JP2021104220A - Cylindrical member and excision portion extractor - Google Patents

Abstract

To provide an excision portion extractor capable of efficiently and easily, extracting an excised portion in a body by laparoscopic surgical operation or the like to the outside of a body, through an anal or a vagina.SOLUTION: An excision portion extractor 100 comprises: a cylindrical member insertion tool 10 comprising, an insertion tool main body 11, an insertion guide part 110, and an open state adjusting part 13; and a cylindrical member 20 comprising control cords 24, 25 which are coupled to a cylindrical part 21 having flexibility for controlling an open state of a first end side opening 21A. The control cords 24, 25 are engaged to the open state adjusting part 13 for making a first dimension D211 of the cylindrical member 20 smaller than a second dimension D212 for inserting the excision portion extractor into a body, and engagement of the control cords 24, 25 is released for opening the first end side opening 21A.SELECTED DRAWING: Figure 2

Description

In the present invention, the excision site remaining in the body by excising the lesion generated in the digestive organ such as the large intestine is removed from the rectal incision through the anus or from the uterine incision formed in advance as a passage inside and outside the abdominal cavity through the vagina. The present invention relates to a tubular member for taking out the body and a device for taking out the excision site.

Conventionally, lesions that occur in the digestive organs such as colorectal cancer are excised by laparotomy and then taken out of the body, or excised by a microscopic automatic suture device and then through a small incision made on the body surface. It is common to take it out of the body.
On the other hand, for example, when a tissue containing a lesion is excised in the body using a laparoscope or the like, when the excised site is taken out of the body, if the excised site comes into direct contact with a normal tissue or a normal organ, these living bodies are contaminated. Therefore, it is necessary to take sufficient measures against contamination when removing the excised site.

Therefore, in order to remove the excised site from the body, a tubular member for arthroscopic surgery and an instrument for inserting the tubular member have been put into practical use (for example, Non-Patent Documents 1 and 2). reference.).

http://leaders.co.jp/product_maker/applied_medical GelPOINT® Path Transanal Access Platform (Applied Medical Catalog)

However, when excising with an automatic suture device or the like and removing the excised part remaining in the body to the outside of the body, in addition to preventing the living body from being contaminated by the excised part, it is minimally invasive, easy and efficient. It is necessary to be able to handle it.

Therefore, the excision site excised in the body by laparoscopic surgery or the like is passed through the anus from the rectal opening that became the opening of the digestive organ after excision, or through the vagina from the uterine opening that was previously formed as a passage inside and outside the abdominal cavity. There is a demand for a tubular member and an excision site extraction device that can be easily and efficiently removed from the body.

The present invention has been made in consideration of such circumstances, and the excision site excised in the body by laparoscopic surgery or the like is easily and efficiently removed from the body via the anus or vagina. It is an object of the present invention to provide a tubular member that can be taken out and a device for taking out a cutting site.

In order to solve the above problems, the present invention proposes the following means.
The invention according to claim 1 is an excision site extraction device that takes out an excision site to the outside of the body via the anus or vagina, and the opening on the first end side of the tubular member is inserted into the body via the anus or vagina. An inserter body formed long along the axis, an insertion guide portion formed at the tip end portion of the inserter body, and an opening state adjusting portion arranged on the base end side of the insertion guide portion. A tubular member inserter having a tubular member, a tubular portion formed of a flexible material and having a deformable first end side opening that opens at least toward the tip side in the tubular axis direction, and the first end side opening. A tubular member provided with a plurality of control ropes connected in the vicinity to control the opening state of the first end side opening, and the insertion guide portion includes the first end side opening of the tubular member. By locking a part of the control rope to the opening state adjusting portion, the first dimension of the opening on the first end side of the tubular member, which is orthogonal to the axis, is set to the first end. The side opening is made smaller than the second dimension along the axis so that it can be inserted into the body through the anus or vagina, and the control cord is released from the locking to the opening state adjusting portion to release the first end side opening. It is characterized in that it can be opened.

According to the excision site extraction device according to the present invention, the insertion guide portion holds a part of the opening on the first end side of the tubular member, and the control rope is locked to the opening state adjusting portion to form the tubular member. The first dimension in the direction in which the opening on the first end side is orthogonal to the axis (insertion direction) of the inserter body is smaller than the second dimension in the insertion direction along the axis (when the tubular member is viewed from the insertion direction). By making it thinner, it can be inserted into the body through the anus or vagina.
Further, by releasing the lock of the control cord to the opening state adjusting portion in the body, the opening on the first end side can be opened. Therefore, using a laparoscope or the like, the excised excision site is taken into the tubular member from the opened first end side opening and taken out of the body via the anus or vagina.
Further, the insertion guide portion formed on the tip end side of the inserter body holds a part of the opening on the first end side of the tubular member, and the tubular member covers the insertion guide portion from the anus or vagina. When inserting the inserter body, the tip of the inserter body is prevented from coming into contact with the anus, vagina, or the respective lumens and being damaged, and the tubular member inserter can be smoothly inserted.
As a result, the excised site excised in the body by laparoscopic surgery or the like can be easily and efficiently taken out of the body from the anus or vagina with minimal invasiveness.

The invention according to claim 2 is the excision site extraction device according to claim 1, wherein the control rope has a first end connected to a position in the first circumferential direction of the opening on the first end side. A first control rope that holds a part of the first end side opening at the tip of the tubular member inserter by being locked to the insertion guide portion, and the first end is the first end side opening. A second control rope connected to a position in the second circumferential direction different from the position in the first circumferential direction of the above is provided, and the opening state adjusting unit locks the second end side of the first control rope. By locking the locking portion and the second end side of the second control rope and pulling the second control rope, the position of the opening on the first end side in the second circumferential direction is set to the first circumference. It is characterized by including a second locking portion located closer to the proximal end side in the axial direction than the directional position.

According to the excision site extraction device according to the present invention, the control rope has a first end side opening by being connected to a position in the first circumferential direction of the first end side opening and being locked to an insertion guide portion. A first control rope that holds a part of the portion at the tip of the tubular member inserter, and a second end that is connected to a second circumferential position different from the first circumferential position of the opening on the first end side. The second control rope is provided with two control ropes, the second end side of the first control rope is locked to the first locking portion, and the second end side of the second control rope is locked to the second locking portion. The second control rope is pulled toward the proximal end side so that the second circumferential position of the opening on the first end side is located closer to the proximal end side in the axial direction than the position in the first circumferential direction.
As a result, with a simple structure, the opening on the first end side of the tubular member can be easily and efficiently formed into the insertable state and the open state.
Here, it is preferable that the second locking portion is arranged closer to the base end side in the axial direction than the first locking portion, but the second locking portion is located closer to the tip end side than the first locking portion. It may be arranged.

The invention according to claim 3 is the excision site extraction device according to claim 2, wherein the insertion guide portion extends along the axis line and a slit is formed in a part in the circumferential direction to the inside. The holding wall portion in which the control rope holding hole is formed is provided, and by accommodating the first control rope in the slit, the first end side opening of the tubular member covers the insertion guide portion. It is characterized in that it holds the opening side on the first end side of the tubular member.

According to the excision site extraction device according to the present invention, since the insertion guide portion includes the holding wall portion in which the slit is formed, the first control cord is accommodated inside the holding wall portion via the slit. , The first control cord can be stably held. Further, the first end side opening side of the tubular member can be held in a state where the tubular portion covers the insertion guide portion at the first end side opening portion of the tubular member.
As a result, the tubular member inserter can be smoothly inserted while suppressing the insertion guide portion from contacting and damaging the anus or vagina or the respective lumens.

The invention according to claim 4 is the excision site extraction device according to claim 2 or 3, and the second locking portion is arranged at intervals in the direction along the axis of the inserter main body. It is characterized by having a plurality of locking protrusions.

