JP6438836B2 - Pneumoperitoneum system - Google Patents

Description

  Embodiments described herein relate generally to an insufflation system, and more particularly, to an insufflation system including an insufflation device and a circulation device.

  In recent years, laparoscopic surgery for performing therapeutic treatment without performing laparotomy has been performed for the purpose of reducing invasion to patients. In this laparoscopic surgery, a patient's abdomen is punctured with, for example, a first trocar for guiding an observation endoscope into a body cavity and a second trocar for guiding a treatment tool to a treatment site. In this laparoscopic surgery, a treatment tool inserted through the insertion hole of the second trocar using the endoscope inserted into the abdominal cavity through the insertion hole of the first trocar Treatment is performed while observing.

  In such a laparoscopic surgical operation, an insufflation apparatus is used for the purpose of securing the field of view of the endoscope and the area for operating the treatment tool. The pneumoperitoneum device injects, for example, carbon dioxide gas as a gas for a pneumoperitone into a body cavity and expands the inside of the cavity to a certain pressure, and secures the field of view of the endoscope and the operation area of the treatment tool.

  In general, when a medical procedure is performed in the abdominal cavity using an electric knife or an ultrasonic treatment tool, smoke or mist may be generated, which may obstruct the surgical field by an endoscope. In order to prevent this, a pneumoperitoneum system has been proposed in which gas in the abdominal cavity is sucked using a circulator and passed through a filter or the like and then returned to the body cavity (see, for example, Patent Document 1). ).

  In the pneumoperitoneum system using a circulator as described in Patent Document 1, there is a possibility that a minute tissue piece or the like cut out from the abdominal cavity may be mixed as a foreign substance into the suction tube when aspirating the gas in the body cavity. is there. When the gas circulation line is clogged due to such foreign matter mixing in, the gas sucked from the body cavity cannot be returned to the body cavity, and the pressure in the body cavity is lowered. When the pressure in the body cavity is lowered, the body cavity is deflated, which makes it difficult to perform a surgical operation.

  A pneumoperitoneum system provided with means for detecting clogging when a pneumoperitoneal tube is clogged has been proposed (see, for example, Patent Document 2).

Special table 2013-541972 gazette Japanese Patent Laid-Open No. 9-38029

  However, the pneumoperitoneum system described in patent document 2 is comprised only by the pneumoperitoneum, and does not have a circulation apparatus. Therefore, clogging of the pneumoperitoneum tube during insufflation can be detected, but where the clogging occurs in the circulation line (line for returning gas from the suction tube to the circulation tube, through the pneumoperitoneum tube to the body cavity) during circulation smoke There was a problem that could not be detected.

  Therefore, an object of the present invention is to provide an insufflation system that can detect which tube is clogged at the time of circulation smoke exhaustion in an insufflation system including an insufflation apparatus and a circulation apparatus.

An insufflation system according to one aspect of the present invention includes an insufflation apparatus having a control unit for supplying a predetermined gas and maintaining a connected pipe line at a predetermined set pressure, and one end inserted into the abdominal wall of a subject. The other end is connected to the insufflation apparatus, and the other end is connected to the insufflation apparatus, and the insufflation apparatus for supplying the predetermined gas and the gas from the body cavity of the subject are sucked and circulated. A circulation device, one end of which is connected to the second connection device inserted into the abdominal wall of the subject, the other end is connected to the circulation device, and an aspiration conduit for sucking the gas; and the circulation device And a circulation line that circulates the gas sucked from the suction line, and the pneumoperitizer detects a pressure in the air supply line. And the difference between the first pressure value and the second pressure value detected by the pressure detector. And determining clogging state determination section for determining which of said feed conduit or the suction channel is clogged by comparing the constant set value, provided with a,
The first pressure value is a pressure value detected by the pressure detection unit immediately before the circulation device starts circulation, and the second pressure value is obtained immediately after the circulation device starts circulation. It is the pressure value detected by the pressure detector.

  According to the pneumoperitoneum system of the present invention, in the pneumoperitoneum system including the pneumoperitoneum and the circulation device, it is possible to detect which tube is clogged during the circulation smoke exhaustion.

