TW201330819A - Medical treatment instrument - Google Patents

Abstract

A medical treatment instrument (10) comprises an incision opener body (30) and an adaptor (20). The incision opening body (30) is in the form of a cylinder and is retained in an incision. The adaptor (20) is removably mounted to an open end (32) of the incision opener body (30) to cover the open end (32). The adaptor (20) has a plurality of portions that are provided with openings (22a)-(22d) for receiving treatment tools for respective insertion into the interior of the incision opener body (30). The adaptor (20) can be mounted to the open end (32) at a mounting angle selected from a plurality of options. The relative positions of the openings (22a)-(22d) with respect to the incision opener body (30) are different when the adaptor (20) is mounted to the open end (32) at various mounting angles.

Description

Medical treatment equipment

The present invention relates to a medical treatment tool for use in an incision wound.

In laparoscopic surgery, a single treatment tool is performed by inserting a plurality of treatment tools such as forceps or optical devices into one incision wound, that is, a so-called single-hole operation. The surgical method remains in the incision wound of the patient's body surface, and the value of the cosmetic aspect is high. In order to prevent postoperative incision and incision, the incision is usually formed at the navel.

In addition, in recent years, special instruments for inserting a plurality of disposal tools in one incision wound have been developed (see Patent Documents 1 and 2). The implements include a cylindrical opener body that holds the incision wound open, and a cap-shaped adaptor having a plurality of small holes (ports) respectively inserted into the treatment tool.

On the other hand, in laparoscopic surgery, the excised organ (removed tissue) must be taken out of the body. When the excised tissue having a larger internal diameter than the opening is taken out, the excised tissue cannot pass through the opening, so that the pliers holding the excised tissue and the incisor body can be pulled out from the incision wound only to this end. Moreover, when there is a suspected cancer on the organ, in order to prevent the implantation of the cancer, the resected tissue is usually stored in the recovery bag in the abdominal cavity, and then the recovery bag and the starter body are pulled out from the wound opening. It is taken out. However, the operation of pulling the opener body from the incision of the wound is burdensome to the patient. In particular, when the multiple affected parts are removed and the tissue is removed In the case of the case, the opener body must be mounted and removed relative to the incision wound multiple times, so that the burden on the patient is large.

On the other hand, in the instruments described in Patent Documents 1 and 2, the adapter can be attached and detached with respect to the main body of the starter. Therefore, when the excised tissue is taken out, the adapter is directly detached from the ejector body by leaving the creator body in the incision wound, and the pliers or the recovery bag can be pulled out through the opening of the large diameter of the ejector body. Therefore, when the larger excised tissue or the recovery bag is taken out to the outside of the body, it is not necessary to repeatedly attach and detach the opener body to the abdominal wall. Therefore, the burden on the patient is small, and a rapid resection can be achieved.

As shown in FIG. 1, the apparatus described in Patent Document 1 pivots an adapter (valve plate) with respect to the starter body (holder body), whereby the projection is engaged with the engagement groove to mount the adapter. Further, as shown in Fig. 5 (b) or Fig. 6 (b) of Patent Document 1, the opening and the projection are arranged at equal angular intervals (120 degree intervals). Therefore, even if the mounting angle of the adapter is not particularly noted, the position of the opening relative to the position of the starter body can be fixed constantly.

Moreover, as shown in FIG. 10 (Fig 11) or FIG. 16 (Fig 17), the adapter (20) provided with a plurality of ports (25-28) can be embedded into the opener at an arbitrary angle. The body (2) is thus detachably mounted. Specifically, it is disclosed that, as shown in FIG. 10 of Patent Document 2, a connection base (80) having a plurality of elastic projections (91) formed around it is attached to the ring (6) in a snap-fit manner. The aspect, and the aspect in which the O-ring (53) is inserted into the coupling ring (54) as shown in FIG.

Prior technical literature Patent literature

Patent Document 1: Japanese Patent Laid-Open Publication No. 2002-28163

Patent Document 2: International Publication No. 2008/149332

When a patient is removed from the stomach, the gallbladder, the large intestine, and the like by a pneumoperitoneum operation in a single-hole operation in which a wound is formed on the navel, etc., each time a plurality of ports are selected each time from the affected part of the subject. Insert the pliers for holding or the scalpel for resection. Auxiliary pliers or optical devices are usually inserted into other ports.

Therefore, when the adapter is detachably mounted on the starter body that is placed in the incision wound, it is required to satisfy the following two opposite requirements: the stability of the operation when repeatedly entering the specific organ in the treatment, And the realization of the diversity of operations that can be easily accessed into a variety of organs.

However, in the instrument of Patent Document 1, the position of the opening of the instrument with respect to the position of the starter body is often reproduced on the same equilateral triangle. Therefore, it becomes difficult to enter due to the position of the affected part, for example, the affected part on the extension line of the two ports. .

Further, in the device of Patent Document 2, since the adapter is attached to the starter body at an arbitrary angle, the adapter has no reproducibility with respect to the attachment angle of the starter body. Therefore, there is a problem that the positional relationship between the organ and the port changes every time when the adapter is removed from the device for a plurality of times and the tissue is removed.

The present invention has been made in view of the above-mentioned problems, and provides a stabilization of a disposal operation when a member is repeatedly introduced into a treated organ through a port. Medical treatment tools that are realized together with the realization of the entry of various organs.

