JP4297710B2 - Exclusion device - Google Patents

Description

[0001]
[Industrial application fields]
The present invention relates to an exclusion device for controlling the exclusion of organs and the like that obstruct the field of view and the field of view in surgical operations and securing a surgical space and a surgical field.
[0002]
[Prior art]
In a surgical operation, in order to prevent peripheral organs that interfere with the operation from entering the surgical target site, it is necessary to hold and hold the surrounding tissue with a hand or a forceps during the operation.
In particular, in the case of endoscopic small incision surgery, which is performed with the incision as small as possible under the field of view of the endoscope, there is a limitation in the surgical space, and in order to ensure an optimal field of view. And this exclusion plays an even more important role.
However, with the conventional forceps, the forceps forceps area is small, so it is difficult to reliably hold organs such as the small intestine that are large and move easily in the body cavity. There is a problem that is difficult.
[0003]
On the other hand, an instrument having a thin film-shaped exclusion portion that can be approached from a small incision and that can exclude a large area by applying endoscopic surgery has been developed by the present inventors. Proposed as a tractor. This is an instrument that is intended for use in endoscopic surgery, and includes an extruding part comprising a sheet of rubber elastic thin film and a frame that substantially surrounds and surrounds the periphery of the sheet of sheet, and the excluding part The frame is made of a super elastic alloy or shape memory alloy, and when inserted into a body cavity, the exclusion part is reduced in diameter so that it can be inserted from a trocar or small incision. In the body cavity, the retractor has a function of restoring the original shape having a wide exclusion area. (See Patent Document 1.)
[0004]
[Patent Document 1]
Japanese Patent Application 2001-36627
[0005]
[Problems to be solved by the invention]
However, according to the above-mentioned exclusion device, there is no major problem with respect to the exclusion function, but like the conventional general forceps, during the operation, the operator or an assistant always grasps the handle portion of the exclusion device to maintain the exclusion. There is a problem that it is a difficult work in a long-time operation, and at the same time, human labor is required only for the work and the human burden is large.
[0006]
Therefore, the present invention can reliably exclude a wide range of organs that are difficult to maintain, such as the small intestine, and does not need to be manually held during the operation, and can be retained by the self-holding force of the instrument itself. The task was to provide equipment.
[0007]
Furthermore, an object of the present invention is to provide a low-cost retraction device that can be applied to a small incision operation under an endoscope.
[0008]
[Means for Solving the Problems]
The exclusion device of the present invention includes a flexible sheet that serves as an exclusion part of tissue such as an organ, and a flexible elastic frame having an elastic restoring force that is fixed around the sheet to form an annular shape. And a device capable of self-holding by the elastic restoring force of the elastic frame when inserted into the body cavity with the organ or the like evacuated. In this specification, the sheet-like sheet basically has a single plate-like form, but also includes a form having a space on the sheet surface such as a mesh form, and forms one sheet as a whole. It is defined to encompass the entire form.
[0009]
As a means for inserting the exclusion device into the body cavity, the elastic frame is crushed and curved between stable tissues narrower than the width of the exclusion device in the body cavity in a state in which an organ or the like is stored in the planar sheet and removed. The elastic frame is held and fixed in a state of being held, and is self-held by the restoring force of the elastic frame.
[0010]
In addition to a flexible planar sheet serving as the exclusion portion and a flexible elastic restoring force that is fixed around the planar sheet to form an annular shape, the planar sheet or the elastic frame One or a plurality of threads are engaged with each other and extended, and when inserted into a body cavity to exclude an organ or the like, an instrument capable of self-holding by the tension of the thread is provided.
[0011]
As a means for inserting the retraction device into the body cavity, the thread is pulled from the outside of the body cavity in a state where the organ or the like is stored in the surface sheet, and the thread end is engaged and fixed to an appropriate part of the human body or outside the body. And held by the tension of the yarn.
[0012]
The elastic frame was constructed using a superelastic alloy or a shape memory alloy for a part or all of the elastic frame.
[0013]
[Action]
According to this means, the retraction device can be fixed at an appropriate position inside the body cavity by the elastic restoring force of the elastic frame or the self-holding force using the tension of the thread. In this case, it can be left as it is during the operation. Further, as in the prior art, the field of view and the space of the incision wound portion are opened by removing the handle of the forceps that interferes with the operator during the operation and the hand holding the forceps from the periphery of the incision wound.
[0014]
In addition, the exclusion part is formed from a flexible sheet and the frame is formed from a flexible elastic body. And allows access to a body cavity from a small incision.
[0015]
Furthermore, in addition to the elastic restoring force of the frame, it is possible to fix the exclusion device to the exclusion part in the body cavity by the tension of the thread, and it is used even when there is no appropriate tissue holding the frame around. be able to.
[0016]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described in detail with reference to the drawings. Various modifications can be made to the following embodiments, and such modifications are also included in the technical scope of the present invention as long as they have the structure of the claims.
[0017]
FIG. 1 shows a first embodiment of the exclusion device of the present invention. This exclusion device includes a flexible planar sheet 1 that is inserted into a body cavity and retains a peripheral tissue around a surgical operation, and a flexible elastic frame that is bonded or welded to a peripheral edge of the planar sheet 1 to form an annular shape. The sheet 1 is made of a silicon rubber sheet having a suitable area and shape for an applied operation such as an ellipse or a polygon as a flexible sheet, while the elastic frame 2 is a superelastic alloy. The wire 21 is covered with a cover tube 22 of a flexible resin (polyurethane resin in the embodiment), and an outer tube 23 of a flexible resin (silicon tube in the embodiment) is further coated on the outer layer to form a triple structure. The end portions are bonded or welded to form an annular body having the same length as the outer periphery of the planar sheet 1, and the elastic frame 2 is entirely surrounded along the outer peripheral edge of the planar sheet 1. Over It is constructed by bonding or welding.
