WO2014157472A1 - 外套管 - Google Patents
外套管 Download PDFInfo
- Publication number
- WO2014157472A1 WO2014157472A1 PCT/JP2014/058773 JP2014058773W WO2014157472A1 WO 2014157472 A1 WO2014157472 A1 WO 2014157472A1 JP 2014058773 W JP2014058773 W JP 2014058773W WO 2014157472 A1 WO2014157472 A1 WO 2014157472A1
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- WO
- WIPO (PCT)
- Prior art keywords
- insertion hole
- slit
- type airtight
- airtight valve
- valve
- Prior art date
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00147—Holding or positioning arrangements
- A61B1/00154—Holding or positioning arrangements using guiding arrangements for insertion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00131—Accessories for endoscopes
- A61B1/00137—End pieces at either end of the endoscope, e.g. caps, seals or forceps plugs
-
- 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
- A61B17/3415—Trocars; Puncturing needles for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters
-
- 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
-
- 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
- A61B17/3462—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals
-
- 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
- A61B17/3498—Valves therefor, e.g. flapper valves, slide valves
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
- A61M39/22—Valves or arrangement of valves
-
- 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
- A61B17/3439—Cannulas with means for changing the inner diameter of the cannula, e.g. expandable
- A61B2017/3441—Cannulas with means for changing the inner diameter of the cannula, e.g. expandable with distal sealing means
-
- 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
- A61B17/3462—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals
- A61B2017/3464—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals with means acting on inner surface of valve or seal for expanding or protecting, e.g. inner pivoting fingers
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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
- A61B17/34—Trocars; Puncturing needles
- A61B17/3462—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals
- A61B2017/3466—Trocars; Puncturing needles with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals for simultaneous sealing of multiple instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/30—Surgical robots
- A61B2034/301—Surgical robots for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
- A61M39/02—Access sites
- A61M39/06—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof
- A61M2039/0633—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof the seal being a passive seal made of a resilient material with or without an opening
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
- A61M39/02—Access sites
- A61M39/06—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof
- A61M2039/0633—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof the seal being a passive seal made of a resilient material with or without an opening
- A61M2039/064—Slit-valve
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
- A61M39/02—Access sites
- A61M39/06—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof
- A61M2039/0633—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof the seal being a passive seal made of a resilient material with or without an opening
- A61M2039/0646—Duckbill-valve
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
- A61M39/02—Access sites
- A61M39/06—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof
- A61M2039/0633—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof the seal being a passive seal made of a resilient material with or without an opening
- A61M2039/0653—Perforated disc
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
- A61M39/02—Access sites
- A61M39/06—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof
- A61M2039/0633—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof the seal being a passive seal made of a resilient material with or without an opening
- A61M2039/066—Septum-like element
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
- A61M39/02—Access sites
- A61M39/06—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof
- A61M2039/0633—Haemostasis valves, i.e. gaskets sealing around a needle, catheter or the like, closing on removal thereof the seal being a passive seal made of a resilient material with or without an opening
- A61M2039/0666—Flap-valve
Definitions
- the present invention relates to a mantle tube, and more particularly, to a mantle tube having two insertion holes capable of advancing and retracting an insertion portion of an endoscope and an insertion portion of a treatment instrument.
- the outer tube is provided with an airtight valve for preventing gas leakage.
- Patent Document 1 proposes a valve member (valve structure) provided in an outer tube (inserter assembly), in which a slit and an opening (hole) constituting an airtight valve are integrated. Yes.
- This valve member is disposed on a cap provided at the proximal end of the outer tube body (cannula).
- the outer tube body of Patent Document 1 includes an insertion hole for advancing and retracting one treatment instrument, but does not include two insertion holes for advancing and retracting two treatment instruments.
- the outer tube disclosed in Patent Document 2 is provided with a plurality of insertion holes (lumens) in the outer tube body (main body tube). According to this mantle tube, since a plurality of treatment tools can be inserted using a plurality of insertion holes, the number of mantle tubes inserted into the abdominal wall can be reduced. This can reduce the invasion applied to the body wall.
- the outer tube of Patent Document 2 can insert a treatment tool and an endoscope into one outer tube body.
- a cap is provided at the base end of the outer tube body, and a valve member made of an elastic sheet is attached to the cap.
- the valve member is provided with a ⁇ (minus) -shaped slit at a position corresponding to each insertion hole.
- the treatment instrument or the insertion portion of the endoscope is inserted into the slit and advanced / retreated with respect to each insertion hole.
- the slit adheres to the outer surface of the insertion portion.
- the slit is closed at the time of non-insertion (extraction) in which the insertion portion is not inserted into the slit.
- Patent Document 2 Furthermore, the two insertion holes of Patent Document 2 are formed in a D-shaped (semi-circular) cross section with a partition wall provided linearly at the center in the cross section perpendicular to the axial direction of the outer tube body. Yes. And the slit of the valve member of patent documents 2 is formed in parallel to the partition.
- JP 7-509626 A Japanese Utility Model Publication No. 7-13301
- the cross-sectional shape of the insertion hole is D-shaped so that the distance between the centers of the two adjacent insertion holes is the distance between the centers when the two adjacent insertion holes are perfect circles. Shorter, the diameter of the outer tube body is reduced, and the invasion applied to the body wall is reduced.
- the slit of the valve member of Patent Document 2 is formed in parallel to the partition wall as described above with respect to the insertion hole having such a shape. For this reason, when the insertion portion is inserted into the slit, the two leaflets on both sides of the slit are elastically deformed, one leaflet abuts against the partition wall of the insertion hole, and the other leaflet contacts the arc edge of the insertion hole. Touch. For this reason, the deformation shapes of the two leaflets are greatly different, that is, the stresses generated in the two leaflets at the time of deformation are greatly different. Therefore, the leaflet having a higher stress than the leaflet having a lower stress is accelerated by fatigue due to repeated stress. However, there was a problem that the elastic force was reduced. For this reason, in the valve member of patent document 2, airtightness may not be secured at an early stage.
- the present invention has been made in view of such circumstances, and an object of the present invention is to provide a mantle tube that can ensure airtightness over a long period of time.
- a penetrating portion that has a distal end, a proximal end, and a longitudinal axis and penetrates a body wall, and two medical instruments that are inserted into the penetrating portion.
- the first insertion portion of one medical instrument is disposed adjacent to the first insertion hole, the first insertion hole capable of being inserted into the penetration portion so as to be movable forward and backward along the direction parallel to the longitudinal axis
- the second insertion portion of the other medical instrument is provided in the first insertion hole, a second insertion hole that can be inserted into the penetration portion so as to advance and retract along the direction parallel to the first insertion hole.
- a first slit-type airtight valve having a first slit that maintains airtightness when the first insertion portion is removed from the first insertion hole, and a second insertion hole
- a second slit-type airtight valve having a second slit that retains hermeticity when the two insertion portions are removed from the second insertion hole
- a first opening is provided in the first insertion hole and is in close contact with the outer peripheral portion of the first insertion portion to maintain airtightness when the first insertion portion is inserted into the first insertion hole.
- Provided in the first opening type airtight valve and the second insertion hole and tightly adheres to the outer peripheral portion of the second insertion portion when the second insertion portion is inserted into the second insertion hole.
- a second opening-type airtight valve having a second opening for holding the first slit-type airtight valve, the first slit-type airtight valve and the second slit-type airtight valve being adjacent to each other via a partition wall,
- the first insertion hole is formed in a shape symmetrical with respect to a reference line passing through the center of the first insertion hole and the center of the second insertion hole, and the first insertion hole The distance from the center to the wall core of the partition is shorter than the distance from the center of the first insertion hole to the edge opposite to the partition, and from the center of the second insertion hole.
- the distance to the wall core of the wall is shorter than the distance from the center of the second insertion hole to the edge on the side opposite to the partition wall, and the first slit and the second slit are the first insertion
- An outer tube is provided that is disposed along a reference line in a plane orthogonal to the hole.
- a penetrating portion that has a distal end, a proximal end, and a longitudinal axis and penetrates a body wall, and two medical instruments that are inserted into the penetrating portion.
- the first insertion hole of one medical instrument can be inserted into the penetration part so as to be able to advance and retract along the direction parallel to the longitudinal axis, and the first insertion hole via a partition wall
- a second insertion hole which is adjacent to the second insertion part of the other medical instrument and can be inserted into the penetration part so as to be movable back and forth along a direction parallel to the first insertion hole;
- a first slit-type airtight valve having a first slit that is provided in the insertion hole and retains hermeticity when the first insertion portion is removed from the first insertion hole; and a second insertion hole.
