JP3965138B2 - Endoscopic blood vessel collection device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
  This inventionFor example, a tissue peeling treatment tool for peeling a tissue such as a blood vessel from the surrounding tissue, and a tissue collecting apparatus using the tissue peeling treatment toolAbout.
[0002]
[Prior art]
  In conventional endoscopic blood vessel sampling, when the subcutaneous blood vessels such as the saphenous veins of the lower limbs are collected, the epidermis is incised along the subcutaneous blood vessels with a scalpel, etc., and the adipose tissue and blood vessels below the epidermis There is also a technique of incising the upper connective tissue to expose a blood vessel of a length to be collected, and cutting both ends of the exposed blood vessel and collecting it outside the body.
  However, this type of extraction technique requires a large incision in the epidermis, so it takes a long time to heal, and the incision becomes scar-like and hardens. is there.
[0003]
  Therefore, as shown in Japanese Patent Publication No. 4-10328, a part of the epidermis is cut with a scalpel or the like, and an endoscope guide tube is inserted into the subcutaneous tissue from the cut part and observed with an endoscope. Attempts have been made to treat.
[0004]
  Thus, when treating while observing with an endoscope, conventionally, US Pat. No. 5,318,582, US Pat. No. 5,346,503 and US Pat. No. 5,356,419 are used. A hook-type probe as shown in the specification is used. This hook-type probe is provided with a hook at one end of a shaft and a handle at the other end, and can be removed by hooking the hook at the tip with the handle and excising part of the tissue.
[0005]
[Problems to be solved by the invention]
  However, in such a conventional hook type probe, a plurality of types of probes that differ only in the shape of the hook provided at one end of the shaft are selectively used according to the situation of the treatment section. Therefore, every time the status of the treatment section changes, it is necessary to deliver the probe with the assistant, and the operation takes time.
[0006]
  For example, when peeling a blood vessel from surrounding tissue, it is generally performed to pick up the surrounding tissue with grasping forceps and cut it with scissors forceps. However, in this method, the operation is complicated, and the operation time becomes long.
[0007]
  This invention was made paying attention to the above circumstances, and the object isFor example, when a tissue to be collected such as a blood vessel is exfoliated from the surrounding tissue, a treatment device for tissue exfoliation that can be performed by one without using a plurality of treatment tools, and can reduce the operation time, and , Tissue collection device using tissue peeling treatment toolIs to provide.
[0008]
[Means for Solving the Problems]
  In order to solve the above problems, according to the present invention,Endoscopic blood vessel collection deviceInsert it from the skinBlood vesselsalongThe blood vesselsAn exfoliator for exfoliating at least a part of the surrounding tissue of thePeeled by the peelerSaidBlood vesselsA cavity securing device that is indwelled to secure a cavity between the cavity securing tissue and the surrounding tissue, and is inserted into the cavity secured by the cavity securing tool,Blood vesselsTo extract from the surrounding tissueBlood vesselsRemove and collectBlood vesselsWith a treatment tool for peelingThe blood vessel peeling treatment tool is provided at first and second shafts extending concentrically in the same direction, and at the proximal ends of the first and second shafts, and the first and second shafts are provided. An operating portion capable of moving and operating the shafts of the first shaft relative to each other along their axial directions, and a tip portion of the first shaft, with respect to the axial direction of the first shaft. A first hook projecting sideways and a tip of the second shaft, projecting sideways with respect to the axial direction of the second shaft, and from the first hook And a second hook disposed at a position proximate to the operation portion, and the second shaft and the second hook are connected to the operation portion by the first shaft and the first hook. Can be moved relative to the operation unit in a relatively fixed state. BeIt is characterized by that.
[0009]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
[0010]
1 to 28 show a first embodiment. First, a procedure for collecting blood vessels of the lower limbs as an endoscopic blood vessel collecting method will be schematically described. FIG. When collecting over the entire length of a blood vessel C to be collected (hereinafter referred to as a blood vessel) C such as a saphenous vein extending from the upper part of the neck A to the ankle B, directly above the blood vessel C, above the neck A, above the knee D, Skin cuts E1, E2, E3, and E4 are provided at four locations below the knee D and above the ankle B with a knife or the like.
[0011]
Then, the blood vessel C is exposed with a peeling forceps or the like at each of the skin incisions E1, E2, E3, E4. Further, the tissue immediately above the blood vessel C is peeled off with the same peeling forceps or the like at a distance that can be observed with the naked eye from each of the skin incisions E1, E2, E3, and E4.
[0012]
Next, FIG. 2A is a cross section taken along the line XX of FIG. 1, where 100 is the epidermis, 200 is the subcutaneous tissue, and 300 is the vascular connective tissue. Blood vessel C is present. First, as shown in FIG. 2 (b), the blood vessel C and the surrounding tissue are peeled using the peeler 10 to form a cavity G. Here, collection of the blood vessel C between the skin incision E2 on the knee D and the skin incision E1 above the neck A will be described. The same applies to other regions.
[0013]
The rigid endoscope 20 is inserted into the peeler 10 and fixed. The tip of the peeler 10 is inserted so as to be along the upper side of the blood vessel C from the upper skin incision E1 of the neck A toward the skin incision E2 on the knee D.
[0014]
In this case, since the distal end portion of the peeler 10 is formed of a transparent member, the blood vessel C and the side branch F can be clearly observed with the rigid endoscope 20. The insertion of the peeler 10 is gradually advanced by an operation of pushing in a little and returning it a little while confirming the progress of the blood vessel C with the rigid endoscope 20. The peeler 10 is penetrated along the blood vessel C to the skin incision E2 on the knee D.
[0015]
Next, the rigid endoscope 20 is removed while the releaser 10 is left in the body, and as shown in FIG. 2 (c), the skin incision E1 above the neck A at the proximal end of the releaser 10 is removed. Attach the tissue protector 30 to the side. Then, the peeler 10 is pulled from the skin incision E2 on the knee D, and the tissue protector 30 is pulled into the cavity G peeled by the peeler 10. In addition, since the cross-sectional area in the cross-sectional direction of the tissue protector 30 is substantially equal to the cross-sectional area in the cross-sectional direction of the peeler 10, almost no force is required when inserting the tissue protector 30. As will be described later, the tissue protector 30 has a T-shape that is larger than the opening of the skin incision E1, and is inserted until the part contacts the skin incision E1 in the upper part of the neck A. The child 10 is separated from the tissue protector 30.
[0016]
Next, the cavity G is expanded. A guide rod 40 whose tip is tapered in accordance with the groove 30a on the upper surface of the tissue protector 30 is inserted from the upper skin incision E1 of the groin A to the skin incision E2 above the knee D. In addition, an unevenness is provided in the vicinity of the distal end portion of the guide rod 40 so that the finger is caught when grasped.
[0017]
The smallest cavity creating tool 50 is attached to the distal end of the guide bar 40, that is, the upper cut portion E1 side of the groin A. A plurality of cavity creation tools 50 having a generally rhombic shape with a flat front end are prepared from a small width to a large width. Further, a rod-shaped member is attached to the rear end side of the cavity creating tool 50, and a connecting mechanism for connecting the cavity creating tool 50 of other sizes is provided at the end of the rod-shaped member.
[0018]
Next, as shown in FIG. 2 (d), the tip of the guide rod 40 is slowly pulled, and the protrusion of the cavity creation tool 50 is aligned with the groove 30 a of the tissue protection tool 30, and the skin is cut above the neck A. Pass from the part E1 to the skin incision E2 on the knee D. At this time, at least the portion having the maximum width on the distal end side of the cavity creating tool 50 is outside the skin incision E2 on the knee D, and the terminal side is outside the skin incision E1 in the upper part of the neck A. It is in.
[0019]
Next, the large cavity creation tool 50 is attached to the distal end of the cavity creation tool 50 in the cavity G, and the cavity creation tool 50 is held in the rhombus, and slowly pulled the cavity creation tool 50 along the groove 30a of the tissue protection tool 30. Let it pass. The same operation is repeated until the cavity G reaches the required size.
[0020]
Next, as shown in FIG. 2E, the cavity securing tool 60 is placed. A cavity securing tool 60 is attached to an insertion assisting tool, which will be described later, and a cavity creating tool 50 is attached to the distal end of the insertion assisting tool. Pull in from cut E2.
[0021]
In order to retract the cavity securing tool 60, the cavity is expanded until the sectional area in the sectional direction of the final (largest) cavity creating tool 50 becomes longer than the maximum sectional area in the sectional direction of the cavity securing tool 60. Little power is required. When the cavity securing device 60 comes out from the skin incision E2 on the knee D, the cavity creation device 50 is removed and taken out of the body. The tissue protector 30 is also taken out of the body. As described above, the blood vessel C is exposed in the cavity G created by the cavity securing tool 60.
[0022]
Next, the rigid endoscope 80 is inserted into the endoscope guide tube 70 of the cavity securing device 60, and the entire cavity G is observed. If the exfoliator 10 passes through the layer immediately above the blood vessel C, the blood vessel C is completely exposed. However, if the exfoliator 10 passes through the blood vessel C through the membrane tissue, The upper vascular connective tissue 300 of C is covered, and it is necessary to remove this vascular connective tissue 300 first. Removal of the vascular connective tissue 300 will be described later.
[0023]
Next, details of an endoscopic blood vessel collection method and instruments used for collection will be described.
[0024]
3 and 4 show the peeler 10 and the rigid endoscope 20. The rigid endoscope 20 includes an endoscope main body portion having a rigid insertion portion 2 for interpolating the observation optical system and the illumination optical system, and an endoscope connection portion 3 provided at a proximal end portion of the insertion portion 2. 4.
[0025]
The distal end portion of the insertion portion 2 is provided with a distal end configuration portion 5 having an oblique observation window and an illumination window inclined with respect to the axis of the insertion portion 2. The endoscope body 4 is provided with a connector 7 connected to a light guide cable (not shown) and a connection pin 9 protruding in a direction orthogonal to the axis of the shaft 8 of the endoscope body 4. Yes.
[0026]
The stripper 10 includes an elongated tubular main body 11 and a tip 12. The main body 11 includes a large-diameter pipe portion 13 that can be fitted to the shaft portion 8 of the endoscope main body 4, and an insertion portion 2 of the rigid endoscope 20 that is connected to the distal end portion of the large-diameter pipe portion 13. The thin-type pipe part 14 which can be inserted, and the transparent observation part 15 which is connected to the front-end | tip part of this small-diameter pipe part 14 and covers the front-end | tip structure part 5 of the rigid endoscope 20 are comprised.
[0027]
As shown in FIG. 5, the observation portion 15 is formed in a cylindrical shape by a transparent synthetic resin material, and the distal end portion is closed by an inclined surface 16 that is inclined with respect to the axis to form the distal end portion 12. . The inclined surface 16 is substantially equal in thickness to the peripheral wall portion of the observation unit 15, so that the inclined surface 16 does not become a prism and can be seen through clearly. Further, the distal end portion 12 has both side portions 17 cut so as to be tapered in a plan view in order to improve the insertability into the tissue, and the tip portion thereof is blunted so as not to damage the blood vessel. It has a typical shape.
[0028]
Further, the length L in the axial direction of the observation portion 15 is about 30 mm, and the diameter φA of the observation portion 15 and the diameter φB of the small-diameter pipe portion 14 are formed so that φA> φB. Further, an arc-shaped concave groove 18 is formed in the lower portion of the observation portion 15 that is positioned behind the distal end portion 12 so as to push the peeler 10 with the blood vessel C as a guide. It can also be used to protect the blood vessel C at the same time.
[0029]
Further, a stepped fitting portion 19 that is fitted to the shaft portion 8 of the endoscope main body 4 is provided at the base end portion of the large diameter pipe portion 13, and the bottom of the stepped fitting portion 19 is provided at the bottom portion. An elastic member 19a such as a rubber ring is accommodated. A pair of slits 21 bent in an L shape that engage with the connection pin 9 are provided on the peripheral wall of the stepped fitting portion 19. Then, the rigid endoscope 20 and the releaser 10 are connected by engaging the connection pin 9 and the slit 21, and at the same time, the elastic member 19 a is compressed by the shaft portion 8, and the rigid endoscope 20 and the releaser 10. The rotation restricting member 22 is configured to prevent rotation.
[0030]
Next, the operation will be described.
[0031]
The insertion portion 2 of the rigid endoscope 20 is inserted into the peeler 10, the stepped fitting portion 19 of the peeler 10 is fitted into the shaft portion 8 of the endoscope main body 4, the connection pin 9, the slit 21, When the rigid endoscope 20 or the peeler 10 is rotated after the positioning, the connecting pin 9 is engaged with the slit 21 and the elastic member 19a is compressed by the shaft portion 8 at the same time. Are connected in a state where the rotation is restricted.
