JP5813848B2 - 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.

  In a conventional general endoscopic surgical operation, a plurality of trocars are drilled in the body surface as a passage into a body cavity, and an endoscope or a treatment instrument is inserted from each of the trocars to advance the operation. Since multiple wounds are required for the surgery, a small (about 2 cm) incision is provided in the umbilical region where scars are not conspicuous as a more invasive technique, and the incision is elastic. Attach a cylindrical retractor that holds the retractor due to the tension of the member, etc., and insert multiple endoscopes and treatment instruments from multiple ports provided on the plate on the body surface side of the retractor. Single-hole endoscopic surgery that performs surgical operation 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 instrument of the above form, it is possible to introduce a plurality of endoscopes and treatment instruments into a body cavity from one incision without providing a plurality of wounds during endoscopic surgery. Since the contact surface becomes a flexible sheet, a less invasive surgery with a small 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 (single-hole endoscopic surgery), it is required to make the incision as small as possible from the viewpoint of minimally invasiveness. Correspondingly, a plate or upper ring surface (hereinafter referred to as the following) provided with the plurality of ports. The area of the plate is simply limited, and each port has its own edge, etc., which occupies a certain range, so the number of ports provided in the plate And placement is limited. In addition, each port has a predetermined size through-hole set in a specific arrangement, and only the specified size endoscope and treatment instrument can be applied to the set arrangement. Furthermore, since it is necessary to attach each port to the inside of the plate surface, there is a concern that the attachment of the port to the plate becomes troublesome.

  Therefore, the present invention provides an insertion instrument capable of introducing a plurality of endoscopes and medical treatment instruments from a single incision, and can set a large number of the treatment instruments and the like in a free arrangement. An object of the present invention is to provide an insertion instrument for a medical treatment instrument to which a treatment instrument or the like can be applied.

  Another object of the present invention is to provide an easy-to-manufacture medical instrument insertion instrument that does not require attachment of a port portion for inserting a treatment instrument or the like into the plate.

An insertion instrument for a medical treatment instrument according to the present invention is disposed on the body surface side of a retracting means for holding an incision in an open state, and serves as an insertion port for a medical treatment instrument or endoscope from outside the body into a body cavity. A cap member capable of setting a plurality of ports is provided, and the cap member is provided in a central space by providing a peripheral portion between the edge portion and the edge portion, and the plurality of ports are formed by puncture penetration. And a port setting portion defined by forming a settable range more transparent than the peripheral portion , and the cap member is integrally formed of an elastic member made of the same material .

The port setting portion defined in the cap member is preferably formed as follows.
-The port setting part is formed with a plate thickness of 1.5 mm or more and 3.0 mm or less.
The elastic member forming the port setting portion is formed with a tensile elongation of 600% or more and a tear strength of 35 kN / m or more and 50 kN / m or less.
-The port setting part is formed transparent, and the periphery of the port setting part is formed opaque.

  The cap member is preferably 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. It is preferably formed from a cylindrical sheet that is connected to the body cavity side ring and the body surface side ring and is located on the body surface side from inside the body cavity, and is formed by connecting the cap member to the body surface side ring.
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 in the above-mentioned means, the cap member is a plate of an elastic member, and the plate surface is not provided with a pre-opening hole into the body cavity, and the plate surface is opened for the first time by opening a through hole with a puncture device such as a trocar. Assuming that it becomes the port portion, only the position necessary for installing the treatment instrument is opened as a port, and the non-wearing portion is closed, so that reliable airtightness at the portion can be maintained.
In addition, since a port can be set at a desired position and arrangement within the range of the port setting part, the degree of freedom of port setting is high. In addition, since the size of the opening hole can be freely set by the puncture device, it can be applied to devices of various sizes such as for 3 mm, 5 mm, and 10 mm.
In addition, each set port is formed as a trocar tube or puncture hole that matches the diameter of the applicable endoscope or treatment instrument, and each port requires an edge or attachment. Therefore, compared with the conventional case, the occupied area of one port can be reduced, and a large number of ports can be set within the same area. Further, since the port setting portion may be formed as a molding die integrated with the entire cap member, it is not necessary to attach a port of a separate member to the cap member, and manufacturing can be facilitated.
Further, since the port setting portion is defined in a specific range in the cap member, the needle tip is concerned about puncture of the trocar outside the setting range, so that the tip of the retracting device It prevents accidents such as contact with the body wall. In addition, there is a concern about setting a port at a position outside the range, for example, at the edge of the instrument, and the operation of tilting the treatment instrument may cause the treatment instrument to hit the body wall. Inconvenience to the procedure is unlikely to occur.