According to the excision site extraction device according to the present invention, since the second locking portion includes a plurality of locking protrusions arranged at intervals in the direction along the axis of the inserter body, a plurality of locking protrusions are provided. The size of the opening on the first end side (opening ratio first dimension / second dimension) can be easily and efficiently adjusted depending on which of the locking protrusions locks the second end side of the second control rope. can do.
As a result, it can be easily and efficiently inserted into the body from the anus or vagina with minimal invasiveness, and the excision site can be taken out of the body.

The invention according to claim 5 is the excision site extraction device according to claim 2 or 3, wherein the second locking portion is movable in a direction along the axis of the inserter body and is stopped at a predetermined position. It is characterized in that it is configured to be possible.

According to the excision site extraction device according to the present invention, the second locking portion is configured to be movable in the direction along the axis of the inserter body and to be stopped at a predetermined position. The size of the opening on the first end side (opening ratio first dimension / second dimension) can be easily and efficiently adjusted by freely adjusting the position on the second end side of the locked second control rope. Can be done.

The invention according to claim 6 is the excision site extraction device according to any one of claims 2 to 4, wherein the second locking portion is the axis of the inserter body in the opening state adjusting portion. It is characterized in that it is provided with an urging member that can move in the direction along the above-mentioned and urges the second locking portion toward the base end side.

According to the excision site extraction device according to the present invention, in the opening state adjusting portion, the second locking portion is movable in the direction along the axis of the inserter body, and the second locking portion is on the proximal end side. Since the urging member is provided, the loosening of the second control cord of the tubular member is suppressed, the excision site extraction device is stably inserted into the body, and the excision site is taken out of the body. be able to.

The invention according to claim 7 is an inserter body formed long along the axis, an insertion guide portion formed at the tip of the inserter body, and a direction along the axis of the inserter body. An excision site extraction device that is attached to a tubular member inserter having a first locking portion and a second locking portion formed at intervals and takes out the excision site to the outside of the body via the anus or vagina. A tubular member that is formed of a flexible material and has at least a deformable first end side opening in the tubular axis direction, and is connected in the vicinity of the first end side opening. A plurality of control ropes for controlling the opening state of the first end side opening are provided, and the first end of the control rope is connected to a position in the first circumferential direction of the first end side opening. A first control rope that holds a part of the first end side opening at the tip of the tubular member inserter by being locked to the insertion guide portion, and the first end is the first end side opening. A second control rope connected to a position in the second circumferential direction different from the position in the first circumferential direction of the above is provided, and a part of the opening on the first end side of the tubular member is held by the insertion guide portion. By locking the second end side to the first locking portion and locking the second end side of the second control rope to the second locking portion, the first end side opening is said to be said. The first dimension orthogonal to the axis is formed smaller than the second dimension along the axis of the first end side opening, and the second control rope is unlocked from the second locking portion. The first end side opening is openable.

According to the tubular member according to the present invention, a tubular portion formed of a flexible material and at least the first end side opening is deformable, and a first connected to the vicinity of the first end side opening. A plurality of control lines for controlling the opening state of the end side opening are provided, and the control line includes a first control line whose first end is connected to a position in the first circumferential direction of the first end side opening, and a first control line. It includes a second control line whose one end is connected to a position in the second circumferential direction of the opening on the first end side.
Then, in the first control rope, the first end side is locked to the insertion guide portion, a part of the opening on the first end side of the tubular member is held by the insertion guide portion, and the second end side is the first locking portion. The second control rope is locked to the base end side by locking the second end side to the second locking portion, so that the position of the first end opening in the second circumferential direction is pulled toward the base end side. The first dimension of the side opening is formed smaller than the second dimension. Further, the opening on the first end side can be opened by releasing the locking of the second control rope to the second locking portion.

The invention according to claim 8 is the tubular member according to claim 6, wherein the first control rope is locked to the first locking portion on the second end side of the first control rope. A first locking ring is formed, and a second locking ring for locking the second control rope to the second locking portion is formed on the second end side of the second control rope. It is characterized by.

According to the tubular member according to the present invention, since the first locking ring is formed on the second end side of the first control rope, the first control rope is efficiently locked to the first locking portion. be able to. Further, since the second locking ring is formed on the second end side of the second control rope, the second control rope can be efficiently locked to the second locking portion.

The invention according to claim 9 is the tubular member according to claim 7, wherein the first control rope is engaged with the first engaging ring for locking the first locking ring to the first locking portion. A stop adjusting portion is formed, and the second control rope is formed with a second locking adjusting portion used for locking the second locking ring to the second locking portion. ..

According to the tubular member according to the present invention, since the first locking adjusting portion is formed on the first control rope, the first locking ring can be efficiently guided to the first locking portion to be locked. can. Further, since the second locking adjusting portion is formed on the second control rope, the second locking ring can be efficiently guided to the second locking portion and locked.

According to the excision site extraction device according to the present invention, the excision site excised in the body by laparoscopic surgery or the like can be easily and efficiently taken out of the body via the anus or vagina with minimal invasiveness.
Further, according to the tubular member according to the present invention, the tubular member can be easily inserted into the body via the anus or vagina, and the excised site can be taken out of the body. As a result, the excision site can be easily and efficiently removed from the body via the anus or vagina with minimal invasiveness.

It is a perspective view explaining an example of the schematic structure of the excision site extraction device which concerns on 1st Embodiment of this invention. It is a figure explaining the schematic structure of the excision site extraction device which concerns on 1st Embodiment, and is the perspective view which shows the state which set the tubular member in the tubular member inserter, and can insert from the anus (or vagina). .. It is a figure explaining an example of the schematic structure of the tubular member inserter of the excision site extraction device which concerns on 1st Embodiment, (A) is a perspective view, (B) is explaining the details of the main part of the insertion guide part. It is a view seen from the side. It is a perspective view explaining an example of the schematic structure of the tubular member of the excision site extraction device which concerns on 1st Embodiment. It is a figure explaining the outline of the use method of the excision site extraction device which concerns on 1st Embodiment, and is the figure which shows the state before inserting the excision site extraction device through an anus. It is a figure explaining the outline of the use method of the excision site extraction device which concerns on 1st Embodiment, and is the figure which shows the state which inserted the excision site extraction device through an anus. It is a figure explaining the outline of the use method of the excision site extraction device which concerns on 1st Embodiment, and is the figure which shows the state which brings the 1st end side opening of the excision site extraction device close to an excision site. It is a figure explaining the outline of the use method of the excision site extraction device which concerns on 1st Embodiment, and is the figure which shows the excision site extraction device which made the opening on the 1st end side of a tubular member open state. It is a figure explaining the outline of the use method of the excision site extraction device which concerns on 1st Embodiment of this invention, and shows the state which took out the insertion support rod after opening the 1st end side opening of a tubular member. It is a figure. It is a figure explaining the outline of the use method of the excision site extraction device which concerns on 1st Embodiment, and is the figure which shows the state which excised part was taken out of the body through a tubular member. It is a side view explaining the details of the main part of the insertion guide part which concerns on 1st modification of 1st Embodiment. It is a side view explaining the details of the main part of the insertion guide part which concerns on 1st modification of 1st Embodiment. It is a side view explaining the details of the main part of the insertion guide part which concerns on the 2nd modification of 1st Embodiment. It is a perspective view explaining the detail of the main part of the insertion guide part which concerns on 3rd modification of 1st Embodiment. FIG. 6D is a cross-sectional view taken along the line VIE-VIE in FIG. 6D for explaining the details of the main part of the insertion guide portion according to the third modification of the first embodiment. FIG. 6D is a cross-sectional view shown by arrow VIF-VIF in FIG. 6D for explaining the details of the main part of the insertion guide portion according to the third modification of the first embodiment. It is a figure explaining an example of the details of the main part of the excision site extraction apparatus which concerns on 2nd Embodiment of this invention. It is a figure explaining an example of the main part details of the excision site extraction apparatus which concerns on 3rd Embodiment of this invention, (A) is a partial cross-sectional view seen from the side, (B) is VIDB- The cross-sectional view shown by VIDB is shown. It is a conceptual diagram explaining an example of the details of the main part of the excision site extraction device which concerns on 4th Embodiment of this invention.

