JP7464923B2 - Treatment tool insertion aid - Google Patents

Description

The present invention relates to a treatment tool insertion aid that assists in the insertion of treatment tools such as endoscopes, forceps, and scalpels into the body.

Surgery within a body cavity is performed under endoscopic observation by inserting treatment tools such as an endoscope, forceps, and scalpel into the body. When performing such surgery, a treatment tool insertion aid (endoscopic surgery platform) is used to assist in the insertion of the treatment tools. The treatment tool insertion aid includes multiple inner tubes into which treatment tools can be inserted so that they can be moved back and forth, and an outer tube into which these multiple inner tubes can be inserted.

From the perspective of ensuring minimal invasiveness, which reduces the physical burden on the patient, it is preferable for the size of the incision to be as small as possible, and an incision of a size corresponding to an outer diameter roughly equal to or larger than the outer diameter of the insertion part of the outer tube is formed on the body surface.

When inserting the treatment tool insertion aid, the tip of the inner tube is in a straightened state, and the size of the treatment tool insertion aid when inserted is configured to be smaller than the outer diameter of the insertion part of the outer tube. After inserting the tip of the inner tube close to the treatment part inside the body cavity, the inner tube is expanded by operating the operating part located outside the body so that the spacing between the tips increases, expanding the range of motion of the treatment tools inserted into the inner tube and ensuring an appropriate operating range (see, for example, Patent Document 1).

Republished Publication No. 2018/070042

However, conventional treatment tool insertion aids require the provision of an unfolding mechanism for converting the tip of the inner tube from a straightened state to an unfolded state, an operating mechanism for operating the conversion mechanism, and a maintenance mechanism for maintaining the unfolded state. This necessitates the provision of parts and the assembly work required to realize these mechanisms.

The present invention aims to eliminate such inconveniences and provide a treatment tool insertion aid that can expand the tip of the inner tube outward from the inner circumferential surface of the tip of the outer tube without requiring a mechanism for expanding the tip of the inner tube.

The present invention comprises an outer tube that is inserted into an incision made in a body wall, and multiple inner tubes that are inserted into the inside of the outer tube with their tips protruding from the outer tube into the body and through which treatment tools are inserted, the outer tube has multiple engagement parts that engage with the inner tube to position the inner tube in the circumferential direction of the outer tube, and at least one of the inner tubes, a first inner tube, has a bent part at the tip and a straight part further rearward than the tip, and is engaged with the engagement part via a ring member connected to be freely rotatable around the axis of the straight part.

According to the present invention, since the multiple inner tubes are inserted from the rear end side of the outer tube and the tip portions protrude from the outer tube into the body, when inserting the treatment tool insertion aid into the body cavity through the incision, it is sufficient to form an incision in the body wall into which the outer tube can be inserted. Then, after inserting the treatment tool insertion aid, it is possible to develop the bent portion of the tip so that it protrudes outward from the inner circumferential surface of the tip of the outer tube by simply rotating the first inner tube without providing a mechanism for bending the inner tube. Then, when removing the treatment tool insertion aid, it is sufficient to rotate the first inner tube to retract the bent portion inward from the inner circumferential surface of the tip of the outer tube, or at least inward from the outer circumferential surface of the tip of the outer tube.

The multiple engagement parts are not limited to those formed directly on the outer tube, but may be formed on a member that is fixedly or removably attached to the outer tube, or may be composed of such a member.

In the present invention, it is preferable that the outer tube has a gap through which at least one of the first inner tubes can pass with its tip bent and be removed to the rear end side when all the inner tubes are inserted.

In this case, at least the first inner tube can be inserted into the outer tube from the rear end while its tip is bent, and can be passed through the inside of the outer tube and protruded from the tip, with all other inner tubes inserted into the outer tube. This allows the first inner tube to be removed and reinserted while the treatment tool insertion aid is inserted, making it possible to replace the inner tube during surgery to suit the treatment tool.

In the present invention, it is also preferable that the second inner tube of the inner tubes has a straight portion that extends linearly at the tip, and that the outer tube has a gap through which the tip of one of the first inner tubes can pass while remaining bent and be removed at the rear end when the second inner tube is removed from a state in which all the inner tubes have been inserted.

In this case, after the second inner tube has been removed from the outer tube, at least one first inner tube can be passed through the outer tube with its tip bent and removed from the rear end.

