WO2019225706A1 - Surgical treatment device - Google Patents

Abstract

A surgical treatment device (1) is provided with: a stabilizer (4) that forms, on the surface of a heart, a suppression area (B) in which pulsations are suppressed, by pressing the surface of the heart; a stabilizer supporting part (5) that supports the stabilizer (4); and a hood (7) that opposes the suppression area (B) in the height direction intersecting with the suppression area (B). The stabilizer supporting part (5) supports the stabilizer (4) at a position spaced apart from the hood (7) in the height direction.

Description

Surgical equipment

The present invention relates to a surgical apparatus.

Conventionally, coronary artery bypass grafting (CABG) is known as a general surgical treatment method for ischemic heart disease due to occlusion of a coronary artery. As a method of approaching the heart with CABG, a thoracotomy by a midline incision of the sternum is often performed. In thoracotomy, there is a problem that the length of hospitalization becomes longer and scars are conspicuous because a large incision is made in the skin and the sternum is cut.
As a surgical method for reducing the above-mentioned problems of CABG, minimally invasive cardiac surgery (MICS) in which a heart is approached through a relatively small incision formed in an intercostal space or a groove is proposed, and a device for MICS is devised. (For example, refer to Patent Document 1).

The device of Patent Document 1 is a stabilizer including an insertion portion that can be selectively switched between a soft state and a hard state, and a contact portion provided at the distal end of the insertion portion. The contact portion comes into contact with the surface of the heart and suppresses pulsation of the heart. The insertion portion has a lumen penetrating in the longitudinal direction. According to such a device, the insertion portion is inserted from the incision portion through the narrow body cavity (chest cavity) to the vicinity of the heart surface, and the endoscope or treatment tool is inserted by the contact portion through the lumen of the insertion portion. It is possible to guide to an area where pulsation is suppressed.

JP 2008-284108 A

In the case of the device of Patent Document 1, the contact portion protruding from the distal end of the insertion portion is covered with an organ around the heart. Therefore, in order to observe the region in which the pulsation is suppressed by the contact portion with the endoscope or to treat the region with the treatment tool, it is necessary to form an incision portion that is large enough to expose the periphery of the contact portion . That is, a device capable of a less invasive surgical operation is desired.

The present invention has been made in view of the above-described circumstances, and an object thereof is to provide a surgical treatment apparatus capable of realizing a minimally invasive surgical operation in a narrow body cavity.

One aspect of the present invention includes a stabilizer that forms a suppression region in which pulsation is suppressed by pressing the heart surface on the heart surface, a stabilizer support that supports the stabilizer, and a height that intersects the suppression region. And a hood that opposes the suppression region in a direction, and the stabilizer support portion supports the stabilizer at a position spaced from the hood in the height direction.

According to the present invention, it is possible to realize a minimally invasive surgical operation in a narrow body cavity.

It is a figure explaining the minimally invasive heart surgery to which the apparatus for surgical treatment of this invention is applied. 1 is a perspective view showing an overall configuration of a surgical treatment apparatus according to an embodiment of the present invention. It is the top view which looked at the tip hood from the upper side. It is the side view which looked at the tip hood from the right side. It is the perspective view which looked at the succeeding hood from the upper side. It is the rear view which looked at the succeeding hood from the base end side. It is the perspective view which looked at the front-end | tip hood, the stabilizer, and the stabilizer support part from the lower side. It is a figure which shows the state which the stabilizer support part and stabilizer of FIG. 5A rotated with respect to the front-end | tip hood. It is a figure which shows the operation wire and pulley for rotating a stabilizer support part. It is a perspective view which shows the modification of a stabilizer support part. FIG. 2 is a diagram illustrating an example of a sternum lifter used with a surgical apparatus in the minimally invasive cardiac surgery of FIG. 1. It is a figure explaining the usage method of the apparatus for surgical treatment of FIG. It is a figure explaining the usage method of the apparatus for surgical treatment of FIG. It is a figure explaining the usage method of the apparatus for surgical treatment of FIG. It is an example of the image | video acquired by the camera. It is an example of the image | video acquired with a camera in the state which rotated the stabilizer support part 90 degrees. 9B is the image of FIG. 9B rotated 90 °. 9B is the image of FIG. 9A rotated 180 °. It is the top view which looked at the modification of the succeeding hood from the upper side. It is a perspective view of the trunk | drum of a surgical treatment apparatus provided with the succeeding hood of FIG. It is the top view which looked at the body part which has the 1st curved field and the 2nd curved field from the upper part. It is the rear view which looked at the succeeding hood of the 2nd curved field of Drawing 12A from the base end side. It is a figure explaining operation | movement of the trunk | drum of FIG. 12A, and is a figure which shows the state which only the 2nd curved area | region curved. It is a figure explaining operation | movement of the trunk | drum of FIG. 12A, and is a figure which shows the state which both the 2nd curved area and the 1st curved area curved. FIG. 10 is a perspective view of another modified example of the surgical treatment apparatus of FIG. 2. It is a figure which shows the camera provided in the apparatus for surgical treatment of FIG. FIG. 10 is a perspective view of another modified example of the surgical treatment apparatus of FIG. 2.

Hereinafter, a surgical treatment apparatus 1 according to an embodiment of the present invention will be described with reference to the drawings.
The surgical treatment apparatus 1 according to the present embodiment has a function of observing the heart and suppressing pulsation, and has a low approach approaching the heart surface from a small incision I formed between a groove (under the xiphoid process) or between the ridges. It is suitably used for invasive cardiac surgery (MICS).

