JP4302246B2 - Medical treatment instrument insertion tool - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention secures a visual field of a subcutaneous tissue space under carbon dioxide gas supply in a surgical operation under a subcutaneous endoscope, and enables an endoscope and forceps to be simultaneously inserted and operated from a single skin incision. The present invention relates to a medical treatment instrument insertion tool.
[0002]
[Prior art]
In recent years, endoscopic surgery has been widely practiced as a method of minimally invasive surgery. Endoscopic surgery mainly forms a treatment space by injecting carbon dioxide into the abdominal cavity when performing operations on various organs of the abdomen, such as the stomach, spleen, intestine, and gallbladder. In this method, a plurality of mantle tubes for inserting a treatment instrument such as the above are inserted, and a surgical operation is performed by remote operation while viewing an image viewed from an endoscope on a screen. Furthermore, it has been applied as a hypodermic endoscopic operation to large saphenous vein sampling, lower extremity varicose vein surgery, and mammary gland surgery in AC bypass surgery, and the surgical incision is smaller than conventional surgery. The subsequent incision can be made so small that it is inconspicuous, and it is cosmetically effective. Further, since the post-operative burden on the patient is light and the hospitalization period is short, there is a great merit for the patient and the hospital.
[0003]
Currently, trocars used for subcutaneous endoscopic surgery are made based on those for laparoscopic and thoracoscopic surgery, and are shorter than those used for intraperitoneal surgery, and are kept airtight with a balloon or sponge. Although it is fixed, it is not sufficient for use in a narrow treatment space. “Tracar itself is hard and long” “Only one endoscope or forceps can be inserted, so another trocar is inserted for treatment "It is necessary to use a tool, and there are two or more wounds", "Because of the trocar sheath or balloon, etc., the blind spot is a blind spot", "The wound edge is not protected", "Not enough airtightness", etc. There were drawbacks.
[0004]
In order to solve these problems, the enclosure is flexible and has an inner surface and an open end, and the open end has a deployment means for protecting the abdominal wall and airtightness, and further includes at least one for accessing the inside of the enclosure. US Pat. No. 5,480,410 discloses a device that has an access opening and is capable of performing surgery in the abdominal cavity or inside an enclosure. This device is not a rigid trocar used in conventional laparoscopic and thoracoscopic surgery, but is made of a flexible sheet material. It is inserted from the mouth and deployed in the abdominal cavity. Carbon dioxide gas for abdominal stomach flows into the enclosure from the abdominal cavity to expand the enclosure, and the deployment means protects the abdominal wall from airtightness. Furthermore, if a plurality of access openings are attached to the outer peripheral surface of the enclosure, a plurality of forceps can be inserted, observation directly under the wound is possible, and the wound edge is protected. However, since the enclosure is basically spherical and the distance to each access opening attached to the outer peripheral surface is determined and fixed at the time of setting, when inserting a plurality of treatment instruments, When the treatment tool is moved greatly, other treatment tools are also dragged and moved.
[0005]
[Problems to be solved by the invention]
The present invention solves such drawbacks of treatment in conventional subcutaneous endoscopic surgery, and the object of the present invention is to provide an endoscope or more than one incision site in a narrow treatment space such as subcutaneous. Treatment tools such as forceps can be inserted at the same time, easy to attach and detach, have sufficient airtightness, are not likely to cause fighting or movement obstacles between forceps, and do not become blind spots directly under the wound, protecting the wound edge Another object of the present invention is to provide a medical treatment instrument insertion tool having a simple structure.
[0006]
[Means for Solving the Problems]
That is, the present invention has a Y-shaped space, of which 50 to 75% of the total length on the proximal end side is divided into two or three in the Y shape at an angle of 20 to 60 degrees. It is a flexible cylindrical sheet with an insertion port at the proximal end and an outlet at the distal end. When a treatment instrument is not inserted into the connector corresponding to each insertion port on the proximal end side A first airtight member that keeps the inside of the apparatus airtight and a second airtight member that keeps the inside of the apparatus airtight when the treatment instrument is inserted are attached, and an annular member is adjacent to the outer periphery of the distal end side. A medical treatment instrument insertion tool which is attached and further has a carbon dioxide gas supply port in a part of a cylindrical sheet or connector.
[0007]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, the present invention will be specifically described with reference to the drawings. FIG. 1 shows an external view of a medical treatment instrument inserter according to an embodiment of the present invention, and FIG. 2 shows an external view of a medical treatment instrument inserter according to another embodiment of the present invention. 3 and 4 are views showing a state where the treatment instrument is inserted in a state where the medical treatment instrument insertion tool is inserted into the small opening and made airtight.
