk of becoming blocked.
In addition to this, there is also a possibility that the closed state may be caused by closing the cock (not shown) of the second trocar 15 as an erroneous operation. As a representative example of such a closed state, FIG. 2 schematically shows a closed portion 35 which generates a closed state by the inner diameter becoming substantially smaller in the middle of the measurement tube 17 . In many cases, the blocking portion 35 occurs in the flexible measuring tube 17 portion.
As shown in FIG. 2, assuming that the pressure loss generated by the trocar 15 is ΔPa, the pressure loss generated by the closed portion 35 is ΔPb, the pressure loss generated by the throttle 33 is ΔPc, the abdominal pressure is Pabd, and the atmospheric pressure is Pair, energy storage in the fluid The following equation (1) is established by the law of.
Pabd-Pair = ΔPa + ΔPb + ΔPc (1)
FIG. 4 shows how the pressure measured by the pressure sensor 32 changes when the solenoid valve 31 of FIG. 2 is temporarily opened.

In addition, as shown in FIG. 4 (the same applies to the other drawings of FIGS. 5A to 5C, etc.), the pressure sensor 32 indicates Pa as a measurement pressure of the abdominal pressure when the solenoid valve 31 is closed. Alternatively, in FIGS. 4 to 5C and the like, Pa and the like may not be described, and as shown in FIG. 9B described later, the measurement pressure immediately before opening the solenoid valve 31 may be defined as Pa.
When the solenoid valve 31 is temporarily opened, the pressure measured by the pressure sensor 32 is lower by ΔPa + ΔPb than the pressure Pa measured by the abdominal pressure and is higher by ΔPc than the atmospheric pressure Pair after the transient time. .
The ratio of each pressure loss corresponds to the ratio of flow path resistance. For example, when the ratio of the flow path resistance of the trocar 15, the closed portion 35, and the throttle 33 is, for example, 2: 1: 2, the ratio of pressure loss is also ΔPa: ΔPb: ΔPc = 2: 1: 2. Therefore, if the difference between the measured pressure Pa of the abdominal pressure and the atmospheric pressure Pair is 10 mmHg, it can be calculated (calculated) as ΔPc = 4 mmHg.
As mentioned above, the magnitude of pressure loss is determined by the ratio of flow path resistance.
For example, in the non-occlusion state, the pressure loss ΔPb at the occlusion portion 35 does not occur. Therefore, when the solenoid valve 31 is opened, the measurement pressure of the pressure sensor 32 drops by ΔPa as shown in FIG. 5A, and becomes higher than the atmospheric pressure Pair by ΔPc.

When a blockage occurs, a pressure drop ΔPb at the blockage 35 occurs. The higher the degree of blockage (high flow path resistance), the larger the value of ΔPb, and the larger the amount (ΔPa + ΔPb) in which the pressure measured by the pressure sensor 32 drops when the solenoid valve 31 is opened. FIG. 5B shows an example of a slight semi-occlusion state in which the pressure loss ΔPb in the occlusion portion 35 is small, and FIG. 5C shows an example of a severe semi-occlusion state in which the pressure loss ΔPb in the occlusion portion 35 is large.
As shown in FIGS. 5B and 5C, the value of ΔPc decreases relatively as the degree of occlusion increases.
Therefore, by obtaining ΔPc in the non-occlusion state in advance and comparing it with the value of the actually measured pressure, it is possible to determine what degree of occlusion has occurred.
Further, FIG. 6 shows a state in which the closing portion 35 is completely closed in the state of FIG. As shown in FIG. 6, the electromagnetic valve 31 is opened in a state where the conduit between the abdominal cavity 2a and the measurement conduit 16 for measuring the pressure is pressured spatially (from the communicating state) Also, all carbon dioxide gas in the measurement pipeline 16 escapes from the gas outlet 16 b. Then, even if the solenoid valve 31 is closed, the atmospheric pressure Pair remains.

