JP4385112B2 - 創傷レトラクタ - Google Patents
創傷レトラクタ Download PDFInfo
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- JP4385112B2 JP4385112B2 JP2001529351A JP2001529351A JP4385112B2 JP 4385112 B2 JP4385112 B2 JP 4385112B2 JP 2001529351 A JP2001529351 A JP 2001529351A JP 2001529351 A JP2001529351 A JP 2001529351A JP 4385112 B2 JP4385112 B2 JP 4385112B2
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0293—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with ring member to support retractor elements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/32—Devices for opening or enlarging the visual field, e.g. of a tube of the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0206—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with antagonistic arms as supports for retractor elements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/50—Supports for surgical instruments, e.g. articulated arms
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B17/3431—Cannulas being collapsible, e.g. made of thin flexible material
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00265—Hand assisted surgery, i.e. minimally invasive surgery with at least part of an assisting hand inside the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
- A61B2017/00557—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated inflatable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
- A61B17/0218—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery
- A61B2017/0225—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors for minimally invasive surgery flexible, e.g. fabrics, meshes, or membranes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B2017/3419—Sealing means between cannula and body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
- A61B17/3421—Cannulas
- A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
- A61B2017/3429—Access ports, e.g. toroid shape introducers for instruments or hands having a unitary compressible body, e.g. made of silicone or foam
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
- A61B2017/3482—Means for supporting the trocar against the body or retaining the trocar inside the body inside
