JP5100263B2 - Treatment instrument guide - Google Patents

Description

  The present invention relates to a treatment instrument guide that guides a treatment instrument that performs a predetermined treatment on an organ to a target organ.

  Conventionally, in a surgical operation, an operation is performed by incising the skin and introducing a surgical treatment tool. A treatment tool introduction port member called a trocar is placed in the incision portion, and the treatment tool is inserted into the body cavity through the port member. In general, a surgical treatment instrument is composed of a rigid forceps in which a portion from a hand of an operator to a treatment function part (a gripping part, an electric conduction part, etc.) at the tip is connected by a hard sheath. In this case, an organ directly under the trocar can be approached, but an organ located at another location cannot be approached. For example, a device inserted into the abdominal cavity could not be inserted into the thoracic cavity via the diaphragm. In addition, approach to the back of organs was impossible.

  Therefore, a soft forceps formed of a soft sheath has been developed. With this soft forceps, it is possible to approach other than the organ just below the trocar. However, since the sheath portion of the soft forceps is passively curved, the tip of the soft forceps must be transported to another target organ by another device, and the operation is complicated.

Therefore, Patent Document 1 proposes using a curved trocar to direct the treatment tool in a predetermined direction.
US Pat. No. 3,778,170

  However, it is difficult to guide the treatment tool to the organ to be treated only by determining the direction of the treatment tool as disclosed in Patent Document 1.

  The present invention has been made in view of the above points, and an object of the present invention is to provide a treatment instrument guide that can easily guide a treatment instrument to a target organ.

One aspect of the treatment instrument guide of the present invention is:
A fastening part that adsorbs and attaches to the surface of the organ;
A treatment instrument fixing portion for fixing a distal end position of a treatment instrument for performing a predetermined treatment on the organ, the positional relationship with the fixing portion being fixed;
A guide unit for guiding the treatment tool that can be inserted into and removed from the treatment tool fixing part;
Comprising
The fastening portion is selectively set between a first form when introduced into the body and a second form having a larger outer shape than the first form and when fastened to the organ. It is characterized by that.

According to the present invention, after inserting the fastening portion that adsorbs and fastens the organ into the organ in the first form, it is fastened to the target organ in the second form having a larger outer shape, thereby widening the surgical field space. It is possible to provide a treatment instrument guide that can guide the treatment instrument that can be inserted from the outside of the body and removed from the body to the target organ easily. be able to.

  The best mode for carrying out the present invention will be described below with reference to the drawings.

[First Embodiment]
FIG. 1A is a perspective view showing the configuration of the treatment instrument guide according to the first embodiment of the present invention.

  The treatment instrument guide 100 according to the present embodiment includes a treatment instrument 200 that performs a predetermined treatment on a target organ and a plurality (three in the figure) of flexible tubes 102 for insertion through an endoscope. The distal ends of these flexible tubes 102 are fixed to a fastening portion 104 that fastens to the organ surface, or are formed integrally with the fastening portion 104 and the positional relationship with the fastening portion 104 is fixed. With this configuration, the distal end of the flexible tube 102 functions as a treatment instrument fixing unit 106 that fixes the distal end position of the treatment instrument 200, and the flexible tube 102 guides the treatment instrument 200 to the treatment instrument fixing unit 106. It functions as a part.

  The anchoring portion 104 includes a plurality of suction holes 108 on a surface on the organ side, and sucks the organ by sucking it with a suction pump (not shown) outside the body through a soft suction tube 110 to absorb the organ. It comes to be attached to the surface. The anchoring portion 104 is also made of a soft material, and has a first form when introduced into the body, and a first form when attached to the organ having a larger outer shape than the first form. 2 can be selectively set.

  Further, on the proximal side of the flexible tube 102, as shown in FIG. 1 (B), it engages with a trocar or a device outside the body which is a port member for introducing a treatment instrument placed in the incision portion of the skin. A hooking hole 112 as a member is formed. FIG. 1C shows a state in which the flexible tube 102 is engaged with the trocar 300. In this case, the flexible tube 102 is engaged with the trocar 300 by inserting (preferably screwing) the tip of the retaining pin 302 penetrating (preferably screwed) into the trocar 300 into the hooking hole 112 of the soft tube 102. Match.

