WO2018229984A1

WO2018229984A1 - Access sheath fixture and access sheath unit

Info

Publication number: WO2018229984A1
Application number: PCT/JP2017/022386
Authority: WO
Inventors: 尚也杉本; 善朗岡崎; 和敏熊谷
Original assignee: オリンパス株式会社
Priority date: 2017-06-16
Filing date: 2017-06-16
Publication date: 2018-12-20

Abstract

This access sheath fixture (2) comprises an endoscope holding portion (5) for holding a midway position in the longitudinal direction of an endoscope (10) inserted into an inner hole (1a) of an access sheath (1), and an attachment portion (6) for detachably attaching the endoscope holding portion (5) to the proximal end portion of the access sheath (1) so that the endoscope (10) held by the endoscope holding portion (5) is positioned to one side in the inner hole (1a) and the entrance of the inner hole (1a) that opens in the proximal end face (4c) of the access sheath (1) can be exposed.

Description

Access sheath fixture and access sheath unit

The present invention relates to an access sheath fixture and an access sheath unit.

2. Description of the Related Art Conventionally, an insertion instrument for endoscopic surgery having a plurality of ports for inserting an endoscope and a treatment tool into the body is known (see, for example, Patent Documents 1 and 2). An insertion instrument includes a cylindrical sheath that is inserted into a body cavity from a single incision formed in a patient's body, and a plate-like or cap-like member that covers a proximal end of the sheath and has a plurality of ports formed therein. It has. By using such an insertion instrument, the endoscope and the treatment tool can be inserted into the body cavity through a single incision.

JP 2014-205041 A Japanese Patent Laying-Open No. 2015-0430302

However, since the insertion instrument of

Patent Documents

1 and 2 is covered with a plate-like or cap-like member and the inside of the sheath cannot be observed because the part other than the port cannot be observed, The positional relationship with the treatment tool cannot be confirmed. Therefore, there is a disadvantage that the insertion property of the treatment tool into the sheath is not good because the treatment tool interferes with an endoscope already arranged in the sheath when the treatment tool is inserted.

The present invention has been made in view of the above-described circumstances, and an object of the present invention is to provide an access sheath fixing tool and an access sheath unit that can improve the insertability of a treatment tool into an access sheath. .

In order to achieve the above object, the present invention provides the following means.
One aspect of the present invention is an access sheath fixture that has an inner hole penetrating in the longitudinal direction and is attached to a proximal end portion of a cylindrical access sheath that is inserted into a body cavity, and is inserted into the inner hole. An endoscope holding portion that holds a midway position in the longitudinal direction of the endoscope, and the endoscope holding portion that is held by the endoscope holding portion in the inner hole. An access sheath fixture comprising: an attachment portion detachably attached to the proximal end portion of the access sheath so as to be located on the side and capable of exposing the inlet of the inner hole opened to the proximal end surface of the access sheath It is.

According to this aspect, the endoscope holding portion is attached to the proximal end portion of the access sheath by the attaching portion, and the intermediate position in the longitudinal direction of the endoscope that is inserted into the inner hole of the access sheath and extends from the inlet of the inner hole is determined. By holding by the endoscope holding portion, the endoscope is held on one side in the inner hole, and a space for inserting the treatment instrument is secured in the inner hole. Further, the inlet of the inner hole can be exposed in this state. Therefore, the operator can easily operate the treatment tool while observing the inlet of the inner hole so as not to interfere with the endoscope already arranged in the inner hole in the secured space in the inner hole. Can be inserted into.

In the above aspect, the attachment portion may have a substantially arcuate attachment arm portion that fits to a substantially cylindrical outer peripheral surface of the proximal end portion of the access sheath, and is more than the inlet of the inner hole. You may have the convex part which can be inserted or removed in the attachment hole opened to the base end surface of the said access sheath in the radial direction outer side.
In this way, the access sheath fixture can be attached to the proximal end portion of the access sheath so that the inlet of the inner hole does not overlap the inlet of the inner hole when viewed in the direction along the longitudinal axis.

In the above aspect, the endoscope holding portion includes a substantially arc-shaped holding arm portion, and protrusions provided at both ends of the holding arm portion and projecting radially inward of the holding arm portion, A substantially fan-shaped opening into which the endoscope can be fitted is formed inside the holding arm portion and the projection portion, and the attachment portion has the holding arm portion along the circumferential direction of the inner hole. The endoscope holding portion may be attached to the proximal end portion of the access sheath so as to be arranged around the hole.
In this way, when the inlet of the inner hole is viewed in the direction along the longitudinal axis, the endoscope holding part does not overlap the inlet of the inner hole except for the protrusions, so that the inlet of the inner hole is always exposed. Can be made.

