JP5475564B2 - Medical instrument insertion device - Google Patents

Description

  The present invention relates to an insertion instrument for introducing an endoscope or a medical treatment instrument into a body cavity during endoscopic surgery, and more specifically, to apply a plurality of treatment instruments from a single incision. The present invention relates to an insertion instrument for a medical treatment instrument capable of performing the above.

Usually, in an endoscopic surgical operation, a plurality of trocars are drilled on the body surface, and an endoscope or a treatment instrument is inserted into each of the trocars. Since a wound is required, a small (several centimeter) incision is provided in some operations such as colectomy as a less invasive technique, and the incision is subjected to tension of an elastic member. An endoscope in which a cylindrical retractor that holds a retractor is mounted, and surgery is performed by inserting a plurality of endoscopes and treatment instruments from a plurality of ports provided on a plate or the like on the body surface side of the retractor Lower single-hole surgery is applied.
As an instrument applicable to this operation, both ends of the cylindrical elastic member are expanded and fixed to the oppositely arranged body surface ring and flexible body cavity inner ring, and the incision is kept open. An incisional wound holding device comprising: a holder body to be mounted; and a multi-valve (hole) plate having a plurality of valves and communication holes that are detachably attached to a body surface side ring of the holder body through a joining means (Patent Document 1) And a medical treatment tool in which a plurality of flexible and bendable cylindrical ports are mounted on the surface of the upper ring of a holding tool (a body portion such as a mantle tube) that holds the incision wound in the same manner as described above. An insertion port (Patent Document 2) and the like have been proposed.

JP 2002-028163 A JP 2004-195037 A

According to the above-described form of the instrument, a plurality of endoscopes and treatment instruments can be introduced into a body cavity from a single incision without providing a plurality of wounds during endoscopic surgery. Since the contact surface becomes a flexible sheet, a less invasive operation with a reduced burden on the human body is possible. Further, according to the instrument of Document 2, since the port is flexible and bendable, an effect of covering a wide range in the body cavity can be expected when operating the inserted medical treatment instrument.
However, in this surgery (endoscopic single-hole surgery), it is required to make the incision as small as possible from the viewpoint of minimally invasiveness. Correspondingly, a plate or an upper ring surface (hereinafter referred to as the plurality of ports) provided with the plurality of ports. The area of the plate is simply limited, and each port has its own edge, etc., and they occupy a certain range so that the ports provided in the plate The number and arrangement are limited. Moreover, since it is necessary to attach each port to the inside of the plate surface, there is a concern that the installation of the port becomes troublesome.

In addition, as a means capable of installing a large number of ports in a plate having a limited area as described above, the strength of the trocar can be drilled over a wide range of the plate surface serving as the port installation space, It is conceivable that the flat plate is formed from a thick elastic member.
According to this, it is possible to drill a relatively large number of trocars in the plate in a relatively arbitrary arrangement. However, a trocar is drilled in the plate and an endoscope or a treatment instrument is inserted. In particular, when the treatment instrument is tilted with respect to the plate surface and tilted to a deep angle, the puncture hole at the trocar puncture site is deformed, and there is a concern that insufflation air leaks due to a gap.

  Therefore, the present invention is an insertion instrument that can introduce a plurality of endoscopes and treatment instruments from a single incision, and without compromising the airtightness of the port part, each port having a small occupied area can be easily and An object of the present invention is to provide an insertion instrument for a medical treatment instrument that can be effectively arranged in large numbers.

An insertion device for a medical treatment instrument of the present invention is attached to an incision and placed on the body surface side of a retracting means for holding the incision in an open state. A cap member having a plurality of port portions serving as an insertion port of an endoscope,
The cap member is made of an elastic member, and a plurality of dents are formed on the surface as a port portion, which are inclined by reducing the diameter from the surface portion toward the bottom as a whole.
In addition, even if there is a portion that is not inclined by reducing the diameter toward the bottom at the entrance of the recess or part of the middle as described above, if the recess is viewed as a whole, the diameter from the surface portion toward the bottom Includes those that are scaled down and tilted.