Therefore, when the solenoid valve 31 is temporarily opened from the closed state in the state where the closed portion 35 is completely closed as shown in FIG. 6, the measurement pressure as the pressure in the measurement line 16 is as shown in FIG. Even if the solenoid valve 31 is closed, the atmospheric pressure Pair remains as it is.
In accordance with the above principle explanatory drawing and the like, in the present embodiment, the blockage state determination is performed to determine the blockage state using the throttle 33 that generates a pressure difference. In this case, the flow path resistance by the throttle 33 may be set appropriately.
For example, the flow path resistance Ro of the throttle 33 is made larger than the flow path resistance Rt of the trocar 15, and the flow path resistance Rt of the trocar 15 is sufficiently larger than the flow path resistance Ro of the throttle 33 (that is, Ro << Rt). When the solenoid valve 31 is opened from the closed state even when the measurement conduit system 19 is in the non-occlusion state, the measurement pressure of the pressure sensor 32 is the atmospheric pressure Pair (or near the atmospheric pressure Pair). Down to). This state is shown in FIG. 8A. In this case, the range at the time of determining the closed state becomes narrow, and the determination becomes difficult.

On the other hand, if the flow path resistance Ro of the throttle 33 is made larger than the flow path resistance Rt of the trocar 15, after the solenoid valve 31 is opened, the pressure measured by the pressure sensor 32 decreases and the time to reach the minimum value is reached. There is a need to set a long time for obtaining a measurement pressure which has become longer and which has decreased completely. This situation is shown in FIG. 8B. It is desirable to shorten the time required to determine the blockage state from the viewpoint of the air supply efficiency.
In this embodiment, the flow path resistance Ro of the throttle 33 is set to the same degree as the flow path resistance Rt of the trocar 15 in consideration of such a viewpoint.
FIG. 9A shows the relationship between the threshold pressure for determining each closed state shown in FIG. 3 and the pressure measured by the pressure sensor 32 (referred to as the minimum value) Pb when the solenoid valve 31 is opened. Is shown in tabular form. Moreover, FIG. 9B shows explanatory drawing of FIG. 9A.
In the present embodiment, three threshold pressures Pth1, Pth2 and Pth3 are used to determine the four occlusion states shown in FIG. 9A. The threshold pressure Pth3 is equal to (set to a value) the atmospheric pressure Pair, as can be seen from FIG. 9B.

The threshold pressures Pth1 and Pth2 are variably set according to the measurement pressure Pa of the abdominal pressure of the pressure sensor 32 immediately before the solenoid valve 31 is opened. The reason is that, as understood from the equation (1), to what extent the measurement pressure of the measurement line 16 measured by the pressure sensor 32 falls when the solenoid valve 31 is opened is the difference between the abdominal pressure and the atmospheric pressure Because the change is caused by the change in the threshold pressure, the feature of the change is included in the threshold pressure.
In the present embodiment, the flow path resistance Ro of the throttle 33 is set to the same degree as the flow path resistance Rt of the trocar 15. In this case, the controller 26 (the closed state determination circuit 26a) determines the threshold pressure Pth1 as follows. , Pth2 and Pth3 Pth1 = Pa × 0.50 (2)
Pth2 = Pa × 0.30 (3)
Pth3 = Pa × 0 (4)
Is calculated and set to the calculated value. As can be seen from the equation (4), the measurement pressure Pa or the like of the abdominal pressure is a gauge pressure at which the atmospheric pressure Pair is zero.

In addition, (the closed state determination circuit 26a of the controller 26) uses the measured pressure Pa immediately before opening the solenoid valve 31 and (the information of (the information of) the threshold pressures Pth1, Pth2 and Pth3 obtained by calculation) to the memory 26b inside the controller 26. It may be stored (held), and may be referred to when determining the closed state. The memory 26 b may be provided inside the closed state determination circuit 26 a.
The threshold pressure is set as in the above equations (2) to (4), the controller 26 opens the solenoid valve 31, samples the measured pressure measured by the pressure sensor 32, and at the point where the measured pressure has dropped The measurement pressure (or minimum value) Pb of is obtained (detected). The measured pressure (or the minimum value) Pb is compared with the threshold pressure Pth1, Pth2, Pth3, and four occlusion states are determined according to the relationship of FIG. 9A from the comparison result.
Specifically, the controller 26 (the closed state determination circuit 26a) measures the pressure in the abdominal cavity measured by the pressure sensor 32 which forms a pressure measurement unit when the gas outlet 16b is closed (or just before opening). Pa, first threshold pressure Pth1 lower than the intra-abdominal pressure, second threshold pressure Pth2 lower than the first threshold pressure Pth1, and third threshold pressure lower than the second threshold pressure Pth2 When the measurement pressure (minimum value) as the pressure measurement result of the pressure measurement unit when holding the information of Pth3 and opening the gas outlet 16b is Pb,
In the case of Pb> Pth1, the measurement pipeline 19 is in the non-occlusion state,
In the case of Pth1 ≧ Pb> Pth2, the measurement conduit system 19 is in a slight semi-occlusion state,
In the case of Pth2 ≧ Pb> Pth3, the measurement conduit system 19 is in a severe semi-occlusive state,
In the case of Pb ≦ Pth3, the measurement conduit system 19 is in a completely closed state,
Each is determined. In the case of (the minimum value of) the measurement pressure Pb of FIG. 9B, the controller 26 (the closed state determination circuit 26a thereof) determines that it is a slight semi-closed state.

