JPH0919440A - Cavity forming tool - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a cavity forming tool which can be inserted in the body by a small force, and which can form a cavity without damaging the tissues above and below the cavity. SOLUTION: A cavity forming tool 1 is composed of a control wire 3 having a predetermined length, and a planer body 2 adapted to be inserted in the body when the control rode 3 is manipulated, so as to separate tissues in the body from each other so as to form a cavity. At least one of opposite end parts of the body 2 which are laid along the longitudinal direction of the control rod 3, is tapered.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a cavity forming tool used for forming a cavity in a body part having no cavity, particularly in a subcutaneous tissue.

[0002]

2. Description of the Related Art In order to perform endoscopic observation of the inside of a subcutaneous tissue or the like where there is no space in the living body, or to perform a treatment operation inside such a site, a part of the tissue is removed to remove the cavity. It is necessary to forcibly form a space in a part of the body that does not exist.

Examples of treatment tools used in such a cavity forming operation include US Pat. No. 4,449,532 and US Pat.
Dilator (cavity creator) disclosed in No. 4,862,891
There is.

This dilator is an expandable and contractible tubular type and is constructed by concentrically arranging a plurality of pipes having different diameters. Then, by gradually feeding the pipe from a pipe with a small diameter to a pipe with a large diameter in an antenna manner, the detached state of the tissues is gradually expanded to form a cavity of a predetermined size in the body. It goes.

[0005]

By the way, when performing vascular bypass surgery in the heart, it is practiced to collect and utilize the saphenous vein existing under the thigh as a bypass tube. When collecting the saphenous vein, it is first necessary to perform an operation of separating the saphenous vein from other tissues. The upper tissue of the saphenous vein has a structure in which a connective tissue covering the saphenous vein and fat and skin are sequentially laminated on the upper side thereof,
Especially when performing saphenous vein collection surgery endoscopically,
Greatly separates the saphenous vein from other tissues including connective tissue,
It is necessary to create a working space between the saphenous vein and the connective tissue to collect the saphenous vein.

[0006] The important thing in such saphenous vein collection is that
It is to collect without damaging the saphenous vein.
However, the above-mentioned antenna-type dilator sends out a pipe with a circular cross-section in a stepwise manner, so when used for saphenous vein sampling, the saphenous vein is pressed vertically. May cause damage.

Since the skin is less extensible than fat,
If an attempt is made to form a cavity in the subcutaneous tissue using this antenna type dilator, a tensile force is applied to the skin and the amount of dilator insertion force increases.

The present invention has been made in view of the above circumstances, and an object of the present invention is to form a cavity without damaging the tissues located in the vertical direction, which can be inserted into the body with a light force. The object is to provide a cavity creating tool that can be used.

[0009]

In order to solve the above problems, the cavity forming tool of the present invention is provided with an operating rod having a predetermined length and at least one end of the operating rod. The body comprises a substantially flat main body that separates tissues in the body to form a cavity by being inserted into the body, and the main body has at least one of both ends thereof along the longitudinal direction of the operating rod. It is tapered in a taper shape.

[0010]

Embodiments of the present invention will be described below with reference to the drawings. 1 to 10 show a first embodiment of the present invention. The cavity creating tool 1 of the present embodiment includes a shaft (operation rod) 3 and a main body 2 provided at the tip of the shaft 3.

The shaft 3 is made of SUS, resin or the like, and has a threaded portion 5 at its base end. The main body 2 is formed as a flat member that spreads with a predetermined width, and is formed by, for example, molding of resin or the like or SUS. Further, the main body 2 is such that both end portions thereof along the longitudinal direction of the shaft 3 are tapered in a taper shape, and are formed in a rhombus shape as a whole. That is,
The main body 2 is provided at one end of the shaft 3 so that the long axis of the rhombus coincides with the long axis of the shaft 3. The peripheral portion of the main body 2 is formed into a smooth surface (a circular arc surface) with R.

