JP2013119017A - Microsnake retractor - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a microsnake retractor allowing easy exclusion of an internal organ and allowing insertion into a treatment tool channel of an endoscope, in minimally invasive treatment such as NOTES (Natural Orifice Translumenal Endoscopic Surgery).SOLUTION: This retractor 1 includes: an exclusion part 11; an introduction part 12 extending to the exclusion part; and a handle part 13 provided at the proximal end of the introduction part. Each of the exclusion part and the introduction part has an outside diameter capable of being inserted into the treatment tool channel of the endoscope, the exclusion part includes an arm, the arm comprises a flat hollow body and at least one wire penetrating the flat hollow body, the wire has a different-shape section having a long diameter larger than the short diameter of the inside diameter of the flat hollow body, the distal end of the flat hollow body and the distal end of the wire are joined, the proximal end of the flat hollow body is fixed to the distal end of the introduction part, the at least one wire furthermore penetrating the introduction part, and the exclusion part exhibits a snake shape by pulling the proximal end of the wire to the handle part side in the handle part.

Description

  The present invention relates to a micro snake retractor for excluding an organ to be treated or an organ that obstructs a visual field during treatment in endoscopic treatment or the like.

  In each clinical department, direct observation and treatment in a body cavity are performed for the purpose of diagnosis for various pathological conditions, determination of therapeutic effects, determination of a therapeutic policy, and the like. Conventionally, these have been performed by a large invasive approach called test laparotomy or test thoracotomy. However, with the spread of endoscopic surgery in recent years, laparoscopes and thoracoscopes with smaller incisions have been performed.

  For example, Patent Documents 1 and 2 describe a trocar system that can provide a passage through which a larger diameter surgical instrument can be easily expanded after penetrating the skin with a small diameter and inserting it into a body cavity. Is disclosed. According to this system, compared with the conventional case where a large incision corresponding to the diameter of the surgical instrument is made, the trauma of the patient is small, and the recovery time is very short.

  Meanwhile, new minimally invasive techniques have been developed to minimize patient trauma. This technique is known as Natural Orifice Translumenal Endoscopic Surgery (NOTES), and can be introduced into the lumen from the body surface opening (natural orifice: mouth, anus, vagina, etc.) of the luminal organ. This is a completely new technique in which an endoscope is inserted, a wall of a luminal organ is incised to reach a body cavity, and diagnosis, treatment, and treatment are performed. Theoretically, since no incision on the surface of the body is required (incisionless), it is expected to be less invasive than endoscopic surgery. Overseas, cases of clinical success of laparoscopic-assisted transvaginal or transgastric “partial NOTES” have been reported and are attracting great interest. In the near future, clinical introduction of “complete NOTES” using only an endoscope, which does not require laparoscopic assistance, is also expected.

  In conventional laparotomy, organs that hinder the operation can be removed manually, but in such endoscopic surgery, opening of the organ is not easy, ensuring an optimal field of view for the operation. There is a drawback that it is difficult. This problem contributes to the difficulty of endoscopic surgery. In order to secure a visual field and an operation space, there is a method of injecting gas into a body cavity. However, this method requires general anesthesia and is not minimally invasive.

  In order to alleviate visual field problems and facilitate endoscopic treatment, instruments called retractors have been developed that exclude or pull organs to be treated and organs that obstruct the visual field being treated. As a basic function, the retractor is required to be able to insert a device through a small opening passage such as a trocar (outer tube) or a small incision as an insertion passage when the retractor is inserted into the body. Therefore, it is necessary to have a small diameter at least at the time of insertion (for example, 10 mm or less for a trocar, and preferably 20 mm or less for a small incision) and a rod-like form. In order to exclude objects widely and safely, it is required that the excluding portion be deformable into a shape having a certain large area.

  In response to the above conflicting demands, various devised retractors have been proposed or marketed. For example, there is one in which the exclusion portion expands in a fan shape (for example, Patent Document 3). When the trocar is inserted into the abdominal cavity, the fan-shaped exclusion portion is folded and stored in the rod-shaped tube, and is pushed out from the rod-shaped tube in the body cavity and spreads in a fan shape. There are structures that can expand the fan-shaped exclusion part to an arbitrary size by hand operation, and those that can change the angle between the exclusion part and the base, etc. It is suitable for. In addition, the shape is not limited to a fan shape, and various shapes such as a rhombus have been proposed.

