JP2010268865A - Retractor - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a low cost retractor having high degree of freedom in operation in a body cavity, enabling stable and secure exclusion, having simple structure, capable of being easily manufactured, in the instrument inserted into the body cavity through a trocar or a small incision and for excluding and holding an organ or the like especially during endoscopic surgery. <P>SOLUTION: The retractor includes a flat sheet 1 having flexibility and formed in an oval shape or a shape similar to the oval shape, and surving as an extrusion face, and a frame 2 fixed to the peripheral edge of the flat sheet 1, forming a ring shape, and having elastic restoration force by including a superelastic alloy 21, and is provided with at least one, or preferably one or a plurality of pairs of through-hole portions 3 through the flat sheet 1 or attached to the frame 2. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention relates to an exclusion device for controlling the exclusion of peripheral organs and the like that interfere with the treatment of an operation target organ and the visual field in a surgical operation and securing a surgical space and a surgical field.

In a surgical operation, in order to prevent peripheral organs that interfere with the operation from entering the surgical target site, it is necessary to hold and hold the peripheral tissue with a retraction forceps or hand during the operation.
In particular, in the case of endoscopic surgery, which is performed through a trocar or small incision under the endoscope's field of view, there are restrictions on the surgical space and field of view, and securing an optimal field of view by the endoscope. Therefore, this exclusion operation plays an even more important role.
However, with the conventional retraction forceps, the displacement area of the forceps is small, so it is difficult to reliably hold an organ such as the small intestine that has a large area and is easy to move in the body cavity. There is a problem that the approach is not possible.

On the other hand, the present inventors have proposed an exclusion device, which is an endoscopic operation, can be approached from a small incision, and is designed to exclude a large area as an exclusion retractor. ing. This is an instrument that is intended for use in endoscopic surgery, and includes an extruding part comprising a sheet of rubber elastic thin film and a frame that substantially surrounds and surrounds the periphery of the sheet of sheet, and the excluding part By using a superelastic alloy or shape memory alloy for the frame, the exclusion part is narrowed to a diameter that can be inserted from a trocar or small incision. Within the body cavity, the retractor has a function of restoring the original shape of the exclusion portion having a wide exclusion area. (Patent Document 1)
In addition, as a self-holding instrument that does not have a gripping part as described above while applying endoscopic surgery as described above, a flexible planar sheet that serves as an exclusion part of an organ or the like, and the planar sheet And a flexible elastic frame that is fixed around the circumference of the body, and when the organ is evacuated and inserted into the body cavity, the instrument is held between the tissues, and the elastic frame restores itself. Proposed as a device that can be held, or as a device that can be self-held by the tension of the yarn by constructing one or a plurality of yarns on the sheet or elastic frame of the above-configured exclusion device. There is something. (Patent Document 2)

JP2003-16459A JP2004-290375

However, since the instrument of the cited document 1 requires a gripping part extending to the exclusion part, the structure for attaching the gripping part is complicated, and the manufacturing is troublesome, resulting in a high cost. In addition, since the exclusion part and the gripping part are fixed, there is a concern that the degree of freedom may be limited in the installation position and operation of the exclusion part in the body cavity, and sometimes the gripping part may become an obstacle. is there.
On the other hand, since the instrument of the cited document 2 does not have a gripping part, the instrument has a simple configuration and is low in cost, and has a high degree of freedom in the body cavity of the exclusion part. In order to ensure self-holding in the body cavity, it is necessary to be securely sandwiched between tissues, and there are many cases that do not meet the conditions depending on the case, and it is not always applicable, and assistance with forceps etc. It may be necessary. In addition, there is a problem in the stability of the exclusion because the concern of detachment during the operation cannot be eliminated because the exclusion depends on self-holding. Moreover, since the thread | yarn is attached beforehand, the instrument suspended by the thread | yarn from the body and hold | maintained by the tension | tensile_strength of this thread | yarn has a possibility that it may become obstructive when this thread | yarn is not used, and there is no versatility.

  Therefore, the present invention has a high degree of freedom in operation in a body cavity, especially in an instrument for inserting and holding an organ or the like from a trocar or small incision wound during endoscopic surgery. An object of the present invention is to provide a low-cost retraction device that is capable of stable and reliable relieving, has a simple structure, and is easy to manufacture.

  The exclusion device of the present invention is constituted by a planar sheet having flexibility to form an exclusion surface, and a frame having an elastic restoring force that is fixed around the edge of the planar sheet to form an annular shape. It is configured to penetrate through the planar sheet or to be attached to the frame and to include at least one through hole.

