JP2011183035A - Surgical instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a variety of improvements for conventional surgical instruments assisting anastomosis. <P>SOLUTION: The surgical instrument includes a pair of leg portions 112 and 114 connected at the base end side 110, and elastically deformable in the direction of approaching each other and the direction of separating from each other, a pair of tilting portions 116 and 118 tilting from the tips of the pair of the leg portions 112 and 114 and extending forward, a pair of tip portions 120 and 122 extending from the tips of the pair of the tilting portions 116 and 118 practically in parallel with the longitudinal directions of the pair of the leg portions 112 and 114, and flexible members 124 interconnecting the pair of the tip portions 120 and 122 with each other. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention relates to a surgical instrument, and more particularly to a surgical instrument that assists in anastomosis.

  In anastomosis in which tubular biological tissues such as luminal organs and blood vessels are connected to each other, the biological tissue to be anastomosed is usually a fine one of a few millimeters, so the suture is placed at a desired position in the biological tissue. Is difficult. In order to cope with this problem, the present inventor proposed a surgical instrument (anastomosis assisting instrument) capable of arranging a suture at a suture position of a living tissue by a simpler method in Japanese Patent Application 2007-217212. . This anastomosis assisting device is provided with a pair of opposing elastically deformable branch pieces, and a straight shape and a loop shape are formed at the respective distal ends of the branch pieces according to the operation of the branch pieces. And a flexible member that is selectively deformed. For example, when anastomosing the pancreas, the flexible member is deformed into a loop along the inner wall of the main pancreatic duct after the anastomosis assist device is inserted into the main pancreatic duct, and the sewing needle is inserted into the pancreas from the joint surface. Let this invade and pass through this loop. Thereafter, when the anastomosis assist device is extracted from the main pancreatic duct, the suture thread attached to the sewing needle is pulled out from the opening of the main pancreatic duct, and the thread is arranged in the vicinity of the opening of the main pancreatic duct. According to this method, the sewing needle can be pulled out from a position far from the opening of the main pancreatic duct in the joint surface by passing between the flexible members in the main pancreatic duct. Compared with the general procedure of intruding from the base and projecting from the opening of the joint surface, the hand movement becomes much easier.

  The above patent application 2007-217212 has been published as Japanese Patent Application Laid-Open No. 2009-50306 (Patent Document 1).

JP 2009-50306 A

  An object of the present invention is to provide various improvements over conventional surgical instruments that assist in anastomosis. As an example, the present inventor has identified a problem that it is difficult to secure an operative field when performing an anastomosis using a conventional surgical instrument for anastomosis. For example, in the anastomosis assist device described in Patent Document 1, each branch piece is formed substantially in a straight line from the proximal end side to the distal end side. The visual field of the place to be inserted into the living tissue may be blocked by the branch piece.

  A surgical instrument according to an embodiment of the present invention includes a pair of legs that are connected at a proximal side and are elastically deformable in a direction toward and away from each other, and a length from each distal end of the pair of legs. A pair of inclined portions that are inclined with respect to the direction and extend forward, a pair of tip portions that extend substantially parallel to the longitudinal direction of the leg portion from the tips of the pair of inclined portions, and the pair And a deformable connecting member for connecting the tip portions to each other.

The front view which shows the surgical instrument in one Embodiment In one embodiment, a plan view showing a surgical instrument with a pair of legs spaced apart from each other In one embodiment, a plan view showing the surgical instrument with a pair of legs approaching each other The front partial enlarged view which shows the front-end | tip part of the surgical instrument in one Embodiment The plane partial enlarged view which shows the processus | protrusion provided in the front-end | tip part of the surgical instrument in one Embodiment The schematic diagram which shows the procedure which inserts the surgical instrument in one Embodiment in a main pancreatic duct The schematic diagram which shows the procedure which inserts the surgical instrument in one Embodiment in a main pancreatic duct The schematic diagram which shows the procedure which arrange | positions a suture using the surgical instrument in one Embodiment. The schematic diagram which shows the procedure which arrange | positions a suture using the surgical instrument in one Embodiment. Schematic showing the procedure for suturing the main pancreatic duct to the side of the intestinal tract The schematic diagram which shows the eyes | visual_axis at the time of inserting the surgical instrument in one Embodiment in a main pancreatic duct

  Hereinafter, various embodiments of the present invention will be described with reference to the accompanying drawings. 1 to 3 show a surgical instrument 100 for assisting anastomosis according to an embodiment of the present invention. The surgical instrument 100 is used, for example, to place a suture at a desired position of the pancreas when anastomosing the main pancreatic duct of the pancreas and the side wall of the intestinal tract.

