JP3148838U - Surgical assist device - Google Patents

Abstract

[PROBLEMS] To secure a sufficient area for moving a suture needle when anastomosing or suturing a tubular site such as pancreaticojejunostomy mucosal anastomosis, etc., and to facilitate the needle movement. Of surgical suturing aids for surgery An auxiliary tool used for anastomosis or suturing of a tubular part in surgery, the auxiliary tool having a holder portion formed with a slit extending in the axial direction on a side surface of a hollow cone shape, and a long length This is a surgical suturing aid having a simple shape and an arm portion having one end fixed to the holder portion. [Selection] Figure 1

Description

  The present invention relates to a suturing aid used in a surgical operation, and more particularly to a surgical suturing aid used to guide a surgical needle (suture needle) in an anastomosis of a tubular site during a surgical operation.

  In a surgical operation, when an operation is performed using a suture needle formed in an arc shape, the suture needle is grasped with forceps, the forceps are operated, the needle is inserted into the suture site, and the needle arc The end portion is exposed using the shape, and the process of repeatedly grasping and pulling it out with forceps is performed to sew the suture site.

  As an assisting tool used when performing such suturing, a suturing support instrument has been proposed in Patent Document 1 (Japanese Patent Laid-Open No. 2006-175216). That is, in this Patent Document 1, for the purpose of facilitating the suturing of the affected part in endoscopic surgery, it has a needle insertion body through which a suture needle can be inserted and a rod-shaped member, and the rod-shaped member There has been proposed a suture assisting device in which the needle insertion body is provided on the end portion side.

Further, in the past, a tweezer is used when handling a fine object or performing a fine treatment during a surgical operation. As such a terminator, one previously described in Patent Document 2 (Japanese Patent Laid-Open No. 11-192230) has been proposed. That is, in Patent Document 2, a pipe is connected to the handle in the longitudinal direction for insertion into a small hole to enable transmission of a subtle force, and a gripping portion is provided at the end of the pipe. The lever is protruded against the spring on the side of the handle, and when the lever is pressurized against the spring force, the wire in the pipe connected to the handle is pulled up. At the same time, there is a suggestion for closing the gripping part connected to the wire at the end of the pipe so as to contact each other.
JP 2006-175216 A JP-A-11-192230

  As a preventive measure against the failure of the pancreatic digestive tract anastomosis after pancreaticoduodenectomy, pancreatic jejunal mucosal anastomosis can be mentioned. However, there is a dilemma that anastomosis is technically difficult in non-expanded cases of the pancreatic duct, which is a risk factor for suture failure. The above-mentioned terminator exists as a means for performing treatments and operations in a narrow site such as the pancreatic duct. However, even if the pertussis is inserted into the pancreatic duct and the pancreatic duct is expanded, it is difficult to move the suture needle curved in an arc shape without difficulty only by being elongated in a straight line in the opening direction. In addition, when a supporting thread is applied to the pancreatic duct wall, anastomosis is facilitated, but the difficulty of suturing the first supporting thread cannot be avoided. In addition, the jejunal anastomosis is difficult to suture when the mucosa is inverted.

  Therefore, the present invention can secure a sufficient area for moving the suture needle when anastomosing or suturing a tubular site such as pancreaticojejunostomy mucosal anastomosis, and can easily carry the needle. It is a first object to provide a surgical suturing assisting device for achieving the above.

  Also, when inserting and expanding a pendulum into the pancreatic duct, it is difficult to open and close the pendulum so that the anastomosis on the jejunum side does not excessively expand during the anastomosis operation. It was.

  Therefore, the present invention provides a surgical suturing aid that can easily and reliably perform anastomosis or suture of a tubular part while avoiding the difficulty of operation adjustment such as adjustment of the opening and closing of the retractor. This is the second task.

  Furthermore, in a surgical operation that is performed with a focus on the mind, it is desirable that the instrument used also has a structure and configuration that can be used intuitively by the operator without requiring complicated operations.

  Therefore, a third object of the present invention is to provide a surgical suturing assisting device that has a simple structure and can be used by an operator with the same feeling as a spoon or fork.