FIG. 1 shows an example of MICS. The patient P lies on his / her back on the bed 30 and a pillow is sandwiched between the bed 30 and the back to warp the chest of the patient P. The operator S makes a small incision in the groove with a scalpel or the like, makes an incision to the heart surface, and lifts the sternum upward by the sternum hoist 40 to widen the body cavity from the small incision I to the heart surface. Next, the operator S inserts the surgical treatment device 1 into the body cavity from the small incision I, and suppresses pulsation of the treatment target site of the heart by the surgical treatment device 1. In addition, the operator S inserts treatment tools 51 and 52 such as forceps into the body cavity from the small incision portion I, and observes the treatment target site by the surgical treatment apparatus 1 while performing anastomosis of the vascular graft to the coronary artery. Take action. An automatic anastomosis device may be used for anastomosis between the coronary artery and the graft. A support column 60 is fixed to the bed 30 and extends across the chest of the patient P in the width direction of the bed 30. The treatment tools 51 and 52 inserted into the body cavity can be suspended from the support column 60, thereby releasing the operator S from the burden of holding the treatment tools 51 and 52 for a long time.

FIG. 2 shows the surgical treatment apparatus 1 according to this embodiment. As shown in FIG. 2, the surgical treatment apparatus 1 has a long body part 2 having a plurality of joints 2 a, 2 b that can be bent, and a joint 2 a, 2 b that is connected to the proximal end of the body part 2. And a joint operation unit 3 for operating the fixation release, a stabilizer 4 for forming a suppression region B in which pulsation is suppressed by pressing the heart surface, and a stabilizer 4 connected to the distal end of the body unit 2. The stabilizer support part 5 to support, and the camera 6 (refer FIG. 5A and FIG. 5B) as an observation part which observes the suppression area | region B are provided.

The trunk portion 2 is a portion that is inserted into the body of the patient P from the small incision portion I. The body portion 2 has a longitudinal axis A. The body portion 2 has a height direction and a width direction orthogonal to the longitudinal direction along the longitudinal axis A and orthogonal to each other. One side in the height direction is defined as the upper side, and the other side in the height direction is defined as the lower side. Further, one side in the width direction is defined as left, and the other side in the width direction is defined as right. The trunk | drum 2 is provided with the two parts 21 and 22 mutually connected by the longitudinal direction.

The first portion 21 on the distal end side includes a plurality of hoods 7 and 8 arranged in the longitudinal direction and connected to each other by the joint 2a.
The second portion 22 on the proximal end side is connected to the proximal end of the first portion 21, extends in the longitudinal direction, and has a smaller diameter than the first portion 21 at least in the width direction. Specifically, the second portion 22 includes a plurality of cylindrical cylindrical members 9 arranged in the longitudinal direction and connected to each other by the joint 2b. The width dimension of the cylindrical member 9 is smaller than the width dimension of the hoods 7 and 8, and the cross-sectional area of the cylindrical member 9 is smaller than the cross-sectional area of the hoods 7 and 8. The front end surface of each cylindrical member 9 is a substantially hemispherical convex surface, and the base end surface of each cylindrical member 9 is a substantially hemispherical concave surface. A ball joint 2b that can be bent in an arbitrary direction is constituted by a convex surface and a concave surface that are fitted to each other. Therefore, the second portion 22 can be bent in any direction.

The hoods 7 and 8 of the first portion 21 have a thin plate shape extending in the width direction, and are gently curved in the width direction so as to protrude upward. The hoods 7 and 8 are rigid bodies made of metal or hard plastic, and have rigidity capable of maintaining the shape against the force received from organs around the heart. The width dimensions of the hoods 7 and 8 are selected so that the widths of the hoods 7 and 8 include the suppression region B when viewed in the longitudinal direction. Preferably, the width dimensions of the hoods 7 and 8 are substantially the same as the interval between leg portions 4a and 4b of the stabilizer 4 described later, and are, for example, 30 mm to 45 mm.

The tip hood 7 that is the hood on the most tip side is opposed to the stabilizer 4 in the height direction, and is disposed above the stabilizer 4. Here, the height direction is a direction intersecting the heart surface that is the suppression region B, and is preferably substantially parallel to the normal line of the suppression region B. As shown in FIG. 3A, the tip portion 7a of the tip hood 7 has a substantially semicircular shape in which the width dimension gradually decreases toward the tip. As shown in FIG. 3B, preferably, the distal end portion 7a of the distal end hood 7 is inclined in a direction closer to the stabilizer 4 toward the distal end, for example, gently curved downward. Such a tip portion 7a functions as a dilator that expands a body cavity between the heart surface and an organ around the heart while the legs 4a and 4b of the stabilizer 4 advance along the heart surface.

As shown in FIG. 4A, the other hood 8 following the proximal end side of the distal end hood 7 is provided with a columnar link portion 81 extending along the longitudinal axis A, and provided in the left and right sides of the link portion 81 in the width direction. And a pair of wings 82 extending in the direction. The plurality of succeeding hoods 8 are geometrically similar or congruent to each other.