In the above aspect, the endoscope holding portion includes a movable member having an end that can swing around a predetermined swing axis, and a biasing member that biases the movable member, and the mounting portion includes A first position at which the end portion of the movable member is held between the inner hole and the inner surface of the inner hole, and a second position that is disposed radially outside the inner hole. The endoscope holding portion may be attached to the proximal end portion of the access sheath so as to swing between the two, and the biasing member biases the movable member toward the first position. .
In this way, when the inlet of the inner hole is viewed in the direction along the longitudinal axis, the endoscope holding part does not overlap the inlet of the inner hole except for the biasing member. Can be exposed.

In the above aspect, the attachment portion is made of an elastic material, has an attachment hole that fits into a proximal end portion of the access sheath, and is formed of a cap-shaped member that covers the proximal end portion of the access sheath, An endoscope holding portion is provided on the cap-shaped member, and includes an endoscope port through which the endoscope passes through the inner hole and along the longitudinal direction of the inner hole. A notch extending in the radial direction from the endoscope port to the outer peripheral surface of the cap-shaped member may be formed.
By doing in this way, the entrance of the inner hole covered with the cap-shaped member can be exposed by turning the cap-shaped member at the position of the cut.

In the said aspect, you may provide the position adjustment part which adjusts the position of the circumferential direction with respect to the entrance of the said internal hole of the said endoscope holding part.
In this way, the position where the endoscope is held can be adjusted in the circumferential direction of the inlet of the inner hole.

In the above aspect, the guide is provided at a position arranged radially outside the inner hole in a state in which the attachment portion is attached to the proximal end portion of the access sheath, and extends outward from the inlet of the inner hole. You may provide the wire holding part which hold | maintains the middle position of the longitudinal direction of a wire.
By doing in this way, the guide wire can be prevented from moving due to pulsation or the like by holding the guide wire by the wire holding portion.

According to another aspect of the present invention, there is provided a cylindrical access sheath having an inner hole through which a endoscope and a treatment instrument can be inserted, and any one of the above-described attachments attached to a proximal end portion of the access sheath. An access sheath unit including an access sheath fixture.

In the above aspect, when the attachment portion of the access sheath fixture has the attachment arm portion, a plurality of grooves are formed on the outer peripheral surface of the proximal end portion of the access sheath at intervals in the circumferential direction. The attachment portion may include a claw portion that is provided at at least one end of the attachment arm portion, protrudes radially inward of the arm portion, and fits in the groove.
By doing so, the attachment arm portion can be positioned in the circumferential direction with respect to the proximal end portion of the access sheath.

In the above aspect, when the mounting portion of the access sheath fixture has the convex portion, a plurality of mounting holes are circumferentially spaced around the inlet of the inner hole on the proximal end surface of the access sheath. It may be formed open.
By doing in this way, the position of an endoscope holding | maintenance part can be changed to the circumferential direction of the entrance of an inner hole by changing the attachment hole which fits a convex part.

According to the present invention, it is possible to improve the insertion property of the treatment instrument into the access sheath.

It is a lineblock diagram of an access sheath with which an access sheath unit concerning a 1st embodiment of the present invention is provided. It is the block diagram seen from the base end side of the fixing tool with which the access sheath unit which concerns on the 1st Embodiment of this invention is provided. It is the block diagram seen from the side of the fixing tool of FIG. 2A. FIG. 2B is a diagram showing a state where the fixture of FIG. 2A is attached to the proximal end portion of the access sheath of FIG. 1. It is a figure which shows the state which fixed the endoscope inserted in the access sheath with the endoscope holding part of a fixing tool. It is a figure which shows the state which hold | maintained the guide wire inserted in the access sheath by the wire holding | maintenance part of a fixing tool. It is the figure which looked at the modification of a fixing tool from the base end side. It is a figure which shows the access sheath unit which concerns on the 2nd Embodiment of this invention, and is a figure which shows the state by which the fixing tool was attached to the base end part of the access sheath. It is the figure which looked at the fixing tool of FIG. 7A from the side. It is a figure which shows the modification of the fixing tool of FIG. 7A. It is a figure which shows the access sheath unit which concerns on the 3rd Embodiment of this invention, and is a figure which shows the state by which the fixing tool was attached to the base end surface of the access sheath. It is the block diagram which looked at the fixing tool of FIG. 9A from the side. It is the figure which looked at the fixing tool in the access sheath unit which concerns on the 4th Embodiment of this invention from the base end side. It is the figure which looked at the fixing tool of FIG. 10A from the side.