[0008]
The medical treatment instrument insertion tool according to the present invention has a proximal end divided into two or three in a Y shape as shown in FIG. 1 or FIG. A connector (2) for inserting forceps or the like is attached to the proximal end of the flexible cylindrical sheet (1) having an outlet, and the connector (2) is airtight when no forceps or the like is inserted. In order to maintain, the 1st airtight member (3) may be arrange | positioned, a connector front-end | tip may be closed with a cap etc., and valve members, such as a flap valve and a duckbill valve, may be attached inside a connector (2). Further, a second airtight member (4) may be disposed and a seal valve with a circular hole may be provided in order to maintain airtightness when inserting forceps or the like. Further, the distal end side forms a deformable annular member (5) adjacent to the outer periphery of the distal end side, and further connects to the connecting tube (6) or the connector (2) connected to the cylindrical sheet (1). It consists of a gas inlet (7) or (8).
[0009]
The cylindrical sheet (1) is a thin cylindrical sheet member having a thickness of 0.1 to 2 mm, and is usually produced by inflation molding, sheet processing such as thermal welding, or the like, but is not particularly limited. The size of the cylindrical sheet (1) varies depending on the site to be treated and the purpose, but when used for subcutaneous surgery of the lower limb, the size is about 10 cm × 15 to 20 cm. The proximal end is divided into two or three in a Y shape. When operating each with an endoscope or forceps inserted, the length of the proximal end is approximately 50 to 75% so that the movement is not restricted. It is preferable that the length is divided into a Y shape at an angle of 20 to 60 degrees, and the remaining length portion in the distal end direction is integrated. Also, during use, because the distal end is inserted into and fixed to the incision, and treatment tools such as endoscopes and forceps frequently enter and exit in the cylindrical sheet (1) in an expanded state due to carbon dioxide gas, It is better to choose a material that does not get in the way, is not bulky, is flexible, and does not easily break, crack, or tear even when hit with a treatment instrument. For example, soft vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene Materials such as resin, polyester resin, silicone rubber, and natural rubber are preferable.
[0010]
The connector (2) is usually formed by injection molding and attached to the proximal end of the cylindrical sheet (1), and the first airtight member (3) and the second airtight member (4) are attached or built in. . In the case of subcutaneous surgery, the endoscope and forceps enter almost in parallel, so if the outer diameter of the connector (2) is too large, the connectors (2) will hit each other and hinder the operation. The outer diameter of the connector (2) is preferably suppressed to the outer diameter of the device to be inserted +15 mm or less. Further, for the connector (2), each airtight member should be attached without deformation, and a material that can be thermally welded or adhered to the cylindrical sheet (1) with a solvent or an adhesive should be selected. Vinyl chloride resin, polyurethane resin Polyethylene resin, polypropylene resin, polyacetal resin, polycarbonate resin, polysulfone resin, or the like may be used.
[0011]
The first airtight member (3) is installed to maintain airtightness when forceps or the like are not inserted, and the connector tip is closed with a cap or the like, or a flap type valve or duckbill is placed inside the connector (2). A valve member such as a type of valve may be provided. When closing with a cap or the like, it may be engaged with the connector (2) by unevenness or fixed with screws. Caps are usually molded by injection molding, etc., and the material should be the same as or slightly softer than connector (2), such as vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, polycarbonate resin, polysulfone resin Resin or synthetic rubber such as silicone rubber, natural rubber or NBR is used. The flap type valve is usually a combination of a hard molded product such as a built-in trocar used in laparoscopic surgery and a spring member, but an elastic member such as silicone rubber is molded into a flap shape. You may process and use. Since the flap type valve does not open to the outside of the body and moves only to the inside of the body, the flap is pushed and closed by the positive pressure inside the body when the treatment tool or the like is not inserted. The flap type valve is molded by injection molding or compression molding, and the material is vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, polycarbonate resin, polysulfone resin, silicone rubber or the like. Similarly, duckbill type valves are molded by injection molding or compression molding, and are mainly made of an elastic material such as silicone rubber.
[0012]
The second hermetic member (4) is arranged to keep hermeticity when inserting forceps or the like, and may be provided with a seal valve or the like having a circular hole. The seal valve is manufactured by injection molding, compression molding, sheet processing or the like, and is thermally welded or bonded to the connector (2). The thickness of the seal valve is suitably about 0.1 to 3 mm. This is because if it is less than 0.1 mm, the valve is easily deformed by the pressure of carbon dioxide gas, and if it exceeds 3 mm, the frictional resistance when inserting a treatment instrument such as forceps increases, making insertion difficult. The inner diameter of the seal valve is suitably 0.5 mm to 30 mm according to the outer diameter of the treatment instrument or the like. The material of the seal valve is preferably flexible, and for example, natural rubber, silicone rubber, vinyl chloride resin, urethane resin, SEBS resin and the like are suitable.
[0013]
The annular member (5) is formed adjacent to the outer periphery on the distal end side of the cylindrical sheet (1). Usually, it is produced by processing of injection molding, compression molding or extrusion molding tube, wrapped in a cylindrical sheet (1), closely adhered and thermally welded or adhesively fixed. The inside / outside diameter is not limited because it depends on the size of the opening to be treated and the size of the opening to be inserted and the size of the treatment tool to be inserted, but it is about 2 to 2.5 cm when performing subcutaneous endoscopic surgery on the lower limbs. It is appropriate to set an inner diameter of about 3 cm and an outer diameter of about 5 cm for a small incision. As the material of the annular member (5), vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, silicone rubber, or the like is used.