- a second slit having a second slit for maintaining airtightness when the second insertion portion is removed from the second insertion hole.
- the first airtight valve and the first insertion hole are provided in the first insertion hole, and the first insertion part is in close contact with the outer peripheral part of the first insertion part when the first insertion part is inserted into the first insertion hole.
- the first opening type airtight valve having one opening and the second insertion hole are provided on the outer periphery of the second insertion part when the second insertion part is inserted into the second insertion hole.
- the distance from the center of the first insertion hole to the wall core of the partition wall is shorter than the distance from the center of the first insertion hole to the edge on the opposite side of the partition wall.
- the distance from the center of the partition wall to the wall core of the partition wall is shorter than the distance from the center of the second insertion hole to the edge on the opposite side of the partition wall, and the first slit and the second slit are the first slit
- An outer tube is provided that is disposed along a reference line on a plane orthogonal to the insertion hole.
- the 1st slit type airtight valve and the 2nd slit type airtight valve are installed adjacently via a partition. And when the 1st slit type airtight valve and the 2nd slit type airtight valve are projected on the field which intersects perpendicularly with the 1st penetration hole, the center of the 1st penetration hole and the center of the 2nd penetration hole are It is formed in a shape that is line symmetric with respect to a reference line that passes through.
- the first insertion hole and the second insertion hole provided in the penetration part are provided via a partition wall. And when the 1st penetration hole and the 2nd penetration hole are projected on the field which intersects perpendicularly with the 1st penetration hole, the reference line which passes through the center of the 1st penetration hole and the center of the 2nd penetration hole A line-symmetric shape is formed at the center.
- the distance from the center of each of the first insertion hole and the second insertion hole to the wall core of the partition wall is shorter than the distance from the center to the edge on the opposite side of the partition wall.
- the first insertion hole has a first slit type airtight valve and a first opening type airtight valve
- the second insertion hole has a second slit type airtight valve and a second opening type. It has an airtight valve.
- the first slit of the first slit type airtight valve is closed, so that the airtightness of the first insertion hole can be ensured.
- the first insertion portion is inserted into the first insertion hole, the first insertion portion is inserted into the first opening of the first open-type airtight valve. Since the inner peripheral edge of the opening is in close contact with the outer peripheral surface of the first insertion portion, the air tightness of the first insertion hole can be ensured.
- the second slit of the second slit type airtight valve is closed, so that the airtightness of the second insertion hole can be ensured.
- the second insertion portion is inserted into the second insertion hole, the second insertion portion is inserted into the second opening of the second open-type airtight valve. Since the inner peripheral edge of the opening is in close contact with the outer peripheral surface of the second insertion portion, the airtightness of the second insertion hole can be ensured.
- the first slit and the second slit are arranged along a reference line in a plane orthogonal to the first insertion hole.
- the two leaflets when the insertion portion is inserted, the two leaflets abut against the arc edge of the insertion hole and the partition wall, respectively, and are deformed into the same shape. Therefore, since the difference in stress generated between the two leaflets is eliminated, the airtightness due to the slit can be secured for a longer period. Since the two leaflets are deformed into the same shape, each of the leaflets smoothly returns to the original shape when the insertion portion is removed.
- “along the reference line” means “on the reference line”, “a direction parallel to the reference line”, and “a direction inclined by a minute angle with respect to the reference line”. In order to obtain the effect satisfactorily, “on the reference line” is preferable.
- the partition wall is preferably formed in a flat plate shape.
- the first slit-type airtight valve and the second slit-type airtight valve have a D-shape having a straight edge and an arc edge when projected onto a plane orthogonal to the first insertion hole. Preferably it is formed.
- a D-shape can be exemplified as the shape of the first insertion hole and the second insertion hole.
- the shape of the first insertion hole and the second insertion hole is not limited to this, and may be a shape that does not depart from the gist of the present invention, for example, a semicircular shape.
- each of the first slit and the second slit has a cross shape, and the longer slit of the two slits constituting the cross-shaped slit is the first slit and the second slit. It preferably functions as a slit.
- the shape of the slit is basically a “-” shape, but in the case of a cross shape, the longer slit of the two slits constituting the cross-shaped slit is the first slit. Functions as a slit and a second slit.
- the first slit-type airtight valve and the first open-type airtight valve, and the second slit-type airtight valve and the second open-type airtight valve It is preferable that an insertion member having an insertion hole and a second insertion hole is provided.
- the leaflet of the slit is deformed when the insertion portion is inserted into the insertion hole formed in the insertion member, and abuts against the edge of the insertion hole.
- the outer tube further includes an introduction portion provided at a proximal end of the penetrating portion, and the first slit-type airtight valve, the second slit-type airtight valve, the first open-type airtight valve, The second opening type airtight valve and the insertion member are preferably provided in the introduction part.
- the first slit-type airtight valve, the second slit-type airtight valve, the first open-type airtight valve, and the second open-type airtight valve are provided at the introduction portion at the proximal end of the penetration portion.
- a valve member made of an insertion member can be provided on the outer tube without increasing the outer diameter of the penetrating portion, that is, without affecting the invasion applied to the body wall.
- One aspect of the present invention is a unit valve in which a first slit-type airtight valve, a second slit-type airtight valve, a first opening-type airtight valve, a second opening-type airtight valve, and an insertion member are integrated.
- valve member as a unit valve body, the assemblability of the valve member with respect to the outer tube is improved, and handling, such as storage and management of the valve member, is facilitated.
- the first insertion portion is an insertion portion of an endoscope and the second insertion portion is an insertion portion of a treatment instrument.
- the endoscope can be operated by an operator who operates the treatment tool. This eliminates the need for a scopist who operates the endoscope. Therefore, the problem that the operator's hand and the scoopist's hand interfere with each other above the abdominal wall of the patient can be solved, and the operator's work space is widened, so that the workability of the operation is improved.
- the diameter of the first opening of the first opening type airtight valve is preferably larger than the diameter of the second opening of the second opening type airtight valve.
- the outer diameter of the insertion portion of the endoscope is a treatment instrument. It is generally larger than the outer diameter of the insertion part.
- the diameter of the first opening of the first opening type airtight valve into which the insertion portion of the endoscope is inserted is set to be the second diameter of the second opening type airtight valve into which the insertion portion of the treatment instrument is inserted. Larger than the diameter of the opening.
- the first slit-type airtight valve and the second open-type airtight valve are integrally configured, and the second slit-type airtight valve and the first open-type airtight valve are integrally configured. It is preferable.
- the first slit-type airtight valve and the second open-type airtight valve are integrated, and the second slit-type airtight valve and the first open-type airtight valve are integrated,
- the number of parts of the valve member can be reduced. Further, the assembling property of the valve member with respect to the outer tube is improved, and handling such as storage and management of the valve member becomes easy.
- the first slit-type airtight valve and the second slit-type airtight valve are integrally configured, and the first open-type airtight valve and the second open-type airtight valve are integrally configured. It is preferable.
- the first slit-type airtight valve and the second slit-type airtight valve are integrated, and the first open-type airtight valve and the second open-type airtight valve are integrated,
- the number of parts of the valve member can be reduced. Further, the assembling property of the valve member with respect to the outer tube is improved, and handling such as storage and management of the valve member becomes easy.
- One aspect of the present invention includes a penetrating portion that has a distal end, a proximal end, and a longitudinal axis, and penetrates the body wall, and two medical devices that are inserted into the penetrating portion.
- a first insertion hole through which the insertion portion can be inserted into the penetration portion in a direction parallel to the longitudinal axis, and adjacent to the first insertion hole, and the first insertion hole of the other medical instrument.
- a second insertion hole through which the two insertion portions can be inserted into the penetration portion in a direction parallel to the first insertion hole, and a first insertion portion.
- a first slit-type airtight valve having a first slit that retains hermeticity when being removed from the first insertion hole; and a second insertion hole provided in the second insertion hole.
- a second slit-type airtight valve having a second slit that retains hermeticity when being removed from the insertion hole, and the first insertion hole,
- a first opening-type airtight valve having a first opening that is in close contact with the outer peripheral portion of the first insertion portion and maintains airtightness when the one insertion portion is inserted into the first insertion hole;
- Two open type airtight valves and the first slit type airtight valve and the second slit type airtight valve provide an outer tube disposed at a position shifted from each other in the axial direction of the longitudinal axis of the penetrating portion. To do.
- the opening / closing operation of one slit type airtight valve does not affect the opening / closing operation of the other slit type airtight valve.
- the first slit-type airtight valve and the second open-type airtight valve are integrally configured, and the second slit-type airtight valve and the first open-type airtight valve are integrally configured. It is preferable.
