WO2010004752A1 - Dispositif à demeure pour instrument médical - Google Patents

Dispositif à demeure pour instrument médical Download PDF

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Publication number
WO2010004752A1
WO2010004752A1 PCT/JP2009/003204 JP2009003204W WO2010004752A1 WO 2010004752 A1 WO2010004752 A1 WO 2010004752A1 JP 2009003204 W JP2009003204 W JP 2009003204W WO 2010004752 A1 WO2010004752 A1 WO 2010004752A1
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WO
WIPO (PCT)
Prior art keywords
needle
medical instrument
medical
tip
indwelling
Prior art date
Application number
PCT/JP2009/003204
Other languages
English (en)
Japanese (ja)
Inventor
大平猛
Original Assignee
学校法人自治医科大学
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by 学校法人自治医科大学 filed Critical 学校法人自治医科大学
Priority to JP2010519650A priority Critical patent/JP5527207B2/ja
Publication of WO2010004752A1 publication Critical patent/WO2010004752A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/07—Endoradiosondes
    • A61B5/076—Permanent implantations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00147—Holding or positioning arrangements
    • A61B1/00148—Holding or positioning arrangements using anchoring means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
    • A61B1/041—Capsule endoscopes for imaging
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/72—Micromanipulators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
    • A61B5/6879—Means for maintaining contact with the body
    • A61B5/6882—Anchoring means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
    • A61B1/3132—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes for laparoscopy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00283—Type of minimally invasive operation with a device releasably connected to an inner wall of the abdomen during surgery, e.g. an illumination source

Definitions

  • the present invention relates to a medical instrument placement device that places a medical instrument or the like in a tissue in a body cavity and can arbitrarily change the orientation of the medical instrument or the like after the placement.
  • Endoscopic surgery such as laparoscopic surgery and thoracoscopic surgery is performed by incising the surface of the body and opening small through holes in the body wall such as the abdominal wall and chest wall.
  • the endoscope is then inserted into the body cavity such as the abdominal cavity and chest cavity.
  • This is a method of taking a picture of the inside of the body cavity and projecting it on an external video screen, and performing surgery using a special instrument while viewing this screen.
  • Endoscopic surgery can be performed simply by opening a small hole in the patient, and therefore there is little postoperative pain and there is a cosmetic advantage because almost no surgical wound is visible.
  • hospitalization for a short period of time is sufficient, and social rehabilitation is quick.
  • NOTES Natural Orifice Transluminal Endoscopic Surgery
  • the vagina wall, the intestinal wall, the esophageal wall, the stomach wall, etc. from the opening part originally possessed by humans such as the vagina, rectum, bladder or mouth through the tubes of the uterus, large intestine, esophagus, etc.
  • An endoscope can be inserted into a body cavity such as the abdominal cavity or chest cavity through a small through-hole opened in the organ wall to treat the affected part in the body cavity.
  • capsule medical instruments that can transmit the state inside the body cavity to the outside of the body by wireless communication, such as a capsule endoscope or a capsule measuring device, are known.
  • a swallow-type capsule endoscope has an imaging observation function and a wireless function, and after being swallowed from the patient's mouth until it is naturally discharged from the human body, for example, digestive organs such as the esophagus, stomach, and small intestine It moves in accordance with its peristaltic movement and sequentially captures images.
  • image data captured by the capsule endoscope is sequentially transmitted outside the body by wireless communication and stored in a memory provided in a receiver outside the body. Diagnosis can be performed based on the image displayed on the display based on the image data stored in the memory.
  • Capsule-type medical devices are used to measure the pH, temperature, pressure, etc. in the body; to observe the presence or absence of bleeding in the body; May be fixed.
  • Patent Document 1 describes a medical capsule that includes a plurality of needle-like members having sharp portions and can be fixed in a body cavity by inserting the needle-like members into a tissue in the body cavity so as to cross each other. ing.
  • the thread-like member that restrains the needle-like member from jumping out while the medical capsule is carried to a predetermined position in the body cavity may break, causing the needle-like member to jump out unexpectedly. There was a risk of damaging the internal tissue.
  • Patent Document 2 describes an indwelling device for a medical device in which locking members are provided on both wings, and the locking members are locked to a tissue in a body cavity with tension.
  • Patent Document 3 describes an indwelling device for a medical device that includes a locking member at one end, clips the locking member to a tissue in the body cavity, and can be hung on the tissue in the body cavity. These indwelling devices use a clip, a needle or the like to lock the locking member of the indwelling device to the body cavity tissue. Therefore, in this indwelling device, since a small clip or the like has to be handled in a narrow and dark body cavity for locking, careful attention and skill are required. In addition, since the indwelling devices proposed in Patent Documents 1 to 3 are mainly intended to perform postoperative follow-up, for example, the orientation of the endoscope is changed after placement in a body cavity. Can not be easily.
