JP2020022553A - Inner retractor instrument for spine percutaneous endoscopic surgery - Google Patents

Abstract

To solve a problem in which only one instrument can be inserted in the lumen for work of a spine percutaneous endoscope in the cervical spine herniated disk resection under the percutaneous endoscope of back entry, and therefore a herniated disk cannot be resected safely by avoiding nerves.SOLUTION: An inner retractor instrument of this invention has a diameter slightly smaller than the lumen for work, is a cylinder capable of being inserted therein, and is capable of inserting forceps into the lumen of the inner retractor instrument, in which the tip end is shaped in a thin spatula of 1/4 of a circle. Operation is made possible by two pieces of a retractor and the forceps in a little safety area in the cervical spine spinal canal, and thereby surgery can be performed safely.SELECTED DRAWING: Figure 7

Description

  The present invention relates to a surgical instrument used in spinal percutaneous endoscopic surgery for cervical disc herniation.

The spine percutaneous endoscope 1 is a body part 1a, which is a part to be inserted into the body as shown in FIG. 1 and FIG. 3, is an elongated cylinder having an outer diameter of about 6 mm to about 7 mm, and includes a lens barrel 1a1. Light source path 1a2, perfusion water path 1a3, and working lumen 1a4 are integrated. A camera is connected to the camera connection part 1b, and the situation of the endoscope end is enlarged and displayed on a monitor, and fine parts are visually recognized. The surgical instrument is operated with instruments such as forceps 3 (FIGS. 1, 2, and 5) and a drill inserted into the working lumen 1a4. The basic shape of the forceps 3 is a cylindrical shape that can be inserted into the cylindrical working lumen 1a4. Insert a cylindrical outer cylinder 2 having an inner diameter slightly larger than the outer diameter of the main body portion 1a of the spinal percutaneous endoscope and an outer diameter of about 7 to 8 mm from the small incision into the spine, into which the vertebral percutaneous is inserted. The main body 1a of the target endoscope 1 is inserted, and the work is performed while securing the space for the percutaneous endoscope endoscope by the distal end of the outer cylinder 2. The skin incision is small, 6 to 7 mm in length, and the invasion of the route from the epidermis to the spine can be minimized.

FIG. 4 shows the approach path P in the posterior approach cervical disc herniation. The epidermis S is incised from the dorsal side, penetrates the subcutaneous and muscular layers, and the vertebral bone V is partially resected. (Where the membrane tube C and nerve root R pass). When the yellow ligament in the spinal canal is partially resected, a dural duct C (a spinal cord or cerebrospinal fluid passes through the lumen surrounded by the dura) and a nerve root R appear, and a disc D or a herniated disc further deeper than that. There is H.

Richard Wolf product catalog `` VERTEBRIS Lumbar-Thoracic Full-endoscopic Spinal Instrumentation ''

Spinal percutaneous endoscopes are small in diameter, and the number of instruments that can be inserted into a smaller working lumen is limited to one, and the working space is secured by an outer cylinder and operated with a single instrument. However, in the cervical vertebra, the spinal canal is occupied almost without gaps by the spinal cord and nerve roots R, and there is no space for inserting the outer cylinder 2 safely. The outer cylinder 2 is inserted up to the vertebral bone V in front of it. Therefore, the outer cylinder 2 cannot be inserted up to the intervertebral disc D. When viewed from the back, the nerve root R and the membrane tissue are in front of the intervertebral disc herniation H, which obstructs the visual field. Therefore, the operation of grasping the intervertebral disc herniation H with the forceps 3 is blind and dangerous operation. For safety, it is necessary to grasp the intervertebral hernia while securely holding the nerve, but at present, only one instrument can be inserted, so it is not possible.

Therefore, in percutaneous endoscopic cervical disc hernia resection, it is necessary to insert two retractors and a forceps into the working lumen. The purpose is to make it possible.

In order to solve the above problems, an inner retractor of a spinal percutaneous endoscopic surgical instrument of the present invention is a cylinder having an outer diameter slightly smaller than the inner diameter of a working lumen of a spinal percutaneous endoscope. The total length is longer than that of a percutaneous endoscope. The tip is cut off into a quarter circle, forming a thin spatula. The three-quarter circle is open. The outer diameter of the handle near the hand is larger than that of the cylinder, making it easier to grasp. The whole is made of hard metal.

The handle may be shaped like a bar.

