JP3934437B2 - Insufflation apparatus and laparoscopic treatment system using the insufflation apparatus - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an insufflation apparatus for supplying gas into a living body cavity such as an abdominal cavity and a laparoscopic treatment system using the insufflation apparatus .
[0002]
[Prior art]
In recent years, in order to reduce the invasion to a patient, laparoscopic surgery for performing a therapeutic treatment while observing a treatment tool and a treatment site with an endoscope without performing laparotomy has been performed.
[0003]
This laparoscopic surgery is performed by piercing the abdomen of a patient with a trocar for guiding an observation endoscope into the abdominal cavity and a trocar for guiding a treatment tool to a treatment site.
[0004]
At that time, in order to secure an observation field of view and a treatment space of the endoscope, an insufflation gas such as carbon dioxide gas is controlled by an insufflation device and injected into the abdominal cavity.
[0005]
[Problems to be solved by the invention]
For example, as disclosed in JP-A-8-256972, there is a safety function for monitoring a pressure increase during gas supply. However, when a high resistance such as an insufflation needle is connected, a transient pressure fluctuation does not settle in 240 ms from the start of air supply due to the valve response, and a pressure fluctuation occurs in an unintended state under conventional control. It stopped and could not deliver enough air, and it took a long time for insufflation, which could hinder the progress of the operation.
[0006]
The present invention has been made in view of the above circumstances, and an object thereof is to provide an insufflation apparatus capable of performing an appropriate flow rate control according to fluid resistance and a laparoscopic treatment system using the insufflation apparatus. Yes.
[0007]
[Means for Solving the Problems]
An insufflation apparatus according to the present invention includes an air supply source capable of supplying a predetermined gas, a connection pipe line having one end connected to the air supply source, and a predetermined pneumothorax treatment tool connected to the other end, A pneumothorax trocar having a first fluid resistance against the fluid supplied from a predetermined air supply source when inserted into the abdominal cavity, and a predetermined air supply when inserted into the abdominal cavity A pneumothorax needle having a second fluid resistance different from the first fluid resistance is detachably connected to the other end of the connection pipe line as a pneumothorax treatment tool with respect to the fluid fed from the source In a possible insufflation apparatus, connected to the flow rate measurement means capable of measuring the instantaneous flow rate of the connection pipe, the pressure measurement means capable of measuring the pressure in the connection pipe, and the other end of the connection pipe An insufflation control means for controlling the insufflation to the pneumothorax treatment instrument by monitoring the pressure, and an instantaneous flow rate value measured by the flow rate measurement means Based on the determination result of the pneumoperitoneal instrument determination means, the pneumothorax treatment instrument determination means for determining the type of pneumoconiency treatment instrument connected to the other end of the connection pipe When the pneumothorax treatment tool connected to the other end of the connection pipe is the pneumoperitoneum, the air supply control is performed more than when the pneumothorax trocar is connected to the other end of the connection pipe. The start timing of monitoring the air supply pressure by the means is delayed for a predetermined time.
The laparoscopic treatment system using the pneumoperitoneum according to the present invention includes an air supply source capable of supplying a predetermined gas, one end connected to the air supply source, and a predetermined pneumothorax treatment tool on the other end. A connection pipe to be connected, and a pneumothorax treatment tool that is detachably connectable to the other end of the connection pipe, and is used for fluid supplied from the air supply source when inserted into the abdominal cavity A pneumothorax trocar having a first fluid resistance and a pneumothorax treatment instrument that can be detachably connected to the other end of the connection conduit, and the air supply source when inserted into the abdominal cavity An insufflation needle having a second fluid resistance different from the first fluid resistance, a flow rate measuring means capable of measuring an instantaneous flow rate of the connection line, and the connection line Pressure measuring means capable of measuring the pressure inside, and monitoring the pressure of air supply to the pneumothorax treatment instrument connected to the other end of the connecting pipe An insufflation control means for controlling the insufflation, and an insufflation treatment tool for determining the type of the insufflation treatment instrument connected to the other end of the connection pipe based on the instantaneous flow rate value measured by the flow rate measurement means And when the pneumothorax treatment tool connected to the other end of the connection pipe is the pneumoperitoneum according to the determination result of the pneumothorax treatment tool judgment means, the connection pipe The start timing of the monitoring of the air supply pressure by the air supply control means is delayed by a predetermined time compared to the case where the pneumoconitory trocar is connected to the other end of the air supply.
[0008]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, embodiments of the present invention will be described with reference to the drawings.
[0009]
1 to 6 relate to an embodiment of the present invention. FIG. 1 is a block diagram showing the configuration of the air supply device. FIG. 2 is a first diagram for explaining the operation of the air supply device of FIG. 1 is a second diagram for explaining the operation of the air supply device of FIG. 1, FIG. 4 is a flowchart showing the processing flow of the control unit of the air supply device of FIG. 1, and FIG. 5 shows the operation of the abdominal pressure measurement processing of FIG. FIG. 6 and FIG. 6 are flowcharts showing the flow of the abdominal pressure measurement process of FIG.