  • the anchor member includes a first connecting portion to which a magnet or the like is attached.
  • the locking member which consists of a medical function part and a 2nd connection part in a body cavity can be connected to an anchor member detachably between a 1st connection part and a 2nd connection part.
  • medical functional parts such as an endoscope and an illuminating device can be placed in the body cavity, and the time required for endoscopic surgery can be shortened.
  • the direction of the endoscope can be changed by an operation outside the body.
  • the puncture needle is penetrated through the body wall, the number of wounds increases, so that the advantages of endoscopic surgery tend to be reduced.
  • An object of the present invention is to provide a medical instrument indwelling device in which a medical instrument or the like is placed in a body cavity tissue and the orientation of the medical instrument or the like can be arbitrarily changed even after the placement.
  • medical devices that can transmit the situation inside the body cavity to the outside of the body via wireless communication can be placed in the tissue inside the body cavity, and the orientation of the medical device can be arbitrarily changed even after placement, making endoscopic surgery inside the body cavity easy and quick
  • An object of the present invention is to provide an indwelling device for medical equipment.
  • the present inventor has a holding means for holding a medical instrument, is rotatable about a base end portion as a support shaft, and has a needle tip and a barb at the distal end portion.
  • a needle-like member, a protection means for enclosing the tip of the needle-like member, and a means for fixing or releasing the tip of the needle-like member from the enclosure by the protection means, which are integrally connected It has been found that by using a medical device placement device, the medical device or the like can be placed in a body cavity tissue, and the orientation of the medical device or the like can be arbitrarily changed even after placement. As a result of further investigation based on this finding, the present invention has been completed.
  • the present invention is as follows. (1) having a holding means for holding the medical device, and a locking means for locking to the tissue in the body cavity; A medical instrument placement device in which the holding means is rotatable or rotatable about at least one spindle, but is integrally connected to the locking means so as not to rotate or rotate by its own weight.
  • holding means for holding the medical device A needle-like member that is rotatable about the base end portion as a support shaft and has a needle tip and a return at the tip end portion; Protective means for enclosing the distal end portion of the needle-like member, and a medical instrument having a means for fixing or releasing the distal end portion of the needle-like member from the enclosure by the protective means, and integrally connecting them Indwelling device.
  • the means for fixing or releasing the tip of the needle-like member to the enclosure by the protection means is at least one electromagnet, and the electromagnet is needle-like to fix the tip of the needle-like member to the enclosure.
  • the medical device indwelling device according to (2) wherein a magnetic field that attracts the member can be generated, and a magnetic field that repels the needle-like member in order to release the tip of the needle-like member from the enclosure can be generated.
  • (4) The medical instrument indwelling device according to (3), wherein a magnet is attached between a distal end portion and a proximal end portion of the needle-like member, and the magnet is attracted or repelled by the magnetic field of the electromagnet.
  • the radio receiver according to (2) to (4) further comprising a wireless receiver for receiving a signal for controlling the operation of the means for fixing or releasing the tip of the needle-like member in the enclosure by the protection means.
  • (6) The medical instrument indwelling device according to any one of (2) to (5), wherein the needle-like member is removable.
  • the medical instrument placement device includes a sensor and a wireless transmitter.
  • the sensor is an image sensor or a night vision device.
  • the holding unit includes a support shaft capable of rotating the held medical instrument.
  • the medical instrument indwelling device according to any one of (1) to (9), further including a linear member and a reel on which the linear member can be wound or unwound.
  • a medical device placement set comprising a controller for controlling with a radio signal.
  • a medical instrument placement set comprising: the medical instrument placement apparatus according to (10); and a controller for controlling the operation of the reel with a wireless signal.
  • a knock type needle in which a needle tip can be inserted into and removed from a shaft cylinder by a mechanism using a rotating cam, a mechanism formed by locking a protrusion in a locking hole, or a mechanism using a heart cam groove.
  • a knock type needle that allows the return of the needle to be inserted into and removed from the shaft cylinder by a mechanism using a rotating cam, a mechanism formed by locking a protrusion in a locking hole, or a mechanism using a heart cam groove.
  • the locking means or the needle-like member is the knock needle according to (18) or (19).
  • a medical instrument or the like can be placed in a body cavity tissue, and the orientation of the medical instrument or the like can be arbitrarily changed even after the placement.
  • a medical device that can transmit the situation inside the body cavity to the outside of the body by wireless communication is placed in the tissue inside the body cavity, and the orientation of the medical device can be arbitrarily changed even after placement, and endoscopic surgery inside the body cavity can be performed quickly and easily be able to.