A projection 6 is provided on one surface of the main body 2 along the longitudinal direction thereof. In addition, at the tapered end of the main body 2 located on the opposite side of the shaft 3, the shaft 3
Is formed with a screw hole 4 that can be screwed into the screw portion 5. 3A and 3B show how the screw hole 4 and the screw portion 5 of the shaft 3 are screwed together. As shown in the drawing, by screwing the threaded portion 5 of the shaft 3 of the one cavity creating tool 1a into the screw hole 4 of the main body 2 of the other cavity creating tool 1b, the two cavity creating tools 1a and 1b are longitudinally moved. Can be connected.

The body 2 has a thickness of about 2 to 10 mm, and the rhombus minor axis (width) of the body 2 is set to 5 to 100 mm. Further, as shown in FIG. 2, the cross section of the main body 2 has an elliptical (oval) shape (see FIG. 2A) or a rhombus shape (see FIG. 2B).

Next, a case of performing saphenous vein sampling operation using the cavity forming tool 1 having the above-described configuration will be described. This surgical procedure is performed, for example, to collect and utilize a saphenous vein existing under the thigh as a bypass tube required when performing a blood vessel bypass operation on the heart. In this operation method, it is important to form and collect a cavity in the subcutaneous tissue so as not to damage the saphenous vein. Therefore, the cavity creating tool 1 of this embodiment is indispensable.

First, as shown in FIG. 4, along the running of the saphenous vein 9 to be sampled, incisions are made at a plurality of points on the thigh 8 to form skin incisions, and peeling forceps or the like is formed at each skin incision. To expose the saphenous vein 9. The number of skin cuts is determined from the length of the saphenous vein 9 to be collected, the length of the cavity creating tool 1, and the like. In the figure, for the sake of simplicity, two skin cutting portions 10 and 11 are shown.

Next, as shown in FIG. 5, the peeler 12 is inserted into the subcutaneous tissue from the skin cut portion 10 toward the skin cut portion 11. As shown in the figure, the tissue existing above the saphenous vein 9 has a structure in which the skin 15, the fat 16 and the connective fabric 17 are sequentially laminated, and the tissue between the saphenous vein 9 and the connective fabric 17 is formed. The dissector 12 is inserted into and the saphenous vein 9 and the connective fabric 17 are separated by the tip of the dissector 12. This peeling work is performed while always checking the peeling condition by the endoscope 13 inserted in the peeler 12. At least the tip of the detacher 12 is made of a transparent material so that the saphenous vein 9 can be clearly observed by the endoscope 13.

After the saphenous vein 9 from the skin cut portion 10 to the skin cut portion 11 and the connecting cloth 17 are completely peeled off, as shown in FIG. 6, the peeling space between the saphenous vein 9 and the connecting cloth 17 is removed. The subcutaneous tissue protector 22 is left inside the saphenous vein 9 to protect the saphenous vein 9 from the next cavity creating operation.

In the cavity creating work, as shown in FIG. 10, a plurality of types of cavity creating tools 1 (1a, 1b ...) In which the width of the main body 2 (the short axis length of the rhombus) is different are prepared in advance. Preferably, these cavity creating tools 1 (1a, 1b ...)
Prepare different widths of (2a, 2b ...) In increments of 5 mm (in the range of 5 to 100 mm).

As described above, a plurality of types of cavity forming tools 1 (1a,
1b ...) to form a cavity of a desired size between the saphenous vein 9 and the connective tissue 17, first, the guide rod 23 is cut along the subcutaneous tissue protector 22 from the skin cut portion 10 to the skin. Cut 11
Through. Next, the threaded portion of the proximal end portion of the guide rod 23 is screwed into the screw hole 4 of the cavity forming tool 1a having a relatively small width of the main body 2 to connect the guide rod 23 and the cavity preparing tool 1a. Then, pull out the guide rod 23 from the skin cutting portion 11 to the outside,
The cavity creating tool 1a is drawn into the separation space between the saphenous vein 9 and the connective tissue 17. At this time, as shown in FIG.
A is pulled in while the projection 6 formed along the longitudinal direction on the lower surface thereof is guided by the guide groove 22a formed on the upper surface of the subcutaneous tissue protective device 22. As a result, the state in which the saphenous vein 9 and the connective fabric 17 are peeled off causes the body 2 of the cavity creating tool 1a to
A cavity 20 having a predetermined size is formed by being expanded by a. In this case, the cavity creating tool 1a includes the saphenous vein 9 and the connective fabric 17.
The saphenous vein 9 is separated from the saphenous vein 9 in the horizontal direction, not in the vertical direction, so that the saphenous vein 9 is not pressed and damaged. In addition, the outer peripheral surface on the distal end side of the guide rod 23 is formed with a finger-holding unevenness 23a so that the operation of gripping and pulling the distal end side of the guide rod 23 can be easily performed without slipping.