As a specific shape of the depression formed in the cap member, a mortar shape, a ball shape, or a shape whose cross section is similar to a sine curve was formed.
In the present invention, the shape similar to a sine curve does not coincide with the mathematical definition of a sine curve, but refers to a continuous S-shaped curve having an inflection point, and its amplitude and cycle width. It means a curve including those in which is not constant.

Moreover, it is preferable to form each part as follows.
-The whole cap member surface is formed in the continuous uneven | corrugated shape by the hollow formed in the said cap member.
-The hollow formed in the said cap member is provided with a some diameter.
-The hollow formed in the said cap member does not provide the pre-opening hole to a body cavity.
The cap member is formed to be detachable from the retracting means.

Further, the retracting means includes a flexible body cavity side ring inserted from the incision and positioned in the body cavity, a body surface side ring positioned opposite to the body cavity side ring and positioned on the body surface side, and both ends. The cap member is formed of a cylindrical sheet that is connected to the body cavity side ring and the body surface side ring and is positioned from the body cavity to the body surface side, and the cap member is connected to the body surface side ring.
Alternatively, the cap member may have a function of a body surface side ring of the retracting means, and may be formed integrally with the body surface side ring.

  As described above, the cap member is an elastic member, the surface is a port portion, and the diameter is reduced from the surface side toward the bottom portion (specifically, a mortar shape, a ball shape, and a cross section having a sine curve shape) With multiple depressions, each port part is formed as a depression that matches the diameter of the endoscope or treatment instrument to be applied, and each one does not require an edge or attachment part. In comparison, the occupied area of one port can be small, and a large number of ports can be set within the same area. Further, since the depression may be formed as a molding die integrated with the cap member, for example, it is not necessary to attach a port of another member to the cap member. In addition, one port is a dent, and the surrounding area is inclined and raised, and since the cap member is made of an elastic member, an endoscope or treatment instrument is inserted and tilted to a deep angle. Even if it is tilted, the raised meat around it is deformed so as to bite following the operation and closely adheres, so that it is difficult to create a gap between the trocar and treatment instrument and the punctured hole of the cap member to which the trocar is attached. In addition, leakage of insufflation gas from the perforated part hardly occurs.

In addition, if the depressions are formed continuously and the entire surface of the cap member has a continuous uneven shape, a large number of ports can be effectively arranged on the limited cap surface, and can be arbitrarily positioned as required. You can select a port for use.
Furthermore, if the depression has a mixture of a plurality of diameters, it can be applied to an endoscopic instrument or a treatment instrument having a plurality of types of diameters. In this case, if the dents of different diameters are arranged regularly and continuously, such as alternately, a large number of ports can be effectively arranged, and the usability is excellent.
Furthermore, if the depression is opened for the first time by puncturing with a puncture device such as a trocar without providing a pre-opening hole in the body cavity, only the port at the position necessary for installation of the treatment instrument is opened. Since the recess of the mounting portion is closed, reliable airtightness can be maintained. In addition, since the cap member is made of an elastic member, and the gap between the treatment instrument and the punctured opening hole is unlikely to occur as described above, when the medical treatment instrument or the like is mounted, the mounting contact portion is sealed from the surroundings and is airtight. In addition, even if the trocar or treatment instrument is removed during surgery, it works in the direction to close the hole punctured by elasticity, so the leakage from the puncture hole is limited and the necessary airtightness is reduced. Can be maintained.
In addition, if the cap member is detachable from the retracting means, it can be used as an endoscopic single-hole operation with the cap member attached, or for small incision surgery that does not require a pneumoperitoneum with the cap member removed. Can also be used as a wound protection device, and can be easily changed during surgery.

Further, when the retracting means is formed by the body cavity side ring, the body surface side ring, and the cylindrical sheet, and the cap member and the body surface side ring are connected, the incision is sandwiched between the rings and the cylindrical sheet. As well as holding the wound. In addition, since the contact surface with the incision is covered and protected by the cylindrical sheet, a less invasive operation with a reduced burden on the human body is possible. Moreover, the above-mentioned detachable instrument can be realized by connecting the body surface side ring and the cap member.
On the other hand, when the cap member and the body surface side ring are integrally formed, the number of parts can be reduced and the manufacturing can be facilitated.

