JP2001340346A - Medical treatment instrument - Google Patents
Medical treatment instrumentInfo
- Publication number
- JP2001340346A JP2001340346A JP2000171384A JP2000171384A JP2001340346A JP 2001340346 A JP2001340346 A JP 2001340346A JP 2000171384 A JP2000171384 A JP 2000171384A JP 2000171384 A JP2000171384 A JP 2000171384A JP 2001340346 A JP2001340346 A JP 2001340346A
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- JP
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- Prior art keywords
- treatment tool
- fixing member
- fixing
- medical treatment
- tool according
- Prior art date
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Abstract
Description
【０００１】[0001]
【発明の属する技術分野】本発明は内視鏡下外科手術に
おいて、気腹下での処置の後、気腹を解除して体外に臓
器を取り出して処置を行ったり、再び臓器を体内に戻し
て再気腹下の操作で患部の確認や追加処置を行うための
医療用処置用具に関するものである。BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an endoscopic surgical operation, in which after an insufflation procedure, the insufflation is released and the organ is taken out of the body to perform the procedure, or the organ is returned to the body again. The present invention relates to a medical treatment tool for confirming an affected part and performing an additional treatment by an operation under re-inflation.
【０００２】[0002]
【従来の技術】近年、低侵襲外科手術の方法として内視
鏡外科手術が広く実施されている。内視鏡下手術は内視
鏡から見た映像を画面で見ながら遠隔操作で手術を行う
方法である。実際に手術を行う術者は、内視鏡で映し出
された映像を画面で見ながら複数の鉗子等の処置具を操
作して遠隔操作で手術を行うため、開腹手術と違い術者
が実際に臓器及び患部を手で直接触ることはできない。
このため、処置は慎重に行う必要があり、特に大腸や胃
の手術の手術時間は長時間におよび、術者のストレスが
かなり大きくなる。このため、最終的に大きな標本を摘
出することが想定される場合、小切開をおくことを前提
として、気腹下での処置と小切開口から臓器を取りだし
ての処置とを簡単に移行できるように小切開口を簡単に
気密に塞ぐことができる装置が特開平１０−１５１１３
５号公報に開示されている。2. Description of the Related Art In recent years, endoscopic surgery has been widely practiced as a method of minimally invasive surgery. Endoscopic surgery is a method of performing surgery by remote control while viewing the image viewed from the endoscope on a screen. Unlike the open surgery, the surgeon who actually performs the surgery performs a remote operation by operating multiple treatment tools such as forceps while watching the image projected by the endoscope on the screen. Organs and affected areas cannot be directly touched by hand.
For this reason, the treatment must be performed carefully, and particularly the operation time for the operation of the large intestine and stomach is long, and the stress of the operator is considerably increased. For this reason, when it is expected that a large specimen will be finally removed, it is possible to easily transition between treatment under the pneumoperitoneum and removal of the organ from the small incision, assuming that a small incision is made. Japanese Patent Laid-Open No. 10-15113 discloses a device which can easily close the small opening airtightly.
No. 5 discloses this.
【０００３】これは、２枚の円盤に糸を通した簡単な装
置で、気密板と呼ばれる可とう性のある材料で作られた
円盤を腹腔内に挿入し、固定板と呼ばれる剛性があり、
糸固定用のスリットの入った円盤との間に腹壁を挟み込
んで糸固定を行うことで小切開口が塞がり再気腹を行う
ことができる。この装置を使用することにより、気腹下
で摘出臓器周囲の剥離などの処置を十分に行った後、臓
器を取出す場所に３〜５ｃｍ程度の小切開をおき、その
小切開口から対象臓器を体外に取りだして病変部の切
離、摘出、縫合を術者の目で直接見て、術者の手で直接
手術を行う。その後臓器を腹腔内へ戻し、再度気腹下の
状態にする必要がある場合、従来、糸で一時的に縫合し
たり、複数の鉗子で小切開部を塞いだりしていたが、糸
で縫合すると再度体外の処置を行いたい場合に糸を取り
去る必要があり、鉗子で塞ぐ場合、組織の損傷の危険が
生じていた。そこで、この装置を使用することで前述の
とおり簡単に気腹下の状態に移ることができ、また、更
に小切開口を通しての処置を行いたい場合は気腹を落と
して本装置を取り外すことで容易に移行できる。しか
し、「再気腹しているときはその部位からトロッカーを
通した鉗子操作が行えない」「癌部位の摘出の際、腹壁
の切開創が保護されていないため、癌細胞の創感染が懸
念される」等の問題点があった。[0003] This is a simple device in which a thread is passed through two disks, a disk made of a flexible material called an airtight plate is inserted into the abdominal cavity, and has a rigidity called a fixed plate.
By inserting the abdominal wall between the disk and the disk having the slit for fixing the thread and fixing the thread, the small opening can be closed and re-inflation can be performed. By using this device, after performing sufficient treatment such as exfoliation around the removed organ under pneumoperitoneum, a small incision of about 3 to 5 cm is made at the place where the organ is to be removed, and the target organ is removed from the small incision. It is taken out of the body, the lesion is cut, removed, and sutures are directly seen by the operator's eyes, and the operation is performed directly by the operator's hand. When it is necessary to return the organs to the abdominal cavity and re-infuse the stomach, it is necessary to suture them temporarily with a thread or close the small incision with multiple forceps. Then, it is necessary to remove the thread when the extracorporeal treatment is to be performed again, and when closing with a forceps, there is a risk of tissue damage. Therefore, by using this device, it is possible to easily move to the state of insufficiency as described above, and if it is desired to perform a treatment through a small incision opening, the insufflation is dropped and the device is removed. Easy migration. However, "If you are re-inflated, you will not be able to operate the forceps through the trocar from that site.""At the time of removing the cancer site, there is concern about wound infection of cancer cells because the incision in the abdominal wall is not protected. To be done. "
【０００４】また、使用する鉗子類の種類を選ばず腹腔
内から気腹ガスがリークするのを防止することが可能な
弁及び弁付トラカール外套管が特開平１０−１０８８６
８号公報に開示されている。この弁は２枚のリングの間
に柔軟な筒状部材を付設し、２枚のリングを逆方向に捻
ることで外径の異なった鉗子や術者の腕を挿入し、体内
の処置を行うことが可能であり、この弁を開くことで臓
器を体外に取りだして処置を行うことも可能である。し
かし、この方式では鉗子等が弁によって絞られながら固
定されるため、前進後退がしにくい欠点がある。また、
腕を挿入した場合は特に前後運動によって腕の太さが変
わるため場合により気密が保持しにくくなり、弁の絞り
を調節する必要がある。Japanese Patent Laid-Open No. 10-10886 discloses a valve and a trocar mantle with a valve capable of preventing the insufflation gas from leaking from the abdominal cavity regardless of the type of forceps to be used.
No. 8 discloses this. In this valve, a flexible tubular member is attached between two rings, and the two rings are twisted in opposite directions to insert forceps having different outer diameters or an operator's arm to perform treatment inside the body. By opening this valve, the organ can be taken out of the body and the treatment can be performed. However, in this method, since the forceps and the like are fixed while being squeezed by the valve, there is a disadvantage that it is difficult to move forward and backward. Also,
When the arm is inserted, the thickness of the arm is changed particularly by the forward and backward movement, so that it becomes more difficult to maintain airtightness in some cases, and it is necessary to adjust the throttle of the valve.
【０００５】更に、柔軟で内面と開口端があるエンクロ
ージャーで、開口端には腹壁固定及び気密を守るための
展開手段を持ち、エンクロージャーの内部にアクセスす
るための少なくとも一つのアクセスオープニングがあ
り、腹腔内あるいはエンクロージャーの内部で外科手術
を行うことが可能である装置がＵＳＰ５４８０４１０号
に開示されている。この装置は従来、腹腔鏡、胸腔鏡手
術に使用されているような硬性のトラカールではなく、
柔軟なシート材で構成されており、腹壁の切開口にあっ
た形状に変形可能な展開手段を切開口から挿入して腹腔
内で展開させ、気腹用の炭酸ガスが腹腔内からエンクロ
ージャー内部へ流入してエンクロージャーが膨脹し、展
開手段は腹壁との気密を守る。更にエンクロージャー外
周表面にアクセスオープニングを複数取り付ければ複数
の鉗子が挿入でき、創部直下の観察も行え、創縁も保護
される。しかし、エンクロージャーは基本的に球状であ
り、外周表面に取り付けられた各々のアクセスオープニ
ングまでの距離は、設定時に決定され固定されてしまう
ため、複数の処置具を挿入している際、１本の処置具を
大きく動かすと他の処置具も引きずられて動いてしまっ
たり、また、腹壁の切開口が鉗子などの処置具に対して
大きく操作時の腹壁での支点がないため鉗子操作が煩雑
になるという欠点があった。[0005] Further, the enclosure is flexible and has an inner surface and an open end. The open end has a deployment means for securing the abdominal wall and protecting the airtightness, and has at least one access opening for accessing the inside of the enclosure. A device capable of performing a surgical operation within or within an enclosure is disclosed in US Pat. No. 5,480,410. This device is not a rigid trocar as used in laparoscopic and thoracoscopic surgery,
It is composed of a flexible sheet material, and deploys in the abdominal cavity by inserting a deployment means that can be deformed to the shape corresponding to the incision in the abdominal wall from the incision and deploys intraperitoneal carbon dioxide from inside the abdominal cavity into the enclosure Upon inflow, the enclosure expands and the deployment means protects the airtight from the abdominal wall. Furthermore, if a plurality of access openings are attached to the outer peripheral surface of the enclosure, a plurality of forceps can be inserted, observation can be made immediately below the wound, and the wound edge is protected. However, the enclosure is basically spherical, and the distance to each access opening attached to the outer peripheral surface is determined at the time of setting and fixed, so when inserting a plurality of treatment tools, one When the treatment tool is largely moved, the other treatment tools may be dragged and move.In addition, since the incision in the abdominal wall is large with respect to the treatment tool such as forceps and there is no fulcrum on the abdominal wall during operation, the forceps operation becomes complicated. There was a disadvantage of becoming.
【０００６】アウタースリーブと２つのシール手段を持
つ構造で、小切開口を通して腹腔内に入り、２つのシー
ル手段を使ってアウタースリーブ内に気密な空間を構成
する装置がＵＳＰ５６４０９７７号に開示されている。
この装置は装置内を通して体内に術者の手及び腕を挿入
した際、気腹をした状態で体内臓器の処置を行うことが
でき、また、第三のシール手段を使えば、腕を抜いた状
態でもスリーブ及び体内の気密を保つことができる。し
かし、この装置は術者が体内の臓器を体外に引き出して
処置したい際、スリーブ部分を患者の体表に被せてある
ドレープに接着する構造であり、接着部より上側を分離
できる状態になっていないため、ドレープを切り取り装
置全体を一旦取り出すか、スリーブ部分を切り取らない
と体外に臓器を取り出して処置することができない。装
置を取り出せば腹壁に癌組織が付着する恐れがあり、ま
た、スリーブ部分を切り取れば、体外での処置が終わっ
た後で再度気腹を行い腹腔内で観察、処置することがで
きない。US Pat. No. 5,640,977 discloses a device having a structure having an outer sleeve and two sealing means, which enters the abdominal cavity through a small incision opening and forms an airtight space in the outer sleeve using the two sealing means. .
This device can perform treatment of internal organs in a state of insufficiency when the operator's hand and arm are inserted into the body through the device, and if the third sealing means is used, the arm is pulled out Even in this state, the airtightness of the sleeve and the body can be maintained. However, this device has a structure in which the sleeve part is adhered to the drape placed on the patient's body surface when the operator wants to pull out the internal organs from the body for treatment, so that the upper part can be separated from the adhesive part. Therefore, unless the drape is cut out and the entire device is once taken out or the sleeve portion is cut out, the organ cannot be taken out of the body and treated. If the device is taken out, cancer tissue may adhere to the abdominal wall. If the sleeve is cut off, insufflation may be performed again after the treatment outside the body, and observation and treatment cannot be performed in the abdominal cavity.