  • the means for fixing or releasing the tip of the needle-like member from the enclosure by the protective means is at least one electromagnet
  • the needle-like member is wirelessly controlled from the outside by the magnetic field of the electromagnet, Fixing or releasing can be easily controlled, and after the needle-like member is locked to the body cavity tissue, the direction of the holding means can be easily changed by attracting or repelling the electromagnet with an external magnet. Can do.
  • FIG. 6 is another partial perspective view showing an outline for explaining a rotating state of a needle-like member portion of the medical instrument placement device shown in FIG. 1.
  • the whole perspective view which shows the state which released
  • the whole perspective view which shows another embodiment of the medical device placement apparatus of this invention.
  • the whole perspective view which shows the state which rotated the holding
  • the whole perspective view which shows another embodiment of the medical device placement apparatus of this invention The figure which shows the state which attached the medical device placement apparatus of this invention to the front-end
  • FIG. 1 is an overall perspective view showing an embodiment of the medical instrument placement device of the present invention.
  • 2 and 3 are partial perspective views showing an outline for explaining the rotating state of the needle-like member of the medical instrument indwelling device shown in FIG.
  • FIG. 4 is an overall perspective view showing the medical device indwelling device of the present invention in a state where the tip of the needle-like member is released from the enclosure by the protection means.
  • the medical instrument indwelling device 10 illustrated in the figure has a holding means 17, a locking means (needle member) 12, and a protection means 13.
  • the needle-like member 12 has a needle tip 12a and a barb 12b at the tip.
  • the needle tip is sharp enough to pierce the tissue in the body cavity.
  • the return is for making it difficult to remove the needle-like member from the distal end portion after piercing the tissue in the body cavity.
  • the needle-shaped member is made of a thin metal tube, and the tip is formed by cutting off the tip at an angle and sharply, and a hole penetrating the tube lumen is formed in the tube wall slightly closer to the needle tip.
  • a return can be formed.
  • the length of the needle-like member is not particularly limited, but it is preferable that the needle-like member does not penetrate the body cavity tissue such as the body wall when pierced.
  • the needle-like member 12 has a support shaft (an axis hidden behind the groove 11b and not visible) for enabling the needle-like member to turn at the base end portion 12c.
  • the rotation angle is not particularly limited, it is preferable that the rotation angle is restricted so as not to be rotated by its own weight.
  • a method of increasing the frictional force between the outer surface of the support shaft of the needle-like member 12 and the inner surface of the hole through which the shaft passes for example, a method of making the outer diameter of the shaft equal to the inner diameter of the hole
  • a plurality of protrusions (not shown) corresponding to the rotation angle are provided on the inner wall of the groove 11b, the base end portion 12c is fitted between the protrusions, and the base end portion 12c is one of the protrusions.
  • the tip of the needle-like member rotates from the left horizontal direction (FIG. 2) to the upper vertical direction (FIG. 3) about the support shaft in the groove 11b. It can be done.
  • the disk-shaped pedestal 11 is used for the portion serving as the pivot shaft, but the present invention is not limited to this.
  • the pedestal 11 of the needle-like member and the holding means 17 are integrally connected by the rotation shaft 11a.
  • the pedestal 11 is rotatable around the rotation shaft 11a.
  • the rotation angle is not particularly limited, but is preferably limited so as not to rotate due to its own weight.
  • a method for increasing the frictional force of the sliding surface of the pedestal 11 or the holding means 17 for example, a method for suppressing the sliding surface of the pedestal 11 and the holding means 17 with the shaft 11a) or the like, 11 or a plurality of protrusions A (not shown) corresponding to the rotation angle are provided on the sliding surface of the holding means 17, and at least one protrusion B is provided on the inner wall of the sliding surface of the holding means 17 or the base 11.
  • the rotation is limited.
  • a method of restricting the rotation of the holding means by attracting an electromagnet 14 described later with a magnet from outside the body.
  • the movement of the needle-like member is limited. Therefore, the rotation around the support shaft of the needle-like member proximal end and / or the rotation shaft 11a is the center. The rotation changes the orientation of the medical device held by the holding means.
  • the needle-like member 12 can be detached from the base 11. After the medical device indwelling device of the present invention is used for one patient, the indwelling device of the present invention can be used for another patient by removing the used needle-shaped member and attaching a new needle-shaped member. it can. As a result, the economy can be improved by reuse and the prevention of infectious diseases such as hepatitis can be achieved.
  • the protection means 13 is for enclosing the tip of the needle-like member.
  • the structure is illustrated as long as it can prevent the tip of the needle-like member from protruding and damaging the tissue when the medical device indwelling device of the present invention is carried into the body cavity. It is not limited to what you did.
  • the protective means is formed with a groove that matches the shape of the needle-like member. Note that the needle-like member 12, the holding means 17, and the protection means 13 are not necessarily integral, and may be separate, and the essential point is that they are integrally connected.