  Further, the plurality of through-hole portions are formed as a pair, a pair or a plurality of pairs, and the through-hole portions are provided at positions that divide the exclusion surface into two when the pair of through-hole portions are connected by a straight line, The halved exclusion surfaces were formed so that each of them had substantially the same area, or the larger area was larger than 50% and 80% or less with respect to the entire displacement surface.

  Furthermore, it is preferable that the frame includes a superelastic alloy, and the planar sheet and the frame are preferably formed in an ellipse or a shape similar to an ellipse.

(Function)
According to the instrument of this means, since it is formed only from a flexible sheet and a frame having an elastic restoring force, the configuration is simple and the manufacturing is easy, and after insertion into the body cavity, the restriction by the gripping part Therefore, it can be moved to a free position and orientation with forceps. This configuration also allows the frame to be crushed when inserted into the body cavity and the entire body to be reduced in diameter so that it can be inserted into the body cavity from a trocar or small incision. Since the restoring force returns to the original shape having a wide exclusion surface, the instrument can have a wide exclusion surface applicable to endoscopic surgery.

In addition, by providing a through-hole portion in the planar sheet or frame, by using the through-hole portion as a portion to be gripped by a forceps tip or the like, for example, the instrument can be inserted into a body cavity from a trocar or small incision. When inserting into the body cavity, grasp the through-hole part with the tip of the forceps and pull it into the body cavity, or after insertion into the body cavity, move it to the desired position, and similarly remove it from the body cavity. Operation can be facilitated.
In addition, when the through-hole portion is used as a threading hole, the instrument is provided with a plurality of through-hole portions, the thread is passed through the through-hole portion, and the tissue is discharged from the body with the tissue being evacuated. It can be used as a device for taking out and holding the end of the yarn outside the body, and removing it by the tension of the yarn. The excision can be maintained by suturing the tissue around the exclusion with the thread in a state where the tissue is excluded.

Furthermore, it can utilize as follows as a usage pattern of the most effective through-hole part in this exclusion apparatus.
When excluding tissue with this instrument, it is a long forceps that is widely used in endoscopic surgical operations. The gripper can be opened and closed by hand operation and can be kept closed. The gripping forceps provided with a long shaft and a hand operating portion are used as one of the through-hole portions provided in a plurality of pairs (a pair of two portions provided at the edge of the planar sheet will be described). Removable instrument and grasping forceps by penetrating the shaft and holding the frame part with the opening and closing gripping part at the tip of the forceps (closing the gripping part) and maintaining the gripping (closed state) using the other through-hole part Are integrated (see FIG. 3), and by holding the forceps from the hand operation unit, stable relieving is possible by the relieving surface of the relieving device.
Note that the forceps for holding the exclusion device is not a gripping forceps as described above, but there are two (a plurality of) exclusion portions by penetrating the shaft portion of the instrument through two (or a plurality of) through holes. The retraction device and the forceps can be integrated.

  Further, for example, by installing a plurality of pairs of two (or a plurality of) through-hole portions (for example, the long side and the short side), depending on the attachment position of the forceps to the through-hole portion, The positional relationship such as the direction can be changed, and can be applied to exclusion under various conditions. Further, depending on the conditions, the forceps does not necessarily have to be on the center line of the exclusion surface, and the exclusion can be performed by setting an eccentric position so as to change the area ratio of the exclusion surface. However, if the forceps setting position with respect to the exclusion surface is set so that the larger area ratio exceeds 80% of the entire area, the retention force of the exclusion is biased to one side, and the stability of the exclusion may be impaired. It is desirable to keep the area ratio at 80% or less.

Furthermore, by using a super elastic alloy for the frame, it is possible to reduce the diameter by crushing during insertion into the body cavity due to its elasticity and restoring force, and to restore the original shape naturally in the body cavity. In addition to being able to do so, the strength of the exclusion holding can be secured by the strength of the metal.
Further, when the planar sheet and the frame are oval, it is easy to reduce the diameter during insertion, and a wide exclusion surface can be secured in the longitudinal direction. In addition, the shape similar to the described ellipse indicates, for example, an overall shape such as a rugby ball-like shape in which a circle is crushed.

  In addition, through the description of the present invention, a portion that is easy to be gripped by forceps or the like provided on the planar sheet or frame is used as a through-hole portion. As long as the above action is exhibited, for example, the portion that holds (penetrates) the shaft portion of the forceps may be an attachment portion having a notch portion such as a hook, or the like. The portion to be grasped may be any configuration as long as it is configured to be substituted for the through-hole, such as a receiving portion such as a projection or a cap, which is sandwiched between the grasping portions of the forceps.