[0014]
The carbon dioxide gas supply port (7) is attached to the end of the connection tube (6) connected to the inside of the cylindrical sheet (1), or is installed as a carbon dioxide gas supply port (8) in the connector (2). The When attached to the connection tube (6), the connection tube (6) is produced by extrusion molding and attached to the cylindrical sheet (1) by thermal welding or adhesion. It is advisable that the tube is partially adhered in the length direction to the inner wall and the outer wall of the cylindrical sheet (1) so that the tube does not wobble during operation. The inner and outer diameters of the connection tube (6) are usually selected from an inner diameter of 0.5 to 2 mm and an outer diameter of 1 to 3 mm. The material may be a flexible material, and soft vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, silicone rubber, or the like is used. The carbon dioxide gas supply ports (7) and (8) are formed by injection molding. In the case of the carbon dioxide gas supply port (7), they are bonded to the connection tube (6) with a solvent or an adhesive, and the carbon dioxide gas supply port. In the case of the mouth (8), the connector (2) is molded at the same time. The carbon dioxide gas inlet is formed in a shape that can be fitted in order to connect to a tube coming from the pipe. As the material, vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, polycarbonate resin, polysulfone resin, silicone rubber and the like are used.
[0015]
Next, an actual method of using the medical treatment instrument insertion tool according to the present invention will be described with reference to FIGS. 3 and 4 to clarify the effects of the present invention. When performing endoscopic subfascular traffic branch dissection, which is a subcutaneous endoscopic operation of the lower limbs, make a skin incision of about 2 cm, insert a treatment tool for peeling under the fascia, etc. Remove the fascia below. An expansion balloon is inserted under the peeled fascia and the like to further expand the subfascia. Insert the part of the annular member (5) of the medical treatment instrument insertion tool according to the present invention from the skin incision below the fascia, and pull the cylindrical sheet (1) to fix the subcutaneous member and the annular member (5) in close contact. To do. When carbon dioxide gas is supplied from the carbon dioxide gas supply port (7) or (8), the first airtight member (3) keeps the airtightness, the subfascial space is expanded, and the medical instrument insertion tool is carbonic acid. Fills with gas and expands. When the endoscope is inserted from the connector (2) through the second hermetic member (4), a good visual field is recognized, and forceps are inserted from the other side to process the object. Even if one forceps or the like is moved back and forth and left and right, the cylindrical sheet (1) is flexible and has a Y-shape, so the other is not affected and the movement is restricted or the treatment tools collide with each other. There is nothing to do. According to the present invention, a conventional incision for arranging a port for inserting forceps and the like in addition to arranging an endoscope insertion port can be performed by only one incision of about 2 cm. become. Further, since only the annular member (5) is inserted under the skin, the area directly under the wound does not become a blind spot, and the wound edge is protected by the cylindrical sheet (1).
[0016]
【The invention's effect】
With the medical treatment tool insertion tool of the present invention, treatment tools such as an endoscope and forceps can be simultaneously inserted from a single incision portion in a narrow treatment space such as subcutaneous. Furthermore, it is easy to attach and detach, has sufficient airtightness, does not easily cause fighting and movement troubles between forceps, and allows safe treatment without causing a blind spot directly under the wound. In addition, the wound edge is protected by the sheet, and the number of ports used by the patient is reduced, so the number of wounds caused by the patient's surgery is reduced, which is useful for cosmetic purposes. Reduction effect can be expected.
[Brief description of the drawings]
FIG. 1 is a diagram showing an external appearance of a structure of a medical treatment instrument insertion tool according to an embodiment of the present invention.
FIG. 2 is a diagram showing the external appearance of the structure of a medical treatment instrument insertion tool according to another embodiment of the present invention.
FIG. 3 is a schematic view showing an example of a method of using a medical treatment instrument insertion tool according to an embodiment of the present invention.
FIG. 4 is a cross-sectional view of an example of a method for using a medical treatment instrument insertion tool according to an embodiment of the present invention.
[Explanation of symbols]
1. 1. Cylindrical sheet Connector 3. First airtight member 4. Second airtight member 5. Annular member 6. 6. Connection tube Carbon dioxide gas inlet 8 Carbon dioxide gas inlet 9. Skin 10 Incision 11. Endoscope 12. forceps

Claims (1)

Has a Y-shaped space, of which 50-75% of the total length on the proximal end side is divided into two or three Y-shaped at an angle of 20-60 degrees, Is a flexible cylindrical sheet with an insertion port and an outlet at the distal end. When the treatment tool is not inserted into the connector corresponding to each insertion port on the proximal end side, the inside of the device is airtight. A first airtight member to be maintained and a second airtight member to keep the inside of the apparatus airtight when the treatment instrument is inserted are attached, and an annular member is attached to the distal end side adjacent to the outer periphery thereof, and further a cylinder A medical treatment instrument insertion tool having a carbon dioxide gas supply port in a part of a sheet-like sheet or connector.

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