- the number of parts of the valve member can be reduced. Further, the assembling property of the valve member with respect to the outer tube is improved, and handling such as storage and management of the valve member becomes easy.
- One aspect of the present invention includes a penetrating portion that has a distal end, a proximal end, and a longitudinal axis, and penetrates the body wall, and two medical devices that are inserted into the penetrating portion.
- a second insertion hole through which the second insertion portion of the instrument can be removably inserted into the penetration portion along a direction parallel to the first insertion hole, and the first insertion hole.
- a first slit-type airtight valve having a first slit that retains hermeticity when the insertion portion is removed from the first insertion hole; and a second insertion portion.
- a second slit-type airtight valve having a second slit that retains hermeticity when being removed from the second insertion hole; and a first insertion hole.
- 1st opening type airtightness which has a 1st opening closely_contact
- a second valve that is provided in the second insertion hole, and is in close contact with the outer peripheral portion of the second insertion portion when the second insertion portion is inserted into the second insertion hole, thereby maintaining airtightness.
- a second opening type airtight valve having an opening, and the first insertion hole and the second insertion hole have a major axis and a minor axis in a cross section perpendicular to the longitudinal axis of the penetration part,
- the slit and the second slit provide an outer tube formed along the minor axis.
- each leaflet of the first slit and the second slit is elastically deformed in the major axis direction of the first insertion hole and the second insertion hole. That is, the load (stress) at the time of elastic deformation of the leaflet is reduced rather than the elastic deformation of the leaflet in the short axis direction in which the elastic deformation amount of the leaflet is regulated from the long axis direction.
- the service life of the airtight valve and the second slit type airtight valve is extended.
- FIG. 13 is a cross-sectional view taken along line 13-13 of FIG. 11 in a form in which the valve member is disposed on the cap.
- FIG. 13 is a front view of an intermediate member.
- It is the assembly perspective view which showed the other form of the valve member.
- It is the assembly perspective view which showed the other form of the valve member.
- It is the assembly perspective view which showed the other form of the valve member.
- It is the assembly perspective view which showed the other form of the valve member.
- It is the assembly perspective view which showed the other form of the valve member.
- It is the assembly perspective view which showed the other form of the valve member.
- It is the assembly perspective view which showed the other form of the valve member.
- It is the front view which showed the other form of the intermediate member.
- FIG. 1 is an external view of a mantle tube 100 according to the embodiment
- FIG. 2 is a schematic configuration diagram of an endoscopic surgical apparatus 1 showing a use form of the mantle tube 100.
- An endoscopic surgical apparatus 1 includes an endoscope 10 that is inserted into a body cavity of a patient and observes the inside of the body cavity, a treatment tool 50 that is inserted into the body cavity of the patient and performs a required treatment, An outer tube 100 for guiding the endoscope 10 and the treatment tool 50 into a body cavity of a patient is provided.
- FIG. 3 is a schematic configuration diagram illustrating an example of the endoscope 10.
- the endoscope 10 is a direct-viewing type rigid endoscope such as a laparoscope.
- the endoscope 10 includes a linear insertion portion 12 that is inserted into a body cavity of a patient, and an eyepiece portion 14 that is disposed at the proximal end of the insertion portion 12.
- the objective lens 16 is disposed at the distal end of the insertion portion 12.
- An eyepiece lens (not shown) is disposed in the eyepiece unit 14.
- a plurality of relay lenses (not shown) are disposed inside the insertion portion 12. An image created by the objective lens is observed by the eyepiece through the relay lens.
- optical axis L of the objective lens 16 is arranged in parallel with the axis of the insertion portion 12 (the same applies to eyepiece lenses and relay lenses). Accordingly, an image of an object facing the distal end surface of the insertion unit 12 is observed at the eyepiece unit 14.
- a TV camera 18 that captures part or all of the observation image of the endoscope 10 is attached to the eyepiece unit 14.
- the TV camera 18 incorporates an image pickup device (for example, a CCD (Charge-Coupled Device), a CMOS (Complementary Metal-Oxide-Semiconductor), etc.) 20 as an image pickup means.
- an image pickup device for example, a CCD (Charge-Coupled Device), a CMOS (Complementary Metal-Oxide-Semiconductor), etc.
- the TV camera 18 is connected to the image processing device 24 via a flexible cable 22.
- the image processing device 24 captures a signal output from the image sensor 20 and performs various processes on the captured signal to generate a video signal that can be output to the display 26.
- a display 26 such as a liquid crystal monitor is connected to the image processing device 24.
- the video signal generated by the image processing device 24 is output to the display 26 and displayed on the screen of the display 26 as an endoscopic image.
- the endoscope 10 of this example is not provided with illumination means.
- the illumination is performed by another means, for example, a needle light.
- the diameter of the insertion portion of the endoscope can be reduced.
- the diameter of the outer tube 100 can also be reduced, and the invasion applied to the patient's body wall can be reduced.
- the endoscope 10 is not limited to the relay lens system, and may be an endoscope in which an imaging unit is provided at the distal end portion of the insertion portion 12.
- FIG. 4 is a schematic configuration diagram illustrating an example of the needle light 30.
- the needle light 30 is inserted into a patient's body cavity and irradiates the body cavity with illumination light.
- the needle light 30 has a linear insertion portion 32.
- An illumination window (not shown) is provided at the distal end of the insertion part 32, and illumination light is irradiated from the illumination window in the axial direction.
- An optical fiber bundle that transmits illumination light emitted from the illumination window is accommodated in the insertion portion 32.
- a connecting portion 34 is provided at the proximal end of the needle light 30.
- a light source device 38 is connected to the connecting portion 34 via a cable 36 having flexibility. Illumination light emitted from the illumination window is supplied from the light source device 38.
- the needle light 30 is inserted into a body cavity via a trocar 40 for needle light.
- FIG. 5 is a schematic configuration diagram illustrating an example of the treatment instrument 50.
- the treatment instrument 50 includes a linear insertion portion 52 that is inserted into a body cavity, a treatment portion 54 that is disposed at a distal end of the insertion portion 52, and a handle portion (an operation portion) that is disposed at a proximal end of the insertion portion 52. 56).
- the treatment portion 54 shown in FIG. 5 has a scissor structure, and the treatment portion 54 is opened and closed by opening and closing the handle portion 56.
- the treatment instrument 50 is not limited to this, and forceps, a laser probe, a suture instrument, an electric knife, a needle holder, an ultrasonic aspirator, and the like can be used as the treatment instrument.
- the mantle tube 100 shown in FIG. 1 is punctured into the body cavity wall of the patient, and guides the endoscope 10 and the treatment tool 50 into the body cavity of the patient.
- FIG. 6 is a front view of the mantle tube 100 in which the endoscope 10 and the treatment tool 50 are inserted
- FIG. 7 is a side partial sectional view of the mantle tube 100 in which the endoscope 10 and the treatment tool 50 are inserted
- FIG. 2 is a rear view of the outer tube 100.
- the outer tube 100 includes a cylindrical outer tube body (penetrating portion) 102 having a longitudinal axis.
- a cap (introducing portion) 104 is attached to the proximal end of the outer tube body 102.
- a valve member 160 (see FIG. 11) according to an embodiment described later is accommodated and disposed.
- the proximal end opening of the outer tube body 102 is closed by a valve member 160 disposed on the cap 104.
- a cap 106 is attached to the distal end of the outer tube body 102.
- the distal end opening of the outer tube body 102 is closed by a cap 106.
- the cap 104 is provided with a treatment instrument insertion port 108 for inserting the insertion portion 52 of the treatment instrument 50 into the outer tube main body 102.
- the treatment instrument insertion port 108 is formed with an inner diameter corresponding to the outer diameter of the insertion portion 52 of the treatment instrument 50 to be used.
- the cap 104 is provided with an endoscope insertion port 112 for inserting the insertion portion 12 of the endoscope 10 into the outer tube main body 102.
- the endoscope insertion port 112 is formed with an inner diameter corresponding to the outer diameter of the insertion portion 12 of the endoscope 10 to be used.
- the cap 106 is provided with a treatment instrument delivery port 114 through which the insertion portion 52 of the treatment instrument 50 inserted into the outer tube body 102 is delivered.
- the treatment instrument delivery port 114 is formed with an inner diameter corresponding to the outer diameter of the insertion portion 52 of the treatment instrument 50 to be used.
- the treatment instrument insertion port 108 in FIG. 8 and the treatment instrument delivery port 114 in FIG. 6 are arranged coaxially and are arranged on an axis parallel to the longitudinal axis of the outer tube body 102.
