WO2013129635A1 - Minimally invasive surgical system - Google Patents

Minimally invasive surgical system Download PDF

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Publication number
WO2013129635A1
WO2013129635A1 PCT/JP2013/055596 JP2013055596W WO2013129635A1 WO 2013129635 A1 WO2013129635 A1 WO 2013129635A1 JP 2013055596 W JP2013055596 W JP 2013055596W WO 2013129635 A1 WO2013129635 A1 WO 2013129635A1
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WO
WIPO (PCT)
Prior art keywords
needle
surgical
rear end
instrument
tip
Prior art date
Application number
PCT/JP2013/055596
Other languages
French (fr)
Japanese (ja)
Inventor
猛 大平
Original Assignee
ハリキ精工株式会社
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 ハリキ精工株式会社 filed Critical ハリキ精工株式会社
Priority to JP2014502404A priority Critical patent/JP5883117B2/en
Publication of WO2013129635A1 publication Critical patent/WO2013129635A1/en

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    • 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
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1477—Needle-like probes
    • 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
    • A61B2017/00278—Transorgan operations, e.g. transgastric
    • 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
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00539—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated hydraulically
    • 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
    • A61B17/22004—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 using mechanical vibrations, e.g. ultrasonic shock waves
    • A61B17/22012—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 using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement
    • A61B2017/22014—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 using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement the ultrasound transducer being outside patient's body; with an ultrasound transmission member; with a wave guide; with a vibrated 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
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B2017/3445—Cannulas used as instrument channel for multiple instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B2017/347—Locking means, e.g. for locking instrument in cannula
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
    • A61B2018/1869—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves with an instrument interstitially inserted into the body, e.g. needles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2217/00—General characteristics of surgical instruments
    • A61B2217/002—Auxiliary appliance
    • A61B2217/005—Auxiliary appliance with suction drainage system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N7/00—Ultrasound therapy
    • A61N2007/0047—Ultrasound therapy interstitial

Definitions

  • the present invention relates to a surgical operation system that eliminates a living body surgery such as an abdominal incision and reduces surgical invasion, and more particularly, a surgical treatment at a surgical site of a diseased organ in a body cavity without requiring incision or laparotomy of a human body.
  • the present invention relates to a minimally invasive surgical system having a needle-type device for surgical treatment that can be easily performed.
  • RPS Reduced Port Surgery
  • the inventor also includes a hollow cylindrical outer needle and a screw cutter that is rotated by a rotary drive device that is detachably connected within the outer needle.
  • a microneedle type medical boring device that completely removes biological tissue fluid and biological tissue such as abscesses, cysts, and abscesses from the lesion.
  • a clip which is a pair of surgical instruments connected to an elastic connector (linear body), is configured to be housed inside or extruded to the outside of the sleeve of the inductor, so that different positions of the desired organ can be obtained.
  • Devices, systems and methods for gripping have been proposed. (For example, see Patent Document 4)
  • the microneedle type medical boring device described in Patent Document 2 pierces a biological tissue such as a tumor part of a lesion while keeping the invasion to the living body small, and a biological tissue fluid such as an abscess, a cyst, a cyst, etc.
  • a biological tissue fluid such as an abscess, a cyst, a cyst, etc.
  • it is specialized in the function of sucking and completely removing a living tissue, and cannot perform a minimally invasive surgical operation that requires a large surgical tip instrument with sufficient supporting force.
  • the present invention has been made in view of the above-described problems of the prior art, and an object of the present invention is to provide freedom of design that can support a surgical procedure for a large, heavy-weight organ with sufficient support. It is an object of the present invention to provide a minimally invasive surgical system having a needle type device for surgical treatment that has a sufficient degree and achieves minimally invasiveness.
  • a minimally invasive surgical system has an outer diameter, a length, a rear end, and a front end, the X axis extending in the length direction as a main axis,
  • the main spindle needle and the plurality of countershaft needles arranged substantially in parallel with the axis around the main spindle needle to reinforce the main spindle needle have stable support rigidity and strength, and the tips of the main spindle needle and the subshaft needle are sharp.
  • Needle structure configured to be punctured directly into the body cavity from the outer skin surface of a living body, a surgical tip device removably connected to the tip portion of the needle structure, and the rear end portion of the needle structure being inserted And a needle support unit that is supported and connected to a rear end portion of the needle support unit, and a rear end portion of the spindle needle is inserted, and in cooperation with the rear end portion of the spindle needle,
  • a surgical treatment needle type device having a surgical tip instrument operating section for operating a surgical tip instrument, an outer diameter, a length, a rear end and a distal end, and a U axis extending in the length direction as a main axis,
  • a body cavity insertion body having a tubular body to be inserted into a body cavity from a natural opening including a peritoneal hole or anus for single-hole laparoscopic surgery, provided at the distal end of the body cavity insertion body, and the distal end of the needle structure
  • a surgical tip instrument holding mechanism for
  • a surgical invasive device having a specific cavity insertion means, wherein the surgical distal end is removed from the distal end portion of the needle structure using the surgical tip special instrument insertion means.
  • Instrument in body cavity After insertion to the vicinity of the lesioned organ, under the monitoring by a laparoscope, the needle structure of the needle type device for surgical treatment is punctured into the body cavity and inserted into the tip of the needle structure to the vicinity of the lesioned organ
  • the surgical distal instrument is operated by the surgical distal instrument operating unit in a state where the surgical distal instrument is opened from the means for inserting the surgical distal instrument into the cavity, and the surgical treatment is performed in the body cavity. It is characterized by executing all.
  • a minimally invasive surgical system includes an outer diameter, a length, a rear end, and a distal end, the X axis extending in the length direction as a main axis, A plurality of countershaft needles arranged in parallel around the main shaft needle in a substantially axisymmetric manner have a stable support rigidity and strength, and the rear ends of the main shaft needle and the subshaft needle are formed in a sharp shape.
  • a needle structure configured to be able to puncture the skin outer surface from the inside of a body cavity, a surgical tip instrument connected to the distal end portion of the needle structure in a detachable manner, and a needle in which a rear end portion of the needle structure is supported in a detachable manner
  • a surgical unit that is connected to a rear end portion of the support unit and the needle support unit, and the rear end portion of the main needle is inserted, and the surgical tip instrument is operated in cooperation with the rear end portion of the main needle.
  • Surgical treatment with a needle-type device for surgical treatment provided with an end instrument operation section, an outer diameter, a length, a rear end and a front end, and a needle support unit removed from the rear end of the needle structure
  • the needle type device has a handle at the rear end opening that is open at both ends so that it can be removably loaded from the rear end side of the needle structure, and a free opening and closing lid at the front end opening.
  • a body cavity insertion main body having a tubular body in which a distal end side inserted from a living body single-hole laparoscopic surgical abdominal hole or a natural opening to the vicinity of a diseased organ in a body cavity is bent in a substantially semicircular hook shape,
  • the main needle and the secondary shaft of the needle structure are loaded into the body cavity insertion body and press the distal end portion of the surgical distal instrument previously loaded into the body cavity through the rear end opening from the distal end opening of the body cavity insertion body.
  • Surgical tip instrument specific cavity insertion means provided with a surgical tip instrument push-out piston that punctures and penetrates from inside the body cavity to the outside of the abdominal skin.
  • the removed needle support unit is directly connected to the rear end of the needle structure that is punctured and penetrated from the inside of the body cavity to the outside of the abdominal skin using the means, and then monitored under a laparoscope,
  • the surgical tip instrument is operated by the surgical tip instrument operating unit to perform all the surgical procedures in the body cavity. It is characterized by doing.
  • a minimally invasive surgical system includes an outer diameter, a length, a rear end, and a distal end, the X axis extending in the length direction as a main axis, and a main axis needle on the X axis. And a plurality of countershaft needles arranged in parallel around the main shaft needle in a substantially axisymmetric manner to reinforce the main shaft needle and having stable support rigidity and strength, and the tips of the main shaft needle and the subshaft needle are formed sharply.
  • a needle structure that can be punctured directly into the body cavity from the skin surface of the living body, a surgical tip device that is removably connected to the tip of the needle structure, and a rear end of the needle structure is inserted and supported A needle support unit; and a rear end portion of the spindle needle that is connected to a rear end portion of the needle support unit, and is inserted into the rear end portion of the main spindle needle.
  • Surgical tip instrument operating section for operating the surgical treatment needle-type device, and the surgical distal end having an outer diameter, a length, a rear end, and a distal end, and removed from the distal end of the needle structure Both ends are opened so that the instrument can be removably loaded from the rear end side.
  • the rear end opening has a handle, and the front end has an openable openable lid.
  • An intracorporeal body insertion body having a tubular body in which a distal end side to be inserted from the abdominal hole or natural opening for laparoscopic surgery to the vicinity of a diseased organ in the body cavity is bent into a substantially semicircular hook shape, and the body cavity
  • the distal end portion of the surgical distal instrument loaded in the internal insertion main body and loaded in advance from the rear end opening in advance is pressed to move the surgical distal instrument from the distal opening of the body cavity insertion main body to the lesion organ in the body cavity.
  • a surgical invasive device having a surgical tip specific cavity insertion means, wherein the surgical tip instrument is previously removed from the tip of the needle structure using the surgical tip specific cavity insertion means.
  • the needle structure of the needle device for surgical treatment is punctured into the body cavity to reach the vicinity of the diseased organ at the tip of the needle structure.
  • the surgical tip instrument is operated by the surgical tip instrument operating section in a state where the surgical tip instrument is extracted from the means for inserting the surgical tip instrument into the cavity. Are all performed in the body cavity.
  • the surgical treatment needle type device is disposed between one or a plurality of guide plates slidably inserted through the main shaft needle and the sub shaft needle, and between the needle support unit and the guide plate. And further comprising one or more springs for urging each guide plate from the back side.
  • the surgical tip instrument includes a surgical tip instrument coupling mechanism in which the leading end portions of the main needle needle and the countershaft needle are detachably connected to the rear end portion.
  • a needle type device for surgical treatment of a minimally invasive surgical system is provided between the needle support unit and a surgical tip instrument operating section, and is on the distal side of the surgical tip instrument operating section.
  • a tilting plate that can be tilted in all directions via a universal bearing provided on a distal end side support shaft extending along the X axis, and a sphere or bowl-like shape provided at the rear end of each countershaft needle
  • the body comprises a secondary shaft needle rear end coupling mechanism that slidably engages with a plurality of long grooves extending in a direction orthogonal to the X axis provided on the inclined plate, and by tilting the inclined plate in an arbitrary direction
  • One of the counter-shaft needles that are opposed to the tilting center is pressed forward and the other is pulled backward, so that a bending moment is generated in the needle structure.
  • It said needle structure operative tip instrument is connected, characterized in that the needle structure bending operation portion to bend the Ryakuyumi type shape is further
  • Each of the main shaft needle and the sub shaft needle is made of a rod-like or linear body having an outer diameter of about 3 mm or less made of a medically compatible material having high rigidity and high elasticity, and is about 2 mm so as to straddle the pain nerve of the living body. It is characterized by being arranged in parallel substantially symmetrically at the above intervals.
  • At least the main spindle needle is made of a shape memory material, and slides, rotates in the main axis direction necessary for the operation of the surgical tip instrument, or energizes the main spindle needle and the sub spindle needle, and transmits microwave or ultrasonic radiation. It is characterized by selectively having various functions.
  • the surgical distal end specific cavity insertion means of the minimally invasive surgical system has an outer diameter, a length, a rear end and a distal end, and a U axis extending in the length direction is a main axis
  • An intracorporeal insertion body having a tubular body inserted into a body cavity through a natural opening including an abdominal hole or anus for living body single-hole laparoscopic surgery and closed at both end faces, and a distal end portion of the intracavity insertion body
  • a surgical tip instrument holding mechanism that detachably holds the surgical tip instrument, and a surgical tip instrument holding operation section that performs a holding operation of the surgical tip instrument holding mechanism at the rear end, and the surgical tip instrument
  • the holding mechanism includes: a first opening provided at a distal end portion of the tubular body; a second opening provided at a distal end side having a symmetrical relationship with the first opening and the U axis; and the first opening Pivot through a fixed pin so that it can tilt
  • the piston rod is exposed to the outside and a gripping portion connected to the rear end portion of the piston rod. After the container The tilting angle of the piston is brought into contact with and guided by the tilt guide of the piston, and the tilt angle can be freely adjusted by the gripping portion at hand.When the piston rod is pulled and retracted, the biasing force of the spring The surgical tip instrument holding container is returned to a position substantially parallel to the U axis.
  • the surgical distal instrument includes a front drive shaft that is slidably inserted in the hollow guide support member in cooperation with the distal end portion of the spindle needle along the X-axis direction, and the distal end portion of the guide support member
  • a jaw opening / closing drive mechanism for opening / closing a jaw mechanism including a first jaw member and a second jaw member pivotally connected to each other by a fixed pin, and the jaw opening / closing drive mechanism includes the front drive shaft.
  • a guide pin provided at the tip of each of the first and second jaw members extends to the rear end of the first jaw member and is slidable together with a long hole guide formed in the X-axis direction and the crossing direction. It is inserted and engaged with, It is characterized by the above-mentioned.
  • the surgical tip instrument coupling mechanism includes a substantially cylindrical outer cylinder that inserts and holds the rear end portion of the surgical tip instrument on the tip side.
  • a spindle needle insertion hole having a tapered guide formed at an opening end portion provided at a rear end surface of the outer cylinder and removably inserted at the tip ends of the spindle needle and the auxiliary shaft needle, respectively, and a plurality of auxiliary needles.
  • the first spindle side small The protrusion rides on the outer periphery of the spindle needle, the first free end is deformed in the diameter increasing direction, and the plurality of auxiliary shaft side small protrusions are expanded in diameter, and are respectively fitted and engaged in the auxiliary shaft needle groove,
  • the second spindle side small protrusion is on the outer circumference of the spindle needle. After the second free end is lifted and deformed in the diameter-expanding direction, the second spindle-side small protrusion is finally inserted into and engaged with the spindle needle groove to reduce the diameter of the second free end. It is characterized in that the distal end portion of the needle structure and the surgical distal instrument connecting mechanism are connected by springback in the direction and returning.
  • the spindle needle groove is partially cut out in a direction perpendicular to the spindle on the opposing outer peripheral surface of the spindle needle tip, and the tip of the needle structure and the surgical tip instrument coupling mechanism
  • the second spindle-side small protrusion is moved to the spindle
  • the first free end is deformed in the diameter-expanding direction on the outer periphery of the needle so that the second spindle-side small protrusion is detached from the spindle needle groove, and then the spindle needle is withdrawn rearward.
  • the first free end portion springs back in the direction of diameter reduction and the plurality of sub shaft side small projections are reduced in diameter so that the sub shaft needle is reduced. It is possible to detach the distal end portion of the needle structure from the surgical distal instrument connecting mechanism by detaching from the groove.
  • the surgical distal instrument is removably attached to the distal end portion of the needle structure composed of the main shaft needle and the plurality of sub shaft needles, so that it has stable support rigidity and strength,
  • the needle structure is punctured directly into the body cavity without incision or laparotomy, and the body cavity from the natural opening such as the abdominal hole or anus of the living body to the distal end of the needle structure first using the surgical tip specific cavity insertion means. Because it is possible to perform all surgical procedures in the body cavity by connecting surgical tip instruments inserted to the vicinity of the lesioned organ in the body cavity, it is minimally invasive and can be used for surgical procedures targeting large and heavy-weight organs.
  • a minimally invasive surgical system having a needle-type device for surgical treatment with a design freedom and a design freedom.
  • a single-hole type laparoscopic surgical abdominal cavity having a diameter of about 10 mm provided in the umbilical region having the least pain in terms of neuroanatomy can be used, thereby realizing further less invasiveness.
  • a needle-type device for surgical treatment loaded with the needle support unit removed in the surgical tip specific cavity insertion means that is inserted from the abdominal cavity to the vicinity of the lesioned organ in the body cavity first,
  • the needle support unit is inserted into the rear end of the needle structure that is extruded from the inside of the body cavity to the outside of the abdominal skin and then pierced and penetrated from the inside of the body cavity to the outside of the abdominal skin without incising or opening the living body.
  • Operate surgical instruments in the state of being directly connected to the eye and perform all surgical procedures in the body cavity, improving operability and adapting to surgical procedures targeting large and heavy-weight organs Effect of selectively providing a minimally invasive surgical system having a needle-type device for surgical treatment with maximum design flexibility and design flexibility according to the patient's situation A.
  • the needle device for surgical treatment is provided with an arbitrary needle structure by tilting a tilting plate of a needle structure bending operation portion provided between the needle support unit and a surgical distal instrument operation portion in an arbitrary direction. Since it can be bent in a substantially arcuate shape in the direction, there is an effect that the degree of freedom of the surgical treatment in the body cavity is increased and the operability is improved.
  • the main axis needle and the sub axis needle are made into a rod-like or linear body having an outer diameter of about 3 mm or less, and are arranged substantially symmetrically in parallel with an interval of about 2 mm or more across the pain nerve of the living body, thereby suppressing pain to the living body. Furthermore, there is an effect that a further less invasiveness that is favorable in terms of neuroanatomy is ensured.
  • the spindle needle is made of a shape memory material, thereby ensuring stable support rigidity and strength to prevent permanent deformation of the needle structure that holds the surgical tip instrument at the tip portion, and through the spindle needle. There is an effect of improving the operation reliability of the surgical instrument.
  • the surgical needle since the spindle needle selectively has various functions such as sliding and rotation in the spindle direction necessary for the operation of the surgical tip instrument, and energization and microwaves to the spindle and countershaft needles, the surgical needle according to the present invention.
  • the treatment needle type device can selectively apply various surgical tip instruments according to the patient's situation, and has the effect of further improving the degree of freedom in design.
  • the surgical tip device specific intracavity insertion means performs surgical treatment in the body cavity by tilting the surgical tip instrument holding container tiltably provided at the distal end portion of the body cavity insertion main body having a tubular body by the tilt guide of the piston.
  • the simple structure of receiving / handing over, that is, connecting / opening the surgical tip instrument to the tip of the needle structure of the needle type device for medical use ensures good operability, reliability and economy of the surgical procedure. Is done.
  • the surgical tip instrument has a jaw opening / closing drive mechanism, a guide pin provided at the tip of the front drive shaft is extended to the rear ends of the first jaw member and the second jaw member, and the X-axis direction
  • the surgical tip instrument has a simple configuration in which it is slidably inserted into and engaged with the long hole guides formed in the directions intersecting each other, and the link-related members are omitted compared to the link type jaw opening / closing drive mechanism in the conventional surgical tip instrument. Since the number of parts is small, and it is lightweight and compact, there is an effect of improving economic efficiency and operability.
  • the surgical tip instrument coupling mechanism first inserts a plurality of countershaft needles into each countershaft needle insertion hole, and then inserts the main needle into the main needle insertion hole.
  • a plurality of sub-shaft side small protrusions provided on the first free end of the small protrusion ride on the outer periphery of the main spindle needle are expanded in diameter, and are fitted into and engaged with each sub-axis needle groove, and the second main spindle side
  • the second spindle-side small protrusion is finally inserted into and engaged with the spindle needle groove, so that the second free end Since the portion springs back in the reduced diameter direction and returns and the connection between the distal end portion of the needle structure and the surgical distal instrument connecting mechanism is facilitated in a short time, there is an effect of improving the operability and the efficiency of the operation.
  • the spindle needle groove is partially cut out in the direction perpendicular to the spindle on the opposing outer peripheral surface of the spindle needle tip, and in the connected state between the tip of the needle structure and the surgical tip instrument connection mechanism,
  • the spindle needle is operated approximately half a half by operating the surgical tip instrument rotating handle while the outer cylinder of the surgical tip instrument coupling mechanism is held first
  • the second spindle-side small protrusion rides on the outer circumference of the spindle needle and the second free end.
  • the first main shaft side small protrusion is detached from the outer peripheral surface of the main shaft needle by pulling the main shaft needle rearward by pulling the main shaft needle rearward.
  • FIG. 1 is a conceptual diagram for conceptually explaining a minimally invasive surgical operation system 1 according to Embodiment 1 of the present invention, in which a surgical tip is inserted into a specific cavity first from the abdominal cavity Mb to the vicinity of a diseased organ T in a body cavity. It is a conceptual diagram which shows the state which inserted the needle structure 30 of the needle type device 10 for surgical treatment in the body cavity toward the back end part of the surgical front-end
  • FIG. 2 is a conceptual diagram showing a state in which the surgical tip instrument 60 connected to the distal end portion 30a of the needle structure 30 of the surgical treatment needle type device 10 is removed from the surgical tip instrument specific intracavity insertion means 200 following
  • FIG. 1 is an overall assembly conceptual diagram conceptually showing a configuration of a surgical treatment needle type device 10 according to Embodiment 1 of the present invention. It is a computer graphic bird's-eye view which shows the structure of 60 operation
  • FIG. 5 is a cross-sectional view of the surgical tip instrument 50 and the surgical tip instrument coupling mechanism 50 of FIG. 4. It is a longitudinal cross-sectional view of the surgical tip instrument operation part 20 side latter half part of FIG.
  • FIG. 9 is a computer graphic diagram showing a state in which the surgical tip instrument holding container 217 of the surgical tip instrument specific cavity insertion means 200 of FIG. 8 is pushed up and tilted by the tilt guide 222a at the tip of the piston 222.
  • FIG. 9 shows notionally the structure of the needle type device 10A for surgical treatment by Embodiment 2 of this invention.
  • FIG. 8 is a longitudinal sectional view of main parts of the needle structure bending operation unit 70 and the needle support unit 40 of FIG. 7. It is the whole assembly conceptual diagram which shows notionally the structure of the needle type device 10B for surgical treatment by Embodiment 3 of this invention.
  • 12 is a conceptual diagram for conceptually explaining a minimally invasive surgical system 1B according to Embodiment 3 of the present invention, in which the surgical treatment needle-type device 10B is connected to the needle support unit 30 from the rear end 30b of the needle structure 30.
  • the needle structure 30 is inserted from the rear end 30b side of the needle structure 30 in a state where the needle 40 is removed to the vicinity of the lesioned organ in the body cavity in a state of being loaded into the surgical tip device specific cavity insertion means 300 of another embodiment.
  • It is a conceptual diagram showing a state in which the rear end portion 30b side is pushed from the inside of the body cavity to the outside of the abdominal skin by the surgical tip instrument pushing piston 308 and punctured from the inside of the body cavity to the outside of the abdominal skin.
  • It is a conceptual diagram which shows the state which connected the rear end part 30b of the needle structure 30 penetrated out of the abdominal skin to the needle support unit 40 previously removed following FIG. FIG.
  • FIG. 15 is a conceptual diagram showing a state in which the entire surgical needle type device 10 ⁇ / b> B in which the needle support unit 40 is connected to the needle structure 30 is extracted from the surgical tip device specific cavity insertion means 300, following FIG. 14.
  • FIG. 5 is a conceptual diagram for conceptually explaining a minimally invasive surgical operation system 1C according to Embodiment 4 of the present invention. From a natural opening, for example, from mouth Ma to the vicinity of a diseased organ T in a body cavity through a living body. A concept showing a state in which the needle structure 30 of the surgical treatment needle type device 10 is inserted into the body cavity toward the rear end portion of the surgical tip instrument 60 delivered from the inserted surgical tip instrument specific intracavity insertion means 100 to the immediate vicinity thereof.
  • FIG. 17 is a conceptual diagram showing a state in which the surgical tip instrument 60 connected to the distal end portion 30 a of the needle structure 30 of the surgical treatment needle type device 10 is removed from the surgical tip instrument specific intracavity insertion means 100 following FIG. 16. It is a computer graphic whole assembly drawing which shows the structure of the needle type device 10C for surgical treatment by Embodiment 5 of this invention.
  • FIG. 19 is a computer graphic cross-sectional view of a surgical tip instrument coupling mechanism 50C of the surgical treatment needle-type device 10C of FIG.
  • FIG. 19 is a computer graphic cross-sectional view of the needle support unit 40 and the surgical instrument operating unit 20 of the surgical treatment needle-type device 10C of FIG. 18.
  • FIG. 9 is a conceptual diagram for conceptually explaining a minimally invasive surgical system 1D according to Embodiment 6 of the present invention, in which a surgical tip is inserted from the abdominal hole Mb to the vicinity of a diseased organ T in the body cavity; It is a conceptual diagram which shows the state which inserted the needle structure 30 of the needle type device 10 for surgical treatment in the body cavity toward the back end part of the surgical front-end
  • the minimally invasive surgical system 1 As shown in FIGS. 1 to 3, the minimally invasive surgical system 1 according to Embodiment 1 of the present invention has an X-axis, a proximal end, which is the main axis and can be set to an outer diameter and a length according to the situation.
  • the countershaft needle 32 has stable support rigidity and strength, and the main shaft needle 31 and the tips 31a and 32a of the subshaft needle 32 are formed in a sharp shape.
  • Surgical tip device comprising a needle structure 30 configured to be able to puncture directly into the body cavity from the outer surface of the abdominal skin, and a surgical tip instrument connecting mechanism 50 detachably connected to the tip portion 30a of the needle structure 30 at the rear end portion.
  • a needle support unit 40 through which the rear end portion 30b of the needle structure 30 is inserted and supported, and a rear end portion 31b of the main shaft needle 31 connected to the rear end portion of the needle support unit 40 and inserted into the main shaft needle.
  • the surgical treatment needle device 10 includes a surgical distal instrument operating unit 20 that operates the surgical distal instrument 60 in cooperation with the rear end 31b of the surgical instrument 31.
  • the minimally invasive surgical operation system 1 includes a tubular body 211 inserted into a body cavity from a natural opening such as a single-hole laparoscopic surgical abdominal hole Mb or anus having a diameter of approximately 10 mm.
  • An intracorporeal insertion main body 210 having a surgical distal instrument holding mechanism that is provided at the distal end of the intracavity insertion main body 210 and that detachably holds the surgical distal instrument 60 removed from the distal end 30a of the needle structure 30;
  • the surgical tip instrument specific cavity insertion means 200 includes a surgical tip instrument holding mechanism operation unit 220 that performs a holding operation of the surgical tip instrument holding mechanism at the rear end.
  • the needle type device 10 for surgical treatment is monitored under a laparoscope (not shown).
  • the needle structure 30 is punctured from the distal end portion 30a into the body cavity and is connected to the surgical distal instrument connection mechanism 50 at the rear end portion of the surgical distal instrument 60 inserted into the distal end portion 30a of the needle structure 30 to the vicinity of the lesioned organ T.
  • the surgical tip instrument 60 is operated by the surgical tip instrument operating unit 20 in a state in which the surgical tip instrument 60 is opened from the surgical tip instrument specific cavity insertion means 200, and all the surgical procedures are executed in the body cavity.
  • Each of the members constituting the surgical treatment needle type device 10 and the surgical tip specific insertion means 200 of the present invention has a corrosion resistance and a chemical resistance, and has a temperature durability capable of withstanding heat sterilization.
  • each material is made to be disassembled so as to facilitate sterilization, and can be disposable on a case-by-case basis.
  • the main shaft needle 31 and the sub shaft needle 32 can be set to an appropriate outer diameter and length according to the situation and can be exchanged to various lengths.
  • the main shaft needle 31 and the sub shaft needle 32 are made of a round bar or a linear medical compatible material having an outer diameter of about 3 mm or less, and are substantially symmetrical at intervals of about 2 mm or more so as to straddle the pain nerve of a living body. It is desirable to arrange in parallel on the circumference. Thereby, the pain to a living body is suppressed and further less invasiveness is ensured.
  • each of the main spindle needle 31 and the four countershaft needles 32 has a high rigidity and a Ti-type shape memory alloy material having an outer diameter of approximately 3 mm and an SUS material having an outer diameter of approximately 2 mm. It consists of a rod-like or linear body having high elasticity.
  • the spindle needle 31 selects various functions such as sliding and rotation in the main axis direction necessary for the operation of the various surgical tip instruments 60, and energization, microwave or ultrasonic radiation transmission to the main spindle needle and the sub spindle needle. Can be given.
  • heat can be used to cauterize blood vessels and stop bleeding.
  • Such heat can be generated using RF current, microwave or ultrasonic radiation.
  • Thermal energy can be applied directly to living tissue and these thermal energy can be transmitted through the spindle needle 31 to the affected lesion tissue.
