WO2012042920A1 - Instrument thérapeutique - Google Patents

Instrument thérapeutique Download PDF

Info

Publication number
WO2012042920A1
WO2012042920A1 PCT/JP2011/053528 JP2011053528W WO2012042920A1 WO 2012042920 A1 WO2012042920 A1 WO 2012042920A1 JP 2011053528 W JP2011053528 W JP 2011053528W WO 2012042920 A1 WO2012042920 A1 WO 2012042920A1
Authority
WO
WIPO (PCT)
Prior art keywords
forceps
pericardium
guide wire
main body
gripping
Prior art date
Application number
PCT/JP2011/053528
Other languages
English (en)
Japanese (ja)
Inventor
悟 菊池
雅之 小林
Original Assignee
オリンパス株式会社
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 オリンパス株式会社 filed Critical オリンパス株式会社
Publication of WO2012042920A1 publication Critical patent/WO2012042920A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/09—Guide wires
    • A61M25/09041—Mechanisms for insertion of guide wires
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0482—Needle or suture guides
    • 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
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B2017/22038—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with a guide wire
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws

Definitions

  • the present invention relates to a treatment instrument.
  • Patent Document 1 when the guide wire is penetrated through the pericardium, there is a problem that the tip of the guide wire may come into contact with the heart adjacent to the pericardium.
  • the present invention has been made in view of the above-described circumstances, and provides a treatment instrument capable of introducing a guide wire into the pericardial cavity while preventing the tip of the guide wire from contacting the heart. With the goal.
  • the present invention provides the following means.
  • the present invention provides a forceps part for gripping a living tissue, a main body part provided on the forceps part, an operation part provided on the main body part for operating the forceps part, and a guide wire introduced into the living tissue.
  • a treatment instrument including a channel portion to be led out and a joint mechanism that is provided in the main body portion and swings the forceps portion in a direction intersecting a longitudinal axis direction of the main body portion.
  • the main body is inserted into the body, the forceps part reaches the pericardium, and the guide wire inserted into the channel part in a state where the pericardium is gripped by the forceps, It can be introduced into the pericardial cavity through the pericardium.
  • the forceps unit is swung by the joint mechanism while the pericardium is gripped by the forceps unit, and the guide wire is pushed out with the forceps unit tilted along the pericardium.
  • the distal end of the forceps part is directed in a substantially tangential direction of the heart surface, and the guide wire is projected along the substantially tangential direction. Therefore, when the guide wire is introduced into the pericardial cavity, the distal end of the forceps part becomes the heart. Can be prevented from touching.
  • the swinging direction of the forceps portion can be known in advance, so that the positional relationship between the guide wire and the pericardium when the forceps portion is swung can be grasped and the guide wire can be more securely penetrated into the pericardium. Can be made.
  • fluctuation of the said forceps part may be sufficient.
  • the forceps part is operated in a closed state, thereby preventing the forceps part from unintentionally swinging and hindering the operation. The operability can be improved.
  • a gripping force transmission member that is connected to the forceps portion and transmits a gripping operation of the operation portion to the forceps portion, and a fitting portion that is provided on the main body portion and engages the gripping force transmission member.
  • the fixing mechanism may fix the swinging direction of the forceps portion via the fitting portion. By doing so, the gripping force transmission member is fitted into the fitting portion in accordance with the gripping operation of the operation portion by the operator, so that the swinging of the forceps portion is fixed. It can be prevented from moving and obstructing operation.
  • the said forceps part is good also as being formed in the shape along the biological tissue surface.
  • the joint mechanism may include a plurality of joints. In this way, when the forceps part is tilted, each joint swings along the pericardium shape and the joint mechanism is arranged along the pericardium, so that the posture of the forceps part can be stabilized. it can.