Each succeeding hood 8 is connected to another adjacent succeeding hood 8 by a joint 2a, and can swing in the width direction and the height direction with respect to the other succeeding succeeding hood 8. Specifically, the distal end surface 81a of each link portion 81 is a hemispherical convex surface, and the base end surface 81b of each link portion 81 is a hemispherical concave surface. A ball joint 2a that can be bent in any direction is configured by the convex surface 81a and the concave surface 81b that are fitted to each other. A concave surface is also formed at the base end of the tip hood 7, and the tip hood 7 and the succeeding hood 8 on the most tip side are connected by a ball joint 2a. Accordingly, the first portion 21 can be bent in any direction.
The joint 2a may be a bending joint other than the ball joint. For example, each joint 2a may be configured by a combination of a yaw joint and a pitch joint that are bent around axes orthogonal to each other.

In a plan view seen from above, the distal end surface and the proximal end surface of the wing portion 82 are curved in the same direction, and the curvature of the distal end surface is larger than the curvature of the proximal end surface. As a result, a gap L is formed between the two adjacent wings 82 to allow the swing of each subsequent hood 8 in the width direction in a state where the body portion 2 extends linearly. The swing angle of each subsequent hood 8 (the bending angle of each joint 2a) is limited by the size of the gap L between the wings 82, and the maximum swing angle of each subsequent hood 8 increases as the gap L increases. For example, the swing angle of each subsequent hood 8 is 5 degrees or less with respect to the longitudinal axis A. Since the swing angle of each succeeding hood 8 is limited, the bending angle of the entire first portion 21 is limited, and the entire first portion 21 is not bent at an excessive angle. Thereby, it becomes easy to make the linear treatment tools 51 and 52 approach the suppression region B directly below the plurality of subsequent hoods 8. In the case of the example of FIG. 2, the bending angle of the first portion 21 in one direction is limited to 20 degrees or 30 degrees.

The plurality of hoods 7, 8 pass through the inside of the link portion 81 and the cylindrical member 9 of the subsequent hood 8, and a plurality of operation wires 10 a, 10 b, 11 a, 11 b extending from the tip hood 7 to the joint fixing knob 3 a of the joint operation unit 3. (See FIG. 12A.) As shown in FIG. 4B, the left end portion, the right end portion, the upper end portion, and the lower end portion of each link portion 81 have four holes 12a and 12b that pass through the operation wires 10a, 10b, 11a, and 11b in the longitudinal direction. , 13a, 13b are formed. The tips of the operation wires 10 a, 10 b, 11 a, 11 b are fixed to the tip hood 7. When one of the two operation wires 10a and 10b in the holes 12a and 12b at the left end and the right end is pulled and the other is pushed out, the first portion 21 is bent leftward or rightward. When one of the two operation wires 11a and 11b in the holes 13a and 13b at the upper end and the lower end is pulled and the other is pushed out, the first portion 21 is bent upward or downward.

The joint operating unit 3 includes a shape fixing knob 3a provided on the base end side of the body portion 2, and a shape fixing wire (see FIG. 12A) 3b that extends from the distal end hood 7 to the shape fixing knob 3a through the link portion 81. . In the example shown in FIG. 2, a device mounting portion 43 (described later) of the sternum hoist 40 is connected to the proximal end of the body portion 2 for holding the surgical apparatus 1. The shape fixing knob 3a is connected to the end.

In the center of the link portion 81, as shown in FIG. 4B, a hole 14 is formed that penetrates in the longitudinal direction and through which the shape fixing wire 3b passes. The shape fixing wire 3b is pulled by the rotation of the shape fixing knob 3a, and the joints 2a, 2b are fixed by the tension of the shape fixing wire 3b so that the hoods 7, 8 and the cylindrical member 9 do not swing. And the shape of the 2nd part 22 is fixed. In addition, by the reverse rotation of the shape fixing knob 3a, the shape fixing wire 3b is relaxed, the joints 2a and 2b are released from being fixed, and the first portion 21 and the second portion 22 are bent.

In the state where the joint 2a of the first portion 21 is fixed, the first portion 21 has rigidity capable of maintaining the shape against the force in the height direction. Therefore, in the body cavity, the first portion 21 has a constant shape regardless of forces from the heart and surrounding organs, and the stabilizer 4 can be stably placed on the heart surface. A working space for observation by the camera 6 and surgical treatment by the treatment tools 51 and 52 is secured above the stabilizer 4 (opposite the heart) by the tip hood 7 covering the opposite side of the stabilizer 4 from the heart. Is done.

The operator S bends the first portion 21 by a desired angle at a desired angle in a desired direction with the joint 2a being released by the shape fixing knob 3a, and then fixes the joint 2a by the shape fixing knob 3a. By doing so, the first portion 21 can be fixed in a desired shape.
A bending operation member (not shown) for operating the operation wires 10a, 10b, 11a, and 11b may be provided on the base end side of the body portion 2. For example, the bending operation member is a bending operation knob in which the proximal ends of the operation wires 10a, 10b, 11a, and 11b are fixed. It may be configured to be controlled.

As shown in FIG. 5A, the stabilizer 4 has two rod- like leg portions 4 a and 4 b that are arranged below the tip hood 7 and extend in the longitudinal direction of the body portion 2. The two leg portions 4a and 4b are arranged at intervals in the width direction. A predetermined distance in the height direction is secured between the two leg portions 4 a and 4 b and the tip hood 7 by the stabilizer support portion 5. The region of the heart surface arranged between the two legs 4a and 4b is a suppression region B in which pulsation is suppressed. The interval between the two leg portions 4a and 4b is, for example, 30 mm to 45 mm.