In addition, in the present invention, it is preferable that the inner tube is composed of a plurality of tube bodies and a tube connector that connects the tube bodies together, and that the ring member is connected to the tube connector.

In this case, the ring body is connected to the tube connector, not to the tube body made of a soft material, which makes it easier to assemble the ring member to the inner tube. This allows the ring member to be compact, which in turn prevents the outer diameter of the outer tube from becoming too large.

Furthermore, in the present invention, it is preferable that the first inner tube has a rotation operating device at the rear end that protrudes circumferentially outward on the same side as the side bent with respect to the straight portion of the tip portion.

In this case, by using the rotation tool, the surgeon can easily rotate the first inner tube. In addition, the surgeon can easily recognize the bending direction of the bent portion by the protruding direction of the rotation tool.

FIG. 2 is a front view showing a treatment tool insertion aid according to an embodiment of the present invention. FIG. 2 is a cross-sectional view taken along line II-II of FIG. FIG. FIG. 4 is a cross-sectional view showing the state after the first inner tube has been inserted. 13 is a cross-sectional view showing the state after the second inner tube has been inserted. FIG. 1A and 1B are cross-sectional views showing a state in which two inner tubes are close to each other and a state in which the inner tubes are deployed.

The following describes a treatment tool insertion aid 100 according to an embodiment of the present invention. The treatment tool insertion aid 100 is used to aid in the insertion of treatment tools (not shown) such as an endoscope, forceps, or scalpel into the body.

As shown in Figs. 1 and 2, the treatment tool insertion aid 100 is mainly composed of an outer tube 10, multiple rail members 20, multiple ring members 30, and multiple inner tubes 40, 50. Multiple rail members 20 are attached to the inner circumferential surface of the outer tube 10, and a ring member 30 is attached to an engagement portion 60 formed by the rail members 20 at intervals in the circumferential direction, and the inner tubes 40, 50 are attached in a state of being inserted into the outer tube 10 using the ring member 30. The inner tube 40 corresponds to the first inner tube of the present invention, and the inner tube 50 corresponds to the second inner tube of the present invention.

Although not shown, the outer tube 10 is inserted through an incision made in the body wall. The outer tube 10 is a flexible, roughly cylindrical body, and is provided with a number of guide portions 11 extending axially from the tip end to the base end on its inner wall surface. In this case, the guide portions 11 are dovetail grooves 11 formed on the inner wall surface of the outer tube 10, and are formed at equal intervals in the circumferential direction on the inner wall surface.

In this embodiment, as shown in FIG. 2, the dovetail groove 11 is formed in a protrusion that protrudes toward the central axis, and both the opening and the back side have a rectangular cross-sectional shape. However, the shape of the dovetail groove 11 is not limited to this, and it may be an approximately trapezoid that spreads further back than the opening, or the opening may be rectangular and the back side may be approximately circular, etc.

The outer tube 10 is made of soft materials such as soft plastics, such as polypropylene and polyvinyl chloride, and rubber. The outer tube 10 may also be made of hard plastics, such as ABS and polycarbonate, and hard rubber. The outer tube 10 may be partially or entirely transparent or translucent.

The rail member 20 is made of the same material as the outer tube 10 and is a flexible, long body. The rail member 20 has a guided portion 21 that extends axially from the tip end to the base end on the outer surface. Here, the guided portion 21 is a protrusion 21 formed on the outer surface of the rail member 20. Note that the guided portion 21 may be formed intermittently.

In this embodiment, the protrusion 21 is formed in a shape that engages with the guide portion 11 of the outer tube 10, and has a rectangular cross-sectional shape along with the outside and the neck. However, the cross-sectional shape of the protrusion 21 is not limited to this, and may be, for example, a roughly trapezoid that widens toward the back, or a roughly circular outside with a rectangular neck.

A dovetail groove 60 is formed by the inner circumferential surface of the outer tube 10 and the left and right side surfaces of the adjacent rail member 20. This dovetail groove 60 functions as an engagement portion 60 with which the ring member 30 attached to the inner tubes 40, 50 engages.

In this embodiment, as shown in FIG. 2, the dovetail groove 60 has a rectangular cross-sectional shape at both the opening and the back side. However, the cross-sectional shape of the dovetail groove 60 may be, for example, a substantially trapezoid that spreads further back than the opening, or a rectangular opening and a substantially circular back side.

