CN1084729A - Be used for the operating trocar of splanchnoscopy and help into device - Google Patents

Abstract

The invention discloses a kind of be used for the splanchnoscopy surgical operation oppositely peritoneal traction help into device to eliminate because of the excessive trocar of stabbing internal's danger.This helps into that utensil has spiral design, has movably guide member of a fixed support ring and, and this guide member has hollow, the cylindrical channel of an insertion that helps the trocar, sleeve pipe and other splanchnoscopy surgical operating instrument and support.In another embodiment, this helps into that device is made into the shape that helps carbon dioxide is imported the patient abdominal cavity.The invention also discloses a kind of improved trocar and help the into bent tip of device blade.

Description

Be used for the operating trocar of splanchnoscopy and help into device

The present invention relates to a kind of trocar and help into device (facilitator), more particularly, it relates to a kind of into device that helps that has the reverse pulling device that helps the trocar to thrust patient body, thus the danger of using the trocar to bring before can eliminating.

The splanchnoscopy surgical operation is a kind of processing procedure of having an operation based on minimal intrusion, to the inside of patient body.This operation is to finish by open a little otch or openning in patient's body, can operate various small-sized, remote-controlled apparatuses by this openning.By means of an endoscope, can under visual situation, finish this operating process, thereby it is called the splanchnoscopy surgical operation again.The operation of this form has some outstanding advantages, comprises the damage that has reduced the patient, has reduced dead danger or complexity, and recovers fast.

Endoscope is a kind of small-sized endoscope, the internal structure that it utilizes the fibre optics instrument to make the surgeon can remote control observe human body.Like this, there are lens in general endoscope in its insertion end or far-end, and the near-end of the instrument outside human body has eyepiece or viewer.Usually, viewer is a video-frequency monitor.At far-end a light source is arranged, in order to illuminate the inside of human body.By means of endoscopic observation, can utilize various apparatuses to carry out the operation relevant with operation.These apparatuses generally include retractor, irrigator, cutter, laser instrument and like instrument.

As mentioned above, each in these apparatuses comprises endoscope itself, all must insert in patient's body by an openning.This openning has a hollow tubular sleeve to be inserted in wherein by constituting at the intravital otch of people.Then, this root sleeve pipe is just as a conduit that holds and support endoscopic instrument.

In forming, peep in the mouth, utilize a trocar also sleeve pipe to be inserted.The trocar is a kind of operating theater instruments that has triangular pointed, and it enters human body by a little operative incision.Casing pipe sleeve is in the outside of the trocar, and together inserts in the otch with it, like this, after otch forms, takes out the Decanning pin, sleeve pipe still stayed original position peep mouth with in limiting.In general, sleeve pipe comprises one and has to be used to control and be blown into that gas flows into or flow out the plug valve of patient body or the medicated cap of other valve.In addition, at intra-operative,, therefore their the near-end outside can be leaned against on the medicated cap because interior specula tool extends internally from mouth.Usually, need support the weight of these apparatuses with a bracing or strutting arrangement.

In general gallbladder surgical operation or cholecystectomy, need four to six opennings of use to satisfy the needs of the various interior specula tools of finishing this operation.Clearly, the endoscopic surgery of other type also needs more or less some opennings.Each openning comprises the sleeve pipe relevant with it, all must pass stomach wall, and stomach wall itself includes the alternating layer and the peritoneum of exodermis, fat deposit, fascia layer or muscle and fascia.Have fat or thin differently according to region and patient, the thickness of fat deposit and fascia layer is vicissitudinous.Peritoneum is that one deck lining pastes abdominal wall, strong and resilient film.Yet, just under peritoneum several vitals, as liver, harmonization of the stomach intestinal, and other sensitive organization.

In the splanchnoscopy surgical operation of gallbladder removal operation and other type (as appendectomy etc.), will with a kind of be in the material input patient body of pneumoperitoneum state, think specula tool operation in carrying out and prevent to damage the internal and a tissue and body cavity that has enlarged is provided.Like this, in pneumoperitoneum, field of operation is blown into carbon dioxide.Beginning realizes being blown into the pin of a kind of Veress of being called, and this pin is a kind of large needle of patient with input gas that be used for thrusting.Yet, carry out this operation and can increase some danger, too dark because pin might thrust human body, thereby stab the patient.On the other hand, when beginning to be blown into,, can cause other serious consequence so again if pin fails to penetrate stomach wall at least.

After beginning to be blown into the Veress pin, at once just by set up by the sleeve pipe of trocar guiding one be used for to inner chamber carry out inner observation first in peep mouth.After this, at the surgery intra-operative, constantly by sleeve pipe input insufflation.As what explain above, carry out surgical procedures also need other in peep mouth.Therefore, the trocar is most important for the operating success of splanchnoscopy, because telescopic insertion guides by it, and sleeve pipe is used for keeping pneumoperitoneum and limit surgical procedures mouth itself.

Yet using the danger of the trocar also is very clearly.In some cases, since sleeve pipe acupuncture get too dark and can produce undesigned visceral injury to vitals.This harm meeting is because the size of surgical experience, the trocar and thrust the different and difference to some extent in the position of body cavity.Other harm may be caused that in these harm, the adhesion meeting causes that the trocar is complicated with the telescopic insertion related with it by former abdominal operation or peritonitis.

Like this, peep mouth in very big danger meeting is inserted by the trocar and cause, particularly when first openning is " blind hole ".Yet even by means of endoscopic observation, the trocar of following inserts also may bring danger to the patient.This is because the toughness and the elasticity of stomach wall causes to a great extent, thereby the strength that need apply the people makes trocar puncturing.Assign power, and then jab the trocar into that the impulse force of stomach wall is difficult to hold, therefore, can cause in some cases too thrusting and damaging by the surgeon.The degree of depth of being thrust when in order to be limited in trocar thorn being entered body, many surgeon use the ulna edge (ulnar border) of hands to carry out stop.The surgeon who has goes up the degree of depth that enters with restriction with the axle that finger is pressed in the sleeve pipe or the trocar.Yet in both cases, the insertion impulse force that hands applies has been transformed into the other parts of health simply.This fact, and stomach wall can not successfully stop the flexibility of the pressure of threading a needle, and makes these methods that effective stop device can't be provided.

In order to reduce the danger that the trocar uses, the surgeon pinches a part of skin with the hands of the inoperation trocar and its edge is mentioned with the vertical opposite direction of trocar direction of advance usually.In other words, want to use mode that cortex, fat deposit, fascia layer and peritoneum are mentioned to come stomach wall is upwards drawn separating with its vitals down, thus the space between expansion stomach wall and the such organ.Even this method is to expect a limit of error so that trocar thorn is dark not at all as for the organ that hurts below the stomach wall.Yet this method also is invalid in many cases.At first, it be difficult clamping skin well with the hands of not taking the trocar, because this hands more weak hands of surgeon normally; Secondly, the rotation that the position that finger pinches can produce some necessity from the position that the trocar inserts, therefore, only some or component pass to the definite position that the trocar thrusts body cavity in the horizontal in the lifting force; The 3rd, when the method for pinching is may be to the thin body effective, but its effect is then very dissatisfied concerning the thicker fat people of fat deposit.Therefore, need improve the method that the trocar inserts.

In view of above-mentioned danger of pinching method, developed the trocar of some special configuration recently, they are equipped with the spring that shields for the tip of the trocar.After abdomen wall puncture was finished, this sealer can automatically outwards launch to cover the tip of the trocar.Yet the expansion of sealer is unpunctual sometimes, even and postpone several microseconds and all may cause the trocar to be stabbed.In addition, every of these trocar will spend several one hundred dollars, and owing to will use a few spider bobbins in a splanchnoscopy surgical operation, this will cause very big spending.Therefore, the use that has a trocar of sealer can not solve this sensitive issue fully.