When a treatment is performed by inserting the treatment tool 200 into a body cavity, conventionally, a surgical visual field is obtained by filling the body cavity with a gas such as CO ₂ by an insufflation apparatus. Therefore, the soft tube 102 includes an O-ring 114 as an airtight member that maintains confidentiality with the trocar 300. When the soft tube 102 is engaged with the trocar 300, the soft tube 102 is filled into the body cavity from the gap between them. Gas is prevented from leaking.

  Further, as shown in FIGS. 1C and 1D, a rubber valve 116 as an airtight member that maintains confidentiality with the inserted treatment instrument 200 is attached to the proximal side of the flexible tube 102. The gas filled in the body cavity is prevented from leaking from the gap between the flexible tube 102 and the treatment instrument 200.

  Next, a method for inserting the treatment instrument guide 100 according to this embodiment having the above-described configuration will be described.

  Before the treatment instrument guide 100 is inserted into the body cavity, as shown in FIG. 2A, first, the fastening part 104 is made to have a small diameter together with the treatment instrument fixing part 106 by the thread 400 or the like. The first form is set. At this time, the diameter is smaller than the inner diameter of the trocar 302 so that it can be introduced into the body cavity 500 via at least the trocar 302. Then, the treatment instrument guide 100 is introduced into the body cavity through the trocar 302.

  Next, the bending endoscope is inserted into the body from another trocar (not shown). As shown in FIG. 2B, the endoscope 202 has a treatment instrument insertion hole. For example, the grasping forceps 204 protrudes from the insertion hole to grasp the treatment instrument guide instrument 100 or the thread 400. . Then, by inserting the endoscope 202 into the deep part of the body cavity 500, the treatment instrument guide 100 is transported to the target site.

  When the treatment instrument guide 100 reaches the target site in this way, the grasping by the grasping forceps 204 is released, and the acupuncture forceps are projected from the treatment instrument insertion hole of the endoscope 202 instead of the grasping forceps 204. Then, as shown in FIG. 2 (C), the thread 400 that binds the treatment instrument guide 100 is cut by the scissors forceps 206. Thereby, the fastening portion 104 of the treatment instrument guide 100 is unfolded and set to the original size which is the second form having a larger outer shape than the first form.

  Thereafter, instead of the scissors forceps 206, the gripping forceps 204 is projected again from the treatment tool insertion hole of the endoscope 202, the treatment tool guide tool 100 is gripped by the gripping forceps 204, and the treatment tool guide is guided to the target organ surface. The fastening part 104 of the tool 100 is brought into contact and sucked through the suction hole 108 of the fastening part 104, so that the fastening part 104 is sucked onto the target organ surface.

  Each of the flexible tubes 102 of the treatment instrument guide 100 has a length sufficient to be pulled out of the body from the target organ, and each flexible tube is attached after or before the attachment portion 104 is attached. 102, after inserting all of them into the body cavity 500, the rear end of the trocar 300 having an inner diameter corresponding to the diameter of each flexible tube 102 is different from the trocar 302 into which the treatment instrument guide 100 is inserted. Pull out. This pulling method is performed by inserting grasping forceps into the body cavity 500 from the trocar 300, grasping the rear end of the flexible tube 102 in the body cavity 500, and pulling out the grasping forceps from the trocar 300 in this state. The rear end of each flexible tube 102 pulled out in this way is engaged with the trocar 300 as shown in FIG. In order to easily pull out the body cavity 500, the O-ring 114 is preferably mounted at a predetermined position on the rear end of the flexible tube 102 after being pulled out.

  As shown in FIG. 3, for example, from the rear end (the operator's hand side) of the main flexible tube 102 having the treatment instrument fixing portion 106 located at the center of the fastening portion 104, for example, a flexible endoscope 202 is provided. When the flexible treatment instrument 200 is inserted from the rear end of the flexible tube 102 different from this, the endoscope 202 and the treatment instrument 200 are guided to the treatment instrument fixing portion 106 of each flexible tube 102. Then, treatment can be performed with the treatment tool 200 while observing the organ 502 to which the fastening portion 104 is fastened with the endoscope 202.

