JP2014140509A - Trocar for endoscopic operation and endoscopic operation system using trocar - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a trocar for endoscopic operation and an endoscopic operation system having no risk of breakage even when a cylindrical trocar endoscopic operation for guiding an endoscope insertion part to a body cavity comes into contact (interference) with another surgical instrument (for example, the tip part of forceps or cautery) in the body cavity.SOLUTION: A trocar for endoscopic operation includes: a hard cylindrical body located at the base end side; and a flexible cylindrical part having flexibility, which is extended forward from the hard cylindrical part. The flexible cylindrical part has a net-like tube body formed by braided body of a thin metallic wire or a carbon fiber on the outermost periphery thereof.

Description

  The present invention relates to an endoscopic surgical trocar and an endoscopic surgical system using the trocar.

  Patent Document 1 discloses a laparoscope (endoscope) device that inserts a laparoscope into a body cavity via a trocar (trocar) made of a hollow tube. The distal end of the insertion part of the laparoscope is a curved part that can be bent vertically and horizontally.

  Surgery using such a trocar (for example, laparoscopic cholecystectomy) reduces the burden on the patient by using a single hole in the patient's body (for example, the abdomen), and through the trocar through the single hole. Thus, a so-called single-hole operation is possible in which a laparoscope is inserted into a body cavity together with other surgical instruments (for example, forceps and cautery). In this single-hole surgery, there is a high possibility that the trocar or the curved portion of the laparoscope protruding from the trocar will contact (interfere) with other surgical instruments (for example, the tip of a forceps or a cautery device) in the body cavity. However, the conventional trocar is a simple cylindrical member made of a hard material (for example, synthetic resin), and may be damaged by interference with other surgical instruments. If the trocar breaks, the insertion part (curved part) of the laparoscope inserted through the trocar may also break.

JP 2003-265402 A

  The present invention is based on the above awareness of the problem, and even if the trocar contacts (interferences) with another surgical instrument (for example, the tip of a forceps or a cautery device) in the body cavity, the trocar itself is not likely to be damaged (small). The purpose is to obtain an endoscopic surgical trocar. Further, according to the present invention, in the combination of the trocar and the endoscope, the projection length can be limited from the trocar tip of the endoscope bending portion (or the bending portion does not protrude from the trocar tip). The purpose is to obtain a surgical system. A further object of the present invention is to provide an endoscopic surgical system that can adjust the length of projection of an endoscope from a trocar into a body cavity.

  In the aspect of the cylindrical endoscopic surgical trocar that guides the endoscope insertion portion into the body cavity, the present invention provides a rigid cylindrical body positioned on the proximal end side, and can extend forward from the rigid cylindrical body. A flexible tubular portion having flexibility, and the flexible tubular portion has a net-like tube body made of a braided body of a fine metal wire or carbon fiber on the outermost periphery thereof.

  The present invention provides an endoscope operating system comprising an endoscope having an internal insertion portion and a cylindrical trocar that guides the internal insertion portion of the endoscope into a body cavity. A hard cylindrical body located on the end side, and a flexible flexible cylindrical portion extending forward from the hard cylindrical body, and the flexible cylindrical portion has a metal It has a reticulated tube body made of a braided body of fine wires or carbon fibers.

  It is preferable that an annular slide body supported by a lid member fixed to the opening of the body cavity is slidably supported on the outer periphery of the rigid cylindrical body.

  Moreover, the stopper part which controls the insertion end of the said endoscope insertion part can be formed in the inner surface of a hard cylindrical body.

  A rigid annular member is provided at the tip of the flexible tubular portion, and the rigid annular member and the rigid tubular body can be connected by a net-like tube body.

  It is preferable that a soft tube body made of a synthetic resin is provided inside the reticulated tube body.

  In the aspect of the endoscopic surgery system according to the present invention, the stopper means is provided so that the distal end of the body insertion portion does not protrude from the distal end of the trocar.

  Specifically, this stopper means can be comprised from the outward flange formed in the insertion part in a body, and the cyclic | annular step part formed in the trocar inner periphery, for example.

  According to the present invention, even when the trocar contacts (interferences) with another surgical instrument (for example, the tip of a forceps or a cautery device) in the body cavity, the trocar may be damaged (therefore, the inside of the trocar). An endoscopic surgical trocar having no risk of damage to the endoscope insertion portion is obtained. In addition, in a combination of a trocar and an endoscope, an endoscopic surgical apparatus capable of limiting the protruding length from the trocar tip of the endoscope bending portion (or the bending portion does not protrude from the trocar tip) Furthermore, an endoscopic surgical system capable of adjusting the projection length of the endoscope from the trocar into the body cavity can be obtained.

