JPH0651019B2 - Endoscopic guide device inserted percutaneously - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial application] The present invention relates to a guide device for securing an insertion path of an endoscope that is percutaneously inserted into the body, such as a laparoscope and a thoracoscope. It is about.

[Prior Art] A trocar is generally used as a guide device for percutaneously securing an insertion path of an endoscope. This trocar is composed of an inner needle and an outer tube, and the inner needle is inserted into the outer tube and pierced from the body skin in a connected state, and is advanced into the body cavity where observation and treatment are performed, By pulling out the inner needle, an insertion path for guiding the insertion portion of the endoscope into the body cavity is secured inside the outer tube. In order to allow the trocar to be inserted into the body, the tip portion of the inner needle has a sharp cone shape, and the tip portion of the outer tube is also sharply formed like a cutting edge.

Further, in order to smoothly perform the observation and treatment of the inside of the body cavity, there is also one that is filled with pneumoperitoneum gas for expanding the inside of the body cavity. In this case, a valve for opening or closing the passage formed inside the outer tube is provided, and the valve automatically operates when the inner needle is pulled out from the outer tube. Thus, when closing the passage and inserting the insertion portion of the endoscope, the valve can be opened by fingers or the like. And when this insertion part is inserted into the outer tube,
Since the valve is open, the difference between the inner diameter of the outer tube and the outer diameter of the insertion section should be as small as possible in order to prevent insufflation gas from leaking from the gap between the inner surface of the outer tube and the outer surface of the insertion section. I have less.

[Problems to be Solved by the Invention] Here, as an endoscope that is inserted into the body percutaneously, such as a laparoscope and a thoracoscope, the entire insertion portion is made of a rigid member made of a metal tube or the like. Although the formed rigid endoscope was used,
In recent years, in order to be able to orient the distal end portion formed with an observation window, a treatment instrument outlet, etc. in a desired direction in a body cavity, a rigid portion is provided with a continuous angle portion. It has become possible to be. As is well known, the angle portion covers a ring structure formed by sequentially pivotally connecting a plurality of angle rings with a protective net, and the protective net is covered with an outer skin layer made of rubber or polyurethane. I am trying to do it.

Thus, using an endoscope having such an angle portion,
After inserting the insertion part into the mantle tube of the trocar and performing an internal angle diagnosis and examination or treatment while appropriately performing the angle operation, when the insertion part is pulled out from the mantle tube, the angle part is bent. If it is, the angled part is scraped off by the sharpened tip of the mantle tube,
It has the drawback of damaging the outer skin layer, and it is very dangerous if a part of this outer skin layer is scraped off and remains in the body, and such a situation must be surely prevented. Moreover, as described above, if the diameter difference between the outer diameter of the insertion part and the inner diameter of the outer tube is reduced in order to reduce the leakage of the pneumoperitoneum gas in the body cavity, the angled portion of the insertion part is changed to the outer tube. There is also a problem in that the operation of inserting and removing is extremely difficult.

The present invention has been made in view of the above points, and an object of the present invention is to provide an endoscope including an insertion portion in which a rigid portion is continuously provided with an angle portion, and the insertion portion is smooth. In addition, it can be inserted and removed without damaging the outer skin layer of the angle portion, and the inside of the body cavity can be surely kept airtight at the time of insertion. An object is to provide a guide device for an endoscope.

[Means for Solving the Problems] In order to achieve the above-mentioned object, the present invention comprises a rigid tube member having a rounded distal end portion, which is inserted into an outer tube of a trocar to insert an endoscope. The guide tube forming the insertion passage of the portion is detachably connected to the outer tube so that the tip of the guide tube projects from the tip of the outer tube. It is characterized in that it is configured to be detachably connected to an airtight holding member that is fitted into the rigid portion and keeps the inside of the body cavity airtight.

[Function] The inner needle of the trocar is inserted into the outer tube, the body tube is inserted into the body cavity, and the inner needle is pulled out while the outer tube is left in place to secure the insertion path of the endoscope. Then, the airtight holding member is inserted into the insertion portion of the endoscope, and the guide tube is inserted so that the guide tube is connected to the airtight holding member.

Therefore, the insertion portion of the endoscope equipped with the guide tube and the airtight holding member as described above is inserted into the outer tube of the trocar,
The angle portion is inserted into the body cavity from the tip of the outer tube to lock the guide tube and the outer tube. As a result, it becomes possible to perform inspections, diagnoses, treatments and the like in the body cavity.

