KR20160130638A

KR20160130638A - Fixator for thoracoscopic surgery

Info

Publication number: KR20160130638A
Application number: KR1020150062666A
Authority: KR
Inventors: 양희철
Original assignee: 국립암센터
Priority date: 2015-05-04
Filing date: 2015-05-04
Publication date: 2016-11-14
Also published as: WO2016178504A1

Abstract

The present invention relates to a fixation device for gripping a tissue to be removed during a thoracoscopic operation, the fixation device comprising: a body detachable portion provided on the other side and including a pair of extension portions whose distal end portions can be varied in distance by a pair of handle portions; And a clamping part including a clamp detachable part detachably coupled to the main body detachable part and at least a pair of clamps holding the tissue in cooperation with the operation of the handle part.

Description

{FIXATOR FOR THORACOSCOPIC SURGERY}

The present invention relates to a fixation device for a thoracoscopic surgery, which allows removal and fixation of a holding part for gripping and fixing a tissue, and which can be operated with minimal incision.

Traditionally, thoracotomy has been used to open the chest wall from the side of the chest to the back to treat trauma and other diseases in the chest cavity. This surgery has a wide field of view, but it has a drawback that the incision is large and the pain is severe and the recovery time is long. In addition, because there is a gap between the bones of the chest, there may be nerve damage, and the degree of satisfaction in terms of cosmetics is low.

In order to overcome these drawbacks, a thoracoscopic surgery method was developed in which three to four skin incisions were made in the skin 2-3 cm in diameter, and a hole was made and the medical camera, thoracoscopic and surgical instrument, come.

At this time, when the body tissue is smooth or moving, such as the lung, it is easy to miss the nodule. Therefore, the organ is fixed and the operation is proceeded.

The size of the fixator used in conventional thoracoscopic surgery was large, so the incision site for insertion into the patient 's chest was large. This leads to a longer recovery time for the patient and a greater burden on the scar and pain. In order to achieve this, it is necessary to purchase several different apparatuses having different phage sizes, which is economically burdensome. When all of the apparatuses are placed in the surgical field, the volume The space was inefficient in terms of management.

Korea Publication No. 2013-0027966 (published on Mar. 18, 2006)

Accordingly, it is an object of the present invention to provide a fixation device for a thoracoscopic surgery that minimizes skin incision in a patient with thoracoscopic surgery and can easily select and apply various sizes of gripper according to the situation, will be.

The object of the present invention is to provide a fixing device for holding tissue to be removed in a thoracoscopic surgery, comprising a pair of handle portions provided on one side and a pair of handle portions provided on the other side, A clamp detachable portion detachably coupled to the main body detachable portion, and at least a pair of clamps for holding the tissue in cooperation with the operation of the handle portion And a clamping portion for clamping the clamping portion.

The extension part is elongated along the inserting direction in the body, and the sectional area cut along the vertical direction of the length may not substantially change.

At least a portion of the surfaces of the pair of clamping portions may be treated with silicon.

The pair of main body attaching / detaching portions and the pair of clamp attaching / detaching portions can be detachably attached by magnetic force.

One of the ends of the pair of main body attaching / detaching portions and the end of the pair of clamp attaching / detaching portions may be detachably coupled to the other in the form of an embossed shape and the other of which is engraved.

The pair of main body attaching / detaching portions and the pair of clamp attaching / detaching portions can be detachably attached by a spiral screw method.

The clamping portions are provided in a plurality of pairs, and each pair can have clamps of different sizes.

At least a part of the clamping part may be provided in different colors for respective sizes.

The clamp may be ring type.

Clamps can face each other.

The cross sectional area cut in the vertical direction of the extension portion plane may be smaller than the maximum cross sectional area cut in the direction parallel to the vertical direction in a state where the clamping portion and the main body attaching / detaching portion are engaged.

According to the present invention, it is possible to minimize the incision of the patient in the thoracoscopic surgery, to reduce the recovery time of the patient, to minimize the scarring, and to easily change the clamping parts of various sizes with only one body, A fixture is provided.