  • the surgical treatment needle type device 10 includes two guide plates 33 and 34 that are slidably inserted into the main shaft needle 31 and the sub shaft needle 32, and the guide plates 33 and 34 on the back surface. Are further provided with two springs 35a and 35b disposed between the guide plates 33 and 34 and between the needle support unit 40 and the guide plate 34, respectively. Thereby, the stable support rigidity and intensity
  • the distal guide plate 33 is pressed against the abdominal surface of the human body M.
  • the spring 35 a, the guide plate 34, and the spring 35 b are sequentially pressed rearward along the needle structure 30, and are slid and reduced in scale as illustrated by the two-dot chain line.
  • the surgical tip instrument 60 can selectively replace various kinds of known surgical tip instruments such as grasping, cutting, puncturing, and punching a living organ.
  • the surgical tip instrument 60 in this embodiment is slidable in cooperation with the tip 31 a of the spindle needle 31 in the hollow guide support member 61 along the spindle direction.
  • the inserted front drive shaft 64 and the jaw mechanism 62 including the first jaw member 62a and the second jaw member 62b pivotally connected to the distal end portion 61a of the guide support member 61 by a fixing pin 63 are opened and closed.
  • a guide pin 65 provided at the distal end portion 64a of the front drive shaft 64 extends to the rear end portions of the first jaw member 62a and the second jaw member 62b, and X Both the shafts and the long hole guides 62c and 62d formed in the crossing direction are slidably inserted and engaged with each other.
  • the guide pin 65 slides and guides along the long hole guides 62c and 62d, whereby the first jaw member 62a and the second jaw member 62b. Are mutually rotated and opened and closed. That is, the first jaw member 62a and the second jaw member 62b are configured to open when the front drive shaft 64 slides forward and to close when the front drive shaft 64 slides backward.
  • the surgical tip instrument 60 of the present invention is economical because the link-related members are omitted, the number of parts is small, and the weight and size are reduced compared to the link type jaw opening / closing drive mechanism and the like in the conventional surgical tip instrument. And operability is improved.
  • the surgical tip instrument 60 is provided with a surgical tip instrument coupling mechanism 50 in which the distal end portions 31a and 32a of the main shaft needle 31 and the countershaft needle 32 are detachably coupled to the rear end portion.
  • the surgical tip instrument coupling mechanism 50 interpolates and holds the rear end portion 61b of the guide support member 61 of the surgical tip instrument 60 on the distal end portion 51a side, and the spindle needle 31 on the rear end portion 51b side.
  • a main shaft needle insertion hole 51c formed with a taper guide at the opening end portion into which the distal end portions 31a and 32a of the sub shaft needle 32 are removably inserted, and a plurality of sub shaft needle insertion holes 51d.
  • a cause 53a is
  • main shaft side small protrusion 52a and the sub shaft side small protrusion 53a are fitted and engaged with each other along the outer circumferences of the tip portions 31a and 32a of the main shaft needle 31 and the sub shaft needle 32, respectively.
  • a countershaft needle groove 32d is formed.
  • the needle structure 30 is pushed forward, and the distal end portions 31a and 32a of the spindle needle 31 and the countershaft needle 32 are inserted into the spindle needle insertion hole 51c and the countershaft needle insertion hole 51d of the surgical tip instrument coupling mechanism 50, respectively.
  • the main shaft side free protrusion 52 and the sub shaft side free end 53 are deformed by pushing the side small protrusion 52a and the sub shaft small protrusion 53a in the radially outward direction of the main shaft needle insertion hole 51c and the sub shaft needle insertion hole 51d.
  • the main shaft side small protrusion 52a and the sub shaft side small protrusion 53a spring back to the main shaft needle groove 31e and the sub shaft needle groove 32d, respectively.
  • the needle tip 30 is pulled backward with a predetermined force while the surgical tip instrument 60 or the surgical tip instrument coupling mechanism 50 is held by the surgical tip instrument specific intra-cavity insertion means 200, the main-axis-side small protrusion 52a and the minor-axis side
  • the main shaft needle free end 52 and the sub shaft side free end 53 are deformed so that the small protrusions 53a run on the outer surfaces of the main shaft needle 31 and the sub shaft needle 32, respectively. It disengages from the ditch
  • the predetermined traction force when the connection is released is set by adjusting the shape of engagement between the main shaft side small protrusion 52a and the sub shaft side small protrusion 53a and the main shaft needle groove 31e and the sub shaft needle groove 32d. Is done.
  • the surgical tip instrument operating unit 20 includes a fixed handle structure 21 including a grip handle 21 a provided at the lower end in the figure and a support body 21 b extending forward along the X axis at the upper end in the figure. And a movable handle 22 that is pivotally connected to the rear end portion of the fixed handle structure 21 by a fixing pin 25 and operates the surgical tip instrument 60 in cooperation with the rear end portion 31b of the spindle needle 31, and the distal end portion of the support body 21b.
  • a surgical tip instrument rotating mechanism 23 that is rotatably inserted and rotates the needle support unit 40, the spindle needle 31 and the surgical tip instrument 60 together.
  • the surgical tip instrument rotating mechanism 23 extends forward along the X-axis at the distal end portion to form a male screw portion 23b, and is inserted into the distal end portion of the support body 21b so as to be freely rotatable.
  • the rear end portion 31b of the main spindle needle 31 is screwed and fixed to the support rotating body 24 including the hollow outer cylinder 24b that is screwed and fixed to the portion 23b, and the female screw portion 28a formed from the front end side along the main shaft.
  • the connecting member 28 is slidably inserted together with the spindle needle 31 in the X-axis direction into the hollow end support 24a, and a spherical body 28c described later is formed at the rear end.
  • a guide key groove 28b is formed along the X-axis direction on the outer surface of the connecting member 28 inserted into the hollow end support 24a.
  • a guide screw 29 is screwed into the distal end support portion 24a in the radial direction from the outer surface, and the distal end portion of the guide screw 29 is slidably fitted into the guide key groove 28b of the connecting member 28.
  • the movable handle 22 is linked with a rear end portion 31 b of the main spindle needle 31 via a rear drive shaft 27 described later.
  • the distal end of the operation is passed through the rear drive shaft 27 and the main spindle needle 31.
  • the front drive shaft 64 of the instrument 60 can be slid in the X-axis direction.
  • the shape and mechanism of the movable handle 22 and the fixed handle structure 21 of the distal instrument operating unit 20 are not particularly limited, and the configuration of the operation unit and movable handle of the known endoscopic surgical forceps and the fixed handle structure are used. Can be applied.
  • the rear drive shaft 27 is formed with a concave groove 27e in which a spherical body 28c formed at the rear end portion of the connecting member 28 is fitted at the front end portion of the shaft main body 27a.
  • a spherical body 27c that is slidably fitted into a recessed groove 22a formed on the X-axis with the flange 27b separated from the fixed pin 25 pivotally connected to the movable handle 22 at the rear end.
  • the flange portion 27b and the shaft main body 27a are slidably inserted in guide holes 21c and 21d formed along the X-axis in the support main body 21b of the fixed handle structure 21, respectively.
  • the movable handle 22 is closed in the direction of the grip handle 21a of the fixed handle structure 21 (in the direction of the solid line arrow) or in the opposite direction (in the direction of the broken line arrow in the drawing). Then, the front drive shaft 64 of the surgical tip instrument 60 is sequentially moved back, that is, retreated or advanced in the X-axis direction via the rear drive shaft member 27 and the main shaft needle 31 sequentially, and the jaw mechanism 62 is driven to close or open.
  • the surgical tip instrument holding mechanism of the surgical tip instrument specific cavity insertion means 200 is provided on the upper surface of the distal end portion 211a of the tubular body 211 of the body cavity insertion body 210 as shown in FIGS.
  • the first opening 211c and the first opening 211c are tilted at a predetermined angle to the second opening 211d provided on the lower surface in the drawing and symmetrical to the U-axis with respect to the U axis, and to the tip of the first opening 211c.
  • a hollow surgical tip instrument holding container 217 which is housed and held in the interior 217a, and one end is fixed to the fixing pin 214, and the other end is a rear portion of the fixing pin 214 of the surgical tip instrument holding container 217. Having a spring 218 for urging the surgical tip instrument holding container 217 is fixed by provided fixed member 217c in the direction of holding the U axis substantially parallel position or not shown horizontal position.
  • the distal end portion 211a and the rear end portion 211b of the tubular body 211 are respectively provided with a distal end cap 212 and a rear end cap 213, which are closed so that foreign matter such as bodily fluids, blood, and tissue fragments enter the tubular body 211 from the body cavity. Prevent extracorporeal leakage as much as possible.
  • the distal instrument holding operation unit 220 of the surgical distal instrument specific cavity insertion means 200 is loaded in the tubular body 211, and a piston 222 having an inclined guide 222a having a downward slope shown in the distal direction formed at the distal end.
  • the piston rod 221 is connected to the rear end portion 222b of the piston 222 and slidably passes through the rear end cap 213 that closes the rear end portion 211 of the tubular body 211 and is exposed to the outside, and the rear end portion of the piston rod 221 And a gripping portion 223 coupled to 221b.
  • the surgical distal instrument holding container 217 comes into contact with the inclined guide 222a of the piston 222 from the rear end and is guided and tilted by a predetermined angle.
  • the surgical instrument holding container 217 is returned to a position substantially parallel to the U-axis by the biasing force of the spring 218.
  • the surgical distal instrument holding container 217 is placed on the distal end side of the surgical distal instrument holding container 217 and the distal end portion 211a side of the tubular body 211 so as to be engaged with each other and prevent unintentional tilting in the body cavity insertion process or the like.
  • Engaging members 217c and 215 are provided to retract and hold at positions substantially parallel to the shaft.
  • a protruding member 219 protruding from the rear side inner surface 217a of the surgical tip instrument holding container 217 and a T-shaped concave groove (not shown) are formed on the outer surface of the surgical tip instrument coupling mechanism 50, and the surgical tip instrument 60 is rotated.
  • the surgical distal instrument 60 is detachably mounted in the surgical distal instrument holding container 217 by engaging and engaging the distal end of the protruding member 219 with the T-shaped groove.
  • a surgical treatment needle type device 10 ⁇ / b> A includes a needle support unit 40 and a surgical tip instrument rotating mechanism in the surgical treatment needle type device 10 of Embodiment 1.
  • the other structure is the same as that of the surgical treatment needle type device 10 of the first embodiment except that a needle structure bending operation unit 70 for bending the needle structure 30 is provided. Therefore, members having the same functions and configurations as those of the first embodiment in FIGS. 10 and 11 to be described later are denoted by the same reference numerals for the sake of simplification of description. explain.
  • the needle structure bending operation unit 70 is provided between the needle support unit 40 and the surgical tip instrument rotating mechanism 23 of the surgical tip instrument operating unit 20, and includes a plurality of tilting handles 73 on the outer surface.
  • a tilting plate 71 that is extrapolated via a center hole 71 a and supported to be tiltable in all directions by a universal bearing 72 provided in the tip support portion 24 a of the tip instrument turning mechanism 23, and the rear end of each countershaft needle 32
  • the spherical shaft or the bowl-shaped body 32c provided in the portion 32b includes a countershaft needle rear end coupling mechanism that is slidably fitted into and engaged with a plurality of long grooves 71b provided in the inclined plate 71, respectively.
  • the universal bearing 72 for example, a spherical plain bearing type having a structure in which inner and outer rings 72a and 72b are in spherical contact is applied.
  • the needle structure bending operation section 70 that bends the needle structure 30 is not limited to this form, and various known insertion section bending mechanisms of endoscopes or surgical instruments for endoscopes can be applied.
  • the minimally invasive surgical system 1B according to the third embodiment of the present invention has a needle structure 30 in which the surgical needle type device 10B is different from the surgical treatment needle type device 10 according to the first embodiment.
  • Other configurations are the same as those of the minimally invasive surgical system 1 of the first embodiment except that the configuration of the needle support unit 40 and the method of use in the surgical procedure are different. Accordingly, members having the same functions and configurations as those of the first embodiment in FIGS. 12 to 15 are denoted by the same reference numerals for the sake of simplicity, and the differences will be described below with reference to the accompanying drawings.
  • a surgical treatment needle type device 10B is first slidably inserted into a main shaft needle 31 and a sub shaft needle 32 as shown in FIG.
  • the guide plate 33 and one spring 35 are provided, and the needle structure 30 is set to be relatively short.
  • the rear end portions 31b and 32b of the main shaft needle 31 and the sub shaft needle 32 of the needle structure 30 are provided.
  • 30b is different from the needle type device 10 for surgical treatment of the first embodiment in that it is configured to be pierced through the body cavity from the inside of the body cavity to the outer surface of the skin. It is the same as in the first embodiment.
  • the surgical treatment needle type device 10 ⁇ / b> B with the needle support unit 40 and subsequent portions removed from the rear end portion 30 b of the needle structure 30 is on the rear end portion 30 b side of the needle structure 30.
  • a handle 304 is provided in the rear end opening 303 that is open at both ends so that it can be removably loaded from the outside, and a substantially disk-like or substantially hollow cone-like opening and closing divided into a plurality of opening and closing freely at the front end opening.
  • the insertion main body 301 and the opening / closing lid 30 of the distal end opening of the body cavity insertion main body 301 are loaded into the insertion body 301 in the body cavity and press the distal end portion of the surgical distal end instrument 60 loaded in advance from the rear end opening 303 in advance.
  • a surgical tip instrument push-out piston 308 that pushes open and extrudes the rear end portions 31b and 32b formed in the sharp shape of the main needle 31 and the sub-shaft needle 32 to pierce and penetrate from the inside of the body cavity to the abdominal skin. It has a surgical distal end specific cavity insertion means 300.
  • a high-pressure fluid supply pipe 306 provided with a flow rate adjustment valve 307 for supplying a high-pressure fluid such as a high-pressure inert gas is connected to the front end of the handle portion 304 of the body cavity insertion main body 301.
  • a high-pressure fluid such as a high-pressure inert gas
  • the back side of the surgical tip instrument push-out piston 308 loaded in advance is pressed by the high-pressure fluid supplied into the body cavity insertion main body 301.
  • a rear end cap 305 is attached to the rear end opening 303 of the handle portion 304, whereby the inside of the body cavity insertion body 301 on the back side of the surgical tip instrument push-out piston 308 is sealed, and the high pressure fluid is maintained in a high pressure state. Is done.
  • the needle support unit 40 that has been removed first is directly connected to the rear end 30b of the needle structure 30 that has been penetrated from the inside of the body cavity to the outside of the abdominal skin by means of the intraoperative cavity insertion means 300.
  • the surgical treatment needle type device 10B is pulled out from the distal end opening of the surgical distal instrument internal cavity insertion means 300 to the distal end of the surgical distal instrument 60 (see FIG. 12).
  • the surgical instrument 60 is operated by the distal instrument operating unit 20 to perform all surgical procedures in the body cavity.
  • the rear end portions 31b and 32b formed in the sharp shape of the main needle 31 and the sub needle 32 are, for example, silicon.
  • Rubber puncture prevention caps SC are respectively attached to prevent an inadvertent puncture and damage of an organ inside a body cavity.
  • the puncture prevention cap SC is placed inside the body cavity in a state of being penetrated from the portions 31b and 32b.
  • a flexible thin wire member 309 having both ends 309 a and 309 b fixed thereto is provided on the back surface of the surgical tip instrument push-out piston 308 and the inner surface of the rear end cap 305, and the surgical tip instrument push-out piston 308 is provided on the body cavity insertion body 301.
  • the length of the thin wire member 309 is set to a position where it comes into contact with the inner surface of the opening / closing lid 302 at the tip opening and stops while holding the opening / closing lid 302 open.
  • the surgical tip instrument push-out piston 308 is not pushed out of the distal end opening of the body cavity insertion body 301, and after the surgical procedure is completed, the needle structure 30 and the needle structure 30 and Alternatively, the surgical instrument 60 can be removed and easily stored in the distal end opening of the body cavity insertion body 301. And finally, the remaining part of the surgical tip device specific cavity insertion means 300 and the surgical treatment needle type device 10B is taken out from the body cavity.
  • the surgical distal end specific cavity insertion means 300 is loaded in advance from the rear end portion with only the surgical distal instrument 60 into the body cavity insertion body 301 and inserted from the abdominal cavity Mb to the vicinity of the lesioned organ (not shown) in the body cavity.
  • the surgical tip instrument 60 is first exposed in a state where the rear end portion of the surgical tip instrument 60 pressed by the surgical tip instrument push-out piston 308 is exposed by pushing open the opening / closing lid 302 from the distal end opening of the body cavity insertion body 301.
  • the distal end of the needle structure 30 of the removed surgical treatment needle type device 10B (or the surgical treatment needle type device 10, 10A of Embodiments 1 and 2) may be punctured into the body cavity from the outer surface of the abdomen.
  • the surgical procedure by manipulating the surgical tip tool 60 by 0 may be an alternative embodiment for performing all within the body cavity (sixth embodiment described later, see FIG. 21). (Embodiment 4)
  • a minimally invasive surgical system 1C is used in a living body tube such as an esophagus alone or through an endoscope 400 from a natural opening portion of a living body such as a mouth Ma.
  • An intracorporeal insertion body 101 having a long and flexible support shaft unit to be inserted into the body cavity, and a surgical tip instrument holder that is provided at the distal end portion of the intracavity insertion body 101 and detachably holds or holds the surgical tip instrument 60
  • a surgical tip instrument specific cavity insertion means 100 having a mechanism 102 and a surgical tip instrument holding operation unit 103 for holding or holding the surgical tip instrument holding mechanism 102 at the rear end is provided.
  • the surgical tip can be inserted into the esophagus from the mouth Ma of the human body M alone or through one or two operating channels 402a of the endoscope 400 as shown in FIGS.
  • the surgical tip instrument 60 is inserted to the vicinity of the stomach bag T via the endoscope, and then the endoscopic monitoring means 402b provided at the distal end of the surgical tip instrument specific cavity insertion means 100 or the endoscope 400 or / and a separate laparoscope Under the monitoring (not shown), the surgical tip instrument inserted into the distal end portion 30a of the needle structure 30 up to the vicinity of the stomach bag T, which is a diseased organ, by puncturing the needle structure 30 of the needle device 10 for surgical treatment into the body cavity.
  • the surgical distal instrument operating unit is connected to the rear end of the surgical instrument 60. 0 by operating the surgical tip tool 60 to perform any surgical procedure within the body cavity.
  • a plurality of surgical tips can be used as needed with a relatively large configuration similar to known endoscopic surgical forceps or surgical treatment gripping tools. Detailed description is omitted. (Embodiment 5)
  • the surgical treatment needle type device 10C according to the fifth embodiment of the present invention differs from the surgical treatment needle type device 10 of the first embodiment in the configuration of the surgical tip instrument coupling mechanism 50C. Except for the differences, the other configuration is the same as that of the surgical treatment needle type device 10 of the first embodiment. Accordingly, members having the same functions and configurations as those of the first embodiment in FIGS. 18 to 20 are denoted by the same reference numerals for the sake of simplicity, and the differences will be described below with reference to the accompanying drawings.
  • the surgical distal instrument connecting mechanism 50C has a substantially cylindrical outer cylinder that inserts and holds the rear end portion 61b of the guide support member 61 of the surgical distal instrument 60 on the distal end side. 51C and a spindle needle provided on the rear end surface of the outer cylinder 51C and having a tapered guide at the opening end portion where the tip end portions 31a and 32a of the spindle needle 31 and the plurality of auxiliary shaft needles 32 are removably inserted.
  • a substantially cylindrical first inner cylinder 53C in which 53Cd is formed, and inner and outer surfaces of the rear end portion of the first free end portion 53Cd, respectively, are provided with a spindle needle insertion hole 51Cc and each countershaft needle insertion hole 51.
  • the first main shaft side small protrusions 53Ce and the plurality of sub shaft side small protrusions 53Cb projecting in the respective main shaft directions of d and the first inner cylinder 53C are accommodated concentrically, and the rear portion is divided by the plurality of slits 52Cc.
  • a substantially cylindrical second inner cylinder 52C formed with a second free end 52Cd that is elastically deformable in the radial direction, and an inner surface of the rear end of the second free end 52Cd, And a second main shaft side small protrusion 52Cb protruding in the main shaft direction.
  • a shaft needle groove 32d is formed on the outer circumferences of the tip portions 31a and 32a of the main shaft needle 31 and the sub shaft needle 32.
  • the main shaft needle 31 is inserted into the main shaft needle insertion holes 51Cc. 19
  • the first main shaft side small protrusion 53Ce rides on the outer periphery of the main shaft needle 31 and the first free end portion 53Cd is deformed in the diameter increasing direction, so that a plurality of sub shaft side small projections are obtained.
  • the protrusions 53b are fitted and engaged with the countershaft needle grooves 32d, respectively, and the second main shaft side small protrusion 52Cb rides on the outer periphery of the main shaft needle and finally the second free end 52Cd is deformed in the diameter increasing direction.
  • the second main shaft side small protrusion 52Cb is fitted into and engaged with the main shaft needle groove 31e, whereby the second free end portion 52Cd springs back in the diameter reducing direction and returns to the needle structure 30. Connecting between the tip portion 30a and the surgical tip tool coupling mechanism 50C is made.
  • the spindle needle groove 31e is partially cut out in two directions in the direction perpendicular to the spindle X axis on the opposing outer peripheral surface of the spindle needle tip 31a. Is formed.
  • the surgical distal instrument rotating handle 23a In the connected state between the distal end portion 30a of the needle structure 30 and the surgical distal instrument connecting mechanism 50A, the surgical distal instrument rotating handle 23a is held in a state where the outer cylinder 51C of the surgical distal instrument connected mechanism 50C is first held by hand.
  • the second main shaft side small protrusion 52Cb rides on the outer periphery of the tip portion 31a of the main shaft needle 31, and the second free end portion 52Cd is deformed in the diameter increasing direction, and the second main shaft side small protrusion 52Cb is disengaged from the main shaft needle concave groove 31e, and at the same time, the main shaft needle 31 is pulled backward, so that the first main shaft side small protrusion 53Ce is detached from the outer peripheral surface of the tip portion 31a of the main shaft needle 31, and the first free end portion 53Cd is contracted.
  • the spring-back in the radial direction returns and the plurality of sub-axis side small protrusions 53Cb are simultaneously released from the counter-axis needle groove 32d to simultaneously remove the needle structure.
  • the distal end portion 30a of the structure 30 and the surgical distal instrument connection mechanism 50C can be detached.
  • the minimally invasive surgical system 1C according to the fourth embodiment of the present invention is different from the minimally invasive surgical system 1 according to the first embodiment in the configuration of the surgical tip-part specific cavity insertion means 500. Except for the differences, the other configuration is the same as that of the first embodiment.
  • the surgical distal instrument specific cavity insertion means 500 is the same as that of the third embodiment except for the difference in the configuration of the surgical tip instrument pushing mechanism 520 from the surgical distal instrument specific cavity insertion means 300 in the third embodiment. It is the same. Accordingly, members having the same functions and configurations as those of the first and third embodiments in FIG. 21 are denoted by the same reference numerals for the sake of simplicity, and the differences will be described below with reference to the accompanying drawings.
  • the surgical distal instrument internal cavity insertion means 500 has an outer diameter, a length, a rear end, and a distal end, and inserts and removes the surgical distal instrument 60 in a state of being removed from the distal end portion 30a of the needle structure 30 from the rear end side. Both ends are opened so that they can be freely loaded, the rear end opening 303 has a handle 304 with a rear end cap 305, and the front end opening has an openable / closable opening / closing lid 302. Insertion into the body cavity having a tubular body in which the distal end side inserted from the abdominal hole Mb for laparoscopic surgery or the natural opening to the vicinity of a diseased organ (not shown) in the body cavity is bent into a substantially semicircular hook shape.
  • the body 301 and the body cavity insertion body 301 are loaded into the body cavity insertion body 301 and the distal end portion of the surgical distal instrument 60 loaded in advance from the rear end opening 303 is pressed to open and close the opening / closing lid 302 of the body cavity insertion body 301 distal end opening. Push open the surgical instrument 60
  • the rear portion comprises a to surgery extruded to the vicinity of the lesion organ tip instrument extruding mechanism 520 of the body cavity.
  • the body cavity insertion body 301 is closed by a rear end cap 305 and an opening / closing lid 302 at the front end opening to prevent entry of foreign matter such as body fluids, blood and tissue pieces from the body cavity into the tubular body 301 and leakage outside the body as much as possible. .
  • the surgical tip instrument push-out mechanism 520 is loaded into the body cavity insertion main body 301, and is connected to the piston 308 that presses the distal end portion of the surgical tip instrument 60 with the distal end surface and the rear end portion of the piston 308.
  • a piston rod 221 that slidably passes through the rear end cap 305 and is exposed to the outside, and has a flexibility that can be bent along a substantially semicircular hook-like curved shape on the distal end side of the body cavity insertion body 301; And a grip 523 connected to the rear end 521b of the 521.
  • the surgical distal instrument 60 previously removed from the distal end portion 30a of the needle structure 30 using the surgical distal instrument specific cavity insertion means 500 is used to replace the lesioned organ in the body cavity.
  • the needle structure 30 of the surgical treatment needle type device 10 is inserted into the body cavity and inserted into the distal end portion 30a of the needle structure 30 to the vicinity of the lesioned organ.
  • the surgical distal instrument 60 is operated by the surgical distal instrument operation unit 20 in a state where the surgical distal instrument 60 is extracted from the surgical distal instrument internal cavity insertion means 500, and the surgical treatment is performed. Perform all in the body cavity.
  • a surgical distal instrument is removably attached to the distal end portion of a needle structure comprising a main spindle needle and a plurality of sub-shaft needles that can be set to an outer diameter and a length according to the situation. It has stable support rigidity and strength, and the needle structure is punctured directly into the body cavity without incising or opening the living body.
  • the surgical tip Since the surgical tip is inserted into the body cavity from the natural abdominal hole of the living body or the natural opening, such as the anus or mouth, to the vicinity of the diseased organ in the body cavity, large and heavyweight Because it is possible to provide a minimally invasive surgical system having a needle type device for surgical treatment with minimal design and minimal degree of invasiveness that can be used for surgical procedures targeting organs It can contribute to a medical industry.

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Abstract

　Provided is a minimally invasive surgical system having a needle-shaped device for surgical treatment, which minimizes invasiveness, is provided with a degree of design freedom which enables large surgical tip instruments to be accommodated, and which has a large bearing capacity. The minimally invasive surgical system (1) of the present invention has a needle-shaped device for surgical treatment (10) equipped with a surgical tip instrument (60) detachably mounted to the tip of a needle structure (30) comprising a sharp-tipped main shaft needle (31) and a plurality of auxiliary shaft needles (32). The needle structure directly makes a hole in a body cavity, and the tip of the needle structure is connected to a surgical tip device (60) already inserted into the area in the periphery of the diseased organ (T) within the body cavity from a hole in the abdomen (Mb) or a natural opening (Ma) using a means (200) for inserting a surgical tip instrument into a body cavity, to carry out surgical treatment within the body cavity. This enables the needle-shaped device to achieve an extremely low degree of invasiveness, and a degree of freedom in terms of design that enables the device to be designed to accommodate surgical techniques on large and/or heavy organs.

Description

最低侵襲外科手術システムMinimally invasive surgical system
　本発明は、腹部切開などの生体手術を省いて手術侵襲を少なくする外科手術システムに係り、より詳しくは、人体の切開あるいは開腹を必要とせずに、体腔内病変臓器の手術部位での手術処置を容易に行うことが可能な外科治療用ニードル型デバイスを有する最低侵襲外科手術システムに関する。 The present invention relates to a surgical operation system that eliminates a living body surgery such as an abdominal incision and reduces surgical invasion, and more particularly, a surgical treatment at a surgical site of a diseased organ in a body cavity without requiring incision or laparotomy of a human body. The present invention relates to a minimally invasive surgical system having a needle-type device for surgical treatment that can be easily performed.
　内視鏡（胃腸）あるいは腹腔鏡（腹部）の小型化及び精度向上と医療技術の向上に伴い健康診断等の病巣の早期発見により、病巣が小さいうちに処置できる鏡視下手術のニーズが高まっている。鏡視下手術においては、従来の切開外科手術に比べて傷が小さく人体への負担も少ない低侵襲化が展開しつつある。 The need for endoscopic surgery that can be treated while the lesion is small is increasing due to the downsizing and accuracy of the endoscope (gastrointestinal) or laparoscope (abdomen) and the advancement of medical technology to detect lesions early in medical examinations. ing. In the endoscopic surgery, a minimally invasive approach is being developed that has less scars and less burden on the human body than conventional open surgery.
