JP2018061607A - Trocar apparatus with camera - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a trocar apparatus with a camera, the trocar apparatus being capable of smoothly deploying a retractable-type camera part disposed at a distal end of a pipe part.SOLUTION: The trocar apparatus with a camera includes a trocar having a pipe part 31 inserted into a body cavity and a trocar shaft which allows a puncture portion 55 to be exposed from the distal end of the pipe part 31. A retractable-type camera part 36 is disposed at the distal end of the pipe part 31. Hinge portions for movably holding the camera part 36 are provided at both ends of the camera part 36. A plurality of projected-strip portions 78 are provided which are formed on an outer peripheral surface of the puncture portion 55 in such a manner as to radially protrude and extend axially of the puncture portion 55. The plurality of protruded-strip portions 78 are disposed at positions corresponding to the positions of the respective hinge portions in a radially circumferential direction of the puncture portion 55 when the camera part 36 is in a storage position.SELECTED DRAWING: Figure 23B

Description

  The present invention is a patent application subject to the application of the 19th Japan Medical Research and Development Organization, "Medical-Engineering Collaboration Promotion Project" commissioned research, Article 19 of the Industrial Technology Strengthening Act, with a camera. The present invention relates to a trocar device.

  In the medical field, endoscopic surgery such as laparoscopic surgery and thoracoscopic surgery is known as a minimally invasive surgical operation that does not require laparotomy. In endoscopic surgery, in addition to rigid endoscopes for securing visual fields in body cavities such as the abdominal cavity and thoracic cavity, treatment tools such as forceps, an electric knife, and a stapler, as well as treatment tools and rigid endoscopes A trocar device is used as an insertion aid for insertion into the inside (see Patent Document 1).

  The trocar device includes a trocar having a pipe portion through which a treatment instrument or the like can be inserted, and a trocar shaft that is attached to the trocar when the pipe portion is inserted into a body cavity. In a state where the trocar shaft is attached to the trocar, the trocar shaft is inserted into the pipe portion, and the puncture portion at the tip of the trocar shaft is exposed from the tip of the pipe portion. When using a trocar, prior to the insertion of the trocar, an incision is formed by partially incising the skin, such as the abdomen of the patient. When inserting the trocar, the trocar is inserted from the puncture portion of the trocar shaft into the incision portion. The trocar pipe part is inserted after the puncture part of the trocar shaft, and the pipe part is inserted. When the pipe part is inserted, the trocar shaft is extracted from the trocar. The trocar is fixed in a state where the pipe portion is inserted into the body cavity, and is used as an insertion port for inserting a treatment instrument or the like in this state.

  The puncture part of the trocar shaft enters the incision part prior to the pipe part, and the abdominal wall formed of skin or fat or other subcutaneous tissue so that the subsequent pipe part can enter the body cavity through the incision part To play a role in spreading Therefore, the puncture portion of the trocar shaft has a tapered cannonball shape or a conical shape. Further, since the puncture part is inserted into the body cavity by scraping the abdominal wall, a ridge part for tearing fat or the like is formed on the outer peripheral surface of the puncture part as described in Patent Document 1. Some are. The protruding portion is formed to protrude outward on the outer peripheral surface of the distal end portion, and has a cutting edge extending from the distal end toward the proximal end. Moreover, in patent document 1, when the front-end | tip part is seen from the front of an axial direction, the arrangement | positioning of the circumferential direction in the outer peripheral surface of a protrusion part is formed in the form which a streak enters in the radial direction of a front-end | tip part in one character shape. .

  In a surgical operation under a microscope, it is a matter of course that the region to be treated cannot be observed with the naked eye, and the visual field of the region to be treated is provided exclusively by a laparoscopic image. Therefore, the field of view is significantly limited in the endoscopic surgery, as compared with the laparotomy in which the treatment target region can be visually observed. In order to perform an appropriate procedure, it is preferable that the blind spot of the visual field is as small as possible. Therefore, it is necessary to ensure a wide visual field without the blind spot. In particular, for a treatment instrument that performs a procedure in direct contact with a region to be treated, a visual field that can accurately confirm the position and posture is required.

  In order to meet these demands, a trocar device with a camera in which a camera is provided at the tip of a trocar pipe has been proposed (see Patent Document 1). Since the trocar is a treatment tool insertion aid, it is possible to photograph the position and posture of the treatment tool with a camera at the tip of the pipe portion. The camera described in Patent Document 1 is a retractable type that is displaced between a storage position stored in the pipe portion and a deployment position that pops up and expands in a direction protruding from the outer peripheral surface of the pipe portion.

Japanese Patent Laid-Open No. 2006-16053

  However, the development of such a camera-equipped trocar device has the following problems. In the case of a trocar device with a camera, the trocar is inserted while the camera is stored, and the camera is deployed after the trocar is inserted into the body cavity. However, such a camera may not be deployed smoothly. It was.

  The reason is considered to be as follows. That is, in the camera-equipped trocar device, the camera is positioned at the distal end of the pipe portion. Therefore, when the trocar shaft is attached, the camera is positioned on the proximal end side with respect to the puncture portion exposed from the distal end of the pipe portion. . For this reason, when the puncture part of the trocar shaft enters the body cavity while scraping the fat, the fat may wrap around the camera position at the tip of the pipe part, and this wrapping of the fat hinders smooth deployment of the camera. It is thought.

  An object of the present invention is to provide a camera-equipped trocar device capable of smoothly deploying a retractable camera unit disposed at the tip of a pipe unit.

  The trocar device with a camera of the present invention includes a trocar, a trocar shaft, a camera part, a hinge part, and a ridge part. The trocar has a pipe portion that is inserted into a body cavity. The trocar shaft is a trocar shaft that is attached to the trocar when the trocar is inserted into a body cavity and has a puncture portion formed at the tip, and the puncture portion is exposed from the tip of the pipe portion when attached to the trocar. . The camera unit is a camera unit disposed at the tip of the pipe unit, and is a retractable type that is displaced between a storage position stored in the pipe unit and a deployment position developed in a direction protruding from the outer peripheral surface of the pipe unit. It is a camera part. The hinge part is provided at both ends of the camera part, and holds the camera part so that it can be displaced between the storage position and the deployed position. A plurality of protrusions formed on the outer peripheral surface of the puncture portion, projecting in the radial direction, and extending along the axial direction of the puncture portion, and when the camera portion is in the retracted position, the circumferential direction around the axis of the puncture portion In FIG. 4, the hinge portions are arranged at positions corresponding to the positions of the hinge portions.

  The plurality of protrusions are preferably arranged in a cross shape in a cross shape when the puncture portion is viewed from the front end side in the axial direction. Moreover, it is preferable that the upper end part of a some protrusion part becomes a flat surface.

  The puncture portion preferably has a tapered shape whose diameter gradually increases from the distal end toward the proximal end. Moreover, it is preferable that the radial maximum diameter of the plurality of protrusions is equal to or less than the maximum diameter of the portion where the protrusions are not formed on the outer peripheral surface of the puncture portion.

  ADVANTAGE OF THE INVENTION According to this invention, in the trocar apparatus with a camera, deployment of the retractable camera part arrange | positioned at the front-end | tip of a pipe part can be performed smoothly.

It is a schematic diagram of a laparoscopic system. It is sectional drawing in the abdominal cavity of the state which inserted the trocar. It is an external appearance perspective view of the trocar device with a camera of the state which stored the camera part. It is an external appearance perspective view of the trocar apparatus with a camera of the state which expand | deployed the camera part. It is a disassembled perspective view of the state which removed the trocar shaft from the trocar with a camera. It is the disassembled perspective view which decomposed | disassembled the trocar with a camera into the inner cylinder member and the outer cylinder member. It is a disassembled perspective view of the trocar with a camera. It is a front view of a trocar shaft. It is an enlarged view of the front-end | tip part of the trocar with a camera of the state which stored the camera part. It is an enlarged view of the front-end | tip part of the trocar with a camera of the state which stored the camera part. It is explanatory drawing of the expansion | deployment mechanism of a camera part. It is explanatory drawing of the expansion | deployment mechanism at the time of seeing a camera part from the back. It is a side view of the trocar device with a camera of the state which stored the camera part. It is a side view of the trocar apparatus with a camera of the state which expand | deployed the camera part. It is sectional drawing of the trocar apparatus with a camera of the state which stored the camera part. It is sectional drawing of the trocar apparatus with a camera of the state which expand | deployed the camera part. It is explanatory drawing of a cam groove. It is explanatory drawing of the expansion | deployment assistance mechanism in the state which has a trocar shaft in an initial position. It is explanatory drawing of the expansion | extension assistance mechanism of the state which the trocar shaft started contact | abutting with the camera part. It is explanatory drawing of the expansion | deployment assistance mechanism in the state which has a trocar shaft in a terminal position. It is explanatory drawing which shows the positional relationship of the press part of a trocar shaft, and a camera part. It is a back perspective view of the press part of a trocar shaft. It is a disassembled perspective view which shows an outer cylinder locking mechanism. It is 1st explanatory drawing of the assembly | attaching method of a lock release operation member. It is 2nd explanatory drawing of the assembly | attaching method of a lock release operation member. It is 3rd explanatory drawing of the assembly | attaching method of a lock release operation member. It is explanatory drawing of the lock release operation member in the state which has an outer cylinder in a holding position. It is explanatory drawing of the lock release operation member of the state which released the lock | rock of the outer cylinder. It is explanatory drawing of the lock release operation member of a state in which an outer cylinder exists in a holding release position. It is an enlarged view of the hinge part of the state which the camera part expand | deployed. It is an enlarged view of the hinge part of the state which the camera part stored. It is 1st explanatory drawing of the attachment method of a camera part. It is 2nd explanatory drawing of the attachment method of a camera part. It is 3rd explanatory drawing of the attachment method of a camera part. It is an enlarged view which shows the positional relationship of the protrusion part of a puncture part, and a camera part. It is a front view of the pipe part of the state in which the camera part is stored, and the protrusion part of a puncture part. It is a front view of the pipe part of the state by which the camera part is expand | deployed, and the protrusion part of a puncture part. It is a side view which shows the winding of the fat to a camera part. It is a top view which shows the winding of the fat to a camera part. It is explanatory drawing which shows the modification of a protrusion part. It is a back perspective view of an airtight structure unit. It is a disassembled perspective view of an airtight structure unit. It is a disassembled perspective view (sectional drawing) of an airtight structure unit. It is a perspective view of a dome shape seal and a centering guide. It is sectional drawing of the head part in which the airtight structure unit was accommodated. It is a rear view of a centering guide. It is explanatory drawing of the segment of a centering guide. It is a rear view of the seal unit of the state which inserted the treatment tool. It is a rear view of the seal unit in the state where the inserted treatment instrument has moved in the radial direction.

[First Embodiment]
[Overall configuration of laparoscopic system]
A laparoscopic system 10 shown in FIG. 1 is an example of an intra-body cavity observation system for medical staff ST including a doctor to observe the inside of a body cavity of a patient P (more specifically, intra-abdominal) during laparoscopic surgery. Used for. The laparoscopic system 10 includes an endoscope system and a trocar device 12 with a camera according to the present invention. The endoscope system includes an endoscope 11, a processor 18, a monitor 19, and a console 20. The camera-equipped trocar device 12 includes a camera-equipped trocar 16 and a trocar shaft 17 (see FIG. 5).

  The trocar 16 with a camera is obtained by adding a camera function to a trocar that is an insertion instrument used as an insertion port for inserting a treatment tool 22 such as forceps into a body cavity.

  The processor 18 performs image processing for each of the endoscopic image in the abdominal cavity photographed by the endoscope 11 and the trocar image in the abdominal cavity photographed by the camera of the camera-equipped trocar 16. The processor 18 has an image synthesis function for synthesizing the endoscopic image and each trocar image. As shown in FIG. 1, a composite image of an endoscopic image and a trocar image is displayed on the monitor 19 of the processor 18. The visual field in the abdominal cavity is provided to the medical staff ST by such a composite image. Instead of or in addition to displaying the composite image, the endoscopic image and the trocar image may be displayed in independent display windows.

  As shown also in FIG. 2, the endoscope 11 is inserted into the abdominal cavity of the patient P through the trocar 21. Unlike the trocar 16 with a camera, the trocar 21 for the endoscope 11 is a normal trocar without a camera. The trocar 21 is an insertion instrument used as an insertion port for inserting the endoscope 11 into the abdominal cavity. The trocar 21 has a substantially cylindrical pipe portion and a head portion which is provided on the proximal end side of the pipe portion and has a diameter larger than that of the pipe portion. The pipe portion of the trocar 21 is provided with an insertion hole that penetrates the inside in the axial direction, and the endoscope 11 is inserted through the insertion hole.

  In laparoscopic surgery, when the trocars 21 and 16 are inserted into the abdominal cavity, the skin of the abdominal wall 23 of the patient P is incised with a scalpel to form incisions 26 and 27. The abdominal wall 23 is formed of skin, subcutaneous tissue such as fat 23A (see FIGS. 24A and 24B), and muscle tissue. Formed with. In this example, since a total of three trocars, one trocar 21 for the endoscope 11 and two trocars 16 with two cameras, are used, the number of incisions 26 and 27 is one incision for the endoscope 11. There are a total of three parts 26 and two incisions 27 for the treatment instrument 22. As for the positions of the three incisions 26 and 27, for example, the incision 27 for the treatment instrument 22 is provided on the left and right of the incision 26 for the endoscope 11. Note that the number and position of the incisions 26 and 27 in this example are merely examples, and can be determined as appropriate depending on the target site for surgery, the number of treatment tools to be used, and the like.

  The trocar 21 is inserted into the incision 26 and fixed to the abdominal wall 23. The camera-equipped trocar 16 is inserted into each of the two incisions 27 and fixed to the abdominal wall 23. Accordingly, the trocar 21 can be used as an insertion port for the endoscope 11, and the trocar 16 with a camera can be used as an insertion port for the treatment instrument 22.

  As shown on the screen of the monitor 19 in FIG. 1, the endoscope 11 inserted into the central trocar 21 provides a field of view of the entire site to be treated in the abdominal cavity, and is positioned on both sides of the endoscope 11. The camera-mounted trocar 16 provides a visual field around the distal end portion 22A of the treatment instrument 22 as a center.