With the guided portion 21 engaged with the guiding portion 11, the rail member 20 has its tip fixed to the tip-most portion of the outer tube 10 by adhesive or the like, but the other portions of the rail member 20 are not fixed to the outer tube 10. As a result, when the outer tube 10 is bent, each rail member 20 bends accordingly and does not impede the bending of the outer tube 10. This allows the outer tube 10 to bend while maintaining its cross-sectional shape.

Furthermore, a guide pipe 12, an air leakage prevention ring 13, and a valve seat (not shown) are attached to the base end side of the outer tube 10.

Referring also to FIG. 3, the ring member 30 comprises a cylindrical ring body 31 and an engaged portion 32 that is provided on the outer peripheral surface of the ring body 31 so as to protrude outward and engages with the engaging portion 60 to slidably guide the inner tubes 40, 50 to which the ring member 30 is attached.

Here, the engaged portion 32 is a wide rectangular protrusion that protrudes from the outer peripheral surface of the ring body 31, but it can be of any shape as long as it can engage with the engaging portion 60.

The engaged portion 32 is provided continuously from the tip to the base end of the ring body main body 31. However, the engaged portion 32 may be provided intermittently on at least the tip of a portion of the outer peripheral surface of the ring body main body 31 that extends from the tip to the base end.

The inner tubes 40 and 50 are flexible cylindrical bodies that are configured to allow treatment tools such as an endoscope, forceps, and scalpels to be inserted therein. Here, the inner tubes 40 and 50 have only one channel for inserting a treatment tool, but may have two or more channels.

As shown in FIG. 3, the inner tubes 40, 50 are composed of cylindrical tube bodies 41, 51 and tube connectors 42, 52 that are located between the tube bodies 41, 51 and connect the tube bodies 41, 51.

The tube bodies 41, 51 located at the tips of the inner tubes 40, 50 are made of hard materials such as hard plastics such as ABS and polycarbonate, and hard rubber. On the other hand, the other tube bodies 41, 51 not located at the tips of the inner tubes 40, 50 are made of soft materials such as soft plastics such as polypropylene and polyvinyl chloride, and rubber, but may be made of hard materials like the tip tube bodies 41, 51. And the tube connectors 42, 52 are made of hard materials with excellent abrasion resistance such as hard plastics such as ABS and polycarbonate.

The inner tube 40 is inserted with a treatment tool (not shown), such as a soft double-arm forceps shaft. The inner tube 50 is inserted with a treatment tool (not shown), such as a soft endoscope. Here, there are two inner tubes 40 and one inner tube 50, but the number is not limited, and other types of inner tubes may be included. The outer diameter of the inner tube 50 is larger than the outer diameter of the inner tube 40, but is not limited to this, and may be smaller or the same.

Here, each inner tube 40, 50 is constructed by connecting three tube bodies 41, 51 and two tube connectors 42, 52 in the axial direction. The tube bodies 41, 51 and the tube connectors 42, 52 to which the ring body 30 is attached are fixedly connected so that when one of them is rotated around its axis, the other also rotates integrally.

The tube bodies 41, 51 and the tube connectors 42, 52 may be separable or inseparable. It is also preferable that the tube connectors 42, 52 have a thin slit extending in the axial direction. This allows the tube connectors 42, 52 to be inserted into the ring member 30 while being deformed in the diametrical direction, making it possible to make the ring member 30 into a compact single member.

In the inner tube 40, the tube body 41 and the tube connector 42 other than the tip are linear sections whose axes (lines connecting the centers of the circular cross sections) are straight. However, the linear sections are not limited to those whose axes are strictly straight, and may be roughly straight, and furthermore, convex or concave portions may be present on the inner or outer circumferential surfaces.

Because the tube body 41 other than the tip is made of a soft material, its axis can be freely changed from a straight line. Also, in the inner tube 50, all of the tube bodies 51 and tube connectors 52 are linear sections whose axes are straight. However, because the tube body 51 is made of a soft material, its axis can be freely changed from a straight line.