- the treatment instrument 50 inserted from the treatment instrument insertion port 108 is fed out from the treatment instrument delivery port 114 (see FIG. 6).
- the insertion portion 52 of the treatment instrument 50 is fed out in a state parallel to the axis of the outer tube body 102.
- the cap 106 of FIG. 6 is provided with an endoscope outlet 116 through which the insertion portion 12 of the endoscope 10 inserted into the outer tube main body 102 is fed out from the endoscope insertion port 112 of FIG.
- the endoscope feeding opening 116 is formed with an inner diameter corresponding to the outer diameter of the insertion portion 12 of the endoscope 10 to be used.
- the endoscope insertion port 112 (see FIG. 8) and the endoscope feeding port 116 (see FIG. 6) are arranged coaxially and are arranged on an axis parallel to the longitudinal axis of the outer tube body 102. Thereby, as shown in FIG. 7, the endoscope 10 inserted from the endoscope insertion port 112 (see FIG. 8) is fed out from the endoscope feed opening 116 (see FIG. 6). At this time, the insertion portion 12 of the endoscope 10 is extended in a state parallel to the axis of the outer tube body 102.
- a slider 118 that is movable in a direction parallel to the axis of the outer tube body 102 is provided in the outer tube body 102.
- the slider 118 is configured in a cylindrical shape that can be accommodated in the outer tube body 102.
- the slider 118 is guided by a pair of guide shafts 120 so as to be movable in the direction parallel to the axis of the outer tube body 102 inside the outer tube body 102.
- Each guide shaft 120 has a round bar shape and is arranged in parallel with each other inside the outer tube body 102 (see FIG. 6). Each guide shaft 120 is arranged in parallel with the axis of the outer tube main body 102 with the base end supported by the cap 104 and the distal end supported by the cap 106.
- the slider 118 is provided with a pair of guide holes 122 through which the pair of guide shafts 120 can be inserted.
- the pair of guide holes 122 are arranged at the same interval as the arrangement interval of the pair of guide shafts 120, and are formed in parallel with the axis of the outer tube body 102, respectively.
- the guide shaft 120 is inserted through the guide hole 122, and the slider 118 is guided by the guide shaft 120.
- the slider 118 includes a treatment instrument holding portion 124 that holds the insertion portion 52 of the treatment instrument 50 inserted into the outer tube body 102 and an inner portion that holds the insertion portion 12 of the endoscope 10 inserted into the outer tube body 102. And an endoscope holding unit 126.
- the endoscope holding part 126 includes an endoscope holding hole 132 through which the insertion part 12 of the endoscope 10 is inserted, and a pair of O-rings 134 disposed in the endoscope holding hole 132.
- the endoscope holding hole 132 is formed through the slider 118.
- the endoscope holding hole 132 is formed in parallel with the axis of the outer tube body 102 and is arranged coaxially with the endoscope insertion port 112 and the endoscope feeding port 116.
- the pair of O-rings 134 are attached to the front and rear two places inside the endoscope holding hole 132.
- the inner diameter of the O-ring 134 is slightly smaller than the outer diameter of the insertion portion 12 of the endoscope 10.
- the insertion portion 12 of the endoscope 10 inserted into the outer tube main body 102 from the endoscope insertion port 112 passes through the endoscope holding hole 132 and is fed out from the endoscope feed opening 116.
- the endoscope 10 passes through the O-ring 134 when passing through the endoscope holding hole 132.
- the inner diameter of the O-ring 134 is slightly smaller than the outer diameter of the insertion portion 12 of the endoscope 10. Therefore, when the insertion portion 12 of the endoscope 10 passes through the endoscope holding hole 132, it is held in the endoscope holding hole 132 by the elastic force of the O-ring 134.
- the holding here is holding by the elastic force of the O-ring 134, the holding position of the endoscope 10 with respect to the slider 118 can be arbitrarily adjusted.
- the treatment instrument holding portion 124 includes a treatment instrument holding hole 128 through which the insertion portion 52 of the treatment instrument 50 is inserted, and a sleeve 140 disposed in the treatment instrument holding hole 128 and moving in the axial direction along the treatment instrument holding hole 128. And a pair of O-rings 130 disposed on the sleeve 140.
- the treatment instrument holding hole 128 is formed through the slider 118.
- the treatment instrument holding hole 128 is formed in parallel to the axis of the outer tube body 102 and is disposed coaxially with the treatment instrument insertion port 108 and the treatment instrument delivery port 114.
- An annular stopper ring 142 is attached to both ends of the treatment instrument holding hole 128.
- the sleeve 140 accommodated in the treatment instrument holding hole 128 is prevented from being removed from the treatment instrument holding hole 128 by the stopper rings 142 and 142.
- the sleeve 140 has a movable amount (play amount) in the axial direction set by the stopper rings 142 and 142. That is, the sleeve 140 is provided so as to be movable with respect to the slider 118 between stopper rings 142 and 142 provided at both ends of the treatment instrument holding hole 128.
- the sleeve 140 is formed in a cylindrical shape, is accommodated inside the treatment instrument holding hole 128, and is arranged coaxially with the treatment instrument holding hole 128. That is, the sleeve 140 is disposed coaxially with the treatment instrument insertion port 108 and the treatment instrument delivery port 114. As a result, when the treatment instrument 50 is inserted from the treatment instrument insertion port 108 along the axial direction, the insertion portion 52 of the treatment instrument 50 is inserted into the inner peripheral portion of the sleeve 140.
- the pair of O-rings 130 are attached to the front and rear two locations inside the sleeve 140.
- the inner diameter of the O-ring 130 is slightly smaller than the outer diameter of the insertion portion 52 of the treatment instrument 50.
- the insertion portion 52 of the treatment instrument 50 inserted into the outer tube body 102 from the treatment instrument insertion port 108 passes through the treatment instrument holding hole 128 and is fed out from the treatment instrument delivery port 114.
- the insertion portion 52 passes through the O-ring 130 disposed on the inner peripheral portion of the sleeve 140 when passing through the treatment instrument holding hole 128.
- the inner diameter of the O-ring 130 is slightly smaller than the outer diameter of the insertion portion 52 of the treatment instrument 50. Therefore, when the insertion portion 52 passes through the O-ring 130, the insertion portion 52 is held by the sleeve 140 by the elastic force of the O-ring 130.
- the holding position of the treatment instrument 50 with respect to the sleeve 140 can be arbitrarily adjusted. That is, the holding position of the treatment instrument 50 with respect to the slider 118 can be arbitrarily adjusted.
- the sleeve 140 is integrated with the treatment instrument 50, and the sleeve 140 moves in conjunction with the movement of the treatment instrument 50.
- the frictional force (F3) between the sleeve 140 and the treatment instrument holding hole 128 is larger than the frictional force (F2) between the insertion portion 52 of the treatment instrument 50 and the O-ring 130, the insertion is performed.
- the portion 52 slides between the O-ring 130 and the sleeve 140 cannot be moved with respect to the slider 118.
- the frictional force (F3) between the sleeve 140 and the treatment instrument holding hole 128 is set smaller than the frictional force (F2) between the treatment instrument 50 and the O-ring 130.
- the frictional force (F2) between the treatment instrument 50 and the O-ring 130 is set larger than the frictional force (F1) between the guide shaft 120 and the guide hole 122.
- the frictional force (F1) between the guide shaft 120 and the guide hole 122 the frictional force (F2) between the treatment instrument 50 and the O-ring 130, and between the sleeve 140 and the treatment instrument holding hole 128.
- the relationship with the frictional force (F3) is set to F2> F1> F3.
- the slider 118 does not move if the movable amount (play amount) set by the pair of stopper links 142 and 142 is moved. That is, the endoscope 10 is not interlocked with the movement of the insertion portion 52 within the range of the movable amount. Thus, the outer tube 100 has “play” for movement of the treatment instrument 50.
- the insertion portion 12 of the endoscope 10 is inserted from the endoscope insertion port 112.
- the insertion portion 12 inserted into the endoscope insertion port 112 passes through the outer tube main body 102 and is fed out from the endoscope feeding port 116.
- the insertion portion 12 passes through the endoscope holding hole 132 formed in the slider 118 in the outer tube main body and is fed out from the endoscope feeding port 116.
- the endoscope holding hole 132 is provided with an O-ring 134, and the insertion portion 12 that has passed through the endoscope holding hole 132 is held by the slider 118 by the elastic force of the O-ring 134.
- the insertion portion 52 of the treatment instrument 50 is inserted from the treatment instrument insertion port 108.
- the insertion portion 52 inserted into the treatment instrument insertion port 108 passes through the outer tube body 102 and is fed out from the treatment instrument delivery port 114.