  As shown in FIG. 2, during laparoscopic surgery, an insufflation procedure is performed to expand the abdominal cavity by injecting carbon dioxide into the abdominal cavity. A space for performing treatment in the abdominal cavity is secured by the pneumoperitoneum treatment. The normal trocar 21 or the camera-equipped trocar 16 is provided with a connection port to which an air supply pipe of a gas supply device (not shown) is connected (refer to FIGS. 3 and 4 for the connection port 49 of the camera-equipped trocar 16). ing. Carbon dioxide supplied from the gas supply device is injected into the abdominal cavity through the trocar 21 and the camera-equipped trocar 16.

  As described above, since pneumoperitoneum is performed in laparoscopic surgery, the trocar 21 and the camera-equipped trocar 16 airtightly insert the insertion holes in order to prevent gas leakage from the inside of the body cavity to the outside of the body cavity through the respective insertion holes. An airtight structure for sealing is provided. The airtight structure of the camera-equipped trocar 16 will be described in detail later.

[Schematic configuration of endoscope]
As shown in FIG. 2, the endoscope 11 is a rigid endoscope in which the insertion portion 11A is formed of a hard member such as metal, for example. At the distal end of the insertion portion 11A, there are provided an illumination window for irradiating illumination light to a subject (such as a viscera) in the abdominal cavity and a camera unit 28 for receiving the reflected light reflected by the subject and photographing the subject. . As is well known, the camera unit 28 includes an image sensor (not shown) that photoelectrically converts received light, such as a charge-coupled device (CCD) image sensor or a complementary metal-oxide-semiconductor (CMOS) image sensor, and an image sensor. A photographing lens (not shown) for forming an optical image of the subject on the imaging surface of the element;

  The image sensor is a color image sensor, for example, and outputs a captured image as an image signal of three colors of R (Red), G (Green), and B (Blue). The image sensor can shoot a moving image and outputs an image signal at a predetermined frame rate. Image signals are sequentially output to the processor 18 via signal lines.

  A signal line, a light guide, and the like are provided in the insertion portion 11A. The light guide guides illumination light supplied from a light source device (not shown) to the illumination window. At the proximal end portion of the endoscope 11, one end of a universal cable (not shown) in which a signal line and a light guide are disposed is provided. At the other end of the universal cable, a connector for connecting the light guide to the light source device and a connector for connecting the signal line to the processor 18 are provided. The endoscope 11 is connected to the light source device and the processor 18 via a universal cable.

[Overall configuration of trocar device with camera]
As shown in FIGS. 3 to 7, the camera-equipped trocar device 12 includes a camera-equipped trocar 16 and a trocar shaft 17. A trocar shaft 17 is detachably attached to the trocar 16 with camera. The camera-equipped trocar 16 includes a cylindrical pipe portion 31 and a head portion 32 provided at the proximal end of the pipe portion 31. The head portion 32 has a substantially cylindrical shape that is larger in diameter than the pipe portion 31. The trocar 16 with a camera is provided with an insertion hole 33 that penetrates the inside of the pipe portion 31 in the axial direction (Z-axis direction) and through which the treatment instrument 22 and the like are inserted.

[Schematic configuration of camera-equipped trocar]
As shown in FIG. 6, the camera-equipped trocar 16 is mainly composed of an inner cylinder member 16A and an outer cylinder member 16B, and most of the inner cylinder member 16A is enclosed in the outer cylinder member 16B. It has become. The inner cylinder member 16A includes a pipe portion inner cylinder 31A and a head portion inner cylinder 32A provided on the proximal end side of the pipe portion inner cylinder 31A. The pipe portion inner cylinder 31A and the head portion inner cylinder 32A are made of, for example, resin, and both are integrally formed. The outer cylinder member 16B includes a pipe portion outer cylinder 31B and a head portion outer cylinder 32B provided on the proximal end side of the pipe portion outer cylinder 31B. In this example, the pipe part outer cylinder 31B and the head part outer cylinder 32B are made of resin, for example, and both are integrally formed.

  The pipe portion inner cylinder 31A is provided with a retractable (retractable) camera portion 36 at the tip thereof. As shown in FIG. 3, the camera unit 36 pops up and expands in a storage position stored inside the pipe portion inner cylinder 31 </ b> A and a direction protruding from the outer peripheral surface of the pipe portion inner cylinder 31 </ b> A as shown in FIG. 4. It is provided so as to be freely displaceable between the deployed position. The inner cylinder member 16A and the outer cylinder member 16B are provided so as to be relatively slidable along the axial direction (Z-axis direction). As will be described later, the camera part 36 is expanded and stored by sliding the pipe part outer cylinder 31B with respect to the pipe part inner cylinder 31A.

  A slip stopper 41 is formed on the outer peripheral surface of the pipe portion outer cylinder 31B. The anti-slip 41 is for fixing the pipe part 31 to the abdominal wall 23 at a desired insertion position. The anti-slip 41 is configured in such a manner that a plurality of irregularities formed in the circumferential direction around the Z axis are arranged in the Z axis direction on the outer peripheral surface of the pipe portion outer cylinder 31B. The anti-slip 41 has a higher friction coefficient than that of a portion having no unevenness. The anti-slip 41 is formed over substantially the entire length in the Z-axis direction of the pipe portion outer cylinder 31B. Therefore, the anti-slip 41 and the abdominal wall 23 can be engaged at any position in the Z-axis direction of the pipe portion 31B. By this engagement, the pipe portion 31B can be fixed to the abdominal wall 23 at a desired insertion depth.

  As shown in FIG. 6 and FIG. 7, the main part of the head part 32 is composed of a head part inner cylinder 32 </ b> A and a head part outer cylinder 32 </ b> B. As shown in FIG. 7, the trocar 16 with a camera incorporates an airtight structure unit 42, and the airtight structure unit 42 is accommodated in the head portion inner cylinder 32A. A rear cover 43 that covers the proximal end side opening is attached to the proximal end portion of the head portion inner cylinder 32A. The head inner cylinder 32A is provided with a connection port 49 (see also FIGS. 3 and 4) to which a gas supply device is connected. As described above, carbon dioxide gas is injected into the abdominal cavity through the connection port 49, and the pneumoperitoneum is performed. The airtight structure unit 42 has a function of preventing gas leakage from the abdominal cavity to the outside of the body.

  Further, the head portion 32 is provided with a connector portion 44. The connector unit 44 is a connector for connecting a communication cable (not shown) for electrical connection with the processor 18. The connector portion 44 is provided on the rear cover 43, and is disposed at a position facing the outer peripheral surface of the head portion 32 when the rear cover 43 is attached to the head portion inner cylinder 32 </ b> A. The connector part 44 is electrically connected to the camera part 36 via a flexible cable (not shown) disposed in the gap between the inner cylinder member 16A and the outer cylinder member 16B. The connector unit 44 relays an image signal from the camera unit 36 to the processor 18 and relays a control signal from the processor 18 to the camera unit 36.

  An opening 43 </ b> E for inserting the trocar shaft 17 and the treatment instrument 22 is formed on the rear surface of the rear cover 43. Further, on the outer peripheral surface of the rear cover 43 in the circumferential direction around the Z-axis, a gripping portion 43D formed with a plurality of irregularities is formed. The grip portion 43D functions as a slip stopper when gripping and operating the head portion inner cylinder 32A.

  Further, four engagement holes 43A are formed on the outer peripheral surface of the rear cover 43 with an interval of about 90 ° in the circumferential direction. Engagement claws 35 that engage with the respective engagement holes 43A are formed on the outer peripheral surface of the head portion inner cylinder 32A. The rear cover 43 is attached to the head portion inner cylinder 32 </ b> A by the engagement of the engagement holes 43 </ b> A and the engagement claws 35.

  Slots 43F that are grooves extending in the Z-axis direction are formed on both sides of each engagement hole 43A. As a result, a portion of the rear cover 43 where the engagement hole 43A is formed can be elastically deformed. When the engagement hole 43 </ b> A and the engagement claw 35 are engaged, a portion where the engagement hole 43 </ b> A is formed is elastically deformed outward in the radial direction so as to ride on the engagement claw 35. By forming the slit 43F, the engagement holes 43A and the engagement claws 35 can be easily engaged.

  A fitting groove 43 </ b> B extending in an arc shape in the circumferential direction is formed in the base end portion of the rear cover 43. The fitting groove 43B is fitted with a fitting claw 54A (see FIG. 6) provided in the handle portion 54 of the trocar shaft 17. By fitting the fitting groove 43B and the fitting claw 54A, the trocar shaft 17 is attached to the head portion inner cylinder 32A as shown in FIGS.

  As shown in FIGS. 6 and 7, a notch 43C is formed in a part of the fitting groove 43B, and the fitting claw 54A is inserted into the fitting groove 43B from the notch 43C and inserted. The handle part 54 is rotated around the axis from the position and fitted. This fitting completion position corresponds to an initial position of the trocar shaft 17 described later (see FIGS. 12A, 13A, and 3).

  An unlocking operation member 46 is disposed on the outer peripheral surface of the head portion outer cylinder 32B. The unlocking operation member 46 is an operation unit for releasing an outer cylinder locking mechanism that locks the sliding of the outer cylinder member 16B with respect to the inner cylinder member 16A. As will be described later, the unlocking operation member 46 is a component of the outer cylinder locking mechanism together with the engaging portion 47 provided on the outer peripheral surface of the head inner cylinder 32A. The engaging portion 47 is provided on the outer peripheral surface of the head portion inner cylinder 32A, and is disposed at two positions opposed to each other in the circumferential direction around the axis of the outer peripheral surface, that is, two locations at intervals of about 180 ° in the circumferential direction. Yes.

  The unlocking operation member 46 is disposed at a position facing the two engaging portions 47 in the circumferential direction around the Z-axis of the head portion outer cylinder 32B. The unlocking operation is performed by simultaneously operating the two unlocking operation members 46 arranged opposite to each other so as to be sandwiched by hands. When the unlocking operation is performed, the outer cylinder member 16B can slide with respect to the inner cylinder member 16A.

  The head outer cylinder 32B is provided with a cam plate 51 extending further rearward from the base end. A cam groove 52 is formed on the outer peripheral surface of the cam plate 51. The cam plates 51 are arranged at two positions facing each other in the circumferential direction of the head portion outer cylinder 32B, that is, at intervals of about 180 ° in the circumferential direction. The cam plate 51 engages with the handle portion 54 (see FIG. 6) of the trocar shaft 17 to change the rotation of the trocar shaft 17 about the axis to slide in the Z-axis direction of the outer cylinder member 16B. As will be described in detail later, the rotation of the trocar shaft 17 causes the head portion outer cylinder 32B to slide, and the camera portion 36 is expanded and stored.

[Schematic configuration of trocar shaft]
As shown in FIGS. 3 and 4, the trocar shaft 17 is attached to the trocar 16 with a camera when the pipe portion 31 is inserted into the body cavity. In FIG. 5 showing a state in which the trocar shaft 17 is removed from the camera-equipped trocar 16, the trocar shaft 17 includes a shaft portion 53 and a handle portion 54 that is provided at the base end of the shaft portion 53 and has a larger diameter than the shaft portion 53. ing. A puncture portion 55 is provided at the tip of the shaft portion 53. In a state where the trocar shaft 17 is mounted on the camera-equipped trocar 16, the shaft portion 53 is inserted into the insertion hole 33 of the pipe portion 31. In this state, as shown in FIG. 3, the shaft portion 53 passes through the insertion hole 33, and the puncture portion 55 protrudes from the tip of the pipe portion 31 and is exposed to the outside.

  As shown in FIG. 3, the puncture portion 55 has a tapered shape in which the outer diameter around the Z-axis is the smallest at the distal end and gradually increases toward the proximal end side. In this example, the shape of the puncture part 55 is a shell type in which a contour line indicating the outer peripheral surface is a curve in a longitudinal section (YZ section) cut along the Z-axis direction. In addition, it is good also as a cone shape in which the outline which shows an outer peripheral surface becomes a straight line in a longitudinal cross-section. When the camera-equipped trocar 16 is inserted into the body cavity, the puncture portion 55 punctures the incision portion 27 (see FIG. 2). Then, the incision portion 27 is pushed and widened by the puncture portion 55, and the pipe portion 31 behind the puncture portion 55 is inserted into the incision portion 27 that has been spread.

  As shown in FIG. 5, the shaft portion 53 has a puncture portion 55, a shaft portion main body 56, and a connecting portion 57. The connecting portion 57 connects the puncture portion 55 and the shaft portion main body 56. The maximum diameter of the puncture portion 55 and the maximum diameter of the shaft portion main body 56 are substantially equal, and the cross-sectional area of the cross section (XY cross section) orthogonal to the Z-axis direction is approximately equal. On the other hand, in the transverse cross section (XY cross section) of the shaft portion 53, the cross sectional area of the connecting portion 57 is smaller than the cross sectional areas of the puncture portion 55 and the shaft portion main body 56. The connecting portion 57 is arranged offset from the central axis of the shaft portion 53. Specifically, the connecting portion 57 is arranged offset in a direction away from the storage position of the camera portion 36.

  When the trocar shaft 17 is attached, the camera unit 36 is located behind the puncture unit 55. When the pipe part 31 is inserted into the body cavity, the camera part 36 is stored in the pipe part 31. The connecting portion 57 is provided to secure a space for storing the camera portion 36 behind the puncture portion 55 in a state where the trocar shaft 17 is attached to the trocar 16 with a camera.

  The handle portion 54 is gripped when the trocar shaft 17 is attached to or removed from the trocar 16 with a camera or rotated in an inserted state. Two pin arrangement plates 58 are provided on the outer peripheral surface of the handle portion 54. The pin arrangement plate 58 extends to the tip side where the puncture portion 55 is located, and a cam pin 59 that engages with the cam groove 52 of the head portion outer cylinder 32B is provided on the inner peripheral surface 58C facing the cam plate 51. ing. The two pin arrangement plates 58 are located at two positions facing each other in the circumferential direction around the Z axis of the handle portion 54 in accordance with the positions of the two cam plates 51, that is, two places at intervals of about 180 ° in the circumferential direction. Has been placed.

  More specifically, the two pin arrangement plates 58 are devised in the following shapes in consideration of moldability by a mold.