The another kind of method of peeping mouth in offering is the method that is called " opening laparoscopic port ", and it does not need to use the sharp-pointed trocar.According to this method, open laparoscopic cannula and need keep lasting observation control in order to insert one.The key of this method is to use a kind of retractor and Ai Lisishi or Ke Heershi grasping tongs of S-shaped shape, to enlarge initial incision in the horizontal and to mention fascia.This processing has been exposed peritoneum and has been made it be in tension state so that can carefully it be pierced through or cut.Although this method is comparatively safe, it also has significant disadvantages.

At first, operating process is tediously long and complicated, needs many steps.Secondly, we is opening for a long time owing to openning, and being blown into pressure can disappear.In addition, openning is usually opened greatlyyer than the openning of trocar guiding, thereby makes the patient produce sticky feeling and prolonged the time of recovering.Therefore, do not having under the situation of attendant risks, need to prepare a series of possess trocar advantage in peep openning.

The present invention helps into device to advocate instrument and solved these problems that exist in the prior art by using a kind of trocar that is arranged on securely under the fascia.In the accurate position that the trocar inserts, this helps into that device allows the surgeon to induce a kind of power that makes progress that reacts on trocar puncturing power.Like this, not only can induce a kind of castering action opposite, and produce a kind of reverse traction with trocar direction of advance, it react on or offset the necessary danger of trocar puncturing to lower punch power.Because the puncture motion can obtain controlling more carefully, therefore, the danger that produces internal injury has has just reduced or eliminated widely.

It is exactly that it can make peritoneum conversely or produce tension force in the other direction that this trocar helps into another significant advantage of device, to prevent too thrusting of the trocar.In other words, the device into of helping of the present invention can not only be mentioned fascia and peritoneum and separated with vitals under it, thinks to avoid damage and produce a place of safety, and has also accomplished so really in the exact position of trocar puncturing.Stop the over-drastic puncture of the trocar with regard to the intensity of having utilized peritoneum like this.Simultaneously, because peritoneum is in tension state, therefore puncture just easily.

The trocar of the present invention helps device into to use for common trocar Assembly, indicate as top, it generally comprise the sleeve pipe peeped in a trocar of finishing the peritoneum puncture, the formation mouthful with for control with in peep the sleeve cap of some related function of mouth.Yet, because its many-sided adaptability, and though the trocar of the present invention help device into also can with unconventional, customized or custom-designed be that existing or leaved for development from now on trocar Assembly is compatible mutually now.The present invention not only can be used as the into device that helps that promotes trocar safe handling, and can be used as the aforesaid retractor that patient's tissue is carried.In addition, according to some embodiment of the present invention, the trocar helps into device also can produce lateral traction in the interior oral area position of peeping.

Of the present inventionly help into device in case it packed in the otch, just be sleeve pipe or casing head as an anchor, it need not use other bracing or strutting arrangement with regard to support being provided for interior specula tool like this.Therefore, of the present inventionly help into that device includes one in initial incision place and patient's the engage tissue or the retention means of clamping.Originally help into that device also contains a lifting member that is contained on the retention means, so that aforesaid reverse traction to be provided.For example, such lifting member may include a handle or other device that supplies hand hoisting or shrink back.If necessary, this helps into that device also may include a guide member, inserts otch with the guiding sleeve and the trocar, thereby peeps mouth in setting up.In this big framework, helping into, the shape of device may alter a great deal.For example, helping into, device can be one or assembling.In another embodiment, help device into can be make standard package so that it can be splitted into parts (as two parts of equity, three parts etc.), do not influencing under the telescopic situation of trocar Assembly and can take away it fully like this from incision site.

In another embodiment, retention means and lifting member fit together, respectively by retracting blade and forming for producing the elongate handgrip of oppositely drawing.Yet the guide member of present embodiment can split into parts, so that it is peeped in being installed in respectively mouthful or dismantles.In the embodiment of another one, help into that device is equipped with a far-end cylindrical blade on retention means, in order to clamping patient's tissue, for the sleeve pipe of trocar Assembly provides firm maintenance by the mode of rotation.Like this and since help this embodiment of device into provide one hard to upper support, to be enough to support various apparatuses, therefore, without any need for other support or apparatus maintenance.

In another embodiment of the present invention, the trocar helps device into to include to contain two lifting members that have a handle and one movably helical form or rotation shape retention means.Each of lifting member partly all has one and is semicylindrical core.These two halves fit together just to have formed and are used for guide sleeves bobbin and sleeve pipe and insert the intravital cylindrical channel of patient.Lifting member/guide member is removably linked on the spiral retention means.Retention means firmly meshes by rotation mode and fascia tissue, strengthens oppositely traction.

This embodiment of the present invention helps improving grip tissue in the scope of 360 degree.Thereby, under the situation of not damaging tissue, can increase oppositely traction.Because laterally retracting of initial incision reduced, thus should organize around and trocar Assembly between provide a kind of sealing closely to help prevent to be blown into the leakage of gas.In addition, the trocar of present embodiment helps into that device also can make the trocar fix, thereby does not need external artificial support or instrument supports.The engagement of helical blade and deep fascia layer can make trocar Assembly uprightly and securely locate as an anchor.This can finish by the sleeve pipe syringe needle is taken out and be screwed to the lifting member/guide member on top from the retention means of bottom.

In this embodiment, the trocar helps into that the tip of device blade is bent upwards a little, and like this, when helping that into device is vertically put in patient's body, the blade elbow is towards the surface of health, thereby has just reduced the danger of stabbing unintentionally to following vitals.

The trocar of the present invention helps into that device also can help carbon dioxide is supplied with the patient, thereby produces a kind of pneumoperitoneum state in patient's body.In one embodiment, gas helps the into guide member of device and a channel transfer in the blade by being formed on.Best, this passage contains a hollow pipe that has near a spring of its far-end.When spring was in relaxed state, the far-end of pipe exceeded the far-end of blade, when organizing of patient punctured at the tip of blade, will suffer from enough resistances and come pressuring spring.And after shifting the end of pipe onto blade end.After peritoneum was pierced, resistance disappeared, relaxing of spring, and the end of pipe also just extends beyond the end of blade.Then, allow the gas pipe of flowing through go forward side by side into patient's abdominal cavity.

In other embodiments, gas passage is formed in the trocar itself.Owing to peep a mouthful safety with originally helping in into the retention means of device is contained in, therefore, the present invention also provides and has allowed patient's tissue remain on the position of an extension so that the splanchnoscopy surgical operation uses the method and apparatus of minimum insufflation.In also providing and formed, the present invention peeps the method for a kind of novelty of mouth.

In a word, the trocar of the present invention helps into device can make different shape, and has many additional features.Therefore, it is compared with the trocar Assembly of prior art and has in essence advantage.

Fig. 1 is that the trocar of the present invention helps the into perspective view of an embodiment of device, and it has shown that a surgical hands can produce the mode of the upward force opposite with trocar thorn Inbound.

Fig. 2 is that the expression trocar thrusts the profile of body cavity, and it is by means of inserting the blade that retracts that the trocar of fascia layer than the superficial part position helps device into, and the reverse pull strength of generation is finished.

Fig. 3 is the exploded view of a trocar Assembly, and it includes the trocar that has two pull device among the trocar, sleeve pipe and the present invention and helps into device.

Fig. 4 is that the trocar of the present invention helps an embodiment of device into to be in the profile of its confined state, and it has further represented to be formed on the trocar mouth in the trocar.