1 is a perspective view of a fastener for a thoracoscopic surgery according to a first embodiment of the present invention.
FIG. 2 is an enlarged view of a portion A in which a clamping portion is separated in a fixing device for a thoracoscopic surgery according to a first embodiment of the present invention.
FIG. 3 is a perspective view of the end of the main body detachable part and the end of the clamp detachable part of FIG. 2, according to the first embodiment of the present invention, in which the magnet is inserted.
FIG. 4 is a cross-sectional view of the extension in FIG. 1 taken along line IV-IV '.
FIG. 5A is a cross-sectional view of a pair of clamps cut in the direction of V-V 'in FIG. 1, and FIG. 5B is a cross-sectional view of one clamp taken in V-V' direction of FIG. .
FIG. 6 shows a clamping unit provided with different colors according to the clamp sizes in the fixator for thoracoscopic surgery according to the first embodiment of the present invention.
FIG. 7 is a view showing a clamping portion opened by a user by a thoracoscopic surgery fixing device according to the first embodiment of the present invention.
FIG. 8 is an enlarged view of a portion B of the locking portion of the fixing device for a thoracoscopic surgery in FIG.
Fig. 9 shows a view of a thoracoscopic operation.
FIG. 10 shows a clamping unit of a fixing device for a thoracoscopic surgery according to a second embodiment of the present invention.
11 is a perspective view of a fixing device for a thoracoscopic surgery according to a third embodiment of the present invention.

1 is a perspective view of a fastener 1 for a thoracoscopic surgery according to a first embodiment of the present invention.

The fixation device for thoracoscopic surgery 1 includes a main body 10 and a clamping part 20 removable from the end of the main body 10.

The main body 10 of the fixation device for thoracoscopic surgery 1 includes a pair of handle parts 110 provided on one side and a pair of handle parts 110 provided on the other side, A body detachable portion 130 and an extension portion 120 positioned between the handle portion 110 and the main body detachable portion 130. The handle portion 110 includes a grip portion 111 which can be gripped by a user and a grip portion 111 which is connected to the grip portion 111 and is held between the end portions of the first and second extended portions 121 and 123 by the grip portion 111. [ A first guide rail 115a is provided between the pair of grip portions 111 and a first guide rail 115a is provided between the pair of grip portions 111. The first guide rail 113a and the second grip connection portion 113b are formed to have a rail- And the second guide rail 115b is engaged with the second guide rail 115b.

The grip portion 111 is formed with a ring to which a user's finger can be inserted. The size and shape of the ring are not limited, but may be sized and shaped such that a user, such as a circle or an ellipse, can help the user to easily operate the fixator (1) for thoracoscopic surgery.

The extension part 120 is composed of a first extension part 121 and a second extension part 123. The first extension part 121 and the second extension part 123 are fixed in close contact with each other, The first extending portion 121 extends to the first holding connection portion 113a and the second extending portion 123 extends to the second holding connecting portion 113b. The first extension portion 121 and the second extension portion 123 are elongated in the body insertion direction so that the fixing device 1 can be inserted into a tissue deeply located in the body. A first main body detachable portion 131a is disposed at the distal end of the first extension portion 121 and a second main body detachable portion 131b is disposed at the distal end of the second extended portion 123. [

A first hole 133a and a second hole 133b are formed at each end of the main body attaching / detaching portion 130 so as to allow the clamp attaching / detaching portion 210 to be coupled thereto.

The first extended portion 121 and the second extended portion 123 are characterized in that the sectional area cut in the vertical direction of the length of the first extended portion 121 and the second extended portion 123 does not substantially change. That is, since the cross-sectional area of the extension 120 is kept constant and extended, the fixator 1 for thoracoscopic surgery can be inserted into the body even with the smallest hole of only the cross-sectional area. Also, because of the long extension, it helps to insert the fixator (1) for the thoracoscopic surgery to the position of the tissue deeply inside the body.

The shape of the cross-sectional area of the extension 120 may be an elliptical shape in which the first extension 121 and the second extension 123 are coupled, but is not limited thereto. Embodiments of various shapes may exist. Preferably minimally invasive, may be possible.

