JP2865550B2 - Perforator for drilling a surgical hole in the abdominal wall - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

The present invention relates to a function to <br/> the drilling device for incising a plurality of surgical holes in the abdominal wall when the surgery using a laparoscope.

[0002]

2. Description of the Related Art Surgery using a laparoscope is employed in operations such as incising the abdominal wall to remove internal organs. This procedure does not make a large incision in the abdominal wall as in normal surgery. Incisions are made in several small holes in the abdominal wall. Laparoscopy and surgical instruments are inserted into the abdominal cavity through the incised surgical hole to perform surgery. To expand the abdominal cavity, pressurized gas is injected into the abdominal cavity, or a plurality of points on the abdominal wall are lifted to widen the space between the abdominal wall and the internal organs.

[0003] In order to insert a surgical instrument or a laparoscope into the abdominal cavity, surgical holes are drilled at a plurality of points on the abdominal wall. Conventionally, an abdominal wall is incised from outside the body to make a surgical hole. A trocar is used to drill the surgical hole. The trocar is obtained by inserting a piercing rod into a guide pipe. The trocar makes a surgical hole in the abdominal wall as follows.

[0004] A plurality of points on the abdominal wall are lifted to expand the space between the abdominal wall and the internal organs. The piercing rod protrudes from the guide pipe. An operation hole is drilled by penetrating the piercing rod from outside the body into the body.

[0005]

When a surgical hole is pierced in the abdominal wall by this method, there is a risk of damaging and bleeding the organs in the abdominal cavity from the abdominal wall. This adverse effect is likely to occur when the abdominal cavity cannot be greatly expanded. It is difficult to greatly expand the abdominal cavity when the patient has a thick abdominal wall or when making an operation hole on the side of the body. In order to avoid this adverse effect, a method of expanding the abdominal cavity by strongly lifting the abdominal wall has been developed. However, even if the abdominal wall is strongly lifted, it is difficult to always greatly expand the abdominal cavity. For this reason, it is not possible to eliminate the risk of damaging a part of the internal organs when drilling an operation hole. Incising part of the internal organs together with the surgical hole,
It is important to eliminate everything. This can have a very bad effect on the patient.

[0006] The present invention has been developed to achieve this. An important object of the present invention is to provide a drilling device for drilling a surgical hole in an abdominal wall which can minimize damage to internal organs when the surgical hole is drilled.

[0007]

According to the present invention, a surgical hole is provided in the abdominal wall of the present invention.
Drilling unit drilling the Ru with the following configuration to achieve the foregoing objects.

[0008] A punch for providing a plurality of surgical holes in the abdominal cavity ,
This is an improvement of the conventional trocar in which the piercing rod 5 is inserted into and out of the guide pipe 4 freely. The perforator extends the entire length of the guide pipe 4 and the perforating rod 5 inserted therein so as to extend from the preceding operation hole 2 through the peritoneal cavity 3 to the next operation hole. . Further, the guide pipe 4 and the piercing rod 5 are curved or have flexibility so that they can be bent when used. In contrast to a conventional trocar, the perforator is configured to penetrate the abdominal wall 1 from the inside of the abdominal cavity 3 to the outside of the abdominal cavity 3 with the perforating rod 5 protruding from the guide pipe 4 so as to perforate a surgical hole. ing.

[0009]

[Action] punching device to open surgery hole in the abdominal wall of the present invention is as follows, drilling surgical hole in the abdominal wall. (1) Since the first operation hole cannot be pierced from the inside of the abdominal cavity 3 to the outside of the abdominal cavity 3, a part of the abdominal wall 1 is incised from outside the body, and the preceding operation hole 2 is made. The preceding operation hole 2 is formed by, for example, incising and perforating the vicinity of the umbilicus. (2) Lift the abdominal wall 1 to expand the abdominal cavity 3. (3) With the piercing rod 5 inserted into the guide pipe 4, the tip of the guide pipe 4 is inserted into the preceding operation hole 2 as shown in FIG. 1. In this state, the guide pipe 4 is inserted into the abdominal cavity 3 from outside the body. (4) As shown in FIG. 2, the curved guide pipe 4 is further inserted into the abdominal cavity 3, and the tip of the guide pipe 4 is moved to the inner surface of the abdominal wall 1 where an operation hole is made, and the abdominal wall is gently pushed up to remove the operation hole. Check the position. At this time, the distal end is inserted into the guide pipe 4 so that the piercing rod 5 does not damage the abdominal cavity 3. (5) As shown in FIGS. 3 and 4, the tip of the piercing rod 5 is projected from the guide pipe 4, and the abdominal wall 1 is cut with a cutting blade.
Is punctured from inside the abdominal cavity 3 to the outside of the body to make a surgical hole. At this time, a scalpel can be used to make a shallow incision outside the abdominal wall at the position of the abdominal wall where the operation hole is punctured.