- the insertion portion 52 is held by the sleeve 140 by the elastic force of the O-ring 130.
- FIG. 9 is a view showing a form when the endoscopic surgical apparatus 1 is used.
- the insertion portion 12 of the endoscope 10 inserted into the outer tube 100 and the insertion portion 52 of the treatment instrument 50 are held in parallel with each other and are held in parallel with the axis of the outer tube 100.
- the insertion portion 52 of the treatment instrument 50 is held by the sleeve 140, and the sleeve 140 is provided so as to be movable in the axial direction with respect to the slider 118.
- the frictional force (F3) between the sleeve 140 and the treatment instrument holding hole 128 and the frictional force (F1) between the guide shaft 120 and the guide hole 122 are set to F3 ⁇ F1.
- the slider 118 is pushed by the sleeve 140 and moves integrally with the treatment instrument 50.
- the insertion portion 12 of the endoscope 10 moves in conjunction with the treatment tool 50.
- the distal end of the sleeve 140 is provided at the distal end of the treatment instrument holding hole 128.
- the slider 118 comes into contact with the stopper ring 142 and moves in the distal direction together with the treatment instrument 50.
- the insertion portion 12 of the endoscope 10 moves in the distal direction together with the treatment instrument 50.
- the proximal end of the sleeve 140 comes into contact with the stopper ring 142 provided at the proximal end of the treatment instrument holding hole 128, and the slider 118. Moves together with the treatment instrument 50 in the proximal direction. As a result, the insertion portion 12 of the endoscope 10 moves in the proximal direction together with the treatment instrument 50.
- the endoscope 10 can be moved in conjunction with the treatment instrument 50 only when the treatment instrument 50 is moved largely. Thereby, since the movement is not transmitted to the endoscope 10 with respect to the movement of small amplitude such as fine shaking, a good endoscopic image without shaking can be provided.
- FIG. 10 is a schematic diagram illustrating an example of a surgical method using the endoscopic surgical apparatus 1.
- This example shows an example where one surgeon performs treatment.
- the endoscope 10 and the treatment tool 50 are inserted into the body cavity 3 through the outer tube 100 punctured in the body cavity wall 2 of the patient.
- the endoscope 10 moves in conjunction with the movement of the treatment instrument 50. Thereby, the image of the treatment portion is always displayed on the display 26, and the visual field can be moved by the movement of the treatment instrument 50.
- a separate needle light 30 is inserted into the body cavity 3 via the needle light trocar 40 as illumination means.
- the body cavity 3 is illuminated with illumination light emitted from the tip of the needle light 30.
- the single needle light 30 was illustrated in this example, you may use the several needle light 30 as needed.
- a scopist becomes unnecessary.
- FIG. 12 is a front view of the valve member 160 of FIG. 11 viewed from the direction of arrow A
- FIG. 13 is a cross-sectional view taken along line 13-13 of FIG. 11 in form.
- the valve member 160 is configured by arranging a valve body 162, an intermediate member (insertion member) 164, and a valve body 166 in parallel from the proximal end to the distal end of the cap 104.
- valve body 162, the intermediate member 164, and the valve body 166 are disk-shaped members having the same diameter, and are arranged in a predetermined position on the cap 104 shown in FIG. Be placed.
- valve body 162, the intermediate member 164, and the valve body 166 are formed by an adhesive applied to each outer peripheral portion, or a locking tool (not shown) penetrating each locking hole (not shown). It is preferable that they are integrated and configured as a unit valve body.
- the intermediate member 164 is made of a metal such as stainless steel or aluminum, or is made of hard plastic, and has a function of reinforcing the valve bodies 162 and 166 stacked in the front-rear direction.
- first insertion holes first insertion holes
- second insertion hole second insertion hole
- the insertion portion 12 (first insertion portion) of the endoscope 10 is inserted into the insertion hole 168 from the endoscope insertion port 112 in FIG. 13 in the direction of arrow C in FIG. 168 is advanced or retracted. Further, the insertion portion 52 (second insertion portion) of the treatment instrument 50 is inserted into the insertion hole 170 in the direction of arrow D in FIG. 11 from the treatment instrument insertion port 108 in FIG. Move forward and backward with respect to 170.
- the insertion holes 168 and 170 are flat plates provided in the center on a plane orthogonal to the axial direction of each of the insertion holes 168 and 170 (the same direction as the arrows C and D, parallel to the axis of the outer tube body 102). It is formed in a D shape through a partition wall 172. That is, the D-cut portions 168A and 170A of the insertion holes 168 and 170 are formed by the partition wall 172, and the insertion holes 168 and 170 are arranged in the intermediate member 164 so that the D-cut portions 168A and 170A face each other. That is, the insertion holes 168 and 170 are provided in a line symmetrical position with respect to the partition wall 172.
- the valve body 162 is a valve body in which an opening type airtight valve (first opening type airtight valve) 174 and a slit type airtight valve (second slit type airtight valve) 176 are integrated.
- the opening type airtight valve 174 is provided with a circular opening (first opening) 178.
- the opening 178 is arranged coaxially with the insertion hole 168 and is formed to be slightly smaller than the outer diameter of the insertion portion 12 of the endoscope 10. Therefore, when the insertion portion 12 is fitted into the opening 178, the inner peripheral edge of the opening 178 is in close contact with the outer peripheral surface of the insertion portion 12. Therefore, the airtightness of the endoscope insertion port 112 is maintained.
- the slit type airtight valve 176 includes a slit (second slit) 180.
- the slit 180 is formed at a position overlapping the insertion hole 170 when viewed from the insertion direction of the insertion portion 52 of the treatment instrument 50 indicated by the arrow D direction.
- the slit 180 is closed when the insertion portion 52 is removed from the treatment instrument insertion port 108. Therefore, the airtightness of the treatment instrument insertion port 108 is maintained.
- valve body 166 is a valve body in which an opening type airtight valve (second opening type airtight valve) 182 and a slit type airtight valve (first slit type airtight valve) 184 are integrated.
- the opening type airtight valve 182 is provided with a circular opening (second opening) 186.
- the opening 186 is disposed coaxially with the insertion hole 170 and is formed to be slightly smaller than the outer diameter of the insertion portion 52 of the treatment instrument 50. Therefore, when the insertion portion 52 is fitted into the opening 186, the inner peripheral edge of the opening 186 is in close contact with the outer peripheral surface of the insertion portion 52. Therefore, the airtightness of the treatment instrument insertion port 108 is maintained.
- the slit type airtight valve 184 includes a slit (first slit) 188.
- the slit 188 is formed at a position overlapping the insertion hole 168 when viewed from the insertion direction of the insertion portion 12 of the endoscope 10 indicated by the arrow C direction.
- the slit 188 is closed when the insertion portion 12 is removed from the endoscope insertion port 112. Therefore, the airtightness of the endoscope insertion port 112 is maintained.
- valve member 160 of the embodiment can ensure airtightness by the openings 178 and 186 when the insertion portions 12 and 52 are inserted, and the slits 180 and 186 when the insertion portions 12 and 52 are removed. Airtightness can be secured by 188.
- the opening / closing operation of the slit-type airtight valve 176 is the slit-type airtight valve.
- the opening / closing operation of the airtight valve 184 is not affected. That is, when the slit-type airtight valve 176 and the slit-type airtight valve 184 are integrally configured, the opening / closing operation of the slit-type airtight valve 176 may affect the opening / closing operation of the slit-type airtight valve 184.
- the slit type airtight valves 176 and 184 are respectively formed on the separate valve bodies 162 and 166, such a problem does not occur.
- the slits 180 and 188 are arranged along a reference line E connecting the arc centers C1 and C2 of the insertion holes 168 and 170 when viewed from the axial direction of the insertion holes 168 and 170. Further, the insertion holes 168 and 170 are formed in a line-symmetric shape with respect to the reference line E.
- the slit-type airtight valves 176 and 184 are formed in a shape that is symmetrical with respect to the reference line E when projected onto a plane orthogonal to the insertion holes 170 and 168.
- the insertion holes 168 and 170 are formed in a shape that is symmetrical with respect to the reference line E.
- the two insertion holes 168 and 170 are formed in a D-shaped cross section via the partition wall 172.
- the distance between the centers of the arcs of the insertion holes 168 and 170 (distance between C1 and C2) is set as, for example, the insertion holes 168 and 170 are perfect circles. It is shorter than the distance between the centers. Thereby, the outer diameter of the outer tube body 102 can be reduced. This will be specifically described below.
- FIG. 14 is a front view of the intermediate member 164.
