JPWO2010050243A1 - Surgical device - Google Patents

Abstract

The surgical device includes a device main body 3 having a conduit 3 for guiding a surgical instrument such as forceps to a body cavity, and an inner needle 4 inserted into the conduit 2. 2 is inserted into the body cavity. The apparatus main body 3 is provided with a bending mechanism 17 for bending the conduit 2. By bending the conduit 2 with the bending mechanism 17 in a state where the conduit 2 is inserted into the body cavity, the surgical instrument inserted into the conduit 2 can be directed in various directions within the body cavity.

Description

  The present invention relates to a surgical apparatus used for introducing a surgical instrument into an abdominal cavity or a chest cavity, for example, during a laparoscopic surgery or a thoracoscopic surgery.

  Conventionally, laparoscopic surgery and thoracoscopic surgery have been performed in place of open surgery with extensive skin incision during intra-abdominal and thoracic surgery. In laparoscopic surgery and thoracoscopic surgery, for example, an instrument called a trocar as disclosed in Patent Documents 1 and 2 is used. The trocar is composed of a straight pipe-shaped conduit and an inner needle inserted into the conduit. When using this trocar, first make a small incision of about 5 mm to 20 mm in the skin, and with the inner needle inserted into the conduit, press the inner needle against the small incision part of the skin to bring the inner needle and conduit together. The body surface side tissue is penetrated and inserted into the body cavity. Thereafter, the inner needle is removed from the conduit, and surgical instruments such as a laparoscope, thoracoscope, forceps, electric scalpel, and suture device are inserted into the conduit to be introduced into the body cavity to perform a surgical procedure.

JP-A-8-168465 JP 2006-87609 A

  By the way, laparoscopic surgery and thoracoscopic surgery are minimally invasive because they do not require extensive skin incision as described above, and there is a demand to increase the number of applicable cases as much as possible. On the other hand, when the trocars of Patent Documents 1 and 2 are used, it is difficult to increase the number of applicable cases because the surgical instrument can only be introduced into the body cavity by a straight pipe-shaped conduit.

  The present invention has been made in view of such a point, and an object thereof is to increase the number of applicable cases of laparoscopic surgery and thoracoscopic surgery.

In order to achieve the above object, according to a first aspect of the present invention, a main body having a conduit for guiding a surgical instrument to a body cavity and an inner needle inserted into the conduit are provided, and the inner needle is punctured into a body surface side tissue. A surgical device configured to penetrate the body surface tissue through the body surface and into the body cavity,
The main body is provided with a bending mechanism for bending the conduit.

  According to this configuration, the bending mechanism can be bent while the conduit is inserted into the body cavity. This allows the surgical instrument inserted into the conduit to be directed in various directions within the body cavity.

  According to a second aspect, in the first aspect, the main body is provided with a rotation mechanism for attaching the proximal end side of the conduit and rotating the conduit about an axis on the proximal end side.

  According to this configuration, the conduit can be rotated around the proximal axis while being bent by the bending mechanism. As a result, even when the bending mechanism is simplified by setting the bending direction of the conduit to, for example, only one direction, the distal end side of the conduit can be directed in various directions.

According to a third aspect of the present invention, a main body having a conduit for guiding a surgical instrument to a body cavity and an inner needle inserted into the conduit are provided, and the inner needle is punctured into the body surface side tissue so that the conduit penetrates the body surface side tissue. A surgical device configured to be inserted into a body cavity,
It is set as the structure by which the illumination part is provided in the front end side of the said conduit | pipe.

  According to this configuration, in addition to the illumination of the laparoscope and the thoracoscope arranged in the body cavity, each part in the body cavity can be illuminated by the illumination unit in a state where the conduit is inserted into the body cavity. It is also possible to omit illumination of the laparoscope and thoracoscope.

  According to a fourth aspect, in the third aspect, the illumination unit has a plurality of light emitters, and the wavelengths of light emitted from the light emitters are different from each other.

  According to this configuration, when the wavelength of the light emitted from the light emitter is short, it is possible to observe a shallow part of the living tissue, and when the wavelength is long, the deep part of the living tissue is observed. Is possible.

According to a fifth aspect of the present invention, a main body having a conduit for guiding a surgical instrument to a body cavity and an inner needle inserted into the conduit are provided, and the inner needle is pierced into the body surface side tissue so as to penetrate the body surface side tissue. A surgical device configured to be inserted into a body cavity,
An imaging unit for imaging the inside of the body cavity is provided on the distal end side of the conduit.

  According to this configuration, the inside of the body cavity can be imaged by the imaging unit of the conduit separately from the laparoscope and the thoracoscope while the conduit is inserted into the body cavity.

In a sixth invention, in the fifth invention, an image processing unit that combines images captured by each imaging unit of the plurality of main body units and obtains a wide range image wider than the range captured by each imaging unit;
And a display unit that displays a wide range image obtained by the image processing unit.

  According to this configuration, since an image of a wide area in the body cavity is displayed on the display unit, the operator can observe the wide area in the body cavity at a time.

  According to the first invention, since the conduit inserted into the body cavity is curved, the surgical instrument inserted into the conduit can be guided in various directions within the body cavity by the conduit. As a result, the surgical instrument can reach a site that could not be reached by a conventional trocar, and therefore the number of cases applicable to laparoscopic surgery and thoracoscopic surgery can be increased.

  According to the second aspect of the invention, since the main body is provided with the rotation mechanism for rotating the conduit around the axis on the proximal end side, the bending mechanism can be simplified by reducing the direction in which the conduit bends. Also, the surgical instrument can be guided in various directions within the body cavity.

