JP5004657B2 - In-vivo surgical field securing member - Google Patents

Description

  The present invention relates to an internal surgical field securing member, and more particularly to a configuration of an internal surgical field securing member for securing a surgical field inside the abdominal cavity or the like in an endoscopic surgical operation.

  For example, in an endoscopic surgical operation, an organ that inhibits surgery (or observation) is moved outside the surgical field in the abdominal cavity, thoracic cavity, retroperitoneal cavity, etc. during the operation, and the target site is placed in a place where surgery is easy. For this purpose, for example, as shown in the following Patent Document 1, a floating ring (medical inflatable body) in which a long cylindrical inflatable body is formed in an annular shape is used. Ensuring a surgical field is being carried out.

On the other hand, in order to expedite recovery from surgery and to reduce surgical scars, surgery using a laparoscope (endoscope) that can reduce the incision of the abdominal wall has been performed. In surgery, carbon dioxide gas was injected into the abdominal cavity, and the abdominal cavity was expanded with this gas pressure to secure the space necessary for the operation. However, this pneumoperitoneal method requires advanced techniques for gas injection with a pneumoperitoneal needle, and requires devices and instruments for preventing gas leakage, which also burdens the patient. In order to solve such a problem of the pneumoperitoneum, an abdominal wall lifting method (method) using an abdominal wall lifting device has been promoted.
JP 7-116262 A JP-A-5-317318

However, the conventional medical inflatable body disclosed in, for example, the above-mentioned Patent Document 1 only has an annular shape like a floating ring when inflated, and when performing endoscopic surgery, an organ that inhibits the operation is in the surgical field. The organ cannot be sufficiently moved out of the surgical field so as not to enter, while the surgical target site cannot be efficiently and easily placed in a place where surgery is easy.
In addition, although there is no description about the height of such a medical inflatable body, if it is low, an organ moved outside the surgical field will get over and invade, and the height of pushing up the abdominal wall to prevent such invasion If it is formed, the insertion position and the insertion angle are limited due to the presence of the medical expansion body when a treatment instrument such as an endoscope or a forceps for treatment is inserted into the operative field.

  On the other hand, in the above-described abdominal wall lifting method, when the abdominal wall is lifted by the abdominal wall lifting device, for example, when the length of the lifting portion must be short, or only two abdominal wall lifting devices are required. When it cannot be used, a sufficient surgical field (surgical space) may not be secured. In this case, it is convenient to have a member for securing the surgical field in an auxiliary or partial manner.

  The present invention has been made in view of the above-described problems, and its purpose is to sufficiently move an organ that inhibits surgery to the outside of the surgical field, and to efficiently and easily arrange the surgical target site in a place where surgery is easy. Another object of the present invention is to provide an in-vivo surgical field securing member that can assist in securing a surgical field using the abdominal wall lifting method.

In order to achieve the above object, the in-vivo surgical field securing member according to the invention of claim 1 is formed into a bag shape that can be inflated by introducing a fluid, and is formed into an annular body when inflated. a operating field securing member that to ensure the operative field within a body cavity, the main trunk of the center portion of the annular body is expanded by fluid introduction, the main trunk portion integrally with the comb teeth communicating with the main trunk portion A comb-tooth portion that expands in a shape, and a gap between the comb-tooth portion is used as an inner and outer penetration portion, and the annular body is configured to be separable in the middle. It is characterized in that end connection means for changing the height is provided.
The end connecting means according to the invention of claim 2 is formed integrally with the main trunk portion or the comb tooth portion, and functions as a connecting means by introducing a fluid.

  According to the above configuration, for example, the abdominal wall lifting method is used. In this case, the abdominal wall lifting device is first inserted into the abdominal cavity through a small opening opened in the abdominal wall, and the abdominal wall is pulled by pulling the device with the puller wire. Can be lifted. Then, when the in-vivo surgical field securing member before expansion is inserted from the small opening and air is injected into the in-vivo surgical field securing member, for example, the main portion and the comb tooth portion of the in-vivo surgical field securing member swell, An annular body is formed by these.

  At this time, by appropriately adjusting the position before expansion, the position during expansion, and the position after expansion of the annular body arranged in the abdominal cavity, the organ that inhibits the operation is placed outside the annular body, that is, outside the surgical field. Thus, it is possible to move only the surgical target site in a place where it is easy to perform surgery in the annular body. The internal surgical field securing member also functions to push up the abdominal wall to some extent in the height direction, and the desired surgical field (surgical space) can be achieved by both pushing up the abdominal wall and eliminating the above-mentioned surgical inhibition organs. Is secured in the abdominal cavity.

  According to the in-vivo surgical field securing member of the present invention, an organ that inhibits surgery can be sufficiently moved outside the surgical field, while the surgical target site can be efficiently and easily placed in a place where surgery is easy, and the abdominal wall is lifted. In the method, there is an effect that it is possible to secure a good operative field by auxiliary use.

Since it changes annular size of the annular member by arranged end connecting means to a separatory Hanaretan portion, it is possible to form and secure a surgical field corresponding to the type and circumstances of operation.

  1 and 2 show the configuration of the in-vivo surgical field securing member according to the first embodiment. As shown in FIG. 2, the main body 10 of the in-vivo surgical field securing member has a vertical central portion. The main trunk portion (vertebral column portion) 14 that is long in the horizontal direction, comb teeth portions 14a and 14b extending from the main trunk portion 12 in both the upper and lower directions, and the left and right ends of the main trunk portion 12 (the main trunk portion and the comb teeth) Extending from the upper portion) and the upper and lower hook-like connecting (connecting) portions 16a and 16b. The main trunk portion 12, the comb tooth portions 14a and 14b, and the connecting portions 16a and 16b are all in communication. It is made into a bag shape. The bag-like main body 10 is formed of a soft member such as vinyl chloride resin or urethane rubber, and is inflated with a fluid (gas, liquid) such as air, and has high shape retention.