When viewed in the height direction, the tip hood 7 has an area including at least a part of the suppression region B. For example, the tip hood 7 has an area including at least a region where a surgical procedure is to be performed among the suppression regions B between the two leg portions 4a and 4b. The tip hood 7 may cover the entire upper portion of the stabilizer 4 so that the entire suppression region B can be protected from surrounding organs and the like.

A plurality of suction holes 4c arranged in the longitudinal direction of the leg portions 4a and 4b are opened on the lower surfaces of the leg portions 4a and 4b arranged on the heart surface side. The stabilizer support 5 is connected to a suction tube 15 (see FIG. 2) that communicates with each suction hole 4c and extends to the proximal end side. The proximal end of the suction tube 15 is connected to a suction device (not shown) such as an exhaust pump. By sucking the inside of the suction tube 15 with the suction device, the lower surface of the legs 4a and 4b can be adsorbed to the heart surface by the negative pressure in each suction hole 4c, and the stabilizer 4 can be fixed to the heart surface.

The stabilizer support portion 5 extends in the height direction on the proximal end side of the stabilizer 4, the upper end portion of the stabilizer support portion 5 is connected to the distal end hood 7, and the lower end portion of the stabilizer support portion 5 has two leg portions 4 a and 4 b. It is fixed with the base end. The stabilizer 4 is supported by a stabilizer support portion 5 at a position separated from the tip hood 7 by a predetermined distance in the height direction. The predetermined distance is in the range of 20 mm to 100 mm, preferably in the range of 20 mm to 50 mm, considering the size of the chest cavity and the space required for the treatment. The length of the stabilizer support portion 5 in the height direction may be variable. In this case, the predetermined distance is preferably configured to be adjustable in the range of 20 mm to 70 mm.

In the example of FIG. 5A, the stabilizer support portion 5 includes a single shaft 5a extending in the height direction, an upper end portion 5b extending from the upper end of the shaft 5a to the distal end side, and a substantially U-shape extending from the lower end of the shaft 5a to the distal end side. And a lower end 5c. The upper end portion 5b is connected to the tip hood 7, and the leg portions 4a and 4b are fixed to each of the two tip ends of the lower end portion 5c.
FIG. 6 shows another example of the stabilizer support portion 5. The stabilizer support part 5 may have two shafts 5a arranged at intervals in the width direction. Legs 4a and 4b are fixed to the lower end of each shaft 5a. Between the two shafts 5a, an air gap having substantially the same width as that of the restraining region B is formed. Therefore, the treatment tools 51 and 52 inserted from the base end side along the trunk portion 2 are connected to the air gap between the shafts 5a. The suppression area B can be easily accessed via

The upward force from the heart can be applied to the stabilizer support portion 5 via the stabilizer 4, and the downward force can be applied from an organ around the heart via the tip hood 7. The stabilizer support portion 5 has a rigidity capable of maintaining the shape against the compressive force in the height direction, and thereby the distance between the stabilizer 4 and the tip hood 7 is kept constant.

The stabilizer support portion 5 may be connected to the tip hood 7 so as to be rotatable around the rotation axis C in the height direction. As shown in FIG. 5B, the two legs 4 a and 4 b of the stabilizer 4 are rotated with respect to the tip hood 7 by the rotation of the stabilizer support portion 5. The rotation direction and rotation angle of the two legs 4a and 4b are the same. Thereby, for example, when the blood vessel on the heart surface intersects the longitudinal direction of the body portion 2, the two legs 4a and 4b are substantially parallel to the blood vessel so that the two legs 4a and 4b are substantially parallel to the blood vessel. The angles of the two leg portions 4a and 4b can be changed (see FIG. 8B).

As shown in FIG. 5C, the rotation of the stabilizer support portion 5 is operated by the operation wire 16. The operation wire 16 extends from the distal end hood 7 to the proximal end side of the body portion 2 through the hole 17 (see FIG. 4B) of the link portion 81 and the inside of the cylindrical member 9. The holes 17 are provided on both sides of the hole 13b at the lower end, for example, and penetrate the link portion 81 in the longitudinal direction. The distal end of the operation wire 16 is fixed to a pulley 18 disposed in the distal end hood 7. The pulley 18 is fixed to the stabilizer support portion 5 and is coaxial with the rotation axis C. Pulling one of the two operation wires 16 causes the pulley 18, the stabilizer support portion 5, and the stabilizer 4 to rotate together. A stabilizer operation member such as a knob for operating the operation wire 16 may be provided on the base end side of the body portion 2.

The camera 6 is disposed under the tip hood 7 and is fixed to the stabilizer support portion 5. The camera 6 is provided at a position spaced upward from the stabilizer 4, for example, at the upper end 5 b, and has a field of view including the two legs 4 a and 4 b and the suppression region B. When the stabilizer support part 5 is rotatable, the camera 6 is preferably arranged in the vicinity of the rotation axis C.

In the example of FIG. 5A, the observation direction (optical axis) of the camera 6 is inclined toward the stabilizer 4 with respect to the longitudinal axis A of the body portion 2, and the camera 6 observes the suppression region B from obliquely above. The angle of the observation direction of the camera 6 with respect to the longitudinal axis A is, for example, 30 °, 45 °, or 70 °. In this case, the camera 6 may be disposed at a position spaced from the coupling portion between the stabilizer support portion 5 and the distal end hood 7 toward the proximal end so that the suppression region B can be observed from the proximal end side. preferable.
The camera 6 may be fixed downward substantially above the center of the suppression region B, and the suppression region B may be observed from directly above.