The figure explaining an example of the whole structure of the pneumoperitoneum system 1 concerning embodiment of this invention. A block diagram explaining an example of composition of insufflation apparatus 11 concerning this embodiment. The figure explaining the state change of the pipeline pressure when clogging arises in the pneumoperitoneum tube. The figure explaining the state change of the pipe line pressure when the suction tube 19 is clogged. The flowchart explaining normal air supply operation | movement into a body cavity. The flowchart explaining the circulation smoke exhaustion operation performed after completion of normal air supply. The flowchart explaining the clogging detection operation | movement in circulation smoke exhaustion operation | movement. The figure explaining the relationship between circulation smoke operation and the state change of pipe line pressure. The figure explaining an example of the whole structure of the modification of the pneumoperitoneum system. The figure explaining an example of the whole structure of another modification of the pneumoperitoneum system.

Hereinafter, embodiments will be described with reference to the drawings.
(First embodiment)

  FIG. 1 is a diagram illustrating an example of the entire configuration of an insufflation system 1 according to the first embodiment of the present invention. As shown in FIG. 1, the pneumoperitoneum system 1 according to the present embodiment includes an insufflation apparatus 11 and a circulation apparatus 12. The pneumoperitoneum system 1 is used for an operation in which an affected part in the abdominal cavity of a patient expanded by air feeding is treated with a treatment tool such as an electric knife or an ultrasonic treatment tool under endoscopic observation.

  As shown in FIG. 1, a patient's abdominal wall 13 is punctured with an air-feeding trocar 15 as a first connecting device and a suction trocar 16 as a second connecting device. , 16, the endoscope and the treatment tool are inserted into the abdominal cavity, and the treatment of the affected part in the patient's body is performed using the treatment tool while observing the endoscope.

A cylinder 17 filled with carbon dioxide gas (CO ₂ gas) is connected to an insufflation apparatus 11 for supplying a predetermined gas via a connection tube 17a. One end of an insufflation tube 18 serving as an insufflation line is connected to the insufflation cap 11 a of the insufflation apparatus 11, and the other end of the insufflation tube 18 is connected to a trocar 15 punctured in the abdominal wall 13 of the patient. ing. The pneumoperitoneum 11 is configured so as to supply carbon dioxide gas into the abdominal cavity of the patient via the pneumoperitoneum tube 18 and the trocar 15.

  That is, one end of the insufflation tube 18 is connected to the insufflation apparatus 11 and the other end is connected to the trocar 15 inserted into the abdominal wall 13, and a predetermined gas is sent into the abdominal cavity through the trocar 15. It is an air supply line.

  A pump 38 is connected to the circulation device 12 for circulating the carbon dioxide gas. One end of a suction tube 19 as a suction pipe line is connected to the pump 38, and the other end of the suction tube 19 is connected to the trocar 16. The pump 38 is connected to a circulation tube 39 as a circulation line connected to the insufflation tube 18.

  The pump 38 is activated by an activation signal from the circulation device 12. When the pump 38 is activated, the pump 38 sucks carbon dioxide in the abdominal cavity through the trocar 16 and the suction tube 19, and supplies the carbon dioxide gas into the abdominal cavity through the circulation tube 39, the pneumoperitoneum tube 18, and the trocar 15. In this manner, carbon dioxide gas is circulated. In other words, carbon dioxide in the abdominal cavity is obtained by the insufflation tube 18 connected to the trocar 15, the suction tube 19 connected to the trocar 16, the circulation tube 39 connecting the suction tube and the insufflation tube 18, and the pump 38. A circulation path that circulates is formed. A suction filter 19 a is provided in the middle of the suction tube 19.

  The pneumoperitoneum 11 and the circulation device 12 are connected by a communication cable 22 so that various data can be communicated with each other.

  FIG. 2 is a block diagram illustrating an example of the configuration of the pneumoperitoneum 11 according to the present embodiment. As shown in FIG. 2, the pneumoperitoneum 11 includes a decompressor 111, an electromagnetic opening / closing valve 112, a flow sensor 113, an electromagnetic relief valve 114, a pressure sensor 115, and components of the pneumoperitoneum 11. A control unit 116 that performs control is mainly provided. The insufflation apparatus 11 is also provided with a front panel 11b as a display unit for performing operation input and information display.