[0032]
When the stripper 10 is fitted to the insertion portion 2 of the rigid endoscope 20 in this way, as shown in FIG. 5, the tip configuration portion 5 is located in the vicinity of the tip inside the observation portion 15 of the stripper 10, While the inclined surface 16 of the observation unit 15 is obliquely upward, the observation direction O of the tip component portion 5 is obliquely downward.
[0033]
FIG. 6A shows a state in which the peeler 10 is attached to the rigid endoscope 20 and inserted into the skin incision E1, and when the tip 12 of the peeler 10 is inserted from the skin incision E1, the tip 12 is It reaches the vascular connective tissue 300. The observation image of the rigid endoscope 20 at this time is as shown in FIG. 6B, and the blood vessel C including the distal end portion 12 of the exfoliator 10 and the vascular connective tissue 300 within the visual field of the rigid endoscope 20. Enters.
[0034]
When the exfoliating element 10 is pushed forward in this state, the distal end portion 12 of the exfoliating element 10 peels off the blood vessel C and the connective tissue 300 on the blood vessel, the blood vessel C is exposed, and the side branch F in the middle of the blood vessel C is also exposed to be hard. Enter the field of view of the endoscope 20. Therefore, the blood vessel C and the vascular connective tissue 300 can be peeled off while observing the blood vessel C with the rigid endoscope 20.
[0035]
At this time, since the groove 18 is provided in the observation portion 15 of the peeler 10, the groove 18 can be fitted to the blood vessel C to push the peeler 10 along the blood vessel C, and the tip portion Although 12 is a taper, since the most advanced part has a blunt shape, it can be peeled without damaging the blood vessel C.
[0036]
Next, the tissue protector 30 will be described as shown in FIG. That is, the protective device main body 31 is formed as a plate-like long member that can be inserted into the subcutaneous tissue, and can cover and protect the subcutaneous tissue to be protected, The length is slightly longer than the distance from E2. In addition, a protruding portion 32 protruding in the width direction is provided at the base end portion of the protective device main body 31. The overhanging portion 32 protrudes from the skin incision E1 with a width that cannot be inserted into the subcutaneous tissue.
[0037]
Further, the protective surface 33 of the protector main body 31 that covers the subcutaneous tissue to be protected, that is, the lower surface is formed on a smooth flat surface having no irregularities. Further, a groove 30a is formed on the surface opposite to the protective surface 33, that is, the upper surface 34, over the entire length in the axial direction.
[0038]
In addition, the front end side of the protective device main body 31 is formed in a tapered shape so that the protective device main body 31 can be easily inserted into the subcutaneous tissue. Moreover, the tip edge of the protective device main body 31 is formed in a smooth blunt shape so as not to damage the tissue. In addition, a connecting portion 35 that can be detachably connected to the peeler 10 or the like is provided at the tip of the protector main body 31.
[0039]
Next, when using the tissue protector 30 to cover and protect the subcutaneous tissue to be protected, the protector 31 is attached to the connecting portion 10a of the peeler 10 protruding from the upper skin incision E1 of the cervical portion A. Are connected to each other. This connection may be a screw-in type as shown in FIG. 8 (a) or a latch-engaged type as shown in FIG. 8 (b).
[0040]
Next, in a state where the connection portion 35 of the protector main body 31 is connected to the connection portion 10a of the base end portion of the peeler 10, the peeler 10 is pulled out from the subcutaneous tissue and the protector main body 31 is connected to the blood vessel C on the blood vessel Pull into the ablation space between the tissues 300. At this time, if the cross-sectional area of the protector main body 31 is set to be equal to or smaller than the cross-sectional area of the peeler 10, the protector main body 31 can be easily inserted between the blood vessel C and the on-vascular connective tissue 300.
[0041]
FIG. 9 shows a state in which the protector main body 31 is inserted and placed between the blood vessel C and the vascular connective tissue 300 in place of the peeler 10. In this state, the peeler 10 is removed from the protector main body 31, and the blood vessel C is completely covered from the upper side by the protective surface 33 of the protector main body 31. Moreover, in this state, the overhang | projection part 32 contact | abuts the skin cut part E1, and the shift | offset | difference of the protector main body 31 to the skin cut part E2 side is prevented.
[0042]
In this state, this time, as shown in FIG. 10, the distal end side of the guide bar 40 is introduced into the proximal end portion of the protector main body 31 from the skin cut portion E1, and the guide bar 40 is inserted into the groove 30a of the tissue protector 30. Push along. When the distal end side of the guide bar 40 protrudes from the skin cutting part E1, the cavity creating tool 50 as a treatment tool is connected to the guide bar 40, and the guide bar 40 is pulled out from the skin cutting part E1 as it is, and the cavity creating tool 50 is removed. It is drawn into the detachment space between the blood vessel C and the vascular connective tissue 300. At this time, as shown in FIG. 11, the cavity creating tool 50 is pulled in while a projection 50a formed on the lower surface along the longitudinal direction is guided by the groove 30a. As a result, the peeled state between the blood vessel C and the connective tissue 300 on the blood vessel is widened by the expanded portion 38 of the cavity creating tool 50, and wide enough to perform a treatment operation on the upper side of the blood vessel C, that is, on the upper side of the tissue protector 30. A cavity G is formed. In this case, since the blood vessel C is protected by the tissue protection tool 30, the blood vessel C is not damaged by the cavity creation work by the cavity creation tool 50. The guide bar 40 is provided with irregularities for hooking on the outer peripheral surface on the front end side so that the operation of gripping and pulling the front end side of the guide bar 40 can be easily performed without slipping.
[0043]
In addition, a plurality of the cavity creating tools 50 are prepared from a small width to a large width of the substantially rhombus-shaped expansion portion 38 having a flat front end side. Further, a rod-shaped member is attached to the rear end side of the cavity creating tool 50, and the end of the rod-shaped member has a connection mechanism with the cavity creating tool 50 of other sizes, and the width of the expansion portion 38 is increased. The cavity G can be gradually expanded by connecting small to large ones in order.
[0044]
After the cavity G having a predetermined size is formed above the blood vessel C as described above, the cavity G is secured by the cavity securing tool 60 next.
[0045]
FIGS. 12 and 13 show a cavity securing device 60. The cavity securing device 60 has a main body 62 in a semi-cylindrical shape or an arc shape obtained by dividing a cylindrical body into two in the radial direction, and is formed of a synthetic resin material or a stainless steel material. Has been.
[0046]
Openings 63 are provided at both ends in the longitudinal direction of the main body 62, and lateral holes 65 are provided symmetrically in the side wall portion 64 in the longitudinal direction. Furthermore, an endoscope guide tube 70 is integrally provided at both ends of the main body 62. The endoscope guide tube 70 has an upper semicircular portion protruding above the side wall portion 64 and a lower semicircular portion protruding below the side wall portion 64, thereby widening the space of the cavity portion 67 inside the main body 62. Secured. Further, both end surfaces, the lower surface of the main body 62 and the inner peripheral surface of the lateral hole 65 are rounded so as not to damage the subcutaneous tissue.
[0047]
14 and 15 show an insertion assisting tool 71 of the cavity securing tool 60, which is formed in a shape obtained by dividing a conical cylindrical body into two in the radial direction. The distal end portion 72 of the insertion assisting tool 71 is rounded so as not to damage the tissue. The proximal end portion of the insertion assisting tool 71 is formed with substantially the same curvature as the main body 62 of the cavity securing tool 60, and is formed so as not to have a step when connected.
[0048]
A pair of elastic connecting pieces 73 projecting backward is provided at the base end portion of the insertion assisting tool 71, and the connecting piece 73 is engaged with the end of the lateral hole 65 of the body 62 of the cavity securing device 60. Engaging projections 74 are provided.
[0049]
When the insertion assisting tool 71 configured in this way is positioned at the end of the main body 62 of the cavity securing tool 60 and the connecting piece 73 is inserted into the main body 62, the engaging convex part 74 is formed into the main body by the elasticity of the connecting piece 73. The insertion assisting tool 71 is connected to the main body 62 with a single touch.
[0050]
Therefore, when inserting the cavity securing device 60 into the indwelling space of the subcutaneous tissue, the cavity securing device 60 can be inserted while being spread out by the tapered surface of the insertion assisting device 60, and the insertion of the cavity securing device 60 can be facilitated.
[0051]
FIGS. 16 to 18 show an operation of inserting the cavity securing device 60 into the subcutaneous tissue using the insertion assisting tool 71. A screw hole 75 is provided in the distal end portion 72 of the insertion assisting tool 71. Is connected to an extension tool 79 as a traction member, and the extension tool 79 includes a shaft 81 and a flat extension portion 82 provided at an end of the shaft 81.
[0052]
The extension part 82 of the extension tool 80 is introduced into the subcutaneous tissue from one skin incision E1 as the distal end of the insertion operation, and the extension part 82 is led out from the skin incision E2. In this state, when the extension portion 82 is grasped as a handle and pulled in the direction of the arrow, the subcutaneous tissue is first inserted while being expanded by the tapered surface of the insertion assisting tool 71, and then the cavity securing device 60 is inserted into the subcutaneous tissue. The both ends of the securing tool 60 are detained in a state exposed from the cut portions E1 and E2. After the placement, the insertion assisting tool 71 and the cavity securing tool 60 are separated.
[0053]
When the cavity securing device 60 is placed under the subcutaneous tissue, the cavity G is secured by the cavity 67 of the cavity securing device 60. Accordingly, as shown in FIG. 19, the insertion portion 80a of the rigid endoscope 80 is inserted into one endoscope guide tube 70 of the main body 62 of the cavity securing device 60, and the distal end portion of the insertion portion 80a is inserted into the cavity G. To do. Further, a treatment tool, for example, acupuncture forceps 91 is inserted from one end side of the main body 62 through the lateral hole 65, and the forceps portion 91 a is inserted into the cavity G. Further, a treatment tool, for example, a hook probe 92 is inserted from one opening 63 of the main body 62, and the hook portion 92 a is inserted into the cavity G.
[0054]
In this way, the rigid endoscope 80, the scissors forceps 91 and the hook probe 92 can be simultaneously inserted from one end side of the main body 62, and the vascular connective tissue is connected by the hook probe 92 while observing the cavity G with the rigid endoscope 80. 300 can be pulled away from the blood vessel C, and the connective tissue 300 on the blood vessel can be cut by the scissors forceps 91 to separate the connective tissue 300 on the blood vessel from the blood vessel C.
[0055]
FIG. 20 is an observation image in the cavity G in the rigid endoscope 80, and the side branch F extending laterally from the middle of the inner peripheral wall of the main body 62, the opening 63, the lateral hole 65, the vascular connective tissue 300, the blood vessel C, and the blood vessel C. Can be observed.
[0056]
FIG. 21 shows a state in which the scissors forceps 91 is inserted into the guide groove 94 of the scissors guide 93, and the scissors forceps 91 slides in the guide groove 94 to easily approach the vascular connective tissue 300. FIG. 22 shows a state immediately before the vascular connective tissue 300 is cut by the scissors forceps 91. FIG. 23 shows a state in which the vascular connective tissue 300 is cut by the scissors forceps 91 and the blood vessel C and the side branch F are exposed.
[0057]
FIG. 24 shows a state in which the clip 96 is deformed by the clip applier 95 as a treatment instrument and the side branch F is sandwiched in the middle. FIG. 25 shows a state in which the middle of the side branch F sandwiched between two clips 96 is cut just before and with the scissors forceps 91. After cutting the side branch F, the above operation is similarly performed between the other skin incisions E2-E3 and between E3-E4, and finally one blood vessel (60 to 90 cm) is collected.
[0058]
As shown in FIG. 26, the hook probe 92 includes a shaft 92a made of, for example, a stainless material, and first and second hooks 92b and 92c provided at both ends of the shaft 92a.
[0059]
The first and second hooks 92b and 92c have basically the same shape, but the first hook 92b is curved in a semicircular shape clockwise and the second hook 92c is semicircular in a counterclockwise direction. The first and second hooks 92b and 92c are provided so as to be perpendicular to the axis of the shaft 92b.
[0060]
The first and second hooks 92b and 92c are obtained by bending a flat plate-like member into a substantially C shape, and the tip portion thereof is formed to be tapered so that it can be easily punctured and hooked into a living tissue. .