The inner tubes 40, 50 are inserted into the outer tube 10 by sliding the engaged portion 32 of the ring member 30 in engagement with the engaging portion 60, with the respective tube connectors 42, 52 already inserted into the ring member 30. In this inserted state, the inner tubes 40, 50 are supported at their middle portions by the ring member 30, which engages with the rail member 20 attached to the inner circumferential surface of the outer tube 10. As a result, the inner tubes 40, 50 are each able to rotate freely around their axis while inserted into the outer tube 10.

In this way, since the ring member 30 is connected to the tube connector 42, 52 instead of the tube body 41, 51 made of a soft material, the ring member 30 can be easily assembled to the inner tube 40, 50. This makes it possible to configure the ring member 30 compactly and prevent the outer diameter of the outer tube 10 from becoming too large.

The inner tube 50 does not have to be configured to be freely rotatable. For example, the inner tube 50 may be composed of a single tube body as a whole, and the engaged portion formed on this tube body may directly engage with the engaging portion 60.

The tip of the tube body 41 at the tip of the inner tube 40 has a portion (hereinafter referred to as the bent portion) 41a whose axis is bent compared to the straight portion. The tube body 41, including the bent portion 41a, has the same inner and outer diameters throughout. When the inner tube 40 is inserted into the outer tube 10 and attached, this bent portion 41a protrudes from the tip of the outer tube 10 into the body. Here, the bent portion 41a is bent so that its axis is in one direction, i.e., so that the axis of the inner tube 40 is located in the same plane.

Here, the axis of the bent portion 41a is a cubic curve such as an S-shape or Z-shape, and after bending in one direction, the axis of the tip portion is offset again parallel to the straight portion to form a straight line or an offset portion approximating a straight line. However, the axis of the bent portion 41a may be, for example (not shown), a quadratic curve such as a V-shape (inverted V-shape) or V-shape, and may be bent in one direction toward the tip. The axis of the bent portion 41a may also be a curve other than a quadratic curve or a cubic curve.

However, the bent portion 41a must be shaped so that one inner tube 40 can be inserted into and removed from the outer tube 10 when all other inner tubes 50 have already been inserted.

Furthermore, nose covers 43, 53 (see Figures 1 and 3) are attached to the tip of the inner tube 40, 50. The nose covers 43, 53 are fixed to the tip of the distal tube body 41, 51. The nose covers 43, 53 are made of a soft material so as not to damage tissue even if they come into contact with it.

On the other hand, slide pipes 44, 54 and anti-leak valves 45, 55 are attached to the base ends of the inner tubes 40, 50.

The slide pipes 44, 54 are connected to the rear ends of the inner tubes 40, 50 and inserted into the air leakage prevention ring 13. This makes it possible to prevent air from leaking from within the body cavity from areas of the outer tube 10 where the inner tubes 40, 50 are not inserted or from the outer periphery of the inserted inner tubes 40, 50.

The anti-deaeration valves 45, 55 can prevent air from leaking from the inner tubes 40, 50 into which no treatment tool is inserted, into a body cavity, such as the abdominal cavity. The anti-deaeration valves 45, 55 are detachably attached to the rear ends of the slide pipes 44, 54.

A rotation operating tool 46 is attached to the base end of the inner tube 40. Although not shown in detail, the rotation operating tool 46 is fixed integrally to the rear end of the tube body 41 at the rear end of the inner tube 40. When the surgeon rotates the rotation operating tool 46, the inner tube 40 rotates, and the bending direction of the bent portion 41a at the tip of the inner tube 40 can be changed. It is preferable that the rotation operating tool 46 protrudes outward in the circumferential direction on the same side as the bent portion 41a is bent relative to the straight portion. This makes it possible for the surgeon to easily recognize the bending direction of the bent portion 41a based on the protruding direction of the rotation operating tool 46.

When inserting the inner tubes 40, 50 into the outer tube 10, it is possible to select which of the engagement parts 60 to use. In addition, the engagement part 60 that is not engaged with the engagement part 32 of the ring member 30 may be engaged with, for example, the engagement part of the guide member disclosed in the above-mentioned Patent Document 1.

The following describes how to perform endoscopic surgery using the above-mentioned treatment tool insertion aid 100.