【０００７】基本的には同様な構造で、スリーブと腹壁
固定部を分離し、スリーブの遠位端のリングと、腹壁固
定部のリングをスナップして固定する装置等がＵＳＰ５
８１３４０９号に開示されている。この装置はスリーブ
と腹壁固定部を分離できるため、スリーブ部分を取り外
して、腹壁固定部を腹壁に残したまま体内の臓器を体外
に引き出して処置できるため、切開口に癌組織が付着す
ることもなく、処置が終わった後、臓器を体内に戻して
再度スリーブを固定して気腹下で観察、処置を行うこと
ができる。しかし、スリーブと腹壁固定具のリングをス
ナップで全周にわたってはめ合わせることは難しく、は
め合わせの不十分な箇所があった場合は、気密を保持で
きなくなる。また、もし、スリーブを通して処置具を操
作するとこの装置も腹壁の切開口が鉗子などの処置具に
対して大きく操作時の腹壁での支点がないため鉗子操作
が煩雑になるという欠点があった。[0007] USP5 has basically the same structure, and separates the sleeve and the abdominal wall fixing portion, and snaps and fixes the ring at the distal end of the sleeve and the ring of the abdominal wall fixing portion.
No. 813409. With this device, the sleeve and the abdominal wall fixing part can be separated, so the internal organs inside the body can be pulled out and treated while the sleeve part is removed, leaving the abdominal wall fixing part on the abdominal wall, so that cancer tissue may adhere to the incision. Instead, after the treatment is completed, the organ can be returned to the body, the sleeve can be fixed again, and observation and treatment can be performed under insufflation. However, it is difficult to fit the sleeve and the ring of the abdominal wall fixture over the entire circumference by snap, and if there is an insufficiently fitted portion, airtightness cannot be maintained. Further, if the treatment tool is operated through the sleeve, this device also has a disadvantage that the incision in the abdominal wall is large with respect to the treatment tool such as forceps and there is no fulcrum on the abdominal wall at the time of operation, so that the operation of the forceps becomes complicated.
【０００８】体内外にわたって一繋がりのドーナツ型の
バルーンを膨脹させることで内腔を閉じて手や鉗子挿入
時および抜去時の腹腔内の気密を保つ装置がＵＳＰ５３
６６４７８号に開示されている。この装置は構造が単純
で組み立ても簡単であるので手術時間を短縮できる。し
かし、この装置では気腹を解除して体外に臓器を取り出
して処置を行いたい場合、バルーンを収縮させなければ
ならず、同時に創部が閉じてしまうために新たに開創器
具を用いなければならないという欠点があった。[0008] USP53 discloses a device that closes the lumen by inflating a series of donut-shaped balloons inside and outside the body and keeps the abdominal cavity airtight when inserting or removing hands or forceps.
66478. This device has a simple structure and is easy to assemble, so that the operation time can be reduced. However, with this device, if you want to release the stomach and remove the organ from the body to perform the treatment, you must deflate the balloon and at the same time use a new retractor to close the wound. There were drawbacks.
【０００９】スリーブを腹壁の上下からリング状部材で
固定し、通常のシール弁と弾性薄膜でつくったスリット
状の開口を有する弁の２つの弁を有することで、手の挿
入時および非挿入時の気密性を高めた装置が特開平１１
−９９１５６号公報に開示されている。この装置は手お
よび鉗子の非挿入時にスリット状の弁が腹腔圧によって
折り返し部分からなる接触面が互いに押し付けられるよ
うに膨脹することにより気密を保持するため、手の挿入
時に弁を開いてしまえば弾性薄膜の弾性力以上の力は発
生しないため、腕を締め付ける力は非常に小さくて済
み、長時間の使用において術者のストレスが軽減され
る。しかし、この装置では気腹を解除して体外に臓器を
取り出して処置を行いたい場合や創部から直視下で処置
を行いたい場合に、特にスリット状の弁が邪魔になって
しまう欠点があり、また、スリーブを通して処置具を操
作するとこの装置も腹壁の切開口が鉗子などの処置具に
対して大きく、また、操作時の腹壁での支点がないため
鉗子操作が煩雑になるという欠点があった。The sleeve is fixed from above and below the abdominal wall with a ring-shaped member, and has two valves, a normal seal valve and a valve having a slit-like opening made of an elastic thin film. Of Japanese Patent Application Laid-Open No.
-99156. This device maintains the airtightness by expanding the slit-shaped valve by the abdominal pressure so that the contact surfaces formed by the folded portions are pressed against each other when the hand and the forceps are not inserted. Since no force greater than the elastic force of the elastic thin film is generated, the force for tightening the arm can be extremely small, and the stress on the operator can be reduced during long-term use. However, this device has a disadvantage that the slit-shaped valve becomes an obstacle particularly when it is desired to perform the treatment by removing the insufflation and taking out the organ outside the body or performing the treatment directly from the wound site, Further, when the treatment tool is operated through the sleeve, this device also has a disadvantage that the incision in the abdominal wall is larger than that of the treatment tool such as forceps, and the operation of the forceps is complicated because there is no fulcrum on the abdominal wall during operation. .
【００１０】腹壁の切開口周辺部の外側と内側からしっ
かり挟んで固定されるポートと、そのポートに取り付け
る蓋により内腔を閉じて手や鉗子挿入時および抜去時の
腹腔内の気密を保つ装置がＵＳＰ５７４１２９８号に開
示されている。この装置は構造が単純で組み立ても簡単
であるので手術時間を短縮できる。しかし、この装置で
は切開口の大きさや腹壁の厚さに柔軟に対応できないと
いう欠点があった。[0010] A device which is tightly clamped between the outside and the inside of the periphery of the incision in the abdominal wall, and a device which keeps the inside of the abdominal cavity airtight at the time of inserting or removing hands or forceps with a lid attached to the port. Are disclosed in US Pat. No. 5,741,298. This device has a simple structure and is easy to assemble, so that the operation time can be reduced. However, this device has a drawback that it cannot flexibly respond to the size of the incision or the thickness of the abdominal wall.
【００１１】ネジ山の付いたテーパー形状の環状部材を
腹壁にねじ込んで固定し、着脱可能な可とう性のエンベ
ロープを取り付け、手や鉗子挿入時および抜去時の腹腔
内の気密を保つ装置がＵＳＰ５６５３７０５号に開示さ
れている。この装置は環状部材を創部にねじ込むだけで
容易に腹腔内へのアクセスポートを設置でき、環状部材
が鉗子の支点となりうるため鉗子操作が容易に行える。
しかし、環状部材を創部にねじ込んで用いるために創部
を痛める恐れがあり、また、腹壁の厚さと切開口の大き
さに対して柔軟に対応できないという欠点があった。US Pat. No. 5,565,705 discloses a device in which a threaded tapered annular member is screwed and fixed to the abdominal wall, a detachable flexible envelope is attached, and the inside of the abdominal cavity is kept airtight when inserting or removing hands or forceps. Issue. With this device, an access port into the abdominal cavity can be easily installed by simply screwing the annular member into the wound, and the forceps can be easily operated because the annular member can be a fulcrum of the forceps.
However, since the annular member is screwed into the wound and used, the wound may be damaged, and the abdominal wall thickness and the size of the incision cannot be flexibly handled.
【００１２】[0012]
【発明が解決しようとする課題】本発明は、従来の内視
鏡下手術における処置のこのような欠点を解決するもの
で、その目的とするところは、組立が簡単で、様々な腹
壁の厚さや切開創の大きさに柔軟に対応した設置が可能
で、簡単に気腹下処置と腹腔外処置との切り替えがで
き、気腹下での処置を行う場合には鉗子操作が可能な医
療用処置用具を提供することにある。SUMMARY OF THE INVENTION The present invention overcomes these disadvantages of conventional endoscopic procedures and is intended to be simple to assemble and provide various abdominal wall thicknesses. It can be installed flexibly according to the size of the pod incision, can be easily switched between intraperitoneal and extra-abdominal procedures, and can be operated with forceps when performing intraperitoneal procedures It is to provide a treatment tool.
【００１３】[0013]
【課題を解決するための手段】すなわち本発明の第１の
発明は、近位端に１つ以上の入口、遠位端に１つの出口
をもち、遠位端は固定部材により固定し、固定部材には
筒状部材を取り付け、近位端のそれぞれの入口には気密
を保つために少なくとも１つの気密部材を付設したこと
を特徴とする医療用処置用具である。That is, a first invention of the present invention has one or more inlets at a proximal end and one outlet at a distal end, and the distal end is fixed by a fixing member. A medical treatment tool, wherein a cylindrical member is attached to the member, and at least one airtight member is provided at each of the inlets at the proximal end to maintain airtightness.
【００１４】又第２の発明は、体内臓器取出用の開口部
を持ち、この開口部には処置具挿入用ポートを気密に取
り付け可能な第１の固定部材を設け、更に開口部の回り
に筒状部材を気密に付設した第２の固定部材、両固定部
材間の長さを調整する固定部材間隔調整部材及び第１の
固定部材に気密に取り付け可能な処置具挿入用ポートを
設けたことを特徴とする医療用処置用具である。According to a second aspect of the present invention, there is provided an opening for removing a body organ, a first fixing member capable of airtightly attaching a treatment instrument insertion port to the opening, and further provided around the opening. A second fixing member having a tubular member hermetically attached thereto, a fixing member interval adjusting member for adjusting the length between the two fixing members, and a treatment tool insertion port which can be hermetically attached to the first fixing member. It is a medical treatment tool characterized by the following.
【００１５】更に第３の発明は、体内臓器取出用の開口
部を中央に持つ可とう性を有するシート、シートの開口
部の内縁に沿って取り付けられた固定部材、シートの外
縁に取付けられた支持部材と張力調整部材、シートを挟
んで互いに気密に嵌合する処置具挿入用ポートとポート
取付部材からなり、支持部材と張力調整部材によりシー
ト外縁に向かって任意の張力を加えて開口部を広げるこ
とを特徴とする医療用処置用具である。According to a third aspect of the present invention, there is provided a flexible sheet having an opening for removing internal organs at the center, a fixing member attached along the inner edge of the opening of the sheet, and an outer edge of the sheet. A support member and a tension adjusting member, a treatment tool insertion port and a port mounting member that fit in an airtight manner with the sheet interposed therebetween, and apply an arbitrary tension toward the outer edge of the sheet by the support member and the tension adjusting member to open the opening. It is a medical treatment tool characterized by spreading.
【００１６】[0016]
【発明の実施の形態】以下、図面により本発明を具体的
に説明する。図１ａは本発明の一実施例となる医療用処
置用具の外観図を示しており、図１ｂはその断面図、図
２ａは本発明の一実施例となる医療用処置用具の外観図
を示しており、図２ｂはその断面図、図３ａは本発明の
一実施例となる医療用処置用具の外観図を示しており、
図３ｂはその断面図、図４ａは本発明の一実施例となる
医療用処置用具の外観図を示しており、図４ｂはその断
面図、図５ａは本発明の一実施例となる医療用処置用具
の外観図を示しており、図５ｂはその断面図、図６は本
発明の一実施例となる医療用処置用具の外観図、図７は
本発明の一実施例となる医療用処置用具の外観図、図８
ａ、ｂ、ｃ、ｄは本発明の医療用処置用具の第１の固定
部材と処置具挿入用ポートを着脱する構造を示す外観図
である。DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS The present invention will be specifically described below with reference to the drawings. FIG. 1a is an external view of a medical treatment tool according to one embodiment of the present invention, FIG. 1b is a cross-sectional view thereof, and FIG. 2a is an external view of a medical treatment tool according to one embodiment of the present invention. FIG. 2B is a cross-sectional view thereof, and FIG. 3A is an external view of a medical treatment tool according to an embodiment of the present invention.
Fig. 3b is a cross-sectional view, Fig. 4a is an external view of a medical treatment tool according to one embodiment of the present invention, Fig. 4b is a cross-sectional view thereof, and Fig. 5a is a medical treatment tool according to one embodiment of the present invention. FIG. 5b is a cross-sectional view of the treatment tool, FIG. 6 is an external view of a medical treatment tool according to one embodiment of the present invention, and FIG. 7 is a medical treatment according to one embodiment of the present invention. External view of the tool, FIG. 8
a, b, c, and d are external views showing a structure for attaching and detaching a first fixing member and a treatment tool insertion port of the medical treatment tool of the present invention.