  • the medical instrument indwelling device of this embodiment has means 14 for fixing or releasing the tip of the needle-like member from the enclosure by the protection means 13.
  • the means 14 is configured to prevent the tip of the needle-like member from protruding when the medical device indwelling device of the present embodiment is carried into the body cavity and causing a risk of scratching the tissue.
  • the distal portion of the needle-like member is surrounded by the protective means 13 in order to pierce the needle-like member into the body cavity tissue after being carried into the desired body cavity.
  • the structure is not particularly limited as long as it can be released.
  • the means 14 for fixing or releasing the tip of the needle-like member 12 in the enclosure by the protection means 13 is at least one electromagnet.
  • the electromagnet 14 can generate a magnetic field that attracts the needle-like member to fix the tip of the needle-like member to the enclosure, and repels the needle-like member to release the tip of the needle-like member from the enclosure.
  • a magnetic field can be generated.
  • movement of the means for fixing to a enclosure or releasing from an enclosure can be attached to the medical device placement apparatus of this embodiment. As a result, the magnetic field of the electromagnet 14 can be adjusted by a wireless signal from the outside.
  • a movable ring is attached to the protection means 13, and the needle-like member can be fixed to the enclosure by the protection means by hooking the ring to the tip of the needle-like member. Further, when the ring is removed from the tip of the needle-like member, the tip of the needle-like member can be released from the enclosure by the protection means 13 by causing the needle-like member to spring up with a spring or the like.
  • a magnet 16 is attached between the distal end portion and the proximal end portion of the needle-like member 12.
  • the magnet may be an electromagnet or a permanent magnet.
  • the magnet 16 can increase the attractive force or the repulsive force due to the magnetic field of the electromagnet 14, and can be reliably fixed to the enclosure or released from the enclosure.
  • the holding means 17 for holding the medical instrument is not particularly limited as long as it can hold the medical instrument.
  • the holding means 17 is a square box.
  • a sensor necessary for medical care, a wireless transmitter and / or a wireless receiver for communicating with the sensor are mounted in the box.
  • the sensor include a pH meter, a gas concentration meter, an ion concentration meter, a thermometer, a pressure gauge, an image sensor, a photodiode, and a night vision device.
  • a window having a transparent flat plate or lens fitted on one surface of the holding means 17 is provided, and the state outside the holding means can be photographed by the image sensor through the window.
  • a CCD image sensor As the image sensor, a CCD image sensor, a CMOS image sensor, or the like is used. Further, when a night vision device is used as a sensor, it is possible to obtain an image that can sense a difference in shape visually or in the dark where the amount of light required for photographing cannot be obtained. Examples of the night vision device include an active infrared night vision device, a passive infrared night vision device, a light-enhanced night vision device, and a heat ray image night vision device.
  • FIG. 19 shows an outline of the internal structure of the imaging unit 80.
  • 19 includes a transparent flat plate 85, an O-ring 82, a focus lens 83, and a CCD image sensor 86 housed in a cylindrical casing 84.
  • the signal from the image sensor 86 can be sent out via a flat cable 87.
  • a window 81 is opened on the left surface of the housing 84 shown in FIG. 19 and is closed by a transparent flat plate 85 and an O-ring 82.
  • the focus lens 83 can adjust the position of the lens by a driving device (not shown) such as an ultrasonic motor.
  • a hydrophilic thin film mainly composed of titanium oxide or the like is preferably laminated on the transparent flat plate or lens that closes the window. Since an object may adhere to the window and obstruct the field of view of the image sensor, it is preferable to provide means for vibrating the window to remove the object.
  • a method of rotating a rotating body having a biased center of gravity is usually used. For example, vibration can be generated by rotating the motor while attaching a weight to the rotating shaft rod of the micro motor and attaching a weight. The vibration surface by the vibration motor is not to be substantially parallel to the surface of the window.
  • FIG. 21 is a perspective view of the inside of the holding means 17 in one embodiment of the medical instrument placement device of the present invention.
  • the internal structure seen through is drawn with a broken line.
  • the above-mentioned imaging means 80 and vibration means 95 are installed in the holding means 17.
  • 19 and 21 show a lumen 93 penetrating from the rear end to the front end of the holding means 17. Air or liquid can be passed through the lumen 93.
  • an endoscope can be fitted into the attachment means 22, and air can be sent from the blower hole of the endoscope through the lumen 93 to the tip of the holding means 17.
  • the air sent through the lumen 93 blows on the window of the image pickup means 80 and the transparent flat plate 85, and the attached matter Can be blown away by blowing air.
  • the imaging unit 80 protrudes from one surface of the holding unit, but the window of the holding unit may be positioned on the same plane as the one surface of the holding unit.