(First embodiment)
An access sheath unit 100 according to a first embodiment of the present invention will be described with reference to FIGS.
The access sheath unit 100 according to the present embodiment is used in endoscopic surgery in which an endoscope and a treatment tool are percutaneously inserted into a pericardial cavity (body cavity) to treat the heart, As shown in FIG. 1, an access sheath 1 into which an endoscope and a treatment instrument are inserted, and as shown in FIGS. 2A and 2B, an access sheath fixing tool that can be attached to and detached from the proximal end portion of the access sheath 1 (Hereinafter simply referred to as “fixing tool”) 2. FIG. 3 shows a state in which the fixture 2 is attached to the access sheath 1.

The access sheath 1 and the fixture 2 are designed according to the endoscope and treatment instrument used. Therefore, the access sheath unit 100 may be provided as a system together with an endoscope and a treatment instrument (not shown). In the present embodiment, an endoscope 10 (see FIG. 4) having a substantially fan-shaped cross section having a central angle of less than 180 ° and having side surfaces composed of two flat surfaces and one curved surface, and two treatment tools. Is assumed to be used.

As shown in FIG. 1, the access sheath 1 includes a cylindrical sheath portion 3 having a longitudinal axis, and a handle portion 4 that is connected to the proximal end of the sheath portion 3 and is gripped by an operator when the access sheath 1 is operated. And.

The sheath portion 3 and the handle portion 4 are formed with an inner hole 1a penetrating along the longitudinal axis of the sheath portion 3 from the outlet opening at the distal end surface of the sheath portion 3 to the inlet opening at the proximal end surface of the handle portion 4. Yes. When the endoscope 10 is inserted into the inner hole 1a so that the curved surface of the side surface of the endoscope 10 contacts the inner surface of the inner hole 1a, and two treatment instruments are inserted into the remaining space in the inner hole 1a. In addition, the inner diameter of the inner hole 1a is designed according to the outer diameter of the endoscope 10 and the treatment tool so that a space in which the endoscope 10 and the treatment tool move in the radial direction does not occur in the inner hole 1a. .

The handle part 4 has a larger outer diameter than the outer diameter of the sheath part 3 and has a substantially cylindrical shape coaxial with the sheath part 3. The handle portion 4 has an attachment surface 4a for attaching the fixture 2 and an abutting surface 4b provided on the tip side of the attachment surface 4a. The mounting surface 4a is a substantially cylindrical side surface adjacent to the base end surface 4c of the handle portion 4, and a plurality of grooves 4d are formed in the mounting surface 4a at intervals in the circumferential direction. The abutting surface 4b is an annular surface protruding in a flange shape radially outward from the tip of the mounting surface 4a. By abutting an attachment arm portion 6a (described later) of the fixture 2 attached to the attachment surface 4a against the abutting surface 4b, the fixture 2 is positioned with respect to the handle portion 4 in the direction along the longitudinal axis. Yes.

As shown in FIGS. 2A and 2B, the fixture 2 includes an endoscope holding portion 5 that holds an endoscope 10 inserted into the inner hole 1a, and the endoscope holding portion 5 as a handle portion. 4 and a mounting portion 6 that is detachably attached.

The endoscope holding portion 5 includes a substantially arc-shaped holding arm portion 5a and protrusions 5b provided at both ends of the holding arm portion 5a. The inner peripheral surface of the holding arm portion 5a has substantially the same curvature as the curvature of the curved surface of the endoscope 10, and the protruding portion 5b protrudes inward in the radial direction from the inner peripheral surface of the holding arm portion 5a. . Inside the holding arm 5a and the two protrusions 5b, a substantially fan-shaped opening 5c substantially the same as the cross-sectional shape of the endoscope 10 is formed. As shown in FIG. 4, when the holding arm 5a and the protrusion 5b are tightly fitted to the side surface of the endoscope 10 inserted into the opening 5c, the intermediate position in the longitudinal direction of the endoscope 10 is set. It is held by the endoscope holding unit 5.