  As shown in FIG. 8, the two pin arrangement plates 58 are provided such that the cam pins 59 are arranged at intervals of 180 ° in the circumferential direction around the Z axis. The two pin arrangement plates 58 are extended portions in which the cam pins 59 are arranged on one end side of the pin arrangement plate 58 and extend in a direction perpendicular to the coupling line Lp connecting the two cam pins 59 facing each other. 58E. The coupling line LP coincides with the protruding direction of the cam pin 59.

  Further, the extension 58 </ b> E is formed in a direction that is point-symmetric with respect to the rotation center O of the trocar shaft 17. That is, in FIG. 8, the extension 58 </ b> E of the right pin arrangement plate 58 extends downward from the position of the cam pin 59, and conversely, the extension 58 </ b> E of the left pin arrangement plate 58 extends from the position of the cam pin 59. It extends upward.

  The pin arrangement plate 58 has a cross-sectional shape orthogonal to the Z-axis of the trocar shaft 17 and has a wedge shape in which the thickness on the cam pin 59 side is thicker and the extension portion 58E becomes thinner as the distance from the cam pin 59 increases. An inner peripheral surface 58C of the pin disposition plate 58 is formed by a plane extending in a direction orthogonal to the coupling line Lp of the cam pin 59, and an outer peripheral surface 58D of the pin disposition plate 58 has a part of the cross-sectional shape. , A curved surface having a portion overlapping with the arc shape of a circle centered on the rotation center O (for example, a concentric circle on the outer peripheral surface of the pipe portion 31).

  By forming the pin arrangement plate 58 in such an arrangement and shape, the moldability by the mold is good. This is because, for example, when using a mold that is divided into two above and below the connecting line Lp, the drawing direction of the two molds after molding is the vertical direction orthogonal to the connecting line Lp. In this case, if the inner peripheral surface 58C of the pin arrangement plate 58 is formed by a plane extending in a direction orthogonal to the coupling line Lp, the two molds can be extracted vertically.

  Further, the cross-sectional shape of the pin mounting plate 59 has a wedge shape in which the thickness on the cam pin 59 side is thick and the thickness becomes thinner as the extension portion 58E is separated from the cam pin 59, and the outer peripheral surface 58D has a cross-sectional shape. A part of the shape is formed by a curved surface having a portion overlapping with the circular arc shape of the circle centered on the rotation center. That is, the shape of the cross-section of the pin mounting plate 59 is reduced in thickness along the mold extraction direction, and therefore does not hinder the mold extraction. Thereby, the favorable moldability of the pin arrangement | positioning board 58 is ensured.

[Camera unit and deployment mechanism]
As shown in FIGS. 9A, 9B, and 10, the camera unit 36 is provided in a notch 61 formed at the tip of the pipe inner cylinder 31A. The camera unit 36 includes a camera unit 62, a mount 63, and a housing 64. Similarly to the camera unit 28 of the endoscope 11, the camera unit 62 includes an imaging element such as a CCD image sensor or a CMOS image sensor and a photographing lens 62A. Further, the camera unit 62 may be provided with illumination units (not shown) formed of light emitting elements such as LEDs (Light Emitting Diodes) on both sides of the lens barrel unit 62B having the photographing lens 62A.

  The camera unit 62 is communicably connected to the connector unit 44 provided in the head unit 32 by a flexible cable (not shown). An image signal output from the camera unit 62 and a control signal transmitted from the processor 18 are communicated between the camera unit 62 and the processor 18 via the flexible cable and the connector unit 44. Although not shown, one end of the flexible cable is connected to the base end side of the camera unit 36, and is disposed in the gap between the pipe unit inner cylinder 31 </ b> A and the pipe unit outer cylinder 31 </ b> B, and the other end extends to the connector unit 44. It is extended.

  The camera unit 62 is attached to the housing 64 via the mount 63. Here, when the pipe part 31 is viewed from the front end side in the Z-axis direction, the position where the notch part 61 and the camera part 36 are arranged is defined above the pipe part 31. The housing 64 has a shape surrounding the camera unit 62 and both side edges in the width direction, and has an upper surface portion 64A that covers the upper side and side surface portions 64B that cover the both side surfaces.

  The upper surface portion 64 </ b> A has a shape corresponding to the shape of the notch portion 61 of the pipe portion 31, and the outer peripheral surface is configured with a curved surface according to the outer diameter of the pipe portion 31. As a result, as shown in FIG. 9A, when the camera unit 36 is in the retracted position, the housing 64 fits into the cutout portion 61 and constitutes a part of the upper surface of the pipe portion 31.

  The camera unit 36 is provided to be rotatable between a retracted position and a deployed position with the base end side as a fulcrum. As shown in FIG. 10, a pair of left and right turning pins 65 are provided on the outer surface of each side surface portion 64 </ b> B located at both ends of the camera portion 36. Each rotation pin 65 protrudes outward from both ends of the camera unit 36 in the width direction of the camera unit 36. The rotation pin 65 constitutes a rotation axis of the camera unit 36. On the proximal end side of the inner periphery of the cutout portion 61, a bearing portion 67 that rotatably supports each rotation pin 65 is provided. Here, the rotation pins 65 provided on the side portions 64B at both ends of the camera portion 36 and the bearing portions 67 provided on the inner periphery of the notch portion 61 constitute hinge portions provided at both ends of the camera portion 36. To do.

  The camera part 36 is held displaceable by the action of the hinge part. Specifically, the camera unit 36 is rotated from the retracted position shown in FIG. 9A around the rotation pin 65 on the proximal end side, and is unfolded so as to jump up the distal end side as shown in FIG. 9B. To do. In the unfolded position shown in FIG. 9B, the photographing lens 62A is arranged so as to face the distal end side so that the treatment instrument 22 protruding from the insertion hole 33 can be photographed.

  As shown in FIGS. 10 and 11, a spring 71 is attached to the camera unit 36 and is urged to the deployed position by the spring 71. The spring 71 is, for example, a coil spring, and two springs 71 are used. A hook 64 </ b> C to which one end of the spring 71 is attached is provided at the base end of the housing 64. The pipe inner cylinder 31 </ b> A is provided with two receiving recesses 72 for receiving the two springs 71 on the proximal end side of the notch 61. The two receiving recesses 72 are formed so that the longitudinal direction thereof coincides with the Z-axis direction and are arranged in parallel. The groove of the housing recess 72 is formed to such a depth that the spring 71 does not protrude from the outer diameter of the pipe portion inner cylinder 31A in a state where the spring 71 is housed. Thereby, interference with the inner peripheral surface of the pipe part outer cylinder 31B sliding with respect to the pipe part inner cylinder 31A and the spring 71 is prevented.

  Each accommodating recess 72 is provided with a hook 72A to which the other end of the spring 71 is attached. The spring 71 is attached to the hook 64C and the hook 72A, respectively, in a state where the spring 71 extends from a natural length to which no external force is applied. For this reason, the spring 71 generates a biasing force in a contracting direction when attached to the hook 64C and the hook 72A. Since the hook 64 </ b> C provided at the base end of the camera unit 36 is located above the rotation pin 65, the hook 64 </ b> C is pulled to the base end side by the urging force in the contraction direction generated by the spring 71. By this pulling, a rotational force acts on the camera unit 36 toward the deployed position with the rotation pin 65 as a fulcrum, and the camera unit 36 is biased toward the deployed position.

  As shown in FIGS. 12A and 12B and FIGS. 13A and 13B, the deployment and storage of the camera unit 36 are performed by a sliding operation of the pipe unit outer cylinder 31B. As shown in FIGS. 12A and 13A, the pipe portion outer cylinder 31B has a holding position for holding the camera portion 36 in the retracted position, and as shown in FIGS. 12B and 13B, is retracted further backward from the holding position. Slide along the axial direction between the holding release position to release the holding.

  As described above, the camera unit 36 is biased by the spring 71 toward the deployed position. As shown in FIGS. 12A and 13A, in the pipe portion outer cylinder 31B, the distal end portion of the pipe portion outer cylinder 31B covers the rear portion of the camera portion 36 in the holding position. Thereby, the pipe outer cylinder 31B restricts the deployment of the camera unit 36 against the biasing force of the spring 71, and holds the camera unit 36 in the retracted position. 13A, when the trocar shaft 17 is mounted on the camera-equipped trocar 16, the camera unit 36 is stored in an accommodation space formed by the connecting portion 57 at the storage position.

  On the other hand, when the pipe portion outer cylinder 31B slides to the holding release position shown in FIGS. 12B and 13B, the tip end portion of the pipe portion outer cylinder 31B is retracted from the rear portion of the camera portion. As a result, the holding of the pipe portion outer cylinder 31B with respect to the camera portion 36 is released. When the holding is released, the camera unit 36 pops up and expands by the bias of the spring 71.

  In this example, the outer cylinder member 16B having the pipe portion outer cylinder 31B corresponds to the holding member. The spring 71 and the outer cylinder member 16B constitute a deployment mechanism that releases the holding of the camera unit 36 by the releasing operation of the outer cylinder member 16B, and pops up and deploys the camera unit to the deployment position.

[Operation mechanism for unfolding and storing the camera unit]
As shown in FIGS. 12A and 12B, the sliding operation of the pipe portion outer cylinder 31 </ b> B is performed by a rotating operation around the axis of the trocar shaft 17. As described above, the cam plate 51 in which the cam groove 52 is formed is provided in the head portion outer cylinder 32B of the outer cylinder member 16B. The cam groove 52 engages with a cam pin 59 (see FIG. 5) provided on the trocar shaft 17. The cam groove 52 and the cam pin 59 constitute an operation mechanism that slides the pipe portion outer cylinder 31 </ b> B to the proximal end side by rotating the trocar shaft 17.

  As shown in FIG. 14, the outer peripheral surface of the cam plate 51 is configured by a curved surface in accordance with the curvature of the head portion outer cylinder 32B (see also FIGS. 3 and 4). The cam groove 52 has an inclined portion 52E that is inclined with respect to the axial direction, and the first end 52A of the inclined portion 52E and the second end 52B of the other are different in the position in the Z-axis direction. . The first end 52A is positioned relatively on the proximal end side in the Z-axis direction, and the second end 52B is positioned on the distal end side.

  Further, the cam groove 52 includes a guide groove 52C and a straight portion 52D in addition to the inclined portion 52E. One end of the guide groove 52C is connected to the second end 52B and extends in the Z-axis direction toward the base end side. One end of the linear portion 52D is connected to the first end 52A and extends in the circumferential direction.

  As shown in FIGS. 12A and 12B and FIGS. 13A and 13B, in a state where the trocar shaft 17 is attached to the trocar 16 with a camera, the handle portion 54 is fitted by the fitting claw 54A and the fitting groove 43B. It is attached to the head portion inner cylinder 32A. Therefore, the position of the trocar shaft 17 in the Z-axis direction is fixed with respect to the inner cylinder member 16A. When the trocar shaft 17 is attached to the camera-equipped trocar 16, the cam pin 59 provided in the head portion outer cylinder 32B engages with the cam groove 52 provided in the head portion inner cylinder 32A. Since the position of the trocar shaft 17 in the Z-axis direction is fixed with respect to the inner cylinder member 16A, when the trocar shaft 17 rotates, the engagement between the cam pin 59 and the inclined portion 52E of the cam groove 52 results in the outer cylinder member 16B. Slides with respect to the trocar shaft 17 and the inner cylinder member 16A.

  Specifically, first, as shown in FIGS. 12A and 13A, when the pipe portion outer cylinder 31B is in the holding position, the camera portion 36 is in the storage position. In the state of the holding position, the cam pin 59 is located in a section between the first end 52A of the cam groove 52 and the linear portion 52D. The initial position of the trocar shaft 17 is a position where the cam pin 59 comes into contact with the end of the linear portion 52D opposite to the first end 52A. That is, the initial position of the trocar shaft 17 is a terminal position when the trocar shaft 17 is rotated counterclockwise as viewed from the front end side in the Z-axis direction.

  Even when the trocar shaft 17 is rotated in the clockwise direction when viewed from the front end side, while the cam pin 59 is positioned at the first end 52A from the initial position, that is, while the cam pin 59 is in the section of the straight portion 52D, the pipe portion The outer cylinder 31B does not slide in the axial direction and maintains the holding position. The straight portion 52D is provided to ensure a play that prevents the pipe portion outer cylinder 31B from starting to slide immediately after the trocar shaft 17 is rotated. By securing such play, the holding of the camera unit 36 is prevented from being released by an inadvertent slight rotation of the trocar shaft 17 in the initial position.

  When the trocar shaft 17 starts rotating from the initial position in the clockwise direction when viewed from the distal end side, the cam pin 59 reaches the first end 52A. Thereafter, when the trocar shaft 17 further rotates in the clockwise direction, the cam pin 59 engages with the inclined portion 52E of the cam groove 52, and the engagement position of the cam pin 59 moves from the first end 52A toward the second end 52B. . Due to the action of the cam pin 59 and the inclined portion 52E, as shown in FIGS. 12B and 13B, the pipe portion outer cylinder 31B slides backward with respect to the pipe portion inner cylinder 31A and retracts to the holding release position. Accordingly, the holding of the camera unit 36 is released, and the pop-up is developed at the development position.

  Here, the position where the cam pin 59 of the trocar shaft 17 reaches the second end 52B is referred to as a release completion position of the trocar shaft 17. The release completion position is the end position of the clockwise rotation of the trocar shaft 17.

  On the other hand, when the camera unit 36 shown in FIGS. 12B and 13B is in the deployed position, the pipe outer cylinder 31B is in the holding release position and the trocar shaft 17 is in the release completion position. In the release completion position, the cam pin 59 is located at the second end 52B of the cam groove 52. In this state, when the trocar shaft 17 is rotated counterclockwise as viewed from the front end side, the cam pin 59 moves from the second end 52B of the inclined portion 52E toward the first end 52A. By the action of the cam pin 59 and the inclined portion 52E of the cam groove 52, as shown in FIGS. 12A and 13A, the pipe portion outer cylinder 31B slides forward with respect to the pipe portion inner cylinder 31A and advances to the holding position.

  As the pipe portion outer cylinder 31B moves forward, the housing 64 that contacts the rear portion of the camera portion 36 at the unfolded position is pressed against the tip of the pipe portion outer cylinder 31B, and the camera portion 36 rotates around the rotation pin 65 for storage. Pushed into position. In the retracted position, the rear portion of the camera portion 36 is covered with the tip of the pipe portion outer cylinder 31B. Thereby, the expansion | deployment by the pop-up to the expansion | deployment position of the camera part 36 by the urging | biasing of the spring 71 is controlled, and the camera part 36 is hold | maintained at a storage position.