Hereinafter, the excision site extraction device according to the first embodiment of the present invention will be described with reference to FIGS. 1 to 4 and 5A to 5F.
FIG. 1 is a perspective view illustrating a schematic configuration of an excision site extraction device according to a first embodiment of the present invention, and FIG. 2 is an anus (or vagina) in which a tubular member is set in a tubular member inserter. It is a perspective view which shows the state which can be inserted from. Further, FIG. 3 is a diagram illustrating an example of a schematic configuration of the tubular member inserter according to the first embodiment, and FIG. 3 (A) is a perspective view of the tubular member inserter, FIG. 3 (B). Is a view seen from the side for explaining the details of the main part of the insertion guide portion. Further, FIG. 4 is a perspective view illustrating an example of a schematic configuration of the tubular member according to the first embodiment.
Reference numeral 100 is a cutting site extraction device, reference numeral 10 is a tubular member inserter, reference numeral 11 is an inserter body, reference numeral 110 is an insertion guide portion, reference numeral 13 is an opening state adjusting portion, and reference numeral 20 is a tubular member. , Reference numeral 21A indicates the opening on the first end side.

As shown in FIGS. 1 and 2, the excision site extraction device 100 includes, for example, a tubular member inserter 10 and a tubular member 20.
Then, as shown in FIG. 2, the first dimension D211 orthogonal to the axis O1 is made smaller than the second dimension D212 in the insertion direction along the axis O1 by being attached to the tubular member inserter 10, and then the anus. Alternatively, the tubular member 20 can be inserted into the body via the vagina.

As shown in FIGS. 1 to 3, the tubular member inserter 10 is, for example, a rod-shaped body having a substantially cylindrical outer shape and extending along the axis O1.
Further, the tubular member inserter 10 is for adjusting the opening state of the inserter main body 11, the gripping portion 12 for gripping the tubular member inserter 10, and the first end opening of the tubular member 20. The opening state adjusting portion 13 and an insertion guide portion 110 formed at the tip end portion of the inserter main body 11 and holding a part of the first end side opening portion 21A of the tubular member 20 are provided.

The inserter main body 11 is arranged between the grip portion 12 and the insertion guide portion 110, and connects the grip portion 12 and the insertion guide portion 110.
Further, the inserter main body 11 is formed to have a smaller diameter than the grip portion 12, has a columnar shape along the axis O1, and a concave groove portion 11U is formed from the middle of the axis O1 direction toward the tip end side F. ..

The concave groove portion 11U is formed in an arc shape having a substantially semicircular cross section when viewed along the axis O1 (longitudinal direction of the inserter main body 11), for example.
Further, when viewed from the side surface, the concave groove portion 11U has a form formed so as to be low (small size) by cutting approximately half of the upper side with respect to the outer diameter of the opening state adjusting portion 13.
The base end side R of the concave groove portion 11U is connected to the outer peripheral surface of substantially half of the upper side of the inserter main body 11 via an inclined surface that inclines upward to the base end side R.

The grip portion 12 is arranged on the base end side R of the tubular member inserter 10 and is formed in a substantially columnar shape.
Further, in the grip portion 12, a plurality of anti-slip grooves formed in the circumferential direction are arranged at intervals in the axis O1 direction, so that the practitioner can stably grip the grip portion 12 and insert a tubular member. When the vessel 10 is inserted, the tubular member inserter 10 is prevented from slipping in the axis O1 direction.

The opening state adjusting portion 13 is formed on the tip end side F of the grip portion 12, and includes a first locking hook (first locking portion) 14 and a second locking hook (second locking portion) 15. There is.
The first locking hook (first locking portion) 14 and the second locking hook (second locking portion) 15 are formed in a substantially L shape so as to protrude from the inserter main body 11 and face the base end side R. ..

The first locking hook (first locking portion) 14 and the second locking hook (second locking portion) 15 are arranged at intervals in the axis O1 direction, for example.
Further, in this embodiment, for example, the second locking hook (second locking portion) 15 is arranged on the proximal end side R in the axis O1 direction with respect to the first locking hook (first locking portion) 14. ing.

The second locking hook 15 includes, for example, a locking hook 15A and a locking hook 15B.
Further, the locking hooks 15A and the locking hooks 15B are arranged at intervals in the axis O1 direction.
Further, the locking hook 15A is arranged on the proximal end side (operator side) R in the axis O1 direction with respect to the locking hook 15B.

The insertion guide portion 110 is formed on the tip end side F of the inserter main body 11.
Further, as shown in FIGS. 3 (A) and 3 (B), the insertion guide portion 110 rises from below along the circumferential direction of the axis O1, and a narrow slit 110S is formed in the upper portion. It is provided with a holding wall portion 110B.
In this embodiment, the outer peripheral surface of the holding wall portion 110B is formed in a substantially arc shape having the same diameter (substantially the same shape) as the outer peripheral surface (outer diameter) of the portion where the opening state adjusting portion 13 is arranged, for example. ..

Further, in the inside of the holding wall portion 110B, a slit 110S extending along the axis O1 and having a narrow upper side is formed, and a control rope holding hole 110A that opens to the tip end side F and the proximal end side R. Is formed.
Further, the base end side R of the control rope holding hole 110A is connected to the tip end side F of the concave groove portion 11U, and is C-shaped (substantially circular) having a substantially constant wall thickness when viewed along the axis O1. It is formed in an arc shape).

Further, as shown in FIG. 3, a tip side shape portion 110F is formed on the tip side F of the holding wall portion 110B.
As shown in FIG. 3B, the tip end side shape portion 110F is substantially deformed from the slit 110S toward the bottom portion, for example, when viewed from the side surface, from the base end side R toward the tip end side F. It is formed in the shape of a / 4 circle arc.
Further, the tip portion of the tip side shape portion 110F protrudes (bulges) outward, and the diameter is reduced from the outer peripheral surface of the holding wall portion 110B toward the control rope holding hole 110A toward the tip side F. An R-shaped surface 110C composed of a shaped portion (curved shape portion) is formed.

Further, as shown in FIG. 3, a proximal end side shape portion 110R is formed on the proximal end side R of the holding wall portion 110B.
As shown in FIG. 3B, the base end side shape portion 110R has an upper edge portion (holding wall portion 110B) of the recessed groove portion 11U from the slit 110S toward the base end side R, for example, when viewed from the side surface. It is composed of a curved shape that gradually lowers to about 1/2 the height of.

Further, the base end side shape portion 110R has a curved shape having a gentler inclination than the tip end side shape portion 110F, so that the insertion guide portion 110 does not get caught on the wall surface of the living body when the inserter main body 11 is pulled out of the body. It can be moved smoothly.

As shown in FIG. 4, the tubular member 20 includes, for example, a tubular portion 21, a first end side opening ring 22, a second end side opening ring 23, and a first string member (first control rope) 24. , A second string member (second control rope) 25, and the like.

The tubular portion 21 is made of a transparent (or translucent) flexible material such as polyurethane, and has a first end side opening located at least on the tip side (first end side) F. The portion 21A can be flexibly deformed.
The first end side opening ring 22 is arranged on the tip end side F of the tubular portion 21, and the second end side opening ring 23 is arranged on the base end side R.

The first end side opening ring 22 is formed by forming, for example, a resin such as silicon rubber having a circular cross section in an annular shape, and is opened in a circular shape when no external force is applied, and is elliptical by applying an external force. It transforms into a shape, etc.
Further, the first end side opening ring 22 is joined to the first end side opening 21A of the tubular portion 21 by fusion, welding or adhesive.

The second end side opening ring 23 is configured by arranging a ring of resin such as silicon rubber having a circular cross section in a single or double arrangement, and opens in a circular shape when no external force is applied. Then, while the second end side opening ring 23 is manually wound inward or outward, the total length of the tubular portion 21 in the tubular axis O2 direction is adjusted to the patient's condition (for example, the dimension from the lock P13A to the stump P11A). It may be adjusted appropriately according to.
Further, the second end side opening ring 23 is joined to the second end side opening 21B of the tubular portion 21 by fusion, welding or adhesive.