- A61B2017/3484—Anchoring means, e.g. spreading-out umbrella-like structure
- A61B2017/3488—Fixation to inner organ or inner body tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
- A61B2017/3492—Means for supporting the trocar against the body or retaining the trocar inside the body against the outside of the body
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- General Health & Medical Sciences (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Pathology (AREA)
- Physics & Mathematics (AREA)
- Biophysics (AREA)
- Optics & Photonics (AREA)
- Radiology & Medical Imaging (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Surgical Instruments (AREA)
- Materials For Medical Uses (AREA)
- Eye Examination Apparatus (AREA)
- Automotive Seat Belt Assembly (AREA)
- Devices For Conveying Motion By Means Of Endless Flexible Members (AREA)
- Macromolecular Compounds Obtained By Forming Nitrogen-Containing Linkages In General (AREA)
- Harvester Elements (AREA)
- Winding Filamentary Materials (AREA)
Description
【技術分野】
本発明はレトラクタに関する。特に、本発明は、検査及び/または外科手術のアクセスのために器官または肉体構造を最大に露出させるべく切創または肉体の自然な開口部の縁を開創しつつ、切創した組織の露出面を保護するためのレトラクタに関する。
【0002】
【背景技術】
様々なレトラクタが知られている。しかしながら、一般に、公知のレトラクタは使用が困難で扱い難く、かつ/又は比較的高価である。更に、公知のレトラクタは、特定の寸法の切創及び特定の患者の解剖について使用するように制限されている。
【0003】
本発明は、これらの問題の少なくとも幾つかを解消する、改良された創傷レトラクタを提供することを目的とし、かつ更に外科的処理の際における創傷の保護手段を提供するものである。
【0004】
【発明の開示】
本発明によれば、創傷開口内に挿入するための遠位側アンカ部材と、
内側創傷係合部分及び外側部分を有し、前記創傷係合部分が前記遠位側アンカ部材に取り付けられ、前記内側創傷係合部分が縮径された放射方向寸法を有するような挿入形状と開創形状とを有する結合手段と、
前記結合手段の前記外側部分のための外部ガイド手段とを備え、
前記外部ガイド手段が前記結合手段に関して動いて、前記結合手段の軸方向長さを短くしかつそれにより前記結合部材の前記創傷係合部分を前記開創形状へと付勢して、前記創傷開口を側方へ開創することができ、かつ
前記結合手段を固定して前記開口の開創を維持するための外部アンカ手段を備えることを特徴とする外科用創傷レトラクタが提供される。
【0005】
本発明のある好適な実施例では、前記結合手段の少なくとも前記内側創傷係合部分が、前記創傷開口の周囲に延長して該開口を保護するためのスリーブからなる。
【0006】
ある実施例では、前記結合手段の前記外側部分が、前記結合手段の前記内側創傷係合部分のスリーブ延長部からなる。
【0007】
好ましくは、前記結合手段が概ね円筒状のスリーブからなる。
【0008】
好適な実施例では、前記ガイド手段が環状リング手段からなる。好ましくは、前記環状リング手段が、その間を前記結合手段が通る内側及び外側リング部からなる。
【0009】
好適な実施例では、前記外側リング部が、前記結合手段を固定するためのアンカ手段を有する。ある構成では、前記アンカ手段が、前記開口の開創時に前記結合手段が取りつけられる前記外側リング状のアンカ構造を有する。
【0010】
