JP2013163004A - Outer cylinder for endoscopic surgery - Google Patents

Abstract

PROBLEM TO BE SOLVED: To secure sufficient operability even when skin incision is made smaller than before in an outer cylinder in a spinal endoscopic surgery.SOLUTION: For an outer cylinder for an endoscope, retractor parts 14 and 15 are turned to a square cylinder shape for which one surface each of two L-shaped columnar planar bodies are in contact with each other and one surface is missing, and it can be inserted from a small skin incision part and can be unfolded large on the vertebra by turning the retractor parts 14 and 15. Insertion is performed by inserting a plurality of square plates, and by securing a space close to a square pole, an useless space in a conventional column is eliminated, the outer cylinder can be brought closer to the exact middle further, and a surgery is facilitated.

Description

  The present invention relates to an outer cylinder that secures an operation space in spinal endoscopic surgery.

  An axial cross-sectional view of the lumbar spinal canal is shown in FIG. The lumbar spinal canal 1 is a lumen surrounded by a vertebral arch 2, an intervertebral disc 3 and the like, and a spinal cord or a nerve root passes through the lumen. The upper side of FIG. 1 is the back side (skin side). Lumbar spinal canal stenosis is a disease that causes neurological symptoms in the lower limbs due to narrowing of the spinal canal.

  In general, posterior decompression is a surgical operation for lumbar spinal canal stenosis, in which a part of the vertebral arch 2 such as the lattice plane 4 in FIG. It is a treatment method that can be expanded. Among the subsequent decompression procedures, there is already an endoscopic posterior decompression procedure as a microinvasive procedure. This is done by inserting a cylindrical outer cylinder having a diameter of 15 to 20 mm as shown in FIG. 2 through a small skin incision, passing through the side of the spinous process 5, and setting the outer cylinder tip on the back side of the vertebral arch 2. Within the cylindrical outer cylinder, the surgery is completed while looking at the monitor magnified by the endoscope. Surgery is possible with less invasiveness than before, but inserting an outer cylinder of that diameter is still not enough to invade the muscles of the same part, making the outer cylinder thinner, It is desirable to minimize muscle invasion. However, when the outer cylinder becomes small, the operation range of the instrument inserted therein is limited, and the operation becomes difficult.

  The objective is to secure a necessary operation space and prevent operability from being impaired as much as possible even in the case of endoscopic surgery, which is less invasive than in the past.

  An instrument for lumbar endoscopic surgery is the METRx system of Medtronic Sofamor Danek (USA, Memphis), which is a serial dilator with a plurality of cylinders whose inner diameter is gradually increased from the skin incision. Are inserted in order from the small diameter, and the outer cylinder is inserted by finally covering the cylindrical outer cylinder (FIG. 2). The flexible arm fixed to the operating table and the flexible arm connecting portion 6 are connected and fixed, and the endoscope is fixed to the endoscope fixing portion 7 of the outer cylinder to perform the operation. In order to secure a deep space while pushing the muscles apart from a small skin incision, a cylindrical shape is used because it needs to be a long and narrow shape that can be inserted while twisting and can be covered. Further, the circle has a shortest outer periphery and a shape that obtains a large area.

  An outer tube for a small invasive surgery that is not for an endoscope, but which is called MAST QUADRANT, is already on the market from Medtronic Sofam Danek (USA, Memphis). The device presented in the published patent gazette (Tokuyo 2007-526080) is similar to this, but this is a retractor with a half-cylinder shape, that is, two half-cylinders facing each other. It is connected to an arm (referred to as a separating device in the publication). The arm of the base can be rotated and expanded, so that the retractor can be rotated and expanded so that it can be inserted through a small skin incision and can be greatly expanded over the vertebral surface. However, when the arm is rotated or opened, a gap is formed between the retractors and the muscle enters.

  The shape of cutting the vertebral arch 8 by posterior decompression as shown in FIG. 3 is close to a rectangle such as the hatched surface 9 when viewed from the back side, so that the outer cylinder is cylindrical as shown in FIG. Part will also come out.