(1) The medical treatment tool of the present invention is characterized by comprising: a cylindrical opener body that is left in the incision wound; and an adapter that is detachably attached to the open end of the above-described starter body to The opening end is closed; and the opening is disposed at a plurality of locations of the adapter, wherein the disposal device is respectively inserted into the inside of the starter body; and the adapter can be selectively selected from a plurality of types The angle is attached to the opening end portion, and when the adapter is attached to the open end portion at each of the installation angles, the positional relationship of the through port with respect to the starter body is different from each other.

In the above invention, the same positional relationship of the plurality of ports with respect to the starter body means that the plurality of ports are disposed at the rotationally symmetrical position, and the arrangement position of the appearance of the set angle port of the adapter is also changed. Conversely, the difference in positional relationship of the ports with respect to the ingenerator body means that the arrangement position of the plurality of ports changes according to the ingenerator body.

According to the above invention, the setting angle of the adapter is selected so that the slight change in the relative position of the actuator body and the opening is prevented, and the position of the opening relative to the position of the starter body is reproduced. Further, since the selection of the setting angle of the adapter is changed by the positional relationship of the opening with respect to the main body of the actuator, the arrangement position of the opening is varied.

In the medical treatment tool of the present invention, as a more specific aspect: (2) the above-described opener body includes an expansion mechanism that holds the above-mentioned incision wound In a state of being expanded in a specific opening direction; and at a plurality of the above-mentioned setting angles, the positional relationship of the opening with respect to the opening direction of the incision can be different from each other. (3) an angle formed by the vertical bisector of the line segment connecting the first port and the second port to the opening direction when the adapter is attached to the open end portion by any one or more of the set angles It can also be 115 degrees ± 20 degrees. (4) At least the first to third through-ports disposed on the substantially equilateral triangle are included, and the set angle may be selected from four or more. (5) A plurality of valve members that can be inserted into the disposal tool may be respectively disposed at the above-mentioned ports. (6) The adapter includes a flexible top plate portion that covers the open end portion; the top plate portion is provided with the first port and the second port, and the valve member may also include The top plate portion is made of a harder material. (7) Further, on the straight line passing through the first opening and parallel to the vertical bisector, the valve member may further have another opening that is different in height from the first opening. (8) Further comprising a locking mechanism for rotating the adapter in a non-locking state in which the adapter abuts the opening end to rotate the adapter in a direction of a shaft rotation relative to the starter body by a specific angle The adapter is locked to the above-described starter body in a locked state. (9) An index portion indicating an extending direction of the vertical bisector in the locked state may be provided before the vertical bisector is further advanced from the axial rotation direction by the specific angle.

In the above invention, the positional relationship of the opening with respect to the opening direction of the incision wound is different from the movement direction of the expansion mechanism, and the arrangement position of the plurality of openings changes.

The various constituent elements of the present invention need not exist independently, and are allowed to be complex. A plurality of constituent elements are formed as one member, one constituent element is formed of a plurality of members, a certain constituent element is one of the other constituent elements, and one of the constituent elements is partially overlapped with one of the other constituent elements.

According to the present invention, in the case where the organ in the treatment is repeatedly passed through the opening, the position of the opening relative to the position of the starter body is reproduced, so that the treatment operation can be stably performed. Further, since the selection of the setting angle of the adapter is changed by the positional relationship of the opening with respect to the main body of the ejector, various entry of various organs is realized.

The above and other objects, features, and advantages of the invention will be apparent from the appended claims appended claims

Hereinafter, embodiments of the present invention will be described based on the drawings. In the drawings, the same components are denoted by the same reference numerals, and the description is omitted as appropriate.

1A and 1B are perspective views showing an example of a medical treatment tool 10 according to an embodiment of the present invention. More specifically, FIG. 1A shows a state in which the adapter 20 is separated from the starter body 30, and FIG. 1B shows a state in which the adapter 20 is attached to the starter body 30.

2A to 2C are plan views showing a state in which the medical treatment tool 10 of the present embodiment is left in the incision incision INC (incision). 2A is a plan view of the incision wound INC formed along the midline ML of the patient by way of a navel BT (not shown in the drawing. See FIG. 5). In FIG. 2A, the medical treatment tool 10 is indicated by a hollow arrow. The opening direction OD of the wound opening of the wound INC will be cut. FIG. 2B is a plan view showing a state in which the medical treatment tool 10 is placed in the incision wound INC. 2C shows that the incision wound INC is pulled in the radial direction in the direction of the arrow (arrow direction) by the expansion mechanism (stretching belt 34) of the medical treatment tool 10, and is expanded to a substantially circular shape in the opening direction OD (hollow arrow). The plan of the state. Furthermore, the adapter 20 can be attached to the starter body 30 when the tensioning belt 34 shown in Fig. 2C is pulled. Alternatively, the stretch band 34 of the starter body 30 can be pulled in a state where the adapter 20 is separated from the starter body 30.

First, the outline of the medical treatment tool 10 of the present embodiment will be described.

The medical treatment tool 10 of the present embodiment includes the starter body 30 and the adapter 20. The introducer body 30 is formed into a cylindrical shape and is left in the incision wound INC. The adapter 20 is detachably attached to the open end 32 of the starter body 30, and the open end 32 is closed. Further, at a plurality of portions of the adapter 20, ports 22a to 22d for inserting a treatment tool (not shown) into the inside of the starter body 30 are provided. In the medical treatment tool 10 of the present embodiment, the adapter 20 can be attached to the open end portion 32 from a plurality of selectively selected installation angles, and the adapter 20 can be attached to the open end portion 32 at various installation angles. In the case of the case, the positional relationship of the ports 22a to 22d with respect to the starter body 30 is different from each other.

Next, the medical treatment tool 10 of the present embodiment will be described in detail.

