WO2015146484A1

WO2015146484A1 - Body cavity access tool

Info

Publication number: WO2015146484A1
Application number: PCT/JP2015/055864
Authority: WO
Inventors: 秀司北城; 卓也宮崎; 慶弘宮澤
Original assignee: 秀司北城; 株式会社トップ
Priority date: 2014-03-27
Filing date: 2015-02-27
Publication date: 2015-10-01
Also published as: TWI641356B; JPWO2015146484A1; JP6378318B2; TW201544068A

Abstract

Provided is a body cavity access tool (1), comprising a retractor (5), a funnel-shaped instrument introduction part (6), and a closing part (7). The retractor (5) further comprises an inner-side ring-shaped member (9) which is to be positioned within a body cavity (3), and an outer-side ring-shaped member (10) which is to be positioned outside the body. Both members (9, 10) are coupled with a flexible cylindrical retraction member (11). The retraction member (11) passes through a body wall (2). The instrument introduction part (6) is inserted in the retractor (5). The closing part (7) is mounted on the outer-side ring-shaped member (10). The closing part further comprises an insertion part (21). The instrument is to be inserted in the body cavity (3), passing through the insertion part (21) and the instrument introduction part (6). A handle member (8) is positioned outside the body and within the retractor (5). The handle member (8) and the inner-side ring-shaped member (9) are coupled with a thread-shaped member (T). After an operation, it is possible, by pulling upward on the handle member (8), to remove the inner-side ring-shaped member (9) from the body cavity (3).

Description

Body cavity access device

The present invention relates to a body cavity access device for introducing a treatment instrument that is attached to a retracted part when performing treatment while accessing the body cavity.

Conventionally, as such a body cavity access device, one having a retractor for opening the retractor and a funnel-shaped treatment instrument introducing unit inserted into the retractor is known (for example, Patent Document 1).

In the body cavity access device described in Patent Document 1, the retractor includes an inner annular member disposed in the body cavity, an outer annular member disposed outside the body, and the inner annular member fixed to one opening. A flexible, tubular retractor member having an outer annular member fixed to the other opening.

The funnel-shaped treatment instrument introduction section functions as a protective lining and introduction path when the treatment instrument is introduced into the body cavity through the retractor. A closure is attached to the outer annular member of the retractor attached to the retractor. Thereby, the opening part outside the body of the retracting member is closed. The occlusion portion has an insertion portion for allowing the treatment tool to pass while maintaining the airtightness of the occlusion.

In addition, as a retractor used in a body cavity access device, one having a retractable member that can be wound with an outer annular member is known (for example, see Patent Document 2). In such a retractor, after the inner annular member is disposed in the body cavity, the retractor is wound around the outer annular member, thereby fixing the retractor to the retracted portion.

On the other hand, as a body cavity access device, an inner annular member provided with a retractor having the inner annular member, the outer annular member, and the retracting member as described above, and a closing portion attached to the outer annular member, and disposed in the body cavity. There is also known one provided with a string-like member for pulling out (see, for example, Patent Document 3).

In the body cavity access device of Patent Document 3, one end of the retracting member is fixed to the outer annular member, the intermediate portion is folded back with the inner annular member inside, and the other end is led out of the outer annular member. Therefore, the retracting member is doubled when mounted on the retracting portion. In this state, one end of the string-like member is fixed to the inner annular member, and extends from the outer peripheral side of the outer annular member to the outside of the retractor body through a doubled retracting member.

One end of the string-like member is fixed to the frame of the closing portion, and starting from this, the outside of the double retractable member passes while being folded back at the end on the inner annular member side, and the other end is the body of the retractor It may extend outward. The end of the string-like member extending to the outside of the retractor is fixed to the ring member or is in a free state. By pulling up the extended end of the string-like member, the inner annular member can be taken out of the body cavity from the body cavity through the retracting portion.

JP 2010-207579 A JP 2013-55993 A Special table 2009-501045 gazette

Even in the above-described body cavity access device of Patent Document 1 and the retractor of Patent Document 2 applied thereto, a string-like member as in Patent Document 3 is adopted, and the inner annular member is easily taken out from the body cavity. It would be preferable to be able to do so.

