WO2017099152A1

WO2017099152A1 - Trocar

Info

Publication number: WO2017099152A1
Application number: PCT/JP2016/086452
Authority: WO
Inventors: 隆春藤井; 翔五月女; 裕規田岡
Original assignee: 京セラオプテック株式会社
Priority date: 2015-12-07
Filing date: 2016-12-07
Publication date: 2017-06-15
Also published as: JP6847854B2; JPWO2017099152A1

Abstract

A trocar 1 equipped with a head part 3 and a pipe part 2 for inserting a medical instrument into a body, wherein the head part 3 is equipped with a head part outer sleeve 31 communicating with the pipe part 2, a head part inner sleeve 32, an airtight structural unit 44 housed inside the head part inner sleeve 32, and a plug member 40 having an opening 7 for closing a base-end side of the head part inner sleeve 32 and inserting the medical instrument into the pipe part. The airtight structural unit 44 is equipped with a duckbill valve 8 positioned on the pipe part 3 side, the medical instrument being inserted through the duckbill valve 8, and a seal unit 60 interposed between the duckbill valve 8 and the plug member 40, the seal unit 60 elastically sealing the outer periphery of the duckbill valve 8.

Description

Trocar

This disclosure relates to trocars used in endoscopic surgery.

In recent years, there has been a demand for minimally invasive surgery such as laparoscopic surgery in which an endoscope is inserted into the abdominal cavity in order to maintain and improve the quality of life (QOL) of patients. Laparoscopic surgery involves injecting carbon dioxide into the abdominal cavity to inflate the abdominal wall to ensure space and field of view for the procedure. Then, a small hole is provided in the abdominal wall, a device called trocar is inserted, a medical device such as an endoscope (CCD camera etc.) and forceps is inserted into the patient's body, and the image displayed on the monitor by the endoscope It is common to perform surgery while observing (Patent Documents 1 and 2).

The trocar consists of a head part and a pipe part, and a trocar shaft that is inserted from the head part and penetrates the pipe part is mounted. The trocar shaft is formed with a puncture portion at the tip for puncturing it into the abdominal cavity through the body wall. The trocar shaft is pulled out of the trocar after puncture into the abdominal cavity, and the trocar pipe portion remains in the abdominal cavity. In this state, carbon dioxide gas is injected into the abdominal cavity from the trocar head to inflate the abdominal wall.

Therefore, the head portion of the trocar is required to have high airtight performance so that the injected gas does not escape. On the other hand, the trocar has a function of inserting a medical instrument such as forceps into a patient's body, and therefore, a high airtight performance must be maintained even when the medical instrument is inserted.
In general, a duckbill valve and other internal seals are provided in the trocar head to prevent the passage of aeration gas, but it does not interfere with the operation of the medical device and is highly airtight. There is a need for a trocar having a structure.

JP 2013-046789 A JP 2006-167475 A

The problem of the present disclosure is to provide a trocar that is easy to insert / remove OLE_LINK1OLE_LINK6 medical devices and to operate medical devices and has a high airtight structure.

The trocar according to the embodiment of the present disclosure includes a pipe portion and a head portion for inserting a medical instrument into the body. The head portion includes a head portion main body communicating with the pipe portion, an airtight structure unit accommodated in the head portion main body, and a head portion main body base end side, and the medical instrument is inserted into the pipe portion via the airtight structure unit. And a plug member having an opening. The hermetic structure unit includes a sealing valve located on the pipe portion side, and a sealing unit interposed between the sealing valve and the plug member and elastically sealed with the outer peripheral portion of the sealing valve.

According to the present disclosure, it is possible to prevent leakage of gas pressurized in the body cavity by the airtight structure unit, and to maintain airtightness when inserting or removing a medical instrument such as forceps from the opening of the plug member. it can. In addition, a seal unit close to the base end side (front side as viewed from the operator side) of the head body is interposed between the sealing valve and the plug member, and is elastically sealed with the outer peripheral portion of the sealing valve. Since it is positioned, it is possible to easily secure the confidentiality between the sealing valve and the seal unit by attaching the plug member to the head portion main body, and to improve the airtightness in the head portion.

