JP2024022727A - thoracoscopic surgical port - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a thoracoscopic port which allows for stable manipulation of a scope and a surgical instrument by alleviating burden on an assistant who is operating and holding the scope while securing free operation of them in a single-hole thoracoscopic surgery.

SOLUTION: A thoracoscopic port includes: a retractor 10 formed of an outer ring 11 located on body surface side, an elastic inner ring 12 located in a thoracic cavity, and an elastic sleeve 13 connected to the outer ring 11 and the inner ring 12 at both ends and located in the thoracic cavity from a body surface; and a holder ring 20 which is made of a rubber elastic member and a portion of which is attached by being connected to the retractor 10 directly or indirectly. The holder ring 20 is located in such a manner that an opening 135 in the retractor 10 is partitioned by a part or the whole of a peripheral surface in top view, and the holder ring 20 is formed so as to be movable with a connection part with the retractor 10 as fulcrum.

SELECTED DRAWING: Figure 1

COPYRIGHT: (C)2024,JPO&INPIT

Description

The present invention relates to a thoracoscopic surgery port that is inserted into a wound site for introducing an endoscope and surgical instruments into the thoracic cavity during thoracoscopic surgery.

In thoracoscopic surgery, a cylindrical chest port extending from the body surface into the thoracic cavity is inserted into multiple incisions made in the intercostal space, and medical instruments such as a thoracoscope and forceps are inserted into the thoracic cavity through the passage of the chest cavity port. Surgery is performed by inserting the

The chest cavity port used for this purpose includes, for example, a cylindrical part made of synthetic resin with an oval cross-section and a mechanical strength that prevents the interior from collapsing when placed in the intercostal space, and both ends of the cylindrical part. An instrument comprising an outer flange and an inner flange provided in the cylindrical part, and the inner cavity of the cylindrical part is partitioned into two or three by a partition (Patent Document 1), or a flange located on the body surface side, For thoracoscopic surgery, equipped with a collar located on the thoracic cavity side, a flexible cylindrical sleeve located from the body surface side into the thoracic cavity, and a suction tube provided parallel to the axial direction along the outer circumferential surface of the sleeve. Port (Patent Document 2) has been proposed.

Patent No. 6302467 Patent No. 6418612

According to the conventional device of Patent Document 1, the cylindrical port set in the intercostal space is flexible while having mechanical strength, and has an oval shape to fit the intercostal space and increase the contact area. It is said that the burden on the patient can be reduced through easy retraction. Furthermore, since the inner cavity of the port is divided into a plurality of sections, instruments such as a plurality of thoracoscopic scopes (hereinafter simply referred to as scopes) and forceps can be applied into the thoracic cavity from one port. Further, according to the device of Patent Document 2, by providing a suction tube in the port, surgical smoke generated by using an electric scalpel or the like can be appropriately discharged from the surgical field.

On the other hand, single-hole surgery has become popular in laparoscopic surgery, and in recent years, thoracoscopic surgery is also being developed, and there is a need for a port instrument that is compatible with the single-hole thoracoscopic surgery. Single-hole surgery is performed by simultaneously inserting multiple scopes and surgical instruments into the chest cavity through a single port (opening), but unlike laparoscopic surgery, thoracoscopic surgery does not require pneumoperitoneum. The lack of air-tight valves on the port opening allows for a high degree of freedom in surgical operation, but while the surgeon is operating the forceps and energy device during the surgery, an assistant must always keep the scope in place. It is necessary to operate and hold the device in a certain position, and there are concerns about stable operation and holding. Furthermore, holding the scope in an appropriate position for a long period of time is a burdensome task.

Therefore, the present invention is particularly suitable for single-hole thoracoscopic surgery, and allows stable operation by reducing the burden on the assistant who operates and holds the scope while ensuring free operation of the scope and surgical instruments. The objective was to provide a thoracoscopic surgical port that could be used.

