KR20190005092A

KR20190005092A - Glisson Ligation Dissector

Info

Publication number: KR20190005092A
Application number: KR1020170085680A
Authority: KR
Inventors: 이승덕
Original assignee: 국립암센터
Priority date: 2017-07-05
Filing date: 2017-07-05
Publication date: 2019-01-15
Also published as: WO2019009581A1; KR101951314B1

Abstract

The present invention relates to a Gleason ligation dissector which can significantly reduce a time required for a medical procedure process in a laparoscopic hepatectomy. The Gleason ligation dissector comprises: a flexible finger; a protruding finger protruding from and inserted into an end of the flexible finger; a grip including a manipulating tool unit; and an elongated arm connecting the other end of the flexible finger and the grip.

Description

Glisson Ligation Dissector}

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a gleason ligation dissection apparatus used in a laparoscopic liver resection. More particularly, the present invention relates to a dissection apparatus that is capable of bending a distal end and pulling a ligature out of a distal end.

The contents described in this section merely provide background information on the present embodiment and do not constitute the prior art.

In the case of hepatic resection, the glisson sheath is removed and temporary or permanent ligation is performed, followed by left and right gastrectomy. If the ligature is removed through Gleason's dissection, temporary bleeding can be stopped and hepatic resection can be minimized. This is one of the most important surgical procedures.

Laparoscopic hepatectomy was introduced by Reich et al. In 1991. However, it was difficult to effectively control the bleeding and it was difficult to expand easily. In the 21st century, stability and surgical techniques developed, And has been established and spreading around the world. In particular, laparoscopic hepatic resection is preferred to laparoscopic surgery because it reduces blood loss and shortens recovery time, and patient satisfaction is high. Despite these advantages, the major reason for preference for open surgery for laparoscopic hepatic resection is the concern that operation time will increase. The increase in operative time is due to an increase in the difficulty of surgery, and the fact that laparoscopic surgery is disadvantageous to cope with unexpected large bleeding in the presentation of the liver.

According to the recent statistics of hepatectomy operations performed worldwide, there has been no substantial difference in operation time between open surgery and laparoscopic surgery in hepatectomy. However, if surgery procedure is expected to be complicated, There are still many.

Pringle`s maneuver, which is commonly used in the presentation of hepatosplenomegaly, is an important surgical technique to prevent hemorrhage in hepatic resection. Temporal or permanent ligation of the blood flow to the liver for laparoscopic hepatic resection contributes to successful end of surgery by reducing intraoperative bleeding. However, glison is often buried in the liver, and there is a need for a mechanism to effectively remove it.

The present invention provides a gleason ligation dissection apparatus that facilitates gleason ligation for the purpose of shortening the operation time in laparoscopic liver resection, and can greatly shorten the time required for the related procedure.

More particularly, it is provided with a flexible finger at the distal end of the dissection mechanism, and is operable to flex the flexible finger and turn the flexible finger back into the grit behind. As the protruding finger protrudes inside the flexible finger, The present invention provides a laparoscopic dissection apparatus that can be easily drawn out. In particular, the degree of bending of the flexible finger is easily adjusted, and the stiffness is maintained high. With effective and successful exfoliation of Gleason's liver buried in the liver, temporary or permanent ligation with exposures contributes to shortening the operation time and reducing blood loss.

In the present invention, the convenience of operation is improved by the structure in which the ligature can be bent close to 360 ° and the ligature is continuously supplied, the small number of parts are assembled, And a component for stiffness are separated from each other, thereby providing a strong and lightweight structure as a whole.

According to an aspect of the present invention, there is provided a gleason ligation dissection apparatus including: a flex finger formed to be curled and curled in a first direction; A protruding finger protruding and inserted in the second direction, which is the longitudinal direction of the flexible finger, from the end of the flexible finger; A grip including an operating mechanism portion for manipulating the bending of the flexible finger and the protrusion and insertion of the protruding finger; And an elongated arm connecting the other end of the flexible finger and the grip, wherein when the protruding finger protrudes from the flexible finger and protrudes in the second direction, the protruding finger curves at a predetermined radius of curvature toward the first direction And the end of the ligature is fixed to expose the ligature to the outside of the flexible finger by the protrusion of the protruding finger.

The flexible finger has an S-shaped cross-section extending in the second direction. The cross-sectional outline is in contact with the circle. The first wing portion and the second wing portion, which are two semi- And a first support connected to both ends of a neutral plane, which is a straight line section, the neutral plane being arranged in a third direction perpendicular to the first direction and the second direction and extending in a second direction do.

Further, the flexible finger may include a second support inserted between the neutral plane and the first wing and disposed on one side of the first direction; A third support inserted between the neutral plane and the second wing and disposed on the other side in the first direction; A nose cone disposed at the end of the flexible finger; And an outer tube into which the first support is inserted.

In addition, the first support extends in the second direction by the length of the flexible finger, the height of the neutral surface is close to the inner diameter of the outer tube, and the two semicircular extensions except for the neutral surface have a plurality of slits in the second direction .

In addition, the second support and the third support have a semicircular cross section extending in the second direction by the length of the flexible finger, and an extension of the cross section except for a part of the cross section adjacent to the neutral plane is formed with a plurality of slits in the second direction And the plurality of slits are formed at positions corresponding to the plurality of slits formed in the first support.