[0010]
FIG. 1 is an explanatory diagram showing the overall configuration of an insufflation apparatus according to a first embodiment of the present invention.
[0011]
As shown in FIG. 1, the insufflation apparatus 1 of the present embodiment is provided with a connection base 2 for connecting a gas supply source, and one or more CO 2 (carbon dioxide) is connected to the connection base 2 via a connection hose 3. ) A cylinder 4 as a gas supply source filled with gas is connected. The insufflation apparatus 1 has an insufflation mouthpiece 5 for connecting an insufflation tool for insufflation such as an insufflation needle or a trocar, and the insufflation device 5 is connected to the insufflation mouthpiece 5 through an insufflation tube 6. A trocar 7 is connected. The pneumothorax trocar 7 is inserted into the abdomen of the patient 8 to inject gas into the abdominal cavity.
[0012]
Further, the insufflation apparatus 1 is provided with a pinch valve 10 for closing / opening the suction tube 9. One end of the suction tube 9 is connected to a treatment trocar 11 inserted into the abdominal cavity of the patient 8 separately from the pneumothorax trocar 7, and the other end is connected to the operating room wall suction device 12 via the pinch valve 10. And a pinch valve 10 to control the suction of gas in the abdominal cavity.
[0013]
A cylinder pressure sensor 13 provided inside the insufflation apparatus 1 is connected to the connection base 2, and a first pressure reducer 15 is connected via a high-pressure pipe 14. The first pressure reducer 15 is connected to the second pressure reducer 18 via the internal pipe 16 and the closing valve 17. These first and second decompressors 15 and 18 constitute decompression means.
[0014]
The pressure of the cylinder detected by the cylinder pressure sensor 13 is displayed on a display panel provided in the operation unit 19 or the like of the pneumoperitoneum 1 so that the operator can recognize the gas remaining amount in the cylinder 4. The CO 2 gas in the cylinder 4 is about 60 bar at room temperature, and the pressure is reduced to about 3 bar by the first pressure reducer 15 and can be reduced to about 80 mmHg by the second pressure reducer 18.
[0015]
The first pressure reducer 15 is provided with a safety valve 20, and an overpressure is not applied to the second pressure reducer 18 when the pressure reduction value exceeds a predetermined pressure (for example, about 5 bar) due to a failure. It is designed to release gas.
[0016]
An internal pipe 21 that guides the CO 2 gas from the second pressure reducer 18 to the downstream side is connected to a manifold valve 24 having a plurality of pipe switching means via a joint 23 via a flow rate sensor 22. In the manifold valve 24, five valves, ie, a first valve 25, a second valve 26, a third valve 27, a fourth valve 28, and a fifth valve 29 are integrally disposed as a pipe switching means. Has been configured. The internal pipe line 30 of the manifold valve 24 communicated with the joint 23 is connected to each valve as a pipe line on the upstream side of the first valve 25, the second valve 26, and the third valve 27, and is assembled. Further, a pressure switch 31 as a failure detection means is connected to the internal conduit 30 via a connection tube 32 and a joint 33.
[0017]
The downstream side of the third valve 27 is connected to the upstream side of the fourth valve 28 via an internal conduit 34, and the internal conduit 34 further includes two pressures via a joint 35 and a connecting tube 36. The sensors 37 and 38 are connected. Note that the downstream pipe 39 of the fifth valve 29 is open to the atmosphere.
[0018]
The downstream side of the first valve 25, the second valve 26, and the fourth valve 28 and the upstream side of the fifth valve 29 are connected to each other by an internal conduit 40 connected to each valve. The internal conduit 40 is connected to the air supply base 5 via a joint 41 and a connection tube 42.
[0019]
The closing valve 17, the first valve 25 to the fifth valve 29 of the manifold valve 24, the flow sensor 22, the pressure switch 31, and the pressure sensors 37 and 38 all control the operation of the pneumoperitoneum device 1. It is electrically connected to the control unit 43 to be performed. The control unit 43 is connected to an operation unit 19 having a switch or the like for instructing operation of the apparatus, or a foot switch 44 as another operation means.
[0020]
(Function)
The upper part of FIG. 2 shows the pressure characteristic when the pipe line resistance such as trocar is small, and the lower part shows the pressure characteristic when the pipe resistance of the pneumoperitonee needle is large.
[0021]
As shown in FIG. 2, when the air supply is started and the manifold valve 24 is turned on, the pressure fluctuates because the air cannot be stably supplied due to the characteristics of the valve response.