The attachment portion 6 includes a substantially semicircular arc-like attachment arm portion 6a located on the radially outer side of the holding arm portion 5a of the endoscope holding portion 5, and claw portions 6b provided at both ends of the attachment arm portion 6a. The connecting arm 6a extends radially inward from the mounting arm 6a and connects the mounting arm 6a and the holding arm 5a.

The inner peripheral surface of the mounting arm portion 6a has a curvature substantially the same as the curvature of the mounting surface 4a of the handle portion 4, and the mounting arm portion 6a is fitted to the mounting surface 4a. Here, the position of the endoscope holding portion 5 relative to the inlet of the inner hole 1a can be changed in the circumferential direction by rotating the attachment arm portion (position adjusting portion) 6a in the circumferential direction with respect to the attachment surface 4a. . The claw portion 6b has a claw shape projecting radially inward from the inner peripheral surface of the mounting arm portion 6a. By fitting the claw portion 6b into the groove 4d of the mounting surface 4a, the mounting portion 6 is positioned in the circumferential direction with respect to the mounting surface 4a.
The claw portion 6b may be omitted, and the attachment arm portion 6a may be fixed to the attachment surface 4a by friction between the inner peripheral surface of the attachment arm portion 6a and the attachment surface 4a.

The connecting portion 6c connects the mounting arm portion 6a and the holding arm portion 5a so that the mounting arm portion 6a and the holding arm portion 5a are arranged concentrically. Further, the connecting portion 6c has a holding arm portion 5a arranged around the inlet of the inner hole 1a along the circumferential direction of the holding arm portion 5a in a state where the mounting arm portion 6a is attached to the mounting surface 4a. It is designed so that the inner peripheral surface and the inner surface of the inner hole 1a are aligned in a line along the longitudinal axis.

Therefore, in the state where the attachment arm portion 6a is attached to the attachment surface 4a, as shown in FIG. 3, the opening 5c communicates with the inlet of the inner hole 1a in the direction along the longitudinal axis. When the inlet of the inner hole 1a is viewed in the direction along the longitudinal axis, the opening 5c is arranged on one side in the inner hole 1a, and only the protruding part 5b protruding radially inward is the inner hole. It overlaps with 1a and the other part of the fixture 2 is arranged radially outside the inlet of the inner hole 1a. Thus, since the entrance of the inner hole 1a is exposed to the outside even when the fixture 2 is attached to the handle portion 4, the operator can visually confirm the entrance of the inner hole 1a from the base end side. It can be done. Further, the endoscope 10 can be held on one side in the inner hole 1 a by the endoscope holding portion 5.

Furthermore, as shown in FIG. 2B, the connecting portion 6c is attached to the attachment arm portion so that the endoscope holding portion 5 does not interfere with the proximal end surface 4c when the attachment arm portion 6a is attached to the attachment surface 4a. 6a and holding arm portion 5a are connected to each other while being shifted from each other in the axial direction.

The fixture 2 further includes a wire holding portion 7 that is formed in a bowl shape and holds the guide wire 20 inserted into the inner hole 1a. The wire holding portion 7 protrudes on the opposite side of the holding arm portion 5a from the mounting arm portion 6a, and is provided on the connecting portion 6c so as to be positioned on the radially outer side with respect to the endoscope holding portion 5. As shown in FIG. 5, the guide wire 20 is moved in the longitudinal direction by bending the midway position in the longitudinal direction of the guide wire 20 extending outward from the inlet of the inner hole 1 a and hooking it on the wire holding portion 7. Is to be blocked.
The wire holding part 7 shown in FIG. 5 is curved like a bowl in a plane parallel to the longitudinal axis, but the wire holding part 7 is in a plane intersecting the longitudinal axis as shown in FIG. It may be curved like a bowl.

Next, the operation of the access sheath unit 100 configured as described above will be described.
In order to insert the endoscope 10 and the treatment instrument into the pericardial cavity using the access sheath unit 100 according to the present embodiment, the guide is guided from the incision formed under the xiphoid process of the patient to the pericardial cavity. The wire 20 is inserted. Subsequently, the guide wire 20 is inserted into the inner hole 1a from the outlet, the sheath portion 3 is inserted into the body from the incision along the guide wire 20, and the distal end portion of the sheath portion 3 is disposed in the pericardial cavity. .

At this time, the guide wire 20 disposed in the pericardial cavity is easily moved to the proximal end side by pulsation. Therefore, by hooking the guide wire 20 extending from the inlet of the inner hole 1a of the handle portion 4 to the wire holding portion 7, the guide wire 20 is prevented from moving in the longitudinal direction, particularly to the proximal end side. The escape from the pericardial cavity can be prevented.