【００１７】また、図９は本発明の一実施例となる医療
用処置用具の構成を示す断面図、図１０は本発明の一実
施例となる医療用処置用具の構成を示す断面図、図１１
は本発明の一実施例となる医療用処置用具の第１の固定
部材と固定部材間隔調整部材の嵌合時の断面図、図１２
は本発明の一実施例となる医療用処置用具の処置具挿入
用ポートと第１の固定部材と固定部材間隔調整部材の嵌
合時の断面図である。FIG. 9 is a sectional view showing the structure of a medical treatment tool according to one embodiment of the present invention, and FIG. 10 is a sectional view showing the structure of a medical treatment tool according to one embodiment of the present invention. 11
FIG. 12 is a cross-sectional view of the medical treatment tool according to one embodiment of the present invention when the first fixing member and the fixing member interval adjusting member are fitted to each other.
FIG. 3 is a cross-sectional view of the medical treatment tool according to one embodiment of the present invention when the treatment tool insertion port, the first fixing member, and the fixing member interval adjusting member are fitted.
【００１８】さらに、図１３は本発明の一実施例となる
医療用処置用具の処置具挿入用ポート取付前の正面図を
示しており、図１４はその断面図、図１５ａ、ｂは本発
明の一実施例となる医療用処置用具の張力調整部材の断
面図を示しており、図１６は本発明の一実施例となる医
療用処置用具の処置具挿入用ポート取付前の正面図を示
しており、図１７はその断面図、図１８は本発明の一実
施例となる医療用処置用具の処置具挿入用ポート取付後
の正面図を示しており、図１９はその断面図、図２０
ａ、ｂは本発明の一実施例となる医療用処置用具の処置
具挿入用ポートの構造を示す断面図である。FIG. 13 is a front view of a medical treatment tool according to an embodiment of the present invention before a treatment tool insertion port is attached. FIG. 14 is a cross-sectional view of the medical treatment tool, and FIGS. FIG. 16 is a cross-sectional view of a tension adjusting member of the medical treatment tool according to one embodiment of the present invention. FIG. 16 is a front view of the medical treatment tool according to one embodiment of the present invention before a treatment instrument insertion port is attached. FIG. 17 is a cross-sectional view of the medical treatment tool, and FIG. 18 is a front view of the medical treatment tool according to an embodiment of the present invention after a treatment tool insertion port is attached. FIG. 19 is a cross-sectional view of FIG.
1A and 1B are cross-sectional views showing the structure of a treatment instrument insertion port of a medical treatment instrument according to one embodiment of the present invention.
【００１９】本発明による医療用処置用具は、筒状部材
（１）（５１）（７３）、第１の気密部材（２）（５
２）（９８）、第２の気密部材（３）（５３）（９
９）、固定部材（４）（８１）、第１の固定部材（５）
（５５）（７４）、第２の固定部材（６）（５６）（７
５）、処置具挿入用ポート（５４）（７８）（９６）、
固定部材間隔調整部材（５７）（７７）、スリット（５
８）、固定用糸（５９）、突起部（６０）、固定部材間
隔調整用シート（６１）、固定用穴（６２）、ネジ（６
３）、シールリング（６４）、つめ（６５）（６７）
（７０）、受け部（６６）、つめ挿入部（６８）（７
１）、クランプ（６９）、つめ挿入部シール部材（７
２）、間隔固定部材（７６）（７９）、シート（８
０）、支持部材（８２）（９３）、張力調整部材（８
３）（９４）、ポート取付部材（８４）、張力調整部材
本体（８５）、歯付支持部材（８６）、爪歯車（８
７）、係止歯（８８）、バネ（８９）、係止解除レバー
（９０）（９５）、ネジ付支持部材（９１）、調整ネジ
（９２）、隔膜（９７）らの構成要素が組み合わされて
形成される。The medical treatment tool according to the present invention comprises a cylindrical member (1) (51) (73), a first airtight member (2) (5).
2) (98), the second hermetic member (3) (53) (9)
9), fixing member (4) (81), first fixing member (5)
(55) (74), the second fixing members (6), (56), (7)
5), treatment instrument insertion ports (54), (78), (96),
Fixing member interval adjusting members (57) (77), slit (5
8), fixing thread (59), protrusion (60), fixing member interval adjusting sheet (61), fixing hole (62), screw (6)
3), seal ring (64), pawl (65), (67)
(70), receiving part (66), pawl insertion part (68) (7
1), a clamp (69), a seal member (7
2), interval fixing members (76) (79), sheet (8)
0), support members (82) and (93), tension adjusting members (8
3) (94), port mounting member (84), tension adjusting member main body (85), toothed support member (86), pawl gear (8)
7) Combination of components such as a locking tooth (88), a spring (89), a locking release lever (90) (95), a support member with screw (91), an adjusting screw (92), a diaphragm (97). Formed.
【００２０】構造を簡単に説明すると、図１〜図３や図
４〜図７のように近位端に１つ以上の入口、遠位端に１
つの出口をもち、遠位端は図１のように１つの固定部材
（４）（８１）により腹壁に固定されたり、図２〜図７
のように第１の固定部材（５）（５５）、第２の固定部
材（６）（５６）の２つの固定部材で腹壁を挟み込むよ
うに位置される。固定部材には創壁を保護するための筒
状部材（１）（５１）が取り付けられるが、筒状部材の
取り付け方法は図１のように固定部材が１つの場合は固
定部材（４）に取り付け、図２〜図７のように固定部材
が２つの場合は、図２、図３、図４のように第２の固定
部材に取り付けて第１の固定部材を移動させて間隔を調
整したり、図５のように第１の固定部材に取り付けて第
２の固定部材を包み込むように筒状部材を位置させ第２
の固定部材を移動させて間隔を調整したり、図６、図７
のように第１の固定部材、第２の固定部材の両方に取り
付けて、固定糸（５９）や固定部材間隔調整用シート
（６１）を引っ張って間隔を調整し、固定糸（５９）を
第１の固定部材（５５）に付設したスリット（５８）に
はめ込んだり、固定部材間隔調整用シート（６１）に付
設されている固定用穴（６２）を第１の固定部材に付設
した突起部（６０）にはめ込んだりして固定する。Briefly describing the structure, one or more inlets at the proximal end and one at the distal end as shown in FIGS. 1-3 and 4-7.
The distal end is fixed to the abdominal wall by one fixing member (4) (81) as shown in FIG.
The first fixing members (5) and (55) and the second fixing members (6) and (56) are positioned so as to sandwich the abdominal wall. A tubular member (1) (51) for protecting the wound wall is attached to the fixed member, and the tubular member is attached to the fixed member (4) when there is only one fixed member as shown in FIG. When two fixing members are attached as shown in FIGS. 2 to 7, the distance is adjusted by attaching the second fixing member and moving the first fixing member as shown in FIGS. 2, 3, and 4. Or, as shown in FIG. 5, the cylindrical member is positioned so as to surround the second fixing member by being attached to the first fixing member.
6 and 7 by moving the fixing member of FIG.
The fixing thread (59) is attached to both the first fixing member and the second fixing member, and the spacing is adjusted by pulling the fixing thread (59) and the fixing member interval adjusting sheet (61). A protrusion (58) attached to a slit (58) attached to the first fixing member (55) or a fixing hole (62) provided to the fixing member interval adjusting sheet (61) attached to the first fixing member. 60) Fit and fix.
【００２１】近位端の入口には鉗子等を挿入していない
際に気密を保つために第１の気密部材（２）（５２）が
配置され先端をキャップ等で閉じたり、内部にフラップ
弁やダックビル弁等の弁部材を付設しても良い。更に、
鉗子等を挿入している際に気密を保つために第２の気密
部材（３）（５３）が配置され円形の穴の開いたシール
弁等を付設しても良い。また、これらは図４〜図７のよ
うに処置具挿入用ポート（５４）に内蔵させて配置して
も良い。更に、図４〜図７は気腹下の処置と腹腔外での
処置を適宜容易に移行できるように、第１の固定部材
（５５）と処置具挿入用ポートの取り付けを図８ａ、
ｂ、ｃ、ｄに示すような方法をとっても良い。At the entrance of the proximal end, first airtight members (2) and (52) are arranged to keep airtight when forceps or the like are not inserted, and the tip is closed with a cap or the like, or a flap valve is provided inside. Or a valve member such as a duck bill valve. Furthermore,
A second hermetic member (3) (53) may be provided to provide airtightness when inserting forceps or the like, and a seal valve having a circular hole may be provided. Further, these may be disposed so as to be built in the treatment instrument insertion port (54) as shown in FIGS. Further, FIGS. 4 to 7 show the attachment of the first fixing member (55) and the treatment instrument insertion port so that the treatment for insufflation and the treatment outside the abdominal cavity can be appropriately and easily changed.
The methods shown in b, c, and d may be used.
【００２２】また、図９、１０のように、筒状部材（７
３）には近位端には第１の固定部材（７４）、遠位端に
は第２の固定部材（７５）が取り付けられ、円筒面上に
は１つ以上の間隔固定部材（７６）（７９）が取り付け
られている。固定部材間隔調整部材（７７）は任意の間
隔固定部材（７６）（７９）を保持し第１の固定部材
（７４）に装着可能である。処置具挿入用ポート（７
８）は第１の固定部材（７４）または固定部材間隔調整
部材（７７）に装着可能で、気腹ガスの漏れを防ぐ構造
としてもよい。Further, as shown in FIGS.
At 3), a first fixing member (74) is attached at the proximal end and a second fixing member (75) is attached at the distal end, and one or more spacing fixing members (76) are provided on the cylindrical surface. (79) is attached. The fixing member interval adjusting member (77) holds an arbitrary interval fixing member (76) (79) and can be attached to the first fixing member (74). Port for insertion of treatment tool (7
8) may be attached to the first fixing member (74) or the fixing member interval adjusting member (77), and may be configured to prevent leakage of insufflation gas.
【００２３】さらに、図１３、１４、１８、１９のよう
に、シート（８０）の中央に臓器取り出し用の開口部を
持ち、シートの開口部の内縁に沿って固定部材（８１）
を取り付け、シートの外縁にシートに任意の張力を与え
ることができる支持部材（８２）と張力調整部材（８
３）を取付けてあり、シートを挟んで互いに気密に嵌合
する処置具挿入用ポート（９６）とポート取付部材（８
４）を持ち、処置具挿入用ポート（９６）には気腹ガス
の漏れを防ぐ処置具挿入用ポート（９６）が装着されて
いるような構造としてもよい。Further, as shown in FIGS. 13, 14, 18, and 19, the sheet (80) has an opening for removing an organ at the center thereof, and the fixing member (81) extends along the inner edge of the opening of the sheet.
A supporting member (82) and a tension adjusting member (8) capable of applying arbitrary tension to the outer edge of the sheet.
3) is attached, and the treatment instrument insertion port (96) and the port attachment member (8) which are airtightly fitted to each other across the sheet.
4), the treatment instrument insertion port (96) may be provided with a treatment instrument insertion port (96) for preventing leakage of insufflation gas.
【００２４】筒状部材（１）（５１）（７３）は肉厚
０．１〜３ｍｍの薄肉の円筒形状の部材であり、通常、
インフレーション成形や、押出成形、熱溶着等のシート
加工等により作製されるが特に限定されない。筒状部材
（１）（５１）（７３）の大きさは処置を行う部位、目
的によって異なるが、腹腔鏡補助下大腸切除術に使用さ
れる場合外径３〜１０ｃｍの大きさとなる。また、使用
時、遠位端を切開口へ挿入・固定して炭酸ガスによる膨
脹状態の中で筒状部材（１）（５１）（７３）内を内視
鏡や鉗子等の処置具が頻繁に出入りし、また、第１の固
定部材（５）（５５）や第２の固定部材（５６）が内部
で移動するため、邪魔にならないような、嵩張らず、適
度に柔軟で、更に、処置具等が当たっても切れたり割れ
たり裂けたり摺れたりし難い材質を選ぶのが良く、例え
ば、軟質塩化ビニル樹脂、ポリウレタン樹脂、ポリエチ
レン樹脂、ポリプロピレン樹脂、ポリエステル樹脂、Ｓ
ＥＢＳ樹脂、シリコーンゴム、天然ゴムのような材質が
好ましい。The cylindrical members (1), (51) and (73) are thin cylindrical members having a wall thickness of 0.1 to 3 mm.
