JP5677718B2 - Forceps for sealing test - Google Patents

Description

The present invention relates to a surgical forceps used in a sealing test for confirming an air leak from a residual lung after excision during a partial excision operation of a lung.

When performing partial resection of the lung, such as lobectomy or lymph node dissection for lung cancer, at the final stage, air is sent inside with the remaining lungs immersed in physiological saline to press the lung surface. A sealing test is performed to confirm the presence or absence of air leaks from inside the lungs by observing the generation of bubbles. When air leak is observed, a treatment for closing the leak portion is performed by closing the corresponding site with suture or covering with a bioadhesive (fibrin glue).
On the other hand, in recent years, low invasiveness has been advocated for lung cancer that is not so large, such as early non-small cell lung cancer, and a thoracoscope or special surgical instrument is inserted through a solacoport or small incision, In many cases, thoracoscopic pulmonary resection is performed, and in this case, the sealing test is also performed under thoracoscopic images.
Conventionally, there is a device for pressing the lung used for the sealing test of this operation, and as a device that can be inserted from the Soracoport or small incision wound, particularly suitable for thoracoscopic assisted surgery, a compressed cotton ball at the tip Tuppel forceps for endoscopic surgery used by grasping and a device (eg, a peeling device of Patent Document 1) having a hard pressing portion which is different from the original use but is not sharp at the tip of the lot. Although it has been diverted, there is no proposal for a device specialized for this application at present.
JP-A-7-67880

  Even with the above-mentioned Tuppel forceps or substitute peeling device, it is possible to confirm the presence or absence of air leaks by pressing the lungs with a compressed cotton ball or the like at the tip. When covering with glue (hereinafter only described as suture occlusion), especially in thoracoscopic-assisted surgery, the number of port holes for surgical instrument insertion is limited, and the size of the device inserted through the port hole is also limited. Because it is limited, it is not always possible to ensure a satisfactory visual field, and there are cases where the sense is different from that under direct vision, and it is difficult to always capture the leak position stably compared to thoracotomy, There are inconveniences such as taking time for the treatment because the work needs to be repeated several times for the certain treatment.

  Therefore, the present invention makes it possible to perform the sealing test easily and in a short time by reliably capturing the position of the specified air leak in the sealing test, and is particularly suitable for thoracoscopic surgery. An object of the present invention is to provide a forceps for a sealing test.

The forceps for sealing test of the present invention comprises a presser at the tip of a lot, and the presser is formed by covering a material capable of elastic deformation and self-restoration with a flexible covering tube. It is formed as an annular frame that divides and surrounds the space in the presser surface , or an annular frame that is partially missing, and by pressing the lung surface during lung thoracoscopic assistance surgery, The presence or absence of air leak from the air is confirmed, and the air leak portion is supplemented.
Further, a hand operation unit that moves the pressing element is provided on the hand side of the lot as necessary.

The pressing element preferably has the following structure and configuration.
1 . The pressing element includes a super elastic alloy, a metal strand, or a spring material.
2 . The presser has a structure in which the size of the frame can be changed by an operation from the hand operation unit.
3 . The pressing element has a structure in which an inclination angle with respect to the lot can be changed by an operation from a hand operating unit.
4 . The lung surface contact portion of the presser is provided with a slip prevention means.

(Function)
According to the forceps for sealing test of the means described above, the position of the air leak specified by the sealing test performed by pressing the lung surface with the presser by configuring the presser as a frame that defines a space formed in an annular shape or the like. Is trapped in the space inside the frame of the presser (for example, inside the annular shape), so that the leak portion in the internal space is sutured and closed without losing sight of the leak portion specified in the sealing test. Thus, the treatment can be surely performed.

  In addition, since the pressing part is formed to include an elastic body such as a superelastic alloy or a spring material, it can be elastically deformed and self-recovered from the deformation. Thus, it can be inserted into the Soraco port in a state where the pressing portion is crushed, and can be maintained in the original open state in the body cavity.

Furthermore, it is possible to change the size of the frame of the pusher and the angle of inclination of the pusher with respect to the lot by the operation from the hand operation unit, so that a single instrument can be used according to the situation. It can be set as a high instrument.
Further, when a slip prevention means is provided at the lung surface contact portion of the presser, the specific position can be surely captured on the lung surface that is slippery due to the influence of physiological saline.

According to the forceps for sealing test of the present invention, after the position of the air leak is specified by the above configuration and operation, the position can be recognized so that the leak portion is not lost, and the sealing test and the suture blockage are performed. The treatment can be performed easily and in a short time.
Further, by making the pressing portion an elastic body that can be elastically deformed and restored, it is possible to provide an instrument that is suitable for thoracoscopic-assisted surgery.

Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.
FIG. 1 shows a forceps for sealing test showing a first embodiment of the present invention, A is an overall configuration diagram, and B is a sectional view of a d section of a pressing portion.
The forceps for sealing test according to this embodiment has a long lot 1 that also serves as an operation gripping part, and an air leaking part that is formed in an annular shape at the tip of the lot to identify an air leak part and capture the identified part. It is basically composed of a pressing element 2 for placing.

  Lot 1 is long (150 mm or more, 350 mm or less, 270 mm in this example) and has a small diameter suitable for thoracoscopic surgery using a metal or a hard resin (in this example, a stainless steel rod). (3 mm or more, 9 mm or less, 7 mm in this example), and the proximal end is an operation gripping part 11 for operating the instrument from outside the chest cavity.

The presser 2 has a superelastic alloy 21 made of a nickel-titanium alloy or the like as a core material as a material capable of elastic deformation and self-recovery from the deformation, and the superelastic alloy 21 is harmless to the human body and is in contact. Covered with a coated tube 22 made of silicone resin or the like having slipperiness and flexibility, formed into a ring shape, and formed in a hole provided in advance at the tip of the lot 1 to the coated tube 22 of the superelastic alloy 21 Both ends not covered were inserted and bonded or welded together. The inner diameter of the ring 9 is set to be 5 mm or more so that the suture can be easily closed in the inner space 9. On the other hand, considering the insertion from the Soraco port, the outer diameter of the ring in the width direction is 15 mm. Although it is preferable to form as follows, it is not particularly specified within this range.
In addition, since the presser 2 uses the super elastic alloy 21, when inserting into the chest cavity, the presser 2 can be crushed and reduced in diameter (elastically deformed) and inserted through the Soraco port or a small incision. In addition, after insertion into the thoracic cavity, the device is naturally restored to its original ring shape (self-restoring), and a space 9 large enough for the procedure is secured, so that the instrument can be adapted for thoracoscopic assisted surgery. ing. As described above, the elastic material is reduced in diameter so that it can be inserted into a Soraco port, etc., can self-restore to its original shape in the thoracic cavity, and functions as a presser when pressing the lung surface. As long as it has a possible strength (bending resistance), it is not limited to the superelastic alloy of this embodiment, and may be a spring material such as a metal stranded wire or a coil spring.
On the other hand, by covering the superelastic alloy 21 with a covering tube 22 that is not harmful to the human body and has a slippage difficulty and flexibility at the time of contact, the direct contact portion to the lung surface becomes soft, Contact stability can be improved by increasing the contact area.
Further, the lung surface contact portion of the coated tube 22 is provided with unevenness as a means for preventing slippage or roughened so that the lung surface that has become slippery with physiological saline or the like can be more reliably placed at a specific position. Can be captured.

FIG. 2 shows a partially enlarged side view of the embodiment.
The presser 2 is configured to make it easy to press the lung surface with the entire pressing surface of the presser 2 by a pressing (up and down) operation from the operation gripping part 11 outside the chest cavity, and to ensure that the leak part is inside the frame body. In order to be easily captured, it is attached to the lot 1 by tilting the pressing surface of the pressing element 2 at 30 degrees or more and 60 degrees or less (45 degrees in this example) at the bent portion 210. ing. And if this inclination angle is a shallow attachment angle of 30 degrees or less, the contact of the presser 2 with the lung surface tends to be weak against the pressure from the outside (the operation gripping part 11), and the contact part is It tends to be on the tip side only. On the other hand, when the mounting angle is deeper than 60 degrees, it is difficult to insert from a small diameter Soraco port. From these facts, considering the adaptation to thoracoscopic assisted surgery in particular, the attachment angle of the presser 2 to the lot 1 is preferably in the above range, but is not particularly limited to this range.
Further, as described above, it is attached with an angle in advance, but since the bent portion 210 is made of a superelastic alloy, the inclination angle can be varied to some extent according to external force such as pressing from the operation gripping portion 11. As a result, it is possible to press the entire pressing surface of the pressing element 2 against the lung surface by applying the pressing force from the operation gripping part 11, and the insertion through the Soraco port is straightened. Insertion in a state becomes possible.

FIG. 3 shows a second embodiment of the present invention, and shows an instrument that forms an annulus in which the presser is partially missing.
When the presser 2 has a shape in which a part of the annular shape is lost as in this example, when the leaked part is captured in the annular inner part 9 and sutured and closed, the instrument for the sutured and closed treatment is operated from the side of the lost part. By doing so, the frame body does not get in the way in operation.
In addition, as the shape of the pressing element 2, an annular shape as in the above-described embodiment or an annular shape that is partially lost as in the present embodiment is the easiest and appropriate shape in manufacturing or the like. In order to capture the air leak portion, any shape may be used as long as it is formed as a frame surrounding the space 9 in the surface of the presser 2.