FIG. 5 is a perspective view showing a trocar in a camera deployed state according to an embodiment of the present disclosure. It is a side view of the trocar shown in FIG. It is sectional drawing of the trocar shown in FIG. FIG. 2 is a side view of the trocar shown in FIG. 1 in a camera storage state. It is sectional drawing in the camera storage state of the trocar shown in FIG. FIG. 2B is a side view of the trocar in a state where the trocar shaft is removed from the trocar shown in FIG. 2A. FIG. 3 is a cross-sectional view of the trocar in a state where the trocar shaft is removed from the trocar shown in FIG. 2B. It is sectional drawing which shows the head part of a trocar. 2 is an exploded perspective view of a trocar according to an embodiment of the present disclosure. FIG. It is a disassembled perspective view of the airtight structure unit in one embodiment of this indication. FIG. 8 is a broken exploded perspective view of FIG. 7. It is a fractured perspective view which shows the assembly state of an airtight structure unit. It is sectional drawing which shows the state which rotated the airtight structure unit shown in FIG. 9 90 degrees. It is a perspective view which shows the front-end | tip part of the trocar in a camera part expansion | deployment state. It is sectional drawing which shows the front-end | tip part of the trocar in a camera part expansion | deployment state. It is sectional drawing of a camera part. It is the perspective view which looked at the front-end | tip part of the trocar in the camera part expansion | deployment state from the operator side (front side). It is a perspective view for demonstrating the rotation mechanism of a camera part. It is a fractured perspective view which shows the structure of a camera part. It is sectional drawing of an optical system lens. It is sectional drawing which shows operation | movement of the pipe part outer cylinder in a camera storing state. It is sectional drawing which shows operation | movement of the pipe part outer cylinder in a camera expansion | deployment state. It is a schematic diagram for demonstrating the locking mechanism of the camera part by a trocar shaft. It is a schematic diagram for demonstrating the locking mechanism of the camera part by a trocar shaft. It is a perspective view which shows the form of a stopper member. It is a perspective view which shows the usage method of a trocar. It is a perspective view which shows the usage method of a trocar. It is a perspective view which shows the usage method of a trocar. It is a perspective view which shows the usage method of a trocar. It is explanatory drawing which shows the use condition of a trocar. FIG. 6 is a perspective view showing a trocar according to another embodiment of the present disclosure.

Hereinafter, embodiments of the present disclosure will be described in detail with reference to the drawings.

<Overall structure of trocar>
FIG. 1 shows a trocar 1 according to an embodiment of the present disclosure. The trocar 1 is used in, for example, laparoscopic surgery, and includes a pipe portion 2 on the distal end side (distant position) when viewed in the direction of insertion at the time of surgery and an operator side (hereinafter referred to as “front side”). And the head portion 3 at the position of the case.

The trocar 1 is provided with a trocar shaft 4 penetrating the pipe portion 2 from the head portion 3. The trocar shaft 4 has a puncture portion 4a for puncturing into the abdominal cavity through the body wall at the tip, and a handle portion 4b at the rear end. The puncture part 4a has a conical shape whose tip substantially coincides with the inner diameter of the pipe part 2. The handle portion 4b is used by the operator to insert and remove the trocar shaft 4 from the trocar 1.

As shown in FIGS. 1 and 2A, B, the trocar 1 has a camera unit 5 as an imaging means attached to the tip of the pipe unit 2. FIGS. 1, 2A, and B are developed from the camera unit 5. Indicates the state. On the other hand, FIGS. 3A and 3B show a state in which the camera unit 5 is stored in the pipe unit 2. As shown in FIG. 3B, the tip portion 4c following the puncture portion 4a of the trocar shaft is formed in a column shape having substantially the same outer diameter as the inner diameter of the pipe portion, and in the retracted state of the camera portion 5, In order to secure a storage space, a notch 6 is formed in a part thereof. And the connection part 4d from the front-end | tip part 4c to the handle | steering-wheel part 4b is formed smaller in outer diameter than the front-end | tip part 4c. This structure is adopted because of the large force applied when inserting the trocar 1 by supporting the tip of the pipe part 2 provided with the camera part 5 from the inside by the tip part 4c having a large outer diameter. This is for ensuring sufficient strength.
Incidentally, when the inner diameter of the pipe part 2 is 12.7 mm, the outer diameter of the columnar tip part 4 c is preferably about 12.6 mm.

4A and 4B show the trocar 1 in which the trocar shaft 4 is extracted from the state shown in FIGS. 2A and 2B. The pipe portion 2 of the trocar 1 has a double structure including a pipe portion outer cylinder 21 and a pipe portion inner cylinder 22 as shown in FIG. 4B. The head section 3 includes a head section outer cylinder 31 formed integrally with the pipe section outer cylinder 21 and a head section inner cylinder 32 formed integrally with the pipe section inner cylinder 22.
In addition, the pipe part outer cylinder 21 and the head part outer cylinder 31, and the pipe part inner cylinder 22 and the head part inner cylinder 32 may be integrally connected or connected.

<Head>
Next, the structure of the head part will be described. The head portion inner cylinder 32 includes an air supply tube 10 that feeds a gas such as carbon dioxide or air into the abdominal cavity (see FIG. 1). The gas sent from the air supply tube 10 attached to the head portion inner cylinder 32 is sent into the abdominal cavity through the pipe portion inner cylinder 22 to pressurize the abdominal cavity.