It is the whole longitudinal cross-sectional view which shows one Embodiment of the trocar by this invention. It is the II section expanded sectional view of FIG. It is the III section expanded sectional view of FIG. FIG. 8 is a cross-sectional view showing a state in which the distal end bending portion of the endoscope whose entire structure example is shown in FIG. 7 is inserted into the trocar of FIG. 1. It is the V section expanded sectional view of FIG. FIG. 5 is an enlarged sectional view of a VI part in FIG. 4. It is a front view which shows the example of the whole structure of the endoscope used for the endoscopic surgery system of this invention. FIG. 8 is an enlarged front view of the distal end of the endoscope insertion portion in FIG. 7. It is a figure which shows a mode that single hole type laparoscopic cholecystectomy is performed using the endoscopic surgery system of this invention. It is sectional drawing which shows the other example of the airtight structure of the endoscope insertion part of the trocar by this invention.

  Hereinafter, illustrated embodiments of a trocar 100 according to the present invention and an endoscopic surgery system using the trocar 100 and an endoscope (laparoscope) 10 will be described.

  7 and 8 show an example of an endoscope 10 used in an endoscopic operation system using a trocar. The endoscope 10 includes a grip operation unit 11 gripped by an operator, and a flexible insertion unit 12 extending from the grip operation unit 11. In the front-rear direction in this specification, the distal end side of the insertion portion 12 is defined as the front, distal end, or front side, and the proximal end side of the insertion portion 12 is defined as the rear, proximal end, or rear side. The insertion portion 12 has substantially the same outer diameter as a whole, and is connected to the distal end rigid portion 13, the bending portion 14, and the flexible portion 15 in order from the distal end side. The bending portion 14 can be bent according to the rotation operation of the bending operation lever 16 provided in the grip operation portion 11.

  A universal tube 17 extends from the grip operation unit 11, and a connector unit 18 is provided at the tip of the universal tube 17. The endoscope 10 incorporates a light guide fiber. The light guide fiber includes an insertion portion 12 (a distal end rigid portion 13, a bending portion 14, a flexible portion 15), a grip operation portion 11, a universal tube 17, and a connector. The light guide sleeve 19 protrudes from the portion 18 and extends into the light guide sleeve 19. When the connector terminal 18a of the connector unit 18 is connected to the connector terminal of the video processor, the pair of light guide fibers are optically connected to an endoscope light source built in the video processor. The illumination light emitted from the endoscope light source is guided through the pair of light guide fibers, and is emitted outward with a predetermined light distribution by the illumination lens provided on the front end surface of the distal end rigid portion 13 of the insertion portion 12. Is emitted. Further, the distal end rigid portion 13 is provided with an objective lens and an image pickup device, and an image signal of a subject obtained by the image pickup device is transmitted to the video processor via the signal cable through the objective lens.

  The above is an example of the configuration of a known endoscope (laparoscope) 10, but the endoscope 10 of the present embodiment is arranged on the outer periphery of the connecting portion between the bending portion 14 and the flexible portion 15, as shown in FIG. A collar member (cylindrical member) 145 is provided, and a flange (position restricting flange) 145a protruding outward in the radial direction is formed integrally with the collar member 145.

  1 to 3 show an embodiment of a single trocar 100 according to the present invention before being combined with an endoscope 10. The trocar 100 is a cylindrical member as a whole that guides the insertion portion 12 of the endoscope 10 into the body cavity. The trocar 100 includes a hard outer cylinder (hard cylindrical body) 101 made of a hard resin material on the proximal end side, It has a bendable flexible cylindrical portion 102 provided at the front end portion of the hard outer cylinder 101 and a seal member 103 provided at the rear end portion. A rigid annular member 104 is coupled to the distal end portion of the flexible cylindrical portion 102.

  As shown in FIG. 2, the hard outer cylinder 101 has a small-diameter portion 101a whose inner and outer diameters are reduced at the tip thereof, and an inner peripheral step (stopper step) 101s on the inner peripheral surface thereof. An annular groove 101b for inserting the O-ring 105 positioned in front of the stopper step 101s is formed. A small-diameter annular portion 101c is formed on the outer periphery of the small-diameter portion 101a, and a bottomed cylindrical groove 101d whose front end is open is formed on the proximal end side of the small-diameter annular portion 101c.

