JP5623133B2 - Valve cap for surgical retractor - Google Patents

Description

  The present invention relates to a valve cap mounted on a retractor used for expanding and maintaining a retracted portion formed on a body wall during endoscopic surgery or relatively small-scale laparotomy.

  The retractor maintains and opens an open state of an access hole into the abdominal cavity provided on the body surface in a manually assisted endoscopic surgical operation or an incision hole formed in a relatively small open operation. Used for surface protection. Further, the treatment tool is introduced into the body cavity from the opening maintained by the retractor, and various treatments are performed.

  Endoscopic surgery and laparotomy require a stable and good surgical field of view in order to perform the treatment smoothly. In order to secure the surgical field of view, for example, the pneumoperitoneum method is widely used. The pneumoperitoneum method is a method of inflating a body cavity by injecting carbon dioxide gas into the body cavity to make a positive pressure.

  However, when the retractor is mounted, carbon dioxide gas escapes from the formed opening, and there is a problem that the body cavity cannot be inflated. For this reason, various caps have been developed that maintain the airtightness of the abdominal cavity while allowing the treatment tool to be introduced from the opening formed by the retractor.

  As such a cap, a gel cap including a gel pad and a cap ring has been proposed (for example, see Patent Document 1). The gel pad is made of an elastomer having an elongation rate of 1000% or more and a hardness represented by durometer A (Shore A) of A5 or less, and for introducing a treatment instrument or the like into a body cavity at a predetermined position. The slit part is provided. The cap ring is provided on the outer periphery of the gel pad and is attached to the retractor.

  According to the gel cap, when the treatment instrument is not inserted into the slit portion of the gel pad, the opposing slit forming surfaces of the slit portion of the gel pad are in close contact with each other, so that the airtightness in the body cavity is maintained. . Further, in a state where the treatment tool is inserted into the slit portion of the gel pad, the opposing slit forming surface of the slit portion of the gel pad is in close contact with the treatment tool, so that confidentiality within the body cavity is maintained. Therefore, confidentiality within the body cavity can be maintained regardless of whether or not the treatment instrument is inserted.

JP 2004-512076 A

  However, the conventional gel cap is made of a very soft elastomer having a gel pad elongation of 1000% or more and a hardness represented by durometer A (Shore A) of A5 or less. Therefore, if the thickness of the gel pad is reduced, sufficient strength cannot be obtained, and the thickness needs to be relatively increased. As a result, there is a problem that high frictional resistance is generated in insertion / extraction of the treatment instrument, and the operability of the treatment instrument is deteriorated.

  The objective of this invention is providing the valve cap of the retractor which improved the operativity of the treatment tool, maintaining the airtightness in a body cavity.

  The present invention relates to a ring-shaped inner fixing member arranged inside a body cavity, a ring-shaped outer fixing member arranged outside the body cavity, and the inner fixing member and the outer fixing member connected to each other to form a body wall. A retractable retractor having a cylindrical seat member that expands the retracted portion, and a flexible pair of first seat members and the pair of first seat members. A circular canopy member formed by laminating a plurality of composite sheet members composed of a second sheet member having elasticity interposed therebetween, and a ring-shaped mounting member that hermetically mounts the canopy member on the outer fixing member The composite sheet member includes a slit portion for introducing a treatment instrument into a body cavity, which passes through the pair of first sheet member and the second sheet member, respectively, and is adjacent to the composite sheet member Slit part The first sheet member has a higher sliding property than the second sheet member, and the second sheet member is a slit facing the slit portion when the treatment instrument is not inserted. The forming surfaces are tightly adhered to each other, and are tightly adhered to the treatment instrument when the treatment instrument is inserted.

  According to the present invention, since the second sheet member is interposed between the pair of first sheet members, the surface that comes into contact with the treatment instrument when the treatment instrument is inserted and removed is mostly the first. It becomes this sheet member. Since the 1st sheet member has higher slidability than the 2nd sheet member, it can reduce the frictional resistance at the time of treatment instrument insertion and extraction.