In this case, since the retracting member of the retractor of

Patent Documents

1 and 2 is not double-folded like the retracting member of Patent Document 3, when the body cavity access device is attached to the retracting part, the string member is Then, it is led out above the retracting portion through the outside or inside of the retracting member. When the string member is led out through the outside of the retracting member, the string member is in direct contact with the retracting portion. For this reason, when pulling out an inner side annular member with a string-like member, there exists a possibility that a wound part may be damaged by a string-like member.

On the other hand, when the string-like member is led out through the inside of the retracting member, the string-like member is led out between the outer annular member fixed to the body outer end of the retracting member and the closing portion. Therefore, there is a possibility that the airtightness due to the blocking portion is deteriorated.

It is also conceivable that the string-like member is led out through the inside of the treatment instrument introduction portion arranged inside the retracting member, but in that case, the string-like member passes between the treatment instrument introduction portion and the blocking portion or the outer annular member. Since the member is derived, there is a concern that the airtightness deteriorates similarly.

An object of the present invention is to provide a body cavity access device that can take out an inner annular member via a string-like member without causing deterioration of airtightness and damage of a retracted portion in view of the problems of the conventional technology. is there.

The body cavity access device of the present invention has an inner annular member disposed on the body cavity side of the retracting portion, an outer annular member disposed on the outer side of the retracting portion, and the inner annular member fixed to one opening, A retractor having a flexible and tubular retractor member in which the outer annular member is fixed to the other opening, and inserted into the retractor mounted on the retractor, and into the body cavity of the treatment instrument A funnel-shaped treatment instrument introduction section constituting an introduction path and an insertion section through which the treatment instrument is passed in an airtight state, and is attached to the outer annular member to block the retractor in an airtight manner A gripping member that is gripped to pull out the inner annular member disposed on the body cavity side of the retracting portion, and one end is fixed to the inner annular member, and the other end is fixed to the gripping member The retractor comprising a string-like member and attached to the retracting portion In a state where the treatment instrument introducing portion is inserted and the retractor is closed by the closing portion, the gripping member is located outside the body in the retractor, and the string-like member is the inner annular member It arrange | positions so that it may reach to the said holding member through between the said retractable member and the said treatment tool introduction part.

In the present invention, when the body cavity access device is attached to the retracting portion, first, the string-like member between the inner annular member of the retractor and the gripping member passes through the inside of the retracting member of the retractor, and the gripping member is the body. A retractor is attached to the retracting portion in a state of being arranged on the outside. At this time, the gripping member is disposed outside the body in the retractor. Then, the treatment instrument introducing portion is inserted into the retractor from the outside of the retractor body.

Thus, the string-like member is placed on the path from the grasping member to the inner annular member through the retractor and the treatment instrument introducing portion. Next, the closure part in which the treatment tool is disposed through the insertion part is attached to the outer annular member of the retractor while the distal end side of the treatment tool is inserted into the treatment tool introduction part. This completes the mounting of the body cavity access device to the retracted portion.

During this time, in a state where the retractor is closed by the closing portion, the gripping member is located in a portion where the airtightness is maintained by the closing, and the string-like member is connected to the retracting member and the treatment instrument introducing portion from the inner annular member. It arrange | positions so that it may reach a holding member after a gap. For this reason, a string-like member is not derived | led-out outside the retractor through between an outer side annular member and an obstruction | occlusion part. Therefore, in a state where the occlusion portion closes the retractor, the airtightness with respect to the outside on the body cavity side does not deteriorate.

When removing the body cavity access device from the retracted part, first, the occlusion part is removed from the outer annular member together with the treatment instrument. Thereafter, the treatment instrument introducing portion is extracted from the retractor, and the gripping member is moved away from the retracting portion, whereby the inner annular member in the body cavity is pulled out of the body together with the retracting member via the string member.

At this time, the string-like member is located inside the retracting member and does not directly contact the retracting portion, so that the retracting portion is not damaged. Therefore, according to the present invention, it is possible to take out the inner annular member via the string-like member without causing deterioration of airtightness and damage to the wound portion.

In the present invention, the grasping member is disposed concentrically with the retracting portion on the outside of the retractor mounted on the retracting portion, and then inserted into the retractor and the retractor It may be comprised by the annular pulling member fixed by being pinched | interposed between the said retracting members.

In this case, when removing the body cavity access device, after removing the treatment instrument introducing portion from the retractor, the inner annular member is pulled out of the body by moving the handle member in a direction away from the retracting portion. Therefore, the inner annular member can be reliably taken out by the pulling member.