  The present invention solves at least one of the above-mentioned problems and expands and holds the treatment site so that anastomosis or suture of a tubular site such as pancreaticojejunostomy mucosal anastomosis can be easily and reliably performed. Provided is a surgical suturing assisting instrument having a conical portion capable of being provided with a slit for moving a suture needle.

  That is, in the present invention, in order to solve at least one of the above-described problems, an auxiliary tool used for anastomosis or suture of a tubular site in surgery, the auxiliary tool is axially formed on a side surface of a hollow cone shape. Provided is a surgical suturing aid comprising a holder part provided with an extending slit and an arm part having an elongated shape and one end fixed to the holder part.

  The holder part is inserted into a tubular part to be a treatment part, and expands and holds the tubular part. For this reason, the holder part needs to be formed in a cone shape so that the tubular part can be easily inserted into the tubular part and the tubular part can be gradually expanded to an appropriate diameter by the insertion. Naturally, the holder part formed in this cone shape is inserted into the tubular part from the front end side, and a long member for operating the holder part is extended on the rear end side. Become.

  The cone shape may be a polygonal shape in addition to the cone shape. However, in order to evenly distribute the load on the tubular portion, a conical shape or an elliptical shape is desirable. In the present specification, the term “conical shape” means to include both a right cone shape and an oblique cone shape. Moreover, the truncated cone shape which is a shape which cut | disconnected the cone in the plane parallel to a bottom face, and remove | excluded the small cone part is also included. Therefore, the holder part in the surgical suturing assisting device according to the present invention can be formed into a hollow cone shape having a hollow cone shape and a tip thereof opened in a direction along the axial direction.

  A slit for moving the suture needle is provided on the side surface of the holder portion. The slit functions to guide the suture needle from the inside to the outside of the holder portion inserted into the tubular portion, and to guide the suture needle from the outside to the inside of the holder portion. Such a slit can be formed by cutting the side surface (circumferential surface) of the holder portion formed in a hollow conical shape in the axial direction. The opening of the slit can be formed so that the central angle in the horizontal sectional view of the holder portion is in the range of 60 ° to 180 °, and preferably the side surface (circumference) of the holder portion formed in a hollow conical shape. About 1/3 of the surface). By forming the slit with such a width, a tubular portion such as the pancreatic duct can be appropriately expanded, and the suture needle can be accurately guided even during anastomosis or suturing.

  The holder part configured as described above may insert the suture needle from the outside to the inside of the holder part. In this case, the sharp tip of the suture needle should contact the inner peripheral surface of the holder part. become. Since the surgical suturing aid is used in the body during surgery, it needs to be formed so that the peripheral surface without the holder portion is not scraped off by the suture needle. Therefore, it is desirable that the surgical suturing assist device according to the present invention is formed to have a hardness that is not cut by a suture needle used at the time of anastomosis. As such a material, it is desirable to use a ceramic material in addition to a metal material such as stainless steel.

  The holder part is provided with an elongated arm part extending in the rear end direction. The arm portion is for operating the holder portion, and can be extended by being bent or bent in addition to being linearly extended from the rear end side of the holder portion. That is, the arm portion may have any shape as long as the above-described holder portion can be operated.

  Furthermore, it is desirable to provide a holding portion on the arm portion so as to easily hold the surgical suturing aid. That is, it is desirable that the distal end side, that is, the holder portion side of the surgical suturing assisting instrument is used by being inserted into the body and formed so as not to obstruct the operator's view during the operation. . For this reason, it is desirable that the distal end side (the holder portion side) of the arm portion be formed as thin as possible. On the other hand, when the surgeon operates the surgical suturing aid, it needs to have a certain thickness in consideration of ease of grasping. For this reason, the arm portion is formed with a narrow heel near the holder. And it is desirable to form the holding | maintenance part which diameter was thicker than the said collar part in the back end side rather than it.