[0061]
FIG. 27 shows a state in which the hook probe 92 is used. FIG. 27 shows an observation image of the rigid endoscope 80. FIG. 27A shows the first state where the hook probe 92 is inserted from the right side of the opening 65a of the cavity securing device 60. (B) shows a case where the hook probe 92 is inserted from the left side of the opening 65a of the cavity securing device 60 and approached from the left side by the second hook 92c. Both show the state where the first or second hook 92b, 92c is hooked and pulled up in the middle of the blood vessel C, but the vascular connective tissue 300 is separated from the blood vessel C, and the vascular connective tissue 300 is cut by the scissors forceps 91. Thus, the vascular connective tissue 300 can be separated from the blood vessel C.
[0062]
Further, the rigid endoscope 80 is installed on a substantially upper surface of the cavity securing device 60, and various treatment instruments are inserted into the rigid endoscope 80 through the right and left openings 65a. At this time, the hook probe 92 itself is inserted. When the blood vessel C is peeled off, if the operator is right-handed, it is better to hold the hook probe 92 with the right hand and insert the hook probe 92 from the right opening 65a. At this time, the first hook 3 curved in the clockwise direction is suitable without observing the visual field of the rigid endoscope 17. On the other hand, when using another treatment tool, it is better to have the hook probe 1 with the left hand and the other treatment tool with the right hand. In this case, the second hook 4 curved in the counterclockwise direction is suitable without observing the visual field of the rigid endoscope 17.
[0063]
As shown in FIG. 28, the hook probe 92 may be a hook 98 that curves integrally from the end of the shaft 92a. The hook 98 is curved in a substantially C shape when viewed from the front, but the edge 98a on the near side of the hook 98 is inclined. Further, the thickness of the hook 98 is gradually reduced toward the edge 98a on the near side.
[0064]
29 to 47 show a second embodiment, and the same components as those in the first embodiment are denoted by the same reference numerals.
[0065]
First, the procedure for collecting blood vessels of the lower limbs as a method of collecting blood vessels endoscopically will be described schematically. FIG. 29 shows the lower limbs, and the saphenous vein extending from the cervical region A of the thigh to the top of the knee D When a blood vessel C to be collected (hereinafter referred to as a blood vessel) C is collected, a skin incision E1 is provided with a scalpel or the like on the neck A of the thigh just above the blood vessel C.
[0066]
Then, the blood vessel C is exposed from the skin incision E1 with a peeling forceps or the like. Further, the tissue immediately above the blood vessel C is peeled off by a similar peeling forceps or the like for a distance that can be observed with the naked eye from the skin incision E1.
[0067]
FIG. 30 is a cross-sectional view taken along the line WW in FIG. 29. As shown in FIG. 30A, 100 is the epidermis, 200 is the subcutaneous tissue, and 300 is the vascular connective tissue. The blood vessel C exists in the lower part. First, as shown in FIG. 30 (b), the blood vessel C and the surrounding tissue are peeled off using the peeler 10 to form a cavity G.
[0068]
The rigid endoscope 20 is inserted into the peeler 10 and fixed. The tip of the peeler 10 is inserted so as to be along the upper side of the blood vessel C from the skin incision E1 of the neck A to the knee D.
[0069]
In this case, since the distal end portion of the peeler 10 is formed of a transparent member, the blood vessel C and the side branch F can be clearly observed with the rigid endoscope 20. The insertion of the peeler 10 is gradually advanced by an operation of pushing in a little and returning it a little while confirming the progress of the blood vessel C with the rigid endoscope 20. The peeler 10 is inserted along the blood vessel C to the vicinity of the knee D. Next, a small incision is made in the skin immediately above the distal end of the peeler 10, and the distal end of the peeler 10 is penetrated from the skin incision E2 to the outside of the body.
[0070]
Next, the rigid endoscope 20 is withdrawn while the exfoliator 10 is left in the body, and the tissue protector 30 is attached to the skin incision E1 side of the neck A at the proximal end of the exfoliator 10. Then, as shown in FIG. 30 (c), the peeler 10 is pulled from the skin incision E 2 on the knee D, and the tissue protector 30 is pulled into the cavity G peeled by the peeler 10. In addition, since the cross-sectional area in the cross-sectional direction of the tissue protector 30 is substantially equal to the cross-sectional area in the cross-sectional direction of the peeler 10, almost no force is required when inserting the tissue protector 30. After the proximal end of the arm is pulled out from the skin incision E2, the peeler 10 is separated from the tissue protector 30, and the tissue protector 30 is left in the cavity G.
[0071]
Next, the cavity G is expanded using the cavity creation tool 50 shown in FIG. The cavity creation tool 50 is connected to the groove 30a on the upper surface of the tissue protection tool 30, and a dilator hook 101 having a tapered tip is tapered from the skin incision E2 above the knee D as shown in FIG. Insert up to E1.
[0072]
A plurality of (for example, 50a to 50d) cavity preparation tools 50 are prepared from a small width to a large width. The smallest cavity creation tool 50 a is attached to the tip of the dilator hook 101. The size of the incision portion of the skin incision E1 is set such that the largest size of the cavity creation tool 50 can be inserted.
[0073]
Next, as shown in FIG. 30 (d), the handle portion of the dilator hook 101 is held, and the protrusion 52 of the cavity creating tool 50 is aligned with the groove 30 a of the tissue protector 30, so that the skin cut portion of the cervical portion A Slowly pull from E1 to near the skin incision E2 above the knee D.
[0074]
After the cavity creating tool 50a reaches the skin incision E2, the dilator hook 101 is pushed, the cavity dilator 50a is returned to the skin incision E1 of the neck A, and the cavity dilator 50a is taken out from the skin incision E1. Remove from the hook 110. Next, the large cavity dilator 50b is inserted / extracted by the same operation. The same operation is sequentially performed on the large cavity dilator 50c, and finally the largest cavity dilator 50d is performed.
[0075]
Next, as shown in FIG. 30 (e), the cavity securing device 60 is placed. As shown in FIG. 41, the guide protrusion 60 a of the distal end portion 61 b of the cavity securing device 60 is aligned with the groove 30 a of the tissue protector 30, and the skin cut portion above the knee D from the skin cut portion E 1 of the cervical portion A. Insert up to E2.
[0076]
Since the cavity is expanded until the final (largest) cavity creating tool 50a has a larger sectional area in the cross-sectional direction than the maximum sectional area in the sectional direction of the cavity securing tool 60, Little power is required. As described above, the blood vessel C is exposed in the cavity G created by the cavity securing tool 60.
[0077]
Next, the rigid endoscope 20 is inserted into the endoscope guide tube 62f of the cavity securing device 60, and the entire cavity G is observed. If the exfoliator 10 passes through the layer immediately above the blood vessel C, the blood vessel C is completely exposed. However, if the exfoliator 10 passes through the blood vessel C through the membrane tissue, The upper vascular connective tissue 300 of C is covered, and it is necessary to remove this vascular connective tissue 300 first. Removal of the vascular connective tissue 300 will be described later.
[0078]
Next, details of an endoscopic blood vessel collection method and instruments used for collection will be described.
[0079]
FIG. 31 shows the rigid endoscope 20, and FIG. 32 shows the peeler 10. This rigid endoscope 20 includes an endoscope main body portion having a rigid insertion portion 2 for interpolating an observation optical system and an illumination optical system, and an endoscope connection portion 3 provided at a base end portion of the insertion portion 2. 4.
[0080]
The distal end portion of the insertion portion 2 is provided with a distal end configuration portion 5 having an inclined observation window and an illumination window inclined with respect to the axis of the insertion portion 2. The endoscope body 4 is provided with a connector 7 connected to a light guide cable (not shown).
[0081]
The exfoliator 10 is an elongated tubular main body 11 made of a pipe into which a rigid endoscope 20 can be inserted, a large-diameter pipe 13 on the proximal side of the main body 11, and a rigid endoscope connected to the distal end of the main body 11. It is comprised from the transparent front-end | tip part 12 which covers 20 front-end | tip structure parts 5. FIG.
[0082]
As shown in FIG. 32, the distal end portion 12 is formed in a substantially cylindrical shape by a transparent synthetic resin material, and is formed to be closed. The ridge line portion 16 between the slope 15a and the observation portion 15b has a blunt shape so as not to damage the blood vessel. From the examination results so far, this ridge line portion 16 requires an R surface having a radius of curvature of at least 1 mm, preferably about 3 mm. If the radius of curvature of the ridge line portion 16 is reduced, blood vessels, particularly side branches, may be cut. There was found.
[0083]
Further, the axial length of the distal end portion 12 is about 20 mm, and when the diameter of the distal end portion 12 is φA and the diameter φB of the main body portion 11 is satisfied, φA> φB is formed. From the examination results so far, it has been found that if φA is about 8.5 mm and φB is about 6 mm, the blood vessel can be efficiently peeled without damaging the blood vessel.
[0084]
The large-diameter pipe portion 13 is fitted into a sheath holder 110 described later, and the diameter φC of the large-diameter pipe portion 13 is smaller than the diameter φA of the distal end portion 12.
[0085]
As shown in FIG. 33, an engagement groove 17a that engages with a pin 18a provided on the sheath holder 110 is provided at the proximal end portion of the large-diameter pipe portion 13, so that the peeler 10 is always attached to the endoscope 2. The position of the peeler 10 in the rotational direction is automatically determined when mounted on the. Further, the large-diameter pipe portion 13 is provided with a slit 13a for hooking a tissue protector 30 described later.
[0086]
The sheath holder 110 includes a connection portion 18b to the rigid endoscope 20 and a connection portion 18c to the peeler 10. The connecting portion 18b with the rigid endoscope 20 can be fixed to the connector 7 of the light guide (not shown) of the rigid endoscope 20. On the other hand, a fixing screw 18d is provided at the connecting portion 18c with the releaser 10. The releaser 10 is fastened and fixed with a fixing screw 18d. Further, the connecting portion 18c is provided with a positioning pin 18a so as to be engaged with the engaging groove 17 in the proximal end portion of the large-diameter pipe portion 13 of the peeler 10.
[0087]
Next, the operation will be described.
[0088]
The sheath holder 110 of the rigid endoscope 20 is inserted, and the connection portion 18b of the sheath holder 110 is fixed to the connector 7 of the light guide (not shown). Next, the releaser 10 is inserted into the insertion portion 2 of the rigid endoscope 20 and engaged with the engagement groove 17 of the releaser 10 and the positioning pin 18a of the sheath holder 110 in the aligned state, and the fixing screw 18d. Then, the peeler 10 is fixed to the rigid endoscope 20.
[0089]
When the stripper 10 is fitted to the insertion portion 2 of the rigid endoscope 20 in this way, the tip constituting portion 5 is positioned in the vicinity of the tip inside the tip portion 12 of the stripper 10, as shown in FIG. The inclined surface 15a of the distal end portion 12 is obliquely upward, while the observation direction center O of the distal end configuration portion 5 is obliquely downward.
[0090]
FIG. 34A shows a state in which the peeler 10 is attached to the rigid endoscope 20 and inserted into the skin incision E1. The tip 12 of the peeler 10 is inserted from the skin incision E1 between the epidermis 100 and the blood vessel C into the vascular connective tissue 300 or the subcutaneous fat layer 200 in the vicinity of the blood vessel C. An observation image of the rigid endoscope 20 at this time is as shown in FIG. 34B, and the blood vessel C including the distal end portion 12 of the exfoliator 10 and the vascular tissue 300 is within the visual field of the rigid endoscope 20. enter.
[0091]
When the exfoliator 10 is pushed forward in this state, the blood vessel C and the upper blood vessel tissue 300 are exfoliated, the blood vessel C is exposed, and the side branch F in the middle of the blood vessel C is also exposed to be in the visual field of the rigid endoscope 20. enter. At this time, when the observation part 15b and the ridge line part 16 of the inclined surface 15a are edges, the side branch F is cut. However, since the R surface has a curvature radius of about 3 mm, the stripper 10 can be inserted without cutting the side branch F. It is. As described above, the blood vessel C and the superior blood vessel tissue 300 can be peeled off while observing the blood vessel C with the rigid endoscope 20.
[0092]
After inserting the peeler 10 along the blood vessel C over the entire length of the collection region, the distal end portion 12 of the peeler 10 is confirmed through the skin 100, and the peeler 10 has a size capable of penetrating just above the distal end portion 12 of the peeler 10. A skin E2 is provided, and the tip of the peeler 10 is projected from the skin E2.
[0093]
Next, the fixing screw 18d of the sheath holder 110 is loosened, the rigid endoscope 20 is removed from the peeler 10, and only the peeler 10 is left in a state of penetrating from the skin incision E1 to the skin incision E2.