  The insufflation system 1 according to the present embodiment includes an insufflation apparatus 3 having a controller 26 that forms a control unit that controls an insufflation operation at the time of insufflation of a predetermined gas; Air supply tube 12 which is connected to the trocar 13 and whose other end is connected to the insufflation apparatus 3 to form an air supply passage for supplying the predetermined gas, and one end is inserted into the abdominal wall Connected to the second trocar 15, and the other end is connected to one end of the first measurement line 16 of the insufflation apparatus 3 to form a second measurement line for measuring the pressure in the abdominal cavity A measurement tube 17; a pressure sensor 32 provided on the first measurement line 16 and forming a pressure measurement unit for measuring the pressure in the first measurement line 16; and the first measurement An opening at the other end of the conduit 16 for discharging the predetermined gas Gas that is provided on the first measurement pipeline 16 and that forms a throttling member that generates a pressure difference between the pressure measurement unit and the gas outlet; From the pressure measurement result of the pressure measurement unit generated by the throttling member when the discharge port 16b is opened, the blockage state of the measurement line consisting of the first measurement line 16 and the second measurement line is determined And a closed state determination circuit 26a that forms a closed state determination unit.

Next, the operation of the present embodiment will be described with reference to FIG. FIG. 10 shows a processing procedure representing a representative operation of this embodiment.
With the insufflation system 1 set as shown in FIG. 1, when the insufflation apparatus 3 is powered on, the controller 26 in the insufflation apparatus 3 starts control.
In the first step S1, the operator inputs, from the panel 27 or the like, a setting pressure which is a target abdominal pressure to be targeted when insufflating the abdominal cavity 2a with respect to the insufflation apparatus 3 constituting the insufflation system 1 . The controller 26 stores the input set pressure in, for example, the memory 26b, and controls the air supply operation so that the pressure in the abdominal cavity 2a becomes the set pressure.
In the next step S 2, the operator turns on the switch of air supply start from the panel 27 and inputs a signal of air supply start to the controller 26.
When the controller 26 receives the signal to start air supply, it opens the solenoid valve 23 from the closed state as shown in step S3. When the solenoid valve 23 is opened, the carbon dioxide gas of the gas cylinder 10 is supplied into the abdominal cavity 2a through the air supply passage 11, the air supply tube 12, and the first trocar 13 as described above.

The controller 26 determines whether or not the switch for ending air supply (or insufflation) from the operator is turned on in step S4, and in the case of a determination result in which this switch is not turned on, the processing of steps S5 to S11 is performed. If it is determined in step S11 that the determination result is neither severe partial occlusion nor complete occlusion, the process returns to step S4. When the switch for the end of air supply (or insufflation) is turned on in step S4, the process proceeds to step S14.
In the case of the determination result of severe semi-occlusion or complete occlusion in step S11, the controller 26 stops the operation of the measurement pipeline system 19 in the next step S12 and performs intermittent air supply control processing.
In the intermittent air supply control process, the operation of the measurement conduit system 19 is stopped, and the abdominal pressure is set to the set pressure by alternately performing the carbon dioxide gas supply and the measurement of the abdominal pressure by the air supply conduit system 14. In this way, carbon dioxide gas is sent out intermittently so as to become an air supply system.
In the control of this intermittent air supply, although the air supply efficiency is lowered as compared with the air supply system using the measurement conduit system 19, for the treatment by the treatment tool 6 under the observation by the endoscope 5 It can be set to a state of insufflation during surgery.