  Furthermore, since the above-mentioned holder portion guides the suture needle through the slit, it may be necessary to rotate the surgical suturing aid so that the slit exists in the direction in which the suture needle is inserted. In this case, although the operability is improved by forming the holding portion as described above, it is possible to form a rod or plate that protrudes outside one of the arm portions. By providing such a bar or plate, it is possible to easily rotate the surgical suturing assisting instrument around the central axis of the arm portion by operating them.

  According to the surgical suturing assist device of the present invention configured as described above, appropriate expansion can be performed simply and reliably by simply inserting the holder portion formed in the cone into the tubular portion. In addition, the expanded tubular portion is not elongated in a straight line as in the case where the preceptor is inserted into a tubular portion such as the pancreatic duct and expanded, but the cross-sectional shape of the cone forming the holder portion, for example, a cone Since the shape can be expanded in a circular shape, the operability and workability during hand movement are improved. Along with this, it is possible to improve the reliability of the anastomosis or suture at the treatment site.

  In addition, in relation to the surgical suturing assisting device according to the present invention, the distal end portion of the jaw, particularly the range to be inserted into the tubular portion, can be formed in a circular arc shape in cross section. In this case, it can be regarded as a mode in which two surgical suturing aids according to the present invention are combined. However, when the action point, the fulcrum, and the force point are arranged in this order from the tip side as in the case of the conventional genus, the tip side opens widely at the action point. Therefore, in order to widely expand the opening side of the tubular part, it is desirable to configure the holder part formed in the shape of a cone as described above to be inserted into the tubular part.

  In the present invention, a surgical method using the surgical suturing aid is disclosed. That is, a method for anastomosing or suturing a tubular part in surgery, in which a tubular part to be anastomosed or sutured is provided with a holder portion having a slit extending in the axial direction on the side surface of a hollow cone shape, and a long shape. Inserting a surgical suturing aid composed of an arm portion whose one end is fixed to the holder portion, expanding the tubular portion, and moving the suturing needle through the slit portion of the surgical suturing aid Thus, a surgical method for suturing an expanded tubular portion is provided. Such a surgical method can be effectively carried out even for surgery on a pet animal having a small surgical site.

  According to the surgical suturing assist device according to the present invention, a sufficient region for moving the suture needle can be secured when anastomosing or suturing a tubular site such as pancreaticojejunostomy mucosal anastomosis, There is provided a surgical suturing aid for facilitating hand movement.

  In addition, since the surgical suturing assist device according to the present invention only inserts the holder part at the tip into the anastomosis or a tubular part to be sutured, the anastomosis port on the jejunum side is excessively enlarged during the anastomosis operation. In addition, it is possible to easily and reliably perform anastomosis or suturing of the tubular portion by avoiding the difficulty of operation adjustment such as adjustment of the opening and closing of the retractor.

  Furthermore, in a surgical operation that is performed with a focus on the mind, it is desirable that the device to be used has a structure and configuration that can be used intuitively by the operator without requiring complicated operations. Accordingly, it is possible to provide a surgical suturing assisting device that has a simple structure and can be used by an operator with the same feeling as a spoon or fork.

  DESCRIPTION OF EMBODIMENTS Hereinafter, a surgical suture assisting device according to the present invention will be described based on one embodiment shown in the drawings. FIG. 1 is a six-side view showing a surgical suturing assist device according to the present embodiment, FIG. 1 (a) is a front view, FIG. 1 (b) is a rear view, and FIG. 1 (c) is a plan view. 1D is a bottom view, FIG. 1E is a right side view, and FIG. 1F is a left side view. FIG. 2 is an enlarged view of a main part showing a holder portion formed at the distal end portion of the surgical suturing assisting device according to this embodiment, and FIG. 3 shows a surgical suturing assisting device according to another embodiment. FIG. 4 is an overall perspective view, and FIG. 4 is an enlarged view of a main part showing a holder portion of the surgical suturing aid shown in FIG. 5 is a horizontal cross-sectional end view of the holder portion showing the opening of the slit formed in the holder portion, and FIG. 6 is an enlarged schematic view of the main part showing the use state of the surgical suturing aid. 1 is a schematic diagram showing pancreatic jejunal mucosal suture.