Further, the second support body may include a first through hole disposed at a position away from the neutral plane; A second through hole disposed in proximity to the neutral plane; And a third through hole in which the ligation yarn is accommodated, and the third support includes a fourth through hole disposed at a position far from the neutral plane.

A first wire connected to one end of a second support adjacent to the nosecone and connected to the grip through the first through hole; A second wire connected to the other end of the protruding finger and connected to the grip through the second through hole; And a third wire connected to one end of the third support body adjacent to the nosecone and connected to the grip through the fourth through hole.

And a compression spring disposed between both sides perpendicular to the second direction of the plurality of slits formed in the third support body, wherein the compression spring is inserted into the third wire.

Further, when the third wire is pulled to the maximum position by the operating mechanism portion, the flexible finger is straightly expanded, and when the third wire is loosely loosened, a plurality of slits formed in the third support body are spread by the compression spring, The plurality of slits formed on the support are narrowed, whereby the neutral plane is bent and dried in the first direction.

When the second wire is pushed by the operating mechanism portion, the projecting finger protrudes from the distal end of the flexible finger. When the second wire is pulled by the operation mechanism portion, the protruding finger is inserted into the flexible finger so that the ligature connected to the tip of the projecting finger Protruding and inserted.

Further, when the third wire is pulled out from the operating mechanism portion, the first wire is controlled to be loosened to a reduced size at a predetermined ratio with respect to the moving distance of the third wire, and when the third wire is loosened, Is controlled so as to be pulled by a predetermined amount.

In addition, the protruding fingers are formed so as to be able to interpose and fix the ligation lug with a notch shape having a U-shape, The prong is guided by the ligation piece housed in the third through-hole, and the ligation lug is placed across the upper end of the U-shaped lug to expose the ligation lug so as to be easy to grasp.

The second support body is formed from one end of the second support body and has a depth corresponding to the length of the protruding fingers, including a slide groove formed on the neutral plane side so as to receive the protruding fingers and to slide the protruding fingers.

The first support is characterized in that the elastic modulus in the first direction is less than 1% of the elastic modulus in the third direction.

The first support body is formed by press-forming and heat-treating the metal spring plate, and is formed so as to have a minimum radius of curvature that curves and dries in the first direction and a middle radius of curvature that is linearly expanded.

The plurality of pin-and-socket assemblies, which are assembled through the assembly through holes, are formed in the second and third supports, respectively, so that the first to third supports Is assembled around the neutral plane.

The second support and the third support are formed of a polymer resin, and the polymer resin includes ultra-high molecular weight polyethylene (UHMW-PE).

Further, the operation mechanism unit may include a first motor and a second motor; A first screw connected to the first motor; A first gear coupled to the first screw; A third screw spaced apart from and spaced apart from the first screw; A second gear coupled to the third screw and meshing with the first gear; A second screw connected to the second motor; A first guide block, a second guide block and a third guide block which are respectively threaded to the first screw, the second screw and the third screw and to which the first wire, the second wire and the third wire are respectively connected; Shaped fixed pin formed in the second guide block so as to allow movement in only one direction and fixed to the ligature; And a tension spring connected between the second guide block and the fixed pin.

The gear ratio of the first gear and the second gear is characterized by a ratio of a distance of movement of the first wire to a distance of movement of the third wire as the flexible fingers are bent.

Further, in the operating mechanism portion, the ligation yarn is fixed between the second guide block and the fixed pin, the second screw is rotated by the driving of the second motor, the second guide block is moved, The finger and the ligature are moved together, and when the movable pin is separated from the second guide block, only the ligature can be manually moved.

Further, the flexible finger dissection apparatus according to an embodiment of the present invention includes: a flexible finger including the first to third support bodies; A first wire; A third wire; And a plurality of compression springs, wherein the second support includes a first through hole disposed at a position distant from the neutral plane, the first wire being connected to the tip of the second support, And the third support includes a fourth through hole disposed at a position distant from the neutral plane and the third wire is connected to the tip of the third support and connected to the grip through the fourth through hole, And the compression spring is inserted into the third wire.

An object of the present invention is to provide a flexible ligation apparatus capable of easily bending such that it has a small radius of curvature by a single hand operation and that the protruding fingers and the ligation lugs are easily drawn out from the tip end of the flexible finger to be bent, And is continuously supplied from the inside of the finger.

Use of the Gleason ligation dissection apparatus according to the present invention facilitates Gleason ligation and shortens the operation time. Especially, when laparoscopic hepatic resection is performed, it can be useful in posterior abdominal cavity, right abdominal cavity, umbilical artery, and left gastrectomy.

Further, the flexible finger structure according to the present invention is characterized by small cross-sectional diameter, high rigidity and small radius of curvature, and is applicable to various surgical fields.