好ましくは、前記内側リング手段が、前記外側リングの補完的な凹所内へ配置するための突起を画定し、それらの間に前記結合手段を配置する。
【0011】
ある実施例では、前記内側リングが、前記外側リング部の凹所に比較的緩やかな嵌め合せを有する。
【0012】
好ましくは、一方の前記リング部の少なくとも一部分が、前記結合部材が実質的に前記リング部間に締め付けられる静止位置から、前記結合部材の少なくとも一部分が前記リング部に関して動くことができる開放位置へと動かすことができる。理想的には、前記結合手段の一部分のみが、前記開放位置において前記リング部に関して動くことができる。
【0013】
ある実施例では、前記内側リングが、前記外側リング部に比較的に比較的きつい嵌め合いを有し、それらの間に前記結合部材を把握するようにする。
【0014】
本発明のある側面では、前記外側リング部が、相互に連結された複数のセグメントを有し、それらが、前記開口において作用する開創力を調整するために前記結合部材の局所的な開放を容易にするべく独立して動くことができる。
【0015】
好ましくは、前記リング部またはそのセグメントが、締め付けられた前記静止位置と前記開放位置との間で手で操作可能である。
【0016】
本発明のある実施例では、前記結合手段が、前記外部アンカ手段と係合するための基部側補強手段を有する。理想的には、前記基部側補強手段が基部側リングである。
【0017】
好ましくは、前記遠位側アンカ手段が弾性材料からなる。一般に、前記遠位側アンカ手段はOリングである。
【0018】
好ましくは、前記結合手段と係合する前記ガイド手段の少なくとも外面が、ポリテトラフルオロエチレンのような低摩擦係数の材料で形成されている。
【0019】
特に好ましい実施例では、前記レトラクタが、別のデバイスの該レトラクタへの取付のためのプラットホームを有する。
【0020】
特に好ましい構成では、一方の前記リング部により、別のデバイスの前記レトラクタへの取付のためのプラットホームが画定される。
【0021】
別の側面では、本発明により、遠位側アンカ部材と、前記遠位側アンカ部材に取りつけられた創傷係合部分及び外側部分を有する結合手段と、前記結合手段の前記外側部分のための外部ガイド手段と、外部アンカ手段とを備える外科用創傷レトラクタを用いて創傷開口を開創するための方法であって、
前記遠位側アンカ部材を創傷開口の内部に保持されるように配置し、そこから前記結合手段が外側へ前記開口の中を延長するようにする過程と、
前記結合手段の前記外側部分に関して前記外部ガイド手段を動かして前記結合手段の軸方向長さを短くし、かつそれにより前記創傷係合部分を開創形状に付勢して前記創傷開口を開創する過程と、
前記結合手段を固定して前記創傷開口の開創を保持する過程とからなることを特徴とする方法が提供される。
【0022】
好ましくは、前記方法は、前記結合手段の前記外側部分に関して前記外部ガイド手段を動かして前記創傷開口を部分的に開創する過程と、前記結合手段の前記外側部分を把握する過程と、それを前記ガイド手段に関して引っ張って前記創傷開口を完全に開創する過程とを有する。
【0023】
ある実施例では、前記方法は、
(a)前記結合手段の前記外側部分の局所的部分を、前記結合手段の前記外側部分の残りの部分を固定しつつ、把握する課程と、
(b)前記局所的部分を引っ張って前記創傷開口の局所領域における開創を大きくする過程と、
(c)前記結合手段の前記局所部分を固定する過程とを含む。
【0024】
理想的には、前記方法は、前記結合手段の前記外側部分の他の局所部分のために前記過程(a)乃至(c)を繰返す過程を含む。
【0025】
【発明を実施するための最良の形態】
本発明は、添付図面を参照しつつ、単なる実施例として記載される以下の詳細な説明からより明確に理解することができる。
【0026】
図1乃至図13に関して言えば、本発明による創傷レトラクタ101が示されており、図示される実施例では、図4に示すように、腹部創傷開口103のような創傷の縁を開創するのに使用される。
【0027】
レトラクタ101は、創傷開口103内に挿入するために、本実施例では弾性内側Oリング105の形態をなす遠位側アンカ部材と、本実施例では実質的に円筒状の弾性スリーブ106の形態をなす結合手段とを有する。スリーブ106は内側創傷係合部分及び外側部分を有し、前記創傷係合部分は内側Oリング105に取り付けられる。前記スリーブは、前記内側創傷係合部分が縮径された放射方向寸法を有する挿入形状と、創傷開口103を側方へ開創する開創形状とを有する。
【0028】
外部ガイド手段がスリーブ106の前記外側部分に設けられており、かつ本実施例では前記ガイド手段が、その間をスリーブ106が通る内側リング部110と外側リング部111とを有する。レトラクタ101は、スリーブ106を固定して創傷開口103の開創を維持するための外部アンカ手段を有し、かつ本実施例では、前記アンカ手段が、外側リング部111の外面上の複数のアンカ構造120によって設けられ(図2)、該構造120は放射方向外向きに延長してフックを画定している。