  According to the third invention, since the illumination part is provided on the distal end side of the conduit, each part in the body cavity can be illuminated separately from the illumination of the laparoscope and the thoracoscope, and each part in the body cavity can be clearly confirmed. Can do. As a result, detailed procedures can be performed, and therefore the number of applicable cases of laparoscopic surgery and thoracoscopic surgery can be increased.

  According to the fourth invention, the illumination part of the conduit has a plurality of light emitters, and the wavelengths of light emitted from these light emitters are different from each other. A site can be observed, and a deep site can be observed by irradiating a living tissue with only light having a long wavelength.

  According to the fifth invention, since the imaging unit is provided on the distal end side of the conduit, the inside of the body cavity can be imaged separately from the laparoscope and the thoracoscope. As a result, for example, an image obtained by viewing a living tissue from a direction different from that of a laparoscope or a thoracoscope can be obtained and used for a procedure. Can be increased.

  According to the sixth invention, the operator can observe a wide range in the body cavity at a time, and can perform a safe procedure while checking the periphery of the surgical site.

It is a side view of an apparatus main part and an inner needle concerning an embodiment. It is a figure which shows a surgery apparatus. It is a block diagram of an apparatus main body. It is the figure which looked at the conduit | pipe from the front end side. It is the VV sectional view taken on the line in FIG. It is an enlarged view of a display. It is sectional drawing of the flexible tube in a straight state. It is sectional drawing of the flexible tube in a curved state. It is a fragmentary sectional view of a grasping forceps. FIG. 10 is a view corresponding to FIG. 9 with the forceps piece open. It is a fragmentary sectional view of a bipolar forceps. FIG. 12 is a view corresponding to FIG. 11 with the forceps piece open. It is a fragmentary sectional view of the forceps for suture needles. FIG. 14 is a view corresponding to FIG. 13 in a state where the needle clamping piece is opened. It is a side view of a snare. It is a figure which shows the image obtained when an abdomen is image | photographed with the camera. FIG. 6 is a view corresponding to FIG. 1 according to a first modification of the embodiment. FIG. 3 is a diagram corresponding to FIG. FIG. 9 is a diagram corresponding to FIG. FIG. 9 is a view corresponding to FIG. 4 according to Modification 3. FIG. 9 is a view corresponding to FIG. 4 according to Modification 4. FIG. 10 is a side view of a conduit according to Modification 5 in which a retaining portion is in a contracted state. FIG. 22 is a view corresponding to FIG. 21 when the retaining portion of the conduit is in an enlarged state. It is a figure explaining the usage point of the conduit | pipe which concerns on the modification 5, and shows the case where the retaining part is in a contracted state. FIG. 24 is a view corresponding to FIG. 23 when the retaining portion of the conduit according to Modification 5 is in an enlarged state.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. It should be noted that the following description of the preferred embodiment is merely illustrative in nature, and is not intended to limit the present invention, its application, or its use.

  FIG. 2 shows a surgical apparatus 1 according to an embodiment of the present invention. The surgical apparatus 1 is used in laparoscopic surgery and thoracoscopic surgery, and includes an apparatus main body 3 having a conduit 2 for introducing various surgical instruments into body cavities (abdominal cavity and thoracic cavity), and a conduit 2. An image processing apparatus 6 for processing an image photographed by an inner needle 4 (shown in FIG. 1) inserted into the camera, a camera (photographing unit) 5 (shown in FIG. 4) provided in the apparatus main body 3, and an image A monitor (display unit) 7 that displays an image processed by the processing device 6 is provided. Examples of the surgical instrument to be introduced into the body cavity by the conduit 2 include, but are not limited to, a laparoscope, a thoracoscope, forceps, an electric knife, and a suture instrument.

  As shown in FIG. 1, the apparatus main body 3 has a body portion 10 to which the conduit 2 is attached. As will be described in detail later, the conduit 2 is bent by the operation of the first motor 32 and the second motor 34 (both shown in FIG. 3) built in the apparatus main body 3 and rotates around the axis on the proximal end side. It is like that. Further, the inner needle 4 extends straight. A tapered puncture portion 4a is formed at the distal end portion of the inner needle 4 so as to puncture the body surface side tissue of the patient. The inner needle 4 is configured such that the puncture portion 4 a protrudes from the distal end portion of the conduit 2 in a state where the inner needle 4 is completely inserted into the conduit 2. This puncture part 4a may be comprised with a resin material, and may be comprised with a metal material.

  The conduit 2 includes a flexible tube 14 (shown in FIGS. 7 and 8) configured to be bendable, a covering material 15 (shown in FIG. 5) covering the outer peripheral surface of the flexible tube 14, and the flexible tube 14 The camera 5 and the illuminating unit 16 (shown in FIG. 4) provided at the front end of the unit. The length of the conduit 2 is preferably set to 100 mm or more and 150 mm or less, but can be changed depending on the physique of the patient. The angle of view of the camera 5 is preferably about 50 ° to 80 °, and the number of pixels is preferably about 3 million to 5 million pixels, but is not limited to this range. The camera 5 is preferably a type that also supports infrared light. The camera 5 is preferably a scanning type using a charge-coupled device (CCD), but is not limited thereto.

  As shown in FIG. 7, a bending mechanism 17 configured to form a tubular shape is provided in a predetermined range on the distal end side of the flexible tube 14. The predetermined range on the proximal end side of the flexible tube 14 has a straight tube shape. This predetermined range is a range of 60 mm or more and 90 mm or less from the proximal end portion of the flexible tube 14 toward the distal end side.