It is produced by sheet processing such as inflation molding, extrusion molding, heat welding or the like, but is not particularly limited. The size of the tubular members (1), (51), and (73) varies depending on the site to be treated and the purpose, but when used for laparoscopically assisted colectomy, it has an outer diameter of 3 to 10 cm. In use, a treatment tool such as an endoscope or forceps frequently inserts and fixes the distal end into the incision and expands the inside of the tubular member (1) (51) (73) in an inflated state by carbon dioxide gas. And the first fixing members (5) and (55) and the second fixing member (56) move inside, so that they are not bulky and moderately flexible so as not to interfere with the treatment. It is good to choose a material that is hard to cut, crack, tear or rub when hit by tools. For example, soft vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyester resin, S
Materials such as EBS resin, silicone rubber and natural rubber are preferred.
【００２５】気密部材は第１の気密部材（２）（５２）
（９８）と第２の気密部材（３）（５３）（９９）から
なるタイプとトロカールを刺入する隔膜（９７）からな
るタイプが考えられる。第１の気密部材（２）（５２）
（９８）は鉗子等を挿入していない時に気密を保つため
に設置するものであり、近位端の先端をキャップ等で閉
じたり、内部にフラップタイプの弁やダックビルタイプ
の弁等の弁部材を付設しても良い。第１の固定部材（５
５）との着脱を行う場合、処置具挿入用ポート（５４）
（７８）（９６）を使用してその中に内蔵させても良
い。キャップ等で閉じる場合は近位端入口に嵌合部材を
取り付け、それとの凹凸で嵌合させたり、ネジによって
固定しても良い。キャップは通常射出成形などで成形さ
れ、その材質は塩化ビニル樹脂、ポリウレタン樹脂、ポ
リエチレン樹脂、ポリプロピレン樹脂、ポリアセタール
樹脂、ポリカーボネート樹脂、ポリサルフォン樹脂など
若干硬質の樹脂かシリコーンゴム、天然ゴム、ＮＢＲ等
の合成ゴムなどが使用される。The airtight member is a first airtight member (2) (52).
(98) and the second airtight members (3), (53) and (99), and a type including a trocar-inserting diaphragm (97). First airtight member (2) (52)
(98) is installed in order to keep the airtight when the forceps etc. are not inserted. The tip of the proximal end is closed with a cap or the like, or a valve member such as a flap type valve or a duck bill type valve is provided inside. May be added. The first fixing member (5
When performing attachment / detachment with 5), a treatment instrument insertion port (54)
(78) (96) may be used to be built therein. When closing with a cap or the like, a fitting member may be attached to the entrance at the proximal end and fitted with unevenness therewith, or fixed with screws. The cap is usually molded by injection molding, etc., and the material is a slightly hard resin such as vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, polycarbonate resin, polysulfone resin, or a synthetic material such as silicone rubber, natural rubber, NBR, etc. Rubber or the like is used.
【００２６】フラップタイプの弁は通常、腹腔鏡外科手
術などで使用されるトラカールに内蔵されているような
硬質の成型品とバネ部材を組み合わせた物でも、シリコ
ーンゴムのような弾性部材をフラップ形状に成形、加工
して使用しても良い。フラップタイプの弁は体外側に開
くことはなく、体内側にのみに動くので、処置具等が挿
入されていない時は体内側の陽圧によりフラップが体外
方向に押されて閉じる構造である。フラップタイプの弁
は射出成形や圧縮成形などで成形され、その材質は塩化
ビニル樹脂、ポリウレタン樹脂、ポリエチレン樹脂、ポ
リプロピレン樹脂、ポリアセタール樹脂、ポリカーボネ
ート樹脂、ポリサルフォン樹脂、シリコーンゴムなどが
使用される。ダックビルタイプの弁も同様に射出成形や
圧縮成形で成形され、主としてシリコーンゴムなどの弾
性材料で作成される。A flap-type valve is usually formed by combining an elastic member such as silicone rubber with a flap-shaped elastic member such as silicone rubber, even when a rigid molded product such as a built-in trocar used in laparoscopic surgery is combined with a spring member. It may be used after being molded and processed. The flap type valve does not open to the outside of the body but moves only inside the body. Therefore, when a treatment tool or the like is not inserted, the flap is pushed outward and closed by the positive pressure inside the body. The flap type valve is molded by injection molding, compression molding, or the like, and the material thereof is, for example, vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, polycarbonate resin, polysulfone resin, or silicone rubber. Duck bill type valves are similarly molded by injection molding or compression molding, and are mainly made of an elastic material such as silicone rubber.
【００２７】第２の気密部材（３）（５３）（９９）は
鉗子等を挿入している際に気密を保つために配置され、
円形の穴の開いたシール弁等を付設しても良い。シール
弁は射出成形、圧縮成形、シート加工等により作製さ
れ、近位端入口や処置具挿入用ポート（５４）（７８）
（９６）に熱溶着または接着される。シール弁の厚さは
０．１〜３ｍｍ程度が適当である。これは、０．１ｍｍ
未満では炭酸ガスの圧力により弁が変形され易くなり、
３ｍｍを超えると鉗子等の処置具を挿入する際の摩擦抵
抗が大きくなり、挿入が困難となるためである。内径は
処置具等の外径に合わせ、０．５ｍｍ〜３０ｍｍが適当
である。シール弁の材質は、可とう性を有するものが望
ましく例えば天然ゴム、シリコーンゴム、塩化ビニル樹
脂、ウレタン樹脂、ＳＥＢＳ樹脂などが適当である。The second airtight members (3), (53) and (99) are arranged to maintain airtightness when inserting forceps or the like.
A seal valve having a circular hole may be provided. The seal valve is manufactured by injection molding, compression molding, sheet processing, or the like, and has a proximal end inlet and a treatment instrument insertion port (54) (78).
It is heat-welded or bonded to (96). An appropriate thickness of the seal valve is about 0.1 to 3 mm. This is 0.1mm
If it is less, the valve is easily deformed by the pressure of carbon dioxide gas,
If it exceeds 3 mm, the frictional resistance when inserting a treatment tool such as forceps increases, which makes insertion difficult. The inner diameter is suitably 0.5 mm to 30 mm in accordance with the outer diameter of the treatment tool or the like. The seal valve is preferably made of a material having flexibility, such as natural rubber, silicone rubber, vinyl chloride resin, urethane resin, or SEBS resin.
【００２８】隔膜（９７）はトロカールを刺入すること
が可能で、その状態での気密性を確保する。隔膜（９
７）の厚さは０．１〜３ｍｍが好ましい。これは、０．
１ｍｍ未満では炭酸ガスの圧力により弁が変形され易く
なり、３ｍｍを超えると鉗子等の処置具を挿入する際の
摩擦抵抗が大きくなり、挿入が困難となるためである。
内径は処置具等の外径に合わせ、０．５ｍｍ〜３０ｍｍ
が好ましい。隔膜（９７）の材質は、可とう性を有する
ものが望ましく例えば天然ゴム、シリコーンゴム、塩化
ビニル樹脂、ウレタン樹脂、ＳＥＢＳ樹脂等が適当であ
る。The septum (97) is capable of penetrating a trocar, and ensures airtightness in that state. Diaphragm (9
The thickness of 7) is preferably 0.1 to 3 mm. This is 0.
If it is less than 1 mm, the valve is likely to be deformed by the pressure of carbon dioxide gas, and if it is more than 3 mm, the frictional resistance when inserting a treatment tool such as forceps increases, which makes insertion difficult.
The inner diameter is 0.5mm to 30mm according to the outer diameter of the treatment tool etc.
Is preferred. The material of the diaphragm (97) is desirably flexible, and for example, natural rubber, silicone rubber, vinyl chloride resin, urethane resin, SEBS resin and the like are suitable.
【００２９】固定部材（４）（８１）は筒状部材（１）
の遠位端側に付設して形成されるか、シート（８０）の
開口部の内縁に沿って付設して形成される。通常、射出
成形、圧縮成形または押出成形チューブの加工によって
作製され、筒状部材（１）もしくはシート（８０）に包
まれ、密着して熱溶着または接着固定されか、固定部材
表面に密着して熱溶着または接着固定される。内外径は
処置を行う部位や挿入箇所となる小切開口の大きさ及
び、挿入する処置具の大きさによるため限定されない
が、腹腔鏡補助下大腸切除術を行う場合、約２〜８ｃｍ
の小切開に対して内径約３〜１１ｃｍ、外径約６〜１２
ｃｍに設定することが適当である。固定部材（４）（８
１）の材質は塩化ビニル樹脂、ポリウレタン樹脂、ポリ
エチレン樹脂、ポリプロピレン樹脂、ポリアセタール樹
脂、ＡＢＳ樹脂、ＳＥＢＳ樹脂、シリコーンゴム等や、
ステンレス鋼などの金属が使用される。The fixing members (4) and (81) are cylindrical members (1).
At the distal end of the seat (80) or along the inner edge of the opening of the seat (80). It is usually produced by injection molding, compression molding or extrusion tube processing, and is wrapped in a tubular member (1) or sheet (80) and closely adhered by heat welding or adhesively fixed, or closely adhered to the surface of the fixed member. Heat welding or adhesive fixing. The inner and outer diameters are not limited because of the size of the small incision opening to be treated or inserted, and the size of the treatment tool to be inserted, but when performing laparoscopically assisted colectomy, about 2 to 8 cm
3 to 11 cm in inner diameter and 6 to 12 in outer diameter for small incisions
It is appropriate to set to cm. Fixing member (4) (8
The material of 1) is vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, ABS resin, SEBS resin, silicone rubber,
Metals such as stainless steel are used.
【００３０】第１の固定部材（５）（５５）（７４）は
筒状部材（１）（５１）（７３）の内周を移動させるよ
うに固定させずに設置される場合と、筒状部材（１）
（５１）（７３）の近位端側に付設して設置される場合
がある。通常、射出成形、圧縮成形または押出成形チュ
ーブの加工によって作製され、筒状部材（１）（７３）
に付設される場合は、筒状部材（１）（７３）に包ま
れ、密着して熱溶着または接着固定されか、固定部材表
面に密着して熱溶着または接着固定される。内外径は処
置を行う部位や挿入箇所となる小切開口の大きさ及び、
挿入する処置具の大きさによるため限定されないが、腹
腔鏡補助下大腸切除術を行う場合、約２〜８ｃｍの小切
開に対して内径約３〜１２ｃｍ、外径約６〜１５ｃｍに
設定することが適当である。第１の固定部材（５）（５
５）（７４）の材質は塩化ビニル樹脂、ポリウレタン樹
脂、ポリエチレン樹脂、ポリプロピレン樹脂、ＡＢＳ樹
脂、ポリアセタール樹脂、ＳＥＢＳ樹脂、シリコーンゴ
ム等や、ステンレス鋼などの金属が使用される。The first fixing members (5), (55), and (74) are installed without being fixed so as to move the inner periphery of the tubular members (1), (51), and (73). Member (1)
(51) There is a case where it is attached and installed on the proximal end side of (73). Usually, it is manufactured by injection molding, compression molding, or processing of an extruded tube, and the tubular member (1) (73)
When it is attached to the fixing member, it is wrapped in the tubular members (1) and (73) and is closely adhered by heat welding or adhesively fixed, or is adhered to the surface of the fixing member by heat welding or adhesively fixed. The inner and outer diameters are the size of the small incision opening to be the site to be treated and the insertion point,
Although it is not limited because of the size of the treatment tool to be inserted, when performing laparoscopic-assisted colectomy, set the inner diameter to about 3 to 12 cm and the outer diameter to about 6 to 15 cm for a small incision of about 2 to 8 cm. Is appropriate. First fixing member (5) (5
5) As the material of (74), metals such as vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, ABS resin, polyacetal resin, SEBS resin, silicone rubber, and stainless steel are used.
【００３１】第２の固定部材（６）（５６）（７５）は
筒状部材（１）（５１）（７３）の周囲（または外周）
を移動させるように固定させずに設置される場合と、筒
状部材（１）（５１）（７３）の遠位端側に付設して設
置される場合がある。通常、射出成形、圧縮成形または
押出成形チューブの加工によって作製され、筒状部材
（１）（７３）に付設される場合は、筒状部材（１）
（７３）に包まれ、密着して熱溶着または接着固定され
か、固定部材表面に密着して熱溶着または接着固定され
る。内外径は処置を行う部位や挿入箇所となる小切開口
の大きさ及び、挿入する処置具の大きさによるため限定
されないが、腹腔鏡補助下大腸切除術を行う場合、約２
〜８ｃｍの小切開に対して内径約３〜１２ｃｍ、外径約
６〜１５ｃｍに設定することが適当である。第２の固定
部材（６）（５６）（７５）の材質は塩化ビニル樹脂、
ポリウレタン樹脂、ポリエチレン樹脂、ポリプロピレン
樹脂、ＡＢＳ樹脂、ポリアセタール樹脂、ＳＥＢＳ樹
脂、シリコーンゴム等が使用される。The second fixing members (6), (56) and (75) are located around (or around) the tubular members (1), (51) and (73).
