JPH0761331B2 - Abdominal dilator - Google Patents

Description

Description: TECHNICAL FIELD The present invention relates to a device for expanding a pneumoperitoneum (abdominal dilator) for endoscopy.

BACKGROUND ART In endoscopy and surgery, especially in the abdomen, it is common to fill the pneumoperitoneum with carbon dioxide so that the internal organs to be treated are properly delivered to the optical and surgical instruments. On rare occasions, the pneumoperitoneum collapses, which poses a risk of damaging internal organs with the surgical instrument that was inserted when the abdominal wall contracts.

Further, there are cases where the use of pneumoperitoneum of carbon dioxide is impossible or unacceptable, but needless to say, in such a case, it is desirable that the endoscopic examination of the abdominal cavity can be performed safely.

One of the medical instruments used for endoscopy is DE-37 09 706
It is disclosed in A1. The instrument has a rod, the end of which has a first position and a second position which are in line with the rod.
There is at least one element between and. The element is made of wire or a flexible, round trunk material that separates obstructing tissue from the organs and allows treatment of the desired organs, thus arching in the pneumoperitoneum. Spread to some extent. However, said elements are not suitable for carrying large loads.

DISCLOSURE OF THE INVENTION An object of the present invention is to provide a device for preventing the pneumoperitoneum from collapsing during endoscopy or surgery.

According to the invention, this object is achieved by the features stated in claim 1.

The rod can be introduced into the pneumoperitoneum through the patient's abdominal wall in the first position, either directly or through a trocar sleeve. When the rod is inserted until the movable element is completely in the pneumoperitoneum, the movable element is swung out to the second position. This swing is by an operating linkage located on or in the rod and coupled to a position remote from the pivot axis of the movable element,
Or with surgical instruments introduced through other trocar sleeves. In this drawn position,
To expand the pneumoperitoneum, the rod is pulled proximally. To prevent gas from escaping the puncture of the abdominal wall, the abdominal dilator of the present invention is an advanced version of the abdominal dilator with a circular sealing plate that can be attached to any position on the rod.

For this purpose the sealing plate is attached to the longitudinal end of the sleeve. The sleeve surrounds the rod tightly and can be fixed to the rod by a fixing screw perpendicular to the rod. In this way, the abdominal wall is fixed between the movable element and the sealing plate, which ensures that gas leakage from the puncture position is prevented. If a ring seal is used, then an exact fit between the sleeve and rod is not required.

The abdominal dilator of the present invention may also be in the form of a foldable anchor that has multiple movable elements. An example thereof is an umbrella-like one in which the movable element is arranged in a rotationally symmetrical shape around the rod, if possible. For this purpose, the movable element may be hinged, for example hinged, at its proximal end so that it can be swung out relative to the rod.

In a further development of the invention, the long movable element is hinged centrally towards the rod and in its first position forms a cylinder with said rod. It can be introduced without problems via the trocar sleeve.

When the dilator of the present invention is used without a trocar sleeve, the patient proximal end of the movable element in the first position is designed to minimize damage to the abdominal wall during puncture. It may be tapered. If the dilator of the present invention is always used with a trocar sleeve, it is desirable that the longitudinal ends of the movable element be rounded to prevent damage.

In the event of a rapid pressure drop in the pneumoperitoneum, the abdominal dilator of the present invention can be introduced through the already inserted trocar sleeve. However, if pneumoperitoneum dilation by rapid insufflation is not desirable, for example at high risk of thrombosis, it is appropriate to use one or two abdominal dilators in a prophylactic sense. .

When the pneumoperitoneum of carbon dioxide is not preferable, it is advantageous to make the dilator or the present invention of a porous structure. This can be done, for example, by providing an air duct formed parallel to the axis of the dilator and connecting the pneumoperitoneum and the outside air. The air duct may include a unidirectional shutoff valve that allows passage of gas in only one direction. If this valve is gas
If the pneumoperitoneum is mounted so that it can be inverted inside the duct, it can be set whether the pneumoperitoneum is inflated or collapsed. With this, in the first case, it is possible to allow only gas (generally air) to enter the pneumoperitoneum, and in the second case, it is possible to set so that only gas can be discharged from the pneumoperitoneum. Becomes

The perforated dilator is usually introduced through a trocar sleeve, which can also be withdrawn when the movable element is inserted or swung out. Another advantage of the perforated dilator is the natural inhalation action that allows air to flow into the abdominal cavity from the outside when the abdominal wall is raised. Further, according to the dilator of the present invention, it becomes possible to diagnose a difficult-to-understand topological anatomical site relatively easily.