As shown in FIGS. 5 and 6, the head portion 3 has a double structure including the head portion outer cylinder 31 and the head portion inner cylinder 32 described above. Further, an airtight structure unit 44 is accommodated in the head portion inner cylinder 32. In order to fix the airtight structure unit 44 at a predetermined position in the head portion inner cylinder 32, a plug is provided on the proximal end side of the head portion inner cylinder 32. A member 40 is provided. The head portion outer cylinder 31 and the head portion inner cylinder 32 containing the airtight structure unit 44 constitute a head portion main body.
The plug member 40 has an opening 7 through which the trocar shaft 4 is inserted at the center. In FIG. 5, the trocar shaft 4 is inserted into the opening 7, and the handle 4 b is locked to the plug member 40. After the trocar shaft 4 is pulled out, a medical instrument such as forceps (not shown, hereinafter sometimes referred to as a surgical instrument) can be inserted from the opening 7.
A connector portion 11 to which a flexible cable 28 (signal / power cable / FPC cable) extending from the camera portion 5 is connected is formed on the outer peripheral surface of the plug member 40.

Next, the airtight structure unit 44 will be described with reference to FIGS.
As shown in FIGS. 7 and 8, the airtight structure unit 44 has a duckbill valve 8 on the distal end side (distant position) of the head portion inner cylinder 32, and further toward the front side (operator side) from the duckbill valve 8. The seal unit 60 is arranged.
The duckbill valve 8 has a flange 8a on the outer peripheral surface. On the other hand, a step portion 50 with which the flange 8a abuts is formed on the inner peripheral surface of the head portion inner cylinder 32 to which the airtight structure unit 44 is attached (see FIG. 6). 51, on the other hand, correspondingly, the step portion 50 is formed with a convex portion 52. Therefore, when the airtight structure unit 44 including the duckbill valve 8 is mounted, the duckbill valve 8 is brought into a predetermined position. In addition, the recessed part 51 and the convex part 52 may each be only one, and may be provided with two or more.
The seal unit 60 includes a seal holder 42, a dome-shaped seal fixing distal end mount 91, a dome-shaped seal 92, an airtight rubber cover 37 (airtight cover) and a seal holder 42 in order from the duckbill valve 8 toward the front side (operator side). A dome-shaped seal fixing front side mount 93 is provided. The seal unit 60 is a seal structure for preventing leakage of gas pressurized into the abdominal cavity by closely contacting the surgical instrument when the surgical instrument is inserted and used. It is configured.

The duckbill valve 8 is a duck mouth-shaped valve mechanism, and partitions the opening 7 and the inside of the pipe portion 2. As shown in FIG. 9, the duckbill valve 8 is closed to prevent leakage of gas pressurized into the abdominal cavity before the insertion of a surgical instrument such as the trocar shaft 4 or forceps. The shaft 4 and the surgical instrument are inserted into the pipe portion 2 so as to push open the opening / closing port 81. The duckbill valve 8 is formed from an elastomer material such as silicone rubber as an elastic material.
FIG. 10 shows the airtight structure unit 44 rotated by 90 ° from the state shown in FIG.

Returning to FIGS. 7 and 8, the seal unit 60 will be described. The seal holder 42 is formed of a resin material such as polycarbonate or acetal, and has a large-diameter portion 42a that fits in the cylindrical portion 8b on the near side of the flange 8a of the duckbill valve 8, and a flange of the dome-shaped seal fixing front end mount 91. And a flat surface portion 42c having a small diameter portion 42b for positioning the portion 91b. The seal holder 42 functions as a holder for holding an airtight rubber cover 37 described later.
The dome-shaped seal fixing front end side mount 91 is formed of a polycarbonate resin or the like, and includes a peripheral wall portion 91a and a flange portion 91b that are fitted with the dome-shaped seal 92, and a plurality of flanges 91b (six in the figure). ) Pin 91c is integrally formed.

The dome-shaped seal 92 is formed of an elastomer material such as silicone rubber as an elastic material, and includes a seal portion main body 92a having a device insertion port 41 for inserting the trocar shaft 4 and other surgical tools, and a flange portion 92b. Composed. The flange portion 92b is provided with a positioning hole 45 through which a pin 91c provided on the dome-shaped seal fixing front end side mount 91 is inserted.

The airtight rubber cover 37 is formed of an elastomer material such as silicone rubber as an elastic material, and has a function of connecting the duckbill valve 8 and the dome-shaped seal 92 to improve the airtightness therebetween. The airtight rubber cover 37 includes a cylindrical portion 37a, a first small-diameter portion 37b provided on the front end side thereof, and a second small-diameter portion 37c provided on the near side, and the second small-diameter portion 37c includes a dome-shaped seal. A bellows portion 371 is formed so as to follow the 92 movement slides. Further, a flat peripheral edge (flat part) 37d is formed at the periphery of the opening 39 on the inner diameter side of the bellows part 37I provided in the second small diameter part 37c, and a pin 91c is inserted into the peripheral part (flat part) 37d. A positioning hole 46 is formed.