【0029】
外側リング部111は、より大きな直径と凹所116とを除いて、内側リング部110と同じ環状形状を有する。内側リング部110は比較的硬い材料からなり、かつ凹所116において外側リング部111と噛み合って、図3に示すように、それらの間にスリーブ106を滑動可能に保持する。この実施例では、リング部110、111が比較的緩やかな嵌め合いで、スリーブ106に関してリング部110、111の動きを容易にしてスリーブ106の軸方向長さを短くし、かつそれにより前記創傷係合部分を開創形状に補正して、創傷開口103を側方に開創する。
【0030】
リング部110、111は、ポリテトラフルオロエチレン(PTFE)のような低摩擦係数を有する材料で形成される。PTFEは、適度な引張り強さ及び優れた潤滑性を有する硬い非弾性材料である。
【0031】
また、レトラクタ101は、アンカ構造120と係合するための基部側補強手段を有し、かつ本実施例では、前記補強手段は、内側Oリング105に関して柔軟な材料の弾性外側Oリング109によって提供される。外側Oリング109はスリーブ106の基端部に取り付けられ、Oリング105、109がその端部においてスリーブ106の開いた形状を保持するのを助けている(図2)。
【0032】
使用時に、内側Oリング105及びスリーブ106を押し潰して、創傷開口103内に内側Oリング105を挿入するための挿入形状にする(図5)。内側Oリング105は、図5に示すように、使用を容易にするべく、内側Oリング105を側面から見て低い、細長い形状に丸めることを容易にする重合体材料からなる。内側Oリング105を解放すると、弾性Oリング105はその通常のO形状に戻り、創傷開口103の内側縁部に重なって、図6に示すように、創傷内のレトラクタ101を安全に固定する。図6及び図7から分かるように、内側Oリング105の挿入後、創傷開口103は実質的に閉じられかつスリーブ106は圧縮されて皺の寄った形状になる。
【0033】
次にスリーブ106を、図8(a)に示すように、創傷開口103の周囲の組織に対してリング部110、111を押しつつ引張り、スリーブ106の軸方向長さを短くしかつそれにより前記創傷係合部分を前記開創形状に付勢して、創傷開口103の右側部分(図8(a)に示すように)側方へ開創する。外側Oリング109の右側部分は、構造120の周囲に引っ掛けられて、創傷開口103の右側部分を開創された状態に保持する(図8(b))。次にスリーブ106の左側部分を、図8(b)に示すように、リング部110、111を押して創傷開口103の左側部分を側方へ開創しつつ引張る。次に、外側Oリング109の左側部分を構造120の周囲に引っ掛けて、図9及び図10に示すように、創傷開口103全体を完全に開創された状態に維持する。
【0034】
別々の構造120及び創傷レトラクタ101の形状によって、一般にスリーブ106は、図8(a)及び図8(b)に示すように局所で容易に操作することができ、最適の開創力が得られる。このように、この操作は単に単一の垂直軸に限定されるだけでなく、スリーブ106を引張ること、及び外側Oリング109を適当な構造120に局在的に引っ掛けることによって、いくつかの異なる向きに実行することができる。このようにして、前記レトラクタは特定の用途に適合させることができる。
【0035】
内側リング部110によりスリーブ106が滑動可能に保持される凹所116は、図13に示すように、延長する上側リップ117を設けたC字形状をなす。上側リップ117は、スリーブ106に作用する引張り方向又は引張り力に拘わらず、内側リング部110を凹所116内に安全に保持する。スリーブ106を垂直方向以外の方向に引張り、かつ外側Oリング109の局在的な引っ掛けを実現することが好ましく、延長する上側リップ117はスリーブ106を垂直以外の方向へ引っ張ることを促進している。
【0036】
弾性スリーブ106は、図9に示すように、開創された創傷開口103の側部に沿って延び、かつ従って創傷の開創及び創傷の保護双方の手段として作用機能する。
【0037】
前記外科用創傷レトラクタは簡単な構成を有し、使用が容易で、かつ安価に製造されて使い捨て可能な製品を提供することができる。
【0038】
本発明による単一の創傷レトラクタは、広範な切創寸法に使用することができ、かつ実行されるべき切創、患者の解剖及び外科的処理に適応させるのに必要な広範な様々な局在的開創力を実現することができる。
【0039】