According to the insertion instrument for a medical treatment instrument of the present invention, the contact between the port (indentation) and the treatment instrument, particularly during single-hole endoscopic surgery, which is the subject of the invention, due to the above means and action. Since the airtightness of the part is not impaired and the occupied area of each port can be reduced, a large number of ports can be effectively arranged.
In addition, the cap member can be formed integrally, so that the port can be easily formed on the instrument surface.

The top view and side view which show embodiment of this invention. Side surface (CC) sectional drawing of the said embodiment. The AA and BB sectional drawing of the cap member of the said embodiment. The enlarged view of the port part (dimple) of the said embodiment. The top view and side surface sectional drawing of the instrument which formed the cap member in the shape of a plane plate.

Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.
1 is a configuration diagram showing an embodiment of the present invention, A is a top view, B is a side view, FIG. 2 is a side (CC) sectional view, FIG. 3 is a sectional view of a cap member, A is an AA cross section, B is a BB cross section, and FIG. 4 is a partially enlarged view of a port portion of the top view of FIG.
The insertion tool for the medical treatment instrument according to the present embodiment is provided in the instrument while providing only one small incision and maintaining the opening by attaching to the incision during an endoscopic surgical operation. Endoscopic single-hole surgery for performing surgery by introducing multiple endoscopes and treatment instruments directly into the body cavity through or without trocars from multiple ports that serve as passages into the body cavity. A body cavity side ring 1 that is inserted into a body cavity from the incision wound, a body surface side ring 2 that is disposed opposite to the body cavity side ring 1 and is positioned on the body surface, and the body cavity side ring 1 and the body surface side. Both ends 31 and 32 are connected to the ring 2 and are made of a cylindrical elastic sheet 3 positioned from the body cavity side to the body surface side so as to cover the incision, and the incision wound (body) is formed by the body cavity side ring 1 and the body surface side ring 2. The incision was opened by the elasticity of the elastic sheet 3 A retracting means that is held in a state, and a medical treatment instrument or endoscope insertion port (port) that is detachably attached to the body surface side ring 2 of the retracting means and is introduced into the body cavity or directly. And the elastic cap 4 provided with a plurality of depressions 41.

As described above, the retracting means holds the incision to be closed in a natural state by the tension of the body cavity side and body surface side rings 1 and 2 and the elastic sheet 3 in an open state, and the flexible elastic sheet 3 The body cavity side ring 1 covers and protects the wound edge by airtight contact, and the body cavity side ring 1 can be inserted into the body cavity from the small incision wound in the crushed state, and the original state in the body cavity ( It is formed with a shape restoration property that can be restored naturally in a ring state. In the present embodiment, a superelastic alloy 11 made of a wire material such as a titanium-nickel alloy having excellent elasticity and shape restoring property is formed in a ring shape as a core material, and a resin tube (this example) is formed on the superelastic alloy 11. In this case, a protective tube 12 made of a polyurethane tube is coated, and further, the protective tube 12 is covered, and the lower end portion 31 of an elastic sheet 3 made of a silicone resin, which will be described later, is wound once and connected by adhesion or welding. Configured.
The size is selected according to the size of the incision at the time of surgery, and the size is selected so that it can be easily inserted from the incision and a sufficient retracted state can be obtained.
In this embodiment, a circular ring with a circular cross section having a diameter of 70 mm and a ring width of 4 mm is used as an application to an incision of 20 to 40 mm in normal colon surgery.

In this embodiment, the body surface side ring 2 has the same shape and configuration as the body cavity side ring 1 and is fitted into a ring locking groove 42 of an elastic cap 4 to be described later and is detachably attached. Is done.
The size is formed to be approximately the same as that of the body cavity side ring 1 for the convenience of connection of the elastic sheet 3, and in the present embodiment, the same circle as the body cavity side ring 1 has a diameter of 70 mm and a ring width of 4 mm. A circular ring with a cross section was used.