　従来の腹部外科では、長径略２０ｍｍ以上の開腹創を伴う侵襲的外科治療に代わり、直径略１０ｍｍ×長さ略３００ｍｍのデバイスを腹壁に刺入し外科手術が施されてきた。ここ数年、長径略２０ｍｍの開腹創から通常４本以上の複数本の各種鉗子や腹腔鏡を挿入し手術を施行するＲｅｄｕｃｅｄ　Ｐｏｒｔ　Ｓｕｒｇｅｒｙ（ＲＰＳ）が開発され実施されている。 In conventional abdominal surgery, instead of invasive surgical treatment involving an open abdominal wound with a major axis of approximately 20 mm or more, a device having a diameter of approximately 10 mm and a length of approximately 300 mm has been inserted into the abdominal wall, and surgery has been performed. In recent years, Reduced Port Surgery (RPS) has been developed and implemented, in which four or more various forceps and laparoscopes are inserted from a laparotomy with a major axis of about 20 mm to perform surgery.
　また、群馬県済生会前橋病院などでは、皮膚を切開せずに刺入できる針型臓器把持器具ミニループレトラクターが開発され、一層低侵襲な２孔式腹腔鏡下胆嚢摘出術が数多く実施されている。（例えば特許文献１参照） In addition, Gunma Prefecture Saiseikai Maebashi Hospital has developed a needle-type organ grasping device mini-loop retractor that can be inserted without incising the skin, and many more minimally invasive two-hole laparoscopic cholecystectomy has been performed. Yes. (For example, see Patent Document 1)
　また、本発明者は、中空円筒状の外針と外針内で着脱自在に連結された回転駆動装置により回転するスクリューカッターを備え、皮膚を切開せずに腹壁に穿入して腫瘍部分などの病巣部生体組織を穿ち、病巣部の膿瘍、素胞、膿胞等の生体組織液及び生体組織を完全に除去するマイクロニードル型医療用ボーリング装置を提案している。（例えば特許文献２参照） The inventor also includes a hollow cylindrical outer needle and a screw cutter that is rotated by a rotary drive device that is detachably connected within the outer needle. Has proposed a microneedle type medical boring device that completely removes biological tissue fluid and biological tissue such as abscesses, cysts, and abscesses from the lesion. (For example, see Patent Document 2)
　その他、これまでの低侵襲外科手術に関する代表例として、綱により検索された手術機器を弁により調節され自己密封式のトロカールやカニューレから体腔内に挿入し、次に外科医が別の最小の腹部切開穴から体腔に手を挿入し前記手術機器を操作して手術処置を体腔内で全て実行する最小侵入外科手術用のシステム、方法及び機器が提案されている。（例えば特許文献３参照） In addition, as a typical example of conventional minimally invasive surgery, surgical instruments searched by ropes are inserted into body cavities through self-sealing trocars and cannulas regulated by valves, and then the surgeon performs another minimal abdominal incision. Systems, methods and devices for minimally invasive surgery have been proposed that insert a hand through a hole into a body cavity and operate the surgical instrument to perform all surgical procedures within the body cavity. (For example, see Patent Document 3)
　また、弾性コネクタ（線状体）に連結された一対の外科用器具であるクリップが誘導子のスリーブに対して内部に収容又は外部に押出されるように構成され、所望の器官の異なる位置を把持するデバイス、システム及び方法が提案されている。（例えば特許文献４参照） In addition, a clip, which is a pair of surgical instruments connected to an elastic connector (linear body), is configured to be housed inside or extruded to the outside of the sleeve of the inductor, so that different positions of the desired organ can be obtained. Devices, systems and methods for gripping have been proposed. (For example, see Patent Document 4)
　さらに、本発明者は、最小限の腹腔鏡下で生体管の病巣部を切除した後に生体の自然開口部内を介して前記生体管の切断端部双方同士を吻合する画期的なＮＯＴＥＳ（Ｎａｔｕｒａｌ　Ｏｒｉｆｉｃｅ
Ｔｒａｎｓｌｕｍｉｎａｌ Ｅｎｄｏｓｃｏｐｉｃ Ｓｕｒｇｅｒｙ）用外科手術システム及び手術方法（ＮＯＴＥＳ）を提案している。（例えば特許文献５参照） Furthermore, the present inventor has made a groundbreaking NOTES (Natural) in which both the cut ends of the living body tube are anastomosed through the natural opening of the living body after excision of the lesion portion of the living body tube under a minimal laparoscope. Office
It proposes a surgical system and method (NOTES) for Transluminal Endoscopic Surgical). (For example, see Patent Document 5)
特開２０００－２３９８９号公報JP 2000-23989 A 特開２００８－６２２６号公報JP 2008-6226 A 特許第４０４９２７５号公報Japanese Patent No. 4049275 特表２０１１－５２２５８６号公報Special table 2011-522586 gazette ＷＯ２００９／１３３８７５WO2009 / 133875
　しかし、従来のＲＰＳ
では、狭い開腹創から多数鉗子を挿入するため鉗子が相互に当たり干渉し、視野が悪いだけでなく、把持していた組織に損傷を来す危険性があった。 However, conventional RPS
Then, since many forceps are inserted from a narrow open abdominal wound, the forceps hit each other and interfere with each other, resulting in a risk of not only poor visual field but also damage the grasped tissue.
　また、従来の特許文献１に記載のミニループレトラクターを利用した２孔式腹腔鏡下胆嚢摘出術や特許文献５に記載のＮＯＴＥＳ用外科手術システム及び手術方法は、良好な視野と腹壁への最小限の開創で低侵襲性が向上しているが、これらの外科処置における腹腔鏡又は内視鏡手術等で用いられる手術機器は支持力が不充分で弱いため充分安全な外科的処置を確保することが難しい場合が多く、支持力が充分な大型の手術先端器具を要する低侵襲の外科手術を行うことが不可能であった。 In addition, the conventional two-hole laparoscopic cholecystectomy using the mini-loop retractor described in Patent Document 1 and the NOTES surgical system and method described in Patent Document 5 have a good visual field and abdominal wall. Although minimal invasiveness improves minimal invasiveness, surgical instruments used in laparoscopic or endoscopic surgery in these surgical procedures have insufficient support and are weak enough to ensure a sufficiently safe surgical procedure In many cases, it is difficult to perform a minimally invasive surgical operation that requires a large surgical tip with sufficient support.
　また、特許文献２に記載のマイクロニードル型医療用ボーリング装置は、生体への侵襲を小さく抑えたまま、病巣部の腫瘍部分などの生体組織を穿ち、膿瘍、素胞、膿胞等の生体組織液及び生体組織を吸引して完全に除去する機能に特化されたものであって、支持力が充分な大型の手術先端器具を要する低侵襲の外科手術を行うことはできない。 In addition, the microneedle type medical boring device described in Patent Document 2 pierces a biological tissue such as a tumor part of a lesion while keeping the invasion to the living body small, and a biological tissue fluid such as an abscess, a cyst, a cyst, etc. In addition, it is specialized in the function of sucking and completely removing a living tissue, and cannot perform a minimally invasive surgical operation that requires a large surgical tip instrument with sufficient supporting force.
　さらに、特許文献３に記載の低侵襲性処置を支援する多要素デバイス、システム、及び方法は、外科医が別の腹部切開穴から体腔に手を挿入し手術機器を操作して手術処置を体腔内で全て実行する点で、まだ低侵襲性が充分とは言い難い。 Furthermore, in the multi-element device, system, and method for supporting a minimally invasive procedure described in Patent Document 3, a surgeon inserts a hand into a body cavity from another abdominal incision hole and operates a surgical instrument to perform the surgical treatment in the body cavity. However, it is still difficult to say that minimally invasiveness is sufficient.
　本発明は、上記従来技術の問題点に鑑みてなされたものであり、本発明の目的は、支持力が充分で大型、重量級の臓器を対象とした手術手技にも対応可能な設計の自由度を備え、低侵襲性を極限まで実現させた外科治療用ニードル型デバイスを有する最低侵襲外科手術システムを提供することにある。 The present invention has been made in view of the above-described problems of the prior art, and an object of the present invention is to provide freedom of design that can support a surgical procedure for a large, heavy-weight organ with sufficient support. It is an object of the present invention to provide a minimally invasive surgical system having a needle type device for surgical treatment that has a sufficient degree and achieves minimally invasiveness.
　上記目的を達成するため、本発明のうち一つの態様に係る最低侵襲外科手術システムは、外径、長さ、後端及び先端を有し、長さ方向に延びるＸ軸を主軸とし、Ｘ軸上の主軸ニードル及び主軸ニードルの周りに略軸対称に並列配置され主軸ニードルを補強する複数の副軸ニードルから安定的な支持剛性及び強度を有し、前記主軸ニードル及び副軸ニードルの先端が尖鋭状に形成され、生体の皮膚外面から体腔内部に直接穿刺可能に構成されたニードル構造、前記ニードル構造の先端部に挿脱可能に連結される手術先端器具、前記ニードル構造の後端部が挿通され支持されるニードル支持ユニット、及び前記ニードル支持ユニットの後端部に連接されるとともに前記主軸ニードルの後端部が挿通され、その主軸ニードル後端部と連携して前記手術先端器具を作動させる手術先端器具操作部、を備えた外科治療用ニードル型デバイスと、外径、長さ、後端及び先端を有し、長さ方向に延びるＵ軸を主軸とし、生体の単孔式腹腔鏡下手術用腹腔孔又は肛門を含む自然開口部から体腔内に挿入される管状体を有する体腔内挿入本体、前記体腔内挿入本体の先端部に設けられ、前記ニードル構造の先端部から取外された状態の前記手術先端器具を着脱自在に保持する手術先端器具保持機構、及び後端側に前記手術先端器具保持機構の保持操作を行う手術先端器具保持機構操作部、を備えた手術先端器具体腔内挿入手段と、を有する最低侵襲外科手術システムであって、先に前記手術先端器具体腔内挿入手段を用いて前記ニードル構造の先端部から取外された状態の前記手術先端器具を体腔内の病変臓器の近傍まで挿入した後で、腹腔鏡によるモニタリング下で、前記外科治療用ニードル型デバイスのニードル構造を体腔内に穿刺してニードル構造の先端部に前記病変臓器の近傍まで挿入された手術先端器具の後端部に連結すると同時に、前記手術先端器具体腔内挿入手段から手術先端器具を開放した状態で、前記手術先端器具操作部により手術先端器具を操作して外科手術処置を体腔内で全て実行することを特徴とする。 In order to achieve the above object, a minimally invasive surgical system according to one aspect of the present invention has an outer diameter, a length, a rear end, and a front end, the X axis extending in the length direction as a main axis, The main spindle needle and the plurality of countershaft needles arranged substantially in parallel with the axis around the main spindle needle to reinforce the main spindle needle have stable support rigidity and strength, and the tips of the main spindle needle and the subshaft needle are sharp. Needle structure configured to be punctured directly into the body cavity from the outer skin surface of a living body, a surgical tip device removably connected to the tip portion of the needle structure, and the rear end portion of the needle structure being inserted And a needle support unit that is supported and connected to a rear end portion of the needle support unit, and a rear end portion of the spindle needle is inserted, and in cooperation with the rear end portion of the spindle needle, A surgical treatment needle type device having a surgical tip instrument operating section for operating a surgical tip instrument, an outer diameter, a length, a rear end and a distal end, and a U axis extending in the length direction as a main axis, A body cavity insertion body having a tubular body to be inserted into a body cavity from a natural opening including a peritoneal hole or anus for single-hole laparoscopic surgery, provided at the distal end of the body cavity insertion body, and the distal end of the needle structure A surgical tip instrument holding mechanism for detachably holding the surgical tip instrument in a state detached from the surgical section, and a surgical tip instrument holding mechanism operation section for performing a holding operation of the surgical tip instrument holding mechanism on the rear end side. And a surgical invasive device having a specific cavity insertion means, wherein the surgical distal end is removed from the distal end portion of the needle structure using the surgical tip special instrument insertion means. Instrument in body cavity After insertion to the vicinity of the lesioned organ, under the monitoring by a laparoscope, the needle structure of the needle type device for surgical treatment is punctured into the body cavity and inserted into the tip of the needle structure to the vicinity of the lesioned organ At the same time as connecting to the rear end portion of the distal instrument, the surgical distal instrument is operated by the surgical distal instrument operating unit in a state where the surgical distal instrument is opened from the means for inserting the surgical distal instrument into the cavity, and the surgical treatment is performed in the body cavity. It is characterized by executing all.
　また、本発明のうち別の態様に係る最低侵襲外科手術システムは、外径、長さ、後端及び先端を有し、長さ方向に延びるＸ軸を主軸とし、Ｘ軸上の主軸ニードル及び主軸ニードルの周りに略軸対称に並列配置され主軸ニードルを補強する複数の副軸ニードルから安定的な支持剛性及び強度を有し、前記主軸ニードル及び副軸ニードルの後端が尖鋭状に形成され、体腔内部から皮膚外面に穿刺可能に構成されたニードル構造、前記ニードル構造の先端部に挿脱可能に連結される手術先端器具、前記ニードル構造の後端部が挿脱可能に支持されるニードル支持ユニット、及び前記ニードル支持ユニットの後端部に連接されるとともに前記主軸ニードルの後端部が挿通され、その主軸ニードル後端部と連携して前記手術先端器具を作動させる手術先端器具操作部、を備えた外科治療用ニードル型デバイスと、外径、長さ、後端及び先端を有し、前記ニードル構造の後端部からニードル支持ユニットが取外された状態の外科治療用ニードル型デバイスがニードル構造の後端部側から挿脱自在に装填可能なように両端が開口された後端開口部には取手部を、先端開口部には開閉フリーな開閉蓋を有し、生体の単孔式腹腔鏡下手術用腹腔孔又は自然開口部から体腔内の病変臓器の近傍まで挿入される先端部側が略半円フック状に湾曲された管状体を有する体腔内挿入本体、及び前記体腔内挿入本体内に装填され、予め後端開口部から内部に装填された前記手術先端器具の先端部を押圧し体腔内挿入本体の先端開口部から前記ニードル構造の主軸ニードル及び副軸ニードルの後端尖鋭部を押出して前記体腔内から腹部皮膚外まで穿刺し貫通させる手術先端器具押出しピストン、を備えた手術先端器具体腔内挿入手段と、を有する最低侵襲外科手術システムであって、先に前記手術先端器具体腔内挿入手段を用いて前記体腔内部から腹部皮膚外まで穿刺し貫通させたニードル構造の後端部に前記取外されたニードル支持ユニットを直接目視下で連結した後で、腹腔鏡によるモニタリング下で、前記手術先端器具体腔内挿入手段から外科治療用ニードル型デバイスを手術先端器具の先端部まで抜出した状態で、前記手術先端器具操作部により手術先端器具を操作して外科手術処置を体腔内で全て実行することを特徴とする。 In addition, a minimally invasive surgical system according to another aspect of the present invention includes an outer diameter, a length, a rear end, and a distal end, the X axis extending in the length direction as a main axis, A plurality of countershaft needles arranged in parallel around the main shaft needle in a substantially axisymmetric manner have a stable support rigidity and strength, and the rear ends of the main shaft needle and the subshaft needle are formed in a sharp shape. , A needle structure configured to be able to puncture the skin outer surface from the inside of a body cavity, a surgical tip instrument connected to the distal end portion of the needle structure in a detachable manner, and a needle in which a rear end portion of the needle structure is supported in a detachable manner A surgical unit that is connected to a rear end portion of the support unit and the needle support unit, and the rear end portion of the main needle is inserted, and the surgical tip instrument is operated in cooperation with the rear end portion of the main needle. Surgical treatment with a needle-type device for surgical treatment provided with an end instrument operation section, an outer diameter, a length, a rear end and a front end, and a needle support unit removed from the rear end of the needle structure The needle type device has a handle at the rear end opening that is open at both ends so that it can be removably loaded from the rear end side of the needle structure, and a free opening and closing lid at the front end opening. A body cavity insertion main body having a tubular body in which a distal end side inserted from a living body single-hole laparoscopic surgical abdominal hole or a natural opening to the vicinity of a diseased organ in a body cavity is bent in a substantially semicircular hook shape, The main needle and the secondary shaft of the needle structure are loaded into the body cavity insertion body and press the distal end portion of the surgical distal instrument previously loaded into the body cavity through the rear end opening from the distal end opening of the body cavity insertion body. Extrude the back edge of the needle Surgical tip instrument specific cavity insertion means provided with a surgical tip instrument push-out piston that punctures and penetrates from inside the body cavity to the outside of the abdominal skin. The removed needle support unit is directly connected to the rear end of the needle structure that is punctured and penetrated from the inside of the body cavity to the outside of the abdominal skin using the means, and then monitored under a laparoscope, In the state where the needle device for surgical treatment is pulled out from the means for inserting the surgical tip into the cavity to the tip of the surgical tip instrument, the surgical tip instrument is operated by the surgical tip instrument operating unit to perform all the surgical procedures in the body cavity. It is characterized by doing.
　また、本発明のうちまた別の態様に係る最低侵襲外科手術システムは、外径、長さ、後端及び先端を有し、長さ方向に延びるＸ軸を主軸とし、Ｘ軸上の主軸ニードル及び主軸ニードルの周りに略軸対称に並列配置され主軸ニードルを補強する複数の副軸ニードルから安定的な支持剛性及び強度を有し、前記主軸ニードル及び副軸ニードルの先端が尖鋭状に形成され、生体の皮膚外面から体腔内部に直接穿刺可能に構成されたニードル構造、　前記ニードル構造の先端部に挿脱可能に連結される手術先端器具、　前記ニードル構造の後端部が挿通され支持されるニードル支持ユニット、　及び前記ニードル支持ユニットの後端部に連接されるとともに前記主軸ニードルの後端部が挿通され、その主軸ニードル後端部と連携して前記手術先端器具を作動させる手術先端器具操作部、を備えた外科治療用ニードル型デバイスと、外径、長さ、後端及び先端を有し、前記ニードル構造の先端部から取外された状態の前記手術先端器具を後端部側から挿脱自在に装填可能なように両端が開口され、後端開口部には取手部を、先端開口部には開閉フリーな開閉蓋を有し、生体の単孔式腹腔鏡下手術用腹腔孔又は自然開口部から体腔内の病変臓器の近傍まで挿入される先端部側が略半円フック状に湾曲可能に形成された管状体を有する体腔内挿入本体、及び前記体腔内挿入本体内に装填され、予め後端開口部から内部に装填された前記手術先端器具の先端部を押圧し体腔内挿入本体の先端開口部から前記手術先端器具を前記体腔内の病変臓器の近傍まで押出す手術先端器具押出し機構、を備えた手術先端器具体腔内挿入手段と、を有する最低侵襲外科手術システムであって、先に前記手術先端器具体腔内挿入手段を用いて前記ニードル構造の先端部から取外された状態の前記手術先端器具を体腔内の病変臓器の近傍まで挿入した後で、腹腔鏡によるモニタリング下で、前記外科治療用ニードル型デバイスのニードル構造を体腔内に穿刺してニードル構造の先端部に前記病変臓器の近傍まで挿入された手術先端器具の後端部に連結すると同時に、前記手術先端器具体腔内挿入手段から手術先端器具を抜出した状態で、前記手術先端器具操作部により手術先端器具を操作して外科手術処置を体腔内で全て実行することを特徴とする。 A minimally invasive surgical system according to still another aspect of the present invention includes an outer diameter, a length, a rear end, and a distal end, the X axis extending in the length direction as a main axis, and a main axis needle on the X axis. And a plurality of countershaft needles arranged in parallel around the main shaft needle in a substantially axisymmetric manner to reinforce the main shaft needle and having stable support rigidity and strength, and the tips of the main shaft needle and the subshaft needle are formed sharply. A needle structure that can be punctured directly into the body cavity from the skin surface of the living body, a surgical tip device that is removably connected to the tip of the needle structure, and a rear end of the needle structure is inserted and supported A needle support unit; and a rear end portion of the spindle needle that is connected to a rear end portion of the needle support unit, and is inserted into the rear end portion of the main spindle needle. Surgical tip instrument operating section for operating the surgical treatment needle-type device, and the surgical distal end having an outer diameter, a length, a rear end, and a distal end, and removed from the distal end of the needle structure Both ends are opened so that the instrument can be removably loaded from the rear end side. The rear end opening has a handle, and the front end has an openable openable lid. An intracorporeal body insertion body having a tubular body in which a distal end side to be inserted from the abdominal hole or natural opening for laparoscopic surgery to the vicinity of a diseased organ in the body cavity is bent into a substantially semicircular hook shape, and the body cavity The distal end portion of the surgical distal instrument loaded in the internal insertion main body and loaded in advance from the rear end opening in advance is pressed to move the surgical distal instrument from the distal opening of the body cavity insertion main body to the lesion organ in the body cavity. Equipped with a surgical tip instrument push-out mechanism that pushes to the vicinity A surgical invasive device having a surgical tip specific cavity insertion means, wherein the surgical tip instrument is previously removed from the tip of the needle structure using the surgical tip specific cavity insertion means. Is inserted to the vicinity of the diseased organ in the body cavity, and then, under monitoring by a laparoscope, the needle structure of the needle device for surgical treatment is punctured into the body cavity to reach the vicinity of the diseased organ at the tip of the needle structure. At the same time as connecting to the rear end portion of the inserted surgical tip instrument, the surgical tip instrument is operated by the surgical tip instrument operating section in a state where the surgical tip instrument is extracted from the means for inserting the surgical tip instrument into the cavity. Are all performed in the body cavity.
　また、前記外科治療用ニードル型デバイスは、いずれも前記主軸ニードル及び副軸ニードルに摺動自在に挿通される１枚又は複数枚のガイド板と、前記ニードル支持ユニットとガイド板との間に配置され、各ガイド板を背面から付勢する１つ又は複数のスプリングをさらに備えることを特徴とする。 The surgical treatment needle type device is disposed between one or a plurality of guide plates slidably inserted through the main shaft needle and the sub shaft needle, and between the needle support unit and the guide plate. And further comprising one or more springs for urging each guide plate from the back side.
　また、前記手術先端器具は、後端部に前記主軸ニードル及び副軸ニードルの先端部がそれぞれ挿脱自在に連結する手術先端器具連結機構を備えることを特徴とする。 Further, the surgical tip instrument includes a surgical tip instrument coupling mechanism in which the leading end portions of the main needle needle and the countershaft needle are detachably connected to the rear end portion.
　本発明のうちまた別の態様に係る最低侵襲外科手術システムの外科治療用ニードル型デバイスは、前記ニードル支持ユニットと手術先端器具操作部との間に設けられ、前記手術先端器具操作部の先端側にＸ軸に沿って延設する先端側支持軸部に設けられたユニバーサル軸受けを介して全方向に傾動可能な傾動板と、前記各副軸ニードルの後端部に設けられた球体又は鍔状体が前記傾斜板に設けられたＸ軸と直交方向に長い複数の長溝にそれぞれ滑動自在に係合する副軸ニードル後端連結機構とからなり、前記傾動板を任意の方向に傾動させることによりその傾動中心に対して対向関係をなす副軸ニードルの一方が先方に押圧されるとともに他方が後方に牽引されることから前記ニードル構造に曲げモーメントが発生することより、先端部に手術先端器具が連結された前記ニードル構造を略弓型状に湾曲させるニードル構造湾曲操作部がさらに設けられることを特徴とする。 A needle type device for surgical treatment of a minimally invasive surgical system according to still another aspect of the present invention is provided between the needle support unit and a surgical tip instrument operating section, and is on the distal side of the surgical tip instrument operating section. A tilting plate that can be tilted in all directions via a universal bearing provided on a distal end side support shaft extending along the X axis, and a sphere or bowl-like shape provided at the rear end of each countershaft needle The body comprises a secondary shaft needle rear end coupling mechanism that slidably engages with a plurality of long grooves extending in a direction orthogonal to the X axis provided on the inclined plate, and by tilting the inclined plate in an arbitrary direction One of the counter-shaft needles that are opposed to the tilting center is pressed forward and the other is pulled backward, so that a bending moment is generated in the needle structure. It said needle structure operative tip instrument is connected, characterized in that the needle structure bending operation portion to bend the Ryakuyumi type shape is further provided.
　また、前記主軸ニードル及び副軸ニードルは、いずれも高剛性及び高弾力性を有する医療適合性材料の外径略３ｍｍ以下の棒状又は線状体からなり、生体の痛み神経を跨ぐように略２ｍｍ以上の間隔で略対称型に並列配置されることを特徴とする。 Each of the main shaft needle and the sub shaft needle is made of a rod-like or linear body having an outer diameter of about 3 mm or less made of a medically compatible material having high rigidity and high elasticity, and is about 2 mm so as to straddle the pain nerve of the living body. It is characterized by being arranged in parallel substantially symmetrically at the above intervals.
　また、少なくとも前記主軸ニードルは、形状記憶材料からなり、前記手術先端器具の動作に必要な主軸方向のスライド、回転、あるいは前記主軸ニードル及び副軸ニードルにも通電、マイクロ波又は超音波放射線伝送を含む各種機能を選択的に有することを特徴とする。 Further, at least the main spindle needle is made of a shape memory material, and slides, rotates in the main axis direction necessary for the operation of the surgical tip instrument, or energizes the main spindle needle and the sub spindle needle, and transmits microwave or ultrasonic radiation. It is characterized by selectively having various functions.
　本発明のうちまた別の態様に係る最低侵襲外科手術システムの手術先端器具体腔内挿入手段は、外径、長さ、後端及び先端を有し、長さ方向に延びるＵ軸を主軸とし、生体の単孔式腹腔鏡下手術用の腹腔孔又は肛門を含む自然開口部から体腔内に挿入され、両端面が閉止された管状体を有する体腔内挿入本体と、体腔内挿入本体の先端部に設けられ、前記手術先端器具を着脱自在に保持する手術先端器具保持機構と、後端に前記手術先端器具保持機構の保持操作を行う手術先端器具保持操作部と、を備え、前記手術先端器具保持機構は、前記管状体の先端部に設けられた第１開口部及び第１開口部とＵ軸に対して対称関係をなす先端側に設けられた第２開口部と、前記第１開口部の先端部に所定の角度傾動自在に固定ピンを介してピボット連結され、先端部及び後端部がそれぞれ前記第１開口部及び第２開口部から出没可能で、前記手術先端器具を挿脱可能に収納し保持する中空状の手術先端器具保持容器と、前記固定ピンと手術先端器具保持容器との間に前記手術先端器具保持容器をＵ軸と略平行位置に保持する方向に付勢するばねと、を有し、前記手術先端器具保持操作部は、前記体腔内挿入本体内に装填され、先端部に先端方向に下り勾配の傾斜ガイドが形成されたピストンと、前記ピストンの後端部に連結され、前記体腔内挿入本体の後端部をスライド自在に貫通して外部に露出するピストンロッドと、前記ピストンロッドの後端部に連結される把持部と、を有し、生体外から前記把持部を介してピストンロッドを押し込むことにより、前記手術先端器具保持容器は、後端部から前記ピストンの傾斜ガイドに当接し案内されて所定角度傾動し、その傾動角度は手元の把持部で自由に調節可能であり、前記ピストンロッドを牽引し後退させると、前記ばねの付勢力により前記手術先端器具保持容器がＵ軸と略平行位置に復帰することを特徴とする。 The surgical distal end specific cavity insertion means of the minimally invasive surgical system according to still another aspect of the present invention has an outer diameter, a length, a rear end and a distal end, and a U axis extending in the length direction is a main axis, An intracorporeal insertion body having a tubular body inserted into a body cavity through a natural opening including an abdominal hole or anus for living body single-hole laparoscopic surgery and closed at both end faces, and a distal end portion of the intracavity insertion body A surgical tip instrument holding mechanism that detachably holds the surgical tip instrument, and a surgical tip instrument holding operation section that performs a holding operation of the surgical tip instrument holding mechanism at the rear end, and the surgical tip instrument The holding mechanism includes: a first opening provided at a distal end portion of the tubular body; a second opening provided at a distal end side having a symmetrical relationship with the first opening and the U axis; and the first opening Pivot through a fixed pin so that it can tilt at a predetermined angle And a hollow surgical tip instrument holding container that can be retracted from the first opening and the second opening, respectively, and that stores and holds the surgical tip instrument in a removable manner, and A spring for biasing the surgical tip instrument holding container in a direction to hold the surgical tip instrument holding container in a position substantially parallel to the U-axis between the fixing pin and the surgical tip instrument holding container; A piston that is loaded into the inner insertion body and has a tip with a downwardly inclined inclination guide formed at the tip, and is connected to the rear end of the piston, and slidably passes through the rear end of the body cavity insertion body. And holding the surgical tip instrument by pushing the piston rod from outside the living body via the gripping portion. The piston rod is exposed to the outside and a gripping portion connected to the rear end portion of the piston rod. After the container The tilting angle of the piston is brought into contact with and guided by the tilt guide of the piston, and the tilt angle can be freely adjusted by the gripping portion at hand.When the piston rod is pulled and retracted, the biasing force of the spring The surgical tip instrument holding container is returned to a position substantially parallel to the U axis.