Fig. 4 a is that expression trocar mouth reaches the wherein details drawing of the trocar far-end of assembly.

Fig. 5-the 10th, expression use the trocar of the present invention help device into method, comprise the part sectioned view of its occupation mode.

Figure 11 is that the expression trocar of the present invention helps the into part sectioned view of another embodiment of device, and the bigger handle of its use produces and is suitable for the reverse traction that two handss use.

Figure 12-15 expression uses the trocar of second embodiment of the present invention to help the into mode and the method for device.

Figure 16 is that Figure 11-15 middle sleeve pin helps the into top view of second embodiment of device.

Figure 17 is that the trocar of the 3rd embodiment of the present invention helps the into perspective view of device, and it has the end tooth that firmly clamps fascia tissue.

Figure 18 is the exploded view of a trocar Assembly, and it has adopted the trocar among Figure 17 to help into device and the trocar, sleeve pipe, sleeve cap and a rotating seal.

Figure 19-21 expression uses the trocar of third embodiment of the invention to help the into mode and the method for device.

Figure 22 represents to help the into matching used improved trocar needle point of device with the trocar of the present invention.

Figure 23 is that the trocar of the present invention helps the into side view of the partial cut-out of the 4th embodiment of device.

Figure 24 is that the trocar among Figure 23 helps the into exploded view of device, and it has represented a retention means and two lifting members.

Figure 25 is the side view of the parts of a trocar Assembly, and it includes the trocar among the trocar, sleeve pipe and Figure 23 and helps into device.

Figure 26-the 27th, expression uses the trocar among Figure 23 to help the into mode of device and the part sectioned view of method.

Figure 28 represents that the trocar of the present invention helps an into improved needle tip of device.

Figure 29 is that the trocar of the present invention helps into that the part of the 4th embodiment of device cuts figure, and it includes one carbon dioxide introduced the intravital hollow pipe of patient.

Figure 30 is that the trocar among Figure 29 helps the into part sectioned view of the amplification of the needle tip of device, and it has represented to be contained in the spring that is in slack position in the needle tip.

Figure 31 is that the trocar among Figure 29 helps the into part sectioned view of the amplification of the needle tip of device, and it has represented to be contained in the spring that is in slack position in the needle tip.

With reference to figure 1, it has represented trocar Assembly 20, wherein includes the trocar of the present invention and helps an into embodiment of device 5, helps device into 5 to insert in the acupuncture otch 22 of patient bodies this trocar and thinks that carrying out the splanchnoscopy surgical operation prepares an openning.Yet, as mentioned above, should be noted that and help into by the trocar of the present invention device is not limited to any specific trocar Assembly, and that can be applicable to various routines or unconventional, the existing or leaved for development from now on trocar now.In addition, help into the device shape to carry out various changes also within the scope of the invention to the trocar.

Device 20 includes the trocar 40 of being pressed by surgical thumb 31 among the figure, trocar sheath 34 and a trocar of peeping mouth 21 in the qualification help into device 50, it is retractile by surgical finger 30 on the direction that makes progress, so that provide buffer brake for penetrating of the trocar 40.The needle tip 42 of the trocar 40 dots under cortex 24.Be noted that the present invention is adapted to the trocar of various different sizes and diameter.In the outer end 43 of the trocar 40 aperture 44 is arranged, it be among Fig. 2-4 more complete representation the proximal openings of trocar mouth 46 of the present invention.As below describing in detail, this trocar mouth 46 can give endoscope or sleeve pipe as a conduit.

In providing and limited, peeps by the sleeve pipe 34 of annular sleeve pin 40 pipeline of mouth 21.By peeping mouth 21 in this, endoscope and other apparatus can be inserted body cavity to carry out surgical operation.During operation is carried out, can keep constantly being blown into of carbon dioxide by the interior mouth 21 of peeping.

Still with reference to figure 1, help into device 50 to include a leader 52, two to retract blade 54(and under patient's cortex 24 surfaces, dot in the trocar Assembly 20), with two have and hold the handle that the surgeon points 30 finger ring 56, in order to the adverse movement of this device.Help device into 50 preferably by being mutually mirror image, can engaging and be hinged to two and half parts 51a of a latch 58 among Fig. 1, b(is shown in Figure 3) formation.Insert and hinged into these the two and half parts 51a of device 50 that helps, the method for b will be explained in more detail below, and be illustrated in conjunction with Fig. 5-10.

Fig. 1 and Fig. 2 have represented the optimum position of surgical hands 32 contact sleeve bobbins 40, and apply power thereon.The thumb 31 of hands 32 is placed on the near-end 43 of the trocar 40 to apply from the power that penetrates motion 60 down.Simultaneously, the finger 30 of hands 32 insert in the ring 56 that helps device handle 55 in case on device 20, apply the power 62 that oppositely makes progress mention the stomach wall of patient body below making it to leave vitals and reduce the trocar 40 and do unnecessary puncture downwards.In other words, importantly, notice that trocar Assembly 20 of the present invention not only can mention stomach wall and make it to leave following vitals 25 producing place of safety 29, and can produce adverse movement or the impulse force that reacts on the downward puncture impulse force that the trocar 40 inserts inherently.Like this, in case stomach wall is punctured simultaneously will being reversed balance and can stopping very soon or even return to lower punch power of puncture.This just had very big advantage than the former trocar, and during the former trocar used, in case pierced through stomach wall, downward impulse force was just uncontrollable.Therefore, the trocar Assembly 20 here not only can be mentioned, and can control and the downward power that punctures of reverse balance.

Represented these important principles of the present invention among Fig. 2, it is a part sectioned view of laying trocar Assembly 20 in the stomach wall at a umbilicus position that is illustrated in patient body.Stomach wall in human body umbilicus position includes cortex 24, fat deposit 26, fascia 27 and peritoneum 28.At other position of human body, muscular tissue is clipped between the fascia tissue 27.Can think that represented homogeneity fascia tissue layer 27 has been represented two positions in the accompanying drawing.Peritoneum 28 is strong, the whippy films of one deck, and it is protecting the vitals 25 under it.

Fig. 2 has represented to act on the direction of each power on the trocar Assembly 20.The downward puncture campaign 60 of the trocar 40 has been subjected to acting on the upwards reverse balance or the retroaction of lifting force 62 that helps on the device 50 into.Like this, the skin of tissue is raised and makes it to leave vitals 25 to obtain error critical zone or place of safety 29, avoids the trocar 40 excessively to puncture.Therefore, as shown in Figure 2,40 of the trocars pierce through peritoneum a little and stop, it be applied the upward force 62 that is helping on the device 50 into to lower punch power or power 60 and offset.This upward force 62 is delivered on the trocar by means of a ring-type retainer 64, and this ring-type retainer 64 can take to be installed in the form of the ring-shaped edge 66 on the inner surface that helps device 50 into.This edge 66 affects the ring-type ridge 68 that is installed in the trocar 40 outsides.These parts have more detailed expression and description in conjunction with Fig. 3-4.

In case the trocar 40 has pierced through peritoneum a little, as shown in Figure 2, just endoscope (not expression among the figure) can be inserted by trocar mouth 46, so that observe the degree that pierces through.Then, the observation by means of endoscope lunges the trocar forward carefully.

Fig. 2 has represented to help the into optimum position of device blade 54 for 27 times at darker fascia tissue, helps into that this arrangement of device 50 has improved its hoisting power, resembles the fat all thick fat deposits 26 of people even run into.