  Further, according to the present invention, when the treatment tool is not inserted, the second sheet member has the slit forming surfaces facing each other in the slit portion in an airtight manner. Furthermore, when the treatment instrument is inserted, the slit members of the adjacent composite sheet members intersect each other, so that the position of the gap formed between the treatment instrument and the second sheet member is adjacent to the composite sheet member. Are formed at different positions. That is, the adjacent composite sheet members cooperate to eliminate a continuous gap between the inside and outside of the body cavity. Therefore, the airtightness in the body cavity can be maintained regardless of whether or not the treatment instrument is inserted.

  The first sheet member preferably has a higher surface hardness than the second sheet member. According to this combination, since the local deformation of the first sheet member is suppressed and the insertion / extraction resistance of the instrument is reduced, the operability when the treatment instrument or the like is inserted can be improved.

  Moreover, airtightness can be more reliably maintained by making the slit parts of the adjacent composite sheet members perpendicular to each other.

In addition, in order to obtain airtightness at the time of inserting the treatment instrument, a plurality of elastic sheet members are used in a complementary manner. Therefore, compared to the case where airtightness is maintained by a single sheet member, the material itself Dependence on adhesion performance can be reduced. Therefore, the thickness of the second sheet member can be reduced, and the operability of the treatment instrument can be improved. For example, a canopy member in which two composite sheet members are stacked can be used.

  A plurality of sets of slit portions can be provided on the canopy member.

  In addition, for example, polyurethane can be used as the first sheet member.

  Moreover, a gel material or silicone rubber can be used as the second sheet member.

The cross-sectional perspective view for demonstrating the time of mounting | wearing with the valve cap of embodiment of this invention. The perspective view for demonstrating the structure of the retractor which mounts | wears with the valve cap of embodiment of this invention. (A) Sectional drawing for demonstrating the structure of the valve cap of embodiment of this invention, (b) The top view for demonstrating the structure of the valve cap of embodiment of this invention. (A) The top view for demonstrating the treatment tool insertion state of the valve cap of embodiment of this invention, (b) Sectional drawing for demonstrating the treatment tool insertion state of the valve cap of embodiment of this invention.

  As shown in FIG. 1, the valve cap 1 of the present embodiment is used in a state where it is mounted on the retractor 2, and maintains the airtightness of the opening formed by the retractor 2.

  As shown in FIGS. 1 and 2, the retractor 2 includes an inner fixing ring 3, a tubular sheet member 4, and an outer fixing ring 5.

  The inner fixing ring 3 is made of, for example, silicone rubber and has a substantially circular cross section. One end of the cylindrical sheet member 4 is fixed over the entire circumference of the inner fixing ring 3 and is disposed in the body cavity.

  The cylindrical sheet member 4 is formed of an elastic thin film made of polyurethane, for example. The tubular sheet member 4 has a substantially funnel shape in which the opening area of the opening end on the side not fixed to the inner fixing ring 3 is larger than the opening area of the inner fixing ring 3 side end.

  The outer fixing ring 5 includes an inner ring 6 and an outer ring 7 arranged outside the body cavity. The inner ring 6 has a substantially rectangular cross section made of, for example, silicone rubber. The outer ring 7 has, for example, a substantially L-shaped cross section. The outer ring 7 has an inner diameter that is approximately the same as the inner diameter of the inner ring 6, and an outer diameter that is approximately the same as the outer diameter of the inner ring 6. With the cylindrical sheet member 4 interposed between the inner ring 6 and the outer ring 7, the outer ring 7 is fitted to the outside of the inner ring 6, thereby fixing the cylindrical sheet member 4, and the inner fixing ring 3 and the outer fixing ring 5 can be defined.

  As shown in FIG. 3A, the valve cap 1 includes a canopy member 8 and a mounting member 9 for mounting the canopy member 8 to the outer fixing ring 5. The canopy member 8 is formed by laminating two composite sheet members 12a and 12b each composed of a pair of first sheet members 10a and 10b and a second sheet member 11 vertically.

  The pair of first sheet members 10 a and 10 b has a circular shape having substantially the same diameter as the outer diameter of the outer fixing ring 5. As the first sheet members 10a and 10b, for example, polyurethane or a PVC sheet can be used.