In the present invention, the gripping member may be constituted by the treatment instrument introducing portion, and the other end of the string-like member may be fixed to a portion outside the body of the treatment instrument introducing portion. According to this, since the treatment instrument introducing portion can be used as a grasping member, the configuration of the body cavity access device can be simplified.

In the present invention, the gripping member may be constituted by the outer annular member, and the other end of the string-like member may be fixed to the outer annular member. According to this, since the outer annular member can also be used as a gripping member, the configuration of the body cavity access device can be simplified.

In the present invention, the retractor is configured such that the inner annular member is disposed on the body cavity side of the retracting portion, and the outer annular member is disposed on the body outer side of the retracting portion, and the outer annular member is wound around the winding shaft. As described above, the wound member is fixed to the wound part by winding a part of the wound member outside the body in one or the other winding direction, and the treatment instrument introducing part is arranged according to the winding direction. You may have the shape suitable for the shape which a member exhibits.

According to this, since the treatment instrument introducing portion has a shape that matches the shape of the retractor corresponding to the winding direction of the retracting member, it is possible to arbitrarily select the winding direction of the retracting member or the shape of the retractor. it can.

FIG. 2 is a perspective cross-sectional view showing a state where the body cavity access device according to the first embodiment of the present invention is attached to a patient's wound part. It is sectional drawing which shows a mode when the retractor of the body cavity access device of FIG. 1 is mounted | worn with a retractor, or when removing a retractor from a retractor. It is sectional drawing which shows the state with which the body cavity access device concerning 2nd Embodiment of this invention was mounted | worn with the patient's wound part. It is sectional drawing which shows a mode that a bending forceps is used via the body cavity access device of FIG. It is a perspective sectional view showing the state where the body cavity access device concerning a 3rd embodiment of the present invention was equipped in the retracted part of a patient. FIG. 6 is a cross-sectional view showing a state where the retractor of the body cavity access device of FIG. 5 is attached to the retractor or when the retractor is removed from the retractor. It is sectional drawing which shows the state with which the body cavity access device concerning 4th Embodiment of this invention was mounted | worn with the patient's wound part. It is a perspective sectional view showing the state where the body cavity access device concerning a 5th embodiment of the present invention was equipped in the retracted part of a patient.

Hereinafter, embodiments of the present invention will be described with reference to the drawings. As shown in FIG. 1, a body cavity access device 1 according to the first embodiment includes a retractor 5 that is provided on a body wall 2 of a patient and that maintains a retractor 4 that leads into the body cavity 3 in an open state. A treatment instrument introducing portion 6 to be inserted into the retractor 5, a closing portion 7 for closing the retractor 5 outside the body, and a pulling member 8 that is operated when the retractor 5 is removed from the retractable portion 4. .

The retractor 5 includes an inner annular member 9 disposed on the body cavity 3 side of the retracting portion 4, an outer annular member 10 disposed on the outer side of the retracting portion 4, and the inner annular member 9 fixed to one opening. And a flexible retracting member 11 having the outer annular member 10 fixed to the other opening. The pulling member 8 functions as a gripping member that is gripped in order to pull out the inner annular member 9 disposed on the body cavity side of the retracting portion 4 to the outside of the body.

The outer annular member 10 and the inner annular member 9 are both elastically deformable by a predetermined external force, are circular in a free state, and typically have substantially the same diameter. The retracting member 11 is formed of an elastic thin film made of polyurethane, for example.

In a state where the retractor 5 is not mounted on the retracting portion 4, the retracting member 11 has a cylindrical shape and has a diameter smaller than the outer diameter of the outer annular member 10 and the inner annular member 9.

The outer annular member 10 is made of, for example, silicone rubber and has a substantially rectangular cross-sectional shape. The inner annular member 9 is made of, for example, silicone rubber and has a substantially circular cross-sectional shape. The retractor 5 has the inner annular member 9 disposed on the body cavity side of the retracting portion 4 and the outer annular member 10 disposed on the body outer side of the retracting portion 4, and the retracting member 11 using the outer annular member 10 as a winding shaft. By winding a part of the outside of the body, the retractable member 11 can be attached to the retracting portion 4 while the substantial length of the retracting member 11 corresponds to the thickness of the body wall 2.

The blocking portion 7 includes a disc-shaped canopy member 12, a first film member 17 and a second film member 18 stacked on the front and back surfaces of the canopy member 12, and a first film member 17 and a second film member 18, respectively. A mounting ring 13 for mounting the stacked canopy member 12 on the outer annular member 10 in an airtight manner is provided.

