JP2003284724A - Trocar system, and sheath used for the same - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a trocar system which can be used for a plurality of cannulae of which, effective lengths against one hand piece unit are different from each other, and to provide a sheath capable of materializing the above trocar system. <P>SOLUTION: A plurality of kinds of sheaths 9A, 9B, 9C of which effective lengths are different from each other, have positioning parts 70A, 70B, 70C regulating the extending length of an inner trocars 6 extending from respective cannulae, to which dilators 8A, 8A', 8B, 8B', fixed to corresponding cannulae 7A, 7A', 7B, 7B', are detachment freely connected. When the sheaths are connected to a hand piece unit 2, relative position of the positioning parts of the plural kinds of sheaths against the trocars 6 in the longitudinal direction thereof, are different from each other. <P>COPYRIGHT: (C)2004,JPO

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a trocar system for puncturing and placing a trocar (outer tube) used as a guide tube for an insertion instrument into a body cavity on a body wall of a patient and used therein. Regarding the sheath.

[0002]

2. Description of the Related Art A trocar system for puncturing and placing a trocar (outer tube) used as a guide tube for an insertion instrument into a body cavity on a body wall of a patient is conventionally known. The trocar system is configured by detachably combining an inner needle having a sharp puncture needle formed at its tip and an outer tube having an insertion portion for puncturing a patient. The inner needle, which is integrally combined with the outer tube, is punctured into the body wall of the patient and introduced into the body cavity. Then, with the introduction operation of the inner needle, the outer tube is successively inserted into the hole of the body wall which is bored by the inner needle. Then, when the mantle tube is introduced into the body cavity so as to penetrate the body wall, the inner needle is removed from the mantle tube to leave the mantle tube in the state of puncturing the body wall, and the mantle tube is inserted into the lesion site. It is used as a guide tube for an insertion instrument such as an optical tube for observing or an instrument for treatment.

Various types of such trocar systems are conventionally known. For example, Japanese Patent Fair 5-
Japanese Patent No. 57863 discloses that an inner needle and an outer tube are introduced into the body wall of a patient while ultrasonically vibrating the inner needle and the outer tube in a combined state, so that the inner needle and the outer tube are safe with a comparatively light force. An ultrasonic trocar system for introduction into the body is disclosed.

Further, in Japanese Unexamined Patent Publication No. 11-89851, a dilator having a substantially conical tip is provided between an inner needle having a relatively small outer diameter and an outer tube (that is, outer jacket). An improved ultrasonic trocar system is disclosed in which a dilator is inserted into the tube and an inner needle is inserted into the dilator. In this system, a state in which these are integrally combined so that the tapered end of the dilator projects from the tip of the outer tube and the puncture needle of the inner needle projects from the tip of the tapered end of the dilator Then, the inner needle is introduced into the body wall of the patient while being ultrasonically vibrated. According to this system, the diameter of the puncture hole formed in the body wall of the patient by the small-diameter inner needle can be reduced to reduce the invasion of the patient, and the small-diameter puncture hole formed by the inner needle can be formed. By expanding the diameter of the outer tube to the outer diameter of the outer tube with a tapered dilator, the large outer tube can be smoothly inserted into the puncture hole in the body wall of the patient.

[0005]

By the way, in the ultrasonic trocar system disclosed in Japanese Unexamined Patent Publication No. 11-89851, a puncture hole is formed in a body wall by an inner needle, and then the puncture hole is expanded by a dilator. As the diameter increases and the outer tube is inserted into the expanded puncture hole, as described above, the tapered end of the dilator projects from the tip of the outer tube and the tip of the tapered end of the dilator. These are integrally combined so that the puncture needle of the inner needle projects from the inside.

In this case, the projecting length of the dilator projecting from the distal end of the outer tube must be set so that a reasonably effective expansion of the diameter of the puncture hole can be realized. Therefore, the length of the dilator inserted in the outer tube in a predetermined relative positional relationship is generally uniquely determined according to the effective length of the outer tube that is set according to the thickness of the body wall to be applied. Target. In addition, the inner needle protruding from the tip of the dilator also needs to be introduced into the body wall so as to penetrate it before the diameter of the puncture hole is expanded by the dilator. Should be set accordingly. That is, the length of the inner needle inserted through the outer tube and the dilator in a predetermined relative positional relationship also needs to be uniquely set according to the effective length of the outer tube. Therefore, generally, the outer tube, the inner needle, and the dilator whose effective lengths are uniquely set to correspond to each other depending on the thickness of the body wall to be applied are combined. That is, the trocar system is individually prepared for each type (thickness) of the applied body wall.

However, it is very uneconomical to separately prepare the whole trocar system for each thickness of the body wall in this way, which imposes an economic burden on the doctor side. In particular, the inner needle constitutes an expensive handpiece unit together with an ultrasonic transducer that transmits ultrasonic vibrations to it, and it is economical to prepare this handpiece unit for each body wall thickness. If you think about it, it's never desirable.

Of course, in order to avoid such an economical problem, a plurality of mantle tubes and dilators, which are cheaper than the handpiece unit, having different lengths depending on the thickness of the body wall are prepared and expensive. It is not unthinkable to use common handpiece units commonly for the plurality of outer tubes.