[0022]
When the resistance is small, the pressure settles after 240 ms, for example, and pressure monitoring is started. When the resistance is large, the pressure needs to settle for about 600 ms, for example, and then the measurement is started. Then, during the operation, a trocar or a pneumoperitoneum is pierced into a living body, and when the pressure fluctuates, the manifold valve 24 is instantly turned off to ensure safety.
[0023]
On the other hand, as shown in FIG. 3, the instantaneous air flow rate is calculated at the initial value at 240 ms, but the stable instantaneous flow rate is measured with a trocar having a low resistance, but the instantaneous flow rate is measured with a pneumoconi needle having a high resistance. Variation is measured, and for example, 13 L / min including the variation is set as a threshold value. If the flow rate is less than that, it is recognized as an insufflation needle, and the start of pressure monitoring is delayed.
[0024]
Specifically, as shown in FIG. 4, the control unit 43 opens the manifold valve 24 in step S1, waits 240 ms from turning on the manifold valve 24 where the valve response is expected to be stable in step S2, and then in step S3. The instantaneous flow rate after 240ms is measured.
[0025]
Then, the control unit 43 determines whether the measured flow rate measured in step S4 is a predetermined flow rate, for example, 13 L / min or less. If the measured flow rate does not exceed the predetermined flow rate, the control unit 43 waits 600 ms from turning on the manifold valve 24 in step S5. Proceeding to step S6, if the measured flow rate is greater than or equal to the predetermined flow rate, the process proceeds to step S6 as it is.
[0026]
The controller 43 starts pressure monitoring in step S6, waits for 10 ms after a predetermined time in step S7, performs abdominal pressure measurement processing described later in step S8, and the abdominal pressure measured in step S9 is a predetermined value, for example, 240 ms or When the value measured at the time of 600 ms is set as an initial value, it is determined whether the initial value is 3.5 mmHg or less. If the abdominal pressure is less than the predetermined value, the process returns to step S7. In step S10, the manifold valve 24 is closed and the process is terminated.
[0027]
Next, the abdominal pressure measurement process in step S8 will be described.
[0028]
Conventionally, in the pressure drop measurement as in Japanese Patent Application No. 3-123340, as shown in FIG. 5, when the difference between the two points is 3.5 mmhg or less from the values of the pressures Pb and Pc. The value was the abdominal pressure. However, when the resistance is large, such as a pneumoperitoneum, the pressure convergence of the pressure drop measurement within a predetermined time has a large error from the actual pressure, and does not satisfy the accuracy of the predetermined abdominal pressure.
[0029]
Therefore, in order to avoid this problem, in this embodiment, a threshold value is provided for the difference between Pb and Pc, and the difference in characteristics when the resistance is large and when the resistance is small is determined in the pressure drop measurement. Even if the difference between Pb and Pc exceeds, for example, 10 mmHg (= P2) when the resistance is large, waiting for a certain period, Pb and Pc are measured again, and the abdominal pressure is calculated, thereby increasing the measurement accuracy of the predetermined standard.
[0030]
As the determination method, it is determined that the resistance is high when the first measurement difference between Pb and Pc is, for example, 10 mmHg or more.
[0031]
Specifically, in the abdominal pressure measurement process, as shown in FIG. 6, the control unit 43 sets the first time t0 as the pressure measurement time ta in step S21, and in step S22 the pressure Pb and the predetermined time td at time ta. The pressure Pc after the lapse is measured and the process proceeds to step S23.
[0032]
Then, the controller 43 determines whether or not | Pb−Pc | is greater than or equal to the predetermined pressure P1 in step S23. If it is greater than or equal to the predetermined pressure P1, whether or not | Pb−Pc | is greater than or equal to the predetermined pressure P2 greater than P1 is determined in step S24. to decide.
[0033]
If | Pb-Pc | is equal to or greater than P2, the process waits for the time Δt greater than td in step S25, returns to step S22 with pressure measurement time ta as ta + Δt in step S26, and | Pb-Pc | is less than P2 In step S27, the pressure measurement time ta is set to ta + td, and the process returns to step S22.
[0034]
If | Pb−Pc | is less than the predetermined pressure P1 in step S23, it is determined that the abdominal pressure has converged, the abdominal pressure is determined in step S28, and the process ends.
[0035]
(effect)
As described above, in this embodiment, even when the resistance is large, such as a pneumoperitoneum, it is possible to improve the measurement accuracy of the abdominal pressure by the pressure drop measurement.
[0036]
The present invention is not limited to the above-described embodiment, and various changes and modifications can be made without departing from the scope of the present invention.
[0037]
【The invention's effect】
As described above, according to the present invention, there is an effect that the measurement accuracy of the abdominal pressure by the pressure drop measurement can be improved.