  As another type, there is a snake retractor in which the rod-like body of the exclusion part bends in the body cavity (for example, Patent Documents 4 and 5). When the trocar is inserted, the bent extruding part is linearly housed inside the rod-shaped tube, and when it is pushed out from the rod-shaped tube in the body cavity, it returns to the bent shape, or when inserted, the rod-shaped one has various shapes in the body cavity. Can be bent and the bent shape can be fixed. These are particularly effective for pulling an object so as to be sandwiched between bent portions, and are widely used in laparoscopic surgery.

  Also disclosed is a snake retractor that is flexible and allows manipulation of organ and tissue structures as a tool arm that is inserted through a lumen provided in an endoscope insertion tube. (Patent Document 6).

  In the exclusion part of these snake retractors, a plurality of segments (cylindrical bodies) are connected at the end face, and there is a through-hole for passing a wire in the center of the cross section of each cylindrical body. Wires pass through the through-holes and the cylinders are linearly connected. And the snake shape of an exclusion part is expressed by pulling a wire by hand operation. However, in order to control the bending direction of the exclusion portion, two or more wires for connecting the cylindrical bodies are required, and therefore, each cylindrical body requires two or more through holes. Due to technical restrictions for making a through hole in such a cylindrical body, it has been difficult to reduce the diameter of the cylindrical body to 2.5 mm or less.

US Pat. No. 5,320,611 Japanese National Patent Publication No. 8-507238 JP-A-6-154152 Japanese National Patent Publication No. 7-502914 US Patent Application Publication No. 2002/011536 Special table 2007-511247 gazette

  An object of the present invention is to provide a micro snake retractor capable of freely excluding an organ and being inserted into a treatment instrument channel of an endoscope in a minimally invasive treatment such as NOTES.

  In the retractor configured in this order from the distal end side to the proximal end side, the exclusion part, the introduction part, and the handle part, the exclusion part includes an arm, and the arm includes a plurality of flat cylindrical bodies. A flat hollow body connected at the end face and at least one wire penetrating the flat hollow body, the distal end of the flat hollow body and the distal end of the wire are joined, and The distal end is fixed to the distal end of the introduction portion, and at least one of the wires further penetrates the introduction portion and reaches the handle portion, so that the exclusion portion and the introduction portion are connected to the treatment instrument channel of the endoscope. The present invention has been completed by finding that the extruding part can express a rigid snake shape by pulling the proximal end of the wire toward the handle part side in the handle part.

  The present invention provides a retractor including an exclusion portion having a blunt-shaped distal end, an introduction portion extending to the exclusion portion, and a handle portion provided at a proximal end of the introduction portion. In the tractor, the exclusion portion and the introduction portion have an outer diameter that can be inserted into a treatment instrument channel of an endoscope, the exclusion portion includes an arm, and the arm includes a plurality of flat cylindrical bodies connected at an end surface. A flat hollow body and at least one wire penetrating the flat hollow body, and at least one of the flat cylindrical bodies has an end surface that is not perpendicular to the axial direction, and at least one of the wires One has a deformed cross section having a major axis larger than the minor axis of the inner diameter of the flat hollow body, the distal end of the flat hollow body and the distal end of the wire are joined, and the proximal end of the flat hollow body The end is secured to the distal end of the introducer and at least one of the wires is further Through the introduction portion reaches to the handle portion, and in the handle part, by pulling the proximal end of the wire to the handle portion, the piezoelectric discharge unit can express the snake shape.

  In one embodiment, the retraction portion comprises two or more arms and the arms are joined at the distal end.

  In one embodiment, the snake shape is annular, circumferential, semicircular, spiral, square or triangular.

  In one embodiment, two or more wires penetrate the flat hollow body.

  In one embodiment, the cross-sectional shape of the flat cylindrical body is an ellipse, a racetrack, a rectangle, or a square.

  In one embodiment, the shape of the irregular cross section is an ellipse, a race track, or a rectangle.

  In one embodiment, the outer diameter that can be inserted into the treatment instrument channel of the endoscope is 2.5 mm or less.

  In one embodiment, the material of the flat cylindrical body is selected from stainless steel, titanium, titanium alloy, shape memory alloy, superelastic alloy, biocompatible metal, or a composite thereof.

  In one embodiment, the material of the wire is selected from stainless steel, titanium, titanium alloy, shape memory alloy, superelastic alloy, biocompatible metal, or a composite thereof.