[0018]
FIG. 2 is a cross-sectional view taken along the line AA of the embodiment. As described above, the elastic frame 2 includes the superelastic alloy wire 21 having a high elastic restoring force at the center core and the elastic frame at the outer layer. Cover tube 22 made of polyurethane resin to form 2 with appropriate hardness and elasticity, and outer tube 23 made of silicone resin that is flexible and does not slip when inserted, is provided on the outer layer. It has a triple structure.
[0019]
FIG. 3 shows a state in which the exclusion device of the first embodiment is inserted into the body cavity and the tissue around the treatment is excluded. The tissue (for example, the small intestine 4) to be evacuated is placed on the surface of the sheet 1 and the elastic frame 2 is squeezed against the elasticity at a position where the evacuation is to be held, and the elastic frame 2 is clamped in a state where the instrument is curved If the tissue between which the elastic frame 2 can contact is disposed between appropriate tissues (for example, the peritoneum 51 and the retroperitoneum 52) narrower than the width of the exclusion device, the elastic restoring force of the elastic frame 2 acts, As a result, it is possible to hold the instrument in a state of being clamped and fixed between the tissues and excluding the tissues. In addition, when inserting into and removing from the body cavity, the elastic frame 2 is similarly crushed and bent so that a large retraction device can be inserted into and removed from the incision. It can be applied to small incision surgery.
[0020]
FIG. 4 shows a second embodiment of the exclusion device of the present invention. At the appropriate position of the elastic frame 2 of the retraction device having the shape and structure of the first embodiment, a plurality of resin yarns 3 (in the embodiment, four polyamide resin yarns) are attached in a balanced manner by ligation or the like. When there is no engaging tissue for holding the elastic frame 2 in a curved state when the tissue surrounding the surgical operation is inserted in the body cavity in a state in which the tissue is evacuated (for example, the peritoneum in a fat patient) 51 and the retroperitoneum 52 have a large width, and there is no tissue gap narrower than the width of the device in the space where the device is desired to be retained), or the retention by the restoring force of the device of the first embodiment. It becomes a form in the case of being used as a fixing auxiliary means for making it more reliable.
[0021]
FIG. 5 shows a state where the exclusion device of the second embodiment is inserted into a body cavity and the surgical tissue is excluded. A tissue to be evacuated (for example, the small intestine 4) is placed on the surface of the planar sheet 1, and the thread 3 is pulled out of the body from the outer tube port 6 that has been drilled through the abdominal wall in advance using forceps or the like. When the end of the thread 3 is fixed and held by ligation or the like at an unspecified human body or an appropriate part outside the body with the tension applied to the thread 3, the tension of the thread 3 acts, and the exclusion device is moved into the body cavity. As a result, it is possible to hold the device in a state where the tissue is evacuated.
In this case, as an operation procedure, when the retraction device is inserted into the body cavity, the thread 3 is pulled out to the outside of the body cavity with forceps in advance, and the tissue to be relieved is placed on the surface of the sheet 1 and set at an appropriate position. Then, pull the yarn and hold it in a state of applying sufficient tension.
Further, the outer tube port 6 of the passage through which the thread 3 is taken out from the body does not need to be provided only for this means, and it is sufficient to share a port drilled for inserting a surgical instrument such as an endoscope or forceps. Further, in the case of surgery without using the mantle tube port 6 or when there is no mantle tube port 6 suitable for removal, it is preferable to use a passage less invasive to the human body, such as a small diameter needle hole. For example, a means may be used in which a hollow puncture needle is punctured, the thread 3 is pulled out of the body with a wire or the like whose tip is formed in a hook shape through the lumen, and the needle tube is removed.
Further, in order to stabilize the exclusion device, it is preferable to disperse the yarn 3 from a plurality of extraction portions in a balanced manner. (In the example, two yarns were taken out from the two outer tube ports.)
Of course, the superelastic alloys of the first embodiment and the second embodiment may be replaced with shape memory alloys.
[0022]
【The invention's effect】
According to the present invention, when the retraction device is inserted into the body cavity due to the above-described action, it is self-held in the body cavity by the restoring force of the elastic frame or the tension of the thread, and the holding from the outside by the assistant or the like becomes unnecessary. Thus, it is possible to perform an operation that does not require manual labor without the burden of an assistant or the like related to the exclusion. In addition, since there are no forceps or a holder's hand around the incision, the field of view and space of the surgical site are widened, and the surgical treatment can be facilitated.
[0023]
In addition, as described above, by using a flexible thin-film planar sheet for the exclusion portion and an elastic body for the frame, it is possible to exclude large and easily moving tissue on the wide surface of the outer sheet. By crushing and bending the elastic frame, it can be deformed to a size that can be inserted into a body cavity from a small incision, so there are conflicting problems such as inserting from a small incision and holding out a large area. It can be set as the instrument applicable to the endoscopic small incision operation which fills.
[0024]
Furthermore, compared to a conventional exclusion device for the purpose of exclusion, the structure is simple and the manufacture is easy, so that the cost can be kept low, and an inexpensive retractor can be provided.
[Brief description of the drawings]
FIG. 1 is a configuration diagram showing a first embodiment of the present invention.
FIG. 3 is a cross-sectional view taken along the line AA of the first embodiment. FIG. 3 is a schematic diagram showing a body cavity insertion state of the first embodiment. FIG. 4 is a configuration showing a second embodiment of the present invention. FIG. 5 is a schematic diagram showing an intracorporeal insertion state of the second embodiment.
1. Planar sheet 2. Elastic frame 21. Superelastic alloy 22. Cover tube 23. 2. Mantle tube Thread 4. Small intestine 51. Peritoneum 52. Retroperitoneum Mantle tube port