The two-dimensional or three-dimensional video signal acquired by the camera 6 is transmitted to the monitor 70 disposed near the bed 30 by the video cable 19 (see FIG. 2). The video cable 19 is connected to the proximal end portion of the first portion 21 of the body portion 2, for example, the rearmost hood 8 on the most proximal side. The monitor 70 displays a two-dimensional or three-dimensional image. The operator S can observe an image of treatment such as coronary artery anastomosis in the suppression region B on the monitor 70. The camera 6 may be operated by a battery and transmit a video signal to the monitor 70 by wireless transmission.

The body 2 may be connected to the camera 6 and an air supply tube (not shown) for removing the liquid adhering to the visual field of the camera 6. The air supply tube is connected to a suction device (not shown) such as an exhaust pump. The gas sent from the air supply tube is ejected from the plurality of holes beside the camera 6 in at least two directions toward the camera 6 and the visual field.

Next, the operation of the surgical treatment apparatus 1 will be described.
FIG. 7 shows a sternum lifter 40 used with the surgical apparatus 1. The sternum lifting device 40 is for lifting the sternum and expanding the body cavity from the small incision I in the groove to the heart surface. The sternum hoist 40 holds an arm part 41 inserted into the body from the small incision part I, an angle part 42 connected to the support column 60, and a holding part 26 of the surgical treatment apparatus 1 connected to the arm part 41. A device mounting unit 43.

The arm portion 41 is, for example, an elongated flat plate shape.
The angle portion 42 is a connecting member that is fixed to the base end of the arm portion 41 and connects the arm portion 41 that lifts the sternum to the support column 60. The angle part 42 has a hole 42 a connected to the support column 60. The angle portion 42 has a bent shape so that the angle portion 42 can be connected to the support column 60 in the hole 42 a in a state where the sternum is lifted by the arm portion 41. The angle portion 42 has a shape that is mechanically stable with respect to the lifting of the sternum by the arm portion 41.

The device mounting portion 43 has an annular ring portion 43 a that is disposed on the opposite side of the angle portion 42 with respect to the arm portion 41 and is attached to the cylindrical outer peripheral surface of the holding portion 26 of the surgical treatment apparatus 1. . The ring portion 43a may be expandable and contractable in the radial direction. The device mounting part 43 adjusts the angle of the ring part 43a in two directions corresponding to the width direction and the height direction of the body part 2, and has a pan head structure for fixing the ring part 43a to a desired angle. It has a mechanism 43b. Further, the device mounting portion 43 includes a linear movement mechanism 43c that moves the ring portion 43a in the longitudinal direction of the arm portion 41 while maintaining the angle of the ring portion 43a. Further, the device mounting portion 43 includes a rotation lever 43d that changes the angle of the body portion 2 by swinging the body portion 2 in a direction orthogonal to the longitudinal direction around the ring portion 43a.

First, the operator S forms a small incision I in each of the patients P and widens the small incision I in three directions with the sternum lifting device 40 and the retractors 53 and 54 as shown in FIG. 8A. Specifically, the operator S inserts the arm portion 41 into the body from the small incision portion I, and lifts the ribs upward by the angle portion 42. In addition, the operator S widens the small incision I in the left-right direction by using the two retractors 53 and 54. Next, the operator S moves the heart H to a position where it can be easily treated by the positioner 55.

Next, the operator S inserts the body part 2 of the surgical treatment apparatus 1 through the small incision part I, and places the stabilizer 4 on the surface of the heart so that a treatment target site such as a coronary artery is placed between the leg parts 4a and 4b. Then, the lower surfaces of the legs 4a and 4b are adsorbed to the surface of the heart near the coronary artery to be treated. As a result, the leg surface 4a, 4b fixed to the heart surface is pressed against the heart surface, and the suppression region B including the treatment target site and suppressed in pulsation can be formed on the heart surface. In this state, a space is secured above the suppression region B by the tip hood 7.

Next, the operator S inserts two treatment tools 51 and 52 such as grasping forceps and scissors forceps from the small incision portion I. The treatment tools 51 and 52 have curved tip portions and are introduced into the body cavity from the small incision portion I at a shallow angle. The surgeon S inserts the treatment tools 51 and 52 to the treatment target site via the space between the first portion 21 of the trunk portion 2 and the heart surface, and the tips of the treatment tools 51 and 52 are connected to the stabilizer 4 and the tip. It arrange | positions in the space between the food | hoods 7. Then, the surgeon S treats the treatment target region with the treatment tools 51 and 52 while observing the image of the suppression region B acquired by the camera 6 on the monitor 70.

As described above, according to the present embodiment, the body 2 and the treatment tools 51 and 52 are inserted to the treatment target site on the heart surface through the narrow body cavity from the small incision I to the heart surface. Can do.
Further, in a state where the suppression region B is formed on the surface of the heart by the stabilizer 4, a working space sufficiently wide for observation of the treatment target region and surgical treatment is provided between the stabilizer 4 and the tip hood 7. Therefore, it is not necessary to make the incision I so large that the stabilizer 4 is exposed to the outside of the body, and the size of the small incision I is the minimum necessary to pass the surgical apparatus 1 and the treatment tools 51 and 52. It can be kept in. Thereby, it is possible to realize a less invasive operation compared to the conventional case.