The front mount 93 for fixing the dome-shaped seal is formed of a resin material such as polycarbonate or polyacetal, and includes a peripheral wall portion 93a and a flange portion 93b that are fitted to the dome-shaped seal 92. The flange portion 93b includes a dome-shaped seal. A positioning hole 47 through which a pin 91c provided in the fixing front end mount 91 is inserted is provided.

The assembled state of the airtight structure unit 44 is shown in FIGS. In assembling, the flat part 42c and the

flange parts

91b and 92b of each of the four parts of the dome type seal fixing front end mount 91, the dome type seal 92, the airtight rubber cover 37 and the dome type seal fixing front side mount 93 are provided. 37d and 93b are overlapped, and the pin 91c provided on the front end side mount 91 is inserted through holes 45, 46, 47 provided in the airtight rubber cover 37 and the front side mount 93 for fixing the dome-shaped seal in order (FIG. 7). See). Finally, the tip end of the pin 91c is integrated by caulking with heat, and then the far side edge 42d of the seal pressing cover 42 is attached to the first small diameter portion 37b provided on the tip end side of the airtight rubber cover 37. By holding, the seal unit 60 is assembled.
Note that a protruding edge 93d is formed on the outer peripheral edge of the flange portion 93b of the dome-shaped seal fixing front side mount 93 so as to extend toward the front side of the flat portion of the flange portion 93b. As shown in FIG. 9, the protruding amount of the protruding edge 93d may be such that the pin 91c crimped by heat does not protrude from the protruding edge 93d but is accommodated in the protruding edge 93d.
Thus, by overlapping the

flange portions

91b, 92b, 37d and 93b and integrating the dome-shaped seal 92, in conjunction with the movement of the surgical instrument inserted into the instrument insertion port 41 of the dome-shaped seal 92, The dome-shaped seal 92 acts on the bellows portion 371 provided on the airtight rubber cover 37, and the dome-shaped seal can be moved while maintaining the close contact state of the instrument insertion port 41.

Next, an airtight structure unit 44 is obtained by bringing the first small-diameter portion 37 b provided on the front end side of the airtight rubber cover 37 constituting the seal unit 60 into close contact with the front surface of the flange portion 8 a of the duckbill valve 8. In this state, as shown in FIG. 6, the airtight structure unit 44 is inserted into the pipe inner cylinder 32, and the flange portion 8 a of the duckbill valve 8 is locked to the step portion 32 a formed on the inner surface of the pipe inner cylinder 32. Further, the plug member 40 is fitted into the pipe inner cylinder 32 from the front side.
At this time, the front end surface 40a (see FIG. 5) of the plug member 40 comes into contact with the protruding edge 93d of the dome-shaped seal fixing front side mount 93. As shown in FIG. 9, this contact force is transmitted to the dome type seal fixing front side mount 91 via a pin 91c caulked by heat, and further contacts the dome type seal fixing front side mount 91. It is transmitted to the first small diameter portion 37b provided on the distal end side of the airtight rubber cover 37 via the distal end side (distant position side edge 42d) of the seal holder 42, and the front surface of the flange portion 8a of the duckbill valve 8 It can be brought into contact with the airtight state.
As a result, the four components are integrally pressed against the flange portion 8a of the duckbill valve 8, whereby the duckbill valve 8 and the dome-shaped seal 92 are connected in an airtight state.
In this embodiment, a structure in which the hermetic structure unit 44 is in close contact with the seal unit 60 and the duckbill valve 8 is adopted, but it is of course possible to integrate up to the duckbill valve 8 using the airtight rubber cover 37 of the seal unit 60. Is possible. That is, the airtight rubber cover 37 and the duckbill valve 8 may be joined or integrally formed.

<Camera part>
As will be described later, the camera unit 6 can be stored in the pipe unit 2 and is deployed outward from the outer peripheral surface of the pipe unit 2 within the abdominal cavity. 2 and 3 show the unfolded state and the retracted state of the camera unit 5 in the trocar 1, respectively. 4A and 4B show a state where the trocar shaft 4 is extracted from the trocar 1 and the camera unit 5 is unfolded.

FIGS. 11A and 11B are enlarged views of the distal end portion of FIGS. 4A and 4B, and the camera unit 5 is in a state of being developed outside the pipe unit 2. The camera unit 5 is pivotally supported at both ends so that the camera unit 5 can be accommodated in the tip notch portion 23 of the pipe portion inner cylinder 22. As a result, the camera unit 5 can freely rotate between the unfolded state in which the camera unit 5 can be photographed outside the pipe unit 2 and the stored state stored in the pipe unit 2. As described above, the unfolded camera unit 5 is located at the distal end portion of the pipe portion inner cylinder 22, so that the field of view is not obstructed by the pipe portion 2, and is suitable for photographing the surgical field.