- the insertion holes 168 and 170 have a line-symmetric shape with a reference line E passing through the arc center C1 of the insertion hole 168 and the arc center C2 of the insertion hole 170 as a center. Further, in the insertion hole 168, on the reference line E, the distance a from the center C1 of the insertion hole 168 to the wall core of the partition wall 172 is the distance b from the center C1 to the edge of the arc part on the opposite side of the partition wall 172. Shorter than.
- the distance a from the center C2 of the insertion hole 170 to the wall core of the partition wall 172 is the distance b from the center C1 to the edge of the arc part on the opposite side of the partition wall 172. Shorter than. Thereby, the center-to-center distance (distance between C1 and C2) between the insertion hole 168 and the insertion hole 170 is shorter than the center-to-center distance when the insertion holes 168 and 170 are perfect circles. The diameter can be reduced.
- the slit 188 of the slit type airtight valve 184 is closed, so that the airtightness of the insertion hole 168 can be ensured. Further, when the insertion portion 12 is inserted into the insertion hole 168, the insertion portion 12 is fitted into the opening 178 of the open type airtight valve 174, that is, the inner peripheral edge of the opening 178 is on the outer peripheral surface of the insertion portion 12. Since it adheres closely, the airtightness of the insertion hole 168 is securable.
- the slit 180 of the slit type airtight valve 176 is closed, so that the airtightness of the insertion hole 170 can be secured. Further, when the insertion portion 52 is inserted into the insertion hole 170, the insertion portion 52 is fitted into the opening 186 of the open type airtight valve 182, that is, the inner peripheral edge of the opening 186 is on the outer peripheral surface of the insertion portion 52. Since it adheres closely, the airtightness of the insertion hole 170 is securable.
- the slits 180 and 188 are arranged along the reference line E in a plane orthogonal to the insertion holes 170 and 168.
- the two leaflets 190 and 192 on both sides of the slit 180 shown in FIG. 13 are formed on the arc edge 170B of the insertion hole 170 and the D-cut portion 170A of the partition 172 when the insertion portion 52 of the treatment instrument 50 is fitted. Each abuts and deforms into the same shape.
- each of the leaflets 190 and 192 returns smoothly to the original shape when the insertion portion 52 is removed.
- the slits 180 and 188 are arranged along the reference line E, that is, on the reference line E.
- the present invention is not limited to this.
- the slits 180 and 188 be arranged in a non-parallel state with respect to the partition wall 172 when viewed from the axial direction of the insertion holes 168 and 170.
- the slits 180 and 188 may be disposed along a direction perpendicular to the partition wall 172 when viewed from the axial direction of the insertion holes 168 and 170. That is, the slits 180 and 188 may not be arranged in parallel to the partition wall 172.
- valve member 160 including the valve body 162, the intermediate member 164, and the valve body 166 is housed in the cap 104 at the base end of the outer tube body 102. Accordingly, the valve member 160 can be provided on the outer tube 100 without increasing the outer diameter of the outer tube body 102, that is, without affecting the invasion applied to the body wall.
- valve member 160 including the valve body 162, the intermediate member 164, and the valve body 166 is configured as an integrated unit valve body.
- the opening 178 is an insertion opening of the insertion portion 12 of the endoscope 10
- the opening 186 is an insertion opening of the insertion portion 52 of the treatment instrument 50.
- the diameter of the opening 178 is preferably larger than the diameter of the opening 186. Since the insertion portion 12 of the endoscope 10 is inserted with an optical system composed of a plurality of lenses and a built-in object such as a signal cable, the outer diameter of the insertion portion 12 is larger than the outer diameter of the insertion portion 52 of the treatment instrument 50. This is because it is generally large. If the openings 178 and 186 and the slits 180 and 188 have the same shape, the valve bodies 162 and 166 can be shared.
- the open type airtight valve 174 and the slit type airtight valve 176 are integrally configured, and the open type airtight valve 182 and the slit type airtight valve 184 are integrally configured. That is, since the open type airtight valve 174 and the slit type airtight valve 176 are integrated, and the open type airtight valve 182 and the slit type airtight valve 184 are integrated, the number of parts of the valve member 160 can be reduced. Further, the assembling property of the valve member 160 with respect to the outer tube 100 is also improved, and handling such as storage and management of the valve member 160 is facilitated.
- valve member 200 shown in FIG. 15 includes valve bodies 202 and 204 and an intermediate member 164.
- the slit type airtight valves 176 and 184 are integrated to form the valve body 202
- the open type airtight valves 174 and 182 are integrated to form the valve body 204.
- the valve body 202 is disposed on the proximal end side with respect to the intermediate member 164
- the valve body 204 is disposed on the distal end side with respect to the intermediate member 164.
- a single valve body 202 disposed on the base end side is provided with slits 180 and 188, and the slits 180 and 188 are disposed along the reference line E.
- the two leaflets 190 and 192 on both sides of the slit 180 are deformed into the same shape with respect to the insertion hole 170, and the two leaflets 206 and 208 on both sides of the slit 188 are deformed with respect to the insertion hole 168. Deform to the same shape.
- valve 16 includes valve bodies 162 and 166 and an intermediate member 164.
- the slit 188 is disposed along the reference line E connecting the centers C1 and C2 of the insertion holes 168 and 170 when viewed from the axial direction of the insertion holes 168 and 170. Therefore, the two leaflets 206 and 208 on both sides of the slit 188 are in contact with the arc edge 168B of the insertion hole 168 and the D-cut portion 168A of the partition 172 when the insertion portion 12 of the endoscope 10 is fitted, respectively. Deform to shape. Accordingly, since the difference in stress generated between the two leaflets 206 and 208 is eliminated, the airtightness by the slit 188 can be ensured over a long period of time. Further, since the two leaflets 206 and 208 are deformed into the same shape, each of the leaflets 206 and 208 smoothly returns to the original shape when the insertion portion 12 is removed.
- the slits 180 and 188 are formed in a cross shape.
- the shape of the slits 180 and 188 in the embodiment is basically a “-” shape, but in the case of a cross shape as shown in FIG. 16, the two slits 180A, 180B and 188A constituting the cross-shaped slits 180 and 188 are formed.
- the longer slits 180A and 188A out of 188B function as the slits 180 and 188 in the embodiment.
- valve member 220 shown in FIG. 17 an open type airtight valve 174 and a slit type airtight valve 176 constituting the valve body 162 are configured separately from the valve member 160 shown in FIG.
- the opening type airtight valve 182 and the slit type airtight valve 184 constituting the valve body 166 are configured separately.
- each valve is not limited to a semicircle, and may be a circle or a rectangle.
- the insertion holes 168 and 170 have a long axis F and a short axis G, respectively, in a cross section perpendicular to the longitudinal axis of the outer tube body 102, and the slits 180 and 188 of the slit type airtight valves 176 and 184 are respectively It is formed along the short axis G.
- the leaflets 190, 192, 206, 208 forming the slits 180, 188 are elastically deformed in the direction of the long axis F of the insertion holes 168, 170. Since the amount of elastic deformation of the leaflets 190, 192, 206, 208 is not regulated in the direction of the long axis F than in the direction of the short axis G, the leaflets 190, 192, 206, 208 are elastically deformed in the direction of the short axis G. Compared with the case where the leaflet 190, 192, 206, 208 is elastically deformed in the direction of the long axis F, the burden (stress) at the time of elastic deformation is reduced. Therefore, the service life of the slit type airtight valves 176 and 184 is extended.
- valve member 230 shown in FIG. 18 an open type airtight valve 182 and a slit type airtight valve 184 that constitute the valve body 166 are configured separately from the valve member 210 shown in FIG.
- the opening type airtight valve 174 and the slit type airtight valve 176 constituting the valve body 162 are configured separately.
- valve member 230 of this embodiment has the same number of parts as the valve member 210 shown in FIG. 16, but the same effect as the valve member 210 shown in FIG. 16 can be obtained.
- valve 19 is different from the valve member 220 shown in FIG. 17 in that the slit type airtight valve 176 is disposed on the distal end side with respect to the intermediate member 164, and the open type airtight valve 182 is provided. Is arranged on the proximal end side with respect to the intermediate member 164.
- valve 20 differs from the valve member 200 shown in FIG. 15 in that the valve body 202 is divided into a slit-type airtight valve 176 and a slit-type airtight valve 184, and the valve body 204 is divided. This is divided into an open type airtight valve 174 and an open type airtight valve 182.
- the valve member 250 of this embodiment has the same number of parts as the valve member 200 shown in FIG. 15, but the same effects as the valve member 200 shown in FIG. 15 can be obtained.