　また、前記手術先端器具は、中空状のガイド支持部材内にＸ軸方向に沿って主軸ニードルの先端部と連携しスライド自在に内挿された前部駆動シャフトと、前記ガイド支持部材の先端部に固定ピンにより回動自在にピボット連結された第一顎部材及び第二顎部材を含む顎機構を開閉駆動する顎開閉駆動機構と、を備え、前記顎開閉駆動機構は、前記前部駆動シャフトの先端部に設けられたガイドピンが、第一顎部材及び第二顎部材の後端部に延設され、Ｘ軸方向及び相互に交叉する方向にそれぞれ形成された長孔ガイドに共にスライド自在に嵌挿され係合することを特徴とする。 In addition, the surgical distal instrument includes a front drive shaft that is slidably inserted in the hollow guide support member in cooperation with the distal end portion of the spindle needle along the X-axis direction, and the distal end portion of the guide support member A jaw opening / closing drive mechanism for opening / closing a jaw mechanism including a first jaw member and a second jaw member pivotally connected to each other by a fixed pin, and the jaw opening / closing drive mechanism includes the front drive shaft. A guide pin provided at the tip of each of the first and second jaw members extends to the rear end of the first jaw member and is slidable together with a long hole guide formed in the X-axis direction and the crossing direction. It is inserted and engaged with, It is characterized by the above-mentioned.
　また、本発明のうちまた別の態様に係る最低侵襲外科手術システムの前記手術先端器具連結機構は、先端部側に前記手術先端器具の後端部を内挿して保持する略円筒型の外筒と、　前記外筒の後端面に設けられ、前記主軸ニードル及び副軸ニードルの先端部がそれぞれ挿脱自在に挿入される開口端部にテーパーガイドが形成された主軸ニードル装入穴及び複数の副軸ニードル装入穴と、前記外筒内に略同芯円筒状に収容されて複数のスリットにより分割され後方に延設された径方向に弾性変形可能な第1自由端部の後端部内外面に、それぞれ前記主軸ニードル装入穴及び各副軸ニードル装入穴の各主軸方向に突出し形成された第1主軸側小突起及び複数の副軸側小突起と、　前記第1自由端部内に略同芯円筒状に収容されて複数のスリットにより分割され後方に延設された径方向に弾性変形可能な第２自由端部の後端部内面に、前記主軸ニードル装入穴の主軸方向に突出し形成された第２主軸側小突起と、を有し、前記主軸ニードル及び副軸ニードルの各先端部の外周には、前記第２主軸側小突起及び副軸側小突起がそれぞれ嵌入し係合する主軸ニードル凹溝及び副軸ニードル凹溝が形成され、先に、前記複数の副軸ニードルが前記副軸ニードル装入穴にそれぞれ挿入された後で、前記主軸ニードルが前記主軸ニードル装入穴に挿入されると、前記第１主軸側小突起が主軸ニードルの外周に乗り上げ前記第1自由端部が拡径方向に変形し前記複数の副軸側小突起が拡径されて前記副軸ニードル凹溝にそれぞれ嵌入し係合するとともに、前記第２主軸側小突起が前記主軸ニードルの外周に乗り上げ前記第２自由端部が拡径方向に変形してから最終的に前記第２主軸側小突起が前記主軸ニードル凹溝に嵌入し係合することにより前記第２自由端部が縮径方向にスプリングバックし復帰して前記ニードル構造の先端部と手術先端器具連結機構との連結がなされることを特徴とする。 In the minimally invasive surgical system according to another aspect of the present invention, the surgical tip instrument coupling mechanism includes a substantially cylindrical outer cylinder that inserts and holds the rear end portion of the surgical tip instrument on the tip side. A spindle needle insertion hole having a tapered guide formed at an opening end portion provided at a rear end surface of the outer cylinder and removably inserted at the tip ends of the spindle needle and the auxiliary shaft needle, respectively, and a plurality of auxiliary needles. A shaft needle insertion hole and an inner surface of a rear end portion of a first free end portion that is accommodated in a substantially concentric cylindrical shape in the outer cylinder, is divided by a plurality of slits, and extends rearward, and is elastically deformable in a radial direction. A first main spindle side small protrusion and a plurality of auxiliary shaft side small protrusions, each projecting in the main shaft direction of each of the main spindle needle insertion hole and each auxiliary shaft needle insertion hole, and substantially in the first free end portion. It is housed in a concentric cylinder and is formed by multiple slits. A second spindle-side small protrusion formed on the inner surface of the rear end of the second free end that is split and extends rearward and elastically deformable in the radial direction so as to protrude in the direction of the spindle of the spindle needle insertion hole; And a main shaft needle groove and a sub shaft needle groove that engage with and engage with the second main shaft side small protrusion and the sub shaft side small protrusion, respectively, on the outer periphery of each tip portion of the main shaft needle and the sub shaft needle. When the spindle needle is inserted into the spindle needle insertion hole after the plurality of countershaft needles are respectively inserted into the countershaft needle insertion holes, the first spindle side small The protrusion rides on the outer periphery of the spindle needle, the first free end is deformed in the diameter increasing direction, and the plurality of auxiliary shaft side small protrusions are expanded in diameter, and are respectively fitted and engaged in the auxiliary shaft needle groove, The second spindle side small protrusion is on the outer circumference of the spindle needle. After the second free end is lifted and deformed in the diameter-expanding direction, the second spindle-side small protrusion is finally inserted into and engaged with the spindle needle groove to reduce the diameter of the second free end. It is characterized in that the distal end portion of the needle structure and the surgical distal instrument connecting mechanism are connected by springback in the direction and returning.
　さらに、前記主軸ニードル凹溝は、前記主軸ニードル先端部の対向する外周面に主軸と直交する方向に部分的に切欠き形成されており、前記ニードル構造の先端部と手術先端器具連結機構との連結状態において、先に前記手術先端器具連結機構の外筒を固持した状態で前記手術先端器具回転ハンドルにより操作して前記主軸ニードルを略半回転させると、前記第２主軸側小突起が前記主軸ニードルの外周に乗り上げ前記第２自由端部が拡径方向に変形して前記第２主軸側小突起が前記主軸ニードル凹溝から離脱し、その後前記主軸ニードルを後方に引抜くことで前記第１主軸側小突起が主軸ニードルの外周面から外れると同時に前記第1自由端部が縮径方向にスプリングバックして復帰し前記複数の副軸側小突起が縮径されて前記副軸ニードル凹溝からそれぞれ離脱することにより前記ニードル構造の先端部と手術先端器具連結機構との離脱が可能となることを特徴とする。 Further, the spindle needle groove is partially cut out in a direction perpendicular to the spindle on the opposing outer peripheral surface of the spindle needle tip, and the tip of the needle structure and the surgical tip instrument coupling mechanism In the connected state, when the outer needle of the surgical tip instrument coupling mechanism is first held and operated by the surgical tip instrument rotating handle to rotate the spindle needle substantially half-turn, the second spindle-side small protrusion is moved to the spindle The first free end is deformed in the diameter-expanding direction on the outer periphery of the needle so that the second spindle-side small protrusion is detached from the spindle needle groove, and then the spindle needle is withdrawn rearward. At the same time that the main shaft side small projections are disengaged from the outer peripheral surface of the main shaft needle, the first free end portion springs back in the direction of diameter reduction and the plurality of sub shaft side small projections are reduced in diameter so that the sub shaft needle is reduced. It is possible to detach the distal end portion of the needle structure from the surgical distal instrument connecting mechanism by detaching from the groove.
　以上のように本発明によれば、主軸ニードル及び複数の副軸ニードルからなるニードル構造の先端部に手術先端器具が挿脱可能に取付けられるため安定的な支持剛性及び強度を有し、生体の切開や開腹をせずにニードル構造を直に体腔内に穿刺してニードル構造の先端部に、先に手術先端器具体腔内挿入手段を用いて生体の腹腔孔又は肛門などの自然開口部から体腔内の病変臓器の近傍まで挿入された手術先端器具を連結して外科手術処置を体腔内で全て実行することから、大型、重量級の臓器を対象とした手術手技にも対応可能な低侵襲性を極限まで実現させるとともに設計の自由度を備えた外科治療用ニードル型デバイスを有する最低侵襲外科手術システムを提供できる効果がある。特に腹腔孔として、神経解剖学的に最も痛みが少ない臍部に設ける直径略１０ｍｍの単孔式腹腔鏡下手術用腹腔孔を利用できるため、一層低侵襲性を実現させる。 As described above, according to the present invention, the surgical distal instrument is removably attached to the distal end portion of the needle structure composed of the main shaft needle and the plurality of sub shaft needles, so that it has stable support rigidity and strength, The needle structure is punctured directly into the body cavity without incision or laparotomy, and the body cavity from the natural opening such as the abdominal hole or anus of the living body to the distal end of the needle structure first using the surgical tip specific cavity insertion means. Because it is possible to perform all surgical procedures in the body cavity by connecting surgical tip instruments inserted to the vicinity of the lesioned organ in the body cavity, it is minimally invasive and can be used for surgical procedures targeting large and heavy-weight organs. This is advantageous in that it is possible to provide a minimally invasive surgical system having a needle-type device for surgical treatment with a design freedom and a design freedom. In particular, as the abdominal cavity, a single-hole type laparoscopic surgical abdominal cavity having a diameter of about 10 mm provided in the umbilical region having the least pain in terms of neuroanatomy can be used, thereby realizing further less invasiveness.
　また、先に腹腔孔から体腔内の病変臓器の近傍まで挿入される手術先端器具体腔内挿入手段内にニードル支持ユニットが取外された状態で装填された外科治療用ニードル型デバイスを、ニードル構造の後端部側を体腔内部から腹部皮膚外に向けて押出し、その後生体の切開や開腹をせずに体腔内部から腹部皮膚外まで穿刺し貫通させたニードル構造の後端部に前記ニードル支持ユニットを直接目視下で連結した状態で手術先端器具を操作し外科手術処置を体腔内で全て実行することから、操作性が向上し、大型、重量級の臓器を対象とした手術手技にも対応可能な低侵襲性を極限まで実現させるとともに設計の自由度を備えた外科治療用ニードル型デバイスを有する最低侵襲外科手術システムを患者の状況に応じて選択的に提供される効果がある。 In addition, a needle-type device for surgical treatment loaded with the needle support unit removed in the surgical tip specific cavity insertion means that is inserted from the abdominal cavity to the vicinity of the lesioned organ in the body cavity first, The needle support unit is inserted into the rear end of the needle structure that is extruded from the inside of the body cavity to the outside of the abdominal skin and then pierced and penetrated from the inside of the body cavity to the outside of the abdominal skin without incising or opening the living body. Operate surgical instruments in the state of being directly connected to the eye and perform all surgical procedures in the body cavity, improving operability and adapting to surgical procedures targeting large and heavy-weight organs Effect of selectively providing a minimally invasive surgical system having a needle-type device for surgical treatment with maximum design flexibility and design flexibility according to the patient's situation A.
　また、主軸ニードル及び副軸ニードルに摺動自在に挿通される１枚又は複数枚のガイド板、及びニードル支持ユニットとガイド板との間に配置され各ガイド板を背面から付勢する１つ又は複数のスプリングをさらに備えることから、先端部に手術先端器具を保持するニードル構造の各ニードルの径方向の変形による屈曲を抑止して安定的な支持剛性及び強度を確保できる効果がある。 Further, one or a plurality of guide plates slidably inserted into the main shaft needle and the sub shaft needle, and one or more guide plates arranged between the needle support unit and the guide plate and biasing each guide plate from the back surface, or Since the plurality of springs are further provided, there is an effect that it is possible to suppress the bending due to the radial deformation of each needle of the needle structure that holds the surgical distal instrument at the distal end portion and to secure stable support rigidity and strength.
　また、前記外科治療用ニードル型デバイスは、前記ニードル支持ユニットと手術先端器具操作部との間に設けられたニードル構造湾曲操作部の傾動板を任意の方向に傾動させることによりニードル構造を任意の方向に略弓型状に湾曲させることが可能なことから、体腔内での外科手術処置の自由度が増し操作性を向上させる効果がある。 Further, the needle device for surgical treatment is provided with an arbitrary needle structure by tilting a tilting plate of a needle structure bending operation portion provided between the needle support unit and a surgical distal instrument operation portion in an arbitrary direction. Since it can be bent in a substantially arcuate shape in the direction, there is an effect that the degree of freedom of the surgical treatment in the body cavity is increased and the operability is improved.
　また、主軸ニードルと副軸ニードルを、外径略３ｍｍ以下の棒状又は線状体とし、生体の痛み神経を跨ぐ略２ｍｍ以上の間隔で略対称に並列配置することにより、生体への痛みを抑え、神経解剖学的にも良好な一層低侵襲性が確保される効果がある。 Moreover, the main axis needle and the sub axis needle are made into a rod-like or linear body having an outer diameter of about 3 mm or less, and are arranged substantially symmetrically in parallel with an interval of about 2 mm or more across the pain nerve of the living body, thereby suppressing pain to the living body. Furthermore, there is an effect that a further less invasiveness that is favorable in terms of neuroanatomy is ensured.
　また、主軸ニードルは、形状記憶材料とすることにより、先端部に手術先端器具を保持するニードル構造の永久的変形を防止する安定的な支持剛性及び強度を確保するとともに、主軸ニードルを介しての手術先端器具の作動の信頼性を向上させる効果がある。 In addition, the spindle needle is made of a shape memory material, thereby ensuring stable support rigidity and strength to prevent permanent deformation of the needle structure that holds the surgical tip instrument at the tip portion, and through the spindle needle. There is an effect of improving the operation reliability of the surgical instrument.
　また、主軸ニードルは手術先端器具の動作に必要な主軸方向のスライド、回転、あるいは前記主軸及び副軸ニードルにも通電、マイクロ波等々の各種機能を選択的に有することから、本発明に係る外科治療用ニードル型デバイスは、患者の状況に応じて各種の手術先端器具を選択的に適用でき、設計の自由度を一層向上させる効果がある。 In addition, since the spindle needle selectively has various functions such as sliding and rotation in the spindle direction necessary for the operation of the surgical tip instrument, and energization and microwaves to the spindle and countershaft needles, the surgical needle according to the present invention. The treatment needle type device can selectively apply various surgical tip instruments according to the patient's situation, and has the effect of further improving the degree of freedom in design.
　また、前記手術先端器具体腔内挿入手段は、管状体を有する体腔内挿入本体の先端部に傾動自在に設けられた手術先端器具保持容器をピストンの傾斜ガイドにより傾動させて、体腔内で外科治療用ニードル型デバイスのニードル構造の先端部に対して手術先端器具の受け・渡しすなわち連結・開放を行う簡潔な構成であることから、外科手術処置の良好な操作性、信頼性及び経済性が確保される。 Further, the surgical tip device specific intracavity insertion means performs surgical treatment in the body cavity by tilting the surgical tip instrument holding container tiltably provided at the distal end portion of the body cavity insertion main body having a tubular body by the tilt guide of the piston. The simple structure of receiving / handing over, that is, connecting / opening the surgical tip instrument to the tip of the needle structure of the needle type device for medical use ensures good operability, reliability and economy of the surgical procedure. Is done.
　また、前記手術先端器具は、顎開閉駆動機構が、前部駆動シャフトの先端部に設けられたガイドピンが、第一顎部材及び第二顎部材の後端部に延設され、Ｘ軸方向及び相互に交叉する方向にそれぞれ形成された長孔ガイドに共にスライド自在に嵌挿され係合する簡潔な構成で、従来の手術先端器具におけるリンク式顎開閉駆動機構に比べリンク関連部材が省かれて部品点数が少なく、軽量且つコンパクト化されることから、経済性及び操作性が向上する効果がある。 Further, the surgical tip instrument has a jaw opening / closing drive mechanism, a guide pin provided at the tip of the front drive shaft is extended to the rear ends of the first jaw member and the second jaw member, and the X-axis direction In addition, it has a simple configuration in which it is slidably inserted into and engaged with the long hole guides formed in the directions intersecting each other, and the link-related members are omitted compared to the link type jaw opening / closing drive mechanism in the conventional surgical tip instrument. Since the number of parts is small, and it is lightweight and compact, there is an effect of improving economic efficiency and operability.
　また、前記手術先端器具連結機構は、先に、複数の副軸ニードルを各副軸ニードル装入穴に一括に挿入した後で、主軸ニードルを主軸ニードル装入穴に挿入し、第１主軸側小突起を主軸ニードルの外周に乗り上げ第1自由端部に設けられた複数の副軸側小突起が拡径されて各副軸ニードル凹溝に一括に嵌入し係合するとともに、第２主軸側小突起が主軸ニードルの外周に乗り上げ第２自由端部が拡径方向に変形してから最終的に第２主軸側小突起が主軸ニードル凹溝に嵌入し係合することにより、第２自由端部が縮径方向にスプリングバックし復帰してニードル構造の先端部と手術先端器具連結機構との連結が短時間に容易になされることから、操作性及び手術の効率を向上させる効果がある。 In addition, the surgical tip instrument coupling mechanism first inserts a plurality of countershaft needles into each countershaft needle insertion hole, and then inserts the main needle into the main needle insertion hole. A plurality of sub-shaft side small protrusions provided on the first free end of the small protrusion ride on the outer periphery of the main spindle needle are expanded in diameter, and are fitted into and engaged with each sub-axis needle groove, and the second main spindle side After the small protrusion rides on the outer periphery of the spindle needle and the second free end is deformed in the diameter-expanding direction, the second spindle-side small protrusion is finally inserted into and engaged with the spindle needle groove, so that the second free end Since the portion springs back in the reduced diameter direction and returns and the connection between the distal end portion of the needle structure and the surgical distal instrument connecting mechanism is facilitated in a short time, there is an effect of improving the operability and the efficiency of the operation.
　さらに、主軸ニードル凹溝が主軸ニードル先端部の対向する外周面に主軸と直交する方向に部分的に切欠き形成されており、ニードル構造の先端部と手術先端器具連結機構との連結状態において、先に手術先端器具連結機構の外筒を固持した状態で手術先端器具回転ハンドルにより操作して主軸ニードルを略半回転させると、第２主軸側小突起が主軸ニードルの外周に乗り上げ第２自由端部が拡径方向に変形して第２主軸側小突起が主軸ニードル凹溝から離脱し、その後主軸ニードルを後方に引抜くことで第１主軸側小突起が主軸ニードルの外周面から外れて第1自由端部が縮径方向にスプリングバックして復帰し複数の副軸側小突起が縮径されて各副軸ニードル凹溝から一括に離脱することにより、ニードル構造の先端部と手術先端器具連結機構との離脱が短時間で容易に可能となることから、操作性及び手術の効率を向上させる効果がある。
　本発明の目的、特徴、局面、及び利点は、以下の詳細な説明と添付図面とによって、より明白となる。 Furthermore, the spindle needle groove is partially cut out in the direction perpendicular to the spindle on the opposing outer peripheral surface of the spindle needle tip, and in the connected state between the tip of the needle structure and the surgical tip instrument connection mechanism, When the spindle needle is operated approximately half a half by operating the surgical tip instrument rotating handle while the outer cylinder of the surgical tip instrument coupling mechanism is held first, the second spindle-side small protrusion rides on the outer circumference of the spindle needle and the second free end. The first main shaft side small protrusion is detached from the outer peripheral surface of the main shaft needle by pulling the main shaft needle rearward by pulling the main shaft needle rearward. (1) The free end springs back in the direction of diameter reduction and returns, and a plurality of minor protrusions on the secondary shaft side are reduced in diameter so that they can be removed from the concave grooves of each secondary shaft all at once. Linking Since separation from the mechanism can be easily performed in a short time, there is an effect of improving operability and efficiency of surgery.
The objects, features, aspects and advantages of the present invention will become more apparent from the following detailed description and the accompanying drawings.
本発明の実施の形態１による最低侵襲外科手術システム１を概念的に説明するための概念図で、先に腹腔孔Ｍｂから体腔内の病変臓器Ｔの近傍まで挿入された手術先端器具体腔内挿入手段２００から受け渡される手術先端器具６０の後端部に向けてその直近まで外科治療用ニードル型デバイス１０のニードル構造３０を体腔内に刺入した状態を示す概念図である。BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a conceptual diagram for conceptually explaining a minimally invasive surgical operation system 1 according to Embodiment 1 of the present invention, in which a surgical tip is inserted into a specific cavity first from the abdominal cavity Mb to the vicinity of a diseased organ T in a body cavity. It is a conceptual diagram which shows the state which inserted the needle structure 30 of the needle type device 10 for surgical treatment in the body cavity toward the back end part of the surgical front-end | tip instrument 60 delivered from the means 200 to the nearest. 図１に引続き、外科治療用ニードル型デバイス１０のニードル構造３０の先端部３０ａに連結した手術先端器具６０を手術先端器具体腔内挿入手段２００から取外した状態を示す概念図である。FIG. 2 is a conceptual diagram showing a state in which the surgical tip instrument 60 connected to the distal end portion 30a of the needle structure 30 of the surgical treatment needle type device 10 is removed from the surgical tip instrument specific intracavity insertion means 200 following FIG. 本発明の実施の形態１による外科治療用ニードル型デバイス１０の構成を概念的に示す全体組立概念図である。1 is an overall assembly conceptual diagram conceptually showing a configuration of a surgical treatment needle type device 10 according to Embodiment 1 of the present invention. 本発明の実施の形態１による外科治療用ニードル型デバイス１０の手術先端器具６０部の構造を示すコンピュータグラフィック鳥瞰図である。It is a computer graphic bird's-eye view which shows the structure of 60 operation | movement tip instruments of the needle type device 10 for surgical treatment by Embodiment 1 of this invention. 図４の手術先端器具５０部及び手術先端器具連結機構５０の横断面図である。FIG. 5 is a cross-sectional view of the surgical tip instrument 50 and the surgical tip instrument coupling mechanism 50 of FIG. 4. 図３の手術先端器具操作部２０側後半部の縦断面図である。It is a longitudinal cross-sectional view of the surgical tip instrument operation part 20 side latter half part of FIG. 本発明の実施の形態１による手術先端器具体腔内挿入手段２００の構成を概念的に示す全体組立概念図である。It is a whole assembly conceptual diagram which shows notionally the composition of operation tip instrument concrete cavity insertion means 200 by Embodiment 1 of the present invention. 図７の手術先端器具体腔内挿入手段２００の先端部側の構造を示すコンピュータグラフィック図である。It is a computer graphic figure which shows the structure by the side of the front-end | tip part of the surgical front-end | tip instrument specific cavity insertion means 200 of FIG. 図８の手術先端器具体腔内挿入手段２００の手術先端器具保持容器２１７をピストン２２２の先端部の傾斜ガイド２２２ａにより押し上げられ傾動させられた状態を示すコンピュータグラフィック図である。FIG. 9 is a computer graphic diagram showing a state in which the surgical tip instrument holding container 217 of the surgical tip instrument specific cavity insertion means 200 of FIG. 8 is pushed up and tilted by the tilt guide 222a at the tip of the piston 222. 本発明の実施の形態２による外科治療用ニードル型デバイス１０Ａの構成を概念的に示す全体組立概念図である。It is the whole assembly conceptual diagram which shows notionally the structure of the needle type device 10A for surgical treatment by Embodiment 2 of this invention. 図７のニードル構造湾曲操作部７０及びニードル支持ユニット４０の要部縦断面図である。FIG. 8 is a longitudinal sectional view of main parts of the needle structure bending operation unit 70 and the needle support unit 40 of FIG. 7. 本発明の実施の形態３による外科治療用ニードル型デバイス１０Ｂの構成を概念的に示す全体組立概念図である。It is the whole assembly conceptual diagram which shows notionally the structure of the needle type device 10B for surgical treatment by Embodiment 3 of this invention. 本発明の実施の形態３による最低侵襲外科手術システム１Ｂを概念的に説明するための概念図で、図１２の外科治療用ニードル型デバイス１０Ｂを、ニードル構造３０の後端部３０ｂからニードル支持ユニット４０を取外した状態のニードル構造３０の後端部３０ｂ側から別の実施形態の手術先端器具体腔内挿入手段３００内に装填した状態で体腔内の病変臓器の近傍まで挿入してニードル構造３０の後端部３０ｂ側を体腔内部から腹部皮膚外に向けて手術先端器具押出しピストン３０８により押出して体腔内部から腹部皮膚外に穿刺し貫通させた状態を示す概念図である。12 is a conceptual diagram for conceptually explaining a minimally invasive surgical system 1B according to Embodiment 3 of the present invention, in which the surgical treatment needle-type device 10B is connected to the needle support unit 30 from the rear end 30b of the needle structure 30. FIG. The needle structure 30 is inserted from the rear end 30b side of the needle structure 30 in a state where the needle 40 is removed to the vicinity of the lesioned organ in the body cavity in a state of being loaded into the surgical tip device specific cavity insertion means 300 of another embodiment. It is a conceptual diagram showing a state in which the rear end portion 30b side is pushed from the inside of the body cavity to the outside of the abdominal skin by the surgical tip instrument pushing piston 308 and punctured from the inside of the body cavity to the outside of the abdominal skin. 図１３に引続き、腹部皮膚外に貫通されたニードル構造３０の後端部３０ｂを先に取外されたニードル支持ユニット４０に連結した状態を示す概念図である。It is a conceptual diagram which shows the state which connected the rear end part 30b of the needle structure 30 penetrated out of the abdominal skin to the needle support unit 40 previously removed following FIG. 図１４に引続き、ニードル構造３０にニードル支持ユニット４０が連結された外科治療用ニードル型デバイス１０Ｂ全体を手術先端器具体腔内挿入手段３００から抜出した状態を示す概念図である。FIG. 15 is a conceptual diagram showing a state in which the entire surgical needle type device 10 </ b> B in which the needle support unit 40 is connected to the needle structure 30 is extracted from the surgical tip device specific cavity insertion means 300, following FIG. 14. 本発明の実施の形態４による最低侵襲外科手術システム１Ｃを概念的に説明するための概念図で、先に自然開口部の例えば口Ｍａからから生体管内を経て体腔内の病変臓器Ｔの近傍まで挿入された手術先端器具体腔内挿入手段１００から受け渡される手術先端器具６０の後端部に向けてその直近まで外科治療用ニードル型デバイス１０のニードル構造３０を体腔内刺入した状態を示す概念図である。FIG. 5 is a conceptual diagram for conceptually explaining a minimally invasive surgical operation system 1C according to Embodiment 4 of the present invention. From a natural opening, for example, from mouth Ma to the vicinity of a diseased organ T in a body cavity through a living body. A concept showing a state in which the needle structure 30 of the surgical treatment needle type device 10 is inserted into the body cavity toward the rear end portion of the surgical tip instrument 60 delivered from the inserted surgical tip instrument specific intracavity insertion means 100 to the immediate vicinity thereof. FIG. 図１６に引続き、外科治療用ニードル型デバイス１０のニードル構造３０の先端部３０ａに連結した手術先端器具６０を手術先端器具体腔内挿入手段１００から取外した状態を示す概念図である。FIG. 17 is a conceptual diagram showing a state in which the surgical tip instrument 60 connected to the distal end portion 30 a of the needle structure 30 of the surgical treatment needle type device 10 is removed from the surgical tip instrument specific intracavity insertion means 100 following FIG. 16. 本発明の実施の形態５による外科治療用ニードル型デバイス１０Ｃの構成を示すコンピュータグラフィック全体組立図である。It is a computer graphic whole assembly drawing which shows the structure of the needle type device 10C for surgical treatment by Embodiment 5 of this invention. 図１８の外科治療用ニードル型デバイス１０Ｃの手術先端器具連結機構５０Ｃのコンピュータグラフィック横断面図である。FIG. 19 is a computer graphic cross-sectional view of a surgical tip instrument coupling mechanism 50C of the surgical treatment needle-type device 10C of FIG. 図１８の外科治療用ニードル型デバイス１０Ｃのニードル支持ユニット４０及び手術先端器具操作部２０のコンピュータグラフィック横断面図である。FIG. 19 is a computer graphic cross-sectional view of the needle support unit 40 and the surgical instrument operating unit 20 of the surgical treatment needle-type device 10C of FIG. 18. 本発明の実施の形態６による最低侵襲外科手術システム１Ｄを概念的に説明するための概念図で、先に腹腔孔Ｍｂから体腔内の病変臓器Ｔの近傍まで挿入された手術先端器具体腔内挿入手段５００から受け渡される手術先端器具６０の後端部に向けてその直近まで外科治療用ニードル型デバイス１０のニードル構造３０を体腔内に刺入した状態を示す概念図である。FIG. 9 is a conceptual diagram for conceptually explaining a minimally invasive surgical system 1D according to Embodiment 6 of the present invention, in which a surgical tip is inserted from the abdominal hole Mb to the vicinity of a diseased organ T in the body cavity; It is a conceptual diagram which shows the state which inserted the needle structure 30 of the needle type device 10 for surgical treatment in the body cavity toward the back end part of the surgical front-end | tip instrument 60 delivered from the means 500 to the nearest.