  Thus, the cam groove 52 and the cam pin 59 constitute an operation mechanism for sliding the pipe portion outer cylinder 31B to the proximal end side by the rotation operation of the trocar shaft 17, so that the pipe portion outer cylinder 31B is slid by hand. Compared to the case, a smooth sliding operation of the pipe outer cylinder 31B is possible. This is because, when the medical staff ST, who is the operator, directly grips and slides the pipe part outer cylinder 31B with a hand, a force in a direction other than the Z-axis direction of the pipe part outer cylinder 31B is applied by the hand gripping force. Is easy to add. Such force hinders smooth sliding of the pipe portion outer cylinder 31B. Therefore, the force acting in the direction other than the Z-axis direction with respect to the pipe part outer cylinder 31B is reduced by the operation mechanism, so that the pipe part outer cylinder 31B can be smoothly slid.

  Further, when the pipe portion outer cylinder 31 </ b> B is in the holding release position, the cam pin 59 is positioned at the second end 52 </ b> B of the cam groove 52. A guide groove 52C extending in the axial direction from the second end 52B is formed. Therefore, when the cam pin 59 moves along the guide groove 52C, the trocar shaft 17 can be slid in the axial direction toward the proximal end side with respect to the pipe portion outer cylinder 31B. As shown in FIG. 12B and FIG. 13B, in the state where the pipe portion outer cylinder 31B is in the holding release position, the camera portion 36 is in the deployed position. Therefore, since the camera unit 36 is retracted from the rear of the puncture unit 55 in the pipe portion inner cylinder 31A, the puncture unit 55 can be retracted. Therefore, the trocar shaft 17 can be extracted from the camera-equipped trocar 16 in a state where the camera unit 36 is deployed.

  Further, when the trocar shaft 17 is attached to the camera-equipped trocar 16, the pipe portion outer cylinder 31B of the camera-equipped trocar 16 is removed, that is, as shown in FIGS. 12B and 13B. The pipe unit 31B is set at the holding release position where the camera unit 36 is at the unfolded position. In this state, the shaft portion 56 is inserted from the head portion 32 into the insertion hole 33 of the pipe portion 31. Since the camera unit 36 is in the deployed position, the camera unit 36 is also retracted from the path of the puncture unit 55 at the tip of the pipe unit 31, so that the puncture unit 55 can be protruded from the tip of the pipe unit 31.

  Thereafter, the handle portion 54 is rotated to align the cam pin 59 with the guide groove 52C. When the positions of the cam pin 59 and the guide groove 52C are matched, the circumferential position of the fitting claw 54A shown in FIGS. 6 and 7 is also opposed to the notch 43C of the fitting groove 43C. In this state, when the trocar shaft 17 is advanced forward along the guide groove 52C along the guide groove 52C and the cam pin 59 reaches the second end 52B, the fitting claw 54A moves from the notch 43C to the fitting groove 43C. enter in. When the trocar shaft 17 is rotated toward the initial position, the cam portion 59 and the cam groove 52 cause the pipe portion outer cylinder 31B to move forward toward the holding position as shown in FIGS. Is stored.

  In this manner, the guide groove 52C is formed between the cam pin 59 of the trocar shaft 17 and the cam groove 52 of the pipe portion outer cylinder 31B when the trocar shaft 17 is attached to the trocar 16 with camera or removed from the trocar 16 with camera. It functions as a groove for starting and releasing engagement.

  On the other hand, in the cam groove 52, a guide groove for releasing the engagement with the cam pin 59 is not formed on the side where the first end 52A and the linear portion 52D exist. For this reason, in a state where the pipe portion outer cylinder 31B is in the holding position, that is, in a state where the camera portion 36 is in the retracted position shown in FIGS. 12A and 13A, the extraction of the trocar shaft 17 is restricted. As shown in FIG. 13A, the camera unit 36 is stored in a storage space formed by the connecting portion 57 of the trocar shaft 17 in the storage position. If an inadvertent extraction operation of the trocar shaft 17 is performed in this state, the rear end of the puncture unit 55 and the camera unit 36 may come into contact with each other, and the camera unit 36 may be damaged. In order to prevent this, the guide groove 52C is formed only on the second end 52B side, and is not formed on the first end 52A side.

  Further, as shown in FIG. 5, two sets of cam pins 59 provided on the pin arrangement plate 58 and cam grooves 52 provided on the cam plate 51 are provided, and these sets are the outer cylinder member 16B. In the circumferential direction around the Z-axis, they are opposed to each other with an interval of about 180 °. Thus, the engagement state is stabilized by providing a plurality of cam pin 59 and cam groove 52 pairs and disposing them in opposition. In addition, it is easy to grip and has good operability.

  Further, since the trocar shaft 17 is provided with a handle portion 54 having a larger diameter than the shaft portion 53, the trocar shaft 17 is easy to rotate.

  Further, as shown in FIG. 14, in the handle portion 54 of the trocar shaft 17, a position mark 58 </ b> A and a direction mark 58 </ b> B are provided on a pin arrangement plate 58 provided with a cam pin 59 that engages with the cam groove 52. . The position mark 58A is arranged on the outer peripheral surface of the pin arrangement plate 58, and indicates the position of the cam pin 59 arranged on the inner peripheral surface.

  Since the cam pin 59 is provided on the inner peripheral surface of the pin mounting plate 58, it is difficult to visually recognize from the outside. By providing the position mark 58A on the outer peripheral surface of the pin mounting plate 58, it is easy to grasp the position of the cam pin 59 from the outside, and the cam pin 59 and the cam groove such as which part of the cam groove 52 the cam pin 59 is engaged with. The engagement state with 52 can be easily confirmed. Thereby, the operation of unfolding and storing the camera unit 36 through the trocar shaft 17 and the detachment of the trocar shaft 17 from the outer cylinder member 16B are easy.

  The direction mark 58B indicates the rotation direction when the trocar shaft 17 is attached to the head portion 32, that is, the rotation direction from the release completion position of the trocar shaft 17 to the initial position.

  In this example, the cam groove 52 formed in the cam plate 51 provided on the base end side of the outer cylinder member 16B corresponds to the first cam portion, and a pin arrangement provided on the base end side of the trocar shaft 17 is provided. The cam pin 59 formed on the plate 58 corresponds to a second cam portion that engages with the cam groove 52. In this example, the first cam portion is a cam groove and the second cam portion is a cam pin. However, the first cam portion may be a cam pin and the second cam portion may be a cam groove.

[Camera unit deployment assist mechanism]
As described above, when the trocar shaft 17 is rotated, the holding of the camera unit 36 by the pipe outer cylinder 31 </ b> B is released, and the camera unit 36 pops up and expands to the deployment position by the bias of the spring 71. The camera-equipped trocar device 12 includes a deployment assist mechanism that pushes the camera unit 36 from the retracted position to the deployed position when the trocar shaft 17 rotates during deployment of the camera unit 36 and the connecting portion 57 contacts the camera unit 36. The deployment assisting mechanism is configured by the trocar shaft 17 having a connecting portion 57 that can rotate within the pipe portion inner cylinder 31A and can come into contact with the camera portion.

  15A to 15C show a cross section (XY cross section) orthogonal to the Z-axis direction of the pipe portion 31 in a portion where the camera portion 36 and the connecting portion 57 are disposed. As shown in FIGS. 15A to 15C, in the cross section of the pipe portion 31, the connecting portion 57 is disposed at a lower position facing the camera portion 36 disposed above the pipe portion 31. 15A and 15B show a state in which the camera unit 36 is in the retracted position, and FIG. 15C shows a state in which the camera unit 36 is in the deployed position.

  15A, the rotational position of the trocar shaft 17 indicates an initial position, that is, a state where the cam pin 59 is in the straight portion 52D of the cam groove 52 (see FIG. 3). In FIG. 15B, the rotational position of the trocar shaft 17 indicates a state in which the cam pin 59 is moving from the first end 52A to the second end 52B of the inclined portion 52E. 15C, the rotational position of the trocar shaft 17 indicates a release completion position, that is, a state where the cam pin 59 is at the second end 52B of the cam groove 52 (see FIG. 4).

  As shown in FIGS. 15A to 15C, when the pipe portion 31 is viewed from the front end side in the Z-axis direction, the cross-sectional shape of the connecting portion 57 is from the radial center of the pipe portion 31 toward the inner wall of the pipe portion 31. It has a mountain shape with an extended skirt. The bottom surface on the base side of the connecting portion 57 is a curved surface matching the curvature of the inner wall of the pipe portion inner cylinder 31A, and comes into contact with the inner wall of the pipe portion inner cylinder 31A. When the trocar shaft 17 rotates in the clockwise direction, the connecting portion 57 rotates in the clockwise direction along the inner wall of the pipe portion inner cylinder 31A.

  When the trocar shaft 17 rotates clockwise from the initial position shown in FIG. 15A and reaches the position shown in FIG. 15B, the connecting portion 57 starts to contact the side surface portion 64B of the camera portion 36. The state shown in FIG. 15B is a state in which the cam pin 59 and the inclined portion 52E of the cam groove 52 are engaged. Therefore, when the trocar shaft 17 rotates, the pipe portion outer cylinder 31B also slides toward the holding release position. Therefore, the holding of the camera unit 36 is gradually released according to the slide of the pipe unit outer cylinder 31B. Then, the camera unit 36 starts pop-up by the urging force of the spring 71 toward the deployed position. At this timing, the connecting portion 57 starts to come into contact with the camera portion 36 and pushes the camera portion 36 up toward the deployment position.

  For this reason, when the camera unit 36 pops up and expands, in addition to the urging force of the spring 71, the camera unit 36 is assisted by the pressing force of the connecting portion 57, so that the pop-up is performed only by the urging force of the spring 71. Thus, the pop-up of the camera unit 36 can be reliably performed. More specifically, fat 23A (see FIGS. 24A and 24B) or the like adheres to the outer peripheral surface of the camera unit 36, which may become a resistance when popping up. Even in such a case, since the deployment assist mechanism configured by the connecting portion 57 is provided, the deployment by pop-up can be performed reliably.

  As shown in FIGS. 15A to 15C, the connecting portion 57 is provided with a pressing portion 57 </ b> B projecting outward from the main body portion 57 </ b> A on the slope contacting the side surface portion 64 </ b> B. As shown in FIGS. 16A and 16B, the pressing portion 57B is not provided over the entire length of the connecting portion 57 in the Z-axis direction, but is provided in a part thereof. Specifically, the pressing portion 57B is provided in a range facing the side surface portion 64B of the camera portion 36 in the Z-axis direction of the connecting portion 57. Thus, the storage space of the camera unit 36 is prevented from being squeezed by minimizing the range in which the pressing portion 57B is provided.

  15A, when the trocar shaft 17 is in the initial position and the camera unit 36 is in the retracted position, the width of the connecting portion 57 when the pipe portion 31 is viewed from the front end side in the Z-axis direction. The center position in the direction (X-axis direction) is offset from the center line C1 in the width direction (X-axis direction) of the camera unit 36. The center line C <b> 1 is a line connecting the center position in the width direction (X-axis direction) of the camera unit 36 and the center of the pipe unit 31. The center line C2 is a center line in the width direction (X-axis direction) of only the main body portion 57A of the connecting portion 57 excluding the pressing portion 57B. The meaning of being offset means that the center line C1 and the center line C2 do not coincide.

  More specifically, in FIG. 15A, in a state where the camera unit 36 is in the storage position, the connecting portion 57 is disposed to face the camera unit 36. In this state, the center line C1 in the width direction of the camera portion 36 and the center line C2 in the width direction (X-axis direction) of the connecting portion 57 do not coincide with each other, and the center line C2 is in relation to the center line C1. , And is offset in the opposite direction (right direction in FIG. 15A) to the slope contacting the side surface portion 64B.

  Thus, the center position of the connecting portion 57 in the width direction (X direction) with respect to the center line C1 of the camera portion 36 in a state where the trocar shaft 17 is in the initial position and the camera portion 36 is in the retracted position. As described below, the rotation amount of the trocar shaft 17 can be easily adjusted.

  That is, the trocar shaft 17 functions as an operation mechanism for expanding and storing the camera unit 36 by sliding the pipe unit outer cylinder 31 </ b> B in addition to functioning as a deployment assisting mechanism for the camera unit 36 by its rotation. When the trocar shaft 17 has a plurality of functions as described above, it is necessary to adjust the rotation amount of the trocar shaft 17 according to each function.

  For example, when the amount of rotation of the trocar shaft 17 required for the operation mechanism is determined, the stroke amount of the connecting portion 57 (the amount of rotation of the connecting portion 57 in the circumferential direction) is also determined. In order for the deployment assist mechanism to function, the distance between the connecting portion 57 and the side surface portion 64B of the camera portion 36 must be adjusted according to the determined stroke amount. By offsetting the connecting portion 57, the distance between the connecting portion 57 and the side surface portion 64B can be finely adjusted. Since fine adjustment is easy in this way, even when the trocar shaft 17 has a plurality of functions, the amount of rotation necessary for one function can be determined with a certain degree of freedom, and as a result, the rotation of the trocar shaft 17 Easy to adjust the amount.

  In other words, the degree of freedom in design is ensured by setting the cross-sectional shape of the connecting portion 57 to such a shape and arrangement. Specifically, in this example, the center line C2 of the main body portion 57A of the connecting portion 57 is arranged offset with respect to the center line C1 of the camera portion 36. However, theoretically, even if the pressing portion 57B is provided, it is possible to provide the main body portion 57A so that the center line C2 and the center line C1 coincide (without being offset).

  The reason for the offset in this example is that the development of the camera part 36 is also related to the sliding amount of the outer cylinder 16B, so in the cam design, the distance between the pressing part 57B of the connecting part 57 and the side part 64B of the camera part 36 is set. This is to ensure. In this way, the side surface portion 64B and the pressing portion are offset by offsetting the center line C2 and the center line C1 of the main body portion 57A and making the cross-sectional shape of the connecting portion 57 including the pressing portion 57B asymmetrical with respect to the center line C2. Since the distance between 57B can be expanded, the freedom degree of design improves.