Fig. 3 has shown the exploded view of trocar Assembly 20, and it includes sleeve pipe 34, the trocar 40 itself and two and contains handle 55, leader 52 and help into that the trocar of the blade 54 of device 50 helps into device half parts 51a, b.As noted above, in can sliding and stay and go up as insertions such as endoscope, apparatuses in position, peeps by sleeve pipe 34 mouth 21 on the trocar 40.Using and settling and to discuss in more detail below in conjunction with Fig. 5-10 about it.

The above-described trocar 40 has comprised a far-end 42 near it, contains the protuberance annular ridge 68 of retainer 64, represents more in detail to this among Fig. 4.What expose on the top of the trocar 40 is the proximal openings 44 of trocar mouth 46, and this trocar mouth is the cylindrical channel as dotting among the figure, and it is vertically extending and extend on the face of trocar tip 42 along the whole length of the trocar 40.

As explained above, help into device half parts 51a, b is equipped with the handle that has finger ring 56 55 that is used to clamp and oppositely draws.When they are bonded together, these two and half parts 51a, b just contains a leader 52 so that the trocar/sleeve pipe links together.In conjunction with what Fig. 2 explained, blade 54 roughly extends on the axle of the trocar 40 in the horizontal, and can be inserted under patient's fascia 27 as top.Can will help into device half parts 51a by a bolt device 58, b is bonded together, and this device can be thrown off, and if desired, it also can make these two and half parts be hinged.At guiding half parts 51a, represented to influence the ring edge 66 of the annular ridge 68 on the trocar 40 on the inner surface of the leader 52 of b, to constitute a retainer 64.

If desired, can do shortlyer this blade 54 of device 50 that helps into and littler, prevent to miss as the carbon dioxide of insufflation so that otch 22 is enlarged.

Fig. 4 has represented trocar Assembly 20 among Fig. 2-3 with the mode of profile.Can notice that the trocar 40 among Fig. 4 is in same position shown in Figure 2, the trocar inserts and has pierced through peritoneum 28 to greatest extent.Like this, Fig. 4 has represented that the spiral shell ridge 68 on the trocar 40 rests on the inner edge 66 that helps device 50 into, to constitute a retainer 64.This retainer 64, by be applied to the finger ring 56 that helps device 50 on reverse pull strength combine, can stop the trocar 40 to puncture too deeply effectively.In addition, Fig. 4 has represented to be enclosed within on the trocar 40 and has injected sleeve pipe 34 in the leader 52 that helps device 50 into.

Fig. 4 has also represented to extend the trocar mouth 46 that also can allow interior specula tool pass through along the length of the trocar 40.Fig. 4 a is the close-up view of trocar mouth 46 distal openings, and it has represented a less auxiliary sleeve pipe 80 and the endoscope 82 that is inserted in wherein.Like this, even can see that from Fig. 4 a these apparatuses insert trocar mouths 46, also to there be one to allow and be blown into the annular space 84 that gas passes through.A significant advantage of the present invention is exactly that trocar Assembly 20 can be eliminated use for the Veress pin (not indicating among the figure) that is blown into purpose, and itself may be a danger close.In other words, use the Veress pin, the surgeon may pierce through or penetrate vitals 25 unintentionally, thus patient harm.On the other hand, be enough to pass peritoneum if pin can not sting, so, gas nethike embrane (Pneumo-omentum) state can occur before being blown into beginning, it also can patient harm.By means of trocar Assembly 20 of the present invention, in case when the doctor be sure of to pierce through peritoneum 28, just the coalition of an auxiliary sleeve pipe 80 and endoscope 82 can be inserted in the trocar mouth 46, to observe the degree that the trocar 40 penetrates.If be punctured to enough deeply, just can allow initial insufflation begin by trocar mouth 46.Otherwise, just can carry out visualization by the endoscope shown in Fig. 4 a 82, make the trocar 40 proceed puncture safely.

Another advantage that trocar mouth 46 brings is exactly not import gas to the patient or extracting out on one's body from the patient under the situation of material, can insert or draw back the trocar 40 mouth 21 from interior peeping.In other words, owing to adopt tight seal between the solid bushing pin of routine and sleeve pipe, the trocar is actual to play a part a piston.But the pressure differential between body cavity that trocar mouth 46 of the present invention produces for moving owing to the trocar 40 and patient's the outside provides decompression device.

Fig. 5-10 has represented method of the present invention and has helped the into mode of device 50 in conjunction with the described trocar of Fig. 2-4 above the use.

Fig. 5 has represented the into intravital method of device 50 embedding patients that helps with trocar Assembly 20.At first, in patient's cortex 24 and fat deposit 26, cut a dark otch 22(as shown in Figure 1), with as the first step of peeping mouthfuls 21 in forming, this otch 22 is an acupuncture otch that preferably arrives the weak point of fascia tissue 27 deeply in essence.If necessary, the wall of otch 22 laterally can be retracted so that help the insertion of trocar Assembly 20.Then, will help near this otch 22 into the mode that keeps flat substantially that one of device half parts 51a installs, so that help the longitudinal axis of half parts of device into parallel with patient's cortex 24 in incision.In this structure, the blade 54 that helps device half parts 51a into is crosscut patient's cortex 24 substantially, and its far-end 57 injects in the otch 22 downwards.The blade 54 that helps half parts 51a of device into injects in the otch 22 by the degree of depth of necessity.To help into again, half parts 51a of device deasil rotates about 90 ° by arrow direction in left-hand side among Fig. 5, rotation just makes and helps into half parts of device to enter into one at otch 22 places substantially and patient's cortex 24 vertical positions like this, and laterally thrust at the tip 57 that makes blade 54 and near under the fascia 27, up to imaginary stand up position as shown in Figure 6.

Except the counter clockwise direction rotation shown in the arrow of pressing Fig. 5 the right, second half parts 51b of device takes similar action to install to helping into.When helping into two and half parts 51a of device, when b reached stand up position, they just can dock by direction shown in the arrow of Fig. 6, and interconnect by latch 58.

Help into half parts 51a of device, the advantage of this insertion method of b is that it reduces to minimum with the size of the otch 22 of necessity, and has kept a less otch in installation.In addition, will helping in this way, the blade 54 of device 50 is inserted under the fascia 27 safely.Therefore, as what describe in detail above, the reverse traction that can obtain to improve by blade 54.As shown in Figure 7, owing to help into half parts 51a of device, b connects together securely, this has just obtained a firm and axial leader 52 to allow the trocar/telescopic coalition insert, thereby under need not be surgical hand steered situation, help into device 50 can the oneself to support and can hold and comprise that sleeve pipe 34 and the trocar 40 such apparatuses insert.This just can make the surgeon carry out other operation and shortening and peep mouthful time of operation in carrying out.

Can see that in Fig. 5 and Fig. 6 vitals 25 are near under the peritoneum 28.In Fig. 7, represented before the trocar 40 punctures, to utilize the trocar of the present invention to help into device that peritoneum 28 and other organized layer on it tractive that makes progress is made it to leave vitals 25 with the mode that is similar to Fig. 2.So just can see, help in the device 50, just can obtain tractive near △ h according to above-described apparatus and method in case the trocar 40 and sleeve pipe 34 inserts.And in case so far tractive, just can begin to carry out the puncture of the trocar 40 safely.Direction shown in arrow among Fig. 7, the reverse pull strength that manpower produced that applies by finger ring on the handle 56 trends towards offsetting the impulse force of trocar puncturing, thereby further avoids injuring vitals.At last, as shown in Figure 8, in case the trocar 40 has been finished puncture peritoneum 28, because the tensile effect of reverse traction and puncture place generation on peritoneum thereof can easily be controlled the trocar 40 again toward the depths puncture.Make the trocar 40 continue puncture if desired,, just can operate safely by means of endoscopic observation by top mode described in conjunction with Figure 40.