  In one embodiment, the arm is covered with a resin cover.

  According to the present invention, it is possible to provide a micro snake retractor that can freely exclude an organ and can be inserted into a treatment instrument channel of an endoscope. The retractor of the present invention is inserted into the lumen of a hollow organ or body cavity via a treatment instrument channel of an endoscope and the like, and quickly develops a snake shape by a hand operation. Arbitrary shapes, such as a circle, a rectangle, and a triangle, can be expressed by appropriately setting the angle of the end surface of the adjacent flat cylindrical body that constitutes the arm of the exclusion portion. The expressed snake shape allows the organ to be freely excluded.

It is a schematic diagram which shows one embodiment of the retractor of this invention. It is a partial schematic diagram which shows one embodiment of the exclusion part which exposed the retractor of this invention through the treatment tool channel of the endoscope. It is a schematic diagram which shows the embodiment of the exclusion part of the retractor of this invention. It is a schematic diagram which shows the embodiment of the side shape of the flat cylinder which comprises the exclusion part of the retractor of this invention. It is a schematic diagram which shows the embodiment of the cross-sectional shape of the wire of the retractor of this invention.

  In the present specification, the “endoscope” refers to a medical endoscope. Such an endoscope uses a flexible material, and there are a built-in observation optical system using a glass fiber and a using a CCD. As an illumination optical system, a light source is generally provided on the side of the control device outside the body, and light is guided by an optical fiber to irradiate from the distal end portion. In addition, the direction of the distal end of the endoscope can be freely changed by an operation at hand. An appropriately sized endoscope is selected according to the target lumen.

  Endoscopes generally have a treatment instrument channel (sublumen) separate from the optical system, and include local cleaning, gas and liquid injection, drug spraying, suction, and treatment using dedicated devices (gripping, cutting, cutting, etc.). Puncture etc.) is possible. Or it has an overtube and a treatment instrument channel may be provided in an overtube. The inner diameter of these treatment instrument channels is usually 3 mm.

  In the present specification, the “retractor” refers to a medical device for excluding, opening, pulling, or raising an object (for example, an organ) or an object that obstructs the visual field in the medical field. Exclusion, opening / extraction, traction, or raising operations may be collectively referred to as “retraction” or “retraction”. Note that the term “exclusion” may include not only an exclusion operation but also an operation of opening, pulling, or raising (that is, meaning retraction). The retractor is required to have an exclusion part and to be deformable to a certain size after insertion into the body. Examples of the insertion path include a treatment instrument channel of an endoscope, a trocar (outer tube), and the like.

  As used herein, the term “distal” refers to the portion of the instrument that is furthest from the operator of the instrument, and the term “proximal” refers to the portion of the instrument that is closest to the operator.

  In this specification, the term “snake shape” refers to an arbitrary shape formed by a curve, and includes a three-dimensional shape.

  Examples of the target luminal organ include stomach, small intestine, large intestine, and vagina. Examples of other organs include liver, pancreas, kidney, gallbladder, spleen, uterus and lung.

  Referring to FIG. 1, the retractor 1 of the present invention includes an exclusion portion 11, an introduction portion 12 extending from the exclusion portion 11, and a handle portion 13 provided at the proximal end of the introduction portion 12. The distal end of the exclusion part 11 has a blunt shape so as not to damage the organ. That is, it is curled up.

  Referring to FIG. 2, the exclusion portion 11 and the introduction portion 12 have outer diameters that can be inserted into the treatment instrument channel 22 of the endoscope 2. Since the inner diameter of the treatment instrument channel 22 is usually about 3 mm, the exclusion section 11 and the introduction section 12 may have an outer diameter of less than 3 mm when inserted into the treatment instrument channel 22. Preferably, it is 2.5 mm or less.

  Referring to FIG. 3, the exclusion unit 11 includes an arm 5. The arm 5 may be one, or two or more. The arm 5 takes a linear shape with an outer diameter of 2.5 mm or less when a snake shape is not exhibited (a-1 and b-1 in FIG. 3). The snake shape expressed in the case of one is not particularly limited, and examples thereof include a circumferential shape, a semicircular shape, and a spiral shape. FIG. 3A-2 shows a circumferential shape. In the case of two or more, since the outer diameter of one arm is smaller, the arms are preferably joined at the distal end so as to increase rigidity. The snake shape expressed in this case is not particularly limited, and examples thereof include a ring shape as shown in FIG. The length of the arm 5 is appropriately set according to the exclusion operation and the shape of the target organ. Preferably, it is 30-120 mm.