  The second sheet member 11 has a circular shape that is slightly smaller in diameter than the first sheet members 10 a and 10 b and larger in diameter than the inner diameter of the outer fixing ring 5. As the 2nd sheet | seat member 11, what consists of a gel material or silicone rubber can be used, for example. Examples of the gel material include polyurethane and various elastomers.

  The composite sheet members 12a and 12b have a peripheral portion between the pair of first sheet members 10a and 10b in a state where the second sheet member 11 is sandwiched between the pair of first sheet members 10a and 10b. It is formed by bonding.

  The two composite sheet members 12a and 12b constituting the canopy member 8 include, for example, three linear slit portions 13 and 14 penetrating the first sheet member 10a and 10b and the second sheet member 11, respectively. I have. Each slit part 13 and 14 is provided in the position mutually spaced apart at substantially equal distance.

  The slit portion 14 of the lower composite sheet member 12b is provided orthogonal to the slit portion 13 of the upper composite sheet member 12a.

  As shown in FIGS. 3A and 3B, the mounting member 9 is formed by bonding the outer peripheral edge portions 16 of the two ring-shaped third sheet members 15a and 15b made of an elastic thin film. It is formed. The mounting member 9 has an inner peripheral edge portion 17 on the inner surface side of the upper third sheet member 15 a and an outer peripheral edge portion 18 on the upper surface of the canopy member 8 bonded to each other. The third sheet members 15 a and 15 b are formed so that the inner diameter is substantially the same as the inner diameter of the inner ring 6 and the outer diameter is larger than the outer diameter of the outer ring 7. As the mounting member 9, a sheet-like material rich in elasticity can be used. Examples of the sheet-like material rich in elasticity include natural rubber and polyurethane.

  Next, the usage method of the retractor 2 for using the valve cap 1 of this embodiment and it is demonstrated.

  First, as a position where the retractor 2 is mounted, for example, an abdominal skin and peritoneum are incised to form an incision not shown. Next, the inner fixing ring 3 to which the tubular sheet member 4 is attached is inserted from the incision while being bent, and is deployed in the abdominal cavity. At this time, the open end of the cylindrical sheet member 4 is located outside the abdominal cavity.

  Next, the tubular sheet member 4 exposed from the incision is passed through the inner ring 6, and the inner ring 6 is disposed on the body surface. Then, the outer ring 7 is attached to the inner ring 6 so that the tubular sheet member 4 passed through the inner ring 6 is opened radially outward and the tubular sheet member 4 is held between the inner ring 6 and the inner ring 6. Fit lightly.

  Next, the incision is expanded by partially releasing the fitting between the inner ring 6 and the outer ring 7 and pulling the cylindrical sheet member 4 at a corresponding position away from the inner fixing ring 3. Then, the outer ring 7 is fitted to the inner ring 6 again. By repeating such an operation over the entire circumference of the incision, an opening 19 having a desired diameter is formed. Thereafter, the outer ring 7 and the inner ring 6 are completely fitted, and the opening 19 is fixed.

  Next, the outer side of the inner ring 6 and the outer ring 7 is covered while the third sheet member 15b on the lower side of the mounting member 9 is appropriately stretched, and the elasticity of the third sheet member 15b allows the upper side of the outer ring 7 to be covered. The canopy member 8 is fixed to the head.

  When the treatment instrument is not inserted, the valve cap 1 mounted on the retractor 2 in this way has the slit forming surfaces tightly adhered to each other due to its elasticity. Further, when it is necessary to insert a treatment tool into the abdominal cavity during the treatment, the treatment tool 20 is inserted into the abdominal cavity from the slit portions 13 and 14 as shown in FIGS. 4 (a) and 4 (b).

  When the treatment tool 20 is inserted into the slit portions 13 and 14, the treatment tool 20 is pushed, and the slit portions 13 and 14 are invaded toward the abdominal cavity. Then, the slit forming surfaces of the slit portions 13 and 14 are deformed away from each other. As a result, only the first sheet members 10a and 10a are in contact with the treatment instrument 20, and the second sheet members 11 and 11 are not in contact with the treatment instrument 20, or only a very small portion is in contact therewith. Since the first sheet member 10a has higher slipperiness than the second sheet member 11, the treatment instrument 20 can be easily inserted.