The first string member (first control cord) 24 is, for example, an elastic member formed of a resin such as silicon, and is a first control string member main body 24A and a first control string member main body 24A formed on the first control string member main body 24A. It includes one locking ring portion 24B and a first guide ring portion (first locking adjusting portion) 24C.
One end side of the first control string member main body 24A is connected to a part (first circumferential direction position) 22A of the first end side opening ring 22 in the circumferential direction.

The first locking ring portion 24B and the first guide ring portion (first locking adjusting portion) 24C are arranged in the first control string member main body 24A in this order from the first end side opening 21A.

The first locking ring portion 24B is hooked on the first locking hook (first locking portion) 14, so that the insertion guide portion 110 holds a part of the first end side opening ring 22 in the circumferential direction. It has become like.

The first guide ring portion (first locking adjustment portion) 24C is formed, for example, on the other end side of the first control string member main body 24A, and is formed in the vicinity of the first locking ring portion 24B.

Then, the first control string member main body 24A is housed in the insertion guide portion 110 via the slit 110S, and the position of the first locking ring portion 24B is determined by the first guide ring portion (first locking adjustment portion) 24C. After adjustment, the first locking ring portion 24B is hooked on the first locking hook 14. Further, at this time, it is preferable that the insertion guide portion 110 is covered with the tubular portion 21.

Further, after the tubular member 20 is inserted into the body, for example, by manually grasping and moving the first guide ring portion (first locking adjustment portion) 24C, the first section in the body is engaged. The stop ring portion 24B can be easily and efficiently removed from the first locking hook (first locking portion) 14.

The second string member (second control rope) 25 is an elastic member formed of, for example, a resin such as silicon, like the first string member 24, and is the fifth control string member main body 25A and the second control. A second locking ring portion 25B formed on the string member main body 25A and a second guide ring portion (second locking adjusting portion) 25C are provided.
One end side of the second control string member main body 25A is connected to a position (second peripheral direction position) 22B 180 ° opposite to the first control string member main body 24A in the circumferential direction of the first end side opening ring 22. ing.

The second locking ring portion 25B and the second guide ring portion (second locking adjusting portion) 25C are arranged in the second control string member main body 25A in this order from the second end side opening 21A.

The second locking ring portion 25B is hooked on the second locking hook (second locking portion) 15 so that the position 22B in the second circumferential direction of the second end side opening ring 22 is set to the base end along the axis O1. When pulled to the side R, the first end side opening 21A becomes an elongated elliptical shape long in the axis O1 direction. Specifically, as shown in FIG. 2, the first dimension D211 of the opening ring 22 is smaller than the second dimension D212. As a result, it can be easily inserted into the body via the anus or vagina.

Then, depending on whether the second locking ring portion 25B is hooked on the locking hook 15A or the locking hook 15B, the second control string member main body 25A has one end side in the circumferential direction of the first end side opening ring 22. The tensile force applied to the first control string member main body 24A is adjusted. Specifically, by hooking the second locking ring portion 25B on the locking hook 15B, the second control string member main body 25A can be compared with the case where the second locking ring portion 25B is hooked on the locking hook 15B. It is pulled by a strong tensile force.

The second guide ring portion (second locking adjustment portion) 25C is formed, for example, on the other end side of the second control string member main body 25A, and is formed in the vicinity of the second locking ring portion 25B.

The second control string member main body 25A is configured to hook the second locking ring portion 25B to the second locking hook 15 through the outside of the insertion guide portion 110, for example. At this time, the position of the second locking ring portion 25B can be adjusted by the second guide ring portion (second locking adjusting portion) 25C.

Further, after the tubular member 20 is inserted into the body, for example, by grasping and moving the second guide ring portion (second locking adjustment portion) 25C as a finger, the second engagement in the body is performed. The stop ring portion 25B can be easily and efficiently removed from the second locking hook (second locking portion) 15.

Next, with reference to FIG. 2, a schematic configuration of the excision site extraction device 100 in a state in which the tubular member 20 is set so as to be insertable from the anus will be described.
FIG. 2 is a perspective view illustrating a schematic configuration of an excision site extraction device 100 in a state where the tubular member 20 is set so as to be insertable from the anus.

As shown in FIG. 2, the excision site extraction device 100 in which the tubular member 20 is set so as to be insertable from the anus first engages with the first locking ring portion 24B of the first string member 24 of the tubular member 20. It is hooked on the stop hook 15 to be locked, and the second locking ring portion 25B of the second string member 25 of the tubular member 20 is hooked on the second locking hook 15 to be locked.

At this time, the first guide ring portion (first locking adjustment portion) 24C and the second guide ring portion (second locking adjustment portion) 25C are pulled while being fingered to hold the first locking ring portion. It is preferable to hook the 24B and the second locking ring portion 25B to the position of the second locking hook 15 to fix them.

As a result, as shown in FIG. 2, in the first end side opening ring 22, the first dimension D211 in the direction orthogonal to the insertion direction of the tubular member 20 of the first end side opening 21A has the first end side opening. The portion 21A is deformed so as to be smaller than the second dimension D212 in the insertion direction, and the tubular member 20 can be easily inserted into the body.

Next, a method of using the excision site extraction device 100 according to the first embodiment will be described with reference to FIGS. 5A to 5F. 5A to 5F are diagrams illustrating an outline of how to use the excision site extraction device 100.

Before inserting the excision site extraction device 100 through the anus P13A, it is assumed that the excision specimen site P12 has already been dissected from the large intestine P1 by using, for example, an automatic suture device.
As shown in FIG. 5A, the excision site P12 is formed in a substantially barrel shape by, for example, the stumps on both sides of the tubular body from which the large intestine has been excised are closed by sutures, staples, or the like. Then, at the stage where the stumps on both sides are closed, it is assumed that the stump remains between the stump P11A of the large intestine cut portion P11 and the stump P13B of the rectal P13, for example. In FIGS. 5A to 5F, the first guide ring portion (first locking adjustment portion) 24C and the second guide ring portion (second locking adjustment portion) 25C are omitted.

(1) First, as shown in FIG. 5A, the excision site extraction device 100 is set in a state in which the tubular member 20 can be easily inserted into the body via the anus P13A.
Specifically, as shown in FIG. 2, the first locking ring portion 24B of the first string member 24 is hooked on the first locking hook 14, and the second locking ring portion 25B of the second string member 25 is hooked. Is hooked on the second locking hook 15.
As a result, the first end side opening ring 22 is pulled along the axis O1 direction, and the first end side opening 21A has a second dimension D211 orthogonal to the axis O1 in the insertion direction along the axis O1. It has a substantially elliptical shape smaller than the dimension D212.
At this time, the first string member 24 is housed in the control rope holding hole 110A in the holding wall portion 110B through the slit 110S, and the tubular portion 21 of the tubular member 20 covers the insertion guide portion 110 from the outside.

(2) Next, as shown in FIG. 5B, for example, the excision site extraction device 100 is moved in the direction of arrow T1, and the tubular member 20 is inserted into the body from the first end side opening 21A side via the anus P13A. insert.

(3) Next, as shown in FIG. 5C, the tubular member 20 is inserted until the tip end side of the first end side opening 21A passes through the rectal stump P13B of the large intestine cutting portion P13, and the tubular member 20 is inserted. The excision site P12 is stopped at a position where it can be taken in through the one-end side opening 21A.

(4) Then, as shown in FIG. 5D, the opening state adjusting portion 13 is opened to bring the first end side opening 21A of the tubular member 20 into an open state.
Specifically, the second locking ring portion 25B of the second string member 25 is removed from the second locking hook 15, and the first locking ring portion 24B of the first string member 24 is removed from the first locking hook 14. By removing it, the second dimension D212 of the first end side opening 21A is reduced and the first dimension D211 is increased to obtain a substantially circular first end side opening 21A. If the opening is insufficiently expanded, it may be assisted by forceps via a tubular member (for example, a trocar) punctured in the abdomen in advance.
Correspondingly, the first end side ring 22 constituting the first end side opening 21A is slightly projected toward the large intestine cut portion P11 side from the rectal stump P13B, as shown in FIG. 5D, for example. By rolling up the second end side ring 23 in the direction of arrow T2, the optimum distance from the rectal P13A to the rectal stump P13B can be maintained.