  As described above, according to the first embodiment, the fastening portion 104 that fastens to the organ is inserted into the body cavity 500 in the first form with a small outer shape that can be easily inserted and guided to the target organ 502. After that, the surgical instrument 200 can be guided to the surgical site by the flexible tube 102 as the guide portion by securing the wide surgical field space by fixing to the organ 502 with the second form having a larger outer shape. The tool 200 can be easily guided to the target organ 502.

  In addition, when fastened to a beating organ such as the heart, the fastened portion 104 itself can move in synchronization with the heartbeat. Since the treatment tool 200 and the endoscope 202 inserted from the treatment tool guide 100 are soft, they can move with pulsation. Therefore, the movement of the target part in the endoscopic image can be suppressed, and the treatment tool can be prevented from removing the target part during the treatment. In such a state, it becomes possible to perform treatment on the heart surface. Thus, since the treatment tool 200 and the endoscope 202 move together with the pulsation and pulsation of the organ 502, the operability of the treatment is improved.

  Further, since the fastening part 104 adsorbs the organ 502 and attaches it to the surface of the organ 502, it can be easily and reliably attached.

  Further, since the flexible tube 102 has an O-ring 114 or a rubber valve 116 as an airtight member for maintaining confidentiality with the treatment instrument 200 or the trocar 300, the gas filled in the body cavity 500 leaks and the surgical field space is leaked. There is no such thing as preventing the securing of

  Furthermore, since the flexible tube 102 has the hook hole 112 for engaging with the trocar 300 or a device outside the body, there is no possibility that the flexible tube 102 is inadvertently detached during the treatment.

[First Modification]
In order to facilitate grasping by the grasping forceps 204 which is an introduction tool for introducing the treatment instrument guide instrument 100 into the body cavity 500, as shown in FIG. It is preferable to further include a joint portion 118.

  Thus, by providing the engaging portion 118, the treatment instrument guide 100 can be easily inserted into a desired position.

[Second Modification]
FIG. 4B is a view for explaining a second modification of the treatment instrument guide according to the first embodiment.

  The treatment instrument guide 100 of this modification further includes an insertion portion 120 having an insertion hole for inserting an introduction instrument for introducing the treatment instrument guide 100 into the body cavity 500. In this case, the introducer is a thread or guide wire 208 inserted into the body cavity 500 from the trocar 302 into which the treatment instrument guide 100 is inserted, and the distal end of the thread or guide wire 208 is placed in the organ 502. Attached to the clip 210.

  When inserting the treatment instrument guide 100 in the second modification, first, the flexible endoscope 202 is inserted from the trocar 302 for inserting the treatment instrument guide 100 to the vicinity of the target organ 502, and the thread or guide is inserted. As shown in FIG. 5A, the clip 210 to which the wire 208 is attached should protrude from the treatment instrument insertion hole of the endoscope 202 and the fastening portion 104 of the treatment instrument guide 100 should be fastened. In place.

  Then, as shown in FIG. 5B, the endoscope 202 is pulled out. As a result, a thread or guide wire 208 drawn around the body cavity 500 from the clip 210 and pulled out of the body via the trocar 302 is obtained.

  Therefore, as shown in FIG. 5 (C), the thread drawn out of the body or the rear end of the guide wire 208 is passed through the insertion hole of the insertion portion 120 of the treatment instrument guide 100, and the treatment instrument guide 100 is placed in the above-described manner. The trocar 302 is inserted into the body cavity 500. Thereby, as shown in FIG. 4B, the treatment instrument guide 100 is inserted along the thread or guide wire 208.

  At this time, as shown in FIG. 5D, the endoscope 202 is inserted while confirming the position of the distal end portion of the treatment instrument guide 100 with the endoscope 202 inserted from another trocar, that is, while ensuring the visual field. It is preferable. As a result, it is possible to deal with the undesired itself, and it is possible to fix the fixing portion 104 to a desired site of the organ 502.

  Thus, by providing the insertion part 120, the treatment tool guide 100 can be easily inserted into a desired position.

[Third Modification]
In addition, as a 2nd form of the fastening part 104, what kind of shape may be sufficient as long as it does not become a hindrance of a treatment.