[0094]
Next, the tissue protector 30 will be described as shown in FIG. That is, the protective device main body 31 is formed as a plate-like long member that can be inserted into the subcutaneous tissue, and has a width that can cover and protect the subcutaneous tissue to be protected, the skin cut portion E1 and the skin. The length is slightly longer than the distance from the cut portion E2. In addition, a protruding portion 32 that extends in the width direction is provided at the base end portion of the protective device main body 31. The overhanging portion 32 protrudes from the skin incision E1 with a width that cannot be inserted into the subcutaneous tissue.
[0095]
Further, the protective surface 33 of the protector main body 31 covering the subcutaneous tissue to be protected, that is, the lower surface is formed on a smooth flat surface having no irregularities. A groove 30a is formed on the surface opposite to the protective surface 33, that is, the upper surface 34, over the entire length in the axial direction.
[0096]
Note that the distal end side of the tissue protector 31 is formed in a tapered shape so that the tissue protector 30 can be easily inserted into the subcutaneous tissue. In addition, the tip edge of the protector main body 31 is formed in a smooth blunt shape so as not to damage the tissue. FIG. 36 shows a method for connecting the tissue protector 30 and the peeler 10. A connection hole 31a is provided on the distal end side of the tissue protector 30. The connection hole 31a is hooked on the slit 13a of the peeler 10 and can be detachably connected.
[0097]
Next, when covering and protecting the subcutaneous tissue to be protected using the tissue protector 30, the connection hole 31a of the tissue protector 30 is provided in the slit 13a of the peeler 10 protruding from the skin incision E1. Connecting. In this state, the tip 12 protruding from the skin E2 of the peeler 10 is pulled, the peeler 10 is pulled out from the subcutaneous tissue, and the tissue protector 30 is peeled between the blood vessel C and the connective tissue 300 on the blood vessel. Pull into the cavity. At this time, if the cross-sectional area of the tissue protector 30 is set to be equal to or smaller than the cross-sectional area of the peeler 10, the tissue protector 30 can be easily inserted between the blood vessel C and the on-vascular connective tissue 300.
[0098]
FIG. 37 shows a state in which the tissue protector 30 is inserted and placed between the blood vessel C and the connective tissue 300 on the blood vessel instead of the peeler 10. In this state, the peeler 10 is removed from the tissue protector 30, and the blood vessel C is completely covered from the upper side by the protective surface 33 of the tissue protector 30.
[0099]
FIG. 38 shows the dilator hook 101, and FIG. 39 shows the cavity creating tool 50.
[0100]
The tip portion 40a of the dilator hook 101 has a shape inclined toward the tip. Therefore, when the dilator hook 101 is inserted into the subcutaneous tissue along the groove 31a of the tissue protector 30, the distal end portion 40a does not catch the subcutaneous tissue.
[0101]
Further, a hook 40 b for connecting to the cavity creating tool 50 is provided at the distal end portion 40 a of the dilator hook 101. On the other hand, the cavity creating tool 50 is provided with a connection hole 51 that engages with the hook 40 b of the dilator hook 101. Note that the hook 40b and the connection hole 51 can be connected only in a direction in which the longitudinal axis of the cavity creating tool 50 is rotated about 90 ° with respect to the axis of the dilator hook 101.
[0102]
In this state, as shown in FIG. 40, the dilator hook 101 is introduced from the skin incision E2 along the groove 30a of the tissue protector 30 and inserted into the skin incision E1, and the tip 40a is in the skin. It protrudes from the cut part E1.
[0103]
The cavity dilator 50a having the minimum size is attached to the distal end portion 40a of the dilator hook 101, and is drawn into the separation space between the blood vessel C and the supravascular connective tissue 300. At this time, as shown in FIG. 30 (d), the cavity creating tool 50 is pulled in while a projection 52 formed on the lower surface along the longitudinal direction is guided by the groove 30a. As a result, the peeled state between the blood vessel C and the connective tissue 300 on the blood vessel is expanded by the expanded portion 38 of the cavity creating tool 50, and the cavity formed by the peeler 10 above the blood vessel C, that is, above the tissue protector 30. A wider cavity is formed.
[0104]
After pulling the cavity expanding tool 50a having the minimum size to the skin incision E2, the dilator hook 101 is pushed to take out the cavity creating tool 50a from the skin incision E1. The cavity creation tool 50a is removed from the dilator hook 101, the next largest cavity creation tool 50b is mounted, and similarly pulled from the skin incision E1, inserted through the skin incision E2, and then returned to the skin incision E1. This operation is sequentially performed up to the cavity creating tool 50d having the maximum size.
[0105]
When the cavity creation tool 50d having the maximum size is inserted and a cavity G having a predetermined size is formed above the blood vessel C, the cavity G is secured by the cavity securing tool 60.
[0106]
41 (a), 41 (b), and 41 (c) show the cavity securing device 60, and an arch having an opening 62a and an endoscope opening 62b for inserting the rigid endoscope 20 on the rear end side 61a of the cavity securing device 60. The conical cylindrical body is divided into two in the radial direction on the distal end side 61b and a distal end portion 62d having a shape that is divided in the radial direction.
[0107]
Further, a guide convex portion 60a is provided on the lower surface side of the distal end portion 62d, and is formed so as to fit into the groove 30a of the tissue protector 30. Between the base 62c and the distal end portion 62d, there are provided four rigid shafts 62e and an endoscope guide cylinder 62f through which the rigid endoscope 20 can be inserted. Therefore, a side opening 62g formed by the shaft 62e, the base 62c, and the tip 62d is formed over the entire length of the cavity securing device 60.
[0108]
The cavity securing device 60 configured as described above is inserted into the cavity created by the cavity securing device 60 from the skin incision E1 along the guide groove 30a of the tissue protector 30 to the vicinity of the skin incision E2. Since the cavity created by the cavity expanding tool 50 is larger than the cross-sectional area of the cavity securing tool 60 and the distal end portion 63 is tapered, it can be inserted with almost no resistance. The skin incision E2 is a small incision and cannot penetrate the distal end 63 of the cavity securing device 60.
[0109]
Fig.42 (a) shows the state which inserted the cavity securing tool 60 in the cavity. Subsequently, the tissue protector 30 is slowly pulled out from the skin incision E1 side while the cavity securing device 60 remains in place. FIG. 42B shows a state in which the placement of the cavity securing device 60 is completed.
[0110]
As described above, the cavity securing device 60 is placed from the skin incision E1 to the skin incision E2 with a part of the rear end side 61a protruding from the skin incision E1, and immediately above the blood vessel C which is a saphenous vein. A cavity G is secured in
[0111]
Next, as shown in FIG. 43, the endoscope 62 is inserted into the cavity G from the rigid endoscope 20 through the endoscope opening 62b of the base 62c on the rear end side 61a of the cavity securing device 60. The endoscope television camera 99a is connected to the rigid endoscope 20, and an endoscope image is displayed on the monitor 99b. The operator can easily observe the entire length of the treatment area by sliding the rigid endoscope 20.
[0112]
Further, a treatment tool, for example, acupuncture forceps 91 is inserted through one side opening 62g of the cavity securing tool 60, and a forceps portion 91a is inserted into the cavity G. Further, for example, a hook probe 92 is inserted from the other side opening 62g, and the hook portion 92a is inserted into the cavity G.
[0113]
In this way, the rigid endoscope 20, the scissors forceps 91 and the hook probe 92 can be simultaneously inserted from the rear end side 61 b of the cavity securing device 60, and the hook probe 92 is observed while observing the cavity G with the rigid endoscope 20. Thus, the vascular connective tissue 300 can be separated from the blood vessel C, the vascular connective tissue 300 can be cut by the scissors forceps 91, and the vascular connective tissue 300 can be separated from the blood vessel C.
[0114]
44 is an observation image inside the cavity G in the rigid endoscope 20, and shows the shaft 64, the side opening 62g, the tip 62d, and the side branch F extending laterally from the middle of the blood vessel C or blood vessel C. Can be observed.
[0115]
FIG. 45 shows a state in which the clip 96 is deformed by the clip applier 95 as a treatment instrument, and the middle of the side branch F is sandwiched. 46 shows a state in which the middle of the side branch F sandwiched between the two clips 96 is cut just before and is cut by the scissors forceps 91, and FIG. 47 shows a state in which the middle of the side branch F is cut by the scissors forceps 91.
[0116]
The above operation is performed from the skin incision E1 to the skin incision E2. Finally, the blood vessel C is cut at the site of the skin incision E1 and the skin incision E2, and collected from the cavity G. This completes the extraction of the blood vessel C of about 25 cm.
[0117]
When a longer blood vessel is required, the same treatment is performed from the skin incision E2 on the knee toward the neck A, and the same treatment is also performed in the knee direction from the skin incision E2. A blood vessel C of 50 to 60 cm can be collected at a time from the blood vessels on the neck side and the ankle side around the skin incision E2.
[0118]
FIG. 47 shows a usage state of the hook probe 92 of the first embodiment shown in FIG. 26, which is an observation image of the rigid endoscope 20, and FIG. 47 (a) is a right side of the side opening 62g of the cavity securing device 60. The hook probe 92 is inserted from the right side and approached from the right side by the first hook 92b. FIG. 47B shows the case where the hook probe 92 is inserted from the left side of the side opening 62g of the cavity securing device 60 and the second hook. This is a case of approaching from the left side by 92c. Both show the state in which the first and second hooks 92b and 92c are hooked and pulled up in the middle of the blood vessel C. The vascular connective tissue 300 is separated from the blood vessel C, and the vascular connective tissue 300 is cut by the scissors forceps 91. Thus, the vascular connective tissue 300 can be separated from the blood vessel C.
[0119]
Further, the rigid endoscope 20 is installed on a substantially upper surface of the cavity securing device 60, and various treatment instruments are inserted into the rigid endoscope 20 through the right and left side openings 62g. At this time, the hook probe 92 is inserted. When the blood vessel C is peeled by itself, if the surgeon is right-handed, it is better to hold the hook probe 92 with the right hand and insert the hook probe 92 from the right side opening 61c. At this time, the first hook 92 b curved in the clockwise direction is suitable without observing the visual field of the rigid endoscope 20. On the other hand, when using another treatment tool, it is better to have the hook probe 92 with the left hand and the other treatment tool with the right hand. In this case, the second hook 92c curved in the counterclockwise direction is suitable without observing the visual field of the rigid endoscope 20.
[0120]
According to this embodiment, the blood vessel can be removed without damaging the blood vessel and without making a large incision in the skin, the risk of postoperative complications can be reduced, and cosmetically excellent results Is obtained.
[0121]
By the way, in the conventional endoscopic blood vessel sampling, when the subcutaneous blood vessel such as the saphenous vein of the lower limb is collected, the epidermis is incised along the subcutaneous blood vessel with a scalpel and the adipose tissue under the epidermis. There is also a technique in which a blood vessel having a length to be collected by incising up to the connective tissue on the blood vessel is exposed, and both ends of the exposed blood vessel are cut and collected outside the body.
[0122]
However, this type of extraction technique requires a large incision in the epidermis, so it takes a long time to heal, and the incision becomes scarred and hardens. is there.
[0123]
Therefore, as shown in Japanese Patent Publication No. 4-10328, a part of the epidermis is cut with a scalpel or the like, and an endoscope guide tube is inserted into the subcutaneous tissue from the cut part and observed with an endoscope. Attempts have been made to treat.
[0124]
The hook probe 92 shown in each of the above-described embodiments is suitable for the treatment while observing with an endoscope as described above. However, in the past, US Pat. No. 5,318,582, US Hook type probes are used as shown in US Pat. No. 5,346,503 and US Pat. No. 5,356,419. This hook-type probe is provided with a hook at one end of a shaft and a handle at the other end, and can be removed by hooking the hook at the tip with the handle and excising part of the tissue.
[0125]
However, in this conventional hook type probe, a plurality of types of probes that differ only in the shape of the hook provided at one end of the shaft are selectively used according to the condition of the treatment section. Therefore, every time the status of the treatment section changes, it is necessary to deliver the probe with the assistant, and the operation takes time.
[0126]
For example, when a blood vessel is peeled off from surrounding tissue, it is generally performed to pick up the surrounding tissue with grasping forceps and cut it with scissors forceps. However, in this method, the operation is complicated, and the operation time becomes long.
[0127]
Therefore, in the embodiment described below, a hook probe that can reduce the operation of transferring the instrument between the operator and the assistant and reduce the operation time will be described.
[0128]
48 to 50 show a third embodiment, two shafts that are movable forward and backward in the axial direction, and front and rear that are opened and closed by advancing and retracting the shafts and projecting to the side of the shafts. An open / close hook probe 130 includes a pair of hooks and an operation unit for moving the shaft forward and backward. The operation portion 131 of the open / close hook probe 130 is provided with a lumen 132 that opens to the distal end side. A proximal end portion is fixed to the operation portion 131 at the center of the lumen 132, and the distal end portion extends from the lumen 132. A shaft 133 protruding forward is provided. The shaft 133 is fitted with a pipe 134 that is movable back and forth in the axial direction.