[Lock mechanism when unfolding and retracting camera]
The camera-equipped trocar device 12 includes an outer cylinder locking mechanism that regulates the sliding of the outer cylinder member 16B having the pipe outer cylinder 31B in the Z-axis direction and locks the outer cylinder member 16B at each of the holding position and the holding release position. I have. As described above, the lock release operation member 46 is an operation member that performs a release operation of the outer cylinder lock mechanism, and constitutes an outer cylinder lock mechanism together with the engaging portion 47.

  As shown in FIG. 17, the engagement portion 47 formed on the outer peripheral surface of the head portion inner cylinder 32A has two engagement grooves 47A and 47B extending in a direction orthogonal to the Z-axis direction. The engagement grooves 47A and 47B are different in the position in the Z-axis direction, and the engagement groove 47A is a groove for locking the outer cylinder member 16B in a state where the pipe portion outer cylinder 31B is in the holding position. 47B is a groove for locking the outer cylinder member 16B in a state where the pipe outer cylinder 31B is in the holding release position. The engagement groove 47A corresponds to the first engagement portion, and the engagement groove 47B corresponds to the second engagement portion.

  The unlocking operation member 46 is attached to the outer periphery of the head portion outer cylinder 32B of the outer cylinder member 16B. The unlocking operation member 46 has an operation part 46A and a support part 46B. The support part 46B is connected to the operation part 46A and is a part for supporting the operation part 46A on the head part outer cylinder 32B. A step is formed between the operation portion 46A and the support portion 46B, and the longitudinal section of the unlocking operation member 46 has a substantially crank shape.

  In the unlocking operation member 46, attachment pins 46C are provided at both ends in the width direction at a portion where the operation portion 46A and the support portion 46B are joined. The support portion 46B is provided with an attachment hole 46D to which a spring 68 for urging the unlocking operation member 46 in a predetermined direction is attached. Further, the support portion 46B is provided with an engaging convex portion 46E (see FIGS. 19A to 19C) on the surface opposite to the mounting hole 46D. As will be described later, the engaging convex portion 46E corresponds to a restricting portion that engages with each of the engaging grooves 47A and 47B and restricts the sliding of the outer cylinder member 16B.

  The head outer cylinder 32B is provided with an attachment portion 66 for attaching the unlocking operation member 46. The attachment portion 66 includes an opening 66A and a bearing portion 66B that is formed on the inner peripheral portion of the opening 66A and supports the attachment pin 46C in a rotatable manner.

  18A to 18C show a method of assembling the unlocking operation member 46. FIG. As shown in FIG. 18A, the unlocking operation member 46 is inserted into the opening 66A, for example, with the spring 68 attached to the support portion 46B. Then, as shown in FIG. 18B, the attachment pin 46C is attached to the bearing portion 66B. Then, the unlocking operation member 46 is rotated around the mounting pin 46C to adjust the posture of the unlocking operation member 46 so that the support portion 46B and the inner peripheral surface of the head portion outer cylinder 32B are parallel to each other.

  In this state, the spring 68 is sandwiched between the support portion 46B and the inner peripheral surface of the head portion outer cylinder 32B. While maintaining this posture, as shown in FIG. 18C, the inner cylinder member 16A is inserted into the outer cylinder member 16B, and the support portion 46B has an inner circumferential surface of the outer cylinder member 16B and an outer circumferential surface of the inner cylinder member 16A. It is pinched between the engaging parts 47 formed in the. In FIG. 18C, the support portion 46 </ b> B is rotated clockwise around the mounting pin 46 </ b> C by the biasing force of the spring 68, and is biased in a direction to press the engagement convex portion 46 </ b> E against the engagement portion 47.

  As shown in FIGS. 19A to 19C, the engagement state of the unlocking operation member 46 and the engaging portion 47 is shown. FIG. 19A shows a state in which the pipe portion outer cylinder 31B is in a holding position where the camera portion 36 is held in the storage position. In the state shown in FIG. 19A, the engaging convex portion 46E is engaged with the engaging groove 47A corresponding to the first engaging portion, and the engaging convex portion 46E is pressed against the engaging groove 47A by the bias of the spring 68. It is done. For this reason, the slide of the axial direction of the outer cylinder member 16B with respect to the inner cylinder member 16A is restricted by the engagement between the engagement convex part 46E and the engagement groove 47A, and the pipe part outer cylinder 31B stores the camera part 36. Locked to a holding position (see FIGS. 12A and 13A) for holding in position.

  FIG. 19B shows a state in which the lock release operation member 46 is operated to release the slide lock of the outer cylinder member 16B. When the operation portion 46A is pressed, the unlocking operation member 46 rotates counterclockwise around the attachment pin 46C against the bias of the spring 68. By this rotation, the support portion 46B is separated from the engagement portion 47, and the engagement between the engagement convex portion 46E and the engagement groove 47A is released. Thereby, the slide lock of the outer cylinder member 16B is released. When the slide lock of the outer cylinder member 16B is released, the pipe portion outer cylinder 31B can be moved backward to the proximal end side and moved to the holding release position.

  FIG. 19C shows a state in which the pipe portion outer cylinder 31B is in the holding release position. As shown in FIG. 19B, when the outer cylinder member 16B is retracted to the proximal end side in the unlocked state, the engagement convex portion 46E of the support portion 46B has an engagement groove 47B corresponding to the second engagement portion. To reach. As shown in FIG. 19C, when the engaging convex portion 46E reaches the engaging groove 47B, the engaging convex portion 46E falls into the engaging groove 47B by the urging of the spring 68, and both engage. At the holding release position where the engaging convex portion 46E and the engaging groove 47B are engaged, the holding of the camera portion 36 by the pipe portion outer cylinder 31B is released, so that the camera portion 36 pops up and expands.

  In the state shown in FIG. 19C, the engaging convex portion 46E engages with the engaging groove 47B, and the engaging convex portion 46E is pressed against the engaging groove 47B by the bias of the spring 68. For this reason, the sliding of the axial direction of the outer cylinder member 16B with respect to the inner cylinder member 16A is restricted by the engagement between the engagement convex part 46E and the engagement groove 47A, and the pipe part outer cylinder 31B is unfolded of the camera part 36. Is held at a holding release position (see FIGS. 12B and 13B).

  Thus, the following effects are obtained by the outer cylinder lock mechanism including the lock release operation member 46 and the engaging portion 47. That is, in the camera-equipped trocar 16, the outer cylinder member 16 </ b> B including the pipe section outer cylinder 31 </ b> B is located on the outermost periphery of the pipe section 31 of the camera-equipped trocar 16. When such a pipe part outer cylinder 31B is used as an operation member for holding or unfolding the storage position of the camera part 36, it is easy to touch the operator's hand, and an inadvertent slide is likely to occur against the operator's will.

  If the pipe outer cylinder 31B is carelessly slid, there is a concern that the camera unit 36 that should be in the retracted position will unfold or the camera unit 36 that should be in the unfolded position may be retracted against the will of the operator. is there. According to the outer cylinder locking mechanism, the pipe section outer cylinder 31B can be locked at the holding position and the holding release position, so that inadvertent sliding of the pipe section outer cylinder 31B can be prevented.

  Further, by engaging with each of the engaging grooves 47A and 47B, an engaging convex portion 46E corresponding to a restricting portion that restricts sliding of the outer cylinder member 16B is formed integrally with the unlocking operation member 46. Therefore, the structure is simple. Therefore, it is advantageous in terms of component cost and assemblability.

  Further, since the unlocking operation member 46 is disposed in the head portion 32 having a larger diameter than the pipe portion 31, operability is good.

[Bearing structure of camera part]
As shown in FIGS. 20A and 20B, the camera unit 36 is attached to the pipe unit inner cylinder 31A and is supported so as to be rotatable between a retracted position and a deployed position. 20A shows the camera unit 36 in the storage position, and FIG. 20B shows the camera unit 36 in the unfolded position. As shown also in FIG. 10, a pair of left and right turning pins 65 are provided at both ends in the width direction (X-axis direction) of the camera portion 36, and each turning pin 65 is a notch portion of the pipe portion inner cylinder 31A. A pair of left and right bearing portions 67 formed on 61 is attached to each. A pair of bearing part 67 supports each rotation pin 65 so that rotation is possible.

  Each bearing portion 67 has a distal end side receiving port 67A that receives the rotation pin 65 on the distal end side of the pipe portion inner cylinder 31A. The bearing 67 has a substantially semicircular shape in cross section perpendicular to the rotation pin 65, and a notch corresponding to the remaining semicircle corresponds to the tip side receiving port 67A. The distal end side receiving port 67A can receive the rotation pin 65 that enters from the distal end side of the pipe portion 31 along the Z-axis direction of the pipe portion 31. A drop-off prevention member 76 that prevents the turning pin 65 supported by the bearing portion 67 from dropping is disposed at a position facing the distal end side receiving port 67A. The drop-off prevention member 76 is a strip-like tongue piece extending in the axial direction, and is provided on the pipe portion inner cylinder 31A.

  The dropout prevention member 76 is formed integrally with the pipe portion inner cylinder 31A, for example. The drop-off prevention member 76 is elastic, with one end fixed to the fixed end 76A fixed to the pipe portion inner cylinder 31A and the other end on the base end side being a free end 76B. With this configuration, the drop-off prevention member 76 can be elastically deformed so that the free end 76B is displaced in the width direction (X-axis direction) of the camera unit 36 with the fixed end 76A as a base point (see FIG. 21B). . The drop-off prevention member 76 is made of resin, and is resin-molded integrally with the pipe portion inner cylinder 31A. The drop-off prevention member 76 is formed in such a length that the free end 76B is positioned at the distal end side receiving port 67A, and the free end 76B is disposed to face the distal end side receiving port 67A. The free end 76B supports the rotation pin 65 in cooperation with the bearing portion 67 and closes the distal end side receiving port 67A to prevent the rotation pin 65 from falling off the bearing portion 67. The bearing structure of the camera unit 36 includes a rotation pin 65 corresponding to a rotation shaft, a bearing portion 67, and a drop-off prevention member 76.

  As shown in FIGS. 21A to 21C, each free end 76B of the left and right drop-off prevention members 76 protrudes inward, that is, has a protruding portion 76C protruding toward each free end 76B facing each other. Provided (see also FIG. 10).

  21A to 21C show a method for attaching the camera unit 36. As shown in FIG. 21A, the camera unit 36 is attached to the bearing unit 67 from the distal end side of the pipe unit inner cylinder 31A. At this time, as shown in FIG. 21B, the left and right turning pins 65 are inserted between the left and right drop-off prevention members 76 and brought into contact with the inside of each drop-off prevention member 76. In this state, the camera unit 36 is moved along the Z-axis direction of the pipe unit inner cylinder 31A.

  The distance between the left and right pivot pins 65 is wider than the distance between the left and right drop-off prevention members 76. Therefore, in a state where the left and right turning pins 65 are in contact with the left and right drop-off prevention members 76, each drop-off prevention member 76 is elastically deformed outward with the fixed end 76A as a base point. The elastic deformation of each drop-off preventing member 76 continues until the left and right turning pins 65 are received by the left and right bearing portions 67 through the distal end side receiving ports 67A.

  As shown in FIG. 21B, when the left and right pivot pins 65 that move from the tip side toward the bearing portion 67 reach the position of the protruding portion 76C, the outward deformation amount of the free end 76B of the drop-off prevention member 76 is as follows. , Become the maximum. In this state, the free end 76B is retracted from the front of the front end side receiving port 67A of the bearing portion 67. Thereby, the rotation pin 65 can enter the bearing portion 67.

  When the camera unit 36 is further moved to the proximal end side, as shown in FIG. 21C, the rotation pin 65 enters the bearing unit 67 and is received. When the rotation pin 65 is received by the bearing portion 67, the contact between the inner side of the dropout prevention member 76 and the rotation pin 65 is released. Therefore, the free end 76B deformed outward is displaced inward by elasticity, and returned to the initial position facing the distal end side receiving port 67A. As a result, the distal end side receiving port 67A of the bearing portion 67 that has received the rotation pin 65 is closed, so that the rotation pin 65 is prevented from falling off from the bearing portion 67. In addition, the outer peripheral surface around the shaft of the rotation pin 65 is covered with the bearing portion 67 and the front end side receiving port 67A, and is supported rotatably by these cooperation.

  As described above, the bearing portion 67 of the rotating pin 65 is configured by the bearing portion 67 having the distal end side receiving port 67A and the drop-off preventing member 76 disposed to face the distal end side receiving port 67A. It is possible to prevent the strength of the rotation pin 65 of the camera unit 36 from being lowered while securing the good mountability of 36.

  That is, since the distal end side receiving port 67A is configured by a substantially semicircular cutout, the rotational pin 65 can have a circular cross-sectional shape in a direction perpendicular to the rotational axis. If the receiving port of the bearing portion 67 is smaller than the radius of the rotation pin 65, the rotation pin 65 cannot be inserted into the bearing portion 67. In that case, in order to reduce the cross-sectional shape of the rotation pin 65, at least a part of the rotation pin 65 needs to be D-cut or I-cut. Such processing causes a decrease in strength of the rotation pin 65. When the strength of the rotation pin 65 is reduced, for example, the rotation pin 65 may be damaged in the abdominal cavity. Such inconvenience can be avoided by preventing the strength of the rotating pin 65 from decreasing.

  Further, since the drop-off preventing member 76 is disposed at the distal end side receiving port 67A, the rotation pin 65 is prevented from dropping from the bearing portion 67.

  Further, since the drop-off prevention member 76 can be elastically deformed, when the camera portion 36 is attached to the bearing portion 67, the drop-off prevention member 76 can be elastically deformed and retracted from the distal end side receiving port 67A. Therefore, since the rotation pin 65 can be entered from the distal end side receiving port 67A into the bearing portion 67 only by moving the camera portion 36 along the axial direction from the distal end side, the mounting property is also good.

  Further, the free end 76B of the drop-off prevention member 76 is provided with a protruding portion 76C that protrudes inward. For this reason, the free end 76B can be greatly deformed outward just before the rotation pin 65 reaches the distal end side receiving port 67A. For this reason, since the retraction amount of the free end 76B becomes large, the rotation pin 65 can easily enter the distal end side receiving port 67A.