The medical treatment tool 10 is used to maintain and protect the incision wound INC in an open state, and to assist in observation and washing in the abdominal cavity. Appliances for various treatments such as resection, indwelling and recycling of appliances.

The starter body 30 is a member that is attached to the incision wound INC so as to sandwich the surface and the back surface of the abdominal wall, and that imparts a force in the diameter direction to the incision wound INC and expands the diameter. The specific structure of the starter body 30 is not particularly limited. As an example, the starter body 30 of the present embodiment includes a cylindrical member 33 having airtightness and flexibility, and both ends of the cylindrical member 33. The first fixing member 37 and the second fixing member 38. Further, on the starter body 30, a plurality of tensile bands 34 spanning the two fixing members are provided. The stretch band 34 is provided inside the cylindrical member 33.

Each of the first fixing member 37 and the second fixing member 38 is formed in a flat ring shape. The first fixing member 37 is inserted into the inside of the abdominal cavity by the incision wound INC, and the member constituting the opening end portion 35 is used in close contact with the back surface of the abdominal wall. The second fixing member 38 is a member constituting the opening end portion 32 and is used in close contact with the surface (body surface) of the abdominal wall. The tubular body member 33 of the starter body 30 is coaxially coupled to the annular first fixing member 37 (opening end portion 35) and the second fixing member 38 (opening end portion 32) to form a tubular shape. Here, the tubular shape may be a cylindrical shape or a rectangular tubular shape.

The front end portion (the lower end portion in FIGS. 1A and 1B) of the stretch band 34 is fixedly coupled to the first fixing member 37. Further, the end portion (the upper end portion in FIGS. 1A and 1B) of the stretch band 34 is inserted through the second fixing member 38 from the inner side in the diameter direction toward the outer side. Each of the tension band 34 and the second fixing member 38 is provided with a ratchet structure (not shown) that allows the end portion of the tension band 34 to be pulled out toward the outer side in the diameter direction of the second fixing member 38, Conversely, the tendency of the end portion of the stretch band 34 to return to the inner side in the diameter direction is restricted Swipe. Further, by pulling the distal end portion of the stretch band 34 to the outer side in the radial direction with respect to the second fixing member 38, the first fixing member 37 is raised to be shortened from the interval between the second fixing member 38. At this time, the outer tubular member 33 is folded into a bellows shape outside the stretch band 34. When the end portions of the four tensile bands 34 are simultaneously or in the same length, the first fixing member 37 is directly adjacent to the second fixing member 38 toward the second fixing member 38.

Here, the first fixing member 37 is inserted into the incision wound opening INC, and the stretching band 34 is pulled in a state where the abdominal wall is loosely held by the first fixing member 37 and the second fixing member 38, whereby the first fixing member 37 and the second fixing member 38 are in close contact with the back surface and the surface of the abdominal wall. As a result, the through holes of the annular first fixing member 37 and the opening end portions 35 and 32 of the second fixing member 38 are formed on the inner side of the incision wound INC. The excised tissue is removed from the body to the outside of the body through the through hole.

For the first fixing member 37 and the second fixing member 38, vinyl chloride resin, polyurethane resin, polyamide resin, polyethylene resin, polypropylene resin, polyacetal resin, acrylonitrile-butadiene-styrene are used. Copolymer (ABS, Acrylonitrile-Butadiene-Styrene) resin, hydrogenated styrene-based thermoplastic elastomer (SEBS, Styrene-Ethylene/Butylene-Styrene block copolymer, styrene-ethylene/butylene-styrene block copolymer) resin, poly A resin material such as silicone rubber or a metal material such as stainless steel.

The cylindrical member 33 includes a film having a wall thickness of 0.05 mm or more and 3 mm or less. The material of the tubular member 33 is preferably a resin material such as a soft vinyl chloride resin, a polyurethane resin, a polyethylene resin, a polyamide resin, a polypropylene resin, a polyester resin, a SEBS resin, a polyoxyethylene rubber, or a natural rubber.

The adapter 20 is detachably attached to the open end 32 of the starter body 30 to cover it to thereby hermetically cover the member that cuts the wound INC. Here, the adapter 20 is disposed such that the open end 32 covers the finger adapter 20 closer to the side of the open end 32 than the tubular member 33. Moreover, the adapter 20 is detachably attached to and detached from the creator body 30 with the ejector body 30 remaining on the abdominal wall.

3A is a top perspective view of the adapter 20. Figure 3B is an arrow view of Figure 3A. 3C is a bottom perspective view of the adapter 20.

The adapter 20 includes a top plate portion 21, a plurality of through holes 22a to 22d formed to protrude from the top plate portion 21, and a plurality of engaging convex portions 26 surrounding the top plate portion 21. The adapter 20 of the present embodiment is formed in a substantially circular shape in plan view, and the engagement convex portions 26 are formed at four positions at intervals of 90 degrees. The engaging convex portion 26 is a protruding piece formed to protrude inward in the radial direction with respect to the adapter 20.

The top plate portion 21 is a member that covers the open end portion 32 on the upper end (proximal) side of the opener body 30. The ports 22a to 22d are provided in the top plate portion 21. The ports 22a to 22d respectively include a tubular portion 23 and valve members 24 and 25. The tubular portion 23 is formed to protrude from the upper surface of the top plate portion 21. The lower end of the tubular portion 23 is connected to the ports 22a to 22d. A treatment tool such as a forceps or a scalpel is inserted from the upper end of the tubular portion 23. The valve members 24 and 25 are disposed inside the tubular portion 23. One or both of the valve members 24 or 25 are in close contact with the treatment tool inserted into the tubular portion 23. Thereby, the gas filled in the abdominal cavity is prevented from leaking from the ports 22a to 22d during the operation of the disposal tool.