In the control of this intermittent air supply, the controller 26 intermittently turns ON / OFF the solenoid valve 23 because the information on the abdominal pressure measured by the pressure sensor 32 provided in the measurement pipeline 16 can not be obtained. The air supply and the air supply stop are performed intermittently, and when the air supply is stopped, the measurement pressure of the air supply passage 11 measured by the pressure sensor 25 is acquired as an intra-abdominal pressure. Then, the controller 26 controls the output of the electro-pneumatic proportional valve 22 when the electromagnetic valve 23 is opened and air is supplied by the control signal based on the measured pressure.
In the case of a determination result in which the switch for ending air supply is not turned on in step S4, the controller 26 acquires the measurement pipeline internal pressure measured by the pressure sensor 32 as the abdominal pressure in the next step S5. In this case, since the other end of the measurement pipeline 16 is closed by the solenoid valve 31, the measurement pipeline internal pressure measured by the pressure sensor 32 is the measurement pressure of the abdominal cavity pressure.
In the next step S6, the controller 26 applies a control signal to the electro-pneumatic proportional valve 22 based on the measurement pressure of the abdominal cavity pressure acquired in step S5 to set the output (valve opening / closing amount) of the electro-pneumatic proportional valve 22 Or control).

Immediately after the start of insufflation, the measured abdominal pressure is much lower than the set pressure, so the output of the electro-pneumatic proportional valve 22 is controlled to be a large value, and the measured abdominal pressure is the set pressure. It is controlled to lower the output of the electro-pneumatic proportional valve 22 as it approaches. As the measured pressure of the abdominal cavity pressure approaches the set pressure, the controller 26 controls the output of the electropneumatic proportional valve 22 to be reduced, so that the abdominal cavity pressure can be prevented from largely exceeding the set pressure.
In the next step S7, the controller 26 periodically acquires the air flow rate measured by the flow rate sensor 24.
In the next step S8, the controller 26 calculates the integrated flow rate Q from the acquired air flow amount. The controller 26 integrates the amount of air flow periodically acquired in step S7 to calculate an integrated flow rate Q.
In the next step S9, the controller 26 determines whether or not the integrated flow rate Q is equal to or greater than a threshold Qth set in advance with respect to the integrated flow rate Q. The threshold value Qth is set to about 0.3 to 1.5 L. If the integrated flow rate Q is less than the threshold value Qth, the process returns to step S4. The processing from step S4 to step S9 is repeated, for example, in a cycle of about 10 ms.

For the determination result of the integrated flow rate Q in step S9 being equal to or greater than the threshold value Qth, the blockade state determination circuit 26a of the controller 26 in the next step S10 performs a blockage state determination operation of determining the blockage state. In addition, the controller 26 (the closed state determination circuit 26a) resets the value of the integrated flow rate Q when performing the closed state determination operation of determining the closed state. Therefore, the blocking state determination circuit 26a performs the blocking state determination operation each time the integrated flow rate Q becomes equal to or more than the threshold value Qth. This closed state determination operation will be described in detail with reference to FIG.
In the next step S11, the blockage state determination circuit 26a determines whether or not the current state of the measurement pipeline system 19 is in the state of severe semi-occlusion or complete occlusion based on the blockage state determination operation of step S10. . If it is determined that the current state of the measurement pipeline 19 is not the state of severe semi-occlusion or total occlusion, the process returns to step S4.
Thus, in the case where the current state of the measurement conduit system 19 is a determination result that is not a state of severe semi-occlusion or complete occlusion (in other words, the determination of a current state of the measurement conduit system 19 is a mild semi-occlusion or non-occlusion state In the case of a result), the controller 26 performs continuous air supply control in steps S4 to S11.

In this continuous air supply control state, in a period other than the blockade state determination process in step S10, as shown in step S5, the controller 26 continuously supplies the air flow amount according to the measured value of the abdominal pressure measured by the pressure sensor 32. Control.
On the other hand, since the measurement pressure of the pressure sensor 32 is not the abdominal pressure in the period when the blockage state determination processing of step S10 is performed, the measured value of the abdominal pressure by the pressure sensor 32 immediately before opening the solenoid valve 31 The air flow amount during a period in which the blockage state determination process of step S10 is performed is controlled (the air flow amount is continued). This period is about 300 ms, and even if the air supply based on the measurement value of the abdominal pressure by the pressure sensor 32 is continued immediately before the electromagnetic valve 31 is opened during that period, the possibility of oversupply is small.
In the determination process of step S11 in FIG. 10, when the current state of the measurement pipeline system 19 is the determination result of the state of severe semi-occlusion or complete occlusion, the process proceeds to the next step S12. In step S12, the controller 26 stops the operation on the measurement conduit system 19 side, and controls the intermittent air supply using the air supply conduit system 14.