Fig. 9 and Figure 10 represented in order to peep mouthfuls 21 in forming, the mode that the sleeve pipe 34 of trocar Assembly 20 is in place.At first, adopt and Fig. 6 similar methods, by not connecting help the into device half parts 51a of latch 58 with trocar Assembly 20 earlier, b separates a little, allow sleeve pipe 34 be passed down through on the trocar mouth 40 spiral shell ridge 68 and by helping into device half parts 51a, the inner edge 66 of b.Like this, sleeve pipe 34 just can be inserted into downwards in the hole that is formed by the trocar 40 in peritoneum 28, and the trocar 40 is used as a guide member.As shown in figure 10, in case sleeve pipe 34 passes peritoneum 28 and puts in place, just can take out the trocar 40 so that the specula tool is put in allowing.If necessary, can will help into device half parts 51a, b couples together once more, so that provide firm vertical support for sleeve pipe 34 or other apparatus that can put into.

Figure 11 has represented a trocar Assembly 86, and the trocar of the present invention helps into that device 88 has long curved handle 90a in this device, and b, its far-end have the blade 94 that inserts under the fascia 27.Owing to have a this into shape of device 88 that helps, can be applied directly on blade 84 and the fascia 27 by the lifting force of direction shown in the arrow among Figure 11, thereby can produce bigger reverse traction.If desired, with a thumb trocar is being stung fashionablely, can produce reciprocal tractive with surgical both hands.If necessary, when curing mainly the surgeon when thrusting the trocar 40 in the peritoneum 28 downwards, the assistant surgeon just can tractive handle 90a, b.Like this, adopt with top and help the described similar mode of device into 50 to help into that device 88 couples together among the trocar 40 and sleeve pipe 343 and Figure 11 Fig. 2-10 middle sleeve pin.

As we can see from the figure, help into device handle 90a, the blade 94 of b end is more greater than the blade among the embodiment of front 54 shorter a little and angle.Such shape helps by blade 94 and handle 90a, and b clamping below the fascia layer 27 in deep gets more firm, so that improve reverse tractive ability.This is an important advantage for some patient, because their subcutaneous fat 26 may thickly reach 10～20 centimetres.

As Figure 12-16 in detail expression, constitute two and half parts 96a of trocar guide member 98 of the present invention, b also some difference on configuration.In the present embodiment, each guides half parts 96a, and b can both be installed in their handle 90a separately versatilely by path 10 0, on the b.Like this, when mounting sleeve needle device 86, just can guiding half parts 96a, any one upwards slides and leaves incision among the b.Especially, Figure 12-15 has represented the method relevant with the present invention and has used this specific trocar to help the into mode of device 88 in trocar Assembly 86.

With reference to Figure 12, first otch 22 makes cortex 24, and fat deposit 26 and fascia layer 27 produce some and relax, thereby cause that they separate a little.Yet, if necessary,, can retract otch 22 a little at horizontal direction for the mounting bush pin helps into device 88.Help into device 50 described similar approach in conjunction with the trocar among Fig. 2-10 above adopting, the blade 94 that Figure 12 middle sleeve pin is helped a handle 90a of device 88 into along with patient's cortex 24 substantially the direction of crosscuts insert in the otch 22, in the direction of the clock handle 90a is rotated then about 90 ° so that help into device blade 94 reaches assumed position shown in Figure 13.Like this, blade 94 just is inserted under the fascia layer 27 in order to carrying out firm reverse tractive.Also can see from Figure 13, the guiding half parts 96a of association upwards can be slided so that do not influence the installation of the guiding half parts 96b on another handle 90b.Second handle 90b the counter clockwise direction rotation in pressing Figure 133 shown in the arrow, can install with similar methods.

Figure 14 has represented handle 90a, and b is installed in the position in the otch 22.First is guided under the half parts 96a then and slide in the groove, mate to constitute a complete cylindrical guide 98 as shown in figure 15 with second guiding half parts 96b.This complete guide member 98 can allow the trocar shown in Figure 11/thimble joint body insert.

Figure 16 is the top view of trocar Assembly 86, and it has represented complete guide member 98 and the half parts 96a of guiding separately, the bond end of b.It has also represented the similar mode of the embodiment of employing as shown in Fig. 2-10 with inner edge 102a, and b combines as a trocar retainer 104(referring to Figure 11).Be installed in guiding half parts 96a, b outside is path 10 0, as mentioned above, it can slide being enclosed within guiding handle 90a separately, on the b.

Therefore, the trocar of the present invention helps device 88 into can realize maximum reverse tractive fully.

In some cases, the trocar Assembly 20 among the embodiment of front and 86 can't by the trocar help the retention means of device into make tissue engaged fully with to a certain degree tractive or essential reverse tractive.For example, patient's fat deposit 26 can make the observation to the fascia 27 of otch 22 depths thicken, and hinders the blade of trocar guide member to enter correct position.In addition,, in forming, peep mouthful necessary otch 22 sizes, may wish to adopt the clamping form that can not make otch 22 that the expansion of any degree is arranged for fear of the leakage on every side of device insertion district is blown into gas helping into.

Correspondingly, represented another trocar Assembly 120 in Figure 17-21, the trocar that it includes the 3rd embodiment helps into device 122.At first referring to Figure 17, it has represented that the trocar of present embodiment helps into device 122, wherein includes a complete cylinder or leader 124, and it has oppositely traction, the transversely relative handle 126 of a pair of generation.Helping the far-end of device 122 into that the sharp-pointed profile of tooth clip of a pair of formation rotation or spiral form is arranged.As following will be clearly, these two profile of tooth clips are used for creeping into to be thought in the fascia tissue 27 and helps into that device 122 provides firm chucking power.In this way, do not have unnecessary expansion and do not need to carry out to apply enough reverse traction forces to cutting part under the situation of deep fascia observation at otch 22.

Figure 18 has represented complete casing bit 120, and it includes the above-described trocar and helps into device 122, contains the sleeve pipe 140 of the medicated cap 142 that connects together with it and pass the telescopic trocar 150 at near-end.What represent at far-end 144 places near sleeve pipe 140 is the rotating seal spare 144 that has external screw thread 145, and it can be avoided being blown into gas and miss around the sleeve pipe 140 of puncture place.

Under the situation of routine, as shown in figure 18, medicated cap 142 contains a clack valve 146 of avoiding being blown into gas loss.Yet this valve 146 can allow the trocar 150 be passed down through fixing head 142 and sleeve pipe 140, so that allow the needle point 152 of the trocar 150 expose at the far-end 141 of sleeve pipe 140.Like this, peep mouth,, stay sleeve pipe 140 and medicated cap 142 in position in case behind the trocar 150 puncture peritoneums 28, just the trocar can be taken out in forming.Valve 146 not only avoids being blown into gas loss but also can allow other interior specula tool insert.Method of the present invention and use the trocar of present embodiment to help the mode of device 122 in conjunction with Figure 19 and 20 expressions.