Further, in such a cavity creating operation, the cavity 20 is formed while separating the saphenous vein 9 and the connective tissue 17, and in the process, the cavity creating tool 1a is guided by the guide rod 23. It is pulled or pushed back.
This is because the peeling is performed smoothly and satisfactorily. Therefore, when the guide rod 23 is pulled, the pulling insertion operation of the main body 2 is smoothly performed by the tapered end portion on the insertion direction side, and when the guide rod 23 is pushed back, the main body 2 is pushed.
The pushing back operation is smoothly performed by the tapered end of the shaft connecting side. Of course, instead of introducing the cavity creating tool 1a into the body by guiding with the guide rod 23, the cavity creating tool 1a may be introduced into the body by directly grasping the shaft 3 and pushing or pulling the shaft 3. .

Further, when the peeled state is further enlarged from the state of FIG. 7 to form the cavity 20 large, the cavity creating tool 1a
The cavity creating tool 1b having the main body 2b having a width larger than that of the main body 2a is connected to the cavity creating tool 1a. As described above, this connection is made by screwing the screw portion 5 of the shaft 3a of the cavity forming tool 1a and the screw hole 4 of the main body 2b of the cavity forming tool 1b.

When the cavity-creating tool 1a and the cavity-creating tool 1b are connected, the body 2a of the cavity-creating tool 1a protruding from the skin cut portion 11
Is grasped by hand and the cavity creating tool 1a is pulled out from the skin cut portion 11 to the outside. By this operation, the separated state of the saphenous vein 9 and the connective tissue 17 is expanded by the main body 2b of the cavity creating tool 1b,
A larger cavity 20 is formed (see Figure 8).

In this way, a plurality of cavity forming tools 1 having different widths of the main body 2 are formed until the cavity 20 having a desired size is formed.
The separated state between the saphenous vein 9 and the connective tissue 17 is gradually expanded by a, 1b, and a cavity 20 having a sufficient width for performing a treatment operation is formed on the upper side of the saphenous vein 9.

After the cavity 20 having a desired size is formed on the upper side of the saphenous vein 9 as described above, the subcutaneous tissue protector 1 is pulled out from the subcutaneous tissue with the cavity secured by a cavity securing device (not shown). Subsequently, the saphenous vein 9 is excised in the space in which the cavity is secured, and the saphenous vein 9 is collected from the skin incision.

As described above, since the body 2 of the cavity forming tool 1 of this embodiment has a flat shape, it is not in the vertical direction with respect to the saphenous vein 9, which is the subcutaneous tissue to be protected. The cavity can be formed by peeling in the lateral direction. That is, the tissue located vertically (saphenous vein 9)
The cavity can be formed without damaging the. Further, the pulling force acting on the skin is smaller than that in the case of peeling in the vertical direction, and the amount of insertion force of the cavity creating tool 1 can be light.

Further, the cavity-creating tool 1 is easy to insert into the subcutaneous tissue because both ends of the main body 2 are tapered. Furthermore, since the cavity creating tool 1 has the screw portions 4 and 5 which are connection means that can be connected to another cavity creating tool or a treatment tool, the main body 2 is pulled by the connecting cavity creating tool or the treatment tool. By doing so, it becomes easy to insert the main body 2 into the subcutaneous tissue.