The canopy member 12 is made of a soft resin having flexibility, and is formed by laminating two sheet members (gel sheets) 14 a and 14 b having the same diameter as the inner diameter of the outer annular member 10. The canopy member 12 may be composed of three or more sheet members. As the soft resin, for example, silicone rubber, polyurethane, or polyethylene can be used.

The

sheet members

14a and 14b are provided with a plurality of slit portions 16 penetrating in the thickness direction in order to introduce the columnar treatment instrument into the body cavity 3. Each slit portion 16 of the sheet member 14a is orthogonal to the corresponding slit portion 16 of the sheet member 14b in a cross shape.

The first film member 17 and the second film member 18 are made of another soft resin that has elasticity and is slidable with respect to the soft resin constituting the

sheet members

14a and 14b, and is larger than the diameter of the canopy member 12. Has a diameter. As this another soft resin, for example, polyurethane, polyvinyl chloride, or polyethylene can be used. The end portions of the first film member 17 and the second film member 18 are bonded to each other so as to sandwich the canopy member 12 therebetween.

The first film member 17 is provided with a circular hole 19 for allowing a treatment instrument passed through each slit portion 16 to pass through at a position overlapping the center position of each slit portion 16 of the sheet member 14a. The circular hole 19 has a diameter in the range of 40 to 90% of the diameter of the treatment instrument.

The second film member 18 includes a slit portion 20 for passing a treatment instrument passed through each slit portion 16 at a position corresponding to each slit portion 16 of the sheet member 14b. The slit portion 20 is orthogonal to the corresponding slit portion 16 of the sheet member 14 b and has the same length as the slit portion 16.

The circular hole 19 of the first membrane member 17, the slit portion 16 of the

sheet members

14a and 14b, and the slit portion 20 of the second membrane member 18 constitute an insertion portion 21 through which the treatment instrument is passed while maintaining airtightness. The

The mounting ring 13 is made of, for example, natural rubber or polyurethane, has a substantially U-shaped cross section, and can be mounted on the outer annular member 10 of the retractor 5. The mounting ring 13 is bonded to the end portions of the first film member 17 and the second film member 18 so that the canopy member 12 is positioned outside the body of the outer annular member 10 when the mounting ring 13 is mounted on the outer annular member 10. .

The treatment instrument introducing unit 6 is inserted into the retractor 5 attached to the retracting unit 4 and constitutes an introduction path into the body cavity of the treatment instrument while protecting the retracting member 11. The treatment instrument introducing portion 6 has a funnel shape, and is adjacent to the cylindrical portion 22 that contacts the outlet side of the funnel, the conical portion 23 adjacent to the inlet side of the cylindrical portion 22, and the outer side of the conical portion 23. And an annular wall portion 24.

The treatment instrument introducing portion 6 has a shape and a size that are substantially contained in a space formed by the retractor 5 attached to the retracting portion 4 and the closing portion 7 that closes the retractor 5. Therefore, the annular wall 24 has a slightly smaller diameter and a slightly shorter axial length than the outer annular member 10 of the retractor 5.

The cylindrical portion 22 has an inner diameter that is slightly smaller than the diameter of the retractable portion 4 opened by the retractor 5, but larger than the outer diameter of the treatment instrument to be introduced. For example, it has an inner diameter that allows three treatment tools having a diameter of about 5 mm to pass through. The length of the cylindrical portion 22 is approximately the same as the thickness of the body wall 2. An elastic material such as polyurethane, polyvinyl chloride, or polyethylene is used as the material constituting the treatment instrument introduction unit 6.

2, one end of the string-like member T is fixed to the inner annular member 9 of the retractor 5, and the other end is fixed to the fixing portion 25 of the pulling member 8. The retractor 5 is attached to the retractable portion 4 in a state in which the string-like member T passes through the inside of the retractor 5 and the handle member 8 is separated above the outer annular member 10.

The length of the string-like member T is shorter than the shortest possible length in the state where the handle member 8 is arranged as shown by the two-dot chain line in FIG. 2 with respect to the retractor 5 attached to the retracting portion 4. Is set to a length having a sufficient margin.