- FIG. 21 is a front view showing another modification of the intermediate member 264.
- the intermediate member 264 includes semicircular insertion holes 268 and 270 with a flat partition 272 interposed therebetween.
- the insertion holes 268 and 270 have a line-symmetric shape centered on the reference line E passing through the arc center C1 of the insertion hole 268 and the arc center C2 of the insertion hole 270.
- the distance a from the center C 1 of the insertion hole 268 to the wall core of the partition wall 272 on the reference line E is a distance b from the center C 1 to the edge of the arc part on the opposite side of the partition wall 272. Shorter than.
- the distance a from the center C2 of the insertion hole 270 to the wall core of the partition wall 272 is the distance b from the center C1 to the edge of the arc portion on the opposite side of the partition wall 272. Shorter than. Accordingly, the distance between the centers of the insertion holes 268 and the insertion holes 270 (distance between C1 and C2) is shorter than the distance between the centers when the insertion holes 268 and 270 are circular, so that the outer diameter of the mantle tube is reduced. Can be small.
- the D-shaped insertion holes 168 and 170 and the semicircular insertion holes 268 and 270 are exemplified as the shape of the insertion hole, but the present invention is not limited to this, and the gist of the present invention Any shape that does not deviate from the above is acceptable.
- SYMBOLS 1 ... Endoscopic surgery apparatus, 2 ... Body cavity wall, 3 ... Body cavity, 10 ... Endoscope, 12 ... Insertion part, 14 ... Eyepiece part, 16 ... Objective lens, 18 ... TV camera, 20 ... Imaging element, 22 DESCRIPTION OF SYMBOLS ... Cable, 24 ... Image processing apparatus, 26 ... Display, 30 ... Needle light, 32 ... Insertion part, 34 ... Connection part, 36 ... Cable, 38 ... Light source device, 40 ... Tracar, 50 ... Treatment tool, 52 ... Insertion part , 54 ... treatment part, 56 ... handle part, 100 ... outer tube, 102 ... outer tube body, 104 ... cap, 106 ...
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Abstract
Description
第1のスリット型気密弁と第2のスリット型気密弁を、隔壁を介して隣設する。そして、第1のスリット型気密弁と第2のスリット型気密弁を、第1の挿通孔と直交する面に投影したとき、第1の挿通孔の中心と第2の挿通孔の中心とを通る基準線を中心として線対称となる形状に形成する。
第1の挿通孔に第1のスリット型気密弁と第1の開口型気密弁とを備え、第2の挿通孔に第2のスリット型気密弁と第2の開口型気密弁とを備えたことにある。
第1の特徴を踏まえて、第1のスリット及び第2のスリットが、第1の挿通孔に直交する面において基準線に沿って配置されたことにある。
内視鏡手術装置1は、患者の体腔内に挿入されて体腔内を観察するための内視鏡10と、患者の体腔内に挿入されて所要の処置を行うための処置具50と、内視鏡10及び処置具50を患者の体腔内に案内するための外套管100とを備える。
図3は、内視鏡10の一例を示した概略構成図である。
図4は、ニードルライト30の一例を示した概略構成図である。
図5は、処置具50の一例を示した概略構成図である。
図1に示した外套管100は、患者の体腔壁に穿刺され、内視鏡10及び処置具50を患者の体腔内に案内する。
図7の如く、外套管本体102の内部には、外套管本体102の軸と平行な方向に移動可能なスライダ118が備えられる。
まず、内視鏡10の挿入部12を、内視鏡挿入口112から挿入する。内視鏡挿入口112に挿入された挿入部12は、外套管本体102を通過して内視鏡繰出口116から繰り出される。この際、挿入部12は、外套管本体内のスライダ118に形成された内視鏡保持孔132を通過して内視鏡繰出口116から繰り出される。内視鏡保持孔132にはOリング134が備えられており、内視鏡保持孔132を通過した挿入部12は、Oリング134の弾性力によってスライダ118に保持される。
図10は、内視鏡手術装置1を用いた手術方法の一例を示す概略図である。
図11は、実施の形態の弁部材160の組立斜視図、図12は、図11の弁部材160を矢印A方向から見た正面図、図13は、弁部材160がキャップ104に配置された形態において図11の13-13線に沿った断面図である。
a)第1の特徴
スリット型気密弁176、184を、挿通孔170、168と直交する面に投影したときに、基準線Eを中心として線対称となる形状に形成したことにある。また、挿通孔168、170を、挿通孔170、168と直交する面に投影したときに、基準線Eを中心として線対称となる形状に形成したことにある。そして、2つの挿通孔168、170を、隔壁172を介して断面D字状に形成したことにある。すなわち、挿通孔168、170を弧部と直線部とから構成し、挿通孔168、170の弧の中心間距離(C1-C2間距離)を、例えば挿通孔168、170が真円である場合の中心間距離よりも短くしている。これによって、外套管本体102の外径を小さくできる。以下、具体的に説明する。
挿通孔168を挟んで開口型気密弁174とスリット型気密弁184を備えるとともに、挿通孔170を挟んでスリット型気密弁176と開口型気密弁182を備えたことにある。
第1の特徴を踏まえて、スリット180、188が、挿通孔170、168に直交する面において基準線Eに沿って配置されたことにある。
外套管本体102の基端のキャップ104に、弁体162、中間部材164、及び弁体166からなる弁部材160を収納したことにある。これにより、外套管本体102の外径を大きくすることなく、すなわち、体壁に加える侵襲に影響を与えることなく、弁部材160を外套管100に設けることができる。
弁体162、中間部材164、及び弁体166からなる弁部材160を、一体化したユニット弁体として構成したことにある。弁部材160をユニット弁体とすることによって、外套管100に対する弁部材160の組立性が向上し、また、弁部材160の保管、管理等の取り扱いが容易になる。
開口178を内視鏡10の挿入部12の挿入用開口とし、開口186を処置具50の挿入部52の挿入用開口としたことにある。これにより、外套管100に内視鏡10及び処置具50を挿入できるため、処置具50を操作する術者によって内視鏡10を操作できる。したがって、内視鏡10を操作するスコピストが不要になるので、患者の腹壁の上方で術者の手とスコピストの手が干渉するという不具合を解消でき、また、術者の作業スペースが広くなるので、手術の作業性が向上する。
開口型気密弁174とスリット型気密弁176とを一体に構成するとともに、開口型気密弁182とスリット型気密弁184とを一体に構成したことにある。すなわち、開口型気密弁174とスリット型気密弁176とが一体であり、開口型気密弁182とスリット型気密弁184とが一体なので、弁部材160の部品点数を削減できる。また、外套管100に対する弁部材160の組立性も向上し、弁部材160の保管、管理等の取り扱いも容易になる。