The first hinge portion 121a and the second hinge portion 121b are respectively formed in a section where the first holding portion 113a and the first extending portion 121, the second holding connecting portion 113b and the second extending portion 123 are connected, 123a are formed. A third hinge portion 121b and a fourth hinge portion 123b are formed at the other end of the first extension portion 121 and the second extension portion 123. [ The first hinge portion 121a through the fourth hinge portion 123b operate the second body detachable portion 131 according to the movement of the handle portion to change the distance between the pair of clamping portions 20.

The clamping unit 20 includes a clamp 230 for gripping and fixing the tissue and a clamp detachable unit 210 connected to the clamp 230 and detachably attached to an end of the extension part 120 of the main body. A first protrusion 211a and a second protrusion 211b are formed at the ends of each clamp detachable portion 210 so as to be detachable from the main body detachable portion 131 of the main body 10. [

The pair of clamps 230 are perpendicular to the plane of the grip portion 111 of the body portion 10 as shown in Fig.

FIG. 2 is an enlarged view of a portion A of the clamping unit 20 of the fixing device 1 for a thoracoscopic operation in FIG.

The clamping part 20 is formed to be bent at a predetermined angle from the end of the clamp detachable part 210 to the clamp 230.

The angle at which the clamp portion 20 is bent is not limited. However, it can be formed at various angles so as to grasp well the tissue which needs to be fixed inside the body. In another embodiment, the clamping portion 20 may be straight without bending.

The shape of the clamp 230 holding the tissue is formed in the shape of a ring to fix the cancer cell tissue that grows in a circular shape. However, it is not limited, and it may be various forms such as ellipses depending on the shape of the body tissue fixed in another embodiment.

The pair of clamps 230 in the present invention are disposed so as to face each other, but are not limited thereto. Other embodiments of various configurations and configurations are possible as long as the tissue to be gripped can be fixed well.

The clamping portion 20 of the fixing device 1 for a thoracoscopic operation of the present invention is attachable and detachable to the extension portion 120 of the main body 10. FIG. 3 shows the end of the main body detachable part 130 and the end of the clamp detachable part 210 in which the magnet is inserted in FIG.

The magnet is inserted into at least a part of the end of the main body detachable part 130 and the end of the clamp detachable part 210 and is magnetically coupled. At this time, in the present invention, both the end surface p of the main body attaching / detaching portion 130 and the end surface q of the clamping attaching / detaching portion 210 are made of magnet, but the end portion of the main body attaching / detaching portion 130, The present invention is not limited thereto, and various embodiments may be used.

The magnet may be inserted only at the end of the main body attaching / detaching portion 130 or at the end of the clamp attaching / detaching portion 210, and the other may be a metal material capable of engaging with the magnet. In another embodiment, the magnet may be inserted into both the end portion of the clamp detachable portion 210 and the end portion of the main body detachable portion 130.

The kind of magnet may preferably be a permanent magnet that does not easily change from the outside to magnetic influence. For example, it may be a neodymium magnet, a samarium cobalt magnet, an alnico magnet, or a ferrite magnet, but is not limited thereto. However, it should be selected in consideration of not only the degree of magnetism appearing inside the body but also the damage to the inside of the body by the magnet.

Neodymium magnets are advantageous in that they can be manufactured in a variety of shapes such as round, square, and ring shapes because they are less expensive than the strong magnetic force and have excellent processability. However, since the nickel plating may corrode during prolonged contact with water, it should be used in consideration of this.

Samarium cobalt magnets can be used at high temperatures up to 350 ° C without decreasing magnetic force, but they are expensive and should be used with this in mind.

The AlNiCo magnet has the best temperature characteristics. Even when used at a high temperature of 600 ° C or higher, there is almost no decrease in magnetic force. However, the hardness is high and the workability may be slightly deteriorated.

Ferrite magnets have relatively high stability against temperature, can be manufactured in complex shapes, and are inexpensive in price, so they are widely used as popular magnets in everyday life.

The shapes, sizes, and shapes of the magnets inserted into the ends of the main body detachable portion 130 and the clamping detachable portion 210 are not limited. However, if the magnet used above can be exercised without losing magnetism inside the body, there may be various embodiments.