  The bending mechanism 17 is configured by arranging a plurality of annular members 20, 20,... In the axial direction. Two projecting pieces 20a projecting in the axial direction of the flexible tube 14 are formed on the circumferential wall portion of each annular member 20 at a distance of about 180 ° in the circumferential direction. These protruding pieces 20a are connected to the peripheral wall portions of the adjacent annular members 20 by pins 21 extending in a direction penetrating the peripheral wall portions. The annular member 20 rotates around the center line of the pin 21. The peripheral wall portion of the annular member 20 has a tapered shape in which the dimension in the axial direction becomes shorter as the distance from the projecting piece 20a in the circumferential direction increases. As a result, a gap S is formed between the adjacent annular members 20, 20 that increases with distance from the protrusion 20 a in the circumferential direction. Thus, by forming the clearance S between the adjacent annular members 20, 20, each annular member 20 can be rotated with respect to the adjacent annular members 20.

  Further, the annular member 20 located at the proximal end portion of the flexible tube 14 in the bending mechanism 17 is rotatably connected to the main body portion 14a of the flexible tube 14 through the same pin 21 as described above. Further, the bending mechanism 17 is provided with a distal end tube portion 18 that constitutes the distal end side of the flexible tube 14. The tip tube portion 18 is provided with two projecting pieces 18 a as with the annular member 20, and these projecting pieces 18 a can be rotated by a pin 21 to the annular member 20 located at the tip portion of the bending mechanism 17. It is connected to.

  Inside the flexible tube 14, a first operation wire 24 and a second operation wire 25 are disposed extending from the distal end portion to the proximal end portion of the flexible tube 14 substantially in parallel with the axis. The first operation wire 24 and the second operation wire 25 are arranged 180 ° apart from each other in the circumferential direction of the flexible tube 14 and 90 ° apart from the projecting piece 20a of the annular member 20 in the circumferential direction. Proximal end portions of the first operation wire 24 and the second operation wire 25 are respectively connected to a first winding shaft and a second winding shaft (which will be described later) incorporated in the body portion 10.

  Hollow first and second wire guides 26 and 27 through which the first and second operation wires 24 and 25 are inserted are respectively disposed on the inner peripheral surface of each annular member 20. It is provided corresponding to. Similarly, first and second wire guides 26 and 27 are also provided on the inner peripheral surface of the main body portion 14 a of the flexible tube 14. Furthermore, the first and second wire fixing members 28 and 29 to which the tip portions of the first and second operation wires 24 and 25 are respectively fixed are provided on the inner peripheral surface of the tip tube portion 18. It is provided corresponding to the arrangement position.

  The covering material 15 is made of a resin material having flexibility, and is formed so as to be in close contact with the outer peripheral surface from the proximal end portion to the distal end portion of the flexible tube 14. The flexible tube 14 and the covering material 15 are integrated. The flexibility of the covering material 15 is set so as not to hinder the bending operation of the bending mechanism 17 of the flexible tube 14.

  As shown in FIG. 1, a tubular member 30 is provided at the distal end portion of the conduit 2. The outer diameter of the cylindrical member 30 is set to be substantially the same as the outer diameter of the flexible tube 14. The inner diameter of the cylindrical member 30 is set to be the same as the inner diameter of the flexible tube 14. The outer peripheral surface on the distal end side of the cylindrical member 30 is configured with a tapered surface 30a having a smaller diameter toward the distal end. As shown in FIG. 4, a red LED (light emitting diode) 16 a, a green LED 16 b, a blue LED 16 c, and an infrared light LED 16 d constituting the illumination unit 16 are embedded in the distal end side of the cylindrical member 30. The embedding holes 30b to 30e and the camera embedding hole 30f into which the camera 5 is embedded are formed at intervals in the circumferential direction. The first to fourth LED embedded holes 30b to 30e and the camera embedded hole 30f are opened in the tapered surface 30a.

  The red LED 16 a is embedded in the first LED embedded hole 30 b so that the light irradiation surface faces the tip of the cylindrical member 30. Similarly, the green LED 16b and the blue LED 16c are embedded in the second LED embedded hole 30c and the third LED embedded hole 30d. The infrared LED 16d is configured to emit infrared light, and is similarly embedded in the fourth LED embedded hole 30e. The camera 5 is embedded in the camera embedding hole 30 f with its lens surface facing the tip of the cylindrical member 30. Wirings 9 and 9 (shown in FIG. 5) extending from the LEDs 16 a to 16 d and the camera 5 extend from the proximal end portion of the flexible tube 14 to the inside of the body portion 10 through the flexible tube 14.

  As shown in FIG. 1, the body portion 10 of the apparatus body 3 is provided with an attachment portion 12 to which the proximal end portion of the conduit 2 is attached. The attachment portion 12 is provided with a ring member 12 a that is fixed to the proximal end portion of the conduit 2 and rotates integrally with the conduit 2 so as to be rotatable around an axis on the proximal end side of the conduit 2. The outer circumferential surface of the ring member 12a is provided with an uneven shape for preventing slipping. By rotating the ring member 12, as shown by an arrow in FIG. 1, the conduit 2 can be rotated around its proximal end axis. The ring member 12 and the attachment portion 2 constitute a rotation mechanism. The conduit 2 may be rotated around the proximal end axis by using a motor or the like.