図15に示す弁部材200の他の形態は、弁体202、204及び中間部材164を備える。弁部材200では、スリット型気密弁176、184を一体化して弁体202として構成し、開口型気密弁174、182を一体化して弁体204として構成する。弁体202は、中間部材164に対して基端側に配置され、弁体204は中間部材164に対して先端側に配置される。
Claims (15)
- 先端と基端と長手軸とを有し、体壁を穿通する穿通部と、
前記穿通部の内部に挿通される2つの医療器具のうち、一方の医療器具の第1の挿入部を前記長手軸に平行な方向に沿って、前記穿通部の内部に進退自在に挿通可能な第1の挿通孔と、
前記第1の挿通孔に隣設し、かつ、他方の医療器具の第2の挿入部を前記第1の挿通孔に平行な方向に沿って前記穿通部の内部に進退自在に挿通可能な第2の挿通孔と、
前記第1の挿通孔に設けられ、前記第1の挿入部が前記第1の挿通孔から抜去されているときに気密性を保持する第1のスリットを有する第1のスリット型気密弁と、
前記第2の挿通孔に設けられ、前記第2の挿入部が前記第2の挿通孔から抜去されているときに気密性を保持する第2のスリットを有する第2のスリット型気密弁と、
前記第1の挿通孔に設けられ、前記第1の挿入部が前記第1の挿通孔に挿入されているときに前記第1の挿入部の外周部に密着して気密性を保持する第1の開口を有する第1の開口型気密弁と、
前記第2の挿通孔に設けられ、前記第2の挿入部が前記第2の挿通孔に挿入されているときに前記第2の挿入部の外周部に密着して気密性を保持する第2の開口を有する第2の開口型気密弁と、
を備え、
前記第1のスリット型気密弁と第2のスリット型気密弁は、隔壁を介して隣設され、前記第1の挿通孔と直交する面に投影したとき、前記第1の挿通孔の中心と前記第2の挿通孔の中心とを通る基準線を中心として線対称となる形状に形成され、かつ、
前記第1の挿通孔の中心から前記隔壁の壁芯までの距離が、前記第1の挿通孔の中心から前記隔壁と反対側の縁部までの距離よりも短く、前記第2の挿通孔の中心から前記隔壁の壁芯までの距離が、前記第2の挿通孔の中心から前記隔壁と反対側の縁部までの距離よりも短く形成されており、
前記第1のスリット及び第2のスリットは、前記第1の挿通孔に直交する面において前記基準線に沿って配置される外套管。 - 先端と基端と長手軸とを有し、体壁を穿通する穿通部と、
前記穿通部の内部に挿通される2つの医療器具のうち、一方の医療器具の第1の挿入部を前記長手軸に平行な方向に沿って、前記穿通部の内部に進退自在に挿通可能な第1の挿通孔と、
前記第1の挿通孔に隔壁を介して隣設し、かつ、他方の医療器具の第2の挿入部を前記第1の挿通孔に平行な方向に沿って前記穿通部の内部に進退自在に挿通可能な第2の挿通孔と、
前記第1の挿通孔に設けられ、前記第1の挿入部が前記第1の挿通孔から抜去されているときに気密性を保持する第1のスリットを有する第1のスリット型気密弁と、
前記第2の挿通孔に設けられ、前記第2の挿入部が前記第2の挿通孔から抜去されているときに気密性を保持する第2のスリットを有する第2のスリット型気密弁と、
前記第1の挿通孔に設けられ、前記第1の挿入部が前記第1の挿通孔に挿入されているときに前記第1の挿入部の外周部に密着して気密性を保持する第1の開口を有する第1の開口型気密弁と、
前記第2の挿通孔に設けられ、前記第2の挿入部が前記第2の挿通孔に挿入されているときに前記第2の挿入部の外周部に密着して気密性を保持する第2の開口を有する第2の開口型気密弁と、
を備え、
前記第1の挿通孔と第2の挿通孔は、前記第1の挿通孔と直交する面に投影したとき、前記第1の挿通孔の中心と第2の挿通孔の中心とを通る基準線を中心として線対称となる形状に形成され、かつ、前記第1の挿通孔と直交する面上において、前記第1の挿通孔の中心から前記隔壁の壁芯までの距離が、前記第1の挿通孔の中心から前記隔壁と反対側の縁部までの距離よりも短く、前記第2の挿通孔の中心から前記隔壁の壁芯までの距離が、前記第2の挿通孔の中心から前記隔壁と反対側の縁部までの距離よりも短く形成されており、
前記第1のスリット及び第2のスリットは、前記第1の挿通孔と直交する面上において前記基準線に沿って配置される外套管。 - 前記隔壁は、平板状に形成される請求項1又は2に記載の外套管。
- 前記第1のスリット型気密弁及び第2のスリット型気密弁は、前記第1の挿通孔と直交する面に投影したとき、直線縁と円弧縁とを有するD字状に形成される請求項1、2又は3に記載の外套管。
- 前記第1のスリット及び第2のスリットは、それぞれ十字形状であり、前記十字形状のスリットを構成する2本のスリットのうち長い方のスリットが、前記第1のスリット及び第2のスリットとして機能する請求項1から4のいずれかに記載の外套管。
- 前記第1のスリット型気密弁と前記第1の開口型気密弁との間、及び前記第2のスリット型気密弁と前記第2の開口型気密弁との間に、前記第1の挿通孔及び第2の挿通孔を有する挿通部材が備えられる請求項1から5のいずれかに記載の外套管。
- 前記外套管は、
前記穿通部の基端に備えられた導入部を更に備え、
前記第1のスリット型気密弁、前記第2のスリット型気密弁、前記第1の開口型気密弁、前記第2の開口型気密弁、及び前記挿通部材は、前記導入部に備えられる請求項6に記載の外套管。 - 前記第1のスリット型気密弁、前記第2のスリット型気密弁、前記第1の開口型気密弁、前記第2の開口型気密弁、及び前記挿通部材は、一体化されたユニット弁体として構成される請求項6又は7に記載の外套管。
- 前記第1の挿入部は内視鏡の挿入部であり、前記第2の挿入部は処置具の挿入部である請求項1から8のいずれかに記載の外套管。
- 前記第1の開口型気密弁の第1の開口の直径が、前記第2の開口型気密弁の第2の開口の直径よりも大きい請求項9に記載の外套管。
- 前記第1のスリット型気密弁と前記第2の開口型気密弁とが一体に構成され、前記第2のスリット型気密弁と前記第1の開口型気密弁とが一体に構成される請求項1から10のいずれかに記載の外套管。
- 前記第1のスリット型気密弁と前記第2のスリット型気密弁とが一体に構成され、前記第1の開口型気密弁と前記第2の開口型気密弁とが一体に構成される請求項1から10のいずれかに記載の外套管。
- 先端と基端と長手軸とを有し、体壁を穿通する穿通部と、
前記穿通部の内部に挿通される2つの医療器具のうち、一方の医療器具の第1の挿入部を、前記長手軸に平行な方向に沿って前記穿通部の内部に進退自在に挿通可能な第1の挿通孔と、
前記第1の挿通孔に隣設し、かつ、他方の医療器具の第2の挿入部を前記第1の挿通孔に平行な方向に沿って前記穿通部の内部に進退自在に挿通可能な第2の挿通孔と、
前記第1の挿通孔に設けられ、前記第1の挿入部が前記第1の挿通孔から抜去されているときに気密性を保持する第1のスリットを有する第1のスリット型気密弁と、
前記第2の挿通孔に設けられ、前記第2の挿入部が前記第2の挿通孔から抜去されているときに気密性を保持する第2のスリットを有する第2のスリット型気密弁と、
前記第1の挿通孔に設けられ、前記第1の挿入部が前記第1の挿通孔に挿入されているときに前記第1の挿入部の外周部に密着して気密性を保持する第1の開口を有する第1の開口型気密弁と、
前記第2の挿通孔に設けられ、前記第2の挿入部が前記第2の挿通孔に挿入されているときに前記第2の挿入部の外周部に密着して気密性を保持する第2の開口を有する第2の開口型気密弁と、
を備え、
前記第1のスリット型気密弁と前記第2のスリット型気密弁とは、前記穿通部の長手軸の軸方向において互いにずれた位置に配置される外套管。 - 前記第1のスリット型気密弁と前記第2の開口型気密弁とが一体に構成され、前記第2のスリット型気密弁と前記第1の開口型気密弁とが一体に構成される請求項13に記載の外套管。
- 先端と基端と長手軸とを有し、体壁を穿通する穿通部と、
前記穿通部の内部に挿通される2つの医療器具のうち、一方の医療器具の第1の挿入部を、前記長手軸に平行な方向に沿って前記穿通部の内部に進退自在に挿通可能な第1の挿通孔と、
前記第1の挿通孔に隔壁を介して隣設し、かつ、他方の医療器具の第2の挿入部を前記第1の挿通孔に平行な方向に沿って前記穿通部の内部に進退自在に挿通可能な第2の挿通孔と、
前記第1の挿通孔に設けられ、前記第1の挿入部が前記第1の挿通孔から抜去されているときに気密性を保持する第1のスリットを有する第1のスリット型気密弁と、
前記第2の挿通孔に設けられ、前記第2の挿入部が前記第2の挿通孔から抜去されているときに気密性を保持する第2のスリットを有する第2のスリット型気密弁と、
前記第1の挿通孔に設けられ、前記第1の挿入部が前記第1の挿通孔に挿入されているときに前記第1の挿入部の外周部に密着して気密性を保持する第1の開口を有する第1の開口型気密弁と、
前記第2の挿通孔に設けられ、前記第2の挿入部が前記第2の挿通孔に挿入されているときに前記第2の挿入部の外周部に密着して気密性を保持する第2の開口を有する第2の開口型気密弁と、
を備え、
前記第1の挿通孔及び第2の挿通孔は、前記穿通部の長手軸に直交した断面において長軸と短軸とを備え、前記第1のスリット及び前記第2のスリットは、前記短軸に沿って形成される外套管。
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EP2979614B1 (en) | 2016-12-28 |
JP6362719B2 (ja) | 2018-07-25 |
US20160022121A1 (en) | 2016-01-28 |
JPWO2014157472A1 (ja) | 2017-02-16 |
EP2979614A4 (en) | 2016-03-16 |
US10251533B2 (en) | 2019-04-09 |
JP6096886B2 (ja) | 2017-03-15 |
EP2979614A1 (en) | 2016-02-03 |
JP2017080607A (ja) | 2017-05-18 |
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