May be installed without being fixed so as to move, or may be installed attached to the distal end side of the tubular members (1), (51), (73). Usually, it is manufactured by injection molding, compression molding, or processing of an extruded tube, and when attached to the tubular member (1) (73), the tubular member (1) is used.
It is wrapped in (73) and closely adhered by heat welding or adhesively fixed, or closely adhered to the surface of the fixing member and thermally welded or adhered and fixed. The inner and outer diameters are not limited because of the size of the small incision opening to be treated or inserted and the size of the treatment tool to be inserted. However, when performing laparoscopic-assisted colectomy, approximately 2
It is appropriate to set the inner diameter to about 3 to 12 cm and the outer diameter to about 6 to 15 cm for a small incision of ８8 cm. The material of the second fixing members (6), (56) and (75) is vinyl chloride resin,
Polyurethane resin, polyethylene resin, polypropylene resin, ABS resin, polyacetal resin, SEBS resin, silicone rubber and the like are used.
【００３２】処置具挿入用ポート（５４）（７８）は通
常射出成形により成形され、第１の固定部材（５５）
（７４）に取り付けられ、気密部材が付設または内蔵さ
れている。第１の固定部材との取り付け方法は図８、図
１２に示すような構造に形成される。図８ａは第１の固
定部材（５５）とネジ（６３）により固定され、図８ｂ
は第１の固定部材（５５）に凸状の受け部（６６）を設
け、処置具挿入用ポート（５４）のつめ（６５）と嵌合
され、図８ｃは第１の固定部材（５５）に凹状のつめ挿
入部（６８）を設け、処置具挿入用ポート（５４）のつ
め（６７）を挿入して回転させると、つめ（６７）の形
状が図のように傾斜を有しているため締め付け固定され
る。また、図８ｄは第１の固定部材（５５）につめ挿入
部（７１）を第１の固定部材を貫通しないように形成す
るか、図のようにつめ挿入部シール部材（７２）を気密
に取り付けて、処置具挿入用ポート（５４）のクランプ
（６９）のつめ（７０）を挿入して固定し、取り外すと
きはクランプ（６９）の手元側をつまむと取り外しがで
きるようにも形成できる。The treatment instrument insertion ports (54) and (78) are usually formed by injection molding, and the first fixing member (55).
(74), and an airtight member is attached or built therein. The attachment method with the first fixing member is formed in a structure as shown in FIGS. FIG. 8A is fixed by a first fixing member (55) and a screw (63), and FIG.
Is provided with a convex receiving portion (66) on the first fixing member (55), and is fitted with the pawl (65) of the treatment instrument insertion port (54). FIG. 8C shows the first fixing member (55). Is provided with a concave claw insertion portion (68), and when the claw (67) of the treatment tool insertion port (54) is inserted and rotated, the shape of the claw (67) has an inclination as shown in the figure. It is tightened and fixed. FIG. 8D shows the first fixing member (55) in which the pawl insertion portion (71) is formed so as not to penetrate the first fixing member, or as shown in FIG. The clamp (69) of the treatment instrument insertion port (54) can be attached and fixed by inserting the claws (70). When the clamp (69) is detached, it can be detached.
【００３３】また、処置具挿入用ポート（９６）は図１
８、１９のようにポート取付部材（８４）とシート（８
０）を挟んで気密に嵌合する。処置具挿入用ポート（９
６）は図２０ａのように開口部のない隔膜（９７）を取
り付け、隔膜（９７）にトロッカーを刺入して用いるタ
イプや、図２０ｂのように第１の気密部材（９８）と第
２の気密部材（９９）を付設したタイプが考えられる。
また、処置具挿入用ポート（９６）はポート取付部材
（８４）との嵌合部分と弁部分で気密に嵌合する２つの
部品に分けてもよい。いずれの方法もシールリング（６
４）等の手段により気腹ガスが漏れないようにすると良
い。処置具挿入用ポート（５４）（７８）（９６）の材
質は塩化ビニル樹脂、ポリウレタン樹脂、ポリエチレン
樹脂、ポリプロピレン樹脂、ポリアセタール樹脂、ポリ
カーボネート樹脂、ポリサルフォン樹脂など若干硬質の
樹脂であれば良い。また、シールリング（６４）の材質
はシリコーンゴムやニトリルゴム等のゴム系のもので良
い。The treatment instrument insertion port (96) is shown in FIG.
8 and 19, the port mounting member (84) and the seat (8).
0) is fitted airtight. Treatment instrument insertion port (9
6) is a type in which a diaphragm (97) having no opening is attached as shown in FIG. 20a and a trocar is inserted into the diaphragm (97), or a first airtight member (98) and a second airtight member (98) as shown in FIG. 20b. A type provided with the airtight member (99) is conceivable.
Further, the treatment instrument insertion port (96) may be divided into two parts which are fitted airtightly at the fitting part with the port mounting member (84) and at the valve part. Both methods use seal rings (6
It is preferable to prevent the insufflation gas from leaking by means such as 4). The material of the treatment instrument insertion ports (54), (78), and (96) may be a slightly hard resin such as vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, polycarbonate resin, and polysulfone resin. Further, the material of the seal ring (64) may be a rubber-based material such as silicone rubber or nitrile rubber.
【００３４】第１の固定部材（５）（５５）（７４）と
第２の固定部材（６）（５６）（７５）の間隔を調整す
る手段としては、図４、５のように、いずれかの固定部
材を筒状部材（１）の内部で動かして間隔を調整して、
固定部材間隔調整部材（５７）で、筒状部材（１）を挟
み込むようにして固定する方法や、図６のように、第２
の固定部材（５６）に取り付けた固定用糸（５９）を引
っ張り上げて間隔を調整し、固定用糸（５９）を第１の
固定部材（５５）に付設したスリット（５８）にはめ込
んで固定する方法や、図７のように、第２の固定部材
（５６）に取り付けた固定部材間隔調整用シート（６
１）に付設された固定用穴（６２）に第１の固定部材
（５５）に付設した突起部（６０）をはめ込んで固定す
るか、第２の固定部材に取り付けた固定部材間隔調整用
シートを第１の固定部材と固定部材間隔調整部材で挟ん
で固定する方法がある。または、図９〜１１のように第
１の固定部材（７４）を引っ張り上げて適当な位置で間
隔固定部材（７６）（７９）を固定部材間隔調整部材
（７７）に引っかけて固定する。As means for adjusting the distance between the first fixing members (5), (55), (74) and the second fixing members (6), (56), (75), as shown in FIGS. The fixing member is moved inside the tubular member (1) to adjust the interval,
A method of fixing the tubular member (1) by sandwiching it with the fixing member interval adjusting member (57), or a second method as shown in FIG.
The fixing thread (59) attached to the fixing member (56) is pulled up to adjust the interval, and the fixing thread (59) is fitted into the slit (58) provided on the first fixing member (55) and fixed. As shown in FIG. 7, the fixing member interval adjusting sheet (6) attached to the second fixing member (56) as shown in FIG.
The protrusion (60) attached to the first fixing member (55) is fitted and fixed in the fixing hole (62) provided in 1), or the fixing member interval adjusting sheet attached to the second fixing member. Is fixed between the first fixing member and the fixing member interval adjusting member. Alternatively, as shown in FIGS. 9 to 11, the first fixing member (74) is pulled up and the gap fixing members (76) and (79) are hooked and fixed to the fixing member gap adjusting member (77) at an appropriate position.
【００３５】固定部材間隔調整部材（５７）（７７）は
通常、射出成形によって作製され、内周に筒状部材（５
１）を通し、第１の固定部材（５５）との間で筒状部材
（５１）を挟み込んで気密を守るように設置されてい
る。内外径は処置を行う部位や挿入箇所となる小切開口
の大きさ及び挿入する処置具の大きさによるため、限定
されないが、腹腔鏡補助下大腸切除術を行う場合、約２
〜８ｃｍの小切開に対して、内径約３〜１０ｃｍ、外径
約６〜１５ｃｍに設定することが適当である。固定部材
間隔調整部材（５７）（７７）の材質は、塩化ビニル樹
脂、ポリウレタン樹脂、ポリエチレン樹脂、ポリプロピ
レン樹脂、ＡＢＳ樹脂、ポリアセタール樹脂、シリコー
ンゴム等や、ステンレス鋼などの金属が使用される。The fixing member interval adjusting members (57) and (77) are usually manufactured by injection molding, and have a cylindrical member (5
1), the tubular member (51) is sandwiched between the first fixing member (55) and the first fixing member (55), so that the airtightness is secured. The inner and outer diameters are not limited because they depend on the size of the small incision opening to be treated or inserted and the size of the treatment tool to be inserted.
For a small incision of ８8 cm, it is appropriate to set the inner diameter to about 3 to 10 cm and the outer diameter to about 6 to 15 cm. As the material of the fixing member interval adjusting members (57) and (77), a metal such as vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, ABS resin, polyacetal resin, silicone rubber, or stainless steel is used.
【００３６】固定部材間隔調整シート（６１）は、肉厚
０．１〜５ｍｍの薄肉のシート部材であり、シート成形
に穴開け加工を加えたり、圧縮成形等により作製される
が特に限定されない。固定部材間隔調整シート（６１）
の大きさは、処置を行う部位、目的によって異なるが、
幅約２０〜３０ｍｍ、長さ１０〜１５ｃｍ程度に成形さ
れる。柔軟であるが切れたり、裂けたりし難い材料を選
ぶこと選ぶのが良く、例えば、軟質塩化ビニル樹脂、ポ
リウレタン樹脂、ポリエチレン樹脂、ポリプロピレン樹
脂、ポリエステル樹脂、ＳＥＢＳ樹脂、シリコーンゴ
ム、天然ゴムの様な材質が好ましい。The fixing member interval adjusting sheet (61) is a thin sheet member having a thickness of 0.1 to 5 mm, and is formed by punching a sheet or by compression molding, but is not particularly limited. Fixing member spacing adjustment sheet (61)
The size depends on the site to be treated and the purpose,
It is formed to a width of about 20 to 30 mm and a length of about 10 to 15 cm. It is good to choose a material that is flexible but difficult to cut or tear, such as soft vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyester resin, SEBS resin, silicone rubber, natural rubber, etc. The material is preferred.
【００３７】間隔固定部材（７６）（７９）は筒状部材
（７３）の外側に１つ以上取り付けられ、固定部材間隔
調整部材（７７）に脱着可能で、筒状部材（７３）に対
して縦方向の張力を加えた状態を保持するために用いら
れる。図９のように１つ以上のリング状の間隔固定部材
（７６）を任意のピッチで筒状部材（７３）上に並べた
タイプや、図１０のように任意のピッチのコイル状の間
隔固定部材（７９）を筒状部材（７３）上に付設したタ
イプなどがある。特にコイル状の間隔固定部材（７９）
では創の大きさに合わせてコイルに捻りを加えることで
筒状部材（７３）の径を自在に操ることができる。通
常、射出成形、圧縮成形または押出成形物の加工によっ
て作製される。筒状部材（７３）の外表面に熱溶着また
は接着固定により取付けるのがよいが特に限定されな
い。One or more spacing fixing members (76) and (79) are attached to the outside of the cylindrical member (73), and are detachable from the fixing member spacing adjusting member (77). It is used to maintain a state in which a vertical tension is applied. As shown in FIG. 9, one or more ring-shaped spacing fixing members (76) are arranged on a cylindrical member (73) at an arbitrary pitch, or as shown in FIG. 10, a coil-shaped spacing fixing at an arbitrary pitch. There is a type in which the member (79) is provided on the tubular member (73). In particular, a coil-shaped spacing fixing member (79)
Then, the diameter of the tubular member (73) can be freely manipulated by twisting the coil according to the size of the wound. It is usually produced by injection molding, compression molding or processing of an extruded product. It is preferable to attach to the outer surface of the tubular member (73) by heat welding or adhesive fixing, but there is no particular limitation.