Next, the guide wire 20 is removed from the inner hole 1a of the access sheath 1, and the distal end portion of the endoscope 10 is inserted into the pericardial cavity through the inner hole 1a. Next, the attachment portion 6 is attached to the attachment surface 4a of the handle portion 4 so that the middle position in the longitudinal direction of the endoscope 10 extending from the entrance of the inner hole 1a is inserted into the opening portion 5c of the endoscope holding portion 5. Install. Thereby, the endoscope 10 is fixed to the access sheath 1 in the longitudinal direction and the circumferential direction. Although the endoscope 10 disposed in the pericardial cavity is easy to move in the longitudinal direction or rotate in the circumferential direction by pulsation, the endoscope 10 is fixed by the endoscope holding unit 5 to The movement and rotation of the endoscope 10 can be prevented, and the position and posture of the endoscope 10 can be stabilized. Next, the two treatment tools are sequentially inserted into the remaining space of the inner hole 1a, and the two treatment tools are arranged in the pericardial cavity.

In this case, according to the present embodiment, when the treatment instrument is inserted into the inner hole 1a, the endoscope 10 already arranged in the inner hole 1a is placed in the inner hole 1a by the endoscope holding portion 5. Since it is held on the side, a space for inserting the treatment instrument is secured in the inner hole 1a. Furthermore, since the entrance of the inner hole 1a is exposed, the operator can visually observe the inside of the inner hole 1a. Thereby, there is an advantage that the operator can easily insert the treatment tool into the inner hole 1a so that the treatment tool does not interfere with the endoscope 10.

Furthermore, since there is no space in the inner hole 1a where the endoscope 10 and the treatment tool can cross each other, the endoscope 10 and the treatment tool extend in parallel with each other in the inner hole 1a. The relative positional relationship between the treatment tool and the treatment tool is maintained from the inlet to the outlet of the inner hole 1a. Thus, since the relative positional relationship between the endoscope 10 and the treatment tool does not change inside the sheath portion 3, the operator places the treatment tool with respect to the endoscope 10 at the entrance of the inner hole 1a. Thus, the position of the treatment tool with respect to the endoscope 10 in the pericardial cavity can be determined by arranging the desired position.

(Second Embodiment)
Next, an access sheath unit 200 according to a second embodiment of the present invention will be described with reference to FIGS. 7A to 8. In the present embodiment, the same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted.
As shown in FIGS. 7A and 7B, the access sheath unit 200 according to the present embodiment includes the access sheath 1 and a fixture 21.

The fixture 21 includes an endoscope holding part 51, an attachment part 61, and a wire holding part 7.
The attachment portion 61 includes another arm portion 6d in addition to the attachment arm portion 6a, the claw portion 6b, and the connecting portion 6c. The arm portion 6d is formed in the same manner as the holding arm portion 5a except that the arm portion 6d has a substantially ¼ arc shape, and is connected to the mounting arm portion 6a by the connecting portion 6c.

The endoscope holding part 51 includes a substantially rod-shaped movable member 51a and an urging member (not shown). The arm portion 6d is provided with a swing shaft 51b parallel to the arc-shaped center axis of the arm portion 6d. The movable member 51a has a first position (see a solid line in FIG. 7A) where one end portion is sandwiched between the inner surface of the inner hole 1a and one end portion is the inner circumference of the arm portion 6d. It is possible to oscillate about the oscillation shaft 51b at a midway position in the longitudinal direction so as to oscillate between a second position (see a two-dot chain line in FIG. 7A) arranged radially outward from the surface. It is supported. The biasing member is, for example, a torsion spring attached to the swing shaft 51b, and biases the movable member 51a toward the first position.

7A, when the attachment portion 61 is attached to the attachment surface 4a, when the inlet of the inner hole 1a is viewed in the direction along the longitudinal axis, only a part of the movable member 51a is connected to the inner hole 1a. The other part of the fixture 21 overlaps and is disposed radially outside the inlet of the inner hole 1a. Therefore, even when the fixture 21 is attached to the handle portion 4, the entrance of the inner hole 1a is exposed to the outside, so that the operator can visually confirm the entrance of the inner hole 1a from the base end side. It has become.