The thoracoscopic surgical port of the present invention includes an outer ring located on the body surface side, an elastic inner ring located within the thoracic cavity, and both ends connected to the outer ring and the inner ring to allow the thoracoscopic surgery port to be connected from the body surface to the thoracic cavity. a retractor configured with an elastic sleeve located inside the retractor and formed into a drum shape in a front view (view from a plane parallel to the axial direction), and a part of the retractor directly or indirectly. It is composed of one or more holder rings made of rubber elastic members that are connected and attached, and the holder ring holds the opening of the retractor in a top view (viewed from a plane perpendicular to the axial direction). , the holder ring is positioned so as to be partitioned by part or all of the circumferential surface of the holder ring, and the holder ring is formed to be movable about the attachment portion to the retractor as a fulcrum.

Further, it is preferable that the holder ring is detachably attached to an attaching portion provided on the retractor.

Furthermore, in addition to the above configuration, the retractor may be provided with an exhaust pipe formed parallel to the axial direction of the elastic sleeve, and a smoke exhaust passage including the exhaust pipe from the inside of the thoracic cavity to the outside of the body. Preferably, the proximal end of the exhaust pipe is provided with a bent portion directed toward the outer circumferential side of the retractor on the upper surface of the retractor, and the bent portion is connected to the retractor of the holder ring. Preferably, it is an attachment part.

According to the thoracoscopic surgery port of the present invention, by inserting a scope or the like into the holder ring, the scope or the like can be supported by the holder ring and prevented from moving in the axial direction. When operating the scope, etc., the connection between the holder ring and the retractor serves as a fulcrum, which stabilizes the operation of the scope and reduces the burden on the operator who operates and holds the scope.

1 is an overall configuration diagram (front view) A and an enlarged diagram B showing a first embodiment of a port for thoracoscopic surgery of the present invention. FIG. FIG. 3 is a top view of the first embodiment. FIG. 3 is a schematic diagram when a scope and surgical instruments are applied to the first embodiment. FIG. 3 is a schematic diagram showing the operation of the holder ring of the first embodiment. FIG. 2 is an overall configuration diagram showing a second embodiment of the present invention. FIG. 7 is an overall configuration diagram showing a third embodiment of the present invention. FIG. 7 is an overall configuration diagram showing a fourth embodiment of the present invention. FIG. 7 is an overall configuration diagram showing a fifth embodiment of the present invention.

DESCRIPTION OF THE PREFERRED EMBODIMENTS Hereinafter, embodiments of the thoracoscopic surgical port of the present invention will be described in detail with reference to the drawings. 1 and 2 are overall configuration diagrams showing a first embodiment of the present invention, where A in FIG. 1 is a front view of the entire configuration, and B is a partially enlarged view. FIG. 2 shows a top view, and FIG. 3 shows a schematic diagram when a scope and surgical instruments are applied to this configuration.
This type of thoracoscopic surgery port (hereinafter referred to as thoracoscopic port) is used in thoracoscopic surgery to insert multiple surgical instruments 72 such as a thoracoscope (scope) 71 and forceps through a single incision. This instrument is suitable for single-hole thoracoscopic surgery, which is performed as a single-hole thoracoscopic surgery. ) 72 is inserted into the thoracic cavity 85 (between the parietal pleura 83 and the visceral pleura 84).

The chest cavity port of this embodiment has an outer ring 11 that is located in contact with the body surface 81 when the chest cavity port is inserted into the intercostal space 86, and an inner ring that is located in contact with the parietal pleura 83 of the chest cavity 85 when the chest cavity port is inserted. 12; and a cylindrical elastic sleeve 13 having an end portion 134 connected to the outer ring 11 and the inner ring 12 to form a drum shape when viewed from the front;
an exhaust pipe 31 provided parallel to the axial direction of the outer circumferential surface of the elastic sleeve 13 of the retractor 10 and provided with a bent portion 32 directed toward the outer circumferential direction of the elastic sleeve 13 on the upper surface of the retractor 10;
It is constituted by a holder ring 20 made of an elastic ring that is removably attached to the bent portion 32 of the exhaust pipe 31.