FIG. 1 is a perspective view showing a gleason ligation dissection apparatus according to an embodiment of the present invention.
FIG. 2 is a perspective view showing main parts of flexible fingers and protruding fingers of the Glyseal ligation dissection apparatus according to an embodiment of the present invention.
FIG. 3 is an exploded perspective view showing the parts assembling relationship of the flexible fingers and the protruding fingers of the glison ligation dissection apparatus according to the embodiment of the present invention.
FIG. 4 is a partial cross-sectional view taken along the line A-A 'of FIG. 2, illustrating portions involved in flexible finger operation according to an embodiment of the present invention.
5 is a partial cross-sectional view taken along line B-B 'of FIG. 2, showing a portion involved in the projecting finger operation according to an embodiment of the present invention.
6 is a part view showing first to third supports of a flexible finger according to an embodiment of the present invention.
7 is a perspective view illustrating a state in which a flexible finger according to an embodiment of the present invention is bent.
8 is a perspective view illustrating a protruding finger protruded in a bent state of the flexible finger according to an embodiment of the present invention.
FIG. 9 is a perspective view showing a flexible finger inside a bent state according to an embodiment of the present invention. FIG.
10 is a perspective view showing a first support of a flexible finger in a bent state according to an embodiment of the present invention.
11 is a perspective view showing a protruding finger protruding from a flexible finger and a second support of a flexible finger in a bent state according to an embodiment of the present invention.
12 is a perspective view showing a third support and a compression spring of a flexible finger in a bent state according to an embodiment of the present invention.
FIG. 13 is a conceptual diagram showing a driving unit for controlling the operation of the Gleason ligation dissection apparatus according to an embodiment of the present invention. FIG.

Hereinafter, some embodiments of the present invention will be described in detail with reference to exemplary drawings. It should be noted that, in adding reference numerals to the constituent elements of the drawings, the same constituent elements are denoted by the same reference symbols as possible even if they are shown in different drawings. In the following description of the present invention, a detailed description of known functions and configurations incorporated herein will be omitted when it may make the subject matter of the present invention rather unclear.

In describing the components of the present invention, terms such as first, second, A, B, (a), and (b) may be used. These terms are intended to distinguish the constituent elements from other constituent elements, and the terms do not limit the nature, order or order of the constituent elements. Throughout the specification, when an element is referred to as being "comprising" or "comprising", it means that it can include other elements as well, without excluding other elements unless specifically stated otherwise . In addition, '... Quot ;, " module ", and " module " refer to a unit that processes at least one function or operation, and may be implemented by hardware or software or a combination of hardware and software.

FIG. 1 is a perspective view showing a gleason ligation dissection apparatus according to an embodiment of the present invention.

Referring to FIG. 1, a gleason ligation dissection apparatus 100 according to an embodiment of the present invention includes a protruding finger 10, a flex finger 20, an elongated arm 30, (grip, 40). FIG. 1 shows a state in which the flexible finger 20 of the Glysingle ligation dissection apparatus 100 according to an embodiment is bent by a user's operation to be curled and the projecting finger 10 protrudes from the flexible finger 20. FIG. The grip 40 is only sketched roughly for convenience of illustration and is virtually cut away from the outside and shows only the internal main portion.

The protruding fingers 10 serve to pull a ligature 60 for ligating the glisson (not shown) out of the flexible finger 20.

The flexible finger 20 is bent in a first direction 1 perpendicular to the second direction 2 which is the longitudinal direction of the body and is formed so as to be curled in a circular manner so that the distal end of the gleason ligation dissection mechanism 100 Gleason can be manipulated to turn around behind.

The grip 40 includes a projecting finger 10 and an operating mechanism 50 for operating the flexible finger 20.

The extension arm 30 corresponds to the body connecting the flexible finger 20 and the grip 40.

FIG. 2 is a perspective view showing main parts of flexible fingers and protruding fingers of the Glyseal ligation dissection apparatus according to an embodiment of the present invention.

FIG. 3 is an exploded perspective view showing the parts assembling relationship of the flexible fingers and the protruding fingers of the glison ligation dissection apparatus according to the embodiment of the present invention.

The flexible finger 20 according to one embodiment includes a first support 210, a second support 220, a third support 230, a nose cone 240, and an outer tube 250.

The flexible finger 20 is supported by a first support body 210 disposed in contact with the inside of the cylindrical outer tube 250 and the first support body 210 is bent in a first direction 1, So that the shape thereof is controlled.

The outer tube 250 is disposed so as to surround the first support body 210 and the second support body 220 and the third support body 230 are disposed on both sides of the center of the end face of the first support body 210.

The nosecone 240 is connected to one end of the outer tube 250 and one end of the first support 210. The nose cone 240 is formed in a cone shape so that the distal end of the gleason ligament dissection device 100 can be easily searched for the glee's back or the like, and the protruding fingers 10 are drawn out or stored through the openings including the openings.

The first support body 210 has an S-shaped section extending in the second direction 2. The center portion of the S-shaped section is a straight line approximating the diameter of the section, and both ends of the S- Is semicircular and is in contact with the circle. The semicircular portion contacting the outer tube 250 is defined as a first wing portion 212 and a second wing portion 214. The straight line of the end face of the first support 210 is arranged in a third direction 3 perpendicular to the first direction 1 and the second direction 2 and is arranged in a neutral plane , 216). The height of the neutral plane 216 is formed to be close to the inner diameter of the outer tube 250. Herein, the neutral plane 216 is a plane in which the length of the longitudinal direction of the flexible finger 20 including the first support body 210 is not changed when the flexible finger 20 is bent in the first direction 1 This is equivalent to the concept of a neutral plane in general beam bending. The length of the first support body 210 extends in the second direction 2 by the length of the flexible finger 20 and the first and second wings 212 and 214 except for the neutral plane 216 The plurality of slits 213 and 215 are formed in the second direction 2 and the slits 213 and 215 of the first wing portion 212 and the second wing portion 214 are narrowed or widened, (210) has a structure bent only in the first direction (1).