Furthermore, even if it is difficult to secure a working space by the lungs or the like like the side surface of the heart H, the camera is provided with the tip hood 7 and the stabilizer 4 that are arranged at positions spaced apart from each other in the height direction. A three-dimensional work space including six visual fields can be ensured.
Further, the stabilizer support portion 5 to which the camera 6 is fixed is rotatable about the rotation axis C in the height direction with respect to the tip hood 7. As a result, as shown in FIG. 8B, when the longitudinal direction of the trunk portion 2, which is the insertion direction of the treatment tools 51 and 52, and the traveling direction of the coronary artery D are greatly different, the stabilizer support portion 5 is attached to the tip hood 7. By rotating, the stabilizer 4 and the camera 6 can be arranged so that the legs 4a and 4b are substantially parallel to the coronary artery D. Thereby, it is possible to observe the blood vessel D while suppressing the pulsation in the vicinity of the blood vessel D to be treated while securing the work space.

The rotation axis C preferably passes through the center or near the center of the suppression region B between the two leg portions 4a and 4b. For example, it is preferable that the connecting portion between the stabilizer support portion 5 through which the rotation axis C passes and the tip hood 7 is located at the approximate center of the tip hood 7, and the center of the suppression region B by the stabilizer 4 is located directly below the connecting portion. . According to this structure, when the stabilizer support part 5 and the stabilizer 4 rotate, the suppression area | region B is always arrange | positioned in the center of the visual field of the camera 6, and an image | video rotates around the center of the suppression area B.

In the above embodiment, the camera 6 may be connected to the image processing unit 20 that processes the video signal, and the video processed by the image processing unit 20 may be displayed on the monitor 70.
The image processing unit 20 includes a processor and a storage device, and is built in the monitor 70 as shown in FIG. Alternatively, the image processing unit 20 may be an image processing device separate from the monitor 70. The image processing unit 20 rotates the image according to the rotation direction and rotation angle around the rotation axis C of the stabilizer 4, and the image is displayed so that the orientation of the heart H in the image displayed on the monitor 70 is maintained constant. Adjust the rotation angle. For example, the image processing unit 20 detects the legs 4a and 4b and / or the coronary artery from the video, and rotates the video based on the positions and angles of the legs 4a and 4b and / or the coronary artery. Alternatively, the image processing unit 20 may rotate the video based on an instruction from the operator S input using an input device (not shown).

9A to 9D show examples of images.
FIG. 9A shows an image in the arrangement of the stabilizer 4 and the treatment tools 51 and 52 of FIG. 8A. FIG. 9B shows an image that is not subjected to the rotation process in the arrangement of the stabilizer 4 and the treatment tools 51 and 52 of FIG. 8B. In the image of FIG. 9B, the treatment tools 51 and 52 that actually protrude from the proximal end side to the suppression region B appear to protrude from the right side to the suppression region B. Such a difference between the actual direction of the treatment tools 51 and 52 and the direction of the treatment tools 51 and 52 in the image obstructs the intuitive operation of the treatment tools 51 and 52 by the operator S. As illustrated in FIG. 9C, the image processing unit 20 rotates the image by 90 ° in a direction corresponding to the rotation direction of the stabilizer 4. Thereby, the operation direction of the treatment tools 51 and 52 by the operator S and the moving direction of the treatment tools 51 and 52 in the video match, and the intuitive operation of the treatment tools 51 and 52 becomes easy.

FIG. 8C shows a state where the surgical treatment apparatus 1 is accessing the coronary artery on the back side of the heart H. The positioner 55 draws the heart H toward the sternum side (the sternum lifting device 40 side), and a space is formed on the back side of the heart H. The surgical treatment apparatus 1 is arranged so that the hoods 7 and 8 are located on the back side and the stabilizer 4 is located on the ventral side.
In the arrangement of the stabilizer 4 and the treatment tools 51 and 52 in FIG. 8C, the image in FIG. 9A is acquired. In this case, the arrangement of the treatment tools 51 and 52 in the image of FIG. 9A is reversed left and right with respect to the actual arrangement of the treatment tools 51 and 52. As shown in FIG. 9D, the image processing unit 20 rotates the video by 180 °. As a result, the actual arrangement of the treatment tools 51 and 52 matches the arrangement of the treatment tools 51 and 52 in the image, so that the operator S can intuitively operate the two treatment tools 51 and 52. it can. In order to enable more intuitive operation of the treatment tools 51 and 52, the image processing unit 20 may invert the video in FIG. 9D in the vertical direction.

In the above embodiment, the specific shapes of the hoods 7 and 8 are not limited to the shapes in FIGS. 3A and 4A, and can be changed as appropriate. FIG. 10 shows a modified example of the succeeding hood 8, and FIG. 11 shows the body part 2 having the succeeding hood 8 of FIG. The succeeding hood 8 of FIG. 10 has a substantially crescent shape in which the end surface on the distal end side and the end surface on the proximal end side have the same curvature, and two adjacent succeeding hoods 8 are in contact with each other over the entire width. . The curvature radii of the end surfaces on the distal end side and the proximal end side are constant and are larger than the curvature radii of a circle whose diameter is the width dimension of the subsequent hood 8. Thereby, each succeeding hood 8 can swing in the width direction with respect to the other succeeding succeeding hoods 8.