  It is desirable to install the outer cylinder as close to the midline as possible because it makes it easier to cut the bone on the side of the approach side. However, although the outer cylinder is installed beside the spinous process instead of being midline due to the presence of the spinous process 12, it is desirable to install it as close to the spinous process as possible.

  The endoscope outer cylinder of the present invention has a first retractor portion and a second retractor portion to be inserted into the body, and the first retractor portion and the second retractor portion are bent plate-like bodies and have a cross section. The shape is substantially L-shaped, one surface of the first retractor portion and one surface of the second retractor portion are in contact with each other, and one side surface of the rectangular tube shape is largely missing. There is an endoscope fixing part for fixing the endoscope on the upper surface of one retractor part, and a base connecting part for connecting to the base is provided to the first retractor part and the second retractor part. The base has arms that are joined to the first retractor part and the second retractor part, respectively, and the arms can be rotated and expanded, and the base can be fixed to the operating table with a flexible arm. The outer cylinder is inserted into a guide after inserting a plurality of rectangular flat plates.

  In FIG. 4, the deployment ranges of the conventional cylindrical outer cylinder and the outer cylinder of the present invention on the vertebral arch are overlapped for comparison. The deployment range 10 of the conventional cylindrical outer cylinder is circular, and the deployment range 11 of the outer cylinder of the present invention is rectangular. However, since the spinous process 12 has a straight side, the outer cylinder of the present invention is more It can be placed close to the spinous process 12. Furthermore, the outer cylinder of the present invention is mostly missing on one side facing the spinous process, so that even if the spinous process has a partial bulge to the side, it will be pushed to the side by that. Less. By these things, operation from near the midline becomes possible, and in particular, the side bone removal on the entry side is facilitated. Even if one surface of the outer cylinder is missing, since the surface faces the spinous process, the muscles rarely protrude into the operation space.

  Further, as shown in the figure, the shape of shaving the vertebral arch is close to a rectangle when viewed from the back side, such as the hatched surface 13, and a portion that protrudes from a portion that does not fit in the development range 10 of the conventional cylindrical outer cylinder appears. The deployment range 11 of the outer cylinder of the present invention is close to a rectangle and close to a shape (shaded surface 13) in which bone is deleted, so that the number of times that the outer cylinder needs to be moved is reduced and the interruption of the operation is shortened. In addition, there are few extra parts. The fact that there are few protruding parts can be said to be protective of the muscles.

  Inserting a rectangular parallelepiped shape is not possible with a conventional cylindrical serial dilator, but a rectangular tube shape can also be inserted by sequentially inserting thin square flat plates.

  It can be inserted through a small skin incision, and by rotating the arm, the lumen area increases at the distal end of the outer cylinder and can be greatly expanded on the vertebra. If it can be expanded widely, the sense of position is easy to grasp, and the need to move the outer cylinder is reduced, so that the operation is easy and quick.

    An embodiment of the present invention will be described with reference to FIGS. As shown in FIG. 5 (top view), the main structure includes a first retractor portion 14 and a second retractor portion 15 that are inserted into the body, and the endoscope is fixed above the first retractor portion 14. There is a cylindrical endoscope fixing portion 16, and the first retractor portion 14 and the second retractor portion 15 are provided with base connecting portions 17 and 18 for connecting to the base. As shown in FIG. 6 (a cross-sectional view of the retractor portion), the first retractor portion 14 and the second retractor portion 15 are bent plate-like bodies and have a substantially L-shaped cross section. And the negative surface of the second retractor portion 15 come into contact with each other, and a cross-sectional shape close to a “U” shape in which most of one side surface of the rectangular tube shape is missing. Insert the “U” -shaped open side of the retractor into the body so that it faces the spinous process, and secure the operating space by suppressing muscles. An operation is performed with the endoscope fixed to the endoscope fixing portion 16. The part joined to it including the first retractor part is referred to as a first part, and the part joined to it including the second retractor part is referred to as a second part.