  According to the exclusion device of the present invention, the configuration and action of the above means can be used as an instrument applicable to endoscopic surgery, and the exclusion portion is manufactured with a simple configuration including only a planar sheet and a frame. In addition, since it is sufficient to use a general-purpose forceps used for a normal endoscopic operation as a forceps or the like for holding the exclusion, it is possible to provide an exclusion device that does not cost much.

  In addition, the general-purpose forceps and thread that become the gripping part and the exclusion device that becomes the exclusion part can be used detachably, and the exclusion direction etc. can be freely set as described above, so that the instrument can be moved freely within the body cavity. In addition, it is possible to make a device having a high degree of freedom in terms of exclusion conditions and operation, such as being capable of being applied to various situations, and further, the exclusion device is securely held by forceps and a thread. Stable exclusion can be achieved by all the exclusion.

BRIEF DESCRIPTION OF THE DRAWINGS The whole block diagram of the exclusion apparatus which shows embodiment of this invention. The partial cross section figure of the said instrument. Explanatory drawing which shows the usage pattern of the said instrument. The enlarged view of the front-end | tip part of the said usage form. The block diagram which shows the modification of this invention.

Hereinafter, an example of the exclusion device of the present invention will be described in detail with reference to the drawings.
FIG. 1 is an overall configuration diagram of an exclusion device of the present embodiment, and FIG. 2 is a partial cross-sectional view of the present embodiment.
The exfoliation device of this example is inserted into a body cavity mainly during endoscopic surgery, and is used for the purpose of excluding control of tissue around the operation, and a flexible planar sheet 1 that forms an exclusion surface, A frame 2 having an elastic restoring force that forms an annular shape by adhering or welding to the periphery of the edge of the sheet 1, and forceps described later can be attached to and detached from the edge of the sheet 1. A pair of through-holes 3 (in this example, two pairs described later) are provided to be attached to and held on.

The planar sheet 1 is formed and used in an area and shape suitable for an operation in which a silicone rubber sheet is applied as a flexible sheet. However, in consideration of adaptation to an endoscopic operation, the sheet 1 is inserted from a trocar or the like. Since the width direction has a limited size, it is recommended to have an ellipse or a shape similar to the ellipse in order to secure a larger exclusion surface. In this example, a rugby ball shape having a major axis of 120 mm and a minor axis of 80 mm was formed.
Further, the planar sheet 1 has through-holes (through holes 3) for holding forceps described later at portions corresponding to the both ends of the long diameter of the planar sheet 1 and the edge portions of both ends of the short diameter. Two pairs were formed, each having a pair of through holes 3a and 3b at both ends of the long diameter and a pair of through holes 3c and 3d at both ends of the short diameter. Further, a sheet of silicone rubber similar to that of the planar sheet 1 is formed slightly larger than the through hole 3 in order to prevent damage, and a reinforcing material 31 having a similar hole is adhered or bonded to the through hole 3. It was constructed by welding. In this example, the two pairs of through-holes 3 are both formed so as to divide the exclusion surface into substantially equal areas, but they may be set at positions that are divided into uneven area ratios. Even if a plurality of through-holes 3 are provided at the edge, two appropriate through-holes 3 are selected as necessary, and the two selected through-holes 3 are used as a pair. good.

On the other hand, the frame 2 is provided with a super elastic alloy 21 wire having a high elastic restoring force at the core, and the outer layer is covered with a cover tube 22 made of polyurethane resin for imparting appropriate hardness and elasticity to the frame 2. Further, the outer layer is covered with an outer tube 23 made of silicone rubber that is flexible so as not to damage the tissue and that is difficult to slip when inserted, and is configured as a triple structure, and its end is bonded or welded. The sheet is formed as an annular body having substantially the same length as the outer periphery of the sheet 1.
Then, the frame 2 was integrated by adhering or welding the entire periphery along the outer peripheral edge of the sheet 1 formed as described above to obtain the exclusion device of this example.

