JP2018000873A - Medical retractor - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical retractor dispensing with an electric configuration and capable of conveniently viewing force applied to a tissue.SOLUTION: A medical retractor 1 according to the present invention includes: an exclusion part 10 capable of coming into contact with a body tissue; a water supply device 30 by which the exclusion part is supported; fluid storage parts 21 fitted to the exclusion part; and index tubes 22 connected to the fluid storage parts 21. Each fluid storage part 21 is configured to deform according to force received from the body tissue, and a degree of deformation of the fluid storage part 21 is visible in the index tube 22.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a medical retractor used for tissue exclusion or the like.

  2. Description of the Related Art Conventionally, in a region such as surgery, a tissue that obstructs a technique or a lesion is visually excluded using a retractor.

  With the exclusion, the surgeon can secure a good surgical field and perform the procedure appropriately. On the other hand, if a tissue that is soft or easily damaged is excessively removed, the tissue may be damaged.

  In relation to this problem, Patent Document 1 describes a fixing device for a brain spatula that is a retractor for the brain. In this fixing device, when a constant pressure is applied to the brain spatula, an alarm is generated from the alarm device, so that it is possible to quickly cope with the occurrence of excessive pressure.

JP-A-9-103435

However, since the device described in Patent Document 1 basically fixes the brain spatula in a predetermined position, it is difficult to cope with an application in which various parts are excluded with various strengths during the procedure.
Furthermore, in the apparatus described in Patent Document 1, since the pressure is detected by a strain gauge, an electrical configuration is essential, the apparatus configuration is complicated, and the manufacturing cost is high and the sterilization is difficult. It is a problem.

  An object of this invention is to provide the medical retractor which does not require an electrical structure and can visually recognize the force currently acting on the structure | tissue easily.

  The present invention includes an exclusion part that can contact a biological tissue, a holding part that supports the exclusion part, a force detection part attached to the exclusion part, and an index part connected to the force detection part. The force detection unit is a medical retractor configured to be deformed according to a force received from the living tissue, and configured to be able to visually recognize the degree of the deformation of the force detection unit in the index unit. .

  The force detection unit has an internal space in which a fluid is accommodated, and the index unit is a tubular index tube connected to the force detection unit so as to communicate with the internal space. When the detector is deformed, a part of the fluid may be moved into the indicator tube.

The said exclusion part and the said force detection part may be formed with the same material.
The holding part may be formed in a tubular shape.

  According to the medical retractor of the present invention, it is possible to visually recognize the force acting on the tissue without requiring an electrical configuration.

It is a perspective view which shows the medical retractor which concerns on 1st embodiment of this invention. It is an enlarged view which shows the exclusion part of the medical retractor. It is a schematic diagram which shows an example of the preliminary experiment in the medical retractor. It is an example of the graph which shows the relationship between the force which acts on a fluid accommodating part, and the displacement amount of a fluid edge part. It is a figure which shows an example at the time of use of the medical retractor. It is a figure which shows the behavior of the fluid accommodating part at the time of use. It is a perspective view which shows the medical retractor which concerns on 2nd embodiment of this invention. It is a disassembled perspective view which expands and shows the front-end | tip part of the medical retractor.

A first embodiment of the present invention will be described with reference to FIGS.
FIG. 1 is a perspective view showing a medical retractor (hereinafter sometimes simply referred to as “retractor”) according to the present embodiment. The medical retractor 1 includes an excluding portion 10 provided at a distal end portion, and a water feeder (holding portion) 30 on which the excluding portion 10 is supported.

  The exclusion part 10 has a sheet-like main body 11 and is configured to be able to contact a living tissue. Five fluid storage portions (force detection portions) 21 are attached to one surface of the main body 11.

  FIG. 2 is an enlarged view showing the exclusion portion 10, with the upper side being a front view and the lower side being a bottom view. The main body 11 is formed with a fixing hole 12 through which the tip of the water feeder 30 is inserted.

  Each fluid storage portion 21 extends in parallel with the fixing hole 12 and has an internal space in which a fluid is stored. The fluid container 21 is deformed when a force such as pressure is applied, and the volume of the internal space changes. The rigidity of the fluid storage portion can be appropriately set in consideration of the upper limit value of the force to be detected, the resolution, and the like. In the present embodiment, both the main body 11 and the fluid storage portion 21 are made of silicone and are integrally molded. Therefore, the main body 11 is also formed flexibly.