Next, means for using the device according to the first or second embodiment will be briefly described.
1. In thoracoscopic assisted surgery, after partial resection of the lung, the remaining lung is soaked in physiological saline, and soracoport or a small cut in a state where the diameter is reduced so as to crush the presser 2 of the device in the length direction. Insert from the incision.
2. When the pusher 2 is projected into the thoracic cavity from the solacoport or small incision, it returns to its original open shape by elastic restoring force.
3. Air is supplied to the inside of the lung, and the lung surface is pressed by the pressing element 2 by an external operation under the thoracoscopic image, and an air leak portion is specified using bubbles as an index.
4). The identified air leak portion is positioned in the space 9 inside the frame of the presser 2, and whether there is a leak portion in the space 9 is checked again.
5. In a state where the presser 2 is fixed on the spot and the air leak portion is captured, the leak portion inside the space 9 of the presser 2 is sewn and closed to close the air leak.
6). Again, confirm that the leak is gone by pressing the pressing element.

FIG. 4 is a configuration diagram of the third embodiment of the present invention, showing a device including a hand operating unit, and FIG. 5 is an enlarged view of the pressing unit.
The sealing test forceps according to the present embodiment includes a pipe 3 that is a long lot, a presser 4 that is formed in an annular shape at the tip of the pipe 3, and the size (internal space 9) of the annular frame can be expanded and contracted; It is provided on the hand side of the pipe 3 and is basically constituted by a hand operating part 5 for operating the pressing element 4.

  The pipe 3 is made of a hollow metal or hard resin (in this example, a stainless steel pipe) and is long (150 mm or more, 300 mm or less, in this example, 200 mm) to be compatible with the operation under thoracoscopic assistance, and The tip tip 31 is formed with a small diameter (3 mm or more, 9 mm or less, in this example, 5 mm), and has two through holes 310 for inserting and holding the presser 4 at the tip portion. Composed.

The presser 4 is elastically deformable and self-recoverable from the deformation, and a linear metal strand 41 is used as a core material. The strand 41 is not harmful to the human body, and is difficult to slip and soft when contacted. The pipe 3 is covered with a covering tube 42 made of a fluororesin or the like, and both end portions are inserted into the pipe lumen from the through hole 310 of the tip end 31 of the pipe 3, and one end portion is the tip end 31. The other end is extended through a pipe lumen to a slide base 52 of the hand operating portion 5 to be described later and connected to form a tip portion in a ring shape. As a result, the size of the formed ring (pressor 4) can be enlarged or reduced in conjunction with the slide of the slide base 52. The size of the pressing element 4 can be set to a desired size range (minimum reduction value, maximum expansion value). In this example, the ease of insertion into the Soraco port is taken into consideration. Then, the width outer diameter at the time of the minimum reduction is set to about 5 mm which is equal to the outer diameter of the pipe 3 (the length direction is about 6 mm for reference), and the size capable of easily closing the suture in the internal space 9 The width inner diameter at the time of maximum expansion is about 7 mm, and the width outer diameter is about 10 mm (the outer diameter in the length direction is about 13 mm for reference).
In addition, since the presser 4 can be expanded and contracted and uses a metal strand 41, when inserting into the thoracic cavity, the outer diameter is reduced or the presser 4 is crushed to reduce the diameter ( It can be inserted through Soracoport or small incision by elastic deformation), and after insertion into the thoracic cavity, the diameter is expanded or it is naturally restored to its original ring shape (self-restoration), which is large enough for the procedure The space 9 can be secured, and the instrument can be adapted for thoracoscopic assisted surgery. In addition, as an elastic material, there is a moderate flexibility that allows the ring to be expanded and contracted by hand operation, a diameter that can be inserted into a Soraco port, etc., and self-restoration to the original shape within the thoracic cavity. As long as it has moderate strength capable of functioning as a presser when pressing the lung surface, it is not limited to the metal strand of this embodiment, for example, a superelastic alloy fine wire, a coil spring, etc. It may be like a spring material.
Further, the presser 4 in this example does not adopt a configuration having an inclination angle with respect to the pipe 3 as in the first embodiment, but a stranded wire 41 having appropriate elasticity (flexibility). And the covering tube 42, the pressing element 4 can be bent at any angle according to the magnitude and direction of the external force (pressing) from the hand operating section 5 when pressing the lung surface. By this operation, the angle with the pipe 3 can be varied. As a result, it is possible to press the entire pressing surface of the pressing element 4 against the lung surface according to the force applied and the direction applied to the hand operating section 5, and a shape that can be easily inserted into a Soraco port or the like in a natural state. It has become. The means for changing the inclination angle of the presser with respect to the lot by hand operation can be a known mechanical means, but the device is complicated and expensive, and may be provided as necessary.
On the other hand, by covering the stranded wire 41 with a covering tube 42 that is not harmful to the human body and has a slippage difficulty and flexibility at the time of contact, the direct contact portion to the lung surface becomes soft, and contact Contact stability can be improved by increasing the area.
Furthermore, the lung surface contact portion of the coated tube 42 is provided with unevenness as a means for preventing slippage or roughened to ensure that the lung surface that has become slippery with physiological saline or the like is in a specific position. Can be captured.