  In the bearing portion 67 of this example, the substantially semicircular shape means a range of plus or minus 10% on the basis of this semicircle in addition to a semicircle having an arc having a length of 50% of the circumference of the circle. That is, it is a concept including a semicircle having an arc having a length of 40% to 60% of the circumference. The tip side receiving port 67A has a smaller mouth size as the arc length of the bearing portion 67 approaches 60%, and the mouth size increases as it approaches 40%.

  For example, when the length of the arc of the bearing portion 67 is 60%, the size of the tip-side receiving port 67A may be slightly smaller than the radius of the rotation pin 65. However, even in this case, the rotation pin 65 can be received in the bearing portion 67 if the distal end side receiving port 67A can be elastically deformed to widen the size of the port. Further, the smaller the size of the distal end side receiving port 67A is, the more the rotation pin 65 can be prevented from dropping from the bearing portion 67.

[Ridge of puncture part]
As shown in FIG. 22, a plurality of protrusions 78 projecting in the radial direction and extending along the Z-axis direction of the puncture portion 55 are formed on the outer peripheral surface of the puncture portion 55 of the trocar shaft 17. As described with reference to FIGS. 2 and 3, puncture portion 55 is first inserted into incision portion 27 formed in abdominal wall 23 of patient P when trocar 16 with camera is inserted into the abdominal cavity of patient P. As described above, the abdominal wall 23 is formed of a subcutaneous tissue such as fat 23A (see reference numeral 23A in FIGS. 24A and 24B), and the puncture portion 55 plays a role of expanding the abdominal wall 23. The ridge portion 78 tears the subcutaneous tissue and prevents the subcutaneous tissue from being wound around the outer peripheral surface of the puncture portion 55, particularly the fat 23A.

  In this example, four protrusions 78 are provided. Here, regarding the four ridges 78, when it is necessary to distinguish the ridges 78, the ridges 78A to 78D are described separately, and when there is no need to distinguish, the ridges 78 are simply projected. This will be described as the strip 78.

  As shown in FIGS. 23A and 23B, the four ridges 78A, 78B, 78C, and 78D intersect in a cross shape as a whole when the puncture portion 55 is viewed from the front end side in the Z-axis direction. Be placed. Specifically, the four protrusions 78A, 78B, 78C, and 78D have proximal ends disposed at 90 ° intervals in the circumferential direction around the Z axis of the puncture portion 55, and the puncture portion At the tip of 55, the end on the tip side intersects.

  FIG. 23A shows the positions of the plurality of protrusions 78 and the camera unit 36 when the camera unit 36 is in the retracted position, that is, when the trocar shaft 17 is in the initial position (see FIGS. 3 and 12A and the like). FIG. 23B shows the positional relationship between the plurality of protrusions 78 and the camera unit 36 in a state where the trocar shaft 17 is in the release completion position (see FIGS. 4 and 12B, etc.).

  As shown in FIG. 23A, when the trocar shaft 17 is in the initial position (the camera unit 36 is in the retracted position), the two ridges 78A and 78B out of the four ridges 78A to 78D. As for the end portion on the base end side, the end portion on the proximal end side is arranged at a position corresponding to the position of each hinge portion at both ends of the camera portion 36 in the circumferential direction around the Z axis of the puncture portion 55. As described above, each hinge part is provided at both ends of the camera part 36, and each hinge part is provided on the inner periphery of the rotation pin 65 provided on each side part 64 </ b> B of the camera part 36 and the notch part 61. It is comprised by each bearing part 67 provided.

  24A and 24B are explanatory views showing the wrapping of the fat 23A around the tip of the pipe part 31 where the camera part 36 is arranged based on knowledge obtained through animal experiments. FIG. 24A shows the pipe part 31 laterally. 24B is a top view of the pipe portion 31 as viewed from above where the camera portion 36 is disposed. As shown in FIG. 24A and FIG. 24B, in the pipe portion 31 behind the puncture portion 55, the region R1 corresponding to the protruding portion 78 has less wrapping of the fat 23A compared to the other region R2. Therefore, by arranging the protrusions 78A and 78B at positions corresponding to the hinges of the camera part 36 provided in the pipe part 31, a peripheral area including the hinge part of the camera part 36 (area R1 in FIGS. 24A and 24B). ) Can be suppressed.

  The fat 23A wrapped around the camera unit 36 becomes a resistance when popping up the deployment position of the camera unit 36, and thus becomes a factor that hinders smooth deployment of the camera unit 36. By arranging the protrusions 78A and 78B at positions corresponding to the hinges of the camera unit 36, the wrapping of the fat 23A can be suppressed. As a result, the camera unit 36 can be smoothly deployed.

  Moreover, in each protrusion 78, the upper end portion 79 corresponding to the ridge line along the Z-axis direction is not a pointed shape like a cutting edge but a flat surface. By making the upper end portion 79 flat, the following effects can be obtained. First, even if the operator touches the puncture portion 55 with a hand wearing rubber gloves, the rubber gloves can be prevented from being damaged. Second, even when a large force is applied to the puncture portion 55 when the trocar device 12 with a camera is inserted into the abdominal cavity, the ridge portion 78 is damaged as compared with the case where the upper end portion 79 has a pointed shape. Hard to do. Thirdly, damage to the seal unit included in the airtight structure unit 42 can be prevented. That is, when the trocar shaft 17 is inserted into the camera-equipped trocar 16, the puncture portion 55 passes through the airtight structure unit 42. By making the protrusion 78 into a flat surface, the seal unit included in the airtight structure unit 42 can be prevented from being damaged.

  23A and 23B, the radial maximum diameter D2 of the plurality of protrusions 78 is equal to or less than the maximum diameter D1 of the part where the protrusions 78 are not formed on the outer peripheral surface 55A of the puncture part 55. It is. In this example, the maximum diameter D1 is the diameter at the proximal end of the tapered puncture portion 55, and the maximum diameter D2 of the protrusion 78 is also the proximal end of the protrusion 78, It is a diameter connecting the upper end portions 79 of the plurality of protrusions 78 arranged in the circumferential direction.

  In this way, by setting the maximum diameter D2 of the ridge portion 78 to be equal to or less than the maximum diameter D1 of the puncture portion 55, the maximum protrusion amount of the ridge portion 78 can be regulated. The above-mentioned first to third effects due to the flat surface can be further enhanced.

  Further, in this example, the example in which the four ridges 78 are provided as the plurality of ridges 78 has been described, but the number of the ridges 78 may be other than four. For example, three or five or more ridges 78 may be included, and two ridges 78A and 78B arranged at positions corresponding to the hinges of the camera unit 36 are included in the plurality of ridges 78. It only has to be. Moreover, you may arrange | position the 2 or more protrusion part 78 in the position corresponding to one hinge part.

  FIG. 25 is an example in which eight protrusions 78 are provided. Two of these are arranged at positions corresponding to the hinges of the camera unit 36, similar to the protrusions 78A and 78B shown in FIG. 23A. Further, as in the example in which the four ridges 78 shown in FIGS. 23A and 23B and the eight ridges 78 shown in FIG. 25 are provided, the arrangement intervals of the plurality of ridges 78 are equal. It is preferable that This is because the effect of preventing the wrapping of the fat 23 </ b> A due to the provision of the plurality of protrusions 78 is considered to be obtained evenly in the circumferential direction of the puncture portion 55.

[Airtight structure unit]
FIG. 26 is a perspective view of the airtight structure unit 42 shown in FIG. 7 as seen from the base end side. As described above, the airtight structure unit 42 has a function of preventing gas leakage from the abdominal cavity to the outside of the body. The airtight structure unit 42 is accommodated in the head portion inner cylinder 32A, and the rear opening of the head portion inner cylinder 32A is closed by the rear cover 43.

  As shown in FIGS. 27 and 28, the airtight structure unit 42 includes a duckbill valve 81 and a seal unit 82 disposed on the proximal end side of the duckbill valve 81. The duckbill valve 81 prevents the gas from leaking from the inhaled body cavity to the outside through the insertion hole 33 when the treatment instrument 22 is not inserted into the trocar 16 with the camera. On the other hand, the seal unit 82 prevents gas from leaking from the body cavity to the outside through the insertion hole 33 in a state where the treatment instrument 22 is inserted.

(Duck bill valve configuration)
The duckbill valve 81 is a valve mechanism in the shape of a duck mouth as is well known, and has a valve portion 81A and a circular portion 81B formed integrally with the base end of the valve portion 81A. The duckbill valve 81 is formed of an elastomer such as silicon rubber. The valve portion 81A has two inclined surfaces that face each other at the tip and spread toward the base end. A streak-shaped opening 81C is formed at the tip of the valve portion 81A. A flange 81D protruding outward is formed at the base end of the circular portion 81B (see also FIG. 4).

  As shown in the cross-sectional view of FIG. 30, an abutting surface 83 that contacts the flange 81 </ b> D of the duckbill valve 81 is formed on the inner wall surface of the head portion inner cylinder 32 </ b> A to which the airtight structure unit 42 is attached. In the head portion inner cylinder 32 </ b> A, the inner diameter on the tip side of the abutting surface 83 is substantially the same as the outer diameter of the circular portion 81 </ b> B of the duckbill valve 81.

(Configuration of seal unit)
As shown in FIGS. 27 and 28, the seal unit 82 includes a seal holder 86, a first mount 87, a dome-shaped seal 88, an airtight rubber cover 89, a centering guide 91, and a second mount 92. The dome-shaped seal 88 corresponds to the seal in the claims, and the airtight rubber cover 89 corresponds to the rubber cover in the claims. These members are arranged in this order from the front end side to the base end side with the seal holder 86 as the head, and are united as a unit by being assembled together.

  The dome-shaped seal 88 is a member having a circular planar shape and a convex dome shape on the tip side. The dome-shaped seal 88 includes a dome-shaped seal portion 88A and a circular flange 88B formed on the outer periphery of the seal portion 88A. An opening 88C through which the treatment instrument 22 and the trocar shaft 17 are inserted is formed at the center in the radial direction of the seal portion 88A, that is, at the center portion located at the apex of the dome shape. The dome-shaped seal 88 is made of a single material having a circular planar shape, and the material is silicon rubber. The opening 88C expands in a state of being in close contact with the outer peripheral surface of the treatment instrument 22 to be inserted due to elastic deformation. The outer peripheral surface of the treatment instrument 22 and the inner periphery of the opening 88C are hermetically sealed. Thereby, in the state which inserted the treatment tool 22, the gas leak from the opening 88C is prevented.

  The diameter of the opening 88C of the dome-shaped seal 88 is determined according to the outer diameter of the treatment instrument 22 to be inserted. Since the outer diameter of the general treatment instrument 22 is about 5 mm, in this example, the diameter of the opening 88C is set to 4 mm, which is slightly smaller than the outer diameter of the treatment instrument 22. Accordingly, when the treatment tool 22 is inserted, the opening 88C is expanded by elastic deformation, and the inner periphery of the opening 88C and the outer periphery of the treatment tool 22 can be brought into close contact with each other.

  The silicon rubber used for the dome-shaped seal 88 is a silicon rubber having a JIS A hardness of 30 according to durometer measurement, and is a relatively flexible material having a wall thickness of about 0.8 mm. By using a flexible material, good operability of the treatment instrument 22 is ensured.

  As shown in FIG. 29, a centering guide 91 is disposed behind the dome-shaped seal 88 (on the base end side of the trocar 16 with camera). The centering guide 91 is composed of four segments 93. The centering guide 91 is configured to have a convex dome shape on the tip side as a whole by combining the segments 93. Each segment 93 is partially overlapped with an adjacent segment 93.

  The overall shape of the centering guide 91 corresponds to the shape of the dome-shaped seal 88. The centering guide 91 includes a dome-shaped guide portion 91A and a flange 91B formed on the outer periphery of the guide portion 91A. An opening 91 </ b> C through which the treatment instrument 22 and the trocar shaft 17 are inserted is formed in the central portion corresponding to the apex of the dome shape of the guide portion 91 </ b> A. The diameter of the opening 91C is the same as or slightly smaller than the opening 88C of the dome-shaped seal 88. In this example, it is 4 mm, which is the same as the opening 88C. The material of the centering guide 91 is polyurethane having a JIS A hardness of 90 by durometer measurement, and has a thickness of about 0.5 mm.

  In FIG. 29, FIG. 31A and FIG. 31B showing the centering guide 91 as viewed from the base end side, the four segments 93 constituting the centering guide 91 are substantially fan-shaped, and the length of the arc is This is 1/4 of the circumference of the centering guide 91. Here, ¼ of the circumference includes a range of plus or minus 10%.

  In addition, the area of the overlapping region 93 </ b> A where the adjacent segments 93 overlap is less than or equal to half of the total area of each segment 93. 31A and 31B, the overlapping region 93A has a shape in which the width of the overlapping region 93A monotonously increases from the outer periphery of the centering guide 91 toward the center.

  Each segment 93 is formed with a notch 93B that constitutes a part of the opening 91C. Further, in the overlapping region 93A, the side on the opening 91C side is smoothly connected to the cutout portion 93B. The side on the opening 91 </ b> C side extends in a direction parallel to the radial direction of the centering guide 91.

  When the treatment tool 22 is inserted, the opening 91C expands according to the outer diameter of the treatment tool. This expansion is performed by displacing adjacent segments 93 in a direction away from each other. The opening 91 </ b> C is configured by a cutout portion 93 </ b> B of each segment 93, and an adjacent region 93 has an overlapping region 93 </ b> A. Therefore, even when the opening 91 </ b> C is expanded, the overlapping of the adjacent segments 93 is maintained, so that a gap is hardly generated between the opening 91 </ b> C and the outer periphery of the treatment instrument 22.

  When the treatment tool 22 is inserted, the centering guide 91 guides the distal end of the treatment tool 22 to the central opening 88C of the dome-shaped seal 88 by the guide portion 91A and the opening 91C.

  The first mount 87 is disposed on the distal end side of the dome-shaped seal 88, has an opening 87C that exposes the seal portion 88A, has a convex mount portion 87A on the distal end side, and a flange formed on the outer periphery of the mount portion 87A. 87B. The first mount 87 is made of a resin material such as polyester, for example. The first mount 87 supports the distal end side of the seal portion 88A of the dome-shaped seal 88 by the mount portion 87A, and supports the flange 88B from the distal end side by the flange 87B. The diameter of the opening 87C is larger than the diameters of the trocar shaft 17 and the treatment tool 22, and these can be inserted.