The hole 133 formed in the end surface p of the main body attaching and detaching portion 130 is formed in a manner such that the protruding portion 211 formed in a concave shape is engaged with the end surface q of the clamp attaching and detaching portion 210, (133). Here, the shape and material of the embossed shape and the embossed shape are not limited, and there may be various embodiments in which the clamp detachable portion 210 and the main body detachable portion 130 are easily detachable from the inside of the body. In another embodiment, the surface p of the end portion of the main body attaching / detaching portion 130 is embossed, and the surface q of the end portion of the clamp attaching / detaching portion 210 may be engraved.

The shape of the end surface p of the main body detachable portion 130 and the end surface q of the clamp detachable portion 210 formed in this embossed and engraved manner is such that the main body portion 10 and the clamping portion 20 are not rotated.

FIG. 4 is a cross-sectional view of the extension 120 taken along the line IV-IV 'in FIG. 1, and FIG. 5 (A) is a cross-sectional view of the clamp 230 cut in the V- FIG. 5B is a cross-sectional view of the clamp 23 cut in the V-V 'direction in FIG.

At this time, the cross-sectional area cut in the vertical direction of the plane of the extension 120 is set such that the clamp 230 and the end of the main body attaching / detaching unit 130 are engaged with each other in a direction parallel to the vertical direction Sectional area smaller than the cut-off maximum cross-sectional area. In other words, in the case of conventional fixators for thoracoscopic surgery, in addition to the hole through which the thoracoscopy is inserted, two large holes for accessing the thoracoscopic surgery fixator and surgical tool were required on the patient's chest, The inserted hole had to be cut by the size of the clamp cross-sectional area as shown in Fig. 5 (a). However, in the case of the fixation device for thoracoscopic surgery of the present invention 1, since the clamping portion 20 can be attached and detached, only the hole of the size of the sectional area of the extension portion 120 shown in FIG. 4 (a) And cut into another hole only by the size of one cross-sectional area of the clamp 230 as shown in Fig. 5 (b). Therefore, the cross-sectional area required for insertion of the fixator 1 for the thoracoscopic surgery into the patient's body is reduced, and the incision of the patient's skin can be minimized.

The surface of the clamp 230 holding the tissue is treated with silicon. When the clamp 230 is made of silicon, there is an effect that the body tissue can be grasped smoothly without being damaged. The clamp surface of conventional fixation device for thoracoscopic surgery was made of stainless steel in the form of sawtooth, which could damage tissues during gripping and could cause tumor cell spillage that cancer cells could flow out if these tissues were cancer cells.

The shape of the clamp 23 is made of the same material as the fixator 1 for the thoracoscopic surgery of the present invention, and the surface of the clamp 23 is treated with silicon. This form is not limited, and there can be various forms of embodiment so that it can be fixed well without damaging the tissue.

The kind of silicone is not limited as long as it can hold the tissue without damaging it, and is safe in the body or harmless to the human body. For example, it can be a liquid silicone rubber (LSR) that is used for baby bottles, toys, etc., with no residue left after curing and is non-toxic.

In another embodiment, the surface of the clamp 230 can be formed of a material other than silicon, which is secure in the body and can be held without damaging the tissue.

The clamping portions 20 are provided in a plurality of pairs, each pair having clamps 230 of different sizes. 6 (a) to 6 (c) show the clamping unit 20 according to the size of the clamp 230. In the case of using a prior art thoracoscopic surgery fixture, a fixator for a thoracoscopic surgical operation including a clamp for a tissue size had to be purchased separately. Since the clamping unit 20 can be attached and detached as described above and the clamping unit 20 for each size of the clamp 230 can be coupled to one body unit 10, can do.

The size of the clamp 230 included in the clamping unit 20 is 45 mm, 35 mm, 25 mm, or the like, which is a clamp size of a conventional fixator used for thoracoscopic surgery. However, the present invention is not limited thereto, and it may be formed in various sizes depending on the size of the tissue to be held in another embodiment.

In addition, the clamping portions 20 are provided in different colors according to sizes of the clamps 230. In this case, even if the size is not directly confirmed by the number, the size of the clamp 230 can be divided more quickly through the color.