  • the distal end portion of the lumen 93 can be aligned on the same plane as the one surface of the holding means.
  • the medical device indwelling device of the present invention can be provided with an illuminating device for assisting photographing with an image sensor.
  • An LED or the like is used for the lighting device.
  • a power supply system for driving these medical instruments can be incorporated in the medical instrument indwelling apparatus of the present invention.
  • the power supply system a battery or capacitor, a wireless power transmission system, a fuel cell capable of generating power, or the like can be used as appropriate.
  • a method for wirelessly transmitting power at least one method selected from the group consisting of an electromagnetic induction power supply method, a radio wave reception power supply method, and a resonance power supply method is preferable. The distance that can be wirelessly transmitted varies depending on the power supply method.
  • the electromagnetic induction power supply method is about several centimeters
  • the radio wave reception type power supply method is several centimeters to several tens of meters
  • the resonance type power supply method is several meters. Although it is said to be several tens of meters, it is not limited thereto.
  • a power storage function in the medical instrument indwelling device of the present invention.
  • means for storing power include a secondary battery and a capacitor.
  • the medical instrument placement device of the present invention preferably further includes an attaching means for attaching to the distal end portion of a medical instrument (excluding a medical instrument attached to the holding means) inserted into a body cavity in endoscopic surgery.
  • An attachment means can be suitably selected according to the structure of the front-end
  • annular attachment means 22 that can be fitted on the distal end portion of a rod-like medical instrument such as a laparoscope, thoracoscope, or Laparo port.
  • the attachment means 22 is stored in the holding means 17 such that the length of the portion protruding from the holding means 17 can be expanded and contracted. After the attachment means 22 is adjusted to a desired length, the length is fixed. It is preferable to provide a lock mechanism so that it can be used.
  • a guide rod is attached to the inner back or outer periphery of the attachment means 22.
  • the guide lights can be lit continuously or flashing.
  • Endoscopes are usually provided with illuminators for illuminating the inside of the body cavity. However, if the endoscope is too close to the illuminated object, halation occurs, making it difficult to see the object. Therefore, in the body cavity, when the lighting fixture attached to the endoscope is turned off, the guide rod is turned on, and the guide rod is used as a clue, the endoscope can be smoothly attached to the attachment means. .
  • a structure (a tab, a rod, a ring, a knob, or the like) that can be picked with a medical forceps, a medical gripper, or the like is provided at the inner back of the attachment means.
  • Endoscopes are usually provided with lumens for passing medical forceps, medical grippers, and the like. After inserting the distal end of the endoscope into the attachment means 22 of the medical instrument indwelling device of the present invention, the structure (knob etc.) inside the attachment means with forceps inserted through the lumen of the endoscope The endoscope and the medical instrument indwelling device of the present invention can be securely connected.
  • the medical device indwelling device of the present invention is carried into and out of the body cavity.
  • a tab, a ring, a knob or the like for picking up with a medical forceps or the like is provided on the outer surface of the medical instrument placement device.
  • the entire medical device indwelling device of the present invention can be sent into a body cavity through the lumen of an endoscope or catheter.
  • FIG. 20 is a view showing an embodiment of the internal structure of the attachment means 22.
  • the tip of a medical instrument such as an endoscope is inserted from the normal direction of the paper surface of FIG.
  • a guide rod 91 is attached to the central portion at the back of the attachment means.
  • a lumen 93 that penetrates from the distal end to the proximal end of the holding means 17 (from the left end to the right end in FIG. 1) is provided.
  • This lumen can be useful in various scenes of endoscopic surgery. For example, when an endoscope having a nozzle capable of supplying air or water is fitted into the attachment means, air or water can be sent from the endoscope to the distal end of the holding means via the lumen. it can.
  • FIG. 21 shows a portion seen through the internal structure of the attachment means 22 shown in FIG.
  • FIG. 2 are perspective views showing another embodiment of the medical device placement device.
  • the indwelling device 210 according to the second embodiment includes a linear member 34 and a reel 32 that can wind or feed the linear member.
  • the structure of the holding means, the needle-like member, and the protection means is the same as that of the first embodiment, but may be replaced by their equivalents.
  • the linear members include metal wires such as wires and piano wires; yarns made of polyamide, silk, cotton, and the like.
  • the linear member is wound around a reel, and the linear member can be fed out to an arbitrary length.
  • Various medical instruments can be attached to the tip of the linear member that is fed out according to the purpose.
  • a clip 33 is attached.
  • the reel is exposed on the outer surface of the holding unit 217, but may be built in the holding unit 217.
  • the reel can be rotated by a micro motor or the like.
  • a CCD is built in the holding means, and an imaging means 80 is provided on the right side surface of the holding means.
  • FIG. 7 is a perspective view showing another embodiment of the medical instrument placement device.