  The arm 5 includes a flat hollow body 52 formed by connecting a plurality of flat cylindrical bodies 51 at end faces, and at least one wire 6 penetrating the flat hollow body 52. The cross-sectional shape of the flat cylindrical body 51 is not particularly limited, and examples thereof include an elliptical shape, a race track shape, a rectangular shape, and a square shape.

  The number of flat cylinders 51 is not particularly limited as long as the arm 5 can be formed. As the number of flat cylinders 51 increases, the snake shape that is expressed can be made smoother. At least one of the flat cylindrical bodies 51 has an end surface that is not perpendicular to the axial direction. For example, as shown in FIG. 4A, in the side surface shape of the flat cylindrical body 51 with the flat surface up and down, one of the end surfaces is formed with a certain angle θ from the surface perpendicular to the axial direction. At this time, the upper side L1 of the side surface shape is longer than the lower side L2. The angle θ may be formed on one of the two end surfaces of the flat cylindrical body 51, or may be formed on both. When forming both, both angles (theta) may be the same and may differ.

  The flat hollow body 52 formed by connecting a plurality of flat cylindrical bodies 51 at the end faces can form a linear shape according to the shape of the wire 6 penetrating the flat hollow body 52, and the end faces of the adjacent flat cylindrical bodies 51 in the linear shape. The space has an angle θ. When the flat hollow body 52 is pressed from both ends, the wire penetrating the flat hollow body 52 until the angle between the end faces of the adjacent flat cylindrical bodies 51 becomes 0 °, that is, until the end faces are in close contact with each other. 6 and the bent shape as shown in FIG. The angle θ is appropriately set according to the snake shape to be expressed. Further, how to arrange the flat cylindrical body 51 having the end face of the angle θ is appropriately set according to the developed snake shape. By setting end faces having substantially the same angle θ to almost all flat cylindrical bodies 51, it is possible to obtain a flat hollow body 52 that expresses a circumferential snake shape as shown in FIG. By setting an end face having an angle θ only to the flat cylinders 51 connected in a certain region, a flat hollow body 52 that expresses a snake shape such as a square shape or a triangular shape can be obtained. In the flat hollow body 52, when an angle θ is formed such that one flat cylindrical body 51 has a side shape upper side L1 longer than the lower side L2, another flat cylindrical body 51 has a side shape upper side L1 shorter than the lower side L2. The angle θ may be formed so that In this case, for example, a flat hollow body 52 that expresses an annular snake shape as shown in FIG.

  The major axis of the outer diameter of the flat cylindrical body 51 is 3 mm or less, preferably 2.5 mm or less. The flatness ratio of the flat cylindrical body 51, that is, the ratio (%) of the minor axis of the outer diameter to the major axis of the outer diameter of the flat cylinder 51 is not particularly limited. As the flatness ratio is larger, the bending directivity of the flat hollow body 52 can be increased. However, if the flatness is too large, the rigidity of the flat hollow body 52 is lowered. L1 and L2 of the flat cylindrical body 51 are appropriately set according to the length of the arm 5, the number of the flat cylindrical bodies 51, and the angle θ. The cylinder thickness of the flat cylinder 51 is not particularly limited as long as the rigidity of the arm 5 can be secured, but is preferably 0.1 to 0.5 mm.

  Although the material of the flat cylinder 51 is not specifically limited, Preferably it is a metal. Examples of the metal include stainless steel, titanium, titanium alloy, shape memory alloy, superelastic alloy, biocompatible metal, and composites thereof. Examples of stainless steel include SUS304, SUS316, and SUS316L. Examples of titanium and titanium alloy include pure titanium and β titanium. Examples of the shape memory alloy and superelastic alloy include nitinol (nickel-titanium alloy).

  The number of wires 6 is appropriately set according to the rigidity of the flat hollow body 52 and the wires 6. Usually, it is 1-6, preferably 2-4.

  At least one of the wires 6 has a deformed cross section having a major axis that is smaller than the major axis of the flat hollow body 52 and larger than the minor axis. Here, the irregular shape means a special shape different from the standard shape. The standard shape of the cross section of the wire is a circle, and examples of the irregular shape include an elliptical shape, a racetrack shape, and a rectangular shape. FIG. 5 shows an example of a racetrack shape.