　以下、本発明の最低侵襲外科手術システムを実施するための形態の具体例を、添付図面を参照して詳細に説明する。
　（実施の形態１) Hereinafter, a specific example of a mode for carrying out the minimally invasive surgical operation system of the present invention will be described in detail with reference to the accompanying drawings.
(Embodiment 1)
　本発明に係る実施の形態１による最低侵襲外科手術システム１は、図１～３に示すように、いずれも状況に応じた外径及び長さに設定自在で主軸であるＸ軸、近位端すなわち後端及び遠位端すなわち先端を有し、Ｘ軸上の主軸ニードル３１及び主軸ニードル３１の周りに略軸対称例えば断面略円周上に並列配置され主軸ニードル３１を補強する複数例えば３本以上（図示例では４本）の副軸ニードル３２から安定的な支持剛性及び強度を有し、主軸ニードル３１及び副軸ニードル３２の先端３１ａ，３２ａが尖鋭状に形成され、生体例えば人体Ｍの腹部皮膚外面から体腔内部に直接穿刺可能に構成されたニードル構造３０と、ニードル構造３０の先端部３０ａに挿脱可能に連結される手術先端器具連結機構５０を後端部に備える手術先端器具６０と、ニードル構造３０の後端部３０ｂが挿通され支持されるニードル支持ユニット４０と、ニードル支持ユニット４０の後端部に連接されるとともに主軸ニードル３１の後端部３１ｂが挿通され、主軸ニードル３１の後端部３１ｂと連携して手術先端器具６０を作動させる手術先端器具操作部２０と、を備えた外科治療用ニードル型デバイス１０を有する。 As shown in FIGS. 1 to 3, the minimally invasive surgical system 1 according to Embodiment 1 of the present invention has an X-axis, a proximal end, which is the main axis and can be set to an outer diameter and a length according to the situation. That is, it has a rear end and a distal end, that is, a tip, and a plurality of, for example, three main shaft needles 31 on the X axis and a plurality of, for example, three which are arranged in parallel on the substantially axial symmetry around the main shaft needle 31 From the above (four in the illustrated example), the countershaft needle 32 has stable support rigidity and strength, and the main shaft needle 31 and the tips 31a and 32a of the subshaft needle 32 are formed in a sharp shape. Surgical tip device comprising a needle structure 30 configured to be able to puncture directly into the body cavity from the outer surface of the abdominal skin, and a surgical tip instrument connecting mechanism 50 detachably connected to the tip portion 30a of the needle structure 30 at the rear end portion. 60, a needle support unit 40 through which the rear end portion 30b of the needle structure 30 is inserted and supported, and a rear end portion 31b of the main shaft needle 31 connected to the rear end portion of the needle support unit 40 and inserted into the main shaft needle. The surgical treatment needle device 10 includes a surgical distal instrument operating unit 20 that operates the surgical distal instrument 60 in cooperation with the rear end 31b of the surgical instrument 31.
　さらに、この実施の形態による最低侵襲外科手術システム１は、生体の直径略１０ｍｍの単孔式腹腔鏡下手術用腹腔孔Ｍｂ又は肛門などの自然開口部から体腔内に挿入される管状体２１１を有する体腔内挿入本体２１０と、体腔内挿入本体２１０の先端部に設けられ、ニードル構造３０の先端部３０ａから取外された状態の手術先端器具６０を着脱自在に保持する手術先端器具保持機構と、後端に手術先端器具保持機構の保持操作を行う手術先端器具保持機構操作部２２０と、を備えた手術先端器具体腔内挿入手段２００を有する。 Further, the minimally invasive surgical operation system 1 according to this embodiment includes a tubular body 211 inserted into a body cavity from a natural opening such as a single-hole laparoscopic surgical abdominal hole Mb or anus having a diameter of approximately 10 mm. An intracorporeal insertion main body 210 having a surgical distal instrument holding mechanism that is provided at the distal end of the intracavity insertion main body 210 and that detachably holds the surgical distal instrument 60 removed from the distal end 30a of the needle structure 30; The surgical tip instrument specific cavity insertion means 200 includes a surgical tip instrument holding mechanism operation unit 220 that performs a holding operation of the surgical tip instrument holding mechanism at the rear end.
　そして、手術先端器具体腔内挿入手段２００を用いて、体腔内の病変臓器Ｔの近傍まで手術先端器具６０を挿入した後で、図示しない腹腔鏡によるモニタリング下で、外科治療用ニードル型デバイス１０のニードル構造３０を先端部３０ａから体腔内に穿刺してニードル構造３０の先端部３０ａに病変臓器Ｔの近傍まで挿入された手術先端器具６０の後端部の手術先端器具連結機構５０に連結すると同時に、手術先端器具体腔内挿入手段２００から手術先端器具６０を開放した状態で、手術先端器具操作部２０により手術先端器具６０を操作して外科手術処置を体腔内で全て実行する。 Then, after the surgical tip instrument 60 is inserted to the vicinity of the lesioned organ T in the body cavity using the surgical tip instrument specific cavity insertion means 200, the needle type device 10 for surgical treatment is monitored under a laparoscope (not shown). At the same time as the needle structure 30 is punctured from the distal end portion 30a into the body cavity and is connected to the surgical distal instrument connection mechanism 50 at the rear end portion of the surgical distal instrument 60 inserted into the distal end portion 30a of the needle structure 30 to the vicinity of the lesioned organ T. The surgical tip instrument 60 is operated by the surgical tip instrument operating unit 20 in a state in which the surgical tip instrument 60 is opened from the surgical tip instrument specific cavity insertion means 200, and all the surgical procedures are executed in the body cavity.
　本発明の外科治療用ニードル型デバイス１０及び手術先端器具体腔内挿入手段２００等を構成する各部材は、耐腐食性、耐薬品性を備えるとともに、加熱滅菌に耐え得る温度耐久性を備える医療適合性材料からなり、特に滅菌を容易にするためそれぞれが分解可能に形成されることが望ましく、ケースバイケースで使い捨てとすることもできる。 Each of the members constituting the surgical treatment needle type device 10 and the surgical tip specific insertion means 200 of the present invention has a corrosion resistance and a chemical resistance, and has a temperature durability capable of withstanding heat sterilization. In particular, it is desirable that each material is made to be disassembled so as to facilitate sterilization, and can be disposable on a case-by-case basis.
　主軸ニードル３１及び副軸ニードル３２は、状況に応じた適宜な外径及び長さに設定自在で様々な長さに交換可能である。 The main shaft needle 31 and the sub shaft needle 32 can be set to an appropriate outer diameter and length according to the situation and can be exchanged to various lengths.
　特に、主軸ニードル３１及び副軸ニードル３２は、外径略３ｍｍ以下の丸棒又は線状の医療適合性材料からなり、生体の痛み神経を跨ぐように略２ｍｍ以上の間隔で略対称型例えば断面円周上に並列配置されることが望ましい。これにより、生体への痛みを抑え、一層低侵襲性が確保される。 In particular, the main shaft needle 31 and the sub shaft needle 32 are made of a round bar or a linear medical compatible material having an outer diameter of about 3 mm or less, and are substantially symmetrical at intervals of about 2 mm or more so as to straddle the pain nerve of a living body. It is desirable to arrange in parallel on the circumference. Thereby, the pain to a living body is suppressed and further less invasiveness is ensured.
　この実施の形態においては、１本の主軸ニードル３１及び４本の副軸ニードル３２が、それぞれ外径略３ｍｍのＴｉ系形状記憶合金材、外径略２ｍｍのＳＵＳ材などのいずれも高剛性及び高弾力性を有する棒状又は線状体からなる。 In this embodiment, each of the main spindle needle 31 and the four countershaft needles 32 has a high rigidity and a Ti-type shape memory alloy material having an outer diameter of approximately 3 mm and an SUS material having an outer diameter of approximately 2 mm. It consists of a rod-like or linear body having high elasticity.
　また、主軸ニードル３１は、各種手術先端器具６０の動作に必要な主軸方向のスライド、回転、あるいは前記主軸ニードル及び副軸ニードルにも通電、マイクロ波又は超音波放射線伝送等々の各種の機能を選択的に持たせることができる。 The spindle needle 31 selects various functions such as sliding and rotation in the main axis direction necessary for the operation of the various surgical tip instruments 60, and energization, microwave or ultrasonic radiation transmission to the main spindle needle and the sub spindle needle. Can be given.
　熱を用いた腫瘍治療の分野に関し、生体組織の加熱又は組織切除が、細胞を死滅させて腫瘍を消滅させるのに利用されることは公知である（例えば特表２００９－５４４３４７号公報参照）。したがって、ここでは詳細な説明は省略するが、血管を焼灼して止血するために熱を利用することもできる。このような熱は、ＲＦ電流、マイクロ波又は超音波放射線を用いて発生させることができる。熱エネルギーは、直接生体組織に適用可能であり、これらの熱エネルギーは、問題のある病変組織に主軸ニードル３１を介して伝送することができる。 Regarding the field of tumor treatment using heat, it is known that heating of tissue or tissue excision can be used to kill cells and extinguish tumors (see, for example, JP 2009-544347 A). Therefore, although detailed explanation is omitted here, heat can be used to cauterize blood vessels and stop bleeding. Such heat can be generated using RF current, microwave or ultrasonic radiation. Thermal energy can be applied directly to living tissue and these thermal energy can be transmitted through the spindle needle 31 to the affected lesion tissue.
　この実施の形態による外科治療用ニードル型デバイス１０は、いずれも主軸ニードル３１及び副軸ニードル３２に摺動自在に挿通される２枚のガイド板３３、３４と、各ガイド板３３、３４を背面から押圧するようにガイド板３３と３４との間、及びニードル支持ユニット４０とガイド板３４との間にそれぞれ配置される２つのスプリング３５ａ、３５ｂをさらに備える。これにより、先端部に手術先端器具６０を保持するニードル構造３０の変形を抑える安定的な支持剛性及び強度が確保される。 The surgical treatment needle type device 10 according to this embodiment includes two guide plates 33 and 34 that are slidably inserted into the main shaft needle 31 and the sub shaft needle 32, and the guide plates 33 and 34 on the back surface. Are further provided with two springs 35a and 35b disposed between the guide plates 33 and 34 and between the needle support unit 40 and the guide plate 34, respectively. Thereby, the stable support rigidity and intensity | strength which suppress the deformation | transformation of the needle structure 30 holding the surgical front instrument 60 in a front-end | tip part are ensured.
　このように構成された外科治療用ニードル型デバイス１０は、図３に示すように、ニードル構造３０を体腔内に穿刺すると、先端側のガイド板３３が人体Ｍの腹部表面に当接して押圧されることにより、二点鎖線で図示されるように、スプリング３５ａ、ガイド板３４、スプリング３５ｂがニードル構造３０に沿って順次後方に押圧されてスライドし縮尺される。 As shown in FIG. 3, in the surgical treatment needle type device 10 configured as described above, when the needle structure 30 is punctured into a body cavity, the distal guide plate 33 is pressed against the abdominal surface of the human body M. As a result, the spring 35 a, the guide plate 34, and the spring 35 b are sequentially pressed rearward along the needle structure 30, and are slid and reduced in scale as illustrated by the two-dot chain line.
　このようなガイド板３３、３４のスプリング３５ａ、３５ｂによるスライド構成より、ニードル構造３０を体腔内に穿刺する過程でもニードル構造３０の各ニードル３１、３２の径方向の変形（屈曲）を防止し、先端部に手術先端器具６０を保持する安定的な支持剛性及び強度が保持される。 Due to the slide configuration of the guide plates 33 and 34 by the springs 35a and 35b, even in the process of puncturing the needle structure 30 into the body cavity, deformation (bending) in the radial direction of the needles 31 and 32 of the needle structure 30 is prevented. Stable support rigidity and strength for holding the surgical tip instrument 60 at the tip are maintained.
　手術先端器具６０は、生体臓器を把持、切断、穿刺、孔明する等々の各種の公知を含む手術先端器具を選択的に取り替えることができる。 The surgical tip instrument 60 can selectively replace various kinds of known surgical tip instruments such as grasping, cutting, puncturing, and punching a living organ.
　この実施の形態における手術先端器具６０は、一例として図４、５に示すように、中空状のガイド支持部材６１内に主軸方向に沿って主軸ニードル３１の先端部３１ａと連携しスライド自在に内挿された前部駆動シャフト６４と、ガイド支持部材６１の先端部６１ａに固定ピン６３により回動自在にピボット連結された第一顎部材６２ａ及び第二顎部材６２ｂを含む顎機構６２を開閉駆動する顎開閉駆動機構と、を備える。 As an example, as shown in FIGS. 4 and 5, the surgical tip instrument 60 in this embodiment is slidable in cooperation with the tip 31 a of the spindle needle 31 in the hollow guide support member 61 along the spindle direction. The inserted front drive shaft 64 and the jaw mechanism 62 including the first jaw member 62a and the second jaw member 62b pivotally connected to the distal end portion 61a of the guide support member 61 by a fixing pin 63 are opened and closed. A jaw opening / closing drive mechanism.
　この実施の形態による顎開閉駆動機構は、前部駆動シャフト６４の先端部６４ａに設けられたガイドピン６５が、第一顎部材６２ａ及び第二顎部材６２ｂの後端部に延設され、Ｘ軸及び相互に交叉する方向にそれぞれ形成された長孔ガイド６２ｃ、６２ｄに共にスライド自在に嵌挿され係合するように構成される。 In the jaw opening / closing drive mechanism according to this embodiment, a guide pin 65 provided at the distal end portion 64a of the front drive shaft 64 extends to the rear end portions of the first jaw member 62a and the second jaw member 62b, and X Both the shafts and the long hole guides 62c and 62d formed in the crossing direction are slidably inserted and engaged with each other.
　そこで、前部駆動シャフト６４がＸ軸方向に前・後進スライドすることにより、ガイドピン６５が長孔ガイド６２ｃ、６２ｄに沿ってスライドしガイドすることで第一顎部材６２ａ及び第二顎部材６２ｂが相互に回動され開閉する。すなわち、第一顎部材６２ａ及び第二顎部材６２ｂは、前部駆動シャフト６４が前進スライドするときに開き、後進スライドするときに閉じるようになっている。 Therefore, when the front drive shaft 64 slides forward and backward in the X-axis direction, the guide pin 65 slides and guides along the long hole guides 62c and 62d, whereby the first jaw member 62a and the second jaw member 62b. Are mutually rotated and opened and closed. That is, the first jaw member 62a and the second jaw member 62b are configured to open when the front drive shaft 64 slides forward and to close when the front drive shaft 64 slides backward.
　したがって、本発明の手術先端器具６０は、従来の手術先端器具におけるリンク式顎開閉駆動機構等に比べてリンク関連部材が省かれて部品点数が少なく、軽量且つコンパクト化されることから、経済性及び操作性が向上する。 Therefore, the surgical tip instrument 60 of the present invention is economical because the link-related members are omitted, the number of parts is small, and the weight and size are reduced compared to the link type jaw opening / closing drive mechanism and the like in the conventional surgical tip instrument. And operability is improved.
　手術先端器具６０は、後端部に主軸ニードル３１及び副軸ニードル３２の先端部３１ａ、３２ａがそれぞれ挿脱自在に連結する手術先端器具連結機構５０を備える。 The surgical tip instrument 60 is provided with a surgical tip instrument coupling mechanism 50 in which the distal end portions 31a and 32a of the main shaft needle 31 and the countershaft needle 32 are detachably coupled to the rear end portion.
　手術先端器具連結機構５０は、図５に示すように、先端部５１ａ側に手術先端器具６０のガイド支持部材６１の後端部６１ｂを内挿して保持し、後端部５１ｂ側に主軸ニードル３１及び副軸ニードル３２の先端部３１ａ、３２ａが挿脱自在にそれぞれ挿入される開口端部にテーパーガイドが形成された主軸ニードル装入穴５１ｃ及び複数の副軸ニードル装入穴５１ｄを備えた略円筒型の外筒５１と、外筒５１内の主軸及び複数の主軸ニードル装入穴５１ｃ及び複数の副軸ニードル装入穴５１ｄにそれぞれ隣接し設けられた径方向に弾性変形可能な主軸側自由端部５２及び副軸側自由端部５３に形成された主軸ニードル装入穴５１ｃ及び複数の副軸ニードル装入穴５１ｄの内径方向にそれぞれ突出する主軸側小突起５２ａ及び複数の副軸側小突起５３ａと、を有する。 As shown in FIG. 5, the surgical tip instrument coupling mechanism 50 interpolates and holds the rear end portion 61b of the guide support member 61 of the surgical tip instrument 60 on the distal end portion 51a side, and the spindle needle 31 on the rear end portion 51b side. And a main shaft needle insertion hole 51c formed with a taper guide at the opening end portion into which the distal end portions 31a and 32a of the sub shaft needle 32 are removably inserted, and a plurality of sub shaft needle insertion holes 51d. A cylindrical outer cylinder 51 and a main shaft-side free elastically deformable in the radial direction provided adjacent to the main shaft in the outer cylinder 51 and the plurality of main shaft needle insertion holes 51c and the plurality of auxiliary shaft needle insertion holes 51d. A main shaft side small protrusion 52a and a plurality of sub shaft side small protrusions projecting in the inner diameter direction of the main shaft needle insertion hole 51c and the plurality of sub shaft needle insertion holes 51d formed in the end portion 52 and the sub shaft side free end portion 53, respectively. And a cause 53a,.
　一方、主軸ニードル３１及び副軸ニードル３２の各先端部３１ａ、３２ａの外周に沿って、主軸側小突起５２ａ及び副軸側小突起５３ａがそれぞれ嵌入し係合するはちまき状の主軸ニードル凹溝３１ｅ及び副軸ニードル凹溝３２ｄが形成されている。 On the other hand, the main shaft side small protrusion 52a and the sub shaft side small protrusion 53a are fitted and engaged with each other along the outer circumferences of the tip portions 31a and 32a of the main shaft needle 31 and the sub shaft needle 32, respectively. And a countershaft needle groove 32d is formed.
　そして、ニードル構造３０を前方に押し込み、主軸ニードル３１及び副軸ニードル３２の先端部３１ａ、３２ａが手術先端器具連結機構５０の主軸ニードル挿入穴５１ｃ及び副軸ニードル挿入穴５１ｄに挿入され、それぞれ主軸側小突起５２ａ及び副軸側小突起５３ａを主軸ニードル挿入穴５１ｃ及び副軸ニードル挿入穴５１ｄの径外方向に押し退けて主軸側自由端部５２及び副軸側自由端部５３を変形させながら主軸ニードル挿入穴５１ｃ及び副軸ニードル挿入５１ｄの穴底まで挿入されると同時に、主軸側小突起５２ａ及び副軸側小突起５３ａがそれぞれ主軸ニードル凹溝３１ｅ及び副軸ニードル凹溝３２ｄにスプリングバックして嵌入し係合することにより、ニードル構造３０の先端部３０ａと手術先端器具連結機構５０との連結がなされる。 Then, the needle structure 30 is pushed forward, and the distal end portions 31a and 32a of the spindle needle 31 and the countershaft needle 32 are inserted into the spindle needle insertion hole 51c and the countershaft needle insertion hole 51d of the surgical tip instrument coupling mechanism 50, respectively. The main shaft side free protrusion 52 and the sub shaft side free end 53 are deformed by pushing the side small protrusion 52a and the sub shaft small protrusion 53a in the radially outward direction of the main shaft needle insertion hole 51c and the sub shaft needle insertion hole 51d. At the same time that the needle insertion hole 51c and the sub-shaft needle insertion 51d are inserted to the bottom of the hole, the main shaft side small protrusion 52a and the sub shaft side small protrusion 53a spring back to the main shaft needle groove 31e and the sub shaft needle groove 32d, respectively. By inserting and engaging, the connection between the distal end portion 30a of the needle structure 30 and the surgical distal instrument connecting mechanism 50 is achieved. It is.
　その後、手術先端器具体腔内挿入手段２００により手術先端器具６０又は手術先端器具連結機構５０を保持した状態で、ニードル構造３０を後方に所定の力で牽引すると、主軸側小突起５２ａ及び副軸側小突起５３ａがそれぞれ主軸ニードル３１及び副軸ニードル３２の外面に乗り上げられるように各主軸側自由端部５２及び副軸側自由端部５３が変形することにより各主軸ニードル凹溝３１ｅ及び副軸ニードル凹溝３２ｄから離脱し、ニードル構造３０の先端部３０ａと手術先端器具連結機構５０との連結が解除される。この連結が解除されるときの前記所定の牽引力は、主軸側小突起５２ａ及び副軸側小突起５３ａと主軸ニードル凹溝３１ｅ及び副軸ニードル凹溝３２ｄの係合する形状を調節することにより設定される。 Thereafter, when the needle tip 30 is pulled backward with a predetermined force while the surgical tip instrument 60 or the surgical tip instrument coupling mechanism 50 is held by the surgical tip instrument specific intra-cavity insertion means 200, the main-axis-side small protrusion 52a and the minor-axis side The main shaft needle free end 52 and the sub shaft side free end 53 are deformed so that the small protrusions 53a run on the outer surfaces of the main shaft needle 31 and the sub shaft needle 32, respectively. It disengages from the ditch | groove 32d, and the connection of the front-end | tip part 30a of the needle structure 30 and the surgery front-end | tip instrument connection mechanism 50 is cancelled | released. The predetermined traction force when the connection is released is set by adjusting the shape of engagement between the main shaft side small protrusion 52a and the sub shaft side small protrusion 53a and the main shaft needle groove 31e and the sub shaft needle groove 32d. Is done.
　手術先端器具操作部２０は、図６に示すように、図示下端部に設けられた把持ハンドル２１ａ及び図示上端部にＸ軸に沿って前方に延設される支持本体２１ｂからなる固定ハンドル構造２１と、固定ハンドル構造２１の後端部に固定ピン２５によりピボット連結され、主軸ニードル３１の後端部３１ｂと連携して手術先端器具６０を作動させる可動ハンドル２２と、支持本体２１ｂの先端部に回動自在に外挿され、ニードル支持ユニット４０、主軸ニードル３１及び手術先端器具６０を共に回動させる手術先端器具回動機構２３とを備える。 As shown in FIG. 6, the surgical tip instrument operating unit 20 includes a fixed handle structure 21 including a grip handle 21 a provided at the lower end in the figure and a support body 21 b extending forward along the X axis at the upper end in the figure. And a movable handle 22 that is pivotally connected to the rear end portion of the fixed handle structure 21 by a fixing pin 25 and operates the surgical tip instrument 60 in cooperation with the rear end portion 31b of the spindle needle 31, and the distal end portion of the support body 21b. A surgical tip instrument rotating mechanism 23 that is rotatably inserted and rotates the needle support unit 40, the spindle needle 31 and the surgical tip instrument 60 together.
　手術先端器具回動機構２３は、先端部にＸ軸に沿って前方に延設されて雄ねじ部２３ｂが形成され、支持本体２１ｂの先端部に回動自在に外挿される手術先端器具回転ハンドル２３ａと、先端部にニードル支持ユニット４０が回動自在に外挿されＸ軸に沿って延設される先端支持部２４ａ、及び後端部が手術先端器具回転ハンドル２３ａの先端部に設けられた雄ねじ部２３ｂに螺合し固着される中空外筒２４ｂからなる支持回動体２４と、先端側から主軸に沿って形成された雌ねじ部２８ａに主軸ニードル３１の後端部３１ｂが螺合し固定されて先端支持部２４ａ中空内にＸ軸方向に主軸ニードル３１と共にスライド自在に内挿され、後端部に後述する球状体２８ｃが形成された連結部材２８と、からなる。 The surgical tip instrument rotating mechanism 23 extends forward along the X-axis at the distal end portion to form a male screw portion 23b, and is inserted into the distal end portion of the support body 21b so as to be freely rotatable. A distal end support portion 24a in which the needle support unit 40 is rotatably inserted at the distal end portion and extends along the X axis, and a rear end portion is a male screw provided at the distal end portion of the surgical distal instrument rotating handle 23a. The rear end portion 31b of the main spindle needle 31 is screwed and fixed to the support rotating body 24 including the hollow outer cylinder 24b that is screwed and fixed to the portion 23b, and the female screw portion 28a formed from the front end side along the main shaft. The connecting member 28 is slidably inserted together with the spindle needle 31 in the X-axis direction into the hollow end support 24a, and a spherical body 28c described later is formed at the rear end.
　先端支持部２４ａ中空内に内挿された連結部材２８の外面には、Ｘ軸方向に沿ってガイドキー溝２８ｂが形成されている。一方、先端支持部２４ａには、ガイドねじ２９が外面から径方向に螺合し設けられており、このガイドねじ２９の先端部が連結部材２８のガイドキー溝２８ｂ内に滑動自在に嵌合しガイドすることにより、主軸ニードル３１と共に連結部材２８はＸ軸方向のスライドは許容されるがＸ軸回りの回転が拘束される。これにより、手術先端器具回転ハンドル２３ａを回転することにより、連結部材２８、主軸ニードル３１及び手術先端器具６０が共に回転する。 A guide key groove 28b is formed along the X-axis direction on the outer surface of the connecting member 28 inserted into the hollow end support 24a. On the other hand, a guide screw 29 is screwed into the distal end support portion 24a in the radial direction from the outer surface, and the distal end portion of the guide screw 29 is slidably fitted into the guide key groove 28b of the connecting member 28. By guiding, the connecting member 28 together with the spindle needle 31 is allowed to slide in the X-axis direction but is restricted from rotating around the X-axis. Accordingly, by rotating the surgical tip instrument rotating handle 23a, the connecting member 28, the spindle needle 31 and the surgical tip instrument 60 are rotated together.
　可動ハンドル２２は、主軸ニードル３１の後端部３１ｂが後述する後部駆動シャフト２７を介して連携されており、この可動ハンドル２２の操作に伴い、後部駆動シャフト２７及び主軸ニードル３１を介して手術先端器具６０の前部駆動シャフト６４をＸ軸方向にスライドさせることができる。先端器具操作部２０の可動ハンドル２２、固定ハンドル構造２１の形状及び機構等は特に限定されるものではなく、公知の内視鏡外科手術用鉗子の操作部及び可動ハンドル、固定ハンドル構造の構成を適用することができる。 The movable handle 22 is linked with a rear end portion 31 b of the main spindle needle 31 via a rear drive shaft 27 described later. When the movable handle 22 is operated, the distal end of the operation is passed through the rear drive shaft 27 and the main spindle needle 31. The front drive shaft 64 of the instrument 60 can be slid in the X-axis direction. The shape and mechanism of the movable handle 22 and the fixed handle structure 21 of the distal instrument operating unit 20 are not particularly limited, and the configuration of the operation unit and movable handle of the known endoscopic surgical forceps and the fixed handle structure are used. Can be applied.