  In the body portion 10, a communication hole 10 a that communicates with the proximal end portion of the conduit 2 is formed. The communication hole 10 a extends linearly in the axial direction on the proximal end side of the conduit 2. A protruding cylinder 13 is formed on the opposite side of the body portion 10 from the mounting portion 12. The communication hole 10 a extends to the inside of the protruding cylinder 13 and opens at the front end surface of the protruding cylinder 13 in the protruding direction.

  The body portion 10 includes a first winding shaft (not shown) for winding the first operation wire 24, a first motor 32 (shown in FIG. 3) that rotationally drives the first winding shaft, and a second operation. A second winding shaft (not shown) for winding the wire 25, a second motor 34 (shown in FIG. 3) that rotationally drives the second winding shaft, and the motors 32 and 34 and the LEDs 16a to 16d are controlled. And a control unit 35 is built in. The body unit 10 is provided with a liquid crystal display 36. The first motor 32, the second motor 34 and the display 36 are connected to the control unit 35.

  The body portion 10 is provided with a first dial switch 11c, a second dial switch 11d, a lock switch 11e, and a lighting switch 11f. The first dial switch 11c, the second dial switch 11d, the lock switch 11e, and the illumination switch 11f are connected to the control unit 35. Further, the body portion 10 incorporates a battery 19 (shown in FIG. 3).

  The first dial switch 11c is operated when the conduit 2 is bent in the right direction in FIG. 1, and the second dial switch 11d is operated when the conduit 2 is bent in the left direction in FIG. is there. The lock switch 11e is for holding the shape of the conduit 2 in a predetermined shape. Further, the illumination switch 11f is for turning on or off the LEDs 16a to 16d.

  When the control unit 35 detects that the first dial switch 11c has been operated, the control unit 35 operates the first motor 32 so that the first winding shaft rotates in the winding direction, and the second motor 34, The second winding shaft is operated so as to rotate in the loosening direction. Further, when the control unit 35 detects that the second dial type switch 11d is operated, the control unit 35 rotates the first motor 32 and the second motor 34 in the reverse direction to the case where the first dial type switch 11c is operated. . Further, when detecting that the lock switch 11e is operated, the control unit 35 cancels the operation of the first dial type switch 11c and the second dial type switch 11d and sets the winding shaft to an electromagnetic actuator or the like (not shown). ) To prevent it from rotating by external force. Further, as shown in FIG. 6, the display 36 includes a bending direction of the conduit 2, an inclination angle of the distal end side with respect to the proximal end side of the conduit 2, whether or not the winding shaft is locked, The remaining amount and whether or not the LEDs 16a to 16d are lit are displayed. The bending direction of the conduit 2 is indicated by “L” when it is bent in the left direction in FIG. 1, and is indicated by “R” when it is bent in the right direction in FIG. The bending angle of the conduit 2 is displayed as, for example, “30”, “60”, “90” every 30 °.

  Moreover, the control part 35 is comprised so that only 1 or 2 or more may be lighted simultaneously among four LED16a-16d by operation of the illumination switch 11f.

  As shown in FIG. 2, the wiring 23 of the camera 5 extends from the apparatus main body 3 to the outside and is connected to the image processing apparatus 6. The image processing apparatus 6 is connected to the wirings 23 of the cameras 5 of the plurality of apparatus main bodies 3. The image processing apparatus 6 is provided with an image processing unit 6 a that processes an image input from the camera 5. The image processing unit 6a is configured to connect images taken by the cameras 5 and synthesize and output a wide range image. The image processing unit 6a can output the images taken by the cameras 5 as they are without being combined.

  As described above, the surgical instrument to be introduced into the body cavity includes the grasping forceps 40 (shown in FIG. 9), the bipolar forceps 50 (shown in FIG. 11), and the suturing needle forceps 60 that holds the suturing needle. (Shown in FIG. 13), a snare 70 (shown in FIG. 15), a resection tool (not shown) for excising tissue, and the like.

  As shown in FIGS. 9 and 10, the grasping forceps 40 includes a tube member 41 inserted into the conduit 2, a pair of forceps pieces 42, 42 provided at the distal end portion of the tube member 41, forceps pieces 42, And a gripping portion 44 provided at the proximal end portion of the pipe member 41. The tube member 41 is formed to have a smaller diameter than the inner diameter of the conduit 2 and has the flexibility to bend following the bending operation of the bending mechanism 17 of the flexible tube 14. The grip 44 is provided with a switch 44a, which will be described in detail later.

  The support mechanism 43 includes a flexible plate member 43 a made of an insulating member that is fixed to the inner peripheral surface on the distal end side of the tube member 41 and extends in the center line direction of the tube member 41. The distal end portion of the plate member 43a protrudes from the distal end portion of the tube member 41, and a support shaft 43b that supports the proximal end portions of the forceps pieces 42 and 42 is provided at the protruding portion.

  Further, a positive electrode portion 43c and a negative electrode portion 43d are provided on the base end side of the plate member 43a with an interval in the width direction of the plate member 43a. These electrode portions 43c and 43d are formed so as to protrude in the same direction. In addition, one end portion of the wiring 45 is connected to the positive electrode portion 43 c and the negative electrode portion 43 d through a connector 46. The wiring 45 extends through the tube member 41 to the grip 44 and is connected to a power supply device (not shown) via a switch 44 a of the grip 44. One end and the other end of a wire 47 made of a shape memory alloy are fixed to the positive electrode portion 43c and the negative electrode portion 43d.