In the next step S13, the controller 26 determines whether or not the switch for ending air supply is turned on by the operator, and in the case of a judgment result in which this switch is not turned on, the process returns to step S12, and intermittent feeding is performed. Continue to control your mind. On the other hand, when the switch for ending air supply is turned on, the process proceeds to step S14. In step S14, the controller 26 closes the solenoid valve 23, and ends the process of insufflation (air supply) of FIG.
Next, the blockage state determination processing will be described with reference to FIG. Although the control in each step in FIG. 11 is described as being performed by the controller 26, it may be performed by the closed state determination circuit 26a.
When the blockage state determination process starts, in the first step S21, the controller 26 detects (acquires) the measured pressure in the pipeline measured by the pressure sensor 32 in the state where the solenoid valve 31 is closed as the measured pressure Pa of the abdominal pressure Ru.

In the next step S22, the controller 26 calculates (sets) the threshold pressures Pth1, Pth2 and Pth3 according to the equations (2) to (4) described above using the measured pressure Pa acquired in step S21. That is, Pth1 = Pa × 0.50, Pth2 = Pa × 0.30, and Pth3 = Pa × 0 are calculated. Then, for example, information of threshold pressures Pth1, Pth2 and Pth3 is stored in the memory 26b.
In the next step S23, the controller 26 opens the solenoid valve 31. In the next steps S24 and S25, the controller 26 measures the measurement pressure of the measurement pipeline internal pressure measured by the pressure sensor 32 in a cycle of 10 ms, for example, until 100 ms elapses (from the time when the solenoid valve 31 is opened). Acquire and detect the minimum value Pb.
Therefore, in step S24, the controller 26 acquires the measurement pressure of the measurement pipeline internal pressure measured by the pressure sensor 32 in a cycle of 10 ms, for example, and 100 ms in step S25 elapses to detect the minimum value Pb. Repeat until.

In the next step S26, the controller 26 closes the solenoid valve 31. In the next step S27, the controller 26 compares the detected minimum value Pb of the measured pressure with the threshold pressure Pth1. If the comparison result is not Pb <Pth1, the controller 26 determines in the next step S28 that the blocked state of the measurement pipeline 19 is non-blocked. On the other hand, when the determination result in step S27 is Pb <Pth1, the controller 26 compares the minimum value Pb with the threshold pressure Pth2 in step S29.
If the comparison result is not Pb <Pth2, in the next step S30, the controller 26 determines that the blocked state of the measurement pipeline 19 is a slight semi-block. On the other hand, when the determination result in step S29 is Pb <Pth2, in step S31, the controller 26 compares the minimum value Pb with the threshold pressure Pth3.
If the comparison result is not Pb ≦ Pth3, in the next step S32, the controller 26 determines that the blockage state of the measurement conduit system 19 is severe semi-occlusion. On the other hand, when the determination result in step S31 is Pb ≦ Pth3, in step S33, the controller 26 determines that the blockage state of the measurement conduit system 19 is complete blockage.

After the processes of steps S28, S30, S32, and S33, the controller 26 performs the process of 200 ms waiting for an elapse of time in step S34, and ends the process of FIG. In addition, the controller 26 waits for the pressure in the measurement pipeline 16 temporarily decreased by opening the solenoid valve 31 by performing the process of step S34 to return to the original level (abdominal pressure). Processing.
This situation is shown in FIG. As shown in FIG. 12, the pressure measured by the pressure sensor 32 is reduced to the minimum value Pb within 100 ms from the time when the solenoid valve 31 is opened, and in many cases, it is opened until 200 ms elapses. Return to the level of the abdominal pressure before.
In the process shown in FIG. 10, when the air supply end switch is OFF, as shown in FIG. 13, the continuous feed in step S36 according to the determination result of the blockage state determination process of step S10 and the determination process of step S11. The air control and the intermittent air supply control of step S12 are performed.

In the determination process of step S11, in the case of the determination result of non-occlusion or slight semi-occlusion, the controller 26 performs continuous air supply control, and returns to the occlusion state determination process. In this case, continuous insufflation is repeated.
On the other hand, in the determination process of step S11, in the case of the determination result of severe semi-occlusion or complete occlusion, the controller 26 performs intermittent air supply control. In this case, the controller 26 is in a state in which the operation of the measurement conduit system 19 is stopped. In other words, the controller 26 controls intermittent air supply using only the air supply conduit system 14 side.
Moreover, FIG. 14 shows the process of intermittent air supply control in FIG.
If it is determined in step S11 that the state of severe semi-occlusion or complete occlusion is present, the controller 26 performs processing for stopping the operation of the measurement pipeline system 19 as shown in step S40 and then performs intermittent air supply. Control the
When the intermittent air supply control starts, the controller 26 closes (temporarily) the solenoid valve 23 in step S41. Then, in the next step S42, the controller 26 waits for a predetermined time (for example, 100 ms) to elapse after closing the solenoid valve 23. This is a process for stabilizing the pressure in the air supply conduit 11. Then, in the next step S43, the controller 26 acquires (or detects) the air supply passage internal pressure measured by the pressure sensor 25 provided in the air supply passage 11 as a measurement value of the abdominal pressure.