　この実施の形態においては、後部駆動シャフト２７は、図６に示すように、シャフト本体２７ａの先端部に連結部材２８の後端部に形成された球状体２８ｃが嵌合する凹溝２７ｅが形成された鍔部２７ｂを、後端部に可動ハンドル２２がピボット連結される固定ピン２５の図示上方に離隔してＸ軸上に形成された凹溝２２ａ内に滑動自在に嵌合する球状体２７ｃを備え、固定ハンドル構造２１の支持本体２１ｂにＸ軸に沿って形成されたガイド孔２１ｃ及び２１ｄ内をそれぞれ鍔部２７ｂ及びシャフト本体２７ａがスライド自在に内挿されている。 In this embodiment, as shown in FIG. 6, the rear drive shaft 27 is formed with a concave groove 27e in which a spherical body 28c formed at the rear end portion of the connecting member 28 is fitted at the front end portion of the shaft main body 27a. A spherical body 27c that is slidably fitted into a recessed groove 22a formed on the X-axis with the flange 27b separated from the fixed pin 25 pivotally connected to the movable handle 22 at the rear end. The flange portion 27b and the shaft main body 27a are slidably inserted in guide holes 21c and 21d formed along the X-axis in the support main body 21b of the fixed handle structure 21, respectively.
　そして、図３乃至６に示すように、可動ハンドル２２を固定ハンドル構造２１の把持ハンドル２１ａ方向（図示実線矢印方向）への閉操作又はこれと反対方向（図示破線矢印方向）の開操作に伴って、順次後部駆動シャフト部材２７及び主軸ニードル３１を介して手術先端器具６０の前部駆動シャフト６４をＸ軸方向にそれぞれ後進すなわち後退又は前進させ、顎機構６２をそれぞれ閉又は開駆動する。 As shown in FIGS. 3 to 6, the movable handle 22 is closed in the direction of the grip handle 21a of the fixed handle structure 21 (in the direction of the solid line arrow) or in the opposite direction (in the direction of the broken line arrow in the drawing). Then, the front drive shaft 64 of the surgical tip instrument 60 is sequentially moved back, that is, retreated or advanced in the X-axis direction via the rear drive shaft member 27 and the main shaft needle 31 sequentially, and the jaw mechanism 62 is driven to close or open.
　この実施の形態による手術先端器具体腔内挿入手段２００の手術先端器具保持機構は、図７乃至９に示すように、体腔内挿入本体２１０の管状体２１１の先端部２１１ａの図示上面に設けられた第１開口部２１１ｃ及び第１開口部２１１ｃとＵ軸に対して対称関係をなす先端側の図示下面に設けられた第２開口部２１１ｄと、第１開口部２１１ｃの先端部に所定の角度傾動自在に固定ピン２１４を介してピボット連結され、先端部及び後端部がそれぞれ前記第２開口部２１１ｄ及び第１開口部２１１ｃから出没可能で、手術先端器具６０を先端方向に向けて挿脱可能に内部２１７ａに収納し保持する中空状の手術先端器具保持容器２１７と、一端が固定ピン２１４に固定され、他端が手術先端器具保持容器２１７の固定ピン２１４の後方部に設けられた固定部材２１７ｃにより固定されて手術先端器具保持容器２１７をＵ軸と略平行位置すなわち図示略水平位置に保持する方向に付勢するばね２１８と、を有する。 The surgical tip instrument holding mechanism of the surgical tip instrument specific cavity insertion means 200 according to this embodiment is provided on the upper surface of the distal end portion 211a of the tubular body 211 of the body cavity insertion body 210 as shown in FIGS. The first opening 211c and the first opening 211c are tilted at a predetermined angle to the second opening 211d provided on the lower surface in the drawing and symmetrical to the U-axis with respect to the U axis, and to the tip of the first opening 211c. It is pivotally connected via a fixing pin 214, and the distal end portion and the rear end portion can protrude and retract from the second opening 211d and the first opening 211c, respectively, and the surgical distal instrument 60 can be inserted and removed in the distal direction. A hollow surgical tip instrument holding container 217 which is housed and held in the interior 217a, and one end is fixed to the fixing pin 214, and the other end is a rear portion of the fixing pin 214 of the surgical tip instrument holding container 217. Having a spring 218 for urging the surgical tip instrument holding container 217 is fixed by provided fixed member 217c in the direction of holding the U axis substantially parallel position or not shown horizontal position.
　管状体２１１の先端部２１１ａ及び後端部２１１ｂにはそれぞれ先端キャップ２１２、後端キャップ２１３が設けられて閉止され、体腔内からの体液、血液及び組織片等の異物の管状体２１１内部侵入及び体外漏出を極力防止する。 The distal end portion 211a and the rear end portion 211b of the tubular body 211 are respectively provided with a distal end cap 212 and a rear end cap 213, which are closed so that foreign matter such as bodily fluids, blood, and tissue fragments enter the tubular body 211 from the body cavity. Prevent extracorporeal leakage as much as possible.
　この実施の形態による手術先端器具体腔内挿入手段２００の先端器具保持操作部２２０は、管状体２１１内に装填され、先端部に先端方向に図示下り勾配の傾斜ガイド２２２ａが形成されたピストン２２２と、ピストン２２２の後端部２２２ｂに連結され、管状体２１１の後端部２１１を閉止する後端キャップ２１３をスライド自在に貫通して外部に露出するピストンロッド２２１と、ピストンロッド２２１の後端部２２１ｂに連結される把持部２２３と、を有する。 The distal instrument holding operation unit 220 of the surgical distal instrument specific cavity insertion means 200 according to this embodiment is loaded in the tubular body 211, and a piston 222 having an inclined guide 222a having a downward slope shown in the distal direction formed at the distal end. The piston rod 221 is connected to the rear end portion 222b of the piston 222 and slidably passes through the rear end cap 213 that closes the rear end portion 211 of the tubular body 211 and is exposed to the outside, and the rear end portion of the piston rod 221 And a gripping portion 223 coupled to 221b.
　そして、生体外から把持部２２３を介してピストンロッド２２１を押し込むことにより、手術先端器具保持容器２１７は、後端部からピストン２２２の傾斜ガイド２２２ａに当接し案内されて所定角度傾動し、ピストンロッド２２１を牽引し後退させると、ばね２１８の付勢力により手術先端器具保持容器２１７がＵ軸と略平行位置に復帰する。 Then, by pushing the piston rod 221 from outside the living body via the gripping part 223, the surgical distal instrument holding container 217 comes into contact with the inclined guide 222a of the piston 222 from the rear end and is guided and tilted by a predetermined angle. When 221 is pulled and retracted, the surgical instrument holding container 217 is returned to a position substantially parallel to the U-axis by the biasing force of the spring 218.
　また、手術先端器具保持容器２１７の先端側及び管状体２１１の先端部２１１ａ側には、相互に係合して体腔内挿入過程等で不意な傾動を防止するよう手術先端器具保持容器２１７をＵ軸と略平行位置に待避し保持する係合部材２１７ｃ、２１５が設けられている。 In addition, the surgical distal instrument holding container 217 is placed on the distal end side of the surgical distal instrument holding container 217 and the distal end portion 211a side of the tubular body 211 so as to be engaged with each other and prevent unintentional tilting in the body cavity insertion process or the like. Engaging members 217c and 215 are provided to retract and hold at positions substantially parallel to the shaft.
　さらに、手術先端器具保持容器２１７の後部側内面２１７ａに突出する突起部材２１９及び手術先端器具連結機構５０の外面には図示しないＴ字状凹溝が形成され、手術先端器具６０を回動させることで突起部材２１９の先端部がＴ字状凹溝に嵌脱可能に嵌入し係合することにより手術先端器具保持容器２１７内に手術先端器具６０が着脱可能に装着される。
（実施の形態２) Further, a protruding member 219 protruding from the rear side inner surface 217a of the surgical tip instrument holding container 217 and a T-shaped concave groove (not shown) are formed on the outer surface of the surgical tip instrument coupling mechanism 50, and the surgical tip instrument 60 is rotated. Thus, the surgical distal instrument 60 is detachably mounted in the surgical distal instrument holding container 217 by engaging and engaging the distal end of the protruding member 219 with the T-shaped groove.
(Embodiment 2)
　本発明の実施の形態２による外科治療用ニードル型デバイス１０Ａは、図１０、１１に示すように、実施の形態１の外科治療用ニードル型デバイス１０におけるニードル支持ユニット４０と手術先端器具回動機構２３との間にニードル構造３０を湾曲させるニードル構造湾曲操作部７０が設けられる相違点を除いて、その他の構成は前記実施の形態１の外科治療用ニードル型デバイス１０と同様である。したがって、後述する図１０、１１における前記実施の形態１と同じ機能・構成を有する部材には、説明を簡明化するため同一の符号を付し、以下、上記相違点に関して添付図を参照して説明する。 As shown in FIGS. 10 and 11, a surgical treatment needle type device 10 </ b> A according to Embodiment 2 of the present invention includes a needle support unit 40 and a surgical tip instrument rotating mechanism in the surgical treatment needle type device 10 of Embodiment 1. The other structure is the same as that of the surgical treatment needle type device 10 of the first embodiment except that a needle structure bending operation unit 70 for bending the needle structure 30 is provided. Therefore, members having the same functions and configurations as those of the first embodiment in FIGS. 10 and 11 to be described later are denoted by the same reference numerals for the sake of simplification of description. explain.
　この実施の形態によるニードル構造湾曲操作部７０は、ニードル支持ユニット４０と手術先端器具操作部２０の手術先端器具回動機構２３との間に設けられ、外面に複数の傾動ハンドル７３を備え、手術先端器具回動機構２３の先端支持部２４ａに設けられたユニバーサル軸受け７２に中心孔７１ａを介して外挿され全方向に傾動自在に支持された傾動板７１と、各副軸ニードル３２の後端部３２ｂに設けられた球状体又は鍔状体３２ｃが傾斜板７１に設けられた複数の長溝７１ｂにそれぞれ滑動自在に嵌入し係合する副軸ニードル後端連結機構と、からなる。 The needle structure bending operation unit 70 according to this embodiment is provided between the needle support unit 40 and the surgical tip instrument rotating mechanism 23 of the surgical tip instrument operating unit 20, and includes a plurality of tilting handles 73 on the outer surface. A tilting plate 71 that is extrapolated via a center hole 71 a and supported to be tiltable in all directions by a universal bearing 72 provided in the tip support portion 24 a of the tip instrument turning mechanism 23, and the rear end of each countershaft needle 32 The spherical shaft or the bowl-shaped body 32c provided in the portion 32b includes a countershaft needle rear end coupling mechanism that is slidably fitted into and engaged with a plurality of long grooves 71b provided in the inclined plate 71, respectively.
　そして、傾動ハンドル７３を介して傾動板７１を任意の方向に傾動させることにより、Ｘ軸上にあるユニバーサル軸受け７２の傾動中心に対して対向関係をなす副軸ニードル３２の一方が前方に押圧されるとともに他方が後方に牽引されることからニードル構造３０に曲げモーメントＢｍが発生することより、先端部３０ａに手術先端器具６０が連結されたニードル構造３０を略弓型状に湾曲させる。 Then, by tilting the tilting plate 71 in an arbitrary direction via the tilting handle 73, one of the countershaft needles 32 that are opposed to the tilting center of the universal bearing 72 on the X axis is pressed forward. Since the other is pulled rearward, a bending moment Bm is generated in the needle structure 30, so that the needle structure 30 having the surgical tip instrument 60 connected to the distal end portion 30 a is bent in a substantially arcuate shape.
　この実施の形態によるユニバーサル軸受け７２としては、例えば内外輪７２ａ、７２ｂを球面接触させた構造を有する球面滑り軸受タイプを適用する。また、ニードル構造３０を湾曲させるニードル構造湾曲操作部７０は、この形態に限定されず、内視鏡あるいは内視鏡用手術器具類の種々公知の挿入部湾曲機構を適用することができる。 As the universal bearing 72 according to this embodiment, for example, a spherical plain bearing type having a structure in which inner and outer rings 72a and 72b are in spherical contact is applied. Further, the needle structure bending operation section 70 that bends the needle structure 30 is not limited to this form, and various known insertion section bending mechanisms of endoscopes or surgical instruments for endoscopes can be applied.
　このように、ニードル構造３０を任意の方向に略弓型状に湾曲させることにより、体腔内での外科手術処置の自由度が増し操作性を向上させる。
　（実施の形態３) In this way, by bending the needle structure 30 in a substantially arcuate shape in an arbitrary direction, the degree of freedom of surgical treatment in the body cavity is increased and the operability is improved.
(Embodiment 3)
　本発明の実施の形態３による最低侵襲外科手術システム１Ｂは、図１２～１５に示すように、外科治療用ニードル型デバイス１０Ｂが実施の形態１の外科治療用ニードル型デバイス１０に対しニードル構造３０とニードル支持ユニット４０の構成及び外科手術処置での使用方法が異なる相違点を除いて、その他の構成は前記実施の形態１の最低侵襲外科手術システム１と同様である。したがって、図１２～１５における前記実施の形態１と同じ機能及び構成を有する部材には、説明を簡明化するため同一の符号を付し、以下、上記相違点に関して添付図を参照し説明する。 As shown in FIGS. 12 to 15, the minimally invasive surgical system 1B according to the third embodiment of the present invention has a needle structure 30 in which the surgical needle type device 10B is different from the surgical treatment needle type device 10 according to the first embodiment. Other configurations are the same as those of the minimally invasive surgical system 1 of the first embodiment except that the configuration of the needle support unit 40 and the method of use in the surgical procedure are different. Accordingly, members having the same functions and configurations as those of the first embodiment in FIGS. 12 to 15 are denoted by the same reference numerals for the sake of simplicity, and the differences will be described below with reference to the accompanying drawings.
　この実施の形態による最低侵襲外科手術システム１Ｂは、外科治療用ニードル型デバイス１０Ｂが、図１２に示すように、第１に、主軸ニードル３１及び副軸ニードル３２に摺動自在に挿通される１枚のガイド板３３及び１つのスプリング３５を備え、ニードル構造３０を比較的短めに設定される点、第２に、ニードル構造３０の主軸ニードル３１及び副軸ニードル３２の後端部３１ｂ、３２ｂが尖鋭状に形成され、いずれも後述するが、ニードル支持ユニット４０に挿脱可能に連結されるとともに予め後述する腹腔孔Ｍｂから体腔内に挿入された手術先端器具付きのニードル構造３０の後端部３０ｂを体腔内部から皮膚外面まで穿刺し貫通可能に構成される点が実施の形態１の外科治療用ニードル型デバイス１０と相違し、その他の構成は実施の形態1と同様である。 In the minimally invasive surgical system 1B according to this embodiment, a surgical treatment needle type device 10B is first slidably inserted into a main shaft needle 31 and a sub shaft needle 32 as shown in FIG. The guide plate 33 and one spring 35 are provided, and the needle structure 30 is set to be relatively short. Second, the rear end portions 31b and 32b of the main shaft needle 31 and the sub shaft needle 32 of the needle structure 30 are provided. Although formed in a sharp shape, both of which will be described later, the rear end portion of the needle structure 30 with the surgical distal instrument inserted into the body cavity from the abdominal hole Mb described later in advance and connected to the needle support unit 40 in a detachable manner. 30b is different from the needle type device 10 for surgical treatment of the first embodiment in that it is configured to be pierced through the body cavity from the inside of the body cavity to the outer surface of the skin. It is the same as in the first embodiment.
　また、図１３、１４に示すように、ニードル構造３０の後端部３０ｂからニードル支持ユニット４０以降部が取外された状態の外科治療用ニードル型デバイス１０Ｂがニードル構造３０の後端部３０ｂ側から挿脱自在に装填可能に両端とも開口された後端開口部３０３には取手部３０４を、先端開口部には開閉フリーな複数に分割された略円板状又は略中空円錐体状の開閉蓋３０２を有し、手術時に用いられる人体Ｍの腹腔孔Ｍｂから体腔内の病変臓器（図示しない）の近傍まで挿入される先端部側が略半円フック状に屈曲された管状体を有する体腔内挿入本体３０１と、体腔内挿入本体３０１内に装填され、予め後端開口部３０３から内部に装填された手術先端器具６０の先端部を押圧し体腔内挿入本体３０１の先端開口部の開閉蓋３０２を押し開けて主軸ニードル３１及び副軸ニードル３２の尖鋭状に形成された後端部３１ｂ、３２ｂを押出して体腔内部から腹部皮膚外に穿刺し貫通させる手術先端器具押出しピストン３０８と、を備えた手術先端器具体腔内挿入手段３００を有する。 Further, as shown in FIGS. 13 and 14, the surgical treatment needle type device 10 </ b> B with the needle support unit 40 and subsequent portions removed from the rear end portion 30 b of the needle structure 30 is on the rear end portion 30 b side of the needle structure 30. A handle 304 is provided in the rear end opening 303 that is open at both ends so that it can be removably loaded from the outside, and a substantially disk-like or substantially hollow cone-like opening and closing divided into a plurality of opening and closing freely at the front end opening. A body cavity having a lid 302 and a tubular body in which the distal end side inserted from the abdominal hole Mb of the human body M used at the time of surgery to the vicinity of a diseased organ (not shown) in the body cavity is bent in a substantially semicircular hook shape. The insertion main body 301 and the opening / closing lid 30 of the distal end opening of the body cavity insertion main body 301 are loaded into the insertion body 301 in the body cavity and press the distal end portion of the surgical distal end instrument 60 loaded in advance from the rear end opening 303 in advance. A surgical tip instrument push-out piston 308 that pushes open and extrudes the rear end portions 31b and 32b formed in the sharp shape of the main needle 31 and the sub-shaft needle 32 to pierce and penetrate from the inside of the body cavity to the abdominal skin. It has a surgical distal end specific cavity insertion means 300.
　この実施の形態においては、体腔内挿入本体３０１の取手部３０４前端部の直近に、高圧不活性ガスなどの高圧流体を供給する流量調整弁３０７を備えた高圧流体供給管３０６が連設されており、体腔内挿入本体３０１内に供給された高圧流体により予め装填された手術先端器具押出しピストン３０８の背面側を押圧するようになっている。この場合、取手部３０４の後端開口部３０３には後端キャップ３０５が装着され、これにより手術先端器具押出しピストン３０８の背面側の体腔内挿入本体３０１内部は密閉され高圧流体の高圧状態が保持される。 In this embodiment, a high-pressure fluid supply pipe 306 provided with a flow rate adjustment valve 307 for supplying a high-pressure fluid such as a high-pressure inert gas is connected to the front end of the handle portion 304 of the body cavity insertion main body 301. In addition, the back side of the surgical tip instrument push-out piston 308 loaded in advance is pressed by the high-pressure fluid supplied into the body cavity insertion main body 301. In this case, a rear end cap 305 is attached to the rear end opening 303 of the handle portion 304, whereby the inside of the body cavity insertion body 301 on the back side of the surgical tip instrument push-out piston 308 is sealed, and the high pressure fluid is maintained in a high pressure state. Is done.
　このようにして、手術先端器具体腔内挿入手段３００により体腔内部から腹部皮膚外に貫通させたニードル構造３０の後端部３０ｂに先に取外されたニードル支持ユニット４０を直接目視下で押し込み連結すると同時に、腹腔鏡によるモニタリング下で、手術先端器具体腔内挿入手段３００の先端開口部から外科治療用ニードル型デバイス１０Ｂを手術先端器具６０の先端部まで抜出した状態（図１２参照）で、手術先端器具操作部２０により手術先端器具６０を操作して外科手術処置を体腔内で全て実行する。 In this manner, the needle support unit 40 that has been removed first is directly connected to the rear end 30b of the needle structure 30 that has been penetrated from the inside of the body cavity to the outside of the abdominal skin by means of the intraoperative cavity insertion means 300. At the same time, under the monitoring by the laparoscope, the surgical treatment needle type device 10B is pulled out from the distal end opening of the surgical distal instrument internal cavity insertion means 300 to the distal end of the surgical distal instrument 60 (see FIG. 12). The surgical instrument 60 is operated by the distal instrument operating unit 20 to perform all surgical procedures in the body cavity.
　この場合、図１３のニードル構造３０の後端部３０ｂ部分の拡大イメージ図に示すように、主軸ニードル３１及び副軸ニードル３２の尖鋭状に形成された各後端部３１ｂ、３２ｂには、例えばシリコンゴム製の穿刺予防キャップＳＣがそれぞれ装着されており、体腔内部の臓器を不用意に穿刺し損傷するのを防止している。そして、主軸ニードル３１及び副軸ニードル３２の尖鋭状後端部３１ｂ、３２ｂを押出して体腔内部から腹部皮膚外に穿刺し貫通させる際には、主軸ニードル３１及び副軸ニードル３２が尖鋭状後端部３１ｂ、３２ｂから貫通された状態で穿刺予防キャップＳＣが体腔内部に留置される。これらの貫通状態の穿刺予防キャップＳＣは、前記外科手術処置後外科治療用ニードル型デバイス１０Ｂの残部と共に体腔内部から取り出される。 In this case, as shown in the enlarged image view of the rear end portion 30b of the needle structure 30 in FIG. 13, the rear end portions 31b and 32b formed in the sharp shape of the main needle 31 and the sub needle 32 are, for example, silicon. Rubber puncture prevention caps SC are respectively attached to prevent an inadvertent puncture and damage of an organ inside a body cavity. When the sharp rear end portions 31b and 32b of the main shaft needle 31 and the sub shaft needle 32 are pushed out and pierced from the inside of the body cavity to the outside of the abdominal skin, the main shaft needle 31 and the sub shaft needle 32 have the sharp rear end. The puncture prevention cap SC is placed inside the body cavity in a state of being penetrated from the portions 31b and 32b. These puncture prevention caps SC in the penetrating state are taken out from the inside of the body cavity together with the remainder of the surgical needle type device 10B after the surgical operation.
　手術先端器具押出しピストン３０８の背面と後端キャップ３０５の内面には、両端部３０９ａ、３０９ｂがそれぞれ固定されたフレキシブルな細線部材３０９が具備され、手術先端器具押出しピストン３０８が体腔内挿入本体３０１の先端開口部の開閉蓋３０２内面に当接して開閉蓋３０２を押し開いた状態を保持したまま停止する位置までの細線部材３０９の長さが設定されている。これにより、手術先端器具押出しピストン３０８が体腔内挿入本体３０１の先端開口部外に押出されないように安全性を確保するとともに、外科手術処置終了後に再度外科治療用ニードル型デバイス１０Ｂからニードル構造３０及び又は手術先端器具６０までを取り外して体腔内挿入本体３０１の先端開口部内に容易に収納することができる。そして、最終的に手術先端器具体腔内挿入手段３００及び外科治療用ニードル型デバイス１０Ｂの残部を体腔内部から取り出す。 A flexible thin wire member 309 having both ends 309 a and 309 b fixed thereto is provided on the back surface of the surgical tip instrument push-out piston 308 and the inner surface of the rear end cap 305, and the surgical tip instrument push-out piston 308 is provided on the body cavity insertion body 301. The length of the thin wire member 309 is set to a position where it comes into contact with the inner surface of the opening / closing lid 302 at the tip opening and stops while holding the opening / closing lid 302 open. This ensures safety so that the surgical tip instrument push-out piston 308 is not pushed out of the distal end opening of the body cavity insertion body 301, and after the surgical procedure is completed, the needle structure 30 and the needle structure 30 and Alternatively, the surgical instrument 60 can be removed and easily stored in the distal end opening of the body cavity insertion body 301. And finally, the remaining part of the surgical tip device specific cavity insertion means 300 and the surgical treatment needle type device 10B is taken out from the body cavity.
　手術先端器具体腔内挿入手段３００の先端開口部から外科治療用ニードル型デバイス１０Ｂを手術先端器具６０の先端部まで抜出す際又は手術先端器具体腔内挿入手段３００を体腔内部から取り出す際には、取手部３０４を徐々に図示矢印方向に倒しながら体腔内挿入本体３０１の先端部側の略半円フック状の湾曲部に沿って腹腔孔Ｍｂ部をスムースにスライドさせて引抜くように操作することが患者に苦痛感を与えない上で望ましい。 When extracting the surgical treatment needle type device 10B from the distal end opening of the surgical distal instrument specific cavity insertion means 300 to the distal end of the surgical distal instrument 60 or when removing the surgical distal instrument specific cavity insertion means 300 from the body cavity, An operation is performed in which the abdominal hole Mb portion is smoothly slid and pulled out along the substantially semicircular hook-like curved portion on the distal end side of the body cavity insertion body 301 while gradually pulling the handle portion 304 in the direction of the arrow shown in the figure. Is desirable because it does not cause pain to the patient.
　なお、手術先端器具体腔内挿入手段３００は、予め体腔内挿入本体３０１内に手術先端器具６０のみを後端部から装填して腹腔孔Ｍｂから体腔内の病変臓器（図示しない）の近傍まで挿入し、手術先端器具押出しピストン３０８により押圧された手術先端器具６０の後端部が体腔内挿入本体３０１の先端開口部から開閉蓋３０２を押し開けて露出した状態で、先に手術先端器具６０が取外された外科治療用ニードル型デバイス１０Ｂ（又は実施の形態１、２の外科治療用ニードル型デバイス１０、１０Ａでもよい）のニードル構造３０の先端部を腹部外面から体腔内に穿刺してニードル構造３０の先端部３０ａに先に病変臓器の近傍まで挿入された手術先端器具６０の後端部に連結し、以降、前記実施の形態１と同様に、手術先端器具操作部２０により手術先端器具６０を操作して外科手術処置を体腔内で全て実行する変形実施形態とすることもできる（後述する実施の形態６、図２１参照）。
　（実施の形態４） In addition, the surgical distal end specific cavity insertion means 300 is loaded in advance from the rear end portion with only the surgical distal instrument 60 into the body cavity insertion body 301 and inserted from the abdominal cavity Mb to the vicinity of the lesioned organ (not shown) in the body cavity. The surgical tip instrument 60 is first exposed in a state where the rear end portion of the surgical tip instrument 60 pressed by the surgical tip instrument push-out piston 308 is exposed by pushing open the opening / closing lid 302 from the distal end opening of the body cavity insertion body 301. The distal end of the needle structure 30 of the removed surgical treatment needle type device 10B (or the surgical treatment needle type device 10, 10A of Embodiments 1 and 2) may be punctured into the body cavity from the outer surface of the abdomen. It is connected to the rear end portion of the surgical tip instrument 60 that has been inserted into the tip portion 30a of the structure 30 up to the vicinity of the lesioned organ, and thereafter, as in the first embodiment, the surgical tip instrument operation unit The surgical procedure by manipulating the surgical tip tool 60 by 0 may be an alternative embodiment for performing all within the body cavity (sixth embodiment described later, see FIG. 21).
(Embodiment 4)
　本発明の実施の形態４による最低侵襲外科手術システム１Ｃは、図１６、１７に示すように、生体の自然開口部例えば口Ｍａから単独で又は内視鏡４００を介し用いて生体管例えば食道内に挿入される長尺可撓性の支持軸ユニットを有する体腔内挿入本体１０１と、体腔内挿入本体１０１の先端部に設けられ、手術先端器具６０を着脱自在に把持又は保持する手術先端器具保持機構１０２と、後端に手術先端器具保持機構１０２の把持又は保持操作を行う手術先端器具保持操作部１０３と、を備えた手術先端器具体腔内挿入手段１００を有する。 As shown in FIGS. 16 and 17, a minimally invasive surgical system 1C according to Embodiment 4 of the present invention is used in a living body tube such as an esophagus alone or through an endoscope 400 from a natural opening portion of a living body such as a mouth Ma. An intracorporeal insertion body 101 having a long and flexible support shaft unit to be inserted into the body cavity, and a surgical tip instrument holder that is provided at the distal end portion of the intracavity insertion body 101 and detachably holds or holds the surgical tip instrument 60 A surgical tip instrument specific cavity insertion means 100 having a mechanism 102 and a surgical tip instrument holding operation unit 103 for holding or holding the surgical tip instrument holding mechanism 102 at the rear end is provided.
　一例として、手術先端器具体腔内挿入手段１００を単独で、又は図１６、１７に示すように、内視鏡４００の１つあるいは２つの作動チャンネル４０２ａを介し用い、人体Ｍの口Ｍａから食道内を経由し胃袋Ｔの近傍まで手術先端器具６０を挿入し、その後、手術先端器具体腔内挿入手段１００あるいは内視鏡４００の先端に設けられた内視鏡的モニタリング手段４０２ｂ又は／及び別途腹腔鏡（図示しない）によるモニタリング下で、外科治療用ニードル型デバイス１０のニードル構造３０を体腔内に穿刺してニードル構造３０の先端部３０ａに病変臓器である胃袋Ｔの近傍まで挿入された手術先端器具６０の後端部に連結すると同時に、手術先端器具体腔内挿入手段１００から手術先端器具６０を開放した状態で、手術先端器具操作部２０により手術先端器具６０を操作して外科手術処置を体腔内で全て実行する。 As an example, the surgical tip can be inserted into the esophagus from the mouth Ma of the human body M alone or through one or two operating channels 402a of the endoscope 400 as shown in FIGS. The surgical tip instrument 60 is inserted to the vicinity of the stomach bag T via the endoscope, and then the endoscopic monitoring means 402b provided at the distal end of the surgical tip instrument specific cavity insertion means 100 or the endoscope 400 or / and a separate laparoscope Under the monitoring (not shown), the surgical tip instrument inserted into the distal end portion 30a of the needle structure 30 up to the vicinity of the stomach bag T, which is a diseased organ, by puncturing the needle structure 30 of the needle device 10 for surgical treatment into the body cavity. At the same time that the surgical distal instrument 60 is opened from the surgical distal instrument specific cavity insertion means 100, the surgical distal instrument operating unit is connected to the rear end of the surgical instrument 60. 0 by operating the surgical tip tool 60 to perform any surgical procedure within the body cavity.