The first support body 210 may be made of a stainless steel spring plate or a spring plate made of Nitinol, but is not limited thereto. The first support body 210 has a plurality of slits 213 and 215 which are first arranged in the second direction 2 in the form of a flat plate and the assembly through holes are formed by press working or laser processing, It can be easily formed into a mass production process by plastic working. The first support 210 of one embodiment may be formed from a metal spring plate material by press working and heat treatment and may be formed in a straight line in the second direction 2, It is also possible to reduce the force required for the bending operation of the first support body 210 by shaping the first support body 210 so as to have the minimum radius of curvature curved in one direction (1) and the intermediate radius of curvature in a straight line.

A second support body 220 and a third support body 230 are inserted and disposed on both sides of the neutral plane 216 of the first support body 210 so that the flexible fingers 20 are bent in a first direction 1 The second support body 220 is disposed on the first wing portion 212 of the first direction 1 and the third support body 230 is disposed on the second wing portion 214 on the other side of the first direction 1. [

The second support body 220 and the third support body 230 extend in the second direction 2 by the length of the flexible finger 20 in a semicircular cross section. Extensions of the cross sections of the second support body 220 and the third support body 230 except for a part of the cross section adjacent to the neutral plane 216 of the first support body 210 have a plurality of slits 222 and 232 The plurality of slits 222 and 232 are formed so as to correspond to a plurality of slits 213 and 215 formed on the first support 210, respectively. The second support body 220 and the third support body 230 are assembled such that one side thereof is in close contact with the neutral surface 216 of the first support body 210. The second support 220 includes a first through hole 224 disposed at a position distant from the neutral plane 216 of the first support 210, a second through hole 226 disposed adjacent to the neutral plane 216, And a third through hole 227 in which the ligation thread 60 is received. When the diameter of the flexible finger 20 is formed small, the second or third through-holes 226 and 227 may be formed in a shape of one side toward the neutral plane 216, if necessary. The third support body 230 includes a fourth through hole 234 disposed at a position distant from the neutral plane 216 of the first support body 210.

FIG. 4 is a partial cross-sectional view taken along the line A-A 'of FIG. 2, illustrating portions involved in flexible finger operation according to an embodiment of the present invention.

4, a first wire 712 is disposed in the first through hole 224 formed in the second support 220 and one end of the first wire 712 is connected to the second support 220 And the other end is connected to the operating mechanism portion 50 inside the grip 40 through the extension arm 30. [ The first wire 712 may be a wire typically used in a laparoscopic dissection apparatus, and may be made of, for example, 304V stainless steel. The first wire 712 is operated by a Bowden cable method so as to narrow a space between a plurality of slits formed in the second support body 220 by pulling the first wire 712 from the operation mechanism unit 50, The support body 220 is bent in the first direction 1.

The second support body 220 is made of a polymer resin, and is formed to be easily bent by the operation of the first wire 712. Further, it is preferable that the material is a material having a low frictional coefficient such that frictional force with the inner circumferential surface of the first through hole 224 is minimized when the first wire 712 is operated. In one embodiment, the second support 220 has a low coefficient of friction, and in general, the Bowden cable, which is a twisted thin wire, is attracted by a large force, and even if it collides with the through hole in which the Bowden cable is received, (UHMW-PE) having excellent properties, for example, a high-molecular-weight polyethylene. In one embodiment, the third support 230 is also made of the same ultra-high molecular weight polyethylene as the second support 220. The second support body 220 and the third support body 230 are manufactured by injection molding.

A third wire 716 is disposed in the fourth through hole 234 formed in the third support body 230. One end of the third wire 716 is connected to the distal end of the third support body 230, 30, and the other end is connected to the operating mechanism portion 50 in the grip 40. [ The third wire 716 is also used in the same manner as the first wire 712. The compression spring 718 is inserted into the plurality of slits 215 formed in the third support body 230 so as to surround the central axis of the fourth through hole 234 in the direction parallel to the second direction 2. [ In other words, the third wire 716 is inserted through the plurality of compression springs 718. The compression spring 718 exerts a force to open each slit 215 of the third support 230 to bend the third support 230 toward the neutral plane 216. The compression spring 718 may be selected to provide most of the force required to bend the flexible finger 20 in the first direction 1. The third wire 716 must be pulled so that the compression spring 718 is in a compressed state in order that the third support body 230 is extended in the second direction 2 in parallel.

The gleason ligation dissection apparatus 100 according to an embodiment of the present invention is a device for laparoscopic surgery and is used mainly in a bent state after being inserted into a patient's body rather than spreading in a straight line. Particularly, in the case of the lobectomy which is difficult in operation, it is desirable to precisely control the degree of bending of the flexible finger 20, and it is easy to bend the flexible finger 20, It becomes easy to search for the glisson backing with the flexible finger 20. The third support body 230 is bent by the compression spring 718 until the flexible finger 20 is bent until it has a fairly small radius of curvature so that the flexible finger 20 bends by relying only on the pulling of the first wire 712 A smaller force or power is required to operate the bending degree.