  The surgical instrument 100 includes a pair of legs 112 and 114 connected at a proximal end portion 110, a pair of inclined portions 116 and 118 formed at the distal ends of the pair of legs 112 and 114, and 1 The distal end portions 120 and 122 formed at the distal ends of the pair of inclined portions 116 and 118, the flexible member 124 that is a connecting member that couples the pair of distal end portions 120 and 122 to each other, and the rear end of the proximal end portion 110 And a balancer 126 that adjusts the position of the center of gravity in use provided at the end. The surgical instrument 100 is formed so that the length from the proximal end (the rear end of the balancer 126) to the distal end (the distal end of the flexible member 124) is about 160 mm.

  The legs 112 and 114 are respectively formed with grips 115 that are gripped by the user. The leg portions 112 and 114 are elastically deformed in a direction toward and away from each other with the base end portion 110 as a fulcrum in response to an operation via the grip 115. As shown in FIG. 2, when no force is applied from the outside, the legs 112 and 114 are held apart from each other by the elasticity of the legs 112 and 114 themselves. Further, by applying a force from the outer surface side to the inner surface side of the grip 115, the leg portions 112 and 114 are elastically deformed in a direction approaching each other, and the inner surfaces shown in FIG. The grip 115 is configured in a substantially plate shape having a width of about 10.5 mm and a thickness of about 5.25 mm. The distal ends of the legs 112 and 114 (portions interposed between the distal end of the grip 115 and the inclined portions 116 and 118) are formed in a substantially plate shape having a width of about 10.5 mm and a thickness of about 2.2 mm. In addition, a taper is formed at a joint portion between the inclined portions 116 and 118.

  The inclined portions 116 and 118 are inclined forward by a predetermined angle with respect to the longitudinal direction of the corresponding leg portions 112 and 114 and extend forward (to the distal end side). This inclination angle can be set to an arbitrary angle within a range of 20 degrees to 80 degrees, for example. FIG. 1 shows an example in which the inclination angle is about 55 degrees. The inclined portions 116 and 118 are formed so as to become narrower from the proximal end side toward the distal end side.

  The distal end portions 120 and 122 extend forward (toward the distal end side) substantially parallel to the longitudinal direction of the leg portions 112 and 114 from the respective distal ends of the corresponding inclined portions 116 and 118, and from the proximal end side. It forms so that it may become narrow as it goes to the front end side. The tip portions 120 and 122 are formed in a flat plate shape having a size suitable for insertion into the main pancreatic duct. For example, the length from the distal end of the distal end portion 120, 122 to the connecting portion with the inclined portion 116, 118 can be about 15 mm in consideration of various factors such as the size of the main pancreatic duct, The portion within 5.0 mm from the distal end to the proximal end side of 122 can be formed so that both the width and thickness thereof are 1.0 mm or less so that the insertion into the main pancreatic duct is not hindered. In addition, the inner surface (surface facing the other tip portion) and the outer surface (surface opposite to the inner surface) of the tip portions 120 and 122 may be formed so as to be curved inward as going to the tip side.

  As shown in FIG. 4, one or more protrusions 130 are formed on one or both outer surfaces of the tip portions 120 and 122. By providing the plurality of protrusions 130 at equal intervals from the tip of the tip 120 or 122, the distance from the tip of the tip 120 or 122 to the protrusion 130 can be measured. Further, as shown in the enlarged partial plan view of FIG. 5, a rising surface on the rear side (base end portion 100 side) of each protrusion constituting the protrusion 130 is formed substantially perpendicular to the outer surface of the tip portion 120 or 122, By forming the rising surface on the distal end side (flexible member 124 side) to be inclined, the rear side of each protrusion constituting the protrusion 130 can be formed so as to protrude higher than the distal end side. Further, a taper is formed near the top of each protrusion constituting the protrusion 130 in order to prevent damage to the pancreas.

  The flexible member 124 is formed by bending a metal wire such as stainless steel having a length of 10 mm and a diameter of 0.3 mm to 1.0 mm near the center, and both ends thereof are attached to the tip portions 120 and 122, respectively. . The flexible member 124 is formed to be deformed with less pressure than any of these members as compared with the leg portions 112 and 114, the inclined portions 116 and 118, and the tip portions 120 and 122. Thereby, the flexible member 124 can selectively take the open posture shown in FIG. 2 or the closed posture shown in FIG. 3 according to the operation to the leg portions 112 and 114. Note that the flexible member 124 may be formed of a long member made of synthetic resin. Here, an example in which the flexible member 124 is used as a connecting member that connects the distal end portions 120 and 122 to each other has been described. The tip portions 120 and 122 can be connected by a member that can be deformed in accordance with the operation of the leg portions 112 and 114.