The type and color of the clamping portion 20 are not limited. In another embodiment, the entire surface of the clamp detachable portion 210 can be painted or painted on the surface of the clamp 230 or a portion of the clamp detachable portion 210, and if the clamp 230 can be classified by size, Can be positioned and shaped.

Hereinafter, the operation of the fixing device for thoracoscopic surgery will be described with reference to FIG. 7 and FIG.

7, when the user inserts and spreads a finger on each of the pair of grip portions 111, the distance between the end portions of the extension portion 120 connected to the grip connection portion 113 changes, The clamping portion 20 connected to the clamping portion 20 is opened to fix the tissue. At this time, the first guide rails 115a and the second guide rails 115b prevent excessive force from being applied to the tissue when the pair of clamping portions 20 grip and fix the tissue, It plays a role to maintain the power to lose.

FIG. 8 is an enlarged view of the portion B of the locking portion 115 of the fixing device 1 for the thoracoscopic surgery shown in FIG.

The first guide rails 115a and the second guide rails 115b are moved and fixed by a space between the first guide rails 115a and the second guide rails 115b according to the size and thickness of the tissue to be gripped so that the force applied to the tissue can be adjusted and maintained.

The first holding part 113a is connected to the first extending part 121 and the second holding part 113b is connected to the second extending part 123. [ When the user opens the grasping portion 111, the second grasping portion 113b and the second grasping portion 123 are pivoted about the second grasping connecting portion 113b and the second grasping portion 123, The second main body detachable portion 131b connected to the end portion and the second protruded portion 211b connected thereto are moved in the direction opposite to the first protruded portion 211a connected to the first main body detachable portion 131a. The operation principle of the fixator for thoracoscopic surgery 1 is not limited to the above description, and various embodiments may be used.

Hereinafter, a method for pulmonary nodule surgery using the fixator for thoracoscopic surgery 1 of the present invention will be described with reference to FIG.

First, a 4-5 cm a hole in the vicinity of the surgical site to insert a thoracoscopic camera, a 1 cm b hole to remove the removed lung tissue, and a minimal And a c-hole of size is formed.

a Insert the thoracoscopic hole into the hole and inserting a double lumen endotracheal tube into the b hole and the c hole to collapse the lung to secure the surgical space.

The clamping portion 20 including the clamp 230 corresponding to the size of the tissue to be gripped is selected and the clamping portion 20 is inserted into the b hole and the body portion 10 is inserted into the c hole to insert the clamping portion 20 and the main body 10 are connected to each other. Since the space in the thoracic cavity in which the lungs are collapsed is wide, it is easy to secure the working space, so that the clamping portion 20 and the main body 10 can be easily combined.

The extended portion 120 of the fixed device 1 for thoracoscopic surgery combined therewith is inserted to the part of the lung nodule to be gripped and gripped and fixed by the above-described operation method.

After the operation is completed, the clamping portion 20 and the main body portion 10 are separated from each other in the thoracic cavity, and are taken out through the respective inserted holes.

10 shows a clamping part 20 of a fixing device 1 for a thoracoscopic surgery according to a second embodiment of the present invention. An end portion of the main body attaching / detaching portion 131 and an end portion of the clamp attaching / detaching portion 210 which can be detached / The end of the main body detachable part 131 is formed of a bolt and the end of the clamp detachable part 210 is formed of a nut and can be assembled in the chest cavity.

The first female screw portion 135a and the second female screw portion 135b of the end portion of the main body detachable portion 131 formed of male thread and the first female screw portion 213a of the clamp detachable portion 210 formed of a female screw and the second female screw portion 135b, And the length and the size of the second portion 213b are not limited. However, the male screw portion 135 and the female screw portion 213 are well engaged with each other in the thoracic cavity, so that they can be easily detached. In another embodiment, the end of the main body detachable portion 131 may be a female thread and the end of the clamp detachable portion 210 may be a bolt.