That is, the camera unit 5 includes a substantially U-shaped housing 13 and a camera mount 17 attached to the front surface of the housing 13 (in this embodiment, a U-shaped inner bottom surface).

Lenses

14a, 14b, and 14c, an imaging sensor protecting translucent plate 15, and an imaging sensor 16 (such as a CMOS) are attached in order along the transmission direction. The

lenses

14 a, 14 b and 14 c are stacked in the lens barrel 25. A flexi cable 28 is connected to the image sensor 16. The flexible cable 28 passes between the pipe part outer cylinder 21 and the pipe part inner cylinder 22, and passes through the gap between the pipe part outer cylinder 21 and the head part outer cylinder 31 and the head part inner cylinder 32 connected to the pipe part inner cylinder 22, respectively. Then, it is drawn out from the front side single edge of the head part outer cylinder 31 to the outside of the head part 3 and drawn into the connector part 11 through an opening (not shown) formed in the surface of the connector part 11 on the head part 3 side. The circuit board 100 (see FIG. 5), which will be described later, is connected. A translucent protective cover 18 is attached to the front surface of the lens 14a.
The

lenses

14a, 14b, and 14c and the protective translucent plate 15 can be made of optical glass or optical resin, but it is desirable that the

lenses

14a, 14b, and 14c be made of a resin material that can be manufactured at low cost and can be easily aspherically molded.

An imaging sensor reinforcing metal plate 19 (back plate) is disposed on the back side of the flexible cable 28 connected to the imaging sensor 16. This imaging sensor reinforcing metal plate 19 is mounted directly on the flexible cable 28, so that the planarity of the imaging sensor 16 is maintained and the sensor is protected. As the reinforcing metal plate 19, it is preferable to use an aluminum plate that also has a heat dissipation effect of the image sensor 16. The reinforcing metal plate 19 and the housing 13 are sealed with a filler 19 'such as a silicone material.

The housing 13 has a curved back surface portion 13a that is flush with the pipe portion inner cylinder 22 in the retracted state of the camera portion 5, and side surface portions 13b are formed on both sides of the back surface portion 13a. Since the back surface portion 13a has a curved surface as described above, the pipe portion outer cylinder 21 can be smoothly slid when the camera portion 5 is stored and deployed. Further, in the unfolded state of the camera unit 5, the

lenses

14 a, 14 b and 14 c face the front of the pipe unit 2.

As shown in FIGS. 12 and 13, on both

side surface portions

13 b and 13 b of the housing 13, a protruding portion 13 c extending downward in the pipe inner cylinder 22 is formed at the lower end portion, and each protruding portion 13 c includes The shaft portion 20 is formed so as to protrude outwardly perpendicular to the axial direction of the pipe portion 2.
Then, as shown in FIGS. 11A, 11B and 13, the shaft portion 20 is inserted through inclined grooves 24 that are obliquely cut from both side portions of the front end notch portion 23 of the pipe portion inner cylinder 22 toward the front side. And is engaged with the inclined groove 24. The center of the shaft portion 20 is a shaft fulcrum S for rotating the camera portion 5. Thereby, although it is compact, the moment at the time of raising / lowering the camera part 5 using the pulling force of the coil spring 12 (elastic member) mentioned later is securable. Further, since the inclined groove 24 inclined as described above is employed, the camera unit 5 can be easily mounted.

As shown in FIG. 14, L-shaped portions 45 project downward from both sides of the bottom portion 13 d of the housing 13, and the L-shaped portion 45 is associated with the ring-shaped portion 12 a at one end of the coil spring 12. Stopped. As shown in FIG. 13, the two coil springs 12 are accommodated in a concave groove 46 that extends from the front end notch portion 23 of the pipe portion inner cylinder 22 to the front side (operator side) along the axial direction of the pipe portion 2. The ring-shaped part 12 b at the other end on the near side of the coil spring 12 is fixed in the groove 46.