  By making the long diameter of the wire 6 larger than the short diameter of the inner diameter of the flat cylindrical body 51, the flat surface of the flat hollow body 52 and the long diameter surface of the deformed cross section of the wire 6 can be made to coincide with each other. In 52, it is possible to prevent free rotation about the axis. The ratio (%) of the sum of the minor diameters of the odd-shaped cross sections of all the wires 6 penetrating the flat cylindrical body 51 to the minor diameter of the inner diameter of the flat cylindrical body 51 is not particularly limited, but the shape of the flat hollow body 52 is maintained ( In order to ensure the prevention of deviation) and rigidity, it is preferably 80% or more. The ratio (%) of the major axis of the wire 6 having the largest major axis irregular shape among the wires 6 penetrating the flat cylinder 51 to the major axis of the inner diameter of the flat cylinder 51 is not particularly limited, but is preferably preferably 80%. That's it.

  The material of the wire 6 is not particularly limited, but is preferably a metal. Examples of the metal include stainless steel, titanium, titanium alloy, shape memory alloy, superelastic alloy, biocompatible metal, and composites thereof. Examples of stainless steel include SUS304, SUS316, and SUS316L. Examples of titanium and titanium alloy include pure titanium and β titanium. Examples of the shape memory alloy and superelastic alloy include nitinol (nickel-titanium alloy). The shape of the wire may be, for example, a spring shape or a mesh shape.

  When there are two or more wires 6, the cross-sectional shape of each wire may be the same or different. For example, as shown in FIG. 5, in the case of one set of wires composed of three wires 61 having the same cross-sectional shape with a small major axis and one wire 62 having a different major cross-sectional shape with a major axis, Since the rigidity is high, the linear directivity is high, and since the wire 62 has low rigidity and the bending directivity is high, it is possible to control the snake shape development property and the linear shape restoration property.

  When there are two or more wires 6, the material of each wire may be the same or different. For example, in the case of one set of wires in which two of the four wires 6 shown in FIG. 5 are high-strength stainless steel and the other two are superelastic nickel-titanium alloys, the stainless steel has high rigidity. While the linear directivity is high, the rigidity at the time of snake shape expression is high, and the nickel-titanium alloy has low rigidity and high elasticity, so that the bending directivity is high, while the flexibility at the time of snake shape expression (linear shape restoration property) is high. High linear shape restoration property ensures the retractability of the retractor with respect to the treatment instrument channel of the bent endoscope.

  Thus, by appropriately selecting the number of wires 6, the cross-sectional shape and material of each wire, and combining them, the balance of characteristics such as snake shape developability, rigidity at the time of snake shape manifestation, and linear shape recoverability is optimally controlled. can do.

  By configuring the arm 5 as described above, the bending direction of the flat cylindrical body 51 can be made constant, and the arm 5 bends in the flat plane side of the flat hollow body 52, that is, in the minor axis direction of the deformed cross section of the wire 6. The directivity is increased, and the snake shape developability and the rigidity at the time of snake shape development are increased.

  The distal end of the flat hollow body 52 and the distal end of the wire 6 are joined by the joining member 3, and the proximal end of the flat hollow body 52 is fixed to the distal end of the introducing portion 12 by the fixing member 4. The joining portion may or may not have the joining member 3 that reinforces the joining, and the securing portion may or may not have the fixing member 4 that reinforces the securing.

  At least one of the wires 6 further penetrates the introduction part 12, and one end reaches the handle part 13. The cross-sectional shape of the wire 6 that penetrates the introduction portion 12 may be the same as or different from the cross-sectional shape in the introduction portion 12 and the cross-sectional shape in the exclusion portion 11. For example, the cross-sectional shape in the introduction part 12 may be a circle. The material of the wire 6 that penetrates the introduction part 12 may be the same as or different from the material in the introduction part 12 and the exclusion part 11. The proximal end of the remaining wire 6 that does not penetrate the introduction portion 12 may be fixed to the distal end of the introduction portion 12 or may not be fixed, but is preferably not fixed.

  The exclusion portion 11 is generally linear in accordance with the shape of the wire 6 that penetrates the flat hollow body 52, but in the handle portion 13, the proximal end of the wire 6 that penetrates the introduction portion 12 is pulled toward the handle portion side. By this, the flat hollow body 52 can be pressed from both ends, and a snake shape can be expressed. By reducing the traction force, the pressing force is weakened and the expression of the snake shape is released.