A cylinder 17 filled with carbon dioxide gas (CO ₂ gas) is connected to the insufflation apparatus 11 via a connection tube 17a. An insufflation tube 18 is connected to the air supply base 11a.

  The decompressor 111 decompresses the high-pressure gas supplied from the cylinder 17 to a pressure that is not dangerous to the human body. For example, the gas supplied from the cylinder 17 at a high pressure of about 6 MPa is reduced to about 0.1 MPa.

  The electromagnetic opening / closing valve 112 performs an opening / closing operation based on a control signal input from the control unit 116. When the electromagnetic on-off valve 112 is opened, carbon dioxide gas supplied from the cylinder 17 is discharged to the insufflation tube 18.

  The flow sensor 113 measures the flow rate of the carbon dioxide gas supplied into the body cavity and outputs the measurement result to the control unit 116.

  The electromagnetic relief valve 114 performs an opening / closing operation based on a control signal input from the control unit 116. When the electromagnetic relief valve 114 is opened, carbon dioxide filled in the abdominal cavity is released into the atmosphere.

  The pressure sensor 115 as a pressure detection unit measures the pressure in the pneumoperitoneum tube 18. When the electromagnetic on-off valve 112 is open (during air supply), the pressure of the gas supplied from the cylinder 17 is measured, and when the electromagnetic on-off valve 112 is closed (air supply is stopped) The pressure in the abdominal cavity is measured via the abdominal tube 18. Note that the measurement result of the pressure sensor 115 is output to the control unit 116.

  The control unit 116 is connected to the electromagnetic on-off valve 112, the flow sensor 113, the electromagnetic relief valve 114, the pressure sensor 115, and the front panel 11b through respective signal lines in order to control the entire insufflation apparatus 11. Further, the control unit 116 can communicate with the circulation device 12 via the communication cable 22. In addition, the control unit 116 also has a function as a clogging state determination unit that detects the occurrence of clogging and the location of clogging when clogging occurs in the circulation path during the gas recirculation / exhaust operation, as will be described later.

  Next, a method for detecting clogging of the pneumoperitoneum tube 18 in a system that circulates carbon dioxide in the abdominal cavity using the pneumoperitoneum system 1 of the present embodiment will be described with reference to FIG. FIG. 3 is a diagram for explaining a change in the state of the pipeline pressure when the pneumoperitoneum tube 18 is clogged.

  Gas is fed into the patient's body cavity using the pneumoperitoneum device 11, and when the measured value P of the pressure sensor 115 reaches a predetermined set pressure, the gas feeding is stopped and the circulation of the gas by the circulation device 12 is started. (Time t1).

  When the circulation is started, the pressure sensor 115 measures the pressure obtained by adding the dynamic pressure during the circulation to the intracavity pressure. Therefore, the measured value P of the line pressure is a value of the dynamic pressure more than the abdominal pressure Pa immediately before the start of the circulation. Only a high value (Pb1) is detected. Here, when clogging occurs in the pneumoperitoneal tube 18, the gas sucked from the body cavity is blocked by the clogged portion and cannot be returned to the body cavity. In this case, the measured value P of the pipeline pressure detected by the pressure sensor 115 is a value (Pb2) higher than the normal state (Pb1).

  For example, when the set pressure is 10 mmHg, the measured value Pb1 of the pipeline pressure immediately after the start of circulation shows a value of about 30 to 180 mmHg in a state where the pneumoperitoneum tube 18 is not clogged. On the other hand, in a state where the pneumoperitoneum tube 18 is clogged, the measured value Pb2 of the line pressure immediately after the start of circulation rises to about 250 mmHg.

  The measured value P of the pipeline pressure immediately after the start of circulation varies depending on the set pressure of the abdominal pressure. Therefore, the difference (P−Pa) between the measured value P of the pipeline pressure immediately after the air supply is stopped and the circulation is started, and the measured value Pa (that is, the set pressure of the abdominal pressure) immediately before the circulation is started. ) And when this value exceeds a predetermined threshold value Pth1, it can be detected that the pneumoperitoneum tube 18 is clogged.