図1乃至図10のレトラクタでは、スリーブ106が外側及び内側ガイドリング部110、111の間に比較的きつい嵌め合いを有する。また、外側及び内側リング部110、111は、内側リング部110が外側リング部111内に比較的緩やかな嵌め合いを有するように形成することが可能である。本実施例では、前記ガイド手段が外側リング部又はその中に第二の要素が滑り込む別の環状形状を有する。前記第二の要素は、直径が小さい点を除いて前記外側リング部と同じ環状形状を有し、かつ前記第二要素の周囲に前記外側リング部が緩やかに嵌め合うように、かつ双方が互いに相対的に容易に滑動するように構成された外側の区画された凹所を有する。前記要素が緩やかに一体に嵌め合うことによって、弾性スリーブはそれらの間のギャップにぴったりとはまり、かつその中に滑り込むことができる。このような構成が図14及び図15に示されている。図15に示すようにスリーブ106の局所領域を引張ると、内側リング部110が適当な側に動いて、前記スリーブの把握された部分の局所的な操作を可能にしつつ、その反対側でスリーブ106を締め付け、前記把握された側での局所的な開創力が、その側で前記スリーブが固定される前に最適化されるのを可能にする。この処理は、スリーブ106の他の局所領域において繰り返すことができる。
【0040】
図16乃至図23に関して、本発明による別の創傷レトラクタが示されており、これは図1乃至図3に関連して記載された創傷レトラクタ101と類似しており、類似部分には図16乃至図17において同じ参照符号を付して示す。
【0041】
この実施例において、前記ガイド手段は、外側リング部151の周囲に周方向に沿って離隔された複数の別々の位置で外側リング部151が内側リング部110に係合し、スリーブ106を内側及び外側リング部110、151間でそれぞれ個別の位置で締め付けるように構成された内側リング部110及び外側PTFEリング部151を有する。外側リング部151は、外側リング部151の周囲に周方向に離隔して配置された複数の相互結合されたセグメント155を有し、これらは内側リング部110に押しつけられてスリーブ106を締め付け、かつ開創力の調整のためにスリーブ106の局所的な解放を容易にするべく個別に動かすことができる。セグメント155と外側リング部151の本体部分158との間には、切り抜かれたT字スロット156が設けられており、かつハンドル160がセグメント155の中間の外側リング部151の本体部分158の放射方向外向きに突出している。
【0042】
使用時には、図20に示すように隣接するハンドル160を手で掴んで、矢印Aの向きに解放力を作用させ、これが次に局所セグメント155を矢印Bの向きに、スリーブ106を締め付ける静止位置(図20及び図21)からスリーブ106が容易に引張られかつ局所的に操作される解放位置(図22及び図23)へと引張る。内側リング部110とセグメント155との間のクランプを解放することによって、弾性スリーブ106は容易に一方の位置から他方の位置へと滑動する。この構成は、特に開創力の局所的操作を容易にするのに有利である。
【0043】
一般に、本発明による創傷レトラクタ150は、内側Oリング105を創傷開口103内に挿入し、かつ内側Oリング105が内側解剖面に対して平坦に位置するようにスリーブ106を引張ることによって用いられる。内側Oリング105がレトラクタ150を創傷内に固定し、かつ弾性スリーブ106が創傷開口103から抜けるのを防止する。次に前記ガイド手段のクランプが、ハンドル160を絞ることによって解放され、かつリング部110、151が前記外部解剖面と接するようになるまで、弾性スリーブ160を滑り落ちる。開創は、スリーブ106を引張って内側Oリング105とリング部110、151間の距離を短くし、それにより弾性スリーブ106を側方へかつ創傷開口103の縁の中に変位させることに実行される。弾性スリーブ106は、外側リング部151のハンドル160を解放してスリーブ106を締め付けることにより、創傷開口103の開創を維持するように固定される。
【0044】
また、本発明の創傷レトラクタは、その上に広範なデバイスを取り付けることができるプラットホームを提供する。ある実施例では、前記プラットホームは内側リング部110の内側突出部によって提供され、その上に補完的な凹所172を有するリング部171が幾分スナップ式に係合するような方法で容易に嵌め合わせることができる。このようなリング部171には様々なデバイスを設けることができる。例えば、図24及び図25に示されるように、前記デバイスは腹腔鏡下外科手術に於いて使用するためのハンドアクセスデバイス175である。別の実施例では、前記デバイスはドレープ180(図26及び図27)又は、例えば押さえておくべき器官187の形態に操作され、かつそれから次に空気を排気管186に沿って抜いて、所望の器官保持形状を保持する形態保持デバイス185(図28及び図29)とすることができる。
【0045】
前記プラットホームは、別の実施例では、図30乃至図32に示されるようなクランプ200によって提供することができる。クランプ200は、上側あご201、下側あご202、クリップ203及びアーム204を有する。