In order to bend the first support 210 in the first direction 1, the third wire 716 is loosened so that the compression spring 718 is stretched, and at the same time, the first wire 712 The first support body 210 is bent. Conversely, by unscrewing the first wire 712 and pulling the third wire 716, the compression spring 718 is compressed and the first support 210 is straightened.

Assuming a flexible finger of a general type bent only by wires on both sides or one side of the neutral plane, the wire in the bent direction and the inner circumferential surface of the through hole in which the wire is received are pulled and slid in a state of tight contact. As a result, the frictional force may become large at the contact surface between the wire and the through hole in the direction of bending, and wear may occur. That is, unnecessary loss of power may occur, which may deteriorate the operation feeling.

On the other hand, if the flexible finger 20 is bent by the compression spring 718 as in the embodiment, only a small force may be applied to the first wire 712 inside the neutral surface 216 in the direction in which the flexible finger 20 is bent. In contrast, when the flexible finger 20 is extended, even if a large force acts on the third wire 716 outside the neutral plane 216, the fourth through hole 234 containing the third wire 716 is aligned in a straight line Therefore, the frictional force is not increased. The flexible fingers 20 that bend inwardly of the neutral plane 216 are bent by a force pulling the wire outside the neutral plane 216 rather than in a manner of bending by the pulling force of the wire inside the neutral plane 216 A method of stretching the flexible fingers 20 is preferable.

5 is a partial cross-sectional view taken along line B-B 'of FIG. 2, showing a portion involved in the projecting finger operation according to an embodiment of the present invention.

Referring to FIG. 5, the protruding fingers 10 are disposed between the second support 220 and the neutral plane 216 of the first support 210. The protruding fingers 10 are kept inside the flexible fingers 20 until the flexible fingers 20 are manipulated so as to turn around the glison backs and when the glison is ready to be guided by the ligature fingers 60, The projecting finger 10 protrudes from the distal end of the flexible finger 20 so that the ligature 60 can be held by the finger.

The ligation tool 60 is temporarily fixed to the ligation tool holder 50 and moves together with the protruding finger 10 and the second wire 714 so that the ligation tool 60 is gripped by the forceps 60, 50 is pulled out by pulling the grip or retracting the flexible finger 20 after the temporarily fixed state with the operation mechanism unit 50 is released.

In one embodiment, the protruding fingers 10 include a "U" shaped ligation pad 610 having a bifurcated tip, with one lobe 612 of the ligation pad 610 having a notch shape And the other fork 614 is formed so as to guide the ligature 60 contained in the third through hole 227 so that the ligature 60 is formed into a U- So as to cover the opening 616 across the top to expose the ligature 60 for easy gripping.

The Glyseal ligation dissection apparatus 100 according to an embodiment of the present invention is configured to have a structure for minimizing a cross-sectional diameter. In order to minimize the cross-sectional size of the protruding fingers 10 inserted into the flexible fingers 20, the protruding fingers 10 are formed of a nitinol material having high elasticity and rigidity and being human-friendly. The protruding fingers 10 are formed in such a manner that the flexible fingers 20 are bent in the first direction 1 so as to bend close to the minimum curvature radius. Further, it is formed so as to be easily stretched or bent along the curvature of the flexible finger 20 in a state of being inserted into the flexible finger 20 with sufficient elasticity.

A second wire 714 is connected to one end 618 of the end of the protruding finger 10 inserted into the flexible finger 20. The protruding fingers 10 protrude from the distal end of the flexible finger 20 when the second wire 714 is pushed in the operation mechanism portion 50 and are pulled out of the flexible finger 20 when the second wire 714 is pulled in the operation mechanism portion 50. [ The ligation tool 60 connected to the tip of the protruding finger 10 is protruded and inserted from the flexible finger 20.

6 is a part view showing first to third supports of a flexible finger according to an embodiment of the present invention.

6 (a) is a sectional view of a third support body 230 according to an embodiment of the present invention, FIG. 6 (b) is a first support body 210, And a top view.

Referring to FIG. 6A, the third support 230 has a semicircular cross section, and a slot 222 is formed at a position corresponding to the slots 213 and 215 of the first support 210. A plurality of assembly sockets 238 are formed at positions corresponding to the assembly through holes 218 of the first support body 210 on the side surface 236 of the first support body 210 which is in close contact with the neutral plane surface 216.

Referring to FIG. 6C, the second support 220 has a semicircular cross section, and a slot 232 is formed at a position corresponding to the slots 213 and 215 of the first support 210. A plurality of assembly pins 228 are formed at positions corresponding to the assembly through holes 218 of the first support body 210 on the side surface 229 of the first support body 210 which is in close contact with the neutral plane surface 216.

6 (b), the assembly pin 228 of the second support body 220 passes through the assembly through hole 218 of the first support body 210 and is inserted into the assembly socket 238 of the third support body 230 And the first to third supporting bodies 210, 220 and 230 are assembled together. The first support body 210 is a leaf spring and the first and second wing parts 212 and 214 are opened in the elastic range and then the second support body 220 and the third support body 230 are inserted Can be assembled.