In this configuration, when performing a surgical operation on a patient using the body cavity access device 1, first, the retractor 5 is attached to the retractable portion 4 provided in advance. That is, in a state where the string-like member T passes through the inside of the retractor 5 and the handle member 8 is separated above the outer annular member 10, the inner annular member 9 of the retractor 5 is bent and the body cavity 3 extends from the retracted portion 4. And inserted into the body cavity 3. Thereby, the inner side annular member 9 is arrange | positioned at the body cavity 3 side of the retracting part 4, and the outer side annular member 10 of the retractor 5 will be in the state located in the body outer side.

Then, by holding the outer annular member 10 and winding the retracting member 11 around the outer annular member 10 as an axis, the retracting member 11 is expanded in the radial direction to form an opening having a desired diameter. The length of the retracting member 11 is made to correspond to the thickness of the body wall 2. Thereby, mounting | wearing of the retractor 5 is completed and it will be in a state as shown in FIG.

Next, the handle member 8 is arranged inside the portion located outside the body of the retracting member 11 so as to be substantially concentric with the outer annular member 10 and the retracting portion 4. That is, the pulling member 8 is arranged at a position as shown by a two-dot chain line in FIG.

Next, the treatment instrument introducing portion 6 is inserted into the retractor 5. At this time, the cylindrical portion 22 of the treatment instrument introducing portion 6 is inserted into the opening formed by the retracting member 11. As a result, the treatment instrument introduction unit 6 is in a state of being fitted (fit) to a region extending from the outside of the retractor 5 to the portion of the retracting unit 4. Further, the pulling member 8 is sandwiched and fixed between the retractor 5 and the treatment instrument introducing portion 6, and the string-like member T is introduced from the retractor 5 and the treatment instrument starting from the fixing portion 25 of the pulling member 8. It will be in the state arrange | positioned on the path | route which passes between between the parts 6 and further passes through the inside of the retractor 5, and reaches the inner annular member 9.

Next, the closed portion 7 in which a few treatment tools for surgery are arranged through the insertion portion 21 is attached to the outer annular member 10. That is, the closure 7 is attached to the retractor 5 by covering the outer annular member 10 with the attachment ring 13. This attachment is performed such that the distal end sides of the respective treatment instruments are bundled and the distal end side is introduced into the body cavity 3 from the cylindrical portion 22 of the treatment instrument introduction section 6.

Thereby, the inside of the body cavity 3 is in an airtight state, and it becomes possible to perform an operation using each treatment instrument. During the operation, the string-like member T is located on the side of the body cavity 3 of the obstruction 7 as shown in FIG. 1, so that the airtight state of the body cavity 3 deteriorates due to the presence of the string-like member T as in the prior art. It is not. In addition, during this time, the treatment tool introduction unit 6 prevents the wound member 11 and the wound part 4 from being damaged by the treatment tool.

When the operation is completed and the body cavity access device 1 is removed from the retracting portion 4, first, the blocking portion 7 is removed from the outer annular member 10 together with the treatment instrument. Next, the treatment instrument introducing portion 6 is extracted from the retractor 5. Further, by moving the pulling member 8 in the direction away from the retracting portion 4, the inner annular member 9 is pulled out from the body cavity 3 together with the retracting member 11 via the string-like member T.

At this time, since the string-like member T is always located inside the retracting member 11, the retracting portion 4 is not damaged by the string-like member T. When the removal of the inner annular member 9 is completed, the removal of the body cavity access device 1 is completed.

According to this embodiment, since the treatment instrument introduction unit 6 is made of an elastic material, the treatment instrument introduction unit 6 can cope with external force with high followability. In addition, since the cylindrical portion 22 of the treatment instrument introduction section 6 has a diameter that allows three treatment instruments to be passed together, for example, two bending forceps are introduced into the body cavity 3 as treatment instruments by the body cavity access instrument 1. Even so, it is possible to maintain a high degree of freedom in the insertion / extraction operation and the turning operation of each bending forceps.

Moreover, since the blocking part 7 can maintain airtightness even if a plurality of treatment tools are passed through the insertion part 21, it is not necessary to ensure airtightness by using a trocar check valve. For this reason, a treatment tool can be directly passed through the closing part 7 without using a trocar. Therefore, the operability is not deteriorated due to the mutual interference (fighting) of the trocar. Thereby, a some treatment tool can be arrange | positioned through the obstruction | occlusion part 7, and the operativity of a treatment tool can be improved.

