JP2020146397A - Transanal surgical tool introduction device - Google Patents

Abstract

To provide a transanal surgical tool introduction device that can sufficiently perform pneumoperitoneum and ensure its airtightness even when an outer tube is placed outside the body rather than the anus.SOLUTION: A transanal surgical tool introduction device 1 comprises: an outer tube 7 to which an inner tube 10 is attached inside; an opening device 4 that comprises an inner ring member 15 and an outer ring member 16 which are fixed on both side of a cylindrical opening member 14 and to be arranged inside and outside the anus, and is attached on the anus 3 to hold the anus 3 in an open state; an opening extension part 6 that comprises a proximal ring member 18 and a distal ring member 19 which are respectively fixed on opening part at both side of a cylindrical extension member 17; a joint part 5 that airtightly joins the opening device 4 and the opening extension part 6; and a reducer 8 that is attached to the distal ring member 19 and airtightly joins the outer tube 7 with the opening extension part 6.SELECTED DRAWING: Figure 1

Description

The present invention relates to a transanal surgical tool introduction device for introducing a surgical tool such as an endoscope or forceps into the rectum via the anus.

Conventionally, an outer tube to which an inner tube is attached is faced into the abdominal cavity through a retractor provided at the wound opening, and an endoscope or forceps are inserted into the inner tube and introduced into the abdominal cavity for surgery (laparoscopic surgery). There are known endoscopic treatment devices for performing the above (see, for example, Patent Document 1). In the endoscopic treatment device of Patent Document 1, the outer tube is introduced into the body cavity on the distal end side by inserting it into the opening of the valve cap attached to the retractor. Therefore, in order to maintain the airtightness in the body cavity, the airtightness between the outer tube and the retractor is maintained by the valve cap.

International Publication No. 2017/119108

However, when performing rectal surgery with the endoscopic treatment device of Patent Document 1, it is necessary to arrange the outer tube outside the body rather than the anus in order to secure a treatment area with a treatment tool such as forceps. Therefore, the airtightness between the outer tube and the retractor cannot be ensured. Therefore, it is not possible to sufficiently perform pneumoperitoneum to secure the surgical area in the rectum.

In view of the above problems of the prior art, an object of the present invention is to provide a transanal surgical tool introduction device capable of sufficiently performing pneumoperitoneum and ensuring its airtightness even when the outer tube is arranged outside the body rather than the anus. There is.

The transanal surgical tool introduction device of the present invention
An outer tube to which an inner tube for introducing surgical tools into the rectum is attached inside,
It has a flexible tubular opening member and an inner annular member and an outer annular member fixed to the openings on both sides of the tubular opening member and arranged inside and outside the anus, respectively, in the anus. An opening device that is attached to hold the anus in an open state,
A flexible tubular extension member, and an opening extension having a proximal annular member and a distal annular member fixed to the openings on both sides of the tubular extension, respectively.
A joint portion that connects the outer annular member and the proximal side annular member to airtightly join the opening device and the opening extension portion.
It is characterized by including a reducer attached to the distal annular member and airtightly connecting the outer tube to the opening extension.

In this configuration, in rectal surgery, the outer tube is connected to the extension of the opening joined to the opening device attached to the anus via the reducer, and the surgical tool is passed through the inner tube attached to the outer tube. The tip of the surgery is introduced into the rectum.

At this time, since the outer tube is connected to the extension of the opening, it is located on the outside (distal side) of the body from the anus. Further, the space between the distal annular member of the opening extension and the outer tube is airtightly held by the reducer. Further, the opening extension portion and the opening device are airtightly joined by a joint portion. Therefore, even when the outer tube is arranged outside the body rather than the anus, it is possible to sufficiently perform pneumoperitoneum and ensure its airtightness.

Therefore, it is possible to secure the surgical area in the rectum by sufficiently performing pneumoperitoneum in the rectum while arranging the tip of the surgical tool protruding from the tip of the inner tube at a position suitable for rectal surgery. In addition, since the tubular extension member of the opening extension has flexibility, the distance of the outer tube from the anus can be arbitrarily adjusted while maintaining the airtightness of the pneumoperitoneum, and the position of the tip of the surgical instrument can be adjusted. It can be freely selected.

In the present invention, the tubular extension member is preferably configured to be retractable by the proximal annular member or the distal annular member.