  An index pipe (index section) 22 is connected to each fluid storage section 21. The indicator tube 22 has transparency that allows the internal space to be visually recognized, and rigidity that does not change the volume of the internal space with a force that is assumed to act when the retractor 1 is used. Both ends are open. As a suitable material for the indicator tube 22, for example, a fluorine-based resin such as PTFE (polytetrafluoroethylene) can be used. The distal end portion 22a of the indicator tube 22 is connected to the proximal end portion of the fluid storage portion 21, and extends toward the proximal end side of the retractor 1 as shown in FIG. Thereby, the inside of the indicator tube 22 communicates with the internal space of the fluid storage portion 21.

  A fluid (for example, a liquid) is accommodated in the internal space of the fluid accommodating portion 21. Therefore, when the volume of the internal space is reduced due to the deformation of the fluid storage unit 21, a part of the fluid stored in the fluid storage unit 21 moves into the indicator tube 22.

  The movement mode of the fluid according to the force acting on the fluid storage unit 21 can be confirmed by an experiment as shown in FIG. 3, for example. A substrate 201 provided with bumps 202 having a shape corresponding to the fluid containing portion 21 is placed on a force gauge 205. The base end portion of the retractor 1 is fixed to the automatic positioning stage 210, and the positional relationship is adjusted so that the fluid storage portion 21 to be measured is positioned above the bump 202.

  In this state, the automatic positioning stage 210 is operated to lower the retractor 1. When the fluid storage unit 21 and the bump 202 come into contact with each other, the detection value of the force gauge 205 increases, and the fluid storage unit 21 is deformed to displace the position (for example, the liquid level) of the fluid end in the indicator tube 22. . This end position is confirmed by the scope 215.

From the above experiment, for example, a graph as shown in FIG. 4 can be obtained, and the relationship between the force F acting on the fluid containing portion 21 and the displacement amount x of the fluid end in the indicator tube 22 can be grasped. . A multiple regression model may be used for obtaining the graph. According to the study by the inventors, a resolution of the detecting force of 0.05 Newton (N) has been realized.
Since the above-mentioned relationship changes depending on the positional relationship between the fluid storage unit 21 and the holding unit, the minute difference in the shape of the internal space, and the like, it is preferably acquired for each fluid storage unit. Further, based on this relationship, a scale or the like may be provided at a position corresponding to a predetermined force magnitude on the outer surface of the indicator tube.

The fluid stored in the fluid storage unit 21 is not required to have an extremely large surface tension, and various liquids typified by water can be used. Above all, it is preferable to use physiological saline because it is safe even if the retractor 1 is damaged and comes into contact with the tissue. In this embodiment, physiological saline is also used.
It is preferable that the fluid stored in the fluid storage unit 21 is colored because the position of the liquid level is easily visible. For coloring, it is preferable to use a pigment having little influence on the living body.

  The water feeder 30 has a tubular portion 31 formed of metal or the like, and a connection portion 32 provided at a proximal end portion of the tubular portion 31, and the whole is formed in a tubular shape. By connecting a fluid supply source such as a syringe to the connection portion 32, the fluid (for example, physiological saline) in the supply source can be discharged from the distal end of the tubular portion 31. A known surgical water feeder can be used as the water feeder 30 as long as it can be inserted into the fixing hole 12.

The operation | movement at the time of use of the retractor 1 of this embodiment comprised as mentioned above is demonstrated. FIG. 5 is a diagram showing a state when the retractor 1 is in use, and shows an example of brain surgery.
The operator grasps the proximal end portion of the water feeder 30 and brings the surface of the exclusion portion 10 on the side where the fluid storage portion 21 is provided into contact with the brain tissue (tissue) Br. The surgeon can secure the operative field so that treatment can be easily performed by excluding the brain tissue Br by applying force to the excluding unit 10 via the water feeder 30. If necessary, water can be fed from the tip of the water feeder 30, or a known suction source can be connected to the connection portion 32 to perform suction or tissue recovery.

  When the tissue is evacuated by the evacuation unit 10, the fluid storage unit 21 in contact with the tissue receives a reaction force from the tissue. As a result, the fluid storage unit 21 is deformed from the initial state shown in FIG. 6A, for example, as shown in FIG. 6B, and the volume of the internal space is reduced. As a result, a part of the fluid stored in the internal space moves to the inside of the indicator tube 22 communicating with the internal space of the fluid storage portion 21, and the position of the liquid level P is displaced in the indicator tube 22.