【0046】
クランプ200は、クリップ203を下側あご202のベースにねじ込み、上側あご201を下側あご202の上に滑らせて、雄型突出部208を対応する雌型凹み209内に係合させ、かつアーム204を上側及び下側あご201、202間の開いた口207の中に挿入することにより組み立てられる。複数の歯205がアーム204上に設けられており、歯205は、アーム204が開いた口207内にある時、上側あご201の凹み206の中を上向きに突出する寸法を有する。歯205は図31により明確に示されるように、ラチェット型の構成をなす開いた口207の中をアーム204を引き戻すことはできるが、再び前方へ押し出すことはできないような形状を有する。クランプ要素201、202、203、204に適した材料はばね鋼である。
【0047】
図30に示すように、形態保持デバイス185のようなアーム204の自由端には、様々のデバイスを取り付けることができる。使用時には、クリップ203が、図31に示すように、形態保持デバイス185が創傷開口103内に延長した状態でスナップ嵌め合わせ構成により創傷レトラクタ101にしっかりと固定される。次に、形態保持デバイス185は、創傷103を横切って側方へラチェットで動き、例えば体内器官220を開創する。クランプ200の前記ラチェット形状及び形態保持デバイス185の堅さによって、体内器官220を所望の位置にしっかりと維持することが確保される。
【0048】
本発明による創傷レトラクタのいずれの実施例も、様々な外科的処理に於いて使用する為の他のデバイスを取り付けるプラットホームとして使用できることがわかる。このようなデバイスには、切創個所又は開口部を覆うためのキャッピング(capping)デバイス、外科手術を開腹手術からハンドアシスト腹腔鏡下手術に転換できるようにするハンドアクセスデバイス、器具の挿入のための器具ポート、腹腔鏡下手術において使用するためのトロカール、手術野から内部構造を移す際に補助するための体内器官レトラクタ、又は手術室の照明から陰になる領域を照明する為の照明手段が含まれる。当業者であれば、本発明の利用範囲が上述した簡単なリストに限定されるものでないことは明らかである。
【0049】
前記創傷レトラクタは、別の環状形状に構成することができる。例えば、前記弾性スリーブに取り付けられる遠位側及び基部側リングは、円形の代わりに卵型又は楕円形にすることができる。
【0050】
前記レトラクタは、肛門又は膣のような肉体の自然な開口部の縁を開創しかつ保護するのに用いることができ、又は気管形成術又はそれに続く胃腸の手術のために創成されるような人工の口(stoma)の縁を開創しかつ保護するのに用いることができる。
【0051】
本発明は上述した実施例に限定されるものでなく、その構成及び詳細な部分に於いて様々に変化させることができる。
【図面の簡単な説明】
【図1】 本発明による創傷レトラクタの分解図である。
【図2】 図1のレトラクタの組立てられた状態の斜視図である。
【図3】 図2の組立てられたレトラクタの側方から見た断面図である。
【図4】 開創されていない創傷開口の斜視図である。
【図5】 図2のレトラクタの部分を創傷開口内に挿入する様子を示す斜視図である。
【図6】 挿入後の図2のレトラクタの側方から見た断面図である。
【図7】 挿入後の図2のレトラクタの平面図である。
【図8】 (a)図及び(b)図は、図2のレトラクタを用いて創傷開口の側方への開創を示す断面図である。
【図9】 創傷開口の側方への開創後における図2のレトラクタの断面図である。
【図10】 創傷開口の側方への開創後における図2のレトラクタの平面図である。
【図11】 図2のレトラクタのガイド手段の一部分を示す平面図である。
【図12】 図11の部分の側面図である。
【図13】 図11のA−A線における断面図である。
【図14】 本発明による別の創傷レトラクタの部分を示す断面図である。
【図15】 使用時における図4のレトラクタの断面図である。
【図16】 本発明による別の創傷レトラクタの部分を示す分解図である。
【図17】 組立てられた図16の創傷レトラクタの斜視図である。
【図18】 別の位置における図17の破砕斜視図である。
【図19】 別の位置における図17の破砕斜視図である。
【図20】 図17乃至図19のレトラクタの一部分の操作を示す概略平面図である。
【図21】 図20の形状におけるレトラクタ部分の側方から見た断面図である。
【図22】 開放位置にあるレトラクタ部分の概略平面図である。
【図23】 図22の形状にあるレトラクタ部分の側方から見た断面図である。
【図24】 本発明による創傷レトラクタについて使用するためのハンドアクセスデバイスの斜視図である。
【図25】 図24のハンドアクセスデバイスが所定位置にある状態の図2のレトラクタの側方から見た断面図である。
