JPH07227397A - Method for providing hole for operation in abdominal wall and perforator used for this method - Google Patents

Abstract

PURPOSE:To perforate safely an abdominal wall under extremely decreasing damages to internal organs when a hole for operation is made on the abdominal wall. CONSTITUTION:An apex of a perforation rod under unprojected condition in a guide pipe 4 is inserted into a preceding hole for operation and under this condition, the apex of the guide pipe is moved to the peritoneum face on the inner wall side of an abdominal cavity 3 of the abdominal wall 1 to be perforated and thereafter, the apex of the perforation rod is projected from the apex of the guide pipe 4 and a hole for operation is made by perforating the abdominal wall 1 from the abdominal cavity 3 out of the abdominal cavity 3 by means of the perforation rod.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a method for incising a plurality of surgical holes in an abdominal wall when operating using a laparoscope, and a perforator used in this method.

[0002]

2. Description of the Related Art Surgery using a laparoscope is adopted as a surgical operation in which the abdominal wall is incised to make a small incision. This surgery does not make a large incision in the abdominal wall like normal surgery. Incisions are made in several small holes in the abdominal wall. A laparoscope or a surgical instrument is inserted into the abdominal cavity through the incised surgical hole to perform surgery. To expand the abdominal cavity, pressurized gas is pressed into the abdominal cavity or a plurality of points on the abdominal wall are lifted to widen the abdominal wall and internal organs.

In order to insert a surgical instrument or a laparoscope into the abdominal cavity, surgical holes are drilled at a plurality of points on the abdominal wall. Conventionally, an abdominal wall is incised from outside the body to open a surgical hole. A trocar is used to drill the surgical hole. The trocar is a guide pipe with a piercing rod inserted. The trocar punctures the abdominal wall as follows.

A plurality of points on the abdominal wall are lifted to expand between the abdominal wall and the internal organs. The piercing rod is projected from the guide pipe. A perforation rod is penetrated from outside the body into the body to perforate a surgical hole.

[0005]

When a surgical hole is drilled in the abdominal wall by this method, there is a risk of organ damage in the abdominal cavity and bleeding from the abdominal wall. This adverse effect is likely to occur when the abdominal cavity cannot be greatly expanded. It is difficult to greatly expand the abdominal cavity when a patient with a thick abdominal wall or a surgical hole is formed on the side of the body. In order to avoid this adverse effect, a method of strongly pulling up the abdominal wall to open the abdominal cavity has been developed. However, even if the abdominal wall is strongly lifted, it is difficult to constantly widen the abdominal cavity. Therefore, when drilling the surgical hole,
There is no risk of damaging part of the internal organs. It is important that no incision is made in the internal organs along with the surgical site. This may have a very bad effect on the patient.

The present invention was developed for the purpose of achieving this. An important object of the present invention is to provide a method of providing a surgical hole in the abdominal wall that can minimize damage to the internal organs when the surgical hole is drilled, and a puncher used in this method.

[0007]

The method for providing a surgical hole in the abdominal wall of the present invention and the hole puncher used in this method have the following constitution in order to achieve the above-mentioned object. The method of providing a surgical hole in the abdominal wall is to punch a plurality of surgical holes in the abdominal wall in the following steps.

(A) A step of piercing the anterior surgical hole 2 through the abdominal wall 1. (B) A hole puncher in which a drilling rod 5 is inserted into the guide pipe 4 from the outside of the body to the inside of the abdominal cavity 3 is provided in the preceding surgical hole 2 so that the tip of the drilling rod 5 does not project from the tip of the guide pipe 4. Inserting process. (C) With the tip of the piercing rod 5 in a non-projecting state from the tip of the guide pipe 4, the guide pipe 4 having the tip inserted into the abdominal cavity 3 is further inserted into the abdominal cavity 3, and the guide pipe 4
Of moving the tip of the inside of the abdominal cavity 3 of the abdominal wall 1 to be perforated. (D) A step of projecting the tip of the piercing rod 5 from the tip of the guide pipe 4 to penetrate the abdominal wall 1 from inside the abdominal cavity 3 to outside the abdominal cavity 3 with the piercing rod 5.