In the next step S44, the controller 26 obtains the difference between the target pressure for the abdominal pressure and the measurement pressure of the abdominal pressure obtained in step S43, and sets the output of the electropneumatic proportional valve 22 according to the obtained difference. Do.
In the next step S45, the controller 26 (temporarily) opens the solenoid valve 23. When the solenoid valve 23 is opened, carbon dioxide gas is fed into the abdominal cavity through the gas feeding passage 11, the gas feeding tube 12 and the trocar 13 at the pressure adjusted by the electropneumatic proportional valve 22. In the next step S46, the controller 26 waits for a predetermined time (for example, 100 ms to 200 ms) to elapse from the time when the solenoid valve 23 is opened.
Then, when the predetermined time has elapsed, the controller 26 determines whether or not the air supply end switch is turned on in step S13, and in the case of a determination result that is not turned on, the process returns to the process of step S41. Thus, the controller 26 controls to perform the operation of intermittently supplying air. The intermittent air supply control is not limited to the control procedure shown in FIG. 10, and a known intermittent air supply control may be performed.

According to the present embodiment that operates in this manner, the closed state of the measurement conduit system 19 can be determined with high accuracy.
Further, according to the present embodiment, since the operation of the insufflation can be continued further according to the determined occlusion state, the operator performs the operation with the treatment tool 6 under observation by the endoscope 5 Can be done smoothly.
Specifically, when the occlusion state is determined to be non-occlusion or slight semi-occlusion, the operation is performed in a state in which the abdominal pressure substantially equal to the set pressure is maintained by performing air supply control as in the non-occlusion case. The person can smoothly perform the operation with the treatment tool 6 under observation by the endoscope 5.
On the other hand, when it is determined that the occlusion state is severe semi-occlusion or complete occlusion, the operation of the measurement conduit system 19 is stopped and the operator is intermittently supplied with air on the air supply conduit system 14 side. Can also ensure the function of performing surgery with the treatment tool 6 under observation with an endoscope.
Next, a modification of the first embodiment will be described. This modification has the same configuration as the first embodiment shown in FIG. 1 etc., but this modification allows changing the threshold Qth of the integrated flow rate Q to, for example, two thresholds Qth1 and Qth2. There is. In this case, the threshold Qth1 is the same as the threshold Qth of the first embodiment (Qth1 = Qth), and the threshold Qth2 is 1/2 (Qth2 = Qth1 / 2) of the threshold Qth1 or Qth.

In the first embodiment, the same continuous air supply is performed in the case of non-occlusion and slight semi-occlusion, but in the present modification, when the occlusion state is non-occlusion, the first embodiment and The same continuous air supply is performed, and in the case of slight semi-occlusion, the same continuous air supply as in the first embodiment is performed using a small threshold value Qth2. By reducing the threshold value, the process of determining the occlusion state is performed more frequently (in the case of non-occlusion). A user such as an operator can set the thresholds Qth1 and Qth2 from the panel 27, for example. Then, the panel 27 forms a threshold value setting unit or setting unit that sets the threshold values Qth1 and Qth2 corresponding to the determination result of the closed state by the closed state determination circuit 26a. The above-described thresholds Qth, Qth1, and Qth2 form thresholds for determining the conditions under which the blockage state determination circuit 26a determines the blockage state during the air supply operation. The threshold values Qth1 and Qth2 are also threshold values set according to the determination result of the blockage state by the blockage state determination circuit 26a.
If it is determined that the blockage state is a slight semi-blocked state, the blockage progresses gradually due to a state in which the measurement tube 17 in the measurement pipe line system 19 is bent or foreign matter intrudes into the measurement pipe line system 19 or the like. It is assumed that
Therefore, in the present modification, by increasing the implementation frequency of the blockage state determination process, even if the case of a severe semi-occlusion state occurs, the state can be detected (or determined) promptly. Do. If the determination result changes from slight semi-occlusion to non-occlusion after the determination of minor semi-occlusion, the threshold Qth2 is returned to the original threshold Qth1 (= Qth).