In the said embodiment, as FIG. 12A shows, the 1st part 21 may have the 1st bending area | region 21A and the 2nd bending area | region 21B which can operate a bending angle and a bending direction mutually independently. . The first curved region 21 </ b> A on the distal end side has the distal end hood 7 and two or more subsequent hoods 8, and the second curved region 21 </ b> B on the proximal end side has the remaining two or more subsequent hoods 8.
The gap L1 of the first bending region 21A and the second bending region 21B are different from each other so that the maximum bending angle of the hoods 7 and 8 in the first bending region 21A and the maximum bending angle of the hood 8 in the second bending region 21B are different from each other. The gap L2 may be different from each other.

In this case, the operation wires (first operation members) 10a, 10b, 11a, 11b and the shape fixing wire 3b for the first bending region 21A and the operation wires (second operation members) 23a, 23b for the second bending region 21B are used. And a shape fixing wire 3c. As shown in FIG. 12B, holes 24a and 24b are formed in the link portion 81 of the succeeding hood 8 in the second curved region 21B so as to pass through the operation wires 23a and 23b in the longitudinal direction.

The operation wires 10a, 10b, 11a, 11b and the shape fixing wire 3b for the first curved region 21A are as described above.
The holes 24 a and 24 b are provided in the left end portion of the left wing portion 82 and the right end portion of the right wing portion 82. The tips of the operation wires 23a and 23b are fixed to the succeeding hood 8 on the most tip side of the second curved region 21B. The shape fixing wire 3c passes through the hole 14 together with the shape fixing wire 3b, and the distal end of the shape fixing wire 3c is fixed to the succeeding hood 8 on the most distal end side of the second curved region 21B.

The proximal ends of the operation wires 10 a, 10 b, 11 a, 11 b, 23 a, 23 b are connected to a bending operation member (not shown) provided on the proximal end side of the body portion 2. The surgeon S pulls the operation wires 10a, 10b, 11a, 11b, 23a, and 23b by operating a bending operation member arranged outside the body, and moves the first bending region 21A and the second bending region 21B in the body cavity. The bending direction and the bending angle can be controlled.

According to such a first portion 21, by pulling one of the operation wires 23a and 23b, as shown in FIG. 13A, the plurality of subsequent hoods 8 in the second curved region 21B are swung in order from the distal end side. Then, only the second curved region 21B is curved leftward or rightward so that the pulled operation wire 23a or 23b is positioned on the radially inner side of the curved shape. The entire bending angle of the second portion 22 is controlled by the pulling amount of the operation wire 23a or 23b.
Further, by pulling one of the operation wires 10a and 10b, as shown in FIG. 13B, the plurality of hoods 7 and 8 of the first portion 21 are swung in order from the tip side, and the pulled operation wire 10a or Only the first curved region 21A is curved leftward or rightward so that 10b is located on the radially inner side of the curved shape. The entire bending angle of the first portion 21 is controlled by the pulling amount of the operation wire 10a or 10b.

After the second bending region 21B and the first bending region 21A are bent in a desired direction at a desired angle, the shape of the second bending region 21B is fixed by pulling the shape fixing wire 3c. Subsequently, the shape of the first curved region 21A is fixed by pulling the shape fixing wire 3b. The first bending region 21A is bent in the vertical direction before the shape fixing wire 3b is pulled.

According to the surgical treatment apparatus 1 having the first curved region 21A and the second curved region 21B, the trunk portion 2 can be inserted into the body cavity from the small incision portion I by making it straight. Thereafter, by operating the bending operation member outside the body, the first bending region 21A and the second bending region 21B of the body part 2 in the body cavity can be bent at a desired angle in a desired direction, respectively, and the shape can be fixed.

In the above embodiment, the body portion 2 is provided with a plurality of hoods 7 and 8 connected to each other. Instead, as shown in FIG. 14, only one hood 7 is provided at the tip. You may do it.
The trunk | drum 2 of the modification of FIG. 14 has an upward convex dome shape when it sees in a longitudinal direction. The trunk 2 can be bent into a shape corresponding to the shape of the body cavity from the small incision I to the heart surface, and the curved shape can be fixed. The hood 7 is provided at the upper end of the body part 2.
The two legs 4 a and 4 b of the stabilizer 4 protrude from the lower end of the front end of the body 2 in the longitudinal direction of the body 2 and are fixed to a stabilizer support (not shown) housed in the front end of the body 2. ing. The legs 4a and 4b may be rotatable at the same angle in the same direction.

The camera 6 may be fixed to the body 2, but may be separate from the body 2 as shown in FIG. 15. The camera 6 in FIG. 15 is fixed to the distal end of the elongated insertion portion 25. The insertion portion 25 is a thin plate having a flat cross-sectional shape, and can be inserted into a lumen penetrating the body portion 2 in the longitudinal direction. It is preferable that the insertion portion 25 has flexibility that can be bent along the curved shape of the body portion 2.
According to this configuration, for example, when observing peeling of the internal thoracic artery, the distance between the treatment target site and the camera 6 can be adjusted to an appropriate distance. Further, since the position of the camera 6 does not change when the stabilizer 4 is rotated, an image without blur is always provided.

In the above embodiment, the surgical apparatus 1 has the three functions of suppressing pulsation by the stabilizer 4, securing space by the tip hood 7, and observing by the camera 6. As shown in FIG. 16, the apparatus 1 may be a hooded stabilizer that does not have an observation unit.
The surgical treatment apparatus 1 is used in combination with an endoscope 80 separate from the surgical treatment apparatus 1 as necessary. The endoscope 80 is a general-purpose rigid endoscope, for example. By disposing the camera 6 at the distal end of the endoscope 80 under the distal end hood 7 or the vicinity thereof, the suppression region B can be observed well.