Further, the perforator for providing a plurality of surgical holes in the abdominal cavity is an improvement on the conventional trocar in which the perforating rod 5 is inserted into and out of the guide pipe 4 freely.
The perforator lengthens the entire length of the guide pipe 4 and the perforating rod 5 inserted into the guide pipe 4 so as to extend through the abdominal cavity 3 from the preceding surgical hole 2 to the surgical hole to be drilled next. . Further, the guide pipe 4 and the preceding surgery hole 2 are curved or have flexibility so that they can be curved when used. Contrary to the conventional trocar, this hole puncher is configured to penetrate the abdominal wall 1 from the inside of the abdominal cavity 3 to the outside of the abdominal cavity 3 to make a surgical hole while the piercing rod 5 is projected from the guide pipe 4. ing.

[0010]

The method of providing a surgical hole in the abdominal wall of the present invention and the hole puncher used in this method punches a surgical hole in the abdominal wall as follows. (1) Since the first surgical hole cannot be drilled from the inside of the abdominal cavity 3 to the outside of the abdominal cavity 3, a part of the abdominal wall 1 is incised from outside the body to open the preceding surgical hole 2. The preceding surgical hole 2 is, for example, incised and drilled around the vicinity of the umbilicus. (2) Lift up the abdominal wall 1 and open the abdominal cavity 3. (3) With the piercing rod 5 inserted into the guide pipe 4, as shown in FIG. 1, the tip of the guide pipe 4 is inserted into the preceding surgical hole 2. In this state, the guide pipe 4 is inserted into the abdominal cavity 3 from outside the body. (4) As shown in FIG. 2, the curved guide pipe 4 is further inserted into the abdominal cavity 3, and the distal end of the guide pipe 4 is moved to the inner surface of the abdominal wall 1 where a surgical hole is formed, and the abdominal wall is lightly pushed up to make the surgical hole. Check the position. At this time, the tip is inserted into the guide pipe 4 so that the perforation rod 5 does not damage the abdominal cavity 3. (5) As shown in FIGS. 3 to 4, the tip of the piercing rod 5 is projected from the guide pipe 4, and the abdominal wall 1 is cut with the cutting blade.
Is punctured from inside the abdominal cavity 3 to the outside of the body to make a surgical hole. At this time, the outside of the abdominal wall at the abdominal wall position where the surgical hole is punctured can be shallowly incised with a scalpel.

Through the above steps, a surgical hole is opened in the abdominal wall 1.
A hard insertion pipe is inserted in the surgical hole so as not to damage the abdominal wall 1 when the surgical instrument is inserted into the abdominal cavity 3 from here. The insertion pipe is made by molding a hard plastic into a cylindrical shape having a flange on the outside. The insertion pipe is inserted into the guide pipe 4 with the perforation rod 5 penetrating the abdominal wall 1.
Is drawn into the body and inserted outside the perforating rod 5.
After the insertion pipe is passed through the abdominal wall 1, the perforating rod 5 is pulled into the guide pipe 4, and the guide pipe 4 and the perforating rod 5 are pulled out of the body through the preceding surgical hole 2.

[0012]

Embodiments of the present invention will be described below with reference to the drawings. However, the examples described below exemplify a method and a perforator for embodying the technical idea of the present invention, and the present invention relates to a method for boring a surgical hole and a structure of the perforator. Are not specified below.

Further, in this specification, for easy understanding of the claims, the numbers corresponding to the members shown in the embodiments are referred to as "claims column", "action column", and "action column". It is added to the members shown in the section of "Means for Solving the Problems". However, the members shown in the claims are
It is by no means specific to the members of the examples.

The hole puncher shown in the overall view of FIG. 5 and the enlarged cross-sectional view of the essential portion of FIG. 6 includes a guide pipe 4, a perforating rod 5 inserted into and out of the guide pipe 4, and a perforating rod. And a member 6 for moving the guide pipe 5 in and out of the guide pipe 4.

The guide pipe 4 and the piercing rod 5 are inserted into the preceding operative hole 2 as shown in FIGS. 1 to 3, and the distal end of the piercing rod 5 pierces the next operating hole. Therefore, the guide pipe 4 and the piercing rod 5 have a total length that passes through the abdominal cavity 3 and extends from the preceding surgical hole 2 to the surgical hole to be drilled next. The total length of the guide pipe 4 and the drilling rod 5 is, for example, 20 to 50 cm, preferably 20 to 4
It is determined to be 0 cm, more preferably 25 to 35 cm.