  A bearing hole through which the support shaft 43b is inserted is formed at the proximal end portion of the forceps pieces 42, 42. The forceps pieces 42 and 42 are rotatable around the support shaft 43b in a state where the support shaft 43b is inserted through the bearing hole. Protrusions 42a projecting in the same direction as the support shaft 43b are provided at the base end portions of the forceps pieces 42, 42 at portions away from the insertion holes. Although not shown, the support mechanism 43 is provided with a spring member that urges the forceps pieces 42 and 42 in the closing direction.

  An intermediate portion of the wire 47 is wound around the protrusions 42 a and 42 a of the forceps pieces 42 and 42. The shape memory alloy constituting the wire 47 is a well-known metal, that is, a so-called SMA having a property of restoring to a memory shape when the temperature exceeds a predetermined temperature. The length of the wire 47 (memory length) is determined by pulling the projections 42a and 42a of the forceps pieces 42 and 42 toward the proximal end side of the tube member 41 to rotate the forceps pieces 42 and 42 around the support shaft 43b. The length is set so that it can be opened. That is, when the wire 47 is at a predetermined temperature or less, it becomes longer than the stored length by the biasing force of the spring member biasing the forceps pieces 42, 42, and the forceps pieces 42, 42 are closed. On the other hand, when the switch 44a is turned on and current is supplied from the power supply device, the wire 47 generates Joule heat due to its own electrical resistance. When the temperature of the wire 47 becomes equal to or higher than the predetermined temperature due to this heat generation, the restoration starts so that the wire 47 becomes the storage length, and the wire 47 shrinks. As a result, the protrusions 42a and 42a are pulled by the wire 47, and the forceps pieces 42 and 42 rotate around the support shaft 43b against the urging force of the spring member as shown in FIG. When the switch 44a is turned off and the supply of current by the power supply device is stopped, the temperature of the wire 47 becomes a predetermined temperature or lower. Then, the wire 47 is pulled and extended by the urging force of the spring member, and the forceps pieces 42 and 42 are closed. That is, the forceps pieces 42 and 42 are configured to be opened and closed by an opening and closing mechanism that is operated by an expansion and contraction operation of the shape memory alloy wire.

  As shown in FIGS. 11 and 12, the bipolar forceps 50 includes a flexible tube member 51, a pair of forceps pieces 52 and 52, a support mechanism 53, and a switch, like the grasping forceps 40. And a grip portion 54 having 54a.

  The support mechanism 53 includes a flexible plate member 53 a made of an insulating member extending in the center line direction of the tube member 51. Supporting shafts 53b and 53b are provided at the distal end of the plate member 53a to support the intermediate portions in the longitudinal direction of the forceps pieces 52 and 52, respectively. Wiring 55 for supplying a high-frequency current is connected to each of the support shafts 53b and 53b. The wiring 55 extends from the grip portion 54 to the outside after extending through the tube member 51 to the grip portion 54, and is connected to a high frequency power supply device (not shown). The high frequency power supply device is connected to a bipolar type hemostasis treatment instrument conventionally used in medical practice, and includes a foot switch (not shown).

  Further, a positive electrode portion 53c and a negative electrode portion 53d are provided on the base end side of the plate member 53a with an interval in the width direction of the plate member 53a. These electrode parts 53c and 53d protrude in the same direction. In addition, one end of a wiring 56 is connected to the positive electrode portion 53 c and the negative electrode portion 53 d through a connector 57. The wiring 56 extends through the tube member 51 to the grip portion 54 and is connected to a power supply device (not shown) via a switch 54a of the grip portion 54. One end and the other end of a wire 58 made of a shape memory alloy are fixed to the positive electrode portion 53c and the negative electrode portion 53d. Although not shown, the support mechanism 53 is provided with a spring member that urges the forceps pieces 52 and 52 in the opening direction.

  A bearing hole through which the support shaft 53b is inserted is formed in the middle portion in the longitudinal direction of the forceps pieces 52 and 52. The forceps piece 52 is rotatable around the support shaft 53b in a state where the support shaft 52b is inserted into the bearing hole. The support shaft 53b and the forceps piece 52 are electrically connected. A cutting blade 52a is formed on the tip side of the forceps piece 52 from the bearing hole. In addition, one end portion of the link 59 is rotatably connected to the proximal end side of the bearing hole of the forceps piece 52. The other ends of these links 59 are connected by a single connecting shaft 59a in an overlapping state. The other end of the link 59 rotates around the connecting shaft 59a. The connecting shaft 59a is not fixed to the plate member 53a, and is movable in the direction of the center line of the tube member 51. The link 59 is composed of an insulating member.

  The intermediate portion of the wire 58 is wound around one support shaft 53b via an insulating member, and is then wound around the connection shaft 59a and the other support shaft 53b in this order. The wire 58 is made of a shape memory alloy like the wire 47 of the grasping forceps 40. That is, when the wire 58 is at a predetermined temperature or lower, it becomes longer than the stored length due to the biasing force of the spring member biasing the forceps pieces 52, 52, and the forceps pieces 52, 52 are opened. On the other hand, when the switch 54a is turned on and current is supplied from the power supply device, the wire 58 is contracted, the connecting shaft 59a is pushed to the distal end side, and the forceps pieces 52 and 52 are supported against the biasing force of the spring member. The shafts 53b and 53b are rotated and closed, and the cutting blades 52a and 52a are combined. When the supply of current by the power supply device is stopped by turning off the switch 54a, the wire 58 is pulled and extended by the biasing force of the spring member, and the forceps pieces 52 and 52 are opened as shown in FIG. In other words, the cutting blades 52a and 52a are configured to open and close by the expansion and contraction of the shape memory alloy wire.