  First, based on FIG. 1, if the structure of the surgical suturing assisting device 50 according to this embodiment is shown, the surgical suturing assisting device is hollow at the distal end side in a substantially conical shape (strictly, a truncated cone shape). A formed holder portion 10 exists, and a slit 11 is formed on the peripheral surface of the holder portion 10 by cutting out about 1/3 of the holder portion 10. And the holder part formed in this way has the front-end | tip part 12 and the rear-end part 13 in the open state.

  An arm portion is connected to the back side of the holder portion 10. As shown in FIG. 3, the arm portion 20 includes a flange portion 22 connected to the holder portion 10 and a holding portion 21 provided at the rear end of the flange portion 22. In particular, in the present embodiment, the heel part 22 has a thin rod shape, and the holding part 21 is formed in a columnar shape with a thickness that is easy for an operator to hold. Further, the outer peripheral surface of the holding portion 21 is embossed or other anti-slip processing so as to eliminate slippage during operation by the operator.

  In the surgical suturing assisting instrument shown in FIG. 1, the arm portion 20 is joined to the back surface of the holder portion. However, the present invention is not limited to this, and for example, the arm portion 20 can be joined to the side surface side of the arm portion. Further, although the arm portion is formed in a straight line, it can be bent or bent, for example.

  Further, the holder portion 10 provided at the distal end portion of the surgical suturing assisting device 50 is provided with a slit 11 as shown in the enlarged view of the main part of FIG. As shown in FIG. 2, the front end side 12 of the holder portion 10 is slightly opened, and the rear end portion 13 is also opened, so that it communicates with the front end portion of the holder, the slit 11, and the rear end portion 13. A space is formed, and the suture needle can be moved from the outside to the inside of the holder portion 10 or from the inside to the outside by using this space.

  In the surgical suturing assistance instrument 50 shown in the embodiment of FIGS. 1 and 2, the holder portion 10 provided on the distal end side is formed to be relatively small, and the rear end portion 13 of the holder portion 10 is an arm portion. It inclines so that it may fall in the direction away from 20.

  However, the surgical suturing assisting device according to the present invention is not limited to the size of the holder portion 10 or the shape of the rear end portion 13 of the holder portion 10, for example, as shown in FIGS. The holder portion 10 can be made relatively large, and the rear end portion 13 of the holder portion 10 can be formed horizontally. For example, the axial length of the holder portion 10 can be formed to be about 8 mm, the outer diameter of the rear end portion 13 of the holder portion 10 can be about 4 mm, and the outer diameter of the front end portion 12 of the holder portion 10 can be about 1 mm. . Desirably, the ratio of the sizes of these parts is maintained even when the overall size of the holder part 10 changes. In addition, it is desirable that the outer diameter of the tip 12 of the holder portion 10 is about 0.5 to 3 mm.

  3 and 4, members having the same functions as those in FIGS. 1 and 2 are denoted by the same reference numerals and description thereof is omitted.

  As shown in FIGS. 1 to 4, the slit 11 is formed in the holder portion 10 of the surgical suturing assisting device 50 according to the present invention. The slit 11 is preferably formed with a central angle θ of 60 ° to 180 ° in the horizontal cross section (cross section orthogonal to the axial direction) of the holder portion, and in particular, 1/3 round of the holder portion 10. It is desirable to form so as to open about (center angle θ is 120 °).

  As shown in FIG. 6, the surgical suturing assisting device 50 formed as described above is operated by the operator to operate the arm portion 20, and the holder portion 10 at the tip thereof is tubular, such as a pancreatic duct. Insert into site 40. Then, depending on how the holder portion 10 is inserted, the extent of expansion of the tubular portion 40 is adjusted, and optimal expansion is performed. In FIG. 6, the suture needle 30 is guided from the inside to the outside of the holder portion 10, and at that time, anastomosis or suture such as pancreatic jejunal mucosal anastomosis is performed. In particular, when the suture needle 30 is guided to the inside of the holder portion 10, the rear end portion 13 of the holder portion 10 is opened, and the portion 13 is operated so that it can be seen outside the tubular portion 40. In this case, a sufficient area for moving the needle can be secured, and the front end of the suture needle 30 can be guided toward the slit 11 on the inner peripheral surface of the holder portion 10. Thereby, the needle movement of the suture needle 30 can be performed more easily and reliably. In addition, the code | symbol 31 in this FIG. 6 has shown the thread | yarn used for sewing.

