WO2013129635A1 - Système chirurgical minimalement invasif - Google Patents

Système chirurgical minimalement invasif 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
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PCT/JP2013/055596
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English (en)
Japanese (ja)
Inventor
猛 大平
Original Assignee
ハリキ精工株式会社
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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/ja
Publication of WO2013129635A1 publication Critical patent/WO2013129635A1/fr

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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
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    • 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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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Ophthalmology & Optometry (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

　L'invention concerne un système chirurgical minimalement invasif comportant un dispositif en forme d'aiguille pour le traitement chirurgical, qui réduit au minimum l'invasivité, possédant un degré de liberté de conception important qui permet l'adaptation d'instruments chirurgicaux à pointe de grande taille, et qui présente une capacité portante importante. Le système chirurgical minimalement invasif (1) de la présente invention possède un dispositif en forme d'aiguille pour le traitement chirurgical (10) équipé d'un instrument chirurgical à pointe (60) monté de manière détachable sur la pointe d'une structure à aiguilles (30) comprenant une aiguille principale à pointe acérée (31) et une pluralité d'aiguilles auxiliaires (32). La structure à aiguilles forme directement un trou dans une cavité corporelle, et sa pointe est accouplée à un dispositif chirurgical à pointe (60) déjà inséré dans la zone se trouvant à la périphérie de l'organe malade (T) à l'intérieur de la cavité corporelle, par un trou dans l'abdomen (Mb) ou un orifice naturel (Ma), à l'aide d'un moyen (200) d'insertion d'un instrument chirurgical à pointe dans une cavité corporelle, en vue d'effectuer le traitement chirurgical à l'intérieur de la cavité corporelle. Cela confère ainsi au dispositif en forme d'aiguille un très faible degré d'invasivité, et un degré de liberté en termes de conception qui permet d'adapter le dispositif à des techniques chirurgicales sur des organes de grande taille et/ou lourds.
PCT/JP2013/055596 2012-02-28 2013-02-28 Système chirurgical minimalement invasif WO2013129635A1 (fr)

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JP2014502404A JP5883117B2 (ja) 2012-02-28 2013-02-28 最低侵襲外科手術システム

Applications Claiming Priority (2)

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JP2012042470 2012-02-28
JP2012-042470 2012-02-28

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WO2013129635A1 true WO2013129635A1 (fr) 2013-09-06

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JP (1) JP5883117B2 (fr)
WO (1) WO2013129635A1 (fr)

Cited By (6)

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CN106955130A (zh) * 2017-05-10 2017-07-18 佛山衡生医疗自动化有限公司 一种带力反馈的微创手术器械
CN106955129A (zh) * 2017-05-09 2017-07-18 佛山衡生医疗自动化有限公司 一种带力反馈的微创手术器械
CN107361802A (zh) * 2017-07-25 2017-11-21 天津职业技术师范大学 一种卡扣式腹腔微创手术压杆
JP2021500982A (ja) * 2017-10-30 2021-01-14 エシコン エルエルシーＥｔｈｉｃｏｎ ＬＬＣ ロック可能なエンドエフェクタソケットを備える外科用器具
JP2021023813A (ja) * 2019-08-05 2021-02-22 カール シュトルツ エスエー ウント コンパニー カーゲー 医療器具
CN113261842A (zh) * 2021-05-19 2021-08-17 赵天怡 一种节能电饭煲

Families Citing this family (1)

* Cited by examiner, † Cited by third party
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US11376401B2 (en) * 2017-04-26 2022-07-05 Acclarent, Inc. Deflectable guide for medical instrument

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JPH10272139A (ja) * 1997-01-31 1998-10-13 Olympus Optical Co Ltd 誘導補助器具
WO2010114634A1 (fr) * 2009-04-03 2010-10-07 The Board Of Trustees Of The Leland Stanford Junior University Dispositif et procédé chirurgicaux
WO2011089565A1 (fr) * 2010-01-20 2011-07-28 EON Surgical Ltd. Système et procédé de déploiement d'une unité allongée dans une cavité corporelle

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JPH10272139A (ja) * 1997-01-31 1998-10-13 Olympus Optical Co Ltd 誘導補助器具
WO2010114634A1 (fr) * 2009-04-03 2010-10-07 The Board Of Trustees Of The Leland Stanford Junior University Dispositif et procédé chirurgicaux
WO2011089565A1 (fr) * 2010-01-20 2011-07-28 EON Surgical Ltd. Système et procédé de déploiement d'une unité allongée dans une cavité corporelle

Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN106955129A (zh) * 2017-05-09 2017-07-18 佛山衡生医疗自动化有限公司 一种带力反馈的微创手术器械
CN106955130A (zh) * 2017-05-10 2017-07-18 佛山衡生医疗自动化有限公司 一种带力反馈的微创手术器械
CN107361802A (zh) * 2017-07-25 2017-11-21 天津职业技术师范大学 一种卡扣式腹腔微创手术压杆
CN107361802B (zh) * 2017-07-25 2023-10-27 天津职业技术师范大学 一种卡扣式腹腔微创手术压杆
JP2021500982A (ja) * 2017-10-30 2021-01-14 エシコン エルエルシーＥｔｈｉｃｏｎ ＬＬＣ ロック可能なエンドエフェクタソケットを備える外科用器具
JP7317819B2 (ja) 2017-10-30 2023-07-31 エシコン エルエルシー ロック可能なエンドエフェクタソケットを備える外科用器具
JP2021023813A (ja) * 2019-08-05 2021-02-22 カール シュトルツ エスエー ウント コンパニー カーゲー 医療器具
JP7002611B2 (ja) 2019-08-05 2022-01-20 カール シュトルツ エスエー ウント コンパニー カーゲー 医療器具
CN113261842A (zh) * 2021-05-19 2021-08-17 赵天怡 一种节能电饭煲
CN113261842B (zh) * 2021-05-19 2022-07-26 江门市南光电器实业有限公司 一种节能电饭煲

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