The retractor 10 sandwiches the chest wall 82 between the outer ring 11 and the inner ring 12, and connects both ends 134 to the outer and inner rings 11 and 12 to generate tension (retracting force) in the elastic sleeve 13 and apply pressure to the incision. When worn, the incision wound is opened outward against the force that tries to return to its original position, and the inner cavity 135 of the elastic sleeve 13 allows the scope 71 and surgical instruments 72 to be inserted into the chest cavity 85. This serves as a passageway for insertion into the

The outer ring 11 and the inner ring 12 are formed as elastic rings having the strength necessary to generate a retraction force on the elastic sleeve 13, and in this example, superelastic alloy wires 111, 121 are attached to the protective tube. The ring was coated with a ring having an oval or other oval shape. In this embodiment, the superelastic wires 111 and 121 are made of a known superelastic wire such as a Ni-Ti alloy as a core material, and the superelastic wires 111 and 121 are made of a relatively elastic polyether block amide copolymer as a protective tube. The reinforcing tubes 112 and 122 of combined/polyurethane tubes were further formed by covering their outer layers with silicone tubes 113 and 123 in consideration of adhesion to the elastic sleeve 13.

The sizes of the outer ring 11 and the inner ring 12 are such that when inserted into the incision in the intercostal space 86, they can be held securely in the incision, and can be inserted easily through the incision, and the insertion portion Although there is no particular requirement as long as it does not impose a burden on the user, the long axis of the oval ring is set to be 50 mm or more and 85 mm or less, and the short axis is set to 40 mm or more and 65 mm or less. In this example, two types of outer ring 11 and inner ring 12 were prepared, each having a long axis and a short axis of 55 mm to 45 mm and 80 mm to 60 mm.

Note that the outer ring 11 and the inner ring 12 preferably have an oval shape such as an ellipse shape as described above as a shape suitable for insertion into the narrow intercostal space 86, but rings of other shapes such as a circular shape may be used. Also good. Further, the inner ring 12 is an elastic ring as described above in consideration of insertion into the thoracic cavity 85 from the body surface 81, but the upper ring 11 does not necessarily have to be an elastic ring.

The elastic sleeve 13 is made of a flexible elastic member (silicone resin in this example) in order to protect the incision and keep it open.The cross section parallel to the axial direction is shaped like a drum, and the cross section perpendicular to the axial direction is shaped like the outer ring 11. , is formed from a cylindrical sheet having a film thickness of about 0.7 mm to 1.0 mm, which is formed into an oblong shape such as an ellipse to match the shape of the inner ring 12, and both ends 134 of the cylindrical sheet are connected to the outer side. It was expanded into the ring 11 and the inner ring 12, wound about half a circumference, and connected to the ring with an adhesive.

Although the size of the elastic sleeve 13 is not specified, the inner diameter of the intermediate part of the sleeve, which can be inserted into an incision made in the intercostal space 86 and can be applied to thoracoscopic single-hole surgery, is set to In a natural state, the major axis is set to be 20 mm or more and 50 mm or less, and the minor axis is 12 mm or more and 30 mm or less. In addition, the axial length of the elastic sleeve 13 from the bottom of the outer ring 11 to the top of the inner ring 12 that holds the chest wall 82 is set to 12 mm or more and 30 mm or less, taking into account the thickness of the chest wall 82 and the elasticity of the sleeve 13. be done. In this example, the inner diameter of the sleeve 13 is prepared in two types: long axis - short axis: 25 mm - 15 mm type and 45 mm - 25 mm type, and the sleeve length (width of outer ring 11 and inner ring 12) is 15 mm. Two types were prepared: 1 and 20 mm.