According to the access sheath unit 200 configured as described above, the endoscope 10 is inserted into the pericardial cavity via the inner hole 1 a, and then the attachment portion 61 is attached to the attachment surface 4 a of the handle portion 4. At this time, by holding the movable member 51a in the second position against the urging force of the urging member, the fixing member 21 can be attached without obstructing one end of the movable member 51a. it can. Next, the movable member 51a is moved to the first position so that a midway position in the longitudinal direction of the endoscope 10 is sandwiched between the inner surface of the inner hole 1a and one end of the movable member 51a. One end of the movable member 51a presses the endoscope 10 against the inner surface of the inner hole 1a by the urging force of the urging member. Thereby, the endoscope 10 is fixed to the access sheath 1 in the longitudinal direction and the circumferential direction so as to be positioned on one side in the inner hole 1a. In this state, the inlet of the inner hole 1a is exposed.
Since the effect of this embodiment is the same as that of the first embodiment, the description thereof is omitted.

In the present embodiment, as shown in FIG. 8, the attachment portion 61 and the wire holding portion 7 may be omitted, and the movable member 51 a may be directly attached to the base end surface 4 c of the handle portion 4. In this case, for example, a movable member 51a and a biasing member (illustrated) are obtained by inserting / removing a rod-like attachment portion (convex portion) that also serves as the swing shaft 51b into an attachment hole formed in the base end surface 4c of the handle portion 4. The endoscope holding portion may be configured to be attached to and detached from the access sheath 1.

(Third embodiment)
Next, an access sheath unit 300 according to a third embodiment of the present invention will be described with reference to FIGS. 9A and 9B. In the present embodiment, the same reference numerals are assigned to configurations common to the first and second embodiments, and the description thereof is omitted.
As shown in FIG. 9A, the access sheath unit 300 according to the present embodiment includes the access sheath 11 and the fixture 22.
The access sheath 11 includes a sheath portion 3 and a handle portion 41 connected to the proximal end of the sheath portion 3.

The base end surface 41c of the handle portion 41 is arranged at intervals in the circumferential direction, and a plurality of attachment holes 41a for attaching the fixture 22 to the handle portion 41 are formed around the inlet of the inner hole 1a. The other configuration of the handle portion 41 is the same as the configuration of the handle portion 4 described in the first embodiment, except that the attachment surface 4a and the abutting surface 4b are not provided.

The fixture 22 includes an endoscope holding part 5, an attachment part 62, and a wire holding part 7.
As shown in FIG. 9B, the attachment portion 62 is a rod-like protrusion 62 a that can be inserted into and removed from the attachment hole 41 a and a connection that connects the protrusion 62 a and the holding arm portion 5 a of the endoscope holding portion 5. Part 62b. The connecting portion 62b extends radially outward from the holding arm portion 5a of the endoscope holding portion 5 so that the convex portion 62a protrudes substantially perpendicularly from a plane defined by the holding arm portion 5a and the connecting portion 62b. One end of the convex part 62a and the holding arm part 5a are connected. The endoscope holding portion 5 is attached to the base end surface 41 c of the handle portion 41 by fitting the convex portion 62 a into any one of the plurality of attachment holes 41 a. At this time, the position of the endoscope holding portion 5 relative to the handle portion 41 can be changed in the circumferential direction by changing the mounting hole (position adjusting portion) 41a into which the convex portion (position adjusting portion) 62a is fitted. .

Also in this embodiment, when the attachment portion 62 is attached to the base end surface 41c of the handle portion 41, as shown in FIG. 9A, when the entrance of the inner hole 1a is viewed in the direction along the longitudinal axis, the protrusion Only 5b overlaps with the inner hole 1a, and the other part of the fixture 22 is arranged radially outside the inlet of the inner hole 1a. Accordingly, even when the fixing tool 22 is attached to the handle portion 41, the inlet of the inner hole 1a is exposed to the outside, so that the operator can visually confirm the inlet of the inner hole 1a from the base end side. It has become.

According to the access sheath unit 300 configured as described above, the endoscope 10 is inserted into the pericardial cavity via the inner hole 1a, and then the longitudinal direction of the endoscope 10 extending from the inlet of the inner hole 1a. The fixture 22 is attached to the base end surface 41c of the handle portion 41 by fitting the convex portion 62a into any of the mounting holes 41a so that the intermediate position of the handle portion 41 is inserted into the opening portion 5c of the endoscope holding portion 5. Install. Thereby, the endoscope 10 is fixed to the access sheath 11 in the longitudinal direction and the circumferential direction so as to be positioned on one side in the inner hole 1a. In this state, the inlet of the inner hole 1a is exposed.
Since the effect of this embodiment is the same as that of the first embodiment, the description thereof is omitted.

