JP2009195265A - Retractor which can be operated by one hand - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a retractor which can be operated by one hand, which realizes a new way to pull tissue. <P>SOLUTION: The retractor comprises a hook plate 10 as an arch structure in which the side fronting on a field of operation is a concavely-curved surface and the rear is a convexly-curved surface, and operating arms (30 and 40) extending from the upper end of the hook plate 10. The operating arms permit the hook plate 10 to be pulled toward the rear portion. The hook plate 10 makes the lower end intrude into an incised region and excludes a biological tissue present in a region shallower than the deepest region of the field of operation when the traction is transmitted through the operating arms by the entire intruding part in the acting direction of a tractive force. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to a new-type one-handed retractor structure that is used to open a patient's wound and secure a visual field during surgery.

  As a simple medical instrument for securing a working space in a wound, a surgical retractor disclosed in Japanese Patent Application Laid-Open No. 2005-27933 (conventional example 1: refer to Patent Document 1) has been known. Yes. The surgical retractor is lightweight and facilitates single-person operation, and a grip portion like a heel, and a pair of arms that open outwardly about a support shaft by operation of the grip portion, Each arm portion has an outward claw portion provided at the tip of the arm portion, a holding means for holding the arm portion in an open state, and a release means for releasing the holding state. When it is closed, it crosses once and then curves outward, and then overlaps the other claw portion. In other words, it is equivalent to a device in which the shape of the tip of the muscle rod widely used in surgery is devised, and a pair of claws that each correspond to a muscle rod is assembled into a structure like a rod. . This surgical retractor has an advantage that it is easy to use because, for example, both claws can be easily inserted into an incision of about 1 [cm].

  However, in the surgical retractor of Conventional Example 1, in the case of a tissue that is too soft, such as a fat-rich mammary gland tissue or a subcutaneous fat tissue, the traction force is not transmitted to tissues other than the portion being pulled. Therefore, the tissue is convex toward the operative field. In such a convex tissue portion, the field of view of the incision line or the planned incision line is poor, and there remains a problem that an appropriate traction force for appropriate incision cannot be applied to the tissue. This is mainly due to the fact that the contact area between the tissue and the claws is too small (tradeoff with the above advantages).

  On the other hand, a retractor disclosed in Japanese Patent Application Laid-Open No. 2005-028001 (conventional example 2: refer to Patent Document 2) is a retractor having a so-called scissor structure and having a large contact area with the tissue of the incision. is there. This retractor is equipped with a flat blade for pushing and expanding the incision site on the distal end side, and a pair of gripping portions having opposite end portions as handle portions can be opened and closed via connecting members (hinge portions). Is. When the retractor is operated so as to close the handle portion as in the case of operating the scissors, the blade rotates around the connecting member (hinge portion) so that the distal end side is opened. And in order to hold | maintain the front end side in the open state, the locking mechanism for locking a handle | steering-wheel part is provided in the position close | similar to the connection member (hinge part) of a handle | steering-wheel part.

  According to the retractor of Conventional Example 2, since the tissue of the incision is pushed and expanded with the blade, the problem that the tissue intrudes into the surgical field can be solved, but the force transmitted indirectly through the connecting member Since the tissue is pushed out with a blade, the force required to operate the handle portion becomes excessive, and skill is required in operation. Therefore, there is a limit to using it in an operation that requires a wide surgical field while appropriately changing the wound site. Further, the purpose of use of the retractor of the conventional example 2 is to secure a “space” between the two blades by the two blades facing each other spreading the tissue in contact with each blade away from each other. is there. Sugino is the bottom of this “space”. In the portion where the blade is not in direct contact, the tissue loosens in a convex shape toward the “space”. As a result, the outline of this “space” has a shape like a double-sided concave lens, which may obstruct the surgical field depending on the type of tissue. In addition, this retractor not only has a high manufacturing cost for realizing a scissors structure provided with a locking mechanism, but also has a problem that it requires an extra operation space in addition to the incision site.

On the other hand, there is also a retractor that has a simpler structure rather than a saddle structure. For example, the retractor disclosed in Japanese Patent Application Laid-Open No. 2007-44266 (conventional example 3: refer to Patent Document 3) can be easily operated by a single operator for a detailed operation such as a spring finger operation. In order to make a retractor with a U-shaped narrow rod with elasticity, an operation knob is attached at the time of use, and it is connected to the hanging part and the hanging part below the tip of the opposing left and right arm parts. And a retracting blade having a blade portion formed to project to the opposite side. In particular, the blade part is formed in a curved concave part with the central part protruding outward, and the lower edge of the blade part is formed in a concave part that curves upward, and the hanging side that is the end of the concave part is folded outward. It is bent and used as a locking part.
The retractor of Conventional Example 3 can be realized at a low cost, has a low burden on the tissue during operation, and is excellent in operability, but it has a depressing force of the energized U-shaped fine rod (will return to the original state) Since the wound is opened by force), the use is remarkably limited, for example, when the wound is small and the tissue is lightweight.