  For example, in the case of the above-described example, when the pneumoperitoneum tube 18 is not clogged, the difference between the measured value Pb1 of the pipeline pressure immediately after the start of circulation and the measured value Pa of the pipeline pressure immediately before the start of circulation is 20 ~ 170 mmHg. On the other hand, in a state where the pneumoperitoneum tube 18 is clogged, the difference between the measured value Pb2 of the line pressure immediately after the start of circulation and the measured value Pa of the line pressure just before the start of circulation is 240 mmHg. Therefore, it is desirable to set a value (for example, 200 mmHg) between 170 mmHg and 240 mmHg as the threshold value Pth1.

Thus, according to this embodiment, when the clogging is occurring in the pneumoperitoneum tube 18, it is utilized that the pipeline pressure during circulation changes at a higher value than when no clogging occurs. And
The difference between the measured value P of the pressure sensor 115 immediately after the air supply is stopped and the circulation is started and the measured value Pa (that is, the set pressure of the abdominal pressure) immediately before the circulation is higher than the threshold value Pth1. By detecting this, it is possible to detect that clogging has occurred in the pneumoperitoneum tube 18.

Note that the pressure sensor 115 for measuring the line pressure may be provided in the circulation device 12 instead of in the insufflation device 11.
(Second Embodiment)

  In the insufflation system 1 of the first embodiment described above, clogging detection of the insufflation tube 18 during the gas circulation operation has been described. However, the present embodiment is different in that clogging of the suction tube 19 is detected. .

  The configuration of the pneumoperitoneum system 1 of the present embodiment is the same as that of the first embodiment. Hereinafter, a method for detecting clogging of the suction tube 19 in the present embodiment will be described with reference to FIG. FIG. 4 is a diagram for explaining the change in the state of the line pressure when the suction tube 19 is clogged.

  Gas is fed into the patient's body cavity using the pneumoperitoneum device 11, and when the measured value P of the pressure sensor 115 reaches a predetermined set pressure, the gas feeding is stopped and the circulation of the gas by the circulation device 12 is started. (Time t1 ′).

  When the circulation is started, the pressure sensor 115 measures the pressure obtained by adding the dynamic pressure during the circulation to the intracavity pressure. Therefore, the line pressure is higher than the abdominal pressure Pa ′ immediately before the start of the circulation by a dynamic pressure. (Pb1 ′) is measured. Here, when the suction tube 19 is clogged, the gas cannot be sucked from the body cavity due to the clogged portion, while the gas accumulated in the circulation tube 39 and the pneumoperitoneum tube 18 is mixed into the body cavity. In this case, the pipeline pressure measured by the pressure sensor 115 temporarily rises to the normal state (Pb1 ′), but immediately returns to the abdominal pressure Pa ′.

  For example, when the set pressure is 10 mmHg, when the suction tube 19 is not clogged, the measured value P of the pipeline pressure immediately after the start of circulation shows a value of about 30 to 180 mmHg, and this pipeline pressure during the circulation operation It will be in the state which kept. On the other hand, in the state where the suction tube 19 is clogged, the measured value P of the pipeline pressure immediately after the start of circulation increases to about 30 to 180 mmHg, but immediately decreases to a value in the vicinity of 10 mmHg which is the set pressure. End up.

  The measured value P of the pipeline pressure immediately after the start of circulation varies depending on the set pressure of the abdominal pressure. Therefore, the difference (P−) between the measured value P of the pipeline pressure immediately after the air supply is stopped and the circulation is started, and the measured value Pa ′ (that is, the set pressure of the abdominal pressure) immediately before the circulation is started. Pa ′) is measured, and when this value once exceeds the predetermined threshold value Pth2, and again falls below the threshold value Pth2, it can be detected that the suction tube 19 is clogged.