Further, since the airtight holding member is connected to the guide tube, the insufflation gas filled in the body cavity can be held by the airtight holding member so as not to leak from the fitting portion of the insertion portion to the outside. Furthermore, even if there is almost no gap between the guide tube and the outer tube, there is no effect on the operability of the insertion / removal operation of the insertion section, so the guide tube should be fitted into the outer tube in a close-fitting state. If it is configured to be inserted, it is possible to prevent the gas from leaking the pneumoperitoneum during this period.

Then, after the procedures such as the examination by the endoscope, diagnosis and treatment are completed, the insertion portion of the endoscope is taken out from the body. When removing the insertion part, the guide tube is held in a state of being connected to the outer tube, and only the insertion part is pulled out. If the angled portion of the insertion portion is not straight and is curved, the outer skin layer of the angled portion will be damaged if it directly contacts the tip of the mantle tube, but the tip of the guide tube is damaged. Since it projects from the tip of the outer tube, the angled portion does not come into contact with the sharp tip of the outer tube. Moreover, since the tip portion of the guide tube is rounded, even if the angle portion hits the tip of the guide tube, it can be smoothly pulled out without being damaged.

After the work is completed, if the insertion portion of the endoscope is pulled out from the outer tube, a passage for discharging the insufflation gas from the body cavity to the outside will be formed inside the guide tube. Even if a holding valve is provided, the pneumoperitoneum gas can be released to the outside without operating this valve.

Embodiments Embodiments of the present invention will be described in detail below with reference to the drawings.

First, FIG. 1 shows the overall configuration of the endoscope. In the figure, 1 indicates the main body operating portion, 2 indicates the inserting portion, and the inserting portion 2 is a rigid portion made of a hard pipe material made of metal or the like for a predetermined length from the connecting portion to the main body operating portion 1. At 3, the angled portion 4 is connected to the rigid portion 3, and the angled portion 4 is provided with a treatment tool lead-out portion for leading out a treatment tool such as an illumination window, an observation window, and forceps. Part 5 is lined up. The angle portion 4 is for orienting the distal end hard portion 5 in a desired direction, and for this reason, the angle portion 4 is connected with an angle ring so as to be pivotable, as is well known. This ring structure has a three-layer structure in which a protective net and an outer skin layer are sequentially deposited.

Next, FIG. 2 shows the entire structure of the trocar 10 for guiding the insertion portion 2 of the endoscope. In the figure, 11
Is an inner needle, and 12 is an outer tube. The inner needle 11 and the tip portion 11b connected to the body rod portion 11a of the inner needle have a sharply pointed pyramid shape so as to be suitable for inserting into the body skin. Further, the base end portion 11c has a shape that can be held by an operator who operates the trocar 10 by hand.

On the other hand, the outer tube 12 allows the inner needle 11 to be inserted and the insertion portion 2
It is made of a tubular member such as a metal having a passage 13 for inserting the blade, and its tip portion 12a has a sharp cutting edge shape. Further, a valve 14 for opening and closing the passage 13 is provided on the peripheral body portion 12b.
Is provided. This valve 14 has a passage blocking portion 16a for closing the passage 13 in a tubular valve casing 15 provided in a direction orthogonal to the axis of the outer tube 12, and a communication portion 16b having the same diameter as the passage 13. A body 16 is slidably mounted. A spring 17 acts on the valve body 16 so that the passage blocking portion 16a normally faces the passage 13 and is urged to block the passage 13. A pusher 18 is connected to the valve body 16, and when the pusher 18 is pushed by a finger, the valve body 16 is pushed against the spring 17 so that the opening 16b faces the passage 13. It will be switched to the open state.

Here, the insertion portion 2 of the endoscope is directly the outer tube of the trocar 10.
It is not designed to be inserted into the passage 13 of 12
As shown in the figure, it is adapted to be inserted into the outer tube 12 via the guide tube 20. The guide tube 20 is made of a hard tubular member such as a metal having an outer diameter slightly smaller than the inner diameter of the outer tube 12, and an inside thereof has an insertion passage 21 through which the insertion portion 2 of the endoscope is inserted. . And the guide tube 20
As is clear from FIG. 4, the front end portion 20a of the is rounded and has no edge. Further, the length of the guide tube 20 in the axial direction is longer than the length of the outer tube 12. Therefore, in the state where the guide tube 20 is inserted into the outer tube 12 and connected, as is apparent from FIG. 5, the tip portion 20a of the guide tube 20 is separated by a predetermined length 1 from the tip of the outer tube 12. It is in a state of protruding from the portion 12a.