(5) Next, as shown in FIG. 5E, the tubular member inserter 10 is pulled out in the direction of arrow T3, and the tubular member 20 is placed in the rectum P13 from the anus P13A to the rectal stump P13B.
Then, as shown in FIG. 5F, the excision site P12 is moved in the direction of the arrow T4, and the excision site P12 is taken out of the body using forceps or the like via the tubular member 20.
After the removal of the excised specimen portion P12 is completed, the second end side opening 21B side of the rolled-up tubular portion 21 is moved in the direction opposite to that when the tubular portion 21 is rolled up to restore the tubular portion 21 to its original state. Then, as before the insertion, the first locking ring portion 24B of the first string member 24 is hooked on the first locking hook 14, and the second locking ring portion 25B of the second string member 25 is engaged in the second engagement. Hooking on the stop hook 15, the tubular member 20 is elongated in the axis O1 direction, and the tubular member 20 is carefully taken out of the body from the anus P13A together with the tubular member inserter 10.

(6) After the tubular member 20 is taken out of the body, the stump P11A of the large intestine P11 and the stump P13B of the rectum P13 are anastomosed.

According to the excision site extraction device 100 according to the first embodiment, the first end side opening 21A of the tubular member 20 has a first dimension D211 in a direction orthogonal to the insertion direction with respect to a second dimension D212 in the insertion direction. By making it smaller, it can be easily inserted into the body through the anus P13A.
Further, in the body, the first dimension D211 is relatively enlarged to open the first end side opening 21A, so that the excised site P12 excised using forceps or the like is opened to the first end side opening 21A. The excision site P12 can be taken out of the body via the anus P13A while being taken into the tubular member 20.
As a result, the excision site P12 excised in the body by endoscopic surgery or the like can be easily and efficiently taken out of the body via the anus P13 with minimal invasiveness.

Further, according to the excision site extraction device 100 according to the first embodiment, the second locking hook (second locking portion) 15 includes two (plural) hooks (locking portions) 15A and 15B. Therefore, the tensile force of the second control string member main body 25A is changed depending on whether the second locking ring portion 25B is hooked on the hook 15A or the hook 15B, so that the opening 21A on the first end side when viewed from the insertion direction The size (thickness) can be efficiently adjusted to a size suitable for each patient.

Further, according to the tubular member 20 according to the first embodiment, the first locking ring portion 24B and the second locking ring portion 25B are locked to the first locking hook 14 and the second locking hook 15. Thereby, the tubular member 20 can be easily inserted into the body via the anus P13A. As a result, the excision site P12 can be easily and efficiently taken out of the body via the anus P13A with minimal invasiveness.

According to the excision site extraction device 100 according to the first embodiment, since the insertion guide portion 110 includes the holding wall portion 110B in which the slit 110S is formed, the first string member (first control) is provided through the slit 110S. The rope) 24 can be housed inside the holding wall portion 110B to stably hold the first string member (first control rope) 24. Further, the first end side opening 21A side of the tubular member 20 can be held in a state where the tubular portion 21 covers the insertion guide portion 110 in the first end side opening 21A of the tubular member 20.
As a result, the tubular member inserter 100 can be smoothly inserted while suppressing the insertion guide portion 110 from coming into contact with the anus or vagina and damaging it.

According to the excision site extraction device 100, since the second locking portion 15 includes a plurality of hooks (locking protrusions) 15A and 15B, the size of the first end side opening 21A (opening ratio first dimension). D211 / second dimension D212) can be adjusted easily and efficiently.
As a result, the excision site can be easily and efficiently inserted into the body from the anus or vagina.

According to the tubular member 20 according to the first embodiment, the excised site P12 can be easily inserted into the body through the anus P13A, and the excised site P12 is opened by opening the first end side opening 21A in the body. It can be taken into the tubular member 20 from the first end side opening 21A and taken out of the body via the anus P13A.
As a result, the excision site P12 can be easily and safely taken out of the body via the anus P13.

Further, according to the tubular member 20, the first locking ring 24B is formed on the first string member (first control rope) 24, and the second locking ring 25B is formed on the second string member (second control rope) 25. Is formed, the first string member 24 and the second string member 25 can be efficiently locked to the first locking portion 14 and the second locking portion 15.

Further, according to the tubular member 20, the first guide ring portion (first locking adjustment portion) 24C is attached to the first string member (first control rope) 24, and the second string member (second control cord) 25 is attached. Since the second guide ring portion (second locking adjustment portion) 25C is formed, the first locking ring 24B and the second locking ring 25B are attached to the first locking portion 14 and the second locking portion 15. It can be locked easily and efficiently. Further, the first locking ring 24B and the second locking ring 25B can be easily and efficiently removed from the first locking portion 14 and the second locking portion 15.

<First modification (first embodiment)>
Next, the excision site extraction device according to the first modification of the first embodiment will be described with reference to FIGS. 6A and 6B. 6A is a side view for explaining the details of the main part of the insertion guide portion according to the first modification of the first embodiment, and FIG. 6B is a side view for explaining the details of the main part.
In FIGS. 6A and 6B, reference numeral 210 indicates an insertion guide portion, and reference numeral 210F indicates a tip-side shape portion. The first modification is different from the first embodiment in that the insertion guide portion 210 is provided instead of the insertion guide portion 110. Since the other parts are the same as those in the first embodiment, the same reference numerals are given and the description thereof will be omitted.

Further, as shown in FIGS. 6A and 6B, the insertion guide portion 210 rises from the lower side to the upper side along the circumferential direction of the axis O1, extends in the axis O1 direction, and has a narrow slit 210S at the upper part. The holding wall portion 210B in which the is formed is provided.

Further, a slit 210S extending along the axis O1 and having a narrow upper side is formed inside the holding wall portion 210B, and a control rope holding hole 210A that opens to the tip end side F and the base end side R. Is formed.
Further, the base end side R of the control rope holding hole 210A is connected to the tip end side F of the concave groove portion 11U, and is C-shaped (substantially circular) having a substantially constant wall thickness when viewed along the axis O1. It is formed in an arc shape).

Further, as shown in FIGS. 6A and 6B, a tip side shape portion 210F is formed on the tip side F of the holding wall portion 210B.
As shown in FIG. 6B, the tip-side shape portion 210F has, for example, an end portion orthogonal to the axis O1.
Further, the tip portion of the tip side shape portion 210F protrudes (bulges) outward, and the diameter is reduced from the outer peripheral surface of the holding wall portion 210B toward the control rope holding hole 210A toward the tip side F. An R-shaped surface 210C composed of a shaped portion (curved shape portion) is formed.

Further, a proximal end side shape portion 110R is formed on the proximal end side R of the holding wall portion 210B.
Since the base end side shape portion 110R is the same as that of the first embodiment, the description thereof will be omitted.

<Second modification (first embodiment)>
Next, a second modification of the first embodiment of the present invention will be described with reference to FIG. 6C.
FIG. 6C is a side view for explaining the details of the main part of the insertion guide portion according to the second modification of the first embodiment.
In FIG. 6C, reference numeral 310 indicates an insertion guide portion, and reference numeral 210F indicates a tip-side shape portion. The second modification is different from the first modification of the first embodiment in that the insertion guide portion 310 is provided instead of the insertion guide portion 210. Since the other parts are the same as those in the first embodiment, the same reference numerals are given and the description thereof will be omitted.

Further, as shown in FIG. 6C, the insertion guide portion 310 rises from the lower side to the upper side along the circumferential direction of the axis O1, extends in the axis O1 direction, and a narrow slit 310S is formed in the upper portion. It is provided with a holding wall portion 310B.

