JP2022185543A - Tissue adhesion sheet insertion appliance for spine percutaneous whole endoscope (secant type) - Google Patents

Abstract

To solve the problem that, in surgery under a spine percutaneous whole endoscope, when inserting a tissue adhesion sheet by pushing it with a stick at the time of damaging a dura mater, the tissue adhesion sheet adheres to the stick, to thereby have a hard time to peel it off.SOLUTION: An appliance is a cylindrical object used for inserting a tissue adhesion sheet. Since it is inserted into an endoscope after being set in an intraluminal tip, by pushing it with a push rod, it is peeled off easily from a body, and can be pushed onto dura mater. A larger tissue adhesion sheet can be inserted into a limited space such as an inner cavity inside of a smaller appliance than the case of being insertable into an inner cavity of the endoscope.SELECTED DRAWING: Figure 5

Description

The present invention relates to an instrument for assisting insertion of a tissue adhesive sheet in percutaneous total endoscopic spinal surgery.

In order to minimize invasiveness in spinal surgery, there is a method using a percutaneous spinal endoscope, which is a small-diameter endoscope with all the necessary functions. As shown in FIGS. 1 and 2, the percutaneous spinal percutaneous endoscope 900 has a body portion 901 which is a portion to be inserted into the body. , a light source channel 903, a perfusion channel 904 and a working lumen 905 are integrated. An outer tube 906 is inserted into the body through the skin incision S, the body part 901 is inserted therein, and water is flushed from the irrigation channel 904 to wash away the surroundings of the object. is magnified on a monitor, and an instrument such as forceps 200 inserted into the working lumen 905 is used to manipulate the vertebral arch 4, intervertebral disc 5, and the like. The instrument that can be inserted into the working lumen 905 is an instrument having a basic outer shape of an elongated cylinder with an outer diameter of about 2.5 mm to 4 mm and a length of about 200 mm to 400 mm, with a handle attached.

In spinal canal enlargement surgery for spinal canal stenosis, as shown in Fig. 3, the dura mater 2 (a lumen surrounded by dura mater 1, in which spinal fluid, spinal cord, and nerve roots pass) is opened. Surrounding tissues such as the compressing intervertebral disc herniation 3, vertebral arch 4, intervertebral disc 5, and ligamentum flavum are excised to expand the dura mater tube. At that time, since the dura 1 is a thin film, it may be damaged. When damaged, cerebrospinal fluid leaks from the hole, causing symptoms of low spinal cord pressure, and nerves collapse into the hole, causing neurological symptoms. be. Conventionally, suturing is the most common method of closure, but there is also a method of covering with a tissue-adhesive sheet.
A tissue adhesive sheet 10 such as Tacoseal (manufactured by CSL Behring Co., Ltd.) is, as shown in FIG. It is a sheet-like biological tissue adhesive/closure agent in which the adhesive surfaces 12 are joined together. It is characterized by its adhesive strength even in liquids. Especially in percutaneous total endoscopic surgery, since the operative field is submerged in irrigation fluid, it is useful to be able to use it without removing the irrigation fluid.

Patent No. 5192254

When using a tissue adhesive sheet in percutaneous total endoscopic surgery for the spine, cut it to an appropriate size and insert it into the working lumen of the percutaneous total endoscope and insert it into the tip of the endoscope. However, this operation causes the tissue adhesive sheet to stick to the tip of the stick. However, since the number of instruments that can be inserted is limited to one, it is not possible to insert another instrument to peel it off. For this reason, the tip of the stick was rubbed against the corners of the surrounding bones to somehow remove it from the stick, but in many cases there were no convenient corners nearby, and it was not easy, and it was necessary to shift the field of view.

In percutaneous total endoscopic spinal surgery, as in other surgical procedures, dural damage occurs with a certain frequency, so it is necessary to make tissue adhesive sheets easier to use as a treatment for this.

The instrument for inserting a tissue adhesive sheet for a percutaneous spinal percutaneous total endoscope of the present invention is hereinafter referred to as the instrument. As shown in FIGS. 5 to 11, the device 100 has an elongated cylindrical main body 110 with an outer diameter that can be inserted into the working lumen of a percutaneous total endoscope, and two or more from the distal end 111 of the main body. Four secant lines 112 enter toward the hand side, and the secant line becomes a slit 113 in which the gap between the secant lines widens from the middle.
There is a push rod 120 within the body lumen and an enlarged portion 121 at the proximal end of the push rod 120 . There is a spring 130 between the body portion proximal end 114 and the bulge portion 121 . The push rod 120 can be slid within the body lumen.
The inner diameter of the ring 140 is slightly larger than the outer diameter of the main body, and the ring 140 covers the outer surface of the main body.
The opening tool 150 has a thickness smaller than the gap of the slit 113 and a width larger than the gap of the slit.