In one embodiment, assuming that a load is applied to the tip in a state where the end of the first support body 210 is fixed, the third direction 3 and the first direction 1 have a stiffness difference of about 150 times or a modulus of elasticity Of the total population. The specification of the first support 210 used in the analysis is assumed to be a general level, assuming that the outer diameter is 8 mm, the slit width and spacing is 3 mm, and the plate thickness is 0.4 mm. The first support 210 and the second support 220 do not have enough torsional rigidity about the second direction 2. The second support 220 and the second support 220 are inserted into the first and second wings 212 and 214, 3 support 230, and the outer tube 250. As shown in FIG. The outer tube 250 may have a flexible structure of a polymer material and may be a braided tube in which a polymer resin encapsulates a thin metal wire woven into a cylindrical shape to enhance torsional rigidity. The polymer resin may be, for example, Teflon (PTFE).

7 is a perspective view illustrating a state in which a flexible finger according to an embodiment of the present invention is bent.

8 is a perspective view illustrating a protruding finger protruded in a bent state of the flexible finger according to an embodiment of the present invention.

Figures 7 and 8 illustrate flexible fingers 20 having an 8 mm cross-sectional outer diameter as an embodiment. 7 shows a state in which the flexible finger 20 is curled and rolled in a round state and the distal end of the flexible finger 20 is pulled in a straight line by the action of releasing the third wire 716 by 10.8 mm and pulling the first wire 712 by 8.4 mm And shows a bent state at an angle of 200 DEG or more in the unfolded state. At this time, the compression spring 718 disposed between the slits 232 of the third support body 230 is compressed in the state where the flexible finger 20 is linearly expanded and compressed at 3 mm, mm. The bent inner diameter of the flexible finger 20 is 30 mm.

The outer diameter of the flexible finger 20 may be configured to be 5 mm. 7, the distal end of the flexible finger 20 is bent at an angle of 200 degrees by an operation of releasing the third wire 716 by 6.5 mm and pulling the first wire 712 by 5.1 mm, 18 mm. The flexible finger 20 can be bent into a form that pulls the first wire 712 further and loosens the third wire 716 to wrap a smaller circle.

8, a state in which the protruding fingers 10 are protruded by pushing the second wire 714 and protruding in a shape close to a circle is shown.

FIG. 9 is a perspective view showing a flexible finger inside a bent state according to an embodiment of the present invention. FIG.

10 is a perspective view showing a first support of a flexible finger in a bent state according to an embodiment of the present invention.

11 is a perspective view showing a protruding finger protruding from a flexible finger and a second support of a flexible finger in a bent state according to an embodiment of the present invention.

12 is a perspective view showing a third support and a compression spring of a flexible finger in a bent state according to an embodiment of the present invention.

9, the flexible fingers 20 in a bent state according to an embodiment are configured such that the slits 232 of the third support body 230, which are located outside the neutral plane 216 of the first support body 210, And the compression spring 718 inserted into the slit 232 is in an extended state. The slit 222 of the second support body 220 on the inner side with respect to the neutral plane 216 is in a contracted state and the state of deformation of the slits 222 and 232 of the second support body 220 and the third support body 230 The flexible finger 20 shown may be further bent to enclose a smaller diameter.

Referring to FIG. 10, the first support body 210 has a slit 213 spaced apart from the first wing 212 with respect to the neutral plane 216 and spaced apart from the slit 215 of the second wing 214 It can be confirmed that the state is open.

11, the protruding fingers 10 are shown protruding from the flexible fingers 20 as the second wires 714 move toward the tip of the flexible fingers 20 and bent by their own elasticity. The ligation tool 60 is shown pulled along the protruding fingers 10 in a fixed state to the ligation tool holder 610.

12, the third support body 230 is shown in a state in which the third spring 716 is loosened to increase the length of the compression spring 718 and the outer side of the third support body 230 farther from the neutral plane 216 is elongated and bent in a round shape .

FIG. 13 is a conceptual diagram showing a driving unit for controlling the operation of the Gleason ligation dissection apparatus according to an embodiment of the present invention. FIG.

13 (a) and 13 (b) are conceptual views showing only the driving or conveying part of the operating mechanism part 50 according to the embodiment of the present invention, respectively, and are perspective views viewed from above and below, respectively.

The operating mechanism 50 according to the embodiment includes first and second motors 810 and 812, a third screw 824 connected to the first motor 810, a second screw 824 coupled to the third screw 824, A first gear 820 coupled to the first screw 820 and engaged with the second gear 834, a second gear 830 coupled to the second gear 834, The first to third wires 712, 714 and 716 are screwed to the second screw 822 and the first to third screws 820, 822 and 824 connected to the second motor 812, Shaped guide pin 850 for fastening the first to third guide blocks 840, 842 and 844 and the ligation thread 60 to be fixed. In one embodiment, the tapered pin 850 is installed in the second guide block 842 so as to allow movement in only one direction. For this purpose, a guide 852 in the form of a dovetail may be used. The stationary pin 850 is formed such that a portion 856 for temporarily fixing the ligation thread 60 is pushed by a button (not shown), and the second guide block 842 is fixed to temporarily fix the ligation thread 60. [ A tension spring (not shown) is connected between the clamp pin 850 and the clamp pin 850 to exert a force to temporarily fix the ligature 60. The tension spring may be disposed within the guide 852 in the form of a dovetail.