Through the above steps, an operation hole is opened in the abdominal wall 1.
In order to prevent the abdominal wall 1 from being damaged when a surgical instrument is inserted into the abdominal cavity 3 from here, a hard insertion pipe is inserted. The insertion pipe is formed by molding a hard plastic into a cylindrical shape having a flange outside. The insertion pipe is inserted into the guide pipe 4 with the piercing rod 5 penetrating the abdominal wall 1.
Is pulled into the body and inserted outside the perforated rod 5.
After penetrating the insertion pipe through the abdominal wall 1, the piercing rod 5 is drawn into the guide pipe 4, and the guide pipe 4 and the piercing rod 5 are drawn out of the body from the preceding operation hole 2.

[0011]

Embodiments of the present invention will be described below with reference to the drawings. However, the following examples illustrate a punch for embodying the technical idea of the present invention,
The present invention does not specify the structure of a punch for drilling an operation hole as follows.

Further, in this specification, in order to facilitate understanding of the claims, the numbers corresponding to the members shown in the embodiments will be referred to as "claims", "actions", and "actions". In the column of "Means for solving the problem". However, the members shown in the claims are
It is by no means specific to the members of the embodiment.

The punch shown in the overall view of FIG. 5 and the enlarged sectional view of the main part of FIG. 6 includes a guide pipe 4, a piercing rod 5 inserted into and out of the guide pipe 4, and a piercing rod. And an access member 6 for allowing the guide pipe 5 to enter and exit the guide pipe 4.

As shown in FIGS. 1 to 3, the guide pipe 4 and the piercing rod 5 are inserted into the preceding operation hole 2, and the next operation hole is pierced at the tip of the piercing rod 5. Therefore, the guide pipe 4 and the piercing rod 5 have a total length extending from the preceding operation hole 2 to the next operation hole to be pierced through the abdominal cavity 3. The total length of the guide pipe 4 and the piercing rod 5 is, for example, 20 to 50 cm, preferably 20 to 4 cm.
0 cm, more preferably 25 to 35 cm.

Further, the guide pipe 4 and the piercing rod 5 are loosely curved so that they can pass through the abdominal cavity 3 and penetrate the abdominal wall 1 from inside the body to outside the body. As shown in FIG. 5, the guide pipe 4 and the piercing rod 5 can be curved when manufactured, or can be curved when used. The guide pipe 4 and the piercing rod 5 that are bent when used have flexibility that can be bent by hand. The flexible guide pipe 4 uses a hard plastic pipe. The flexible piercing rod 5
A metal rod that can be bent by hand, for example, a rod of soft aluminum, copper, Shinchu, or the like is used. As shown in FIG. 7, a flexible metal rod can be connected to a cutting edge 5A made of, for example, a hard metal at its tip. Stainless steel, steel, iron or the like can be used as the hard metal cutting blade 5A. The inflexible piercing rod 5 is made of a metal that cannot be bent by hand, for example, iron or stainless steel. The guide pipe 4 made of hard plastic is most suitable for a disposable product. Further, as shown in FIG. 7, the cutting blade 5A is detachably connected to the tip of the piercing rod, and the guide pipe 4 having a different thickness is detachably connected to the tip of the guide pipe 4. By changing the thickness of the guide pipe 4, the operation holes having different sizes can be punctured.

A drilling device in which the guide pipe 4 and the piercing rod 5 are flexible can be used in accordance with the physique and the piercing position of the patient.
The radius of curvature for bending the guide pipe 4 and the drill rod 5 can be adjusted. For this reason, as the optimal radius of curvature for the patient,
There is a feature that the operation hole can be drilled.

The piercing rod 5 has a cutting blade at the tip. The piercing rod 5 made of hard metal is sharply sharpened at its tip to form a cutting blade. The incision blade has a pyramidal shape and sharply sharpens corners so that the abdominal wall 1 can be incised and penetrated from inside the body to outside the body. The flexible piercing rod 5 makes a cutting blade of hard metal and connects it to the tip. The diameter of the cutting blade at the tip of the piercing rod 5 and the inner diameter of the guide pipe 4 are adjusted according to the size of the surgical hole to be pierced. The guide pipe 4 is a pipe slightly thicker than the piercing rod 5 so that the piercing rod 5 can be inserted and slid.
5 mm, 10 mm, 11 mm, 12 mm, and 15 mm.