  The length of the wire 6 that penetrates the introduction portion 12 is appropriately set according to the length of the retractor 1.

  Referring to FIG. 1, the introduction part 12 extends to the exclusion part 11 and connects the handle part 13 and the exclusion part 11. The length of the introduction part 12 may be sufficient as long as the exclusion part 11 protrudes (or is exposed) into the body cavity, and is usually equivalent to the wires extended to the endoscope treatment instrument. It can be. The introduction unit 12 can move together in the treatment instrument channel as the endoscope moves without interfering with the movement of the endoscope.

  The introduction part 12 has a hollow cylindrical shape, and at least one of the wires 6 passes through the cylinder. The material of the introduction part 12 is not particularly limited as long as it is flexible, and examples thereof include stainless steel such as SUS304, resin such as polyamide and polytetrafluoroethylene (PTFE), and stainless steel coated with a resin.

  The exclusion part 11 and the introduction part 12 have a smooth surface so as not to damage the organ. In particular, the exclusion portion 11 may be covered with a resin cover 7 (a-1 'and a-2' in FIG. 3). Preferably, the region from the distal end to the proximal end of the exclusion portion 11 and the boundary region between the exclusion portion 11 and the introduction portion 12 are in close contact with and covered with the resin cover 7. The resin cover 7 not only prevents sparks during the operation, but also protects the retractor from contamination, such as preventing body fluid from entering the retractor. After the operation, the resin cover 7 is removed and made disposable, while the retractor can be easily reused by washing and sterilizing the retractor. As resin, the raw material normally used for a medical device is mentioned, for example. For example, polyamide, polyolefin, fluororesin (PTFE, Teflon (registered trademark) FEP, fluon (registered trademark) PFA, etc.), silicone, polyurethane, polyethylene terephthalate (Daclon (registered trademark)) can be used. The thickness of the resin cover 7 is preferably 10 to 250 μm.

  The handle portion 13 is provided at the proximal end of the introduction portion 12. By operating the handle portion 13, the exclusion portion 11 and the introduction portion 12 are inserted into the treatment instrument channel of the endoscope, the exclusion portion 11 is delivered to the distal end of the endoscope, and protrudes (or exposed) into the body cavity. ).

  The handle portion 13 can be operated so as to change the shape of the exclusion portion 11. The method of changing the shape of the exclusion part 11 is a method of pulling the proximal end of the wire 6 penetrating the introduction part 12 toward the handle part 13 as described above.

  The shape and structure of the handle portion 13 are not particularly limited as long as the handle portion 13 has the above function. It may be of a size and shape that is easy for the operator of the instrument to handle and is normally employed in the art.

  The retractor 1 of the present invention is inserted into a body cavity from a treatment instrument channel of an endoscope, and the exclusion part 11 develops a snake shape. While this exclusion part 11 is monitored with an endoscope, it is brought into contact with the inner wall of the lumen by the operation by the handle part 13 or the operation of the endoscope itself, and the inner wall is pressed or pushed up. By this operation, it is possible to realize the exclusion, opening, traction, or elevation required for the outer wall of the lumen in surgery or the like in the abdominal cavity. Appropriate traction can be obtained on the outer wall of the luminal organ, and a visual field can be secured in the abdominal cavity. Or, for example, by expanding the mucosal surface in the large intestine and expanding the fold, for example, the entire polyp hidden in the fold can be observed, and the stem can be exposed to allow treatment with a normal endoscope It becomes.

  According to the present invention, it is possible to provide a micro snake retractor that can freely exclude an organ and can be inserted into a treatment instrument channel of an endoscope. The retractor of the present invention is inserted into the lumen of a hollow organ or body cavity via a treatment instrument channel of an endoscope and the like, and quickly develops a snake shape by a hand operation. Arbitrary shapes, such as a circle, a rectangle, and a triangle, can be expressed by appropriately setting the angle of the end surface of the adjacent flat cylindrical body that constitutes the arm of the exclusion portion. The expressed snake shape allows the organ to be freely excluded.

  If the retractor of the present invention is used, it is possible to perform the exclusion operation while securing a visual field. For example, when there is a small lesion in the digestive tract cavity, it is possible to operate without damaging the lesion. is there. Furthermore, there is no tissue pinching or damage caused by the instrument during use.