  • the guide wire can be introduced into the pericardial space while preventing the tip of the guide wire from contacting the heart.
  • FIG. 1 It is a whole block diagram of the treatment tool which concerns on one Embodiment of this invention, and has shown the state which opened the forceps part. It is a figure which shows the state which closed the forceps part of the treatment tool of FIG. It is the side view to which a part of the front end side of the treatment tool of FIG. 1 was expanded, and has shown the state which closed the forceps part. It is the top view to which a part of the front end side of the treatment tool of FIG. 1 was expanded, and has shown the state which closed the forceps part. It is the side view to which a part of the front end side of the treatment tool of FIG. 1 was expanded, and has shown the state which opened the forceps part.
  • the treatment instrument 1 includes a rigid insertion portion (main body portion) 2 that is inserted into the body and a forceps portion that is disposed on the distal end side of the insertion portion 2. 3, a joint part (joint mechanism) 4 that pivotally connects the forceps part 3 to the distal end of the insertion part 2, and an operation part 5 that opens and closes the forceps part 3 when operated by an operator.
  • FIG. 1 shows a state in which the forceps portion 3 is opened
  • FIG. 2 shows a state in which the forceps portion 3 is closed.
  • the insertion portion 2 has an elongated cylindrical shape and is made of a hard material such as metal.
  • a lumen (fitting portion) 2a having both ends opened is formed along the longitudinal direction.
  • the forceps portion 3 includes a pair of gripping pieces 6 a and 6 b, and the gripping pieces 6 a and 6 b are connected to each other by a link mechanism 7 on the base end side.
  • the link mechanism 7 closes the gripping pieces 6 a and 6 b when a gripping force transmission member 8, which will be described later, retreats, and the gripping force transmission member 8 moves forward as shown in FIG. 5.
  • the gripping pieces 6a and 6b are sometimes opened.
  • a channel (channel portion) 10 into which a guide wire 9 can be inserted is formed on one gripping piece 6a. The channel 10 opens at the tip and outer surface of the gripping piece 6a.
  • the joint part 4 connects the forceps part 3 to the insertion part 2 via a connecting member 11.
  • the connecting member 11 has a distal end side attached to the gripping pieces 6 a and 6 b so as to be swingable at a position of a node on the distal end side of the link mechanism 7, and a proximal end side connected to the distal end of the insertion portion 2 by the joint portion 4.
  • the joint portion 4 has the forceps portion 3 inserted into the insertion portion so that the joint portion 4 can swing in the substantially same direction as the direction in which the gripping pieces 6 a and 6 b open and close. 2 is connected.
  • the connecting member 11 is provided with a stopper (restricting mechanism) 11a that restricts the swinging direction of the forceps portion 3 by the joint portion 4 only in the direction in which the grip piece 6a on the side having the channel 9 is directed outward.
  • the operation unit 5 includes a fixed handle 12a fixed to the insertion unit 2 and a movable handle 12a.
  • the movable handle 12 a is connected to the forceps portion 3 through the gripping force transmission member 8.
  • the gripping force transmission member 8 is inserted into the lumen 2a so as to be movable in the forward / backward direction, penetrates the joint portion 4, and is connected to the base ends of the gripping pieces 6a, 6b.
  • the operation unit 5 is configured such that when the operator grips the fixed handle 12a and the movable handle 12b, the movable handle 12b approaches the fixed handle 12a and the gripping force transmission member 8 is pulled to the proximal end side. . Thereby, the operator can close the gripping pieces 6a and 6b by grasping both the handles 12a and 12b.
  • the operation unit 5 is configured such that when the operator releases his hands from both the handles 12a and 12b, the gripping force transmission member 8 moves forward to open the gripping pieces 6a and 6b.
  • a fixing portion (not shown) that holds the opening angle of the gripping pieces 6a and 6b constant by fixing the relative positions of both the handles 12a and 12b may be provided in the operation portion 5.