According to this, by winding an appropriate amount of the tubular extension member according to the surgical site, the slack of the tubular extension member can be eliminated and more appropriate surgery can be performed.

In the present invention
An annular packing for maintaining airtightness between the inner annular member and the tubular opening member and the inner wall of the anus.
The annular packing has an outer diameter larger than the inner diameter of the inner annular member and smaller than the outer diameter, and is in contact with the inner annular member arranged inside the anus directly or by sandwiching the tubular opening member. It is preferable that the tubular opening member is arranged outside the tubular opening member.

According to this, the position of the opening device in the circumferential direction can be changed while maintaining the airtightness of the pneumoperitoneum, and appropriate surgery can be performed.

It is a top view which shows the endoscopic treatment apparatus provided with the transanal surgical instrument introduction apparatus which concerns on one Embodiment of this invention. It is a side view of the endoscopic treatment apparatus of FIG.

Hereinafter, embodiments of the present invention will be described with reference to the drawings. 1 and 2 show an endoscopic treatment device 2 to which the transanal surgical device introduction device 1 according to the embodiment of the present invention is applied. As shown in FIGS. 1 and 2, the transanal surgical instrument introduction device 1 has an opening device 4 attached to the anal portion 3 and an opening extension portion that is airtightly joined to the opening device 4 via the joint portion 5. 6, an outer tube 7 connected to the opening extension portion 6, and a reducer 8 provided in the opening extension portion 6 are provided.

An inner tube 10 for introducing a surgical tool into the rectum 9 is attached to the outer tube 7 inside. This attachment is performed so that the tip of the inner tube 10 protrudes from the tip of the outer tube 7.

Further, in this attachment, the position of the inner tube 10 with respect to the outer tube 7 in the direction along the central axis and the rotation angle around the central axis can be adjusted. Further, the diameter and the number of the inner tubes 10 can be arbitrarily selected according to the surgical tools required for the procedure. Examples of surgical tools include endoscopes and forceps.

The inner tube 10 is attached to the outer tube 7, for example, a cross section provided on the side surface of the inner tube 10 in a T-shaped guide groove having a plurality of cross sections provided inside the outer tube 7 along the length direction thereof. Can be done by fitting a T-shaped guided portion.

In this case, by selecting the guide groove for mounting the inner tube 10, the rotation angle of the inner tube 10 around the central axis and the mounting position in the circumferential direction with respect to the outer tube 7 can be adjusted to some extent. Means for realizing such mounting are disclosed in, for example, International Publication WO2017 / 119108.

The inner tube 10 is a flexible tubular body, and a treatment tool such as a forceps 11 or a scalpel or an endoscope 12 can be inserted and passed through the inner tube 10.

At the distal end of the outer tube 7, a reducer 13 is provided to maintain airtightness to the outside when the inner tube 10 is attached to the outer tube 7. The reducer 13 is stretched with a valve seat provided with a plurality of openings for inserting the inner tube 10 into the outer tube 7 while maintaining airtightness with the outside.

The opening device 4 is a flexible tubular opening member 14, and an inner annular member 15 and an outer annular member fixed to the openings on both sides of the tubular opening member 14 and arranged inside and outside the anus 3, respectively. 16 is attached to the anus 3 to hold the anus 3 in an open state. The distal end side of the tubular opening member 14 can be wound up to some extent by the outer annular member 16 so that the opening device 4 is securely attached to the anus portion 3.

The opening extension portion 6 has a flexible tubular extension member 17, and a proximal annular member 18 and a distal annular member 19 fixed to openings on both sides of the tubular extension member 17, respectively. The tubular extension member 17 can be wound by the proximal annular member 18 and / or the distal annular member 19.

The joint portion 5 connects the outer annular member 16 and the proximal side annular member 18 to join the opening device 4 and the opening extension portion 6.

The reducer 8 of the opening extension portion 6 is provided on the distal annular member 19, and airtightly connects the outer tube 7 to the opening device 4 so that the opening on the proximal side thereof is located in the opening device 4. .. In order to realize this connection, the reducer 8 includes an annular frame 20 and a valve seat 21 stretched on the distal side of the annular frame 20.