  By confirming the position of the liquid level P in the indicator tube 22, the operator can easily grasp the degree of deformation of the fluid container 21, that is, how much force is applied to the tissue. Therefore, by adjusting the force (exclusion force) applied to the tissue to an appropriate magnitude as necessary, the procedure can be suitably performed while suppressing an excessive burden on the patient.

  As described above, according to the medical retractor 1 of the present embodiment, since the fluid containing portion 21 and the index tube 22 are provided, the force acting on the tissue can be easily obtained without requiring an electrical configuration. It can be visually recognized. As a result, the structure of the retractor 1 is simplified, and it is easy to increase the sterilization resistance or to make it disposable.

  Further, the retractor 1 is configured such that the fluid level serving as an index of the force acting on the tissue is located away from the exclusion portion 10 that contacts the tissue. Therefore, even if blood or exudate adheres to the main body 11 during the procedure, the position of the liquid level P does not become difficult to visually recognize, and the position of the liquid level can be easily confirmed.

  Furthermore, since the mechanism for detecting the force applied to the tissue is composed of only the fluid storage unit 21, the indicator tube 22, and the fluid to be stored, the portion that contacts the tissue in the retractor 1 is thin. The thickness can be about several millimeters. Therefore, the exclusion part 10 can be suitably inserted and used also in the clearance gap between tissues, etc., and it can respond to exclusion in various aspects.

  In addition, since a plurality of sets of the fluid storage unit 21 and the index tube 22 are provided, the force acting on the tissue can be grasped for each part of the exclusion unit 10, and a finer adjustment operation can be performed.

  In addition, since the main body 11 is formed of the same material as that of the fluid storage part 21, the shape of the exclusion part 10 can be made to appropriately follow the surface shape of the tissue. Moreover, the exclusion part can be manufactured efficiently.

In the retractor of the present invention, the initial position of the end portion of the fluid stored in the fluid storage portion and the indicator tube, represented by the liquid level, can be appropriately set in consideration of the usage mode of the retractor and the like. For example, when the retractor is operated by an assistant or the like, if the index tube is extended to the vicinity of the hand of the holding portion and the initial position such as the liquid level is set to be close to the hand of the index tube, by looking at the hand The force acting on the organization can be grasped.
On the other hand, when the retractor is operated by a brain surgeon or the like, by setting an initial position near the main body 11, the position of the liquid level or the like can be easily visually recognized even within the surgical field using a microscope.
Thus, the point which can set a visual recognition position freely is one of the advantages of the retractor of this invention.

  Further, the initial position of the liquid level or the like may be set not in the indicator tube but in the fluid storage unit. In this case, for example, by setting the amount of fluid so that the liquid level is located in the index tube for the first time when the force acting on the tissue becomes a value to be careful, the user can eliminate the pressure without depending on the scale. Intuitively grasp the situation where power should be reduced.

  Furthermore, when water supply, suction, or the like is not necessary, a solid rod-like member, a spatula-like member, or the like may be used as the holding portion instead of the suction device.

  Further, in the present embodiment, an example in which the main body 11 and the fluid storage portion 21 are formed of the same material has been described. However, unlike the fluid storage portion 21, the main body 11 has a rigidity that does not easily deform. It does not have to be transparent.

  In addition, only the exclusion part, the fluid storage part, and the indicator tube (including the contained fluid) in the above embodiment can be used as a disposable pressure detection unit with a force detection function, and can be used in combination with a known water feeder or brain spatula You may comprise. In this way, it is possible to prepare multiple types of exclusion units with different sizes, thicknesses, etc., and use the exclusion unit with the most suitable dimensions for the procedure contents attached to the water feeder or brain spatula. You can easily change the size during the procedure.

  A second embodiment of the present invention will be described with reference to FIGS. In the retractor of the present embodiment, the exclusion part and the holding part are configured by the same member. In the following description, components that are the same as those already described are denoted by the same reference numerals and redundant description is omitted.

FIG. 7 is a view showing the medical retractor 101 of the present embodiment. FIG. 8 is an exploded perspective view showing the distal end portion of the retractor 101 in an enlarged manner.
As shown in FIGS. 7 and 8, the retractor 101 includes a plate-like upper member 111 and a lower member 112, and a fluid storage unit 121 and an indicator tube that are disposed between the upper member 111 and the lower member 112. 122.

  The upper members 111 and 112 are made of a metal such as stainless steel and are formed in an elongated plate shape. The upper member 111 is partially removed to form a window portion 111a.

  The dimension of the fluid storage unit 121 is set so as to be disposed between the upper member 111 and the lower member 112.