  The seal holder 86 has an opening 86C that exposes the seal portion 88A of the dome-shaped seal 88, a convex substantially conical cover portion 86A on the distal end side, and a cylindrical portion formed on the proximal end side of the cover portion 86A. 86B. The diameter of the opening 86 </ b> C of the seal holder 86 is slightly larger than the diameter of the opening 87 </ b> C of the first mount 87. The seal holder 86 is formed of a resin material such as polyester.

  The cover portion 86A supports and covers the periphery of the mount portion 87A of the first mount 87 that exposes the seal portion 88A of the dome-shaped seal 88 from the distal end side. The cover portion 86 </ b> A functions as an abutment of the mount portion 87 when the dome-shaped seal 88 and the mount portion 87 </ b> A move to the distal end side in accordance with the operation of the treatment instrument 22, thereby restricting the amount of movement toward the distal end side. To do.

  The cylindrical portion 86B functions as a frame to which the airtight rubber cover 89B is attached. The inner diameter of the cylindrical portion 86B is large enough to accommodate the first mount 87, the dome-shaped seal 88, the centering guide 91, and the second mount 92 inside. In the cylindrical portion 86B, a peripheral edge 86D (see FIG. 30) on the front end side located around the cover portion 86A functions as an abutting surface for the flange 81D of the duckbill valve 81 via the airtight rubber cover 89B.

  The second mount 92 is disposed on the proximal end side of the centering guide 91. The second mount 92 has a convex mount portion 92A on the distal end side and a flange 92B formed on the outer periphery of the mount portion 92A. The second mount 92 is formed of a resin material such as polyester, for example. The second mount 92 supports the proximal end side of the guide portion 91A of the centering guide 91 by the mount portion 92A, and supports the flange 91B from the proximal end side by the flange 92B. An opening 92C is formed in the mount portion 92A. The opening 92 </ b> C has substantially the same diameter as the opening 87 </ b> C of the first mount 87, so that the trocar shaft 17 and the treatment instrument 22 can be inserted.

  The flange 92B is formed with a plurality of pins 92D protruding to the tip side. The pins 92D are arranged at equal intervals on the circumference of the flange 92B. The plurality of pins 92D are small holes 91E (see FIG. 29) of the flange 91B of the centering guide 91, small holes 88E (see FIG. 29) of the flange 88B of the dome-shaped seal 88, and small holes of the flange 87B of the first mount 87. Inserted into. As a result, the centering guide 91, the dome-shaped seal 88, the first mount 87, and the second mount 92 are assembled together as shown in FIG.

  The pin 92 </ b> D is inserted into the small holes 91 </ b> E, 88 </ b> E, and the like, and is crimped by heat welding such as ultrasonic welding. As a result, the flange 87B of the first mount 91, the flange 88B of the dome-shaped seal 88, and the flanges of the airtight cover 92 and the centering guide 91 are fixed in close contact. Since the pin 92 </ b> D is provided on the second mount 92 and protrudes toward the distal end side, the distal end side of the pin 92 </ b> D to be crimped is not visible from the proximal end side of the airtight structure unit 92. By doing this, it looks better.

  The airtight rubber cover 89 has a cylindrical cylindrical portion 89A and an inner flange 89B provided inside the cylindrical portion 89A. The inner flange 89B has an opening 89C through which the trocar shaft 17 and the treatment instrument 22 are inserted. A bellows portion 89D is provided between the cylindrical portion 89A and the inner flange 89B. The airtight rubber cover 89 is formed of an elastomer such as silicon rubber having a JIS A hardness of 30 by durometer measurement. The hardness of the airtight rubber cover 89 is as soft as that of the dome-shaped seal 88. Further, the airtight rubber cover 89 is formed such that the bellows portion 89D is thinner than other portions such as the peripheral edge 82A and the folded portion 89E, and the bellows portion 89D has a thickness of 0.3 mm and the thickness of the other portions. Is 0.5 mm.

  A small hole into which the pin 92D of the second mount 92 is inserted is also formed in the inner flange 89B. As shown in FIG. 30, the inner flange 89B is sandwiched between the flange 88B of the dome-shaped seal 88 and the flange 91B of the centering guide 91 by inserting a pin 92D into the small hole. As a result, the first mount 87, the dome-shaped seal 88, the centering guide 91, and the second mount 92 are attached to the airtight rubber cover 89. Further, the bellows portion 89D elastically deforms and expands and contracts to support the dome-shaped seal 88, the centering guide 91 and the like inside the airtight rubber cover 89 so as to be displaceable. The bellows portion 89D allows the dome-shaped seal 88 and the centering guide 91 to move in the radial direction.

  The cylindrical portion 89A of the airtight rubber cover 89 is attached so as to cover the outer peripheral surface of the cylindrical portion 86B of the seal holder 86. At the peripheral end on the tip end side of the cylindrical portion 89 </ b> A, a folded portion 89 </ b> E that is folded inward is provided.

(Assembling the seal unit)
For example, the seal unit 82 is assembled as follows. First, the centering guide 91 is formed by overlapping the segments 93, and the pin 92D is inserted into the small hole 91E of the flange 91B and attached to the second mount 92.

  Next, the second mount 92 with the centering guide 91 attached is attached to the airtight rubber cover 89 by inserting a pin 92D into the small hole of the inner flange 89B. A pin 92D protrudes from a small hole in the inner flange 89B of the airtight rubber cover 89. In this state, the flange 88B of the dome-shaped seal 88 and the flange 87B of the first mount 87 are sequentially attached to the pin D protruding from the inner flange 89B of the airtight rubber cover 89 from the front end side. After these attachments are finished, the pin 92D is crimped.

  Finally, an airtight rubber cover 89 is covered from the base end side of the seal holder 86. The cylindrical portion 89B is attached to the outer periphery of the cylindrical portion 86B, and the peripheral end portion 86D is covered with the folded portion 89E. The first mount 87, the dome-shaped seal 88, the centering guide 91, and the second mount 92, which are fixed to the inner flange 89C, are accommodated inside the seal holder 86. As a result, the seal holder 86, the first mount 87, the dome-shaped seal 88, the centering guide 91, the second mount 92, and the airtight rubber cover 89 are integrated to complete the seal unit 82.

(Attaching the airtight structure unit to the head)
As shown in the cross-sectional view of FIG. 30, the duckbill valve 81 is pushed toward the distal end until the flange 81D abuts against the abutting surface 83 with the outer peripheral surface of the circular portion 81B in pressure contact with the inner wall of the head inner cylinder 32A. It is mounted by being.

  When the duckbill valve 81 is mounted, an internal space S1 is formed by the outer peripheral surface of the duckbill valve 81 and the inner peripheral surface of the head portion inner cylinder 32A in the head portion inner cylinder 32A. The internal space S1 communicates with the insertion hole 33 of the pipe portion inner cylinder 31A, and a connection port 49 to which carbon dioxide gas is supplied is also connected to the internal space S1.

  After the duckbill valve 81 is mounted, the seal unit 82 is mounted on the proximal end side of the duckbill valve 81. The seal unit 82 is attached in a state in which the folded portion 89E of the airtight rubber cover 89 that covers the peripheral end portion 86D of the seal holder 86 is in contact with the proximal end side of the flange 81D of the duckbill valve 81. After the seal unit 82 is mounted, the rear cover 43 is attached from the base end side of the seal unit 82.

  When the rear cover 43 is attached to the head portion inner cylinder 32A, the seal unit 82 receives pressure from the rear cover 43, and the duckbill valve 81 is pushed to the distal end side. Thereby, the flange 81D of the duckbill valve 81 is pressed against the abutting surface 83. The space between the outer peripheral surface of the duckbill valve 81 and the inner wall of the head portion inner cylinder 32A is hermetically sealed. Thereby, the internal space S1 is hermetically sealed.

  When the rear cover 43 is attached, the abutting surface 43G on the distal end side of the rear cover 43 and the peripheral edge 82A on the proximal end side of the seal unit 82 covered with the airtight rubber cover 89 are pressed against each other. At the distal end side of the seal unit 82, the folded portion 89E and the flange 81D of the duckbill valve 81 are in pressure contact. By this pressure contact, the peripheral end portion on the proximal end side of the duckbill valve 81 is sealed in the internal space S <b> 2 of the duckbill valve 81. Further, by attaching the rear cover 43, the seal unit 82 is sandwiched between the distal-side duckbill valve 81 and the proximal-side rear cover 43 and fixed so as not to move in the Z-axis direction.

  In the seal unit 82, the inner flange 89B of the airtight rubber cover 89 and the flange 88B of the dome-shaped seal 88 are pressed against each other and hermetically sealed by caulking the pin 92D. For this reason, in a state where the treatment instrument 22 is inserted through the opening 88C of the dome-shaped seal 88, the internal space S2 of the duckbill valve 81 is hermetically sealed.

(Function of airtight structure unit)
When the camera-equipped trocar 16 is inserted into the body cavity and inhaled by supplying carbon dioxide, the air pressure in the internal space S1 rises, and the openings 81C are formed on the two inclined surfaces of the valve portion 81A of the duckbill valve 81. Pressure acts in the closing direction. In a state where the treatment tool 22 is not inserted through the opening 81C, the opening 81C is hermetically sealed by the atmospheric pressure. Further, the duckbill valve 81 is airtightly attached to the head portion inner cylinder 31A. Therefore, in a state where the treatment instrument 22 is not inserted through the opening 81C, gas leakage from the internal space S1 to the outside of the body is prevented.

  When the trocar shaft 17 and the treatment instrument 22 are inserted through the opening 88C of the dome-shaped seal 88, the opening 88C expands due to elasticity and comes into close contact with the outer peripheral surface of the trocar shaft 17 and the treatment instrument 22. On the other hand, the opening 81C of the duckbill valve 81 opens when the trocar shaft 17 and the treatment instrument 22 are inserted. Since the opening 81C is a streak-like opening, when the opening 81C is opened, a gap is formed between the trocar shaft 17 and the outer peripheral surface of the treatment instrument 22, and the sealing is released.

  However, when the trocar shaft 17 and the treatment instrument 22 are inserted, the proximal end side of the internal space S2 in the duckbill valve 81 is sealed by the seal unit 82 including the dome-shaped seal 88. For this reason, even if the opening 81C of the duckbill valve 81 is opened by the insertion of the trocar shaft 17 and the treatment instrument 22, gas is prevented from leaking from the body cavity to the outside through the insertion hole 33.

  The seal unit 82 uses a single-layer dome-shaped seal 88 having an opening 88C, so that the gap between the segments does not occur as compared with the conventional seal in which the seal is configured by a plurality of segments. improves.

  A centering guide 91 having a hardness higher than that of the dome-shaped seal 88 and having an opening 91 </ b> C is disposed on the base end side of the dome-shaped seal 88. Therefore, when the treatment instrument 22 is inserted through the camera-equipped trocar 16, the treatment instrument 22 can be easily guided to the position of the opening 88 </ b> C at the center of the dome-shaped seal 88. This is because the treatment tool 22 is guided to the position of the opening 88C of the dome-shaped seal 88 when the treatment tool 22 is abutted against the proximal end side of the centering guide 91 and the position of the opening 91C is found by touch. Compared to the case where a protector without an opening is arranged on the base end side of the seal as in the conventional case, it is easier to find the opening position. Further, the centering guide 91 is harder than the dome-shaped seal 88, and the frictional resistance of the treatment instrument 22 is reduced.

  Further, in this example, the seal unit 82 uses a combination of a dome-shaped seal 88, a centering guide 91 composed of a plurality of segments 93, and an airtight rubber cover 89. The hardness of the dome-shaped seal 88 and the airtight rubber cover 89 is lower than the hardness of the centering guide 91. Therefore, as described below, even when a radial force is applied to the opening 88C of the dome-shaped seal 88 due to the movement of the treatment instrument 22, the deformation of the opening 88C is prevented. When the opening 88C is prevented from being deformed, a gap is unlikely to be formed between the treatment tool 22 and the outer peripheral surface, so that a good sealing performance can be ensured.

  32A and 32B are views of the seal unit 82 in a state where the treatment tool 22 is inserted, as viewed from the proximal end side. 32A shows a state in which the treatment instrument 22 is at the center in the radial direction of the seal unit 82, and FIG. 32B shows a state in which the treatment instrument 22 has moved to the right in the radial direction of the seal unit 82 from the state in FIG. Indicates.

  When the treatment tool 22 is inserted, the opening 88C of the dome-shaped seal 88 and the opening 91C of the centering guide 91 are expanded according to the outer diameter of the treatment tool 22. As shown in FIG. 32A, in a state where the treatment instrument 22 is at the center, the bellows portion 89D of the airtight rubber cover 89 maintains an initial state where the distance from the cylindrical portion 89A is uniform over the entire circumference.

  When the treatment tool 22 is operated and the treatment tool 22 moves in the radial direction (right side in the figure) as shown in FIG. 32B, a force acts in the direction of expanding the opening 91C of the centering guide 91. In order for the opening 91C to expand, the adjacent segments 93 must move away from each other. In this case, frictional resistance is generated by contact of the overlapping region 93A. The resistance force when expanding the opening 91C due to the frictional resistance includes the resistance force when expanding the opening 88C of the dome-shaped seal 88 and the resistance force when elastically deforming the bellows portion 89D of the airtight rubber cover 89. Bigger than.

  Therefore, the bellows portion 89D is elastically deformed faster than the opening 91 expands. When the bellows portion 89D is elastically deformed, the centering guide 91 and the dome-shaped seal 88 held by the inner flange 89B of the airtight rubber cover 89 are moved in the radial direction as a whole. Thereby, the force for expanding the opening 88C of the dome-shaped seal 88 is also reduced, so that the deformation of the opening 88C is prevented.

  Further, the shape of the segment 93 constituting the centering guide 91 is a fan shape having an arc of ¼ of the circumference of the centering guide 91, so that the segment 93 has a semicircular segment protector. The overlapping amount of the adjacent segments 93 is reduced. Thereby, the smoothness of insertion and extraction of the treatment tool 22 with respect to the opening 91C is improved. In addition, by setting the area of the overlap region to be half or less of the total area of the segment, the overlap amount is reduced as compared with the conventional technique, and thus smoothness is further improved.