  • the holding means 117 has a structure in which the holding means 117 is integrally held in a surface contact state with respect to the outer peripheral surface of the capsule medical instrument or the like, and the capsule medical instrument or the like that is fitted and mounted. Can be held together.
  • the structures of the needle-like member and the protection means are the same as those of the first embodiment, but they may be replaced by their equivalents.
  • the holding means 117 shown in FIG. 7 is formed of a substantially cylindrical portion having substantially the same radius as that of the capsule medical device or the like.
  • the capsule medical device or the like By inserting a capsule medical device or the like into the cylindrical portion, the capsule medical device or the like is held.
  • the cylindrical portion is preferably formed of a stretchable material or the like.
  • the holding means for holding the capsule medical device is not limited to that shown in FIG. 7.
  • holding means such as concave-convex fitting, suction cups, hook-and-loop fasteners, magnets, hooks, and clips can be used as capsule-type medical devices. It can be appropriately selected and used according to the shape of the medical device.
  • a capsule endoscope is suitable as the capsule medical instrument.
  • the capsule endoscope is, for example, a button that supplies power to a plurality of illumination units such as LEDs that illuminate the inside of a body cavity of a subject and an imaging element such as a CCD or CMOS that captures an image inside the body cavity.
  • a plurality of illumination units such as LEDs that illuminate the inside of a body cavity of a subject
  • an imaging element such as a CCD or CMOS that captures an image inside the body cavity.
  • a commercially available capsule endoscope can be used.
  • a rotatable needle-like member is used as a means for engaging with a body cavity tissue. It is not limited to the above-mentioned acicular member.
  • the medical instrument indwelling device of the present invention has a holding means for holding the medical instrument and a locking means for locking to the tissue in the body cavity, and the holding means is centered on at least one spindle.
  • the locking means it is only necessary to be integrally connected to the locking means so as to be rotatable or rotatable. And it is preferable that rotation or rotation is restricted so that the holding means does not rotate or rotate by its own weight.
  • the knock type needle of the present invention can be used as a needle-shaped member.
  • the knock type needle of the present invention is a needle provided with a needle tip insertion / removal mechanism.
  • This needle tip insertion / removal mechanism means that when the knock member is pressed once, the needle tip portion housed in the shaft cylinder is fed out from the tip opening of the shaft cylinder and the state is maintained, and when the knock member is pressed once again, the needle tip portion This is a mechanism in which the part is retracted into the shaft cylinder and the state is maintained.
  • This mechanism is a mechanism employed in a pen-tip insertion / removal mechanism of a knock type ballpoint pen.
  • Examples of the mechanism include a mechanism using a rotating cam, a mechanism in which a protrusion is locked in a locking hole, and a mechanism using a heart cam groove.
  • Examples of the needle tip insertion / removal mechanism include those shown in FIGS. 15 and 16.
  • an inner toothed protrusion IK in the axial direction is provided on the inner surface of the shaft cylinder S ⁇ b> 13, and the rotation has an outer toothed protrusion OK that can slide along the protrusion IK.
  • the child RE is pushed forward while being given a rotational force by a knock member (not shown), and when the meshing of both ridges is released, the rotor RE rotates at a predetermined angle and the end surfaces of both ridges. The needles are engaged and the needle tip is extended.
  • FIG. 14 shows an example of the rotor RE.
  • the rotor RE has two external toothed protrusions OK symmetrically on its side surface.
  • the rotor RE is interlocked with the needle body N12.
  • FIG. 15 (I) shows a state in which the external tooth-shaped protrusion OK is fitted in the deep groove portion of the internal tooth-shaped protrusion IK. In this state, the needle tip is housed in the barrel (FIG. 16 (a)).
  • the knock member is pushed, the rotor RE moves upward while receiving a rotational force (a force leftward with respect to the shaft cylinder in FIG. 15) (FIG. 15 (II)).
  • the return R12 can be taken in and out as well as the tip of the needle.
  • a through-hole H12 is opened on the side surface of the shaft cylinder S13, and a return needle R12 is attached to the side surface of the needle body N12 by being fixed at the base.
  • the return needle R12 is adapted to receive a force in the direction of rising from the side surface of the needle body by a torsion spring or the like.
  • the tip of the needle is housed in the shaft tube, the return needle is held by the inner wall of the shaft tube and lies along the side surface of the needle body.
  • the return needle protrudes from the through hole H12 on the side surface of the shaft cylinder.
  • the return needle is pushed again and the tip of the needle is retracted, the return needle is pushed down at the edge of the through hole of the shaft tube and lies again along the side surface of the needle body.
  • the knock type needle of the present invention having such a mechanism has a danger of accidentally piercing a finger or the like because the tip of the needle is housed in the shaft tube in a normal state (FIG. 16A).