Compared with the body part 2, the stabilizer 4, and the stabilizer support part 5, the camera 6 is expensive. By excluding the function of the camera 6, an inexpensive surgical apparatus 1 suitable for disposable can be realized.
Preferably, a cylindrical engagement portion (not shown) through which the distal end portion of the endoscope 80 passes is provided on the lower surface of the distal end hood 7 facing the stabilizer 4. By passing the distal end portion of the endoscope 80 through the engaging portion, the distal end portion of the endoscope 80 is held at a certain distance from the suppression region B of the heart surface formed by the stabilizer 4, thereby stabilizing the heart surface. Can be observed.

Although the embodiment of the present invention has been described above, the present invention is not limited to this, and various modifications and changes can be made within the scope of the claims.
For example, in the above embodiment, the hoods 7 and 8 can swing in both the width direction and the height direction. Instead, the hoods 7 and 8 can swing only in the width direction or only in the height direction. It may be.
Moreover, in the said embodiment, although the 2nd part 22 decided to have the joint structure which can be bent according to the shape of a body cavity, it may replace with this and may be comprised from one or more rod-shaped members. The rod-shaped member may be flexible so that it can be bent, or may be a rigid body.

Moreover, in the said embodiment, although the shaft 5a of the stabilizer support part 5 was arrange | positioned at the base end side of the stabilizer 4, it replaces with this and the shaft 5a may be arrange | positioned at the front end side of the stabilizer 4. Good. In this case, the camera 6 may be fixed to the stabilizer support portion 5 so as to observe the suppression region B from the distal end side.
The camera 6 may be fixed to a portion other than the stabilizer support portion 5. For example, the camera 6 may be fixed to the tip hood 7.
In the above-described embodiment, the operator S is applied to an operation in which the treatment tools 51 and 52 are manually operated. Instead of this, a surgical system for remotely operating an electric treatment tool, for example, medical It may be applied to an industrial robot.

DESCRIPTION OF SYMBOLS 1 Surgical device 2 Body part 2a, 2b Joint, ball joint 21 1st part 21A 1st curved area 21B 2nd curved area 22 2nd part 3 Joint operation part 4 Stabilizer 5 Stabilizer support part 6 Camera (observation part)
7 Tip hood (hood)
8 Subsequent hoods 10a, 10b, 11a, 11b Operation wire (first operation member)
23a, 23b Operation wire (second operation member)
20 Image processing part B Inhibition area C Rotation axis I Incision part H Heart

Claims (13)

1. A stabilizer for forming a suppression region on the heart surface in which pulsation is suppressed by pressing the heart surface;
   A stabilizer support for supporting the stabilizer;
   A hood facing the suppression region in a height direction intersecting the suppression region,
   The surgical apparatus, wherein the stabilizer support part supports the stabilizer at a position spaced apart from the hood in the height direction.
2. The surgical apparatus according to claim 1, further comprising an observation unit that observes the suppression region.
3. The stabilizer is fixed to the stabilizer support;
   The surgical apparatus according to claim 1 or 2, wherein the stabilizer support portion is connected to the hood so as to be rotatable about a rotation axis in the height direction.
4. The stabilizer and the observation unit are fixed to the stabilizer support unit,
   The surgical apparatus according to claim 2, wherein the stabilizer support portion is coupled to the hood so as to be rotatable about a rotation axis in the height direction.
5. An image processing unit that processes the video acquired by the observation unit;
   The surgical apparatus according to claim 4, wherein the image processing unit rotates the video according to a rotation direction and a rotation angle of the stabilizer with respect to the hood.
6. The surgical apparatus according to any one of claims 1 to 5, wherein the distal end portion of the hood is inclined in a direction closer to the stabilizer as it goes toward the distal end.
7. The surgical apparatus according to claim 1, further comprising a long body part inserted into the body cavity.
8. The body part is
   A plurality of subsequent hoods arranged in the longitudinal direction of the body portion and connected to the base end of the hood;
   A joint for interconnecting the plurality of subsequent hoods,
   Each of the plurality of succeeding hoods extends in a width direction orthogonal to the longitudinal direction and the height direction, and swings in at least one of the height direction and the width direction with respect to the other succeeding hoods. The surgical apparatus according to claim 7, wherein the surgical apparatus is movable.
9. The surgical apparatus according to claim 8, further comprising a joint operation unit that fixes and releases the joint.
10. The surgical apparatus according to claim 8 or 9, wherein the joint is a ball joint.
11. The body portion has a first curved region on the distal end side and a second curved region on the proximal end side, and the first curved region and the second curved region each include two or more subsequent hoods,
    A first operating member for operating swinging of the two or more subsequent hoods in the first curved region;
    The surgical operation apparatus according to any one of claims 8 to 10, further comprising a second operation member that operates swinging of the two or more subsequent hoods in the second curved region.
12. The body portion has a second portion extending in the longitudinal direction and having a smaller diameter than a first portion including the hood and the plurality of succeeding hoods, and the second portion is a base end of the plurality of succeeding hoods The surgical apparatus according to claim 8, wherein the surgical apparatus is connected to the surgical apparatus.
13. The surgical apparatus according to claim 12, wherein the second portion is bendable.

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