  In addition, the overlapping region 93A between the adjacent segments 93 has a shape in which the overlapping width monotonously increases from the outer periphery toward the center opening 91C, thereby facilitating the insertion and withdrawal of the treatment tool 22 from and into the opening 91C. Further improvement can be achieved. This is because the treatment instrument 22 is inserted in the vicinity of the center where the opening 91C is located, so that the adjacent segments 93 are easily separated. On the other hand, the closer to the outer periphery, the farther from the treatment tool 22 near the center, the smaller the amount of the adjacent segments 93 that are separated from each other.

  As described above, considering the smoothness of insertion and withdrawal of the treatment instrument 22, it is preferable that the overlapping region 93A is small. Therefore, by making the width of the overlapping region 93A monotonically increase from the outer periphery toward the center opening 91C, it is possible to prevent a gap from occurring between the adjacent segments 93 and to prevent the overlapping region 93A from being formed. The width can be kept to a minimum.

  Hereinafter, the operation of the above configuration will be described. When performing laparoscopic surgery, the endoscope 11 and the camera-equipped trocar 16 are connected to the processor 18. After the connection is completed, the processor 18 is activated. Thereby, driving of the camera unit 28 of the endoscope 11 and the camera unit 62 of the trocar 16 with a camera is started, and photographing is started. Image signals from the camera unit 28 and the camera unit 62 are input to the processor 18. The processor 18 performs image processing on the image signal and displays a combined image obtained by combining the endoscopic image and the trocar image on the monitor 19.

  The medical staff member ST inserts the endoscope 11 and the trocars 16 and 17 into the abdominal cavity while confirming the composite image displayed on the monitor 19. First, for example, three incisions 26 and 27 are opened in the abdomen of the patient P as shown in FIG. A normal trocar 21 having no camera function is inserted into the central incision 26.

  On the other hand, two trocars 16 with a camera are inserted into the two incisions 27. The camera-equipped trocar 16 is inserted in a state where the trocar shaft 17 is attached to the camera-equipped trocar 16. At the time of mounting, as shown in FIGS. 12B and 13B, the outer cylinder member 16B of the camera-equipped trocar 16 is set to the holding release position where the camera unit 36 is in the deployed position.

  The slide of the outer cylinder member 16B is locked by the unlocking operation member 46. Therefore, when in the holding position, as shown in FIG. 19B, the outer cylinder member 16B is slid to the holding release position on the base end side in a state where the lock release operation member 46 is pressed to release the lock. As shown in FIG. 19C, when the outer cylindrical member 16B is slid toward the holding release position and the engaging convex portion 46E reaches the engaging groove 47B, the engaging convex portion 46E and the engaging groove are acted upon by the spring 68. 47B is engaged, and the outer cylinder member 16B is locked at the holding release position.

  In this state, the shaft portion 53 is inserted from the head portion 32 into the insertion hole 33 of the pipe portion 31. As indicated by a two-dot chain line in FIG. 14, the cam pin 59 is aligned with the position of the guide groove 52C, the trocar shaft 17 is advanced to the tip side, and the cam pin 59 is engaged with the guide groove 52C. When the cam pin 59 reaches the second end 52B, the fitting claw 54A shown in FIG. 6 enters the fitting groove 43B from the notch 43C shown in FIG. 7, and the state shown in FIG. 4, FIG. 12B and FIG. Become. This state is a holding release position of the outer cylinder member 16B where the camera unit 36 is in the deployed position.

  When the trocar shaft 17 is rotated toward the initial position, the lock release operation member 46 is pressed so that the slide of the outer cylinder member 16B is locked. In this state, the handle portion 54 of the trocar shaft 17 is rotated. As the trocar shaft 17 rotates, the outer cylindrical member 16B slides to the tip side along the Z-axis direction by the action of the cam pin 59 and the cam groove 52B. By this slide, the tip of the pipe portion 31 comes into contact with the camera portion 36 in the deployed position from the rear, and the camera portion 36 is rotated toward the storage position. When the outer cylinder member 16B reaches the holding position, the storage of the camera unit 36 is completed as shown in FIGS. 3, 12A, and 13A.

  Thus, since the outer cylinder member 16B is slid by the rotation of the trocar shaft 17, the force acting in a direction other than the Z-axis direction is reduced as compared with the case where the pipe outer cylinder 31B is directly gripped and operated. Therefore, smooth sliding operation of the pipe part outer cylinder 31B is possible.

  In a state where the trocar shaft 17 is attached to the trocar 16 with a camera, the puncture portion 55 is exposed from the tip of the pipe portion 31. When inserting the camera-equipped trocar 16, the puncture portion 55 is inserted into the incision portion 27. The puncture portion 55 enters the body cavity while expanding the abdominal wall 23, and the pipe portion 31 enters after the puncture portion 55. At this time, the puncture unit 55 advances while tearing the subcutaneous tissue of the fat 23A.

  At this time, the puncture portion 55 and the pipe portion 31 are wound with the subcutaneous tissue of the fat 23 </ b> A constituting the abdominal wall 23. As shown in FIG. 23A, when the trocar shaft 17 is in the initial position and the camera unit 36 is in the retracted position, the two protrusions 78 of the puncture unit 55 are positions corresponding to the hinges of the camera unit 36. Placed in. Therefore, as shown in FIGS. 24A and 24B, in the region R1 around the hinge portion including the hinge portion of the camera portion 36 behind the puncture portion 55, the wrapping of the fat 23A is performed as compared with the other region R2. Is suppressed.

  When the pipe portion 31 of the camera-equipped trocar 16 is inserted to a desired depth in the body cavity, the camera portion 36 is deployed. In this development, the lock operation member 46 is pressed to release the slide lock of the outer cylinder member 16B. In this state, the handle portion 54 of the trocar shaft 17 is rotated from the initial position to the release completion position. Then, due to the action of the cam pin 59 and the cam groove 52, the outer cylinder member 16B slides toward the proximal end side from the holding position toward the holding release position. As described above, since the outer cylinder member 16B is slid by rotating the trocar shaft 17, a smooth operation is possible. By this slide, the holding of the camera unit 36 is released, and the camera unit 36 pops up toward the deployed position by the urging force of the spring 71.

  Further, when the trocar shaft 17 is rotated toward the release completion position, as shown in FIGS. 15A to 15C, the pressing portion 57 </ b> B provided in the connecting portion 57 contacts the camera portion 36 to expand the camera portion 36. Push up to the position. There is a case where fat 23A adheres to the tip of the pipe part 31 where the camera part 36 is provided, and becomes a resistance when the camera part 36 pops up. Even in such a case, since the urging force of the spring 71 is assisted by the deployment assist mechanism configured by the connecting portion 57, the deployment by the pop-up of the camera unit 36 can be reliably performed.

  Further, the two protrusions 78A and 78B of the puncture portion 55 also suppress the wrapping of the fat 23A around the region R1 around the hinge portion of the camera portion 36, so that the camera portion 36 can be smoothly deployed. become.

  Further, in the holding release position where the camera portion 36 is at the unfolded position, as shown in FIG. 19C, the outer cylinder member 16B is engaged with the engaging convex portion 46E and the engaging groove 47B, and the slide is locked. . For this reason, the outer cylinder member 16B does not slide carelessly and the camera unit 36 is not stored.

  In the state where the camera unit 36 is deployed, the trocar shaft 17 is in the release completion position. In this state, the cam pin 59 has reached the second end 52B as shown by a two-dot chain line in FIG. Therefore, the trocar shaft 17 can be extracted from the trocar 16 with a camera while moving the cam pin 59 along the guide groove 52C.

  After the trocar shaft 17 is extracted, carbon dioxide is supplied into the body cavity through the connection port 49 and the insertion hole 33 of the camera-equipped trocar 16 to perform an insufflation procedure. In a state where the treatment instrument 22 is not inserted through the camera-equipped trocar 16, the internal space S <b> 1 (see FIG. 30) communicating with the insertion hole 33 is hermetically sealed by the duckbill valve 81. Therefore, no gas leakage occurs in this state.

  After the end of the pneumoperitoneum, the endoscope 11 is inserted into the body cavity using the trocar 21 as an insertion port. Then, the treatment tool 22 is inserted into the body cavity using the camera-equipped trocar 16 as an insertion port.

  When the treatment tool 22 is inserted, it is harder than the dome-shaped seal 88 and is easily guided to the opening 88C of the dome-shaped seal 88 by the action of the centering guide 91 having the opening 91C.

  When the treatment tool 22 is inserted, the opening 81C of the duckbill valve 81 is opened. The treatment tool 22 is inserted through the opening 88C of the dome-shaped seal 88 of the airtight structure unit 42, and the opening 88C and the treatment tool 22 are in close contact with each other. For this reason, the sealing by the duckbill valve 81 is released, but the seal of the internal space S2 (see FIG. 30) communicating with the insertion hole 33 is maintained by the airtight structure unit. In addition, since the dome-shaped seal 88 has a single sheet configuration, the sealing performance is better than the case where it is configured by a plurality of segments.

  The medical staff ST performs the procedure by operating the treatment tool 22 while observing the inside of the body cavity through the composite image displayed on the monitor 19. Since the dome-shaped seal 88 is highly flexible, good operability of the treatment instrument 22 is ensured. Even when the treatment instrument 22 moves in the radial direction, the combination of the dome-shaped seal 88, the bellows portion 89D of the airtight rubber cover 89, and the centering guide 91 having higher hardness than these, as shown in FIG. The deformation of the opening is prevented. The sealing performance can be ensured by preventing the opening 88C from being deformed.

  The present invention is not limited to the above-described embodiment, and it goes without saying that the embodiment is appropriately modified within a range not departing from the present invention. For example, although the above-described embodiment includes a plurality of inventions, they may be implemented alone or two or more inventions may be appropriately combined. In the above embodiment, the seal unit including the dome-shaped seal and the centering guide can be applied to a normal trocar not provided with a camera.

DESCRIPTION OF SYMBOLS 10 Laparoscope system 11 Endoscope 11A Insertion part 12 Trocar apparatus with a camera 16 Trocar with a camera 16A Inner cylinder member 16B Outer cylinder member 17 Trocar shaft 18 Processor 19 Monitor 20 Console 21 Trocar 22 Treatment tool 22A Tip part 23 Abdominal wall 23A Fat 26 27 Incision part 28 Camera unit 31 Pipe part 31A Pipe part inner cylinder 31B Pipe part outer cylinder 32 Head part 32A Head part inner cylinder 32B Head part outer cylinder 33 Insertion hole 35 Engagement claw 36 Camera part 41 Non-slip 42 Airtight structure unit 43 Rear cover 43A Engagement hole 43B Fitting groove 43C Notch 43D Grasping part 43E Opening 43F Slot 43G Abutting surface 44 Connector part 46 Unlocking operation member 46A Operation part 46B Supporting part 46C Attachment pin 46D Attachment hole 46E Engagement Convex part 47 Engagement part 47A, 47B Engagement groove 49 Connection port 51 Cam plate 52 Cam groove 52A First end 52B Second end 52C Guide groove 52D Straight part 52E Inclination part 53 Shaft part 54 Handle part 54A Fitting claw 55 Puncture Portion 55A outer peripheral surface 56 shaft portion main body 57 connecting portion 57A main body portion 57B pressing portion 58 pin disposition plate 58A position mark 58B direction mark 58C inner peripheral surface 58D outer peripheral surface 58E extended portion 59 cam pin 61 notch 62 camera unit 62A photographing lens 62B Lens barrel portion 63 Mount 64 Housing 64A Upper surface portion 64B Side surface portion 64C Hook 65 Rotating pin 66 Mounting portion 66A Opening 66B Bearing portion 67 Bearing portion 67A Tip side receiving port 68 Spring 71 Spring 72 Housing recess 72A Hook 76 Drop prevention member 76A Fixed end 76B Free end 76C Projection 78 Projection part 79 Upper end part 81 Duck bill valve 81A Valve part 81B Circular part 81C Opening 81D Flange 82 Seal unit 82A Peripheral edge 83 Abutting surface 86 Seal holder 86A Cover part 86B Cylindrical part 86C Opening 86D Peripheral edge 87 First mount 87A Mount part 87B Flange 87C Opening 88 Dome type seal 88A Sealing part 88B Flange 88C Opening 88E Small hole 89 Airtight rubber cover 89A Cylindrical part 89B Inner flange 89C Opening 89D Bellows part 89E Folding part 91 Centering guide 91A Guide part 91B Flange 91C Opening 91E Small hole 92 Second mount 92A Mount portion 92B Flange 92C Opening 92D Pin 93 Segment 93A Overlapping region C1, C2 Center line D1, D2 Maximum diameter Lp Bond line P Patient R1 region R2 region S 1 Internal space S2 Internal space ST Medical staff

Claims (5)

A trocar having a pipe portion inserted into a body cavity;
A trocar shaft that is attached to the trocar when the trocar is inserted into the body cavity and has a puncture portion formed at a tip thereof, and the puncture portion is inserted from the tip of the pipe portion when attached to the trocar. An exposed trocar shaft,
A retractable camera that is disposed at a distal end of the pipe part and is displaced between a storage position stored in the pipe part and a deployment position that is deployed in a direction protruding from the outer peripheral surface of the pipe part. And
Hinge portions that are provided at both ends of the camera portion and hold the camera portion displaceably between the retracted position and the deployed position;
A plurality of protrusions formed on an outer peripheral surface of the puncture portion, projecting in a radial direction, and extending along an axial direction of the puncture portion, wherein the camera portion is in the retracted position; In the circumferential direction around the axis, a plurality of protrusions arranged at positions corresponding to the respective positions of the hinge parts,
Trocar device with camera.   The trocar device with a camera according to claim 1, wherein the plurality of protrusions are arranged in a cross shape in a cross shape when the puncture portion is viewed from the front end side in the axial direction.   The trocar device with a camera according to claim 1, wherein upper end portions of the plurality of protrusions are flat surfaces.   The trocar device with a camera according to any one of claims 1 to 3, wherein the puncture portion has a tapered shape whose diameter gradually increases from the distal end toward the proximal end.   The trocar device with a camera according to claim 4, wherein a maximum radial diameter of the plurality of protrusions is equal to or less than a maximum diameter of a portion where the protrusions are not formed on an outer peripheral surface of the puncture part.

Images