[0129]
A first hook 135 is fixed to the tip end of the shaft 133, and a second hook 136 is fixed to the tip end of the pipe 134. The first hook 135 and the second hook 136 have basically the same shape, are curved in a substantially C shape, and project to the side of the shaft 133 and the pipe 134.
[0130]
A fixing member 137 located in the lumen 132 of the operation portion 131 is attached to the proximal end portion of the pipe 134, and a pin that protrudes outside through the long hole 138 provided in the operation portion 131 is attached to the fixing member 137. 139 protrudes. An operation button 140 is provided at the tip of the pin 139. When the operator grasps the operation unit 131 and moves the operation button 140 forward and backward, the pipe 134 moves forward and backward to move the first and second hooks 135, 136 opens and closes.
[0131]
Therefore, the tissue can be collected by sandwiching the tissue between the first and second hooks 135 and 136, and the open / close hook probe 130 is inserted into the cavity G as in the observation image of the rigid endoscope shown in FIG. With the first and second hooks 135 and 136 closed, the vascular epithelial connective tissue 300 is approached, the first and second hooks 135 and 136 are hidden under the blood vessel C, and then the first By opening the first and second hooks 135 and 136, the connective tissue 300 on the blood vessel can be pulled open to expose the blood vessel C.
[0132]
Moreover, according to the said embodiment, although the 1st hook 135 was fixed and the 2nd hook 136 was made movable, it may be reversed and both may be made movable. Furthermore, by forming the outer edges of the first and second hooks 135 and 136 sharply, the tissue can be cut open when the first and second hooks 135 and 136 are moved away from each other. .
[0133]
According to the present embodiment, there is an effect that peeling from a surrounding tissue of a blood vessel can be easily and in a short time with one open / close hook probe without using a plurality of treatment tools. FIG. 51 shows a fourth embodiment, FIG. 51 (a) is a longitudinal side view, and FIG. 51 (b) is an arrow view as seen from the direction of arrow U. Reference numeral 141 denotes an open / close hook probe. The open / close hook probe 141 includes an operation part 142, a shaft part 143 provided in the operation part 142, and a hook part 144 provided at the tip of the shaft part 143.
[0134]
The operation part 142 will be described. A cylindrical body 147 having an opening 145 at the front end and a closing part 146 at the rear end is provided, and a long hole 148 is provided in the side wall of the cylindrical body 147 along the long axis direction. It has been. Further, a male screw portion 149 is formed on the outer peripheral portion of the closing portion 146, and a female screw portion 150 is formed on the axial center portion of the closing portion 146.
[0135]
A fixing member 152 having a slit 151 is screwed and fixed to the female screw portion 150. The outer periphery of the distal end portion of the fixing member 152 has a tapered shape, and a hole penetrating in the axial direction is formed at the center thereof. An inner diameter portion of the hole is reduced in diameter at the taper side end portion, and a step portion 153 is provided.
[0136]
A cap 154 is screwed and fixed to the male screw portion 149 of the fixing member 152. A tapered hole 155 that fits into the distal end portion of the fixing member 152 is provided in the inner back portion of the cap 154.
[0137]
Further, a slider 156 having a through hole 156a in the axial direction is inserted into the cylindrical body 147 so as to be movable in the axial direction. The slider 156 is fixed to an operation button 157 slidable in the axial direction of the cylindrical body 147 with the elongated hole 148 as a guide. In addition, a coil spring 158 is interposed between the slider 156 and the closing portion 146 inside the cylindrical body 147, and the slider 156 is biased toward the tip of the cylindrical body 147 by the biasing force of the coil spring 158. .
[0138]
Further, the shaft portion 143 will be described. The shaft portion 143 is formed of a shaft 160 and a pipe 161 that is slidably fitted in the shaft 160 in the axial direction. The base end portion of the shaft 160 passes through the through hole 156 a of the slider 156 and is fixed to the fixing member 152, and the base end portion of the pipe 161 is fixed to the slider 156. The pipe 161 is moved forward and backward by the movement of the slider 156 in the front-rear direction.
[0139]
Further, the hook portion 144 will be described. The hook portion 144 includes a first hook 162 and a second hook 163, and the base end portion of the first hook 162 is fixed to the distal end portion of the shaft 160. The base end portion of the pipe 161 is fixed to the base end portion of the pipe 161.
[0140]
The first hook 162 is formed in a semicircular arc shape, and has a pointed portion 162a having a sharp tip. Similarly to the first hook 152, the second hook 153 is also formed in a semicircular arc shape, and has a pointed end portion 163a having a sharp tip. Further, a concavo-convex portion 164 that engages with each other is formed at the base end portions of the first and second hooks 162 and 163.
[0141]
Therefore, when a finger is put on the operation button 157 of the operation unit 142 and is retracted against the urging force of the coil spring 158, the slider 156 is drawn into the cylindrical body 147. As the slider 156 moves backward, the second hook 163 opens away from the first hook 162 via the pipe 161, and when the finger is released from the operation button 157, the slider 156 moves forward by the urging force of the coil spring 158, The second hook 163 contacts the first hook 162 through the pipe 161.
[0142]
Therefore, as in the third embodiment, the openable hook probe 141 is inserted into the cavity G, the first and second hooks 162 and 163 are closed, the vascular connective tissue 300 is approached, and the blood vessel C The first and second hooks 162 and 163 are submerged in the lower side, and then the first and second hooks 162 and 163 are opened, thereby pulling up the vascular connective tissue 300 and exposing the blood vessel C. it can.
[0143]
Moreover, according to the said embodiment, although the 1st hook 162 was fixed and the 2nd hook 163 was movable, you may make it reverse and may make both move. Furthermore, by forming the outer edges of the first and second hooks 162 and 163 sharply, the tissue can be cut open when the first and second hooks 162 and 163 are moved away from each other. .
[0144]
Further, the openable hook probe 141 of the present embodiment can be assembled by the user. That is, the shaft 160 having the first hook 162 is inserted into the pipe 161 having the second hook 163 from the second hook 163 side. Then, the shaft 160 and the pipe 161 are inserted into the operation portion 142 in a state where the concave and convex portions 164 of the first hook 162 and the second hook 163 are aligned.
[0145]
At this time, the coil spring 158 is sandwiched between the slider 156 and the closing portion 146, and the shaft portion of the operation button 157 is guided by the long hole 148. Then, the tip of the shaft 160 is abutted against the step 153 of the fixing member 152. Next, by screwing the cap 154 into the male threaded portion 149 of the cylindrical body 147, the tapered hole 155 is pressed against the tapered portion of the fixing member 152, and the shaft 160 can be fastened and fixed.
[0146]
Since the open / close hook probe 141 can be disassembled in this manner, the cleaning performance is further improved, and the first and second hooks 162 and 163 are provided with the concavo-convex portions 164, and further protruded against the fixing member 152 of the shaft 160. By providing the contact step 153, the assembly of the first and second hooks 162 and 163 in the state where the tip positions are aligned is facilitated.
[0147]
In addition, by attaching the coil spring 158, the hook portion 144 is closed in a normal state, and the living tissue can be safely treated without inadvertently damaging the sharp portion of the nail.
[0148]
52 shows a fifth embodiment, FIG. 52 (a) is a side view, and FIG. 52 (b) is a front view. A grip 166 is provided at the base end portion of the hook probe 165, and a hook mark 167 and an up mark 168 are engraved on the grip 166.
[0149]
The hook mark 167 is changed depending on the bending direction and the size of the C-shaped hook 169 at the tip. An up mark 168 indicates the direction of the tip of the hook 169.
[0150]
With this configuration, the shape and size of the hook 169 can be confirmed by looking at the hook mark 167, and the shape of the hook 169 can be determined by just looking at the grip 166. Usability is improved because the tip direction is known.
[0151]
53 shows a sixth embodiment, FIG. 53 (a) is a longitudinal side view, and FIG. 53 (b) is an arrow view as seen from the direction of arrow H. FIG. The basic configuration is the same as that of the fourth embodiment, but there is no coil spring 158. With this configuration, there is no load for opening and closing the hook portion 144, and the surgeon can perform a delicate opening and closing operation of the hook portion 144, thereby enabling a finer treatment. In addition, there are fewer parts that become disassembled during disassembly, and operability is improved.
[0152]
Each of the embodiments described above is far less invasive than the prior art described at the beginning of the specification. However, it is necessary to make an incision through the skin about 4 cm and to create a similar sized exfoliation cavity under the skin. Therefore, the seventh embodiment provides an endoscopic blood vessel collection system that is less invasive than the above-described embodiments.
[0153]
In the seventh embodiment, when blood vessels are collected endoscopically, for example, when blood vessels of the lower limbs are collected, as in the second embodiment described above, as shown in FIG. A skin incision E1 is provided with a scalpel or the like in the cervical region A of the thigh just above the blood vessel C to be collected such as the saphenous vein extending from the part A to the knee D. Then, the blood vessel C is exposed with a peeling forceps or the like at the skin incision E1. Further, the tissue immediately above the blood vessel C is peeled off by a similar peeling forceps or the like at a distance that can be visually observed through the skin incision E1.
[0154]
Next, the rigid endoscope 20 is inserted and fixed to the peeler 10 (see FIG. 32) shown in the second embodiment. And in this insertion fixed state, it inserts so that the front-end | tip part 12 of the peeler 10 may be along the upper part of the blood vessel C toward the knee D from the skin incision part E1 of the neck part A (refer FIG. 34). In this case, since the distal end portion 12 of the peeler 10 is formed of a transparent member, the blood vessel C and the side branch F can be clearly observed with the rigid endoscope 20. The insertion of the peeler 10 is gradually advanced by an operation of pushing the peeler 10 slightly and returning it slightly while confirming the progress of the blood vessel C with the rigid endoscope 20. Thus, after the peeler 10 is inserted along the blood vessel C to the vicinity of the knee D, next, a small incision is made in the skin immediately above the distal end portion 12 of the peeler 10, and the peeler 10 is inserted through the skin incision E2. The distal end portion 12 is led out of the body.
[0155]
Next, with the exfoliator 10 left in the body, the rigid endoscope 20 is removed from the exfoliator 10, and a tissue protector is attached to the proximal end of the exfoliator 10 located on the skin incision E1 side of the neck A. 30 is attached. Then, the peeler 10 is pulled out from the skin incision E2 on the knee D, and the tissue protector 30 is pulled into the cavity G peeled by the peeler 10. In this case, since the cross-sectional area in the width direction of the tissue protector 30 is substantially equal to the cross-sectional area in the width direction of the peeler 10, little force is required to insert the tissue protector 30. Thereafter, the tissue protection tool 30 is separated from the peeler 10 after the proximal end of the peeler 10 is pulled out from the skin cut portion E2, and is placed in the cavity G (see FIG. 37).
[0156]
Next, as shown in FIG. 54, the peeler 10 to which the rigid endoscope 20 is mounted again is inserted from the skin incision E1 while being along the groove 30a on the upper surface side of the tissue protector 30, and the skin incision is made. Pull it through to E2. Thereby, the separation cavity G is slightly expanded.
[0157]
Next, as shown in FIG. 55, the second peeler 10A shown in FIG. 56 is inserted from the skin incision E1 and penetrates to the skin incision E2 along the groove 30a on the upper surface of the tissue protector 30. Let it pull out. As shown in FIG. 56, the second stripper 10 </ b> A has a cross-sectional area in the width direction of the tip portion 12 </ b> A larger than that of the tip portion 12 of the stripper 10. Further, the distal end portion 12A is made of a transparent material, and the shape thereof is similar to the distal end portion 12 of the peeler 10. Therefore, when the second peeler 10A is inserted from the skin incision E1, penetrated to the skin incision E2, and pulled out, the separation cavity G is further expanded to a size that allows insertion of a cavity securing tool 60A described later.
[0158]
FIG. 57 shows a cavity securing tool 172 according to this embodiment. As illustrated, the cavity securing tool 172 includes an outer tube 172A and two inner tube tubes 172B and 172C that can be inserted into the outer tube 172A. The outer tube 172A has a substantially cylindrical shape, and both ends thereof are open. Further, the outer tube 172A has a side face cut out to a predetermined depth over substantially the entire length excluding both ends thereof, thereby forming a side port 173 that opens to the side. The outer diameter of the outer tube 172A is suitably about 10 mm to 20 mm.