【００３８】内外径は処置を行う部位や挿入箇所となる
小切開口の大きさ及び、挿入する処置具の大きさによる
ため限定されないが、腹腔鏡補助下大腸切除術を行う場
合、約２〜８ｃｍの小切開に対して内径約３〜１２ｃ
ｍ、外径約４〜１５ｃｍに設定することが好ましい。ま
た、間隔固定部材の断面積は０．５〜２０ｍｍ2程度が
好ましい。間隔固定部材（７６）間もしくは間隔固定部
材（７９）のピッチは０．２ｃｍ〜２ｃｍが好ましい。
材質は硬質で弾力に富んだものがよく、通常ステンレス
鋼などの金属が使用されるが、特に厳密なバネ弾性係数
を必要とはしないので、塩化ビニル樹脂、ポリウレタン
樹脂、ポリエチレン樹脂、ポリプロピレン樹脂、ポリア
セタール樹脂、ＡＢＳ樹脂等のプラスチック材料でもよ
い。The inner and outer diameters are not limited because they depend on the size of the small incision opening to be treated or inserted and the size of the treatment tool to be inserted. 8cm small incision about 3-12c inside diameter
m and an outer diameter of about 4 to 15 cm. Further, the sectional area of the space fixing member is preferably about 0.5 to 20 mm 2 . The pitch between the space fixing members (76) or between the space fixing members (79) is preferably 0.2 cm to 2 cm.
The material is preferably hard and highly elastic.Metal such as stainless steel is usually used, but it does not require a strict spring elastic modulus.Therefore, vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, Plastic materials such as polyacetal resin and ABS resin may be used.
【００３９】シート（８０）は肉厚０．１〜３ｍｍの平
面またはテーパーのかかった円筒形状であり、通常、押
出成形またはインフレーション成形等により作製される
が特に限定されない。シート（８０）の大きさは処置を
行う部位、目的によって異なるが、腹腔鏡補助下大腸切
除術に使用される場合、外径が１０〜３０ｃｍ、開口径
が３〜１０ｃｍとなり、また、使用時、内視鏡や鉗子等
の処置具が頻繁に出入りするため、嵩張らず、適度に柔
軟で、更に、処置具等が当たっても切れたり裂けたりし
難い材質を選ぶのが良く、例えば、軟質塩化ビニル樹
脂、ポリウレタン樹脂、ポリエチレン樹脂、ポリプロピ
レン樹脂、ポリエステル樹脂、ＳＥＢＳ樹脂、シリコー
ンゴム、天然ゴム等の材質が好ましい。The sheet (80) is a flat or tapered cylindrical shape having a wall thickness of 0.1 to 3 mm, and is usually produced by extrusion molding or inflation molding, but is not particularly limited. The size of the sheet (80) varies depending on the site to be treated and the purpose, but when used for laparoscopically assisted colectomy, the outer diameter is 10 to 30 cm and the opening diameter is 3 to 10 cm. Since treatment tools such as an endoscope and forceps come and go frequently, it is not bulky and is appropriately flexible.In addition, it is better to select a material that is hard to be cut or torn even when the treatment tool is hit. Materials such as vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyester resin, SEBS resin, silicone rubber, and natural rubber are preferred.
【００４０】支持部材（８２）はシート（８０）にドー
ナツ状に包まれ、シート（８０）の熱溶着または接着固
定により取付けられて、シート（８０）外縁を支持する
か、新たに別の部材を用いて両部材間をつないでもよ
い。支持部材（８２）は直径を３〜３０ｃｍの間で調整
可能なのがよく、支持部材の幅もしくは径は０．５ｍｍ
〜２ｃｍが好ましい。また、支持部材（８２）の表面は
張力調整部材（８３）に固定されやすいように歯付支持
部材（８６）やネジ付支持部材（９１）に見られるよう
な加工を施してもよい。この時の歯やネジのピッチは
０．５ｍｍ〜１ｃｍが好ましい。The supporting member (82) is wrapped in a donut shape on the sheet (80) and attached by heat welding or adhesive fixing of the sheet (80) to support the outer edge of the sheet (80) or to provide another member. May be used to connect both members. The diameter of the support member (82) is preferably adjustable between 3 and 30 cm, and the width or diameter of the support member is 0.5 mm.
~ 2 cm is preferred. Further, the surface of the support member (82) may be subjected to a process such as that seen on the toothed support member (86) or the threaded support member (91) so as to be easily fixed to the tension adjusting member (83). The pitch of the teeth and screws at this time is preferably 0.5 mm to 1 cm.
【００４１】通常、支持部材（８２）、歯付支持部材
（８６）、ネジ付支持部材（９１）は射出成形、圧縮成
形または押出成形物の加工によって作製される。材質は
硬質で弾力に富んだものがよく、通常ステンレス鋼など
の金属が使用されるが、特に厳密なバネ弾性係数を必要
とはしないので、塩化ビニル樹脂、ポリウレタン樹脂、
ポリエチレン樹脂、ポリプロピレン樹脂、ポリアセター
ル樹脂、ＡＢＳ樹脂等のプラスチック材料でもよい。Usually, the support member (82), the toothed support member (86) and the threaded support member (91) are manufactured by injection molding, compression molding or processing of an extruded product. The material should be hard and highly elastic.Metal such as stainless steel is usually used, but it does not require a strict spring elastic modulus.
Plastic materials such as polyethylene resin, polypropylene resin, polyacetal resin and ABS resin may be used.
【００４２】張力調整部材（８３）は支持部材（８２）
の片端に取り付けられる。また、張力調整部材（８３）
は支持部材（８２）の外周を調整し、任意の位置で固
定、解除が可能である。張力調整部材本体（８５）の長
さは長寸で２〜１０ｃｍ程度、短寸で５ｍｍ〜４ｃｍ程
度で、厚さは５ｍｍ〜２ｃｍと術中に邪魔にならないよ
うにできるだけ薄い方がよい。支持部材（８２）の外周
を調整する方法は、図１５ａのように爪歯車（８７）を
回して歯付支持部材（８６）を任意の位置で係止歯（８
８）を用いてバネ（８９）の応力により係止させ、係止
解除レバー（９０）により解除してもよい。また、図１
５ｂのようにネジ付支持部材（９１）を調整ネジ（９
２）により固定してもよい。張力調整部材本体（８５）
は通常、射出成形によって作製される。張力調整部材本
体（８５）の材質は塩化ビニル樹脂、ポリウレタン樹
脂、ポリエチレン樹脂、ポリプロピレン樹脂、ポリアセ
タール樹脂、ポリカーボネート樹脂、ポリサルフォン樹
脂等の硬質樹脂かステンレス鋼等の金属が使用できる。The tension adjusting member (83) is a supporting member (82).
Attached to one end. Also, a tension adjusting member (83)
Can adjust and fix the outer circumference of the support member (82), and can fix and release it at an arbitrary position. The length of the tension adjusting member body (85) is about 2 to 10 cm in a long dimension, about 5 mm to 4 cm in a short dimension, and the thickness is 5 mm to 2 cm, and it is preferable that the thickness is as thin as possible so as not to interfere during the operation. The method of adjusting the outer circumference of the support member (82) is to turn the toothed support member (86) at any position by turning the pawl gear (87) as shown in FIG.
The lock may be locked by the stress of the spring (89) using 8) and released by the lock release lever (90). FIG.
5b, the supporting member (91) with the screw is adjusted with the adjusting screw (9).
You may fix by 2). Tension adjusting member body (85)
Is usually produced by injection molding. As the material of the tension adjusting member main body (85), a hard resin such as a vinyl chloride resin, a polyurethane resin, a polyethylene resin, a polypropylene resin, a polyacetal resin, a polycarbonate resin, a polysulfone resin, or a metal such as stainless steel can be used.
【００４３】また、図１６、１７のように支持部材（９
３）は張力調整部材（９４）を介して井桁に組んでもよ
い。このとき、支持部材の表面は図１６のような歯をつ
け、図１５ａで示したようなラチェット機構で支持部材
同士を任意の位置で固定、解除してもよい。なお、シー
ト（８０）と支持部材（９３）は新たに別の部材を用い
て接続するのが好ましい。支持部材（９３）は一辺を３
〜３０ｃｍの間で調整可能なのがよく、支持部材の幅も
しくは径は０．５ｍｍ〜２ｃｍが好ましい。Also, as shown in FIGS.
3) may be assembled to a girder via a tension adjusting member (94). At this time, the surface of the support member may be provided with teeth as shown in FIG. 16, and the support members may be fixed and released at an arbitrary position by a ratchet mechanism as shown in FIG. 15A. Preferably, the sheet (80) and the support member (93) are newly connected using another member. The support member (93) has three sides.
The width or diameter of the supporting member is preferably 0.5 mm to 2 cm.
【００４４】係止解除レバー（９０）は長さは１〜１０
ｃｍ、厚さは２ｍｍ〜２ｃｍが好ましい。爪歯車（８
７）は直径５ｍｍ〜３ｃｍ、厚さは２ｍｍ〜２ｃｍが好
ましい。係止歯（８８）の幅は２ｍｍ〜２ｃｍが好まし
い。調整ネジ（９２）は外径１〜３ｃｍ、内径２〜５ｍ
ｍ、長さが２ｍｍ〜３ｃｍが好ましい。バネ（８９）は
図１５ａのように板状物を折り曲げたような形状でもよ
いが普通の支持部材バネでもよく、張力調整部材本体
（８５）に収まる大きさであればよい。爪歯車（８
７）、係止歯（８８）、バネ（８９）、係止解除レバー
（９０）、調整ネジ（９２）は通常、射出成形によって
作製される。これらの材質は硬質で変形しにくい材料が
よく、塩化ビニル樹脂、ポリウレタン樹脂、ポリエチレ
ン樹脂、ポリプロピレン樹脂、ポリアセタール樹脂、ポ
リカーボネート樹脂、ポリサルフォン樹脂等の硬質樹脂
かステンレス鋼等の金属が使用できる。The length of the unlocking lever (90) is 1 to 10
cm and a thickness of 2 mm to 2 cm are preferable. Claw gear (8
7) preferably has a diameter of 5 mm to 3 cm and a thickness of 2 mm to 2 cm. The width of the locking teeth (88) is preferably 2 mm to 2 cm. Adjustment screw (92) has outer diameter of 1-3cm, inner diameter of 2-5m
m and a length of 2 mm to 3 cm are preferable. The spring (89) may have a shape obtained by bending a plate-like object as shown in FIG. 15A, but may be an ordinary support member spring, and may be any size as long as it can be accommodated in the tension adjusting member main body (85). Claw gear (8
7) The locking teeth (88), the spring (89), the locking release lever (90), and the adjusting screw (92) are usually manufactured by injection molding. These materials are preferably hard and not easily deformed. Hard resins such as vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, polycarbonate resin and polysulfone resin, and metals such as stainless steel can be used.
【００４５】ポート取付部材（８４）は図１８、１９の
ように処置具挿入用ポート（９６）をシート（８０）上
に固定するために設置し、気腹時に腹腔内の気密を確保
するためのものであり、処置具挿入用ポート（９６）と
の着脱を行う場合、互いの凹凸やネジによって固定して
も良い。通常射出成形などで成形される。内外径は処置
を行う部位や挿入箇所となる小切開口の大きさ及び、挿
入する処置具の大きさによって決められ、腹腔鏡補助下
大腸切除術を行う場合、約２〜８ｃｍの小切開に対して
内径約３〜９ｃｍ、外径約４〜１２ｃｍに設定すること
が適当である。高さは処置の際に邪魔にならないように
０．１〜１ｃｍが適当である。その材質は塩化ビニル樹
脂、ポリウレタン樹脂、ポリエチレン樹脂、ポリプロピ
レン樹脂、ポリアセタール樹脂、ポリカーボネート樹
脂、ポリサルフォン樹脂等の硬質樹脂かシリコーンゴ
ム、天然ゴム、ＮＢＲ等の合成ゴムが使用される。The port mounting member (84) is installed to fix the treatment instrument insertion port (96) on the sheet (80) as shown in FIGS. 18 and 19, and to ensure airtightness in the abdominal cavity during insufflation. When the attachment / detachment with respect to the treatment instrument insertion port (96) is performed, the treatment instrument insertion / removal port (96) may be fixed by mutual unevenness or screws. Usually molded by injection molding or the like. The inner and outer diameters are determined by the size of the small incision opening, which is the site to be treated and the insertion point, and the size of the treatment tool to be inserted. When performing laparoscopically assisted colectomy, a small incision of about 2 to 8 cm is required. On the other hand, it is appropriate to set the inner diameter to about 3 to 9 cm and the outer diameter to about 4 to 12 cm. The height is suitably 0.1 to 1 cm so as not to disturb the treatment. The material used is a hard resin such as vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, polycarbonate resin, polysulfone resin, or a synthetic rubber such as silicone rubber, natural rubber, or NBR.