  The leg portions 112 and 114 can be configured such that their distal ends can be separated from their proximal ends. For example, the front part of the grip 115 can be configured to be separable from the base end side including the grip 115. In addition, the inclined portions 116 and 118 may be formed integrally with the corresponding leg portions 112 and 114, or may be assembled separately. Moreover, the front-end | tip parts 120 and 122 may be formed integrally with the corresponding inclination parts 116 and 118, and may be formed so that attachment or detachment is possible with the corresponding inclination parts 116 and 118 separately. When the tip portions 120 and 122 are provided separately from the inclined portions 116 and 118, the tip portions 120 and 122 are formed so as to extend substantially parallel to the longitudinal direction of the pair of leg portions in the mounted state. The shape and size of the tip portions 120 and 122 can be appropriately changed according to the treatment target. In particular, when the tip portions 120 and 122 are formed as separate bodies, the tip portions 120 and 122 having various shapes and sizes according to the use are prepared, and the tip portions 120 and 122 are simply replaced as appropriate. Therefore, the surgical instrument 100 can be realized. Moreover, the front-end | tip parts 120 and 122 can be formed with materials, such as resin. In this case, by making the unit composed of the tip portions 120 and 122 and the flexible member 124 disposable, it is possible to reduce the trouble of washing the surgical instrument 100 and to prevent the connecting member from being damaged by washing. Can do.

  As described above, the surgical instrument 100 in one embodiment has the distal ends 120 and 122 disposed at positions away from the long axes of the legs 112 and 114, so that the surgical instrument 100 can be used to thread a suture. When arranging, the visual field from the base end side is not obstructed by the legs 112 and 114. Thereby, compared with the conventional anastomosis assistance instrument, an operation field can be ensured easily.

  Next, a procedure for anastomosing the main pancreatic duct T of the pancreas P and the side wall of the intestinal tract K using the surgical instrument 100 according to one embodiment will be described with reference to FIGS. First, the surgeon grasps the grip 115 and keeps the surgical instrument 100 in the closed position shown in FIGS. 6A and 7A, and holds the flexible member 124 and the distal end portions 120 and 122 in this position. Insert into the main pancreatic duct T to a predetermined depth. The distal end of the flexible member 124 is inserted into the main pancreatic duct T from the joint surface S of the pancreas P to a depth similar to the length of the curved needle N in order to facilitate the handling of the curved needle N described later. The curved needle N may be a strong needle having a diameter of 0.1 mm and a length in the circumferential direction of 10 mm to 20 mm in consideration of the size of the pancreas and the like. When it is confirmed that the surgical instrument 100 has been inserted into the main pancreatic duct T to a predetermined depth, the pressing force on the grip 115 is released, and the legs 112 and 114 are separated from each other by their own elasticity. The legs 112 and 114 are separated from each other, and the sides of the flexible member 124 and the distal ends 120 and 122 are also deformed in a direction away from each other. As shown in FIGS. 6B and 7B, the flexible member 124 is restricted from moving away from the inner wall of the main pancreatic duct T. In this way, the flexible member 124 is disposed along the inner wall of the main pancreatic duct T. At this time, since the cross-sectional shape of the main pancreatic duct T is flattened by a force that deforms the distal end portions 120 and 122 in a direction away from each other, the curved needle N is caused to enter the inside of the pancreas P from the joint surface S as described later. Further, the operation of projecting into the main pancreatic duct T can be easily performed.

  Subsequently, as shown in FIGS. 8A and 8B, the surgeon grasps the strong curved needle N with the suture thread Y with the needle holder G, and holds the curved needle N with the joint surface S. From the inside of the pancreas P. The curved needle N advances in the main pancreatic duct T according to the curvature thereof according to the procedure of the surgeon, and protrudes from the inner wall of the main pancreatic duct T into the main pancreatic duct T. The curved needle N passes through the inside of the flexible member 124 (between both sides of the flexible member 124) disposed in the main pancreatic duct T, and again enters the inside of the pancreas P from the inner wall on the opposite side of the main pancreatic duct T. Break into. The curved needle N advances in the pancreas P according to its curvature as shown in FIG. 8 (c), and protrudes from the cut surface S of the pancreas P as shown in FIG. 8 (d). The curved needle N protrudes from a position opposite to the entry position on the cut surface S with reference to the opening of the main pancreatic duct T.