At first referring to Figure 19, after otch 22 cut, will helping into separately, device 122 inserted in the otch 22 so that begin reverse traction process.Peculiarly, retracting of otch 22 do not need use to help into device 122; Yet if necessary, device 122 enters darker fascia tissue 27 so that help into can to retract otch a little.Yet present embodiment middle sleeve pin helps into that a significant advantage of device 122 do not need to be fascia tissue 27 is carried out this fact of actual observation.Device 122 is inserted in the otch 22 firmly in case help into, can make it rotate nearly 45 ° or half cycle simply by handle 126, so that allow rotation clip 128 bite or clamp firmly the fascia tissue 27 in deep in otch.Like this, as shown in figure 19, reverse tractive can be applied on the handle 126, make it to leave following vitals 25 so that patient's organized layer mentioned.Simultaneously, adopt above-mentioned identical method, the coalition of the sleeve pipe 140 and the trocar 150 is passed down through helps into device 122, and allow trocar puncturing peritoneum 28.In the present embodiment, because screw thread 145 is positioned at the outside of rotating seal 144, so rotating seal 144 has played the effect of a retainer.In other words, screw thread 145 influences the tissue on otch 22 sidewalls and provides resistance for darker puncture.This advantage, and effectively reverse tractive have just been protected the vitals 25 under the tip of the trocar 150.

After puncture is finished, extract the trocar 150 out, and sealing member 144 is rotated down position shown in Figure 20, avoid being blown into gas loss so that obtain effective seal.The rotation of medicated cap 142 and sleeve pipe 140 will be defined as dynamic seal 144 rotations and it is advanced downwards, thereby clamp the wall of otch 22.Continue rotation and reach a suitable position up to sealing member 144, what of patient's fatty tissue this position depend on.

Can see among the figure, can think that sealing member 144 is the unique rubbing devices that are attached on sleeve pipe 140 stack shells, it can be rotated on the correct position in the otch 22.Therefore, according to the thickness of patient tissue layer and the degree of desirable sealing, can change and adjust the length and the thickness of sealing member 144 at different patients.Like this, as shown in figure 20, the adjustment that the surgeon can do last minute mouthful is complete and can uses to peep in guaranteeing.

From figure, also can see, after sealing member 144 location, the medicated cap 142 of sleeve pipe 140 can be screwed on the screw thread 130 that helps the proximal part of device 122 into, so that medicated cap 142 is installed firmly.Other can be used as the securing device of locking, as collaborative slide unit, also can consider.In addition, helping into the firm grip of device 122 in the present embodiment is oneself to come firm support and stand upright in the otch 22 by it in many cases, so that allow the surgeon free hand to finish other action.Like this, do not having under other auxiliary mouthful or the situation by the help of surgical hands, other interior specula tool can be supported in the mouth.In addition, the instrument that also other can be had a suitable spiral shell point is screwed on the proximal threads part 130 that helps device 122 into.

Help into device 122 in the present embodiment,, thereby can reduce the use of pneumoperitoneum effectively because it tiltedly clips patient's fascia tissue 27.Like this, as shown in figure 21, by by means of the several into devices 122 that help in the present embodiment, patient's outer tissue can be mentioned and make it to leave vitals 25, and be fixed on a shelf or the bracing or strutting arrangement 134 with metal wire 132, can avoid like this using being blown into gas.Certainly, helping into, the position and the quantity of device 122 will depend on the operating type of splanchnoscopy of being carried out.Into device 122 fixed methods are identical with the process described in top Figure 17-20 with helping.Also can connect suitable ring on the device 122 into or enclose 136 helping, on the supporter around static line is connected on.

The present invention has also considered with trocar needle point and a trocar Assembly of the present invention that has improved and has linked.Figure 22 has represented a kind of like this trocar needle point, is described in detail as follows.

Can see that in the common trocar, needle point is pyramidal basically, is made up of three limits or face, each face is separated by seamed edge.Why common trocar needle point makes this shape is because they can be cut by three directions along the face of blade, thereby is convenient to the strong and resilient peritoneum of trocar puncturing.That is to say, must apply a certain amount of power, therefore be appreciated that and use this common trocar tip can puncture sooner owing to will pierce through peritoneum.Use the main impulse force that produces when making puncture procedure of the doctor of this needle point to puncture by hands.

Yet common trocar needle point has can perceptible critical defect.At first, knife face can produce a bigger hole and cause and tear obviously by three direction incision tissues in patient's tissue.Although this is an important disadvantages, because the aforesaid peritoneum that need puncture, so this also can tolerate.Yet,, can cause that the patient feels pain and uncomfortable if, a hernia or other adhesion will occur at this position so because the opening that trocar puncturing stays can not enough heal.The adhesion meeting appears at stitching out-of-flatness place of peritoneum, stays scar tissue.Intestines or other tissue can hinder the peritoneum work that those and organ are separated independently to operate in trocar puncturing place and peritoneal cavity bonding like this.

Help into device by means of the trocar of the present invention, can not use too sharp-pointed prismatic trocar needle point.In other words,, comprise that the device puncture can apply reverse tractive on peritoneum for helping into, therefore can use a kind of less trocar that damages because the trocar of the present invention helps into device to control.As shown in figure 22, a kind of conical sleeve bobbin needle point 160 is adapted at using in the trocar of the present invention.

Because the surgeon needn't be according to the size of puncture impulse force, operating sleeve bobbin well just under the situation that does not injure the internal, therefore, trocar needle point only stings a little opening in peritoneum.Subsequently, by means of top described in detail, the endoscopic observation that penetrates trocar mouth 46, the trocar 160 is advanced to necessary degree peeps mouth with in producing.In this mode, tissue is torn less, and wound is a circle or circular open.This wound ratio is easier to healing, thereby has reduced the danger of adhesion and hernia.In other words, for common trocar needle point, after the initial apertures, this hole will enlarge rather than diminish under stinging in peritoneum.

The trocar among the 4th embodiment helps into device 165, can be used in the trocar Assembly 180 shown in Figure 23-31.Figure 23 has represented that the trocar that contains a retention means 164 and lifting member or guide member 168 helps into device 165, wherein retention means 164 has a cylindrical shape support ring 166 that is connected on insert or the helical blade 167, lifting member or guide member 168 include two cylindrical shape leader 168a, b, on them, have a pair of for the usefulness that produces reverse tractive, symmetrically relative handle 169 in the horizontal.Hollow a, cylindrical channel 170 is arranged so that the insertion of the trocar, sleeve pipe and other splanchnoscopy surgical operating instrument in the central authorities of this guide member 168.Far-end in helical blade 167 has a cusp 171.Will describe in detail as following, this cusp 171 is to be used for creeping into thinking in the organized layer to help into that device 165 provides firm grip power.Thereby under not enlarging otch and not needing to do situation that the deep fascia observes, enough reverse traction forces can be applied on the cutting part.

Figure 24 more clearly shows the trocar that constitutes present embodiment and helps into three parts of device 165.Helical blade 167 is connected on the support ring 166, and the female thread 172 that holds guide member 168 is arranged on this ring.This guide member 168 is made up of two and half parts, and one of them half parts 168a has two latches 173 transversely, and two perforates 174 of holding these two latches 173 are arranged on another half parts 168b.Latch on the half parts 168a 173 is inserted in the perforate 174 among another half parts 168b, and the mutual jam-packed of two and half parts has just been assembled them.The external screw thread 175 that the guide member 168 that assembles has the female thread in the support ring with blade 166 to be complementary helps avoid and is blown into the spiral sealing member that gas is missed in the site of puncture to form one.

Figure 25 has represented trocar Assembly 180 complete in the present embodiment.This device is by above-describedly helping device 165 into, containing the sleeve pipe 181 and the trocar 184 that are linked to be a whole medicated cap 182 with it at near-end 183 and constitute.Near sleeve pipe 181 far-ends 185 be a rotating seal 186, it has also to help avoid be blown into the external screw thread 187 that gas is missed around the sleeve pipe 181 of site of puncture.Near-end in sleeve pipe 181 also is provided with external screw thread 188 near medicated cap 182 places.Will describe in detail as following, female thread 172 engagements in these external screw threads 188 and the retention means 164 are into to obtain an anchor shape and engage with helping at sleeve pipe 188 and medicated cap 182 thereof between the device 165.