The retractor 10 constituted by the outer ring 11, the inner ring 12, and the elastic sleeve 13 according to the embodiment includes an elliptical cylindrical portion 131 that is a contact portion with the chest wall 82 at the middle portion of the elastic sleeve 13, and an elastic One end 134a of the sleeve 13 is expanded and the upper surface 132 is located on the body surface 81 side connected to the outer ring 11, and the other end 134b of the elastic sleeve 13 is expanded and connected to the inner ring 12 inside the thoracic cavity 85. The inner cavity 135 of the elliptical cylindrical part 131 serves as a port 135 for the surgical instruments 71 and 72.

The shape of the present retractor 10 is such that it has a width that fits the intercostal space 86 and can retract the incision, and an internal cavity into which a scope 71 and a surgical instrument 72 can be inserted and operated without interfering with each other. The shape is not limited to this embodiment as long as the space of 135 can be secured.

The exhaust pipe 31 is formed as a part of a smoke exhaust passage 30 for exhausting surgical smoke generated by the use of an energy device such as an electric scalpel during surgery from the intrathoracic cavity 85 to a smoke exhaust device (not shown) outside the body. Ru. The exhaust pipe 31 of this embodiment is a flexible tube provided parallel to the axial direction in contact with the outer peripheral surface of the elliptical cylinder portion 131 of the elastic sleeve 13 of the retractor 10. The distal end 312 is provided in a position that does not protrude from the inner ring 12, and the proximal end 311 is provided in a position that protrudes from the outer ring 11. The through hole passage portion 31 is fixedly attached with an adhesive. In addition, in this example, the exhaust pipe 31 is located at one of the long sides of the inner cavity 135 of the elastic sleeve 13, which is formed into an elliptical shape, so that the surgical operation using the surgical instrument 72 such as forceps is less affected. It was set at the position of the top 136 of the side.

A connecting tube 33 oriented toward the outer circumferential side of the retractor 10 at the upper surface 132 of the retractor 10 is connected to the proximal end 311 of the exhaust pipe 31 via an L-shaped connector 32. Furthermore, a connection adapter 34 to a smoke evacuation device was connected to the end of the connecting tube 33 to form a smoke evacuation passage 30 from the exhaust pipe 31.

The holder ring 20 suppresses natural movement in the axial direction when the scope 71 is inserted into the inner cavity 23 of the holder ring 20, and also functions as a fulcrum when moving and operating the scope 71. A ring-shaped core material 21 made of polyamide synthetic resin or the like was covered with a resin tube 22 (silicone tube in this example) having rubber elasticity and appropriate frictional force to form a circular shape.

The size of the holder ring 20 is selected to match the size of the scope 71 used for surgery, and in this embodiment, one has an outer diameter of about 21.5 mm and an inner diameter of about 15.5 mm, and another has an outer diameter of about 26 mm and an inner diameter of about 20 mm. We have prepared two types, large and small.

Then, the holder ring 20 is hooked onto the L-shaped connector 32 that connects to the connecting tube 33 provided at the proximal end 311 of the exhaust pipe 31, and is connected to the upper surface 132 of the elastic sleeve 13. By holding it between the tubes 33, it can be detachably attached to the retractor 10 without being firmly attached. Here, at least a part of the inner cavity 23 of the holder ring 20 attached to the retractor 10 covers a part of the opening 135 of the elastic sleeve 13 in a top view, and defines the opening 135 of the elastic sleeve. When the scope 71 or the like is inserted into the holder ring 20, it is introduced into the opening 135 without interfering with the elastic sleeve 13. Note that the two sizes of holder rings 20, large and small, can be selected and replaced as needed, but two sizes of holder rings 20 can be attached in advance, and one of the holder rings 20 that is not needed for the surgery can be cut off. It may also be designed to be removed.