　手術先端器具体腔内挿入手段１００としては、公知の内視鏡外科手術用鉗子もしくは手術処置把持具等と同様な比較的大型の構成で必要に応じて複数個使用することができるので、ここでは詳細な説明を省略する。
　（実施の形態５） As the surgical distal end specific cavity insertion means 100, a plurality of surgical tips can be used as needed with a relatively large configuration similar to known endoscopic surgical forceps or surgical treatment gripping tools. Detailed description is omitted.
(Embodiment 5)
　本発明の実施の形態５による外科治療用ニードル型デバイス１０Ｃは、図１８～２０に示すように、実施の形態１の外科治療用ニードル型デバイス１０に対し手術先端器具連結機構５０Ｃの構成が異なる相違点を除いて、その他の構成は前記実施の形態１の外科治療用ニードル型デバイス１０と同様である。したがって、図１８～２０における前記実施の形態１と同じ機能及び構成を有する部材には、説明を簡明化するため同一の符号を付し、以下、上記相違点に関して添付図を参照し説明する。 As shown in FIGS. 18 to 20, the surgical treatment needle type device 10C according to the fifth embodiment of the present invention differs from the surgical treatment needle type device 10 of the first embodiment in the configuration of the surgical tip instrument coupling mechanism 50C. Except for the differences, the other configuration is the same as that of the surgical treatment needle type device 10 of the first embodiment. Accordingly, members having the same functions and configurations as those of the first embodiment in FIGS. 18 to 20 are denoted by the same reference numerals for the sake of simplicity, and the differences will be described below with reference to the accompanying drawings.
　この実施の形態による手術先端器具連結機構５０Ｃは、図１９に示すように、先端部側に手術先端器具６０のガイド支持部材６１の後端部６１ｂを内挿して保持する略円筒型の外筒５１Ｃと、外筒５１Ｃの後端面に設けられ、主軸ニードル３１及び複数の副軸ニードル３２の先端部３１ａ、３２ａがそれぞれ挿脱自在に挿入される開口端部にテーパーガイドが形成された主軸ニードル装入穴５１Ｃｃ及び複数の副軸ニードル装入穴５１Ｃｄと、外筒５１Ｃ内に同芯状に収容され、後方部が複数のスリット５３Ｃｃにより分割され径方向に弾性変形可能な第１自由端部５３Ｃｄが形成された略円筒型の第１内筒５３Ｃと、第１自由端部５３Ｃｄの後端部内外面にそれぞれ設けられ、主軸ニードル装入穴５１Ｃｃ及び各副軸ニードル装入穴５１Ｃｄの各主軸方向に突出する第１主軸側小突起５３Ｃｅ及び複数の副軸側小突起５３Ｃｂと、第１内筒５３Ｃ内に同芯状に収容され、後方部が複数のスリット５２Ｃｃにより分割され径方向に弾性変形可能な第２自由端部５２Ｃｄが形成された略円筒型の第２内筒５２Ｃと、第２自由端部５２Ｃｄの後端部内面に設けられ、主軸ニードル装入穴５１Ｃｃの主軸方向に突出する第２主軸側小突起５２Ｃｂと、を有する。 As shown in FIG. 19, the surgical distal instrument connecting mechanism 50C according to this embodiment has a substantially cylindrical outer cylinder that inserts and holds the rear end portion 61b of the guide support member 61 of the surgical distal instrument 60 on the distal end side. 51C and a spindle needle provided on the rear end surface of the outer cylinder 51C and having a tapered guide at the opening end portion where the tip end portions 31a and 32a of the spindle needle 31 and the plurality of auxiliary shaft needles 32 are removably inserted. 51Cc and a plurality of countershaft needle insertion holes 51Cd, a first free end portion that is concentrically accommodated in the outer cylinder 51C, and whose rear portion is divided by a plurality of slits 53Cc and is elastically deformable in the radial direction. A substantially cylindrical first inner cylinder 53C in which 53Cd is formed, and inner and outer surfaces of the rear end portion of the first free end portion 53Cd, respectively, are provided with a spindle needle insertion hole 51Cc and each countershaft needle insertion hole 51. The first main shaft side small protrusions 53Ce and the plurality of sub shaft side small protrusions 53Cb projecting in the respective main shaft directions of d and the first inner cylinder 53C are accommodated concentrically, and the rear portion is divided by the plurality of slits 52Cc. A substantially cylindrical second inner cylinder 52C formed with a second free end 52Cd that is elastically deformable in the radial direction, and an inner surface of the rear end of the second free end 52Cd, And a second main shaft side small protrusion 52Cb protruding in the main shaft direction.
　一方、主軸ニードル３１及び副軸ニードル３２の各先端部３１ａ、３２ａの外周には、第２主軸側小突起５２Ｃｂ及び副軸側小突起５３Ｃｂがそれぞれ嵌入し係合する主軸ニードル凹溝３１ｅ及び副軸ニードル凹溝３２ｄが形成されている。 On the other hand, on the outer circumferences of the tip portions 31a and 32a of the main shaft needle 31 and the sub shaft needle 32, the second main shaft side small protrusion 52Cb and the sub shaft side small protrusion 53Cb are fitted and engaged, respectively, A shaft needle groove 32d is formed.
　そして先に、ニードル支持ユニット４０に取付けられた複数の副軸ニードル３２が同時に副軸ニードル装入穴５１Ｃｄにそれぞれ挿入された後で、主軸ニードル３１が主軸ニードル装入穴５１Ｃｃに挿入されると、図１９中のＮ３部の拡大図に示すように、第１主軸側小突起５３Ｃｅが主軸ニードル３１の外周に乗り上げ第１自由端部５３Ｃｄが拡径方向に変形して複数の副軸側小突起５３ｂが副軸ニードル凹溝３２ｄにそれぞれ嵌入し係合するとともに、第２主軸側小突起５２Ｃｂが主軸ニードルの外周に乗り上げ第２自由端部５２Ｃｄが拡径方向に変形してから最終的に第２主軸側小突起５２Ｃｂが主軸ニードル凹溝３１ｅに嵌入し係合することにより第２自由端部５２Ｃｄが縮径方向にスプリングバックし復帰してニードル構造３０の先端部３０ａと手術先端器具連結機構５０Ｃとの連結がなされる。 First, after the plurality of countershaft needles 32 attached to the needle support unit 40 are simultaneously inserted into the countershaft needle insertion holes 51Cd, the main shaft needle 31 is inserted into the main shaft needle insertion holes 51Cc. 19, the first main shaft side small protrusion 53Ce rides on the outer periphery of the main shaft needle 31 and the first free end portion 53Cd is deformed in the diameter increasing direction, so that a plurality of sub shaft side small projections are obtained. The protrusions 53b are fitted and engaged with the countershaft needle grooves 32d, respectively, and the second main shaft side small protrusion 52Cb rides on the outer periphery of the main shaft needle and finally the second free end 52Cd is deformed in the diameter increasing direction. The second main shaft side small protrusion 52Cb is fitted into and engaged with the main shaft needle groove 31e, whereby the second free end portion 52Cd springs back in the diameter reducing direction and returns to the needle structure 30. Connecting between the tip portion 30a and the surgical tip tool coupling mechanism 50C is made.
　また、主軸ニードル凹溝３１ｅは、図１９中のＮ４部の拡大断面図に示すように、主軸ニードル先端部３１ａの対向する外周面に主軸Ｘ軸と直交する方向に部分的に２ヶ所切欠き形成されている。 Further, as shown in the enlarged cross-sectional view of the portion N4 in FIG. 19, the spindle needle groove 31e is partially cut out in two directions in the direction perpendicular to the spindle X axis on the opposing outer peripheral surface of the spindle needle tip 31a. Is formed.
　そして、ニードル構造３０の先端部３０ａと手術先端器具連結機構５０Ａとの連結状態において、先に手術先端器具連結機構５０Ｃの外筒５１Ｃを手で把持するなど固持した状態で手術先端器具回転ハンドル２３ａにより主軸ニードル３１を略半回転させると、第２主軸側小突起５２Ｃｂが主軸ニードル３１の先端部３１ａの外周に乗り上げ第２自由端部５２Ｃｄが拡径方向に変形して第２主軸側小突起５２Ｃｂが主軸ニードル凹溝３１ｅから離脱すると同時に主軸ニードル３１を後方に引抜くことで第１主軸側小突起５３Ｃｅが主軸ニードル３１の先端部３１ａの外周面から外れて第1自由端部５３Ｃｄが縮径方向にスプリングバックし復帰して複数の副軸側小突起５３Ｃｂが副軸ニードル凹溝３２ｄから一括して同時に離脱しニードル構造３０の先端部３０ａと手術先端器具連結機構５０Ｃとの離脱が可能となる。 In the connected state between the distal end portion 30a of the needle structure 30 and the surgical distal instrument connecting mechanism 50A, the surgical distal instrument rotating handle 23a is held in a state where the outer cylinder 51C of the surgical distal instrument connected mechanism 50C is first held by hand. When the main shaft needle 31 is rotated approximately half a turn, the second main shaft side small protrusion 52Cb rides on the outer periphery of the tip portion 31a of the main shaft needle 31, and the second free end portion 52Cd is deformed in the diameter increasing direction, and the second main shaft side small protrusion 52Cb is disengaged from the main shaft needle concave groove 31e, and at the same time, the main shaft needle 31 is pulled backward, so that the first main shaft side small protrusion 53Ce is detached from the outer peripheral surface of the tip portion 31a of the main shaft needle 31, and the first free end portion 53Cd is contracted. The spring-back in the radial direction returns and the plurality of sub-axis side small protrusions 53Cb are simultaneously released from the counter-axis needle groove 32d to simultaneously remove the needle structure. The distal end portion 30a of the structure 30 and the surgical distal instrument connection mechanism 50C can be detached.
　このような手術先端器具連結機構５０Ｃの構成により、ニードル構造３０の先端部３０と手術先端器具連結機構５０Ｃとの着脱が短時間で容易に可能となることから、操作性及び手術の効率を向上させることができる。
　（実施の形態６） With such a configuration of the surgical tip instrument coupling mechanism 50C, it is possible to easily attach and detach the tip portion 30 of the needle structure 30 and the surgical tip instrument coupling mechanism 50C in a short time, thereby improving operability and efficiency of surgery. Can be made.
(Embodiment 6)
　本発明の実施の形態４による最低侵襲外科手術システム１Ｃは、図２１に示すように、実施の形態１の最低侵襲外科手術システム１に対して、手術先端器具体腔内挿入手段５００の構成が異なる相違点を除いてその他の構成は前記実施の形態１と同様である。手術先端器具体腔内挿入手段５００は、実施の形態３における手術先端器具体腔内挿入手段３００に対して手術先端器具押出し機構５２０の構成が異なる相違点を除いてその他の構成は前記実施の形態３と同様である。したがって、図２１における前記実施の形態１及び３と同じ機能及び構成を有する部材には、説明を簡明化するため同一の符号を付し、以下、上記相違点に関して添付図を参照し説明する。 As shown in FIG. 21, the minimally invasive surgical system 1C according to the fourth embodiment of the present invention is different from the minimally invasive surgical system 1 according to the first embodiment in the configuration of the surgical tip-part specific cavity insertion means 500. Except for the differences, the other configuration is the same as that of the first embodiment. The surgical distal instrument specific cavity insertion means 500 is the same as that of the third embodiment except for the difference in the configuration of the surgical tip instrument pushing mechanism 520 from the surgical distal instrument specific cavity insertion means 300 in the third embodiment. It is the same. Accordingly, members having the same functions and configurations as those of the first and third embodiments in FIG. 21 are denoted by the same reference numerals for the sake of simplicity, and the differences will be described below with reference to the accompanying drawings.
　手術先端器具体腔内挿入手段５００は、外径、長さ、後端及び先端を有し、ニードル構造３０の先端部３０ａから取外された状態の手術先端器具６０を後端部側から挿脱自在に装填可能なように両端が開口され、後端開口部３０３には後端キャップ３０５付の取手部３０４を、先端開口部には開閉フリーな開閉蓋３０２を有し、生体の単孔式腹腔鏡下手術用腹腔孔Ｍｂ又は自然開口部から体腔内の病変臓器（図示しない）の近傍まで挿入される先端部側が略半円フック状に湾曲可能に形成される管状体を有する体腔内挿入本体３０１、及び体腔内挿入本体３０１内に装填され、予め後端開口部３０３から内部に装填された手術先端器具６０の先端部を押圧し体腔内挿入本体３０１の先端開口部の開閉蓋３０２を押し開けて手術先端器具６０の後端部を前記体腔内の病変臓器の近傍まで押出す手術先端器具押出し機構５２０を備える。 The surgical distal instrument internal cavity insertion means 500 has an outer diameter, a length, a rear end, and a distal end, and inserts and removes the surgical distal instrument 60 in a state of being removed from the distal end portion 30a of the needle structure 30 from the rear end side. Both ends are opened so that they can be freely loaded, the rear end opening 303 has a handle 304 with a rear end cap 305, and the front end opening has an openable / closable opening / closing lid 302. Insertion into the body cavity having a tubular body in which the distal end side inserted from the abdominal hole Mb for laparoscopic surgery or the natural opening to the vicinity of a diseased organ (not shown) in the body cavity is bent into a substantially semicircular hook shape. The body 301 and the body cavity insertion body 301 are loaded into the body cavity insertion body 301 and the distal end portion of the surgical distal instrument 60 loaded in advance from the rear end opening 303 is pressed to open and close the opening / closing lid 302 of the body cavity insertion body 301 distal end opening. Push open the surgical instrument 60 The rear portion comprises a to surgery extruded to the vicinity of the lesion organ tip instrument extruding mechanism 520 of the body cavity.
　体腔内挿入本体３０１内は、後端キャップ３０５及び先端開口部の開閉蓋３０２により閉止され、体腔内からの体液、血液及び組織片等の異物の管状体３０１内部侵入及び体外漏出を極力防止する。 The body cavity insertion body 301 is closed by a rear end cap 305 and an opening / closing lid 302 at the front end opening to prevent entry of foreign matter such as body fluids, blood and tissue pieces from the body cavity into the tubular body 301 and leakage outside the body as much as possible. .
　手術先端器具押出し機構５２０は、体腔内挿入本体３０１内に装填され、先端面で手術先端器具６０の先端部を押圧するピストン３０８と、ピストン３０８の後端部に連結され、体腔内挿入本体３０１の後端キャップ３０５をスライド自在に貫通して外部に露出し、体腔内挿入本体３０１先端部側の略半円フック状湾曲形状に沿って湾曲可能なフレキシブル性を有するピストンロッド２２１と、ピストンロッド５２１の後端部５２１ｂに連結される把持部５２３と、を有する。 The surgical tip instrument push-out mechanism 520 is loaded into the body cavity insertion main body 301, and is connected to the piston 308 that presses the distal end portion of the surgical tip instrument 60 with the distal end surface and the rear end portion of the piston 308. A piston rod 221 that slidably passes through the rear end cap 305 and is exposed to the outside, and has a flexibility that can be bent along a substantially semicircular hook-like curved shape on the distal end side of the body cavity insertion body 301; And a grip 523 connected to the rear end 521b of the 521.
　そして、前記実施の形態１におけると同様に、先に手術先端器具体腔内挿入手段５００を用いてニードル構造３０の先端部３０ａから取外された状態の手術先端器具６０を体腔内の病変臓器の近傍まで挿入した後で、腹腔鏡によるモニタリング下で、外科治療用ニードル型デバイス１０のニードル構造３０を体腔内に穿刺してニードル構造３０の先端部３０ａに前記病変臓器の近傍まで挿入された手術先端器具６０の後端部に連結すると同時に、手術先端器具体腔内挿入手段５００から手術先端器具６０を抜出した状態で、手術先端器具操作部２０により手術先端器具６０を操作して外科手術処置を体腔内で全て実行する。 As in the first embodiment, the surgical distal instrument 60 previously removed from the distal end portion 30a of the needle structure 30 using the surgical distal instrument specific cavity insertion means 500 is used to replace the lesioned organ in the body cavity. After being inserted to the vicinity, under the monitoring by the laparoscope, the needle structure 30 of the surgical treatment needle type device 10 is inserted into the body cavity and inserted into the distal end portion 30a of the needle structure 30 to the vicinity of the lesioned organ. At the same time as connecting to the rear end portion of the distal instrument 60, the surgical distal instrument 60 is operated by the surgical distal instrument operation unit 20 in a state where the surgical distal instrument 60 is extracted from the surgical distal instrument internal cavity insertion means 500, and the surgical treatment is performed. Perform all in the body cavity.
　本出願は、２０１２年２月２８日に日本国に本出願人により出願された特願２０１２－４２４７０号に基づくものであり、その全内容は参照により本出願に組み込まれる。 This application is based on Japanese Patent Application No. 2012-42470 filed by the applicant in Japan on February 28, 2012, the entire contents of which are incorporated into this application by reference.
　本発明の特定の実施の形態についての上記説明は、例示を目的として提示したものである。それらは、網羅的であったり、記載した形態そのままに本発明を制限したりすることを意図したものではない。数多くの変形や変更が、上記の記載内容に照らして可能であることは当業者に自明である。 The above description of specific embodiments of the present invention has been presented for purposes of illustration. They are not intended to be exhaustive or to limit the invention to the precise form described. It will be apparent to those skilled in the art that many modifications and variations are possible in light of the above description.
　本発明の最低侵襲外科手術システムは、状況に応じた外径及び長さに設定自在な主軸ニードル及び複数の副軸ニードルからなるニードル構造の先端部に手術先端器具が挿脱可能に取付けられるため安定的な支持剛性及び強度を有し、生体の切開や開腹をせずにニードル構造を直に体腔内に穿刺してニードル構造の先端部に、先に手術先端器具体腔内挿入手段を用いて生体の腹腔孔又は肛門や口などの自然開口部から体腔内の病変臓器の近傍まで挿入された手術先端器具を連結して外科手術処置を体腔内で全て実行することから、大型、重量級の臓器を対象とした手術手技にも対応可能な低侵襲性を極限まで実現させるとともに設計の自由度を備えた外科治療用ニードル型デバイスを有する最低侵襲外科手術システムを提供できることから広範な医療業界に貢献できる。 In the minimally invasive surgical operation system of the present invention, a surgical distal instrument is removably attached to the distal end portion of a needle structure comprising a main spindle needle and a plurality of sub-shaft needles that can be set to an outer diameter and a length according to the situation. It has stable support rigidity and strength, and the needle structure is punctured directly into the body cavity without incising or opening the living body. Since the surgical tip is inserted into the body cavity from the natural abdominal hole of the living body or the natural opening, such as the anus or mouth, to the vicinity of the diseased organ in the body cavity, large and heavyweight Because it is possible to provide a minimally invasive surgical system having a needle type device for surgical treatment with minimal design and minimal degree of invasiveness that can be used for surgical procedures targeting organs It can contribute to a medical industry.
　１、１Ｂ、１Ｃ、１Ｄ　最低侵襲外科手術システム
　１０、１０Ａ、１０Ｂ、１０Ｃ　外科治療用ニードル型デバイス
　２０　　　手術先端器具操作部
　２１　　　固定ハンドル構造
　２１ａ　　把持ハンドル
　２１ｂ　　支持本体
　２２　　　可動ハンドル
　２２ａ、２７ｅ　凹溝
　２３　　　手術先端器具回動機構
　２３ａ　　手術先端器具回転ハンドル
　２３ｂ　　雄ねじ部
　２４　　　支持回動体
　２４ａ　　先端支持部
　２４ｂ　　中空外筒
　２５、６３、２１４　固定ピン
　２７　　　後部駆動シャフト
　２７ａ　　シャフト本体
　２７ｂ　　鍔部
　２７ｃ、２８ｃ　球状体
　２８　　　連結部材
　２８ｂ　　ガイドキー溝
　２９　　　ガイドねじ
　３０　　　ニードル構造
　３１　　　主軸ニードル
　３１ａ、３２ａ、５１ａ、５１Ｃａ、６１ａ、２１１ａ　先端部
　３１ｂ、３２ｂ、５１ｂ、５１Ｃｂ、６１ｂ、２１１ｂ、２２２ｂ　後端部
　３１ｅ　　主軸ニードル凹溝
　３２　　　副軸ニードル
　３２ｃ　　球状体又は鍔状体
　３２ｄ　　副軸ニードル凹溝
　３３、３４　ガイド板
　３５、３５ａ、３５ｂ　スプリング
　４０　　　ニードル支持ユニット
　５０、５０Ｃ　手術先端器具連結機構
　５１、５１Ｃ　外筒
　５１ｃ、５１Ｃｃ　主軸ニードル装入穴
　５１ｄ、５１Ｃｄ　副軸ニードル装入穴
　５２　　　主軸側自由端部
　５２ａ　　主軸側小突起
　５２Ｃ　　第２内筒
　５２Ｃｂ　第２主軸側小突起
　５２Ｃｃ、５３Ｃｃ　スリット
　５２Ｃｄ　第２自由端部
　５３　　　副軸側自由端部
　５３ａ、５３Ｃｂ　副軸側小突起
　５３Ｃ　　第１内筒
　５３Ｃｂ　副軸側小突起
　５３Ｃｄ　第１自由端部
　５３Ｃｅ　第１主軸側小突起
　６０　　　手術先端器具
　６１　　　ガイド支持部材
　６２　　　顎機構
　６２ａ　　第一顎部材
　６２ｂ　　第二顎部材
　６２ｃ、６２ｄ　長孔ガイド
　６４　　　前部駆動シャフト
　６５　　　ガイドピン
　７０　　　ニードル構造湾曲操作部
　７１　　　傾斜板
　７１ａ　　中心孔
　７１ｂ　　長溝
　７２　　　ユニバーサル軸受け
　７２ａ　　内輪
　７２ｂ　　外輪
　７３　　　傾動ハンドル
　１００、２００、３００、４００、５００　手術先端器具体腔内挿入手段
　１０１、２１０、３０１、４０１　体腔内挿入本体
　１０２　　手術先端器具保持機構
　１０３　　手術先端器具保持操作部
　２１１　　管状体
　２１１ｃ　第１開口部
　２１１ｄ　第２開口部
　２１２　　先端キャップ
　２１３、３０５　　後端キャップ
　２１５、２１７ｃ　係合部材
　２１７　　手術先端器具保持容器
　２１７ａ　内面
　２１８　　ばね
　２１９　　突起部材
　２２０　　手術先端器具保持機構操作部
　２２１　　ピストンロッド
　２２２　　ピストン
　２２２ａ　傾斜ガイド
　２２３　　把持部
　３００　　手術先端器具体腔内挿入手段
　３０２　　開閉蓋
　３０３　　後端開口部
　３０４　　取手部
　３０６　　高圧流体供給管
　３０７　　流量調整弁
　３０８　　手術先端器具押出しピストン
　３０９　　細線部材
　４００　　内視鏡
　４０２ａ　作動チャンネル
　Ｂｍ　　　曲げモーメント
　Ｍ　　　　人体（生体）
　Ｍａ　　　自然開口部（口、肛門など）
　Ｍｂ　　　腹腔孔（単孔式腹腔鏡下手術用）
　ＳＣ　　　穿刺予防キャップ
　Ｔ　　　　（病変）臓器（胃袋など）
  1, 1B, 1C, 1D Minimally Invasive Surgical System 10, 10A, 10B, 10C Needle-type Device for Surgical Treatment 20 Surgery Tool Operation Unit 21 Fixed Handle Structure 21a Grip Handle 21b Support Body 22 Movable Handle 22a, 27e Groove 23 Surgical distal instrument rotating mechanism 23a Surgical distal instrument rotating handle 23b Male screw part 24 Support rotating body 24a Tip supporting part 24b Hollow outer cylinder 25, 63, 214 Fixed pin 27 Rear drive shaft 27a Shaft body 27b Saddle part 27c, 28c Spherical body 28 Connecting member 28b Guide keyway 29 Guide screw 30 Needle structure 31 Spindle needle 31a, 32a, 51a, 51Ca, 61a, 211a Tip 31b, 32b, 51b, 51Cb, 61b, 211b, 222b Rear end 1e Main shaft needle groove 32 Secondary shaft needle 32c Spherical or bowl-shaped body 32d Secondary shaft needle groove 33, 34 Guide plate 35, 35a, 35b Spring 40 Needle support unit 50, 50C Surgical instrument connection mechanism 51, 51C Outer cylinder 51c, 51Cc Main shaft needle insertion hole 51d, 51Cd Sub shaft needle insertion hole 52 Main shaft side free end 52a Main shaft side small protrusion 52C Second inner cylinder 52Cb Second main shaft side small protrusion 52Cc, 53Cc Slit 52Cd Second free end portion 53 Secondary shaft side free end 53a, 53Cb Secondary shaft side small projection 53C First inner cylinder 53Cb Secondary shaft side small projection 53Cd First free end portion 53Ce First main shaft side small projection 60 Surgical tip instrument 61 Guide support member 62 Jaw mechanism 62a First jaw member 62b Second jaw member 62c, 62d Slot guide 64 Front drive shaft 65 Guide pin 70 Needle structure bending operation section 71 Inclined plate 71a Center hole 71b Long groove 72 Universal bearing 72a Inner ring 72b Outer ring 73 Tilt handle 100, 200, 300, 400, 500 Surgical tip device specific cavity insertion means 101, 210, 301, 401 Body cavity insertion body 102 Surgical distal instrument holding mechanism 103 Surgical distal instrument holding operation section 211 Tubular body 211c First opening 211d Second opening 212 Front end cap 213, 305 Rear end cap 215, 217c Engagement member 217 Surgical tip instrument holding container 217a Inner surface 218 Spring 219 Projection member 220 Surgical tip instrument holding mechanism operation part 221 Piston rod 222 Piston 222a Inclination guide 223 Grasping part 300 Surgical tip instrument specific cavity Internal insertion means 302 Opening / closing lid 303 Rear end opening 304 Handle portion 306 High-pressure fluid supply pipe 307 Flow rate adjustment valve 308 Operating tip instrument push-out piston 309 Fine wire member 400 Endoscope 402a Operating channel Bm Bending moment M Human body (living body)
Ma natural opening (mouth, anus, etc.)