(Fourth embodiment)
Next, an access sheath unit according to a fourth embodiment of the present invention will be described with reference to FIGS. 10A and 10B. In the present embodiment, the same reference numerals are assigned to configurations common to the first to third embodiments, and the description thereof is omitted.
The access sheath unit according to the present embodiment includes an access sheath and a fixture 23 shown in FIGS. 10A and 10B.

The access sheath used in this embodiment is the same as the access sheath 11 described in the third embodiment, except that the attachment hole 41a is not provided in the proximal end surface of the handle portion.
The fixing tool 23 includes a cap-shaped member 63 as an attachment portion that covers the proximal end portion of the handle portion so as to cover the proximal end surface of the handle portion, and an endoscope port (internal) provided on the cap-shaped member 63. An endoscope holding part) 52 and a treatment instrument port 8.

The cap-shaped member 63 has a mounting hole 63a into which the base end portion of the handle portion is fitted on one end surface of a circular sheet or plate made of an elastic material. On the other end face of the cap-shaped member 63, an endoscope port 52 and a treatment instrument port 8 projecting from the other end face are provided. The endoscope port 52 has an insertion hole that communicates with the attachment hole 63a and penetrates the endoscope 10, and the treatment instrument port 8 has an insertion hole that communicates with the attachment hole 63a and penetrates the treatment instrument. ing. The insertion hole of the endoscope port 52 has an inner diameter that is substantially the same as the outer diameter of the endoscope 10, and the endoscope 10 is inserted by friction between the inner surface of the insertion hole and the side surface of the endoscope 10. The endoscope port 52 is fixed in the longitudinal direction and the circumferential direction.

Further, in a state where the cap-shaped member 63 is attached to the proximal end portion of the handle portion, the endoscope 10 inserted into the inner hole 1a via the endoscope port 52 is placed on one side of the inner hole 1a. The treatment tool that is located and inserted into the inner hole 1a via the treatment tool port 8 is located in the remaining space of the inner hole 1a without interfering in the radial direction with the endoscope 10 in the inner hole 1a. Thus, the positions of the

ports

52 and 8 are designed. Here, the position of the endoscope port 52 with respect to the inlet of the inner hole 1a is changed in the circumferential direction by rotating the cap-like member (position adjusting portion) 63 in the circumferential direction with respect to the proximal end portion of the handle portion 41. can do.

The cap-shaped member 63 is formed with a notch 9 in the radial direction of the cap-shaped member 63 from the inner surface of the insertion hole of each

port

52, 8 to the outer peripheral surface of the cap-shaped member 63. The cuts 9 are preferably formed at substantially equal intervals in the circumferential direction. The operator can visually check the inside of the inner hole 1a from the base end side by exposing the inlet of the inner hole 1a to the outside by partially turning the cap-shaped member 63 at the position of the notch 9. It has become.

According to the access sheath unit configured as described above, the endoscope 10 is inserted into the pericardial cavity through the inner hole 1a, and then the cap-like member 63 is covered on the proximal end portion of the handle portion. The fixing tool 23 is attached to the proximal end surface of the handle portion. At this time, even after the endoscope 10 is inserted into the inner hole 1a by inserting the endoscope 10 in the radial direction through the notch 9 to the insertion hole of the endoscope port 52. The cap-shaped member 63 can be attached to the handle portion. Thereby, the endoscope 10 is fixed to the access sheath in the longitudinal direction and the circumferential direction so as to be positioned on one side in the inner hole 1a.

Next, the treatment tool is inserted into the inner hole 1a through the treatment tool port 8. At this time, it is possible to easily insert the treatment tool while turning a part of the cap-shaped member 63 at the position of the notch 9 and visually observing the inlet of the inner hole 1a.
Since the effect of this embodiment is the same as that of the first embodiment, the description thereof is omitted.

In the first to fourth embodiments described above, the

endoscope holding portions

5, 51, 52 applied to the endoscope 10 having a substantially fan-shaped cross-sectional shape have been described. The endoscope holding portion may be designed so as to be applicable to an endoscope having the following cross-sectional shape or an endoscope having a general circular cross-sectional shape.