Since the first and third wires 712 and 716 move at different distances depending on how the flexible finger 20 is bent, the first gear 830 and the third wire 830, which control the first wire 712, The gear ratio of the second gear 834 for controlling the gears 716 and 716 is selected in consideration of the ratio. In one embodiment, the gear ratio of the first gear 830 and the second gear 834 is 1: 1.3, and the first wire 712 and the third wire 716 are connected to the first screw 814, And are moved in different directions by the motor 810.

That is, when the first wire 712 is pulled, the third wire 716 is released 1.3 times faster than the first wire 712. In one embodiment, a substantial portion of the power required for bending is provided by the compression spring 718, so that the first and third wires 712, 716 can be driven by a single motor to reduce the size of the grip 40 .

The first motor 810 may be coupled to the first screw 820 and the combination of the first gear 830 and the second gear 834 coupled to the first gear 830 serves as a speed reducer The speed at which the third wire 716 is pulled is reduced, but the power consumption of the first motor 810 can be reduced.

Although not shown in the drawings, the ligature 60 may be housed in the grip 40 in the form of being wound on a roll. The ligation tool 60 is temporarily fixed between the second guide block 842 and the fixing pin 850 so that the second screw 822 is rotated by the driving of the second motor 812 and the second guide block 842 are moved and the protruding fingers 10 and the ligation threads 60 are moved together as the second wires 714 are moved. In order to pull the ligation tool 60 out of the protruding fingers 10 for glean ligation, the lancing tool 850 is separated from the second guide block 842 by operation of a button (not shown) Allow them to be released freely. When the ligation tool 60 is pulled out and cut to a required length, the ligation tool 60 on the side of the protruding fingers 10 is again fixed to the ligation tool temporary fixing portion 610. The button which has not moved before the protruding finger 10 is retracted and the prong pin 850 has been separated is released and the prong pin 850 is closed so that the ligation prongs 60 are synchronized with the movement of the second guide block 842.

The ligation lances 60 disposed inside the Glyseal ligation dissection apparatus 100 according to an embodiment of the present invention are configured such that the ligation lances 60 are allowed to move only in the fixed state to the ligation lancing unit 610 and the gripping pins 850 Thereby preventing the ligature 60 from twisting inside. For example, when a button operation for separating or opening the movable pin 850 is confirmed, a control unit (not shown) may be configured to limit the driving of the second motor 812.

The Glyseal ligation dissection apparatus 100 according to an embodiment of the present invention includes the first to third supports 210, 220 and 230 and is connected to the flexible fingers 20 Is operated by bending. It has high bending freedom, high stiffness in static state, small cross sectional diameter, and small number of internal parts, so it can be applied to various types of laparoscopic surgical instruments besides gleason ligation.

The foregoing description is merely illustrative of the technical idea of the present embodiment, and various modifications and changes may be made to those skilled in the art without departing from the essential characteristics of the embodiments. Therefore, the present embodiments are to be construed as illustrative rather than restrictive, and the scope of the technical idea of the present embodiment is not limited by these embodiments. The scope of protection of the present embodiment should be construed according to the following claims, and all technical ideas within the scope of equivalents thereof should be construed as being included in the scope of the present invention.

Claims

A flex finger flexibly curved in a first direction;
A protruding finger protruding and inserted in a second direction which is the longitudinal direction of the flexible finger from the end of the flexible finger;
A grip including a bending portion of the flexible finger and an operation mechanism portion for manipulating protrusion and insertion of the protruding finger; And
An elongated arm connecting the other end of the flexible finger to the grip;
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The protruding fingers,
Wherein the first flexible guide member has a curved shape that curves at a predetermined radius of curvature toward the first direction when the flexible finger is protruded in the second direction,
The termination is such that the ligature is fixed and the ligation is exposed to the outside of the flexible finger by the protrusion of the protruding finger
A gleason ligation dissection apparatus.

The method according to claim 1,
Wherein the flexible finger comprises:
An S-shaped cross section extending in the second direction,
Wherein the cross-section outer periphery is in contact with a circle,
The first wing portion and the second wing portion having two semicircular shapes on the outer periphery of the cross section are respectively connected to both ends of a neutral plane which is a straight section corresponding to the diameter of the circle,
And the neutral plane includes a first support disposed in a third direction perpendicular to the first direction and the second direction and extending in the second direction
A gleason ligation dissection apparatus.

3. The method of claim 2,
Wherein the flexible finger comprises:
A second support inserted between the neutral plane and the first wing and disposed on one side of the first direction;
A third support inserted between the neutral plane and the second wing and disposed on the other side of the first direction;
A nose cone disposed at an end of the flexible finger; And
An outer tube into which the first support is inserted;
Wherein the glenoid ligature dissection apparatus comprises:

The method of claim 3,
Wherein the first support comprises:
Extending in the second direction by a length of the flexible finger,
The height of the neutral plane being close to the inner diameter of the outer tube,
Wherein the two semicircular extensions except for the neutral plane have a plurality of slits formed in the second direction.