The processing procedure of this modification is as shown in FIG. FIG. 15 shows the contents in which a part of the processing in FIG. 10 is changed, so a simplified notation method is adopted. In FIG. 15, the threshold Qth1 (= Qth) is selected in the case of non-occlusion by the occlusion state determination processing in FIG. 10, and the threshold Qth2 (= Qth1 / 2) is selected in the case of slight semi-occlusion to continuously transmit I try to do my best. That is, the flow chart of FIG. 15 is the contents of the flow chart of FIG. 10 modified from the processing of continuous air supply in the case of non-occlusion and the process of continuous air supply in the case of slight semi-occlusion. The same processing as that of the embodiment of FIG.
As shown in FIG. 15, when it is determined in the closed state determination process of step S10 that the controller 26 is in the non-closed state, the controller 26 performs the process of selecting the threshold value Qth1 in step S51, and returns to the process of step S4.
When it is determined in the blockage state determination process of step S10 that the state is a slight semi-occlusion state, the controller 26 performs the process of selecting the threshold value Qth2 (= Qth / 2) in step S52, and then the process of step S4. Return to
Steps S <b> 4 to S <b> 10, S <b> 51, and S <b> 52 in FIG. 15 are control processes of continuous air supply in which air supply is continuously performed based on the measurement pressure of the pressure sensor 32.

On the other hand, if it is determined in step S10 that the state is severe semi-occlusion or complete occlusion, the controller 26 operates the measurement pipeline 19 as shown in step S40 (shown in FIG. 10). And stop control of intermittent air supply as shown in step S12.
According to this modification, the same effect as that of the first embodiment is obtained, and in the case of the determination result of minor semi-occlusion, the determination result of the minor semi-occlusion is more appropriate than that of the first embodiment. Air supply control can be performed. In this modification, although the threshold Qth1 and Qth2 of the integrated flow rate are set as an example of different threshold values corresponding to the determination result of non-occlusion and slight semi-occlusion, the threshold Qth1 and Qth2 of the integrated flow rate are described. Other threshold values may be set. For example, the first threshold Tth1 and the second threshold Tth2 (Tth1> Tth2) may be set for the air supply time. In this case, the timer in the controller 26 measures the time, and when it is determined that the state is non-occlusion, the occlusion state determination circuit 26a is closed every time the measured time reaches the first threshold Tth1. If it is determined that the semi-occlusion is slight, the occlusion state determination circuit 26a determines the occlusion state every time the measured time reaches the second threshold Tth2 (the controller 26 sends the air). The operation and the operation of the closed state determination circuit 26a may be controlled).

Even when the thresholds Tth1 and Tth2 of the insufflation time are set in this manner, as in the case of the threshold Qth1 and Qth2 of the integrated flow rate, when the occlusion state is determined to be a slight semi-occlusion, it is determined to be non-occlusion. The blockage state determination process is performed more frequently than in the case of the above case, and the same effect as in the case of the integrated flow rate thresholds Qth1 and Qth2 is obtained.
In addition to this, according to the determination result of non-occlusion and slight semi-occlusion, set the first threshold and the second threshold that differ in the amount of increase in abdominal pressure, and according to the determination result of non-occlusion and minor semi-occlusion As described above, the first threshold and the second threshold that are actually used may be set (selected) to be switched.
In the modification and the first embodiment described above, a pressure sensor 32 forming a pressure measurement unit provided in the measurement pipeline 16 and an end portion of the measurement pipeline 16 and a gas outlet for discharging a predetermined gas, The throttling member that generates a pressure difference between and 形成 can be formed using a throttling 33 that has a flow path resistance greater than that of the measurement pipeline 16, or may be formed using a filter. Alternatively, a solenoid valve with a small orifice diameter may be used as the solenoid valve 31 to double as the function of the throttle 33. By using a solenoid valve having a small orifice diameter as the solenoid valve 31 as described above, the throttle 33 can be omitted. Further, within the scope of the description of the specification, the components of each claim constituting the insufflation system may be changed.