In addition, if the thickness of the plate part of the port setting part is set to 1.5 mm or more and 3.0 mm or less, it can be penetrated without difficulty by a trocar when opening the port with an appropriate thickness, and a trocar is drilled. In this state, leakage of insufflation gas from the opening can be sufficiently prevented.
Here, if the thickness is set to be smaller than 1.5 mm, due to the lack of contact surface with the drilled trocar or the like, sufficient holding by elasticity is not possible, and the holding force at the contact portion becomes weak, and the penetration portion There is concern that the airtightness cannot be maintained. On the other hand, if it is set to be larger than 3.0 mm, it becomes difficult to puncture the plate part with a trocar or the like, and the contact surface with the trocar or the like becomes excessive, the holding force due to elasticity becomes too large, and the operation after the drilling is performed. There is concern that it will be difficult to do.

In addition, by using a high-strength elastic member having a tensile elongation rate of 600% or more and a tearing strength of 35 kN / m or more and 50 kN / m or less as the elastic member forming the port setting site, Even if the opening hole is formed on the surface, the contact surface of the opening hole presses and holds the trocar, the treatment instrument, and the like from the periphery due to appropriate elasticity, so there is a gap between the trocar or the treatment instrument and the opening hole. It does not occur and can be kept airtight. Further, when the elongation rate and strength within the above ranges are provided, the airtightness in the body cavity can be maintained without the opening hole (puncture wound) expanding or tearing even if the treatment instrument or the like is moved by a surgical operation.
Here, if the tensile elongation is less than 600% or the tear strength is 35 kN / m or less, there is a possibility that a gap is generated between the treatment instrument and the opening hole due to insufficient elastic force, and sufficient airtightness cannot be maintained. There is a concern that the opening hole may be expanded or torn due to a surgical operation such as tilting the trocar or the like due to the lack of tearing strength or the like. On the other hand, if the tear strength is greater than 50 kN / m, the strength becomes higher than necessary, and there is a concern that the operation of a trocar puncture or a treatment instrument may be hindered.

  Furthermore, since the plate portion of the port setting portion is made of an elastic member having the above thickness and strength, as described above, a gap between the trocar or treatment instrument and the punctured opening hole is unlikely to occur. At the time of wearing, the wearing contact portion is sealed from the surroundings to maintain airtightness, and even if the trocar or treatment instrument is removed during surgery, it works in the direction of closing the punctured hole due to elasticity. Leakage from the puncture hole is limited and the necessary airtightness can be maintained.

  In addition, if the port setting part is transparent and the periphery of the port setting part is opaque, it is possible to directly observe a part of the operative field such as when setting the port. And the boundary can be clarified.

  In addition, if the cap member is detachable from the retracting means, it can be used for single-hole endoscopic surgery with the cap member attached, or for small incision surgery that does not require a pneumoperitoneum with the cap member removed. Therefore, it is also possible to easily change between the procedures 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 of the medical treatment instrument of the present invention, in the insertion instrument capable of introducing a plurality of endoscopes and medical treatment instruments from a single incision, the treatment instrument, etc. Can be set in a free arrangement, and it is possible to provide a highly flexible instrument to which treatment instruments of a plurality of sizes can be applied.

  Moreover, it can be set as the instrument which is easy to manufacture which does not require attachment of a port part.

The top view and side view which show embodiment of the insertion instrument of the medical treatment tool of this invention. Part of CC sectional drawing of the said embodiment. DD sectional drawing of the cap member of the said embodiment.

Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.
FIG. 1 is a configuration diagram showing an embodiment of the present invention, in which A is a top view, B is a side view, FIG. 2 is a partially enlarged view of a CC section of the side view, and FIG. DD sectional views are shown respectively.
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. Single-hole endoscopic surgery in which surgery is performed by introducing an endoscope, a treatment instrument, or a plurality of devices into a body cavity directly from or without a trocar through a plurality of ports serving as passages into the body cavity. A body cavity side ring 1 that is inserted into a body cavity from the incision, 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 body Both ends 31 and 32 are connected to the front ring 2, and are formed 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 is formed by the body cavity side ring 1 and the body surface side ring 2. (Body wall) is held and the incision is opened by the elasticity of the elastic sheet 3 The retracting means for holding the retracted state and the trocar or treatment instrument, which is detachably attached to the body surface side ring 2 of the retracting means and does not have a pre-open hole in the plate surface of the elastic member, is introduced into the body cavity A range in which a plurality of insertion ports (ports) can be set is configured by the elastic cap 4 defined as a port setting portion.

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 the present 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 incision wound of 20 to 40 mm.