Hereinafter, the present invention will be described in detail with reference to the accompanying drawings in connection with an example of a perforated or non-perforated abdominal dilator according to the present invention.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a partial cross-sectional side view of a bidirectionally insertable abdominal dilator with a sealing plate.

2-5 are the abdominal dilators of FIG. 1 with the trocar sleeve inserted into the pneumoperitoneum through the abdominal wall to inflate the pneumoperitoneum.

FIG. 6 is a partial cross-sectional side view of a dilator having a perforated structure.

BEST MODE FOR CARRYING OUT THE INVENTION FIG. 1 shows a bidirectionally insertable abdominal dilator 10 during extension. For clarity, only one longitudinal end of the dilator is shown, but the other longitudinal end may be identical or similar. The dilator 10 of the present invention is configured to include a rod 12 having a distal end 14 of the rod 12.
A movable element 16 is hinged to the. The movable element 16 is aligned with the rod 12 in its first position and laterally with respect to the rod 12 in its second position (FIGS. 3-5). A sleeve 18 is attached to the rod 12, and is fixed to the rod 12 with a fixing screw 20 perpendicular to the rod 12. At the tip of the sleeve 18 is a sealing plate 22. When the dilator 10 is inserted into the pneumoperitoneum, the movable element 16 is swung out, and the dilator 10 is pulled to expand the pneumoperitoneum.
The plate 22 is pressed against the abdominal wall to prevent gas leakage from the puncture position on the abdominal wall. For this purpose, the sleeve 18 encloses the rod 12 tightly and / or a seal is provided between the sleeve 18 and the rod 12. Advantageously, this seal is in the form of a rubber or plastic ring. The movable elements 16 at both ends 14 in the longitudinal direction of the dilator 10 may be swung in the same direction or may be swung in the opposite directions. The diameters of both longitudinal ends 14 of the dilator differ from those shown in the figures and need not be the same at both ends. For example, one end may be 5 mm and the other end may be 10 mm. One end of the dilator in the long axis direction may be perforated as described below. The bidirectional insertable abdominal dilator of the present invention is easy to hold and replace.

The operation of the abdominal dilator 10 of the present invention will be described with reference to FIGS. The same reference numerals are used for the same parts as in FIG.

The abdominal dilator 10 of the present invention is introduced into the pneumoperitoneum 28 through the patient's abdominal wall 26 using the trocar sleeve 24 (FIG. 2). The elongated movable element 16 is moved from the previous position in which it is aligned with the rod 12 to the second lateral direction which is lateral to the rod 12.
Is drawn to the position. In this example, this is done with the aid of other surgical instruments introduced through another trocar sleeve of the pneumoperitoneum. The swinging and swinging of the movable element is performed by an operating linkage passing on or through said rod, or by weight, or by a biased spring. After swinging out the movable element 16, the trocar sleeve 24 is first pulled proximally from the pneumoperitoneum. The dilator 10 is then also moved proximally (Fig. 4) until the movable element 16 contacts the abdominal wall 26 of the patient (Fig. 5). The dilator
10 is tensioned proximally, which lifts the abdominal wall 26 and also inflates (expands) the pneumoperitoneum 28.

The movable element at the other end of the dilator can also be different by having the proximal end of the dilator of the present invention have different diameters or movable elements of different lengths.

At the position of the dilator 10 of the present invention shown in FIG.
The plate 22 is pressed against the outside of the abdominal wall 26 and the fixing screw 20
It is fixed to the rod 12 with. A suitable diameter of this sealing plate is about 50 mm, and the dilator has a diameter of 5 mm or 10 mm.