The internal retractor device is inserted into the working lumen of the spinal percutaneous endoscope, and can be inserted into a small space with a small diameter and a quarter circle tip. The distal end is inserted into a small space between the nerves in the spinal canal to keep the nerve away, but the open part is directed toward the lens of the spinal percutaneous endoscope to secure the visual field. And the lumen of the inner retractor is a cylindrical through-lumen, and the existing forceps can be inserted. It becomes possible to grasp the herniated disc with forceps and remove it while keeping the nerve away with the internal retractor. In other words, it is possible to insert a retractor and forceps into a working lumen in a spinal percutaneous endoscopy, and remove a herniated disc through a nerve in a narrow space of the cervical spinal canal.

For example, it is conceivable that not only the tip but also the entire length is made into a quarter circle. However, the width is only a few millimeters and the length is 100 times the length. Stiffness is insufficient. The instrument of the present invention can function as a retractor without having to be a whole, and can insert existing forceps into its lumen, enabling operation of two forceps and retractor.

Conventional outer cylinders have various tip shapes, some of which are spatula-shaped, but all outer cylinders, including these, are intended for inserting a percutaneous percutaneous endoscope into them. It is a device of a different purpose from the invention, and of course, cannot be inserted into the working lumen of a spinal endoscope as in the present invention. Also, since the outer cylinder is too large in diameter, there is nothing that can be used in a small range like this device. If the same function as in the present invention is to be performed with an outer cylinder, the outer cylinder is large, so the tip of the outer cylinder may be formed into a thin spatula shape of 1/8 circle or less. However, only a small part acts as a retractor, losing its original role of preventing muscle tissue up to the vertebrae. The device of the present invention is ideal because the nerve root R is only removed at the final stage of the operation, and it is desirable that the device be used only at that time.

Overview of existing spinal percutaneous endoscope, outer tube and forceps (before insertion). FIG. 1 is a front view of an existing spinal percutaneous endoscopic forceps. FIG. 2 is a cross-sectional view of an existing spinal percutaneous endoscope main body. Anatomy of cervical spine cross section Sectional drawing at the time of forceps insertion of the existing spinal percutaneous percutaneous endoscope main body. FIG. 2 is an axial cross-sectional view of an existing spinal percutaneous endoscope main body portion when the instrument of the present invention and forceps are inserted. FIG. 2 is a side view of the first embodiment of the present invention. 1 is a sectional view of a shaft according to a first embodiment of the present invention. FIG. 2 is a front perspective view of the instrument, spinal percutaneous endoscope, outer tube and forceps of the present invention in use. The side view of Embodiment 2 of the present invention.

Embodiment 1 of the present invention will be described with reference to FIGS. Assuming that the inner diameter of the working lumen 1a4 of the spinal percutaneous endoscope 1 is 4.1 mm, the outer diameter of the cylindrical portion 401 of the inner retractor device 4 of the present invention is a slightly smaller 4 mm outer diameter cylinder. Assuming that the total length of the spinal percutaneous endoscope 1 is 260 mm, the total length of the inner retractor 4 is about 300 mm, which is longer than that. The tip portion 402 is cut into a quarter circle over a length of about 20 mm, and has a thin spatula shape. A handle portion 403 is provided on the hand side of the cylindrical portion 401, and its outer diameter is about 15 mm, which is larger than the outer diameter of the cylindrical portion 401, so that it can be easily gripped.

Embodiment 2 of the present invention will be described with reference to FIG. The handle portion 404 is formed as a bar-shaped protrusion, and the rest is the same as in the first embodiment.

As shown in FIGS. 6 and 9, the relative positions of the outer cylinder 2, the spinal percutaneous endoscope main body 1a, the inner retractor device 4, and the forceps 3 from the outside. Conventionally, only one forceps 3 enters the working lumen 1a4 as shown in FIG. 5, but in the case of the present invention, the inner retractor 4 and the forceps 3 are connected to the working lumen 1a4. Insert into 1a4. The outer diameter of the forceps 3 that can be inserted by the thickness of the inner retractor device 4 is small, but the existing small-diameter forceps are sufficient because the cervical disc herniation is small and soft.

Claims (1)

A cylinder with an outer diameter slightly smaller than the inner diameter of the working lumen of the spinal percutaneous endoscope, having a lumen,
The tip side has a spatula shape of less than half a circle due to the lack of the cylinder.
An instrument for spinal percutaneous endoscopic surgery, comprising a handle portion having a size deviating from the outer diameter of the cylinder on the proximal side.