However, since the mantle tube for lapa used in laparoscopic surgery and the mantle tube for Soraco used in endoscopic surgery of the chest are greatly different in length from each other. If one handpiece unit is to be shared between the mantle tubes, the inner needle that protrudes forward from the tip of the mantle tube when the Soraco mantle tube is used as the handpiece unit for the rapa The length is too long, and before or during the work of expanding the small-diameter puncture hole formed by the inner needle with the dilator, the tip of the inner needle becomes closer to the lung in the chest cavity, for example. . for that reason,
Careful operation is required. On the contrary, when the outer tube for lapa is used in the handpiece unit for Soraco, the protruding length of the inner needle protruding forward from the tip of the outer tube is too short, and There is a possibility that it may not be possible to completely penetrate the abdominal wall and puncture it. Therefore, conventionally, it has been practically impossible to use a plurality of outer tubes having different effective lengths for one handpiece unit.

The present invention has been made in view of the above circumstances, and an object thereof is to provide a trocar system capable of using a plurality of mantle tubes having different effective lengths for one handpiece unit, Another object is to provide a sheath that can realize such a trocar system.

[0011]

In order to solve the above-mentioned problems, the trocar system according to claim 1 transmits an ultrasonic vibration to an inner needle having a predetermined length to be punctured in a body wall and the inner needle. A single handpiece unit having an ultrasonic transducer and a plurality of types of outer tubes having different effective lengths depending on the thickness of the body wall, the body wall of the inner needle being inserted therein. And a plurality of types of dilators each having a length corresponding to the effective length of each of the plurality of types of the mantle tubes, and the corresponding mantle tube. Is inserted between the inner needle and the inner needle and is detachably fixed to the corresponding outer tube in a predetermined relative positional relationship, and the puncture hole in the body wall formed by the inner needle is introduced into the outer tube. A dilator that expands prior to A plurality of types of sheaths that are detachably connected to the sheath unit and are provided corresponding to the effective lengths of the plurality of types of outer tubes, respectively, and that cover the inner needle in its longitudinal direction. Each of the plurality of types of sheaths has a positioning portion to which the dilator fixed to the corresponding outer tube is detachably connected and which defines a protruding amount of the inner needle projected from the corresponding outer tube. The positioning portions of the sheaths of the plurality of types are
The relative position of the sheath and the inner needle when the sheath is connected to the handpiece unit is different in the longitudinal direction of the inner needle.

According to a second aspect of the present invention, in a sheath that covers an inner needle of a predetermined length punctured in a body wall over its longitudinal direction, the body wall is punctured as the inner needle punctures the body wall. A handpiece unit having a tube portion that is inserted into an outer tube that is introduced and left in the tube, an inner needle that is provided in the tube portion, and an ultrasonic transducer that transmits ultrasonic vibration to the inner needle. And a second connecting part connected to the dilator that is attached to the outer tube and that expands a puncture hole in the body wall attached to the outer tube and bored by the inner needle prior to the introduction of the outer tube. A connecting portion, and the second connecting portion is movable along the longitudinal direction of the pipe portion.

Further, in the trocar system according to the third aspect, an inner needle having a predetermined length and capable of puncturing a body wall and an ultrasonic vibration can be generated in the inner needle by connecting with the inner needle. Different ultrasonic transducers, a plurality of sheaths having an extension through which the inner needle can penetrate, a plurality of dilators with different lengths through which the sheath can penetrate, and different effective lengths. Depending on the desired treatment, a plurality of types of outer tubes through which a dilator having a length corresponding to the effective length is selected from among the plurality of types of dilators, and the outer tube in accordance with the effective length of the outer tube The plurality of sheaths are provided at different positions of the extending portion, and the positioning portion is capable of changing the protrusion amount of the inner needle with respect to the distal end portion of the outer tube.

[0014]

BEST MODE FOR CARRYING OUT THE INVENTION Embodiments of the present invention will be described below with reference to the drawings.

FIG. 1 shows a schematic structure of one example of assembling a trocar system according to an embodiment of the present invention. As shown in the figure, the trocar device according to this assembly example has a hand piece unit 2 that has an inner needle 6 that is punctured in a body wall and that is grasped and operated by an operator, and a tubular member through which the inner needle 6 is inserted. The outer sheath tube 7 into which the inner needle 6 and the sheath 9 are inserted, and the dilator 8 inserted between the outer sheath tube 7 and the inner needle 6 and the sheath 9. The handpiece unit 2 includes an ultrasonic oscillator (not shown) that supplies energy for ultrasonic vibration through a connection cable (not shown), and a foot switch and a hand switch that control energy output. The output control device is connected. Further, such a trocar device has a state in which the handpiece unit 2 (inner needle 6), the outer tube 7, the dilator 8 and the guide member 9 are assembled (state of FIG. 1), and The respective component parts are used by appropriately switching to the separated state (see FIG. 2).