Surgery using this embodiment of the chest cavity port is performed by making a single incision of approximately 20 to 40 mm in the intercostal space 86 of the patient.
The chest cavity port is inserted into the incision by utilizing the elasticity of the inner ring 12 of the chest cavity port, and is inserted into the chest cavity 85 in a compressed state. Once inserted, the inner ring 12 returns to its original natural state due to its elastic restoring force, and the chest wall 82 is held in a sandwiched state by the outer ring 11 in contact with the body surface 81 and the inner ring 12 in contact with the parietal pleura 83. At this time, the elastic sleeve 13, which is connected to the outer ring 11 and the inner ring 12 by expanding both ends 134, maintains the open wound without being crushed by the outward stress that resists the force of closing the incision. , functions as a port for a scope 71 and a surgical instrument 72.

Then, the scope 71 is inserted into the holder ring 20 of the chest cavity port, and the scope 71 is held by an assistant while the surgeon operates the surgical instruments 72 such as forceps inserted from the chest cavity port to proceed with the surgery. , is movable and operated around the holder ring 20.

According to the chest cavity port of this embodiment, by providing the holder ring 20 attached to define the opening 135 of the retractor used for single-hole thoracoscopic surgery, the scope 71 that fits into the holder ring 20 is inserted. When the scope 71 is placed in the opening 135, its movement in the axial direction is restricted and held, so that the scope 71 can be stably held at a desired position by simply placing your hand on the scope 71. The burden on the assistant holding the device 71 can be reduced, and surgery can be performed under stable images.

Moreover, FIG. 4 is a schematic diagram showing the operation of the holder ring in this embodiment. Since the holder ring 20 has rubber elasticity and the attachment portion between the holder ring 20 and the retractor 10 is only a part of the holder ring 20, the attachment portion between the retractor 10 and the holder ring 20 is As a fulcrum, it can freely move in the circumferential direction M1 and angular direction M2 with the scope as an axis within the range of the inner cavity 135 of the elastic sleeve 13. As a result, even if the scope 71 is inserted into the holder ring 20, it can be moved to a desired angle, the burden on the assistant who operates the scope 71 is reduced, and surgery can be performed using stable images.

Further, since the holder ring 20 can be detachably attached to the retractor 10 portion, for example, holder rings 20 of different sizes can be selected or replaced depending on the diameter of the scope 71.

Further, by providing the smoke exhaust passage 30 including the exhaust pipe 31 for exhausting surgical smoke generated inside the thoracic cavity 85 to the outside of the body during surgery, there is no need to separately set and operate an exhaust pipe for smoke exhaust. Further, if the smoke exhaust passage 30 is provided with a bent portion 32 directed toward the outer circumferential direction of the retractor 10 on the upper surface portion 132 of the retractor 10, and the bent portion 32 is used as the attachment portion of the holder ring 20, the holder ring 20 There is no need to provide a separate mounting section for installation.

5 to 8 show other embodiments of the present invention, and all show variations in the means for attaching the holder ring to the retractor. The structures of the retractor 10, the smoke exhaust passage 30, and the holder ring 20 in these embodiments are basically the same as in the first embodiment, so explanations of the similar parts will be omitted and only the different parts will be described.

FIG. 5 shows a second embodiment of the invention. The chest cavity port in this embodiment has a hook 4 provided on the upper surface 132 of the retractor 10 as a means for attaching the holder ring 20 to the retractor 10. When the holder ring 20 is attached to the upper surface 132 of the retractor 10, a part of the inner cavity 23 of the holder ring 20 or , are all fixed with adhesive to the elastic sleeve 13 at a position where the inner cavity 135 of the retractor 10 can be defined. Note that when the hook 4 of this embodiment is used, the smoke exhaust passage 30 does not necessarily need to be provided.

FIG. 6 shows a third embodiment of the invention. In the chest cavity port of this embodiment, a part of the outer peripheral surface of the holder ring 20 is directly connected to the retractor 10, and in this embodiment, the upper surface (expanded portion) 132 of the elastic sleeve 13 and the elliptical cylindrical portion 131 are connected to each other. The adhesive part 5 is attached to the elliptical cylindrical part 131 near the cylindrical part 131 with an adhesive or the like so as to be parallel to the outer ring 11 toward the inner cavity so as to partition the inner cavity 135. Further, the adhesive portion 5 in this example is provided on the other top portion 136b diagonally to the exhaust pipe 31 provided on one top portion 136a side of the long side of the elliptical cylinder portion 131. By providing it at this position, interference between the scope 71 and the like inserted into the holder ring 20 and the surgical instruments 72 inserted from other ports can be suppressed.