A tubular extension member 17 is fixed to the inside of the proximal side of the annular frame 20, or a distal annular member 19 in a state in which the tubular extension member 17 is appropriately wound is fitted and fixed from the inside. An annular groove 22 open to the inside is provided. An insertion opening 23 for inserting the outer tube 7 and airtightly connecting to the opening device 4 is provided in the central portion of the valve seat 21.

The joint portion 5 is provided with an annular groove 24 opened inward for fitting and fixing the outer annular member 16 in a state in which the tubular opening member 14 is appropriately wound from the inside. Further, the joint portion 5 is an annular member that is open to the inside for fitting and fixing the proximal side annular member 18 in a state where the tubular extension member 17 is fixed or the tubular extension member 17 is appropriately wound. The groove 25 is provided on the distal side. That is, by fixing the outer annular member 16 to the annular groove 24 and fixing the proximal side annular member 18 to the annular groove 25, the opening device 4 and the opening extension portion 6 are airtightly joined. ..

Further, the transanal surgical tool introduction device 1 includes an annular packing 26 for maintaining airtightness between the inner annular member 15 and the tubular opening member 14 and the inner wall of the anal portion 3. The annular packing 26 has an outer diameter larger than the inner diameter of the inner annular member 15 and smaller than the outer diameter, and is in contact with the inner annular member 15 arranged inside the anal portion 3 directly or with the tubular opening member 14 in between. In this state, it is arranged outside the tubular opening member 14.

The inner tube 10 includes a tube main body 27 and a bendable swing pipe 28 connected to the tip end side thereof. A nose cover 29 is attached to the tip of the swing pipe 28. The swing pipe 28 is a pipe having flexibility in which thin ring-shaped members are connected in an articulated manner and can be bent only in any one direction. For example, the swing pipe 28 is configured as a processed product of a stainless steel pipe and is straightened. It can be configured as a bending mechanism that bends in only one direction from the state.

Further, the swing pipe 28 can also be configured by connecting a pipe made of a flexible soft material or a ring made of a hard plastic material such as ABS or polycarbonate.

The nose cover 29 is made of a plastic similar to or softer than the swing pipe 28, for example, a soft plastic such as vinyl chloride, rubber or the like. Since the nose cover 29 is made of a soft material, even if it comes into contact with the inner wall of the rectum, the inner wall is not damaged.

A slide pipe 30, slide knobs 31 and 32, and a degassing prevention valve 33 are attached to the base end of the inner tube 10.

Wire members 34 and 35 are attached to the inner tube 10 from the tip end side to the base end side. Specifically, the tip portions of the wire members 34 and 35 are fixed to the nose cover 29, pass outside the swing pipe 28, and are embedded in the tube body 27 along the axial direction, and the base end of the inner tube 10 The base end portion is fixed to the slide knobs 31 and 32, respectively, extending rearward from the portion.

The slide knobs 31 and 32 are configured to be slidable with respect to the slide pipe 30. Therefore, when the tip of the inner tube 10 protrudes from the tip of the outer tube 7, the swing pipe 28 is bent outward in the radial direction by pulling the slide knob 31 toward the base end side. be able to. On the contrary, by pulling the slide knob 32 toward the base end side, the swing pipe 28 can be returned to a straight line without bending.

The degassing prevention valve 33 is connected to the slide pipe 30 via the valve connector 36, and has a function of preventing air leakage from the inner tube 10 into which no surgical tool such as an endoscope 12 or forceps 11 is inserted. ..

The slide knob 31 is provided so that the stopper ring 37 can rotate. The stopper ring 37 can rotate between the rotational position of the slide pipe 30 standing outward in the radial direction and the tilted rotational position. With the slide knob 31 pulled toward the base end side, the stopper ring 37 is tilted and hooked on the valve connector 36 to fix the pulled state.

The endoscope 12 and the forceps 11 have bending portions 38 and 39 that can be bent at the tip end portion, and a driving portion 40 that operates the bending portions 38 and 39 at the base end portion, respectively. The drive unit 40 includes a motor 41, a drive side pulley 42, a wire 43, and a driven side pulley 44.