The method of claim 3,
Wherein the second support and the third support are made of a metal,
Wherein the semicircular cross section extends in the second direction by a length of the flexible finger,
A plurality of slits are formed in the second direction in the extension of the cross section except for a part of the cross section close to the neutral plane,
Wherein the plurality of slits are formed at positions corresponding to a plurality of slits formed in the first support body.

6. The method of claim 5,
Wherein the second support comprises:
A first through hole disposed at a position away from the neutral plane;
A second through hole disposed adjacent to the neutral plane; And
A third through hole in which the ligature is accommodated;
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And the third support body comprises:
And a fourth through hole disposed at a position away from the neutral plane.

The method according to claim 6,
A first wire connected to one end of the second support body adjacent to the nosecone and connected to the grip through the first through hole;
A second wire connected to the other end of the protruding finger and connected to the grip through the second through hole; And
A third wire connected to one end of the third support body adjacent to the nosecone and connected to the grip through the fourth through hole;
Wherein the glenoid ligature dissection apparatus comprises:

8. The method of claim 7,
And a compression spring disposed between both side surfaces perpendicular to the second direction of the plurality of slits formed in the third support body,
And the compression spring is inserted into the third wire.

9. The method of claim 8,
When the third wire is pulled to the maximum at the operating mechanism portion,
The flexible fingers are straightly extended,
If the third wire is loosely loosened,
A plurality of slits formed in the third support body are spread by the compression springs,
At the same time, a plurality of slits formed in the second support member are narrowed,
And the neutral plane is bent and dried in the first direction.

8. The method of claim 7,
When the second wire is pushed by the operating mechanism,
The protruding finger protrudes from the tip of the flexible finger,
When the second wire is pulled in the operating mechanism portion,
And the ligation lug connected to the tip of the protruding finger is protruded and inserted from the flexible finger by inserting the protruding finger into the flexible finger.

8. The method of claim 7,
When the third wire is pulled out from the operating mechanism portion,
The first wire is controlled to be loosened to a reduced size at a predetermined ratio with respect to the moving distance of the third wire,
When the third wire is loosened,
Wherein the first wire is controlled to be pulled by the reduced amount at the predetermined ratio.

The method according to claim 6,
The protruding fingers,
The termination is a "U" shaped ligature that is divided into two bifurcations and includes the government,
The ligation tool has a notch shape at one side of the temporary fixing part, and is formed so that the ligation tool can be inserted and fixed,
And the other branch exposes the ligation lap housed in the third through hole so that the ligation lap is straddled across the 'U' shaped upper end to facilitate catching of the ligation lap.

The method of claim 3,
Wherein the second support comprises:
And a slide groove formed on the neutral surface side so as to receive the protruding finger and to slide the protruding finger,
Wherein the protruding finger is formed from one end of the second support body and has a depth corresponding to the length of the protruding finger.

The method of claim 3,
Wherein the first support comprises:
And the elastic modulus in the first direction is less than 1% of the modulus of elasticity in the third direction.

The method of claim 3,
Wherein the first support comprises:
The metal spring plate material is press-formed and heat-treated to be molded,
Wherein the bending portion is formed so as to have a minimum radius of curvature that is curved and curled in the first direction and a middle radius of curvature that is straightened.

The method of claim 3,
Wherein the neutral plane includes a plurality of assembly through holes in the second direction,
And a plurality of pin-and-socket assemblies, which are assembled through the assembly through holes, are formed in the second support body and the third support body, respectively, so that the first to third support bodies are assembled around the neutral plane. Ligature anatomy.

The method of claim 3,
Wherein the second support and the third support are formed of a polymer resin,
Wherein the polymer resin comprises ultra-high molecular weight polyethylene (UHMW-PE).

8. The method of claim 7,
Wherein the operating mechanism portion
A first motor and a second motor;
A first screw connected to the first motor;
A first gear coupled to the first screw;
A third screw disposed in parallel with the first screw;
A second gear coupled to the third screw and meshing with the first gear;
A second screw connected to the second motor;
A first guide block, a second guide block, and a third guide block which are respectively threaded to the first screw, the second screw, and the third screw and to which the first wire, the second wire, and the third wire are connected, respectively;
A first guide pin formed in the second guide block so as to allow movement in only one direction, And
A tension spring connected between the second guide block and the fixed pin;
Wherein the gleason ligation dissection apparatus comprises:

19. The method of claim 18,
Wherein the gear ratio of the first gear and the second gear is set so that,
And a ratio of a distance of movement of the first wire and a distance of movement of the third wire according to bending of the flexible finger.

19. The method of claim 18,
Wherein the operating mechanism portion
The ligation yarn is fixed between the second guide block and the fixed pin,
As the second motor is driven, the second screw is rotated, the second guide block is moved, and the protruding finger and the ligature are moved together as the second wire is moved,
When the fixed pin is separated from the second guide block,
Wherein the ligation apparatus is configured such that only the ligature can be manually moved.

The flexible finger of claim 5;
A first wire;
A third wire; And
A plurality of compression springs;
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The second support body includes a first through hole disposed at a position distant from the neutral plane, the first wire is connected to the tip of the second support body, is connected to the grip through the first through hole,
Wherein the third support includes a fourth through hole disposed at a position distant from the neutral plane, the third wire is connected to the tip of the third support, is connected to the grip through the fourth through hole,
The plurality of compression springs being inserted into the third wire
A flexible finger dissection device.