FIG. 7 shows a fourth embodiment of the present invention, in which A shows the overall configuration and B shows an enlarged view of the connecting portion 60. The chest cavity port of this embodiment is such that the holder ring 20 is attached to the retractor 10 indirectly via the connecting portion 60. The holder ring 20 is attached to the outer ring 11 by a hook 61, and the holder ring 20 is attached to a second hook 62 provided at the other end of the connecting portion 60. Note that the outer ring 11 and the first hook 61 and/or the holder ring 20 and the second hook 62 may be provided detachably or may be fixedly connected in advance. Here, if the first hook 61 is detachably provided, the connecting part 60 can be set at any position, and if the second hook 62 is detachably provided, holder rings 20 of different sizes can be used interchangeably. .

FIG. 8 shows a fifth embodiment of this form. The chest cavity port of this embodiment has a plurality of holder rings 20, and the first holder ring 20a is attached to the bent part 32 of the smoke exhaust passage 30, as in the first embodiment. The second holder ring 20b is provided to be hung on the hook 4 similarly to the second embodiment. Note that the plurality of holder rings 20 may be of the same size or of different sizes, and any of the above-mentioned means may be used as the attachment means.

The method of attaching the holder ring 20 to the retractor 10 of the first to fifth embodiments is not limited to the above, and the inner cavity 135 of the retractor 10 is made of rubber elastic material when viewed from above. It is sufficient if the holder ring 20 can be set at a position defined by the inner cavity 23 of the holder ring 20.

10. Retractor 11. Outer ring 12. inner ring
111.121. Superelastic alloy wire 112.122. Reinforcement tube 113.123. Silicone tube 13. Elastic sleeve 131. Oval cylinder part 132. Top part (extension part)
133. Bottom part (extension part)
134. End 135. Inner cavity (opening/port)
136. Top of long side 20. Holder ring 21. Core material 22. (ring) tube 23. (Ring) Inner cavity 30. Smoke exhaust passage 31. Exhaust pipe 311. Proximal end 312. Distal end 32. Bend part (L-shaped connector)
33. Connecting tube 34. Connection adapter 4. Hook-shaped hook 5. Adhesive part 60. Connecting part 61. First hook 62. Second hook 71. Scope 72. Surgical instruments (forceps, etc.)
81. Body surface 82. Battlements 83. Parietal pleura 84. Visceral pleura 85. Thoracic cavity 86. intercostal space

Claims (4)

An outer ring located on the body surface side, an elastic inner ring located within the thoracic cavity, and both ends connected to the outer ring and the inner ring to be located from the body surface into the thoracic cavity. an elastic sleeve formed in a retractor;
one or more holder rings made of a rubber elastic member that are partially connected and attached to the retractor directly or indirectly;
The holder ring is positioned in such a manner that the opening of the retractor is defined by part or all of the circumferential surface of the holder ring when viewed from above,
A port for thoracoscopic surgery, characterized in that the holder ring is movable about a portion where it is attached to the retractor as a fulcrum. The thoracoscopic surgical port according to claim 1, wherein the holder ring is detachably attached to a mounting portion provided on the retractor. 3. The retractor is provided with an exhaust pipe formed parallel to the axial direction of the elastic sleeve, and includes a smoke exhaust passage from the inside of the thoracic cavity to the outside of the body including the exhaust pipe. Thoracoscopic surgical port. The proximal end of the exhaust pipe is provided with a bent portion that is directed toward the outer circumferential side of the retractor on the upper surface of the retractor, and the bent portion serves as an attachment portion for attaching the holder ring to the retractor. Section 3 thoracoscopic surgery port.

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