In this embodiment, the main body 2 is provided at one end of the shaft 3, but the main body 2 may be provided at both ends of the shaft 3. In this case, both ends of the body 2 at both ends of the shaft 3 may be tapered as in the present embodiment, or only one end thereof may be tapered. When the main body 2 having only one end formed in a tapered shape is provided at both ends of the shaft 3, it is desirable that the two main bodies 2 are tapered in opposite directions.

Further, in this embodiment, the projection 6 is provided in the longitudinal direction of the main body 2, and the projection 6 is engaged with the guide groove 22a formed on the upper surface of the subcutaneous tissue protector 22. Conversely, a protrusion may be provided on the upper surface of the tissue protector 22 and a groove that engages with the protrusion may be formed in the main body 2.

11 and 12 show a second embodiment of the present invention. As shown in FIG. 12, in the cavity creating tool 1'of the embodiment, the shaft 3 can be elastically deformed. The other configuration is the same as that of the first embodiment.

According to this structure, as shown in FIG. 11, when the cavity forming tool 1'is introduced into the subcutaneous tissue from the skin-cutting portion 10, the shaft 3 is curved along the cross section of the skin tissue. Therefore, the body 2 can be smoothly inserted without pressing the skin tissue near the skin cut portion 10 with the shaft 3.

FIG. 13 shows a third embodiment of the present invention. In the cavity creating tool 40 of this embodiment, the main body 42 has a substantially oval shape. The other configuration is the same as that of the first embodiment.

FIG. 14 shows a fourth embodiment of the present invention. In the cavity creating tool 70 of the present embodiment, the shaft 3 and the main body 2 are detachable by, for example, screws. The other configuration is the same as that of the first embodiment.

FIG. 14A shows a state in which the shaft 3 and the main body 2 are connected, and FIG. 14B shows a state in which the shaft 3 and the main body 2 are separated. With such a configuration, the bodies 2 of various sizes can be exchangeably connected to the common shaft 3, so that the number of parts can be reduced and the usability is improved. Further, the shaft 3 having an appropriate length can be attached according to the distance between the skin cuts, and the operability is good.

FIG. 15 shows a fifth embodiment of the present invention. The cavity creating tool 80 of the present embodiment has holes 30, 32 through which the guide rod 23 can be inserted into the main body 2 and the shaft 3, respectively.
have. The other configuration is the same as that of the first embodiment.

According to this structure, the cavity creating tool 80 can be introduced into the body using the guide rod 23 as a guide. FIG. 16 shows a sixth embodiment of the present invention. The cavity creating tool 50 of the present embodiment is configured by providing a substantially triangular main body 52 at one end of the shaft 3. A protrusion 53 is provided on one surface of the main body 52 along the longitudinal direction thereof. The projection 53 can be engaged with the guide groove 22a (see FIG. 9) of the subcutaneous tissue protector 22 used in the above-described saphenous vein sampling operation, for example.

As shown, the cavity creating tool 50 includes a body 52.
The apex of the triangle and one end of the shaft 3 are connected. Therefore, when the cavity creating tool 50 is introduced into a subcutaneous tissue to form a cavity, for example, the cavity creating tool 5
0 is introduced into the subcutaneous tissue from the shaft 3 side,
It suffices to pull the shaft 3 in the direction of the arrow in the figure and direct the tip of the tapered portion of the main body 52 in the insertion direction. This allows the body 52 to be smoothly introduced into the subcutaneous tissue.

On the other hand, the cavity creating tool 60 shown in FIG.
One side of the triangle of the main body 52 and one end of the shaft 3 are connected. Therefore, when the cavity creating tool 60 is introduced into, for example, subcutaneous tissue to form a cavity, the cavity creating tool 60 is introduced into the subcutaneous tissue from the main body 52 side, and
It suffices to push the shaft 3 in the direction of the arrow in the figure and direct the tip of the tapered portion of the main body 52 in the insertion direction. This allows the body 52 to be smoothly introduced into the subcutaneous tissue.

By the way, according to the embodiment described above, the following configuration can be obtained. 1. An operating rod having a predetermined length, and a substantially flat body which is provided at least at one end of the operating rod and which is inserted into the body by operating the operating rod to separate tissues in the body to form a cavity. The main body has at least one of both ends thereof along the longitudinal direction of the operating rod,
A cavity creating tool characterized by being tapered in a taper shape.