  For example, in the case of the above-described example, when the suction tube 19 is not clogged, the difference between the measured value P of the pipeline pressure immediately after the start of circulation and the measured value Pa ′ of the pipeline pressure immediately before the start of circulation is 20 It is ˜170 mmHg, and this value is maintained even during circulation. On the other hand, in a state where the suction tube 19 is clogged, the difference between the measured value P of the pipeline pressure immediately after the start of circulation and the measured value Pa ′ of the pipeline pressure immediately before the start of circulation is 20 to 170 mmHg. However, it immediately decreases to about 10 mmHg and changes around this value. Therefore, as the threshold value Pth2, it is desirable to set a value as small as possible (for example, 20 mmHg) among values between 20 and 170 mmHg.

  Thus, according to the present embodiment, when the clogging of the suction tube 19 occurs, the pipeline pressure increases at the start of circulation as in the case where clogging does not occur, but immediately the pipeline pressure Is that the difference between the measured value P of the pressure sensor 115 immediately after the air supply is stopped and the circulation is started and the measured value Pa ′ of the pipe pressure immediately before the circulation is started is a threshold value. It is possible to detect that the suction tube 19 is clogged by detecting again that the threshold value Pth2 is exceeded after exceeding Pth2.

Note that the pressure sensor 115 for measuring the line pressure may be provided in the circulation device 12 instead of in the insufflation device 11.
(Third embodiment)

  In the insufflation system 1 of the first and second embodiments described above, detection of clogging of either the insufflation tube 18 or the suction tube 19 during the circulation operation has been described, but in this embodiment, during the circulation operation. When tube clogging occurs, it is different in that the clogged tube 18 or the suction tube 19 is detected separately.

  The configuration of the pneumoperitoneum system 1 of the present embodiment is the same as that of the first embodiment. Hereinafter, a method of detecting a clogged tube among the circulatory tubes in the present embodiment will be described with reference to FIGS. FIG. 5 is a flowchart for explaining a normal air supply operation into the body cavity. FIG. 6 is a flowchart for explaining the circulation smoke exhaustion operation performed after the normal air supply is completed. FIG. 7 is a flowchart for explaining the clogging detection operation during the circulation smoke exhaustion operation. FIG. 8 is a diagram for explaining the relationship between the circulation smoke emission operation and the state change of the pipeline pressure.

  First, according to the flow of FIG. 5, gas is intermittently supplied until the patient's body cavity pressure reaches the set pressure, and the stomach is inhaled. That is, the controller 116 opens the electromagnetic on-off valve 112, discharges the carbon dioxide gas supplied from the cylinder 17 to the pneumoperitoneum tube 18, and feeds it into the body cavity of the patient (step S1). When a certain period of time has elapsed since the start of air supply, the control unit 116 closes the electromagnetic on-off valve 112 and stops the discharge of carbon dioxide into the body cavity (step S2). Then, during the air supply stop period, the pressure P in the body cavity is measured by the pressure sensor 115 (step S3), and if the measured value does not reach the preset set pressure (step S4, NO), step Return to S1 and continue intermittent air supply.

  On the other hand, when the measured value P by the pressure sensor 115 has reached the preset pressure (step S4, YES), it is determined that the insufflation is sufficiently performed, and the normal air supply operation of FIG. Exit. The control unit 116 of the pneumoperitoneum 11 outputs a circulation instruction to the circulation device 12 via the communication cable 22 and shifts to the circulation smoke discharge operation of FIG.

  In the circulation smoke exhaustion operation, first, the pump 38 is operated to suck the gas from the body cavity, and the circulation operation of returning the gas into the body cavity through the suction tube 19, the circulation tube 39, and the insufflation tube 18 is performed (step S11). ). At this time, smoke and mist in the gas are removed by a suction filter 19a provided in the middle of the suction tube 19 or a smoke exhaust mechanism (not shown) in the circulation device 12.

  During the circulation operation in step S11, the presence / absence of clogging in the circulation path is also detected. A specific procedure for detecting clogging will be described with reference to FIG. First, with the pump 38 stopped and the circulation stopped, the cavity pressure P is measured by the pressure sensor 115 (step S21). Note that step S21 is performed immediately after step S4 in FIG. Therefore, the cavity pressure P measured in step S21 is equal to the set pressure. Hereinafter, the measured value of the cavity pressure P in step S21 is Pa. Then, the control unit 116 of the pneumoperitoneum 11 outputs a circulation start instruction to the circulation device 12 via the communication cable, operates the pump 38, and starts gas circulation (step S22). Immediately after the start of gas circulation, the pressure sensor 115 measures the cavity pressure P again (step S23). Hereinafter, the measured value of the cavity pressure P in step S23 is assumed to be Pb.