First, referring to FIG. 4, one inner tube 50 with the ring member 30 attached is inserted into the outer tube 10 by sliding it while engaging the engaging portion 60 with the engaged portion 32 of the ring member 30. The tube body 51 at the tip of the inner tube 50 is straight and not bent. As a result, the straight tip of the one inner tube 50 protrudes forward from the tip of the outer tube 10. The inner tube 50 is positioned circumferentially within the outer tube 10 by the engagement between the engaged portion 32 and the engaging portion 60. The surgeon then inserts a flexible endoscope (not shown) into the inner tube 50.

Next, the first inner tube 40 with the ring member 30 attached is slid through the outer tube 10 while engaging the engaging portion 60 with the engaged portion 32 of the ring member 30. At this time, the inner tube 40 is inserted from the rear end side of the outer tube 10 so that the bent portion 41a at the tip of the inner tube 40 does not interfere with the inner tube 50 (see the bent portion 41a drawn by the dashed line in Figure 4). The inner tube 40 is positioned circumferentially within the outer tube 10 by the engagement between the engaged portion 32 and the engaging portion 60.

Then, with the bent portion 41a at the tip of the inner tube 40 protruding from the tip of the outer tube 10, the surgeon operates the rotation operating tool 46 to rotate the inner tube 40 so that the bent portion 41a faces outward (see the bent portion 41a depicted by the two-dot chain line in FIG. 4). This makes it possible to insert the second inner tube 40 through the outer tube 10 and protrude the tip without interference. Note that at this time, at least a portion of the bent portion 41a protrudes outward from the area obtained by projecting the inner circumferential surface of the tip of the outer tube 10 forward, but is not limited to this.

Next, the second inner tube 40 with the ring member 30 attached is slid through the outer tube 10 while engaging the engaging portion 60 with the engaged portion 32 of the ring member 30. At this time, the inner tube 40 is inserted from the rear end side of the outer tube 10 so that the bent portion 41a at the tip of the inner tube 40 does not interfere with the inner tube 50 and the first inner tube 40 (see the bent portion 41a drawn by the dashed line in Figure 5).

Then, with the bent portion 41a at the tip of the second inner tube 40 protruding from the tip of the outer tube 10, the surgeon operates the rotation operating tool 46 to rotate the first inner tube 40 so that the bent portion 41a of the first inner tube 40 faces inward (see the upper bent portion 41a depicted by the dashed line in Figure 5).

The surgeon then operates the rotation tool 46 to rotate the second inner tube 40 so that the bent portion 41a of the second inner tube 40 approaches the bent portion 41a of the first inner tube 40 (see the lower bent portion 41a depicted by the dashed line in FIG. 5). This brings the bent portions 41a of the two inner tubes 40 closer together, and all of the inner tubes 40, 50 are contained within the area formed by projecting the inner circumferential surface of the tip of the outer tube 10 forward.

Then, although not shown, the treatment tool insertion aid 100 in this state is inserted into the body cavity through the incision made in the body wall using a reducer or the like, and the surgeon uses an endoscope to confirm that the tips of the inner tubes 40, 50 have reached the desired position.

Then, the surgeon operates the rotation operating tool 46 to rotate the two inner tubes 40, and the bent portion 41a at the tip of each inner tube 40 is deployed in an appropriate direction according to the case, etc., to the extent that it does not interfere with the other inner tubes 40, 50 (see the upper and lower bent portions 41a depicted by the two-dot chain lines in Figure 5). At this time, at least a portion of each of the bent portions 41a of the two inner tubes 40 protrudes outward from the area obtained by projecting the inner circumferential surface of the tip of the outer tube 10 forward.

Then, the surgeon inserts a treatment tool (not shown), such as a double-arm forceps shaft, into each of the two inner tubes 40. Note that the bent portion 41a at the tip of the inner tube 40 may be deployed in a direction different from the initial direction during the surgical procedure.

As described above, according to the treatment tool insertion aid 100 of this embodiment, the inner tubes 40, 50 are inserted from the rear end side of the outer tube 10, and their distal ends protrude into the body from the distal end side of the outer tube 10. When inserting the treatment tool insertion aid 100, it is sufficient to form an incision in the body wall through which the outer tube 10 can be inserted. Then, after inserting the treatment tool insertion aid 100, simply by rotating the two inner tubes 40, it is possible to deploy the bending portion 41a at the distal end outward from the outer tube 10 without providing a mechanism for bending the inner tubes 40.