FIG. 2 shows a trocar system 1 according to an embodiment of the present invention, in which the above-mentioned components are shown in a separated state. As shown in the figure, the trocar system 1 has the same length (covers the inner needle 6 with the same length over its longitudinal direction), and has a length S1 to be described later.
Plural kinds of sheaths 9A, 9B, 9C having different S3
And a plurality of types of dilators 8A, 8A ', 8B, 8B' having different lengths M1 and M2 and outer diameters described later, and an effective length L.
1 to L3 and a plurality of types of outer tube 7A, 7 having different inner and outer diameters
A ', 7A ", 7B, 7B', 7B", 7C and one handpiece unit 2 commonly used for these sheaths, dilators and outer tubes.

The first sheath 9A, the first and second dilators 8A and 8A ', and the first to third outer tubes 7A and 7A.
A ′ and 7A ″ are, for example, those for lapa used in laparoscopic surgery, and the lengths S1, M1, and L1 are set to be long. In this case, the first dilator 8A has the length. M1 is the same as that of the second dilator 8A ', but its outer diameter is set smaller than that of the second dilator 8A'.
The outer diameter is set corresponding to the first outer tube 7A, and the second dilator 8A 'is set to the outer diameter corresponding to the second outer tube 7A'. The first outer tube 7A has the same effective length L1 as that of the second outer tube 7A ', but the outer diameter thereof is set smaller than that of the second outer tube 7A'. In addition, the third mantle tube 7
A ″ has an effective length L1 of the first and second outer tubes 7
It is the same as that of A, 7A ', but its outer diameter is set smaller than that of the first and second outer tubes 7A, 7A'. The third outermost tube 7A ″ having the smallest diameter is used for applications that do not require dilation (expansion of the diameter of the puncture hole), and the first sheath 9A can be directly attached without using a dilator. Since it is inserted, it does not have a corresponding dilator, that is, the outer tube 7A "
The outer diameter of the sheath 9A is larger than that of the sheath 9A.
Can be inserted into the mantle tube 7A ″, and for dilation, the puncture hole is changed from the outer diameter of the sheath 9A to the mantle tube 7A ″.
A slight dilation is performed to the extent that it expands to the outer diameter of. Further, the sheath 9A is provided with the outer tubes 7A and 7A.
Commonly used for A ', 7A "and dilators 8A, 8A'.

On the other hand, the second sheath 9B, the third and fourth sheaths
Dilators 8B, 8B 'and fourth to sixth outer tubes 7
B, 7B ′, 7B ″ are, for example, those for Soraco used in endoscopic surgery of the chest, each length S2 (<S1),
M2 (<M1) and L2 (<L1) are set to be short. In this case, the third dilator 8B has a length M2.
Is the same as that of the fourth dilator 8B ', but its outer diameter is set smaller than that of the fourth dilator 8B'. The outer diameter of the third dilator 8B is set corresponding to the fourth outer tube 7B, and the outer diameter of the fourth dilator 8B 'is set corresponding to the fifth outer tube 7B'. Is set. Further, the fourth mantle tube 7B is
Its effective length L2 is the same as that of the fifth outer tube 7B ', but its outer diameter is set smaller than that of the fifth outer tube 7B'. The sixth outer tube 7B ″ has the same effective length L2 as that of the fourth and fifth outer tubes 7B and 7B ′, but has the outer diameter of the fourth and fifth outer tubes 7B and 7B. It is set smaller than that of '. The sixth outermost tube 7B ″ with the smallest diameter is used for applications that do not require large dilation (diameter expansion of the puncture hole), and Since the second sheath 9B is directly inserted without any intervention, it does not have a corresponding dilator. That is, the outer diameter of the outer tube 7B ″ is larger than the outer diameter of the sheath 9B, and the sheath 9B can be inserted into the outer tube 7B ″. For dilation, the puncture hole is moved from the outer diameter of the sheath 9B to the outer tube 7B. A slight dilation is performed to the extent that it expands to the outer diameter of ".
Further, the second sheath 9B is provided with the outer tubes 7B and 7B.
Commonly used for B ', 7B "and dilators 8B, 8B'.

Further, the trocar system 1 of the present embodiment.
Has a third sheath 9C having a length of S3 (<S2) and a seventh sheath tube 7C having an effective length of L3 (<L2) for children. Since the seventh outer tube 7C is used for children, it is directly inserted into the third sheath 9C without a dilator (that is, it does not have a corresponding dilator).

FIG. 3 shows the first to third sheaths 9A,
9B and 9C are shown enlarged. As shown in the drawing, each sheath 9A, 9B, 9C has an elongated straight pipe portion 28 and a handle portion (first connection portion) 29 connected to the terminal portion of the straight pipe portion 28 on the proximal end side. I have it. Here, the straight pipe section 28
Is made of a flexible material having high heat resistance and high slipperiness, such as Teflon (registered trademark): PTFE (polytetrafluoroethylene), because it comes into contact with the inner needle 6 that vibrates ultrasonically. . Also, for example, a hard metal pipe having Teflon (registered trademark) attached to the inner peripheral surface can achieve the same effect. Further, the inner diameter of the straight pipe portion 28 is set to be substantially the same as the outer diameter of the inner needle 6.
The dilators 8A, 8A ', 8B, 8B' (the third sheath 9C) corresponding to the proximal end side of the straight pipe portion 28 are provided.
In this case, the outer tube 7C) is detachably connected and the dilators 8A, 8A ', 8B, 8B' and the outer tubes 7A, 7A ', 7A ", 7B, 7B', 7 connected thereto.
Positioning portions (second connecting portions) 70A, 70B, 70C for defining the protrusion amount of the inner needle 6 (and the sheaths 9A, 9B, 9C) protruding from the tips of B ", 7C are formed. These positioning parts 70A, 70B, 70C
Is the corresponding dilator 8A, 8A ', 8B, 8B'
(In the case of the positioning portion 70C of the third sheath 9C, the diameter is set to be substantially the same as the inner diameter dimension of the insertion portion of the outer tube 7C).