Claims (5)

An instrument that is inserted into a body cavity during surgery to hold an organ or the like in place, and is a flexible sheet that serves as an exclusion part, and a flexible elasticity that forms a ring by adhering to the periphery of the sheet. An exclusion device comprising an elastic frame having a restoring force, and capable of self-holding by the elastic restoring force of the elastic frame when the organ or the like is removed by being inserted into a body cavity. As means for inserting the exfoliation device into the body cavity, the elastic frame is bent and held between stable tissues narrower than the width of the exfoliation device in the body cavity in a state in which an organ or the like is contained in the planar sheet and is excised. The retraction device according to claim 1, wherein the retraction device is self-held by a restoring force of the elastic frame. An instrument that is inserted into a body cavity during surgery to hold an organ or the like in place, and is a flexible sheet that serves as an exclusion part, and a flexible elasticity that forms a ring by adhering to the periphery of the sheet. The elastic frame having a restoring force, and a sheet, or one or a plurality of threads extending from the elastic frame, are configured to be inserted into a body cavity to exclude an organ or the like, and the tension of the thread Relief device characterized by being capable of self-holding. The thread is fixed to an appropriate part of the human body or outside the body, and is self-held by the tension of the thread as a means for inserting the exclusion device into the body cavity in a state where an organ or the like is stored and removed by the planar sheet. 3. Exclusion device. The exclusion device according to any one of claims 1 to 4, wherein a superelastic alloy or a shape memory alloy is used for a part or all of the elastic frame.

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