Furthermore, when removing the treatment tool insertion aid 100, the inner tube 40 can be rotated to move the bent portion 41a inward from the inner peripheral surface of the tip of the outer tube 10.

When all the inner tubes 40, 50 have been inserted, the tip 41a of at least the first or second inner tube 40 inserted can pass through the outer tube 10 while remaining bent and can be pulled out to the rear end side. This allows the inner diameter of the outer tube 10 to be reduced.

In addition, by rotating the first inner tube 40 inserted and expanding it so that its tip protrudes outward from the inner surface of the outer tube 10, it is possible to make the tip of the second inner tube 40 protrude from the tip of the outer tube 10 without interfering with the first inner tube 40.

Furthermore, while the treatment tool insertion aid 100 is inserted, the inner tubes 40 can be removed and reinserted one by one, making it possible to replace the inner tubes 40 with those appropriate for each treatment tool during surgery.

Although the embodiment of the present invention has been described above, the present invention is not limited to this, and the configuration and form of the treatment tool insertion aid can be changed as appropriate. For example, the total number of inner tubes 40, 50 and the number of tubes having bent portions 41a are not limited to those described above.

In the embodiment, the case where the inner tubes 40, 50 are attached via the ring member 30 by the engagement portion 60 formed on the rail member 20 attached to the guide portion 11 formed on the inner circumferential surface of the outer tube 10 has been described. However, this is not limited to this, and for example, an engagement portion may be formed on the inner circumferential surface of the outer tube 10, and the inner tubes 40, 50 may be attached to this engagement portion. Also, a member with an engagement portion formed on the inner circumferential surface of the outer tube 10 may be attached.

The outer tube 10 may have a gap at the rear end side of the outer tube 10 through which the bent portion 41a of at least one of the inner tubes 40 can pass while remaining bent when the inner tube 50 is removed from the state in which all the inner tubes 40, 50 have been inserted.

As a result, when the inner tube 50 has been removed from the outer tube 10, the inner tube 40 can be passed through the outer tube 10 with the bent portion 41a still bent, and removed from the rear end side.

10...outer tube, 11...guiding portion, dovetail groove, 12...guide pipe, 13...air leakage prevention ring, 20...rail member, 21...guided portion, protrusion, 30...ring member, 31...ring body main body, 32...engaged portion, 40...inner tube, first inner tube, 41, 51...tube body, straight portion, 41a...bent portion (bent portion), 42, 52...tube connector, straight portion, 43, 53...nose cover, 44, 54...slide pipe, 45, 55...deaeration prevention valve, 46...rotation operation tool, 50...inner tube, second inner tube, 60...engagement portion, dovetail groove, 100...treatment tool insertion aid.

Claims (5)

an outer tube that is inserted into an incision in the body wall;
a plurality of inner tubes, each of which has a distal end portion projecting from the outer tube into a body, and each of which has a treatment tool inserted therein;
the outer tube has a plurality of engagement portions that engage with the inner tube to position the inner tube in a circumferential direction of the outer tube,
The treatment tool insertion aid is characterized in that a first inner tube among the inner tubes has a bent portion at the tip portion and a straight portion further rearward than the tip portion, and engages with the engagement portion via a ring member connected to be freely rotatable around the axis of the straight portion. 2. The treatment tool insertion aid according to claim 1,
The outer tube has a gap through which at least one of the first inner tubes can pass and be extracted at the rear end side while keeping the tip end bent when all of the inner tubes are inserted. 2. The treatment tool insertion aid according to claim 1,
The second inner tube of the inner tubes has a straight portion extending straight at the tip portion,
The treatment tool insertion aid is characterized in that, when all of the inner tubes have been inserted and the second inner tube has been removed, the outer tube has a gap through which the tip portion of one of the first inner tubes can pass while remaining bent and be removed at the rear end. The treatment tool insertion aid according to any one of claims 1 to 3,
The inner tube is composed of a plurality of tube bodies and a tube connector that connects the tube bodies to each other,
The treatment tool insertion aid is characterized in that the ring member is connected to the tube connector. The treatment tool insertion aid according to any one of claims 1 to 4,
The treatment tool insertion aid is characterized in that the first inner tube has a rotation operating tool at its rear end that protrudes circumferentially outward on the same side as the side bent with respect to the straight portion of the tip portion.

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