【００４６】次に本発明の第２の発明による医療用処置
用具の実際の使用方法について図４を用いて解説し、本
発明の効果を明確にする。腹腔鏡補助下大腸切除術を行
う場合、まず、複数本のトロッカーを腹部に挿入し、臓
器摘出予想部位に約３〜５ｃｍ程度の小切開を置いて、
本発明の第２の固定部材（５６）を腹腔内に挿入し、第
１の固定部材（５５）を筒状部材（５１）内で移動させ
て図４ｂのように腹壁の幅に調節する。固定部材間隔調
整部材（５７）により、第１の固定部材との間に筒状部
材（５１）を挟み込んで気密に固定する。Next, an actual method of using the medical treatment tool according to the second aspect of the present invention will be described with reference to FIG. 4 to clarify the effects of the present invention. When performing laparoscopic-assisted colectomy, first, insert multiple trocars into the abdomen, place a small incision of about 3 to 5 cm at the expected organ removal site,
The second fixing member (56) of the present invention is inserted into the abdominal cavity, and the first fixing member (55) is moved within the tubular member (51) to adjust the width of the abdominal wall as shown in FIG. 4b. The cylindrical member (51) is sandwiched between the first fixing member and the fixing member by the fixing member interval adjusting member (57) to be air-tightly fixed.
【００４７】トロッカー及び本発明の処置具挿入用ポー
トより腹腔鏡、処置具を挿入して大腸の剥離、リンパ節
の郭清、血管の処理などの処置を腹腔鏡下で行い、十分
な受動ができた後、本発明の処置具挿入用ポート（５
４）を取り外して大腸を体外へ取り出し、直視下で患部
付近の大腸の切離・縫合等を行った後、体内へ大腸を戻
す。再度本発明の処置具挿入用ポート（５４）を第１の
固定部材に取り付け、再気腹を行い、腹腔内を十分に観
察する。再度、体外での処置が必要な場合は気腹を落と
し、処置具挿入用ポート（５４）を取り外して処置を行
う。第１の発明の使用方法については固定部材間隔の調
整作業がない他は第２の発明と同様である。Laparoscopy and a treatment tool are inserted from the trocar and the port for inserting a treatment tool of the present invention, and treatments such as exfoliation of the large intestine, dissection of lymph nodes, and treatment of blood vessels are performed under the laparoscope. After completion, the treatment instrument insertion port (5
4) is removed and the large intestine is taken out of the body, the large intestine in the vicinity of the affected part is cut off and sewn under direct vision, and then the large intestine is returned to the body. The treatment instrument insertion port (54) of the present invention is again attached to the first fixing member, re-inflation is performed, and the inside of the abdominal cavity is sufficiently observed. When treatment outside the body is necessary again, the patient is insufflated, and the treatment is performed by removing the treatment instrument insertion port (54). The method of use of the first invention is the same as that of the second invention except that there is no work of adjusting the interval between the fixing members.
【００４８】次に本発明の第３の発明による医療用処置
用具の実際の使用方法について図１３、１４、１８、１
９を用いて説明し、本発明の効果を明確にする。腹腔鏡
補助下大腸切除術を行う場合、まず、複数本のトロッカ
ーを腹部に挿入し、臓器摘出予想部位に約３〜５ｃｍ程
度の小切開を置く。図１３、１４のようにその小切開を
囲むように本発明のポート取付部材（８４）を置き、ポ
ート取付部材（８４）を通して固定部材（８１）を腹腔
内に挿入し、張力調整部材（８３）を用いて支持部材
（８２）の径を大きくし、シート外縁に向かって任意の
張力を加えて開口部を広げ、腹壁の幅に調節する。この
時、シートは外縁に向かって引っ張られているので、従
来のようにシートにしわがよって開口部の内側にせり出
したりして処置時の邪魔になったりしない。Next, an actual method of using the medical treatment tool according to the third invention of the present invention will be described with reference to FIGS.
9 to clarify the effects of the present invention. When performing laparoscopic-assisted colectomy, first, a plurality of trocars are inserted into the abdomen, and a small incision of about 3 to 5 cm is placed at a site where an organ is to be removed. As shown in FIGS. 13 and 14, the port mounting member (84) of the present invention is placed so as to surround the small incision, the fixing member (81) is inserted into the abdominal cavity through the port mounting member (84), and the tension adjusting member (83) is inserted. ) To increase the diameter of the support member (82), apply an arbitrary tension toward the outer edge of the sheet to widen the opening, and adjust the width to the width of the abdominal wall. At this time, since the sheet is pulled toward the outer edge, the sheet does not protrude to the inside of the opening due to wrinkling as in the related art and does not obstruct the treatment.
【００４９】次に図１８、１９のように処置具挿入用ポ
ート（９６）をシート（８０）を挟んでポート取付部材
（８４）に気密に固定する。処置具挿入用ポート（９
６）よりトロッカー等を刺入し、そこから腹腔鏡、処置
具を挿入して大腸の剥離、リンパ節の郭清、血管の処理
などの処置を腹腔鏡下で行い、十分な受動ができた後、
処置具挿入用ポート（９６）を取り外して大腸を体外へ
取り出し、直視下で患部付近の大腸の切離・縫合等を行
った後、体内へ大腸を戻す。再度、処置具挿入用ポート
（９６）をポート取付部材（８４）に取り付け、再気腹
を行い、腹腔内を十分に観察する。再度、体外での処置
が必要な場合は気腹を落とし、処置具挿入用ポート（９
６）を取り外して処置を行う。Next, as shown in FIGS. 18 and 19, the treatment instrument insertion port (96) is airtightly fixed to the port mounting member (84) with the sheet (80) interposed therebetween. Treatment instrument insertion port (9
6) A trocar or the like was inserted from there, and a laparoscope and a treatment tool were inserted therefrom, and procedures such as exfoliation of the large intestine, dissection of lymph nodes, and treatment of blood vessels were performed under the laparoscope, and sufficient passiveness was achieved. rear,
After removing the treatment instrument insertion port (96), the large intestine is taken out of the body, the large intestine near the affected area is cut off and sewn under direct view, and then the large intestine is returned to the body. Again, the treatment instrument insertion port (96) is attached to the port attaching member (84), re-insufflation is performed, and the inside of the abdominal cavity is sufficiently observed. When the treatment outside the body is necessary again, the insufficiency is lowered and the treatment instrument insertion port (9
6) Remove and perform treatment.
【００５０】これにより、「簡単に気腹下処置と腹腔外
処置との切り替えができる」「気腹下での処置を行う場
合には本発明からも鉗子操作が行える」「癌部位の摘出
の際に腹壁の切開創が保護され、癌細胞の創感染の問題
がない」等の効果が得られた。さらに、図９、１０のよ
うな構造とすることによって「固定部材間隔調整後も筒
状部材の弛みは間隔固定部材の間に蛇腹状に折り畳まれ
るため、術中の視野を妨げない」「筒状部材を全周にわ
たり均等に引っ張れるので固定部材間のずれが少なく気
密を保持しやすい」「間隔固定部材の張力と筒状部材に
与えられた張力により開創する」等の効果が、図１３、
１４、１６、１７のような構造にすることで、「シート
全周にわたって均等に引っ張れるので固定部材間のずれ
が少なく気密を保持しやすい」「固定部材間隔調整後も
シートに弛みが生じないため、術中の視野を妨げない」
「シートに与えられた張力により開創する」等の効果が
得られた。[0050] Thereby, "switching between intraperitoneal treatment and extra-abdominal treatment can be easily performed", "when performing treatment under pneumoperitoneum, the forceps operation can also be performed from the present invention", and "cancer removal". In this case, the incision wound on the abdominal wall is protected, and there is no problem of wound infection of cancer cells. " Further, by adopting the structure as shown in FIGS. 9 and 10, "the slack of the tubular member is folded in a bellows shape between the fixed spacing members even after adjusting the spacing between the fixed members, so that the visual field during the operation is not disturbed." Since the member can be pulled evenly over the entire circumference, the gap between the fixing members is less likely to be kept airtight, and the effects such as "retracting by the tension of the space fixing member and the tension given to the cylindrical member" are shown in FIG.
By adopting a structure such as 14, 16, and 17, "the sheet is evenly pulled over the entire circumference of the sheet, so that there is little displacement between the fixing members and airtightness is easily maintained." , It doesn't interfere with the field of view during surgery. ''
An effect such as "retract by the tension given to the sheet" was obtained.
【００５１】[0051]
【発明の効果】本発明の医療用処置用具は、腹腔鏡下手
術の術中には、簡単に気腹下処置と腹腔外処置との切り
替えができ、気腹下での処置を行う場合には本発明から
も鉗子操作が行え、癌部位の摘出の際に腹壁の切開創が
保護され、癌細胞の創感染の問題がないため、術者のス
トレスが軽減され、手術時間のスピードアップや感染防
止が図られ、更には、開腹手術より手術創が小さく美容
面で有用であり、ひいては患者の早期社会復帰、医療経
済への削減効果が期待できる。The medical treatment tool of the present invention can easily switch between intraperitoneal and extra-abdominal procedures during laparoscopic surgery, and can be used when performing intraperitoneal procedures. According to the present invention, the forceps operation can be performed, the incision wound on the abdominal wall is protected during the removal of the cancer site, and since there is no problem of wound infection of the cancer cells, the stress on the operator is reduced, and the operation time is increased and infection is reduced. In addition, the surgical wound is smaller than a laparotomy, which is useful in cosmetics, and it is expected that the patient will be able to return to society early and to reduce the medical economy.
【図１】図１ａは本発明の一実施例となる医療用処置用
具の外観図を示しており、図１ｂはその断面図。FIG. 1a is an external view of a medical treatment tool according to one embodiment of the present invention, and FIG. 1b is a cross-sectional view thereof.
【図２】図２ａは本発明の一実施例となる医療用処置用
具の外観図を示しており、図２ｂはその断面図。FIG. 2A is an external view of a medical treatment tool according to an embodiment of the present invention, and FIG. 2B is a cross-sectional view thereof.
【図３】図３ａは本発明の一実施例となる医療用処置用
具の外観図を示しており、図３ｂはその断面図。FIG. 3A is an external view of a medical treatment tool according to an embodiment of the present invention, and FIG. 3B is a cross-sectional view thereof.
【図４】図４ａは本発明の一実施例となる医療用処置用
具の外観図を示しており、図４ｂはその断面図。FIG. 4A is an external view of a medical treatment tool according to an embodiment of the present invention, and FIG. 4B is a cross-sectional view thereof.
【図５】図５ａは本発明の一実施例となる医療用処置用
具の外観図を示しており、図５ｂはその断面図。FIG. 5A is an external view of a medical treatment tool according to one embodiment of the present invention, and FIG. 5B is a cross-sectional view thereof.
【図６】図６は本発明の一実施例となる医療用処置用具
の外観図。FIG. 6 is an external view of a medical treatment tool according to one embodiment of the present invention.
【図７】図７は本発明の一実施例となる医療用処置用具
の外観図。FIG. 7 is an external view of a medical treatment tool according to one embodiment of the present invention.
【図８】図８ａ、ｂ、ｃ、ｄは本発明の医療用処置用具
の第１の固定部材と処置具挿入用ポートを着脱する構造
を示す外観図。8A, 8B, 8C, and 8D are external views showing a structure for attaching and detaching a first fixing member and a treatment instrument insertion port of the medical treatment instrument of the present invention.
【図９】本発明の一実施例となる医療用処置用具の構成
を示す断面図を示している。FIG. 9 is a cross-sectional view showing a configuration of a medical treatment tool according to one embodiment of the present invention.
【図１０】本発明の一実施例となる医療用処置用具の構
成を示す断面図を示している。FIG. 10 is a sectional view showing a configuration of a medical treatment tool according to one embodiment of the present invention.