  Further, when the surgeon turns on the foot switch, the high-frequency power supply device is activated. At this time, when both the forceps pieces 52 and 52 are in contact with the living tissue, a high-frequency current is supplied to the living tissue. When no high-frequency current is passed through the bipolar forceps 50, the bipolar forceps 50 can be used as a normal excision tool.

  Further, as shown in FIGS. 13 and 14, the suturing needle forceps 60 includes a flexible tube member 61, a pair of needle clamping pieces 62, 63, and a support for supporting the needle clamping pieces 62, 63. A mechanism 64 and a grip portion 68 having a switch 68a are provided. The support mechanism 64 includes a flexible plate member 64 a made of an insulating member that extends in the center line direction of the tube member 61. The distal end portion of the plate member 64a protrudes from the distal end portion of the tube member 61 and has a rod shape. One clamping piece 62 is fixed to the front end portion of the plate member 64a, and the other clamping piece 63 is swingably attached to the tube member 61 side of the one clamping piece 62. The plate member 64 a is provided with a spring member 65 that urges the other clamping piece 63 to press against the one clamping piece 62. The plate member 64a is provided with a positive electrode portion 64b and a negative electrode portion (not shown). The negative electrode portion is electrically connected to the other clamping piece 63.

  One end of a wire 66 similar to the wire 47 of the grasping forceps 40 is fixed to the positive electrode portion 64b. The other end portion of the wire 66 is fixed to the other holding piece 63 and is electrically connected to the negative electrode portion via the holding piece 63. Reference numerals 69a and 69b denote wirings and connectors for supplying a current to the wire 66, respectively. When the wire 66 is at a predetermined temperature or less, the biasing force of the spring member 65 biasing the other forceps piece 63 becomes longer than the stored length, so that the other forceps piece 63 comes into pressure contact with the one forceps piece 62. At this time, by disposing the needle 67 between the forceps pieces 63, the needle 67 is held between the forceps pieces 62 and 63. On the other hand, when the switch 68a of the gripping portion 68 is turned on and current is supplied from the power supply device, the wire 66 contracts, and the other forceps piece 63 resists the biasing force of the spring member 65 as shown in FIG. The one forceps piece 62 is separated. Further, when the switch 68a is turned off and the supply of current by the power supply device is stopped, the wire 66 is pulled and extended by the urging force of the spring member 65, and the other forceps piece 63 comes into pressure contact with the one forceps piece 62. .

  The snare 70 includes a tube member 71 inserted into the conduit and a wire 72 inserted through the tube member 71. A grip portion 71 a is provided at the proximal end portion of the pipe member 71. The wire 72 protrudes from the distal end portion of the tube member 71, and a loop 72 a is configured by a portion protruding from the tube member 71. An operation portion 73 is provided at the proximal end portion of the wire 72. The operation unit 73 moves in the center line direction of the tube member 71 with respect to the gripping unit 71a. When the operation unit 73 is moved to the distal end side of the pipe member 71, the loop 72a is enlarged, and when the operation unit 73 is moved to the opposite side, the loop 72a is reduced. As a result, the living tissue can be grasped or excised.

  Next, the case where the surgical apparatus 1 configured as described above is used in laparoscopic surgery will be described. First, a small incision of about 5 mm to 20 mm is formed in the abdominal skin, and the subcutaneous fat layer is cut with an electric knife or the like. When the peritoneum is reached, the peritoneum is incised with a scalpel, and the part into which the conduit 2 of the apparatus body 3 is inserted is determined. On the other hand, the inner needle 4 of the surgical apparatus 1 is inserted into the conduit 2 from the protruding cylinder 13 of the apparatus main body 3 through the communication hole 10a. As a result, the distal end portion of the inner needle 4 protrudes from the distal end portion of the conduit 2. And after making the flexible tube 4 of the conduit | pipe 2 into a linear state, the lock switch 11e is turned ON. Then, the rotation of the first winding shaft and the second winding shaft is prevented, and the flexible tube 14 is maintained in a straight state.

  Thereafter, when the inner needle 4 and the conduit 2 are pressed against the peritoneum and inserted into the abdominal cavity, the inner needle 4 and the conduit 2 penetrate the body surface tissue, and the distal end side of the conduit 2 reaches the abdominal cavity. After the conduit 2 penetrates the body surface tissue, the inner needle 4 is withdrawn from the conduit 2. In this way, the other three conduits 2 of the apparatus body 3 are respectively inserted into the abdominal cavity. The positions where these conduits 2 are inserted are changed depending on symptoms.

  Of the four device bodies 3, for example, a laparoscope is inserted into one conduit 2 and introduced into the abdominal cavity, and forceps, a suture instrument, etc. are inserted into the other conduit 2 and introduced into the abdominal cavity. At this time, when the illumination switch 11f of each device body 3 is turned ON, the LEDs 16a to 16d of the conduit 2 are lit in the abdominal cavity. When the LEDs 16a to 16c of each device main body 3 are turned on, white light is irradiated to the living tissue in the abdominal cavity. Since the positions of the LEDs 16a to 16d of the four apparatus main bodies 3 are separated from each other, the light of the LEDs 16a to 16d is irradiated from a different angle from the illumination of the laparoscope to the imaging region imaged by the laparoscope Is done. This makes it difficult to create a shadow on the imaging region. It is also possible to uniformly illuminate a wide range of the abdominal cavity.