As shown in figure 25, the trocar helps device 165 into can make the central authorities of sleeve pipe 181 by helical blade 190, and passes the central authorities of guide member 170.A clack valve 191 is arranged in the medicated cap 182 on the sleeve pipe 181, and it can allow the trocar 184 be passed down through medicated cap 182 and sleeve pipe 181, so that allow the needle point 192 of the trocar expose at telescopic far-end 185.When allowing other interior specula tool insert, this valve 191 also can prevent to be blown into gas loss.The using method of in Figure 26 and 27, more completely having represented method of the present invention and present embodiment middle sleeve needle device 180.

At first referring to Figure 26, after cut initial incision, help the trocar that has assembled into that the handle 169 of device 165 rotates several circles with it, organized layer 24,26,27 and 28 is screwed in help on the helical blade 167 of device 165 into.For the thin body, the support ring 166 that has fixed can be stayed on the surface of health, and for the overweight people, just is necessary that the support ring 166 that will fix lunges fat deposit 26 and is enough to make peritoneum 28 to pierce through so that the pointed tip 171 of blade can be punctured to.Device 165 has pierced through organized layer shown in Figure 26 24,26 and 27 fully in case help into, just reverse traction force can be applied on the handle 169, so that organized layer 24,26,27 and 28 mentioned the vitals 25 that make it to leave under it.

The use of helical blade 167 has reduced the damage to fascia 27 and other tissue 24,26 and 28.Lifting force is distributed in along on the vertical direction of blade 167 whole length, and not only concentrates on the tip.What this just helped to prevent to organize tearing up and tearing.The interval of rotating can be reduced so that to promote operation more firm, perhaps increases the interval of rotating and further reduces damage to fascia and other tissue.In addition, before blade 167 inserts patient body, can coat silicon cave or other lubricant thereon to help insertion and to reduce spiral blade 167 along the friction between its whole length and the tissue.

As shown in figure 26, help into after device 167 inserts the 26-27 of organized layer, reverse traction force will be applied on the handle 169, so that organized layer mentioned the vitals 25 that make it to leave under it at the trocar.Simultaneously, the coalition of the sleeve pipe 181 and the trocar 184 is inserted help in the device 165 and allow the trocar 184 pierce through peritoneum 28.As top shown in Figure 19, because there is screw thread 187 in the outside of rotating seal 186, therefore the rotating seal 186 in sleeve pipe 181 outsides can play the effect of retainer.Screw thread 187 influences the tissue 26 and 27 on the otch sidewall, and stops to more depths puncture.This advantage, and effective and firm reverse tractive have just been protected the vitals 25 under the tip of the trocar 192.

Forward Figure 27 now to, after puncture is finished, take out the trocar 184, the sealing member 186 on sleeve pipe 185 far-ends is rotated down in place, prevent to be blown into gas loss so that obtain efficient sealing effect.The rotation of medicated cap 182 and sleeve pipe 181 will be defined as dynamic seal 186 rotation, and make it advance and clamp with the otch wall downwards.Rotation continues, and arrives a suitable degree of depth up to sealing member, this degree of depth determine to depend on the thick or thin of fat tissue layer 26.

After sleeve pipe 181 arrives suitable position, as shown in figure 27, just can remove the trocar and help the into guide member 168 of device 165.This step can be by the guide member 168 of dismantling from support ring 166, and in the horizontal with two and half parts 168a, b draws back by opposite direction and finishes.The blade of propeller 167 still is screwed in organized layer 26 and 27.Firm grip by helping the helical blade 167 of device 165 into and it is connected on the support ring 166, sleeve pipe 181 just can be fixed in the otch, and surgical hands also can be leisure.Especially, if sleeve pipe 181 is meshing with each other near the external screw thread 188 of near-end 183 and the female thread 172 of retention means 164, facilitates and obtain firm joint.In other words, along with sleeve pipe 181 and fixing head 182 are inserted into the position of a certain hope by being directed downwards shown in Figure 27, the external screw thread 188 on the sleeve pipe will be rotatably and female thread 172 engagements, thereby form telescopic maintenance securely.Also other interior specula tool can be inserted in the mouth under auxiliary mouthful or surgical hand steered the situation not needing.

Help among another embodiment of the retention means 164 of device 165 at the trocar of the present invention, as shown in figure 28, the pointed tip 195 of helical blade 167 makes progress.165 one-tenth one certain angles of device will tilt if will help into, and blade 167 just can be inserted in the tissue, and like this, tip 195 will be tilted to down thrusts in the organized layer.In case help into device 165 fully to insert in the tissue, it can return to plumbness again, the tip of blade 195 is again angledly towards the surface of patient body like this.Thereby following vitals just can not be subjected to helping the into undesigned damage of blade 195 pointed tip of device 165.

The present invention has also imagined a kind of trocar that has improved and has helped into device 196, and it is used for eliminating the use for the Veress pin that obtains the initial insufflation in abdominal cavity.The trocar of the present invention helps device 196 into can make as shown in figure 29 shape, to obtain that gas is input to device in patient's body.The trocar helps into that device 196 contains a hollow pipe 197 especially, and it starts from the handle 198 of guide member, passes guide member body 199 and enters to flow through and help the into pipeline 200 of device blade 201, leads to the tip 202 of blade at last.A plug valve 203 that is used to control gas flow is housed on the hollow handle 198 of guide member.

Figure 30 and 31 has represented to help an into embodiment of device insert tip 202.The using method of this embodiment among explanation the present invention now.

As top described in conjunction with Figure 23 3-27, helping the trocar into, device 196 inserts in the initial incision of patient body.Rotation helps into device 196, so that organized layer is screwed on the helical blade 201.Along with the pointed tip of blade 202 is inserted in the tissue, come the resistance of self-organizing that the termination 205 of pipe is returned in hollow 202 on the blade, compress the spring 206 behind the termination 205 as shown in figure 30, that be located at pipe.In case when the tip 202 of blade is pierced through peritoneum and arrived in the Intraabdominal cavity, come the resistance of self-organizing to disappear, spring 206 is lax, thereby makes pipe end 205 can and trip out the tip 202 of blade to remote extension again.These descriptions can be referring to Figure 31.

When managing 205 when remote extension exceeds insert tip 202, as shown in figure 31, the opening 208 on the pipe end 205 will expose.Then, the surgeon can help the plug valve 203 on the handle of device 198 into to open with being contained in the trocar, and device 196 enters patient's abdominal cavity by helping into to allow carbon dioxide.The blade 201 of device all stays put in the whole surgery process because the trocar helps into, therefore not needing to increase any additional apparatus or opening on the patient body under any auxiliary mouthful situation, can increase insufflation at any time.

Like this, the trocar of present embodiment helps device 196 into just to eliminate use and because its danger that use brought of Veress.Owing to unnecessaryly the patient is carried out the part puncture, thereby reduced damage, also eliminated the danger that syringe needle is stabbed unintentionally vitals the patient.When the resistance that is produced when organized layer blade tip 202 disappeared, because gas only passes through pipe 200, thereby the danger of gas nethike embrane had reduced.Like this, the common relatively trocar Assembly of present embodiment has some tangible advantages.

Although invention has been described by several preferred embodiments,, scope of the present invention is not limited to this four certain embodiments.Therefore, also to limit by following claim scope of the present invention.

Claims (44)

1, a kind of into device that helps that helps to open an openning for the splanchnoscopy surgical operation, it comprises:

Be used for a far-end engaging with patient's textura epidermoidea in said incision;

Be used to apply a near-end of opposite force, this said textura epidermoidea of opposite force tractive makes it to separate with patient's vitals.