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 fitting groove 5 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 40 mm, the film thickness was 0.4 mm, and the height (space 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 an elastic resin having a tensile elongation of 600% or more (in this example, about 980%), a tear strength of 35 kN / m or more and 50 kN / m or less (in this example, about 43 kN / m). In this example, the transparent silicone resin is formed into a circular plate shape having a diameter of 75 mm and a maximum thickness of 12.4 mm, and the central space excluding the circular peripheral edge 46 on the plate surface is a body cavity. A port setting portion 41 is defined and formed as a range in which a port that becomes an insertion port of a trocar or medical treatment instrument can be set. In addition, a ring fitting groove 5 having a shape matching the body surface side ring 2 is provided on the inner periphery of the back side surface of the peripheral edge 46 of the circle so as to fit and house and connect the body surface side ring 2 of the retracting means. In addition, there are three gripping portions 48 that are partly attached to and removed from the peripheral edge 46 of the circle, and are formed integrally with each other at intervals of 120 degrees. did.

The port setting portion 41 is a range in which a port can be set by puncturing the trocar, and when the trocar is punctured, the puncture route is the lumen of the elastic sheet 3 of the retracting means (the range in which it is opened) ) Is set to a diameter equivalent to the diameter of the elastic sheet 3 (in this example, a diameter of 40 mm) as a line capable of setting a port, and provided in a space in the center of the elastic cap 4. The trocar insertion marker 42 is recommended as a line recommended for port setting, and a circular shape slightly projecting on the line approximately 5 mm inside (in this example, a position having a diameter of 30 mm) from the port setting portion 41. Point markers 43 are provided at four positions at intervals of 90 degrees.
In this way, by setting the port setting part 41 and the trocar insertion marker 42 clearly, the trocar puncture as described above can be prevented from inadvertently touching the retracting means, and the intended operation cannot be performed. Inconvenience to the procedure is unlikely to occur.

  Further, a range of 5 mm to 10 mm width (6.5 mm in this example) around the outer periphery of the port setting portion 41 is defined as a rough surface processing portion 44, and a boundary between the rough surface processing portion 44 and the port setting portion 41 (this example) In FIG. 2, a slight step 45 (in this example, 0.2 mm in the direction of increasing thickness) is provided from the port setting portion 41 at a position having a diameter of 40 mm, and the entire range is made opaque by embossing. . By providing the rough surface processing portion 44, the boundary between the port setting portion 41 and the rough surface processing portion 44 that is a port setting non-permissible portion can be clarified. By not setting a steep step to the trocar, the trocar is tilted and used, so that the operability is not deteriorated.

Further, the outer periphery of the rough surface processed portion 44 is formed as a peripheral edge portion 46 having a thickness (in this example, 2.3 mm thicker than the rough surface processed portion) than the rough surface processed portion 44 as a whole. The port setting part 41 and the rough surface processed part 44 are formed in a shape recessed from the edge part 46 with the recessed part boundary line 47 as a boundary.
In addition, the port setting part 41 is a substantially flat surface that does not have an opening hole before use, and is configured to be opened as a port for the first time by puncturing through a desired position of the port setting part 41 with a trocar. The penetrating part (site penetrated by the trocar) has a thickness of 1.5 mm or more and 3 mm or less (2.5 mm in this example) as a thickness that can be easily penetrated by the trocar.
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. Further, even when it becomes necessary to remove the trocar after the trocar has been drilled, the entire elastic cap 4 is formed of an elastic member, and a certain amount of thickness (in this example, 2. 5 mm), the opening after removal works in the closing direction, 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 the ring fitting groove 5 formed in 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.

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 sheet end 32. Seat upper edge 4. Elastic cap (cap member)
41. Port setting part 42. Trocar insertion marker 43. Point marker 44. Rough surface processing section 45. Setting part demarcation line 46. Edge part 47. Edge border 48. Handle 5. Ring fitting groove

Claims (2)

A cap member that is disposed on the body surface side of the retracting means that holds the incision in an open state, and is capable of setting a plurality of ports that serve as insertion ports for medical treatment tools and endoscopes from outside the body,
The cap member is provided in a central space by providing a peripheral portion between the edge portion and the edge portion, and a range in which the plurality of ports can be set by puncture penetration is more transparent than the peripheral portion. A port setting portion defined by forming ,
An insertion instrument for a medical treatment instrument, wherein the cap member is integrally formed of an elastic member made of the same material .   The insertion instrument for a medical treatment instrument according to claim 1, wherein the edge portion of the cap member is formed with a fitting portion that fits with the retracting means and a grip portion provided outside the fitting portion. .

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