  As shown in FIG. 12, the base connected to the outer cylinder has arms 20 and 21 joined to the base connecting portions 17 and 18, respectively, and the arms can be rotated and opened, respectively. The flexible arm fixed to the operating table is connected and fixed to the flexible arm connecting portion 22. This base is the same as the MAST QUADRANT retractor base manufactured by Medtronic Sofam Danek (USA, Memphis), or the separation device disclosed in the published patent publication (Japanese Patent Publication No. 2007-526080). The endoscope and endoscope attachment are the same as those of METRx system manufactured by Medtronic Sofamor Danek (USA, Memphis).

  FIG. 7 is an outer side view of the first and second parts of the present invention in a state where they are not in contact with each other. An endoscope fixing part 16 is provided at the upper part of the first retractor part 14. FIG. 8a shows a state in which the first part and the second part are brought into contact with each other and are closed, and FIG. 8b shows that the second part 15 is rotated and the second retractor part 15 is rotated so that the space of the retractor tip is increased. It is a figure of the state which spread. FIG. 9 is a left side view of the present invention. The base connection portion 17 is bent slightly upward.

  A dilator for assisting insertion of the outer cylinder is shown in FIGS. As shown in FIG. 10, the dilator 19 has a plurality of rectangular flat plates, and firstly inserts one piece from the skin incision portion between the spinous process and the muscle and inserts it onto the vertebra. Next, insert a dilator along it. As shown in FIG. 11 (a), there is an insertion auxiliary portion that is cut obliquely at the base of the dilator, and the next dilator is inserted into the gap between the two sheets. The dilators are aligned and the outer cylinder of the present invention is inserted over the outer edges. As shown in FIG. 11B, the tip of the dilator is slightly pointed.

It is an axial sectional view of a lumbar spinal canal. It is a perspective view of the existing cylindrical retractor for spinal endoscopic surgery. It is the vertebra dorsal side view which showed the excision range of the vertebra. It is a vertebra dorsal side view which compared the expansion | deployment range of the conventional cylindrical outer cylinder and this invention. It is a top view of the present invention. It is sectional drawing of the retractor part of this invention. (A) State at the time of insertion (b) State at the time of opening It is an outer side view in the separated state of the present invention. It is an outer side view of this invention. (A) State at the time of insertion (b) State at the time of rotation. It is a left view of the present invention. It is a perspective view of the dilator of the present invention. It is a side view of the dilator of the present invention. (A) Base (b) Tip It is a top view of a base.

14 1st retractor part 15 2nd retractor part 16 Endoscope fixing part 17 1st base connection part 18 2nd base connection part 19 Dilator

Claims (3)

In the outer cylinder that secures the operation space during endoscopic surgery,
There are a first retractor part and a second retractor part to be inserted into the body,
The first retractor part and the second retractor part are bent plate-like bodies, and the cross-section is L-shaped or U-shaped,
One surface of the first retractor part and one surface of the second retractor part are in contact with each other, and one side surface of a similar quadrangular cylinder is partially or entirely missing.
There is an endoscope fixing part to fix the endoscope on the upper surface of any retractor part,
An outer tube for endoscopic surgery, characterized in that a base connecting portion for connecting to a base is provided on the first retractor portion and the second retractor portion. The dilator for assisting insertion of the outer cylinder is
With a plurality of rectangular flat plates, the tip has a blade-like form, and the base has an insertion assisting portion cut obliquely,
The endoscopic surgical outer tube according to claim 1, wherein the dilators are sequentially inserted into the body through the skin incision portion, and then the combined ones are inserted into the guide. The base connected to the outer cylinder is
Arms joined to the first retractor part and the second retractor part, respectively, and the arms can be rotated and opened,
2. The endoscopic surgical outer cylinder according to claim 1, wherein the base includes a flexible arm connecting portion that connects to a flexible arm fixed to the operating table.

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