  The difference between the cavity pressure Pa measured in step S21 and the cavity pressure Pb measured in step S23 is calculated, and if the difference is larger than a preset threshold value Pth1 (step S24, YES), the pneumoperitoneum tube 18 is clogged. (Step S25), and the circulation operation including clogging detection is terminated. As described in the first embodiment, the threshold value Pth1 includes the pipeline pressure Pb1 immediately after the start of circulation in a normal state where no clogging has occurred, and the measured value Pa of the pipeline pressure immediately before the start of circulation. Greater than the difference between the pipe pressure Pb2 immediately after the start of circulation in a state where the pneumoperitoneum tube 18 is clogged, and a value smaller than the difference between the measured value Pa of the pipe pressure immediately before the start of circulation (for example, 200mmHg).

  On the other hand, when the difference between the cavity pressure Pa measured in step S21 and the cavity pressure Pb measured in step S23 is equal to or less than a preset threshold value Pth1 (step S24, NO), the process proceeds to step S26, and the line pressure is increased from the cavity pressure Pa. It is determined whether or not the rising has been detected before. If no pressure increase is detected (NO in step S26), the difference between the cavity pressure Pa measured in step S21 and the cavity pressure Pb measured in step S23 is compared with a preset threshold value Pth2. As described in the second embodiment, the threshold value Pth2 is the difference between the pipeline pressure Pb1 immediately after the start of circulation in the state where no clogging has occurred and the measured value Pa of the pipeline pressure immediately before the start of circulation. It is set within the range of values and as small as possible (for example, 20 mmHg).

  When the difference is larger than the threshold value Pth2 (step S27, YES), it is detected that the pipeline pressure is rising from the cavity pressure Pa (step S28), and the process proceeds to step S29. On the other hand, when the difference is equal to or smaller than the threshold value Pth2, the process proceeds to step S29 without detecting an increase in the pipeline pressure.

  On the other hand, when a pressure increase has been detected before (step S26, YES), the difference between the cavity pressure Pa measured in step S21 and the cavity pressure Pb measured in step S23 is compared with a preset threshold value Pth2. If the difference is smaller than the threshold value Pth2 (step S30, YES), it can be determined that the duct pressure has once increased, but has decreased to about the measured value Pa of the cavity pressure immediately before the start of circulation, so the suction tube 19 is clogged. It is detected that it has occurred (step S31), and the circulation operation including clogging detection is terminated.

  If the difference is greater than or equal to the threshold value Pth2 (step S31, NO), it is determined that the pipe pressure has not increased but decreased and is in a normal circulation state, and the process proceeds to step S29. In step S29, it is determined whether or not a predetermined time has elapsed since the start of gas circulation in step S22. If the predetermined time has not elapsed since the start of the gas circulation (step S29, NO), the process returns to step S22, and the series of detection operations after step S23 is repeatedly executed while the circulation is continued. When a predetermined time has elapsed since the start of gas circulation (step S29, YES), the series of procedures for the circulation operation including clogging detection shown in FIG.

  As described above, when the circulation operation in step S11 of FIG. 6 is completed, the control unit 116 of the pneumoperitoneum device 11 outputs a circulation stop instruction to the circulation device 12 via the communication cable, and stops the pump 38 (step S12), the cavity pressure is measured by the pressure sensor 115 (step S13).