[0159]
The rigid endoscope 20 can be inserted into the first inner tube 172B of the cavity securing tool 172. When the rigid endoscope 20 is inserted into the inner tube 172B, the rigid endoscope 20 is fixed to the inner tube 172B by a fixing screw 174 provided on the proximal side of the inner tube 172B. In addition, the second inner tube 172C of the cavity securing device 172 can insert a treatment tool, which will be described later, for treating a blood vessel.
[0160]
It should be noted that both ends of the outer tube 172A and the inner tube 172B, 172C have no edge so as not to damage the tissue.
[0161]
58 shows an insertion assisting tool 175 that is detachably attached to the outer tube 172A and guides and assists the insertion of the outer tube 172A. As shown in the figure, the insertion assisting tool 175 includes a tip portion 175a having a tapered tip, and a support portion 175b that is detachably attached to the tip portion 175a by screw fixing. The support portion 175 b includes a long shaft portion 176 and a hand portion 177 provided at an end portion of the shaft portion 176.
[0162]
FIG. 59 shows a state where the insertion aid 175 is attached to the outer tube 172A. As a procedure for mounting in this way, for example, the outer tube is inserted in a state where the shaft portion 176 of the insertion assisting tool 175 is inserted into the outer tube 172A and the hand portion 177 is in contact with the opening end surface on one side of the outer tube 172A. The distal end portion 175a is screwed into the threaded portion of the shaft portion 176 protruding from the opening on the other side of 172A, and the proximal end surface of the distal end portion 175a may be brought into contact with the opening end surface on the other side of the outer tube 172A. Thus, the contact state of the distal end portion 175a is supported by the support portion 175b, and the insertion assisting tool 175 is attached to the outer tube 172A so as to sandwich the outer tube 172A.
[0163]
The outer tube 172A to which the insertion assisting tool 175 is attached is inserted into the cavity G expanded by the second stripper 10A and is left in place. When inserting the outer tube 172A into the subcutaneous lumen G, first, the distal end portion 175a of the insertion assisting tool 175 attached to the outer tube 172A is placed along the groove 30a of the tissue protector 30 from one skin incision E1 to the other. Is penetrated through the skin E2. Then, after penetration, the insertion assisting tool 175 is removed from the outer tube 172A. This state is shown in FIG.
[0164]
When the above operation is completed, the first inner tube 172B and the second inner tube 172C are inserted into the outer tube 172A, and then the tissue protector 30 is removed from the cavity G. This state is shown in FIG. A cross-sectional view of this state is shown in FIG. As shown in FIG. 62, in the state where the cavity securing device 172 is placed subcutaneously along the blood vessel C, the tissue is lifted upward (excluded) by the outer tube 172A, and the first inner tube 172B and The blood vessel C and its surrounding tissue 300 are pressed (excluded) downward by the second inner tube 172C, and thereby a treatment space (cavity) G capable of performing a treatment for separating the blood vessel C from the surrounding tissue 300. Is secured.
[0165]
In this state of FIG. 62, the rigid endoscope 20 is inserted into the first inner tube 172B this time as shown in FIG. 63 (a). In this case, in order to obtain a good field of view by the rigid endoscope 20, the distal end portion of the rigid endoscope 20 is placed in the first inner tube without bringing the objective lens of the rigid endoscope 20 into contact with the tissue. It is desirable to locate in the vicinity of the tip of 172B. That is, it is desirable to set the length of the first inner tube 172B so that the rigid endoscope 20 can be inserted and fixed to the first inner tube 172B in such a state. An endoscopic observation image in this desirable state is shown in FIG. 63 (b). As shown in the figure, the blood vessel C and its side branch F are clearly observed, and the second inner tube 172C is visible in the distance.
[0166]
If the first inner tube 172B is moved within the outer tube 172A in the state of FIG. 63, the subcutaneous cavity G from one skin incision E1 to the other skin incision E2 can be observed. Further, the size of the treatment space (cavity) G can be adjusted by changing the interval between the first inner tube 172B and the second inner tube 172C.
[0167]
FIG. 64A shows the openable hook probe 130 shown in the third embodiment in the treatment space (cavity) G through the second inner tube 172C in order to peel the blood vessel C from the surrounding tissue 300. FIG. The inserted state is shown. Further, an endoscope observation image at this time is shown in FIG. 64 (b). As can be seen from the drawing, since the openable hook probe 130 and the rigid endoscope 20 are inserted from the opposite sides of the outer tube 172A, when the openable hook probe 130 is moved in the right direction, an endoscopic observation image is obtained. Above, the open / close hook probe 130 moves to the left. Therefore, the operation of the open / close hook probe 130 becomes very difficult.
[0168]
Therefore, in this embodiment, an endoscope system 500 shown in FIG. 65 is used. In this endoscope system 500, an image obtained by the rigid endoscope 20 is transmitted to a television camera 502 having a built-in imaging device (not shown) through a video adapter 501 having an optical system bent at a right angle. Here, the optical signal is converted into an electric signal and sent to a CCU (camera control unit) 503. A signal from the CCU 503 is sent to the image inverting device 504, converted into a video image that is horizontally reversed by the image inverting device 504, and sent to the monitor 505. Therefore, the surgeon can see an image that matches the actual moving direction of the treatment tool.
[0169]
When the blood vessel C is peeled from the surrounding tissue 300 by the open / close hook probe 130, first, the distal end hook 135 of the open / close hook probe 130 is viewed while viewing an image that matches the moving direction of the actual treatment instrument by the endoscope system 500. 136 is closed, and the tip hooks 135 and 136 are inserted into the surrounding tissue 300 and penetrate the lower side of the blood vessel C to penetrate to the opposite side (see FIG. 64 (b)). Then, from this state, the hooks 135 and 136 are gradually opened to peel the blood vessel C from the surrounding tissue 300. A state in which the blood vessel C is detached from the surrounding tissue 300 is shown in FIG. The above operation is performed over the length of blood vessel C extracted. In this case, a laparoscopic peeling forceps or the like (not shown) may be used as necessary.
[0170]
When the blood vessel C is peeled over the extracted length (for example, about 25 cm), as shown in FIG. 66 (b), clips 96, 96 are hit at two locations on the side branch F (see FIG. 66 (b)). , 96 is cut with scissors forceps (see FIG. 66 (c)). If the cutting operation of the side branch F is performed over the length of the blood vessel C, the blood vessel C can be extracted outside the body. If it is necessary to remove a longer blood vessel, the same operation may be performed continuously. Thereby, the blood vessel from the cervical part A to the ankle can also be extracted.
[0171]
As described above, according to the present embodiment, it is possible to easily extract a very small skin incision without damaging a blood vessel. In addition, according to this embodiment (of course, each embodiment mentioned above is also the same), not only blood vessels but also subcutaneous nerves can be removed.
[0172]
67 and 68 show an eighth embodiment of the present invention. The present embodiment is a modification of the cavity securing device 172 in the seventh embodiment, and other configurations and procedures are the same as those in the seventh embodiment.
[0173]
As shown in FIG. 68, the cavity securing device 180 of this embodiment has a substantially cylindrical shape. The central side surface of the cavity securing device 180 is cut out to a predetermined depth, and thereby, a side port 181 is formed to open to the side and form a treatment space (cavity) G. The method for inserting and placing the cavity securing device 180 in the subcutaneous cavity and the endoscope system for obtaining a reverse image are the same as those in the seventh embodiment.
[0174]
68 (a) shows a state in which the cavity securing device 180 is placed in the subcutaneous cavity, and FIG. 68 (b) shows an endoscopic observation image by the rigid endoscope 20 inserted into the cavity securing device 180. Respectively. By moving the position of the side opening 181 of the cavity securing device 180 from one skin incision E1 to the other skin incision E2, the entire length of the blood vessel C can be observed and treated. The method for separating the blood vessel C from the surrounding tissue 300 is the same as that in the seventh embodiment.
[0175]
FIG. 69 shows a ninth embodiment of the present invention. The present embodiment is a modification of the cavity securing device 180 in the eighth embodiment, and other configurations and procedures are the same as those in the eighth embodiment.
[0176]
As shown in the drawing, the cavity securing device 190 according to the present embodiment includes a substantially cylindrical main body 190a and extensions 190b and 190b that are detachably attached to both ends of the main body 190a by screws. The central side surface of the main body 190a is cut out to a predetermined depth, thereby forming a side port 191 that opens to the side to form a treatment space (cavity) G. Therefore, the cavity securing tool 190 of the present embodiment has the same shape as the cavity securing tool 180 of the eighth embodiment in a state where the main body 190a and the extensions 190b and 190b are connected.
[0177]
The overall length of the cavity securing device 180 according to the eighth embodiment is relatively long. However, the cavity securing device 190 according to the present embodiment is separated so that the overall length is adjusted according to the length of the treatment region. Therefore, the operability is improved. If a plurality of types of lengths of the extension 190b are prepared, the extension 190b having an optimum length corresponding to the length of the treatment instrument to be used can be selected and used, and the operability is further improved.
[0178]
70 to 76 show a tenth embodiment of the present invention. This embodiment is a modification of the cavity securing tool 172 of the seventh embodiment. Therefore, the same components as those in the seventh embodiment are denoted by the same reference numerals and description thereof is omitted.
[0179]
As shown in FIG. 70, the outer tube 172A of the cavity securing device 172 'according to the present embodiment has notches 210 and 210 at the cylindrical portions 201 and 201 at both ends thereof with the side port 173 interposed therebetween. These notches 210 and 210 are formed over the entire length of the cylindrical portion 201. As shown in FIG. 71, a protrusion 204 having a recess 203 at the center is provided at the distal end of each of the first and second inner tube 172B and 172C of the cavity securing device 172 ′. FIG. 72 shows a state in which the insertion assisting tool 175 shown in FIG. 58 is attached to the outer tube 172A of the cavity securing tool 172 ′. FIG. 73 shows that the distal end portion 175a of the insertion assisting tool 175 attached to the outer tube 172A of the cavity securing tool 172 ′ is moved from the one skin incision E1 to the other skin incision E2 along the groove 30a of the tissue protector 30. A state is shown in which the insertion aid 175 is removed from the outer tube 172A after the penetration. FIG. 74 shows the tissue protector 30 after inserting the first inner tube 172B and the second inner tube 172C into the outer tube 172A in the state of FIG. 73 in the cavity securing device 172 ′ of the present embodiment. The state which extracted from the cavity G is shown. A cross-sectional view of this state is shown in FIG. In the cavity securing device 172 ′ of this embodiment, the first and second inner tube 172B and 172C are inserted into the outer tube 172A by the protrusions of the first and second inner tube 172B and 172C. This is performed in a state where 204 is inserted into the notches 210 and 210 of the outer tube 172A. In this case, the recess 203 of the protrusion 204 is moved along the blood vessel C. As shown in FIG. 75, in the state where the cavity securing tool 172 ′ is placed subcutaneously along the blood vessel C, the tissue is lifted upward (excluded) by the outer tube 172A, and the first inner tube 172B. And the second inner tube 172C press (displace) the blood vessel C and the surrounding tissue 300 downward, and thereby a treatment space (cavity) capable of performing a treatment for separating the blood vessel C from the surrounding tissue 300. G is secured. In particular, the protrusions 204 of the first and second inner cylindrical tubes 172B and 172C press the both ends (bilateral tissues) of the blood vessel C by the concave portion 203 at the center.
[0180]
FIG. 76A shows a state in which the rigid endoscope 20 is inserted into the first inner tube 172B in the state of FIG. Further, an endoscopic observation image at this time is shown in FIG. 76 (b). FIG. 77 (a) shows the openable hook probe 130 shown in the third embodiment in the treatment space (cavity) G through the second inner tube 172C in order to peel the blood vessel C from the surrounding tissue 300. The inserted state is shown. Further, an endoscopic observation image at this time is shown in FIG. 77 (b). As can be seen from the figure, since both ends (bilateral tissues) of the blood vessel C are pressed by the concave portions 203 of the projections 204 of the first and second inner cylindrical tubes 172B and 172C, the blood vessel C protrudes from the surrounding tissue. As a result, the distal hooks 135 and 136 are inserted into the surrounding tissue 300, and the treatment of passing through the lower side of the blood vessel C to penetrate to the opposite side is facilitated.
[0181]
78 and 79 show an eleventh embodiment of the present invention. The cavity securing device 180 ′ according to the present embodiment is arranged along the blood vessel C on the lower side in the vicinity of the side port 181 of the cavity securing device 180 according to the eighth embodiment, and is used to lift the blood vessel C from the surrounding tissue. It has the recessed part 220,220. The rest of the configuration is the same as in the eighth embodiment.