One end (ring-shaped portion 12 a) of the coil spring 12 is locked on the front side of the shaft portion 20 and at a radially outward position of the pipe portion 2 from the shaft portion 20. Thereby, the camera part 5 is urged | biased to the near side. As a result, the camera unit 5 rotates rearward with the pivot point S as the rotation center, and is in a deployed state.
Therefore, when the trocar 1 is pulled out from the body while the camera unit 5 is deployed in the body, the camera unit 5 is rotated by an external force applied from the rear end side to the front end side in the axial direction of the pipe portion 2 at the time of removal. Since it is stored in the pipe portion inner cylinder 22, it is safe.
In particular, when a large force that is not assumed from the rear end side to the front end side acts on the camera unit 5, the L-shaped portion 45 and the ring-shaped portion 12a at one end of the coil spring 12 are disengaged from each other. Since the shaft portion 20 is engaged with the inclined groove 24 of the pipe portion inner cylinder 22, the shaft portion 20 can be detached so as to slide along the inclined groove 24, and the camera portion 5 can be detached. Accordingly, in an emergency or the like, the camera unit 5 can be detached from the trocar 1 without damaging it, so that safety can be improved and the risk of damaging the camera unit 5 can be reduced.
At this time, since the other end of the coil spring 12 is fixed, it does not fall into the abdominal cavity.

In this embodiment, the imaging sensor 16 is directly mounted on the flexible cable 28 in order to make the camera unit 5 as small as possible. The mounting unit does not have a controller function for controlling the image sensor 16, and controller functions such as clock control are arranged on the circuit board 100 (control means, see FIG. 5) provided in the head unit 3. ing. Therefore, the end portion of the flexible cable 28 directly mounted on the imaging sensor 16 is connected to the circuit board 100 at the connector portion 11 of the head portion 3, and is connected to the external cable 102 (USB cable) soldered from the circuit board 100. The image signal is sent to the outside.

When the translucent protective cover 18 is formed from a transparent optical resin, as shown in FIGS. 15A and 15B, the inner surface adjacent to the lens 14a becomes a concave curved surface 181 and can have optical performance. Become. Therefore, since the translucent protective cover 18 itself exhibits the function of a lens, the number of lenses to be used can be reduced, and the distance between the translucent protective cover 18 and the

lenses

14a, 14b, and 14c can be reduced. Thus, the camera unit 5 can be reduced in thickness and size. In addition, a structure such as a peripheral wall described later can be integrally formed.
The translucent protective cover 18 has a peripheral wall 182, and a hole 26 is formed in the peripheral wall 182. On the other hand, the camera mount 17 has a claw portion 27 on the distal end side, and is integrated by locking the claw portion 27 in the hole 26 when the translucent protective cover 18 is attached. At that time, a sealing material 29 such as rubber is fitted between the camera mount 17 and the translucent protective cover 18 in order to ensure waterproofness.

<Lock mechanism (1)>
Next, a lock mechanism for holding the camera unit 5 in the unfolded state or the stored state and preventing the camera unit 5 from inadvertently operating will be described. 16A and 16B show cross-sectional views obtained by rotating the cross-sectional views of FIG. 3B showing the retracted state and FIG. 2B showing the unfolded state by 90 °, respectively.
As shown in FIGS. 16A and 16B, two concave portions 30a and 30b are arranged in parallel on the outer peripheral surface of the head portion inner tube 32 to which the pipe portion inner tube 22 is connected. On the other hand, a lock lever 34 having a claw-like convex portion 33 is attached to the head portion outer tube 31 to which the pipe portion outer tube 21 is connected.
The recesses 30a and 30b and the lock lever 34 are provided as a pair at positions symmetrical to 180 degrees.
In the retracted state of the camera unit 5 (FIG. 16A), the convex portion 33 provided at the distal end of the lock lever 34 is engaged with the concave portion 30a on the distal end side to lock the pipe portion outer cylinder 21. On the other hand, in the unfolded state of the camera unit 5 (FIG. 16B), the pipe unit outer cylinder 21 is locked by engaging with the concave portion 30b on the near side. These operations can be performed by the lock lever 34 extending from the head portion outer cylinder 31 to the outside. That is, when one end exposed to the outside of the lock lever 34 is pushed with a finger, the convex portion 33 provided at the other end of the lock lever 34 is rotated upward to be detached from the concave portion 30a or 30b. The external cylinder 21 is slid.

The pipe portion outer cylinder 21 is formed to be shorter than the pipe portion inner cylinder 22. This is a state in which the camera unit 5 is deployed out of the pipe part 2 from the tip notch part 23 of the pipe part inner cylinder 22 (the state of FIG. 16B), and the pipe part outer cylinder 21 is located behind the camera part 5. It is for doing so.
Further, as shown in FIGS. 17A and 17B, a tubular sealing material 49 is interposed between the pipe portion outer cylinder 21 and the pipe portion inner cylinder 22. The tubular sealing material 49 is formed of silicone rubber or the like, and is sheathed on the pipe portion inner cylinder 22 so as to sandwich the above-described flexible cable 28, and even in the presence of the flexible cable 28, the pipe portion outer cylinder 21. Can be slid while maintaining an airtight state. In addition, in order to reduce the friction coefficient of the tube-shaped sealing material 49, you may make it ensure a lubrication effect | action with the oils and fats which can be used for medical uses, such as silicone oil.