A locking portion 36 constituting a locking mechanism of the adapter 20 is provided around the annular second fixing member 38 of the starter body 30. The locking portion 36 includes a card The stopper piece 36a, the notch recessed part 36b, and the inclined surface part 36c. The locking piece 36a is adjacent to the tab of the notch recess 36b formed on the circumferential surface of the second fixing member 38, and is abutted in the circumferential direction with respect to the engaging convex portion 26, thereby locking the adapter 20 At the site. The slanted surface portion 36b is formed with a slope portion 36c on the opposite side of the locking piece 36a. The inclined surface portion 36c is a tab formed on the circumferential surface of the second fixing member 38, and is inclined downward in the axial direction. At the lowermost end of the inclined surface portion 36c, a notched recess 36b is formed via a discontinuous step.

The locking portion 36 (the locking piece 36a) is formed at a position corresponding to the engaging convex portion 26. Specifically, the second fixing member 38 is formed at four intervals at intervals of 90 degrees. Further, in the notch recessed portion 36b, the reinforcing rib 36d is formed to protrude outward in the radial direction.

As described below with reference to Fig. 7, in the medical treatment tool 10 of the present embodiment, the adapter 20 is placed in the right-hand spiral direction with respect to the starter body 30 (clockwise when the adapter 20 is viewed in plan). In the case of screwing, the engaging convex portion 26 abuts against the locking piece 36a and is locked. Specifically, if the adapter 20 is rotated in the axial rotation direction (clockwise direction) with respect to the starter body 30, the first engaging convex portion 26 is slowly pressed by the inclined surface portion 36c, and the adapter 20 is opposed to the adapter 20 The starter body 30 (second fixing member 38) is hooped. When the adapter 20 is further rotated in the clockwise direction, the engaging convex portion 26 passes over the inclined surface portion 36c to reach the notch concave portion 36b. Here, since the circumferential length of the notch concave portion 36b is larger than the circumferential length (width dimension) of the engagement convex portion 26, the engagement convex portion 26 is fitted into the notch concave portion 36b. Further, if the adapter 20 is further rotated in the clockwise direction, the engaging convex portion 26 is inserted into the notch concave portion 36b, and the card is inserted. It is locked by the locking piece 36a (refer to FIG. 1B). The second fixing member 38 is reinforced in the diametrical direction by the rib 36d, and the engaging convex portion 26 of the adapter 20 is surely fitted into the notch concave portion 36b and locked by the locking piece 36a to be locked. Therefore, according to the medical treatment tool 10 of the present embodiment, the user can lock the adapter 20 to the starter body 30 while feeling the feeling that the adapter 20 is hooped. Therefore, the mounting angle of the adapter 20 can be confirmed at the time of installation, in other words, the erroneous mounting of the adapter 20 such as the opening positions 22a to 22d can be prevented from becoming an arrangement position other than the assumption.

On the other hand, when the adapter 20 is rotated relative to the starter body 30 in the opposite direction (counterclockwise direction) about the axis, the engaging convex portion 26 is unlocked by the notch recess 36b, and the adapter 20 becomes The self-creator body 30 is separated (refer to FIG. 1A). The engaging convex portion 26 and the locking piece 36a are arranged at four intervals at intervals of 90 degrees, so that the adapter 20 can selectively select the angle of the setting from the plurality of (four types) with respect to the open end of the starter body 30. 32 (second fixing member 38) is mounted.

As shown in FIGS. 3A and 3C, a plurality of valve members 24, 25 through which the treatment tool can be inserted are provided in the ports 22a to 22d, respectively. The valve members 24 and 25 are respectively provided on the upper edge side and the lower edge side of the ports 22a to 22d. In each of the ports, the valve members 24 and 25 are disposed apart from each other. The valve member 24 is disposed on the upper end side than the valve member 25. The valve members 24, 25 include a piercing through the insertion device and a baffle that blocks the insertion hole in a natural state. For example, the valve member 24 is a leaf valve that is opened through the socket, and the valve member 25 is a duckbill valve or a cross valve. The insertion hole of the valve member 24 is a circular hole that is isotropically contracted or elongated in the diameter direction. The valve member 25 is a duckbill valve or a cross valve, so that it is in a specific direction or two The direction is contracted or elongated. That is, the opening and closing directions of the valve members 24 and 25 are different from each other (not the same). Therefore, the two valve members are not simultaneously separated from the disposal tool from the state in which the valve members 24 and 25 are closely adhered to the periphery of the treatment tool. Thus, when various treatments are performed under the pneumoperitoneum, it is preferable to prevent degassing around the treatment tool. Further, the valve members 24 and 25 support the treatment tool and become a fulcrum during operation. In particular, the valve member 24 that protrudes upward from the top plate portion 21 is used as a fulcrum to operate the surgical tool.

The top plate portion 21 is a member having a flexible flat film shape. The top plate portion 21 is flexibly deformed, whereby the ports 22a to 22d are displaced. Therefore, in the single-hole operation, the position and direction of the treatment tool inserted into the ports 22a to 22d can be freely operated.