  For example, as shown in FIG. 4C, it may be a fan-shaped one. In this case, the center of the fastening part 104 is left open, and the fastening part 104 is fastened so that the treatment site is located there, so that secure fastening is possible while securing a treatment space for the surgical site. Become.

[Second Embodiment]
Next, a second embodiment of the present invention will be described. In the first embodiment, since the fastening portion 104 is formed of a soft material, the fastening portion 104 is set independently from the first form to the second form simply by cutting the thread 400. However, in the present embodiment, the fastening portion 104 is configured to actively set the first form and the second form.

  FIG. 6 (A) is a view showing the configuration of the distal end portion of the treatment instrument guide 100 according to the second embodiment of the present invention, and FIG. 6 (B) is the configuration on the hand side of the treatment instrument guide 100. FIG. Note that in FIG. 6A, the structure is partially cut away for clarity.

  Similarly to the first embodiment, the treatment instrument guide 100 according to the present embodiment also has a plurality of (three in the figure) flexible tubes 102 for inserting the treatment instrument 200 and the endoscope 202. However, in the present embodiment, the flexible tube 102 that passes through the treatment instrument 200 is fixed to the treatment instrument fixing portion 106 provided on the fixing portion 104 so that the distal end of the flexible tube 102 is positioned relative to the fixing portion 104. Although the main flexible tube 102 (hereinafter referred to as the flexible tube 102A) inserted through the endoscope 202 is fixed, the fastening portion 104 moves in a direction perpendicular to the axial direction of the flexible tube 102A. By doing so, the positional relationship is not fixed because it is configured to take the first form and the second form.

  Here, a pinion gear 122 is disposed at the distal end of the flexible tube 102 </ b> A, and a rack gear 124 is provided at the fastening portion 104. The shaft 126 of the pinion gear 122 communicates with an opening / closing operation unit 128 provided on the proximal side of the flexible tube 102A so that the pinion gear 122 rotates in accordance with the rotation operation of the opening / closing operation unit 128. It is configured. As shown in FIG. 7, when the pinion gear 122 is rotated, the fastening portion 104 is opened by the rack gear 124 that meshes with the pinion gear 122, and the fastening portion 104 is moved from the first configuration at the time of insertion to the first configuration described above. It is possible to set the second form when it is fixed to the organ 502 having a larger outer shape than the form. Of course, when pulling out the treatment instrument guide 100 after the treatment, the opening / closing operation section 128 is rotated in the reverse direction, the pinion gear 122 is rotated in the reverse direction, and the fastening section 104 is set to the first form. The opening / closing operation unit 128 may be rotated manually or by a motor (not shown).

  Further, in the flexible tube 102A, in addition to the guide path (not shown) of the endoscope 202 extending from the insertion port 130 on the proximal side to the protruding port 132 at the distal end, the suction hole 108 of the fastening portion 104 is provided. The suction tube 110 connected to is passed, and the rear end of the suction tube 110 is pulled out from the proximal side of the flexible tube 102 and connected to a suction pump (not shown).

  In the treatment instrument guide 100 according to the second embodiment having such a configuration, as described in the first embodiment, the treatment is performed by the grasping forceps 204 that protrudes from the endoscope 202 inserted from another trocar. The arbitrary position of the tip part of the tool guide 100 is grasped and conveyed to the target site. In this case, of course, the treatment instrument guide 100 may be provided with the engaging portion 118 or the insertion portion 120 as described in the first or second modification.

  When the treatment instrument guide 100 reaches the target site, the grasping by the grasping forceps 204 is released and the opening / closing operation section 128 is operated to set the fastening section 104 to the second form. Thereafter, the fastening part 104 of the treatment instrument guide 100 is brought into contact with the surface of the target organ 502 with the grasping forceps 204 and sucked from the suction hole 108 of the fastening part 104 to cause the fastening part 104 to be attracted to the surface of the target organ 502. .