[Brief description of the drawings]
FIG. 1 is a block diagram showing the configuration of an air supply device according to an embodiment of the present invention. FIG. 2 is a first diagram for explaining the operation of the air supply device of FIG. FIG. 4 is a flowchart showing a process flow of the control unit of the insufflation apparatus in FIG. 1. FIG. 5 is a diagram for explaining the action of the abdominal pressure measurement process in FIG. FIG. 4 is a flowchart showing the flow of the abdominal pressure measurement process.
DESCRIPTION OF SYMBOLS 1 ... Insufflation apparatus 4 ... Cylinder 6 ... Insufflation tube 7 ... Insufflation trocar 15 ... First decompressor 17 ... Closing valve 18 ... Second decompressor 19 ... Operation part 22 ... Flow rate sensor 24 ... Manifold valve 31 ... pressure switches 37, 38 ... pressure sensor 43 ... control unit

Claims (4)

An air supply source capable of supplying a predetermined gas;
One end connected to the air supply source, and the other end connected to a predetermined pneumothorax treatment instrument,
With
A pneumothorax trocar having a first fluid resistance with respect to a fluid supplied from a predetermined air supply source when inserted into the abdominal cavity, and a predetermined air supply source when inserted into the abdominal cavity. A gas that can be detachably connected to the other end of the connection pipe as a pneumoperitoneum with a pneumoperitoneum needle having a second fluid resistance different from the first fluid resistance with respect to the fluid that has been gassed. In the abdominal device,
A flow rate measuring means capable of measuring an instantaneous flow rate of the connection pipe line;
Pressure measuring means capable of measuring the pressure in the connection pipe line;
An insufflation control means for monitoring and controlling the insufflation with respect to the pneumothorax treatment instrument connected to the other end of the connection pipe;
Based on the instantaneous flow rate value measured by the flow rate measuring means, a pneumothorax treatment tool determining means for determining the type of the pneumothorax treatment tool connected to the other end of the connection pipe line;
Comprising
When the pneumoperitia treatment tool connected to the other end of the connection pipe line is the pneumoperitoneum needle according to the determination result of the pneumothorax treatment tool determination means, the pneumothorax is connected to the other end of the connection pipe line. The start timing of the monitoring of the air supply pressure by the air supply control means is delayed by a predetermined time compared to the case where a trocar is connected.
A pneumoperitoneum characterized by that.   An air supply source capable of supplying a predetermined gas;
  One end connected to the air supply source, and the other end connected to a predetermined pneumothorax treatment instrument,
  An insufflation treatment tool that is detachably connectable to the other end of the connection pipe line, and has a first fluid resistance against the fluid supplied from the air supply source when inserted into the abdominal cavity. A pneumothorax trocar having,
  An insufflation treatment tool that can be detachably connected to the other end of the connection pipe line, and the first fluid with respect to the fluid supplied from the air supply source when inserted into the abdominal cavity An insufflation needle having a second fluid resistance different from the resistance;
  A flow rate measuring means capable of measuring an instantaneous flow rate of the connection pipe line;
  Pressure measuring means capable of measuring the pressure in the connection pipe line;
  An insufflation control means for monitoring and controlling the insufflation with respect to the pneumothorax treatment instrument connected to the other end of the connection pipe;
  Based on the instantaneous flow rate value measured by the flow rate measuring means, a pneumothorax treatment tool determining means for determining the type of the pneumothorax treatment tool connected to the other end of the connection pipe line;
  Comprising
  When the pneumoperitia treatment tool connected to the other end of the connection pipe line is the pneumoperitoneum needle according to the determination result of the pneumothorax treatment tool determination means, the pneumothorax is connected to the other end of the connection pipe line. The start timing of the monitoring of the air supply pressure by the air supply control means is delayed by a predetermined time compared to the case where a trocar is connected.
  A laparoscopic treatment system using a pneumoperitoneum device.   Based on the instantaneous flow rate value measured by the flow rate measuring means when the predetermined time elapses after the start of air supply, the pneumothorax treatment tool determining means, when the instantaneous flow rate value is below a predetermined threshold, It is determined that the pneumothorax treatment tool connected to the other end of the connection pipe is the pneumoperitoneum, and if the instantaneous flow rate value is greater than a predetermined threshold value, it is connected to the other end of the connection pipe The insufflation apparatus according to claim 1, wherein the insufflation instrument is determined to be the insufflation trocar.   The pneumothorax treatment tool determining means is configured to measure the flow rate when the predetermined time has elapsed after the start of air supply. When the instantaneous flow rate value is equal to or less than a predetermined threshold value based on the instantaneous flow rate value measured in Step 1, it is determined that the pneumothorax treatment tool connected to the other end of the connection pipe is the pneumothorax needle. When the instantaneous flow rate value is larger than a predetermined threshold value, it is determined that the insufflation instrument connected to the other end of the connection pipe is the insufflation trocar. A laparoscopic treatment system using the pneumoperitoneum device described in 1.

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