JP2022036316A - Retractor for intracardiac surgery - Google Patents

Abstract

To provide a multi-purpose expansion assisting device (a retractor) aiming at simplifying complicated an intracardiac surgery procedure quickly by securing an excellent field of vision when performing an intravascular surgery under an endoscope or by a surgery support robot, especially, mitral valvuloplasty.SOLUTION: A multi-purpose expansion assisting device has a configuration in which a flexible tube body winding a flexible tube in a spiral shape is detained in the heart. Its material includes, for example, Teflon, polyethylen, polypropylene, nylon, polyurethane, vinyl chloride, and the like so that the surgery becomes quick, accurate, and easy, and a safe heart surgery of the elderly and extremely serious patients is possible.SELECTED DRAWING: Figure 1

Description

This study is a multipurpose development aimed at ensuring a good field of view and quickly facilitating complex intracardiac surgery procedures when performing endoscopic or surgical support robot intracardiac surgery, especially mitral valve repair. Regarding auxiliary equipment (retractor)

Conventional cardiac surgery is almost the same as the original procedure of cardiac surgery in the 1960s. After making a large midline incision in the sternum, the heart is exposed, an artificial heart lung is attached from the surgical field, and then cardiac arrest fluid is injected to perform cardiac arrest. He obtained a cardiac incision, during which he was treating valves and repairs in the heart. All operations were surgery with the naked eye directly under a large incision. From around 2000, endoscopic surgery began to be performed mainly in the United States and Europe. For surgery that monitors the endoscope without looking directly at the affected area, the surgical support robot "da Vinci Surgical System" has been developed and put on the market in earnest, and even forceps operation can be performed remotely and is three-dimensional. Innovative methods that allow surgery while looking at a monitor under an endoscope are becoming widespread.

This method is very promising because it can be operated with only a few small holes, it is extremely minimally invasive, it can be walked from the day after the operation without pain, and it can be discharged in about 3 days, but the dermis of the peripheral equipment cannot catch up. The surgical environment is not easy. In addition, since the surgery support robot can only be operated by one surgeon, it cannot be expected to be assisted by an assistant, which was possible in conventional surgery. The long-awaited.

Especially in mitral valve repair, it is necessary to accurately repair a complicated mitral valve and its lesion, and it is indispensable that the mitral valve itself is sufficiently expanded in the surgical field. When the mitral valve located in the deep part of the heart is deployed under cardiac arrest, the mitral valve is usually crushed by the myocardium, so a special metal "hoe" is used. Raise and deploy. The same is true for atrial septal defect, and all intracardiac structures require special equipment to deploy.

The standard forceps of the surgical support robot "da Vinci Surgical System" are conventional endoscopes that can only "grip", "pinch", and "cut", which are devised for gastrointestinal surgery and respiratory surgery. There are no forceps or deployment retractors for heart surgery that are centered on forceps and do not have endoscopic surgery in the first place. Therefore, when performing heart surgery with a surgery support robot, there was no instrument suitable for performing the procedure, which caused great difficulty.

Therefore, an object of the present invention is to develop a retractor for cardiac deployment that can be used under an endoscope or a surgical support robot that does not require a surgical assistant or auxiliary forceps.

Problems to be solved by the invention

However, the above-mentioned problems have the following problems. First, in devising such a retractor for cardiac deployment, it is necessary to have a structure that can maintain an optimal space for securing a visual field in the heart. Further, if the retractor is to be inserted from a small port, it needs to be an automatically expanding structure that can be deformed into a thin shape and automatically returns to the original structure after entering the body. For example, it must be large enough to fit through a port with a diameter of 8 mm for an endoscope, and when it is taken out of the body, it must be structured so that it can be pulled out from a small hole as when it is put in.

Also, since the retractor is inserted into the left atrium, it must be made of a soft material so as not to damage the endometrium of the atrium.

The present invention has been made to solve the above-mentioned problems, and an object of the present invention is to form a body that can be inserted into the heart under cardiac arrest and that can be expanded in the heart and can be well expanded inside. Furthermore, it is an object of the present invention to provide a retractor having performance comparable to that of a large metal retractor used at the time of thoracotomy even though it can be inserted from a port.

Means for solving problems and the effect of the invention

In order to achieve the above object, the invention according to claim 1 is a flexible tubular body in which a highly plastic tube is spirally wound, and is inserted into the body with the proximal end of the tube left outside the body. It is characterized by having a structure in which the body is placed in the heart.

This retractor is characterized by being a flexible, spirally wound tubular body, but various materials can be considered that match such a structure. According to the results of experimental studies, specifically, when the retractor is made of a resin material suitable for medical equipment such as Teflon, polyethylene, polypropylene, nylon, polyurethane, and vinyl chloride, it is extremely safe and smooth. It was confirmed that intracardiac structures such as the cap valve could be deployed.

The invention's effect

In addition to this, in order to secure a sufficient bloodless field of view, a structure is made in which a spirally wound tube can be used to suck blood in the heart, or a separate suction tube can be added.

According to the retractor configured as described above, a good view of intracardiac structures can be obtained in intracardiac surgery even under endoscopy or with the assistance of a surgical robot, which enables complicated surgery and cardiac arrest time. Can be shortened.

Furthermore, since blood in the heart is sucked by blood suction and guided to the outside of the body to develop a bloodless field of view, the time spent for blood suction can be shortened. As a result, it is clinically possible to safely perform heart surgery for elderly patients and patients with many complications because it shortens the operation time and operation time of the heart-lung machine and can prevent serious life-threatening heart-lung machine complications. I have also confirmed.