Further, the guide pipe 4 and the perforating rod 5 are gently curved so as to pass through the abdominal cavity 3 and penetrate the abdominal wall 1 from the inside of the body to the outside of the body. The guide pipe 4 and the piercing rod 5 can be curved when they are manufactured as shown in FIG. 5, but they can also be curved when they are used. The guide pipe 4 and the piercing rod 5 that are bent when used are flexible enough to be bent manually. As the flexible guide pipe 4, a pipe made of hard plastic is used. The flexible piercing rod 5
Use a metal rod that can be bent by hand, such as soft aluminum, copper, or Shinchu. As shown in FIG. 7, the flexible metal rod can be connected to a cutting edge 5A made of, for example, a hard metal at its tip. The hard metal cutting blade 5A may be made of stainless steel, steel, iron or the like. The inflexible piercing rod 5 is made of a metal that cannot be bent by hand, such as iron or stainless steel. The hard plastic guide pipe 4 is most suitable for disposable products. Further, as shown in FIG. 7, the cutting blade 5A is detachably connected to the tip of the piercing rod, and the guide pipe 4 having a different thickness is detachably connected to the tip of the guide pipe 4. The thickness of the guide pipe 4 can be changed to puncture surgical holes having different sizes.

The puncher having a flexible guide pipe 4 and punching rod 5 is designed according to the size of the patient and the punching position.
The radius of curvature for bending the guide pipe 4 and the piercing rod 5 can be adjusted. Therefore, as the optimum radius of curvature of the patient,
It has the feature of being able to drill surgical holes.

The piercing rod 5 has a cutting blade at its tip. The piercing rod 5 made of hard metal is sharply polished at its tip to form a cutting blade. The incision blade has a pyramidal shape and sharply sharpens the corners so that the abdominal wall 1 can be incised and penetrated from the body to the outside of the body. The flexible piercing rod 5 makes an incision blade out of high metal and connects it to the tip. The diameter of the cutting blade at the tip of the drilling rod 5 and the inner diameter of the guide pipe 4 are adjusted according to the size of the surgical hole to be drilled. The guide pipe 4 is a pipe slightly thicker than the piercing rod 5 so that the piercing rod 5 can be inserted and slid.
It is 5 mm, 10 mm, 11 mm, 12 mm, and 15 mm.

The loading / unloading member 6 moves the guide pipe 4 and the drilling rod 5 relative to each other so that the tip of the drilling rod 5 projects from the guide pipe 4 and the tip of the drilling rod 5 is inserted into the guide pipe 4. The entrance / exit member 6 shown in FIGS. 6 and 8.
Is inserted into the piercing rod 5, and a handle 7 fixing the rear end of the piercing rod 5, a slide member 9 connected to the handle 7 via a stopper pin 8 so as to be movable in the axial direction. And a coil spring 21 that elastically pushes out the guide pipe 4.

The handle 7 can be grasped by hand,
It has a plate shape with a width of 3 to 7 cm and a length of 4 to 15 cm, and a female screw hole into which the stopper pin 8 is screwed is provided at the tip. The slide member 9 has a slit 9A for sliding the stopper pin 8 and a connecting portion 9B of the guide pipe 4 at the tip. The connecting portion 9B has a cylindrical shape in which the perforating rod 5 can be slidably inserted, and the tip thereof is tapered. In order to clamp the guide pipe 4 in the tapered portion, a male screw is provided on the outer periphery, and the tightening nut 10 is screwed into this male screw to clamp the guide pipe 4. The tightening nut 10 has an inclined surface on the inner surface in order to press the guide pipe 4 against the tapered portion. The coil spring 21 inserted into the piercing rod 5 elastically presses the handle 7 and the connecting portion 9B, and when the stopper pin 8 is loosened, the tip of the guide pipe 4 is pushed out from the piercing rod 5.

The insertion / removal member 6 of this structure has a stopper pin 8
When is loosened, the slide member 9 can freely slide on the handle 7, and the coil spring 21 elastically presses the guide pipe 4. When the slide member 9 is slid, the guide pipe 4 moves in the axial direction. Therefore, the tip of the piercing rod 5 can be inserted into the guide pipe 4, and the tip of the piercing rod 5 can be projected from the guide pipe 4.

The hole puncher shown in FIG. 9 and FIG. 10 shows the loading / unloading member 6 which can be elastically pushed out by the coil spring 16. The loading / unloading member 6 shown in this figure includes an outer cylinder 11 to which the piercing rod 5 is connected, and a reciprocating member 12 axially moved along the outer cylinder 11.
The reciprocating member 12 is connected to the guide pipe 4.