[0182]
FIG. 80 shows a twelfth embodiment of the present invention. The cavity securing device 190 ′ according to the present embodiment is disposed along the blood vessel C on the lower side in the vicinity of the side port 191 of the cavity securing device 190 according to the ninth embodiment, and is used to lift the blood vessel C from the surrounding tissue. It has the recessed part 220,220. The rest of the configuration is the same as in the ninth embodiment.
[0183]
81 to 83 show a thirteenth embodiment of the present invention. The present embodiment relates to a cavity preparation tool and a tissue protection tool. As shown in FIGS. 81 (a) and 81 (b), a cavity creating tool 50 'according to the present embodiment includes a flat plate portion 231 and a substantially hemispherical enlarging provided on the base end side of the plate portion 231. Part 230. The enormous portion 230 is formed such that the height gradually increases from the distal end side, and the height gradually decreases from the top portion, which is the maximum height, toward the proximal end side. 82 are respectively associated with the groove portions 30a of the tissue protectors 30 ′ and 30 ″ shown in FIG. 82. The lower surface portion of the distal end side of the plate portion 231 and the lower surface portion extending from the proximal end side of the plate portion 231 to the proximal end of the massive portion 230 are respectively. A mating protrusion 52 is formed. In addition, a connecting hole 51 that engages with the hook 40b of the dilator hook 101 shown in FIG.
[0184]
A plurality of cavity creation tools 50 ′ are prepared from one having a small outer circumference to a large one. (C) to (f) of FIG. 81 show an example. As shown in (c) of FIG. 81, the width of the first cavity creating tool 50a ′ having the shortest outer peripheral length is set to W1. As shown in FIG. 81 (d), the second cavity creating tool 50b ′ whose outer peripheral length is longer than that of the first cavity creating tool 50a ′ is also set to the width of W1. Further, as shown in FIG. 81 (e), the third cavity creating tool 50c ′ whose outer peripheral length is longer than the second cavity creating tool 50b ′ and the fourth cavity creating tool 50d ′ having the longest outer peripheral length. Has a width set to W2.
[0185]
In this embodiment, as shown in FIGS. 81 (c) to 81 (f), four types of cavity creation tool 50 'are prepared. Of course, five or more types or less are provided. It may be prepared.
[0186]
82 (a) and 82 (b) show tissue protectors 30 ′ and 30 ″ used in the present embodiment. As shown in FIG. 82 (a), the first tissue protector 30 ′ has the same shape as the tissue protector 30 shown in FIG. 35 (therefore, the same as the tissue protector 30 shown in FIG. 35). The parts are denoted by the same reference numerals and description thereof is omitted), but the width dimension is set to W3. The width W3 is set to be equal to or greater than the width W1 of the first and second cavity creation tools 50a ′ and 50b ′. In other words, W3 ≧ W1 is set so that the first and second cavity creation tools 50a ′ and 50b ′ do not protrude from the first tissue protection tool 30 ′ in the width direction.
[0187]
As shown in (b) of FIG. 82, the width of the second tissue protector 30 ″ is set to W4 which is larger than the width W3 of the first tissue protector 30 ′. The width W4 is set such that W3 ≧ W2 so that the third and fourth cavity creation tools 50c ′, 50d ′ do not protrude from the second tissue protection tool 30 ″ in the width direction. In addition, a protrusion 240 that can be engaged with the groove 30a of the first tissue protector 30 'is provided on the lower surface of the distal end portion of the second tissue protector 30 ".
[0188]
In the case where a cavity is formed in the subcutaneous tissue using the tissue protectors 30 ′ and 30 ″ and the cavity creation tools 50a ′ to 50d ′ of the present embodiment described above, first, it is described in the second embodiment. Similarly, the first tissue protector 30 'is placed in the subcutaneous tissue (see FIG. 37), and the smallest size is attached to the tip of the dilator hook 101 that penetrates through the subcutaneous tissue through the two skin incisions E1 and E2. The cavity creation tool 50a ′ is attached. Then, hold the handle portion of the dilator hook 101 and cut the dilator hook 101 while keeping the protrusion 52 of the cavity creating device 50a ′ engaged with the groove 30a of the first tissue protector 30 ′. Slowly pull from the part E1 to the vicinity of the skin incision E2. As a result, the cavity creating tool 50 a ′ is inserted into the subcutaneous tissue by the guidance of the dilator hook 101. After the cavity preparation tool 50a ′ reaches the skin incision E2, the dilator hook 101 is pushed, the cavity dilator 50a ′ is returned to the skin incision E1, the cavity dilator 50a ′ is taken out from the skin incision E1, and the dilator hook Remove from 101. Next, the large cavity dilator 50b ′ is inserted / extracted by the same operation. When the expansion by the cavity expander 50b ′ is completed, the first tissue protector 30 ′ is replaced with the second tissue protector 30 ″. In this replacement, the protrusion 240 of the second tissue protector 30 ″ is pushed along the groove 30a in a state where the protrusion 240 is engaged with the groove 30a of the first tissue protector 30 ′, and the second tissue protector 30 ′ is pushed. This is done by slowly pulling out the first tissue protector 30 'to the outside in a state where' is inserted into the subcutaneous tissue until the arrangement state is substantially the same as that of the first tissue protector 30 '. When the replacement with the second tissue protector 30 ″ is completed, the same expansion operation is performed on the third cavity expander 50c ′, and finally the largest cavity expander 50d ′ is performed. As a result, the cavity is gradually expanded.
[0189]
FIG. 83 is a cross-sectional view showing a state in which the connective tissue 300 is gradually peeled by receiving a tensile force in the vertical direction by the cavity creating tool 50 ′. Such a peeling state is made effective by the shape characteristic of the enormous portion 230 described above. It should be noted that as the enormous portion 230 is lowered from both sides to the top, the cavity creation tool 50 ′ can be moved in the opposite direction while passing subcutaneously without requiring a large amount of force. As shown in FIG. 83, when the blood vessel C exists directly below the tissue protector 30 ′ (30 ″) (indicated by a broken line in the figure), the blood vessel C is viewed from below the tissue protector 30 ′ (30 ″). There is a case where it exists at a position deviated (indicated by a solid line in the figure). Therefore, when the blood vessel C exists at a position off the lower side of the tissue protector 30 ′ (30 ″), the blood vessel C may be damaged by the cavity creating tool. The width of 50 ′ is set smaller than the width of the tissue protector 30 ′ (30 ″) so that the cavity creating tool 50 ′ does not protrude in the width direction of the tissue protector 30 ′ (30 ″). Therefore, the blood vessel C is not damaged under any circumstances.
[0190]
According to the embodiment, the following configuration is obtained.
[0191]
(Appendix 1) A first stage in which skin cut portions are provided in at least two places of the epidermis to expose a blood vessel to be collected immediately below the skin cut portion, and the blood vessel to be collected from the one skin cut portion to the other skin cut portion A second stage in which the blood vessel to be collected and at least a part of the surrounding tissue are peeled to form a peeled portion by inserting a peeling means along the penetrating portion from the one skin incision to the other skin incision A third step of securing a cavity to be a treatment region in the vicinity of the blood vessel to be collected by the cavity securing means inserted and indwelled in the peeled portion in the state, and a cavity to be a treatment region formed by the cavity securing means An endoscopic blood vessel collection method comprising: a fourth stage in which an endoscope and treatment means are inserted into the blood vessel, and a blood vessel to be collected is collected by the treatment means under endoscopic observation.
[0192]
(Supplementary note 2) The endoscopic blood vessel sampling method according to supplementary note 1, wherein the first stage skin incision is an incision of about 2 to 5 cm.
[0193]
(Additional remark 3) The said 2nd step is performed under observation of the rigid endoscope inserted in the peeling means, The endoscopic blood vessel collection method of Additional remark 1 characterized by the above-mentioned.
[0194]
(Supplementary note 4) The endoscopic blood vessel sampling method according to Supplementary note 1 or 3, wherein the peeling means is a peeler.
[0195]
(Supplementary note 5) The endoscopic blood vessel sampling method according to supplementary note 1, wherein the cavity securing means is a cavity securing tool placed in the cavity.
[0196]
(Supplementary note 6) The endoscopic blood vessel sampling method according to supplementary note 1, wherein the treatment means is a scissors forceps.
[0197]
(Supplementary note 7) The endoscopic blood vessel sampling method according to supplementary note 1, wherein the treatment means is a hook probe.
[0198]
(Appendix 8) A first means for providing a skin incision at at least two places on the epidermis to expose a collection blood vessel immediately below the skin incision, along the collection blood vessel from the one skin incision to the other skin incision Inserting the exfoliator, exfoliating the collection blood vessel and the surrounding tissue to form a cavity, and inserting the cavity securing device into the cavity from the one skin incision and placing it in place, Third means for securing a cavity at the top, and fourth means for inserting an endoscope and a treatment instrument into the cavity formed by the cavity securing tool and collecting a collection blood vessel under endoscopic observation An endoscopic blood vessel collection device comprising:
[0199]
(Supplementary Note 9) First means for providing skin cuts at at least two places on the epidermis to expose the collected blood vessels immediately below the skin cuts, along the collected blood vessels from the one skin cut to the other skin cut A second means for inserting a peeler to peel the collected blood vessel and its surrounding tissue to form a cavity; and a second means for further expanding the cavity by inserting a cavity creation tool from the one skin incision into the cavity. 3, a fourth means for inserting and placing a cavity securing device into the cavity from the one skin incision, and securing a cavity above the collection blood vessel, and a cavity formed by the cavity securing tool An endoscopic blood vessel collecting device comprising: a fifth means for inserting an endoscope and a treatment instrument into the blood vessel and collecting a collected blood vessel under endoscopic observation.
[0200]
(Supplementary Note 10) First means for providing skin cuts at at least two places on the epidermis to expose the collected blood vessels immediately below the skin cuts, along the collected blood vessels from the one skin cut to the other skin cut A second means for inserting the exfoliator and exfoliating the collected blood vessel and surrounding tissue to form a cavity; and a second means for protecting the collected blood vessel by inserting a tissue protector into the cavity from the one skin incision. 3 means, a fourth means for further expanding the cavity by inserting a cavity creating tool into the cavity from the one skin incision, and a cavity securing tool from the one skin incision to the cavity. A fifth means for securing a cavity in the upper part of the collected blood vessel, and inserting an endoscope and a treatment tool into the cavity formed by the cavity securing device, and collecting the collected blood vessel under observation of the endoscope An endoscopic blood vessel collection device characterized by comprising:
[0201]
(Additional remark 11) The endoscopic blood-vessel collection device of Additional remark 8 characterized by the above-mentioned skin cutting part of the 1st means being an incision of about 2-5 cm.
[0202]
(Additional remark 12) The said 2nd means is performed under observation of the rigid endoscope inserted in the exfoliator, The endoscopic blood vessel collection apparatus of Additional remark 8 characterized by the above-mentioned.
[0203]
(Supplementary note 13) Two shafts that can be moved back and forth in the axial direction, a pair of front and rear hooks that are provided at the front end portions of these shafts and that are opened and closed by advancing and retracting the shafts and projecting to the side of the shaft, Opening and closing hook probe consisting of an operating part.
[0204]
(Supplementary note 14) The openable hook probe according to supplementary note 13, wherein, of the pair of front and rear hooks, the front hook is fixed and the rear hook is movable in the front-rear direction.
[0205]
(Supplementary note 15) The open / close hook probe according to supplementary note 13, wherein, of the pair of front and rear hooks, a rear hook is fixed and a front hook is movable in the front-rear direction.
[0206]
(Supplementary note 16) The open / close hook probe according to supplementary note 13, wherein two shafts that are movable back and forth in the axial direction are detachably fixed to the grip body.
[0207]
(Supplementary note 17) The open / close hook probe according to supplementary note 13, wherein the pair of front and rear hooks are provided with concave and convex portions at opposing portions in the closed state.
[0208]
(Supplementary note 18) At least a part of the surrounding tissue of the blood vessel to be collected is peeled along the blood vessel to be collected by the peeler inserted from the skin incision, the peeled region is expanded by the cavity dilator and inserted into the expanded region. In the endoscopic blood vessel collecting system comprising a cavity securing device for securing a sufficient treatment space for collecting blood vessels, the cavity securing device is used for collecting an endoscope capable of observing the treatment space and a blood vessel to be collected. Endoscopic blood vessel collection system characterized in that the treatment tool can be inserted freely.
[0209]
(Supplementary note 19) The endoscopic blood vessel sampling device according to supplementary note 10, wherein the width of the cavity preparation tool is set to be equal to or less than the width of the tissue protection tool.