<Lock mechanism (2)>
In the present embodiment, the camera unit 5 is locked by the trocar shaft 4 so that the camera unit 5 is not unintentionally deployed when the camera unit 5 is stored. That is, as shown in FIG. 17A, in the state where the camera unit 5 is stored in the notch 6 formed in the trocar shaft 4, the tip surface of the camera 5 is the tip wall 6 of the notch 6. Is prevented from rotating in contact with the. Therefore, the lock state can be reliably maintained in cooperation with the lock mechanism by the lock lever 34 described above.
On the other hand, in order to release the lock by the trocar shaft 4, as shown in FIG. 17B, if a gap is formed between the distal end wall portion 6 of the trocar shaft 4 and the distal end surface of the camera portion 5, it is easy. The camera unit 5 can be deployed.

In order to perform locking and releasing by the trocar shaft 4, as shown in FIG. 18, a camera portion storage position click groove 47a and a camera are provided on the outer peripheral portion of the end surface of the plug member 40 located on the front side (operator side) of the trocar 1. Partial development position click grooves 47b are juxtaposed in a predetermined sense. When the trocar shaft 4 is inserted into the opening 7 of the plug member 40 and the handle portion 4b is attached to the end face of the plug member 40, the projection (not shown) provided on the handle portion 4b is shown in the retracted state of the camera unit 5. Is engaged with the camera portion storage position click groove 47a. On the other hand, at the time of deployment, the trocar shaft 4 is rotated by holding the handle portion 4b to engage the protrusion with the camera portion deployment position click groove 47b. Thereby, a gap D is formed between the distal end wall portion 6 of the trocar shaft 4 and the distal end surface of the camera portion 5 (see FIG. 19B), and the camera portion 5 can be deployed.
That is, since the camera portion unfolding position click groove 47b is deeper than the camera portion storage position click groove 47a, the trocar shaft 4 is moved to the tip side and the gap D is formed between the camera portion 5 and the tip surface. Can be formed.

Next, a method of using the trocar 1 according to this embodiment will be described with reference to FIGS. 19A to 19 (d). First, in the initial state shown in FIG. 19A (the storage state of the camera unit 5), the trocar shaft 4 is rotated from the camera unit storage position click groove 47a to the camera unit deployment position click groove 47b, A gap D is formed between 6 and the front end surface of the camera unit 5 (FIG. 19B).

Next, as shown in FIG. 19C, the lock lever 34 of the pipe portion outer cylinder 21 is pushed, and the pipe portion outer cylinder 21 is slid forward. Thereby, the camera unit 5 is developed by the urging force of the coil spring 12 (see FIG. 11), and the trocar shaft 4 can be pulled out.
In this state, as shown in FIG. 19D, the trocar shaft 4 can be pulled out and used as a trocar port.

In actual use, in the initial state shown in FIG. 19A (in the retracted state of the camera unit 5), the puncture portion 4a formed at the tip of the trocar shaft 4 is punctured into the abdominal cavity through the body wall. Next, as described above, the camera unit 5 is deployed in the body wall 35, the trocar shaft 4 is extracted from the trocar 1, and the operation is performed while photographing the trunk portion 36 in the abdominal cavity as shown in FIG.

Therefore, the surgeon can insert a forceps or the like (not shown) from the opening 7 of the trocar 1 while looking at the image displayed on the monitor (not shown), so that the field of view is enlarged. In addition, the operation becomes easier and the safety of the operation is improved. In particular, since the camera unit 5 is provided at the tip of the pipe unit 2, there is an advantage that the visual field is not obstructed by the pipe unit 2 or the like.

<Other embodiments>
In the above embodiment, the case where the camera unit 5 and the connector unit 11 are arranged on the same side with respect to the pipe unit 2 has been described, but the camera unit 5 and the connector unit 11 may be arranged at different positions. Good. For example, as shown in FIG. 21, the camera unit 5 and the connector unit 11 can be arranged in a symmetrical position with respect to the axis of the pipe unit 2 or in the vicinity thereof.
In this case, the external cable 102 during the operation can be arranged below the position of the operator's hand, and when the operator's hand touches the external cable 102, the camera unit 5 moves and rotates around the pipe unit 2 as the rotation axis. It is possible to effectively prevent the projected surgical field from rotating.
The positions of the camera unit 5 and the connector unit 11 may be arranged at positions different from the mounting position of the camera unit in the circumferential direction of the head unit so that the operator's hand does not touch the external cable 102. For example, the connector part 11 may be disposed at an angle of 90 ° or more from the camera part 5 with respect to the axial center of the pipe part 2.
Others are the same as the said embodiment.