In addition, since the retractor is formed extremely flexibly, even if the retractor is placed in the heart, the problem of damaging the inner wall is unlikely to occur.

By the way, since the retractor of the present invention is made of a material that is fairly flexible and has a smooth surface as described above, even if only the retractor is pushed into the blood vessel by the operation on the hand side, the retractor may rotate in the heart. There is a risk that the field of view will deteriorate due to movement. Therefore, in order to successfully place such a retractor in the heart, it is important to have a support that can be added to the retractor, such as a non-slip or guide.

Therefore, for example, like the metal according to claim 4, the retractor according to claim 1 and a member having a flexibility larger than that of the retractor, and the retractor is towed at several places like a garter belt. It is preferable to have a support to support it.

Such a support is intended to prevent the retractor from entering or rotating into the heart, with the metal support waiting outside the heart for the retractor to perform a cardiotomy. The retractor is fixed with a few threads that are inserted into the heart from the part and extend from the metal support. The metal support is sized and shaped so that it cannot pass through the incision in the heart, so it stays outside the heart and the retractor is pulled by a few threads between it and the support so it is automatically in the optimal position. Is fixed to.

Overall perspective view of the present invention including the retractor and the support Perspective view of the retractor section Perspective view showing the state of use of the present invention for cardiac surgery. Perspective view with the adduct of the present invention

Next, an embodiment of the present invention will be described with reference to an example. As shown in FIG. 1, the retractor system 1 includes a retractor 2 and a support 3 attached to the retractor 2.

As shown in FIG. 2, the retractor 2 is composed of a cylindrical portion 5 in which an elastic cylindrical material (hereinafter referred to as a tube) 1 is spirally wound, and the adjacent tubes 1 are roughly adhered to each other. The tube 1 has a diameter of 3-10 mm, and the wall thickness of the material forming the tube is about 0.5 to 1.0 mm. The tube portion 2 has the same shape continuously, but the total length is actually about 20 mm to 60 mm. The diameter of the cylindrical portion 5 is 40 mm to 60 mm. Further, the shape of the tube 1 may have various possibilities such as an elliptical cross section and a square cross section. The material of the tube uses the structural maintenance force of the cylinder to create a space in the heart and develop the surgical field for performing surgery, and the tube is made of elastic silicone, vinyl chloride, rubber, etc. It is characterized by being made of a soft material that does not damage the heart.

On the other hand, the support 3 is made of metal and has a diameter larger than that of the retractor 2 as shown in FIG. 1, and has a shape that can be inserted from a port having a diameter of about 8 mm. The support 3 and the retractor 2 are connected by several threads 4, and the support 3 has a shape in which the retractor 2 is lifted.

Further, a mesh portion 6 having a mesh structure is added to the side surface of the retractor 2 in FIG. 2 so as to prevent slipping in the heart of the retractor.

Next, how to use this instrument 1 will be described. First, the heart is stopped with a cardiac arrest solution and the preparation is completed. Then an incision is made in the heart. The retractor 2 is inserted through the incision as shown in FIG. 3, but the retractor 2 is pulled from a certain distance because the support 3 is outside the heart and is fixed, and is towed by the thread 4. It does not go into the back or rotate and becomes immobile in the optimum position.

Since the retractor 2 is made of an elastic material and is spirally wound into a cylinder, a space is created in the heart by utilizing the structural maintenance force of the cylinder, and the mitral valve 10 in FIG. 3 is a good technique. Can be deployed in the field.

As a method of removing blood in the heart, as shown in FIG. 4, the blood in the heart is removed by using the tubular tube leaving the proximal end 14 of the tube, which is a component of the retractor 2, outside the body. It is possible to suck and discharge the blood to the outside of the body, or to add a small-diameter tube 11 for blood suction separately from the retractor 2.

On the other hand, as shown in FIG. 4, it is also possible to attach a detachable small hook 12 for towing or the like attached to the retractor 2 for the purpose of pulling the heart tissue and developing a better field of view.

1 Retractor system 2 Retractor 3 Support 4 Thread 5 Cylindrical part 6 Mesh part 10 Mitral valve 12 Small hook 14 Proximal end of tube

Claims (5)

A self-expanding deployment characterized by creating a short, flexible tubular body, inserting it into the body or the heart, and expanding the field of view so that the valves, which are the intracardiac structures during cardiac surgery, can be clearly seen. Auxiliary equipment (hereinafter referred to as retractor). In the short and flexible tubular retractor according to claim 1, an elastic cylindrical material (tube) having a diameter of 3-10 mm and a wall thickness forming a tube of 0.5-1.0 mm is spirally formed. A wound cylinder is made, a space is created in the heart by using the structural maintenance force of the cylinder, and a surgical field for performing surgery is developed. The tube is elastic silicon, vinyl chloride, rubber, etc. A retractor characterized by being made of a soft material that does not damage the heart. The retractor according to claim 1 or 2, leaves the proximal end of the tube as a component outside the body, and the tubular tube is used to suck and discharge the blood in the heart to the outside of the body, or the same. A retractor characterized by attaching a small-diameter blood suction tube to the tractor via an adhesive layer and fixing it to obtain a similar bloodless field of view. A mesh or the like having a mesh structure is added to the side surface of the portion to be inserted into the heart of the retractor according to claim 1 or 2, so as to prevent slipping in the heart of the retractor, and a ring type. A retractor characterized by being able to control the retractor's falling off to the deep part of the heart and slipping out of the heart by adding a support bracket. The retractor according to claim 1 or 2, wherein a detachable small hook for towing or the like can be attached for the purpose of pulling the heart tissue and developing a better field of view.

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