The access member 6 moves the guide pipe 4 and the piercing rod 5 relative to each other so that the tip of the piercing rod 5 projects from the guide pipe 4 and inserts the tip of the piercing rod 5 into the guide pipe 4. Access member 6 shown in FIGS. 6 and 8
Is a handle 7 fixing the rear end of the piercing rod 5, a slide member 9 connected to the handle 7 via a stopper pin 8 so as to be movable in the axial direction, and a handle 7 inserted into the piercing rod 5. And a coil spring 21 for pushing the guide pipe 4 elastically.

The handle 7 can be gripped by hand,
It is a plate having a width of 3 to 7 cm and a length of 4 to 15 cm. A female screw hole for screwing the stopper pin 8 is provided at the tip. The slide member 9 has a slit 9A for sliding the stopper pin 8, and has a connecting portion 9B of the guide pipe 4 at the tip. The connecting portion 9B has a cylindrical shape through which the piercing rod 5 can be slidably inserted, and has a tapered distal end. In order to clamp the guide pipe 4 in the tapered portion, a male screw is provided on the outer periphery, and a tightening nut 10 is screwed into the male screw to clamp the guide pipe 4. The tightening nut 10 has an inclined surface on the inner surface to press the guide pipe 4 against the tapered portion. The coil spring 21 inserted into the perforated rod 5 elastically presses the handle 7 and the connecting portion 9B, and pushes out the tip of the guide pipe 4 from the perforated rod 5 when the stopper pin 8 is loosened.

The access member 6 having this structure includes a stopper pin 8
Is loosened, the slide member 9 can slide freely on the handle 7, and the coil spring 21 presses the guide pipe 4 elastically. When the slide member 9 is slid, the guide pipe 4 moves in the axial direction. Therefore, the tip of the piercing rod 5 can be inserted into the guide pipe 4, and the tip of the piercing rod 5 can project from the guide pipe 4.

9 and 10 show the access member 6 which can elastically push the guide pipe 4 by the coil spring 16. Access member 6 shown in FIG.
Includes an outer cylinder 11 to which the piercing rod 5 is connected via a connecting pipe 19, and a reciprocating member 12 that is moved in the axial direction along the outer cylinder 11. The reciprocating member 12 is connected to the guide pipe 4 via a connecting rod 15.

The reciprocating member 12 shown in FIG.
Is fixed to the left side, and a ratchet member 14 having a ratchet groove on the outer periphery is provided at the right end, and a connecting rod 15 is connected to the right end of the ratchet member 14. The connecting rod 15 is connected to the guide pipe 4. Between the reciprocating member 12 and the outer cylinder 11, a coil spring 16 as a pressing spring is incorporated. The coil spring 16 elastically presses the ratchet member 14 to push the reciprocating member 12 rightward in FIG.

The outer cylinder 11 is connected to a lever 17 which stops by hooking the ratchet member 14. The lever 17 has, at its tip, a claw that is locked in a ratchet groove of the ratchet member 14. The lever 17 has an intermediate portion connected to the outer peripheral surface of the outer cylinder 11 via a rotation shaft, and a claw at the tip is made to penetrate the outer cylinder 11 and protrude to the inner surface. The rear end of lever 17 is spring 1
8. The spring 18 elastically presses the claw at the tip of the lever 17 into the ratchet groove of the ratchet member 14.

The access member 6 having this structure is composed of the guide rod 1
The reciprocating member 12 is moved from the right to the left end in FIG. 9 by pulling the flange fixed to 3. The reciprocating member 12 moved to the left end is stopped at the left end by the pawl at the tip of the lever 17 being locked in the ratchet groove of the ratchet member 14. In this state, the reciprocating member 12 pulls in the guide pipe 4, and the tip of the piercing rod 5 projects from the guide pipe 4. When the rear end of the lever 17 is pushed in this state, the pawl releases the locked state of the ratchet member 14, and the reciprocating member 12 is pushed by the coil spring 16 and moves to the right end. In this state, the guide pipe 4 is pushed out, and the tip of the piercing rod 5 is drawn into the guide pipe 4.

FIG. 10 shows the guide pipe 4 and the piercing rod 5.
It is sectional drawing of the front-end | tip part of FIG. As shown in this figure, the outer cylinder 11 is connected to the piercing rod 5 via a connecting pipe 19. The drilling rod 5 has a cutting blade 5A fixed to the tip. The distal end of the connecting rod 15 of the reciprocating member 12 is connected to the guide pipe 4 via the connecting member 20. As shown in the cross-sectional view of FIG. 11, the connecting member 20 has an arm 20A penetrating the connecting pipe 19 in the radial direction, and connects the outside of the arm 20A to the guide pipe 4. The connection pipe 19 is provided with a slit extending in the axial direction at a position facing each other in order to penetrate the arm 20A of the connection member 20. The connecting member 20 is centered on the connecting rod 1.
5 and the outer periphery of the arm 20A is connected to the guide pipe 4. To connect the tip of the arm 20A to the guide pipe 4, a cylinder (not shown) is attached to the tip of the arm 20A.
And the cylinder can be inserted into the guide pipe 4 to connect the guide pipe 4.