The positions of the positioning portions 70A, 70B and 70C in the respective sheaths 9A, 9B and 9C are determined by the sheath 9
A, 9B and 9C are different from each other in the longitudinal direction. That is, the first positioning portion 70 in the first sheath 9A
A is a predetermined length Z1 in which the amount of protrusion of the inner needle 6 (sheath 9A) from the tips of the dilators 8A and 8A 'is suitable for lapa.
(Not shown) is provided close to the handle portion 29. The second positioning portion 70B of the second sheath 9B has a predetermined length that allows the inner needle 6 (sheath 9B) to project from the distal ends of the dilators 8B and 8B 'for Soraco, that is, for the lapa. Is provided at a substantially middle portion of the sheath 9B so as to have a length Z2 (see FIG. 1) shorter than the length Z1. Further, the third positioning portion 70C of the third sheath 9C has a predetermined length such that the protruding amount of the inner needle 6 (sheath 9C) from the tip of the outer tube 7C is suitable for children, that is, for rapa and soraco. For length Z1, Z
It is provided on the distal end side of the sheath 9C (the side opposite to the handle portion 29) so as to have a length Z3 (not shown) shorter than 2.

Further, each positioning portion 70A, 70B, 70
C is the corresponding dilator 8A, 8A ', 8B, 8B'
Later-described engaging claw portion 47 (in the case of the positioning portion 70C of the third sheath 9C, for example, an elastic engaging portion of the outer tube 7C).
Are formed by the ring-shaped first engaging groove portion 33 which is engaged. In particular, in the present embodiment, each positioning portion 70A, 70B, 70C is formed by a plurality of (three in the figure) engagement groove portions 33 that are spaced from each other at equal intervals along the axial direction. Therefore, the positioning portions 70A, 70B, 70C of the present embodiment can also function as a position adjusting mechanism for variably adjusting the tip position of the inner needle 6 in the axial direction (adjusting the protrusion amount of the inner needle 6). In the case of the present embodiment having a plurality of engaging groove portions 33, the lengths S1, S2, S3 of the sheaths 9A, 9B, 9C are from the engaging groove portion 33 located closest to the distal end side to the straight pipe portion 28. It is defined as the length to the tip.

The third outer tube 7A "can be elastically engaged with, for example, the positioning portion 70A of the first sheath 9A, and the sixth outer tube 7B" is also the second outer tube 7A ".
The positioning portion 70B of the sheath 9B can be elastically engaged, for example.

FIG. 4 shows a modification of the sheaths 9B and 9C. In this modification, the positioning portions 70B, 70
The sheath portion between C and the handle portion 29 has a large diameter grip portion 9a.
Is formed as. An example of assembling the trocar device having such a structure is shown in FIG. In this assembled state, not only the grip portion of the handpiece unit 2 but also the grip portion 9a of the sheath 9 can be gripped by hand to perform the treatment, and thus the operability is improved.

Next, the main components other than the sheath will be briefly described with reference mainly to FIG. Note that FIG.
Shows, as an example, a trocar device for Soraco in which a second sheath 9B having a grip portion 9a, a dilator 8B corresponding to the second sheath 9B, and a mantle tube 7B are combined, but hereinafter, the folds will be touched, and the sheaths 9A, 9B, 9C is generically referred to as sheath 9 and includes dilators 8A, 8A ', 8B, 8B'.
Are collectively referred to as the dilator 8, and the outer tubes 7A, 7A ',
7B and 7B 'are collectively referred to as a jacket tube 7. In some cases, the tip end of the member is called the lower end and the base end is called the upper end, depending on the direction of the drawing.

As shown in each drawing, the handpiece unit 2 is provided with a grip portion 11 on the proximal end side of the inner needle 6. The grip portion 11 is formed by a substantially cylindrical housing 12. An ultrasonic transducer, which is an element that generates ultrasonic vibrations, is arranged in the housing 12. Further, as shown in FIG. 6, a horn 14 for amplifying ultrasonic vibration is arranged at the tip of the ultrasonic vibrator. The tip of the horn 14 is attached to the housing 12
Of the inner needle 6 as an ultrasonic vibration transmitting member is detachably connected by screwing connection. Further, at the tip of the inner needle 6,
The tapered puncture portion 16 having a conical shape, a triangular pyramid shape, a quadrangular pyramid shape, or the like is formed. by this,
The mechanical vibration of the ultrasonic transducer is transmitted to the puncture portion 16 at the tip of the inner needle 6 via the horn 14.