The attachment / detachment of the end of the main body attachment / detachment unit 131 and the end of the clamp attachment / detachment unit 210 is not limited to the magnetic or spiral screw system described above. If the attachment and detachment can be safely performed in the body, And the end of the main body detachable portion 131 and the shape of the clamp detachable portion 210 can be variously manufactured according to the method.

11 is a perspective view of a fixing device 1 for a thoracoscopic surgery according to a third embodiment of the present invention. 1 is the same as the first embodiment of FIG. 1, but the operation principle is another embodiment. When the user puts his finger on the gripping portion and opens in the direction of d in Fig. 11, the first gripping connection portion 113a connected thereto is opened. At this time, the first extension portion 121 is connected to the end of the first gripping connection portion 113a So that it is pushed in the direction e in FIG. The pushed first annular portion 121 opens the second main body detachable portion 131b connected thereto in a slide manner and causes the clamp detachable portion 210 attached thereto to spread in the direction f in Fig.

The operation principle of the screw fixator for thoracoscopic surgery (1) may be the same as that of node grasping clamps (product number: 9009-23) manufactured by SCANLAN, Germany. However, it is not limited thereto, and there may be embodiments of various operating principles.

In the conventional fixation device for a thoracoscopic surgery, since the clamping portion can not be attached to or detached from the body portion, the skin has to be cut by the cross-sectional area of the clamp to be inserted into the body. However, in the present invention, the size of the hole into which the fixator for thoracoscopic surgery 1 is inserted can be reduced only by the size of the cross-sectional area of the extension portion 120, so that the skin incision can be minimized. Here, if the shaft of the extension part 120, which penetrates the skin, can be formed as the smallest port of 5 mm in the conventional thoracoscopic surgery, the minimally invasive operation is possible.

The fact that the incision can be minimized has the effect of not only increasing the size of the wound, speeding up the healing, but also increasing the patient's satisfaction. In addition, since only the clamping unit 20 according to the sizes of the clamps 230 can be purchased, the load can be economically reduced. If the clamps 230 are formed in different colors according to the sizes of the clamps 230, have.

Further, the clamp 230 formed of a silicon material can be formed more smoothly than a conventional stainless steel material, so that damage to the structure can be prevented.

The above-described embodiments are illustrative of the present invention, and the present invention is not limited thereto. It will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the spirit and scope of the present invention as defined by the appended claims and their equivalents. something to do.

Claims

In a fixator for grasping tissue to be removed in thoracoscopic surgery,
A pair of handle portions provided on one side;
A pair of main body attaching / detaching portions provided on the other side and capable of varying the distance of the end portions by the pair of handle portions;
An extension disposed between the handle portion and the main body detachable portion;
And
A clamp detachable portion detachably coupled to the main body detachable portion;
At least a pair of clamps for gripping the tissue in cooperation with the operation of the handle portion;
A clamping part including a clamping part;
&Lt; / RTI >

The method according to claim 1,
Wherein the extension is elongated along an insertion direction in the body, and the cross-sectional area along the vertical direction of the length is substantially unchanged.

The method according to claim 1,
Wherein at least a part of the surfaces of the pair of clamping parts is treated with silicon.

The method according to claim 1,
Wherein the pair of main body attaching / detaching portions and the pair of clamp attaching / detaching portions are detachably provided by magnetism.

5. The method of claim 4,
Wherein one of the end portions of the pair of main body attaching / detaching portions and the end portion of the pair of clamp attaching / detaching portions is engaged with an embossed shape and the other is engageable / detachable.

The method according to claim 1,
Wherein the pair of main body attaching / detaching portions and the pair of clamp attaching / detaching portions are attachable / detachable by a spiral screw method.

The method according to claim 1,
Wherein the clamping portion is provided in a plurality of pairs,
Each pair having a clamp of a different size.

8. The method of claim 7,
Wherein at least some of the clamping portions are provided in different colors for respective sizes.

The method according to claim 1,
Wherein the clamp is a ring type.

The method according to claim 1,
Wherein the clamps are opposed to each other.

The method according to claim 1,
Sectional area in a direction perpendicular to the plane of the extended portion is smaller than a maximum sectional area of the clamp cut in a direction parallel to the vertical direction in a state where the clamping portion and the end portion of the extended portion are engaged.