Next, with reference to FIG. 3 and FIG. 4, the most characteristic usage pattern (a state in which gripping forceps are attached) of the exclusion device of this example will be described.
The exclusion device of this example is used together with grasping forceps commonly used for endoscopic surgery as a device for holding tissue exclusion by this device from outside the body.
Since the grasping forceps 4 used in this example is a general-purpose forceps, a detailed description thereof is omitted. However, in simple terms, the grasping forceps 4 can be freely opened and closed by operating the hand operation unit 43 provided as a gripping portion at the distal end portion, and A pair of upper and lower jaws 41 capable of maintaining a closed state, a shaft 42 formed in a long length so as to be applicable to an endoscopic operation extending from the jaws 41, and a base. It is basically composed of a hand operating portion 43 that operates the jaw portion 41 and serves as a forceps holding portion. The forceps for holding the exclusion device is not limited to the grasping forceps of the present example, and may be any rod-like one that can hold the exclusion portion.
The gripping forceps 4 is attached to the exclusion device by holding the shaft 42 by passing the gripping forceps 4 through one of the pair of through-holes 3, for example, the through-hole 3 a, and then the other of the pair of through-holes 3. One of the jaw parts 41 of the grasping forceps 4, for example, the lower jaw part 411 is passed through the side through-hole 3 b, the jaw part 41 is closed, and the frame 2 of the exclusion device is held together with the other upper jaw part 412. Thus, by maintaining the closed state of the jaw portion 41 by the hand operation, the exclusion device is held at two points of the through-hole portion 3 by the shaft 42 and the jaw portion 41 of the grasping forceps 4. The grasping forceps are integrated. Thereby, the holding part using a general purpose forceps can be functioned as a detachable exclusion device.

FIG. 5 shows a modification of the above embodiment, and shows an example in which the through hole 3 is attached to the frame 2.
The through-hole portion 3 may be attached to the frame 2 in addition to the planar sheet 1. In this example, the projection 5 having the through-hole 51 is provided with 2 on both ends of the long diameter and the short diameter. Formed in pairs. The through-hole portion 3 is basically a through-hole, and at least one is preferably a through-hole. However, depending on the use of the through-hole portion, as described above, for example, a grasping forceps The portion gripped by the jaw portion 41 may be a protrusion that can be gripped.

Next, a procedure for using this instrument in an endoscopic operation will be briefly described. In addition, this description is an example assumed using this apparatus, and does not necessarily show the procedure performed in practice.
1. First, by using the flexibility of the sheet and the elasticity of the frame, only the retraction device of this embodiment is compressed to a small diameter, and is pushed into the body cavity from the trocar or small incision.
2. When the distal end portion of the exclusion device protrudes into the body cavity gradually, the through-hole portion 3 provided at the distal end is grasped by the jaw 41 of the distal end of the grasping forceps and pulled into the body cavity. (When fully exiting into the body cavity, the retraction device is restored to its original rugby ball shape by elastic restoring force.)
3. The grasping forceps is used to grasp the through hole as it is, move the instrument to the vicinity of the tissue to be relieved, determine the position and direction according to the relieving conditions, and place it.
4). When the exclusion position is determined, another grasping forceps 4 is inserted from the trocar, and with the aid of appropriate forceps or the like, the grasping forceps 4 is attached to the through hole portion 3 of the exclusion device as described above and integrated with the exclusion device.
5). During the operation, the hand operating part of the integrated grasping forceps is held to maintain the tissue exclusion by the exclusion device.
6). The extruding device can be taken out of the body in the integrated state or once separated, and grasped through the hole 3 with the jaw portion 41 with grasping forceps from the outside of the body and pulled out from the small incision.

  Moreover, as another usage pattern for holding this instrument in the exclusion portion, a plurality of through-hole portions 3 are provided on the edge of the sheet 1 or the frame 2, and each is provided with a thread (not shown). It is used as a hole for passing through, and the surrounding tissue is sutured with the thread in the exclusion part to maintain the exclusion. Similarly, a plurality of through-hole parts 3 are provided in advance, or in advance, After insertion into the body cavity, by tying or passing the thread, hold the thread end positioned outside the body, hold the exclusion tissue on the exclusion surface, and pull the thread from the outside of the body It is also possible to maintain the displacement by the tension of the yarn.

1. Planar sheet 2. Frame 21. Superelastic alloy 22. Cover tube 23. 2. Mantle tube Through hole 31. Reinforcing material4. Grasping forceps 41. Jaw 42. Shaft 43. 4. Hand control section Protrusion 51. Through hole

Claims (5)

  An instrument for inserting into a body cavity during surgical operation and holding out organs and the like, a sheet having flexibility to form an exclusion surface, and a ring fixed to the periphery of the edge of the sheet And a frame having an elastic restoring force to form an at least one through-hole portion penetrating the planar sheet or attached to the frame.   The said through-hole part is provided in the position which divides the said exclusion surface into two, if a plurality is made into a pair, a pair or multiple pairs are formed, and a pair of through-hole part is tied with a straight line. Exclusion device.   The exclusion surface divided into two by the straight line connecting the through-hole portions has substantially the same area, or the larger area is greater than 50% and less than 80% with respect to the entire exclusion surface. 2. Exclusion device.   The exclusion device according to any one of claims 1 to 3, wherein the frame includes a superelastic alloy.   The exclusion device according to any one of claims 1 to 4, wherein the planar sheet and the frame are formed in an ellipse or a shape similar to an ellipse.

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