  Then, the rear ends of the flexible tubes 102 and 102A are pulled out from a trocar 300 different from the trocar 302 into which the treatment instrument guide 100 is inserted. Thereafter, when the flexible endoscope 202 is inserted from the insertion port 130 of the flexible tube 102A and the flexible treatment instrument 200 is inserted from the rear end of the flexible tube 102 different from the insertion opening 130, as shown in FIG. The inside of the flexible tube 102A is guided and protrudes from the protrusion 132, and the treatment instrument 200 is guided through the flexible tube 102 and protrudes from the treatment instrument fixing portion 106 to the operative field space between the spread fastening portions 104. . Therefore, the treatment tool 200 can perform a treatment on the organ 502 to which the fastening portion 104 is fastened while observing the surgical site with the endoscope 202 protruding from the projection 132.

  As described above, according to the second embodiment, the same effects as those of the first embodiment can be obtained.

  Although the present invention has been described above based on the embodiments, the present invention is not limited to the above-described embodiments, and various modifications and applications are naturally possible within the scope of the gist of the present invention.

  For example, in the above embodiment, the fastening portion is fastened to the organ surface by suction, but the fastening portion is not limited to suction, and any means such as a hook that is tied to the organ with a thread or the like is used. You may fasten.

FIG. 1A is a perspective view showing the configuration of the treatment instrument guide according to the first embodiment of the present invention, and FIG. 1B shows the configuration of the hand side of the treatment instrument guide according to the first embodiment. FIG. 1C illustrates a configuration of an engagement portion that engages with the trocar in the treatment instrument guide according to the first embodiment and a configuration of an airtight member that maintains airtightness between the trocar and the treatment instrument. FIG. 1D is a cross-sectional view of the treatment instrument guide and the trocar for explaining the configuration of an airtight member that maintains airtightness with the treatment instrument in the treatment instrument guide according to the first embodiment. FIG. FIG. 2 is a view for explaining the insertion method of the treatment instrument guide according to the first embodiment. FIG. 3 is a view for explaining a method of using the treatment instrument guide according to the first embodiment. FIG. 4 is a view for explaining first to third modified examples of the treatment instrument guide according to the first embodiment. FIG. 5 is a view for explaining a method of inserting the treatment instrument guide in the second modification. FIG. 6 (A) is a diagram showing the configuration of the distal end portion of the treatment instrument guide according to the second embodiment of the present invention, and FIG. 6 (B) is the proximal side of the treatment instrument guide according to the second embodiment. It is a perspective view which shows a structure. Drawing 7 is a figure for explaining the 1st and 2nd form of a stop part of a treatment implement guide concerning a 2nd embodiment. FIG. 8 is a view for explaining how to use the treatment instrument guide according to the second embodiment.

Explanation of symbols

    DESCRIPTION OF SYMBOLS 100 ... Treatment tool guide tool 102,102A ... Soft tube 104 ... Fastening part 106 ... Treatment tool fixing part 108 ... Suction hole 110 ... Suction tube 112 ... Hook hole 114 ... O-ring 116 ... Rubber valve, 118 ... engaging portion, 120 ... insertion portion, 122 ... pinion gear, 124 ... rack gear, 126 ... shaft, 128 ... opening / closing operation portion, 130 ... insertion port, 132 ... projecting port, 200 ... treatment tool, 202 ... Endoscope, 204 ... grasping forceps, 206 ... scissors forceps, 208 ... thread or guide wire, 210 ... clip, 300, 302 ... trocar, 302 ... retaining pin, 400 ... thread, 500 ... body cavity, 502 ... organ.

Claims (4)

A fastening part that adsorbs and attaches to the surface of the organ;
A treatment instrument fixing portion for fixing a distal end position of a treatment instrument for performing a predetermined treatment on the organ, the positional relationship with the fixing portion being fixed;
A guide unit for guiding the treatment tool that can be inserted into and removed from the treatment tool fixing part;
Comprising
The fastening portion is selectively set between a first form when introduced into the body and a second form having a larger outer shape than the first form and when fastened to the organ. A treatment instrument guide characterized by that. The guide portion, the treatment instrument guiding device according to claim 1, characterized in that it comprises an airtight member to maintain airtight between the treatment tool or trocar. The guide portion, the treatment instrument guiding device according to claim 1 or 2, characterized in that it has an engagement member for engaging the device of the trocar or extracorporeal. Engaging portion is the treatment instrument guide member engaged with introducer for introducing into the body cavity, or to any one of claims 1 to 3, characterized by further comprising an insertion hole for inserting the introducer The treatment instrument guide described.

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