The reciprocating member 12 shown in FIG.
A guide rod 13 penetrating through is fixed to the left side, a ratchet member 14 having a ratchet groove on the outer periphery is provided at the right end, and a connecting rod 15 is connected to the right end of the ratchet member 14. The connecting rod 15 is connected to the guide pipe 4. A coil spring 16 that is a push spring is built in between the ratchet member 14 and the outer cylinder 11. The coil spring 16 elastically presses the ratchet member 14 to push the reciprocating member 12 to the right in FIG.

The outer cylinder 11 is connected to a lever 17 which hooks the ratchet member 14 to stop it. The lever 17 has, at its tip, a claw that is locked in the ratchet groove of the ratchet member 14. The lever 17 has an intermediate portion connected to the outer peripheral surface of the outer cylinder 11 via a rotary shaft, and a claw at the tip of the lever 17 penetrates the outer cylinder 11 to project to the inner surface. The rear end of lever 17 is spring 1.
8 is pressed. The spring 18 elastically presses the claw at the tip of the lever 17 into the ratchet groove of the ratchet member 14.

The loading / unloading member 6 of this structure is the guide rod 1
By pulling the collar fixed to 3, the reciprocating member 12 is moved from the right end to the left end in FIG. The reciprocating member 12 moved to the left end is stopped at the left end by the ratchet groove of the ratchet member 14 having the claw at the tip of the lever 17 locked. In this state, the reciprocating member 12 draws in the guide pipe 4, and the tip of the piercing rod 5 projects from the guide pipe 4. When the rear end of the lever 17 is pushed in this state, the pawl releases the latched state of the ratchet member 14, and the reciprocating member 12 is pushed by the coil spring 16 and moves to the right end. In this state, the guide pipe 4 is pushed out, and the tip of the piercing rod 5 is drawn into the guide pipe 4.

FIG. 10 shows a guide pipe 4 and a piercing rod 5.
3 is a cross-sectional view of the tip portion of FIG. As shown in this figure, the outer cylinder 11 is connected to the piercing rod 5 via a connecting pipe 19. The piercing rod 5 has a cutting blade 5A fixed to the tip thereof. The tip of the connecting rod 15 of the reciprocating member 12 is connected to the guide pipe 4 via the connecting member 20. As shown in the sectional view of FIG. 11, the connecting member 20 has an arm 20A that penetrates the connecting pipe 19 in the radial direction, and connects the outside of the arm 20A to the guide pipe 4. The connecting pipe 19 is provided with slits extending in the axial direction at positions facing each other in order to penetrate the arm 20A of the connecting member 20. The connecting member 20 is centered on the connecting rod 1.
5 and the outer circumference of the arm 20A is connected to the guide pipe 4. In order to connect the tip of the arm 20A to the guide pipe 4, a cylinder (not shown) is attached to the tip of the arm 20A.
It is also possible to connect the guide pipe 4 by providing this cylinder and inserting this cylinder into the guide pipe 4.

When the connecting member 20 is moved to the right by the reciprocating member 12, the guide pipe 4 and the piercing rod 5 shown in FIG. 10 are pushed out and the tip of the piercing rod 5 is pushed inside the guide pipe 4. To insert. When the connecting member 20 is moved to the left, the guide pipe 4 is pulled in, and the tip of the piercing rod 5 projects from the guide pipe 4.

The hole puncher shown in FIGS. 9 and 10 is a lever 1
When 7 is pushed, the tip of the piercing rod 5 can be pulled into the inside of the guide pipe 4, so that it can be conveniently used. In the puncher shown in these figures, the connecting pipe 19 constitutes a part of the piercing rod 5, and the connecting rod 15 constitutes a part of the guide pipe 4. Therefore, by bending a part of the connecting pipe 19 and the connecting rod 15, the surgical hole can be drilled at a predetermined position of the abdominal wall 1 with the drilling rod 5. The perforator of this structure has a connection pipe 19
Since the sliding resistance between the guide rod 4 and the connecting rod 15 is small, the guide pipe 4 and the drilling rod 5 can be moved relatively lightly.