  When the cavity pressure is equal to the set pressure (step S14, YES), the process returns to step S11 to repeatedly execute the gas circulation operation including clogging detection (see FIG. 8). On the other hand, when the cavity pressure measured in step S13 does not coincide with the set pressure (step S14, NO), it is determined whether or not the cavity pressure is much higher than the set pressure. When the cavity pressure is much higher than the set pressure (step S15, YES), the control unit 116 of the pneumoperitoneum device 11 controls the electromagnetic relief valve 114 to be in an open state so that the gas in the cavity is in the atmosphere. (Step S17). After a certain period of time has elapsed since the electromagnetic relief valve 114 was opened, the control unit 116 controls the electromagnetic relief valve 114 to be closed, and stops gas relief (step S118). Then, the process returns to step S13, and the cavity pressure is measured by the pressure sensor 115. The gas relief operation from step S13 to step S18 is repeated until the cavity pressure reaches the set pressure.

  On the other hand, when the cavity pressure is very low compared to the set pressure (step S15, NO), the process proceeds to step S16, and the normal air supply operation shown in FIG. 5 is performed until the cavity pressure reaches the set pressure, and the patient's body cavity is inhaled. . With the series of operations described above, when clogging occurs during the circulation operation while supplying air into the patient's body cavity and circulating operation, it is possible to immediately detect which tube has caused the clogging. .

  As described above, in this embodiment, when the air supply into the body cavity of the patient is finished, and the pressure in the body cavity reaches the set pressure and the gas circulation is started, the cavity pressure Pa immediately before the start of circulation (i.e., The set pressure of the abdominal pressure) and the cavity pressure Pb after the start of circulation are measured, and the difference is compared with the threshold value Pth1 and the threshold value Pth2. The threshold value Pth1 is greater than the difference between the line pressure Pb1 immediately after the start of circulation in the normal state where no clogging has occurred and the cavity pressure Pa immediately before the start of circulation, and the circulation in a state where the pneumoperitoneum tube 18 is clogged. A value smaller than the difference between the line pressure Pb2 immediately after the start of the circulation and the cavity pressure Pa immediately before the start of circulation is set in advance. Further, the threshold Pth2 is set to the smallest possible value within the range of the difference value between the pipe pressure Pb1 ′ immediately after the start of circulation in the state where clogging has not occurred and the cavity pressure Pa immediately before the start of circulation. Keep it.

  If the difference is larger than the threshold value Pth1, it can be immediately detected that the pneumoperitoneum 18 is clogged, and the difference once becomes larger than the threshold value Pth2, but if the difference immediately becomes smaller than the threshold value Pth2, the suction is performed. It can be immediately detected that the tube 19 is clogged. That is, in the present embodiment, when the circulation path is clogged in the normal cavity pressure measurement routine during the inhalation-circulating smoke operation, the clogged tube can be identified. .

  If it is detected that the circulation path is clogged, the pneumoperitoneum tube 18 and the suction tube 19 are connected to the front panel 11b of the pneumoperitoneum 11 or the monitor of the operating room where the pneumoperitoneum system 1 is installed. Which of the clogs has occurred may be displayed using a message or a system diagram.

  Furthermore, in the first to third embodiments, the presence or absence of the circulation path and its location are detected using the pipeline pressure measured by the pressure sensor 115. However, as shown in FIG. The clogging of the tube may be detected by installing a flow meter 40 in the middle and detecting the presence or absence of gas flow. FIG. 9 is a diagram illustrating an example of the overall configuration of a modified example of the pneumoperitoneum system 1. In this case, the flow meter 40 and the control unit 116 of the insufflation apparatus 11 are connected by the communication cable 41, and the control unit 116 monitors the measured value of the flow meter 40 to detect tube clogging. The flow meter 40 may be provided not in the middle of the circulation tube 39 but in the middle of the insufflation tube 18 or in the middle of the suction tube 19.

  In addition, as shown in FIG. 10, a throttle 42 is installed instead of the flow meter 40, and the differential pressure before and after the throttle 42 is measured by the differential pressure gauge 43, thereby detecting the presence or absence of gas flow and detecting tube clogging. You may comprise. FIG. 10 is a diagram illustrating an example of the overall configuration of a modified example of the pneumoperitoneum system 1. In this case, the differential pressure gauge 43 and the control unit 116 of the pneumoperitoneum device 11 are connected by a communication cable, and the control unit 116 monitors the measured value of the differential pressure gauge 43 to detect tube clogging.