  On the other hand, the rigid annular member 104 at the distal end of the flexible cylindrical portion 102 has a cylindrical shape having substantially the same inner diameter as the rigid outer cylinder 101, and a small-diameter portion 104b having an inner peripheral step portion 104a is formed at the distal end portion. Yes. A small-diameter annular portion 104c is formed on the outer periphery of the intermediate portion in the front-rear direction of the hard annular member 104, and a large-diameter portion 104f is formed in front of the small-diameter annular portion 104c.

  The rigid outer cylinder 101 and the rigid annular member 104 are connected by a flexible cylindrical portion 102 (the rear end portion of the flexible cylindrical portion 102 having the rigid annular member 104 at the distal end is the distal end portion of the rigid outer cylinder 101) It is connected to the). The flexible cylindrical portion 102 includes a soft tube body 102a made of a soft synthetic resin on the inner peripheral side and a high-strength reticulated tube body 102b located on the outer periphery of the soft tube body 102a. As shown in FIG. 2, the rear end portion of the soft tube body 102a is fitted into the small-diameter annular portion 101c of the hard outer cylinder 101, and is connected by the connecting member (string-like bundle) 101e and the adhesive 101f located on the outer periphery thereof. The small diameter annular portion 101c is coupled. As shown in FIG. 3, the distal end portion of the soft tube body 102a is fitted into a small-diameter annular portion 104c of the rigid annular member 104, and is joined by a connecting member (string-like bundle) 104d located on the outer periphery thereof and an adhesive 104e. ing. “Hard” of the hard outer cylinder 101 and the hard annular member 104 means that it is harder than the soft tube body 102a, and is not deformed when viewed macroscopically. On the other hand, the soft tube body 102a can be flexibly deformed.

  The reticulated tube body 102b is formed of a braided tube formed by braiding metal thin wires made of a material such as stainless steel wire in a lattice shape, is harder than the soft tube body 102a, and is a surgical instrument (for example, the tip of forceps or a cautery device). The braid is braided at such a density that it can be extended following the bending operation of the insertion portion 12 (curved portion 14) inserted therein and has durability that does not break when it comes into contact (interference). Note that the net-like tube body 102b can be made of carbon fiber. As shown in FIG. 2, the rear end portion of the mesh tube body 102b is inserted into the bottomed cylindrical groove 101d of the hard outer cylinder 101 together with the inner peripheral holding ring 102c covering the outer periphery of the connecting member 101e. It is bonded and fixed with an adhesive 101g. Further, as shown in FIG. 3, the distal end portion of the mesh tube body 102b is covered with the large-diameter portion 104f of the rigid annular member 104 together with the inner peripheral holding ring 102d covering the outer periphery of the connecting member 104d, and the adhesive 104e. Is fixed by adhesion. The flexible cylindrical portion 102 composed of the net-like tube body 102b and the soft tube body 102a can be bent freely (without questioning the directionality) with a small force.

  As shown in FIG. 1, an outer flange 101 h is formed at the rear end of the hard outer cylinder 101 of the trocar 100, and an annular slide body 106 is slidable on the outer periphery, and by an O-ring 105. Supported in a liquid-tight manner.

  The seal member 103 at the rear end of the hard outer cylinder 101 has a rotationally symmetric shape about the axis, and has an insertion slit 103a that closes when the external force is released. The insertion part 12 of the mirror 10 can be inserted.

  FIGS. 4 to 6 (and FIG. 9) show a state where the insertion portion 12 of the endoscope 10 is inserted through the above trocar 100. When the insertion slit 12a is pushed open to insert the insertion portion 12 of the endoscope 10 into the hard outer cylinder 101, the insertion portion 12 eventually reaches the flexible cylindrical portion 102, and its outer flange 145a is the rigid outer cylinder 101. The insertion end is regulated while being in contact with the stopper step 101s (FIG. 5). At this time, the distal end of the distal end rigid portion 13 of the insertion portion 12 is substantially flush with the distal end of the small diameter portion 104b of the rigid annular member 104 (FIG. 6), and the insertion portion 12 (the distal end rigid portion 13) is a flexible cylindrical portion. No protrusion from 102. At this time, the O-ring 105 held on the inner peripheral surface of the trocar 100 (hard outer cylinder 101) comes into contact with the collar member 145 on the outer periphery of the insertion portion 12 and elastically deforms to maintain liquid-tightness ( The liquid in the body cavity does not leak outside through the gap between the insertion portion 12 and the trocar 100).