  When the insertion of the treatment instrument 20 is completed, the slit portions 13 and 14 are released from the indented state due to the elasticity of the second sheet member 11 so that the second sheet member 11 comes into contact with and closely contacts the treatment instrument 20. Become. At this time, a gap is formed between the treatment instrument 20 and the slit portion 13 or the slit portion 14 on both sides in the slit direction of the treatment instrument. However, since the slit portion 13 and the slit portion 14 are formed in a direction perpendicular to each other, the gap formed by the treatment instrument 20 and the slit portion 13, and the treatment instrument 20 and the slit portion 14 The gap formed is discontinuous. Therefore, the valve cap 1 can maintain the airtightness in the abdominal cavity even when the treatment instrument is inserted.

  When the treatment tool 20 is pulled out from the slit portions 13 and 14, the treatment tool 20 is inserted except that only the first sheet member 10b is in contact with the treatment tool 20 instead of the first sheet member 10a. Done in the same way. Since the first sheet member 10b has higher slipperiness than the second sheet member 11, the treatment instrument 20 can be easily pulled out.

  When the treatment instrument 20 is completely extracted, the first sheet members 10a and 10b and the second sheet member 11 are brought into a state in which the slit forming surfaces are in close contact with each other due to their elasticity, and the airtightness in the abdominal cavity is maintained. .

  In the valve cap 1 of the present embodiment, the slit portions of the adjacent composite sheet members are provided so as to be orthogonal to each other. However, the present invention is not limited to this, and the airtightness in the body cavity can be maintained when the treatment instrument is inserted. It can be set freely within the range.

  Further, in the valve cap 1 of the present embodiment, the canopy member is configured by two composite sheet members, but three or more composite sheet members may be used.

  Further, in the valve cap 1 of the present embodiment, three sets of slit portions are provided in the canopy member 8, but the present invention is not limited to this, and one or more sets of slit portions may be used.

DESCRIPTION OF SYMBOLS 1 ... Valve cap, 2 ... Retractor, 3 ... Inner fixing member, 4 ... Expansion member, 5 ... Outer fixing member, 8 ... Canopy member, 9 ... Mounting member, 10a, 10b ... First seat member, 11 ... First 2 sheet members, 12a, 12b ... composite sheet member, 13, 14 ... slit part.

Claims (7)

A ring-shaped inner fixing member disposed on the inner side of the body cavity, a ring-shaped outer fixing member disposed on the outer side of the body cavity, and the retracting portion formed on the body wall by connecting the inner fixing member and the outer fixing member. A valve cap attached to a retractor comprising a tubular sheet member for expanding
Circular canopy formed by laminating a plurality of composite sheet members composed of a pair of flexible first sheet members and an elastic second sheet member interposed between the pair of first sheet members Members,
A ring-shaped mounting member that hermetically mounts the canopy member to the outer fixing member;
The composite sheet member includes a slit portion for introducing a treatment instrument into a body cavity, which penetrates the pair of first sheet member and the second sheet member, respectively.
The adjacent slit portions of the composite sheet member intersect each other,
The first sheet member has higher lubricity than the second sheet member,
When the treatment instrument is not inserted into the second sheet member, the opposing slit forming surfaces of the slit portion are in close airtight contact with each other,
A valve cap characterized in that when a treatment instrument is inserted, the valve cap is hermetically adhered to the treatment instrument.   2. The valve cap according to claim 1, wherein the surface hardness of the first seat member is equal to or greater than the surface hardness of the second seat member.   The valve cap according to claim 1 or 2, wherein the slit portions of the adjacent composite sheet members are orthogonal to each other.   The valve cap according to any one of claims 1 to 3, wherein the canopy member is formed by stacking two composite sheet members.   The valve cap according to any one of claims 1 to 4, wherein a plurality of sets of the slit portions are provided on the canopy member.   The valve cap according to any one of claims 1 to 5, wherein the first seat member is made of polyurethane.   The valve cap according to any one of claims 1 to 6, wherein the second seat member is made of a gel material or silicone rubber.

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