The indicator tube 122 connected to the fluid storage unit 121 is disposed so as to be visible from the window 111a. The cross-sectional shape of the indicator tube 122 is a rectangle so as to be stably disposed between the upper member 111 and the lower member 112. Unlike the index pipe 22 of the first embodiment, the base end of the index pipe 122 is closed, but an air vent hole 122a is formed on the outer peripheral surface of the index pipe 122 so as not to hinder the movement of the fluid contained therein. Is formed.
The amount of fluid accommodated in the fluid accommodating part 121 and the indicator pipe 122 is set so that the initial position of the end P is located in the window 111a.

  Both ends in the longitudinal direction of the upper member 111 and the lower member 112 are integrally connected by a connecting member 113 as shown in FIGS. Since the connection member 113 is a flexible material, it does not hinder the upper member 111 and the lower member 112 from approaching (described later). For example, various tape materials having an adhesive layer can be used as the connection member 113.

  In the retractor 101, of the upper member 111 and the lower member 112 that are integrally connected, the distal end portion where the fluid storage portion 121 is disposed functions as the exclusion portion 102, and is an area closer to the proximal end than the exclusion portion 102. Functions as the holding unit 103. That is, in the retractor 101, the exclusion part and the holding part are formed in the same member.

  The operation of the retractor 1 during use is substantially the same as in the first embodiment. When the lower member 112 is removed from the tissue by bringing the lower member 112 into contact with the tissue, the lower member 112 and the upper member 111 approach each other so as to reduce the distance by a reaction force received from the tissue. As a result, the internal space of the fluid storage unit 121 disposed between the lower member 112 and the upper member 111 is deformed, and a part of the liquid moves into the indicator tube 122. The user can grasp the magnitude of the force acting on the tissue by looking at the indicator tube 122 in the window portion 111a and confirming the position of the end portion P.

Also in the retractor 101 of this embodiment, similarly to the first embodiment, the force acting on the tissue can be easily visually recognized without requiring an electrical configuration.
Moreover, since the exclusion part 102 and the holding | maintenance part 103 are formed of the plate-shaped upper member 111 and the lower member 112, it can be used with the feeling close | similar to a general medical retractor.

  Furthermore, since the index pipe 122 is disposed between the upper member 111 and the lower member 112, the position of the index pipe 122 is stable and easily visible.

  In the present embodiment, the upper member and the lower member may be formed of different materials. For example, the lower member in contact with the tissue may be formed of stainless steel, and the upper member may be formed of resin to easily form the window portion. Or you may comprise so that the position of the fluid edge part in an indicator pipe | tube can be visually recognized by providing an upper member with transparent resin, without providing a window part.

  Further, the shapes of the upper member and the lower member may be appropriately changed. For example, the upper member and the lower member may be tapered so that the width gradually decreases as they approach the tip so as to cope with the exclusion of a finer part. Moreover, the front-end | tip part of an upper member and a lower member may be bent with a desired curvature radius.

  The embodiments of the present invention have been described above. However, the technical scope of the present invention is not limited to the above-described embodiments, and the constituent elements of different embodiments may be combined without departing from the spirit of the present invention. Various changes can be added to or deleted from the components.

  The application area of the medical retractor of the present invention is not limited to the exemplified brain surgery area. Even in other regions, the medical retractor of the present invention can be suitably used when performing exclusion on a soft tissue or the like having low tolerance to exclusion.

DESCRIPTION OF SYMBOLS 1,101 Medical retractor 10,102 Exclusion part 21,121 Fluid accommodating part (force detection part)
22, 122 Indicator tube (indicator part)
30 Water feeder (holding part)
103 Holding part

Claims (4)

An exclusion part capable of contacting a living tissue;
A holding part on which the exclusion part is supported;
A force detection unit attached to the exclusion unit;
An index unit connected to the force detection unit;
With
The force detection unit is configured to be deformed according to a force received from the living tissue,
In the indicator unit, the degree of deformation of the force detection unit is configured to be visible.
Medical retractor. The force detection unit has an internal space in which a fluid is accommodated,
The indicator portion is an indicator tube formed in a tubular shape, and is connected to the force detection portion so as to communicate with the internal space.
When the force detection unit is deformed, a part of the fluid is configured to move into the indicator tube.
The medical retractor according to claim 1. The exclusion part and the force detection part are formed of the same material,
The medical retractor according to claim 1 or 2.   The medical retractor according to any one of claims 1 to 3, wherein the holding portion is formed in a tubular shape.

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