At the lower end of the grip 11, the sheath 9 (9
A lock mechanism 17 for releasably locking B) is provided. A ring-shaped second engagement groove 32 is formed on the outer peripheral surface of the handle portion 29 of the sheath 9 inserted into the lock mechanism 17 (see FIG. 6).

The lock mechanism 17 is provided with a substantially cylindrical lock mechanism support member 34 connected to the lower end of the housing 12. On the outer peripheral surface of the lock mechanism supporting member 34, a guide pin 35 and a cylindrical guide cylinder 36 are provided in a protruding manner. The guide pin 35 and the guide tube body 36 are 180 degrees apart in the circumferential direction of the lock mechanism support member 34.
They are placed facing each other at a distance. Further, the ring-shaped lock member 1 is provided on the outer peripheral surface of the lock mechanism support member 34.
8 are provided. A pin insertion hole 18a into which the guide pin 35 is axially movable is formed on the outer peripheral surface of the lock member 18, and the lock button 3 is also provided.
7 is screwed in a protruding state. The lock button 37 has an insertion hole 38 into which the guide cylinder 36 is inserted so as to be movable in the axial direction. The lock member 18 is supported so as to be movable in the direction orthogonal to the axial direction of the inner needle 6 with the guide pin 35 and the guide cylinder 36 as guides.

Further, the lock member 18 has a pin insertion hole 1
In the vicinity of 8a, an engagement claw portion 39 that is engaged with the first engagement groove portion 32 of the sheath 7 so as to be engageable and disengageable is provided to protrude inward. Further, the engaging claw portion 39 is provided inside the guide tubular body 36.
A compression coil spring 40 for urging the guide member 9 toward the engagement direction with the first engagement groove portion 32 of the guide member 9 is provided. When the handpiece unit 2 and the sheath 9 are assembled, the spring force of the compression coil spring 40 causes the engaging claw portion 39 of the lock member 18 of the lock mechanism 17 of the handpiece unit 2 to move to the first position of the sheath 9. It is designed to be held in a locked state in which it is engaged with the engaging groove portion 32. Furthermore, in this locked state, the lock button 3
By pushing 7 against the spring force of the compression coil spring 40, the lock member 18 moves to the right in the drawing,
The engaging claw portion 39 of the lock member 18 is disengaged from the first engaging groove portion 32 of the sheath 9 so that the lock is released.

The outer tube 7 (7B) has an effective length L
A tubular elongated insert 19 defining 1, L2, L3;
A proximal end 20 having a relatively large diameter is provided at the proximal end of the insertion portion 19.

Further, the dilator 8 (8B) is provided with a tubular elongated insertion portion 21 and a proximal end portion 22 arranged at the proximal end portion of the insertion portion 21. Insertion part 21
As shown in an enlarged view in FIG. 7, a connecting cylinder 21b connected to the proximal end portion 20 of the outer tube 7 and tubular bodies 21a and 21c connected to the upper and lower sides of the connecting cylinder 21b. Has been formed. Then, in the substantially annular groove portion formed on the outer peripheral surface of the connection tubular body 21b, the substantially annular groove formed on the inner surface of the proximal end portion 22 of the outer tube 7 (especially outer tube 7B, 7B 'for lapa) is formed. A C-ring 80 that is detachably engaged with the engagement groove 82 is mounted. That is, the outer tube 7 and the dilator 7 to be combined correspondingly can be easily attached and detached by the click engagement of the C ring 80 and the engaging groove 82, and in the connected state, the dilator 8 from the tip of the outer tube 7 is attached. The amount of protrusion of is set to a prescribed amount according to its application.

At the tip of the insertion portion 21 of the dilator 8, a large diameter straight tip pipe for positioning is set to have an outer diameter dimension substantially the same as the inner diameter dimension of the insertion portion 19 of the corresponding outer tube 7. The part 23 is provided. The straight tube portion 23 together with the insertion portion 21 defines the lengths M1 and M2 of the dilator 8. In addition, a tapered substantially cone-shaped puncture hole expansion portion 24 is further arranged on the distal end side of the distal straight tube portion 23. In addition, a straight tube-shaped bend preventing portion 25 is provided at the tip of the cone of the puncture hole expanding portion 24. The length of the bend preventing portion 25 is set to an appropriate dimension from the tip of the cone of the puncture hole expanding portion 24. The inner diameter of the break preventing portion 25 is set to be substantially the same as the outer diameter of the straight tube portion 28 of the sheath 9. Further, the insertion portion 2 is attached to the tip of the break preventing portion 25.
A front end inclined surface 25a that is inclined with respect to the direction orthogonal to the center line direction of 1 is formed. In addition, as clearly shown in FIG. 6, a large-diameter tubular portion 22a is provided at the proximal end portion 22 of the dilator 8 and a large-diameter tubular portion 22a protruding from the large-diameter tubular portion 22a. A small diameter cylindrical portion 22b having a small diameter is formed. In addition, the large-diameter cylindrical portion 22 of the dilator 8
The base end of the operation handle 27 is screwed and fixed to the outer peripheral surface of a.