  • the gripping force transmitting member 8 includes a hard shaft portion (fixing mechanism) 8a having a diameter that forms a sufficiently narrow gap with the inner surface of the lumen 2a, and a movable shaft 8a provided on the distal end side of the shaft portion 8a. And a flexible wire portion (flexible portion) 8b.
  • a hard shaft portion (fixing mechanism) 8a having a diameter that forms a sufficiently narrow gap with the inner surface of the lumen 2a
  • a movable shaft 8a provided on the distal end side of the shaft portion 8a.
  • a flexible wire portion (flexible portion) 8b When the shaft portion 8a is advanced, the shaft portion 8a penetrates the joint portion 4 and the tip thereof is disposed forward of the joint portion 4. On the other hand, when the shaft portion 8a is retracted, the shaft portion 8a is disposed rearward of the joint portion 4. It is provided as follows.
  • a groove (fitting portion, fixing mechanism) 13 into which the tip of the shaft portion 6a disposed in front of the joint portion 4 is fitted is formed in the connecting member 11.
  • the shaft portion 8a is fitted into both the groove 13 of the connecting member 11 and the lumen 2a of the insertion portion 2 with the joint portion 4 interposed therebetween.
  • the angle of the forceps portion 3 with respect to the insertion portion 2 is fixed in a direction along the longitudinal direction of the insertion portion 2.
  • the wire portion 8b is disposed at the position of the joint portion 4, and the forceps portion 3 can swing.
  • the insertion portion 2 is inserted into the body while the distal end portion of the guide wire 9 is housed in the channel 10. Then, the forceps 3 is disposed outside the pericardium B. At this time, as shown in FIG. 7, by inserting the treatment instrument 1 into the body with the grasping pieces 6a and 6b opened, the shaft portion 8a is fitted into the groove 13, so that the forceps portion 3 is not necessary. Thus, the insertion portion 2 can be smoothly run without being swung or being caught by tissue in the body.
  • the pericardium B is gripped by the gripping pieces 6a and 6b, and the insertion portion 2 is pulled back slightly to pull the pericardium B. .
  • the shaft portion 8 a is disengaged from the fitting with the groove 13
  • the forceps portion 3 is rocked and tilted by the joint portion 4 and is tilted on the pericardium B.
  • the grip piece 6a on the side having the guide wire 9 is sandwiched between the pericardium B folded, and the opening of the channel 10 provided at the tip of the grip piece 6a is opened.
  • the guide wire 9 is pushed on the proximal end side so as to protrude from the channel 10 so that the distal end of the guide wire 9 is easily penetrated into the pericardium B in a tensioned state, and the guide wire 9 is inserted into the pericardial cavity.
  • A can be introduced into A.
  • a puncture needle (not shown) is inserted into the pericardium B along the guide wire 9, and the puncture needle is pushed out from the channel 10 to puncture the pericardium B.
  • Perforation for penetrating the pericardium may be formed in the pericardium B in advance.
  • the guide wire 9 is pushed out in a direction substantially perpendicular to the surface of the heart C and penetrated into the pericardium B.
  • the guide wire 9 since the guide wire 9 is introduced into the pericardial cavity A with the distal end directed toward the heart C, the guide wire 9 easily contacts the heart C after passing through the pericardium B.
  • the guide wire 9 is penetrated through the pericardium B along the substantially tangential direction of the surface of the heart C, that is, with the tip directed away from the heart C. Accordingly, there is an advantage that the guide wire 9 can be introduced into the pericardial cavity A without bringing the tip of the guide wire 9 into contact with the heart C.
  • the channel 10 into which the guide wire 9 is inserted is provided only in one gripping piece 6a.
  • the channel 10 may be provided in both gripping pieces 6a and 6b. .
  • the stopper 11a is not necessary.
  • the outer surface of the gripping piece 6 a having the channel 10 may be formed in a curved shape that is recessed along the surface shape of the pericardium B.
  • a plurality of joint portions 4 are spaced apart in the longitudinal direction of the insertion portion 2 (shown).
  • two joints 4a may be provided. Even if it does in this way, when the forceps part 3 is fallen on the pericardium B, since each joint 4a bends and the joint part 4 is arrange