  The hook-like connecting portions 16a and 16b are configured to be locked between the comb teeth of the upper and lower comb teeth portions 14a and 14b when not expanded, thereby maintaining the main body 10 in an annular shape. be able to. And between each comb tooth of this comb-tooth part 14a, 14b becomes a penetration part which penetrates inside and outside. In addition, a fluid supply tube 18a and a connector 18b are attached to a part of the comb tooth portion 14a (which may be the main trunk portion 12 or the comb tooth portion 14b), and air is introduced into the bag-shaped main body 10 by the fluid supply tube 18a. Supplied.

  The first embodiment is configured as described above, and this in-vivo surgical field securing member is used in a state as shown in FIG. 3 together with an abdominal wall lifting device, for example. As shown in FIG. 3, first, a lifting part (a spatula) on the lower side of the abdominal wall lifting device 20 is inserted into the abdominal cavity from a small opening formed in the abdominal wall (navel part, etc.). The abdominal wall is lifted and the upper pulling engagement arm (engagement hole) of the abdominal wall lifting device 20 is pulled by the wire 21 of the traction tool, thereby forming a surgical space in the abdominal cavity.

  Thereafter, the bag-like body 10 set in an annular shape of an appropriate size is locked from the small opening in a contracted state by engaging the hook-shaped connecting portions 16a and 16b of the body surgery field securing member between the upper and lower comb teeth. The main body 10 swells in an annular shape as shown in FIG. 3 by entering the abdominal cavity and supplying air into the bag-shaped main body 10 through the fluid supply tube 18a from the pump connected by the connector 18b. In the middle of this expansion, by adjusting the arrangement position of the organ in the abdominal cavity and the main body 10, the organ that inhibits the operation is moved out of the annular main body 10. 10 is placed in a place where surgery is easy.

Then, the laparoscope 23 inserted from the small opening and the forceps 24 inserted from the small opening opened separately are introduced into the surgical field in the annular body 10 from between the comb teeth of the comb tooth portion 14a. Surgery using the mirror 23 and forceps 24 is performed well.
In the first embodiment, since the ring size of the main body 10 can be changed by the connecting portions 16a and 16b, an operation field corresponding to the type and situation of the operation can be formed.

  FIG. 4 shows a modified configuration example of the in-vivo surgical field securing member according to the first embodiment. In this bag-like main body 26, a flat plate shape that is relatively easy to break between the comb teeth of the comb teeth portions 14a and 14b is shown. The thin film (sheet) 27 is closed. The thin film 27 may be provided with vertical perforations (perforated pores) 28 at the center thereof. According to such a configuration, by opening the penetrating portion only between the necessary comb teeth of the comb tooth portions 14a and 14b, in a place where the penetrating portion is not provided, the holding force of the annular shape is increased and the surgical inhibition organ There is an advantage that the exclusion force is increased, and the strength in the vertical (vertical) direction of the comb teeth portions 14a and 14b of the main body 10 is increased to increase the force for pushing up or supporting the abdominal wall.

FIG. 5 shows a configuration of the endoscopic field securing member of the reference example. As shown in FIG. 5, the in-vivo surgical field securing member of the reference example has a plurality of circular (or elliptical) through-holes 31 along the annular shape at the upper and lower portions of the annular bag-shaped main body 30. Is provided. According to such an example, it is possible to introduce the laparoscope 23 and forceps 24 described in FIG. 3 from the circular through portion 31 to the annular body 30, by this, the circle organs inhibits surgery While moving to the outside of the annular main body 30, the surgical site can be placed in the annular main body 30, and the function of pushing up the abdominal wall to some extent in the height direction is also achieved.

In the first embodiment, the main bodies 10 and 26 are separable in the middle of the ring using the connecting portions 16a and 16b. However, as shown in the example of FIG. It is also possible to form.

It is a perspective view when the in-vivo surgical field ensuring member which concerns on 1st Example of this invention is expanded in the annular | circular shape. It is a top view which shows the state before expansion | swelling of the endoscopic field securing member of 1st Example. It is a figure which shows a state when using the endoscopic field securing member of 1st Example. It is an expanded view which shows the structure (before expansion | swelling) of the modification of 1st Example. It is a perspective view which shows the structure (at the time of expansion | swelling) of the endoscopic field securing member of a reference example.

Explanation of symbols

10, 26, 30 ... bag-shaped body,
12 ... Executives,
14a, 14b ... comb teeth,
16a, 16b ... bowl-shaped connection part,
18a ... fluid supply tube,
31 ... through hole.

Claims (2)

An in-vivo surgical field securing member that is formed into a bag shape that can be inflated by introducing a fluid, and is formed into an annular body when inflated, and secures a surgical field in a body cavity inside the annular body,
A main trunk part that expands by introduction of fluid and becomes the center part of the annular body, and a comb tooth part that communicates with the main trunk part and expands in a comb-teeth shape integrally with the main trunk part are provided. While using the gap as a penetration part inside and outside ,
An in-vivo surgical field securing member, wherein the annular body is configured to be separable in the middle, and an end connecting means for changing the size of the ring is provided at the separated end . The in-vivo surgical field securing member according to claim 1 , wherein the end connecting means is formed integrally with the main trunk portion or the comb tooth portion and functions as connecting means by introducing a fluid .

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