  More specifically, the retractor of the present invention is a gastric resection, an esophagectomy, a small intestine resection, a splenectomy (expanding between the stomach and the spleen by expanding the stomach from the lumen) Etc.) and can be applied via a gastroscope. Transgastric NOTES can be applied via an enteroscope in colectomy, rectal resection, small intestine resection, and the like. Alternatively, it can be applied to the fields of gynecology, urology, and respiratory surgery.

  Moreover, the retractor of this invention is applicable not only to NOTES but in laparoscopic surgery, endoscopic surgery, or open surgery. For example, in order to obtain appropriate traction of the digestive tract in normal laparoscopic surgery, it can be inserted into the digestive tract cavity via an endoscope and used. Such an operation eliminates the need for an organ repellent used under a laparoscope, thereby reducing the abdominal incision.

  Furthermore, the retractor of the present invention can be used supplementarily when performing complicated operations in a normal gastrointestinal endoscope (stomach camera or large intestine camera). For example, a polyp present on the back side of a heel that is difficult to access can be viewed from the front by expanding the wall using the retractor of the present invention, and can be excised under an endoscope.

  The retractor of the present invention has a simple structure and can be supplied at low cost.

DESCRIPTION OF SYMBOLS 1 Retractor 11 Exclusion part 12 Introduction part 13 Handle part 2 Endoscope 21 Observation optical system (camera lens)
22 treatment instrument channel 3 joint member 4 fixing member 5 arm 51 flat tube body 52 flat hollow body 6 wire 61 wire having a cross-sectional shape with a small long diameter 62 wire having a cross-sectional shape with a large long diameter 7 resin cover L1 flat with a flat surface up and down The upper side of the side surface shape of the cylindrical body L2 The lower side of the side surface shape of the flat cylindrical body 51 with the flat surface up and down θ The angle formed by the end surface of the flat cylindrical body 51 and the surface perpendicular to the axial direction

Claims (10)

A retractor comprising an exclusion part having a blunt-shaped distal end, an introduction part extending to the exclusion part, and a handle part provided at the proximal end of the introduction part,
The exclusion part and the introduction part have an outer diameter that can be inserted into a treatment instrument channel of an endoscope,
The exclusion part comprises an arm;
The arm is composed of a flat hollow body formed by connecting a plurality of flat cylindrical bodies at end faces, and at least one wire penetrating the flat hollow body,
At least one of the flat cylindrical bodies has an end surface that is not perpendicular to the axial direction;
The wire has an irregular cross section having a major axis larger than the minor axis of the inner diameter of the flat hollow body;
The distal end of the flat hollow body and the distal end of the wire are joined;
The proximal end of the flat hollow body is secured to the distal end of the introducer,
At least one of the wires further penetrates the introduction part to reach the handle part, and in the handle part, the proximal end of the wire is pulled toward the handle part side so that the exclusion part has a snake shape. Can express,
Retractor.   The retractor according to claim 1, wherein the exclusion unit includes two or more arms, and the arms are joined to each other at a distal end.   The retractor according to claim 1 or 2, wherein the snake shape is an annular shape, a circumferential shape, a semicircular shape, a spiral shape, a square shape, or a triangular shape.   The retractor according to any one of claims 1 to 3, wherein two or more wires penetrate the flat hollow body.     The retractor according to any one of claims 1 to 4, wherein a cross-sectional shape of the flat cylindrical body is an elliptical shape, a race track shape, a rectangular shape, or a square shape.   The retractor according to any one of claims 1 to 5, wherein a shape of the irregular cross section is an ellipse, a racetrack, or a rectangle.   The retractor according to any one of claims 1 to 6, wherein an outer diameter that can be inserted into a treatment instrument channel of the endoscope is 2.5 mm or less.   8. The material according to claim 1, wherein a material of the flat cylindrical body is selected from stainless steel, titanium, a titanium alloy, a shape memory alloy, a superelastic alloy, a biocompatible metal, or a composite thereof. Retractor.   The retractor according to any one of claims 1 to 8, wherein a material of the wire is selected from stainless steel, titanium, a titanium alloy, a shape memory alloy, a superelastic alloy, a biocompatible metal, or a composite thereof. .   The retractor according to any one of claims 1 to 9, wherein the arm is covered with a resin cover.

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