[0029]

INDUSTRIAL APPLICABILITY The method of forming an operation hole in the abdominal wall of the present invention and the hole puncher used in this method do not form an operation hole in the abdominal wall from outside the abdominal cavity to inside the abdominal cavity. With the tip of the piercing rod inserted in the guide pipe, insert the guide pipe into the anterior surgical hole, move the guide pipe into the abdominal cavity in this state, and place the tip of the guide pipe in the position to pierce the abdominal wall surgical hole. Then, the distal end of the piercing rod is projected from the guide pipe, and a surgical hole is formed in the abdominal wall.
Therefore, unlike the conventional trocar, the piercing rod that penetrates the abdominal cavity does not project the internal organs at the tip and damage them. This is because the tip of the piercing rod is inserted inside the guide pipe when the piercing rod may damage the abdominal cavity. Therefore, the method of providing a surgical hole in the abdominal wall of the present invention and the hole puncher used for the method have an excellent feature that the surgical hole can be incised very safely.

[Brief description of drawings]

FIG. 1 is a sectional view showing a state in which a surgical hole is made in an abdominal wall with a hole puncher.

FIG. 2 is a cross-sectional view showing a state in which a surgical hole is made in the abdominal wall with a hole puncher.

FIG. 3 is a cross-sectional view showing a state in which a surgical hole is made in the abdominal wall with a hole puncher.

FIG. 4 is a cross-sectional view showing a state in which a surgical hole is made in the abdominal wall with a hole puncher.

FIG. 5 is a side view showing the entire punching device according to the embodiment of the present invention.

FIG. 6 is an enlarged cross-sectional view of the essential parts of the punch shown in FIG.

FIG. 7 is an enlarged cross-sectional view of the tip portion of the punch shown in FIG.

FIG. 8 is a plan view showing a portion of an inlet / outlet member of the hole puncher shown in FIG.

FIG. 9 is a cross-sectional view showing a portion of an inlet / outlet member of a hole puncher according to another embodiment of the present invention.

FIG. 10 is a cross-sectional view showing a guide pipe and a piercing rod connected to the tip of the punch shown in FIG.

11 is a cross-sectional view taken along the line AA of FIG.

[Explanation of symbols]

1 …… Abdominal wall 2 …… Preceding surgery hole 3 …… Abdominal cavity 4 …… Guide pipe 5 …… Punching rod 5A …… Incision blade 6 …… Incoming / outgoing member 7 …… Handle 8 …… Stopper pin 9 …… Sliding member 9A… …slit
9B ... Connection part 10 ... Tightening nut 11 ... Outer cylinder 12 ... Reciprocating member 13 ... Guide rod 14 ... Ratchet member 15 ... Connecting rod 16 ... Coil spring 17 ... Lever 18 ... Spring 19 ... Connection pipe 20 ... Connection member 20A ... Arm 21 ... Coil spring

Claims (2)

[Claims] 1. A method for forming a plurality of surgical holes through the abdominal wall (1), which comprises the step of forming a surgical hole in the abdominal cavity (3) in the following steps. (A) A step of piercing the anterior surgical site (2) through the abdominal wall (1). (B) Into this preceding surgical hole (2), from the outside of the body toward the inside of the abdominal cavity (3), insert a hole punching device in which the drilling rod (5) is inserted into the guide pipe (4), and insert the tip of the drilling rod (5). A step of inserting the guide pipe (4) in a non-projecting state from the tip. (C) The tip of the piercing rod (5) is not projected from the tip of the guide pipe (4), and the guide pipe (4) having the tip inserted into the abdominal cavity (3) is further inserted into the abdominal cavity (3). , The tip of the guide pipe (4), the abdominal cavity (3) of the abdominal wall (1) to be perforated
The process of moving inside. (D) The tip of the piercing rod (5) is projected from the tip of the guide pipe (4), and the abdominal wall (1) is abdominal cavity with the piercing rod (5).
(3) A step of penetrating from the inside to the outside of the abdominal cavity (3). 2. An abdominal wall punching device in which a drilling rod (5) is inserted into and out of a guide pipe (4), wherein the guide pipe (4) and the drilling rod (5) inserted therein are Whether the guide pipe (4) and the preceding surgery hole (2) are curved while having a total length that passes through the abdominal cavity (3) and extends from the preceding surgery hole (2) to the surgery hole to be drilled next, Alternatively, it is flexible so that it can be bent, and the perforation rod (5) is configured to project from the guide pipe (4) and penetrate the abdominal wall (1) from inside to outside the body to form a surgical hole. A perforator for making a surgical hole in the abdominal cavity.