The material of the top plate portion 21 and the valve members 24 and 25 may be selected from a hard resin such as vinyl chloride resin, polyurethane resin, polyethylene resin, polypropylene resin, polyacetal resin, polycarbonate resin or polyfluorene resin, or polyoxyl oxide. Synthetic rubber such as rubber, natural rubber and nitrile rubber. The material of the valve members 24, 25 is preferably harder than the material of the top plate portion 21. Thereby, when the treatment tool inserted into the tubular portion 23 is operated, the top plate portion 21 is directly bent while maintaining the state in which the valve members 24 and 25 are in close contact with the treatment tool, and the displacement of the openings 22a to 22d is allowed. Therefore, according to the medical treatment tool 10 of the present embodiment, the patient's pneumoperitoneum state can be maintained, and the operation of the treatment tool can be realized freely. As an index of the material of the valve members 24, 25 being harder than the material of the top plate portion 21, it is preferable that the hardness of the hardness of the valve members 24, 25 is higher than that of the hardness of the top plate portion 21. More specifically, it is preferable that the hardness A of the valve members 24 and 25 is 40 or more and 70 or less, and the hardness A of the top plate portion 21 is 30 or more and 60. Hereinafter, the durometer A hardness of the valve members 24, 25 is higher than that of the top plate portion 21 by the hardness A. The hardness A hardness of the valve members 24 and 25 and the top plate portion 21 can be measured by a method prescribed by JIS (Japanese Industrial Standards) K6253 and ISO (International Standardization Organization) 7619.

Examples of the treatment tool include a forceps for gripping, a scalpel for cutting, a forceps for assisting, an optical device, or a trocar (sleeve) for inserting the same, but the present invention is not limited thereto.

The arrangement of the ports 22a to 22d of the present embodiment will be described. Fig. 4 is a plan view showing the indwelling state of the medical treatment tool 10, corresponding to Fig. 2C. The illustration of the incision wound INC is omitted. The ports 22a to 22d arranged in the clockwise direction as shown in Fig. 4 are referred to as first to fourth ports in order.

The adapter 20 includes at least a first through third port 22a to a third port 22c disposed on a substantially equilateral triangle. Further, as described above, the installation angle of the adapter 20 with respect to the starter body 30 is selected from four or more (four in the present embodiment). Therefore, by changing the set angle of the four-time adapter 20, the direction of the triangle drawn by the first port 22a, the second port 22b, and the third port 22c changes four times.

In the medical treatment tool 10 of the present embodiment, the positional relationship of the ports 22a to 22d with respect to the starter body 30 differs depending on the respective installation angles selected from a plurality of types (up to four types). In most of the four types, the positional relationship of any two types of ports 22a to 22d with respect to the starter body 30 may be different, and it is preferably in all of the plurality (four types) as in the present embodiment. The positional relationship of the ports 22a to 22d is different.

Furthermore, the first through-port 22a to the third through-port 22c are located on a substantially equilateral triangle and refer to the line segment LS of the adapter 20 shown in FIG. 4 to connect the centers of any two of the ports to each other. The third vertex of the equilateral triangle as one side is located inside the other port. Specifically, in the present embodiment, the third vertex of the equilateral triangle having the center of the first port 22a as the first vertex and the center of the second port 22b as the second vertex is located inside the third port 22c. . Further preferably, the third apex is located inside the valve member 24 or 25 (see Fig. 4).

The vertical bisector PB (perpendicular bisection) of the line segment LS connecting the first port 22a and the second port 22b passes through the third port 22c in a plan view of the adapter 20. In other words, the third port 22c is present above the vertical bisector PB of the line segment LS connecting the first port 22a and the second port 22b.

Further, the adapter 20 is provided with a fourth port 22d on a straight line (parallel line PL) that passes through the first port 22a and is parallel to the vertical bisector PB. In other words, the parallel line PL passes through the fourth port 22d in plan view of the adapter 20.

In other words, the expander main body 30 of the present embodiment includes an expansion mechanism (stretching belt 34) that holds the incision wound in the state of being expanded in the specific opening direction OD. The positional relationship of the ports 22a to 22d with respect to the opening direction OD of the incision wounds INC is different from each other at a plurality of setting angles. In other words, when the adapter 20 is locked at a certain angle with respect to the starter body 30 fixed to the incision INC, the center of each of the ports 22a to 22d is a quadrangle of the apex, and relative to The starter body 30 is carded at another set angle The above quadrilateral shape in the case of the adapter 20 is not completely identical. The adapter 20 of the present embodiment and the starter body 30 are locked to each other at four installation angles. The above quadrilaterals at the four set angles are all different from each other. In this way, it is possible to select the port arrangement of the affected part that is most suitable for the treatment from among the four types in the present embodiment.

The reason why the above-described arrangement of the first to fourth ports 22a to 22d is preferable will be described.

In a single-hole operation, a forceps for gripping is inserted into one of the two ports that are equal to the organ to be treated (the affected part), and the scalpel for cutting is inserted in the other. can. The organ of the subject is grasped by the forceps and lifted, thereby imparting tension to the organ to preferably perform the removal by the scalpel. Therefore, in the case of the present embodiment, the affected part of the treatment target is placed on the vertical bisector PB of the line segment LS connecting the first port 22a and the second port 22b, and the treatment of the affected part is preferably performed. In addition, in the case of removing the affected part, the case where the medical jig or the like is left in the affected part or the affected part is the same, as long as the gripping pliers are inserted from a through port, and the organ is aligned with the opening and facing the organ The other port can be inserted into each treatment tool.

On the other hand, in the single-hole type operation, it is preferable to insert an optical device such as a CCD (Charge Coupled Device) camera at a position where the treatment tool inserted from the two ports is shielded from the field of view. Therefore, in the medical treatment tool 10 of the present embodiment, the third opening 22c is disposed on the vertical bisector PB of the line segment LS, and can be substantially equally spaced from the first and second openings 22a and 22b. Insert the optics at the location.