[0210]
【The invention's effect】
  As explained above, according to the present invention,For example, when a tissue to be collected such as a blood vessel is exfoliated from the surrounding tissue, a treatment device for tissue exfoliation that can be performed by one without using a plurality of treatment tools, and can reduce the operation time, and A tissue collection device using a tissue peeling treatment tool can be provided.
[Brief description of the drawings]
FIG. 1 is a diagram showing a first embodiment of the present invention in a state in which a skin cut is formed on a lower limb.
FIG. 2 is a cross-sectional view taken along line XX in FIG. 1, showing the sampling method of the embodiment.
FIG. 3 is a perspective view of the rigid endoscope and the peeler according to the embodiment.
FIG. 4 is a cross-sectional view of a connecting portion between the rigid endoscope and the peeler according to the embodiment.
5A is a plan view, FIG. 5B is a longitudinal side view, and FIG. 5C is a cross-sectional view taken along line YY.
6A and 6B show a usage state of the embodiment, in which FIG. 6A is a longitudinal side view during a peeling operation, and FIG. 6B is a view showing a field of view during the operation.
7A and 7B show a tissue protector according to the embodiment, in which FIG. 7A is a perspective view, and FIG. 7B is a cross-sectional view taken along line ZZ.
FIG. 8 is a perspective view of a connection portion between the peeler and the tissue protector according to the embodiment.
FIG. 9 is a perspective view showing a state in which the tissue protector of the same embodiment is inserted between skin cut portions.
FIG. 10 is a perspective view showing a state in which the cavity creating tool is connected to the tissue protector inserted between the skin incisions of the embodiment.
FIG. 11 is a cross-sectional view showing a state in which the tissue protection device and the cavity creation device of the embodiment are inserted into a pulling tissue.
FIG. 12 is a perspective view of the cavity securing device of the embodiment.
FIG. 13 is a front view and a longitudinal side view of the cavity securing device of the embodiment.
FIG. 14 is a perspective view before the insertion assisting tool is connected to the cavity securing tool of the embodiment.
FIG. 15 is a perspective view showing a state where an insertion assisting tool is connected to the cavity securing tool of the embodiment.
FIG. 16 is an operation explanatory diagram for inserting the cavity securing device of the embodiment into the subcutaneous tissue.
FIG. 17 is an operation explanatory diagram for inserting the cavity securing device of the embodiment into the subcutaneous tissue.
FIG. 18 is an operation explanatory diagram for inserting the cavity securing device of the embodiment into the subcutaneous tissue.
FIG. 19 is a perspective view showing a state where a rigid endoscope and a treatment tool are inserted into the cavity securing device of the embodiment.
FIG. 20 is a view showing an observation image of the rigid endoscope of the embodiment.
FIG. 21 is a view showing an observation image of the rigid endoscope of the embodiment.
FIG. 22 is a view showing an observation image of the rigid endoscope of the embodiment.
FIG. 23 is a view showing an observation image of the rigid endoscope of the embodiment.
FIG. 24 is a view showing an observation image of the rigid endoscope of the embodiment.
FIG. 25 is a view showing an observation image of the rigid endoscope of the embodiment.
FIG. 26 is a perspective view of the hook probe according to the embodiment.
FIG. 27 is a perspective view of the hook probe of the same embodiment in use.
FIG. 28 shows a modification of the hook of the hook probe according to the embodiment, wherein (a) is a side view, (b) is a front view, and (c) is a cross-sectional view taken along the line QQ.
FIG. 29 is a diagram showing a second embodiment of the present invention in a state in which a skin incision is formed in the lower limb.
30 is a cross-sectional view taken along the line WW of FIG. 29, showing the sampling method of the embodiment.
FIG. 31 is a side view of the rigid endoscope of the embodiment.
FIGS. 32A and 32B show a peeler according to the embodiment, wherein FIG. 32A is a plan view, FIG. 32B is a longitudinal side view, FIG. 32C is a front view, FIG. 32D is a longitudinal side view of an observation unit, and FIG. The sectional view on the aa line, (f) is the sectional view on the bb line, (g) is the sectional view on the cc line.
FIG. 33 shows a sheath holder according to the embodiment, wherein (a) is a top view and (b) is a longitudinal side view.
34A and 34B show a usage state of the embodiment, in which FIG. 34A is a longitudinal side view during a peeling operation, and FIG. 34B is a view showing a field of view during the operation.
FIG. 35 shows the tissue protector of the same embodiment, (a) is a perspective view, and (b) is a cross-sectional view taken along the line GG.
FIG. 36 shows a connecting portion between the peeler and the tissue protector of the same embodiment, (a) is a perspective view, and (b) is a longitudinal side view.
FIG. 37 is a perspective view showing a state in which the tissue protector of the same embodiment is inserted between skin cut portions.
38A and 38B show a connecting portion between the cavity forming tool and the dilator hook according to the embodiment, wherein FIG. 38A is a perspective view, and FIG. 38B is a longitudinal side view and a plan view.
FIG. 39 shows the cavity creating tool of the same embodiment, (a) is a bottom view of the cavity creating tool with a different expansion part, and (b) is a cross-sectional view taken along line VV.
FIG. 40 is a perspective view showing a state where the cavity creating tool is connected to the tissue protector inserted between the skin incisions of the embodiment.
41A and 41B show the cavity securing device of the embodiment, where FIG. 41A is a perspective view, FIG. 41B is a front view, and FIG. 41C is a longitudinal side view.
42 (a) and 42 (b) are operation explanatory views for inserting the cavity securing device of the embodiment into the subcutaneous tissue.
FIG. 43 is a perspective view showing a state in which a rigid endoscope and a treatment tool are inserted into the cavity securing device of the embodiment.
44 is a view showing an observation image of the rigid endoscope of the embodiment. FIG.
FIG. 45 is a view showing an observation image of the rigid endoscope of the embodiment.
46 is a view showing an observation image of the rigid endoscope of the embodiment. FIG.
FIG. 47 is a perspective view of the hook probe according to the embodiment in use.
FIG. 48 is a perspective view of an openable hook probe showing a third embodiment of the present invention.
FIG. 49 is a longitudinal side view of the openable hook probe of the same embodiment.
FIG. 50 is a view showing an observation image of the usage state of the embodiment.
FIGS. 51A and 51B show an open / close hook probe according to a fourth embodiment of the present invention, in which FIG. 51A is a longitudinal side view, and FIG.
52 shows an open / close hook probe according to a fifth embodiment of the present invention, in which (a) is a side view and (b) is a front view. FIG.
53 shows an open / close hook probe according to a sixth embodiment of the present invention, in which (a) is a longitudinal side view, and (b) is an arrow view seen from the direction of arrow H. FIG.
FIG. 54 shows a system according to a seventh embodiment of the present invention, in which a peeler is inserted from one skin cut portion along the groove on the upper surface side of the tissue protector and penetrated to the other skin cut portion. FIG.
FIG. 55 shows a state in which the exfoliator constituting the system according to the seventh embodiment is inserted from one skin incision part along the groove on the upper surface side of the tissue protector and penetrated to the other skin incision part. Figure.
FIG. 56 is a side view of a peeler constituting a system according to a seventh embodiment.
FIG. 57 is an exploded perspective view of a cavity securing device constituting the system according to the seventh embodiment.
58 is a perspective view of an insertion assisting tool for guiding and assisting insertion of the outer tube of the cavity securing tool of FIG. 57. FIG.
59 is a side sectional view showing a state in which the insertion assisting tool of FIG. 57 is attached to the outer tube of the cavity securing tool of FIG. 57.
60 is a perspective view showing a state in which the outer tube of the cavity securing device of FIG. 57 is inserted into the subcutaneous tissue.
61 is a view showing a state in which the inner tube is inserted into the outer tube from the state of FIG. 60. FIG.
62A is a longitudinal side view of FIG. 61, FIG. 62B is a sectional view taken along line JJ in FIG. 61A, and FIG. 62C is a sectional view taken along line KK in FIG.
63 (a) is a longitudinal side view showing a state where a rigid endoscope is inserted into the inner tube in the state of FIG. 62 (a), and FIG. 63 (b) is an observation by the endoscope in the state of (a). The figure which shows an image.
64A is a longitudinal side view showing a state in which the hook probe is inserted into the inner tube in the state of FIG. 63A, and FIG. 64B is an observation image by the endoscope in the state of FIG. FIG.
FIG. 65 is a schematic configuration diagram of an endoscope system.
FIG. 66 is a plan view showing an image observed by an endoscope.
FIG. 67 is a perspective view of a cavity securing device according to an eighth embodiment of the present invention.
68 (a) is a longitudinal side view showing a state in which a rigid endoscope is inserted into an inner tube while the cavity securing device of FIG. 67 is inserted into a subcutaneous tissue, and (b) is a state of (a). The figure which shows the observation image by the endoscope in.
69A is an exploded perspective view of a cavity securing device according to a ninth embodiment of the present invention, and FIG. 69B is a vertical side view of the cavity securing device in FIG.
70 is a perspective view of a mantle tube of a cavity securing device according to a tenth embodiment of the present invention. FIG.
FIG. 71 is an exploded perspective view of the cavity securing device according to the tenth embodiment of the present invention.
72 is a side sectional view showing a state in which the insertion assisting tool of FIG. 58 is attached to the outer tube of FIG. 70.
73 is a perspective view showing a state in which the outer tube of the cavity securing device of FIG. 71 is inserted into the subcutaneous tissue. FIG.
74 is a view showing a state in which the inner tube is inserted into the outer tube from the state of FIG. 73. FIG.
75A is a longitudinal side view of FIG. 74, FIG. 75B is a sectional view taken along line LL in FIG. 74A, and FIG. 75C is a sectional view taken along line MM in FIG.
76A is a longitudinal side view showing a state in which a rigid endoscope is inserted into the inner tube in the state of FIG. 75A, and FIG. 76B is an observation by the endoscope in the state of FIG. The figure which shows an image.
77 (a) is a longitudinal side view showing a state in which the hook probe is inserted into the inner tube in the state of FIG. 76 (a), and FIG. 77 (b) is an observation image by the endoscope in the state of (a). FIG.
78 is a perspective view of a cavity securing device according to an eleventh embodiment of the present invention. FIG.
79 (a) is a longitudinal side view showing a state in which a rigid endoscope is inserted into an inner tube while the cavity securing device of FIG. 78 is inserted into a subcutaneous tissue, and (b) is a state of (a). The figure which shows the observation image by the endoscope in.
80A is an exploded perspective view of a cavity securing device according to a twelfth embodiment of the present invention, and FIG. 80B is a vertical side view of the cavity securing device in FIG.
81 (a) is a perspective view of a cavity preparation device according to a thirteenth embodiment of the present invention, FIG. 81 (b) is a side view of the cavity preparation device of FIG. 81 (a), and FIGS. Front view of the tool.
82A and 82B are plan views of a tissue protector according to a thirteenth embodiment of the present invention, and FIG. 82C is a cross-sectional view of the distal end portion of the tissue protector of FIG.
83 is a cross-sectional view showing a state where the cavity creating tool of FIG. 81 and the tissue protector of FIG. 82 are inserted into the subcutaneous tissue.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 10 ... Stripper, 20,80 ... Rigid endoscope, 30 ... Tissue protector, 50 ... Cavity preparation tool, 60 ... Cavity securing tool, 130, 141 ... Open / close hook probe (tissue peel probe), 131, 142 ... operation unit, 133, 160 ... shaft, 134, 161 ... pipe (shaft), 135, 136, 162, 163 ... hook.

Claims (2)

An exfoliator that is inserted from the skin incision, and exfoliates at least part of the tissue surrounding the blood vessel along the blood vessel ;
A cavity securing device to be placed in order to secure a cavity between the blood vessel peeled by the peeler from the skin incision and the surrounding tissue;
A blood vessel detachment treatment tool that is inserted into the cavity secured by the cavity securing tool and detaches the blood vessel from the surrounding tissue so as to collect the blood vessel in the cavity .
The vascular detachment treatment tool
First and second shafts extending concentrically in the same direction;
An operating portion that is provided at proximal ends of the first and second shafts and is capable of moving and operating the first and second shafts relative to each other along their axial directions;
A first hook provided at a tip of the first shaft and protruding laterally with respect to an axial direction of the first shaft;
It is provided at the tip of the second shaft, protrudes laterally with respect to the axial direction of the second shaft, and is disposed at a position closer to the operation portion than the first hook. With the second hook
Comprising
The second shaft and the second hook are movable with respect to the operation unit in a state where the first shaft and the first hook are fixed relative to the operation unit. Endoscopic blood vessel collection device. The endoscopic blood vessel collection device according to claim 1 , further comprising an endoscope that is inserted into a cavity formed by the cavity securing tool and is capable of observing the blood vessel and the cavity.

Images