2, the into device that helps according to claim 1 is characterized in that: the said device into of helping places a kind of tension state that increases progressively with patient's textura epidermoidea, so that the puncture of a trocar.

3, the into device that helps according to claim 1 and 2 is characterized in that: saidly help into that device includes a guide member that is used to hold the said trocar and causes the direction of this trocar puncturing.

4, according to claim 2 or the 3 described into devices that help, it is characterized in that: said help device into along the side of said trocar puncturing the said textura epidermoidea of tractive in the opposite direction.

5, according to the described into device that helps of any one claim in the claim 1 to 4, it is characterized in that: saidly help into that device includes a spiral blade, this blade can with the said form twisting of organizing in the shape of a spiral.

6, according to the described into device that helps of any one claim in the claim 2 to 5, it is characterized in that: the said trocar includes one to be peeped in allowing and observes vertical mouthful that apparatus passes through.

7, according to the described into device that helps of any one claim in the claim 2 to 6, it is characterized in that: the said trocar has a cone tip to reduce the damage to the patient.

8, according to the described into device that helps of any one claim in the claim 2 to 7, it is characterized in that: it comprises a sleeve pipe that is used for being enclosed within outside the said trocar and forms said openning at opening after extracting this trocar out.

9, the into device that helps according to claim 8 is characterized in that: said sleeve pipe includes a sealing member that is positioned near this boot proximal end, and it forms sealing between this sleeve pipe and this opening.

10, the into device that helps according to claim 9 is characterized in that: said sealing member can be with respect to the rotation of said hole, to improve its sealing effectiveness.

11, the into device that helps according to claim 9 is characterized in that: for said sealing member is adjusted, the sealing device is that adjustable ground slides with respect to said sleeve pipe.

12, according to the described into device that helps of any one claim in the claim 1 to 11, it further includes one and prevents the over-drastic retainer of trocar puncturing.

13, the into device that helps according to claim 12 is characterized in that: said retainer includes a bump on the edge on the inner surface of said retractor and outer surface at the said trocar.

14, according to the described into device that helps of any one claim in the claim 1 to 13, it is characterized in that: saidly help into that device is to be used for setting up one to pass patient's the textura epidermoidea and the openning of peritoneum, this helps into, and device uses with the trocar that can pierce through said peritoneum, and this helps into device to include one to hold this trocar and a telescopic guide member, one is applied to this with power with the direction opposite with this trocar puncturing with the far-end of this textura epidermoidea's twisting and one and helps lifting member on the device into, this power that is applied in this textura epidermoidea can produce reverse traction and make this peritoneum be in tensile state, whereby, the puncture of this trocar just can be controlled preferably.

15, the into device that helps according to claim 14 is characterized in that: said lifting member includes one at least and is used for manually applying the handle that oppositely pulls up.

16, the into device that helps according to claim 14 is characterized in that: said guide member is enclosed within said trocar outside, is applied directly to this trocar puncturing place so that will oppositely draw.

17, the into device that helps according to claim 14, it is characterized in that: said guide member is columnar.

18, the into device that helps according to claim 14 is characterized in that: said guide member includes two half parts that can take apart mutually and assemble, so that they can be dismantled after said openning forms.

19, the into device that helps according to claim 14 is characterized in that: the said blade that helps the far-end of device into to include an energy and the textura epidermoidea's twisting of said patient around the said otch, the contiguous said peritoneum of this textura epidermoidea.

20, the into device that helps according to claim 19, it is characterized in that: said blade twist.

21, the into device that helps according to claim 20 is characterized in that: the textura epidermoidea around said blade and the said otch is twisting twist, so that can apply reverse pull strength.

22, the into device that helps according to claim 19, it is characterized in that: said blade is cusp shape at its end.

23, according to the described into device that helps of any one claim in the claim 1 to 22, it is characterized in that: the end of said blade is bending in vertical direction.

24, the into device that helps according to claim 14, it is characterized in that: said lifting member includes a pair of finger ring, just can produce reverse traction and punctures with a hands by means of it.

25, the into device that helps according to claim 14, it is characterized in that: said lifting member includes a pair of big handle, is used to apply reverse pull strength.

26, the into device that helps according to claim 14 is characterized in that: said guide member includes guiding half parts that can take apart mutually and assemble, so that these parts are installed in the said otch.

27, the into device that helps according to claim 26 is characterized in that: said guide member half parts can assemble in the vertical slidably.

28, the into device that helps according to claim 26 is characterized in that: each guide member half parts all has a blade that comprises the end of said retractor, with the clamping mutually of said textura epidermoidea.

29, the into device that helps according to claim 14 is characterized in that: the end of said retractor comprises that at least one can insert the blade of said otch, in the textura epidermoidea that is embedded in said patient around this otch, contiguous said peritoneal layer.

30, the into device that helps according to claim 14 is characterized in that: the terminal blade of said retractor all with the said edge of a knife around textura epidermoidea's embedding mutually in the horizontal so that can apply reverse pull strength.

31, the into device that helps according to claim 30 is characterized in that: each terminal blade all is being inserted under the said textura epidermoidea on the direction of crosscut basically with the direction of trocar puncturing.

32, the into device that helps according to claim 30 is characterized in that: each terminal blade can be rotatably and textura epidermoidea's embedding mutually around the said otch.

33, according to the described into device that helps of any one claim in the claim 1 to 32, it is characterized in that: said end and said textura epidermoidea oblique.

34, according to the described into device that helps of any one claim in the claim 1 to 33, it is characterized in that: the end of said retractor and said patient's textura epidermoidea be the formula twisting in the shape of a spiral.

35, according to the described into device that helps of any one claim in the claim 1 to 34, it is characterized in that: said near-end comprises a handle, and the end of this handle comprises the end of said retractor.

36, a kind ofly set up the method for opening for the splanchnoscopy surgical operation, it comprises:

A. cut patient's outer tissue;

B. a retractor is inserted in the otch;

C. clamp the tissue in this otch deep with this retractor;

D. this outer tissue of tractive makes it to leave the vitals under it;

E. at said tractive position with this outer tissue of trocar puncturing.

37, method according to claim 36 is characterized in that: finish said clamping step by rotating said retractor.

38, method according to claim 36 is characterized in that: said insertion and clamping step can follow these steps to finish:

A. the first with a retractor inserts said otch so that make the blade of this retractor parallel substantially with the direction of this otch;

B. rotate the first of this retractor, so that allow the horizontal application of force in this blade edge under the outer tissue of said patient's the said peritoneum of vicinity;

C. to insert similar mode the second portion of this retractor is inserted this otch to the first of this retractor;

D. rotate the second portion of this retractor with the direction opposite with the first of this retractor;

E. two parts with this retractor link up.

39, the into device that helps according to claim 36 is characterized in that: said tractive step and puncture step are to carry out simultaneously substantially.

40, the into device that helps according to claim 36 is characterized in that: said tractive step and puncture step all use a hands to carry out.

41, the into device that helps according to claim 36 is characterized in that: the said trocar is inserted in the leader of said retractor so that directly puncture in said tractive position.

42, the into device that helps according to claim 36 is characterized in that: further comprise and observe apparatus and insert step in the openning that the said trocar forms peeping in one, so that peritoneal cavity is observed.

43, according to the described into device that helps of claim 42, it is characterized in that: further comprise by means of the propulsive step of the said trocar of endoscopic observation, to prevent to stab the patient.

44, the into device that helps according to claim 36 is characterized in that: also comprise along with to the puncture of said textura epidermoidea with a casing pipe sleeve on the said trocar, and rotate this sleeve pipe so that the step of this openning sealing.

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