Further, the fourth port 22d is disposed at a position spaced apart from the first port 22a and the third port 22c, thereby suppressing interference between the disposal members. Therefore, the fourth port 22d is formed between the first port 22a and the third port 22c, in other words, along the vertical bisector PB and behind the first port 22a, that is, on the parallel line PL and relative to the line segment. The LS is on the same side as the third port 22c.

Here, for the incision of the wound INC, it is required to reduce the cutting length as much as possible to reduce the burden on the patient, and to fully expand the diameter to ensure a wide movable area of the disposal tool. From this point of view, it is preferable to form the incision wound INC into a shape as shown in FIG. 2A, and to expand it radially by the starter body 30. Furthermore, when the incision wound INC is formed into a cross shape, the incision can be expanded to a square shape having the four end points of the cross as a vertex.

The introducer body 30 can be mounted at any angle relative to the incision wound INC. 2 and 4, a state in which a cut-shaped wound incision INC (not shown) is formed on the abdominal wall along the median line ML, and the axis C of the medical treatment tool 10 and the wound opening INC are The epilator body 30 is secured to the incision wound INC in a centrally consistent manner.

At this time, the starter body 30 is fixed to the incision wound INC by the four stretch bands 34 disposed at an angle at which the median line ML is at the mirror symmetry of the axis of symmetry. In other words, the medical treatment tool 10 is fixed to the abdominal wall in such a manner that the stretching direction of the stretching belt 34 is mirror-symmetrical with respect to the median line ML.

Further, in the state in which the incision wound INC is fixed to the starter body 30, the four stretching bands 34 are simultaneously or sequentially pulled, whereby the wound opening INC is expanded in the opening direction OD in a direction orthogonal to the center line ML.

The adapter 20 is mounted at an installation angle selected from a plurality of (four in the present embodiment) with respect to the open end portion 32 of the starter body 30 fixed to the incision wound INC in this manner.

Further, when the adapter 20 is attached to the open end portion 32 at any one or more of the installation angles (refer to FIG. 4), the vertical bisector PB of the line segment LS connecting the first port 22a and the second port 22b is connected. The angle θ ₁ formed by the opening direction OD of the incision wound INC is preferably 115 degrees ± 20 degrees, that is, 95 degrees or more and 135 degrees or less. Further, the angle θ ₂ formed by the line segment LS connecting the first port 22a and the second port 22b and the median line ML is preferably 115 degrees ± 20 degrees. Further, the angle θ ₁ and the angle θ _{2 are} preferably 115 degrees ± 10 degrees, that is, 105 degrees or more and 125 degrees or less. In the case of the present embodiment, the opening direction OD is orthogonal to the center line ML, and the vertical bisector PB is orthogonal to the line segment LS, so the angle θ ₁ is equal to the angle θ ₂ .

Here, the angle θ ₁ and the angle θ 2 are directional angles. The angle θ ₁ is measured in the counterclockwise direction to the angle of the vertical bisector PB with respect to the right direction of the body BOD (body) (zero degree). The angle θ ₂ is an angle measured in the counterclockwise direction to the line segment LS with respect to the direction (zero degree) from the axis C (navel) of the medical treatment tool 10 in the midline ML.

Since the angle θ ₁ and the angle θ ₂ are 115 degrees ± 20 degrees, the medical treatment tool 10 of the present embodiment is particularly suitable for the treatment of the gallbladder GB. The reason will be described using FIG. 5 and FIG. 6.

Fig. 5 is a schematic view showing the body BOD of the patient. The gallbladder GB and the stomach ST (stomach) are schematically illustrated in FIG. Cut wounds INC formed in the body On the median line ML of the BOD, the initiator body 30 is placed in the incision wound INC at the same mounting angle as in Figures 2C and 4. Specifically, the opening direction OD of the incision wound INC coincides with the orthogonal direction of the median line ML (the left and right direction of the body BOD). The mounting angle of the adapter 20 with respect to the starter body 30 is also the same as that of FIGS. 2C and 4 (hereinafter referred to as a first mounting angle).

Fig. 6 shows a state in which the starter body 30 is fixed to the incision wound INC, and the other mounting angle (hereinafter referred to as the second mounting angle) is directly selected to fix the adapter 20 to the starter body 30. More specifically, the second mounting angle shown in FIG. 6 is an angle formed by advancing the first mounting angle shown in FIG. 5 by 90 degrees in the clockwise direction.

As described above, at the first mounting angle shown in FIG. 5, the vertical bisector PB of the line segment LS connecting the first port 22a and the second port 22b and the opening of the wound opening by the stretching band 34 are opened. The angle θ ₁ formed by the direction OD is 115 degrees ± 20 degrees. Therefore, in the representative use aspect of the medical treatment tool 10 shown in FIG. 5, the extending direction of the vertical bisector PB when the adapter 20 is set at the first mounting angle is directed to the gallbladder GB. In FIG. 5, the incision incision INC is formed with the navel BT as the center and formed along the median line ML, and the epilator body 30 is left by the direction in which the opening direction OD of the stretching band 34 coincides with the orthogonal direction of the median line ML. Moreover, the medical treatment tool 10 provided with the adapter 20 at the first mounting angle shown in FIG. 5 can be equal to the first port 22a and the second port 22b opposite to the gallbladder GB, respectively. Insert the forceps and the scalpel, so it is suitable for the treatment of the gallbladder GB. That is, at the first mounting angle, the gripping forceps can be inserted from the first port 22a and the gallbladder GB can be lifted, and the scalpel can be inserted from the second port 22b to preferably remove the cystic duct of the gallbladder GB.