Further, the small-diameter cylindrical portion 22b of the dilator 8 is provided with a positioning adjusting mechanism 26 for defining the projecting amount of the inner needle 6 (and the sheath 9) projecting from the tips of the dilator 8 and the outer tube 7. ing. The positioning adjustment mechanism 26 includes a guide pin 42 provided on the outer peripheral surface of the small diameter cylindrical portion 22b of the dilator 8 and a cylindrical guide cylindrical body 43.
It has and. The guide pin 42 and the guide cylinder body 43 are arranged opposite to each other at a position separated by 180 ° in the circumferential direction of the small diameter cylinder portion 22b. A substantially ring-shaped lock member 44 is arranged outside the small diameter tubular portion 22b. The guide pin 42 is provided on the outer peripheral surface of the lock member 44.
Is formed with a pin insertion hole 44a into which the lock button 45 is axially movable, and a lock button 45 is screwed in a protruding state. The lock button 45 has an insertion hole into which the guide cylinder 43 is inserted so as to be movable in the axial direction. The lock member 44 is movably supported in the direction orthogonal to the axial direction of the inner needle 6 with the guide pin 42 and the guide cylinder 43 as a guide. The lock button 45 is arranged in a state (180 ° apart) in the direction opposite to the operation handle 27 of the dilator 8 with respect to the center line of the inner needle 6.

The lock member 44 has a pin insertion hole 4
An engaging claw portion 47 is provided in the vicinity of 4a so as to be inwardly engageable with an arbitrary second engaging groove portion 33 of the sheath 9 so as to be engageable and disengageable. Further, a compression coil spring (biasing member) 48 that biases the engaging claw portion 47 toward the engagement direction with the second engaging groove portion 33 of the sheath 9 is provided inside the guide cylinder body 43. Has been done.

When the dilator 8 and the sheath 9 are assembled, the engaging claw portion 47 of the lock member 44 in the positioning adjustment mechanism 26 of the dilator 8 is arbitrarily attached to the sheath 9 by the spring force of the compression coil spring 48. It is adapted to be held in a locked state in which it is engaged with the second engagement groove portion 33. Further, by pushing the lock button 45 against the spring force of the compression coil spring 48 in this locked state, the lock member 44 moves to the right in the drawing, and the engagement claw portion 47 of the lock member 44 is moved to the sheath. The lock is released by being disengaged from the second engaging groove 33 of No. 9. Therefore, by moving the sheath 9 in the axial direction with respect to the dilator 8 while the positioning adjustment mechanism 26 of the dilator 8 is unlocked, the position of the tip of the inner needle 6 protruding from the outer tube 7 is finely adjusted. be able to.

Next, the operation of the above configuration will be described.
When the trocar system 1 of the present embodiment is used, the sheath, the outer tube, and the dilator are assembled to the handpiece unit 2 as a common member in a combination (corresponding to that indicated by an arrow in FIG. 2) according to the application (( In the following, only connection configurations that require a dilator will be described). Specifically, the selected sheath 9 and the handpiece unit 2 are connected by the lock mechanism 17, and the dilator 8 selected corresponding to the sheath 9 is positioned by the positioning section 70 ( 70A
Or 70B). Further, the outer tube 7C selected corresponding to the dilator 8 is connected to the ring 80 and the engaging groove 8
Connected by click engagement with 2. At this time, as can be seen from the assembling examples shown in FIGS. 1, 5, and 6, the tip portion of the dilator 8 (a part of the straight pipe portion 23 and the expansion portion 24) is moved by a predetermined amount from the tip of the outer tube 7. The distal end portion of the straight tube portion 28 of the sheath 9 is held in a protruding state, and is also held in a state of protruding by a predetermined length from the bending preventing portion 25 of the dilator 8 to the outside. Further, the puncture portion 16 of the inner needle 6 is also held in a state of being projected from the distal end portion of the straight tube portion 28 of the sheath 9.

FIG. 8 shows a combination form for the rapa (see FIG. 8).
(See (a)) and a combination form for Soraco (see (b) in FIG. 8) are shown for comparison. FIG. 8 (a)
As shown in, for example, when the first outer tube 7A, the first dilator 8A, and the first sheath 9A are used in combination, the tip portion of the dilator 8A is adjusted from the tip of the outer tube 7A for lapping. And the straight pipe portion 28 of the sheath 9A is held by the dilator 8A.
It is held in a state in which it is protruded from the break-preventing portion 25 by an amount suitable for lapping. Therefore, the first outer tube 7A can be surely punctured and set in the abdominal wall portion H, which is a thick body wall portion. On the other hand, as shown in FIG. 8B, for example, the fourth outer tube 7B and the third dilator 8B are used.
When the second sheath 9B and the second sheath 9B are used in combination, the tip portion of the dilator 8B is held in a state of protruding from the tip of the outer tube 7B by an amount suitable for Soraco, and the straight tube portion 28 of the sheath 9B is held. The dilator 8B is held in a state of being protruded from the break-preventing portion 25 by an amount suitable for Soraco. Therefore, it is possible to surely puncture and set the fourth outer tube 7B in the chest wall portion H'which is a thin body wall portion.