  Subsequently, as shown in FIGS. 9A and 9B, the flexible member 124 and the distal end portions 120 and 122 are pulled out from the main pancreatic duct T. At this time, the suture thread Y that has passed between the flexible members 124 is locked to the distal end of the flexible member 124 and pulled out of the main pancreatic duct T. As shown in FIG. 9C, the drawn suture Y is cut near the tip of the flexible member 124, and the bent needle N is removed from the suture Y after the cutting. As described above, the cut sutures Y1 and Y2 are respectively arranged so that one end thereof is positioned in the vicinity of the opening of the main pancreatic duct T and the other end protrudes from the joint surface S via the inner wall of the main pancreatic duct T. The In addition, when connecting the front-end | tip parts 120 and 122 using deformable members, such as a thread | yarn, instead of the flexible member 124, this deformable member has the intensity | strength of the grade which is not cut | disconnected when pulling out a suture thread. It is necessary to have.

  According to the above-described arrangement method of the suture thread Y, since the curved needle N can be naturally advanced according to the curvature thereof, damage to the pancreas P can be suppressed. When an auxiliary instrument of the same type as the surgical instrument 100 is not used, the curved needle N that has entered from the joint surface S of the pancreas P needs to protrude from the opening of the main pancreatic duct T. The course will deviate from the curvature, and damage to the pancreas P is inevitable. Also in the conventional technique, by using a curved needle having a small diameter, the curved needle that has entered from the joint surface S can be protruded from the opening of the main pancreatic duct T by the needle operation according to the curvature. Compared to the case where a curved needle having a diameter is used, the invasion of the pancreas P in the depth direction is insufficient, and this may cause anastomosis failure such as failure of the anastomosis. Compared with such a conventional technique, by using the surgical instrument 100, even when a curved needle having a relatively large diameter is used, the damage to the pancreas P is minimized, and the suture is performed at a desired position. Yarn can be placed.

  Subsequently, other curved needles (not shown) are respectively attached to the cut ends E1 and E2 of the suture Y, and a small hole formed in the opening of the main pancreatic duct T and the side wall of the intestinal tract K as shown in FIG. Align H and start anastomosis between pancreas P and intestine K. First, the curved needle attached to the suture thread Y1 is entered from the small hole H into the lumen of the intestinal tract K, and then penetrates the side wall of the intestinal tract K from the lumen side and protrudes to the outside of the intestinal tract K. Remove from Y1. A curved needle is similarly attached to the suture thread Y2, and the same procedure is repeated. As a result, as shown in FIG. 10A, the sutures Y1 and Y2 pass from the cut surface S of the pancreas P through the small hole H of the intestinal tract K through the inside of the pancreas P and the main pancreatic duct T. It is arranged so as to penetrate the side wall from the lumen of K and reach the outside of the intestinal tract K.

  6 to 10A described above is repeated a plurality of times, and a plurality of sutures are arranged similarly to Y1 and Y2. For example, when eight sutures are arranged, both ends of each suture are pulled together to join the small hole H and the opening of the main pancreatic duct T as shown in FIG. H and main pancreatic duct T are connected. Thereby, the anastomosis is completed, and pancreatic juice or the like secreted from the pancreas P flows into the intestinal tract K through the main pancreatic duct T and the small hole H.

  8 and 9, the surgeon secures a surgical field in the vicinity of the opening of the main pancreatic duct T from the proximal end side of the surgical instrument 100. At this time, according to the surgical instrument 100 according to one aspect of the present invention, the distal end portions 120 and 122 inserted into the main pancreatic duct T and the flexible member 124 side are disposed at positions away from the axial direction of the leg portions 112 and 114. Therefore, as schematically shown in FIG. 11, the surgical field can be easily secured near the anastomosis position.

  Further, since the protrusion 130 is provided on at least one outer surface of the distal end portions 120 and 122, the surgical instrument 100 inserted into the main pancreatic duct T may be prevented from coming out of the main pancreatic duct T during the procedure shown in FIG. it can. In particular, since the rising surface on the base end side (rear side) of the protrusion 130 is formed substantially perpendicular to the outer surface of the distal end portion 120 or 122 and the rising surface on the distal end side is inclined, The rising surface acts as a guide so that the distal end portions 120 and 122 can be smoothly inserted into the main pancreatic duct T, and the rising surface on the rear side can prevent the surgical instrument 100 from coming out of the main pancreatic duct T. In addition, since the plurality of protrusions 130 are provided at equal intervals from the tip of the tip 120 or 122, the distance from the tip of the tip 120 or 122 to the protrusion 130 can be visually recognized. It is possible to easily check whether the flexible member 124 has reached a sufficient depth.