The motor shaft of the motor 41 is connected to the drive-side pulley 42, and one end of the wire 43 is bridged to the drive-side pulley 42. The wire 43 is movably housed inside the endoscope 12 and the forceps 11 along the axial direction, and the other end thereof is bridged over the driven pulley 44. That is, when the motor 41 is rotated, the drive side pulley 42 is rotated, the wire 43 is moved, the driven side pulley 44 is rotated, and the bent portions 38 and 39 are bent.

As a result, the tip portions of the camera 45 and the forceps 11 provided at the tip end of the endoscope 12 can be bent inward in the radial direction so as to face the treated portion 46. The on / off operation of the motor 41 may be either a manual type or a mechanically controlled type. Further, the wire 43 may be moved manually.

Further, the bent portions 38 and 39 can be formed into a bent shape and elastically deformed so as to be able to be bent linearly. That is, the endoscope 12 or the forceps 11 is inserted into the inner tube 10 in a state where the bending portions 38 and 39 are linearly extended from the bent state, and the endoscope 12 or the forceps 11 is advanced to advance the bending portion. When the 38 and 39 are projected from the nose cover 29 of the inner tube 10, the bent portions 38 and 39 are configured to return to the original bent state. As a result, the bent portions 38 and 39 can be bent inward in the radial direction without providing the drive portion 40.

In this configuration, when using the endoscopic treatment device 2, the opening device 4 is first attached to the anus portion 3 together with the annular packing 26. At this time, the distal end side of the tubular opening member 14 is appropriately wound by the outer annular member 16 so that the opening device 4 is securely attached to the anus portion 3.

Next, the joint portion 5 is attached to the outer annular member 16 of the opening device 4, and the proximal side annular member 18 of the opening extension portion 6 is attached to the joint portion 5, whereby the opening extension portion 6 is connected to the opening device 4. To do. Then, the reducer 8 is attached to the distal annular member 19 of the opening extension portion 6.

Next, the inner tube 10 is inserted into the outer tube 7 and attached. In the present embodiment, as shown in FIG. 1, the endoscope 12 is attached so as to be separated by 60 degrees in the circumferential direction so that the endoscope 12 is arranged upward and each of the two forceps 11 is arranged in the left-right direction. At this point, the inner tube 10 is in a state of being buried without protruding from the tip of the outer tube 7.

Next, the endoscope 12 and the forceps 11 are inserted into the inner tube 10, respectively. At this time, the endoscope 12 and the forceps 11 are in a state of being buried without protruding from the tip of the inner tube 10.

Next, the inner tube 10 is advanced, protrudes from the tip of the outer tube 7, and the slide knob 31 is pulled to bend the swing pipe 28 radially outward of the outer tube 7. Next, the outer tube 7 is inserted into the body cavity via the reducer 8.

Next, the endoscope 12 is advanced and protrudes from the tip of the inner tube 10. Then, by operating the operation unit for the endoscope, the endoscope 12 is bent inward in the radial direction by the bending portion 38 and directed toward the treated portion 46.

Further, the forceps 11 are advanced, protruded from the tip of the inner tube 10, and while observing with the endoscope 12, the forceps 11 are bent inward in the radial direction by the bending portion 39 by operating the operation unit for the treatment tool. And bring it closer to the treated portion 46. This completes the preparation and allows the procedure to be performed.

According to the present embodiment, in the operation of the rectum 9, the opening device 4 is first attached to the anus portion 3 and the tubular opening member 14 is wound up to ensure that the opening device 4 is attached to the anus portion 3. Since it is worn, it can be appropriately adapted to various sizes of anus 3.

Therefore, in the case of a conventional fixture (corresponding to the opening device 4) fixed to the opening of the anus 3, the airtightness with the anus 3 depends on the deployment reaction force of the anus 3 itself, and varies. While it is necessary to prepare a fixture of the size of the above, according to the present embodiment, there are few variations in the size of the opening device 4.

Further, in the conventional fixture, the occupied space of the fixture itself at the inner diameter of the anal portion 3 is larger than that of the opening device 4 of the present embodiment having the elastic sheet-shaped tubular opening member 14. Therefore, according to the present embodiment, the movable range of the treatment instrument near the anus can be made wider than that of the conventional fixture.

Further, according to the present embodiment, in the operation of the rectum 9, the outer tube 7 is attached to the opening extension portion 6 joined to the opening device 4 attached to the anus portion 3, and the outer tube 7 is passed through the inner tube 10. The tips of the endoscope 12 and the forceps 11 are introduced into the rectum 9. At this time, since the outer tube 7 is opened in the opening extension portion 6, it is located outside the body (distal side) of the anus portion 3 as compared with the case where it is directly connected to the opening device 4.