Further, a slit 310S extending along the axis O1 and having a narrow upper side is formed inside the holding wall portion 310B, and a control rope holding hole 310A that opens to the tip end side F and the proximal end side R. Is formed.
Further, the base end side R of the control rope holding hole 310A is connected to the tip end side F of the concave groove portion 11U, and is C-shaped (substantially circular) having a substantially constant wall thickness when viewed along the axis O1. It is formed in an arc shape).

Further, as shown in FIG. 6C, a tip side shape portion 310F is formed on the tip side F of the holding wall portion 310B.
As shown in FIG. 6C, the tip-side shape portion 310F has, for example, an end portion orthogonal to the axis O1.
Further, the tip portion of the tip side shape portion 310F is a chamfered portion formed of a chamfered shape portion whose diameter is linearly reduced from the outer peripheral surface of the holding wall portion 310B toward the control rope holding hole 310A toward the tip end side F. The shape surface 310C is formed.
Further, a proximal end side shape portion 110R is formed on the proximal end side R of the holding wall portion 310B.
Since the base end side shape portion 110R is the same as that of the first embodiment, the description thereof will be omitted.

<Third variant (first embodiment)>
Next, a third modification of the first embodiment of the present invention will be described with reference to FIGS. 6D to 6F. FIG. 6D is a perspective view for explaining the details of the main part of the insertion guide portion according to the third modification of the first embodiment, and FIG. 6E shows FIG. 6D for explaining the details of the main part of the insertion guide portion. -VIE is a cross-sectional view, and FIG. 6F is a cross-sectional view shown by arrow view VIF-VIF in FIG. 6D for explaining the details of the main part.
In FIGS. 6D to 6F, reference numeral 410 indicates an insertion guide portion, reference numeral 410B indicates a holding wall portion, and reference numeral 410S indicates a slit.
The third modification is different from the first embodiment in that the insertion guide portion 410 is provided instead of the insertion guide portion 110, and the other parts are the same as those of the first embodiment, so the same reference numerals are given. The explanation will be omitted.

Further, as shown in FIGS. 6D to 6F, the insertion guide portion 410 rises from below along the circumferential direction of the axis O1, and has a holding wall portion 410B having a narrow slit 410S formed in the upper portion. I have.
A control rope holding hole 110A that opens to the distal end side F and the proximal end side R is formed inside the holding wall portion 410B.
Further, the holding wall portion 410B is formed in a C shape (substantially arcuate shape) having a substantially constant wall thickness when viewed along the axis O1.

Further, a tip side shape portion 410F is formed on the tip side F of the holding wall portion 410B.
As shown in FIGS. 6D to 6F, the tip end side shape portion 410F is an inclined surface that deforms from the slit 110S toward the bottom portion from the base end side R toward the tip end side F, for example, when viewed from the side surface. Is formed.

Further, the tip portion of the tip side shape portion 410F protrudes (bulges) outward, and the diameter is gradually reduced from the outer peripheral surface of the holding wall portion 110B toward the control rope holding hole 110A toward the tip side F. A dome-shaped surface 410C formed of a bullet-shaped R-shaped portion (curved shape portion) is formed.

Further, a proximal end side shape portion 110R is formed on the proximal end side R of the holding wall portion 310B.
Since the base end side shape portion 110R is the same as that of the first embodiment, the description thereof will be omitted.

<Second Embodiment>
Next, with reference to FIG. 7, the excision site extraction device according to the second embodiment of the present invention will be described. FIG. 7 is a diagram illustrating an example of details of a main part of the excision site extraction device according to the second embodiment. In FIG. 7, reference numeral 200 indicates a cutting site extraction device, reference numeral 213 indicates an opening state adjusting portion, reference numeral 214 indicates a first locking protrusion, and reference numeral 215 indicates a second locking protrusion 215.
The second embodiment is different from the first embodiment in that the excision site extraction device 200 replaces the opening state adjusting unit 13, the first locking hook 14, and the second locking hook 15 according to the first embodiment. It is a point that the opening state adjusting portion 213, the first locking protrusion 214, and the second locking protrusion 215 are provided, and the other parts are the same as those in the first embodiment, so the same reference numerals are given and the description thereof will be omitted. ..

The excision site extraction device 200 includes, for example, a tubular member inserter (not shown) and a tubular member (not shown), and the tubular member inserter has, for example, a rod shape as shown in FIG. The inserter main body 11 formed in the above, a grip portion (not shown) formed on the base end side (second end side) of the inserter main body 11, and an opening state adjusting portion 213 are provided.

As shown in FIG. 7, the opening state adjusting portion 213 includes, for example, a first locking protrusion 214 and a second locking protrusion 215.
As shown in FIG. 7, the first locking protrusion (first locking portion) 214 is formed, for example, in a substantially spherical shape protruding from the inserter main body 11, and on the inserter main body 11, the inserter main body 11 is formed. It is arranged at a predetermined interval on the same line as the concave groove (not shown) and the slit (not shown).

As shown in FIG. 7, the second locking protrusion 215 includes, for example, two (plurality) locking protrusions 215A formed in a substantially spherical shape protruding from the inserter main body 11, and a locking protrusion 215. It is equipped with 215B.

The locking protrusion 215A and the locking protrusion 215B are arranged on the same line as the first locking protrusion 214 on the inserter main body 11, and are on the proximal end side (operator side) of the first locking protrusion 214. Is located in.
Further, the locking protrusion 215A is arranged on the inserter main body 11 on the base end side of the locking protrusion 215B.

According to the excision site extraction device 200 according to the second embodiment, since the locking protrusion 215A and the locking protrusion 215B are formed in a substantially spherical shape, the size can be reduced and the size can be reduced to a tubular shape. The member 20 can be easily and efficiently inserted and removed.
Further, according to the excision site extraction device 200 according to the second embodiment, it is possible to prevent the device from being caught in the surrounding tissue during insertion and removal.

<Third Embodiment>
Next, with reference to FIG. 8, the excision site extraction device according to the third embodiment of the present invention will be described. 8A and 8B are views for explaining an example of the details of the main part of the excision site extraction device according to the third embodiment, FIG. 8A is a partial cross-sectional view seen from the side surface, and FIG. 8B is a view. 8 (A) shows the cross-sectional view shown by VIDB-VIIIIB. In FIG. 8, reference numeral 300 is an excision site extraction device, reference numeral 313 is an opening state adjusting portion, reference numeral 14 is a first locking hook (first locking portion), and reference numeral 315 is a movable second locking hook (reference numeral 315). The second locking portion) is shown.
The third embodiment is different from the first embodiment in that the excision site extraction device 300 replaces the opening state adjusting portion 13 and the second locking hook (second locking portion) 15 according to the first embodiment. The point is that the opening state adjusting portion 313 and the movable second locking hook (second locking portion) 315 are provided, and the other parts are the same as those in the first embodiment, so the same reference numerals are given and the description thereof will be omitted. ..

The excision site extraction device 300 includes, for example, a tubular member inserter (not shown) and a tubular member (not shown), and the tubular member inserter has, for example, a rod shape as shown in FIG. The inserter main body 11 formed in the above, a grip portion (not shown) formed on the base end side (second end side) of the inserter main body 11, and an opening state adjusting portion 313 are provided.

As shown in FIG. 8, the opening state adjusting portion 313 includes, for example, a first locking hook (first locking portion) 14 and a movable second locking hook (second locking portion) 315. ing.
Since the first locking hook (first locking portion) 14 is the same as that of the first embodiment, the description thereof will be omitted.

As shown in FIG. 8, the movable second locking hook (second locking portion) 315 includes, for example, the second locking hook main body (second locking portion) 315A and the second locking hook holding member (2nd locking portion). A second locking portion) 315S and a locking position adjusting ratchet (second locking portion) 318 are provided.
Further, the second locking hook main body (second locking portion) 315A protrudes upward from the upper surface of the second locking hook holding member 315S and opens in the proximal end side R in the axis O1 direction in a substantially L shape. Is formed in.