The elastic sheet 3 is formed in a cylindrical shape by a flexible resin (in this example, silicone rubber) having elasticity, and the size is pulled to the tension (external direction (opening the incision)) for maintaining the wound. Force) is set to have a smaller outer diameter than the body cavity side ring 1 and the body surface side ring 2.
In this example, the diameter was 35 to 40 mm, the film thickness was 0.4 mm, and the height (interval between the body cavity side ring 1 and the body surface side ring 2) was 65 mm.
As described above, the lower end 31 of the elastic sheet 3 is covered with the body cavity side ring 1 in an expanded state, and is wound and connected by bonding or welding, while the upper end of the sheet 32 is configured by covering the body surface side ring 2 in an expanded state and connecting it by one roll and bonding or welding.
According to such a retracting means, the incision can be closed by the tension toward the outside of the elastic sheet 3 generated by expanding and connecting the both ends of the elastic sheet 3 to the body cavity side ring 1 and the body surface side ring 2. The wound is maintained against the force described above, and a protective wound protection is realized by hermetic covering the wound edge of the elastic sheet 3 made of a flexible resin.

The elastic cap 4 is formed in a circular plate shape as a whole by an elastic resin (silicone resin in this example), and a central space excluding the circular peripheral edge 46 on the surface of the plate is formed in the body cavity. As a space where a port serving as an insertion port for a trocar or medical treatment instrument can be set, a large number of recesses 41 that are continuously uneven are formed. Further, a ring engagement groove 42 is provided on the inner periphery of the lower side surface of the peripheral edge 46 of the circle so that the body surface side ring 2 of the retracting means is fitted, received, and connected. Three gripping portions 47 for attaching and removing, in which a part of the peripheral edge portion 46 further protrudes outward, are provided at 120-degree intervals, and these are integrally formed.
The recess 41 in this embodiment is formed by alternately and continuously forming recesses 41A and 41B having two diameters over the entire space where the port can be set, and the cross section of one recess 41 is a sine curve. In this example, the outer diameter (the width of the inflection point 45 to the inflection point 45 from the inflection point 45 to the inflection point 45) is used as a 5 mm trocar port. 6mm, depth (depth from the inflection point 45 of the sine curve to the bottom) is 1.5mm, the small diameter recess 41B is for 3mm trocar, the outer diameter is 3mm and the depth is 1.5mm. , Between each of the depressions 41A and 41B is a convex portion, and the interval (width) (width from the inflection point 45 to the inflection point 45 of the sine curve (convex portion side)) is 3 mm, and the height (sine curve variation). Height from bend 45 to convex top 43 As 1.5mm and a recess, arranged so as to be surrounded on all sides in different recesses of diameters, which was formed to have a concavo-convex shape continuously over the entire surface. The space surrounded by the four depressions 41 is formed as a flat portion 44 having a height that is continuous with the convex portion top 43.
In addition, the recess 41 is not opened (closed) before use, and is configured to be opened as a port for the first time by puncturing through the recess 41 with a trocar. The puncture site) has a thickness that can be easily penetrated by the trocar. In this example, the thickness is 1.5 mm from the bottom of the recess 41. Thereby, the maximum thickness of the space where the port of the elastic cap can be set is 4.5 mm (the depth of the recess is 1.5 mm, the convex portion is 1.5 mm, and the penetration portion is 1.5 mm).
With this configuration, as described above, the ports that are not used are reliably closed, and can be easily opened by trocar puncture when used. In addition, even when it becomes necessary to remove the trocar from the depression 41 after the trocar is drilled, the entire elastic cap 4 is formed as a depression by the elastic member, and a certain amount of thickness (in this example) , The opening after removal works in the direction of closing, and the necessary airtightness can be maintained.