2. The cavity creating tool according to item 1, wherein the main body is tapered in the insertion direction. 3. The cavity preparation tool according to item 1, wherein the main body has a width that can be selected within a range of 5 mm to 100 mm.

4. The cavity creating tool according to claim 1, wherein the main body is provided with guide portions (projections, grooves) along the longitudinal direction thereof. 5. The cavity creating tool according to claim 1, wherein R is attached to both ends of a cross section perpendicular to the longitudinal axis direction of the main body.

6. The cavity creating tool according to claim 1, wherein the operation rod and the main body are provided with through holes penetrating them along the longitudinal axis direction. 7. The cavity creating tool according to item 1, wherein the operating rod is detachable from the main body.

8. 2. The cavity creating tool according to claim 1, wherein the tapered end portion of the main body located on the side opposite to the operation rod is provided with a connecting means that can be detachably connected to another member. 9. A first feature that the operating rod has flexibility
The cavity preparation tool according to item. 10. First, the operating rod has elasticity
The cavity preparation tool according to item.

[0043]

As described above, since the main body of the cavity forming tool of the present invention has a flat shape, it can be separated from the tissue in the lateral direction rather than in the vertical direction to form the cavity. it can. That is, the cavity can be formed without damaging the tissues located in the vertical direction. Further, since the tensile force acting on the skin is smaller than that in the case of peeling in the vertical direction, the amount of insertion force of the cavity creating tool can be light.
Further, the main cavity creating tool is easy to insert into the body because the end portion of the main body is tapered.

[Brief description of the drawings]

FIG. 1 is a perspective view of a cavity creating tool according to a first embodiment of the present invention.

2 is a front view of the cavity creating tool of FIG. 1. FIG.

FIG. 3A is a plan view showing a connection state of the cavity-creating tools, and FIG. 3B is an enlarged view of a dotted line portion of FIG.

FIG. 4 is a plan view showing a state in which a skin cut is provided on a thigh.

FIG. 5 is a cross-sectional view showing a state in which a subcutaneous tissue protector is inserted into subcutaneous tissue.

FIG. 6 is a plan view showing a state in which the cavity creating tool is inserted between the skin incisions where the subcutaneous tissue protecting tool is placed.

FIG. 7 is a plan view showing how a cavity is formed by the cavity creating tool.

FIG. 8 is a plan view showing how a cavity is formed by the cavity creating tool.

FIG. 9 is a cross-sectional view of the subcutaneous tissue in which the subcutaneous tissue protector and the cavity creating tool are inserted.

FIG. 10 is a plan view showing various cavity-creating tools having different main body widths.

FIG. 11 is a cross-sectional view showing a state in which the cavity creating tool according to the second embodiment of the present invention is inserted between skin cut portions in which a subcutaneous tissue protector is placed.

FIG. 12 is a plan view of a cavity creating tool according to a second embodiment of the present invention.

FIG. 13 is a plan view of a cavity creating tool according to a third embodiment of the present invention.

FIG. 14 is a plan view of a cavity creating tool according to a fourth embodiment of the present invention.

FIG. 15 is a sectional view of a cavity creating tool according to a fifth embodiment of the present invention.

FIG. 16 is a perspective view of a cavity creating tool according to a sixth embodiment of the present invention.

FIG. 17 is a perspective view of a cavity creating tool according to a modified example of the sixth embodiment.

[Explanation of symbols]

1, 1 ', 40, 50, 60, 70, 80 ... cavity preparation tool,
2, 42, 52 ... Main body, 3 ... Shaft (operating rod).

Claims (1)

[Claims] 1. An operating rod having a predetermined length, and an operating rod which is provided at least at one end of the operating rod and which is inserted into the body by operating the operating rod to separate tissues in the body to form a cavity. A cavity forming tool comprising: a flat-shaped main body, wherein at least one of both ends of the main body along the longitudinal direction of the operation rod is tapered.