【図１１】本発明の一実施例となる医療用処置用具の第
１の固定部材と固定部材間隔調整部材の嵌合時の断面図
を示している。FIG. 11 is a cross-sectional view of the medical treatment tool according to one embodiment of the present invention when the first fixing member and the fixing member interval adjusting member are fitted.
【図１２】本発明の一実施例となる医療用処置用具の処
置具挿入用ポートと第１の固定部材と固定部材間隔調整
部材の嵌合時の断面図を示している。FIG. 12 is a cross-sectional view of the medical treatment tool according to one embodiment of the present invention when the treatment tool insertion port, the first fixing member, and the fixing member interval adjusting member are fitted.
【図１３】本発明の一実施例となる医療用処置用具の処
置具挿入用ポート取付前の正面図を示している。FIG. 13 is a front view of a medical treatment tool according to an embodiment of the present invention before a treatment tool insertion port is attached.
【図１４】本発明の一実施例となる医療用処置用具の処
置具挿入用ポート取付前の断面図を示している。FIG. 14 is a cross-sectional view of a medical treatment tool according to an embodiment of the present invention before a treatment tool insertion port is attached.
【図１５】本発明の一実施例となる医療用処置用具の張
力調整部材の断面図を示している。FIG. 15 is a sectional view of a tension adjusting member of the medical treatment tool according to one embodiment of the present invention.
【図１６】本発明の一実施例となる医療用処置用具の処
置具挿入用ポート取付前の正面図を示している。FIG. 16 is a front view of a medical treatment tool according to an embodiment of the present invention before a treatment tool insertion port is attached.
【図１７】本発明の一実施例となる医療用処置用具の処
置具挿入用ポート取付前の断面図を示している。FIG. 17 is a cross-sectional view of a medical treatment tool according to an embodiment of the present invention before a treatment tool insertion port is attached.
【図１８】本発明の一実施例となる医療用処置用具の処
置具挿入用ポート取付後の正面図を示している。FIG. 18 is a front view of the medical treatment tool according to one embodiment of the present invention after the treatment tool insertion port is attached.
【図１９】本発明の一実施例となる医療用処置用具の処
置具挿入用ポート取付後の断面図を示している。FIG. 19 is a cross-sectional view of the medical treatment tool according to one embodiment of the present invention after the treatment tool insertion port is attached.
【図２０】本発明の一実施例となる医療用処置用具の処
置具挿入用ポートの構造を示す断面図である。FIG. 20 is a sectional view showing the structure of a treatment instrument insertion port of the medical treatment instrument according to one embodiment of the present invention.
１、５１、７３ 筒状部材 ２、５２、９８ 第１の気密部材 ３、５３、９９ 第２の気密部材 ４、８１ 固定部材 ５、５５、７４ 第１の固定部材 ６、５６、７５ 第２の固定部材 ５４、７８、９６ 処置具挿入用ポート ５７、７７ 固定部材間隔調整部材 ５８ スリット ５９ 固定糸 ６０ 突起部 ６１ 固定部材間隔調整用シート ６２ 固定用穴 ６３ ネジ ６４ シールリング ６５、６７、７０ つめ ６６ 受け部 ６８、７１ つめ挿入部 ６９ クランプ ７２ つめ挿入部シール部材 ７６、７９ 間隔固定部材 ８０ シート ８２、９３ 支持部材 ８３、９４ 張力調整部材 ８４ ポート取付部材 ８５ 張力調整部材本体 ８６ 歯付支持部材 ８７ 爪歯車 ８８ 係止歯 ８９ バネ ９０、９５ 係止解除レバー ９１ ネジ付支持部材 ９２ 調整ネジ ９７ 隔膜 1, 51, 73 cylindrical member 2, 52, 98 first hermetic member 3, 53, 99 second hermetic member 4, 81 fixing member 5, 55, 74 first fixing member 6, 56, 75 second Fixing members 54, 78, 96 Treatment tool insertion port 57, 77 Fixing member interval adjusting member 58 Slit 59 Fixing thread 60 Projection 61 Fixing member interval adjusting sheet 62 Fixing hole 63 Screw 64 Seal ring 65, 67, 70 Claw 66 Receiving part 68, 71 Claw insertion part 69 Clamp 72 Claw insertion part seal member 76, 79 Interval fixing member 80 Sheet 82, 93 Support member 83, 94 Tension adjustment member 84 Port mounting member 85 Tension adjustment member main body 86 Toothed support Member 87 Claw gear 88 Locking tooth 89 Spring 90, 95 Lock release lever 91 Threaded support member 92 Adjusting screw 97 Diaphragm
Claims (20)
の出口をもち、遠位端は固定部材により固定し、固定部
材には筒状部材を取り付け、近位端のそれぞれの入口に
は気密を保つために少なくとも１つの気密部材を付設し
たことを特徴とする医療用処置用具。The invention has at least one inlet at a proximal end, one outlet at a distal end, a distal end secured by a securing member, a tubular member attached to the securing member, and a respective proximal end. A medical treatment tool characterized in that at least one airtight member is provided at an entrance of the airtight device to maintain airtightness.
部材からなり、両固定部材の間には間隔変更可能な筒状
部材を気密に付設した請求項１記載の医療用処置用具。2. The medical treatment tool according to claim 1, wherein the fixing member comprises a first fixing member and a second fixing member, and a cylindrical member capable of changing the interval is hermetically provided between the two fixing members. .
からなる請求項１又は２記載の医療用処置用具。3. The medical treatment tool according to claim 1, wherein the second fixing member is made of a flexible material.
る請求項１〜３記載のいずれかの医療用処置用具。4. The medical treatment tool according to claim 1, wherein the tubular member is made of a flexible material.
記載のいずれかの医療用処置用具。5. The cylindrical member has a cylindrical shape.
The medical treatment device of any of the preceding claims.
部材からなる請求項１〜５記載のいずれかの医療用処置
用具。6. The medical treatment tool according to claim 1, wherein the hermetic member comprises a first hermetic member and a second hermetic member.
請求項１〜６記載のいずれかの医療用処置用具。7. The medical treatment tool according to claim 1, wherein the airtight member is made of a flexible diaphragm.
口部には処置具挿入用ポートを気密に取り付け可能な第
１の固定部材を設け、更に開口部の回りに筒状部材を気
密に付設した第２の固定部材、両固定部材間の長さを調
整する固定部材間隔調整部材及び第１の固定部材に気密
に取り付け可能な処置具挿入用ポートを設けたことを特
徴とする医療用処置用具。8. An opening for removing a body organ, a first fixing member capable of airtightly attaching a treatment instrument insertion port to the opening, and a cylindrical member being airtightly sealed around the opening. A medical instrument comprising: a second fixing member attached to the first fixing member, a fixing member interval adjusting member for adjusting the length between the two fixing members, and a treatment tool insertion port that can be hermetically attached to the first fixing member. Treatment tools.
を有する請求項８記載の医療用処置用具。9. The medical treatment tool according to claim 8, wherein the tubular member and the second fixing member have flexibility.
の固定部材と筒状部材を挟んで固定でき、筒状部材を十
分に引張て間隔を調整し、固定部材間隔調整部材を第１
の固定部材に被せて固定する請求項８又は９記載の医療
用処置用具。10. The fixing member interval adjusting member has a lid shape and has a first shape.
The fixing member can be fixed by sandwiching the cylindrical member with the fixing member, the cylindrical member can be sufficiently pulled to adjust the interval, and the fixing member interval adjusting member can be fixed to the first member.
The medical treatment tool according to claim 8, wherein the medical treatment tool is fixed by covering the fixing member.
材に形付けられたスリット形状であり、第２の固定部材
に取り付けた固定用糸により第１の固定部材と第２の固
定部材の間隔を調整可能な請求項８又は９記載の医療用
処置用具。11. The fixing member interval adjusting member has a slit shape formed on the first fixing member, and is fixed to the first fixing member and the second fixing member by a fixing thread attached to the second fixing member. The medical treatment tool according to claim 8, wherein the interval can be adjusted.
材に取り付けられた突起部であり、第２の固定部材に取
り付けられた固定部材間隔調整用シートにより第１の固
定部材と第２の固定部材の間隔を調整して固定部材間隔
調整用シートに付設された固定用穴と第１の固定部材の
突起部を嵌合させて固定する請求項８又は９記載の医療
用処置用具。12. The fixing member interval adjusting member is a protrusion attached to the first fixing member, and the first fixing member and the second fixing member are adjusted by a fixing member interval adjusting sheet attached to the second fixing member. The medical treatment tool according to claim 8 or 9, wherein the distance between the fixing members is adjusted, and the fixing holes provided on the fixing member interval adjusting sheet are fitted to and fixed to the projections of the first fixing member.
材に取り付け可能で、筒状部材を十分に引張て間隔を調
整し、筒状部材上に付設した１つ以上の間隔固定部材に
引っかけて固定する請求項８又は９記載の医療用処置用
具。13. A fixing member interval adjusting member is attachable to the first fixing member, adjusts the interval by sufficiently pulling the cylindrical member, and hooks on one or more interval fixing members provided on the cylindrical member. The medical treatment tool according to claim 8, wherein the medical treatment tool is fixed.
１３記載のいずれかの医療用処置用具。14. The cylindrical member according to claim 8, wherein the cylindrical member has a cylindrical shape.
14. The medical treatment tool according to any one of claims 13 to 13.
複数である請求項８〜１４記載のいずれかの医療用処置
用具。15. The medical treatment tool according to claim 8, wherein the treatment tool insertion port has a plurality of treatment tool insertion ports.
と第２の気密部材を付設した請求項８〜１５記載のいず
れかの医療用処置用具。16. The medical treatment tool according to claim 8, wherein a first airtight member and a second airtight member are attached to the treatment tool insertion port.
請求項１６記載の医療用処置用具。17. The medical treatment tool according to claim 16, wherein the airtight member is a flexible diaphragm.
可とう性を有するシート、シートの開口部の内縁に沿っ
て取り付けられた固定部材、シートの外縁に取付けられ
た支持部材と張力調整部材、シートを挟んで互いに気密
に嵌合する処置具挿入用ポートとポート取付部材からな
り、支持部材と張力調整部材によりシート外縁に向かっ
て任意の張力を加えて開口部を広げることを特徴とする
医療用処置用具。18. A flexible sheet having an opening for removing a body organ in the center, a fixing member attached along the inner edge of the opening of the sheet, a support member attached to the outer edge of the sheet, and tension adjustment. A member, a treatment tool insertion port and a port attachment member that fit airtightly with each other across a sheet, and a supporting member and a tension adjusting member apply arbitrary tension toward the outer edge of the sheet to widen an opening. Medical treatment tool.
と第２の気密部材を付設した請求項１８記載の医療用処
置用具。19. The medical treatment tool according to claim 18, wherein the treatment tool insertion port is provided with a first airtight member and a second airtight member.
請求項１９記載の医療用処置用具。20. The medical treatment tool according to claim 19, wherein the airtight member is a flexible diaphragm.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2000171384A JP2001340346A (en) | 1999-06-08 | 2000-06-08 | Medical treatment instrument |
Applications Claiming Priority (5)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP16094299 | 1999-06-08 | ||
| JP11-160942 | 2000-03-31 | ||
| JP2000096205 | 2000-03-31 | ||
| JP2000-96205 | 2000-03-31 | ||
| JP2000171384A JP2001340346A (en) | 1999-06-08 | 2000-06-08 | Medical treatment instrument |
Related Child Applications (3)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP2005366225A Division JP4134161B2 (en) | 1999-06-08 | 2005-12-20 | Medical treatment tool |
| JP2005366226A Division JP4145918B2 (en) | 1999-06-08 | 2005-12-20 | Medical treatment tool |
| JP2006195735A Division JP2006272018A (en) | 1999-06-08 | 2006-07-18 | Medical treatment instrument |
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| Publication Number | Publication Date |
|---|---|
| JP2001340346A true JP2001340346A (en) | 2001-12-11 |
Family
ID=27321768
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP2000171384A Pending JP2001340346A (en) | 1999-06-08 | 2000-06-08 | Medical treatment instrument |
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| KR20100036989A (en) * | 2008-09-30 | 2010-04-08 | 에디컨 엔도-서저리 인코포레이티드 | Multiple port surgical access device |
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| JP2006150132A (en) * | 2006-03-15 | 2006-06-15 | Hakko Co Ltd | Insertion port for medical treatment instrument |
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