  Each “unit” in this specification is a conceptual one corresponding to each function of the embodiment, and does not necessarily correspond to a specific hardware or software routine on a one-to-one basis. Therefore, in the present specification, the embodiment has been described assuming a virtual circuit block (unit) having each function of the embodiment. In addition, each step of each procedure in the present embodiment may be executed in a different order for each execution by changing the execution order and performing a plurality of steps at the same time, as long as it does not contradict its nature. Furthermore, all or part of each step of each procedure in the present embodiment may be realized by hardware.

  Although several embodiments of the present invention have been described, these embodiments are illustrated by way of example and are not intended to limit the scope of the invention. These novel embodiments can be implemented in various other forms, and various omissions, replacements, and changes can be made without departing from the scope of the invention. These embodiments and modifications thereof are included in the scope and gist of the invention, and are included in the invention described in the claims and the equivalents thereof.

DESCRIPTION OF SYMBOLS 1 ... Insufflation system, 11 ... Insufflation apparatus, 11a ... Insufflation mouthpiece, 11b ... Front panel, 12 ... Circulation apparatus, 13 ... Abdominal wall, 15, 16 ... Trocar, 17 ... Cylinder, 17a ... Connection tube, 18 ... Abdominal tube, 19 ... suction tube, 19a ... suction filter, 22, 41 ... communication cable, 38 ... pump, 39 ... circulation tube, 40 ... flow meter, 43 ... differential pressure gauge, 111 ... pressure reducer, 112 ... electromagnetic on-off valve, 113 ... Flow rate sensor, 114 ... Electromagnetic relief valve, 115 ... Pressure sensor, 116 ... Control part,

Claims (5)

An insufflation apparatus having a control unit for supplying a predetermined gas and maintaining a connected pipe line at a predetermined set pressure;
One end is connected to the first connection device inserted into the abdominal wall of the subject, and the other end is connected to the pneumoperitoneum, and an air supply conduit for supplying the predetermined gas;
A circulator that sucks and circulates gas from within the body cavity of the subject;
One end is connected to the second connection device inserted into the abdominal wall of the subject, the other end is connected to the circulation device, and the suction pipe for sucking the gas,
A circulation line for connecting the circulation device and the pneumoperitoneum and circulating the gas sucked from the suction line;
The pneumoperitoneum includes a pressure detection unit that detects the pressure of the air supply conduit, and a difference between the first pressure value and the second pressure value detected by the pressure detection unit is a predetermined set value. A clogged state determination unit that determines whether the air supply line or the suction line is clogged by comparing with,
The first pressure value is a pressure value detected by the pressure detection unit immediately before the circulation device starts circulation, and the second pressure value is obtained immediately after the circulation device starts circulation. The pneumoperitoneum system characterized by being the pressure value detected by the pressure detection part.   The set value is a value larger than the dynamic pressure when the circulation device is circulating, and the clogging state determination unit has a difference between the first pressure value and the second pressure value. The pneumoperitoneum system according to claim 1 which judges with said air supply line being clogged when larger than said set value.   The set value is a value within a dynamic pressure range when the circulation device is circulating, and the clogging state determination unit determines that a difference between the first pressure value and the second pressure value is When the difference between the first pressure value and the third pressure value detected by the pressure detector after detecting the second pressure value is smaller than the set value. The pneumoperitoneum system according to claim 1, wherein the suction line is determined to be clogged.   The set value is a first set value having a value larger than the dynamic pressure when the circulation device is circulating, and a value within the range of the dynamic pressure when the circulation device is circulating. The clogged state determination unit has the difference between the first pressure value and the second pressure value greater than the first set value, It is determined that the air supply line is clogged, and the difference between the first pressure value and the second pressure value is greater than the second set value, and the second pressure value is detected. It is determined that the suction line is clogged when a difference between a third pressure value detected by the pressure detection unit and the first pressure value is smaller than the second set value. Item 14. The pneumoperitoneum system according to Item 1.   The pneumoperitoneum system according to any one of claims 1 to 3, further comprising a display unit that displays a clogged state of the air supply conduit or the suction conduit based on a determination result of the clogged state determination unit.

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