  In particular, in pancreaticojejunostomy mucosal anastomosis, which is performed as a preventive measure against failure of the pancreatic digestive tract anastomosis after pancreaticoduodenectomy, the holder portion 10 is placed in the pancreatic duct 40 even in a non-expanded pancreatic duct that is a risk factor for suture failure. When inserted into the pancreatic duct 40, the pancreatic duct 40 of the non-expanded example of the pancreatic duct can be expanded into a circular shape with an appropriate diameter, thereby obtaining a good visual field for suturing. Further, the hand movement is easy by the slit 11 formed in the holder portion 10. Further, the holder portion 10 is useful for the jejunum side suture.

  When this surgical suturing assisting device 50 is used in 12 cases of pancreaticoduodenectomy (of which 7 cases of non-dilated pancreatic duct), pancreatic jejunal mucosal suture is easy, 8 cases in non-dilated pancreatic duct cases, and 12 to 16 in dilated cases. Needle stitching was possible. During the anastomosis, the pancreatic duct / pancreatic parenchyma was not damaged and the jejunal anastomosis was not excessively enlarged.

  Therefore, it was confirmed that anastomosis or suture of a tubular part such as pancreatic jejunal mucosal suture or the like can be easily and reliably performed by using the surgical suturing assist device according to the present invention.

  FIG. 8 is a schematic view showing an example in which this pancreaticojejunostomy mucosal suture is performed, and the surgical thread indicated by reference numeral 31 in this figure uses the surgical suturing assist device according to the present embodiment. The anastomosis state is shown. In this drawing, reference numeral 33 denotes a pancreatic duct 40, and reference numeral 32 denotes a pancreatic duct tube inserted into the pancreatic duct 40.

FIGS. 1A and 1B are six views illustrating a surgical suturing assist device according to the present embodiment, in which FIG. 1A is a front view, FIG. 1B is a rear view, FIG. 1C is a plan view, and FIG. ) Is a bottom view, FIG. 1 (e) is a right side view, and FIG. 1 (f) is a left side view. The principal part enlarged view which shows the holder part formed in the front-end | tip part of the surgical suturing assistance instrument. The whole perspective view which shows the suture auxiliary instrument for surgery which concerns on other embodiment. The principal part enlarged view which shows the holder part of the surgical suturing assistance instrument shown in FIG. The horizontal cross section end view of a holder part which shows the opening condition of the slit formed in a holder part. The principal part expansion schematic which shows the use condition of the suturing auxiliary instrument for surgery. Schematic showing pancreatic jejunal mucosal suture.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Holder part 11 Slit 12 Front-end | tip part 13 Rear-end part 20 Arm part 21 Holding | maintenance part 22 Gutter part 30 Suture needle 40 Tubular site | part 50 Surgical auxiliary instrument for surgery

Claims (4)

An auxiliary tool used for anastomosis or suture of a tubular site in surgery,
A surgical suturing aid comprising a holder part having a slit extending in the axial direction on a side surface of a hollow cone shape, and an arm part having an elongated shape and one end fixed to the holder part. The holder portion has a hollow cone shape, and the slit is formed by cutting the side surface of the cone shape in the axial direction thereof,
2. The surgical suturing aid according to claim 1, wherein the distal end of the holder portion formed in the hollow conical shape opens in a direction along the axial direction.   The surgical suturing aid according to claim 2, wherein the slit is opened in a range of a central angle of 60 ° to 180 °. The surgical holder according to any one of claims 1 to 3, wherein the holder portion is formed to have a hardness that is not cut by a suture needle used during anastomosis.