Thus, in order to fix the guide tube 20 in a state of being connected to the outer tube 12, the base end portion 12c of the outer tube 12 is bulged outward, and the hook 30 is attached to the base end portion 12c. Is installed. The hook 30 is rotatable about a shaft 31 and is always urged by a toggle spring 32 in the insertion direction of the guide tube 20. In contrast, the guide tube
An extension portion 22 is formed at the base end of the extension portion 20.
A locking collar 23 that functions as a stopper that restricts the insertion depth of the guide tube 20 into the outer tube 12 and that engages with the hook 30 is formed on the.

Further, reference numeral 40 denotes an airtight holding cap, which is formed in an annular body portion 40a with an inner diameter slightly larger than that of the hard portion 3 of the insertion portion 2 and an inner surface of which is in sliding contact with the hard portion 3. The sliding contact portion 40b is arranged in series. Then, the click engaging element 41 is provided on the main body 40a.
a, a click mechanism 41 including a click spring 41b for urging the click engaging element 41a inward in the radial direction is provided, and the extension 22 of the guide tube 20 is clicked by the click engaging element 41a. Grooves 42 are provided in the circumferential direction. A skirt portion 40c is connected to the body portion 40a of the airtight holding cap 40, and the skirt portion 40c
As is apparent from FIG. 5, the outer tube 12 and the guide tube are
20 and the insertion part 2 of the endoscope are connected, the hook 30
Is a partition that surrounds the wall so that it is not exposed to the outside.

The present invention is configured in this way, and its operation will be described below.

First, the trocar 10 is assembled with the inner needle 11 inserted in the outer tube 12. On the other hand, in the insertion portion 2 of the endoscope, the airtight holding cap 40 is fitted to the rigid portion 3 of the endoscope, the guide tube 20 is fitted, and the airtight holding cap 40 is clicked on the extension portion 22 of the guide tube 20. To combine. here,
The sliding contact portion 40b of the airtight holding cap 40 should have almost no gap with the rigid portion 3, but since there is no particular inconvenience even if a slight gap is provided between the guide tube 20 and the insertion portion 2, By setting the inner diameter of the guide tube 20 to be somewhat larger than the outer diameter of the insertion section 2, the insertion operation of the insertion section 2, particularly the angle section 4 thereof into the guide tube 20 can be performed smoothly and easily. Moreover, the airtight holding cap 40 may be held in a state of being inserted into the rigid portion 3 in advance.

Therefore, the inner needle 11 is inserted from the skin on the abdomen or chest of the patient who has been filled with the trocar 10 with the pneumoperitoneum gas in advance, and the outer tube 12 is extended to the inside of the body cavity where predetermined observation and treatment are performed. Get in. Since the outer tube 12 has a sharp edge without a stepped portion or the like, the outer tube 12 can be smoothly and smoothly inserted into a predetermined portion. In this state, the inner needle 11 is pulled out from the outer tube 12. As a result, the valve 14 is actuated, the passage blocking portion 16a faces the passage 13 of the outer tube 12, and the state in which the communication between the inside of the body cavity and the outside is blocked, that is, the state in which the pneumoperitoneum gas is prevented is retained. To be done.

To insert the endoscope in this state, the guide tube 20 is inserted into the outer tube 12 with the guide tube 20 covering the angle portion 4. Here, the diameter difference between the guide tube 20 and the outer tube 12 is very small, but since the guide tube 20 is made of a hard pipe material, it can be smoothly inserted. Then, by the hook 30 attached to the outer tube 12,
The state where the guide tube 20 is connected to the outer tube 12 is neglected. As a result, as is apparent from FIG. 5, the tip portion 20a of the guide tube 20 protrudes from the tip of the outer tube 12 by a predetermined length l, and the insertion portion 2 is separated from the tip portion 12a of the outer tube 12. Are held in a non-contact state. Moreover, since the hook 30 is covered by the skirt portion 40c of the airtight holding cap 40, the hook 30 comes off during operation of the endoscope, and the guide tube 20
There will be no inconvenience that the tip portion 20a of the above will retract into the outer tube 12.