In addition, since the treatment instrument introduction section 6 is inserted into the retractor 5 before the closure section 7 is attached to the retractor 5, the treatment instrument is attached to the body cavity using a trocar even when a bending forceps is used as the treatment instrument. Similarly to the case of insertion into 3, the wound part 4 can be prevented from being damaged by the treatment tool. Moreover, damage of the retractable member 11 by a treatment tool can also be prevented. In addition, such an effect can be obtained by a simple operation by simply inserting the treatment instrument introducing portion 6 into the retractor 5.

Further, at that time, compared with the case where a plurality of flexible trocars composed of several kinds of materials and parts are used, the treatment instrument introducing portion 6 that can be configured as an integrally molded product of an elastic material enables a very low cost. Thus, the retracting portion 4 and the retracting member 11 can be protected.

In addition, the pulling member 8 used as a tab for pulling out the retracting member 11 together with the inner annular member 9 is fixed on the treatment instrument introducing portion 6 after being arranged on the retracting member 11, so that it is stable during the operation period. In this state, it can be left at the arrangement position.

Further, in the state where the body cavity access device 1 is mounted on the retracting portion 4, the pulling member 8 is located outside the body in the retractor 5, and the string member T is treated from the inner annular member 9 to the retracting member 11. It arrange | positions so that it may reach the handle member 8 through between the tool introduction parts 6. FIG. For this reason, the string-like member T is present inside the closure part 7 and the retractor 5, and is not led out from between the treatment instrument introduction part 6 and the closure part 7 or the outer annular member 10, The airtightness due to the blocking portion 7 is not impaired by the string member T.

FIG. 3 shows a body cavity access device according to the second embodiment of the present invention. In FIG. 3, the same reference numerals are given to the same elements as those in FIG. In this body cavity access device 26, the winding direction of the retracting member 11 by the outer annular member 10 in the retractor 5 is opposite to the case of the body cavity access device 1 of FIG. 1. For this reason, in a state where the body cavity access device 26 is mounted on the retracting portion 4, the retracting member 11 of the retractor 5 has an isosceles triangular shape having a smaller apex angle than the case of FIG. 1 inside the outer annular member 10. A cross-sectional shape is formed.

Therefore, the outer shape of the conical portion 28 in the treatment instrument introducing portion 27 of the body cavity access device 26 is a conical shape that matches the shape of the retracting member 11 having the cross-sectional shape. In addition, the cylindrical portion 30 and the annular wall portion 29 adjacent to the conical portion 28 also have a shape and a size that match the shape of the retractor 5.

Also in this embodiment, a pulling member 8 that is operated when the retractor 5 is removed from the retracting portion 4 is provided, and a string-like member T is provided between the pulling member 8 and the inner annular member 9. The pulling member 8 is disposed in the retractor 5 in the same manner as described above, and is fixed by the treatment instrument introducing portion 6.

Also in the present embodiment, the cylindrical portion 30 of the treatment instrument introduction section 27 is slightly smaller than the diameter of the retractable section 4 opened by the retractor 5, but a treatment instrument having a diameter of about 5 [mm] is provided. It has a diameter that can be passed through all together. Therefore, as shown in FIG. 4, a plurality of bending forceps 31 is inserted into the body cavity as a treatment tool through the obstruction portion 7 and the treatment tool introduction portion 27 by the body cavity access device 26 attached to the retractable portion 4 and used. can do.

Also in this case, the degree of freedom of the insertion / extraction operation and the turning operation of each bending forceps 31 can be kept high. At this time, the treatment instrument introducing portion 27 can prevent the bent portion of the bending forceps 31 from coming into contact with the retracting portion 4 and the retracting member 11 of the retractor 5 to cause damage.

Other points of the body cavity access device 26 are the same as those of the body cavity access device 1 of FIGS. 1 and 2, and the same effects as those of the first embodiment can be obtained. Moreover, according to this embodiment, the retracting member 11 of the retractor 5 can be wound up in the opposite direction to the case of the first embodiment.

FIG. 5 shows a body cavity access device according to a third embodiment of the present invention. 5, the same elements as those in FIG. 1 are denoted by the same reference numerals. In this body cavity access device 32, the treatment instrument introducing portion 6 is used as a grasping member that is grasped to pull out the inner annular member 9 disposed on the body cavity 3 side of the retracting portion 4 to the outside of the body.