Moreover, the direction in which the vertical bisector PB extends when the adapter 20 is mounted on the starter body 30 at the second mounting angle as shown in FIG. 6 is directed to the greater curvature GC of the stomach ST. Therefore, according to the medical treatment tool 10 in which the adapter 20 is provided at the second mounting angle, the pliers and the scalpel inserted from the first port 22a and the second port 22b can be used, and the pylorus PY from the stomach ST ( Pylorus) to the Big Bend GC is preferably disposed of.

The vertical bisector PB is directed to the vicinity of the rectum at a third mounting angle formed by the second mounting angle and further 90 degrees in the clockwise direction, so that the disposal tool can be inserted from the first opening 22a and the second opening 22b. Preferably, the treatment of the rectum is performed. Further, the vertical bisector PB is directed to the large intestine at a fourth mounting angle formed by advancing 90 degrees in the clockwise direction from the third mounting angle, and thus can be inserted by the first port 22a and the second port 22b. The treatment of the large intestine is preferably carried out.

In other words, according to the medical treatment tool 10 of the present embodiment, the plurality of organs, such as the gallbladder GB and the stomach ST, which are exemplified above, can be treated as a treatment by the attachment angle of the plurality of selection adapters 20 with respect to the starter body 30. The subject is preferably subjected to a single-hole procedure. Further, since the adapter 20 is detachably attached to the starter body 30, the adapter 20 can be removed from the opener body 30 by the large-diameter open end 32 by the removal of the organ. Therefore, according to the medical treatment tool 10 of the present embodiment, the operation can be performed in a series of operations from the pneumoperitoneum in which the adapter 20 is attached, and the operation of the adapter 20 is removed, and the operation is performed under direct vision. Remove the organ.

Further, according to the present embodiment, when the adapter 20 that has been temporarily detached is attached to the starter body 30 again, the positional relationship between the ports 22a to 22d and the organ is reproduced as long as the selection of the attachment angle is made common. The reason for this is that the adapter 20 is fixed to the starter body 30 at the same position by the engaging convex portion 26 and the locking portion 36 (the locking piece 36a).

Here, in the case where the adapter 20 is repeatedly attached to the starter body 30, the index portion 29 is provided in the medical treatment tool 10 of the present embodiment in order to prevent the selection of the attachment angle from being erroneously changed (refer to Figure 4).

7A and 7B are plan views illustrating a method of mounting the adapter 20 using the index unit 29.

FIG. 7A shows the non-locked state in which the adapter 20 abuts against the open end 32. FIG. 7B shows the locked state in which the adapter 20 is locked to the starter body 30. The non-locking state of FIG. 7A causes the adapter 20 to rotate a certain angle φ with respect to the starter body 30 in the axial rotation direction (clockwise direction in this embodiment), whereby the adapter 20 becomes as shown in FIG. 7B. The card is in a locked state. In the locked state, the locking mechanism (the engaging projection 26 and the locking portion 36) locks the adapter 20 to the starter body 30.

The state in which the non-locking state locking mechanism (the engaging convex portion 26 and the locking portion 36) is not engaged with each other is a state in which the adapter 20 is temporarily pressed against the starter body 30. The specific non-locking state can be variously used. In the medical treatment tool 10 of the present embodiment, the engaging convex portion 26 of the adapter 20 and the locking portion 36 of the starter body 30 are maximally offset from each other. The state is shown in Fig. 7A as a non-locked state. In other words, the non-locking state illustrated in FIG. 7A is a state in which the engaging convex portion 26 and the locking portion 36 are spaced apart by 45 degrees, the above specific angle It is 45 degrees.

Here, the index portion 29 indicates the extending direction of the vertical bisector PB in the locked state shown in FIG. 7B. The index portion 29 is disposed at a specific angle from the vertical bisector PB More in the direction of the axis of rotation (clockwise). That is, the direction in which the adapter 20 is temporarily crimped to the direction indicated by the index portion 29 in FIG. 7A of the starter body 30 and the vertical bisector PB in FIG. 7B in which the adapter 20 is surely mounted on the starter body 30 The direction pointed is the same.

Therefore, when the adapter 20 is repeatedly attached or detached to the starter body 30 and the excised tissue (the gallbladder GB) is taken out from the incision wound INC, the adapter 20 can be surely attached to the starter body before installation. The position of the ports 22a to 22d at the time of 30. Thereby, the erroneous selection of the mounting angle with respect to the adapter 20 can be prevented, so that the burden on the patient due to reinstallation can be avoided.

Further, the index portion 29 of the present embodiment is a mark for indicating the direction of the vicinity of the outer periphery of the top plate portion 21 of the adapter 20, which is merely an example. As another example of the indicator unit 29, the angular direction of the adapter 20 can be recognized by color or character display or the like.

Furthermore, the present invention is not limited to the above-described embodiments, and various modifications and improvements are also included as long as the object of the present invention is achieved.

Fig. 8 is a top perspective view of the adapter 20 of the modification. On the straight line (parallel line PL) passing through the first port 22a and parallel to the vertical bisector PB, there is further another port (fourth port 22d). Moreover, the height at which the valve member 24 of the fourth port 22d is formed is different from the height at which the valve member 24 of the first port 22a is formed. In other words, the adapter 20 is opposite to the top plate portion. The formation height of the valve member 24 at the upper position of 21 is different between the first port 22a and the fourth port 22d. Here, the valve member 24 serves as a fulcrum of the treatment tool inserted into the ports 22a to 22d. Therefore, the heights of the fulcrums are made different on the first opening 22a and the fourth opening 22d which are arranged adjacent to each other in the extending direction of the vertical bisector PB, thereby preferably preventing the disposal members from interfering with each other.