  An image photographed by the camera 5 of the apparatus main body 3 is input to the image processing device 6, synthesized by the image processing unit 6 a to be a wide range image, and displayed on the monitor 7. Since this wide-range image is an image in a wider range than the range photographed by the camera 5 of one apparatus body 3, the operator can observe the wide range of the abdominal cavity at a time by looking at the monitor 7. become. This wide range image is shown in FIG. An area X1 shown in the figure is an image of the camera 5 that images the upper right area of the patient's abdomen, an area X2 is an image of the camera 5 that images the upper left area of the abdomen, and similarly, the areas X3 and X4 are These are images of the camera 5 that photographed the lower right region and lower left region of the abdomen, respectively. The area actually captured by each camera 5 is set to be wider than X1 to X4, and the overlapping part is deleted at the time of synthesis. As shown in this figure, the stomach, small intestine and large intestine can be seen at a time. The sizes of the regions X1 to X4 may be different from each other. It is also possible to photograph the chest with the camera 5.

  When the positions of the laparoscope, forceps, and suture device are changed within the abdominal cavity, the lock switch 11e of the apparatus body 3 is turned OFF to release the locked state of the first winding shaft and the second winding shaft. Thereafter, when the first dial switch 11c is operated, the first operation wire 24 is wound around the first winding shaft 31, the second operation wire 25 is loosened, and the conduit 2 is bent in the abdominal cavity. At this time, the image photographed by the camera 5 is displayed on the monitor 7 without being synthesized with the image photographed by the camera 5 of another apparatus main body 3. Thereby, the bending angle of the conduit 2 can be adjusted while confirming the direction in which the distal end portion of the conduit 2 is directed on the monitor 7. When the conduit 2 is bent to a desired angle, the lock switch 11e is turned on to maintain the shape of the conduit 2. Further, when the ring member 12a is turned in a state where the conduit 2 is bent, the conduit 2 is rotated around the axis on the proximal end side. This also makes it possible to change the position of the distal end portion of the conduit 2. Further, the position in the abdominal cavity may be changed by moving the laparoscope or the like in the direction of taking in or out of the conduit 2.

  Further, by turning on only the LED 16a that emits red light having a long wavelength, it is possible to observe a deep part of the living tissue, and by turning on only the LED 16c that emits blue light having a short wavelength, It becomes possible to observe a shallow part of the. Further, only one of the LEDs 16a to 16c may be lit, or two may be lit. Further, when the camera 5 or the laparoscope is configured by an infrared camera, only the LED 16c may be turned on.

  As described above, in the surgical apparatus 1 according to this embodiment, the bending mechanism 17 can be bent while the conduit 2 is inserted into the body cavity. Thereby, various surgical instruments inserted into the conduit 2 can be guided by the conduit 2 in various directions within the body cavity. As a result, the surgical instrument can reach a site that could not be reached by a conventional trocar, and therefore the number of cases applicable to laparoscopic surgery and thoracoscopic surgery can be increased.

  Further, by turning the ring member 12a while the conduit 2 is bent by the bending mechanism 17, it is possible to rotate the conduit 2 around its proximal end axis. Thereby, even when the bending direction of the conduit 2 is reduced to simplify the bending mechanism 17, the distal end side of the conduit 2 can be directed in various directions.

  Further, since the illuminating unit 16 is provided in the conduit 2, it is possible to illuminate each part in the body cavity with the illuminating unit 16 in a state where the conduit 2 is inserted into the body cavity separately from the illumination of the laparoscope and the thoracoscope disposed in the body cavity. It becomes possible. Thereby, each part in a body cavity can be confirmed clearly, and a detailed procedure can also be performed. Therefore, the number of cases to which laparoscopic surgery and thoracoscopic surgery can be applied can be increased.

  In addition, since the camera 5 is provided on the distal end side of the conduit 2, the inside of the body cavity can be imaged separately from the laparoscope and the thoracoscope. As a result, for example, an image obtained by viewing a living tissue from a direction different from that of a laparoscope or a thoracoscope can be obtained and used for a procedure. Can be increased.

  In the above-described embodiment, the surgical apparatus 1 is configured by the four apparatus main bodies 3, the inner needle 4, the image processing apparatus 6, and the monitor 7. However, the present invention is not limited thereto, and for example, the apparatus main body 3 and the inner needle 4 are used. The surgical device may be configured as above.

  Moreover, you may make it provide the grip part 11b in the apparatus main body 3 like the modification 1 shown in FIG.17 and FIG.16. The grip part 11b is formed so as to protrude in the radial direction of the communication hole 10a from the vicinity of the protruding cylinder 13 of the body part 10, and incorporates a battery (not shown). The grip portion 11b is attached to the apparatus main body 3 via an attaching / detaching mechanism so that the battery can be replaced.

  19, a partition member 80 extending in the axial direction of the conduit 2 is provided in the conduit 2 so that the interior of the conduit 2 is partitioned into a first insertion hole 81 and a second insertion hole 82. It may be. The cross-sectional area of the first insertion hole 81 is set smaller than the cross-sectional area of the second insertion hole 82. For example, a thin endoscope (not shown) for nasal cavity is inserted into the first insertion hole 81. The surgical instrument is inserted into the second insertion hole 82. The LEDs 16 a to 16 d and the camera 5 are attached to the tapered surface 30 a of the cylindrical member 30. As in Modification 2, a plurality of cameras 5 may be provided. Moreover, you may make it insert a surgical instrument in both the insertion holes 81 and 82. FIG. The shape of the first insertion hole 81 and the second insertion hole 82 may be circular or elliptical.