The trocar 1 according to the embodiment of the present disclosure has been described above, but the present disclosure is not limited to the above embodiment, and various improvements and improvements can be made within the scope of the claims. For example, in the above-described embodiment, the pin 91c is provided in the dome-shaped seal fixing front-end mount 91, and the positioning hole 47 through which the pin 91c is inserted is provided in the dome-shaped seal fixing front-side mount 93. Alternatively, a positioning hole 47 may be provided in the distal end side mount 91, and a pin 91c may be provided in the near side mount 93. Others are the same as that of the said embodiment.
Further, the camera unit 5 may be provided with an illumination device so that the surgical field is brightened. Note that the trocar of the present disclosure can also be suitably used for endoscopic surgery in the thoracic cavity.

DESCRIPTION OF SYMBOLS 1 Trocar 2 Pipe part 3 Head part 4 Trocar shaft 4a Puncture part 4b Handle part 5 Camera part 6 Notch part 7 Opening part 8 Duck bill valve 10 Air supply pipe 11 Connector part 12 Coil spring (elastic member)
13

Housing

14a, 14b, 14c Lens 15 Imaging sensor protective cover 16 Imaging sensor 17 Camera mount 18 Translucent protective cover 19 Imaging sensor reinforcing metal plate 20 Shaft portion 21 Pipe portion outer cylinder 22 Pipe portion inner cylinder 23 Tip notch portion 24 Inclined groove 25 Lens barrel 26 Hole 27 Claw portion 28 Flexible cable 29 Sealing material 30a, 30b Recess 31 Head portion outer cylinder 32 Head portion inner tube 33 Convex portion 34 Lock lever 35 Body wall 37 Airtight rubber cover (airtight cover)
40 Plug member 42 Seal holder 44 Airtight structure unit 50 Step 51 Recess 52 Protrusion 60 Seal unit 91 Front side mount 92 for fixing the dome type seal Dome type seal 93 Front side mount 100 for fixing the dome type seal Circuit board (control means)
102 Cable 371 Bellows

Claims

A trocar having a pipe part and a head part for inserting a medical instrument into the body,
The head portion is
A head portion main body communicating with the pipe portion; an airtight structure unit housed in the head portion main body;
A plug member that covers a proximal end side of the head body and has an opening for inserting the medical device into the pipe part through an airtight structure unit;
The airtight structural unit is
A sealing valve located on the pipe part side;
A trocar comprising a sealing unit interposed between the sealing valve and the plug member and elastically sealed with an outer peripheral portion of the sealing valve.
The trocar according to claim 1, wherein the sealing valve is a duckbill valve made of an elastic member.
The trocar according to claim 1 or 2, wherein the seal unit includes an airtight cover having an abutting portion that elastically contacts a peripheral portion of the sealing valve.
The airtight cover includes a cylindrical part, a first small diameter part provided on the pipe part side of the cylindrical part, and a second small diameter part provided on the opening part side,
The trocar according to claim 3, wherein an elastic bellows portion is formed on the second small diameter portion, and a flat peripheral edge portion is formed further on the inner diameter side of the bellows portion.
5. The seal unit further includes a dome-type seal fixing front-end mount and a dome-type seal fixation front-side mount, which are respectively disposed before and after the airtight cover as viewed in the insertion direction during surgery. Trocar as described in.
The seal unit includes a dome-type seal fixing distal end mount, a dome-type seal, an airtight rubber cover, and a dome-type seal fixing front-side mount, which are arranged in order from the sealing valve toward the base end side of the head portion main body. And is integrated at the periphery,
A seal holder is arranged between the sealing valve,
The trocar according to any one of claims 1 to 5, wherein the seal holder is enclosed by a cylindrical portion of the hermetic cover and the first small diameter portion provided on the pipe portion side of the cylindrical portion.
One of the flange portion of the front end mount for fixing the dome-shaped seal and the flange portion of the front mount for fixing the dome-shaped seal has a pin projecting toward the other flange portion, The flange is provided with positioning holes,
The flange portion of the dome-shaped seal and the flat peripheral portion of the airtight cover are further provided with positioning holes,
The pin is inserted into a positioning hole provided in the other flange portion through the flange portion of the dome type seal and the peripheral flat portion of the airtight cover, and the tip side mount for fixing the dome type seal 7. The trocar according to claim 6, wherein the dome-type seal, the airtight rubber cover, and the dome-type seal fixing front side mount are fixed integrally.
The head part main body includes a head part outer cylinder and a head part inner cylinder,
The pipe part includes a pipe part outer cylinder integrated with the head part outer cylinder, and a pipe part inner cylinder integrated with the head part inner cylinder, and the pipe part outer cylinder extends axially on the pipe part inner cylinder. Slidably extrapolated,
8. The pipe according to claim 1, wherein the camera unit is pivotally supported on the inner cylinder of the pipe unit so as to be rotatable between a deployed state in which the camera unit is rotated out of the pipe unit and a stored state in which the camera unit is stored in the pipe unit. The trocar according to crab.