Mb peritoneal cavity (for single-hole laparoscopic surgery)
SC Puncture prevention cap T (lesion) organ (eg, stomach bag)

Claims (12)

  1. 　外径、長さ、後端及び先端を有し、長さ方向に延びるＸ軸を主軸とし、Ｘ軸上の主軸ニードル及び主軸ニードルの周りに略軸対称に並列配置され主軸ニードルを補強する複数の副軸ニードルから安定的な支持剛性及び強度を有し、前記主軸ニードル及び副軸ニードルの先端が尖鋭状に形成され、生体の皮膚外面から体腔内部に直接穿刺可能に構成されたニードル構造、
    　前記ニードル構造の先端部に挿脱可能に連結される手術先端器具、
    　前記ニードル構造の後端部が挿通され支持されるニードル支持ユニット、
    　及び前記ニードル支持ユニットの後端部に連接されるとともに前記主軸ニードルの後端部が挿通され、その主軸ニードル後端部と連携して前記手術先端器具を作動させる手術先端器具操作部、を備えた外科治療用ニードル型デバイスと、
    　外径、長さ、後端及び先端を有し、長さ方向に延びるＵ軸を主軸とし、前記生体の単孔式腹腔鏡下手術用腹腔孔又は肛門を含む自然開口部から体腔内に挿入される管状体を有する体腔内挿入本体、
    　前記体腔内挿入本体の先端部に設けられ、前記ニードル構造の先端部から取外された状態の前記手術先端器具を着脱自在に保持する手術先端器具保持機構、
    　及び後端側に前記手術先端器具保持機構の保持操作を行う手術先端器具保持機構操作部、を備えた手術先端器具体腔内挿入手段と、を有する最低侵襲外科手術システムであって、
    　先に前記手術先端器具体腔内挿入手段を用いて、前記ニードル構造の先端部から取外された状態の前記手術先端器具を体腔内の病変臓器の近傍まで挿入した後で、腹腔鏡によるモニタリング下で、前記外科治療用ニードル型デバイスのニードル構造を体腔内に穿刺してニードル構造の先端部に前記病変臓器の近傍まで挿入された手術先端器具の後端部に連結すると同時に、前記手術先端器具体腔内挿入手段から手術先端器具を開放した状態で、前記手術先端器具操作部により手術先端器具を操作して外科手術処置を体腔内で全て実行することを特徴とする最低侵襲外科手術システム。     A plurality of shafts having an outer diameter, a length, a rear end, and a front end, the main shaft needle on the X axis being arranged in parallel with the main shaft needle and the main shaft needle in parallel with the main shaft needle. A needle structure having a stable support rigidity and strength from the countershaft needle of the main shaft, the tip of the main shaft needle and the countershaft needle being formed in a sharp shape, and configured to be able to puncture directly into the body cavity from the skin outer surface of the living body,
    Surgical tip instrument detachably connected to the tip of the needle structure;
    A needle support unit through which the rear end of the needle structure is inserted and supported;
    And a surgical tip instrument operating unit that is connected to the rear end part of the needle support unit and is inserted through the rear end part of the spindle needle and operates the surgical tip instrument in cooperation with the spindle needle rear end part. A surgical needle-type device;
    It has an outer diameter, length, rear end, and tip, and the U-axis extending in the length direction is the main axis, and is inserted into a body cavity through a natural opening including the abdominal hole or anus for single-hole laparoscopic surgery of the living body A body cavity insertion body having a tubular body,
    A surgical tip instrument holding mechanism that is provided at the tip of the body cavity insertion body and detachably holds the surgical tip instrument in a state of being removed from the tip of the needle structure;
    And a surgical tip instrument specific cavity insertion means provided with a surgical tip instrument holding mechanism operation section for holding the surgical tip instrument holding mechanism on the rear end side, and a minimally invasive surgical system comprising:
    First, the surgical tip instrument removed from the tip of the needle structure is inserted to the vicinity of the lesioned organ in the body cavity using the surgical tip instrument specific intracavity insertion means, and then monitored under a laparoscope. The needle structure of the needle device for surgical treatment is punctured into a body cavity and connected to the rear end portion of the surgical tip instrument inserted to the tip of the needle structure up to the vicinity of the lesioned organ, and at the same time, the surgical tip instrument A minimally invasive surgical system characterized in that, in a state where the surgical tip instrument is opened from the body cavity insertion means, the surgical tip instrument is operated by the surgical tip instrument operating section to perform all surgical procedures in the body cavity.
  2. 　外径、長さ、後端及び先端を有し、長さ方向に延びるＸ軸を主軸とし、Ｘ軸上の主軸ニードル及び主軸ニードルの周りに略軸対称に並列配置され主軸ニードルを補強する複数の副軸ニードルから安定的な支持剛性及び強度を有し、前記主軸ニードル及び副軸ニードルの後端が尖鋭状に形成され、体腔内部から皮膚外面に穿刺可能に構成されたニードル構造、
    　前記ニードル構造の先端部に挿脱可能に連結される手術先端器具、
    　前記ニードル構造の後端部が挿脱可能に支持されるニードル支持ユニット、
    　及び前記ニードル支持ユニットの後端部に連接されるとともに前記主軸ニードルの後端部が挿通され、その主軸ニードル後端部と連携して前記手術先端器具を作動させる手術先端器具操作部、を備えた外科治療用ニードル型デバイスと、
    　外径、長さ、後端及び先端を有し、前記ニードル構造の後端部からニードル支持ユニットが取外された状態の外科治療用ニードル型デバイスがニードル構造の後端部側から挿脱自在に装填可能なように両端が開口され、後端開口部には取手部を、先端開口部には開閉フリーな開閉蓋を有し、生体の単孔式腹腔鏡下手術用腹腔孔又は自然開口部から体腔内の病変臓器の近傍まで挿入される先端部側が略半円フック状に湾曲された管状体を有する体腔内挿入本体、
    　及び前記体腔内挿入本体内に装填され、予め後端開口部から内部に装填された前記手術先端器具の先端部を押圧し体腔内挿入本体の先端開口部から前記ニードル構造の主軸ニードル及び副軸ニードルの後端尖鋭部を押出して前記体腔内から腹部皮膚外まで穿刺し貫通させる手術先端器具押出しピストン、を備えた手術先端器具体腔内挿入手段と、を有する最低侵襲外科手術システムであって、
    　先に前記手術先端器具体腔内挿入手段を用いて前記体腔内部から腹部皮膚外まで穿刺し貫通させたニードル構造の後端部に前記取外されたニードル支持ユニットを直接目視下で連結した後で、腹腔鏡によるモニタリング下で、前記手術先端器具体腔内挿入手段から外科治療用ニードル型デバイスを手術先端器具の先端部まで抜出した状態で、前記手術先端器具操作部により手術先端器具を操作して外科手術処置を体腔内で全て実行することを特徴とする最低侵襲外科手術システム。     A plurality of shafts having an outer diameter, a length, a rear end, and a front end, the main shaft needle on the X axis being arranged in parallel with the main shaft needle and the main shaft needle in parallel with the main shaft needle. A needle structure that has a stable support rigidity and strength from the countershaft needle of the main shaft, the rear end of the main shaft needle and the countershaft needle is formed in a sharp shape, and can be punctured from the inside of the body cavity to the outer surface of the skin,
    Surgical tip instrument detachably connected to the tip of the needle structure;
    A needle support unit in which a rear end portion of the needle structure is removably supported;
    And a surgical tip instrument operating unit that is connected to the rear end part of the needle support unit and is inserted through the rear end part of the spindle needle and operates the surgical tip instrument in cooperation with the spindle needle rear end part. A surgical needle-type device;
    A needle type device for surgical treatment having an outer diameter, a length, a rear end and a front end and having a needle support unit removed from the rear end of the needle structure is detachable from the rear end side of the needle structure. Both ends are opened so that they can be loaded, and the rear end opening has a handle part, and the front end opening part has an openable / closable opening / closing lid. A body cavity insertion main body having a tubular body in which a distal end side to be inserted from a portion to the vicinity of a lesioned organ in a body cavity is curved in a substantially semicircular hook shape,
    The main needle and the secondary shaft of the needle structure are loaded into the body cavity insertion body and press the distal end portion of the surgical distal instrument previously loaded into the body cavity through the rear end opening from the distal end opening of the body cavity insertion body. A surgical tip instrument specific intra-cavity insertion means comprising a surgical tip instrument pushing piston that pushes and penetrates from the body cavity to the outside of the abdominal skin by extruding the sharp tip of the needle, and a minimally invasive surgical system comprising:
    After the removed needle support unit is directly connected to the rear end portion of the needle structure that has been previously pierced and penetrated from the inside of the body cavity to the outside of the abdominal skin using the surgical tip device specific intracavity insertion means. Under the monitoring by the laparoscope, the surgical tip instrument is operated by the surgical tip instrument operating section in a state where the needle type device for surgical treatment is extracted from the surgical tip instrument specific cavity insertion means to the distal end section of the surgical tip instrument. A minimally invasive surgical system characterized by performing all surgical procedures in a body cavity.
  3. 　外径、長さ、後端及び先端を有し、長さ方向に延びるＸ軸を主軸とし、Ｘ軸上の主軸ニードル及び主軸ニードルの周りに略軸対称に並列配置され主軸ニードルを補強する複数の副軸ニードルから安定的な支持剛性及び強度を有し、前記主軸ニードル及び副軸ニードルの先端が尖鋭状に形成され、生体の皮膚外面から体腔内部に直接穿刺可能に構成されたニードル構造、
    　前記ニードル構造の先端部に挿脱可能に連結される手術先端器具、
    　前記ニードル構造の後端部が挿通され支持されるニードル支持ユニット、
    　及び前記ニードル支持ユニットの後端部に連接されるとともに前記主軸ニードルの後端部が挿通され、その主軸ニードル後端部と連携して前記手術先端器具を作動させる手術先端器具操作部、を備えた外科治療用ニードル型デバイスと、
    　外径、長さ、後端及び先端を有し、前記ニードル構造の先端部から取外された状態の前記手術先端器具を後端部側から挿脱自在に装填可能なように両端が開口され、後端開口部には取手部を、先端開口部には開閉フリーな開閉蓋を有し、生体の単孔式腹腔鏡下手術用腹腔孔又は自然開口部から体腔内の病変臓器の近傍まで挿入される先端部側が略半円フック状に湾曲可能に形成された管状体を有する体腔内挿入本体、
    　及び前記体腔内挿入本体内に装填され、予め後端開口部から内部に装填された前記手術先端器具の先端部を押圧し体腔内挿入本体の先端開口部から前記手術先端器具を前記体腔内の病変臓器の近傍まで押出す手術先端器具押出し機構、を備えた手術先端器具体腔内挿入手段と、を有する最低侵襲外科手術システムであって、
    　先に前記手術先端器具体腔内挿入手段を用いて前記ニードル構造の先端部から取外された状態の前記手術先端器具を体腔内の病変臓器の近傍まで挿入した後で、腹腔鏡によるモニタリング下で、前記外科治療用ニードル型デバイスのニードル構造を体腔内に穿刺してニードル構造の先端部に前記病変臓器の近傍まで挿入された手術先端器具の後端部に連結すると同時に、前記手術先端器具体腔内挿入手段から手術先端器具を抜出した状態で、前記手術先端器具操作部により手術先端器具を操作して外科手術処置を体腔内で全て実行することを特徴とする最低侵襲外科手術システム。     A plurality of shafts having an outer diameter, a length, a rear end, and a front end, the main shaft needle on the X axis being arranged in parallel with the main shaft needle and the main shaft needle in parallel with the main shaft needle. A needle structure having a stable support rigidity and strength from the countershaft needle of the main shaft, the tip of the main shaft needle and the countershaft needle being formed in a sharp shape, and configured to be able to puncture directly into the body cavity from the skin outer surface of the living body,
    Surgical tip instrument detachably connected to the tip of the needle structure;
    A needle support unit through which the rear end of the needle structure is inserted and supported;
    And a surgical tip instrument operating unit that is connected to the rear end part of the needle support unit and is inserted through the rear end part of the spindle needle and operates the surgical tip instrument in cooperation with the spindle needle rear end part. A surgical needle-type device;
    Both ends are opened so that the surgical distal instrument having an outer diameter, length, rear end and front end and detachable from the front end of the needle structure can be removably loaded from the rear end side. The handle has a handle at the rear end opening and an openable / closable lid at the tip opening. From the living body single-hole laparoscopic abdominal hole or natural opening to the vicinity of the affected organ in the body cavity An intracorporeal insertion body having a tubular body in which the distal end side to be inserted is formed so as to be bent in a substantially semicircular hook shape;
    And the distal end portion of the surgical tip instrument that is loaded into the body cavity insertion body and previously loaded into the body cavity from the rear end opening is pressed into the body cavity from the distal end opening of the body cavity insertion body. A minimally invasive surgical system comprising a surgical tip instrument specific cavity insertion means with a surgical tip instrument push-out mechanism for pushing to the vicinity of a diseased organ,
    First, the surgical tip instrument, which has been removed from the tip of the needle structure using the means for inserting the surgical tip into the cavity, is inserted to the vicinity of the lesioned organ in the body cavity, and then monitored under a laparoscope. Puncturing the needle structure of the needle device for surgical treatment into a body cavity and connecting it to the rear end of the surgical tip instrument inserted to the tip of the needle structure up to the vicinity of the lesioned organ, A minimally invasive surgical system characterized in that in a state where a surgical tip instrument is extracted from an internal insertion means, the surgical tip instrument is operated by the surgical tip instrument operating section to perform all surgical procedures in a body cavity.
  4. 　前記外科治療用ニードル型デバイスは、
    　いずれも前記主軸ニードル及び副軸ニードルに摺動自在に挿通される１枚又は複数枚のガイド板と、
    　前記ニードル支持ユニットとガイド板との間に配置され、各ガイド板を背面から付勢する１つ又は複数のスプリングをさらに備えることを特徴とする請求項１乃至請求項３のいずれか１項に記載の最低侵襲外科手術システム。     The needle type device for surgical treatment is:
    Any one or a plurality of guide plates slidably inserted through the main shaft needle and the sub shaft needle,
    4. The apparatus according to claim 1, further comprising one or a plurality of springs disposed between the needle support unit and the guide plate and urging each guide plate from the back surface. The minimally invasive surgical system described.
  5. 　前記手術先端器具は、
    　後端部に前記主軸及び副軸ニードルの先端部がそれぞれ挿脱自在に連結する手術先端器具連結機構を備えることを特徴とする請求項１項乃至請求項４のいずれか１項に記載の最低侵襲外科手術システム。     The surgical tip instrument is:
    5. The minimum according to claim 1, further comprising a surgical tip instrument coupling mechanism in which a distal end portion of each of the main shaft and the countershaft needle is detachably coupled to a rear end portion. Invasive surgical system.
  6. 　前記外科治療用ニードル型デバイスは、
    　前記ニードル支持ユニットと手術先端器具操作部との間に設けられ、前記手術先端器具操作部の先端側にＸ軸に沿って延設する先端側支持軸部に設けられたユニバーサル軸受けを介して全方向に傾動可能な傾動板と、
    　前記各副軸ニードルの後端部に設けられた球体又は鍔状体が前記傾斜板に設けられたＸ軸と直交方向に長い複数の長溝にそれぞれ滑動自在に係合する副軸ニードル後端連結機構とからなり、
    　前記傾動板を任意の方向に傾動させることによりその傾動中心に対して対向関係をなす副軸ニードルの一方が先方に押圧されるとともに他方が後方に牽引されることから前記ニードル構造に曲げモーメントが発生することより、先端部に手術先端器具が連結された前記ニードル構造を略弓型状に湾曲させるニードル構造湾曲操作部がさらに設けられることを特徴とする請求項１乃至請求項５のいずれか１項に記載の最低侵襲外科手術システム。     The needle type device for surgical treatment is:
    It is provided between the needle support unit and the surgical tip instrument operating part, and is universally provided via a universal bearing provided on the tip side support shaft part extending along the X axis on the tip side of the surgical tip instrument operating part. A tilting plate that can tilt in a direction;
    A countershaft needle rear end connection in which a spherical body or a bowl-shaped body provided at the rear end portion of each countershaft needle is slidably engaged with a plurality of long grooves extending in a direction orthogonal to the X axis provided on the inclined plate. The mechanism,
    By tilting the tilting plate in an arbitrary direction, one of the countershaft needles that are opposed to the tilting center is pressed forward and the other is pulled backward, so that a bending moment is applied to the needle structure. 6. The needle structure bending operation section for bending the needle structure having a surgical tip connected to the distal end portion into a substantially arcuate shape by being generated. 2. The minimally invasive surgical system according to item 1.
  7. 　前記主軸ニードル及び副軸ニードルは、いずれも高剛性及び高弾力性を有する医療適合性材料の外径略３ｍｍ以下の棒状又は線状体からなり、生体の痛み神経を跨ぐように略２ｍｍ以上の間隔で略対称型に並列配置されることを特徴とする請求項１乃至請求項６のいずれか１項に記載の最低侵襲外科手術システム。 Each of the main shaft needle and the sub shaft needle is composed of a rod-like or linear body having an outer diameter of about 3 mm or less made of a medically compatible material having high rigidity and high elasticity, and is about 2 mm or more so as to straddle the pain nerve of a living body. The minimally invasive surgical system according to any one of claims 1 to 6, wherein the minimally invasive surgical system is arranged in parallel in a substantially symmetrical manner at intervals.
  8. 　少なくとも前記主軸ニードルは、形状記憶材料からなり、前記手術先端器具の動作に必要な主軸方向のスライド、回転、通電、あるいは前記主軸及び副軸ニードルにも通電、マイクロ波又は超音波放射線伝送を含む各種機能を選択的に有することを特徴とする請求項１乃至請求項７のいずれか１項に記載の最低侵襲外科手術システム。 At least the main spindle needle is made of a shape memory material, and includes main axis sliding, rotation, energization necessary for the operation of the surgical tip instrument, or energization, microwave or ultrasonic radiation transmission to the main and sub axis needles. The minimally invasive surgical system according to any one of claims 1 to 7, wherein the system is selectively provided with various functions.
  9. 　前記手術先端器具体腔内挿入手段は、
    　外径、長さ、後端及び先端を有し、長さ方向に延びるＵ軸を主軸とし、生体の単孔式腹腔鏡下手術用の腹腔孔又は肛門を含む自然開口部から体腔内に挿入され、両端面が閉止された管状体を有する体腔内挿入本体と、
    　体腔内挿入本体の先端部に設けられ、前記手術先端器具を着脱自在に保持する手術先端器具保持機構と、
    　後端に前記手術先端器具保持機構の保持操作を行う手術先端器具保持操作部と、を備え、
    　前記手術先端器具保持機構は、
    　前記管状体の先端部に設けられた第１開口部及び第１開口部とＵ軸に対して対称関係をなす先端側に設けられた第２開口部と、
    　前記第１開口部の先端部に所定の角度傾動自在に固定ピンを介してピボット連結され、先端部及び後端部がそれぞれ前記第１開口部及び第２開口部から出没可能で、前記手術先端器具を挿脱可能に収納し保持する中空状の手術先端器具保持容器と、
    　前記固定ピンと手術先端器具保持容器との間に前記手術先端器具保持容器をＵ軸と略平行位置に保持する方向に付勢するばねと、を有し、
    　前記手術先端器具保持操作部は、
    　前記体腔内挿入本体内に装填され、先端部に先端方向に下り勾配の傾斜ガイドが形成されたピストンと、
    　前記ピストンの後端部に連結され、前記体腔内挿入本体の後端部をスライド自在に貫通して外部に露出するピストンロッドと、
    　前記ピストンロッドの後端部に連結される把持部と、を有し、
    　生体外から前記把持部を介してピストンロッドを押し込むことにより、前記手術先端器具保持容器は、後端部から前記ピストンの傾斜ガイドに当接し案内されて所定角度傾動し、
    　その傾動角度は手元の把持部で自由に調節可能であり、
    　前記ピストンロッドを牽引し後退させると、前記ばねの付勢力により前記手術先端器具保持容器がＵ軸と略平行位置に復帰することを特徴とする請求項１記載の最低侵襲外科手術システム。     The surgical tip device specific insertion means
    It has an outer diameter, length, rear end, and tip, with the U axis extending in the length direction as the main axis, and is inserted into a body cavity through a natural opening including a peritoneal hole or anus for living body single-hole laparoscopic surgery An intracorporeal insertion body having a tubular body closed at both end faces;
    A surgical tip instrument holding mechanism that is provided at the tip of the body cavity insertion main body and detachably holds the surgical tip instrument;
    A surgical tip instrument holding operation section for holding the surgical tip instrument holding mechanism at the rear end, and
    The surgical instrument holding mechanism is
    A first opening provided at the distal end of the tubular body and a second opening provided on the distal end side that is symmetrical to the first opening and the U axis;
    The surgical distal end is pivotally connected to the distal end of the first opening via a fixed pin so as to be tiltable at a predetermined angle, and the distal end and the rear end can protrude and retract from the first opening and the second opening, respectively. A hollow surgical tip instrument holding container for storing and holding the instrument in a removable manner, and
    A spring that biases the surgical tip instrument holding container between the fixing pin and the surgical tip instrument holding container in a direction to hold the surgical tip instrument holding container in a position substantially parallel to the U-axis,
    The surgical tip instrument holding operation part is
    A piston that is loaded into the body cavity insertion body, and has a downwardly inclined inclination guide formed in the distal direction at the distal end; and
    A piston rod connected to a rear end portion of the piston and slidably penetrating a rear end portion of the body cavity insertion body, and exposed to the outside;
    A grip portion coupled to a rear end portion of the piston rod,
    By pushing the piston rod from outside the living body through the grip portion, the surgical tip instrument holding container is in contact with and guided by the tilt guide of the piston from the rear end portion and tilted by a predetermined angle,
    The tilt angle can be freely adjusted with the gripping part at hand,
    The minimally invasive surgical system according to claim 1, wherein when the piston rod is pulled and retracted, the surgical instrument holding container returns to a position substantially parallel to the U-axis by the biasing force of the spring.
  10. 　前記手術先端器具は、
    　中空状のガイド支持部材内にＸ軸方向に沿って主軸ニードルの先端部と連携しスライド自在に内挿された前部駆動シャフトと、
    　前記ガイド支持部材の先端部に固定ピンにより回動自在にピボット連結された第一顎部材及び第二顎部材を含む顎機構を開閉駆動する顎開閉駆動機構と、を備え、
    　前記顎開閉駆動機構は、前記前部駆動シャフトの先端部に設けられたガイドピンが、第一顎部材及び第二顎部材の後端部に延設され、Ｘ軸及び相互に交叉する方向にそれぞれ形成された長孔ガイドに共にスライド自在に嵌挿され係合することを特徴とする請求項１乃至請求項９のいずれか１項に記載の最低侵襲外科手術システム。     The surgical tip instrument is:
    A front drive shaft that is slidably inserted in the hollow guide support member in cooperation with the tip of the spindle needle along the X-axis direction;
    A jaw opening and closing drive mechanism for opening and closing a jaw mechanism including a first jaw member and a second jaw member pivotally connected to a distal end portion of the guide support member by a fixed pin,
    In the jaw opening / closing drive mechanism, a guide pin provided at a front end portion of the front drive shaft extends to the rear end portions of the first jaw member and the second jaw member, and intersects with the X axis. The minimally invasive surgical system according to any one of claims 1 to 9, wherein the system is slidably inserted and engaged with each of the formed long hole guides.
  11. 　前記手術先端器具連結機構は、
    　先端部側に前記手術先端器具の後端部を内挿して保持する略円筒型の外筒と、　前記外筒の後端面に設けられ、前記主軸ニードル及び副軸ニードルの先端部がそれぞれ挿脱自在に挿入される開口端部にテーパーガイドが形成された主軸ニードル装入穴及び複数の副軸ニードル装入穴と、
    　前記外筒内に略同芯円筒状に収容されて複数のスリットにより分割され後方に延設された径方向に弾性変形可能な第1自由端部の後端部内外面に、それぞれ前記主軸ニードル装入穴及び各副軸ニードル装入穴の各主軸方向に突出し形成された第1主軸側小突起及び複数の副軸側小突起と、
    　前記第1自由端部内に略同芯円筒状に収容されて複数のスリットにより分割され後方に延設された径方向に弾性変形可能な第２自由端部の後端部内面に、前記主軸ニードル装入穴の主軸方向に突出し形成された第２主軸側小突起と、を有し、
    　前記主軸ニードル及び副軸ニードルの各先端部の外周には、前記第２主軸側小突起及び副軸側小突起がそれぞれ嵌入し係合する主軸ニードル凹溝及び副軸ニードル凹溝が形成され、
    　先に、前記複数の副軸ニードルが前記副軸ニードル装入穴にそれぞれ挿入された後で、前記主軸ニードルが前記主軸ニードル装入穴に挿入されると、前記第１主軸側小突起が主軸ニードルの外周に乗り上げ前記第1自由端部が拡径方向に変形し前記複数の副軸側小突起が拡径されて前記副軸ニードル凹溝にそれぞれ嵌入し係合するとともに、前記第２主軸側小突起が前記主軸ニードルの外周に乗り上げ前記第２自由端部が拡径方向に変形してから最終的に前記第２主軸側小突起が前記主軸ニードル凹溝に嵌入し係合することにより前記第２自由端部が縮径方向にスプリングバックし復帰して前記ニードル構造の先端部と手術先端器具連結機構との連結がなされることを特徴とする請求項５記載の最低侵襲外科手術システム。     The surgical tip instrument coupling mechanism is
    A substantially cylindrical outer cylinder that inserts and holds a rear end portion of the surgical distal instrument on the distal end side, and a rear end surface of the outer cylinder. A spindle needle insertion hole and a plurality of countershaft needle insertion holes in which a tapered guide is formed at an opening end portion to be freely inserted; and
    The main spindle needle device is respectively disposed on the inner and outer surfaces of the rear end portion of the first free end portion that is accommodated in the outer cylinder in a substantially concentric cylindrical shape, is divided by a plurality of slits, and extends rearward and elastically deformable in the radial direction. A first main-axis-side small protrusion and a plurality of sub-axis-side small protrusions formed to protrude in the respective main-axis directions of the insertion hole and each auxiliary-shaft needle insertion hole,
    The main spindle needle is disposed on the inner surface of the rear end portion of the second free end portion that is accommodated in the first free end portion in a substantially concentric cylindrical shape and is divided by a plurality of slits and extends rearward and elastically deformable in the radial direction. A second main shaft side small protrusion formed to protrude in the main shaft direction of the insertion hole,
    A main shaft needle groove and a sub shaft needle groove are formed on the outer periphery of each tip of the main shaft needle and the sub shaft needle, and the second main shaft side small protrusion and the sub shaft side small protrusion are fitted and engaged with each other.
    When the spindle needle is inserted into the spindle needle insertion hole after the plurality of countershaft needles are inserted into the countershaft needle insertion holes, respectively, the first spindle-side small protrusion becomes the spindle. Riding on the outer periphery of the needle, the first free end portion is deformed in the diameter increasing direction, the plurality of sub-axis side small protrusions are expanded in diameter, and are fitted and engaged with the counter-axis needle grooves, respectively, and the second main shaft When the side small protrusion rides on the outer periphery of the main spindle needle and the second free end is deformed in the diameter increasing direction, the second main spindle side small protrusion finally fits into and engages with the main spindle needle groove. 6. The minimally invasive surgical system according to claim 5, wherein the second free end portion is spring-backed in the reduced diameter direction and returned to connect the distal end portion of the needle structure and the surgical distal instrument connecting mechanism. .
  12. 　前記主軸ニードル凹溝は、前記主軸ニードル先端部の対向する外周面に主軸と直交する方向に部分的に切欠き形成されており、
    　前記ニードル構造の先端部と手術先端器具連結機構との連結状態において、先に前記手術先端器具連結機構の外筒を固持した状態で前記手術先端器具回転ハンドルにより前記主軸ニードルを略半回転させると、前記第２主軸側小突起が前記主軸ニードルの外周に乗り上げ前記第２自由端部が拡径方向に変形して前記第２主軸側小突起が前記主軸ニードル凹溝から離脱し、その後前記主軸ニードルを後方に引抜くことで前記第１主軸側小突起が主軸ニードルの外周面から外れると同時に前記第1自由端部が縮径方向にスプリングバックして復帰し前記複数の副軸側小突起が縮径されて前記副軸ニードル凹溝からそれぞれ離脱することにより前記ニードル構造の先端部と手術先端器具連結機構との離脱が可能となることを特徴とする請求項１１記載の最低侵襲外科手術システム。     The spindle needle groove is partially cut out in the direction perpendicular to the spindle on the opposing outer peripheral surface of the spindle needle tip.
    When the distal end portion of the needle structure and the surgical tip instrument coupling mechanism are connected, the spindle needle is rotated approximately half by the surgical tip instrument rotating handle in a state where the outer tube of the surgical tip instrument coupling mechanism is first fixed. The second main spindle-side small protrusion rides on the outer periphery of the main spindle needle, the second free end is deformed in the diameter increasing direction, and the second main spindle-side small protrusion is detached from the main spindle needle groove, and then the main spindle. By pulling the needle rearward, the first main shaft side small projections are detached from the outer peripheral surface of the main shaft needle, and at the same time, the first free end springs back in the direction of diameter reduction and returns to the plurality of minor shaft side small projections. 12. The detachment between the distal end portion of the needle structure and the surgical distal instrument connecting mechanism is enabled by reducing the diameter of the needle and detaching it from the concave groove of the countershaft needle. The minimally invasive surgical system.
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CN106955129A (en) * 2017-05-09 2017-07-18 佛山衡生医疗自动化有限公司 A kind of Minimally Invasive Surgery apparatus with force feedback
CN106955130A (en) * 2017-05-10 2017-07-18 佛山衡生医疗自动化有限公司 A kind of Minimally Invasive Surgery apparatus with force feedback
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