The second locking hook holding member (second locking portion) 315S is formed of, for example, an elastic material, and the inner shape of the second locking hook holding member (second locking portion) 315S is inserted. It is formed to be substantially the same as the outer shape (for example, outer diameter) of the vessel body 11.

In the third embodiment, the second locking hook holding member (second locking portion) 315S has, for example, a substantially C-shaped cross section when viewed along the axis of the inserter main body 11. It is configured to hold the inserter body 11 by urging the circular outer shape of the inserter body 11 from the outside to the inside.
Further, when an external force is applied to the second locking hook main body 315S in a direction away from the inserter main body 11, the C-shaped opening expands and rises from the inserter main body 11.

The locking position adjusting ratchet 318 has a locking claw portion 318A formed so as to project at a position opposite to the opening on the inner circumference of the second locking hook holding member 315S, and a direction along the axis O1 of the inserter main body 11. It is provided with a positioning convex portion 318B formed along the above.

Then, the locking claw portion 318A and the positioning convex portion 318B are engaged with each other in a state where no external force is applied, and the locking claw portion 318A stops with respect to the positioning convex portion 318B.
On the other hand, for example, when the second locking hook body (second locking portion) 315A is picked up, the second locking hook holding member (second locking portion) 315S expands, and the locking claw portion 318A is positioned as a convex portion. It floats up from 318B, and the engagement between the locking claw portion 318A and the positioning convex portion 318B is released.
Then, the second locking hook main body (second locking portion) 315A and the second locking hook holding member 315S are configured to be able to move in the direction along the axis O1 of the inserter main body 11.

According to the excision site extraction device 300 according to the third embodiment, since the opening state adjusting portion 313 includes the movable second locking hook (second locking portion) 315, the second locking hook main body ( The second locking portion) 315A can be moved along the direction along the axis O1 of the inserter main body 11.
Further, according to the excision site extraction device 300, since the movable second locking hook (second locking portion) 315 is provided with the locking position adjusting ratchet 318, the second locking hook main body (second locking) is provided. The position of the second locking hook main body (second locking portion) 315A can be adjusted by stopping the 315A at a desired position.
As a result, the size (thickness) of the first end side opening 21A when the tubular member 20 is viewed from the insertion direction can be flexibly changed, and the tubular member 20 can be easily and efficiently inserted and removed. Can be done

<Fourth Embodiment>
Next, with reference to FIG. 9, the excision site extraction device according to the fourth embodiment of the present invention will be described. FIG. 9 is a conceptual diagram illustrating an example of details of a main part of the excision site extraction device according to the fourth embodiment. In FIG. 9, reference numeral 400 is an excision site extraction device, reference numeral 411 is an inserter body, reference numeral 413 is an opening state adjusting portion, reference numeral 14 is a first locking hook (first locking portion), and reference numeral 415 is a reference numeral 415. Movable second locking hook (second locking portion), reference numeral 411U indicates a guide groove, and reference numeral 418 indicates a coil spring (a urging member).

The fourth embodiment is different from the first embodiment in that the excision site extraction device 400 has an inserter main body 11, an opening state adjusting portion 13, and a second locking hook (second locking portion) according to the first embodiment. Instead of 15, the inserter main body 411, the opening state adjusting portion 413, the movable second locking hook (second locking portion) 415, the guide groove 411U, and the coil spring (biasing member) 418 are provided. Yes, and the others are the same as those in the first embodiment, so the same reference numerals are given and the description thereof will be omitted.

The excision site extraction device 400 includes, for example, a tubular member inserter (not shown) and a tubular member (not shown), and the tubular member inserter has, for example, a rod shape as shown in FIG. The inserter main body 411 formed in the above, a grip portion (not shown) formed on the proximal end side R of the inserter main body 411, and an opening state adjusting portion 413 are provided.

As shown in FIG. 9, the opening state adjusting portion 413 includes, for example, a first locking hook (first locking portion) 14, a guide groove 411U, and a movable second locking hook (second locking portion). It includes a 415 and a coil spring (biasing member) 418.
Since the first locking hook (first locking portion) 14 is the same as that of the first embodiment, the description thereof will be omitted.

The guide groove 411U is a guide groove formed along the axis O1 and having a constant cross section when viewed along the axis O1.
As shown in FIG. 9, the movable second locking hook (second locking portion) 415 has, for example, a substantially L-shaped protrusion that protrudes upward and opens to the base end side R, and a guide groove 411U. It is provided with a protrusion 148T which is arranged in and slidable along the guide groove 411U.
The movable second locking hook (second locking portion) 415 is movable in the direction along the axis O1 of the inserter body.

The coil spring (biasing member) 418 is arranged in the guide groove 411, for example, and comes into contact with the protrusion 148T to move the movable second locking hook (second locking portion) 415 in the base end side R direction. It is supposed to be urged.

According to the excision site extraction device 400 according to the fourth embodiment, the movable second locking hook (second locking portion) 415 is urged to the proximal end side R by the coil spring (biasing member) 418. The loosening of the second string member (second control cord) 25 of the tubular member 20 is suppressed, and the excision site extraction device 400 can be stably inserted into the body.

The present invention is not limited to the above embodiment, and various modifications can be made without departing from the spirit of the invention.
For example, in the above embodiment, the first end side ring 22 and the second end side ring 23 are both formed of flexible silicon rubber, and the first end side opening 21A and the second end side opening 21B are formed. Although the case where both are deformable has been described, for example, only the first end side ring 22 may be deformable. That is, the members constituting the second end side opening 21B such as the second end side ring 23 may be formed of a material that does not deform, for example, the first end side opening 21A and the second end side. The opening 21B may not be circular, but may be polygonal or non-deformable.

Further, in the above embodiment, the case where the first end side ring 22 is provided on the first end side of the tubular portion 21 and the second end side ring 23 is provided on the second end side has been described. Instead of the 1-end side ring 22 and the 2nd end-side ring 23, the shape may be maintained by making a part of the tubular portion 21 thicker or the like.

Further, in the above embodiment, the case where the control rope is the first string member 24 and the second string member 25 connected to the first end side ring 22 has been described. For example, the first string member 24 and the second string member 25 have been described. Instead of the two-string member 25, it may be composed of a control rope made of a metal such as a wire or another material, or may be composed of three or more control ropes.

Further, in the above embodiment, the case where the control rope is one first string member 24 and one second string member 25, respectively, has been described, but the circumferential position connected to the first end side ring 22 is adjusted. Therefore, a plurality of one or both of the unit control rope connected to the first locking portion and the unit control rope connected to the second locking portion may be provided. Further, in such a case, one or both of the first locking portion and the second locking portion may be provided in plurality.

Further, in the above embodiment, the case where the first string member 24 and the second string member 25 include the first locking ring portion 24B and the second locking ring portion 25B has been described. Instead of the stop ring portion 24B and the second locking ring portion 25B, for example, a locking portion having another lockable form such as binding may be provided.

Further, in the above embodiment, the first string member 24 and the second string member 25 form the first guide ring portion (first locking adjustment portion) 24C and the second guide ring portion (second locking adjustment portion) 25C. Although the case where it is provided has been described, for example, either one of the first guide ring portion (first locking adjustment portion) 24C, the second guide ring portion (second locking adjustment portion) 25C, or the first guide ring It may be configured not to be provided together with the portion (first locking adjustment portion) 24C and the second guide ring portion (second locking adjustment portion) 25C.

Further, in the above embodiment, the first string member 24 and the second string member 25 are formed to have the same length, and the second locking portions 15, 16 and 17 are formed with respect to the first locking portions 14 and 14A. Although the case where the first locking portions 14 and 14A are arranged closer to the base end side has been described, the first string member 24 and the second string member 25 are formed to have different lengths, and the first locking portions 14, 14A are formed. The positions of the second locking portions 15, 16 and 17 with respect to the relative may be arbitrarily set.

Further, in the above embodiment, the second locking hook (second locking portion) 15 includes two hooks (locking protrusions) 15A and 15B, and the second locking protrusion (second locking portion) is provided. ) 16 has two locking protrusions 16A and 16B, but the first end side opening 21A has a configuration in which the second locking portion has three or more locking protrusions. The size may be finely adjusted.