Japanese Patent Laid-Open No. 2005-27933 JP 2005-280001 A JP 2007-44266 A

  For example, suppose a mastectomy, that is, an operation that cuts very soft mammary tissue in an arc. In such an operation, it is necessary to perform an arc-shaped traction along the planned incision line without distorting the mammary gland tissue while ensuring a good visual field with respect to the arc-shaped planned incision line. However, in the retractors of the conventional examples 2 and 3 in which the tissue is linearly moved away from each other by two blades, an arc-shaped traction cannot be applied (there is no situation in which linear traction is applied to the breast in the first place). . In addition, it is impossible to meet the surgical operation needs of changing the pulling force of the mammary gland by the surgeon in the direction opposite to the surgeon. In the surgical retractor of Conventional Example 1, the tissue has a convex shape toward the operative field, and therefore the field of view of the incision line is poor, so that a plurality of retractors are necessary for proper operation. It becomes.

This type of medical device is required to be easy for the operator to operate with one hand, to be light, to be able to suppress the strain or deformation (stress) on the tissue to be incised as much as possible, and to be displaced along the planned incision line. It is easy (including fine adjustment of the position). The ability to meet the demand at a low cost is also an important viewpoint in spreading this kind of medical device.
This invention makes it the subject to provide the retractor excellent in the operativity which implement | achieves the method of the new pulling of the biological tissue at low cost.

  The retractor of the present invention is a retractor that can be operated with one hand to cut open a wound of a living body and secure a surgical field, and includes a first end that enters from an incision site of the wound, and the first From the second end portion of the arch plate having a second end portion opposite to the end portion, an arched ridge plate whose surface facing the operative field is a concave curved surface, and its back surface portion is a convex curved surface. And an operating arm that extends. The operation arm is configured to pull the saddle plate in the direction of the back surface thereof. When the first end portion enters the incision site and the traction force is transmitted through the operation arm, the saddle plate has a larger portion than the deepest portion of the operative field in the entire invaded portion of the back surface portion. The biological tissue existing in the shallow part is squeezed out in the direction in which the traction force acts.

  In one embodiment, one or a plurality of translucent parts for visually recognizing the state of the biological tissue to be excluded are formed on the rib plate. In addition, an auxiliary hook portion is formed at the first end portion of the saddle plate, with the first end portion as a base end, and a distal end thereof extending in the direction of the back surface of the saddle plate. Further, the operation arm includes a first arm extending from the second end portion toward the back surface of the flange plate, and a second arm formed at a predetermined angle from the first arm. The two arms are formed with a grip portion for the operator to grip it with one hand. A hole for inserting the operator's finger is formed in the grip.

  In the retractor according to the present invention, since the scissors have an arch structure, the force applied to the living tissue of the wound at the time of evacuation is substantially uniform over the entire invaded portion of the back surface of the scissors. This is the same as the design concept of arched dams, tunnels and bridges. Therefore, the stress on the tissue of the wound that comes into contact with the pressure is relieved significantly. Moreover, since the surface facing the operative field is a concave curved surface, an ideal operative field can be developed. In addition, since the operator can feel the development of the operative field with only one hand while the operator feels with his eyes and hands, there is an advantage that the other hand of the operator is free.

With the worldwide shortage of surgeons, the burden on surgeons is increasing. Opportunities to perform surgery with fewer assistants are expected to increase. In particular, for example, the spread of medical examinations facilitates the early detection of breast cancer, and it is considered that the opportunities for surgery such as a partial mastectomy will increase.
In the present invention, since the development of a good surgical field is realized by one-handed operation, it is expected to improve the safety and efficiency of the operation even under such a background. Specifically, since it is possible to shorten the time required for the operation, the time for anesthesia, and the amount of bleeding during the operation, not only medical personnel but also patients can be greatly benefited. Since the amount of work of the assistant who has been performed using a number of stirrups or the retractor of Conventional Example 1 can be ensured with only one retractor, cost performance is excellent.