DESCRIPTION OF SYMBOLS 1 ... abdominal cavity system, 2 ... patient, 2a ... abdominal cavity, 3 ... endoscope apparatus, 4 ... endoscope, 5 ... treatment instrument, 7 ... video processor, 8 ... monitor, 9 ... (carbonic acid) gas cylinder, 11 ... 12: air feeding tube, 13: first trocar, 14: air feeding system, 15: second trocar, 16: (first) measuring line, 17: measuring tube, 19: measuring Pipeline system, 21: pressure reducer, 22: electropneumatic proportional valve, 23: (first) solenoid valve, 24: flow sensor, 25: (first) pressure sensor, 26: controller, 26a: closed state determination Circuit 26b memory 27 panel 31 (second) solenoid valve 32 (second) pressure sensor 33 aperture stop 35 closed portion

Claims (3)

An insufflation apparatus having a control unit that controls an insufflation operation at the time of insufflation of a predetermined gas;
An air supply passage connected at one end to a first trocar inserted into the abdominal wall and connected at the other end to the insufflation apparatus to supply the predetermined gas;
A second measurement line for measuring the pressure in the abdominal cavity, one end of which is connected to the second trocar pierced into the abdominal wall and the other end of which is connected to one end of the first measurement line of the insufflator device. When,
A pressure measurement unit provided on the first measurement line for measuring the pressure in the first measurement line;
An openable / closable gas outlet at the other end of the first measurement line for discharging the predetermined gas;
A throttling member provided on the first measurement conduit and generating a pressure difference between the pressure measurement unit and the gas outlet;
From the pressure measurement result of the pressure measurement unit generated by the throttling member when the gas discharge port is opened, the blockage state of the measurement line consisting of the first measurement line and the second measurement line is determined An occlusion state determination unit,
A setting unit that sets a threshold that determines a condition under which the closed state determination unit determines the closed state during the insufflation operation;
Have
The closed state determination unit
A non-occlusion state, which is a normal state in which the measurement line is not occluded;
A slight semi-occlusion state in which the measurement conduit is in a slight occlusion state and the pressure in the abdominal cavity can be measured;
A severe semi-occlusive condition in which the measurement line is in a severe obstructive condition, which may mismeasure the pressure in the abdominal cavity;
Total occlusion where the measurement line is completely blocked and the pressure in the abdominal cavity can not be measured,
Makes it possible to judge any of
The control unit continuously supplies the predetermined gas to the abdominal cavity in the non-occlusion state or the slight semi-occlusion state according to the determination result of the occlusion state determination unit, and the severe semi-occlusion state or In the case of complete occlusion, control is performed so that the predetermined gas is intermittently supplied to the abdominal cavity, and in accordance with the determination of the occlusion by the occlusion determination unit, determination as the slight semi-occlusion Determination of the closed state by the closed state determination unit during the insufflation operation than the threshold when the closed state is determined to be the non-closed state as the threshold set by the setting unit in the case where The insufflation system according to the present invention is controlled to perform the air supply operation of the predetermined gas by switching the threshold value so as to perform more frequently . The closed state determination unit
Intra-abdominal pressure measured by the pressure measuring unit when the gas outlet is closed;
A first threshold pressure Pth1 lower than the intra-abdominal pressure,
A second threshold pressure Pth2 lower than the first threshold pressure,
A third threshold pressure Pth3 lower than the second threshold pressure,
Hold the information of
When the pressure measurement result of the pressure measurement unit when the gas discharge port is opened is Pb,
Being in the non-blocked state when Pb>Pth1;
In the case of Pth1 ≧ Pb> Pth2, the above-mentioned slight semi-occlusion state,
The severe semi-occlusive state when Pth2 ≧ Pb>Pth3;
In the case of Pb ≦ Pth3, the above-mentioned completely closed state is obtained,
The insufflation system according to claim 1, characterized in that each is determined. Furthermore, an air flow amount integrating unit that calculates an integrated flow rate obtained by integrating an air flow amount of the predetermined gas supplied to the abdominal cavity through the air supply conduit,
A determination unit that determines whether the integrated flow rate calculated by the air flow rate integration unit is equal to or greater than a first threshold or a second threshold that is smaller than the first threshold;
Equipped with
The control unit is configured to determine the closed state each time the integrated flow rate is determined to be equal to or higher than the first threshold when the closed state determination unit determines that the non-closed state is set. Continuously feeding the predetermined gas in a state of
When it is determined by the closed state determination unit that the slight semi-closed state is present, the closed state determination unit determines the closed state each time it determines that the integrated flow rate is equal to or higher than the second threshold. The insufflation system according to claim 1, wherein a predetermined gas is controlled to be continuously insufflated.

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