6, one end of the string-like member T is fixed to the inner annular member 9, and the other end is fixed to a portion outside the body of the treatment instrument introducing portion 6 through the inside of the retracting member 11. In the present embodiment, the other end of the string-like member T is fixed to the fixing portion 25 of the annular wall portion 24. The length of the string-like member T is such that the other end is fixed from the portion of the inner annular member 9 to which one end is fixed in a state where the treatment instrument introducing portion 6 is inserted into the retractor 5 attached to the retracting portion 4. The length is set to have a sufficient margin than the shortest length of the annular wall portion 24 reaching the fixed portion 25.

When the treatment tool introducing portion 6 is inserted into the retractor 5 when the body cavity access device 32 is attached to the retracting portion 4, the string-like member T passes through the inside of the retracting member 11 to the fixing portion 25 of the treatment instrument introducing portion 6. It will be in the extended state. Therefore, most of the string-like member T is in a state of being sandwiched between the retracting member 11 and the treatment instrument introducing portion 6.

When removing the body cavity access device 32 from the retracting portion 4, as shown in FIG. 6, the treatment instrument introducing portion 6 is extracted from the retractor 5, and further moved away from the retracting portion 4, thereby the string-like member T is removed. The inner annular member 9 is pulled out from the body cavity 3 together with the retracting member 11. At this time, since the string-like member T is always located inside the retracting member 11, the retracting portion 4 is not damaged by the string-like member T.

Further, in the state where the treatment instrument introducing portion 6 is inserted into the retractor 5, a part of the string-like member T on the inner annular member 9 side is located inside the retracting member 11, and the other part is the retracting member 11. And the treatment instrument introduction part 6. That is, when the occlusion part 7 occludes the retractor 5, the string member T is not led out of the body cavity access device 32 through the space between the retractor 5 and the occlusion part 7. The airtightness of the body cavity access device 32 due to the occlusion 7 does not deteriorate.

According to the present embodiment, since the treatment instrument introduction unit 6 can be used as a grasping member, the configuration of the body cavity access device 32 can be simplified. Other points are the same as those in the first embodiment of FIG.

FIG. 7 shows a body cavity access device according to the fourth embodiment of the present invention. In FIG. 7, the same elements as those in FIG. 3 or FIG. In this body cavity access device 33, the winding direction of the retracting member 11 by the outer annular member 10 in the retractor 5 is opposite to the case of the body cavity access device 32 of FIG. 5. For this reason, in the state where the body cavity access device 33 is mounted on the retracting portion 4, the retracting member 11 of the retractor 5 has an isosceles triangular shape having a smaller apex angle than that of FIG. A cross-sectional shape is formed.

Therefore, the outer shape of the conical portion 28 in the treatment instrument introducing portion 27 of the body cavity access device 33 is a conical shape that matches the shape of the retracting member 11 having the cross-sectional shape. In addition, the cylindrical portion 30 adjacent to the conical portion 28 and the fixing portion 25 of the annular wall portion 29 also have a shape and dimensions that match the shape of the retractor 5. Other points of the body cavity access device 33 are the same as those of the body cavity access device 32 of FIG.

According to the present embodiment, when considered in conjunction with the embodiment of FIG. 5, a treatment instrument introducing portion having a shape suitable for the shape of the retractor corresponding to the winding direction of the retractable member can be employed. . Therefore, it is possible to select the desired winding direction of the retracting member or the shape of the retractor with emphasis on either the winding direction of the retracting member or the shape of the retractor.

FIG. 8 shows a body cavity access device according to the fifth embodiment of the present invention. In FIG. 8, the same elements as those in FIG. 1 are denoted by the same reference numerals. In this body cavity access device 34, the outer annular member 10 is used as a gripping member that is gripped in order to pull out the inner annular member 9 disposed on the body cavity 3 side of the retractable portion 4 to the outside of the body.

8, one end of the string-like member T is fixed to the inner annular member 9, and the other end is fixed to the fixing portion 25 of the outer annular member 10 through the inside of the retracting member 11. The length of the string-like member T is such that the other end is fixed from the portion of the inner annular member 9 to which one end is fixed in a state where the treatment instrument introducing portion 6 is inserted into the retractor 5 attached to the retracting portion 4. The outer annular member 10 is set to a length that has a sufficient margin than the shortest length to the fixed portion 25 of the outer annular member 10.