A bi-directional insertable dilator 30 with an elongated rod-shaped body 32 is shown in FIG. An axial duct 36 extends to the longitudinal end 34 of the rod 32. The duct 36 ensures a pressure balance between the pneumoperitoneum and a gas storage space outside the pneumoperitoneum (for example, an operating room or outside air). The reduced pressure when the abdominal cavity is expanded is balanced by the duct 36. A valve 38 is screwed to the opening of the duct 36 on one side of the dilator 30 that can be inserted from any direction, and allows the gas to flow in only one direction. This valve is designed to be rotatable about an axis perpendicular to the plane of the drawing, so that the flow direction can be reversed. As a result, the gas flow direction can be systematically controlled in only one direction. The outlet of the valve 38 may be left open, or may be connected to a gas container of a predetermined pressure and / or a designated gas. Therefore, the dilator of the present invention can also be used to set the pneumoperitoneum to a specific pressure.

Generally, the dilator or prong of the present invention, which is insertable or extendable from either direction, is mounted through a trocar sleeve having a diameter of 5 mm or 10 mm. After placement in the abdominal cavity, the trocar sleeve may be removed. The perforated dilator of the present invention draws in air from the surroundings, which is advantageous when carbon dioxide pneumoperitoneum is not desirable.

Claims (13)

[Claims] 1. A peritoneal dilator usable for endoscopy, comprising a rod (12), at the end (14) of which at least one element (16) is provided.
Located between a first position and a second position that are in the same direction with respect to 2), and the element (16) is rod-shaped and is a movable element (16).
Is movably hinged to the rod (12) at substantially the center thereof, and the movable element (16) is oriented substantially at right angles to the rod (12) at the second position. Abdominal dilator to do. 2. The abdominal dilator of claim 1, wherein the first
In the position, the abdominal dilator is characterized in that the rod (12) and the movable element (16) form a cylinder. 3. The abdominal dilator of claim 2, which is introduced through a trocar sleeve, wherein the outer diameter of the cylinder corresponds to the inner diameter of the trocar sleeve. And abdominal dilator. 4. The abdominal dilator according to any one of claims 1 to 3, wherein the movable element (16) has a distal end in the longitudinal direction at the first position. An abdominal dilator characterized by. 5. The abdominal dilator of any one of claims 1 to 4, wherein the rod (12) has an operating linkage for a movable element (16), the movable element (16). Operating system above
The abdominal dilator, wherein the attachment part of the linkage is separated from the hinge connection part of the movable element (16). 6. The abdominal dilator according to claim 1, wherein the movable element (16) can be held at a predetermined position by being biased by a spring. 7. The abdominal dilator according to any one of claims 1 to 6, wherein a sealing plate (22) is fixed to the rod (12), and the sealing plate (22) is fixed.
Surrounds the rod (12) in a circular shape, and the sealing plate (22) substantially surrounds the rod (12) at the distal end of the sleeve (18) in the long axis direction. An abdominal dilator, which is made and can be fixed to the rod (12) with a fixing screw (20) perpendicular to the rod. 8. The abdominal dilator of claim 7, wherein the ring
Celiac dilator, wherein the seal is between the sleeve (18) and the rod (12). 9. The abdominal dilator according to any one of claims 1 to 8, wherein the two abdominal dilators of the abdominal dilator (10) are provided in two longitudinal directions in order to allow insertion in any of two directions. Edge (1
Each of 4) has a movable element (16), and each of the two movable elements (16) is hinged to a rod (12) so that the movable element (16) can be swung in the same direction or in the opposite direction. Dilator. 10. The abdominal cavity dilator according to claim 1, wherein the abdominal cavity dilator (10) has longitudinal ends (14) having different diameters from each other. Dilator. 11. The abdominal dilator according to any one of claims 1 to 10, wherein the abdominal dilator as a perforated abdominal dilator (30) serves as a gas supply source for the pneumoperitoneum, and particularly for the outside air. An abdominal dilator having an axially extending duct (36) for tying. 12. The abdominal dilator according to claim 11, wherein the duct (36) is provided with a unidirectional shutoff valve (38). 13. The abdominal dilator according to claim 12, wherein the closing direction of the valve (38) is reversible.