【図26】 本発明による創傷レトラクタについて使用するためのドレープの斜視図である。
【図27】 図26のドレープが所定位置にある状態の図2のレトラクタの側方から見た断面図である。
【図28】 (a)図は、本発明による創傷レトラクタについて使用するための柔軟な状態の形態保持デバイスの斜視図、(b)図は、(a)図の形態保持デバイスの堅い状態における斜視図である。
【図29】 図28(b)の堅い状態の形態保持デバイスが所定位置にある場合の図2のレトラクタの側方から見た断面図である。
【図30】 図28の形態保持デバイス及びクランプの分解斜視図である。
【図31】 図28の形態保持デバイス及び図31のクランプの側面図である。
【図32】 図20の形態保持デバイス及び図30のクランプが所定位置にある状態での図2のレトラクタの側方から見た断面図である。
Claims (19)
- 創傷開口内に挿入するための遠位側アンカ部材と、
内側創傷係合部分及び外側部分を有し、前記内側創傷係合部分が前記遠位側アンカ部材に取り付けられ、前記内側創傷係合部分が縮径された放射方向寸法を有するような挿入形状と開創形状とを有するスリーブと、
内側リング部及び外側リング部を有し、前記リング部の間に前記スリーブを案内する環状リング手段からなる外部ガイド手段とを備え、
前記外部ガイド手段を前記スリーブに関して動かして、前記スリーブの軸方向に前記遠位側アンカ部材と前記環状リング手段との間における長さを短くしかつそれにより前記スリーブの前記内側創傷係合部分を前記開創形状へと付勢して、前記創傷開口を側方へ開創することができることを特徴とする外科用創傷レトラクタ。 - 前記スリーブが概ね円筒状のスリーブからなることを特徴とする請求項1に記載のレトラクタ。
- 前記外側リング部が、前記内側リング部を配置するための凹所を画定し、それらの間に前記スリーブを配置したことを特徴とする請求項1又は2に記載のレトラクタ。
- 前記内側リング部が、前記外側リング部の前記凹所に緩やかな嵌め合いを有することを特徴とする請求項3に記載のレトラクタ。
- 一方の前記リング部の少なくとも一部分が、前記スリーブが実質的に前記リング部間に締め付けられる静止位置から、前記スリーブの少なくとも一部分が前記リング部に関して動くことができる開放位置へと動かすことができることを特徴とする請求項1乃至4のいずれかに記載のレトラクタ。
- 前記スリーブの一部分のみが、前記開放位置において前記リング部に関して動くことができることを特徴とする請求項5に記載のレトラクタ。
- 前記内側リング部が、前記外側リング部にきつい嵌め合いを有し、それらの間に前記スリーブを把握するようにしたことを特徴とする請求項1乃至3のいずれかに記載のレトラクタ。
- 前記外側リング部が、相互に連結された複数のセグメントを有し、それらが、前記創傷開口において作用する開創力を調整するために前記スリーブの局所的な開放を容易にするべく独立して動くことができることを特徴とする請求項1乃至7のいずれかに記載のレトラクタ。
- 前記リング部またはそのセグメントが、締め付けられた前記静止位置と前記開放位置との間で手で操作可能であることを特徴とする請求項8に記載のレトラクタ。
- 前記外側リング部が、前記スリーブを固定するための外部アンカ手段を有することを特徴とする請求項1乃至9のいずれかに記載のレトラクタ。
- 前記外部アンカ手段が、前記創傷開口の開創時に前記スリーブが取りつけられる前記外側リング上のアンカ構造を有することを特徴とする請求項10に記載のレトラクタ。
- 前記スリーブが、前記外部アンカ手段と係合するための基部側補強手段を有することを特徴とする請求項10又は11に記載のレトラクタ。
- 前記基部側補強手段が基部側リングであることを特徴とする請求項12に記載のレトラクタ。
- 前記遠位側アンカ部材が弾性材料からなることを特徴とする請求項1乃至13のいずれかに記載のレトラクタ。
- 前記遠位側アンカ部材がOリングであることを特徴とする請求項1乃至14のいずれかに記載のレトラクタ。
- 前記スリーブと係合する前記外部ガイド手段の少なくとも外面が、低摩擦係数の材料で形成されていることを特徴とする請求項1乃至15のいずれかに記載のレトラクタ。
- 前記外部ガイド手段の少なくとも外面がポリテトラフルオロエチレンで形成されていることを特徴とする請求項16に記載のレトラクタ。
- 別のデバイスの前記レトラクタとの取付のためのプラットホームを有することを特徴とする請求項1乃至17のいずれかに記載のレトラクタ。
- 前記内側リング部により、別のデバイスの前記レトラクタへの取付のためのプラットホームが画定されることを特徴とする請求項1乃至18のいずれかに記載のレトラクタ。
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