In a specific puncturing operation by the combined trocar device, first, the ultrasonic oscillating device (not shown) is driven according to the operation of the output control device (not shown). At this time, energy for ultrasonic vibration is supplied from the ultrasonic oscillator to the ultrasonic vibrator of the handpiece unit 2 via the connection cable (not shown), and ultrasonic vibration is generated from the ultrasonic vibrator. Is generated. The ultrasonic vibration output from the ultrasonic vibrator is transmitted to the inner needle 6 in a state of being amplified by the horn 14.

Then, with the handpiece unit 2 held, the puncturing portion 16 of the inner needle 6 is punctured into the body wall portions H and H'of the patient. At this time, the ultrasonic vibration is transmitted to the puncture portion 16 of the inner needle 6, and the puncture portion 16 of the inner needle 6 is
Punctures the body wall portions H and H ′, the puncture portion 1 of the inner needle 6
6 can be easily punctured into the body wall portions H and H ′ with a light force. By this operation, small puncture holes are formed in the body wall portions H and H '.

Only the handpiece unit 2 is pulled out to the outside in a state in which the break preventing portion 25 of the dilator 8 near the puncture hole expanding portion 24 is inserted into the puncture hole. In this state, by further pushing the dilator 8 into the body wall portions H and H ′, the hole diameter of the small diameter puncture hole formed by the inner needle 6 by the conical portion of the puncture hole expansion portion 24 of the dilator 8 is reduced. The outer diameter of the outer tube 7 is expanded. Then, the insertion portion 19 of the mantle tube 7 is continuously inserted into the puncture hole of the body wall portions H and H ′ expanded to the same diameter as the insertion portion 19 of the mantle tube 7 by the puncture hole expanding portion 24 of the dilator 8. It is inserted continuously. As a result, the insertion portion 19 of the outer tube 7 is inserted into the puncture holes of the body wall portions H and H '. Further, when the insertion portion 19 of the trocar outer tube 7 is inserted into the puncture holes of the body wall portions H and H ′, the body expanded to a large diameter by the inserting operation of the insertion portion 19 of the outer tube 7 at this time. Wall H,
The insertion portion 19 of the outer tube 7 is relatively firmly fixed to the puncture holes of the body wall portions H and H ′ by the elasticity of the tissue around the puncture hole of H ′. In this state, the outer tube 7 to the dilator 8
The assembly unit of the sheath 9 and the sheath 9 is pulled out to the outside. As a result, the outer tube 7 is indwelled while being pierced and penetrated in the puncture holes of the body wall portions H and H ′.

As described above, the trocar system 1 of this embodiment has the inner needle 6 of a predetermined length that is punctured in the body wall.
And a single handpiece unit 2 having an ultrasonic transducer for transmitting ultrasonic vibrations to the inner needle 6, and a plurality of types of mantle tubes having different effective lengths depending on the thickness of the body wall. An outer sheath tube 7 that connects the inside and outside of the body by being introduced into the body wall and indwelling with the inner needle 6 inserted therein and puncturing the body wall; A plurality of types of dilators each having a length corresponding to the effective length of each of the outer sheaths, and the dilators are inserted between the corresponding outer sheath tubes 7 and the inner needles 6, and are attached to and detached from the corresponding outer sheath tubes 7 in a predetermined relative positional relationship. A dilator 8 that is freely fixed and that expands a puncture hole in the body wall that has been pierced by the inner needle 6 prior to the introduction of the mantle tube 7; detachably connected to the handpiece unit 2; Plural types provided corresponding to the effective length of the mantle tube 7, respectively And a sheath 9 that covers the inner needle 6 in the longitudinal direction thereof, and each of the plurality of types of sheaths 9 is detachably connected to and corresponds to a dilator 8 fixed to a corresponding outer tube 7. Positioning portion 70 that defines the amount of protrusion of the inner needle 6 protruding from the outer tube 7.
(70A, 70B, 70C), the positioning portion 70 of each of the plurality of types of sheaths 9 has a relative position with respect to the inner needle 6 when the sheath 9 is connected to the handpiece unit 2. They differ from each other in the longitudinal direction (as in the present embodiment, each sheath 9 is connected to the handpiece unit 2 by a common connecting portion 17 and covers the inner needle 6 with the same length in its longitudinal direction. In this case, the positioning unit 70A,
The positions of 70B and 70C are different from each other in the longitudinal direction of the sheaths 9A, 9B and 9C).

Therefore, by properly selecting the sheaths 9A, 9B and 9C, one handpiece unit 2
It is possible to use a plurality of jacket tubes 7 having different effective lengths. That is, the outer tube 7 is attached to the body walls having different thicknesses.
Since the work of puncturing and indwelling can be performed by one common hand piece 2, it is not necessary to separately prepare the entire trocar system for each thickness of the body wall, which is very economical.