  • the knock type needle of the present invention can be applied not only to the medical device indwelling apparatus of the present invention but also to a syringe, an infusion set, and the like. As shown in FIG. 16, when the knock type needle of the present invention is inserted into the body of a patient or the like, the shaft tube is pushed to the hand side (first knock pressing).
  • the pressed shaft cylinder moves downward while rotating to the right with respect to the needle body (in other words, the needle body rotates to the left with respect to the shaft cylinder), and the needle tip is extended.
  • the barb protrudes from the hole H12 opened on the side surface of the shaft cylinder, and the pierced needle is difficult to come out by the barb (FIG. 16B).
  • the pressed barrel moves downward while rotating to the right with respect to the needle body (in other words, the needle body rotates to the left with respect to the barrel) and returned.
  • Retreats into the barrel (FIG. 16 (c)).
  • the shaft cylinder moves upward while rotating rightward, returns to the normal state (FIG. 16A), and the needle can be removed from the body.
  • the shaft cylinder plays a role as a protection means.
  • an ultrasonic motor can be used to rotate or rotate the needle-like member.
  • An ultrasonic motor is a motor that drives a rotor or a linear driven body using ultrasonic vibration.
  • the wave principle of an ultrasonic motor includes a traveling wave type and a standing wave type.
  • the vibration mode includes a resonance type and a non-resonance type.
  • Ultrasonic motors include discs, flat plates, and wedges.
  • the needle-like member is only fixed to the support shaft, but a pantograph-shaped structure can be used for supporting the needle-like member.
  • an electric motor such as an ultrasonic motor can be used for driving the pantograph.
  • a worm gear, an electromagnet, or the like can be used for driving the pantograph.
  • FIG. 17 is a conceptual diagram showing an operation example of a mechanism for rotating or rotating a needle-like member to which a linear drive ultrasonic motor and a pantograph are applied.
  • the ultrasonic transducer W uses the ultrasonic transducer W to generate ultrasonic vibration in the rod-like ultrasonic vibrator PE to move the driven ring DR left or right.
  • the ultrasonic transducer W can be controlled by an operation control circuit through an electric wire.
  • FIG. 17A shows a state where the driven ring DR is moved to the left, the pantograph is closed, and the needle-like member 12 is lying sideways.
  • FIG. 17B shows a state in which the driven ring DR moves to the right, the pantograph PG opens, and the needle-like member 12 becomes vertical.
  • the needle-like member 12 can be positioned by moving the driven ring DR left and right with the ultrasonic motor.
  • the rotation of the pedestal can be controlled by providing an ultrasonic motor under the pedestal 11.
  • the ultrasonic motor can be used preferably in the present invention because it can generate high torque with low power and has high response.
  • FIG. 18 shows an example of an electric circuit for controlling the operation of the ultrasonic motor. This electric circuit can control the operation of the ultrasonic motor with low power.
  • the distal end of the endoscope 50 is inserted into the attachment means 222 of the medical instrument placement device of the present invention, and the medical device placement device is attached to the distal end of the endoscope (FIG. 8).
  • the endoscope 50 can be prevented from being easily removed from the attachment means.
  • a through-hole 62 connected to a body cavity is opened with a scalpel or scissors in an organ wall such as the digestive tract wall 60.
  • An endoscope having a medical device indwelling device attached to the tip is inserted, for example, from the anus, and through the digestive tract, through the through-hole 62 opened in the digestive tract wall 60 and into the abdominal cavity (FIG. 9). While the medical device indwelling apparatus is carried, the needle-like member 212 is fixed to the enclosure of the protection means 213 by the attractive force of the fixing / release means 214 (electromagnet) to the magnet 216.
  • the magnetic field of the fixing / releasing means 214 (electromagnet) is switched to the direction in which the magnet 216 is repelled.
  • the magnetic field direction of the electromagnet can be controlled by sending a signal wirelessly from an external controller to an electric circuit with a receiver that can change the direction of the current flowing through the electromagnet.
  • the endoscope 50 is extracted from the attachment means 222 of the medical instrument placement device 210.
  • the medical instrument placement device 210 is locked to the body wall (FIG. 11).
  • the electromagnet 214 of the medical instrument indwelling device 210 is offset from the support shaft of the needle-like member base and the rotating shaft 211a of the pedestal.
  • the electromagnet 214 is attracted or repelled by a magnet from outside the body, the position of the electromagnet 214 rotates around the support shaft of the needle-like member base and the rotation shaft 211a of the pedestal.
  • the holding means also rotates as the electromagnet 214 rotates. Using this phenomenon, the orientation of the holding means 217 can be changed.
  • the orientation of the holding means 217 is changed from left to right on the paper (FIG. 12). Further, by using a mechanism that combines a pantograph and an ultrasonic motor as described above, the orientation of the holding means can be changed by a signal command from outside the body.