Then, the retracting means and the elastic cap 4 are connected by fitting the body surface side ring 2 of the retracting means into a ring locking groove 42 formed on the inner periphery of the lower side surface of the elastic cap 4 by using each elasticity. This connecting means is separable. Thus, when the elastic cap 4 is configured to be detachable, it can be selected that the elastic cap 4 is not attached to the retracting means, but simply used as a wound protection device, and a large opening is required during the operation. Switching from a pneumoperitoneal surgery to an open abdominal surgery, for example, becomes possible by removing the cap.
The retracting means and the attaching means of the elastic cap 4 are not limited to this embodiment. For example, if the elastic cap 4 is not assumed to be attached / detached, the elastic cap 4 has the function of the body surface side ring 2 and is integrated. It is also possible to attach the one end of the elastic sheet 3 of the retracting means directly to the integrated elastic cap using an O-ring or the like.

FIG. 5 is an example of an insertion instrument for a medical treatment instrument in which the elastic cap according to the above-described embodiment is formed as a substantially flat plate, in which A is a top view and B is a side view. In the side view, only the elastic cap is shown as a cross-sectional view.
The retracting means of this example is the same as that of the above-described embodiment, and the elastic cap 5 is easily punctured by a trocar in a space 53 in which a port can be set, which is formed as an uneven surface of a continuous depression in the above-described embodiment. In order to facilitate the puncture of the trocar, it is formed as a flat surface having a thickness (2.5 mm in this example) that can hold the treatment instrument and the like, and a hollow 51 having a ball-like cross section is provided. In the example, a width of 2.5 mm and a depth of 0.3 mm were arranged at four positions at an interval of 90 degrees at an equal distance from the axis of the elastic cap 5.
And like the said embodiment, the body surface side ring 2 of the retracting means was inserted and connected to the ring latching groove | channel 52 of the elastic cap 5, and it was set as the instrument of this form.
According to the insertion instrument of this embodiment, it is possible to drill a relatively large number of trocars in the elastic cap 5 with a good balance.

1. Body cavity side ring 11. Superelastic alloy 12. Protective tube Body side ring 21. Superelastic alloy 22. 2. Protection tube Elastic sheet 31. Lower end 32. Upper end 4. Elastic cap (cap member)
41. Dimple 42. Ring locking groove 43. Convex part 44. Flat part
45. Inflection point (virtual line)
46. Edge 47. Grip part

Claims (8)

A cap member that is disposed on the body surface side of a retracting means that holds an incision in an open state, and includes a plurality of port portions that serve as insertion ports for medical treatment instruments and endoscopes from outside the body to the body cavity. ,
The cap member is made of an elastic member, and a surface of the medical treatment instrument is characterized in that a plurality of depressions are formed on the surface as a port portion, and the diameter of the port portion is reduced from the surface portion toward the bottom portion. Insertion instrument.   The insertion instrument for a medical treatment instrument according to claim 1, wherein the recess formed in the cap member has a mortar shape, a ball shape, or a cross-sectional shape similar to a sine curve.   The insertion instrument for a medical treatment instrument according to claim 1 or 2, wherein the recess formed in the cap member is formed in a continuously concave and convex shape.   4. The medical instrument insertion instrument according to claim 1, wherein the recess formed in the cap member has a plurality of diameters.   5. The medical instrument insertion instrument according to claim 1, wherein the recess formed in the cap member does not provide a pre-opening hole into the body cavity.   6. The medical instrument insertion instrument according to claim 1, wherein the cap member is detachably formed with the retracting means.   The retracting means includes a flexible body cavity side ring that is inserted from the incision and is positioned in the body cavity, a body surface side ring that is disposed opposite to the body cavity side ring and is positioned on the body surface side, and both ends are respectively located on the body cavity side. The medical instrument insertion instrument according to any one of claims 1 to 6, wherein the instrument is formed from a cylindrical sheet that is connected to the ring and the body surface side ring and is positioned from the body cavity to the body surface side, and the cap member is connected to the body surface side ring.   The insertion device for a medical treatment instrument according to claim 7, wherein the cap member is integrally formed with a function of a body surface side ring of a retracting means.

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