Embodiments of the present invention will be described below with reference to the drawings.
[Construction]
FIG. 1 is an external perspective view showing an example of the shape and structure of a retractor according to the present embodiment, FIG. 2A is a top view of the opening device, and FIG.
The retractor 1 according to the present embodiment has an arched slat 10 and has one feature in that the traction force can be easily transmitted to the slat 10. That is, the anchor plate 10 has a substantially rectangular flat plate in which the short portion is left as it is and only the long portion is bent into a bow, that is, an arch structure resistant to stress such as a dam, a bridge, and a tunnel. . For convenience of explanation, a plane including the upper end or the lower end of the long part of the long plate 10 is a horizontal plane, a plane including a pair of side ends of the short part is a vertical plane, a concave surface is a front surface portion, and a convex surface is a back surface portion. A slit window 11 as an example of a translucent part is formed in the arch surface of the roof plate 10 in the vertical direction.

  The slit window 11 is for visually recognizing the state of the tissue when the tissue to be operated is removed. For example, when there is bleeding from the tissue during use of the retractor 1, an operator (an assistant or the like) immediately notices it through the slit window 11 and can immediately take appropriate measures such as discontinuing use.

  A plurality of slit windows 11 are formed at predetermined intervals. If the width (lateral length) of each slit window 11 is increased in order to make it easier to visually recognize, it becomes easier for living tissue to invade from the slit window 11 during exclusion. Therefore, when it is desired to secure a large number of viewing areas, it is desirable that the individual slit windows 11 have a width as small as possible and increase the number.

  The lower end portion of the saddle plate 10 is formed with an auxiliary saddle portion 20 having the lower end portion as a base end and the tip extending horizontally in the direction of the back surface of the saddle plate 10. The auxiliary heel portion 20 is provided to prevent the living tissue from sliding off the heel plate 10 during exclusion. The shape is either the thinnest at the tip and having a step that increases in thickness toward the back of the plate 10, the theme, or the “R” shape with no corners. A groove (concave portion) may be provided at an arbitrary position of the auxiliary collar part 20 to increase the frictional force with the living tissue.

  The saddle plate 10 is provided with an operation arm. The operation arm is configured to allow the roof plate 10 to be pulled in the direction of the back surface, and one end of the operation arm extends from the substantially central portion of the upper end of the roof plate 10 in the horizontal direction of the center of the arc of the back surface. 30 and a second arm 40 extending in the vertical direction from the other end of the first arm 30. The second arm 40 is formed with a grip portion for facilitating the operator to grip it with one hand. A hole 41 is formed in the grip portion so that an operator can easily operate by inserting one or more fingers.

  By using the operation arm having such a structure, the traction force can be directly transmitted to the roof plate 10, and the force adjustment can be easily adjusted. In addition, since it is easy to finely adjust the displacement and position along the incision line, operability can be improved.

[Material]
The retractor 1 of the present embodiment is preferably composed of a heat resistant member, for example, a stainless steel material. Thereby, since it can boil disinfect by putting in hot water etc. as it is, handling becomes easy. Further, the retractor 1 having the structure shown in FIG. 1 is not necessarily required to be so, but can be integrally formed by metal processing, so that mass production is easy and cost reduction is realized. Can do.

[size]
The size of the retractor 1 can be determined by considering the softness of the living tissue to be incised, the size of the incision, and the incision shape. For example, when used in a mastectomy, the horizontal length A between the side edges of the plate 10 shown in FIGS. 2 (a) and 2 (b) is about 7 [cm], and the vertical of the plate 10 is vertical. The length (height) B in the direction is about 7 [cm], the length C in the horizontal direction of the first arm 30 is about 5 [cm], and the length (height) D in the vertical direction of the second arm 40 is About 10 [cm]. In addition, these numerical values are examples.

[Example of use]
Next, the usage pattern of the retractor 1 will be described.
Here, an example in which a mammary gland tissue is incised in a circular shape in a partial breast excision will be described. One assistant grasps the grasping portion 40 of the operating arm of the retractor 1 (inserts a finger into the hole portion 41 as necessary) and tilts at a certain angle to assist the claw plate 10 on the patient's wound. The buttock 20 is invaded. When it is confirmed that the invasion has reached the depth necessary for securing the surgical field, the assistant adjusts the posture of the retractor 1 so that the operation can be started. A traction force is transmitted to the mortar 10 through the operation arm, and the mammary tissue is pulled. The pulling direction is the direction of the back surface of the plate 10. By this traction force, the heel plate 10 excludes the living tissue existing in a portion shallower than the deepest portion of the operative field in the entire portion of the back surface portion intruded in the direction of the traction force.

  This operation is repeated for the arcuate incision line. Thereby, it is possible to perform arc-shaped traction along the planned incision line while ensuring a good visual field without protruding fat or mammary gland, that is, without applying stress to the mammary gland tissue. Since the traction force is transmitted to the saddle plate 10 without waste, the tissue can be pulled with a relatively small force even in a patient with thick subcutaneous fat or a patient whose mammary gland tissue itself is fat. Since the assistant's one hand is in a free state, the necessary measures can be taken anytime and the operation can be performed safely and promptly.