  Moreover, you may comprise LED16a-16d by white LED.

  Moreover, you may provide the illumination part 83 which consists of organic EL (Organic Electro-Luminescence) in the front-end | tip part of the cylindrical member 30 of the conduit | pipe 2 like the modification 3 shown in FIG. The illumination unit 83 has an annular shape that is continuous in the circumferential direction of the cylindrical member 30, and a wide light emitting area is ensured.

  Further, as in Modification 4 shown in FIG. 21, only the LEDs 16 a to 16 d are provided at the distal end portion of the tubular member 30 of the conduit 2 so that the side surfaces of these LEDs 16 a to 16 d face the distal end of the tubular member 30. May be.

  The light emitter of the present invention is not limited to LED and organic EL, and various light emitters can be used.

  Further, as in Modification 5 shown in FIGS. 22 to 25, the conduit 84 may be provided with a retaining portion 85 that prevents the conduit 84 from being detached when inserted into the thoracic cavity or abdominal cavity. The retaining portion 85 includes rod-shaped portions 85 a and 85 a that protrude from the tip of the conduit 84. These rod-shaped portions 85 a and 85 a are arranged at intervals in the circumferential direction of the conduit 84. A bent portion 85b is provided at an intermediate portion in the protruding direction of each rod-like portion 85a. An operation portion 86 formed in a rod shape is connected to the tip end portion of each rod-shaped portion 85a in the protruding direction. Each operating portion 86 extends through the conduit 84 toward the proximal end of the conduit 84 and protrudes from the proximal end.

  As shown in FIG. 22, the retaining portion 85 has a contracted state in which the rod-like portion 85a extends in parallel with the axis of the conduit 84, and the rod-like portion 85a faces outward in the radial direction of the conduit 2 as shown in FIG. It can be switched to an enlarged state bent so as to protrude.

  When the retaining portion 85 in the contracted state is to be expanded, the portion of the operating portion 86 that protrudes from the proximal end portion of the conduit 84 is pulled in the direction of the arrow shown in FIG. Then, the operating portion 86 moves toward the proximal end side of the conduit 84, and in conjunction with the movement of the operating portion 86, the rod-shaped portion 85a is bent outwardly in the radial direction of the conduit 84 from the bent portion 85b. It bends so as to protrude and enters an enlarged state as shown in FIG. On the other hand, when the retaining portion 85 in the enlarged state is to be reduced, the portion protruding from the proximal end portion of the conduit 84 in the operation portion 86 may be pushed opposite to the above-described direction. Although not shown, the tip of the conduit 84 can be provided with an LED, a camera, and a bending mechanism similar to those of the conduit 2.

  When using the conduit 84 of the modified example 5, first, the conduit 84 is inserted into the abdominal cavity B with the retaining portion 85 being contracted as shown in FIG. Thereafter, as shown in FIG. 25, the retaining portion 85 is brought into an enlarged state. As a result, the rod-like portions 85a and 85a are hooked from the abdominal cavity B to the tissue of the abdominal portion A, so that the conduit 84 is prevented from coming off. Symbol A in FIGS. 24 and 25 represents the abdomen of the patient.

  In addition, the said usage method is an illustration and it is also possible to use it by another method.

As described above, the surgical apparatus according to the present invention is suitable for, for example, laparoscopic surgery and thoracoscopic surgery.

DESCRIPTION OF SYMBOLS 1 Surgical apparatus 2, 84 Conduit 3 Apparatus main body 4 Inner needle 5 Camera (imaging part)
6 Image processing device 6a Image processing unit 16, 83 Illumination unit 16a to 16d LED (light emitting body)
17 Bending mechanism

Claims (6)

A main body having a conduit for guiding a surgical instrument to a body cavity, and an inner needle inserted into the conduit. The inner needle is punctured into a body surface side tissue, and the conduit penetrates the body surface side tissue and is inserted into the body cavity. A surgical device configured as follows:
The surgical apparatus according to claim 1, wherein the main body portion is provided with a bending mechanism for bending the conduit. The surgical apparatus according to claim 1, wherein
A surgical apparatus characterized in that a proximal end side of a conduit is attached to the main body, and a rotation mechanism for rotating the conduit around an axis on the proximal end side is provided. A main body having a conduit for guiding a surgical instrument to a body cavity and an inner needle inserted into the conduit, and piercing the inner needle into the body surface tissue so that the conduit penetrates the body surface tissue and is inserted into the body cavity. A configured surgical device comprising:
A surgical apparatus characterized in that an illumination part is provided on the distal end side of the conduit. The surgical apparatus according to claim 3, wherein
The illumination unit has a plurality of light emitters,
A surgical apparatus characterized in that wavelengths of light emitted from the light emitters are different from each other. A main body having a conduit for guiding a surgical instrument to a body cavity and an inner needle inserted into the conduit, and piercing the inner needle into the body surface tissue so that the conduit penetrates the body surface tissue and is inserted into the body cavity. A configured surgical device comprising:
A surgical apparatus characterized in that an imaging unit for imaging the inside of a body cavity is provided on the distal end side of the conduit. The surgical apparatus according to claim 5, wherein
An image processing unit that combines images captured by each imaging unit of a plurality of main body units and obtains a wide range image wider than the range captured by each imaging unit;
A surgical apparatus comprising: a display unit that displays a wide range image obtained by the image processing unit.

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