When using this instrument, as shown in FIG. 12, first insert the opening tool 150 into the slit and twist the opening tool to open the secant line 112, the tip of the body part 110 expands, and the tissue An adhesive sheet cut to a suitable size is placed over the tip 111 of the main body with the adhesive surface 12 facing downward (Fig. 12a). Then, when the opening tool is removed, the tissue adhesive sheet is compressed, and when the ring 140 is moved to the distal side, the secant line is securely closed (Fig. 12b). Insert the main body into the working lumen of the spinal percutaneous total endoscope and advance it. At this time, the ring on the tip side is moved to the proximal side. When the push rod 120 is pushed after the tip of the main body reaches the dura mater of interest, the tissue adhesive sheet in the lumen of the tip of the main body is pushed out (Fig. 12c), stretched a little and adheres to the dura mater. .

Since the adhesive surface of the tissue adhesive sheet moves while remaining in the lumen at the tip of the main body, it sticks only inside the lumen of the main body. It can be extruded into the dura mater.

What can be inserted into the spinal percutaneous total endoscope lumen is an instrument with an outer diameter smaller than that lumen, and if a tissue adhesive sheet is placed in the lumen of the instrument, it is very small. Only the size can be inserted, but it can be widened by the secant line, and a tissue adhesive sheet larger than the instrument lumen can be inserted.

Schematic diagram of the lumbar cross-section and instruments during percutaneous total endoscopic surgery for the spine. Percutaneous spinal percutaneous endoscope and perspective view of the distal end of the outer tube. Sectional view of the spine. Schematic diagram of tissue adhesive sheet. The whole side view of Embodiment 1 of this invention. BRIEF DESCRIPTION OF THE DRAWINGS Fig. 1 is a perspective view of the distal end side of Embodiment 1 of the present invention; Sectional drawing of the front end side of Embodiment 1 of this invention. 1 is a perspective view of the hand side of Embodiment 1 of the present invention. Sectional drawing of the hand side of Embodiment 1 of this invention. Fig. 2 is a front view of the distal end of Embodiments 1 and 2 of the present invention; BRIEF DESCRIPTION OF THE DRAWINGS The perspective view of the opening tool of Embodiment 1 of this invention. The schematic diagram at the time of use of Embodiment 1 of this invention.

Embodiment 1 of the present invention will be described with reference to FIGS. The main components of this instrument 100 are a body part 110 and a push rod 120 . The body part 110 has an elongated cylindrical shape with an outer diameter of 3 to 4 mm and a length of about 350 mm, which can be inserted into the working lumen of a percutaneous spinal percutaneous endoscope. is entered toward the hand side, and the secant line 112 becomes a slit 113 whose gap widens from the middle, and the slit 113 does not continue to the hand end 114 of the main body.
There is a push rod 120 within the body lumen and an enlarged portion 121 at the proximal end of the push rod 120 . There is a spring 130 between the proximal end 141 of the body portion and the bulging portion 121 . The push rod 120 can be slid within the body lumen.
The inner diameter of the ring 140 is slightly larger than the outer diameter of the main body 110, and the ring 140 covers the outer surface of the main body.

As shown in FIG. 10, two secant lines 112 and slits are provided facing each other (a, Embodiment 1), and two are added at positions shifted by 90° from them (b, Embodiment 2). ) can also be considered.

The opening tool 150 has a thickness smaller than the gap of the slit 113 and a width larger than the gap of the slit 113 (Fig. 11a). The secant line can be widened by inserting the opening tool into the slit and twisting it.
As another form of the opening tool, the opening tool 160 may have a thickness smaller than the gap of the slit 113 at the distal end and larger than the gap of the slit 113 at the proximal side (Fig. 11b). By inserting and pushing this opening tool 160 into the slit 113, the secant line can be enlarged.

Claims (3)

A device that assists the insertion of a tissue adhesive sheet in percutaneous total endoscopy of the spine, and has an elongated cylindrical shape with an outer diameter that can be inserted into the working lumen of the percutaneous total endoscopy of the spine. There is a main body,
Two or four secant lines enter from the tip of the main body toward the hand side, and the secant line becomes a slit with a gap between the secant lines widening from the middle, and the slit does not continue to the hand end of the main body.
There is a push rod in the lumen of the main body, and by sliding the push rod in the lumen of the main body, the object inserted into the tip of the main body can be pushed out.
The inner diameter of the ring is slightly larger than the outer diameter of the main body, and it covers the outer surface of the main body,
An instrument for percutaneous total endoscopy of the spine, characterized in that the secant line can be widened by inserting an opener into a slit. 3. The opening tool has a thickness smaller than the gap of the slit and a width larger than the gap of the slit, and the split line can be opened by inserting the opening tool into the slit and twisting it. 1. The spinal percutaneous total endoscope instrument according to 1. The opening tool has a thickness smaller than that of the slit at the distal end and larger than that of the slit at the proximal side, so that the dividing line can be widened by inserting and pushing the opening tool into the slit. The spinal percutaneous total endoscope instrument according to claim 1.

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