The hand operating section 5 functions as a gripping section provided on the hand side of the pipe 3 and an operating section for operating the presser 4 from the hand, and is a lot base made of a resin molded product connected to the rear end of the pipe 3. 51 and a slide base 52 made of a resin molded product connected to an end extending from the presser 4. In this example, the slide base 52 is fitted into the inner cavity of the lot base 51. did.
The lot base 51 is provided with a slit 510 (15 mm in this example) along the axial direction, while the slide base 52 is provided with a stopper 520 formed as a protrusion that fits into the slit 510. , And the stopper 520 is movable in the slit 510 so that the slide base 52 can be slid forward and backward within the range of the slide length. The slide base 52 and one end of the presser 4 are formed. Are connected, the size of the presser 4 is enlarged or reduced in conjunction with the sliding of the slide base 52. That is, when the stopper 520 is at the rearmost end of the slit 510, the pressing element 4 is minimum, and when the stopper 520 is at the forefront of the slit 510, it is maximum.
By providing this handy operation unit, when inserting into the Soraco port, the pusher can be easily inserted in a contracted state, while when working in the thoracic cavity, a desired size that is easy to work depending on the situation Since the presser can be set and used, a single size can be used for general purposes.

Next, a means for using the device according to the third embodiment will be briefly described.
1. In thoracoscopically assisted surgery, after partial resection of the lung, the remaining lung is immersed in physiological saline, and the presser 4 of the device is in the minimum state (the state in which the slide base 52 is pulled most), and If necessary, the instrument is inserted through a Soraco port or a small incision wound in a state of being reduced in diameter so as to be crushed in the length direction.
2. When the pusher 4 protrudes from the Soraco port or small incision into the chest cavity, the lot base 51 is fixed, the slide base 52 is advanced, and the pusher 4 is expanded to a desired size.
3. Air is supplied to the inside of the lung, and the surface of the lung is pressed with the pressing element 4 by an external operation under the thoracoscopic image, and an air leak portion is specified using bubbles as an index.
4). The identified air leak portion is positioned in the space 9 inside the frame of the presser 4, and whether there is a leak portion in the space 9 is checked again.
5. In a state where the pressing element 4 is fixed on the spot and the air leak part is captured, the leak part inside the space 9 of the pressing element 4 is sutured and closed to close the air leak.
6). Again, confirm that the leak is gone by pressing the pressing element.
7). After the treatment is completed, the pusher 4 is taken out of the body through the Soraco port or a small incision with the minimum state.

The block diagram which shows 1st embodiment of this invention. The enlarged side view of a part (pressing part) of the said form. The block diagram which shows 2nd embodiment of this invention. The block diagram which shows 3rd embodiment of this invention. The enlarged view of a part (pressing part) of the said form.

Explanation of symbols

1. Lot 2. Presser 21. Superelastic alloy 22. 2. Coated tube Pipe 31. Tip tip 310. Through hole 4. Presser 41. Stranded wire 42. 4. Coated tube Hand operation unit 51. Lot base 510. Slit 52. Slide base 520. stopper

Claims (6)

A lot is provided with a pressing element at the tip of the lot, and the pressing element is a space in the pressing element surface that is formed by covering a material that can be elastically deformed and self-recovered with a covering tube having flexibility. It is formed as an annular frame that partitions and surrounds , or an annular frame that is partially missing , and during lung thoracoscopic assist surgery, by pressing the lung surface, confirm the presence or absence of air leak from the lung, A forceps for sealing test characterized by supplementing the air leak portion.   The sealing test forceps according to claim 1, wherein the forceps for sealing test include a hand operation unit that moves the presser on a hand side of a lot. The forceps for a sealing test according to any one of claims 1 to 2 , wherein the pressing element includes a super elastic alloy, a metal stranded wire, or a spring material. The forceps for sealing test according to any one of claims 1 to 3 , wherein the size of the frame body can be changed by an operation from a hand operation unit. The sealing test forceps according to any one of claims 1 to 4 , wherein the pressing element can change an inclination angle with respect to the lot by an operation from an operation unit. The sealing test forceps according to any one of claims 1 to 5 , further comprising a slip prevention means at a lung surface contact portion of the presser.

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