[Modification]
The retractor 1 of the present invention can be implemented in various modes. A structural modification is shown in FIGS. In contrast to the above-described example, the retractor of “Modification 1” in FIG. 3 has only one slit window 11 extending in the vertical direction at the center of the roof plate 10. Since it is the central part of the arc of the base plate 10 that stresses the tissue at the time of the exclusion, it is important to achieve the intended purpose if a slit window is provided only in this part. Since the number of slit windows is reduced, the mold for integral molding is simplified, which can contribute to cost reduction.

  The retractor of “Modification 2” in FIG. 3 is obtained by forming the slit window in the horizontal direction, not in the vertical direction. Although simple, there is an advantage that the state in the horizontal direction of all tissues in contact with the back surface portion of the plate 10 can be easily grasped.

  The retractor of “Modification 3” in FIG. 3 is an example in which no slit window is provided. Further, the retractor of “Modification 4” in FIG. 4 does not include the slit 41 and the hole 41 of the grip 40 of the operation arm. Neither of them can monitor the condition of the tissue at the time of exclusion, but the assistant is easy to operate with one hand, can suppress the stress on the tissue to be incised as much as possible, and is easy to displace along the planned incision line. We can respond at cost.

  The retractor of “Modification 5” in FIG. 4 is an example in which a translucent member, for example, a heat-resistant glass 50 is integrally provided instead of the slit window. Although the cost increases somewhat, it can be said to be a desirable embodiment from the viewpoint of correctly monitoring the state of the tissue at the time of exclusion.

  The retractor of “Modification 6” in FIG. 4 is different in the structure of the operating arm from the above-described embodiment and each modification. That is, in order to extend the entire operation arm from the upper end portion of the cover plate 10 toward the back surface portion of the cover plate 10, the first arm 60 is extended from the upper end portion of the cover plate 10 in the vertical direction. The second arm 70 is provided in the horizontal direction from 60. The operator uses the retractor by holding the second arm 70 with one hand.

The above example is an example of a retractor formed integrally with metal, but may be not necessarily metal as long as it is heat resistant. Also good.
Moreover, in this embodiment and various modifications, although the example at the time of providing the auxiliary hook part 20 in the lower end part of the board 10 was shown, this auxiliary hook part 20 always exists in implementing this invention. It is not something you have to do.

  The retractor of the present invention can be used not only for partial mastectomy, but also for groin hernia (when securing a field of view of the internal groin ring of a patient with abdominal wall fat) For example, when the abdominal wall is expanded from side to side, and when a large-sized subcutaneous tumor tissue is removed in a patient with thick subcutaneous fat, the present invention can be widely used. Moreover, the present invention can be applied not only to human beings but also to other living organisms with soft tissues.

The external appearance perspective view of the retractor used as one embodiment of the present invention. (A) is a top view of the surgical retractor for carrying this embodiment, and (b) is a side view. The figure which showed the modification 1-3 of the retractor shown by this embodiment. The figure which showed the modification 4-6 of the retractor shown by this embodiment.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Retraction tool 10 Girder board 11 Slit window 20 Auxiliary collar part 30, 60 The 1st arm 40,70 which comprises the operation arm 2nd arm which comprises the operation arm 41

Claims (6)

A retractor for securing a surgical field by opening a wound of a living body,
It has a first end portion that enters from the incision site of the wound portion and a second end portion that opposes the first end portion, the surface facing the surgical field is a concave curved surface, and the back surface portion is a convex curved surface An arched slab that forms
An operating arm extending from the second end of the saddle plate,
This operating arm is capable of pulling the saddle plate in the direction of its back surface,
When the first end portion enters the incision site and the traction force is transmitted through the operation arm, the saddle plate has a larger portion than the deepest portion of the operative field in the entire invaded portion of the back surface portion. Excluding biological tissue present in a shallow region in the direction in which the traction force acts,
One-handed retractor. One or a plurality of translucent parts for visually recognizing the state of the biological tissue to be excluded are formed on the plate.
The retractor according to claim 1. In the first end portion of the saddle plate, an auxiliary saddle portion is formed with the first end portion as a base end and the tip extending in the direction of the back surface portion of the saddle plate.
The retractor according to claim 1. The operating arm has a first arm extending from the second end portion toward the back surface of the flange plate, and a second arm formed at a predetermined angle from the first arm. Is formed with a gripping part for the operator to grip it with one hand,
The retractor according to claim 1. The grip portion is formed with a hole for inserting an operator's finger.
The retractor according to claim 4. The saddle plate and the operation arm are made of a heat-resistant metal member,
The retractor according to any one of claims 1 to 5.

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