  • An imaging means 80 including a CCD image sensor and an LED illumination device is attached to the left side surface of the holding means 217 of the medical instrument placement device 210 shown in FIG.
  • the imaging means 80 can capture the state of the lesion.
  • the visual field can be secured by shaking the foreign object by driving a vibration motor.
  • the lesioned part 70 can be picked by the clip 33 attached to the tip of the linear member by feeding the linear member 34 from the reel 32 provided in the medical instrument placement device 210. By winding the linear member, the clip can be lifted and the lesion can be pulled up.
  • an electric knife, forceps, and other medical instruments generally used in endoscopic surgery are inserted into the body cavity through the lumen of the endoscope carrying the medical instrument placement device, and the affected part is operated.
  • the lesioned part can be illuminated by both the LED illumination device provided in the imaging means 80 of the medical instrument placement device 210 and the illumination device (not shown) at the distal end of the endoscope 50.
  • the lesioned part can be observed from multiple directions by both the CCD provided in the imaging means 80 of the medical instrument placement device 210 and the CCD (not shown) at the distal end of the endoscope 50, and the reliability of the endoscopic surgery. Increase.
  • FIG. 12 shows the state immediately before excising the lesioned part with the electric knife 51
  • FIG. 13 shows the state after the lesioned part is excised.
  • the excised lesioned part 70 a is picked up by the clip 33 lifted by winding up the reel 32.
  • the medical device indwelling device of the present invention can be removed from the body wall 61 and removed outside the body by following the above-described procedure in reverse.
  • the medical instrument indwelling device of the present invention can be left in the body cavity for a while for follow-up after surgery. If the wireless power transmission system is used, electric power can be sent from outside the body to the medical instrument indwelling device of the present invention placed in the body cavity, so that long-term indwelling is possible.
  • the medical instrument indwelling device of the present invention controls the means for fixing the tip of the needle-like member to the enclosure by the protection means and the means for releasing the tip of the needle-like member from the enclosure by the protection means by radio signals. It can be stored compactly as a medical instrument placement set including a controller for controlling a reel or a reel with a radio signal, and further as a medical device placement set including a replacement needle-like member. They can be unpacked and used in mirror surgery.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • General Health & Medical Sciences (AREA)
  • Medical Informatics (AREA)
  • Animal Behavior & Ethology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Public Health (AREA)
  • Molecular Biology (AREA)
  • Biomedical Technology (AREA)
  • Veterinary Medicine (AREA)
  • Biophysics (AREA)
  • Physics & Mathematics (AREA)
  • Pathology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Optics & Photonics (AREA)
  • Radiology & Medical Imaging (AREA)
  • Robotics (AREA)
  • Surgical Instruments (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)

Abstract

La présente invention concerne un dispositif à demeure pour instrument médical comprenant un moyen de retenue destiné à maintenir un instrument médical, un élément en forme d'aiguille pouvant être animé d'un mouvement de rotation autour de son extrémité proximale et comportant une pointe d'aiguille et un dardillon au niveau de son extrémité distale, un moyen de protection permettant d'enfermer l'extrémité distale de l'élément en forme d'aiguille et un moyen de fixation de l'extrémité distale de l'élément en forme d'aiguille dans l'enceinte constituée par le moyen de protection ou encore un moyen permettant de la libérer de ladite enceinte, tous ces composants étant entièrement reliés les uns aux autres. L'invention concerne également un ensemble pour dispositif à demeure pour instrument médical, comprenant le dispositif à demeure pour instrument médical et un organe de commande permettant de commander l'actionnement du moyen permettant de fixer l'extrémité distale de l'élément en forme d'aiguille dans l'enceinte constituée par le moyen de protection ou de l'en libérer, grâce à un signal radio.
PCT/JP2009/003204 2008-07-10 2009-07-09 Dispositif à demeure pour instrument médical WO2010004752A1 (fr)

Priority Applications (1)

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JP2010519650A JP5527207B2 (ja) 2008-07-10 2009-07-09 医療器具留置装置

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JP2008-179812 2008-07-10
JP2008179812 2008-07-10

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WO2010004752A1 true WO2010004752A1 (fr) 2010-01-14

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JP4578740B2 (ja) * 2001-09-21 2010-11-10 オリンパス株式会社 カプセル型医療装置
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Publication number Priority date Publication date Assignee Title
EP2492745A1 (fr) * 2011-02-24 2012-08-29 General Electric Company Appareil de câble pour changer la position du câble
US8730316B2 (en) 2011-02-24 2014-05-20 General Electric Company Cable apparatus

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JP5527207B2 (ja) 2014-06-18
JPWO2010004752A1 (ja) 2011-12-22

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