Abstract

La présente invention concerne un instrument thérapeutique servant à l'introduction d'un fil-guide dans un espace péricardique tout en empêchant l'extrémité du fil-guide d'entrer en contact avec le cœur ; ledit instrument thérapeutique (1) selon l'invention est équipé de pince (3) pour saisir du tissu vivant, d'un corps principal prévu sur la pince (3), d'un actionneur (5) qui est prévu sur le corps principal (2) et fait fonctionner la pince (3), un canal (10) pour la pose du fil-guide (9) à introduire dans le tissu vivant, et un mécanisme articulé (4) qui fait osciller la pince (3) dans une direction orthogonale à la direction longitudinale du corps principal (2).
PCT/JP2011/053528 2010-09-30 2011-02-18 Instrument thérapeutique WO2012042920A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JP2010-222670 2010-09-30
JP2010222670A JP2012075604A (ja) 2010-09-30 2010-09-30 処置具

Publications (1)

Publication Number Publication Date
WO2012042920A1 true WO2012042920A1 (fr) 2012-04-05

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/JP2011/053528 WO2012042920A1 (fr) 2010-09-30 2011-02-18 Instrument thérapeutique

Country Status (2)

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JP (1) JP2012075604A (fr)
WO (1) WO2012042920A1 (fr)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN103860237A (zh) * 2014-02-25 2014-06-18 复旦大学附属中山医院青浦分院 一种带光源的曲张静脉剥离钳
CN105615931A (zh) * 2014-10-29 2016-06-01 上海理工大学 经心尖植入人工腱索修复二尖瓣反流的微创手术器械

Families Citing this family (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9826992B2 (en) 2007-12-21 2017-11-28 Smith & Nephew, Inc. Multiple portal guide
EP2231035B1 (fr) 2007-12-21 2019-08-07 Smith & Nephew, Inc. Guide à multiples portes
CN103429178A (zh) 2010-09-27 2013-12-04 史密夫和内修有限公司 用于在关节镜手术期间使用的装置和方法
WO2012061642A1 (fr) 2010-11-03 2012-05-10 Smith & Nephew, Inc Guide-foret
US9125707B2 (en) * 2011-01-06 2015-09-08 Smith & Nephew, Inc. Cannulated guide tools
KR20140037037A (ko) * 2011-01-06 2014-03-26 스미스 앤드 네퓨, 인크. 캐뉼라형 안내 공구

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH03236833A (ja) * 1989-09-08 1991-10-22 Thomas J Fogarty 心膜内へ電極を挿入する方法とその装置
JPH10174689A (ja) * 1996-10-04 1998-06-30 Charles H Klieman 内視鏡用外科器具
JP2001505464A (ja) * 1996-12-05 2001-04-24 コメディカス・インコーポレーテッド 心膜空隙にアクセスする装置及び方法
JP2002291765A (ja) * 2001-03-30 2002-10-08 Olympus Optical Co Ltd 外科用処置具用の保持具
JP2004329624A (ja) * 2003-05-08 2004-11-25 Olympus Corp 外科用処置具

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH03236833A (ja) * 1989-09-08 1991-10-22 Thomas J Fogarty 心膜内へ電極を挿入する方法とその装置
JPH10174689A (ja) * 1996-10-04 1998-06-30 Charles H Klieman 内視鏡用外科器具
JP2001505464A (ja) * 1996-12-05 2001-04-24 コメディカス・インコーポレーテッド 心膜空隙にアクセスする装置及び方法
JP2002291765A (ja) * 2001-03-30 2002-10-08 Olympus Optical Co Ltd 外科用処置具用の保持具
JP2004329624A (ja) * 2003-05-08 2004-11-25 Olympus Corp 外科用処置具

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN103860237A (zh) * 2014-02-25 2014-06-18 复旦大学附属中山医院青浦分院 一种带光源的曲张静脉剥离钳
CN105615931A (zh) * 2014-10-29 2016-06-01 上海理工大学 经心尖植入人工腱索修复二尖瓣反流的微创手术器械

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