It is needless to say that the present invention is not limited to the above-described embodiment, and various modifications can be made without departing from the spirit of the invention. For example, in the above-described embodiment, three types of sheaths 9A, 9B, 9C having different lengths are provided, but the types of the sheath 9 are not limited to three types.
If the number of types is increased, the amount of protrusion of the inner needle 6 protruding from the outer tube 7 can be set finely, which is advantageous. Further, in the above-described embodiment, each positioning portion 70A, 70B, 70C has three grooves 33, but the number of grooves 33 in each positioning portion is not limited to three (one may be sufficient). However, if the number of the grooves 33 of each positioning portion is increased, the number of the sheaths 9 can be reduced correspondingly, which is advantageous. Further, the type of the sheath 9 can be distinguished by the position of the positioning portion 70, but the sheath 9 may be distinguished by color coding. Further, in the above-described embodiment, the positioning portion 70 is in the form of a groove, but the shape of the positioning portion 70 is not limited to the groove as long as the protrusion amount of the inner needle 6 protruding from the outer tube 7 can be defined. Absent. Further, in the above-described embodiment, the position of the positioning portion 70 is fixed for each sheath 9, but it is possible to move the positioning portion 70 along the longitudinal direction of the sheath 9 as shown in FIG. In this case, it is not necessary to prepare multiple types of sheath 9 (one sheath is sufficient).
Therefore, it becomes more economical. In the example of FIG. 9, the positioning unit 7
0 is formed as a tubular body that is movably fitted to the outer periphery of the straight pipe portion 28 of the sheath 9, and the positioning portion 70 is fixed to the sheath 9 by the screw 95.

[0044]

As described above, according to the present invention,
A trocar system capable of using a plurality of outer tubes having different effective lengths for one handpiece unit, and a sheath capable of realizing such a trocar system can be provided.

[Brief description of drawings]

FIG. 1 is a schematic configuration diagram of one assembly example of a trocar system according to an embodiment of the present invention.

FIG. 2 is a schematic configuration diagram of a trocar system according to an embodiment of the present invention, in which each component is shown in a separated state.

FIG. 3 is an enlarged view of a plurality of types of sheaths that make up the system of FIG.

FIG. 4 is a side view of a modified example of the sheath of FIG.

5 is a schematic configuration diagram of an assembly example of a trocar device including the sheath of FIG.

6 is a half cross-sectional view of the trocar device of FIG.

FIG. 7 is a half cross-sectional view showing an enlarged connection portion between the outer tube and the dilator.

FIG. 8A is a side view of a trocar device showing a combination form for a rapa, and FIG. 8B is a side view of a trocar device showing a combination form for a soraco.

9A is a side view of a modified example of the sheath, and FIG. 9B is an enlarged cross-sectional view showing a main part of the sheath of FIG.

[Explanation of symbols]

1 ... trocar system 2 ... handpiece unit 6 ... inner needles 7A, 7A ', 7A ", 7B, 7B', 7B", 7C ...
Outer tube 8A, 8A ', 8B, 8B' ... Dilator 9A, 9B, 9C ... Sheath 70A, 70B, 70C ... Positioning portion

Claims (3)

[Claims] 1. A handpiece unit having an inner needle of a predetermined length to be punctured into a body wall, and an ultrasonic transducer capable of generating ultrasonic vibration in the inner needle, and a handpiece unit according to the thickness of the body wall. In addition, there are a plurality of types of mantle tubes having different effective lengths from each other, and a mantle tube that is introduced and left in the body wall when the inner needle inserted through the body wall is punctured, and a plurality of the types. A plurality of types of dilators each having a length corresponding to the effective length of each outer tube, and being inserted between the corresponding outer tube and the inner needle, and having a predetermined relative position to the corresponding outer tube. A dilator that is detachably fixed in a positional relationship and that expands a puncture hole in the body wall formed by the inner needle prior to the introduction of the mantle tube; and a dilator that is detachably connected to the handpiece unit, Corresponds to the effective length of each type of outer tube And a sheath that covers the inner needle in the longitudinal direction thereof, and each of the plurality of types of sheaths has a dilator attached to and detached from the corresponding outer tube. A positioning portion that defines a protrusion amount of the inner needle that is freely connected and protrudes from the corresponding outer tube, and the positioning portion of each of the plurality of types of sheaths has a sheath connected to the handpiece unit. The trocar system, wherein relative positions of the inner needle and the inner needle when they are struck are different from each other in the longitudinal direction of the inner needle. 2. A sheath for covering an inner needle of a predetermined length to be punctured in a body wall over its longitudinal direction, wherein a sheath tube is introduced and left in the body wall as the inner needle punctures the body wall. A first connection part that is connected to a handpiece unit that has a pipe part that is inserted inside, and that is provided in the pipe part and that has the inner needle and an ultrasonic transducer that transmits ultrasonic vibration to the inner needle; A second connecting portion attached to the outer sheath tube and connected to a dilator that expands a puncture hole in a body wall formed by the inner needle prior to the introduction of the outer sheath tube; The connecting portion of the sheath is movable along the longitudinal direction of the tube portion. 3. An inner needle having a predetermined length capable of puncturing a body wall, an ultrasonic transducer capable of generating ultrasonic vibration in the inner needle by connecting to the inner needle, and the inner needle A plurality of sheaths having inwardly extending portions, a plurality of types of dilators having different lengths through which the sheaths can penetrate, and a plurality of dilators having different effective lengths and selected according to a desired treatment, A plurality of types of outer tubes through which a dilator having a length corresponding to the effective length is selected from among various types of dilators, and the extension portions of each of the plurality of sheaths differ depending on the effective length of the outer tube. A trocar system, which is provided at a position and is capable of changing a protruding amount of the inner needle with respect to a distal end portion of the outer tube.