When the retractor 5 is attached to the retractor 4 to attach the body cavity access device 34, the inner annular member 9 is disposed on the body cavity 3 side of the retractor 4, and the retractor 11 is wound around the outer annular member 10 as an axis. Taken. Accordingly, the string-like member T is also wound up by the outer annular member 10 from the fixed portion 25 side. Thereby, the remaining portion of the string-like member T that has not been wound is in a state of extending to the inner annular member 9 through the inside of the retracting member 11.

After that, when the treatment instrument introducing portion 6 is inserted into the retractor 5 attached to the retractable portion 4, the remaining portion of the string-like member T that is not wound is removed except for a portion on the inner annular member 9 side, Most of the state is sandwiched between the retracting member 11 of the retractor 5 and the treatment instrument introducing portion 6.

When the retractor 5 is withdrawn from the retracting portion 4 in order to remove the body cavity access device 34, the winding of the retracting member 11 with the outer annular member 10 as an axis is released, and accordingly, the string member T Is also extended along the inside of the retracting member 11. Thereafter, by moving the outer annular member 10 in the direction away from the retracting portion 4, the inner annular member 9 can be pulled out from the body cavity 3 together with the retracting member 11 via the string-like member T. At this time, since the string-like member T is always located inside the retracting member 11, the retracting portion 4 is not damaged by the string-like member T.

In addition, the string-like member T is not led out of the body cavity access device 34 through the space between the retractor 5 and the occlusion portion 7 in a state where the body cavity access device 34 is attached to the retractable portion 4. In addition, the airtightness of the body cavity access device 34 due to the occlusion portion 7 does not deteriorate.

According to the present embodiment, since the outer annular member 10 can be used as a gripping member, the configuration of the body cavity access device 34 can be simplified. Other points are the same as those in the first embodiment of FIG.

As mentioned above, although embodiment of this invention was described, this invention is not limited to embodiment. For example, the retractor may not be of a type in which a part of the retracting member is wound up by the outer annular member as long as the closing part and the treatment instrument introducing part can be attached.

Further, the pulling member does not need to be completely closed in a ring shape, and a part thereof may be open. Further, the pulling member does not need to be a perfect circle, and may be a polygonal shape or an elliptical shape.

1, 26, 32, 33, 34 ... body cavity access device, 3 ... body cavity, 4 ... retractor, 5 ... retractor, 6 ... treatment instrument introduction part (gripping member), 7 ... obstruction part, 8 ... handle member (gripping) Member), 9 ... inner annular member, 10 ... outer annular member (gripping member), 11 ... retracting member, T ... string-like member.

Claims

An inner annular member disposed on the body cavity side of the retracting portion, an outer annular member disposed on the outer side of the retracting portion, the inner annular member fixed to one opening, and the outer annular member serving as the other opening A retractor having a flexible and tubular retractor fixed to the portion;
A funnel-shaped treatment instrument introduction portion that is inserted into the retractor attached to the wound portion and constitutes an introduction path into the body cavity of the treatment instrument;
An occlusion part that has an insertion part that is passed through in a state where the treatment instrument is kept airtight, and is attached to the outer annular member to airtightly close the retractor;
A gripping member gripped to pull out the inner annular member disposed on the body cavity side of the retracting portion;
A string-like member having one end fixed to the inner annular member and the other end fixed to the gripping member;
In the state where the treatment instrument introducing portion is inserted into the retractor attached to the retractor and the retractor is closed by the closing portion, the grasping member is located outside the body in the retractor, The string-like member is disposed so as to reach the grasping member from the inner annular member through the retracting member and the treatment instrument introducing portion.
The body cavity access device of claim 1.
The body cavity access device, wherein the grasping member is constituted by an annular pulling member disposed on the outside of the body of the retractor mounted on the retracting portion.
The body cavity access device of claim 1.
The grasping member is constituted by the treatment instrument introducing portion, and the other end of the string-like member is fixed to a portion outside the body of the treatment instrument introducing portion.
The body cavity access device of claim 1.
The grasping member is constituted by the outer annular member, and the other end of the string-like member is fixed to the outer annular member.
The body cavity access device of claim 1.
In the retractor, the inner annular member is arranged on the body cavity side of the retracting portion, and the outer annular member is arranged on the outer side of the retracting portion, and one or the other is used with the outer annular member as a winding shaft. Is fixed to the retracting part by winding a part of the retracting member outside the body in the winding direction of
The treatment tool introduction part has a shape adapted to the shape exhibited by the retracting member according to the winding direction.