  The surgical instrument according to the present invention is not limited to those explicitly shown in the present specification, and various changes can be made. For example, in the present specification, the surgical instrument 100 used for the anastomosis between the main pancreatic duct and the intestinal tract of the pancreas is illustrated, but by making necessary changes, the surgical instrument 100 can convert any kind of parenchymal organ into any kind. It can be used for anastomosing the luminal organs or for anastomosing the luminal organs. The luminal organs to be anastomosed include digestive tracts such as the pharynx, esophagus, stomach, duodenum, jejunum, colon, and rectum. It can also be used for anastomoses of trachea, blood vessels, ureters, fallopian tubes and the like. Necessary changes to the surgical instrument 100 include changes in rigidity, elasticity, material, size, and shape of each part, depending on the application. The curved needle N is not limited to a strong needle, and a weak needle can be used. In addition to those explicitly described herein, various modifications can be made to the surgical instrument 100 as will be apparent to those skilled in the art.

  Moreover, the dimension shown in this specification is an example of one embodiment, and different dimensions can be adopted depending on the purpose of use, material, production method, and the like.

DESCRIPTION OF SYMBOLS 100 Surgical instrument 110 Base end part 112,114 Leg part 115 Grip 116,118 Inclination part 120,122 Tip part 124 Flexible member 130 Protrusion part

Claims (13)

A pair of legs connected on the base end side and elastically deformable in a direction approaching and separating from each other;
A pair of inclined portions that are inclined with respect to the longitudinal direction of the pair of leg portions and extend forward from respective tips of the pair of leg portions;
A pair of tip portions extending substantially parallel to the longitudinal direction of the pair of leg portions from the tips of the pair of inclined portions;
A deformable connecting member for connecting the pair of tip portions to each other;
Including surgical instruments.   The surgical instrument according to claim 1, wherein the connecting member is flexible.   The surgical instrument according to claim 2, wherein the connecting member bends with less pressure than any of the pair of leg portions, the pair of inclined portions, and the pair of tip portions.   The surgical instrument according to any one of claims 1 to 3, wherein one or a plurality of protrusions are formed on an outer peripheral surface of at least one of the pair of tip portions.   The surgical instrument according to claim 4, wherein the protrusion is provided on a surface of the outer peripheral surface that does not face the other tip portion.   The surgical instrument according to claim 4, wherein a plurality of the protrusions are formed at equal intervals from the tips of the pair of tip portions.   The surgical instrument according to any one of claims 4 to 6, wherein a proximal end side of the protrusion protrudes higher than a distal end side.   The surgical instrument according to any one of claims 1 to 7, wherein an inclination of the inclined portion is in a range of 20 degrees to 80 degrees.   The surgical instrument according to any one of claims 1 to 8, wherein a distal end side of the pair of legs is configured to be separable from a proximal end side.   The surgical instrument according to any one of claims 1 to 9, wherein the pair of tip portions are configured to be separable from the pair of inclined portions.   The surgical instrument according to any one of claims 1 to 9, wherein the pair of inclined portions are configured to be separable from the pair of legs. A pair of legs connected at the base end side and elastically deformable in directions toward and away from each other, and inclined from the distal ends of the pair of legs with respect to the longitudinal direction of the pair of legs A pair of inclined portions extending forward, and detachably attached to the respective distal ends of the pair of inclined portions of the surgical instrument proximal unit, and in a mounted state, the lengths of the pair of leg portions A pair of tips formed to extend substantially parallel to the direction;
A deformable connecting member for connecting the pair of tip portions to each other;
Surgical instrument replacement unit. Removably attached to the distal ends of the pair of leg portions that are connected at the base end side and can be elastically deformed in a direction approaching and separating from each other, and in a mounted state, from the respective distal ends of the pair of leg portions A pair of inclined portions formed to be inclined with respect to the longitudinal direction of the pair of leg portions and extend forward;
A pair of tip portions extending substantially parallel to the longitudinal direction of the pair of leg portions from the tips of the pair of inclined portions;
A deformable connecting member for connecting the pair of tip portions to each other;
Surgical instrument replacement unit.

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