More specifically, the protruding height of the first opening 22a from the top plate portion 21 is lower than the protruding height of the second to fourth ports 22b to 22d. Therefore, the movable area of the treatment tool inserted into the first port 22a is enlarged. For the same reason, the first port 22a may be formed to have a larger diameter than the fourth port 22d to enlarge the movable region of the distal end portion of the treatment tool.

10‧‧‧Medical treatment equipment

20‧‧‧Adapter

21‧‧‧ top board

22a‧‧‧ mouth

22b‧‧‧ mouth

22c‧‧‧ mouth

22d‧‧‧ mouth

23‧‧‧Cylinder

24‧‧‧ valve components

25‧‧‧ valve components

26‧‧‧Clamping convex

29‧‧‧ indicator department

30‧‧‧Creator body

32‧‧‧Open end

33‧‧‧Cylinder members

34‧‧‧ stretching tape

35‧‧‧Open end

36‧‧‧Cards

36a‧‧‧ card stop

36b‧‧‧ notch recess

36c‧‧‧Bevel

36d‧‧‧ rib

37‧‧‧First fixed member

38‧‧‧Second fixed component

BOD‧‧‧ body

BT‧‧‧ belly button

C‧‧‧Axis

GB‧‧‧ gallbladder

GC‧‧‧Big Bend

INC‧‧‧ cut wounds

LS‧‧ ‧ line segment

ML‧‧‧中中线

OD‧‧‧Open direction

PB‧‧‧ vertical bisector

PL‧‧‧ parallel lines

PY‧‧ 幽门

ST‧‧‧ stomach

θ ₁ ‧‧‧ angle

θ ₂ ‧‧‧ angle

‧‧‧angle

Fig. 1A is a perspective view showing a state in which an adapter is separated from a starter body. Fig. 1B is a perspective view showing a state in which the adapter is attached to the starter body.

Figure 2A is a plan view of the incision wound. Fig. 2B is a plan view showing a state in which a medical treatment tool is placed in the incision wound. Fig. 2C is a plan view showing a state in which the incision wound is expanded by using a medical treatment tool.

Figure 3A is a top perspective view of the adapter. Figure 3B is an arrow view of Figure 3A. Figure 3C is a bottom perspective view of the adapter.

Fig. 4 is a plan view showing the state of indwelling of the medical treatment tool.

Fig. 5 is a schematic view showing a state in which a medical treatment tool is placed at a first attachment angle.

Fig. 6 is a schematic view showing a state in which a medical treatment tool is placed at a second attachment angle.

Fig. 7A is a plan view showing the non-locked state in which the adapter is brought into contact with the open end. Fig. 7B is a plan view showing the locked state in which the adapter is locked to the starter body.

Fig. 8 is a top perspective view of the adapter of the modification.

10‧‧‧Medical treatment equipment

20‧‧‧Adapter

22a‧‧‧ mouth

22b‧‧‧ mouth

22c‧‧‧ mouth

22d‧‧‧ mouth

26‧‧‧Clamping convex

30‧‧‧Creator body

32‧‧‧Open end

33‧‧‧Cylinder members

34‧‧‧ stretching tape

35‧‧‧Open end

36‧‧‧Cards

36a‧‧‧ card stop

36b‧‧‧ notch recess

36c‧‧‧Bevel

36d‧‧‧ rib

37‧‧‧First fixed member

38‧‧‧Second fixed component

Claims (9)

A medical treatment tool, comprising: a cylindrical opener body, which is left in the incision wound; and an adapter that is detachably attached to the open end of the opener body to cover the open end cover And a port disposed at a plurality of locations of the adapter for inserting the disposal tool into the interior of the ingenerator body; and the adapter is mountable to the plurality of selectively selected angles The positional relationship of the through-ports with respect to the starter body when the adapter is attached to the open end portion at each of the above-described installation angles is different from each other. The medical treatment tool of claim 1, wherein the predisposing body includes an expansion mechanism that maintains the incision wound in a state of being expanded in a specific opening direction; and at a plurality of the above-mentioned setting angles, the opening is relatively The positional relationship in the opening direction of the above-described incision wound is different from each other. The medical treatment tool according to claim 2, wherein the adapter is attached to the open end portion at any one of the above-described installation angles, and the vertical bisector of the line connecting the first port and the second port The angle formed with the above opening direction is 115 degrees ± 20 degrees. The medical treatment tool according to claim 3, wherein at least the first to third ports disposed on the substantially equilateral triangle are included, and the installation angle is selected from four or more. The medical treatment tool of claim 3 or 4, wherein the above disposal can be interspersed A plurality of valve members are respectively disposed at the above-mentioned ports. The medical treatment tool according to claim 5, wherein the adapter includes a flexible top plate portion that covers the open end portion, and the first opening portion and the second opening portion are provided in the top plate portion; The valve member contains a material that is harder than the top plate portion described above. The medical treatment tool according to claim 5, wherein the valve member is formed on the straight line passing through the first opening and parallel to the vertical bisector, and further includes the other opening of the valve member different from the first opening . The medical treatment tool according to claim 3 or 4, further comprising a locking mechanism that causes the adapter to be opened relative to the above-described opening from a non-locking state in which the adapter abuts against the open end The body is rotated by a specific angle in the direction of the rotation of the shaft, whereby the adapter is locked in the locked state to the starter body. The medical treatment tool according to claim 8, wherein an index portion indicating an extending direction of the vertical bisector in the locked state is provided before the vertical bisector is further forward of the axial rotation direction at the specific angle.