100, 200, 300

Access sheath unit

1, 11 Access sheath 1a

Inner hole

2, 21, 22, 23 Access sheath fixture 3, 31

Sheath portion

4, 41 Handle portion

4a Mounting surface

4b Abutting surface 4c Base end surface 4d Groove 41a Attachment holes 5, 51, 52 Endoscope holding part 5a Holding arm part 5b Projection part 5c

Opening part

6, 61, 62 Attachment part 63 Cap-shaped member (attachment part)
6a Mounting arm portion

6b Claw portion

62a Convex portion 7 Wire holding portion 10 Endoscope 20 Guide wire

Claims

An access sheath fixture attached to a proximal end portion of a cylindrical access sheath having an inner hole penetrating in the longitudinal direction and inserted into a body cavity,
An endoscope holding portion that holds a midway position in the longitudinal direction of the endoscope inserted into the inner hole;
The inner hole that opens to the proximal end surface of the access sheath so that the endoscope held by the endoscope holding part is positioned on one side in the inner hole. An access sheath fixture comprising: an attachment portion that is removably attached to a proximal end portion of the access sheath so that the entrance of the access sheath can be exposed.
The access sheath fixture according to claim 1, wherein the attachment portion has a substantially arcuate attachment arm portion fitted to a substantially cylindrical outer peripheral surface of a proximal end portion of the access sheath.
2. The access sheath fixture according to claim 1, wherein the attachment portion has a convex portion that can be inserted into and removed from an attachment hole that opens in a proximal end surface of the access sheath on a radially outer side than an inlet of the inner hole.
The endoscope holding portion includes a substantially arc-shaped holding arm portion, and protrusions provided at both ends of the holding arm portion and projecting radially inward of the holding arm portion, A substantially fan-shaped opening is formed inside the projection so that the endoscope can be fitted.
The attachment portion attaches the endoscope holding portion to a proximal end portion of the access sheath so that the holding arm portion is arranged around the inner hole along a circumferential direction of the inner hole. The access sheath fixture according to claim 3.
The endoscope holding portion includes a movable member having an end that can swing around a predetermined swing axis, and a biasing member that biases the movable member,
The mounting portion is arranged such that the end portion of the movable member is disposed at a radially outer side than the inner hole and a first position where the endoscope is held between the inner hole and the inner surface of the inner hole. The endoscope holding portion is attached to the proximal end portion of the access sheath so as to swing between the two positions,
The access sheath fixture according to any one of claims 1 to 3, wherein the biasing member biases the movable member toward the first position.
The mounting portion is formed of an elastic material, has a mounting hole that fits into the base end portion of the access sheath, and is composed of a cap-shaped member that covers the base end portion of the access sheath,
The endoscope holding portion is provided in the cap-shaped member, and includes an endoscope port through which the endoscope passes through the inner hole and along the longitudinal direction of the inner hole.
The access sheath fixture according to claim 1, wherein the cap-shaped member is formed with a notch extending in a radial direction from the endoscope port to an outer peripheral surface of the cap-shaped member.
The access sheath fixture according to any one of claims 1 to 6, further comprising a position adjusting unit that adjusts a position of the endoscope holding unit with respect to an inlet of the inner hole in a circumferential direction of the inlet.
In the state where the attachment portion is attached to the proximal end portion of the access sheath, it is provided at a position arranged radially outside the inner hole, and a midway position in the longitudinal direction of the guide wire inserted into the inner hole The access sheath fixture according to any one of claims 1 to 7, further comprising a wire holding portion that holds the wire.
A cylindrical access sheath having an inner hole that penetrates in the longitudinal direction and into which an endoscope and a treatment instrument can be inserted;
An access sheath unit comprising the access sheath fixture according to any one of claims 1 to 8, which is attached to a proximal end portion of the access sheath.
A cylindrical access sheath having an inner hole that penetrates in the longitudinal direction and into which an endoscope and a treatment instrument can be inserted;
The access sheath fixture according to claim 2 attached to a proximal end portion of the access sheath,
On the outer peripheral surface of the proximal end portion of the access sheath, a plurality of grooves are formed at intervals in the circumferential direction,
An access sheath unit, wherein the attachment portion is provided at at least one end of the attachment arm portion, protrudes radially inward of the attachment arm portion, and has a claw portion that fits into the groove.
A cylindrical access sheath having an inner hole that penetrates in the longitudinal direction and into which an endoscope and a treatment instrument can be inserted;
The access sheath fixture according to claim 3, which is attached to a proximal end portion of the access sheath.
An access sheath unit in which a plurality of the mounting holes are formed in the proximal end surface of the access sheath at intervals around the inlet of the inner hole in the circumferential direction.