When the connecting member 20 is moved to the right by the reciprocating member 12, the guide pipe 4 and the piercing rod 5 shown in FIG. Insert When the connecting member 20 is moved to the left, the guide pipe 4 is retracted, and the tip of the piercing rod 5 projects from the guide pipe 4.

The punch shown in FIG. 9 and FIG.
By pressing 7, the tip of the piercing rod 5 can be pulled into the inside of the guide pipe 4, so that there is a feature that it can be conveniently used. In the perforators shown in these figures, the connecting pipe 19 forms a part of the drilling rod 5 and the connecting rod 15 forms a part of the guide pipe 4. Therefore, by bending a part of the connecting pipe 19 and the connecting rod 15, it is possible to make a surgical hole at a predetermined position of the abdominal wall 1 with the piercing rod 5. The perforator of this structure is a connecting pipe 19
Since the sliding resistance between the guide pipe 4 and the connecting rod 15 is small, the guide pipe 4 and the piercing rod 5 can be relatively moved relatively.

[0028]

The perforator for perforating an abdominal wall according to the present invention does not perforate an abdominal wall from outside the abdominal cavity into the abdominal cavity as in the prior art. With the tip of the piercing rod inserted in the guide pipe, insert the guide pipe into the preceding operation hole,
In this state, the guide pipe is moved into the abdominal cavity, and the tip of the guide pipe is moved to a position at which a surgical hole is formed in the abdominal wall,
Here, the distal end of the piercing rod protrudes from the guide pipe, and an operation hole is formed in the abdominal wall. For this reason, unlike a conventional trocar, a piercing rod penetrating the abdominal cavity does not strike and damage the internal organ at the distal end. When there is a risk that the perforation rod may damage the abdominal cavity, the tip of the perforation rod is inserted into the guide pipe. Therefore, the perforator for perforating an operation hole in the abdominal wall according to the present invention has an excellent feature that the operation hole can be incised extremely safely.

[Brief description of the drawings]

FIG. 1 is a cross-sectional view showing a state in which a surgical hole is drilled in an abdominal wall with a punch.

FIG. 2 is a cross-sectional view showing a state in which a surgical hole is drilled in the abdominal wall with a punch.

FIG. 3 is a cross-sectional view showing a state in which a surgical hole is drilled in the abdominal wall with a punch.

FIG. 4 is a cross-sectional view showing a state in which a surgical hole is drilled in the abdominal wall with a punch.

FIG. 5 is a side view showing the entire punch according to the embodiment of the present invention.

FIG. 6 is an enlarged sectional view of a main part of the punch shown in FIG. 5;

FIG. 7 is an enlarged cross-sectional view showing a specific example of a tip portion of a perforator.

FIG. 8 is a plan view showing a part of an access member of the punch shown in FIG. 5;

FIG. 9 is a sectional view showing a part of an access member of a punch according to another embodiment of the present invention.

FIG. 10 is a sectional view showing a guide pipe and a piercing rod connected to the tip of the punch shown in FIG. 9;

11 is a sectional view taken along line AA of FIG.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... Abdominal wall 2 ... Surgical hole 3 ... Abdominal cavity 4 ... Guide pipe 5 ... Punch rod 5A ... Cutting blade 6 ... Entrance member 7 ... Handle 8 ... Stopper pin 9 ... Slide member 9A ... …slit
9B Connection part 10 Tightening nut 11 Outer cylinder 12 Reciprocating member 13 Guide rod 14 Ratchet member 15 Connection rod 16 Coil spring 17 Lever 18 Spring 19 connecting pipe 20 connecting member 20A arm 21 coil spring

──────────────────────────────────────────────────続 き Continuation of the front page (56) References Jikken Sho 56-37684 (JP, Y1) (58) Fields investigated (Int. Cl. ⁶ , DB name) A61B 17/34 A61B 1/00 320

Claims (1)

(57) [Claims] An abdominal wall boring device in which a piercing rod (5) is inserted into and out of a guide pipe (4), wherein the guide pipe (4) and a piercing rod (5) inserted into the guide pipe (4) are: The guide pipe (4) and the piercing rod (5) are curved, or have a total length that extends through the abdominal cavity (3) from the preceding operative hole (2) to the next pierced surgical hole, or It has flexibility that can be bent, and is characterized in that a piercing rod (5) is configured to protrude from the guide pipe (4) and penetrate the abdominal wall (1) from inside the body to outside the body to pierce the surgical hole. Perforator to make a surgical hole in the abdominal cavity.