Therefore, by projecting the angle portion 4 of the insertion portion 2 from the tip portion 20a of the guide tube 20, while observing the inside of the body cavity while bending the angle portion 4 in a desired direction, forceps or a high-frequency knife. And the like can be used to perform a predetermined treatment or the like. However, if the pneumoperitoneum gas filled in the body cavity leaks to the outside, the body cavity contracts and interferes with the various operations described above.
There is almost no gap between the guide tube 20 and the inner surface of the guide tube 20 and even if a slight gap is formed between the inner surface of the guide tube 20 and the outer surface of the insertion portion 2, an airtight holding connected to the guide tube 20. Since there is almost no gap between the sliding contact portion 40b of the cap 40 and the rigid portion 3 of the endoscope 2, gas leakage from this portion is also suppressed to a minimum.

Thus, when the insertion portion 2 is pulled out after the examination, diagnosis, treatment and the like in the body cavity are completed, the outer tube 12 is fixed by grasping it by hand and only the insertion portion 2 is pulled out. At this time, even if the angle part 4 is not in a straight state,
The angle portion 4 is in contact with the tip portion 20a of the guide tube 20, but is surely kept in a non-contact state with the tip portion 12a of the outer tube 12, and the tip portion 20a of the guide tube 20 is rounded. Since it is held, there is no risk of the outer skin layer of the angle portion 4 being scraped or damaged, and the insertion portion 2 can be pulled out extremely smoothly.

The angle portion 4 is the sliding contact portion 40 of the airtight holding cap 40.
When it comes into contact with b, the resistance against pulling out increases and the click mechanism 41 disengages the airtight holding cap 40 from the guide tube 20, and the airtight holding cap 40 is detached from the guide tube 20 together with the insertion portion 2. Will be done. As a result, the inside of the body cavity is communicated with the outside air via the guide tube 20, and the pneumoperitoneum gas in the body cavity can be discharged without performing a troublesome operation of operating the valve 14. become.

In addition, in the above-described embodiment, the connection between the outer tube and the guide tube is not performed by using the hook, and the connection between the guide tube and the airtight holding cap is performed by using the click mechanism. Although shown as constructed, suitable connecting mechanisms such as a screw, a bayonet mechanism, and a snap action mechanism can be used for these connecting mechanisms.

[Effects of the Invention] As described above, according to the present invention, a guide tube which is made of a rigid tube member having a rounded distal end portion and through which an insertion portion of an endoscope is inserted, and the guide tube, By using an airtight holding member that maintains airtightness with the insertion portion, this gado tube can be inserted into the outer tube of the trocar with its tip protruding from the tip of the outer tube, and both can be engaged and disengaged. Since the airtight holding member is detachably connected to the proximal end portion of the guide tube, the insertion portion of the endoscope can be smoothly inserted into the body cavity through the body skin. In addition, it can be pulled out without contacting the outer tube, the outer skin layer forming the angle part is not scratched or damaged, and the insertion part is inserted into the body cavity. Has pneumoperitoneum gas to inflate the body cavity It has various effects such as being able to hold it so as not to leak outside.

[Brief description of drawings]

The drawings show one embodiment of the present invention. FIG. 1 is an overall configuration diagram of an endoscope, FIG. 2 is a cross-sectional view of a trocar, and FIG. 3 shows a connection state between a guide bottom and an airtight holding cap. A sectional view, FIG. 4 is a sectional view of a main part of a guide tube, and FIG. 5 is a partial sectional front view showing a connected state of an endoscope and a guide device thereof. 1: Main body operation part, 2: Insert part, 3: Hard part, 4: Angle part, 5:
Hard tip, 10: trocar, 11: inner needle, 12: outer tube,
12a: tip part, 12b: peripheral body part, 13: passage, 14: valve,
20: Guide tube, 20a: Tip part, 21: Insertion passage, 22: Extension part, 23: Locking collar, 30: Hook, 40: Airtight holding cap,
40a: body part, 40b: peripheral body part, 40c: skirt part, 41:
Click mechanism.

Claims (1)

[Claims] 1. A route for percutaneously inserting an endoscope having a trocar having an inner needle and an outer tube and having an insertion portion formed by connecting an angle portion to the tip of a rigid portion is ensured. In the guide device, which is made of a rigid tube member having a rounded tip, the tube is inserted into the outer tube of the trocar,
A guide tube that forms an insertion passage of the insertion portion is detachably connected to the outer tube so that the tip of the guide tube projects from the tip of the outer tube. A guide device for a percutaneously inserted endoscope, characterized in that it is configured to be detachably connected to a rigid portion of an insertion portion so as to keep a body cavity airtight.