Therefore, while arranging the tips of the endoscope 12 and the forceps 11 protruding from the tip of the inner tube 10 at positions suitable for the treatment of the treated portion 46, the rectum 9 is sufficiently pneumoperitoneum. The surgical area inside can be secured. Further, since the tubular extension member 17 of the opening extension portion 6 has flexibility, the distance of the outer tube 7 from the anus portion 3 is arbitrarily adjusted while maintaining the airtightness of the pneumoperitoneum, and the endoscope 12 And the position of the tip of the forceps 11 can be freely selected.

Further, since the tubular extension member 17 is configured to be retractable by the proximal side annular member 18 or the distal side annular member 19, the tubular extension member 17 is wound by an appropriate amount according to the position of the treated portion 46. By taking it, the slack of the tubular extension member 17 can be eliminated, and a more appropriate operation can be performed.

Further, since the annular packing 26 for maintaining the airtightness between the inner annular member 15 and the tubular opening member 14 and the inner wall of the anal portion 3 is provided, the opening device 4 is in the circumferential direction while maintaining the airtightness due to pneumoperitoneum. The position can be changed and appropriate surgery can be performed.

The present invention is not limited to the above embodiment. For example, in the operation of the rectum 9, instead of first attaching only the opening device 4 to the anus 3 and then connecting the opening extension 6 to the anus 3 via the joint 5, the opening extension 6 is previously attached. The joined mouth opening device 4 may be attached to the anal portion 3 together with the annular packing 26. This procedure can also be applied when the above-mentioned conventional fixture is used instead of the opening device 4.

1 ... Transanal surgical tool introduction device, 2 ... Endoscopic treatment device, 3 ... Anal part, 4 ... Opening device, 5 ... Joint part, 6 ... Opening extension part, 7 ... Outer tube, 8 ... Reducer, 9 ... Rectum 10, 10 ... Inner tube, 11 ... Force, 12 ... Endoscope, 13 ... Reducer, 14 ... Cylindrical opening member, 15 ... Inner annular member, 16 ... Outer annular member, 17 ... Cylindrical extension member, 18 ... Proximal Side annular member, 19 ... distal annular member, 20 ... annular frame, 21 ... valve seat, 22 ... annular groove, 23 ... insertion opening, 24, 25 ... annular groove, 26 ... annular packing, 27 ... tube body, 28 ... Swing pipe, 29 ... Nose cover, 30 ... Slide pipe, 31, 32 ... Slide knob, 33 ... Degassing prevention valve, 34, 35 ... Wire member, 36 ... Valve connector, 37 ... Stopper ring, 38, 39 ... Bending part, 40 ... drive part, 41 ... motor, 42 ... drive side pulley, 43 ... wire, 44 ... driven side pulley, 45 ... camera, 46 ... treated part.

Claims (3)

An outer tube to which an inner tube for introducing surgical tools into the rectum is attached inside,
It has a flexible tubular opening member and an inner annular member and an outer annular member fixed to the openings on both sides of the tubular opening member and arranged inside and outside the anus, respectively, in the anus. An opening device that is attached to hold the anus in an open state,
A flexible tubular extension member, and an opening extension having a proximal annular member and a distal annular member fixed to the openings on both sides of the tubular extension, respectively.
A joint portion that connects the outer annular member and the proximal side annular member to airtightly join the opening device and the opening extension portion.
A transanal surgical instrument introduction device, which comprises a reducer attached to the distal annular member and airtightly connecting the outer tube to the opening extension. The transanal surgical instrument introducing device according to claim 1, wherein the tubular extension member is configured to be retractable by the proximal annular member or the distal annular member. An annular packing for maintaining airtightness between the inner annular member and the tubular opening member and the inner wall of the anus.
The annular packing has an outer diameter larger than the inner diameter of the inner annular member and smaller than the outer diameter, and is in contact with the inner annular member arranged inside the anus directly or by sandwiching the tubular opening member. The transanal surgical instrument introducing device according to claim 1 or 2, wherein the device is arranged outside the tubular opening member in the state of being