  5 and 6, a bending piece 14a, a rivet 14b, a bending operation wire 14c, and the like, which are well-known components of the bending portion 14, are shown. Further, FIG. 5 shows a spiral tube 15a, which is a component of the flexible portion 15, and FIG. 6 shows a forceps channel 13a formed in the distal end rigid portion 13. As shown in FIG. 6, the outer ring member 13b provided on the outer periphery of the distal end portion of the distal end rigid portion 13 abuts on the inner circumferential step portion 104a of the rigid annular member 104, and the outer flange 145a and the stopper described above. In addition to the engagement with the step portion 101s, it acts to limit the protruding end of the insertion portion 12 from the rigid annular member 104 (flexible cylindrical portion 102). In addition, the inner peripheral step 104a of the hard annular member 104 can smoothly guide the tip rigid portion 13 to the small diameter portion 104b instead of the tapered conical surface (tapered surface).

  FIG. 9 shows a state in which a single-hole laparoscopic cholecystectomy is performed using the above trocar 100 and endoscope 10. A single hole 2 pierced in the patient's abdomen 1 is covered with a retractable part protection member 3 and covered with a plastic lid member 4. The retracting part protection member 3 is provided with a rubber member 3b between a pair of ring members 3a. The hard outer cylinder 101 of the trocar 100 is inserted into the insertion hole 4a drilled in the center of the lid member 4, and the annular slide body 106 is supported in the insertion hole 4a. Then, macroscopically, the annular slide body 106 is fixed to the lid member 4, and the trocar 100 (hard outer cylinder 101) can slide with respect to the annular slide body 106. That is, the protrusion length of the trocar 100 (and the insertion portion 12) into the body cavity can be adjusted. The maximum projecting position of the trocar 100 into the body cavity is regulated at a position where the outer flange 101 h of the hard outer cylinder 101 contacts the annular slide body 106.

  In the state shown in FIG. 9, the cholecystectomy is performed by sending carbon dioxide gas through the trocar 100 to inflate the patient's abdomen 1 and keep the stomach. Subsequently, the grasping forceps 5 for the rigid endoscope is inserted into the abdomen 1 of the patient through the retractor protection member 3 and the lid member 4 to grip the gallbladder 6. At the same time, the endoscope 10 is inserted into the patient's abdomen 1 together with other surgical instruments (for example, forceps and cautery) (not shown) via the trocar 100 and this is observed while observing the patient's gallbladder 6 with the endoscope 10. To extract.

  During this extraction operation, the trocar 100 into which the insertion portion 12 of the endoscope 10 is inserted is inserted into the abdomen 1 of the patient together with other surgical instruments (for example, forceps and cautery). Therefore, the trocar 100 may be in contact with (interfering with) other surgical instruments (for example, the tip of a forceps or a cautery device). However, in the present embodiment, the flexible cylindrical portion 102 of the trocar 100 is composed of the mesh tube body 102b at the outermost periphery, so even if it interferes with other surgical instruments, the flexible cylindrical portion of the trocar 100 The portion 102 (and the insertion portion 12 inside the portion 102) is not damaged. In this embodiment, since the insertion portion 12 of the endoscope 10 does not protrude from the flexible cylindrical portion 102 of the trocar 100, the distal end portion of the insertion portion 12 is not damaged. Further, the amount of protrusion of the flexible tubular portion 102 (and the insertion portion 12 inside thereof) of the trocar 100 into the body cavity is made by sliding the hard outer tube 101 with respect to the annular slide body 106 (lid member 4). It is adjustable and the advantages of surgery are not compromised.

  Although the present invention does not ask for the seal structure between the tubular portion of the trocar 100 and the endoscope insertion portion inserted into the trocar 100, FIG. 10 shows the rear end of the hard outer tube 101 of the trocar 100. Another embodiment of a seal assembly 103A provided in place of the seal member 103 is shown in FIG. The seal assembly 103A has an elastic seal lip 103d sandwiched and supported by a funnel-shaped (conical) housing 103b and a lid 103c, and the funnel-shaped housing 103b is fixed to the rear end portion of the rigid outer cylinder 101 by a cylindrical retainer 103e. Is. The elastic seal lip 103d is formed with a slit 103f that is normally closed and is perpendicular to the paper surface. The lid 103c is formed with a circular opening 103g into which the endoscope insertion portion 12 is inserted. According to this embodiment, the elastic seal lip 103d can be protected by the hard funnel-shaped housing 103b and the lid 103c, and the radial position of the endoscope insertion portion 12 is restricted by the circular opening 103g of the lid 103c. can do.