Further, in the above embodiment, the first locking shape portion is the first locking ring portion 24B formed at the second end portion of the first string member 24, and the second locking shape portion is the second string member. The case where the second locking ring portion 25B is formed at the second end portion of the 25 has been described, but the positions and shapes of the first locking shape portion and the second locking shape portion are arbitrarily set. be able to.

Further, in the third embodiment, the case where the position of the movable second locking hook 17 can be moved and stopped by the locking position adjusting ratchet 318 has been described, but by an adjusting means other than the locking position adjusting ratchet 318. The position of the second locking portion may be changed.

Further, in the above embodiment, the opening state adjusting portion 13 manually attaches the second locking ring portion 25B of the second string member 25 to the second locking hook 15, the second locking protruding portion 16, and the movable type. The case where the tubular member 20 is opened by removing it from the second locking hook 17 has been described. However, for example, the first string member 24 and the second string member are provided by a lever switch or the like provided on the tubular member inserter 10. The control rope including the 25 may be opened to open the tubular member 20.

Further, in the above embodiment, the case where the opening state adjusting portion includes the urging member and the case where the coil spring 418 is provided has been described, but an urging member other than the coil spring 418 may be used.

Further, in the above embodiment, for example, a case where the excision site extraction device is inserted from the anus P13A and the excision site P12 is taken out of the body has been described, but instead of the anus P13A, for example, it is formed in advance as a passage inside and outside the abdominal cavity. Needless to say, the excision site extraction device may be applied when the excision site P12 is removed from the uterine opening via the vagina.

Further, the materials and embodiments shown in the above embodiments are examples, and the materials and embodiments can be arbitrarily set.

According to the excision site extraction device according to the present invention, the excision site formed by excising the lesion formed in the digestive organ can be efficiently taken out of the body, and thus it can be industrially used.

O1 axis (inserter body)
O2 axis (cylindrical member)
P patient (human body)
P1 Large intestine P11 Large intestine cut P11A Large intestine stump P12 Resection site P13 Rectum P13A Anus P13B Rectal stump 10 Cylindrical member inserter 11,110 Inserter body 110, 210, 310, 410 Insertion guide part 110B, 210B, 310B, 410B Foreign language wall part 110S, 210S, 310S, 410S Slit 12 Gripping part 13 Opening state adjusting part 14 First locking hook (first locking part)
14A First locking protrusion (first locking portion)
15 Second locking hook (second locking part)
15A, 15B locking hooks (locking protrusions constituting the second locking portion)
16 Second locking protrusion (second locking portion)
16A, 16B locking protrusions (locking protrusions constituting the second locking portion)
17 Movable second locking hook (second locking part)
17S 2nd locking hook holding spring (2nd locking part)
18, 18A, 18B Locking position adjustment ratchet (second locking part)
20 Cylindrical member 21 Cylindrical portion 21A 1st end side opening 21B 2nd end side opening 22 1st end side ring 23 2nd end side ring 24 1st string member (1st control rope)
24A 1st string member body (1st control rope body)
24B 1st locking ring part (1st locking shape part)
24C 1st locking adjustment ring (1st locking adjustment part)
25 Second string member (second control rope)
25A 2nd string member body (2nd control rope body)
25B 2nd locking ring part (2nd locking shape part)
25C 2nd locking adjustment ring (2nd locking adjustment part)
100, 200, 300 Excision site extraction device 110, 210, 310, 410 Insertion guide part 110B, 210B, 310B, 410B Holding wall part 418 Coil spring (biasing member)

Claims (9)

An excision site extraction device that removes the excision site from the body via the anus or vagina.
An inserter body in which the opening on the first end side of the tubular member is inserted into the body via the anus or vagina and formed long along the axis, and an insertion guide portion formed at the tip of the inserter body. And a tubular member inserter having an opening state adjusting portion arranged on the base end side of the insertion guide portion, and
The first end side opening formed of a flexible material and having at least a first end side opening in the tubular axis direction is deformable, and the first end side opening is connected in the vicinity of the first end side opening. A tubular member provided with a plurality of control lines for controlling the opening state of one end side opening, and
With
The insertion guide portion holds a part of the opening on the first end side of the tubular member, and the control rope is locked to the opening state adjusting portion to open the opening on the first end side of the tubular member. The first dimension orthogonal to the axis of the portion is made smaller than the second dimension along the axis of the first end side opening so that it can be inserted into the body through the anus or vagina, and the opening state of the control cord. An excision site extraction device characterized in that the first end side opening can be opened by releasing the lock on the adjusting portion. The excision site extraction device according to claim 1.
The control rope
A part of the first end side opening is connected to the position in the first circumferential direction of the first end side opening and is locked to the insertion guide part, so that a part of the first end side opening is of the tubular member inserter. The first control cord held at the tip and
A second control rope whose first end is connected to a second circumferential position different from the first circumferential position of the first end side opening,
With
The opening state adjusting unit is
A first locking portion that locks the second end side of the first control rope,
By locking the second end side of the second control rope and pulling the second control rope, the position of the opening on the first end side in the second circumferential direction is set to be higher than the position in the first circumferential direction. A second locking portion located on the base end side in the axial direction,
An excision site extraction device characterized by comprising. The excision site extraction device according to claim 2.
The insertion guide portion is
A holding wall portion extending along the axis and having a slit formed in a part in the circumferential direction and a control rope holding hole formed inward is provided, and the first control rope is accommodated in the slit. An excision site extraction device characterized in that the opening on the first end side of the tubular member is held on the opening side on the first end side of the tubular member in a state of covering the insertion guide portion. The excision site extraction device according to claim 2 or 3.
The second locking part is
An excision site extraction device comprising a plurality of locking protrusions arranged at intervals in a direction along the axis of the inserter body. The excision site extraction device according to claim 2 or 3.
The second locking part is
An excision site extraction device characterized in that it can be moved in a direction along an axis of the inserter body and can be stopped at a predetermined position. The excision site extraction device according to any one of claims 2 to 4.
The opening state adjusting unit is
The excision portion is characterized in that the second locking portion is movable in a direction along the axis of the inserter main body and is provided with an urging member for urging the second locking portion toward the proximal end side. Extraction device. The inserter body formed long along the axis, the insertion guide portion formed at the tip of the inserter body, and the insert body formed at intervals in the direction along the axis of the inserter body. A tubular member that is attached to a tubular member inserter having a 1-locking portion and a second locking portion and constitutes an excision site extraction device that extracts an excision site from the body via an anus or vagina.
A tubular portion formed of a flexible material and at least the first end side opening in the tubular axis direction is deformable, and a tubular portion connected in the vicinity of the first end side opening to form the first end side opening. Equipped with multiple control lines to control the open state,
The control rope
A part of the first end side opening is connected to the position in the first circumferential direction of the first end side opening and is locked to the insertion guide part, so that a part of the first end side opening is of the tubular member inserter. The first control cord held at the tip and
A second control rope whose first end is connected to a second circumferential position different from the first circumferential position of the first end side opening,
With
The insertion guide portion holds a part of the opening on the first end side of the tubular member to lock the second end side to the first locking portion, and the second end side of the second control rope. Is locked to the second locking portion so that the first dimension of the first end-side opening orthogonal to the axis is smaller than the second dimension of the first-end opening along the axis. A tubular member formed, wherein the second control rope is unlocked from the second locking portion so that the opening on the first end side can be opened. The tubular member according to claim 7.
A first locking ring for locking the first control rope to the first locking portion is formed on the second end side of the first control rope.
A tubular member characterized in that a second locking ring for locking the second control rope to the second locking portion is formed on the second end side of the second control rope. The tubular member according to claim 8.
A first locking adjusting portion for locking the first locking ring to the first locking portion is formed on the first control rope.
A tubular member characterized in that a second locking adjusting portion used in a field for locking the second locking ring to the second locking portion is formed on the second control rope.

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