  In the above embodiment, the case where the single-hole laparoscopic cholecystectomy is performed using the endoscope 10 inserted into the trocar 100 has been described as an example. However, the trocar and the endoscopic surgery system of the present invention are described. Can be applied to operations other than cholecystectomy.

10 Endoscope (laparoscope)
DESCRIPTION OF SYMBOLS 11 Grip operation part 12 Insertion part 13 Tip rigid part 14 Bending part 15 Flexible part 16 Bending operation lever 17 Universal tube 18 Connector part 145 Collar member 145a Outer flange 100 Trocar 101 Hard outer cylinder (hard cylindrical body)
101a Small-diameter portion 101b Annular groove 101c Small-diameter annular portion 101d Bottomed tubular groove 101e Connecting member 101f 101g Adhesive 101h Outer flange 101s Stopper step portion 102 Flexible tubular portion 102a Soft tube body 102b Reticulated tube body 102a Soft tube body 102b Reticulated tube body 102c 102d Holding ring 103 103A Seal member 103a Insertion slit 104 Hard annular member 104a Inner circumferential step 104b Small diameter portion 104c Small diameter annular portion 104d Connecting member 104e Adhesive 104f Large diameter portion 105 O-ring 106 Annular slide body

Claims (12)

In a tubular endoscopic surgical trocar that guides an endoscope insertion portion into a body cavity,
A rigid cylindrical body located on the proximal side;
A flexible flexible tubular portion extending forward from the rigid tubular body;
Have
An endoscopic surgical trocar characterized in that the flexible cylindrical portion has a net-like tube body made of a braided body of fine metal wires or carbon fibers on the outermost periphery thereof. The endoscopic surgical trocar according to claim 1, wherein an annular slide body supported by a lid member fixed to an opening of a body cavity is slidably supported on an outer periphery of the hard cylindrical body. Mirror surgery trocar. The endoscopic surgical trocar according to claim 1 or 2, wherein a stopper portion for restricting an insertion end of the endoscopic insertion portion is formed on an inner surface of the rigid cylindrical body. . The endoscopic surgical trocar according to any one of claims 1 to 3, wherein a rigid annular member is provided at a distal end of the flexible cylindrical portion, and the mesh tube body includes the rigid annular member and the above-described rigid annular member. Endoscopic surgery trocar connecting hard cylinders. The endoscopic surgical trocar according to any one of claims 1 to 4, wherein a soft tube body made of a synthetic resin is provided inside the mesh tube body. In an endoscopic surgery system comprising an endoscope having an in-vivo insertion portion and a cylindrical trocar that guides the in-body insertion portion of the endoscope into a body cavity,
The trocar has a hard cylindrical body located on the base end side,
A flexible flexible tubular portion extending forward from the rigid tubular body;
Have
The above-mentioned flexible cylindrical part has a reticulated tube body made of a braided body of fine metal wires or carbon fibers on its outermost periphery. The endoscopic surgery system according to claim 6, wherein an annular slide body supported by a lid member fixed to an opening of a body cavity is slidably supported on an outer periphery of the hard cylindrical body of the trocar. Endoscopic surgery system. The endoscopic surgery system according to claim 6 or 7, wherein a stopper means for restricting a protruding position of the distal end portion of the in-vivo insertion portion from the trocar tip portion is provided between the in-vivo insertion portion and the trocar. Mirror surgery system. The endoscopic surgery system according to any one of claims 6 to 8, wherein a hard annular member is provided at a distal end of the flexible cylindrical portion of the trocar, and the mesh tube body includes the rigid annular member and An endoscopic surgery system connecting the hard cylindrical bodies. The endoscopic surgery system according to any one of claims 6 to 9, wherein a soft tube body made of a synthetic resin is provided inside the mesh tube body of the trocar. The endoscopic surgery system according to claim 8, wherein the stopper means does not cause the distal end of the body insertion portion to protrude from the distal end of the trocar. 12. The endoscopic surgery system according to claim 11, wherein the stopper means is composed of an outer flange formed in the body insertion portion and an annular step portion formed on the inner periphery of the trocar.

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